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Advanced Glycation End Products: A Sweet Flavor That Embitters Cardiovascular Disease. Int J Mol Sci 2022; 23:ijms23052404. [PMID: 35269546 PMCID: PMC8910157 DOI: 10.3390/ijms23052404] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
Epidemiological studies demonstrate the role of early and intensive glycemic control in the prevention of micro and macrovascular disease in both type 1 and type 2 diabetes mellitus (DM). Hyperglycemia elicits several pathways related to the etiopathogenesis of cardiovascular disease (CVD), including the generation of advanced glycation end products (AGEs). In this review, we revisit the role played by AGEs in CVD based in clinical trials and experimental evidence. Mechanistic aspects concerning the recognition of AGEs by the advanced glycosylation end product-specific receptor (AGER) and its counterpart, the dolichyl-diphosphooligosaccharide-protein glycosyltransferase (DDOST) and soluble AGER are discussed. A special focus is offered to the AGE-elicited pathways that promote cholesterol accumulation in the arterial wall by enhanced oxidative stress, inflammation, endoplasmic reticulum stress and impairment in the reverse cholesterol transport (RCT).
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Rossi MC, Lucisano G, Ceriello A, Mazzucchelli C, Musacchio N, Ozzello A, Nicolucci A, Di Bartolo P. Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement. Acta Diabetol 2018; 55:1059-1066. [PMID: 30062588 DOI: 10.1007/s00592-018-1186-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
AIMS To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals). METHODS 14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen. RESULTS Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15-23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53-58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3-88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7-81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl). CONCLUSIONS SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.
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Affiliation(s)
- Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio 2, 65124, Pescara, Italy.
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio 2, 65124, Pescara, Italy
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, MI, Italy
| | | | | | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio 2, 65124, Pescara, Italy
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Chen CM, Hung LC, Chen YL, Yeh MC. Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study. J Clin Nurs 2018; 27:1673-1683. [PMID: 29266453 DOI: 10.1111/jocn.14227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. BACKGROUND Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. DESIGN The descriptive phenomenological method was used. METHODS Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6 months, (iv) being at least 20 years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. RESULTS The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. CONCLUSIONS The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene appropriately, discuss self-monitoring of blood glucose results with patients and track these results.
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Affiliation(s)
- Chen-Mei Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Li-Chen Hung
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Mei Chang Yeh
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Schnell O, Klausmann G, Gutschek B, Garcia-Verdugo RM, Hummel M. Impact on Diabetes Self-Management and Glycemic Control of a New Color-Based SMBG Meter. J Diabetes Sci Technol 2017; 11:1218-1225. [PMID: 28443343 PMCID: PMC5951041 DOI: 10.1177/1932296817706376] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a key pillar of personal diabetes management. The objective of this observational study was to analyze diabetes self-management (DSM) and glycemic outcomes before and during system implementation in real-life settings of a blood glucose meter system with a color-coded display of glucose levels, which helps identify out-of-range levels. METHODS A total of 193 insulin-treated diabetes patients (11% T1DM; 55% male, age 60 ± 4 years, mean diabetes duration 14 ± 9 years, HbA1c 8.68 ± 1.2%) were enrolled into the study. Both the Diabetes Self-Management Questionnaire (DSMQ) and glycemic control were analyzed at baseline and 3 and 6 months after study initiation. RESULTS DSMQ general perception improved significantly by the end of the study period ("Sum Scale," P < .05). Moreover, after 6 months patient's attitudes on self-care (Q16, P = .0046) and nutrition ("Dietary Control," P = .004) showed significant improvements. Use of the blood glucose meter resulted in improved glycemic control, as shown by mean HbA1c levels, which decreased from 8.68 ± 1.2% at baseline to 8.13 ± 1.02% after 3 months ( P < .0001) and to 7.9 ± 1.1% at 6 months ( P < .0001). Both patients and diabetes educators agreed in the advantages of the color-coded indicator and on its helpfulness in assisting patients on their diabetes management, as drawn from the results of the self-reported satisfaction questionnaire. CONCLUSION This real-world study demonstrates that SMBG implemented via this new blood glucose meter not only leads to an improvement in metabolic control, but also is associated with a significant improvement in diabetes management.
