Use Of Antihyperglycemic Medications Research Articles

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).

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%.

Factors Associated With Attainment of Glycemic Targets Among Adults With Type 1 and Type 2 Diabetes in Canada: A Cross-sectional Study Using Primary and Specialty Care Electronic Medical Record Data

ObjectiveUsing a new database combining primary and specialty care electronic medical record (EMR) data in Canada, we determined attainment of glycemic targets and associated predictors among adults with diabetes. MethodsWe conducted a cross-sectional observational study combining primary and specialty care EMR data in Canada. Adults with diabetes whose primary care provider contributed to the National Diabetes Repository or who were assessed at a diabetes specialty clinic (LMC Diabetes and Endocrinology) between July 3, 2015, and June 30, 2019, were included. Diabetes type was categorized as type 2 diabetes (T2D) not prescribed insulin, T2D prescribed insulin, and type 1 diabetes (T1D). Covariates were age, sex, income quintile, province, rural/urban location, estimated glomerular filtration rate, medications, and insulin pump use. Associations between predictors and the outcome (glycated hemoglobin [A1C] of ≤7.0%) were assessed by multivariable logistic regressions. ResultsAmong 122,106 adults, consisting of 91,366 with T2D not prescribed insulin, 25,131 with T2D prescribed insulin, and 5,609 with T1D, attainment of an A1C of ≤7.0% was 60%, 25%, and 23%, respectively. Proportions with an A1C of ≤7.5% and ≤8.0% were 75% and 84% for those with T2D not prescribed insulin, 41% and 57% for those with T2D prescribed insulin, and 37% and 53% for those with T1D. Highest vs lowest income quintile was associated with greater odds of meeting the A1C target (adjusted odds ratio [95% confidence interval] for each diabetes category: 1.15 [1.10 to 1.21], 1.21 [1.10 to 1.33], and 1.29 [1.04 to 1.60], respectively). Individuals in Alberta and Manitoba had less antihyperglycemic medication use and attainment of A1C target than other provinces. ConclusionsAttainment of glycemic targets among adults with diabetes was poor and differed by income and geographic location, which must be addressed in national diabetes strategies.

1408-P: Use of Antihyperglycemic Medications among U.S. Patients with Limited English Proficiency

Language-concordant care enhances self-management and adherence of patients. In agreement, limited English proficiency (LEP) is adversely associated with glycemic control and cardiovascular health of patients with diabetes mellites (DM). New antihyperglycemic medications with high effectiveness and cardiovascular benefit are now available in the market. The STEPS analysis identifies simplicity of administration as an important parameter for assessing medications, and communication barriers can complicate prescribing decisions for patients with LEP. This study examines the pharmacologic management of DM by LEP status. Data are for non-pregnant adults recruited for the National Health and Nutrition Examination Survey (NHANES, 2003-18). The sample included 4645 participants with self-reported physician-diagnosed probable type 2 DM (age of diagnosis ≥ 20 years; not solely using insulin). Most participants completed the NHANES interview in English (90%), whereas 7% completed the interview in Spanish and 3% requested an interpreter. Approximately 20% of English-speaking, 27% of LEP-Spanish, and 15% of LEP-interpreter participants did not use any antihyperglycemic medication in the past 30 days (Rao-Scott χ2 p = 0.003). The use of medications with hypoglycemia risk (insulin and/or secretagogues) did not differ by LEP status (52%, 52%, and 57%; p = 0.6). Similarly, there were no differences in the use of metformin (69%, 73%, and 64%; p = 0.3) or newer medications (GLP1 agonists, SGLT2 and DPP4 inhibitors) with weight loss or cardiovascular benefits (12%, 10%, and 11%; p = 0.7) between the 3 groups. Medications with cardiovascular risk (thiazolidinediones) were more commonly used among English-speaking (14%) than LEP-Spanish (7%) and LEP-interpreter participants (12%; p = 0.04). Pharmacologic management of DM did not significantly differ based on LEP status, suggesting that access to effective antihyperglycemic medications does not explain the observed disparities in DM control. Disclosure O.Alshaarawy: None. J.J.Kottutt: None. N.Bhangu: None. H.Holman: None. F.Mueller: None. Funding National Institutes of Health (AT009156)

Medication use and contextual factors associated with meeting guideline-based glycemic levels in diabetes among a nationally representative sample.

