1
|
Boye KS, Lebrec J, Dib A, Heitmann E, Federici MO, Yu M, Sapin H, Barrett A, Guerci B, Giorgino F, Füchtenbusch M, García-Pérez LE. The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients (TROPHIES): Final patient-reported outcomes at 24 months. Diabetes Obes Metab 2023; 25:3453-3464. [PMID: 37712754 DOI: 10.1111/dom.15145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/10/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 09/16/2023]
Abstract
AIM To report health-related patient-reported outcomes (PROs) in people with type 2 diabetes (T2D) initiating their first injectable glucose-lowering medication (GLM) with two commonly prescribed glucagon-like peptide-1 receptor agonists (GLP-1RAs) from the prospective, observational TROPHIES study (The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients). MATERIALS AND METHODS TROPHIES was a two-cohort, 24-month study conducted in France, Germany and Italy. Adults with a T2D diagnosis, naïve to injectable treatment for T2D and prescribed dulaglutide or liraglutide as their first injectable GLM, were eligible for inclusion. Study objectives included describing the following PROs associated with the treatment of T2D with GLP-1RAs: health-related quality of life; impact of weight on self-perception; life and work productivity; and patient satisfaction with treatment and injection device. Additional analyses formally compared PRO measures between the treatment cohorts. RESULTS Overall, improvements from baseline in PRO scores were observed among people who started dulaglutide or liraglutide. A more pronounced trend of improvement was observed in the dulaglutide cohort for changes from baseline in treatment satisfaction and impact of weight on self-perception, supported by statistically significant differences between treatment cohorts in additional comparative analyses at 12, 18 and 24 months. More positive patient perceptions of the injection device were observed with dulaglutide than with liraglutide. CONCLUSIONS Improvements in PROs observed in TROPHIES, which were more evident with dulaglutide than liraglutide, reflect a relevant clinical benefit. From the patients' perspective, satisfaction, and confidence in continuing treatment with GLP-1RAs is likely to contribute to long-term treatment persistence.
Collapse
Affiliation(s)
| | | | - Anne Dib
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Maria Yu
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Hélène Sapin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Bruno Guerci
- University Hospital of Nancy, Vandoeuvre Lès Nancy, France
| | | | | | | |
Collapse
|
2
|
Giorgino F, Guerci B, Füchtenbusch M, Lebrec J, Boye K, Orsini Federici M, Heitmann E, Dib A, Yu M, Sapin H, García-Pérez LE. The real-world observational prospective study of health outcomes with dulaglutide and liraglutide in patients with type 2 diabetes (TROPHIES): Final, 24-month analysis of time to first significant treatment change, treatment persistence and clinical outcomes. Diabetes Obes Metab 2023; 25:3465-3477. [PMID: 37700627 DOI: 10.1111/dom.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/17/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/14/2023]
Abstract
AIMS To present the final results of the TROPHIES study (The real-world observational prospective study of health outcomes with dulaglutide and liraglutide in patients with type 2 diabetes). MATERIALS AND METHODS The prospective, real-world TROPHIES study included patients with type 2 diabetes initiating their first injectable glucose-lowering medication (GLM), dulaglutide or liraglutide, in France, Germany and Italy. The primary endpoint was the time spent on dulaglutide or liraglutide until a significant treatment change over 24 months. Other endpoints measured persistence with treatment, clinical outcomes (glycated haemoglobin [HbA1c] and weight) and treatment patterns. Kaplan-Meier estimates of time to first significant treatment change and persistence with treatment were generated. Propensity-score-based inverse probability of treatment weighting (IPTW) was used to adjust for baseline imbalances in the comparison between cohorts. RESULTS The 286 of 1014 patients (28.2%) in the dulaglutide cohort and 448 of 991 patients (45.2%) in the liraglutide cohort had a significant treatment change over 24 months. By IPTW analysis, dulaglutide-initiating patients were less likely to have a significant treatment change (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.46-0.63) and more likely to be persistent with treatment (HR 0.69, 95% CI 0.56-0.86) over 24 months than liraglutide-initiating patients. Dulaglutide and liraglutide yielded similar HbA1c (-11.80 mmol/mol [1.08%] and -11.91 mmol/mol [1.09%]) and weight (-3.5 kg and -3.3 kg) reductions from baseline to 24 months. Few changes in patterns of treatment with other GLMs were observed in the two cohorts. CONCLUSIONS Dulaglutide-initiating patients had a longer time spent without any significant treatment change and higher persistence than those initiating liraglutide. Treatment with either glucagon-like peptide-1 receptor agonist yielded similar and clinically meaningful reductions in HbA1c and body weight.
