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Oliveira R, Monteiro-Soares M, Guerreiro JP, Pereira R, Teixeira-Rodrigues A. Estimating Type 2 Diabetes Prevalence: A Model of Drug Consumption Data. Pharmacy (Basel) 2024; 12:18. [PMID: 38392925 PMCID: PMC10892415 DOI: 10.3390/pharmacy12010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Observational, cross-sectional prevalence studies are costly and time-consuming. The development of indirect methods estimating prevalence used to obtain faster, less-expensive, and more robust results would be an advantage for several healthcare applications. This study aimed to use the drug dispensing data from community pharmacies to estimate the prevalence of Type 2 Diabetes mellitus (T2DM) in the Portuguese population. A cross-sectional study was conducted using a database of dispensed medicines with an indication for Diabetes mellitus in 2018 and 2021, stratified by geographic region. The methodology was based on a sequential method of acquiring prevalence estimates obtained through exposure to medicines using the daily doses defined per thousand inhabitants per day and adjusted to the rate of adherence to therapy, prescription patterns, and concomitance of antidiabetic drugs. The estimated overall T2DM prevalence in 2018 was 13.9%, and it was 14.2% for 2021. The results show the increased consumption of antidiabetic drugs, with fixed-dose combination antidiabetics and new antidiabetics being particularly important in 2021. This work allowed for the development of a model to obtain the estimated prevalence of T2DM based on drug consumption, using a simple, fast, and robust method that is in line with the available evidence. However, with the recent expanding indications for new antidiabetics, the inclusion of further data in the model needs to be studied.
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Affiliation(s)
- Rita Oliveira
- FP-BHS—Biomedical and Health Sciences Research Unit, FFP-I3ID—Instituto de Investigação, Inovação e Desenvolvimento, Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Rua Carlos da Maia 296, 4200-150 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, MedTech, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo de Ferreira 228, 4050-313 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Matilde Monteiro-Soares
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal;
- MEDCIDS—Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- Portuguese Red Cross Health School Lisbon, Avenida de Ceuta nº 1, 1300-125 Lisbon, Portugal
- Cross I&D, Avenida de Ceuta nº 1, 1300-125 Lisbon, Portugal
| | - José Pedro Guerreiro
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, 1300-125 Lisbon, Portugal; (J.P.G.); (R.P.); (A.T.-R.)
| | - Rúben Pereira
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, 1300-125 Lisbon, Portugal; (J.P.G.); (R.P.); (A.T.-R.)
| | - António Teixeira-Rodrigues
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, 1300-125 Lisbon, Portugal; (J.P.G.); (R.P.); (A.T.-R.)
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Campus de Gualtar, 4710-057 Braga, Portugal
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Rodrigues EA, Rosa CM, Campos DHS, Damatto FC, Murata GM, Souza LM, Pagan LU, Gatto M, Brosler JY, Souza HOA, Martins MM, Bastos LM, Tanni SE, Okoshi K, Okoshi MP. The influence of dapagliflozin on cardiac remodeling, myocardial function and metabolomics in type 1 diabetes mellitus rats. Diabetol Metab Syndr 2023; 15:223. [PMID: 37908006 PMCID: PMC10617150 DOI: 10.1186/s13098-023-01196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter (SGLT)2 inhibitors have displayed beneficial effects on the cardiovascular system in diabetes mellitus (DM) patients. As most clinical trials were performed in Type 2 DM, their effects in Type 1 DM have not been established. OBJECTIVE To evaluate the influence of long-term treatment with SGLT2 inhibitor dapagliflozin on cardiac remodeling, myocardial function, energy metabolism, and metabolomics in rats with Type 1 DM. METHODS Male Wistar rats were divided into groups: Control (C, n = 15); DM (n = 15); and DM treated with dapagliflozin (DM + DAPA, n = 15) for 30 weeks. DM was induced by streptozotocin. Dapagliflozin 5 mg/kg/day was added to chow. STATISTICAL ANALYSIS ANOVA and Tukey or Kruskal-Wallis and Dunn. RESULTS DM + DAPA presented lower glycemia and higher body weight than DM. Echocardiogram showed DM with left atrium dilation and left ventricular (LV) hypertrophy, dilation, and systolic and diastolic dysfunction. In LV isolated papillary muscles, DM had reduced developed tension, +dT/dt and -dT/dt in basal condition and after inotropic stimulation. All functional changes were attenuated by dapagliflozin. Hexokinase (HK), phosphofructokinase (PFK) and pyruvate kinase (PK) activity was lower in DM than C, and PFK and PK activity higher in DM + DAPA than DM. Metabolomics revealed 21 and 5 metabolites positively regulated in DM vs. C and DM + DAPA vs. DM, respectively; 6 and 3 metabolites were negatively regulated in DM vs. C and DM + DAPA vs. DM, respectively. Five metabolites that participate in cell membrane ultrastructure were higher in DM than C. Metabolites levels of N-oleoyl glutamic acid, chlorocresol and N-oleoyl-L-serine were lower and phosphatidylethanolamine and ceramide higher in DM + DAPA than DM. CONCLUSION Long-term treatment with dapagliflozin attenuates cardiac remodeling, myocardial dysfunction, and contractile reserve impairment in Type 1 diabetic rats. The functional improvement is combined with restored pyruvate kinase and phosphofructokinase activity and attenuated metabolomics changes.
