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Chen M, Weissglass D, Li C, Li D, Wu Z, Zhang L. A multisectoral and multidisciplinary endeavor: a review of diabetes self-management apps in China. BMC Public Health 2023; 23:1859. [PMID: 37749494 PMCID: PMC10521460 DOI: 10.1186/s12889-023-16735-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND While the use of self-management apps has considerable promise to efficiently reduce the diabetes burden that disproportionally affects low- and middle-income countries (LMICs), and the multisectoral and multidisciplinary approaches have been encouraged to be used in diabetes management, little is known about the status of the integration of these approaches in the existing diabetes self-management apps. This review examines the diabetes apps in China as an indication of the current status of integrating multisectoral and multidisciplinary approaches in diabetes mHealth care in LMICs. METHODS Eligible diabetes apps were searched on major Chinese app stores up to December 23, 2022. The app comprehensiveness index (ranging 0-80) regarding the app functions and diabetes management domains was created. The multisectoral and multidisciplinary features were summarized using indices derived from current guidance. RESULTS Sixty-six apps were reviewed, all developed by private companies. The average comprehensiveness score was 16, with many major self-management domains and functions not represented among the reviewed apps. Forty apps (61%) involved multiple sectoral entities, with public/private and private/private collaborations being the most common collaborative combinations. Thirty-seven apps (56%) involved multiple disciplines, among which endocrinology/metabolism, nutrition, and cardiovascular medicine were the top three most common disciplines. Compared to non-multidisciplinary apps, multidisciplinary apps tended to provide more comprehensive services in apps (6.14 vs. 5.18, p = 0.0345). Different sectors and disciplines tended to work independently, without robust interactions, in providing diabetes management services in the reviewed apps. CONCLUSION Multisectoral and multidisciplinary features has presented in the current diabetes self-management apps in China; however, it is still in its infancy and significant limitations existed. More engagement of civil society organizations and community groups and innovative collaborations between sectors and disciplines are needed to provide comprehensive, continuous, and patient-centered mHealth care for patients with diabetes in LMICs like China. Clear guidance for integrating and evaluating the multisectoral and multidisciplinary efforts in self-management apps is necessary to ensure the effective use of mHealth solutions for diabetes management in LMICs.
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Affiliation(s)
- Meifang Chen
- Division of Social Science, Global Health Research Center, Duke Kunshan University, 8 Duke Avenue, Suzhou, 215316, Jiangsu, China.
| | - Daniel Weissglass
- Division of Arts and Humanities, Duke Kunshan University, 8 Duke Avenue, Suzhou, Jiangsu, China
| | - Chengyi Li
- Duke Kunshan University, 8 Duke Avenue, Suzhou, Jiangsu, China
| | - Di Li
- Duke Kunshan University, 8 Duke Avenue, Suzhou, Jiangsu, China
| | - Zixuan Wu
- Duke Kunshan University, 8 Duke Avenue, Suzhou, Jiangsu, China
| | - Li Zhang
- Department of Endocrinology, The First People's Hospital of Kunshan, 188 Jijie St., Suzhou, Jiangsu, China
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Santos S, Pentzek M, Altiner A, Daubmann A, Drewelow E, Helbig C, Löffler C, Löscher S, Wegscheider K, Abholz HH, Wilm S, Wollny A. HbA1c as a shared treatment goal in type 2 diabetes? A secondary analysis of the DEBATE trial. BMC PRIMARY CARE 2023; 24:115. [PMID: 37173620 PMCID: PMC10182591 DOI: 10.1186/s12875-023-02067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major health problem in the western world. Despite a widespread implementation of integrated care programs there are still patients with poorly controlled T2DM. Shared goal setting within the process of Shared Decision Making (SDM) may increase patient's compliance and adherence to treatment regimen. In our secondary analysis of the cluster-randomized controlled DEBATE trial, we investigated if patients with shared vs. non-shared HbA1c treatment goal, achieve their glycemic goals. METHODS In a German primary care setting, we collected data before intervention at baseline, 6, 12 and 24 months. Patients with T2DM with an HbA1c ≥ 8.0% (64 mmol/mol) at the time of recruitment and complete data at baseline and after 24 months were eligible for the presented analyses. Using a generalized estimating equation analysis, we analysed the association between the achievement of HbA1c goals at 24 months based on their shared vs. non-shared status, age, sex, education, partner status, controlled for baseline HbA1c and insulin therapy. RESULTS From N = 833 recruited patients at baseline, n = 547 (65.7%) from 105 General Practitioners (GPs) were analysed. 53.4% patients were male, 33.1% without a partner, 64.4% had a low educational level, mean age was 64.6 (SD 10.6), 60.7% took insulin at baseline, mean baseline HbA1c was 9.1 (SD 1.0). For 287 patients (52.5%), the GPs reported to use HbA1c as a shared goal, for 260 patients (47.5%) as a non-shared goal. 235 patients (43.0%) reached the HbA1c goal after two years, 312 patients (57.0%) missed it. Multivariable analysis shows that shared vs. non-shared HbA1c goal setting, age, sex, and education are not associated with the achievement of the HbA1c goal. However, patients living without a partner show a higher risk of missing the goal (p = .003; OR 1.89; 95% CI 1.25-2.86). CONCLUSIONS Shared goal setting with T2DM patients targeting on HbA1c-levels had no significant impact on goal achievement. It may be assumed, that shared goal setting on patient-related clinical outcomes within the process of SDM has not been fully captured yet. TRIAL REGISTRATION The trial was registered at ISRCTN registry under the reference ISRCTN70713571.
