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Wan CS, Nankervis A, Teede H, Aroni R. Priorities to improve woman-centred gestational diabetes mellitus care: A qualitative study to compare views between clinical and consumer end-users. J Hum Nutr Diet 2023; 36:1636-1648. [PMID: 37282816 DOI: 10.1111/jhn.13191] [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: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Immigrants worldwide have a two-fold higher risk of gestational diabetes mellitus (GDM) than women of the host country. Providing culturally appropriate woman-centred GDM care to attenuate adverse maternal and neonatal health outcomes is a persistent challenge for health services. Underpinned by the Knowledge to Action Framework, understanding and comparing the views of patients from different ethnic backgrounds and healthcare professionals (HCPs) about current and optimal GDM care can highlight priority areas to improve woman-centred care. This qualitative study aimed to compare the views of ethnic Chinese and Australian-born Caucasian women and their HCPs, including endocrinologists, obstetricians, midwives, diabetes nurse educators and dietitians, about what constitutes optimal GDM care and how to improve woman-centred GDM care. METHODS Purposive sampling was used to recruit 42 Chinese and 30 Caucasian women with GDM and 17 HCPs from two large Australian hospital maternity services to complete in-depth, semi-structured interviews. Patients' and HCPs' views were thematically analysed and compared. RESULTS Four out of nine themes showed misalignments between patients' and HCPs' views on GDM care, reflecting priority areas to improve woman-centred care by (i) reaching agreement on the attitudes towards different treatment targets between HCPs; (ii) enhancing inter-professional communication; (iii) improving GDM care transition to postpartum care; and (iv) providing detailed dietary advice tailored to Chinese patients' cultural diet. CONCLUSIONS Further research on reaching consensus on treatment targets, enhancing inter-professional communication, developing a perinatal care transition model from pregnancy to postpartum, and developing Chinese patient-oriented educational resources is required to improve woman-centred care.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
| | - Alison Nankervis
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Rosalie Aroni
- Medical School, College of Health and Medicine, Canberra, ACT, Australia
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Kim J, Kwon HS. Not Control but Conquest: Strategies for the Remission of Type 2 Diabetes Mellitus. Diabetes Metab J 2022; 46:165-180. [PMID: 35385632 PMCID: PMC8987695 DOI: 10.4093/dmj.2021.0377] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
A durable normoglycemic state was observed in several studies that treated type 2 diabetes mellitus (T2DM) patients through metabolic surgery, intensive therapeutic intervention, or significant lifestyle modification, and it was confirmed that the functional β-cell mass was also restored to a normal level. Therefore, expert consensus introduced the concept of remission as a common term to express this phenomenon in 2009. Throughout this article, we introduce the recently updated consensus statement on the remission of T2DM in 2021 and share our perspective on the remission of diabetes. There is a need for more research on remission in Korea as well as in Western countries. Remission appears to be prompted by proactive treatment for hyperglycemia and significant weight loss prior to irreversible β-cell changes. T2DM is not a diagnosis for vulnerable individuals to helplessly accept. We attempt to explain how remission of T2DM can be achieved through a personalized approach. It may be necessary to change the concept of T2DM towards that of an urgent condition that requires rapid intervention rather than a chronic, progressive disease. We must grasp this paradigm shift in our understanding of T2DM for the benefit of our patients as endocrine experts.
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Affiliation(s)
- Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Hyuk-Sang Kwon https://orcid.org/0000-0003-4026-4572 Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63(yuksam)-ro, Yeongdeungpo-gu, Seoul 07345, Korea E-mail:
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3
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Paldánius PM. Evaluating the Evidence behind the Novel Strategy of Early Combination from Vision to Implementation. Diabetes Metab J 2020; 44:785-801. [PMID: 33081426 PMCID: PMC7801764 DOI: 10.4093/dmj.2020.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a complex and progressive chronic disease characterised by elevating hyperglycaemia and associated need to gradually intensify therapy in order to achieve and maintain glycaemic control. Treating hyperglycaemia with sequential therapy is proposed to allow holistic assessment of the efficacy and risk-to-benefit ratio of each added component. However, there is an array of evidence supporting the scientific rationale for using synergistic, earlier, modern drug combinations to achieve glycaemic goals, delay the deterioration of glycaemic control, and, therefore, potentially preserve or slow down the declining β-cell function. Additionally, implementation of early combination(s) may lead to opportunities to combat clinical inertia and other hurdles to optimised disease management outcomes. This review aims to discuss the latest empirical evidence for long-term clinical benefits of this novel strategy of early combination in people with newly diagnosed T2DM versus the current widely-implemented treatment paradigm, which focuses on control of hyperglycaemia using lifestyle interventions followed by sequentially intensified (mostly metformin-based) monotherapy. The recent reported Vildagliptin Efficacy in combination with metfoRmin For earlY treatment of T2DM (VERIFY) study results have provided significant new evidence confirming long-term glycaemic durability and tolerability of a specific early combination in the management of newly diagnosed, treatment-naïve patients worldwide. These results have also contributed to changes in clinical treatment guidelines and standards of care while clinical implementation and individualised treatment decisions based on VERIFY results might face barriers beyond the existing scientific evidence.
