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Abi Mosleh K, Salameh Y, Ghusn W, Jawhar N, Mundi MS, Collazo-Clavell ML, Kendrick ML, Ghanem OM. Impact of metabolic and bariatric surgery on weight loss and insulin requirements in type 1 and insulin-treated type 2 diabetes. Clin Obes 2024:e12689. [PMID: 38934261 DOI: 10.1111/cob.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Metabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin-treated type 2 diabetes (T2D) patients over a 5-year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin-treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin-treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin-treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG.
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Affiliation(s)
| | - Yara Salameh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wissam Ghusn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria L Collazo-Clavell
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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2
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Fundoiano-Hershcovitz Y, Ritholz MD, Horwitz DL, Behar E, Manejwala O, Goldstein P. The Impact of Digital Self-Monitoring of Weight on Improving Diabetes Clinical Outcomes: Quasi-Randomized Study. J Med Internet Res 2024; 26:e54940. [PMID: 38564266 PMCID: PMC11022133 DOI: 10.2196/54940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80% to 90% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals in managing chronic conditions is to increase awareness and generate behavioral change to improve outcomes in diabetes and related comorbidities, such as overweight or obesity. There is a lack of real-life evidence to test the impact of self-monitoring of weight on glycemic outcomes and its underlying mechanisms. OBJECTIVE This study aims to assess the efficacy of digital self-monitoring of weight on blood glucose (BG) levels during diabetes management, investigating whether the weight changes may drive glucose fluctuations. METHODS In this retrospective, real-world quasi-randomized study, 50% of the individuals who regularly used the weight monitoring (WM) feature were propensity score matched with 50% of the users who did not use the weight monitoring feature (NWM) based on demographic and clinical characteristics. All the patients were diagnosed with T2D and tracked their BG levels. We analyzed monthly aggregated data 6 months before and after starting their weight monitoring. A piecewise mixed model was used for analyzing the time trajectories of BG and weight as well as exploring the disaggregation effect of between- and within-patient lagged effects of weight on BG. RESULTS The WM group exhibited a significant reduction in BG levels post intervention (P<.001), whereas the nonmonitoring group showed no significant changes (P=.59), and both groups showed no differences in BG pattern before the intervention (P=.59). Furthermore, the WM group achieved a meaningful decrease in BMI (P<.001). Finally, both within-patient (P<.001) and between-patient (P=.008) weight variability was positively associated with BG levels. However, 1-month lagged back BMI was not associated with BG levels (P=.36). CONCLUSIONS This study highlights the substantial benefits of self-monitoring of weight in managing BG levels in patients with diabetes, facilitated by a digital health platform, and advocates for the integration of digital self-monitoring tools in chronic disease management. We also provide initial evidence of testing the underlying mechanisms associated with BG management, underscoring the potential role of patient empowerment.
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Affiliation(s)
| | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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3
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Cebrián-Cuenca AM, Moreno-Pérez O, Campuzano-Ruiz R, Soler MJ, García de Lucas MD, Orozco-Beltrán D. Multidisciplinary Panel Consensus for the Management of Patients with Type 2 Diabetes: A Delphi Study. Arch Med Res 2024; 55:102923. [PMID: 38141271 DOI: 10.1016/j.arcmed.2023.102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/29/2023] [Accepted: 11/16/2023] [Indexed: 12/25/2023]
Abstract
AIM To reach a multidisciplinary consensus on managing patients with type 2 diabetes among specialists in family medicine, cardiology, endocrinology, internal medicine, and nephrology. METHODS A two-round Delphi study was conducted using a questionnaire with 68 positive/negative statements distributed in four thematic blocks on diabetes management: early diagnosis and prediabetes, referral criteria, treatment and comorbidities, and clinical management. The expert panel was composed of 105 physicians from different specialties (family medicine, cardiology, endocrinology, internal medicine, and nephrology) with experience in managing patients with diabetes and who were members of a diabetes-related society. RESULTS Response rates for the first and second rounds were 86.7 and 75.2%, respectively. After both rounds, a consensus was reached on 52 (76.5%) items. The recommendations with the highest degree of consensus (median = 10, IQR = 0.00) were related to anti-smoking education, cardiovascular risk factor target control, and diabetic kidney disease. There were significant differences between family physicians and other specialties for some items. CONCLUSIONS This study provides a set of recommendations for diabetes management agreed upon by specialists from different healthcare settings.
