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Ajjan RA, Battelino T, Cos X, Del Prato S, Philips JC, Meyer L, Seufert J, Seidu S. Continuous glucose monitoring for the routine care of type 2 diabetes mellitus. Nat Rev Endocrinol 2024:10.1038/s41574-024-00973-1. [PMID: 38589493 DOI: 10.1038/s41574-024-00973-1] [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] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Abstract
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.
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Affiliation(s)
- Ramzi A Ajjan
- The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Xavier Cos
- DAP Cat Research Group, Foundation University Institute for Primary Health Care Research Jordi Gol i Gorina, Barcelona, Spain
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Strasbourg, France
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
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Schöler F, Storz MA, Khavaran A, Hümmler N, Russe MF, Wielenberg C, Laubner K, Seufert J. Effective management of recurrent Doege-Potter syndrome with somatostatin-analogues: A case report. Cancer Rep (Hoboken) 2024; 7:e1992. [PMID: 38441351 PMCID: PMC10913086 DOI: 10.1002/cnr2.1992] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Doege-Potter syndrome is defined as paraneoplastic hypoinsulinemic hypoglycemia associated with a benign or malignant solitary fibrous tumor frequently located in pleural, but also extrapleural sites. Hypoglycemia can be attributed to paraneoplastic secretion of "Big-IGF-II," a precursor of Insulin-like growth factor-II. This prohormone aberrantly binds to and activates insulin receptors, with consecutive initiation of common insulin actions such as inhibition of gluconeogenesis, activation of glycolysis and stimulation of cellular glucose uptake culminating in recurrent tumor-induced hypoglycemic episodes. Complete tumor resection or debulking surgery is considered the most promising treatment for DPS. CASE Here, we report a rare case of a recurrent Doege-Poter Syndrome with atypical gelatinous tumor lesions of the lung, pleura and pericardial fat tissue in an 87-year-old woman. Although previously described as ineffective, we propose that adjuvant treatment with Octreotide in conjunction with intravenous glucose helped to maintain tolerable blood glucose levels before tumor resection. The somatostatin-analogue Lanreotide was successfully used after tumor debulking surgery (R2-resection) to maintain adequate blood glucose control. CONCLUSION We conclude that somatostatin-analogues bear the potential of being effective in conjunction with limited surgical approaches for the treatment of hypoglycemia in recurrent or non-totally resectable SFT entities underlying DPS.
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Affiliation(s)
- Felix Schöler
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Maximilian Andreas Storz
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
- Department of Internal Medicine II, Center for Complementary Medicine, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Ashkan Khavaran
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Nicolas Hümmler
- Department of Thoracic Surgery, Medical CenterUniversity Hospital of FreiburgFreiburgGermany
| | - Maximilian Frederik Russe
- Department of Radiology, Clinic for Diagnostic and Interventional Radiology, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
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Seufert J, Krishnan N, Darmstadt GL, Wang G, Bärnighausen T, Geldsetzer P. Subnational estimates of vitamin A supplementation coverage in children: a geospatial analysis of 45 low- and middle-income countries. Public Health 2024; 228:194-199. [PMID: 38394746 DOI: 10.1016/j.puhe.2024.01.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Vitamin A supplementation (VAS) can protect children from the adverse health consequences of vitamin A deficiency. Granular data on VAS coverage can guide global and national efforts to achieve universal VAS coverage. To provide geographically precise targeting of VAS programs and to monitor progress in reducing geographic disparities, we aimed to create high-resolution (5 × 5 km2) maps of VAS coverage in children under 5 years across VAS priority countries. STUDY DESIGN We used cross-sectional data from the Demographic and Health Surveys (DHS) program. METHODS We used data from the DHS program for United Nations Children's Fund -designated VAS priority countries between 2000 and 2017 with data available from 2005 or later. The outcome variable was the proportion of children under 5 years who received a vitamin A dose in each sampled cluster. We applied a Bayesian geostatistical approach incorporating geographic, climatic, and nutritional covariates to estimate VAS coverage for each cell. We estimated and mapped absolute VAS coverage, Bayesian uncertainty intervals, and exceedance probabilities. RESULTS Our sample included countries from Latin America and the Caribbean, Asia, and Africa. Most countries had estimated VAS coverage levels <70%, and our exceedance probabilities indicated high certainty that our estimates fell below this threshold in most grid cells. International variations were most notable in the Latin America and the Caribbean region and Africa. Intranational variations were greatest in some South Asian and West and Central African countries. CONCLUSIONS These prevalence and exceedance maps, especially used with data on indicators of VAS need, could help to improve equity.
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Affiliation(s)
- J Seufert
- Department of Economics and Business, KU Leuven, Leuven, Belgium.
| | - N Krishnan
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - G L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - G Wang
- Department of Biology, Stanford University, Stanford, CA, USA
| | - T Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty, Heidelberg University, Heidelberg, Germany; Africa Research Institute, Durban, South Africa; Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - P Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA
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Störmann S, Meyhöfer SM, Groener JB, Faust J, Schilbach K, Seufert J, Vergès B. Management of pasireotide-induced hyperglycemia in patients with acromegaly: An experts' consensus statement. Front Endocrinol (Lausanne) 2024; 15:1348990. [PMID: 38405148 PMCID: PMC10884330 DOI: 10.3389/fendo.2024.1348990] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Pasireotide is a somatostatin analogue for the treatment of acromegaly, a chronic condition caused by excess growth hormone. Despite the therapeutic benefits of pasireotide as a second-line treatment for inadequately controlled acromegaly, a major concern is its hyperglycemic side-effect. Here, we provide guidance on how to select appropriate patients with acromegaly for treatment with pasireotide. We summarize baseline characteristics of patients at high risk for pasireotide-associated hyperglycemia and recommend a monitoring strategy based on the risk profile. Self-monitoring of blood glucose levels (SMBG), measurements of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and regular HbA1c measurements are the foundation of our proposed monitoring approach. The pathophysiology of pasireotide-induced hyperglycemia involves decreased secretion of the incretin hormones GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). Our expert recommendations address the specific pathophysiology of pasireotide-induced hyperglycemia by recommending the incretin-based therapeutics dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in all appropriate patients as an alternative to first-line monotherapy with metformin. Furthermore, we emphasize the importance of adequate control of acromegaly, excellent diabetes education, nutrition and lifestyle guidance and advise to consult expert diabetologists in case of uncertainty in the management of patients with hyperglycemia under pasireotide.
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Affiliation(s)
- Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sebastian M. Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Jan B. Groener
- Zentrum für Diabetes und Hormonerkrankungen Neustadt, Neustadt, Germany
| | | | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jochen Seufert
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Bruno Vergès
- Endocrinology Diabetics and Metabolic Disorders Department, Dijon University Hospital, Dijon, France
- French National Health and Medical Research Body Unit, Lipid-Nutrition-Cancer-1231, University of Burgundy, Dijon, France
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Harris SB, Mohammedi K, Bertolini M, Carlyle M, Walker V, Zhou FL, Anderson JE, Seufert J. Patient and physician perspectives and experiences of basal insulin titration in type 2 diabetes in the United States: Cross-sectional surveys. Diabetes Obes Metab 2023; 25:3478-3489. [PMID: 37749746 DOI: 10.1111/dom.15240] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 09/27/2023]
Abstract
AIM Patient- and physician-associated barriers impact the effectiveness of basal insulin (BI) titration in the management of type 2 diabetes (T2D). We evaluated the experiences of patients with T2D and physicians with BI titration education. MATERIALS AND METHODS In this observational, cross-sectional study, patients with T2D and physicians treating patients with T2D were identified by claims in the Optum Research Database and were invited to complete a survey. Eligible patients had 12 months of continuous health-plan enrolment with medical and pharmacy benefits during the baseline period, and recent initiation of BI therapy. Eligible physicians had initiated BI for ≥1 eligible patient with T2D during the past 6 months. RESULTS In total, 416 patients and 386 physicians completed the survey. Ninety per cent of physicians reported treating ≥50 patients with T2D; 66% treated ≥25% of patients with BI. Whereas 74% of patients reported that BI titration was explained to them by a physician, 96% of physicians reported doing so. Furthermore, 20% of patients stated they were offered educational materials whereas 56% of physicians reported having provided materials. Physicians had higher expectations of glycaemic target achievement than were seen in the patient survey; their main concern was the patients' ability to titrate accurately (79%). CONCLUSIONS There is a marked difference in patients' and physicians' experiences of BI titration education. Novel tools and strategies are required to enable effective BI titration, with more educational resources at the outset, and ongoing access to tools that provide clear, simple direction for self-titration with less reliance on physicians/health care providers.
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Affiliation(s)
- Stewart B Harris
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bramlage P, Lanzinger S, Mühldorfer S, Milek K, Gillessen A, Veith R, Ohde T, Danne T, Holl RW, Seufert J. An analysis of DPV and DIVE registry patients with chronic kidney disease according to the finerenone phase III clinical trial selection criteria. Cardiovasc Diabetol 2023; 22:108. [PMID: 37158855 PMCID: PMC10169333 DOI: 10.1186/s12933-023-01840-5] [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: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The FIDELIO-DKD and FIGARO-DKD randomized clinical trials (RCTs) showed finerenone, a novel non-steroidal mineralocorticoid receptor antagonist (MRA), reduced the risk of renal and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Using RCT inclusion and exclusion criteria, we analyzed the RCT coverage for patients with T2DM and CKD in routine clinical practice in Germany. METHODS German patients from the DPV/DIVE registries who were ≥ 18 years, had T2DM and CKD (an estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2 OR eGFR ≥ 60 mL/min/1.73m2 and albuminuria [≥ 30 mg/g]) were included. RCT inclusion and exclusion criteria were then applied, and the characteristics of the two populations compared. RESULTS Overall, 65,168 patients with T2DM and CKD were identified from DPV/DIVE. Key findings were (1) Registry patients with CKD were older, less often male, and had a lower eGFR, but more were normoalbuminuric vs the RCTs. Cardiovascular disease burden was higher in the RCTs; diabetic neuropathy, lipid metabolism disorders, and peripheral arterial disease were more frequent in the registry. CKD-specific drugs (e.g., angiotensin-converting enzyme inhibitors [ACEi] and angiotensin receptor blocker [ARBs]) were used less often in clinical practice; (2) Due to the RCT's albuminuric G1/2 to G4 CKD focus, they did not cover 28,147 (43.2%) normoalbuminuric registry patients, 4,519 (6.9%) albuminuric patients with eGFR < 25, and 6,565 (10.1%) patients with microalbuminuria but normal GFR (≥ 90 ml/min); 3) As RCTs required baseline ACEi or ARB treatment, the number of comparable registry patients was reduced to 28,359. Of these, only 12,322 (43.5%) registry patients fulfilled all trial inclusion and exclusion criteria. Registry patients that would have been eligible for the RCTs were more often male, had higher eGFR values, higher rates of albuminuria, more received metformin, and more SGLT-2 inhibitors than patients that would not be eligible. CONCLUSIONS Certain patient subgroups, especially non-albuminuric CKD-patients, were not included in the RCTs. Although recommended by guidelines, there was an undertreatment of CKD-patients with renin-angiotensin system (RAS) blockers. Further research into patients with normoalbuminuric CKD and a wider prescription of RAS blocking agents for CKD patients in clinical practice appears warranted.