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Affiliation(s)
- Päivi Maria Paldánius
- Research Program for Clinical and Molecular Metabolism, Helsinki University, Helsinki, Finland
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4
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Type II diabetes mellitus: a review on recent drug based therapeutics. Biomed Pharmacother 2020; 131:110708. [DOI: 10.1016/j.biopha.2020.110708] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/15/2022] Open
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Abstract
PURPOSE OF REVIEW Genetic, socioeconomic and clinical features vary considerably among individuals with type 2 diabetes (T2D) influencing disease development, progression and response to therapy. Although a patient-centred approach to pharmacologic therapy of T2D is widely recommended, patients are often treated similarly, irrespective of the differences that may affect therapeutic response. Addressing the heterogeneity of T2D is a major task of diabetes research to lower the high rate of treatment failure as well as to reduce the risk of long-term complications. RECENT FINDINGS A pathophysiology-based clustering system seems the most promising to help in the stratification of diabetes in terms of complication risk and response to treatment. This urges for clinical studies looking at novel biomarkers related to the different metabolic pathways of T2D and able to inform about the therapeutic cluster of each patient. Here, we review the main settings of diabetes heterogeneity, to what extent it has been already addressed and the current gaps in knowledge towards a personalized therapeutic approach that considers the distinctive features of each patient.
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Affiliation(s)
- Pieralice Silvia
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Zampetti Simona
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Maddaloni Ernesto
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Buzzetti Raffaella
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
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6
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Nini Shuhaida MH, Siti Suhaila MY, Azidah KA, Norhayati NM, Nani D, Juliawati M. Depression, anxiety, stress and socio-demographic factors for poor glycaemic control in patients with type II diabetes. J Taibah Univ Med Sci 2019; 14:268-276. [PMID: 31435416 PMCID: PMC6695081 DOI: 10.1016/j.jtumed.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/31/2022] Open
Abstract
Objective This study aims to identify risks induced by depression, anxiety, stress, and socio-demographic factors associated with poor glycaemic control among type II diabetes mellitus patients in Kuala Terengganu, Malaysia. Methods This cross-sectional study was performed in two Malaysian health clinics by using the Malay version of a self-administered questionnaire. This instrument contains a diabetes care profile, a 21-item version of the Depression Anxiety Stress Scales (DASS21), and a Malaysian Medication Adherence Score (MalMAS). Simple and multiple logistic regression analyses were performed. Results A total of 338 type II diabetes mellitus patients responded (response rate 93.1%). The proportion of patients with poor glycaemic control was 76.0%. Multiple logistic regression analysis showed that 1) social support scores [Adj. OR (95% CI): 1.06 (1.03,1.10); p = 0.001]; 2) unemployment [Adj. OR (95% CI): 0.46 (0.22,0.95); p = 0.035]; 3) pensioner status [Adj. OR (95% CI): 0.28 (0.13,0.61); p = 0.001]; and 4) perception of diabetes as interfering with daily living activities [Adj. OR (95% CI): 3.18 (1.17,8.70); p = 0.024] were significant factors for poor glycaemic control. Conclusions Unemployment, perception of diabetes' interference with daily living activities, and social support are significantly correlated with poor glycaemic control. Further studies assessing other important clinical and psychosocial factors that may influence glycaemic control are suggested. A younger age range of participants is recommended for better outcomes and interventional implementation of findings.
