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Garibotto G, Russo E, Viazzi F, Moore LW. Hypoglycemia in Patients With End-Stage Kidney Disease. J Ren Nutr 2024; 34:187-191. [PMID: 38718929 DOI: 10.1053/j.jrn.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
- Giacomo Garibotto
- Department of Internal Medicine, University of Genova, Genoa, Italy.
| | - Elisa Russo
- Department of Internal Medicine, University of Genova, Italy; Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, Italy; Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Sloan L, Cheng AYY, Escalada J, Haluzík M, Mauricio D. The role of basal insulins in the treatment of people with type 2 diabetes and chronic kidney disease: A narrative review. Diabetes Obes Metab 2024; 26:1157-1170. [PMID: 38225217 DOI: 10.1111/dom.15425] [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: 05/25/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
The majority of cases of chronic kidney disease (CKD) worldwide are driven by the presence of type 2 diabetes (T2D), resulting in an increase in CKD rates over the past few decades. The existence of CKD alongside diabetes is associated with increased burden of cardiovascular disease and increased risk of death. Optimal glycaemic control is essential to prevent progression of CKD, but achieving glycaemic targets in people with CKD and diabetes can be challenging because of increased risk of hypoglycaemia and limitations on glucose-lowering therapeutic options. This review considers the challenges in management of T2D in people with impaired kidney function and assesses evidence for use of basal insulin analogues in people with CKD.
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Affiliation(s)
- Lance Sloan
- Texas Institute for Kidney and Endocrine Disorders, Lufkin, Texas, USA
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Alice Y Y Cheng
- Trillium Health Partners & Unity Health, University of Toronto, Toronto, Ontario, Canada
| | - Javier Escalada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Center for Biomedical Research in Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, CIBERDEM, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Faculty of Medicine, University of Vic (UVIC/UCC), Vic, Spain
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Rossing P, Bain SC, Bosch-Traberg H, Sokareva E, Heerspink HJL, Rasmussen S, Mellbin LG. Effect of semaglutide on major adverse cardiovascular events by baseline kidney parameters in participants with type 2 diabetes and at high risk of cardiovascular disease: SUSTAIN 6 and PIONEER 6 post hoc pooled analysis. Cardiovasc Diabetol 2023; 22:220. [PMID: 37620807 PMCID: PMC10463803 DOI: 10.1186/s12933-023-01949-7] [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: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Semaglutide is a glucose-lowering treatment for type 2 diabetes (T2D) with demonstrated cardiovascular benefits; semaglutide may also have kidney-protective effects. This post hoc analysis investigated the association between major adverse cardiovascular events (MACE) and baseline kidney parameters and whether the effect of semaglutide on MACE risk was impacted by baseline kidney parameters in people with T2D at high cardiovascular risk. METHODS Participants from the SUSTAIN 6 and PIONEER 6 trials, receiving semaglutide or placebo, were categorised according to baseline kidney function (estimated glomerular filtration rate [eGFR] < 45 and ≥ 45-<60 versus ≥ 60 mL/min/1.73 m2) or damage (urine albumin:creatinine ratio [UACR] ≥ 30-≤300 and > 300 versus < 30 mg/g). Relative risk of first MACE by baseline kidney parameters was evaluated using a Cox proportional hazards model. The same model, adjusted with inverse probability weighting, and a quadratic spline regression were applied to evaluate the effect of semaglutide on risk and event rate of first MACE across subgroups. The semaglutide effects on glycated haemoglobin (HbA1c), body weight (BW) and serious adverse events (SAEs) across subgroups were also evaluated. RESULTS Independently of treatment, participants with reduced kidney function (eGFR ≥ 45-<60 and < 45 mL/min/1.73 m2: hazard ratio [95% confidence interval]; 1.36 [1.04;1.76] and 1.52 [1.15;1.99]) and increased albuminuria (UACR ≥ 30-≤300 and > 300 mg/g: 1.53 [1.14;2.04] and 2.52 [1.84;3.42]) had an increased MACE risk versus those without. Semaglutide consistently reduced MACE risk versus placebo across all eGFR and UACR subgroups (interaction p value [pINT] > 0.05). Semaglutide reduced HbA1c regardless of baseline eGFR and UACR (pINT>0.05); reductions in BW were affected by baseline eGFR (pINT<0.001) but not UACR (pINT>0.05). More participants in the lower eGFR or higher UACR subgroups experienced SAEs versus participants in reference groups; the number of SAEs was similar between semaglutide and placebo arms in each subgroup. CONCLUSIONS MACE risk was greater for participants with kidney impairment or damage than for those without. Semaglutide consistently reduced MACE risk across eGFR and UACR subgroups, indicating that semaglutide provides cardiovascular benefits in people with T2D and at high cardiovascular risk across a broad spectrum of kidney function and damage. TRIAL REGISTRATIONS NCT01720446; NCT02692716.
