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Gad H, Kalra S, Pinzon R, Gracia RAN, Yotsombut K, Coetzee A, Nafach J, Lim LL, Fletcher PE, Lim V, Malik RA. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst 2024; 29:28-37. [PMID: 38268316 DOI: 10.1111/jns.12613] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.
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Affiliation(s)
- Hoda Gad
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Rizaldy Pinzon
- Neurology Department of the Bethesda, General Hospital Yogyakarta, Yogyakarta, Indonesia
| | - Rey-An Nino Gracia
- College of Medicine, De LA Salle, Health Medical and Science Institute College of Medicine, Manila, Philippines
| | - Kitiyot Yotsombut
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ankia Coetzee
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Academic Health Corporation, Dubai, UAE
| | - Lee-Ling Lim
- Department of Medicine, Diabetes Care Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Pablo E Fletcher
- Endocrinology Department, Medical School, University of Panama, Panama, Panama
| | - Vivien Lim
- Endocrinology Department, Gleneagles Hospital, Singapore, Singapore
| | - Rayaz A Malik
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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Pinzon RT, Schellack N, Matawaran BJ, Tsang MW, Deerochanawong C, Hiew FL, Nafach J, Khadilkar S. Clinical Recommendations for the use of Neurotropic B vitamins (B1, B6, and B12) for the Management of Peripheral Neuropathy: Consensus from a Multidisciplinary Expert Panel. J Assoc Physicians India 2023; 71:11-12. [PMID: 37449697 DOI: 10.59556/japi.71.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Peripheral neuropathy (PN) is an insidious disease that is often asymptomatic during the early stages but which can have a significant impact on quality of life at later stages when nerve damage occurs. There is currently no guidance on the use of neurotropic B vitamins (B1, B6, and B12) for the management of asymptomatic and symptomatic PN. OBJECTIVE To provide guidance to primary care physicians on an integrated approach to managing PN with neurotropic B vitamins (B1, B6, and B12). MATERIALS AND METHODS A multidisciplinary panel of eight experts participated in an iterative quasi-anonymous Delphi survey consisting of two rounds of questions and a virtual meeting. A literature review formed the basis of the survey questions. The first round included multiple select, qualitative, and Likert Scale questions; the subsequent round consisted of 2-point scale (agree or disagree) questions that sought to develop consensus-based statements refined from the first round and recommendations derived from discussions during the virtual expert panel meeting. RESULTS Clinical recommendations for the use of neurotropic B vitamins (B1, B6, and B12) have been developed for the prevention of PN progression or to delay onset in patients at high risk of developing PN. Recommendations have also been provided for the assessment of PN etiology and considerations for the use of loading dose (high dose) and maintenance dose (lower dose) of these neurotropic B vitamins (B1, B6, and B12). CONCLUSION These clinical recommendations provide an initial step towards formulating comprehensive guidelines for the early and long-term management of PN with neurotropic B vitamins (B1, B6, and B12) and move beyond addressing only neuropathic pain associated with the late stages of PN.
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Affiliation(s)
- Rizaldy T Pinzon
- Department of Neurology, Duta Wacana Christian University/Bethesda Hospital, Yogyakarta, Indonesia; Corresponding Author
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Bien J Matawaran
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Man W Tsang
- Department of Medicine, United Medical Practice, Hong Kong, SAR, China
| | - Chaicharn Deerochanawong
- Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Fu L Hiew
- Department of Medicine, Sunway Medical Centre, Selangor, Malaysia
| | - Jalal Nafach
- Department of Diabetes, Dubai Diabetes Center, Dubai, United Arab Emirates
| | - Satish Khadilkar
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, India
