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Mody R, Valentine WJ, Hoog M, Sharland H, Belger M. Tirzepatide 10 and 15 mg vs semaglutide 2.0 mg: A long-term cost-effectiveness analysis in patients with type 2 diabetes in the United States. J Manag Care Spec Pharm 2024; 30:153-162. [PMID: 38308628 PMCID: PMC10839462 DOI: 10.18553/jmcp.2024.30.2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
BACKGROUND Tirzepatide is a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for type 2 diabetes (T2D) treatment. OBJECTIVE To compare the long-term cost-effectiveness of tirzepatide 10 mg and 15 mg vs semaglutide 2.0 mg, an injectable glucagon-like peptide-1 receptor agonist, in patients with T2D from a US health care payer perspective. METHODS The PRIME T2D Model was used to project clinical and cost outcomes over a 50-year time horizon. Baseline cohort characteristics and treatment effects were sourced from a published adjusted indirect treatment comparison that used data from the SURPASS-2 and SUSTAIN FORTE trials. Patients were assumed to intensify to insulin therapy at a hemoglobin A1c of greater than 7.5%. Costs and health state utilities were derived from published sources. Future costs and clinical benefits were discounted at 3% annually. RESULTS Tirzepatide 10 mg and 15 mg were associated with improved quality-adjusted life-expectancy (10 mg: 0.085 quality-adjusted life-years [QALYs], 15 mg: 0.121 QALYs), higher direct costs (10 mg: USD 5,990, 15 mg: USD 6,617), and incremental cost-effectiveness ratios of USD 70,147 and 54,699 per QALY gained, respectively, vs semaglutide 2.0 mg. Both doses of tirzepatide remained cost-effective vs semaglutide 2.0 mg over a range of sensitivity analyses. CONCLUSIONS Long-term projections using the PRIME T2D model and based on treatment effects from an adjusted indirect treatment comparison indicate that tirzepatide 10 mg and 15 mg are likely to be cost-effective vs semaglutide 2.0 mg for the treatment of T2D in the United States.
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Affiliation(s)
| | | | | | - Helen Sharland
- Ossian Health Economics and Communications GmbH, Basel, Switzerland
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Lubaki JPF, Omole OB, Francis JM. Consensus on potential interventions for improving glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a Delphi study. Glob Health Action 2023; 16:2247894. [PMID: 37622241 PMCID: PMC10461491 DOI: 10.1080/16549716.2023.2247894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Poor glycaemic control is a multifactorial and complex problem with dire clinical and economic implications. In the Democratic Republic of the Congo, recent studies have shown alarming poor control rates. There is no policy framework to guide corrective actions. OBJECTIVES To build a consensus on interventions to improve glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo. METHODS This was a two-round electronic Delphi study involving 31 local and 5 international experts. The experts rated proposed interventions from previous studies on glycaemic control in sub-Saharan Africa and Kinshasa on a 4-Likert scale questionnaire. Additionally, the experts were asked to suggest other recommendations useful for the purpose. The mode, mean and standard deviation of each statement were calculated for each round. RESULTS Participants reached consensus in five domains that included 39 statements on how to improve glycaemic control in Kinshasa: strengthening the health system, enhancing the awareness of diabetes, alleviating the financial burden of diabetes, enhancing the adoption of lifestyle modifications, and reducing the proportion of undiagnosed diabetes. CONCLUSIONS Improved glycaemic control needs to be considered within the broader framework of managing noncommunicable diseases in a more integrated, coordinated and better financed healthcare system. Further studies are needed to operationalise the interventions identified for successful implementation.
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Affiliation(s)
- Jean-Pierre Fina Lubaki
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Family Medicine and Primary Care, Protestant University of the Congo, Kinshasa, Democratic Republic of the Congo
| | - Olufemi Babatunde Omole
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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3
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Lubaki JPF, Francis JM, Omole OB. Perspectives for glycaemic control in type 2 diabetes in Kinshasa, Democratic Republic of the Congo. Health Promot Int 2023; 38:daad128. [PMID: 37815062 PMCID: PMC10563016 DOI: 10.1093/heapro/daad128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Glycaemic control is a significant problem in the Democratic Republic of the Congo (DRC), the perspectives associated with glycaemic control are not fully known as previous studies rarely explored patients' perspectives and lived experiences. This qualitative study described the perspectives regarding glycaemic control among persons with type 2 diabetes in Kinshasa, DRC. A total of 23 participants were purposively selected in seven health centres in Kinshasa. In-depth interviews were used for data collection. The study used a phenomenology approach, and deductive, constructionist and thematic analysis. Data analysis was performed using the MAXQDA 2022. Five themes were identified as perspectives for glycaemic control in Kinshasa: financial constraints, limited social and relational support, difficulties with lifestyle changes, beliefs and practices about diabetes and ability to adapt for caring for the illness. Themes were integrated using social cognitive theory. Participants expressed that they were unable to achieve better glycaemic control due to financial constraints, limited social and relational support and difficulty in changing their lifestyle. Their beliefs and practices about diabetes also constituted a barrier. Our results showed that lack of adequate funding is a major determinant of glycaemic control and therefore it is crucial to integrate a consistent and reliable funding system for care of people living with diabetes. Persons with diabetes must be empowered to successfully adapt to the requirements of diabetes care. In this process, support for people living with type 2 diabetes is also essential and should involve their families as well as healthcare providers.
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Affiliation(s)
- Jean-Pierre Fina Lubaki
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Phillip V Tobias Health Sciences Building, 29 Princess of Wales, Parktown, Johannesburg 2193, South Africa
- Department of Family Medicine and Primary Care,Protestant University of Congo, Croisement des Avenues Libération et Triomphale, Commune de Lingwala, Kinshasa, Democratic Republic of the Congo
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care,University of the Witwatersrand, Phillip V Tobias Health Sciences Building, 29 Princess of Wales, Parktown, Johannesburg 2193, South Africa
| | - Olufemi Babatunde Omole
- Department of Family Medicine and Primary Care,University of the Witwatersrand, Phillip V Tobias Health Sciences Building, 29 Princess of Wales, Parktown, Johannesburg 2193, South Africa
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Morales J, Handelsman Y. Cardiovascular Outcomes in Patients With Diabetes and Kidney Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:161-170. [PMID: 37407115 DOI: 10.1016/j.jacc.2023.04.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 07/07/2023]
Abstract
Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a significant inter-relationship in patients with diabetes. Controlling blood pressure, dyslipidemia, and glucose levels is a common treatment approach to managing CVD risk in patients with CKD and diabetes; despite strict control, however, a high residual risk remains. This review focuses on patients who require pharmacotherapy, in whom new and existing cardiorenal therapies (renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists) with differing mechanisms of action and safety profiles can reduce cardiovascular risk beyond the outcomes achieved with blood pressure, dyslipidemia, or glycemic control alone. Several treatment guidelines have been updated recently to reflect new evidence. Studies of these cardiorenal agents used in combination are ongoing, and results are awaited with interest, with the hope that potential synergistic effects may lead to further improvements in cardiovascular outcomes.
