1
|
Sharma A, Wanner C, Ofstad AP, Mattheus M, Kraus BJ, Zinman B, Ferreira JP. Impact of changes in weight and haematocrit on the reduction in systolic office and ambulatory blood pressure with empagliflozin in patients with type 2 diabetes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is uncertainty on how empagliflozin (EMPA) reduces blood pressure (BP), and in particular the potential role for changes in weight and haematocrit in mediating these effects.
Purpose
To assess the contributions of changes in weight and haematocrit on EMPA induced changes in BP in patients with type 2 diabetes mellitus (T2DM) in the EMPA-BP and EMPA-REG OUTCOME trials.
Methods
Patients received placebo (PBO), EMPA 10 mg or EMPA 25 mg. In EMPA-BP (12-week study), 823 patients with T2DM and hypertension (mean [SD] age 60.2 [9.0] years, HbA1c 7.90 [0.74] %, BMI 32.6 [5.1] kg/m2) were studied. In EMPA-REG OUTCOME, of the 7,020 treated patients with T2DM and cardiovascular disease (mean [SD] age 63.1 [8.6] years, HbA1c 8.07 [0.85] %, BMI 30.6 [5.3] kg/m2), 95.0% were on anti-hypertensive treatment at baseline. ANCOVA/MMRM models were applied to assess changes in systolic BP (SBP) at week 12 associated with, and independent of, changes in weight and haematocrit (Hct). SBP measurements are based on mean 24-h measurements from an ambulatory blood pressure monitoring (ABPM) device in EMPA-BP and seated office measurements in EMPA-REG OUTCOME.
Results
Mean (SD) baseline SBP was 131.7 (11.8), 131.3 (13.0) and 131.2 (12.1) mmHg in the PBO, EMPA 10 mg and EMPA 25 mg groups, respectively in EMPA-BP (mean 24-h SBP) and 135.8 (17.2), 134.9 (16.8) and 135.6 (17.0) mmHg (office SBP), respectively in EMPA-REG OUTCOME. In these relatively young patients with T2DM and mildly elevated mean SBP, EMPA reduced mean SBP by 3.4–4.2 mmHg compared with PBO (table) at week 12. Mean (SE) weight was reduced with EMPA (10 and 25mg) vs PBO treatment by −1.5 (0.2) kg and −2.0 (0.2) kg in EMPA-BP and by −1.2 (0.1) kg and −1.5 (0.1) kg in EMPA-REG OUTCOME at week 12. Mean (SE) haematocrit was increased by 2.1 (0.2) % and 1.8 (0.2) % versus placebo in EMPA-BP and by 2.2 (0.1) % and 2.5 (0.1) % in EMPA-REG OUTCOME with EMPA 10 mg and EMPA 25 mg, respectively. Weight loss accounted for 21–24% of the SBP reduction with EMPA treatment in EMPA-BP and 9–11% in EMPA-REG OUTCOME. Changes in Hct accounted for negligible (between −10% to 1%) SBP reduction with EMPA.
Conclusion
The reduction in SBP is modestly mediated through a reduction in weight. There was no meaningful effect of EMPA induced changes in Hct on SBP. Results were consistent using ABPM or office SBP. These findings suggest that EMPA's effects on SBP are likely mediated through other mechanisms such as natriuresis or reduction in arterial stiffness.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim and Eli Lilly and Company. Table 1
Collapse
Affiliation(s)
- A Sharma
- McGill University Health Centre, Montreal, Canada
| | - C Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - A P Ofstad
- Boehringer Ingelheim Norway KS, Asker, Norway
| | - M Mattheus
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - B J Kraus
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - J P Ferreira
- Université de Lorraine, INSERM, Centre d'Investigation Clinique et Plurithématique 1433, INSERM U1116, CHRU de Nancy, Cardiovascular and Renal Clinical Trialists, Nancy, France
| |
Collapse
|
2
|
Wanner C, Nangaku M, Kraus B, Zinman B, Mattheus M, Ohneberg K, Ben Hajmessaoud N, Zaoui P, Schmoor C, Inzucchi S. Médiateurs de l’effet du traitement par empagliflozine sur les résultats rénaux dans l’essai EMPA-REG OUTCOME. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
3
|
Hamilton A, Fitchett D, Zinman B, Inzucchi S, Wanner C, Anker S, Pocock S, Kaspers S, Mattheus M, Vedin O, Hantel S, Lund S. Effect of Empagliflozin on Total Events of Myocardial Infarctions by Subtype in the EMPA-REG OUTCOME Trial. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Yaggi H, Eliasson B, Kasai T, Marx N, Zinman B, Inzucchi S, Wanner C, Zwiener I, Wojeck B, Neeland I, Johansen O. Obstructive sleep apnoe and cardiovascular, heart failure and mortality outcomes with empagliflozin versus placebo in the EMPA-REG OUTCOME trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Obstructive sleep apnoe (OSA) and type 2 diabetes (T2D) occurs more frequently in persons with obesity, and both OSA and T2D are associated with metabolic disturbances that increases the risk for cardiovascular disease (CVD). In EMPA-REG OUTCOME, a randomized placebo-controlled outcome trial involving 7020 patients with T2D and CVD, the sodium glucose co-transporter (SGLT)-2 inhibitor empagliflozin reduced HbA1c, systolic blood pressure, waist circumference, and weight, and also reduced the risk of 3-point major adverse CV events (3P- MACE) by 14%, CV death by 38% and hospitalization for heart failure (HHF) by 35%.
Purpose
We investigated incidence rates of CV, HHF, and mortality outcomes in patients with or without OSA at baseline, and the treatment effect of empagliflozin, in EMPA-REG OUTCOME.
Methods
The trial included patients from 42 countries with T2D (with HbA1c 7.0–9.0% for drug-naïve patients and 7.0–10.0% for those on stable glucose-lowering therapy), established CVD, and estimated glomerular filtration rate >30 mL/min/1.73 m2. Patients were randomised (1:1:1) to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo once daily in addition to standard of care. All CV outcomes were independently adjudicated and events were pooled for the 10 and 25mg doses. In this post-hoc analysis, OSA were assessed based on investigator reports using MedDRA 18.0 and incidence rates for outcomes were reported by adjusted event-rates per 100 patient-years. Analysis of effects on outcomes were performed using Cox regression models with multivariable adjustments.
Results
Of 7020 patients with T2D and CVD, OSA was reported in 391 (5.6% [placebo 5.4%; pooled empagliflozin doses 5.7%]. Compared with patients without OSA at baseline, those with OSA were more frequent males (82.9% vs 70.8%), living in region North-America (63.2% vs 17.3%), and had more obesity (BMI ≥35 kg/m2: 55.2% vs 18.2%) and more coronary artery disease (88.0 vs 74.9%). Over a median 3.1 years, individuals with OSA at baseline relative to those without OSA in the placebo group, experienced 1.3–2.0 fold higher event rates for 3P-MACE (OSA vs no OSA: 6.49 vs 4.27/100-patient-year), CV death (2.57 vs 1.99), HHF (2.71 vs 1.38) and all-cause mortality (4.29 vs 2.78). Empagliflozin improved CV, HHF, and mortality outcomes regardless of presence of OSA at baseline (p-for interactions >0.05 [Figure 1]).
Conclusions
In this post-hoc exploratory analysis, patients with OSA had higher frequency of events for 3P-MACE, HHF and mortality. The cardio-protective effects of empagliflozin was consistent in those with and without OSA at baseline.
Figure 1. Sleep apnea and empagliflozin
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boehringer Ingelheim and Eli Lilly Diabetes Alliance
Collapse
Affiliation(s)
- H.K Yaggi
- Yale University, Yale School of Medicine, New Haven, United States of America
| | | | - T Kasai
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Marx
- RWTH University Hospital Aachen, Aachen, Germany
| | - B Zinman
- Mount Sinai Hospital of the University Health Network, Toronto, Canada
| | - S.E Inzucchi
- Yale University, Yale School of Medicine, New Haven, United States of America
| | - C Wanner
- University Hospital of Wurzburg, Wurzburg, Germany
| | - I Zwiener
- Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - B Wojeck
- Yale University, Yale School of Medicine, New Haven, United States of America
| | - I Neeland
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | | |
Collapse
|
5
|
Marx N, McGuire D, Johansen O, Rosenstock J, Pfarr E, Mattheus M, George J, Espeland M, Zinman B. Analysis of first plus recurrent cardiovascular (CV) and hospitalisation events in the CAROLINA trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
CAROLINA (cardiovascular outcome study of linagliptin versus glimepiride in type 2 diabetes) was a randomised controlled clinical trial designed to compare the effects of linagliptin with glimepiride on CV events and other outcomes in patients with relatively early type 2 diabetes at elevated CV risk.
