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Schernthaner G, Shehadeh N, Ametov AS, Bazarova AV, Ebrahimi F, Fasching P, Janež A, Kempler P, Konrāde I, Lalić NM, Mankovsky B, Martinka E, Rahelić D, Serafinceanu C, Škrha J, Tankova T, Visockienė Ž. Worldwide inertia to the use of cardiorenal protective glucose-lowering drugs (SGLT2i and GLP-1 RA) in high-risk patients with type 2 diabetes. Cardiovasc Diabetol 2020; 19:185. [PMID: 33097060 PMCID: PMC7585305 DOI: 10.1186/s12933-020-01154-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [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: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
The disclosure of proven cardiorenal benefits with certain antidiabetic agents was supposed to herald a new era in the management of type 2 diabetes (T2D), especially for the many patients with T2D who are at high risk for cardiovascular and renal events. However, as the evidence in favour of various sodium-glucose transporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) accumulates, prescriptions of these agents continue to stagnate, even among eligible, at-risk patients. By contrast, dipeptidyl peptidase-4 inhibitors (DPP-4i) DPP-4i remain more widely used than SGLT2i and GLP-1 RA in these patients, despite a similar cost to SGLT2i and a large body of evidence showing no clear benefit on cardiorenal outcomes. We are a group of diabetologists united by a shared concern that clinical inertia is preventing these patients from receiving life-saving treatments, as well as placing them at greater risk of hospitalisation for heart failure and progression of renal disease. We propose a manifesto for change, in order to increase uptake of SGLT2i and GLP-1 RA in appropriate patients as a matter of urgency, especially those who could be readily switched from an agent without proven cardiorenal benefit. Central to our manifesto is a shift from linear treatment algorithms based on HbA1c target setting to parallel, independent considerations of atherosclerotic cardiovascular disease, heart failure and renal risks, in accordance with newly updated guidelines. Finally, we call upon all colleagues to play their part in implementing our manifesto at a local level, ensuring that patients do not pay a heavy price for continued clinical inertia in T2D.
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Affiliation(s)
| | - Naim Shehadeh
- Institute of Diabetes, Endocrinology and Metabolism, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, P.O. Box 9602, 3109601 Haifa, Israel
| | - Alexander S. Ametov
- Head of Endocrinology, Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Anna V. Bazarova
- Department of Internal Medicine #3, Astana Medical University (NpJSC “AMU”), 49A Beybitshilik Street, Nur-Sultan City, Kazakhstan
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Division of Gastroenterology, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Peter Fasching
- 5th Medical Department With Endocrinology, Rheumatology and Acute Geriatrics, Vienna Health Association Clinic Ottakring, 37 Montleartstraße, 1160 Vienna, Austria
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 7 Zaloška Cesta, 1000 Ljubljana, Slovenia
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, 2/a Korányi Sándor Utca, Budapest, 1083 Hungary
| | - Ilze Konrāde
- Riga Stradins University, Riga, Latvia
- Riga East Clinical Hospital, Riga, Latvia
| | - Nebojša M. Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Boris Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Emil Martinka
- National Institute of Endocrinology and Diabetology, Lubochna, Slovak Republic
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Cristian Serafinceanu
- Department of Diabetes, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology/Dialysis, N C Paulescu National Institute for Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
| | - Jan Škrha
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, 1 Ulice Nemocnice, 128 08 Prague 2, Czech Republic
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University — Sofia, 2 Zdrave Street, Sofia, Bulgaria
| | - Žydrūnė Visockienė
