Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

Abstract Background Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016–2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every 3 months in the 1-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results A total of 1512 subjects receiving dulaglutide and 1513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: − 1.06%, p < 0.001; liraglutide: − 0.83%, p < 0.001), with a significant between-group difference (− 0.23%, 95% confidence interval − 0.38 to − 0.08%, p < 0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: − 1.14 kg, − 3.08 U/L and − 2.08 mL/min/1.73 m2, p < 0.01; liraglutide: − 1.64 kg, − 3.65 U/L and − 2.33 mL/min/1.73 m2, p < 0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (− 2.47 mmHg, p < 0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

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Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

10.21203/rs.3.rs-48852/v2 ◽

2020 ◽

Author(s):

Kai-Cheng Chang ◽

Shih-Chieh Shao ◽

Shihchen Kuo ◽

Chen-Yi Yang ◽

Hui-Yu Chen ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cohort Study ◽

Real World ◽

Comparative Effectiveness ◽

Blood Pressure Reduction ◽

Renal Functions ◽

Diabetes Patients

Abstract Background Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016-2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every three months in the one-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results A total of 1,512 subjects receiving dulaglutide and 1,513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: -1.06%, p<0.001; liraglutide: -0.83%, p<0.001), with a significant between-group difference (-0.23%, 95% confidence interval: -0.38 to -0.08%, p<0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: -1.14 kg, -3.08 U/L and -2.08 ml/min/1.73 m2, p<0.01; liraglutide: -1.64 kg, -3.65 U/L and -2.33 ml/min/1.73 m2, p<0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (-2.47 mmHg, p<0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

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Comparative Effectiveness of Dulaglutide Versus Iiraglutide in Asian type 2 Diabetes Patients: A Multi-Institutional Cohort Study and Meta-Analysis

10.21203/rs.3.rs-48852/v1 ◽

2020 ◽

Author(s):

Kai-Cheng Chang ◽

Shih-Chieh Shao ◽

Shihchen Kuo ◽

Chen-Yi Yang ◽

Hui-Yu Chen ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cohort Study ◽

Real World ◽

Comparative Effectiveness ◽

Blood Pressure Reduction ◽

Renal Functions ◽

Diabetes Patients

Abstract BackgroundHead-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. MethodsWe conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016-2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every three months in the one-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. ResultsA total of 1,512 subjects receiving dulaglutide and 1,513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: -1.06%, p<0.001; liraglutide: -0.83%, p<0.001), with a significant between-group difference (-0.23%, 95% confidence interval: -0.38 to -0.08%, p<0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: -1.14 kg, -3.08 U/L and -2.08 ml/min/1.73 m2, p<0.01; liraglutide: -1.64 kg, -3.65 U/L and -2.33 ml/min/1.73 m2, p<0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (-2.47 mmHg, p<0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. ConclusionsIn real-world T2D patients, dulaglutide versus liraglutide yielded better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

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Endothelin-1 predicts incident diabetic peripheral neuropathy in Type 2 Diabetes: a cohort study

Acta Endocrinologica ◽

10.1530/eje-19-0523 ◽

2020 ◽

Vol 182 (4) ◽

pp. 429-438

Author(s):

Sharon Li Ting Pek ◽

Su Chi Lim ◽

Keven Ang ◽

Pek Yee Kwan ◽

Wern Ee Tang ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Cohort Study ◽

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Diabetes Duration ◽

Endothelin 1

Introduction Diabetic peripheral neuropathy (DPN) is a common microvascular complication in patients with type 2 diabetes (T2D). Apart from hyperglycemia, few modifiable risk factors have been identified. Endothelin-1 is a potent vasoconstrictor peptide, implicated in the causal pathway of microangiopathy. We investigated whether baseline plasma endothelin-1 and other metabolic and vascular risk factors predicted the incidence of DPN. Design This is a 3-year observational, cohort study. Methods In patients with T2D (n = 2057), anthropometric data, fasting blood, and urine were collected for biochemistry and urine albumin/creatinine measurements. Forearm cutaneous endothelial reactivity was assessed by iontophoresis and laser Doppler flowmetry/imaging. Measurements were repeated on follow-up. Incident DPN was considered present if an abnormal finding in monofilament (<8 of 10 points) or neurothesiometer testing was ≥25 volts on either foot at 3-year follow-up, but normal at baseline. Plasma endothelin-1 was assessed by ELISA. Results At baseline, mean age of patients was 57.4 ± 10.8 years old and prevalence of DPN was 10.8%. Of the 1767 patients without DPN, 1250 patients returned for follow-up assessment ((2.9 ± 0.7) years), with a 10.7% incidence of DPN. Patients with incident DPN had significantly higher baseline endothelin-1 (1.43 (1.19–1.73) vs 1.30 (1.06–1.63)) pg/mL, P < 0.0001. Multivariable Cox proportional hazards ratio showed a 1-s.d. increase in log endothelin-1 (adjusted HR: 4.345 (1.451–13.009), P = 0.009), systolic blood pressure (per 10-unit) (adjusted HR: 1.107 (1.001–1.223), P = 0.047) and diabetes duration (adjusted HR: 1.025 (1.004–1.047), P = 0.017) predicted incident DPN, after adjustment for glycemic control, eGFR, albuminuria, peripheral arterial disease and retinopathy status. Conclusion Higher baseline endothelin-1, blood pressure and diabetes duration were significant and independent predictors for incident DPN. Validation of our findings in independent cohorts and molecular mechanistic studies will help better our understanding on the role of endothelin-1 in DPN.

