1
|
Kunutsor SK, Balasubramanian VG, Zaccardi F, Gillies CL, Aroda VR, Seidu S, Khunti K. Glycaemic control and macrovascular and microvascular outcomes: A systematic review and meta-analysis of trials investigating intensive glucose-lowering strategies in people with type 2 diabetes. Diabetes Obes Metab 2024; 26:2069-2081. [PMID: 38409644 DOI: 10.1111/dom.15511] [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: 01/03/2024] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
AIM We aimed to determine the macrovascular and microvascular outcomes of intensive versus standard glucose-lowering strategies in type 2 diabetes (T2D) and investigate the relationships between these outcomes and trial arm glycated haemoglobin (HbA1c) reduction. MATERIALS AND METHODS In this systematic review and meta-analysis, we identified relevant trials from MEDLINE, Embase, the Cochrane Library, and bibliographies up to August 2023. Macrovascular and microvascular outcomes, along with safety outcomes, were evaluated. Pooled study-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and meta-regression was employed to analyse the relationships between outcomes and HbA1c reduction. RESULTS We included 11 unique RCTs involving 51 469 patients with T2D (intensive therapy, N = 26 691; standard therapy, N = 24 778). Intensive versus standard therapy reduced the risk of non-fatal myocardial infarction (MI) (HR 0.84; 95% CI 0.75-0.94) with no difference in the risk of major adverse cardiovascular events (HR 0.97; 95% CI 0.92-1.03) and other adverse cardiovascular outcomes. Intensive versus standard therapy reduced the risk of retinopathy (HR 0.85; 0.78-0.93), nephropathy (HR 0.71; 0.58-0.87) and composite microvascular outcomes (HR 0.88; 0.77-1.00). Meta-regression analyses showed modest evidence of inverse linear relationships between HbA1c reduction and the outcomes of major adverse cardiovascular events, non-fatal MI, stroke and retinopathy, but these were not statistically significant. CONCLUSIONS In people with T2D, intensive glucose control was associated with a reduced risk of non-fatal MI and several microvascular outcomes, particularly retinopathy and nephropathy. The lack of an effect of intensive glucose-lowering on most macrovascular outcomes calls for a more comprehensive approach to managing cardiovascular risk factors alongside glycaemic control.
Collapse
Affiliation(s)
- Setor K Kunutsor
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Victoria G Balasubramanian
- Diabetes Research Centre, University of Leicester, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Vanita R Aroda
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| |
Collapse
|
2
|
Wang K, Zhao S, Lee EKP, Yau SZM, Wu Y, Hung CT, Yeoh EK. Risk of Dementia Among Patients With Diabetes in a Multidisciplinary, Primary Care Management Program. JAMA Netw Open 2024; 7:e2355733. [PMID: 38345817 PMCID: PMC10862158 DOI: 10.1001/jamanetworkopen.2023.55733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Although poorly controlled diabetes is associated with a higher incidence of dementia, few studies have examined the association of diabetes management interventions with dementia incidence. Objective To examine the association of receiving a multidisciplinary diabetes management program (the Risk Assessment and Management Program-Diabetes Mellitus [RAMP-DM]) that enables better glycemic control with subsequent risk of dementia incidence and the association of dementia with glycemic control. Design, Setting, and Participants This territory-wide, retrospective, matched cohort study with more than 8 years of follow-up was conducted using electronic health care records from all the patients who used public health care services in Hong Kong from 2011 to 2019. Eligible participants included all patients with type 2 diabetes (T2D) who were managed in primary care settings. Patients who received RAMP-DM were matched in a 1:1 ratio with patients who received usual care only. Data analysis occurred from April 2023 to July 2023. Exposures Diagnosis of T2D, hemoglobin A1C (HbA1C) level, and attendance at a general outpatient clinic or family medicine clinic. Patients received either RAMP-DM or usual care. Main Outcomes and Measures Incidence of all-cause dementia and subtypes of dementia were compared between the RAMP-DM and usual care participants using a Cox proportional hazard model with other baseline characteristics, biomarkers, and medication history adjusted. HbA1C levels were measured as a secondary outcome. Results Among the 55 618 matched participants (mean [SD] age, 62.28 [11.90] years; 28 561 female [51.4%]; 27 057 male [48.6%]), including the 27 809 patients in the RAMP-DM group and 27 809 patients in the usual care group, patients had been diagnosed with T2D for a mean (SD) of 5.90 (4.20) years. During a median (IQR) follow-up period of 8.4 (6.8-8.8) years, 1938 patients in the RAMP-DM group (6.97%) and 2728 patients in the usual care group (9.81%) received a diagnosis of dementia. Compared with those receiving usual care, RAMP-DM participants had a lower risk of developing all-cause dementia (adjusted hazard ratio [aHR], 0.72; 95% CI, 0.68-0.77; P < .001), Alzheimer disease (aHR, 0.85; 95% CI, 0.76-0.96; P = .009), vascular dementia (aHR, 0.61; 95% CI, 0.51-0.73; P < .001), and other or unspecified dementia (aHR, 0.71; 95% CI, 0.66-0.77; P < .001). Compared with having a mean HbA1C level during the first 3 years after cohort entry between 6.5% and 7.5%, a higher risk of dementia incidence was detected for patients with a 3-year mean HbA1C level greater than 8.5% (aHR, 1.54; 95% CI, 1.31-1.80]), between 7.5% and 8.5% (aHR, 1.33; 95% CI, 1.19-1.48), between 6% and 6.5% (aHR, 1.17; 95% CI, 1.07-1.29), and 6% or less (aHR, 1.39; 95% CI, 1.24-1.57). Conclusions and Relevance In this cohort study of patients with T2D, the findings strengthened evidence of an association of glycemic control with dementia incidence, and revealed that a multidisciplinary primary care diabetes management program was associated with beneficial outcomes for T2D patients against dementia and its major subtypes. A moderate glycemic control target of HbA1C between 6.5% and 7.5% was associated with lower dementia incidence.