Based on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors. This serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into <7% versus ≥7% (meeting vs. not meeting guideline-based glycemic levels, respectively). We stratified the outcome by antihyperglycemic medication use and contextual factors (e.g., race/ethnicity, gender, chronic conditions, diet, healthcare utilization, insurance, etc.) and performed multivariable logistic regression analyses. The 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39-59.09) were male, and 51.82% (95% CI = 47.11-56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an "excellent" versus "poor" diet (aOR = 4.21, 95% CI = 1.92-9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03-1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10-0.26), taking metformin (aOR = 0.66, 95% CI = 0.46-0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27-0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33-0.79), etc. Meeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.

Adjusting background insulin therapy in type 2 diabetes when initiating a glucagon-like peptide 1 receptor agonist: A case series

Introduction: Guidelines recommend preferential use of antihyperglycemic medications with proven cardiovascular benefit for the treatment of patients with type 2 diabetes with established atherosclerotic cardiovascular disease (ASCVD), high risk factors for ASCVD, kidney disease, or heart failure. However, current guidelines offer little to no practical recommendations for adding these therapies to a patient’s current regimen while avoiding hyperglycemia or hypoglycemia. Nevertheless, considering background therapy in a proactive effort to avoid undesirable glycemic excursions when initiating any new antidiabetic medication remains paramount. Case Series: A six-patient case series investigates adjustments to background therapies and glycemic outcomes surrounding the initiation and titration of long-acting glucagon-like peptide 1 receptor agonists (GLP-1 RAs) to shed light on practical methods to manage patient care during this tenuous phase. Overarching findings regarding background therapy adjustments to avoid hypoglycemia when initiating a GLP-1 RA include: (1) safe continuation of metformin regardless of baseline A1C or concurrent glycemic background therapy; (2) continuation of background therapy when the baseline A1C is above 9%; (3) consideration of a proactive 15–20% basal insulin dose reduction when the baseline A1C is below 7.5%; (4) proactive bolus insulin dose reduction by 25% or complete discontinuation at the time of GLP-1 RA initiation. Conclusion: No dose adjustments are necessary when A1C &gt; 9%, and possibly &gt;8%. When A1C is &lt;7.5% and possibly &lt;8%, discontinue or reduce bolus insulin by 25% and/or reduce basal insulin by 15–25%. Adjust background therapy using shared-decision making while considering fasting blood glucose, A1C, hypoglycemia risk, and chosen GLP-1 RA therapy.

Adjusting background insulin therapy in type 2 diabetes when initiating a glucagon-like peptide 1 receptor agonist: A case series

Introduction: Guidelines recommend preferential use of antihyperglycemic medications with proven cardiovascular benefit for the treatment of patients with type 2 diabetes with established atherosclerotic cardiovascular disease (ASCVD), high risk factors for ASCVD, kidney disease, or heart failure. However, current guidelines offer little to no practical recommendations for adding these therapies to a patient’s current regimen while avoiding hyperglycemia or hypoglycemia. Nevertheless, considering background therapy in a proactive effort to avoid undesirable glycemic excursions when initiating any new antidiabetic medication remains paramount. Case Series: A six-patient case series investigates adjustments to background therapies and glycemic outcomes surrounding the initiation and titration of long-acting glucagon-like peptide 1 receptor agonists (GLP-1 RAs) to shed light on practical methods to manage patient care during this tenuous phase. Overarching findings regarding background therapy adjustments to avoid hypoglycemia when initiating a GLP-1 RA include: (1) safe continuation of metformin regardless of baseline A1C or concurrent glycemic background therapy; (2) continuation of background therapy when the baseline A1C is above 9%; (3) consideration of a proactive 15–20% basal insulin dose reduction when the baseline A1C is below 7.5%; (4) proactive bolus insulin dose reduction by 25% or complete discontinuation at the time of GLP-1 RA initiation. Conclusion: No dose adjustments are necessary when A1C &gt; 9%, and possibly &gt;8%. When A1C is &lt;7.5% and possibly &lt;8%, discontinue or reduce bolus insulin by 25% and/or reduce basal insulin by 15–25%. Adjust background therapy using shared-decision making while considering fasting blood glucose, A1C, hypoglycemia risk, and chosen GLP-1 RA therapy.

