Use Of Oral Antidiabetic Drugs Research Articles

Evaluation Of Metformin Use in Type 2 Diabetes Mellitus Patients X Clinic Sei Karang

Diabetes mellitus is a disease or chronic metabolic disorder characterized by high blood sugar levels accompanied by impaired metabolism of carbohydrates, lipids and proteins as a result of insulin function insufficiency, which can be caused by impaired insulin production by the Langerhans beta cells of the pancreatic gland or caused by a lack of insulin. responsiveness of body cells to insulin. Type 2 DM is often found in around 90% of diabetes sufferers and usually occurs from the age of over 40 years in obese people. Metformin is the most frequently prescribed therapy for patients with type 2 diabetes mellitus. In addition, Metformin has a very good safety profile and is also pharmacoeconomically beneficial. The research was carried out by tracing the patient's past data from medical records obtained from the medical records unit at the X Sei Karang Clinic in the patient's medical records for 2022. Based on gender, it shows that of the 40 patients using oral anti-diabetic drugs in type II DM patients based on gender in 2022, the majority of genders are women (28 people) and the rest are men (12 people). Based on age, it shows that there are more people aged 34-60 years with a percentage of 67.5% compared to those aged 61-77 years with a percentage of 32.5%. Therapeutic use of oral antidiabetic drugs in outpatient type II DM patients at the X Sei Karang Clinic for the period October-December 2022 is Metformin with a 30% result with or without combination therapy. The accuracy of using oral anti-diabetic drugs in outpatients with type II DM at the X Sei Karang Clinic in 2022, found that the accuracy of using anti-diabetic therapy drugs at the appropriate dose was 83.33%.

Knowledge and Attitude Towards Insulin Therapy in Type 2 Diabetes Mellitus Patients and Associated Factors at an Adult Endocrine Clinic of SPHMMC Addis Ababa Ethiopia

<i>Background:</i> Diabetes Mellitus (DM), a chronic disease characterized by elevated blood glucose levels, is associated with severe complications. Type 2 DM (T2DM), the most prevalent form of DM in adults, is characterized by varying degrees of insulin deficiency or resistance. The prevention or delay of macrovascular and microvascular problems associated with DM depends on achieving appropriate glycemic control. The percentage of T2DM patients failing to reach glycemic targets keeps rising even with the expanded availability of numerous anti-hyperglycemic drugs and evidence-based treatment guidelines. The delay in treatment intensification despite inadequate glucose control—often referred to as clinical or therapeutic inertia-contributes significantly to this trend.<i> Objective:</i> This study aims to evaluate the understanding and perceptions of insulin therapy among patients with T2DM. The study focuses on patients under follow-up care at the Adult Endocrine Clinic of St. Paul Hospital Millennium Medical College.<i> Method and Material:</i> An institutional-based, cross-sectional study was carried out from January to March 2021 to evaluate knowledge and attitudes regarding insulin therapy and related factors. A structured questionnaire was used for interviews with a representative sample of 271 T2DM patients who are receiving follow-up care at the endocrine clinic at SPHMMC. The SPSS, version 25, was the software utilized. The statistical significance of the relationship between the dependent and independent variables was assessed using a 95% confidence interval and a p-value less than 0.05.<i> Results:</i> The majority of the respondents were between the ages of 56 and 65, with a mean age of 57.35 years. More than half of the participants, accounting for 231 (85.2%) of the total, were from urban areas. Out of the 271 respondents, approximately 85.6% demonstrated poor knowledge of insulin therapy, and around 37.6% exhibited negative attitudes towards it. Factors such as age, occupation, and a history of long-term Oral Antidiabetic Drug use were found to be associated with the level of knowledge about insulin. In addition to these factors, marital status and a family history of insulin use were found to be associated with patients’ attitudes towards insulin. <i>Conclusions:</i> Our study identified a significant knowledge gap about insulin usage among T2DM patients in the designated study area. We recommend the implementation of regular, structured health education programs, delivered by trained health professionals. This approach is expected to enhance both the knowledge and attitudes toward insulin usage among patients attending follow-up sessions at the SPHMMC diabetic clinic.

De-indexed estimated glomerular filtration rates for the dosing of oral antidiabetic drugs in patients with chronic kidney disease.