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Affiliation(s)
- Oliver Schnell
- Sciarc Institute, Baierbrunn, Germany
- Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany
| | | | - Bettina Gutschek
- Johnson & Johnson Medical GmbH; Geschäftsbereich Johnson & Johnson Diabetes Care Companies, Neuss, Germany
| | | | - Michael Hummel
- Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany
- Diabetologische Schwerpunktpraxis Rosenheim, Rosenheim, Germany
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Gentile S, Ceriello A, Pipicelli G, Strollo F. Type 2 diabetes mellitus treatment habits in a specialized care setting: the START-DIAB study. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2017. [DOI: 10.3233/mnm-17160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Sandro Gentile
- Department of Clinical and ExperimentalMedicine, 2nd Campania University of Naples, “LuigiVanvitelli”, Naples, Italy
| | | | | | - Felice Strollo
- Department of Pharmacology and Biomolecular Sciences, University of Milan, Italy
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Profiling Patients' Healthcare Needs to Support Integrated, Person-Centered Models for Long-Term Disease Management (Profile): Research Design. Int J Integr Care 2016; 16:1. [PMID: 27616957 PMCID: PMC5015555 DOI: 10.5334/ijic.2208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: This article presents the design of PROFILe, a study
investigating which (bio)medical and non-(bio)medical patient characteristics
should guide more tailored chronic care. Based on this insight, the project aims
to develop and validate ‘patient profiles’ that can be used in
practice to determine optimal treatment strategies for subgroups of chronically
ill with similar healthcare needs and preferences. Methods/Design: PROFILe is a practice-based research comprising four
phases. The project focuses on patients with type 2 diabetes. During the first
study phase, patient profiles are drafted based on a systematic literature
research, latent class growth modeling, and expert collaboration. In phase 2,
the profiles are validated from a clinical, patient-related and statistical
perspective. Phase 3 involves a discrete choice experiment to gain insight into
the patient preferences that exist per profile. In phase 4, the results from all
analyses are integrated and recommendations formulated on which patient
characteristics should guide tailored chronic care. Discussion: PROFILe is an innovative study which uses a uniquely
holistic approach to assess the healthcare needs and preferences of chronically
ill. The patient profiles resulting from this project must be tested in practice
to investigate the effects of tailored management on patient experience,
population health and costs.
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Cox DJ, Taylor AG, Singh H, Moncrief M, Diamond A, Yancy WS, Hegde S, McCall AL. Glycemic load, exercise, and monitoring blood glucose (GEM): A paradigm shift in the treatment of type 2 diabetes mellitus. Diabetes Res Clin Pract 2016; 111:28-35. [PMID: 26556234 DOI: 10.1016/j.diabres.2015.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/01/2015] [Accepted: 10/14/2015] [Indexed: 01/06/2023]
Abstract
AIMS This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postprandial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose (GEM) could improve metabolic control of adults with type 2 diabetes mellitus, without compromising other physiological parameters. METHODS Forty-seven adults (mean age 55.3 years) who were diagnosed with type 2 diabetes mellitus for less than 5 years (mean 2.1 years), had HbA1c ≥ 7% (mean 8.4%) and were not taking blood glucose lowering medications, were randomized to routine care or five 1-h instructional sessions of GEM. Assessments at baseline and 6 months included a physical exam, metabolic and lipid panels, and psychological questionnaires. RESULTS The GEM intervention led to significant improvements in HbA1c (decreasing from 8.4 to 7.4% [69-57 mmol/mol] compared with 8.3 to 8.3% [68-68 mmol/mol] for routine care; Interaction p<.01) and psychological functioning without compromising other physiological parameters. CONCLUSIONS Consistent with a patient-centered approach, GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus.
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Affiliation(s)
- Daniel J Cox
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA.