WCN23-0277 Use of anti-hyperglycemic medications in patients with incident CKD and T2D by CKD severity: a descriptive study using a large US electronic health records database

WCN23-0277 Use of anti-hyperglycemic medications in patients with incident CKD and T2D by CKD severity: a descriptive study using a large US electronic health records database

Differential glycemic control explained by contextual factors and antihyperglycemic medication use

Differential glycemic control explained by contextual factors and antihyperglycemic medication use

Association of cardiovascular health metrics with annual incidence of prediabetes or diabetes: Analysis of a nationwide real‐world database

Little is known about the relationship between cardiovascular health (CVH) metrics and the risk of developing prediabetes or diabetes. We examined the association of CVH metrics with the annual risk of developing prediabetes or diabetes. We carried out this study including 403,857 participants aged 18-71 years with available data on fasting plasma glucose (FPG) data for five consecutive years and with normal FPG (<100 mg/dL) at the initial health checkup. We identified the following ideal CVH metrics: non-smoking, body mass index of <25 kg/m2 , maintaining physical activity, taking breakfast, untreated blood pressure of <120/80 mmHg and untreated total cholesterol of <200 mg/dL. We defined the primary end-point as prediabetes (FPG 100-125 mg/dL) or diabetes (FPG ≥126 mg/dL or use of antihyperglycemic medications). We examined the relationship of CVH metrics with the annual incidence of prediabetes or diabetes. Additionally, we examined the association of 1-year changes in CVH metrics with the risk for prediabetes or diabetes. The median age was 44 years, and 65.6% were men. An increasing number of non-ideal CVH metrics was associated with an elevated risk of prediabetes or diabetes. A non-ideal body mass index was most strongly associated with the risk of prediabetes or diabetes. The risk of developing prediabetes or diabetes rose as the number of non-ideal CVH metrics increased over 1 year. CVH metrics could stratify the risk of the annual development of prediabetes or diabetes. The risk of developing prediabetes or diabetes might be reduced by improving CVH metrics.

Use of Antihyperglycemic Drugs and Risk of Cancer in Patients with Diabetes.

Diabetes is associated with an increased risk for several types of cancer. Therefore, use of antihyperglycemic medications to lower blood glucose may modify cancer risk. Here we review available data on the link between the most common classes of antihyperglycemic agents and cancer risk among patients with diabetes. A database search was conducted between February 2022 and June 2022 on PubMed and Embase for systematic reviews and meta-analyses investigating the association between antihyperglycemic agents and risk of cancer. Use of biguanides such as metformin is associated with 20-30% lower risk for all cancer incidence, and somewhat greater benefit for cancer-related mortality. Alpha-glucosidase inhibitors, e.g., acarbose, have not been consistently associated with cancer. Similarly, no consistent effects have been reported for thiazolidinediones, but the relationship with cancer seems to depend on the type of drug, dose, and duration of treatment. Exposure to various types of incretin-based therapies (glucagon-like peptide-1 agonists and dipeptidyl peptidase-4 inhibitors) has not been found to significantly modify cancer risk. Inhibitors of sodium glucose cotransporter-2 may raise risk for bladder cancer and reduce risk for gastrointestinal cancer. Use of insulin and insulin analogs is associated with a significant increase in total cancer risk by almost 50% compared to other antihyperglycemic drugs. Likewise, insulin secretagogues like sulfonylureas have generally been linked to greater risk for cancer by ~ 20%, although these associations may be agent-specific and dose-dependent. Current evidence suggests that the risk of cancer associated with the use of antihyperglycemic medications among patients with diabetes depends on the class of drug and type of agent, dosage, and duration of treatment. More research is needed to delineate the mechanisms by which these agents affect the process of carcinogenesis.

Clinical risk factors and social needs of 30-day readmission among patients with diabetes: A retrospective study of the Deep South.