- Clinic of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Tricò D, Mengozzi A, Nesti L, Hatunic M, Gabriel Sanchez R, Konrad T, Lalić K, Lalić NM, Mari A, Natali A. Circulating palmitoleic acid is an independent determinant of insulin sensitivity, beta cell function and glucose tolerance in non-diabetic individuals: a longitudinal analysis. Diabetologia 2020; 63:206-218. [PMID: 31676981 DOI: 10.1007/s00125-019-05013-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 07/02/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Experimental studies suggest that the fatty acid palmitoleate may act as an adipocyte-derived lipid hormone (or 'lipokine') to regulate systemic metabolism. We investigated the relationship of circulating palmitoleate with insulin sensitivity, beta cell function and glucose tolerance in humans. METHODS Plasma NEFA concentration and composition were determined in non-diabetic individuals from the Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) study cohort at baseline (n = 1234) and after a 3 year follow-up (n = 924). Glucose tolerance, insulin secretion and beta cell function were assessed during an OGTT. Whole-body insulin sensitivity was measured by a hyperinsulinaemic-euglycaemic clamp (M/I) and OGTT (oral glucose insulin sensitivity index [OGIS]). The liver insulin resistance index was calculated using clinical and biochemical data. Body composition including fat mass was determined by bioelectrical impedance. RESULTS Circulating palmitoleate was proportional to fat mass (r = 0.21, p < 0.0001) and total NEFA levels (r = 0.19, p < 0.0001). It correlated with whole-body insulin sensitivity (M/I: standardised regression coefficient [std. β] = 0.16, p < 0.0001), liver insulin resistance (std. β = -0.14, p < 0.0001), beta cell function (potentiation: std. β = 0.08, p = 0.045) and glucose tolerance (2 h glucose: std. β = -0.24, p < 0.0001) after adjustment for age, sex, BMI, adiposity and other NEFA. High palmitoleate concentrations prevented the decrease in insulin sensitivity associated with excess palmitate (p = 0.0001). In a longitudinal analysis, a positive independent relationship was observed between changes in palmitoleate and insulin sensitivity over time (std. β = 0.07, p = 0.04). CONCLUSIONS/INTERPRETATION We demonstrated that plasma palmitoleate is an independent determinant of insulin sensitivity, beta cell function and glucose tolerance in non-diabetic individuals. These results support the role of palmitoleate as a beneficial lipokine released by adipose tissue to prevent the negative effects of adiposity and excess NEFA on systemic glucose metabolism.
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Affiliation(s)
- Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Mensud Hatunic
- Department of Endocrinology, Mater Misericordiae University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | | | - Thomas Konrad
- Institute for Metabolic Research, Goethe University, Frankfurt am Main, Germany
| | - Katarina Lalić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nebojša M Lalić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Mari
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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Lalić K, Rajković N, Popović L, Lukač SS, Stošić L, Rasulić I, Lalić NM. The effects of 3-year statin therapy and the achievement of LDL cholesterol target values in familial hypercholesterolemia patients: An experience from Serbia. Atherosclerosis 2019; 277:298-303. [PMID: 30270062 DOI: 10.1016/j.atherosclerosis.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/28/2018] [Revised: 06/13/2018] [Accepted: 08/21/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Despite the use of statins, familial hypercholesterolemia (FH) patients often have increased LDL-cholesterol (Ch) and high risk for atherosclerotic cardiovascular disease (ASCVD). This study aimed to analyze the effect of statin therapy on attainment of LDL-Ch treatment targets and appearance of new ASCVD and diabetes in FH patients. METHODS This study is a retrospective analysis of data from medical records of 302 FH patients treated continuously with statins during 3 years. At baseline and once yearly, anthropometric measurements, lipids (total Ch, LDL-Ch, HDL-Ch, triglycerides, apoliporotein A1 and B), fasting plasma glucose, and insulin were determined. RESULTS In FH patients, high intensity statin was prescribed only in 17.9% of cases. LDL-Ch levels were significantly lower after 3 years of statin treatment (3.61 ± 1.19 mmol/l) vs. baseline (4.51 ± 1.69 mmol/l; p < 0.01), but only 6.9% of FH patients reached the recommended ≥50% LDL-Ch reduction and 16.2% attained the LDL-Ch <2.6 mmol/l target. Simultaneously, 9.6% of FH patients developed new ASCVD, with lower HDL-Ch after 3 years of statin treatment than in those who remained free of ASCVD. In addition, we observed new onset diabetes in 6.4% of FH patients who were more obese, older and with higher fasting glucose at baseline than FH patients free of diabetes, regardless of the type of statin. CONCLUSIONS These results imply that only a small proportion of FH patients achieved the recommended LDL-Ch treatment targets, mostly due to the use of low statin dose and infrequent implementation of high-intensity statin treatment, which altogether could not prevent the increase in residual cardiovascular risk.
