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Gavin JR, Rodbard HW, Battelino T, Brosius F, Ceriello A, Cosentino F, Giorgino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Prashant Nedungadi T, Parkin CG, Topsever P, Rydén L, Huey-Herng Sheu W, Standl E, Olav Vandvik P, Schnell O. Disparities in prevalence and treatment of diabetes, cardiovascular and chronic kidney diseases - Recommendations from the taskforce of the guideline workshop. Diabetes Res Clin Pract 2024; 211:111666. [PMID: 38616041 DOI: 10.1016/j.diabres.2024.111666] [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: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
There is a mounting clinical, psychosocial, and socioeconomic burden worldwide as the prevalence of diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD) continues to rise. Despite the introduction of therapeutic interventions with demonstrated efficacy to prevent the development or progression of these common chronic diseases, many individuals have limited access to these innovations due to their race/ethnicity, and/or socioeconomic status (SES). However, practical guidance to providers and healthcare systems for addressing these disparities is often lacking. In this article, we review the prevalence and impact of healthcare disparities derived from the above-mentioned chronic conditions and present broad-based recommendations for improving access to quality care and health outcomes within the most vulnerable populations.
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Affiliation(s)
- James R Gavin
- Emory University School of Medicine, Atlanta, GA, USA
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD 20852, USA.
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724-5022, USA.
| | - Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni MI 20099, Italy.
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 641 Durham Centre, Box 17969, Durham, NC 27715, USA.
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China.
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, Stuttgart 70199, Germany.
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI 53703, USA.
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA; The George Institute for Global Health and University of New South Wales, Sydney, Australia.
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, Beograd 11000, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University Pauwelsstraße 30, 52074 Aachen, Germany.
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV 89074, USA
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İçerenköy, Kayışdağı Cd. No: 32, Ataşehir/İstanbul 34752, Türkiye.
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden.
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli 350, Taiwan.
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Institute of Health and Society, University of Oslo, Lovisenberggata 17, Oslo 0456, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
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Battelino T, Brosius F, Ceriello A, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Rydén L, Rodbard HW, Ji L, Sheu WHH, Standl E, Parkin CG, Schnell O. Guideline Development for Medical Device Technology: Issues for Consideration. J Diabetes Sci Technol 2023; 17:1698-1710. [PMID: 35531901 PMCID: PMC10658688 DOI: 10.1177/19322968221093355] [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: 11/15/2022]
Abstract
Advances in the development of innovative medical devices and telehealth technologies create the potential to improve the quality and efficiency of diabetes care through collecting, aggregating, and interpreting relevant health data in ways that facilitate more informed decisions among all stakeholder groups. Although many medical societies publish guidelines for utilizing these technologies in clinical practice, we believe that the methodologies used for the selection and grading of the evidence should be revised. In this article, we discuss the strengths and limitations of the various types of research commonly used for evidence selection and grading and present recommendations for modifying the process to more effectively address the rapid pace of device and technology innovation and new product development.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine–Tucson, AZ, USA
| | | | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | | | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
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Ceriello A, Rodbard HW, Battelino T, Brosius F, Cosentino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Parkin CG, Rydén L, Sheu WHH, Standl E, Vandvik PO, Schnell O. Data from network meta-analyses can inform clinical practice guidelines and decision-making in diabetes management: perspectives of the taskforce of the guideline workshop. Cardiovasc Diabetol 2023; 22:277. [PMID: 37833776 PMCID: PMC10576408 DOI: 10.1186/s12933-023-01993-3] [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: 06/17/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
In recent years, several novel agents have become available to treat individuals with type 2 diabetes (T2D), such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i), tirzepatide, which is a dual glucose-dependent insulinotropic polypeptide receptor agonist (GIP RA)/glucagon-like peptide-1 receptor agonist (GLP-1 RA), and finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA) that confers significant renal and cardiovascular benefits in individuals with (CKD). New medications have the potential to improve the lives of individuals with diabetes. However, clinicians are challenged to understand the benefits and potential risks associated with these new and emerging treatment options. In this article, we discuss how use of network meta-analyses (NMA) can fill this need.
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Affiliation(s)
- Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD, 20852, USA
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ, 85724-5022, USA
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, DUMC Box 3850, Durham, NC, 27715, USA
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Germany
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI, 53703, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO, 64111, USA
- The George Institute for Global Health and University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV, 89074, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli, 350, Taiwan
| | - Eberhard Standl
- Forschergruppe Diabetes E. V, Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes E. V, Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany.
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Gabriel R, Boukichou-Abdelkader N, Gilis-Januszewska A, Makrilakis K, Gómez-Huelgas R, Kamenov Z, Paulweber B, Satman I, Djordjevic P, Alkandari A, Mitrakou A, Lalic N, Egido J, Más-Fontao S, Calvet JH, Pastor JC, Lindström J, Lind M, Acosta T, Silva L, Tuomilehto J. Reduction in the Risk of Peripheral Neuropathy and Lower Decrease in Kidney Function with Metformin, Linagliptin or Their Fixed-Dose Combination Compared to Placebo in Prediabetes: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12052035. [PMID: 36902821 PMCID: PMC10004435 DOI: 10.3390/jcm12052035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To compare the effect of glucose-lowering drugs on peripheral nerve and kidney function in prediabetes. METHODS Multicenter, randomized, placebo-controlled trial in 658 adults with prediabetes treated for 1 year with metformin, linagliptin, their combination or placebo. Endpoints are small fiber peripheral neuropathy (SFPN) risk estimated by foot electrochemical skin conductance (FESC < 70 μSiemens) and estimated glomerular filtration rate (eGFR). RESULTS Compared to the placebo, the proportion of SFPN was reduced by 25.1% (95% CI:16.3-33.9) with metformin alone, by 17.3% (95% CI 7.4-27.2) with linagliptin alone, and by 19.5% (95% CI 10.1-29.0) with the combination linagliptin/metformin (p < 0.0001 for all comparisons). eGFR remained +3.3 mL/min (95% CI: 0.38-6.22) higher with the combination linagliptin/metformin than with the placebo (p = 0.03). Fasting plasma glucose (FPG) decreased more with metformin monotherapy -0.3 mmol/L (95%CI: -0.48; 0.12, p = 0.0009) and with the combination metformin/linagliptin -0.2 mmol/L (95% CI: -0.37; -0.03) than with the placebo (p = 0.0219). Body weight (BW) decreased by -2.0 kg (95% CI: -5.65; -1.65, p = 0.0006) with metformin monotherapy, and by -1.9 kg (95% CI: -3.02; -0.97) with the combination metformin/linagliptin as compared to the placebo (p = 0.0002). CONCLUSIONS in people with prediabetes, a 1 year treatment with metformin and linagliptin, combined or in monotherapy, was associated with a lower risk of SFPN, and with a lower decrease in eGFR, than treatment with placebo.
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Affiliation(s)
- Rafael Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), 28001 Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- Correspondence:
| | - Nisa Boukichou-Abdelkader
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- EVIDEM CONSULTORES, 28030 Madrid, Spain
| | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29018 Málaga, Spain
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Multi-Profile Hospital for Active Treatment Alexandrovska EAD, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Bernhard Paulweber
- Gemeinnuetzige Salzburger Landeskliniken Betriebsgesellschaft (SALK), 5020 Salzburg, Austria
| | - Ilhan Satman
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Istanbul University, 34093 Istanbul, Turkey
| | | | | | | | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain
| | - Sebastián Más-Fontao
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain
| | | | - José Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Hospital Clínico Universitario, Universidad de Valladolid, 47011 Valladolid, Spain
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, 451 53 Uddevalla, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla 080001, Colombia
| | | | - Jaakko Tuomilehto
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), 28001 Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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5
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Janez A, Muzurovic E, Stoian AP, Haluzik M, Guja C, Czupryniak L, Duvnjak L, Lalic N, Tankova T, Bogdanski P, Papanas N, Nunes JS, Kempler P, Fras Z, Rizzo M. Translating results from the cardiovascular outcomes trials with glucagon-like peptide-1 receptor agonists into clinical practice: Recommendations from a Eastern and Southern Europe diabetes expert group. Int J Cardiol 2022; 365:8-18. [PMID: 35905827 DOI: 10.1016/j.ijcard.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 02/06/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists mimic the action of the endogenous GLP-1 incretin hormone, improving glycaemic control in type 2 diabetes mellitus (T2DM) by increasing insulin secretion and decreasing glucagon secretion in a glucose-dependent manner. However, as cardiovascular (CV) morbidity and mortality is common in patients with T2DM, several trials with the use of GLP-1 receptor agonists (RAs) have been performed focusing on endpoints related to cardiovascular disease rather than metabolic control of T2DM. Following the positive cardiovascular effects of liraglutide, dulaglutide and semaglutide observed in these trials, major changes in T2DM management guidelines have occurred. This document from a Eastern and Southern European Diabetes Expert Group discusses the results of GLP-1 RA CV outcomes trials, their impact on recent clinical guidelines for the management of T2DM, and some selected combination regimens utilising GLP-1 RAs. We also propose an algorithm for guiding GLP-1 RA-based treatment according to patients' characteristics, which can be easily applied in every day clinical practice.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Slovenia.
| | - Emir Muzurovic
- Faculty of Medicine, University of Montenegro, Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Haluzik
- Diabetes Centre and Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine and Institute of Endocrinology, Prague, Czech Republic
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Poland
| | - Lea Duvnjak
- School of Medicine University of Zagreb, Vuk Vrhovac University Clinic, Zagreb, Croatia
| | - Nebojsa Lalic
- Faculty of Medicine University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Pawel Bogdanski
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, University of Medical Sciences, Poznan, Poland
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Josè Silva Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Peter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zlatko Fras
- Preventive Cardiology Unit, Division of Medicine, University Medical Centre Ljubljana and Chair of Internal Medicine, Medical Faculty, University of Ljubljana, Slovenia
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Italy
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6
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Gojnic M, Todorovic J, Stanisavljevic D, Jotic A, Lukic L, Milicic T, Lalic N, Lalic K, Stoiljkovic M, Stanisavljevic T, Stefanovic A, Stefanovic K, Vrzic-Petronijevic S, Petronijevic M, Terzic-Supic Z, Macura M, Perovic M, Babic S, Piperac P, Jovanovic M, Parapid B, Doklestic K, Cerovic R, Djurasevic S, Dugalic S. Maternal and Fetal Outcomes among Pregnant Women with Diabetes. IJERPH 2022; 19:ijerph19063684. [PMID: 35329371 PMCID: PMC8953700 DOI: 10.3390/ijerph19063684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023]
Abstract
The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.
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Affiliation(s)
- Miroslava Gojnic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.T.); (Z.T.-S.)
