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Affiliation(s)
- Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, U.K
| | - Robert G Moses
- Director of Diabetes Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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2
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Immanuel J, Flack J, Wong VW, Yuen L, Eagleton C, Graham D, Lagstrom J, Wolmarans L, Martin M, Cheung NW, Padmanabhan S, Rudland V, Ross G, Moses RG, Maple-Brown L, Fulcher I, Chemmanam J, Nolan CJ, Oats JJN, Sweeting A, Simmons D. The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme. Int J Environ Res Public Health 2021; 18:ijerph18094899. [PMID: 34064492 PMCID: PMC8125192 DOI: 10.3390/ijerph18094899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. METHODS A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. RESULTS The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8-57.3%), metformin alone in 18.8% (0.4-43.7%), and metformin and insulin in 10.1% (1.5-23.4%); when compared between sites, all p < 0.001. Birth was by elective caesarean in 12.1% (3.6-23.7%) or emergency caesarean in 9.5% (3.5-21.2%) (all p < 0.001). Preterm births (<37 weeks) ranged from 3.7% to 9.4% (p < 0.05), large for gestational age 10.3-26.7% (p < 0.001), admission to special care nursery 16.7-25.0% (p < 0.001), and neonatal hypoglycaemia (<2.6 mmol/L) 6.0-27.0% (p < 0.001). Many women with T1D and T2D had limited pregnancy planning including first trimester hyperglycaemia (HbA1c > 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). CONCLUSION Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.
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Affiliation(s)
- Jincy Immanuel
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
| | - Jeff Flack
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, 2200 Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, 2170 Liverpool, Australia;
| | - Vincent W Wong
- South Western Sydney Clinical School, University of New South Wales, 2170 Liverpool, Australia;
- Diabetes and Endocrinology Service, Liverpool Hospital, 2170 Sydney, Australia
| | - Lili Yuen
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
| | - Carl Eagleton
- Department of Endocrinology, Auckland City Hospital, 1023 Auckland, New Zealand;
| | - Dorothy Graham
- Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, 6008 Subiaco, Australia;
| | - Janet Lagstrom
- Nathalia Cobram Numurkah Health, 3636 Victoria, Australia;
| | | | - Michele Martin
- Diabetes Service, Illawarra Shoalhaven Local Health District, 2500 Wollongong, Australia; (M.M.); (R.G.M.)
| | - Ngai Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia; (N.W.C.); (S.P.); (V.R.)
| | - Suja Padmanabhan
- Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia; (N.W.C.); (S.P.); (V.R.)
| | - Victoria Rudland
- Department of Diabetes and Endocrinology, Westmead Hospital, 2145 Sydney, Australia; (N.W.C.); (S.P.); (V.R.)
| | - Glynis Ross
- Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, 2050 Sydney, Australia; (G.R.); (A.S.)
| | - Robert G Moses
- Diabetes Service, Illawarra Shoalhaven Local Health District, 2500 Wollongong, Australia; (M.M.); (R.G.M.)
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, 0810 Darwin, Australia;
- Department of Endocrinology, Royal Darwin Hospital, 0810 Darwin, Australia
| | - Ian Fulcher
- Department of Obstetrics and Gynaecology, Liverpool Hospital, 2170 Sydney, Australia;
| | - Julie Chemmanam
- Endocrinology and Diabetes Centre, Women’s and Children’s Hospital, 5006 Adelaide, Australia;
| | - Christopher J Nolan
- Department of Diabetes and Endocrinology, The Canberra Hospital, 2605 Garran, Australia;
- Medical School, Australian National University, 2605 Canberra, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, 3053 Victoria, Australia;
| | - Arianne Sweeting
- Department of Diabetes and Endocrinology, Royal Prince Alfred Hospital, 2050 Sydney, Australia; (G.R.); (A.S.)
| | - David Simmons
- School of Medicine, Western Sydney University, 2560 Sydney, Australia; (J.I.); (J.F.); (L.Y.)
- Macarthur Diabetes Service, Campbelltown Hospital, 2560 Sydney, Australia
- Correspondence: ; Tel.: +61-246-203-899
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3
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van Gemert TE, Moses RG. Climate change and an increased prevalence of gestational diabetes. Aust N Z J Obstet Gynaecol 2021; 60:E14. [PMID: 33043433 DOI: 10.1111/ajo.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tegan E van Gemert
- Department of Endocrinology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Robert G Moses
- Illawarra Diabetes Service, Wollongong, New South Wales, Australia
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Van Gemert TE, Moses RG, Lambert K. The potential effects of climate change on the prevalence of gestational diabetes are less apparent with different diagnostic criteria. Aust N Z J Obstet Gynaecol 2021; 61:E3-E4. [PMID: 33523461 DOI: 10.1111/ajo.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tegan E Van Gemert
- Department of Endocrinology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Robert G Moses
- Illawarra Diabetes Service, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Riddle MC, Bakris G, Blonde L, Boulton AJM, D'Alessio D, DiMeglio LA, Gonder-Frederick L, Hood KK, Hu FB, Kahn SE, Kaul S, Leiter LA, Moses RG, Rich SS, Rosenstock J, Wylie-Rosett J. A Lesson From 2020: Public Health Matters for Both COVID-19 and Diabetes. Diabetes Care 2021; 44:8-10. [PMID: 33571952 DOI: 10.2337/dci20-0071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - George Bakris
- Endocrine Division, American Society of Hypertension (ASH) Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, IL
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | | | - David D'Alessio
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Linda Gonder-Frederick
- Center for Diabetes Technology, Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
| | - Korey K Hood
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steven E Kahn
- VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, WA
| | - Sanjay Kaul
- Medicine/Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert G Moses
- Diabetes Center, South Eastern Sydney and Illawarra Area Health Service, Wollongong West, New South Wales, Australia
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Julio Rosenstock
- Dallas Diabetes Research Center, Medical City Dallas, Dallas, TX
| | - Judith Wylie-Rosett
- New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY
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6
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McIntyre HD, Moses RG. Response to Comment on McIntyre and Moses The Diagnosis and Management of Gestational Diabetes Mellitus in the Context of the COVID-19 Pandemic. Diabetes Care 2020;43:1433-1434. Diabetes Care 2020; 43:e193. [PMID: 33082250 DOI: 10.2337/dci20-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- H David McIntyre
- Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert G Moses
- Wollongong Hospital, Illawarra and Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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7
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van Gemert TE, Moses RG, Pape AV, Morris GJ. Gestational diabetes mellitus testing in the COVID-19 pandemic: The problems with simplifying the diagnostic process. Aust N Z J Obstet Gynaecol 2020; 60:671-674. [PMID: 32662072 PMCID: PMC7405039 DOI: 10.1111/ajo.13203] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 05/01/2020] [Accepted: 05/30/2020] [Indexed: 01/11/2023]
Abstract
Background Multiple professional bodies have temporarily revised recommendations for gestational diabetes mellitus (GDM) testing during the COVID‐19 pandemic to reduce person‐to‐person contact. The current Australian temporary criteria advise that if the fasting glucose is ≤4.6 mmol/L, then no glucose tolerance test (GTT) is required. Aims The aim of this study is to examine the extent of underdiagnosis of GDM using a fasting glucose ≤4.6 mmol/L as a cut‐off to determine that a GTT is not necessary. Materials and Methods De‐identified data from pregnant women having a GTT test in the Illawarra area during a six‐year period was used to determine the number of women with GDM and the proportion of positive cases that would be missed for different fasting glucose values. Results There were 16 522 results identified and GDM was diagnosed in 12.2%. The majority of women were more than 30 years of age (85.2%) and diagnosed at ≥20 weeks gestation (81.1%). Of those diagnosed with GDM, 29% had a fasting glucose of ≤4.6 mmol/L and would have been missed. Conclusions Our results show that using a fasting glucose of 4.6 mmol/L or less would miss nearly a third of women who would otherwise be diagnosed with GDM.
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Affiliation(s)
- Tegan E van Gemert
- Department of Endocrinology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Robert G Moses
- Department of Endocrinology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Alexia V Pape
- Department of Endocrinology, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Gary J Morris
- Biochemistry, Southern IML Pathology, Wollongong, New South Wales, Australia
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8
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Affiliation(s)
- Sarah A L Price
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Robert G Moses
- Diabetes Services, University of Wollongong, West Wollongong, New South Wales, Australia
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9
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Affiliation(s)
- H David McIntyre
- Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert G Moses
- Wollongong Hospital, Illawarra and Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Cheung NW, Campbell LV, Fulcher GR, McElduff P, Depczynski B, Acharya S, Carter J, Champion B, Chen R, Chipps D, Flack J, Kinsella J, Layton M, McLean M, Moses RG, Park K, Poynten AM, Pollock C, Scadden D, Tonks KT, Webber M, White C, Wong V, Middleton S. Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial. Med J Aust 2019; 211:454-459. [DOI: 10.5694/mja2.50394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/25/2019] [Indexed: 01/17/2023]
Affiliation(s)
- N Wah Cheung
- Westmead Hospital Sydney NSW
- University of Sydney Sydney NSW
| | | | | | | | - Barbara Depczynski
- Prince of Wales Private Hospital Sydney NSW
- Liverpool Hospital Sydney NSW
- Fairfield Hospital Sydney NSW
| | | | | | | | - Roger Chen
- Concord Repatriation General Hospital Sydney NSW
| | | | | | | | | | - Mark McLean
- Western Sydney University School of Medicine Penrith NSW
| | | | | | | | - Carol Pollock
- University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
| | | | | | | | | | | | - Sandy Middleton
- St Vincent's Health Australia Sydney NSW
- Australian Catholic University Nursing Research Institute Sydney NSW
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11
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Shen EX, Moses RG, Oats JJN, Lowe J, McIntyre HD. Seasonality, temperature and pregnancy oral glucose tolerance test results in Australia. BMC Pregnancy Childbirth 2019; 19:263. [PMID: 31340766 PMCID: PMC6657158 DOI: 10.1186/s12884-019-2413-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/16/2019] [Indexed: 01/12/2023] Open
Abstract
Background The oral glucose-tolerance test (OGTT) is currently the standard method for diagnosis of gestational diabetes (GDM). We conducted a post hoc analysis using the Australian Hyperglycemia and Adverse Pregnancy Outcome (HAPO) data to determine seasonal variations in OGTT results, the consequent prevalence of GDM, and association with select perinatal parameters. Method Women enrolled in the Australian HAPO study sites (Brisbane and Newcastle) from 2001 to 2006 were included if OGTT results between 24 to 32 weeks gestation were available (n = 2120). Fasting plasma glucose, 1-h plasma glucose, 2-h plasma glucose, HbA1c, HOMA-IR, and umbilical cord C-peptide and glucose values were categorized by season and correlated to monthly temperature records from the Australian Bureau of Meteorology for Brisbane and Newcastle. GDM was defined post hoc using the IADPSG/WHO criteria. Results Small but significant (p < 0.01 on ANOVA) elevations in fasting glucose (+ 0.12 mM), HbA1c (+ 0.09%), and HOMA-IR (+ 0.88 units) were observed during the winter months. Conversely, higher 1-h (+ 0.19 mM) and 2-h (+ 0.33 mM) post-load glucose values (both p < 0.01) were observed during the summer months. The correlations between fasting glucose, 1-h glucose, 2-h glucose, and HbA1c with average monthly temperatures confirmed this trend, with positive Pearson’s correlations between 1-h and 2-h glucose with increasing average monthly temperatures, and negative correlations with fasting glucose and HbA1c. Further, umbilical cord C-peptide and glucose displayed negative Pearson’s correlation with average monthly temperature, aligned with trends seen in the fasting plasma glucose. Overall prevalence of GDM did not display significant seasonal variations due to the opposing trends seen in the fasting versus 1-h and 2-h post-load values. Conclusion A significant winter increase was observed for fasting plasma glucose, HbA1c, and HOMA-IR, which contrasted with changes in 1-h and 2-h post-load venous plasma glucose values. Interestingly, umbilical cord C-peptide and glucose displayed similar trends to that of the fasting plasma glucose. While overall prevalence of GDM did not vary significantly by seasons, this study illustrates that seasonality is indeed an additional factor when interpreting OGTT results for the diagnosis of GDM and provides new direction for future research into the seasonal adjustment of OGTT results.