Introduction: Adjusting drug dose levels based on equations that standardize the estimated glomerular filtration rate (eGFR) to a body surface area (BSA) of 1.73m2 can pose challenges, especially for patients with extremely high or low body mass index (BMI). The objective of the present study of patients with CKD and diabetes was to assess the impact of deindexing creatinine-based equations on estimates of kidney function and on the frequency of inappropriate prescriptions of oral antidiabetic drugs (OADs). Methods: The prospective CKD-REIN cohort is comprised of patients with eGFR <60mL/min/1.73m2. The inclusion criteria for this study were the use of OADs and the availability of data on weight, height and serum creatinine. We compared data for three BMI subgroups (group 1 <30kg/m2; group 2 30-34.9kg/m2; group 3 ≥35kg/m2). Inappropriate prescriptions (contraindicated or over-dosed drugs) were assessed with regard to the summary of product characteristics and the patient's kidney function estimated with the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the 2021 CKD-EPI equation, the Modification of Diet in Renal Disease (MDRD) equation, the European Kidney Function Consortium (EKFC) equation, their deindexed estimates, and the Cockcroft-Gault (CG) formula. The impact of deindexing the equations was evaluated by assessing 1) the difference between the indexed and deindexed eGFRs, and 2) the difference in the proportion of patients with at least one inappropriate OAD prescription between the indexed and deindexed estimates. Results: At baseline, 694 patients were receiving OADs. The median BMI was 30.7kg/m2, the mean BSA was 1.98m2, and 90% of patients had a BSA >1.73m2. Deindexing the kidney function estimates led to higher eGFRs, especially in BMI group 3. The proportion of patients with at least one inappropriate prescription differed greatly when comparing indexed and deindexed estimates. The magnitude of the difference increased with the BMI: when comparing BMI group 1 with BMI group 3, the difference was respectively -4% and -10% between deindexed 2021 CKD-EPI and indexed CKD-EPI. Metformin and sitagliptin were the most frequent inappropriately prescribed OADs. Conclusion: We highlight significant differences between the BSA-indexed and deindexed versions of equations used to estimate kidney function, emphasizing the importance of using deindexed estimates to adjust drug dose levels - especially in patients with an extreme BMI.

Risk factors for 5-year complications after midurethral sling surgery for stress urinary incontinence: a retrospective cohort study from Taiwan

Midurethral sling surgery is the current gold standard worldwide for stress urinary incontinence (SUI) surgery, with over 90% of surgeons worldwide using the midurethral sling for SUI between 2008 and 2018. However, concerns surround mesh-related adverse events associated with the midurethral sling. The decision to use the midurethral sling for surgical treatment has become a challenging one for clinicians, surgeons and patients. We sought to determine the factors for 5-year complications after midurethral sling surgery, to improve the clinical decision-making process. Records were reviewed from a total of 1961 female patients who underwent their first midurethral sling surgery for SUI between 2003 and 2018 at a single teaching hospital in Taiwan. A multivariable Cox proportional hazard model calculated the hazard ratios of risk factors for surgical complications, after adjusting for confounders. Surgical complications (i.e., secondary surgery and urinary retention) occurred in 93 (4.7%) patients within 5 years following the index operations. These patients were more likely to be older, to have a history of menopausal syndrome within 1 year prior to the index operation, a medication history of oral antidiabetic drug use, hormone replacement therapy (HRT), slower average flow rate, and longer voiding time compared with patients without surgical complications. In the multivariate analysis, HRT (adjusted hazard ratio, 1.787; 95% confidence interval, 1.011–3.158, p = 0.04) was significantly associated with surgical complications at 5 years, after adjusting for age, gender, diabetes, menopause syndrome, average flow rate, and sling type. Our findings suggest that a medication history of HRT may be a risk factor associated with surgical complications, especially urinary retention, at 5 years in women undergoing midurethral sling surgery for SUI.

The impact of the antidiabetic oral drugs cost on health expenditure in diabetic care in México

Introduction: There is an urgent need to evaluate the factors contributing to the increased health expenditures in patients with diabetes mellitus, especially the cost of drugs used to treat Type 2 diabetes mellitus (T2DM) in economically developing countries. Methods: We compared the cost of oral antidiabetic drugs using the prices of two large Mexican pharmaceutical retail corporations. The prescribed daily dose was utilized for each drug, and the total expenditure per year was calculated. In addition, the percentage expenditure on medications concerning the total annual expenditure on DM care was considered. Results: Mean annual cost per person/year for the use of oral antidiabetic drugs ranged between US$8.9 and US$1355. We found significant differences between the cost of generic and brand versions of the same drug. Conclusion: There is an increased expenditure on the treatment of T2DM. Further, the prescription patterns as newer ones are more expensive than the older drugs, hence the newer are still under patent.