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Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661, Cloppenburg, Germany.
| | - Stefanie Lanzinger
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Munich-Neuherberg, Germany
| | | | - Karsten Milek
- Diabetologische Schwerpunktpraxis, Hohenmölsen, Germany
| | | | - Roman Veith
- Nephrologie, Klinikum Bad Hersfeld, Bad Hersfeld, Germany
| | | | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - Reinhard W Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V., Munich-Neuherberg, Germany
| | - Jochen Seufert
- Abteilung Endokrinologie und Diabetologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Freiburg, Germany
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Harris SB, Mohammedi K, Bertolini M, White J, Walker V, Zhou FL, Anderson JE, Seufert J. Patient perspectives and experiences with basal insulin titration in type 2 diabetes in the United States: A cross-sectional survey. Diabetes Obes Metab 2023; 25:1408-1412. [PMID: 36633521 DOI: 10.1111/dom.14973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/22/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Stewart B Harris
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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8
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Haluzík M, Seufert J, Guja C, Bonnemaire M, Bigot G, Tournay M, Kis JT, Freemantle N. Effectiveness and Safety of iGlarLixi (Insulin Glargine 100 U/mL Plus Lixisenatide) in Type 2 Diabetes According to the Timing of Daily Administration: Data from the REALI Pooled Analysis. Diabetes Ther 2023; 14:639-652. [PMID: 36787044 PMCID: PMC10064361 DOI: 10.1007/s13300-023-01375-8] [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: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION iGlarLixi (insulin glargine 100 U/mL plus lixisenatide) has demonstrated glycaemic efficacy and safety in adults with inadequately controlled type 2 diabetes mellitus (T2DM). Per the European Medicines Agency's product label, iGlarLixi should be injected once a day within 1 h prior to a meal, preferably the same meal every day when the most convenient meal has been chosen. It is however unknown whether iGlarLixi administration timing affects glycaemic control and safety, as clinical trial evidence is mainly based on pre-breakfast iGlarLixi administration. Therefore, we assessed the effectiveness and safety of iGlarLixi in clinical practice, according to its administration timing. METHODS Data were pooled from two prospective observational studies including 1303 European participants with T2DM inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi therapy for 24 weeks. Participants were classified into four subgroups based on daily timing of iGlarLixi injection: pre-breakfast (N = 436), pre-lunch (N = 262), pre-dinner (N = 399), and those who switched iGlarLixi injection time during the study (N = 206). RESULTS No meaningful differences in baseline characteristics were observed between the study groups. Least-squares mean reductions in haemoglobin A1c (HbA1c) from baseline to week 24 were substantial in all groups, with the numerically largest decrease observed in the pre-breakfast group (1.57%) compared with the pre-lunch (1.27%), pre-dinner (1.42%), or changed injection time (1.33%) groups. Pre-breakfast iGlarLixi injection also resulted in a numerically greater proportion of participants achieving HbA1c < 7.0% at week 24 (33.7% versus 19.0% for pre-lunch, 25.6% pre-dinner, and 23.2% changed injection time). iGlarLixi was well tolerated across all groups, with low rates of gastrointestinal disorders and hypoglycaemia. Mean body weight decreased similarly in all groups (by 1.3-2.3 kg). CONCLUSION iGlarLixi was effective and safe regardless of its daily administration time. However, pre-breakfast iGlarLixi injection resulted in a more effective glycaemic control.
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Affiliation(s)
- Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Mathilde Tournay
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - János Tibor Kis
- Department of Internal Medicine Centrum, Szent János Hospital, Budapest, Hungary
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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9
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Ryder REJ, Laubner K, Benes M, Haluzik M, Munro L, Frydenberg H, Teare JP, Ruban A, Fishman S, Santo E, Stengel R, De Jonge C, Greve JW, Cohen RV, Aboud CM, Holtmann GJ, Rich G, McMaster JJ, Battelino T, Kotnik P, Byrne JP, Mason JC, Bessell J, Bascomb J, Kow L, Collins J, Chisholm J, Pferschy PN, Sourij H, Cull ML, Wyres MC, Drummond R, McGowan B, Amiel SA, Yadagiri M, Sen Gupta P, Aberle J, Seufert J. Endoscopic Duodenal-Jejunal Bypass Liner Treatment for Type 2 Diabetes and Obesity: Glycemic and Cardiovascular Disease Risk Factor Improvements in 1,022 Patients Treated Worldwide. Diabetes Care 2023; 46:e89-e91. [PMID: 36716004 PMCID: PMC10090889 DOI: 10.2337/dc22-1952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/23/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Robert E J Ryder
- Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, U.K
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Freiburg, Germany
| | - Marek Benes
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
| | - Lynne Munro
- Epworth Centre for Bariatric Surgery, Richmond, Australia
| | | | | | | | - Sigal Fishman
- Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Erwin Santo
- Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rainer Stengel
- Diabetes, Diakonissensanstalt Emmaus Niesky, Niesky, Germany
| | - Charlotte De Jonge
- Catharina Hospital, Eindhoven, the Netherlands
- General Surgery, Maastricht UMC+, Maastricht, the Netherlands
- Atrium Medical Center Parkstad, Heerlen, the Netherlands
| | - Jan W Greve
- Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
- Metabolic and Bariatric Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Ricardo V Cohen
- Specialized Center for Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Cristina M Aboud
- Specialized Center for Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Graeme Rich
- Sydney Adventist Hospital, Wahroonga, Australia
| | - Jess J McMaster
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Primoz Kotnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - James P Byrne
- Surgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, U.K
| | - John C Mason
- Gastroenterology, Manchester University National Health Service Foundation Trust, Manchester, U.K
| | - Justin Bessell
- Surgery, Calvary North Adelaide Hospital, Adelaide, Australia
| | | | | | - Janes Collins
- Adelaide Bariatric Centre, Flinders Medical Centre, Bedford Park, Australia
| | - Jacob Chisholm
- Adelaide Bariatric Centre, Flinders Medical Centre, Bedford Park, Australia
| | - Peter N Pferschy
- Internal Medicine, Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Internal Medicine, Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Melissa L Cull
- Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, U.K
| | - Melanie C Wyres
- Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, U.K
| | - Russell Drummond
- Diabetes, Endocrinology, and Clinical Pharmacology, University of Glasgow, Glasgow, U.K
| | - Barbara McGowan
- Diabetes and Endocrinology, Guy's and St. Thomas' Hospital, London, U.K
| | - Stephanie A Amiel
- Diabetes Research Group, Division of Diabetes and Nutritional Sciences, King's College London, London, U.K
| | - Mahi Yadagiri
- Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, U.K
| | - Piya Sen Gupta
- Diabetes and Endocrinology, Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, U.K
- Diabetes and Endocrinology, Guy's and St. Thomas' Hospital, London, U.K
| | - Jens Aberle
- Endokrinologie und Diabetologie, Universitätsklinikum Hamburg-Eppendorf Ringgold, Hamburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Freiburg, Germany
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Yi TW, Wong MMY, Neuen BL, Arnott C, Poirier P, Seufert J, Slee A, Rapattoni W, Ang FG, Wheeler DC, Mahaffey KW, Perkovic V, Levin A. Effects of canagliflozin on cardiovascular and kidney events in patients with chronic kidney disease with and without peripheral arterial disease: integrated analysis from the CANVAS Program and CREDENCE trial. Diabetes Obes Metab 2023. [PMID: 36974373 DOI: 10.1111/dom.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Tae Won Yi
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle M Y Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | - David C Wheeler
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Centre for Nephrology, University College London, London, UK
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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Tsoukas MA, Woo V, Tobe SW, Slee A, Rapattoni W, Ang FG, Seufert J, Neuen BL, Arnott C, Mahaffey KW, Wheeler DC. Cardiovascular and kidney outcomes with canagliflozin according to type 2 diabetes treatment targets at baseline: Data from the CANVAS Program and CREDENCE. Diabetes Obes Metab 2023. [PMID: 36942888 DOI: 10.1111/dom.15057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Affiliation(s)
| | - Vincent Woo
- University of Manitoba, Winnipeg, MB, Canada
| | - Sheldon W Tobe
- Sunnybrook Research Institute, Toronto, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
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12
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Ibald-Mulli A, Seufert J, Grimsmann JM, Laimer M, Bramlage P, Civet A, Blanchon M, Gosset S, Templier A, Paar WD, Zhou FL, Lanzinger S. Identification of Predictive Factors of Diabetic Ketoacidosis in Type 1 Diabetes Using a Subgroup Discovery Algorithm. Diabetes Obes Metab 2023. [PMID: 36867100 DOI: 10.1111/dom.15039] [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] [Received: 09/29/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
AIMS Diabetic ketoacidosis (DKA) is a serious and potentially fatal complication of type 1 diabetes and it is difficult to identify individuals at increased risk. The aim of this study was to identify predictive factors for DKA by retrospective analysis of registry data and use of a subgroup discovery algorithm. MATERIALS AND METHODS Data from adults and children with type 1 diabetes and >2 diabetes-related visits were analyzed from the Diabetes Prospective Follow-up Registry. Q-Finder®, a supervised non-parametric proprietary subgroup discovery algorithm, was used to identify subgroups with clinical characteristics associated with increased DKA risk. DKA was defined as pH <7.3 during a hospitalization event. RESULTS Data for 108,223 adults and children, of whom 5,609 (5.2%) had DKA, were studied. Q-Finder® analysis identified 11 profiles associated with increased risk of DKA: low body mass index standard deviation score; DKA at diagnosis; age 6-10 years; age 11-15 years; HbA1c ≥8.87 [73 mmol/mol]; no fast-acting insulin intake; age <15 years and not using a continuous glucose monitoring system; physician diagnosis of nephrotic kidney disease; severe hypoglycemia; hypoglycemic coma; and autoimmune thyroiditis. Risk of DKA increased with number of risk profiles matching patients' characteristics. CONCLUSIONS Q-Finder® confirmed common risk profiles identified by conventional statistical methods and allowed the generation of new profiles that may help predict patients with type 1 diabetes who are at a greater risk of experiencing DKA. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Angela Ibald-Mulli
- Real World Evidence and Clinical Outcome Generation, Sanofi, Paris, France
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | | | | | | | | | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
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13
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Kress S, Bramlage P, Holl RW, Möller CD, Mühldorfer S, Reindel J, Seufert J, Landgraf R, Merker L, Meyhöfer SM, Danne T, Fasching P, Mertens PR, Wanner C, Lanzinger S. Validation of a risk prediction model for early chronic kidney disease in patients with type 2 diabetes: Data from the German/Austrian Diabetes Prospective Follow-up registry. Diabetes Obes Metab 2023; 25:776-784. [PMID: 36444743 DOI: 10.1111/dom.14925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
AIM To validate a recently proposed risk prediction model for chronic kidney disease (CKD) in type 2 diabetes (T2D). MATERIALS AND METHODS Subjects from the German/Austrian Diabetes Prospective Follow-up (DPV) registry with T2D, normoalbuminuria, an estimated glomerular filtration rate of 60 ml/min/1.73m2 or higher and aged 39-75 years were included. Prognostic factors included age, body mass index (BMI), smoking status and HbA1c. Subjects were categorized into low, moderate, high and very high-risk groups. Outcome was CKD occurrence. RESULTS Subjects (n = 10 922) had a mean age of 61 years, diabetes duration of 6 years, BMI of 31.7 kg/m2 , HbA1c of 6.9% (52 mmol/mol); 9.1% had diabetic retinopathy and 16.3% were smokers. After the follow-up (~59 months), 37.4% subjects developed CKD. The area under the curve (AUC; unadjusted base model) was 0.58 (95% CI 0.57-0.59). After adjustment for diabetes and follow-up duration, the AUC was 0.69 (95% CI 0.68-0.70), indicating improved discrimination. After follow-up, 15.0%, 20.1%, 27.7% and 40.2% patients in the low, moderate, high and very high-risk groups, respectively, had developed CKD. Increasing risk score correlated with increasing cumulative risk of incident CKD over a median of 4.5 years of follow-up (P < .0001). CONCLUSIONS The predictive model achieved moderate discrimination but good calibration in a German/Austrian T2D population, suggesting that the model may be relevant for determining CKD risk.
