Suivi sur un an dans les conditions de pratique courante d’une cohorte de patients diabétiques de type 2 traités par rosiglitazone : l’étude Avantage

Diabetes mellitus and the skin

Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.

A review of methods used in assessing non-serious adverse drug events in observational studies among type 2 diabetes mellitus patients

Clinical drug trials are often conducted in selective patient populations, with relatively small numbers of patients, and a short duration of follow-up. Observational studies are therefore important for collecting additional information on adverse drug events (ADEs). Currently, there is no guidance regarding the methodology for measuring ADEs in such studies. Our aim was to evaluate whether the methodology used to assess non-serious ADEs in observational studies is adequate for detecting these ADEs, and for addressing limitations from clinical trials in patients with type 2 diabetes mellitus. We systematically searched MEDLINE and EMBASE for observational studies reporting non-serious ADEs (1999-2008). Methods to assess ADEs were classified as: 1) medical record review; 2) surveillance by health care professionals (HCP); 3) patient survey; 4) administrative data; 5) laboratory/clinical values; 6) not specified. We compared the range of ADEs identified, number and selection of patients included, and duration of follow-up. Out of 10,125 publications, 68 studies met our inclusion criteria. The most common methods were based on laboratory/clinical values (n = 25) and medical record review (n = 18). Solicited surveillance by HCP (n = 17) revealed the largest diversity of ADEs. Patient surveys (n = 15) focused mostly on hypoglycaemia and gastrointestinal ADEs, laboratory values based studies on hepatic and metabolic ADEs, and administrative database studies (n = 5) on cardiovascular ADEs. Four studies presented ADEs that were identified with the use of more than one method. The patient population was restricted to a lower risk population in 19% of the studies. Less than one third of the studies exceeded pre-approval regulatory requirements for sample size and duration of follow-up. We conclude that the current assessment of ADEs is hampered by the choice of methods. Many observational studies rely on methods that are inadequate for identifying all possible ADEs. Patient-reported outcomes and combinations of methods are underutilized. Furthermore, while observational studies often include unselective patient populations, many do not adequately address other limitations of pre-approval trials. This implies that these studies will not provide sufficient information about ADEs to clinicians and patients. Better protocols are needed on how to assess adverse drug events not only in clinical trials but also in observational studies.

Adding liraglutide to oral antidiabetic drug therapy: onset of treatment effects over time

AIM

To investigate the onset of treatment effects over time observed for liraglutide in combination with oral antidiabetic drugs (OADs).

METHODS

This analysis included patients from three phase 3, 26-week, randomised, double-blind, parallel-group trials. Prior to randomisation, patients underwent a run-in and titration period with metformin (Liraglutide Effect and Action in Diabetes-2, LEAD-2), glimepiride (LEAD-1) or metformin plus rosiglitazone (LEAD-4). Patients were then randomised to receive liraglutide (0.6, 1.2 or 1.8 mg once-daily), active comparator and/or placebo. For this analysis, only the 1.2 mg and 1.8 mg liraglutide doses were included. Outcome measures included change in HbA(1c), fasting plasma glucose (FPG), weight and systolic blood pressure (SBP). The safety profile was also investigated.

RESULTS

Significant reductions in HbA(1c) were observed within 8 weeks of treatment with liraglutide plus OADs (p < 0.0001) and maintained until week 26. Furthermore, liraglutide plus OADs led to significant reductions in FPG within 2 weeks (p < 0.0001) and sustained over 26 weeks. Adding liraglutide to metformin or metformin plus rosiglitazone also led to early reductions and maintained reductions in body weight (within 8 weeks, p < 0.0001); however, liraglutide treatment plus glimepiride was weight neutral. Rapid reductions in SBP were observed for liraglutide plus OADs (within 2 weeks, p < 0.05-0.001) and maintained for 26 weeks. Some patients experienced nausea, which for the majority it diminished within 2 weeks.

CONCLUSION

Liraglutide treatment combined with OADs led to rapid improvements in FPG and SBP. Early reductions in HbA(1c) and body weight were also observed. Adding liraglutide to OADs early on may therefore be a good treatment option for patients with type 2 diabetes.