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Sheng L, Deng M, Li X, Wan H, Lei C, Prabahar K, Hernández-Wolters B, Kord-Varkaneh H. The effect of subcutaneous Lixisenatide on weight loss in patients with type 2 Diabetes Mellitus: Systematic review and Meta-Analysis of randomized controlled trials. Diabetes Res Clin Pract 2024; 210:111617. [PMID: 38490492 DOI: 10.1016/j.diabres.2024.111617] [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: 12/17/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The impacts of subcutaneous Lixisenatide on body weight in patients with type 2 DM, remain inadequately understood; consequently, this systematic review and meta-regression analysis of randomized controlled trials (RCTs) was conducted to evaluate the influence of subcutaneous Lixisenatide administration on BW and BMI values in individuals with Type 2 diabetes. METHODS A comprehensive literature search was conducted across four databases, spanning from their inception to February 2023. We computed effect sizes employing the random-effects model and reported results in terms of weighted mean differences (WMD) along with their corresponding 95% confidence intervals (CI). RESULTS 23 articles with 26 RCT arms were included in the meta-analysis. The combined findings from a random-effects model demonstrated a significant reduction in body weight (WMD: -0.97 kg, 95 % CI: -1.10, -0.83, p < 0.001) and BMI (WMD: -0.48 kg/m2, 95 % CI: -0.67, -0.29, P < 0.001) after subcutaneous administration of Lixisenatide. Furthermore, a more pronounced reduction in body weight was discovered in RCTs lasting less than 24 weeks (WMD: -1.56 kg, 95 % CI: -2.91, -0.20, p < 0.001), employing a daily dosage of subcutaneous Lixisenatide lower than 19 µg per day (WMD: -1.94 kg, 95 % CI: -2.54, -1.34, p < 0.001) and with a mean participant age of 60 years or more (WMD: -1.86 kg, 95 % CI: -3.16, -0.57, p = 0.005). CONCLUSIONS Lixisenatide was found to significantly decrease BW and BMI in patients with type 2 DM and could be considered as a therapeutic option for those suffering from weight gain caused by other anti-diabetic agents. However, while prescribing Lixisenatide, careful consideration of patient-specific factors is recommended.
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Affiliation(s)
- Lei Sheng
- Department of Health Management Center, the Fifth Hospital of Wuhan, Wuhan, Hubei 430050, China
| | - Meixian Deng
- Department of Gynecology, the Fifth Hospital of Wuhan, Wuhan, Hubei 430050, China
| | - Xin Li
- Department of Neurology, the Fifth Hospital of Wuhan, Wuhan, Hubei 430050, China
| | - Huan Wan
- Department of Neurology, the Fifth Hospital of Wuhan, Wuhan, Hubei 430050, China; Department of Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, China.
| | - Changjiang Lei
- Department of Oncology, the Fifth Hospital of Wuhan, Wuhan, Hubei 430050, China.
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Hamed Kord-Varkaneh
- Department of Nutrition and Food Hygiene, School of Medicine, Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Management of Obesity and Obesity-Related Disorders: From Stem Cells and Epigenetics to Its Treatment. Int J Mol Sci 2023; 24:ijms24032310. [PMID: 36768633 PMCID: PMC9916844 DOI: 10.3390/ijms24032310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Obesity is a complex worldwide disease, characterized by an abnormal or excessive fat accumulation. The onset of this pathology is generally linked to a complex network of interactions among genetic and environmental factors, aging, lifestyle, and diets. During adipogenesis, several regulatory mechanisms and transcription factors are involved. As fat cells grow, adipose tissue becomes increasingly large and dysfunctional, losing its endocrine function, secreting pro-inflammatory cytokines, and recruiting infiltrating macrophages. This long-term low-grade systemic inflammation results in insulin resistance in peripheral tissues. In this review we describe the main mechanisms involved in adipogenesis, from a physiological condition to obesity. Current therapeutic strategies for the management of obesity and the related metabolic syndrome are also reported.
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Hejjaji V, Gorgojo-Martinez JJ, Tang F, Garnelo JB, Cooper A, Medina J, Mutiozabal MS, Khunti K, Nicolucci A, Shestakova MV, Ji L, Gomes MB, Watada H, Vora J, Malik AO, Kosiborod M, Arnold SV. Factors associated with weight loss in people with overweight or obesity living with type 2 diabetes mellitus: Insights from the global DISCOVER study. Diabetes Obes Metab 2022; 24:1734-1740. [PMID: 35546275 DOI: 10.1111/dom.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
AIMS To estimate real-world change in weight over 3 years and the factors influencing it in participants who are overweight and live with type 2 diabetes. MATERIALS AND METHODS DISCOVER is a multinational prospective observational study that enrolled participants with type 2 diabetes between December 2014 and June 2016 at the time of initiation of a second-line glucose-lowering medication (GLM). Demographic, anthropometric, and quality-of-life data were collected at baseline, and after 6, 12, 24 and 36 months of follow-up. Using a hierarchical, repeated-measures linear regression model, we examined factors associated with weight change over time. RESULTS Of 10 675 participants with type 2 diabetes who were overweight/obese (mean age 57.1 ± 11.1 years, 46% women), 21% lost ≥5% weight over 3 years, which was associated with modestly improved physical and mental health. Advancing age, female sex, and higher baseline weight were associated with weight loss. Most importantly, the type of GLM prescribed at previous visit had the strongest impact on weight change over time independent of participant factors, with use of a sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist associated with 1.0% weight loss versus a 0.6% weight gain with sulphonylureas, thiazolidinediones, meglitinides or insulin. CONCLUSION In this large contemporary prospective study, approximately one in five participants with early-stage type 2 diabetes and overweight/obesity lost ≥5% weight over 3 years. The type of GLM has the most impact on weight loss over time, highlighting the need for a careful selection of agents that takes baseline weight into consideration.
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Affiliation(s)
- Vittal Hejjaji
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Juan J Gorgojo-Martinez
- Unit of Endocrinology and Nutrition, Hospital Universitario Fundación Alcorcón Madrid, Madrid, Spain
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Marina V Shestakova
- Endocrinology Research Center, Diabetes Institute, Moscow, Russian Federation
| | - Linong Ji
- Peking University Subjects's Hospital, Beijing, China
| | | | - Hirotaka Watada
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Ali O Malik
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
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Williams DM, Jones H, Stephens JW. Personalized Type 2 Diabetes Management: An Update on Recent Advances and Recommendations. Diabetes Metab Syndr Obes 2022; 15:281-295. [PMID: 35153495 PMCID: PMC8824792 DOI: 10.2147/dmso.s331654] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/18/2022] [Indexed: 12/19/2022] Open
Abstract
Previous guidelines for the treatment of people with type 2 diabetes mellitus (T2D) have relied heavily upon rigid algorithms for the sequential addition of pharmacotherapies to achieve target glycemic control. More recent guidelines advocate a personalized approach for diabetes treatment, to improve patient satisfaction, quality of life, medication adherence and overall health outcomes. Clinicians should work with patients to develop personalized goals for their treatment, including targeted glycemic control, weight management, prevention and treatment of associated comorbidities and avoidance of complications such as hypoglycemia. Factors that affect the intensity of treatment and choice of pharmacotherapy should include medical and patient influences. Medical considerations include the diabetes phenotype, biomarkers including genetic tests, and the presence of comorbidities such as cardiovascular, renal, or hepatic disease. Patient factors include their treatment preference, age and life expectancy, diabetes duration, hypoglycemia fear and unawareness, psychological and social circumstances. The use of a personalized approach in the management of people with T2D can reduce the cost and failure associated with the algorithmic "one-size-fits-all" approach, to anticipate disease progression, improve the response to diabetes pharmacotherapy and reduce the incidence of diabetes-associated complications. Ultimately, the use of personalized medicine in people with T2D should improve medication adherence, patient satisfaction and quality of life to reduce diabetes distress and improve physical health outcomes.