Evidence is needed for 30-day readmission risk factors (clinical factors and social needs) among patients with diabetes in the Deep South. To address this need, our objectives were to identify risk factors associated with 30-day readmissions among this population and determine the added predictive value of considering social needs. This retrospective cohort study utilized electronic health records from an urban health system in the Southeastern U.S. The unit of analysis was index hospitalization with a 30-day washout period. The index hospitalizations were preceded by a 6-month pre-index period to capture risk factors (including social needs), and hospitalizations were followed 30 days post-discharge to evaluate all-cause readmissions (1=readmission; 0=no readmission). We performed unadjusted (chi-square and student's t-test, where applicable) and adjusted analyses (multiple logistic regression) to predict 30-day readmissions. A total of 26,332 adults were retained in the study population. Eligible patients contributed a total of 42,126 index hospitalizations, and the readmission rate was 15.21%. Risk factors associated with 30-day readmissions included demographics (e.g., age, race/ethnicity, insurance), characteristics of hospitalizations (e.g., admission type, discharge status, length of stay), labs and vitals (e.g., highest and lowest blood glucose measurements, systolic and diastolic blood pressure), co-existing chronic conditions, and preadmission antihyperglycemic medication use. In univariate analyses of social needs, activities of daily living (p<0.001), alcohol use (p<0.001), substance use (p=0.002), smoking/tobacco use (p<0.001), employment status (p<0.001), housing stability (p<0.001), and social support (p=0.043) were significantly associated with readmission status. In the sensitivity analysis, former alcohol use was significantly associated with higher odds of readmission compared to no alcohol use [aOR (95% CI): 1.121 (1.008-1.247)]. Clinical assessment of readmission risk in the Deep South should consider patients' demographics, characteristics of hospitalizations, labs, vitals, co-existing chronic conditions, preadmission antihyperglycemic medication use, and social need (i.e., former alcohol use). Factors associated with readmission risk can help pharmacists and other healthcare providers identify high-risk patient groups for all-cause 30-day readmissions during transitions of care. Further research is needed about the influence of social needs on readmissions among populations with diabetes to understand the potential clinical utility of incorporating social needs into clinical services.

Association between Periodontitis and Diabetes Mellitus in the General Population.

This study aimed to examine the association between periodontitis and diabetes mellitus. Participants with natural teeth in one jaw from the Third United States National Health and Nutrition Examination Survey (1988-1994) were included in this analysis. Participants with moderate (> 4mm attachment loss in ≥ 2 mesial sites or 5mm pocket depth in ≥ 2 mesial sites) or severe (> 6mm attachment loss in ≥ 2 mesial sites and > 5mm pocket depth in ≥ 1 mesial site) periodontitis were classified as having periodontal disease. The rest of the participants were considered without periodontal disease. Diabetes mellitus was defined as fasting glucose ≥ 126mg/dL, hemoglobin A1c ≥ 6.5% or the use of antihyperglycemic medications. Multivariable logistic regression was used to examine the association between periodontitis and diabetes mellitus in all study population and subgroups stratified by demographics and comorbidities. This analysis included 13,000 participants [mean age 43.8 ± 19.1 years, 47.5% male, 30% whites]. About 12.7% (n = 1,656) of the study population had periodontitis, and 9.2% (n = 1,200) had diabetes. In a multivariable-adjusted model, presence (vs. absence) of periodontitis was associated with 66% increased odds of diabetes (OR (95% CI):1.66 (1.43-1.94); p < 0.001). Compared to those without periodontitis, the odds of diabetes among those with severe periodontitis was much higher (OR (95% CI): 2.31(1.72-3.11); p < 0.001) than in those with moderate periodontitis (OR (95% CI): 1.54(1.30-1.82); p < 0.001). Periodontitis is associated with prevalent diabetes in a dose-response fashion, suggesting a bidirectional relationship between those two diseases. Patients with periodontal disease should be counseled regarding their elevated risk of diabetes. The online version contains supplementary material available at 10.1007/s40200-022-01010-6.

Abstract #1157747: Pseudohypoglycemia Secondary to Leukocytosis in a Leukemic Patient

