Pharmacoepidemiological study of treatment managment in patients with type 2 diabetes mellitus in Omsk

Treatment management strategy for patients with type 2 diabetes mellitus (2DM) includes glycaemic control, blood pressure and lipid metabolism parameters. Pharmacoepidemiological monitoring allows evaluating the compliance of the treatment really provided for 2DM with the present guidelines.Aim.To study the actual implementation of pharmaceuticals control for patientswith type 2 diabetes, residents of the city of Omsk, in 2013—2014.Material and methods. It was a retrospective open cohort study based on the fragment data of the Regional Diabetes Register including 33 187 cases with prescription of oral antidiabetic drugs (OAD), 285 patient cases and OAD consumption and expenses data in 2014. The prescribed daily dose (PDD) was determined. It was assessed the efficiency and effectiveness of antihypertensive and lipid-lowering therapy.Results.In Omsk metformin prevails in OAD take-in that corresponds to the modern Clinical Guidelines. Prescribed daily doses of metformin (PDD) are significantly lower (by 34.71%) than the doses fixed by the WHO Centre. The second frequently prescribed drugs are sulfonylureas with gliclazide MB at the top. PDD of glimepiride and glibenclamide are considerably higher than DDD. DPP-4 medicines are quite often prescribed (up to 10.2% as a part of the combined therapy, including fixed combinations).Conclusion.The efficacy of antihyperglycemic therapy assessed upon achievement of HbA1c individual target in Omsk is 40.5%. Most patients with type 2 diabetes in the studied cohort have had the adequate antihypertensive therapy with reaching a target blood pressure in 75.8% of patients. Statin drugs are prescribed only in 39.3% of cases of dyslipidemia in type 2 diabetes, and only in 32.3% of them the targets of lipid metabolism parameters are achieved.

Download Full-text

Influence of Bromocriptine Plus Metformin Treatment on Glycaemia and Blood Pressure in Patients with Type 2 Diabetes Mellitus

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2018-0006 ◽

2018 ◽

Vol 25 (1) ◽

pp. 59-66

Author(s):

Alfredo Briones-Aranda ◽

Javier Ramírez-Carballo ◽

Bernardo Alfredo Romero Gómez ◽

Victor Manuel Vega Villa ◽

Manuela Castellanos Pérez ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Controlled Trial ◽

Combined Therapy ◽

The Body ◽

Open Label ◽

D2 Agonist

Abstract Background and aims: Bromocriptine is a dopaminergic (D2) agonist that has shown hypoglycemic and normotensive activity in preclinical and clinical studies. The main objective of this study was to investigate the effect of bromocriptine plus metformin on glycaemia and blood pressure in patients with type 2 diabetes mellitus (T2DM). Material and methods: An open-label randomised controlled trial was conducted for three months. It involved two groups (n=10), each containing 2 women and 8 men with an average age of 50 years. One group was given monotherapy (MT) with metformin (850 mg every 12 h) and the other combined therapy (CT) with the same dose of metformin plus an increasing dose of bromocriptine (from 1.25 mg per day to 2.5 mg per day). The parameters monitored were glycaemia, glycated hemoglobin (HbA1c), serum creatinine, blood pressure, and the body mass index. Results: CT was able to significantly decrease the level of glycaemia, HbA1c and diastolic blood pressure, whereas MT had no effect on any of the measured variables. Conclusions: The ability of CT with bromocriptine and metformin to control glycaemia and produce a normotensive effect reaffirms its advantages for controlling T2DM. Further research is needed to improve this therapeutic strategy.

Download Full-text

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

Doctor Ru ◽

10.31550/1727-2378-2021-20-2-40-44 ◽

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.

Download Full-text

Efficacy of intensive lipid-lowering therapy with statins stratified by blood pressure levels in patients with type 2 diabetes mellitus and retinopathy: Insight from the EMPATHY study

Hypertension Research ◽

10.1038/s41440-021-00734-x ◽

2021 ◽

Author(s):

Keisuke Shinohara ◽

Shota Ikeda ◽

Nobuyuki Enzan ◽

Shouji Matsushima ◽

Takeshi Tohyama ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Lowering Therapy

Download Full-text

Abstract P199: Effectiveness Of Intensive Lipid-lowering Therapy With Statins In Type 2 Diabetes Mellitus Patients With Poorly Controlled Blood Pressure

Hypertension ◽

10.1161/hyp.76.suppl_1.p199 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Shota Ikeda ◽

Keisuke Shinohara ◽

Nobuyuki Enzan ◽

Shouji Matsushima ◽

Takeshi Tohyama ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Standard Therapy ◽

Intensive Therapy ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Lowering Therapy

Introduction: Control of blood pressure (BP) is associated with decreased risk of cardiovascular (CV) events in patients with type 2 diabetes mellitus (T2DM). Lowering the level of low-density lipoprotein cholesterol (LDL-C) by statins is also effective to reduce CV events in T2DM patients with hyperlipidemia. In this study, we examined whether the effectiveness of statin lipid-lowering therapy was affected by baseline BP level in T2DM patients in a primary prevention setting. Methods: The EMPATHY study was a randomized controlled trial investigating the effects of statin intensive therapy targeting LDL-C <70 mg/dL compared to standard therapy targeting LDL-C ≥100 to <120 mg/dL in T2DM patients with diabetic retinopathy and hyperlipidemia without known CV diseases. In this post-hoc subgroup analysis, a total of 4980 patients were divided into two groups based on baseline BP: high BP (systolic BP ≥130 mmHg and/or diastolic BP ≥80 mmHg) and non-high BP (systolic BP <130 mmHg and diastolic BP <80 mmHg) groups. CV events were defined as composite of cardiac, cerebral, renal, and vascular events. Results: At baseline, mean systolic and diastolic BP values were 141.7 and 78.3 mmHg in high BP group (n=3335) and 120.2 and 67.9 mmHg in non-high BP group (n=1645). Compared to non-high BP group, the proportion of patients with diabetic nephropathy (55.5 % vs 46.6 %), body mass index (26.1 kg/m 2 vs 24.8 kg/m 2 ), HbA1c (7.82 % vs 7.67 %), and LDL-C (131.3 mg/dL vs 129.6 mg/dL) were significantly higher in high BP group. During a median follow-up of 36.8 months, 281 CV events were observed. In high BP group, statin intensive therapy was associated with low risk of CV events (HR 0.70, 95% CI 0.54-0.92, p=0.011) compared to standard therapy after adjustment. In non-high BP group, no such association was observed. Interaction between BP group and statin therapy was significant in CV events (p=0.036). Conclusion: Compared to statin standard therapy, statin intensive therapy targeting LDL-C <70 mg/dL significantly reduced CV events in the primary prevention setting among T2DM patients with BP ≥130/80 mmHg, but not among those with BP <130/80 mmHg.

Download Full-text