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Aleksandra Jotic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ljiljana Lukic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tanja Milicic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Katarina Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Milica Stoiljkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tamara Stanisavljevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Katarina Stefanovic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Svetlana Vrzic-Petronijevic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Milos Petronijevic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Zorica Terzic-Supic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.T.); (Z.T.-S.)
| | - Maja Macura
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
| | - Milan Perovic
- Clinic for Gynecology and Obstetrics “NarodniFront”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Sandra Babic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
| | - Pavle Piperac
- Department for Humanities, Faculty of Medicine, University of Belgrade, 11000 belgrade, Serbia;
| | | | - Bijana Parapid
- Clinic for Cardiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Krisitna Doklestic
- Emergency Department, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Radmila Cerovic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
| | | | - Stefan Dugalic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Correspondence:
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Migdalis IN, Czupryniak L, Lalic N, Papanas N, Valensi P. Chronic Diabetic Complications: Current Challenges and Opportunities. J Clin Med 2022; 11:jcm11030673. [PMID: 35160129 PMCID: PMC8836424 DOI: 10.3390/jcm11030673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ilias N. Migdalis
- Diabetes Centre, Second Department of Internal Medicine, NIMTS Hospital, 11521 Athens, Greece
- Correspondence:
| | - Leszek Czupryniak
- Department of Internal Medicine and Diabetology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases UCC of Serbia, 11000 Belgrade, Serbia;
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68132 Alexandroupolis, Greece;
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93140 Bondy, France;
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8
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Gojnic-Dugalic M, Stefanovic K, Stefanovic A, Jotic A, Lalic N, Petronijevic-Vrzic S, Petronijevic M, Milicic T, Lukic L, Todorovic J, Dugalic S, Pantic I, Nesic D, Stoiljkovic M, Stanisavljevic D, Perovic M. Distribution of normal and pathological OGTTs among pregnant population and non-pregnant women with PCOS - the cross-sectional study. Medicine (Baltimore) 2021; 100:e27232. [PMID: 34664864 PMCID: PMC8448046 DOI: 10.1097/md.0000000000027232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/28/2021] [Indexed: 01/07/2023] Open
Abstract
Both pregnancy, as physiological, and polycystic ovary syndrome (PCOS), as a pathological condition, carry the risk for developing glucose metabolism abnormalities. In this retrospective cross-sectional study, we hypothesized that pregnancy as a physiological condition carries a higher likelihood for abnormal oral glucose tolerance test (OGTT) results than PCOS as a pathological condition.We have compared the prevalence and likelihood ratios for abnormal OGTT results between non-pregnant women with PCOS (Group A) and pregnant women at 24 to 28 weeks of gestation (Group B). Participants of both study groups underwent glucose tolerance testing with 75 g glucose OGTT. During the study period, 7411 women were tested, 3932 women encompassed Group A, and 3479 women comprised Group B.The numbers of yearly tested pregnant women and the corresponding proportion of tested women among all study participants have decreased during the study period, from 766 to 131 and 89.1% to 20.5%, respectively. Group A had a significantly lower prevalence (4.4%) of pathological OGTT results compared to Group B (8.1%). This has resulted in a 45.427 likelihood ratio (P < .001) for abnormal OGTT results in pregnant women compared to non-pregnant women with PCOS.We might conclude that pregnancy could have a more challenging influence on glucose metabolism and that carries higher risks for abnormal glucose metabolism than PCOS. The awareness of obstetricians regarding physiological changes during pregnancy that predisposes abnormal glucose metabolism is decreasing over time and the compliance concerning OGTT testing of pregnant women is decreasing too.
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Affiliation(s)
- Miroslava Gojnic-Dugalic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Katarina Stefanovic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar Stefanovic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Jotic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Svetlana Petronijevic-Vrzic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Milos Petronijevic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Tanja Milicic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Ljiljana Lukic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Serbia
| | - Stefan Dugalic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Igor Pantic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Dejan Nesic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Milica Stoiljkovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Dejana Stanisavljevic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Milan Perovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Gynaecology and Obstetrics “Narodni front,” Belgrade, Serbia
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Rosenstock J, Emral R, Sauque-Reyna L, Mohan V, Trescolí C, Al Sifri S, Lalic N, Alvarez A, Picard P, Bonnemaire M, Demil N, McCrimmon RJ. Advancing Therapy in Suboptimally Controlled Basal Insulin-Treated Type 2 Diabetes: Clinical Outcomes With iGlarLixi Versus Premix BIAsp 30 in the SoliMix Randomized Controlled Trial. Diabetes Care 2021; 44:dc210393. [PMID: 34183429 PMCID: PMC8740944 DOI: 10.2337/dc21-0393] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To directly compare the efficacy and safety of a fixed-ratio combination, of insulin glargine 100 units/mL and the glucagon-like peptide 1 receptor agonist lixisenatide (iGlarLixi), with those of a premix insulin analog, biphasic aspart insulin 30 (30% insulin aspart and 70% insulin aspart protamine) (BIAsp 30) as treatment advancement in type 2 diabetes suboptimally controlled on basal insulin plus oral antihyperglycemic drugs (OADs). RESEARCH DESIGN AND METHODS In SoliMix, a 26-week, open-label, multicenter study, adults with suboptimally controlled basal insulin-treated type 2 diabetes (HbA1c ≥7.5% and ≤10%) were randomized to once-daily iGlarLixi or twice-daily BIAsp 30. Primary efficacy end points were noninferiority in HbA1c reduction (margin 0.3%) or superiority in body weight change for iGlarLixi versus BIAsp 30. RESULTS Both primary efficacy end points were met: after 26 weeks, baseline HbA1c (8.6%) was reduced by 1.3% with iGlarLixi and 1.1% with BIAsp 30, meeting noninferiority (least squares [LS] mean difference -0.2% [97.5% CI -0.4, -0.1]; P < 0.001). iGlarLixi was also superior to BIAsp 30 for body weight change (LS mean difference -1.9 kg [95% CI -2.3, -1.4]) and percentage of participants achieving HbA1c <7% without weight gain and HbA1c <7% without weight gain and without hypoglycemia (all P < 0.001). iGlarLixi was also superior versus BIAsp 30 for HbA1c reduction (P < 0.001). Incidence and rates of American Diabetes Association level 1 and 2 hypoglycemia were lower with iGlarLixi versus BIAsp 30. CONCLUSIONS Once-daily iGlarLixi provided better glycemic control with weight benefit and less hypoglycemia than twice-daily premix BIAsp 30. iGlarLixi is a more efficacious, simpler, and well-tolerated alternative to premix BIAsp 30 in suboptimally controlled type 2 diabetes requiring treatment beyond basal insulin plus OAD therapy. VIDEO 1: diacare;dc21-0393v4/F1F1f1Infographic available at https://care.diabetesjournals.org/content/dc21-0393-infographic.
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Affiliation(s)
| | - Rifat Emral
- Department of Endocrinology and Metabolic Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, IDF Centre of Excellence in Diabetes Care & ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | | | | | - Nebojsa Lalic
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | - Nacima Demil
- Diabetes Medical Operation Department, Sanofi, Chilly-Mazarin, France
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McCrimmon RJ, Al Sifri S, Emral R, Mohan V, Sauque-Reyna L, Trescolí C, Lalic N, Alvarez A, Demil N, Coudert M, Shaunik A, Bonnemaire M, Rosenstock J. Advancing therapy with iGlarLixi versus premix BIAsp 30 in basal insulin-treated type 2 diabetes: Design and baseline characteristics of the SoliMix randomized controlled trial. Diabetes Obes Metab 2021; 23:1221-1231. [PMID: 33606908 DOI: 10.1111/dom.14354] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
AIM Premix insulin is commonly used in some regions of the world, despite the higher risk of hypoglycaemia and weight gain compared with basal insulin, based on the premise that it offers a simplified insulin regimen. iGlarLixi is a once-daily titratable fixed-ratio formulation that combines basal insulin glargine 100 units/mL (iGlar) and the GLP-1 RA, lixisenatide, which offers a single-injection option for treatment intensification, with improved HbA1c reductions, similar hypoglycaemia risk and more favourable bodyweight profiles over iGlar alone. This randomized controlled study directly compares, for the first time, treatment intensification with iGlarLixi versus premix insulin analogue biphasic insulin aspart 30 (BIAsp 30) in adults with T2D inadequately controlled on basal insulin in combination with one or two oral antihyperglycaemic drugs. MATERIALS AND METHODS This was an open-label, active-controlled, comparative, parallel-group, multicentre, phase 3b study. In total, 887 adults with T2D uncontrolled on basal insulin were randomized to switch to either iGlarLixi once daily, or BIAsp 30 twice daily, for 26 weeks. RESULTS Overall, 887 participants were enrolled (mean age 59.8 years, 50.2% female) from 89 centres in 17 countries. At baseline, 65.6% had a duration of T2D of 10 years or longer, and the mean HbA1c at baseline was 8.6%. CONCLUSIONS The study directly compared the efficacy and safety of iGlarLixi versus BIAsp 30 in people with T2D uncontrolled on basal insulin and one or more oral antihyperglycaemic agents. These results provide robust clinical data that may inform clinicians in their therapeutic management of people with T2D uncontrolled on basal insulin requiring additional therapy.
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Affiliation(s)
- Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Rifat Emral
- Department of Endocrinology and Metabolic Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, IDF Centre of Excellence in Diabetes Care & ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | | | | | - Nebojsa Lalic
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Nacima Demil
- Diabetes Medical Operation Department, Sanofi, Chilly-Mazarin, France
| | - Mathieu Coudert
- Biostatistics and Programming Department, Sanofi, Chilly-Mazarin, France
| | | | | | - Julio Rosenstock
- Dallas Diabetes Research Center at Medical City, Dallas, Texas, USA
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Hancu N, Janez A, Lalic N, Papanas N, Rahelic D, Roman G, Serafinceanu C, Tentolouris N, Vukovic B, Ylli A, Tankova T. Expert Opinion: A Call for Basal Insulin Titration in Patients with Type 2 Diabetes in Daily Practice: Southeast European Perspective. Diabetes Ther 2021; 12:1575-1589. [PMID: 33721212 PMCID: PMC7957039 DOI: 10.1007/s13300-021-01037-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
Therapeutic inertia related to insulin treatment, i.e. delays in initiation, especially titration of basal insulin, is a significant problem in daily practice in Southeast European countries. This phenomenon can be traced back to several patient-, physician- and health system-related factors. In recognition of the issue of inadequate insulin titration, 11 leading experts from countries in this region held a consensus-seeking meeting to review the current status of insulin initiation after non-insulin treatment and the potential barriers to insulin titration to provide an algorithm and tools for outpatient physicians and for patients aimed at optimizing basal insulin titration. The experts reached a consensus on the majority of the topics and proposed recommendations on how clinical inertia can be overcome. The outcomes of the meeting have been summarized in this paper.
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Affiliation(s)
- Nicolae Hancu
- Regina Maria Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania.
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Ljubljana, Ljubljana, Slovenia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Medical School, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Dario Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer, University of Osijek School of Medicine, Osijek, Croatia
| | - Gabriela Roman
- Clinical Centre of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinic County Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Cristian Serafinceanu
- Diabetology Clinic National Institute of Diabetes, Nutrition and Metabolic Diseases Prof. NC Paulescu, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nikolaos Tentolouris
- Laiko General Hospital, National and Kapodistrian, University of Athens, Medical School, Athens, Greece
| | - Blaženko Vukovic
- Department of Endocrinology With General Internal Medicine, University Clinical Center of Republika Srpska, Banja Luka, Bosnia and Herzegovina
| | - Agron Ylli
- Endocrinology Service in UHC Mother Teresa Tirane, Tirane, Albania
| | - Tsvetalina Tankova
- Department of Endocrinology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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12
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Banach M, Gaita D, Haluzik M, Janez A, Kamenov Z, Kempler P, Lalic N, Linhart A, Mikhailidis DP, Nocoń A, Silva Nunes J, Papanas N, Raposo JF, Rizzo M, Pantea Stoian A. Adoption of the ADA/EASD guidelines in 10 Eastern and Southern European countries: Physician survey and good clinical practice recommendations from an international expert panel. Diabetes Res Clin Pract 2021; 172:108535. [PMID: 33189792 DOI: 10.1016/j.diabres.2020.108535] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
AIMS Evidence from cardiovascular outcomes trials (CVOTs) of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors was reflected in the most recent guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). The aim of the present study was to assess the adoption of the ADA/EASD guidelines in a convenience sample of physicians from Eastern and Southern Europe, the barriers to the implementation of these guidelines and the measures needed to facilitate their implementation. METHODS Attendees at two international diabetes conferences could volunteer to respond to a fully anonymous survey. Responses were analysed descriptively and a panel of experts from around the region was consulted to interpret the survey results. RESULTS Responses (n = 96) from 10 countries were analysed. Most participants (63.4%) considered the ADA/EASD guidelines fundamental to their practice. All respondents saw the value of the CVOT-based ADA/EASD recommendations and 77-80% generally implemented them. Measures suggested to improve adherence to the ADA/EASD guidelines included aligning reimbursement policy with the guidelines (54.4%), publishing guidelines in a simple and concise form (42.4%) and translating guidelines into local languages (33.3%). CONCLUSIONS Aligning reimbursement with recent evidence and providing short summaries of the ADA/EASD guidelines in local languages could facilitate physician adherence.