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Ushiogi Y, Kanehara H, Kato T. Frequency of Hypoglycemia Assessed by Continuous Glucose Monitoring in Advanced CKD. Clin J Am Soc Nephrol 2023; 18:475-484. [PMID: 36723294 PMCID: PMC10103209 DOI: 10.2215/cjn.0000000000000102] [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: 07/29/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypoglycemia represents a risk for serious morbidity. We evaluated the prevalence and risk factors of hypoglycemia by continuous glucose monitoring (CGM) in patients with CKD with or without diabetes. METHODS In this cross-sectional study, outpatients with CKD stages G3-G5 (including hemodialysis) and type 2 diabetes without CKD were enrolled and underwent intermittently scanned CGM measurements for 7 days. The burden of CGM-measured hypoglycemia was assessed using the 7-day sum of area over the curve with glucose levels <70 mg/dl and the sum of time spent <54 mg/dl. RESULTS A total of 366 participants (148 participants with CKD and diabetes, 115 with CKD and without diabetes, and 103 without CKD and with diabetes) were included. Glucose levels of <54 mg/dl were observed in 41% of participants with CKD and diabetes, 48% of participants with CKD and without diabetes, and 14% of participants with diabetes and without CKD. However, only two participants reported hypoglycemic symptoms during CGM measurements, which were confirmed and documented by capillary blood glucose measurements. Between-group differences of 7-day area over the curve (<70 mg/dl) were as follows: hemodialysis group versus CKD stage G4 and G5 groups, -0.25 min·mg/dl per hour (95% confidence interval [CI], -6.40 to -0.59) P <0.001; CKD stage G4 and G5 groups versus CKD stage G3 group, -0.08 min·mg/dl per hour (95% CI, -0.0 to -0.50) P =0.15; and CKD stage G3 group versus diabetes without CKD group, -0.14 min·mg/dl per hour (95% CI, -0.0 to -0.20) P =0.01. In addition, the subgroup analysis of the diabetic or nondiabetic and at daytime or nighttime showed that the 7-day area over the curve (<70 mg/dl) and time spent (<54 mg/dl) was larger with worse kidney function. CONCLUSIONS The lowering level of kidney function was strongly associated with the burden of hypoglycemia in patients with CKD.
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Affiliation(s)
- Yasuyuki Ushiogi
- Department of Nephrology, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Hideo Kanehara
- Department of Endocrinology, Diabetes and Metabolism, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Tamayo Kato
- Department of Nephrology, Fukui-ken Saiseikai Hospital, Fukui, Japan
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Nedyalkova M, Robeva R, Elenkova A, Simeonov V. Chemometric exploratory data analysis for patients with diabetes type 2 and diabetic complications. PHYSICAL SCIENCES REVIEWS 2022. [DOI: 10.1515/psr-2020-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The present study deals with the interpretation and modeling of clinical data for patients with diabetes mellitus type 2 (DMT2) additionally diagnosed with complications of the disease by the use of multivariate statistical methods. The major goal is to determine some specific clinical descriptors characterizing each health problem by applying the options of the exploratory data analysis. The results from the statistical analysis are commented in details by medical reasons for each of the complications. It was found that each of the complications is characterized by specific medical descriptors linked into each one of the five latent factors identified by factor and principal components analysis. Such an approach to interpret concomitant to DMT2 complications is original and allows a better understanding of the role of clinical parameters for diagnostic and prevention goals.