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Affiliation(s)
- Eder Anderson Rodrigues
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Camila Moreno Rosa
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Dijon Henrique Salome Campos
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Felipe Cesar Damatto
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Gilson Masahiro Murata
- LIM29, Division of Nephrology, Medical School, University of Sao Paulo, USP, Sao Paulo, SP, Brazil
| | - Lidiane Moreira Souza
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Luana Urbano Pagan
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Mariana Gatto
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Jessica Yumi Brosler
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Hebreia Oliveira Almeida Souza
- Laboratory of Nanobiotechnology Prof. Dr. Luiz Ricardo Goulart, Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Mario Machado Martins
- Laboratory of Nanobiotechnology Prof. Dr. Luiz Ricardo Goulart, Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Luciana Machado Bastos
- Laboratory of Nanobiotechnology Prof. Dr. Luiz Ricardo Goulart, Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Suzana Erico Tanni
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Katashi Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Marina Politi Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, SP, Brazil.
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Silva Almodóvar A, Clevenger J, Nahata MC. Effects of Adjuvant Medications on A1C, Body Mass Index, and Insulin Requirements among Patients with Type 1 Diabetes. Pharmacy (Basel) 2022; 10. [PMID: 36005937 DOI: 10.3390/pharmacy10040097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Randomized controlled trials have demonstrated that noninsulin medications used to treat type 2 diabetes can improve health outcomes among patients with type 1 diabetes (T1D). This study assessed the effects of adjuvant diabetes medications on glycated hemoglobin (A1C), body mass index (BMI), or total daily insulin (TDI) among patients with T1D in a real-world setting. This was an analysis of the T1D Exchange Clinic Registry, using the study periods of 2010−2012, 2015−2016, and 2016−2017, to assess differences in A1C, BMI, and TDI between patients with and without adjuvant medications. The relationships between characteristics and A1C in 2015−2016 and 2016−2017 were determined. Analysis included 517 patients in the adjuvant medication cohort and 4968 in the insulin-only cohort. No significant improvement in A1C was observed. A significant difference in BMI and TDI between the insulin-only (median BMI: 25.5, 26.2, 26.4 and median TDI: 45, 44 units) and adjuvant medication cohorts (median BMI: 29.8, 30.5, 30.5 and median TDI: 51, 52 units) (p < 0.001) was observed. Patients with a continuous glucose monitor (CGM), higher education level, higher annual income, and older age were associated with lower A1C (p ≤ 0.001). Higher BMI and self-description as African American/Black were associated with higher A1C (p ≤ 0.01). Insulin pump use was associated with lower A1C (p < 0.01) in 2015−2016. Patients who used adjuvant medications did not demonstrate significant improvement in disease control. These data suggest that findings from well-designed research studies may not be consistently reproducible in real-world settings, due to patient-specific factors.