| | - Ann G Taylor
- University of Virginia School of Nursing, PO Box 800782, Charlottesville, VA 22908, USA
| | - Harsimran Singh
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA
| | - Matthew Moncrief
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA
| | - Anne Diamond
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA
| | - William S Yancy
- Duke University School of Medicine, Durham Veterans Affairs Medical Center, 508 Fulton St # 3, Durham, NC 27705, USA
| | - Shefali Hegde
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA
| | - Anthony L McCall
- Endocrinology and Metabolism, University of Virginia School of Medicine, PO Box 801407, Charlottesville, VA 22908, USA
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Martono DP, Lub R, Lambers Heerspink HJ, Hak E, Wilffert B, Denig P. Predictors of response in initial users of metformin and sulphonylurea derivatives: a systematic review. Diabet Med 2015; 32:853-64. [PMID: 25582542 DOI: 10.1111/dme.12688] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 12/14/2022]
Abstract
AIM To provide an overview of factors predicting metformin and sulphonylurea treatment response. BACKGROUND A large variability between individuals in treatment response to metformin and sulphonylurea derivatives exists. Understanding which factors determine response to these drugs may pave the way for more individualized therapy. METHODS We conducted a systematic search in the MEDLINE, Cochrane and EMBASE databases, between 2003 and 2012 for articles assessing demographic and clinical prediction factors of treatment response in initial users of metformin or sulphonylurea. A literature search of articles referenced within the studies identified was also performed. Treatment response was defined as change in HbA1c level, reaching target HbA1c levels or time to treatment change. Studies were assessed on quality, sample size and type of analysis. Results were summarized by tabulating positive, null and negative associations observed for included predictors. RESULTS A total of 10 articles (six trial reports and four cohort studies) were obtained, including three of sufficient quality. For metformin, baseline HbA1c , older age, lower BMI and shorter disease duration were found to be predictors of better treatment response in at least three studies of sufficient quality. For sulphonylurea derivatives, baseline HbA1c and shorter duration were identified as predictors of better treatment response in at least two studies of sufficient quality. Race, smoking status, lipid levels, blood pressure, kidney function and comorbidities were not significantly associated with treatment response. CONCLUSIONS Several demographic and clinical factors were identified as possible predictors of response to metformin and sulphonylurea, but the number of studies with sufficient quality was small. Generally, early treatment seems important for achieving better glycaemic outcomes.
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Affiliation(s)
- D P Martono
- Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- School of Pharmacy, Institut Teknologi Bandung, Bandung, Indonesia
| | - R Lub
- Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H J Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E Hak
- Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - B Wilffert
- Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Tokajuk A, Krzyżanowska-Grycel E, Tokajuk A, Grycel S, Sadowska A, Car H. Antidiabetic drugs and risk of cancer. Pharmacol Rep 2015; 67:1240-50. [PMID: 26481548 DOI: 10.1016/j.pharep.2015.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 12/18/2022]
Abstract
Antidiabetic drugs are an important group of medications used worldwide. They differ from each other in the mechanisms of lowering blood glucose as well as in adverse effects that may affect the course of the treatment and its efficacy. In recent years, new drugs have been discovered in order to improve the maintenance of proper blood glucose level and to reduce unwanted effects of these drugs. Their growing administration is related to the increasing incidence of diabetes observed in all countries in the world. Epidemiological data indicate that diabetes increases the risk of cancer, as well as the risk of death linked with neoplasms. It is still unknown whether this is an effect of antidiabetic drugs or just the effect of diabetes itself. In recent years there have been numerous investigations and meta-analyzes, based on both comparative and cohort studies trying to establish the relationship between antidiabetic pharmacotherapy and the incidence and mortality due to cancer. According to their findings, most of antidiabetic drugs increase the risk of cancer while only few of them show antitumor properties. Different mechanisms of action of glucose-lowering drugs may be responsible for these effects. However, most of the published studies concerning the influence of these drugs on cancer incidence were designed with some limitations and differed from each other in the approach. In this review, we discuss the association between antidiabetic drugs used in monotherapy or polytherapy and cancer risk, and consider potential mechanisms responsible for the observed effects.
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Affiliation(s)
- Anna Tokajuk
- Department of Experimental Pharmacology, Medical University of Białystok, Białystok, Poland.
| | | | - Adrian Tokajuk
- Department of Experimental Pharmacology, Medical University of Białystok, Białystok, Poland
| | - Sławomir Grycel
- Department of Diabetology, Endocrinology and Internal Medicine, J. Sniadecki Hospital, Białystok, Poland
| | - Anna Sadowska
- Department of Experimental Pharmacology, Medical University of Białystok, Białystok, Poland
| | - Halina Car
- Department of Experimental Pharmacology, Medical University of Białystok, Białystok, Poland
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Gallo M, Mannucci E, De Cosmo S, Gentile S, Candido R, De Micheli A, Di Benedetto A, Esposito K, Genovese S, Medea G, Ceriello A. Algorithms for personalized therapy of type 2 diabetes: results of a web-based international survey. BMJ Open Diabetes Res Care 2015; 3:e000109. [PMID: 26301097 PMCID: PMC4537916 DOI: 10.1136/bmjdrc-2015-000109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/17/2015] [Accepted: 07/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE In recent years increasing interest in the issue of treatment personalization for type 2 diabetes (T2DM) has emerged. This international web-based survey aimed to evaluate opinions of physicians about tailored therapeutic algorithms developed by the Italian Association of Diabetologists (AMD) and available online, and to get suggestions for future developments. Another aim of this initiative was to assess whether the online advertising and the survey would have increased the global visibility of the AMD algorithms. RESEARCH DESIGN AND METHODS The web-based survey, which comprised five questions, has been available from the homepage of the web-version of the journal Diabetes Care throughout the month of December 2013, and on the AMD website between December 2013 and September 2014. Participation was totally free and responders were anonymous. RESULTS Overall, 452 physicians (M=58.4%) participated in the survey. Diabetologists accounted for 76.8% of responders. The results of the survey show wide agreement (>90%) by participants on the utility of the algorithms proposed, even if they do not cover all possible needs of patients with T2DM for a personalized therapeutic approach. In the online survey period and in the months after its conclusion, a relevant and durable increase in the number of unique users who visited the websites was registered, compared to the period preceding the survey. CONCLUSIONS Patients with T2DM are heterogeneous, and there is interest toward accessible and easy to use personalized therapeutic algorithms. Responders opinions probably reflect the peculiar organization of diabetes care in each country.