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Affiliation(s)
- David M Williams
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, SA6 8NL, UK
- Correspondence: David M Williams, Diabetes Centre, Morriston Hospital, Swansea, SA6 6NL., UK, Tel +441792704078, Email
| | - Hannah Jones
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, SA6 8NL, UK
| | - Jeffrey W Stephens
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, SA6 8NL, UK
- Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
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Yoshida Y, Hong D, Nauman E, Price-Haywood EG, Bazzano AN, Stoecker C, Hu G, Shen Y, Katzmarzyk PT, Fonseca VA, Shi L. Patient-specific factors associated with use of diabetes self-management education and support programs in Louisiana. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002136. [PMID: 34933871 PMCID: PMC8679102 DOI: 10.1136/bmjdrc-2021-002136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/22/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The prevalence of diabetes self-management education and support (DSME/S) use among patients with newly diagnosed type 2 diabetes mellitus (T2DM) and patients with insulin prescription has not been evaluated. It is also unclear what demographic, behavioral, and clinical factors associated with use of DSME/S. RESEARCH DESIGN AND METHODS This retrospective analysis was based on electronic health records from the Research Action for Health Network (2013-2019). Patients with newly diagnosed T2DM were identified as 35-94 year-olds diagnosed with T2DM≥1 year after the first recorded office visit. Patients with insulin were identified by the first insulin prescription records. DSME/S (Healthcare Common Procedure Coding System G0108 and G0109) codes that occurred from 2 months before the 'new diagnosis date' or first insulin prescription date through 1 year after were defined as use of DSME/S. Age-matched controls (non-users) were identified from the Electronic Health Records (EHR). The date of first DSME/S record was selected as the index date. Logistic regression was used to estimate the associations between patient factors and use of DSME/S. RESULTS The prevalence of DSME/S use was 6.5% (8909/137 629) among patients with newly diagnosed T2DM and 32.7% (13,152/40,212) among patients with diabetes taking insulin. Multivariable analysis found that among patients with newly diagnosed T2DM, black and male patients were less likely to use DSME/S, while in patients with insulin, they were more likely to use the service compared with white and female counterparts, respectively. Among patients taking insulin, those with private insurance or self-pay status were significantly less likely, while those with Medicaid were more likely to use the service compared with their Medicare counterparts. A strong positive association was found between HbA1c, obesity, and DSME/S use in both cohorts, while hypertension was negatively associated with DSME/S in both cohorts. CONCLUSION We showed a low rate of DSME/S use in Louisiana, especially in patients with newly diagnosed T2DM. Our findings demonstrated heterogeneity in factors influencing DSME/S use between patients with newly diagnosed T2D and patients with insulin.
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Affiliation(s)
- Yilin Yoshida
- Section of Endocrinology and Metabolism, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Dongzhe Hong
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Eboni G Price-Haywood
- Ochsner Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, Louisiana, USA
| | - Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Charles Stoecker
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Gang Hu
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Yun Shen
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Shanghai Jiao Tong University, Shanghai, China
| | - Peter T Katzmarzyk
- Physical Activity and Obesity Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Vivian A Fonseca
- Section of Endocrinology and Metabolism, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Tijssen A, Snaterse M, Minneboo M, Lachman S, Scholte Op Reimer W, Peters RJ, Jørstad HT. Weight management and determinants of weight change in patients with coronary artery disease. Heart 2021; 107:1552-1559. [PMID: 34326136 DOI: 10.1136/heartjnl-2021-319224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD). METHODS We performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change. RESULTS Intervention patients (n=280) lost significantly more weight than control patients (n=257) (-2.4±7.1 kg vs -0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59). CONCLUSION The comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight. TRIAL REGISTRATION NUMBER NTR3937.
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Affiliation(s)
- Arno Tijssen
- Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Noord-Holland, The Netherlands
| | - Marjolein Snaterse
- Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Noord-Holland, The Netherlands
| | - Madelon Minneboo
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Sangeeta Lachman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Wilma Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands.,Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Ron J Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Harald Thune Jørstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
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7
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Chalmers J, Woodward M. Observational analyses from ADVANCE and ADVANCE-ON. Diabetes Obes Metab 2020; 22 Suppl 2:19-32. [PMID: 31729126 DOI: 10.1111/dom.13894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
AIMS To explain, and document, the epidemiological work associated with the action in diabetes and vascular disease: preterax and diamicron-modified release controlled evaluation (ADVANCE) clinical trial. MATERIALS AND METHODS ADVANCE was designed as a randomized controlled multicentre factorial trial in high-risk patients with diabetes. The two interventions were blood pressure lowering medications versus placebo, and intensive glucose control versus standard glucose control. Following termination of the trial, an observational study of surviving participants, able to join, was mounted: the ADVANCE - observational study (ADVANCE-ON). Other epidemiological analyses that were undertaken treated the trial as a cohort study, including using biomarkers from the blood samples taken from ADVANCE subjects as risk exposures. RESULTS More than 50 publications have reported epidemiological results from ADVANCE. The main results from ADVANCE-ON suggested attenuated benefits of ADVANCE's blood pressure lowering treatment on all-cause and cardiovascular death, but no such long-term benefits for intensive glucose control, although this did give persistent benefit for end-stage renal disease. The other epidemiological studies found, amongst other things, strong effects of NT-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T on macrovascular events, microvascular events and all-cause death. CONCLUSIONS Embedding post-randomization and epidemiological analyses into clinical trials is worthwhile and can be highly productive in advancing scientific knowledge.
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Affiliation(s)
- John Chalmers
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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8
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Zoungas S. ADVANCE in context: The benefits, risks and feasibility of providing intensive glycaemic control based on gliclazide modified release. Diabetes Obes Metab 2020; 22 Suppl 2:5-11. [PMID: 32250522 DOI: 10.1111/dom.13968] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/10/2023]
Abstract
In the last 3 decades, four large multicentre, randomized clinical trials of patients with type 2 diabetes (UKPDS, ADVANCE, ACCORD and VADT) have studied different approaches to achieving near normal glycaemic targets. Each was designed against a background of international and national guidelines recommending glycaemic targets of 6.5% or less to prevent diabetic complications. Collectively, these clinical trials provide the most robust evidence of the potential vascular benefits and risks of more versus less glucose control and provide critical insights into how therapies are used. In this review, the glucose-lowering approach used by the ADVANCE trial is considered and compared with those used by the other trials.
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Affiliation(s)
- Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
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9
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Naeem N, Basit A, Shiraz A, Bin Zafar A, Mustafa N, Ali Siddique S, Fawwad A. Insulin-associated Weight Gain in Type 2 Diabetes and Its Relation with Caloric Intake. Cureus 2019; 11:e5275. [PMID: 31576267 PMCID: PMC6764643 DOI: 10.7759/cureus.5275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to observe the weight change in a patient with type 2 diabetes initiated on insulin therapy and the relation of weight gain with caloric intake. Methods This retrospective longitudinal follow-up study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care hospital of Karachi, Pakistan. Records of 917 patients attending the tertiary care diabetic clinic were retrieved from January 2009 to May 2016 from the Hospital Management System (HMS). Subjects were divided into two groups: group A consisted of subjects on oral hypoglycemic agents (OHA), while group B consisted of subjects on insulin therapy with OHA. Change in weight, change in HbA1c, and change in calories intake were calculated by examining data at baseline and end-line visit of the study. Results Group B showed significantly higher weight gain than group A (48.3% vs 24.8%). Insulin therapy with OHA (OR (95% CI = 1.78(1.05-3.02)), increased caloric intake (OR [95% CI = 1.98(1.093.60)]) and decreased HbA1c (OR [95% CI = 0.44(0.24-0.79)]) were the only factors identified as significant predictors of weight gain. Conclusion It is concluded that type 2 diabetic subjects, especially on insulin treatment, gain weight due to increase or unadvised caloric intake. Long-term multicenter studies are needed to ascertain the findings of this study.
