The prognostic impact of insulin resistance surrogates in patients with acute myocardial infarction with and without type 2 diabetes

BACKGROUND

Cardiovascular disease is the major cause of morbidity and mortality, particularly in type 2 diabetes mellitus (T2DM). Novel markers of insulin resistance and progression of atherosclerosis include the triglycerides and glucose index (TyG index), the triglycerides and body mass index (Tyg-BMI) and the metabolic score for insulin resistance (METS-IR). Establishing independent risk factors for in-hospital death and major adverse cardiac and cerebrovascular events (MACCE) in patients with myocardial infarction (MI) remains critical. The aim of the study was to assess the risk of in-hospital death and MACCE within 12 months after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients with and without T2DM based on TyG index, Tyg-BMI and METS-IR.

METHODS

Retrospective analysis included 1706 patients with STEMI and NSTEMI hospitalized between 2013 and 2021. We analyzed prognostic value of TyG index, Tyg-BMI and METS-IR for in-hospital death and MACCE as its components (death from any cause, MI, stroke, revascularization) within 12 months after STEMI or NSTEMI in patients with and without T2DM.

RESULTS

Of 1706 patients, 58 in-hospital deaths were reported (29 patients [4.3%] in the group with T2DM and 29 patients [2.8%] in the group without T2DM; p = 0.1). MACCE occurred in 18.9% of the total study population (25.8% in the group with T2DM and 14.4% in the group without T2DM; p < 0.001). TyG index, Tyg-BMI and METS-IR were significantly higher in the group of patients with T2DM compared to those without T2DM (p < 0.001). Long-term MACCE were more prevalent in patients with T2DM (p < 0.001). The area under the ROC curve (AUC-ROC) for the prediction of in-hospital death and the TyG index was 0.69 (p < 0.001). The ROC curve for predicting in-hospital death based on METS-IR was 0.682 (p < 0.001). The AUC-ROC values for MACCE prediction based on the TyG index and METS-IR were 0.582 (p < 0.001) and 0.57 (p < 0.001), respectively.

CONCLUSIONS

TyG index was an independent risk factor for in-hospital death in patients with STEMI or NSTEMI. TyG index, TyG-BMI and METS-IR were not independent risk factors for MACCE at 12 month follow-up. TyG index and METS-IR have low predictive value in predicting MACCE within 12 months after STEMI and NSTEMI.

Metal-on-metal metaphyseal and ceramic-on-ceramic femoral neck arthroplasty: the impact on clinical results, oxidative stress and concentration of metal ions in serum and blood

PURPOSE

Growing number of hip arthroplasty in Poland performed with the use of metaphyseal stems results from the decreasing age of patients qualified for procedures and is consistent with the corresponding trends in European countries. To this day, a significant population functions after undergoing hip replacement using metal-on-metal implant. This study was aimed at the assessment of the variability of the oxidative system, as well as the concentrations of chromium and cobalt ions in serum and blood and their potential impact on postoperative clinical status.

MATERIAL AND METHODS

The analysis included 58 men. The first group-operated using J&J DePuy ASR metal-on-metal implant with metaphyseal stem ProximaTm. Second group-operated using K-Implant SPIRON® femoral neck prosthesis in full ceramic articulation. Selected parameters of oxidative stress and the antioxidant system as well as the concentration of metal ions in blood were determined twice. Each patient underwent two clinical evaluations using acclaimed physical examination scale systems.

RESULTS

In the first group, significantly higher concentrations of Cr (p = 0.028) and Co (p = 0.002) were demonstrated compared to the group of femoral neck arthroplasty. The mean concentrations of Cr and Co, 10.45 and 9.26 μg/l, respectively, were higher in patients operated bilaterally. In the ASR group, greater pain intensity in the operated hip and higher indicators of oxidative stress were found.

CONCLUSIONS

Metal-on-metal articulation of the hip significantly increases the concentration of Cr and Co in blood, induces oxidative stress and modifies function of the antioxidant system and generates greater pain in the operated hip.

The Wedding Bells Sound Really Good! iGlarLixi Fixed-Ratio Combination in the Treatment of Type 2 Diabetes: A Narrative Review

iGlarLixi is a fixed-ratio combination of insulin glargine 100 U/mL and lixisenatide used in the treatment of type 2 diabetes. iGlarLixi has proven clinical benefits in terms of glycemia, weight control, and safety, defined by the risk of hypoglycemia. It simultaneously targets many pathophysiologic abnormalities which are at the root of type 2 diabetes and thus presents a complementary mode of action. Finally, it may also address diabetes treatment burden, and, by decreasing the complexity of treatment, it may improve patient adherence and persistence and fight against clinical inertia. This article reviews the results of major randomized controlled trials in people with type 2 diabetes that compared iGlarLixi to other therapeutic regimens, representing different intensification strategies, such as basal supported oral therapy, oral antidiabetic drugs, and a combination of the latter with glucagon-like peptide 1 receptor agonists. Moreover, as a supplement to randomized trials, data from real-world evidence have also been included.

Use of metformin in patients who require intravascular administration of a contrast agent

Metformin is a drug that has been widely used around the world for many years. Due to its properties, metformin is used in the treatment of carbohydrate disorders (in type 2 diabetes, prediabetes) and in insulin resistance syndromes (including polycystic ovary syndrome). Many patients using metformin, due to complications of carbohydrate metabolism disorders, including cardiovascular complications or other accompanying diseases, require cardiological or radiological diagnostics related to the administration of a contrast agent. The aim of this study is to summarize the recommendations regarding the use of metformin before procedures involving the use of contrast agents and to share our own experience in this area, based on observations of a large group of patients with cardiological diseases hospitalized at the Silesian Centre for Heart Diseases in Zabrze.

Effect of once-weekly semaglutide versus thrice-daily insulin aspart, both as add-on to metformin and optimized insulin glargine treatment in participants with type 2 diabetes (SUSTAIN 11): A randomized, open-label, multinational, phase 3b trial

AIM

To compare the efficacy and safety of once-weekly (OW) semaglutide versus thrice-daily (TID) insulin aspart (IAsp) in participants with inadequately controlled type 2 diabetes (T2D) treated with insulin glargine (IGlar) and metformin.