The Use of Oral Antidiabetics in Heart Failure: A Promising Therapeutic Approach

This article examines the use of oral antidiabetic agents in the treatment of heart failure. Heart failure is a serious condition that is often associated with diabetes mellitus, which worsens the prognosis for patients. Oral antidiabetic agents, such as SGLT2 inhibitors and GLP-1 receptor agonists, have recently gained increasing interest due to their potential beneficial effects on cardiac function. Clinical studies have shown that these medications reduce cardiovascular morbidity and mortality, decrease hospitalizations for heart failure, and improve cardiac function in patients with heart failure, whether they are diabetic or not. The mechanisms of action of these medications include blood pressure reduction, improvement in endothelial function, modulation of cardiac energy metabolism, and reduction of oxidative stress and inflammation. While these findings are promising, further research is needed to better understand the long-term effectiveness and optimization of the use of these medications in the context of heart failure.

859-P: Study of Oral Antihyperglycemic Agents in the Hospital—A Multinational Perspective

Oral antidiabetic drugs (OAD) are commonly used in the hospital setting despite limited safety and efficacy data. To better understand the safety and efficacy of inpatient use of OAD, we pooled data from three healthcare systems in the US and Israel between from 2008-2018 (N=78,947). Treatment with OAD in the hospital was compared to Insulin (I) and OAD+Insulin (OAD+I). Patients on OAD were slightly older than those on I or OAD+I (67 vs 64 vs 65, respectively), more likely to admitted to surgical services (OAD: 33%; I: 21%, OAD+I: 23%, p&amp;lt;0.0001), and to have lower admission blood glucose (Blood glucose (BG): (161 vs 200 vs 192 mg/dl, p&amp;lt;0.0001). The average length of stay was 4-5 days for all groups. We performed propensity score matching by age, sex, Carlson Comorbidity Index, service (medicine or surgery), admission BG and creatinine to assess glycemic control and outcomes (Table). The primary outcome was good glycemic control with defined as mean hospital BG of 80-180 mg/dL and no hypoglycemia. Compared to I, patients treated with OAD were more likely to have good glycemic control [Odds Ratio (OR): 2.07 (95% CI: 1.85, 2.31)] and less hypoglycemia defined by BG &amp;lt;70mg/dL [OR: 0.63 (95% CI: 0.54, 0.74)]. No differences in rate of lactic acidosis were observed. In summary, patients treated with OAD had better in-hospital inpatient glycemic control, lower rates of hypoglycemia and no difference in lactic acidosis as compared to Insulin. Disclosure M.Fayfman: None. I.Hochberg: Other Relationship; Eli Lilly and Company, Novo Nordisk. M.F.Magee: None. A.A.Rashied: None. R.Jagannathan: None. G.Blanco: None. E.Moreno: None. F.J.Pasquel: Consultant; Dexcom, Inc., Medscape, Research Support; Dexcom, Inc., Ideal Medical Technologies. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

794-P: Effectiveness and Safety of iGlarLixi in People with Type 2 Diabetes (Pw2D), Not at Target on Basal Insulin (BI) and Oral Antidiabetic Therapy (BOT)—Results from the Observational, Prospective Study CHANCE

iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL and lixisenatide, is a once-daily treatment advancement option for Pw2D not at target on BOT. CHANCE investigated effectiveness and safety of switching the BI to iGlarLixi in daily clinical practice. Primary objective was to assess absolute change in HbA1c 24 weeks (W24) after switching to iGlarLixi. Secondary objectives included changes in fasting plasma glucose (FPG), bodyweight (BW), use of oral antidiabetic drugs (OADs), dose of previous BI, and hypoglycemia incidence. Overall, data from 70 Pw2D were analyzed. Mean BI dose was 38.9 units per day and individual target HbA1c was 6.9%. iGlarLixi was started with 30 dose steps per day (DS/d); at W24, mean dose was 41.6 DS/d. HbA1c decreased by -0.7% (P &amp;lt; 0.001), while FPG trended down by ~20 mg/dL. This was accompanied by a -3.0 kg decrease in BW (P = 0.442). Numbers of OADs used decreased markedly 24 weeks after switching to iGlarLixi (P &amp;lt; 0.05). Hypoglycemia incidence was low before and did not change significantly after switching to iGlarLixi. In conclusion, advancing BOT by switching the BI to iGlarLixi, improved glycemic control of Pw2D in daily clinical practice without BW gain and with low hypoglycemia incidence; however, titration was not sufficient to reach glycemic targets after 24 weeks. Disclosure T.Wiesner: Advisory Panel; Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Sanofi-Aventis Deutschland GmbH, Lilly Diabetes, Boehringer Ingelheim Inc., Abbott Diabetes, Novo Nordisk, Dexcom, Inc., Novartis. M.Pfohl: Advisory Panel; Boehringer Ingelheim and Eli Lilly Alliance, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Sanofi-Aventis Deutschland GmbH. K.Pegelow: Employee; Sanofi-Aventis Deutschland GmbH, Stock/Shareholder; Sanofi-Aventis Deutschland GmbH. J.Müller: Employee; Sanofi-Aventis Deutschland GmbH, Stock/Shareholder; Bayer Inc., Inmunebio Inc. J.Seufert: Advisory Panel; Abbott Diabetes, Boehringer Ingelheim Pharma GmbH&amp;Co.KG, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Abbott Diabetes, Bayer Inc., Boehringer Ingelheim Pharma GmbH&amp;Co.KG, Merck Sharp &amp; Dohme Corp., Sanofi-Aventis Deutschland GmbH, Novartis, Novo Nordisk. Funding Sanofi-Aventis Deutschland GmbH

