scholarly journals Risk of Nonfatal Stroke in Type 2 Diabetes Mellitus Patients: A Retrospective Comparison Between Disease Management Programs and Standard Care

2017 ◽  
Vol 11 (4) ◽  
pp. 808-813 ◽  
Author(s):  
Stefan Wiefarn ◽  
Christian Heumann ◽  
Anja Rettelbach ◽  
Karel Kostev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Disease Management ◽  
Standard Care ◽  
Cox Model ◽  
Nonfatal Stroke ◽  
Disease Management Programs ◽  
Antihyperglycemic Therapy

Objective: The present retrospective study examines the influence of disease management programs on nonfatal stroke in type 2 diabetes mellitus (T2DM) patients in Germany. Methods: The evaluation is based on retrospective patient data from the Disease Analyzer (IMS Health). The analysis included 169 414 T2DM patients aged 40 years and older with an initial prescription of antihyperglycemic therapy between January 2004 and December 2014. A total of 86 713 patients participated in a disease management program (DMP) for T2DM and 82 701 patients received standard care. The main outcome measure of this study was nonfatal stroke. Kaplan-Meier curves of DMP and SC patients were compared using log rank test. The Cox proportional hazards model was used to provide an adjusted estimate of the DMP effect. Results: It is apparent from the baseline characteristics that the general health of patients receiving standard care was poorer than that of patients participating in a DMP. The baseline HbA1c value was 7.6% in the DMP group and 7.8% in the SC group. Furthermore, the SC group had a higher proportion of preexisting conditions, such as coronary heart disease (CHD), peripheral arterial occlusive disease (pAOD), and renal insufficiency. The proportion of patients who received insulin in first year therapy was higher in the SC group. Time to event analysis showed that DMP was associated with a delayed occurrence of stroke, because stroke occurred an average of 350 days later in DMP patients than in patients receiving SC (DMP: 1.216 days, RV: 866 days). The Cox model with covariable adjustment confirmed the significant association of DMPs with nonfatal stroke in patients with type 2 diabetes mellitus (HR 0.71; 95% CI: 0.69-0.74). Conclusion: The present study indicates that DMPs are positively associated with stroke. The possible reasons for this must be verified in further studies.

scholarly journals Current Management of Type 2 Diabetes Mellitus: What to Pay Attention to in Outpatient Settings

Doctor Ru ◽  
2021 ◽  
Vol 20 (2) ◽  
pp. 40-44
Author(s):  
N.A. Chernikova ◽  
◽  
O.A. Knyshenko ◽  
◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Combined Therapy ◽  
Individual Characteristics ◽  
Antihyperglycemic Agents ◽  
Number Of Patients ◽  
Antihyperglycemic Therapy ◽  
Selection Of

Objective of the Review: To discuss the problem of selecting antihyperglycemic drugs; to identify the trends in prescription of various groups of oral antihyperglycemic agents. Key Points. When type 2 diabetes mellitus (DM2) is diagnosed, a number of patients need prompt combined antihyperglycemic therapy because of a marked carbohydrate metabolism disorder. The prescription paradigm of initial therapy has shifted towards antihyperglycemic agents with established nephro- and cardioprotective effects (sodium-glucose linked transporter-2 inhibitors, glucagon-like peptide-1 receptor agonists). Drugs are recommended depending on presence or absence of a comorbid cardiovascular disease (CVD) and cardiovascular risk factors, and safety as regards hypoglycaemic events; therefore, very often selection of a therapeutic regimen can be challenging. Still, the first-line treatment for patients without CVD is metformin; however, a combined therapy is required in the majority of cases. Poor compliance, continued use of monotherapy, despite the need to boost the therapy, patient’s reluctance to take additional drugs can facilitate occurrence and progression of a lot of associated complications. In such cases, combined medications reducing the amount of tablets and improving compliance are useful. The most common combination of antihyperglycemic drugs is metformin and sulfonylureas. Still, care should be taken because of differences in pharmacokinetics and pharmacodynamics of the molecules in the latter group. High selectivity of some sulfonylureas can evidence their milder effect for glucose level reduction. Sulfonylureas are also cost-effective as compared to other antidiabetic medications. Conclusion. A wide choice of drugs allows a medical professional selecting an optimal antihyperglycemic regimen, taking into account individual characteristics of a patient. Prompt combined medications are a treatment of choice for the majority of patients with DM. Selection of antihyperglycemic drugs is affected by the cost as well. The most important thing is that the drugs are well-studied, efficient and safe. Keywords: type 2 diabetes mellitus, combined therapy, sulphonylurea, Glimepiride, metformin.

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