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Affiliation(s)
- Eddie X Shen
- Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Queensland, 4006, Australia
| | - Robert G Moses
- Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
| | - Jeremy J N Oats
- Melbourne School of Global and Population Health, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Julia Lowe
- University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - H David McIntyre
- Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Queensland, 4006, Australia. .,Mater Research, Level 3, Aubigny Place, Raymond Terrace, Brisbane, Queensland, 4101, Australia.
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Martin MB, Harding AL, Borchard JP, Moses RG. Gestational diabetes: Is early testing appropriate and does it identify women at increased pregnancy risk? Aust N Z J Obstet Gynaecol 2019; 58:E1. [PMID: 29400396 DOI: 10.1111/ajo.12763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michele B Martin
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Anne L Harding
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Jay P Borchard
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Robert G Moses
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Cheung NW, Moses RG. Response to Comment on Cheung and Moses. Gestational Diabetes Mellitus: Is It Time to Reconsider the Diagnostic Criteria? Diabetes Care 2018;41:1337-1338. Diabetes Care 2019; 42:e13. [PMID: 30811340 DOI: 10.2337/dci18-0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- N Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia .,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Robert G Moses
- Diabetes Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Barbour LA, Scifres C, Valent AM, Friedman JE, Buchanan TA, Coustan D, Aagaard K, Thornburg KL, Catalano PM, Galan HL, Hay WW, Frias AE, Shankar K, Simmons RA, Moses RG, Sacks DA, Loeken MR. A cautionary response to SMFM statement: pharmacological treatment of gestational diabetes. Am J Obstet Gynecol 2018; 219:367.e1-367.e7. [PMID: 29959933 DOI: 10.1016/j.ajog.2018.06.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/07/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
Use of oral agents to treat gestational diabetes mellitus remains controversial. Recent recommendations from the Society for Maternal-Fetal Medicine assert that metformin may be a safe first-line alternative to insulin for gestational diabetes mellitus treatment and preferable to glyburide. However, several issues should give pause to the widespread adoption of metformin use during pregnancy. Fetal concentrations of metformin are equal to maternal, and metformin can inhibit growth, suppress mitochondrial respiration, have epigenetic modifications on gene expression, mimic fetal nutrient restriction, and alter postnatal gluconeogenic responses. Because both the placenta and fetus express metformin transporters and exhibit high mitochondrial activity, these properties raise important questions about developmental programming of metabolic disease in offspring. Animal studies have demonstrated that prenatal metformin exposure results in adverse long-term outcomes on body weight and metabolism. Two recent clinical randomized controlled trials in women with gestational diabetes mellitus or polycystic ovary syndrome provide evidence that metformin exposure in utero may produce a metabolic phenotype that increases childhood weight or obesity. These developmental programming effects challenge the conclusion that metformin is equivalent to insulin. Although the Society for Maternal-Fetal Medicine statement endorsed metformin over glyburide if oral agents are used, there are few studies directly comparing the 2 agents and it is not clear that metformin alone is superior to glyburide. Moreover, it should be noted that prior clinical studies have dosed glyburide in a manner inconsistent with its pharmacokinetic properties, resulting in poor glycemic control and high rates of maternal hypoglycemia. We concur with the American Diabetes Association and American Congress of Obstetricians and Gynecologists, which recommend insulin as the preferred agent, but we believe that it is premature to embrace metformin as equivalent to insulin or superior to glyburide. Due to the uncertainty of the long-term metabolic risks of either metformin or glyburide, we call for carefully controlled studies that optimize oral medication dosing according to their pharmacodynamic and pharmacokinetic properties in pregnancy, appropriately target medications based on individual patterns of hyperglycemia, and follow the offspring long-term for metabolic risk.
