scholarly journals Real-world evidence of glycemic control among patients with type 2 diabetes mellitus in India: the TIGHT study

2019 ◽  
Vol 7 (1) ◽  
pp. e000654 ◽  
Author(s):  
Surendra S Borgharkar ◽  
Soma S Das
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Microvascular Complications ◽  
Stage I ◽  
Stage Ii ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Cross Sectional ◽  
Antidiabetic Therapy

ObjectiveTo determine glycemic control in adult patients with type 2 diabetes receiving antidiabetic therapy as part of routine healthcare in India.Research design and methodsThis was a retrospective analysis of cross-sectional data of patients with type 2 diabetes receiving oral hypoglycemic agents (OHAs) with or without insulin between 2015 and 2017. We assessed proportion of patients with uncontrolled glycemia and performed logistic regression to evaluate its association with various risk factors and microvascular complications.ResultsA total of 55 639 eligible records were identified; mean age of patients was 54.31 (±11.11) years. One-third of the study population had microvascular complications, predominantly neuropathy. Nearly 76.6% of patients had uncontrolled glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol); 62% of these patients had HbA1c between 7% and 8% (53–64 mmol/mol). Glycemic control from combination of OHAs with or without insulin varied between 14.2% and 24.8%. In multivariate analysis, factors statistically associated with uncontrolled glycemia were obesity (OR: 1.15), hypertension (stage I OR: 1.65 and stage II OR: 2.73) and diabetes duration >5 years (OR: 1.19) (p<0.001). Similarly, the odds of having any microvascular complication increased with duration of diabetes (past 1–2 years, OR: 1.67; 2–5 years, OR: 2.53; >5 years, OR: 4.01; p<0.0001), hypertension (stage I, OR: 1.18 and stage II, OR: 1.34; p<0.05) and uncontrolled HbA1c (OR: 1.28; p<0.0001).ConclusionsIndian population with type 2 diabetes has a high burden (76.6%) of poor glycemic control. This study highlights the need for early implementation of optimum diabetes pharmacotherapy to maintain recommended glycemic control, thereby reducing burden of microvascular complications.

scholarly journals Clinical Characteristics and Prevalence of Comorbidities according to Metformin Use in Korean Patients with Type 2 Diabetes

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Sang Ouk Chin ◽  
In Gyoon Ha ◽  
Sang Youl Rhee ◽  
Su Jin Jeong ◽  
Suk Chon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Characteristics ◽  
Microvascular Complications ◽  
Cross Sectional Study ◽  
Hypoglycemic Agents ◽  
University Hospitals ◽  
Oral Hypoglycemic Agents ◽  
Cross Sectional ◽  
Korean Patients

Background/Aims. This study was designed to identify the clinical characteristics of Korean patients with type 2 diabetes according to metformin use. Methods. This cross-sectional study based on the Korean National Diabetes Program 2 registry used its baseline clinical data collected from seven participating university hospitals in Korea. Patients with no significant changes in their oral hypoglycemic agents and no diabetes-related complications within the year prior to participation were enrolled. Patients’ clinical characteristics according to metformin use were analyzed. Results. Among 858 subjects included in the analyses, 706 were metformin users and 152 were nonmetformin users. Metformin users were significantly younger and had higher and glycated hemoglobin with significantly lower rates of accompanying microvascular complications such as retinopathy, cataracts, overt proteinuria, renal insufficiency, and peripheral neuropathy than nonusers. Meanwhile, there was a significantly lower prevalence of malignancy and depression among metformin users. These associations remained significant in multivariate analyses. The prevalence rate of macrovascular complications was not significantly different between the two groups. Conclusions. There were significant differences with respect to clinical characteristics and comorbidity prevalence according to metformin use among Korean type 2 diabetes patients. Long-term follow-up of these patients is necessary to observe how this difference will affect clinical outcomes for these patients.