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Affiliation(s)
- Miroslava Nedyalkova
- Chair of General and Inorganic Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Okhridski”, 1 , J. Bourchier Blvd. , 1164 Sofia , Bulgaria
| | - Ralitsa Robeva
- USHATE “Acad. Iv. Penchev”, Department of Endocrinology , Medical Faculty, Medical University-Sofia , 2, Zdrave Str. , 1431 Sofia , Bulgaria
| | - Atanaska Elenkova
- USHATE “Acad. Iv. Penchev”, Department of Endocrinology , Medical Faculty, Medical University-Sofia , 2, Zdrave Str. , 1431 Sofia , Bulgaria
| | - Vasil Simeonov
- Chair of Analytical Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Okhridski”, 1 , J. Bourchier Blvd. , 1164 Sofia , Bulgaria
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Hirose N, Tsujimoto N, Katayose T, Chin R. Utilization of glucagon-like peptide-1 receptor agonists and changes in clinical characteristics in patients with type 2 diabetes by chronic kidney disease stage in Japan: A descriptive observational study using a nationwide electronic medical records database. Diabetes Obes Metab 2022; 24:486-498. [PMID: 34779098 PMCID: PMC9300085 DOI: 10.1111/dom.14600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/24/2023]
Abstract
AIM To describe the utilization of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and changes in clinical characteristics before and after GLP-1 RA initiation in patients with type 2 diabetes (T2D) by chronic kidney disease (CKD) stage. MATERIALS AND METHODS In this retrospective descriptive study using a nationwide electronic medical records database in Japan, we included patients with GLP-1 RA prescriptions from June 2010 to October 2019. Clinical characteristics at GLP-1 RA initiation, persistence proportion, and changes in clinical measurements after GLP-1 RA initiation were described for all patients and by CKD stage, defined by baseline estimated glomerular filtration rate (eGFR). RESULTS We included 8049 patients. During the study period, the proportion of patients with T2D initiating GLP-1 RAs increased from 1.5% in 2010 to 3.3% in 2019. Also, the mean (95% confidence interval) of baseline age and eGFR ranged from 58.6 (56.7-60.4) to 66.3 (65.5-67.2) years and from 72.9 (68.0-77.9) to 64.0 (62.2-65.8) mL/min/1.73m2 , respectively. The persistence proportion at 12 months was 49.5% overall, 37.8% in T2D patients with CKD with a baseline eGFR of less than 30 mL/min/1.73m2 , and 34.6% in those undergoing dialysis. The rate of deterioration in renal function reduced after GLP-1 RA initiation. CONCLUSIONS The utilization of GLP-1 RAs has been increasing over the past decade, and GLP-1 RAs have been used in patients with limited treatment options, such as the elderly or those with CKD. In T2D patients with CKD, the persistence proportion of GLP-1 RAs was not low, and the renal dysfunction may be moderated by GLP-1 RA initiation.
