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Lira-Meriguete AM, Santos MP, Viana VCDS, Gonçalves NAZ, Kitagawa RR, Carnielli-Queiroz L, Bem DAMGD, Gonçalves RDCR. Can pharmaceutical care decrease the oxidative stress in type 2 diabetes mellitus? Biomed Pharmacother 2024; 171:116178. [PMID: 38266624 DOI: 10.1016/j.biopha.2024.116178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder characterized by an increase in oxidative stress, which is itself related to development of T2D's main chronic complications. Oxidative stress caused by elevated production of reactive species of oxygen and decrease of antioxidant defense system level, leads to activation of lipid peroxidation (LPO) and oxidative lipoprotein modification with increasing atherogenicity. Therefore, the aim of this study was to evaluate whether pharmacotherapeutic follow-up in patients with T2D, users and non-users of insulin, interferes with the levels of oxidative stress, measuring lipid peroxidation and protein oxidation, nitric oxide and superoxide dismutase levels. After the follow-up, there was a decrease in nitric oxide levels and an increase in superoxide dismutase concentration for the group with insulin therapy. Accordingly, these results show that the proposed pharmaceutical care program reduced the oxidative stress levels, mainly in patients in insulin therapy, as a consequence, can impact in the surging of the main chronic complications in T2D.
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Affiliation(s)
| | - Mayara Paes Santos
- Graduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | | | | | - Rodrigo Rezende Kitagawa
- Graduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil; Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Daniela Amorim Melgaço Guimarães do Bem
- Graduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil; Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Rita de Cássia Ribeiro Gonçalves
- Graduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil; Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, Brazil.
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Shabnam S, Gillies CL, Davies MJ, Dex T, Melson E, Khunti K, Webb DR, Zaccardi F, Seidu S. Factors associated with therapeutic inertia in individuals with type 2 diabetes mellitus started on basal insulin. Diabetes Res Clin Pract 2023; 203:110888. [PMID: 37604284 DOI: 10.1016/j.diabres.2023.110888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIM In this study we aim to identify the factors associated with treatment inertia in patients with type 2 diabetes mellitus (T2DM) who have been recently started on basal insulin (BI). METHODS Using UK CPRD GOLD, we identified adults with T2DM with suboptimal glycaemia (HbA1c within 12 months of BI ≥ 7% (≥53 mmol/mol)). We used multivariable Cox regression model to describe the association between patient characteristics and the time to treatment intensification. RESULTS A total of 12,556 patients were analysed. Compared to individuals aged < 65 years, those aged ≥ 65 years had lower risk of treatment intensification (HR: 0.69; 95% CI: 0.64-0.73). Other factors included being female (0.93, 0.89-0.99), longer T2DM duration (0.99, 0.98-0.99), living in the most deprived areas (0.90, 0.83-0.98), being a current smoker (0.91, 0.84-0.98), having one (0.91, 0.85-0.97) or more than one comorbidity (0.88, 0.82-0.94), and patients who were on metformin (0.71, 0.63-0.80), or 2nd generation sulphonylureas (0.85; 0.79-0.92) or DPP4 inhibitors (0.87, 0.82-0.93) compared to those who were not. CONCLUSION Therapeutic inertia still remains a major barrier, with multiple factors associated with delay in intensification. Interventions to overcome therapeutic inertia need to be implemented at both patient and health care professional level.
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Affiliation(s)
- Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Terry Dex
- Department of Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Eka Melson
- Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - David R Webb
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK.
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Chen M, Zhang P, Zhao Y, Duolikun N, Ji L. Where to Initiate Basal Insulin Therapy: Inpatient or Outpatient Department? Real-World Observation in China. Diabetes Metab Syndr Obes 2022; 15:3375-3385. [PMID: 36341227 PMCID: PMC9635311 DOI: 10.2147/dmso.s386230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aims to compare the effectiveness of initiating insulin therapy in inpatient and outpatient settings during a 6-month follow-up period among patients with type 2 diabetes mellitus (T2DM) in real-world settings. MATERIALS AND METHODS The study was based on the ORBIT study, a real-world observational study which recruited patients with inadequate glycemic control by oral antidiabetic drugs (OAD) and initiated basal insulin (BI). We compare difference in initiation and evolution of insulin therapy and glycemic control after six months were compared between patients initiating basal insulin in the inpatient department (inpatient initiators) and those starting in outpatient (outpatient initiators) among participants without rehospitalization during the six months follow-up. RESULTS Among all 18,995 participants in the ORBIT study, 56.0% were inpatient initiators and 44.0% outpatient. We conducted in-depth analysis among 14,860 patients without rehospitalization, 8129 inpatient initiators and 6731 outpatient initiators. (1) Inpatient initiators had lower insulin therapy persistence during six months (64.2%) than outpatient ones (78.6%) (p<0.001), which was mainly explained by more therapy switches from basal-bolus regimen to other therapies among inpatient initiators (50.1%) than that among outpatient initiators (37.5%) (p<0.001). (2) Inpatient initiation had a higher proportion of people achieving glucose targets (HbA1c <7%) than outpatient initiation. However, the benefit of inpatient initiation versus outpatient initiation was mainly observed among patients persisting with the initial insulin therapies (46.3% vs 39.5% p<0.001), rather than those nonpersistent (37.3% vs 36.2%, p=0.723). (3) Among patients with HbA1c <9%, taking only one OAD and without complications at baseline, inpatient insulin initiation did not show a higher proportion of people achieving glucose target than outpatient initiation (adjusted odds ratio=0.96, 95% CI: 0.76-1.21). CONCLUSION For patients with HbA1c ≥9%, who were taking more than one OAD and had complications at baseline, initiating insulin treatment during hospitalization has a higher proportion of people achieving glucose target than that in the outpatient department, but the premise is that the initial therapy is acceptable and can be maintained after discharge. Patient-centered approach with co-agreed decision-making to select a suitable insulin regimen should be strengthened.
