Effectiveness of metabolic management centers online tools in patients with type 2 diabetes

Disclosure: K. Ahn: None. J. Ji Eun: None. J. In-Kyung: None. Background: Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, ameliorates hyperglycemia and obesity by inhibiting renal glucose reabsorption. However, significant heterogeneity exists in glucose-lowering efficacy and the magnitude of the weight loss among patients with type 2 diabetes. Herein, we aimed to evaluate the clinical factors affecting response to dapagliflozin treatment. Methods: We performed a post-hoc analysis of the BEYOND (Effects of Dapagliflozin Compared with Glimepiride on Body Composition in Patients with Type 2 Diabetes Inadequately Controlled with Metformin) randomized, double-blind, parallel-group trial. Patients were randomly assigned (1:1) to receive the addition of either dapagliflozin 10 mg per day or glimepiride 1∼2 mg per day to background metformin therapy for 52 weeks. Changes in HbA1c and body weight from baseline during the observation period were assessed for all patients. Responder to dapagliflozin was defined by >1% reduction in A1c and >3% reduction in body weight at week 52. Then, we classified the total subjects into 4 groups: non-responder of both A1c reduction and body weight reduction, responders of A1c reduction but non-responder of body weight reduction, non-responder of A1c reduction but responders of body weight reduction, and responders of both A1c reduction and body weight reduction. Results: Among 56 patients in a dapagliflozin arm, 55.4% (N = 31) and 57.1% (N = 32) experienced clinical responses as indicated by reductions in HbA1c and in body weight reduction, respectively. Younger age and higher HbA1c level at baseline were significantly associated with a greater HbA1c reduction, and a higher estimated glomerular filtration rate (eGFR) was significantly associated with a greater body weight reduction. However, there was no association between the change in HbA1c and the change in body weight (r = −0.133, P = 0.328). Responders of both A1c reduction and body weight reduction were most common (32.1%), non-responders of A1c reduction but responders of body weight reduction were second-most (25.0%), responders of A1c reduction but non-responders of body weight reduction were 23.2%, and non-responders of both A1c reduction and body weight reduction were 19.6%. Subjects with higher fasting plasma glucose (FPG) and HbA1c in addition to lower eGFR at baseline had a greater reduction in HbA1c, but less reduction in body weight. Conversely, those with lower FPG and HbA1c in addition to higher eGFR at baseline had a greater reduction in body weight, but less reduction in HbA1c level. Conclusion: Patients with type 2 diabetes actually exhibit a heterogeneous response to dapagliflozin treatment. Glucose-lowering efficacy of dapagliflozin was associated with worse baseline glycemic status, and body weight reduction was associated with baseline higher eGFR. Presentation: Thursday, June 15, 2023

Objective: To evaluate the impact of a 0.2% reduction in glycated hemoglobin (HbA1c) on treatment intensification, poor HbA1c control and HbA1c goal attainment in patients with type 2 diabetes mellitus (T2DM) initiated on a sodium glucose co-transporter 2 (SGLT2) inhibitor (SGLT2i).Methods: IQVIATM Health Plan Claims Data – US and IQVIATM Ambulatory EMR Data – US databases (29 October 2012–31 March 2016) were used to identify adults with T2DM initiated on an SGLT2i (index date) who had HbA1c measurements pre- and post-index, and ≥6 months of eligibility pre-index (baseline). HbA1c change was defined as the difference between the first post-index and the last pre-index measurements. Cox regression models were used to assess treatment intensification, poor HbA1c control (i.e. HbA1c > 9%, among patients <9% at baseline) and goal attainment (HbA1c < 7%, <8%; among patients with HbA1c above goal at baseline) adjusting for HbA1c change and baseline characteristics. Patients were observed up to one year after the first HbA1c measurement or end of eligibility. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.Results: A total of 938 patients (mean age 54.9, 42.5% female, mean HbA1c 8.5%) were selected. Following SGLT2i initiation, each 0.2% reduction in HbA1c levels was associated with a decreased risk of treatment intensification (HR [95% CI] = 0.90 [0.86–0.92]), a decreased likelihood of reaching HbA1c > 9% (HR [95% CI] = 0.85 [0.79–0.88]) and higher likelihoods of achieving a treatment goal of HbA1c < 7% (HR [95% CI] = 1.17 [1.12–1.21]) and HbA1c < 8% (HR [95% CI] = 1.08 [1.04–1.10]).Conclusions: In T2DM patients, each HbA1c reduction of 0.2% following the initiation of an SGLT2i was associated with a significant positive impact on treatment intensification and HbA1c goal attainment.