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Affiliation(s)
- Sara Santos
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Michael Pentzek
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Institute of General Practice and Primary Care, Chair of General Practice II and Patient Centredness in Primary Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christian Helbig
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Susanne Löscher
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Heinz-Harald Abholz
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
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Kellerer M, Kaltoft MS, Lawson J, Nielsen LL, Strojek K, Tabak Ö, Jacob S. Effect of once-weekly semaglutide versus thrice-daily insulin aspart, both as add-on to metformin and optimized insulin glargine treatment in participants with type 2 diabetes (SUSTAIN 11): A randomized, open-label, multinational, phase 3b trial. Diabetes Obes Metab 2022; 24:1788-1799. [PMID: 35546450 PMCID: PMC9545869 DOI: 10.1111/dom.14765] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 01/10/2023]
Abstract
AIM To compare the efficacy and safety of once-weekly (OW) semaglutide versus thrice-daily (TID) insulin aspart (IAsp) in participants with inadequately controlled type 2 diabetes (T2D) treated with insulin glargine (IGlar) and metformin. MATERIALS AND METHODS SUSTAIN 11 (NCT03689374) was a randomized (1:1), parallel, open-label, multinational, phase 3b trial. After a 12-week run-in to optimize once-daily IGlar U100, 1748 adults with T2D (HbA1c >7.5% to ≤10.0%) were randomized to OW semaglutide or TID IAsp as add-on to optimized IGlar and metformin for 52 weeks. The primary outcome was change in HbA1c from randomization to week 52. Confirmatory secondary endpoints included the occurrence of severe hypoglycaemic episodes and change in body weight (BW). Safety was assessed. RESULTS HbA1c (randomization: 8.6% [70.0 mmol/mol]) decreased by 1.5% points (16.6 mmol/mol) and 1.2% points (13.4 mmol/mol) with semaglutide (n = 874) and IAsp (n = 874), respectively (estimated treatment difference [ETD] -0.29% points [95% confidence interval {CI} -0.38; -0.20]; P < .0001 for non-inferiority). Few severe hypoglycaemic episodes were recorded in either group, with no statistically significant difference between the groups. Change in BW from randomization (87.9 kg) to week 52 was in favour of semaglutide (-4.1 kg) versus IAsp (+2.8 kg) (ETD -6.99 kg [95% CI -7.41; -6.57]). A higher proportion of participants experienced adverse events with semaglutide (58.5%) versus IAsp (52.1%); most were mild to moderate. CONCLUSIONS In this basal insulin-treated population, OW semaglutide improved glycaemic control to a greater extent than TID IAsp and provided numerically greater weight loss.
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Affiliation(s)
- Monika Kellerer
- Centre for Internal Medicine IMarienhospitalStuttgartGermany
| | | | | | | | - Krzysztof Strojek
- Department of Internal Diseases Diabetology and Cardiometabolic Diseases, Faculty of Medical Sciences in ZabrzeMedical University of SilesiaKatowicePoland
| | - Ömür Tabak
- Istanbul Kanuni Sultan Suleyman Education and Research HospitalIstanbulTurkey
| | - Stephan Jacob
- Department of Internal Medicine, Division of Endocrinology/DiabetologyCardiometabolic InstituteVillingen‐SchwenningenGermany
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Lee S, Zhou J, Wong WT, Liu T, Wu WKK, Wong ICK, Zhang Q, Tse G. Glycemic and lipid variability for predicting complications and mortality in diabetes mellitus using machine learning. BMC Endocr Disord 2021; 21:94. [PMID: 33947391 PMCID: PMC8097996 DOI: 10.1186/s12902-021-00751-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Recent studies have reported that HbA1c and lipid variability is useful for risk stratification in diabetes mellitus. The present study evaluated the predictive value of the baseline, subsequent mean of at least three measurements and variability of HbA1c and lipids for adverse outcomes. METHODS This retrospective cohort study consists of type 1 and type 2 diabetic patients who were prescribed insulin at outpatient clinics of Hong Kong public hospitals, from 1st January to 31st December 2009. Standard deviation (SD) and coefficient of variation were used to measure the variability of HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride. The primary outcome is all-cause mortality. Secondary outcomes were diabetes-related complications. RESULT The study consists of 25,186 patients (mean age = 63.0, interquartile range [IQR] of age = 15.1 years, male = 50%). HbA1c and lipid value and variability were significant predictors of all-cause mortality. Higher HbA1c and lipid variability measures were associated with increased risks of neurological, ophthalmological and renal complications, as well as incident dementia, osteoporosis, peripheral vascular disease, ischemic heart disease, atrial fibrillation and heart failure (p < 0.05). Significant association was found between hypoglycemic frequency (p < 0.0001), HbA1c (p < 0.0001) and lipid variability against baseline neutrophil-lymphocyte ratio (NLR). CONCLUSION Raised variability in HbA1c and lipid parameters are associated with an elevated risk in both diabetic complications and all-cause mortality. The association between hypoglycemic frequency, baseline NLR, and both HbA1c and lipid variability implicate a role for inflammation in mediating adverse outcomes in diabetes, but this should be explored further in future studies.