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Affiliation(s)
- Nadeem Naeem
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Abdul Basit
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | | | - Awn Bin Zafar
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Nida Mustafa
- Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Shaista Ali Siddique
- Miscellaneous, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Asher Fawwad
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
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10
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Gant CM, Mensink I, Binnenmars SH, van der Palen JAM, Bakker SJL, Navis G, Laverman GD. Body weight course in the DIAbetes and LifEstyle Cohort Twente (DIALECT-1)-A 20-year observational study. PLoS One 2019; 14:e0218400. [PMID: 31216324 PMCID: PMC6583961 DOI: 10.1371/journal.pone.0218400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background Although weight gain increases risk of type 2 diabetes, real-life data on the weight course in patients with established type 2 diabetes are scarce. We assessed weight course in a real-life diabetes secondary care setting and analyzed its association with patient characteristics, lifestyle habits and initiation of insulin, glucagon like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Methods Data on weight, insulin, GLP-1 RA and SGLT-2i use were collected retrospectively (12 years) and prospectively (8 years) from patients included in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1, n = 450, age 63 ± 9 years, 58% men, diabetes duration [7–18] years). Lifestyle habits were assessed using validated questionnaires. The association of clinical parameters with body mass index (BMI) course was determined using linear mixed models. Patients who underwent bariatric surgery (n = 19) had a distinct BMI course and were excluded from the study. Results Baseline BMI was 31.3 (0.3) and was higher in women, patients aged <60 years and patients with unfavorable lifestyle habits. BMI increased to 32.5 (0.3) after 12 years (P<0.001), and thereafter decreased to 31.5 (0.3) after 20 years, resulting in a similar BMI as the baseline BMI (P = 0.96, compared to baseline). Clinical parameters or initiation of insulin or SGLT-2i were not associated with BMI course. Patients who initiated GLP-1 RA declined in BMI compared to non-users (Pinteraction = 0.003). Conclusions High BMI that real-life patients with type 2 diabetes gained earlier in life, remained stable in the following decades. Weight loss interventions should remain a priority, and GLP-1 RA might be considered to support weight loss.
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Affiliation(s)
- Christina M. Gant
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Ijmke Mensink
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands
| | - S. Heleen Binnenmars
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job A. M. van der Palen
- Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands and Medical School Twente, Medisch spectrum Twente, Enschede, The Netherlands
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gozewijn D. Laverman
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands
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Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes 2019. [PMID: 31372016 DOI: 10.2147/dmso.s186600[publishedonlinefirst:2019/08/03]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The incidence and prevalence of metabolic and musculoskeletal diseases are increasing. Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, inflammation, advanced glycation end-product accumulation and increased oxidative stress. These characteristics can negatively affect various aspects of muscle health, including muscle mass, strength, quality and function through impairments in protein metabolism, vascular and mitochondrial dysfunction, and cell death. Sarcopenia is a term used to describe the age-related loss in skeletal muscle mass and function and has been implicated as both a cause and consequence of T2DM. Sarcopenia may contribute to the development and progression of T2DM through altered glucose disposal due to low muscle mass, and also increased localized inflammation, which can arise through inter- and intramuscular adipose tissue accumulation. Lifestyle modifications are important for improving and maintaining mobility and metabolic health in individuals with T2DM and sarcopenia. However, evidence for the most effective and feasible exercise and dietary interventions in this population is lacking. In this review, we discuss the current literature highlighting the bidirectional relationship between T2DM and sarcopenia, highlight current research gaps and treatments, and provide recommendations for future research.
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Affiliation(s)
- Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
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Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes 2019; 12:1057-1072. [PMID: 31372016 PMCID: PMC6630094 DOI: 10.2147/dmso.s186600] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 12/05/2022] Open
Abstract
The incidence and prevalence of metabolic and musculoskeletal diseases are increasing. Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, inflammation, advanced glycation end-product accumulation and increased oxidative stress. These characteristics can negatively affect various aspects of muscle health, including muscle mass, strength, quality and function through impairments in protein metabolism, vascular and mitochondrial dysfunction, and cell death. Sarcopenia is a term used to describe the age-related loss in skeletal muscle mass and function and has been implicated as both a cause and consequence of T2DM. Sarcopenia may contribute to the development and progression of T2DM through altered glucose disposal due to low muscle mass, and also increased localized inflammation, which can arise through inter- and intramuscular adipose tissue accumulation. Lifestyle modifications are important for improving and maintaining mobility and metabolic health in individuals with T2DM and sarcopenia. However, evidence for the most effective and feasible exercise and dietary interventions in this population is lacking. In this review, we discuss the current literature highlighting the bidirectional relationship between T2DM and sarcopenia, highlight current research gaps and treatments, and provide recommendations for future research.
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Affiliation(s)
- Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Correspondence: Jakub MesinovicDepartment of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Clayton, Victoria3068, AustraliaTel + 6 138 572 2919Fax + 6 139 594 6495Email
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
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Hurren KM, Dunham MW. Understanding the impact of commonly utilized, non-insulin, glucose-lowering drugs on body weight in patients with type 2 diabetes. Expert Opin Pharmacother 2018; 19:1087-1095. [PMID: 29958007 DOI: 10.1080/14656566.2018.1494727] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The majority of patients with type 2 diabetes also have obesity. Obesity increases the risk of developing diabetes and is associated with worsened glycemic control and increased morbidity and mortality in individuals with diabetes. Sustained weight loss is associated with improved glycemic control, potential for diabetes remission, and decreased medical expenditures. AREAS COVERED Herein, the impact of commonly utilized, non-insulin, glucose-lowering drugs on body weight in patients with type 2 diabetes is discussed. The weight change magnitudes, mechanisms, and any within-class differences are also explored. EXPERT OPINION The weight impact of diabetes medications should be considered when designing treatment regimens, especially in patients who are overweight or have obesity. Lifestyle modification is paramount for optimal diabetes management. Therapeutic regimens should ideally be designed to maximize weight loss and at least minimize or avoid weight gain. Future glucose-lowering medications should continue to offer improvement in cardiovascular risk factors, including weight, in order to be accepted into the armamentarium of diabetes therapy. Therapeutic regimens should be designed to help patients with diabetes and obesity achieve both glycemic and weight goals. Management of these disease states is expected to become increasingly integrated.