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Affiliation(s)
- Stephan Kress
- Medical Clinic I, Diabetes Center, Vinzentius-Hospital, Landau, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, 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
| | | | | | - Jörg Reindel
- Herz- und Diabeteszentrum, Klinikum Karlsburg, Karlsburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Ludwig Merker
- Diabetologie im MVZ am Park Ville d'Eu, Haan, Germany
| | - Sebastian M Meyhöfer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - Peter Fasching
- 5th Medical Department for Endocrinology, Rheumatology and Acute Geriatrics, Clinic Ottakring, Vienna, Austria
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christoph Wanner
- Division of Nephrology, Wuerzburg University Clinic, Würzburg, Germany
| | - Stefanie Lanzinger
- 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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14
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Guja C, Kis JT, Haluzík M, Bonnemaire M, Bigot G, Tournay M, Freemantle N, Seufert J. iGlarLixi (insulin glargine 100 U/ml plus lixisenatide) is effective and well tolerated in people with uncontrolled type 2 diabetes regardless of age: A REALI pooled analysis of prospective real-world data. Diabetes Obes Metab 2023; 25:1723-1730. [PMID: 36810874 DOI: 10.1111/dom.15027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
AIM To evaluate the effectiveness and safety in routine clinical practice of insulin glargine/lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D) according to age. METHODS Patient-level data were pooled from 1316 adults with T2D inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi for 24 weeks. Participants were classified into age subgroups of younger than 65 years (N = 806) and 65 years or older (N = 510). RESULTS Compared with participants aged younger than 65 years, those aged 65 years or older had a numerically lower mean body mass index (31.6 vs. 32.6 kg/m2 ), a longer median diabetes duration (11.0 vs. 8.0 years), were more likely to receive prior basal insulin (48.4% vs. 43.5%) and had a lower mean HbA1c (8.93% [74.10 mmol/mol] vs. 9.22% [77.28 mmol/mol]). Similar and clinically relevant reductions in HbA1c and fasting plasma glucose from baseline to week 24 of iGlarLixi therapy were observed regardless of age. At 24 weeks, least-squares adjusted mean (95% confidence interval [CI]) change in HbA1c from baseline was -1.55% (-1.65% to -1.44%) in those aged 65 years or older and -1.42% (-1.50% to -1.33%) in those aged younger than 65 years (95% CI: -0.26% to 0.00%; P = .058 between subgroups). Low incidences of gastrointestinal adverse events and hypoglycaemic episodes were reported in both age subgroups. iGlarLixi decreased mean body weight from baseline to week 24 in both subgroups (-1.6 kg in those aged ≥ 65 years and -2.0 kg in those aged < 65 years). CONCLUSIONS iGlarLixi is effective and well tolerated in both younger and older people with uncontrolled T2D.
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Affiliation(s)
- Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - János Tibor Kis
- Department of Internal Medicine Centrum, Szent János Hospital, Budapest, Hungary
| | - Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | | | | | - Mathilde Tournay
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, Medical Centre - Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Metzner G, Horstmeier LM, Bengel J, Bitzer EM, Dreher E, Frank F, Göhner A, Heimbach B, Himmelsbach I, Kaier K, Kiekert J, Kohler K, Laubner K, Lyssenko L, Maun A, Maurer C, Salm C, Seufert J, Voigt-Radloff S, Farin-Glattacker E. Local, collaborative, stepped, and personalized care management for older people with chronic diseases - results from the randomized controlled LoChro-trial. BMC Geriatr 2023; 23:92. [PMID: 36782119 PMCID: PMC9924193 DOI: 10.1186/s12877-023-03797-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness. METHODS A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants' evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling. RESULTS We analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity. CONCLUSION Supporting patients' self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Lukas Maximilian Horstmeier
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Eva Maria Bitzer
- University of Education Freiburg, Public Health and Health Education, Kunzenweg 21, 79117, Freiburg, Germany
| | - Elena Dreher
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Fabian Frank
- Department of Social Work, Protestant University of Applied Sciences Freiburg, Bugginger Straße 38, 79114, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany
| | - Anne Göhner
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Bernhard Heimbach
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Ines Himmelsbach
- Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstr. 6a, 79108, Freiburg, Germany
| | - Jasmin Kiekert
- Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany
| | - Katharina Kohler
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Lisa Lyssenko
- University of Education Freiburg, Public Health and Health Education, Kunzenweg 21, 79117, Freiburg, Germany
| | - Andy Maun
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Elsässer Str. 2m, 79110, Freiburg, Germany
| | - Christoph Maurer
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Claudia Salm
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Elsässer Str. 2m, 79110, Freiburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.,Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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16
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2023. [DOI: 10.1055/a-1933-5729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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17
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Päth G, Perakakis N, Mantzoros CS, Seufert J. PCSK9 inhibition and cholesterol homeostasis in insulin producing β-cells. Lipids Health Dis 2022; 21:138. [PMID: 36527064 PMCID: PMC9756761 DOI: 10.1186/s12944-022-01751-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Low-density lipoprotein cholesterol (LDL-C) plays a central role in the pathology of atherosclerotic cardiovascular disease. For decades, the gold standard for LDL-C lowering have been statins, although these drugs carry a moderate risk for the development of new-onset diabetes. The inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) have emerged in the last years as potential alternatives to statins due to their high efficiency and safety without indications for a diabetes risk so far. Both approaches finally eliminate LDL-C from bloodstream by upregulation of LDL receptor surface expression. Due to their low antioxidant capacity, insulin producing pancreatic β-cells are sensitive to increased lipid oxidation and related generation of reactive oxygen species. Thus, PCSK9 inhibition has been argued to promote diabetes like statins. Potentially, the remaining patients at risk will be identified in the future. Otherwise, there is increasing evidence that loss of circulating PCSK9 does not worsen glycaemia since it is compensated by local PCSK9 expression in β-cells and other islet cells. This review explores the situation in β-cells. We evaluated the relevant biology of PCSK9 and the effects of its functional loss in rodent knockout models, carriers of LDL-lowering gene variants and PCSK9 inhibitor-treated patients.
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Affiliation(s)
- Günter Päth
- grid.5963.9Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Hugstetter Str. 55, Freiburg, Germany
| | - Nikolaos Perakakis
- grid.4488.00000 0001 2111 7257Division of Metabolic and Vascular Medicine, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany ,grid.38142.3c000000041936754XDivision of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Christos S. Mantzoros
- grid.38142.3c000000041936754XDivision of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA ,grid.410370.10000 0004 4657 1992Section of Endocrinology, VA Boston Healthcare System, MA Jamaica Plain, USA
| | - Jochen Seufert
- grid.5963.9Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Hugstetter Str. 55, Freiburg, Germany
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18
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1733-0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Grimsmann JM, Tittel SR, Bramlage P, Mayer B, Fritsche A, Seufert J, Laimer M, Zimny S, Meyhoefer SM, Hummel M, Holl RW. Disease heterogeneity of adult diabetes based on routine clinical variables at diagnosis: Results from the German/Austrian Diabetes Follow-up Registry. Diabetes Obes Metab 2022; 24:2253-2262. [PMID: 35791641 DOI: 10.1111/dom.14812] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
AIM To cluster adults with diabetes using variables from real-world clinical care at manifestation. MATERIALS AND METHODS We applied hierarchical clustering using Ward's method to 56 869 adults documented in the prospective Diabetes Follow-up Registry (DPV). Clustering variables included age, sex, body mass index (BMI), HbA1c, diabetic ketoacidosis (DKA), components of the metabolic syndrome (hypertension/dyslipidaemia/hyperuricaemia) and beta-cell antibody status. Time until use of oral antidiabetic drugs (OADs), use of insulin, chronic kidney disease (CKD), cardiovascular disease (CVD), retinopathy or neuropathy were assessed using Kaplan-Meier analysis and Cox regression models. RESULTS We identified eight clusters: four clusters comprised early diabetes onset (median age 40-50 years) but differed with regard to BMI, HbA1c, DKA and antibody positivity. Two clusters included adults with diabetes onset aged in their early 60s who met target HbA1c, but differed in BMI and sex distribution. Two clusters were characterized by late diabetes onset (median age 69 and 77 years) and comparatively low BMI, but differences in HbA1c. Earlier insulin use was observed in adults with high HbA1c, and earlier OAD use was observed in those with high BMI. Time until CKD or CVD was shorter in those with late onset, whereas retinopathy occurred earlier in adults with late onset and high HbA1c, and in adults with early onset, but high HbA1c and high percentage of antibody positivity. CONCLUSIONS Adult diabetes is heterogeneous beyond classical type 1/type 2 diabetes, based on easily available variables in clinical practice using an automated clustering algorithm that allows both continuous and binary variables.
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Affiliation(s)
- Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andreas Fritsche
- German Center for Diabetes Research, Eberhard Karl University, Tuebingen, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Zimny
- Department of General Internal Medicine, Endocrinology and Diabetology, Helios Clinic Schwerin, Schwerin, Germany
| | - Sebastian M Meyhoefer
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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August D, Stete K, Hilger H, Götz V, Biever P, Hosp J, Wagner D, Köhler TC, Gerstacker K, Seufert J, Laubner K, Kern W, Rieg S. [Complaints and clinical findings six months after COVID-19: outpatient follow-up at the University Medical Center Freiburg]. Pneumologie 2022; 76:679-688. [PMID: 36257307 DOI: 10.1055/a-1916-1405] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Increasing evidence suggests that some patients suffer from persistent symptoms for months after recovery from acute COVID-19. However, the clinical phenotype and its pathogenesis remain unclear. We here present data on complaints and results of a diagnostic workup of patients presenting to the post-COVID clinic at the University Medical Center Freiburg. METHODS Retrospective data analysis of persistently symptomatic patients presenting to our clinic at least 6 months after onset of acute COVID-19. All patients were assessed by a doctor and routine laboratory analysis was carried out. Quality of life was assessed using SF-36 questionnaire. In case of specific persisting symptoms, further organ-specific diagnostic evaluation was performed, and patients were referred to respective departments/specialists. FINDINGS 132 Patients (58 male, 74 female; mean age 53.8 years) presented to our clinic at least 6 months after COVID-19. 79 (60 %) had been treated as outpatients and 53 (40 %) as inpatients. Most common complaints were persistent fatigue (82 %) and dyspnea on exertion (61 %). Further common complaints were impairments of concentration (54 %), insomnia (43 %), and impairments of smell or taste (35 %). Quality of life was reduced in all sections of the SF-36 questionnaire, yielding a reduced working capacity. Significant pathological findings in laboratory, echocardiographic and radiological work-up were rare. Impairments in lung function tests were more common in previously hospitalized patients. CONCLUSION Patients presenting 6 months after onset of acute COVID-19 suffer from a diverse spectrum of symptoms with impaired quality of life, also referred to as Long COVID or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Further research is needed to determine the frequency of these post-COVID syndromes and their pathogenesis, natural course and treatment options. Evaluation and management should be multi-disciplinary.
