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Yoon JP, Park SJ, Choi YS, Kim DH, Lee HJ, Park EJJ, Chung SW. Current research trends on the effect of diabetes mellitus on rotator cuff tendon healing/tendinopathy. Arch Orthop Trauma Surg 2024; 144:2491-2500. [PMID: 38698293 DOI: 10.1007/s00402-024-05350-1] [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: 02/15/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
Rotator cuff tendon tears are a leading cause of shoulder pain. They are challenging to treat, and tendon-bone healing has a high failure rate despite successful surgery. Tendons connect the muscles and bones, which make them important for the body's overall mobility and stability. Metabolic diseases, including diabetes or high blood pressure, can affect the healing process after repair of a damaged tendon. With a global incidence of 9.3%, diabetes is considered as a significant risk factor for rotator cuff tendon healing because it causes structural, inflammatory, and vascular changes in the tendon. However, the mechanisms of how diabetes affects tendon healing remain unknown. Several factors have been suggested, including glycation product accumulation, adipokine dysregulation, increased levels of reactive oxygen species, apoptosis, inflammatory cytokines, imbalanced matrix-metalloproteinase-to-tissue-inhibitor ratio, and impaired angiogenesis and differentiation of the tendon sheath. Despite the effects of diabetes on tendon function and healing, few treatments are available to improve recovery in these patients. This review summarizes the current literature on the pathophysiological changes of the tendon in diabetes and hyperlipidemia. Preclinical and clinical evidence regarding the association between diabetes and tendon healing is presented. Moreover, current approaches to improve tendon healing in patients with diabetes are reviewed.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Sung-Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea.
| | - Yoon Seong Choi
- Department of Carbon Hybrid Fiber Science, Kyungpook National University, Daegu, Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Eugene Jae Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, Korea
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Huang D, Du Z, Chen Y, Dong Z, Wang X, Li M, Zhang F, Chen W, Sun L. Bio-Guided Isolation of Two New Hypoglycemic Triterpenoid Saponins from Polygonum capitatum. Drug Des Devel Ther 2021; 15:5001-5010. [PMID: 34949913 PMCID: PMC8689516 DOI: 10.2147/dddt.s341354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/25/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Diabetes is a common disease caused by a combination of genetic and environmental factors, which was the top three diseases threatening human health. Therefore, it is necessary to seek more efficient hypoglycemic drugs. The main objective of this study was to investigate the potential hypoglycemic effects of compounds from Polygonum capitatum. Materials and Methods Our experiments were divided into three steps: (1) α-amylase test and oral starch tolerance test (OSTT) for screening the biological extract part of P. capitatum; (2) chemical isolation and identification using various separation techniques, and spectrum methods; and (3) evaluation of α-amylase inhibitory activity of isolates and in silico analysis for mechanism investigation. Results The n-butanol fractioned part of P. capitatum was confirmed to be the biological part according to α-amylase test. Then, two new triterpenoid saponins were isolated from the n-butanol part, which were also the first isolated triterpenoid saponins from P. capitatum. The activities of compounds 1 and 2 against α-amylase were 51.9±2.8% and 38.1±2.2%, respectively, which was consistent with the molecular docking analysis. In which, 1 and 2 showed the binding affinity energy for α-amylase was −9.4 kcal/mol and −7.8 kcal/mol, respectively. Conclusion Two new triterpenoid saponins were firstly isolated from P. capitatum, and displays potency as a hypoglycemic agent through blocking α-amylase.
