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Thaenpramun R, Komolsuradej N, Buathong N, Srikrajang S. Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study. Br J Nutr 2024; 131:1497-1505. [PMID: 38239007 PMCID: PMC11043908 DOI: 10.1017/s0007114524000175] [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: 08/29/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61-70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118-355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.
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Affiliation(s)
- Rattiyaphon Thaenpramun
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Narucha Komolsuradej
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Napakkawat Buathong
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Siwaluk Srikrajang
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich road, Hat Yai, Songkhla90110, Thailand
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Reith C, Preiss D, Blackwell L, Emberson J, Spata E, Davies K, Halls H, Harper C, Holland L, Wilson K, Roddick AJ, Cannon CP, Clarke R, Colhoun HM, Durrington PN, Goto S, Hitman GA, Hovingh GK, Jukema JW, Koenig W, Marschner I, Mihaylova B, Newman C, Probsfield JL, Ridker PM, Sabatine MS, Sattar N, Schwartz GG, Tavazzi L, Tonkin A, Trompet S, White H, Yusuf S, Armitage J, Keech A, Simes J, Collins R, Baigent C, Barnes E, Fulcher J, Herrington WG, Kirby A, O'Connell R, Amarenco P, Arashi H, Barter P, Betteridge DJ, Blazing M, Blauw GJ, Bosch J, Bowman L, Braunwald E, Bulbulia R, Byington R, Clearfield M, Cobbe S, Dahlöf B, Davis B, de Lemos J, Downs JR, Fellström B, Flather M, Ford I, Franzosi MG, Fuller J, Furberg C, Glynn R, Goldbourt U, Gordon D, Gotto, Jr A, Grimm R, Gupta A, Hawkins CM, Haynes R, Holdaas H, Hopewell J, Jardine A, Kastelein JJP, Kean S, Kearney P, Kitas G, Kjekshus J, Knatterud G, Knopp RH, Koren M, Krane V, Landray M, LaRosa J, Latini R, Lonn E, Lucci D, MacFadyen J, Macfarlane P, MacMahon S, Maggioni A, Marchioli R, Moyé L, Murphy S, Neil A, Nicolis EB, Packard C, Parish S, Pedersen TR, Peto R, Pfeffer M, Poulter N, Pressel S, Probstfield J, Rahman M, Robertson M, Sacks F, Schmieder R, Serruys P, Sever P, Shaw J, Shepherd J, Simpson L, Sleight P, Smeeth L, Tobert J, Tognoni G, Varigos J, Wanner C, Wedel H, Weis S, Welch KM, Wikstrand J, Wilhelmsen L, Wiviott S, Yamaguchi J, Young R, Zannad F. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. Lancet Diabetes Endocrinol 2024; 12:306-319. [PMID: 38554713 DOI: 10.1016/s2213-8587(24)00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Previous meta-analyses of summary data from randomised controlled trials have shown that statin therapy increases the risk of diabetes, but less is known about the size or timing of this effect, or who is at greatest risk. We aimed to address these gaps in knowledge through analysis of individual participant data from large, long-term, randomised, double-blind trials of statin therapy. METHODS We conducted a meta-analysis of individual participant data from randomised controlled trials of statin therapy that participated in the CTT Collaboration. All double-blind randomised controlled trials of statin therapy of at least 2 years' scheduled duration and with at least 1000 participants were eligible for inclusion in this meta-analysis. All recorded diabetes-related adverse events, treatments, and measures of glycaemia were sought from eligible trials. Meta-analyses assessed the effects of allocation to statin therapy on new-onset diabetes (defined by diabetes-related adverse events, use of new glucose-lowering medications, glucose concentrations, or HbA1c values) and on worsening glycaemia in people with diabetes (defined by complications of glucose control, increased use of glucose-lowering medication, or HbA1c increase of ≥0·5%). Standard inverse-variance-weighted meta-analyses of the effects on these outcomes were conducted according to a prespecified protocol. FINDINGS Of the trials participating in the CTT Collaboration, 19 trials compared statin versus placebo (123 940 participants, 25 701 [21%] with diabetes; median follow-up of 4·3 years), and four trials compared more versus less intensive statin therapy (30 724 participants, 5340 [17%] with diabetes, median follow-up of 4·9 years). Compared with placebo, allocation to low-intensity or moderate-intensity statin therapy resulted in a 10% proportional increase in new-onset diabetes (2420 of 39 179 participants assigned to receive a statin [1·3% per year] vs 2214 of 39 266 participants assigned to receive placebo [1·2% per year]; rate ratio [RR] 1·10, 95% CI 1·04-1·16), and allocation to high-intensity statin therapy resulted in a 36% proportional increase (1221 of 9935 participants assigned to receive a statin [4·8% per year] vs 905 of 9859 participants assigned to receive placebo [3·5% per year]; 1·36, 1·25-1·48). For each trial, the rate of new-onset diabetes among participants allocated to receive placebo depended mostly on the proportion of participants who had at least one follow-up HbA1c measurement; this proportion was much higher in the high-intensity than the low-intensity or moderate-intensity trials. Consequently, the main determinant of the magnitude of the absolute excesses in the two types of trial was the extent of HbA1c measurement rather than the proportional increase in risk associated with statin therapy. In participants without baseline diabetes, mean glucose increased by 0·04 mmol/L with both low-intensity or moderate-intensity (95% CI 0·03-0·05) and high-intensity statins (0·02-0·06), and mean HbA1c increased by 0·06% (0·00-0·12) with low-intensity or moderate-intensity statins and 0·08% (0·07-0·09) with high-intensity statins. Among those with a baseline measure of glycaemia, approximately 62% of new-onset diabetes cases were among participants who were already in the top quarter of the baseline distribution. The relative effects of statin therapy on new-onset diabetes were similar among different types of participants and over time. Among participants with baseline diabetes, the RRs for worsening glycaemia were 1·10 (1·06-1·14) for low-intensity or moderate-intensity statin therapy and 1·24 (1·06-1·44) for high-intensity statin therapy compared with placebo. INTERPRETATION Statins cause a moderate dose-dependent increase in new diagnoses of diabetes that is consistent with a small upwards shift in glycaemia, with the majority of new diagnoses of diabetes occurring in people with baseline glycaemic markers that are close to the diagnostic threshold for diabetes. Importantly, however, any theoretical adverse effects of statins on cardiovascular risk that might arise from these small increases in glycaemia (or, indeed, from any other mechanism) are already accounted for in the overall reduction in cardiovascular risk that is seen with statin therapy in these trials. These findings should further inform clinical guidelines regarding clinical management of people taking statin therapy. FUNDING British Heart Foundation, UK Medical Research Council, and Australian National Health and Medical Research Council.
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Verma N, Mittal M, Ali Mahdi A, Awasthi V, Kumar P, Goel A, Banik SP, Chakraborty S, Rungta M, Bagchi M, Bagchi D. Clinical Evaluation of a Novel, Patented Green Coffee Bean Extract (GCB70®), Enriched in 70% Chlorogenic Acid, in Overweight Individuals. J Am Nutr Assoc 2024; 43:315-325. [PMID: 38227783 DOI: 10.1080/27697061.2023.2284994] [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] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Obesity and overweight are challenging health problems of the millennium that lead to diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), and atherosclerosis. Green coffee bean exhibited significant promise in healthy weight management, potentiating glucose-insulin sensitization and supporting liver health. The safety and efficacy of a novel, patented water-soluble green coffee bean extract (GCB70® enriched in 70% total chlorogenic acid and <1% caffeine) was investigated in 105 participants for 12 consecutive weeks. An institutional review board and Drugs Controller General (India) (DCGI) approvals were obtained, and the study was registered at ClinicalTrials.gov. METHOD Body weight, body mass index (BMI), waist circumference, lipid profile, plasma leptin, glycosylated hemoglobin (HbA1c), and total blood chemistry were assessed over a period of 12 weeks of treatment. Safety was affirmed. RESULTS GCB70 (500 mg BID) supplementation significantly reduced body weight (approximately 6%; p = 0.000**) in approximately 97% of the study population. About a 5.65% statistically significant reduction (p = 0.000**) in BMI was observed in 96% of the study volunteers. Waist circumference was significantly reduced by 6.77% and 6.62% in 98% of the male and female participants, respectively. Plasma leptin levels decreased by 13.6% in 99% of the study population as compared to the baseline value. Upon completion of 12 weeks' treatment, fasting glucose levels decreased by 13.05% (p = 0.000**) in 79% of the study population. There was a statistically significant decrease in HbA1c levels in both male and female participants (p = 0.000**), while 86.7% of the study participants showed a statistically significant decrease in thyroid-stimulating hormone (TSH) levels (p = 0.000**). The mean decrease in TSH levels on completion of the treatment was 14.07% in the study population as compared to baseline levels. Total blood chemistry analysis exhibited broad-spectrum safety. CONCLUSIONS This investigation demonstrated that GCB70 is safe and efficacious in healthy weight management.
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Affiliation(s)
- Narsingh Verma
- Department of Physiology, and Department of Transfusion Medicine, King George's Medical University (KGMU), Lucknow, India
| | - Madhukar Mittal
- Department of Endocrinology, King George's Medical University (KGMU), Lucknow, India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George's Medical University, Lucknow, India
| | - Vandana Awasthi
- Department of Physiology, and Department of Transfusion Medicine, King George's Medical University (KGMU), Lucknow, India
| | - Pawan Kumar
- R&D Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
| | - Apurva Goel
- Regulatory Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
| | - Samudra P Banik
- Department of Microbiology, Maulana Azad College, Kolkata, India
| | - Sanjoy Chakraborty
- Department of Biological Sciences, New York City College of Technology/CUNY, Brooklyn, New York, USA
| | - Mehul Rungta
- R&D Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
| | - Manashi Bagchi
- Department of R&D, Dr. Herbs LLC, Concord, California, USA
| | - Debasis Bagchi
- Department of Biology, College of Arts and Sciences, Adelphi University, Garden City, New York, USA
- Department of Psychology, Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA
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Ahmed M, Shafiq A, Javaid H, Jain H, Nashwan AJ, Tul‐Ain Q, Basit J. Clinical Outcomes With Once-Weekly Insulin Icodec Versus Once-Daily Insulin Glargine U100 in Insulin-Naïve and Previously Insulin-Treated Individuals With Type 2 Diabetes: A Meta-Analysis of Randomised Controlled Trials. Endocrinol Diabetes Metab 2024; 7:e00480. [PMID: 38659132 PMCID: PMC11043492 DOI: 10.1002/edm2.480] [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: 11/20/2023] [Revised: 12/24/2023] [Accepted: 03/03/2024] [Indexed: 04/26/2024] Open
Abstract
AIMS The once-weekly insulin icodec, a new basal insulin analog, may positively support a reduction in injection frequency and improve adherence to therapy in type 2 diabetes (T2D). This study aimed to evaluate the safety and efficacy of insulin icodec compared with those of once-daily glargine U100. METHODS A comprehensive literature search was conducted using PubMed/MEDLINE, Embase and the Cochrane Library from inception till September 2023. Data about clinical outcomes in both groups were extracted. Forest plots were generated using the random-effects model by pooling odds ratios (ORs) and mean differences (MDs). RESULTS Five randomised controlled trials and 2019 individuals with T2DM were included. In the pooled analysis, time in range was significantly higher (MD = 4.35; 95% CI: 1.65 to 7.05; p = 0.002) in the icodec group than in the once-daily glargine group. The HbA1c levels were significantly reduced (MD = -0.13; 95% CI: -0.24 to -0.03; p = 0.02) in the weekly icodec group compared with those in the once-daily glargine group. The weight gain was significantly less in the glargine group than in the weekly icodec group (MD = 0.41; 95% CI: 0.04 to 0.78; p = 0.03); however, in the subgroup analysis, this change became statistically insignificant in both insulin-naïve and previously insulin-treated individuals. The results were comparable across two groups for fasting plasma glucose levels, hypoglycaemia alert (Level 1), clinically significant (Level 2) or severe hypoglycaemia (Level 3), and adverse events. CONCLUSION Insulin icodec was associated with a reduction in glycated haemoglobin levels and higher time in range, with a similar safety profile as compared to insulin glargine U100. However, further evidence is still needed to reach a definitive conclusion.
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Affiliation(s)
- Mushood Ahmed
- Department of MedicineRawalpindi Medical UniversityRawalpindiPakistan
| | - Aimen Shafiq
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Hira Javaid
- Department of MedicineAllama Iqbal Medical CollegeLahorePakistan
| | - Hritvik Jain
- Department of Internal MedicineAll India Institute of Medical Sciences (AIIMS)JodhpurIndia
| | | | - Qura Tul‐Ain
- Department of PharmacologyShifa Tameer‐e‐Millat UniversityIslamabadPakistan
| | - Jawad Basit
- Department of MedicineRawalpindi Medical UniversityRawalpindiPakistan
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Hong EG, Min KW, Lim JS, Ahn KJ, Ahn CW, Yu JM, Kim HS, Kim HJ, Kim W, Kim DH, Jang HC. Real-World Outcomes of Individualized Targeted Therapy with Insulin Glargine 300 Units/mL in Insulin-Naïve Korean People with Type 2 Diabetes: TOBE Study. Adv Ther 2024; 41:1967-1982. [PMID: 38512540 DOI: 10.1007/s12325-024-02830-z] [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: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The TOujeo BEyond glucose control (TOBE) study evaluated clinical outcomes with insulin glargine 300 units/mL (Gla-300) in insulin-naïve Korean people with type 2 diabetes mellitus (T2DM) in a real-world setting. METHODS This 24-week, prospective, non-interventional, multicenter, open-label, single-arm, observational study included adults aged ≥ 20 years with T2DM suboptimally controlled with oral hypoglycemic agents and/or glucagon-like peptide 1 receptor agonists who require basal insulin. Eligible participants were assigned to either general target glycated hemoglobin (HbA1c < 7%) or individualized target groups as per physician's discretion considering guidelines and participants' characteristics. The primary endpoint was the proportion of participants achieving the HbA1c target (individualized or general) at 24 weeks. RESULTS Among 369 participants, 19.5% (72/369) of participants achieved the HbA1c target at week 24; 37.5% (33/88) in the individualized and 13.9% (39/281) in the general target group. In both target groups, similar reductions in fasting plasma glucose and body weight were observed, with low incidence of hypoglycemia, and T2DM duration was significantly shorter in participants who did versus those who did not achieve the target HbA1c (individualized target group: 9.6 ± 8.0 versus 13.1 ± 8.4 years, P = 0.0454; general target group: 10.2 ± 8.6 versus 12.8 ± 7.4 years, P = 0.0378). CONCLUSIONS This study showed that initiation of insulin therapy with Gla-300 in people with T2DM using an individualized approach is more effective in achieving an HbA1c target. Moreover, earlier initiation of insulin therapy in people with suboptimally controlled T2DM may increase the success rate of glycemic control. A graphical abstract is available with this article.
