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Abstract
BACKGROUND Glycaemic control is suboptimal in a large proportion of people with type 2 diabetes who are consequently at an increased and avoidable risk of potentially severe complications. We sought to explore attitudes and practices among healthcare professionals that may contribute to suboptimal glycaemic control through a review of recent relevant publications in the scientific literature. METHODS An electronic search of the PubMed database was performed to identify relevant publications from January 2011 to July 2015. The electronic search was complemented by a manual search of abstracts from key diabetes conferences in 2014/2015 available online. RESULTS Recently published data indicate that glycaemic control is suboptimal in a substantial proportion (typically 40%-60%) of people with diabetes. This is the case across geographic regions and in both low- and higher-income countries. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type 2 diabetes. In particular, prescribers are often willing to tolerate extended periods of 'mild' hyperglycaemia as well as having low expectations for their patients. There are often delays of 3 years or longer in initiating or intensifying glucose-lowering therapy when needed. CONCLUSION Many people with type 2 diabetes are failed by current management, with approximately half not achieving or maintaining appropriate target blood glucose levels, leaving these patients at increased and avoidable risk of serious complications. Review criteria: The methodology of this review article is detailed in the 'Methods' section.
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Affiliation(s)
- Lawrence Blonde
- Department of Endocrinology, Ochsner Medical Center, New Orleans, LA, USA
- Lawrence Blonde, Department of Endocrinology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Pablo Aschner
- Endocrinology Unit, Javeriana University School of Medicine, Bogotá, Colombia
| | - Clifford Bailey
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Lawrence A Leiter
- Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital and Division of Endocrinology & Metabolism, University of Toronto, Toronto, ON, Canada
| | - Stephan Matthaei
- Diabetes, Metabolism and Endocrinology Center, Quakenbrück Hospital, Quakenbrück, Germany
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Matthaei S, Aggarwal N, Garcia-Hernandez P, Iqbal N, Chen H, Johnsson E, Chin A, Hansen L. One-year efficacy and safety of saxagliptin add-on in patients receiving dapagliflozin and metformin. Diabetes Obes Metab 2016; 18:1128-1133. [PMID: 27403645 DOI: 10.1111/dom.12741] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 04/20/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
Abstract
AIMS Greater reductions in glycated haemoglobin (HbA1c) with saxagliptin, a dipeptidyl peptidase-4 inhibitor, versus placebo add-on in patients with type 2 diabetes who had inadequate glycaemic control with dapagliflozin 10 mg/d plus metformin were demonstrated after 24 weeks of treatment. Results over 52 weeks of treatment were assessed in this analysis. MATERIALS AND METHODS Patients (mean baseline HbA1c 7.9%) receiving open-label dapagliflozin 10 mg/d plus metformin were randomized to double-blind saxagliptin 5 mg/d or placebo add-on. RESULTS The adjusted mean change from baseline to week 52 in HbA1c was greater with saxagliptin than with placebo add-on -0.38% vs 0.05%; difference -0.42% (95% confidence interval -0.64, -0.20)]. More patients achieved the HbA1c target of <7% with saxagliptin than with placebo add-on (29% vs 13%), and fewer patients were rescued or discontinued the study for lack of glycaemic control with saxagliptin than with placebo add-on (19% vs 28%). Reductions from baseline in body weight (≤1.5 kg) occurred in both groups. Similar proportions of patients reported ≥1 adverse event with saxagliptin (58.2%) and placebo add-on (58.0%); no new safety signals were detected. Hypoglycaemia was infrequent in both treatment groups (≤2.5%), with no major episodes. The rate of urinary tract infections was similar in the saxagliptin and placebo add-on groups (7.8% vs 7.4%). The incidence of genital infections was 3.3% with saxagliptin versus 6.2% with placebo add-on. CONCLUSIONS Triple therapy with saxagliptin add-on to dapagliflozin plus metformin for 52 weeks resulted in sustained improvements in glycaemic control without an increase in body weight or increased risk of hypoglycaemia.
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Affiliation(s)
- S Matthaei
- Diabetes-Zentrum, Quakenbrück Hospital, Quakenbrück, Germany
| | - N Aggarwal
- Aggarwal and Associates, Ltd, Brampton, Ontario, Canada
| | - P Garcia-Hernandez
- Servicio de Endocrinologia, Hospital Universitario Dr. José Eleuterio Gonzalez, Monterrey, Nuevo Leon, Mexico
| | - N Iqbal
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA.
