1
|
Khalil SHA, Khaled M, Zakhary R, Shereen M. The Rate of Insulin use and Suboptimal Glycemic Control among Egyptian Patients with T2DM: Cohort Analysis of Eighth Wave of the International Diabetes Management Practices Study (IDMPS). Curr Diabetes Rev 2024; 20:e020623217590. [PMID: 37264625 PMCID: PMC10909816 DOI: 10.2174/1573399820666230602100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/03/2023]
Abstract
AIMS The International Diabetes Management Practices Study (IDMPS) is an international annual survey aiming to study and characterize the current standards of care for managing DM in developing countries. BACKGROUND In Egypt, DM represents a substantial burden on the healthcare system, with an estimated 10.9 million patients, ranking it 10th amongst countries with the highest prevalence of DM. Previous studies showed that to maintain safety and achieve treatment goals among diabetic patients, optimal insulin therapy should be selected individually based on the patient's needs. We reported the proportion of Egyptian T2DM patients on insulin therapy who participated in the eighth wave of the IDMPS. METHODS The 2018 IDMPS wave consisted of cross-sectional and longitudinal phases and aimed to evaluate the proportion of T2DM who were on insulin therapy in 13 countries from four regions. In Egypt, 17 physicians agreed to participate in the present study and were required to include at least one patient. RESULTS A total of 180 T2DM patients were included in the cross-section phase. At the end of the ninth month of follow-up, data from 170 T2DM patients were available. A total of 39 T2DM patients (21.7%) were on insulin therapy, with a mean duration of 32.4 ± 36.6 months. More than half of the patients (n = 22; 56.4%) were on basal insulin, mainly long-acting (n = 20; 90.9%). The mean basal insulin daily dose was 0.3 ± 0.1 IU/Kg. Notably, 28.2% of the patients received insulin via vials, and 46.2% stated that they were adjusting the insulin dose by themselves. On the other hand, 60.2% of the study population was on oral antidiabetic drugs at the cross-sectional phase. Nearly 17.4% and 27% of the patients in the cross-sectional phase achieved the glycemic target per recommendations of international guidelines and the treating physicians, respectively. At the end of the longitudinal phase, the percentage of T2DM patients who achieved glycemic targets increased to 38.4% and 77.4% as per recommendations of international guidelines and the treating physicians, respectively. Overall, 38.3% of T2DM patients received diabetes education, and 28.9% were involved in an educational program provided by the physician or their clinical staff. Besides, 85.5% of T2DM patients followed their diabetes medication dosage and frequency strictly as prescribed. CONCLUSION The proportion of insulin use in patients with T2DM aligned with the previous studies from different countries; however, it is still inadequate to achieve the targeted glycemic control. Nearly one-third of Egyptian patients received diabetes education, highlighting the need for adopting a national educational program. Nonetheless, the level of adherence among T2DM from Egypt appears to be high.
Collapse
Affiliation(s)
- Samir Helmy Assaad Khalil
- Department of Internal Medicine, Unit of Diabetology, Lipidology & Metabolism, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohsen Khaled
- Diabetes and Endocrinology Department, National Institute of Diabetes and Endocrinology, Cairo, Egypt
| | - Raafat Zakhary
- Consultant of Diabetes and Internal Medicine, Alexandria University, Alexandria, Egypt
| | - Mark Shereen
- Department of Medical Affairs, Sanofi, Cairo, Egypt
| |
Collapse
|
2
|
Pitak P, Tasai S, Kumpat N, Na Songkla P, Fuangchan A, Krass I, Dhippayom T. The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis. Public Health 2023; 225:218-228. [PMID: 37939463 DOI: 10.1016/j.puhe.2023.10.015] [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: 04/06/2023] [Revised: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package). RESULTS A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control. CONCLUSIONS This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.