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Affiliation(s)
- Minyuan Chen
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
| | - Puhong Zhang
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2050, Australia
- Correspondence: Puhong Zhang, Diabetes Research Program, The George Institute for Global Health, China, Room 052A, Unit 1, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, 100600, People’s Republic of China, Tel/Fax +86 10 8280 0177, Email
| | - Yang Zhao
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia
| | - Nadila Duolikun
- The George Institute for Global Health, China, Beijing, 100600, People’s Republic of China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
- Linong Ji, Department of Endocrinology and Metabolism, Peking University People’s Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing, 100044, People’s Republic of China, Tel +86 10 88325578, Fax +86 10 68358517, Email
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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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Rosenstock J, Nino A, Soffer J, Erskine L, Acusta A, Dole J, Carr MC, Mallory J, Home P. Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial. Diabetes Care 2020; 43:2509-2518. [PMID: 32694215 PMCID: PMC7510023 DOI: 10.2337/dc19-2316] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The principle of replacing prandial insulin lispro with a once-weekly glucagon-like peptide 1 receptor agonist (GLP-1RA) for type 2 diabetes inadequately controlled on a multiple daily insulin injections regimen was tested with albiglutide. RESEARCH DESIGN AND METHODS In this treat-to-target study, basal plus prandial insulin was optimized over 4 weeks before participants were randomized (1:1) to albiglutide plus optimized basal insulin glargine and lispro (dose reduced by 50% at randomization; subsequently, lispro injections were fully discontinued 4 weeks later) (n = 402) or to continued optimized lispro plus optimized glargine (n = 412). RESULTS Mean ± SD HbA1c at baseline, 7.8 ± 0.6% (61 ± 7 mmol/mol) in the albiglutide + glargine group and 7.7 ± 0.6% (60 ± 7 mmol/mol) in the lispro + glargine group, was reduced at week 26 to 6.7 ± 0.8% (49 ± 8 mmol/mol) and 6.6 ± 0.8% (48 ± 8 mmol/mol), respectively (least squares [LS] difference 0.06% [95% CI -0.05 to 0.17]; noninferiority P < 0.0001). In the albiglutide + glargine group, 218 participants (54%) replaced all prandial insulin without reintroducing lispro up to week 26. Total daily prandial insulin dose was similar at baseline but was lower by 62 units/day (95% CI -65.9 to -57.8; P < 0.0001) at week 26 in the albiglutide + glargine group, and the total number of weekly injections was also reduced from 29 to 13 per week. Less severe/documented symptomatic hypoglycemia (57.2% vs. 75.0%) occurred in the albiglutide + glargine group with meaningful weight differences (LS mean ± SE -2.0 ± 0.2 vs. +2.4 ± 0.2 kg; P < 0.0001) vs. lispro + glargine. Gastrointestinal adverse events were higher with albiglutide + glargine (26% vs. 13%). CONCLUSIONS A once-weekly GLP-1RA was able to substitute for prandial insulin in 54% of people, substantially reducing the number of prandial insulin injections; glycemic control improved, with the added benefits of weight loss and less hypoglycemia in the GLP-1RA arm. Replacing prandial insulin with a weekly GLP-1RA can simplify basal plus prandial insulin treatments and achieve better outcomes in type 2 diabetes.
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Affiliation(s)
| | - Antonio Nino
- Research and Development Immuno-Inflammation Therapy Area Unit, GlaxoSmithKline, Collegeville, PA
| | - Joseph Soffer
- Research and Development Future Pipelines Discovery, GlaxoSmithKline, Collegeville, PA
| | - Lois Erskine
- Clinical Development, GlaxoSmithKline, King of Prussia, PA
| | - Andre Acusta
- Clinical Statistics, GlaxoSmithKline, Collegeville, PA
| | - Jo Dole
- Research and Development Future Pipelines Discovery, GlaxoSmithKline, Collegeville, PA
| | - Molly C Carr
- Research and Development Future Pipelines Discovery, GlaxoSmithKline, Collegeville, PA
| | - Jason Mallory
- Clinical Development, GlaxoSmithKline, King of Prussia, PA
| | - Philip Home
- Newcastle University, Newcastle upon Tyne, U.K
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Hirose T, Chen CC, Ahn KJ, Kiljański J. Use of Insulin Glargine 100 U/mL for the Treatment of Type 2 Diabetes Mellitus in East Asians: A Review. Diabetes Ther 2019; 10:805-833. [PMID: 31020538 PMCID: PMC6531539 DOI: 10.1007/s13300-019-0613-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
Insulin glargine (IGlar) 100 U/mL (IGlar-100) is widely used in East Asian countries for the treatment of type 2 diabetes mellitus (T2DM) and is the gold standard of basal insulin treatment. In this review we summarize key information about clinical experience with IGlar-100 in East Asian patients with T2DM, including findings from clinical trials and postmarketing studies. We also provide recommendations and opinions on the optimal use of IGlar-100 in this population. The findings from the studies highlighted in our review indicate that IGlar-100 can be a suitable treatment option for East Asians with T2DM, from initial therapy in combination with oral antihyperglycemic medications through to different combinations and intensification models. FUNDING: Eli Lilly and Company.