| | - H Chen
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - E Johnsson
- Global Medicines Development, AstraZeneca, Gothenburg, Sweden
| | - A Chin
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - L Hansen
- Global Clinical Research Metabolics, Bristol-Myers Squibb, Princeton, New Jersey, USA
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Matthaei S, Catrinoiu D, Celiński A, Ekholm E, Cook W, Hirshberg B, Iqbal N, Hansen L. Eine randomisierte doppelblinde Studie mit Saxagliptin als Zusatz zu Dapagliflozin + Metformin. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580787] [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: 10/21/2022]
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Schmitt A, Reimer A, Kulzer B, Icks A, Paust R, Rölver KM, Matthaei S, Kaltheuner M, Ehrmann D, Krichbaum M, Haak T, Hermanns N. Validierung eines Fragebogens zu Problemen der Krankheitsakzeptanz bei Diabetes mellitus: Diabetes Acceptance Scale (DAS). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580981] [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: 10/21/2022]
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Matthaei S, Müller-Wieland D, Hamann A, Siegel E. Erhebung einer systematischen HbA1c-Messung zum Zeitpunkt der Aufnahme zur Bestimmung der Prävalenz des Typ-2-Diabetes (T2DM) bei Krankenhauspatienten in Deutschland. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Landgraf R, Kellerer M, Fach E, Gallwitz B, Hamann A, Joost H, Klein H, Müller-Wieland D, Nauck M, Reuter H, Schreiber S, Siegel E, Matthaei S. Praxisempfehlungen DDG/DGIM. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1553539] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - E. Fach
- Studienzentrum Stephanskirchen
| | - B. Gallwitz
- Medizinische Klinik IV, Universitätsklinikum Tübingen
| | - A. Hamann
- Medizinische Klinik IV, Hochtaunuskliniken gGmbH, Bad Homburg v.d.H
| | - H. Joost
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DIfE), Nuthetal
| | - H. Klein
- Medizinische Klinik I, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | | | - M. Nauck
- St. Josef-Hospital, Klinikum der Ruhr-Universität, Bochum
| | - H. Reuter
- Innere Medizin/Diabetologie, GP Ambulantes Medizinisches Zentrum, Jena
| | | | - E. Siegel
- Abteilung für Innere Medizin – Gastroenterologie, Diabetologie/Endokrinologie und Ernährungsmedizin, St. Josefskrankenhaus Heidelberg GmbH
| | - S. Matthaei
- Fachabteilung für Diabetologie, Endokrinologie und Stoffwechselerkrankungen am Christlichen Krankenhaus Diabetes-Zentrum Quakenbrück
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Matthaei S, Catrinoiu D, Celiński A, Ekholm E, Cook W, Hirshberg B, Chen H, Iqbal N, Hansen L. Randomized, Double-Blind Trial of Triple Therapy With Saxagliptin Add-on to Dapagliflozin Plus Metformin in Patients With Type 2 Diabetes. Diabetes Care 2015; 38:2018-24. [PMID: 26324329 DOI: 10.2337/dc15-0811] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 04/16/2015] [Accepted: 07/28/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess the efficacy and safety of triple therapy with saxagliptin add-on versus placebo add-on to dapagliflozin plus metformin in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Patients on stable metformin (≥1,500 mg/day) for ≥8 weeks with glycated hemoglobin (HbA1c) 8.0-11.5% (64-102 mmol/mol) at screening received open-label dapagliflozin (10 mg/day) plus metformin immediate release (IR) for 16 weeks. Patients with inadequate glycemic control (HbA1c 7-10.5% [53-91 mmol/mol]) were then randomized to receive placebo (n = 153) or saxagliptin 5 mg/day (n = 162) in addition to background dapagliflozin plus metformin IR. The primary efficacy end point was change in HbA1c from baseline to week 24. RESULTS There was a significantly greater reduction in HbA1c at 24 weeks with saxagliptin add-on (-0.51% [-5.6 mmol/mol]) versus placebo (-0.16% [-1.7 mmol/mol]) add-on to dapagliflozin plus metformin (difference, -0.35% [95% CI -0.52% to -0.18%] and -3.8 [-5.7 to -2.0 mmol/mol], respectively; P < 0.0001). Reductions in fasting plasma glucose and 2-h postprandial glucose were similar between treatment arms. A larger proportion of patients achieved HbA1c <7% (53 mmol/mol) with saxagliptin add-on (35.3%) versus placebo add-on (23.1%) to dapagliflozin plus metformin. Adverse events were similar between treatment groups. Episodes of hypoglycemia were infrequent in both treatment arms, and there were no episodes of major hypoglycemia. CONCLUSIONS Triple therapy with the addition of saxagliptin to dapagliflozin plus metformin was well tolerated and produced significant improvements in HbA1c in patients with type 2 diabetes inadequately controlled with dapagliflozin plus metformin.
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Affiliation(s)
| | - Doina Catrinoiu
- Spitalul Clinic Judetean de Urgenta Constanta, Constanta, Romania
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Matthaei S, Bowering K, Rohwedder K, Sugg J, Parikh S, Johnsson E. Durability and tolerability of dapagliflozin over 52 weeks as add-on to metformin and sulphonylurea in type 2 diabetes. Diabetes Obes Metab 2015. [PMID: 26212528 DOI: 10.1111/dom.12543] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 12/13/2022]
Abstract
AIMS To evaluate the safety and efficacy of dapagliflozin as add-on therapy to metformin plus sulphonylurea over 52 weeks. METHODS Patients with type 2 diabetes mellitus (T2DM) using sulphonylurea and metformin received dapagliflozin 10 mg/day or placebo added to therapy for 52 weeks (24-week randomized, double-blind period plus 28-week double-blind extension). RESULTS A total of 219 patients were randomized 1 : 1 to dapagliflozin or placebo. Over 52 weeks, glycated haemoglobin (HbA1c) and fasting plasma glucose levels showed greater improvement from baseline with dapagliflozin (-0.8% and -1.5 mmol/l) than with placebo (-0.1% and 0.6 mmol/l). More patients achieved HbA1c <7.0% with dapagliflozin (27.3%) than with placebo (11.3%) at 52 weeks. Dapagliflozin was associated with greater reductions in body weight and systolic blood pressure (-2.9 kg and -1.0 mmHg) compared with placebo (-1.0 kg and 1.1 mmHg). Greater increases in total, LDL and HDL cholesterol and decreases in triglycerides were observed with dapagliflozin (3.4, 4.8, 6.9 and -8.0%, respectively) versus placebo (1.4, 0.9, 0.6 and 2.9%, respectively). Fewer patients were rescued for failing to reach glycaemic targets with dapagliflozin (9.3%) than with placebo (44.4%). Adverse events and serious adverse events were similar between groups (dapagliflozin: 69.7 and 6.4%; placebo: 73.4 and 7.3%). More hypoglycaemic events were observed with dapagliflozin (15.6%) than with placebo (8.3%). Genital infections were reported in more patients in the dapagliflozin (10.1%) than in the placebo group (0.9%) and urinary tract infection frequency was similar in the two groups (10.1 and 11.0%). CONCLUSION Dapagliflozin as add-on to metformin plus a sulphonylurea was well tolerated and improvement in glycaemic control was maintained over 52 weeks.