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Vaxillaire M, Bonnefond A, Liatis S, Ben Salem Hachmi L, Jotic A, Boissel M, Gaget S, Durand E, Vaillant E, Derhourhi M, Canouil M, Larcher N, Allegaert F, Medlej R, Chadli A, Belhadj A, Chaieb M, Raposo JF, Ilkova H, Loizou D, Lalic N, Vassallo J, Marre M, Froguel P. Monogenic diabetes characteristics in a transnational multicenter study from Mediterranean countries. Diabetes Res Clin Pract 2021; 171:108553. [PMID: 33242514 DOI: 10.1016/j.diabres.2020.108553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/01/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnosis of monogenic diabetes has important clinical implications for treatment and health expenditure. However, its prevalence remains to be specified in many countries, particularly from South Europe, North Africa and Middle-East, where non-autoimmune diabetes in young adults is increasing dramatically. AIMS To identify cases of monogenic diabetes in young adults from Mediterranean countries and assess the specificities between countries. METHODS We conducted a transnational multicenter study based on exome sequencing in 204 unrelated patients with diabetes (age-at-diagnosis: 26.1 ± 9.1 years). Rare coding variants in 35 targeted genes were evaluated for pathogenicity. Data were analyzed using one-way ANOVA, chi-squared test and factor analysis of mixed data. RESULTS Forty pathogenic or likely pathogenic variants, 14 of which novel, were identified in 36 patients yielding a genetic diagnosis rate of 17.6%. The majority of cases were due to GCK, HNF1A, ABCC8 and HNF4A variants. We observed highly variable diagnosis rates according to countries, with association to genetic ancestry. Lower body mass index and HbA1c at study inclusion, and less frequent insulin treatment were hallmarks of pathogenic variant carriers. Treatment changes following genetic diagnosis have been made in several patients. CONCLUSIONS Our data from patients in several Mediterranean countries highlight a broad clinical and genetic spectrum of diabetes, showing the relevance of wide genetic testing for personalized care of early-onset diabetes.
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Affiliation(s)
- Martine Vaxillaire
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France.
| | - Amélie Bonnefond
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France; Department of Metabolism, Section of Genomics of Common Disease, Imperial College London, London, United Kingdom.
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, National and Kapodistrian University of Athens Medical School, Diabetes Center, Laiko General Hospital, Athens, Greece
| | - Leila Ben Salem Hachmi
- Department of Endocrinology and Metabolic Diseases, National Institut of Nutrition, Tunis, Tunisia
| | - Aleksandra Jotic
- Department of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mathilde Boissel
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Stefan Gaget
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Emmanuelle Durand
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Emmanuel Vaillant
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Mehdi Derhourhi
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Mickaël Canouil
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Nicolas Larcher
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | - Frédéric Allegaert
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France
| | | | - Asma Chadli
- Department of Endocrinology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Azzedine Belhadj
- Department of Internal Medicine, CHU Dr Ben Badis University Hospital, Constantine, Algeria
| | - Molka Chaieb
- Department of Endocrinology, Farhat Hached Hospital, Sousse, Tunisia
| | | | - Hasan Ilkova
- Department of Endocrinology, School of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Nebojsa Lalic
- Department of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Josanne Vassallo
- Division of Endocrinology and University of Malta Medical School, Mater Dei Hospital; Centre of Molecular Medicine and Biobanking, University of Malta, Malta
| | - Michel Marre
- Department of Diabetology-Endocrinology-Nutrition, Hôpital Bichat, DHU FIRE, Assistance Publique Hôpitaux de Paris, Paris, France; Inserm U1138, Centre de Recherche des Cordeliers, Paris, France; UFR de Médecine, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Philippe Froguel
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur Lille, Univ. Lille, Lille University Hospital, Lille, France; Department of Metabolism, Section of Genomics of Common Disease, Imperial College London, London, United Kingdom
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14
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Gabriel R, Boukichou Abdelkader N, Acosta T, Gilis-Januszewska A, Gómez-Huelgas R, Makrilakis K, Kamenov Z, Paulweber B, Satman I, Djordjevic P, Alkandari A, Mitrakou A, Lalic N, Colagiuri S, Lindström J, Egido J, Natali A, Pastor JC, Teuschl Y, Lind M, Silva L, López-Ridaura R, Tuomilehto J. Early prevention of diabetes microvascular complications in people with hyperglycaemia in Europe. ePREDICE randomized trial. Study protocol, recruitment and selected baseline data. PLoS One 2020; 15:e0231196. [PMID: 32282852 PMCID: PMC7153858 DOI: 10.1371/journal.pone.0231196] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 03/14/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives To assess the effects of early management of hyperglycaemia with antidiabetic drugs plus lifestyle intervention compared with lifestyle alone, on microvascular function in adults with pre-diabetes. Methods Trial design: International, multicenter, randomised, partially double-blind, placebo-controlled, clinical trial. Participants Males and females aged 45–74 years with IFG, IGT or IFG+IGT, recruited from primary care centres in Australia, Austria, Bulgaria, Greece, Kuwait, Poland, Serbia, Spain and Turkey. Intervention Participants were randomized to placebo; metformin 1.700 mg/day; linagliptin 5 mg/day or fixed-dose combination of linagliptin/metformin. All patients were enrolled in a lifestyle intervention program (diet and physical activity). Drug intervention will last 2 years. Primary Outcome: composite end-point of diabetic retinopathy estimated by the Early Treatment Diabetic Retinopathy Study Score, urinary albumin to creatinine ratio, and skin conductance in feet estimated by the sudomotor index. Secondary outcomes in a subsample include insulin sensitivity, beta-cell function, biomarkers of inflammation and fatty liver disease, quality of life, cognitive function, depressive symptoms and endothelial function. Results One thousand three hundred ninety one individuals with hyperglycaemia were assessed for eligibility, 424 excluded after screening, 967 allocated to placebo, metformin, linagliptin or to fixed-dose combination of metformin + linagliptin. A total of 809 people (91.1%) accepted and initiated the assigned treatment. Study sample after randomization was well balanced among the four groups. No statistical differences for the main risk factors analysed were observed between those accepting or rejecting treatment initiation. At baseline prevalence of diabetic retinopathy was 4.2%, severe neuropathy 5.3% and nephropathy 5.7%. Conclusions ePREDICE is the first -randomized clinical trial with the aim to assess effects of different interventions (lifestyle and pharmacological) on microvascular function in people with pre-diabetes. The trial will provide novel data on lifestyle modification combined with glucose lowering drugs for the prevention of early microvascular complications and diabetes. Registration - ClinicalTrials.Gov Identifier: NCT03222765 - EUDRACT Registry Number: 2013-000418-39
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Affiliation(s)
- Rafael Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), Madrid, Spain
| | - Nisa Boukichou Abdelkader
- EVIDEM CONSULTORES, Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), Madrid, Spain
| | - Tania Acosta
- EVIDEM CONSULTORES, Madrid, Spain
- Department of Public Health. Universidad del Norte, Barranquilla, Colombia
| | | | | | | | - Zdravko Kamenov
- University Multi-Profile Hospital for Active Treatment Alexandrovska EAD, Sofia, Bulgaria
| | - Bernhard Paulweber
- Gemeinnuetzige Salzburger Landeskliniken Betriebsgesellschaft, (SALK) Salzburg, Austria
| | | | - Predrag Djordjevic
- General Hospital Medical System Beograd-MSB Belgrade Serbia, Beograd, Serbia
| | | | | | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stephen Colagiuri
- The University of Sydney, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, Australia
| | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Andrea Natali
- Department of Internal Medicine, Universita di Pisa, Pisa, Italy
| | - J Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Hospital Clínico Universitario, Valladolid, Spain
| | - Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Marcus Lind
- Västra Götalands Läns Landsting, Gothenburg, Sweden
| | | | | | - Jaakko Tuomilehto
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), Madrid, Spain
- National Institute for Health and Welfare, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
- King Abdulaziz University, Jeddah, Saudi Arabia
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Janež A, Guja C, Mitrakou A, Lalic N, Tankova T, Czupryniak L, Tabák AG, Prazny M, Martinka E, Smircic-Duvnjak L. Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. Diabetes Ther 2020; 11:387-409. [PMID: 31902063 PMCID: PMC6995794 DOI: 10.1007/s13300-019-00743-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Here, we review insulin management options and strategies in nonpregnant adult patients with type 1 diabetes mellitus (T1DM). Most patients with T1DM should follow a regimen of multiple daily injections of basal/bolus insulin, but those not meeting individual glycemic targets or those with frequent or severe hypoglycemia or pronounced dawn phenomenon should consider continuous subcutaneous insulin infusion. The latter treatment modality could also be an alternative based on patient preferences and availability of reimbursement. Continuous glucose monitoring may improve glycemic control irrespective of treatment regimen. A glycemic target of glycated hemoglobin < 7% (53 mmol/mol) is appropriate for most nonpregnant adults. Basal insulin analogues with a reduced peak profile and an extended duration of action with lower intraindividual variability relative to neutral protamine Hagedorn insulin are preferred. The clinical advantages of basal analogues compared with older basal insulins include reduced injection burden, better efficacy, lower risk of hypoglycemic episodes (especially nocturnal), and reduced weight gain. For prandial glycemic control, any rapid-acting prandial analogue (aspart, glulisine, lispro) is preferred over regular human insulin. Faster-acting insulin aspart is a relatively new option with the advantage of better postprandial glucose coverage. Frequent blood glucose measurements along with patient education on insulin dosing based on carbohydrate counting, premeal blood glucose, and anticipated physical activity is paramount, as is education on the management of blood glucose under different circumstances.Plain Language Summary: Plain language summary is available for this article.
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Affiliation(s)
- Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
| | - Cristian Guja
- Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 020021, Bucharest, Romania
| | - Asimina Mitrakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nebojsa Lalic
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University of Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Adam G Tabák
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, 2/a Korányi S. Str, 1083, Budapest, Hungary
| | - Martin Prazny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Emil Martinka
- Department of Diabetology, National Institute for Endocrinology and Diabetology, Kollarova 2/283, 034 91, Lubochna, Slovakia
| | - Lea Smircic-Duvnjak
- Vuk Vrhovac University Clinic-UH Merkur, School of Medicine, University of Zagreb, Dugi dol 4A, Zagreb, Croatia
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Trebinjac D, Petronic I, Lalic N, Cirovic D, Nikolic D, Stojkovic J. Effects of aerobic training on the risk of coronary artery disease by Duke Treadmill Score in type 2 diabetes mellitus and cardiometabolic health. MED SPORT 2019. [DOI: 10.23736/s0025-7826.19.03484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chaturvedi SK, Manche Gowda S, Ahmed HU, Alosaimi FD, Andreone N, Bobrov A, Bulgari V, Carrà G, Castelnuovo G, de Girolamo G, Gondek T, Jovanovic N, Kamala T, Kiejna A, Lalic N, Lecic-Tosevski D, Minhas F, Mutiso V, Ndetei D, Rabbani G, Somruk S, Srikanta S, Taj R, Valentini U, Vukovic O, Wölwer W, Cimino L, Nouwen A, Lloyd C, Sartorius N. More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. Gen Psychiatr 2019; 32:e100076. [PMID: 31552386 PMCID: PMC6738670 DOI: 10.1136/gpsych-2019-100076] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 01/02/2023] Open
Abstract
Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited. Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries. Methods People aged 18–65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected. Results A total of 3170 people with type 2 diabetes (56.2% women; with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%; however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India. Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.