Collapse
Affiliation(s)
- P Pitak
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Clinical Department, Nan Hospital, Nan, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Science, Naresuan University, Phitsanulok, Thailand
| | - S Tasai
- Inventory Department, Ramathibodi Hospital, Bangkok, Thailand
| | - N Kumpat
- Clinical Department, Wisetchaichan Hospital, Angthong, Thailand
| | - P Na Songkla
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - A Fuangchan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - I Krass
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - T Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Science, Naresuan University, Phitsanulok, Thailand.
| |
Collapse
|
3
|
Ratzki-Leewing A, Black JE, Kahkoska AR, Ryan BL, Zou G, Klar N, Timcevska K, Harris SB. Severe (level 3) hypoglycaemia occurrence in a real-world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States). Diabetes Obes Metab 2023; 25:3736-3747. [PMID: 37700692 PMCID: PMC10958739 DOI: 10.1111/dom.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
AIMS Among adults with insulin- and/or secretagogue-treated diabetes in the United States, very little is known about the real-world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. MATERIALS AND METHODS iNPHORM is a US-wide, 12-month ambidirectional panel survey (2020-2021). Adults with type 1 diabetes mellitus (T1DM) or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T2DM) were recruited from a probability-based internet panel. Participants completing ≥1 follow-up questionnaire(s) were analysed. RESULTS Among 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12-month prospective period, one-third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%-51.8%); T2DM 30.8% (95% CI 28.7%-35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15-6.05) events per person-year (EPPY) [T1DM 3.57 (95% CI 2.49-5.11) EPPY; T2DM 5.29 (95% CI 4.26-6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non-transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants. CONCLUSIONS iNPHORM is one of the first long-term, prospective US-based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant-reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.
Collapse
Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason E. Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine/Division of Endocrinology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
4
|
Nocturnal Hypoglycaemia in Patients with Diabetes Mellitus: Database Analysis of a Cohort Using Telemedicine Support for Self-Monitoring of Blood Glucose over a 10-Year-Long Period. MEDICINA-LITHUANIA 2021; 57:medicina57020167. [PMID: 33672913 PMCID: PMC7918473 DOI: 10.3390/medicina57020167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/09/2023]
Abstract
Background and Objectives: In patients with diabetes mellitus, hypoglycaemic episodes, especially during night hours, carry a significant risk. Data about the occurrence of nocturnal hypoglycaemia in real-world settings are of clinical importance. The aim of our study was to evaluate the occurrence of nocturnal hypoglycaemia among patients with diabetes using self-monitoring of blood glucose (SMBG) with telemedicine support. Materials and Methods: We retrospectively analysed the central database of an internet-based supportive system between 2010 and 2020 when 8190 SMBG users uploaded nearly 10 million capillary blood glucose values. Nocturnal hypoglycaemia was defined as capillary blood glucose < 3.0 mmol/L measured between 00:00 and 05:59 h. Results: The database contained 914,146 nocturnal blood glucose values from 7298 users; 24,623 (2.7%) glucose values were below the hypoglycaemic threshold and 2363 patients (32.4%) had at least one hypoglycaemic glucose value. Nocturnal hypoglycaemia was more often found in patients with type 1 vs. type 2 diabetes (n = 1890 (80.0%) vs. n = 387 (16.4%), respectively). Hypoglycaemic blood glucose values were most frequently observed in the age group of 10.0–19.9 years (n = 481 (20.4%)). Patients with nocturnal hypoglycaemia were mostly on insulin treatment (1854 (78.5%) patients with 20,727 (84.1%) hypoglycaemic glucose values). Only 356 patients (15.1%) with nocturnal hypoglycaemia performed a retest within 120 min. Within a one-day-long (1440 min) timeframe, the elapsed median time until a retest, yielding a safe blood glucose value (>3.9 mml/L), was 273 min (interquartile range: 157–300 min). Conclusions: Nocturnal hypoglycaemia should be considered as a persisting challenge to antihyperglycaemic treatment in patients living with diabetes. Continuous efforts are needed to improve both antihyperglycaemic treatment and patient education for preventing nocturnal hypoglycaemia, and to act adequately if hypoglycaemic values are detected.