Purpose
To characterise the effects on net CV disease and the hospitalisation burden of this population, we assessed the effects of linagliptin vs glimepiride on all first plus recurrent CV events and all cause hospitalisations.
Methods
Participants with relatively early type 2 diabetes, high CV risk and HbA1c 6.5–8.5% were randomized to linagliptin 5 mg or glimepiride 1–4 mg once daily on top of standard of care. Cox regression was used to produce hazard ratios for time to first event. A negative binomial model was used to produce event rate ratios for all events.
Results
A total of 6033 participants were enrolled (mean age 64.0 years, HbA1c 7.2%, body mass index 30.1 kg/m2, eGFR 77 ml/min/1.73 m2, median type 2 diabetes duration 6.3 years, urine albumin:creatine ratio 10 mg/g, 42% with CV disease, 4.5% with heart failure). Adding recurrent events increased the number of events for analysis from first event by 10% more to 77% across CV/heart failure outcomes and by 119% for all cause hospitalisations, with corresponding increases in rates per 100-patient years in both treatment groups (e.g. for the composite of CV death/MI/stroke from 2.1 to 2.8 for linagliptin and 2.1 to 2.9 for glimepiride) over a median follow up of 6.3 years. Results of analyses of first-event and first plus recurrent events are presented below (Fig).
Conclusion
No significant differences were observed between linagliptin and glimepiride for either first or first + recurrent CV or hospitalisation events. These data underscore the significant CV disease burden experienced even in relatively early type 2 diabetes and reinforce the similar CV safety between linagliptin and glimepiride, differing only on hypoglycaemia risk.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boehringer Ingelheim and Eli Lilly and Company
Collapse
Affiliation(s)
- N Marx
- RWTH University Hospital Aachen, Aachen, Germany
| | - D.K McGuire
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - O.E Johansen
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J Rosenstock
- Dallas Diabetes Research Center at Medical City, Dallas, United States of America
| | - E Pfarr
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M Mattheus
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - J.T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M.A Espeland
- Wake Forest University, Winston-Salem, United States of America
| | - B Zinman
- Mount Sinai Hospital of the University Health Network, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| |
Collapse
|
6
|
Verma S, Mazer C, Inzucchi S, Wanner C, Ofstad A, Johansen O, Zwiener I, George J, Butler J, Zinman B. Impact of polyvascular disease and renal dysfunction on cardiovascular outcomes in diabetes: post hoc analyses from EMPA-REG OUTCOME. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Individuals with polyvascular disease and impaired renal function are at high risk of cardiovascular (CV) events, but this relationship is not well investigated in people with type 2 diabetes (T2D). Furthermore, the impact of polyvascular disease plus renal dysfunction on the risk for hospitalisation for heart failure (HHF) remains unclear.
Purpose
We investigated this in a post hoc analysis of the EMPA-REG OUTCOME trial in which empagliflozin reduced risk of CV death and HHF versus placebo in people with T2D and vascular disease. In addition, we explored the treatment effect of empagliflozin on CV, HF and mortality outcomes across the spectrum of baseline polyvascular disease and impaired renal function.
Methods
Patients with T2D, CV disease and estimated glomerular filtration rate (eGFR) of ≥30 ml/min/1.73 m2 received empagliflozin 10 mg, 25 mg, or placebo. Vascular beds (VBs) were defined as coronary artery disease, peripheral artery disease, and cerebrovascular disease (Fig). By use of Cox regression, we explored the association between baseline eGFR < or ≥60 ml/min/1.73 m2, with or without polyvascular disease (1 vs ≥2 VBs involved), and CV death, HHF, CV death (excl. fatal stroke)/HHF, and all-cause mortality (ACM), as well as the treatment effect of empagliflozin versus placebo on these outcomes.
Results
Patients with ≥2 VBs involved and eGFR <60 ml/min/1.73 m2 [n=463], were slightly older (mean age 68.2 vs. 64.3 or 62.6 years), had T2D duration >10 years more often (73.4% vs. 63.2% or 54.9%), and a higher HF prevalence at baseline (19.4% vs. 11.1% or 9.2%) versus those with ≥2 VBs involved and eGFR ≥60 ml/min/1.73 m2 [n=866], or those with only 1 VB involved regardless of eGFR [n=5630], respectively. However, characteristics were generally balanced between treatment groups. Notably, co-existing polyvascular disease and eGFR <60 ml/min/1.73 m2 was strongly associated with increased risk of all outcomes. The placebo incidence rates per 1000 patient-years for CV death were 14.4 (95% CI 10.9, 18.3) and 19.6 (12.8, 27.8) in those with 1 VB involved and eGFR ≥60 or eGFR <60, respectively, and 32.7 (21.7, 45.8), and 52.4 (32.9, 76.5) in those with 2 VBs and eGFR ≥60 or eGFR <60 ml/min/1.73 m2, respectively. Importantly, empagliflozin reduced the risk for all outcomes regardless of number of VBs affected and kidney function (Fig).
Conclusions
Co-existing polyvascular disease and eGFR <60 ml/min/1.73 m2 confer an extremely high risk of CV and all-cause mortality, and HHF. Empagliflozin lowered this risk consistently compared with placebo, regardless of polyvascular disease and impaired kidney function.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance
Collapse
Affiliation(s)
- S Verma
- St Michael's Hospital, Division of Cardiac Surgery, University of Toronto, Toronto, Canada
| | - C.D Mazer
- St. Michael's Hospital, Department of Anesthesia, Toronto, Canada
| | - S.E Inzucchi
- Yale University School of Medicine, New Haven, United States of America
| | - C Wanner
- Würzburg University Clinic, Würzburg, Germany
| | - A.P Ofstad
- Boehringer Ingelheim Norway Ks, Asker, Norway
| | | | - I Zwiener
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - J.T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, United States of America
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
7
|
McGuire D, Zinman B, Inzucchi SE, Anker SD, Wanner C, Kaspers S, Von Eynatten M, Johansen OE, Elsasser U, Pocock S, Fitchett D, Jamal W, Hantel S, Lund SS. P6270Empagliflozin reduces the total burden of first and recurrent hospitalisations in patients with type 2 diabetes and established cardiovascular disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
The EMPA-REG OUTCOME trial included patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular (CV) disease. Empagliflozin reduced the risk of 3-point major adverse CV events (MACE; composite of CV death, myocardial infarction [MI], or stroke) by 14%, CV death by 38% and hospitalisation for heart failure (HF) by 35% vs placebo in analyses of time to first event. We assessed the effect of empagliflozin on all-cause hospitalisation in post-hoc analyses of all (first and recurrent) events.
Materials and methods
Patients were randomised to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo in addition to standard of care. We assessed the effects of empagliflozin pooled vs placebo on first event of all-cause hospitalisation using Cox regression and all (first and recurrent) events of all-cause hospitalisation using a negative binomial model.
Results
A total of 7020 patients were treated (4687 empagliflozin; 2333 placebo, mean [SD] age 63 [9] years, 71% male, 47% with history of MI, 23% with history of stroke, 10% with HF). In this analysis, 1725/4687 (36.8%) empagliflozin patients and 925/2333 (39.6%) placebo patients experienced an event leading to hospitalisation. The adjusted hazard ratio (HR; 95% CI) vs placebo for first all-cause hospitalisation using the Cox regression model was 0.89 (0.82, 0.96; p=0.0033; Figure); In analyses of all (first and recurrent) hospitalisation events, there were 3168 events in the empagliflozin group and 1863 in the placebo group. The adjusted event rate ratio (95% CI) vs placebo was 0.83 (0.76, 0.91; p<0.0001; Figure).
Conclusion
In the EMPA-REG OUTCOME trial, risk reductions with empagliflozin were seen in both first and all hospitalisation events and were numerically more favourable in analyses of all events vs analyses of first events. These analyses expand on the favourable CV effects of empagliflozin by also showing a reduction in the total burden of hospitalisation events in patients with T2D and established CV disease.
Acknowledgement/Funding
Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
Collapse
Affiliation(s)
- D McGuire
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - S E Inzucchi
- Yale University School of Medicine, Section of Endocrinology, New Haven, United States of America
| | - S D Anker
- Charité - Universitätsmedizin, Department of Cardiology (Campus CVK) & BRCT, Berlin, Germany
| | - C Wanner
- Würzburg University Clinic, Würzburg, Germany
| | - S Kaspers
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M Von Eynatten
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - O.-E Johansen
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - U Elsasser
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - S Pocock
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom
| | - D Fitchett
- St. Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - W Jamal
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S Hantel
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - S S Lund
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| |
Collapse
|
8
|
Pellicori P, Pernille Ofstad A, Fitchett D, Zeller C, Wanner C, George J, Zinman B, Brueckmann M, Lindenfeld J. P2629Early benefits of empagliflozin in patients with type 2 diabetes with heart failure are not offset by increased adverse events: results from the EMPA-REG OUTCOME trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The cardiovascular (CV) benefits of sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with type 2 diabetes (T2D) have been demonstrated in long-term clinical trials. In the EMPA-REG OUTCOME trial, the SGLT2 inhibitor empagliflozin (EMPA), compared with placebo (PBO), significantly reduced the risk of CV death and hospitalisation for heart failure (HHF) in patients with T2D and established CV disease, with a median follow-up time of 3.1 years.
