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Jeong Y, Lee BJ, Hur W, Lee M, Han SH. Associations of Insulin Resistance and High-Sensitivity C-Reactive Protein with Metabolic Abnormalities in Korean Patients with Type 2 Diabetes Mellitus: A Preliminary Study. Metabolites 2024; 14:371. [PMID: 39057694 PMCID: PMC11279201 DOI: 10.3390/metabo14070371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
We conducted this single-center, retrospective, cohort study to examine whether insulin resistance (IR) and high-sensitivity C-reactive protein (hsCRP) have a relationship with metabolic abnormalities in patients with type 2 diabetes mellitus (T2DM). In a total of 3758 patients (n = 3758) with T2DM, we analyzed medical records and thereby evaluated their baseline characteristics such as age, sex, duration of T2DM, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference, body mass index (BMI), visceral fat thickness (VFT), fasting plasma insulin levels, C-peptide levels, glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-β), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), albuminuria, intima-media thickness (IMT) and hsCRP. The patients were stratified according to the tertile of the K index of the insulin tolerance test (KITT) or hsCRP. Thus, they were divided into the lowest (≥2.37), middle (1.54-2.36) and highest tertile (0-1.53) of KITT and the lowest (0.00-0.49), middle (0.50-1.21) and highest tertile (≥1.22) of hsCRP. Moreover, associations of KITT and hsCRP with metabolic abnormalities, such as steatotic liver disease (SLD), metabolic syndrome (MetS), albuminuria, diabetic retinopathy and carotid atherosclerosis, were also analyzed. There was a significant positive correlation between the prevalence of SLD, MetS, albuminuria and diabetic retinopathy and KITT (p < 0.001). Moreover, there was a significant positive association between the prevalence of SLD, MetS and albuminuria and hsCRP (p < 0.001). In conclusion, our results indicate that clinicians should consider the relationships of IR and hsCRP with metabolic abnormalities in the management of patients with T2DM. However, further large-scale, prospective, multi-center studies are warranted to confirm our results.
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Affiliation(s)
- Yuchul Jeong
- Department of Internal Medicine, Chungna Good Hospital, Incheon 22738, Republic of Korea
| | - Beom Jun Lee
- St. Mary’s Best ENT Clinic, Seoul 08849, Republic of Korea
| | - Wonjai Hur
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea
| | - Minjoon Lee
- Department of Internal Medicine, BS General Hospital, Incheon 23037, Republic of Korea
| | - Se-Hyeon Han
- Department of Companion Animal Industry, College of Health Science, Honam University, Gwangju 62399, Republic of Korea
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Quigley M, Earnest A, Szwarcbard N, Wischer N, Andrikopoulos S, Green S, Zoungas S. Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors. PLoS One 2022; 17:e0263511. [PMID: 35120182 PMCID: PMC8815864 DOI: 10.1371/journal.pone.0263511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 01/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Increasing global diabetes incidence has profound implications for health systems and for people living with diabetes. Guidelines have established clinical targets but there may be variation in clinical outcomes including HbA1c, based on location and practice size. Investigating this variation may help identify factors amenable to systemic improvement interventions. The aims of this study were to identify centre-specific and patient-specific factors associated with variation in HbA1c levels and to determine how these associations contribute to variation in performance across diabetes centres. Methods This cross-sectional study analysed data for 5,872 people with type 1 (n = 1,729) or type 2 (n = 4,143) diabetes mellitus collected through the Australian National Diabetes Audit (ANDA). A linear mixed-effects model examined centre-level and patient-level factors associated with variation in HbA1c levels. Results Mean age was: 43±17 years (type 1), 64±13 (type 2); median disease duration: 18 years (10,29) (type 1), 12 years (6,20) (type 2); female: 52% (type 1), 45% (type 2). For people with type 1 diabetes, volume of patients was associated with increases in HbA1c (p = 0.019). For people with type 2 diabetes, type of centre was associated with reduction in HbA1c (p <0.001), but location and patient volume were not. Associated patient-level factors associated with increases in HbA1c included past hyperglycaemic emergencies (type 1 and type 2, p<0.001) and Aboriginal and Torres Strait Islander status (type 2, p<0.001). Being a non-smoker was associated with reductions in HbA1c (type 1 and type 2, p<0.001). Conclusions Centre-level and patient-level factors were associated with variation in HbA1c, but patient-level factors had greater impact. Interventions targeting patient-level factors conducted at a centre level including sick-day management, smoking cessation programs and culturally appropriate diabetes education for and Aboriginal and Torres Strait Islander peoples may be more important for improving glycaemic control than targeting factors related to the Centre itself.
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Affiliation(s)
- Matthew Quigley
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Szwarcbard
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Natalie Wischer
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Association of Diabetes Centres, Sydney, New South Wales Australia
| | - Sofianos Andrikopoulos
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Diabetes Society, Sydney, New South Wales, Australia
| | - Sally Green
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- School Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, Victoria, Australia
- * E-mail:
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Odularu AT, Ajibade PA. Challenge of diabetes mellitus and researchers’ contributions to its control. OPEN CHEM 2021. [DOI: 10.1515/chem-2020-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of this review study was to assess the past significant events on diabetes mellitus, transformations that took place over the years in the medical records of treatment, countries involved, and the researchers who brought about the revolutions. This study used the content analysis to report the existence of diabetes mellitus and the treatments provided by researchers to control it. The focus was mainly on three main types of diabetes (type 1, type 2, and type 3 diabetes). Ethical consideration has also helped to boost diabetic studies globally. The research has a history path from pharmaceuticals of organic-based drugs to metal-based drugs with their nanoparticles in addition to the impacts of nanomedicine, biosensors, and telemedicine. Ongoing and future studies in alternative medicine such as vanadium nanoparticles (metal nanoparticles) are promising.
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Affiliation(s)
- Ayodele T. Odularu
- Department of Chemistry, University of Fort Hare , Private Bag X1314 , Alice 5700 , Eastern Cape , South Africa
| | - Peter A. Ajibade
- Department of Chemistry, University of KwaZulu-Natal , Pietermaritzburg Campus , Scottsville 3209 , South Africa
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Gembillo G, Ingrasciotta Y, Crisafulli S, Luxi N, Siligato R, Santoro D, Trifirò G. Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia. Int J Mol Sci 2021; 22:4824. [PMID: 34062938 PMCID: PMC8124790 DOI: 10.3390/ijms22094824] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients' quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7-10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.
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Affiliation(s)
- Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (R.S.)
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (Y.I.); (S.C.)
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (Y.I.); (S.C.)
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (Y.I.); (S.C.)
| | - Nicoletta Luxi
- Department of Diagnostics and Public Health, University of Verona, 37100 Verona, Italy; (N.L.); (G.T.)
| | - Rossella Siligato
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (R.S.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (R.S.)
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, 37100 Verona, Italy; (N.L.); (G.T.)