Collapse
Affiliation(s)
- Kailu Wang
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Shi Zhao
- School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Tianjin Medical University, Tianjin, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Eric Kam-Pui Lee
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Susan Zi-May Yau
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yushan Wu
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Tim Hung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
3
|
Olvera-Barrios A, Owen CG, Anderson J, Warwick AN, Chambers R, Bolter L, Wu Y, Welikala R, Fajtl J, Barman SA, Remagnino P, Chew EY, Ferris FL, Hingorani AD, Sofat R, Lee AY, Egan C, Tufail A, Rudnicka AR. Ethnic disparities in progression rates for sight-threatening diabetic retinopathy in diabetic eye screening: a population-based retrospective cohort study. BMJ Open Diabetes Res Care 2023; 11:e003683. [PMID: 37949472 PMCID: PMC10649497 DOI: 10.1136/bmjdrc-2023-003683] [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: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual eye screening. We examined incidence and determinants of sight-threatening diabetic retinopathy (STDR) in a sociodemographically diverse multi-ethnic population. RESEARCH DESIGN AND METHODS North East London DESP cohort data (January 2012 to December 2021) with 137 591 PLD with no retinopathy, or non-STDR at baseline in one/both eyes, were used to calculate STDR incidence rates by sociodemographic factors, diabetes type, and duration. HR from Cox models examined associations with STDR. RESULTS There were 16 388 incident STDR cases over a median of 5.4 years (IQR 2.8-8.2; STDR rate 2.214, 95% CI 2.214 to 2.215 per 100 person-years). People with no retinopathy at baseline had a lower risk of sight-threatening diabetic retinopathy (STDR) compared with those with non-STDR in one eye (HR 3.03, 95% CI 2.91 to 3.15, p<0.001) and both eyes (HR 7.88, 95% CI 7.59 to 8.18, p<0.001). Black and South Asian individuals had higher STDR hazards than white individuals (HR 1.57, 95% CI 1.50 to 1.64 and HR 1.36, 95% CI 1.31 to 1.42, respectively). Additionally, every 5-year increase in age at inclusion was associated with an 8% reduction in STDR hazards (p<0.001). CONCLUSIONS Ethnic disparities exist in a health system limited by capacity rather than patient economic circumstances. Diabetic retinopathy at first screen is a strong determinant of STDR development. By using basic demographic characteristics, screening programmes or clinical practices can stratify risk for sight-threatening diabetic retinopathy development.