MATERIALS AND METHODS

SUSTAIN 11 (NCT03689374) was a randomized (1:1), parallel, open-label, multinational, phase 3b trial. After a 12-week run-in to optimize once-daily IGlar U100, 1748 adults with T2D (HbA1c >7.5% to ≤10.0%) were randomized to OW semaglutide or TID IAsp as add-on to optimized IGlar and metformin for 52 weeks. The primary outcome was change in HbA1c from randomization to week 52. Confirmatory secondary endpoints included the occurrence of severe hypoglycaemic episodes and change in body weight (BW). Safety was assessed.

RESULTS

HbA1c (randomization: 8.6% [70.0 mmol/mol]) decreased by 1.5% points (16.6 mmol/mol) and 1.2% points (13.4 mmol/mol) with semaglutide (n = 874) and IAsp (n = 874), respectively (estimated treatment difference [ETD] -0.29% points [95% confidence interval {CI} -0.38; -0.20]; P < .0001 for non-inferiority). Few severe hypoglycaemic episodes were recorded in either group, with no statistically significant difference between the groups. Change in BW from randomization (87.9 kg) to week 52 was in favour of semaglutide (-4.1 kg) versus IAsp (+2.8 kg) (ETD -6.99 kg [95% CI -7.41; -6.57]). A higher proportion of participants experienced adverse events with semaglutide (58.5%) versus IAsp (52.1%); most were mild to moderate.

CONCLUSIONS

In this basal insulin-treated population, OW semaglutide improved glycaemic control to a greater extent than TID IAsp and provided numerically greater weight loss.

Cementless femoral neck endoprosthesis SPIRON in men in aspects of clinical status and quality of life in an average 7-year follow-up

Background

We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis.

Methods

The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up.

Results

The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p < 0.001). The median WOMAC HIP score was pre-operatively 57 and post-operatively 0 (p < 0.001). The median SF-12 score was pre-operatively 4 and post-operatively 33 (p < 0.001). The median pain assessment in VAS scale was 7 pre-operatively and 0 post-operatively (p < 0.001).

Conclusions

The results of all examined patients have changed significantly in every category showing that SPIRON endoprosthesis improved their quality of life and statistically reduced pain ailments. Moreover we have proved that higher BMI (> 30) is associated with worse operation outcomes.

Antioxidant System and Ions Concentrations After Femoral Neck and Resurfacing Hip Arthroplasty

Background

Oxidative stress is a disruption of the pro-oxidative-antioxidant balance, caused by excessive production or ineffective removal of reactive oxygen species.

Material/Methods

The study included 42 male patients aged 38 to 69 years. The first group consisted of 21 men with osteoarthritis after primary hip arthroplasty using the Smith & Nephew Birmingham Hip Resurfacing implant. The second group included 21 men after hip arthroplasty using the femoral neck SPIRON K-implant. In both groups, concentrations of ions, the antioxidant system in the blood, and parameters of oxidative stress were evaluated twice. Clinical assessment using the Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score, and Short Form (12) Health Survey (SF-12) scales was performed.

Results

Concentrations of metal ions in the blood and the level of oxidative stress were significantly higher in the resurfacing group than in the femoral neck arthroplasty group. The response of the antioxidant system was significantly greater in the femoral neck arthroplasty group. During clinical evaluation, groups did not show significant differences, with the exception of greater shortening of the operated limb and a lower score in the mental-sphere of the SF-12 scale in the resurfacing arthroplasty group.

Conclusions

Resurfacing hip arthroplasty increased oxidative stress, increased the concentration of metal ions, and did not affect alignment of the abbreviation of the operated limb. A significant improvement in the quality of life of patients in the mental sphere according to the SF-12 occurred after the application of resurfacing arthroplasty, in the first month after the procedure.

Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement

Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.

Management of obesity in the times of climate change and COVID-19: an interdisciplinary expert consensus report

Obesity is a chronic disease that is associated with increased metabolic and cardiovascular risk, excessive morbidity and mortality worldwide. The authors of the present consensus, clinicians representing medical specialties related to the treatment of obesity and its complications, reviewed a number of European and American guidelines mostly published in 2019-2021, and summarized the principles of obesity management to provide a practical guidance considering the impact that increased adiposity poses to health. The primary goal of obesity treatment from clinical perspective is to prevent or slow down the progression of diseases associated with obesity, reduce metabolic and cardiovascular risk and improve the quality of life by achieving adequate and stable weight reduction. However, obesity should not only be considered as a disease requiring treatment in an individual patient, but also as a civilization disease requiring preventive measures at the population level. Despite the evident benefits, obesity management within the health care system - whether through pharmacotherapy or bariatric surgery - is only a symptomatic treatment, with all its limitations, and will not ultimately solve the problem of obesity. The important message is that available treatment options fail to correct the true drivers of the obesity pandemic. To this end, new solutions and efforts to prevent obesity in the populations are needed.

The influence of resistance training on muscle strength, irisin concentration, and metabolic parameters in type 1 diabetic patients

INTRODUCTION

Resistance effort has a beneficial effect on muscle mass, body composition, bone density, and cardiac parameters. It is also a modulator of the inflammatory reaction. The aim of the study was to assess the impact of 3 months of resistance training on muscle strength, irisin levels, and metabolic parameters in patients with long-term type 1 diabetes.

MATERIAL AND METHODS

Eleven type 1 male diabetic patients with low levels of physical activity were recruited, with mean age 38 ± 6 years, body mass index (BMI) 28.4 ± 2.6 kg/m², and diabetes duration 23 ± 7 years. All subjects participated in 60-minute resistance training sessions twice a week, for three months. At baseline and after 3 months in all patients, maximal muscle strength level, serum irisin concentration, metabolic control parameters, and anthropometric measures were assessed.

RESULTS

After 3 months there was a statistically significant increase of maximal muscle strength in comparison to baseline. There was no significant change in serum irisin concentration, HbA1c, or other assessed parameters.

CONCLUSION

A 3-month resistance training programme in patients with long-term type 1 diabetes and low level of physical activity significantly affects their maximum strength level. This indicates that people with diabetes are more adaptive to additional loads, which allows them to increase their load faster.

Revision arthroplasty using a custom-made implant in the course of acetabular loosening of the J&J DePuy ASR replacement system - case report

RATIONALE

Resurfacing arthroplasty using the J&J DePuy ASR system was withdrawn from surgical treatment due to the necessity of frequent revision procedures after its application. There have been many studies concerning treatment of acetabular bone loss using different operating techniques. However, we felt that data of custom - made implant usage in such cases is highly insufficient, and there is lack of evidence on its application in treatment of loosening of the previous implant. The aim of the study was to evaluate the effectiveness of surgical treatment with a custom-made implant in a patient with extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in the early period of observation.

