scholarly journals Number of type 2 diabetes patients achieving HbA1c goal and Related Factors in Brazil: A real world evidence study

2020 ◽  
Author(s):  
Lillian Harder ◽  
Tarik K Andrade ◽  
Fernando B Serra ◽  
Felipe M Pinho ◽  
Adolfo Pinzon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Glycated Hemoglobin ◽  
Goal Achievement ◽  
Antidiabetic Agent ◽  
Antidiabetic Agents ◽  
Final Level ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background Despite the clinical advances in the management of type 2 diabetes mellitus (T2DM) over the past decades, in the US, nearly 48% of patients do not achieve the ADA recommended glycemic goal of glycated hemoglobin (HbA1c) below 7.0%1. The Brazilian Guidelines for the Treatment of T2DM has established the same goal of HbA1c below 7.0%2, but the data for the rate of glycemic goal achievement in Brazil is lacking. The aim of this study was to determine the rate of HbA1c goal achievement among Brazilian patients receiving antidiabetic therapy and investigate its relation to other clinical and demographic covariates. Methods Using a cross-sectional database analysis from a group of private clinics in São Paulo, Brazil, this Real Word Evidence study evaluated 1034 patients with T2DM, which were being treated with at least one antidiabetic agent for a minimum of three months and had a basal level of Glycated Hemoglobin (HbA1c) above 7.0%. The number of patients that did not achieve the therapeutic target of HbA1c below 7% was calculated. Demographic and clinical characteristics were collected and a correlation analysis with the treatment target achievement was performed. Results The average age of the population was 60.5 years and gender were equally distributed. A total of 60.3% of the patients did not achieve the target of HbA1c below 7% after a minimum of three months treatment with one or more antidiabetic agents. The average time between HbA1c basal to final was 9.9 months. The average basal level of HbA1c was 9.9% ± 2.2 and the final level was 7.8% ± 1.9. In the univariate analysis a statistically significant difference was observed in the following clinical variables: age, total cholesterol level, LDL level, basal and final HbA1c, time to HbA1c final measure, treatment time, and number of antidiabetic agents. Conclusion In this retrospective real-world study, only 40% of patients achieved the glycemic target of HbA1c below 7% after at least 3 months of treatment with one or more antidiabetic agent. The average initial HbA1c was 9.9% and the final level was 7.8%. Patients not at goal were older and had more comorbidities, which highlight the challenge that represents the management of diabetes in Brazil. This study confirms previous published data that T2DM glycemic targets are difficult to achieve and the reasons for this are complex and multifactorial

scholarly journals MON-624 Effect of Whole Body Vibration on Glycemic Control in Adults with Type 2 Diabetes

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Manuela de Lucca Michels ◽  
Ana Clara d’Acampora ◽  
Camila Sartor Spivakoski ◽  
Priscila Nobre Dantas Mattje ◽  
Bruna da Silva Réus ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Glycated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Whole Body Vibration ◽  
Whole Body ◽  
Control Group ◽  
Body Vibration ◽  
Number Of Patients

Abstract Introduction: Physical activity plays an important role in glycemic control in patients with type 2 diabetes, but overall adherence rate is low. For patients not able or willing to engage in regular physical exercise, whole body vibration comes as a potential alternative. Objective: To evaluate the effect of 28Hz whole body mechanical vibration on glycemic control and other metabolic parameters in patients with type 2 diabetes. Methods: 24 adults with type 2 diabetes on oral antidiabetic agents, with a baseline HbA1c between 6.5 and 9.0%, were randomized into two groups. The control group (CG) was advised to adopt lifestyle modifications, and the intervention group (IG) received the same orientations and used a 28 Hz whole body vibrating platform daily for 20-30 minutes during 12 weeks. Results: Data from 22 patients were analyzed (one from each group was excluded). Baseline characteristics of both groups were similar except for triglycerides, which were higher in the CG (111.8±39.9 mg/dL vs. 188.9±68.8 mg/dL, p<0.05). After 12 weeks, there was a significant reduction in glycated hemoglobin in the IG (7.69±0.49 vs. 7.17±0.77%, p<0.05), not observed in the CG (8.05±0.98 vs. 7.92±1.07%, p=0.52). A non-significant trend for weight loss in IG was observed (78.14±10.47 vs. 77.14±11.08Kg, p=0.069). There were no significant differences between the groups regarding fasting blood glucose or any other clinical and biochemical variables analyzed. Conclusion: This study suggests an improvement in glycated hemoglobin at 12 weeks with the use of the 28Hz vibration platform in patients with type 2 diabetes. However, further studies with a larger number of patients and longer follow-up are needed to better define the role of whole body vibration as an adjuvant in glycemic control.