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Affiliation(s)
- Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, China
- Medicines Optimisation Research and Education (CMORE), UCL School of Pharmacy, London, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
| | - Gary Tse
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China.
- Medicines Optimisation Research and Education (CMORE), UCL School of Pharmacy, London, UK.
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK.
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Consoli A, Czupryniak L, Duarte R, Jermendy G, Kautzky-Willer A, Mathieu C, Melo M, Mosenzon O, Nobels F, Papanas N, Roman G, Schnell O, Sotiropoulos A, Stehouwer CDA, Tack CJ, Woo V, Fadini GP, Raz I. Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel. Diabetes Obes Metab 2020; 22:1705-1713. [PMID: 32476244 DOI: 10.1111/dom.14102] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Because newer agents offer several advantages, whether and when sulphonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The current consensus paper aims to provide additional guidance on the use of SUs in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second-line treatment after metformin and are often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that sodium-glucose co-transporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with low hypoglycaemia risk, promote weight loss, and exert a positive impact on vascular, cardiac and renal endpoints. Thus, using SUs in place of SGLT-2is and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT-2is and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second-line agents continues to be acceptable in resource-constrained settings.
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Affiliation(s)
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Rui Duarte
- Associação Protectora dos Diabéticos de Portugal (APDP), Lisbon, Portugal
| | | | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, University and Hospital Center of Coimbra, Coimbra, Portugal
- Medical Faculty, University of Coimbra, Coimbra, Portugal
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, The Faculty of Medicine, Jerusalem, Israel
| | | | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Gabriela Roman
- "Iuliu Hatieganu" University of Medicine & Pharmacy, Clinical Centre of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania
| | - Oliver Schnell
- Forschergruppe Diabetes e.V., Helmholtz Centre, Munich, Germany
| | | | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vincent Woo
- Section of Endocrinology and Metabolism, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Itamar Raz
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, The Faculty of Medicine, Jerusalem, Israel
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Kolesnik E, Krainer T, Wallner M, Djalinac N, Verheyen N, Ablasser K, Eaton DM, Rainer PP, Pelzmann B, von Lewinski D. Myocardial GLP-1 Receptor Activation in the Presence of Glucose: Strong Partners. Int J Pept Res Ther 2019. [DOI: 10.1007/s10989-018-9706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Development of sodium glucose co-transporter 2 (SGLT2) inhibitors with novel structure by molecular docking and dynamics simulation. J Mol Model 2019; 25:175. [PMID: 31154518 DOI: 10.1007/s00894-019-4067-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 05/17/2019] [Indexed: 01/09/2023]
Abstract
In this study, molecular docking studies were carried out to explore the binding interactions of sodium glucose co-transporter 2 (SGLT2) with its inhibitors. A correlation between the docking scores and the experimental bioactivity was observed (R2 = 0.8368, N = 24). The new inhibitors were designed using the 3D quantitative structure activity relationship (3D-QSAR) method, and the activities were predicted by the docking method. In order to understand the structure-activity correlation of compound 1 m (the highest score of docking) and compound 1 t (the lowest score), we carried out a combined molecular dynamics simulation and MM-GBSA method. It was found that, in the system of SGLT2-1 m, the interaction between Gln271 and Val272 exhibited significant effects, which were absent in the SGLT2-1 t system. This study is expected to shed light on the mechanism of action of compound 1 m, leading to development of active drug candidates targeting SGLT2.
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Rodbard HW, Bellary S, Hramiak I, Seino Y, Silver R, Damgaard LH, Nayak G, Zacho J, Aroda VR. Greater Combined Reductions in Hba1C ≥1.0% and Weight ≥5.0% with Semaglutide Versus Comparators in type 2 Diabetes. Endocr Pract 2019; 25:589-597. [DOI: 10.4158/ep-2018-0444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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9
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DeVries JH, Desouza C, Bellary S, Unger J, Hansen OKH, Zacho J, Woo V. Achieving glycaemic control without weight gain, hypoglycaemia, or gastrointestinal adverse events in type 2 diabetes in the SUSTAIN clinical trial programme. Diabetes Obes Metab 2018; 20:2426-2434. [PMID: 29862621 PMCID: PMC6175309 DOI: 10.1111/dom.13396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the potential for semaglutide to help people with type 2 diabetes (T2D) achieve glycated haemoglobin (HbA1c) targets while avoiding unwanted outcomes, such as weight gain, hypoglycaemia and gastrointestinal (GI) side effects. MATERIALS AND METHODS Data from the phase IIIa SUSTAIN 1 to 5 clinical trials were analysed. Participants had inadequately controlled T2D and were drug-naïve (SUSTAIN 1) or on a range of background treatments (SUSTAIN 2 to 5). The main protocol-specified composite endpoint was the proportion of participants achieving HbA1c <53 mmol/mol (7.0%) at end of treatment (30 or 56 weeks) without weight gain and with no severe or blood glucose (BG)-confirmed symptomatic hypoglycaemia. A post hoc composite endpoint was the proportion of participants achieving the primary composite endpoint without moderate or severe GI adverse events (AEs). RESULTS Across the SUSTAIN trials 1 to 5, 3918 participants with T2D were randomized to once-weekly subcutaneous semaglutide 0.5 mg, 1.0 mg, or comparators (placebo, sitagliptin 100 mg, exenatide extended release 2.0 mg or insulin glargine). The proportion of participants achieving HbA1c <53 mmol/mol (7.0%) with no weight gain and no severe/BG-confirmed symptomatic hypoglycaemia was 47% to 66% (semaglutide 0.5 mg) and 57% to 74% (semaglutide 1.0 mg) vs 7% to 19% (placebo) and 16% to 29% (active comparators; all P < .0001). More participants achieved the primary composite endpoint with no moderate or severe GI AEs with semaglutide vs comparators (all P < .0001). CONCLUSION Semaglutide helped more people with T2D achieve HbA1c targets than did comparators in the SUSTAIN 1 to 5 trials, while avoiding unwanted outcomes such as weight gain, hypoglycaemia and GI side effects.