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Affiliation(s)
- Kathryn M Hurren
- a Clinical Pharmacy Specialist, Department of Ambulatory Care , Veterans Affairs Ann Arbor Healthcare System , Ann Arbor , MI , USA
| | - Marissa W Dunham
- a Clinical Pharmacy Specialist, Department of Ambulatory Care , Veterans Affairs Ann Arbor Healthcare System , Ann Arbor , MI , USA
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14
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Bowering K, Case C, Harvey J, Reeves M, Sampson M, Strzinek R, Bretler DM, Bang RB, Bode BW. Faster Aspart Versus Insulin Aspart as Part of a Basal-Bolus Regimen in Inadequately Controlled Type 2 Diabetes: The onset 2 Trial. Diabetes Care 2017; 40:951-957. [PMID: 28483786 DOI: 10.2337/dc16-1770] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/14/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This multicenter, double-blind, treat-to-target, phase 3 trial evaluated the efficacy and safety of fast-acting insulin aspart (faster aspart) versus insulin aspart (IAsp) in adults with type 2 diabetes receiving basal insulin and oral antidiabetic agents. RESEARCH DESIGN AND METHODS: The primary end point was HbA1c change from baseline after 26 weeks' treatment. After an 8-week run-in to optimize basal insulin, subjects were randomized (1:1) to mealtime faster aspart (n = 345) or IAsp (n = 344), titrated using a simple daily patient-driven algorithm, plus insulin glargine U100 and metformin. RESULTS HbA1c change was -1.38% (faster aspart) and -1.36% (IAsp); mean HbA1c was 6.6% for both groups. Faster aspart demonstrated noninferiority versus IAsp in reducing HbA1c (estimated treatment difference [ETD] [95% CI] -0.02% [-0.15; 0.10]). Both treatments improved postprandial plasma glucose (PPG) control; the PPG increment (liquid meal test) was statistically significant in favor of faster aspart after 1 h (ETD [95% CI] -0.59 mmol/L [-1.09; -0.09]; -10.63 mg/dL [-19.56; -1.69]; P = 0.0198), but not after 2-4 h. Change from baseline in fasting plasma glucose, body weight, and overall severe/blood glucose-confirmed hypoglycemia rates (rate ratio [RR] [95% CI] 1.09 [0.88; 1.36]) were similar between treatments. Postmeal hypoglycemia (0-2 h) rates were 2.27 (faster aspart) and 1.49 (IAsp) per patient-year of exposure (RR [95% CI] 1.60 [1.13; 2.27]). CONCLUSIONS Faster aspart and IAsp were confirmed noninferior in a basal-bolus regimen regarding change from baseline in HbA1c. Faster aspart improved 1-h PPG with no differences in 2-4-h PPG versus IAsp. Overall hypoglycemia rates were similar except for an increase in 0-2-h postmeal hypoglycemia with faster aspart.
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Affiliation(s)
- Keith Bowering
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
| | | | - John Harvey
- Gladstone Centre, Maelor Hospital, Bangor University, Wrexham, U.K
| | | | - Michael Sampson
- Diabetes, Endocrinology and General Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, U.K
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Gordon J, McEwan P, Evans M, Puelles J, Sinclair A. Managing glycaemia in older people with type 2 diabetes: A retrospective, primary care-based cohort study, with economic assessment of patient outcomes. Diabetes Obes Metab 2017; 19:644-653. [PMID: 28026911 PMCID: PMC5412932 DOI: 10.1111/dom.12867] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022]
Abstract
AIMS To describe the relative health and economic outcomes associated with different second-line therapeutic approaches to manage glycaemia in older type 2 diabetes patients requiring escalation from metformin monotherapy. MATERIALS AND METHODS The Clinical Practice Research Datalink database was used to inform a retrospective observational cohort study of patients with type 2 diabetes treated with metformin monotherapy requiring escalation (addition or switch) to a second-line oral regimen from January 1, 2008 to December 31, 2014. Primary outcomes included time to first event (any event, myocardial infarction [MI], stroke, or composite of MI/stroke [major adverse cardiovascular event; MACE]) and total event rate. The health economic consequences associated with the choice of second-line treatment in older patients were assessed using the CORE Diabetes Model. RESULTS A total of 10 484 patients were included; the majority escalated to second-line treatment with metformin + sulphonylurea (SU; 42%) or switched to SU monotherapy (28%). In multivariate adjusted analyses, total event rates for MACE with metformin + dipeptidyl peptidase-4 (DPP-4) inhibitor were significantly lower than with metformin + SU (0.61, 95% confidence interval [CI] 0.39-0.98), driven by a lower MI rate in the metformin + DPP-4 inhibitor group (0.52, 95% CI 0.27-0.99). Economic analyses estimated that metformin + DPP-4 inhibitor treatment was associated with the largest gain in health benefit, and cost-effectiveness ratios were favourable (<£30 000 per quality-adjusted life-year) for all second-line treatment scenarios. CONCLUSIONS With respect to treatment choice, data from the present study support the notion of prescribing beyond metformin + SU, as alternative regimens have been shown to be associated with reduced outcomes risk and value for money.
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Affiliation(s)
- Jason Gordon
- Health Economics and Outcomes Research LtdCardiffUK
- School of MedicineUniversity of NottinghamNottinghamUK
- Department of Public HealthUniversity of AdelaideAdelaideAustralia
| | - Phil McEwan
- Health Economics and Outcomes Research LtdCardiffUK
- Swansea Centre for Health EconomicsSwansea UniversitySwanseaUK
| | - Marc Evans
- Diabetes Resource Centre, Llandough HospitalCardiffUK
| | - Jorge Puelles
- Global Outcomes ResearchTakeda Development Centre Europe LtdLondonUK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older PeopleDiabetes Frail LtdWorcesterUK
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Hong S, Park C, Hwang D, Han KA, Lee CB, Chung CH, Yoon K, Mok J, Park KS, Park S. Efficacy and safety of adding evogliptin versus sitagliptin for metformin-treated patients with type 2 diabetes: A 24-week randomized, controlled trial with open label extension. Diabetes Obes Metab 2017; 19:654-663. [PMID: 28058750 PMCID: PMC5412933 DOI: 10.1111/dom.12870] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 12/11/2022]
Abstract
AIMS This trial consisted of a 24-week multicentre, randomized, double-blind, double-dummy, active-controlled study and a 52-week open label extension study to assess the efficacy and safety of evogliptin, a novel dipeptidyl peptidase-4 inhibitor, compared to sitagliptin in patients with type 2 diabetes who have inadequate glycaemic control with metformin alone. METHODS Adult patients with type 2 diabetes mellitus (N = 222) with HbA1c 6.5% to 11% who were receiving stable doses of metformin (≥1000 mg/d) were randomized 1:1 to add-on evogliptin 5 mg (N = 112) or sitagliptin 100 mg (N = 110) once daily for 24 weeks. The primary efficacy analysis consisted of a comparison of the change from baseline HbA1c at week 24. Non-inferiority was concluded if the upper limit of the 2-sided 95% confidence interval for the HbA1c difference between treatments was <0.35%. RESULTS Mean changes in HbA1c following addition of evogliptin or sitagliptin were -0.59% and -0.65%, respectively. The between-group difference was 0.06% (2-sided 95% confidence interval, -0.10 to 0.22), demonstrating non-inferiority. After the 52-week treatment, evogliptin caused a persistently decreased level of HbA1c (-0.44% ± 0.65%, P < .0001). In general, both treatments were well tolerated, with incidences and types of adverse events comparable between the two groups. Hypoglycaemic events, mostly mild, were reported in 0.9% of patients treated with evogliptin and in 2.8% of patients treated with sitagliptin for 24 weeks. CONCLUSIONS Evogliptin 5 mg added to metformin therapy effectively improved glycaemic control and was non-inferior to sitagliptin and well tolerated in patients with type 2 diabetes mellitus that was inadequately controlled by metformin alone.
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Affiliation(s)
- Sang‐Mo Hong
- Department of Internal MedicineHallym University Dongtan Sacred Heart HospitalHwaseong‐siRepublic of Korea
| | - Cheol‐Young Park
- Department of Internal Medicine, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Dong‐Min Hwang
- Data Management and Clinical Statistics Team, Dong‐A STSeoulRepublic of Korea
| | - Kyung Ah Han
- Department of Internal MedicineEulji University College of MedicineDaejeon, Republic of Korea
| | - Chang Beom Lee
- Department of Internal Medicine, College of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Choon Hee Chung
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Kun‐Ho Yoon
- Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Ji‐Oh Mok
- Department of Internal MedicineSoonchunhyang University College of MedicineBucheon‐siRepublic of Korea
| | - Kyong Soo Park
- Department of Internal Medicine, College of MedicineSeoul National UniversitySeoulRepublic of Korea
| | - Sung‐Woo Park
- Department of Internal Medicine, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea
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Cichosz SL, Lundby-Christensen L, Johansen MD, Tarnow L, Almdal TP, Hejlesen OK. Prediction of excessive weight gain in insulin treated patients with type 2 diabetes. J Diabetes 2017; 9:325-331. [PMID: 27130075 DOI: 10.1111/1753-0407.12418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/20/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Weight gain is an ongoing challenge when initiating insulin therapy in patients with type 2 diabetes mellitus (T2DM). However, if prediction of insulin-associated weight gain was possible on an individual level, targeted initiatives could be implemented to reduce weight gain. The aim of the present study was to identify predictors of weight gain in insulin-treated patients with T2DM. METHODS In all, 412 individuals with T2DM were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analog treatment regimens (biphasic, aspart, detemir). Participants with excessive weight gain were defined as the group with weight gain in the 4th quartile (>6.2 kg).We developed a pattern classification method to predict individuals prone to excessive weight gain. RESULTS Over the 18-month treatment period, median weight gain among all 412 patients was 2.4 kg (95% prediction interval [PI] -5.6, 12.4 kg), whereas median weight gain for those in the upper 4th quartile (n = 103) was 8.9 kg (95% PI 6.3, 15.2 kg). No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a receiver operating characteristic area under the curve of 0.80. CONCLUSIONS We have developed a prediction model that could help identify a substantial proportion of individuals with T2DM prone to large weight gain during insulin therapy.