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Affiliation(s)
- Katarina Lalić
- Faculty of Medicine University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia.
| | - Nataša Rajković
- Faculty of Medicine University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Ljiljana Popović
- Faculty of Medicine University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Sandra Singh Lukač
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Ljubica Stošić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Iva Rasulić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Nebojša M Lalić
- Faculty of Medicine University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
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Bogdanović J, Ašanin M, Krljanac G, Lalić NM, Jotić A, Stanković S, Rajković N, Stošić L, Rasulić I, Milin J, Popović D, Bogdanović L, Lalić K. Impact of acute hyperglycemia on layer-specific left ventricular strain in asymptomatic diabetic patients: an analysis based on two-dimensional speckle tracking echocardiography. Cardiovasc Diabetol 2019; 18:68. [PMID: 31159858 PMCID: PMC6545629 DOI: 10.1186/s12933-019-0876-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/28/2019] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Hyperglycemia has detrimental effect on ischemic myocardium, but the impact of acute hyperglycemia on the myocardium in asymptomatic diabetic patients has not been fully elucidated. Thus, this follow-up study was aimed to investigate the effects and reversibility of acute hyperglycemia on regional contractile function of left ventricle (LV) in diabetic patients without cardiovascular disease. METHODS The two-dimensional speckle tracking echocardiography (2D-STE), including multilayer strain analysis, was used for evaluation of global and regional LV function in asymptomatic, normotensive patients with uncomplicated diabetes, with acute hyperglycemia ( ≥ 11.1 mmol/l) (Group A, n = 67), or with optimal metabolic control (fasting plasma glucose < 7 mmol/l and HbA1c < 7%) (Group B, n = 20), while 20 healthy individuals served as controls (Group C). In group A, after 72 h of i.v. continuous insulin treatment (at the time euglycemia was achieved) (second examination) and after 3 months following acute hyperglycemia (third examination) 2D-STE was repeated. RESULTS Global longitudinal strain (GLS) (- 19.6 ± 0.4%) in Group A was significantly lower in comparison to both groups B (- 21.3 ± 0.4%; p < 0.05) and C (- 21.9 ± 0.4%; p < 0.01) at baseline, while we could not detect the differences between groups B and C. Peak systolic longitudinal endocardial (Endo), mid-myocardial (Mid) and epicardial (Epi) layer strain were significantly lower in group A at baseline compared to both groups B and C. Deterioration in peak systolic circumferential strain was observed at basal LV level, in all three layers (Endo, Mid and Epi) and in mid-cavity LV level in Epi layer in group A in comparison to group C. Moreover, in group A, after euglycemia was achieved (at second and third examination) GLS, as well as peak longitudinal and circumferential strain remain the same. CONCLUSION Acute hyperglycemia in asymptomatic diabetic patients has significant negative effects on systolic LV myocardial mechanics primarily by reducing GLS and multilayer peak systolic longitudinal and circumferential strain which was not reversible after three months of good glycemic control.
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Affiliation(s)
- Jelena Bogdanović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia
| | - Milika Ašanin
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Clinic for Cardiology, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Clinic for Cardiology, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Nebojša M Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Aleksandra Jotić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Sanja Stanković
- Center for Medical Biochemistry, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Nataša Rajković
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Ljubica Stošić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Iva Rasulić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia
| | - Jelena Milin
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Institute for Medical Statistics and Informatics, dr Subotića 15, Belgrade, 11000, Serbia
| | - Dragana Popović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia
| | - Ljiljana Bogdanović
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Institute for Pathology, dr Subotića 1, Belgrade, 11000, Serbia
| | - Katarina Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia. .,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.