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Affiliation(s)
- Ana M Cebrián-Cuenca
- Family Medicine Health Center of Cartagena Casco, Primary Care Research Group, Biomedical Research Institute of Murcia, Cartagena, Spain
| | - Oscar Moreno-Pérez
- Endocrinology Department, Dr. Balmis General University Hospital - Alicante Institute of Health and Biomedical Research, Alicante, Spain; Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain.
| | | | - Maria Jose Soler
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | - Domingo Orozco-Beltrán
- Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain; Family Medicine Health Center of Cabo Huertas, Alicante, Spain
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4
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Zhu Z, Wong SYS, Sung JJY, Lam TYT. Team-Based Approach to Reduce Malignancies in People with Diabetes and Obesity. Curr Diab Rep 2023; 23:253-263. [PMID: 37535293 PMCID: PMC10520129 DOI: 10.1007/s11892-023-01518-y] [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] [Accepted: 06/18/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE OF REVIEW Numerous observations have indicated an increased risk of developing various types of cancers, as well as cancer-related mortality, among patients with diabetes and obesity. The purpose of this review is to outline multiple-cancer screening among these patients through a team-based approach and to present the findings of a pioneering integrated care program designed for patients with obesity with a specific emphasis on cancer prevention. RECENT FINDINGS A community-based multi-cancer prevention program, which provides all services in one location and utilizes team-based approaches, is reported to be feasible and has the potential to enhance the uptake rate of multiple cancers screening among patients with diabetes and obesity. The team-based approach is a commonly utilized method for managing patients with diabetes, obesity, and cancer, and has been shown to be efficacious. Nevertheless, research on team-based cancer screening programs for patients with diabetes and obesity remains limited. Providing a comprehensive screening for colorectal, prostate, and breast cancer, as well as metabolic syndrome, during a single clinic visit has been proven effective and well-received by participants.
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Affiliation(s)
- Ziyue Zhu
- Stanley Ho Big Data Analytic and Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Yeung Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joseph Jao Yiu Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Thomas Yuen Tung Lam
- Stanley Ho Big Data Analytic and Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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Persson DR, Zhukouskaya K, Wegener AMK, Jørgensen LK, Bardram JE, Bækgaard P. Exploring Patient Needs and Designing Concepts for Digitally Supported Health Solutions in Managing Type 2 Diabetes: Cocreation Study. JMIR Form Res 2023; 7:e49738. [PMID: 37624633 PMCID: PMC10492168 DOI: 10.2196/49738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient's perspective. OBJECTIVE The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user's perspective. The goal was to address the patients' expressed real-world needs by having the users themselves choose the scope and format of the solutions. METHODS Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. RESULTS The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. CONCLUSIONS Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making.
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Affiliation(s)
- Dan Roland Persson
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Katiarina Zhukouskaya
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Per Bækgaard
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
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6
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Stults-Kolehmainen MA, Bond DS, Richardson LA, Herring LY, Mulone B, Garber CE, Morton J, Ghiassi S, Duffy AJ, Balk E, Abolt CJ, Howard MC, Ash GI, Williamson S, Marcon ER, De Los Santos M, Bond S, Huehls J, Alowaish O, Heyman NB, Gualano B. Role of the exercise professional in metabolic and bariatric surgery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.20.23288698. [PMID: 37645986 PMCID: PMC10462198 DOI: 10.1101/2023.04.20.23288698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting Clinical and academic exercise settings worldwide. Methods This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.