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Valaiyapathi B, Gower B, Ashraf AP. Pathophysiology of Type 2 Diabetes in Children and Adolescents. Curr Diabetes Rev 2020; 16:220-229. [PMID: 29879890 PMCID: PMC7516333 DOI: 10.2174/1573399814666180608074510] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of type 2 diabetes (DM) in children is disturbingly increasing in parallel with the increasing childhood obesity. Better knowledge regarding the pathophysiology of type 2 DM in children is paramount to devise an effective management plan. OBJECTIVE Discuss the pathophysiology of type 2 DM in children and adolescents. METHODS AND RESULTS This is a comprehensive review of the literature on this topic. Type 2 DM in childhood is viewed as a continuum of insulin resistance (IR) which is determined by an underlying genetic predisposition, intrauterine environment, excessive food consumption, continued rapid weight gain, and poor lifestyle. Besides IR, this is compounded by multiple metabolic defects including β-cell dysfunction and inadequate insulin secretion, α-cell dysfunction, hyperglucagonemia and increased hepatic glucose production, lipotoxicity, inflammation, deficiencies in incretin production and action, and increased renal glucose reabsorption. The confluence of genetic and environmental factors underscores the complexity in disease progression. CONCLUSION A consistent single risk factor for type 2 DM is obesity and related IR and therefore it is essential to curtail the progression of obesity. It is important to investigate the role of stringent dietary and nutritional approaches, medications that enhance β-cell function and insulin sensitivity.
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Affiliation(s)
- Badhma Valaiyapathi
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ambika P. Ashraf
- Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, The University of Alabama at Birmingham, Birmingham, AL, USA
- Address correspondence to this author at the Department Pediatric Endocrinology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; Tel: 205 638 9107, Fax: 205 638 9821; E-mail:
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Vaughan EM, Johnston CA, Cardenas VJ, Moreno JP, Foreyt JP. Integrating CHWs as Part of the Team Leading Diabetes Group Visits: A Randomized Controlled Feasibility Study. THE DIABETES EDUCATOR 2017; 43:589-599. [PMID: 29047326 PMCID: PMC5753422 DOI: 10.1177/0145721717737742] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. Methods This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n = 50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Results Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Conclusions Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system-level intervention to improve glycemic control and achieve guideline concordance.
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Affiliation(s)
- Elizabeth M Vaughan
- Department of Medicine, Baylor College of Medicine, Houston, Texas (Dr Vaughan, Dr Foreyt)
| | - Craig A Johnston
- Department of Health & Human Performance and the Texas Obesity Research Center, University of Houston, Houston, Texas (Dr Johnston)
| | - Victor J Cardenas
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas (Dr Cardenas)
| | - Jennette P Moreno
- Department of Pediatrics-Nutrition SDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas (Dr Moreno)
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas (Dr Vaughan, Dr Foreyt)
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Ramli AS, Selvarajah S, Daud MH, Haniff J, Abdul-Razak S, Tg-Abu-Bakar-Sidik TMI, Bujang MA, Chew BH, Rahman T, Tong SF, Shafie AA, Lee VKM, Ng KK, Ariffin F, Abdul-Hamid H, Mazapuspavina MY, Mat-Nasir N, Chan CW, Yong-Rafidah AR, Ismail M, Lakshmanan S, Low WHH. Effectiveness of the EMPOWER-PAR Intervention in Improving Clinical Outcomes of Type 2 Diabetes Mellitus in Primary Care: A Pragmatic Cluster Randomised Controlled Trial. BMC FAMILY PRACTICE 2016; 17:157. [PMID: 27842495 PMCID: PMC5109682 DOI: 10.1186/s12875-016-0557-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting. METHODS This was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c < 6.5%. Secondary outcomes were the change in proportion of patients achieving targets for blood pressure, lipid profile, body mass index and waist circumference. Intention to treat analysis was performed for all outcome measures. A generalised estimating equation method was used to account for baseline differences and clustering effect. RESULTS A total of 888 type 2 diabetes mellitus patients were recruited at baseline (intervention: 471 vs. CONTROL 417). At 1-year, 96.6 and 97.8% of patients in the intervention and control groups completed the study, respectively. The baseline demographic and clinical characteristics of both groups were comparable. The change in the proportion of patients achieving HbA1c target was significantly higher in the intervention compared to the control group (intervention: 3.0% vs. CONTROL -4.1%, P < 0.002). Patients who received the EMPOWER-PAR intervention were twice more likely to achieve HbA1c target compared to those in the control group (adjusted OR 2.16, 95% CI 1.34-3.50, P < 0.002). However, there was no significant improvement found in the secondary outcomes. CONCLUSIONS This study demonstrates that the EMPOWER-PAR intervention was effective in improving the primary outcome for type 2 diabetes in the Malaysian public primary care setting. TRIAL REGISTRATION Registered with: ClinicalTrials.gov.: NCT01545401 . Date of registration: 1st March 2012.
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Affiliation(s)
- Anis Safura Ramli
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Sharmini Selvarajah
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Maryam Hannah Daud
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Jamaiyah Haniff
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Suraya Abdul-Razak
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | | | - Mohamad Adam Bujang
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Thuhairah Rahman
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Asrul Akmal Shafie
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Verna K. M. Lee
- Department of Family Medicine, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Kien Keat Ng
- Faculty of Medicine & Defense Health, National Defense University of Malaysia, Sungai Besi Camp, Kuala Lumpur, Malaysia
| | - Farnaza Ariffin
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Hasidah Abdul-Hamid
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Md Yasin Mazapuspavina
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Nafiza Mat-Nasir
- Discipline of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100 Batu Caves, Selangor Malaysia
| | - Chun W. Chan
- Department of Family Medicine, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Abdul Rahman Yong-Rafidah
- Discipline of Family Medicine, Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor Malaysia
| | - Mastura Ismail
- Klinik Kesihatan Seremban 2, Seremban, Negeri Sembilan Malaysia
| | - Sharmila Lakshmanan
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Wilson H. H. Low
- Monash Health, Monash Medical Centre, Clayton Campus, Clayton, VIC Australia
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Ross SA, Caballero AE, Del Prato S, Gallwitz B, Lewis-D'Agostino D, Bailes Z, Thiemann S, Patel S, Woerle HJ, von Eynatten M. Linagliptin plus metformin in patients with newly diagnosed type 2 diabetes and marked hyperglycemia. Postgrad Med 2016; 128:747-754. [PMID: 27684308 DOI: 10.1080/00325481.2016.1238280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Few studies of oral glucose-lowering drugs exist in newly diagnosed type 2 diabetes (T2D) patients with marked hyperglycemia, and insulin is often proposed as initial treatment. We evaluated the oral initial combination of metformin and linagliptin, a dipeptidyl peptidase-4 inhibitor, in this population. METHODS We performed a pre-specified subgroup analysis of a randomized study in which newly diagnosed T2D patients with glycated hemoglobin A1c (HbA1c) 8.5%-12.0% received linagliptin/metformin or linagliptin monotherapy. Subgroups of baseline HbA1c, age, body-mass index (BMI), renal function, race, and ethnicity were evaluated, with efficacy measured by HbA1c change from baseline after 24 weeks. RESULTS HbA1c reductions from baseline (mean 9.7%) at week 24 in the overall population were an adjusted mean -2.81% ± 0.12% with linagliptin/metformin (n = 132) and -2.02% ± 0.13% with linagliptin (n = 113); treatment difference -0.79% (95% CI -1.13 to -0.46, P < 0.0001). In patients with baseline HbA1c ≥9.5%, HbA1c reduction was -3.37% with linagliptin/metformin (n = 76) and -2.53% with linagliptin (n = 61); difference -0.84% (95% CI -1.32 to -0.35). In those with baseline HbA1c <9.5%, HbA1c reduction was -2.08% with linagliptin/metformin (n = 56) and -1.39% with linagliptin (n = 52); difference -0.69% (95% CI -1.23 to -0.15). Changes in HbA1c and treatment differences between the linagliptin/metformin and linagliptin groups were of similar magnitudes to the overall population across patient subgroups based on age, BMI, renal function, and race. Drug-related adverse events occurred in 8.8% and 5.7% of linagliptin/metformin and linagliptin patients, respectively; no severe hypoglycemia occurred. CONCLUSION Linagliptin/metformin combination in newly diagnosed T2D patients with marked hyperglycemia was well tolerated and elicited substantial improvements in glycemic control regardless of baseline HbA1c, age, BMI, renal function, or race. Thus, newly diagnosed, markedly hyperglycemic patients may be effectively treated by combinations of oral agents. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT01512979.