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Affiliation(s)
- S Matthaei
- Diabetes-Zentrum Quakenbrück, Quakenbrück, Germany
| | - K Bowering
- University of Alberta, Department of Medicine, Alberta, Canada
| | | | - J Sugg
- Formerly AstraZeneca, Wilmington, DE, USA
| | - S Parikh
- AstraZeneca, Gaithersburg, MD, USA
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Affiliation(s)
- B Gallwitz
- Universitätsklinikum Tübingen, Medizinische Klinik IV, Tübingen
| | - S Matthaei
- Diabetes-Zentrum Quakenbrück, Fachabteilung für Diabetologie, Endokrinologie und Stoffwechsel am Christlichen Krankenhaus Quakenbrück, Quakenbrück
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Rohwedder K, Matthaei S, Bowering K, Grohl A, Johnsson E. Verbesserung der glykämischen Kontrolle und Verringerung des Körpergewichtes innerhalb von 52 Wochen mit Dapagliflozin als Add-on-Therapie zu Metformin und Sulfonylharnstoff. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549811] [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: 10/23/2022]
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Rölver KM, Matthaei S, Lueg A, Lutze B, Lange K. Beeinflusst die Typ-1-Diabetesdiagnose in früher Kindheit die Lebenschancen im jungen Erwachsenenalter? DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549773] [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: 10/23/2022]
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Matthaei S, Bowering K, Rohwedder K, Grohl A, Parikh S. Dapagliflozin improves glycemic control and reduces body weight as add-on therapy to metformin plus sulfonylurea: a 24-week randomized, double-blind clinical trial. Diabetes Care 2015; 38:365-72. [PMID: 25592197 DOI: 10.2337/dc14-0666] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of dapagliflozin in patients with type 2 diabetes inadequately controlled with metformin and sulfonylurea. RESEARCH DESIGN AND METHODS Patients with HbA1c of 7.0% (53 mmol/mol) to 10.5% (91 mmol/mol) receiving sulfonylurea and metformin were randomized to receive dapagliflozin 10 mg/day (n = 109) or placebo (n = 109) for 24 weeks. RESULTS HbA1c (baseline: dapagliflozin 8.08% [65 mmol/mol]; placebo 8.24% [67 mmol/mol]) and fasting plasma glucose (baseline: dapagliflozin 167.4 mg/dL [9.29 mmol/L]; placebo 180.5 mg/dL [10.02 mmol/L]) significantly improved from baseline with dapagliflozin (placebo-subtracted change -0.69% [-7.5 mmol/mol], P < 0.0001; -33.5 mg/dL [-1.86 mmol/L], P < 0.0001, respectively). More patients achieved a therapeutic glycemic response (HbA1c <7.0% [53 mmol/mol]) with dapagliflozin (31.8%) versus placebo (11.1%) (P < 0.0001). Body weight and systolic blood pressure were significantly reduced from baseline over 24 and 8 weeks, respectively, with dapagliflozin (placebo-subtracted change -2.1 kg, P < 0.0001; -3.8 mmHg, P = 0.0250). Patients receiving dapagliflozin showed placebo-subtracted increases in total, LDL, and HDL cholesterol (11.4 mg/dL, P = 0.0091; 11.4 mg/dL, P = 0.0030; 2.2 mg/dL, P = 0.0172, respectively) with no change in LDL/HDL cholesterol ratio (0.1; P = 0.2008) or triglycerides (-16.5 mg/dL; P = 0.1755). Adverse events occurred in 48.6% of patients receiving dapagliflozin and 51.4% receiving placebo. Significantly more patients with dapagliflozin compared with placebo experienced hypoglycemia (12.8 vs. 3.7%; P = 0.024) and genital infections (5.5 vs. 0%; P = 0.029). Events of urinary tract infection were reported by 6.4% of patients in both groups. CONCLUSIONS Dapagliflozin was well tolerated and effective over 24 weeks as add-on to metformin plus sulfonylurea. Adverse effects included hypoglycemia and genital infections.