Collapse
Affiliation(s)
- Abraham Olvera-Barrios
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St. George's University of London, London, UK
| | - John Anderson
- Diabetes, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Alasdair N Warwick
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ryan Chambers
- Diabetes, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Louis Bolter
- Diabetes, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Roger and Angie Keralis Johnson Retina Center, Seattle, Washington, USA
| | - Roshan Welikala
- School of Computer Science and Mathematics, Kingston University, London, UK
| | - Jiri Fajtl
- School of Computer Science and Mathematics, Kingston University, London, UK
| | - Sarah A Barman
- School of Computer Science and Mathematics, Kingston University, London, UK
| | - Paolo Remagnino
- Department of Computer Science, Durham University, Durham, UK
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, NEI/NIH, Bethesda, Maryland, USA
| | | | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Roger and Angie Keralis Johnson Retina Center, Seattle, Washington, USA
| | - Catherine Egan
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St. George's University of London, London, UK
| |
Collapse
|
4
|
Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
Collapse
Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
| |
Collapse
|
5
|
Kibirige D, Chamba N, Andia-Biraro I, Kilonzo K, Laizer SN, Sekitoleko I, Kyazze AP, Ninsiima S, Ssekamatte P, Bongomin F, Mrema LE, Olomi W, Mbunda TD, Ntinginya NE, Sabi I, Sharples K, Hill P, Te Brake L, VandeMaat J, vanCrevel R, Critchley JA. Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e060786. [PMID: 36351737 PMCID: PMC9644326 DOI: 10.1136/bmjopen-2022-060786] [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] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes. METHODS We systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the prevalence of five diabetes complications. RESULTS In total, 109 studies with a total of 63 890 participants (53.3% being females) were included in the meta-analysis. Most of the studies were conducted in Eastern African countries (n=44, 40.4%). The pooled proportion of attainment of an optimal HbA1c, BP and LDLC goal was 27% (95% CI 24 to 30, I2=94.7%), 38% (95% CI 30 to 46, I2=98.7%) and 42% (95% CI 32 to 52, I2=97.4%), respectively. The pooled prevalence of diabetic peripheral neuropathy, retinopathy, diabetic nephropathy, peripheral arterial disease and foot ulcers was 38% (95% CI 31 to 45, I2=98.2%), 32% (95% CI 28 to 36, I2=98%), 31% (95% CI 22 to 41, I2=99.3%), 19% (95% CI 12 to 25, I2=98.1%) and 11% (95% CI 9 to 14, I2=97.4%), respectively. CONCLUSION Attainment of optimal diabetes treatment goals, especially HbA1c, in adult patients with type 2 diabetes in Africa remains a challenge. Diabetes complications, especially diabetic peripheral neuropathy and retinopathy, are highly prevalent in adult populations with type 2 diabetes in Africa.
Collapse
Affiliation(s)
- Davis Kibirige
- Department of Medicine, Lubaga Hospital, Kampala, Uganda
| | - Nyasatu Chamba
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunomudation and Vaccines, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Sweetness Naftal Laizer
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Isaac Sekitoleko
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew Peter Kyazze
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sandra Ninsiima
- Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Lucy Elauteri Mrema
- Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | - Willyhelmina Olomi
- Department of Medical Statistics, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | - Theodora D Mbunda
- Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | | | - Issa Sabi
- Department of Paediatrics and Child Health, NIMR-Mbeya Medical Research Programme, Mbeya, Tanzania
| | - Katrina Sharples
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Lindsey Te Brake
- Department of Pharmacology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Josephine VandeMaat
- Department of Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Reinout vanCrevel
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
- University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
| | | |
Collapse
|
6
|
Takahara M, Mita T, Katakami N, Wada F, Morita N, Kidani Y, Yajima T, Shimomura I, Watada H. Three-Year Glycaemic Control and Management in Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER. Diabetes Ther 2022; 13:251-264. [PMID: 34962628 PMCID: PMC8873328 DOI: 10.1007/s13300-021-01192-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION J-DISCOVER is a prospective, observational cohort study that aimed to understand characteristics, glycaemic control, comorbidities and real-world management of patients with early-stage type 2 diabetes mellitus (T2DM) in Japan, by enrolling patients initiating second-line treatment from both diabetes specialist and non-specialist care settings. METHODS As part of the global DISCOVER programme, J-DISCOVER enrolled 1798 patients with T2DM aged at least 20 years old from 142 sites across Japan, from September 2014 to December 2015, and followed these patients for 3 years. Glycaemic control, body mass index (BMI), blood pressure, lipid profiles, treatment patterns, and prevalence of CKD and retinopathy were examined from baseline to 6, 12, 24 and 36 months, stratified by class of second-line treatment. RESULTS At baseline, the median time after T2DM diagnosis was 3.1 years and mean glycated haemoglobin (HbA1c) was 7.7%. The mean individualized HbA1c target was 6.7 ± 0.5%, and 55.3% of patients were set the target of < 7.0%. HbA1c reductions were noted from 6 months and mean HbA1c was 7.1% at 36 months. The proportion of patients with HbA1c < 7.0% increased from 28.8% at baseline to 53.3% at 36 months, and the achievement rate of individualized HbA1c targets increased from 6.1% to 30.3%. Only two cases of severe hypoglycaemia occurred during the study. No major changes in BMI, blood pressure, lipid profile or prescription of antihypertensive or dyslipidaemia medications were observed. The frequencies of screening to detect retinopathy and chronic kidney disease (CKD) were 17.0-21.0% and 14.5-16.0%, respectively, during the follow-up period. The prevalence of CKD, but not retinopathy, increased over the follow-up period. CONCLUSIONS This study provided an overview of the 3-year management of early-stage T2DM in patients initiating second-line treatment. Contemporary management improved glycaemic control with an acceptable risk-benefit balance, although hurdles remain to sufficient implementation of guideline-recommended treatments in current clinical practice. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02226822.
