Types Of Diabetes Medications Research Articles

Self Management among Diabetes Patients

Background: In the management of diabetes mellitus, the role of self-care has been pivotal. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of disease by participating in their care.This study aimed to assess self-management among diabetes patients.
 Materials and Methods: Analytical cross-sectional study was conducted among 232 patients with diabetes selected by convenience sampling. Diabetes Self Management Questionnaire-Revised was used to assess self-management among diabetes patients. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (bivariate logistic regression).
 Results: Findings of the study revealed that out of 232 respondents, 48.7% had suboptimal diabetes self-management practices. The global score for diabetes self-management was 5.28± 1.34 The mean score for subscale cooperation with the diabetes team was highest i.e., 7.50± 1.94 followed by medication taking subscale (6.94±3.14), physical activity subscale (5.37± 3.09), eating behavior subscale (5.35±1.71) and glucose monitoring subscale (0.83± 2.19) respectively. The results further indicated a significant association between diabetes self-management and religion, type of diabetes medication, glycemic control, and diabetes complications at p<0.05.
 Conclusion: The present study showed that almost half of the respondents had suboptimal diabetes self-management. Therefore, healthcare providers should further design and implement interventions to improve self-management behavior among diabetes patients

Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care

ObjectiveTo compare rates of performing National Institute for Health and Care Excellence-recommended health checks and prescribing in people with type 2 diabetes (T2D), before and after the first COVID-19 peak...

Prognostic roles of diabetes mellitus and hypertension in advanced hepatocellular carcinoma treated with sorafenib.

It remains limited whether diabetes mellitus (DM) and hypertension (HTN) affect the prognosis of advanced hepatocellular carcinoma (HCC) treated with sorafenib. Our study attempted to elucidate the roles of DM/HTN and the effects of diabetes medications among advanced HCC patients receiving sorafenib. From August 2012 to February 2018, 733 advanced HCC patients receiving sorafenib were enrolled at China Medical University, Taichung, Taiwan. According to the presence/absence of DM or HTN, they were divided into four groups: control [DM(-)/HTN(-), n = 353], DM-only [DM(+)/HTN(-), n = 91], HTN-only [DM(-)/HTN(+), n = 184] and DM+HTN groups [DM(+)/HTN(+), n = 105]. Based on the types of diabetes medications, there were three groups among DM patients (the combined cohort of DM-only and DM+HTN groups), including metformin (n = 63), non-metformin oral hypoglycemic agent (OHA) (n = 104) and regular insulin (RI)/neutral protamine hagedorn (NPH) groups (n = 29). We then assessed the survival differences between these groups. DM-only and DM+HTN groups significantly presented longer overall survival (OS) than control group (control vs. DM-only, 7.70 vs. 11.83 months, p = 0.003; control vs. DM+HTN, 7.70 vs. 11.43 months, p = 0.008). However, there was no significant OS difference between control and HTN-only group (7.70 vs. 8.80 months, p = 0.111). Besides, all groups of DM patients showed significantly longer OS than control group (control vs. metformin, 7.70 vs. 12.60 months, p = 0.011; control vs. non-metformin OHA, 7.70 vs. 10.80 months, p = 0.016; control vs. RI/NPH, 7.70 vs. 15.20 months, p = 0.026). Rather than HTN, DM predicts better prognosis in advanced HCC treated with sorafenib. Besides, metformin, non-metformin OHA and RI/NPH are associated with longer survival among DM-related advanced HCC patients receiving sorafenib.

Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes.

To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. In this secondary analysis of a randomized trial in patients with obesity and uncontrolled type 2 diabetes, multivariable logistic regression was used to evaluate associations between several clinical factors (measured with survey questionnaires at study baseline) and self-reported non-adherence to insulin and non-insulin medications. Among 263 patients, reported non-adherence was 62% (52% for insulin, 55% for non-insulin medications). Reported non-adherence to non-insulin medications was less likely in white versus non-white patients (odds ratio (OR) = 0.42; 95%CI: 0.22,0.80) and with each additional medication taken (OR = 0.75; 95%CI: 0.61,0.93). Non-adherence to non-insulin medications was more likely with each point increase in a measure of diabetes medication intensity (OR = 1.43; 95%CI: 1.01,2.03), the Problem Areas in Diabetes (PAID) score (OR = 1.06; 95%CI: 1.02,1.12), and in men versus women (OR = 3.03; 95%CI: 1.06,8.65). For insulin, reporting non-adherence was more likely (OR = 1.02; 95%CI: 1.00,1.04) with each point increase in the PAID. Despite similar overall rates of reported non-adherence to insulin and non-insulin medications, factors associated with reported non-adherence to each medication type differed. These findings may help tailor approaches to supporting adherence in patients using different types of diabetes medications.