Recognition of pseudohypoglycemia secondary to leukocytosis can prevent false diagnosis of hypoglycemia. A 73-year-old male with history of chronic myeloid leukemia (CML), end-stage renal disease (ESRD), hypertension, and hypothyroidism was admitted for a hip fracture after a mechanical fall associated with lethargy. He had no associated lightheadedness or syncope. Laboratory testing on admission revealed a venous serum glucose level of 88mg/dL. The following day, his venous glucose was 58mg/dL, but a follow-up point-of-care capillary glucose was 77mg/dL. On examination, he appeared cachectic, but was alert and fully oriented. He denied palpitations, tremor, diaphoresis, headache, visual disturbances, syncope, lightheadedness, or confusion. He denied any use of antihyperglycemic medications and had no history of diabetes. Subsequent venous glucose levels over the next days were in the lower limit of normal, ranging from 65 to 85mg/dL, with discrepantly higher capillary glucose values checked within two hours of phlebotomy. On the fourth day of admission, venous glucose level dipped to 40mg/dL. Follow-up capillary glucose was 65mg/dL. Patient appeared unchanged on examination and continued to deny acute symptoms. He received 25cc of dextrose 50% without any change in symptoms. Endocrinology was consulted for evaluation of hypoglycemia. Other than suboptimal food intake, further history and examination was unrevealing. Laboratory testing was significant for leukocytosis, ranging from 43,360 to 69,300/uL, secondary to CML. Although poor carbohydrate intake and diminished gluconeogenesis from ESRD could lead to hypoglycemia, the lack of any hypoglycemic symptoms was inconsistent with the reported severity of hypoglycemia. Given the severe leukocytosis, consistent discrepancy between venous and capillary glucose levels, and lack of hypoglycemic symptoms, the most convincing diagnosis was pseudohypoglycemia due to leukocytosis. Diagnosis of hypoglycemia in a person without diabetes is defined by Whipple’s Triad: 1) blood glucose level less than 55mg/dL, 2) symptoms of hypoglycemia, and 3) improvement of symptoms with correction of blood glucose. Pseudohypoglycemia presents a challenge in accurately diagnosing hypoglycemia. Pseudohypoglycemia is a phenomenon of falsely low glucose level due to glucose consumption by blood cells in vitro during the interval time between phlebotomy and laboratory processing. This phenomenon has been reported in cancers of the blood with high red or white blood cell count, such as polycythemia vera and leukemia. In this case, leukocytosis likely affected the accuracy of venous glucose results. Pseudohypoglycemia may be difficult to recognize in patients with concurrent critical illness that causes true hypoglycemia, such as sepsis, malnourishment, and hepatic, renal, or cardiac failure. One actionable step to distinguish true hypoglycemia from pseudohypoglycemia is minimizing the time between phlebotomy and laboratory processing.

Association of Sugar-Sweetened Beverage Consumption with Prediabetes and Glucose Metabolism Markers in Hispanic/Latino Adults in the United States: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BackgroundBoth the incidence of diabetes mellitus and consumption of sugar-sweetened beverages are high in the Hispanic/Latino population in the United States. The associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers in the diverse Hispanic/Latino population in the United States are unknown. ObjectivesThe objective of this study was to examine the cross-sectional associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers such as fasting glucose and insulin, 2-h oral-glucose-tolerance test, HOMA-IR, HOMA index for β-cell function (HOMA-B), and glycated hemoglobin (HbA1c) among US Hispanic/Latino adults. MethodsUsing baseline data from the Hispanic Community Health Study/Study of Latinos (2008–2011), beverage consumption was ascertained using two 24-h dietary recalls and a food propensity questionnaire. Diabetes/prediabetes status was defined by self-report, antihyperglycemic medication use, and American Diabetes Association laboratory criteria. Among 9965 individuals without diabetes (5194 normoglycemia, 4771 prediabetes) aged 18–74 y, the associations of beverage consumption with prediabetes and glucose metabolism markers were analyzed using logistic and linear regressions, respectively, accounting for complex survey design. ResultsCompared with individuals who consumed <1 serving/d (<240 mL/d) of sugar-sweetened beverages, individuals who consumed >2 servings/d (>480 mL/d) had 1.3 times greater odds of having prediabetes (95% CI: 1.06, 1.61) and higher glucose metabolism markers including fasting glucose, fasting insulin, HOMA-IR, and HbA1c. Consumption of artificially sweetened beverages showed an inverse association with β-cell function (HOMA-B). Intake of 100% fruit juice was not significantly associated with prediabetes nor with glucose metabolism markers. ConclusionsAmong US Hispanic/Latino adults, higher sugar-sweetened beverage consumption was associated with increased odds of prediabetes and higher glucose metabolism markers. Public health initiatives to decrease sugar-sweetened beverage consumption could potentially reduce the burden of diabetes among Hispanics/Latinos in the United States.

Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19

IntroductionRisk factors and mediators of associations of diabetes with COVID-19 outcomes are unclear.Research design and methodsWe identified all veterans receiving Department of Veterans Affairs healthcare with ≥1 positive nasal swab...