Purpose
To investigate the early benefits and safety associated with use of EMPA in patients enrolled in the EMPA-REG OUTCOME trial according to heart failure (HF) status at baseline.
Methods
We evaluated the effects of treatments on glycated haemoglobin (HbA1c) levels and on the clinical endpoints of HHF, HHF or CV death, and HHF or all-cause mortality (ACM), as well as the occurrence of adverse events (AEs), at 12 weeks, 6 months, and 1 year after randomisation. Outcomes data were explored descriptively at 12 weeks, and assessed by Cox regression models adjusting for baseline risk factors at 6 months, and 1 year, whereas safety data were explored descriptively. Effects on HbA1c were evaluated using a Mixed Model Repeated Measures (MMRM) model.
Results
A total of 7020 participants, 706 (10%) with investigator-reported HF at baseline, were randomised to PBO, or two different doses of EMPA (10 mg or 25 mg once daily). In patients with HF at baseline, the adjusted mean differences in HbA1c between pooled EMPA and PBO at 12 weeks, 6 months, and 1 year after randomisation were −0.55, −0.54 and −0.53%-point, respectively, p<0.001 vs PBO for all, with similar results in those without HF (p for interactions 0.822, 0.939 and 0.539 at 12 weeks, 6 months and 1 year, respectively). Already at 12 weeks, patients assigned to EMPA had a lower frequency of all evaluated clinical outcome events (HHF, HHF or CV death, HHF or ACM) compared with PBO, regardless of HF status. This effect was sustained and significant at 6 months and 1 year in those with and without HF (see Figure). During the same time frame, the rates of AEs were generally higher in those with HF than without HF, but were not increased by the use of EMPA. At 1 year, any AE occurred in 206 (84.4%) and 1694 (81.1%) patients with and without HF, respectively, on PBO vs 363 (78.6%) and 3246 (76.8%) patients with and without HF on EMPA; any serious AE at 1 year occurred in 79 (32.4%) and 447 (21.4%) patients with and without HF on PBO vs 105 (22.7%) and 764 (18.1%) of those with and without HF on EMPA.
Conclusions
In the EMPA-REG OUTCOME trial, EMPA led to early beneficial effects on morbidity and mortality outcomes in patients with T2D with or without HF, which were not offset by an increased risk of AEs.
Collapse
Affiliation(s)
- P Pellicori
- University of Glasgow, Glasgow, United Kingdom
| | | | | | - C Zeller
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - C Wanner
- Würzburg University Clinic, Würzburg, Germany
| | - J George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - B Zinman
- Mount Sinai Hospital, Toronto, Canada
| | | | - J Lindenfeld
- Vanderbilt University, Nashville, United States of America
| |
Collapse
|
9
|
Marx N, McGuire DK, Johansen O, Rosenstock J, Kahn SE, Cooper ME, Toto R, Wanner C, Pfarr E, Schnaidt SY, George JT, Von Eynatten M, Perkovic V, Zinman B, Alexander JA. P6272First plus recurrent CV and hospitalization events in the CArdiovascular and Renal Microvascular outcomE study with LINAgliptin (CARMELINA) in patients with type 2 diabetes and cardiorenal disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
CARMELINA was a randomized placebo-controlled clinical trial designed to demonstrate the cardiovascular (CV) safety of linagliptin in patients with type 2 diabetes (T2D) and concomitant cardiorenal disease. Despite a particularly elevated CV risk, only limited long-term evidence from randomized controlled trials for safety and efficacy of glucose lowering medications is available for this population.
Purpose
To characterize the effects of linagliptin on net CV disease and hospitalization burden in this population.
Methods
People with T2D and either i) urine albumin creatinine ratio (UACR) >30 mg/g with concomitant CV disease, or ii) estimated glomerular filtration rate (eGFR) <45 ml/min/1.73m2 regardless of UACR, or eGFR ≥45–75 mL/min/1.73m2 and UACR >200 mg/g, were randomized to linagliptin 5 mg or placebo q.d. in a double-blind fashion in addition to standard of care. We assessed the effects of linagliptin versus placebo on all first plus recurrent CV events and all-cause hospitalizations using a using a negative binomial model to account for within-subject correlation.
Results
A total of 6979 participants were enrolled (mean age 66 years, 63% male, eGFR 54.6 ml/min/1.73m2, median UACR 162 mg/g, 59% with history of ischemic heart disease, 27% with history of heart failure (HF)) and followed for a median of 2.2 years. Adding recurrent events increased the number of events for analysis from 5.3–57.5% across CV/HF outcomes and 112.4% for hospitalizations. In analyses of first plus recurrent events, the event rate ratio (95% CI) with linagliptin versus placebo was 0.98 (0.82, 1.16; p=0.78) for 3-point MACE, 1.03 (0.79, 1.35; p=0.83) for myocardial infarction 1.03 (0.83, 1.29; p=0.77) for myocardial infarction plus revascularization, 0.89 (0.65, 1.22; p=0.48) for stroke, 0.94 (0.70, 1.27; p=0.69) for stroke plus TIA, 0.94 (0.75, 1.20; p=0.63) for hospitalized HF, 0.92 (0.77, 1.11; p=0.40) for the composite of CV death or hospitalized HF, and 0.96 (0.87, 1.06; p=0.40) for all-cause hospitalization (Figure).
Conclusion
Linagliptin showed similar risk of either first or recurrent CV or hospitalization events compared with placebo in patients with T2D and cardiorenal disease. These data support the CV safety of linagliptin and, considering the high volume of recurrent events, underscores the significant CV disease burden experienced by patients with T2D and cardiorenal disease
Acknowledgement/Funding
Boehringer Ingelheim and Eli Lilly
Collapse
Affiliation(s)
- N Marx
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - D K McGuire
- University of Texas Southwestern Medical School, Dallas, United States of America
| | | | - J Rosenstock
- Dallas Diabetes Research Center at Medical City, Dallas, United States of America
| | - S E Kahn
- University of Washington, Seattle, United States of America
| | | | - R Toto
- University of Texas Southwestern Medical School, Dallas, United States of America
| | - C Wanner
- University Hospital of Wurzburg, Wurzburg, Germany
| | - E Pfarr
- Boehringer Ingelheim, Ingelheim, Germany
| | | | - J T George
- Boehringer Ingelheim, Ingelheim, Germany
| | | | - V Perkovic
- The George Institute for Global Health, Sydney, Australia
| | - B Zinman
- Mount Sinai Hospital of the University Health Network, Toronto, Canada
| | - J A Alexander
- Duke Clinical Research Institute, Durham, United States of America
| |
Collapse
|
10
|
Verma S, Bain S, Honoré J, Mann J, Nauck M, Pratley R, Rasmussen S, Sejersten Ripa M, Zinman B, Buse J. IMPACT OF MICROVASCULAR DISEASE ON CARDIORENAL OUTCOMES IN TYPE 2 DIABETES: AN ANALYSIS FROM THE LEADER AND SUSTAIN 6 CLINICAL TRIALS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
11
|
Verma S, Böhm M, Brueckmann M, Fitchett D, George J, Inzucchi S, Marx N, Mattheus M, Ofstad A, Slawik J, Wanner C, Zinman B. HEART FAILURE OUTCOMES IN PATIENTS WITH DIABETES WITH AND WITHOUT ATRIAL FIBRILLATION - DATA FROM THE EMPA-REG OUTCOME STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
12
|
Udell J, Zinman B, Wanner C, Von Eynatten M, George JT, Zwiener I, Lund SS, Hantel S, Fitchett D. 193Qualifying event proximity, cardiovascular risk, and benefit of empagliflozin in patients with type 2 diabetes and stable atherosclerosis in the EMPA-REG OUTCOME trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In type 2 diabetes, the temporal proximity of an atherosclerotic cardiovascular (CV) event can impact prognosis, but whether timing influences sodium glucose co-transporter 2 inhibitor effects is unknown. We explored the association of time from last qualifying CV event before randomisation (myocardial infarction [MI], stroke, coronary artery disease or peripheral arterial disease) with CV outcomes and benefit of empagliflozin (EMPA) in EMPA-REG OUTCOME.
