Glucose-lowering Medicines Research Articles

Glucose-lowering medicines use before and after entry into long-term care facilities.

To examine changes in the use of glucose-lowering medicine (GLM) 12 months before and 12 months after long-term care facility (LTCF) entry among people with diabetes. A national retrospective cohort study was conducted using linked health and aged care data from the Registry of Senior Australians National Historical Cohort. Residents of LTCFs with diabetes aged 65 years or older from 2015 to 2019 were included. Prevalence of GLM use and the number of defined daily doses (DDDs) dispensed per 1000 resident-days were estimated quarterly (91-day) using Poisson regression models, or negative binomial regression when overdispersion was present. Among the 50 993 residents studied (median age 84 years), the prevalence of GLM use was 58.4% (95% confidence interval [CI] 58.0%-58.8%) in the 9-12 months pre-LTCF entry and 56.3% (95% CI 55.9%-56.8%) in the 9-12 months post-entry. The number of DDDs/1000 resident-days increased from 1015.2 (95% CI 1002.3-1028.1) to 1253.8 (95% CI 1168.4-1339.3) during the same period. GLM use in the 3 months pre-entry was 56.8% (95% CI 56.4%-57.2%) compared with 61.7% (95% CI 61.3%-62.1%) in the 3 months post-entry, with the increased use driven mainly by insulin. No marked changes in the number of GLMs dispensed or GLM type were observed at 9-12 months post-entry compared with 3 months pre-entry. Among 22 792 individuals dispensed a GLM in the 3 months prior to LTCF entry, 50.2% continued the same GLM at 9-12 months post-entry. GLM use peaked in the first 3 months following LTCF entry, driven mainly by insulin, hence, residents may benefit from close monitoring of diabetes treatment during this period.

The role of glucagon-like peptide 1 in the postprandial effects of metformin in type 2 diabetes: a randomized crossover trial.

Although metformin is widely used for treatment of type 2 diabetes (T2D), its glucose-lowering mechanism remains unclear. Using the glucagon-like peptide 1 (GLP-1) receptor (GLP-1R) antagonist exendin(9-39)NH2, we tested the hypothesis that postprandial GLP-1-mediated effects contribute to the glucose-lowering potential of metformin in T2D. In a randomized, placebo-controlled, double-blind, crossover study, 15 individuals with T2D (median HbA1c 50 mmol/mol [6.7%], body mass index 30.1 kg/m2, age 71 years) underwent, in randomized order, 14 days of metformin and placebo treatment, respectively. Each treatment period was preceded by 14 days without any glucose-lowering medicine and concluded by two 4 h mixed meal tests performed in randomized order and separated by >24 h with either continuous intravenous exendin(9-39)NH2 or saline infusion. Compared to placebo, metformin treatment lowered fasting plasma glucose (mean of differences [MD] 1.4 mmol/L × min [95% CI 0.8-2.0]) as well as postprandial plasma glucose excursions during both saline infusion (MD 186 mmol/L × min [95% CI 64-307]) and exendin(9-39)NH2 infusion (MD 268 mmol/L × min [95% CI 108-427]). The metformin-induced improvement in postprandial glucose tolerance was unaffected by GLP-1R antagonization (MD 82 mmol/L × min [95% CI -6564-170]). Metformin treatment increased fasting plasma GLP-1 (MD 1.7 pmol/L × min [95% CI 0.39-2.9]) but did not affect postprandial GLP-1 responses (MD 820 pmol/L × min [95% CI -1750-111]). Using GLP-1R antagonization, we could not detect GLP-1-mediated postprandial glucose-lowering effect of metformin in individuals with T2D. We show that 2 weeks of metformin treatment increases fasting plasma GLP-1, which may contribute to metformin's beneficial effect on fasting plasma glucose in T2D. Trial registration: Clinicaltrials.gov NCT03246451.