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Affiliation(s)
- Javier Morales
- Department of Medicine, Donald and Barbara Zucker School of Medicine, Hofstra University, Hempstead, New York, USA.
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Zwane J, Modjadji P, Madiba S, Moropeng L, Mokgalaboni K, Mphekgwana PM, Kengne AP, Mchiza ZJR. Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105887. [PMID: 37239611 DOI: 10.3390/ijerph20105887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34-0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69-4.77 and White: AOR = 3.84, 95% CI: 1.46-10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13-10.29], social support [average: AOR = 2.51, 95% CI: 1.05-6.00 and good: AOR = 4.49, 95% CI: 1.61-7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10-0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33-0.10 and good: AOR = 1.86, 95% CI: 0.71-4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47-5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.
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Affiliation(s)
- Janke Zwane
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Lucky Moropeng
- Faculty of Health Sciences, School of Health Systems and Public Health Care Sciences, University of Pretoria, 31 Bophelo Road, Gezina 0031, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida 1710, South Africa
| | - Peter Modupi Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Zandile June-Rose Mchiza
- Non-Communicable Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
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Lim LL, Chow E, Chan JCN. Cardiorenal diseases in type 2 diabetes mellitus: clinical trials and real-world practice. Nat Rev Endocrinol 2023; 19:151-163. [PMID: 36446898 DOI: 10.1038/s41574-022-00776-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/30/2022]
Abstract
Patients with type 2 diabetes mellitus (T2DM) can have multiple comorbidities and premature mortality due to atherosclerotic cardiovascular disease, hospitalization with heart failure and/or chronic kidney disease. Traditional drugs that lower glucose, such as metformin, or that treat high blood pressure and blood levels of lipids, such as renin-angiotensin-system inhibitors and statins, have organ-protective effects in patients with T2DM. Amongst patients with T2DM treated with these traditional drugs, randomized clinical trials have confirmed the additional cardiorenal benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor agonists (GLP1RA) and nonsteroidal mineralocorticoid receptor antagonists. The cardiorenal benefits of SGLT2i extended to patients with heart failure and/or chronic kidney disease without T2DM, whereas incretin-based therapy (such as GLP1RA) reduced cardiovascular events in patients with obesity and T2DM. However, considerable care gaps exist owing to insufficient detection, therapeutic inertia and poor adherence to these life-saving medications. In this Review, we discuss the complex interconnections of cardiorenal-metabolic diseases and strategies to implement evidence-based practice. Furthermore, we consider the need to conduct clinical trials combined with registers in specific patient segments to evaluate existing and emerging therapies to address unmet needs in T2DM.
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Affiliation(s)
- Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
- Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
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Valentine WJ, Hoog M, Mody R, Belger M, Pollock R. Long-term cost-effectiveness analysis of tirzepatide versus semaglutide 1.0 mg for the management of type 2 diabetes in the United States. Diabetes Obes Metab 2023; 25:1292-1300. [PMID: 36655340 DOI: 10.1111/dom.14979] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the long-term cost-effectiveness of tirzepatide (5, 10 and 15 mg doses), a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, versus semaglutide 1.0 mg, an injectable glucagon-like peptide-1 receptor agonist, based on the results of the head-to-head SURPASS-2 trial, from a US healthcare payer perspective. MATERIALS AND METHODS The PRIME Type 2 Diabetes Model was used to make projections of clinical and cost outcomes over a 50-year time horizon. Baseline cohort characteristics, treatment effects and adverse event rates were derived from the 40-week SURPASS-2 trial. Intensification to insulin therapy occurred when HbA1c reached 7.5%, in line with American Diabetes Association recommendations. Direct costs in 2021 US dollars (US$) and health state utilities were derived from published sources. Future costs and clinical benefits were discounted at 3% annually. RESULTS All three doses of tirzepatide were associated with lower diabetes-related complication rates, improved life expectancy, improved quality-adjusted life expectancy and higher direct costs versus semaglutide. This resulted in incremental cost-effectiveness ratios of US$ 75 803, 58 908 and 48 785 per quality-adjusted life year gained for tirzepatide 5, 10 and 15 mg, respectively, versus semaglutide. Tirzepatide remained cost-effective versus semaglutide over a range of sensitivity analyses. CONCLUSIONS Long-term projections based on the SURPASS-2 trial results indicate that 5, 10 and 15 mg doses of tirzepatide are likely to be cost-effective versus semaglutide 1.0 mg for the treatment of type 2 diabetes in the United States.
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Affiliation(s)
| | | | - Reema Mody
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Fina Lubaki JP, Omole OB, Francis JM. Protocol: Developing a framework to improve glycaemic control among patients with type 2 diabetes mellitus in Kinshasa, Democratic Republic of the Congo. PLoS One 2022; 17:e0268177. [PMID: 36156594 PMCID: PMC9512168 DOI: 10.1371/journal.pone.0268177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/25/2022] [Indexed: 12/05/2022] Open
Abstract
In Kinshasa, Democratic Republic of the Congo (DRC), between 68–86% of patients with type 2 diabetes present with poor glycaemic control leading to increased risk of complications and high cost of care. Identifying the factors driving glycaemic control is essential for better management. There is lack of data on factors associated with poor glycaemic control and targeted interventions in the DRC. This study aims to determine the factors associated with type 2 diabetes control and develop an appropriate intervention package in Kinshasa. The study will comprise of three sub-studies as follows: the first sub-study being a concurrent parallel mixed-methods cross-sectional study to determine factors driving poor glycaemic control among patients in Kinshasa. A total of 614 patients will be invited to participate in a cross-sectional study and respond to standardized questionnaires. A minimum of 20 purposively selected patients will participate in the qualitative study that will involve in-depth interviews about their perspectives on glycaemic control. In the quantitative study, multivariable logistic regression will be performed to determine factors associated with glycaemic control, after identifying the confounding factors. In the qualitative study, thematic analysis will be performed. Findings of the quantitative and qualitative studies on factors that are associated with glycaemic control will be triangulated. And allow to conduct the second sub-study, a qualitative inquiry with a minimum of 20 healthcare providers and 20 patients, selected purposively, to explore their perspectives about potential interventions to improve glycaemic control. At the last, the findings of both sub-studies will be subjected to an anonymous electronic three-round process Delphi study involving 25 stakeholders on the intervention package to develop a framework to optimise glycaemic control in Kinshasa. The implementation of the intervention package will occur after the completion of this study with expected substantial impact on the patients, healthcare providers, and health system.
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Affiliation(s)
- Jean-Pierre Fina Lubaki
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
- Department of Family Medicine and Primary Healthcare, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo
- * E-mail:
| | - Olufemi Babatunde Omole
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Fina Lubaki JP, Omole OB, Francis JM. Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis. Diabetol Metab Syndr 2022; 14:134. [PMID: 36127712 PMCID: PMC9487067 DOI: 10.1186/s13098-022-00902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo. METHODS We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2. RESULTS A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control. CONCLUSION Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.
