Prognostic value of physicians' assessment of compliance regarding all-cause mortality in patients with type 2 diabetes: primary care follow-up study

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

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A 4 year follow-up study of cognitive functioning in patients with type 2 diabetes mellitus

Diabetologia ◽

10.1007/s00125-009-1571-9 ◽

2009 ◽

Vol 53 (1) ◽

pp. 58-65 ◽

Cited By ~ 157

Author(s):

E. van den Berg ◽

◽

Y. D. Reijmer ◽

J. de Bresser ◽

R. P. C. Kessels ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cognitive Functioning ◽

Follow Up Study

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Postprandial Blood Glucose Predicts Cardiovascular Events and All-Cause Mortality in Type 2 Diabetes in a 14-Year Follow-Up: Lessons from the San Luigi Gonzaga Diabetes Study

Diabetes Care ◽

10.2337/dc10-2414 ◽

2011 ◽

Vol 34 (10) ◽

pp. 2237-2243 ◽

Cited By ~ 173

Author(s):

F. Cavalot ◽

A. Pagliarino ◽

M. Valle ◽

L. Di Martino ◽

K. Bonomo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Cardiovascular Events ◽

Postprandial Blood Glucose ◽

All Cause Mortality

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Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes

Acta Endocrinologica ◽

10.1530/eje-13-0321 ◽

2013 ◽

Vol 169 (6) ◽

pp. 725-733 ◽

Cited By ~ 219

Author(s):

Vakkat Muraleedharan ◽

Hazel Marsh ◽

Dheeraj Kapoor ◽

Kevin S Channer ◽

T Hugh Jones

Keyword(s):

Type 2 Diabetes ◽

Untreated Group ◽

Testosterone Replacement ◽

Testosterone Deficiency ◽

Testosterone Levels ◽

All Cause Mortality ◽

Low Testosterone

ObjectiveMen with type 2 diabetes are known to have a high prevalence of testosterone deficiency. No long-term data are available regarding testosterone and mortality in men with type 2 diabetes or any effect of testosterone replacement therapy (TRT). We report a 6-year follow-up study to examine the effect of baseline testosterone and TRT on all-cause mortality in men with type 2 diabetes and low testosterone.Research design and methodsA total of 581 men with type 2 diabetes who had testosterone levels performed between 2002 and 2005 were followed up for a mean period of 5.8±1.3 s.d. years. Mortality rates were compared between total testosterone >10.4 nmol/l (300 ng/dl; n=343) and testosterone ≤10.4 nmol/l (n=238). The effect of TRT (as per normal clinical practise: 85.9% testosterone gel and 14.1% intramuscular testosterone undecanoate) was assessed retrospectively within the low testosterone group.ResultsMortality was increased in the low testosterone group (17.2%) compared with the normal testosterone group (9%; P=0.003) when controlled for covariates. In the Cox regression model, multivariate-adjusted hazard ratio (HR) for decreased survival was 2.02 (P=0.009, 95% CI 1.2–3.4). TRT (mean duration 41.6±20.7 months; n=64) was associated with a reduced mortality of 8.4% compared with 19.2% (P=0.002) in the untreated group (n=174). The multivariate-adjusted HR for decreased survival in the untreated group was 2.3 (95% CI 1.3–3.9, P=0.004).ConclusionsLow testosterone levels predict an increase in all-cause mortality during long-term follow-up. Testosterone replacement may improve survival in hypogonadal men with type 2 diabetes.

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Predictors of type 2 diabetes relapse after Roux-en-Y Gastric Bypass: a ten-year follow-up study

Diabetes & Metabolism ◽

10.1016/j.diabet.2021.101282 ◽

2021 ◽

pp. 101282

Author(s):

Diego Moriconi ◽

Maria Laura Manca ◽

Marco Anselmino ◽

Eleni Rebelos ◽

Rosario Bellini ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Follow Up Study

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Association between On-Treatment Haemoglobin A1c and All-Cause Mortality in Individuals with Type 2 Diabetes: Importance of Personalized Goals and Type of Anti-Hyperglycaemic Treatment

Journal of Clinical Medicine ◽

10.3390/jcm9010246 ◽

2020 ◽

Vol 9 (1) ◽

pp. 246

Author(s):

Emanuela Orsi ◽

Enzo Bonora ◽

Anna Solini ◽

Cecilia Fondelli ◽

Roberto Trevisan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Haemoglobin A1c ◽

Vital Status ◽

Increased Risk ◽

All Cause Mortality ◽

Severe Comorbidity ◽

Potential Risks ◽

Risk Of Treatment

The increased mortality reported with intensive glycaemic control has been attributed to an increased risk of treatment-related hypoglycaemia. This study investigated the relationships of haemoglobin (Hb) A1c, anti-hyperglycaemic treatment, and potential risks of adverse effects with all-cause mortality in patients with type 2 diabetes. Patients (n = 15,773) were stratified into four categories according to baseline HbA1c and then assigned to three target categories, based on whether HbA1c was ≤0.5% below or above (on-target), >0.5% below (below-target) or >0.5% above (above-target) their HbA1c goal, personalized according to the number of potential risks among age > 70 years, diabetes duration > 10 years, advanced complication(s), and severe comorbidity (ies). The vital status was retrieved for 15,656 patients (99.26%). Over a 7.4-year follow-up, mortality risk was increased among patients in the highest HbA1c category (≥8.5%) (adjusted hazard ratio, 1.34 (95% confidence interval, 1.22–1.47), p < 0.001) and those above-target (1.42 (1.29–1.57), p < 0.001). Risk was increased among individuals in the lowest HbA1c category (<6.5%) and those below-target only if treated with agents causing hypoglycaemia (1.16 (1.03–1.29), p = 0.01 and 1.10 (1.01–1.22), p = 0.04, respectively). These data suggest the importance of setting both upper and lower personalized HbA1c goals to avoid overtreatment in high-risk individuals with type 2 diabetes treated with agents causing hypoglycaemia.

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