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Affiliation(s)
- Stuart A Ross
- a LMC Endocrinology Centres , University of Calgary , Calgary , Canada
| | | | - Stefano Del Prato
- c Department of Endocrinology and Metabolism, Section of Diabetes , University of Pisa , Pisa , Italy
| | - Baptist Gallwitz
- d Department of Medicine IV , Universitätsklinikum Tübingen , Tübingen , Germany
| | | | | | - Sandra Thiemann
- g Boehringer Ingelheim Pharma GmbH & Co. KG , Ingelheim , Germany
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Mast MR, Walraven I, Hoekstra T, Jansen APD, van der Heijden AAWA, Elders PJM, Heine RJ, Dekker JM, Nijpels G, Hugtenburg JG. Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System. Diabet Med 2016; 33:794-802. [PMID: 26946450 DOI: 10.1111/dme.13110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/28/2022]
Abstract
AIMS To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy. METHODS The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion criteria were: age ≥ 40 years; initiation of insulin during follow-up after failure to reach HbA1c levels ≤ 53 mmol/mol (7%) with oral glucose-lowering agents; and a follow up ≥ 2 years after initiating insulin. Latent class growth modelling was used to identify trajectories of HbA1c . Subjects considered to be 'off target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during one-third or more of the follow-up time, and those considered to be 'on target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during less than one-third of the follow-up time. RESULTS Four HbA1c trajectories were identified. Most people (88.7%) were classified as having a stable HbA1c trajectory of ~57 mmol/mol (7.4%). Only 24.4% of the people were on target in response to insulin; this was associated with lower HbA1c levels and a higher age at the start of insulin treatment. CONCLUSIONS Using latent class growth modelling, four HbA1c trajectories were identified. A quarter of the people starting insulin were on target. Low HbA1c levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy. Initiating insulin earlier improves the likelihood of achieving and sustaining glycaemic control.
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Affiliation(s)
- M R Mast
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands
| | - I Walraven
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands
| | - T Hoekstra
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - A P D Jansen
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - A A W A van der Heijden
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - P J M Elders
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - R J Heine
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J M Dekker
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
| | - G Nijpels
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - J G Hugtenburg
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands
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10
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Yavuz DG, Bilen H, Sancak S, Garip T, Hekimsoy Z, Sahin I, Yilmaz M, Aydin H, Atmaca A, Sert M, Karakaya P, Arpaci D, Oguz A, Guvener N. Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naïve type 2 diabetes patients: dropout study. Patient Prefer Adherence 2016; 10:851-61. [PMID: 27274207 PMCID: PMC4876103 DOI: 10.2147/ppa.s100626] [Citation(s) in RCA: 5] [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: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetes patients initiated on different insulin regimens in a 3-month period. METHODS A total of 1,456 insulin-naïve patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection. RESULTS Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093-2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999-1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011-2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028-1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection. CONCLUSION Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University Faculty of Medicine, Istanbul, Turkey
- Correspondence: Dilek Gogas Yavuz, Department of Endocrinology and Metabolism, Faculty of Medicine, Marmara University, Fevzi Cakmak Mahallesi, Muhsin Yazicioglu Caddesi, No 10, Ust Kaynarca, Pendik, 34584 Istanbul, Turkey, Tel/fax +90 216 625 4685, Email
| | - Habip Bilen
- Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Seda Sancak
- Clinic of Endocrinology and Metabolism, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Tayfun Garip
- Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Murat Yilmaz
- Department of Endocrinology and Metabolism, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Hasan Aydin
- Department of Endocrinology and Metabolism, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Ondokuzmayıs University Faculty of Medicine, Samsun, Turkey
| | - Murat Sert
- Department of Endocrinology and Metabolism, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Pinar Karakaya
- Clinic of Endocrinology and Metabolism, Bakırkoy Training and Research Hospital, Istanbul, Turkey
| | - Dilek Arpaci
- Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, Turkey
| | - Aytekin Oguz
- Department of Internal Medicine, Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Nilgun Guvener
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Istanbul, Turkey
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11
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Shen W, Li Y, Zhang Y, Wu T, Hung Yu Ng E, Wu X. Acupuncture for adults with type 2 diabetes mellitus. Hippokratia 2015. [DOI: 10.1002/14651858.cd010491.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Wenjuan Shen
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine; Department of Obstetrics and Gynecology; No.26 Heping Road, Xiangfang District Harbin Heilongjiang China 150040
| | - Yan Li
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine; Department of Obstetrics and Gynecology; No.26 Heping Road, Xiangfang District Harbin Heilongjiang China 150040
| | - Yang Zhang
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine; Department of Internal Medicine; Heping Road 26, Xiangfang District Harbin Heilongjiang China 150040
| | - Taixiang Wu
- West China Hospital, Sichuan University; Chinese Clinical Trial Registry, Chinese Ethics Committee of Registering Clinical Trials; No. 37, Guo Xue Xiang Chengdu Sichuan China 610041
| | - Ernest Hung Yu Ng
- University of Hong Kong, Queen Mary Hospital; Department of Obstetrics and Gynaecology; Pokfulam Road Hong Kong Hong Kong Hong Kong
| | - XiaoKe Wu
- National Key Discipline and Clinical Base, Heilongjiang University of Chinese Medicine; Department of Obstetrics and Gynaecology; Harbin China 150040
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12