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Cheung NW, Moses RG. Gestational Diabetes Mellitus: Is It Time to Reconsider the Diagnostic Criteria? Diabetes Care 2018; 41:1337-1338. [PMID: 29934476 DOI: 10.2337/dci18-0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/16/2018] [Indexed: 02/03/2023]
Affiliation(s)
- N Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia .,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Robert G Moses
- Diabetes Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Riddle MC, Bakris G, Boulton AJM, Blonde L, D'Alessio D, Greene EL, de Groot M, Hood K, Hu FB, Kahn SE, Kaul S, LeRoith D, Moses RG, Rich SS, Rosenstock J, Tamborlane WV, Wylie-Rosett J, Reynolds L. Big Topics for Diabetes Care in 2018: Clinical Guidelines, Costs of Diabetes, and Information Technology. Diabetes Care 2018; 41:1327-1329. [PMID: 29934474 DOI: 10.2337/dci18-0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - George Bakris
- American Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL
| | | | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Endocrinology Section, Ochsner Medical Center, New Orleans, LA
| | - David D'Alessio
- Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, NC
| | - Eddie L Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health System and the University of Washington School of Medicine, Seattle, WA
| | - Sanjay Kaul
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert G Moses
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | | | | | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Cefalu WT, Boulton AJM, Tamborlane WV, Moses RG, LeRoith D, Greene EL, Hu FB, Bakris G, Wylie-Rosett J, Rosenstock J, Kahn SE, Weinger K, Blonde L, de Groot M, Rich S, D'Alessio D, Reynolds L, Riddle MC. Diabetes Care: "Taking It to the Limit One More Time". Diabetes Care 2017; 40:3-6. [PMID: 27999000 PMCID: PMC5180460 DOI: 10.2337/dc16-2326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | | | | | | | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eddie L Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - George Bakris
- ASH Comprehensive Hypertension Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, IL
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA
| | - Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | - Stephen Rich
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - David D'Alessio
- Division of Endocrinology, Diabetes and Metabolism, Duke University, Durham, NC
| | | | - Matthew C Riddle
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR
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Moses RG, Round E, Shentu Y, Golm GT, O'neill EA, Gantz I, Engel SS, Kaufman KD, Goldstein BJ. A randomized clinical trial evaluating the safety and efficacy of sitagliptin added to the combination of sulfonylurea and metformin in patients with type 2 diabetes mellitus and inadequate glycemic control. J Diabetes 2016; 8:701-11. [PMID: 26625270 DOI: 10.1111/1753-0407.12351] [Citation(s) in RCA: 18] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/02/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) treatment generally requires multiple antihyperglycemic agents. When diet, exercise, and treatment with sulfonylurea and metformin do not achieve glycemic goals, several options are available. The present study evaluated the efficacy and tolerability of sitagliptin 100 mg/day added to therapy with sulfonylurea and metformin. METHODS Patients with HbA1c ≥7.5% and ≤10.5% while on a sulfonylurea and metformin were randomized 1: 1 to sitagliptin 100 mg/day or placebo for 24 weeks. At Week 24, patients in the placebo group switched to pioglitazone 30 mg/day and both groups continued treatment for another 30 weeks. RESULTS Of 427 patients randomized, 339 (79.4%) completed the study. At Week 24, significantly greater (P < 0.001) mean reductions from baseline were seen in the sitagliptin versus placebo group for HbA1c (-0.84% vs -0.16%, respectively), 2-h post-meal glucose (-2.0 vs -0.2 mmol/L, respectively) and fasting plasma glucose (-0.7 vs 0.3 mmol/L, respectively). At Week 54, improvements in glycemic control continued. At Week 24, the incidence of adverse events (AEs) was numerically greater with sitagliptin than placebo, primarily because of a higher incidence of hypoglycemia. At Week 54, the incidence of AEs was similar in both groups, primarily because of a higher incidence of hypoglycemia and edema in the placebo/pioglitazone group after Week 24. The only meaningful change in body weight was an increase in the placebo/pioglitazone group at Week 54. CONCLUSIONS In this study, sitagliptin 100 mg/day was generally well tolerated and provided improvement in glycemic control when added to the combination of sulfonylurea and metformin in patients with T2DM.
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Affiliation(s)
- Robert G Moses
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | | | - Yue Shentu
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | | | | | - Ira Gantz
- Merck & Co., Inc, Kenilworth, New Jersey, USA
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Moses RG, Wong VCK, Lambert K, Morris GJ, San Gil F. Seasonal Changes in the Prevalence of Gestational Diabetes Mellitus. Diabetes Care 2016; 39:1218-21. [PMID: 27208334 DOI: 10.2337/dc16-0451] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/18/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effect of different seasons on the prevalence of gestational diabetes mellitus (GDM) by using World Health Organization criteria. RESEARCH DESIGN AND METHODS The results of all pregnancy glucose tolerance tests (GTTs) were prospectively collected over a 3-year period in a temperate climate, and the results were grouped by season. RESULTS The results of 7,369 pregnancy GTTs were available for consideration. In winter, the median 1-h and 2-h glucose results after GTT were significantly (P < 0.0001) lower than the overall 1-h and 2-h results. The prevalence of GDM at the 1-h diagnostic level was 29% higher in summer and 27% lower in winter than the overall prevalence (P = 0.02). The prevalence of GDM at the 2-h diagnostic level was 28% higher in summer and 31% lower in winter than the overall prevalence (P = 0.01). CONCLUSIONS The prevalence of GDM varies according to seasons, which leads to the possible overdiagnosis of GDM in summer and/or underdiagnosis in winter. Further research into standardization of the GTT or seasonal adjustment of the results may need to be considered.
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Cefalu WT, Boulton AJM, Tamborlane WV, Moses RG, LeRoith D, Greene EL, Hu FB, Bakris G, Wylie-Rosett J, Rosenstock J, Weinger K, Blonde L, de Groot M, Rich SS, D'Alessio D, Riddle MC, Reynolds L. Diabetes Care: "Lagniappe" and "Seeing Is Believing"! Diabetes Care 2016; 39:1069-71. [PMID: 27631957 PMCID: PMC5013720 DOI: 10.2337/dc16-0891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | | | | | | | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eddie L Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - George Bakris
- ASH Comprehensive Hypertension Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, IL
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX
| | - Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | - Stephen S Rich
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - David D'Alessio
- Division of Endocrinology, Diabetes and Metabolism, Duke University, Durham, NC
| | - Matthew C Riddle
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR
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Moses RG, Wong VCK, Lambert K, Morris GJ. Fasting target for hyperglycaemia in pregnancy. Aust N Z J Obstet Gynaecol 2016; 56:530-531. [PMID: 27144374 DOI: 10.1111/ajo.12473] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 11/27/2022]
Abstract
Knowledge of the fasting plasma glucose of healthy women may assist in the setting of treatment targets for women with hyperglycaemia in pregnancy (HIP). This study examines the pregnancy glucose tolerance test results of 3344 women without HIP collected over a three-year period. The median fasting plasma glucose was 4.4 mmol/L with an interquartile range of 4.2-4.6 mmol/L and a 5th to 95th centile of 3.8-4.9 mmol/L. As the diagnostic fasting glucose level for HIP is ≥5.1 mmol/L, these data support a treatment target of ≤5.0 mmol/L.
