Achieve Target Glycemic Control Research Articles

Performance of Primary Care Physicians in the Management of Glycemia, Lipids, and Blood Pressure among People with Type 2 Diabetes: A Cross-Sectional Study.

Background: Our study aimed to evaluate the performance of primary healthcare physicians (PCPs) in managing glycemia, lipids, and blood pressure in people with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. Methods: We included 3267 PCPs with 367,132 T2DM subjects in a cross-sectional analysis of the SIDIAP (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària) database for the year 2017. Results: 63.1% of PCPs were female, with an average practice size of 1512 subjects. T2DM individuals had a mean (standard deviation) age of 70 (±12.2) years old, a mean body mass index (BMI) of 30.2 (±5.21) kg/m2, and a median diabetes duration of 8.8 years. Overall, 42.6% of subjects achieved target glycemic control (glycated hemoglobin < 7%). Notably, 59.2% maintained blood pressure < 140/90 mmHg during the 12-month study period. The multivariable analysis identified positive associations between glycemic control and female PCPs, practice sizes (1000-1500 people), a higher proportion of patients aged ≥ 65 years, and rural practices. Combined glycemic, lipid, and blood pressure target attainment was associated with medium-sized practices and those with a higher proportion of patients aged ≥ 65 years. Conclusions: Practice size, patient age distribution, and rurality are factors associated with the performance of PCPs in the control of glycemia, lipids, and blood pressure in T2DM subjects in primary health care centers in our region.

Glycemic control parameters in children with type 1 diabetes treated with fast-acting insulin aspart domestic biosimilar by continuous subcutaneous infusion

Introduction. Type 1 diabetes (T1D) is a chronic autoimmune disease requiring constant insulin therapy under regular continuous monitoring of glycemic parameters. The use of domestic insulin bioanalogues in CSII therapy is currently not sufficiently covered in the literature.Aim. To evaluate glycemic control parameters in children with T1D treated with the domestic fast-acting insulin aspart biosimilar by CSII.Materials and methods. Retrospective study was carried out on the basis of K.A. Raukhfus center St. Petersburg State Medical and Biomedical Center VMT. Fifty-five children with T1D aged 6 to 17 years (mean age 12 ± 4) were examined, including 29 boys (52.7%, mean age 11 ± 3 years) and 26 girls (47.3%, mean age 13 ± 4 years). Insulin therapy was carried out by systems of CSII Glycemic parameters were monitored by continuous and flash glycemic monitoring systems. The center visits frequency was once a month.Results. During dynamic follow-up after 3 and 6 months, children showed statistically significant (p &lt; 0.05) improvement in glycemic control parameters–decrease in HbA1c level from 8.0 ± 1.8% to 7, 1 ± 1.2% and 6.8 ± 0.6%, increase in TIR from 60.4 ± 20.6% to 71.5 ± 13.0% and 75.9 ± 9.4%, decrease in TAR from 31.1 ± 22.1% to 23.0 ± 12.8% and 20.3 ± 9.3%, decrease in TBR from 9.1 ± 8.2% to 5.8 ± 4.3% and 4.1 ± 1.8%, and decrease in CV from 40.0 ± 9.1% to 33.7 ± 6.7% and 32.5 ± 5.6%.Discussion. The use of domestic biosimilar insulin aspart in insulin pumps iis associated with significant improvement in glycemic control in children and adolescents with T1D. Dynamic observation together with therapeutic education contribute to the maintenance of the achieved parameters at a high level.Conclusions. Therapy with the domestic fast-acting insulin aspart biosimilar by CSII allows achieving target glycemic control in children with T1D.

Real-World Observational Study on Vildagliptin With Insulin (VIL-INS) or Vildagliptin and Metformin With Insulin (VIL-MET-INS) Therapy in Indian Patients With Type 2 Diabetes Mellitus.