Collapse
|
5
|
Xu Y, Wang T, Yang Z, Lin H, Shen P, Zhan S. Sulphonylureas monotherapy and risk of hospitalization for heart failure in patients with type 2 diabetes mellitus: A population-based cohort study in China. Pharmacoepidemiol Drug Saf 2020; 29:635-643. [PMID: 32383226 DOI: 10.1002/pds.5024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/19/2019] [Accepted: 04/19/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The risk of heart failure associated with sulphonylureas is unclear. We evaluated the association between sulphonylureas and hospitalization of heart failure (HHF) in patients with type 2 diabetes mellitus (T2DM) in China. METHODS A retrospective cohort study was implemented using the Yinzhou Regional Health Care Database (YRHCD). We identified 15 752 adult patients with T2DM who were newly exposed to sulphonylurea monotherapy (N = 12 487) or acarbose monotherapy (N = 3265) from January 2010 to September 2016. Cox proportional hazards models weighted by inverse probability of treatment weights were used to compare the risk of HHF between initiators of sulphonylurea and acarbose. RESULTS During a median follow-up of 0.55 (0.49, 1.11) and 0.49 (0.35, 0.70) years for sulphonylureas and acarbose initiators separately, 320 patients developed HHF, with 279 events in sulphonylureas group, and 41 events in acarbose group. The incidence rates of HHF among sulphonylureas initiators and acarbose initiators were 22.2 (95% CI 19.6-24.9) and 18.3 (95% CI 13.2-24.9) per 1000 person-years, respectively. The adjusted hazard ratio (aHR) of HHF for sulphonylureas vs acarbose was 1.61 (95% CI 1.14-2.27). When stratified by history of heart failure, aHR was 1.55 (95% CI 0.79-3.06) in patients with a history of heart failure, and 1.64 (95% CI 1.10-2.45) in patients with no history of heart failure. CONCLUSIONS Our study suggested that use of sulphonylureas monotherapy compared with acarbose monotherapy for initial treatment of T2DM for approximately 0.5 years are significantly associated with a higher risk of HHF.
Collapse
Affiliation(s)
- Yang Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Tiansheng Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zhirong Yang
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
6
|
Assessing the Burden of Type 2 Diabetes in China Considering the Current Status-Quo Management and Implications of Improved Management Using a Modeling Approach. Value Health Reg Issues 2019; 18:36-46. [DOI: 10.1016/j.vhri.2018.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/17/2018] [Accepted: 08/17/2018] [Indexed: 01/07/2023]
|
7
|
Pedersen‐Bjergaard U, Alsifri S, Aronson R, Berković MC, Galstyan G, Gydesen H, Lekdorf JB, Ludvik B, Moberg E, Ramachandran A, Khunti K. Comparison of the HAT study, the largest global hypoglycaemia study to date, with similar large real-world studies. Diabetes Obes Metab 2019; 21:844-853. [PMID: 30456887 PMCID: PMC6590793 DOI: 10.1111/dom.13588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
Abstract
AIMS Optimal diabetes care requires clear understanding of the incidence of hypoglycaemia in real-world clinical practice. Current data on hypoglycaemia are generally limited to those reported from randomised controlled clinical trials. The Hypoglycaemia Assessment Tool (HAT) study, a non-interventional real-world study of hypoglycaemia, assessed hypoglycaemia in 27 585 individuals across 24 countries. The present study compared the incidence of hypoglycaemia from the HAT study with other similarly designed, large, real-world studies. MATERIALS AND METHODS A literature search of PubMed (1995-2017) for population-based studies of insulin-treated patients with type 1 or type 2 diabetes (T1D, T2D), excluding clinical trials and reviews, identified comparable population-based studies reporting the incidence of hypoglycaemia. RESULTS The 24 comparative studies, including more than 24 000 participants with T1D and more than 160 000 participants with T2D, varied in design, size, inclusion criteria, definitions of hypoglycaemia and method of recording hypoglycaemia. Reported rates (events per patient-year [PPY]) of hypoglycaemia were higher in patients with T1D than in those with T2D (overall T1D, 21.8-73.3 and T2D, 1.3-37.7; mild/non-severe T1D, 29.0-126.7 and T2D, 1.3-41.5; severe T1D, 0.7-5.8 and T2D, 0.0-2.5; nocturnal T1D, 2.6-11.3 and T2D, 0.38-9.7) and were similar to the ranges found in the HAT study. CONCLUSIONS The HAT data on hypoglycaemia incidence were comparable with those from other real-world studies and indicate a high incidence of hypoglycaemia among insulin-treated patients. Differences in rates among studies are mostly explained by differences in patient populations and study methodology. The goal of reducing hypoglycaemia should be a target for continued educational and evidence-based pharmacological interventions.