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Affiliation(s)
- Jean-Pierre Fina Lubaki
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Family Medicine and Primary Care, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo.
| | - Olufemi Babatunde Omole
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Trabucco Aurilio M, Maiorino MI, Mennini FS, Scappaticcio L, Longo M, Nardone C, Coppeta L, Gazzillo S, Migliorini R, Bellastella G, Giugliano D, Esposito K. Applications for social security benefits related to diabetes in the working age in Italy between 2009 and 2019: a nationwide retrospective cohort study. BMJ Open 2022; 12:e057825. [PMID: 35613811 PMCID: PMC9174764 DOI: 10.1136/bmjopen-2021-057825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study is to estimate the average number of claims for social security benefits from workers with diabetes-related disability. DESIGN Nationwide retrospective cohort study. SETTING The database of the Italian Social Security Institute (INPS) was used to analyse the trends and the breakdown of all claims for social security benefit with diabetes as primary diagnosis from 2009 to 2019. PARTICIPANTS We selected all the applications with the 250.xx International Classification of Diseases, Ninth Revision-CM diagnosis code from 2009 to 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The ratio between accepted or rejected claims for both ordinary incapacity benefit (OIB) and disability pension (DP) and total submitted claims over a 10-year period was computed. RESULTS From 2009 to 2019, 40 800 applications for social security benefits were filed with diabetes as the principal diagnosis, with an annual increase of 30% per year. Throughout the study decade, there was a higher rate of rejected (67.2%) than accepted (32.8%) applications. Among the accepted requests, most of them (30.7%) were recognised as OIB and the remaining 2.1% were recognised as DP. When related to the total number of claims presented per year, there was a 8.8% decrease of rejected applications, associated with a 20.6% increase of overall acceptance rate. In terms of time trends, the overall rise of submitted requests from 2009 to 2019 resulted in an increase in both rejected (+18%) and accepted (+61% for OIB, +11% for DP) applications. The higher rate of accepted requests was for workers aged 51-60 years, with 52% of admitted applications. CONCLUSIONS Between 2009 and 2019, the number of applications for social security benefits due to diabetes in Italy increased significantly, and so did the number of applications approved, mainly represented by the OIBs.
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Affiliation(s)
- Marco Trabucco Aurilio
- Office of Medical Forensic Coordination, Italian National Social Security Institute (INPS), Rome, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, Division of Endocrinology and Metabolic Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Saverio Mennini
- CEIS-Economic Evaluation and HTA (EEHTA), Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
- Department of Accounting and Finance, Kingston University, Kingston, UK
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, Division of Endocrinology and Metabolic Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Miriam Longo
- Department of Advanced Medical and Surgical Sciences, Division of Endocrinology and Metabolic Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Claudia Nardone
- CEIS-Economic Evaluation and HTA (EEHTA), Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Luca Coppeta
- Department of Occupational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simone Gazzillo
- CEIS-Economic Evaluation and HTA (EEHTA), Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Raffaele Migliorini
- Office of Medical Forensic Coordination, Italian National Social Security Institute (INPS), Rome, Italy
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, Division of Endocrinology and Metabolic Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dario Giugliano
- Department of Advanced Medical and Surgical Sciences, Division of Endocrinology and Metabolic Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, Division of Endocrinology and Metabolic Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
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Narcisse DI, Katzenberger DR, Gutierrez JA. Contemporary Medical Therapies for Patients with Peripheral Artery Disease and Concomitant Type 2 Diabetes Mellitus: a Review of Current Evidence. Curr Cardiol Rep 2022; 24:567-576. [PMID: 35201560 DOI: 10.1007/s11886-022-01677-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the evidence behind landmark trials involving these two novel drug classes in conjunction with a review of long-standing therapies used to improve cardiovascular (CV) outcomes among patients with peripheral artery disease (PAD) patients and type 2 diabetes mellitus (T2DM). RECENT FINDINGS Recently, societal guideline recommendations have expanded the management of T2DM to incorporate therapies with CV risk factor modification. This is due to CV outcome trials (CVOT) uncovering advantageous cardioprotective effects of several novel therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Providers who manage high-risk patients with T2DM, such as those with concomitant PAD, are expected to incorporate these novel medical therapies into routine patient care. The body of evidence surrounding GLP-1 RA demonstrates a strong benefit in mitigating the innate heightened CV risk among patients with T2DM. Furthermore, SGLT2i not only have a favorable CV profile but also reduce the risk of HF hospitalizations and progression of renal disease. Patients with T2DM and PAD are known to be at a heightened risk for major adverse cardiac and lower extremity events, heart failure, and chronic kidney disease. As such, the use of novel therapies such as GLP-RA and SGLT2i should be strongly considered to minimize morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Dennis I Narcisse
- Division of Cardiology, Duke University Health System, Durham, NC, USA.
| | | | - J Antonio Gutierrez
- Division of Cardiology, Duke University Health System, Durham, NC, USA
- Section of Cardiology, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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12
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Empagliflozin Alleviates Left Ventricle Hypertrophy in High-Fat-Fed Mice by Modulating Renin Angiotensin Pathway. J Renin Angiotensin Aldosterone Syst 2022; 2022:8861911. [PMID: 35111238 PMCID: PMC8789460 DOI: 10.1155/2022/8861911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 12/13/2022] Open
Abstract
Aims. The cardiobenefits of empagliflozin are multidimensional, and some mechanisms are still unclear. The aim of the present study was to evaluate the effect of treatment with empagliflozin on biometric parameters and gene expression in the local cardiac RAS, oxidative stress, and endoplasmic reticulum pathways in a mouse model. Main Methods. Forty male C57BL/6 mice were fed with control (C) or high-fat (HF) diets for 10 weeks. After that, the groups were redistributed according to the treatment with empagliflozin—CE or HFE. The empagliflozin was administered via food for 5 weeks (10 mg/kg/day). We performed biochemical analyses, blood pressure monitoring, oral glucose tolerance test, left ventricle (LV) stereology, RT-qPCR for genes related to classical and counterregulatory local RAS, oxidative stress, and endoplasmic reticulum stress. Key Findings. In comparison to HF, HFE decreased body mass and improved glucose intolerance and insulin resistance. The cardiac parameters were enhanced after treatment as expressed by decrease in plasma cholesterol, plasma uric acid, and systolic blood pressure. In addition, LV analysis showed that empagliflozin reduces cardiomyocyte area and LV thickness. The local RAS had less activity of the classical pathway and positive effects on the counterregulatory pathway. Empagliflozin treatment also decreased oxidative stress and endoplasmic reticulum stress-related genes. Significance. Our results suggests that empagliflozin modulates the local RAS pathway towards alleviation of oxidative stress and ER stress in the LV, which may be a route to its effects on improved cardiac remodeling.