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Moses RG, Wong VCK, Lambert K, Morris GJ, San Gil F. The prevalence of hyperglycaemia in pregnancy in Australia. Aust N Z J Obstet Gynaecol 2016; 56:341-5. [PMID: 26914693 DOI: 10.1111/ajo.12447] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Australasian Diabetes in Pregnancy Society (ADIPS) has recently endorsed the World Health Organization (WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population. AIMS To determine the prevalence of hyperglycaemia in pregnancy (HIP) using results from both the public and private sectors in a population that has a similar ethnicity to the overall Australian population. MATERIAL AND METHODS The results of all pregnancy oral glucose tolerance tests (POGTT) in the public sector and by a dominant private pathology provider in a major city have been prospectively collected for a three-year period and analysed using the ADIPS (WHO) criteria. RESULTS The prevalence of hyperglycaemia in pregnancy (HIP) was 13.1% with diabetes mellitus in pregnancy (DIP) being 0.4% and gestational diabetes mellitus (GDM) being 12.7%. CONCLUSION The new criteria will diagnose about one-third more women with GDM than the previous ADIPS criteria. This will have resource and health implications. Focussed local health economic data will be important.
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Zheng ASY, Morris G, Moses RG. The prevalence of gestational diabetes mellitus: The accuracy of the NSW perinatal data collection based on a private hospital experience. Aust N Z J Obstet Gynaecol 2016; 56:349-51. [DOI: 10.1111/ajo.12438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Anna S. Y. Zheng
- Department of Endocrinology and Diabetes; Wollongong Hospital; Wollongong NSW Australia
| | - Gary Morris
- Department of Biochemistry; Southern IML Pathology; Wollongong NSW Australia
| | - Robert G. Moses
- Diabetes Services & Principal Investigator; Clinical Trial and Research Unit; Wollongong NSW Australia
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Cefalu WT, Boulton AJM, Tamborlane WV, Moses RG, LeRoith D, Greene EL, Hu FB, Bakris G, Wylie-Rosett J, Rosenstock J, Weinger K, Blonde L, de Groot M, Riddle MC, Hill Golden S, Rich SS, D'Alessio D, Reynolds L. Building Momentum: Taking on the Real “Issues” of Diabetes Care! Diabetes Care 2016; 39:10-12. [PMID: 27606379 PMCID: PMC4822403 DOI: 10.2337/dc15-2315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William T Cefalu
- 1Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA. WilliamT. Cefalu,
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Affiliation(s)
- Robert G Moses
- Diabetes Services, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
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Goletzke J, Buyken AE, Louie JCY, Moses RG, Brand-Miller JC. Dietary micronutrient intake during pregnancy is a function of carbohydrate quality. Am J Clin Nutr 2015; 102:626-32. [PMID: 26178724 DOI: 10.3945/ajcn.114.104836] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 12/09/2014] [Accepted: 06/15/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Despite normal gestational weight gain, dietary studies in pregnant women show intakes below the recommendations for energy and micronutrients. OBJECTIVE This study compared changes in dietary intake from the second to third trimester with emphasis on energy intake and carbohydrate quality. DESIGN These post hoc analyses were based on 566 women participating in the Pregnancy and Glycemic Index Outcomes study, a randomized controlled trial comparing the effect of low-glycemic index (GI) dietary advice with healthy eating advice on selected pregnancy outcomes. With the use of multilevel mixed-regression analysis, changes in total energy intake, starch, sugar, fiber intake, GI, and glycemic load (GL) were correlated with intake of different micronutrients. RESULTS Energy intake decreased in the third trimester, and most women did not meet the national recommended amounts for iron, folate, and dietary fiber from food sources alone. After adjustment for age, ethnicity, prepregnancy body mass index, and intervention group, change in energy intake was positively related to change in intake of all micronutrients (P < 0.001). GI, GL, and starch intake were inversely related to micronutrient intake (P < 0.001), whereas higher total sugars predicted higher intake (P < 0.001). Associations with dietary fiber were inconsistent. CONCLUSIONS Normal pregnancy can be associated with a decline in energy and micronutrient intake from diet. Low dietary GI and GL were the best predictors of a favorable micronutrient profile. This trial was registered at www.anzctr.org.au as ACTRN12610000174088.