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Affiliation(s)
- Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Shayanth Manche Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Helal Uddin Ahmed
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | | | - Alexey Bobrov
- National Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - Viola Bulgari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Tomasz Gondek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Thummala Kamala
- Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
| | | | | | | | - Fareed Minhas
- Center for Global Mental Health, Rawalpindi, Pakistan
| | | | | | - Golam Rabbani
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | | | - Sathyanarayana Srikanta
- Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
| | - Rizwan Taj
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Umberto Valentini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany
| | | | - Arie Nouwen
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
| | - Cathy Lloyd
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
| | - Norman Sartorius
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
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De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
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Djokovic R, Cincovic M, Ilic Z, Kurcubic V, Andjelic B, Petrovic M, Lalic N, Jasovic B. Estimation Metabolic Status in High Yielding Dairy Cows During Transition Period and Full Lactation. ACTA SCI VET 2019. [DOI: 10.22456/1679-9216.92100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Major changes in the metabolic functions in high-yielding dairy cows occur during the transitional period and during lactation. Parturition and lactogenesis are accompanied by many physiological changes that facilitate the maintenance of homeostasis Consequently, physiological situations leading to a negative energy balance are coupled to an increased uncontrolled rate of body fat mobilisation and the increased fatty acids accumulation in hepatocytes and blood ketone bodies, resulting in disturbances of the morphological and physiological liver integrity. The objective of the present study was to estimate metabolic status in late pregnant, early lactation and full lactation Holstein dairy cows on the basis changes of blood concentrations of selected biochemical markers.Materials, Methods & Results: The experiment included 36 Holstein cows. Three groups of clinically healthy cows were chosen from the herd. Group 1 consisted of late pregnant cows (n = 12) from 30 to 1 day (20 ± 15) to partus; Group 2 comprised early lactation cows (n = 12) in the first month of lactation (15 ± 12 days), and Group 3 included full lactation cows (n = 12) between 60 to 90 days of lactation (81 ± 30 days). Blood samples were collected from all cows, by punction of the jugular vein. Biochemical testing for markers in the blood serum showed significantly lower values (P < 0.05) of glucose, TG, Tchol. and urea in early cows than in full lactation and late-pregnant cows. The blood concentration of NEFA and BHB was significantly increased (P < 0.05) in the group of cows in early lactation compared to the other groups of cows. The mean tBIL. concentration and the serum AST, GGT and ALT activities were markedly increased (P < 0.01) in the lactation cows compared to the late pregnant cows. Furthermore, the intensity of lipomobilisation (NEFA or BHB concentrations) correlated positively (P < 0.05) with the markers of cell damage or liver function impairment (tBIL., serum AST, ALT and GGT activities), but negatively (P < 0.05) with the circulating concentrations of compounds synthesised in liver (glucose, TG and urea).Discussion: In dairy cows, it was observed that up to 50 % of females exhibited some lipid accumulation in liver in the first 3 weeks after calving and that fatty liver occurs primarily in this period. Liver can be categorized into mild, moderate and severe fatty liver as dependent on the degree of pathology and a mild fatty infiltration of liver in dairy cows during lactation is considered to be almost physiological. The blood BHB and NEFA concentrations are markers of lipomobilisation and positively associated with the ketosis and liver steatosis intensity. The simultaneous and parallel variations observed between the extent of the fat infiltration in liver and the serum BHB and NEFA concentrations in puerperal cows clearly indicated that the intense lipomobilisation in the post-partum period has induced lipid overloading and ketogenesis in the liver. On the other hand, it was observed significant decreases in the serum biochemical markers, at least partially synthesised in the liver, such as glucose, TG, Tchol., urea, albumin and TP during the postpartum period. However, the liver steatosis has induced some cellular lesions as evidenced by significant increases in the serum tBIL. concentrations and in the AST, ALT, GGT and LDH enzyme activities in puerperal cows. All these biochemical metabolites may be used as important biochemical markers in the determination of the metabolic status in high-yielding dairy cows during the transition period and during lactation.
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Schnell O, Standl E, Catrinoiu D, Itzhak B, Lalic N, Rahelic D, Skrha J, Valensi P, Ceriello A. Report from the 4th Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group. Cardiovasc Diabetol 2019; 18:30. [PMID: 30857522 PMCID: PMC6410488 DOI: 10.1186/s12933-019-0822-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
The 4th Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group was held in Munich on 25–26 October 2018. As in previous years, this summit served as a reference meeting for in-depth discussions on the topic of recently completed and presented CVOTs. This year, focus was placed on the CVOTs CARMELINA, DECLARE-TIMI 58 and Harmony Outcomes. Trial implications for diabetes management and the impact of the new ADA/EASD consensus statement treatment algorithm were highlighted for diabetologists, cardiologists, endocrinologists, nephrologists and general practitioners. Discussions evolved from CVOTs to additional therapy options for heart failure (ARNI), knowledge gained for adjunct therapy of type 1 diabetes and, on the occasion of the 10 year anniversary of the FDA’s “Guidance for Industry: “should CVOTs be continued and/or modified?” The 5th Cardiovascular Outcome Trial Summit will be held in Munich on 24–25 October 2019 (http://www.cvot.org).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany.
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany
| | - Doina Catrinoiu
- Internal Medicine Department, Clinical County Emergency Hospital Constanta, Tomis Blvd. No. 145, 900591, Constanța, Romania
| | - Baruch Itzhak
- Clalit Health Services and Technion Faculty of Medicine, 3 Zivoni Street, Haifa, Israel
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 13, Belgrade, 11000, Serbia
| | - Dario Rahelic
- Diabetes and Metabolic Disorders, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia
| | - Jan Skrha
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, U Nemocnice 1, 128 08, Prague 2, Czech Republic
| | - Paul Valensi
- Department of Endocrinology Diabetology Nutrition, CINFO, CRNH-IdF, Jean VERDIER Hospital, Paris 13 University, Avenue du 14 Juillet, 93140, Bondy, France
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.,Department of Cardiovascular and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy
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Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Deckers J, De Smedt D, De Sutter J, Dilic M, Dolzhenko M, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Heuschmann P, Hasan-Ali H, Jankowski P, Lalic N, Lehto S, Lovic D, Mancas S, Mellbin L, Milicic D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Z, Stöerk S, Tokgözoğlu L, Tsioufis C, Vulic D, Wood D. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol 2019; 26:824-835. [DOI: 10.1177/2047487318825350] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aims The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.
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Affiliation(s)
- Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Lars Rydén
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Arno Hoes
- European Society of Cardiology, Sophia Antipolis, France
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Diederick Grobbee
- European Society of Cardiology, Sophia Antipolis, France
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Aldo Maggioni
- European Society of Cardiology, Sophia Antipolis, France
- ANMCO Research Centre, Florence, Italy
| | - Pedro Marques-Vidal
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
| | - Catriona Jennings
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Ana Abreu
- Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Aguiar
- European Society of Cardiology, Sophia Antipolis, France
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jolita Badariene
- Clinic of Cardiac and Vascular diseases, Medical Faculty, Vilnius University, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Jan Bruthans
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Almudena Castro Conde
- Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Renata Cifkova
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Jim Crowley
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Galway University Hospital and Croí, the West of Ireland Cardiac and Stroke Foundation, Croí Heart and Stroke Centre, Galway, Ireland
| | - Kairat Davletov
- School of Public Health, Public Health Research Centre, Kazakh National Medical University, Almaty, Kazakhstan
| | - Jaap Deckers
- European Society of Cardiology, Sophia Antipolis, France
- Erasmus MC, Rotterdam, The Netherlands
| | - Delphine De Smedt
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Johan De Sutter
- European Society of Cardiology, Sophia Antipolis, France
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium
- AZ Maria Middelares Ghent, Belgium
| | - Mirza Dilic
- European Society of Cardiology, Sophia Antipolis, France
- Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Marina Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Vilnis Dzerve
- European Society of Cardiology, Sophia Antipolis, France
- Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia
| | - Andrejs Erglis
- European Society of Cardiology, Sophia Antipolis, France
- Pauls Stradins Clinical University Hospita, University of Latvia, Riga, Latvia
| | - Zlatko Fras
- European Society of Cardiology, Sophia Antipolis, France
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
| | - Dan Gaita
- European Society of Cardiology, Sophia Antipolis, France
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Nina Gotcheva
- National Heart Hospital, Dept Cardiology, Sofia, Bulgaria
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Centre, University Hospital Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
| | - Hosam Hasan-Ali
- Assiut University Heart Hospital, Cardiovascular Medicine Department, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Nebojsa Lalic
- Department for Metabolic Disorder, Intensive Treatment and Cell Therapy in Diabetes, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Seppo Lehto
- European Society of Cardiology, Sophia Antipolis, France
- Varkaus Hospital, Finland
| | - Dragan Lovic
- European Society of Cardiology, Sophia Antipolis, France
- Clinic for Internal Disease Intermedic, Cardiology Department, Hypertension Centre, Nis, Serbia
| | - Silvia Mancas
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Linda Mellbin
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Davor Milicic
- European Society of Cardiology, Sophia Antipolis, France
- University of Zagreb School of Medicine & University Hospital Centre Zagreb, Croatia
| | - Erkin Mirrakhimov
- European Society of Cardiology, Sophia Antipolis, France
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
| | - Rafael Oganov
- National Research Centre for Preventive Medicine, Directorate, Moscow, Russia
| | - Nana Pogosova
- Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Zeljko Reiner
- European Society of Cardiology, Sophia Antipolis, France
- University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Stefan Stöerk
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Lâle Tokgözoğlu
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Costas Tsioufis
- European Society of Cardiology, Sophia Antipolis, France
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dusko Vulic
- Centre for Medical Research, School of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
- National University of Ireland, Galway, Ireland *Listed in Supplemental Appendix
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Haluzik M, Kretowski A, Strojek K, Czupryniak L, Janez A, Kempler P, Andel M, Tankova T, Boyanov M, Smircic Duvnjak L, Madacsy L, Tarnowska I, Zychma M, Lalic N. Perspectives of Patients with Insulin-Treated Type 1 and Type 2 Diabetes on Hypoglycemia: Results of the HAT Observational Study in Central and Eastern European Countries. Diabetes Ther 2018; 9:727-741. [PMID: 29524189 PMCID: PMC6104285 DOI: 10.1007/s13300-018-0388-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the level of awareness of hypoglycemia, the level of fear for hypoglycemia, and the response to hypoglycemic events among insulin-treated diabetes patients from Central and Eastern Europe (CEE). The impact of hypoglycemia on the use of healthcare resources and patient productivity was also assessed. METHODS This was a multicenter, non-interventional, two-part, patient self-reported questionnaire study that comprised both a retrospective cross-sectional evaluation and a prospective observational evaluation. Study participants were insulin-treated adult patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) from CEE. RESULTS Most patients (85.4% T1DM and 83.6% T2DM) reported normal hypoglycemia awareness. The median hypoglycemia fear score was 5 out of 10 for T1DM and 4 out of 10 for T2DM patients. Patients increased glucose monitoring, consulted a doctor/nurse, and/or reduced the insulin dose in response to hypoglycemia. As a consequence of hypoglycemia, patients took leave from work/studies or arrived late and/or left early. Hospitalization was required for 31 (1.2%) patients with T1DM and 66 (2.1%) patients with T2DM. CONCLUSION Hypoglycemia impacts patients' personal and social functioning, reduces productivity, and results in additional costs, both direct (related to increased use of healthcare resources) and indirect (related to absenteeism. FUNDING Novo Nordisk.
