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Pharmacology. Prim Care 2022; 49:315-326. [DOI: 10.1016/j.pop.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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152
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Bae J, Kim YE, Lee M, Lee YH, Lee BW, Cha BS, Kang ES. Sodium Glucose Cotransporter-2 Inhibitors as an Add-on Therapy to Metformin Plus Dipeptidyl Peptidase-4 Inhibitor in Patients with Type 2 Diabetes. Yonsei Med J 2022; 63:539-544. [PMID: 35619577 PMCID: PMC9171674 DOI: 10.3349/ymj.2022.63.6.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To date, no study has compared the effects of adding sodium glucose cotransporter-2 (SGLT-2) inhibitors to the combination of metformin plus dipeptidyl peptidase-4 (DPP-4) inhibitors to the effects of adding other conventional anti-diabetic drugs (ADDs) to the dual therapy. We aimed to compare the effect of adding SGLT-2 inhibitors with that of adding sulfonylurea (SU) in type 2 diabetes (T2D) patients inadequately controlled with metformin plus DPP-4 inhibitors. MATERIALS AND METHODS This study was designed to evaluate the non-inferiority of SGLT-2 inhibitor to SU as an add-on therapy to the dual combination of metformin plus DPP-4 inhibitors. A total of 292 T2D patients who started SU or SGLT-2 inhibitors as an add-on therapy to metformin plus DPP-4 inhibitors due to uncontrolled hyperglycemia, defined as glycated hemoglobin (HbA1c) ≥7%, were recruited. After propensity score matching, 90 pairs of patients remained, and 12-week changes in HbA1c levels were reviewed to assess glycemic effectiveness. Data from these patients were analyzed retrospectively. RESULTS After 12 weeks of triple therapy, both groups showed significant changes in HbA1c levels, with a mean of -0.9% in each group. The inter-group difference was 0.01% [95% confidence interval (CI): -0.26-0.27], and the upper limit of the 95% CI was within the limit for non-inferiority (0.40%). There were no inter-group differences in the changes of liver enzyme levels and kidney function. CONCLUSION Adding SGLT-2 inhibitors is not inferior to adding SU as a third-line ADD to metformin plus DPP-4 inhibitor combination therapy.
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Affiliation(s)
- Jaehyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Korea
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Eun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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153
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Zhang F, Ji L, Hong T, Guo L, Li Y, Zhu Z, Liu X, Liu F, Tang L, Zhang Y, Li J, Lü Q, Tong N. Expert consensus on personalized initiation of glucose-lowering therapy in adults with newly diagnosed type 2 diabetes without clinical cardiovascular disease or chronic kidney disease. J Evid Based Med 2022; 15:168-179. [PMID: 35715995 DOI: 10.1111/jebm.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/22/2022] [Indexed: 02/05/2023]
Abstract
Since it is difficult for clinicians to make a decision among the various types of antidiabetic medications due to their great discrepancy in mechanisms, pharmacological properties, and cardiovascular/renal protection, a relatively "precision" or personalized hypoglycemic treatment suggestion is practical for type 2 diabetes (T2D) management in adults. This expert consensus makes some recommendations based on the characteristics of adult T2D patients without clinical cardiovascular disease (CVD) or chronic kidney disease (CKD) by evidence from large-scale clinical trials. The main consideration for initiating antidiabetic medications is the safety and benefits for prevention of target organ damage, such as CVD and CKD. The choice of personalized glucose-lowering therapy regarding target organ protection is based on the various effects of antidiabetic medications, patients' clinical characteristics and their key risks, as well as the sociological factors. According to the effects on glucose reduction, cardiovascular protection, renal benefit, body weight change, hypoglycemic risk, and liver function impact, the antidiabetic medications are recategorized in this consensus. Combined with the glucose control target and the different effects of hypoglycemic agents, a significant body of recommendations have been developed for optimal T2D management according to the risk factors for atherosclerotic CVD, heart failure, CKD, primary fatty liver, and hypoglycemia. This consensus gives detailed guidance on personalized antidiabetic therapy initiation in newly diagnosed T2D adults, which attaches great importance to both glucose control and target organ protection.
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Affiliation(s)
- Fang Zhang
- Division of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, National Center of Gerontology, Beijing Hospital, Beijing, China
| | - Yan Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Chongqing Institute of Hypertension, Daping Hospital, Army Medical University, Chongqing, China
| | - Xingbin Liu
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fang Liu
- Department of Nephrology, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lizhi Tang
- Division of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuwei Zhang
- Division of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Juan Li
- Division of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qingguo Lü
- Division of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nanwei Tong
- Division of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Kelsey MD, Nelson AJ, Green JB, Granger CB, Peterson ED, McGuire DK, Pagidipati NJ. Guidelines for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: JACC Guideline Comparison. J Am Coll Cardiol 2022; 79:1849-1857. [PMID: 35512864 DOI: 10.1016/j.jacc.2022.02.046] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus. These high-risk patients benefit from aggressive risk factor management, with blood pressure and low-density lipoprotein-cholesterol treatment, glycemic control, kidney protection, and lifestyle intervention. There are several recommendation and guideline documents across cardiology, endocrinology, nephrology, and general medicine professional societies from the United States and Europe with recommendations for cardiovascular risk reduction in patients with type 2 diabetes mellitus. Although there are some noteworthy differences, particularly in risk stratification, low-density lipoprotein-cholesterol and blood pressure treatment targets, and the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, overall there is considerable alignment across recommendations from different professional societies.
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Affiliation(s)
- Michelle D Kelsey
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Adam J Nelson
- Duke Clinical Research Institute, Durham, North Carolina, USA. https://twitter.com/ajnelson
| | - Jennifer B Green
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher B Granger
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Eric D Peterson
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, Texas, USA
| | - Darren K McGuire
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, Texas, USA
| | - Neha J Pagidipati
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
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155
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Prevalence and In-hospital outcomes of diabetes among acute ischemic stroke patients in china: results from the Chinese Stroke Center Alliance. J Neurol 2022; 269:4772-4782. [PMID: 35511281 PMCID: PMC9363385 DOI: 10.1007/s00415-022-11112-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022]
Abstract
Background Patients with ischemic stroke and diabetes are classified as extreme risk for secondary prevention, with much attention and specific management. However, the up-to-date information regarding the burden of diabetes in acute ischemic stroke (AIS) patients is lacking in China, and evidence for an association between diabetes and in-hospital outcomes after AIS remains controversial. Methods This quality improvement study was conducted at 1,476 participating hospitals in the Chinese Stroke Center Alliance between 2015 and 2019. Prevalence of diabetes was evaluated in the overall study population and different subgroups. The association between diabetes and in-hospital outcomes in AIS patients was analyzed by using multivariable logistic regression analysis and propensity score-matched analysis. Results Of 838,229 patients with AIS, 286,252 (34.2%) had diabetes/possible diabetes. The prevalence of diabetes/possible diabetes was higher in women than in men (37.6% versus 32.1%). Patients with diabetes/possible diabetes had higher rates of adverse in-hospital outcomes than those without. Multivariable analysis revealed a significant association between diabetes/possible diabetes and adverse in-hospital outcomes (all-cause mortality: odds ratio [OR], 1.30 [95% confidence interval [CI], 1.23–1.38]; major adverse cardiovascular events (MACEs): OR, 1.08 [95% CI, 1.06–1.10]) in AIS patients. The excess risk of in-hospital outcomes still remained in AIS patients with diabetes/possible diabetes after propensity score-matching analysis (all-cause mortality: OR, 1.26 [95% CI, 1.17–1.35]; MACEs: OR, 1.07 [95% CI, 1.05–1.10]). Conclusion Diabetes was highly prevalent among AIS patients in China and associated with worse in-hospital outcomes. Greater efforts to increase targeted approach to secondary prevention treatments of diabetes in AIS patients are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11112-z.
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156
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Van Dril E, Allison M, Schumacher C. Deprescribing in type 2 diabetes and cardiovascular disease: Recommendations for safe and effective initiation of glucagon-like peptide-1 receptor agonists in patients on insulin therapy. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100163. [PMID: 38559880 PMCID: PMC10978364 DOI: 10.1016/j.ahjo.2022.100163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 04/04/2024]
Abstract
Select glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated cardiovascular benefits in both primary and secondary prevention populations and are recommended in multiple guidelines for cardiovascular risk reduction in people with type 2 diabetes (T2D). Despite this, uptake of GLP-1 receptor agonists in clinical practice has been lagging. While the etiology of their underuse is multifactorial, lack of comfortability in adding a GLP-1 receptor agonist to established insulin regimens is a common barrier. Adjustments to basal and bolus insulin doses upon initiation of GLP-1 receptor agonists in trials have varied. When recommending empiric dose adjustments during initiation of GLP-1 receptors agonists, the most recent A1C and the current blood glucose levels, if available, should be taken into consideration. When initiating in a person being managed with basal-only insulin regimens, an empiric 20 % dose reduction is recommended if the baseline A1C is ≤8 %. For individuals using intensive insulin regimens, empiric dose reductions of up to 25 % in basal and 50 % in bolus therapy were implemented and summarized further in this review. Overall, initiation of GLP-1 receptor agonists can decrease insulin requirements and may permit deintensification of antihyperglycemic therapy through the reduction or discontinuation of bolus insulin therapy. As a result, this simplified regimen promotes increased adherence, reduces glycemic variability and hypoglycemia, and improves overall glycemic management and quality of life. This review aims to serve as a guide for clinicians to facilitate the initiation of GLP-1 receptor agonists and deintensification of insulin by providing suggested dose adjustments based on available literature.
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Affiliation(s)
- Elizabeth Van Dril
- University of Illinois at Chicago College of Pharmacy, 840 South Wood Street, CSB 324 (MC 886), Chicago, IL 60612, United States of America
| | - Margaret Allison
- Ascension Illinois, Department of Pharmacy, 1000 Remington Boulevard, Suite 100, Bolingbrook, IL 60440, United States of America
| | - Christie Schumacher
- Midwestern University College of Pharmacy, Downers Grove Campus (CPDG), 555 31st St, Downers Grove, IL 60515, United States of America
- Advocate Medical Group, 2301 E 93rd St, Chicago, IL 60617, United States of America
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157
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Rosenfeld RM, Kelly JH, Agarwal M, Aspry K, Barnett T, Davis BC, Fields D, Gaillard T, Gulati M, Guthrie GE, Moore DJ, Panigrahi G, Rothberg A, Sannidhi DV, Weatherspoon L, Pauly K, Karlsen MC. Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine. Am J Lifestyle Med 2022; 16:342-362. [PMID: 35706589 PMCID: PMC9189586 DOI: 10.1177/15598276221087624] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Objective The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA (RMR)
| | - John H Kelly
- Loma Linda University School of Medicine, Loma Linda, CA, USA (JHK)
| | - Monica Agarwal
- Department of Medicine Division of Endocrinology, Diabetes, & Metabolism, Birmingham, University of Alabama at Birmingham, AL, USA (MA)
| | - Karen Aspry
- Lipid and Prevention Program, Lifespan Cardiovascular Institute, East Greenwich, RI, USA (KA)
| | - Ted Barnett
- Rochester Lifestyle Medicine Institute, Rochester, NY, USA (TB)
| | - Brenda C Davis
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
| | | | - Trudy Gaillard
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA (TG)
| | - Mahima Gulati
- Middlesex Health Multispecialty Group, Middletown, CT, USA (MG)
| | | | | | | | - Amy Rothberg
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, USA (AR)
| | - Deepa V Sannidhi
- University of California San Diego Department of Family Medicine and Public Health, La Jolla, CA, USA (DVS)
| | | | - Kaitlyn Pauly
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
| | - Micaela C Karlsen
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
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158
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Clements JN. Development and Current Role of Sodium Glucose Cotransporter Inhibition in Cardiorenal Metabolic Syndrome. J Cardiovasc Pharmacol 2022; 79:593-604. [PMID: 35522700 DOI: 10.1097/fjc.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sodium-glucose cotransporter-2 inhibitors were approved as adjunct therapy for the management of type 2 diabetes and have become a high-level recommendation for this population with cardiorenal metabolic syndrome. In addition, evidence continues to grow supporting this class of medications for people with heart failure and chronic kidney disease, regardless of diabetes status. This narrative review summarizes the sodium-glucose cotransporter inhibitors for cardiorenal metabolic syndrome.