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Yi NY, He Q, Caligan TB, Smith GR, Forsberg LJ, Brenman JE, Sexton JZ. Development of a Cell-Based Fluorescence Polarization Biosensor Using Preproinsulin to Identify Compounds That Alter Insulin Granule Dynamics. Assay Drug Dev Technol 2015; 13:558-69. [PMID: 26505612 PMCID: PMC4955689 DOI: 10.1089/adt.2015.665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Diabetes currently affects 9.3% of the U.S. population totaling $245 billion annually in U.S. direct and indirect healthcare costs. Current therapies for diabetes are limited in their ability to control blood glucose and/or enhance insulin sensitivity. Therefore, innovative and efficacious therapies for diabetes are urgently needed. Herein we describe a fluorescent insulin reporter system (preproinsulin-mCherry, PPI-mCherry) that tracks live-cell insulin dynamics and secretion in pancreatic β-cells with utility for high-content assessment of real-time insulin dynamics. Additionally, we report a new modality for sensing insulin granule packaging in conventional high-throughput screening (HTS), using a hybrid cell-based fluorescence polarization (FP)/internal FRET biosensor using the PPI-mCherry reporter system. We observed that bafilomycin, a vacuolar H(+) ATPase inhibitor and inhibitor of insulin granule formation, significantly increased mCherry FP in INS-1 cells with PPI-mCherry. Partial least squares regression analysis demonstrated that an increase of FP by bafilomycin is significantly correlated with a decrease in granularity of PPI-mCherry signal in the cells. The increased FP by bafilomycin is due to inhibition of self-Förster resonant energy transfer (homo-FRET) caused by the increased mCherry intermolecular distance. FP substantially decreases when insulin is tightly packaged in the granules, and the homo-FRET decreases when insulin granule packaging is inhibited, resulting in increased FP. We performed pilot HTS of 1782 FDA-approved small molecules and natural products from Prestwick and Enzo chemical libraries resulting in an overall Z'-factor of 0.52 ± 0.03, indicating the suitability of this biosensor for HTS. This novel biosensor enables live-cell assessment of protein-protein interaction/protein aggregation in live cells and is compatible with conventional FP plate readers.
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Affiliation(s)
- Na Young Yi
- Biomanufacturing Research Institute and Technology Enterprise, Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina
| | - Qingping He
- Biomanufacturing Research Institute and Technology Enterprise, Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina
| | - Thomas B. Caligan
- Biomanufacturing Research Institute and Technology Enterprise, Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina
| | - Ginger R. Smith
- Biomanufacturing Research Institute and Technology Enterprise, Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina
| | - Lawrence J. Forsberg
- The Neuroscience Center and Department of Cell Biology & Physiology, UNC Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jay E. Brenman
- The Neuroscience Center and Department of Cell Biology & Physiology, UNC Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jonathan Z. Sexton
- Biomanufacturing Research Institute and Technology Enterprise, Department of Pharmaceutical Sciences, North Carolina Central University, Durham, North Carolina
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13
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Vivian E. Sodium-Glucose Cotransporter 2 Inhibitors in the Treatment of Type 2 Diabetes Mellitus. DIABETES EDUCATOR 2015; 41:5S-18S. [DOI: 10.1177/0145721715607643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose The purpose of this review article is to provide guidance to clinicians and diabetes educators regarding the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors as a therapeutic option for the treatment of patients with type 2 diabetes mellitus (T2DM). Methods The PubMed database was searched through February 2015 to identify clinical trials and meta-analyses evaluating the use of the SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin administered as monotherapy or in combination with other oral antidiabetes drugs or with insulin. Results SGLT2 inhibitors reduce hyperglycemia in an insulin-independent manner by inhibiting the reabsorption of glucose into the systemic circulation by the kidneys. In patients with T2DM, SGLT2 inhibitors provide consistent reductions in glycated hemoglobin, fasting plasma and postprandial glucose, body weight, and blood pressure when used as monotherapy or in combination with other oral antidiabetes agents or with insulin. SGLT2 inhibitors are associated with a low risk of hypoglycemia, except when used with agents known to be associated with a higher risk of hypoglycemia, such as sulfonylureas or insulin. Conclusions The unique renal-specific mechanism of action and favorable efficacy and safety profile of SGLT2 inhibitors support consideration of these antidiabetes agents as a treatment option for patients with T2DM.
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Affiliation(s)
- Eva Vivian
- School of Pharmacy, University of Wisconsin, Madison, Wisconsin (Dr Vivian)
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14
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Ji L, Lu J, Weng J, Jia W, Tian H, Zhu D, Xing X, Guo L. China type 2 diabetes treatment status survey of treatment pattern of oral drugs users. J Diabetes 2015; 7:166-73. [PMID: 24809622 DOI: 10.1111/1753-0407.12165] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/04/2014] [Accepted: 05/03/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim of the present study was to investigate the current status of oral anti-diabetic drug (OAD) therapy in patients with type 2 diabetes and influencing factors in a real-world setting in China. METHODS A total of 9872 outpatients with type 2 diabetes, who had received OADs (monotherapy or combination therapy) for at least 3 months were recruited in this study. Current antidiabetic treatment regimen and related clinical data were collected from medical records and analyzed. RESULTS The most common OADs in use were insulin secretagogues (70.2%) such as sulfonylureas (SUs; 42.7%) or glinides (27.5%), followed by metformin (53.7%), α-glucosidase inhibitors (35.9%), thiazolidinediones (17.2%), and dipeptidyl peptidase-4 (DPP-4) inhibitors (0.8%). Dual-drug combination therapy was more common (45.4%) than monotherapy (35.8%) and combination therapy with at least three drugs (17.0%). Patients on SU or glinide monotherapy were more likely to alter their treatment frequently (odds ratio [OR], 1.7; 95% CI, 1.38-2.08; P < 0.001). CONCLUSIONS The status of OAD use in China is varied with a majority of the patients altering their treatment regimen citing poor effectiveness. These observations from a real-world setting may serve as guidance for improving diabetes management in China.