PATIENT CONCERNS

A 74-year-old patient was taken to the Orthopaedic Trauma Emergency Room due to increasing pain in the right hip for about 3 months. Nine years earlier he underwent resurfacing arthroplasty of the right hip using the J&J DePuy ASR method.

DIAGNOSES

The imaging diagnostics (X-ray, computed tomography, ultrasound) revealed the presence of a pseudotumor and lysis around the acetabular implant, which caused a fracture in the acetabulum.

INTERVENTIONS

Revision arthroplasty of the right hip joint was performed with the removal of the ASR implant. During the procedure extensive bone defects were visualized, preventing the insertion of the revision acetabulum. After extensive plasticization of the defects with the use of allogeneic cancellous chips the "hanging hip" was left with the intention of making another attempt to insert the implant after the reconstitution of the acetabular bone. A computed tomography examination 2.5 years after the ASR removal revealed the lack of an adequate degree of bone remodeling for the planned implant. Arthroplasty using custom - made aMace Acetabular Revision System by Materialize was performed 3 years after the removal of ASR.

OUTCOMES

Optimal implant adherence to the bone base and full osseointegration with the pelvic bone bearing has been achieved. Significant improvement in clinical parameters has been noted, with no complications in the postoperative period.

LESSONS

The use of an individual custom-made implant in extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in patients is an effective method of surgical treatment.

Combined Aerobic and Resistance Training Performed under Conditions of Normobaric Hypoxia and Normoxia Has the Same Impact on Metabolic Control in Men with Type 1 Diabetes

(1) Background: The aim was to assess whether combined aerobic and resistance training performed under hypoxic and normoxic conditions had an impact on diabetes control, VO2max (maximum oxygen consumption), and echocardiological and anthropometric parameters in men with long-term type 1 diabetes. (2) Methods: Sixteen male participants (mean age: 37 years, mean HbA1c (glycated hemoglobin): 7.0%) were randomly assigned to two groups: training in normoxic conditions or training in conditions of altitude hypoxia. All subjects participated in 60 min combined aerobic and resistance training sessions twice a week for 6 weeks. At baseline and in the 6th week, echocardiography, incremental exercise test, and anthropometric and diabetes control parameters were assessed. (3) Results: After 6 weeks, there was no significant change in HbA1c value in any group. We noted a more stable glycemia profile during training in the hypoxia group (p > 0.05). Patients in the hypoxia group required less carbohydrates during training than in the normoxia group. A comparable increase in VO2max was observed in both groups (p > 0.05). There were no significant differences in cardiological and anthropometric parameters. (4) Conclusions: Combined aerobic and resistance training improved VO2max after 6 weeks regardless of the conditions of the experiments. This exercise is safe in terms of glycemic control in patients with well-controlled diabetes.

Efficacy and Safety of Ertugliflozin in Patients With Diabetes Mellitus Inadequately Controlled by Sulfonylurea Monotherapy: a Substudy of VERTIS CV

INTRODUCTION

Sulfonylureas (SU) are commonly used antihyperglycemic agents. VERTIS CV was the cardiovascular outcome study for the sodium-glucose cotransporter 2 inhibitor ertugliflozin. Enrollment of patients in VERTIS CV occurred in two sequential cohorts (Cohort 1 and Cohort 2).

METHODS

This substudy assessed the efficacy and safety of adding ertugliflozin to SU monotherapy. The primary endpoint was the change in HbA1c from baseline at 18 weeks.

RESULTS

Among the 8246 patients who were randomized in VERTIS CV, 157 patients in Cohort 1 and 135 patients in Cohort 2 were on SU monotherapy at baseline. In the prespecified analysis (Cohort 1 only), the least squares (LS) mean HbA1c change from baseline for placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg was -  0.56%, -  0.91%, and -  0.78%, respectively (placebo-adjusted LS mean [95% CI] change: - 0.35% [-  0.72%, 0.02%]; -  0.22% [-  0.60%, 0.16%] for ertugliflozin 5 and 15 mg, respectively; p > 0.05 for both). In a post-hoc analysis that included Cohorts 1 and 2 (N = 292), the LS mean HbA1c change from baseline at week 18 for placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg was -  0.31%, - 0.77%, and -  0.68%, respectively (placebo-adjusted change: -  0.46% [-  0.73%, -  0.18%]; -  0.37% [-  0.66%, -  0.09%]; p = 0.001 and 0.01 for ertugliflozin 5 and 15 mg, respectively). In Cohort 1, adverse events were reported in 45.8%, 47.3%, and 25.9% of patients with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg. The incidence rates of symptomatic hypoglycemia were 0.0%, 5.5%, and 3.7%, respectively, with no cases of severe hypoglycemia. The safety profile was similar for Cohorts 1 and 2 combined.

CONCLUSION

The addition of ertugliflozin to SU monotherapy reduced HbA1c but did not result in significant placebo-adjusted reductions from baseline according to the prespecified primary analysis (n = 157); however, in a post-hoc analysis with a larger patient population (n = 292), significant and clinically relevant HbA1c reductions were observed. Ertugliflozin was generally well tolerated.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01986881.

Prevalence and Risk Factors of New-Onset Diabetes After Transplantation (NODAT)

Background

New-onset diabetes after transplantation (NODAT) is a serious complication after a solid organ transplant. NODAT occurs in 2% to 53% of all solid organ transplant recipients. The identification of high-risk patients and the implementation of measures to limit the development of NODAT can improve the long-term patient prognosis.

Material/Methods

Our study group consisted of 336 patients undergoing heart transplant. Patients with prior diabetes (60 patients) were excluded from analysis. The remaining 276 patients were divided in 2 groups: with NODAT (n=109) and without NODAT (n=167). Logistic regression analysis was used for NODAT risk factor assessment.

Results

NODAT occurred in 109 (32%) out of 336 patients without diagnosed diabetes before heart transplantation. Risk factors for post-transplant diabetes mellitus, which was shown by the analysis of the collected data, were BMI at discharge (OR=1.082, CI 1.011–1.158, p=0.0233), history of diagnosed CMV infection (OR=1.464, CI 1.068–2.007, p=0.0179), and age over 51 years (OR=1.634, CI 1.274–2.095, p=0.0001).

Conclusions

1. New-onset diabetes after transplantation (NODAT) or long-lasting hypoglycemia (over 2 years after transplantation) was diagnosed in 32% patients after heart transplantation developed. 2. The risk factors of NODAT were BMI at discharge and history of diagnosed CMV infection, and age over 51 years was an independent risk factor.