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Affiliation(s)
- Doudou Huang
- Department of TCM Processing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Zenan Du
- Department of TCM Processing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yanhong Chen
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Zhiying Dong
- Department of TCM Processing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xiujuan Wang
- Department of TCM Processing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Mengshuang Li
- Department of TCM Processing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Feng Zhang
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Wansheng Chen
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Lianna Sun
- Department of TCM Processing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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Bilgin S, Aktas G, Kurtkulagi O, Atak BM, Kahveci G, Demirkol ME, Duman TT. Characteristics of the type 2 diabetic patients with hypoglycemia in a tertiary referral hospital. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (UKRAINE) 2021; 17:472-476. [DOI: 10.22141/2224-0721.17.6.2021.243209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Background. Hypoglycemia is an important complication of the treatment of type 2 diabetes mellitus, which constitutes a barrier in stringent diabetic control. Beside it constitutes nearly 10 % of emergency department admissions that caused by adverse drug events, it may also increase morbidities and mortality by inducing, cardiac arrhythmias, neurological impairment and ischemic events. Hypoglycemia is the most common side effect of insulin treatment, however, oral antidiabetic agents may also induce hypoglycemic complications. In present retrospective study, we purposed to observe general characteristics and laboratory data of the type 2 diabetic patients whom presented with mild or moderate/severe hypoglycemia. Materials and methods. Patients with type 2 diabetes mellitus whom presented to our institution with hypoglycemia between January 2019 and January 2020 were retrospectively analyzed. General characteristics and laboratory data of the subjects recorded. Patients grouped into two groups, group I consisted of subjects with mild hypoglycemia and group II consisted of patients with moderate/severe hypoglycemia. Data of the subjects in groups I and II were compared. Results. There were 15 subjects in group I and 23 in group II. HbA1c and other laboratory markers were not significantly different in study groups. Similarly diabetes duration and anti-diabetic treatment were not significantly different in study groups. The rate of geriatric patients was significantly higher in group II compared to group I (p = 0.04). Conclusions. Subjects with moderate/severe hypoglycemia tend to be more frequently in geriatric age and HbA1c not correlates with the degree of the hypoglycemia. Since neither duration of diabetes, nor anti-diabetic treatment were associated with the severity of the hypoglycemia, each case should be evaluated individually to prevent further episodes which could increase morbidity and mortality in diabetic population.
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Jamal A, Tharkar S, Babaier WS, Alsomali SF, Alsulayhim AS, Alayuni MA, Aldakheel NA, Al-Osaimi SS, Alshehri N, Batais M. Blood Glucose Monitoring and Sharing Amongst People With Diabetes and Their Facilitators: Cross-sectional Study of Methods and Practices. JMIR Diabetes 2021; 6:e29178. [PMID: 34704954 PMCID: PMC8581747 DOI: 10.2196/29178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/30/2021] [Accepted: 08/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The last two decades have witnessed a burgeoning rise in the prevalence of diabetes globally. It has already reached epidemic proportions in Saudi Arabia, with reported high risk among women. As a result, diabetes monitoring and self-management programs are being highly prioritized for diabetes control and management. OBJECTIVE To investigate measuring and sharing practices of the self-monitoring of blood glucose (SMBG) among patients with type 1 or 2 diabetes using insulin. METHODS A cross-sectional study was conducted on a sample of 203 patients attending primary care clinics at a tertiary care center. The questionnaire assessed the measuring, recording, and sharing of SMBG practices of patients having diabetes with their physicians. The methods used for recording and sharing were categorized into paper-based and electronic-based. In addition, the determinants of the different methods used and frequency of sharing were analyzed. RESULTS The overall monitoring prevalence was 95% (193/203), and 57% (117/203) of participants shared the SMBG results. Among the 193 individuals that performed self-monitoring, 138 (72%) performed daily monitoring, and 147 (76%) recorded their blood sugar levels. Almost 55% (81/147) used paper-based materials like notebooks and paper for recording, while the rest (66/147, 45%) used digital devices like laptops and smartphones. A shift towards the use of digital devices and smart applications was observed in patients below 50 years of age. The digitally recorded blood glucose measurements were being shared thrice more often than the recordings made on paper or in notebooks (OR [odds ratio] 2.8; P=.01). Patients >50 years of age (OR 2.3; P=.02), with lesser formal education, married (OR 4.2; P<.001), with smaller family size (OR 2.6; P=.01), having type 2 diabetes (OR 4.1; P<.001) and any comorbid conditions (OR 2.6; P=.01) were associated with higher odds of using paper-based sharing methods. Only the female gender and type 2 diabetes were associated with increased frequency of sharing, while uncontrolled diabetes, the presence of other comorbidities, and duration of diabetes did not show any influence. CONCLUSIONS Good monitoring and optimal sharing practices were found. Sharing using electronic devices can be emphasized. Diabetes self-management programs can incorporate the use of digital technology in training sessions. Digital literacy and its applications in health care may enhance SMBG practices resulting in better diabetes control.