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Affiliation(s)
- Jennifer N Clements
- Clinical Pharmacist-Diabetes Transition, Department of Nursing Administration, Spartanburg Regional Healthcare System, Spartanburg, SC
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159
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Phillippe H, Pogge E. Part Two: Diabetes Part 2: A Review of Insulin Therapy in Older Patients. Sr Care Pharm 2022; 37:181-190. [PMID: 35450560 DOI: 10.4140/tcp.n.2022.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diabetes mellitus is a common disease state among older people, with type 2 diabetes making up most cases. As the disease progresses, many patients will need to transition to insulin therapy. Pharmacists can play a pivotal role in the care of older people with diabetes by providing recommendations related to insulin therapy. Senior care pharmacists need to be knowledgeable about the pharmacokinetics, dosing, adverse effects, and cost concerns related to insulin therapy.
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160
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Harris SB, Parente EB, Karalliedde J. Clinical Use of Insulin Glargine 300 U/mL in Adults with Type 2 Diabetes: Hypothetical Case Studies. Diabetes Ther 2022; 13:913-930. [PMID: 35355207 PMCID: PMC9373591 DOI: 10.1007/s13300-022-01247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022] Open
Abstract
Type 2 diabetes (T2D) is a progressive disease, with many individuals eventually requiring basal insulin therapy to maintain glycaemic control. However, there exists considerable therapeutic inertia to the prompt initiation and optimal titration of basal insulin therapy due to barriers that include fear of injections, hypoglycaemia, weight gain, and burdensome regimens. Hypoglycaemia is thought to be a major barrier to optimal glycaemic control and is associated with significant morbidity and mortality. Newer second-generation basal insulin analogues provide comparable glycaemic control with lower risk of hypoglycaemia compared with first-generation basal insulin analogues. The present review article discusses clinical evidence for one such second-generation basal insulin analogue, insulin glargine 300 U/mL (Gla-300), in the context of hypothetical case studies that are representative of individuals who may attend routine clinical practice. These case studies discuss individualised treatment needs for people with T2D who are insulin-naïve or pre-treated. Clinical characteristics such as older age, frequent nocturnal hypoglycaemia, and renal impairment, which are known risk factors for hypoglycaemia, are also considered.
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Affiliation(s)
- Stewart B Harris
- Schulich School of Medicine & Dentistry at The University of Western Ontario, in London, 1151 Richmond St, London, ON, N6A 5C1, Canada.
| | - Erika B Parente
- Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Janaka Karalliedde
- School of Cardiovascular Medicine & Sciences, King's College London, London, UK
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161
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Quispe R, Alfaddagh A, Kazzi B, Zghyer F, Marvel FA, Blumenthal RS, Sharma G, Martin SS. Controversies in the Use of Omega-3 Fatty Acids to Prevent Atherosclerosis. Curr Atheroscler Rep 2022; 24:571-581. [PMID: 35499805 DOI: 10.1007/s11883-022-01031-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We discuss current controversies in the clinical use of omega-3 fatty acids (FA), primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and examine discrepancies between recent trials. Furthermore, we discuss potential side effects reported in these studies and the role of mixed omega-3 FA dietary supplements and concerns about their use. RECENT FINDINGS REDUCE-IT showed that addition of icosapent ethyl, a highly purified form of EPA, can reduce risk of cardiovascular events among statin-treated individuals with high triglycerides. Additional supportive evidence for EPA has come from other trials and meta-analyses of omega-3 FA therapy. In contrast, trials of mixed EPA/DHA products have consistently failed to improve cardiovascular outcomes. Discrepancies in results reported in RCTs could be explained by differences in omega-3 FA products, dosing, study populations, and study designs including the placebo control formulation. Evidence obtained from highly purified forms should not be extrapolated to other mixed formulations, including "over-the-counter" omega-3 supplements. Targeting TG-rich lipoproteins represents a new frontier for mitigating ASCVD risk. Clinical and basic research evidence suggests that the use of omega-3 FA, specifically EPA, appears to slow atherosclerosis by reducing triglyceride-rich lipoproteins and/or inflammation, therefore addressing residual risk of clinical ASCVD.
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Affiliation(s)
- Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Abdulhamied Alfaddagh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Brigitte Kazzi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Fawzi Zghyer
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Francoise A Marvel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA.
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162
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Gerardo González-González J, Cesar Solis R, Díaz González-Colmenero A, Raygoza-Cortez K, Moreno-Peña PJ, Sánchez AL, McCoy RG, Singh Ospina N, Maraka S, Brito JP, Rodriguez-Gutierrez R. Effect of metformin on microvascular outcomes in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2022; 186:109821. [PMID: 35247521 PMCID: PMC9064963 DOI: 10.1016/j.diabres.2022.109821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/05/2022] [Accepted: 02/28/2022] [Indexed: 12/26/2022]
Abstract
AIMS Examine the efficacy of metformin compared to placebo or other glucose-lowering medications on microvascular outcomes in patients with Type 2 Diabetes Mellitus (T2DM). METHODS MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to March 2020. We included randomized clinical trials of patients with T2DM receiving metformin compared with another active glucose-lowering treatment or placebo in which a microvascular outcome was assessed. The risk of bias was assessed using the Cochrane Risk of Bias tool. Microvascular complications included kidney-related outcomes, retinopathy, and peripheral neuropathy. An inverse-weighted variance random-effect meta-analysis was performed to estimate drugs effect over microvascular disease. PROSPERO (CRD42019120365). RESULTS Nineteen RCTs (n = 18,181) were included. Metformin increased estimated glomerular filtration rate (eGFR) by a mean difference (MD) of 1.08 (95% CI 0.84 to 1.33 ml/min/1.73 m2) after 24 weeks. No effect was found on urinary albumin-creatinine ratio, serum creatinine, and end-stage kidney disease; Patient-important outcomes regarding kidney disease, retinal outcomes, peripheral neuropathy or quality of life were not assessed by any of the included studies and could not be analyzed. CONCLUSIONS There is no evidence of clinically significant beneficial effect of metformin therapy as compared to other glucose-lowering medications or placebo on the examined microvascular complications.
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Affiliation(s)
- José Gerardo González-González
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo León, Monterrey 64460, Mexico
| | - Ricardo Cesar Solis
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | | | - Karina Raygoza-Cortez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Pablo J Moreno-Peña
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Alicia L Sánchez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, FL 32610, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Central Arkansas Veterans Healthcare System, Medicine Service, Little Rock, AR, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA
| | - René Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo León, Monterrey 64460, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
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163
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Abdelhamid M, Kandil H, Hassanin M, Shaheen S, Sobhy M, ElEtreby A, Hasan-Ali H, Mahfouz H, Nasr G, Shawky I, Emil S, ElSetiha M, Hasssan M, Sadek Y, Karim MA, Asham A, Ghaleb M, Samir A, Shokry K. Egyptian expert opinion for the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2022; 9:800-811. [PMID: 35118822 PMCID: PMC8934981 DOI: 10.1002/ehf2.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the risk of serious heart failure events, specifically the risk of hospitalization for heart failure, and cardiovascular death. The benefit is most apparent in patients with a heart failure with reduced ejection fraction (HFrEF). Dapagliflozin and empagliflozin reduced the risk of cardiovascular death and hospitalizations for heart failure in patients with established HFrEF, including those without diabetes. Considering the magnitude of the problem and the expected benefit on the target population, an Egyptian consensus document was conducted to demonstrate the importance of and the critical knowledge needed for effective and safe implementation of SGLT2i in the daily practice for the management of patients with HFrEF.
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Affiliation(s)
- Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
| | - Hossam Kandil
- Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
| | | | - Sameh Shaheen
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Sobhy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Adel ElEtreby
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Hala Mahfouz
- Faculty of Medicine, Menoufia University, Shibin Al Kawm, Egypt
| | - Gamila Nasr
- Faculty of Medicine, Suiz Canal University, Ismailia, Egypt
| | - Islam Shawky
- Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Sameh Emil
- Armed Forces College of Medicine, Cardiology Department, Cairo, Egypt
| | | | - Mohamed Hasssan
- Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
| | - Yasser Sadek
- Faculty of Medicine, Helwan University, Helwan, Egypt
| | | | - Ayman Asham
- Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Mohamed Ghaleb
- Cardiology Unit, Research Institute of Ophthalmology, Cairo, Egypt
| | - Ahmad Samir
- Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
| | - Khaled Shokry
- Armed Forces College of Medicine, Cardiology Department, Cairo, Egypt
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164
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Mottl AK, Alicic R, Argyropoulos C, Brosius FC, Mauer M, Molitch M, Nelson RG, Perreault L, Nicholas SB. KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD. Am J Kidney Dis 2022; 79:457-479. [PMID: 35144840 PMCID: PMC9740752 DOI: 10.1053/j.ajkd.2021.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit.
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165
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Casale M, Baldini MI, Del Monte P, Gigante A, Grandone A, Origa R, Poggi M, Gadda F, Lai R, Marchetti M, Forni GL. Good Clinical Practice of the Italian Society of Thalassemia and Haemoglobinopathies (SITE) for the Management of Endocrine Complications in Patients with Haemoglobinopathies. J Clin Med 2022; 11:jcm11071826. [PMID: 35407442 PMCID: PMC8999784 DOI: 10.3390/jcm11071826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The treatment of endocrinopathies in haemoglobinopathies is a continually expanding research area; therefore, recommendations supporting the appropriateness of treatments are a pressing need for the medical community. Methods: The Management Committee of SITE selected and gathered a multidisciplinary and multi-professional team, including experts in haemoglobinopathies and experts in endocrinopathies, who have been flanked by experts with methodological and organizational expertise, in order to formulate recommendations based on the available scientific evidence integrated by personal clinical experience. The project followed the systematic approach for the production of clinical practice guidelines according to the methodology suggested by the National Center for Clinical Excellence, Quality and Safety of Care (CNEC). Results: Out of 14 topics, 100 clinical questions were addressed, and 206 recommendations were elaborated on. The strength of recommendations, panel agreement, a short general description of the topic, and the interpretation of evidence were reported. Conclusions: Good Practice Recommendations are the final outcome of translational research and allow one to transfer to the daily clinical practice of endocrine complications in haemoglobinopathies.