ABSTRACTAimsHbA1c and body weight were assessed across selected subgroups of adults with type 2 diabetes receiving oral semaglutide in clinical practice.MethodsIn this non‐interventional study, changes in HbA1c and body weight to end of study (EoS) and safety were assessed by subgroup: baseline age, body mass index (BMI), type 2 diabetes duration, participants switching from dipeptidyl peptidase‐4 inhibitors, and semaglutide dose at EoS.ResultsAll subgroups experienced reductions in HbA1c and body weight. Younger participants had greater reductions in HbA1c than older participants (−0.9, −0.7, −0.7, and −0.5 percentage points for participants aged <55, ≥55–<65, ≥65–<75, and ≥75 years, respectively [P = 0.0467]). Shorter type 2 diabetes duration and lower EoS semaglutide dose were associated with greater HbA1c reductions (−0.8, −0.7, and −0.6 percentage points with ≤5, >5–≤10, and >10 years' duration, respectively [P < 0.0001]; −1.2, −0.7, and −0.4 percentage points with 3, 7, and 14 mg, respectively [P < 0.0001]). Changes in HbA1c were not significantly different across other subgroups. Lower EoS semaglutide dose was associated with greater body weight reductions (−3.8, −2.9, and −2.8 kg with 3, 7, and 14 mg, respectively [P < 0.0001]); body weight reductions were not significantly different across other subgroups. Adverse events were similar between subgroups, except that older subgroups experienced more events.ConclusionsHbA1c and body weight decreased across all subgroups, providing insights into oral semaglutide use in clinical practice for individuals with different characteristics in the real‐world setting.

Background: As insulin is important regulator of growth hormone related factors, especially insulin like growth factors (IGF-1) and insulin like growth factors binding proteins (IGFBP-3), disorders of insulin production can result in poor growth. Studies suggest that growth abnormalities are common in subjects with poor metabolic control and longer disease duration. Growth parameters are important indicators of a child overall health and they are influenced by factors like blood glucose control in diabetic children. Methods: After obtaining institutional ethical committee clearance and informed consent from parents/subjects, a prospective observational study was conducted from January 2018 to June 2019. Anthropometry of each participant (height, weight, BMI) measured and 4 ml of venous blood was collected for HbA1C levels. Results were compared with age specific standards. Anthropometry and blood investigations performed once in 3 months for 1 year. Results: Out of 30 cases, 53.3% (n=16) were males and 46.7% (n=14) were females with M:F ratio of was 1:1.04. Among those with poor HbA1C control 73.69% (n=14) had short stature at the entry of the study and the results was statistically significant (p=0.043). Among those with poor HbA1C control, 72.73% (n=08) had short stature at the one year follow up and the results was statistically significant (p=0.017). Which suggests that linear growth in children with type 1 diabetes is highly related to glycemic control. Conclusions: Growth was compromised in diabetic children. Children diagnosed at younger age need monitoring of good glycemic control and drug compliance to optimize the growth.

Guideline-Consistent Antidepressant Treatment Patterns Among Veterans With Diabetes and Major Depressive Disorder

