Compliance with Prescription Guidelines for Glucose-Lowering Therapies According to Renal Function: Real-Life Study in Inpatients of Internal Medicine, Endocrinology and Cardiology Units

Background and objectives: Renal failure is a contraindication for some glucose-lowering drugs and requires dosage adjustment for others, particularly biguanides, sulfonylureas, and inhibitors of dipeptidyl peptidase 4. In this study, we assessed adherence to prescription recommendations for glucose-lowering drugs according to renal function in hospitalized diabetic subjects. Materials and Methods: This prospective cohort study was carried out over a 2-year period in a university hospital. Glomerular filtration rate (GFR) was determined by averaging all measurements performed during hospitalization. Glucose-lowering drug dosages were analyzed according to the recommendations of the relevant medical societies. Results: In total, 2071 diabetic patients (53% hospitalized in cardiology units) were examined. GFR was <30 mL/min/1.73 m2 in 13.4% of these patients, 30–44 in 15.1%, 45–60 in 18.3%, and >60 in 53.3%. Inappropriate oral glucose-lowering treatments were administered to 273 (13.2%) patients, including 53 (2.6%) with a contraindication. In cardiology units, 53.1% and 14.3% of patients had GFRs of <60 and <30 mL/min/1.73 m2, respectively, and 179 (15.4%) patients had a contraindication or were prescribed an excessive dose of glucose-lowering drugs. Conclusions: We showed that the burden of inappropriate prescriptions is high in diabetic patients. Given the high number of patients receiving these medications, particularly in cardiology units, a search for potential adverse effects related to these drugs should be performed.

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Pasireotide-LAR in acromegaly patients treated with a combination therapy: a real-life study

Endocrine Connections ◽

10.1530/ec-19-0332 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1383-1394 ◽

Cited By ~ 3

Author(s):

Hélène Lasolle ◽

Amandine Ferriere ◽

Alexandre Vasiljevic ◽

Sandrine Eimer ◽

Marie-Laure Nunes ◽

...

Keyword(s):

Combination Therapy ◽

First Generation ◽

Real Life ◽

University Hospital ◽

Diabetic Patients ◽

Life Study ◽

Antidiabetic Treatment ◽

Lack Of Control ◽

Before And After ◽

Granulation Pattern

Purpose Little data are available regarding the safety and efficacy of switching to Pasireotide-LAR monotherapy in acromegaly patients with partial resistance to first-generation somatostatin agonists (1gSRL) who require combination treatment with cabergoline or pegvisomant. Method In this monocentric prospective study within a tertiary university hospital, 15 consecutive acromegalic adults partially resistant to 1gSRL treated with octreotide LAR or lanreotide SR, and cabergoline (n = 4, 3.5 mg/week) or pegvisomant (n = 11, median dose 100 mg/week), were switched to Pasireotide-LAR (8 with 40 mg/month; 7 with 60 mg/month). Immunohistochemical expression level of SSTR5 and the granulation pattern of nine somatotroph adenomas were retrospectively determined to test for a correlation with the therapeutic efficacy of Pasireotide-LAR. Results Median IGF-1 concentration at the first evaluation (median 3 months) was similar to baseline (1.0 vs 1.1 ULN). 11/15 patients had IGF-1 levels ≤1.3 ULN before and after the switch but individual changes were variable. Hyperglycemia was frequent and greater in diabetic patients. 7/15 patients stopped Pasireotide-LAR due to lack of control of IGF-1 or intolerance. 8/15 patients received Pasireotide-LAR for a median of 29 months with IGF-1 levels ≤1.3 ULN and acceptable glucose tolerance (median HbA1c 6.1%). Two patients required initiation of oral antidiabetic treatment. The intensity of SSTR5 expression and the granulation pattern of adenomas were of limited value for the prediction of Pasireotide-LAR effectiveness. Conclusion Pasireotide-LAR may represent a suitable therapeutic alternative in a subset of acromegalic patients requiring combination therapy involving a 1gSRL

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Emergence of SGLT2 Inhibitors as Powerful Antioxidants in Human Diseases

Antioxidants ◽

10.3390/antiox10081166 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1166

Author(s):

Kai-Fan Tsai ◽

Yung-Lung Chen ◽

Terry Ting-Yu Chiou ◽

Tian-Huei Chu ◽

Lung-Chih Li ◽

...