Geographic and Racial/Ethnic Variation in Glycemic Control and Treatment in a National Sample of Veterans With Diabetes.

Geographic and racial/ethnic disparities related to diabetes control and treatment have not previously been examined at the national level. A retrospective cohort study was conducted in a national cohort of 1,140,634 veterans with diabetes, defined as two or more diabetes ICD-9 codes (250.xx) across inpatient and outpatient records. Main exposures of interest included 125 Veterans Administration Medical Center (VAMC) catchment areas as well as racial/ethnic group. The main outcome measure was HbA1c level dichotomized at ≥8.0% (≥64 mmol/mol). After adjustment for age, sex, racial/ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of uncontrolled diabetes varied by VAMC catchment area, with values ranging from 19.1% to 29.2%. Moreover, these differences largely persisted after further adjusting for medication use and adherence as well as utilization and access metrics. Racial/ethnic differences in diabetes control were also noted. In our final models, compared with non-Hispanic Whites, non-Hispanic Blacks (odds ratio 1.11 [95% credible interval 1.09-1.14]) and Hispanics (1.36 [1.09-1.14]) had a higher odds of uncontrolled HBA1c level. In a national cohort of veterans with diabetes, we found geographic as well as racial/ethnic differences in diabetes control rates that were not explained by adjustment for demographics, comorbidity burden, use or type of diabetes medication, health care utilization, access metrics, or medication adherence. Moreover, disparities in suboptimal control appeared consistent across most, but not all, VAMC catchment areas, with non-Hispanic Black and Hispanic veterans having a higher odds of suboptimal diabetes control than non-Hispanic White veterans.

The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE.

Weight loss is strongly recommended for overweight and obese adults with type 2 diabetes. Unintentional weight loss is associated with increased risk of all-cause mortality, but few studies have examined its association with cardiovascular outcomes in patients with diabetes. To evaluate 2-year weight change and subsequent risk of cardiovascular events and mortality in established type 2 diabetes. The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation was an international, multisite 2×2 factorial trial of intensive glucose control and blood pressure control. We examined 5 categories of 2-year weight change: >10% loss, 4% to 10% loss, stable (±<4%), 4% to 10% gain, and >10% gain. We used Cox regression with follow-up time starting at 2 years, adjusting for intervention arm, demographics, cardiovascular risk factors, and diabetes medication use from the 2-year visit. Among 10 081 participants with valid weight measurements, average age was 66 years. By the 2-year examination, 4.3% had >10% weight loss, 18.4% had 4% to 10% weight loss, and 5.3% had >10% weight gain. Over the following 3 years of the trial, >10% weight loss was strongly associated with major macrovascular events (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.26-2.44), cardiovascular mortality (HR, 2.76; 95% CI, 1.87-4.09), all-cause mortality (HR, 2.79; 95% CI, 2.10-3.71), but not major microvascular events (HR, 0.91; 95% CI, 0.61-1.36), compared with stable weight. There was no evidence of effect modification by baseline body mass index, age, or type of diabetes medication. In the absence of substantial lifestyle changes, weight loss may be a warning sign of poor health meriting further workup in patients with type 2 diabetes.

Vitamin D deficiency and glycemic control among patients with type 2 diabetes mellitus in Jazan City, Saudi Arabia.

Background: The prevalence of vitamin D deficiency (VDD) is predicted to be high in patients with type 2 diabetes mellitus (T2DM), but the exact figure is not known in Jazan, Saudi Arabia. Emerging data suggests that VDD plays a role in glycemic control. The aim of this study was to measure the prevalence of VDD among T2DM patients and to investigate its association with patients’ characteristics and glycemic control in Jazan.Methods: This is an analytical cross-sectional study which recruited 309 patients with T2DM randomly from primary health care centers in Jazan. Logistic regression analysis was conducted to determine the VDD predictors and to examine the association of VDD and glycemic control.Results: The VDD prevalence was found to be 60.8% in patients with T2DM. Age, gender, diabetic retinopathy (DR), dyslipidemia, glycemic control, and obesity were significantly associated with VDD, and all except obesity were independent predictors of VDD. There was a significant negative correlation between 25-hydroxyvitamin D and HbA1c. VDD was a significant independent predictor of poor glycemic control after adjustment for hypertension, DR, diabetic neuropathy, type of diabetes medication, diabetes duration, and education level.Conclusion: In this Saudi Arabian population, VDD is highly prevalent in people with T2DM and is associated with poor glycemic control. Health education targeting patients with T2DM and national strategies regarding vitamin D fortification are needed to prevent VDD in Saudi Arabia. Earlier VDD diagnosis by health care providers may help to improve the outcome for patients with T2DM. Establishing the causal association between VDD and glycemic control and clarifying the biological role of vitamin D in T2DM are important aims for future studies.

