scholarly journals Characterisation of type 2 diabetes subgroups and their association with ethnicity and clinical outcomes: a UK real-world data study using the East London Database

2021 ◽  
Author(s):  
Rohini Mathur ◽  
Sally A Hull ◽  
Sam Hodgson ◽  
Sarah Finer
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycaemic Control ◽  
Clinical Outcomes ◽  
South Asian ◽  
Real World ◽  
Treatment Initiation ◽  
Microvascular Complications ◽  
Antidiabetic Treatment

Background: Subgroups of type 2 diabetes (T2DM) have been well characterised in experimental studies. However, it is unclear whether T2DM subgroups can be identified in UK based real-world populations and if they impact clinical outcomes. Aim: To derive T2DM subgroups using primary care data from a multi-ethnic population, evaluate associations with glycaemic control, treatment initiation and vascular outcomes, and understand how these vary by ethnicity. Design and setting: An observational cohort study in the East London Primary Care Database from 2008-2018. Method: Latent class analysis using age, sex, glycated haemoglobin, and body mass index at diagnosis was used to derive T2DM subgroups in White, South Asian, and Black groups. Time to treatment initiation and vascular outcomes was estimated using multivariable Cox-proportional hazards regression. Results: 31,931 adults with T2DM were included: 47% south Asian, 25% White, 20% Black. We replicated two previously described subgroups, "Mild Age-Related Diabetes" (MARD), "Mild Obesity-related Diabetes" (MOD), and characterised a third "Severe Hyperglycaemic Diabetes" (SHD). Compared to MARD, SHD had the poorest long term glycaemic control, fastest initiation of antidiabetic treatment (HR 2.02, 1.76-2.32), and highest risk of microvascular complications (HR 1.38, 1.28-1.49). MOD had the highest risk of macrovascular complications (HR 1.50, 1.23-1.83). Subgroup differences in treatment initiation were most pronounced for the White group, and vascular complications for the Black group. Conclusions: Clinically useful T2DM subgroups, identified at diagnosis, can be generated in routine real-world multi-ethnic populations, and may offer a pragmatic means to develop stratified primary care pathways and improve healthcare resource allocation.

scholarly journals The benefits of non‐surgical weight management on weight and glycaemic control in people with complex type 2 diabetes: A primary care service evaluation of clinical outcomes at 12 months

2019 ◽  
Vol 2 (2) ◽  
pp. e00045 ◽  
Author(s):  
Amanda Avery ◽  
Jill Griffin ◽  
Julie Stokes ◽  
Rosie Coulton ◽  
Carolyn Pallister ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycaemic Control ◽  
Weight Management ◽  
Clinical Outcomes ◽  
Care Service ◽  
Service Evaluation ◽  
Primary Care Service ◽  
Complex Type

Real-World Clinical Outcomes of Type 2 Diabetes (T2D) Patients Switching From Insulin Glargine 100 U/mL (Gla-100) or Insulin Detemir (IDet) to Insulin Glargine 300 U/mL (Gla-300) or Insulin Degludec (IDeg)—DELIVER D+ Subgroup Analyses

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1057-P
Author(s):  
SEAN D. SULLIVAN ◽  
TIMOTHY S. BAILEY ◽  
RONAN ROUSSEL ◽  
FANG L. ZHOU ◽  
ZSOLT BOSNYAK ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Glargine ◽  
Clinical Outcomes ◽  
Real World ◽  
Insulin Detemir ◽  
Insulin Degludec ◽  
Subgroup Analyses

scholarly journals Intra-cluster correlation coefficients in primary care patients with type 2 diabetes and hypertension

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lin Lee ◽  
Yvonne Mei Fong Lim ◽  
Kian Boon Law ◽  
Sheamini Sivasampu
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Clinical Outcomes ◽  
Patient Experience ◽  
Correlation Coefficients ◽  
Middle Income ◽  
Processes Of Care ◽  
Middle Income Countries ◽  
Cluster Correlation