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Huang J, Ding S, Xiong S, Liu Z. Medication Adherence and Associated Factors in Patients With Type 2 Diabetes: A Structural Equation Model. Front Public Health 2021; 9:730845. [PMID: 34805063 PMCID: PMC8599446 DOI: 10.3389/fpubh.2021.730845] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background: The number of patients with type 2 diabetes (T2D) is increasing. Medication treatment is of great importance to stabilize blood glucose. Previous studies have reported that neuroticism, self-efficacy, and social support are factors associated with medication adherence, but few studies have fully investigated the mechanisms between these factors and medication adherence in patients with T2D. Purpose: To explore the prevalence of medication adherence and the factors associated with medication adherence in patients with T2D. Methods: A cross-sectional study consisting of 483 patients with T2D was conducted from July to December 2020. Questionnaires containing sociodemographic and clinical characteristics, the Morisky Medication Adherence Scale-8 (MMAS-8), the neuroticism subscale of the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Diabetes Management Self-efficacy Scale (DMSES) were used to collect data. The structural equation model (SEM) was used to test the hypotheses. Results: This study included 305 (63.1%) medication adherence and 178 (36.9%) medication non-adherence patients with T2D. Social support directly influenced medication adherence (β = 0.115, P = 0.029) and indirectly influenced medication adherence through self-efficacy (β = 0.044, P = 0.016). Self-efficacy directly influenced medication adherence (β = 0.139, P = 0.023). Neuroticism indirectly affected medication adherence through social support (β = -0.027, P = 0.023) and self-efficacy (β = -0.019, P = 0.014). Moreover, there was a sequential mediating effect of social support and self-efficacy on the relationship between neuroticism and medication adherence (β = -0.010, P = 0.012). After controlling for age and gender, similar results were obtained. The model fit indices showed a good fit. Conclusions: The medication adherence of patients with T2D needs to be improved. Neuroticism, social support, and self-efficacy had direct or indirect effects on medication adherence in patients with T2D. Healthcare providers should comprehensively develop intervention programs based on neuroticism, social support, and self-efficacy to improve medication adherence in patients with T2D.
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Affiliation(s)
- Jing Huang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shenglan Ding
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuyuan Xiong
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiping Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Amatruda M, Gembillo G, Giuffrida AE, Santoro D, Conti G. The Aggressive Diabetic Kidney Disease in Youth-Onset Type 2 Diabetes: Pathogenetic Mechanisms and Potential Therapies. ACTA ACUST UNITED AC 2021; 57:medicina57090868. [PMID: 34577791 PMCID: PMC8467670 DOI: 10.3390/medicina57090868] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023]
Abstract
Youth-onset Type 2 Diabetes Mellitus (T2DM) represents a major burden worldwide. In the last decades, the prevalence of T2DM became higher than that of Type 1 Diabetes Mellitus (T1DM), helped by the increasing rate of childhood obesity. The highest prevalence rates of youth-onset T2DM are recorded in China (520 cases/100,000) and in the United States (212 cases/100,000), and the numbers are still increasing. T2DM young people present a strong hereditary component, often unmasked by social and environmental risk factors. These patients are affected by multiple coexisting risk factors, including obesity, hyperglycemia, dyslipidemia, insulin resistance, hypertension, and inflammation. Juvenile T2DM nephropathy occurs earlier in life compared to T1DM-related nephropathy in children or T2DM-related nephropathy in adult. Diabetic kidney disease (DKD) is T2DM major long term microvascular complication. This review summarizes the main mechanisms involved in the pathogenesis of the DKD in young population and the recent evolution of treatment, in order to reduce the risk of DKD progression.
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Affiliation(s)
- Michela Amatruda
- Unit of Pediatric Nephrology with Dialysis, AOU Policlinic G Martino, University of Messina, 98125 Messina, Italy;
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (A.E.G.); (D.S.)
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, 98125 Messina, Italy
| | - Alfio Edoardo Giuffrida
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (A.E.G.); (D.S.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (A.E.G.); (D.S.)
| | - Giovanni Conti
- Unit of Pediatric Nephrology with Dialysis, AOU Policlinic G Martino, University of Messina, 98125 Messina, Italy;
- Correspondence:
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Gebrie D, Manyazewal T, A Ejigu D, Makonnen E. Metformin-Insulin versus Metformin-Sulfonylurea Combination Therapies in Type 2 Diabetes: A Comparative Study of Glycemic Control and Risk of Cardiovascular Diseases in Addis Ababa, Ethiopia. Diabetes Metab Syndr Obes 2021; 14:3345-3359. [PMID: 34335036 PMCID: PMC8317933 DOI: 10.2147/dmso.s312997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study aimed to compare glycemic control and risk of cardiovascular outcomes of metformin-insulin versus metformin-sulfonylurea combination therapies in type 2 diabetes mellitus. METHODS We conducted a comparative cross-sectional study in five tertiary level hospitals in Addis Ababa, Ethiopia. We enrolled 321 patients with type 2 diabetes mellitus who were on continuous treatment follow-up on either metformin-insulin or metformin-sulfonylurea combination therapy. We interviewed the participants and reviewed their medical records to investigate medication efficacy, safety, and adherence. The primary outcome measure was glycemic control and the secondary outcome measures were composite cardiovascular outcomes. RESULTS Of the total participants enrolled, 50.5% (n = 162) were those who received metformin-insulin and 49.5% (n = 159) metformin-sulfonylurea combination therapies for a median of 48 months follow-up. The reduction of Hb1Ac levels was comparable between the metformin-insulin (-1.04 ± 0.96%) and metformin-sulfonylurea (-1.02 ± 1.03%), p = 0.912. Patients who received metformin-sulfonylurea had 4.3 times more likely to have achieved target HbA1c level compared to those who received metformin-insulin, p < 0.001, adjusted odds ratio (AOR) with 95% CI = 4.31[1.79-10.32]. Risk of composite cardiovascular outcomes was higher in metformin-insulin group (40.5% versus 34.0%), p = 0.021. Co-morbidities, body mass index, systolic blood pressure, and HbA1c had a significant association with composite cardiovascular outcomes. Reductions of bodyweight, HDL-C, LDL-C, triglycerides levels, and microvascular complications were different between the two groups, p < 0.05. CONCLUSION High proportion of patients who received metformin-sulfonylurea achieved target HbA1c level and had less composite cardiovascular outcomes compared to those who received metformin-insulin. However, these findings have to be confirmed with randomized control trials to determine risks associated with insulin use, while efficacy is maintained as second-line treatment in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Desye Gebrie
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dawit A Ejigu
- Department of Pharmacology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ino J, Kasama E, Kodama M, Sato K, Eizumi H, Kawashima Y, Sekiguchi M, Fujiwara T, Yamazaki A, Suzuki C, Ina S, Okuma A, Nitta K. Multidisciplinary Team Care Delays the Initiation of Renal Replacement Therapy in Diabetes: A Five-year Prospective, Single-center Study. Intern Med 2021; 60:2017-2026. [PMID: 33518556 PMCID: PMC8313920 DOI: 10.2169/internalmedicine.4927-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Although recent reports have highlighted the benefits of multidisciplinary team care (MTC) for chronic kidney disease (CKD) in slowing the progress of renal insufficiency, its long-term effects have not been evaluated for patients with diabetes mellitus (DM). We compared the renal survival rate between MTC and conservative care (CC). Methods In this five-year, single-center, prospective, observational study, we examined 24 patients (mean age 65.5±12.1 years old, men/women 18/6) with DM-induced CKD stage ≥3 in an MTC clinic. The control group included 24 random patients with DM (mean age 61.0±12.8 years old, men/women 22/2) who received CC. MTC was provided by a nephrologist and medical staff, and CC was provided by a nephrologist. Results In total, 10 MTC and 20 CC patients experienced renal events [creatinine doubling, initiation of renal replacement therapy (RRT), or death due to end-stage CKD]. During the five-year observation period, there were significantly fewer renal events in the MTC group than in the CC group according to the cumulative incidence method (p=0.006). Compared to CC, MTC significantly reduced the need for urgent initiation of hemodialysis (relative risk reduction 0.79, 95% confidence interval [CI] 0.107-0.964). On a multivariate analysis, MTC (hazard ratio [HR], 0.434, 95% CI 0.200-0.939) and the slope of the estimated glomerular filtration rate during the first year (HR, 0.429 per 1 mL/min/m2/year, 95% CI 0.279-0.661) were negatively associated with renal events. Conclusion MTC for DM-induced CKD is an effective strategy for delaying RRT. Long-term MTC can demonstrate reno-protective effects.
