Abstract P444: Changes in Glucose-Lowering Medication Prescriptions After an Incident Cardiovascular Event Across eGFR Levels in an Integrated Health System

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jung-Im Shin ◽  
Elizabeth Selvin ◽  
Lesley Inker ◽  
Jodie Reider ◽  
Alex R CHANG ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health System ◽  
Cardiovascular Event ◽  
Diabetes Duration ◽  
Cardiovascular Risk Reduction ◽  
Antihypertensive Medications ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes

Introduction: Cardiovascular disease is a major complication among patients with diabetes, and may merit changes in both antihypertensive medications (e.g., to beta blockers and ACE inhibitors) and glucose-lowering medications (e.g., to sodium-glucose cotransporter 2 inhibitors [SGLT2i] and glucagon-like peptide 1 receptor agonists [GLP1 RA], medication classes with evidence of cardiovascular outcome benefit). The objective of this study was to assess how glucose-lowering medication prescriptions changed after a cardiovascular event among persons with diabetes. Hypothesis: There are changes in glucose-lowering medication prescription following a cardiovascular event. Methods: We identified adult patients with diabetes and estimated glomerular filtration rate (eGFR)≥15mL/min/1.73 m 2 who experienced a cardiovascular event (myocardial infarction, stroke, or heart failure) from 2005-2018 in the Geisinger Health System (cases). We selected control patients with diabetes but without a cardiovascular event by 1:1 matching on demographics, diabetes duration, HbA1c, eGFR, and calendar year. Results: In 15,918 matched case and control patients with diabetes (mean age 65 years, 52% female, mean HbA1c 7.55%, median diabetes duration 5.6 years, and 28% eGFR<60 mL/min/1.73 m 2 ), insulin prescriptions increased and metformin prescriptions decreased after a cardiovascular event among cases compared with controls in all eGFR categories ( Table ). There were no differences between cases and controls with respect to changes in SGLT2i, GLP1 RA, or dipeptidyl peptidase 4 inhibitors (DPP4i). Conclusions: In a real-world setting, insulin prescriptions increased and metformin prescriptions decreased, after a cardiovascular event regardless of eGFR level. Prescriptions for SGLT2i and GLP1 RA did not change following a cardiovascular event in all eGFR categories. More efforts are needed to provide optimal therapies for cardiovascular risk reduction in patients with diabetes and cardiovascular disease.

scholarly journals Glucose-Lowering Medications and Post-Dementia Survival in Patients with Diabetes and Dementia

2022 ◽  
pp. 1-13
Author(s):  
Juraj Secnik ◽  
Hong Xu ◽  
Emilia Schwertner ◽  
Niklas Hammar ◽  
Michael Alvarsson ◽  
...  
Keyword(s):  
Survival Models ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Intention To Treat ◽  
Dementia Patients ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide 1 ◽  
Using Data

Background: The effectiveness of glucose-lowering drugs (GLDs) is unknown among patients with dementia. Objective: To analyze all-cause mortality among users of six GLDs in dementia and dementia-free subjects, respectively. Methods: This was a longitudinal open-cohort registry-based study using data from the Swedish Dementia Registry, Total Population Register, and four supplemental registers providing data on dementia status, drug usage, confounders, and mortality. The cohort comprised 132,402 subjects with diabetes at baseline, of which 11,401 (8.6%) had dementia and 121,001 (91.4%) were dementia-free. Subsequently, comparable dementia – dementia-free pairs were sampled. Then, as-treated and intention-to-treat exposures to metformin, insulin, sulfonylurea, dipeptidyl-peptidase-4 inhibitors, glucagon-like peptide-1 analogues (GLP-1a), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) were analyzed in the parallel dementia and dementia-free cohorts. Confounding was addressed using inverse-probability weighting and propensity-score matching, and flexible parametric survival models were used to produce hazard ratios (HR) and 95% confidence intervals (CI) of the association between GLDs and all-cause mortality. Results: In the as-treated models, increased mortality was observed among insulin users with dementia (HR 1.34 [95%CI 1.24–1.45]) as well as in dementia-free subjects (1.54 [1.10–1.55]). Conversely, sulfonylurea was associated with higher mortality only in dementia subjects (1.19 [1.01–1.42]). GLP-1a (0.44 [0.25–0.78]) and SGLT-2i users with dementia (0.43 [0.23–0.80]) experienced lower mortality compared to non-users. Conclusion: Insulin and sulfonylurea carried higher mortality risk among dementia patients, while GLP-1a and SGLT-2i were associated with lower risk. GLD-associated mortality varied between dementia and comparable dementia-free subjects. Further studies are needed to optimize GLD use in dementia patients.