Keyword(s):

Liver Diseases ◽

Redox Homeostasis ◽

Sglt2 Inhibitors ◽

Human Diseases ◽

Oral Glucose ◽

Diabetic Patients ◽

Protective Effects ◽

Glucose Lowering ◽

Therapeutic Benefits ◽

Neural Disorders

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of oral glucose-lowering agents. Apart from their glucose-lowering effects, large clinical trials assessing certain SGLT2 inhibitors have revealed cardiac and renal protective effects in non-diabetic patients. These excellent outcomes motivated scientists and clinical professionals to revisit their underlying mechanisms. In addition to the heart and kidney, redox homeostasis is crucial in several human diseases, including liver diseases, neural disorders, and cancers, with accumulating preclinical studies demonstrating the therapeutic benefits of SGLT2 inhibitors. In the present review, we aimed to update recent advances in the antioxidant roles of SGLT2 inhibitors in common but debilitating human diseases. We anticipate that this review will guide new research directions and novel therapeutic strategies for diabetes, cardiovascular diseases, nephropathies, liver diseases, neural disorders, and cancers in the era of SGLT2 inhibitors.

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Can an electronic glycaemic notebook associated with an insulin calculator improve HbA1cin diabetic patients on a multiple insulin injections regimen? A 26-week observational real-life study

Acta Clinica Belgica ◽

10.1080/17843286.2015.1116151 ◽

2016 ◽

Vol 71 (1) ◽

pp. 51-56

Author(s):

Philippe Oriot ◽

Michel Ponchon ◽

Michel P. Hermans

Keyword(s):

Real Life ◽

Diabetic Patients ◽

Life Study ◽

Real Life Study

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Are dipeptidyl peptidase-4 inhibitors effective and safe in long term when added to ongoing therapies of diabetics? a real-life study in tertiary referral center

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20190540 ◽

2019 ◽

Vol 6 (2) ◽

pp. 264

Author(s):

Deniz Avci ◽

Ali Cetinkaya

Keyword(s):

Hemoglobin A1c ◽

Real Life ◽

Dipeptidyl Peptidase ◽

Diabetic Patients ◽

Mean Values ◽

Tertiary Referral Center ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors

Background: The aim of this study was to determine how HbA1c, lipid, renal functions and such parameters were affected in the long term by adding dipeptidyl peptidase-4 inhibitors to the ongoing treatment regimens of patients with Type 2 diabetes mellitus.Methods: The study was conducted in diabetes mellitus outpatient clinic of Kayseri Training and Research Hospital between February 2012 and May 2017, with patients who did not achieve the sufficient success in diabetes their controls at the time of admission. From these patients, those who added (dipeptidyl peptidase-4 inhibitors) to their treatments were selected. Patients were followed up as long as they continued to these new treatments and the parameters at the baseline were compared with final values.Results: A total of 80 diabetic patients were followed in the study. The median age of the patients was 56.08±9.71 years. During this follow-up, an average decrease of 1.03% was noted when patients were compared with 9.53±1.87% of the initial hemoglobin A1c, and 8.50±1.48% of the Hemoglobin A1c values at the end of follow-up. This decrease was statistically significant (p <0.001). However, differences in the initial and final values of the lipid parameters of the patients were not statistically significant.Conclusions: Addition of dipeptidyl peptidase-4 inhibitors to patients' treatments causes significant decreases in Hemoglobin A1c mean values. This decline is long lasting. However, there are no positive or negative effects on biochemical parameters such as lipids, kidney and liver functions.

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Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

British Journal of General Practice ◽

10.3399/bjgp20x714089 ◽

2020 ◽

pp. bjgp20X714089

Author(s):

Michelle Greiver ◽

Alys Havard ◽

Juliana Bowles ◽

Sumeet Kalia ◽

Chen Tao ◽

...

Keyword(s):

New Drugs ◽

Cross Sectional ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 ◽

Cross Sectional Analysis ◽

Drug Classes ◽

Sodium Glucose Cotransporter ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Lowering Drug ◽

Sectional Analysis

Abstract Background: Several new classes of glucose lowering medications have been introduced in the past two decades. Some, such as Sodium-glucose cotransporter 2 inhibitors (SGLT2s), have evidence of improved cardiovascular outcomes, while others, such as Dipeptidyl peptidase-4 inhibitors (DPP4s), do not. It is therefore important to identify their uptake, in order to find ways to support the use of more effective medications. Aims: We studied the uptake of these new classes amongst patients with type 2 diabetes. Design and setting: Retrospective repeated cross-sectional analysis. We compared rates of medication uptake in Australia, Canada, England and Scotland. Method: We used primary care Electronic Medical Data on prescriptions (Canada, UK) and dispensing data (Australia) from 2012 to 2017. We included persons aged 40 years or over on at least one glucose-lowering drug class in each year of interest, excluding those on insulin only. We determined proportions of patients in each nation, for each year, on each class of medication, and on combinations of classes. Results: By 2017, data from 238,609 patients were included. The proportion of patients on sulfonylureas (SUs) decreased in three out of four nations, while metformin decreased in Canada. Use of combinations of metformin and new drug classes increased in all nations, replacing combinations involving SUs. In 2017 more patients were on DPP4s (between 19.1% and 27.6%) than on SGLT2s (between 10.1% and 15.3%). Conclusions: New drugs are displacing SUs. However, despite evidence of better outcomes, the adoption of SGLT2s lagged behind DPP4s.