scholarly journals A Randomized Trial of Insulin Glargine plus Oral Hypoglycemic Agents versus Continuous Subcutaneous Insulin Infusion to Treat Newly Diagnosed Type 2 Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Shuo Lin ◽  
Mu Chen ◽  
Wanling Chen ◽  
Keyi Lin ◽  
Panwei Mu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Glargine ◽  
Basal Insulin ◽  
Insulin Infusion ◽  
Cell Function ◽  
Hypoglycemic Agents ◽  
Newly Diagnosed ◽  
Oral Hypoglycemic Agents

Aims. Basal insulin plus oral hypoglycemic agents (OHAs) has not been investigated for early intensive antihyperglycemic treatment in people with newly diagnosed type 2 diabetes. This study is aimed at comparing the short-term (over a period of 12 days) effects of basal insulin glargine plus OHAs and continuous subcutaneous insulin infusion (CSII) on glycemic control and beta-cell function in this setting. Methods. An open-label parallel-group study. Newly diagnosed hospitalized patients with type 2 diabetes and fasting plasma glucose (FPG) ≥11.1 mmol/L or glycated hemoglobin (HbA1c) ≥9% (75 mmol/mol) were randomized to CSII or insulin glargine in combination with metformin and gliclazide. The primary outcome measure was the mean amplitude of glycemic excursions (MAGE), and secondary endpoints included time to reach glycemic control target (FPG < 7 mmol/L and 2-hour postprandial plasma glucose < 10 mmol/L), markers of β-cell function, and hypoglycemia. Results. Subjects in the CSII (n=35) and basal insulin plus OHA (n=33) groups had a similar significant reduction from baseline to end of treatment in glycated albumin (−6.44 ± 3.23% and− 6.42 ± 3.56%, P=0.970). Groups A and B have comparable time to glycemic control (3.6 ± 1.2 days and 4.0 ± 1.4 days), MAGE (3.40 ± 1.40 mmol/L vs. 3.16 ± 1.38 mmol/L; p=0.484), and 24-hour mean blood glucose (7.49 ± 0.96 mmol/L vs. 7.02 ± 1.03 mmol/L). Changes in the C-peptide reactivity index, the secretory unit of islet in transplantation index, and insulin secretion-sensitivity index-2 indicated a greater β-cell function improvement with basal insulin plus OHAs versus CSII. Conclusions. Short-term insulin glargine plus OHAs may be an alternative to CSII for initial intensive therapy in people with newly diagnosed type 2 diabetes.

scholarly journals The Prevalence and Risk Factors of Osteoporosis among a Saudi Female Diabetic Population

2017 ◽  
Vol 5 (2) ◽  
pp. 177-181
Author(s):  
Ibrahim Abdulrazag AL-Homood ◽  
Iman Sheshah ◽  
Abdel Gaffar A. Mohammed ◽  
Gasim I. Gasim
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Self Report ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Mineral Density ◽  
Cross Sectional ◽  
Vitamin D Levels

 AIM: This study aimed to assess the prevalence and determinants of osteoporosis [lumbar spine (LS) and femoral neck (FN)] among patients with type 2 diabetes at King Salman Hospital.MATERIALS AND METHODS: One hundred seventy patients with type 2 diabetes were enrolled in this cross-sectional study in the period from the 1st of January until the 1st of July 2015. Patient selection was based on self-report of the previous diagnosis by a physician, being on an antidiabetic agent, or a fasting glucose of 126 mg/dl as per the American Diabetes Association criteria. A dual energy X-ray absorptiometry scan with the bone mineral density (BMD) categorization based on the WHO cut of levels of T-scores and determination of vitamin D levels were performed. A detailed questionnaire was used to collect demographic data.RESULTS: Out of 170 participants, 50 (29.4%) were diagnosed as having osteoporosis, while 68 (40%) were diagnosed with osteopenia. Age was determined as a risk factor for a decreased BMD in patients with osteopenia (odds ratio (OR) = 1.1, 95% confidence interval (CI) = (1.0-1.1), p = 0.039) and osteoporosis (OR = 1.1, CI = 1.0-1.2, p < 0.001). Similarly, oral hypoglycemic agents (OHA) increased the risk of decreased BMD in osteopenia (OR = 2.6; CI = 1.0-6.7; p = 0.023) as well as osteoporosis, (OR = 3.8; CI = 1.3-10.9; p = 0.013), while vitamin D deficiency increased the risk of osteopenia OR = 3.0; CI = 1.2-7.2; p = 0.012). Increased BMI decreased the risk of both osteopenia and osteoporosis (OR = 0.9; CI = 0.9-0.99; p = 0.031 vs. OR = 0.9; CI = 0.80-0.95; p = 0.003).CONCLUSION: Advanced age, OHA and vitamin D deficiency are determinants of decreased BMD in Saudi women with type 2 diabetes, while an increased BMI protects against low BMD.