The therapeutic use of vildagliptin and insulin (VIL-INS) or vildagliptin and metformin in combination with insulin (VIL-MET-INS) in the Indian scenario has yet to be explored by generating real-world evidence. Therefore, the present study aimed to evaluate the demographic, clinical characteristics, and treatment patterns of patients with type 2 diabetes mellitus (T2DM) in Indian settings in the above context. This observational study conducted at 600 healthcare centers in India retrospectively analyzed data of adult patients with T2DM who had been treated with either vildagliptin with insulin or a combination of vildagliptin and metformin with insulin. Data were collected from medical records and analyzed by appropriate statistical tests. A total of 12,603 patients with T2DM were included with a mean age of 53.4 years of which 63.8% were males. The majority of patients (n=6511; 51.7%) received a combination of vildagliptin and metformin on top of insulin. A significantly high proportion of patients in the age group of 18-40 years received this treatment compared to patients who were initiated on insulin treatment after vildagliptin and metformin combination (11.6% vs. 9.7%; P<0.001). Of all the patients, 70.0% were able to achieve target glycemic control with either VIS-INS or VIL-MET-INS. After treatment with VIL-INS or VIL-MET-INS, the mean glycated hemoglobin (HbA1c) levels significantly decreased with a mean change of 1.46%. Out of all patients, 13.5% experienced weight changes during treatment, with 67.4% of them showing weight loss. A total of 68 patients reported hypoglycemic events and among them, 49 patients had mild hypoglycemic events. Physician global evaluation of efficacy and tolerability showed a majority of patients rated their experience as good to excellent (86.3% and 86.0%, respectively). Both treatment regimens wereeffective in terms of reduced HbA1c to achieve glycemic control. Furthermore, it is well tolerated without an increase in the risk of hypoglycemia or weight gain. Hence, this therapy has favorable outcomes for T2DM management in Indian clinical settings.

Impact of Initiation of Insulin Therapy on Serum Prolactin and Cortisol Levels in Type 2 Diabetic Male Patients

Background Type 2 Diabetes Mellitus is a common metabolic disease characterized by a decline in insulin sensitivity and relative insulin insufficiency-induced hyperglycemia. In type 2 diabetic patients who have failed to achieve target glycemic control goals on oral anti-diabetic drug therapy, Initiating insulin therapy significantly improved overall glycemic control. Objective To assess Impact of Initiation of Insulin Therapy on Serum Prolactin and Cortisol levels In Type 2 Diabetic Male Patients. Subjects and Methods It was conducted on thirty (30) male patients who were diagnosed to have type 2 diabetes attending diabetes clinic at Ain- Shams University Hospital from 1 Jan. to 1 July 2018. Their ages range from 40 to 60 years old. Results On studying the Correlation between cortisol and prolactin with other laboratory findings showed that: There were no significant correlations between cortisol a.m. and prolactin with FBS, 2HPPBG and HbA1C (P &amp;gt; 0.05) in the first and third visits in group I. And no significant correlations between cortisol a.m. and prolactin with FBS and 2HPPBG (P &amp;gt; 0.05) in the second visit in group I. But there was a significant positive correlation between cortisol with FBS (P = 0.028) and HbA1C (P = 0.033) in group II. And a significant positive correlation between cortisol with FBS (P = 0.034) and 2HPPBG (P = 0.041) in group III. There was a highly significant positive correlation between cortisol and FBS (P = 0.001) in group III. And there was a highly significant positive correlation between prolactin with 2HPPBG (P = 0.008) in group II. Conclusion We conclude from this study that initiation of insulin therapy in poorly controlled diabetic patients achieves a highly significant reduction in blood glucose level. Also, insulin therapy in diabetic patients has impact on other hormones regulating blood glucose level as it reduces serum prolactin and cortisol levels. Also we conclude that prolactin is a diabetogenic hormone.

Personalized Type 2 Diabetes Management: An Update on Recent Advances and Recommendations.

Previous guidelines for the treatment of people with type 2 diabetes mellitus (T2D) have relied heavily upon rigid algorithms for the sequential addition of pharmacotherapies to achieve target glycemic control. More recent guidelines advocate a personalized approach for diabetes treatment, to improve patient satisfaction, quality of life, medication adherence and overall health outcomes. Clinicians should work with patients to develop personalized goals for their treatment, including targeted glycemic control, weight management, prevention and treatment of associated comorbidities and avoidance of complications such as hypoglycemia. Factors that affect the intensity of treatment and choice of pharmacotherapy should include medical and patient influences. Medical considerations include the diabetes phenotype, biomarkers including genetic tests, and the presence of comorbidities such as cardiovascular, renal, or hepatic disease. Patient factors include their treatment preference, age and life expectancy, diabetes duration, hypoglycemia fear and unawareness, psychological and social circumstances. The use of a personalized approach in the management of people with T2D can reduce the cost and failure associated with the algorithmic “one-size-fits-all” approach, to anticipate disease progression, improve the response to diabetes pharmacotherapy and reduce the incidence of diabetes-associated complications. Ultimately, the use of personalized medicine in people with T2D should improve medication adherence, patient satisfaction and quality of life to reduce diabetes distress and improve physical health outcomes.

