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Harrison RK, Cruz M, Wong A, Davitt C, Palatnik A. The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus. BMC Pregnancy Childbirth 2020; 20:773. [PMID: 33308193 PMCID: PMC7731563 DOI: 10.1186/s12884-020-03449-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/22/2020] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes. METHODS This was a retrospective cohort study of women with GDM delivering in a single tertiary care center. Pregnancy outcomes were compared using bivariable and multivariable analyses between women who started pharmacotherapy (insulin or oral hypoglycemic agent) after a failed trial of dietary modifications at two different ranges of elevated capillary blood glucose (CBG) values: Group 1 when 20-39% CBG values were above goal; Group 2 when ≥40% CBG values were above goal. The primary outcome was a composite GDM-associated neonatal adverse outcome that included: macrosomia, large for gestational age (LGA), shoulder dystocia, hypoglycemia, hyperbilirubinemia requiring phototherapy, respiratory distress syndrome, stillbirth, and neonatal demise. Secondary outcomes included cesarean delivery, preterm birth (< 37 weeks), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA). RESULTS A total of 417 women were included in the study. In univariable analysis, the composite neonatal outcome was statistically significantly higher in Group 2 compared to Group 1 (47.9% vs. 31.4%, p = 0.001). In addition, rates of preterm birth (15.7% vs 7.4%, p = 0.011), NICU admission (11.7% vs 4.0%, p = 0.006), and LGA (21.2% vs 9.1% p = 0.001) were higher in Group 2. In contrast, higher rates of SGA were noted in Group 1 (8.0% vs. 2.9%, p = 0.019). There was no difference in cesarean section rates. These findings persisted in multivariable analysis after adjusting for confounding factors (composite neonatal outcome aOR = 0.50, 95%CI [0.31-0.78]). CONCLUSIONS Initiation of pharmacotherapy for GDM when 20-39% of CBG values are above goal, compared to ≥40%, was associated with decreased rates of adverse neonatal outcomes attributable to GDM. This was accompanied by higher rates of SGA among women receiving pharmacotherapy at the lower threshold. Additional studies are required to identify the optimal threshold of abnormal CBG values to initiate pharmacotherapy for GDM.
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Affiliation(s)
- Rachel K Harrison
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Meredith Cruz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Ashley Wong
- Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Caroline Davitt
- Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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Yaguchi Y, Fujihara K, Yamada MH, Matsubayashi Y, Kitazawa M, Osawa T, Yamamoto M, Kaneko M, Yamanaka N, Seida H, Kodama S, Sone H. Skipping breakfast, late-night eating and current smoking are associated with medication adherence in Japanese patients with diabetes. Prim Care Diabetes 2020; 14:753-759. [PMID: 32527662 DOI: 10.1016/j.pcd.2020.05.002] [Citation(s) in RCA: 4] [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] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/23/2022]
Abstract
AIMS Little is known about the relationship between medication adherence for oral hypoglycemic agents (OHAs) and glycemic control after adjusting healthy adherer effect in large scale study. Thus, adjusting for health-related behaviors, we investigated the clinical variables associated with medication adherence and the relationship between medication adherence and glycemic control using a large claims database. METHODS Analyzed were 8805 patients with diabetes whose medication records for OHA were available for at least 1year. Medication adherence was evaluated by the proportion of days covered (PDC). Multivariate logistic regression model was used to identify clinical variables significantly associated with non-adherence. Multiple regression analysis evaluated the relationship between PDC and HbA1c after adjusting for health-related behaviors. RESULTS Mean PDC was 80.1% and 32.8% of patients were non-adherence. Logistic analysis indicated that older age and taking concomitant medications were significantly associated with adherence while skipping breakfast (odds ratio 0.66 [95% CI 0.57-0.76]), late-night eating (0.86 [0.75-0.98]), and current smoking (0.89 [0.80-0.99]) were significantly associated with non-adherence. CONCLUSIONS Skipping breakfast, late-night eating and current smoking were significantly associated with medication adherence, suggesting that clinicians pay attention to those health-related behaviors to achieve good medication adherence.