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Predictors of reversible airway obstruction with omalizumab in severe asthma: a real-life study

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466619841274 ◽

2019 ◽

Vol 13 ◽

pp. 175346661984127 ◽

Cited By ~ 5

Author(s):

Paolo Solidoro ◽

Filippo Patrucco ◽

Francesca de Blasio ◽

Luisa Brussino ◽

Michela Bellocchia ◽

...

Keyword(s):

Airway Obstruction ◽

Allergic Asthma ◽

Severe Asthma ◽

Airway Remodeling ◽

Real Life ◽

Forced Expiratory Volume ◽

Life Study ◽

Reversible Airway Obstruction ◽

Number Of Patients ◽

Severe Allergic Asthma

Background: Omalizumab may modulate airway remodeling in severe asthma. Using forced expiratory volume in 1 second (FEV1) as a surrogate of airway remodeling, we aimed to investigate if an omalizumab add-on in severe allergic asthma may lead to a persistent reversal of airway obstruction and to evaluate the potential biomarkers of airway obstruction reversibility. Methods: Data were collected before (T0) and after omalizumab add-on for 1 year (T1, 32 patients), 2 years (T2, 26 patients) and 4 years (T4, 13 patients). All patients had baseline FEV1 below 80 % predicted (60.5 ± 12.5 %). After omalizumab, 18 patients showed FEV1 normalization (reversible airway obstruction; RAO+) already at T1 (88.7 ± 14.9 %, p < 0.0001) that persisted up to T4 (83.2 ± 7.9, p < 0.01), while 14 patients (RAO−) had FEV1 persistently decreased, from T1 (65.2 ± 8.4%, p < 0.05) up to T4 (61.4 ± 6.2%, not significant). Both groups had significant improvement of symptoms and exacerbations after omalizumab at T1, which persisted up to T4. The comparison between pretreatment characteristics of the two groups showed that RAO+ patients, had higher values of circulating eosinophils, exhaled nitric oxide (FENO), prevalence of rhinitis and nasal polyps, need of oral corticosteroids, shorter asthma duration, higher FEV1 and response to albuterol test. The optimal cut-off points predicting FEV1 normalization after omalizumab add-on were 30.5 ppb for FENO and 305 cells/µl for eosinophils. Conclusions: This study suggests that omalizumab add-on contributes to the persistent reversal of airway obstruction in a consistent number of patients with severe allergic asthma, and this beneficial effect is predicted by elevated pretreatment FENO and circulating eosinophils.

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Comparison of Efficacy and Safety of Rosuvastatin, Atorvastatin and Pravastatin among Dyslipidemic Diabetic Patients

ISRN Pharmacology ◽

10.1155/2013/146579 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Lolwa Barakat ◽

Amin Jayyousi ◽

Abdulbari Bener ◽

Bilal Zuby ◽

Mahmoud Zirie

Keyword(s):

Renal Function ◽

Electronic Medical Records ◽

Medical Records ◽

Large Scale ◽

Population Based ◽

Diabetic Patients ◽

Population Based Study ◽

Number Of Patients ◽

Second Year ◽

New Onset

Objectives. To investigate the efficacy and the safety of the three most commonly prescribed statins (rosuvastatin, atorvastatin, and pravastatin) for managing dyslipidemia among diabetic patients in Qatar. Subjects and Methods. This retrospective observational population-based study included 350 consecutive diabetes patients who were diagnosed with dyslipidemia and prescribed any of the indicated statins between September 2005 and September 2009. Data was collected by review of the Pharmacy Database, the Electronic Medical Records Database (EMR viewer), and the Patient's Medical Records. Comparisons of lipid profile measurements at baseline and at first- and second-year intervals were taken. Results. Rosuvastatin (10 mg) was the most effective at reducing LDL-C (29.03%). Atorvastatin reduced LDL-C the most at a dose of 40 mg (22.8%), and pravastatin reduced LDL-C the most at a dose of 20 mg (20.3%). All three statins were safe in relation to muscular and hepatic functions. In relation to renal function, atorvastatin was the safest statin as it resulted in the least number of patients at the end of 2 years of treatment with the new onset of microalbuminuria (10.9%) followed by rosuvastatin (14.3%) and then pravastatin (26.6%). Conclusion. In the Qatari context, the most effective statin at reducing LDL-C was rosuvastatin 10 mg. Atorvastatin was the safest statin in relation to renal function. Future large-scale prospective studies are needed to confirm these results.

