Antihyperglycemic Medications Research Articles

Prevalence, Predictors, and Outcomes of Type 2 NSTEMI in Hospitalized Patients With COVID-19.

Data on the incidence of type 2 non-ST-segment-elevation myocardial infarction (T2MI) in hospitalized patients with COVID-19 has been limited to single-center studies. Given that certain characteristics, such as obesity and type 2 diabetes, have been associated with higher mortality in COVID-19 infections, we aimed to define the incidence of T2MI in a national cohort and identify pre-hospital patient characteristics associated with T2MI in hospitalized patients with COVID-19. Using the national American Heart Association COVID-19 Cardiovascular Disease Quality Improvement Registry, we performed a retrospective 4:1 matched (age, sex, race, and body mass index) analysis of controls versus cases with T2MI. We performed (1) conditional multivariable logistic regression to identify predictive pre-hospital patient characteristics of T2MI for patients hospitalized with COVID-19 and (2) stratified proportional hazards regression to investigate the association of T2MI with morbidity and mortality. From January 2020 through May 2021, there were 709 (2.2%) out of 32 015 patients with T2MI. Five hundred seventy-nine cases with T2MI were matched to 2171 controls (mean age 70; 43% female). Known coronary artery disease, heart failure, chronic kidney disease, hypertension, payor source, and presenting heart rate were associated with higher odds of T2MI. Anti-hyperglycemic medication and anti-coagulation use before admission were associated with lower odds of T2MI. Those with T2MI had higher morbidity and mortality (hazard ratio, 1.40 [95% CI, 1.13-1.74]; P=0.002). In hospitalized patients with COVID-19, those with a T2MI compared with those without had higher morbidity and mortality. Outpatient anti-hyperglycemic and anti-coagulation use were the only pre-admission factors associated with reduced odds of T2MI.

Patient-Driven Solutions: Integrating Vildagliptin and Dapagliflozin in Diabetes Management

Type 2 diabetes mellitus (T2DM), an ongoing, chronic and multifactorial condition frequently necessitates multiple anti-hyperglycemic medications for optimal glycemic control. Diabetes rarely occurs in isolation, commonly coexisting with obesity, cardiovascular disease (CVD), and kidney dysfunction. Shared risk factors, such as sedentary lifestyles and poor dietary choices, contribute to the convergence of these health conditions. The interplay between obesity and insulin resistance (IR), a precursor to diabetes, amplifies cardiovascular risks through shared pathological pathways. Addressing this complex interrelation necessitates a holistic approach involving early detection, lifestyle modifications, and comprehensive management to navigate the intricate web of interrelated ailments. Clinical guidelines advocate early adoption of combination therapy. Combining two different therapeutic classes is a promising theoretical strategy for achieving safe and optimum glycemic regulation. Recent research trials combining dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) confirm their safety and clinical efficacy and consequently, this combination emerges as an appealing therapy for T2DM patients, offering a favorable safety profile and positive clinical effects in terms of weight management and cardiorenal protection. This review highlights the utilization of Vildagliptin and Dapagliflozin in diabetes management, underscoring their necessity, pleiotropic advantages, and the importance of an individualized, patient-centric approach for optimal outcomes.

A randomized, double-blind trial assessing the efficacy and safety of two doses of dulaglutide in Japanese participants with type 2 diabetes (AWARD-JPN).