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Affiliation(s)
- Martin Haluzik
- Diabetes Centre and Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21, Prague 4, Czech Republic.
| | - Adam Kretowski
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Krzysztof Strojek
- Department of Internal Diseases Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry (SMDZ) in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center, Ljubljana, Slovenia
| | - Peter Kempler
- First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Michal Andel
- Center for Research of Nutrition, Metabolism and Diabetes, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University-Sofia, Sofia, Bulgaria
| | - Mihail Boyanov
- Clinic of Endocrinology and Metabolism, Department of Internal Medicine, University Hospital Alexandrovska, Medical University-Sofia, Sofia, Bulgaria
| | - Lea Smircic Duvnjak
- Vuk Vrhovac University Clinic for Diabetes-UH Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Laszlo Madacsy
- First Department of Pediatrics, Faculty of Medicine, Semmelweis University Budapest, Budapest, Hungary
| | | | | | - Nebojsa Lalic
- Clinic for Endocrinology Diabetes and Metabolic Diseases, Clinical Center of Serbia (CCS), Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Schnell O, Standl E, Catrinoiu D, Genovese S, Lalic N, Lalic K, Skrha J, Valensi P, Ceriello A. Report from the 3rd Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group. Cardiovasc Diabetol 2018; 17:30. [PMID: 29458368 PMCID: PMC5819256 DOI: 10.1186/s12933-018-0667-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 01/14/2023] Open
Abstract
The 3rd Cardiovascular Outcome Trial Summit of the Diabetes & Cardiovascular Disease EASD Study Group was held on the 26-27 October 2017 in Munich. As in 2015 and 2016, this summit was organised in light of recently completed and published CVOTs on diabetes, aiming to serve as a reference meeting for in-depth discussions on the topic. Amongst others, the CVOTs EXSCEL, DEVOTE, the CANVAS program and the ACE-trial, which released primary outcome results in 2017, were discussed. Trial implications for diabetes management and recent perspectives of diabetologists, cardiologists, endocrinologists, nephrologists and general practitioners were highlighted. The clinical relevance of cardiovascular outcome trials and its implications regarding reimbursement were compared with real-world studies. The 4th Cardiovascular Outcome Trial Summit will be held in Munich 25-26 October 2018 ( http://www.dcvd.org ).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V., Munich, Ingolstaedter Landstrasse 1, Neuherberg, 85764, Munich, Germany.
| | - Eberhard Standl
- Forschergruppe Diabetes e.V., Munich, Ingolstaedter Landstrasse 1, Neuherberg, 85764, Munich, Germany
| | - Doina Catrinoiu
- Internal Medicine Department, Clinical County Emergency Hospital Constanta, Tomis Blvd. No. 145, 900591, Constanta, Romania
| | - Stefano Genovese
- Diabetes, Endocrine and Metabolic Disease Unit, IRCCS Centro Cardiologico Monzino, Via Carlo Parea 4, 20138, Milan, Italy
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 13, Belgrade, 11000, Serbia
| | - Katarina Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 13, Belgrade, 11000, Serbia
| | - Jan Skrha
- 3rd Department of Internal Medicine, Charles University, 1st Faculty of Medicine, U Nemocnice 1, Prague 2, 128 08, Czech Republic
| | - Paul Valensi
- Department of Endocrinology Diabetology Nutrition, Paris 13 University, CINFO, CRNH-IdF, Jean VERDIER Hospital, Avenue du 14 Juillet, 93140, Bondy, France
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.,Department of Cardiovascular and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy
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Migdalis I, Czupryniak L, Lalic N, Leslie RD, Papanas N, Valensi P. Diabetic Microvascular Complications. Int J Endocrinol 2018; 2018:5683287. [PMID: 29997650 PMCID: PMC5994569 DOI: 10.1155/2018/5683287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- I. Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
| | - L. Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - N. Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Belgrade, Serbia
| | - R. D. Leslie
- Department of Diabetes, Saint Bartholomew's Hospital, University of London and Blizard Institute, EC1A 7BE London, UK
| | - N. Papanas
- Diabetic Foot Clinic-Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - P. Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, 93140 Bondy, France
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Schnell O, Standl E, Catrinoiu D, Genovese S, Lalic N, Skra J, Valensi P, Rahelic D, Ceriello A. Correction to: Report from the 2nd Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group. Cardiovasc Diabetol 2017; 16:135. [PMID: 29047392 PMCID: PMC5645923 DOI: 10.1186/s12933-017-0616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/02/2022] Open
Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V., Munich, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Eberhard Standl
- Forschergruppe Diabetes e.V., Munich, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Doina Catrinoiu
- Internal Medicine Department, Clinical County Emergency Hospital Constanta, Tomis Blvd, No. 145, 900591, Constanta, Romania
| | - Stefano Genovese
- Diabetes and Metabolic Disease Unit, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 13, Belgrade, 11000, Serbia
| | - Jan Skra
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, U Nemocnice 1, 128 08, Prague 2, Czech Republic
| | - Paul Valensi
- Department of Endocrinology Diabetology Nutrition, CINFO, CRNH-IdF, Jean VERDIER Hospital, Paris 13 University, Avenue du 14 Juillet, 93140, Bondy, France
| | - Dario Rahelic
- Diabetes and Metabolic Disorders, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain.,Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
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Micic S, Lalic N, Bojanic N, Djordjevic D, Virmani A, Agarwal A. DBPC study showed significant correlation of DNA fragmetation index (DFI) and seminal carnitine with progressive sperm motility in oligospermic men treated with metabolic andessential nutrients. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Khunti K, Alsifri S, Aronson R, Cigrovski Berković M, Enters-Weijnen C, Forsén T, Galstyan G, Geelhoed-Duijvestijn P, Goldfracht M, Gydesen H, Kapur R, Lalic N, Ludvik B, Moberg E, Pedersen-Bjergaard U, Ramachandran A. Impact of hypoglycaemia on patient-reported outcomes from a global, 24-country study of 27,585 people with type 1 and insulin-treated type 2 diabetes. Diabetes Res Clin Pract 2017; 130:121-129. [PMID: 28602812 DOI: 10.1016/j.diabres.2017.05.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 09/09/2016] [Accepted: 05/08/2017] [Indexed: 12/23/2022]
Abstract
AIMS Data on the impact of hypoglycaemia on patients' daily lives and diabetes self-management, particularly in developing countries, are lacking. The aim of this study was to assess fear of, and responses to, hypoglycaemia experienced by patients globally. MATERIALS AND METHODS This non-interventional, multicentre, 4-week prospective study using self-assessment questionnaires and patient diaries consisted of 27,585 patients, ≥18years, with type 1 diabetes (n=8022) or type 2 diabetes (n=19,563) treated with insulin for >12months, at 2004 sites in 24 countries worldwide. RESULTS Increased blood glucose monitoring (69.7%) and seeking medical assistance (62.0%) were the most common responses in the 4weeks following hypoglycaemic events for patients with type 1 diabetes and type 2 diabetes, respectively. Approximately 44% of patients with type 1 diabetes or type 2 diabetes increased calorie intake in response to a hypoglycaemic episode. Following hypoglycaemia, 3.9% (type 1 diabetes) and 6.2% (type 2 diabetes) of patients took leave from work or study. Regional differences in fear of, and responses to, hypoglycaemia were evident - in particular, a lower level of hypoglycaemic fear and utilisation of healthcare resources in Northern Europe and Canada. CONCLUSIONS Hypoglycaemia has a major impact on patients and their behaviour. These global data for the first time reveal regional variations in response to hypoglycaemia and highlight the importance of patient education and management strategies.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
| | - Saud Alsifri
- Al Hada Military Hospital, Taif 21944, Saudi Arabia.
| | - Ronnie Aronson
- LMC Diabetes & Endocrinology, 1929 Bayview Ave, Suite 107, Toronto, ON M4G 3E8, Canada.
| | | | | | - Tom Forsén
- Department of General Practice and Primary Health Care, University of Helsinki, Yliopistonkatu 4, Helsinki 00100, Finland.
| | - Gagik Galstyan
- Endocrinology Research Center, 1 Dmitriya Ulyanova str., Moscow 117036, Russian Federation; I.M.Sechenov First Moscow State Medical University, Moscow, Russia.
| | | | - Margalit Goldfracht
- Clalit Health Services, Tel Aviv, and The Technion, 101 Arlozorov, Haifa, Israel.
| | - Helge Gydesen
- Novo Nordisk A/S, Vandtårnsvej 112, Søborg DK-2860, Denmark.
| | - Rahul Kapur
- Novo Nordisk A/S, Vandtårnsvej 112, Søborg DK-2860, Denmark.
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 8, Belgrade 11 000, Serbia.
| | - Bernhard Ludvik
- Rudolfstiftung Hospital and Medical University of Vienna, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030 Vienna, Austria.
| | - Erik Moberg
- Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden.
| | | | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, 110, Anna Salai, Guindy, Chennai 600032, India.
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Schnell O, Standl E, Catrinoiu D, Genovese S, Lalic N, Skra J, Valensi P, Rahelic D, Ceriello A. Report from the 2nd Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group. Cardiovasc Diabetol 2017; 16:35. [PMID: 28284218 PMCID: PMC5346258 DOI: 10.1186/s12933-017-0508-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/03/2017] [Indexed: 01/24/2023] Open
Abstract
The 2nd Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group was held on the 20th–21st October 2016 in Munich. This second Summit was organized in light of recently published CVOTs on diabetes, with the aim of serving as a reference meeting for discussion on this topic. Along with presentations on the results of the most recently published CVOTs, panel discussions on trial implications for reimbursement and the perspective of cardiologists and/or nephrologists, as well as on CVOTs weaknesses and potentials constituted the heart of the program. Future activities of the D&CVD EASD Study Group in 2017 include an annual meeting in Milano and the 3rd CVOT Summit on Diabetes of the D&CVD EASD Study Group, in Munich (http://www.dcvd.org).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V., Munich, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Eberhard Standl
- Forschergruppe Diabetes e.V., Munich, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Doina Catrinoiu
- Internal Medicine Department, Clinical County Emergency Hospital Constanta, Tomis Blvd, No. 145, 900591 Constanta, Romania
| | - Stefano Genovese
- Diabetes and Metabolic Disease Unit, IRCCS MultiMedica, Via Milanese 300, 20099 Sesto San Giovanni, MI Italy
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 13, Belgrade, 11000 Serbia
| | - Jan Skra
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, U Nemocnice 1, 128 08 Prague 2, Czech Republic
| | - Paul Valensi
- Department of Endocrinology Diabetology Nutrition, CINFO, CRNH-IdF, Jean VERDIER Hospital, Paris 13 University, Avenue du 14 Juillet, 93140 Bondy, France
| | - Dario Rahelic
- Diabetes and Metabolic Disorders, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Antonio Ceriello
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain.,Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
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Gottsäter M, Balkau B, Hatunic M, Gabriel R, Anderwald CH, Dekker J, Lalic N, Nilsson PM. Insulin resistance and β-cell function in smokers: results from the EGIR-RISC European multicentre study. Diabet Med 2017; 34:223-228. [PMID: 27334352 DOI: 10.1111/dme.13172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Accepted: 06/21/2016] [Indexed: 01/08/2023]
Abstract
AIMS Tobacco smoking is known to increase the long-term risk of developing Type 2 diabetes mellitus, but the mechanisms involved are poorly understood. This observational, cross-sectional study aims to compare measures of insulin sensitivity and β-cell function in current, ex- and never-smokers. METHODS The study population included 1246 people without diabetes (mean age 44 years, 55% women) from the EGIR-RISC population, a large European multicentre cohort. Insulin sensitivity was measured using a hyperinsulinaemic, euglycaemic clamp and the homeostatic model assessment - insulin resistance (HOMA-IR) index. Two β-cell function parameters were derived from measures during an oral glucose tolerance test: the early insulin response index and β-cell glucose sensitivity. Additionally, the areas under the curve during the oral glucose tolerance test were calculated for glucose, insulin and C-peptide. RESULTS According to smoking habits, there were differences in insulin sensitivity, which was lower in women who smoked, and in β-cell glucose sensitivity, which was lower in men who smoked, but these associations lost significance after adjustment. However, after adjustment, the areas under the glucose and the C-peptide curves during the oral glucose tolerance test were significantly higher in men who smoked. CONCLUSIONS Smoking habits were not independently associated with insulin sensitivity or β-cell function in a healthy middle-aged European population. Health-selection bias, methodological shortcomings or a true lack of causal links between smoking and impaired insulin sensitivity/secretion are possible explanations. The mechanisms behind the observed increased glucose and C-peptide areas under the curve during the oral glucose tolerance test in male smokers need to be further evaluated.