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Affiliation(s)
- Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- China Medical University School of Chinese Medicine, Taichung, Taiwan
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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7
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Billings LK, Mocarski M, Basse A, Hunt B, Valentine WJ, Jodar E. Cost of achieving HbA1c and weight loss treatment targets with IDegLira vs insulin glargine U100 plus insulin aspart in the USA. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:271-282. [PMID: 30962697 PMCID: PMC6432901 DOI: 10.2147/ceor.s194719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Compared with basal-bolus insulin therapy (insulin glargine U100 plus insulin aspart), IDegLira has been shown to be associated with similar improvements in HbA1c, with superior weight loss and reduced hypoglycemia in patients with type 2 diabetes. The present analysis evaluated the cost per patient with type 2 diabetes achieving HbA1c-focused and composite treatment targets with IDegLira and insulin glargine U100 plus insulin aspart (≤4 times daily). Methods The proportions of patients achieving treatment targets were obtained from the treat-to-target, non-inferiority DUAL VII study (NCT02420262). The annual cost per patient achieving target (cost of control) was analyzed from a US healthcare payer perspective. The annual cost of control was assessed for eight prespecified endpoints and four post-hoc endpoints. Results The number needed to treat to bring one patient to targets of HbA1c <7.0% and HbA1c ≤6.5% was similar with IDegLira and insulin glargine U100 plus insulin aspart. However, when weight gain and/or hypoglycemia were included, the number needed to treat was lower with IDegLira. IDegLira and insulin glargine U100 plus insulin aspart had similar costs of control for HbA1c <7.0%. However, cost of control values were substantially lower with IDegLira when the more stringent target of HbA1c ≤6.5% was used, and when patient-centered outcomes of hypoglycemia risk and impact on weight were included. Conclusion IDegLira was shown to be a cost-effective treatment vs insulin glargine U100 plus insulin aspart for patients with type 2 diabetes not achieving glycemic targets on basal insulin in the USA.
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Affiliation(s)
- L K Billings
- Division of Endocrinology and Metabolism, NorthShore University HealthSystem, Skokie, IL, USA.,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - M Mocarski
- Value Evidence and Outcomes, Novo Nordisk Inc., Plainsboro, NJ, USA
| | - A Basse
- Market Access-Region AAMEO, Novo Nordisk Pharma Gulf FZ-LLC, Dubai, United Arab Emirates
| | - B Hunt
- Health Economics, Ossian Health Economics and Communications, Basel, Switzerland,
| | - W J Valentine
- Health Economics, Ossian Health Economics and Communications, Basel, Switzerland,
| | - E Jodar
- Department of Endocrinology and Clinical Nutrition, H.U. Quirón Salud Madrid & Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
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8
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Migdal A, Abrahamson M, Peters A, Vint N. Approaches to rapid acting insulin intensification in patients with type 2 diabetes mellitus not achieving glycemic targets. Ann Med 2018; 50:453-460. [PMID: 30103624 DOI: 10.1080/07853890.2018.1493216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a growing problem in the USA, affecting 30.3 million Americans, or 9.4% of the US population. Given that T2DM is a progressive disease, intensification of rapid acting insulin (RAI) to address hyperglycaemia is often required. The American Diabetes Association and the European Association for the Study of Diabetes recommend individualizing the treatment approach to glucose control, considering factors such as age, health behaviours, comorbidities and life expectancy. There are several validated treatment algorithms in the literature, which can be helpful for providing guidance on initiation of RAI while simultaneously considering patient preferences and clinical needs during treatment intensification. This paper provides expert recommendations on prandial insulin regimens and how to use treatment algorithms to promote better glucose control through best practice guidelines. To help patients reach HbA1c targets through treatment intensification, the FullSTEP, SimpleSTEP, ExtraSTEP and AUTONOMY algorithms are discussed in this paper. KEY MESSAGES Clinical inertia should be prevented with timely intensification of therapy when HbA1c levels are greater than 7% (or rising above a patient's individual target) according to national guidelines. Increased personalization in the intensification of T2D treatment is necessary to improve HbA1c targets while addressing risk of hypoglycaemia, concern about weight gain, and overall health goals. Healthcare providers are encouraged to address glycaemic control with a variety of strategies, including prandial insulin, while developing evidence-based treatment plans on the basis of algorithms discussed in the literature.