To assess the efficacy and safety of dulaglutide 1.5 mg versus dulaglutide 0.75 mg in Japanese participants with type 2 diabetes (T2D). A Phase 3, multicentre, randomized, double-blind, parallel-group study was conducted in Japanese participants aged ≥20 years, with T2D for ≥6 months and inadequate glycaemic control, while on a single oral antihyperglycaemic medication (NCT04809220). The primary objective was to evaluate superiority of dulaglutide 1.5 mg versus dulaglutide 0.75 mg measured by mean change in glycated haemoglobin (HbA1c) from baseline to 26 weeks. Other efficacy and safety endpoints were evaluated at 26 and 52 weeks. All statistical analyses were conducted using the intention-to-treat population. Overall, 591 participants were randomized to once-weekly dulaglutide 1.5 mg or 0.75 mg. At Week 26, dulaglutide 1.5 mg was superior to dulaglutide 0.75 mg in HbA1c reduction from baseline (least squares mean [LSM] difference -0.29% [95% confidence interval {CI} -0.43, -0.14]). At Week 52, the dulaglutide 1.5-mg arm had a significantly greater proportion of participants who achieved HbA1c <7.0% (46.3% vs. 38.5%; p = 0.03) and showed significantly greater reduction in fasting serum glucose (LSM difference -9.4 mg/dL [95% CI -14.4, -4.3]; p < 0.001) versus the dulaglutide 0.75-mg arm. No statistically significant change in body weight was observed in either treatment arm. Overall, 442 participants (75.4%) experienced treatment emergent adverse events (TEAEs). Constipation (11.3%), diarrhoea (9.6%) and pyrexia (9.0%) were the most commonly reported TEAEs. Dulaglutide 1.5 mg once weekly demonstrated superior glycaemic control versus dulaglutide 0.75 mg once weekly, with comparable safety and tolerability, in Japanese people with T2D.

Quality of Life Following TPIAT: A Patient Experience Survey.

Total pancreatectomy with islet autotransplantation (TPIAT) is performed to improve the quality of life (QOL) of patients with chronic pancreatitis. Few reports have documented QOL following TPIAT, with none using the pancreatitis-specific Pancreatitis Quality of Life Instrument (PANQOLI). We surveyed patients at our center who underwent TPIAT to document postoperative QOL. We collected survey data from 18 adult patients who underwent TPIAT at our medical center from 2012 to 2020. Patients were asked questions assessing QOL following TPIAT and completed the Short Form (SF)-12 and PANQOLI instruments. Forty-three patients who underwent TPIAT were mailed surveys, and 18 were returned. The mean age was 45 years, and 67% of respondents were female. Almost half (44%) had hereditary pancreatitis. Sixty-seven percent believed their overall QOL had improved after surgery. The mean post-operative SF-12 physical score was 38.9 and mean mental score was 44. The mean PANQOLI score was 66 (physical function 20, role function 16, emotional function 14, self-worth 15). Following surgery, 33% were using opiate medications and 67% were using anti-hyperglycemic medications. TPIAT resulted in improved self-reported QOL in most patients, although post-operative physical and mental QOL are less compared to the average healthy United States adult.

The Effect of Antihyperglycemic Medications on COVID-19: A Meta-analysis and Systematic Review from Observational Studies.

Diabetes, a chronic disease worldwide, may be associated with a poorer prognosis in patients with coronavirus disease 2019 (COVID-19). While some antihyperglycemic medications may be beneficial, others may increase the risk of adverse clinical outcomes of COVID-19. We aimed to analyze the effect of antihyperglycemic medications on COVID-19. We searched the Web of Science, Cochrane Library, EMBASE, PubMed, and Scopus databases from December 2019 to June 2022 to identify literature related to patients with COVID-19 and type 2 diabetes mellitus (T2DM) treated with antihyperglycemic medications. 56 studies were included in the analysis. Metformin (OR 0.66; 95% CI 0.58-0.74; p < 0.05), Glucagon-like peptide-1 receptor agonist (GLP-1ra) (OR 0.73; 95% CI 0.59-0.91; p < 0.05), and sodium-dependent glucose transporters 2 inhibitor (SGLT 2i) (OR 0.77; 95% CI 0.69-0.87; p < 0.05) were associated with lower mortality risk, while insulin was associated with increased mortality risk (OR 1.40; 95% CI 1.26-1.55; p < 0.05). Meanwhile, metformin (OR 0.65; 95% CI 0.50-0.85; p < 0.05) and GLP-1ra (OR 0.84; 95% CI 0.76-0.94; p < 0.05) were significantly associated with decreased severe manifestation risk. What's more, metformin (OR 0.77; 95% CI 0.62-0.96; p < 0.05), GLP-1ra (OR 0.86; 95% CI 0.81-0.92; p < 0.05), and SGLT 2i (OR 0.87; 95% CI 0.79-0.97; p < 0.05) were also associated with a decreased risk of hospitalization, but insulin were associated with an increased risk of hospitalization (OR 1.31; 95% CI 1.12-1.52; p < 0.05). Nevertheless, the results of the subgroup analyses showed that the effects of different glucose-lowering agents on COVID-19 may be related to in-hospital use or out-hospital use, elderly or non-elderly patients use, and different geography. Metformin, GLP-1ra, and SGLT 2i have shown a positive effect on clinical outcomes in COVID-19, particularly in non-elderly individuals. However, insulin use may pose a higher risk, especially in elderly patients, so need with caution. Meanwhile, DPP-4i, TZD, α-GLUi, and sulfonylureas appeared to have a neutral effect. These results need to be validated in future clinical studies.