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Landgraf R, Kellerer M, Fach E, Gallwitz B, Hamann A, Joost H, Klein H, Müller-Wieland D, Nauck M, Reuter H, Schreiber S, Siegel E, Matthaei S. Praxisempfehlungen DDG/DGIM. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0034-1385405] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - E. Fach
- Diabetologische Schwerpunktpraxis, Rosenheim
| | - B. Gallwitz
- Medizinische Klinik IV, Universitätsklinikum Tübingen
| | - A. Hamann
- Medizinische Klinik IV, Hochtaunuskliniken gGmbH, Bad Homburg v.d. H
| | - H. Joost
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DIfE), Nuthetal
| | - H. Klein
- Medizinische Klinik I, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | | | - M. Nauck
- Fachklinik für Diabetes und Stoffwechselkrankheiten, Diabetes-Zentrum Bad Lauterberg, Bad Lauterberg im Harz
| | - H.- Reuter
- Innere Medizin/Diabetologie, GP Ambulantes Medizinisches Zentrum, Jena
| | | | - E. Siegel
- Abteilung für Innere Medizin – Gastroenterologie, Diabetologie/Endokrinologie und Ernährungsmedizin, St. Josefskrankenhaus Heidelberg GmbH
| | - S. Matthaei
- Fachabteilung für Diabetologie, Endokrinologie und Stoffwechselerkrankungen am Christlichen Krankenhaus Diabetes-Zentrum Quakenbrück
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Matthaei S, DeAlaiz RA, Bosi E, Evans M, Geelhoed-Duijvestijn N, Joubert M. Consensus recommendations for the use of Ambulatory Glucose Profile in clinical practice. Br J Diabetes 2014. [DOI: 10.15277/bjdvd.2014.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Matthaei S. Type 2 diabetes and cancer: should we prefer antihyperglycaemic treatments without unnecessarily increasing insulin levels? Diab Vasc Dis Res 2014; 11:370. [PMID: 25249176 DOI: 10.1177/1479164114550641] [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] [Indexed: 11/17/2022] Open
Affiliation(s)
- Stephan Matthaei
- Diabetology, Endocrinology and Metabolism, Diabetes-Center, Quakenbrück, Germany
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Tamm J, Thienel F, Matthaei S. Therapie des Typ 2 Diabetes: Nachhaltige Reduktion kardiovaskulärer Risikoparameter 12 Monate nach strukturierter Diabetes-Schulung und Initiierung einer zielwertorientierten, multifaktoriellen Therapie in den Jahren 2011 bis 2012. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375081] [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: 10/25/2022]
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Matthaei S, Rohwedder K, Grohl A, Johnsson E. Verbesserung der Blutzuckerkontrolle und Verringerung des Körpergewichts unter Dapagliflozin als Zusatztherapie zu Metformin und Sulfonylharnstoff. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375125] [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: 10/25/2022]
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Affiliation(s)
- S Matthaei
- Diabetes-Zentrum Quakenbrück, Fachabteilung für Diabetologie, Endokrinologie & Stoffwechselerkrankungen am Christlichen Krankenhaus Quakenbrück
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Reaney M, Mathieu C, Ostenson CG, Matthaei S, Krarup T, Kiljański J, Salaun-Martin C, Sapin H, Theodorakis M, Guerci B. Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study. Health Qual Life Outcomes 2013; 11:217. [PMID: 24369764 PMCID: PMC3900476 DOI: 10.1186/1477-7525-11-217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 12/02/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Improvements in the clinical condition of patients with type 2 diabetes are often accompanied by improvements in health-related quality of life and other patient-reported outcomes (PROs), but data assessing injectable treatment initiation from the patient's perspective in routine clinical practice are lacking. We examined PROs in patients initiating injectable treatment in the CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) study. METHODS CHOICE was a 24-month, prospective observational study conducted in six European countries. Patients initiated exenatide twice daily (BID) or insulin based on a physician's clinical judgement. Clinical and PRO data were collected at baseline (injectable therapy initiation) and after approximately 3, 6, 12, 18 and 24 months. The two treatment cohorts had different baseline characteristics; therefore, no statistical comparisons of endpoints between main cohorts were conducted. RESULTS There were 2388 patients eligible for analysis (exenatide BID cohort, n = 1114; insulin cohort, n = 1274). Mean positive changes in Impact of Weight on Quality of Life-Lite (IWQOL-Lite) total score and EuroQoL5-Dimension (EQ-5D) index and visual analogue scale (VAS) scores were observed in both cohorts with most changes observed during the first 6 months after injectable therapy initiation. Patients who experienced weight loss (≥ 1 kg) at 24 months appeared to have higher mean improvements in IWQOL-Lite total score than did patients with weight gain or no weight change. Patients who met the composite clinical endpoint of glycated haemoglobin (HbA1c) <7.0%, no weight gain (≤ 1 kg) and no hypoglycaemia generally experienced higher mean improvements in EQ-5D index and VAS scores (compared with patients who did not meet this endpoint) and Diabetes Health Profile-18 scores (versus the main cohorts). High levels of missing data were observed for all PRO measures in both cohorts compared with those for clinical outcomes. CONCLUSIONS These data from a clinical practice study support those from clinical trials, suggesting that PROs are not adversely affected, and may be improved, by injectable therapy initiation. PRO data may aid appropriate treatment selection for individual patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT00635492.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Michael Theodorakis
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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Landgraf R, Kellerer M, Fach E, Gallwitz B, Hamann A, Joost H, Klein H, Müller-Wieland D, Nauck M, Reuter HM, Schreiber S, Siegel E, Matthaei S. Erratum:Praxisempfehlungen DDG/DGIM. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1356348] [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: 10/25/2022]
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Müller-Wieland D, Gallwitz B, Kellerer M, Matthaei S. Moderne Diabetestherapie im Spannungsfeld der Gesundheitspolitik: Forderungen der DDG zur Optimierung des AMNOG-Prozesses. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1356314] [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: 10/25/2022]