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Affiliation(s)
- M Gottsäter
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - B Balkau
- INSERM U-1018, CESP, Team5 (EpReC, Renal and Cardiovascular Epidemiology), Villejuif, France
| | - M Hatunic
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - R Gabriel
- Instituto de Investigación Princesa IP, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - C-H Anderwald
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Metabolic Unit, Institute of Biomedical Engineering, Padua, Italy
- Mariahilf Community Pharmacy, Arnoldstein, Austria
| | - J Dekker
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands
| | - N Lalic
- University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | - P M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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30
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Affiliation(s)
- I. Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
| | - L. Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - N. Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - R. D. Leslie
- Department of Diabetes, Saint Bartholomew's Hospital, University of London and Blizard Institute, EC1A 7BE, London, UK
| | - N. Papanas
- Diabetic Foot Clinic-Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - P. Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, 93140 Bondy, France
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Ninkovic VM, Ninkovic SM, Miloradovic V, Stanojevic D, Babic M, Giga V, Dobric M, Trenell MI, Lalic N, Seferovic PM, Jakovljevic DG. Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes. Acta Diabetol 2016; 53:737-44. [PMID: 27107571 PMCID: PMC5014905 DOI: 10.1007/s00592-016-0864-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/30/2016] [Indexed: 01/08/2023]
Abstract
AIMS Prolonged QT interval is associated with cardiac arrhythmias and sudden death. The present study determined the prevalence of prolonged QT interval and QT dispersion and defined their clinical and metabolic predictors in patients with type 2 diabetes. METHODS Cross-sectional study included 501 patients with type 2 diabetes. A standard 12-lead electrocardiogram was recorded. QT corrected for heart rate (QTc) >440 ms and QT dispersion (QTd) >80 ms were considered abnormally prolonged. QTc ≥ 500 ms was considered a high-risk QTc prolongation. Demographic, clinical and laboratory data were collected. Independent risk factors for prolonged QTc and QTd were assessed using logistic regression analysis. RESULTS Prevalence of QTc > 440 ms and QTd > 80 ms were 44.1 and 3.6 %, respectively. Prevalence of high-risk QTc (≥500 ms) was 2 % only. Independent risk factors for QTc prolongation >440 ms were mean blood glucose (β = 2.192, p < 0.001), treatment with sulphonylurea (β = 5.198, p = 0.027), female gender (β = 8.844, p < 0.001), and coronary heart disease (β = 8.636, p = 0.001). Independent risk factors for QTc ≥ 500 ms were coronary heart disease (β = 4.134, p < 0.001) and mean blood glucose level (β = 1.735, p < 0.001). The independent risk factor for prolonged QTd was only coronary heart disease (β = 5.354, p < 0.001). CONCLUSIONS Although the prevalence of prolonged QTc > 440 ms is significant, the prevalence of high-risk QTc (≥500 ms) and QTd > 80 ms is very low in patients with type 2 diabetes. Hyperglycaemia and coronary heart disease are strong predictors of high-risk QTc.
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Affiliation(s)
- Vladan M Ninkovic
- Department of Cardiology, Specialist Hospital Merkur, Bulevar Srpskih Ratnika 18, 36210, Vrnjacka Banja, Serbia.
| | - Srdjan M Ninkovic
- Clinical Centre, Kragujevac, Serbia
- Medical School, University of Kragujevac, Kragujevac, Serbia
| | - Vanja Miloradovic
- Clinical Centre, Kragujevac, Serbia
- Medical School, University of Kragujevac, Kragujevac, Serbia
| | - Dejan Stanojevic
- Department of Cardiology, Specialist Hospital Merkur, Bulevar Srpskih Ratnika 18, 36210, Vrnjacka Banja, Serbia
| | - Marijana Babic
- Department of Cardiology, Specialist Hospital Merkur, Bulevar Srpskih Ratnika 18, 36210, Vrnjacka Banja, Serbia
| | - Vojislav Giga
- Cardiology Department, Clinical Centre of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milan Dobric
- Cardiology Department, Clinical Centre of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Michael I Trenell
- Institute of Cellular Medicine, Faculty of Medical Sciences, Medical School, Newcastle University, Framlington Place, William Leech B., NE2 4HH, Newcastle upon Tyne, UK
- Research Councils UK Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Nebojsa Lalic
- Cardiology Department, Clinical Centre of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, Faculty of Medical Sciences, Medical School, Newcastle University, Framlington Place, William Leech B., NE2 4HH, Newcastle upon Tyne, UK.
- Research Councils UK Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
- Clinical Research Facility, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Kotseva K, De Bacquer D, De Backer G, Rydén L, Jennings C, Gyberg V, Abreu A, Aguiar C, Conde AC, Davletov K, Dilic M, Dolzhenko M, Gaita D, Georgiev B, Gotcheva N, Lalic N, Laucevicius A, Lovic D, Mancas S, Miličić D, Oganov R, Pajak A, Pogosova N, Reiner Ž, Vulic D, Wood D, On Behalf Of The Euroaspire Investigators. Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV cross-sectional survey in 14 European regions. Eur J Prev Cardiol 2016; 23:2007-2018. [PMID: 27638542 DOI: 10.1177/2047487316667784] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV in primary care was a cross-sectional survey carried out by the European Society of Cardiology, EURObservational Research Programme in 2014-2015 in 71 centres from 14 European countries. The main objective was to determine whether the 2012 Joint European Societies' guidelines on cardiovascular disease (CVD) prevention in people at high CVD risk have been followed in clinical practice. Methods Patients without a history of atherosclerotic disease started on either blood pressure and/or lipid and/or glucose-lowering treatments were identified and interviewed at least six months after the start of medication. Results Medical notes of 6700 patients were reviewed, and 4579 patients (58.7% women; mean age 58.8 (standard deviation (SD) 11.3) years) interviewed (interview rate 68.3%). Overall, 16.6% were smokers, 39.9% were overweight (body mass index (BMI)≥25 and <30 kg/m2), 43.5% obese (BMI ≥30 kg/m2) and 63.9% centrally obese (waist circumference of ≥88 cm for women, ≥102 cm for men). The medical risk factor control was very poor, with less than half (42.8%) of the patients on blood pressure lowering medication reaching the target of <140/90 mm Hg (<140/80 mm Hg in people with self-reported diabetes). Among treated dyslipidaemic patients only 32.7% attained the low-density lipoprotein (LDL)-cholesterol target of <2.5 mmol/l. Among people treated for type 2 diabetes mellitus, 58.5% achieved the glycated haemoglobin (HbA1c) target of <7.0%. Conclusion The EUROASPIRE IV survey shows that large proportions of patients at high CVD risk have unhealthy lifestyle habits and uncontrolled blood pressure, lipids and diabetes. The present data make it clear that more efforts must be taken to improve cardiovascular prevention in people at high CVD risk.
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Affiliation(s)
- Kornelia Kotseva
- 1 European Society of Cardiology, Sophia Antipolis, France.,2 International Centre for Circulatory Health, Imperial College London, UK
| | - Dirk De Bacquer
- 1 European Society of Cardiology, Sophia Antipolis, France.,3 Department of Public Health, University of Ghent, Ghent, Belgium
| | - Guy De Backer
- 1 European Society of Cardiology, Sophia Antipolis, France.,3 Department of Public Health, University of Ghent, Ghent, Belgium
| | - Lars Rydén
- 1 European Society of Cardiology, Sophia Antipolis, France.,4 Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Catriona Jennings
- 1 European Society of Cardiology, Sophia Antipolis, France.,2 International Centre for Circulatory Health, Imperial College London, UK
| | - Viveca Gyberg
- 4 Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Ana Abreu
- 5 Cardiology Department, Hospital Santa Marta, Portugal
| | - Carlos Aguiar
- 6 Cardiology Department, Hospital Santa Cruz, Portugal
| | - Almudena C Conde
- 7 Cardiac Rehabilitation Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Kairat Davletov
- 8 Republican Institute of Cardiology and Internal Diseases, Kazakhstan
| | - Mirza Dilic
- 1 European Society of Cardiology, Sophia Antipolis, France.,9 Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - Maryna Dolzhenko
- 10 Department of Cardiology, Shupyk National Medical Academy of Postgraduate Education, Ukraine
| | - Dan Gaita
- 1 European Society of Cardiology, Sophia Antipolis, France.,11 Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie 'Victor Babes', Romania
| | | | - Nina Gotcheva
- 12 Department of Cardiology, National Heart Hospital, Bulgaria
| | - Nebojsa Lalic
- 13 Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade, Serbia
| | - Aleksandras Laucevicius
- 1 European Society of Cardiology, Sophia Antipolis, France.,14 Clinic of Cardiovascular Diseases, Vilnius University, Lithuania
| | - Dragan Lovic
- 1 European Society of Cardiology, Sophia Antipolis, France.,15 Clinic for Internal Medicine Intermedica, Serbia
| | - Silvia Mancas
- 11 Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie 'Victor Babes', Romania
| | - Davor Miličić
- 1 European Society of Cardiology, Sophia Antipolis, France.,16 University Hospital Centre, University of Zagreb, Croatia
| | - Raphael Oganov
- 17 National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Russia
| | - Andrzej Pajak
- 18 Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Poland
| | - Nana Pogosova
- 1 European Society of Cardiology, Sophia Antipolis, France.,17 National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Russia
| | - Željko Reiner
- 1 European Society of Cardiology, Sophia Antipolis, France.,16 University Hospital Centre, University of Zagreb, Croatia
| | - Dusko Vulic
- 19 Centre for Medical Research, University of Banja Luka, Bosnia and Herzegovina
| | - David Wood
- 1 European Society of Cardiology, Sophia Antipolis, France.,2 International Centre for Circulatory Health, Imperial College London, UK
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Khunti K, Alsifri S, Aronson R, Cigrovski Berković M, Enters‐Weijnen C, Forsén T, Galstyan G, Geelhoed‐Duijvestijn P, Goldfracht M, Gydesen H, Kapur R, Lalic N, Ludvik B, Moberg E, Pedersen‐Bjergaard U, Ramachandran A. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes Obes Metab 2016; 18:907-15. [PMID: 27161418 PMCID: PMC5031206 DOI: 10.1111/dom.12689] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [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: 12/01/2015] [Revised: 04/22/2016] [Accepted: 05/04/2016] [Indexed: 12/16/2022]
Abstract
AIMS To determine the global extent of hypoglycaemia experienced by patients with diabetes using insulin, as there is a lack of data on the prevalence of hypoglycaemia in developed and developing countries. METHODS This non-interventional, multicentre, 6-month retrospective and 4-week prospective study using self-assessment questionnaire and patient diaries included 27 585 patients, aged ≥18 years, with type 1 diabetes (T1D; n = 8022) or type 2 diabetes (T2D; n = 19 563) treated with insulin for >12 months, at 2004 sites in 24 countries worldwide. The primary endpoint was the proportion of patients experiencing at least one hypoglycaemic event during the observational period. RESULTS During the prospective period, 83.0% of patients with T1D and 46.5% of patients with T2D reported hypoglycaemia. Rates of any, nocturnal and severe hypoglycaemia were 73.3 [95% confidence interval (CI) 72.6-74.0], 11.3 (95% CI 11.0-11.6) and 4.9 (95% CI 4.7-5.1) events/patient-year for T1D and 19.3 (95% CI 19.1-19.6), 3.7 (95% CI 3.6-3.8) and 2.5 events/patient-year (95% CI 2.4-2.5) for T2D, respectively. The highest rates of any hypoglycaemia were observed in Latin America for T1D and Russia for T2D. Glycated haemoglobin level was not a significant predictor of hypoglycaemia. CONCLUSIONS We report hypoglycaemia rates in a global population, including those in countries without previous data. Overall hypoglycaemia rates were high, with large variations between geographical regions. Further investigation into these differences may help to optimize therapy and reduce the risk of hypoglycaemia.
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Affiliation(s)
- K. Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - S. Alsifri
- Al Hada Military HospitalTaifSaudi Arabia
| | - R. Aronson
- LMC Diabetes and EndocrinologyTorontoCanada
| | | | | | - T. Forsén
- Department of General Practice and Primary Health CareUniversity of HelsinkiHelsinkiFinland
| | - G. Galstyan
- Endocrinology Research CenterMoscowRussian Federation
| | | | - M. Goldfracht
- Clalit Health ServicesTel AvivIsrael
- The TechnionHaifaIsrael
| | | | | | - N. Lalic
- Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of SerbiaUniversity of BelgradeBelgradeSerbia
| | - B. Ludvik
- Rudolfstiftung Hospital and Medical University of ViennaViennaAustria
| | - E. Moberg
- Karolinska InstitutetStockholmSweden
| | | | - A. Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes HospitalsChennaiIndia
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Seferovic PM, Pelliccia F, Zivkovic I, Ristic A, Lalic N, Seferovic J, Simeunovic D, Milinkovic I, Rosano G. Mineralocorticoid receptor antagonists, a class beyond spironolactone--Focus on the special pharmacologic properties of eplerenone. Int J Cardiol 2016; 200:3-7. [PMID: 26404746 DOI: 10.1016/j.ijcard.2015.02.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/21/2015] [Indexed: 11/24/2022]
Abstract
The renin-angiotensin-aldosterone system can be blocked at specific levels by using different classes of pharmacologic agents, including angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers and mineralocorticoid receptor antagonists. Broad use of the latter, such as spironolactone, has been limited by significant incidence of gynecomastia and other sex-related adverse effects. These problems can be overcome with use of eplerenone, a selective mineralocorticoid receptor antagonist. Eplerenone has been specifically developed to bind selectively to the mineralocorticoid receptors in order to minimize binding to the progesterone and androgen receptors. In the last decade, multiple scientific evidences have been accumulated showing the efficacy and safety of the drug in multiple clinical conditions, including heart failure and arterial hypertension. Eplerenone is generally well tolerated, with the most frequent adverse event being hyperkalemia, with sexual adverse events (i.e. gynecomastia) being more uncommon, due to the selectivity of eplerenone. This review focuses on the pharmacodynamic and pharmacokinetic properties of eplerenone, thus providing the scientific basis to fully understand drug-to-drug interactions, in particular, and its efficacy and tolerability, in general. Noteworthy, the activity of eplerenone in special conditions and different patient populations is summarized.