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Affiliation(s)
- Eun-Gyoung Hong
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Kyung-Wan Min
- Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Daejeon, South Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyu-Jeung Ahn
- Division of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Chul Woo Ahn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Myung Yu
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hye Soon Kim
- Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Won Kim
- Medical Department, Sanofi Korea, Seoul, South Korea
| | - Dong Han Kim
- Medical Department, Sanofi Korea, Seoul, South Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173-Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Shareef J, Apidechkul T, Srichan P. Prevalence of and factors associated with suboptimal glycemic control among patients with type 2 diabetes mellitus attending public hospitals in the Greater Male' Region, Maldives: a hospital-based cross-sectional study. BMC Public Health 2024; 24:1166. [PMID: 38664794 DOI: 10.1186/s12889-024-18693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Suboptimal glycemic control of type 2 diabetes mellitus (T2DM) which is defined as having HbA1c greater than 7% is a major public health problem in several countries, including the Maldives. The study aimed to estimate the prevalence and determine factors associated with suboptimal glycemic control among T2DM patients. METHODS A hospital-based cross-sectional was applied to collect data from T2DM patients who attended public hospitals in the Greater Male' Region, Maldives where were one of the highest reports of T2DM and suboptimal glycemic control cases in the country between January to March 2023 by a validated questionnaire and anthropometric measurements. Five (5) ml blood specimens were collected to measure the glycated hemoglobin (HbA1c) level. Univariable and multivariable logistic regressions were employed to determine factors associated with suboptimal glycemic control of T2DM at a significant level of α = 0.05. RESULTS A total of 341 participants were recruited for the study: 65.7% were female, 42.5% were aged 40-60 years, and 42.2% were married. The overall prevalence of suboptimal glycemic control was 50.7%. Ten variables were found to be associated with suboptimal glycemic control in multivariable logistic regression. Those aged 40-60 years (AOR = 3.35, 95% CI = 1.78-6.30), being single (AOR = 2.53, 95% CI = 1.21-5.30), preparation of food using more than three tablespoons of cooking oil (AOR = 2.78, 95% CI = 1.46-5.28), preparation of food with more than three tablespoons of sugar (AOR = 2.55, 95% CI = 1.31-4.93), no exercise (AOR = 2.04, 95% CI = 1.15-3.61), DM diagnosed with more than twenty years prior (AOR = 2.59, 95% CI = 1.34-4.99), obese body mass index (BMI) (AOR = 3.82, 95% CI = 1.75-8.32), high total cholesterol (AOR = 2.43, 95% CI = 1.36-4.35), high triglycerides (AOR = 3.43, 95% CI = 1.93-6.11), and high-level stress (AOR = 2.97, 95% CI = 1.48-5.93) were having a greater odds of having suboptimal glycemic control than those who did not have these characteristics. CONCLUSION A large proportion of T2DM patients in the Greater Male' Region fail to control their blood glucose. Effective public health interventions should be introduced, especially interventions focused on reducing cooking oil and sugar in daily cooking practices, encouraging regular exercise, and maintaining cholesterol levels, particularly for those diagnosed with diabetes mellitus for more than 20 years prior.
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Affiliation(s)
- Jeehana Shareef
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand
| | - Tawatchai Apidechkul
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand.
- Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
| | - Peeradone Srichan
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand
- Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Chiang Rai, 57100, Thailand
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Davies MJ, Bodicoat DH, Brennan A, Dixon S, Eborall H, Glab A, Gray LJ, Hadjiconstantinou M, Huddlestone L, Hudson N, Keetharuth A, Khunti K, Martin G, Northern A, Pritchard R, Schreder S, Speight J, Sturt J, Turner J. Uptake of self-management education programmes for people with type 2 diabetes in primary care through the embedding package: a cluster randomised control trial and ethnographic study. BMC Prim Care 2024; 25:136. [PMID: 38664727 DOI: 10.1186/s12875-024-02372-x] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Self-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care. METHODS Using a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. 'Embedders' supported practices and self-management programme providers to embed programme referral into routine practice, and an online 'toolkit' contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months - 3-0), step one (months 1-9), step 2 (months 10-18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory. RESULTS No significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices' interactions with the toolkit. CONCLUSIONS Barriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted. TRIAL REGISTRATION ISRCTN23474120, registered 05/04/2018.
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Affiliation(s)
- Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | | | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Helen Eborall
- Usher Institute, Old Medical School, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Agnieszka Glab
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Michelle Hadjiconstantinou
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Lisa Huddlestone
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, YO10 5DD, York, UK
| | - Nicky Hudson
- School of Applied Health Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | - Anju Keetharuth
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Rebecca Pritchard
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- School of Psychology, Deakin University, Geelong VIC, 3220, Australia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Strand, London, WC2R 2LS, UK
| | - Jessica Turner
- School of Applied Health Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
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Taramasco C, Rimassa C, Lagos Garrido ME, Figueroa RL. How effective are mobile apps in managing people with type 2 diabetes mellitus? A systematic literature review protocol. PLoS One 2024; 19:e0301523. [PMID: 38662739 PMCID: PMC11045108 DOI: 10.1371/journal.pone.0301523] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The rise of new technologies in the field of health is yielding promising results. In certain chronic conditions such as type 2 diabetes mellitus, which ranks among the top five causes of global mortality, it could be useful in supporting patient management. MATERIALS AND METHODS A systematic review will be conducted on scientific publications from the last 5 years (January 2019 to October 2023) to describe the effect of mobile app usage on glycated hemoglobin for the management of adult patients with type 2 diabetes mellitus who participated in randomized controlled clinical trials. The search will be carried out in the databases of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), CENTRAL, WoS, Scopus, Epistemonikos, and LILACS. The search strategy will be constructed using both controlled and natural language. Additionally, the Cochrane filter will be applied to identify randomized controlled trials. The review will include scientific articles reporting studies that present results from randomized controlled trials, with texts in Spanish, English, or French, utilizing mobile applications for the management of adult individuals (over 18 years) with type 2 diabetes mellitus, and whose outcomes report the effects on glycated hemoglobin. The Cochrane Risk of Bias Tool will be used to assess the quality of the studies, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology will be implemented to evaluate the certainty of the evidence. RESULTS The analysis will be conducted by observing the value of the glycated hemoglobin levels of the participants. Given that this data is a quantitative and continuous value, it facilitates the identification of the effects of the mobile applications used for the management of type 2 diabetes mellitus (T2DM) in adults. Furthermore, if sufficient data are available, a meta-analysis will be conducted using IBM-SPSS. The effect of the intervention will be estimated by the mean difference. All point estimates will be accompanied by 95% confidence intervals. A random effects model will be used. The heterogeneity of the results will be assessed using Cochrane's Q and I2 statistics. DISCUSSION Considering that the quality of content and functionality of certain applications in the healthcare field is highly variable, it is necessary to evaluate the scientific evidence reported on the effect of the use of this type of technology in people with T2DM.
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Affiliation(s)
- Carla Taramasco
- Instituto de Tecnologías para la Innovación en Salud y Bienestar (ITiSB), Faculty of Engineering, Universidad Andrés Bello, Viña del Mar, Chile
- Millennium Nucleus on Sociomedicine, Santiago, Chile
| | - Carla Rimassa
- Instituto de Tecnologías para la Innovación en Salud y Bienestar (ITiSB), Faculty of Engineering, Universidad Andrés Bello, Viña del Mar, Chile
- Escuela de Fonoaudiología, Facultad de Medicina, Campus San Felipe, Universidad de Valparaíso, San Felipe, Chile
| | - María Elena Lagos Garrido
- Millennium Nucleus on Sociomedicine, Santiago, Chile
- Department of Fundamentals and Public Health, Faculty of Nursing, Universidad de Concepción, Bío Bío, Chile
| | - Rosa L. Figueroa
- Millennium Nucleus on Sociomedicine, Santiago, Chile
- Department of Electrical Engineering, Faculty of Engineering, Universidad de Concepción, Bío Bío, Chile
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Ng SM, Wright NP, Yardley D, Campbell F, Randell T, Trevelyan N, Ghatak A, Hindmarsh PC. Long-term assessment of the NHS hybrid closed-loop real-world study on glycaemic outcomes, time-in-range, and quality of life in children and young people with type 1 diabetes. BMC Med 2024; 22:175. [PMID: 38659016 PMCID: PMC11044460 DOI: 10.1186/s12916-024-03396-x] [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: 12/07/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Hybrid closed-loop (HCL) systems seamlessly interface continuous glucose monitoring (CGM) with insulin pumps, employing specialised algorithms and user-initiated automated insulin delivery. This study aimed to assess the efficacy of HCLs at 12 months post-initiation on glycated haemoglobin (HbA1c), time-in-range (TIR), hypoglycaemia frequency, and quality of life measures among children and young people (CYP) with type 1 diabetes mellitus (T1DM) and their caregivers in a real-world setting. Conducted between August 1, 2021, and December 10, 2022, the prospective recruitment took place in eight paediatric diabetes centres across England under the National Health Service England's (NHSE) HCL pilot real-world study. A cohort of 251 CYP (58% males, mean age 12.3 years) with T1DM participated (89% white, 3% Asian, 4% black, 3% mixed ethnicity, and 1% other). The study utilised three HCL systems: (1) Tandem Control-IQ AP system, which uses the Tandem t:slim X2 insulin pump (Tandem Diabetes Care, San Diego, CA, USA) with the Dexcom G6® CGM (Dexcom, San Diego, CA, USA) sensor; (2) Medtronic MiniMed™ 780G with the Guardian 4 sensor (Medtronic, Northridge, CA, USA); and (3) the CamAPS FX (CamDiab, Cambridge, UK) with the Ypsomed insulin pump (Ypsomed Ltd, Escrick, UK) and Dexcom G6® CGM.All systems were fully funded by the NHS. Results demonstrated significant improvements in HbA1c (average reduction at 12 months 7 mmol/mol; P < 0.001), time-in-range (TIR) (average increase 13.4%; P < 0.001), hypoglycaemia frequency (50% reduction), hypoglycaemia fear, and quality of sleep (P < 0.001) among CYP over a 12-month period of HCL usage. Additionally, parents and carers experienced improvements in hypoglycaemia fear and quality of sleep after 6 and 12 months of use. In addition to the improvements in glycaemic management, these findings underscore the positive impact of HCL systems on both the well-being of CYP with T1DM and the individuals caring for them.
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Affiliation(s)
- Sze May Ng
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
- Paediatric Department, Mersey and West Lancashire Teaching Hospitals, Ormskirk, L39 2AZ, UK.
| | | | - Diana Yardley
- Children's Diabetes Team, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fiona Campbell
- Children's Diabetes Centre, Leeds Children's Hospital, Leeds, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham, UK
| | | | | | - Peter C Hindmarsh
- Children and Young People's Diabetes Service, University College London Hospitals NHS Foundation Trust, London, UK
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Liu XY, Wang XH. Effect of glycotoxicity and lipotoxicity on carbohydrate antigen 19 - 9 in the patients with diabetes. BMC Endocr Disord 2024; 24:51. [PMID: 38654232 DOI: 10.1186/s12902-024-01578-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES In comparison to the subjects without diabetes, a greater concentration of serum carbohydrate antigen 19 - 9 (CA 19 - 9) was observed in the subjects with diabetes. Nevertheless, since the occurrence of abnormal CA 19 - 9 is not widespread among the whole diabetic population, this phenomenon has not attracted enough attention. The prevalence of abnormal CA 19 - 9 in hospitalized patients with diabetes was the focus of our research. METHOD A total of 385 subjects with diabetes and 200 controls were enrolled and all had been tested the CA19-9 levels. Cases of cancers were excluded through examination and followup for 1 year. RESULTS We found that the rate of patients with abnormal CA19-9 level was 8.3%. The rate of patients with abnormal CA19-9 level was 14.0% in the HbA1c ≥ 9% group, and 3.0% in the HbA1c < 9% group, 2.5% in the control group. There was no significant difference in the HbA1c < 9% group and the control group. A significant correlation between serum CA19-9 and both HbA1c and total cholesterol was observed, yet no difference in CRP level was observed between subjects with normal CA19-9 level and subjects with abnormal CA19-9 level. However, a significant difference in fasting C-peptide levels was observed between the two groups, p = 0.039. CONCLUSION The percentage of patients with diabetes exhibiting elevated CA19-9 level is 14% in the HbA1c ≥ 9% diabetic patients, much higher than expected. The underlying mechanism may be related to islet injury caused by glycotoxicity and lipotoxicity. STRENGTHS AND LIMITATIONS OF THE STUDY We studied the rate of hospitalized diabetic patients with elevated CA 19 - 9 which were characterized with poorly controlled blood glucose. We found that the elevation of CA 19 - 9 was unexpectedly high in diabetic inpatients without development to cancer. The limitation of this study is that the underlying mechanism is not sufficiently studied.
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Affiliation(s)
- Xi-Yu Liu
- The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China.
| | - Xiao-Hong Wang
- The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
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Issa LM, Kehlet H, Madsbad S, Lindberg-Larsen M, Varnum C, Jakobsen T, Andersen MR, Bieder MJ, Overgaard S, Hansen TB, Gromov K, Jørgensen CC. Protocol for a prospective multicentre cohort study to address the question whether diabetes and its management is still a risk factor in fast-track joint arthroplasty. BMJ Open 2024; 14:e080232. [PMID: 38658012 PMCID: PMC11043738 DOI: 10.1136/bmjopen-2023-080232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Perioperative glycaemic control is important. However, the complexity of guidelines for perioperative diabetes management is complicated due to different and novel antihyperglycaemic medications, limited procedure-specific data and lack of data from implemented fast-track regimens which otherwise are known to reduce morbidity and glucose homeostasis disturbances. Consequently, outcome in patients with diabetes mellitus (DM) after surgery and the influence of perioperative diabetes management on postoperative recovery remains poorly understood. METHODS AND ANALYSIS A prospective observational multicentre study involving 8 arthroplasty centres across Denmark with a documented implemented fast-track programme (median length of hospitalisation (LOS) 1 day). We will collect detailed perioperative data including preoperative haemoglobin A1c and antidiabetic treatment in 1400 unselected consecutive patients with DM undergoing hip and knee arthroplasty from September 2022 to December 2025, enrolled after consent. Follow-up duration is 90 days after surgery. The primary outcome is the proportion of patients with DM with LOS >4 days and 90-day readmission rate after fast-track total hip arthroplasty (THA), total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). The secondary outcome is the association between perioperative diabetes treatment and LOS >2 days, 90-day readmission rate, other patient demographics and Comprehensive Complication Index for patients with DM after THA/TKA/UKA in a fast-track regimen. ETHICS AND DISSEMINATION The study will follow the principles of the Declaration of Helsinki and ICH-Good Clinical Practice guideline. Ethical approval was not necessary as this is a non-interventional observational study on current practice. The trial is registered in the Region of Southern Denmark and on ClinicalTrials.gov. The main results and all substudies of this trial will be published in peer-reviewed international medical journals. TRIAL REGISTRATION NUMBER NCT05613439.
