Depression and microvascular complications predict poor goal achievement among Colombian patients with type 2 diabetes

Aims: Many patients with type 2 diabetes (DM2) in Latin American countries remain insufficiently controlled. We aimed to identify factors associated with persistent poor metabolic control in Colombian patients with DM2.Methods: Retrospective one-year follow-up cohort study of adult patients with DM2. The primary outcome was persistent poor metabolic control (PPMC): HbA1c level >8% in all measurements during follow-up. Secondary outcomes were intermittent poor metabolic control (IPMC) and good control (GC: simultaneous achievement of HbA1c, blood pressure and LDL cholesterol goals). Multiple demographic, clinical and laboratory variables were predictors in multivariable logistical models. Results: Of 399 patients included, 50 had the primary endpoint during follow-up. Older age was negatively associated with PPMC (OR 0.40, 95%CI 0.17-0.92 for extreme quartiles), even after multivariate adjustment. Depression and the presence of multiple microvascular complications were strongly associated with the secondary endpoint IPMC (multivariate OR respectively 4.2, 95%CI 1.08-16.4 for depression; 5.61, 95%CI 1.03-30.6 for microvascular complications). Being unemployed was associated with significantly less odds of achieving GC (multivariate OR 0.19, 95%CI 0.04-0.95). Conclusions: Age, depression, the presence of microvascular complications and employment status were associated with the success or failure of diabetes management. These factors were better correlates of therapeutic success than the pharmacological agent employed.

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Determinants of good metabolic control without weight gain in type 2 diabetes management: a machine learning analysis

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001362 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001362

Author(s):

Carlo Bruno Giorda ◽

Federico Pisani ◽

Alberto De Micheli ◽

Paola Ponzani ◽

Giuseppina Russo ◽

...

Keyword(s):

Machine Learning ◽

Type 2 Diabetes ◽

Weight Gain ◽

Metabolic Control ◽

Diabetes Management ◽

Microvascular Complications ◽

Clinical Inertia ◽

Oral Agents

IntroductionThe aim of this study was to investigate the factors (clinical, organizational or doctor-related) involved in a timely and effective achievement of metabolic control, with no weight gain, in type 2 diabetes.Research design and MethodsOverall, 5.5 million of Hab1c and corresponding weight were studied in the Associazione Medici Diabetologi Annals database (2005–2017 data from 1.5 million patients of the Italian diabetes clinics network). Logic learning machine, a specific type of machine learning technique, was used to extract and rank the most relevant variables and to create the best model underlying the achievement of HbA1c<7 and no weight gain.ResultsThe combined goal was achieved in 37.5% of measurements. High HbA1c and fasting glucose values and slow drop of HbA1c have the greatest relevance and emerge as first, main, obstacles the doctor has to overcome. However, as a second line of negative factors, markers of insulin resistance, microvascular complications, years of observation and proxy of duration of disease appear to be important determinants. Quality of assistance provided by the clinic plays a positive role. Almost all the available oral agents are effective whereas insulin use shows positive impact on glucometabolism but negative on weight containment. We also tried to analyze the contribution of each component of the combined endpoint; we found that weight gain was less frequently the reason for not reaching the endpoint and that HbA1c and weight have different determinants. Of note, use of glucagon-like peptide-1 receptor agonists (GLP1-RA) and glifozins improves weight control.ConclusionsTreating diabetes as early as possible with the best quality of care, before beta-cell deterioration and microvascular complications occurrence, make it easier to compensate patients. This message is a warning against clinical inertia. All medications play a role in goal achievements but use of GLP1-RAs and glifozins contributes to overweight prevention.

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Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm

International Journal of Endocrinology ◽

10.1155/2015/381415 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Anna M. Lucas Martín ◽

Elena Guanyabens ◽

R. Zavala-Arauco ◽

Joaquín Chamorro ◽

Maria Luisa Granada ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Metabolic Control ◽

Hospitalized Patients ◽

Therapeutic Inertia ◽

Therapeutic Algorithm ◽

Fasting Glycaemia ◽

Active Detection

Type 2 diabetes (T2D) exists in 25–40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittanceHbA1cwas 7.7 ± 1.5%; 47% (189) hadHbA1c≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their currentHbA1c. Ninety-four of the 189 SCGC patients were evaluated 3–6 months later. TheirHbA1cbefore in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P<0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.

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C-peptide and the risk for incident complications and mortality in type 2 diabetic patients: a retrospective cohort study after a 14-year follow-up

Acta Endocrinologica ◽

10.1530/eje-12-0085 ◽

2012 ◽

Vol 167 (2) ◽

pp. 173-180 ◽

Cited By ~ 41

Author(s):

S Bo ◽

L Gentile ◽

A Castiglione ◽

V Prandi ◽

S Canil ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Retrospective Cohort ◽