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Rosa CM, Campos DHS, Reyes DRA, Damatto FC, Kurosaki LY, Pagan LU, Gomes MJ, Corrêa CR, Fernandes AAH, Okoshi MP, Okoshi K. Effects of the SGLT2 Inhibition on Cardiac Remodeling in Streptozotocin-Induced Diabetic Rats, a Model of Type 1 Diabetes Mellitus. Antioxidants (Basel) 2022; 11:antiox11050982. [PMID: 35624845 PMCID: PMC9137562 DOI: 10.3390/antiox11050982] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 02/07/2023] Open
Abstract
Clinical trials have shown that sodium glucose co-transporter 2 (SGLT2) inhibitors improve clinical outcomes in diabetes mellitus (DM) patients. As most studies were performed in Type 2 DM, the cardiovascular effects of SGLT2 inhibition still require clarification in Type 1 DM. We analyzed the effects of SGLT2 inhibitor dapagliflozin on cardiac remodeling in rats with streptozotocin-induced diabetes, an experimental model of Type 1 DM. Methods: Male Wistar rats were assigned into four groups: control (C, n = 14); control treated with dapagliflozin (C + DAPA, n = 14); diabetes (DM, n = 20); and diabetes treated with dapagliflozin (DM + DAPA, n = 20) for 8 weeks. Dapagliflozin dosage was 5 mg/kg/day. Statistical analyses: ANOVA and Tukey or Kruskal−Wallis and Dunn. Results: DM + DAPA presented decreased blood pressure and glycemia and increased body weight compared to DM (C 507 ± 52; C + DAPA 474 ± 50; DM 381 ± 52 *; DM + DAPA 430 ± 48 # g; * p < 0.05 vs. C; # p < 0.05 vs. C + DAPA and DM + DAPA). DM echocardiogram presented left ventricular and left atrium dilation with impaired systolic and diastolic function. Cardiac changes were attenuated by dapagliflozin. Myocardial hydroxyproline concentration and interstitial collagen fraction did not differ between groups. The expression of Type III collagen was lower in DM and DM + DAPA than their controls. Type I collagen expression and Type I-to-III collagen ratio were lower in DM + DAPA than C + DAPA. DM + DAPA had lower lipid hydroperoxide concentration (C 275 ± 42; C + DAPA 299 ± 50; DM 385 ± 54 *; DM + DAPA 304 ± 40 # nmol/g tissue; * p < 0.05 vs. C; # p < 0.05 vs. DM) and higher superoxide dismutase and glutathione peroxidase activity than DM. Advanced glycation end products did not differ between groups. Conclusion: Dapagliflozin is safe, increases body weight, decreases glycemia and oxidative stress, and attenuates cardiac remodeling in an experimental rat model of Type 1 diabetes mellitus.
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Affiliation(s)
- Camila Moreno Rosa
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | - Dijon Henrique Salome Campos
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | - David Rafael Abreu Reyes
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | - Felipe Cesar Damatto
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | - Lucas Yamada Kurosaki
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | - Luana Urbano Pagan
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | | | - Camila Renata Corrêa
- Department of Pathology, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-689, SP, Brazil;
| | - Ana Angelica Henrique Fernandes
- Department of Chemistry and Biochemistry, Institute of Biosciences, Sao Paulo State University, UNESP, Botucatu 18618-970, SP, Brazil;
| | - Marina Politi Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
| | - Katashi Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.M.R.); (D.H.S.C.); (D.R.A.R.); (F.C.D.); (L.Y.K.); (L.U.P.); (M.P.O.)
- Correspondence: ; Tel.: +55-14-3880-1171
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Czupryniak L, Danne T, Szymańska-Garbacz E, Zozulińska-Ziółkiewicz D, Gumprecht J, Klupa T. Sodium-glucose co-transporter-2 inhibitors for type 1 diabetes: Not any more? Diabetes Obes Metab 2022; 24:764-765. [PMID: 34931428 DOI: 10.1111/dom.14631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Thomas Danne
- Diabetes Center AUF DER BULT, Hannover Medical School, Hannover, Germany
| | | | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Klupa
- Unit on Advanced Technologies in Diabetes, Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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Seufert J, Lanzinger S, Danne T, Bramlage P, Schmid SM, Kopp F, Kress S, Fasching P, Schäfer C, Holl RW. Real-world data of 12-month adjunct sodium-glucose co-transporter-2 inhibitor treatment in type 1 diabetes from the German/Austrian DPV registry: Improved HbA1c without diabetic ketoacidosis. Diabetes Obes Metab 2022; 24:742-746. [PMID: 34897941 DOI: 10.1111/dom.14620] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Thomas Danne
- Diabetes Center for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Sebastian M Schmid
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
| | - Florian Kopp
- Diabetes Center, Augsburg Clinical Center, Augsburg, Germany
| | - Stephan Kress
- Medical Clinic I, Diabetes Center, Vinzentius-Hospital, Landau, Germany
| | - Peter Fasching
- Medical Division for Endocrinology, Rheumatology and Acute Geriatrics, Wilhelminen Hospital Vienna, Vienna, Austria
| | - Claus Schäfer
- Medical Clinic II, Klinikum Neumarkt, Neumarkt i.d. OPf., Neumarkt, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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