Greater Reduction In HbA1c Levels Research Articles

A Comparison of Rosuvastatin Monotherapy and Rosuvastatin Plus Ezetimibe Combination Therapy in Patients With Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

Type 2 diabetes mellitus is a metabolic condition where vascular inflammation and oxidative stress contribute to disease progression and associated complications. Although statins are recommended for managing dyslipidemia in diabetes, additional therapies are often required to achieve target lipid levels. This meta-analysis aimed to evaluate the efficacy of rosuvastatin monotherapy versus combination therapy with ezetimibe in patients with type 2 diabetes. A systematic literature search was conducted across multiple databases until April 2024, identifying six randomized controlled trials meeting the inclusion criteria. The meta-analysis revealed that the rosuvastatin plus ezetimibe combination resulted in significantly greater reductions in total cholesterol (mean difference, or MD: 19.49; 95% CI: 13.99 to 24.99), triglycerides (MD: 13.44; 95% CI: 2.04 to 24.85), and low-density lipoprotein cholesterol(MD: -17.68; 95% CI: 12.85 to 22.51) compared to rosuvastatin monotherapy. Conversely, rosuvastatin monotherapy achieved a greater reduction in HbA1c levels (MD: -0.11; 95% CI: -0.17 to -0.04). Subgroup analysis demonstrated that using the same dose of rosuvastatin in both groups led to more significant improvements in lipid parameters with lower heterogeneity. The findings suggest that the rosuvastatin-ezetimibe combination may be a more effective lipid-lowering strategy for patients with type 2 diabetes, though larger studies are needed to assess long-term safety and optimal dosing. Additionally, while rosuvastatin monotherapy provided modest HbA1c reductions, the clinical relevance remains uncertain, and potential risks with high-dose statins should be considered.

Effectiveness of insulin degludec/liraglutide versus insulin degludec/insulin aspart in Japanese patients with type 2 diabetes.

To evaluate and compare the effectiveness of once-daily insulin degludec/liraglutide (IDegLira) to that of once-daily insulin degludec/insulin aspart (IDegAsp) after switching from basal insulin therapy at 6months by assessing changes in hemoglobin A1c (HbA1c), body weight, and insulin doses in patients with type 2 diabetes (T2D). A total of 91 patients with T2D with HbA1c levels exceeding 7.0% were included in this study. Adjusted least square mean changes in HbA1c, body weight, and total insulin doses were compared between the IDegLira group and IDegAsp group. Subgroup analyses were performed, stratified by median values of HbA1c (< 8.5 and ≥ 8.5%), obesity (body mass index < 25 and ≥ 25kg/m2), and basal insulin doses (< 14 and ≥ 14 units) at baseline to assess treatment interaction by subgroup. The IDegLira group showed a greater reduction in HbA1c levels than the IDegAsp group (-0.17 vs -0.79%, p = 0.003) with comparable body weight changes. The analyses of adjusted mean changes of total insulin doses showed that the IDegAsp group had a larger increase than the IDegLira group (3.64 vs 1.30 unis, p = 0.016). The effect of IDegLira on HbA1c levels was superior to that of IDegAsp in patients with high HbA1c. There were no inter-group differences in the rate of hypoglycemic episodes. Once-daily IDegLira had greater effects on HbA1c and a lesser increase in insulin doses than IDegAsp when patients are switched from basal insulin therapy. Moreover, the effect on HbA1c was enhanced in patients with high HbA1c levels at baseline.

Personalized glucose-lowering effect of chiglitazar in type 2 diabetes

Chiglitazar (carfloglitazar) is a peroxisome proliferator-activated receptor pan-agonist presenting non-inferior glucose-lowering efficacy with sitagliptin in patients with type 2 diabetes. To delineate the subgroup of patients with greater benefit from chiglitazar, we conducted a machine learning-based post-hoc analysis in two randomized controlled trials. We established a character phenomap based on 13 variables and estimated HbA1c decline to the effects of chiglitazar in reference to sitagliptin. Out of 1,069 patients, 63.3% were found to have greater reduction in HbA1c levels with chiglitazar, while 36.7% showed greater reduction with sitagliptin. This distinction in treatment response was statistically significant between groups (pinteraction<0.001). To identify patients who would gain the most glycemic control benefit from chiglitazar, we developed a machine learning model, ML-PANPPAR, which demonstrated robust performance using sex, BMI, HbA1c, HDL, and fasting insulin. The phenomapping-derived tool successfully identified chiglitazar responders and enabled personalized drug allocation in patients with drug-naïve diabetes.