Methods
Patients (pts) were randomised to EMPA 10 mg, 25 mg or placebo and followed for 3.1 years (median). Risk of major adverse CV events (3P MACE: CV death, MI, stroke), CV death or hospitalisation for heart failure (HHF) were evaluated using Cox regression in subgroups of ≤1/>1 year since last qualifying CV event. Qualifying event stratification was possible in 6796 (97%) pts.
Results
In the overall population, N=6796 (4547 EMPA and 2249 placebo pts), median (Q1, Q3) time from last CV event was 3.8 (1.5–7.6) years. Overall, 1214 (EMPA 841; placebo 373) and 5582 (EMPA 3706; placebo 1876) pts had a last qualifying CV event ≤1 and >1 year, respectively. Pts with more recent events had similar risk for CV outcomes compared with pts >1 year from qualifying event (Figure). Moreover, the benefit of EMPA on CV outcomes was consistent between pts enrolled ≤1 or >1 year from the qualifying CV event (all p-interaction >0.05; Figure).
Conclusion
Although most pts had a qualifying CV event >1 year before randomisation in EMPA-REG OUTCOME, the benefits of EMPA appear to extend to pts with more recent CV events.
Acknowledgement/Funding
Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
Collapse
Affiliation(s)
- J Udell
- UHN - University of Toronto, Cardiovascular Division, Women's College Hospital and Peter Munk Cardiac Centre, Toronto, Canada
| | - B Zinman
- UHN - University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - C Wanner
- University Hospital of Wurzburg, Department of Internal Medicine I, Nephrology, Wurzburg, Germany
| | - M Von Eynatten
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - I Zwiener
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S S Lund
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S Hantel
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | |
Collapse
|
13
|
Udell J, Zinman B, Wanner C, von Eynatten M, George J, Zwiener I, Lund S, Hantel S, Fitchett D. QUALIFYING EVENT PROXIMITY, CARDIOVASCULAR RISK, AND BENEFIT OF EMPAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES AND STABLE ATHEROSCLEROSIS IN THE EMPA-REG OUTCOME TRIAL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
14
|
Terenzi DC, Verma S, Trac JZ, Quan A, Mason T, Al-Omran M, Dhingra N, Leiter LA, Zinman B, Yan AT, Connelly KA, Teoh H, Mazer CD, Hess DA. P317A novel role of SGLT2 inhibitors to increase circulating proangiogenic progenitor cells in patients with type 2 diabetes and cardiovascular disease: A sub-study of the EMPA-HEART CardioLink-6 Trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
SGLT2 inhibitors (SGLT2i) have been demonstrated to reduce major adverse cardiovascular events and mortality in patients with type 2 diabetes (T2D) who are at high risk for cardiovascular disease (CVD). However, the mechanism(s) of the underlying benefit remain unclear. Since regenerative cell exhaustion resulting in impaired vascular homeostasis has been proposed as a key driver of CV events in T2D, we hypothesised that modulation of circulating vascular regenerative cell content by SGLT2i may be a novel basis of cardioprotection.
Purpose
To evaluate the effects of the SGLT2i, empagliflozin (EMPA), vs placebo on circulating vascular regenerative and pro-inflammatory cells in patients with T2D and CVD.
Methods
This was a biomarker sub-study of the EMPA-HEART Cardiolink-6 randomised trial of EMPA (10mg QD) vs placebo in patients with T2D and a history of coronary artery disease (prior myocardial infarction and/or coronary revascularisation). Blood samples (baseline N=48; study end N=26) underwent multiparametric progenitor cell analyses by flow cytometry. Circulating cells were assessed for aldehyde dehydrogenase (ALDH) activity, a self-protective enzyme highly expressed in several proangiogenic progenitor cell lineages, as well as cell surface co-expression of the primitive progenitor (CD34, CD133) or M1/M2 macrophage (CD80, CD163) markers.
Results
Individuals with increased inflammatory burden (ALDHhi granulocytes above the baseline median) were older (61±2 vs 67±2 years), more likely to be current or past smokers (21% vs 42%) and had reduced LV function, assessed by echocardiography. The placebo- and EMPA-assigned groups were equivalent at baseline with respect to the frequency and distribution of proangiogenic progenitor cells (ALDHhiSSClo), monocyte/macrophage (ALDHhiSSCmid) and inflammatory granulocyte (ALDHhiSSChi) precursors. Following 6-months of treatment with EMPA, there was a marked increase in the number of circulating primitive ALDHhiSSClo cells with CD133 (Placebo: −2.8±3.8%, EMPA: +8.6±2.5%, P<0.02) or CD133/CD34 (Placebo: 0.4±4.5%, EMPA: +13.3±3.8%, P<0.05) co-expression. Furthermore, EMPA treatment was associated with an increase in the frequency of circulating anti-inflammatory cells with M2 macrophage polarisation marked by CD163 (Placebo: −0.7±0.8%, EMPA = +3.9±1.3%, P<0.01) expression. Non-significant increases in circulating proangiogenic monocytes, and decreases in the frequency of circulating inflammatory granulocytes were also observed after EMPA treatment (vs placebo).
Conclusion
We provide the first evidence showing that SGLT2i treatment with EMPA alters the balance of key circulating vascular progenitor and inflammatory cells in patients with T2D and CVD. We suggest that SGLT2i may afford cardioprotection through a novel and previously unrecognised capacity to limit regenerative cell exhaustion in T2D.
Acknowledgement/Funding
This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.
Collapse
Affiliation(s)
- D C Terenzi
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - J Z Trac
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - A Quan
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - T Mason
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - M Al-Omran
- St. Michael's Hospital, Vascular Surgery, Toronto, Canada
| | - N Dhingra
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - L A Leiter
- St. Michael's Hospital, Endocrinology & Metabolism, Toronto, Canada
| | - B Zinman
- Mount Sinai Hospital of the University Health Network, Endocrinology & Metabolism, Toronto, Canada
| | - A T Yan
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - K A Connelly
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - H Teoh
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - C D Mazer
- St. Michael's Hospital, Anesthesia, Toronto, Canada
| | - D A Hess
- University of Western Ontario, Physiology and Pharmacology, London, Canada
| |
Collapse
|
15
|
Verma S, Qiuhe J, Bhatt D, Mazer C, Al-Omran M, Inzucchi S, Wanner C, Ofstad A, Zwiener I, George J, Zinman B, Fitchett D. URIC ACID LEVELS PREDICT CARDIORENAL OUTCOMES AND CARDIOVASCULAR DEATH IN PATIENTS WITH TYPE 2 DIABETES: A SUB-ANALYSIS OF EMPA-REG OUTCOME. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
16
|
Garg V, Verma S, Connelly KA, Yan AT, Sikand A, Garg A, Dorian P, Zuo F, Leiter LA, Zinman B, Juni P, Verma A, Quan A, Mazer CD, Ha ACT. P3753Does empagliflozin modulate the autonomic system among patients with type 2 diabetes and coronary artery disease? Insights from the Holter sub-study of the EMPA-Heart CardioLink-6 Randomised Trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The mechanism behind how empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces all-cause and cardiovascular mortality among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) is unknown. Autonomic tone, as reflected by changes in heart rate variability (HRV), is an established prognosticator in patients with CAD and/or heart failure.
Purpose
To assess if empagliflozin treatment changes HRV in subjects with T2DM and CAD.
Methods
In the double-blind EMPA-Heart trial, 97 subjects with T2DM and CAD were randomised to empagliflozin 10 mg/day or placebo for 6 months and underwent 24-hour Holter monitoring at baseline and 6 months. Using automated algorithms, time and frequency HRV domain measures were obtained (standard deviation of NN intervals (SDNN); SD of the average NN intervals for each 5-minute segment (SDANN); root mean square of successive RR interval differences (rMSSD); % interval differences of successive NN intervals >50 ms (pNN50); ratio of low to high frequency (LF/HF)). Changes of these HRV parameters were calculated over 6 months. Between-group differences in HRV parameters were compared using ANCOVA.
Results
Complete Holter data (baseline and 6-month) were available for 68% (n=66) of the cohort. The average heart rate (HR) at baseline/6 months was 69.5±9.8 bpm/72.8±8.1 bpm and 76±10.4 bpm/76.5±10.6 in the placebo group and empagliflozin group, respectively. Both groups had similar changes in average HR over 6 months. Key Holter data are summarised in the table. SDNN and SDANN were higher in the placebo vs. empagliflozin group at 6 months; no significant difference was noted for all other measures.