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Mathieu C, Ostenson CG, Matthaei S, Reaney M, Krarup T, Guerci B, Kiljański J, Salaun-Martin C, Sapin H, Theodorakis M. Using Exenatide Twice Daily or Insulin in Clinical Practice: Results from CHOICE. Diabetes Ther 2013; 4:285-308. [PMID: 24018835 PMCID: PMC3889314 DOI: 10.1007/s13300-013-0037-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy; NCT00635492) assessed, as its primary objective, the time to a 'significant treatment change' (defined within this paper) after patients with type 2 diabetes mellitus initiated their first injectable, glucose-lowering therapy [exenatide twice daily (BID) or insulin] in clinical practice in six European countries and evaluated outcomes during the study. METHODS CHOICE was a 24-month, prospective, noninterventional observational study. Patients were invited to participate in CHOICE only after their treating physician had made the clinical decision to initiate first injectable therapy with either exenatide BID or insulin. Clinical data were collected at initiation of first injectable therapy and after approximately 3, 6, 12, 18, and 24 months. RESULTS A total of 2,515 patients were recruited; 1,114 patients in the exenatide BID cohort and 1,274 patients in the insulin cohort were eligible for the 24-month analysis. During the study, 42.2% and 36.0% of patients from each cohort, respectively, had a significant treatment change. By 24 months, improved mean glycated hemoglobin (p < 0.001 for both cohorts) and reduced severity of several cardiovascular risk factors were observed in both cohorts; additionally, mean weight was reduced in the exenatide BID cohort (p < 0.001) and increased in the insulin cohort (p < 0.001). Hypoglycemia was reported by 18.4% of the exenatide BID cohort and 36.8% of the insulin cohort; 25.9% of the exenatide BID cohort and 10.0% of the insulin cohort had met the secondary endpoint of glycated hemoglobin <7.0%, no weight gain, and no hypoglycemia. CONCLUSION CHOICE provided data on exenatide BID and insulin usage patterns and 24-month outcomes in clinical practice. On average, improved glycemic control and reduced severity of cardiovascular risk factors were observed in both cohorts, and those in the exenatide BID cohort also had mean weight loss.
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Affiliation(s)
- Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, 3000, Leuven, Belgium,
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Landgraf R, Kellerer M, Fach E, Gallwitz B, Hamann A, Joost H, Klein H, Müller-Wieland D, Nauck M, Reuter H, Schreiber S, Siegel E, Matthaei S. Praxisempfehlungen DDG/DGIM. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1356099] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - E. Fach
- Diabetologische Schwerpunktpraxis, Rosenheim
| | - B. Gallwitz
- Medizinische Klinik IV, Universitätsklinikum Tübingen
| | - A. Hamann
- Medizinische Klinik IV, Hochtaunuskliniken gGmbH, Bad Homburg v.d. H
| | - H. Joost
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DIfE), Nuthetal
| | - H. Klein
- Medizinische Klinik I, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | | | - M. Nauck
- Fachklinik für Diabetes und Stoffwechselkrankheiten, Diabetes-Zentrum Bad Lauterberg, Bad Lauterberg im Harz
| | - H.- Reuter
- Innere Medizin/Diabetologie, GP Ambulantes Medizinisches Zentrum, Jena
| | | | - E. Siegel
- Abteilung für Innere Medizin – Gastroenterologie, Diabetologie/Endokrinologie und Ernährungsmedizin, St. Josefskrankenhaus Heidelberg GmbH
| | - S. Matthaei
- Fachabteilung für Diabetologie, Endokrinologie und Stoffwechselerkrankungen am Christlichen Krankenhaus Diabetes-Zentrum Quakenbrück
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Abstract
The Global Partnership for Effective Diabetes Management, established to provide practical guidance to improve patient outcomes in diabetes, has developed and modified recommendations to improve glycaemic control in type 2 diabetes. The Global Partnership advocates an individualized therapeutic approach and, as part of the process to customize therapy, has previously identified specific type 2 diabetes patient subgroups that require special consideration. This article builds on earlier publications, expanding the scope of practical guidance to include newly diagnosed individuals with complications and women with diabetes in pregnancy. Good glycaemic control remains the cornerstone of managing type 2 diabetes, and plays a vital role in preventing or delaying the onset and progression of diabetic complications. Individualizing therapeutic goals and treatments to meet glycaemic targets safely and without delay remains paramount, in addition to a wider programme of care to reduce cardiovascular risk factors and improve patient outcomes.
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Affiliation(s)
- Clifford J Bailey
- Diabetes Research, School of Life & Health Sciences, Aston University, Birmingham, UK.
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Kiiskinen U, Matthaei S, Reaney M, Mathieu C, Ostenson CG, Krarup T, Theodorakis M, Kiljański J, Salaun-Martin C, Sapin H, Guerci B. Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study. Clinicoecon Outcomes Res 2013; 5:355-67. [PMID: 23874113 PMCID: PMC3713896 DOI: 10.2147/ceor.s44060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 02/04/2023] Open
Abstract
Purpose CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin) and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both), but mean weight was reduced in the exenatide bid cohort (P < 0.001) and increased in the insulin cohort (P < 0.001) by 24 months. Across all countries, total per patient health care costs for the 24 months post baseline were €3997.9 in the exenatide bid cohort and €3265.5 in the insulin cohort (€1791.9 versus €2465.5 due to costs other than those of injectable therapy). When baseline direct cost and patients’ and disease characteristics were controlled for, mean direct costs differed by country (P < 0.0001), irrespective of treatment initiated, and the mean cost difference between treatments varied by country (P < 0.0001). Conclusion Much of the higher mean cost of exenatide bid, compared with insulin, therapy was compensated for by lower mean costs of other health service utilization. Costs associated with exenatide bid or insulin initiation varied across countries, highlighting the need to avoid generalization of resource use and cost implications of a particular therapy when estimated in specific country settings.