Erroneous reduction of HbA1c levels in patients with type 2 diabetes mellitus on dapsone treatment for Hansen's disease - a single-center retrospective cohort study.

Background Dapsone treatment may reduce HbA1c levels in patients with diabetes. Aims To assess the prevalence and characteristics of dapsone associated reduction of HbA1c in patients with Hansen's disease. Methods A retrospective data review of outpatient and inpatient charts of consecutive patients with Hansen's disease and type 2 diabetes mellitus was conducted over two years from January 2014 to January 2016 at the Department of Dermatology, CMC Vellore, India. Results Of the 245 patients with a confirmed diagnosis of Hansen's disease who were on oral dapsone 100 mg/day as part of their treatment regimen, 49 patients had diabetes and were eligible for the study as per predetermined inclusion criteria. Of these, 35 subjects (71%) had an HbA1c discordantly lower than the corresponding mean plasma glucose levels. Patients with discordant HbA1c levels were more likely to be male and to have a higher RBC mean corpuscular volume (MCV). A greater reduction in HbA1c levels was seen during the initial 3 months of therapy of dapsone treatment. Limitations The small sample size and retrospective design were limitations of this study. Also, we did not analyze the role of methemoglobinemia or the utility of alternative measures of glycemic control in these patients. Conclusion We describe a high prevalence of dapsone associated inappropriate HbA1c lowering in type 2 diabetes mellitus patients. This may have serious implications for the management of diabetes in patients on therapy with dapsone.

Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases

Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases Abstract. Abstract: The ketogenic diet (KD) is a high-fat and very low-carb diet, which has been used primarily for treatment of therapy-resistant epilepsy in children. Implementation of the KD in other target populations is increasingly being discussed. This literature review provides first indications for a clinical benefit of the KD in diabetes mellitus type 2 (T2DM) and polycystic ovarian syndrome (PCOS). In many analysed studies, KD led to significant weight loss and had beneficial effects on lipoprotein profile and insulin resistance. In half of the comparative studies with T2DM, the KD lead to signifiantly greater reductions in HbA1c-levels (HbA1c difference: -0.5 to -1.5 %) compared to reference diets (HbA1c difference: +0.2 to -0.5 %). Nevertheless, study results are too heterogenic for a general recommendation of the KD in this patient population.

Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials.

Background:Telemedicine is instrumental in improving diabetes patient care, as well as providing significant cost benefits. This meta-analysis was conducted to compare the effectiveness of telemedicine intervention with usual care in diabetes patients.Methods:Randomized controlled trials (RCTs) reporting a change in HbA1c after usual care and telemedicine intervention were retrieved from electronic databases.Results:Data on 6,170 participants (mean age 13.3 to 71.0 years), with 3,128 randomized to usual care and 3,042 to telemedicine intervention, were retrieved from 42 RCTs. Eight studies used teleconsultation, while 34 used telemonitoring (device based). Nine studies enrolled both type 1 and type 2 diabetes patients, 21 focused on type 2 diabetes patients, and 12 on type 1 diabetes patients. The mean reduction in HbA1c was significantly higher in the telemedicine groups (Hedges' g = -0.37, p < 0.001). Type 2 diabetes patients experienced a higher reduction in HbA1c compared to type 1 diabetes patients (Hedges' g = -0.48, p < 0.001 vs. -0.26, p < 0.05; Q = 1935.75, p < 0.0001). Older patients (41-50 years, Hedges' g = -1.82, p < 0.001; >50 years, Hedges' g = -1.05, p < 0.001) benefited more than their younger counterparts (Hedges' g = -0.84, p = 0.07). Telemedicine programs lasting >6 months produced a significantly greater reduction in HbA1c levels (Hedges' g = -2.24 vs. -0.66, p < 0.001).Conclusion:Telemedicine interventions are more effective than usual care in managing diabetes, especially type 2 diabetes. Furthermore, older patients and a longer duration of intervention provide superior results.