Abstract Introduction There are few sources of published data on intra-cluster correlation coefficients (ICCs) amongst patients with type 2 diabetes (T2D) and/or hypertension in primary care, particularly in low- and middle-income countries. ICC values are necessary for determining the sample sizes of cluster randomized trials. Hence, we aim to report the ICC values for a range of measures from a cluster-based interventional study conducted in Malaysia. Method Baseline data from a large study entitled Evaluation of Enhanced Primary Health Care interventions in public health clinics (EnPHC-EVA: Facility) were used in this analysis. Data from 40 public primary care clinics were collected through retrospective chart reviews and a patient exit survey. We calculated the ICCs for processes of care, clinical outcomes and patient experiences in patients with T2D and/or hypertension using the analysis of variance approach. Results Patient experience had the highest ICC values compared to processes of care and clinical outcomes. The ICC values ranged from 0.01 to 0.48 for processes of care. Generally, the ICC values for processes of care for patients with hypertension only are higher than those for T2D patients, with or without hypertension. However, both groups of patients have similar ICCs for antihypertensive medications use. In addition, similar ICC values were observed for clinical outcomes, ranging from 0.01 to 0.09. For patient experience, the ICCs were between 0.03 (proportion of patients who are willing to recommend the clinic to their friends and family) and 0.25 (for Patient Assessment of Chronic Illness Care item 9, Given a copy of my treatment plan). Conclusion The reported ICCs and their respective 95% confidence intervals for T2D and hypertension will be useful for estimating sample sizes and improving efficiency of cluster trials conducted in the primary care setting, particularly for low- and middle-income countries.

scholarly journals Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non‐insulin antidiabetic drugs in a real‐world setting

2019 ◽  
Vol 21 (6) ◽  
pp. 1373-1380 ◽  
Author(s):  
Silvia Canivell ◽  
Manel Mata‐Cases ◽  
Jordi Real ◽  
Josep Franch‐Nadal ◽  
Bogdan Vlacho ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Real World ◽  
Antidiabetic Drugs ◽  
Treatment Intensification ◽  
Real World Setting

scholarly journals Correction to: Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS)

Diabetologia ◽  
2020 ◽  
Vol 63 (5) ◽  
pp. 1088-1089
Author(s):  
Pablo Aschner ◽  
Juan J. Gagliardino ◽  
Hasan Ilkova ◽  
Fernando Lavalle ◽  
Ambady Ramachandran ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Developing Countries ◽  
Glycaemic Control ◽  
Real World ◽  
Management Practices ◽  
Diabetes Management ◽  
Poor Glycaemic Control ◽  
Real World Evidence

Sodium–Glucose Co-transporter 2 Inhibition – A Novel Strategy for Glucose Control in Type 2 Diabetes

2010 ◽  
Vol 7 (1) ◽  
pp. 30
Author(s):  
Luke Norton ◽  
Ralph A DeFronzo ◽  
Muhammad A Abdul-Ghani ◽  
◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Beta Cell ◽  
Mechanism Of Action ◽  
Microvascular Complications ◽  
Oral Antidiabetic Agents ◽  
Oral Antidiabetic ◽  
Tissue Sensitivity ◽  
Novel Strategy

In addition to its central role in the development of microvascular complications, hyperglycaemia plays an important role in the pathogenesis of type 2 diabetes, i.e. glucotoxicity. Thus, effective glycaemic control not only reduces the incidence of microvascular complications, but also corrects the metabolic abnormalities that contribute to the progression of the disease. Progressive beta-cell failure and side effects associated with therapy, such as hypoglycaemia and weight gain, present obstacles to the achievement of optimal durable glycaemic control in subjects with type 2 diabetes. Most recently, inhibitors of the renal sodium glucose co-transporter have been developed to produce glucosuria and reduce the plasma glucose concentration. Because the mechanism of action of these oral antidiabetic agents is independent of beta-cell and tissue sensitivity to insulin, they improve glycaemic control while avoiding hypoglycaemia and promoting weight loss. In this article, we will summarise the available data concerning the mechanism of action, efficacy and safety of this novel antidiabetic therapeutic approach.

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