Weight loss in heart failure is associated with increased mortality only in non-obese patients without diabetes

BACKGROUND

Weight loss (WL) is an independent predictor of mortality in patients with heart failure (HF). Moderate WL is recommended for overweight or obese patients with type 2 diabetes mellitus (DM). The aim of this study was to assess the prognostic impact of body weight reduction on survival in patients with both HF with reduced ejection fraction (HFrEF) and DM.

METHODS

The study comprised patients with HFrEF at the outpatient clinic. WL was defined as a body weight reduction of at least 7.5% during at least 6 months. Clinical features and 1 year mortality were analysed in WL and DM groups. Multivariate regression model was chosen to assess the predictive role of WL in HF patients with and without DM. The analysis regarding obesity before HF was also performed.

RESULTS

The study comprised 777 patients with HFrEF. Mean age was 53.2 ± 9.2, 12.0% were women, mean EF was 23.7 ± 6.0 %, and New York Heart Association III or IV class, DM, and WL were found in 60.5%, 33.3%, and 47.1% patients, respectively. WL was more prevalent in diabetic patients, comparing with those without DM (53.7% vs. 43.8%, respectively, 0.01), and was associated with higher 1 year mortality only in non-diabetic group (17.6% for WL vs. 8.2% for non-WL, log-rank 0.001). In the multivariate analysis, WL was associated with a higher risk of 1 year mortality in non-diabetic patients: HR 1.76 (1.05-2.95), 0.03 and only in the subgroup without obesity: HR 2.35 (1.28-4.32), 0.006. In non-diabetic patients with obesity and in diabetic patients regardless of weight status, WL was not associated with worse prognosis (thereof, WL was excluded from the multivariate models).

CONCLUSIONS

Overall, WL in HFrEF has emerged as a predictor of unfavourable outcomes only in non-obese patients without DM. More importantly, this study has identified that the presence of DM (irrespective of weight status) or the presence of obesity in non-diabetic patients abolished the unfavourable impact of WL on long-term outcomes.

Prevalence of diabetes in Poland: a combined analysis of national databases

AIMS

To assess the number of people with diabetes in Poland using combined national sources and to evaluate the usefulness of data from an insurance system for epidemiological purposes.

METHODS

The data were collected from four sources: 1) 2013 all-billing records of the national insurance system comprising people of all age groups undergoing procedures or receiving services in primary healthcare, specialist practices and hospitals and also those receiving drugs; 2) an epidemiological study, NATPOL, that involved the assessment of people with undiagnosed diabetes; 3) the RECEPTOmetr Sequence study on prescriptions; and 4) regional child diabetes registries.

RESULTS

In 2013, 1.76 million people (0.98 million women and 0.79 million men) had medical consultations (coded E10-E14) and 2.13 million people (1.19 million women and 0.94 million men) purchased drugs or strip tests for diabetes. A total of 0.04 million people who used medical services did not buy drugs. In total, the number of people with diabetes in the insurance system was 2.16 million (1.21 million women and 0.95 million men), which corresponds to 6.1% (95% CI 6.11-6.14) of women and 5.1% (95% CI 5.12-5.14) of men. Including undiagnosed cases, the total number of people with diabetes in Poland was 2.68 million in 2013.

CONCLUSION

The estimated prevalence of diabetes (diagnosed and undiagnosed cases) in Poland is 6.97%. Data from the national insurance system with full coverage of the population can be treated as a reliable source of information on diseases with well-defined diagnosis and treatment methods, combined with an assessment of the number of undiagnosed individuals.

Hypoglycaemia in endocrine, diabetic, and internal diseases [Hipoglikemia w schorzeniach endokrynologicznych, diabetologicznych i internistycznych]

Hypoglycemia is a decrease in blood glucose concentration below the physiological level. It occurs in healthy people and in people with various diseases with inadequate secretion of insulin by β cells, or deficiency of counterregulatory hormones secreted at the moment of hypoglycemia. Hypoglycemia is also associated with diabetes therapy, regardless of whether behavioral therapy, oral hypoglycemic agents, or insulin are used. Distinguishing the causes of hypoglycemia is the basis for taking appropriate therapeutic actions that protect patients against subsequent episodes of lowering blood glucose and complications caused by hypoglycemia.

Take Control: A randomized trial evaluating the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL in patients with uncontrolled type 2 diabetes

AIM

To compare the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL (Gla-300) in people with inadequately controlled type 2 diabetes.

METHODS

Take Control (EudraCT number: 2015-001626-42) was a 24-week, multi-national, open-label, controlled, two-arm, parallel-group study in insulin-naïve and pre-treated participants, randomized 1:1 to a self- or physician-managed titration of Gla-300. The fasting self-monitored plasma glucose (SMPG) target was 4.4 to 7.2 mmol/L. The primary outcome was non-inferiority of glycated haemoglobin (HbA1c) change from baseline to week 24. Secondary outcomes included SMPG target achievement without hypoglycaemia, hypoglycaemia incidence, adverse events and participant-reported outcomes (PROs).

RESULTS

At week 24, the least squares (LS) mean HbA1c reduction was 0.97% (10.6 mmol/mol) and 0.84% (9.2 mmol/mol) in the self- and physician-managed groups, respectively, with an LS mean difference of -0.13% [95% confidence interval -0.2619 to -0.0004] (-1.4 mmol/mol [-2.863 to -0.004]), demonstrating non-inferiority (P < 0.0001) and superiority (P = 0.0247) of self- versus physician-managed titration. Significantly more of the self- than physician-managed group achieved SMPG target without hypoglycaemia (67% vs 58%; P = 0.0187). Overall, hypoglycaemia incidence was similar in each group. No safety concerns were reported. In both groups, similar PRO improvements were observed for distress related to diabetes disease burden and for confidence in diabetes self-management, with even more individuals achieving a clinically relevant reduction in emotional burden and fewer individuals with high emotional burden in the self-managed group.

CONCLUSIONS

Self-managed titration of Gla-300 was superior to physician-managed titration in terms of HbA1c reduction, accompanied by similar total PRO scores, with a clinically relevant reduction in emotional burden, and similar hypoglycaemia frequency.

Aerobic as well as resistance exercises are good for patients with type 1 diabetes

AIMS

To assess whether aerobic or resistance training has greater benefits in non-physically active men with a long lasting type 1 diabetes. The effects of exercise were evaluated in terms of diabetes control and risk factors for cardiovascular complications.