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Affiliation(s)
- Simon Lebech Cichosz
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Louise Lundby-Christensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology PE, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mette D Johansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lise Tarnow
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Nordsjaellands Hospital, Hilleroed, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
- Department of Endocrinology PE, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Ole K Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Bramlage P, Bluhmki T, Fleischmann H, Kaltheuner M, Beyersmann J, Holl RW, Danne T. Determinants of weight change in patients on basal insulin treatment: an analysis of the DIVE registry. BMJ Open Diabetes Res Care 2017; 5:e000301. [PMID: 28176957 PMCID: PMC5278215 DOI: 10.1136/bmjdrc-2016-000301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We aimed to describe patterns of weight change in insulin-naive patients with type 2 diabetes mellitus (T2DM) starting basal insulin (BI) treatment. RESEARCH DESIGN AND METHODS Diabetes Versorgungs-Evaluation (DIVE) is an observational, multicenter, prospective registry in patients with T2DM. Patients were divided into those initiating BI therapy for the first time (with optional oral antidiabetic drugs (OADs)) and those initiating OADs only (OADo). RESULTS 521 patients were included in the analysis, 113 in the BI arm and 408 in the OADo arm. Relative to baseline, the BI group gained an average of 0.98±7.1 kg at 1 year, compared with a loss of 1.52±11.8 kg in the OADo group (p<0.001). This difference remained statistically significant when expressed as a proportional change from baseline (+0.014±0.08 vs -0.015±0.12, respectively (p<0.001)). Baseline weight (regression coefficient (RC) 0.89; 95% CI 0.81 to 0.97; p<0.001) and diabetes duration (RC 2.52; 95% CI 0.53 to 4.52; p=0.01) were the only factors identified as significant predictors of weight gain between baseline and 1 year follow-up in BI patients. CONCLUSIONS Though BI therapy leads to modest weight gain over the subsequent year, this may be limited by BI initiation at an early stage of the disease. As such, delaying the start of insulin therapy based on fears of weight gain appears counter-productive, and should be reconsidered.
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Affiliation(s)
- Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany
| | | | | | - Matthias Kaltheuner
- winDiab GmbH, Düsseldorf, Germany
- Gemeinschaftspraxis Kaltheuner—v. Boxberg, Leverkusen, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Neuherberg, Germany
| | - Thomas Danne
- Kinder- und Jugendkrankenhaus “AUF DER BULT”, Hannover, Germany
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Kamil S, Finer N, James WPT, Caterson ID, Andersson C, Torp-Pedersen C. Influence of sibutramine in addition to diet and exercise on the relationship between weight loss and blood glucose changes. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 3:134-139. [DOI: 10.1093/ehjcvp/pvw029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/21/2016] [Indexed: 11/14/2022]
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Giorgino F, Home PD, Tuomilehto J. Glucose Control and Vascular Outcomes in Type 2 Diabetes: Is the Picture Clear? Diabetes Care 2016; 39 Suppl 2:S187-95. [PMID: 27440832 DOI: 10.2337/dcs15-3023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The overall impact of glucose lowering on vascular complications and major clinical outcomes, including mortality, in type 2 diabetes is still an open issue. While intensive glucose control has undoubted benefit for microvascular end points, the relationship between glucose-lowering approaches and reduced incidence and/or progression of macrovascular complications is less clear. This review article will discuss the effect of glucose lowering per se as well as the effects of specific glucose-lowering therapies on vascular outcomes in type 2 diabetes. The role of lifestyle changes on cardiovascular outcomes will be also addressed. Recent analyses from large cardiovascular outcome studies (ACCORD, ADVANCE, and VADT) provide new information on factors that modulate the impact of intensive glucose lowering on outcomes, helping to identify the specific clinical characteristics of the patients receiving the intervention that would show a better response. While several studies on cardiovascular outcomes with diabetes drugs are available, they do not clearly highlight a benefit from using a specific medication or will require additional evidence, as for the sodium-glucose cotransporter 2 blockers.
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Affiliation(s)
- Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Philip D Home
- Institute for Cellular Medicine-Diabetes, Newcastle University, Newcastle-upon-Tyne, U.K
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Center for Vascular Prevention, Danube-University Krems, Krems, Austria Dasman Diabetes Institute, Dasman, Kuwait Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Yadgar-Yalda R, Colman PG, Fourlanos S, Wentworth JM. Factors associated with insulin-induced weight gain in an Australian type 2 diabetes outpatient clinic. Intern Med J 2016; 46:834-9. [DOI: 10.1111/imj.13122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/15/2016] [Accepted: 04/17/2016] [Indexed: 01/20/2023]
Affiliation(s)
- R. Yadgar-Yalda
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - P. G. Colman
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - S. Fourlanos
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. M. Wentworth
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Population Health and Immunity; Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
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Baltzis D, Grammatikopoulou MG, Papanas N, Trakatelli CM, Kintiraki E, Hassapidou MN, Manes C. Obese Patients with Type 2 Diabetes on Conventional Versus Intensive Insulin Therapy: Efficacy of Low-Calorie Dietary Intervention. Adv Ther 2016; 33:447-59. [PMID: 26886777 DOI: 10.1007/s12325-016-0300-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The aim of this prospective study was to assess the results of a standard low-calorie dietary intervention (7.5 MJ/day) on body weight (BW) and the metabolic profile of obese patients with type 2 diabetes mellitus (T2DM) on intensive insulin therapy (IIT: 4 insulin injections/day) versus conventional insulin therapy (CIT: 2/3 insulin injections/day). METHODS A total of 60 patients (n = 60, 23 males and 37 postmenopausal females) were recruited and categorized into two groups according to the scheme of insulin treatment. Thirty were on IIT (13 males and 17 females) and an equal number on CIT (10 males and 20 females). BW, body mass index (BMI), HbA1c, and metabolic parameters were compared at 6 and 12 months after baseline. RESULTS Significant reductions were observed in the BW, BMI, HbA1c (p ≤ 0.001 for all) and cholesterol (p ≤ 0.05) at 6 months post-intervention. At 1 year, median BW reduction was 4.5 kg (3.3, 5.8) for patients on IIT and 4.8 kg (3.6, 7.0) for those on CIT. The 12-month dietary intervention increased prevalence of normoglycemia in the IIT group and reduced the prevalence of obesity prevalence among the CIT participants (all p < 0.001). CIT patients with BW reduction ≥5.0% demonstrated 11-fold greater chances of being normoglycemic (odds ratio 11.3, 95% CI 1.1-110.5). BW reduction ≥7.0% was associated with CIT, being overweight, and having normal HDLc, LDLc, and cholesterol levels. A reduction in BW between 5.0% and 6.9% was associated with IIT, normoglycemia, and obesity. CONCLUSION A 12-month 1800-kcal dietary intervention achieved significant BW and HbA1c reductions irrespectively of insulin regimen. CIT was associated with BW reduction greater than 8.0%, whereas IIT was associated with higher rates of normoglycemia.