Levels of insulin pathway proteins in persons with concomitant Alzheimer’s disease dementia and type 2 diabetes mellitus

AbstractBackgroundAlzheimer’s disease (AD) is a gradual and progressive neurodegenerative disease characterized by predominant cortical atrophy in the medial temporal lobe. Since the results of the Rotterdam study in 1992, it has been known that type 2 diabetes mellitus (T2DM) increases the risk of dementia. Persons with T2DM have structural brain changes and cognitive impairment, with a high risk of developing AD. These data suggest that insulin may play a key role in brain activity and memory formation. The objective of this study was to verify if there are alterations in the levels of proteins of the insulin pathway in cognitively healthy individuals, with AD, with T2DM and with the concomitant presence of AD and T2DM.MethodThe study was approved by the UFSCar’s ethics committee (CAAE: 31634720.9.0000.5504) and recruited participants aged 60 years or older. The AD diagnosis was obtained using the criteria of the National Institute Aging Alzheimer’s Association (NIA/AA). T2DM was defined as self‐reported use of oral antidiabetic drugs. Specific inclusion and exclusion criteria and cognitive assessment of the MMSE and CDR were applied to all participants. Plasma was collected by venepuncture and protein levels of ISNR, IRS1, Akt1, PI3KCD, MAPK1, MAPK8, PTP1B and IDE (Life‐Span Biosciences) were analysed using ELISA (Enzyme Enzyme‐Linked Immunosorbent Assay).ResultSeveral proteins of the insulin pathway were found to be significantly different among patients with AD, T2DM and AD+T2DM, compared with healthy controls (figure 1), reinforcing the strong correlation between T2DM and AD. Main alterations were found for INSR, IRS1, Akt1, PIK3, MAPK, PTP1b and IDE among healthy participants and those with AD+T2DM.ConclusionThe peripheral alterations found in the levels of insulin pathway proteins confirm the possible relationship between T2DM and AD and reinforce the importance of the insulin signalling pathways, as they can play a fundamental role in AD. The clinical impact of this study is related to a new approach that could be used in the treatment of this type of dementia, also observing the metabolic and inflammatory states of the patients, in addition to contributing to a better understanding of the biology of the disease itself.

Use of metformin and insulin among pregnant women with gestation diabetes in the United Kingdom: A population-based cohort study.

The contemporary prescription patterns of antidiabetic drugs following guideline changes recommending metformin as first-line gestational diabetes (GDM) pharmacotherapy is underexplored. We aimed to examined use of metformin and insulin during pregnancy among women with GDM over 20 years in the United Kingdom. We conducted a population-based cohort study using linked data from the Clinical Practice Research Datalink, its pregnancy register and Hospital Episode Statistics from 1998 to 2017. We included pregnancies of women without prior diabetes history who received GDM diagnosis or initiated an antidiabetic drug after 20 weeks gestation. Patient-level and practice-level characteristics were compared between metformin initiators and insulin initiators. We described trends of initiating metformin as first-line treatment and described time to initiation of rescue insulin overall, and by body mass index among metformin initiators. Our cohort included 5633 pregnancies from 5393 women with GDM, of whom 38.9% initiated pharmacotherapy (41% insulin, 59% metformin). Metformin prescriptions (as opposed to insulin) increased substantially, from <5% of pregnancies before 2007 to 42.5% in 2008. Over 85% of pregnancies that were prescribed pharmacotherapy were prescribed metformin as first-line treatment in 2015. Among metformin initiators, 16% initiated rescue insulin, typically occurring within 40 days of metformin initiation. Choice of GDM pharmacotherapy varied by characteristics, including smoking, obesity, race/ethnicity and general practice regions. Metformin was the most prescribed medication for GDM, with large increases over the past 2 decades. The increasing use of oral-antidiabetic drugs during pregnancy, consistent with other regions, highlights the need for future studies examining effectiveness and safety of antidiabetic drug use during pregnancy.