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Influence Of Different Hypoglycemic Therapy Schemes On Carbohydrate Exchange Indicators In Type 2 Diabetes Mellitus

The American Journal of Medical Sciences and Pharmaceutical Research ◽

10.37547/tajmspr/volume03issue06-02 ◽

2021 ◽

Vol 03 (06) ◽

pp. 13-19

Author(s):

S.I. Ismailov ◽

◽

S.U. Muminova ◽

Keyword(s):

Type 2 Diabetes ◽

Renal Function ◽

Diabetic Nephropathy ◽

Carbohydrate Metabolism ◽

Impaired Renal Function ◽

The State ◽

Dipeptidyl Peptidase 4 ◽

Number Of Patients ◽

Group 1

Aim of the study: To study the effect of prescribing inhibitors of sodium glucose cotransporter type 2 (iSGLT-2) and inhibitors of dipeptidyl peptidase-4 (iDDP-4) on the parameters of carbohydrate metabolism in patients with type 2 diabetes. Materials and methods: A prospective study included 80 patients with type 2 diabetes. The average age was 52.7 ± 3.78 years; diabetes experience - 8 years; BMI-30 ± 0.17; Hb1C-9.2 ± 0.4%; fasting glycemia –10.2 mmol/; eGFR-78 ml/min; TG-2.7 ± 0.44; total cholesterol-3.4 ± 0.72; MAU 32 ± 0.125. The patients were divided into 2 groups: group 1 - 30 patients with DN with impaired renal function and 30 patients with diabetic nephropathy without renal dysfunction in the presence of metformin + iSGLT- 2; 2 group of 30 patients with impaired renal function and 30 patients with diabetic nephropathy without impaired renal function on the background of metformin + iDPP-4. Results: The study of the effect of the inclusion of drugs iSGLT-2 (group 1) and iDPP-4 (group 2) showed a positive dynamics of carbohydrate metabolism indicators in patients with type 2 diabetes. So if the initial indicators in the groups were comparable in terms of glycemic control indicators, then by the 3rd month of treatment there was a significant decrease in HbA1c in the 1st group of patients in relation to the 2nd group. The result of the correction performed within 3 months was the achievement of the state of compensation in the 1st group in 36.7%, and in the 2nd group in 28.3%, 48.3% of the patients of the 1st group were brought into the state of sub compensation and 31.7 % of patients of the 2nd group. Conclusion: On the combination of metformin and INGLT-2, a larger number of patients managed to achieve the set goals of therapy with a lower risk of overt hypoglycemia, then this combination should be considered not only more effective.

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Diagnostic Accuracy of SARS-CoV-2 Antigen Detection Test in Children: A Real-Life Study

Frontiers in Pediatrics ◽

10.3389/fped.2021.647274 ◽

2021 ◽

Vol 9 ◽

Author(s):

Camille Jung ◽

Corinne Levy ◽

Emmanuelle Varon ◽

Sandra Biscardi ◽

Christophe Batard ◽

...

Keyword(s):

Real Life ◽

University Hospital ◽

Rt Pcr ◽

Life Study ◽

Mean Delay ◽

Positive Person ◽

The Mean ◽

Real Life Study ◽

The University ◽

Positive Groups

Naso-pharyngeal RT-PCR is the gold standard for the diagnosis of COVID-19, but there is a need for rapid and reliable tests. Some validation studies have used frozen aliquots mainly from adults. The aim of this real-life study was to test the performance of a SARS-CoV-2 rapid antigen test (SC2-RAT) in children. Symptomatic patients aged 0 to 17 years were recruited in the emergency department of the University Hospital of Creteil and in primary care pediatric practices from October 10, 2020 for 7 weeks. Each enrolled child had a SARS-CoV-2 RT-PCR test and a SC2-RAT from two distinct nasopharyngeal swabs. Among the 308 patients (mean [SD] age 4.9 [5.3] years), fever was the main symptom (73.4%), with no difference between COVID-19–negative and –positive groups. The prevalence of COVID-19 was 10.7% (95% CI 7.5–14.7). On the whole cohort, the sensitivity and specificity of the SC2-RAT compared to RT-PCR was 87.9% (95% CI 71.8–96.6) and 98.5% (95% CI 96.3–99.6). Considering samples with cycle threshold >25, the sensibility was lower: 63.6% (95% CI 30.8–89.1) and the specificity 99.6% (95% CI 98.0–100.0). The mean delay to obtain an SC2-RAT result was <15 min but was 3.2 h (SD 5.5) for an RT-PCR result. Contact with a COVID-19–positive person was more frequent for COVID-19–positive than –negative patients (n = 21, 61.6%, vs. n = 64, 24.6%; p < 0.01). In real life, SC2-RAT seems reliable for symptomatic children, allowing to detect contagious children.

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

10.2337/figshare.12970958 ◽

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

OBJECTIVE 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. RESEARCH DESIGN AND METHODS 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. <a>RESULTS 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> CONCLUSIONS 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.

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