Real-world experience of treatment individualization based on fixed-dose combination of gliclazide extended release+ metformin extended release in type 2 diabetes mellitus

Objective To evaluate efficacy of gliclazide extended release (XR) 60 mg + metformin XR 500 mg fixed-dose combination (FDC) with metformin as add-on (as needed) in real-world clinical practice. Methods This prospective observational study was performed in patients with type 2 diabetes mellitus uncontrolled on metformin (group M) or on conventional gliclazide XR 60 mg + metformin XR 500 mg (group GM); and newly diagnosed or untreated patients with HbA1c &gt;9% (group U) at 6 out-patient diabetes care units. Patients received gliclazide XR 60 mg + metformin XR 500 mg FDC and metformin (as needed) at baseline for 30 days. Up-titration with gliclazide capped at 120 mg and metformin every 30 days till day-90. Proportion of patients achieving target FPG was primary endpoint. Results Of 455 patients (mean age:51.9±11.3 years; mean BMI 26.7±6.2 kg/m2), 261 patients had family history of diabetes and 161 patients had hypertension. Target FPG was achieved with 1 tablet each of gliclazide XR 60 mg + metformin XR 500 mg FDC and metformin by 73.09%, 74.26%, and 60.66% patients in groups M, GM, and U, respectively. Only 29.23% patients required up-titration to 1 tablet of FDC + 2 tablets each of metformin and FDC at days 60 and 90. Mean FPG, PPG and HbA1c significantly reduced at day-90 (P&lt;0.001). Conclusions It can be concluded from this real-world primary-care practice study that the use of gliclazide XR 60 mg + metformin XR 500 mg FDC and metformin (as needed) was effective and well tolerated, and &gt;3 out-of 5 patients achieved target glycemic control within 30 days in all groups.

Inpatient Glycemic Control With Sliding Scale Insulin in Noncritical Patients With Type 2 Diabetes: Who Can Slide?

Despite clinical guideline recommendations, sliding scale insulin (SSI) is widely used for the hospital management of patients with type 2 diabetes (T2D). We aimed to determine which patients with T2D can be appropriately managed with SSI in non-critical care settings. We used electronic health records to assess inpatient glycemic control in medicine and surgical patients treated with SSI according to admission blood glucose (BG) concentration between June 2010 and June 2018. Primary outcome was the percentage of patients with T2D achieving target glycemic control, defined as mean hospital BG 70 to 180 mg/dL without hypoglycemia <70 mg/dL during SSI therapy. Among 25,813 adult patients with T2D, 8,095 patients (31.4%) were treated with SSI. Among patients with admission BG <140 mg/dL and BG 140 to 180 mg/dL, 86% and 83%, respectively, achieved target control without hypoglycemia, as compared with only 18% of those with admission BG ≥250 mg/dL (P < .001). After adjusting for age, gender, body mass index (BMI), race, Charlson Comorbidity Index score, and setting, the odds of poor glycemic control increased with higher admission BG (BG 140-180 mg/dL: odds ratio [OR], 1.8; 95% CI, 1.5-2.2; BG 181-250 mg/dL: OR, 3.7; 95% CI, 3.1-4.4; BG >250 mg/dL: OR, 7.2; 95% CI, 5.8-9.0), as compared with patients with BG <140 mg/dL. A total of 1,192 patients (15%) treated with SSI required additional basal insulin during hospitalization. Most non-intensive care unit patients with admission BG <180 mg/dL treated with SSI alone achieve target glycemic control during hospitalization, suggesting that cautious use of SSI may be a viable option for certain patients with mild hyperglycemia.