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Affiliation(s)
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
| | - Thomas Jakobsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Manuel Josef Bieder
- Department of Orthopaedic Surgery, Næstved Sygehus Ortopædkirurgi, Nastved, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital Orthopedic Surgery Department M, Kobenhavn, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West Jutland, Aarhus Universitetshospital, Herning, Denmark
| | - Kirill Gromov
- Hvidovre Hospital Department of Orthopaedic Surgery, Hvidovre, Denmark
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Qu YD, Zhu ZH, Li JX, Zhang W, Chen Q, Xia CL, Ma JN, Ou SJ, Yang Y, Qi Y, Xu CP. Diabetes and osteoporosis: a two-sample mendelian randomization study. BMC Musculoskelet Disord 2024; 25:317. [PMID: 38654244 PMCID: PMC11036742 DOI: 10.1186/s12891-024-07430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The effects on bone mineral density (BMD)/fracture between type 1 (T1D) and type 2 (T2D) diabetes are unknown. Therefore, we aimed to investigate the causal relationship between the two types of diabetes and BMD/fracture using a Mendelian randomization (MR) design. METHODS A two-sample MR study was conducted to examine the causal relationship between diabetes and BMD/fracture, with three phenotypes (T1D, T2D, and glycosylated hemoglobin [HbA1c]) of diabetes as exposures and five phenotypes (femoral neck BMD [FN-BMD], lumbar spine BMD [LS-BMD], heel-BMD, total body BMD [TB-BMD], and fracture) as outcomes, combining MR-Egger, weighted median, simple mode, and inverse variance weighted (IVW) sensitivity assessments. Additionally, horizontal pleiotropy was evaluated and corrected using the residual sum and outlier approaches. RESULTS The IVW method showed that genetically predicted T1D was negatively associated with TB-BMD (β = -0.018, 95% CI: -0.030, -0.006), while T2D was positively associated with FN-BMD (β = 0.033, 95% CI: 0.003, 0.062), heel-BMD (β = 0.018, 95% CI: 0.006, 0.031), and TB-BMD (β = 0.050, 95% CI: 0.022, 0.079). Further, HbA1c was not associated with the five outcomes (β ranged from - 0.012 to 0.075). CONCLUSIONS Our results showed that T1D and T2D have different effects on BMD at the genetic level. BMD decreased in patients with T1D and increased in those with T2D. These findings highlight the complex interplay between diabetes and bone health, suggesting potential age-specific effects and genetic influences. To better understand the mechanisms of bone metabolism in patients with diabetes, further longitudinal studies are required to explain BMD changes in different types of diabetes.
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Grants
- 202201020303, 202102080052, 202102010057, 201804010226 Science and Technology Planning Project of Guangzhou
- 202201020303, 202102080052, 202102010057, 201804010226 Science and Technology Planning Project of Guangzhou
- 3D-A2020004, 3D-A2020002, YQ2019-009, C2020019 Foundation of Guangdong Second Provincial General Hospital
- 3D-A2020004, 3D-A2020002, YQ2019-009, C2020019 Foundation of Guangdong Second Provincial General Hospital
- 81972083 National Natural Science Foundation of China
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Affiliation(s)
- Yu-Dun Qu
- The Second School of Clinical Medicine, Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Zhao-Hua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jia-Xuan Li
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Wei Zhang
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China
| | - Qi Chen
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China
| | - Chang-Liang Xia
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China
| | - Jun-Nan Ma
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China
| | - Shuan-Ji Ou
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China
| | - Yang Yang
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China
| | - Yong Qi
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, No. 466 Xingang Road, Haizhu District, Guangzhou, 510317, Guangdong, People's Republic of China.
| | - Chang-Peng Xu
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R. China.
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Tyagi S, Koh GCH, Lee ES, Ong KP, Heng R, Er LH, Oh E, Teo V, Ng DWL. Primary Technology Enhanced Care Home HbA1c Testing (PTEC HAT) programme: a feasibility pilot study in Singapore. BMC Prim Care 2024; 25:127. [PMID: 38654201 DOI: 10.1186/s12875-024-02373-w] [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] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Considering time-consuming, cost-related limitations of laboratory-based HbA1c testing and follow-up clinic visits for diabetes management, it is important to explore alternative care models which incorporate point-of-care testing for HbA1c to monitor glycaemic control and related management. METHODS Therefore, we adopted an implementation perspective to conduct one group pre- and post-intervention feasibility pilot assessing feasibility, acceptability and satisfaction with conducting home HbA1c test by patients with type 2 diabetes coupled with telemonitoring and teleconsultations (i.e., the Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme) in Singaporean primary care setting. The secondary objective was to compare the HbA1c, blood pressure and primary care visits at the end or during intervention, vs. 6 months before. Adult patients with type 2 diabetes with HbA1c ≤ 8% without any diabetes complications and having phone compatibility were recruited. Data was collected via patient self-reports and electronic medical records extraction. While summary statistics and paired t-test were computed for quantitative data, open-ended feedback was analysed using content analysis. RESULTS A total of 33 participants completed the intervention out of 37 (33/37 = 89%) recruited from 73 eligible (37/73 = 51%). Most were either 51 to 60 years old (46.9%) or more than 60 years (37.5%), with more males (53.1%) and majority Chinese (93.8%). Majority (81.3%) felt that home HbA1c testing was beneficial with most commonly reported benefit of not having a clinic visit. A key finding was the average of diabetes-related visits being significantly lower post-intervention with comparable HbA1c values pre- and post-intervention. The most commonly reported challenge was using Bluetooth to transmit the reading (43.7%), followed by having too many steps to remember (28.1%). While participants reported being overall satisfied with the intervention, only 22% were willing to pay for it. CONCLUSION Our findings support home HbA1c testing by patients coupled with telemonitoring and teleconsultations. Following are practical recommendations for the implementation scaling phase: offering PTEC HAT Programme to suitable patients who are self-motivated and have adequate digital literacy, provision of adequate educational and training support, sending reminders and exploring enabling manual submission of HbA1c readings considering Bluetooth-related challenges.
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Affiliation(s)
- Shilpa Tyagi
- MOH Office for Healthcare Transformation (MOHT), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- MOH Office for Healthcare Transformation (MOHT), Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Eng Sing Lee
- MOH Office for Healthcare Transformation (MOHT), Singapore, Singapore
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Kah Pieng Ong
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Roy Heng
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Lian Hwa Er
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Evonne Oh
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Valerie Teo
- National Healthcare Group Polyclinics, Singapore, Singapore
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Sá R, Roquette R, Rebecchi A, Matias J, Rocha J, Buffoli M, Capolongo S, Ribeiro AI, Nunes B, Dias C, Sousa Uva M. Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study. BMC Public Health 2024; 24:1116. [PMID: 38654178 PMCID: PMC11036776 DOI: 10.1186/s12889-024-18627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.
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Affiliation(s)
- Regina Sá
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) do Baixo Vouga, Aveiro, Portugal.
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) Algarve I, Faro, Portugal.
| | - Rita Roquette
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
| | - Andrea Rebecchi
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Judite Matias
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) do Baixo Vouga, Aveiro, Portugal
| | - Jorge Rocha
- Instituto de Geografia e Ordenamento do Território (IGOT), Universidade de Lisboa e Laboratório Associado TERRA, Lisbon, Portugal
| | - Maddalena Buffoli
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Stefano Capolongo
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Ana Isabel Ribeiro
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Carlos Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Mafalda Sousa Uva
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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McKay CD, Gubhaju L, Gibberd AJ, McNamara BJ, Banks E, Azzopardi P, Williams R, Eades S. Cardiometabolic health markers among Aboriginal adolescents from the Next Generation Youth Wellbeing Cohort Study. Aust N Z J Public Health 2024; 48:100139. [PMID: 38447271 DOI: 10.1016/j.anzjph.2024.100139] [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: 04/25/2023] [Revised: 11/28/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate cardiometabolic health markers among Aboriginal adolescents aged 10-24 years and relationships with age, gender, and body composition. METHODS Baseline data (2018-2020) from the Next Generation Youth Wellbeing Cohort Study (Western Australia, New South Wales, and Central Australia) on clinically assessed body mass index, waist/height ratio, blood pressure, glycated haemoglobin (HbA1c), total and high-density lipoprotein cholesterol, total/high-density lipoprotein cholesterol ratio, and triglycerides were analysed. RESULTS Among 1100 participants, the proportion with individual health markers within the ideal range ranged from 59% for total cholesterol to 91% for HbA1c. Four percent had high blood pressure, which was more common with increasing age and among males; 1% had HbA1c indicative of diabetes. Healthier body composition (body mass index and waist/height ratio) was associated with having individual health markers in the ideal range and with an ideal cardiometabolic profile. CONCLUSIONS Most Aboriginal adolescents in this study had cardiometabolic markers within the ideal range, though markers of high risk were present from early adolescence. Ideal health markers were more prevalent among those with healthy body composition. IMPLICATIONS FOR PUBLIC HEALTH Specific screening and management guidelines for Aboriginal adolescents and population health initiatives that support maintenance of healthy body composition could help improve cardiometabolic health in this population.
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Affiliation(s)
- Christopher D McKay
- Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - Lina Gubhaju
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Alison J Gibberd
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Emily Banks
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population Health, College of Health & Medicine, Australian National University, Australia
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Australia; Telethon Kids Institute, Australia
| | | | - Sandra Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Cláudio MM, Garcia VG, Freitas RM, Rodrigues JVS, Wainwright M, Casarin RCV, Duque C, Theodoro LH. Association of active oxygen-releasing gel and photodynamic therapy in the treatment of residual periodontal pockets in type 2 diabetic patients: A randomized controlled clinical study. J Periodontol 2024; 95:360-371. [PMID: 38112075 DOI: 10.1002/jper.23-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of active oxygen-releasing gel as an adjuvant, with and without antimicrobial photodynamic therapy (aPDT), in the treatment of residual pockets in periodontal patients with type 2 diabetes mellitus (DM2). METHODS Patients with residual pockets with probing depth (PD) ≥4 mm and bleeding on probing (BOP) were divided into the following groups: SI (n = 17)-subgingival instrumentation in a single session; BM (n = 17)-SI followed by local application of active oxygen-releasing gel inside the periodontal pocket for 3 min; BM + aPDT (n = 17)-SI followed by application of BM for 3 min and pocket irrigation with methylene blue, and 660-nm diode laser irradiation at 100 mW for 50 s. The periodontal clinical parameters, serum levels of glycated hemoglobin, and immunological analysis of crevicular fluid were evaluated. All data were submitted to statistical analysis (α = 5%). RESULTS A significant reduction in BOP was verified at 90 and 180 days in the BM + aPDT group. The percentage of sites with PD ≥ 4 mm was significantly reduced at 90 days in BM + aPDT and BM, whereas after 180 days only BM showed a significant reduction. In the BM + aPDT group, there was a significant reduction in tumor necrosis factor α levels at 90 days. There were no differences between the treatments. CONCLUSION The use of adjuvant active oxygen-releasing gel, with or without aPDT, resulted in the same clinical benefits as SI in the treatment of residual pockets in poorly controlled DM2 patients.
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Affiliation(s)
- Marina M Cláudio
- Department of Diagnostics and Surgery, Periodontics Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Valdir G Garcia
- Latin American Institute of Dental Research and Teaching (ILAPEO), Curitiba, PR, Brazil
| | - Rubens M Freitas
- Latin American Institute of Dental Research and Teaching (ILAPEO), Curitiba, PR, Brazil
| | - João Victor S Rodrigues
- Department of Diagnostics and Surgery, Periodontics Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
- Center for Dental Assistance to Persons with Disabilities (CAOE), School of Dentistry, Araçatuba, SP, Brazil
| | - Mark Wainwright
- Department of Biology, Edge Hill University, Ormskirk, Lancashire, UK
| | - Renato C V Casarin
- Department of Periodontics, State University of Campinas, Piracicaba, SP, Brazil
| | - Cristiane Duque
- Department of Preventive and Restorative Dentistry, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Leticia H Theodoro
- Department of Diagnostics and Surgery, Periodontics Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
- Center for Dental Assistance to Persons with Disabilities (CAOE), School of Dentistry, Araçatuba, SP, Brazil
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Patelakis E, Schienkiewitz A, Truthmann J, Holl RW, Poethko-Müller C, Mensink GBM, Heidemann C. Distribution and determinants of glycosylated hemoglobin in adolescents - Results from a nationwide population-based survey in Germany. PLoS One 2024; 19:e0296962. [PMID: 38386644 PMCID: PMC10883580 DOI: 10.1371/journal.pone.0296962] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/25/2023] [Indexed: 02/24/2024] Open
Abstract
The role of glycosylated hemoglobin (HbA1c) in youth is largely unclear. The aims of this study are to investigate the distribution and potential determinants of HbA1c among a population-based sample of adolescents. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) Wave 2 includes a nationwide representative sample of 0-17-year-old participants. For this evaluation, data from a randomly selected subgroup aged 14-17 years and without diagnosed diabetes was included (n = 857). Percentile-based HbA1c values (measured at laboratory in whole blood samples by high performance liquid chromatography) were calculated to examine HbA1c distribution. Multivariable linear regression analyses were performed to investigate factors (age, sex, parental socioeconomic status, body mass index (BMI), birth weight, smoking, alcohol consumption, healthy food diversity, sport activity, oral contraceptive use) associated with HbA1c. The mean HbA1c level was 5.2% (minimum: 3.9%, P10: 4.8%, P50: 5.1%, P90: 5.5%, maximum: 6.7%). Overall, 2.8% of adolescents had an HbA1c value in the prediabetic range (5.7-6.4%) and 0.1% had an undiagnosed diabetes (≥6.5%). Multivariable regression analysis showed an inverse association of age with HbA1c (17 vs. 14 years: ß: -1.18; 95% CI -2.05, -0.31). Higher HbA1c values were observed for higher BMI-standard deviation scores (SDS) (ß: 0.24; 95% CI -0.04, 0.52) and smoking (ß: 0.73; 95% CI -0.12, 1.57), but these tendencies were non-significant. In sex-stratified analysis, smoking and birth weight were significantly associated with HbA1c in boys. Among adolescents without diagnosed diabetes in Germany, HbA1c values ranged from 3.9% to 6.7%. To ensure health in adulthood, the influence of determinants on HbA1c levels in younger age should be further investigated.
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Affiliation(s)
- Eleni Patelakis
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Truthmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, University Medical Centre, Ulm, Germany
| | | | - Gert B. M. Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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18
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Grew EC, Jain V, Brodowski KR, Burton CD, Patel JC, Doshi DA. Obesity Medicine Intervention at an Academic Medical Center in a Resource-Limited Population Shows Promise. J Health Care Poor Underserved 2024; 35:55-64. [PMID: 38661859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Obesity disproportionately affects some non-White and low-socioeconomic-status Americans. Medical obesity treatment includes aggressive lifestyle interventions with medications when applicable. We evaluated a physician-led, resource-limited obesity medicine program. METHODS This retrospective review included 98 adults with BMI >30 completing three or more obesity medicine physician visits, without bariatric surgery before or during Oct 2019-Feb 2022 at an academic medical center in Newark, N.J. Outcomes included changes in weight, HbA1c, blood pressure, and lipids. RESULTS Sixty-eight percent (68%) of patients lost weight, with one-third losing 5% or more of total weight. Almost 30% (29.3%) gained and 2.4% maintained weight. Number of visits (p<.01) and GLP-1 receptor agonist use predicted weight loss (p<.05). Hemoglobin A1c decreased (p<.01); blood pressure and lipids did not. CONCLUSION Our study shows that medical weight management programs can achieve meaningful weight loss, despite resource limitations. Patients using GLP-1 receptor agonists lost more weight compared with other agents, even on suboptimal doses.