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Hassoun A, Dhanwal DK, Nafach J, Ajaz Y, Khan AM, Ben Nakhi A, AlArouj M, Hafidh K, AlNajjar M, Reyas A, Qamar S, Alsayed M, Bdair A. Real-World Assessment of Efficacy and Safety Parameters for Dapagliflozin in Management of Type 2 Diabetes Mellitus: REWARD Study. Dubai Diabetes Endocrinol J 2022. [DOI: 10.1159/000519871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> While ample evidence on improved glycemic control, weight reduction, and lowered blood pressure (BP) with sodium-glucose cotransporter type 2 inhibitors (SGLT2is) exists, real-world data on the potential benefit of SGLT2i on the diabetic population in the Middle East are lacking. The aim of our study was to describe the glycemic control, changes in body weight, body mass index (BMI), lipid profile, and BPs in patients receiving dapagliflozin with other antidiabetic medication. <b><i>Methods:</i></b> The REWARD study was a multicenter, post-authorization, prospective, open-label, noninterventional, real-world, cohort study. We enrolled 511 adult, type 2 diabetes mellitus patients on antidiabetic medications. These patients were started on dapagliflozin and followed up for 1 year to assess changes in their clinical and laboratory outcomes. <b><i>Results:</i></b> The mean HbA1c decreased significantly from 8.5 ± 1.6% at baseline to 7.6 ± 1.3% after 12 months (<i>p</i> value <0.001), with an absolute change of 0.9%. Of the study population, 41.6% of patients reached an HbA1c level less than 7% (53 mmol/mol). The systolic pressure improved (mean change = −1.9 mm Hg, <i>p</i> value = 0.003), yet no change in the diastolic pressure was observed. Both body weight and BMI significantly decreased by 0.7 kg and 0.2 kg/m<sup>2</sup>, respectively (<i>p</i> value <0.001). About 84.5% of patients were on antidyslipidemic agents, while 57.4% were on antihypertensives. Approximately 83.6% of adverse events were mild. A total of 90 hypoglycemic episodes were reported; none were severe. <b><i>Conclusion:</i></b> In a real-world setting, dapagliflozin in combination with other antidiabetic medications exhibited significant improvement in glycemic control, weight, BMI, and systolic BP. Additionally, it demonstrated a well-tolerated safety profile.
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Blonde L, Belousova L, Fainberg U, Garcia‐Hernandez PA, Jain SM, Kaltoft MS, Mosenzon O, Nafach J, Palle MS, Rea R. Liraglutide as add-on to sodium-glucose co-transporter-2 inhibitors in patients with inadequately controlled type 2 diabetes: LIRA-ADD2SGLT2i, a 26-week, randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2020; 22:929-937. [PMID: 31984646 PMCID: PMC7317838 DOI: 10.1111/dom.13978] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 12/13/2022]
Abstract
AIM To compare the effect of liraglutide or placebo added on to sodium-glucose co-transporter-2 inhibitor (SGLT2i) ± metformin on glycaemic control in patients with type 2 diabetes. MATERIALS AND METHODS Patients with type 2 diabetes on a stable SGLT2i dose ± metformin (with HbA1c 7.0%-9.5% and body mass index [BMI] ≥ 20 kg/m2 ) were randomized 2:1 to add-on liraglutide 1.8 mg/day or placebo in this parallel, double-blind, multinational trial. Primary and confirmatory secondary endpoints were changes in HbA1c and body weight from baseline to week 26, respectively. The proportions of patients achieving HbA1c (<7.0%) targets and safety events after week 26 were also assessed. RESULTS Of 303 patients randomized (one in error), 280 completed treatment. Mean changes in HbA1c from baseline to week 26 with liraglutide (n = 202) and placebo (n = 100) were - 0.98% and - 0.30%, respectively (estimated treatment difference [ETD]: -0.68% [95% CI: -0.89, -0.48]; P < 0.001). Mean body weight changes from baseline were - 2.81 versus -1.99 kg, respectively (ETD: -0.82 kg [95% CI: -1.73, 0.09]; P = 0.077); 51.8% of liraglutide-treated patients achieved HbA1c < 7.0% versus 23.2% receiving placebo (odds ratio: 5.1 [95% CI: 2.67, 9.87]; P < 0.001). More patients treated with liraglutide reported ≥1 treatment-emergent adverse events (66.3%) versus placebo (47.0%). CONCLUSIONS Liraglutide significantly improved glycaemic control compared with placebo in patients with type 2 diabetes, insufficiently controlled with SGLT2is with/without metformin, with no unexpected safety findings.