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Affiliation(s)
- Amr Jamal
- Evidence-Based Healthcare and Knowledge Translation Research Chair, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shabana Tharkar
- Prince Sattam Chair for Epidemiology and Public Health Research, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | - Norah Alshehri
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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5
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Liu C, Tang S, An K, Zhang S, Zhou Y, Su N, Yang R, Liao X, An Z, Li S. Knowledge, Attitude, and Practice of Metformin Extended-Release Tablets Among Clinicians in China: A Cross-Sectional Survey. Front Pharmacol 2021; 12:634561. [PMID: 34322016 PMCID: PMC8312381 DOI: 10.3389/fphar.2021.634561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Metformin extended-release (XR) is a once-daily alternative conventional immediate-release (IR) tablet for adults with type 2 diabetes. Aim: This study aimed to investigate the knowledge, attitude, and practice of the use of metformin XR tablets among clinicians. Methods: We conducted a cross-sectional online survey among endocrinologists, general practitioners, and internists, who are taking routine care of adults with type 2 diabetes in health institutes at all levels in Sichuan Province, China. We designed an online questionnaire including the demographic information, knowledge, attitude, and practice about metformin XR tablets. Results: We included 158 clinicians, 67.7% of whom were females and 63.9% were from tertiary hospitals. The median age was 39.6 years (ranging between 22 and 62 years). Only 8.2% of the clinicians correctly answered the knowledge questions, 82.3% and 62.0% of the responders assumed that metformin XR had superior efficacy and tolerability to the metformin IR, respectively. Only 46.8% of the clinicians prescribed the metformin XR based on the patient’s preference for once daily frequency. Conclusion: The knowledge, attitude, and practice of metformin XR among Chinese clinicians need improving. Clinicians need credible information to support their clinical decision-making regarding metformin XR.
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Affiliation(s)
- Chang Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Siqi Tang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kang An
- Department of General Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shengzhao Zhang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Yiling Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Na Su
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yang
- Department of General Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Department of General Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenmei An
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-based Medicine Centre, Cochrane China Centre and MAGIC China Centre, West China Hospital, Sichuan University, Chengdu, China.,Engineering Research Centre of Medical Information Technology, Ministry of Education, West China Hospital, Sichuan University, Chengdu, China
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Patorno E, Najafzadeh M, Pawar A, Franklin JM, Déruaz‐Luyet A, Brodovicz KG, Santiago Ortiz AJ, Bessette LG, Kulldorff M, Schneeweiss S. The EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study programme: Design and exposure accrual for an evaluation of empagliflozin in routine clinical care. Endocrinol Diabetes Metab 2020; 3:e00103. [PMID: 31922030 PMCID: PMC6947693 DOI: 10.1002/edm2.103] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/09/2019] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The EMPA-REG OUTCOME trial showed that empagliflozin reduced the risk of cardiovascular death and hospitalization for heart failure (HHF) in diabetic patients with cardiovascular disease. EMPRISE is a study programme on the effectiveness, safety and healthcare utilization of empagliflozin in routine care, leveraging real-world data from two commercial and one federal US data sources from 2014 to 2019. OBJECTIVES To describe rationale and design of EMPRISE, assess ability to minimize confounding and evaluate the time to reach sufficient statistical power for a key study outcome, HHF, using baseline information from the first year of EMPRISE. METHODS In 3 claims data sets, we identified a 1:1 propensity score (PS)-matched cohort of diabetic patients ≥18 years initiating empagliflozin or a dipeptidyl peptidase-4 inhibitor (DPP4i), resulting in 6643 total pairs. The PS model included >140 baseline covariates. We measured covariate balance via standardized differences (SD) and postmatching c-statistic. We computed the incidence rate (IR) of HHF, predicted exposure accrual over time and calculated expected power. RESULTS After PS matching, patient characteristics were balanced with SD <0.1 and c-statistic between 0.54 and 0.59. The population IR of HHF was 4.4 per 1000 person-years using a specific HHF definition and 14.8 using a broader HHF definition. In our projection, 80%-powered analyses would require a minimum of 169 HHF events, expected to accumulate by year 3 (specific definition) or year 2 (broader definition). CONCLUSION Baseline information from EMPRISE provided evidence of solid confounding control and adequate exposure accrual with expected powered analyses for the primary outcomes.