Kepatuhan Minum Obat Antidiabetika Oral Pasien Ulkus Diabetikum Rawat Jalan di Klinik X Kota Pontianak Menggunakan Metode Kuantitatif

Non-communicable diseases (PMT) have increased globally and nationally which have occupied the top ten causes of death with the most cases being diabetes mellitus. Diabetes Mellitus is a chronic disease that occurs due to impaired insulin action which causes blood sugar levels to increase. Uncontrolled sugar levels cause complications, one of which is diabetic ulcers. This study aims to analyze the level of adherence in taking medication in patients and the factors that influence adherence in taking medication in diabetic ulcer patients at Clinic Pontianak. The method used in this research is analytic observational method with the research design used is a cohort study. Compliance with drug use was measured using the Medication Possession Ratio (MPR) method. Data collection was carried out retrospectively based on manual and electronic data collection (medical records) and outpatient diabetic ulcer patient prescriptions at the Clinic Pontianak from January to December. Analysis of compliance relationship data using the chi square test. The results of this study showed that patients tended to be 45 years old (16.7%), female sex (87.5%), and monotherapy regimen (87.3%), this stated that there was no significant relationship between compliance with patient characteristics. Based on the results of the research, the percentage of compliance with the use of oral anti-diabetic drugs in outpatient diabetic ulcer patients at the Pontianak Clinic in 2021 is 26.1%.

Patients' Satisfaction, Diabetic Control and Associated Factors at a Tertiary Health Facility in Rivers State, Nigeria.

Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus (DM) is the fourth main contributor. The incidence of its complications could be reduced with high-quality care and good glycaemic control. Treatment satisfaction is an important aspect of quality of care, especially in treating chronic diseases like DM. This study sought to determine the satisfaction of diabetics with their care and to identify the relationship between patients' satisfaction and diabetic control alongside other associated factors. The study was a descriptive cross-sectional, hospital-based study. Respondents were admitted into the study based on inclusion criteria and selected using a systematic random sampling technique. Blood samples for fasting plasma glucose and total cholesterol were collected. Diabetic Treatment Satisfaction Questionnaire and the Patient Satisfaction Questionnaire were used to assess treatment satisfaction. The SPSS version 21.0 was used for data analysis and linear regression was used to determine the factors influencing satisfaction. The level of significance was set at 0.05. The mean total Diabetes Treatment Satisfaction score was 33.8 ± 8.2 and the mean total Short-Form Patient Satisfaction score was found to be 16.8 ± 3.6. There was a statistically significant difference between the mean satisfaction scores with treatment of diabetes mellitus and age groups (p < 0.001). There was also a statistically significant association between DM treatment satisfaction with the use of oral antidiabetic agents (p = 0.043) and the presence of complications (P < 0.001). There was a significant correlation between patient satisfaction scores and other factors like accessibility and convenience, time spent with doctors, and so on. In conclusion, the study identified the use of oral anti-diabetic agents, and the presence of complications, among others as factors affecting patient satisfaction. This study, therefore, suggests improving the practice of patient-centered medicine by increasing patient satisfaction through addressing these factors.

STUDY OF DOSAGE ADJUSTMENT OF ORAL ANTIDIABETIC DRUG IN TYPE II DIABETES MELLITUS PATIENTS WITH DISORDERS KIDNEY FUNCTION AT DR. SOEKARDJO TASIKMALAYA HOSPITAL

Diabetic nephropathy is one of the complications in DM that can end up becoming DM kidney failure. Nephropathy complications, if not handled properly, will lead to terminal chronic kidney disease. One of the factors that trigger complications of diabetic nephropathy in DM patients is the long-term use of oral anti-diabetic drugs. Therefore, proper dosage adjustment of these antidiabetic drugs, which are excreted through the kidneys, is required. The purpose of this study was to determine whether the dose received by type II DM patients with impaired renal function in the hospital was appropriate or not. This research will be carried out quantitatively and retrospectively by collecting patient medical record data at the hospital, and then the data obtained will be analyzed descriptively by calculating the creatinine clearance using the Cockcroft &amp; Gault formula and comparing it with the literature dose based on the value of creatinine clearance. The sampling technique used was purposive sampling using the inclusion and exclusion criteria determined by the researcher. The inclusion criteria are data on type II diabetes mellitus patients with impaired kidney function at dr. Soekardjo Tasikmalaya Hospital in October–December 2020 who were treated with oral anti-diabetic drugs. The exclusion criteria were type II DM patients with impaired renal function who were treated with insulin, type I DM patients, and type II DM patients with impaired renal function who were treated with oral antidiabetic with incomplete laboratory data. Based on research that has been conducted on 35 samples, as many as 25 people, or 71.43 percent of patients, received therapeutic doses that were not in accordance with their kidney conditions. Meanwhile, 10 people, or 28,57% of patients, received a therapeutic dose according to their kidney condition.