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Affiliation(s)
- Yuta Yaguchi
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan.
| | - Mayuko Harada Yamada
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Masahiko Yamamoto
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Masanori Kaneko
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | | | | | - Satoru Kodama
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
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Chang HS, Kim SJ, Kim YH. Association Between Colonic 18F-FDG Uptake and Glycemic Control in Patients with Diabetes Mellitus. Nucl Med Mol Imaging 2020; 54:168-174. [PMID: 32831962 DOI: 10.1007/s13139-020-00647-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) is a useful imaging modality that visualizes glucose utilization. Diffuse colonic FDG uptake is frequently observed in patients being treated for diabetes mellitus (DM), especially with metformin. The aim of this study was to evaluate whether patients without increased colonic FDG uptake after taking oral hypoglycemic agents (OHA) are associated with insufficient glycemic control. Methods A total of 279 subjects who underwent FDG PET/CT scans for health examinations and had been diagnosed with DM and taken an OHA before the day of the FDG PET/CT were included. Colonic FDG uptake in the study subjects was visually assessed, and the maximal and mean standard uptake value (SUV) was measured. Fasting blood glucose and glycated hemoglobin A1c (HbA1c) levels at both baseline and follow-up visits as well as DM management were compared according to the colonic FDG uptake. Results The mean age of study subjects was 48.8 years old, and 251 of subjects were male. Positive colonic FDG uptake was observed in 200 (71.7%) subjects. Fasting blood glucose and Hb1Ac levels on the day of FDG PET/CT were higher in subjects without positive colonic FDG uptake than those with positive colonic FDG uptake (p ≤ 0.001). But there was no significant difference between the two groups at follow-up visits. Conclusions Patients with DM who did not show increased colonic FDG uptake after taking OHA were associated with higher fasting blood glucose and HbA1c levels on the day of FDG PET/CT.
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Affiliation(s)
- Hyung Seok Chang
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 Republic of Korea
| | - Soo Jeong Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 Republic of Korea
| | - Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 Republic of Korea
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Chao CT, Wang J, Huang JW, Chan DC, Chien KL. Hypoglycemic episodes are associated with an increased risk of incident frailty among new onset diabetic patients. J Diabetes Complications 2020; 34:107492. [PMID: 31806427 DOI: 10.1016/j.jdiacomp.2019.107492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
AIMS Patients with diabetes mellitus (DM) are at risk for developing frailty due to the complex interplay between different cardiometabolic factors. We examined whether hypoglycemia could independently increase frailty risk besides these factors. METHODS From the Longitudinal Cohort of Diabetic Patients, 210,254 patients with new onset DM between 2004 and 2011 were identified, among whom 2119 non-frail patients had at least 1 hypoglycemic episode within 3 years of DM diagnosis. They were propensity score-matched to 8432 non-frail ones without hypoglycemia throughout the study period. Both groups were followed up longitudinally for incident physical frailty according to a modified FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and Loss of weight). We analyzed the risk of frailty (primary) and mortality (secondary outcome) introduced by hypoglycemia, adjusted for known risk factors of frailty. RESULTS The mean age of patients (46.2% male) was 65.9 ± 14 years; diabetic patients with hypoglycemia had significantly higher comorbidity burden than those without. After 2.68 years, 172 (1.6%) patients with hypoglycemia developed incident frailty, representing a 60% higher risk (hazard ratio [HR] 1.599, 95% confidence interval [CI] 1.14-2.42). After adjusting for other risk factors, those with hypoglycemia had a significantly higher risk of frailty than those without (HR 1.443, 95% CI 1.01-2.05). Additionally, the mortality of those with hypoglycemia was 2-fold higher than those without, and the risk persisted despite confounder adjustment (HR 1.462, 95% CI 1.3-1.65). CONCLUSION In this population-based cohort, hypoglycemic episodes among diabetic patients increased the risk of incident frailty and mortality.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan; Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Jenq-Wen Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital ChuTung branch, HsinChu County, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