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Affiliation(s)
- Matthew A. Stults-Kolehmainen
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Dale S. Bond
- Departments of Surgery and Research, Hartford Hospital/HealthCare, Hartford, CT, United States
| | | | - Louisa Y. Herring
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, England, United Kingdom
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, England, United Kingdom
| | - Bethany Mulone
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - John Morton
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Saber Ghiassi
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Andrew J. Duffy
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Ethan Balk
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
| | - Charles J. Abolt
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Matt C. Howard
- Department of Marketing & Quantitative Methods, University of South Alabama, Mobile, AL, United States
| | - Garrett I. Ash
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
- Center for Pain, Research, Informatics, Medical Comorbidities and Education Center (PRIME), VA Connecticut Healthcare System, West Haven, CT, United States
| | - Susannah Williamson
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
- Army Educational Outreach Program, Rochester Institute of Technology, United States
| | - Emilian Rejane Marcon
- Department of Bariatric Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa De Los Santos
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Samantha Bond
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Janet Huehls
- UMass Memorial Weight Center, UMASS Memorial Medical Center, Worchester, MA, United States
| | - Osama Alowaish
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Nina Brojan Heyman
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil
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7
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Mosbah H, Donadille B, Vatier C, Janmaat S, Atlan M, Badens C, Barat P, Béliard S, Beltrand J, Ben Yaou R, Bismuth E, Boccara F, Cariou B, Chaouat M, Charriot G, Christin-Maitre S, De Kerdanet M, Delemer B, Disse E, Dubois N, Eymard B, Fève B, Lascols O, Mathurin P, Nobécourt E, Poujol-Robert A, Prevost G, Richard P, Sellam J, Tauveron I, Treboz D, Vergès B, Vermot-Desroches V, Wahbi K, Jéru I, Vantyghem MC, Vigouroux C. Dunnigan lipodystrophy syndrome: French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins). Orphanet J Rare Dis 2022; 17:170. [PMID: 35440056 PMCID: PMC9019936 DOI: 10.1186/s13023-022-02308-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Dunnigan syndrome, or Familial Partial Lipodystrophy type 2 (FPLD2; ORPHA 2348), is a rare autosomal dominant disorder due to pathogenic variants of the LMNA gene. The objective of the French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins), is to provide health professionals with a guide to optimal management and care of patients with FPLD2, based on a critical literature review and multidisciplinary expert consensus. The PNDS, written by members of the French National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), is available on the French Health Authority website (in French). Dunnigan syndrome is characterized by a partial atrophy of the subcutaneous adipose tissue and by an insulin resistance syndrome, associated with a risk of metabolic, cardiovascular and muscular complications. Its prevalence, assessed at 1/100.000 in Europe, is probably considerably underestimated. Thorough clinical examination is key to diagnosis. Biochemical testing frequently shows hyperinsulinemia, abnormal glucose tolerance and hypertriglyceridemia. Elevated hepatic transaminases (hepatic steatosis) and creatine phosphokinase, and hyperandrogenism in women, are common. Molecular analysis of the LMNA gene confirms diagnosis and allows for family investigations. Regular screening and multidisciplinary monitoring of the associated complications are necessary. Diabetes frequently develops from puberty onwards. Hypertriglyceridemia may lead to acute pancreatitis. Early atherosclerosis and cardiomyopathy should be monitored. In women, polycystic ovary syndrome is common. Overall, the management of patients with Dunnigan syndrome requires the collaboration of several health care providers. The attending physician, in conjunction with the national care network, will ensure that the patient receives optimal care through regular follow-up and screening. The various elements of this PNDS are described to provide such a support.