A case of diabetic striatopathy due to uncontrolled type 2 diabetes.

Hemichorea-hemiballismus (HCHB) syndrome is a syndrome characterized by choreic movements which are irregular, nonrepetitive, and random movements, and ballismus which are spontaneous and violent movements. HCHB syndrome with a metabolic cause is a rare presentation that can be precipitated by uncontrolled diabetes. Presented here is a case of HCHB syndrome with right-sided neuroimaging findings and contralateral chorea due to uncontrolled type 2 diabetes mellitus. This patient was found to be obtunded with a blood glucose of greater than 500 mg/dL by EMS. After the administration of insulin, she was able to answer clarifying questions of noncompliance with her antihyperglycemic medications. She had a computed tomography without contrast of the head which showed hyperdense lesions in the right caudate nucleus and putamen consistent with HCHB syndrome. She was started on treatment for nonketotic hyperglycemia with insulin. As her mentation improved, she was able to cooperate with physical examination, which revealed irregular and violent movements in the left upper and lower extremities. Her hemichorea and hemiballismus improved with strict glycemic control, and she was able to be discharged to a skilled nursing facility for further rehabilitation. She would later have repeated hospitalizations for poor glycemic control, and repeat neuroimaging would reveal the resolution of hyperdensities after 4 months. HCHB syndrome due to uncontrolled diabetes has been termed diabetic striatopathy and is characterized by poor glycemic control, unilateral striatal hyperdensity on CT imaging, and contralateral choreic movements. Diabetic striatopathy remains a poorly understood disease, and the exact pathophysiologic mechanism has not been definitively elucidated. Diabetic striatopathy is a relatively new term for metabolic etiology of hemichorea-hemiballismus syndrome and was coined in 2009. The triad for diabetic striatopathy is poor glycemic control, unilateral striatal hyperdensity on CT imaging, and contralateral choreic movements. Multiple etiologies have been suggested for the cause of diabetic striatopathy including petechial hemorrhage, mineral deposition, myelin destruction, and infarction with reactive astrocytosis; however, the exact mechanism has yet to be determined. Antidopaminergic medications may be used to control the choreic movements of diabetic striatopathy; however, the mainstay of treatment is glycemic control, often with insulin therapy.

Protocol for a prospective multicentre cohort study to address the question whether diabetes and its management is still a risk factor in fast-track joint arthroplasty

IntroductionPerioperative glycaemic control is important. However, the complexity of guidelines for perioperative diabetes management is complicated due to different and novel antihyperglycaemic medications, limited procedure-specific data and lack of data...

Antihyperglycemic Medication to Combat Skin AGE-ing.

Antihyperglycemic Medication to Combat Skin AGE-ing.

DEVELOPMENT AND EVALUATION OF METFORMIN TABLETS: EFFECT OF SUPERDISINTEGRANTS

Metformin is an oral antihyperglycemic medication used to treat type 2 diabetes. BCS-III classification of medications includes metformin hydrochloride, which has a high solubility and a low permeability. This study’s objective was to develop wet granulated metformin hydrochloride tablets using various synthetic superdisintegrants. On disintegration and dissolution, the effects of different superdisintegrants have been studied. After evaluation, it were observed that post-compression properties such as weight variability, thickness, hardness, and friability were within the IP ranges. The formulation F4 with Croscarmellose sodium (CCS) in low concentration was chosen as the best formulation. By increasing the quantity of Croscarmellose sodium (CCS), the in vitro dissolution profile increased, and in vitro disintegration time also increased in the formulated tablets using wet granulation method. The statistical significance was determined using one-way ANOVA, and there is no significant difference between formulations.