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Affiliation(s)
- Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-566-5432
| | - Marina Itala Baldini
- Centro Malattie Rare, UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.I.B.); (F.G.)
| | | | - Antonia Gigante
- Società Italiana Talassemie d Emoglobinopatie (SITE), Fondazione per la Ricerca sulle Anemie ed Emoglobinopatie in Italia—For Anemia, 16124 Genoa, Italy;
| | - Anna Grandone
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Raffaella Origa
- SSD Talassemia, Ospedale Pediatrico Microcitemico Cao, Università di Cagliari, 09124 Cagliari, Italy; (R.O.); (R.L.)
| | - Maurizio Poggi
- UOC Endocrinologia, Azienda Ospedaliera Sant’Andrea, 00189 Rome, Italy;
| | - Franco Gadda
- Centro Malattie Rare, UOC Medicina Interna, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.I.B.); (F.G.)
| | - Rosalba Lai
- SSD Talassemia, Ospedale Pediatrico Microcitemico Cao, Università di Cagliari, 09124 Cagliari, Italy; (R.O.); (R.L.)
| | - Monia Marchetti
- Day Service Ematologia, SOC Oncologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Gian Luca Forni
- Centro Emoglobinopatie e Anemie Congenite, Ospedali Galliera, 16128 Genoa, Italy;
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166
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Lau KTK, Wong CKH, Au ICH, Lau WCY, Man KKC, Chui CSL, Wong ICK. Switching to Versus Addition of Incretin-Based Drugs Among Patients With Type 2 Diabetes Taking Sodium-Glucose Cotransporter-2 Inhibitors. J Am Heart Assoc 2022; 11:e023489. [PMID: 35322676 PMCID: PMC9075422 DOI: 10.1161/jaha.121.023489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Evidence is limited in comparing treatment modification by substitution or add‐on of glucose‐lowering medications in patients with type 2 diabetes. This observational study aims to compare switching versus add‐on of incretin‐based drugs among patients with type 2 diabetes on background sodium‐glucose cotransporter‐2 inhibitors (SGLT2i). Methods and Results This population‐based, retrospective cohort study was conducted using the IQVIA Medical Research Data, including adults with type 2 diabetes on background SGLT2i from 2005 to 2020. New users of incretin‐based drugs were allocated into the “Switch” group if they had discontinued SGLT2i treatment, or the “Add‐on” group if their background SGLT2i was continued. Baseline characteristics of patients were balanced between groups. Study outcomes were all‐cause mortality, cardiovascular diseases, kidney diseases, hypoglycemia, and ketoacidosis. Patients were observed from the index date of initiating incretin‐based drugs until the earliest of an outcome event, death, or data cut‐off date. Changes in anthropometric and metabolic parameters were also compared between groups from baseline to 12‐month follow‐up. A total of 2888 patients were included, classified into “Switch” (n=1461) or “Add‐on” group (n=1427). Median follow‐up was 18 months with 5183 person‐years. Overall, no significant differences in the risks of study outcomes were observed between groups; however, patients in the “Add‐on” group achieved significantly greater reductions in glycated hemoglobin, weight, percentage weight loss, and systolic blood pressure than their “Switch” counterparts. Conclusions Initiating incretin‐based drugs as add‐on among patients with type 2 diabetes on background SGLT2i was associated with risks of clinical end points comparable to switching treatments, in addition to better glycemic and weight control observed with the combination approach.
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Affiliation(s)
- Kristy T K Lau
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Carlos K H Wong
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Department of Family Medicine and Primary Care School of Clinical Medicine Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Laboratory of Data Discovery for Health (D24H) Hong Kong Science Park, New Territories Hong Kong SAR China
| | - Ivan C H Au
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Research Department of Policy and Practice University College London School of Pharmacy London UK
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Research Department of Policy and Practice University College London School of Pharmacy London UK
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H) Hong Kong Science Park, New Territories Hong Kong SAR China.,School of Nursing Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,School of Public Health Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Laboratory of Data Discovery for Health (D24H) Hong Kong Science Park, New Territories Hong Kong SAR China.,Research Department of Policy and Practice University College London School of Pharmacy London UK
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167
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Garvey WT. New Horizons. A New Paradigm for Treating to Target with Second-Generation Obesity Medications. J Clin Endocrinol Metab 2022; 107:e1339-e1347. [PMID: 34865050 PMCID: PMC8947217 DOI: 10.1210/clinem/dgab848] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/12/2022]
Abstract
In treating obesity as a chronic disease, the essential goal of weight loss therapy is not the quantity of weight loss as an end unto itself but rather the prevention and treatment of complications to enhance health and mitigate morbidity and mortality. This perspective on obesity care is consistent with the complications-centric American Association of Clinical Endocrinology (AACE) obesity guidelines and the diagnostic term of adiposity-based chronic disease (ABCD). Many complications require 10% to 20% weight loss to achieve therapeutic goals; however, existing obesity medications fail to produce ≥10% weight loss in the majority of patients. In June, 2021, semaglutide 2.4 mg/week was approved for chronic weight management. Phase 3 clinical trials demonstrated that this medication produced > 10% placebo-subtracted weight loss, more than half of patents lost ≥15%, and over one third lost ≥20% of baseline weight. This essentially doubles effectiveness over existing obesity medications, provides sufficient weight loss to ameliorate a broad range of complications, and qualifies as the first member of a second-generation class of obesity medications. The advent of second-generation medications fully enables a treat-to-target approach for management of ABCD as a chronic disease. Specifically, with this degree of efficacy, second-generation medications permit active management of body weight as a biomarker to targets associated with effective treatment and prevention of specific complications. ABCD can now be managed similar to other chronic diseases such as type 2 diabetes, hypertension, and atherosclerosis, which are treated to biomarker targets that can be modified based on the clinical status of individual patients [ie, hemoglobin A1c (HbA1c), blood pressure, and low-density lipoprotein cholesterol (LDL-c)] to prevent the respective complications of these diseases.
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Affiliation(s)
- W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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168
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Valeeva FV, Medvedeva MS, Khasanova KB, Valeeva EV, Kiseleva TA, Egorova ES, Pickering C, Ahmetov II. Association of gene polymorphisms with body weight changes in prediabetic patients. Mol Biol Rep 2022; 49:4217-4224. [PMID: 35292917 PMCID: PMC9262768 DOI: 10.1007/s11033-022-07254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/09/2022] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recent research has demonstrated that Type 2 Diabetes (T2D) risk is influenced by a number of common polymorphisms, including MC4R rs17782313, PPARG rs1801282, and TCF7L2 rs7903146. Knowledge of the association between these single nucleotide polymorphisms (SNPs) and body weight changes in different forms of prediabetes treatment is still limited. The aim of this study was to investigate the association of polymorphisms within the MC4R, PPARG, and TCF7L2 genes on the risk of carbohydrate metabolism disorders and body composition changes in overweight or obese patients with early carbohydrate metabolism disorders. METHODS AND RESULTS From 327 patients, a subgroup of 81 prediabetic female patients (48.7 ± 14.8 years) of Eastern European descent participated in a 3-month study comprised of diet therapy or diet therapy accompanied with metformin treatment. Bioelectrical impedance analysis and genotyping of MC4R rs17782313, PPARG rs1801282, and TCF7L2 rs7903146 polymorphisms were performed. The MC4R CC and TCF7L2 TT genotypes were associated with increased risk of T2D (OR = 1.46, p = 0.05 and OR = 2.47, p = 0.006, respectively). PPARG CC homozygotes experienced increased weight loss; however, no additional improvements were experienced with the addition of metformin. MC4R TT homozygotes who took metformin alongside dietary intervention experienced increased weight loss and reductions in fat mass (p < 0.05). CONCLUSIONS We have shown that the obesity-protective alleles (MC4R T and PPARG C) were positively associated with weight loss efficiency. Furthermore, we confirmed the previous association of the MC4R C and TCF7L2 T alleles with T2D risk.
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Affiliation(s)
- Farida V Valeeva
- Department of Endocrinology, Kazan State Medical University, Kazan, Russia
| | - Mariya S Medvedeva
- Department of Endocrinology, Kazan State Medical University, Kazan, Russia
| | | | - Elena V Valeeva
- Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia.,Department of Biochemistry, Biotechnology and Pharmacology, Kazan Federal (Volga Region) University, Kazan, Russia
| | - Tatyana A Kiseleva
- Department of Endocrinology, Kazan State Medical University, Kazan, Russia
| | - Emiliya S Egorova
- Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia
| | - Craig Pickering
- Institute of Coaching and Performance, School of Sport and Wellbeing, University of Central Lancashire, Preston, UK
| | - Ildus I Ahmetov
- Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia. .,Department of Physical Education, Plekhanov Russian University of Economics, Moscow, Russia. .,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
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169
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Zhu M, Li Y, Luo B, Cui J, Liu Y, Liu Y. Comorbidity of Type 2 Diabetes Mellitus and Depression: Clinical Evidence and Rationale for the Exacerbation of Cardiovascular Disease. Front Cardiovasc Med 2022; 9:861110. [PMID: 35360021 PMCID: PMC8960118 DOI: 10.3389/fcvm.2022.861110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 12/25/2022] Open
Abstract
Depression is a common comorbidity of type 2 diabetes mellitus (T2DM). T2DM with comorbid depression increases the risk of cardiovascular events and death. Depression and T2DM and its macrovascular complications exhibited a two-way relationship. Regarding treatment, antidepressants can affect the development of T2DM and cardiovascular events, and hypoglycemic drugs can also affect the development of depression and cardiovascular events. The combination of these two types of medications may increase the risk of the first myocardial infarction. Herein, we review the latest research progress in the exacerbation of cardiovascular disease due to T2DM with comorbid depression and provide a rationale and an outlook for the prevention and treatment of cardiovascular disease in T2DM with comorbid depression.