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Affiliation(s)
- H Mosbah
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.,Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - B Donadille
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - C Vatier
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.,Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - S Janmaat
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.,Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - M Atlan
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.,Plastic Surgery Department, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - C Badens
- Department of Genetics, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - P Barat
- Pediatric Endocrinology Unit, Bordeaux University Hospitals, Bordeaux, France
| | - S Béliard
- Nutrition Department, Assistance Publique-Hôpitaux de Marseille, La Conception Hospital, Marseille, France
| | - J Beltrand
- Paediatric Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Paris University, Paris, France
| | - R Ben Yaou
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Myology Institute, Sorbonne University, Paris, France
| | - E Bismuth
- Paediatric Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris University, Paris, France
| | - F Boccara
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, St Antoine Hospital, Sorbonne University, Paris, France
| | - B Cariou
- Endocrinology Department, Nantes University Hospitals, Guillaume et René Laennec Hospital, Nantes University, Nantes, France
| | - M Chaouat
- Plastic Surgery Department, Assistance Publique-Hôpitaux de Paris, St Louis Hospital, Paris University, Paris, France
| | - G Charriot
- French Lipodystrophy Association (AFLIP; Association Française des Lipodystrophies), Pierrevert, France
| | - S Christin-Maitre
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.,Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.,Sorbonne University, Inserm UMR_S933, Paris, France
| | - M De Kerdanet
- Paediatric Endocrinology Department, Rennes University Hospitals, South Hospital, Rennes, France
| | - B Delemer
- Endocrinology Department, Reims University Hospitals, Robert Debré Hospital, Reims, France
| | - E Disse
- Endocrinology Department, Lyon University Hospitals, South Lyon Civil Hospital, Lyon University, Pierre Benite, France
| | - N Dubois
- Nutrition Department, Assistance Publique-Hôpitaux de Marseille, La Conception Hospital, Marseille, France
| | - B Eymard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Myology Institute, Sorbonne University, Paris, France
| | - B Fève
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.,Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - O Lascols
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.,Molecular Biology and Genetics Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
| | - P Mathurin
- Hepatology Department, Lille 2 University Hospitals, Lille University, Lille, France
| | - E Nobécourt
- Endocrinology Department, La Reunion University Hospitals, Reunion South Hospital, St Pierre de la Reunion, France
| | - A Poujol-Robert
- Hepatology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - G Prevost
- Endocrinology Department, Rouen University Hospitals, Bois-Guillaume Hospital, Rouen, France
| | - P Richard
- Cardiogenetics and Myogenetics Department, Assistance Publique-Hôpitaux de Paris, Pitie Salpêtrière Hospital, Sorbonne University, Paris, France
| | - J Sellam
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.,Rhumatology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - I Tauveron
- Endocrinology Department, Clermont-Ferrand University Hospital, Clermont Auvergne University, Clermont-Ferrand, France
| | - D Treboz
- French Lipodystrophy Association (AFLIP; Association Française des Lipodystrophies), Pierrevert, France
| | - B Vergès
- Endocrinology-Diabetology Department, Dijon University Hospital, François Mitterand Hospital, Bourgogne University, Dijon, France
| | - V Vermot-Desroches
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - K Wahbi
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Paris University, Paris, France
| | - I Jéru
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.,Molecular Biology and Genetics Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
| | - M C Vantyghem
- Endocrinology Department, Lille 2 University Hospitals, Lille University, Lille, France
| | - C Vigouroux
- Endocrinology, Diabetology and Reproductive Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France. .,Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France. .,Molecular Biology and Genetics Department, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France.
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8
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Madsen N, Joyce C, Vlasses F, Burkhart L. Effectiveness of an interprofessional ambulatory care model on diabetes: evaluating clinical markers in a low-income patient population. J Interprof Care 2021; 36:500-508. [PMID: 34353211 DOI: 10.1080/13561820.2021.1941816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care-coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p = .02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p = .04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes.