Data on vildagliptin and vildagliptin plus metformin combination in type-2 diabetes mellitus management

It is of interest to evaluate the clinical effectiveness and safety of vildagliptin as monotherapy and combination therapy of vildagliptin and metformin for the management of type 2 diabetes mellitus (T2DM) patients in Indian settings. The study included patients with T2DM (aged &gt;18 years) receiving vildagliptin monotherapy and vildagliptin in combination with metformin therapy of various strengths. Data related to demographics, risk factors, medical history, glycated hemoglobin (HbA1c) levels, and medical therapies were retrieved from medical records. Out of 9678 patients (median age, 52.0 years), 59.1% were men. A combination of vildagliptin and metformin (50/500 mg) was the most commonly used therapy (54.8%), and the median duration of therapy was 24.0 months. The predominant reason for selecting vildagliptin therapy was to improve HbA1c levels (87.8%). A total of 87.5% of patients required dosage up-titration. Vildagliptin therapy was used in patients with T2DM and associated complications (peripheral neuropathy, CAD, nephropathy, retinopathy, autonomous neuropathy, stroke/TIA, and peripheral artery disease). Among 5175 patients who experienced body weight changes, a majority of patients had lost weight (68.6%). The target glycemic control was achieved in 95.3% of patients. The mean HbA1c levels were significantly decreased post-treatment (mean change: 1.34%; p&lt;0.001). Adverse events were reported in 0.4% of patients. Physicians rated the majority of patients as good to excellent on the global evaluation of efficacy and tolerability scale (98.9%, each). Vildagliptin with or without metformin was an effective therapy in reducing HbA1c helps in achieving target glycemic control, and was well-tolerated in Indian patients with T2DM continuum.

Data on vildagliptin and vildagliptin plus metformin combination in type-2 diabetes mellitus management.

It is of interest to evaluate the clinical effectiveness and safety of vildagliptin as monotherapy and combination therapy of vildagliptin and metformin for the management of type 2 diabetes mellitus (T2DM) patients in Indian settings. The study included patients with T2DM (aged >18 years) receiving vildagliptin monotherapy and vildagliptin in combination with metformin therapy of various strengths. Data related to demographics, risk factors, medical history, glycated hemoglobin (HbA1c) levels, and medical therapies were retrieved from medical records. Out of 9678 patients (median age, 52.0 years), 59.1% were men. A combination of vildagliptin and metformin (50/500 mg) was the most commonly used therapy (54.8%), and the median duration of therapy was 24.0 months. The predominant reason for selecting vildagliptin therapy was to improve HbA1c levels (87.8%). A total of 87.5% of patients required dosage up-titration. Vildagliptin therapy was used in patients with T2DM and associated complications (peripheral neuropathy, CAD, nephropathy, retinopathy, autonomous neuropathy, stroke/TIA, and peripheral artery disease). Among 5175 patients who experienced body weight changes, a majority of patients showed a loss of weight (68.6%). The target glycemic control was achieved in 95.3% of patients. The mean HbA1c levels were significantly decreased post-treatment (mean change: 1.34%; p<0.001). Adverse events were reported in 0.4% of patients. Physicians rated the majority of patients as good to excellent on the global evaluation of efficacy and tolerability scale (98.9%, each). Vildagliptin as monotherapy and combination therapy of vildagliptin and metformin was an effective therapy in reducing HbA1c helps in achieving target glycemic control, and was well tolerated in Indian patients with T2DM continuum.

Advances in Insulin Pump Infusion Sets Symposium Report.

Continuous subcutaneous insulin infusion (CSII) is becoming increasingly used for achieving target glycemic control as well as providing flexibility in lifestyle. In a widely used version of CSII, the insulin pump itself is attached to one end of an insulin infusion set (IIS), which delivers insulin via a thin flexible plastic tube to the patient's body via a cannula or needle that is inserted under the skin at the other end of the IIS. Despite the increased use of CSII by patients with diabetes, there have been few recent advances in IIS technology, especially when compared to the many recent advances made in insulin pump technology and in insulin pharmacokinetics. To discuss recent developments in, and future plans for IIS development, Diabetes Technology Society virtually hosted the Advances in Insulin Pump Infusion Sets Symposium on December 1, 2020. This symposium featured experts in the field of IISs, including representatives from Medtronic and ConvaTec (which are two manufacturers that are currently developing IISs), Stanford University, Steno Diabetes Center Copenhagen, and Science Consulting in Diabetes. The webinar's six speakers covered (1) patient burden, (2) extended wear technology, and (3) future directions in IIS development.

Prevention of Type 1 Diabetes: Past Experiences and Future Opportunities.