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Affiliation(s)
- Alexandra Migdal
- a Department of Medicine , Emory University , Atlanta , GA , USA
| | - Martin Abrahamson
- b Division of Endocrinology, Department of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Anne Peters
- c Keck School of Medicine of the University of Southern California , Los Angeles , CA , USA
| | - Nan Vint
- d Lilly Corporate Center , Eli Lilly & Company , Indianapolis , IN , USA
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Torre E, Bruno GM, Di Matteo S, Martinotti C, Oselin M, Valentino MC, Parodi A, Bottaro LC, Colombo GL. Cost-minimization analysis of degludec/liraglutide versus glargine/aspart: economic implications of the DUAL VII study outcomes. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:413-421. [PMID: 30100746 PMCID: PMC6067612 DOI: 10.2147/ceor.s169045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Diabetes represents a relevant public health problem worldwide due to its increasing prevalence and socioeconomic burden. There is no doubt that tight glycemic control reduces the development of diabetic complications such as the long-term costs related to the disease. The aim of our model was to calculate total direct costs associated with the two treatments considered in DUAL VII study, and hence evaluate the potential economic benefits for the National Health System (NHS) deriving from the use of insulin degludec plus liraglutide (IDegLira) in a once-daily fixed combination. Materials and methods We applied the cost-minimization technique adopting the NHS point of view to the DUAL VII trial outcomes. In the model, developed in Microsoft Excel®, we calculated and compared annual costs per patient of the two therapeutic options for type 2 diabetes (T2D) patients not achieving glycemic control on basal insulin and metformin described in the trial, including costs of therapy management and side effects, both negative and positive. Annual treatment costs were calculated based on IDegLira and basal bolus end-of-trial doses resulting in a 1:2 ratio (40.4 U vs 84.1 U). Therefore, maintaining the IDegLira/basal bolus at 1:2 dose ratio, we calculated the correlation between the dose reduction and costs compared to DUAL VII doses base case scenario. Results Total treatment costs were obtained by adding annual cost of drug, needles, glycemic self-monitoring, hypoglycemic events, and effect on consumption of other drugs. Total annual costs of IDegLira combination resulted in €434 higher than basal bolus in DUAL VII base case (40.4 U); the two treatments reported equal costs at 34% dose reduction (26.7 U), while below this value IDegLira treatment became less expensive, with about €215 gain at 50% dose reduction (20.2 U). It is also important to notice that above the break-even point, until an IDegLira dose of 30 U, the cost difference is negligible in view of the clinical benefit provided by the fixed combination highlighted in DUAL VII trial. Conclusion Adding the significant clinical findings derived from DUAL VII trial to our economic evaluation, IDegLira seems to offer an important alternative to basal-bolus therapy.
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Affiliation(s)
- Enrico Torre
- Endocrinology, Diabetology and Metabolic Diseases Unit, ASL3, Genoa, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Martina Oselin
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Alessio Parodi
- General Direction International Evangelic Hospital, Genoa, Italy
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Trautmann ME, Vora J. Use of glucagon-like peptide-1 receptor agonists among individuals on basal insulin requiring treatment intensification. Diabet Med 2018; 35:694-706. [PMID: 29478255 PMCID: PMC5969085 DOI: 10.1111/dme.13610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/14/2022]
Abstract
As Type 2 diabetes progresses, treatment is intensified with additional therapies in an effort to manage hyperglycaemia effectively and therefore avoid complications. When greater efficacy is required, options for injectable treatments include glucagon-like peptide-1 receptor agonists and insulin, which may be added on to oral glucose-lowering treatments. Among individuals receiving long-acting basal insulin as their first injectable treatment, ~40-60% are unable to achieve or maintain their target HbA1c goals. For these people, treatment intensification options are relatively limited and include the addition of short-acting prandial insulin or a glucagon-like peptide-1 receptor agonist. Glucagon-like peptide-1 receptor agonists vary in their effects, with short- and long-acting agents having a greater impact on postprandial and fasting hyperglycaemia, respectively. Studies comparing treatment intensification options have found both glucagon-like peptide-1 receptor agonists and prandial insulin to be effective in reducing HbA1c concentrations; however, recipients of glucagon-like peptide-1 receptor agonists lost weight and had a greater frequency of gastrointestinal adverse events, whereas those receiving prandial insulin gained weight and had a greater incidence of hypoglycaemia. In addition to the separate administration of a glucagon-like peptide-1 receptor agonist and basal insulin, fixed-ratio combinations of a glucagon-like peptide-1 receptor agonist and basal insulin offer a single administration for both treatments but have less flexibility in dose titration than treatment with their individual components. For individuals who require treatment intensification beyond basal insulin, use of these various options allows physicians to target the individual needs of their patients for the achievement of optimal long-term glycaemic control.
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Affiliation(s)
| | - J. Vora
- Diabetes and EndocrinologyRoyal Liverpool University HospitalLiverpoolUK
- AstraZenecaCambridgeUK
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11
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Khairnar R, Kamal KM, Giannetti V, Dwibedi N, McConaha J. Barriers and facilitators to diabetes self-management in a primary care setting - Patient perspectives. Res Social Adm Pharm 2018; 15:279-286. [PMID: 29776663 DOI: 10.1016/j.sapharm.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. OBJECTIVE To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. METHODS This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having ≥2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels: <7, 7-9, and >9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted. RESULTS A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years ( ±11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X2 = 15.73, p < 0.01), insurance status (X2 = 12.03, p < 0.05), referral to an endocrinologist (X2 = 6.17, p < 0.05), level of self-management (X2 = 12.01, p < 0.05) and willingness to use insulin (X2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X2 = 33.04, p < 0.01) and referral to an endocrinologist (X2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and 'less than graduate level' education were significant predictors of glycemic stability. CONCLUSIONS Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.
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Affiliation(s)
- Rahul Khairnar
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, USA
| | - Khalid M Kamal
- School of Pharmacy, Pharmaceutical, Administrative and Social Sciences, Duquesne University, USA.
| | - Vincent Giannetti
- School of Pharmacy, Pharmaceutical, Administrative and Social Sciences, Duquesne University, USA
| | | | - Jamie McConaha
- Pharmacy Practice, School of Pharmacy, Duquesne University, USA
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12
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Ghosh S, Unnikrishnan AG, Saboo B, Kesavadev J, Aravind SR, Bajaj S, Rajput R, Seshadri K, Verma N, Gupta A, Makkar BM, Saikia M, Kale S, Damodaran S, Dengra A, Eashwar TKM, Maheshwari A, Pendsey S, Phatak SR, Sharma SK, Singh SK, Ramachandran A, Zargar AH, Joshi SR, Sadikot SM. Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes. Diabetes Metab Syndr 2017; 11 Suppl 1:S507-S521. [PMID: 28433618 DOI: 10.1016/j.dsx.2017.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Indexed: 01/27/2023]
Abstract
Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy.