Predictive factors and the management of hyperglycemia in patients with acromegaly and Cushing's disease receiving pasireotide treatment: post hoc analyses from the SOM230B2219 study.

Pasireotide, a somatostatin receptor ligand, is approved for treating acromegaly and Cushing's disease (CD). Hyperglycemia during treatment can occur because of the drug's mechanism of action, although treatment discontinuation is rarely required. The prospective, randomized, Phase IV SOM230B2219 (NCT02060383) trial was designed to assess optimal management of pasireotide-associated hyperglycemia. Here, we investigated predictive factors for requiring antihyperglycemic medication during pasireotide treatment. Participants with acromegaly or CD initiated long-acting pasireotide 40 mg/28 days intramuscularly (acromegaly) or pasireotide 600 μg subcutaneously twice daily during pre-randomization (≤16 weeks). Those who did not need antihyperglycemic medication, were managed with metformin, or received insulin from baseline entered an observational arm ending at 16 weeks. Those who required additional/alternative antihyperglycemic medication to metformin were randomized to incretin-based therapy or insulin for an additional 16 weeks. Logistic-regression analyses evaluated quantitative and qualitative factors for requiring antihyperglycemic medication during pre-randomization. Of 190 participants with acromegaly and 59 with CD, 88 and 15, respectively, did not need antihyperglycemic medication; most were aged <40 years (acromegaly 62.5%, CD 86.7%), with baseline glycated hemoglobin (HbA1c) <6.5% (<48 mmol/mol; acromegaly 98.9%, CD 100%) and fasting plasma glucose (FPG) <100 mg/dL (<5.6 mmol/L; acromegaly 76.1%, CD 100%). By logistic regression, increasing baseline HbA1c (odds ratio [OR] 3.6; P=0.0162) and FPG (OR 1.0; P=0.0472) and history of diabetes/pre-diabetes (OR 3.0; P=0.0221) predicted receipt of antihyperglycemic medication in acromegaly participants; increasing baseline HbA1c (OR 12.6; P=0.0276) was also predictive in CD participants. Investigator-reported hyperglycemia-related adverse events were recorded in 47.9% and 54.2% of acromegaly and CD participants, respectively, mainly those with diabetes/pre-diabetes. Increasing age, HbA1c, and FPG and pre-diabetes/diabetes were associated with increased likelihood of requiring antihyperglycemic medication during pasireotide treatment. These risk factors may be used to identify those who need more vigilant monitoring to optimize outcomes during pasireotide treatment.

Managing high blood sugar (hyperglycemia) during pasireotide treatment: A plain language summary of the B2219 study

What is this summary about? Pasireotide is a medication used to treat people with acromegaly or Cushing's disease, both of which are hormonal disorders caused by a non-cancerous tumor (adenoma) in the pituitary gland. Because of the way pasireotide works to treat these conditions, sometimes blood sugar levels can increase during treatment, causing a side effect known as hyperglycemia. This is a summary about a study called B2219 (ClinicalTrials.gov ID: NCT02060383), which was designed specifically to look at which additional medication(s) work(s) best to reduce blood sugar levels (antihyperglycemic medication) for people who require treatment for hyperglycemia while receiving pasireotide. What were the results? Researchers found that 4 in every 10 people who took part in the; study did not develop hyperglycemia and therefore did not require antihyperglycemic medication. For those who did, metformin was a good treatment option, followed by incretin-based therapy (sitagliptin and/or liraglutide) if hyperglycemia continued. What do the results of the study mean? This study shows that if hyperglycemia occurs during pasireotide treatment, it is manageable in most people. As such, people with acromegaly or Cushing's disease can experience long-term treatment benefits with pasireotide. Clinical Trial Registration: NCT02060383 ( ClinicalTrials.gov ) (B2219 study); 2012-002916-16 (B2219 study)

Efficacy and Safety of Tirzepatide in Patients with Type 2 Diabetes: Analysis of SURPASS-AP-Combo by Different Subgroups.