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Lalić K, Nedeljković M, Jotić A, Babić R, Rajković N, Popović L, Lukić L, Miličić T, Singh Lukač S, Stošić L, Maćešić M, Rasulić I, Gajović JS, Lalić NM. Endothelial dysfunction of coronary arteries in subjects without diabetes: An association with both insulin resistance and impaired insulin secretion response. Diabetes Res Clin Pract 2018. [PMID: 29526680 DOI: 10.1016/j.diabres.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Indexed: 02/02/2023]
Abstract
AIMS This study was aimed to compare insulin sensitivity and secretion response, lipoprotein and plasminogen activator inhibitor 1 (PAI-1) levels between the subjects with and without coronary artery endothelial dysfunction (ED). METHODS ED was detected by intracoronary injection of acetylcholine (ACh) in 47 nondiabetes subjects without stenotic coronary arteries, selected from 316 consecutive patients with coronary angiography performed for suspected coronary artery disease. The subjects were divided into two groups: presence of ACh-induced coronary spasm (group ED+, N = 30) and absence of ACh-induced coronary spasm (group ED-, N = 17). Insulin sensitivity (Si) was evaluated by frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis and by HOMA-IR, insulin secretion by acute insulin response (AIR) (calculated from the first 8 min of FSIGTT) and by disposition index (DI) (Si × AIR). Lipids and PAI-1 levels were determined enzymatically, and LDL particle size by gradient gel electrophoresis. RESULTS Si was significantly lower (4.22 ± 0.62 vs 6.98 ± 1.47 min-1/mU/l × 104; p < 0.05) while HOMA-IR was significantly higher in ED + group vs ED- group (2.8 ± 0.3 vs 1.7 ± 0.2; p < 0.05). Simultaneously, AIR and DI was significantly lower in ED + vs ED- groups (p < 0.05 and p < 0.01, respectively). Investigated groups did not differ in fasting lipid levels but ED+ group had significantly smaller LDL particles (p < 0.01) and higher PAI-1 levels (p < 0.05). Regression analysis shown that DI was a strong independent predictor of appearance of ED, together with PAI-1 and LDL particle size. CONCLUSIONS Both insulin resistance and impairment in insulin secretion response strongly correlate with coronary ED in subjects without diabetes.
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Affiliation(s)
- Katarina Lalić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Milan Nedeljković
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Cardiology, Clinical Center of Serbia, Koste Todorovića 8, 11000 Belgrade, Serbia.
| | - Alekasandra Jotić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Rade Babić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Cardiology, Clinical Center of Serbia, Koste Todorovića 8, 11000 Belgrade, Serbia.
| | - Nataša Rajković
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Ljiljana Popović
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Ljiljana Lukić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Tanja Miličić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Sandra Singh Lukač
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Ljubica Stošić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Marija Maćešić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Iva Rasulić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Jelena Stanarčić Gajović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
| | - Nebojša M Lalić
- Faculty of Medicine University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotića 13, 11000 Belgrade, Serbia.
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Lalić NM, Lalić K, Jotić A, Stanojević D, Živojinović D, Janićijević A, Parkin C. The Impact of Structured Self-Monitoring of Blood Glucose Combined With Intensive Education on HbA1c Levels, Hospitalizations, and Quality-of-Life Parameters in Insulin-Treated Patients With Diabetes at Primary Care in Serbia: The Multicenter SPA-EDU Study. J Diabetes Sci Technol 2017; 11. [PMID: 28625073 PMCID: PMC5588818 DOI: 10.1177/1932296816681323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We assessed the effect of structured self-monitoring of blood glucose (SMBG), in combination with intensive education, on metabolic control, SMBG frequency, hospitalizations, cardiovascular risk factors, and quality-of-life parameters in patients with insulin-treated diabetes in primary health care settings in Serbia. METHODS This 6-month, observational, noninterventional study, followed 346 insulin-treated diabetes patients (type 1 diabetes [T1D], n = 57; type 2 diabetes [T2D], n = 289) from 28 primary care centers. Patients attended a 10-day course at the specialized educational center and were followed monthly by their primary care physicians. Patients used a simple paper tool to document 3-day, 7-point glucose profiles prior to each monthly clinic visit. Physicians reviewed the completed forms at each visit and used a standardized education program to provide remedial training. Changes in HbA1c levels, SMBG frequency, metabolic risk factors, and Diabetes Distress Scale (DDS) were assessed. RESULTS Mean (± SD) HbA1c within the full cohort was significantly improved from baseline at 6 months (8.85 ± 1.17% vs 7.91 ± 1.24%, P < .01). Significant increases in average SMBG frequency per week were seen at 6 months versus baseline (14.6/week vs 4.3/week, P < .001). The mean (± SE) number of hospitalizations due to metabolic conditions was significantly lower during the 6-month study compared to the 6-month period prior to the study (0.14 ± 0.04 vs 0.59 ± 0.09). DDS scores decreased from 39.6 ± 13.9 to 33.9 ± 14.5, P < .01. CONCLUSION The use of structured SMBG combined with intensive education was associated with clinically significant reductions in HbA1c, increased SMBG frequency, and improved quality of life.
