scholarly journals Incidence of Hypoglycemia and Hospitalization Related to Chronic Diabetes Complications and Its Effect on Quality of Life Among Patients Initiating Second Line Therapy: DISCOVER Study

2021 ◽  
Author(s):  
Khalid Al-Rubeaan ◽  
Faisal Banah ◽  
Fayez Alruwaily ◽  
Eman Sheshah ◽  
Dhekra Alnaqeb ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Metabolic Control ◽  
Annual Incidence ◽  
Second Line ◽  
Second Line Therapy ◽  
Fear Of Hypoglycemia ◽  
Line Therapy

Abstract The management of patients with type 2 diabetes is a complex process that must be individualized and be patient centered. The aim of this study was to assess the metabolic control, the annual incidence and crude prevalence of hypoglycemia, hospitalization, and complications among patients with type 2 diabetes initiating second-line therapy. This study is an observational, longitudinal, prospective study as a part of the multinational DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings (DISCOVER) study, that recruited 519 patients with type 2 diabetes who were non-insulin users, aged ≥18 years, and switching to second-line therapy. The cohort was clinically evaluated over three years of follow up. Fear of hypoglycemia was assessed using the Hypoglycemia Fear Survey (HFS II), while the quality of life was assessed using SF36v2 questionnaire. Using second-line therapy improved metabolic control but the annual incidence of microangiopathies were at 61/1000 patient-years, 47/1000 patient-years, and 4/1000 patient-years for neuropathy, retinopathy, and nephropathy, respectively. The incidence of hypoglycemia was 57/1000 patient-years, where 50% were recurrent during the three-years period. The HFS II showed a significant increase in patients’ worries related to hypoglycemia. The incidence of hospitalization was 31/1000 patient-years, out of which 8/1000 patient-years were related to cardiovascular events, mainly myocardial infarction. Moderate metabolic control was associated with lower incidence of macro angiopathy and an increased incidence and fear of hypoglycemia, while it was associated with improved mental component score when assessing the patients’ quality of life. The treating physician’s decision of treatment intensification should be individualized with consideration of befits of good glycemic control versus the risk of hypoglycemia, especially in elderly patients.

40-OR: Quality of Life in People with Type 2 Diabetes following Initiation of Second-Line Therapy: DISCOVER

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 40-OR
Author(s):  
ANTONIO NICOLUCCI ◽  
HUNGTA CHEN ◽  
ANDREW COOPER ◽  
MARILIA B. GOMES ◽  
LINONG JI ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

Individualized HbA1c Targets in People with Type 2 Diabetes Initiating Second-Line Therapy—The Global DISCOVER Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1629-P
Author(s):  
KAMLESH KHUNTI ◽  
HUNGTA CHEN ◽  
JAVIER CID-RUZAFA ◽  
PETER FENICI ◽  
MARILIA B. GOMES ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

“Position Paper” Timely Insulinisation in Type 2 Diabetes Patients

2012 ◽  
Vol 19 (4) ◽  
pp. 441-444
Author(s):  
László Barkai ◽  
Nicolae Hâncu ◽  
György Jermendy ◽  
Maya Konstantinova ◽  
Radu Lichiardopol ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Life Expectancy ◽  
Insulin Therapy ◽  
Metabolic Control ◽  
Current Medical ◽  
Position Paper ◽  
Medical Evidence

AbstractThe objective of this position paper is to review the current medical evidence andguidelines regarding the treatment of type 2 diabetes (T2DM) and to issue medicalrecommendations strengthening the timely use of insulin in patients with T2DMuncontrolled on noninsulin therapy. When noninsulin therapy fails to achieve or tomaintain HbA1c targets, insulin therapy is required. Timely insulin therapy couldprovide proper metabolic control that might prevent complications, lead toimprovement of life expectancy and quality of life.

scholarly journals Combination of Empagliflozin and Linagliptin as Second-Line Therapy in Subjects With Type 2 Diabetes Inadequately Controlled on Metformin

Diabetes Care ◽  
2015 ◽  
Vol 38 (3) ◽  
pp. 384-393 ◽  
Author(s):  
Ralph A. DeFronzo ◽  
Andrew Lewin ◽  
Sanjay Patel ◽  
Dacheng Liu ◽  
Renee Kaste ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy

scholarly journals The Model of Self Care Behaviour and the Relationship with Quality Of Life, Metabolic Control and Lipid Control of Type 2 Diabetes Mellitus Patients in Binjai City, Indonesia

2018 ◽  
Vol 6 (9) ◽  
pp. 1762-1767 ◽  
Author(s):  
Rina Amelia
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Metabolic Control ◽  
Self Care ◽  
The Self ◽  
Lipid Control ◽  
Diabetes Patients