Collapse
Affiliation(s)
| | - Bruno Guerci
- University Hospital of Nancy, Vandoeuvre Lès Nancy, France
| | | | | | - Kristina Boye
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Elke Heitmann
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Anne Dib
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Maria Yu
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Hélène Sapin
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana, USA
| | | |
Collapse
|
3
|
Otto T, Diesing J, Borchert J, Heitmann E, C Schloot N, Lebrec J, Müller-Wieland D, Haeckl D. Age-dependent prevalence of type 2 diabetes, cardiovascular risk profiles and use of diabetes drugs in Germany using health claims data. Diabetes Obes Metab 2023; 25:767-775. [PMID: 36457132 DOI: 10.1111/dom.14924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/11/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
AIMS This study evaluates type 2 diabetes mellitus (T2DM) prevalence in Germany, focusing on patients at risk for, or with already established, cardiovascular disease (CVD), as well as their antidiabetic and cardiovascular treatments. MATERIALS AND METHODS Using anonymized claims data from the WIG2 database, we calculated 2018 T2DM prevalence, extrapolating rates to the German statutory health insurance population. In the study period, 3 376 228 patients were eligible in the database. Forming antidiabetic medication groups, we evaluated treatment regimens of patients at risk for, or with already established CVD, based on the REWIND study criteria. We also evaluated their CVD medication prescriptions. RESULTS Statutory health insurance extrapolated T2DM prevalence was estimated at 11.9%, with higher prevalence rates in older patients. When only patients with prescriptions of antidiabetic drugs were included, prevalence was 7.6%. At least 94% of patients with T2DM medication had at least one risk factor (without considering age) according to REWIND criteria, while 67%-80% had at least two risk factors depending on treatment received. Patients taking insulin combined with oral therapy comprised the largest proportion of patients with at least two REWIND risk factors. Approximately 85% of all patients with T2DM in the population were treated with antihypertensive medication. CONCLUSIONS T2DM is widespread and affects older patients particularly. Most patients with T2DM had at least one CV risk factor, and about half already had established CVD. Early prevention of CVD, which disproportionately affects patients with T2DM, is necessary. Furthermore, the treatment of older patients with T2DM with insulin is still common and needs further evaluation.
Collapse
Affiliation(s)
| | - Joanna Diesing
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany
| | - Julia Borchert
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany
| | | | | | | | - Dirk Müller-Wieland
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Dennis Haeckl
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany
- Faculty of Economics and Management, Leipzig University, Leipzig, Germany
| |
Collapse
|
4
|
Jung H, Tittel SR, Schloot NC, Heitmann E, Otto T, Lebrec J, Pavel M, Lanzinger S. Clinical characteristics, treatment patterns, and persistence in individuals with type 2 diabetes initiating a glucagon-like peptide-1 receptor agonist: A retrospective analysis of the Diabetes Prospective Follow-Up Registry. Diabetes Obes Metab 2023. [PMID: 36855221 DOI: 10.1111/dom.15038] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/31/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
AIMS To describe clinical characteristics, treatment patterns and glucagon-like peptide-1 receptor agonist (GLP-1 RA) persistence in individuals with type 2 diabetes (T2D) initiating their first GLP-1 RA. MATERIALS AND METHODS A real-world analysis of adults with T2D initiating GLP-1 RA therapy between 2007 and June 2020 from the multicentre Diabetes Prospective Follow-Up (DPV) Registry, stratified by antidiabetes therapy at the time of GLP-1 RA initiation: oral antidiabetic drugs (OAD), insulin ± OAD or lifestyle modification (LM). GLP-1 RA treatment persistence in individuals with ≥12 months follow-up was determined by Kaplan-Meier analysis. RESULTS Overall, 15 111 individuals with T2D initiating GLP-1 RA therapy (55% men) were identified; median [interquartile range (IQR)] age [58.7 (50.6-66.7) years], diabetes duration [8.5 (3.6-14.7) years], glycated haemoglobin [HbA1c; 8.2 (7.1-9.8)%]. Median (95% confidence interval) GLP-1 RA persistence in eligible individuals (n = 5189) was 11 (10-12) months; OAD 12 (11-14) months (n = 2453); insulin ± OAD 11 (9-12) months (n = 2204); and LM 7 (5-9) months (n = 532). Median treatment persistence tended to increase from 2007-2012 to 2017-2020. Median (IQR) HbA1c decreased from baseline [8.2 (7.1-9.8)%] to discontinuation [7.5 (6.6-8.7)%], with a greater decrease observed in individuals with persistence >12 months versus ≤12 months. Individuals who discontinued GLP-1 RA therapy predominantly switched to insulin (if not already using) or dipeptidyl peptidase-4 inhibitors. CONCLUSION Real-world registry data revealed improved outcomes with longer median GLP-1 RA persistence; ~50% of patients overall achieved HbA1c <7% at 12 months. Persistence was highest with baseline OAD and/or insulin, and tended to increase over the period 2007-2020.