National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities

AimsTo examine national trends in glucose lowering medicine (GLM) use among older people with diabetes in long-term care facilities (LTCFs) during 2009–2019. MethodsA repeated cross-sectional study of individuals ≥65 years with diabetes in Australian LTCFs (n = 140,322) was conducted. Annual age-sex standardised prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Multivariable Poisson or Negative binomial regression models were used to estimate adjusted rate ratios (aRRs) and 95 % confidence intervals (CIs). ResultsPrevalence of GLM use remained steady between 2009 (63.9%, 95 %CI 63.3–64.4) and 2019 (64.3%, 95 %CI 63.9–64.8) (aRR 1.00, 95 %CI 1.00–1.00). The percentage of residents receiving metformin increased from 36.0% (95 %CI 35.3–36.7) to 43.5% (95 %CI 42.9–44.1) (aRR 1.01, 95 %CI 1.01–1.01). Insulin use also increased from 21.5% (95 %CI 21.0–22.0) to 27.0% (95 %CI 26.5–27.5) (aRR 1.02, 95 %CI 1.02–1.02). Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95 %CI 0.9–1.1) to 21.1% (95 %CI 20.7–21.5) (aRR 1.24, 95 %CI 1.24–1.25), while sulfonylurea use decreased from 34.4% (95 %CI 33.8–35.1) to 19.3% (95 %CI 18.9–19.7) (aRR 0.93, 95 %CI 0.93–0.94). Similar trends were observed in DDDs/1000 resident days. ConclusionsThe increasing use of insulin and ongoing use of sulfonylureas suggests a need to implement evidence-based strategies to optimise diabetes care in LTCFs.

Cardiovascular and mortality benefits of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists as third-step glucose-lowering medicine in patients with type 2 diabetes: a retrospective cohort analysis

IntroductionStudies have found that sodium-glucose cotransporter 2 inhibitors (SGLT2) and glucagon-like peptide 1 receptor agonists (GLP1) have cardiovascular benefits for patients with type 2 diabetes (DM2) and atherosclerotic cardiovascular disease...

Comparative analysis of availability and affordability of hypoglycaemic medicines for Ukrainian patients during the war 2022-2023

Purpose: Diabetes care, particularly type 2 diabetes (T2D), is recognised as a growing challenge in emergency situations. During the humanitarian crisis of war in Ukraine, it is important to focus on ensuring that patients have access to essential medicines for T2D. Since 1 April 2017, the Ministry of Health of Ukraine has been implementing the government programme "Affordable medicines". The List of reimbursed medicines necessary for the treatment of hypertension, diabetes and bronchial asthma includes 3 glucose lowering medicines (GLMs) - gliclazide, metformin, glibenclamide. From 01 April 2019, electronic prescribing has been implemented as part of the "Affordable Medicines" programme. It is important to investigate changes in the availability and affordability of GLMs for the treatment of T2D during the war and future directions in 2022-2023 in Ukraine. Methods: Information from the State Register of Medicinal Products of the Ministry of Health of Ukraine from March 2023 and February 2022 (before the start of the war) was the subject of the study. Marketing, analytical, graphical, generalisation analyses were applied. Analysis of the cost of 1 DDD GLM according to the WHO ATC/DDD index and solvency ratio analysis were applied. Results: This study is based on actual data from before the war in Ukraine and now shows that the affordability and availability of GLMs during the war in 2022-2023 has not changed dramatically. The 'Affordable Medicines' program was stably implemented, with €111.9 million allocated in 2023 and within 6 months of 2023. The National Health Service of Ukraine reimbursed €42.8 million to pharmacies for the Reimbursement List. Most Ukrainian manufacturers and foreign GLMs are very affordable due to the reimbursement system. From October 2023, 23 names of test stripes were included in the Reimbursement list of the "Affordable medicines" programme. However, foreign GLMs of innovative groups are moderately affordable for the working population based on the calculated solvency ratio. Conclusions: Our study revealed that despite the challenges of war, the healthcare system in Ukraine remains robust, particularly in ensuring stable access to pharmaceuticals for diabetes treatment. The "Affordable Medicines" programme and the Reimbursement List are updated twice a year, and the introduction of the new drugs for T2D and diabetes insipidus was completed in 2022. Thus, the innovative GLMs, despite being registered on the market in 2022, such as Semaglutide, Semaglutide and Dapagliflozin, are not affordable in 2023. A prospective trend is the inclusion of innovative GLMs for diabetes better care on the reimbursement list.