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19
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Waibel M, Wentworth JM, So M, Couper JJ, Cameron FJ, MacIsaac RJ, Atlas G, Gorelik A, Litwak S, Sanz-Villanueva L, Trivedi P, Ahmed S, Martin FJ, Doyle ME, Harbison JE, Hall C, Krishnamurthy B, Colman PG, Harrison LC, Thomas HE, Kay TWH. Baricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes. N Engl J Med 2023; 389:2140-2150. [PMID: 38055252 DOI: 10.1056/nejmoa2306691] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Janus kinase (JAK) inhibitors, including baricitinib, block cytokine signaling and are effective disease-modifying treatments for several autoimmune diseases. Whether baricitinib preserves β-cell function in type 1 diabetes is unclear. METHODS In this phase 2, double-blind, randomized, placebo-controlled trial, we assigned patients with type 1 diabetes diagnosed during the previous 100 days to receive baricitinib (4 mg once per day) or matched placebo orally for 48 weeks. The primary outcome was the mean C-peptide level, determined from the area under the concentration-time curve, during a 2-hour mixed-meal tolerance test at week 48. Secondary outcomes included the change from baseline in the glycated hemoglobin level, the daily insulin dose, and measures of glycemic control assessed with the use of continuous glucose monitoring. RESULTS A total of 91 patients received baricitinib (60 patients) or placebo (31 patients). The median of the mixed-meal-stimulated mean C-peptide level at week 48 was 0.65 nmol per liter per minute (interquartile range, 0.31 to 0.82) in the baricitinib group and 0.43 nmol per liter per minute (interquartile range, 0.13 to 0.63) in the placebo group (P = 0.001). The mean daily insulin dose at 48 weeks was 0.41 U per kilogram of body weight per day (95% confidence interval [CI], 0.35 to 0.48) in the baricitinib group and 0.52 U per kilogram per day (95% CI, 0.44 to 0.60) in the placebo group. The levels of glycated hemoglobin were similar in the two trial groups. However, the mean coefficient of variation of the glucose level at 48 weeks, as measured by continuous glucose monitoring, was 29.6% (95% CI, 27.8 to 31.3) in the baricitinib group and 33.8% (95% CI, 31.5 to 36.2) in the placebo group. The frequency and severity of adverse events were similar in the two trial groups, and no serious adverse events were attributed to baricitinib or placebo. CONCLUSIONS In patients with type 1 diabetes of recent onset, daily treatment with baricitinib over 48 weeks appeared to preserve β-cell function as estimated by the mixed-meal-stimulated mean C-peptide level. (Funded by JDRF International and others; BANDIT Australian New Zealand Clinical Trials Registry number, ACTRN12620000239965.).
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Affiliation(s)
- Michaela Waibel
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - John M Wentworth
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Michelle So
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Jennifer J Couper
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Fergus J Cameron
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Richard J MacIsaac
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Gabby Atlas
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Alexandra Gorelik
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Sara Litwak
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Laura Sanz-Villanueva
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Prerak Trivedi
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Simi Ahmed
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Francis J Martin
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Madeleine E Doyle
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Jessica E Harbison
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Candice Hall
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Balasubramanian Krishnamurthy
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Peter G Colman
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Leonard C Harrison
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Helen E Thomas
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
| | - Thomas W H Kay
- From St. Vincent's Institute of Medical Research (M.W., M.S., S.L., L.S.-V., P.T., M.E.D., C.H., B.K., H.E.T., T.W.H.K.), St. Vincent's Hospital Melbourne (R.J.M., B.K., T.W.H.K.), and the Department of Medicine at St. Vincent's Hospital, University of Melbourne (R.J.M., L.S.-V., M.E.D., B.K., H.E.T., T.W.H.K.), Fitzroy, the Walter and Eliza Hall Institute of Medical Research (J.M.W., P.G.C., L.C.H.), the Departments of Medical Biology (J.M.W., L.C.H.) and Medicine (A.G.), University of Melbourne, the Royal Melbourne Hospital (J.M.W., M.S., C.H., P.G.C., L.C.H.), the Royal Children's Hospital (F.J.C., G.A.), and the Murdoch Children's Research Institute (F.J.C.), Parkville, and the School of Public Health and Preventive Medicine, Monash University, Melbourne (A.G.), VIC, and Women's and Children's Hospital (J.J.C., J.E.H.) and the University of Adelaide (J.J.C.), Adelaide, SA - all in Australia; the New York Stem Cell Foundation, New York (S.A.); and Macromoltek, Austin, TX (F.J.M.)
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20
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Heo JE, Kim DG, Yoo JW, Lee KS. Metabolic syndrome-related factors as possible targets for lower urinary tract symptoms in Korean males. Aging Male 2023; 26:6-12. [PMID: 36633207 DOI: 10.1080/13685538.2023.2166920] [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] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION A positive association between benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and metabolic syndrome (MetS) was reported in several studies, but studies from Asia often showed conflicting results. MATERIALS AND METHODS Medical records were obtained from a health promotion center database between 2021 and 2022. Men without a history of treatment for LUTS were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), transrectal ultrasonography. RESULTS Of 1345 individuals, 603 (44.8%) had MetS. Older age, higher IPSS values, higher prevalence rates of BPH and overactive bladder, higher triiodothyronine, and lower testosterone and sex-hormone binding globulin were observed in individuals with MetS than in individuals without MetS. The severity of LUTS significantly increased in the individuals with MetS (p = .002). In individuals with MetS, age, HbA1c, and cerebrovascular disease (CVD) were associated with IPSS. For OABSS, age, HbA1c, thyroid-stimulating hormone (TSH), coronary artery occlusive disease, and CVD were identified as predictors. CONCLUSIONS We confirmed the positive correlation between MetS and BPH/LUTS in Korean. Factors including TSH and atherosclerosis affected LUTS in individuals with MetS. These findings suggested a potential role of thyroid hormones and atherosclerosis in the etiology and treatment of BPH/LUTS in patients with MetS.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Gyun Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Woo Yoo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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21
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Lemp JM, Bommer C, Xie M, Michalik F, Jani A, Davies JI, Bärnighausen T, Vollmer S, Geldsetzer P. Quasi-experimental evaluation of a nationwide diabetes prevention programme. Nature 2023; 624:138-144. [PMID: 37968391 DOI: 10.1038/s41586-023-06756-4] [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] [Received: 05/19/2022] [Accepted: 10/17/2023] [Indexed: 11/17/2023]
Abstract
Diabetes is a leading cause of morbidity, mortality and cost of illness1,2. Health behaviours, particularly those related to nutrition and physical activity, play a key role in the development of type 2 diabetes mellitus3. Whereas behaviour change programmes (also known as lifestyle interventions or similar) have been found efficacious in controlled clinical trials4,5, there remains controversy about whether targeting health behaviours at the individual level is an effective preventive strategy for type 2 diabetes mellitus6 and doubt among clinicians that lifestyle advice and counselling provided in the routine health system can achieve improvements in health7-9. Here we show that being referred to the largest behaviour change programme for prediabetes globally (the English Diabetes Prevention Programme) is effective in improving key cardiovascular risk factors, including glycated haemoglobin (HbA1c), excess body weight and serum lipid levels. We do so by using a regression discontinuity design10, which uses the eligibility threshold in HbA1c for referral to the behaviour change programme, in electronic health data from about one-fifth of all primary care practices in England. We confirm our main finding, the improvement of HbA1c, using two other quasi-experimental approaches: difference-in-differences analysis exploiting the phased roll-out of the programme and instrumental variable estimation exploiting regional variation in programme coverage. This analysis provides causal, rather than associational, evidence that lifestyle advice and counselling implemented at scale in a national health system can achieve important health improvements.
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Affiliation(s)
- Julia M Lemp
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Christian Bommer
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Min Xie
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Felix Michalik
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Anant Jani
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- University of Oxford, Oxford, UK
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Africa Health Research Institute, Somkhele, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
- Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA.
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22
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Rosenstock J, Frías JP, Rodbard HW, Tofé S, Sears E, Huh R, Fernández Landó L, Patel H. Tirzepatide vs Insulin Lispro Added to Basal Insulin in Type 2 Diabetes: The SURPASS-6 Randomized Clinical Trial. JAMA 2023; 330:1631-1640. [PMID: 37786396 PMCID: PMC10548360 DOI: 10.1001/jama.2023.20294] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
Importance Tirzepatide is a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist used for the treatment of type 2 diabetes. Efficacy and safety of adding tirzepatide vs prandial insulin to treatment in patients with inadequate glycemic control with basal insulin have not been described. Objective To assess the efficacy and safety of tirzepatide vs insulin lispro as an adjunctive therapy to insulin glargine. Design, Setting, and Participants This open-label, phase 3b clinical trial was conducted at 135 sites in 15 countries (participants enrolled from October 19, 2020, to November 1, 2022) in 1428 adults with type 2 diabetes taking basal insulin. Interventions Participants were randomized (in a 1:1:1:3 ratio) to receive once-weekly subcutaneous injections of tirzepatide (5 mg [n = 243], 10 mg [n = 238], or 15 mg [n = 236]) or prandial thrice-daily insulin lispro (n = 708). Main Outcomes and Measures Outcomes included noninferiority of tirzepatide (pooled cohort) vs insulin lispro, both in addition to insulin glargine, in HbA1c change from baseline at week 52 (noninferiority margin, 0.3%). Key secondary end points included change in body weight and percentage of participants achieving hemoglobin A1c (HbA1c) target of less than 7.0%. Results Among 1428 randomized participants (824 [57.7%] women; mean [SD] age, 58.8 [9.7] years; mean [SD] HbA1c, 8.8% [1.0%]), 1304 (91.3%) completed the trial. At week 52, estimated mean change from baseline in HbA1c with tirzepatide (pooled cohort) was -2.1% vs -1.1% with insulin lispro, resulting in mean HbA1c levels of 6.7% vs 7.7% (estimated treatment difference, -0.98% [95% CI, -1.17% to -0.79%]; P < .001); results met noninferiority criteria and statistical superiority was achieved. Estimated mean change from baseline in body weight was -9.0 kg with tirzepatide and 3.2 kg with insulin lispro (estimated treatment difference, -12.2 kg [95% CI, -13.4 to -10.9]). The percentage of participants reaching HbA1c less than 7.0% was 68% (483 of 716) with tirzepatide and 36% (256 of 708) with insulin lispro (odds ratio, 4.2 [95% CI, 3.2-5.5]). The most common adverse events with tirzepatide were mild to moderate gastrointestinal symptoms (nausea: 14%-26%; diarrhea: 11%-15%; vomiting: 5%-13%). Hypoglycemia event rates (blood glucose level <54 mg/dL or severe hypoglycemia) were 0.4 events per patient-year with tirzepatide (pooled) and 4.4 events per patient-year with insulin lispro. Conclusions and Relevance In people with inadequately controlled type 2 diabetes treated with basal insulin, weekly tirzepatide compared with prandial insulin as an additional treatment with insulin glargine demonstrated reductions in HbA1c and body weight with less hypoglycemia. Trial Registration ClinicalTrials.gov Identifier: NCT04537923.
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Affiliation(s)
| | | | | | - Santiago Tofé
- Department of Endocrinology and Nutrition, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Ruth Huh
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - Hiren Patel
- Eli Lilly and Company, Indianapolis, Indiana
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23
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Lee TTM, Collett C, Bergford S, Hartnell S, Scott EM, Lindsay RS, Hunt KF, McCance DR, Barnard-Kelly K, Rankin D, Lawton J, Reynolds RM, Flanagan E, Hammond M, Shepstone L, Wilinska ME, Sibayan J, Kollman C, Beck R, Hovorka R, Murphy HR. Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes. N Engl J Med 2023; 389:1566-1578. [PMID: 37796241 DOI: 10.1056/nejmoa2303911] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Hybrid closed-loop insulin therapy has shown promise for management of type 1 diabetes during pregnancy; however, its efficacy is unclear. METHODS In this multicenter, controlled trial, we randomly assigned pregnant women with type 1 diabetes and a glycated hemoglobin level of at least 6.5% at nine sites in the United Kingdom to receive standard insulin therapy or hybrid closed-loop therapy, with both groups using continuous glucose monitoring. The primary outcome was the percentage of time in the pregnancy-specific target glucose range (63 to 140 mg per deciliter [3.5 to 7.8 mmol per liter]) as measured by continuous glucose monitoring from 16 weeks' gestation until delivery. Analyses were performed according to the intention-to-treat principle. Key secondary outcomes were the percentage of time spent in a hyperglycemic state (glucose level >140 mg per deciliter), overnight time in the target range, the glycated hemoglobin level, and safety events. RESULTS A total of 124 participants with a mean (±SD) age of 31.1±5.3 years and a mean baseline glycated hemoglobin level of 7.7±1.2% underwent randomization. The mean percentage of time that the maternal glucose level was in the target range was 68.2±10.5% in the closed-loop group and 55.6±12.5% in the standard-care group (mean adjusted difference, 10.5 percentage points; 95% confidence interval [CI], 7.0 to 14.0; P<0.001). Results for the secondary outcomes were consistent with those of the primary outcome; participants in the closed-loop group spent less time in a hyperglycemic state than those in the standard-care group (difference, -10.2 percentage points; 95% CI, -13.8 to -6.6); had more overnight time in the target range (difference, 12.3 percentage points; 95% CI, 8.3 to 16.2), and had lower glycated hemoglobin levels (difference, -0.31 percentage points; 95% CI, -0.50 to -0.12). Little time was spent in a hypoglycemic state. No unanticipated safety problems associated with the use of closed-loop therapy during pregnancy occurred (6 instances of severe hypoglycemia, vs. 5 in the standard-care group; 1 instance of diabetic ketoacidosis in each group; and 12 device-related adverse events in the closed-loop group, 7 related to closed-loop therapy). CONCLUSIONS Hybrid closed-loop therapy significantly improved maternal glycemic control during pregnancy complicated by type 1 diabetes. (Funded by the Efficacy and Mechanism Evaluation Program; AiDAPT ISRCTN Registry number, ISRCTN56898625.).
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Affiliation(s)
- Tara T M Lee
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Corinne Collett
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Simon Bergford
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Sara Hartnell
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Eleanor M Scott
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Robert S Lindsay
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Katharine F Hunt
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - David R McCance
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Katharine Barnard-Kelly
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - David Rankin
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Julia Lawton
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Rebecca M Reynolds
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Emma Flanagan
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Matthew Hammond
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Lee Shepstone
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Malgorzata E Wilinska
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Judy Sibayan
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Craig Kollman
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Roy Beck
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Roman Hovorka
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
| | - Helen R Murphy
- From the Norfolk and Norwich University Hospitals NHS Foundation Trust (T.T.M.L., H.R.M.) and the Norwich Clinical Trials Unit (C.C., E.F., M.H., L.S.), Norwich Medical School (T.T.M.L., H.R.M.), University of East Anglia, Norwich, Cambridge University Hospitals NHS Foundation Trust (S.H.), and the Wellcome-MRC Institute of Metabolic Science, University of Cambridge (M.E.W., R.H.), Cambridge, the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds (E.M.S.), the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow (R.S.L.), King's College Hospital NHS Foundation Trust, London (K.F.H.), the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast (D.R.M.), Barnard Health Research, Southampton (K.B.-K.), and the Usher Institute (D.R., J.L.) and the Centre for Cardiovascular Science (R.M.R.), University of Edinburgh, Edinburgh - all in the United Kingdom; and the Jaeb Center for Health Research, Tampa, FL (S.B., J.S., C.K., R.B.)