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Affiliation(s)
- Dietrich August
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Katarina Stete
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Hanna Hilger
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Veronika Götz
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Paul Biever
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
- Klinik für Innere Medizin III - Medizinische Intensivmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Jonas Hosp
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Dirk Wagner
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Thomas Christian Köhler
- Klinik für Pneumologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Kathrin Gerstacker
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Jochen Seufert
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Katharina Laubner
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Winfried Kern
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Siegbert Rieg
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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21
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1733-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Elrakaybi A, Laubner K, Zhou Q, Hug MJ, Seufert J. Cardiovascular protection by SGLT2 inhibitors - Do anti-inflammatory mechanisms play a role? Mol Metab 2022; 64:101549. [PMID: 35863639 PMCID: PMC9352970 DOI: 10.1016/j.molmet.2022.101549] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Metabolic syndrome and related metabolic disturbances represent a state of low-grade inflammation, which accelerates insulin resistance, type 2 diabetes (T2D) and cardiovascular disease (CVD) progression. Among antidiabetic medications, sodium glucose co-transporter (SGLT) 2 inhibitors are the only agents which showed remarkable reductions in heart failure (HF) hospitalizations and major cardiovascular endpoints (MACE) as well as renal endpoints regardless of diabetes status in large randomized clinical outcome trials (RCTs). Although the exact mechanisms underlying these benefits are yet to be established, growing evidence suggests that modulating inflammation by SGLT2 inhibitors may play a key role. SCOPE OF REVIEW In this manuscript, we summarize the current knowledge on anti-inflammatory effects of SGLT2 inhibitors as one of the mechanisms potentially mediating their cardiovascular (CV) benefits. We introduce the different metabolic and systemic actions mediated by these agents which could mitigate inflammation, and further present the signalling pathways potentially responsible for their proposed direct anti-inflammatory effects. We also discuss controversies surrounding some of these mechanisms. MAJOR CONCLUSIONS SGLT2 inhibitors are promising anti-inflammatory agents by acting either indirectly via improving metabolism and reducing stress conditions or via direct modulation of inflammatory signalling pathways. These effects were achieved, to a great extent, in a glucose-independent manner which established their clinical use in HF patients with and without diabetes.
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Affiliation(s)
- Asmaa Elrakaybi
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; Department of Clinical Pharmacy, Ain Shams University, 11566 Cairo, Egypt
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I, Heart Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Martin J Hug
- Pharmacy, Medical Centre - University of Freiburg, 79106 Freiburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
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Dierks C, Ruf J, Seufert J, Kreissl M, Klein C, Spitzweg C, Kroiss M, Thomusch O, Lorenz K, Zielke A, Miething C. 1646MO Phase II ATLEP trial: Final results for lenvatinib/pembrolizumab in metastasized anaplastic and poorly differentiated thyroid carcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1732-9567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1732-9069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Levin A, Poirier P, Seufert J, Slee A, Rapattoni W, Ang F, Wheeler D. FC 122: Effects of Canagliflozin on Cardiovascular and Kidney Events in Patients With Chronic Kidney Disease With and Without Peripheral Vascular Disease: Integrated Analysis From the Canvas Program and Credence Trial. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac126.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Type 2 diabetes mellitus (T2DM) is associated with comorbidities, such as chronic kidney disease (CKD) and peripheral vascular disease (PVD), which may increase risk of cardiovascular (CV) and kidney events. Canagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, reduced the risk of CV and kidney events in patients with T2DM and high CV risk or nephropathy in the CANVAS Program and CREDENCE trial, respectively. The effects of canagliflozin on CV and kidney outcomes in patients with CKD with and without PVD remain unknown.
METHOD
This post hoc analysis included integrated, pooled data from the CANVAS Program and the CREDENCE trial. The effects of canagliflozin compared with placebo on CV and kidney outcomes were assessed in patients with CKD with and without PVD at baseline. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and PVD was defined based on investigator classification on the electronic case report form without requirement for specific clinical evaluation or imaging. Propensity score (PS) matching was used to balance patient demographics and baseline clinical characteristics between groups. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox regression models.
RESULTS
A total of 14 543 participants from the CANVAS Program (N = 10 142) and CREDENCE (N = 4401) were included. Of these, 3514 had CKD alone (canagliflozin, n = 1792; placebo, n = 1722; mean eGFR, 46 mL/min/1.73 m2; symptomatic CV disease history, 49%; insulin use, 64%) and 1156 had CKD + PVD (canagliflozin, n = 626; placebo, n = 530; mean eGFR, 46 mL/min/1.73 m2; symptomatic CV disease history, 96%; insulin use, 74%) at baseline. Canagliflozin was associated with a reduced risk of major adverse cardiovascular events (MACE), the composite of hospitalization for heart failure (HHF) or CV death (HHF/CV death), doubling of serum creatinine (dSCr), end-stage kidney disease (ESKD) and the composite of ESKD or dSCr compared with placebo in patients with CKD with and without PVD (Figure 1A).
After matching, 3210 patients had CKD alone (mean eGFR, 46 mL/min/1.73 m2; symptomatic CV disease history, 49%; insulin use, 64%) and 966 had CKD + PVD (mean eGFR, 46 mL/min/1.73 m2; symptomatic CV disease history, 98%; insulin use, 74%), with equal numbers in the canagliflozin and placebo groups. In the PS-matched groups, canagliflozin was associated with a reduced risk of MACE, HHF/CV death, dSCr, ESKD and the composite of ESKD or dSCr compared with placebo in patients with CKD with and without PVD (Figure 1B).
CONCLUSION
Canagliflozin significantly reduced the risk of MACE, HHF/CV death, dSCr, ESKD, and the composite of ESKD or dSCr in patients with CKD with and without PVD, suggesting that the beneficial effects of canagliflozin on CV and kidney outcomes are consistent and can be seen in patients regardless of these comorbidities.
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Affiliation(s)
- Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | | | | | | | - David Wheeler
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Centre for Nephrology, University College London, London, UK
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1732-8581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Meyhöfer S, Eckert AJ, Hummel M, Laimer M, Roden M, Kress S, Seufert J, Meyhöfer SM, Holl RW. Elevated liver enzymes and comorbidities in type 2 diabetes: A multicentre analysis of 51 645 patients from the Diabetes Prospective Follow-up (DPV) database. Diabetes Obes Metab 2022; 24:727-732. [PMID: 34882949 DOI: 10.1111/dom.14616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
AIM To assess the prevalence of elevated liver enzymes and associated diabetes-related comorbidities in type 2 diabetes (T2D). SUBJECTS AND METHODS Between 2010 and 2019, 281 245 patients with T2D (aged 18-75 years) from 501 Diabetes Prospective Follow-up (DPV) centres were evaluated, resulting in analysis of 51 645 patients with complete data on demographics and liver enzymes. RESULTS Elevated liver enzymes were found in 40.2% of all patients. However, only 8.6% of these patients had International Classification of Diseases-10 codes for nonalcoholic fatty liver disease and/or nonalcoholic steatohepatitis. Adjusted for age, sex, diabetes duration, body mass index and glycated haemoglobin, a higher prevalence of arterial hypertension (P < 0.0001), dyslipidaemia (P < 0.0001), peripheral artery disease (P = 0.0029), myocardial infarction (P = 0.0003), coronary artery disease (P = 0.0001), microalbuminuria (P < 0.0001) and chronic kidney disease (P < 0.0001) was seen in patients with elevated versus normal liver enzymes. The prevalence of elevated liver enzymes was lowest in patients receiving sodium-glucose cotransporter-2 (SGLT2) inhibitors or a combination of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists. CONCLUSION Elevated liver enzymes are common in patients with T2D and clearly correlate with a higher prevalence of clinically relevant comorbidities. Assessing liver enzymes should be standard clinical routine in T2D due to a possible predictive role for comorbidities and complications.
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Affiliation(s)
- Svenja Meyhöfer
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- German Centre for Diabetes Research, Neuherberg, Germany
- Department of Internal Medicine 1, Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Alexander J Eckert
- German Centre for Diabetes Research, Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Markus Laimer
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Roden
- German Centre for Diabetes Research, Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Kress
- Medical Clinic I, Vinzentius-Krankenhaus, Landau, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian M Meyhöfer
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- German Centre for Diabetes Research, Neuherberg, Germany
| | - Reinhard W Holl
- German Centre for Diabetes Research, Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
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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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Seufert J, Wiesli P, Fritsche A, Anderten H, Pegelow K, Pscherer S, Pfohl M. Switching the basal insulin to insulin glargine 300 U/ml in people with type 2 diabetes under basal insulin supported oral therapy: Observational trial on effectiveness and safety. Diabetes Obes Metab 2022; 24:72-81. [PMID: 34514696 DOI: 10.1111/dom.14549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
AIMS This study evaluated the effectiveness and safety of switching the basal insulin (BI) in a BI-supported oral therapy (BOT) to insulin glargine 300 U/ml (Gla-300) in adults with inadequately controlled type 2 diabetes (T2D). MATERIALS AND METHODS This was a non-interventional, multicentre, prospective 12-month study, conducted in Germany, Austria and Switzerland. The study documented people with T2D with glycated haemoglobin (HbA1c) between 7.5% and 10.0%, currently treated by a non-Gla-300 BOT regimen, after the physician had decided to switch the BI to Gla-300. Primary endpoint was the proportion of patients achieving the fasting plasma glucose (FPG; ≤110 mg/dl) target. RESULTS In total, 1194 participants comprised the full analysis set, of which 793 completed documentation of 12 months Gla-300 treatment (FAS-M12). The main previous BI was insulin glargine 100 U/ml (Gla-100; 47.2%). Twelve months after switching to Gla-300, 27.0% of FAS-M12 participants achieved the FPG target and 44.8% their individualized HbA1c target. The greatest FPG target achievements were seen in previous Gla-100 (29.3%), and greatest HbA1c target achievements in previous insulin detemir users (57.7%). The mean FPG decreased by -36.3 ± 51.2 mg/dl to 135.5 ± 36.9 mg/dl and mean HbA1c by -0.79 ± 1.01% to 7.45 ± 0.94%. Symptomatic and nocturnal hypoglycaemia incidence significantly decreased over 12 months of Gla-300 treatment. Body weight remained unchanged. CONCLUSIONS Switching the BI to Gla-300 in a BOT regimen improved metabolic control and treatment satisfaction in a substantial proportion of patients with T2D and inadequate target achievement within 12 months in clinical practice with a decreased risk of symptomatic and nocturnal hypoglycaemia and without weight gain.
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Affiliation(s)
- Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Wiesli
- Hospital for Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Andreas Fritsche
- Hospital for Internal Medicine IV, University of Tuebingen, Tuebingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, University of Tuebingen (IDM), Tuebingen, Germany
| | | | | | - Stefan Pscherer
- Department of Internal Medicine III, Sophien- and Hufeland-Hospital, Weimar, Germany
| | - Martin Pfohl
- Medical Clinic I, Evang. Bethesda-Hospital Duisburg, Duisburg, Germany
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1647-6441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Schürmann A, Seufert J. Durch Förderung des diabetologischen Nachwuchses in der DDG exzellente Forschung und Patientenversorgung zukunftssicher aufstellen – Hellmut-Otto-Medaille 2021 - Kurzübersicht der Preisträger Annette Schürmann und Jochen Seufert. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1664-5121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tan S, Ignatenko S, Wagner F, Dokras A, Seufert J, Zwanziger D, Dunschen K, Zakaria M, Huseinovic N, Basson CT, Mahling P, Fuhrer D, Hinder M. Licogliflozin versus placebo in women with polycystic ovary syndrome: A randomized, double-blind, phase 2 trial. Diabetes Obes Metab 2021; 23:2595-2599. [PMID: 34263971 DOI: 10.1111/dom.14495] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 12/27/2022]
Abstract
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and insulin resistance. The dual sodium-glucose co-transporter 1/2 inhibitor (SGLT1/2i) licogliflozin (LIK066) ameliorates hyperinsulinism in patients with diabetes and obesity. This study examines the effect of licogliflozin on androgens in women with PCOS. In a multicentre, randomized, placebo-controlled, double-blind, 2-week trial, patients with PCOS received licogliflozin 50 mg or placebo three times a day (TID). Changes in free testosterone (FT), other androgens and variables of insulin resistance were analysed. Concentration of FT did not change (TRLIK066 :TRPCB [FT]: 0.88; 90% CI: 0.70-1.11; P = .353). Licogliflozin reduced androstendione (A4) by 19% (TRLIK066 :TRPCB [A4]: 0.81; 90% CI: 0.68-0.99; P = .089) and dehydroepiandrosteron sulphate (DHEAS) by 24% (TRLIK066 :TRPCB [DHEAS]: 0.76; 90% CI: 0.65-0.89; P = .008). Hyperinsulinaemia was reduced by 70% by licogliflozin (highest insulin concentration [MAXI]; TRLIK066 :TRPCB [MAXI]: 0·26; 90% CI:0.20-0.34; P < .001 and area under the curve insulin [AUCI]; TRLIK066 :TRPCB [AUCI]: 0.32; 90% CI: 0.25-0.41; P < .001). Diarrhoea and nausea occurred as common adverse events. Dual inhibition of SGLT1/2 ameliorates hyperinsulinaemia and hyperandrogenaemia in women with PCOS. Licogliflozin may represent a promising novel treatment option for PCOS.