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Affiliation(s)
- Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
| | | | | | | | | | - Sarita Bajaj
- Department of Medicine, Motilal Nehru Medical College, Allahabad, India
| | - Rajesh Rajput
- Department of Endocrinology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Krishna Seshadri
- Department of Endocrinology and Metabolism, Shri Rama Chandra University, Chennai, India
| | | | | | | | | | | | | | - Ashish Dengra
- Mahi Diabetes & Thyroid Care and Research Center, Jabalpur, India
| | | | - Anuj Maheshwari
- Department of Medicine, Babu Banarasi Das University, Lucknow, India
| | | | | | | | - Surya Kumar Singh
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Abdul H Zargar
- Advanced Center for Diabetes and Endocrine Care, Srinagar, India
| | - Shashank R Joshi
- Lilavati and Bhatia Hospital and Grant Medical College, Mumbai, India
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13
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Ma X, Chien JY, Johnson J, Malone J, Sinha V. Simulation-Based Evaluation of Dose-Titration Algorithms for Rapid-Acting Insulin in Subjects with Type 2 Diabetes Mellitus Inadequately Controlled on Basal Insulin and Oral Antihyperglycemic Medications. Diabetes Technol Ther 2017; 19:483-490. [PMID: 28700249 DOI: 10.1089/dia.2016.0361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The purpose of this prospective, model-based simulation approach was to evaluate the impact of various rapid-acting mealtime insulin dose-titration algorithms on glycemic control (hemoglobin A1c [HbA1c]). METHODS Seven stepwise, glucose-driven insulin dose-titration algorithms were evaluated with a model-based simulation approach by using insulin lispro. Pre-meal blood glucose readings were used to adjust insulin lispro doses. Two control dosing algorithms were included for comparison: no insulin lispro (basal insulin+metformin only) or insulin lispro with fixed doses without titration. RESULTS Of the seven dosing algorithms assessed, daily adjustment of insulin lispro dose, when glucose targets were met at pre-breakfast, pre-lunch, and pre-dinner, sequentially, demonstrated greater HbA1c reduction at 24 weeks, compared with the other dosing algorithms. Hypoglycemic rates were comparable among the dosing algorithms except for higher rates with the insulin lispro fixed-dose scenario (no titration), as expected. The inferior HbA1c response for the "basal plus metformin only" arm supports the additional glycemic benefit with prandial insulin lispro. CONCLUSIONS Our model-based simulations support a simplified dosing algorithm that does not include carbohydrate counting, but that includes glucose targets for daily dose adjustment to maintain glycemic control with a low risk of hypoglycemia.
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Affiliation(s)
- Xiaosu Ma
- 1 Eli Lilly and Company , Indianapolis, Indiana
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14
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Weng W, Tian Y, Kimball ES, Kong SX, Bouchard J, Hobbs TM, Sakurada B. Treatment patterns and clinical characteristics of patients with type 2 diabetes mellitus according to body mass index: findings from an electronic medical records database. BMJ Open Diabetes Res Care 2017; 5:e000382. [PMID: 28761654 PMCID: PMC5530246 DOI: 10.1136/bmjdrc-2016-000382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/09/2017] [Accepted: 03/27/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study evaluated relationships between glycaemic control, body mass index (BMI), comorbidities and pharmacological treatment in patients with type 2 diabetes mellitus (T2D). RESEARCH DESIGN AND METHODS This was a retrospective, cross-sectional analysis of Quintiles electronic medical records research data (study period 1 October 2013-30 September 2014). Eligibility included age ≥18 years, T2D diagnosis, and at least one available BMI measurement. RESULTS The study included 626 386 patients (mean age, 63.8 year; 51.3% female; 78.5% white; 62.6%, BMI ≥30 kg/m2). A1c data were available for 414 266 patients. The proportion of patients with good glycaemic control (A1c ≤6.5) decreased as BMI category increased, ranging from 40.1% of patients with BMI <30% to 30.1% of patients with BMI ≥40. The proportions of patients with poor glycaemic control (A1c >8% and A1c ≥9%) increased with increasing BMI category. Oral antidiabetic drugs (OAD) were the most frequently used (54.4% of patients with A1c values). Among patients using insulin-based therapy, 50% had an A1c ≥8% and 29% had an A1c ≥9% regardless of concomitant OAD or glucagon-like peptide 1 receptor agonist use. Among patients using three or more OADs, 34.3% and 16.1% had A1c values ≥8% and ≥9%, respectively. There was no common trend observed for changes in the proportion of patients with T2D-related comorbidities according to BMI category. The most notable trend was a 7.6% net increase in the percentage of patients with hypertension from BMI <30 to BMI ≥40. CONCLUSIONS This large dataset provides evidence that roughly one out of four patients with T2D is not well controlled, and the prevalence of poor glycaemic control increases as BMI increases.