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Affiliation(s)
- Jun Ino
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Eri Kasama
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Mio Kodama
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Keitaro Sato
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Hitoshi Eizumi
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Youichiro Kawashima
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Maki Sekiguchi
- Department of Nursing, Kidney Center, Toda Central General Hospital, Japan
| | - Tomoko Fujiwara
- Department of Nutrition, Toda Central General Hospital, Japan
| | - Aya Yamazaki
- Department of Nutrition, Toda Central General Hospital, Japan
| | - Chie Suzuki
- Department of Pharmacy, Toda Central General Hospital, Japan
| | - Shuji Ina
- Department of Pharmacy, Toda Central General Hospital, Japan
| | - Astushi Okuma
- Department of Rehabilitation, Toda Central General Hospital, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Japan
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Sia HK, Kor CT, Tu ST, Liao PY, Chang YC. Predictors of treatment failure during the first year in newly diagnosed type 2 diabetes patients: a retrospective, observational study. PeerJ 2021; 9:e11005. [PMID: 33717708 PMCID: PMC7934644 DOI: 10.7717/peerj.11005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background Diabetes patients who fail to achieve early glycemic control may increase the future risk of complications and mortality. The aim of the study was to identify factors that predict treatment failure (TF) during the first year in adults with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study conducted at a medical center in Taiwan enrolled 4,282 eligible patients with newly diagnosed T2DM between 2002 and 2017. Data were collected from electronic medical records. TF was defined as the HbA1c value >7% at the end of 1-year observation. A subgroup analysis of 2,392 patients with baseline HbA1c ≥8% was performed. Multivariable logistic regression analysis using backward elimination was applied to establish prediction models. Results Of all study participants, 1,439 (33.6%) were classified as TF during the first year. For every 1% increase in baseline HbA1c, the risk of TF was 1.17 (95% CI 1.15–1.20) times higher. Patients with baseline HbA1c ≥8% had a higher rate of TF than those with HbA1c <8% (42.0 vs 23.0%, p < 0.001). Medication adherence, self-monitoring of blood glucose (SMBG), regular exercise, gender (men), non-insulin treatment, and enrollment during 2010–2017 predicted a significant lower risk of TF in both of the primary and subgroup models. Conclusions Newly diagnosed diabetes patients with baseline HbA1c ≥8% did have a much higher rate of TF during the first year. Subgroup analysis for them highlights the important predictors of TF, including medication adherence, performing SMBG, regular exercise, and gender, in achieving glycemic control.
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Affiliation(s)
- Hon-Ke Sia
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Healthcare Administration, Asia University, Taichung City, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Pei-Yung Liao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan
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Zhang ZP, Premikha M, Luo M, Venkataraman K. Diabetes distress and peripheral neuropathy are associated with medication non-adherence in individuals with type 2 diabetes in primary care. Acta Diabetol 2021; 58:309-317. [PMID: 33211180 DOI: 10.1007/s00592-020-01609-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Psychosocial factors like diabetes distress and social support, as well as the presence of complications, affect an individual's self-management ability; however, their role in adherence behaviours is not yet clear. We examined the role of psychosocial factors and complications in non-adherence behaviours in individuals with diabetes in primary care. METHODS Baseline survey with nine-month follow up through medical records of patients with type 2 diabetes attending primary care. Medication adherence and diabetes distress were assessed using Morisky Green Levine Medication Adherence Scale and Problem Areas in Diabetes, respectively. Appointment adherence was assessed through medical records. RESULTS Of the 448 participants studied, 59.8% had medication non-adherence and 21.7% were non-adherent to scheduled appointments. PAID score (odds ratio (OR) 1.01, 95% confidence interval 1.00-1.03, p = 0.013), peripheral neuropathy (OR 1.99, 95%CI 1.18-3.37, p = 0.01), home glucose monitoring (OR 0.46, 95%CI 0.30-0.69, p < 0.001), HbA1c (OR 1.34, 95%CI 1.13-1.61, p = 0.001), and age (OR 0.96, 95%CI 0.93-0.98, p = 0.001) were associated with medication non-adherence. Indian ethnicity (OR 2.93, 95%CI 1.59-5.39, p = 0.001), secondary or higher education (OR 1.94, 95%CI 1.14-3.27, p = 0.014), and HbA1c (OR 1.38, 95%CI 1.18-1.63, p < 0.001) were associated with appointment non-adherence. CONCLUSIONS Non-adherence behaviours were prevalent and significantly associated with higher HbA1c. Medication non-adherence was more likely in younger individuals, those with higher diabetes distress or peripheral neuropathy. Appointment non-adherence was more likely in individuals of Indian ethnicity or those with higher education. Greater support for these groups may help improve adherence behaviours and outcomes.
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Affiliation(s)
| | - M Premikha
- Ministry of Health Holdings Pte Ltd, Singapore, Singapore
| | - Miyang Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 10-03J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, 10-03J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore.
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Abstract
In this commentary, we introduce the concepts of removed and residual risks in conditioning thecardiorenal outlook of patients with type 2 diabetes (T2D). The removed cardiorenal risk represents the risk of progression of CV events (major adverse cardiovascular events, MACE; heart failure, HF) and diabetes kidney disease (DKD) taken away by optimal glycemic control or the use of newer antihyperglycemic drugs (glucagon-like peptide-1 receptor agonists, GLP-1RA, andsodium-glucose transporter-2 inhibitors, SGLT-2i) in patients with T2D, as demonstrated by the results of intensive glucose lowering trials (IGT) and cardiovascular outcome trials (CVOT). IGT have shown that successful glycemic control has modest benefits, as the removed cardiorenal risk ranges from 9% for MACE, to 20% for progression of DKD and to 0% for HF. The removed risk of MACE is 13% for GLP-1RA and 12% for SGLT-2i. However, SGLT-2i, as compared with GLP-1RA, removed twofold more risk (39% vs 17%) for kidney outcomes and fourfold more risk (33% vs 9%) for HF. Dipeptidyl peptidase-4 inhibitors have no clinically important cardiorenal benefits, as residual risk is 99% for MACE, 100% for kidney outcomes (excluding new albuminuria), and 100% for HF. Although the results of some real world, population-based cohort studies suggest the possibility that the cardiorenal protection afforded by newer antihyperglycemic drugs is additive to that of optimal glycemic control, only specific randomized controlled trials could answer this question.