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Nakajima H, Okada S, Mohri T, Kanda E, Inaba N, Hirasawa Y, Seino H, Kuroda H, Hiyoshi T, Niiya T, Ishii H. Dapagliflozin improves treatment satisfaction in overweight patients with type 2 diabetes mellitus: a patient reported outcome study (PRO study). Diabetol Metab Syndr 2018; 10:11. [PMID: 29507611 PMCID: PMC5831584 DOI: 10.1186/s13098-018-0313-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/12/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The benefits of sodium glucose cotransporters 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus include plasma glucose control, reduction in body weight and blood pressure, and low risk of hypoglycemia, although they may also cause genitourinary infections, polyuria, or volume depletion. It is not clear whether dapagliflozin, an SGLT2 inhibitor, improves treatment satisfaction among patients in a comprehensive way despite the negative side effects. This study assessed the effect of dapagliflozin on glycosylated hemoglobin (HbA1c), body weight, and treatment satisfaction in overweight patients with type 2 diabetes mellitus treated with oral hypoglycemic agents. METHODS This multicenter, open-label, single-arm observational study included patients with type 2 diabetes mellitus administering dapagliflozin 5 or 10 mg per day for 14 weeks. Changes in treatment satisfaction were evaluated using a new version of the Oral Hypoglycemic Agent-Questionnaire (OHA-Q ver. 2) consisting of 23 items. Correlation between treatment satisfaction and HbA1c levels and body weight were analyzed using the Spearman's rank-correlation coefficient. RESULTS Of the 221 patients enrolled, 188 completed the study. Mean HbA1c decreased from 7.8 ± 0.7% (62.1 ± 7.5 mmol/mol) to 7.3 ± 0.8% (55.9 ± 8.7 mmol/mol) (change - 0.6 ± 0.7%, P < 0.001) and body weight decreased from 82.5 ± 14.6 to 80.7 ± 14.8 kg (change - 2.3 ± 2.8 kg, P < 0.001). OHA-Q ver. 2 was validated as well, the mean OHA-Q ver. 2 total score increased from 44.3 ± 9.4 to 46.6 ± 9.8 (best score 69, worst score 0; change 2.3 ± 6.6, P < 0.001). The change in body weight significantly correlated with the OHA-Q ver. 2 total score (Spearman's ρ = - 0.17, P = 0.035). The change in HbA1c levels significantly correlated with the satisfaction subscale score (Spearman's ρ = - 0.19, P = 0.011). CONCLUSIONS Dapagliflozin significantly improved treatment satisfaction among patients with type 2 diabetes mellitus for 14 weeks. Body weight loss significantly correlated with treatment satisfaction.Trial registration UMIN-CTR: UMIN000016304.
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Affiliation(s)
- Hiroki Nakajima
- Department of Diabetology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Sadanori Okada
- Department of Diabetology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Takako Mohri
- Department of Diabetology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Eiichiro Kanda
- Department of Nephrology, Tokyo Kyosai Hospital, Tokyo, Japan
- Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Inaba
- Department of Metabolism & Endocrinology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | | | | | | | | | - Tetsuji Niiya
- Department of Internal Medicine, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Hitoshi Ishii
- Department of Diabetology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
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Ghadge AA, Kuvalekar AA. Controversy of oral hypoglycemic agents in type 2 diabetes mellitus: Novel move towards combination therapies. Diabetes Metab Syndr 2017; 11 Suppl 1:S5-S13. [PMID: 27578618 DOI: 10.1016/j.dsx.2016.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 06/22/2016] [Accepted: 08/22/2016] [Indexed: 01/18/2023]
Abstract
AIM As diabetes mellitus is multi-factorial disease, use of several oral hypoglycemic agents (OHAs) is the main stay of pharmacological treatment. The treatment has become more challenging and controversial as OHAs are heterogeneous in their mode of action that causes unwanted side effects. Complementary approaches such as use of medicinal plants and dietary polyunsaturated fatty acids (PUFA) with hypoglycemic and hypolipidemic activities are therefore imperative. A vast literature has independently documented the effects of OHAs, medicinal plants and PUFA for management of diabetes. In the present article, we have reviewed the current literature to describe the effects of commonly used OHAs, their mechanisms of action and reported controversies. The antidiabetic potential of herbs and/or formulations and omega-3 PUFA with its potential benefits and mode of action is also discussed. METHODS PUBMED, MEDLINE, Cochrane Library etc., were searched for relevant articles using appropriate terms (until February 2015). Human and animal studies were selected for the review. Data extraction was carried out by one author and checked by second author. RESULTS There is still controversy over the safety profile of OHAs. Medicinal herbs with hypoglycemic activities are increasingly sought because of its natural origin, active constituents and minimal side effects. The current literature suggests that supplementation with PUFA improves macro- and microvascular complications. CONCLUSION There is a need for best possible individualized treatment based on variations in biochemical parameters with combinational therapy of nutritional/herbal supplementations. Such a combination may be helpful for better management of diabetes and its complications.