Professional continuous glucose monitoring and endocrinology eConsult for adults with type 2 diabetes in primary care: Results of a clinical pilot program

BackgroundLimitations in access to specialty diabetes care exist. Endocrinology eConsult that integrates professional continuous glucose monitoring (CGM-enhanced eConsult) may improve healthcare delivery, but has yet to be evaluated. We implemented a pilot program for patients with type 2 diabetes (T2DM) managed by primary care clinical pharmacists using CGM-enhanced eConsult and evaluated the acceptability and clinical outcomes in comparison to routine in-person endocrinology consultation. MethodsSeventy-four adult patients with established T2DM (age 18–65) were included. Twenty-nine were seen in-person by endocrinology and 45 were seen by pharmacists in primary care. Thirteen patients were referred for CGM-enhanced eConsult. Acceptability was assessed with pre/post clinician acceptability questionnaires and patient assessment of perceived burden. Clinical outcomes included time to first specialty appointment, baseline and 3-month follow-up HbA1c, and antihyperglycemic medication use. ResultsThere were no differences in patient acceptability of the CGM-enhanced eConsult as compared to endocrinology referral or pharmacy care. At baseline, all patients referred for eConsult were prescribed insulin. Three-month glycemic outcomes were comparable, with HbA1c reduction 1% + 2% in endocrinology, 1.5% + 1.1% with CGM-enhanced eConsult, and 1.6% + 1.8% in clinical pharmacy (p = 0.19). Time to an initial diabetes visit with a pharmacist was significantly shorter than with endocrinology, 20 days (IQR 26) for pharmacy vs. 45 days (IQR 54) for endocrinology, (p = 0.0001). ConclusionsCGM-enhanced eConsult resulted in more timely access to endocrinology expertise, was acceptable to patients, and resulted in similar short-term glycemic outcomes compared to in-person consultation. Effectiveness of CGM-enhanced eConsults should be further explored.

Dulaglutide Shows Sustained Reduction in Glycosylated Hemoglobin Values: 2-Year US Real-world Study Results

PurposeDue to the chronic and progressive nature of type 2 diabetes mellitus (T2DM), it is important to understand the long-term outcomes associated with antihyperglycemic medications. There are currently few long-term studies evaluating the real-world effectiveness of dulaglutide, a glucagon-like peptide-1 receptor agonist. The primary objective of this retrospective observational study was to evaluate glycemic control over a 24-month follow-up period among dulaglutide initiators with continuous treatment. The study used US claims data from the HealthCore Integrated Research Database between May 2014 and May 2019. MethodsPatients were included if they were ≥18 years old with T2DM and had ≥1 pharmacy claim for dulaglutide during the index period between November 2014 and May 2017 (with index date = set as the earliest dulaglutide fill during index period), continuous enrollment in the 6 months' preindex and 24 months' postindex, ≥1 claim for dulaglutide or ≥60 days’ supply in every quarter during the 24-month follow-up period, and ≥1 glycosylated hemoglobin (HbA1c) result at both baseline and 24 months. FindingsAt baseline, 872 patients (47.5% female) had a mean (SD) age of 54.5 (8.2) years and an HbA1c value of 8.68% (1.8%) (71.36 [19.7] mmol/mol). More than two thirds were being treated for dyslipidemia, hypertension, or cardiovascular disease. A significant HbA1c reduction was observed from baseline to 24 months (−1.3% [–14.2 mmol/mol]; P < 0.0001) for dulaglutide initiators with continuous treatment. A significant reduction in HbA1c level was also observed for all prespecified subgroups (age, index dulaglutide dose [0.75 mg or 1.5 mg], insulin use, sodium-glucose co-transporter 2 inhibitor use, and dipeptidyl peptidase-4 inhibitor use; all, P < 0.0001). Forty-three percent of patients achieved an HbA1c value < 7% (53 mmol/mol), and 73% achieved an HbA1c value < 8% (64 mmol/mol) at 24 months. Most (520 [59.6%]) patients were initiated on dulaglutide 0.75 mg. Of these patients, 70% increased to dulaglutide 1.5 mg during follow-up. The mean time to first dose change was 242 (196) days for 0.75 mg–1.5 mg and 225 (160) days for 1.5 mg–0.75 mg. Antihyperglycemic medication use preindex/postindex included: insulin, 28%/35%; dipeptidyl peptidase-4 inhibitors, 37%/20%; and sodium-glucose co-transporter 2 inhibitors, 29%/44%. ImplicationsIn this real-world study among dulaglutide initiators with continuous treatment, a clinically significant reduction in HbA1c value was seen at the 3-month assessment and persisted for up to 24 months. These data support the use of dulaglutide as an effective long-term treatment for T2DM in clinical practice.