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Affiliation(s)
- J. Hans DeVries
- Department of EndocrinologyAcademic Medical CentreAmsterdamThe Netherlands
- Profil Institute for Metabolic ResearchNeussGermany
| | - Cyrus Desouza
- Division of Diabetes Endocrinology & MetabolismUniversity of Nebraska Medical CenterOmahaNebraska
| | | | - Jeffrey Unger
- Director, Metabolic StudiesCatalina Research InstituteChino, California
| | | | | | - Vincent Woo
- Section of Endocrinology and Metabolism, Health Sciences CentreUniversity of ManitobaWinnipegCanada
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10
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Warren M, Chaykin L, Trachtenbarg D, Nayak G, Wijayasinghe N, Cariou B. Semaglutide as a therapeutic option for elderly patients with type 2 diabetes: Pooled analysis of the SUSTAIN 1-5 trials. Diabetes Obes Metab 2018; 20:2291-2297. [PMID: 29687620 PMCID: PMC6099273 DOI: 10.1111/dom.13331] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 01/22/2023]
Abstract
The efficacy and safety of semaglutide vs comparators in non-elderly (<65 years) and elderly (≥65 years) patients with type 2 diabetes (T2D) across the SUSTAIN 1-5 trials were evaluated. Patients were randomized to once-weekly subcutaneous semaglutide (0.5 or 1.0 mg) vs placebo, sitagliptin, exenatide or insulin. The primary objective was change in HbA1c and secondary objectives were changes in body weight and safety. Mean HbA1c decreased from baseline by 1.2%-1.5% and 1.5%-1.9% vs 0%-0.9% (non-elderly, n = 3045) and by 1.3%-1.5% and 1.2%-1.8% vs 0.2%-1.0% (elderly, n = 854) with semaglutide 0.5 and 1.0 mg vs comparators. Similar reductions from baseline in mean body weight with semaglutide occurred in both age groups. Similar proportions of patients experienced adverse events; premature treatment discontinuations were higher in elderly vs non-elderly patients. No increased risk of severe or blood glucose-confirmed hypoglycaemia was seen with semaglutide vs comparators between age groups. Semaglutide had a comparable efficacy and safety profile in non-elderly and elderly patients across the SUSTAIN 1-5 trials, making it an effective treatment option for elderly patients with T2D.
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Affiliation(s)
| | | | | | | | | | - Bertrand Cariou
- L'Institut du Thorax, Department of EndocrinologyCHU de NantesNantesFrance
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11
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Haselgrübler R, Stübl F, Stadlbauer V, Lanzerstorfer P, Weghuber J. An In Ovo Model for Testing Insulin-mimetic Compounds. J Vis Exp 2018:57237. [PMID: 29733303 PMCID: PMC6100700 DOI: 10.3791/57237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Elevated blood glucose levels in type 2 diabetes mellitus (T2DM), a complex and multifactorial metabolic disease, are caused by insulin resistance and β-cell failure. Various strategies, including the injection of insulin or the usage of insulin-sensitizing drugs, were pursued to treat T2DM or at least reduce the symptoms. In addition, the application of herbal compounds has attracted increasing attention. Thus, it is necessary to find efficient test systems to identify and characterize insulin-mimetic compounds. Here we developed a modified chick embryo model, which enables testing of synthetic compounds and herbal extracts with insulin-mimetic properties. Using a fluorescence microscopy-based primary screen, which quantifies the translocation of Glucose transporter 4 (Glut4) to the plasma membrane, we were able to identify compounds, mainly herbal extracts, which lead to an increase of intracellular glucose concentrations in adipocytes. However, the efficacy of these substances requires further verification in a living organism. Thus, we used an in-ovo approach to identify their blood glucose-reducing properties. The approval by an ethics committee is not needed since the use of chicken embryos during the first two-thirds of embryonic development is not considered an animal experiment. Here, the application of this model is described in detail.