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Affiliation(s)
- Petar M Seferovic
- Department of Cardiology, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia.
| | | | - Ivana Zivkovic
- Department of Cardiology, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia
| | - Arsen Ristic
- Department of Cardiology, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia
| | - Nebojsa Lalic
- Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia
| | - Jelena Seferovic
- Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia
| | - Dejan Simeunovic
- Department of Cardiology, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia
| | - Ivan Milinkovic
- Department of Cardiology, University Medical Center and Belgrade School of Medicine, Belgrade, Serbia
| | - Giuseppe Rosano
- IRCCS San Raffaele Pisana, Rome, Italy; Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
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Schnell O, Standl E, Catrinoiu D, Genovese S, Lalic N, Skra J, Valensi P, Ceriello A. Report from the 1st Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group. Cardiovasc Diabetol 2016; 15:33. [PMID: 26892706 PMCID: PMC4758171 DOI: 10.1186/s12933-016-0357-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
The 1st Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group was held during the annual meeting on 30 October 2015 in Munich. This summit was organized in light of recently published and numerous ongoing CVOTs on diabetes, which have emerged in response to the FDA and the EMA Guidelines. The CVOT Summit stands as a novel conference setup, with the aim of serving as a reference meeting for all topics related to CVOTs in diabetes. Members of the steering committee of the D&CVD EASD Study Group constitute the backbone of the summit. It included presentations of key results on DPP-4 inhibitors, GLP-1-Analogues, SGLT-2 inhibitors, acarbose and insulins. Diabetologists’ and cardiologists’ perspective on the potential need of new study designs were also highlighted. Furthermore, panel discussions on the design of CVOTs on diabetes were included in the program. The D&CVD EASD Study Group will continue its activity. In-depth discussions and presentations of new CVOTs like LEADER, will be resumed at the 2nd CVOT on diabetes of the D&CVD EASD Study Group, which will be held from 20–22 October 2016 in Munich (http://www.dcvd.org).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V, Helmholtz Center Munich, Ingolstaedter Landstrasse 1, Neuherberg, 85764, Munich, Germany.
| | - Eberhard Standl
- Forschergruppe Diabetes e.V, Helmholtz Center Munich, Ingolstaedter Landstrasse 1, Neuherberg, 85764, Munich, Germany.
| | - Doina Catrinoiu
- Internal Medicine Department, Clinical County Emergency Hospital Constanta, Tomis Blvd. No. 145, 900591, Constanta, Romania.
| | - Stefano Genovese
- Diabetes and Metabolic Disease Unit, IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy.
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 13, Belgrade, 11000, Serbia.
| | - Jan Skra
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, U Nemocnice 1, 128 08, Prague 2, Czech Republic.
| | - Paul Valensi
- Department of Endocrinology Diabetology Nutrition, Hôpital Jean VERDIER, Paris 13 University, CINFO, CRNH-IdF, Avenue du 14 Juillet, 93140, Bondy, France.
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi I Sunyer-IDIBAPS, Mallorca, 183, 08036, Barcelona, Spain.
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Micic D, Lalic N, Djukic V. Insulin resistance and surgical stress. Med podmladak 2016. [DOI: 10.5937/mp67-12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Czupryniak L, Barkai L, Bolgarska S, Bronisz A, Broz J, Cypryk K, Honka M, Janez A, Krnic M, Lalic N, Martinka E, Rahelic D, Roman G, Tankova T, Várkonyi T, Wolnik B, Zherdova N. Self-monitoring of blood glucose in diabetes: from evidence to clinical reality in Central and Eastern Europe--recommendations from the international Central-Eastern European expert group. Diabetes Technol Ther 2014; 16:460-75. [PMID: 24716890 PMCID: PMC4074758 DOI: 10.1089/dia.2013.0302] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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] [Indexed: 12/12/2022]
Abstract
Self-monitoring of blood glucose (SMBG) is universally considered to be an integral part of type 1 diabetes management and crucial for optimizing the safety and efficacy of complex insulin regimens. This extends to type 2 diabetes patients on intensive insulin therapy, and there is also a growing body of evidence suggesting that structured SMBG is beneficial for all type 2 diabetes patients, regardless of therapy. However, access to SMBG can be limited in many countries in Central and Eastern Europe. A consensus group of diabetes experts from 10 countries in this region (with overlapping historical, political, and social environments)--Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine--was formed to discuss the role of SMBG across the spectrum of patients with diabetes. The group considered SMBG to be an essential tool that should be accessible to all patients with diabetes, including those with non-insulin-treated type 2 diabetes. The current article summarizes the evidence put forward by the consensus group and provides their recommendations for the appropriate use of SMBG as part of individualized patient management. The ultimate goal of these evidence-based recommendations is to help patients and providers in Central and Eastern Europe to make optimal use of SMBG in order to maximize the efficacy and safety of glucose-lowering therapies, to prevent complications, and to empower the patient to play a more active role in the management of their diabetes.
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Affiliation(s)
- Leszek Czupryniak
- Internal Medicine and Diabetology Department, Medical University of Lodz, Lodz, Poland
| | - László Barkai
- Postgraduate Institute of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
- Department of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | - Svetlana Bolgarska
- Department of Diabetology, National Medical Academy of Post-Graduate Education, Institute of Endocrinology and Metabolism of National Academy of Medical Science, Kiev, Ukraine
| | - Agata Bronisz
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Toruń, Poland
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jan Broz
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty Hospital Motol, Prague, Czech Republic
| | - Katarzyna Cypryk
- Department of Diabetology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Marek Honka
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty Hospital Motol, Prague, Czech Republic
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center, Ljubljana, Slovenia
| | | | - Nebojsa Lalic
- Department for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emil Martinka
- National Institute for Endocrinology and Diabetology, Lubochna, Slovakia
| | - Dario Rahelic
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dubrava University Hospital, Zagreb, Croatia
| | - Gabriela Roman
- Iuliu Hatieganu University of Medicine & Pharmacy, Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania
| | | | - Tamás Várkonyi
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Nadia Zherdova
- Department of Diabetology, National Medical Academy of Post-Graduate Education, Institute of Endocrinology and Metabolism of National Academy of Medical Science, Kiev, Ukraine
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Golay A, Brock E, Gabriel R, Konrad T, Lalic N, Laville M, Mingrone G, Petrie J, Phan TM, Pietiläinen KH, Anderwald CH. Taking small steps towards targets - perspectives for clinical practice in diabetes, cardiometabolic disorders and beyond. Int J Clin Pract 2013; 67:322-32. [PMID: 23521324 DOI: 10.1111/ijcp.12114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 06/25/2012] [Accepted: 12/18/2012] [Indexed: 01/26/2023] Open
Abstract
Big changes are hard. When trying to achieve guideline targets in diabetes and cardiometabolic disorders, patients can lack commitment or suffer despondency. It is much easier to make small changes in lifestyle or treatment, which are less noticeable and easier to manage long-term. Obesity is central to the cardiometabolic disorders, and even small weight losses of 2-5% can improve the cardiometabolic risk profile and substantially reduce the risk of developing type 2 diabetes. Likewise, small increases in physical activity, such as 15-30 min of brisk walking per day, can cut the risk of heart disease by 10%. Lifestyle or treatment changes that lead to small improvements in metabolic parameters also impact patient outcome - for example, a 5 mmHg decrease in blood pressure can translate into significant reductions in the rates of myocardial infarction and cardiovascular mortality. Benefits of small changes can also be seen in health economic outcome models. Implementing change at an individual versus a population level has different implications for overall benefit and patient motivation. Even very small steps taken in trying to reach guideline targets should represent a positive achievement for patients. Patient engagement is essential - only when patients commit themselves to change can benefits be maintained, and physicians should recognise their influence. Small changes in individual parameters can result in significant beneficial effects; however, a major impact can occur when small changes are made together in multiple parameters. More research is required to elucidate the full impact of small changes on patient outcome.
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Affiliation(s)
- A Golay
- Division of Therapeutical Teaching for Chronic Diseases, University Hospital Geneva, Geneva, Switzerland.
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Lalic N, Tankova T, Nourredine M, Parkin C, Schweppe U, Amann-Zalan I. Value and utility of structured self-monitoring of blood glucose in real world clinical practice: findings from a multinational observational study. Diabetes Technol Ther 2012; 14:338-43. [PMID: 22339238 DOI: 10.1089/dia.2011.0186] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Structured Testing Program (STeP) study, a cluster-randomized, controlled trial, showed that a structured self-monitoring of blood glucose (SMBG)-based intervention improves clinical outcomes. It is important to determine whether this intervention can be adapted for use in general medical practice. This study examined the feasibility and effects of a modified version of the STeP intervention on clinical and attitudinal outcomes in real world clinical settings. METHODS In this 3-month, observational, multinational study, 375 type 1 and type 2 diabetes patients in 11 countries were asked to generate a blood glucose (bG) profile once per month for 3 consecutive months, using a paper-based bG analysis tool (Accu-Chek® 360° View® bG analysis system, Roche Diagnostics, Mannheim, Germany). Measurements were to be performed before and 2 h after main meals and before bedtime on 3 consecutive days. End points included change from baseline in glycated hemoglobin (HbA1c) and other parameters of diabetes complications. Patient and physician attitudes toward use of the structured testing form were also assessed. RESULTS Reductions in mean (SD) HbA1c from baseline were significant, from 9.2% (1.6%) to 8.0% (1.4%) (Δ -1.2% [1.6%], P<0.001). Reductions in mean (SD) average bG from baseline were significant, from 189.5 mg/dL (55.5 mg/dL) to 153 mg/dL (39.6 mg/dL) (Δ-36.4 mg/dL [52.5 mg/dL], P<0.001). Significant (P<0.001) improvements in body mass index, lipids, and blood pressure were also observed. Patients and physicians were generally positive about the utility of the structured testing form. CONCLUSIONS Use of the structured SMBG intervention is practical in real world clinical settings and is associated with improved diabetes management.
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Affiliation(s)
- Nebojsa Lalic
- Clinic of Endocrinology, Diabetes, and Metabolic Diseases, Belgrade, Serbia
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Mari A, Tura A, Natali A, Anderwald C, Balkau B, Lalic N, Walker M, Ferrannini E. Influence of hyperinsulinemia and insulin resistance on in vivo β-cell function: their role in human β-cell dysfunction. Diabetes 2011; 60:3141-7. [PMID: 22028180 PMCID: PMC3219936 DOI: 10.2337/db11-0827] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Recent work has shown that insulin stimulates its own secretion in insulin-sensitive humans, suggesting that insulin resistance in the β-cell could cause β-cell dysfunction. We have tested whether insulin exposure and insulin sensitivity modulate β-cell function in subjects with normal glucose tolerance (NGT) and whether they contribute to dysglycemia in impaired glucose regulation (IGR). RESEARCH DESIGN AND METHODS Insulin sensitivity (by euglycemic clamp), insulin-induced secretory response at isoglycemia (IISR) (as C-peptide percent change from basal during the clamp), glucose-induced secretory response (GISR) to an intravenous glucose bolus, and β-cell glucose sensitivity (β-GS) (by oral glucose tolerance test [OGTT] modeling) were measured in 1,151 NGT and 163 IGR subjects from the RISC (Relationship between Insulin Sensitivity and Cardiovascular Disease) study. RESULTS In NGT, IISR was related to both insulin sensitivity and antecedent insulin exposure; GISR was related to insulin exposure. IISR was positively, if weakly, related to β-GS (r= 0.16, P < 0.0001). Both IISR (-23 [39] vs. -9 [2]%, median [interquartile range], P < 0.03) and β-GS (69 [47] vs. 118 [83] pmol ⋅ min(-1) ⋅ m(-2) ⋅ mmol(-1) ⋅ L, P < 0.0001) were decreased in IGR compared with NGT. Insulin sensitivity and β-GS were the major determinants of mean OGTT glucose in both NGT and IGR, with a minor role for IISR. In a multivariate logistic model, IGR was predicted by β-GS (odds ratio 4.84 [95% CI 2.89-8.09]) and insulin sensitivity (3.06 [2.19-4.27]) but not by IISR (1.11 [0.77-1.61]). CONCLUSIONS Pre-exposure to physiological hyperinsulinemia stimulates insulin secretion to a degree that depends on insulin sensitivity. However, this phenomenon has limited impact on β-cell dysfunction and dysglycemia.