Tirzepatide is a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist. In the SURPASS-AP-Combo trial, once-weekly tirzepatide was associated with improved glycemic control and weight loss versus insulin glargine and was generally well tolerated in an Asia-Pacific, predominately Chinese, population with type 2 diabetes (T2D). This post hoc subgroup analysis of SURPASS-AP-Combo assessed the potential influence of patient baseline characteristics on the efficacy and safety of tirzepatide. Changes from baseline to week 40 in HbA1c, body weight, fasting serum glucose (FSG), and daily glucose average from self-measured blood glucose profiles were analyzed by potential influential factors including age (< 65, ≥ 65years), sex, baseline HbA1c (≤ 8.5, > 8.5%), body mass index (BMI) (< 25, ≥ 25kg/m2), body weight (< 75, ≥ 75kg), duration of diabetes (< 10, ≥ 10years), and concomitant oral antihyperglycemic medications (metformin, metformin plus sulphonylurea). Gastrointestinal adverse events and hypoglycemia were also evaluated. At week 40, all tirzepatide doses were associated with reduced HbA1c, body weight, FSG, and daily glucose average from baseline in all subgroups. Greater HbA1c reductions were achieved in patients with higher baseline HbA1c across all tirzepatide doses, higher body weight with 10mg and younger age with 15mg tirzepatide. Greater reductions in body weight were observed in patients with higher body weight across all tirzepatide doses, lower baseline HbA1c with 5mg and higher BMI with 5mg tirzepatide. In this post hoc analysis, tirzepatide was associated with reduced blood glucose and body weight in a predominantly Chinese population with T2D across different subgroups, consistent with previous reports for tirzepatide. NCT04093752.

Cytotoxicity and anti-inflammatory properties of a GLP-1 receptor agonist in a model of human peripheral blood mononuclear cell culture

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;GLP-1R agonists (GLP-1RAs) are a type of anti-hyperglycemic medications used for the management of type 2 diabetes mellitus (T2DM). In addition to glucose-lowering effects, GLP-1R agonists (GLP-1RAs) also provide further advantages by promoting weight loss and controlling blood pressure. Furthermore, GLP-1RAs have been reported for their therapeutic benefits in neurological, cardiovascular, endocrine, and metabolic diseases. Emerging evidence from many clinical and experimental studies, as well as in vitro researches, suggests that GLP-1RA agonists may reduce inflamma tion and modify the immunological response, but the underlying molecu lar mechanisms remain unclear. In this research, we examined the effect of GLP-1RA on the cytotoxicity, proliferative activity, and cytokine production of human peripheral blood mononuclear cells (PBMCs) in vitro.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt; Methods. &amp;lt;/strong&amp;gt;The peripheral blood mononuclear cells (PBMCs) cultures from healthy volunteers were used. GLP-1RA (DMB), in different concentrations, was added to the cell cultures. A flow cytometry assay was used to assess cell viability, while MTT and CFSE dye dilution assays were used to quantify proliferative activity. Cytokine levels were measured using a sandwich en zyme-linked immunosorbent assay (ELISA).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; The cytotoxicity data demonstrated that only the highest DMB concentration (1000 nM) decreased the metabolic activity (viability) of PBMCs (p&amp;amp;lt;0.05) in comparison to untreated cultures, while concentra tions of 200 nM (p&amp;amp;lt;0.05) and 1000 nM (p&amp;amp;lt;0.001) of GLP-1RA increased the proportion of late apoptotic and necrotic cells (p&amp;amp;lt;0.001). The prolif eration of PBMCs was significantly decreased in the presence of GLP-1RA at a 100 nM concentration when compared to the control (p&amp;amp;lt;0.05). The same concentration of GLP-1RA significantly reduced the production of IL-6, IL-1&amp;amp;beta;, and TNF-&amp;amp;alpha;.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion.&amp;lt;/strong&amp;gt; Our results suggested that GLP-1RA (DMB), at a non-toxic concentration of 100 nM, inhibited the proliferation and production of pro-inflammatory cytokines by human PBMCs in vitro. These findings open the perspective to study the immune response in detail in future experiments.&amp;lt;/p&amp;gt;