scholarly journals Glycemic Control of Type 2 Diabetic Patients Managed in Tertiary Care Internal Medicine Clinics Using HbA1c

2013 ◽  
Vol 3 (1) ◽  
pp. 23-28
Author(s):  
Helal S. Alenezi ◽  
Mubasher Kharal ◽  
Muhammad Yousuf ◽  
Yousef Al Saleh ◽  
Salih Bin Salih
Keyword(s):  
Internal Medicine ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
American Diabetes Association ◽  
Diabetic Control ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents

Background /Objective: The aim was to assess the glycemic control in patients with type 2 diabetes mellitus using American Diabetes Association HbA1c definition of good control of ≤ 7.0%. Methods: This retrospective study conducted in internal medicine outpatient clinics at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia. All patients with type 2 diabetes mellitus attending the clinic from August 2005 to January 2006 were evaluated. Patients with HbA1c measured regularly and under anti-diabetic therapy were included in the study. Last measured HbA1c was used to evaluate diabetic control. Results: Data for 968 (81.5%) patients out of 1188 were available for analysis. Only 211 (21.8%) patients had their HbA1c within the American Diabetes Association recommended target of HbA1c ≤ 7%. Mean HbA1c was 8.98%. Patients were stratified into groups of good (HbA1c £ 7%), average (HbA1c 7.1% - 9.9%) and poor diabetic control (HbA1c ≥ 10%) included 21.8%, 46.2% and 32.0% of the study population, respectively. Mean HbA1c in patients on diabetic diet only, oral hypoglycemic agents, insulin, and oral hypoglycemic agents plus insulin was 7.62%, 8.67%, 8.92% and 9.70%, respectively. Conclusion: Majority of patients in our study did not meet the American Diabetes Association recommended target HbA1c for type 2 diabetes mellitus. Causes for this failure need to be assessed in Saudi type 2 diabetes mellitus population.

scholarly journals Assessment of Type 2 Diabetes Patients’ Knowledge of Oral Hypoglycemic Agents

2019 ◽  
Author(s):  
Milica Paut Kusturica ◽  
Mina Maričić ◽  
Ana Tomas Petrović ◽  
Veljko Crnobrnja ◽  
Olga Horvat
Keyword(s):  
Type 2 Diabetes ◽  
Side Effects ◽  
Mechanism Of Action ◽  
Treatment Success ◽  
Community Pharmacists ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Cross Sectional ◽  
Diabetes Patients

Objective: Considering that adherence level affects diabetes treatment success and maintenance of glycemic control greatly, the aim of this study was to examine diabetes patients’ adherence to oral hypoglycemic agents (OHAs) and knowledge about their mechanism of action, dosing regimen, and side effects. Material and Methods: This cross-sectional study was conducted on a sample of 100 patients with type 2 diabetes in order to assess their knowledge of OHAs using anonymous questionnaires. Results: Most patients had used OHAs between 2 and 5 years (61.0%), where 78.0% were treated with metformin, and the remaining 22.0% were prescribed sulfonylurea derivatives. Besides drugs used for the treatment of type 2 diabetes, 58.0% of patients took another 1-3 drugs daily for the treatment of other conditions. Although 75.0% achieved a score of 5-6 out of the maximum score of 8, only 2.0% of respondents listed at least 2 side effects of the OHA they used, and none of them could explain its mechanism of action. Most of the information about OHAs was given to patients by endocrinologists (53.0%). Conclusion: More than half of participants considered their knowledge of OHAs insufficient. Results clearly indicate that the respondents were not sufficiently familiar with the mechanism of action and possible side effects of such medications. Information about OHAs given in written form as well as via community pharmacists would contribute to educating type 2 diabetes patients significantly.