BACKGROUND: Diabetes is a type of chronic disease with exceptional medical care for a patient's lifetime, which ultimately requires lifestyle and behavioural adjustments to prevent complications to death. Patients with good self-care behaviour will cause diabetes to be controlled to avoid complications to death and make patients have a better quality of life. AIM: This study aims (1) to determine the model of self-care behaviour in Type 2 diabetes patients in Binjai City (2) to analyse the effect of self-care behaviour on quality of life, metabolic control and lipid control of Type 2 diabetes patients in Binjai City. METHODS: This type of research is survey-based and explanatory using a cross-sectional approach. The study population was Type 2 Diabetes Mellitus (T2DM) patients who remained patients in 8 primary health centres in Binjai City. The consecutive sampling yielded a sample size of 115 people. Data analysis method uses descriptive statistics and Structural Equation Modeling (SEM) using SPSS and Amos 16.0. RESULTS: The results showed that all factors that build T2DM patient self-care behaviour were able to be predictors that shape the patient's self-care behaviour. The self-care behaviour model consists of knowledge, attitudes, communication, financing, family support, motivation, and self-efficacy. Motivation is the most significant predictor of its contribution to the self-care behaviour of Type 2 diabetes patients. Self-care behaviour was also known to be significantly related to the quality of life, metabolic control and lipid control of T2DM patients (p < 0.05). CONCLUSION: Self-care behaviour in T2DM patients can have a substantial and significant impact on quality of life, metabolic control and lipid control possessed by Type 2 Diabetes patients.

scholarly journals P1011CARDIOVASCULAR OUTCOME TRIALS (CVOT) USING NEW ANTI-DIABETIC AGENTS IN CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nadia Sarween ◽  
Nuvreen Phagura ◽  
Adnan Sharif
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Second Line ◽  
Second Line Therapy ◽  
Receptor Agonists ◽  
Line Therapy

Abstract Background and Aims The latest consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommends metformin and lifestyle intervention as first-line therapy for type 2 diabetes. Second-line therapy recommendation is the use sodium-glucose cotransporter 2 (SGLT 2) inhibitors (if estimated glomerular filtration rate [eGFR] is adequate) or GLP-1 receptor agonists if eGFR is inadequate (or SGLT-2 inhibitors not tolerated). No recommendation is made for dipeptidyl peptidase-4 (DPP-4) inhibitors. Therapy choices are limited for patients with both type 2 diabetes and moderate-to-severe chronic kidney disease (CKD) and it is unclear from published data if observed cardiovascular benefits of new anti-diabetic agents extend to the CKD cohort. The aim of this study was to undertake a systematic review of all published CVOT trials using new anti-diabetic agents (GLP-1 receptor agonist, DPP-4 inhibitor, SGLT 2 inhibitor). Method We searched MEDLINE (via PubMed and the Cochrane Central Register of Controlled Trials) up to 1st December 2019. Data was stratified by trial entry eGFR into normal (eGFR ≥60 ml/min) and CKD (eGFR &lt;60 ml/min), with data extracted for primary major cardiovascular event (MACE) rates such as cardiovascular death, stroke and/or myocardial infarct. A meta-analysis with random effects model was performed to estimate overall hazard ratios (HRs) for MACE with new anti-diabetic agents stratified by eGFR. Inter-study heterogeneity was assessed with the I2 index and Cochran’s Q test. Results We analysed 13 studies from 16 that were eligible after our search strategy, with 2 excluded due lack of data stratified by eGFR and 1 excluded due to combined MACE/renal outcomes. The studies (GLP-1 agonists, n=6; DPP-4 inhibitors, n=4; SGLT 2 inhibitors, n=3) had a combined total of 128,266 participants (22.1% with eGFR &lt;60 ml/min). HR for MACE with GLP-1 agonists for participants with eGFR ≥60 ml/min was 0.87 (95% CI 0.77-0.98; p=0.02) and for participants with eGFR &lt;60 ml/min was 0.90 (95% CI 0.78-1.04; p=0.14). HR for MACE with DPP-4 inhibitors for participants with eGFR ≥60 ml/min was 0.99 (95% CI 0.92-1.07; p=0.86) and for participants with eGFR &lt;60 ml/min was 0.99 (95% CI 0.91-1.08; p=0.86). HR for MACE with SGLT 2 inhibitors for participants with eGFR ≥60 ml/min was 0.98 (95% CI 0.88-1.10; p=0.78) and for participants with eGFR &lt;60 ml/min was 0.82 (95% CI 0.70-0.96; p=0.01). Significant heterogeneity was observed in the meta-analyses for each new anti-diabetic therapy drug class stratified by eGFR. Conclusion Among the new anti-diabetic agents, our study suggests efficacy for prevention of MACE in the setting of CKD exists only for SGLT 2 inhibitors and not with GLP-1 receptor agonists or DPP-4 inhibitors. Targeted CVOT studies incorporating participants with diabetes and CKD are critical to guide glycaemic management in these high-risk patients. Until then, we suggest recommendations for second-line therapy in patients with type 2 diabetes and renal impairment should be amended to reflect the current evidence base supporting prevention of MACE with SGLT 2 inhibitors versus other new anti-diabetic agents.

Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study

2019 ◽  
Vol 29 (7) ◽  
pp. 736-743 ◽  
Author(s):  
Maria Chiara Rossi ◽  
Antonio Nicolucci ◽  
Alessandro Ozzello ◽  
Sandro Gentile ◽  
Alberto Aglialoro ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Observational Study ◽  
Fear Of Hypoglycemia
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