Empagliflozin 10 mg/day (n=33) Placebo (n=33) Adjusted difference between Empagliflozin and Placebo (ANCOVA) Baseline, Mean (SD) 6-month, Mean (SD) Baseline, Mean (SD) 6-month, Mean (SD) Mean, (95% CI) P-value SDNN (ms) 100.49 (43.74) 98.05 (38.86) 109.35 (30.02) 125.08 (43.83) −18.55 (−34.28, −2.82) 0.022 SDANN (ms) 86.84 (39.34) 83.76 (35.53) 94.70 (28.52) 118.28 (77.41) −20.24 (−37.27, −3.21) 0.021 rMSSD (ms) 27.00 (11.84) 27.22 (13.48) 28.00 (11.58) 27.17 (9.38) −1.23 (−6.02, 3.55) 0.608 pNN50 (%) 7.81 (7.59) 8.32 (9.51) 8.26 (7.8) 6.93 (5.35) 0.51 (−2.61, 3.62) 0.746 LF/HF ratio 1.63 (0.52) 1.65 (0.51) 1.53 (0.43) 1.83 (0.82) −0.08 (−0.38, 0.22) 0.602
Conclusions
Among subjects with T2DM and CAD, changes in HRV over 6 months were similar in the empagliflozin and placebo arms suggesting that the mortality benefit conferred by empagliflozin is not associated with positive modulation of autonomic tone.
Acknowledgement/Funding
This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.
Collapse
Affiliation(s)
- V Garg
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - K A Connelly
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - A T Yan
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - A Sikand
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - A Garg
- University of Toronto, Medicine, Toronto, Canada
| | - P Dorian
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - F Zuo
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | - L A Leiter
- St. Michael's Hospital, Endocrinology & Metabolism, Toronto, Canada
| | - B Zinman
- Mount Sinai Hospital of the University Health Network, Endocrinology & Metabolism, Toronto, Canada
| | - P Juni
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | - A Verma
- Southlake Regional Health Centre, Cardiology, Toronto, Canada
| | - A Quan
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - C D Mazer
- St. Michael's Hospital, Anesthesia, Toronto, Canada
| | - A C T Ha
- UHN - University of Toronto, Peter Munk Cardiac Centre, Toronto, Canada
| |
Collapse
|
17
|
Wanner MD C, Zinman B, von Eynatten M, Koitka-Weber A, Zwiener I, Hauske S. SAT-305 EFFECTS OF EMPAGLIFLOZIN VS PLACEBO ON CARDIORENAL OUTCOMES IN PEOPLE WITH TYPE 2 DIABETES AND PROTEINURIC DIABETIC KIDNEY DISEASE: INSIGHTS FROM EMPA-REG OUTCOME. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
18
|
Böhm M, Brueckmann M, Fitchett D, George J, Inzucchi S, Marx N, Mattheus M, Ofstad A, Slawik J, Verma S, Wanner C, Zinman B. Heart Failure Outcomes in Patients with Diabetes With and Without Atrial Fibrillation – Data From the EMPA-REG OUTCOME Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Verma S, Mazer D, Bhatt D, Raj S, Yan A, Verma A, Ferrannini E, Simons G, Zinman B, Fitchett D. MS09.2 Empagliflozin Reduces Mortality In Patients With Type 2 Diabetes and A History of Left Ventricular Hypertrophy: A Sub-analysis of the EMPA-REG OUTCOME Trial. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
20
|
Verma S, Mazer C, Fitchett D, Inzucchi S, George J, Pfarr E, Woerle H, Zinman B. EMPAGLIFLOZIN REDUCES MORTALITY AND HOSPITALIZATION FOR HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES AND PERIPHERAL ARTERY DISEASE: A SUB-ANALYSIS OF THE EMPA-REG OUTCOME TRIAL. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
21
|
Fitchett D, Inzucchi S, Sambevski S, Kaspers S, Pfarr E, George J, Zinman B. EMPAGLIFLOZIN REDUCES MORTALITY AND HOSPITALIZATION FOR HEART FAILURE IN PATIENTS WITH OR WITHOUT A HISTORY OF MYOCARDIAL INFARCTION OR STROKE AT BASELINE. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
22
|
Verma S, Leiter L, Mazer C, Bain S, Buse J, Marso S, Nauck M, Zinman B, Bosch-Traberg H, Frimer-Larsen H, Michelsen M, Bhatt D. LIRAGLUTIDE REDUCES CARDIOVASCULAR EVENTS AND MORTALITY IN TYPE 2 DIABETES INDEPENDENT OF LDL CHOLESTEROL AND STATIN USE: RESULTS OF THE LEADER TRIAL. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
23
|
Verma S, Mazer C, Bhatt D, Raj S, Yan A, Verma A, Ferrannini E, Simons G, Lee J, Zinman B, George J, Fitchett D. EMPAGLIFLOZIN REDUCES MORTALITY IN PATIENTS WITH TYPE 2 DIABETES AND A HISTORY OF LEFT VENTRICULAR HYPERTROPHY: A SUB-ANALYSIS OF THE EMPA-REG OUTCOME TRIAL. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
24
|
Verma S, Mazer DC, Bhatt DL, Raj SR, Yan AT, Verma A, Ferrannini E, Simons G, Lee J, Zinman B, George JT, Fitchett D. P1876Empagliflozin reduces mortality in patients with type 2 diabetes and a history of left ventricular hypertrophy: a sub-analysis of the EMPA-REG OUTCOME trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Verma
- St Michael's Hospital, Division of Cardiac Surgery, University of Toronto, Toronto, Canada
| | - D C Mazer
- St Michael's Hospital, Department of Anesthesia, University of Toronto, Toronto, Canada
| | - D L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, United States of America
| | - S R Raj
- Vanderbilt University, Division of Clinical Pharmacology, Nashville, United States of America
| | - A T Yan
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - A Verma
- St Michael's Hospital, Division of Cardiac Surgery, University of Toronto, Toronto, Canada
| | - E Ferrannini
- University of Pisa School of Medicine, Pisa, Italy
| | - G Simons
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J Lee
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - J T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - D Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
McGuire DK, Zinman B, Inzucchi SE, Anker SD, Wanner C, Kaspers S, George JT, Elsasser U, Woerle HJ, Lund SS, Fitchett D. P5334Effect of empagliflozin on cardiovascular events including recurrent events in the EMPA-REG OUTCOME trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D K McGuire
- University of Texas Southwestern Medical School, Dallas, United States of America
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - S E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, United States of America
| | - S D Anker
- Division of Cardiology and Metabolism, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Wanner
- Würzburg University Clinic, Würzburg, Germany
| | - S Kaspers
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - U Elsasser
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - H J Woerle
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S S Lund
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - D Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| |
Collapse
|
26
|
Fitchett D, Inzucchi SE, Cannon CP, McGuire DK, Johansen OE, Sambevski S, Hehnke U, George J, Zinman B. P1879Empagliflozin reduces mortality and hospitalisation for heart failure irrespective of cardiovascular risk score at baseline. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - S E Inzucchi
- Yale University, Section of Endocrinology, New Haven, United States of America
| | - C P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, United States of America
| | - D K McGuire
- University of Texas Southwestern Medical School, Dallas, United States of America
| | | | - S Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - U Hehnke
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
27
|
Verma S, Leiter LA, Mazer CD, Bain SC, Buse J, Marso S, Nauck M, Zinman B, Bosch-Traberg H, Frimer-Larsen H, Michelsen MM, Bhatt DL. P2858Liraglutide reduces cardiovascular events and mortality in type 2 diabetes independent of LDL cholesterol and statin use: results of the LEADER trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | | | - C D Mazer
- University of Toronto, Toronto, Canada
| | - S C Bain
- Swansea University, Swansea, United Kingdom
| | - J Buse
- University of North Carolina Hospitals, Chapel Hill, United States of America
| | - S Marso
- HCA Midwest Health Heart & Vascular Institute, Kansas City, United States of America
| | - M Nauck
- Ruhr University Bochum (RUB), Bochum, Germany
| | - B Zinman
- University of Toronto, Toronto, Canada
| | | | | | | | - D L Bhatt
- Harvard Medical School, Boston, United States of America
| | | | | |
Collapse
|
28
|
Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
Collapse
Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Inzucchi SE, Fitchett D, Wanner C, George J, Woerle HJ, Zinman B. Reduction in cardiovascular death with empagliflozin is consistent across categories of baseline HbA1c and change in HbA1c: Results from EMPA-REG OUTCOME. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- SE Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT, United States
| | - D Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - C Wanner
- Department of Medicine, Division of Nephrology, Würzburg University Clinic, Würzburg, Germany
| | - J George
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - HJ Woerle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - B Zinman
- Division of Endocrinology, University of Toronto, Toronto, Canada
| |
Collapse
|
30
|
Zinman B, Marso SP, Christiansen E, Calanna S, Rasmussen S, Buse JB, Jacob S. Schwere Hypoglykämien, kardiovaskuläre Ergebnisse und Tod – Erfahrungen aus der LEADER Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B Zinman
- Mt. Sinai Hospital, University of Toronto, Toronto, Canada
| | - SP Marso
- Research Medical Center, Kansas City, United States
| | | | | | | | - JB Buse
- University of North Carolina School of Medicine, Chapel Hill, United States
| | - S Jacob
- Internist, Endokrinologe und Diabetologe, Kardio-Metabolisches Institut, Villingen-Schwenningen, Germany
| |
Collapse
|
31
|
Zinman B, Mathieu C, Kaspers S, Woerle HJ, Fitchett D. Empagliflozin reduces mortality in analyses adjusted for control of blood pressure, low density lipoprotein cholesterol and HbA1c over time. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B Zinman
- Division of Endocrinology, University of Toronto, Toronto, Canada