Type 1 diabetes (T1D) results from autoimmune destruction of insulin-producing beta-cells in the pancreas, caused by the interplay of genetic and environmental factors. Despite the introduction of advanced technologies for diabetes management, most patients fail to achieve target glycemic control, and T1D still has a high burden of long-term end-organ complications. Over several decades, multiple clinical trials have attempted to find prevention for T1D in at-risk individuals or to stabilize, ultimately reverse, the disease in those with T1D. To date, T1D remains yet incurable condition; however, recently improved understanding of the natural history of the disease may lead to new strategies to preserve or improve beta-cell function in those at increased risk and T1D patients. This publication aims to provide an overview of past experiences and recent findings in the prevention of T1D.

113-LB: Home Diabetes Regimen and Admission HbA1c as Predictors of Hospital Glycemic Control: A Pooled Analysis of Inpatient Clinical Trials

Glycated hemoglobin (HbA1c) on admission has been suggested as a predictor of glycemic control in the hospital. However, no studies have examined the interaction of pre-admission patient characteristics (i.e., complexity of home regimen or diabetes duration) and HbA1c on inpatient glycemic control. We pooled data from eight randomized controlled trials of patients assigned to a standardized basal-bolus insulin regimen in the hospital. Patients were categorized according to: A) increasing home regimen complexity [group 1: diet alone or ≤1 oral antihyperglycemic drugs (OADs) (n=338, 39%); group 2: two or more OADs (n=177, 20%); and group 3: insulin based regimens (n=356, 41%) and B) admission HbA1c categories (&amp;lt;7%, 7-9%, or &amp;gt;9%). Logistic regression models adjusting for age, gender, BMI, admission BG, and hospital service (medicine vs. surgery) were constructed to determine associations between home regimen complexity, diabetes duration, HbA1c and inpatient glycemic control. Compared to patients treated at home with OADs, patients using insulin had a longer duration of diabetes and higher admission HbA1c (both p&amp;lt;0.001). Compared to group 1 (reference), patients on insulin were less likely to achieve target glycemic control (mean BG 70-180 mg/dl without hypoglycemia) regardless of admission HbA1c [HbA1c &amp;lt;7% adjusted odd ratio (aOR) 0.36 (0.16, 0.81); HbA1c 7-9% aOR 0.5 (0.30, 0.91), or HbA1c &amp;gt;9% aOR 0.44 (0.24, 0.83), and had higher risk for hypoglycemia (all p&amp;lt;0.05). Patients with a longer duration of diabetes (&amp;gt;10 years) were less likely to achieve good glycemic control compared to patients with shorter duration of diabetes irrespective of home regimen complexity. Though admission HbA1c has been proposed as a predictor of inpatient glycemic control, our data show patients requiring complex therapy with insulin at home are less likely to achieve inpatient glucose targets independent of admission HbA1c. Disclosure M.A. Urrutia: None. Y. Guo: None. M. Fayfman: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. A. Migdal: None. G. Davis: None. I. Anzola: None. B.S. Albury: None. M.F. Scioscia: None. K.W. Zamudio: None. G.E. Umpierrez: None. F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp &amp; Dohme Corp., National Institutes of Health.

Diabetic health literacy and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of a university hospital in Ethiopia.

BackgroundDespite how much effect of low health literacy is on diabetic treatment cannot be accurate, it has an impact on controlling blood glucose level. Less is known about diabetic health literacy in Ethiopian diabetic patients which can affect patient medication adherence, self-care, and glycemic control.ObjectiveThis study was aimed to assess the diabetic health literacy level and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of University of Gondar Comprehensive Specialized Hospital (UOGCSH): Northwest Ethiopia.MethodsA cross-sectional study was employed at the outpatient clinic of the University of Gondar Comprehensive Specialized Hospital from May, 1 –May 30, 2019. The comprehensive 15-items diabetic health literacy questions with a 5-point Likert scale used to measure diabetic health literacy. The mean score calculated and switched to the percentage (5 points as 100%) to determine the level of diabetic health literacy. Morisky Green Levine Scale 4 item adherence assessment tool was used to assess the diabetic patient's level of adherence. Binary and multivariable logistic regression analysis was used to assess the association between sociodemographic, clinical variables, diabetic-related literacy, and glycemic control. Independent samples t-test and One-way ANOVA test was employed to compare the mean literacy score difference in different groups.Result400 respondents were included in the study. Of all the respondents, 17.3%, 26.3%, and 56.5% had low, medium and high diabetic-related health literacy, respectively. The proportions of patients with low, medium and high adherence to medication were 9.8%, 56.3%, and 34% respectively. Patients with high diabetes literacy are 1.85 times more likely to achieve target glycemic control than lower diabetic literacy patients with 95% CI Adjusted Odds Ratio (AOR). 1.85(1.09–3.40). While patients with good adherence 1.61 times more likely to achieve target glycemic control than patients with low adherence; 95% CI AOR 1.61(1.04–4.79). Diabetic patients with morbidity have 67% less likelihood to achieve the target glycemic control; 95% CI AOR 0.33(0.15–0.73).ConclusionAdequate diabetic health literacy and better glycemic control are highly correlated. Adjusting all variables; younger age, high diabetic health literacy and good adherence are associated with achieving the target glycemic control.