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Affiliation(s)
- Janina Goletzke
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study at the Research Institute of Child Nutrition, Dortmund, Germany; School of Molecular Bioscience and
| | - Anette E Buyken
- IEL-Nutritional Epidemiology, University of Bonn, DONALD Study at the Research Institute of Child Nutrition, Dortmund, Germany
| | | | - Robert G Moses
- Illawarra Shoalhaven Local Health District Wollongong, Wollongong, Australia
| | - Jennie C Brand-Miller
- School of Molecular Bioscience and Charles Perkins Centre, University of Sydney, Sydney, Australia; and
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Cefalu WT, Boulton AJ, Tamborlane WV, Moses RG, LeRoith D, Greene EL, Hu FB, Bakris G, Wylie-Rosett J, Rosenstock J, Weinger K, Blonde L, de Groot M, Riddle MC, Henry R, Golden SH, Rich S, Reynolds L. Status of Diabetes Care: New Challenges, New Concepts, New Measures--Focusing on the Future! Diabetes Care 2015; 38:1177-80. [PMID: 26312261 PMCID: PMC5131862 DOI: 10.2337/dc15-0875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- William T. Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | | | | | | | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eddie L. Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Frank B. Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - George Bakris
- ASH Comprehensive Hypertension Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, IL
| | - Judith Wylie-Rosett
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX
| | - Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | - Matthew C. Riddle
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | | | - Sherita Hill Golden
- Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen Rich
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
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Zheng ASY, O'Leary T, Moses RG. Reassessment of the new diagnostic thresholds for gestational diabetes mellitus: an opportunity for improvement. Med J Aust 2015; 202:133. [PMID: 25669473 DOI: 10.5694/mja14.01492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | - Tony O'Leary
- Australasian Life Underwriting and Claims Association Inc, Melbourne, VIC, Australia
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Abstract
OBJECTIVE There is no clear consensus regarding treatment of patients with type 2 diabetes mellitus (T2DM) that is inadequately controlled using dual combination therapy. Recommended agents for triple combination therapy should have complementary mechanisms of action with minimal risk of added side effects such as weight gain and hypoglycemia. We discuss considerations in selecting triple oral therapy regimens in patients with T2DM, and review clinical trial data regarding triple oral therapy using dipeptidyl peptidase-4 (DPP-4) inhibitors. METHODS A search of the PubMed database was conducted to identify clinical trials of triple oral therapy incorporating a DPP-4 inhibitor (November 2013 to January 2015), using the following search terms: 'type 2 diabetes' AND 'alogliptin OR linagliptin OR saxagliptin OR sitagliptin OR vildagliptin' AND 'metformin'. Trials had to include adult patients with T2DM who received triple oral therapy with a DPP-4 inhibitor for ≥18 weeks. The bibliographies of retrieved articles were also searched to identify any other relevant trials. RESULTS A total of 17 clinical trials evaluating metformin and a DPP-4 inhibitor combined with a sulfonylurea (SU), thiazolidinedione (TZD), or sodium-glucose cotransporter 2 (SGLT2) inhibitor were identified and included in this review. Consistently, the addition of a DPP-4 inhibitor to metformin and SU, TZD, or SGLT2 inhibitor therapy improved glycemic measures, and these combinations were generally well tolerated. An increased incidence of hypoglycemia was reported for combinations that included an SU. CONCLUSIONS Triple oral therapy that includes a DPP-4 inhibitor is a valid option for patients with T2DM not adequately controlled with dual combination therapy, and offers an alternative to insulin therapy. Triple oral therapy with a DPP-4 inhibitor, metformin, and a TZD or SGLT2 inhibitor should be considered when avoidance of hypoglycemia is a primary goal.
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Affiliation(s)
- Anthony H Barnett
- a a Heart of England NHS Foundation Trust and University of Birmingham, Birmingham, UK , Nantes , France
| | | | - Robert G Moses
- c c Illawarra Diabetes Service, South East Sydney & Illawarra Area Health Service , Wollongong , Australia
| | - Sanjay Kalra
- d d Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology , Kamal , India
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Zheng ASY, O'Leary T, Moses RG. Gestational diabetes mellitus and life insurance: what is the impact of gestational diabetes mellitus on life insurance premiums? Diabetes Care 2014; 37:e235. [PMID: 25342835 DOI: 10.2337/dc14-1619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Anna S Y Zheng
- Endocrinology Department, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Tony O'Leary
- Australasian Life Underwriting and Claims Association Inc., Canterbury, Victoria, Australia
| | - Robert G Moses
- Endocrinology Department, Wollongong Hospital, Wollongong, New South Wales, Australia
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Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is rising in Australia. Sodium glucose co-transporter 2 (SGLT2) inhibitors are an emerging treatment for T2DM. SGLT2 inhibitors offer a novel approach to lowering hyperglycaemia by suppressing renal glucose reabsorption and increasing urinary glucose excretion. The increased urinary glucose excretion has also been associated with caloric loss and osmotic diuresis. Dapagliflozin and canagliflozin are the SGLT2 inhibitors that are approved for clinical use in the US, the European Union (EU), and Australia. Their use results in reductions in HbA1c and body weight across a broad range of patient populations ranging from drug-naive patients to those who require additional therapy due to inadequate glycaemic control on their existing treatment. In addition, reductions in blood pressure (BP), particularly systolic BP, have also been noted. SGLT2 inhibitors are generally well tolerated with low rates of adverse events. Episodes of hypoglycaemia were mostly classified as minor, with low and balanced rates of severe hypoglycaemia across studies. The proportions of patients with genital infections and urinary tract infections were higher with dapagliflozin and canagliflozin versus their comparators. However, these infections were generally mild-to-moderate in intensity, treated with standard antimicrobial therapies, and rarely led to discontinuation. No dosage adjustments for dapagliflozin and canagliflozin are recommended for normal-to-mild renal impairment. Dapagliflozin and canagliflozin are not recommended for use in patients with eGFR<60 and <45mL/min/1.73m(2), respectively. Overall, SGLT2 inhibitors have shown the potential to become an important addition to the treatment armamentarium for effective management of patients with T2DM.