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Affiliation(s)
- Dimitrios Baltzis
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Thessaloniki, Greece.
- Microcirculation Lab and Joslin-Beth Israel Deaconess Foot Center, Harvard Medical School, Boston, MA, USA.
| | - Maria G Grammatikopoulou
- Department of Human Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Nikolaos Papanas
- Diabetes Center, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Evangelia Kintiraki
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Maria N Hassapidou
- Department of Human Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Christos Manes
- Diabetes Center, Papageorgiou General Hospital, Thessaloniki, Greece
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Gordon JP, Evans M, Puelles J, McEwan PC. Factors Predictive of Weight Gain and Implications for Modeling in Type 2 Diabetes Patients Initiating Metformin and Sulfonylurea Combination Therapy. Diabetes Ther 2015; 6:495-507. [PMID: 26446552 PMCID: PMC4674479 DOI: 10.1007/s13300-015-0134-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The objectives of this study were to (a) assess the factors associated with weight gain in a population of type 2 diabetes patients escalating from metformin (M) to M+ sulfonylurea (M + S) and (b) evaluate whether healthcare resource utilization associated with being overweight or obese is underestimated in typical health economic evaluations. METHODS The study was a retrospective cohort study using UK Clinical Practice Research Datalink linked to Hospital Episode Statistics (CPRD/HES) data. The association between baseline phenotypic factors and weight gain was assessed using logistic regression. Hospitalization incidence rates per 1000 person-years for major diabetes-related complications according to body mass index (BMI) at baseline were estimated from the data (observed) and compared to those obtained from a validated diabetes model (predicted). RESULTS 11,071 patients were included in the analysis; approximately 40% gained weight in the first year following escalation to M + S. Baseline age, HbA1c and gender were found to be predictors of weight gain [odds ratios 0.99 (1-year increment), 1.11 (1% increment) and 0.81 (female vs male), respectively, p < 0.001]. Observed vs predicted incidence rates of hospitalization were 265 vs 13 (normal), 297 vs 31 (overweight), 223 vs 50 (obese) and 378 vs 41 (severe obese). CONCLUSION This analysis suggests there are identifiable patient characteristics predictive of weight gain that may be informative to clinical and economic decision making in the context of patients escalating from M to an M + S regimen. Hospital admissions in people with type 2 diabetes were generally under-predicted. A particular focus of future research should be the need for diabetes models to make the likelihood of experiencing an event conditional on BMI. FUNDING Takeda Development Centre Europe Ltd., UK.
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Affiliation(s)
- Jason P Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK.
- Public Health, University of Adelaide, Adelaide, Australia.
| | - Marc Evans
- Llandough Hospital, Diabetes Resource Centre, Cardiff, UK
| | - Jorge Puelles
- Global Outcomes Research, Takeda Development Centre Europe, TDC (Europe) Ltd, London, UK
| | - Philip C McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
- Centre for Health Economics, Swansea University, Swansea, UK
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Seino Y, Yabe D, Takami A, Niemoeller E, Takagi H. Long-term safety of once-daily lixisenatide in Japanese patients with type 2 diabetes mellitus: GetGoal-Mono-Japan. J Diabetes Complications 2015; 29:1304-9. [PMID: 26342556 DOI: 10.1016/j.jdiacomp.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 02/03/2023]
Abstract
AIMS This 76-week, open-label, parallel-group study assessed the long-term safety of once-daily lixisenatide monotherapy in Japanese patients with type 2 diabetes mellitus. METHODS Patients were randomized to receive lixisenatide in a 2-step or a 1-step dose-increase regimen. The primary objective was to assess the safety of lixisenatide at week 24 by a descriptive comparison of the 2- and 1-step groups. RESULTS As expected with treatment with a glucagon-like peptide-1 agonist, nausea was the most common treatment-emergent adverse event (2-step group: n=12/33 [36.4%] vs 1-step group: n=18/36 [50.0%] up to week 24). In total, 5/33 patients (15.2%; 2-step group) and 2/36 patients (5.6%; 1-step group) prematurely discontinued treatment up to week 24, mainly due to adverse events. Serious treatment-emergent adverse events occurred in 2/33 patients (6.1%; 2-step group) versus 0/36 patients (0%; 1-step group) up to week 24. Symptomatic hypoglycemia occurred in 2/33 patients (6.1%; 2-step group) versus 1/36 patients (2.8%; 1-step group) up to week 24, with no severe events reported. Glycated hemoglobin, fasting plasma glucose, and body weight were reduced from baseline at weeks 24 and 76. CONCLUSION In Japanese patients with type 2 diabetes mellitus, once-daily lixisenatide monotherapy was well tolerated, with less nausea with the 2-step regimen.
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Affiliation(s)
- Yutaka Seino
- Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Osaka, Japan.
| | - Daisuke Yabe
- Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Osaka, Japan
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Cefalu WT, Bray GA, Home PD, Garvey WT, Klein S, Pi-Sunyer FX, Hu FB, Raz I, Van Gaal L, Wolfe BM, Ryan DH. Advances in the Science, Treatment, and Prevention of the Disease of Obesity: Reflections From a Diabetes Care Editors' Expert Forum. Diabetes Care 2015; 38:1567-82. [PMID: 26421334 PMCID: PMC4831905 DOI: 10.2337/dc15-1081] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As obesity rates increase, so too do the risks of type 2 diabetes, cardiovascular disease, and numerous other detrimental conditions. The prevalence of obesity in U.S. adults more than doubled between 1980 and 2010, from 15.0 to 36.1%. Although this trend may be leveling off, obesity and its individual, societal, and economic costs remain of grave concern. In June 2014, a Diabetes Care Editors' Expert Forum convened to review the state of obesity research and discuss the latest prevention initiatives and behavioral, medical, and surgical therapies. This article, an outgrowth of the forum, offers an expansive view of the obesity epidemic, beginning with a discussion of its root causes. Recent insights into the genetic and physiological factors that influence body weight are reviewed, as are the pathophysiology of obesity-related metabolic dysfunction and the concept of metabolically healthy obesity. The authors address the crucial question of how much weight loss is necessary to yield meaningful benefits. They describe the challenges of behavioral modification and predictors of its success. The effects of diabetes pharmacotherapies on body weight are reviewed, including potential weight-neutral combination therapies. The authors also summarize the evidence for safety and efficacy of pharmacotherapeutic and surgical obesity treatments. The article concludes with an impassioned call for researchers, clinicians, governmental agencies, health policymakers, and health-related industries to collectively embrace the urgent mandate to improve prevention and treatment and for society at large to acknowledge and manage obesity as a serious disease.
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Affiliation(s)
- William T. Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - George A. Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | | | - W. Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO
| | - F. Xavier Pi-Sunyer
- Obesity Research Center, Department of Medicine, Columbia University, New York, NY
| | - Frank B. Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Itamar Raz
- Department of Internal Medicine, Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Luc Van Gaal
- Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - Bruce M. Wolfe
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Donna H. Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
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Van Gaal L, Scheen A. Weight management in type 2 diabetes: current and emerging approaches to treatment. Diabetes Care 2015; 38:1161-72. [PMID: 25998297 DOI: 10.2337/dc14-1630] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetes is a growing global health concern, as is obesity. Diabetes and obesity are intrinsically linked: obesity increases the risk of diabetes and also contributes to disease progression and cardiovascular disease. Although the benefits of weight loss in the prevention of diabetes and as a critical component of managing the condition are well established, weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors. For many patients, lifestyle intervention is not enough to achieve weight loss, and alternative options, such as pharmacotherapy, need to be considered. However, many traditional glucose-lowering medications may lead to weight gain. This article focuses on the potential of currently available pharmacological strategies and on emerging approaches in development to support the glycemic and weight-loss goals of individuals with type 2 diabetes. Two pharmacotherapy types are considered: those developed primarily for blood glucose control that have a favorable effect on body weight and those developed primarily to induce weight loss that have a favorable effect on blood glucose control. Finally, the potential of combination therapies for the management of obese patients with type 2 diabetes is discussed.