scholarly journals Oral Hypoglycemics in Patients with type 2 Diabetes and Peripheral Artery Disease

2019 ◽  
Vol 14 (2) ◽  
pp. 13-17
Author(s):  
Luke Rannelli ◽  
Eric Kaplovitch ◽  
Sonia Anand
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Microvascular Complications ◽  
Limb Ischemia ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Peripheral Artery ◽  
Cardiovascular Morbidity And Mortality

Worldwide, in 2010, 202 million people were living with PAD, with a prevalence between 3-12 percent. The prevalence of PAD is three times greater in diabetic patients compared to those with normal glycaemia. PAD of the limbs is associated with increased cardiovascular morbidity and mortality, as well as major adverse limb events including acute limb ischemia and amputation. These risks are particularly high in patients who smoke and/or have type 2 diabetes.  The goal of treatment in diabetic patients with PAD is to prevent cardiovascular events and prevent further peripheral artery stenosis leading to limb ischemia, and amputation. Poor glycemic control contributes to atherosclerotic progression; however, no randomized control trial evidence exists that demonstrates improved glycemic control reduces the risk of PAD. Oral diabetic medications are designed to lower glucose levels, reduce symptoms and the microvascular complications of diabetes without the inconvenience of daily injections. However, the data supporting benefit of these medications in diabetic populations with concurrent PAD are limited. We review the evidence for oral hypoglycemic agents in the treatment of patients with concurrent PAD and diabetes.

Bone marrow adiposity in premenopausal women with type 2 diabetes with observations on peri-trabecular adipocytes

2021 ◽  
Author(s):  
Vicente F C Andrade ◽  
Débora Besen ◽  
Domingos C Chula ◽  
Victória Z C Borba ◽  
David Dempster ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bone Marrow ◽  
Glycemic Control ◽  
Structural Parameters ◽  
Premenopausal Women ◽  
Hypoglycemic Agents ◽  
Good Glycemic Control ◽  
Cross Sectional ◽  
Marrow Adiposity

Abstract Context No study has evaluated the relationships among of bone marrow adiposity(BMA), bone histomorphometry(BH) and glycemic control in premenopausal women with type 2 diabetes(T2DM). Objectives Assess the effect of glycemic control on BMA;correlate the parameters of BH with BMA and correlate BMA with the use of hypoglycemic agents and with BMD. Design, settings and patients This was a cross-sectional study that evaluated 26 premenopausal women with T2DM were divided into groups with HbA1c&lt;7% (GC,n=10) and HbA1c&gt;7% (PC,n=16).BMA parameters (Ad.N, Ad.Pm, Ad.Ar, Ad.V/Ma.V and peri-trabecular adipocyte number (Ad.N/BS) were evaluated.BH static(BV/TV, O.Th, OS/BS) and dynamic parameters and serum IGF-1 were measured.BMA data were compared between the GC vs PC groups. Correlations were performed. Results Ad.N, Ad.Pm and Ad.Ar were higher in PC(all, p=0.04). HbA1c correlated positively with Ad.N/BS(p&lt; 0.01) and Ad.N/BS correlated negatively with O.Th(p&lt;0.01) and OS/BS(p=0.02). Positive and negative correlations were observed between insulin and metformin use, respectively, with all adipocyte parameters except Ad.N/BS(p&lt;0.05). Structural parameters were negatively correlated with the BMA. BMD of the femoral neck(r = -549, p&lt;0.01) and total femur(r=-0.502, p&lt;0.01) were negatively correlated with Ad.V/Ma.V. Conclusion Poor glycemic control is associated with hyperplasia and hypertrophy of BMAs and with lower BVTV. Ad,N/BS, a new BMA parameter, is correlated with HbA1c and negatively with O.Th. The use of insulin seems to stimulate the expansion of BMA while that of metformin has the opposite effect. These findings suggest that the increase in BMA may play a role in the T2DM bone disease, on the other hand, good glycemic control might help prevent it.

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