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Affiliation(s)
- Nancy Madsen
- School of Nursing/DeKalb, Northern Illinois University, US
| | - Cara Joyce
- Health Informatics and Data Science Parkinson School of Health Sciences and Public Health Maywood, Illinois, US
| | - Frances Vlasses
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US
| | - Lisa Burkhart
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US.,Research Health Scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Junior VA Hospital, Hines, IL, US
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Yousef CC, Thomas A, Matar MA, Ghandoura L, Aldossary I, Almuhanna SM, Alhussain F, Al Bisher FB, Aljohani RM, Balubaid AN, Nouh MI, Almurashi A, AlAmoudi R. Liraglutide effects on glycemic control and weight in patients with type 2 diabetes Mellitus: A real-world, observational study and brief narrative review. Diabetes Res Clin Pract 2021; 177:108871. [PMID: 34052248 DOI: 10.1016/j.diabres.2021.108871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Glycemic control and weight gain are two essential considerations in the pharmacological management of type 2 diabetes mellitus. Pharmacological agents are effective in lowering blood glucose levels but may result in significant weight gain. Liraglutideeffectively maintains glycemic control while reducingweight. METHODS This is a real-world study and brief narrative review of the effects of liraglutide on glycemic control and weight in adult patients with type 2 diabetes mellitus. The study uses data extracted from the electronic health record of the Ministry of National Guard-Health Affairs. RESULTS In this study of 348 subjects, there was a statistically significant reduction in hemoglobin A1c of 0.9% (P < .0001) and weight of 2.3 kg (P < .0001). The majority (77.3%) were on concomitant insulin.Subjects with a baseline hemoglobin A1c greater than 9% had a significantly greater reduction than those below 9% (-0.7%;P < .0001). Those with a weight more than 100 kg had a significantly greater reduction than those below 100 kg (-0.9 kg;P = .0096). CONCLUSION In this real-world, observational study, liraglutide was shown to be effective in improving glycemic control and reducing weight in adult patients with type 2 diabetes mellitus.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Dammam, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Abin Thomas
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Biostatistics and Bioinformatics, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Manar Al Matar
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Lama Ghandoura
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Family Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Sarah Musa Almuhanna
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Fatimah Alhussain
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Fatmh Bisher Al Bisher
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Raneem Mohammad Aljohani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ibn Sina National College, College of Clinical Pharmacy, Jeddah, Saudi Arabia
| | - Alya Najeeb Balubaid
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ibn Sina National College, College of Clinical Pharmacy, Jeddah, Saudi Arabia
| | - Mahmoud Ismail Nouh
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Umm Al-Qura University, College of Pharmacy, Makkah, Saudi Arabia
| | - Abdulhalim Almurashi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; General Directorate of Health Affairs, Department of Family Medicine, Madinah, Saudi Arabia
| | - Reem AlAmoudi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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10
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Heilbrun A, Drossos T. Evidence for Mental Health Contributions to Medical Care in Diabetes Management: Economic and Professional Considerations. Curr Diab Rep 2020; 20:79. [PMID: 33247792 PMCID: PMC8647713 DOI: 10.1007/s11892-020-01337-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This paper considers the potential contributions of behavioral health providers to interprofessional, collaborative treatment for diabetes. We have the following objectives: (1) review the behavioral health complications, risks, burdens, and costs associated with diabetes management and consider the role of behavioral health providers in treating mental health concerns specific to diabetes; (2) highlight two frameworks for incorporating behavioral health into diabetes treatment, and review the empirical support for each; and (3) consider the financial feasibility of integrating behavioral health services into diabetes medical care settings. RECENT FINDINGS The healthcare field is still in the nascent stages of integrating behavioral health services in endocrinology clinics, but there is growing evidence that integrated behavioral healthcare has the potential to improve disease management and psychological functioning for individuals with chronic medical conditions. Furthermore, as a result of recent changes to the billing structure for behavioral health services in a medical setting, reimbursement rates for behavioral health providers in this capacity have improved considerably. If delivered by qualified behavioral health providers using evidence-based guidelines, behavioral health integration has the potential to optimize health outcomes, improve quality of life, and decrease fragmentation of care for patients with diabetes. Future research should focus on developing a financially feasible, empirically supported model of integrated behavioral health and disseminating the model to medical providers treating patients with diabetes.