Background: It is not well quantified if diabetes mellitus (DM) as a cardiovascular disease (CVD) risk equivalent depends on DM severity and other CVD risk factors. Methods: We pooled 4 US community-based cohorts (ARIC, JHS, MESA, FHS Offspring) and classified subjects by baseline DM/CVD status. DM+/CVD- was further classified by DM duration, HbA1c control or DM medication. Hazard ratios (HR) were estimated for CVD during a median follow-up of 14 years. Subgroup analysis comparing the HR of DM+/CVD- vs. DM-/CVD+ was done by CVD risk factors. We integrated all factors that impacted DM-conferred CVD risk and defined one with DM+/CVD- as CVD risk equivalent when his/her CVD risk was as high or higher than that if he/she had DM-/CVD+. CVD risk profile and event risk were compared between the CVD risk equivalent subgroups in DM+/CVD-. Results: The pooled cohort included 27,732 adults (mean age of 58 years, 45% males). CVD event rates per 1000 P-Y were 16.3, 33.3, 40.9 and 69.0 among those with DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. DM participants with HbA1c≥7%, DM duration over 10 years, or DM medication use had similar CVD risk as those with DM-/CVD+ while those without these factors had lower CVD risk; DM+/CVD- had similar CVD risk as those DM-/CVD+ among women, age &lt;55 years, White race, or high triglyceride groups (Figure). Among those with DM+/CVD-, 17.5% were found to be CVD risk equivalents. Compared to those non-CVD risk equivalent DM, they had lower 10-year PCE scores (14.8% vs. 22.7%, p&lt;0.0001) however higher actual CVD event rates (44.9 vs. 31.0 per 1000 P-Y). Conclusion: Among CVD-free adults with DM, fewer than 20% are actually CVD risk equivalents. Poor HbA1c control, long DM duration, and current diabetes medication use were identified as predictors of CVD risk equivalent status and DM was more detrimental for CVD risk if one is female, younger age, White, or with high triglycerides. These risk enhancing factors should be considered in the treatment decision.

A better baseline renal function is associated with a better response to sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes. Low serum adiponectin is associated with visceral fat accumulation...

IntroductionReal-world evidence (RWE) confirms that reductions in HbA1c for children and adults with type 1 diabetes (T1DM) and adults with type 2 diabetes (T2DM) are associated with use of the FreeStyle Libre system. This current meta-analysis aims to investigate whether HbA1c benefits are sustained over 24 months and to identify patterns of change in HbA1c for users of the FreeStyle Libre system for people living with T1DM or T2DM.MethodsA bibliographic search up to December 2020 identified 75 studies reporting data on change in lab HbA1c in 30,478 participants with type 1 (n = 28,063; 62 trials) or type 2 diabetes (n = 2415; 13 trials) using the FreeStyle Libre system, including observations on children, adolescents and adults. Meta-analysis was performed using a random effects model.ResultsReductions in HbA1c at 3–4 months were similar for adults with T1DM (− 0.53%, 95% CI − 0.69 to − 0.38) or with T2DM (− 0.45%, 95% CI − 0.57 to − 0.33), continuing through 4.5–7.5 months in T1DM (− 0.42%, 95% CI − 0.58 to − 0.27) and in T2DM (− 0.59%, 95% CI − 0.80 to − 0.39). Meta-regression analysis shows that higher starting HbA1c is correlated with greater reductions in HbA1c in T1DM and in T2DM. These patterns of change in HbA1c were sustained for 24 months in T1DM and for at least 12 months in T2DM.ConclusionsMeta-analysis of RWE confirms that using the FreeStyle Libre system is associated with significant reductions in HbA1c for adults with T1DM or with T2DM. Reductions are greater for people with higher baseline HbA1c and are sustained for 24 and 12 months in T1DM and TD2M respectively.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-022-01253-9.

BackgroundDepression is a common mental disorder in people with type 2 diabetes mellitus (T2DM). Depression and T2DM have a reciprocal interaction through many factors, of which the most important is the multifactorial control and microvascular complications of T2DM.AimThis research aims to determine the rate of depression and the association between depression and multifactorial control and microvascular complications in patients with T2DM aged 30–60 years in Vietnam.MethodsA cross-sectional and descriptive study was conducted on 231 outpatients with T2DM at Bach Mai hospital, Hanoi, Vietnam. Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9).ResultsThe rate of depression in patients with T2DM aged 30–60 years was 16.9% (in which, the rate of mild depression was 15.2% and moderate depression was 1.7%; no serious depression). The prevalence of depression was higher in female patients than in male patients (p = 0.049). There is a statistically significant difference in the rate of depression by age, duration of diabetes, and treatment method for type 2 diabetes. Poor HbA1c control and microvascular complications increase the risk of depression (OR = 2.37; 95% CI 1.11–5.02, p = 0.033 and OR = 2.62; 95% CI 1.15–5.93, p = 0.027, respectively). When the multivariate analysis was performed, it was shown that sex, treatment for glycemic control, and microvascular complications had a statistically significant influence on PHQ-9 score.ConclusionIn Vietnam, there are 16.9% of patients with T2DM aged 30–60 years suffer from depression. Poor HbA1c control, the presence of microvascular complications, and without antihyperglycemic treatment increase the risk of developing depression.