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FRAILTY AND THE COMPARATIVE EFFECTIVENESS AND SAFETY OF SGLT2I AND SULFONYLUREA IN OLDER ADULTS WITH TYPE 2 DIABETES

Innovation in Aging ◽

10.1093/geroni/igz038.2156 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S581-S581

Author(s):

Ajinkya Pawar ◽

elisabetta Patorno ◽

Dae Kim

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cohort Study ◽

Comparative Effectiveness ◽

Retrospective Cohort ◽

Severe Hypoglycemia ◽

Medicare Data ◽

Cardiovascular Endpoint

Abstract We conducted a 1:1 propensity score-matched retrospective cohort study of 70,826 patients with type 2 diabetes (mean age, 71.4 years [standard deviation, 5.0]) initiating a SGLT2i or a second-generation sulfonylurea in Medicare data. We estimated HRs (95% CIs) for a composite cardiovascular endpoint and severe hypoglycemia comparing the two treatments in the entire population and by the CFI-based frailty subgroups. Compared with sulfonylureas, SGLT2is were associated with lower rates of the composite cardiovascular endpoint (HR, 0.68 [95% CI, 0.62-0.75]) and severe hypoglycemia (0.43 [0.35-0.53]) over a mean follow-up of 9.5 months. The lower rate of composite cardiovascular endpoint for SGLT2i vs sulfonylureas was observed in pre-frail (0.68 [0.61-0.77]) and frail (0.64 [0.53-0.77]) subgroups, but not in non-frail subgroup (0.95 [0.59-1.54]). The rate of severe hypoglycemia was consistently lower for SGLT2i vs sulfonylureas across frailty subgroups (non-frail, 0.37 [0.12-1.16]; pre-frail, 0.45 [0.35-0.59]; frail, 0.40 [0.28-0.58]).

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Comparative Effectiveness of Metformin Dosage Uptitration Versus Adding Another Antihyperglycemic Medication on Glycemic Control in Type 2 Diabetes Patients Failing Initial Metformin Monotherapy: A Retrospective Cohort Study

Population Health Management ◽

10.1089/pop.2018.0158 ◽

2019 ◽

Vol 22 (5) ◽

pp. 457-463 ◽

Cited By ~ 1

Author(s):

Rohan Mahabaleshwarkar ◽

Tsai-Ling Liu ◽

Holly Mulder

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Glycemic Control ◽

Retrospective Cohort Study ◽

Comparative Effectiveness ◽

Retrospective Cohort ◽

Metformin Monotherapy ◽

Diabetes Patients

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Glycaemic goal attainment and hypoglycaemia outcomes in type 2 diabetes patients initiating insulin glargine 300 units/mL or 100 units/mL: Real‐world results from the DELIVER Naïve cohort study

Diabetes Obesity and Metabolism ◽

10.1111/dom.13693 ◽

2019 ◽

Vol 21 (7) ◽

pp. 1596-1605 ◽

Cited By ~ 10

Author(s):

Timothy S. Bailey ◽

Fang L. Zhou ◽

Rishab A. Gupta ◽

Ronald Preblick ◽

Vineet E. Gupta ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Insulin Glargine ◽

Real World ◽

Goal Attainment ◽

Diabetes Patients

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The Effect of Comorbidity on Glycemic Control and Systolic Blood Pressure in Type 2 Diabetes: A Cohort Study with 5 Year Follow-Up in Primary Care

PLoS ONE ◽

10.1371/journal.pone.0138662 ◽

2015 ◽

Vol 10 (10) ◽

pp. e0138662 ◽

Cited By ~ 14

Author(s):

Hilde Luijks ◽

Marion Biermans ◽

Hans Bor ◽

Chris van Weel ◽

Toine Lagro-Janssen ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Primary Care ◽

Cohort Study ◽

Glycemic Control ◽

Systolic Blood Pressure

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Clinical outcomes in real-world patients with type 2 diabetes switching from first- to second-generation basal insulin analogues: Comparative effectiveness of insulin glargine 300 units/mL and insulin degludec in the DELIVER D+ cohort study

