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Hasselstrøm Jensen J, Vestergaard P, Hasselstrøm Jensen M. Association between Glucose-lowering Treatments and Risk of Diabetic Retinopathy in People with Type 2 Diabetes: A Nationwide Cohort Study. Curr Drug Saf 2024; 19:236-243. [PMID: 37078347 DOI: 10.2174/1574886318666230420084701] [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] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Glycaemic variability is possibly linked to the development of diabetic retinopathy, and newer second-line glucose-lowering treatments in type 2 diabetes might reduce glycaemic variability. AIM This study aimed to investigate whether newer second-line glucose-lowering treatments are associated with an alternative risk of developing diabetic retinopathy in people with type 2 diabetes. METHODS A nationwide cohort of people with type 2 diabetes on second-line glucose-lowering treatment regimens in 2008-2018 was extracted from the Danish National Patient Registry. Adjusted time to diabetic retinopathy was estimated with a Cox Proportional Hazards model. The model was adjusted for age, sex, diabetes duration, alcohol abuse, treatment start year, education, income, history of late-diabetic complications, history of non-fatal major adverse cardiovascular events, history of chronic kidney disease, and history of hypoglycaemic episodes. RESULTS Treatment regimens of metformin + basal insulin (HR: 3.15, 95% CI: 2.42-4.10) and metformin + glucagon-like peptide-1 receptor agonist (GLP-1-RA, HR: 1.46, 95% CI: 1.09-1.96) were associated with an increased risk of diabetic retinopathy compared with metformin + dipeptidyl peptidase-4 inhibitors (DPP-4i). Treatment with metformin + sodium-glucose cotransporter-2 inhibitor (SGLT2i, HR: 0.77, 95% CI: 0.28-2.11) was associated with the numerically lowest risk of diabetic retinopathy compared with all regimens investigated. CONCLUSION Findings from this study indicate that basal insulin and GLP-1-RA are suboptimal second- line choices for people with type 2 diabetes at risk of developing diabetic retinopathy. However, many other considerations concerning the choice of second-line glucose-lowering treatment for type 2 diabetes patients should be taken into account.
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Affiliation(s)
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
| | - Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9220, Aalborg, Denmark
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Christiaens A, Baretella O, Del Giovane C, Rodondi N, Knol W, Peters M, Jennings E, O’Mahony D, Spinewine A, Boland B, Henrard S. Association between diabetes overtreatment in older multimorbid patients and clinical outcomes: an ancillary European multicentre study. Age Ageing 2023; 52:6974851. [PMID: 36626323 PMCID: PMC9831262 DOI: 10.1093/ageing/afac320] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Diabetes overtreatment is a frequent and severe issue in multimorbid older patients with type 2 diabetes (T2D). OBJECTIVE This study aimed at assessing the association between diabetes overtreatment and 1-year functional decline, hospitalisation and mortality in older inpatients with multimorbidity and polypharmacy. METHODS Ancillary study of the European multicentre OPERAM project on multimorbid patients aged ≥70 years with T2D and glucose-lowering treatment (GLT). Diabetes overtreatment was defined according to the 2019 Endocrine Society guideline using HbA1c target range individualised according to the patient's overall health status and the use of GLT with a high risk of hypoglycaemia. Multivariable regressions were used to assess the association between diabetes overtreatment and the three outcomes. RESULTS Among the 490 patients with T2D on GLT (median age: 78 years; 38% female), 168 (34.3%) had diabetes overtreatment. In patients with diabetes overtreatment as compared with those not overtreated, there was no difference in functional decline (29.3% vs 38.0%, P = 0.088) nor hospitalisation rates (107.3 vs 125.8/100 p-y, P = 0.115) but there was a higher mortality rate (32.8 vs 21.4/100 p-y, P = 0.033). In multivariable analyses, diabetes overtreatment was not associated with functional decline nor hospitalisation (hazard ratio, HR [95%CI]: 0.80 [0.63; 1.02]) but was associated with a higher mortality rate (HR [95%CI]: 1.64 [1.06; 2.52]). CONCLUSIONS Diabetes overtreatment was associated with a higher mortality rate but not with hospitalisation or functional decline. Interventional studies should be undertaken to test the effect of de-intensifying GLT on clinical outcomes in overtreated patients.