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Affiliation(s)
- Marco Gallo
- Department of Oncological Endocrinology, AOU Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Edoardo Mannucci
- Department of Diabetes Agency, Careggi Teaching Hospital, Florence, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sandro Gentile
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | | | | | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Stefano Genovese
- Department of Cardiovascular and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico Gruppo Multimedica, Sesto San Giovanni, Italy
| | - Gerardo Medea
- Italian College of General Practitioners (Società Italiana di Medicina Generale), Florence, Italy
| | - Antonio Ceriello
- Department of Endocrinology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
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Ceriello A, Gallo M, Candido R, De Micheli A, Esposito K, Gentile S, Medea G. Personalized therapy algorithms for type 2 diabetes: a phenotype-based approach. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2014; 7:129-36. [PMID: 24971031 PMCID: PMC4070713 DOI: 10.2147/pgpm.s50288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Type 2 diabetes is a progressive disease with a complex and multifactorial pathophysiology. Patients with type 2 diabetes show a variety of clinical features, including different “phenotypes” of hyperglycemia (eg, fasting/preprandial or postprandial). Thus, the best treatment choice is sometimes difficult to make, and treatment initiation or optimization is postponed. This situation may explain why, despite the existing complex therapeutic armamentarium and guidelines for the treatment of type 2 diabetes, a significant proportion of patients do not have good metabolic control and at risk of developing the late complications of diabetes. The Italian Association of Medical Diabetologists has developed an innovative personalized algorithm for the treatment of type 2 diabetes, which is available online. According to the main features shown by the patient, six algorithms are proposed, according to glycated hemoglobin (HbA1c, ≥9% or ≤9%), body mass index (≤30 kg/m2 or ≥30 kg/m2), occupational risk potentially related to hypoglycemia, chronic renal failure, and frail elderly status. Through self-monitoring of blood glucose, patients are phenotyped according to the occurrence of fasting/preprandial or postprandial hyperglycemia. In each of these six algorithms, the gradual choice of treatment is related to the identified phenotype. With one exception, these algorithms contain a stepwise approach for patients with type 2 diabetes who are metformin-intolerant. The glycemic targets (HbA1c, fasting/preprandial and postprandial glycemia) are also personalized. This accessible and easy to use algorithm may help physicians to choose a personalized treatment plan for each patient and to optimize it in a timely manner, thereby lessening clinical inertia.
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Affiliation(s)
- Antonio Ceriello
- Department of Endocrinology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Spain ; Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas, Barcelona, Spain
| | - Marco Gallo
- Oncological Endocrinology, AOU Città della Salute e della Scienza-Molinette, Turin, Italy
| | | | | | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Sandro Gentile
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Gerardo Medea
- Italian College of General Practitioners, Florence, Italy
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Gallo M, Candido R, De Micheli A, Esposito K, Gentile S, Ceriello A. Acarbose vs metformin for new-onset type 2 diabetes. Lancet Diabetes Endocrinol 2014; 2:104. [PMID: 24622707 DOI: 10.1016/s2213-8587(13)70217-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marco Gallo
- Oncological Endocrinology, AO Città della Salute e della Scienza-Molinette, Via Genova, 3, I-10137 Turin, Italy.
| | | | | | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Sandro Gentile
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Antonio Ceriello
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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Mulimba AAC, Byron-Daniel J. Motivational interviewing-based interventions and diabetes mellitus. ACTA ACUST UNITED AC 2014; 23:8-14. [DOI: 10.12968/bjon.2014.23.1.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Anderson M, Powell J, Campbell KM, Taylor JR. Optimal management of type 2 diabetes in patients with increased risk of hypoglycemia. Diabetes Metab Syndr Obes 2014; 7:85-94. [PMID: 24623984 PMCID: PMC3949696 DOI: 10.2147/dmso.s48896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
With the number of individuals diagnosed with type 2 diabetes on the rise, it has become more important to ensure these patients are effectively treated. The Centers for Disease Control and Prevention estimated that 8.3% of all Americans were diagnosed with diabetes in 2011 and this number will likely continue to rise. With lifestyle interventions, such as proper diet and exercise, continuing to be an essential component of diabetes treatment, more patients are requiring medication therapy to help them reach their therapeutic goals. It is important for the clinician, when determining the treatment strategy for these individuals, to find a balance between reaching treatment goals and limiting the adverse effects of the treatments themselves. Of all the adverse events associated with treatment of diabetes, the risk of hypoglycemia is one that most therapies have in common. This risk is often a limiting factor when attempting to aggressively treat diabetic patients. This manuscript will review how hypoglycemia is defined and categorized, as well as discuss the prevalence of hypoglycemia among the many different treatment options.
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Affiliation(s)
- Morgan Anderson
- North Florida/South Georgia Veterans Health System, Malcom Randall VAMC, Gainesville, FL, USA
| | - Jason Powell
- University of Florida, College of Pharmacy, Gainesville, FL, USA
| | - Kendall M Campbell
- The Center for Underrepresented Minorities in Academic Medicine, The Florida State University College of Medicine Tallahassee, FL, USA
| | - James R Taylor
- University of Florida, College of Pharmacy, Gainesville, FL, USA
- Correspondence: James R Taylor, University of Florida, College of Pharmacy, 1225 Center Drive HPNP Bulding, Room 3309 Gainesville, FL 32610, USA, Tel +1 352 273 6239, Fax +1 352 273 6242, Email
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15
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Esposito K, Gentile S, Candido R, De Micheli A, Gallo M, Medea G, Ceriello A. Management of hyperglycemia in type 2 diabetes: evidence and uncertainty. Cardiovasc Diabetol 2013; 12:81. [PMID: 23721170 PMCID: PMC3669612 DOI: 10.1186/1475-2840-12-81] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/19/2013] [Indexed: 01/12/2023] Open
Abstract
The panoply of treatment algorithms, periodically released to improve guidance, is one mean to face therapeutic uncertainty in pharmacological management of hyperglycemia in type 2 diabetes, especially after metformin failure. Failure of recent guidelines to give advice on the use of specific antidiabetic drugs in patients with co-morbidity may generate further uncertainty, given the frequent association of type 2 diabetes with common comorbidity, including, although not limited to obesity, cardiovascular disease, impaired renal function, and frailty. The Italian Association of Diabetologists (Associazione Medici Diabetologi, AMD) recognized the need to develop personalized treatment plans for people with type 2 diabetes, taking into account the patients' individual profile (phenotype), with the objective of the safest possible glycemic control. As not every subject with type 2 diabetes benefits from intensive glycemic control, flexible regimens of treatment with diabetes drugs (including insulin) are needed for reaching individualized glycemic goals. Whether personalized diabetology will improve the quality healthcare practice of diabetes management is unknown, but specific research has been launched.
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Affiliation(s)
- Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
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16
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Schnell O, Alawi H, Battelino T, Ceriello A, Diem P, Felton AM, Grzeszczak W, Harno K, Kempler P, Satman I, Vergès B. Self-monitoring of blood glucose in type 2 diabetes: recent studies. J Diabetes Sci Technol 2013; 7:478-88. [PMID: 23567007 PMCID: PMC3737650 DOI: 10.1177/193229681300700225] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing role for structured and personalized self-monitoring of blood glucose (SMBG) in management of type 2 diabetes has been underlined by randomized and prospective clinical trials. These include Structured Testing Program (or STeP), St. Carlos, Role of Self-Monitoring of Blood Glucose and Intensive Education in Patients with Type 2 Diabetes Not Receiving Insulin, and Retrolective Study Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes (or ROSSO)-in-praxi follow-up. The evidence for the benefit of SMBG both in insulin-treated and non-insulin-treated patients with diabetes is also supported by published reviews, meta-analyses, and guidelines. A Cochrane review reported an overall effect of SMBG on glycemic control up to 6 months after initiation, which was considered to subside after 12 months. Particularly, the 12-month analysis has been criticized for the inclusion of a small number of studies and the conclusions drawn. The aim of this article is to review key publications on SMBG and also to put them into perspective with regard to results of the Cochrane review and current aspects of diabetes management.
