scholarly journals Glucose-Lowering Medications and Post-Dementia Survival in Patients with Diabetes and Dementia

2022 ◽  
pp. 1-13
Author(s):  
Juraj Secnik ◽  
Hong Xu ◽  
Emilia Schwertner ◽  
Niklas Hammar ◽  
Michael Alvarsson ◽  
...  
Keyword(s):  
Survival Models ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Intention To Treat ◽  
Dementia Patients ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide 1 ◽  
Using Data

Background: The effectiveness of glucose-lowering drugs (GLDs) is unknown among patients with dementia. Objective: To analyze all-cause mortality among users of six GLDs in dementia and dementia-free subjects, respectively. Methods: This was a longitudinal open-cohort registry-based study using data from the Swedish Dementia Registry, Total Population Register, and four supplemental registers providing data on dementia status, drug usage, confounders, and mortality. The cohort comprised 132,402 subjects with diabetes at baseline, of which 11,401 (8.6%) had dementia and 121,001 (91.4%) were dementia-free. Subsequently, comparable dementia – dementia-free pairs were sampled. Then, as-treated and intention-to-treat exposures to metformin, insulin, sulfonylurea, dipeptidyl-peptidase-4 inhibitors, glucagon-like peptide-1 analogues (GLP-1a), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) were analyzed in the parallel dementia and dementia-free cohorts. Confounding was addressed using inverse-probability weighting and propensity-score matching, and flexible parametric survival models were used to produce hazard ratios (HR) and 95% confidence intervals (CI) of the association between GLDs and all-cause mortality. Results: In the as-treated models, increased mortality was observed among insulin users with dementia (HR 1.34 [95%CI 1.24–1.45]) as well as in dementia-free subjects (1.54 [1.10–1.55]). Conversely, sulfonylurea was associated with higher mortality only in dementia subjects (1.19 [1.01–1.42]). GLP-1a (0.44 [0.25–0.78]) and SGLT-2i users with dementia (0.43 [0.23–0.80]) experienced lower mortality compared to non-users. Conclusion: Insulin and sulfonylurea carried higher mortality risk among dementia patients, while GLP-1a and SGLT-2i were associated with lower risk. GLD-associated mortality varied between dementia and comparable dementia-free subjects. Further studies are needed to optimize GLD use in dementia patients.

Abstract P444: Changes in Glucose-Lowering Medication Prescriptions After an Incident Cardiovascular Event Across eGFR Levels in an Integrated Health System

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jung-Im Shin ◽  
Elizabeth Selvin ◽  
Lesley Inker ◽  
Jodie Reider ◽  
Alex R CHANG ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health System ◽  
Cardiovascular Event ◽  
Diabetes Duration ◽  
Cardiovascular Risk Reduction ◽  
Antihypertensive Medications ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes

Introduction: Cardiovascular disease is a major complication among patients with diabetes, and may merit changes in both antihypertensive medications (e.g., to beta blockers and ACE inhibitors) and glucose-lowering medications (e.g., to sodium-glucose cotransporter 2 inhibitors [SGLT2i] and glucagon-like peptide 1 receptor agonists [GLP1 RA], medication classes with evidence of cardiovascular outcome benefit). The objective of this study was to assess how glucose-lowering medication prescriptions changed after a cardiovascular event among persons with diabetes. Hypothesis: There are changes in glucose-lowering medication prescription following a cardiovascular event. Methods: We identified adult patients with diabetes and estimated glomerular filtration rate (eGFR)≥15mL/min/1.73 m 2 who experienced a cardiovascular event (myocardial infarction, stroke, or heart failure) from 2005-2018 in the Geisinger Health System (cases). We selected control patients with diabetes but without a cardiovascular event by 1:1 matching on demographics, diabetes duration, HbA1c, eGFR, and calendar year. Results: In 15,918 matched case and control patients with diabetes (mean age 65 years, 52% female, mean HbA1c 7.55%, median diabetes duration 5.6 years, and 28% eGFR<60 mL/min/1.73 m 2 ), insulin prescriptions increased and metformin prescriptions decreased after a cardiovascular event among cases compared with controls in all eGFR categories ( Table ). There were no differences between cases and controls with respect to changes in SGLT2i, GLP1 RA, or dipeptidyl peptidase 4 inhibitors (DPP4i). Conclusions: In a real-world setting, insulin prescriptions increased and metformin prescriptions decreased, after a cardiovascular event regardless of eGFR level. Prescriptions for SGLT2i and GLP1 RA did not change following a cardiovascular event in all eGFR categories. More efforts are needed to provide optimal therapies for cardiovascular risk reduction in patients with diabetes and cardiovascular disease.

scholarly journals The Effects of DPP-4 Inhibitors, GLP-1RAs, and SGLT-2/1 Inhibitors on Heart Failure Outcomes in Diabetic Patients With and Without Heart Failure History: Insights From CVOTs and Drug Mechanism

2020 ◽  
Vol 11 ◽  
Author(s):  
Xiaohui Pan ◽  
Shishi Xu ◽  
Juan Li ◽  
Nanwei Tong
Keyword(s):  
Heart Failure ◽  
Diabetic Patients ◽  
Dipeptidyl Peptidase 4 ◽  
Cardiovascular Outcome Trials ◽  
Drug Mechanism ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
History Of ◽  
Glucagon Like Peptide 1 ◽  
Diabetes Drug