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Thiery J, Luppa P, Koschinsky T, Matthaei S. Anforderungen an die Messqualität und Qualitätssicherung (QS) von Point-of-Care-Testing(POCT)-Blutglukose-Messsystemen, die für das Screening und die Diagnose eines Gestationsdiabetes mellitus (GDM) gemäß der GDM-Leitlinie der Deutschen Diabetes-Gesellschaft (DDG) geeignet sind. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1335716] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Landgraf R, Kellerer M, Fach E, Gallwitz B, Hamann A, Joost H, Klein H, Müller-Wieland D, Nauck M, Reuter H, Schreiber S, Siegel E, Matthaei S. Praxisempfehlungen DDG/DGIM. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1335297] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - E. Fach
- Diabetologische Schwerpunktpraxis, Rosenheim
| | - B. Gallwitz
- Medizinische Klinik IV, Universitätsklinikum Tübingen
| | - A. Hamann
- Medizinische Klinik IV, Hochtaunuskliniken gGmbH, Bad Homburg v.d. H
| | - H. Joost
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DIfE), Nuthetal
| | - H. Klein
- Medizinische Klinik I, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | | | - M. Nauck
- Fachklinik für Diabetes und Stoffwechselkrankheiten, Diabetes-Zentrum Bad Lauterberg, Bad Lauterberg im Harz
| | - H.- Reuter
- Innere Medizin/Diabetologie, GP Ambulantes Medizinisches Zentrum, Jena
| | | | - E. Siegel
- Abteilung für Innere Medizin - Gastroenterologie, Diabetologie/Endokrinologie und Ernährungsmedizin, St. Josefskrankenhaus Heidelberg GmbH
| | - S. Matthaei
- Fachabteilung für Diabetologie, Endokrinologie und Stoffwechselerkrankungen am Christlichen Krankenhaus Diabetes-Zentrum Quakenbrück
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Östenson CG, Matthaei S, Reaney M, Krarup T, Guerci B, Kiljanski J, Salaun-Martin C, Sapin H, Bruhn D, Mathieu C, Theodorakis M. Treatment outcomes after initiation of exenatide twice daily or insulin in clinical practice: 12-month results from CHOICE in six European countries. Diabetes Metab Syndr Obes 2013; 6:171-85. [PMID: 23667315 PMCID: PMC3650573 DOI: 10.2147/dmso.s41827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy (CHOICE) study assessed time to, and reasons for, significant treatment change after patients with type 2 diabetes (T2DM) initiated their first injectable glucose-lowering therapy (exenatide twice daily [BID] or insulin) in routine clinical practice, and these patients' clinical outcomes, in six European countries. This paper reports interim data from the first 12 months of the study. RESEARCH DESIGN AND METHODS CHOICE (NCT00635492) is a prospective, noninterventional, observational study. Clinical data were collected at initiation of first injectable therapy and after approximately 3, 6, and 12 months. RESULTS Of 2497 patients enrolled in CHOICE, 1096 in the exenatide BID and 1239 in the insulin cohorts had ≥1 post-baseline assessment and were included in this analysis. Overall, 32.2% of the exenatide BID cohort and 29.1% of the insulin cohort (Kaplan-Meier estimates) had significant treatment change during the first 12 months, most commonly discontinuing injectable therapy or adding new T2DM therapy, respectively. Glycemic control improved in both cohorts, but weight loss occurred only in the exenatide BID cohort (mean change -3.3 kg). Hypoglycemia occurred in 13.2% of the exenatide BID cohort and 28.6% of the insulin cohort (82.8% and 55.6% of these patients, respectively, received sulfonylureas). The post hoc endpoint of glycated hemoglobin < 7%, no weight gain, and no hypoglycemia was attained at 12 months by 24.3% and 10.3% of patients who had data at 12 months and who were receiving exenatide BID and insulin, respectively. CONCLUSION About 30% of patients in CHOICE changed treatment in the first 12 months after initiation of first injectable therapy (exenatide BID or insulin). Overall, both cohorts achieved improved glycemic control, which was accompanied by a mean weight loss in the exenatide BID cohort.
