scholarly journals Pathophysiologic Approach to Type 2 Diabetes Management: One Centre Experience 1980–2020

2021 ◽  
Author(s):  
Rudolf Chlup ◽  
Richard Kaňa ◽  
Lada Hanáčková ◽  
Hana Zálešáková ◽  
Blanka Doubravová
Keyword(s):  
Diabetes Management ◽  
Case Reports ◽  
Sglt2 Inhibitor ◽  
Diabetes Type 2 ◽  
Clinical Inertia ◽  
Insulin Analogs ◽  
Receptor Agonists ◽  
Multiple Doses ◽  
Insulin Pens

This overview summarizes the evolution of pathophysiologic treatment of diabetes type 2 (T2D) in the period of the last 40 years. Randomized Controlled Trials (RCT) and Real World Evidence (RWE) studies resulted in recent Statements of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) in the year 2020. Case reports and studies of a single-centre in Czech Republic are reported. The authors demonstrate the impact of (1) multiple doses of rapid insulin, (2) multiple doses of rapid or ultrarapid insulin analogs (3) continuous subcutaneous insulin infusion (CSII) (4) incretin receptor agonists, (5) fixed combination of insulin degludec with liraglutide (IDegLira) and (6) SGLT2 inhibitor dapagliflozin, on plasma glucose concentration, HbA1c, body mass and patient satisfaction. The importance of therapeutic patients´ education and technology (personal glucometers, continuous/flash glucose monitors, insulin pens/pumps) is emphasized. Most of the observations were already published. Hence, individually adopted education, lifstyle, technical equipment, incretin receptor agonists and/or metformin and/or gliflozins and/or insulin analogs appear to be the core of an effective pathophysiologic approach. Scientific conclusions from RCTs, RWE trials and own clinical case reports may prevail over clinical inertia and induce early implementation of effective methods into routine T2D treatment.

scholarly journals Case Reports That Illustrate the Efficacy of SGLT2 Inhibitors in the Type 1 Diabetic Patient

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
David S. H. Bell
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Case Reports ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Endogenous Insulin ◽  
Large Randomized Clinical Trial ◽  
Endogenous Insulin Production

SGLT2 inhibitors are only approved for use in adults with type 2 diabetes. However, because SGLT2 inhibitors have a mechanism of action that does not require the presence of endogenous insulin, these drugs should also be efficacious in type 1 diabetes where endogenous insulin production is greatly reduced or absent. Herein, I present five cases which illustrate the benefits of utilizing an SGLT2 inhibitor with type 1 diabetes. In these cases the use of SGLT2 inhibitors resulted not only in better glycemic control in most patients but also in some patients’ less hypoglycemia, weight loss, and decreased doses of insulin. In type 1 diabetesCandida albicansvaginitis and balanitis may occur more frequently than in type 2 diabetes. These cases show that a large randomized clinical trial of SGLT2 inhibitors in type 1 diabetes needs to be performed.

Understanding the Influence of Diabetes Management Practices on Co-Morbidity Development

2020 ◽  
pp. 324-337
Author(s):  
Chinedu I. Ossai ◽  
Steven L. Goldberg ◽  
Nilmini Wickramasinghe
Keyword(s):  
Chronic Condition ◽  
Management Practices ◽  
Diabetes Management ◽  
Self Care ◽  
Diabetes Type 2 ◽  
Diabetes Type ◽  
Qualitative Information ◽  
Co Morbidity ◽  
Diet Management

Diabetes type 2 is a chronic condition that currently has no cure. Hence, proper management is key as the best approach to ensure the wellness of sufferers. To establish the attitudes of self-care patients towards the management of this ailment, the authors designed a study that targeted 100 Australian residents in the first phase. These participants provided quantitative and qualitative information about various diabetes type 2 management practices that include exercising and diet management and the co-morbidities they currently suffer.

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

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.

scholarly journals Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 580
Author(s):  
Yu-Ting Li ◽  
Yi Wang ◽  
Xiu-Jing Hu ◽  
Jia-Heng Chen ◽  
Yun-Yi Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetes Management ◽  
Clinical Laboratory ◽  
Clinical Inertia ◽  
Diabetic Patients ◽  
Haemoglobin A1c ◽  
Ordinal Logistic Regression Analysis

A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words)

scholarly journals Overview of In-Hospital Diabetes Management: Audit of Patients Attending a Rural Hospital in Queensland, Australia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A429-A429
Author(s):  
Sarah X M Goh ◽  
Jun Kwei Ng ◽  
On Sze Yun ◽  
Holly Gibbons ◽  
Anis Zand Irani
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Diabetes Care ◽  
Diabetes Management ◽  
Diabetes Type 2 ◽  
Diabetes Type ◽  
Australian Institute ◽  
Clinical Records ◽  
Improve Diabetes Care