Collapse
Affiliation(s)
| | | | - Ronnie Aronson
- Endocrinology and MetabolismLMC Diabetes and EndocrinologyTorontoOntarioCanada
| | | | | | | | | | - Bernhard Ludvik
- Division of Endocrinology and MetabolismRudolfstiftung Hospital and Karl‐Landsteiner InstituteViennaAustria
| | | | | | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| |
Collapse
|
8
|
Andrade EF, de Oliveira Silva V, Orlando DR, Pereira LJ. Mechanisms Involved in Glycemic Control Promoted by Exercise in Diabetics. Curr Diabetes Rev 2019; 15:105-110. [PMID: 29446746 DOI: 10.2174/1573399814666180214144717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Diabetes mellitus is a metabolic disease characterized by high glycemic levels for long periods. This disease has a high prevalence in the world population, being currently observed an increase in its incidence. This fact is mainly due to the sedentary lifestyle and hypercaloric diets. Non-pharmacological interventions for glycemic control include exercise, which promotes changes in skeletal muscle and adipocytes. Thus, increased glucose uptake by skeletal muscle and decreased insulin resistance through modulating adipocytes are the main factors that improve glycemic control against diabetes. CONCLUSION It was sought to elucidate mechanisms involved in the improvement of glycemic control in diabetics in front of the exercise.
Collapse
Affiliation(s)
| | | | - Débora Ribeiro Orlando
- Department of Agricultural Sciences, Federal University of Jequitinhonha and Mucuri Valleys, Unai, Brazil
| | | |
Collapse
|
9
|
Chen SY, Hsu HC, Wang RH, Lee YJ, Hsieh CH. Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes: Empowerment Perceptions and Diabetes Distress as Important Determinants. Biol Res Nurs 2018; 21:182-189. [PMID: 30585081 DOI: 10.1177/1099800418820170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this cross-sectional study was to explore the determinants of hemoglobin A1c (HbA1c) levels in insulin-treated patients with Type 2 diabetes mellitus (T2DM) based on demographic and disease characteristics, self-reported regimen adherence factors (adherence in insulin regimen and self-monitoring of blood glucose), and psychosocial factors (decisional balance for insulin injection, health literacy, self-efficacy for insulin injection, diabetes distress, and empowerment perceptions). Via convenience sampling, 255 insulin-treated patients with T2DM were recruited from two endocrinology clinics in Taiwan. A self-report questionnaire was used to collect demographic and disease characteristics, regimen adherence factors, and psychosocial factors. The first HbA1c level measured after completion of the questionnaire was the dependent variable. The last HbA1c level measured before patients started insulin therapy as well as body mass index (BMI) was collected from medical records. Results indicated that adherence in insulin regimen was relatively good. Regimen adherence factors did not significantly correlate with HbA1c levels, but empowerment perception, decisional balance for insulin injection, health literacy, and diabetes distress did. The hierarchical multiple regression models indicated that BMI, the last HbA1c levels before starting insulin therapy, empowerment perception, and diabetes distress were important determinants of HbA1c levels. Nurses could periodically assess the diabetes distress of insulin-treated patients with T2DM and refer to mental health professionals when needed. Furthermore, applying empowerment approaches such as enhancing self-awareness of improved glycemic control and sharing more decision-making power with insulin-treated patients with T2DM might have benefits for their glycemic control.