Collapse
Affiliation(s)
- Heike Jung
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | - Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | | | | | | | | | | | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| |
Collapse
|
5
|
Guerci B, Giorgino F, Sapin H, Boye K, Lebrec J, Federici MO, Heitmann E, Dib A, Füchtenbusch M, García‐Pérez L. The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Patients with Type 2 Diabetes (TROPHIES): Patient disposition, clinical characteristics and treatment persistence at 12 months. Diabetes Obes Metab 2022; 24:2373-2382. [PMID: 35876235 PMCID: PMC9804517 DOI: 10.1111/dom.14823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023]
Abstract
AIMS The primary objective of the TROPHIES observational study is to estimate the duration of treatment on dulaglutide or liraglutide without a significant treatment change by 24 months in patients with type 2 diabetes (T2D) initiating their first injectable treatment with these glucagon-like peptide-1 receptor agonists (GLP-1 RAs). This manuscript presents 12-month interim data. MATERIALS AND METHODS TROPHIES is a prospective, non-comparative, observational study of patients with T2D in Europe, naïve to injectable antihyperglycaemic treatments and initiating dulaglutide or liraglutide. Data on clinical characteristics, GLP-1 RA persistence and treatment patterns of glucose-lowering medication were collected at initiation of first injectable therapy and by 12 months. RESULTS By 12 months, 1014 dulaglutide and 991 liraglutide patients were eligible across France, Germany and Italy. Both cohorts presented a high probability [95% confidence interval (CI)] of GLP-1 RA persistence [dulaglutide, 0.88 (0.86 to 0.90); liraglutide, 0.83 (0.80 to 0.85)] and reduction in mean glycated haemoglobin percentage (95% CI) from baseline [dulaglutide, -1.18 (-1.27 to -1.08); liraglutide, -1.15 (-1.26 to -1.05)] with 48.2% of dulaglutide and 41.2% of liraglutide patients reaching their individualized glycated haemoglobin percentage target set by the physician at baseline. Mean weight (95% CI) change from baseline was -3.2 kg (-3.6 to -2.8) for dulaglutide and -3.4 kg (-3.9 to -3.0) for liraglutide. Slight changes in concomitant medications were observed compared with baseline. CONCLUSIONS In the real-world setting, dulaglutide and liraglutide cohorts achieved good persistence with similarly improved glycaemic control that was accompanied by weight loss at 12 months, consistent with previous clinical trial results.