Abstract Context: The Australian Institute of Health and Welfare (AIHW) health survey in 2018 demonstrated that mortality rates from diabetes in remote and very remote areas were twice as high compared to those in the urban regions. Moreover, diabetic patients in the lowest socioeconomic areas were more than twice as likely to die from the disease and its associated complications than those living in the highest socioeconomic areas (77 and 33 per 10,000 respectively) [1]. These health disparities prompted a closer look into the quality of local inpatient diabetes management in order to identify the changes required to improve diabetes care in a rural community. Methods: A retrospective audit assessing all adult patients (aged over 18) with diabetes between August and October 2019 who attended treatment in one rural health centre in Queensland, Australia was conducted. Information was obtained from paper based patient records, especially the state-wide insulin subcutaneous order and blood glucose chart. Results: There were 122 diabetic inpatients during the study period. 9 were excluded due to poor documentation on the details of diabetes or insulin management. Men comprised 62% (n = 75) of the patients and the chronicity of diabetes in the majority of the patients was either unknown or undocumented (n = 90). Type 2 diabetes represented 87% (n = 106) of the hospitalisations. There were 64 hospitalisations with diabetes or diabetic related complications as the principal diagnoses. Among these, 7% (n = 8) were due to diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) or severe hyperglycaemia with ketosis, while 2 patients (1.7%) presented with hypoglycaemia. The majority (32%, n = 36) of the diabetic related complications were due to an underlying infection. Throughout inpatient stay, half (50.4%, n = 57) of the patients experienced one or more hyperglycaemic episodes and 14% (n = 16) experienced at least one hypoglycaemic events. The prevalence of inappropriate management of hyperglycaemia during this period was observed to be 21%. This was due to prescription errors i.e. usual insulin not prescribed (n = 7), erroneous insulin type (n = 3) and unsigned order (n = 4). Persistent hyperglycaemia, defined locally by blood glucose level (BGL) &gt; 12 mmol/L was not managed ideally in 10 patients due to either lack of communication between staffs and physicians or failure to make changes when notifications were relayed. Patients were followed up until the discharge phase. Nearly half (41.8%, n = 51) of the patients were found to have no clearly documented follow up plans albeit the limitations of paper based clinical records should be taken into account. Conclusion: The management of diabetes in the rural communities can be challenging. Communication between the different layers of healthcare providers is imperative to ensure hyperglycaemia among hospitalised patients is not mismanaged. Clear documentation of insulin doses and BGL levels on paper records as well as regular education and shared clinical experience on insulin titration in response to abnormal BGL levels by clinicians are strategies to improve diabetes care. Reference: 1. Australian Institute of Health and Welfare. 2021. Diabetes, Type 2 Diabetes - Australian Institute Of Health And Welfare. [online] Available at: &lt;https://www.aihw.gov.au/reports/diabetes/diabetes/contents/hospital-care-for-diabetes/type-2-diabetes&gt; [Accessed 6 January 2021].

scholarly journals Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0240531
Author(s):  
Kim Sui Wan ◽  
Foong Ming Moy ◽  
Khalijah Mohd Yusof ◽  
Feisul Idzwan Mustapha ◽  
Zainudin Mohd Ali ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Diabetes Management ◽  
Middle Income Country ◽  
Income Country ◽  
Clinical Inertia ◽  
Middle Income

scholarly journals Renal Benefits of SGLT 2 Inhibitors and GLP-1 Receptor Agonists: Evidence Supporting a Paradigm Shift in the Medical Management of Type 2 Diabetes

2019 ◽  
Vol 20 (23) ◽  
pp. 5831 ◽  
Author(s):  
Vjera Ninčević ◽  
Tea Omanović Kolarić ◽  
Hrvoje Roguljić ◽  
Tomislav Kizivat ◽  
Martina Smolić ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Body Weight Loss ◽  
Diabetes Type 2 ◽  
Pressure Control ◽  
Diabetes Mellitus Type 1 ◽  
Receptor Agonists ◽  
Include Blood Pressure ◽  
Progression Of Kidney Disease ◽  
Control Body

Diabetic nephropathy (DN) is one of the most perilous side effects of diabetes mellitus type 1 and type 2 (T1DM and T2DM).). It is known that sodium/glucose cotransporter 2 inhibitors (SGLT 2i) and glucagone like peptide-1 receptor agonists (GLP-1 RAs) have renoprotective effects, but the molecular mechanisms are still unknown. In clinical trials GLP-1 analogs exerted important impact on renal composite outcomes, primarily on macroalbuminuria, possibly through suppression of inflammation-related pathways, however enhancement of natriuresis and diuresis is also one of possible mechanisms of nephroprotection. Dapagliflozin, canagliflozin, and empagliflozin are SGLT2i drugs, useful in reducing hyperglycemia and in their potential renoprotective mechanisms, which include blood pressure control, body weight loss, intraglomerular pressure reduction, and a decrease in urinary proximal tubular injury biomarkers. In this review we have discussed the potential synergistic and/or additive effects of GLP 1 RA and SGLT2 inhibitors on the primary onset and progression of kidney disease, and the potential implications on current guidelines of diabetes type 2 management.

scholarly journals Clinical Inertia in Type 2 Diabetes Management: Evidence From a Large, Real-World Data Set

Diabetes Care ◽  
2018 ◽  
Vol 41 (7) ◽  
pp. e113-e114 ◽  
Author(s):  
Kevin M. Pantalone ◽  
Anita D. Misra-Hebert ◽  
Todd M. Hobbs ◽  
Xinge Ji ◽  
Sheldon X. Kong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Diabetes Management ◽  
Clinical Inertia ◽  
Real World Data ◽  
Data Set ◽  
World Data
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