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Yuan S, Wu Y. Effectiveness and cost-effectiveness of six GLP-1RAs for treatment of Chinese type 2 diabetes mellitus patients that inadequately controlled on metformin: a micro-simulation model. Front Public Health 2023; 11:1201818. [PMID: 37744474 PMCID: PMC10513082 DOI: 10.3389/fpubh.2023.1201818] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To systematically estimate and compare the effectiveness and cost-effectiveness of the glucagon-like peptide-1 receptor agonists (GLP-1RAs) approved in China and to quantify the relationship between the burden of diabetic comorbidities and glycosylated hemoglobin (HbA1c) or body mass index (BMI). Methods To estimate the costs (US dollars, USD) and quality-adjusted life years (QALY) for six GLP-1RAs (exenatide, loxenatide, lixisenatide, dulaglutide, semaglutide, and liraglutide) combined with metformin in the treatment of patients with type 2 diabetes mellitus (T2DM) which is inadequately controlled on metformin from the Chinese healthcare system perspective, a discrete event microsimulation cost-effectiveness model based on the Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) simulation model was developed. A cohort of 30,000 Chinese patients was established, and one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) with 50,000 iterations were conducted considering parameter uncertainty. Scenario analysis was conducted considering the impacts of research time limits. A network meta-analysis was conducted to compare the effects of six GLP-1RAs on HbA1c, BMI, systolic blood pressure, and diastolic blood pressure. The incremental net monetary benefit (INMB) between therapies was used to evaluate the cost-effectiveness. China's per capita GDP in 2021 was used as the willingness-to-pay threshold. A generalized linear model was used to quantify the relationship between the burden of diabetic comorbidities and HbA1c or BMI. Results During a lifetime, the cost for a patient ranged from USD 42,092 with loxenatide to USD 47,026 with liraglutide, while the QALY gained ranged from 12.50 with dulaglutide to 12.65 with loxenatide. Compared to exenatide, the INMB of each drug from highest to lowest were: loxenatide (USD 1,124), dulaglutide (USD -1,418), lixisenatide (USD -1,713), semaglutide (USD -4,298), and liraglutide (USD -4,672). Loxenatide was better than the other GLP-1RAs in the base-case analysis. Sensitivity and scenario analysis results were consistent with the base-case analysis. Overall, the price of GLP-1RAs most affected the results. Medications with effective control of HbA1c or BMI were associated with a significantly smaller disease burden (p < 0.05). Conclusion Loxenatide combined with metformin was identified as the most economical choice, while the long-term health benefits of patients taking the six GLP-1RAs are approximate.
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Affiliation(s)
| | - Yingyu Wu
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
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25
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Young KG, McGovern AP, Barroso I, Hattersley AT, Jones AG, Shields BM, Thomas NJ, Dennis JM. HbA 1c screening for the diagnosis of diabetes. Reply to Brož J, Brabec M, Krollová P et al [letter]. Diabetologia 2023; 66:1578-1579. [PMID: 37272950 DOI: 10.1007/s00125-023-05939-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Katherine G Young
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK.
| | - Andrew P McGovern
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Inês Barroso
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
| | - Andrew T Hattersley
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Angus G Jones
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Beverley M Shields
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
| | - Nicholas J Thomas
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - John M Dennis
- Exeter Centre of Excellence in Diabetes (EXCEED), University of Exeter Medical School, Exeter, UK
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Rosenstock J, Bain SC, Gowda A, Jódar E, Liang B, Lingvay I, Nishida T, Trevisan R, Mosenzon O. Weekly Icodec versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin. N Engl J Med 2023; 389:297-308. [PMID: 37356066 DOI: 10.1056/nejmoa2303208] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Insulin icodec is an investigational once-weekly basal insulin analogue for diabetes management. METHODS We conducted a 78-week randomized, open-label, treat-to-target phase 3a trial (including a 52-week main phase and a 26-week extension phase, plus a 5-week follow-up period) involving adults with type 2 diabetes (glycated hemoglobin level, 7 to 11%) who had not previously received insulin. Participants were randomly assigned in a 1:1 ratio to receive once-weekly insulin icodec or once-daily insulin glargine U100. The primary end point was the change in the glycated hemoglobin level from baseline to week 52; the confirmatory secondary end point was the percentage of time spent in the glycemic range of 70 to 180 mg per deciliter (3.9 to 10.0 mmol per liter) in weeks 48 to 52. Hypoglycemic episodes (from baseline to weeks 52 and 83) were recorded. RESULTS Each group included 492 participants. Baseline characteristics were similar in the two groups. The mean reduction in the glycated hemoglobin level at 52 weeks was greater with icodec than with glargine U100 (from 8.50% to 6.93% with icodec [mean change, -1.55 percentage points] and from 8.44% to 7.12% with glargine U100 [mean change, -1.35 percentage points]); the estimated between-group difference (-0.19 percentage points; 95% confidence interval [CI], -0.36 to -0.03) confirmed the noninferiority (P<0.001) and superiority (P = 0.02) of icodec. The percentage of time spent in the glycemic range of 70 to 180 mg per deciliter was significantly higher with icodec than with glargine U100 (71.9% vs. 66.9%; estimated between-group difference, 4.27 percentage points [95% CI, 1.92 to 6.62]; P<0.001), which confirmed superiority. Rates of combined clinically significant or severe hypoglycemia were 0.30 events per person-year of exposure with icodec and 0.16 events per person-year of exposure with glargine U100 at week 52 (estimated rate ratio, 1.64; 95% CI, 0.98 to 2.75) and 0.30 and 0.16 events per person-year of exposure, respectively, at week 83 (estimated rate ratio, 1.63; 95% CI, 1.02 to 2.61). No new safety signals were identified, and incidences of adverse events were similar in the two groups. CONCLUSIONS Glycemic control was significantly better with once-weekly insulin icodec than with once-daily insulin glargine U100. (Funded by Novo Nordisk; ONWARDS 1 ClinicalTrials.gov number, NCT04460885.).
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Affiliation(s)
- Julio Rosenstock
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Stephen C Bain
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Amoolya Gowda
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Esteban Jódar
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Bo Liang
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Ildiko Lingvay
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Tomoyuki Nishida
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Roberto Trevisan
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
| | - Ofri Mosenzon
- From Velocity Clinical Research at Medical City (J.R.) and the Division of Endocrinology, Department of Internal Medicine, and the Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center (I.L.) - both in Dallas; Swansea University Medical School, Swansea, United Kingdom (S.C.B.); Novo Nordisk, Søborg, Denmark (A.G., B.L.); Servicio de Endocrinología y Nutrición, Hospital Universitario Quironsalud Madrid, Facultad de Medicina, Universidad Europea, Madrid (E.J.); Novo Nordisk, Tokyo (T.N.); Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo (R.T.), and the Department of Medicine and Surgery, University of Milano Bicocca, Milan (R.T.) - both in Italy; and the Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center (O.M.), and the Faculty of Medicine, Hebrew University of Jerusalem (O.M.) - both in Jerusalem
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Lingvay I, Asong M, Desouza C, Gourdy P, Kar S, Vianna A, Vilsbøll T, Vinther S, Mu Y. Once-Weekly Insulin Icodec vs Once-Daily Insulin Degludec in Adults With Insulin-Naive Type 2 Diabetes: The ONWARDS 3 Randomized Clinical Trial. JAMA 2023; 330:228-237. [PMID: 37354562 PMCID: PMC10354685 DOI: 10.1001/jama.2023.11313] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 03/24/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
Importance Once-weekly insulin icodec could provide a simpler dosing alternative to daily basal insulin in people with type 2 diabetes. Objective To evaluate the efficacy and safety of once-weekly icodec vs once-daily insulin degludec in people with insulin-naive type 2 diabetes. Design, Setting, and Participants Randomized, double-masked, noninferiority, treat-to-target, phase 3a trial conducted from March 2021 to June 2022 at 92 sites in 11 countries in adults with type 2 diabetes treated with any noninsulin glucose-lowering agents with hemoglobin A1c (HbA1c) of 7%-11% (53-97 mmol/mol). Interventions Participants were randomly assigned in a 1:1 ratio to receive either once-weekly icodec and once-daily placebo (icodec group; n = 294) or once-daily degludec and once-weekly placebo (degludec group; n = 294). Main Outcomes and Measures The primary end point was change in HbA1c from baseline to week 26 (noninferiority margin, 0.3% percentage points). Secondary end points included change in fasting plasma glucose from baseline to week 26, mean weekly insulin dose during the last 2 weeks of treatment, body weight change from baseline to week 26, and number of level 2 (clinically significant; glucose level <54 mg/dL) and level 3 (severe; requiring external assistance for recovery) hypoglycemic episodes. Results Among 588 randomized participants (mean [SD] age, 58 [10] years; 219 [37%] women), 564 (96%) completed the trial. Mean HbA1c level decreased from 8.6% (observed) to 7.0% (estimated) at 26 weeks in the icodec group and from 8.5% (observed) to 7.2% (estimated) in the degludec group (estimated treatment difference [ETD], -0.2 [95% CI, -0.3 to -0.1] percentage points), confirming noninferiority (P < .001) and superiority (P = .002). There were no significant differences between the icodec and degludec groups for fasting plasma glucose change from baseline to week 26 (ETD, 0 [95% CI, -6 to 5] mg/dL; P = .90), mean weekly insulin dose during the last 2 weeks of treatment, or body weight change from baseline to week 26 (2.8 kg vs 2.3 kg; ETD, 0.46 [95% CI, -0.19 to 1.10] kg; P = .17). Combined level 2 or 3 hypoglycemia rates were numerically higher in the icodec group than the degludec group from week 0 to 31 (0.31 vs 0.15 events per patient-year exposure; P = .11) and statistically higher in the icodec group from week 0 to 26 (0.35 vs 0.12 events per patient-year exposure; P = .01). Conclusions and Relevance Among people with insulin-naive type 2 diabetes, once-weekly icodec demonstrated superior HbA1c reduction to once-daily degludec after 26 weeks of treatment, with no difference in weight change and a higher rate of combined level 2 or 3 hypoglycemic events in the context of less than 1 event per patient-year exposure in both groups. Trial Registration ClinicalTrials.gov Identifier: NCT04795531.
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Affiliation(s)
- Ildiko Lingvay
- Division of Endocrinology, Department of Internal Medicine and Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas
| | | | - Cyrus Desouza
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Pierre Gourdy
- CHU de Toulouse & UMR1297/I2MC, Inserm, Université Toulouse 3, Toulouse, France
| | - Soumitra Kar
- Novo Nordisk Service Centre India Private Ltd, Bangalore, India
| | - André Vianna
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Tina Vilsbøll
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Yiming Mu
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
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Ikem RT, Lawal-Bello AT, Soyoye DO, Fasanu AN, Kolawole BA. Assessing the Burden of Kidney Disease among Type 2 Diabetic Subjects Attending a Semi-Urban Tertiary Health Facility in South-West Nigeria. West Afr J Med 2023; 40:640-645. [PMID: 37390451] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Diabetes Mellitus (DM) remains an important public health issue and its complications are important causes of morbidity and mortality. Diabetic nephropathy (DN) is one of these complications and could be prevented/delayed by early detection. This study determined the burden of DN among patients with type 2 diabetes (T2DM). METHODS This cross-sectional, hospital-based study was conducted among 100 T2DM patients attending the medical outpatient clinics of a tertiary hospital in Nigeria and 100 age- and sex-matched healthy controls. The procedure included collection of sociodemographic parameters, urine for microalbuminuria and blood samples for estimation of fasting plasma glucose, glycated haemoglobin (HbA1c), and creatinine. Estimated creatinine clearance (eGFR) was derived from two formulae - Cockroft Gault formula, and Modification of Diet in Renal Disease study (MDRD) for staging chronic kidney disease. Data were analysed using the IBM SPSS version 23 software. RESULTS Participants' ages ranged from 28 years to 73 years [mean 53.0 (±10.7) years] with males accounting for 56% of the population and females 44%. Mean HbA1c was 7.6 (±1.8) % among the subjects; 59% had poor glycaemic control with HbA1c >7% (p-value <0.001). Overt proteinuria was present in 13% of T2DM participants while 48% had microalbuminuria compared to the non-diabetic group where 2% had overt proteinuria and 17% had microalbuminuria. Using the eGFR, chronic kidney disease was present in 14% of T2DM group and in 6% of the non-diabetic population. Increased age [OR= 1.09; 95%CI (1.03-1.14)], male sex [OR = 3.50; 95%CI (1.13 10.88)], and duration of diabetes [OR =1.01; 95%CI (1.00-1.01)] were associated with DN. CONCLUSION The burden of diabetic nephropathy is high in the T2DM patients attending our clinic and this is linked with advancing age.
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Affiliation(s)
- R T Ikem
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Phone: +2348033183331
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - A T Lawal-Bello
- Department of Medicine, Federal Medical Centre, Birnin-Kebbi, Nigeria
| | - D O Soyoye
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Phone: +2348033183331
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - A N Fasanu
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - B A Kolawole
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Phone: +2348033183331
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
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Abstract
Importance Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide. Observations Prediabetes is defined by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4%. In the US, approximately 10% of people with prediabetes progress to having diabetes each year. A meta-analysis found that prediabetes at baseline was associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.36 per 10 000 person-years for mortality and 8.75 per 10 000 person-years for cardiovascular disease during 6.6 years). Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years. Metformin is most effective for women with prior gestational diabetes and for individuals younger than 60 years with body mass index of 35 or greater, fasting plasma glucose level of 110 mg/dL or higher, or HbA1c level of 6.0% or higher. Conclusions and Relevance Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality. First-line therapy for prediabetes is lifestyle modification that includes weight loss and exercise or metformin. Lifestyle modification is associated with a larger benefit than metformin.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leigh Perreault
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis
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Miyazawa I, Yokoyama H, Yagi N, Araki SI, Morino K, Kume S, Shirabe S, Yamazaki K, Maegawa H. Annual trends in glycemic control and prescribing patterns in diabetic treatment according to age in Japanese patients with type 2 diabetes between 2012 and 2019 (JDDM 71). Diabetes Res Clin Pract 2023; 198:110599. [PMID: 36849048 DOI: 10.1016/j.diabres.2023.110599] [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: 09/07/2022] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
AIMS This study aimed to evaluate changes in glycemic control and diabetes treatment by age group in Japanese patients with type 2 diabetes. METHODS The study included the results of approximately 40,000 patients/year using cross-sectional and retrospective analyses from 2012 to 2019. RESULTS There was little change in the glycemic control status in all age groups during the study period. However, by age group, patients aged ≤ 44 years continued to have the highest glycated hemoglobinA1c (HbA1c) values during the study period (7.4 % ± 1.7 % in 2012 and 7.4 % ± 1.5 % in 2019), especially in insulin-treated patients (8.3 % ± 1.9 % in 2012 and 8.4 % ± 1.8 % in 2019). Biguanides and dipeptidyl peptidase-4 inhibitors were widely prescribed. Sulfonylurea and insulin use showed a decreasing trend, but older patients had a higher percentage of prescriptions. Sodium glucose transporter 2 inhibitors were prescribed rapidly, especially in younger patients. CONCLUSIONS There were no obvious changes in glycemic control over time in the study period. The mean HbA1c level was higher in younger patients, which suggested that improvement is required. In older patients, there was a trend toward greater emphasis on management to avoid hypoglycemia. Different treatment strategies based on age showed different drug choices.