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Affiliation(s)
- Wayne Weng
- Department of Health and Economics Outcomes Research, Novo Nordisk, Plainsboro, New Jersey, USA
| | - Ye Tian
- Department of Health and Economics Outcomes Research, Novo Nordisk, Plainsboro, New Jersey, USA
| | - Edward S. Kimball
- Medical Writing and Education, Novo Nordisk, Plainsboro, New Jersey, USA
| | - Sheldon X. Kong
- Department of Health and Economics Outcomes Research, Novo Nordisk, Plainsboro, New Jersey, USA
| | - Jonathan Bouchard
- Department of Health and Economics Outcomes Research, Novo Nordisk, Plainsboro, New Jersey, USA
| | - Todd M. Hobbs
- Department of Diabetes and Obesity, Novo Nordisk, Plainsboro, New Jersey, USA
| | - Brian Sakurada
- Medical Affairs, Novo Nordisk, Plainsboro, New Jersey, USA
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15
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Affiliation(s)
- P. Gaye Knutsen
- Washington University Diabetes Center at Barnes Jewish Hospital, St. Louis, MO
| | - Cheryl Q. Voelker
- Washington University Diabetes Center at Barnes Jewish Hospital, St. Louis, MO
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16
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Bennett AL, Munkholm P, Andrews JM. Tools for primary care management of inflammatory bowel disease: Do they exist? World J Gastroenterol 2015; 21:4457-4465. [PMID: 25914455 PMCID: PMC4402293 DOI: 10.3748/wjg.v21.i15.4457] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/09/2015] [Accepted: 03/12/2015] [Indexed: 02/06/2023] Open
Abstract
Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician’s IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions.
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17
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Tran L, Zielinski A, Roach AH, Jende JA, Householder AM, Cole EE, Atway SA, Amornyard M, Accursi ML, Shieh SW, Thompson EE. Pharmacologic Treatment of Type 2 Diabetes. Ann Pharmacother 2015; 49:700-14. [DOI: 10.1177/1060028015573010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To review the oral and injectable pharmacologic treatment options for type 2 diabetes. Data Sources: A literature search was conducted using PubMed electronic database for studies published in English between 1993 and September 2014. Search terms included diabetes mellitus, type 2 diabetes, and the individual name for each antidiabetic medication reviewed. In addition, manual searches were performed for cross-references from publications. Package inserts, United States Food and Drug Administration (FDA) Web site, Institute for Safe Medication Practices Web site, American Diabetes Association Web site and scientific session poster presentations, and individual drug company Web pages were also reviewed. Study Selection and Data Extraction: This review focused on information elucidated over the past 10 years to assist prescribers in choosing optimal therapy based on individual patient characteristics. Studies leading to the approval of or raising safety concerns for the antidiabetic medications reviewed in this article were included. Data Synthesis: In the past 10 years, there have been 4 novel oral antidiabetic medication classes and 10 new injectable agents and insulin products approved by the FDA for the treatment of type 2 diabetes as well as new information regarding the safety and use of several older antidiabetic medication classes. The distinctions were reviewed for each individual agent, and a comparison was completed if there was more than one agent in a particular therapeutic class. Using current information available, select investigational agents in phase III trials or with a pending new drug application were highlighted. Conclusion: There are now 9 distinct oral pharmacologic classes and a variety of insulin and noninsulin injectable medications available for the treatment of type 2 diabetes. Metformin remains the first-line treatment option for most patients. When considering options for alternative or additional treatment, prescribers must weigh the benefits and risks using individual patient characteristics.
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Affiliation(s)
- Linda Tran
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Angela Zielinski
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Arpi H. Roach
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Jennifer A. Jende
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | | | - Emily E. Cole
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Shuruq A. Atway
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Melinda Amornyard
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Mallory L. Accursi
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Suzanna W. Shieh
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
| | - Erin E. Thompson
- Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Columbus, OH, USA
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18
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Shimoda S, Okubo M, Koga K, Sekigami T, Kawashima J, Kukidome D, Igata M, Ishii N, Shimakawa A, Matsumura T, Motoshima H, Furukawa N, Nishida K, Araki E. Insulin requirement profiles in Japanese hospitalized subjects with type 2 diabetes treated with basal-bolus insulin therapy. Endocr J 2015; 62:209-16. [PMID: 25392020 DOI: 10.1507/endocrj.ej14-0487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To assess the total daily inulin dose (TDD) and contribution of basal insulin to TDD and to identify the predictive factors for insulin requirement profiles in subjects with type 2 diabetes, we retrospectively examined insulin requirement profiles of 275 hospitalized subjects treated with basal-bolus insulin therapy (BBT) (mean age, 60.1 ± 12.9 years; HbA1c, 10.2 ± 4.5%). Target plasma glucose level was set between 80 and 129 mg/dL before breakfast and between 80 and 179 mg/dL at 2-hour after each meal without causing hypoglycemia. We also analyzed the relationship between the insulin requirement profiles (TDD and basal/total daily insulin ratio [B/TD ratio]) and insulin-associated clinical parameters. The mean TDD was 0.463 ± 0.190 unit/kg/day (range, 0.16-1.13 unit/kg/day). The mean B/TD ratio was 0.300 ± 0.099 (range, 0.091-0.667). A positive correlation of TDD with B/TD ratio was revealed by linear regression analysis (r=0.129, p=0.03). Stepwise multiple regression analysis identified post-breakfast glucose levels before titrating insulin as an independent determinant of the insulin requirement profile [Std β (standard regression coefficient) = 0.228, p<0.01 for TDD, Std β = -0.189, p<0.01 for B/TD ratio]. The TDD was <0.6 unit/kg/day and the B/TD ratio was <0.4 in the majority (70.2%) of subjects in the present study. These findings may have relevance in improving glycemic control and decreasing the risk of hypoglycemia and weight gain in subjects with type 2 diabetes treated with BBT.