Collapse
Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Fumitaka Wada
- Medical Affairs, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Naru Morita
- Medical Affairs, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Yoko Kidani
- Medical Affairs, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Toshitaka Yajima
- Medical Affairs, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan.
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
Caballero AE, Nordstrom BL, Liao B, Fan L, Zhang N, Fraeman KH, Perez-Nieves M. Individualized HbA1c target selection and achievement in the Multinational Observational Study Assessing Insulin Use (MOSA1c) type 2 diabetes study. J Diabetes Complications 2021; 35:108011. [PMID: 34535360 DOI: 10.1016/j.jdiacomp.2021.108011] [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: 10/21/2020] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
AIM To identify which individual-, physician-, and the healthcare system-related factors can predict individualized hemoglobin A1c (HbA1c) targets and the likelihood of reaching those targets after initial insulin therapy over a two-year follow-up period. METHODS Real-world data, including baseline characteristics of people with type 2 diabetes mellitus (T2DM), psychosocial data, and diabetes medication use, collected from the Multinational Observational Study Assessing Insulin Use (MOSA1c) study in 18 countries were analyzed. RESULTS Overall, 225 of 1194 people with T2DM (18.8%) who received initial insulin therapy for ≥3 months reached HbA1c targets at two-year follow-up; most were likely to be White (64.9%) and perceptions of their relationship with physicians were less positive than those who did not reach HbA1c targets. Higher baseline HbA1c (>8%) was the strongest predictor of being assigned an HbA1c target >7% (odds ratio [OR] 6.06, 95% confidence interval [CI] 3.97, 9.26). A smaller difference between baseline and target HbA1c levels was the strongest predictor of reaching an HbA1c target at two-year follow-up (large vs small difference, OR 0.28, 95% CI 0.17, 0.47). CONCLUSIONS Several factors were significantly associated with establishing individualized HbA1c targets and reaching these targets. A small proportion of people with T2DM on insulin therapy reached their HbA1c target. Personalized management of glycemic targets necessitates the adoption of multi-factorial strategies, as several factors could influence an individual's glycemic outcome. CLINICALTRIALS. GOV IDENTIFIER NCT01400971.
Collapse
Affiliation(s)
| | | | - Birong Liao
- Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - Nan Zhang
- Eli Lilly and Company, Indianapolis, IN 46285, USA
| | | | | |
Collapse
|
8
|
Pretorius D, Couper ID, Mlambo MG. Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34636612 PMCID: PMC8517797 DOI: 10.4102/phcfm.v13i1.2985] [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] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire. AIM The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios. SETTING This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district. METHODS This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group. RESULTS One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group. CONCLUSION Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.
Collapse
Affiliation(s)
- Deidré Pretorius
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
| | | | | |
Collapse
|
9
|
Wood L, Bishop A, Lewis M, Smeets RJEM, Bronfort G, Hayden JA, Foster NE. Treatment targets of exercise for persistent non-specific low back pain: a consensus study. Physiotherapy 2021; 112:78-86. [PMID: 34029781 DOI: 10.1016/j.physio.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Despite several hundred previous randomised controlled trials (RCTs), the key treatment targets of exercise for persistent non-specific low back pain (NSLBP) remain unclear. This study aimed to generate consensus about the key treatment targets of exercise interventions for patients with NSLBP. DESIGN Consensus was generated using modified nominal group technique in two, sequential, workshops. The results of a previous systematic review informed the first, national, workshop idea generation and the results of this workshop informed the second, international, workshop. The authors generated a starting list of 30 treatment targets from the systematic review. A pre-specified consensus threshold of 75% was used in the voting stage. PARTICIPANTS Workshop participants included people with experience of using exercise to manage their persistent NSLBP, clinicians who prescribe exercise for persistent NSLBP, and researchers who design and evaluate exercise interventions in RCTs. All participants generated, voted and ranked the treatment targets in each workshop using an online platform. RESULTS A total of 39 participants contributed to the consensus (15 in the national workshop and 24 in the international workshop), comprising two people with NSLBP, six clinicians and 31 researchers/clinicians. A total of 40 exercise treatment targets were generated, and 25 were retained after voting and ranking. The prioritised targets of exercise for persistent NSLBP were: improving function, improving quality of life, reducing pain, meeting patient-specific goals and reducing fear of movement. CONCLUSIONS Future RCTs of exercise should specify the targets of their exercise intervention and consider assessing these treatment targets as well as including mediation analyses.