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Affiliation(s)
- Mengmeng Zhu
- National Clinical Research Centre for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yiwen Li
- National Clinical Research Centre for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Binyu Luo
- National Clinical Research Centre for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Cui
- National Clinical Research Centre for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanfei Liu
- Second Department of Geriatrics, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Yanfei Liu
| | - Yue Liu
- National Clinical Research Centre for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Yue Liu
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170
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Kalra S, Das S, Zargar AH. A Review of Oral Semaglutide Available Evidence: A New Era of Management of Diabetes with Peptide in a Pill Form. Indian J Endocrinol Metab 2022; 26:98-105. [PMID: 35873937 PMCID: PMC9302409 DOI: 10.4103/ijem.ijem_522_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/28/2022] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have gained an important place in the management of diabetes management because of their exceptional glucose-lowering, weight lowering and cardiovascular (CV) benefits. Despite recommendations by various clinical practice guidelines and benefits, their usage in clinical practice was limited because of being injectable in nature. Oral semaglutide is a novel GLP-1RA with 94% homology to human GLP-1 which is co-formulated with absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate (SNAC), that overcomes the challenges of peptide absorption in the acidic conditions of the stomach. Oral semaglutide has been evaluated in an extensive phase 3 clinical trial programme named Peptide Innovation for Early Diabetes Treatment (PIONEER) which demonstrated its robust glucose and weight lowering effects against other comparators. The evolution of the GLP-1RA class to include an oral pill will facilitate the use of this class of agents much earlier in the diabetes treatment cascade owing to wider acceptance from patients and clinicians alike. The current review discusses the various aspects of oral semaglutide and its place in clinical practice.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Sambit Das
- Senior Consultant Endocrinologist Apollo Hospitals, Bhubaneshwar, Odisha, India
| | - Abdul H. Zargar
- Senior Consultant Endocrinologist, Center for Diabetes and Endocrine Care, Srinagar, Jammu and Kashmir, India
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171
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Insulin-Related Liver Pathways and the Therapeutic Effects of Aerobic Training, Green Coffee, and Chlorogenic Acid Supplementation in Prediabetic Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:5318245. [PMID: 35663196 PMCID: PMC9162863 DOI: 10.1155/2022/5318245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
Background The liver controls blood glucose levels via regulation of anabolic (glycogen synthesis and gluconeogenesis) and catabolic (glycolysis and glycogenolysis) processes through activation of the PI3K-AKT signalling pathway. The aim of this study was to assess the effect of aerobic training, green coffee, and chlorogenic acid supplementation on glucose metabolism-regulating pathways in prediabetic mice. Methods C57BL/6 mice were exposed to a high-fat diet and physical activity limitation to induce a state of prediabetes. After 12 weeks, mice were fed a high-fat diet compared to the control mice. The prediabetic mice were further treated with either green coffee, chlorogenic acid, or training or combinations of the same for 10 weeks. At the end of the experimental period, metabolic data (FBG, GTT, HOMA for IR, plasma level of insulinfrom systematic, AST, and ALT assessed into blood), histopathologic, and analysis of gene and protein expressions were obtained for target tissues. Results Training along with green coffee and chlorogenic acid supplementation improved complications of prediabetes including weight gain and elevated fasting blood glucose and plasma insulin levels. These effects were associated with the changes in mRNA levels of genes important in hepatic glycogen synthesis (GYS2), glucogenesis (PCK and G6PC2), and glycolysis (GK, PK, and PFKL). Conclusion The training in conjunction with green coffee or chlorogenic acid is effective in the prevention of prediabetes in mice. As these interventions are relatively inexpensive and safe application to individuals with prediabetes appears warranted.
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172
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Hu S, Wang S, Qi C, Gu S, Shi C, Mao L, Fan G. Cost-Utility Analysis of Once-Weekly Semaglutide, Dulaglutide, and Exenatide for Type 2 Diabetes Patients Receiving Metformin-Based Background Therapy in China. Front Pharmacol 2022; 13:831364. [PMID: 35250578 PMCID: PMC8894868 DOI: 10.3389/fphar.2022.831364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: The substantial financial burden associated with type 2 diabetes (T2D) over a lifetime cannot be neglected. Therefore, the objective of this study was to evaluate the pharmacoeconomic value of three once-weekly GLP-1 RAs, namely subcutaneous semaglutide (sc. SEMA), dulaglutide (DULA), and extended-release exenatide (e-r EXEN), in treating patients with T2D that cannot be controlled with metformin-based background therapy, and to find a suitable price reduction for non-cost-effective medications, to provide reasonable recommendations to the administration for adjusting drug prices. Methods: The baseline characteristics of the simulation patient cohort were sourced from a comprehensive meta-analysis synthesizing 453 trials evaluating 21 hypoglycemic agents from nine categories of drugs. The UKPDS OM2 was applied to project the long-term effectiveness and costs from a Chinese health care provider’s perspective. After cost-utility analysis, the reasonable price adjustment of non-cost-effective options was explored via binary search. Uncertainty was measured by means of sensitivity analysis. Results: After a 40-year simulation, the sc. SEMA, DULA, and e-r EXEN groups yielded 9.6315, 9.5968, and 9.5895 quality-adjusted life years (QALYs), respectively. In terms of expenditure, the total costs for the sc. SEMA, DULA, and e-r EXEN groups were $42012.47, $24931.27, and $40264.80, respectively. DULA was dominant over e-r EXEN due to the higher QALYs and lower total costs. The ICURs of sc. SEMA vs. DULA and sc. SEMA vs. e-r EXEN were $492994.72/QALY and $41622.69/QALY (ICUR > λ), respectively, indicating that sc. SEMA was not more cost-effective than DULA or e-r EXEN. The INMB and absolute NMB yielded the same conclusions which were robust to one-way, scenario, and probabilistic sensitivity analyses. After several assumptions in the binary search, sc. SEMA and e-r EXEN appear to become cost-effective when their annual costs are decreased by 57.67% and 70.34%, respectively, with DULA as a counterpart. Conclusion: From the cost-utility analysis, DULA appears to be the most cost-effective option among sc. SEMA, DULA, and e-r EXEN for the treatment of patients with T2D receiving metformin-based background therapy. With a 57.67% or 70.34% reduction in cost, sc. SEMA or e-r EXEN, respectively, would become as cost-effective as DULA in China.
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Mohan V, Saboo B, Khader J, Modi KD, Jindal S, Wangnoo SK, Amarnath S. Position of Sulfonylureas in the Current ERA: Review of National and International Guidelines. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221074663. [PMID: 35185350 PMCID: PMC8854230 DOI: 10.1177/11795514221074663] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/22/2021] [Indexed: 01/21/2023] Open
Abstract
Sulfonylureas (SUs) are one of the commonly prescribed oral anti-hyperglycemic agents (AHA) in low- and middle-income countries (LMICs), either in combination with metformin therapy or alone. However, concern about cardiovascular safety has limited the use of SUs in the management of type 2 diabetes mellitus (T2DM). Additionally, lack of uniformity in the national and international guidelines regarding the positioning of SUs in the management of diabetes has also been reported. The objective of this review was to assess the various national and international guidelines on diabetes management and understand the recommendations specific to SUs in various scenarios. A total of 33 national and international guidelines on the management of T2DM published in English were evaluated. These guidelines have considered the latest evidence and suggest the use of certain second-generation SUs as second-line therapy or in combination with other AHAs in select population and specific scenarios. Identification of the appropriate population, classification based on underlying risk, thorough assessment of the comorbid conditions, and a step-wise approach for the selection of appropriate SUs is essential for the effective management of T2DM. Additionally, cost-to-benefit ratio should be considered, particularly in LMICs, and SUs could continue to play an important role in such settings.
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Affiliation(s)
- Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Jabbar Khader
- Department of Endocrinology, Government Medical College, Trivandrum, Kerala, India
| | | | - Sushil Jindal
- Department of Endocrinology, People’s college of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Subhash Kumar Wangnoo
- Endocrinologist and Diabetologist, Apollo centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, New Delhi, India
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174
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Yabe D, Deenadayalan S, Horio H, Kaneto H, Jensen TB, Terauchi Y, Yamada Y, Inagaki N. Efficacy and safety of oral semaglutide in Japanese patients with type 2 diabetes: A subgroup analysis by baseline variables in the PIONEER 9 and PIONEER 10 trials. J Diabetes Investig 2022; 13:975-985. [PMID: 35112504 PMCID: PMC9153832 DOI: 10.1111/jdi.13764] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction To assess the impact of baseline characteristics on the efficacy and safety of oral semaglutide in Japanese patients with type 2 diabetes. Materials and Methods In the Peptide InnOvatioN for Early diabEtes tReatment (PIONEER) 9 and 10 trials, Japanese patients were randomized to once‐daily oral semaglutide (3, 7, or 14 mg) or a comparator (placebo or once‐daily subcutaneous liraglutide 0.9 mg in PIONEER 9; once‐weekly subcutaneous dulaglutide 0.75 mg in PIONEER 10) for 52 weeks, with 5 weeks of follow up. An exploratory analysis grouped patients in each trial according to baseline glycated hemoglobin (HbA1c; ≤8.0, >8.0–≤9.0, or >9.0%), body mass index (<25, ≥25–<30, or ≥30 kg/m2) and, for PIONEER 10 only, by background medication (sulfonylurea, glinide, thiazolidinedione, α‐glucosidase inhibitor, sodium‐glucose cotransporter 2 inhibitor). Efficacy (changes from baseline to week 26 in HbA1c and bodyweight) and safety were assessed. Results Seven hundred and one patients were included (PIONEER 9: N = 243; PIONEER 10: N = 458). In both trials, HbA1c reductions increased as baseline HbA1c increased; there were no other apparent patterns between the variables investigated and HbA1c or bodyweight changes. There was one statistically significant subgroup interaction between baseline HbA1c and estimated treatment differences in bodyweight change for oral semaglutide 14 mg versus placebo in PIONEER 9 (P = 0.0286). Baseline HbA1c, baseline body mass index and background medication did not appear to affect the proportions of patients reporting adverse events. Conclusions Oral semaglutide is effective across a range of baseline subgroups of Japanese patients with type 2 diabetes, with no unexpected safety findings.
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Affiliation(s)
- Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | | | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | | | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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175
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Coke LA, Deedwania PC, Hinnen D, Magwire M, Miller NH. GLP-1 receptor agonists and cardiovascular outcomes in patients with type 2 diabetes: Clinical evidence and best practice. J Am Assoc Nurse Pract 2022; 34:418-440. [PMID: 35120085 DOI: 10.1097/jxx.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
ABSTRACT Cardiovascular disease (CVD) is a major cause of death and disability among people with type 2 diabetes (T2D), presenting a significant impact on longevity, patient quality of life, and health care costs. In the United States, attainment of recommended glycemic targets is low and T2D-related cardiovascular complications remain a significant burden. Many glucose-lowering treatment options are available, but glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are recommended in recent guidelines as the preferred add-on therapy to metformin to improve glycemic control. This is particularly the case for patients with T2D and established atherosclerotic CVD, at high risk of atherosclerotic CVD, and/or with chronic kidney disease. Recommendations were based on GLP-1RA and SGLT-2 inhibitor cardiovascular outcomes trials (CVOTs), which consistently showed that these agents pose no additional cardiovascular risk compared with placebo. Three GLP-1RAs (liraglutide, dulaglutide, and subcutaneous semaglutide) demonstrated significantly lower major adverse cardiovascular events versus placebo and are now approved for this indication. However, to realize improvement in outcomes in the clinical setting, organized, systematic, and coordinated approaches to patient management are also needed. For example, nurse-led diabetes self-management education and support programs have been shown to be effective. This article explores T2D management with emphasis on cardiovascular risk and CVOTs performed to date and reviews the clinical experience with GLP-1RAs for managing hyperglycemia and their impact on cardiovascular risk. In addition, practical guidance is given for key health care providers involved in the care of patients with T2D with cardiovascular risk outside of diabetes clinics/endocrinology centers.