Collapse
Affiliation(s)
- Shi-Yu Chen
- 1 Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Hui-Chun Hsu
- 2 Lee's Endocrinology Clinic, Pingtung City, Taiwan
| | - Ruey-Hsia Wang
- 3 College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,4 Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Chang-Hsun Hsieh
- 1 Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| |
Collapse
|
10
|
Wang L, Ye Q, Nielsen OK, Gadegaard A, Valentine WJ, Hunt B, Wang L. Evaluation of the Long-Term Impact of Improving Care for People with Type 2 Diabetes in China. Value Health Reg Issues 2018; 15:169-174. [PMID: 29754037 DOI: 10.1016/j.vhri.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/05/2018] [Accepted: 03/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The member states of the United Nations launched 17 sustainable development goals (SDGs) as part of the 2030 Sustainable Development Agenda. SDG target 3.4 focused on reducing premature mortality from noncommunicable diseases by one-third by 2030 through prevention and treatment and promoting mental health and well-being. Diabetes is associated with significant clinical and economic burden in China. OBJECTIVES To examine the impact of improving care for people with diabetes in China, and how this relates to achieving SDG target 3.4. METHODS Long-term outcomes were projected for people with type 2 diabetes meeting treatment targets recommended by the Chinese Diabetes Society versus remaining at current care. Baseline characteristics were taken from the China Noncommunicable Disease Surveillance Study. Costs of treating diabetes-related complications were accounted in 2015 Chinese yuan (CNY). Outcomes were discounted at 3% annually when appropriate. RESULTS Bringing people with diabetes to treatment targets was associated with improved mean undiscounted life expectancy compared with current care (by 0.42 years). Nationally, discounted cost savings of up to CNY540 billion could be generated as a result of reduced onset of diabetes-related complications if all people with diabetes achieved treatment targets. Bringing people to treatment targets reduced premature mortality from diabetes by 6% compared with current care. CONCLUSIONS Long-term projections suggested that bringing people with diabetes to treatment targets resulted in improved life expectancy and significant cost savings. However, this was not sufficient to meet SDG target 3.4, indicating that diabetes prevention should form a key objective in China.
Collapse
Affiliation(s)
- Limin Wang
- National Center for Chronic and Noncommunicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qing Ye
- Novo Nordisk A/S, Copenhagen, Denmark
| | | | | | | | - Barnaby Hunt
- Ossian Health Economics and Communications GmbH, Basel, Switzerland.
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
11
|
Yigazu DM, Desse TA. Glycemic control and associated factors among type 2 diabetic patients at Shanan Gibe Hospital, Southwest Ethiopia. BMC Res Notes 2017; 10:597. [PMID: 29141693 PMCID: PMC5688756 DOI: 10.1186/s13104-017-2924-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/09/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the rate of glycemic control and factors affecting glycemic control in type 2 diabetic patients. RESULTS A total of 174 type 2 diabetic patients were interviewed and were studied. Mean age of the patients was 48.98 ± 14.96 years (range 18-80 years). More than half (51.7%) of the patients were males. About a third of patients, 53 (30.5%), were on antidiabetic medications for less than 5 years. The most common prescribed antidiabetic medications were insulin, 48 (27.6%), and metformin 15 (8.6%). One hundred seven (61.5%) patients were on combination therapy (two drug treatment) and the remaining patients were on monotherapy. The majority, 103 (59.2%), of patients had uncontrolled blood glucose. A larger proportion of female patients, 54 (52.4%), had uncontrolled blood glucose than males. Level of education (p < 0.001) and duration of diabetes treatment (p < 0.001) were significantly associated with glycemic control. Adherence of patients to regular follow up (Adjusted Odds Ratio (AOR) = 2.42, 95% CI 1.08-5.44, p = 0.03) and diabetes treatment for 5-10 years (AOR = 4.64, 95% CI 1.79-12.06, p = 0.002) are found to be independent predictors of glycemic control among type 2 diabetes patients.