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Affiliation(s)
- Susanne Tan
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Frank Wagner
- Charité Research Organisation GmbH, Berlin, Germany
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karin Dunschen
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marjorie Zakaria
- Novartis Institutes for BioMedical Research, Translational Medicine, Cambridge, Massachusetts, USA
| | - Neda Huseinovic
- Novartis Institutes for BioMedical Research, Translational Medicine, Cambridge, Massachusetts, USA
| | - Craig T Basson
- Novartis Institutes for BioMedical Research, Translational Medicine, Cambridge, Massachusetts, USA
- Boston Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Ping Mahling
- Novartis Institutes for BioMedical Research, Translational Medicine, Cambridge, Massachusetts, USA
| | - Dagmar Fuhrer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Hinder
- Novartis Institutes for BioMedical Research, Translational Medicine, Basel, Switzerland
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Gallwitz B, Müssig K, Ritzel RA, Seufert J, Weigert C. Liebe Leserin, lieber Leser,. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1503-8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Renard E, Ikegami H, Daher Vianna AG, Pozzilli P, Brette S, Bosnyak Z, Lauand F, Peters A, Pilorget V, Jurišić‐Eržen D, Kesavadev J, Seufert J, Wilmot EG. The SAGE study: Global observational analysis of glycaemic control, hypoglycaemia and diabetes management in T1DM. Diabetes Metab Res Rev 2021; 37:e3430. [PMID: 33369842 PMCID: PMC8518876 DOI: 10.1002/dmrr.3430] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/20/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS To describe glycaemic control and diabetes management in adults with type 1 diabetes (T1DM), in a real-life global setting. MATERIALS AND METHODS Study of Adults' GlycEmia (SAGE) was a multinational, multicentre, single visit, noninterventional, cross-sectional study in adult patients with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26-44, 45-64 and ≥65 years) and reported across different regions. The primary endpoint was the proportion of participants achieving HbA1c less than 7.0 % in each age group. Secondary endpoints included incidence of hypoglycaemia, severe hypoglycaemia and severe hyperglycaemia leading to diabetic ketoacidosis (DKA) and therapeutic management of T1DM. RESULTS Of 3903 included participants, 3858 (98.8%) were eligible for the study. Overall, 24.3% (95% confidence interval [CI]: 22.9-25.6) of participants achieved the glycaemic target of HbA1c less than 7.0 %, with more participants achieving this target in the 26-44 years group (27.6% [95% CI: 25.5-29.8]). Target achievement was highest in Eastern and Western Europe, and lowest in the Middle East. The incidence of hypoglycaemia and of severe hyperglycaemia leading to DKA tended to decrease with age, and varied across regions. Age and regional differences were observed in therapeutic management, including types of device/insulin usage, frequency of insulin dose adjustment and technology usage. CONCLUSIONS Glycaemic control remains poor in adults with T1DM globally. Several areas of treatment may be optimised to improve outcomes, including supporting patient self-management of insulin therapy, increasing use of technologies such as CGM, and greater provision of healthcare support.
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Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, NutritionMontpellier University HospitalINSERM Clinical Investigation Centre 1411Institute of Functional GenomicsCNRSINSERMUniversity of MontpellierMontpellierFrance
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
| | | | - Paolo Pozzilli
- Department of Diabetes and EndocrinologyUnit of Endocrinology and Diabetes, Campus Bio‐Medico University of RomeItaly
- Centre of Immunobiology, Barts and the London School of Medicine and Dentistry, Queen Mary University of LondonUK
| | | | | | | | - Anne Peters
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Dubravka Jurišić‐Eržen
- Department of Endocrinology and DiabetologyFaculty of MedicineUniversity Hospital CentreUniversity of RijekaRijekaCroatia
| | | | - Jochen Seufert
- Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Emma G. Wilmot
- Diabetes DepartmentUniversity Hospitals of Derby and BurtonDerbyUK
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Wilmot EG, Close KL, Jurišić-Eržen D, Bruttomesso D, Ampudia-Blasco FJ, Bosnyak Z, Roborel de Climens A, Bigot G, Peters AL, Renard E, Berard L, Calliari LE, Seufert J. Patient-reported outcomes in adults with type 1 diabetes in global real-world clinical practice: The SAGE study. Diabetes Obes Metab 2021; 23:1892-1901. [PMID: 33914401 DOI: 10.1111/dom.14416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Abstract
AIMS To conduct a secondary analysis of the SAGE study to evaluate the association between glycaemic control and patient-reported outcomes (PROs), in adults with type 1 diabetes (T1DM) across different age groups and regions. MATERIALS AND METHODS SAGE was a multinational, cross-sectional, observational study in adults with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26-44, 45-64, and ≥65 years), and reported across different regions. PRO questionnaires were applied to assess hypoglycaemia fear (Hypoglycemia Fear Survey-II), diabetes-related distress (Problem Areas In Diabetes questionnaire), insulin treatment satisfaction (Insulin Treatment Satisfaction Questionnaire), and diabetes-specific quality of life (QoL; Audit of Diabetes-Dependent Quality of Life). Multivariable analysis was performed to evaluate the relationship between glycated haemoglobin (HbA1c) target achievement (<7% and individualised targets) with PRO scores. RESULTS The PRO scores showed relatively low levels of diabetes-related emotional distress and fear of hypoglycaemia, moderate to high treatment satisfaction, and low diabetes-related impact on QoL. Results were generally comparable across age groups with some regional variability. Achievement of the HbA1c <7% target was associated with less worry about hypoglycaemia, lower diabetes-related emotional distress, higher insulin treatment satisfaction, and higher QoL. Achievement of individualised HbA1c targets was associated with lower diabetes-related emotional distress and higher insulin treatment satisfaction. CONCLUSIONS Better glycaemic control was most closely associated with low emotional distress due to diabetes and high patient-reported insulin treatment satisfaction.
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Affiliation(s)
- Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kelly L Close
- The diaTribe Foundation, San Francisco, California, USA
| | | | | | | | | | | | | | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital; INSERM Clinical Investigation Centre 1411; Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Lori Berard
- Nurse Consultant, Winnipeg, Manitoba, Canada
| | | | - Jochen Seufert
- Medical Faculty, University Hospital of Freiburg, Freiburg, Germany
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Dierks C, Seufert J, Aumann K, Ruf J, Klein C, Kiefer S, Rassner M, Boerries M, Zielke A, la Rosee P, Meyer PT, Kroiss M, Weißenberger C, Schumacher T, Metzger P, Weiss H, Smaxwil C, Laubner K, Duyster J, von Bubnoff N, Miething C, Thomusch O. Combination of Lenvatinib and Pembrolizumab Is an Effective Treatment Option for Anaplastic and Poorly Differentiated Thyroid Carcinoma. Thyroid 2021; 31:1076-1085. [PMID: 33509020 PMCID: PMC8290324 DOI: 10.1089/thy.2020.0322] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Anaplastic thyroid carcinoma (ATC) and metastatic poorly differentiated thyroid carcinomas (PDTCs) are rare aggressive malignancies with poor overall survival (OS) despite extensive multimodal therapy. These tumors are highly proliferative, with frequently increased tumor mutational burden (TMB) compared with differentiated thyroid carcinomas, and elevated programmed death ligand 1 (PD-L1) levels. These tumor properties implicate responsiveness to antiangiogenic and antiproliferative multikinase inhibitors such as lenvatinib, and immune checkpoint inhibitors such as pembrolizumab. Patients and Methods: In a retrospective study, we analyzed six patients with metastatic ATC and two patients with PDTC, who received a combination therapy of lenvatinib and pembrolizumab. Lenvatinib was started at 14-24 mg daily and combined with pembrolizumab at a fixed dose of 200 mg every three weeks. Maximum treatment duration with this combination was 40 months, and 3 of 6 ATC patients are still on therapy. Patient tumors were characterized by whole-exome sequencing and PD-L1 expression levels (tumor proportion score [TPS] 1-90%). Results: Best overall response (BOR) within ATCs was 66% complete remissions (4/6 CR), 16% stable disease (1/6 SD), and 16% progressive disease (1/6 PD). BOR within PDTCs was partial remission (PR 2/2). The median progression-free survival was 17.75 months for all patients, and 16.5 months for ATCs, with treatment durations ranging from 1 to 40 months (1, 4, 11, 15, 19, 25, 27, and 40 months). Grade III/IV toxicities developed in 4 of 8 patients, requiring dose reduction/discontinuation of lenvatinib. The median OS was 18.5 months, with three ATC patients being still alive without relapse (40, 27, and 19 months) despite metastatic disease at the time of treatment initiation (UICC and stage IVC). All patients with long-term (>2 years) or complete responses (CRs) had either increased TMB or a PD-L1 TPS >50%. Conclusions: Our results implicate that the combination of lenvatinib and pembrolizumab might be safe and effective in patients with ATC/PDTC and can result in complete and long-term remissions. The combination treatment is now being systematically examined in a phase II clinical trial (Anaplastic Thyroid Carcinoma Lenvatinib Pembrolizumab [ATLEP]) in ATC/PDTC patients.
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Affiliation(s)
- Christine Dierks
- Department of Hematology and Oncology, KIM IV, Faculty of Medicine, University Halle-Wittenberg, Halle, Germany
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Konrad Aumann
- Institute of Pathology, University of Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, University of Freiburg, Germany
| | - Claudius Klein
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
- Institute of Pathology, University of Freiburg, Germany
- Department of Nuclear Medicine, University of Freiburg, Germany
| | - Selina Kiefer
- Institute of Pathology, University of Freiburg, Germany
| | - Michael Rassner
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), University Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine and Institute of Molecular Medicine and Cell Research; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Zielke
- Outcomes Research Unit, Department of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Paul la Rosee
- Klinikum Villingen-Schwenningen, Hämatologie/Onkologie, Villingen-Schwenningen, Germany
| | - Philipp Tobias Meyer
- Department of Nuclear Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Matthias Kroiss
- Division of Endocrinology/Diabetology, Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | | | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine and Institute of Molecular Medicine and Cell Research; Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | | | - Constantin Smaxwil
- Outcomes Research Unit, Department of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
- Department of Hematology/Oncology, University of Luebeck, Luebeck, Germany
| | - Cornelius Miething
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Oliver Thomusch
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
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Roelz R, Schubach F, Coenen VA, Jenkner C, Scheiwe C, Grauvogel J, Niesen WD, Urbach H, Taschner C, Seufert J, Kätzler J, Beck J, Reinacher PC. Stereotactic cisternal lavage in patients with aneurysmal subarachnoid hemorrhage with urokinase and nimodipine for the prevention of secondary brain injury (SPLASH): study protocol for a randomized controlled trial. Trials 2021; 22:285. [PMID: 33858493 PMCID: PMC8048077 DOI: 10.1186/s13063-021-05208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed cerebral infarction (DCI) is a major cause of death and poor neurological outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Direct intrathecal therapies with fibrinolytic and spasmolytic drugs have appeared promising in clinical trials. However, access to the subarachnoid space for intrathecal drug administration is an unsolved problem so far, especially in patients with endovascular aneurysm securing. We investigate a therapy protocol based on stereotactic catheter ventriculocisternostomy (STX-VCS), a new approach to overcome this problem. The primary objective of this study is to assess whether cisternal lavage with urokinase, nimodipine, and Ringer's solution administered via a stereotactically implanted catheter into the basal cisterns (= investigational treatment (IT)) is safe and improves neurological outcome in patients with aSAH. METHODS This is a randomized, controlled, parallel-group, open-label phase II trial. Fifty-four patients with severe aSAH (WFNS grade ≥ 3) will be enrolled at one academic tertiary care center in Southern Germany. Patients will be randomized at a ratio of 1:1 to receive either standard of care only or standard of care plus the IT. The primary endpoint is the proportion of subjects with a favorable outcome on the Modified Rankin Scale (defined as mRS 0-3) at 6 months after aSAH. Further clinical and surrogate outcome parameters are defined as secondary endpoints. DISCUSSION New approaches for the prevention and therapy of secondary brain injury in patients with aSAH are urgently needed. We propose this RCT to assess the clinical safety and efficacy of a novel therapy protocol for intrathecal administration of urokinase, nimodipine, and Ringer's solution. TRIAL REGISTRATION Deutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00015645 . Registered on 8 May 2019.