| | - C Mathieu
- Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - S Kaspers
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - HJ Woerle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - D Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| |
Collapse
|
32
|
Choi H, Kramer CK, Zinman B, Connelly PW, Retnakaran R. Effect of short-term intensive insulin therapy on the incretin response in early type 2 diabetes. Diabetes Metab 2018; 45:197-200. [PMID: 29395808 DOI: 10.1016/j.diabet.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/04/2017] [Accepted: 01/03/2018] [Indexed: 01/07/2023]
Abstract
AIMS Short-term intensive insulin therapy (IIT) and gastric bypass surgery are both interventions that can improve beta-cell function, reduce insulin resistance and induce remission of type 2 diabetes. Whereas gastric bypass yields an enhanced glucagon-like peptide-1 (GLP-1) response that may contribute to its metabolic benefits, the effect of short-term IIT on the incretin response is unclear. Thus, we sought to evaluate the impact of IIT on GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) secretion in early type 2 diabetes. METHODS In this study, 63 patients (age 59±8.3 years, baseline A1c 6.8±0.7%, diabetes duration 3.0±2.1 years) underwent 4 weeks of IIT (basal insulin detemir and pre-meal insulin aspart). GLP-1, GIP and glucagon responses were assessed by the area-under-the-curve (AUC) of these hormones on oral glucose tolerance tests at baseline and 1-day after the completion of therapy. Beta-cell function was assessed by Insulin Secretion-Sensitivity Index-2 (ISSI-2), with insulin resistance measured by Homeostasis Model Assessment (HOMA-IR). RESULTS As expected, comparing the post-therapy oral glucose tolerance test to that at baseline, IIT increased ISSI-2 (P=0.02), decreased HOMA-IR (P<0.001), and reduced AUCglucagon (P<0.001). Of note, however, IIT had no significant impact on AUCGLP-1 (P=0.24) and reduced AUCGIP (P=0.02). CONCLUSION Despite improving beta-cell function, insulin resistance and glucagonemia, short-term IIT does not change GLP-1 secretion and decreases the GIP response to an oral glucose challenge in early type 2 diabetes. Thus, the beneficial impact of this therapy on glucose homeostasis is not attributable to its effects on incretin secretion.
Collapse
Affiliation(s)
- H Choi
- Leadership Sinai center for diabetes, Mount Sinai hospital, Toronto, Canada
| | - C K Kramer
- Leadership Sinai center for diabetes, Mount Sinai hospital, Toronto, Canada; Division of endocrinology, university of Toronto, Toronto, Canada
| | - B Zinman
- Leadership Sinai center for diabetes, Mount Sinai hospital, Toronto, Canada; Division of endocrinology, university of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum research institute, Mount Sinai hospital, Toronto, Canada
| | - P W Connelly
- Division of endocrinology, university of Toronto, Toronto, Canada; Keenan research center for biomedical science of St. Michael's hospital, Toronto, Canada; Department of laboratory medicine and pathobiology, university of Toronto, Toronto, Canada
| | - R Retnakaran
- Leadership Sinai center for diabetes, Mount Sinai hospital, Toronto, Canada; Division of endocrinology, university of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum research institute, Mount Sinai hospital, Toronto, Canada.
| |
Collapse
|
33
|
Davis T, Poulter N, Bain S, Buse J, Monk-Hansen T, Nauck M, Rasmussen S, Pratley R, Zinman B, Ørsted D, Marso S. Risk of Major Cardiovascular Events in Patients With Type 2 Diabetes With and Without Prior CV Events: Results From The LEADER Trial. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Leiter L, Poulter N, Bain S, Buse J, Monk-Hansen T, Nauck M, Rasmussen S, Pratley R, Zinman B, Ørsted D, Marso S. RISK OF MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES WITH AND WITHOUT PRIOR CARDIOVASCULAR EVENTS: RESULTS FROM THE LEADER TRIAL. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
35
|
Zinman B, Mathieu C, Kaspers S, Mattheus M, Woerle H, Fitchett D. 4881Empagliflozin reduces mortality in analyses adjusted for control of blood pressure, low density lipoprotein cholesterol and HbA1c over time. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Jurišić-Eržen D, Johansen OE, George J, Mattheus M, Zinman B, Inzucchi SE. Effect of empagliflozin when added to insulin in patients with type 2 diabetes and established cardiovascular disease: Results from the EMPA-REG OUTCOME trial. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - OE Johansen
- Boehringer Ingelheim Norway KS, Asker, Norway
| | - J George
- Boehringer Ingelheim Ltd, Bracknell, Berkshire, United Kingdom
| | - M Mattheus
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - B Zinman
- University of Toronto, Division of Endocrinology, Toronto, Ontario, Canada
| | - SE Inzucchi
- Yale University School of Medicine, Section of Endocrinology, New Haven, Connecticut, United States
| |
Collapse
|
37
|
Zinman B, Inzucchi SE, Lachin JM, George J, Mattheus M, Woerle HJ, Fitchett D. Consistent effect of empagliflozin on cardiovascular death in subgroups by type of cardiovascular disease: results from EMPA-REG OUTCOME. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B Zinman
- University of Toronto, Division of Endocrinology, Toronto, Canada
| | - SE Inzucchi
- Yale University School of Medicine, Section of Endocrinology, New Haven, United States
| | - JM Lachin
- George Washington University, The Biostatistics Center, Rockville, United States
| | - J George
- Boehringer Ingelheim Ltd, Bracknell, United Kingdom
| | - M Mattheus
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - HJ Woerle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - D Fitchett
- St Michael's Hospital, University of Toronto, Division of Cardiology, Toronto, Canada
| |
Collapse
|
38
|
Mann JF, Nauck MA, Jacob S, Lüdemann J, Brown-Frandsen K, Daniels GH, Kristensen P, Nissen SE, Pocock S, Poulter NR, Ravn LS, Rasmussen S, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Rieck M, Baeres FM, Marso SP, Buse JB. Liraglutid und renale Endpunkte bei Typ 2 Diabetes: Ergebnisse der LEADER Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- JF Mann
- Friedrich Alexander Universität Erlangen, Abteilung Nephrologie, Erlangen, Germany
| | - MA Nauck
- Ruhr-University Bochum, St. Josef Hospital, Klinische Forschung, Abteilung Diabetologie, Medizinische Klinik I, Bochum, Germany
| | - S Jacob
- Praxis für Prävention und Therapie, Villingen-Schwenningen, Germany
| | - J Lüdemann
- Diabetes- und Fußzentrum 'diabetes falkensee', Falkensee, Germany
| | | | - GH Daniels
- Massachusetts General Hospital, Boston, United States
| | | | - SE Nissen
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States
| | - S Pocock
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - NR Poulter
- Imperial College London, London, United Kingdom
| | - LS Ravn
- Novo Nordisk A/S, Soeborg, Denmark
| | | | - WM Steinberg
- George Washington University Medical Center, Department of Medicine, Rockville, United States
| | | | - B Zinman
- University of Toronto, Mount Sinai Hospital, Sinai Centre for Diabetes, Toronto, Canada
| | - RM Bergenstal
- Park Nicollet Institute for Research and Education, International Diabetes Center, Minneapolis, United States
| | - M Rieck
- Novo Nordisk Pharma GmbH, Mainz, Germany
| | | | - SP Marso
- University of Texas Southwestern, Department of Internal Medicine, Dallas, United States
| | - JB Buse
- University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, United States
| |
Collapse
|
39
|
Jaskolka D, Retnakaran R, Zinman B, Kramer CK. Fetal sex and maternal risk of pre-eclampsia/eclampsia: a systematic review and meta-analysis. BJOG 2017; 124:553-560. [PMID: 27315789 DOI: 10.1111/1471-0528.14163] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND A preponderance of male fetuses in pregnancies complicated by pre-eclampsia was described over 40 years ago. Since then, however, there has been conflicting evidence in the literature, with some studies supporting a male preponderance, some demonstrating no relationship with fetal sex, and others reporting increased risk in pregnancies bearing females. OBJECTIVES In this context, we sought to conduct a systematic review and meta-analysis to objectively evaluate the relationship between fetal sex and maternal risk of pre-eclampsia/eclampsia. SEARCH STRATEGY Studies from January 1950 to April 2015 were identified from PUBMED and EMBASE. SELECTION CRITERIA This systematic review and meta-analysis evaluated 22 articles reporting data on fetal sex and prevalence of pre-eclampsia/eclampsia. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers. Pooled estimates of the relative risk (RR) were calculated by random-effects model. MAIN RESULTS Male fetus was considered the exposure and prevalence of maternal pre-eclampsia/eclampsia was the outcome of interest. We identified 534 studies through electronic searches and three studies through manual searches. Twenty-two studies fulfilled the inclusion criteria, yielding data on 3 163 735 women. Pooled analyses of these studies showed no association between male fetal sex and maternal risk of pre-eclampsia/eclampsia (RR 1.01; 95% confidence interval, 95% CI 0.97-1.05); however, a subgroup analysis including only studies that evaluated the non-Asian population (n = 2 931 771 women) demonstrated that male fetal sex was associated with increased maternal risk of pre-eclampsia/eclampsia (RR 1.05; 95% CI 1.03-1.06; I2 = 10%; P = 0.33). CONCLUSION Male fetal sex is associated with maternal risk of pre-eclampsia/eclampsia in the non-Asian population. TWEETABLE ABSTRACT Fetal sex is associated with maternal risk of pre-eclampsia/eclampsia in the non-Asian population.