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Affiliation(s)
- Anna Heilbrun
- The University of Chicago, 5801 S Ellis Ave, Chicago, IL 60637, USA
| | - Tina Drossos
- The University of Chicago, 5801 S Ellis Ave, Chicago, IL 60637, USA
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11
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Di Domenico EG, De Angelis B, Cavallo I, Sivori F, Orlandi F, Fernandes Lopes Morais D’Autilio M, Di Segni C, Gentile P, Scioli MG, Orlandi A, D’Agosto G, Trento E, Kovacs D, Cardinali G, Stefanile A, Koudriavtseva T, Prignano G, Pimpinelli F, Lesnoni La Parola I, Toma L, Cervelli V, Ensoli F. Silver Sulfadiazine Eradicates Antibiotic-Tolerant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms in Patients with Infected Diabetic Foot Ulcers. J Clin Med 2020; 9:jcm9123807. [PMID: 33255545 PMCID: PMC7760944 DOI: 10.3390/jcm9123807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
Infections are among the most frequent and challenging events in diabetic foot ulcers (DFUs). Pathogenic bacteria growing in biofilms within host tissue are highly tolerant to environmental and chemical agents, including antibiotics. The present study was aimed at assessing the use of silver sulfadiazine (SSD) for wound healing and infection control in 16 patients with DFUs harboring biofilm-growing Staphylococcus aureus and Pseudomonas aeruginosa. All patients received a treatment based on a dressing protocol including disinfection, cleansing, application of SSD, and application of nonadherent gauze, followed by sterile gauze and tibio-breech bandage, in preparation for toilet surgery after 30 days of treatment. Clinical parameters were analyzed by the T.I.M.E. classification system. In addition, the activity of SSD against biofilm-growing S. aureus and P. aeruginosa isolates was assessed in vitro. A total of 16 patients with S. aureus and P. aeruginosa infected DFUs were included in the study. Clinical data showed a statistically significant (p < 0.002) improvement of patients’ DFUs after 30 days of treatment with SSD with significant amelioration of all the parameters analyzed. Notably, after 30 days of treatment, resolution of infection was observed in all DFUs. In vitro analysis showed that both S. aureus and P. aeruginosa isolates developed complex and highly structured biofilms. Antibiotic susceptibility profiles indicated that biofilm cultures were significantly (p ≤ 0.002) more tolerant to all tested antimicrobials than their planktonic counterparts. However, SSD was found to be effective against fully developed biofilms of both S. aureus and P. aeruginosa at concentrations below those normally used in clinical preparations (10 mg/mL). These results strongly suggest that the topical administration of SSD may represent an effective alternative to conventional antibiotics for the successful treatment of DFUs infected by biofilm-growing S. aureus and P. aeruginosa.
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Affiliation(s)
- Enea Gino Di Domenico
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
- Correspondence: ; Tel.: +39-06-5266-5564
| | - Barbara De Angelis
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Fabrizio Orlandi
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | | | - Chiara Di Segni
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Pietro Gentile
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Maria Giovanna Scioli
- Department of Anatomic Pathology, University of Rome Tor Vergata, 00144 Rome, Italy; (M.G.S.); (A.O.)
| | - Augusto Orlandi
- Department of Anatomic Pathology, University of Rome Tor Vergata, 00144 Rome, Italy; (M.G.S.); (A.O.)
| | - Giovanna D’Agosto
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Elisabetta Trento
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Daniela Kovacs
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (D.K.); (G.C.)
| | - Giorgia Cardinali
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (D.K.); (G.C.)
| | - Annunziata Stefanile
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.S.); (T.K.)
| | - Tatiana Koudriavtseva
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.S.); (T.K.)