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Affiliation(s)
- Lola A Coke
- Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan
| | | | - Debbie Hinnen
- University of Colorado Health, Diabetes Clinic, Colorado Springs, Colorado
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176
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Boye KS, Lage MJ, Thieu VT. The Association Between HbA1c and 1-Year Diabetes-Related Medical Costs: A Retrospective Claims Database Analysis. Diabetes Ther 2022; 13:367-377. [PMID: 35129822 PMCID: PMC8873294 DOI: 10.1007/s13300-022-01212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The American Diabetes Association (ADA) has identified a target hemoglobin A1c (HbA1c) < 7% as appropriate for most adults with type 2 diabetes (T2D). This research examines US diabetes-related healthcare costs for adults with T2D for individuals with glycemic control (HbA1c < 7%) compared to poor glycemic control (HbA1c ≥ 7%). METHODS The Optum Clinformatics® Data Mart database from 2016 to 2020 was used to identify a cohort of adults with T2D who had a recorded HbA1c test (with first such date identified as the index date) and continuous insurance from 1 year prior through 1 year post index date. Patients with glycemic control were propensity matched to patients with poor glycemic control. Generalized linear models and two-part models examined diabetes-related outpatient, drug, acute care, and total costs over the 1-year post-period. RESULTS There were 34,538 propensity matched individuals included in the study. Results indicate that glycemic control (HbA1c < 7%), compared to poor glycemic control (HbA1c ≥ 7%) ,was associated with statistically significantly lower annual diabetes-related acute ($5671 ± $4216 vs $6138 ± $4211), outpatient ($6051 ± $4216 vs $7259 ± $7771), drug ($3739 ± $4581 vs $4288 ± $4788), and total costs care ($13,704 ± $10,635 vs $16,460 ± $10,885) (all P < 0.0001). Sensitivity analyses also examined results based upon alternative HbA1c thresholds which were chosen on the basis of expert guidelines and prior clinical trial thresholds (< 6%, ≤ 6.5%, < 8%, and ≤ 9%). In all cases, being below threshold was associated with statistically significantly lower diabetes-related total costs and component costs. Results also illustrate that, in general, higher HbA1c thresholds are associated with higher diabetes-related costs. CONCLUSION Glycemic control was found to be associated with significantly lower annual diabetes-related component and total costs. Results suggest economic benefits associated with having HbA1c at or below target.
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Affiliation(s)
- Kristina S. Boye
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
| | - Maureen J. Lage
- HealthMetrics Outcomes Research, 17 Benton’s Knoll, Guilford, CT 06437 USA
| | - Vivian T. Thieu
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
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Handelsman Y, Anderson JE, Bakris GL, Ballantyne CM, Beckman JA, Bhatt DL, Bloomgarden ZT, Bozkurt B, Budoff MJ, Butler J, Dagogo-Jack S, de Boer IH, DeFronzo RA, Eckel RH, Einhorn D, Fonseca VA, Green JB, Grunberger G, Guerin C, Inzucchi SE, Jellinger PS, Kosiborod MN, Kushner P, Lepor N, Mende CW, Michos ED, Plutzky J, Taub PR, Umpierrez GE, Vaduganathan M, Weir MR. DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases. J Diabetes Complications 2022; 36:108101. [PMID: 34922811 PMCID: PMC9803322 DOI: 10.1016/j.jdiacomp.2021.108101] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 11/27/2021] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF)-along with their associated risk factors-have overlapping etiologies, and two or more of these conditions frequently occur in the same patient. Many recent cardiovascular outcome trials (CVOTs) have demonstrated the benefits of agents originally developed to control T2D, ASCVD, or CKD risk factors, and these agents have transcended their primary indications to confer benefits across a range of conditions. This evolution in CVOT evidence calls for practice recommendations that are not constrained by a single discipline to help clinicians manage patients with complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. The ultimate goal for these recommendations is to be comprehensive yet succinct and easy to follow by the nonexpert-whether a specialist or a primary care clinician. To meet this need, we formed a volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM Practice Recommendations, a multispecialty consensus on the comprehensive management of the patient with complicated metabolic disease. The task force recommendations are based on strong evidence and incorporate practical guidance that is clinically relevant and simple to implement, with the aim of improving outcomes in patients with DCRM. The recommendations are presented as 18 separate graphics covering lifestyle therapy, patient self-management education, technology for DCRM management, prediabetes, cognitive dysfunction, vaccinations, clinical tests, lipids, hypertension, anticoagulation and antiplatelet therapy, antihyperglycemic therapy, hypoglycemia, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), ASCVD, HF, CKD, and comorbid HF and CKD, as well as a graphical summary of medications used for DCRM.
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Affiliation(s)
| | | | | | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Daniel Einhorn
- Scripps Whittier Institute for Diabetes, San Diego, CA, USA
| | | | | | - George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA, Wayne State University School of Medicine, Detroit, MI, USA, Oakland University William Beaumont School of Medicine, Rochester, MI, USA, Charles University, Prague, Czech Republic
| | - Chris Guerin
- University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Paul S Jellinger
- The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Norman Lepor
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Christian W Mende
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Erin D Michos
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jorge Plutzky
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pam R Taub
- University of California San Diego School of Medicine, San Diego, CA, USA
| | | | | | - Matthew R Weir
- University of Maryland School of Medicine, Baltimore, MD, USA
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178
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Gómez-Huelgas R, Sanz-Cánovas J, Cobos-Palacios L, López-Sampalo A, Pérez-Belmonte LM. Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors for cardiovascular and renal protection: A treatment approach far beyond their glucose-lowering effect. Eur J Intern Med 2022; 96:26-33. [PMID: 34799233 DOI: 10.1016/j.ejim.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022]
Abstract
Findings from cardiovascular outcome trials on certain newer glucose-lowering drugs have shown clear cardiovascular and renal benefits. In this review, we provide an updated overview of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT-2) inhibitors in terms of cardiovascular and renal protection. Both drugs have been described as diabetes/disease-modifying drugs. There is robust evidence on the benefits of GLP-1 receptor agonists in renal disease and atherosclerotic cardiovascular disease-especially in stroke-which are mainly explained by their antiproteinuric effect. However, this class of drugs has only shown neutral effects on heart failure and further studies are necessary in order to assess their role in this disease. SGLT-2 inhibitors have shown strong benefits in heart failure hospitalizations and renal outcomes, mainly through limiting glomerular filtration rate deterioration, regardless of the presence of diabetes. Nonetheless, their effect on the prevention of major adverse atherosclerotic cardiovascular events and cardiovascular mortality seems to be limited to patients with type 2 diabetes and established cardiovascular disease. Evidence on the cardiovascular and renal benefits of GLP-1 receptor agonists and SGLT-2 inhibitors have significantly modified management plans and treatment choices for patients with type 2 diabetes. There is now a focus on a multifactorial approach that goes beyond the glucose-lowering effect of these drugs, which are the preferred choice in routine clinical practice. According to the current evidence, a patient-focused approach that includes both individualized glycemic control and cardiorenal prevention using GLP-1 receptor agonists and SGLT-2 inhibitors with proven cardiovascular and renal benefits is believed to be the best strategy for achieving the treatment goals of patients with type 2 diabetes. Despite the strong cardiovascular and renal benefits of these drugs, further research is required in order to clarify questions that remain unanswered.
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Affiliation(s)
- Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jaime Sanz-Cánovas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Lidia Cobos-Palacios
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Almudena López-Sampalo
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Luis M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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179
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Dib A, Chartier F, Ihle K, Jamonneau I, Ludwig L, Darmon P. Cardiovascular Profile of Patients with Type 2 Diabetes in France Based on REWIND CVOT Inclusion Criteria: A Real-World Retrospective Study. Diabetes Ther 2022; 13:287-299. [PMID: 35034340 PMCID: PMC8873332 DOI: 10.1007/s13300-021-01200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/24/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The REWIND study demonstrated a cardiovascular (CV) benefit of dulaglutide treatment in patients with type 2 diabetes (T2D) with or without established cardiovascular disease (CVD). The current study aims to describe similarities and differences between characteristics of patients with T2D in France and the REWIND population. METHODS A retrospective, observational study was conducted in France using primary care IQVIA electronic medical records. Patients aged ≥ 18 years with at least one clinical visit and/or glucose-lowering agent prescription in 2019 were identified. The percentages of patients aged ≥ 50 years with established CVD, aged ≥ 55 years with subclinical CVD or aged ≥ 60 years with multiple CV risk factors based on REWIND definitions were calculated. RESULTS A total of 63,927 patients with T2D were included. Mean age was 67 years, 93% were aged ≥ 50 years and 58% were male. The median time since T2D diagnosis was 5.6 years, mean glycated hemoglobin was 7.1% and mean body mass index was 30.4 kg/m2. Of the patients included in the current study, 59.4% fulfilled REWIND CV criteria; 12.4% of patients were ≥ 50 years old with established CVD; 9.7% of patients were aged ≥ 55 years with subclinical vascular disease and 44.7% were aged ≥ 60 years with ≥ 2 CV risk factors. CONCLUSION Almost 60% of this primary care French cohort with T2D fulfilled key REWIND CV criteria, with a lower percentage of patients having established CVD than REWIND participants.
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Affiliation(s)
- Anne Dib
- Eli Lilly France SAS, Neuilly Sur Seine, France.
| | | | | | | | - Lisa Ludwig
- Eli Lilly France SAS, Neuilly Sur Seine, France
| | - Patrice Darmon
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
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180
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Blaine E, Tumlinson R, Colvin M, Haynes T, Whitley HP. Systematic literature review of insulin dose adjustments when initiating hemodialysis or peritoneal dialysis. Pharmacotherapy 2022; 42:177-187. [DOI: 10.1002/phar.2659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Emily Blaine
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Robin Tumlinson
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Marion Colvin
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Tyler Haynes
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Heather P. Whitley
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
- Baptist Family Medicine Baptist Health System Montgomery Alabama USA
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181
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Bradley SA, Spring KJ, Beran RG, Chatzis D, Killingsworth MC, Bhaskar SMM. Role of diabetes in stroke: Recent advances in pathophysiology and clinical management. Diabetes Metab Res Rev 2022; 38:e3495. [PMID: 34530485 DOI: 10.1002/dmrr.3495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
The increasing prevalence of diabetes and stroke is a major global public health concern. Specifically, acute stroke patients, with pre-existing diabetes, pose a clinical challenge. It is established that diabetes is associated with a worse prognosis after acute stroke and the various biological factors that mediate poor recovery profiles in diabetic patients is unknown. The level of association and impact of diabetes, in the setting of reperfusion therapy, is yet to be determined. This article presents a comprehensive overview of the current knowledge of the role of diabetes in stroke, therapeutic strategies for primary and secondary prevention of cardiovascular disease and/or stroke in diabetes, and various therapeutic considerations that may apply during pre-stroke, acute, sub-acute and post-stroke stages. The early diagnosis of diabetes as a comorbidity for stroke, as well as tailored post-stroke management of diabetes, is pivotal to our efforts to limit the burden. Increasing awareness and involvement of neurologists in the management of diabetes and other cardiovascular risk factors is desirable towards improving stroke prevention and efficacy of reperfusion therapy in acute stroke patients with diabetes.