IntroductionTo assess real-world effectiveness of linagliptin in persons with type 2 diabetes mellitus (T2DM) across a range of ages and renal function. Effectiveness was assessed in different races, with a focus on African Americans (AA).MethodsThis was a non-interventional retrospective cohort study using data in the Optum clinical database from adults with T2DM initiating linagliptin. Date of the first linagliptin prescription was the index date. Outcomes included change in glycated hemoglobin (HbA1c) and the percentage of persons achieving an HbA1c < 7% (53 mmol/mol) during the 60–180 days following linagliptin initiation. Analyses of age by renal function were conducted. Multivariate regression analysis was performed to assess change in HbA1c, controlling for an a priori list of covariates.ResultsOverall, 11,001 persons were included. Mean pre-index HbA1c value was 8.2% (66 mmol/mol), with higher levels in younger versus older persons and AAs versus other race groups. Persons initiating linagliptin had an average HbA1c reduction of 0.51% (5.6 mmol/mol). Without adjusting for age, renal function, race, and pre-index HbA1c, greater reductions in HbA1c were observed in younger versus older persons, persons with higher versus lower estimated glomerular filtration rate (eGFR), and AAs versus white or Asians. After multivariate analysis, variables significantly associated with a greater HbA1c reduction included higher pre-index HbA1c and older age.ConclusionsThese results support the HbA1c-lowering effectiveness of linagliptin across age, race, and renal function categories among a large real-world population of adults with T2DM.Electronic supplementary materialThe online version of this article (10.1007/s13300-020-00841-x) contains supplementary material, which is available to authorized users.

Background: Peripheral Artery Disease (PAD) is a condition that reduces blood flow to the lower extremities and is primarily caused by atherosclerosis. PAD is one of the complications of Diabetes Mellitus (DM). Diabetics have an 11.6 times more likely to develop PAD than those without diabetes. Glycated haemoglobin (HbA1c) levels &gt;7% are at a higher risk of chronic complications. Obesity and overweight also raise the risk of developing PAD disease. However, research on the correlation between Body Mass Index (BMI) and PAD remains unclear and controversial. Aims: To analyze the correlation between HbA1c levels and BMI with the incidence of Peripheral Artery Disease in patients with type 2 Diabetes Mellitus at Waled Hospital. Methods: This is an analytical observational study with a cross-sectional design. Data was collected on patients diagnosed with type 2 Diabetes Mellitus at the Internal Medicine Clinic at Waled Hospital in June - July 2024. A total sample of 77 was obtained using consecutive sampling. The inclusion criteria were type 2 DM, aged 19-60 years, and medical record data equipped with the HbA1c levels for at least the last 3 months prior to data collection. The exclusion criteria were patients with a history of diabetic ulcers, amputation and limb disability, Acute Coronary Syndrome, stroke, kidney failure, recurrent anaemia, and blood transfusions in the last 3 months. Primary data was gathered through an ABI examination, while secondary data was obtained from medical records. The data was analysed using the Spearman correlation test. Results: Patients had poor HbA1c control (51.9%), moderate HbA1c control (29.9%) and good HbA1c control (18.2%), with the majority of patients had normal BMI (39%) followed by obese I (22.1%), overweight and obese II (16.9%). Our study showed that the distribution of PAD levels was severe (0%), moderate (3.9%), mild (44.2%), normal (46.8%), and arteriosclerotic (5.2%). The correlation test showed p-0.789 (p&gt; 0.05) for HbA1c levels with PAD and p- 0.653 (p&gt;0.05) for BMI with PAD. Conclusion: There was no association between glycated hemoglobin or Body Mass Index values and the incidence of PAD in patients with type 2 Diabetes Mellitus at Waled Hospital, Cirebon, Indonesia. Received: 25 September 2024 | Reviewed: 21 October 2024 | Revised: 30 November 2024 | Accepted: 11 December 2024.