| | - Grazia Prignano
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Ilaria Lesnoni La Parola
- Lichen Sclerosus Unit, Department of Dermatology, STI, Environmental Health, Tropical and Immigration, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy;
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Fabrizio Ensoli
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
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12
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Schernthaner G, Shehadeh N, Ametov AS, Bazarova AV, Ebrahimi F, Fasching P, Janež A, Kempler P, Konrāde I, Lalić NM, Mankovsky B, Martinka E, Rahelić D, Serafinceanu C, Škrha J, Tankova T, Visockienė Ž. Worldwide inertia to the use of cardiorenal protective glucose-lowering drugs (SGLT2i and GLP-1 RA) in high-risk patients with type 2 diabetes. Cardiovasc Diabetol 2020; 19:185. [PMID: 33097060 PMCID: PMC7585305 DOI: 10.1186/s12933-020-01154-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
The disclosure of proven cardiorenal benefits with certain antidiabetic agents was supposed to herald a new era in the management of type 2 diabetes (T2D), especially for the many patients with T2D who are at high risk for cardiovascular and renal events. However, as the evidence in favour of various sodium-glucose transporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) accumulates, prescriptions of these agents continue to stagnate, even among eligible, at-risk patients. By contrast, dipeptidyl peptidase-4 inhibitors (DPP-4i) DPP-4i remain more widely used than SGLT2i and GLP-1 RA in these patients, despite a similar cost to SGLT2i and a large body of evidence showing no clear benefit on cardiorenal outcomes. We are a group of diabetologists united by a shared concern that clinical inertia is preventing these patients from receiving life-saving treatments, as well as placing them at greater risk of hospitalisation for heart failure and progression of renal disease. We propose a manifesto for change, in order to increase uptake of SGLT2i and GLP-1 RA in appropriate patients as a matter of urgency, especially those who could be readily switched from an agent without proven cardiorenal benefit. Central to our manifesto is a shift from linear treatment algorithms based on HbA1c target setting to parallel, independent considerations of atherosclerotic cardiovascular disease, heart failure and renal risks, in accordance with newly updated guidelines. Finally, we call upon all colleagues to play their part in implementing our manifesto at a local level, ensuring that patients do not pay a heavy price for continued clinical inertia in T2D.
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Affiliation(s)
| | - Naim Shehadeh
- Institute of Diabetes, Endocrinology and Metabolism, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, P.O. Box 9602, 3109601 Haifa, Israel
| | - Alexander S. Ametov
- Head of Endocrinology, Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Anna V. Bazarova
- Department of Internal Medicine #3, Astana Medical University (NpJSC “AMU”), 49A Beybitshilik Street, Nur-Sultan City, Kazakhstan
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Division of Gastroenterology, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Peter Fasching
- 5th Medical Department With Endocrinology, Rheumatology and Acute Geriatrics, Vienna Health Association Clinic Ottakring, 37 Montleartstraße, 1160 Vienna, Austria
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 7 Zaloška Cesta, 1000 Ljubljana, Slovenia
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, 2/a Korányi Sándor Utca, Budapest, 1083 Hungary
| | - Ilze Konrāde
- Riga Stradins University, Riga, Latvia
- Riga East Clinical Hospital, Riga, Latvia
| | - Nebojša M. Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Boris Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Emil Martinka
- National Institute of Endocrinology and Diabetology, Lubochna, Slovak Republic
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Cristian Serafinceanu
- Department of Diabetes, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology/Dialysis, N C Paulescu National Institute for Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
| | - Jan Škrha
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, 1 Ulice Nemocnice, 128 08 Prague 2, Czech Republic
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University — Sofia, 2 Zdrave Street, Sofia, Bulgaria
| | - Žydrūnė Visockienė
- Clinic of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Cai X, Qiu S, Luo D, Wang L, Lu Y, Li M. Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring) 2020; 28:502-509. [PMID: 31965748 DOI: 10.1002/oby.22715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This meta-analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. METHODS Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random-effects model was applied to obtain weight mean differences and 95% CIs. RESULTS Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, -0.84 kg; 95% CI: -1.51 to -0.17 kg) and lower waist circumference (-1.35 cm; 95% CI: -2.16 to -0.55 cm) but may not decrease BMI (-0.08 kg/m2 ; 95% CI: -0.41 to 0.25 kg/m2 ). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalities of the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). CONCLUSIONS Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.