Collapse
Affiliation(s)
- Lianne Wood
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham NG 2UH, UK.
| | - Annette Bishop
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, The Netherlands; CIR Revalidatie, Eindhoven, The Netherlands
| | - Gert Bronfort
- Earl E Bakken Centre for Spirituality and Healing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
| |
Collapse
|
10
|
Roldan Munoz S, Postmus D, de Vries ST, Arnardottir AH, Dolu İ, Hillege H, Mol PGM. Differences in Importance Attached to Drug Effects Between Patients With Type 2 Diabetes From the Netherlands and Turkey: A Preference Study. Front Pharmacol 2021; 11:617409. [PMID: 33716729 PMCID: PMC7948228 DOI: 10.3389/fphar.2020.617409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to compare the importance that patients with type 2 diabetes mellitus from the Netherlands and Turkey attach to certain drug effects of oral anti-diabetic drugs. Methods: Data were collected through a cross-sectional survey containing demographic questions and a discrete choice experiment assessing preferences for oral anti-diabetic drugs. Adults from the Netherlands and Turkey were included if they had type 2 diabetes mellitus and had received a prescription of an oral anti-diabetic drug in the last 4 months. The oral anti-diabetic drugs in the discrete choice experiment were described in terms of six attributes: effects on HbA1c, cardiovascular diseases, weight change, gastrointestinal adverse drug events hypoglycemic events, and bladder cancer. Multinomial logit models with country as an interaction factor were fitted. Results: In total, 381 patients were included, 199 from the Netherlands and 182 from Turkey. Patients' preferences toward drug effects varied between the countries. Turkish patients attached the highest importance to reducing the risk of cardiovascular diseases (relative weight: 0.51, 95% CI 0.45-0.55), followed by reducing hypoglycemic events (relative weight: 0.16, 95% CI 0.11-0.22), and reducing gastrointestinal adverse drug events (relative weight: 0.11, 95% CI 0.07-0.18). Patients from the Netherlands attached the highest importance to gastrointestinal ADEs (relative weight: 0.22, 95% CI 0.14-0.39), followed by reducing hypoglycemic events (relative weight: 0.22, 95% CI 0.16-0.25), and reducing the risk of cardiovascular diseases (relative weight: 0.20, 95% CI 0.13-0.23). Conclusion: Patient preferences may differ across countries. Such differences should be acknowledged in regulatory decisions and clinical practice.
Collapse
Affiliation(s)
- Sonia Roldan Munoz
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sieta T de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Arna H Arnardottir
- Department of Pharmaceutical Safety and Efficacy, Dada Consultancy B.V., Nijmegen, Netherlands
| | - İlknur Dolu
- Faculty of Health Science, Bartin University, Bartın, Turkey
| | - Hans Hillege
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Dutch Medicines Evaluation Board, Utrecht, Netherlands
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Dutch Medicines Evaluation Board, Utrecht, Netherlands
| |
Collapse
|
11
|
Brunton SA. Introducing a novel therapy for type 2 diabetes to primary care. Postgrad Med 2020; 132:1-2. [DOI: 10.1080/00325481.2020.1798686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Koto R, Nakajima A, Horiuchi H, Yamanaka H. Factors associated with achieving target serum uric acid level and occurrence of gouty arthritis: A retrospective observational study of Japanese health insurance claims data. Pharmacoepidemiol Drug Saf 2020; 30:157-168. [PMID: 32939919 PMCID: PMC7821287 DOI: 10.1002/pds.5127] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Purpose This study assessed factors associated with achieving target serum uric acid (sUA) level and occurrence of gouty arthritis in Japanese clinical practice. Methods Japanese health insurance claims and medical check‐up data from October 2015 to March 2017 were analyzed to assess factors associated with target sUA achievement in gout and asymptomatic hyperuricemia and gouty arthritis in gout. Target sUA was further assessed by subgroup analysis of urate‐lowering therapy (ULT) prescriptions and outcomes, stratified by renal function. Results Patients achieving target sUA tended toward older, female, higher ULT dose, higher adherence, more comorbidities, and/or antidiabetic drugs prescribed. Renal dysfunction and/or diuretic prescriptions were associated with reduced achievement of target sUA. Severe renal dysfunction was particularly influential (odds ratio [OR] = 0.22 [95% confidence interval (CI): 0.10‐0.48] for <15, 0.15 [0.10‐0.23] for ≥15 to <30, compared with eGFR ≥90 mL/min/1.73 m2). Across all renal function categories, mean prescribed ULT dose was low (febuxostat 17.0‐21.0 mg/day, allopurinol 123.1‐139.6 mg/day), and target sUA achievement was reduced among renal dysfunction patients. Gouty arthritis was more likely in patients with a prior history of such occurrences, and less likely for higher ULT adherence, sUA monitored regularly at medical facilities, and/or more comorbidities. Conclusion In a real‐world setting, severe renal dysfunction is the most important risk factor for failure to achieve the target sUA, suggesting suboptimal disease management in patients with gout or hyperuricemia complicated by this condition. Findings associated with gouty arthritis suggest that these occurrences could be successfully managed by regular monitoring of sUA and closer adherence to ULT.