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Pieber TR, Bajaj HS, Heller SR, Jia T, Khunti K, Klonoff DC, Ladelund S, Leiter LA, Wagner L, Philis‐Tsimikas A. Impact of kidney function on the safety and efficacy of insulin degludec versus insulin glargine U300 in people with type 2 diabetes: A post hoc analysis of the CONCLUDE trial. Diabetes Obes Metab 2022; 24:332-336. [PMID: 34605127 PMCID: PMC9298323 DOI: 10.1111/dom.14564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Thomas R. Pieber
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | | | - Simon R. Heller
- Academic Unit of Diabetes, Endocrinology and MetabolismUniversity of SheffieldSheffieldUK
| | | | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - David C. Klonoff
- Diabetes Research InstituteMills‐Peninsula Medical CenterSan MateoCaliforniaUSA
| | | | - Lawrence A. Leiter
- Li Ka Shing Knowledge Institute, Division of Endocrinology & Metabolism, St Michael's HospitalUniversity of TorontoTorontoOntarioCanada
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León-Jiménez D, Miramontes-González JP, Márquez-López L, Astudillo-Martín F, Beltrán-Romero LM, Moreno-Obregón F, Escalada-San Martín J. Basal insulin analogues in people with diabetes and chronic kidney disease. Diabet Med 2022; 39:e14679. [PMID: 34449911 DOI: 10.1111/dme.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetic kidney disease is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide. ESKD has a high prevalence in patients with diabetes mellitus (DM). CKD increases the chances of hypoglycaemia by different mechanisms, causes insulin resistance and a decrease in insulin metabolism. Both the "Kidney Disease: Improving Global Outcomes" (KDIGO) and "American Diabetes Association" (ADA) guidelines recommend the use of insulin as part of treatment, but the type of basal insulin is not specified. METHODS We reviewed the literature to determine whether first- and second-generation basal insulins are effective and safe in CKD patients. We reviewed specific pivotal studies conducted by pharmaceutical laboratories, as well as independent studies. CONCLUSIONS Basal insulins are safe and effective in patients with CKD and diabetes mellitus but we do not have specific studies. Given that CKD is one of the main complications of type 2 DM, and insulin specific treatment in the final stages, the absence of studies is striking. Real-life data are also important since trials such as pivotal studies do not fully represent actual patients. Treatment should be individualized until we have specific trials in this type of population.
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Affiliation(s)
- David León-Jiménez
- Clinical Epidemiology and Vascular Unit, Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Instituto de Biomedicina de Sevilla (IBIS, Hospital Universitario Virgen del Rocío SAS/CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Pablo Miramontes-González
- Internal Medicine Unit, Facultad de Medicina, Hospital Universitario Río Hortega, Instituto De Investigaciones Biomédicas De Salamanca-IBSAL, Universidad de Valladolid, Valladolid, Spain
| | - Laura Márquez-López
- Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Luis M Beltrán-Romero
- Clinical Epidemiology and Vascular Unit, Internal Medicine, Clinical Unit for Comprehensive Medical Care (UCAMI), Instituto de Biomedicina de Sevilla (IBIS, Hospital Universitario Virgen del Rocío SAS/CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Javier Escalada-San Martín
- Department Of Endocrinology and Nutrition, Biomedical Research Networking Center For Physiopathology of Obesity and Nutrition (CIBERON), ISCIII, Diabetes and Metabolic Diseases Group, Clínica Universidad De Navarra, Instituto De Investigación Sanitaria De Navarra (IdiSNA), Pamplona, Spain
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Heller SR, Geybels MS, Iqbal A, Liu L, Wagner L, Chow E. A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study. Diabetologia 2022; 65:55-64. [PMID: 34704120 PMCID: PMC8660716 DOI: 10.1007/s00125-021-05556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/09/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
AIMS/HYPOTHESIS Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. METHODS LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. RESULTS We demonstrate that there is an association between NSHEs (2-11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2-11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). CONCLUSIONS/INTERPRETATION The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. TRIAL REGISTRATION ClinicalTrials.gov (NCT01179048).
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Affiliation(s)
- Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | | | - Ahmed Iqbal
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lei Liu
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Elaine Chow
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Hypoglykämien und kardiovaskuläres Risiko bei Typ-2-Diabetes. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Katsiki N, Kotsa K, Stoian AP, Mikhailidis DP. Hypoglycaemia and Cardiovascular Disease Risk in Patients with Diabetes. Curr Pharm Des 2021; 26:5637-5649. [PMID: 32912117 DOI: 10.2174/1381612826666200909142658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/09/2020] [Indexed: 12/12/2022]
Abstract
Hypoglycaemia represents an important side effect of insulin therapy and insulin secretagogues. It can occur in both type 1 and type 2 diabetes mellitus patients. Also, some associations between hypoglycaemia and cardiovascular (CV) risk have been reported. Several mechanisms may be involved, including the sympathoadrenal system, hypokalaemia, endothelial dysfunction, coagulation, platelets, inflammation, atherothrombosis and impaired autonomic cardiac reflexes. This narrative review discusses the associations of hypoglycaemia with CV diseases, including coronary heart disease (CHD), cardiac arrhythmias, stroke, carotid disease and peripheral artery disease (PAD), as well as with dementia. Severe hypoglycaemia has been related to CHD, CV and all-cause mortality. Furthermore, there is evidence supporting an association between hypoglycaemia and cardiac arrhythmias, potentially predisposing to sudden death. The data linking hypoglycaemia with stroke, carotid disease and PAD is limited. Several factors may affect the hypoglycaemia-CV relationships, such as the definition of hypoglycaemia, patient characteristics, co-morbidities (including chronic kidney disease) and antidiabetic drug therapy. However, the association between hypoglycaemia and dementia is bilateral. Both the disorders are more common in the elderly; thus, glycaemic goals should be carefully selected in older patients. Further research is needed to elucidate the impact of hypoglycaemia on CV disease.