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Affiliation(s)
- Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
| | - Hiroki Yokoyama
- Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido Obihiro, Hokkaido 080-0016, Japan
| | | | - Shin-Ichi Araki
- Department of Internal Medicine, Division of Nephrology, Wakayama Medical University, Wakayama, Wakayama 641-8509, Japan
| | - Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Institutional Research Office, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | | | | | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Yasu City Hospital, Yasu, Shiga 520-2331, Japan
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31
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Wadwa RP, Reed ZW, Buckingham BA, DeBoer MD, Ekhlaspour L, Forlenza GP, Schoelwer M, Lum J, Kollman C, Beck RW, Breton MD. Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes. N Engl J Med 2023; 388:991-1001. [PMID: 36920756 PMCID: PMC10082994 DOI: 10.1056/nejmoa2210834] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Closed-loop control systems of insulin delivery may improve glycemic outcomes in young children with type 1 diabetes. The efficacy and safety of initiating a closed-loop system virtually are unclear. METHODS In this 13-week, multicenter trial, we randomly assigned, in a 2:1 ratio, children who were at least 2 years of age but younger than 6 years of age who had type 1 diabetes to receive treatment with a closed-loop system of insulin delivery or standard care that included either an insulin pump or multiple daily injections of insulin plus a continuous glucose monitor. The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring. Secondary outcomes included the percentage of time that the glucose level was above 250 mg per deciliter or below 70 mg per deciliter, the mean glucose level, the glycated hemoglobin level, and safety outcomes. RESULTS A total of 102 children underwent randomization (68 to the closed-loop group and 34 to the standard-care group); the glycated hemoglobin levels at baseline ranged from 5.2 to 11.5%. Initiation of the closed-loop system was virtual in 55 patients (81%). The mean (±SD) percentage of time that the glucose level was within the target range increased from 56.7±18.0% at baseline to 69.3±11.1% during the 13-week follow-up period in the closed-loop group and from 54.9±14.7% to 55.9±12.6% in the standard-care group (mean adjusted difference, 12.4 percentage points [equivalent to approximately 3 hours per day]; 95% confidence interval, 9.5 to 15.3; P<0.001). We observed similar treatment effects (favoring the closed-loop system) on the percentage of time that the glucose level was above 250 mg per deciliter, on the mean glucose level, and on the glycated hemoglobin level, with no significant between-group difference in the percentage of time that the glucose level was below 70 mg per deciliter. There were two cases of severe hypoglycemia in the closed-loop group and one case in the standard-care group. One case of diabetic ketoacidosis occurred in the closed-loop group. CONCLUSIONS In this trial involving young children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with a closed-loop system than with standard care. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; PEDAP ClinicalTrials.gov number, NCT04796779.).
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Affiliation(s)
- R Paul Wadwa
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Zachariah W Reed
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Bruce A Buckingham
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Mark D DeBoer
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Laya Ekhlaspour
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Gregory P Forlenza
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Melissa Schoelwer
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - John Lum
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Craig Kollman
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Roy W Beck
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
| | - Marc D Breton
- From the Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora (R.P.W., G.P.F.); the Jaeb Center for Health Research, Tampa, FL (Z.W.R., J.L., C.K., R.W.B.); the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford (B.A.B.), and the Division of Pediatric Endocrinology, University of California, San Francisco, San Francisco (L.E.) - both in California; and the University of Virginia Center for Diabetes Technology, Charlottesville (M.D.D., M.S., M.D.B.)
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Salina A, Bassi M, Aloi C, Strati MF, Bocciardi R, d’Annunzio G, Maghnie M, Minuto N. "Pesto" Mutation: Phenotypic and Genotypic Characteristics of Eight GCK/MODY Ligurian Patients. Int J Mol Sci 2023; 24:ijms24044034. [PMID: 36835446 PMCID: PMC9961661 DOI: 10.3390/ijms24044034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Maturity Onset Diabetes of the Young (MODY) is a monogenic form of diabetes mellitus (DM) that accounts for around 2-5% of all types of diabetes. Autosomal dominant inheritance in pathogenic variations of 14 genes related to β-cell functions can lead to monogenic types of diabetes. In Italy, GCK/MODY is the most frequent form and it is caused by mutations of the glucokinase (GCK). Patients with GCK/MODY usually have stable mild fasting hyperglycaemia with mildly elevated HbA1c levels and rarely need pharmacological treatment. Molecular analysis of the GCK coding exons was carried out by Sanger sequencing in eight Italian patients. All the probands were found to be heterozygous carriers of a pathogenic gross insertion/deletion c.1279_1358delinsTTACA; p.Ser426_Ala454delinsLeuGln. It was previously described for the first time by our group in a large cohort of Italian GCK/MODY patients. The higher levels of HbA1c (6.57% vs. 6.1%), and the higher percentage of patients requiring insulin therapy (25% vs. 2%) compared to the previously studied Italian patients with GCK/MODY, suggest that the mutation discovered could be responsible for a clinically worse form of GCK/MODY. Moreover, as all the patients carrying this variant share an origin from the same geographic area (Liguria), we postulate a possible founder effect and we propose to name it the "pesto" mutation.
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Affiliation(s)
- Alessandro Salina
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16100 Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Concetta Aloi
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Correspondence: ; Tel.: +39-01-05636-3786
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16100 Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Renata Bocciardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16100 Genoa, Italy
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuseppe d’Annunzio
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16100 Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Kim H, Jung DY, Lee SH, Cho JH, Yim HW, Kim HS. Long-Term Risk of Cardiovascular Disease Among Type 2 Diabetes Patients According to Average and Visit-to-Visit Variations of HbA1c Levels During the First 3 Years of Diabetes Diagnosis. J Korean Med Sci 2023; 38:e24. [PMID: 36718561 PMCID: PMC9886525 DOI: 10.3346/jkms.2023.38.e24] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/18/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It remains unclear whether a combination of glycemic variability and glycated hemoglobin (HbA1c) status leads to a higher incidence of cardiovascular disease (CVD). Therefore, to investigate CVD risk according to the glucose control status during early diabetes, we examined visit-to-visit HbA1c variability among patients with type 2 diabetes (T2DM). METHODS In this 9-year retrospective study, we measured HbA1c levels at each visit and tracked the change in HbA1c levels for 3 years after the first presentation (observation window) in newly diagnosed T2DM patients. We later assessed the occurrence of CVD in the last 3 years (target outcome window) of the study period after allowing a 3-year buffering window. The HbA1c variability score (HVS; divided into quartiles, HVS_Q1-4) was used to determine visit-to-visit HbA1c variability. RESULTS Among 4,817 enrolled T2DM patients, the mean HbA1c level was < 7% for the first 3 years. The group with the lowest HVS had the lowest rate of CVD (9.4%; 104/1,109 patients). The highest incidence of CVD of 26.7% (8/30 patients) was found in HVS [≥ 9.0%]_Q3, which was significantly higher than that in HVS [6.0-6.9%]_Q1 (P = 0.006), HVS [6.0-6.9%]_Q2 (P = 0.013), HVS [6.0-6.9%]_Q3 (P = 0.018), and HVS [7.0-7.9%]_Q3 (P = 0.040). CONCLUSION To our knowledge, this is the first long-term study to analyze the importance of both HbA1c change and visit-to-visit HbA1c variability during outpatient visits within the first 3 years. Lowering glucose levels during early diabetes may be more critical than reducing visit-to-visit HbA1c variability.
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Affiliation(s)
- Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - Da Young Jung
- Department of Biostatistics, Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hun-Sung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Tee C, Xu H, Fu X, Cui D, Jafar TH, Bee YM. Longitudinal HbA1c trajectory modelling reveals the association of HbA1c and risk of hospitalization for heart failure for patients with type 2 diabetes mellitus. PLoS One 2023; 18:e0275610. [PMID: 36662791 PMCID: PMC9858041 DOI: 10.1371/journal.pone.0275610] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/20/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Inconsistent conclusions in past studies on the association between poor glycaemic control and the risk of hospitalization for heart failure (HHF) have been reported largely due to the analysis of non-trajectory-based HbA1c values. Trajectory analysis can incorporate the effects of HbA1c variability across time, which may better elucidate its association with macrovascular complications. Furthermore, studies analysing the relationship between HbA1c trajectories from diabetes diagnosis and the occurrence of HHF are scarce. METHODS This is a prospective cohort study of the SingHealth Diabetes Registry (SDR). 17,389 patients diagnosed with type 2 diabetes mellitus (T2DM) from 2013 to 2016 with clinical records extending to the end of 2019 were included in the latent class growth analysis to extract longitudinal HbA1c trajectories. Association between HbA1c trajectories and risk of first known HHF is quantified with the Cox Proportional Hazards (PH) model. RESULTS 5 distinct HbA1c trajectories were identified as 1. low stable (36.1%), 2. elevated stable (40.4%), 3. high decreasing (3.5%), 4. high with a sharp decline (10.8%), and 5. moderate decreasing (9.2%) over the study period of 7 years. Poorly controlled HbA1c trajectories (Classes 3, 4, and 5) are associated with a higher risk of HHF. Using the diabetes diagnosis time instead of a commonly used pre-defined study start time or time from recruitment has an impact on HbA1c clustering results. CONCLUSIONS Findings suggest that tracking the evolution of HbA1c with time has its importance in assessing the HHF risk of T2DM patients, and T2DM diagnosis time as a baseline is strongly recommended in HbA1c trajectory modelling. To the authors' knowledge, this is the first study to identify an association between HbA1c trajectories and HHF occurrence from diabetes diagnosis time.
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Affiliation(s)
- Clarence Tee
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Haiyan Xu
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Xiuju Fu
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Di Cui
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
- Department of Advanced Design and Systmes Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Tazeen H. Jafar
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
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Huang X, Qin C, Guo X, Cao F, Tang C. Association of hemoglobin A1c with the incidence of hypertension: A large prospective study. Front Endocrinol (Lausanne) 2023; 13:1098012. [PMID: 36726461 PMCID: PMC9884972 DOI: 10.3389/fendo.2022.1098012] [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: 11/14/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
Background Although hemoglobin A1c (HbA1c) is closely related to diabetes, its relationship with the incidence of hypertension is still unknown, so we aimed to evaluate the relationship between HbA1c and the incidence of hypertension in the general population. Method In this large prospective cohort study with a median follow-up of 2 years, we included 4,074 participants from the China Health and Nutrition Survey (CHNS). Multivariate COX regression, subgroup analysis, receiver operator characteristic (ROC) curve and restricted cubic spline (RCS) were used to evaluate the relationship between HbA1c and incidental hypertension. Results Compared with participants without incident hypertension, participants with incident hypertension had higher levels of HbA1c (P < 0.05). In univariate COX regression analysis, HbA1c was associated with the risk of hypertension (HR: 1.161, 95% CI: 1.105-1.221, P < 0.001). In multivariate COX regression analysis adjusted for confounding variables, HbA1c was still closely related to the risk of hypertension (HR: 1.102, 95% CI: 1.006-1.206, P = 0.037). And subgroup analysis showed that the relationship between HbA1c and hypertension remained significant in female, lower than high school and non-obese subgroups (P < 0.05). ROC curve also showed that HbA1c could predict the risk of hypertension (AUC = 0.583, 95% CI: 0.568-0.598, P < 0.001). Further RCS analysis showed that HbA1c was positively correlated with the risk of hypertension (P for nonlinearity = 0.642). Conclusion HbA1c was linearly and positively associated with the incidence of hypertension.
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Affiliation(s)
- Xu Huang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Cheng Qin
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, 2nd Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaoxu Guo
- Department of Digestive Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, 2nd Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Yuan Y, Zhou X, Jia W, Zhou J, Zhang F, Du J, Ji L. The association between self-monitoring of blood glucose and HbA1c in type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1056828. [PMID: 36824358 PMCID: PMC9942703 DOI: 10.3389/fendo.2023.1056828] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023] Open
Abstract
AIMS Fasting capillary blood glucose (FCG) and postprandial capillary blood glucose (PCG) both contribute to HbA1c in diabetes. Due to the collinearity between FCG and PCG, the HbA1c prediction model could not be developed with both FCG and PCG by linear regression. The study aimed to develop an HbA1c prediction model with both FCG and PCG to estimate HbA1c in type 2 diabetes. METHODS A total of 1,642 patients with type 2 diabetes who had at least three FCG and three PCG measurements in the past 3 months were enrolled in the study. The mean of FCG (MEANFCG) and PCG (MEANPCG) were calculated for each patient. The patients were randomized into exploratory and validation groups. The former was used for developing HbA1c prediction models and the latter for performance evaluation. RESULTS The new HbA1c prediction model using ridge regression expressed as HbA1c (%) = 0.320×MEANFCG (mmol/L) + 0.187×MEANPCG (mmol/L) + 2.979, R2 = 0.668. Compared to linear regression models developed with FCG, PCG, fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2-h PPG), respectively, the new HbA1c prediction model showed the smallest mean square error, root mean square error, mean absolute error. The concordance correlation coefficient of the new HbA1c prediction model and the linear regression models with MEANFCG, MEANPCG, FPG or 2-h PPG were 0.810,0.773,0.749,0.715,0.672. CONCLUSION We have developed a new HbA1c prediction model with both FCG and PCG, which showed better prediction ability and good agreement.
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Affiliation(s)
- Yanping Yuan
- Department of Endocrinology, Peking University People’s Hospital, Beijing, China
| | - Xianghai Zhou
- Department of Endocrinology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xianghai Zhou, ; Linong Ji,
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology & Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai, China
| | - Fan Zhang
- Department of Endocrinology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jianling Du
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Linong Ji
- Department of Endocrinology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xianghai Zhou, ; Linong Ji,
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Love-Osborne KA, Ringwood HB, Wallace JF, Sheeder JL, Knierim SD. Type 2 Diabetes in High-risk Youth: Improving Identification and Interventions in Community Health with a Decade of Quality Improvement Efforts. J Health Care Poor Underserved 2023; 34:1366-1385. [PMID: 38661761 DOI: 10.1353/hpu.2023.a912723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION This manuscript describes quality improvement interventions with aims (1) to increase identification and follow-up testing of youth with prediabetes and type 2 diabetes (T2D) and (2) to improve outcomes for youth with prediabetes and low-range T2D (HbA1c 6.5-6.9%). METHODS Interventions included (a) dissemination of evidence-based guidelines and (b) creation of in-house weight management (WM) programs and programs to increase prediabetes follow-up testing and T2D self-management. Data from the electronic health record are presented. RESULTS Between 2009-2020, T2D screening for obese youth increased from 24% to 76%. Two WM programs served 2,726 unique youth for 11,110 billable visits. Youth with prediabetes seen in WM clinic had a lower risk of developing T2D if they attended three or more visits. Teaching self-monitoring blood glucose showed promise for improving HbA1c outcomes in youth with low-range T2D. CONCLUSIONS Interventions have increased identification, access to preventive services, and treatment for youth with prediabetes and T2D.