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Affiliation(s)
| | - Mohd Y Siti Suhaila
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Kadir A Azidah
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noor M Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Draman Nani
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Muhammad Juliawati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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7
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Abstract
IN BRIEF This study examined the relationship between patient commitment and A1C. Patients completed the Altarum Consumer Engagement (ACE) measure. Multiple A1C values were extracted from medical records for 273 military beneficiaries. Effects were analyzed with generalized linear models. The ACE Commitment subscale was significantly inversely related to A1C trends. Low-commitment patients were more likely to have a high A1C. High-commitment patients were 16% more likely to have an A1C <7.0%; this likelihood increased to 65% over time. The ACE Commitment domain may be a useful clinical tool. Increasing patients' commitment to managing diabetes may improve their A1C over time.
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Affiliation(s)
- Jana Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center (WHASC), Lackland, TX
| | | | - Chris Duke
- Center for Consumer Choice in Health Care, Altarum Institute, Ann Arbor, MI
| | - Tom J. Sauerwein
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center (WHASC), Lackland, TX
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8
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Cai X, Gao X, Yang W, Han X, Ji L. Efficacy and Safety of Initial Combination Therapy in Treatment-Naïve Type 2 Diabetes Patients: A Systematic Review and Meta-analysis. Diabetes Ther 2018; 9:1995-2014. [PMID: 30155646 PMCID: PMC6167297 DOI: 10.1007/s13300-018-0493-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy and safety of initial combination therapy compared with monotherapy in drug-naïve type 2 diabetes patients. METHODS MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched for randomized clinical trials of initial combination therapy with hypoglycemic agents compared with monotherapy. Those which satisfied the search criteria were included in the meta-analysis. Weighted mean difference and relative risks were calculated. RESULTS A total of 36 studies were included in the meta-analysis. Compared with metformin monotherapy, initial combination therapy with metformin plus another anti-diabetes drug exhibited significant reductions in glycated hemoglobin (HbA1c) (p < 0.001). Most of the combination therapies had a similar risk of hypoglycemia (p > 0.05), with the exception of combinations of sulfonylurea/glinide and metformin or combinations of thiazolidinedione and metformin. Compared with dipeptidyl peptidase-4 (DPP-4) inhibitor monotherapy, initial combination therapy with DPP-4 inhibitor plus another anti-diabetes drug showed a significant decrease in HbA1c (p < 0.001) and a similar risk of hypoglycemia (p > 0.05). Compared with monotherapy with other anti-diabetes drugs, initial combination therapies also resulted in significant HbA1c reductions, a similar risk of hypoglycemia and similar risks of other adverse events. CONCLUSION Compared with monotherapy, all initial combination therapies resulted in significant HbA1c reductions. Compared with metformin monotherapy, initial combination therapies with DPP-4 inhibitors plus metformin, sodium/glucose cotransporter 2 inhibitors and metformin, respectively, were associated with similar risks of hypoglycemia, but initial combination therapies with sulfonylurea plus metformin, thiazolidinedione and metformin, respectively, were associated with higher risks of hypoglycemia. FUNDING AstraZeneca Ltd. (China). TRIAL REGISTRATION Registration number CRD42017060717 in PROSPERO.
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Affiliation(s)
- Xiaoling Cai
- Department of Endocrine and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xueying Gao
- Department of Endocrine and Metabolism, Peking University People's Hospital, Beijing, China
| | - Wenjia Yang
- Department of Endocrine and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xueyao Han
- Department of Endocrine and Metabolism, Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrine and Metabolism, Peking University People's Hospital, Beijing, China.
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9
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Maddaloni E, Pozzilli P. Diabetes: the disease of the 10 D. Endocrine 2018; 61:353-354. [PMID: 29075975 DOI: 10.1007/s12020-017-1454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy.
- Centre of Diabetes, Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK.