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Affiliation(s)
- Niki Katsiki
- Division of Endocrinology and Metabolism, Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism, Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Anca P Stoian
- Diabetes, Nutrition and Metabolic diseases Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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12
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Song X, Li G, Zhu Y, Laukkanen JA. Glomerular Filtration Dysfunction is Associated with Cardiac Adverse Remodeling in Menopausal Diabetic Chinese Women. Clin Interv Aging 2021; 16:603-609. [PMID: 33883887 PMCID: PMC8055368 DOI: 10.2147/cia.s306342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Previous studies have showed that nephropathy was associated with cardiac structural changes and dysfunction among diabetic adults. However, information on the association of glomerular filtration dysfunction with the cardiac adverse remodeling is still limited in menopausal diabetic women. Therefore, we investigated whether impaired glomerular filtration function is associated with the cardiac adverse remodeling in menopausal Chinese women with type 2 diabetes mellitus (DM). Methods A total of 1231 hospitalized menopausal Chinese women with type 2 DM were collected retrospectively. The cross-sectional data of echocardiography were compared among estimated glomerular filtration rate (eGFR) categorized groups. Results In menopausal diabetic women, moderate to severe glomerular filtration dysfunction (eGFR <60 mL/min per 1.73m2) was found to be associated with enlarged left-side atrioventricular chambers, increased ventricular wall thickness, decreased cardiac function and dilated right ventricle (All P < 0.05). Conclusion Glomerular filtration dysfunction is associated with cardiac adverse structural remodeling and dysfunction in menopausal Chinese women with type 2 DM.
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Affiliation(s)
- Xing Song
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Gang Li
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuqi Zhu
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.,Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland
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Fadini GP, Disoteo O, Candido R, Di Bartolo P, Laviola L, Consoli A. Delphi-Based Consensus on Treatment Intensification in Type 2 Diabetes Subjects Failing Basal Insulin Supported Oral Treatment: Focus on Basal Insulin + GLP-1 Receptor Agonist Combination Therapies. Diabetes Ther 2021; 12:781-800. [PMID: 33550569 PMCID: PMC7947045 DOI: 10.1007/s13300-021-01012-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/23/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The aim of this study was to elaborate a consensus on treatment intensification strategies in patients with type 2 diabetes failing basal insulin supported oral therapy (BOT). The panel focused on glucagon-like peptide-1 receptor agonists (GLP-1RA) and basal insulin (BI) combinations. METHODS The authors developed a Delphi questionnaire organized into ten statements and 77 items that focused on: the definition of BOT and BOT failure, intensification strategies, fixed-dose combinations in general and the BI/GLP-1RA fixed combination. The survey was administered in two rounds to a panel of 80 Italian diabetes specialists, who rated their level of agreement with each item on a 5-point Likert scale. Consensus was predefined as > 66% of the panel agreeing/disagreeing on any given item. RESULTS Consensus was achieved for 71 of the 77 items. The panel agreed that the use of sulfonylureas in the BOT regimen is inappropriate. BOT failure was defined as individualized targets not being met for glycated hemoglobin, fasting plasma glucose and/or postprandial plasma glucose. There was agreement that postprandial hyperglycaemia and/or presence of nocturnal hypoglycaemia or weight gain define BOT failure. Addition of a GLP-1RA to BI therapy was considered to be the best option for BOT intensification. There was consensus for the use of BI/GLP-1RA fixed combinations as valuable options to increase compliance and safely improve glycaemic control. The panel agreed in considering the fixed-ratio combination insulin degludec/liraglutide (IDegLira) to be preferable to the fixed-ratio combination insulin glargine/lixisenatide (iGlarLixi) in the control of glycaemia, body weight and cardiovascular risk. CONCLUSION According to this Delphi consensus, the addition of a GLP-1RA may be the best option to intensify BOT. The BI/GLP-1RA fixed combinations may increase compliance and optimize the advantages of each of these molecules.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Padua, Italy.