Functional assessments of Psidium guajava L. and Morus alba L. leaf extracts on postprandial glucose control.

Diabetes is a leading cause of death, according to statistics published by the Department of Health, Executive Yuan of Taiwan. In modern medicine, diabetes can be controlled using various medications; however, some drugs often have undesirable side effects. It therefore became a goal to find plant-based material that can reduce glucose concentration in the blood while reducing the incidence of complications and not causing side effects. Alpha-glucosidase inhibitors (AGIs) are effective glucose-lowering medicines and are enzymes essential to carbohydrate digestion. Inhibition of α-glucosidase leads to a delayed and reduced rise in postprandial blood glucose levels. This study evaluates the inhibitory effect of mixed extracts of Psidium guajava L. and Morus alba L. leaves on α-glucosidase activity and postprandial hyperglycemia in normal and diabetic rats. The inhibition of α-glucosidase activity was assayed invitro. Half maximal inhibitory concentration (IC50) values of Psidium guajava L. and Morus alba L. were 2.25 and 0.1 mg/mL, respectively. The IC50 value of a commercial anti-hyperglycemic agent (Glucobay) is 6.41 mg/mL. The IC50 value of a mixture of extracts of Psidium guajava L. and Morus alba L. was 0.07 mg/mL. In cytotoxicity tests, survival percentages and shape did not significantly affect the murine embryonic liver cell line (BNL CL.2) when treated with varying concentrations of mixture extracts for varying periods of time. In summary, Psidium guajava L. and Morus alba L. showed positive anti-diabetes activity and suggested promising potential for alternative functional foods for diabetes mellitus (DM) patients.

Geographic variation in sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist use in people with type 2 diabetes in New South Wales, Australia.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve glycaemic control and cardio-renal outcomes for people with type 2 diabetes (T2D). However, geographic and socio-economic variation in use is not well understood. We identified 367 829 New South Wales residents aged ≥40 years who dispensed metformin in 2020 as a proxy for T2D. We estimated the prevalence of use of other glucose-lowering medicines among people with T2D and the prevalence of SGLT2i and GLP-1RA use among people using concomitant T2D therapy (i.e. metformin + another glucose-lowering medicine). We measured the prevalence by small-level geography, stratified by age group, and characterized by remoteness and socio-economic status. The prevalence of SGLT2i (29.7%) and GLP-1RA (8.3%) use in people with T2D aged 40-64 increased with geographic remoteness and in areas of greater socio-economic disadvantage, similar to other glucose-lowering medicines. The prevalence of SGLT2i (55.4%) and GLP-1RA (15.4%) among people using concomitant T2D therapy varied across geographic areas, with lower SGLT2i use in more disadvantaged areas and localized areas of high GLP-1RA use (2.5 times the median). Compared with people aged 40-64 years, the prevalence of SGLT2i and GLP-1RA use was lower in older age groups, but with similar patterns of variation across geographic areas. The prevalence of SGLT2i and GLP-1RA use varied by geography, probably reflecting a combination of system- and prescriber-level factors. Socio-economic variation in GLP-1RA use was overshadowed by localized patterns of prescribing. Continued monitoring of variation can help shape interventions to optimize use among people who would benefit the most.

Comparisons of clinical outcomes between newly diagnosed early- and late-onset T2DM: a real-world study from the Shanghai Hospital Link Database.