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Affiliation(s)
- Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of EndocrinologyOchsner Medical CenterNew OrleansLouisianaUnited States
| | - Lidia Belousova
- Almazov National Medical Research CentreSaint‐PetersburgRussian Federation
| | | | | | - Sunil M. Jain
- EndocrinologyTOTALL Diabetes Hormone InstituteIndoreMadhya PradeshIndia
| | | | - Ofri Mosenzon
- Diabetes Unit, Division of Internal MedicineHadassah Hebrew University HospitalJerusalemIsrael
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Health AuthorityDubaiUnited Arab Emirates
| | | | - Rosangela Rea
- Endocrinology and Metabolism Service (SEMPR), Universidade Federal do ParanáCuritibaBrazil
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Blonde L, Belousova L, Fainberg U, Garcia-Hernandez P, Jain S, Kaltoft M, Mosenzon O, Nafach J, Palle M, Réa R. OR22-1 Liraglutide as Add-on to SGLT2 Inhibitors in Patients with Inadequately Controlled Type 2 Diabetes (LIRA-ADD2SGLT2i): A 26-Week, Randomized, Double-Blind, Placebo-Controlled Trial. J Endocr Soc 2019. [PMCID: PMC6554790 DOI: 10.1210/js.2019-or22-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce glycated hemoglobin (HbA1c), but randomized controlled trial data on their combined use are limited. The LIRA-ADD2SGLT2i trial compared the effect on glycemic control of liraglutide 1.8 mg/day (a GLP-1 analog) vs placebo as add-on to SGLT2i ± metformin in patients with type 2 diabetes (T2D). In this phase 3b trial, patients with T2D on a stable dose of SGLT2i ± metformin and with HbA1c 7.0-9.5% were randomized 2:1 to add either liraglutide 1.8 mg/day or placebo. Exclusion criteria included a history of diabetic ketoacidosis (DKA) while being treated with SGLT2i and/or estimated glomerular filtration rate <60 mL/min/1.73 m2. The primary endpoint was change in HbA1c from baseline at 26 weeks; also assessed after 26 weeks were change in body weight, the proportion of patients achieving HbA1c <7%, and safety. All were analyzed regardless of premature trial product discontinuation or initiation of glucoselowering rescue medication. Overall, 412 patients were screened, 303 were randomized and 280 (92.4%) completed treatment (92.1% with liraglutide, 93.0% with placebo). Baseline characteristics were balanced between treatment groups: mean HbA1c 8.0%, mean body weight 91.1 kg, mean duration of diabetes 9.9 years. At week 26, the mean change in HbA1c from baseline with liraglutide was 0.98% (n=203) vs 0.30% with placebo (n=100) (estimated treatment difference [ETD]: 0.68%, 95% confidence interval [CI]: 0.89, 0.48; p<0.001). The mean change in body weight from baseline with liraglutide was -2.81 kg vs 1.99 kg with placebo (ETD: 0.82 kg; 95% CI: -1.73, 0.09, p=0.077). In the liraglutide group, 51.8% of patients achieved HbA1c <7.0% vs 23.2% in the placebo group (odds ratio: 5.1, 95% CI: 2.67, 9.87; p<0.001). A higher proportion of patients in the liraglutide group reported ≥1 treatment-emergent adverse event (AE) than in the placebo group (66.3% vs 47.0%). Nausea was the most frequent AE, occurring in 26.2% of the liraglutide group and 6.0% of the placebo group, and it generally had early onset in the initial 4 weeks and was transient. Similar incidences of hypoglycemic episodes were reported in both groups (8.9% with liraglutide vs 8.0% with placebo); none were severe. The proportion of patients reporting serious AEs was low in both groups (liraglutide 2.5% vs placebo 1.0%). No fatalities occurred in either group and there were no reports of acute renal failure, DKA, diabetic foot ulcers or amputations with liraglutide in combination with SGLT-2i. In patients with T2D, the addition of liraglutide to SGLT2i therapy (± metformin) provided superior glycemic control vs placebo, and had a safety profile consistent with the known safety profile of both drug classes. The LIRA-ADD2SGLT2i is registered with ClinicalTrials.gov NCT02964247.