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center Munich, Ingolstädter Landstrasse 1, 85764 Munich-Neuherberg, Germany.
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17
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Abstract
During the last years, various novel anti-diabetic drugs have considerably enriched the therapeutic armamentarium for subjects with Type 2 diabetes. In the meantime, much interest has recently been focused on the potential cardiovascular and oncological adverse effects of these new therapies. As to glucagon-like peptide 1 (GLP-1) analogs, medullary thyroid tumors were reported to be more common in rodent toxicology studies with liraglutide, although the relevance of this finding in humans has been questioned. Analyses of sequential changes in calcitonin levels in several thousands of subjects did not reveal a relationship between liraglutide therapy and plasma calcitonin. Furthermore, no medullary thyroid cancer has been detected in humans taking liraglutide. Nevertheless, the long-term consequences of sustained GLP-1 receptor activation in the human thyroid remain unknown and deserve further investigation.
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Affiliation(s)
- M Gallo
- Oncological Endocrinology, AO Citta' della Salute e della Scienza-Molinette, Via Genova, 3, I-10137 Turin, Italy.
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18
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Ceriello A, Barkai L, Christiansen JS, Czupryniak L, Gomis R, Harno K, Kulzer B, Ludvigsson J, Némethyová Z, Owens D, Schnell O, Tankova T, Taskinen MR, Vergès B, Weitgasser R, Wens J. Diabetes as a case study of chronic disease management with a personalized approach: the role of a structured feedback loop. Diabetes Res Clin Pract 2012; 98:5-10. [PMID: 22917639 DOI: 10.1016/j.diabres.2012.07.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/10/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
As non-communicable or chronic diseases are a growing threat to human health and economic growth, political stakeholders are aiming to identify options for improved response to the challenges of prevention and management of non-communicable diseases. This paper is intended to contribute ideas on personalized chronic disease management which are based on experience with one major chronic disease, namely diabetes mellitus. Diabetes provides a pertinent case of chronic disease management with a particular focus on patient self-management. Despite advances in diabetes therapy, many people with diabetes still fail to achieve treatment targets thus remaining at risk of complications. Personalizing the management of diabetes according to the patient's individual profile can help in improving therapy adherence and treatment outcomes. This paper suggests using a six-step cycle for personalized diabetes (self-)management and collaborative use of structured blood glucose data. E-health solutions can be used to improve process efficiencies and allow remote access. Decision support tools and algorithms can help doctors in making therapeutic decisions based on individual patient profiles. Available evidence about the effectiveness of the cycle's constituting elements justifies expectations that the diabetes management cycle as a whole can generate medical and economic benefit.
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Affiliation(s)
- Antonio Ceriello
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Hospital Clínic Barcelona, Barcelona, Spain.
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19
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Ceriello A, Gallo M, Gentile S, Giorda CB, De Micheli A. To what extent is the new position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 'personalised'? Diabetologia 2012; 55:2853-2855. [PMID: 22801904 DOI: 10.1007/s00125-012-2642-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Affiliation(s)
- A Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain, .
| | - M Gallo
- Oncological Endocrinology, University Hospital San Giovanni Battista, Turin, Italy
| | - S Gentile
- Department of Geriatrics and Metabolic Disease, Second University of Naples, Naples, Italy
| | - C B Giorda
- Diabetes and Metabolism Unit, ASL TO5, Chieri, Turin, Italy
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20
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Gallo M, Esposito K, Giugliano D. Diabetes medications and cancer: a way out of uncertainty. Diabetes Res Clin Pract 2012; 97:175-7. [PMID: 22560795 DOI: 10.1016/j.diabres.2012.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Marco Gallo
- Oncological Endocrinology, University Hospital San Giovanni Battista, Turin, Italy.
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21
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Ceriello A. Self-monitoring of blood glucose in type 2 diabetes: is the debate (finally) ending? Diabetes Res Clin Pract 2012; 97:1-2. [PMID: 22503946 DOI: 10.1016/j.diabres.2012.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 03/19/2012] [Indexed: 11/26/2022]
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