scholarly journals Use Of The GLYCEMIZER® Tool By General Practitioners To Meet Individual Glycated Hemoglobin Goals In Patients With Type 2 Diabetes Mellitus

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Nicolas Byron Hatziisaak ◽  
Telemachos Hatziisaak ◽  
Urs Keller
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
General Practitioners ◽  
Glycated Hemoglobin ◽  
Cross Sectional Survey ◽  
Significant Difference ◽  
The Individual ◽  
Hba1c Levels

Background — For general practitioners (GPs), it is often not easy to determine the individual glycated hemoglobin (HbA1c)-goal of patients with type 2 diabetes mellitus (T2DM) in order to offer them a tailored treatment and minimize side effects. Usually, they simply rely on their gut feeling. Objective — We assessed the usefulness of an easy-to-use algorithm (GLYCEMIZER®) to calculate individual HbA1c-goals and compared them with targeted (‘gut feeling’ of the GP’s) and achieved levels. Material and Methods — In this cross-sectional survey, general practitioners were asked to report anonymized data of at least 30 consecutive patients with T2DM presenting in their offices from May 1st to August 15th 2016 after obtaining informed consent. Demographic, clinical and biochemical data were used for the GLYCEMIZER® tool to calculate the individual HbA1c-goals. A statistical analysis was conducted in order to compare the calculated HbA1c-goals with targeted and achieved HbA1c-levels. Results — A total of 184 patients (mean age: 69y) were enrolled by 6 participating general practitioners from the Werdenberg-Sarganserland region in eastern Switzerland. Four patients did not meet the inclusion criteria. The overall median calculated HbA1c-goal did not differ from the targeted and achieved levels (7.1% vs. 7.0% vs. 7.1%, p=0.894). There was a significant difference between achieved and calculated HbA1c-levels in patients aged <50 (n=13, median 7.2% vs. 6.5%, p=0.014), goals not achieved) and patients aged >71 (n=85, median 6.9% vs. 7.5%, p=0.005), lower levels achieved in relation to calculated HbA1c-goals). Both in patients treated with insulin (n=44) and in patients without insulin (n=136) the achieved HbA1c-levels met the calculated goals (no insulin: 6.9% vs. 7.0%, ns; with insulin: 7.8% vs. 7.7%, ns). In regard to CKD-stages 3 and 4 the achieved HbA1c-levels were significantly lower than calculated (n= 41, median 6.9% vs. 7.6%, p=0.001). Conclusion — Calculating HbA1c-goals using the GLYCEMIZER tool is more accurate than relying on gut feeling alone, and is specifically useful in the treatment of patients with T2DM of less than 50, as well as more than 70 years of age. Furthermore, it is helpful to meet individual HbA1c-goals in patients with CKD-stages 3+.

scholarly journals Real-world Observational Study on Patient Outcomes in Diabetes (RESPOND): study design and baseline characteristics of patients with type 2 diabetes newly initiating oral antidiabetic drug monotherapy in Japan

2020 ◽  
Vol 8 (2) ◽  
pp. e001361
Author(s):  
Daisuke Yabe ◽  
Hiroko Higashiyama ◽  
Takashi Kadowaki ◽  
Hideki Origasa ◽  
Iichiro Shimomura ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Patient Outcomes ◽  
Real World ◽  
Glycated Hemoglobin ◽  
Self Care ◽  
Antidiabetic Drug ◽  
Oral Antidiabetic Drug ◽  
Oral Antidiabetic ◽  
Diet And Exercise