IntroductionAchieving optimal glycemic control remains challenging for many patients with diabetes. Text message-based interventions offer a scalable approach to enhance management. This systematic review and meta-analysis evaluated the impact of texting interventions on glycemic control in adults with diabetes.Research design and methodsWe searched EMBASE, PubMed, and Cochrane CENTRAL for randomized controlled trials comparing texting interventions to standard care in high-income countries. The primary outcome was the between-group difference in hemoglobin A1c (HbA1c) change from baseline. Risk of bias and overall quality of evidence were assessed using the Cochrane and Grading of Recommendations Assessment, Development, and Evaluation tools respectively. Results were pooled using an inverse variance random-effects model. Heterogeneity was evaluated using the I2 statistic.ResultsOver 3 months of follow-up (14 trials, n=1,460 intervention, n=1,487 control), texting interventions were associated with a 0.29-unit greater reduction in percent HbA1c over control (95% CI 0.14 to 0.45, p=0.0001, I2=57%). At 6 months (20 trials, n=2,332 intervention, n=2,371 control), texting was associated with 0.19-unit greater HbA1c reduction (95% CI 0.07 to 0.30, p=0.001 I2=45%). At 12 months (seven trials, n=2,038), there was a non-significant benefit associated with texting. Among studies with a mean baseline HbA1c ≥8.6%, texting was associated with 0.48- and 0.36-unit greater HbA1c reductions at 3 (p=0.004) and 6 (p=0.004) months, respectively. Subgroups were not significantly different.ConclusionText messaging interventions are associated with modest improvements in glycemic control over 3–6 months, particularly in patients with poorer baseline HbA1c. These effects may be meaningful at scale and support texting as a potential adjunct to routine diabetes care. Benefits appear to diminish by 12 months, underscoring the need for high-quality trials focused on long-term impact and intervention optimization.PROSPERO registration numberCRD42023416462.

Background: India is the diabetes capital of the world. Despite several pharmacological options, almost 70% of patients present with poor HbA1c control. Lifestyle modifications are one of the most important interventions for such chronic metabolic disorders. Therefore, adding Lifestyle Modifier, a dietary approach collectively utilizing efficacious nutrients (natural source of very high dietary fiber, omega-3, proteins, minerals, and vitamins) while maximizing adherence is the key to the management of type 2 diabetes mellitus (T2DM). Methodology: Patients were enrolled by adding Salvia hispanica L. Seeds (Azpro) along with standard medications to evaluate outcomes on risk factors in patients of T2DM. The objective was to determine the role of Salvia hispanica L. (Azpro), as an adjunct to conventional treatment in the reduction of major and emerging cardiovascular risk factors in individuals with type 2 diabetes. A retrospective analysis was conducted on fifty patient’s data available at Advanced Diabetes Centre, Surat, India. Salvia hispanica L. (Azpro) seeds were given 10 g twice a day for 3 months as an adjunct to the standard diabetes management therapy. HbA1c, body fat, visceral fat, BMI, and weight loss were calculated at three months. Results: Consumption of Salvia hispanica L. (Azpro) seeds for three months in addition to the standard treatment led to a total 1.13 kg weight loss (p=0.0008), and HbA1c reduction by 0.58% (p=0.016). Conclusion: This result affirms the role of Salvia hispanica L. seeds in the dietary management of diabetic patients with significant (P =0.0008) weight loss &amp; overall metabolic management. Keywords: Salvia hispanica L. (Azpro) seeds, Chia seeds, diabetes, type 2 diabetes, weight loss, HbA1c, BMI, total fat, visceral fat, cardiovascular risk, dietary fiber, omega 3 fatty acids