Diabetic peripheral neuropathy: the potential role of vitamin D deficiency

BackgroundVitamin D is well known for its role in promoting calcium and phosphorus absorption and is recently associated with various neurological disorders.ObjectiveTo study the possible relation between vitamin D deficiency and diabetic peripheral neuropathy in a sample of patients recruited from Beni-Suef governorate, north Upper EgyptMethodsA case-control study included 25 type 2 diabetic patients with diabetic peripheral neuropathy and 25 healthy controls. The patients included were subjected to clinical evaluation including Michigan Neuropathy Screening Instrument and nerve conduction study. And all patients and control were subjected to assessment of fasting and 2-h post prandial blood sugar, hemoglobin A1C, and serum vitamin D level.ResultsSerum vitamin D level was significantly lower in patients compared to control (P value = 0.008). For the patients group, females and patients with Michigan neuropathy screening instrument score more than 4 had statistically significant lower vitamin D level (P value = 0.003 and 0.006, respectively).No statistically significant difference in vitamin D level was found between patients below and above the age of 50 years, duration of diabetes less and more than 5 years, different types of diabetes medications, or patients with fair and poor control (P value = 0.525, 0.700, 0.881 and 0.252, respectively). No significant correlation was found between vitamin D level and the results of nerve conduction study.ConclusionVitamin D deficiency was highly prevalent in diabetic peripheral neuropathy patients. Females and patients with severe form of neuropathy are more liable for lower vitamin D levels.

Effect of metformin treatment in patients with type 2 diabetes with respect to glyoxalase 1 activity in atherosclerotic lesions.

The enzyme glyoxalase1 (GLO1) is the main opponent in the degradation of the reactive metabolite methylglyoxal (MG), which by glycation of macromolecules is involved in atherogenesis. Reduced GLO1-activity in atherosclerotic tissue is known to be associated with diabetes. It has been shown that treatment of patients with type 2 diabetes with metformin leads to increased GLO1-activity in peripheral-blood-cells. The aim of this study was to evaluate whether metformin treatment increases GLO1-activity in atherosclerotic lesions of patients with type 2 diabetes. Patients with type 2 diabetes and carotid artery disease were included into the study prospectively. Type of diabetes-medication was documented upon admission along with demographic and clinical history. Using shock frozen endarterectomy-derived carotid artery plaques, GLO1-activity as well as protein expression was measured by a spectophotometric assay and western-blotting respectively. 33 patients (76 % male, mean age 71 years) were included into the study and were divided according to treatment with metformin or not (15 vs. 18 patients). GLO1-activity was increased by the factor 1.36 when treated with metformin - however, not significantly (0.86 vs. 0.63 U/mg, p = 0.056). Normalisation of GLO1-activity onto GLO1-expression level lead to a significant increase by more than twofold (8.48 vs. 3.85, p = 0.044) while GLO1-protein levels did not differ significantly. GLO1-activity correlated positively with increasing HbA1c, especially under metformin treatment. Treatment with metformin in patients with type 2 diabetes is associated with enhanced GLO1-activity in atherosclerotic lesions. Regarding the macro- and microvascular complications in these patients further studies are needed to gain more insight into the effect of metformin on the GLO/MG system.