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Affiliation(s)
- Luc Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - André Scheen
- Department of Diabetes, Nutrition and Metabolic Disorders and Clinical Pharmacology Unit, University of Liège, Liège, Belgium
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E., Karnal, Haryana, India
| | - S. V. Madhu
- Department of Medicine, University College of Medical Sciences, New Delhi, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
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van de Vyver M, Andrag E, Cockburn IL, Ferris WF. Thiazolidinedione-induced lipid droplet formation during osteogenic differentiation. J Endocrinol 2014; 223:119-32. [PMID: 25210048 DOI: 10.1530/joe-14-0425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic administration of the insulin-sensitising drugs, thiazolidinediones (TZDs), results in low bone mineral density and 'fatty bones'. This is thought to be due, at least in part, to aberrant differentiation of progenitor mesenchymal stem cells (MSCs) away from osteogenesis towards adipogenesis. This study directly compared the effects of rosiglitazone, pioglitazone, and netoglitazone treatment on osteogenesis and adipogenesis in MSCs derived from subcutaneous (SC) or visceral (PV) white adipose tissue. MSCs were isolated from adipose tissue depots of male Wistar rats and characterised using flow cytometry. The effects of TZD treatment on osteogenic and adipogenic differentiation were assessed histologically (day 14) and by quantitative PCR analysis (Pparγ2 (Pparg2), Ap2 (Fabp4), Adipsin (Adps), Msx2, Collagen I (Col1a1), and Alp) on days 0, 7, and 10. Uniquely, lipid droplet formation and mineralisation were found to occur concurrently in response to TZD treatment during osteogenesis. Compared with SC MSCs, PV MSCs were more prone to lipid accumulation under controlled osteogenic and adipogenic differentiation conditions. This study demonstrated that the extent of lipid accumulation is dependent on the nature of the Ppar ligand and that SC and PV MSCs respond differently to in vitro TZD treatment, suggesting that metabolic status can contribute to the adverse effects associated with TZD treatment.
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Affiliation(s)
- M van de Vyver
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa
| | - E Andrag
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa
| | - I L Cockburn
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa
| | - W F Ferris
- Division of EndocrinologyDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa
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Inagaki N, Kondo K, Yoshinari T, Kuki H. Efficacy and safety of canagliflozin alone or as add-on to other oral antihyperglycemic drugs in Japanese patients with type 2 diabetes: A 52-week open-label study. J Diabetes Investig 2014; 6:210-8. [PMID: 25802729 PMCID: PMC4364856 DOI: 10.1111/jdi.12266] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 01/09/2023] Open
Abstract
Aims/Introduction Canagliflozin is a sodium–glucose cotransporter 2 inhibitor under development for the treatment of type 2 diabetes. Our aim was to examine its efficacy and safety as monotherapy or in combination with commonly used oral antihyperglycemic drugs in Japanese patients with type 2 diabetes. Materials and Methods Patients on diet/exercise alone or diet/exercise plus an oral antihyperglycemic drug (sulfonylurea, glinide, α-glucosidase inhibitor, biguanide, thiazolidinedione or dipeptidyl peptidase-4 inhibitor) were randomized to either 100 or 200 mg canagliflozin while continuing prior therapy. Patients were treated for 52 weeks in an open-label manner. Results Canagliflozin significantly reduced hemoglobin A1c, fasting plasma glucose and bodyweight in all the study groups. Improvements were apparent by 4 weeks of treatment, and were maintained for 52 weeks. The reduction in hemoglobin A1c ranged from −0.80 to −1.06%, and from −0.93 to −1.26% in the 100 and 200 mg canagliflozin groups, respectively. Drug-related adverse events occurred in approximately one-third of patients, and included hypoglycemia/asymptomatic hypoglycemia and pollakiuria. Hypoglycemia/asymptomatic hypoglycemia was most common in patients treated with a sulfonylurea. Most adverse events were classified as mild or moderate in severity. Conclusions The results of the present study confirmed that treatment with canagliflozin resulted in significant reductions in glycemic control and bodyweight that were maintained for 52 weeks of treatment irrespective of whether it was administered as monotherapy or in combination with another oral antihyperglycemic drug. Canagliflozin was well tolerated, with a low incidence of drug-related adverse events. This trial was registered with ClinicalTrials.gov (no. NCT01387737).
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Affiliation(s)
- Nobuya Inagaki
- Department of Diabetes Endocrinology and Nutrition, Kyoto University Graduate School of Medicine Kyoto, Japan
| | | | | | - Hideki Kuki
- Mitsubishi Tanabe Pharma Corporation Tokyo, Japan
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Balkau B, Home PD, Vincent M, Marre M, Freemantle N. Factors associated with weight gain in people with type 2 diabetes starting on insulin. Diabetes Care 2014; 37:2108-13. [PMID: 24824546 DOI: 10.2337/dc13-3010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Moderate weight gain is usual after starting insulin therapy. The identification and quantification of factors associated with weight gain may help target strategies for avoidance of weight gain. RESEARCH DESIGN AND METHODS The noninterventional CREDIT (Cardiovascular Risk Evaluation in people with type 2 Diabetes on Insulin Therapy) study included data from people with type 2 diabetes starting any insulin in 314 centers, in 12 countries. From a number of predefined candidate explanatory variables, analyses identified factors associated with weight gain 1 year after starting insulin treatment, after adjusting for investigational site as a random factor. A multivariable backward regression analysis selected a subset of these factors associated with weight gain. RESULTS We studied the 2,179 people with data for body weight change at 1 year and for potential predictive factors. The mean weight gain was 1.78 kg, and 24% gained ≥5.0 kg. Baseline factors associated with weight gain were BMI, A1C, insulin regimen, insulin dose, other glucose-lowering therapies, and hypertension; at 1 year, additional factors were A1C, insulin regimen, insulin dose, and use of other glucose-lowering therapies. In multivariable analysis, weight gain at 1 year was associated with a higher A1C at baseline, a higher insulin dose at baseline and at 1 year, and a lower baseline BMI. CONCLUSIONS By the time insulin was started, a high baseline A1C and insulin dose requirements were independently associated with greater weight gain, as was lower baseline BMI. Insulin regimen per se was not a predictive factor.
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Affiliation(s)
- Beverley Balkau
- INSERM Centre for Research in Epidemiology and Population Health, U1018, Villejuif, FranceUniversity Paris-Sud, URMS 1018, Villejuif, France
| | | | | | - Michel Marre
- INSERM U695, University of Paris 7, Paris, France
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Bloomgarden Z, Handelsman Y. Lessons from glargine trials: what is the goal fasting glucose with basal insulin? J Diabetes 2014; 6:271-3. [PMID: 24656089 DOI: 10.1111/1753-0407.12152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Li CJ, Zhang JY, Yu DM, Zhang QM. Adding glimepiride to current insulin therapy increases high-molecular weight adiponectin levels to improve glycemic control in poorly controlled type 2 diabetes. Diabetol Metab Syndr 2014; 6:41. [PMID: 24650537 PMCID: PMC3994470 DOI: 10.1186/1758-5996-6-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/14/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To observe the efficacy and safety of adding glimepiride to established insulin therapy in poorly controlled type 2 diabetes (T2D) and to assess the relationship of changes in the serum high-molecular weight (HMW) adiponectin levels and glycemic control after glimepiride treatment. METHODS Fifty-six subjects with poorly controlled insulin-treated T2D were randomly assigned to either the glimepiride-added group (the group A, n = 29) or the insulin-increasing group (the group B, n = 27) while continuing current insulin-based therapy. Glycosylated hemoglobin (HbA1c) value, daily insulin dose, body weight, waist circumference, plasma lipid concentration, serum HMW adiponectin level and the number of hypoglycemic events were evaluated before and after treatment. RESULTS At the end of study, insulin doses were significantly reduced, and the mean HbA1c, fasting blood glucose (FBG) and 2-hour postprandial blood glucose (P2BG) were improved greater in the group A compared with the group B. The serum HMW adiponectin levels were significantly increased in the group A compared with the group B. Most importantly, we found that changes in HbA1c were inversely correlated with changes in serum HMW adiponectin in the group A (r = -0.452, p = 0.02). CONCLUSIONS Adding glimepiride to current insulin treatment led to better improvement in glycemic control with a significant smaller daily insulin dose, and the increases in the serum HMW adiponectin levels may directly contribute to improvement glycemic control.