Collapse
Affiliation(s)
- Ruriko Koto
- Medical Science Department, Teijin Pharma Limited, Tokyo, Japan
| | - Akihiro Nakajima
- Pharmaceutical Development Administration Department, Teijin Pharma Limited, Tokyo, Japan
| | - Hideki Horiuchi
- Medical Science Department, Teijin Pharma Limited, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
13
|
Ceriello A, deValk HW, Guerci B, Haak T, Owens D, Canobbio M, Fritzen K, Stautner C, Schnell O. The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives. Diabetes Res Clin Pract 2020; 161:108053. [PMID: 32035117 DOI: 10.1016/j.diabres.2020.108053] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 02/08/2023]
Abstract
Due to the progressive nature of type 2 diabetes (T2DM), initiation of insulin therapy is very likely in the disease continuum. This article aims at highlighting the current situation with regard to insulin therapy in people with T2DM in Europe and at presenting the associated unmet need. Challenges for both people with T2DM and healthcare professionals include clinical inertia also derived from fear of hypoglycaemia, weight gain and injections as well as increased need for a comprehensive diabetes management. We compare national and international guidelines and recommendations for the initiation and intensification of insulin therapy with the real-world situation in six European countries, demonstrating that glycaemic targets are only met in a minority of people with T2DM on insulin therapy. Furthermore, this work evaluates currently recorded numbers of people with T2DM treated with insulin in Europe, the proportion not achieving the stated glycaemic targets and thus in need to enhance insulin therapy e.g. by a change in means of insulin delivery including, but not limited to, insulin pens, wearable mealtime insulin delivery patches, patch pumps, and conventional insulin pumps with continuous subcutaneous insulin infusion.
Collapse
Affiliation(s)
| | - Harold W deValk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bruno Guerci
- Endocrinology, Diabetology & Nutrition Clinical Unit, Brabois Hospital & Center of Clinical Investigation ILCV, Centre Hospitalier Universitaire of Nancy, University of Lorraine Vandoeuvre-lès-Nancy, France
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Bad Mergentheim, Germany
| | - David Owens
- Diabetes Research Unit Cymru, Swansea University, Swansea, Wales, UK
| | | | | | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany; Forschergruppe Diabetes e.V., Muenchen-Neuherberg, Germany.
| |
Collapse
|
14
|
Morieri ML, Longato E, Mazzucato M, Di Camillo B, Cocchiglia A, Gubian L, Sparacino G, Avogaro A, Fadini GP, Vigili de Kreutzenberg S. Improved long-term cardiovascular outcomes after intensive versus standard screening of diabetic complications: an observational study. Cardiovasc Diabetol 2019; 18:117. [PMID: 31526380 PMCID: PMC6747737 DOI: 10.1186/s12933-019-0922-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Complication screening is recommended for patients with type 2 diabetes (T2D), but the optimal screening intensity and schedules are unknown. In this study, we evaluated whether intensive versus standard complication screening affects long-term cardiovascular outcomes. METHODS In this observational study, we included 368 T2D patients referred for intensive screening provided as a 1-day session of clinical-instrumental evaluation of diabetic complications, followed by dedicated counseling. From a total of 4906 patients, we selected control T2D patients who underwent standard complication screening at different visits, by 2:1 propensity score matching. The primary endpoint was the 4p-MACE, defined as cardiovascular mortality, or non-fatal myocardial infarction, stroke, or heart failure. The Cox proportional regression analyses was used to compare outcome occurrence in the two groups, adjusted for residual confounders. RESULTS 357 patients from the intensive screening group (out of 368) were matched with 683 patients in the standard screening group. Clinical characteristics were well balanced between the two groups, except for a slightly higher prevalence of microangiopathy in the intensive group (56% vs 50%; standardized mean difference 0.11, p = 0.1). Median follow-up was 5.6 years. The adjusted incidence of 4p-MACE was significantly lower in the intensive versus standard screening group (HR 0.70; 95% CI 0.52-0.95; p = 0.02). All components of the primary endpoint had nominally lower rates in the intensive versus standard screening group, which was particularly significant for heart failure (HR 0.43; 95% CI 0.22-0.83; p = 0.01). CONCLUSION Among T2D patients attending a specialist outpatient clinic, intensive complication screening is followed by better long-term cardiovascular outcomes. No significant effect was noted for cardiovascular and all-cause mortality and the benefit was mainly driven by a reduced rate of hospitalization for heart failure.