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Affiliation(s)
- Andrea Mari
- National Research Council Institute of Biomedical Engineering, Padova, Italy.
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Pejcic T, Glisic B, Dragicevic D, Lalic N, Hadzi-Djokic J. UP-02.010 Urinary PSA: Marker of Benign Prostatic Hyperplasia? Urology 2011. [DOI: 10.1016/j.urology.2011.07.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pajunen P, Landgraf R, Muylle F, Neumann A, Lindström J, Schwarz PE, Peltonen M, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE. Horm Metab Res 2010; 42 Suppl 1:S56-63. [PMID: 20391308 DOI: 10.1055/s-0029-1240976] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 10/19/2022]
Abstract
BACKGROUND The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. METHODS Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. RESULTS The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. CONCLUSIONS We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.
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Affiliation(s)
- P Pajunen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
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Lindström J, Neumann A, Sheppard KE, Gilis-Januszewska A, Greaves CJ, Handke U, Pajunen P, Puhl S, Pölönen A, Rissanen A, Roden M, Stemper T, Telle-Hjellset V, Tuomilehto J, Velickiene D, Schwarz PE, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. Take action to prevent diabetes--the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res 2010; 42 Suppl 1:S37-55. [PMID: 20391307 DOI: 10.1055/s-0029-1240975] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [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: 10/19/2022]
Abstract
When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.
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Affiliation(s)
- J Lindström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare (THL), Helsinki, Finland
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Paulweber B, Valensi P, Lindström J, Lalic NM, Greaves CJ, McKee M, Kissimova-Skarbek K, Liatis S, Cosson E, Szendroedi J, Sheppard KE, Charlesworth K, Felton AM, Hall M, Rissanen A, Tuomilehto J, Schwarz PE, Roden M, Paulweber M, Stadlmayr A, Kedenko L, Katsilambros N, Makrilakis K, Kamenov Z, Evans P, Gilis-Januszewska A, Lalic K, Jotic A, Djordevic P, Dimitrijevic-Sreckovic V, Hühmer U, Kulzer B, Puhl S, Lee-Barkey YH, AlKerwi A, Abraham C, Hardeman W, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res 2010; 42 Suppl 1:S3-36. [PMID: 20391306 DOI: 10.1055/s-0029-1240928] [Citation(s) in RCA: 309] [Impact Index Per Article: 22.1] [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: 10/19/2022]
Abstract
BACKGROUND The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide. AIMS This guideline provides evidence-based recommendations for preventing T2DM. METHODS A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria. RESULTS Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (number-needed-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by >or= 5 % lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective. CONCLUSIONS Prevention using lifestyle modifications in high-risk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.
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Affiliation(s)
- B Paulweber
- Paracelsus Medical University, Salzburg, Austria
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Nedeljkovic MA, Ostojic M, Lalic N, Beleslin B, Nedeljkovic I, Lalic K, Ristic M, Giga V, Angelkov L, Tomasevic M, Kanjuh V. Stenting and surgery for coronary vasospasm : the wrong solution fails to solve the problem. Herz 2010; 34:564-6. [PMID: 20091257 DOI: 10.1007/s00059-009-3228-3] [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: 02/02/2009] [Accepted: 05/14/2009] [Indexed: 11/25/2022]
Abstract
A 55-year-old man, with a history of medically uncontrolled coronary vasospasm, presented for evaluation of chest pain 6 months after implantation of left internal mammary artery. Due to recurrent episodes of vasospastic angina and serious complications of coronary spasm (ventricular fibrillation, myocardial infarction), a stent had previously been implanted in the proximal part of left anterior descending artery at the site of angiographically and ergonovine-proven coronary spasm, with subsequent in-stent restenosis.
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Affiliation(s)
- Milan A Nedeljkovic
- Department of Diagnostic and Catheterization Laboratories, University Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
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Jotic A, Lalic N, Sternic N, Mijajlovic M. PO03-MO-03 Insulin resistance and hyperlipidemia are strongly associated with ischemic stroke and asymptomatic carotid artery stenosis in non diabetic patients. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Russell-Jones D, Vaag A, Schmitz O, Sethi BK, Lalic N, Antic S, Zdravkovic M, Ravn GM, Simó R. Liraglutide vs insulin glargine and placebo in combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+SU): a randomised controlled trial. Diabetologia 2009; 52:2046-55. [PMID: 19688338 PMCID: PMC2744824 DOI: 10.1007/s00125-009-1472-y] [Citation(s) in RCA: 654] [Impact Index Per Article: 43.6] [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: 05/18/2009] [Accepted: 06/30/2009] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to compare the efficacy and safety of liraglutide in type 2 diabetes mellitus vs placebo and insulin glargine (A21Gly,B31Arg,B32Arg human insulin), all in combination with metformin and glimepiride. METHODS This randomised (using a telephone or web-based randomisation system), parallel-group, controlled 26 week trial of 581 patients with type 2 diabetes mellitus on prior monotherapy (HbA(1c) 7.5-10%) and combination therapy (7.0-10%) was conducted in 107 centres in 17 countries. The primary endpoint was HbA(1c). Patients were randomised (2:1:2) to liraglutide 1.8 mg once daily (n = 232), liraglutide placebo (n = 115) and open-label insulin glargine (n = 234), all in combination with metformin (1 g twice daily) and glimepiride (4 mg once daily). Investigators, participants and study monitors were blinded to the treatment status of the liraglutide and placebo groups at all times. RESULTS The number of patients analysed as intention to treat were: liraglutide n = 230, placebo n = 114, insulin glargine n = 232. Liraglutide reduced HbA(1c) significantly vs glargine (1.33% vs 1.09%; -0.24% difference, 95% CI 0.08, 0.39; p = 0.0015) and placebo (-1.09% difference, 95% CI 0.90, 1.28; p < 0.0001). There was greater weight loss with liraglutide vs placebo (treatment difference -1.39 kg, 95% CI 2.10, 0.69; p = 0.0001), and vs glargine (treatment difference -3.43 kg, 95% CI 4.00, 2.86; p < 0.0001). Liraglutide reduced systolic BP (-4.0 mmHg) vs glargine (+0.5 mmHg; -4.5 mmHg difference, 95% CI 6.8, -2.2; p = 0.0001) but not vs placebo (p = 0.0791). Rates of hypoglycaemic episodes (major, minor and symptoms only, respectively) were 0.06, 1.2 and 1.0 events/patient/year, respectively, in the liraglutide group (vs 0, 1.3, 1.8 and 0, 1.0, 0.5 with glargine and placebo, respectively). A slightly higher number of adverse events (including nausea at 14%) were reported with liraglutide, but only 9.8% of participants in the group receiving liraglutide developed anti-liraglutide antibodies. CONCLUSIONS/INTERPRETATION Liraglutide added to metformin and sulfonylurea produced significant improvement in glycaemic control and bodyweight compared with placebo and insulin glargine. The difference vs insulin glargine in HbA(1c) was within the predefined non-inferiority margin. TRIAL REGISTRATION ClinicalTrials.gov NCT00331851. FUNDING The study was funded by Novo Nordisk A/S.
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Affiliation(s)
- D Russell-Jones
- Department of Diabetes and Endocrinology, Royal Guildford Hospital, UK.
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Bonnet F, Patel S, Laville M, Balkau B, Favuzzi A, Monti LD, Lalic N, Walker M. Influence of the ACE gene insertion/deletion polymorphism on insulin sensitivity and impaired glucose tolerance in healthy subjects. Diabetes Care 2008; 31:789-94. [PMID: 18235053 DOI: 10.2337/dc07-1788] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent studies suggested that the blockade of the renin-angiotensin system (RAS) may be associated with metabolic benefits. However, data about the potential influence of the ACE insertion/deletion (I/D) genotype on insulin resistance have been contradictory with studies of limited sample sizes. The purpose of this study was to investigate the relationship between the ACE gene I/D polymorphism and both insulin sensitivity and glucose intolerance in a large cohort of healthy subjects. RESEARCH DESIGN AND METHODS A total of 1,286 participants in the Relationship Between Insulin Sensitivity and Cardiovascular Disease Risk Study had a 75-g oral glucose tolerance test and a hyperinsulinemic-euglycemic clamp to assess whole-body insulin sensitivity. RESULTS Age, BMI, waist, fat-free mass (ffm), and physical activity did not differ by ACE genotype. Fasting glucose and insulin were similar among genotypes, but 2-h glucose levels were higher in DD than in ID and II subjects (DD: 5.9 +/- 1.7; ID: 5.7 +/- 1.5; II: 5.6 +/- 1.5 mmol/l) (P = 0.004). Participants with the DD genotype were more likely to have impaired glucose tolerance than those with the ID and II genotypes (13.1 vs. 8.7%; P = 0.02). Insulin sensitivity was lower in participants with the DD genotype than in those with the II genotype (136 +/- 63 vs. 147 +/- 65 micromol x min(-1)x kg ffm(-1) x mmol(-1) x l(-1); P = 0.02). The presence of the D allele was associated with a trend, albeit not significant, for reduced insulin secretion during the oral glucose tolerance test (P = 0.07). CONCLUSIONS The ACE I/D polymorphism is associated with whole-body insulin sensitivity and with impaired glucose tolerance in our healthy population. These findings confirm potential interactions between the RAS and glucose metabolism.
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Affiliation(s)
- Fabrice Bonnet
- Department of Medicine, Endocrinology Unit, Centre Hospitalier Universitaire, Université Rennes, Rennes, France.
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Bjegovic V, Terzic Z, Marinkovic J, Lalic N, Sipetic S, Laaser U. The burden of type 2 diabetes in Serbia and the cost-effectiveness of its management. Eur J Health Econ 2007; 8:97-103. [PMID: 17221182 DOI: 10.1007/s10198-006-0012-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 09/08/2006] [Indexed: 05/13/2023]
Abstract
The purpose of this study was to analyse whether the nationwide application of the national Serbian guideline for diabetes mellitus (NSGDM) would save a relevant amount of disability-adjusted life years (DALYs) and/or reduce the medical cost of treating diabetic patients in Serbia, as compared to the present situation. Disability-adjusted life years were calculated for Serbia and the cost-effectiveness was analysed in eight population groups under ideal and present conditions; prevalent and incident cases were each split up for patients with blood glucose that was well controlled and that was uncontrolled. Under ideal conditions, i.e., according to the NSGDM, 8,031 DALYs could be saved with a potential cost reduction at the same time of approximately 19 million Euros. The implementation of the NSGDM in clinical practice bears a great potential to save lives and reduce years lived with lowered quality of life, but in addition it may reduce costs by about a quarter.
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Affiliation(s)
- Vesna Bjegovic
- Centre School of Public Health and Institute of Social Medicine, School of Medicine, University of Belgrade, Dr Subotica 15, 11000, Belgrade, Serbia and Montenegro.
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Micic S, Djordjevic D, Bojanic N, Lalic N, Nale D, Vuksanovic A. UP-01.19. Urology 2006. [DOI: 10.1016/j.urology.2006.08.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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