&lt;p&gt;Association of diabetes knowledge with glycemic control and self-care practices among Pakistani people with type 2 diabetes mellitus&lt;/p&gt;

ObjectiveThis study explored the relationship of disease knowledge with glycemic control and self-care practices in adult Pakistani people diabetes (PWD).MethodsPeople diagnosed with type 2 diabetes (n=218) were selected from three health care centers, located in different cities of Pakistan. Disease knowledge and self-care practices were assessed by Urdu versions of Diabetes Knowledge Questionnaire (DKQ) and Diabetes Self-Management Questionnaire (DSMQ), using a cross-sectional design. Chi-square and correlation analysis were applied to explore the relationship of disease knowledge with glycemic control and self-care practices. Linear regression was used to explore the predictors for disease knowledge.ResultsMajority of the sample was >45–60 years old (48.8%), suffering from type 2 diabetes mellitus for <5 years (49.5%) and had poor glycemic control (HbA1C≥7%; n=181 participants). Disease knowledge was significantly associated (p<0.05) with patient’s gender, level of education, family history of diabetes, nature of euglycemic therapy, and glycemic control. Correlation matrix showed strongly inverse correlations of DKQ with glycated hemoglobin levels (r=−0.62; p<0.001) and strongly positive with DSMQ sum scale (r=0.63; p<0.001). PWD having university-level education (β=0.22; 95% Confidence Interval (CI) 0.189, 0.872; p<0.01), doing job (β=0.22; 95% CI 0.009, 0.908]; p=0.046), and use of oral hypoglycemic agents in combination with insulin (β=−0.16; 95% CI [−1.224, −0.071]; p=0.028) were the significant predictors for disease knowledge.ConclusionDisease knowledge significantly correlated with glycated hemoglobin levels and self-care activities of PWD. These findings will help in designing patient-tailored diabetes educational interventions for yielding a higher probability of achieving target glycemic control.

Treatment Costs and Factors Associated with Glycemic Control among Patients with Diabetes in the United Arab Emirates.

BackgroundWe aimed to estimate the proportion of patients with diabetes who achieved target glycemic control, to estimate diabetes-related costs attributable to poor control, and to identify factors associated with them in the United Arab Emirates.MethodsThis retrospective cohort study used administrative claims data handled by Abu Dhabi Health Authority (January 2010 to June 2012) to determine glycemic control and diabetes-related treatment costs. A total of 4,058 patients were matched using propensity scores to eliminate selection bias between patients with glycosylated hemoglobin (HbA1c) <7% and HbA1c ≥7%. Diabetes-related costs attributable to poor control were estimated using a recycled prediction method. Factors associated with glycemic control were investigated using logistic regression and factors associated with these costs were identified using a generalized linear model.ResultsDuring the 1-year follow-up period, 46.6% of the patients achieved HbA1c <7%. Older age, female sex, better insurance coverage, non-use of insulin in the index diagnosis month, and non-use of antidiabetic medications during the follow-up period were significantly associated with improved glycemic control. The mean diabetes-related annual costs were $2,282 and $2,667 for patients with and without glycemic control, respectively, and the cost attributable to poor glycemic control was $172 (95% confidence interval [CI], $164–180). The diabetes-related costs were lower with mean HbA1c levels <7% (cost ratio, 0.94; 95% CI, 0.88–0.99). The costs were significantly higher in patients aged ≥65 years than those aged ≤44 years (cost ratio, 1.45; 95% CI, 1.25–1.70).ConclusionMore than 50% of patients with diabetes had poorly controlled HbA1c. Poor glycemic control may increase diabetes-related costs.