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Affiliation(s)
- Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Limin Wang
- School of Nursing, Peking University, Beijing, China
| | - Yanhu Lu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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14
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Di Stefano AB, Massihnia D, Grisafi F, Castiglia M, Toia F, Montesano L, Russo A, Moschella F, Cordova A. Adipose tissue, angiogenesis and angio-MIR under physiological and pathological conditions. Eur J Cell Biol 2019; 98:53-64. [DOI: 10.1016/j.ejcb.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/06/2023] Open
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15
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Li X, Qie S, Wang X, Zheng Y, Liu Y, Liu G. The safety and efficacy of once-weekly glucagon-like peptide-1 receptor agonist semaglutide in patients with type 2 diabetes mellitus: a systemic review and meta-analysis. Endocrine 2018; 62:535-545. [PMID: 30101378 DOI: 10.1007/s12020-018-1708-z] [Citation(s) in RCA: 15] [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: 04/19/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the safety and efficacy of once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide as monotherapy or add-on to other antihyperglycaemic agents (AHAs) in patients with type 2 diabetes mellitus (T2DM). METHODS PubMed, Embase, Cochrane library and ClinicalTrials.gov were searched from the inception to January 18, 2018. Randomised controlled trials (RCTs) comparing semaglutide with placebo or other AHAs in T2DM patients were included in our meta-analysis. Risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) were used to evaluate the outcomes. RESULTS A total of 11 studies with 9519 patients were included in our meta-analysis. The results revealed that compared with placebo or other AHAs, semaglutide had further reduced the level of haemoglobin A1c (HbA1c) [MD 1.03%, 95% CI (0.85%, 1.22%), p < 0.00001], self-measured plasma glucose (SMPG) [MD 1.19 mmol/L, 95% CI (0.84 mmol/L, 1.53 mmol/L), p < 0.00001], fasting plasma glucose (FPG) [MD 1.33 mmol/L, 95% CI (0.97 mmol/L, 1.69 mmol/L), p < 0.00001] and weight [MD 3.61 kg, 95% CI (3.05 kg, 4.17 kg), p < 0.00001] and significantly increased participants who achieved HbA1c < 7.0% [RR 2.26, 95% CI (1.89, 2.70), p < 0.00001] in T2DM patients. Semaglutide had a significant increase in the incidence of adverse events (AEs) [RR 1.06, 95% CI (1.02, 1.11), p < 0.0001] and an analogous incidence in serious adverse events (SAEs) [RR 0.94, 95% CI (0.86, 1.02), p = 0.11] and hypoglycaemic events (severe or blood glucose (BG)-confirmed symptomatic) [RR 0.93, 95% CI (0.74, 1.16), p = 0.50] compared with the control group. CONCLUSIONS This article revealed that semaglutide had a favourable efficacy and safety in treating T2DM patients. It maybe a superior choice for T2DM patients who have obesity or a poor adherence to daily AHAs.
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Affiliation(s)
- Xuejing Li
- Department of Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, 050051, Shijiazhuang, Hebei Province, China
| | - Suhui Qie
- Department of Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, 050051, Shijiazhuang, Hebei Province, China
| | - Xianying Wang
- Department of Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, 050051, Shijiazhuang, Hebei Province, China
| | - Yingying Zheng
- Department of Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, 050051, Shijiazhuang, Hebei Province, China
| | - Yang Liu
- Department of Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, 050051, Shijiazhuang, Hebei Province, China
| | - Guoqiang Liu
- Department of Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, 050051, Shijiazhuang, Hebei Province, China.
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