IntroductionTo investigate factors affecting glycemic control, oral antidiabetic drug (OAD) treatment distribution and self-care activities among patients with type 2 diabetes mellitus (T2DM) who newly initiate OAD monotherapy in a real-world setting in Japan.Research design and methodsA Real-world Observational Study on Patient Outcomes in Diabetes (RESPOND) is an ongoing, prospective, observational cohort study with follow-up at 6, 12, 18 and 24 months. Primary objectives include OAD treatment patterns (cross-sectional and longitudinal) among diabetes specialists versus non-specialists; adherence to diabetes self-care activities; quality of life; treatment satisfaction among patients and target attainment rates of parameters, including glycated hemoglobin. Here, we present the study design and baseline data.ResultsOf 1506 patients enrolled (June 2016–May 2017; 174 sites in Japan), 1485 were included in the baseline analysis (617 treated by specialists, 868 by non-specialists). Most patients were prescribed dipeptidyl peptidase-4 inhibitors (DPP-4Is) (specialist vs non-specialist, 54.1% vs 57.1%), then sodium-glucose cotransporter 2 inhibitors (13.9% vs 22.2%), metformin (20.3% vs 12.9%) and other OADs (<5% individually in both groups). Regardless of age, body mass index and glycated hemoglobin, DPP-4Is were the most commonly prescribed OADs by both specialists and non-specialists. About one-fifth and one-third of patients visiting specialists and non-specialists, respectively, received no advice on diet and exercise. The proportion of patients following self-care recommendations for diet and exercise (2/5 items on the Summary of Diabetes Self-Care Activities) was significantly higher among those visiting specialists than non-specialists.ConclusionThe use of newer OAD was common across a broad range of clinical characteristics in patients with T2DM who newly initiated monotherapy in Japan. However, patient-related and physician-related factors could affect the treatment changes during the following course of treatment. In addition, treatment outcome could vary with the observed difference in the level of patient education provided by diabetes specialists versus non-specialists.

Controlling glycated hemoglobin prevent diabetic retinopathy

2019 ◽  
Vol 7 (2) ◽  
pp. 125-137
Author(s):  
Philip Patel ◽  
Alan Craig
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Diabetic Retinopathy ◽  
Visual Loss ◽  
Glycated Hemoglobin ◽  
Common Cause ◽  
Medline Search ◽  
Global Pandemic ◽  
Number Of Patients

The overall number of patients with Diabetic retinopathy (DR) will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Diabetic retinopathy is the most common cause of visual loss in United Kingdom. A systematic medline search was conducted initially using the following keywords: clinical trials, diabetic retinopathy, hyperglycemia, macular edema, visual loss. Relevant abstracts and computer links to these abstracts were reviewed and a preliminary list of possible articles from this search was compiled. Next, the original articles from the list were retrieved and evaluated. Based on landmark of data, DR have become preventable by controlling hyperglycemia targeting HbA1c<7.0%, with other multifactorial treatment.

Controlling glycated hemoglobin prevent diabetic retinopathy

2019 ◽  
Vol 7 (2) ◽  
pp. 125-137
Author(s):  
Philip Patel ◽  
Alan Craig
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Diabetic Retinopathy ◽  
Visual Loss ◽  
Glycated Hemoglobin ◽  
Common Cause ◽  
Medline Search ◽  
Global Pandemic ◽  
Number Of Patients

The overall number of patients with Diabetic retinopathy (DR) will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Diabetic retinopathy is the most common cause of visual loss in United Kingdom. A systematic medline search was conducted initially using the following keywords: clinical trials, diabetic retinopathy, hyperglycemia, macular edema, visual loss. Relevant abstracts and computer links to these abstracts were reviewed and a preliminary list of possible articles from this search was compiled. Next, the original articles from the list were retrieved and evaluated. Based on landmark of data, DR have become preventable by controlling hyperglycemia targeting HbA1c<7.0%, with other multifactorial treatment.