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Affiliation(s)
- Elisabetta Patorno
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Mehdi Najafzadeh
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Ajinkya Pawar
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Jessica M. Franklin
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | | | | | - Adrian J. Santiago Ortiz
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Martin Kulldorff
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
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7
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du Pon E, Wildeboer AT, van Dooren AA, Bilo HJG, Kleefstra N, van Dulmen S. Active participation of patients with type 2 diabetes in consultations with their primary care practice nurses - what helps and what hinders: a qualitative study. BMC Health Serv Res 2019; 19:814. [PMID: 31703680 PMCID: PMC6839213 DOI: 10.1186/s12913-019-4572-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients with type 2 diabetes mellitus (T2DM) receiving primary care regularly visit their practice nurses (PNs). By actively participating during medical consultations, patients can better manage their disease, improving clinical outcomes and their quality of life. However, many patients with T2DM do not actively participate during medical consultations. To understand the factors affecting engagement of patients with T2DM, this study aimed to identify factors that help or hinder them from actively participating in consultations with their primary care PNs. Methods Two semi-structured focus groups and 12 semi-structured individual interviews were conducted with patients with T2DM (n = 20) who were undergoing treatment by primary care PNs. All interviews were transcribed verbatim and analyzed using a two-step approach derived from the context-mapping framework. Results Four factors were found to help encourage patients to actively participate in their consultation: developing trusting relationships with their PNs, having enough time in the appointment, deliberately preparing for consultations, and allowing for the presence of a spouse. Conversely, four factors were found to hinder patients from participating during consultations: lacking the need or motivation to participate, readjusting to a new PN, forgetting to ask questions, and ineffectively expressing their thoughts. Conclusion Patients lacked the skills necessary to adequately prepare for a consultation and achieve an active role. In addition, patients’ keen involvement appeared to benefit from a trusting relationship with their PNs. When active participation is impeded by barriers such as a lack of patient’s skills, facilitators should be introduced at an early stage. Trial registration Current Controlled Trials NTR4693 (July 16, 2014).
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Affiliation(s)
- E du Pon
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501 AA, Utrecht, the Netherlands. .,Diabetes Centre, Isala, Zwolle, Dr. Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands.
| | - A T Wildeboer
- Department of Health Science, Section of Nursing Research, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - A A van Dooren
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501 AA, Utrecht, the Netherlands
| | - H J G Bilo
- Diabetes Centre, Isala, Zwolle, Dr. Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands.,Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - N Kleefstra
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.,Medical Research Group, Langerhans, Ommen, the Netherlands
| | - S van Dulmen
- Nivel (Netherlands institute for health services research), Otterstraat 118, 3513 CR, Utrecht, the Netherlands.,Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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8
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, Hirsch IB, McDonnell ME, Molitch ME, Murad MH, Sinclair AJ. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:1520-1574. [PMID: 30903688 PMCID: PMC7271968 DOI: 10.1210/jc.2019-00198] [Citation(s) in RCA: 268] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. CONCLUSIONS Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.
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Affiliation(s)
- Derek LeRoith
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Susan S Braithwaite
- Presence Saint Francis Hospital, Evanston, Illinois
- Presence Saint Joseph Hospital, Chicago, Illinois
| | - Felipe F Casanueva
- Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatologia Obesidad y Nutricion, Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Boris Draznin
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Jeffrey B Halter
- University of Michigan, Ann Arbor, Michigan
- National University of Singapore, Singapore, Singapore
| | - Irl B Hirsch
- University of Washington Medical Center–Roosevelt, Seattle, Washington
| | - Marie E McDonnell
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark E Molitch
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
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10
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Leung AA, Padwal RS. Metformin use was linked to hospitalization for acidosis at 6 y only in patients with eGFR < 30 mL/min/1.73 m2. Ann Intern Med 2018; 169:JC47. [PMID: 30326091 DOI: 10.7326/acpjc-2018-169-8-047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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11
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Harrington JL, de Albuquerque Rocha N, Patel KV, Verma S, McGuire DK. Should Metformin Remain First-Line Medical Therapy for Patients with Type 2 Diabetes Mellitus and Atherosclerotic Cardiovascular Disease? An Alternative Approach. Curr Diab Rep 2018; 18:64. [PMID: 30008022 DOI: 10.1007/s11892-018-1035-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW With recent cardiovascular outcome trial (CVOT) results for antihyperglycemic medications, the treatment algorithm for patients with type 2 diabetes (T2DM) and atherosclerotic vascular disease (ASCVD) requires revision. RECENT FINDINGS All completed CVOTs have demonstrated CV safety of the tested medications, with some trials demonstrating CV efficacy. While metformin remains the first-line recommended medication for T2DM, 18-37% of the patients enrolled in the completed CVOTs were not treated with metformin, providing substantial power to assess CV outcomes independent of metformin. The safety and tolerability of metformin are indisputable, but there are no robust data proving its efficacy for either macro or microvascular disease outcomes. We should reconsider the primacy of metformin in the management of T2DM in patients with ASCVD. This article will review the evidence for CV effects of antihyperglycemic agents (AHAs), and propose an evidence-based treatment algorithm for patients with T2DM and ASCVD.