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Affiliation(s)
- Roland Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Fabian Schubach
- Clinical Trials Unit, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Carolin Jenkner
- Clinical Trials Unit, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Taschner
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jochen Seufert
- Department of Medicine II, Division of Endocrinology and Diabetology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jürgen Kätzler
- Department of Internal Medicine III, Clinical Trials Office, University Medical Center Ulm, Ulm, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
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Pfohl M, Seufert J, Borck A, Bramlage P, Siegmund T. Effectiveness and Safety of Insulin Glulisine When Initiating Supplementary Prandial Insulin Treatment (SIT) in Insulin-Naïve Patients with Type 2 Diabetes: The Observational IGLU-SIT Study. Diabetes Ther 2021; 12:733-747. [PMID: 33544355 PMCID: PMC7947113 DOI: 10.1007/s13300-021-00998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/06/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The IGLU-SIT study documented the effectiveness of initiating supplementary prandial insulin treatment (SIT) with insulin glulisine after failure of oral antidiabetic drugs alone in patients with type 2 diabetes (T2DM) in a real-world setting in Germany. METHODS The IGLU-SIT study was an open-label, prospective, multicentre, non-interventional study with an observation period of 12 ± 1 months. The primary objective was to determine the proportion of patients reaching their pre-defined glycosylated haemoglobin (HbA1c) goal at 3, 6, 9 and 12 months. Selected secondary objectives were absolute change in HbA1c, a 7-point blood glucose profile, and rate of hypoglycaemia. Data were evaluated overall and by age group (< 65, 65-74 and ≥ 75 years). RESULTS Overall, 215 patients with T2DM were observed in 64 centres. Baseline HbA1c was 8.3%, and mean HbA1c target was 6.8% (baseline 8.1% and target 6.9% in patients ≥ 75 years). Individual HbA1c target attainment in patients peaked at 38.9% (95% confidence interval [CI] 32.1-46.1%) after 12 months; this was 45.9% in patients aged ≥ 75 years. The mean HbA1c reduction was 1.12 ± 1.05% (p < 0.0001) with only minor differences by age group. A 7-point blood glucose profile revealed significant reductions (p < 0.0001) at all time-points. The rate of confirmed symptomatic hypoglycaemia was 2.2% (95% CI 0.7-5.1) during the 12-month follow-up; rates were increased in patients aged ≥ 75 years (7.0%; 95% CI 1.5-19.1) as were the rates of adverse events (17.8 vs. 6.1%). CONCLUSION Initiating SIT with insulin glulisine is an appropriate treatment option in patients whose T2DM is insufficiently controlled. Particular attention should be paid to elderly patients in whom higher attainment rates of treatment target were associated with adverse events. TRIAL REGISTRATION https://awbdb.bfarm.de ; Identifier: 6819; Date of registration: 23.06.2016.
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Affiliation(s)
- Martin Pfohl
- Department of Internal Medicine I, Bethesda-Hospital Duisburg, Evangelisches Krankenhaus Bethesda, Duisburg, Germany.
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Anja Borck
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thorsten Siegmund
- Division for Endocrinology, Diabetology and Metabolism, Isar Clinic, Munich, Germany
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Seufert J, Pfohl M, Borck A, Bramlage P, Siegmund T. Effectiveness and Safety of Switching Rapid-Acting Insulins to Insulin Glulisine in Patients with Diabetes: The Observational IGLU-S Study. Diabetes Ther 2021; 12:749-764. [PMID: 33544356 PMCID: PMC7947079 DOI: 10.1007/s13300-021-00999-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The IGLU-S study assessed the effectiveness of insulin glulisine after switching from human insulin/other rapid-acting insulin analogues in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in a real-world setting in Germany. METHODS Open-label, prospective, multicentre, non-interventional study in Germany. The primary outcome was proportion of patients reaching pre-defined glycosylated haemoglobin A1c (HbA1c) goal at 3, 6, 9 and 12 months. Secondary outcomes included absolute changes in HbA1c, rate of hypoglycaemia and 7-point blood glucose profiles. RESULTS Overall, 432 (55 T1DM, 377 T2DM) patients were enrolled. Baseline HbA1c was 8.2% (T1DM) and 8.3% (T2DM); individual HbA1c targets were 6.8% and 6.9%, respectively. After insulin glulisine introduction, the proportion of patients achieving their individual HbA1c increased to 43.6% (T1DM) and 39.6% (T2DM) of patients at 12 months. At 12 months, mean HbA1c was reduced by 0.86 ± 1.03% (p < 0.0001) in T1DM and 1.01 ± 1.02 (p < 0.0001) in T2DM. The 7-point blood glucose profile showed a significant reduction in patients with T2DM (p< 0.0001) and a non-significant reduction in T1DM patients. Confirmed symptomatic hypoglycaemia was 5.7% (T1DM) and 1.6% (T2DM). There were no cases of severe hypoglycaemia. CONCLUSION Switching prandial insulin to insulin glulisine resulted in improved effectiveness with 43.6% of T1DM and 39.6% of T2DM patients reaching their individual pre-defined HbA1c target within 1 year. Switching was safe and was associated with a low rate of hypoglycaemia and adverse events. TRIAL REGISTRATION https://awbdb.bfarm.de ; Identifier: 6818; Date of registration: 23.06.2016.
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Affiliation(s)
- Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Martin Pfohl
- Department of Internal Medicine I, Evang. Bethesda-Hospital Duisburg, Duisburg, Germany
| | - Anja Borck
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thorsten Siegmund
- Division for Endocrinology, Diabetology and Metabolism, Isar Clinic, Munich, Germany
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Bornstein SR, Gallwitz B, Kellerer M, Ludwig B, Müller-Wieland D, Neu A, Reuter HM, Roden M, Seufert J. Praktische Empfehlungen der Deutschen Diabetes Gesellschaft zum Diabetesmanagement bei Patientinnen und Patienten mit einer COVID-19-Erkrankung. Diabetologe 2021; 17. [PMCID: PMC7799164 DOI: 10.1007/s11428-020-00715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Bei Menschen mit einer Infektion mit dem neuartigen Coronavirus SARS-CoV-2 und einer COVID-19-Erkrankung sind Diabetes mellitus und kardiovaskuläre Erkrankungen sehr häufige Komorbiditäten. Patienten mit Diabetes und Begleit- beziehungsweise Folgeerkrankungen scheinen ein erhöhtes Risiko für einen schweren Krankheitsverlauf bei COVID-19 einschließlich ARDS und Multiorganversagen zu haben. Die genauen Zusammenhänge zwischen Diabetes und COVID-19-Krankheitsverlauf sind noch nicht vollständig geklärt. Die DDG hat daher prinzipielle Handlungsempfehlungen zur Diabetestherapie bei Diabetes mellitus und COVID-19-Erkrankung zusammengefasst.
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Affiliation(s)
- Stefan R. Bornstein
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Baptist Gallwitz
- Department Innere Medizin, Abt. IV, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Monika Kellerer
- Zentrum für Innere Medizin I, Marienhospital, Böheimstr. 37, 70199 Stuttgart, Deutschland
| | - Barbara Ludwig
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Dirk Müller-Wieland
- Medizinische Klinik I, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - Andreas Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Hans-Martin Reuter
- Diabetologische Schwerpunktpraxis, Gemeinschaftspraxis für Innere Medizin, Jena, Deutschland
| | - Michael Roden
- Medizinische Klinik, Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Jochen Seufert
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Mann JFE, Hansen T, Idorn T, Leiter LA, Marso SP, Rossing P, Seufert J, Tadayon S, Vilsbøll T. Effects of once-weekly subcutaneous semaglutide on kidney function and safety in patients with type 2 diabetes: a post-hoc analysis of the SUSTAIN 1-7 randomised controlled trials. Lancet Diabetes Endocrinol 2020; 8:880-893. [PMID: 32971040 DOI: 10.1016/s2213-8587(20)30313-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with type 2 diabetes have a high risk of developing chronic kidney disease. We examined the effects of semaglutide on kidney function and safety in a large, broad type 2 diabetes population. METHODS We did a post-hoc analysis of 8416 patients with type 2 diabetes enrolled in the SUSTAIN 1-5 and SUSTAIN 7 randomised controlled trials, and the SUSTAIN 6 cardiovascular outcomes trial, to examine the effects of once-weekly subcutaneous semaglutide 0·5 mg and 1·0 mg versus comparators (active treatments or placebo) on estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and kidney adverse events. Data from SUSTAIN 1-5 and SUSTAIN 7 were pooled. eGFR and UACR were also analysed by kidney function and albuminuria status. FINDINGS In SUSTAIN 1-5 and SUSTAIN 7, eGFR decreased from baseline to week 12 with all active treatments; estimated treatment differences (ETDs) versus placebo were -2·15 (95% CI -3·47 to -0·83) mL/min per 1·73 m2 with semaglutide 0·5 mg and -3·00 (-4·31 to -1·68) mL/min per 1·73 m2 with semaglutide 1·0 mg; after week 12, eGFR plateaued. In SUSTAIN 1-5 and SUSTAIN 7, from baseline to end of treatment the decline in eGFR was greater with semaglutide than with placebo (ETD -1·58 [95% CI -2·92 to -0·25] mL/min per 1·73 m2 with semaglutide 0·5 mg and -2·02 [-3·35 to -0·68] mL/min per 1·73 m2 with semaglutide 1·0 mg). In SUSTAIN 6, the decline in eGFR was greater with semaglutide than with placebo from baseline to week 16 (ETD -1·29 [95% CI -2·07 to -0·51] mL/min per 1·73 m2 with semaglutide 0·5 mg and -1·56 [-2·33 to -0·78] mL/min per 1·73 m2 with semaglutide 1·0 mg), but not from week 16 to week 104 (1·29 [0·30 to 2·28] mL/min per 1·73 m2 with semaglutide 0·5 mg and 2·44 [1·45 to 3·44] mL/min per 1·73 m2 with semaglutide 1·0 mg). Overall (ie, from baseline to week 104), the eGFR decline in SUSTAIN 6 was similar between semaglutide and placebo (ETD 0·07 [95% CI -0·92 to 1·07] mL/min per 1·73 m2 with semaglutide 0·5 mg and 0·97 [-0·03 to 1·97] mL/min per 1·73 m2 with semaglutide 1·0 mg). In SUSTAIN 1-5, UACR ratios at end of treatment to baseline were 0·917 with semaglutide 0·5 mg, 0·836 with semaglutide 1·0 mg, and 1·239 with placebo; at end of treatment, greater reductions in UACR were observed with semaglutide versus placebo (estimated treatment ratios 0·74 [95% CI 0·64 to 0·85] for semaglutide 0·5 mg and 0·68 [0·59 to 0·78] for semaglutide 1·0 mg). In SUSTAIN 6, UACR ratios at end of treatment (week 104) to baseline were 0·973 with semaglutide 0·5 mg, 0·858 with semaglutide 1·0 mg, and 1·302 with placebo; at week 104, greater reductions in UACR were observed with semaglutide versus placebo (estimated treatment ratios 0·75 [95% CI 0·66 to 0·85] for semaglutide 0·5 mg and 0·66 [0·58 to 0·75] for semaglutide 1·0 mg). In SUSTAIN 1-7, eGFR initially declined in patients with normal kidney function (and in those with mild kidney impairment with semaglutide 1·0 mg in SUSTAIN 6), but overall (ie, by week 30 for SUSTAIN 1-5 and SUSTAIN 7, and week 104 for SUSTAIN 6), eGFR did not differ between semaglutide and placebo. In SUSTAIN 1-6, UACR decreased in patients with pre-existing microalbuminuria or macroalbuminuria at baseline; it did not change or increased in those with normoalbuminuria at baseline. Kidney adverse events were balanced between treatment groups. INTERPRETATION Across the SUSTAIN 1-7 trials, semaglutide was associated with initial reductions in eGFR that plateaued, and marked reductions in UACR. This post-hoc analysis suggests no increase in the risk of kidney adverse events with semaglutide versus the active comparators used across SUSTAIN 1-7. FUNDING Novo Nordisk.