The number of overweight gastric cancer patients who are undergoing laparoscopic gastrectomy (LG) has increased in Japan. However, the relationship between obesity and surgical outcomes of LG remains unclear. Therefore, this study aimed to evaluate the effect of visceral fat area (VFA) on surgical outcomes of LG for gastric cancer compared to the body mass index (BMI). This study was a retrospective, cohort study that included 587 patients who underwent LG in our institution between January 2015 and December 2019. The patients were divided into two groups according to VFA (< 100 cm2 and ≥ 100 cm2) and BMI (< 25kg/m2 and ≥ 25kg/m2) values, respectively. Surgical outcomes and postoperative complications were compared between the low and high groups for each VFA and BMI value. Propensity score matching was used to minimize potential selection bias. After propensity score matching, 144 pairs of patients in the VFA group and 82 pairs of patients in the BMI group were extracted. Operative time (p = 0.003), intraoperative blood loss (p = 0.0006), and CRP levels on postoperative day 1 (p = 0.002) and on postoperative day 3 (p = 0.004) were significantly higher in the high-VFA group than in the low-VFA group. However, these surgical outcomes were not significantly different between the high-BMI and low-BMI groups. There was no strong correlation between VFA and BMI (R2 = 0.64). There were no significant differences in postoperative complications between the high and low groups for both VFA and BMI values. On multivariate analysis, high VFA was an independent predictor of operative time, but it was not significantly associated with the incidence of postoperative complications. VFA is a better indicator of longer operative time than BMI. However, increased VFA did not affect postoperative complications.

Disclosure: K.M. Barton: None. J.Y. Yip: None. K.C. Geckeler: None. A. Popelka: None. D.J. Ramsey: None. Purpose: To explore whether patients with diabetes mellitus (DM) who met Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set (HEDIS) metrics had a reduced likelihood of experiencing unplanned emergency department (ED) visits, hospitalizations, or mortality. Introduction: The prevalence of DM among U.S. adults is approximately 15% and continues to rise. To enhance care for individuals with DM, Comprehensive Diabetes Care HEDIS quality measures have been established. These measures encompass criteria such as blood pressure control, hemoglobin A1c (HbA1c) levels, and the completion of an annual eye examination. However, the connection of these metrics to health outcomes remains insufficiently studied. Methods: This study comprised a retrospective, cross-sectional exploratory analysis of established patients aged 18 years or older with DM receiving primary care within a suburban integrated delivery network (IDN). Multivariate logistic regression was used to analyze patient characteristics, including demographics, sociomedical factors, and biometrics. Outcome variables encompassed one or more unplanned ED visits (including urgent care), one or more unplanned hospitalizations, or mortality within the one-year study period. Results: Out of 28,929 patients with DM, 5293 (18.3%) had ≥1 ED visit, 3725 (12.9%) had ≥1 hospital admission, and 614 (2.1%) died during 2022. After controlling for available demographic and sociomedical factors, patients with poor HbA1c control (considered HbA1c &amp;gt; 9.0) in the year prior were more likely to experience an ED visit in the study year (adjusted odds ratio [aOR] = 1.292, 95% CI, 1.121-1.489, p &amp;lt; 0.001). Patients who achieved HbA1c control (considered HbA1c &amp;lt; 8.0) in the year prior were less likely to experience an ED visit (aOR = 0.845, 95% CI, 0.763-0.936, p = 0.001) and less likely to experience a hospitalization in the study year (aOR = 0.878, 95% CI, 0.779-0.989, p = 0.032). Patients who completed an eye exam in the year prior were less likely to experience a hospitalization (aOR = 0.913, 95% CI, 0.847-0.984, p = 0.017) or die (aOR = 0.694, 95% CI, 0.579-0.831, p &amp;lt; 0.001) in the study year. Finally, patients who completed microalbumin testing in the year prior were less likely to experience an ED visit (aOR = 0.902, 95% CI, 0.84-0.968, p = 0.004), or die (aOR = 0.464, 95% CI, 0.389-0.554, p &amp;lt; 0.001). Conclusion: Achieving HbA1c control in the previous year is linked to decreased likelihood of experiencing an unplanned ED visit or hospitalization. An eye exam in the year prior was associated with decreased likelihood of hospitalization or death. Further research into interventions aimed at enhancing DM management and reducing associated complications may have potential to enhance patient health outcomes while reducing health care costs. Presentation: 6/3/2024