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Xing Y, Zhen Y, Yang L, Huo L, Ma H. Association between hemoglobin glycation index and non-alcoholic fatty liver disease. Front Endocrinol (Lausanne) 2023; 14:1094101. [PMID: 36824362 PMCID: PMC9941148 DOI: 10.3389/fendo.2023.1094101] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE The hemoglobin glycation index (HGI) reflects biological variability in hemoglobin A1c. Even so, studies on the relationship between HGI and non-alcoholic fatty liver disease (NAFLD) are limited. Therefore, this study aimed to explore the relationship between HGI and NAFLD. In addition, the study also aimed to provide new methods to identify patients with a high risk for the development of NAFLD. METHODS This was a retrospective study based on physical examination data from Japan. Patients were divided into quartiles (Q1-Q4) according to their HGI level; the lowest quartile (Q1) was used as the reference group. Patents were also classified into two subgroups based on the presence or absence of NAFLD. Baseline characteristics between the groups were compared. Multivariate logistic regression analysis was used to investigate the association between the HGI and NAFLD. A mediation analysis examined the mediation relationship between HGI and NAFLD. Subgroup analyses were performed to the reliability of the results. RESULTS A total of 14280 patients were eligible for inclusion in this study; 2515 had NAFLD. Patients in the NAFLD group had higher levels of HGI than patients in the non-NAFLD group. Increases in HGI correlated with an increased risk of NAFLD. After adjusting for confounding factors, the multivariate logistic regression analysis revealed that HGI was positively related to the prevalence of NAFLD. In addition, mediation analysis showed that body mass index (BMI) partly mediated the indirect impact of HGI on NAFLD preference. Subgroup analyses were performed according to age, sex, smoking status, and waist circumference. Our results indicated that HGI significantly correlated with NAFLD in patients with one of the following factors: age ≤60 years, BMI >28 kg/m2, female sex, a history of smoking, and abdominal obesity. CONCLUSIONS HGI was an independent risk factor for NAFLD, and BMI partly mediated the association between HGI and NAFLD.
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Affiliation(s)
- Yuling Xing
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
- Department of School of Post Graduate Studies, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yunfeng Zhen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
| | - Liqun Yang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
| | - Lijing Huo
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, China
| | - Huijuan Ma
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, China
- Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital Shijiazhuang, Hebei, China
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
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MM S, JS N, M BC, AP M, MJ F, F M, MJ F, D S, J P, V G, E L, A V, P F, D C. Higher magnesium levels are associated with better glycaemic control and diabetes remission post-bariatric surgery. BMC Endocr Disord 2022; 22:303. [PMID: 36471364 PMCID: PMC9724332 DOI: 10.1186/s12902-022-01210-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Low Magnesium (Mg) dietary intake has been associated with increased risk of type 2 diabetes mellitus (T2DM). Furthermore, in patients with T2DM, hypomagnesemia is associated with worst glycaemic control. Bariatric surgery (BS) remains the most effective treatment in severe obesity and also provides resolution/improvement of T2DM. Our aim is to evaluate the association between Mg supplementation post-BS and Mg serum levels with diabetes status after BS. METHODS We performed an observational study on patients with obesity and T2DM who underwent BS. Data was assessed pre-BS and one-year post-BS. RESULTS We included a total of 403 patients with T2DM. At baseline, 43.4% of the patients had Mg deficiency. Pre-BS, patients with Mg deficiency had poorer glycaemic control - HbA1c 7.2 ± 1.6% vs 6.4 ± 1.0% (p < 0.001), fasting plasma glucose 146.2 ± 58.8 mg/dL vs 117.5 ± 36.6 mg/dL (p < 0.001) and were under a greater number of anti-diabetic drugs 1.0 (IQR 0-2.0) vs 1.0 (IQR 0-1.0) (p = 0.002). These findings persisted at one-year post-BS. At the first-year post-BS, 58.4% of the patients had total remission of T2DM and 4.1% had partial remission. Patients without Mg deficiency at one-year post-BS had higher rates of total and partial remission. Higher serum Mg levels at baseline is an independent predictor of total T2DM remission (p < 0.0001). The optimal cut-off of baseline Mg to predict total T2DM remission was 1.50 mg/dL with a sensitivity of 73% and a specificity of 58% (area under ROC = 0.65). Patients that were under Mg supplementation post-BS had serum Mg values, glycaemic control and total remission of T2DM similar to patients non-supplemented. CONCLUSION In patients with T2DM submitted to BS, higher Mg serum levels at baseline and 1-year after BS were associated with better glycaemic control and higher rates of total T2DM remission at the first year post-BS.
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Affiliation(s)
- Silva MM
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Neves JS
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
- Departamento de Cirurgia E Fisiologia, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Borges-Canha M
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
- Departamento de Cirurgia E Fisiologia, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Mendes AP
- Medical and Performance Department, Sporting Clube de Portugal, Estrada da Malhada de Meias, Barroca d’Alva, 2890-529 Lisboa, Portugal
| | - Fonseca MJ
- Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal
| | - Mendonça F
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Ferreira MJ
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Salazar D
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Pedro J
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Guerreiro V
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Lau E
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Varela A
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Freitas P
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Carvalho D
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
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Raghavan A, Nanditha A, Satheesh K, Susairaj P, Vinitha R, Nair DR, Jeyaraj S, Sharad V, Ramachandran A. Improvement in glycaemic control in patients with type 2 diabetes with treatment using an interactive mobile application - A pilot study from India. Prim Care Diabetes 2022; 16:844-848. [PMID: 36307371 DOI: 10.1016/j.pcd.2022.10.008] [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: 06/19/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
AIMS We studied the outcome of glycaemic management using Diahome, a smart-phone application compared to conventional treatment. Overall acceptability of the application among users was also assessed. METHODS This is a retrospective, case-control study of patients on virtual diabetes care using the Diahome app (n = 441) and those visited the hospital out-patient services (n = 446) between April and June 2021. Men and women aged 45-60 years with type 2 diabetes (T2DM) were selected. RESULTS A total of 173 records with initial and follow-up visits were analyzed (app users n = 91, non-app users n = 82). Participants were aged 59 ± 12 years and were obese. The two groups were similar by age, gender distribution and duration of T2DM. Fasting blood glucose significantly reduced only among the app-users from a baseline level of 156 ± 70 mg/dl to 129 ± 40 mg/dl at follow-up (p < 0.02). Reduction in HbA1c levels was observed in both groups (p < 0.0001); percentage improvement was better among app (15.8%) than in non-app users (10.4%), p = 0.004. Triglycerides level were higher at both time points among app-users (p < 0.05) as compared to the other group. More than 56% of the users rated the performance of Diahome app as excellent; virtual consultation was rated the highest (71.5%) among the Diahome services. DISCUSSION Glycaemic management of diabetes using a dedicated mobile application was superior to in-person hospital visits. Its long-term effectiveness and cost savings need to be ascertained.
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Affiliation(s)
- Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | - Dhruv Rajesh Nair
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | - Santhosh Jeyaraj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India
| | | | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India; ARH Digital Services, Chennai, India.
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41
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Castle JR, Wilson LM, Tyler NS, Espinoza AZ, Mosquera-Lopez CM, Kushner T, Young GM, Pinsonault J, Dodier RH, Hilts WW, Oganessian SM, Branigan DL, Gabo VB, Eom JH, Ramsey K, Youssef JE, Cafazzo JA, Winters-Stone K, Jacobs PG. Assessment of a Decision Support System for Adults with Type 1 Diabetes on Multiple Daily Insulin Injections. Diabetes Technol Ther 2022; 24:892-897. [PMID: 35920839 PMCID: PMC9700374 DOI: 10.1089/dia.2022.0252] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: DailyDose is a decision support system designed to provide real-time dosing advice and weekly insulin dose adjustments for adults living with type 1 diabetes using multiple daily insulin injections. Materials and Methods: Twenty-five adults were enrolled in this single-arm study. All participants used Dexcom G6 for continuous glucose monitoring, InPen for short-acting insulin doses, and Clipsulin to track long-acting insulin doses. Participants used DailyDose on an iPhone for 8 weeks. The primary endpoint was % time in range (TIR) comparing the 2-week baseline to the final 2-week period of DailyDose use. Results: There were no significant differences between TIR or other glycemic metrics between the baseline period compared to final 2-week period of DailyDose use. TIR significantly improved by 6.3% when more than half of recommendations were accepted and followed compared with 50% or fewer recommendations (95% CI 2.5%-10.1%, P = 0.001). Conclusions: Use of DailyDose did not improve glycemic outcomes compared to the baseline period. In a post hoc analysis, accepting and following recommendations from DailyDose was associated with improved TIR. Clinical Trial Registration Number: NCT04428645.
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Affiliation(s)
- Jessica R. Castle
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Leah M. Wilson
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Nichole S. Tyler
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Alejandro Z. Espinoza
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Clara M. Mosquera-Lopez
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Taisa Kushner
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Gavin M. Young
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Pinsonault
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Robert H. Dodier
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Wade W. Hilts
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Sos M. Oganessian
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah L. Branigan
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Virginia B. Gabo
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Jae H. Eom
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Katrina Ramsey
- Biostatistics & Design Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph El Youssef
- Department of Medicine, Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter G. Jacobs
- Department of Biomedical Engineering, Artificial Intelligence for Medical Systems Lab, Oregon Health & Science University, Portland, Oregon, USA
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Franco DW, Alessi J, de Carvalho TR, Kobe GL, Oliveira GB, Knijnik CP, Amaral B, Becker AS, Schaan BD, Telo GH. The impact of a telehealth intervention on the metabolic profile of diabetes mellitus patients during the COVID-19 pandemic - A randomized clinical trial. Prim Care Diabetes 2022; 16:745-752. [PMID: 36266163 PMCID: PMC9553195 DOI: 10.1016/j.pcd.2022.09.011] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of a telehealth intervention on metabolic outcomes and self-perceptions of the patients regarding their management of diabetes during the COVID-19 pandemic. METHODS This is a non-blind randomized controlled clinical trial to assess a telehealth intervention. We included adults with diabetes mellitus. The outcomes assessed were the level of HbA1c, lipid profile, blood pressure levels, weight, body mass index and self-perceptions about diabetes management. RESULTS A total of 150 individuals with diabetes participated in the study and at the end of telehealth intervention there were no changes in the patient's HbA1c levels between intervention and control groups for neither type 1 (8.1% vs. 8.6%; p = 0.11) nor type 2 diabetes (8.6% vs. 9.0%; p = 0.09), respectively. From the rest of the metabolic profile, triglyceride levels from type 1 diabetes group was the only variable that demonstrated improvement with telehealth intervention (66.5% intervention group vs. 86.5% control group; p = 0.05). CONCLUSIONS After 4 months of telehealth intervention, no statistically significant results were observed in HbA1c nor in secondary outcomes (with the exception of triglycerides for the type 1 diabetes group).
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Affiliation(s)
- Debora Wilke Franco
- Post-graduate program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil.
| | - Janine Alessi
- Internal Medicine department, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Post-graduate program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil
| | - Taíse Rosa de Carvalho
- Post-graduate program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Internal Medicine department, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Gabriel Luiz Kobe
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | | | - Bibiana Amaral
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | - Beatriz D Schaan
- Post-graduate program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil; Endocrinology division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Post-graduate program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Internal Medicine department, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Radovnická L, Hásková A, Do QD, Horová E, Navrátilová V, Mikeš O, Cihlář D, Parkin CG, Grunberger G, Prázný M, Šoupal J. Lower Glycated Hemoglobin with Real-Time Continuous Glucose Monitoring Than with Intermittently Scanned Continuous Glucose Monitoring After 1 Year: The CORRIDA LIFE Study. Diabetes Technol Ther 2022; 24:859-867. [PMID: 36037056 DOI: 10.1089/dia.2022.0152] [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] [Indexed: 11/13/2022]
Abstract
Background: The aim was to compare the efficacy of real-time continuous glucose monitoring (rtCGM) and intermittently scanned continuous glucose monitoring (isCGM) focusing on glycated hemoglobin (HbA1c) as the primary endpoint. Methods: The CORRIDA LIFE was a 12-month, real-world, nonrandomized study that is part of the CORRIDA clinical trials program. The study compared rtCGM (Dexcom G5 or G6) and isCGM (FreeStyle Libre 14-Day; Abbott) in adults with type 1 diabetes (T1D). Only patients on multiple daily insulin injections or continuous subcutaneous insulin infusion with no automatic functions were included in this study. Primary outcome was the difference in HbA1c between study groups at 12 months. Results: One hundred ninety-one adults with T1D (mean age 40 ± 13 years, HbA1c 8.1% ± 3.4% [65 ± 14 mmol/mol]) participated in this study; 81 patients initiated rtCGM and 110 initiated isCGM. After 12-months, HbA1c was significantly lower with rtCGM versus isCGM (7.1% ± 3.1% [54.1 ± 10.1 mmol/mol] vs. 7.7% ± 3.3% [61.2 ± 12.2 mmol/mol]), P = 0.0001. The percentage of time in hypoglycemia (<70 mg/dL [<3.9 mmol/L]) was lower among rtCGM vs. isCGM participants [4.3% ± 2.8% vs. 6.4% ± 5.3%], P = 0.003). Patients with rtCGM spent less time in clinically significant hypoglycemia (<54 mg/dL [<3.0 mmol/L]) (0.9% ± 1.0% vs. 2.3% ± 2.5%, P < 0.0001) and more time in target range (70-180 mg/dL [3.9-10 mmol/L]) than isCGM users (67.5% ± 14.8% vs. 57.8% ± 17.0%), P = 0.0002. Conclusions: rtCGM was superior to isCGM in HbA1c, hypoglycemia, and other glycemic outcomes. Our findings provide guidance to clinicians when discussing monitoring options with their patients. The study was registered at www.clinicaltrials.gov (NCT04759495).