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Giugliano D, Longo M, Scappaticcio L, Caruso P, Esposito K. Sodium-glucose transporter-2 inhibitors for prevention and treatment of cardiorenal complications of type 2 diabetes. Cardiovasc Diabetol 2021; 20:17. [PMID: 33430860 PMCID: PMC7798345 DOI: 10.1186/s12933-021-01213-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
Hospitalization for major diabetes complications, including myocardial infarction, stroke, lower-extremity amputation, and end-stage kidney disease, is on the rise and represents a great health burden for patients with type 2 diabetes (T2D), in particular for older people. Newer glucose-lowering medications have generated some optimism on the possibility to influence the natural history of cardiorenal complications of T2D. This review summarizes work in the area of sodium–glucose cotransporter 2 inhibitors (SGLT-2i) treatment and prevention of cardiorenal complications in patients with T2D (major adverse cardiovascular events, hospitalization for heart failure, kidney outcomes), with a particular emphasis on the effect of age, the role of primary versus secondary prevention and the possible extension of their cardiorenal benefits to the entire class of SGLT-2i.
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Affiliation(s)
- Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Miriam Longo
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Scappaticcio
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Caruso
- Ph.D. of Translational Medicine, Chair of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Reach G, Benarbia L, Bruckert E, Kevorkian JP, Farnier M, Mourad JJ, Vaisse BC. Intentionality in adherence to long-term therapies. Results from an online survey of 3,001 patients with cardio-metabolic pathologies in France. Patient Prefer Adherence 2021; 15:1739-1753. [PMID: 34408407 PMCID: PMC8366034 DOI: 10.2147/ppa.s318116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Some patients make a rational choice not to follow medical prescriptions; others fail to take their medications for reasons beyond their control, such as mere forgetfulness or a weak medication routine. The aim of this study was to elucidate the functioning of patient intentionality in medication adherence. PATIENTS AND METHODS This online study was conducted in metropolitan France in 2019. A cross-sectional survey of 50 questions was conducted with 3001 respondents diagnosed with diabetes, hypertension, and/or hypercholesterolemia identified from a panel of 54,000 people. These questions included a validated six-item questionnaire to detect nonadherence, two questions to detect intentional nonadherence by patients, and three questions on the effects of habit. Our questionnaire also included questions on the feelings of respondents regarding their doctor's attitude to their problems and needs, their trust in general practitioners (GP) and specialists, their sense of being involved in treatment decisions, and the influence of side effects and habits on patients' adherence. This study used the strategy of focusing on strictly adherent patients in the hope of finding ways to improve adherence. For this reason, we defined adherence as the absence of a positive response to the 6-item nonadherence screening questionnaire. RESULTS Of 3001 respondents, 1804 were diagnosed with hypertension, 1458 with hypercholesterolemia, and 774 with diabetes. Of the total number of patients, 72% were afflicted with one disease, 21% with two ailments, and 7% with three simultaneous illnesses. One-third (33%) of the patients did not tender a positive answer to the adherence questionnaire and were deemed adherent. 1) Thirty-two percent of the patients reported occasionally omitting their medication deliberately, and 84% said they had a reason for missing doses. These statements suggesting intentional nonadherence were negatively associated with adherence as identified via multivariate analysis (P = 0.0012 and P < 0.0001, for the first and second statement, respectively). 2) Univariate analyses revealed strong associations (P < 0.0001) between strict adherence on one hand and lack of intentional nonadherence, patient age, absence of drug side effects, taking drugs by habit, feeling involved in treatment decisions, getting information about treatment, and disease, and trust in doctors, on the other hand. 3) Specifically, univariate analysis of the absence of reported side effects revealed strong associations (P < 0.0001) with adequate information about medicines and diseases and trust in GP. These original data were consistent with the concept of the nocebo effect. 4) We observed a strong association between the absence of intentional nonadherence (statement of never deliberately missing medication) and respondent statements about generally sticking to the routine (P < 0.0001), ie, "I take my medication because I am used to taking it." This important result suggests that patients are strictly adherent in two ways: the absence of intentional nonadherence and reliance on habit, which we term as "unintentional adherence." 5) Finally, a multiple correspondence analysis illustrated all statistically significant relationships found in this study. CONCLUSION We present a new global model of adherence in which patient adherence was improved both by reducing intentional nonadherence and by promoting the abovementioned unintentional adherence by habit. This model highlights the role of shared decision-making and the trust felt by patients in their doctors. These results could exert a major impact on medical practice and education by demonstrating the importance of physicians' attitudes, involving the patient in decisions (shared decision-making), offering information about medicines and diseases (patient education), understanding the problems of patients, and taking their needs into account (empathy). The development of these attitudes should be an important aspect of the medical curricula.
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Affiliation(s)
- Gérard Reach
- Health Education and Practices Laboratory (LEPS), Sorbonne Paris-Nord University, Bobigny, France
- Correspondence: Gérard Reach Health Education and Practices Laboratory (LEPS), Sorbonne Paris-Nord University, 74 rue Marcel Cachin, Bobigny, 93017, FranceTel +33 6 60 84 53 25 Email
| | | | - Eric Bruckert
- Department of Endocrinology and Prevention of Cardiovascular Diseases, Institute of Cardiometabolism and Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Jean-Philippe Kevorkian
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, 75010, France
| | - Michel Farnier
- PEC2, EA 7460, University of Bourgogne Franche-Comté, Dijon, France
- Cardiology Department, University Hospital Centre of Dijon Bourgogne, Dijon, France
| | - Jean-Jacques Mourad
- Department of Internal Medicine and ESH Excellence Centre, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Bernard-Charles Vaisse
- Hypertension Unit -Vascular Medicine, Department of Cardiology, CHU Timone, Marseille, France
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Association of pancreatic fat content with type II diabetes mellitus. Clin Radiol 2019; 75:51-56. [PMID: 31711639 DOI: 10.1016/j.crad.2019.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022]
Abstract
AIM To determine the association between regional fat content in the pancreas and the presence or absence of type II diabetes mellitus (T2DM), the value of regional pancreatic fat quantification in identifying patients at risk of T2DM, and whether pancreatic fat content is associated with glycaemic control in T2DM. MATERIALS AND METHODS A retrospective survey of a radiology database identified 45 patients with T2DM, and 81 "at risk for T2DM" patients who developed diabetes, between 0.6 and 3.7 years after magnetic resonance imaging (MRI). A control group who did not develop diabetes during a 5-year follow-up and without known metabolic syndrome, liver, or pancreatic diseases were also identified. Fat content was measured by placing regions of interest (ROIs) on in-phase and out-of-phase chemical shift MRI images. Multiple clinical parameters including body mass index, cholesterol levels, blood pressure, glycated haemoglobin (HbA1c; in T2DM group) were collected. RESULTS There was a significant difference between the T2DM and control groups for fat fraction in the pancreatic head (p=0.043), body (p=0.015), and tail (p=0.001), but not liver (p=0.107). On regression analysis, only the fat fraction within the pancreatic tail was significantly different between control group and "at risk" for T2DM group (p=0.007). A pancreatic tail fat content of >10% had a sensitivity of 45.5% and specificity of 81.3% for predicting development of T2DM within 4 years. Pancreatic fat content was not associated with glycaemic control. CONCLUSIONS Increased fat in the pancreatic tail may identify patients at risk for T2DM.
