Differential effects of treatment targets on risks of adverse outcomes according to diabetes duration, age and complications: Can these characteristics be used to individualize diabetes treatment? The Rio de Janeiro type 2 diabetes cohort

Objective: Most, but not all studies suggested that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in prediabetic women compared to men. Research Design and Methods: In a cross-sectional study, in 3540 normal glucose tolerant (NGT), prediabetic, and diabetic adults, we compared the RR for prevalent non-fatal CVD between men and women. In a longitudinal study including 1658 NGT, prediabetic, and diabetic adults, we compared the RR for incident major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events after 5.6 years follow-up. Results: Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total, LDL and HDL cholesterol, triglycerides, fasting glucose, hsCRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in diabetic women (RR 9.29; 95% CI 4.73-18.25; P<0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; P<0.0001), but no difference in RR for CVD was observed comparing prediabetic women and men. In the longitudinal study, we found that diabetic, but not prediabetic women have higher RR (RR 5.25; 95% CI 3.22-8.56; P<0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; P<0.0001). Conclusions: This study suggests that diabetic, but not prediabetic, women have higher RR for prevalent and incident major adverse outcomes than men.

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Impact of Glucose-Lowering Drugs on Mortality and Other Adverse Outcomes in Patients with Type 2 Diabetes Admitted for COVID-19

SSRN Electronic Journal ◽

10.2139/ssrn.3666251 ◽

2020 ◽

Author(s):

Luis Miguel Pérez-Belmonte ◽

José David Torres-Peña ◽

María D. López-Carmona ◽

M. Mar Ayala-Gutiérrez ◽

Francisco Fuentes-Jiménez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Adverse Outcomes ◽

Glucose Lowering

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Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care

Diabetes/Metabolism Research and Reviews ◽

10.1002/dmrr.3434 ◽

2021 ◽

Author(s):

Marco Orsini Federici ◽

Raffaella Gentilella ◽

Antonella Corcos ◽

Enrico Torre ◽

Stefano Genovese

Keyword(s):

Type 2 Diabetes ◽

Continuum Of Care ◽

Diabetes Treatment ◽

Receptor Agonists ◽

Type 2 Diabetes Treatment ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

The Continuum

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Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

BMC Family Practice ◽

10.1186/s12875-021-01472-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Boon-How Chew ◽

Husni Hussain ◽

Ziti Akthar Supian

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Ldl Cholesterol ◽

Therapeutic Inertia ◽

Treatment Targets ◽

Health Clinics

Abstract Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

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Age- and Gender-Related Differences in LDL-Cholesterol Management in Outpatients with Type 2 Diabetes Mellitus

International Journal of Endocrinology ◽

10.1155/2015/957105 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Giuseppina Russo ◽

Basilio Pintaudi ◽

Carlo Giorda ◽

Giuseppe Lucisano ◽

Antonio Nicolucci ◽

...

Keyword(s):

Type 2 Diabetes ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Serum Levels ◽

Diabetes Duration ◽

Lipid Lowering ◽

Age And Gender ◽

Chd Risk ◽

And Gender

Background. Dyslipidemia contribute to the excess of coronary heart disease (CHD) risk observed in women with type 2 diabetes (T2DM). Low density lipoprotein-cholesterol (LDL-C) is the major target for CHD prevention, and T2DM women seem to reach LDL-C targets less frequently than men.Aim. To explore age- and gender-related differences in LDL-C management in a large sample of outpatients with T2DM.Results. Overall, 415.294 patients (45.3% women) from 236 diabetes centers in Italy were included. Women were older and more obese, with longer diabetes duration, higher total-cholesterol, LDL-C, and HDL-C serum levels compared to men (P<0.0001). Lipid profile was monitored in ~75% of subjects, women being monitored less frequently than men, irrespective of age. More women did not reach the LDL-C target as compared to men, particularly in the subgroup treated with lipid-lowering medications. The between-genders gap in reaching LDL-C targets increased with age and diabetes duration, favouring men in all groups.Conclusions. LDL-C management is worst in women with T2DM, who are monitored and reach targets less frequently than T2DM men. Similarly to men, they do not receive medications despite high LDL-C. These gender discrepancies increase with age and diabetes duration, exposing older women to higher CHD risk.

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Improving the management of type 2 diabetes through large-scale general practice: the role of a data-driven and technology-enabled education programme

BMJ Open Quality ◽

10.1136/bmjoq-2020-001087 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001087

Author(s):

Tarek F Radwan ◽

Yvette Agyako ◽

Alireza Ettefaghian ◽

Tahira Kamran ◽

Omar Din ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Large Scale ◽

Education Programme ◽

Educational Programme ◽

Data Driven ◽

Treatment Targets ◽

Care Processes ◽

Data Driven Approach

A quality improvement (QI) scheme was launched in 2017, covering a large group of 25 general practices working with a deprived registered population. The aim was to improve the measurable quality of care in a population where type 2 diabetes (T2D) care had previously proved challenging. A complex set of QI interventions were co-designed by a team of primary care clinicians and educationalists and managers. These interventions included organisation-wide goal setting, using a data-driven approach, ensuring staff engagement, implementing an educational programme for pharmacists, facilitating web-based QI learning at-scale and using methods which ensured sustainability. This programme was used to optimise the management of T2D through improving the eight care processes and three treatment targets which form part of the annual national diabetes audit for patients with T2D. With the implemented improvement interventions, there was significant improvement in all care processes and all treatment targets for patients with diabetes. Achievement of all the eight care processes improved by 46.0% (p<0.001) while achievement of all three treatment targets improved by 13.5% (p<0.001). The QI programme provides an example of a data-driven large-scale multicomponent intervention delivered in primary care in ethnically diverse and socially deprived areas.

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