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Affiliation(s)
| | - Flora Stübl
- University of Applied Sciences Upper Austria
| | - Verena Stadlbauer
- University of Applied Sciences Upper Austria; Austrian Competence Center for Feed and Food Quality, Safety and Innovation
| | | | - Julian Weghuber
- University of Applied Sciences Upper Austria; Austrian Competence Center for Feed and Food Quality, Safety and Innovation;
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12
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Schmieder RE, Tschöpe D, Koch C, Ouarrak T, Gitt AK. Individualised treatment targets in patients with type-2 diabetes and hypertension. Cardiovasc Diabetol 2018; 17:18. [PMID: 29357854 PMCID: PMC5778654 DOI: 10.1186/s12933-018-0661-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
Aim Patients with type-2 diabetes mellitus (T2DM) are at high risk of cardiovascular events, accentuated in the presence of hypertension. At present, it is unclear to what extent the guidelines for the management of T2DM, advocating reduction in HbA1c levels to below target levels, are being adhered to in clinical practice. Methods DIALOGUE was a prospective, observational, non‐interventional registry performed across multiple centres in Germany. Patients aged 18 years or older who had T2DM and hypertension for whom the treating physician considered blood glucose lowering medication as inadequate and/or not safe/tolerable and chose to add a further oral drug or switch drug treatment were included. Patients were assigned a treatment target HbA1c value (≤ 6.5% [strict]; > 6.5 to ≤ 7.0% [intermediate]; > 7.0 to ≤ 7.5% [lenient]). Results 8568 patients with T2DM and hypertension were enrolled. 6691 (78.1%) had 12-month follow-up. Patients who were assigned a strict HbA1c treatment target (n = 2644) were younger, had shorter diabetes duration, and less comorbidity in comparison to those with intermediate (n = 2912) or lenient targets (n = 1135). Only 53.1% of patients achieved their HbA1c treatment target (46.2% [strict], 56.8% [intermediate], 59.4% [lenient]). There was little sign of treatment intensification for patients that had not achieved their HbA1c target. Conclusions Achievement of treatment targets was poor, leaving many patients with sub-optimal blood glucose levels. The apparent reluctance of physicians to intensify antidiabetic drug therapy is alarming, especially considering the evidence pointing to an association of hyperglycaemia and microvascular complications in patients with T2DM. Electronic supplementary material The online version of this article (10.1186/s12933-018-0661-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roland E Schmieder
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Diethelm Tschöpe
- Diabeteszentrum am Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | | | | | - Anselm K Gitt
- Institut für Herzinfarktforschung, Ludwigshafen, Germany.,Medizinische Klinik B, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
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13
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Lahiri SW. Personalizing Type 2 Diabetes Management: Use of a Patient-Centered Approach to Individualizing A1C Goals and Pharmacological Regimens. Clin Diabetes 2017; 35:321-328. [PMID: 29263575 PMCID: PMC5734170 DOI: 10.2337/cd17-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients' individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients' behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.
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Affiliation(s)
- Sharon W Lahiri
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Hospital, Detroit, MI
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14
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Gluc-HET, a complementary chick embryo model for the characterization of antidiabetic compounds. PLoS One 2017; 12:e0182788. [PMID: 28777818 PMCID: PMC5544204 DOI: 10.1371/journal.pone.0182788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 07/24/2017] [Indexed: 01/01/2023] Open
Abstract
Insulin resistance and β cell failure are the main causes of elevated blood glucose levels in Type 2 diabetes mellitus (T2DM), a complex and multifactorial metabolic disease. Several medications to treat or reduce the symptoms of T2DM are used, including the injection of insulin and the application of insulin sensitizing or glucose production reducing drugs. Furthermore, the use of phytochemicals has attracted increasing attention for the therapy and prevention of T2DM. In order to identify and characterize antidiabetic compounds, efficient test systems are required. Here we present a modified chick embryo model (hens egg test, HET), which has originally been developed to determine the potential irritancy of chemicals, as a versatile tool for the characterization of phytochemicals with antidiabetic properties. We termed this modified assay variation Gluc-HET. More precisely, we determined the influence of variations in the incubation time of the fertilized eggs and studied the effects of different buffer parameters, such as the temperature, composition and volume, used for drug application. In addition, we tested several putative antidiabetic plant extracts, which have been identified in an in-vitro primary screening procedure, for their effectiveness in reducing blood glucose levels in-ovo. Taken together, our Gluc-HET model has proven to be a reliable and manageable system for the characterization of antidiabetic compounds.
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15
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He M, Gao J, Liu W, Tang X, Tang S, Long Q. Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China. BMC Health Serv Res 2017; 17:129. [PMID: 28187724 PMCID: PMC5303217 DOI: 10.1186/s12913-017-2039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022] Open
Abstract
Background Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. Methods A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants’ demographic and socio-economic characteristics and outcome measures. Results Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests. Conclusions Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.
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Affiliation(s)
- Miao He
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Jiaqi Gao
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Weiwei Liu
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China
| | - Xiaojun Tang
- School of Public Health and Management, Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, Yuzhong district, 400016, People's Republic of China.
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Qian Long
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
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16
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McGill M, Blonde L, Chan JCN, Khunti K, Lavalle FJ, Bailey CJ. The interdisciplinary team in type 2 diabetes management: Challenges and best practice solutions from real-world scenarios. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 7:21-27. [PMID: 29067246 PMCID: PMC5651292 DOI: 10.1016/j.jcte.2016.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/03/2022]
Abstract
Interdisciplinary teams (IDTs) should aim to implement a patient-centred approach. IDTs can enable improved glycaemic control and reduced cardiometabolic risk. Successful IDTs require strong leadership, good communication and shared goals.