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Affiliation(s)
- Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
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15
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Ross SA, Caballero AE, Del Prato S, Gallwitz B, Lewis-D'Agostino D, Bailes Z, Thiemann S, Patel S, Woerle HJ, von Eynatten M. Initial combination of linagliptin and metformin compared with linagliptin monotherapy in patients with newly diagnosed type 2 diabetes and marked hyperglycaemia: a randomized, double-blind, active-controlled, parallel group, multinational clinical trial. Diabetes Obes Metab 2015; 17:136-44. [PMID: 25298165 DOI: 10.1111/dom.12399] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/22/2014] [Accepted: 09/30/2014] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate glucose-lowering treatment strategies with linagliptin and metformin in people with newly diagnosed type 2 diabetes and marked hyperglycaemia, a prevalent population for which few dedicated studies of oral antidiabetes drugs have been conducted. METHODS A total of 316 patients, with type 2 diabetes diagnosed for ≤12 months and with glycated haemoglobin (HbA1c) concentration in the range 8.5-12.0%, were randomized 1:1 to double-blind, free-combination treatment with linagliptin 5 mg once daily and metformin twice daily (uptitrated to 2000 mg/day maximum) or to linagliptin monotherapy. The primary endpoint was change in HbA1c concentration from baseline at week 24 (per-protocol completers' cohort: n = 245). RESULTS The mean (standard deviation) age and HbA1c at baseline were 48.8 (11.0) years and 9.8 (1.1)%, respectively. At week 24, the mean ± standard error (s.e.) HbA1c decreased from baseline by -2.8 ± 0.1% with linagliptin/metformin and -2.0 ± 0.1% with linagliptin; a treatment difference of -0.8% (95% confidence interval -1.1 to -0.5; p <0.0001). Similar results were observed in a sensitivity analysis based on intent-to-treat principles: adjusted mean ± s.e. changes in HbA1c of -2.7 ± 0.1% and -1.8 ± 0.1%, respectively; treatment difference of -0.9% (95% CI -1.3 to -0.6; p <0.0001). A treatment response of HbA1c <7.0% was achieved by 61 and 40% of patients in the linagliptin/metformin and linagliptin groups, respectively. Few patients experienced drug-related adverse events (8.8 and 5.7% of patients in the linagliptin/metformin and linagliptin groups, respectively). Hypoglycaemia occurred in 1.9 and 3.2% of patients in the linagliptin/metformin and linagliptin groups, respectively (no severe episodes). Body weight decreased significantly with the combination therapy (-1.3 kg between-group difference; p =0.0033). CONCLUSIONS Linagliptin in initial combination with metformin in patients with newly diagnosed type 2 diabetes and marked hyperglycaemia, an understudied group, elicited significant improvements in glycaemic control with a low incidence of hypoglycaemia, weight gain or other adverse effects. These results support early combination treatment strategies and suggest that newly diagnosed patients with marked hyperglycaemia may be effectively managed with oral, non-insulin therapy.
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Affiliation(s)
- S A Ross
- University of Calgary, LMC Endocrinology Centres, Calgary, Alberta, Canada
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16
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Yavuz DG, Ozcan S, Deyneli O. Adherence to insulin treatment in insulin-naïve type 2 diabetic patients initiated on different insulin regimens. Patient Prefer Adherence 2015; 9:1225-31. [PMID: 26346988 PMCID: PMC4556254 DOI: 10.2147/ppa.s87935] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to evaluate adherence to insulin treatment in terms of treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetic patients initiating insulin therapy with basal (long acting), basal-bolus, and premixed insulin regimens in a tertiary endocrinology outpatient clinic. METHODS A total of 433 (mean age of 55.5±13.0 years; 52.4% females) insulin-naïve type 2 diabetic patients initiated on insulin therapy were included in this questionnaire-based phone interview survey at the sixth month of therapy. Via the telephone interview questions, patients were required to provide information about persistence to insulin treatment, self-reported blood glucose values, and side effects; data on demographics and diabetes characteristics were obtained from medical records. RESULTS Self-reported treatment withdrawal occurred in 20.1% patients, while 20.3% patients were nonadherent to daily insulin. Negative beliefs about insulin therapy (24.1%) and forgetting injections (40.9%) were the most common reasons for treatment withdrawal and dose skipping, respectively. Younger age (49.5±15.0 vs 56.4±12.0 years) (P=0.001) and shorter duration of diabetes (4.8±4.3 vs 8.8±6.3 years) (P=0.0008) and treatment duration (5.2±2.4 vs 10.7±2.4 months) (P=0.0001) were noted, respectively, in discontinuers vs continuers. Basal bolus was the most commonly prescribed insulin regimen (51.0%), while associated with higher likelihood of skipping a dose than regular use (61.3% vs. 46.0%, P=0.04). CONCLUSIONS Persistence to insulin therapy was poorer than anticipated but appeared to be higher in patients with the basal bolus regimen. Negative perceptions about insulin therapy seemed to be the main cause for poor adherence in our cohort.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
- Correspondence: Dilek Gogas Yavuz, Department of Endocrinology and Metabolism, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddessi No:41, Pendik Kaynarca Istanbul 34890, Turkey, Tel +90 216 625 4685, Fax +90 216 625 4685, Email
| | - Sevim Ozcan
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Oguzhan Deyneli
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
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Adherence to premixed insulin in a prefilled pen compared with a vial/syringe in people with diabetes in Singapore. Clin Ther 2014; 36:1043-53. [PMID: 24913030 DOI: 10.1016/j.clinthera.2014.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/25/2014] [Accepted: 05/16/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The real-world clinical effectiveness of exogenous insulin is limited by nonadherence. Various insulin delivery systems have been developed to help improve adherence, with prefilled pens gaining popularity among adult Singaporeans with diabetes. However, adherence to insulin in people with diabetes in Singapore and most of Asia has not been studied. OBJECTIVES This study aimed to compare adherence to premixed insulin formulated in a prefilled pen versus a vial/syringe and to identify predictors of adherence in 955 patients managed at the outpatient clinics of the largest acute care hospital in Singapore. METHODS In this retrospective longitudinal study, electronic medical and pharmacy refill records were used to determine adherence to insulin over 24 months, measured in terms of compliance and persistence. Compliance is expressed as the medication possession ratio (used as continuous and categorical variables), and persistence is reported as a dichotomous variable with a permissible refill gap of 30 days before discontinuation of therapy is considered. Multivariate linear or logistic regression analysis was used to identify predictors of adherence. RESULTS Compared with prefilled pen users, vial/syringe users were older (mean [SD] age, 64.1 [10.6] vs 62.4 [11.9] years; P = 0.032), and more were undergoing polypharmacy (69.6% vs 54.1%; P < 0.001). The mean (SD) medication possession ratio was comparable in vial/syringe versus prefilled pen users (83.8% [26.9%] vs 86.0% [23.2%]; P = 0.266). Prefilled pen users were more persistent with therapy compared with vial/syringe users (odds ratio = 1.36; 95% CI, 1.01-1.86) after adjusting for sociodemographic and clinical covariates. Median time to discontinuation of therapy was comparable (vial/syringe vs prefilled pen: 409 vs 532 days; P = 0.076). Being managed by an endocrinologist and not receiving government subsidies were significant predictors of persistence. CONCLUSIONS Compared with other studies that found strong associations between adherence and insulin devices, the findings of this study suggest that persistence but not compliance varies by insulin device. The willingness to pay for health care, in addition to affordability, may affect insulin therapy adherence. Patients with uncontrolled diabetes due to suspected nonadherence may benefit from referral to a multidisciplinary care team comprising endocrinologists, diabetes nurse educators, dietitians, and allied health professionals. These findings are applicable to outpatients with similar demographic features managed at other acute care hospitals in Singapore. The impact of insulin devices on glycemic control needs to be investigated in future larger studies.