Diabetes Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-term Care Facilities: Data From the GeroCovid Vax Study.

Type 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTCFs) and tested for differences according to antidiabetic treatment. For this analysis, 555 older residents of LTCFs participating in the GeroCovid Vax study were included. SARS-CoV-2 trimeric S immunoglobulin G (anti-S IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2 and 6 months. The impact of diabetes on anti-S IgG levels was evaluated using linear mixed models, which included the interaction between time and presence of diabetes. A second model also considered diabetes treatment: no insulin therapy (including dietary only or use of oral antidiabetic agents) and insulin therapy (alone or in combination with oral antidiabetic agents). The mean age of the sample was 82.1 years, 68.1% were women, and 25.2% had diabetes. In linear mixed models, presence of diabetes was associated with lower anti-S IgG levels at 2 (β = -0.20; 95% CI -0.34, -0.06) and 6 months (β = -0.22; 95% CI -0.37, -0.07) after the first vaccine dose. Compared with those without diabetes, residents with diabetes not using insulin had lower IgG levels at 2- and 6-month assessments (β = -0.24; 95% CI -0.43, -0.05 and β = -0.30; 95% CI -0.50, -0.10, respectively), whereas no differences were observed for those using insulin. Older residents of LTCFs with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish humoral immunity similar to that in individuals without diabetes.

Disease heterogeneity of adult diabetes based on routine clinical variables at diagnosis: Results from the German/Austrian Diabetes Follow-up Registry.

To cluster adults with diabetes using variables from real-world clinical care at manifestation. We applied hierarchical clustering using Ward's method to 56 869 adults documented in the prospective Diabetes Follow-up Registry (DPV). Clustering variables included age, sex, body mass index (BMI), HbA1c, diabetic ketoacidosis (DKA), components of the metabolic syndrome (hypertension/dyslipidaemia/hyperuricaemia) and beta-cell antibody status. Time until use of oral antidiabetic drugs (OADs), use of insulin, chronic kidney disease (CKD), cardiovascular disease (CVD), retinopathy or neuropathy were assessed using Kaplan-Meier analysis and Cox regression models. We identified eight clusters: four clusters comprised early diabetes onset (median age 40-50 years) but differed with regard to BMI, HbA1c, DKA and antibody positivity. Two clusters included adults with diabetes onset aged in their early 60s who met target HbA1c, but differed in BMI and sex distribution. Two clusters were characterized by late diabetes onset (median age 69 and 77 years) and comparatively low BMI, but differences in HbA1c. Earlier insulin use was observed in adults with high HbA1c, and earlier OAD use was observed in those with high BMI. Time until CKD or CVD was shorter in those with late onset, whereas retinopathy occurred earlier in adults with late onset and high HbA1c, and in adults with early onset, but high HbA1c and high percentage of antibody positivity. Adult diabetes is heterogeneous beyond classical type 1/type 2 diabetes, based on easily available variables in clinical practice using an automated clustering algorithm that allows both continuous and binary variables.

Self-Management Knowledge among Patients with Type 2 Diabetes Mellitus in Hospital Taiping, Malaysia

Type 2 diabetes mellitus (T2DM) is characterised by hyperglycaemia resulting from insulin insufficiency, insulin resistance or both. Although different anti-diabetic agents are available to control blood glucose, patient self-management is essential for achieving good glycaemic control. Good knowledge of disease self-management is a pre-requisite to enable patients in making informed decisions in disease management. In this study, we aimed to determine the knowledge of self-management among patients with T2DM visiting outpatient pharmacy at Hospital Taiping. Adult patients with T2DM were invited to participate in a survey from December 2018 to February 2019. A pre-validated, selfadministered questionnaire was used to capture patients’ demographics, glucose level and diabetes self-management knowledge. A total of 148 patients responded to the survey. More than half of the patients (54.7%) in this study were found to have low knowledge scores (&lt; 70%). The level of education (p = 0.041), occupation (p = 0.024) and the use of insulin (p &lt; 0.001) were significantly associated with patients’ level of self-management knowledge whereas no significant relationships were found between knowledge score across age, gender, ethnicity, living status, use of oral anti-diabetic agents, attending diabetes education before and the duration of diabetes. A low but significant negative correlation was found between the score of self-management knowledge and fasting blood glucose (r = −0.264, p = 0.002). Despite the fact that nearly half of the respondents had good knowledge scores, the knowledge gaps remain to be filled s o t hat p atients are empowered to practise self-management in managing their T2DM.