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Affiliation(s)
- Abhijit A Ghadge
- Diabetes Laboratory, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth Deemed University, Pune-Satara Road, Pune, Maharashtra, 411043 India
| | - Aniket A Kuvalekar
- Diabetes Laboratory, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth Deemed University, Pune-Satara Road, Pune, Maharashtra, 411043 India.
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Choi SH, Oh TJ, Jang HC. Comparison of Antidiabetic Regimens in Patients with Type 2 Diabetes Uncontrolled by Combination Therapy of Sulfonylurea and Metformin: Results of the MOHAS Disease Registry in Korea. Diabetes Metab J 2017; 41:170-178. [PMID: 28537056 PMCID: PMC5489497 DOI: 10.4093/dmj.2017.41.3.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/06/2016] [Accepted: 11/16/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the glucose-lowering efficacy of antidiabetic treatments in patients with type 2 diabetes mellitus (T2DM) uncontrolled by sulfonylurea plus metformin. METHODS This open-label, multicenter, prospective, observational study was conducted in 144 centers in Korea, from June 2008 to July 2010, and included patients with T2DM who had received sulfonylurea and metformin for at least 3 months and had levels of glycosylated hemoglobin (HbA1c) >7.0% in the last month. Data of clinical and biochemical characteristics were collected at baseline and 6 months after treatment. The treatment option was decided at the physician's discretion. Subjects were classified into the following three groups: intensifying oral hypoglycemic agents (group A), adding basal insulin (group B), or starting intensified insulin therapy (group C). RESULTS Of 2,995 patients enrolled, 2,901 patients were evaluated, and 504 (17.4%), 2,316 (79.8%), and 81 patients (2.8%) were classified into groups A, B, and C, respectively. Subjects in group C showed relatively higher baseline levels of HbA1c and longer duration of diabetes. The mean decrease in HbA1c level was higher in the insulin treated groups (-0.9%±1.3%, -1.6%±1.3%, and -2.4%±2.3% in groups A, B, and C, respectively, P=0.042). The proportion of patients who achieved target HbA1c <7.0% was comparable among the groups; however, intensified insulin therapy seemed to be the most effective in achieving the target HbA1c of 6.5%. CONCLUSION These findings suggest that insulin-based therapy will be an important option in the improved management of Korean patients with T2DM whose glycemic control is not sufficient with sulfonylurea and metformin.
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Affiliation(s)
- Sung Hee Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Tanabe M, Motonaga R, Terawaki Y, Nomiyama T, Yanase T. Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database. J Diabetes Investig 2016; 8:227-234. [PMID: 27549920 PMCID: PMC5334304 DOI: 10.1111/jdi.12567] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 02/24/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
Aims/Introduction In treatment algorithms of type 2 diabetes mellitus in Western countries, biguanides are recommended as first‐line agents. In Japan, various oral hypoglycemic agents (OHAs) are available, but prescription patterns are unclear. Materials and Methods Data of 7,108 and 2,655 type 2 diabetes mellitus patients in study 1 and study 2, respectively, were extracted from the Medical Data Vision database (2008–2013). Cardiovascular disease history was not considered in study 1, but was in study 2. Initial choice of OHA, adherence to its use, effect on glycated hemoglobin levels for 2 years and the second choice of OHA were investigated. Results In study 1, α‐glucosidase inhibitor, glinide and thiazolidinedione were preferentially medicated in relatively lower glycated hemoglobin cases compared with other OHAs. The two most prevalent first prescriptions of OHAs were biguanides and dipeptidyl peptidase‐4 inhibitors, and the greatest adherence was for α‐glucosidase inhibitors. In patients treated continuously with a single OHA for 2 years, improvement in glycated hemoglobin levels was greatest for dipeptidyl peptidase‐4 inhibitors. As a second OHA added to the first OHA during the first 2 years, dipeptidyl peptidase‐4 inhibitors were chosen most often, especially if a biguanide was the first OHA. In study 2, targeting patients with a cardiovascular disease history, a similar tendency to study 1 was observed in the first choice of OHA, adherence and the second choice of OHA. Conclusions Even in Japanese type 2 diabetes mellitus patients, a Western algorithm seems to be respected to some degree. The OHA choice does not seem to be affected by a cardiovascular disease history.