Collapse
Affiliation(s)
- Daniel Miteku Yigazu
- School of Pharmacy, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tigestu Alemu Desse
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
12
|
Noor SK, Elmadhoun WM, Bushara SO, Almobarak AO, Salim RS, Forawi SA, Awadallah H, Elwali ES, Ahmed MH. Glycaemic control in Sudanese individuals with type 2 diabetes: Population based study. Diabetes Metab Syndr 2017; 11 Suppl 1:S147-S151. [PMID: 28034691 DOI: 10.1016/j.dsx.2016.12.024] [Citation(s) in RCA: 21] [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: 10/31/2016] [Accepted: 12/12/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study was to determine the prevalence of glycaemic control among individuals with type 2 diabetes across different cities in Sudan. METHODS Individuals with type 2 diabetes attending selected diabetes centres in Sudan, who had been on treatment for DM for at least one year and volunteered to participate were included. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic and life style characteristics. Lipid profile and glycosylated hemoglobin were tested by calibrated laboratory methods. Blood pressure, Body mass index (BMI) and waist circumference were measured. Chi squared and logistic regression were used as statistical methods. RESULTS A total of 387 individuals with T2DM were included in this study (50.4% males and 49.6% females). The glycemic control indicator (HbAIc>7) was poor in 85% of patients. Factors associated with poor glycemic control were prolonged duration of diabetes (p=0.03), high plasma triglyceride (p=0.02), low high density lipoprotein (HDL) level (p=0.04) and low glomerular filtration rate (GFR) (P=0.01). Logistic regression analysis showed that low GFR is independent factor with poor diabetes control. CONCLUSION High prevalence of uncontrolled diabetes (85%) is noted in Sudanese individuals with type 2 diabetes.
Collapse
Affiliation(s)
- Sufian K Noor
- Department of Medicine, Nile Valley University, Atbara, Sudan
| | | | - Sarra O Bushara
- Department of Medicine, Nile Valley University, Atbara, Sudan
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Reham S Salim
- Public and Tropical Health Program, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Sittana A Forawi
- Public and Tropical Health Program, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Heitham Awadallah
- Department of community medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Einas S Elwali
- Public and Tropical Health Program, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK.
| |
Collapse
|
13
|
Shu H, Gu LN, Men LC, Lu JM. Lixisenatide Improves Glycemic Control in Asian Type 2 Diabetic Patients Inadequately Controlled With Oral Antidiabetic Drugs: An Individual Patient Data Meta-Analysis. Diabetes Ther 2016; 7:777-792. [PMID: 27796905 PMCID: PMC5118245 DOI: 10.1007/s13300-016-0207-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Lixisenatide is a novel GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus (T2DM). Its efficacy and safety have been assessed in a series of phase 3 studies included in the GetGoal program. In these studies, lixisenatide was found to be superior to placebo in glycemic control. The aim of this meta-analysis was to assess the safety and efficacy of lixisenatide as an adjunct therapy in Asian patients with T2DM in adequately controlled with oral antidiabetic drugs (OADs). METHODS We performed a meta-analysis from five lixisenatide phase 3 studies. In each of these multiethnic studies, patients with T2DM inadequately controlled (glycated hemoglobin, HbA1c ≥7%) with established OADs were randomized to lixisenatide or placebo for 24 weeks, with a balanced distribution of Asian patients in these two arms (503 and 338 patients in the intent-to-treat population, respectively). RESULTS Lixisenatide was superior to placebo in reducing HbA1c (weighted, total mean difference -0.57%; P = 0.002). More patients treated with lixisenatide versus placebo achieved HbA1c targets of ≤7% (49.1% vs. 28.4%, P = 0.003). Lixisenatide was superior to placebo in lowering 2-h postprandial glucose (PPG) (weighted, total mean difference -5.50 mmol/l, P = 0.0005). More patients treated with lixisenatide versus placebo achieved 2-h PPG targets of ≤7.8 mmol/l (39.2% vs. 2.2%, P < 0.0001). More patients treated with lixisenatide versus placebo achieved both an HbA1c target of ≤7% and a 2-h PPG target of ≤10 mmol/l (34.8% vs. 2.69%, P < 0.00001). The body weight of the lixisenatide group tended to decrease. Lixisenatide was generally well tolerated. CONCLUSION Lixisenatide as an adjunct therapy can significantly improve the glycemic control of Asian patients with type 2 DM who do not meet targets for glycemic control with an established OAD regimen. FUNDING Sanofi (China) Investment Co., Ltd., Shanghai, China.