scholarly journals Sodium-glucose cotransporter-2 inhibitors and risk for genitourinary infections in older adults with type 2 diabetes

2021 ◽  
Vol 12 ◽  
pp. 204209862199770
Author(s):  
Navya Varshney ◽  
Sarah J. Billups ◽  
Joseph J. Saseen ◽  
Cy W. Fixen
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Urinary Tract ◽  
Real World ◽  
Fungal Infections ◽  
Sodium Glucose Cotransporter ◽  
Increased Risk ◽  
Significant Difference ◽  
Tract Infections

Background and aims: Although landmark clinical trials have demonstrated an increased risk for genitourinary infection (GUI) after initiation of sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy that led to an FDA label warning, real world findings have been inconsistent and evidence specifically in older adults is lacking. The objective of the study was to examine the incidence of GUI in patients aged 65 years or older initiated on SGLT2i compared with glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy at a large academic health system. Methods: A retrospective population-based cohort study was conducted using electronic health records of patients aged 65 years and older with a diagnosis of type 2 diabetes mellitus. Patients newly initiated on SGLT2i or GLP1-RA therapy with estimated glomerular filtration rate (eGFR) ⩾30 mL/min per 1.73 m² and active within the health system for at least 1 year prior to initiation were included. We compared the incidence of inpatient, emergency room, or outpatient diagnosis of GUI (bacterial and mycotic) within 6 months of SGLT2i or GLP1-RA initiation. A chi-square or Fisher’s exact test were used to analyze between-group differences for categorical variables, while a t-test was used for continuous variables. A Cox proportional hazards model was used to estimate the impact of confounding variables on the primary outcome. Results: One hundred and thirty-three patients were initiated on SGLT2i therapy and 341 patients newly initiated on GLP1-RA therapy. After adjusting for differences in age, A1c, body mass index, eGFR, race and sex, there was no statistically significant difference in GUI incidence within 6 months of SGLT2i versus GLP1-RA initiation (3.8% versus 6.5%, adjusted hazard ratio: 0.784, 95% confidence interval 0.260–2.367). Conclusion: We found no increased risk of composite GUI within 6 months of initiating SGLT2i compared with GLP1-RA therapy. These real-world data in older adults add to previous findings, which suggest no increased risk of urinary tract infection with SGLT2i initiation. Plain language summary A class of antidiabetic medications and risk for genitourinary infections in older adults with type 2 diabetes Older adults with type 2 diabetes often benefit from a class of antidiabetic medications known as sodium-glucose cotransporter-2 inhibitors (SGLT2is) which help to lower blood glucose, decrease risk for cardiovascular disease and prevent kidney disease progression. However, there is concern that these medications may increase risk for urinary tract infections and/or genital fungal infections in older adults based on clinical trial evidence. Our study evaluated the real-world occurrence of these safety events in patients aged 65 years or older who were newly started on these medications. We compared these patients with a group of patients newly started on an alternative class of antidiabetic agents which are not expected to increase risk for infections, known as glucagon-like peptide-1 receptor agonists (GLP1-RA). In our study, we included 133 patients who started an SGLT2i and 341 patients who started a GLP1-RA at a large teaching hospital. We evaluated the occurrence of infection up to 6 months after initiation of these mediations. We found no significant difference in infection rate between these two groups. We conclude in the study that the use of SGLT2i in older adults was not associated with increased risk for urinary tract infections or genital fungal infections when compared with GLP1-RA use.

scholarly journals The Role of Serum Angiopoietin-Like Protein 4 (ANGPTL-4) and its Gene in Iraq Patients with Type2 Diabetes Mellitus: Case-Control Study

2021 ◽  
Vol 24 (4) ◽  
pp. 7-14
Author(s):  
Aseel Ali Abd Ali Sahib ◽  
◽  
Mohammed I. Hamzah ◽  
Mahmood Shakir Khudhair ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Case Control Study ◽  
Glycated Hemoglobin ◽  
Control Group ◽  
Diabetes Group ◽  
Significant Difference ◽  
Control Study