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Affiliation(s)
- Johannes F E Mann
- KfH Kidney Center, Munich, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
| | | | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven P Marso
- HCA Midwest Heart and Vascular Institute, Overland Park, Overland Park, KS, USA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center -Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, University of Copenhagen, Hellerup, Denmark
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Päth G, Mehana AE, Pilz IH, Alt M, Baumann J, Sommerer I, Hoffmeister A, Seufert J. NUPR1 preserves insulin secretion of pancreatic β-cells during inflammatory stress by multiple low-dose streptozotocin and high-fat diet. Am J Physiol Endocrinol Metab 2020; 319:E338-E344. [PMID: 32574111 PMCID: PMC7473916 DOI: 10.1152/ajpendo.00088.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Obesity is associated with dyslipidemia and subclinical inflammation that promotes metabolic disturbances including insulin resistance and pancreatic β-cell dysfunction. The nuclear protein, transcriptional regulator 1 (NUPR1) responds to cellular stresses and features tissue protective properties. To characterize the role of NUPR1 in endocrine pancreatic islets during inflammatory stress, we generated transgenic mice with β-cell-specific Nupr1 overexpression (βNUPR1). Under normal conditions, βNUPR1 mice did not differ from wild type (WT) littermates and display normal glucose homeostasis and β-cell mass. For induction of inflammatory conditions, mice were treated with multiple low-dose streptozotocin (mld-STZ) and/or fed a high-fat diet (HFD). All treatments significantly worsened glycaemia in WT mice, while βNUPR1 mice substantially preserved insulin secretion and glucose tolerance. HFD increased β-cell mass in all animals, with βNUPR1 mice tending to show higher values. The improved outcome of βNUPR1 mice was accompanied by decreased NF-κB activation and lymphocyte infiltration in response to mld-STZ. In vitro, isolated βNUPR1 islets preserved insulin secretion and content with insignificantly low apoptosis during culture stress and IL-1β exposure. These findings suggest that NUPR1 plays a vital role in the protection of β-cells from apoptosis, related degradation of insulin storages and subsequent secretion during inflammatory and obesity-related tissue stress.
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Affiliation(s)
- Günter Päth
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Amir E Mehana
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Science, Department of Zoology, Suez Canal University, Ismailia, Egypt
| | - Ingo H Pilz
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Alt
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Baumann
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ines Sommerer
- Division of Gastroenterology and Rheumatology, Neurology and Dermatology, Department of Medicine, University of Leipzig, Germany
| | - Albrecht Hoffmeister
- Division of Gastroenterology and Rheumatology, Neurology and Dermatology, Department of Medicine, University of Leipzig, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hanefeld M, Fleischmann H, Siegmund T, Seufert J. Rationale for Timely Insulin Therapy in Type 2 Diabetes Within the Framework of Individualised Treatment: 2020 Update. Diabetes Ther 2020; 11:1645-1666. [PMID: 32564335 PMCID: PMC7376805 DOI: 10.1007/s13300-020-00855-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes is characterised by chronic hyperglycaemia and variable degrees of insulin deficiency and resistance. Hyperglycaemia and elevated fatty acids exert harmful effects on β-cell function, regeneration and apoptosis (gluco-lipotoxicity). Furthermore, chronic hyperglycaemia triggers a vicious cycle of insulin resistance, low-grade inflammation and a cascade of pro-atherogenic processes. Thus, timely near to normal glucose control is of utmost importance in the management of type 2 diabetes and prevention of micro- and macroangiopathy. The majority of patients are multimorbid and obese, with critical comorbidities such as cardiovascular disease, heart failure and chronic kidney disease. Recently published guidelines therefore recommend patient-centred risk/benefit-balanced use of oral glucose-lowering drugs or a glucagon-like peptide 1 (GLP-1) receptor agonist, or switching to insulin with glycated haemoglobin (HbA1c) out of target. This article covers the indications of early insulin treatment to prevent diabetes-related complications, particularly in subgroups with severe insulin deficit, and to achieve recovery of residual β-cell function. Furthermore, the individualised, risk/benefit-balanced, timely initiation of insulin as second and third option is analysed. Timely insulin initiation may prevent diabetes progression, reduce diabetes-related complications and has less serious adverse effects. Basal insulin is the preferred option in most clinical situations with consequences of undertreatment of chronic hyperglycaemia.
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Affiliation(s)
- Markolf Hanefeld
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
| | - Holger Fleischmann
- Diabetes and Cardiovascular, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Thorsten Siegmund
- Diabetes-, Hormon- und Stoffwechselzentrum, Isar Klinikum München GmbH, München, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bramlage P, Lanzinger S, Hess E, Fahrner S, Heyer CHJ, Friebe M, Buschmann I, Danne T, Holl RW, Seufert J. Renal function deterioration in adult patients with type-2 diabetes. BMC Nephrol 2020; 21:312. [PMID: 32727401 PMCID: PMC7391505 DOI: 10.1186/s12882-020-01952-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore, in a large group of patients with type-2 diabetes (T2DM), renal function decline in terms of the slope of the estimated glomerular filtration rate (eGFR) over time, and to find out how classical risk factors, such as the presence of hypertension, dyslipidemia and microalbuminuria, affect the renal function. METHODS The analysis included 32,492 adult T2DM patients from the DIVE/DPV registries who had serial eGFR determinations and information on the presence of microalbuminuria, hypertension and dyslipidemia available. RESULTS Patients had a mean age of 66.3 years, 52.6% were male with a mean BMI of 31.7 kg/m2. The mean eGFR was 78.4 ± 21.4 mL/min/1.73m2. The results showed that the prevalence of renal function impairment understood as chronic kidney disease (CKD) is considerable (53.0%) in a population of patients with T2DM and has a high incidence rate of 6.6% within a year. Serial determinations of the eGFR are, however, infrequent (7.8% of all patients) and these patients are characterised by the presence of a high-risk profile for CKD, such as hypertension (88.1%) and dyslipidemia (66.1%). Over a three-year time period, 30.9% of the patients had an eGFR slope of -12 mL/min/1.73m2 or more; and more than a doubled proportion of patients with an eGFR < 30 mL/min/1.73 m2 (3.8% vs. 1.8%; p < 0.001). Hypertension and albuminuria contributed to renal function decline while dyslipidemia did not negatively affect the slope. CONCLUSION CKD is highly prevalent in patients with T2DM. Serial surveillance of the glomerular filtration rate is, however, not established in clinical practice, which would be necessary as indicated by a doubling of patients with an eGFR < 30 mL/min/1.73 m2 within 3 years. Moreover, the use of renin-angiotensin blocking agents was low, pointing at considerable room for improvement. Taken together we conclude that a closer surveillance of patients with diabetes based on the presence of further risk factors is mandatory combined with a mandatory prescription of RAS blocking agents once microalbuminuria and / or renal function deterioration develops.
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Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661 Cloppenburg, Germany
| | - Stefanie Lanzinger
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V, München-Neuherberg, Germany
| | - Eva Hess
- Diabetologische Schwerpunktpraxis Dres, Hess, Worms, Germany
| | - Simon Fahrner
- Medizinische Klinik, SRH Klinik Sigmaringen, Pfullendorf, Germany
| | | | | | - Ivo Buschmann
- Department of Angiology, Medical University of Brandenburg, Brandenburg, Germany
| | - Thomas Danne
- Kinderkrankenhaus auf der Bult, Diabeteszentrum für Kinder und Jugendliche, Hannover, Germany
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V, München-Neuherberg, Germany
| | - Jochen Seufert
- Universitätsklinikum Freiburg, Medizinische Fakultät, Freiburg, Germany
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Bramlage P, Tittel SR, Wagner C, König K, Raddatz D, Weber-Lauffer R, Erath D, Hilgenberg J, Spies C, Danne T, Gabler M, Foersch J, Ley L, Seufert J. The DIVE/DPV registries: evolution of empagliflozin use in clinical practice in Germany. BMJ Open Diabetes Res Care 2020; 8:e001486. [PMID: 32719080 PMCID: PMC7388887 DOI: 10.1136/bmjdrc-2020-001486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2020] [Revised: 05/23/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Empagliflozin reduced morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) in clinical trials. A registry study was undertaken to describe evolution of patient characteristics and assess the real-world effectiveness/safety of empagliflozin. RESEARCH DESIGN AND METHODS Data from the Diabetes Patienten Verlaufsdokumentation (DPV)/Diabetes Versorgungsevaluation (DIVE) registries on 9571 adults with T2DM (registered in 2014-2019) receiving empagliflozin were used. Patients were grouped according to the following: early users (group 1; n=505) received empagliflozin before the EMPA-REG OUTCOME study publication (mid-September 2015); intermediate users (group 2; n=2961) started empagliflozin after the EMPA-REG OUTCOME publication but before the European Medicines Agency label change (from mid-September 2015 to mid-January 2017); and late users (group 3; n=6105) started empagliflozin after mid-January 2017. Data on clinical and treatment characteristics were collected. RESULTS Over time, the proportion of recipients aged <65 years decreased (71.1% vs 54.4% among early and late adopters), male patients increased (from 50.9% to 66.5%), body mass index (mean±SD) decreased (from 35.5±6.7 to 32.7±6.6 kg/m2), proportion with cardiovascular morbidities increased (from 20.4% to 26.4%), and mean estimated glomerular filtration rate decreased (from 83.2±19.5 to 78.5±21.1 mL/min/1.73 m2) (all p<0.001). Patients increasingly received empagliflozin in combination with metformin (60.8% vs 68.6% of early and late adopters; p<0.001), glucagon-like peptide-1 (GLP-1) agonists (11.0 vs 14.1%; p<0.001) or insulin (34.3% vs 49.9%; p<0.001). Empagliflozin was generally added to existing antidiabetic regimens. Six months after empagliflozin initiation, the mean glycated hemoglobin (HbA1c) decreased by 0.4%, the proportion of patients with HbA1c <6.5% increased (19.2% vs 12.8%), and the mean fasting plasma glucose decreased (155.8±49.7 vs 168.0±55.1 mg/dL) (all p<0.001). No significant changes in rates of severe hypoglycemia and no cases of diabetic ketoacidosis were seen. CONCLUSIONS Over time, empagliflozin is being prescribed to a broader patient range in routine practice, is usually added to existing antidiabetic regimens, and is increasingly used in combination with metformin, GLP-1 agonists and/or insulin. Empagliflozin had a beneficial effect on glycemic control, with no increase in hypoglycemia.