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10
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Suárez Vázquez A, Del Río Lanza AB, Suárez Álvarez L, Vázquez Casielles R. Empower Me? Yes, Please, But in My Way: Different Patterns of Experiencing Empowerment in Patients with Chronic Conditions. HEALTH COMMUNICATION 2017; 32:910-915. [PMID: 27435319 DOI: 10.1080/10410236.2016.1196409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Empowerment is a widely used word within the realm of health care. This is especially true in the case of patients living with a chronic illness, who may be active participants and learn to manage their disease, irrespective of their desires or preferences. This article focuses on the empowering experience of patients with chronic conditions. We have built on earlier research that explains the factors that mediate communication between health care professionals and patients: patient participation, patient impact, meaning, health care professionals' information provision, health care professionals' emotional support, health care professionals' attentive listening, health care professionals' trust, and patient collaboration. We propose a new model for detecting types of patients who differ in the way they live their empowering experience. Using survey data from a sample of 181 patients of hemophilia, we found two types of patients: patients with an inner locus of empowerment and patients with an outer locus of empowerment. We conclude by discussing different strategies for fostering the sense of power in each of these types of patients.
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Affiliation(s)
- Ana Suárez Vázquez
- a Biomedicine and Health Cluster , Business Administration Department, University of Oviedo
| | | | - Leticia Suárez Álvarez
- a Biomedicine and Health Cluster , Business Administration Department, University of Oviedo
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11
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Mosenzon O, Pollack R, Raz I. Treatment of Type 2 Diabetes: From "Guidelines" to "Position Statements" and Back: Recommendations of the Israel National Diabetes Council. Diabetes Care 2016; 39 Suppl 2:S146-53. [PMID: 27440827 DOI: 10.2337/dcs15-3003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the increased prevalence of type 2 diabetes worldwide, most patients are treated by their primary health care team (PHCT). PHCTs need guidance in choosing the best treatment regimen for patients, since the number of glucose-lowering agents (GLAs) is rapidly increasing, as is the amount of clinical data regarding these drugs. The American Diabetes Association/European Association for the Study of Diabetes Position Statement emphasizes the importance of personalized treatment and lists drug efficacy, risk of hypoglycemia, effect on weight, side effects, and cost as important parameters to consider when choosing GLAs. The suggested Israeli guidelines refocus earlier international recommendations from 2012 and 2015, based on emerging data from cardiovascular outcome trials as well as what we believe are important issues for patient care (i.e., durability, hypoglycemia risk, and weight gain).
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Affiliation(s)
- Ofri Mosenzon
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Rena Pollack
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Itamar Raz
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
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12
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Abstract
Type 2 diabetes is a progressive disorder characterized by increasing hyperglycemia and the need to gradually intensify therapy in order to achieve and maintain glycemic control. Early initiation of combination therapy has been proposed as an approach to achieve glycemic goals earlier and delay the deterioration of glycemic control and with possible better preservation of β-cell function. We discuss in this article the pros and cons of this approach, focusing on individuals with HbA1c at diagnosis of 7.5-9.0%, where difference of opinion still exists on management. Initial combination therapy is proposed to lead to better and faster achievement of glycemic targets versus monotherapy and to impede clinical inertia and may possibly slow the deterioration of β-cell function. However, treating patients with sequential therapy is proposed to allow one to fully assess the efficacy and risk-to-benefit ratio of each drug as it is added. Furthermore, there is no evidence to support that rapid addition and titration of medications according to the glycemic profile achieved are inferior to initial combination therapy if glycemic targets are attained in a timely manner. Initial combination therapy is argued to postpone clinical inertia to the next decision point but does not eliminate it. Additionally, it may have been the agents chosen and not the timing of their initiation that led to improved β-cell function in the studies of initial combination therapy, and there are no data currently comparing use of the same drugs initiated simultaneously or sequentially. Heightened awareness of providers, individualization of therapy and setting, and reaching glycemic targets remain the mainstays of care.