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Giugliano D, Chiodini P, Maiorino MI, Bellastella G, Esposito K. Cardiovascular outcome trials and major cardiovascular events: does glucose matter? A systematic review with meta-analysis. J Endocrinol Invest 2019; 42:1165-1169. [PMID: 30955180 DOI: 10.1007/s40618-019-01047-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE We did a meta-analysis with meta-regression to evaluate the relationship between hemoglobin A1c (A1C) reduction and the primary CV outcome of cardiovascular outcome trials (CVOTs). METHODS We used a random effects meta-analysis of the 12 CVOTs to quantify the effect of A1C reduction on major cardiovascular events (MACE) risk by stratifying the difference in achieved A1C (drug vs placebo) in three strata: A1c < 0.3%, A1c ≥ 0.3% and < 0.5%, and A1c ≥ 0.5%. RESULTS We found a relation between the reduction in achieved A1C and the hazard ratio reduction for MACE (P = 0.002), explaining almost all (94.1%) the between-study variances: lowering A1C by 0.5% conferred a significant HRR of 20% (95% CI 4-33%) for MACE. CONCLUSIONS Blood glucose reduction may play a more important role than previously thought in reducing the risk of MACE during treatment with the newer glucose-lowering drugs, including peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors.
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Affiliation(s)
- D Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Piazza L. Miraglia, 80131, Naples, Italy.
| | - P Chiodini
- Medical Statistics Unit, Department of Mental and Physical Health and Preventive Medicine, Università della Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - M I Maiorino
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Piazza L. Miraglia, 80131, Naples, Italy
| | - G Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Piazza L. Miraglia, 80131, Naples, Italy
| | - K Esposito
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Piazza L. Miraglia, 80131, Naples, Italy
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Giugliano D, Maiorino MI, Longo M, Bellastella G, Chiodini P, Esposito K. Type 2 diabetes and risk of heart failure: a systematic review and meta-analysis from cardiovascular outcome trials. Endocrine 2019; 65:15-24. [PMID: 31028667 DOI: 10.1007/s12020-019-01931-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/09/2019] [Indexed: 01/22/2023]
Abstract
AIM We performed a meta-analysis of randomized controlled trials (RCTs) that evaluated the effect of dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium glucose co-transporter-2 inhibitors (SGLT-2i) on heart failure (HF) risk in patients with type 2 diabetes (T2D). METHODS AND RESULTS The electronic search was carried out until 10 November 2018. RCTs were included if they compared add-on therapy with any DPP-4i, GLP-1 RAs, or SGLT-2i with placebo, and included in the outcome hospitalization for HF, and other outcomes required for cardiovascular safety studies. Risk of HF was the primary outcome for this meta-analysis. We used a random-effect model to calculate hazard ratio (HR) and 95% CI. Twelve trials were identified, involving 120,765 patients. Compared with placebo, HF risk showed a non-significant 10% reduction with the newer anti-hyperglycemic drugs (HR = 0.90, 0.80-1.01); use of DPP-4i and GLP-1 RAs was associated with nonsignificant modifications of the HF risk (+5% and -9%, respectively), while the use of SGLT-2i was associated with a significant 31% reduction of the HF risk (HR = 0.69, 0.61-0.79, P < 0.001), with no heterogeneity (I2 = 0%, P = 0.741), suggesting a class effect. The meta-regression analysis of all 12 trials showed no association of reductions of hemoglobin A1C with HF risk. CONCLUSION In T2D, SGLT-2i can reduce the risk of HF that is unrelated to improved glycemic control; DPP-4i and GLP-1 RAs behave as neutral.
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Affiliation(s)
- Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, Università della Campania L. Vanvitelli, Naples, Italy.
| | - Maria Ida Maiorino
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, Università della Campania L. Vanvitelli, Naples, Italy
| | - Miriam Longo
- Medical Statistics Unit, Università della Campania L. Vanvitelli, Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, Università della Campania L. Vanvitelli, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Università della Campania L. Vanvitelli, Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, Università della Campania L. Vanvitelli, Naples, Italy
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25
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Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Esposito K. Glycemic Control, Preexisting Cardiovascular Disease, and Risk of Major Cardiovascular Events in Patients with Type 2 Diabetes Mellitus: Systematic Review With Meta-Analysis of Cardiovascular Outcome Trials and Intensive Glucose Control Trials. J Am Heart Assoc 2019; 8:e012356. [PMID: 31166153 PMCID: PMC6645638 DOI: 10.1161/jaha.119.012356] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The value of glycemic control and preexisting cardiovascular disease in determining the risk of major cardiovascular events (MACE) in type 2 diabetes mellitus is uncertain. Intensive glucose control trials suggest that the 9% lower risk of MACE associated with intensive glycemic control, as compared with conventional glycemic control, is only driven by patients with type 2 diabetes mellitus without cardiovascular disease at baseline. Methods and Results We did a meta‐analysis of cardiovascular outcome trials dividing patients with or without preexisting cardiovascular disease; we found that the lower risk of MACE is confined to patients with cardiovascular disease at baseline. Compared with placebo, the use of both glucagon‐like peptide‐1 receptor agonists and sodium‐glucose cotransporter‐2 inhibitors was associated with a significant 14% lower MACE risk in patients with preexisting cardiovascular disease and with a nonsignificant 2% higher MACE risk in those without preexisting cardiovascular disease (P for interaction=0.021). The meta‐regression analysis of all 12 trials demonstrated a significant (P=0.002) association between reductions of glycated hemoglobin in glycated hemoglobin A1C. Accordingly, the reduction of MACE expected if all cardiovascular outcome trials had achieved a 0.9% glycated hemoglobin reduction would have been 33%. Routine clinical care data complement the results of cardiovascular outcome trials but with some differences: the lower risk of MACE with sodium‐glucose cotransporter‐2 inhibitor use is evident in patients with type 2 diabetes mellitus with or without preexisting cardiovascular disease. Conclusions Sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists should be included in the therapeutic plan of patients with type 2 diabetes mellitus and overt cardiovascular disease, with due attention paid to improvement of glycemic control, which may amplify their benefit on MACE.