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Affiliation(s)
- Nebojša M. Lalić
- Faculty of Medicine University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | - Katarina Lalić
- Faculty of Medicine University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | - Aleksandra Jotić
- Faculty of Medicine University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | | | | | | | - Christopher Parkin
- CGParkin Communications, Inc, Boulder City, NV, USA
- Christopher Parkin, MS, CGParkin Communications, Inc, 932 Vista Lago Way, Boulder City, NV 89005, USA.
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Lalić K, Jotić A, Rajković N, Singh S, Stošić L, Popović L, Lukić L, Miličić T, Seferović JP, Maćešić M, Stanarčić J, Čivčić M, Kadić I, Lalić NM. Altered Daytime Fluctuation Pattern of Plasminogen Activator Inhibitor 1 in Type 2 Diabetes Patients with Coronary Artery Disease: A Strong Association with Persistently Elevated Plasma Insulin, Increased Insulin Resistance, and Abdominal Obesity. Int J Endocrinol 2015; 2015:390185. [PMID: 26089884 PMCID: PMC4451778 DOI: 10.1155/2015/390185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022] Open
Abstract
This study was aimed at investigating daily fluctuation of PAI-1 levels in relation to insulin resistance (IR) and daily profile of plasma insulin and glucose levels in 26 type 2 diabetic (T2D) patients with coronary artery disease (CAD) (group A), 10 T2D patients without CAD (group B), 12 nondiabetics with CAD (group C), and 12 healthy controls (group D). The percentage of PAI-1 decrease was lower in group A versus group B (4.4 ± 2.7 versus 35.0 ± 5.4%; P < 0.05) and in C versus D (14.0 ± 5.8 versus 44.7 ± 3.1%; P < 0.001). HOMA-IR was higher in group A versus group B (P < 0.05) and in C versus D (P < 0.01). Simultaneously, AUCs of PAI-1 and insulin were higher in group A versus group B (P < 0.05) and in C versus D (P < 0.01), while AUC of glucose did not differ between groups. In multiple regression analysis waist-to-hip ratio and AUC of insulin were independent determinants of decrease in PAI-1. The altered diurnal fluctuation of PAI-1, especially in T2D with CAD, might be strongly influenced by a prolonged exposure to hyperinsulinemia in the settings of increased IR and abdominal obesity, facilitating altogether an accelerated atherosclerosis.
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Affiliation(s)
- Katarina Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
- *Katarina Lalić:
| | - Aleksandra Jotić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
| | - Nataša Rajković
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
| | - Sandra Singh
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Ljubica Stošić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Ljiljana Popović
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Ljiljana Lukić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
| | - Tanja Miličić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
| | - Jelena P. Seferović
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
| | - Marija Maćešić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Jelena Stanarčić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Milorad Čivčić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Iva Kadić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
| | - Nebojša M. Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Dr. Subotica 13, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
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Lalić NM, Dragašević N, Stefanova E, Jotić A, Lalić K, Miličić T, Petrović I, Maćešić M, Kostić VS. Impaired insulin sensitivity and secretion in normoglycemic patients with spinocerebellar ataxia type 1. Mov Disord 2010; 25:1976-80. [DOI: 10.1002/mds.23176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Lalić NM, Micić D, Antić S, Bajović L, Pantelinac P, Jotić A, Kendereski A, Dimić D, Djukić A, Mitrović M, Vujasin M. Effect of biphasic insulin aspart on glucose and lipid control in patients with Type 2 diabetes mellitus. Expert Opin Pharmacother 2007; 8:2895-901. [PMID: 18001251 DOI: 10.1517/14656566.8.17.2895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study examined the efficacy and safety of biphasic insulin aspart 30 (BIAsp 30) monotherapy in insulin-naive patients with Type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS In this 12-week, open-labelled, uncontrolled, clinical-experience study involving 71 patients with secondary oral antidiabetic agent failure, patients received BIAsp 30 after discontinuing oral antidiabetic drugs (OADs). Glucose and lipid concentrations, hypoglycaemic episodes and adverse events were assessed before and after treatment. Patient data were categorised according to previous OADs into the biguanides (BI) plus sulfonylureas/meglitinides (SU/MEG) and SU-only groups. RESULTS After treatment, glucose and lipid control was significantly improved in both groups, with a greater improvement in the SU-only group. Mean glycated haemoglobin, fasting blood glucose and postprandial blood glucose excursion improved by 2.15 +/- 1.24%, 3.70 +/- 3.18 mmol/l and 1.26 +/- 2.65 mmol/l in the BI plus SU/MEG group, and by 3.09 +/- 1.62%, 6.11 +/- 5.02 mmol/l and 2.06 +/- 2.33 mmol/l in the SU-only group, respectively. Mean high-density lipoprotein cholesterol and triglycerides improved by 0.09 +/- 0.18 mmol/l and 0.94 +/- 1.17 mmol/l in the BI plus SU/MEG group and by 0.09 +/- 0.18 mmol/l and 1.04 +/- 2.72 mmol/l in the SU-only group, respectively. No major hypoglycaemic episodes or serious treatment-related adverse events were reported. CONCLUSIONS Our study showed that BIAsp 30 treatment safely improved glucose and lipid control in insulin-naive patients with Type 2 diabetes poorly controlled on BI plus SU/MEG and SU-only. Key limitations were the lack of a comparator group and the short study duration.