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Affiliation(s)
- Sian A Bradley
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Kevin J Spring
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University & Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Roy G Beran
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Medical School, Griffith University, Southport, Queensland, Australia
- Sechenov Moscow First State University, Moscow, Russia
| | | | - Murray C Killingsworth
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, Correlatively Microscopy Facility, NSW Health Pathctology, Sydney, New South Wales, Australia
| | - Sonu M M Bhaskar
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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182
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Moulton MK, Johnson BR, Lavender DL, Osae SP, Phillips BB, Thomas I, Stone RH. A Scoping Review Evaluating the Effect of SGLT-2 Inhibitors on Insulin Dose Requirements in Insulin-Dependent Patients With Type 2 Diabetes. Ann Pharmacother 2022; 56:1030-1040. [PMID: 35040335 DOI: 10.1177/10600280211071089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Assess evidence describing the effect of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors on total daily insulin (TDI) requirements in insulin-dependent patients with type 2 diabetes. DATA SOURCES A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR) guidelines. The search was conducted in PubMed; citation mapping was completed in Web of Science. Filters for human studies, English language, and a publication date, from January 1, 2005 to April 12, 2021, were applied. STUDY SELECTION AND DATA EXTRACTION Studies assessing insulin dose requirements with concurrent use of an SGLT2 inhibitor for patients with type 2 diabetes were included. DATA SYNTHESIS Sixteen studies were included and demonstrated that addition of an SGLT2 inhibitor typically reduced TDI requirements. Insulin reductions were often statistically significant, occurring in studies evaluating (1) within subjects who received SGLT2 inhibitors, and (2) between subjects receiving SGLT2 inhibitors versus placebo. Compared with placebo, insulin dose reduction ranged from -0.72 to -19.2 units. However, studies were relatively small, not designed to assess TDI change, and some utilized fixed dose insulin protocols or empiric insulin dose reductions. CONCLUSIONS Lowering insulin requirements may have benefits, such as decreased hypoglycemia risk, insulin resistance, and cost. Addition of an SGLT2 inhibitor may modestly reduce TDI requirements for patients with type 2 diabetes. Evidence indicating SGLT2 inhibitor use reduces TDI may lead to additional implementation in practice and inform future research. Further research is needed to clarify insulin type (i.e., basal or prandial) and degree of TDI reduction expected with addition of an SGLT2 inhibitor.
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Affiliation(s)
- Morgan K Moulton
- Central Alabama Veterans Health Care System, U.S. Department of Veterans Affairs, Montgomery, AL, USA
| | - Blake R Johnson
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Devin L Lavender
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Sharmon P Osae
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Beth Bryles Phillips
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
| | - Ian Thomas
- UGA Libraries, The University of Georgia, Athens, GA, USA
| | - Rebecca H Stone
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Georgia, Athens, GA, USA
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Li Y, Wu Y, Shu Y, Li S, Pei J, Chen H, Liu S, Xiang G, Wang W, Shan P, Su H, Wu X, Yan D, Li W. Blood glucose may be another index to initiate insulin treatment besides glycated hemoglobin A1c after oral antidiabetic medications failure for glycemic control: A real-world survey. Front Endocrinol (Lausanne) 2022; 13:998210. [PMID: 36506049 PMCID: PMC9729526 DOI: 10.3389/fendo.2022.998210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The inertia of insulin initiation is a barrier to achieving glycemic control when oral antidiabetic drugs fail to control glucose during the treatment of type 2 diabetes (T2D). Insulin initiation is usually based on glycated hemoglobin A1c (A1C). To investigate whether there is another index for insulin initiation besides A1C, we conducted a cross-sectional survey in the real world. METHODS We conducted a multicenter cross-section survey with a total of 1034 T2D patients. All patients, at the time of the survey, decided to initiate insulin therapy due to failure of controlling glucose using only oral antidiabetic drugs. We analyzed the differences of blood glucose between patients who were tested for A1C and those who were not. RESULTS 666 (64.4%) patients were tested A1C and 368 (35.6%) were not. Neither fasting blood glucose (FBG) (12.0 ± 2.9 vs 12.3 ± 2.9 mmol/L, t = 1.494, P = 0.135) nor postprandial blood glucose (PBG) (18.4 ± 4.8 vs 17.9 ± 4.8 mmol/L, t = 1.315, P = 0.189) were significantly different between patients with and without A1C. CONCLUSION Our results demonstrated that initiating insulin based on FBG or PBG is a common clinical practice, at least in China; moreover, since it is easier to obtain than A1C, it can be a simple and effective way to overcome clinical inertia for initiating insulin.
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Affiliation(s)
- Yanli Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan Wu
- Department of Endocrinology, Shenzhen People’s Hospital, Shenzhen, China
| | - Yi Shu
- Department of Endocrinology, The Sixth Affiliated Hospital of South China University of Technology, Foshan, China
| | - Shu Li
- Department of Endocrinology, Huizhou Municipal Central Hospital, Huizhou, China
| | - Jianhao Pei
- Department of Endocrinology, Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Hong Chen
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shiping Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guangda Xiang
- Department of Endocrinology, General Hospital of Central Theater Command, Wuhan, China
| | - Wenbo Wang
- Department of Endocrinology, Peking University Shougang Hospital, Beijing, China
| | - Pengfei Shan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Su
- Department of Endocrinology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xiaoyan Wu
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dewen Yan
- Department of Endocrinology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Wangen Li, ; Dewen Yan,
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Wangen Li, ; Dewen Yan,
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184
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Gagner M. Metabolic Surgery Needs Stronger Scientific and Genetic Endorsements in Asian T2DM Patients with Low BMI. Obes Surg 2022; 32:214-215. [PMID: 34357534 DOI: 10.1007/s11695-021-05637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Canada.
- Department of Surgery, Hopital du Sacre Coeur, Montreal, Canada.
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185
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Nourizadeh M, Hassan Adel S, Seyedian M. The relationship between HbA1c and cardiovascular events in diabetic patients with coronary angioplasty: A cross-sectional study. J Family Med Prim Care 2022; 11:772-774. [PMID: 35360770 PMCID: PMC8963624 DOI: 10.4103/jfmpc.jfmpc_1206_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/12/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: Re-establishment of coronary artery blood flow in diabetic patients has always been a controversial issue in the treatment of cardiovascular diseases. Due to the importance of this issue and the increase in mortality due to heart disease, the present study was performed to determine the relationship between HbA1C and cardiovascular events in diabetic patients with coronary angioplasty referred to Imam Khomeini Hospital in Ahvaz. Methods: This was a descriptive cross-sectional study in which 114 patients were enrolled in a census study that was followed for 3 to 6 months. Data was collected by a checklist and by the researcher using the patient’s medical record. Then it was analyzed by SPSS 22 software and descriptive statistics. Results: There was no significant relationship between age, gender, family history of diabetes, family history of heart disease, duration of diabetes, stroke, myocardial infarction, and heart failure with HbA1c (P > 0.05). However, there was a significant relationship between the type of coronary angioplasty, hypertension, and heart block with HbA1c (P < 0.05). Conclusion: According to the results of this study, there was a significant relationship between the type of coronary angioplasty, hypertension, and heart block with HbA1c; thus HbA1c should be better controlled in diabetic patients who decide to have angioplasty.
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186
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Noronha JC, Mechanick JI. Is There a Role for Diabetes-Specific Nutrition Formulas as Meal Replacements in Type 2 Diabetes? Front Endocrinol (Lausanne) 2022; 13:874968. [PMID: 35573987 PMCID: PMC9099205 DOI: 10.3389/fendo.2022.874968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/29/2022] [Indexed: 12/13/2022] Open
Abstract
Nutrition therapy plays an integral role in the prevention and management of patients with type 2 diabetes (T2D). A potential strategy is the utilization of diabetes-specific nutrition formulas (DSNFs) as meal replacements. In this article, we distinguish DSNFs from standard nutrition formulas, review the clinical data examining the effectiveness of DSNFs, and propose an evidence-based algorithm for incorporating DSNFs as part of nutrition therapy in T2D. DSNFs contain slowly-digestible carbohydrates, healthy fats (e.g., monounsaturated fatty acids), and specific micronutrients, which provide added benefits over standard nutrition formulas. In short- and long-term clinical trials, DSNFs demonstrate improvements in postprandial glycemic responses translating into sustainable benefits in long-term glycemic control (e.g., hemoglobin A1c and glycemic variability) and various cardiometabolic outcomes. To facilitate the delivery of DSNFs in a clinical setting, the transcultural diabetes nutrition algorithm can be utilized based on body weight (underweight, normal weight, or overweight) and level of glycemic control (controlled or uncontrolled).
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Affiliation(s)
- Jarvis C. Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON, Canada
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Jarvis C. Noronha,
| | - Jeffrey I. Mechanick
- Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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187
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Salazar IMC, Tibuakuu M, Blumenthal RS, Sarkar S. Cardiovascular Disease in Patients with Diabetes: A Comparison of Professional Society Guidelines. Curr Diabetes Rev 2022; 18:e200821195733. [PMID: 34420507 DOI: 10.2174/1573399817666210820105514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
In this review, we compare major points given in the 2021 American Diabetes Association and the 2020 American Association of Clinical Endocrinologists/American College of Endocrinology guidelines, in particular, the assessment and management of cardiovascular risk in patients with diabetes with a focus on dyslipidemia, blood pressure, and pharmacotherapy in diabetes.
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Affiliation(s)
- Ilton M Cubero Salazar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Martin Tibuakuu
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sudipa Sarkar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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188
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Anderson J, Gavin JR, Kruger DF, Miller E. Optimizing the Use of Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes: Executive Summary. Clin Diabetes 2022; 40:265-269. [PMID: 35983422 PMCID: PMC9331622 DOI: 10.2337/cd22-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Eden Miller
- Division of Endocrinology, Diabetes, Bone and Mineral Disease, Henry Ford Health System, Detroit, MI
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189
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Kim KS, Hong S, Han K, Park CY. Assessing the Validity of the Criteria for the Extreme Risk Category of Atherosclerotic Cardiovascular Disease: A Nationwide Population-Based Study. J Lipid Atheroscler 2022; 11:73-83. [PMID: 35118023 PMCID: PMC8792820 DOI: 10.12997/jla.2022.11.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To validate the criteria for the extreme risk category for atherosclerotic cardiovascular disease (ASCVD). Methods An observational cohort study of 35,464 individuals with established ASCVD was performed using the National Health Information Database. Incident myocardial infarction (MI), ischemic stroke, and death in patients with established ASCVD was investigated to validate the criteria for the extreme risk category of ASCVD defined as the presence of diabetes mellitus (DM), chronic kidney disease (CKD), and history of premature ASCVD. Results Among 35,464 patients, 77.97% of them were classified into the extreme risk group of ASCVD. A total of 28.10%, 39.61%, and 32.12% had DM, CKD, and a history of premature ASCVD, respectively. During a mean follow-up of 8.39 years, MI, ischemic stroke, and all-cause death were found in 3.87%, 8.51%, and 23.98% of participants, respectively. In multivariate analysis, patients with DM had higher risk for MI (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.45–1.81), ischemic stroke (HR, 1.39; 95% CI, 1.29–1.50), and all-cause death (HR, 1.52; 95% CI, 1.45–1.59) than those without DM. Patients with CKD had 1.56 times higher risk for MI, 1.12 times higher risk for ischemic stroke, and 1.34 times higher risk for death than those without CKD. However, the risk for MI, ischemic stroke, and all-cause death was not different between patients with and without a history of premature ASCVD. Conclusion DM and CKD, but not a history of premature ASCVD, could be considered as reasonable criteria of an extreme risk for ASCVD.