Collapse
Affiliation(s)
- D Jaskolka
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Retnakaran
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - B Zinman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - C K Kramer
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
40
|
Matthews DR, Zinman B, Tong C, Meininger G, Polidori D. Glycaemic efficacy of canagliflozin is largely independent of baseline β-cell function or insulin sensitivity. Diabet Med 2016; 33:1744-1747. [PMID: 26600115 DOI: 10.1111/dme.13033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - B Zinman
- Luenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C Tong
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - G Meininger
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - D Polidori
- Janssen Research & Development, LLC, San Diego, CA, USA
| |
Collapse
|
41
|
Fitchett D, Zinman B, Lachin J, Mattheus M, George J, Johansen O, Inzucchi S. EFFECTS OF EMPAGLIFLOZIN ON OVERALL HEART FAILURE BURDEN IN EMPA-REG OUTCOME. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
42
|
Fitchett D, Inzucchi S, Lachin J, Wanner C, Mattheus M, Johansen O, Woerle H, Broedl U, Zinman B. EFFECT OF EMPAGLIFLOZIN ON MORTALITY AND CAUSES OF DEATH IN PATIENTS WITH TYPE 2 DIABETES AT HIGH CARDIOVASCULAR RISK. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
43
|
Heller S, Mathieu C, Kapur R, Wolden ML, Zinman B. A meta-analysis of rate ratios for nocturnal confirmed hypoglycaemia with insulin degludec vs. insulin glargine using different definitions for hypoglycaemia. Diabet Med 2016; 33:478-87. [PMID: 26484727 PMCID: PMC5064738 DOI: 10.1111/dme.13002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/27/2022]
Abstract
AIMS A prospective meta-analysis of phase 3 trials showed lower rates of nocturnal hypoglycaemia with insulin degludec vs. insulin glargine. We investigated the consistency of the results across different definitions of hypoglycaemia. METHODS This post-hoc, patient-level meta-analysis included six randomized, controlled, 26- or 52-week phase 3a trials in insulin-naïve participants with Type 2 diabetes mellitus (Type 2 diabetesinsulin naïve ), participants with Type 2 diabetes mellitus using basal-bolus therapy (Type 2 diabetesBB ) and those with Type 1 diabetes mellitus. We used three definitions of hypoglycaemia and different timescales for the nocturnal period. Rates were analysed for the entire core trial period, the 'maintenance period' only, and the extension trial set population. Analyses utilized a negative binomial regression model. RESULTS In Type 2 diabetesinsulin naïve participants, risk of nocturnal hypoglycaemia was significantly lower with insulin degludec vs. insulin glargine for all hypoglycaemia definitions and trial periods. Risk was also lower for the timescale 21.59-05.59, but not 00.01-07.59. For Type 2 diabetesBB , nocturnal hypoglycaemia rates were lower with insulin degludec vs. insulin glargine across all definitions, timescales and trial periods, with one exception. For individuals with Type 1 diabetes mellitus, nocturnal hypoglycaemia risk was significantly lower with insulin degludec during the maintenance period for the original definition (plasma glucose < 3.1 mmol/l, timescale 00.01-05.59) and in the extension trial set population for all hypoglycaemia definitions except for the nocturnal timescale 00.01-07.59. CONCLUSIONS Compared with insulin glargine, insulin degludec is associated with lower rates of nocturnal hypoglycaemia in people with Type 2 diabetes mellitus, and similar or lower rates in Type 1 diabetes mellitus, across different definitions.
Collapse
Affiliation(s)
- S Heller
- University of Sheffield, Sheffield, UK
| | | | - R Kapur
- Novo Nordisk A/S, Søborg, Denmark
| | | | - B Zinman
- The Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
44
|
Kramer CK, Hamilton JK, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Differential impact of maternal and paternal ethnicity on the pattern of fat distribution in infants at age 3 months. Pediatr Obes 2016; 11:11-7. [PMID: 25676072 DOI: 10.1111/ijpo.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/24/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND As ethnicity is typically recorded as a single demographic variable in clinical studies, little is known about the relative impact of maternal vs. paternal ethnicity on fat distribution. OBJECTIVES The objective of this study was to determine whether there is a differential impact of maternal and paternal ethnicity on infant adiposity. METHODS Three hundred fifty-five infants underwent anthropometric assessment at age 3 months, including skin-fold thickness (SFT) measurement at subscapular, suprailiac and triceps. Maternal (M) and paternal (P) ethnicity were classified as white (M = 241, P = 252), Asian (M = 50, P = 42) or other (M = 64, P = 61). RESULTS Infants with either Asian mother (compared with white) or Asian father (compared with white) had increased subscapular, suprailiac and triceps SFT (all P < 0.05). On logistic regression analysis, however, only maternal Asian ethnicity (compared with white) independently predicted the likelihood of an infant being in the highest tertile for SFT at subscapular (odds ratio [OR] = 2.72, 95% confidence interval 1.17-6.34, P = 0.02), suprailiac (OR = 3.56, 1.51-8.42, P = 0.004) and triceps (OR = 3.26, 1.40-7.55, P = 0.005). In contrast, paternal Asian ethnicity was independently associated with sum of SFT only (OR = 2.46, 1.02-5.97, P = 0.04). CONCLUSION Maternal and paternal Asian ethnicity have differential effects on infant fat distribution. Future clinical studies on obesity and fat composition should consider the distinct contributions of both parents to the ethnic classification of participants.
Collapse
Affiliation(s)
- C K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.,Division of Endocrinology, University of Toronto, Toronto, Canada
| | - J K Hamilton
- Hospital for Sick Children, Department of Pediatrics, Toronto, Canada
| | - C Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - A J Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.,Division of Endocrinology, University of Toronto, Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - P W Connelly
- Division of Endocrinology, University of Toronto, Toronto, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - M Sermer
- Division of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - B Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.,Division of Endocrinology, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - R Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.,Division of Endocrinology, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
45
|
Kramer CK, Zinman B, Retnakaran R. Response to the Letter by Kalra S. et al. J Clin Endocrinol Metab 2015; 100:L118. [PMID: 26544664 DOI: 10.1210/jc.2015-3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
46
|
Daniels GH, Hegedüs L, Marso SP, Nauck MA, Zinman B, Bergenstal RM, Mann JFE, Derving Karsbøl J, Moses AC, Buse JB, Tuttle RM. LEADER 2: baseline calcitonin in 9340 people with type 2 diabetes enrolled in the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial: preliminary observations. Diabetes Obes Metab 2015; 17:477-86. [PMID: 25656058 PMCID: PMC4405040 DOI: 10.1111/dom.12444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/18/2015] [Accepted: 01/31/2015] [Indexed: 01/31/2023]
Abstract
AIMS To report preliminary data on baseline serum calcitonin concentrations and associated clinical characteristics in a global population with type 2 diabetes before liraglutide or placebo randomization. METHODS The ongoing LEADER trial has enrolled 9340 people with type 2 diabetes and at high risk of cardiovascular disease at 410 centres worldwide. People with baseline serum calcitonin ≤ 50 ng/l were randomized to liraglutide once daily or placebo and will be followed for up to 5 years. Serum calcitonin was measured at baseline and will be measured annually thereafter. An independent committee of thyroid experts will oversee calcitonin monitoring throughout the trial and will review all calcitonin concentrations ≥ 20 ng/l. RESULTS The mean age of participants was 64.3 ± 7.2 years, 64.3% were men, and mean the body mass index was 32.5 ± 6.3 kg/m(2). The median (interquartile range) baseline serum calcitonin values were 3.9 (1.0 to >7.6) ng/l in men and 1.0 (1.0 to >1) ng/l in women. Serum calcitonin was >10 ng/l in 14.6% of men and in 0.96% of women. In sex-specific multivariable linear analysis of covariance models, a reduced glomerular filtration rate (GFR) was associated with higher serum calcitonin concentrations that were statistically significant. A 20 ml/min/1.73 m(2) decrease in estimated GFR (eGFR) was associated with a 14% increase in serum calcitonin in women and an 11% increase in men. CONCLUSIONS In the LEADER population, the prevalence of elevated serum calcitonin concentrations at baseline was high, and there was an inverse association between eGFR and serum calcitonin concentrations.