The aim of this study was to compare the differences in incident population, comorbidities, and glucose-lowering drug prescriptions between newly diagnosed patients with early-onset type 2 diabetes mellitus (T2DM) and those with late-onset T2DM to provide real-world evidence for clinical practice. This study was based on the Shanghai Hospital Link Database (SHLD). Anonymized electronic medical record (EHR) data from 2013 to 2021 were included in this study. Newly diagnosed patients with T2DM were defined as those without related diagnostic records or glucose-lowering medicine prescriptions in the past 3 years. Early-onset T2DM was defined as patients who were aged 18-40 years old at the first visit for T2DM to represent those who were born after the 1980s. And late-onset T2DM was defined as those aged 65-80 years old to represent those who were born in a relatively undeveloped period. Descriptive statistical analyses were performed to describe their incidence number, glucose-lowering drug prescriptions, and comorbidities at the first visit to the hospital between two T2DM groups. There were a total of 35,457 newly diagnosed patients with early-onset T2DM and 149,108 newly diagnosed patients with late-onset T2DM included in this study. Patients with late-onset T2DM constituted the majority and their number increased by 2.5% on average by years, while the number of patients with early-onset T2DM remained stable each year. Compared with late-onset T2DM patients, more early-onset T2DM patients had dyslipidemia at the first visit to hospitals (9.5% vs 7.7%, P < 0.01) despite their significant age differences. Patients with early-onset T2DM were more likely to use metformin (74.8% vs 46.5, P < 0.01), dipeptidyl peptidase-4 inhibitors (DDP-4i) (16.7% vs 11.2%, P < 0.01), thiazolidinediones (TZD) (14.9% vs 8.4%, P < 0.01), sodium glucose cotransporter 2 inhibitors (SGLT2-i) (0.8% vs 0.3%, P < 0.01), and glucagon-like peptide 1 receptor agonists (GLP-1 RA) (3.7% vs 0.5%, P < 0.01) at their first visit to the hospital. Different characteristics were observed between patients with early-onset T2DM and those with late-onset T2DM. Compared with patients with late-onset T2DM, those with early-onset T2DM were more prone to dyslipidemia and had novel organ-protective drugs prescribed.

Impact of Treviamet® & Treviamet XR® on quality of life besides glycemic control in type 2 DM patients

BackgroundMaintaining the quality of life is the main objective of managing type 2 diabetes (T2DM) (QoL). Since it is a key factor in patient motivation and adherence, treatment-related QoL has always been considered when choosing glucose-lowering medicines. The objective of the study was to evaluate the quality of life besides glycemic control among type 2 diabetes mellitus patients receiving Treviamet® & Treviamet XR® (Sitagliptin with Metformin) in routine care.MethodsIt was a prospective, open-label, non-randomized clinical trial including T2DM patients uncontrolled on Metformin therapy. All patients received Treviamet® & Treviamet XR® for six months. Sequential changes in QoL, fasting plasma glucose, HbA1c, body weight, and blood pressure were monitored from baseline to 3 consecutive follow-up visits. The frequency of adverse events (AEs) was also noted throughout the study.ResultsA total of 504 patients were screened; 188 completed all three follow-ups. The mean QoL score significantly declined from 57.09% at baseline to 33.64% at the 3rd follow-up visit (p < 0.01). Moreover, a significant decline in mean HbA1c and FPG levels was observed from baseline to 3rd follow-up visit (p < 0.01). Minor adverse events were observed, including abdominal discomfort, nausea, flatulence, and indigestion. Gender, HbA1c, diarrhea, and abdominal discomfort were significant predictors of a patient’s QoL, as revealed by the Linear Regression Model (R2 = 0.265, F(16, 99) = 2.231).ConclusionTreviamet® & Treviamet XR® significantly improved glycemic control (HbA1c levels) and QoL in T2DM patients without serious adverse events.Trial registrationClinicalTrials.gov identifier (NCT05167513), Date of registration: December 22, 2021.