A risk analysis of alpelisib-induced hyperglycemia in patients with advanced solid tumors and breast cancer

BackgroundHyperglycemia is an on-target effect of PI3Kα inhibitors. Early identification and intervention of treatment-induced hyperglycemia is important for improving management of patients receiving a PI3Kα inhibitor like alpelisib. Here, we characterize incidence of grade 3/4 alpelisib-related hyperglycemia, along with time to event, management, and outcomes using a machine learning model.MethodsData for the risk model were pooled from patients receiving alpelisib ± fulvestrant in the open-label, phase 1 X2101 trial and the randomized, double-blind, phase 3 SOLAR-1 trial. The pooled population (n = 505) included patients with advanced solid tumors (X2101, n = 221) or HR+/HER2− advanced breast cancer (SOLAR-1, n = 284). External validation was performed using BYLieve trial patient data (n = 340). Hyperglycemia incidence and management were analyzed for SOLAR-1.ResultsA random forest model identified 5 baseline characteristics most associated with risk of developing grade 3/4 hyperglycemia (fasting plasma glucose, body mass index, HbA1c, monocytes, age). This model was used to derive a score to classify patients as high or low risk for developing grade 3/4 hyperglycemia. Applying the model to patients treated with alpelisib and fulvestrant in SOLAR-1 showed higher incidence of hyperglycemia (all grade and grade 3/4), increased use of antihyperglycemic medications, and more discontinuations due to hyperglycemia (16.7% vs. 2.6% of discontinuations) in the high- versus low-risk group. Among patients in SOLAR-1 (alpelisib + fulvestrant arm) with PIK3CA mutations, median progression-free survival was similar between the high- and low-risk groups (11.0 vs. 10.9 months). For external validation, the model was applied to the BYLieve trial, for which successful classification into high- and low-risk groups with shorter time to grade 3/4 hyperglycemia in the high-risk group was observed.ConclusionsA risk model using 5 clinically relevant baseline characteristics was able to identify patients at higher or lower probability for developing alpelisib-induced hyperglycemia. Early identification of patients who may be at higher risk for hyperglycemia may improve management (including monitoring and early intervention) and potentially lead to improved outcomes.Registration: ClinicalTrials.gov: NCT01219699 (registration date: October 13, 2010; retrospectively registered), ClinicalTrials.gov: NCT02437318 (registration date: May 7, 2015); ClinicalTrials.gov: NCT03056755 (registration date: February 17, 2017).

Pilot feasibility and efficacy of a strategy to sustain A1C improvement among diverse adults with type 2 diabetes completing a diabetes care management program

IntroductionEvidence-based strategies are needed to sustain improvements in outcomes following diabetes care management (DCM) programs. We examined the impact of Boot Camp-Plus (BC-Plus), an innovative sustaining strategy, on A1C among...

Association between Glucagon-like Peptide-1 Receptor Agonists and the Risk of Glaucoma in Individuals with Type 2 Diabetes

To examine the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and the development of glaucoma in individuals with type 2 diabetes. Nationwide, nested case-control study. From a nationwide cohort of 264 708 individuals, we identified 1737 incident glaucoma cases and matched them to 8685 glaucoma-free controls, all aged more than 21 years and treated with metformin and a second-line antihyperglycemic drug formulation, with no history of glaucoma, eye trauma, or eye surgery. Cases were incidence-density-matched to 5 controls by birth year, sex, and date of second-line treatment initiation. Conditional logistic regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for glaucoma, defined by first-time diagnosis, first-time use of glaucoma-specific medication, or first-time glaucoma-specific surgical intervention. Compared with the reference group, who received treatments other than GLP-1RA, individuals whowere exposed to GLP-1RA treatment exhibited a lower risk of incident glaucoma (HR, 0.81; CI, 0.70-0.94; P= 0.006). Prolonged treatment extending beyond 3 years lowered the risk even further (HR, 0.71; CI, 0.55-0.91; P= 0.007). Treatment with GLP-1RA for 0 to 1 year (HR, 0.89; CI, 0.70-1.14; P= 0.35) and 1 to 3 years (HR, 0.85; CI, 0.67-1.06; P= 0.15) was not significant. Exposure to GLP-1RA was associated with a lower risk of developing glaucoma compared with receiving other second-line antihyperglycemic medication. Proprietary or commercial disclosure may be found after the references.