The Global Partnership for Effective Diabetes Management has previously recommended the implementation of an interdisciplinary team (IDT) approach to type 2 diabetes (T2DM) management as one of 10 practical steps for health care professionals to help more people achieve their glycaemic goal. This article discusses some of the key contributors to success and also the challenges faced when applying IDT care, by examining case studies and examples from around the world. The real-world practices discussed show that implementing successful interdisciplinary care in diabetes is possible despite significant barriers such as established hierarchal structures and financial resource constraints. Instituting collaborative, integrated working relationships among multiple disciplines under strong leadership, together with enhanced and active communication and improved patient access to appropriate specialties is essential. Patients have a crucial role in the management of their own disease and including them as part of the treatment team is also critical. IDTs in diabetes care improve patient outcomes in terms of control of glycaemia and cardiometabolic risk factors, and decreased risk of diabetes complications. Ensuring access to an appropriate IDT, in whatever form, is paramount to enable the best care to be delivered.
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Affiliation(s)
- Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Centre, New Orleans, LA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Fernando J Lavalle
- Departamento de Medicina Interna, Hospital Universitario Dr. José Eleuterio, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Clifford J Bailey
- School of Life and Health Sciences, Aston University, Birmingham, UK
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17
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Felton AM, LaSalle J, McGill M. Treatment urgency: The importance of getting people with type 2 diabetes to target promptly. Diabetes Res Clin Pract 2016; 117:100-3. [PMID: 27329028 DOI: 10.1016/j.diabres.2016.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/04/2016] [Accepted: 04/16/2016] [Indexed: 11/21/2022]
Abstract
The burgeoning population of individuals with type 2 diabetes provides challenges for management in terms of risk of diabetes-related complications. Early, intensive glycemic control particularly in newly-diagnosed people with type 2 diabetes has been shown to be beneficial in terms of reducing diabetic complications, indeed various national and international guidelines now routinely recommend intensive blood glucose control as an essential element of type 2 diabetes management. However, despite this, current management of glycemia is suboptimal and not enough people achieve their glucose targets worldwide. The Global Partnership for Effective Diabetes Management believe that an improved understanding of these contributing factors should enable the development of practice and guidance that will promote a drive toward better quality clinical outcomes.
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Affiliation(s)
| | - James LaSalle
- Medical Arts Research Collaborative, Excelsior Springs, MO, USA
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
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18
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Abstract
Personalized medicine aims at better targeting therapeutic intervention to the individual to maximize benefit and minimize harm. Type 2 diabetes (T2D) is a heterogeneous disease from a genetic, pathophysiological and clinical point of view. Thus, the response to any antidiabetic medication may considerably vary between individuals. Numerous glucose-lowering agents, with different mechanisms of action, have been developed, a diversified armamentarium that offers the possibility of a patient-centred therapeutic approach. In the current clinical practice, a personalized approach is only based upon phenotype, taking into account patient and disease individual characteristics. If this approach may help increase both efficacy and safety outcomes, there remains considerable room for improvement. In recent years, many efforts were taken to identify genetic and genotype SNP's (Single Nucleotide Polymorphism's) variants that influence the pharmacokinetics, pharmacodynamics, and ultimately the therapeutic response of oral glucose-lowering drugs. This approach mainly concerns metformin, sulphonylureas, meglitinides and thiazolidinediones, with only scarce data concerning gliptins and gliflozins yet. However, the contribution of pharmacogenetics and pharmacogenomics to personalized therapy still needs to mature greatly before routine clinical implementation is possible. This review discusses both opportunities and challenges of precision medicine and how this new paradigm may lead to a better individualized treatment of T2D.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, Liège, Belgium; Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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19
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Colca JR. The TZD insulin sensitizer clue provides a new route into diabetes drug discovery. Expert Opin Drug Discov 2015; 10:1259-70. [DOI: 10.1517/17460441.2015.1100164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Lavernia F, Adkins SE, Shubrook JH. Use of oral combination therapy for type 2 diabetes in primary care: Meeting individualized patient goals. Postgrad Med 2015; 127:808-17. [DOI: 10.1080/00325481.2015.1085293] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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21
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Brunton SA. The potential role of sodium glucose co-transporter 2 inhibitors in the early treatment of type 2 diabetes mellitus. Int J Clin Pract 2015; 69:1071-87. [PMID: 26147213 PMCID: PMC4758393 DOI: 10.1111/ijcp.12675] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sodium glucose co-transporter 2 (SGLT2) inhibitors are a new class of pharmacologic agents developed for the treatment of type 2 diabetes mellitus (T2DM). Their unique mechanism of action is independent of pancreatic beta-cell function or the degree of insulin resistance, giving these agents the potential for use in combination with any of the existing classes of glucose-lowering agents, including insulin. This makes SGLT2 inhibitors an option for patients with long-standing T2DM, but they also have a promising role for early intervention in T2DM, and that role is explored in this review. METHODS A literature search was performed to identify relevant English language articles relating to SGLT2 inhibitors, particularly dapagliflozin, canagliflozin and empagliflozin. RESULTS Clinical trials of dapagliflozin, canagliflozin and empagliflozin, given as monotherapy or in combination with other glucose-lowering agents, reported clinically significant improvements in glycaemic control, body weight and systolic blood pressure. SGLT2 inhibitors were well tolerated and had a generally favourable safety profile. Few serious adverse events have been reported to date. The frequency of hypoglycaemic events was low, similar to that of placebo, and the choice of co-administered glucose-lowering agent was the major determinant of hypoglycaemic risk. Increased genital and urinary tract infections were consistently reported with SGLT2 inhibitors. CONCLUSIONS SGLT2 inhibitors, with their unique insulin-independent mode of action, could have a significant impact on the early management of T2DM, by addressing some of the specific risk factors associated with this disease. SGLT2 inhibitors induce beneficial changes in a number of cardiovascular risk factors, such as lowering blood pressure and body weight, in addition to improved glycaemic control, although information on clinical cardiovascular outcomes is currently limited.