Collapse
Affiliation(s)
- Bruno Guerci
- Department of Endocrinology, Diabetology and NutritionUniversity Hospital of NancyVandoeuvre‐lès‐NancyFrance
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic DiseasesUniversity of Bari Aldo MoroBariItaly
| | - Hélène Sapin
- Statistics and Real World AnalyticsLilly France SASNeuilly‐sur‐SeineFrance
| | - Kristina Boye
- Value, Evidence, and OutcomesEli Lilly and CompanyIndianapolisIndianaUSA
| | - Jérémie Lebrec
- Real World Access and AnalyticsHaaPACS GmbHSchriesheimGermany
| | | | - Elke Heitmann
- Medical AffairsLilly Deutschland GmbHBad HomburgGermany
| | - Anne Dib
- Medical AffairsLilly France SASNeuilly‐sur‐SeineFrance
| | | | | |
Collapse
|
6
|
García-Pérez LE, Boye KS, Rosilio M, Jung H, Heitmann E, Norrbacka K, Federici MO, Gentilella R, Guerci B, Giorgino F, Aigner U, Sapin H. The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients (TROPHIES): Design and Baseline Characteristics. Diabetes Ther 2021; 12:1929-1946. [PMID: 34097244 PMCID: PMC8266969 DOI: 10.1007/s13300-021-01076-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/08/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The TROPHIES observational study enrolled patients with type 2 diabetes mellitus (T2DM) initiating their first injectable treatment with the glucagon-like peptide 1 receptor agonists (GLP-1 RAs) dulaglutide or liraglutide. This manuscript focuses on the study design, baseline characteristics of the enrolled population, and factors associated with GLP-1 RA choice. METHODS TROPHIES is a prospective, observational, 24-month study conducted in France, Germany, and Italy. Inclusion criteria include adult patients with T2DM, naïve to injectable antihyperglycemic treatments, initiating dulaglutide or liraglutide per routine clinical practice. The primary outcome is the duration of treatment on dulaglutide or liraglutide without a significant treatment change. RESULTS The analysis included 2181 patients (dulaglutide, 1130; liraglutide, 1051) (cutoff date May 15, 2019). The population was 56% male with mean [standard deviation (SD)] patient characteristics at baseline as follows: age, 59.2 (11.0) years; body mass index (BMI), 33.9 (6.6) kg/m2; T2DM duration, 8.5 (6.9) years; and glycated hemoglobin (HbA1c), 8.2 (1.3)%. Between-cohort demographic and clinical characteristics were balanced. The mean (SD) HbA1c and BMI values for French, German, and Italian patients were, respectively, 8.6 (1.4)%, 8.2 (1.4)%, 8.0 (0.8)%; 33.3 (6.1) kg/m2, 36.0 (7.2) kg/m2, and 32.6 (5.9) kg/m2. CONCLUSION This study analysis at baseline provides an opportunity to evaluate between-country differences in baseline HbA1c, weight, macrovascular complications, and factors driving GLP-1 RA selection for patients with T2DM in daily practice.
Collapse
Affiliation(s)
| | | | | | - Heike Jung
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | | | | | | | | | - Bruno Guerci
- Hôpital Brabois Adultes, CHRU de Nancy and University of Lorraine, Nancy, France
| | | | | | | |
Collapse
|
7
|
Boye KS, Sapin H, García-Pérez LE, Rosilio M, Orsini Federici M, Heitmann E, Jung H, Aigner U, Guerci B, Giorgino F, Norrbacka K. The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients (TROPHIES): Baseline Patient-Reported Outcomes. Diabetes Ther 2020; 11:2383-2399. [PMID: 32880876 PMCID: PMC7509014 DOI: 10.1007/s13300-020-00908-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Although patient-reported outcome (PRO) measures provide important information beyond clinical data, studies that assess the PROs of type 2 diabetes mellitus (T2DM) patients initiating injectable glucose-lowering medications in routine clinical practice are limited. We describe the perspectives of patients based on a diversified panel of generic and disease-specific PRO measures at the time of enrollment (baseline) in the TROPHIES study. METHODS TROPHIES is a 24-month prospective observational study performed in France, Germany, and Italy in patients with T2DM who initiated their first injectable glucose-lowering