IDF2022-0908 Study of affordability and accessibility of glucose-lowering medicines for type 2 diabetes in Ukraine

IDF2022-0908 Study of affordability and accessibility of glucose-lowering medicines for type 2 diabetes in Ukraine

Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study

BackgroundDeprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willing to have their medicines deprescribed. This study aims to assess attitudes of Indonesian patients with T2D towards deprescribing in general and regarding specific cardiometabolic medicines, and factors influencing their willingness to stop medicines.MethodsPrimary care patients with T2D of ≥60 years in Indonesia completed the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Attitudes in general and for cardiometabolic medicines were reported descriptively. Proportions of patients willing to stop one or more medicines when recommended by different healthcare professionals were compared with Chi-square test. Multiple regression analysis was used to analyse the influence between patient-related factors and the willingness to stop medicines.ResultsThe survey was completed by 196 participants (median age 69 years, 73% female). The percentages willing to stop medicines were 69, 67, and 41%, when the general practitioner (GP), the specialist, or the pharmacist initiates the process (p-value < 0.001). Higher perceived burden of medicines (p-value = 0.03) and less concerns about stopping (p-value < 0.001) were associated with a higher willingness to stop medicines if proposed by the GP. Patients using multiple glucose-regulating medicines were less willing to stop (p-value = 0.02). Using complementary or alternative medicines was not associated with the willingness to stop. If proposed by their pharmacist, patients without substantial education were more willing to stop than educated patients.ConclusionsOnly two-thirds of older people with T2D in Indonesia were willing to stop one or more of their medicines if the GP or specialist recommended this, and even less when the pharmacist proposed this. Attention should be given to concerns about stopping specific medicines, especially among patients using multiple glucose-lowering medicines, who may be more eligible but were less willing to accept deprescribing.

Prioritizing the glucose-lowering medicines for type 2 diabetes by an extended fuzzy decision-making approach with target-based attributes.

Different therapeutic classes have been authorized for the treatment of hyperglycemia in type 2 diabetic patients, and even more drug classes are under development. This variety of alternative treatments and the general treatment algorithms of the clinical guidelines lead to a nonuniform prescription of drugs by endocrinologists and diabetic specialists. Diabetes medication choice is a multi-objective problem with many difficulties in making rational decisions because of the wide range of hyperglycemia-lowering agents with multiple benefits and multiple risk elements. This paper proposes a group Entropy-CRiteria Importance Through Inter-criteria Correlation (CRITIC)-Weighted Aggregated Sum Product ASsessment (WASPAS) multi-criteria decision-making (MCDM) model with target-based criteria to prioritize and rank the glucose-lowering medicines for type 2 diabetes using the American Diabetes Association and International Diabetes Federation Clinical Guidelines. The proposed model consists of a weighting method comprising both objective and subjective approaches; the two most common objective approaches (i.e., Entropy and CRITIC methods) are used to find the objective weights. Then, these weights are aggregated with the subjective weights that endocrinologists assign to the criteria. Afterward, a WASPAS target-based method is developed to provide the final ranking of the medications. Finally, the close correlation between the final ranking of the proposed methodology and the average priority order of the medications obtained by different MCDM methods implies the strength and validity of the model performance.

Management of patients with type 2 diabetes and cardiovascular disease in primary care.

Approximately 65% of cardiovascular disease (CVD)-related deaths in Australia occur in people with diabetes or pre-diabetes. The aim of this study was to investigate general practice management of risk factors among patients with both conditions. This was a cross-sectional study of 33,559 adult patients with both type 2 diabetes and CVD at 1 November 2018, using the general practice data program MedicineInsight. One-third of patients did not have a record in their current medications list forall three recommended medicines to reduce cardiovascular risk. Potentially suboptimal monitoring and achievement of targets for diabetes and cardiovascular risk factors was also identified. Most patients using metformin-based combination therapy were prescribed blood glucose-lowering medicines that do not have evidence of cardiovascular benefit. These data suggest opportunities to support general practices to optimise patient management. Datasets such asMedicineInsight can help practices identify patients who may benefit fromrecall.

Factors Contributing to the Rising National Cost of Glucose-Lowering Medicines for Diabetes During 2005-2007 and 2015-2017.