Long Term Metabolic Effects of Sacubitril/Valsartan in Non-Diabetic and Diabetic Patients With Heart Failure Reduced Ejection Fraction: A Real Life Study.

Sacubitril/Valsartan (sac/val) has improved clinical prognosis in patients affected by heart failure (HF) with reduced ejection fraction (HFrEF). HF and type 2 diabetes mellitus (T2DM) frequently coexist, with a prevalence of T2DM of 35%–40% in patients with HF. T2DM is the third co-morbidities in patients with HF and a strong independent risk factor for the progression of HF. In a post hoc analysis of PARADIGM-HF, improved glycemic control was shown in patients with T2DM and HFrEF receiving sac/val compared to enalapril at 12 months of follow-up. The aim of the present study was to evaluate, in a series of repeated observations in 90 HFrEF patients, the long term effect of sac/val treatment on renal function, glycometabolic state and insulin sensitivity parameters, according to diabetic status. We studied 90 patients (74 men and 16 women, mean age 68 ± 10 years, 60 diabetics and 30 non-diabetics) suffering from HFrEF and still symptomatic despite optimal pharmacological therapy. Patients with left ventricular ejection fraction (LVEF) <35% and II-III NYHA functional class were enrolled. All patients underwent clinical-instrumental and laboratory determinations and Minnesota Living with HF Questionnaire (MLHFQ) every 6 months until 30 months to evaluate benefits and adverse events. After 30 months follow-up, we observed a significant improvement in glycometabolic parameters including HbA1c, fasting glucose and insulin, insulin-like growth factor-1 (IGF-1), HOMA index, and LDL cholesterol. Moreover, renal function, NTpro-BNP levels and echocardiographic parameters significantly improved. In diabetic patients a significant reduction in use of oral antidiabetic drugs and insulin was observed after 30 months of sac/val treatment. In the whole population, multivariate analysis shows that the evolution of cardiac index (CI) was significantly associated to simultaneous changes in HOMA, IGF-1 and visit; per each visit and for 1 ng/ml increase in IGF-1 there was an increase in CI of 64.77 ml/min/m2 (p < 0.0001) and 0.98 ml/min/m2 (p = 0.003), respectively, whereas 1 point increase in HOMA was associated with a −7.33 ml/min/m2 (p = 0.003) reduction in CI. The present data confirm persistent metabolic improvement in patients with HFrEF after treatment with sac/val and highlights its potential therapeutical role in patients with metabolic comorbidities.

Association of Dulaglutide Initiation Timing With Treatment Patterns and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus in the United States

PurposeTo describe clinical characteristics and treatment outcomes for early or late initiation of dulaglutide therapy in patients with type 2 diabetes. MethodsThis retrospective, claims-based analysis evaluated adults with type 2 diabetes, ≥1 claim for dulaglutide 0.75 mg or 1.5 mg once-weekly injection (between November 2014 and August 2019), and no prior use of glucagon-like peptide 1 receptor agonists or insulin. Cohorts were defined based on the number of oral antidiabetic drug (OAD) classes used within the 24-month baseline period before dulaglutide therapy initiation: 1 OAD, 2 OADs, or ≥3 OADs. The number of OAD classes used before dulaglutide therapy initiation served as a proxy for timing of initiation, with a higher number of OAD classes indicating a longer duration of T2D. Baseline demographic and clinical characteristics were compared across each cohort. Six-month follow-up outcomes, including change in glycosylated hemoglobin (HbA1c) and treatment patterns, were descriptively assessed within each cohort. FindingsThe study population consisted of 18,121 patients across the 1 OAD (n = 4822), 2 OADs (n = 6293), and ≥3 OADs (n = 7006) cohorts. Mean age at baseline was 54.7 years. Males were more prevalent in the ≥3 OADs cohort. Most patients (67%–70%) initiated treatment with dulaglutide 0.75 mg. Dose escalation to 1.5 mg was uncommon (15%–20%) but trended higher in the ≥3 OAD cohort. Adherence to dulaglutide at 6-month follow-up (61%–67%) increased with higher baseline OAD use. The HbA1c assessment (n = 3178) included 761 patients in the 1 OAD cohort, 1088 patients in the 2 OADs cohort, and 1329 patients in the ≥3 OADs cohort. Baseline mean [SD] HbA1c level increased with number of OAD classes (1 OAD: 8.18% [1.80]; 2 OADs: 8.56% [1.66]; and ≥3 OADs: 8.73% [1.51]). Patients in the early dulaglutide therapy initiator group experienced larger reductions in HbA1c levels (1 OAD: −1.39%; 95% CI, −1.50 to −1.27; 2 OADs: −1.30%; 95% CI, −1.39 to −1.20; and ≥3 OADs: −1.01%; 95% CI, −1.09 to −0.93) versus the patients in the delayed initiator group. Patients in the early dulaglutide therapy initiator group also achieved HbA1c <7% at 6-month follow-up more frequently than those in the later initiator group (1 OAD: 68%; 2 OADs: 51%; and ≥3 OADs: 33%). ImplicationsCohorts of dulaglutide therapy initiators, defined by prior OAD use as a proxy of timing of initiation, differed in their baseline characteristics and short-term follow-up outcomes. Earlier dulaglutide therapy initiation was associated with lower mean HbA1c levels and increased probability of achievement of HbA1c <7% during the 6-month follow-up period.