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Affiliation(s)
- Josephine L Harrington
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
| | - Natalia de Albuquerque Rocha
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
- Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
| | - Kershaw V Patel
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
- Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Darren K McGuire
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA.
- Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA.
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Velojić-Golubović M. LIRAGLUTIDE AND INSULIN DETEMIR IN COMBINATION - A NEW THERAPEUTIC OPTION IN PATIENTS WITH TYPE 2 DIABETES: A CASE REPORT. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Choi JB, Moon HW, Park YH, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW, Han KD, Ha US. The Impact of Diabetes on the Risk of Prostate Cancer Development according to Body Mass Index: A 10-year Nationwide Cohort Study. J Cancer 2016; 7:2061-2066. [PMID: 27877221 PMCID: PMC5118669 DOI: 10.7150/jca.16110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/04/2016] [Indexed: 01/25/2023] Open
Abstract
Purpose: We examined the association between obesity and prostate cancer both with and without diabetic patients included in the analysis using nationally representative data of the Korean population from the National Health Insurance System (NHIS). Materials and Methods: Of the 424,712 participants who underwent health examinations in 2002-2008, 139,519 men ≥40 years old and without prostate cancer were followed from the beginning of 2002 to the end of 2012. Multivariate adjusted Cox regression analysis was conducted to examine the hazard ratio (HR) and 95% confidence interval (CI) for the association between prostate cancer and body mass index (BMI) both with and without diabetes. Results: The HR for prostate cancer according to the existence of diabetes was stratified by BMI in both age- and multivariable-adjusted models. In the population without diabetes, the HR for prostate cancer significantly increased as BMI increased beyond the reference range in a model adjusted for age and multiple variables; however, the increase in the HR was small. In the population with diabetes, the HR for prostate cancer significantly increased as BMI increased from < 18.5 kg/m2 to within the reference range (18.5 to 22.9) in the multivariable-adjusted model. In addition, a marked decrease in HR in the population with BMI of < 18.5 kg/m2 was seen compared to the reference or higher BMI population. Conclusion: This population-based study shows the evidence of association between obesity and development of prostate cancer, and the risk increases vary according to the change of BMI category and the existence of diabetes.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;; The Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;; The Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;; The Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;; The Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;; The Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
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Zhang N, McNeil E, Assanangkornchai S, Fan Y. Hospital and patient influencing factors of treatment schemes given to type 2 diabetes mellitus inpatients in Inner Mongolia, China. F1000Res 2016; 5:1577. [PMID: 27429746 PMCID: PMC4943291 DOI: 10.12688/f1000research.9095.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/20/2022] Open
Abstract
Background: In clinical practice, the physician’s treatment decision making is influenced by many factors besides the patient’s clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM) is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician’s treatment choices. Objective: To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China. Methods: A cross-sectional, hospital-based survey using a cluster sampling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the individual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes. Results: Regardless of patients’ clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81) and insulin therapy (RRR=1.94, 95% CI=1.29-2.91) compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61) and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67) than lifestyle management. Compared with non-reformed tertiary hospitals, reformed tertiary hospitals and county hospitals were less likely to give T2DM patients oral therapy (RRR = 0.07 and 0.1 respectively) and insulin therapy (RRR = 0.11 and 0.17 respectively). Conclusion: Gender was the only socio-demographic factors associated with treatment scheme for T2DM patients. Hospitals from different regions have different T2DM treatment patterns. Implementation of reform was shown to be associated with controlling medication use for T2DM inpatients. Further studies are needed to investigate the causes of unreasonable treatment disparities so that policies can be generated accordingly.