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Affiliation(s)
- S A Brunton
- Primary Care Metabolic Group, Charlotte, NC, USA
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22
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Kajbaf F, De Broe ME, Lalau JD. Therapeutic Concentrations of Metformin: A Systematic Review. Clin Pharmacokinet 2015; 55:439-59. [DOI: 10.1007/s40262-015-0323-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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23
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Weng J, Retnakaran R, Ariachery C A, Ji L, Meneghini L, Yang W, Woo JT. Short-term intensive insulin therapy at diagnosis in type 2 diabetes: plan for filling the gaps. Diabetes Metab Res Rev 2015; 31:537-44. [PMID: 25196375 DOI: 10.1002/dmrr.2603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/22/2014] [Accepted: 08/24/2014] [Indexed: 12/16/2022]
Abstract
Short-term intensive insulin therapy is unique amongst therapies for type 2 diabetes because it offers the potential to preserve and improve beta-cell function without additional pharmacological treatment. On the basis of clinical experience and the promising results of a series of studies in newly diagnosed patients, mostly in Asian populations, an expert workshop was convened to assess the available evidence and the potential application of short-term intensive insulin therapy should it be advocated for inclusion in clinical practice. Participants included primary care physicians and endocrinologists. We endorse the concept of short-term intensive insulin therapy as an option for some patients with type 2 diabetes at the time of diagnosis and have identified the following six areas where additional knowledge could help clarify optimal use in clinical practice: (1) generalizability to primary care, (2) target population and biomarkers, (3) follow-up treatment, (4) education of patients and providers, (5) relevance of ethnicity, and (6) health economics.
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Affiliation(s)
- Jianping Weng
- Guangdong Provincial Key Laboratory of Diabetology, Sun Yat-sen University of Medical Sciences, Canton, China
- Department of Endocrinology at Third Affiliated Hospital, Sun Yat-sen University of Medical Sciences, Canton, China
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ammini Ariachery C
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Linong Ji
- Department of Endocrinology, Peking University Hospital, Beijing, China
| | - Luigi Meneghini
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Jeong-Taek Woo
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, South Korea
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24
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Dorajoo R, Liu J, Boehm BO. Genetics of Type 2 Diabetes and Clinical Utility. Genes (Basel) 2015; 6:372-84. [PMID: 26110315 PMCID: PMC4488669 DOI: 10.3390/genes6020372] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/02/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
A large proportion of heritability of type 2 diabetes (T2D) has been attributed to inherent genetics. Recent genetic studies, especially genome-wide association studies (GWAS), have identified a multitude of variants associated with T2D. It is thus reasonable to question if these findings may be utilized in a clinical setting. Here we briefly review the identification of risk loci for T2D and discuss recent efforts and propose future work to utilize these loci in clinical setting-for the identification of individuals who are at particularly high risks of developing T2D and for the stratification of specific health-care approaches for those who would benefit most from such interventions.
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Affiliation(s)
- Rajkumar Dorajoo
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672, Singapore.
| | - Jianjun Liu
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
| | - Bernhard O Boehm
- Genome Institute of Singapore, Agency for Science, Technology and Research, 138672, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.
- Imperial College London, London, SW7 2AZ, UK.
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore 308433, Singapore.
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25
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Blüher M. [Pharmacological therapy versus bariatric surgery for patients with obesity and type 2 diabetes]. Internist (Berl) 2015; 56:143-8, 150-2. [PMID: 25636953 DOI: 10.1007/s00108-014-3534-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There is strong epidemiological evidence for an association between increased body weight and a higher incidence of type 2 diabetes. Moreover, reduction in body weight may delay the onset of type 2 diabetes. The basic therapy of type 2 diabetes includes lifestyle modifications, such as education, nutritional advice, increased physical activity, non-smoking and strategies to cope with stress. If lifestyle modifications are not successful, antidiabetic pharmacotherapy is stepwise intensified to achieve individual therapeutic targets; however, pharmacological treatment of type 2 diabetes frequently fails to prevent the progress of the disease and the manifestation of diabetes complications. Sustained weight reduction belongs to the individual treatment targets for patients with obesity and type 2 diabetes. Because conservative weight reduction strategies are frequently not successful, bariatric surgery has emerged as an effective treatment particularly for those patients with obesity-associated type 2 diabetes in whom a glycosylated hemoglobin (HbA1c) target < 7.5% could not be achieved with pharmacological therapy. Bariatric surgery should no longer be considered as the last option for patients with obesity-associated type 2 diabetes.