We examined changes in glucose-lowering medication spending and quantified the magnitude of factors that are contributing to these changes. Using the Medical Expenditure Panel Survey, we estimated the change in spending on glucose-lowering medications during 2005-2007 and 2015-2017 among adults aged ≥18 years with diabetes. We decomposed the increase in total spending by medication groups: for insulin, by human and analog; and for noninsulin, by metformin, older, newer, and combination medications. For each group, we quantified the contributions by the number of users and cost-per-user. Costs were in 2017 U.S. dollars. National spending on glucose-lowering medications increased by $40.6 billion (240%), of which insulin and noninsulin medications contributed $28.6 billion (169%) and $12.0 billion (71%), respectively. For insulin, the increase was mainly associated with higher expenditures from analogs (156%). For noninsulin, the increase was a net effect of higher cost for newer medications (+88%) and decreased cost for older medications (-34%). Most of the increase in insulin spending came from the increase in cost-per-user. However, the increase in the number of users contributed more than cost-per-user in the rise of most noninsulin groups. The increase in national spending on glucose-lowering medications during the past decade was mostly associated with the increased costs for insulin, analogs in particular, and newer noninsulin medicines, and cost-per-user had a larger effect than the number of users. Understanding the factors contributing to the increase helps identify ways to curb the growth in costs.

Diabetes-related symptoms, acute complications and management of diabetes mellitus of patients who are receiving palliative care: a protocol for a systematic review

IntroductionWorldwide, an estimated 40 million people are in need of palliative care each year, but only 14% receive it. The incidence of diabetes mellitus (DM) in patients receiving palliative care...

The characteristics of the outpatient utilisation of medicines in the Republic of Srpska in the period 2009-2017

Background: Monitoring and measuring of the medicine utilisation enables to assess the quality of use of medicines, providing the evidence-based data for the improvement of the prescribing practice and a more rational use of medicines. The aim of this study was to analyse utilisation patterns of medicines and to compare the results with other countries. Methods: A retrospective, observational study to analyse outpatient medicines utilisation in the Republic of Srpska between 2009 and 2017. Data of medicines utilisation were retrieved from the national database in the Public Health Institute of the Republic of Srpska and calculated and analysed by using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. The results were expressed as Defined Daily Doses (DDDs) per 1,000 inhabitants per day. Results: Total medicines utilisation increased, from 448 DDDs in 2009 to 1,036 DDDs in 2017. Cardiovascular medicines (group C) were the most used medicines, and their share in the total utilisation increased from 36.6% in 2009 to 44.4% in 2017. Among them, the most frequently used were angiotensin-converting enzyme inhibitors, plain and in combinations with diuretics, namely enalapril. The share of medicines used in diabetes in the total utilisation increased from 3.9% in 2009 to 5.1% in 2017. Metformin and glimepiride accounted for about 83% of the blood glucose lowering medicines group (A10B). Among the antithrombotic medicines, the most frequently used were platelet aggregation inhibitors (B01AC), mainly acetylsalicylic acid whose use tripled since 2009. Diclofenac was the most frequently used non-steroidal anti-inflammatory and antirheumatic drug (M01). Conclusion: The trend of increased medicines utilisation was observed in this study. This finding is comparable with other countries. Variations between countries in the preferred medicines within a class as well as the extent of medicines use were observed. These differences were probably consistent, but not solely attributable, to differences in local guidelines and reimbursement policies.

Patients' Perspectives of Oral and Injectable Type 2 Diabetes Medicines, Their Body Weight and Medicine-Taking Behavior in the UK: A Systematic Review and Meta-Ethnography.