Laparoscopic Roux-en-Y versus One Anastomosis Gastric Bypass on Remission of Diabetes in Morbid Obesity

Background: Laparoscopic one anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are common treatments for morbid obese patients who suffer from type 2 diabetes mellitus (T2DM). It has been hypothesized that diabetes may be resolved or improved after bariatric procedures, although the exact effect has not been well established. The present study aimed to compare remission of T2DM after LRYGB versus OAGB in this study. Methods: All diabetic obese patients, aged between 16 to 60, who referred to Hazrat Rasul Akram obesity clinic from April 2010 to March 2013 for LRYGB or OAGB were included in the present study. Pre-operative parameters, including glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), body mass index (BMI), and type of diabetes medication were extracted from database and recorded. Pre-operative and three months postoperative values were then compared between the groups. Results: Out of 95 eligible patients, 50 patients underwent OAGB and 45 patients had LRYGB. The two groups were homogenous in distribution of gender, mean age, weight, BMI, and FPG; however, mean HbA1C was relatively higher in LRYGB group (P = 0.05) than other group, which was non-significant after adjustment. Rate of remission was significantly higher in OAGB group than other group after three months follow-up (64.0 versus 31.1%, respectively) (P = 0.002). Conclusions: In our short-term follow-up, OAGB had a higher rate of remission of T2DM compared to LRYGB, which could be due to different baseline value of HbA1c (before surgery) between two groups. Future research is thus suggested with linger follow-up and randomized study design.

Depression, distress and self-efficacy: The impact on diabetes self-care practices.

The prevalence of type 2 diabetes is increasing in Malaysia, and people with diabetes have been reported to suffer from depression and diabetes distress which influences their self-efficacy in performing diabetes self-care practices. This interviewer administered, cross sectional study, conducted in the district of Hulu Selangor, Malaysia, involving 371 randomly selected patients with type 2 diabetes, recruited from 6 health clinics, aimed to examine a conceptual model regarding the association between depression, diabetes distress and self-efficacy with diabetes self-care practices using the partial least square approach of structural equation modeling. In this study, diabetes self-care practices were similar regardless of sex, age group, ethnicity, education level, diabetes complications or type of diabetes medication. This study found that self-efficacy had a direct effect on diabetes self-care practice (path coefficient = 0.438, p<0.001). Self-care was not directly affected by depression and diabetes distress, but indirectly by depression (path coefficient = -0.115, p<0.01) and diabetes distress (path coefficient = -0.122, p<0.001) via self-efficacy. In conclusion, to improve self-care practices, effort must be focused on enhancing self-efficacy levels, while not forgetting to deal with depression and diabetes distress, especially among those with poorer levels of self-efficacy.

Abstract P048: Risk Factors for Severe Hypoglycemia Differ in Black and White Older Adults With Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Blacks with diabetes have roughly twice the rate of severe hypoglycemia compared to whites with diabetes; it is unclear whether hypoglycemia risk factors identified in studies of white participants are similarly associated with hypoglycemia in blacks. Methods: We included ARIC participants aged 65+ at Visit 4 (1996-1998) who had Medicare fee-for-service Part B and diagnosed diabetes. We identified severe hypoglycemic events through 2013 using ICD-9 codes from hospitalizations, emergency department visits, and ambulance services. We evaluated previously identified risk factors: age, sex, chronic kidney disease (CKD), diabetes medication use, obesity, cognition, glycemic control, and number of comorbidities. We stratified Cox proportional hazards models by race and used Harrell’s C-statistic to compare discrimination. Results: There were 33 hypoglycemic events in 135 black participants and 43 hypoglycemic events in 319 white participants (incidence rate 2.8 vs. 1.5 per 100 person-years, p&lt;0.01). Most risk factors had similar associations with risk of hypoglycemia in blacks and whites, with some notable exceptions. Obesity was associated with greater risk in blacks but not whites ( Table ). CKD was more strongly associated with risk in blacks than whites. Type of diabetes medication was associated with risk in whites but not in blacks. The C-statistic suggested better model discrimination in whites (C=0.795) than in blacks (C=0.759), but confidence intervals were wide. Conclusion: The direction and strength of risk factors for hypoglycemia may differ for blacks and whites. It is unclear why the relative importance of risk factors for hypoglycemia differ between whites and blacks. These data suggest that the mechanism by which CKD influences hypoglycemia risk may be decreased renal gluconeogenesis in blacks and reduced insulin clearance in whites. Additional research is needed to understand those factors that contribute to hypoglycemia risk in blacks and may underlie health disparities.

Abstract 2274: Metformin use and risk of lung cancer in patients with diabetes.