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Affiliation(s)
- Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sangmo Hong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Cheol-Young Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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190
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Amaro A, Sugimoto D, Wharton S. Efficacy and safety of semaglutide for weight management: evidence from the STEP program. Postgrad Med 2022; 134:5-17. [PMID: 36691309 DOI: 10.1080/00325481.2022.2147326] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Obesity is a global health challenge. It is a multifactorial, complex, and progressive disease associated with various health complications and increased mortality. Lifestyle modifications are central to weight management but may be insufficient to maintain clinically meaningful weight loss. Pharmacotherapies are recommended as an adjunct to lifestyle interventions to induce and sustain clinically meaningful weight loss and reduce the risk of comorbidities in appropriate patients. Glucagon-like peptide-1 is an incretin metabolic hormone responsible for a range of physiological effects, including glucose and appetite regulation. Several glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been approved for the treatment of type 2 diabetes since 2005 including exenatide (short- and extended-release), lixisenatide, liraglutide, dulaglutide, albiglutide, and semaglutide. Of these, semaglutide (subcutaneous) and liraglutide are currently US Food and Drug Administration (FDA)-approved for chronic weight management in patients with or without diabetes. The phase 3 Semaglutide Treatment Effect in People with obesity (STEP) program was designed to investigate the effect of semaglutide versus placebo on weight loss, safety, and tolerability in adults with overweight or obesity. Following the submission of the results of the STEP 1-4 trials, the FDA approved once-weekly subcutaneous semaglutide 2.4 mg for chronic weight management in people with overweight or obesity in April 2021. Data from the program demonstrated that semaglutide (2.4 mg once weekly) achieved significant and sustained weight loss, together with improvements in cardiometabolic risk factors compared with placebo, and was generally well tolerated, with a safety profile consistent with other GLP-1RAs. The most common adverse events reported in STEP 1-5 were gastrointestinal events, which were transient, mild-to-moderate in severity, and typically resolved without permanent treatment discontinuation. This article reviews the data from STEP 1-5 and highlights clinically relevant findings for primary care providers.
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Affiliation(s)
- Anastassia Amaro
- Penn Metabolic Medicine, Division of Endocrinology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sean Wharton
- York University, McMaster University and Wharton Weight Management Clinic, Toronto, Ontario, Canada
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191
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Alkhatib NS, Almutairi AR, Alkhezi OS, Alfayez OM, Al Yami MS, Almohammed OA. Economic Analysis of glucagon like peptide-1 receptor agonists from the Saudi Arabia Payer Perspective. Saudi Pharm J 2022; 30:433-439. [PMID: 35527835 PMCID: PMC9068523 DOI: 10.1016/j.jsps.2022.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/21/2022] [Indexed: 12/09/2022] Open
Abstract
Objectives To perform a cost of control analysis of glucagon like peptide-1 receptor agonists (GLP1RA) in Saudi Arabia (SA) and determine the economic impact of adopting GLP1RAs. Methods A budget impact model that captures the cost of control model was constructed to simulate hypothetical patient on six treatment options: a current mix of 60% liraglutide and 40% dulaglutide, semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide. We estimated the relative amounts of SAR spend to achieve HbA1c targets (≤6.5% or < 7.0%). For each treatment option, annual treatment cost, proportion of patients achieving HbA1c targets, and cost to treat major adverse cardiovascular events (MACE) were aggregated to estimate the cost of control per patient per year (CCPPPY) over 5-year horizon (2021–2025). Probabilistic sensitivity analysis (PSA) was performed as a confirmatory analysis. Results The CCPPPY to achieve HbA1c ≤ 6.5%/<7.0% using current mix, semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide were SAR 17,097/SAR 14,113, SAR 12,889/SAR 11,123, SAR 15,594/SAR 12,892, SAR 19,184/SAR 15,940, SAR 580,211/SAR 380,936, and SAR 246,570/SAR 143,759, respectively. The relative amounts of SAR spend to achieve HbA1c ≤ 6.5%/<7.0% relative to 1 SAR on semaglutide in case of adopting current mix, liraglutide, dulaglutide, exenatide, and lixisenatide were SAR 1.42/SAR 1.18, SAR 1.30/SAR 1.07, SAR 1.60/SAR 1.33, SAR 48.33/SAR 31.73, and SAR 20.54/SAR 11.97, respectively. These results were confirmed in the PSA. Conclusions Semaglutide 1 mg once weekly was the most economically favorable GLP1RA; associated with the least CCPPPY, and amount of SAR spent to achieve HbA1c of ≤6.50%/<7.00% versus all other GLP1RAs.
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192
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Kalra S, Mithal A, Zargar AH, Sethi B, Dharmalingam M, Ghosh S, Sen R. Indian Phenotype Characteristics Among Patients with Type 2 Diabetes Mellitus: Insights from a Non-interventional Nationwide Registry in India. Endocrinology 2022; 18:63-70. [PMID: 35949363 PMCID: PMC9354966 DOI: 10.17925/ee.2022.18.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
Background: Indian patients with type 2 diabetes mellitus (T2D)
constitute one-sixth of affected adults globally. Here, we evaluate the
association of body mass index (BMI) with body fat percentage (BF%) and glycated
haemoglobin (HbA1c) levels among patients with T2D in India.
Method: This was a cross-sectional Indian registry study across 845
geographically diverse zones between December 2017 and August 2019.
Results: Of 37,927 patients, 55.6% were men, with a mean
± standard deviation age of 54.2 ± 11.5 years and HbA1c of 8.3
± 1.71%. Mean ± standard deviation BMI and BF% were 27.0 ±
4.6 kg/m2 and 32.0 ± 8.0%, respectively. Overall, 15.4% of patients were
overweight, and 25.0% were obese. Despite fewer males (20.7%) having BMI-based
obesity than females (31.2%), around three-quarters of both sexes had
BF%-defined obesity (males 77.2%; females 71.2%). One-third of males (34.6%) and
41.9% of females had BF%-defined obesity despite normal BMI. The association was
substantiated by a moderately significant correlation (r=0.51) between BMI and
BF% in the overall population (p<0.0001). Conclusion: This
pan-India registry presents a real-world reflection of the Asian Indian
phenotype: high BF% despite lower BMI in people with T2D. This highlights the
importance of primordial and primary prevention, and may guide decisions on the
choice of agents for glycaemic control, with a preference for drugs that promote
weight loss or are weight neutral.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Ambrish Mithal
- Department of Endocrinology, Max Healthcare, Saket, India
| | | | - Bipin Sethi
- Department of Endocrinology, CARE Super Specialty Hospital &
Transplant Centre, Hyderabad, India
| | - Mala Dharmalingam
- Department of Endocrinology, Ramaiah Medical College, Bengaluru,
India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post-Graduate Medical Education
and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata,
India
| | - Ranjini Sen
- AstraZeneca Pharma India Ltd, Bengaluru, India
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193
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Li Q, Zhang Q, Wang R, Hong T. Efficacy of Dulaglutide in Chinese Patients with Type 2 Diabetes and Different Glycemic Patterns: a Post-hoc Analysis of the Phase 3 AWARD-CHN2 Trial. Diabetes Ther 2022; 13:161-173. [PMID: 34870792 PMCID: PMC8776932 DOI: 10.1007/s13300-021-01182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/15/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION We evaluated the effect of dulaglutide on the relative contributions of fasting glucose (FG) and postprandial glucose (PPG) to overall hyperglycemia in patients with type 2 diabetes (T2D), and assessed responses to dulaglutide versus insulin glargine (glargine) in patients with different baseline glycemic patterns. METHODS This post-hoc analysis of the phase 3 AWARD-CHN2 trial included data from 560 Chinese patients with uncontrolled T2D who received once-weekly dulaglutide (1.5 or 0.75 mg) or once-daily glargine for 26 weeks. The relative contributions of FG and PPG to overall hyperglycemia across different glycated hemoglobin (HbA1c) categories were calculated using the area under the curve of 7-point self-monitored blood glucose profiles. Patients were also categorized into four subgroups according to median baseline FG (cutoff 8.9 mmol/L) and PPG (cutoff 12.5 mmol/L): low FG/low PPG, low FG/high PPG, high FG/low PPG and high FG/high PPG. Changes in glycemic parameters and body weight were calculated for patients in each subgroup. RESULTS Among patients receiving dulaglutide, higher HbA1c was associated with higher relative contributions of FG and lower relative contributions of PPG to overall hyperglycemia at baseline and week 26 of dulaglutide treatment. After 26 weeks, dulaglutide 1.5 mg led to statistically greater decreases in HbA1c from baseline versus glargine in most subgroups, including the high FG subgroups, and a numerically greater decrease in HbA1c was observed in the low FG/high PPG subgroup. Across all subgroups, higher proportions of patients achieved HbA1c ≤ 6.5% with dulaglutide 1.5 mg than with glargine (all P < 0.05). Dulaglutide 1.5 mg showed better control of body weight than glargine in all subgroups (all P < 0.05). CONCLUSIONS Dulaglutide reduced HbA1c through reductions in both FG and PPG across HbA1c categories in T2D patients with uncontrolled hyperglycemia. Furthermore, treatment with dulaglutide provided a greater reduction in HbA1c than glargine, regardless of baseline FG and PPG levels.
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Affiliation(s)
- Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiqi Zhang
- Lilly Suzhou Pharmaceutical Co., Ltd, Shanghai Branch, No. 288 Shimen No.1 Road, Jingan District, Shanghai, 200041, China
| | - Rui Wang
- Lilly Suzhou Pharmaceutical Co., Ltd, Shanghai Branch, No. 288 Shimen No.1 Road, Jingan District, Shanghai, 200041, China.
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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194
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Kujath AS, Frei J. Orthopaedic Nursing and Heart Failure: A Review of Pathophysiology and Management. Orthop Nurs 2022; 41:25-34. [PMID: 35045539 DOI: 10.1097/nor.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Heart failure prevalence increases with age and is one of the most common reasons for inpatient hospitalizations. There are many opportunities for orthopaedic nurses to recognize the risks and symptoms of heart failure during an episode of orthopaedic care. In the context of bundled care, the orthopaedic nurse plays a key role in the prevention and early identification of complications that can prolong hospitalization and increase hospital readmission. This article presents two cases of patients with heart failure. The pathophysiology and management of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction are reviewed. Opportunities for orthopaedic nurses to impact care of patients at risk for or with heart failure are also highlighted.