| | - Olga Disoteo
- Diabetes Unit, SSD Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Candido
- Diabetes Center District 3, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Paolo Di Bartolo
- Ravenna Diabetes Clinic, Romagna Local Health Authority, Ravenna, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Transplants, University of Bari Aldo Moro, Bari, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences (DMSI) and Center for Research on Ageing and Translational Medicine (CeSI-Met), University of Chieti, Chieti, Italy
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Abstract
Chronic kidney disease (CKD) is characterized by increasing prevalence, catalyzing properties in relation to cardiovascular and general mortality, and, in most cases, is asymptomatic, which means late diagnostic verifiability. The global average prevalence of CKD is 13.4%, and CKD C3-5 is 10.6%. The main causes of CKD C5 are diabetes mellitus (DM, 46.9%), hypertension (28.8%) and to a lesser extent, glomerulonephritis (7.1%) and polycystic diseases (2.8%), while other causes account for a total of 14.4%. Despite the simple diagnosis of CKD, one of the key problems of modern therapeutic and pediatric clinics is its low detection rate at the early stages, which, according to some data, reaches 96.6%. This review provides data on the criteria for the diagnosis of CKD, as well as more detailed consideration of the course of CKD in patients with DM, hypertension, and heart failure. Attention is paid to the medicinal origin of CKD, as well as to the development of anxiety and depressive disorders in CKD. General issues of treatment of patients with CKD are considered in detail. Lifestyle changes are an important part of the fight against the development and progression of CKD. Currently, Smoking, alcohol, and physical inactivity have been shown to have a harmful effect on the risk of developing and progressing CKD. Diet plays a certain preventive role. The main drugs with nephroprotective properties are angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Both classes of drugs are effective in proteinuric forms of nephropathies and in combination/association of CKD with diabetes or hypertension. The review also provides data on the nephroprotective properties of mineralocorticoid receptor antagonists, endothelin receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Given the high importance of identifying and effectively treating patients with CKD, it is necessary to focus on early detection of CKD, especially in high-risk groups. It is necessary to raise public awareness by creating and implementing programs for primary prevention of CKD, as well as awareness of patients, motivating them to follow the doctor's recommendations for a long time, including as part of the implementation of a non-drug strategy to combat CKD. It is important to use the full range of methods of drug therapy for CKD, including measures of universal nephroprotection. It should be remembered that the cost of late diagnosis of CKD is a reduction in life expectancy, primarily due to high rates of cardiovascular mortality, disability, and high-cost medication and kidney replacement therapy.
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15
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Cheng AYY, Wong J, Freemantle N, Acharya SH, Ekinci E. The Safety and Efficacy of Second-Generation Basal Insulin Analogues in Adults with Type 2 Diabetes at Risk of Hypoglycemia and Use in Other Special Populations: A Narrative Review. Diabetes Ther 2020; 11:2555-2593. [PMID: 32975710 PMCID: PMC7547921 DOI: 10.1007/s13300-020-00925-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
Hypoglycemia is a major barrier impeding glycemic control in persons with type 2 diabetes mellitus and creates a substantial burden on the healthcare system. Certain populations that require special attention, such as older adults and individuals with renal impairment, a longer duration of diabetes or those who have experienced prior hypoglycemia, may be at a higher risk of hypoglycemia, particularly with insulin treatment. Second-generation basal insulin analogues (insulin glargine 300 U/mL and degludec) have demonstrated reductions in hypoglycemia compared with insulin glargine 100 U/mL although evidence of this benefit across specific populations is less clear. In this review we summarize the literature with respect to the efficacy and safety data for second-generation basal insulin analogues in adults with type 2 diabetes mellitus who are at risk of hypoglycemia or who require special attention. Randomized controlled trials, meta-analyses and real-world evidence demonstrate that the use of second-generation basal insulin analogues is associated with less hypoglycemia compared with insulin glargine 100 U/mL without compromising glycated hemoglobin control. A reduced risk of hypoglycemia with second-generation basal insulin analogues was evident in older adults and in individuals with obesity, renal impairment, a history of cardiovascular disease or a long duration of insulin use. Further studies are needed in other populations, including those with more severe renal impairment or hepatic dysfunction, the hospitalized population and those with cognitive impairment. Overall, less hypoglycemia associated with second-generation basal insulin analogues may help reduce barriers for insulin use, improve adherence and offset the costs of hypoglycemia-related healthcare resource utilization.