Collapse
Affiliation(s)
- Mario Luca Morieri
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Enrico Longato
- Department of Information Engineering, University of Padova, 35131, Padua, Italy
| | - Marta Mazzucato
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, 35131, Padua, Italy
| | | | | | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, 35131, Padua, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | | |
Collapse
|
15
|
Role of ultrafast-acting insulin analogues in the management of diabetes. J Am Assoc Nurse Pract 2019; 31:537-548. [DOI: 10.1097/jxx.0000000000000261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Jain M, Carlson G, Cook W, Morrow L, Petrone M, White NE, Wang T, Naylor J, Ambery P, Lee C, Hirshberg B. Randomised, phase 1, dose-finding study of MEDI4166, a PCSK9 antibody and GLP-1 analogue fusion molecule, in overweight or obese patients with type 2 diabetes mellitus. Diabetologia 2019; 62:373-386. [PMID: 30593607 DOI: 10.1007/s00125-018-4789-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS Cardiovascular disease is the leading cause of morbidity and mortality in people with type 2 diabetes. MEDI4166 is a proprotein convertase subtilisin/kexin type 9 (PCSK9) antibody and glucagon-like peptide-1 (GLP-1) analogue fusion molecule designed to treat patients with type 2 diabetes who are at risk for cardiovascular disease. In this completed, first-in-human study, we evaluated the safety and efficacy of single or multiple doses of MEDI4166 in participants with type 2 diabetes. METHODS In this phase 1 study that was conducted across 11 clinics in the USA, eligible adults had type 2 diabetes, a BMI of ≥25 kg/m2 to ≤42 kg/m2, and LDL-cholesterol levels ≥1.81 mmol/l. Participants were randomised 3:1 to receive MEDI4166 or placebo using an interactive voice/web response system, which blinded all participants, investigators and study site personnel to the study drug administered. In 'Part A' of the study, five cohorts of participants received a single s.c. injection of MEDI4166 at 10 mg, 30 mg, 100 mg, 200 mg or 400 mg, or placebo. 'Part B' of the study consisted of three cohorts of participants who received an s.c. dose of MEDI4166 once weekly for 5 weeks at 50 mg, 200 mg or 400 mg, or placebo. The primary endpoint in Part A was safety. The co-primary endpoints in Part B were change in LDL-cholesterol levels and area under the plasma glucose concentration-time curve (AUC0-4h) post-mixed-meal tolerance test (MMTT) from baseline to day 36. The pharmacokinetics and immunogenicity of MEDI4166 were also evaluated. RESULTS MEDI4166 or placebo was administered to n = 30 or n = 10 participants, respectively, in Part A of the study, and n = 48 or n = 15 participants, respectively, in Part B. The incidence of treatment-emergent adverse events (TEAEs) were comparable between MEDI4166 and placebo in both Part A (60% vs 50%) and Part B (79% vs 87%) of the study. Common TEAEs with MEDI4166 included injection-site reactions, diarrhoea and headache; there was no evidence for dose-related increases in TEAEs. In Part B of the study, at all tested doses of MEDI4166, there was a significant decrease in LDL-cholesterol levels vs placebo (least squares mean [95% CI]; MEDI4166 50 mg, -1.25 [-1.66, -0.84]; MEDI4166 200 mg, -1.97 [-2.26, -1.68]; MEDI4166 400 mg, -1.96 [-2.23, -1.70]; placebo, -0.03 [-0.35, 0.28]; all p < 0.0001). However, there were no clinically relevant reductions or significant differences between MEDI4166 vs placebo in glucose AUC0-4h post-MMTT (least squares mean [95% CI]; MEDI4166 50 mg, -10.86 [-17.69, -4.02]; MEDI4166 200 mg, -4.23 [-8.73, 0.28]; MEDI4166 400 mg, -2.59 [-7.14, 1.95]; placebo, -4.84 [-9.95, 0.28]; all p > 0.05). MEDI4166 was associated with a pharmacokinetic profile supportive of weekly dosing and an overall treatment-induced anti-drug antibody-positive rate of 22%. CONCLUSIONS/INTERPRETATION MEDI4166 was associated with an acceptable tolerability profile and significantly decreased LDL-cholesterol levels in a dose-dependent manner in overweight or obese patients with type 2 diabetes. However, there were no significant reductions in postprandial glucose levels at any dose of MEDI4166. TRIAL REGISTRATION ClinicalTrials.gov NCT02524782 FUNDING: This study was funded by MedImmune LLC, Gaithersburg, MD, USA.