Patients with type 2 diabetes (T2D) have a higher risk of heart failure (HF) than healthy people, and the prognosis of patients with diabetes and current or previous HF is worse than that of patients with only diabetes. We reviewed the HF outcomes in recently published cardiovascular outcome trials (CVOTs) of three new classes of anti-diabetic agents, namely, dipeptidyl peptidase-4 inhibitors (DPP-4is), glucagon-like-peptide 1 receptor agonists (GLP-1RAs), and sodium glucose cotransporter-2 inhibitors (SGLT-2is) or SGLT-2 and SGLT-1 dual inhibitors and divided the patients into two groups based on the history of HF (with or without) and analyzed their risks of HHF based on the receipt of the aforementioned anti-diabetes drug types. Since the follow-up period differed among the trials, we expressed the rate of HHF as events/1,000 person-years to describe the HF outcome. At last we pooled the data and analyzed their different effects and mechanisms on heart failure outcomes. Although DPP-4is did not increase the risk of HHF in T2D patients with a history of HF, they were associated with a significantly higher risk of HHF among patients without history of HF. Some GLP-1RAs reduced the risk of macrovascular events, but none of these drugs reduced the risk of HHF in patients with T2D irrespective of their HF history. It was not clarified whether SGLT-1/2is can improve the prognosis of macrovascular events in patients with T2D, but these drugs reduced the risk of HHF regardless of patients’ histories of HF. This information may be useful or referential for the “precise” selection of hyperglycemic medications. Further researches still needed to clarify the mechanisms of these anti-diabetic medications.

scholarly journals Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

2021 ◽  
Author(s):  
Hui Shao ◽  
Michael Laxy ◽  
Stephen R. Benoit ◽  
Yiling J. Cheng ◽  
Edward W. Gregg ◽  
...  
Keyword(s):  
Decomposition Analysis ◽  
Fee For Service ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Drug Classes ◽  
Out Of Pocket Payments ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Main Driver ◽  
Glucagon Like Peptide 1 ◽  
Total Payment

<b><i>Objective </i></b> <p>To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018.</p> <p><b><i>Methods</i></b></p> <p>We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. </p> <p><b><i>Results</i></b></p> <p>Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase.<b><i> </i></b></p> <p><b><i>Conclusion</i></b></p> <p>Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver. </p>

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

scholarly journals Regulatory and clinical perspective on patient access to antidiabetic medicines in Slovenia

2021 ◽  
pp. 58-58
Author(s):  
Spela Zerovnik ◽  
Nika Mardjetko ◽  
Igor Locatelli ◽  
Mitja Kos
Keyword(s):  
National Registry ◽  
Point Of View ◽  
Multidisciplinary Teams ◽  
Patient Access ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Regulatory Bodies ◽  
Verbatim Transcript ◽  
Glucagon Like Peptide 1

Introduction/Objective. Three novel classes of antidiabetic medicines have been introduced to the market in the last decade, namely dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 analogues and sodium-glucose co-transporter 2 inhibitors. There are many factors that influence patient access to these medicines and their utilization in clinical practice that need to be explored. The aim of the study was to gain an insight into patient access to antidiabetic medicines in Slovenia from a regulatory and clinical point of view. Methods. A focus group with five Slovenian experts (representatives of regulatory bodies and prescribers of antidiabetic medicines) was performed in January 2019. The discussion was audiotaped upon obtaining written consent from the experts and transformed into a verbatim transcript. Two researchers independently analyzed the content of the discussion, using NVivo 11 to identify main themes and subthemes. Results. Slovenia provides satisfactory patient access to antidiabetic medicines; however, prescribing restrictions and unequal access to diabetologists in the Slovenian regions may limit patient access to novel antidiabetic medicines. Prescribing restrictions should be aligned with the new evidence on cardiovascular benefit of some antidiabetic medicines. A national registry of patients with diabetes should be established in order to obtain reliable data on patient outcomes and improve the quality of patient care. Conclusion. Patient access to antidiabetic medicines not only in Slovenia but also in other countries could be improved by changing prescribing restrictions, establishment of national registries of patients with diabetes and involvement of multidisciplinary teams in diabetes care.

Adverse Effects Associated With Newer Diabetes Therapies

2016 ◽  
Vol 30 (2) ◽  
pp. 238-244 ◽  
Author(s):  
Oluwaranti F. Akiyode ◽  
Adebola A. Adesoye
Keyword(s):  
Type 2 Diabetes ◽  
Adverse Effects ◽  
Dipeptidyl Peptidase 4 ◽  
Health Care Practitioners ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

The increasing number of newer type 2 diabetes therapies has allowed providers an increased armamentarium for the optimal management of patients with diabetes. In fact, these newer agents have unique benefits in the management of type 2 diabetes. However, they are also associated with certain adverse effects. This review article aims to describe the notable adverse effects of these newer antidiabetic therapies including the glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and the sodium-glucose cotransporter 2 inhibitors. The adverse effects reviewed herein include pancreatitis, medullary thyroid carcinoma, heart failure, gastrointestinal disturbances, renal impairment, and genitourinary infections. More clinical data are necessary to solidify the association of some of these adverse effects with the newer diabetes agents. However, it is important for health care practitioners to be well informed and prepared to properly monitor patients for these adverse effects.

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