Abstract TP68: Nina Campbell MSN BSN RN

Many of the American Heart Association’s Get with the Guidelines metrics for stroke are medication-related, including appropriate utilization of antithrombotics, statins, and anticoagulation. Furthermore, for the subpopulation of patients with type 2 diabetes, an antihyperglycemic medication with proven cardiovascular benefit is indicated. Abstraction to the American Heart Association Get with the Guidelines has clear but complex guidelines on criteria for meeting these metrics. Our goal was to improve adherence to the guidelines via pharmacist assessment, discussion, and documentation. Prior to December 2022, clinical pharmacists had been reviewing the use of antithrombotics, statins, and anticoagulation in stroke patients and reaching out to the provider with concerns. However, they were not yet reviewing the use of antihyperglycemic medications with proven cardiovascular benefit nor documenting assessments/rationale in the patient’s chart. In December 2022, pharmacists started evaluating antihyperglycemic medications with proven CVD benefits in addition to the above, with assessments taking place Monday through Friday. The pharmacist would reach out to the provider when necessary and also document rationale for appropriate avoidance of usual recommended therapy, if indicated. The most notable intervention was the creation of pre-formatted note with the various specific ways to meet each medication-related metric in accordance with Get with the Guidelines abstraction criteria. Baseline data from January to November 2022 indicated good adherence to the stroke metrics involving the use of antithrombotics, statins, and anticoagulation that pharmacy was already following at that time, ranging from 97.7-100% adherence. However, the metric of addressing an antihyperglycemic medication with proven CVD benefit was only met 47.1% of the time. After the above intervention, data collected from March to July of 2023 demonstrated a stable effect on the metrics that were already above goal, ranging 96.5% to 100%, but there was a significant increase in adherence to the antihyperglycemic medication with proven CVD benefit, which went from 47.1% to 83.3%.

Abstract WP48: Prescription Rate for Antihyperglycemic Medication With Proven Cardiovascular Benefit at Discharge in Stroke Patients Not Equal Among Payer Sources

Background: Mortality doubles in stroke patients when Diabetes Mellitus (DM) is present. Target: Type 2 Diabetes SM (TT2DM) is an American Heart Association® (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Participating Get With The Guidelines® (GWTG)-Stroke hospitals track EBG data to improve outcomes. TT2DM initiative has10 EBG data elements related to stroke and the DM subpopulation. The measure&amp;nbsp; Antihyperglycemic Medication with Proven Cardiovascular (CVD) Benefit at Discharge in Stroke Patients with DM (AMPB) has low compliance. Further data analysis was needed. Methods: GWTG®-Stroke DM reports specific to AMPB were reviewed from Jan.1, 2020-Dec. 21, 2022, from 51 Wisconsin Coverdell Stroke hospitals. Analysis comprised of 5,045 patients with a primary diagnosis of stroke and history of DM or newly identified DM in the denominator. The numerator was satisfied when patients were prescribed a GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source. Payer sources were identified as: self-pay, Medicaid, Medicare, and Private/HMO. Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source. Only 2.3% identified as self-pay were prescribed AMPB at discharge. Differences in compliance rates were 10% for Medicare, 13.5% Medicaid, and 15.3% with private insurance/HMO. Conclusions: Discharge prescription rate for AMPB has low compliance, further variation exists among patient payer sources. Items for consideration are higher cost of medication and thus payer status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, along with existing medication knowledge gaps. Providing EBC requires shared decision making to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow-up needs may enhance compliance. Future considerations are to assess race “within” payer source to gauge if there is disparate care.