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

scholarly journals Platelet Effects of Anti-diabetic Therapies: New Perspectives in the Management of Patients with Diabetes and Cardiovascular Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Annunziata Nusca ◽  
Dario Tuccinardi ◽  
Silvia Pieralice ◽  
Sara Giannone ◽  
Myriam Carpenito ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Large Population ◽  
Optimal Management ◽  
Direct And Indirect Effects ◽  
Thrombotic Risk ◽  
Glucose Lowering ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Patients With Diabetes

In type 2 diabetes, anti-thrombotic management is challenging, and current anti-platelet agents have demonstrated reduced efficacy. Old and new anti-diabetic drugs exhibited—besides lowering blood glucose levels—direct and indirect effects on platelet function and on thrombotic milieu, eventually conditioning cardiovascular outcomes. The present review summarizes existing evidence on the effects of glucose-lowering agents on platelet properties, addressing pre-clinical and clinical research, as well as drug–drug interactions with anti-platelet agents. We aimed at expanding clinicians’ understanding by highlighting new opportunities for an optimal management of patients with diabetes and cardiovascular disease. We suggest how an improvement of the thrombotic risk in this large population of patients may be achieved by a careful and tailored combination of anti-diabetic and anti-platelet therapies.

scholarly journals Association between Dipeptidyl Peptidase-4 Inhibitors and Allergic Rhinitis in Asian Patients with Diabetes

2019 ◽  
Vol 16 (8) ◽  
pp. 1323 ◽  
Author(s):  
Hsin-Hung Chen ◽  
Shang-Yi Li ◽  
Weishan Chen ◽  
Chia-Hung Kao
Keyword(s):  
Allergic Rhinitis ◽  
Dipeptidyl Peptidase ◽  
High Dose ◽  
Defined Daily Dose ◽  
Multivariable Logistic Regression Model ◽  
Dipeptidyl Peptidase 4 ◽  
Asian Patients ◽  
Severity Scores ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes

In this retrospective study, we attempted to evaluate the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and allergic rhinitis in patients with diabetes. We analyzed the Longitudinal Health Insurance Database 2000 subdatabase. Our study population included patients with type 2 diabetes (ICD-9-CM 250) between 2009 and 2012, and the study groups were DPP-4 inhibitor users and nonusers. Propensity scores were estimated in a multivariable logistic regression model for the analysis of allergic rhinitis (ICD-9-CM 477.9). Each group consisted of 6204 patients. DPP-4 inhibitor users had a reduced risk of allergic rhinitis (aHR = 0.74, 95% confidence interval (CI) = 0.61–0.90) in all stratifications. Among women, DPP-4 inhibitor users had a lower risk of allergic rhinitis (aHR = 0.67, 95% CI = 0.50–0.90). Among patients aged older than 40 years, DPP-4 inhibitor users had a decreased risk of allergic rhinitis (those aged 40–59: aHR = 0.75, 95% CI = 0.56–0.99; those aged ≧60: aHR = 0.73, 95% CI = 0.54–0.97). Among patients with comorbidities, the risk of allergic rhinitis for DPP-4 inhibitor users was 0.73 (95% CI = 0.60–0.90). High-dose (cumulative defined daily dose ≧648mg) DPP-4 inhibitor users had a decreased risk of allergic rhinitis (aHR = 0.23, 95% CI = 0.15–0.35). Our study revealed that Asian patients with diabetes who used DPP-4 inhibitors had decreased risk of allergic rhinitis, especially for DPP-4 inhibitor treatment in patients who were women, were older than 40 years, had higher diabetes severity scores, were taking higher doses of DPP-4 inhibitors, and had diabetes with comorbidities.

scholarly journals Dipeptidyl peptidase 4 inhibitors and bullous pemphigoid − more evidence of a link: a report of three cases

2020 ◽  
Vol 20 (2) ◽  
pp. 147-148
Author(s):  
Amrita Randhawa ◽  
Donna Torley ◽  
Alastair Kerr ◽  
Grant Wylie
Keyword(s):  
Elderly Patients ◽  
Bullous Pemphigoid ◽  
Dipeptidyl Peptidase ◽  
Antidiabetic Medication ◽  
Dermatology Department ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes

Recently, dipeptidyl peptidase 4 (DPP-4) inhibitors, an antidiabetic medication, have been implicated in the development of bullous pemphigoid, the most common autoimmune cutaneous blistering disorder. In this report we present three cases of DPP-4 associated bullous pemphigoid in our dermatology department. These cases illustrate the importance for clinicians to consider a drug as a trigger for bullous pemphigoid in elderly patients with diabetes.

scholarly journals Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

2020 ◽  
pp. bjgp20X714089
Author(s):  
Michelle Greiver ◽  
Alys Havard ◽  
Juliana Bowles ◽  
Sumeet Kalia ◽  
Chen Tao ◽  
...  
Keyword(s):  
New Drugs ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Cross Sectional Analysis ◽  
Drug Classes ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Lowering Drug ◽  
Sectional Analysis

Abstract Background: Several new classes of glucose lowering medications have been introduced in the past two decades. Some, such as Sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as Dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake, in order to find ways to support the use of more effective medications. Aims: We studied the uptake of these new classes amongst patients with type 2 diabetes. Design and setting: Retrospective repeated cross-sectional analysis. We compared rates of medication uptake in Australia, Canada, England and Scotland. Method: We used primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017. We included persons aged 40 years or over on at least one glucose-lowering drug class in each year of interest, excluding those on insulin only. We determined proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes. Results: By 2017, data from 238,609 patients were included. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017 more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). Conclusions: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.

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