METHODS

21 male participants (mean age: 37 yrs, diabetes duration: 23 yrs, mean HbA1c: 7.4%) randomly assigned to 2 groups: 1-aerobic training (n = 10) and 2-resistance training (n = 11). All subjects participated in 60-min training sessions, either aerobic or resistance, twice a week for three months. At baseline and after 3 months: echocardiography, ECG and incremental exercise test, ECG and blood pressure monitoring, lipid profile, lactate and diabetes control parameters were assessed in all patients.

RESULTS

Baseline HbA1c was 7.44% in aerobic group and 7.36% in resistance group (p = 0.84). After 3 months there was no significant change in HbA1c value in any exercise group but a non-statistically significant downward trend was seen particularly in aerobic exercise group (p = 0.07) vs the resistance group (p = 0.15). There was no significant difference in body mass, risk of hypoglycemia and cardiovascular risk factors.

CONCLUSIONS

Both forms of exercise are safe in terms of glycemic control and cardiovascular risk factors in patients with quite well-controlled type 1 diabetes without advanced late complications.

15 Years of Experience with Biphasic Insulin Aspart 30 in Type 2 Diabetes

Since clinical experience with biphasic insulin aspart 30 (BIAsp 30) in type 2 diabetes mellitus (T2DM) was reviewed in 2012 after 10 years of use worldwide, additional studies have been published that highlight new aspects, including use in real-world populations. Evidence from 35 new studies confirms and builds upon previous work indicating that BIAsp 30 continues to have pharmacodynamic and clinical advantages over biphasic human insulin (BHI 30), including in real-world practice with unselected populations of patients. BIAsp 30 has also been shown to be safe and efficacious as an add-on to dipeptidyl peptidase-4 (DPP-4) inhibitors. Intensification with BIAsp 30 is a safe and effective way to improve glycemic control, and titration performed by patients can achieve results that are at least comparable to those when being guided by healthcare providers. Stepwise intensification using BIAsp 30 is comparable to intensification using a basal–bolus regimen, and twice-daily BIAsp 30 provides similar glycemic control to a basal-plus regimen. Data from large observational studies, in particular, have identified patient-related characteristics that are associated with improved clinical responses, suggesting that earlier initiation and intensification of therapy is warranted. Finally, new health-economic analyses continue to confirm that BIAsp 30 is cost effective versus other therapies such as BHI 30, neutral protamine Hagedorn (NPH), or insulin glargine in both insulin-naïve and insulin-experienced patients. After 15 years of clinical use worldwide, analysis of more recent 5-year data indicates that BIAsp 30 remains a safe, effective, and simple-to-use insulin for initiation and intensification by diabetes specialists and primary care physicians in a variety of patients with T2DM.

Perspectives of Patients with Insulin-Treated Type 1 and Type 2 Diabetes on Hypoglycemia: Results of the HAT Observational Study in Central and Eastern European Countries

INTRODUCTION

The aim of this study was to determine the level of awareness of hypoglycemia, the level of fear for hypoglycemia, and the response to hypoglycemic events among insulin-treated diabetes patients from Central and Eastern Europe (CEE). The impact of hypoglycemia on the use of healthcare resources and patient productivity was also assessed.

METHODS

This was a multicenter, non-interventional, two-part, patient self-reported questionnaire study that comprised both a retrospective cross-sectional evaluation and a prospective observational evaluation. Study participants were insulin-treated adult patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) from CEE.

RESULTS

Most patients (85.4% T1DM and 83.6% T2DM) reported normal hypoglycemia awareness. The median hypoglycemia fear score was 5 out of 10 for T1DM and 4 out of 10 for T2DM patients. Patients increased glucose monitoring, consulted a doctor/nurse, and/or reduced the insulin dose in response to hypoglycemia. As a consequence of hypoglycemia, patients took leave from work/studies or arrived late and/or left early. Hospitalization was required for 31 (1.2%) patients with T1DM and 66 (2.1%) patients with T2DM.

CONCLUSION

Hypoglycemia impacts patients' personal and social functioning, reduces productivity, and results in additional costs, both direct (related to increased use of healthcare resources) and indirect (related to absenteeism.

FUNDING

Novo Nordisk.

The age of developing diabetes and FTO polymorphisms (rs9939609, rs1421085, and rs9930506)

INTRODUCTION

Type 2 diabetes (T2DM) is a common complex metabolic disorder that has a strong genetic predisposition. Fat mass and obesity-associated protein (FTO) is one of the genes of interest to us. Hypomethylation of a CpG site in the FTO gene was significantly associated with the risk of T2DM. The aim of the study was to find the answer to the question of whether the polymorphism changes of the FTO gene in the pathogenesis of type 2 diabetes are comparable in young, middle aged, and elderly people.

MATERIAL AND METHODS

The study involved 282 consecutive patients with type 2 diabetes, who attended a primary healthcare clinic in Southern Poland. The study subjects were divided into three groups according to the age at which type 2 diabetes mellitus was diagnosed (> 40 years old, 40-60 years old, and > 60 years old). The genotyping of rs9939609, rs1421085, and rs9930506 FTO polymorphisms was conducted using TaqManPre-designed SNP Genotyping Assay.

RESULTS

No statistically significant difference was shown between the examined FTO polymorphism (rs9939609, rs1421085, and rs9930506) distribution between the subjects diagnosed with diabetes < 40 years , 40-60 years, and > 60 years old.

CONCLUSIONS

There were no statistically significant relationships between the different analysed anthropometric and other parameters and distribution of examined FTO polymorphisms (rs9939609 , rs1421085, and rs9930506). The age of diabetes was not affect by the tested FTO polymorphisms (rs9939609 , rs1421085, and rs9930506).

Effect of intravenous versus subcutaneous insulin delivery on the intensity of neuropathic pain in diabetic subjects

INTRODUCTION

The effectiveness of treatment of painful diabetic polyneuropathy remains unsatisfactory. The aim of this study was to compare effects of intravenous vs. subcutaneous insulin delivery in patients with diabetic symmetric sensorimotor polyneuropathy on pain relief, the quality of life, sleep disturbance, and the nerve conduction.

MATERIAL AND METHODS

Thirty-four patients with diabetic polyneuropathy (mean age 62 ± 10 years, duration 17 ± 10 years), who reached a pain score over 40 mm on the VAS scale, HbA(1c) 7.5-10%, were randomly assigned to continuous intravenous insulin infusion (examined group) and multiple injections (control subjects). Before and after five days of the insulin treatment the effects on pain relief (SFMPQ-VAS), the quality of life improvement (EuroQol EQ-5D), and sleep disturbances (AIS) were assessed.