The influences of bariatric surgery on hemoglobin A1c in a sample of obese patients in Saudi Arabia.

BackgroundAlthough the frequency of surgical weight loss interventions has increased in Saudi Arabia, literature describing the clinical outcomes of bariatric surgery in Saudi Arabia is limited. This study aimed to assess whether weight loss intervention improves hemoglobin A1c (HbA1c) in obese patients and to identify its associated factors.Patients and methodsA retrospective study was carried out on 318 patients with obesity class 1 or higher (body mass index [BMI] ≥ 30 kg/m2) who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass at King Abdulaziz Medical City in Riyadh, Saudi Arabia, between January 1, 2001 and March 31, 2017. Preoperatively and 12 months postoperatively, characteristics of patients were collected. BMI reduction was calculated, based on which patients were divided into three groups (0–9, 10–14, and >14 kg/m2).ResultsThe postoperative HbA1c was 5.83±0.9, while the baseline level was 6.74±2.1 (P=0.001). Fifty-eight of the 318 patients had diabetes. We observed significantly higher HbA1c in diabetic than in non-diabetic patients preoperatively, whereas an insignificantly different HbA1c was observed postoperatively. Among those who had minimal reduction in BMI (0–9 kg/m2), we observed significantly higher HbA1c in diabetic than in non-diabetic patients, whereas among those who had large reduction in BMI (10–14 kg/m2) and (>14 kg/m2), we observed insignificant differences in HbA1c in diabetic than in non-diabetic patients.ConclusionBeing a diabetic patient was related to a significant reduction in HbA1c levels postoperatively. The study suggests that the reduction in HbA1c levels could be modified by BMI, wherein greater reduction in BMI leads to greater reduction in HbA1c levels.

Effects of Insulin Plus Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) in Treating Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

IntroductionCombination therapy with insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) has already been proven an efficient treatment option for type 2 diabetes. This combination can effectively improve glycated hemoglobin levels, cause weight loss and reduce the dosage of insulin. In addition, it can also reduce the risk of hypoglycemia. Several randomized controlled trials have confirmed that this treatment may be just as effective for type 1 diabetes mellitus (T1DM) patients. The objective of this meta-analysis was to assess the effects and efficacy of the treatment on glycemic changes, weight loss and insulin dosage in type 1 diabetes mellitus patients.MethodsWe searched Embase, PubMed and Cochrane for randomized controlled trials (no time restrictions) that investigated combined insulin and GLP-1 treatment. The main endpoints were measurements of glycated hemoglobin and changes in the weight and the dosage of insulin.ResultsIn total, 1093 were studies identified, and 7 studies were included in our meta-analysis. GLP-1 agonist and insulin combination therapy led to greater reductions in HbA1c levels [P = 0.03; mean difference −0.21; 95% confidence intervals (CI) (−0.40, 0.02)] and weight [P < 0.05; −3.53 (−4.86, 2.19)] compared to control treatments. The combination therapy did not significantly influence the daily weight-adjusted total insulin dose [P = 0.05; −0.11 (−0.23, 0)], but it did reduce the daily weight-adjusted bolus insulin dose [P = 0.001; −0.06 (−0.1, 0.02)].ConclusionOur meta-analysis supports the use of a combined therapeutic regimen of insulin and GLP-1RAs for treating patients with T1DM. Combination therapy with GLP-1 and insulin could achieve an ideal treatment effect on glycemic control, weight loss and bolus insulin dose in patients with T1DM.