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Affiliation(s)
- Robert G Moses
- Illawarra Diabetes Service, Clinical Trial and Research Unit, Illawarra Shoalhaven Local Health District,Wollongong, NSW, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, NSW, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
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Cefalu WT, Boulton AJ, Tamborlane WV, Moses RG, LeRoith D, Greene EL, Hu FB, Bakris G, Wylie-Rosett J, Rosenstock J, Weinger K, Blonde L, de Groot M, Riddle MC, Henry RR, Golden SH, Rich S, Reynolds L. Status of Diabetes Care: "It just doesn't get any better . . . or does it?". Diabetes Care 2014; 37:1782-5. [PMID: 25093231 PMCID: PMC5131856 DOI: 10.2337/dc14-1073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William T. Cefalu
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
| | | | | | | | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eddie L. Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Frank B. Hu
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
| | - George Bakris
- ASH Comprehensive Hypertension Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, IL
| | - Judith Wylie-Rosett
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX
| | - Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diabetes and Metabolism, Ochsner Medical Center, New Orleans, LA
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | - Matthew C. Riddle
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | | | - Sherita Hill Golden
- Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen Rich
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
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Moses RG, Kalra S, Brook D, Sockler J, Monyak J, Visvanathan J, Montanaro M, Fisher SA. A randomized controlled trial of the efficacy and safety of saxagliptin as add-on therapy in patients with type 2 diabetes and inadequate glycaemic control on metformin plus a sulphonylurea. Diabetes Obes Metab 2014; 16:443-50. [PMID: 24205943 DOI: 10.1111/dom.12234] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/20/2013] [Accepted: 11/06/2013] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate the efficacy and safety of saxagliptin as add-on therapy in adults with type 2 diabetes with inadequate glycaemic control on metformin plus a sulphonylurea. METHODS In this 24-week, multicentre, randomized, parallel-group, double-blind study, outpatients aged ≥18 years with type 2 diabetes, body mass index ≤40 kg/m(2) and inadequate glycaemic control, received saxagliptin 5 mg or placebo once-daily added to background medication consisting of a stable maximum tolerated dose of metformin plus a sulphonylurea. The primary end point was change in glycated haemoglobin (HbA1c) from baseline to week 24. Safety and tolerability assessments included adverse events (AEs), hypoglycaemia and body weight. RESULTS A total of 257 patients were randomized, treated and included in the safety analysis (saxagliptin, n = 129; placebo, n = 128); 255 were included in the efficacy analysis (saxagliptin, n = 127; placebo, n = 128). HbA1c reduction was greater with saxagliptin versus placebo [between-group difference in adjusted mean change from baseline, -0.66%; 95% confidence interval (CI), -0.86 to -0.47 (7 mmol/mol, -9.4 to -5.1); p < 0.0001]. The proportion of patients with ≥1 AE was 62.8% with saxagliptin and 71.7% with placebo. In the saxagliptin and placebo groups, rates of reported hypoglycaemia were 10.1 and 6.3%, respectively, and rates of confirmed hypoglycaemia (symptoms + glucose < 2.8 mmol/l) were 1.6 and 0%. Mean change in body weight was 0.2 kg for saxagliptin and -0.6 kg for placebo (p = 0.0272). CONCLUSION Addition of saxagliptin 5 mg/day in patients inadequately controlled on metformin and sulphonylurea effectively improved glycaemic control and was well tolerated.
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Affiliation(s)
- R G Moses
- Wollongong Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
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Moses RG, Casey SA, Quinn EG, Cleary JM, Tapsell LC, Milosavljevic M, Petocz P, Brand-Miller JC. Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. Am J Clin Nutr 2014; 99:517-23. [PMID: 24351875 DOI: 10.3945/ajcn.113.074138] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Eating carbohydrate foods with a high glycemic index (GI) has been postulated to result in fetoplacental overgrowth and higher infant body fat. A diet with a low glycemic index (LGI) has been shown to reduce birth percentiles and the ponderal index (PI). OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight, birth percentile, and PI than providing healthy eating (HE) advice. This advice had to be presented within the resources of routine antenatal care. DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm, parallel-design, randomized, controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes. Eligible volunteers who attended for routine antenatal care at <20 wk of gestation were randomly assigned to either group. RESULTS A total of 691 women were enrolled, and 576 women had final data considered. In the LGI group, the GI was reduced from a mean (± SEM) of 56 ± 0.3 at enrollment to 52 ± 0.3 (P < 0.001) at the final assessment. There were no significant differences in primary outcomes of fetal birth weight, birth percentile, or PI. In a multivariate regression analysis, the glycemic load was the only significant dietary predictor (P = 0.046) of primary outcomes but explained <1% of all variation. CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight, fetal percentile, or PI.
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Affiliation(s)
- Robert G Moses
- Illawarra Shoalhaven Local Health District Wollongong, Wollongong, Australia (RGM, SAC, EGQ, JMC, and MM); the School of Health Sciences, University of Wollongong, Wollongong, Australia (LCT); the Department of Statistics, Macquarie University, Sydney, Australia (PP); and the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders and School of Molecular Bioscience, University of Sydney, Sydney, Australia (JCB-M)
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Moses RG, Colagiuri S, Pollock C. SGLT2 inhibitors: New medicines for addressing unmet therapeutic needs in type 2 diabetes. Australas Med J 2014. [DOI: 10.21767/amj.2014.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moses RG, Casey S, Cleary J, Milosavljevic M, Quinn E, Tapsell L, Petocz P, Brand-Miller JC. Effect of low glycaemic index dietary advice in normal pregnancy: The PREGGIO study. Obes Res Clin Pract 2013. [DOI: 10.1016/j.orcp.2013.12.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
| | | | | | - Glynis P. Ross
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Abstract
This review critically evaluates the current evidence regarding the effect of the dietary glycemic index (GI) on pregnancy outcomes in gestational diabetes mellitus (GDM). Current evidence, although limited, consistently supports the advantages of, and has demonstrated no disadvantages of, a low-GI diet. We conclude that pregnant women with GDM are likely to benefit from following a low-GI meal pattern, with no significant side effects, and consideration of the GI should be given when formulating a diet for GDM. However, until larger scale intervention trials are completed, an exclusive low-GI diet should not replace the current recommended diets for GDM from relevant government and health agencies. Further studies that intervene at an earlier stage of pregnancy are required.
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Affiliation(s)
- Jimmy Chun Yu Louie
- School of Health Sciences, Faculty of Health and Behavioral Sciences, The University of Wollongong, Wollongong, NSW, 2522, Australia.
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Abstract
 The aim of this study was to examine the monetary cost of dietary change among pregnant women before and after receiving low glycaemic index (GI) dietary advice. The pregnant women in this study were a subgroup of participants in the Pregnancy and Glycaemic Index Outcomes (PREGGIO) study. Twenty women from the low GI dietary advice group, who had completed their pregnancies, were randomly chosen. All these women had completed three day food records at 12–16 weeks and again around 36 weeks of gestation. Consumer food prices were applied to recorded dietary intake data. The mean ± SD GI of the diet reduced from 55.1 ± 4.3 to 51.6 ± 3.9 (p = 0.003). The daily cost of the diet (AUD) was 9.1 ± 2.7 at enrolment and 9.5 ± 2.1 prior to delivery was not significantly different (p = 0.52). There were also no significant differences in the daily energy intake (p = 0.2) or the daily cost per MJ (p = 0.16). Women were able to follow low GI dietary advice during pregnancy with no significant increase in the daily costs.