medication with once-weekly dulaglutide or once-daily liraglutide. To better understand the perspectives of these patients regarding their overall health, treatment satisfaction, and quality of life and work, the patients' responses to the following questionnaires were collected at baseline before they initiated treatment with dulaglutide or liraglutide: EQ-5D-5L (scale: 0-1), EQ-VAS (visual analog scale: 0-100), Impact of Weight on Self-Perceptions Questionnaire (IW-SP; scale: 0-100), Diabetes Treatment Satisfaction Questionnaire Status (DTSQs; scale: 0-36), and Diabetes Productivity Measure (DPM; scale: 0-100). Analyses were descriptive in nature, with higher scores reflecting better outcomes. RESULTS Data from patients at the time of enrollment were analyzed. At baseline, patients initiating dulaglutide (N = 1130) or liraglutide (N = 1051) rated their quality of life in terms of mean EQ-5D-5L index as 0.84 and 0.83, and in terms of mean EQ-VAS as 67.5 and 67.5, respectively. The mean baseline scores in patients initiating dulaglutide or liraglutide were 59.8 and 61.3 for IW-SP, 24.6 and 25.8 for DTSQs, 78.6 and 79.5 for DPM Life Productivity, and 87.5 and 86.8 for DPM Work Productivity, respectively. CONCLUSION The information from this varied panel of PRO instruments collected at baseline complements clinical outcomes data.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Heike Jung
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | | | - Bruno Guerci
- University Hospital of Nancy, Vandoeuvre Lès Nancy, France
| | | | | |
Collapse
|
8
|
Fuechtenbusch M, Aberle J, Heitmann E, Nicolay C, Jung H. Weight loss in patients with type 2 diabetes receiving once-weekly dulaglutide plus insulin lispro or insulin glargine plus insulin lispro: A post-hoc analysis of the AWARD-4 study across baseline body mass index subgroups. Diabetes Obes Metab 2019; 21:1340-1348. [PMID: 30737891 DOI: 10.1111/dom.13658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/02/2018] [Revised: 11/15/2018] [Accepted: 12/02/2018] [Indexed: 01/19/2023]
Abstract
AIMS Insulin-treated patients with type 2 diabetes (T2D) and obesity are challenged in achieving body weight stability or reduction, in addition to glycaemic control. Post-hoc analyses of body weight and insulin dose data from the AWARD-4 trial involved comparison of treatment with once-weekly dulaglutide 1.5 mg (N = 295) or 0.75 mg (N = 293) and treatment with daily insulin glargine (N = 296), each with prandial insulin lispro (± metformin). MATERIALS AND METHODS Changes in weight and in the proportion of patients without weight gain or with weight loss of at least 3%, 5% or 10% or composites of HbA1c less than 7% without weight gain and weight loss of at least 3% after 52 weeks were compared between the dulaglutide (either dose) groups and the insulin glargine group, overall and by baseline BMI (<30, 30-<35, ≥35 kg/m2 ), using analysis of covariance and logistic regression, including interaction terms. RESULTS The following parameters were statistically significant (P < 0.01) in favour of the dulaglutide-treated groups, at lower mean total daily insulin doses, vs the insulin glargine group. The achieved targets were more pronounced with dulaglutide 1.5 mg than with insulin glargine: LSM weight change difference, -3.23 kg; proportion of patients without weight gain, 49.0% vs 19.0%; proportion of patients with weight loss ≥3%, 21.7% vs 5.7% or with weight loss ≥5%, 10.5% vs 2.4%; proportion of patients with HbA1c <7% without weight gain, 26.2% vs 7.9%; proportion of patients with HbA1c <7% and weight loss ≥3%, 11.9% vs 1.4%, respectively. Treatment effect for these parameters was not significantly different across BMI categories. CONCLUSIONS Larger proportions of patients in late-stage T2D needing treatment intensification achieved glycemic control without weight gain or with weight loss at lower insulin doses with once-weekly dulaglutide plus daily prandial insulin than with a basal-bolus insulin regimen, overall and across all three BMI subgroups.