Collapse
Affiliation(s)
- Hua Shu
- Department of Endocrinology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Li-Na Gu
- Sanofi (China) Investment Co., Ltd., 19F Tower III Kerry Center, 1228 Middle Yan'an Road, Shanghai, China
| | - Li-Chuang Men
- Sanofi (China) Investment Co., Ltd., 19F Tower III Kerry Center, 1228 Middle Yan'an Road, Shanghai, China
| | - Ju-Ming Lu
- Department of Endocrinology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
| |
Collapse
|
14
|
Yang W, Yang Z, Zhao J, Lu H, Luo T. Assessment of three fasting plasma glucose targets for insulin glargine-based therapy in people with type 2 diabetes mellitus in China: study protocol for a randomized controlled trial. Trials 2016; 17:470. [PMID: 27669747 PMCID: PMC5037905 DOI: 10.1186/s13063-016-1588-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background A large proportion of patients with T2DM in China do not meet accepted HbA1c targets despite the availability of guidelines that describe a treatment pathway for achieving glycemic control. The aim of this study is to identify the fasting plasma glucose (FPG) target that will provide the highest control rate of HbA1c <7 % in Chinese patients with T2DM treated with an insulin glargine-based regimen as an adjunct to an established OAD regimen. This information will support improvements in diabetes care management in China. Methods Approximately 934 men and women aged ≥18 to ≤65 years with poorly controlled T2DM will be enrolled and randomized to one of three FPG target groups; ≤5.6 mmol/L, ≤6.1 mmol/L, or ≤7.0 mmol/L. They will be initiated on daily insulin glargine (Lantus®) in addition to their usual OAD regimen for 24 weeks. Patients will self-monitor fasting blood glucose (SM-FBG), and the study physician will titrate the basal insulin dose according to the SM-FBG results. In addition, HbA1c and safety will be recorded. We plan to statistically derive the optimal FPG target for an HbA1c of <7 %. Discussion In China, treatment strategies that would achieve an optimum balance between glycemic control (as per HbA1c) and hypoglycemia are imperative to ensure improvements in the management of T2DM. Furthermore, elucidating the contribution of FPG to HbA1c in Chinese patients with T2DM and identifying a predictable relationship between FPG and HbA1c would be a valuable tool for patient self-management of diabetes. Trial registration NCT02545842. Registered on 8 September 2015.
Collapse
Affiliation(s)
- Wenying Yang
- China-Japan Friendship Hospital, East Yinghuayuan Street, Hepingli, Beijing, 100029, People's Republic of China.
| | - Zhaojun Yang
- China-Japan Friendship Hospital, East Yinghuayuan Street, Hepingli, Beijing, 100029, People's Republic of China
| | - Jing Zhao
- Jing'An Kerry Centre, 19F, Tower III, No.1228M, Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Hai Lu
- Jing'An Kerry Centre, 19F, Tower III, No.1228M, Yan'an Road, Shanghai, 200040, People's Republic of China
| | - Tianhong Luo
- Jing'An Kerry Centre, 19F, Tower III, No.1228M, Yan'an Road, Shanghai, 200040, People's Republic of China
| |
Collapse
|