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Affiliation(s)
- Alice Y Y Cheng
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Shamasunder H Acharya
- Department of Diabetes, John Hunter Hospital, Hunter New England Health-University of Newcastle, New Lambton, NSW, Australia
| | - Elif Ekinci
- Department of Medicine, Austin Health-University of Melbourne, Melbourne, VIC, Australia
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16
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Amod A, Buse JB, McGuire DK, Pieber TR, Pop-Busui R, Pratley RE, Zinman B, Hansen MB, Jia T, Mark T, Poulter NR. Risk factors for kidney disorders in patients with type 2 diabetes at high cardiovascular risk: An exploratory analysis (DEVOTE 12). Diab Vasc Dis Res 2020; 17:1479164120970933. [PMID: 33280425 PMCID: PMC7919227 DOI: 10.1177/1479164120970933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To investigate risk factors associated with kidney disorders in patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk. METHODS In DEVOTE, a cardiovascular outcomes trial, 7637 patients were randomised to insulin degludec (degludec) or insulin glargine 100 units/mL (glargine U100), with standard of care. In these exploratory post hoc analyses, serious adverse event reports were searched using Standardised MedDRA® Queries related to chronic kidney disease (CKD) or acute kidney injury (AKI). Baseline predictors of CKD, AKI and change in estimated glomerular filtration rate (eGFR) were identified using stepwise selection and Cox or linear regression. RESULTS Over 2 years, eGFR (mL/min/1.73 m2) decline was small and similar between treatments (degludec: 2.70; glargine U100: 2.92). Overall, 97 and 208 patients experienced CKD and AKI events, respectively. A history of heart failure was a risk factor for CKD (hazard ratio [HR] 1.97 [95% confidence interval [CI] 1.41; 2.75]) and AKI (HR 2.28 [95% CI 1.64; 3.17]). A history of hepatic impairment was a significant predictor of CKD (HR 3.28 [95% CI 2.12; 5.07]) and change in eGFR (estimate: -8.59 [95% CI -10.20; -7.00]). CONCLUSION Our findings indicate that traditional, non-modifiable risk factors for kidney disorders apply to insulin-treated patients with T2D at high CV risk. TRIAL REGISTRATION NCT01959529 (ClinicalTrials.gov).
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Affiliation(s)
- Aslam Amod
- Department of Diabetes and Endocrinology, Life Chatsmed Garden Hospital and Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Aslam Amod, Department of Diabetes and Endocrinology, Life Chatsmed Garden Hospital and Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, PO Box 201685, Durban North 4016, South Africa.