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Affiliation(s)
- Lucie Radovnická
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Aneta Hásková
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Quoc Dat Do
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Eva Horová
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Vendula Navrátilová
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Ondřej Mikeš
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - David Cihlář
- Department of Physical Education and Sport, Pedagogical Faculty, Jan Evangelista Purkyně University in Ústí nad Labem, Ústí nad Labem, Czech Republic
| | | | | | - Martin Prázný
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Jan Šoupal
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
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Parry‐Strong A, Wright‐McNaughton M, Weatherall M, Hall RM, Coppell KJ, Barthow C, Krebs JD. Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2022; 24:2431-2442. [PMID: 36064937 PMCID: PMC9826205 DOI: 10.1111/dom.14837] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
AIM Very low carbohydrate/ketogenic diets (VLC/KDs) are popular but their role in managing pre-diabetes and type 2 diabetes (T2D) is uncertain. This study uses a systematic review and meta-analysis of randomized controlled trials to estimate the effect of these diets in this population. MATERIALS AND METHODS A systematic review identified randomized controlled trials of at least 6 months duration comparing efficacy and safety of VLC/KDs (≤50 g carbohydrate or ≤10% total energy from carbohydrate per day) with a control diet (carbohydrate above the VLC/KD threshold) in adults with pre-diabetes or T2D. The primary outcome variable was glycated haemoglobin (HbA1c) after 12 months. The meta-analysis method was inverse variance weighting of mean values for continuous variables. RESULTS Key word searches identified 2290 studies; 2221 were not in scope. A full text review of 69 studies identified eight meeting inclusion criteria; in total, it involved 606 participants. Six studies reported HbA1c (%) at 12 months; four as change from baseline with a fixed effects estimate (95% confidence interval): VLC/KD minus control of 0.01% (-0.22 to 0.25), p = .91; and two as change from baseline: -0.65% (-0.99; -0.31) [-7.1 mmol/mol (-10.8; -3.4)], p < .001. Serum triglycerides were lower with VLC/KD versus control: -0.28 mmol/L (-0.44 to -0.11), p < .001. High-density lipoprotein was higher with an estimate of 0.04 mmol/L (0.01 to 0.08), p = .03, in the five studies reporting 12-month summary data. CONCLUSIONS A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited. More well-designed studies are required to provide certain evidence.
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Affiliation(s)
- Amber Parry‐Strong
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Morag Wright‐McNaughton
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Mark Weatherall
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Rosemary M. Hall
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Kirsten J. Coppell
- Department of Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Christine Barthow
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
| | - Jeremy D. Krebs
- Department of Medicine, Division of Health SciencesUniversity of Otago Wellington, School of Medicine and Health Sciences BuildingWellingtonNew Zealand
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Vazeou A, Tittel SR, Kordonouri O, Birkebaek NH, Iotova V, Piccini B, Seget S, Guness PK, Maahs DM, Stergiou GS. Increased prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes and hypertension: The SWEET international database. Diabetes Obes Metab 2022; 24:2420-2430. [PMID: 36089908 DOI: 10.1111/dom.14834] [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: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the prevalence of modifiable cardiovascular risk factors (CVRFs), including dyslipidaemia, obesity and high glycated haemoglobin (HbA1c) concentration, in patients with type 1 diabetes (T1D), and to evaluate their association with blood pressure (BP) categories. METHODS We analysed 21 634 children and adolescents with T1D from the SWEET international database with office BP values assessed at a three or more visits within a year from 2010 to 2021. Participants were classified into a normotensive group, a group with elevated BP (90 to 94th percentile) or a hypertensive group (≥95th percentile), based on the median BP for the visits within the last treatment year. The prevalences of dyslipidaemia [cholesterol ≥ 5.18 mmol/L (200 mg/dL) and/or HDL cholesterol ≤ 1.036 mmol/L (40 mg/dL) and/or LDL cholesterol ≥ 2.59 mmol/L (100 mg/dL)], obesity (body mass index ≥2 standard deviation score) and elevated HbA1c [≥ 75 mmol/mol (9%)] were evaluated in patients within each BP group. RESULTS Patients with hypertension/elevated BP had less favourable lipid profiles, and a higher prevalence of obesity and HbA1c ≥ 75 mmol/mol than normotensive patients. A total of 38.4% of hypertensive patients and 36.0% of those with elevated BP had one CVRF, 15.1% and 10.1%, respectively, had two CVRFs, and 2.3% and 0.8%, respectively, had three CVRFs. Patients with hypertension/elevated BP had a higher prevalence of one or more CVRFs versus normotensive patients (P < 0.001). Obesity was the CVRF most strongly related to hypertension. Girls had a higher prevalence of one or more CVRFs than boys. Similar results were found in patients aged ≥13 years with hypertension compared to those aged <13 years. CONCLUSIONS The prevalence of modifiable CVRFs is higher in children and adolescents with T1D who have elevated BP/hypertension than in those with normotension, suggesting that they are more vulnerable to future morbidity and mortality requiring early detection and intervention.
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Affiliation(s)
- Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospitals, Athens, Greece
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Hannover Medical School, Hannover, Germany
| | - Niels H Birkebaek
- Department of Pediatrics and Steno Diabetes Center Aarhus, Aarhus University hospital, Aarhus, Denmark
| | - Violeta Iotova
- Department of Pediatrics, Medical University, Varna, Bulgaria
| | - Barbara Piccini
- Regional Center for Pediatric Diabetes, Meyer University Children's Hospital, Florence, Italy
| | - Sebastian Seget
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Pravesh Kumar Guness
- Department of diabetes, nutrition and endocrinology, Reunion Island and T1Diams Quatres Bornes, Vacoas, Mauritius
| | - David M Maahs
- Department of Pediatrics and Stanford Diabetes Research Center, Stanford University and the Lucile Packard Children's Hospital, Stanford, California, USA
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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Moreno-Fernandez J, Chico A, Martínez-Brocca MA, Beato-Víbora PI, Vidal M, Piedra M, Quirós C, Muñoz-Rodríguez JR. Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes Mellitus Patients: Results from the Spanish National Registry. Diabetes Technol Ther 2022; 24:898-906. [PMID: 35947087 DOI: 10.1089/dia.2022.0207] [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] [Indexed: 11/12/2022]
Abstract
Aim: To analyze the clinical effect of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1D) patients in the Spanish real-world scenario. Methods: All T1D patients on CSII registered in the SPAnish Insulin Pump (SPAIP) registry were included. The primary efficacy outcome was change in HbA1c during follow-up. Secondary efficacy outcomes included: insulin pump indications, diabetes complication rates, insulin and pump use, and continuous glucose monitoring (CGM) glycometrics. Patient data were typed through the web-based SPAIP registry. Results: Data from 2979 T1D patients treated with CSII were analyzed. The median age was 44 years (interquartile range [IQR] 34-52 years), and T1D duration was 27 years (IQR 18-35 years). The median duration of CSII therapy was 6 years (IQR 3-10 years). The main indications for treatment were suboptimal glycemic control (33.8%), hypoglycemia (22.1%), and increased glycemic variability (18.8%). Glycated hemoglobin decreased by 6 mmol/mol (95% CI, -5 to -6 mmol/mol, P < 0.001) [-0.5%, 95% CI, -0.4 to -0.5, P < 0.001] during the follow-up. The percentage of patients with severe hypoglycemia decreased from 14.9% to 0.9% (P < 0.001). We observed an inverse correlation between final HbA1c levels and CGM adherence (R = -0.24, P < 0.001) or percentage of time with active hybrid closed-loop functions (R = -0.25, P < 0.001). Conclusions: CSII treatment was associated with a sustained improvement in glycemic control in the Spanish population. This benefit was greater among patients with higher CGM or active hybrid closed-loop functions adherence. The protocol was publicly registered at ClinicalTrials.gov (NCT04761094).
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Affiliation(s)
- Jesus Moreno-Fernandez
- Department of Endocrinology and Nutrition, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Ana Chico
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Mercé Vidal
- Department of Endocrinology and Nutrition, Barcelona Clinic Hospital, Barcelona, Spain
| | - María Piedra
- Department of Endocrinology and Nutrition, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Terrassa Hospital, Terrassa, Barcelona, Spain
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Verma I, Gopaldasani V, Jain V, Chauhan S, Chawla R, Verma PK, Hosseinzadeh H. The impact of peer coach-led type 2 diabetes mellitus interventions on glycaemic control and self-management outcomes: A systematic review and meta-analysis. Prim Care Diabetes 2022; 16:719-735. [PMID: 36307372 DOI: 10.1016/j.pcd.2022.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/16/2021] [Revised: 09/12/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a major health risk and dominant cause of global mortality and morbidity. Disease-specific support from peers with similar chronic condition has shown to improve chronic disease self-management outcomes. The purpose of this systematic review is to summarise the existing evidence on the impact of peer coach-led type 2 diabetes mellitus self-management interventions on glycaemic control and self-management outcomes. Databases including MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest Central, ScienceDirect, web of science, Wiley Online Library and UOW Library were searched for eligible papers. Thirteen randomised controlled trials (RCTs) published between 2008 and 2021 were included in this review. Random-effects meta-analyses found that there were statistically significant changes in Haemoglobin A1c HbA1c) after the interventions. However, the meta-analyses showed no significant changes in LDL (low-density lipoprotein), BMI (Body mass index), systolic BP (Blood Pressure), and HRQoL (Health-related quality of life) among intervention and control groups after the intervention. The identified studies mainly recruited patients with suboptimal glucose levels; majority of them belonging to low-income population. Our findings showed that peer coaching was helpful in improving HbA1c levels, quality of life, self-efficacy, diabetes distress and patient activation. Moreover, peer coaching associations with medication adherence, hypoglycaemic symptoms, diabetes specific social support and depression were inconclusive. This review concludes that peer-led community-based interventions with longer follow up, using a mixed method of delivery among patients with suboptimal levels of HbA1c were more efficient compared to usual care for improving T2DM self-management.
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Affiliation(s)
- Iksheta Verma
- School of Health and Society, University of Wollongong, Building 29, Room 315, NSW 2522, Australia.
| | - Vinod Gopaldasani
- School of Health and Society, University of Wollongong, Building 29, Room 315, NSW 2522, Australia
| | - Vishesh Jain
- Data & Analytics, RMIT Building 106, Level 7, 222 Lonsdale Street, Melbourne, VIC 3000, Australia
| | - Saroj Chauhan
- Employees State Insurance, Faridabad, Haryana 121002, India
| | - Rajeev Chawla
- North Delhi Diabetes Centre, 180, Jai Apartment, Rohini Sector 9, New Delhi 110085, India
| | | | - Hassan Hosseinzadeh
- School of Health and Society, University of Wollongong, Building 29, Room 315, NSW 2522, Australia
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Frank S, Hames KC, Jbaily A, Park JH, Stroyeck C, Price D. Feasibility of Using a Factory-Calibrated Continuous Glucose Monitoring System to Diagnose Type 2 Diabetes. Diabetes Technol Ther 2022; 24:907-914. [PMID: 35920831 DOI: 10.1089/dia.2022.0189] [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] [Indexed: 11/13/2022]
Abstract
Context: Plasma glucose or A1C criteria can be used to establish the diagnosis of type 2 diabetes (T2D). Objective: We examined whether continuous glucose monitoring (CGM) data from a single 10-day wear period could form the basis of an alternative diagnostic test for T2D. Design: We developed a binary classification diagnostic CGM (dCGM) algorithm using a dataset of 716 individual CGM sensor sessions from 563 participants with associated A1C measurements from seven clinical trials. Data from 470 participants were used for training and 93 participants for testing (49 normoglycemic [A1C <5.7%], 27 prediabetes, and 17 T2D [A1C ≥6.5%] not using pharmacotherapy). dCGM performance was evaluated against the accompanying A1C measurement, which was assumed to provide the correct diagnosis. Results: The dCGM algorithm's overall sensitivity, specificity, positive predictive value, and negative predictive value were 71%, 93%, 71%, and 93%, respectively. At other clinically relevant A1C thresholds, dCGM specificity among normoglycemic participants was 98% (48/49 correctly classified), and for participants with suboptimally controlled diabetes (A1C ≥7%, above the American Diabetes Association recommended A1C goal) the sensitivity was 100% (8/8 participants correctly diagnosed with T2D). Conclusions: Classifications based on the dCGM algorithm were in good agreement with traditional methods based on A1C. The dCGM algorithm may provide an alternative method for screening and diagnosing T2D, and warrants further investigation.
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Affiliation(s)
- Spencer Frank
- R&D Department, Dexcom, Inc., San Diego, California, USA
| | | | | | - Jee Hye Park
- R&D Department, Dexcom, Inc., San Diego, California, USA
| | - Chuck Stroyeck
- R&D Department, Dexcom, Inc., San Diego, California, USA
| | - David Price
- R&D Department, Dexcom, Inc., San Diego, California, USA
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Xu Y, Oriot P, Dunn TC, Hermans MP, Ram Y, Cheng A, Ajjan RA. Evaluation of continuous glucose monitoring-derived person-specific HbA1c in the presence and absence of complications in type 1 diabetes. Diabetes Obes Metab 2022; 24:2383-2390. [PMID: 35876223 PMCID: PMC9804663 DOI: 10.1111/dom.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the accuracy of a novel kinetic model at predicting HbA1c in a real-world setting and to understand and explore the role of diabetes complications in altering the glucose-HbA1c relationship and the mechanisms involved. MATERIALS AND METHODS Deidentified HbA1c and continuous glucose monitoring values were collected from 93 individuals with type 1 diabetes. Person-specific kinetic variables were used, including red blood cell (RBC) glucose uptake and lifespan, to characterize the relationship between glucose levels and HbA1c. The resulting calculated HbA1c (cHbA1c) was compared with glucose management indicator (GMI) for prospective agreement with laboratory HbA1c. RESULTS The cohort (42 men and 51 women) had a median age (IQR) of 61 (43, 72) years and a diabetes duration of 21 (10, 33) years. A total of 24 459 days of continuous glucose monitoring (CGM) data were available and 357 laboratory HbA1c were used to assess the average glucose-HbA1c relationship. cHbA1c had a superior correlation with laboratory HbA1c compared with GMI with a mean absolute deviation of 1.7 and 6.7 mmol/mol, r2 = 0.85 and 0.44, respectively. The fraction within 10% of absolute relative deviation from laboratory HbA1c was 93% for cHbA1c and 63% for GMI. Macrovascular disease had no effect on the model's accuracy, whereas microvascular complications resulted in a trend towards higher HbA1c, secondary to increased RBC glucose uptake. CONCLUSIONS cHbA1c, which takes into account RBC glucose uptake and lifespan, accurately reflects laboratory HbA1c in a real-world setting and can aid in the management of individuals with diabetes.
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Affiliation(s)
| | - Philippe Oriot
- Centre Hospitalier de Mouscron, Service de diabétologie et endocrinologieMouscronBelgium
| | | | - Michel P. Hermans
- Cliniques universitaires Saint‐Luc, UCL Louvain – Service d'Endocrinologie et NutritionBrusselsBelgium
| | | | | | - Ramzi A. Ajjan
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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Zhou K, Li Q, Hu X, Zhu H, Liu J. The effect of preoperative HbA1c on chronic postsurgical pain in diabetic patients undergoing video-assisted thoracic surgery - A retrospective cohort study. J Clin Anesth 2022; 83:110988. [PMID: 36332364 DOI: 10.1016/j.jclinane.2022.110988] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Kang Zhou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Qing Li
- School of Nursing, Xuzhou Medical University, China
| | - Xiaoyi Hu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - He Zhu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Jindong Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, China.
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