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Affiliation(s)
- Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | | | - Thure Krarup
- Department of Endocrinology I, Bispebjerg Hospital, Copenhagen, Denmark
| | - Bruno Guerci
- Diabetology, Metabolic Diseases and Nutrition, Brabois Hospital, CHU Nancy, and INSERM CIC, ILCV, Vandoeuvre Lès Nancy, France
| | | | | | | | | | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium
| | - Michael Theodorakis
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece*
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Rölver KM, Matthaei S, Lueg A, Lutze B, Lange K. Lebenschancen junger Erwachsener mit Typ 1 Diabetes. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341855] [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: 10/26/2022]
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Matthaei S, Bierwirth R, Fritsche A, Gallwitz B, Häring HU, Joost HG, Kellerer M, Kloos C, Kunt T, Nauck M, Schernthaner G, Siegel E, Thienel F. Behandlung des Diabetes mellitus Typ 2*. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1325582] [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: 10/27/2022]
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Kellerer M, Matthaei S. Praxisempfehlungen der Deutschen Diabetes Gesellschaft. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1325333] [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: 10/27/2022]
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Matthaei S, Reaney M, Mathieu C, Ostenson CG, Krarup T, Guerci B, Kiljanski J, Petto H, Bruhn D, Theodorakis M. Patients with Type 2 Diabetes Initiating Exenatide Twice Daily or Insulin in Clinical Practice: CHOICE Study. Diabetes Ther 2012; 3:6. [PMID: 22714818 PMCID: PMC3508107 DOI: 10.1007/s13300-012-0006-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Changes to Treatment and Outcomes in Patients with Type 2 Diabetes Initiating Injectable Therapy (CHOICE) is a European prospective, observational cohort study assessing time to, and factors associated with, a significant change in therapy after type 2 diabetes patients initiate their first injectable glucose-lowering therapy, and these patients' clinical outcomes over 24 months. The authors report baseline data and factors associated with the injectable treatment regimen. METHODS Demographic, clinical, and healthcare resource-use data were collected at initiation of injectable therapy and analyzed using univariate tests between cohorts and multivariate logistic regression analysis for treatment. RESULTS Overall, 1,177 patients initiated exenatide twice daily (b.i.d.) and 1,315 initiated insulin. Most patients were recruited by secondary-care physicians. Univariate analyses revealed statistically significant differences between the characteristics of patients who initiated exenatide b.i.d. and patients who initiated insulin. On multivariate analysis, higher body mass index [BMI; 5 kg/m(2) higher: odds ratio (OR) 2.10, 95% confidence intervals (CI) 1.84-2.40], lower glycated hemoglobin (HbA(1c); 1% higher: OR 0.77, 95% CI 0.69-0.86), and lower age (5 years older: OR 0.82, 95% CI 0.76-0.88) were the variables most strongly associated with increased probability of receiving exenatide b.i.d. (P < 0.0001). Patients initiating exenatide b.i.d. had a mean BMI of 35.3 ± 6.5 kg/m(2), HbA(1c) of 8.4 ± 1.4%, and age of 58 ± 10 years, compared with 29.7 ± 5.4 kg/m(2), 9.2 ± 1.9%, and 64 ± 11 years, respectively, in patients initiating insulin (P < 0.0001). Other characteristics significantly associated with exenatide b.i.d. initiation were "disinhibited eating" (Diabetes Health Profile-18), lower random blood glucose, less blood glucose self-monitoring, lower low-density lipoprotein cholesterol, and receipt of diet/exercise advice. CONCLUSIONS Patients who initiated exenatide b.i.d. were on average younger and more obese with lower HbA(1c) than those initiating insulin.
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Affiliation(s)
- Stephan Matthaei
- Diabetes-Zentrum Quakenbrück, Fachabteilung fur Diabetologie, Stoffwechsel und Endokrinologie am Christlichen Krankenhaus, Klinisches Diabeteszentrum der DDG, Akademisches Lehrkrankenhausder Medizinischen Hochschule Hannover, Danziger Str.10, 49610, Quakenbruck, Germany,
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Lemke C, Petruschke T, Wallace JF, Pardo S, Parkes JL, Matthaei S. Vergleichende Evaluierung des Blutzuckermesssystems CONTOUR XT®. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314564] [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: 10/28/2022]
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Reaney M, Matthaei S, Kiljanski J, Nicolay C. Therapie-assoziierte Faktoren bei Patienten mit Typ-2-Diabetes, die erstmalig mit einem injizierbaren Antidiabetikum behandelt werden sowie deren Behandlungsergebnisse nach 6 Monaten: Die CHOICE-Studie in Deutschland. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0031-1283989] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Reaney
- Eli Lilly & Co, Windlesham, Surrey, Großbritannien
| | - S. Matthaei
- Diabetes-Zentrum Quakenbrück, Quakenbrück, Deutschland
| | | | - C. Nicolay
- Eli Lilly & Co, Bad Homburg, Deutschland
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Matthaei S, Bierwirth R, Fritsche A, Gallwitz B, Häring HU, Joost HG, Kellerer M, Kloos C, Kunt T, Nauck M, Schernthaner G, Siegel E, Thienel F. Behandlung des Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1283899] [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: 10/14/2022]
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Affiliation(s)
- A. Hamann
- Medizinische Klinik IV, Hochtaunus-Kliniken, Bad Homburg
| | - S. Matthaei
- Diabetes-Zentrum am Christlichen Krankenhaus, Quakenbrück
| | - E. Siegel
- Abteilung für Gastroenterologie und Diabetologie, St. Vincenz-Krankenhaus, Limburg / Lahn
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Kellerer M, Matthaei S. Praxisempfehlungen der Deutschen Diabetes-Gesellschaft. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1283738] [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: 10/15/2022]