| | - John B Buse
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Darren K McGuire
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA
| | - Thomas R Pieber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Rodica Pop-Busui
- Department of Internal Medicine, Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | | | - Bernard Zinman
- Department of Medicine, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ting Jia
- Novo Nordisk A/S, Søborg, Hovedstaden, Denmark
| | - Thomas Mark
- Novo Nordisk A/S, Søborg, Hovedstaden, Denmark
| | - Neil R Poulter
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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17
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Runesson B, Xu Y, Qureshi AR, Lindholm B, Barany P, Elinder CG, Carrero JJ. Association between reduced kidney function and incident hypoglycaemia in people with diabetes: The Stockholm Creatinine Measurements (SCREAM) project. Diabetes Obes Metab 2020; 22:1425-1435. [PMID: 32250539 DOI: 10.1111/dom.14051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022]
Abstract
AIM To evaluate possible associations between estimated glomerular filtration rate (eGFR) and hypoglycaemia in adults with diabetes. METHODS We conducted an observational study in adults with diabetes from the Stockholm Creatinine Measurement (SCREAM) project, a Swedish healthcare utilization cohort during 2007 to 2011. We evaluated diagnoses and outpatient glucose tests for incidence rate ratios (IRRs) of hypoglycaemia (overall and by severity) in outpatient care by eGFR strata using zero-inflated negative binomial regression. We identified clinical predictors through ordinal logistic regression and assessed 7-day and 30-day mortality from hypoglycaemia in relation to eGFR with Cox proportional hazard models. RESULTS We identified 29 434 people with diabetes (13% with type 1 diabetes). Their mean age was 66 years, 43% were women and the median eGFR was 80 mL/min/1.73 m2 . During 2 years of follow-up, 1812 patients (6.2%) had hypoglycaemia registered at least once. The risk of hypoglycaemia increased linearly with lower eGFR, with an IRR of 1.2 (95% confidence interval [CI] 1.0-1.4) for eGFR 60-89 mL/min/1.73 m2 and 5.8 (95% CI 3.8-9.0) for eGFR <15 mL/min/1.73 m2 compared to eGFR 90 to 104 mL/min/1.73 m2 . This trend was observed for both mild and severe hypoglycaemia. Both 7-day and 30-day post-hypoglycaemia mortality increased with lower eGFR, peaking in those with eGFR <15 mL/min/1.73 m2 (hazard ratio 21.2, 95% CI 5.1-87.9) as compared to those with eGFR 90 to 104 mL/min/1.73 m2 . Lower eGFR categories, type 1 diabetes, previous hypoglycaemia, liver disease, presence of diabetic complications and use of insulin and sulphonylureas increased the odds of hypoglycaemia. CONCLUSION In this large, observational study, low eGFR was strongly associated with the occurrence, severity and fatality of hypoglycaemia in people with diabetes.
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Affiliation(s)
| | - Yang Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Abdul R Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Carl G Elinder
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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18
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Unruh ML, Arzhan S, Feldman HI, Looker HC, Nelson RG, Faber T, Johnson D, Son-Stone L, Pankratz VS, Myaskovsky L, Shah VO. American Indian chronic Renal insufficiency cohort study (AI-CRIC study). BMC Nephrol 2020; 21:291. [PMID: 32698776 PMCID: PMC7376925 DOI: 10.1186/s12882-020-01954-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an increasing epidemic globally that is associated with adverse health outcomes including end stage kidney disease (ESKD), cardiovascular disease (CVD), and death. American Indians (AIs) have a higher prevalence of CKD than most other racial/ethnic groups, due in part to a high prevalence of type 2 diabetes. Other genetic and environmental factors not yet identified may also contribute to the disproportionate burden of CKD in AIs. METHOD We will establish 3 clinical centers to recruit AIs from the Southwest United States (US) to expand the Chronic Renal Insufficiency Cohort (CRIC) study. We will follow the current CRIC protocol for kidney and cardiovascular measures and outcomes, which include ambulatory monitoring of kidney function and the use of mobile health technologies for CVD sub-phenotyping, and compare the outcomes in AIs with those in other racial/ethnic groups in CRIC. DISCUSSION AI-CRIC will identify the role of various risk factors for rapid loss of kidney function among AIs of the Southwest US. In addition, to better understand the natural history of CKD and CVD in this high-risk population, we will identify unique risk factors for CKD and CVD progression in AIs. We will also compare event rates and risk factors for kidney and cardiovascular events in AIs with the other populations represented in CRIC.
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Affiliation(s)
- Mark L Unruh
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Soraya Arzhan
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | | | | | | | | | | | | | - Vernon S Pankratz
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, University of New Mexico, School of Medicine, MSC 10 5550, Albuquerque, NM, 87131, USA.
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