Diabetes Prevalence, Treatment, Control, and Outcomes Among Hemodialysis Patients in the Gulf Cooperation Council Countries

IntroductionDiabetes mellitus (DM) is a leading cause of end-stage kidney disease (ESKD). We provide the first description of DM prevalence, related outcomes, and the hemoglobin A1c (HbA1c)/mortality relationship in national hemodialysis (HD) patient samples across the Gulf Cooperation Council (GCC) countries.MethodsWe analyzed data from the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) in the GCC (2012–2018, N = 2274 HD patients ≥18 years old). Descriptive statistics were calculated, and all-cause mortality was analyzed for patients with DM versus without DM and by HbA1c levels in patients with DM by Cox regression with progressive confounder adjustments.ResultsDM in the GCC ranged from 45% to 74% in patients with HD by country. Patients with DM were 13 years older (59.9 vs. 46.7 years) and had greater body mass index (BMI), shorter median years on dialysis (1.5 vs. 3.0 years), and higher comorbidity burden. In patients with DM, insulin use was 26% to 50% across countries, with variable oral antidiabetic drug use (2%–32%); median HbA1c levels were 6.1% to 7.5% across countries. Patients with DM (vs. without DM) had higher crude death rates (15.6 vs. 6.2 deaths per 100 patient-years, mean follow-up 1.3 years) and adjusted mortality (hazard ratio [HR] = 1.72 [95% CI 1.23–2.39]). In patients with DM, mortality was lowest at HbA1c 6.5% to 7.5%, with mortality particularly elevated at high HbA1c >9% (HR = 2.13 [95% CI 1.10–4.10]).ConclusionPatients with DM in the GCC have high comorbidity burden and mortality rates despite a relatively young mean age. In GCC countries, a holistic strategy for improving diabetes care and outcomes for HD patients is needed at the primary, secondary, and tertiary levels.

Use of oral anti-diabetic drugs and risk of hospital and intensive care unit admissions for infections

BackgroundSepsis is one of the leading causes of hospital mortality, and diabetes is a risk factor for the development of infections. Although strong evidence has shown an association between metformin and reduced risk of infections, the risk of developing infections with newer classes of oral anti-diabetic drugs (OADs) has been less certain. Our study aims to examine the association between outpatient OAD use and hospital admissions for infections. MethodsThe study cohort included 1.39 million adults with diabetes utilizing the Veterans Health Affairs Corporate Data Warehouse. Multivariate logistic regression was used to estimate the effect of each drug class on hospital admission for infection while adjusting for covariates. ResultsAfter adjusting for covariates, those who took metformin during the study period had 3.3% lower odds of hospital admission for infection compared to those who were never on metformin (OR 0.97, 95% CI 0.95-0.98). OADs that were associated with a statistically significant increased odds of being admitted included meglitinides (OR 1.22, 95% CI 1.07-1.38), SGLT2 inhibitors (OR 1.16, 95% CI 1.08-1.24), alpha-glucosidase inhibitors (OR 1.09, 95% CI 1.04-1.15), and DPP4 inhibitors (OR 1.04, 95% CI 1.01-1.06). ConclusionsMetformin was associated with lower odds of hospital admission for infection while meglitinides, SGLT2 inhibitors, alpha-glucosidase inhibitors, and DPP4 inhibitors were associated with higher odds of admission for infection.