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Affiliation(s)
| | - Lidia Belousova
- Almazov National Medical Research Centre, Saint-Petersburg, , Russian Federation
| | | | | | - Sunil Jain
- TOTALL Diabetes Hormone Institute, Indore, , India
| | - Margit Kaltoft
- GLP-1 and Obesity, Global Development, Novo Nordisk A/S, Søborg, , Denmark
| | - Ofri Mosenzon
- Diabetes Clinical Research Unit, Hadassah Hebrew University Hospital, Jerusalem, , Israel
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Health Authority, Dubai, , United Arab Emirates
| | | | - Rosangela Réa
- SEMPR, Universidade Federal do Paraná, Curitiba, , Brazil
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Bashier A, Khalifa AA, Rashid F, Abdelgadir EI, Al Qaysi AA, Ali R, Eltinay A, Nafach J, Alsayyah F, Alawadi F. Efficacy and Safety of SGLT2 Inhibitors in Reducing Glycated Hemoglobin and Weight in Emirati Patients With Type 2 Diabetes. J Clin Med Res 2017; 9:499-507. [PMID: 28496550 PMCID: PMC5412523 DOI: 10.14740/jocmr2976w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Accepted: 03/09/2017] [Indexed: 01/10/2023] Open
Abstract
Background SGLT2 inhibitors are a new class of drugs that act by inhibiting glucose reabsorption in the proximal renal tubules. Many trials have demonstrated their effectiveness in reducing glycated hemoglobin (HbA1c) and weight, but they have never been examined in Arab or Emirati populations. Methods We assessed the efficacy of SGLT2 inhibitors in reducing HbA1c and weight in our population and specifically in an Emirati cohort. We also assessed the effect on fasting blood glucose, blood pressure, lipid profile, serum creatinine, and side effects. Results The total number of patients was 307. The baseline HbA1c in the Emirati cohort was 8.9±1.7%, which dropped significantly to 8±1.5% at 6 months (P = 0.0001). At 1 year, the mean HbA1c was 8±1.4%, which was significantly different from baseline (P = 0.0001). However, the change in mean HbA1c from 6 months (8±1.5%) to 1 year (8±1.4%) was not statistically significant (P = 0.88). A similar highly significant change was observed when comparing weights at baseline and 6 months in the Emirati population (85.7 ± 17.8 kg vs. 84 ± 17.2 kg, P = 0.0001). Total cholesterol dropped significantly at 6 months (P = 0.008), as did low-density lipoprotein (LDL) (P = 0.005). Conclusions The use of SGLT2 inhibitors is associated with significant reductions in HbA1c and weight. Unlike all previous trials, the inhibitors significantly reduced total cholesterol and LDL. Larger trials are needed to reassess their effects on lipid parameters.
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Affiliation(s)
| | | | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, Dubai, United Arab Emirates
| | | | - Amina Adil Al Qaysi
- Internal Medicine Residency Program, Dubai Hospital, Dubai, United Arab Emirates
| | - Razan Ali
- Internal Medicine Residency Program, Dubai Hospital, Dubai, United Arab Emirates
| | - Ahmed Eltinay
- Emergency Medicine Residency Program, Rashid Hospital, Dubai, United Arab Emirates
| | - Jalal Nafach
- Dubai Diabetes Centre, Dubai, United Arab Emirates
| | - Fatima Alsayyah
- Endocrine Department, Dubai Hospital, Dubai, United Arab Emirates
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai, United Arab Emirates
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Abstract
AIM To describe the status of diabetes control and complications, and the quality of diabetes management in Saudi Arabia, Kuwait, and the United Arab Emirates, and to obtain an insight into the relationship between these factors. METHODS Patients with diabetes for>12 months were enrolled from specialist clinics and general hospitals. All available data from the patients' medical files including patient demographics; glycemic, lipid, and blood pressure status; diabetes-related complications; and diabetes management were recorded in data collection forms and analyzed. RESULTS Overall, 1290 patients with diabetes were enrolled with a mean (±standard deviation) age of 49.4 ± 12.3 years and duration of diabetes of 8.7 ± 5.9 years. Glycemic control was poor: Mean glycated hemoglobin A1c of 8.3 ± 2.0%, fasting and postprandial plasma glucose levels of 155.9 ± 57.1 mg/dL (8.7 ± 3.2 mmol/L), and 218.2 ± 87.4 mg/dL (12.1 ± 4.9 mmol/L), respectively. Diabetes-related complications such as neuropathy (34.9% of patients), background retinopathy (29.9%), and cataract (14.1%) were common. Cardiovascular complications were reported in <10% of patients, and microalbuminuria was detected in 34.4% of patients. Oral antidiabetic drug (OAD) monotherapy (43.3%) was the most common treatment, followed by insulin + OADs (39.3%) and insulin monotherapy (17.6%). CONCLUSION The status of diabetes care was found to be suboptimal. Further improvements in diabetes management are necessary to prevent or delay the development of diabetes-related complications.
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Affiliation(s)
| | - Khaled Khudada
- Department of Internal Medicine, Ahmadi Hospital, Kuwait Oil Company, Al Ahmadi, Kuwait
| | - Saher Safarini
- Department of Endocrinology and Metabolic Diseases, Dallah Hospital, Riyadh, Saudi Arabia
| | | | - Jalal Nafach
- Department of Endocrinology, Dubai Diabetes Center, Dubai, United Arab Emirates
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