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Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Sascha R Tittel
- Institut für Epidemiologie und medizinische Biometrie, University of Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung eV, München-Neuherberg, Germany
| | | | | | - Dirk Raddatz
- Department of Gastroenterology and Endocrinology, University of Göttingen, Gottingen, Germany
| | | | | | - Jost Hilgenberg
- Gemeinschaftspraxis, Nienburg - Locum - Landsbergen, Germany
| | | | - Thomas Danne
- Diabeteszentrum für Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | | | | | - Ludwin Ley
- Boehringer Ingelheim Pharma GmbH und Co KG, Ingelheim, Germany
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Bornstein SR, Gallwitz B, Kellerer M, Ludwig B, Müller-Wieland D, Neu A, Reuter HM, Roden M, Seufert J. Praktische Empfehlungen der Deutschen Diabetes Gesellschaft zum Diabetesmanagement bei Patientinnen und Patienten mit einer COVID-19-Erkrankung. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1159-1486] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungBei Menschen mit einer Infektion mit dem neuartigen Coronavirus SARS-CoV-2 und einer COVID-19-Erkrankung sind Diabetes mellitus und kardiovaskuläre Erkrankungen sehr häufige Komorbiditäten. Patienten mit Diabetes und Begleit- beziehungsweise Folgeerkrankungen scheinen ein erhöhtes Risiko für einen schweren Krankheitsverlauf bei COVID-19 einschließlich ARDS und Multiorganversagen zu haben. Die genauen Zusammenhänge zwischen Diabetes und COVID-19-Krankheitsverlauf sind noch nicht vollständig geklärt. Die DDG hat daher prinzipielle Handlungsempfehlungen zur Diabetestherapie bei Diabetes mellitus und COVID-19-Erkrankung zusammengefasst.
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Affiliation(s)
- Stefan R. Bornstein
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Dresden
| | - Baptist Gallwitz
- Department Innere Medizin, Abt. IV, Universitätsklinikum Tübingen, Tübingen
| | | | - Barbara Ludwig
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | - Andreas Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen
| | - Hans-Martin Reuter
- Gemeinschaftspraxis für Innere Medizin, Diabetologische Schwerpunktpraxis, Jena
| | - Michael Roden
- Medizinische Klinik, Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - Jochen Seufert
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Freiburg
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Pfohl M, Jornayvaz FR, Fritsche A, Pscherer S, Anderten H, Pegelow K, Seufert J. Effectiveness and safety of insulin glargine 300 U/mL in insulin-naïve patients with type 2 diabetes after failure of oral therapy in a real-world setting. Diabetes Obes Metab 2020; 22:759-766. [PMID: 31903680 PMCID: PMC7187365 DOI: 10.1111/dom.13952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/28/2019] [Revised: 12/12/2019] [Accepted: 12/26/2019] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness and safety of initiating basal insulin-supported oral therapy (BOT) with insulin glargine 300 U/mL (Gla-300) in patients with type 2 diabetes inadequately controlled on oral antidiabetic drugs (OADs). MATERIALS AND METHODS This non-interventional, multi-centre, prospective 52-week study, conducted in Germany and Switzerland, documented patients with type 2 diabetes with an HbA1c of between 7.5% and 10.0%, currently treated with OADs, after the physician had decided to start a BOT regimen with Gla-300. The primary endpoint was the rate of achievement of the individualized predefined HbA1c target. RESULTS Of 1748 patients included, 1153 comprised the full analysis set, of whom 721 completed documentation of 12 months of Gla-300 treatment. Twelve months after starting Gla-300, 49.9% achieved their individualized HbA1c target, and 61.1% achieved either their HbA1c target or a fasting plasma glucose (FPG) of ≤110 mg/dL. Mean HbA1c decreased by -1.22% ± 1.05% to 7.28% ± 0.92% and mean FPG by -51.5 (±48.63) mg/dl to 132.9 ± 33.0 mg/dL. Median duration of HbA1c target achievement was 341 days and probability to remain on target after 6 months was 81%. Hypoglycaemia incidence and rates remained low after 12 months of Gla-300 treatment; no severe or severe nocturnal hypoglycaemia was observed. Body weight remained unchanged. CONCLUSIONS Starting a BOT regimen with Gla-300 allowed about 60% of 721 German and Swiss patients with inadequately controlled type 2 diabetes to achieve glycaemic control within 12 months in daily clinical practice. Glycaemic control was achieved without weight gain or increased risk of nocturnal or severe hypoglycaemia.
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Affiliation(s)
- Martin Pfohl
- Department of Internal Medicine I, Evang. Bethesda‐Hospital DuisburgDuisburgGermany
| | - François R. Jornayvaz
- Department of Endocrinology, Diabetology, Hypertension and NutritionUniversity Hospital of GenevaGenevaSwitzerland
| | - Andreas Fritsche
- Department of Internal Medicine IVUniversity of TuebingenTuebingenGermany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tuebingen (IDM)TuebingenGermany
| | - Stefan Pscherer
- Department of Internal Medicine IIISophien‐ and Hufeland‐HospitalWeimarGermany
| | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of FreiburgFaculty of Medicine, University of FreiburgGermany
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Freemantle N, Mauricio D, Giaccari A, Bailey T, Roussel R, Franco D, Berthou B, Pilorget V, Westerbacka J, Bosnyak Z, Bonnemaire M, Cali AMG, Nguyên-Pascal ML, Penfornis A, Perez-Maraver M, Seufert J, Sullivan SD, Wilding J, Wysham C, Davies M. Real-world outcomes of treatment with insulin glargine 300 U/mL versus standard-of-care in people with uncontrolled type 2 diabetes mellitus. Curr Med Res Opin 2020; 36:571-581. [PMID: 31865758 DOI: 10.1080/03007995.2019.1708287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To compare real-world outcomes with newer (insulin glargine 300 U/mL; Gla-300) versus standard of care (SoC) basal insulins (BIs) in the REACH (insulin-naïve; NCT02967224) and REGAIN (basal insulin-treated; NCT02967211) studies in participants with uncontrolled type 2 diabetes (T2DM) in Europe and Brazil.Methods: In these open-label, parallel-group, pragmatic studies, patients (HbA1c > 7.0%) were randomized to Gla-300 or SoC BI for a 6-month treatment period (to demonstrate non-inferiority of Gla-300 vs SoC BIs for HbA1c change [non-inferiority margin 0.3%]) and a 6-month extension period (continuing with their assigned treatment). Insulin titration/other medication changes were at investigator/patient discretion post-randomization.Results: Overall, 703 patients were randomized to treatment in REACH (Gla-300, n = 352; SoC, n = 351) and 609 (Gla-300, n = 305, SoC, n = 304) in REGAIN. The primary outcome, non-inferiority of Gla-300 versus SoC for HbA1c change from baseline to month 6, was met in REACH (least squares [LS] mean difference 0.12% [95% CI -0.046 to 0.281]) but not REGAIN (LS mean difference 0.17% [0.015-0.329]); no between-treatment difference in HbA1c change was shown after 12 months in either study. BI dose increased minimally from baseline to 12 months in REACH (Gla-300, +0.17 U/kg; SoC, +0.15 U/kg) and REGAIN (Gla-300, +0.11 U/kg; SoC, +0.07 U/kg). Hypoglycemia incidence was low and similar between treatment arms in both studies.Conclusions: In both REACH and REGAIN, no differences in glycemic control or hypoglycemia outcomes with Gla-300 versus SoC BIs were seen over 12 months. However, the suboptimal insulin titration in REACH and REGAIN limits comparisons of outcomes between treatment arms and suggests that more titration instruction/support may be required for patients to fully derive the benefits from newer basal insulin formulations.
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Affiliation(s)
- Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, CIBERDEM, Barcelona, Spain
| | - Andrea Giaccari
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Ronan Roussel
- Department of Diabetology, Endocrinology, and Nutrition, Bichat Hospital, AP-HP, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
- UFR de Médecine, Paris University, Paris, France
| | | | | | | | | | | | | | | | | | - Alfred Penfornis
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes and Université Paris Sud, Paris, France
| | - Manuel Perez-Maraver
- Servei d´Endocrinologia i Nutrició, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, IDIBELL, Barcelona, Spain
| | - Jochen Seufert
- Faculty of Medicine, Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - Sean D Sullivan
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - John Wilding
- Obesity and Endocrinology Clinical Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Carol Wysham
- Diabetes and Endocrinology Center, Multicare Rockwood Clinic, Spokane, WA, USA
| | - Melanie Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
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Cheng A, Harris S, Giorgino F, Seufert J, Ritzel R, Khunti K, Lauand F, Melas‐Melt L, Westerbacka J, Bosnyak Z, Rosenstock J. Similar glycaemic control and less hypoglycaemia during active titration after insulin initiation with glargine 300 units/mL and degludec 100 units/mL: A subanalysis of the BRIGHT study. Diabetes Obes Metab 2020; 22:346-354. [PMID: 31646724 PMCID: PMC7064957 DOI: 10.1111/dom.13901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/15/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
Abstract
AIM To further investigate glycaemic control and hypoglycaemia in BRIGHT, focusing on the titration period. MATERIALS AND METHODS BRIGHT was a multicentre, open-label, randomized, active-controlled, two-arm, parallel-group, 24-week study in insulin-naïve patients with uncontrolled type 2 diabetes initiated on glargine 300 U/mL (Gla-300) (N = 466) or degludec (IDeg-100) (N = 463). Predefined efficacy and safety outcomes were investigated during the initial 12-week titration period. In addition, patients' characteristics and clinical outcomes were assessed descriptively, stratified by confirmed (≤3.9 mmol/L) hypoglycaemia incidence during the initial titration period. RESULTS At week 12, HbA1c was comparable between Gla-300 (7.32%) and IDeg-100 (7.23%), with similar least squares (LS) mean reductions from baseline (-1.37% and - 1.39%, respectively; LS mean difference of 0.02; 95% confidence interval: -0.08 to 0.12). Patients who experienced hypoglycaemia during the initial titration period had numerically greater HbA1c reductions by week 12 than patients who did not (-1.46% vs. -1.28%), and higher incidence of anytime (24 hours; 73.3% vs. 35.7%) and nocturnal (00:00-06:00 hours; 30.0% vs. 11.9%) hypoglycaemia between weeks 13-24. CONCLUSIONS The use of Gla-300 resulted in similar glycaemic control as IDeg-100 during the initial 12-week titration period of the BRIGHT study, when less anytime (24 hours) hypoglycaemia with Gla-300 versus IDeg-100 has been reported. Experiencing hypoglycaemia shortly after initiating Gla-300 or IDeg-100 may be associated with hypoglycaemia incidence in the longer term, potentially impacting glycaemic management.
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Affiliation(s)
- Alice Cheng
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Stewart Harris
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic DiseasesUniversity of Bari Aldo MoroBariItaly
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of FreiburgFaculty of Medicine, University of FreiburgGermany
| | - Robert Ritzel
- Division of Endocrinology, Diabetes and AngiologyKlinikum Schwabing and Klinikum BogenhausenMunichGermany
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | | | | | | | | | - Julio Rosenstock
- Dallas Diabetes Research Center at Medical CityDallasTexasUnited States
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