Abstract Observational studies suggest that cancer incidence is lower in patients with type 2 diabetes treated with metformin, relative to patients treated with other diabetes medications. The few studies to examine metformin use in relation to lung cancer risk, however, have produced inconsistent results. To clarify this relationship, we conducted a retrospective cohort study of 50,722 adults aged 40 years or older included in the Kaiser Permanente Northern California Diabetes Registry, who completed a mailed survey administered in 1994 to 1996 on health-related traits and behaviors. All prescribed diabetes medications were identified for each patient from pharmacy records. Patients were followed for lung cancer from 1997 to 2009, with a median follow-up of 8.1 years. Using Cox regression, with age as the time scale, rate ratios (RR) and 95% confidence intervals (CI) were calculated to estimate risk of lung cancer associated with new use of metformin, adjusted for sex, race/ethnicity, smoking status, income, education level, diabetes duration, baseline measures of hemoglobin A1c and creatinine, and ever use of other types of diabetes medications. Measures of metformin use, along with ever use for each type of diabetes medication, were modeled as time-dependent variables. During 389,887 person-years of follow-up, 685 patients were diagnosed with lung cancer. The adjusted RR for ever use of metformin was 0.95 (95% CI, 0.79-1.14). For duration of metformin use, the adjusted RRs for &amp;lt;2.0, 2.0-4.9, and 5.0+ years were 1.01 (95% CI, 0.80-1.28), 0.94 (95% CI, 0.73-1.22), and 0.86 (95% CI, 0.63-1.18), respectively. In analyses stratified by smoking status, the adjusted RRs for ever use of metformin were 0.98 (95% CI, 0.79-1.21) in ever smokers and 0.59 (95% CI, 0.34-1.01) in never smokers. However, in never smokers, the number of users diagnosed with lung cancer was relatively small, and no dose-response decrease in risk with increasing duration of metformin use was found; the corresponding adjusted RRs for &amp;lt;2.0, 2.0-4.9, and 5.0+ years of metformin use were 0.52 (95% CI, 0.23-1.16), 0.58 (95% CI, 0.26-1.26), and 0.70 (95% CI, 0.31-1.58), respectively. Our results suggest that metformin use is not associated with lung cancer risk in former or current smokers with diabetes. Additional research is needed to determine whether metformin use might alter lung cancer risk in never smokers with diabetes. Citation Format: Lori C. Sakoda, Ninah S. Achacoso, Charles P. Quesenberry, Tiffany Peng, Samantha F. Ehrlich, Assiamira Ferrara, Laurel A. Habel. Metformin use and risk of lung cancer in patients with diabetes. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2274. doi:10.1158/1538-7445.AM2013-2274

Obesity, Diabetes, and Preoperative Hyperglycemia as Predictors of Periprosthetic Joint Infection

Diabetes and obesity are common in patients undergoing joint replacement. Studies analyzing the effects of diabetes and obesity on the occurrence of periprosthetic joint infection have yielded contradictory results, and the combined effects of these conditions are not known. The one-year incidence of periprosthetic joint infections was analyzed in a single-center series of 7181 primary hip and knee replacements (unilateral and simultaneous bilateral) performed between 2002 and 2008 to treat osteoarthritis. The data regarding periprosthetic joint infection (defined according to Centers for Disease Control and Prevention criteria) were collected from the hospital infection register and were based on prospective, active surveillance. Patients diagnosed with diabetes were identified from the registers of the Social Insurance Institution of Finland. The odds ratios (ORs) for infection and the accompanying 95% confidence intervals (CIs) were calculated with use of binary logistic regression with adjustment for age, sex, American Society of Anesthesiologists risk score, arthroplasty site, body mass index, and diabetic status. Fifty-two periprosthetic joint infections occurred during the first postoperative year (0.72%; 95% CI, 0.55% to 0.95%). The infection rate increased from 0.37% (95% CI, 0.15% to 0.96%) in patients with a normal body mass index to 4.66% (95% CI, 2.47% to 8.62%) in the morbidly obese group (adjusted OR, 6.4; 95% CI, 1.7 to 24.6). Diabetes more than doubled the periprosthetic joint infection risk independent of obesity (adjusted OR, 2.3; 95% CI, 1.1 to 4.7). The infection rate was highest in morbidly obese patients with diabetes; this group contained fifty-one patients and periprosthetic infection developed in five (9.8%; 95% CI, 4.26% to 20.98%). In patients without a diagnosis of diabetes at the time of the surgery, there was a trend toward a higher infection rate in association with a preoperative glucose level of ≥6.9 mmol/L (124 mg/dL) compared with &lt;6.9 mmol/L. The infection rate was 1.15% (95% CI, 0.56% to 2.35%) in the former group compared with 0.28% (95% CI, 0.15% to 0.53%) in the latter, and the adjusted OR was 3.3 (95% CI, 0.96 to 11.0). The type of diabetes medication was not associated with the infection rate. Diabetes and morbid obesity increased the risk of periprosthetic joint infection following primary hip and knee replacement. The benefits of joint replacement should be carefully weighed against the incidence of postoperative infection, especially in morbidly obese patients. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Does supplemental vitamin C increase cardiovascular disease risk in women with diabetes?