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Affiliation(s)
- Antoine Christiaens
- Author correspondence to: Antoine Christiaens, 30, Clos Chapelle-Aux-Champs Bte B1.30.15, 1200 Brussels, Belgium. Phone: 0032 2 764 34 59; Fax: 0032 2 764 34 70. E-mail:
| | - Oliver Baretella
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), UMC Utrecht, Utrecht, the Netherlands
| | - Mike Peters
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), UMC Utrecht, Utrecht, the Netherlands
| | - Emma Jennings
- Department of Medicine Cork, University College Cork National University of Ireland, Munster, IE, Republic of Ireland,Department of Geriatric Medicine Cork, Cork University Hospital Group, Munster, IE, Republic of Ireland
| | - Denis O’Mahony
- Department of Medicine Cork, University College Cork National University of Ireland, Munster, IE, Republic of Ireland,Department of Geriatric Medicine Cork, Cork University Hospital Group, Munster, IE, Republic of Ireland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium,Department of Pharmacy, Centre Hospitalier Universitaire UCL Namur—Godinne, Université catholique de Louvain, Brussels, Belgium
| | - Benoit Boland
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium,Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium,Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Rautio A, Boman K, Gerstein HC, Hernestål-Boman J, Lee SF, Olofsson M, Mellbin LG. The effect of basal insulin glargine on the fibrinolytic system and von Willebrand factor in people with dysglycaemia and high risk for cardiovascular events: Swedish substudy of the Outcome Reduction with an Initial Glargine Intervention trial. Diab Vasc Dis Res 2017; 14:345-352. [PMID: 28403644 DOI: 10.1177/1479164117703034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Fibrinolytic factors, plasminogen activator inhibitor-1, tissue plasminogen activator, tissue plasminogen activator/plasminogen activator-complex and the haemostatic factor von Willebrand factor are known markers of cardiovascular disease. Their plasma levels are adversely affected in patients with dysglycaemia, and glucose normalization with insulin glargine might improve the levels of these factors. METHODS Prespecified Swedish substudy of the Outcome Reduction with an Initial Glargine Intervention trial (ClinicalTrials.gov number, NCT00069784). Tissue plasminogen activator activity, tissue plasminogen activator antigen, plasminogen activator inhibitor-1 antigen, tissue plasminogen activator/plasminogen activator inhibitor-1 complex and von Willebrand factor were analysed at study start, after 2 years and at the end of the study (median follow-up of 6.2 years). RESULTS Of 129 patients (mean age of 64 ± 7 years, females: 19%), 68 (53%) and 61 (47%) were randomized to the insulin glargine and standard care group, respectively. Allocation to insulin glargine did not significantly affect the studied fibrinolytic markers or von Willebrand factor compared to standard care. Likewise, there were no significant differences in plasminogen activator inhibitor-1, tissue plasminogen activator antigen and von Willebrand factor. During the whole study period, the within-group analysis revealed a curvilinear pattern and significant changes for tissue plasminogen activator/plasminogen activator inhibitor-1 complex, tissue plasminogen activator antigen and von Willebrand factor in the insulin glargine but not in the standard care group. CONCLUSION In people with dysglycaemia and other cardiovascular risk factors, basal insulin does not improve the levels of markers of fibrinolysis or von Willebrand factor compared to standard glucose-lowering treatments.
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Affiliation(s)
- Aslak Rautio
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 2 Department of Medicine, Sunderby Hospital, Luleå, Sweden
| | - Kurt Boman
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Hertzel C Gerstein
- 4 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Jenny Hernestål-Boman
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Shun Fu Lee
- 4 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Mona Olofsson
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Linda Garcia Mellbin
- 5 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Abstract
INTRODUCTION The epidemic of diabetes has now taken on epic proportions and therefore reducing the impact of diabetic complications represents one of the major global challenges in improving health and well-being worldwide. Preventing the development of diabetic kidney disease (DKD) is particularly important, as diabetes is one of the main risk factors for the development of chronic kidney disease, which in turn is strongly linked to development of cardiovascular disease, end-stage renal failure, hospitalization and premature death. Intensive glucose-lowering treatment has been shown to prevent and slow progression of DKD, yet to date, only certain populations have benefited from this intervention. AREAS COVERED We review the evidence for existing glucose-lowering treatments in the prevention of DKD, and research into techniques to better target individuals who will benefit from these therapies. EXPERT OPINION Diabetic patients with established kidney disease may benefit from glucose-lowering treatment, particularly if a safer side-effect profile of these treatments is achieved. Better understanding of glucose homeostasis and evaluation of compounds inhibiting its downstream effects are required in order to improve the outlook for individuals with DKD. An additional approach to improve the success rate of glucose-lowering treatment is to improve the selection of individuals who may benefit from treatment. A potential means to identify such subjects could involve the use of biomarkers.
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Affiliation(s)
- Nordin M J Hanssen
- Maastricht University, CARIM School of Cardiovascular Diseases, Department of Internal Medicine , Maastricht , The Netherlands
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