The Effect of Linagliptin versus Metformin Treatment-Related Quality of Life in Patients with Type 2 Diabetes Mellitus.

IntroductionThere have been no studies directly comparing the effect of dipeptidyl peptidase-4 inhibitors with that of metformin on treatment-related quality of life (QOL) when used as first-line therapy in patients with type 2 diabetes mellitus (T2DM).MethodsThis study is a prospective, randomized, open-label, multicenter, parallel-group, comparative study. Forty-four participants who failed to achieve target glycemic control with diet and exercise therapy were randomly allocated to receive linagliptin or metformin therapy. We compared treatment-related QOL among the two groups using the Oral Hypoglycemic Agent Questionnaire, version 2 (OHA-Q version 2) and the self-administered Diabetes Therapy-Related QOL (DTR-QOL) questionnaire.ResultsAfter randomization, 21 patients in the linagliptin group and 22 patients in the metformin treatment group were included in the full analysis set. Biochemical parameters, incidence of adverse effects, and rate of adherence to medication were comparable between the two groups. Over the 24-week treatment period, no significant differences in overall OHA-Q scores between the groups were observed, although the subscale 1 (treatment convenience) score was significantly higher in the linagliptin group than in the metformin group. The overall DTR-QOL score did not differ between the two groups; however, the DTR-QOL scores significantly improved after 24 weeks of linagliptin treatment, but not after metformin treatment.ConclusionWe did not find significantly better treatment-related QOL with linagliptin among Japanese patients with T2DM. In terms of treatment convenience, our data showed that linagliptin was superior to metformin.FundingThis study was financially supported by Nippon Boehringer Ingelheim Co., Ltd. and Eli Lilly and Company. The journal’s article processing fees were covered by a research fund from Juntendo University.Clinical Trial RegistrationUMIN000022953.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-018-0539-5) contains supplementary material, which is available to authorized users.

Adjuvant Pharmacotherapies to Insulin for the Treatment of Type 1 Diabetes.

Insulin therapy alone fails to achieve target glycemic control in the majority of individuals with type 1 diabetes (T1D), motivating the investigation of additive medications. This review focuses on the recent findings on the use of adjunctive pharmacotherapy in T1D. Metformin and glucagon-like peptide-1 receptor agonists have been associated with weight reduction and decrease in daily insulin requirements without sustainable improvement in glycemic control. Sodium-glucose cotransporter (SGLT)-2 inhibitors, dual SGLT-1/2 inhibitors, and pramlintide have been shown to reduce hemoglobin A1c, induce weight loss, and lower insulin dose. The benefits of dipeptidyl peptidase-4 inhibitors, thiazolidinediones, and alpha glucosidase inhibitors appear to be more limited. Gastrointestinal symptoms and increased hypoglycemia are adverse effects of certain classes. Although not devoid of side effects, additive pharmacotherapies in T1D can improve glycemic control and lower body weight and insulin requirement. Longer studies are needed before consideration for widespread clinical care.

Grazing in Young Children with Type 1 Diabetes Is Associated with Higher HbA1c

Glycemic control in the young child with type 1 diabetes (T1D) has traditionally been challenging. Unpredictability in appetite and dietary intake has made the achievement of glycemic targets difficult. This study aimed to assess the nutritional quality and dietary behaviors of young children with T1D that attend a clinic that meets glycemic targets in this age group. Carers of children aged &amp;lt;7 years with type 1 diabetes attending a specialist Pediatric Diabetes Service in Australia completed a 3 day food diary and a survey regarding diabetes management and dietary behaviours. Twenty one children participated (mean age: 4.7 ±1.3y, 57% male, mean BMI z score: 0.9 ± 0.9, duration since diagnosis 1.6 ±1.1y, 38% insulin pump therapy, mean HbA1c: 6.3 ± 0.7% (45±7mmol/mol)). Offering food ’whenever they are hungry’ was associated with higher HbA1c than routine meals (7.2% vs. 6.1%, p=0.02). HbA1c was not correlated with daily total CHO intake, which ranged from 126g to 236g/day. Almost all carers (95%) gave mealtime insulin before food. Most carers (55%) substituted when 6-10 grams (range 1g to &amp;gt;15g) of CHO less than the predicted quantity was consumed. Children consumed saturated fat in excess of recommendations (15 ± 3% E) with no children meeting recommended serves of vegetables. Young children with type 1 diabetes can achieve target glycemic control and can safely dose insulin before meals. Continuous eating episodes were positively associated with HbA1c. Dietary quality remains a concern in this age group. Disclosure R.L. Seckold: None. P. Howley: None. B.R. King: None. K. Bell: Other Relationship; Self; Novo Nordisk Inc.. C.E. Smart: None.

