Evaluation Approach can Significantly Influence Oral Glucose-Lowering Drugs Total Mortality Risks in Retrospective Cohorts of Type 2 Diabetes Mellitus Patients

2014 ◽  
Vol 10 (5) ◽  
pp. 336-342 ◽  
Author(s):  
Mykolay Khalangot ◽  
Volodymir Kovtun
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Total Mortality ◽  
Oral Glucose ◽  
Glucose Lowering ◽  
Mortality Risks ◽  
Evaluation Approach

scholarly journals P1028EFFECTS OF CANAGLIFLOZIN ON MAJOR ADVERSE CARDIOVASCULAR OUTCOMES IN PATIENTS WITH DIFFERENT BASELINE LEVELS OF TYPE 2 DIABETES MELLITUS DISEASE SEVERITY: RESULTS FROM THE CANVAS PROGRAM

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tamara Young ◽  
Jing-wei Li ◽  
Amy Kang ◽  
Hiddo Heerspink ◽  
Carinna Hockham ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Disease Severity ◽  
Cardiovascular Outcomes ◽  
Oral Glucose ◽  
Glucose Lowering ◽  
Duration Of Diabetes ◽  
Event Rates

Abstract Background and Aims Patient with type 2 diabetes mellitus (T2DM) included in trials of sodium-glucose cotransporter 2 inhibitors are heterogeneous in terms of disease severity. We assessed the effects of canagliflozin compared to placebo on cardiovascular and renal outcomes in the CANVAS program according to severity of T2DM as indicated by intensity of treatment, duration of diabetes and glycaemic control. Method We compared effects on major adverse cardiovascular events ([MACE], defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) according to three indicators of T2DM severity at study baseline: number of oral glucose lowering treatments or insulin therapy (0-1, 2, 3+, insulin), duration of diabetes (<10, 10-16, >16 years) and HbA1c (<7.0, 7.0-7.5, 7.5-8.0, 8.0-8.5, 8.5-9, >9.0%). We also assessed effects on other pre-specified cardiovascular outcomes, and an adjudicated composite of end-stage kidney disease, renal death or sustained 40% decline in estimated glomerular filtration rate. We assessed for constancy of hazard ratios across subgroups by fitting an interaction term that tested for linear trend. Results Of 10,142 participants in the CANVAS Program, 1011 experienced a MACE during a mean follow-up of 3.6 years. Event rates for MACE were higher in those with longer duration of diabetes and higher HbA1c at baseline. The effect of canagliflozin on MACE in the overall population (HR 0.86, 95 % CI 0.75-0.97) was consistent irrespective of the number of glucose lowering treatments (p=0.509), duration of diabetes (p=0.174) and baseline HbA1c (p =0.314). Effects were also consistent across different levels of T2DM disease severity for all other outcomes studied. Conclusion Higher event rates were observed in those with longer disease duration and higher HbA1c. The proportional risk reductions achieved with canagliflozin were comparable regardless of diabetes duration, number of therapies or HbA1C at baseline.

scholarly journals Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study

Gut ◽  
2019 ◽  
Vol 69 (2) ◽  
pp. 295-303 ◽  
Author(s):  
Annieke C G van Baar ◽  
Frits Holleman ◽  
Laurent Crenier ◽  
Rehan Haidry ◽  
Cormac Magee ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Multicentre Study ◽  
Treatment Satisfaction ◽  
Oral Glucose ◽  
Open Label ◽  
Glucose Lowering

BackgroundThe duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months.MethodsInternational multicentre, open-label study. Patients (BMI 24–40) with T2D (HbA1c 59–86 mmol/mol (7.5%–10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction.ResultsForty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (−10±2 mmol/mol (−0.9%±0.2%), p<0.001), FPG (−1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (−2.9±1.1, p<0.001), weight was modestly reduced (−2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly.ConclusionsIn this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further.Trial registration numberNCT02413567

scholarly journals Clinical And Biochemical Outcomes Of Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors In Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A467-A467
Author(s):  
Muhammad Saleem ◽  
Nanik Ram ◽  
Sajjad Ali Khan ◽  
Zafar Aleem Suchal ◽  
Muhammad Mustansir Mehdi Khan
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Standard Deviation ◽  
P Value ◽  
Oral Glucose ◽  
Glucose Lowering