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Affiliation(s)
- Dario Giugliano
- 1 Division of Endocrinology and Metabolic Diseases Università della Campania Luigi Vanvitelli Naples Italy
| | | | - Giuseppe Bellastella
- 1 Division of Endocrinology and Metabolic Diseases Università della Campania Luigi Vanvitelli Naples Italy
| | - Paolo Chiodini
- 3 Medical Statistics Unit Università della Campania Luigi Vanvitelli Naples Italy
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Giugliano D, Meier JJ, Esposito K. Heart failure and type 2 diabetes: From cardiovascular outcome trials, with hope. Diabetes Obes Metab 2019; 21:1081-1087. [PMID: 30609236 DOI: 10.1111/dom.13629] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 12/23/2022]
Abstract
An excess risk of heart failure (HF) persists in patients with type 2 diabetes (T2D) despite optimal control of an array of conventional risk factors, including hyperglycaemia. Twelve cardiovascular outcome trials (CVOTs) have been published to date, although none, with the exception of the DECLARE trial with dapagliflozin, has included HF as a primary endpoint. The four trials with dipeptidyl-peptidase inhibitors (DPP-4i) (SAVOR-TIMI 53 with saxagliptin, EXAMINE with alogliptin, TECOS with sitagliptin and CARMELINA with linagliptin) failed to show any significant effect on HF risk in patients with T2D, with the notable exception of saxagliptin which was associated with a 27% increased risk. Five completed CVOTs with the GLP-1 RAs lixisenatide (ELIXA), liraglutide (LEADER), semaglutide (SUSTAIN-6), exenatide once weekly (EXSCEL) and albiglutide (HARMONY) also failed to reveal any significant effect on HF risk. The three trials with sodium glucose co-transporter-2 inhibitors (SGLT-2i) (EMPA-REG OUTCOME with empagliflozin, CANVAS with canagliflozin and DECLARE with dapagliflozin) all revealed a robust and significant reduction in the hazard ratios of hospitalization for HF, from 27% to 35%, which remained consistent, significant and of similar magnitude regardless of the presence of a history of HF or established atherosclerotic cardiovascular disease. There is no association between reductions in HF risk and haemoglobin A1c (A1C) levels, while there is a significant association between reductions in HR for MACE and A1C levels (Spearman's correlation, r = 0.695; P = 0.013). All of the 12 CVOTs completed to date have provided reassurance of the overall cardiovascular safety of the newer anti-hyperglycaemic drugs. At present, the robust, consistent and reproducible reduction of approximately 30% in the risk of HF with SGLT-2i may be considered a class effect. The beneficial effect on MACE outcome observed with the use of some GLP-1RAs and SGLT-2i must be interpreted within the frame of the single trial.
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Affiliation(s)
- Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Juris J Meier
- Diabetes Division, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katherine Esposito
- Diabetes Division, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
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27
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Giugliano D, Maiorino MI, Bellastella G, Esposito K. Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes. J Endocrinol Invest 2019; 42:495-503. [PMID: 30291589 DOI: 10.1007/s40618-018-0951-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/05/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Clinical inertia and medication non-adherence are thought to contribute largely to the suboptimal glycemic control in many patients with type 2 diabetes. The present review explores the relations between A1C targets, clinical inertia and medication non-adherence in type 2 diabetes. METHODS We searched PubMed for English-language studies published from 2001 through June 1, 2018. We also manually searched the references of selected articles, reviews, meta-analyses, and practice guidelines. Selected articles were mutually agreed upon by the authors. RESULTS Clinical inertia is the failure of clinicians to initiate or intensify therapy when indicated, while medication non-adherence is the failure of patients to start or continue therapy that a clinician has recommended. Although clinical inertia may occur at all stages of diabetes treatment, the longest delays were reported for initiation or intensification of insulin. Medication non-adherence to antidiabetic drugs may range from 53 to 65% at 1 year and may be responsible for uncontrolled A1C in about 23% of cases. Reverse clinical inertia can be acknowledged as the failure to reduce or change therapy when no longer needed or indicated. Clinical inertia and medication non-adherence are difficult to address: clinician-and patient-targeted educational programs, more connected communications between clinicians and patients, the help of other health professional figures (nurse, pharmacist) have been explored with mixed results. CONCLUSIONS Both clinical inertia and medication non-adherence remain significant barriers to optimal glycemic targets in type 2 diabetes. Moreover, part of clinical inertia may be a way through which clinicians face current uncertainty in medicine, including some dissonance among therapeutic guidelines. Scientific associations should find an agreement about how to measure and report clinical inertia in clinical practice and should exhort clinicians to consider reverse clinical inertia as a cause of persisting inappropriate therapy in vulnerable patients.
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Affiliation(s)
- D Giugliano
- Division of Endocrinology and Metabolic Diseases, Università della Campania L. Vanvitelli, Piazza L. Miraglia, 2, 80138, Naples, Italy.
| | - M I Maiorino
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Università della Campania L. Vanvitelli, Naples, Italy
| | - G Bellastella
- Division of Endocrinology and Metabolic Diseases, Università della Campania L. Vanvitelli, Piazza L. Miraglia, 2, 80138, Naples, Italy
| | - K Esposito
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Università della Campania L. Vanvitelli, Naples, Italy
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Giugliano D, Maiorino MI, Bellastella G, Esposito K. Dissonance among treatment algorithms for hyperglycemia in type 2 diabetes: an egalitarian dialog. J Endocrinol Invest 2019; 42:237-242. [PMID: 29704235 DOI: 10.1007/s40618-018-0893-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy.
| | - M I Maiorino
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - G Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
| | - K Esposito
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
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29
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Goldenberg RM, Assimakopoulos P, Gilbert JD, Gottesman IS, Yale JF. A practical approach and algorithm for intensifying beyond basal insulin in type 2 diabetes. Diabetes Obes Metab 2018; 20:2064-2074. [PMID: 29707875 DOI: 10.1111/dom.13337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
Abstract
Despite the availability of long-term data demonstrating the benefits of timely and aggressive intensification of antihyperglycaemic regimens among individuals with type 2 diabetes, intensification beyond basal insulin continues to be suboptimal and a global challenge. This review summarizes the evidence surrounding the various options of advancing glucose-lowering management beyond basal insulin and provides a practical algorithm to assist in optimizing patient care and enhancing glycaemic target achievements.
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Affiliation(s)
| | - Peter Assimakopoulos
- Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeremy D Gilbert
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Irving S Gottesman
- Trillium Health Partners, Credit Valley Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jean-François Yale
- Division of Endocrinology and Metabolism, McGill University Health Centre, McGill University and LMC Diabetes and Endocrinology, Montreal, Quebec, Canada
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Gazzaruso C, Coppola A, Montalcini T, Falcone C. Anti-diabetic agents and heart health: how to use new diabetes medications in a global strategy for the prevention of cardiovascular complications in type 2 diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:195. [PMID: 29951517 DOI: 10.21037/atm.2018.03.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Carmine Gazzaruso
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.,Interdepartmental Center for Research in Molecular Medicine (CIRMC), University of Pavia, Pavia, Italy
| | - Adriana Coppola
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Colomba Falcone
- Interdepartmental Center for Research in Molecular Medicine (CIRMC), University of Pavia, Pavia, Italy.,Department of Cardiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy
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