The effects of short-term continuous subcutaneous insulin infusion treatment on fasting glucagon-like peptide-1 concentrations in newly diagnosed type 2 diabetes

ObjectiveEarly short-term intensive insulin therapy in newly diagnosed type 2 diabetes patients shows benefit in glycemic control and β-cell function. Glucagon-like peptide-1 (GLP-1) plays an important role in glucose metabolism and development of type 2 diabetes. We did a study to observe the changes of GLP-1 and β-cell function after short-term continuous subcutaneous insulin infusion (CSII) treatment. MethodsA total of 66 subjects were enrolled, including 30 normal glucose tolerance controls (NGT) and 36 patients with newly diagnosed type 2 diabetes between October 2015 and July 2016. Fasting plasma glucose (FPG), insulin, and GLP-1 were measured in each subject. The patients underwent CSII treatment for 2 weeks, and then FBG, insulin, and GLP-1 were measured. HOMA-IR and HOMA-B were then calculated. ResultsAll patients achieved target glycemic control in two weeks. HOMA-IR and HOMA-B improved significantly after intensive interventions (p < 0.05). The GLP-1 concentration increased significantly in patients after treatment (p < 0.05). When grouped according to bodyweight and age in all patients, the HOMA-IR changed significantly in overweight and old age subgroups, the HOMA-B increased significantly in normal weight, overweight and middle age subgroups, and the GLP-1 concentration also increased significantly in overweight and middle age subgroups respectively (p < 0.05). ConclusionShort-term CSII treatment can obtain glycemic control target and recover β-cell function and GLP-1 secretion in newly diagnosed type 2 diabetes patients. The overweight and middle-aged patients may get more benefit from this treatment.

Effect of Lifestyle Modification and Oral Anti-Diabetic Drugs on Metabolic Parameters in Recently Diagnosed Patientswith Uncomplicated Type 2 Diabetes Mellitus in Eastern India

BACKGROUND: Oral anti-diabetic drugs (OADs) are often advised for initial treatment for patients with Type 2 Diabetes Mellitus (T2DM). Their effects on glycemic control, lipid profile, insulin resistance and beta cell function has not been systematically studied in India. The objective of this study was to evaluate the effect of lifestyle modification and OADs on metabolic parameters in recently diagnosed uncomplicated T2DM patients. MATERIAL METHODS: A total of consecutive sixty four (64) cases of recently diagnosed uncomplicated T2DM in the age group of 30 - 60 years were studied. They were evaluated for weight, body mass index (BMI), fasting plasma glucose (FPG), 2hr post glucose plasma glucose (2hrPGPG), HbA1c, lipid profile, serum fasting insulin, c-peptide, HOMA-IR and HOMA-β. They were divided into four groups according to increasing order of HbA1c values (6.5% - 6.9%, 7% - 7.5%, 7.6% - 8.5%, 8.6% - 8.9%). These four groups were subjected to lifestyle modification (LSM), monotherapy with metformin (1 g) and LSM, dual drug therapy i.e. metformin (1 g), glimepiride (1 mg) and LSM, triple drug therapy i.e. metformin (1 g), glimepiride 1 mg, sitagliptin 100 mg) and LSM respectively. These patients were followed up after three months of therapy. They were evaluated for the same metabolic parameters and compared with their baseline value. Fourteen (14) patients were lost to follow up. RESULTS: We found 91%, 92.8%, 53.3% and 60% of our patients from above four different groups achieved target glycemic control (HbA1c ≤ 6.5%). In all the four groups, significant improvement in glycemic status, lipid profile, HOMA-IR and HOMA-β were observed (p value < 0.05). CONCLUSION: In our study, early Initiation of LSM along with OADs either as monotherapy or in combination therapy according to HbA1c value showed significant improvement in glycemic control, insulin resistance and beta cell function.