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Affiliation(s)
- Amber S Kujath
- Amber S. Kujath, PhD, RN, ONC, Associate Professor, Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University Medical Center, Chicago, IL
- Judith Frei, DNP, FNP-BC, Assistant Professor, Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University Medical Center, Chicago, IL
| | - Judith Frei
- Amber S. Kujath, PhD, RN, ONC, Associate Professor, Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University Medical Center, Chicago, IL
- Judith Frei, DNP, FNP-BC, Assistant Professor, Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University Medical Center, Chicago, IL
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195
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Jung HN, Cho YK, Min SH, Kim HS, Kim YJ, Park JY, Lee WJ, Jung CH. Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison. Front Endocrinol (Lausanne) 2022; 13:870722. [PMID: 35669682 PMCID: PMC9165059 DOI: 10.3389/fendo.2022.870722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This study evaluates the efficacy and safety of the free up-titration of basal insulin and fixed-ratio combination (FRC) of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients inadequately controlled with GLP-1RA. METHODS With the use of a systematic literature review of PubMed, Embase, Web of Science, and the Cochrane Library databases through July 2021, randomized controlled trials that compared the free up-titration or FRC with remaining on GLP-1RA in T2DM patients uncontrolled with GLP-1RA were included. A comparison of adding basal insulin to maintaining GLP-1RA and an indirect comparison between the two strategies were conducted on the change in HbA1c, fasting plasma glucose (FPG), target achievement [HbA1c < 7.0%], and the risk of confirmed hypoglycemia. The Cochrane Collaboration's tool was used to assess the risk of bias. RESULTS Two free up-titration and two FRC trials involving 1,612 participants, all lasting 26 weeks, were included. Both approaches significantly lowered HbA1c levels (weighted mean difference [WMD] -0.75%, 95% CI -0.97 to -0.53) but increased hypoglycemic risk [risk ratio (RR) 7.59, 95% CI 3.35-17.17] compared to the unchanged GLP-1RA. No significant differences were discovered between the two methods regarding the decrease in HbA1c (WMD 0.08%, 95% CI -1.07% to 1.23%), FPG (WMD -2.29 mg/dl, 95% CI -45.07 to 40.49 mg/dl), target achievement (RR 1.03, 95% CI 0.50-2.14), and hypoglycemic risk (RR 0.32, 95% CI 0.03-3.59). CONCLUSION In patients who failed to reach target HbA1c levels despite the GLP-1RA treatment, both strategies of adding basal insulin, free up-titration and FRC, are comparable options are comparable options.
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Affiliation(s)
- Han Na Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Yun Kyung Cho
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, South Korea
| | - Se Hee Min
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Hwi Seung Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
- *Correspondence: Chang Hee Jung, ;
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Arrieta F, Pedro-Botet J, Iglesias P, Obaya JC, Montanez L, Maldonado GF, Becerra A, Navarro J, Perez JC, Petrecca R, Pardo JL, Ribalta J, Sánchez-Margalet V, Duran S, Tébar FJ, Aguilar M. Diabetes mellitus and cardiovascular risk: an update of the recommendations of the Diabetes and Cardiovascular Disease Working Group of the Spanish Society of Diabetes (SED, 2021). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:36-55. [PMID: 34330545 DOI: 10.1016/j.arteri.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.
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Affiliation(s)
- Francisco Arrieta
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España.
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Juan Carlos Obaya
- Centro de Salud CHOPERA, Atención Primaria Alcobendas, Gdt Enfermedades Cardiovasculares Semfyc, Madrid, España
| | - Laura Montanez
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | | | - Antonio Becerra
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | - Jorge Navarro
- Hospital Clínico Universitario de Valencia, Gdt Diabetes Semfyc, Valencia, España
| | - J C Perez
- Centro de Salud Rincón de la Victoria, Atención Primaria, Málaga, España
| | - Romina Petrecca
- Unidad de Nutrición y dietética, Hospital de la Princesa, Madrid, España
| | - José Luis Pardo
- Centro de Salud Orihuela I. Médico de Familia, Atención Primaria Alicante, Alicante, España
| | - Josep Ribalta
- Universidad Rovira i Vigili, IISPV, CIBERDEM, Tarragona, España
| | | | - Santiago Duran
- Servicio de Endocrinología y Nutrición, Hospital Virgen de Valme, Sevilla, España
| | - Francisco Javier Tébar
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Manuel Aguilar
- Servicio de Endocrinología y Nutrición, Hospital Puerta del Mar, Cádiz, España
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Banjara B, Poudel N, Garza KB, Westrick S, Whitley HP, Redden D, Ngorsuraches S. Patients' Preferences for Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists. Patient Prefer Adherence 2022; 16:3415-3428. [PMID: 36597550 PMCID: PMC9805720 DOI: 10.2147/ppa.s391719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To determine patients' preferences for sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs). PATIENTS AND METHODS A cross-sectional, web-based discrete choice experiment was conducted among US adults with type 2 diabetes mellitus (T2DM) in May 2021. Six attributes-the route and frequency of administration, the chance of reaching target HbA1c in six months, the percentage reduction in the risk of major adverse cardiovascular events (MACE), the chance of gastrointestinal side effects, the chance of genital infection, and out-of-pocket cost per month-were identified from literature review and consultation with patients and clinicians. A Bayesian efficient design was used to generate choice sets. Each choice set contained two hypothetical SGLT-2i and GLP-1 RA alternatives described by the attributes and an opt-out alternative. A total of 176 patients were asked to select the most preferred option from each choice set. Mixed logit (ML) and latent class (LC) models were developed. The conditional relative importance of each attribute was determined. RESULTS The ML model showed the out-of-pocket cost had the highest conditional relative importance, followed by the chance of reaching the target HbA1c. The best LC model revealed two patient classes. All attributes were significantly important to the patients in both classes, except the chance of genital infection in class 2. Compared to the patients in class 2, the patients in class 1 were older (approximately 65 vs 56 years) and had a higher number of comorbidities (approximately three vs two). CONCLUSION T2DM patients placed different preference weights or importance across SGLT-2i and GLP-1 RA attributes. Preference heterogeneity was found among patients with different ages and numbers of comorbidities.
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Affiliation(s)
- Bidur Banjara
- Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
- Cytel Inc, Waltham, MA, USA
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
| | - Salisa Westrick
- Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
| | - Heather P Whitley
- Department of Pharmacy Practice, Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
| | - David Redden
- Department of Biomedical Affairs and Research, Auburn University, Edward via College of Osteopathic Medicine, Auburn, AL, USA
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
- Correspondence: Surachat Ngorsuraches, Department of Health Outcomes Research and Policy, Auburn University, Harrison College of Pharmacy, 4306A Walker Building, Auburn, AL, 36849, USA, Tel +1 334 844 8357, Fax +1 334 844 8307, Email
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Kim HS, Yu JM, Jang HC, Choi EK, Park JH, Shon HS, Chung CH, Park KG, Cho JH, Kim W, Lee KH, Lee JH, Yoo SJ. Real-World Analysis of Rapid-Acting Insulin Analog Use and Its Blood Glucose Lowering Effect in Patients with Type 2 Diabetes Mellitus: Results from PASSION Disease Registry in Korea. Diabetes Metab Syndr Obes 2022; 15:1495-1503. [PMID: 35591905 PMCID: PMC9112041 DOI: 10.2147/dmso.s334944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Although rapid-acting insulins (RAIs) are used frequently in Korean clinical settings, evidence on their use is limited. This study explores the pattern and clinical effectiveness of the use of RAIs in Korean patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS This non-interventional, observational study enrolled patients (aged >18 years) with T2DM who were prescribed RAIs. The pattern of use and effectiveness of RAI analogs were evaluated over 6 months. RESULTS A total of 299/451 patients were analyzed. Approximately 90% (n/N=270/299) of the patients received insulin glulisine, which significantly reduced their levels of glycated hemoglobin (HbA1c: n=270, mean± standard deviation [SD]; -1.16±6.02%, p=0.0017), fasting plasma glucose (n=40; mean±SD: -54.9±90.89 mg/dl, p=0.0005), and post prandial blood glucose (n=35, mean±SD: -89.46± 105.68 mg/dl, p<0.0001) at 6 months, with a corresponding increase in body weight (BW) (n=197, mean±SD:1.45±3.64 kg, p<0.0001). At 6 months, more patients receiving an intensive regimen (basal insulin+≥2 RAI injections/day) had HbA1c <7% than those receiving a non-intensive regimen (basal insulin+1 RAI injection/day) (20.69% vs 7.46%; p=0.0333); the corresponding reduction in HbA1c was also higher in patients receiving the intensive regimen (p<0.0001). About one-fourth patients (n/N=22/95) were switched to the intensive regimen (from 1 to ≥2 RAI injections/day), and only 4.41% (n/N=9/204) of the patients were switched to 1 RAI injection/day. The patients receiving the intensive regimen showed higher levels of HbA1c reductions (mean±SD: -1.27±1.96%) compared with the maintenance group-1 RAI injection/day (mean±SD: -0.72±1.66%) (p=0.0459), without a significant increase in BW and body mass index. CONCLUSION The insulin glulisine intensification regimen showed glycemic target achievement and can be considered a therapeutic tool in the management of T2DM patients.
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Affiliation(s)
- Hye Soon Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jae Myung Yu
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eui Kwang Choi
- Department of Internal Medicine, Naedang Dr. Choi’s Clinic, Seoul, Republic of Korea
| | - Jeong Hyun Park
- Department of Internal Medicine, College of Medicine, Inje University, Busan, Republic of Korea
| | - Ho Sang Shon
- Department of Internal Medicine, Catholic University of Daegu, School of Medicine, Daegu, Republic of Korea
| | - Choon Hee Chung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Keun-Gyu Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jae Hyoung Cho
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won Kim
- Medical Department Sanofi-Aventis Korea, Seoul, Republic of Korea
| | - Kyoung Hwa Lee
- Medical Department Sanofi-Aventis Korea, Seoul, Republic of Korea
| | - Jee Hyun Lee
- Medical Department Sanofi-Aventis Korea, Seoul, Republic of Korea
| | - Soon Jib Yoo
- Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
- Correspondence: Soon Jib Yoo, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, 14647, Republic of Korea, Tel +82-32-340-7011, Fax +82-32-340-2039, Email
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Kushner PR, Cavender MA, Mende CW. Role of Primary Care Clinicians in the Management of Patients With Type 2 Diabetes and Cardiorenal Diseases. Clin Diabetes 2022; 40:401-412. [PMID: 36381309 PMCID: PMC9606551 DOI: 10.2337/cd21-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals with type 2 diabetes are at increased risk of both renal and cardiovascular events. The convergence of type 2 diabetes, chronic kidney disease, and cardiovascular disease, including heart failure, requires management by a multidisciplinary health care team. Primary care clinicians are likely to be the first and most frequent point of contact for individuals with type 2 diabetes who are at high risk of cardiorenal disease and therefore play a pivotal role in early diagnosis, establishment of effective treatment strategies, and coordination of care. This article presents a clinical perspective with multidisciplinary collaboration on a patient case representative of those seen in routine clinical practice. The authors assess reasons why patients may not receive evidence-based care and identify opportunities to initiate therapies that reduce cardiovascular and renal events in the primary care setting.
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Affiliation(s)
- Pamela R. Kushner
- University of California, Irvine, CA
- Corresponding author: Pamela R. Kushner,
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Vargas-Uricoechea H. Current State and Principles of Basal Insulin Therapy in Type 2 Diabetes. J Clin Med Res 2022; 14:8-21. [PMID: 35211212 PMCID: PMC8827224 DOI: 10.14740/jocmr4660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/11/2022] Open
Abstract
Treatment with basal insulins is a fundamental part of management in many patients with type 2 diabetes mellitus. Multiple management schemes may be indicated in these individuals, for example, the use of oral antihyperglycemic agents with basal insulins (basal-supported oral therapy) or the combinations of basal insulins with glucagon-like peptide-1 receptor agonists; each of these strategies makes it easier to achieve glycemic control goals. A basic knowledge of the physiology, pharmacodynamic and pharmacokinetic aspects of the different basal insulins is essential to achieve treatment goals and compliance. This review addresses the principles of management with basal insulins.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayan, Colombia.
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