Vitamin C acts as a potent antioxidant; however, it can also be a prooxidant and glycate protein under certain circumstances in vitro. These observations led us to hypothesize that a high intake of vitamin C in diabetic persons might promote atherosclerosis. The objective was to examine the relation between vitamin C intake and mortality from cardiovascular disease. We studied the relation between vitamin C intake and mortality from total cardiovascular disease (n = 281), coronary artery disease (n = 175), and stroke (n = 57) in 1923 postmenopausal women who reported being diabetic at baseline. Diet was assessed with a food-frequency questionnaire at baseline, and subjects initially free of coronary artery disease were prospectively followed for 15 y. After adjustment for cardiovascular disease risk factors, type of diabetes medication used, duration of diabetes, and intakes of folate, vitamin E, and beta-carotene, the adjusted relative risks of total cardiovascular disease mortality were 1.0, 0.97, 1.11, 1.47, and 1.84 (P for trend < 0.01) across quintiles of total vitamin C intake from food and supplements. Adjusted relative risks of coronary artery disease were 1.0, 0.81, 0.99, 1.26, and 1.91 (P for trend = 0.01) and of stroke were 1.0, 0.52, 1.23, 2.22, and 2.57 (P for trend < 0.01). When dietary and supplemental vitamin C were analyzed separately, only supplemental vitamin C showed a positive association with mortality endpoints. Vitamin C intake was unrelated to mortality from cardiovascular disease in the nondiabetic subjects at baseline. A high vitamin C intake from supplements is associated with an increased risk of cardiovascular disease mortality in postmenopausal women with diabetes.

PDB6: AN EARLY LOOK AT TZD USE AMONG TYPE 2 DIABETES PATIENTS

OBJECTIVE: One of the newest drug classes used in the treatment of type-2 diabetes is the thiazolidinediones (TZDs). TZDs enhance insulin action in insulin-dependent tissues without stimulating insulin secretion. These drugs are used both as monotherapy and in combination with other anti-diabetic pharmacotherapies. Two TZDs are currently on the market, rosiglitazone and pioglitazone. Both of these compounds were approved in the US mid-year 1999. This study examines the patient characteristics, drug use, and resource utilization of individuals treated with a TZD in the first year following approval. METHODS: Patients who received at least one prescription for rosiglitazone or pioglitazone were selected from over 2.3 million employees, retirees, and dependents in the MarketScan® databases. Health plan enrollment data, medical claims, and pharmacy claims were used to construct the final sample. Descriptive information is presented on patient demographics, inpatient, outpatient and prescription drug use. Comparisons between these variables across the different therapy groups (e.g., monotherapy versus combination therapy) were made using appropriate statistical tests. RESULTS: 18,801 patients received at least one prescription for rosiglitazone or pioglitazone during the study period. Mean age is 60.0 years (SD = 11.6 years), including 6,510 who were 65 or older. The sample is almost evenly split between males and females (52.3% and 47.7%, respectively). 54.9% (10,324) of the patients had at least three months follow-up available. Of these, 6.3% (655) were hospitalized within three months of TZD initiation. Patients filled other types of diabetes medications after initiating therapy with a TZD—28.8% (n = 5,417) insulin, 52.0% (n = 9,776) sulfonylureas, 39.8% (n = 7,475) metformin, and 7.1% (n = 1,340) other types of diabetes drugs. CONCLUSIONS: Additional TZD-type compounds are being developed. This study provides an early look at the characteristics and subsequent outcomes of patients who are being prescribed this important new type of therapy for diabetes.

Exercise: Part I. Physiological Response to Exercise in Diabetes Mellitus

Exercise is a valuable and effective tool for assisting with diabetes management. The benefits of exercise are significant. Metabolic responses to various workloads vary greatly and depend on many factors, including type of diabetes; time, dosage, and type of diabetes medication; time and content of last meal; fitness level; and intensity and duration of activity performed. Exercise-induced hypo- and hyperglycemia can occur in diabetes, and strategies to avoid this should be taught. Weight loss is a common goal in NIDDM, although often difficult to attain. Exercise plays a critical role in weight loss and should be considered part of the treatment plan when fat loss is a goal.