S0301 Impact of Type 2 Diabetes Mellitus on Colorectal Adenoma-Carcinoma Progression: Which Metabolic Factors Play a Role?

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer. Retrospective studies have shown that T2DM is associated with an increased risk of colorectal adenoma (CRA), but there is no clear consensus on the effects of glycemic control and insulin resistance on the risk of CRA development in subjects with T2DM. In this prospective study, we investigated the effects of glycemic control, insulin resistance, and antihyperglycemic medication use on the incidence of CRA and advanced CRA in subjects with T2DM. METHODS: We measured fasting glucose, insulin, hemoglobin A1c, and C-peptide levels in subjects with T2DM undergoing routine screening colonoscopy. Homeostatic model assessment of insulin resistance (HOMA-IR) was subsequently calculated. Subjects were stratified based on glycemic control and insulin resistance, and medications were analyzed. We recorded size, location, and pathology for each adenoma detected. Advanced adenomas were defined as size >1 cm, presence of >3 adenomas, or presence of villous or tubulovillous features. RESULTS: In 61 subjects with T2DM, 27 were found to have at least one adenomatous polyp (7 with advanced adenoma), yielding an adenoma detection rate (ADR) of 44.26%. Subjects taking a DPP4-inhibitor had a significantly lower ADR compared to subjects not taking a DPP4-inhibitor (P = 0.03). There was no significant difference in ADR between subjects with high versus low A1c (P = 0.83), between subjects with high versus low HOMA-IR (P = 0.57), and between subjects taking and not taking metformin (P = 0.46). (table 1, Figure 1). CONCLUSION: To our knowledge, this is the first prospective study to investigate the association between glycemic control, insulin resistance, and antihyperglycemics with CRA in subjects with established T2DM. At our center, we demonstrated that subjects with T2DM have a higher ADR (44.26%) compared to the national benchmark ADR of ∼25%. DDP4-inhibitor use was noted to confer a significant decrease in CRA development, while metformin did not. Interestingly, glycemic control and insulin resistance, as measured by A1c and HOMA-IR respectively, did not have statistically significant associations with ADR. Rather, T2DM by itself appeared to be a predictor for CRA development, suggesting that the threshold for CRA risk may be lower than previously thought. We plan to expand our study population to include subjects with pre-diabetes, who may already be at increased risk and benefit from more stringent screening guidelines.Table 1Figure 1

Longitudinal Associations between Obesity, Inflammation, and the Incidence of Type 2 Diabetes Mellitus among US Black and White Adults in the CARDIA Study.

Aim Assess prospective relationships between obesity and inflammation on the incidence of type 2 diabetes mellitus (T2DM). Methods A cohort of nondiabetic respondents from the Coronary Artery Risk Development in Young Adults (CARDIA) study was followed from 2005-2006 (wave 7) to 2010-2011 (wave 8). Diabetes status was determined in wave 8 based on self-report, blood glucose level, and anti-hyperglycemic medication use in conjunction with a homeostatic model assessment-based classification for distinguishing diabetes subtype. We performed a series of multivariable logistic regression analyses to assess the relative influence of obesity (waist circumference) and individual inflammatory biomarkers (i.e., C-reactive protein, fibrinogen, and sex-specific serum uric acid and gamma-glutamyltransferase) on the odds of developing incident T2DM between waves 7 and 8. Results Among 2784 nondiabetic CARDIA respondents, 146 (5.2%) new cases of T2DM were identified between waves. Having a high waist circumference (AOR = 6.15; 95%CI = 4.14, 9.14) and being Black (vs. White) (AOR = 1.60; 95%CI = 1.05, 2.44) were associated with T2DM. Adjusting for inflammation biomarkers attenuated the effects of waist circumference and race with T2DM. Clinically elevated CRP (AOR = 1.83; 95%CI = 1.18, 2.82) and uric acid (AOR = 2.57; 95%CI = 1.70, 3.89) predicted T2DM among all respondents. However, stratification by race showed greater attenuation of the effects of waist circumference on T2DM in Whites than in Blacks when inflammation biomarkers were accounted for in the model. Conclusion Targeted control of systemic inflammation may reduce the risk of developing T2DM, especially among Blacks, and could help address Black-White disparities in diabetes care and outcomes.