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MESH Headings
- Aged
- Blood Glucose/analysis
- Combined Modality Therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diet therapy
- Diabetes Mellitus, Type 2/drug therapy
- Diet, Diabetic
- Drug Administration Schedule
- Drug Therapy, Combination/adverse effects
- Female
- Glycated Hemoglobin/analysis
- Hospitalization
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/epidemiology
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Insulin Resistance
- Insulin, Long-Acting/administration & dosage
- Insulin, Long-Acting/adverse effects
- Insulin, Long-Acting/therapeutic use
- Insulin, Short-Acting/administration & dosage
- Insulin, Short-Acting/adverse effects
- Insulin, Short-Acting/therapeutic use
- Japan/epidemiology
- Male
- Middle Aged
- Retrospective Studies
- Risk
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Affiliation(s)
- Seiya Shimoda
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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19
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Diamant M, Nauck MA, Shaginian R, Malone JK, Cleall S, Reaney M, de Vries D, Hoogwerf BJ, MacConell L, Wolffenbuttel BHR. Glucagon-like peptide 1 receptor agonist or bolus insulin with optimized basal insulin in type 2 diabetes. Diabetes Care 2014; 37:2763-73. [PMID: 25011946 DOI: 10.2337/dc14-0876] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Mealtime insulin is commonly added to manage hyperglycemia in type 2 diabetes when basal insulin is insufficient. However, this complex regimen is associated with weight gain and hypoglycemia. This study compared the efficacy and safety of exenatide twice daily or mealtime insulin lispro in patients inadequately controlled by insulin glargine and metformin despite up-titration. RESEARCH DESIGN AND METHODS In this 30-week, open-label, multicenter, randomized, noninferiority trial with 12 weeks prior insulin optimization, 627 patients with insufficient postoptimization glycated hemoglobin A1c (HbA1c) were randomized to exenatide (10-20 µg/day) or thrice-daily mealtime lispro titrated to premeal glucose of 5.6-6.0 mmol/L, both added to insulin glargine (mean 61 units/day at randomization) and metformin (mean 2,000 mg/day). RESULTS Randomization HbA1c and fasting glucose (FG) were 8.3% (67 mmol/mol) and 7.1 mmol/L for exenatide and 8.2% (66 mmol/mol) and 7.1 mmol/L for lispro. At 30 weeks postrandomization, mean HbA1c changes were noninferior for exenatide compared with lispro (-1.13 and -1.10%, respectively); treatment differences were -0.04 (95% CI -0.18, 0.11) in per-protocol (n = 510) and -0.03 (95% CI -0.16, 0.11) in intent-to-treat (n = 627) populations. FG was lower with exenatide than lispro (6.5 vs. 7.2 mmol/L; P = 0.002). Weight decreased with exenatide and increased with lispro (-2.5 vs. +2.1 kg; P < 0.001). More patients reported treatment satisfaction and better quality of life with exenatide than lispro, although a larger proportion of patients with exenatide experienced treatment-emergent adverse events. Exenatide resulted in fewer nonnocturnal hypoglycemic episodes but more gastrointestinal adverse events than lispro. CONCLUSIONS Adding exenatide to titrated glargine with metformin resulted in similar glycemic control as adding lispro and was well tolerated. These findings support exenatide as a noninsulin addition for patients failing basal insulin.
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Affiliation(s)
- Michaela Diamant
- Diabetes Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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20
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Akhtar ST, Mahmood K, Naqvi IH, Vaswani AS. Inpatient management of type 2 Diabetes Mellitus: Does choice of insulin regimen really matter? Pak J Med Sci 2014; 30:895-8. [PMID: 25097540 PMCID: PMC4121721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 05/11/2014] [Accepted: 05/13/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess inpatient management of non-critically ill type 2 diabetics with different insulin regimen. METHODS We reviewed the medical records of all non-critically ill type 2 diabetic patients more than 18 years of age in medical department of civil hospital Karachi and Dow University of Health Sciences from January 2011 to December 2012. We collected the data from case records in data collection sheets that fulfill the inclusion criteria and divided the study subjects into three groups according to insulin regimen they received. RESULTS A total of 416 patients were analyzed out of which 220 were male. Subjects were divided into three groups according to insulin regimen they received. Majority were put on sliding scale of insulin (44.7%), while 33.1% and 22.1% subjects received basal bolus and pre-mixed insulin regimen respectively. Patients treated with basal bolus regimen had greater improvement in glycaemic control with short duration of hospital stay as compared to other two groups. The mean hyperglycaemic events were higher in sliding scale group while mean hypoglycaemic events were higher in basal bolus group. CONCLUSION In non-critically ill type 2 diabetic patients the basal bolus regimen is superior to sliding and pre-mixed insulin regimen. Sliding scale should be discouraged in non-critically ill type 2 diabetic patients.
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Affiliation(s)
- Syed Tehseen Akhtar
- Dr. Syed Tehseen Akhtar, FCPS, Assistant Professor of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Khalid Mahmood
- Dr. Prof. Khalid Mahmood, FRCS, FCPS, Professor of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Iftikhar Haider Naqvi
- Dr. Iftikhar Haider Naqvi, FCPS, Assistant Professor of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Aneel Sham Vaswani
- Dr. Aneel Sham Vaswani, FCPS, Assistant Professor of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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21
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Lee MY, Choi DS, Lee MK, Lee HW, Park TS, Kim DM, Chung CH, Kim DK, Kim IJ, Jang HC, Park YS, Kwon HS, Lee SH, Shin HK. Comparison of acarbose and voglibose in diabetes patients who are inadequately controlled with basal insulin treatment: randomized, parallel, open-label, active-controlled study. J Korean Med Sci 2014; 29:90-7. [PMID: 24431911 PMCID: PMC3890482 DOI: 10.3346/jkms.2014.29.1.90] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/31/2013] [Indexed: 02/06/2023] Open
Abstract
We studied the efficacy and safety of acarbose in comparison with voglibose in type 2 diabetes patients whose blood glucose levels were inadequately controlled with basal insulin alone or in combination with metformin (or a sulfonylurea). This study was a 24-week prospective, open-label, randomized, active-controlled multi-center study. Participants were randomized to receive either acarbose (n=59, 300 mg/day) or voglibose (n=62, 0.9 mg/day). The mean HbA1c at week 24 was significantly decreased approximately 0.7% from baseline in both acarbose (from 8.43% ± 0.71% to 7.71% ± 0.93%) and voglibose groups (from 8.38% ± 0.73% to 7.68% ± 0.94%). The mean fasting plasma glucose level and self-monitoring of blood glucose data from 1 hr before and after each meal were significantly decreased at week 24 in comparison to baseline in both groups. The levels 1 hr after dinner at week 24 were significantly decreased in the acarbose group (from 233.54 ± 69.38 to 176.80 ± 46.63 mg/dL) compared with the voglibose group (from 224.18 ± 70.07 to 193.01 ± 55.39 mg/dL). In conclusion, both acarbose and voglibose are efficacious and safe in patients with type 2 diabetes who are inadequately controlled with basal insulin. (ClinicalTrials.gov number, NCT00970528).