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Affiliation(s)
- Makito Tanabe
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryoko Motonaga
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuichi Terawaki
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Nomiyama
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshihiko Yanase
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Gentil L, Vasiliadis HM, Berbiche D, Préville M. Impact of depression and anxiety disorders on adherence to oral hypoglycemics in older adults with diabetes mellitus in Canada. Eur J Ageing 2016; 14:111-121. [PMID: 28804397 DOI: 10.1007/s10433-016-0390-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The prevalence of diabetes mellitus is increasing in Canada, and nonadherence to oral hypoglycemics is a common problem among older adults. This study aims to document the impact of depression and anxiety disorders on adherence to oral hypoglycemics in older adults with diabetes mellitus. Data used in this study came from the longitudinal Quebec survey on senior's health (Enquête sur la Santé des Ainés), using a representative sample of 2811 older adults aged 65 and over. The final sample for analysis consisted of 301 patients who received oral hypoglycemic pharmacotherapy. Medication adherence was measured with the medication possession ratio. An adapted version of Andersen's behavioral model was used to explain adherence to oral hypoglycemic medication while considering the following predisposing factors: age, gender, and level of education: enabling factors: marital status and income level: and need factors: physical and mental health status. Our explanatory model of oral hypoglycemic medication adherence was tested using a latent growth curve model. The results of the multiple-group analysis did not show any significant difference in oral hypoglycemic medication adherence (p > 0.05). Furthermore, individuals with higher levels of education were less adherent to oral hypoglycemics than those with lower levels of education (p < 0.05). Medication adherence to oral hypoglycemics did not show any significant difference between participants with and without depression and anxiety disorders. Future studies with larger samples are needed to fully explore the association between mental disorders and oral hypoglycemic medication adherence in the older adult populations.
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Affiliation(s)
- Lia Gentil
- Faculty of Medicine and Health Sciences, Sherbrooke University, 150 Place Charles-Le Moyne bureau 200, C.P. 11, Longueuil, QC J4K 0A8 Canada
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Sherbrooke University, 150 Place Charles-Le Moyne bureau 200, C.P. 11, Longueuil, QC J4K 0A8 Canada
- Research Center, Charles LeMoyne Hospital, Longueuil, QC Canada
| | - Djamal Berbiche
- Research Center, Charles LeMoyne Hospital, Longueuil, QC Canada
| | - Michel Préville
- Faculty of Medicine and Health Sciences, Sherbrooke University, 150 Place Charles-Le Moyne bureau 200, C.P. 11, Longueuil, QC J4K 0A8 Canada
- Research Center, Charles LeMoyne Hospital, Longueuil, QC Canada
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10
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Kitwitee P, Limwattananon S, Limwattananon C, Waleekachonlert O, Ratanachotpanich T, Phimphilai M, Nguyen TV, Pongchaiyakul C. Metformin for the treatment of gestational diabetes: An updated meta-analysis. Diabetes Res Clin Pract 2015; 109:521-32. [PMID: 26117686 DOI: 10.1016/j.diabres.2015.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 07/21/2014] [Revised: 03/02/2015] [Accepted: 05/03/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM). METHODS A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy. RESULTS Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensive care admission (RR 0.76; 95% CI 0.59-0.97; P=0.03). Bayesian analysis revealed that the efficacy of metformin was consistently higher than insulin with a probability of over 98% on these two neonatal complications. Other outcomes were not significantly different between the two treatment groups. CONCLUSION In women with gestational diabetes, metformin use and insulin therapy have comparable glycemic control profile, but metformin use was associated with lower risk of neonatal hypoglycemia.
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Affiliation(s)
- Pimprapa Kitwitee
- Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
| | - Supon Limwattananon
- Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
| | - Chulaporn Limwattananon
- Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
| | | | | | - Mattabhorn Phimphilai
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - Tuan V Nguyen
- Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
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