Collapse
Affiliation(s)
- G H Daniels
- Thyroid Unit and Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, USA
- Correspondence to: Gilbert H. Daniels, MD, Massachusetts General Hospital, Thyroid Unit ACC 730, Boston, MA 02114, USA. E-mail:
| | - L Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern DenmarkOdense, Denmark
| | - S P Marso
- Division of Cardiology, Department of Internal Medicine, University of Texas SouthwesternDallas, TX, USA
| | - M A Nauck
- DiabeteszentrumBad Lauterberg, Germany
| | - B Zinman
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of TorontoToronto, Canada
| | - R M Bergenstal
- International Diabetes Center at Park NicolletMinneapolis, MN, USA
| | - J F E Mann
- Dept. of Nephrology, Hypertension & Rheumatology, Friedrich Alexander University of ErlangenMunchen, Germany
| | | | | | - J B Buse
- Department of Medicine, University of North Carolina School of MedicineChapel Hill, NC, USA
| | - R M Tuttle
- Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| |
Collapse
|
47
|
Stein CM, Kramer CK, Zinman B, Choi H, Opsteen C, Retnakaran R. Clinical predictors and time course of the improvement in β-cell function with short-term intensive insulin therapy in patients with Type 2 diabetes. Diabet Med 2015; 32:645-52. [PMID: 25495067 DOI: 10.1111/dme.12671] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/26/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
AIMS In patients with Type 2 diabetes, a short course of intensive insulin therapy can improve β-cell function and even induce transient remission of diabetes. However, not all patients respond to this therapy. Although the achievement of fasting glucose < 7.0 mmol/l one day after stopping intensive insulin therapy can identify patients in whom β-cell function has improved, we sought to determine clinical predictors for the early identification of such responders and the time course of response. METHODS We pooled data from two studies in which 97 patients with Type 2 diabetes mellitus (median 3 years duration) and HbA1c 51 ± 8.7 mmol/mol (6.8 ± 0.8%) underwent 4-8 weeks of intensive insulin therapy, consisting of basal detemir and pre-meal insulin aspart. They were classified as responders (n = 74) or non-responders (n = 23), defined by the achievement of fasting glucose < 7.0 mmol/l after stopping intensive insulin therapy. RESULTS On logistic regression analyses, duration of diabetes (odds ratio [OR] = 0.72, 95% confidence interval [CI] 0.56-0.92, P = 0.009) and baseline fasting glucose (OR = 0.40, 95% CI 0.24-0.68, P = 0.001) emerged as predictors of the likelihood of responding. Ninety per cent of patients with duration ≤ 4 years and fasting glucose ≤ 8.0 mmol/l responded to intensive insulin therapy. Despite having lower glucose levels during intensive insulin therapy, responders had less hypoglycaemia than non-responders (median 0.3 vs. 1.6 episodes/week, P < 0.0001), with rates of hypoglycaemia diverging sharply from the third week onwards. CONCLUSION At baseline, shorter duration of diabetes and lower fasting glucose can identify patients most likely to benefit from short-term intensive insulin therapy. Most importantly, during therapy, responders had less hypoglycaemia from the third week onwards, despite lower glycaemia, suggesting that 2 weeks of intensive insulin therapy may be needed to improve endogenous islet function.
Collapse
Affiliation(s)
- C M Stein
- Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
48
|
Grundner M, Heller S, Mathieu C, Kapur R, Wolden ML, Zinman B. Bestätigte nächtliche Hypoglykämien mit Insulin degludec vs. Insulin glargin unter Verwendung unterschiedlicher Definitionen. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
49
|
Rodbard HW, Cariou B, Zinman B, Handelsman Y, Wolden ML, Rana A, Mathieu C. Health status and hypoglycaemia with insulin degludec versus insulin glargine: a 2-year trial in insulin-naïve patients with type 2 diabetes. Diabetes Obes Metab 2014; 16:869-72. [PMID: 24495158 PMCID: PMC4237540 DOI: 10.1111/dom.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 12/16/2022]
Abstract
Insulin degludec (IDeg) is a new basal insulin with an ultra-long and stable glucose-lowering effect. We compared once-daily IDeg and insulin glargine (IGlar), both in combination with metformin ± dipeptidyl peptidase-4 inhibitors, in a 52-week, open-label, treat-to-target trial in patients with type 2 diabetes followed by a 52-week extension trial in which subjects [n = 725/1030 (70.4%)] maintained their initial randomised treatment. Health status was assessed at baseline and 105 weeks using the Short Form-36 (SF-36 v2) questionnaire. SF-36 scores were analysed (ITT population) using anova, with adjustments for covariates. At 105 weeks, the overall physical component score was significantly better with IDeg versus IGlar [treatment contrast (TC): 1.1 (0.1; 2.1)95% CI , p < 0.05]. This was largely because of significantly better physical functioning [TC: 1.1 (0.0; 2.3)95% CI , p < 0.05] and bodily pain sub-domain scores [TC: 1.5 (0.2; 2.9)95% CI , p < 0.05]. Improvements in health status with IDeg compared to IGlar were maintained after 2 years.
Collapse
Affiliation(s)
- H W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Mathieu C, Rodbard HW, Cariou B, Handelsman Y, Philis-Tsimikas A, Ocampo Francisco AM, Rana A, Zinman B. A comparison of adding liraglutide versus a single daily dose of insulin aspart to insulin degludec in subjects with type 2 diabetes (BEGIN: VICTOZA ADD-ON). Diabetes Obes Metab 2014; 16:636-44. [PMID: 24443830 DOI: 10.1111/dom.12262] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 01/02/2023]
Abstract
AIM Two treatment strategies were compared in patients with type 2 diabetes (T2DM) on basal insulin requiring intensification: addition of once-daily (OD) liraglutide (Lira) or OD insulin aspart (IAsp) with largest meal. METHODS Subjects completing 104 weeks (52-week main trial BEGIN ONCE-LONG + 52-week extension) on insulin degludec (IDeg) OD + metformin with HbA1c ≥ 7.0% (≥53 mmol/mol) were randomized to IDeg+Lira [n = 88, mean HbA1c: 7.7% (61 mmol/mol)] or IDeg+IAsp (n = 89, mean HbA1c: 7.7%) for 26 weeks, continuing metformin. Subjects completing 104 weeks with HbA1c <7.0% continued IDeg + metformin in a third, non-randomized arm (n = 236). RESULTS IDeg+Lira reduced HbA1c (-0.74%-points) significantly more than IDeg+IAsp (-0.39%-points); estimated treatment difference (ETD) (IDeg+Lira-IDeg+IAsp) -0.32%-points (95% CI -0.53; -0.12); p = 0.0024. More IDeg+Lira (49.4%) than IDeg+IAsp (7.2%) subjects achieved HbA1c <7.0% without confirmed hypoglycaemia [plasma glucose <3.1 mmol/l (<56 mg/dl) or severe hypoglycaemia) and without weight gain; estimated odds ratio (IDeg+Lira/IDeg+IAsp) 13.79 (95% CI 5.24; 36.28); p < 0.0001. IDeg+Lira subjects had significantly less confirmed and nocturnal confirmed hypoglycaemia, and significantly greater weight loss (-2.8 kg) versus IDeg+IAsp (+0.9 kg); ETD (IDeg+Lira-IDeg+IAsp) -3.75 kg (95% CI -4.70; -2.79); p < 0.0001. Other than more gastrointestinal side effects with IDeg+Lira, no safety differences occurred. Durability of IDeg was established in the non-randomized arm, as mean HbA1c remained <7.0% [mean 6.5% (48 mmol/mol) at end-of-trial]. CONCLUSIONS IDeg+Lira improved long-term glycaemic control, with weight loss and less hypoglycaemia versus adding a single daily dose of IAsp in patients with T2DM inadequately controlled with IDeg + metformin.
Collapse
Affiliation(s)
- C Mathieu
- UZ Leuven, University of Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|