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Affiliation(s)
- Mi Young Lee
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Seop Choi
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Moon Kyu Lee
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyoung Woo Lee
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Sun Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Doo Man Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Choon Hee Chung
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Duk Kyu Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - In Joo Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Hak Chul Jang
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Soo Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyuk Sang Kwon
- Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Panagoulias GS, Doupis J. Clinical utility in the treatment of type 2 diabetes with the saxagliptin/metformin fixed combination. Patient Prefer Adherence 2014; 8:227-36. [PMID: 24627627 PMCID: PMC3931578 DOI: 10.2147/ppa.s34089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fixed-dose combination (FDC) products represent a widely accepted approach to type 2 diabetes treatment, given that monotherapies sometimes fail to meet the treatment targets - obtaining a sustained reduction in micro- and macrovascular complications. Saxagliptin (SAXA)/metformin (MET) FDC tablets can be used either alone or in combination with glyburide, thiazolidinediones, or insulin. It has been proven that the SAXA/MET combination leads to a significant improvement in glycemic control compared to placebo in patients with type 2 diabetes that is inadequately controlled with MET alone. In addition, this FDC has been proven to be safe for people with diabetes mellitus and established cardiovascular disease, elderly patients, and patients with impaired renal function (>30 mL/minute), with dosage modification. Patient compliance, adherence, and persistence to the therapeutic regimen has been shown to be very good, while the titration of each compound according to the patient's profile is easy, given the availability of different formulations. The SAXA/MET FDC is a patient-friendly, dosage-flexible, and hypoglycemia-safe regimen with very few adverse events and a neutral or even favorable effect on body weight. It achieves significant glycosylated hemoglobin A1c reduction helping the patient to achieve his/her individual glycemic goals.
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Affiliation(s)
- George S Panagoulias
- 1st Department of Propaedeutic and Internal Medicine, Athens University Medical School,Laiko General Hospital, Athens, Greece
| | - John Doupis
- Salamis Naval Hospital, Athens, Greece
- DiabetesDivision, Iatriko Paleou Falirou Medical Center, Athens, Greece
- Correspondence: John Doupis, Iatriko Paleou Falirou Medical Center, Diabetes Division, 36 Areosst, 175 62 Paleou Falirou, Athens, Greece, Tel/Fax +30 210 989 2300, Email
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Shimoda S, Iwashita S, Ichimori S, Matsuo Y, Goto R, Maeda T, Matsuo T, Sekigami T, Kawashima J, Kondo T, Matsumura T, Motoshima H, Furukawa N, Nishida K, Araki E. Efficacy and safety of sitagliptin as add-on therapy on glycemic control and blood glucose fluctuation in Japanese type 2 diabetes subjects ongoing with multiple daily insulin injections therapy. Endocr J 2013; 60:1207-14. [PMID: 23912974 DOI: 10.1507/endocrj.ej13-0198] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To assess the efficacy and safety of adding sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, in subjects with type 2 diabetes inadequately controlled with multiple daily insulin injections therapy (MDI). HbA1c, 1,5-anhydroglucitol (1,5-AG), body mass index (BMI), insulin doses, six-point self-measured plasma glucose (SMPG) profiles were assessed before, after 12 weeks, and after 24 weeks of MDI with 50 mg/day of sitagliptin in 40 subjects with type 2 diabetes. Safety endpoints included hypoglycemia and any adverse events. HbA1c significantly decreased during the first 12 weeks ( -0.64±0.60%), and was sustained over 24 weeks ( -0.69±0.85%). 1,5-AG increased significantly from 7.5±4.5 μg/mL at baseline to 9.6±5.5 μg/mL after 24 weeks. The bolus insulin dose at 12 weeks was decreased, and the mean plasma glucose, the SD of daily glucose, M-value, and the mean amplitude of glycemic excursions (MAGE) also decreased significantly as compared with baseline values. BMI and frequency of hypoglycemia were not changed significantly. Univariate linear regression analyses revealed that % change in HbA1c was significantly associated with BMI, and % changes in the indexes of glycemic instability (SD of daily glucose and MAGE) were significantly associated with age. In conclusion, adding sitagliptin to MDI significantly improved glycemic control and decreased the daily glucose fluctuation in subjects with type 2 diabetes inadequately controlled with MDI, without weight gain or an increase in the incidence of hypoglycemia. This trial was registered with UMIN (no. UMIN000010157).
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Affiliation(s)
- Seiya Shimoda
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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