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Affiliation(s)
- Chun-Jun Li
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - Jing-Yun Zhang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - De-Min Yu
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - Qiu-Mei Zhang
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital, Tianjin 300070, China
- Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
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Forst T, Pfützner A. Pharmacological profile, efficacy and safety of lixisenatide in type 2 diabetes mellitus. Expert Opin Pharmacother 2013; 14:2281-96. [DOI: 10.1517/14656566.2013.838559] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Rascati K, Richards K, Lopez D, Cheng LI, Wilson J. Progression to insulin for patients with diabetes mellitus on dual oral antidiabetic therapy using the US Department of Defense Database. Diabetes Obes Metab 2013; 15:901-5. [PMID: 23531154 DOI: 10.1111/dom.12103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/14/2013] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare 'progression to insulin' for three cohorts on oral antidiabetic medication combinations: metformin/sulphonylurea (Met/SU), metformin/thiazolidinedione (Met/TZD) and sulphonylurea/thiazolidinedione (SU/TZD). METHODS Retrospective cohort analysis design was used. The subjects were US nationwide members of military and their families. A total of 5608 patients who were on antidiabetic monotherapy for at least 1 year before adding a second agent to their medication regimen between October 2001 and September 2008 participated in this study. Mean age ranged from 64 to 71 years among the cohorts. Cox regression compared the progression to insulin, adjusting for demographics, months of follow-up and co-morbidities [measured with Chronic Disease Score (CDS)]. RESULTS By the end of the 2- to 6-year follow-up period, 14.3% of the Met/TZD cohort, 23.6% of the Met/SU cohort and 28.2% of the SU/TZD cohort had insulin added to their regimen. Those in the Met/SU cohort had a 1.8 times higher probability of progression to insulin than those in the Met/TZD cohort [odds ratio (OR) = 1.80, 95% confidence interval (CI) = 1.51-2.14), and those in the SU/TZD cohort had a 2.5 times higher probability of progression to insulin than those in the Met/TZD cohort (OR = 2.51, 95% CI = 2.04-3.08). CONCLUSION When sensitizers were paired (Met/TZD), a lower percentage of patients progressed to insulin during the study period, as opposed to patients who used a combination of a secretagogue with a sensitizer (SU/TZD or Met/SU).
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Affiliation(s)
- K Rascati
- Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, TX, USA
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Bodegard J, Sundström J, Svennblad B, Östgren CJ, Nilsson PM, Johansson G. Changes in body mass index following newly diagnosed type 2 diabetes and risk of cardiovascular mortality: a cohort study of 8486 primary-care patients. DIABETES & METABOLISM 2013; 39:306-13. [PMID: 23871502 DOI: 10.1016/j.diabet.2013.05.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/25/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
AIMS Elevated body mass index (BMI) is associated with an increased risk of type 2 diabetes and cardiovascular disease (CVD). This study explored the association between BMI changes in the first 18 months of newly diagnosed type 2 diabetes and the risk of long-term CVD mortality. METHODS A total of 8486 patients with newly diagnosed type 2 diabetes and no previous history of CVD or cancer were identified from 84 primary-care centres in Sweden. During the first year after diagnosis, patients were grouped according to BMI change: 'Increase', or ≥+1 BMI unit; 'unchanged', or between +1 and-1 BMI unit; and 'decrease', or ≤-1 BMI unit. Associations between BMI change and CVD mortality, defined as death from stroke, myocardial infarction or sudden death, were estimated using adjusted Cox proportional hazards models (NCT 01121315). RESULTS Baseline mean age was 60.0 years and mean BMI was 30.2kg/m(2). Patients were followed for up to 9 years (median: 4.6 years). During the first 18 months, 53.4% had no change in their BMI, while 32.2% decreased and 14.4% increased. Compared with patients with unchanged BMI, those with an increased BMI had higher risks of CVD mortality (hazard ratio: 1.63, 95% CI: 1.11-2.39) and all-cause mortality (1.33, 1.01-1.76). BMI decreases had no association with these risks compared with unchanged BMI: 1.06 (0.76-1.48) and 1.06 (0.85-1.33), respectively. CONCLUSION Increased BMI within the first 18 months of type 2 diabetes diagnosis was associated with an increased long-term risk of CVD mortality. However, BMI decrease did not lower the long-term risk of mortality.
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Affiliation(s)
- J Bodegard
- Department of Medicine, AstraZeneca AB, Karlebyhus, 151 85 Södertälje, Sweden.
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Ridderstråle M, Jensen MM, Gjesing RP, Niskanen L. Cost-effectiveness of insulin detemir compared with NPH insulin in people with type 2 diabetes in Denmark, Finland, Norway, and Sweden. J Med Econ 2013; 16:468-78. [PMID: 23384160 DOI: 10.3111/13696998.2013.768999] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of insulin detemir compared with Neutral Protamine Hagedorn (NPH) insulin when initiating insulin treatment in people with type 2 diabetes mellitus (T2DM) in Denmark, Finland, Norway, and Sweden. METHODS Efficacy and safety data were derived from a 20-week multi-centre randomized controlled head-to-head clinical trial comparing insulin detemir and NPH insulin in insulin naïve people with T2DM, and short-term (1-year) cost effectiveness analyses were performed. As no significant differences in HbA1c were observed between the two treatment arms, the model was based on significant differences in favour of insulin detemir in frequency of hypoglycaemia (Rate-Ratio = 0.52; CI = 0.44-0.61) and weight gain (Δ = 0.9 kg). Model outcomes were measured in Quality Adjusted Life Years (QALYs) using published utility estimates. Acquisition costs for insulin and direct healthcare costs associated with non-severe hypoglycaemic events were obtained from National Health Service public sources. One-way and probabilistic sensitivity analyses were performed. RESULTS Based on lower incidence of non-severe hypoglycaemic events and less weight gain, the QALY gain from initiating treatment with insulin detemir compared with NPH insulin was 0.01 per patient per year. Incremental cost-effectiveness ratios for the individual countries were: Denmark, Danish Kroner 170,852 (€22,933); Finland, €28,349; Norway, Norwegian Kroner 169,789 (€21,768); and Sweden, Swedish Krona 226,622 (€25,097) per QALY gained. Possible limitations of the study are that data on hypoglycaemia and relative weight benefits from a clinical trial were combined with hypoglycaemia incidence data from observational studies. These populations may have slightly different patient characteristics. CONCLUSIONS The lower risk of non-severe hypoglycaemia and less weight gain associated with using insulin detemir compared with NPH insulin when initiating insulin treatment in insulin naïve patients with type 2 diabetes provide economic benefits in the short-term. Based on cost/QALY threshold values, this represents good value for money in the Nordic countries. Using a short-term modelling approach may be conservative, as reduced frequency of hypoglycaemia and less weight gain may also have positive long-term health-related implications.
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