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Balducci S, Sacchetti M, Haxhi J, Orlando G, D'Errico V, Fallucca S, Menini S, Pugliese G. Physical exercise as therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev 2014; 30 Suppl 1:13-23. [PMID: 24353273 DOI: 10.1002/dmrr.2514] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/19/2013] [Indexed: 12/14/2022]
Abstract
Many studies have highlighted the importance of physical activity (PA) for health, and recent evidence now points to the positive improvements associated with exercise in type 2 diabetes mellitus (T2DM). However, few physicians are willing to prescribe exercise as a therapy for diabetic patients. In addition, there is a lack of information on how to implement exercise therapy especially in long-term exercise regimens. The purpose of this manuscript is to summarize standards of exercise therapy for patients with T2DM, both in terms of prescribing and monitoring, according to the American College of Sports Medicine and the American Diabetes Association guidelines. We present details of the exercise therapies used in long-term studies, describing how the parameters for exercise prescription were applied in clinical practice. These parameters are described in terms of frequency, intensity, duration, mode and rate of progression in long-term therapeutic prescriptions. Individual responses to exercise dose are discussed, and critical issues to be considered in patients with underlying disease and in T2DM patients are highlighted.
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Affiliation(s)
- Stefano Balducci
- Metabolic Fitness Association, Rome, Italy; Department of Clinical and Molecular Medicine, 'La Sapienza' University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
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Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care 2013; 36:3411-7. [PMID: 23877982 PMCID: PMC3816889 DOI: 10.2337/dc13-0331] [Citation(s) in RCA: 453] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine time to treatment intensification in people with type 2 diabetes treated with one, two, or three oral antidiabetes drugs (OADs) and associated levels of glycemic control. RESEARCH DESIGN AND METHODS This was a retrospective cohort study based on 81,573 people with type 2 diabetes in the U.K. Clinical Practice Research Datalink between January 2004 and December 2006, with follow-up until April 2011. RESULTS In people with HbA1c ≥7.0, ≥7.5, or ≥8.0% (≥53, ≥58, or ≥64 mmol/mol), median time from above HbA1c cutoff to intensification with an additional OAD was 2.9, 1.9, or 1.6 years, respectively, for those taking one OAD and >7.2, >7.2, and >6.9 years for those taking two OADs. Median time to intensification with insulin was >7.1, >6.1, or 6.0 years for those taking one, two, or three OADs. Mean HbA1c at intensification with an OAD or insulin for people taking one, two, or three OADs was 8.7, 9.1, and 9.7%. In patients taking one, two, or three OADs, median time from treatment initiation to intensification with an OAD or insulin exceeded the maximum follow-up time of 7.2 years. The probability of patients with poor glycemic control taking one, two, or three OADs, intensifying at end of follow-up with an OAD, was 21.1-43.6% and with insulin 5.1-12.0%. CONCLUSIONS There are delays in treatment intensification in people with type 2 diabetes despite suboptimal glycemic control. A substantial proportion of people remain in poor glycemic control for several years before intensification with OADs and insulin.
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Ji LN, Pan CY, Lu JM, Li H, Li Q, Li QF, Peng YD, Tian HM, Yao C, Zhao ZG, Zhang RY, Wang XL, Wang L. Efficacy and safety of combination therapy with vildagliptin and metformin versus metformin up-titration in Chinese patients with type 2 diabetes mellitus: study design and rationale of the vision study. Cardiovasc Diabetol 2013; 12:118. [PMID: 23958390 PMCID: PMC3766124 DOI: 10.1186/1475-2840-12-118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/13/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Limitations of the currently recommended stepwise treatment pathway for type 2 diabetes mellitus (T2DM), especially the failure of monotherapies to maintain good glycemic control, have prompted use of early, more aggressive combination therapies.The VISION study is designed to explore the efficacy and safety of vildagliptin as an add-on to metformin therapy compared with up-titration of metformin monotherapy in Chinese patients with T2DM. METHODS VISION, a 24-week, phase 4, prospective, randomized, multicenter, open-label, parallel-group study, will include 3312 Chinese T2DM patients aged ≥18 years who are inadequately controlled (6.5% >HbA1c ≤9%) by metformin (750-1000 mg/day). Eligible patients will be randomized to receive either vildagliptin plus metformin or up-titration of metformin monotherapy (5:1). Patients will also be subgrouped (1:1:1:1) based on their age and body mass index (BMI): <60 years and <24 kg/m²; <60 years and ≥24 kg/m²; ≥60 years and <24 kg/m²; and ≥60 years and ≥24 kg/m². CONCLUSION The VISION study will test the hypothesis that early use of combination therapy with vildagliptin and metformin will provide good glycemic control and will be better tolerated than up-titration of metformin monotherapy. The study will also correlate these benefits with age and BMI.