Abstract Background: SGLT-2 inhibitors are a group of oral medications that work independently of insulin working as anti-diabetics by enhancing the excretion of glucose. The purpose of our study was to assess the improvement in terms of HbA1c, weight, blood pressure and BMI and the hepatics and renal effect in terms of SGPT and Creatinine in patients already on three oral glucose lowering agents when SGLT-2 inhibitor was added to their medications. Methods: This retrospective, real world, single center study included 99 patients (mean age [Standard Deviation]: 53.8 [9.63] years) with poorly control type 2 diabetes. Data was recorded at three times, before the addition of SGLT-2 inhibitor and then at 3 and 6 month follow up after the drug had been added in patient’s medications. Physical parameters namely weight, BMI and blood pressure were recorded in the clinic while HbA1c, SGPT and Creatinine were checked by laboratory. Results: Improvement was seen in all parameters at both 3 and 6 month follow up interval. The reduction in HbA1c was statistically significant (P-value &lt; 0.001) with (Mean Reduction [Standard Deviation)) 0.81[1.02] % at 3 months and 1.07[1.11] % at 6 months. Weight was also significantly reduced (P-value &lt; 0.001) with (MR [SD]) 1.83[2.32] kg at 3 and 4.02[6.04] kg at 6 months. Statistically significant reduction (P-value &lt; 0.001) in BMI was also seen with 0.69[0.95] kgm-2 at 3 months and 2.13[3.41] kgm-2 at 6 months of follow up. The systolic blood pressure showed significant reduction (P-value &lt; 0.05) of 5.9[15.76] mmHg at 3 months and 6.37[18.33] mmHg at 6 months. The creatinine and SGPT values of the patient showed minimal variation over the course of these 6 months of follow up. Conclusion: Our study showed that SGPT-2 can be reliably used in patients in which diabetes is not being controlled by other glucose lowering agents and is safe for use in patients in which hepatic and renal function needs to be preserved. Keywords: SGLT-2 inhibitors, Type 2 Diabetes Mellitus, Pakistan

Cinammon (Cinnamomum Spp.) and Type 2 Diabetes Mellitus

2019 ◽  
Vol 18 (3) ◽  
pp. 247-255
Author(s):  
Sierra-Puente D. ◽  
Abadi-Alfie S. ◽  
Arakanchi-Altaled K. ◽  
Bogard-Brondo M. ◽  
García-Lascurain M. ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Fasting Blood Glucose ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Key Aspects

Spices such as cinnamon (Cinnamomum Spp.) have been of interest due to their phytochemical composition that exert hypoglycemic effects with potential for management of type 2 diabetes mellitus (T2DM). We summarize data from 27 manuscripts that include, one book chapter, 3 review articles, 10 randomized controlled trials, 4 systematic reviews with meta-analysis, and 9 preclinical studies. The most frequently used cinnamon variety was Cinnamomum cassia rather than the Cinnamomum zeylanicum, whereas outcomes were defined as fasting blood glucose, glycated hemoglobin, and oral glucose tolerance test. A great variability in methodology such as different doses (from 120 mg to 6 g), duration of intervention, data retrieved and use of different concomitant medication, were found to be key aspects of most of trials and systematic reviews with meta-analysis available to date. Low quality studies have been made in most cases with a lot of heterogeneity clouding significance of results. More research needs to be done in order to yield accurate evidence for evidence-based recommendations. Its use is not currently a reliable nor advisable option for the treatment of T2DM.

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