Collapse
Affiliation(s)
| | - Jens Aberle
- Department of Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Heike Jung
- Lilly Deutschland GmbH, Bad Homburg, Germany
| |
Collapse
|
9
|
Pavo I, García-Pérez LE, Tao Y, Thieu VT, Sattar NA, Heitmann E. Changes in lipid concentrations in patients with type 2 diabetes on once-weekly dulaglutide 1.5 mg: Post hoc pooled analysis of the AWARD trials. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641919] [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)
- I Pavo
- Eli Lilly and Company, Indianapolis, United States
| | | | - Y Tao
- Eli Lilly and Company, Indianapolis, United States
| | - VT Thieu
- Eli Lilly and Company, Indianapolis, United States
| | - NA Sattar
- University of Glasgow, Institute of Cardiovascular and Medical Sciences Glasgow, Glasgow, United Kingdom
| | - E Heitmann
- Lilly Deutschland GmbH, Bad Homburg vor der Höhe, Germany
| |
Collapse
|
10
|
Heitmann E, Jung H, Schloot N, Pavo I, Forst T, Trautmann M, Schernthaner G. Dulaglutid: GLP-1-Rezeptoragonist zur einmal wöchentlichen Therapie des Typ-2-Diabetes. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0036-1585054] [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: 10/20/2022]
Affiliation(s)
- E. Heitmann
- Medizinische Abteilung – Diabetes, Lilly Deutschland GmbH, Bad Homburg, Deutschland
| | - H. Jung
- Medizinische Abteilung – Diabetes, Lilly Deutschland GmbH, Bad Homburg, Deutschland
| | - N. Schloot
- Medizinische Abteilung – Diabetes, Lilly Deutschland GmbH, Bad Homburg, Deutschland
| | - I. Pavo
- Medizinische Abteilung – Diabetes, Eli Lilly GesmbH, Wien, Österreich
| | - T. Forst
- Medical Sciences, Profil Mainz GmbH und Co KG, Mainz, Deutschland
| | - M. Trautmann
- Diabetes Research, Consultant, Hamburg, Deutschland
| | - G. Schernthaner
- 1. Medizinische Abteilung Hospital, Krankenhaus Rudolfstiftung, Wien, Österreich
| |
Collapse
|
11
|
Heitmann E, Jung H, Schloot N, Pavo I, Forst T, Trautmann M, Schernthaner G. Dulaglutid: GLP-1-Rezeptoragonist zur einmal wöchentlichen Therapie des Typ-2-Diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-118174] [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: 10/20/2022]
Affiliation(s)
- E. Heitmann
- Medizinische Abteilung – Diabetes, Lilly Deutschland GmbH, Bad Homburg, Deutschland
| | - H. Jung
- Medizinische Abteilung – Diabetes, Lilly Deutschland GmbH, Bad Homburg, Deutschland
| | - N. Schloot
- Medizinische Abteilung – Diabetes, Lilly Deutschland GmbH, Bad Homburg, Deutschland
| | - I. Pavo
- Medizinische Abteilung – Diabetes, Eli Lilly GesmbH, Wien, Österreich
| | - T. Forst
- Medical Sciences, Profil Mainz GmbH und Co KG, Mainz, Deutschland
| | - M. Trautmann
- Diabetes Research, Consultant, Hamburg, Deutschland
| | - G. Schernthaner
- 1. Medizinische Abteilung Hospital, Krankenhaus Rudolfstiftung, Wien, Österreich
| |
Collapse
|
12
|
Linscheid C, Heitmann E, Singh P, Wickstrom E, Qiu L, Hodes H, Nauser T, Petroff MG. Trophoblast expression of the minor histocompatibility antigen HA-1 is regulated by oxygen and is increased in placentas from preeclamptic women. Placenta 2015; 36:832-8. [PMID: 26095815 DOI: 10.1016/j.placenta.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 12/01/2014] [Revised: 05/25/2015] [Accepted: 05/28/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Maternal T-cells reactive towards paternally inherited fetal minor histocompatibility antigens are expanded during pregnancy. Placental trophoblast cells express at least four fetal antigens, including human minor histocompatibility antigen 1 (HA-1). We investigated oxygen as a potential regulator of HA-1 and whether HA-1 expression is altered in preeclamptic placentas. METHODS Expression and regulation of HA-1 mRNA and protein were examined by qRT-PCR and immunohistochemistry, using first, second, and third trimester placentas, first trimester placental explant cultures, and term purified cytotrophoblast cells. Low oxygen conditions were achieved by varying ambient oxygen, and were mimicked using cobalt chloride. HA-1 mRNA and protein expression levels were evaluated in preeclamptic and control placentas. RESULTS HA-1 protein expression was higher in the syncytiotrophoblast of first trimester as compared to second trimester and term placentas (P<0.01). HA-1 mRNA was increased in cobalt chloride-treated placental explants and purified cytotrophoblast cells (P = 0.04 and P<0.01, respectively) and in purified cytotrophoblast cells cultured under 2% as compared to 8% and 21% oxygen (P<0.01). HA-1 mRNA expression in preeclamptic vs. control placentas was increased 3.3-fold (P = 0.015). HA-1 protein expression was increased in syncytial nuclear aggregates and the syncytiotrophoblast of preeclamptic vs. control placentas (P = 0.02 and 0.03, respectively). DISCUSSION Placental HA-1 expression is regulated by oxygen and is increased in the syncytial nuclear aggregates and syncytiotrophoblast of preeclamptic as compared to control placentas. Increased HA-1 expression, combined with increased preeclamptic syncytiotrophoblast deportation, provides a novel potential mechanism for exposure of the maternal immune system to increased fetal antigenic load during preeclampsia.