RESULTS

Both groups experienced significant pain reduction, improvement of the quality of life, and reduction of sleep disturbances, i.e. a VAS in the study group of 69 ± 14 mm before treatment vs. 40 ± 19 mm after treatment (p < 0.001), and in control subjects 66 ± 16 mm vs. 47 ± 17 mm (p < 0.001). No difference in level of pain intensity reduction between the groups studied was found.

CONCLUSIONS

Intensification of insulin treatment applied for five days results in improvement of the physical condition of patients with painful diabetic polyneuropathy, through pain relief, and improvement of the quality of life and sleep quality. The efficacy of insulin intravenous infusion and multiple injections is comparable.

Factors Associated With Cardiovascular Events in Patients With Type 2 Diabetes and Acute Myocardial Infarction

CONTEXT

Decreasing risk of cardiovascular (CV) disease remains a challenge to survival in type 2 diabetes.

OBJECTIVE

The objective was to assess the association between demographic, glycemic, and other clinical factors and CV risk in the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus trial. DESIGN, SETTINGS, PARTICIPANTS, AND INTERVENTION: We used discrete-time survival tree analysis to examine data collected for up to 4.6 years in 1115 patients with type 2 diabetes mellitus experiencing acute myocardial infarction (MI) less than or equal to 18 days before enrollment.

MAIN OUTCOME MEASURES

The primary objective was to identify demographic, glycemic, and CV risk factors best separating survival curves over time for a composite end point: CV death, nonfatal MI, nonfatal stroke, hospitalization for acute coronary syndromes, or coronary revascularization planned after randomization.

RESULTS

Average change across visits in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for the primary end point: mean time to 75% event-free survival for an average change across visits less than or equal to -0.14 mmol/L, 73.48 weeks; for visits with average change more -0.14 mmol/L, 29.10 weeks. An average change across visits in the hemoglobin A1c level less than or equal to -0.92% (-10.06 mmol/mol) and the absence of a history of stroke or acute MI increased CV event-free survival time further. Fasting blood glucose and randomized insulin treatment strategy were weak predicting factors of event-free survival.

CONCLUSIONS

Postprandial glycemia should be considered a potential target in trials to reduce CV morbidity and mortality in type 2 diabetes mellitus.

Is there an impact of treatment with DPP-4 inhibitors on lymphocyte subpopulations in type 2 diabetic patients?

INTRODUCTION

Dipeptidil peptidase 4 inhibitors (DPP-4) are a group of antihyperglycemic agents. DPP-4 is an enzyme expressed on lymphocyte surface as co-stimulatory molecule in activation processes. The aim was to assess lymphocyte subpopulations initially and after 14 days of treatment with DPP-4 inhibitors sitagliptin, saxagliptin and vildagliptin.

MATERIAL AND METHODS

The study was conducted in three groups 10 subjects each, of type 2 diabetic patients. In subjects studied an initial tests followed by repeated ones after 14 days of treatment with sitagliptin, saxagliptin, and vildagliptin in therapeutic doses were performed. Baseline test as well as lymphocyte subpopulations (total T cells, and T-cell subsets CD4+, CD8+, CD26+, CD45RA+, CD45RO+, CD4+/CD25+) using 7-colour flow cytometry method were performed.

RESULTS

In patients receiving sitagliptin no significant increase in lymphocyte subpopulations were observed. In patients who received vildagliptin significant increase of total T-cells (p < 0.05); in patients treated with saxagliptin significant (p < 0.05) though mild increased percentage of total T-cells and CD4+, CD26+, CD45RO+ subsets were found.

CONCLUSIONS

The study showed mild but significant increase of several T-cell subsets after treatment with saxagliptin and vildagliptin with non significant elevation after treatment with sitagliptin. It seems that changes are not expressed enough to have a clinical impact.

Incidence of Fractures in Patients With Type 2 Diabetes in the SAVOR-TIMI 53 Trial

OBJECTIVE

Patients with type 2 diabetes have an increased risk of bone fractures, the predisposing factors for which are unknown. Treatment with thiazolidinediones (TZDs) further increases the incidence of osteoporotic fractures. In the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) trial, fractures were considered an adverse event of special interest, and information regarding fractures was collected.

RESEARCH DESIGN AND METHODS

We compared the incidence of fractures among the 8,280 patients who were assigned to treatment with saxagliptin with that in the 8,212 patients who were assigned to placebo. We further analyzed the participants' baseline characteristics and fracture risk.

RESULTS

During a median follow-up of 2.1 years, 241 patients (2.9%) in the saxagliptin group and 240 (2.9%) in the placebo group experienced a fracture (hazard ratio [HR] 1.00 [95% CI 0.83-1.19]). Event rates for fractures were the same in both treatment arms: 14.7 per 1,000 patient-years in the entire population and 14.0 in the on-treatment population (first event only). Fracture risk was similar in patients treated with saxagliptin or placebo across different subgroups defined by race, cardiovascular risk, and renal function. A multivariable Cox regression analysis showed that risk of fracture was associated with female sex (P < 0.0001), longer diabetes duration (P < 0.0001), older age (P = 0.002), major hypoglycemic events (P = 0.01), noncompliance with study drug (P = 0.01), and treatment with TZDs (P = 0.03).

CONCLUSIONS

In a large population of older patients with type 2 diabetes, treatment with saxagliptin was not associated with an increased risk of fractures. The association between longer diabetes duration and increased risk of bone fracture is an intriguing finding.

Recommendations for health-enhancing physical activities in type 2 diabetes patients

[Purpose] Type 2 diabetes mellitus is a disease of civilization with epidemiological coverage. An integral component of a comprehensive process of type 2 diabetes mellitus prevention and treatment is reasonably proportioned exercise. The aim of the study was to evaluate the weekly physical activity of patients with type 2 diabetes mellitus and healthy subjects with respect to recommendations of the American College of Sports Medicine and American Diabetes Association. [Subjects] The study involved 31 patients with type 2 diabetes mellitus (treatment duration 9 ± 0.8) and 31 healthy people. [Methods] Physical activity levels were determined by the International Physical Activity Questionnaire. A χ² test was applied to determine the percentage of people who met recommendations. [Results] Analysis of the obtained results demonstrated that the intensity of physical activity in patients with diabetes was moderate or low. The men in the control group met the recommendations for standard health-related activities significantly more often than the patients with diabetes. In women, there was no such relationship, since most of the women were insufficiently physically active. [Conclusion] The conclusion to be drawn is that there is an urgent need to develop and implement effective programs to enhance physical activity among people at risk of diseases of civilization, including type 2 diabetes.