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Affiliation(s)
- M Blüher
- Department für Innere Medizin, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland,
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26
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Abstract
Obesity significantly increases the risk of developing type 2 diabetes by a factor of up to 9. Medical treatment of type 2 diabetes with lifestyle and pharmacological interventions frequently fails to prevent the progress of the disease and the manifestation of diabetes complications. In recent years bariatric metabolic surgery has emerged as an effective treatment for patients with obesity and type 2 diabetes. Compared to medical treatment alone, metabolic surgery has been shown to be more effective in reducing mortality, improving hyperglycemia, hypertension and dyslipidemia in randomized clinical trials among patients with obesity and type 2 diabetes. However, surgery also has the risk for acute perioperative complications, long-term micronutrient deficiencies and psychological problems. Weighing these risks against the benefits of significant weight loss and improved glycemic control, metabolic surgery seems to be a promising treatment option for obesity-associated type 2 diabetes. However, current guidelines and treatment algorithms for the treatment of type 2 diabetes either ignore or underestimate the potential of metabolic surgery. In my opinion, metabolic surgery should be considered earlier in the treatment of type 2 diabetes and obesity and no longer be considered as the last therapeutic option for patients with obesity-associated type 2 diabetes.
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Affiliation(s)
- M Blüher
- Department für Innere Medizin, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland,
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27
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Wong AIC, Huang D. Assessment of the degree of interference of polyphenolic compounds on glucose oxidation/peroxidase assay. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2014; 62:4571-4576. [PMID: 24766280 DOI: 10.1021/jf500431z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The glucose oxidase/peroxidase assay (GOP) is a coupled enzymatic assay commonly used in measuring glucose concentrations in biological sciences and food chemistry, particularly for quantification of α-glucosidase activity. However, we found that the GOP assay is prone to interference, especially from reducing substances such as polyphenolic compounds, which are commonly found in botanical materials. To establish the scope and limitation of the assay in measuring α-glucosidase inhibition activity, we systematically investigated the structural features of the polyphenolic compounds that can lead to false positives. Utilizing sodium dodecyl sulfate (SDS) as surrogate for the meriquinone intermediate formed during the reaction, we measured the reactivity of this redox active intermediate toward common flavonoids. Our results show that flavonoids with o-dihydroxy groups in the B-ring cause strong interference and that compounds with little DPPH scavenging activity do not have interference. Our results highlight the need for checking the suitability of the GOP assay first before it is applied in measuring α-glucosidase inhibition activity. In addition, when the literature data on α-glucosidase inhibition activity of botanical extracts or polyphenolic compounds using GOP assay are interpreted, potential false positives due to interference on the assay will need to be taken into consideration.
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Affiliation(s)
- Adeline Ik Chian Wong
- Food Science and Technology Program, Department of Chemistry, National University of Singapore , 3 Science Drive 3, Singapore 117543, Singapore
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28
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Subramanian S, Hirsch IB. Personalized Diabetes Management: Moving from Algorithmic to Individualized Therapy. Diabetes Spectr 2014; 27:87-91. [PMID: 26246764 PMCID: PMC4522883 DOI: 10.2337/diaspect.27.2.87] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Management of individuals with type 2 diabetes involves complex decision-making to attain good glycemic control. A personalized approach to the care of these individuals provides a unique management plan for each patient. This article reviews some of the important variables that require consideration for management of individuals with type 2 diabetes. We also provide a scoring scale to help clinicians make appropriate decisions regarding A1C targets while caring for these patients.
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29
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Geller AI, Shehab N, Lovegrove MC, Kegler SR, Weidenbach KN, Ryan GJ, Budnitz DS. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern Med 2014; 174:678-86. [PMID: 24615164 PMCID: PMC4631022 DOI: 10.1001/jamainternmed.2014.136] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Detailed, nationally representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets. OBJECTIVE To describe the US burden, rates, and characteristics of emergency department (ED) visits and emergency hospitalizations for IHEs. DESIGN, SETTING, AND PARTICIPANTS Nationally representative public health surveillance of adverse drug events among insulin-treated patients seeking ED care (National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project) and a national household survey of insulin use (the National Health Interview Survey) were used to obtain data from January 1, 2007, through December 31, 2011. MAIN OUTCOMES AND MEASURES Estimated annual numbers and estimated annual rates of ED visits and hospitalizations for IHEs among insulin-treated patients with diabetes mellitus. RESULTS Based on 8100 National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance cases, an estimated 97,648 (95% CI, 64,410-130,887) ED visits for IHEs occurred annually; almost one-third (29.3%; 95% CI, 21.8%-36.8%) resulted in hospitalization. Severe neurologic sequelae were documented in an estimated 60.6% (95% CI, 51.3%-69.9%) of ED visits for IHEs, and blood glucose levels of 50 mg/dL (to convert to millimoles per liter, multiply by 0.0555) or less were recorded in more than half of cases (53.4%). Insulin-treated patients 80 years or older were more than twice as likely to visit the ED (rate ratio, 2.5; 95% CI, 1.5-4.3) and nearly 5 times as likely to be subsequently hospitalized (rate ratio, 4.9; 95% CI, 2.6-9.1) for IHEs than those 45 to 64 years. The most commonly identified IHE precipitants were reduced food intake and administration of the wrong insulin product. CONCLUSIONS AND RELEVANCE Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients 80 years or older; the risks of hypoglycemic sequelae in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning misadventures and insulin product mix-ups are important targets for hypoglycemia prevention efforts.
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Affiliation(s)
- Andrew I Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nadine Shehab
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott R Kegler
- Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Gina J Ryan
- College of Pharmacy and Health Sciences, Mercer University, Atlanta, Georgia
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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