Background Type 2 Diabetes Mellitus is produced by cell failure of pancreatic cells and insulin resistance and is a disorder in which the amount of sugar in the blood is elevated. Angiopoietin-like protein 4 (ANGPTL4) functions as an inhibitor of lipoprotein lipase, a critical enzyme in lipid metabolism. The aim of this study was to explore if the ANGPTL4 gene's E40K variant and ANGPTL4 serum levels are related to the Body mass index, fasting glucose levels, lipid levels, and glycated hemoglobin.Method75 people were enrolled in this case-control study, 25 of whom had type 2 diabetes mellitus while the other 50 were healthy control subjects. Fasting blood glucose, Lipid profile, Glycated hemoglobin were estimated by Cobas 111 analyzer, BMI (weight, height) was calculated, angiopoietin-like protein 4by anenzyme-linked immune sorbent test kit and TaqMan genotyping-based real-time PCR was used to ascertain ANGPTL4 genotypes. The variant was linked to the risk of Type 2 Diabetes Mellitus and parameters used to quantify the variant were identified. Result Patients in the 30-50 age range with type 2 diabetes and those in the same age group who serve as controls. The control group had a lower level of angiopoietin-like protein 4 (ANGPTL4) than the diabetes group. Patients with T2DM had a substantially (p< 0.0001) greater fasting serum Angiopoietin-like protein 4 level than the control group (135.1±6.70) ng/ml and (62.35±6.4) ng/ml, respectively. The diabetes group has significantly higher fasting serum glucose, lipid profile, and glycated hemoglobin compared with non-diabetics. Serum Angiopoietin-like protein 4 was correlated positively with body mass index. (CC,CT,TT) genotypes of the rs2010871 polymorphism There was a significant difference in frequency of the control group (p =0.0477); however, there was no significant difference in its level of (diabetics, newly diagnosed type 2 diabetic before treatment)p-value (0.7066, 0.5555) respectively Conclusion Serum Angiopoietin-like protein 4 levels are negatively correlated to cholesterol, positively correlated to triglyceride, negatively correlated to HDL, positively correlated to HbA1c, negatively correlated to LDL, negatively correlated to VLDL, negatively correlated to FBS, negatively correlated to BMI. The C>T allele at the ANGPTL4 gene's rs2010871polymorphic locus was linked to a decreased prevalence of Type 2 diabetes.

scholarly journals The Effect of Uric Acid and Bilirubin Levels on Type 2 Diabetes Mellitus Development in Prediabetic Patients

2019 ◽  
pp. 1-6
Author(s):  
Burak Furkan Demir ◽  
Alper Alay ◽  
Aslı Kısacık ◽  
Burak Furkan Demir ◽  
Dilek Berker ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Uric Acid ◽  
Total Bilirubin ◽  
Oral Glucose ◽  
Number Of Patients ◽  
Significant Difference

Background: This study aims to investigate whether or not uric acid and bilirubin have a role in the development of type 2 diabetes mellitus (T2DM) in prediabetic patients. Methods: 93 patients were included in the study. These patients were diagnosed as being prediabetic using the oral glucose tolerance test, and they also had their serum uric acid and total bilirubin measured during the follow-up application (1 - 5 years). Results: 17 out of the 93 patients developed T2DM during the study period. The only significant difference between the T2DM group and the non-T2DM group was OGTT 0.min and 120.min (p=0.001 and p=0.007, respectively). Analysis of the relationship between age, sex, HbA1c, uric acid, total bilirubin, direct bilirubin levels and T2DM development showed that none of the aforementioned risk factors were related with diabetes development. In the non-T2DM group, the median total bilirubin level was only found to be higher in the baseline assessment (p=0.042). Conclusion: It was found that uric acid and bilirubin had no effect on the development of diabetes in the 1-5-year follow-up of prediabetic patients. Randomized-controlled studies of a larger number of patients and sufficient follow-up time are required to provide clearer data on this topic.

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