Diabetes Obesity and Metabolism ◽

10.1111/dom.13345 ◽

2018 ◽

Vol 20 (9) ◽

pp. 2148-2158 ◽

Cited By ~ 33

Author(s):

Sean D. Sullivan ◽

Timothy S. Bailey ◽

Ronan Roussel ◽

Fang Liz Zhou ◽

Zsolt Bosnyak ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Insulin Glargine ◽

Clinical Outcomes ◽

Real World ◽

Comparative Effectiveness ◽

Basal Insulin ◽

Insulin Analogues ◽

Insulin Degludec

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Implementation of a Personalized Care Plan for Patients With Type 2 Diabetes Is Associated With Improvements in Clinical Outcomes: An Observational Real-World Study

Journal of Primary Care & Community Health ◽

10.1177/2150132720921700 ◽

2020 ◽

Vol 11 ◽

pp. 215013272092170

Author(s):

Anni Vuohijoki ◽

Ilona Mikkola ◽

Jari Jokelainen ◽

Sirkka Keinänen-Kiukaanniemi ◽

Klas Winell ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Health Care ◽

Clinical Outcomes ◽

Real World ◽

Care Plan ◽

Personalized Care ◽

Primary Health

Objective: To analyze the clinical outcomes of patients with type 2 diabetes (T2D) before and after implementation of a personalized care plan in the primary health care setting. Design: Observational, retrospective, real-world study. Setting: All T2D patients with a care plan in Rovaniemi Health Center, Rovaniemi, Finland, for whom data were available from a baseline visit (in 2013-2015 during which the care plan was written) and from a follow-up visit, including an updated care plan by the year 2017. Subjects: In total, 447 patients were included. Mean age was 66.9 (SD 10.1) years, 58.8% were male, 15.4% were smokers, 33.1% had vascular disease, and 17.0% were receiving insulin treatment. The mean follow-up time was 14.4 months. Main Outcome Measures: Glycosylated hemoglobin A1 (HbA1c), low-density lipoprotein (LDL), blood pressure (BP), and body mass index (BMI). Clinical values were taken at both baseline and follow-up. Results: LDL decreased by 0.2 mmol/L, systolic blood pressure by 2.2 mm Hg, diastolic blood pressure by 1.5 mm Hg, and BMI by 0.5 kg/m2 ( P < .05 for each). The decrease in HbA1c was 0.8 mmol/mol ( P = .07). Conclusion: We observed statistically significant decreases in LDL, BP, and BMI. Our results indicate that, over 14 months of follow-up, implementation of a written care plan was associated with small improvements in the clinical outcomes of T2D patients in a primary health care study population in a real-world setting.

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Glycemic Control, Diabetic Complications, and Risk of Dementia in Patients With Diabetes: Results From a Large U.K. Cohort Study

10.2337/figshare.14484852 ◽

2021 ◽

Author(s):

Bang Zheng ◽

Bowen Su ◽

Geraint Price ◽

Ioanna Tzoulaki ◽

Sara Ahmadi-Abhari ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Diabetic Complications ◽

Time Varying ◽

Dementia Risk ◽

Dementia Incidence ◽

Hba1c Levels ◽

Diabetes Patients

<a>Objective:</a> Type 2 diabetes is an established risk factor for dementia. However, the roles of glycaemic control and diabetic complications in the development of dementia have been less well substantiated. This large-scale cohort study aims to examine associations of longitudinal HbA1c levels and diabetic complications with the risk of dementia incidence among patients with type 2 diabetes. Research Design and Methods: Data of eligible diabetes patients, aged over 50 years in the UK Clinical Practice Research Datalink from 1987 to 2018, were analysed. Time-varying Cox regressions were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for dementia risk. Results: Among 457,902 diabetes patients, 28,627 (6.3%) incident dementia cases were observed during a median of six years follow-up. Patients with recorded hypoglycaemic events or microvascular complications were at higher risk of dementia incidence compared to those without such complications (HR [95% CI]=1.30 [1.22-1.39] and 1.10 [1.06-1.14], respectively). The HbA1c level, modelled as a time-varying exposure, was associated with increased dementia risk (HR=1.08, 95% CI: 1.07-1.09 per 1% HbA1c increment) among 372,287 diabetes patients with post-diagnosis HbA1c records. Similarly, higher coefficient of variation of HbA1c during the initial three years of follow-up was associated with higher subsequent dementia risk (HR=1.03, 95% CI: 1.01-1.04 per 1 SD increment). Conclusions: Higher or unstable HbA1c levels and the presence of diabetic complications in patients with type 2 diabetes are associated with increased dementia risk. Effective management of glycaemia might have significant role in maintaining cognitive health among older adults with diabetes.

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