The aim of this review is to identify peoples’ perspectives of their glucose-lowering and anti-obesity drugs in relation to diabetes and weight control and to explore how these views affect medication adherence. Theoretical perspectives associated with medicine-taking behavior are also explored. The systematic review was based on a meta-ethnography of qualitative studies identified through a search of 12 medical and social science databases and subsequent citation searches. The quality of all studies was assessed. Sixteen studies were included with data from 360 UK individuals. No relevant studies were identified which focused on anti-obesity and non-insulin injectable drugs. The review revealed that the patients’ perspectives and emotional state were influenced by starting and/or changing to a new glucose-lowering medicine. These were also influenced by prior medication experience, disease perceptions and interactions with clinicians. Despite reports of positive experiences with and positive perceptions of medicines, and of participation in strategies to regain life control, medication non-adherence was common. Accepting glucose-lowering medicines impacted on the individual’s perception of lifestyle changes, and it was notable that weight loss was not perceived as a strategy to support diabetes management. Synthesis revealed that more than one theory is required to explain medicine-taking behavior. New insights into the underlying factors of poor adherence and the specific practical issues identified in this review can help in the development of patient-centered interventions.Funding: Diabetes UK.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0490-5) contains supplementary material, which is available to authorized users.

The Impact of Prepregnancy Body Mass Index and Gestational Weight Gain on Perinatal Outcomes for Women With Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM), an obstetric disease that affects the health of pregnant women, is one of the key factors associated with perinatal mortality or disease. To explore the impact of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on perinatal outcomes for women with GDM. With a retrospective study design, women were recruited who received prenatal checkups, gave birth at two teaching hospitals in southern Taiwan from 1995 to 2011, and received a diagnosis of GDM by an obstetrician. A trained research assistant collected the participants' data in each hospital's archives room. The researcher used a retrospective casestudy method to identify women who received a GDM diagnosis between 1995 and 2011. Women with GDM and with an overweight prepregnancy BMI were more likely to have cesarean deliveries and to use glucose-lowering medicines after delivery. Their newborns also had a higher birth weight. In addition, gestational hypertension and cesarean delivery were more common in women with GDM and with excessive GWG than in women with GDM and with normal GWG. The newborns of women with GDM and with excessive GWG had higher birth weights and more nuchal cord than those of women with GDM and with normal GWG. More women with GDM and with excessive GWG underwent blood glucose monitoring than did women with GDM and with normal GWG. The prepregnancy weight and GWG significantly affected perinatal outcomes in both the women with GDM themselves and their newborns. Healthcare professionals must provide childbearing women with additional health education in the areas of health promotion, nutrition, weight control, exercise, and maintaining regular everyday lives.

Metformin attenuates folic-acid induced renal fibrosis in mice.

Progressive tubulointerstitial fibrosis has been recognized as a common pathological process that leads to the progression of all chronic kidney disease (CKD). Innovative strategies are needed to both prevent and treat CKD. Inflammatory and fibrotic signaling pathways play central roles in the progression of CKD regardless of aetiology. Hence, targeting inflammatory and fibrotic responses holds promise to limit renal fibrosis. Metformin has been the most prescribed glucose-lowering medicine worldwide, and its potential for many other therapeutic applications is also being explored intensively. Increasing evidence indicates metformin may limit renal fibrosis. However, the exact mechanisms whereby metformin limits renal injury are not fully understood. The anti-fibrotic effects of metformin, independent of improved glycaemic control was examined in a folic acid-induced mouse model of nephropathy for 14 days. Human proximal tubular cells (HK2 cells) exposed to TGF-β1 were used in in vitro models to examine mechanistic pathways. Folic acid induced nephropathy was associated with the overexpression of inflammatory markers MCP-1, F4/80, type IV collagen, fibronectin and TGF-β1 compared to control groups, which were partially attenuated by metformin treatment. In vitro studies confirmed that metformin inhibited TGF-β1 induced inflammatory and fibrotic responses through Smad3, ERK1/2, and P38 pathways in human renal proximal tubular cells. These results suggest that metoformin attenuates folic acid-induced renal interstitial fibrogenesis through TGF-β1 signaling pathways.

Primary care diabetes prescribing volume and costs are on the increase

Primary care diabetes prescribing volume and costs are on the increase