Role of impaired glucose tolerance in patients with acute myocardial infarction in relation to sex

INTRODUCTION

Impaired glucose tolerance (IGT) has a negative impact on the outcome of patients with acute myocardial infarction (AMI).

OBJECTIVES

The aim of the study was to compare the effect of IGT on early and late prognosis in women and men with AMI treated with percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

Based on the results of oral glucose tolerance test, 560 patients with IGT (395 men, 165 women) were selected out of a single center registry of 2733 consecutive patients with AMI. Sex‑related mortality and major adverse cardiovascular events (MACEs) including myocardial reinfarction, stroke, or repeat revascularization during hospitalization and long‑term follow‑up were compared in the whole study population and within the high‑risk subgroups.

RESULTS

Mortality and MACE rates were comparable between men and women except for a higher stroke rate in women (4.8% vs. 1.5%, P <0.05). No significant differences were observed in the subgroups of patients with reduced ejection fraction (<35%) and those aged above 70 years, during both short and long‑term follow‑up. However, in women compared with men, higher stroke rates were observed in the subgroup of patients with incomplete revascularization (6.9% vs. 1.1%, P <0.05) and higher total mortality rates in the subgroup with renal dysfunction (40% vs. 16%, P <0.05). Female sex was an independent risk factor for stroke (hazard ratio [HR], 2.94; P = 0.048) and MACEs (HR, 1.45; P = 0.009), but not for death, in the population of patients with AMI and IGT.

CONCLUSIONS

Mortality in women and men with AMI treated with PCI with concomitant IGT is comparable, but female sex is an independent risk factor for stroke and MACEs, particularly worsening prognosis in patients with renal dysfunction.

Dapagliflozin added to glimepiride in patients with type 2 diabetes mellitus sustains glycemic control and weight loss over 48 weeks: a randomized, double-blind, parallel-group, placebo-controlled trial

INTRODUCTION

Maintenance of drug efficacy and safety over the long term is important to investigate for progressive conditions like type 2 diabetes mellitus (T2DM). This study aimed to evaluate whether efficacy of dapagliflozin added to glimepiride observed at 24 weeks was maintained at 48 weeks, and to provide further safety and tolerability data in patients with T2DM.

METHODS

This 24-week randomized, double-blind, parallel-group, placebo-controlled trial with a 24-week double-blind extension period enrolled adults whose T2DM was inadequately controlled [glycated hemoglobin (HbA1c) 7.0-10.0%] on sulfonylurea monotherapy. Patients were randomized to placebo (n = 146) or dapagliflozin 2.5 mg (n = 154), 5 mg (n = 145), or 10 mg (n = 151) per day added to open-label glimepiride 4 mg/day.

RESULTS

In total, 519 patients (87.1%) completed the study. At 48 weeks, HbA1c adjusted mean changes from baseline for the placebo versus dapagliflozin 2.5/5/10-mg groups were -0.04% versus -0.41%, -0.56% and -0.73%, respectively. There were no meaningful differences in HbA1c changes from baseline from 24 to 48 weeks, indicating that glycemic efficacy was maintained. Improvements in fasting plasma glucose and post-challenge plasma glucose were also observed with dapagliflozin over 48 weeks. Dapagliflozin 2.5/5/10 mg produced sustained reductions in weight (-1.36/-1.54/-2.41 kg) versus placebo (-0.77 kg). Adjusted mean reductions from baseline in systolic blood pressure were also greater than placebo for all dapagliflozin doses. In the placebo versus dapagliflozin groups, serious adverse events were 8.9% versus 8.6-11.0%, hypoglycemic events were 6.8% versus 9.7-11.3%, and events suggestive of genital infection were 1.4% versus 5.2-8.6%.

CONCLUSION

Dapagliflozin added to glimepiride improved glycemic control and body weight, with short-term findings maintained during the study's extension period. Therapy was generally well tolerated over 48 weeks; hypoglycemic events and events suggestive of genital infection were reported more often in patients receiving dapagliflozin.

Association between hypoglycemia and the type of insulin in diabetic patients treated with multiple injections: an observational study

INTRODUCTION

Hypoglycemia may have serious health consequences; therefore, it is important to expand knowledge on the factors that increase its prevalence.

OBJECTIVES

The aim of the study was to evaluate the effect of the type of insulin-human vs. analogue-on the incidence of mild and severe hypoglycemia, body weight, and hemoglobin A1c (HbA1c) levels.

PATIENTS AND METHODS

A total of 203 diabetic patients treated with intensive insulin therapy completed the questionnaire on hypoglycemia at baseline and at 3 and 6 months of the follow‑up. Body weight and HbA1c levels were measured at baseline and at 6 months. Incidence of mild and severe hypoglycemia, body weight, and HbA1c levels were compared between patients treated with short‑acting analogue and those treated with short‑acting human insulin (regardless of the type of long‑acting insulin used) and between patients receiving short- and long‑acting analogue insulin and those receiving short- and long‑acting human insulin. A multiple logistic regression analysis was used to find independent risk factors of severe hypoglycemia.

RESULTS

At baseline, mild hypoglycemia was more common in patients receiving insulin analogue. There were no differences between the subgroups in the incidence of severe hypoglycemia, HbA1c levels, and body weight. Male sex, older age, and the dose of long‑acting insulin were independently associated with a higher incidence of severe hypoglycemia. Type 2 diabetes and higher body weight were associated with a lower risk of severe hypoglycemia.

CONCLUSIONS

Our results suggest that use of insulin analogues may predispose to more frequent episodes of mild hypoglycemia, but it does not increase the incidence of severe hypoglycemia in patients on intensive insulin therapy. Insulin analogues are not different from human insulin in terms of the effects on HbA1c levels and body mass.

Declared and real physical activity in patients with type 2 diabetes mellitus as assessed by the International Physical Activity Questionnaire and Caltrac accelerometer monitor: a potential tool for physical activity assessment in patients with type 2 diabetes mellitus

AIMS

The aims of this study were to assess and compare declared and real volume of physical activity (PA), and to evaluate correlations of these measurements with glycemic control (HbA1c) and body mass index (BMI), in patients with type 2 diabetes mellitus (T2DM).