Metformin improves nonalcoholic fatty liver disease in db/db mice by inhibiting ferroptosis

Nonalcoholic fatty liver disease (NAFLD) is the primary complication of type 2 diabetes (T2DM)-related liver disease, lacking effective treatment options. Metformin (Met), a widely prescribed anti-hyperglycemic medication, has been found to protect against NAFLD. Ferroptosis, a newly discovered form of cell death, is associated with the development of NAFLD. Despite this association, the extent of Met's protective effects on NAFLD through the modulation of ferroptosis has yet to be thoroughly investigated. In the present study, the administration of erastin or Ras-selective lethal 3 (RSL3), both known ferroptosis inducers, resulted in elevated cell mortality and reduced cell viability in AML12 hepatocytes. Notably, Met treatment demonstrated the capacity to mitigate these effects. Furthermore, we observed increased ferroptosis levels in both AML12 hepatocytes treated with palmitate and oleate (PA/OA) and in the liver tissue of db/db mice. Met treatment demonstrated significant reductions in iron accumulation and lipid-related reactive oxygen species production, simultaneously elevating the glutathione/glutathione disulfide ratio in both PA/OA-treated AML12 hepatocytes and the liver tissue of db/db mice. Interestingly, the anti-ferroptosis effects of Met were significantly reversed with the administration of RSL3, both in vitro and in vivo. Mechanistically, Met treatment regulated the glutathione peroxidase 4/solute carrier family 7 member 11/acyl-CoA synthetase long-chain family member 4 axis to alleviate ferroptosis in NAFLD hepatocytes. Overall, our findings highlight the crucial role of ferroptosis in the development of T2DM-related NAFLD and underscore the potential of Met in modulating key factors associated with ferroptosis in the context of NAFLD.

Evaluation of physical and mental health conditions related to employees' absenteeism.

Employees' health conditions are issues for not only employees themselves but also companies and society to keep medical costs low and productivity high. In this analysis, 15,574 observations from 2,319 employees at four operational sites of a large corporation were used. The dataset contained physical and mental health conditions obtained from annual mandatory medical checkups, the Brief Job Stress Questionnaire (BJSQ), and work record information. Health and other factors related to long-term absenteeism (over three days in a quarter) were analyzed. Data were collected between February 2021 and January 2022, and we converted into quarterly observations. A logit (logistic regression) model was used in the analysis. Age and gender were identified as important basic characteristics. The estimates for these variables were positive and negative and significant at the 1% level. Among the variables obtained from the medical checkups, the estimates for diastolic blood pressure, HbA1c, anamnesis, heart disease history, smoking, increased weight, and frequency of alcohol consumption were positive and significant at the 1% level, further those for taking antihypertensive medications and kidney disease history were positive and significant at the 5% level. In contrast, the estimates for systolic blood pressure and amount of alcohol consumption were negative and significant at the 1% level. The estimate for taking antihyperglycemic medications and health guidelines were negative and significant at the 5% level. Among the variables obtained from the BJSQ, the estimates for amount of work felt, fatigue and support from family and friends were positive and significant at the 1%, and the estimate for irritation was positive and significant at the 5% level. The estimates for controlling job and physical complaints were negative and significant at the 1% level, and those for usage of employee's ability to work and suitability of the work were negative and significant at the 5% level. As all four operational sites were located in the northeastern region of Japan (cold and snowy in winter), the seasonal effects were significant at the 1% level. The effect of year was also significant and significant differences were observed among the sites at the 1% level. Some physical and mental health conditions were strongly associated with long-term absenteeism. By improving these conditions, corporations could reduce the number of employee absence days. As absenteeism was costly for corporations due to replacement employees and their training costs to maintain operations, employers must be concerned about rising healthcare (direct and indirect) costs and implement investments to improve employees' health conditions. This study's results were based on only one corporation and the dataset was observatory. The employees were primarily operators working inside the building and most of them are healthy. Therefore, the sample selection biases might exist, and the results cannot be generalized to other types of jobs, working conditions, or companies. As medical checkups and the BJSQ are mandatory for most companies in Japan, the framework of this study can be applied to other companies. Although we used the BJSQ results, better mental measures might exist. Similar analyses for different corporations are necessary.