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Affiliation(s)
- Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China
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Iemitsu K, Iizuka T, Takihata M, Takai M, Nakajima S, Minami N, Umezawa S, Kanamori A, Takeda H, Kawata T, Ito S, Kikuchi T, Amemiya H, Kaneshiro M, Mokubo A, Takuma T, Machimura H, Tanaka K, Asakura T, Kubota A, Aoyagi S, Hoshino K, Ishikawa M, Obana M, Sasai N, Kaneshige H, Miyakawa M, Tanaka Y, Terauchi Y, Matsuba I. Factors Influencing Changes in Hemoglobin A1c and Body Weight During Treatment of Type 2 Diabetes With Ipragliflozin: Interim Analysis of the ASSIGN-K Study. J Clin Med Res 2016; 8:373-8. [PMID: 27081422 PMCID: PMC4817576 DOI: 10.14740/jocmr2492w] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ipragliflozin is a selective sodium glucose co-transporter 2 (SGLT2) inhibitor that blocks glucose reabsorption in the proximal tubules. SGLT2 inhibitors are expected to be effective in patients with insulin resistance and obesity, but it is important to select treatment according to patient background factors that minimizes the risk of adverse events. There have been a limited number of investigations into the relationship between the clinical efficacy (reducing hemoglobin A1c (HbA1c) and body weight (BW)) or safety of SGLT2 inhibitors and patient characteristics. METHODS ASSIGN-K is an investigator-initiated, multicenter, prospective observational study examining the efficacy and safety of ipragliflozin (50 - 100 mg/day for 52 weeks) in Japanese patients with type 2 diabetes mellitus (T2DM) who had inadequate glycemic control with HbA1c ≥ 6.0% (National Glycohemoglobin Standardization Program) despite diet and exercise therapy or diet and exercise plus antidiabetic drug therapy. We conducted an interim analysis of the relationship between changes in HbA1c or BW and characteristics in patients who had been on treatment for more than 12 weeks. RESULTS In 257 patients completing 12 weeks of treatment, HbA1c decreased significantly from 8.23% to 7.55% (-0.68%, P < 0.01). The change in HbA1c after 12 weeks was -0.17%, -0.33%, and -1.16% when baseline HbA1c was < 7%, 7% to < 8%, and ≥ 8%, respectively (P < 0.05, P < 0.01, and P < 0.01, respectively), and -1.30%, -0.62%, and -0.62% when baseline body mass index (BMI) was < 25, 25 to < 30, and ≥ 30, respectively (all P < 0.01). Stratified analysis showed that age, gender, or BMI did not have a significant influence on the improvement in HbA1c. Multiple regression analysis showed that reduction in HbA1c was greater as baseline HbA1c increased and the duration of diabetes decreased. A higher baseline HbA1c was associated with less weight loss. CONCLUSIONS Ipragliflozin significantly improved HbA1c in patients with T2DM. HbA1c improved more when baseline HbA1c was higher and the duration of diabetes was shorter, suggesting that current treatment policies for diabetes could be re-examined.
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Affiliation(s)
- Kotaro Iemitsu
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Takashi Iizuka
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masahiro Takihata
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masahiko Takai
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Shigeru Nakajima
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Nobuaki Minami
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Shinichi Umezawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Akira Kanamori
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hiroshi Takeda
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Takehiro Kawata
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Shogo Ito
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taisuke Kikuchi
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hikaru Amemiya
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Mizuki Kaneshiro
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Atsuko Mokubo
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Tetsuro Takuma
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hideo Machimura
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Keiji Tanaka
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taro Asakura
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Akira Kubota
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Sachio Aoyagi
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Kazuhiko Hoshino
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masashi Ishikawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Mitsuo Obana
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Nobuo Sasai
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hideaki Kaneshige
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Masaaki Miyakawa
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Yasushi Tanaka
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ikuro Matsuba
- Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
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Winkler G. [Sulfonylureas in today's blood glucose lowering therapy. New data on advantages and potential barriers of an "old" antidiabetic group]. Orv Hetil 2015; 156:511-5. [PMID: 25796278 DOI: 10.1556/oh.2015.30114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sulfonylurea compounds have been basic elements of antidiabetic treatment in type 2 diabetes for a long time. However, with the introduction of incretin type insulin secretagogues it is often arises, whether is still there a place for sulfonylureas in the today's therapy. To answer this question the author overviews general pharmaceutical characteristics of the sulfonylurea compounds as well as individual particularities of the second generation derivatives used at present in Hungary. The author details also the most important differences between incretin type drugs - first of all dipeptidyl peptidase-4 inhibitors - and sulfonylureas. On the basis of available data it can be concluded in accordance with the latest international guidelines, that sulfonylureas have still role in the blood glucose lowering therapy of type 2 diabetes, though they became somewhat pushed back among insulin secretagogue type drugs. If a sulfonylurea compound is the drug of choice, it is important to select the appropriate molecule (in case of normal renal function gliclazide or glimepiride). It is also important to re-educate the patient, as well as to apply the minimal dose providing the desired glycaemic effect.
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Affiliation(s)
- Gábor Winkler
- Fővárosi Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125 Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Intézet Miskolc
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