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Affiliation(s)
- Li-Nong Ji
- Peking University People’s Hospital, 11 Xizhimen Nan Dajie, Xicheng District, Beijing, China
| | - Chang-Yu Pan
- Chinese PLA General Hospital, No. 28 Fuxing Street, Beijing 100853, China
| | - Ju-Ming Lu
- Chinese PLA General Hospital, No. 28 Fuxing Street, Beijing 100853, China
| | - Hong Li
- Sir Run Run Shaw Hospital, Zhejiang University Medical College, Hangzhou, China
| | - Qiang Li
- The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qi-Fu Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-De Peng
- Shanghai First People's Hospital, Shanghai, China
| | - Hao-Ming Tian
- West China Hospital, Sichuan University, Chengdu, China
| | - Chen Yao
- Peking University First Hospital, Beijing, China
| | - Zhi-Gang Zhao
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Ru-Ya Zhang
- Beijing Novartis Pharma Co. Ltd, Beijing, China
| | | | - Lei Wang
- Beijing Novartis Pharma Co. Ltd, Beijing, China
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Ross SA, Rafeiro E, Meinicke T, Toorawa R, Weber-Born S, Woerle HJ. Efficacy and safety of linagliptin 2.5 mg twice daily versus 5 mg once daily in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, placebo-controlled trial. Curr Med Res Opin 2012; 28:1465-74. [PMID: 22816729 DOI: 10.1185/03007995.2012.714360] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Glycaemic control in patients with type 2 diabetes (T2DM) is often not achieved or not sustained using monotherapy such as metformin, necessitating the addition of other antihyperglycaemic agents. Linagliptin, a dipeptidyl peptidase-4 inhibitor, is licensed for 5 mg once-daily dosing. As metformin is administered twice daily, a fixed-dose combination of these compounds would require twice-daily administration of linagliptin. This study evaluated whether 2.5 mg twice-daily dosing of linagliptin has comparable efficacy and safety to 5 mg once-daily dosing when given in addition to metformin twice daily in patients with inadequate glycaemic control. METHODS A total of 491 T2DM patients with glycated haemoglobin (HbA1c) 7.0-10.0% were randomised (5:5:1) to double-blind treatment with linagliptin 2.5 mg twice daily, 5 mg once daily or placebo, respectively, in addition to continuing metformin twice daily (≥1500 mg/day or maximally tolerated dose). The primary endpoint was change from baseline in HbA1c after 12 weeks. ClinicalTrials.gov, NCT01012037. RESULTS Mean baseline HbA1c for all patients was 7.97%. After 12 weeks, linagliptin 2.5 mg twice daily and 5 mg once daily both significantly reduced HbA1c (placebo-adjusted changes from baseline -0.74% (95% CI -0.97, -0.52) and -0.80% (95% CI -1.02, -0.58), respectively, both p<0.0001). The treatment difference (twice daily-once daily) between the linagliptin regimens was 0.06 (95% CI -0.07, 0.19), the upper bound of which was less than the predefined noninferiority margin (0.35%). The overall incidence of adverse events with linagliptin 2.5 mg twice daily, 5 mg once daily and placebo was 43.0%, 34.8%, and 38.6% respectively. Hypoglycaemia was rare (3.1% with linagliptin 2.5 mg twice daily, 0.9% with 5 mg once daily, 2.3% with placebo) with no severe episodes. Study limitations include duration, patient population (mainly white) and absence of postprandial glucose data. CONCLUSIONS Linagliptin 2.5 mg twice daily had non-inferior HbA1c-lowering effects after 12 weeks compared to 5 mg once daily, with comparable safety and tolerability, in T2DM patients inadequately controlled with metformin.
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Affiliation(s)
- Stuart A Ross
- University of Calgary, LMC Endocrinology Centres, Calgary, Alberta, Canada.
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22
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Acute and chronic administration of SHR117887, a novel and specific dipeptidyl peptidase-4 inhibitor, improves metabolic control in diabetic rodent models. Acta Pharmacol Sin 2012; 33:1013-22. [PMID: 22842733 DOI: 10.1038/aps.2012.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Dipeptidyl deptidase-4 (DPP-4) inhibitors are a new class of anti-diabetic agents. The purpose of this study was to assess the acute and chronic effects of SHR117887, a novel DPP-4 inhibitor, on metabolic control and pancreatic β-cell function in normal or diabetic rodent models. METHODS In the acute experiments, ICR mice, diet-induced obese (DIO) rats and ob/ob mice were subjected to an oral glucose tolerance test (OGTT) following a single oral administration of SHR117887 (0.1, 0.3, 1 or 3 mg/kg). Blood samples were collected to measure glucose, insulin, DPP-4 activity and active GLP-1 level. In the chronic experiments, ob/ob mice was administered SHR117887 (3, 10 or 30 mg/kg) twice daily for 33 d to assess the effects on metabolic control and pancreatic β-cell function. Vildagliptin (LAF237) was used as a positive control in all the experiments. RESULTS Acute oral administration of SHR117887 dose-dependently decreased the serum DPP-4 activity and improved glucose tolerance in ICR mice, DIO rats and ob/ob mice. This was accompanied by significant increases in the serum active GLP-1 and insulin levels. Chronic administration of SHR117887 significantly decreased fasting blood glucose level and improved the lipid profiles in ob/ob mice by reducing the serum triglyceride and free fatty acid levels, and its efficacy was comparable with that of vildagliptin at the same molarity. Moreover, chronic administration of SHR117887 increased the insulin staining of islet cells, which is suggestive of improved β-cell function. CONCLUSION SHR117887 is a potent DPP-4 inhibitor that improves metabolic control and β-cell function in diabetic rodent models, suggesting that it could be a new therapeutic agent for the treatment of type 2 diabetes.
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Haak T, Meinicke T, Jones R, Weber S, von Eynatten M, Woerle HJ. Initial combination of linagliptin and metformin improves glycaemic control in type 2 diabetes: a randomized, double-blind, placebo-controlled study. Diabetes Obes Metab 2012; 14:565-74. [PMID: 22356132 DOI: 10.1111/j.1463-1326.2012.01590.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the efficacy and safety of initial combination therapy with linagliptin plus metformin versus linagliptin or metformin monotherapy in patients with type 2 diabetes. METHODS In this 24-week, double-blind, placebo-controlled, Phase III trial, 791 patients were randomized to one of six treatment arms. Two free combination therapy arms received linagliptin 2.5 mg twice daily (bid) + either low (500 mg) or high (1000 mg) dose metformin bid. Four monotherapy arms received linagliptin 5 mg once daily, metformin 500 mg or 1000 mg bid or placebo. Patients with haemoglobin A1c (HbA1c) ≥11.0% were not eligible for randomization and received open-label linagliptin + high-dose metformin. RESULTS The placebo-corrected mean (95% confidence interval) change in HbA1c from baseline (8.7%) to week 24 was -1.7% (-2.0, -1.4) for linagliptin + high-dose metformin, -1.3% (-1.6, -1.1) for linagliptin + low-dose metformin, -1.2% (-1.5, -0.9) for high-dose metformin, -0.8% (-1.0, -0.5) for low-dose metformin and -0.6 (-0.9, -0.3) for linagliptin (all p < 0.0001). In the open-label arm, the mean change in HbA1c from baseline (11.8%) was -3.7%. Hypoglycaemia occurred at a similar low rate with linagliptin + metformin (1.7%) as with metformin alone (2.4%). Adverse event rates were comparable across treatment arms. No clinically significant changes in body weight were noted. CONCLUSIONS Initial combination therapy with linagliptin plus metformin was superior to metformin monotherapy in improving glycaemic control, with a similar safety and tolerability profile, no weight gain and a low risk of hypoglycaemia.
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Affiliation(s)
- Thomas Haak
- Diabetes Center Mergentheim, Bad Mergentheim, Germany.
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24
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Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med 2012; 29:682-9. [PMID: 22313123 PMCID: PMC3433794 DOI: 10.1111/j.1464-5491.2012.03605.x] [Citation(s) in RCA: 439] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens. METHODS Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA. RESULTS One third (33.2%) of patients reported insulin omission/non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission/non-adherence and 5.7 days per month of prandial insulin omission/non-adherence. Patients and providers indicated the same five most common reasons for insulin omission/non-adherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives. CONCLUSIONS Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission/non-adherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia.
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Affiliation(s)
- M Peyrot
- Department of Sociology, Loyola University of Maryland, Baltimore, MD 21210-2699, USA.