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Affiliation(s)
- Jane Cleary
- Department of Nutrition, Wollongong Hospital, Wollongong, NSW 2500, Australia; (S.C.); (M.M.)
- Author to whom correspondence should be addressed; ; Tel.: +61-2-42534547; Fax: +61-2-42534504
| | - Shelly Casey
- Department of Nutrition, Wollongong Hospital, Wollongong, NSW 2500, Australia; (S.C.); (M.M.)
| | - Clare Hofsteede
- School of Health Sciences, University of Wollongong, NSW 2500, Australia;
| | - Robert G. Moses
- Illawarra Diabetes Services, P.O. Box W58, Wollongong, NSW 2500, Australia;
| | - Marianna Milosavljevic
- Department of Nutrition, Wollongong Hospital, Wollongong, NSW 2500, Australia; (S.C.); (M.M.)
| | - Jennie Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW 2006, Australia;
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Abstract
Insulin therapy is essential for optimal glycemic control during pregnancy in women with type 1 diabetes and is frequently required to optimize control in women with type 2 diabetes. Less commonly, women with gestational diabetes mellitus (GDM) require insulin for glycemic control. However, because of its greater prevalence, GDM is the most common reason for insulin use in pregnancy. The most frequently used insulin regimen in pregnancy is a basal/bolus combination of long- and short-acting insulin preparations. There is no evidence base to support one treatment regimen over another. Therapy should be individualized and based on local expertise.
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Affiliation(s)
- Aidan McElduff
- Discipline of Medicine, Sydney University, Sydney, NSW, Australia.
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Affiliation(s)
- Robert G. Moses
- From Diabetes Services, South Eastern Sydney and Illawarra Area Health Service, Wollongong, New South Wales, Australia
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Affiliation(s)
- Denice S. Feig
- From the Department of Medicine, University of Toronto, Toronto, Ontario, Canada; the
- Division of Endocrinology, Mount Sinai Hospital, Toronto, Ontario, Canada; the
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; the
| | - Robert G. Moses
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; and the
- University of Wollongong, Wollongong, New South Wales, Australia
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Affiliation(s)
- C. Andrew Combs
- From the Obstetrix Medical Group, San Jose, California; and the
| | - Robert G. Moses
- Diabetes Services, Wollongong Hospital, Wollongong, New South Wales, Australia
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Moses RG, Morris GJ, Petocz P, San Gil F, Garg D. The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011; 194:338-40. [DOI: 10.5694/j.1326-5377.2011.tb03001.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/16/2011] [Indexed: 11/17/2022]
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Moses RG, Brand-Miller JC. The use of a low glycaemic index diet in pregnancy: an evolving treatment paradigm. Diabetes Res Clin Pract 2011; 91:13-4. [PMID: 21109323 DOI: 10.1016/j.diabres.2010.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
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Abstract
Type 2 diabetes is a progressive disease associated with high levels of morbidity and mortality and for which there is both a large and growing prevalence worldwide. Lifestyle advice plus metformin is commonly recommended initially to manage hyperglycemia and to minimize the risk of vascular complications. However, additional agents are required when glycemic targets cannot be achieved or maintained due to the progressive nature of the disease. Repaglinide/metformin fixed-dose combination (FDC) therapy (PrandiMet(®); Novo Nordisk, Bagsværd, Denmark) has been approved for use in the USA. This FDC is a rational second-line therapy given the complementary mechanisms of action of the components. Repaglinide is a rapidly absorbed, short-acting insulin secretagogue targeting postprandial glucose excursions; metformin is an insulin sensitizer with a longer duration of action that principally regulates basal glucose levels. A pivotal, 26-week, randomized study with repaglinide/metformin FDC therapy has been conducted in patients experiencing suboptimal control with previous oral antidiabetes therapy. Repaglinide/metformin FDC improved glycemic control and weight neutrality without adverse effects on lipid profiles. There were no major hypoglycemic episodes and patients expressed greater satisfaction with repaglinide/metformin FDC than previous treatments. Repaglinide/metformin FDC is expected to be more convenient than individual tablets for patients taking repaglinide and metformin in loose combination, and it is expected to improve glycemic control in patients for whom meglitinide or metformin monotherapies provide inadequate control.
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Affiliation(s)
- Robert G Moses
- Correspondence: Robert Moses, Director of the Illawarra Diabetes Service, Principal Investigator, Clinical Trials and Research Unit, South East Sydney and Illawarra Area Health Service, New South Wales, Australia, Tel +61 (02) 4231 1952, Fax +61 (02) 4225 9452, Email
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Abstract
In patients with Type 2 diabetes mellitus (T2DM), adequate glycemic control is a critical factor in reducing long-term micro- and macro-vascular complications. Traditionally, the approach is to initiate monotherapy first, followed by combination therapy that targets two main defects in T2DM. Repaglinide, a rapidly acting insulin secretagog, stimulates insulin secretion via closure of ATP-dependent potassium channels on the cell membrane of β-cells. Repaglinide is ideally used at mealtime to reduce postprandial glucose levels, thus lowering the 24-h blood glucose profile and improving HbA1c levels. Metformin is an insulin sensitizer that effectively acts against insulin resistance, one of the predominant metabolic defects in T2DM. A combination of repaglinide and metformin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. When monotherapy with oral antidiabetic agents fails, combination therapy with repaglinide plus metformin has been demonstrated to be safe and effective in the treatment of T2DM.
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Affiliation(s)
- Robert G Moses
- a Clinical Trial and Research Unit, South Eastern Sydney and Illawarra Area Health Service, PO Box W58, Wollongong West, NSW, 2500, Australia.
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