The societal impact of early intensified treatment in patients with type 2 diabetes mellitus

Efficiency of periodontal treatment to improve type 2 diabetes mellitus outcomes: A systematic review and meta-analysis of economic evaluations

BACKGROUND

To assess the efficiency of periodontal treatment (PT) in improving diabetes-related outcomes in adults with type 2 diabetes mellitus (T2DM) and periodontitis, providing an updated and comprehensive synthesis from economic evaluations (EE).

METHODS

Seven databases and one register were independently searched by two reviewers for articles published up to 8 May 2024. Studies that assessed the efficiency of PT versus no treatment or other dental treatments were included. Risk of bias was assessed using the Cochrane RoB 2, ROBINS-I and ECOBIAS tools for the first stage of EE and the CHEERS checklist and NICE quality appraisal tool for overall EE. Qualitative and quantitative syntheses of the articles were conducted and assessed using the GRADE approach.

RESULTS

Eleven studies were included. PT reduces total healthcare costs, including inpatient and outpatient, diabetes-related costs and other drug costs (low to moderate certainty). A total incremental net benefit of USD 12 348 (2022 currency, 95% CI 12 195-12 500) was estimated from three high-quality model-based cost-utility analyses (high certainty).

DISCUSSION

The inclusion of PT in the comprehensive treatment of patients with T2DM and periodontitis is cost-effective. Future research is required to ensure the transferability of these findings and inform decision makers from different countries.

REGISTRATION

PROSPERO CRD42023443146.

Removing barriers to management of adults with type 2 diabetes on insulin using continuous glucose monitoring in UK primary care practice: An expert consensus

AIMS

This expert consensus reviews the reality of primary care clinical management of people with type 2 diabetes (T2D) on non-intensive insulin therapy, with an emphasis on the use of continuous glucose monitoring (CGM) technology for effective care in this participant group. Here, we identify key unmet needs for skills and systems development within this frontline healthcare setting, along with major challenges and opportunities associated with managing these changes effectively.

METHODS

The authors participated in two primary care consensus panels held on 28 November 2023 and on 21 May 2024. The focus for these expert panels was to understand the unmet needs within primary care to manage adults with T2D treated with non-intensive insulin therapy and incorporating the use of CGM systems. A Delphi Survey was undertaken among a wider group of Primary Care Diabetes Technology Network members in the United Kingdom, to understand prevalent attitudes to management of adults with T2D on insulin and using CGM in primary care. Based on these activities, a series of consensus statements were tested in a second Delphi Survey.

RESULTS

The activities described, involving primary care healthcare professionals (HCPs) with expertise in diabetes management, identified a series of training and educational needs within UK general practice that are central to skills development for the care of adults with T2D on insulin therapy and the application of CGM technology. Potential barriers to effective primary care management of people with T2D using CGM devices were identified. Areas of concern included confidence in national and local guidelines for the management of T2D using CGM systems, lack of experience on the part both of HCPs and people with T2D, clinical workflows and systems, as well as inbuilt resistance to change among primary care teams. However, the expert group were clear that the goal of providing care for people with T2D on non-intensive insulin therapy using CGM technology as standard of care could be met (94.3%, n = 33). This will deliver clinical benefits for people with T2D, and improvements to clinical workflows in primary care. Cost-savings to the health service were also identified as an outcome.

CONCLUSIONS

The need to adapt to the management of people with T2D on insulin therapy puts significant pressure on current workflows and skills for primary care teams. Steps in overcoming these immediate pressures, to ensure effective clinical management of people with T2D, are discussed, along with a series of consensus statements that identify the key areas of change to manage. Ultimately, the great majority of expert primary care HCPs were confident or very confident that using CGM technology will become the standard of care for people with T2D treated with insulin in primary care.

Research Hotspots and Frontier Trends of Autophagy in Diabetic Cardiomyopathy From 2014 to 2024: A Bibliometric Analysis

Objective

In recent years, the investigation of autophagy mechanisms has gained prominence as a key focus for understanding the pathogenesis and therapeutic potential of diabetic cardiomyopathy. This study aims to present an overview of the current state, major research areas, and emerging trends in autophagy related to diabetic cardiomyopathy through bibliometric analysis, offering a scientific foundation for future research.

Methods

The Web of Science Core Collection served as the data source for this study, from which full-text publications were extracted. Using CiteSpace 6.3.R1, VOSviewer v1.6.18, and R-Bibliometrix, the analysis evaluated research output across dimensions such as subjects, countries, institutions, journals, authors, and co-cited references, generating a comprehensive visual map.

Results

A total of 367 publications met the inclusion criteria. Between 2014 and 2024, the volume of articles demonstrated a consistent upward trajectory. Research on autophagy in diabetic cardiomyopathy predominantly spans the disciplines of biology and medicine. China and the Fourth Military Medical University emerged as leading contributors among 41 countries and 505 institutions. Sun Dongdong was identified as the most prolific author, while Jia GH was the most frequently cited. Key journals in this field include Biochimica et Biophysica Acta - Molecular Basis of Disease and Frontiers in Cardiovascular Medicine, while Circulation Research recorded the highest number of co-citations. The most cited reference was an experimental study by Xie ZL. Current research focuses on autophagy, diabetic cardiomyopathy, oxidative stress, and their underlying mechanisms.

Conclusion

Research on the role of autophagy in diabetic cardiomyopathy has reached a stable phase of development. Future investigations should prioritize mechanistic studies and emphasize the clinical application of novel pharmacological interventions, thereby advancing therapeutic strategies and contributing to improved human health outcomes.