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Matthaei S, Bierwirth R, Fritsche A, Gallwitz B, Häring HU, Joost HG, Kellerer M, Kloos C, Kunt T, Nauck M, Schernthaner G, Siegel E, Thienel F. Behandlung des Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1283744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Matthaei S, Bierwirth R, Fritsche A, Gallwitz B, Häring HU, Joost HG, Kellerer M, Kloos C, Kunt T, Nauck M, Schernthaner G, Siegel E, Thienel F. Behandlung des Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1262619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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Lange M, Thienel F, Kläne-Menke I, Schadwinkel N, Wernsing M, Matthaei S. Therapie des Typ-2-Diabetes: Nachhaltige Reduktion kardiovaskulärer Risikoparameter 12 Monate nach strukturierter Diabetes-Schulung und Initiierung einer zielwertorientierten, multifaktoriellen Therapie. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1247335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Thienel FT, Kläne-Menke I, Matthaei S. Diabetisches Fußsyndrom: Druckentlastung mittels VACOdiaped® im Vergleich mit Total Contact Cast (TCC) und Orthese. Ergebnisse einer Pilotstudie. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253920] [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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Del Prato S, LaSalle J, Matthaei S, Bailey CJ. Tailoring treatment to the individual in type 2 diabetes practical guidance from the Global Partnership for Effective Diabetes Management. Int J Clin Pract 2010; 64:295-304. [PMID: 20456169 PMCID: PMC2814090 DOI: 10.1111/j.1742-1241.2009.02227.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Good glycaemic control continues to be the most effective therapeutic manoeuvre to reduce the risk of development and/or progression of microvascular disease, and therefore remains the cornerstone of diabetes management despite recent scepticism about tight glucose control strategies. The impact on macrovascular complications is still a matter of debate, and so glycaemic control strategies should be placed in the context of multifactorial intervention to address all cardiovascular risk factors. Approaches to achieve glycaemic targets should always ensure patient safety, and results from recent landmark outcome studies support the need for appropriate individualisation of glycaemic targets and of the means to achieve these targets, with the ultimate aim to optimise outcomes and minimise adverse events, such as hypoglycaemia and marked weight gain. The primary goal of the Global Partnership for Effective Diabetes Management is the provision of practical guidance to improve patient outcomes and, in this article, we aim to support healthcare professionals in appropriately tailoring type 2 diabetes treatment to the individual. Patient groups requiring special consideration are identified, including newly diagnosed individuals with type 2 diabetes but no complications, individuals with a history of inadequate glycaemic control, those with a history of cardiovascular disease, children and individuals at risk of hypoglycaemia. Practical guidance specific to each group is provided.
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Matthaei S. [Type 2 diabetes: interview with Prof. Stephan Matthaei. Reaching HbA1c target value while preventing hypoglycemia]. MMW Fortschr Med 2009; 151:54. [PMID: 19938786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Matthaei S, Bierwirth R, Fritsche A, Gallwitz B, Häring HU, Joost HG, Kellerer M, Kloos C, Kunt T, Nauck M, Schernthaner G, Siegel E, Thienel F. Behandlung des Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1224577] [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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Matthaei S, Bierwirth R, Fritsche A, Gallwitz B, Häring HU, Joost HG, Kellerer M, Kloos C, Kunt T, Nauck M, Schernthaner G, Siegel E, Thienel F. Medical antihyperglycaemic treatment of type 2 diabetes mellitus: update of the evidence-based guideline of the German Diabetes Association. Exp Clin Endocrinol Diabetes 2009; 117:522-57. [PMID: 19876795 DOI: 10.1055/s-0029-1239559] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
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- Diabetes-Zentrum Quakenbrück, Quakenbrück.
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Kausch C, Hamann A, Niendorf A, Joost HG, Dreyer M, Rüdiger HW, Holman GD, Greten H, Matthaei S. O-50: A novel mechanism of cellular insulin resistance: Defective insulin-stimulated glucose transport due to malinsertion of glucose transporters into the plasma membrane of fibroblasts from a patient with an insulin resistance syndrome. Exp Clin Endocrinol Diabetes 2009. [DOI: 10.1055/s-0029-1211541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The high prevalence of obesity and its well documented association with the cardiovascular risk factors diabetes mellitus, dyslipidemia and hypertension represents a major problem for the general health status of industrialized societies. Although numerous studies have shown that genetic factors have a major influence on the regulation of energy homeostasis and the susceptibility to obesity, the genes and predisposing mutations involved are insufficiently understood. Among several known rodent models of obesity due to single gene mutations, mice homozygous for the obese (ob) gene exhibit massive early-onset obesity, hyperphagia, non-insulin-dependent diabetes mellitus, defective thermoregulation and infertility. Recently the ob gene was identified by positional cloning and shown to be mutated in ob/ob mice. Leptin, the product of the ob gene, is a 167-amino acid secreted protein that is synthesized exclusively in adipose tissue. With the exception of ob/ob mice, circulating plasma leptin is elevated in obesity. Administration of recombinant leptin to ob/ob mice reduces fat mass, food intake, hyperglycemia and hyperinsulinemia. The various effects of the hormone are mediated by leptin receptors expressed at high levels in the hypothalamus, but also in several other non-neuronal tissues. A mutation in the leptin receptor gene is responsible for the obese phenotype of db/db mice. Plasma leptin in humans is positively correlated with body fat mass, suggesting that leptin resistance rather than leptin deficiency is a common feature of human obesity. This review briefly summarizes the current status of the rapidly growing evidence that leptin plays an important role in the regulation of body weight and fat deposition.
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Affiliation(s)
- A Hamann
- Department of Medicine, University of Hamburg, Germany
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Matthaei S, Gallwitz B, Joost H, Kloos C, Schernthaner G, Thienel F. Diabetes mellitus Typ 2 – Therapie mit oralen Antidiabetika. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0028-1098872] [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: 10/21/2022]
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Lemke C, Matthaei S. Präzision und Richtigkeit der neuesten Version des Point of Care (POC) Gerätes A1CNow+. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222097] [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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