Young patients with type 1 diabetes poorly controlled and poorly compliant with self-monitoring of blood glucose: can technology help? Results of the i-NewTrend randomized clinical trial

To compare iBGStar™+DMApp (experimental meter+telemedicine system) (iBGStar) with a traditional glucose meter (Control) in type 1 diabetes adolescents/young adults. i-NewTrend was a multicenter, open-label, randomized trial involving subjects aged 14-24years, on basal-bolus insulin, HbA1c≥8.0%, and poorly compliant with SMBG (i.e., <30% of the recommended frequency). Primary end points were change in HbA1c and achievement of compliance with SMBG (≥30% of the recommended frequency) after 6months. Quality of life was also evaluated. A post-trial observational phase was conducted, where both groups used the experimental device. Of 182 randomized patients (51.1% male; age 17.7±3.0years; diabetes duration 8.8±4.7years; HbA1c levels 10.0%±1.4), 92 were allocated to iBGStar and 90 to Control; 6.5% in iBGStar and 8.9% in Control dropped-out. After 6months, HbA1c changes (±SE) were -0.44%±0.13 in iBGStar and -0.32%±0.13 in Control (p=0.51). In the post-trial phase, HbA1c changes from 6months (±SE) were -0.07%±0.14 in iBGStar and -0.31%±0.14 in Control (p=0.24). Compliance end point was reached by 53.6% in iBGStar and 55.0% in Control (p=0.86). Mean daily SMBG measurements increased from 1.1 to 2.3 in both groups without worsening quality of life. Compliant subjects showed a greater reduction in HbA1c levels (-0.60%±0.23 in iBGStar; -0.41%±0.21 in Control; p=0.31). Within iBGStar group, telemedicine users (38.0%) reduced HbA1c by -0.58±0.18. iBGStar was not superior to the traditional meter. Irrespective of the strategy, increasing from 1 to 2 SMBG tests/day was associated with HbA1c reduction in both groups, without pharmacologic interventions. Identifying new technologies effective and acceptable to patients is an option to improve adherence to diabetes care. The trial was registered at ClinicalTrials.gov (registration number NCT02073188).

Clinical efficacy and safety of insulin aspart compared with regular human insulin in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis.

Prandial insulin is a key component in insulin treatment of type 1 diabetes mellitus (T1DM) and in many patients with type 2 diabetes mellitus (T2DM). The evidence-based data supporting the choice of an insulin preparation are still limited. We performed a systematic review to summarize and update the evidence on relative efficacy and safety of insulin aspart (IAsp) and regular human insulin (RHI) in both types of diabetes. Randomized controlled trials comparing IAsp with RHI in patients with either T1DM or T2DM and conducted until May 2013 were retrieved from a systematic search of MEDLINE, EMBASE, and Cochrane Library. Of 16 relevant trials, 11 involved patients with T1DM and 5--with T2DM. In the T1DM population, IAsp, when compared with RHI, provided a greater reduction in hemoglobin A₁c (HbA₁c) levels (weighted mean difference [WMD], -0.11%; 95% confidence interval [CI], -0.16 to -0.05; WMD, -1.2 mmol/mol; 95% CI, -1.7 to -0.5), and improved postprandial glucose levels following breakfast (WMD, -1.40 mmol/l; 95% CI, -1.72 to -1.07), lunch (WMD, -1.01 mmol/l; 95% CI, -1.61 to -0.41), and dinner (WMD, -0.89 mmol/l; 95% CI, -1.19 to -0.59). The risk of nocturnal hypoglycemia was lower in T1DM patients receiving IAsp (relative risk, 0.76; 95% CI, 0.64-0.91), while no difference was observed for severe hypoglycemia. In T2DM patients, IAsp led to a greater reduction in HbA₁c levels (WMD, -0.22%; 95% CI, -0.39 to -0.05; -2.4 mmol/mol, -4.3 to -0.5) and postprandial blood glucose. The risk of overall hypoglycemia and severe adverse effects was comparable between the groups. IAsp provides better glycemic control when compared with RHI in patients with T1DM and T2DM. Fewer T1DM patients treated with IAsp experienced nocturnal hypoglycemia, while both interventions showed a comparable risk of severe hypoglycemic events in both types of diabetes.