Collapse
Affiliation(s)
- C Linscheid
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - E Heitmann
- Saint Luke's Health System, Department of Maternal and Fetal Medicine, Kansas City, MO, USA
| | - P Singh
- Saint Luke's Health System, Department of Maternal and Fetal Medicine, Kansas City, MO, USA
| | - E Wickstrom
- Saint Luke's Health System, Department of Maternal and Fetal Medicine, Kansas City, MO, USA
| | - L Qiu
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - H Hodes
- The Center for Women's Health, Overland Park, KS, USA
| | - T Nauser
- The Center for Women's Health, Overland Park, KS, USA
| | - M G Petroff
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
13
|
Füchtenbusch M, Heitmann E, Nicolay C, Jung H. Weight loss with once-weekly dulaglutide versus insulin glargine, both with insulin lispro (+/- metformin), in patients with type 2 diabetes (T2D) from AWARD-4, stratified by baseline body mass index (BMI) category. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549751] [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]
|
14
|
Baeumler J, Heitmann E, Nicolay C, Jung H. Indirect comparisons (ICs) of once weekly dulaglutide (DU) plus metformin (MET) versus sulphonylureas (SU) plus MET in patients with type 2 diabetes (T2D) from AWARD-5. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549664] [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: 10/23/2022]
|
15
|
Jodicke C, Maulik D, Singh P, Heitmann E, Maulik D. Role of ultrasound in pre-eclampsia. Minerva Ginecol 2012; 64:293-308. [PMID: 22728574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pre-eclampsia (PE), defined as de novo hypertension (>140/90 mmHg) appearing after 20 weeks of gestation accompanied by proteinuria (>0.3 g/24 h), remains a major source of perinatal growth restriction, prematurity and death worldwide. Since its introduction practitioners have increasingly utilized fetal ultrasonography for the management of pre-eclampsia. Ultrasonographic diagnostic modalities including fetal biometric growth curves, the biophysical profile and umbilical artery Doppler have been used to detect fetal growth restriction and assess fetal wellbeing, respectively. Doppler studies of the middle cerebral and uterine arteries offer additional utility in the prediction of adverse pregnancy outcomes and as a potential screening test for pre-eclampsia. The purpose of this review was to explore the developments of ultrasound technology that have been relevant to the screening, diagnosis and management of pre-eclampsia.
Collapse
Affiliation(s)
- C Jodicke
- Department of Obstetrics and Gynecology University of Missouri-Kansas City, School of Medicine, Kansas City, MO 64108, USA.
| | | | | | | | | |
Collapse
|
16
|
Heitmann E. [Significance of tooth root resection in tooth conservation]. Quintessenz 1985; 36:2269-72. [PMID: 3869695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
17
|
Heitmann E. [Possibilities and limits during treatment with endosseous implants (II)]. Quintessenz 1984; 35:657-63. [PMID: 6382392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
18
|
Heitmann E. [Possibilities and limits during treatment with endosseous implants (I)]. Quintessenz 1984; 35:435-44. [PMID: 6382389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
19
|
Heitmann E. [Observations of mandibular growth after endosseous implantation in the left lower 1st and 2d molar region in a 13-year-old girl]. Dtsch Zahnarztl Z 1983; 38:594-6. [PMID: 6574907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
20
|
Heitmann E. [The enossal implant and its possible meaning for problem cases]. Zahnarztl Prax 1976; 27:348-9. [PMID: 802364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
21
|
Heitmann E. [Failures and errors in the interpretation of intraoral and Panorex pictures in dental practice]. Dtsch Zahnarztl Z 1974; 29:559-62. [PMID: 4527211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|