Microvascular Complications ◽

Chronic Complications ◽

C Peptide ◽

All Cause Mortality

ObjectiveC-peptide, a cleavage product of insulin, exerts biological effects in patients with type 1 diabetes mellitus, but its role in type 2 diabetes mellitus is controversial. Our aim was to examine the associations between fasting C-peptide levels and all-cause mortality, specific-cause mortality and the incidence of chronic complications in patients with type 2 diabetes.DesignRetrospective cohort study with a median follow-up of 14 years.MethodsA representative cohort of 2113 patients with type 2 diabetes mellitus and a subgroup of 931 individuals from this cohort without chronic complications at baseline from a diabetic clinic were studied.ResultsPatients with higher C-peptide levels had higher baseline BMI and triglyceride and lower HDL-cholesterol values. During the follow-up, 46.1% of the patients died. In a Cox proportional hazard model, after multiple adjustments, no significant association was found between the C-peptide tertiles and all-cause mortality or mortality due to cancer, diabetes or cardiovascular diseases. In the subgroup of 931 patients without chronic complications at baseline, the incidence of microvascular complications decreased from the first to the third C-peptide level tertile, while the incidence of cardiovascular disease did not differ. The risks for incident retinopathy (hazard ratio (HR)=0.33; 95% confidence interval (CI) 0.23–0.47), nephropathy (HR=0.27; 95% CI 0.18–0.38) and neuropathy (HR=0.39; 95% CI 0.25–0.61) were negatively associated with the highest C-peptide tertile, after adjusting for multiple confounders.ConclusionsHigher baseline C-peptide levels were associated with a reduced risk of incident microvascular complications but imparted no survival benefit to patients with type 2 diabetes mellitus.

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A comparison of glycaemic and metabolic control over time among South Asian and European patients with Type 2 diabetes: results from follow-up in a routine diabetes clinic

Diabetic Medicine ◽

10.1111/j.1464-5491.2005.01735.x ◽

2006 ◽

Vol 23 (1) ◽

pp. 94-98 ◽

Cited By ~ 65

Author(s):

B. Mukhopadhyay ◽

N. G. Forouhi ◽

B. M. Fisher ◽

C. M. Kesson ◽

N. Sattar

Keyword(s):

Type 2 Diabetes ◽

Metabolic Control ◽

South Asian ◽

Diabetes Clinic ◽

Over Time

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2 Advances in oral and insulin treatments for diabetes

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-fpm.2 ◽

2019 ◽

Vol 95 (1130) ◽

pp. 685.2-685

Author(s):

Tahseen A Chowdhury

Keyword(s):

Type 2 Diabetes ◽

Diabetes Management ◽

New Technology ◽

Microvascular Complications ◽

Tight Glucose Control ◽

Cardiovascular Risk Reduction ◽

Important Condition ◽

Improved Glycaemic Control

Prevalence of type 2 diabetes is rising worldwide, and adding significant burdens of morbidity, mortality and financial costs to healthcare systems worldwide. Whilst cardiovascular risk reduction is central to diabetes management, improved glycaemic control remains an important aim of management, in order to reduce the risk of microvascular complications.In this presentation, I hope to remind the audience why diabetes is such an important condition, to review the evidence behind tight glucose control, and to assess the options and evidence behind newer oral and injectable therapies in the management of glucose in type 2 diabetes. I will also discuss recent studies concerning the prevention and remission of type 2 diabetes.Finally, I hope to highlight the huge potential value of new technology in the management of Type 1 diabetes, which is set to change the treatment of this condition completely in the next few years.

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Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study

Acta Diabetologica ◽

10.1007/s00592-014-0701-0 ◽

2014 ◽

Vol 52 (3) ◽

pp. 601-609 ◽

Cited By ~ 12

Author(s):

Ranjit Mohan Anjana ◽

Coimbatore Subramanian Shanthirani ◽

Ranjit Unnikrishnan ◽

Poongkunran Mugilan ◽

Anandakumar Amutha ◽

...

Keyword(s):

Type 2 Diabetes ◽

Microvascular Complications ◽

Follow Up Study

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Treatment of Type 2 Diabetes in Primary Health Care: A Drug Utilization Study

Annals of Pharmacotherapy ◽

10.1345/aph.1e273 ◽

2005 ◽

Vol 39 (3) ◽

pp. 441-445 ◽

Cited By ~ 7

Author(s):

Dolores Mino-León ◽

Albert Figueras ◽

Dante Amato ◽

Joan-Ramon Laporte

Keyword(s):

Type 2 Diabetes ◽

Metabolic Control ◽

Medical Record ◽

Drug Utilization ◽

Diabetes Management ◽

Patient Adherence ◽

Glycosylated Hemoglobin ◽

Standards Of Care ◽

Drug Utilization Study

BACKGROUND: Metabolic control in type 2 diabetes depends on patient adherence to therapy. Quantitative consumption data do not supply information regarding the appropriate use of medicine. Drug utilization studies are useful to identify treatment adherence problems and, thus, design interventions to improve drug use. OBJECTIVE: To describe the treatment and outcome in terms of degree of metabolic control in these patients, assess the agreement between the doses of antidiabetic drugs reported by the patient and those written in the medical record, and describe the drug utilization characteristics in relation to the standards of care. METHODS: This drug utilization study was conducted in primary care centers in Barcelona, Spain. Consecutive patients with type 2 diabetes attending a follow-up visit were interviewed regarding lifestyle, diet, glycosylated hemoglobin level, and treatment. Concordance between the information obtained through medical records and patient interviews was analyzed. RESULTS: Metabolic control was deficient in 73 (40%), acceptable in 50 (28%), and good in 58 (32%) of the 181 patients with available information. For 38 (19%) patients, there was disagreement between the dose of the antidiabetic drug reported by the patient and that written in the medical record. For 83 (41%) patients, the treatment in the medical history was in agreement with published standards. CONCLUSIONS: Identification of disagreement between standards of care and clinical practice in type 2 diabetes management is the basis to improve drug utilization and achieve better metabolic control in these patients.

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