Management of Patients Using Combination Therapy With Pioglitazone and a Dipeptidyl Peptidase-4 Inhibitor: An Analysis of Initial Versus Sequential Combination Therapy

Current type 2 diabetes mellitus (T2DM) treatment involves progressive interventions from lifestyle changes to pharmacological therapies. Previous studies found that combination therapy with a dipeptidyl peptidase-4 inhibitor (DPP-4i) and pioglitazone (PIO) is more effective than monotherapies in treating poorly controlled T2DM, but there is no consensus on whether these drugs should be initiated at the same time (initial combination therapy) or sequentially. We aimed to assess glycemic control with initial versus sequential combination therapy with PIO and a DPP-4i in patients with glycosylated hemoglobin (HbA1c) levels ≥ 7%. A retrospective chart review was conducted on T2DM patients from diverse geographic sites in the United States initiating therapies from March 2, 2010 to February 28, 2011. Patients were selected for initial combination therapy, if starting PIO and a DPP-4i within 30 days of each other, or sequential combination therapy, if first taking PIO alone for ≥ 60 days before adding a DPP-4i within 1 year of PIO initiation. The HbA1c level reduction from baseline was compared between cohorts using linear regression models adjusting for demographics, baseline HbA1c, T2DM duration, comorbidities, and various medications. There were 250 patients in the initial and 211 in the sequential combination therapy cohorts; 57.3% were male, 65.3% were Caucasian, and the mean age was 54.3 years. Patients receiving initial combination therapy had a significantly higher mean baseline HbA1c level (8.6% vs 8.0%, P < 0.0001), a higher prevalence of coronary artery disease (11.6% vs 6.2%, P = 0.0430), and a lower prevalence of hyperlipidemia (56.4% vs 67.8%, P = 0.0120) and of hypertension (62.4% vs 72.0%, P = 0.0290), compared with the sequential therapy cohort. In adjusted analyses, initial combination therapy was associated with a significantly greater reduction in HbA1c levels than sequential combination therapy at months 12, 16, and 20 (−0.977 vs −0.819, P = 0.034; −1.453 vs −1.242, P = 0.048; and −1.182 vs −0.810, P = 0.013, respectively). Our findings suggest initial combination therapy may be the preferred option in choosing combination therapies.

Insulinization: A promising strategy for the treatment of type 2 diabetes mellitus

The aim of the present study was to assess the efficiency of the long-term use of continuous subcutaneous insulin infusion (CSII), a novel regimen known as insulinization, for the treatment of type 2 diabetes mellitus. A total of 150 subjects who fulfilled the diagnostic criteria for type 2 diabetes were included in the study. The patients were divided into eight groups according to the treatment regimens they received and were monitored for 3 months. Insulin doses were adjusted to optimize glycemic control with the simplest possible insulin regimen. The outcomes studied included the time required for glycemic control and insulin dose reduction, the total daily insulin dose, the ratio of patients not requiring the administration of oral antidiabetic drugs (OADs), the rate of hypoglycemia, and hemoglobin A1c (HbA1c) and fasting plasma insulin (FinS) levels. Patients receiving insulinization required less time to achieve optimal glycemic control and insulin decrement compared with patients receiving other treatments. The total daily insulin dose for patients receiving insulinization therapy was 0.23±0.07 U/kg/day, which was lower than that in any other group. In patients receiving insulinization, the ratio of patients that did not require OADs (43.3%) and the concentration of FinS A were higher than those in the other groups. Furthermore, insulinization resulted in a greater reduction in HbA1c levels, as well as a reduced incidence of severe hypoglycemia. Insulinization may mimic physiological insulin secretion more effectively than other therapies. This regimen is more efficient and reduces the incidence of hypoglycemia in patients with type 2 diabetes, indicating that it is likely to be a promising treatment strategy for the disease.