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Sinclair AJ, Alexander CM, Davies MJ, Zhao C, Mavros P. Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes. BMC Endocr Disord 2012; 12:1. [PMID: 22397700 PMCID: PMC3353844 DOI: 10.1186/1472-6823-12-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 03/07/2012] [Indexed: 11/10/2022] Open
Abstract
AIM To assess the factors associated with antihyperglycaemic medication initiation in UK patients with newly diagnosed type 2 diabetes. METHODS In a retrospective cohort study, patients with newly diagnosed type 2 diabetes were identified during the index period of 2003-2005. Eligible patients were ≥ 30 years old at the date of the first observed diabetes diagnosis (referred to as index date) and had at least 2 years of follow-up medical history (N = 9,158). Initiation of antihyperglycaemic medication (i.e., treatment) was assessed in the 2-year period following the index date. Adjusted Cox regression models were used to examine the association between time to medication initiation and patient age and other factors. RESULTS Mean (SD) HbA1c at diagnosis was 8.1% (2.3). Overall, 51% of patients initiated antihyperglycaemic medication within 2 years (65%, 55%, 46% and 40% for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively). Among the treated patients, median (25th, 75th percentile) time to treatment initiation was 63 (8, 257) days. Of the patients with HbA1c ≥ 7.5% at diagnosis, 87% initiated treatment within 2 years. These patients with a higher HbA1c also had shorter time to treatment initiation (adjusted hazard ratio (HR) = 2.44 [95% confidence interval (CI): 1.61, 3.70]; p < 0.0001). Increasing age (in years) was negatively associated with time to treatment initiation (HR = 0.98 [95% CI: 0.97, 0.99]; p < 0.001). Factors significantly associated with shorter time to treatment initiation included female gender and use of cardiovascular medications at baseline or initiated during follow up. CONCLUSIONS In this UK cohort of patients with newly diagnosed type 2 diabetes, only 51% had antihyperglycaemic medication initiated over a 2-year period following diagnosis. Older patients were significantly less likely to have been prescribed antihyperglycaemic medications. Elevated HbA1c was the strongest factor associated with initiating antihyperglycaemic medication in these patients.
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Affiliation(s)
| | | | | | | | - Panagiotis Mavros
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
- Global Health Outcomes, Merck Sharp & Dohme Corp, Mail: WS2E76, 1 Merck Drive, Whitehouse Station, NJ 08889, USA
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Baetta R, Corsini A. Pharmacology of dipeptidyl peptidase-4 inhibitors: similarities and differences. Drugs 2012; 71:1441-67. [PMID: 21812507 DOI: 10.2165/11591400-000000000-00000] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The dipeptidyl peptidase (DPP)-4 inhibitors, which enhance glucose-dependent insulin secretion from pancreatic β cells by preventing DPP-4-mediated degradation of endogenously released incretin hormones, represent a new therapeutic approach to the management of type 2 diabetes mellitus. The 'first-in-class' DPP-4 inhibitor, sitagliptin, was approved in 2006; it was followed by vildagliptin (available in the EU and many other countries since 2007, although approval in the US is still pending), saxagliptin (in 2009), alogliptin (in 2010, presently only in Japan) and linagliptin, which was approved in the US in May 2011 and is undergoing regulatory review in Japan and the EU. As the number of DPP-4 inhibitors on the market increases, potential differences among the different members of the class become important when deciding which agent is best suited for an individual patient. The aim of this review is to provide a comprehensive and updated comparison of the pharmacodynamic and pharmacokinetic properties of DPP-4 inhibitors, and to pinpoint pharmacological differences of potential interest for their use in therapy. Despite their common mechanism of action, these agents show significant structural heterogeneity that could translate into different pharmacological properties. At the pharmacokinetic level, DPP-4 inhibitors have important differences, including half-life, systemic exposure, bioavailability, protein binding, metabolism, presence of active metabolites and excretion routes. These differences could be relevant, especially in patients with renal or hepatic impairment, and when considering combination therapy. At the pharmacodynamic level, the data available so far indicate a similar glucose-lowering efficacy of DPP-4 inhibitors, either as monotherapy or in combination with other hypoglycaemic drugs, a similar weight-neutral effect, and a comparable safety and tolerability profile. Data on nonglycaemic parameters are scant at present and do not allow a comparison among DPP-4 inhibitors. Several phase III trials of DPP-4 inhibitors are currently ongoing; these trials, along with post-marketing surveillance data, will hopefully increase our knowledge about the long-term efficacy and safety of DPP-4 inhibitor therapy, the effect on pancreatic cell function and peripheral glucose metabolism, and the effect on cardiovascular outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Roberta Baetta
- Department of Pharmacological Sciences, University of Milan, Italy.
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Kania DS, Gonzalvo JD, Weber ZA. Saxagliptin: A Clinical Review in the Treatment of Type 2 Diabetes Mellitus. Clin Ther 2011; 33:1005-22. [DOI: 10.1016/j.clinthera.2011.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2011] [Indexed: 12/24/2022]
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Lee SW, Kim YC, Oh SW, Koo HS, Na KY, Chae DW, Kim S, Chin HJ. Trends in the prevalence of chronic kidney disease, other chronic diseases and health-related behaviors in an adult Korean population: data from the Korean National Health and Nutrition Examination Survey (KNHANES). Nephrol Dial Transplant 2011; 26:3975-80. [PMID: 21454352 DOI: 10.1093/ndt/gfr154] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an increasing public health problem. However, there have been limited data on the trend of CKD prevalence, along with the changes of health-related behaviors and other chronic diseases in an adult Korean population. METHODS Data from the Korean National Health and Nutrition Examination Survey in 2005 and 2007 were analyzed. The study subjects comprised 8400 participants aged ≥ 20 years with creatinine data. CKD was defined as estimated glomerular filtration rate (GFR) <60 mL/min/1.73m(2). GFR was estimated by the abbreviated Modification of Diet in Renal Disease equation. RESULTS The CKD prevalence was significantly decreased from 2005 to 2007 (8.8 versus 7.2%; P = 0.010). The prevalence of hypertension was stable but that of diabetes was increased. The proportion of blood pressure (BP) <130/80 mmHg in the whole population, and HbA1c <7% in the diabetic participants was increased from 2005 to 2007. Participants in 2007 walked more than those in 2005. The proportion of current smoking and sodium/energy/protein excess was decreased from 2005 to 2007. In subgroup analysis, only hypertensive participants without diabetes revealed a decreasing trend of CKD. CONCLUSIONS The CKD prevalence was decreased from 2005 to 2007. Since increased diabetes and improved diabetic control neutralized their impact on CKD, improved BP was the fundamental reason for the decrease. Various health-related behaviors may have indirectly affected the decrease of CKD through their effect in controlling BP and diabetes.
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Affiliation(s)
- Seong Woo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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