Exploration of Pharmacological Mechanisms of Dapagliflozin against Type 2 Diabetes Mellitus through PI3K-Akt Signaling Pathway based on Network Pharmacology Analysis and Deep Learning Technology

BACKGROUND

Dapagliflozin is commonly used to treat type 2 diabetes mellitus (T2DM). However, research into the specific anti-T2DM mechanisms of dapagliflozin remains scarce.

OBJECTIVE

This study aimed to explore the underlying mechanisms of dapagliflozin against T2DM.

METHODS

Dapagliflozin-associated targets were acquired from CTD, SwissTargetPrediction, and SuperPred. T2DM-associated targets were obtained from GeneCards and DigSee. VennDiagram was used to obtain the overlapping targets of dapagliflozin and T2DM. GO and KEGG analyses were performed using clusterProfiler. A PPI network was built by STRING database and Cytoscape, and the top 30 targets were screened using the degree, maximal clique centrality (MCC), and edge percolated component (EPC) algorithms of CytoHubba. The top 30 targets screened by the three algorithms were intersected with the core pathway-related targets to obtain the key targets. DeepPurpose was used to evaluate the binding affinity of dapagliflozin with the key targets.

RESULTS

In total, 155 overlapping targets of dapagliflozin and T2DM were obtained. GO and KEGG analyses revealed that the targets were primarily enriched in response to peptide, membrane microdomain, protein serine/threonine/tyrosine kinase activity, PI3K-Akt signaling pathway, MAPK signaling pathway, and AGE-RAGE signaling pathway in diabetic complications. AKT1, PIK3CA, NOS3, EGFR, MAPK1, MAPK3, HSP90AA1, MTOR, RELA, NFKB1, IKBKB, ITGB1, and TP53 were the key targets, mainly related to oxidative stress, endothelial function, and autophagy. Through the DeepPurpose algorithm, AKT1, HSP90AA1, RELA, ITGB1, and TP53 were identified as the top 5 anti-targets of dapagliflozin.

CONCLUSION

Dapagliflozin might treat T2DM mainly by targeting AKT1, HSP90AA1, RELA, ITGB1, and TP53 through PI3K-Akt signaling.

Continuous glucose monitoring for the routine care of type 2 diabetes mellitus

Although continuous glucose monitoring (CGM) devices are now considered the standard of care for people with type 1 diabetes mellitus, the uptake among people with type 2 diabetes mellitus (T2DM) has been slower and is focused on those receiving intensive insulin therapy. However, increasing evidence now supports the inclusion of CGM in the routine care of people with T2DM who are on basal insulin-only regimens or are managed with other medications. Expanding CGM to these groups could minimize hypoglycaemia while allowing efficient adaptation and escalation of therapies. Increasing evidence from randomized controlled trials and observational studies indicates that CGM is of clinical value in people with T2DM on non-intensive treatment regimens. If further studies confirm this finding, CGM could soon become a part of routine care for T2DM. In this Perspective we explore the potential benefits of widening the application of CGM in T2DM, along with the challenges that must be overcome for the evidence-based benefits of this technology to be delivered for all people with T2DM.

Health and Productivity Benefits with Early Intensified Treatment in Patients with Type 2 Diabetes: Results from Korea

The available evidence suggests positive health outcomes associated with early treatment intensification in Type 2 diabetes mellitus (T2DM). Our study estimated the productivity effects arising from improved health correlated with early intensified treatment in T2DM in Korea. Using a recently published methodology and model, we investigated the association between early intensified treatment and the probability of experiencing fewer diabetes-related complication events. Treatment strategies leading to better health outcomes are expected to be associated with social value through increased participation in paid and unpaid work activities. Therefore, we translated the lower incidence of complications into monetary terms related to productivity for the Korean population. We quantified productivity by considering (a) absenteeism, (b) presenteeism, (c) permanent loss of labor force, and (d) activity restriction. Deterministic and probabilistic sensitivity analyses in the base case parameter were performed. Approximately, 1.7 thousand (standard deviation [SD] ±580 events) micro- and macrovascular complication events could potentially be avoided by early treatment intensification. This led to a societal gain attributed to increased productivity of 23 million USD (SD ± $8.2 million). This article demonstrates the likelihood of achieving better health and productivity through early intensified treatment in diabetes.

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease

Application of continuous glucose monitoring (CGM) has moved diabetes care from a reactive to a proactive process, in which a person with diabetes can prevent episodes of hypoglycemia or hyperglycemia, rather than taking action only once low and high glucose are detected. Consequently, CGM devices are now seen as the standard of care for people with type 1 diabetes mellitus (T1DM). Evidence now supports the use of CGM in people with type 2 diabetes mellitus (T2DM) on any treatment regimen, not just for those on insulin therapy. Expanding the application of CGM to include all people with T1DM or T2DM can support effective intensification of therapies to reduce glucose exposure and lower the risk of complications and hospital admissions, which are associated with high healthcare costs. All of this can be achieved while minimizing the risk of hypoglycemia and improving quality of life for people with diabetes. Wider application of CGM can also bring considerable benefits for women with diabetes during pregnancy and their children, as well as providing support for acute care of hospital inpatients who experience the adverse effects of hyperglycemia following admission and surgical procedures, as a consequence of treatment-related insulin resistance or reduced insulin secretion. By tailoring the application of CGM for daily or intermittent use, depending on the patient profile and their needs, one can ensure the cost-effectiveness of CGM in each setting. In this article we discuss the evidence-based benefits of expanding the use of CGM technology to include all people with diabetes, along with a diverse population of people with non-diabetic glycemic dysregulation.