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Affiliation(s)
- N M Lalić
- University of Belgrade, School of Medicine, Institute for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia.
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Djordjević PB, Lalić NM, Jotić A, Paunović I, Raketić N, Zamaklar M, Lalić K, Rajković N, Lukić L. Requirements for the beneficial effect of long-term incubation with growth hormone on insulin secretion from isolated human fetal islets. Transplant Proc 1998; 30:602-3. [PMID: 9532195 DOI: 10.1016/s0041-1345(97)01424-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lalić NM, Djordjević PB, Jotić A, Lalić K, Zamaklar M, Paunović I, Raketić N, Rajković N, Lukić L. Determinants of the inhibitory effect of glucose toxicity on growth hormone-induced improvement of insulin secretion from isolated human fetal islets. Transplant Proc 1998; 30:604-5. [PMID: 9532196 DOI: 10.1016/s0041-1345(98)00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- N M Lalić
- Institute for Endocrinology, Belgrade, Yugoslavia
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Djordjevic PB, Lalić NM, Jotic A, Dragasević M, Lalić K, Paunović I, Raketić N, Zamaklar M, Rajković N, Lukić L. Requirements for optimal insulin secretion capacity of human fetal islet graft. Transplant Proc 1997; 29:2006-7. [PMID: 9193502 DOI: 10.1016/s0041-1345(97)00207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- P B Djordjevic
- Diabetes Center, Institute for Endocrinology, Belgrade, Yugoslavia
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13
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Lalić NM, Djordjević PB, Jotić A, Lalić K, Zamaklar M, Paunović I, Raketić N, Rajković N, Lukić L. Glucose toxicity alters growth hormone-induced potentiation of insulin secretion in isolated human fetal islets: a reversible effect. Transplant Proc 1997; 29:2035-6. [PMID: 9193514 DOI: 10.1016/s0041-1345(97)00219-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- N M Lalić
- Diabetes Center, Institute for Endocrinology, Belgrade, Yugoslavia
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Lalić NM, Dordević PB, Brkić S, Zamaklar M, Lalić K, Jotić A. Influence of gestational age on growth hormone-induced potentiation of insulin secretion from isolated human fetal islets. Transplant Proc 1995; 27:3411-2. [PMID: 8540024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- N M Lalić
- Diabetes Center, Institute for Endocrinology, Belgrade, Yugoslavia
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Dordević PB, Lalić NM, Brkić S, Jotić A, Paunović I, Lalić K, Dimitrijević V, Dragasević M, Zamaklar M, Popović S. Human fetal islet transplantation in IDDM patients: an 8-year experience. Transplant Proc 1995; 27:3146-7. [PMID: 8539884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P B Dordević
- Diabetes Center, Institute for Endocrinology, Belgrade, Yugoslavia
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Dordević PB, Heding LG, Lalić NM, Dinesen B, Zamaklar M, Dragasević M, Popović S, Banović D, Dimitrijević V, Savić K. Evaluation of the effect of insulin pump therapy on insulin secretion from transplanted human fetal islets in insulin-dependent diabetics. Transplant Proc 1994; 26:702-3. [PMID: 8171615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P B Dordević
- Diabetes Center, Institute for Endocrinology, Belgrade, Yugoslavia
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