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Affiliation(s)
- Avivit Cahn
- Diabetes Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
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13
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Maddaloni E, Pozzilli P. Why China guidelines for type 2 diabetes represent an opportunity for treating this disease. Diabetes Metab Res Rev 2016; 32:438-9. [PMID: 27464263 DOI: 10.1002/dmrr.2825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/18/2016] [Indexed: 11/08/2022]
Abstract
More than one quarter of people affected by type 2 diabetes worldwide live in China, where an alarming increase in diabetes incidence is taking place. However, most of the evidence about diabetes management derives from studies conducted on non-Asian people, raising concerns about their validity in other ethnic groups, including the Chinese. The guidelines proposed by the Chinese Diabetes Society suggest tools for medical doctors in China and worldwide to appropriately face diabetes in Chinese people, whose number in non-Chinese countries is continuously increasing. However, additional efforts are still needed to achieve an evidence-based tailored therapy for type 2 diabetes in Chinese people. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico of Rome, Rome, Italy
- Centre of Immunobiology, Barts and The London School of Medicine, Queen Mary, University of London, London, UK
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14
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Maddaloni E, D'Onofrio L, Pozzilli P. Frailty and geography: should these two factors be added to the ABCDE contemporary guide to diabetes therapy? Diabetes Metab Res Rev 2016; 32:169-75. [PMID: 26484614 DOI: 10.1002/dmrr.2762] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/13/2015] [Accepted: 10/09/2015] [Indexed: 12/19/2022]
Abstract
On the road towards personalized treatments for type 2 diabetes, we suggest here that two parameters could be added to the ABCDE algorithm, 'F' for frailty and 'G' for geography. Indeed, the progressive ageing of population is causing a simultaneous increase of frailty worldwide. The identification of the optimal therapeutic approach is often difficult in frail subjects because of the complexity of 'frailty syndrome'. Nevertheless, given the relevance of diabetes in the development and progression of frailty, a safe and effective cure of diabetes is extremely important to guarantee a good medical outcome. There are few data about diabetes treatment in this delicate category of patients, and the choice of the appropriate therapy mostly remains a challenge. Moreover, type 2 diabetes affects more than 382 million people of different countries, races and ethnicities. To face the lack of solid evidence-based medicine for the treatment of diabetes in different ethnic groups, it is extremely important to increase knowledge about the different pathophysiology of diabetes according to ethnicity. In this way, a tailored approach to treatment of various ethnic groups living in the same or different regions can eventually be developed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ernesto Maddaloni
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Italy
| | - Luca D'Onofrio
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Italy
- Centre of Immunobiology, The Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
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15
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Łuczyński W, Głowińska-Olszewska B, Bossowski A. Empowerment in the Treatment of Diabetes and Obesity. J Diabetes Res 2016; 2016:5671492. [PMID: 28090541 PMCID: PMC5206444 DOI: 10.1155/2016/5671492] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/30/2016] [Indexed: 12/26/2022] Open
Abstract
As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.
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Affiliation(s)
- Włodzimierz Łuczyński
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
- *Włodzimierz Łuczyński:
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
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16
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Valencia WM, Florez HJ. A new angle for glp-1 receptor agonist: the medical economics argument. Editorial on: Huetson P, Palmer JL, Levorsen A, et al. Cost-effectiveness of the once-daily glp-1 receptor agonist lixisenatide compared to bolus insulin both in combination with basal insulin for the treatment of patients with type 2 diabetes in Norway. J Med Econ 2015: 1-13 [Epub ahead of print]. J Med Econ 2015; 18:1029-31. [PMID: 26337323 DOI: 10.3111/13696998.2015.1069297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are relatively new medications for diabetes that offer a weight-loss profile that can be considered desirable for patients with both type 2 diabetes (T2D) and obesity. GLP-1 RA are effective in combination with insulin, and even slightly superior or at least equal to short-acting insulin in T2D; however, since they work in the incretin system, they may not be effective in long-standing disease. Additionally, only recently have publications reported their cardiovascular safety, and there is limited evidence for long-term effectiveness. The work presented by Huetson et al. offers a much needed perspective through a medical economic model for the long term cost-effectiveness of GLP-1 RA. The authors found benefits in quality-adjusted life years and reduced lifetime healthcare costs. While there are a few limitations, this study contributes to the understanding of these agents and their impact on the epidemics of obesity in T2D, where weight management is no longer an option, but an essential component of the diabetes plan of care.
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Affiliation(s)
- Willy Marcos Valencia
- a a ABIM Internal Medicine, Geriatric Medicine, Endocrinology, Diabetes & Metabolism, Geriatrics Research, Education and Clinical Center (GRECC), Metabolic Clinic Director, Miami VA Medical Center , Miami , FL , USA
- b b Division of Epidemiology, Division of Geriatric Medicine , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Hermes Jose Florez
- c c ABIM Geriatric Medicine, Endocrinology, Diabetes & Metabolism, GRECC Director, Miami VA Healthcare System , Miami , FL , USA
- d d Division of Epidemiology Chief, Division of Geriatric Medicine Interim Chief , University of Miami Miller School of Medicine , Miami , FL , USA
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