MATERIAL AND METHODS

A group of 31 (16 women and 15 men) type 2 diabetic patients treated with insulin monotherapy, from (mean age=54 ± 3.6 years, BMI=29.7 ± 4.8 kg/m(2), T2DM treatment=9 ± 8 years, HbA1c 7 ± 1%) and not professionally active (unemployed or retired) was recruited. An assessment of energy cost (EC) of their weekly PA using International Physical Activity Questionnaire (IPAQ), and an accelerometer assessment was performed.

RESULTS

Total energy expenditure of the declared weekly PA, calculated from the IPAQ (DPA) was 2513 ± 1349 METmin/week, and 2428 ± 1348, for male and female participants, respectively (p > 0.05). EC of the real PA (RPA), registered with the accelerometer was 4552 ± 2028 kcal/week, and 4032 ± 2288 kcal/week, for males, and females, respectively. Patients who demonstrated a high DPA, based on their IPAQ score, showed a significantly higher RPA, as registered by the accelerometer (p < 0.05). HbA1c and BMI did not correlate with their PA measurements.

CONCLUSIONS

Our findings indicate that the IPAQ may serve as a potential tool for physical activity assessment with no further requirement for more sophisticated methods. Our results suggest that habitual physical activity has no impact on glycemic control and BMI in type 2 diabetic patients. However, further studies on a larger population are needed to explore these issues.

Cardiovascular therapy, diagnostic procedures, and control of risk factors in patients with diabetes or coronary artery disease in Poland: the Kardia‑Pol registry

INTRODUCTION

Diabetes mellitus (DM) and coronary artery disease (CAD) are associated with increased cardiovascular risk.

OBJECTIVES

The aim of the study was to compare management of high-risk patients with DM and patients with CAD in Poland.

PATIENTS AND METHODS

Randomly selected primary care offices enrolled patients aged 55 years and older, with DM and no documented CAD (n = 210) or with CAD and no documented DM (n = 186).

RESULTS

Statins were given to 64% vs. 87% (P <0.05), acetylsalicylic acid (ASA) to 53% vs. 84% (P <0.05), and angiotensin-converting enzyme inhibitors to 70% vs. 69% (P = 0.8) of the patients with DM and CAD, respectively. Screening tests to detect glucose abnormalities in patients with CAD or to detect CAD in patients with DM were not performed in 26% of patients with DM and 24% of those with CAD (P = 0.64). Mean systolic blood pressure was 136.8 ± 13.6 vs. 131.7 ± 15.8 mmHg (P = 0.001), diastolic blood pressure was 80.4 ± 7.4 vs. 79.4 ± 11.6 mmHg (P = 0.316), and total cholesterol was 196 ± 42 vs. 183 ± 42 mg/dl (P = 0.003) in patients with DM and CAD, respectively. The percentage of patients with blood pressure below 140/90 mmHg, total cholesterol below 175 mg/dl, and low-density lipoprotein (LDL) cholesterol below 100 mg/dl was 15% vs. 25% (P = 0.055), while the percentage of patients with blood pressure below 130/80 mmHg, total cholesterol below 175 mg/dl, and LDL cholesterol <70 mg/dl was 1% vs. 3% (P = 0.016) in the DM vs. CAD groups, respectively.

CONCLUSIONS

Use of statins and ASA was more frequent in patients with CAD than in patients with DM. Control of risk factors in the study population was better in the CAD group but still unsatisfactory in most patients.

The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively

Background

Diabetes (DM) deteriorates the prognosis in patients with coronary heart disease. However, the prognostic value of different glucose abnormalities (GA) other than DM in subjects with acute myocardial infarction (AMI) treated invasively remains unclear.

Aims

To assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI).

Methods

A single-center, prospective registry encompassed 2733 consecutive AMI subjects treated with PCI. In all in-hospital survivors (n = 2527, 92.5%) without the history of DM diagnosed before or during index hospitalization standard oral glucose tolerance test (OGTT) was performed during stable condition before hospital discharge and interpreted according to WHO criteria. The mean follow-up period was 37.5 months.

Results

The incidence of GA was as follows: impaired fasting glycaemia - IFG (n = 376, 15%); impaired glucose tolerance - IGT (n = 560, 22%); DM (n = 425, 17%); new onset DM (n = 384, 15%); and normal glucose tolerance – NGT (n = 782, 31%). During the long-term follow-up, death rate events for previously known DM, new onset DM and IGT were significantly more frequent than those for IFG and NGT (12.3; 9.6 and 9.4 vs. 5.6 and 6.4%, respectively, P < 0.05). The strongest and common independent predictors of death in GA patients were glomerular filtration rate < 60 ml/min/1,73 m^2 (HR 2.0 and 2.8) and left ventricle ejection fraction < 35% (HR 2.5 and 1.8, all P < 0.05) respectively.

Conclusions

Glucose abnormalities are very common in AMI patients. DM, new onset DM and IGT increase remote mortality. Impaired glucose tolerance bears similar long-term prognosis as diabetes.

Efficacy of short-term adjunctive subantimicrobial dose doxycycline in diabetic patients--randomized study

OBJECTIVE

To investigate the effectiveness of short-term adjunctive subantimicrobial dose doxycycline (SDD) treatment in patients with diabetes mellitus type 2 and chronic periodontitis (CP).

METHODS

Thirty-four patients with CP and type 2 diabetes mellitus were included in the placebo-controlled, double-blind study. After scaling and root planing (SRP), patients were randomly assigned to two groups, receiving either SDD or placebo bid for 3 months. The probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), approximal plaque index, glycated hemoglobin (HbA1c) level were recorded and gingival crevicular fluid (GCF) samples were collected at baseline and after 3-month therapy for the estimation of matrix metalloproteinase-8 levels.

RESULTS

Clinical attachment level, PD, and BOP improved significantly in both groups after therapy (P < 0.05). The statistically significant difference between the two groups after the therapy was observed only in PD in tooth sites with initial PD ≥ 4 mm (SRP + placebo: 3.41 ± 0.6 mm vs SRP + SDD: 2.92 ± 0.5 mm, P < 0.05). GCF matrix metalloproteinase-8 levels were significantly reduced only in SRP + SDD group (P < 0.01). There were no changes in HbA1c levels after therapy.

CONCLUSION

The short-term administration of SDD gives significant benefit at tooth sites with moderate disease (PD ≥ 4 mm) when compared to SRP alone in patients with diabetes and CP.