Collapse
Affiliation(s)
- Meena Jain
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK.
| | | | | | | | - Marcella Petrone
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Nicholas E White
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Tao Wang
- MedImmune, Gaithersburg, MD, USA
| | - Jacqueline Naylor
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | - Philip Ambery
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, CB21 6GH, UK
| | | | | |
Collapse
|
17
|
Rashid F, Abdelgadir E, Alsaeed M, Alemadi B, Khalifa A, Farooqi MH, Alawadi F, Bashier A. Glycemic and lipids control in patients with diabetes and cardiovascular or renal diseases across all the government health sectors in the Emirate of Dubai, United Arab Emirates. Diabetes Metab Syndr 2019; 13:590-594. [PMID: 30641771 DOI: 10.1016/j.dsx.2018.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/02/2018] [Indexed: 12/17/2022]
Abstract
UNLABELLED The guidelines suggest setting the glycemic and lipid targets according to the stage of the disease and other co -existing complications in the patients with diabetes. AIMS We aimed to evaluate the HbA1c and lipids level in patients with high risk diabetes from 2012-2016, attending different level of care in Dubai health authority. MATERIALS AND METHODS This is a retrospective analysis of the electronic medical records of all patients who attended the Dubai Health authority between 2012-2016. All patients with an ICD code of any type of diabetes in addition to cardiovascular or renal diseases were. Patients were categorized based on their HbA1c into control of<7.5, 7.5 - 8, and >8%. While lipids were categorized as f LDL < 70 mg/dl, and the Non-HDL <100 mg/dl. RESULTS Out of total number of 26647 patients diagnosed with diabetes, 2015 patients did fit the criteria of this study. The desired mean of HbA1c of <7.5% achieved by 21.76% and 28.94% in T1DM and T2DM, respectively. The LDL of < 70 mg/dl was achieved by 27.8% of the patients. CONCLUSION In patients with diabetes and multiple complications, the glycemic and lipids control is suboptimal. However, the pattern showed numerical improvement over the years.
Collapse
|
18
|
Effects of a hydroalcoholic extract of Juglans regia (walnut) leaves on blood glucose and major cardiovascular risk factors in type 2 diabetic patients: a double-blind, placebo-controlled clinical trial. Altern Ther Health Med 2018; 18:206. [PMID: 29973195 PMCID: PMC6031195 DOI: 10.1186/s12906-018-2268-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/22/2018] [Indexed: 01/15/2023]
Abstract
Background We aimed to evaluate the effects of a hydroalcoholic extract of Juglans regia L. leaves on blood glucose level and cardiovascular risk factors in type 2 diabetic patients. Methods In this randomized, double-blind, placebo-controlled, parallel-group (2 arms) clinical trial, 50 diabetic patients were divided into two groups: treatment group (receive the capsules containing 100 mg J. regia leaf extract) and control group (receive the capsules containing placebo, microcrystallin cellulose). Baseline participant data were matched between the two arms of the study. We administered the prepared capsules to the patients twice daily for 8 weeks. Blood glucose level, glycosylated hemoglobin (HbA1c) level, body weight, body mass index, blood pressure, lipid profile, serum insulin, and insulin resistance were compared between the two groups before and after the intervention. P < 0.05 was considered significant. Results After excluding eleven patients, 20 received J. regia leaf extract and 20 patients received placebo. The J. regia leaf extract did not significantly change the blood glucose and insulin resistance condition. However, in this group, body weight, body mass index, and systolic blood pressure significantly decreased compared with the baseline measurements (P = 0.028, P = 0.030, and P = 0.005, respectively). The lipid profile did not change significantly compared with the baseline measurements. In the control group, postprandial glucose and HbA1c levels significantly decreased after the intervention (P = 0.030 and P = 0.028, respectively). The other variables were not significantly different in this group. At the end of the study, the variables were not significantly different between the two groups. Conclusion In this double-blind study, 200 mg/d of J. regia leaf extract had no significant effect on blood glucose level and HOMA-IR score in patients with type 2 diabetes. However, the J. regia leaf extract was effective in reducing body weight and blood pressure. An accidental finding of our study was that microcrystalline cellulose, a widely used placebo in clinical trials, led to a reduction in blood glucose level. Trial registration Iranian Registry of Clinical Trials (IRCT: 138901203180 N2, 2010/6/6); retrospectively registered.
Collapse
|