Nora Hennies, Sven W Görgens, Jonas Killer, Thorsten Otto, Lena M Richter, Dirk Müller-Wieland, Dennis Häckl
Aims: To identify the prevalence of cardiovascular disease (CVD) and obesity in patients with type 2 diabetes (T2D) in Germany and to evaluate if antidiabetic treatment patterns varied by comorbidity status.
Materials and methods: Patients with T2D (aged ≥18 years) were identified during the study period (2014-2020) from medical claims of 4.5 million publicly insured German residents and divided into different cohorts based on CVD and/or obesity diagnosis. Annual prevalence and incidence were estimated for each study year, while characteristics and treatments were assessed in 2020. Data were extrapolated to the German population by age and sex.
Results: The prevalence of T2D in 2020 was 11.4%. Among patients with T2D, 53.0% had CVD, 39.3% had obesity, and 20.9% had CVD and obesity. Since 2014, CVD increased by 1.4%, obesity by 4.5%, and CVD with obesity by 2.7% in patients with T2D. The incidence of T2D in 2020 was 1.0% (42.9% had CVD, 37.9% had obesity, and 15.8% had CVD and obesity). Among the prevalent T2D population in 2020, 4.9% received glucagon-like peptide-1 receptor agonists (GLP-1RAs), 9.7% received sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 13.0% received GLP-1 RAs and/or SGLT2 inhibitors. Of those with CVD, 12.9% received GLP-1 RAs and/or SGLT2 inhibitors (without CVD, 13.2%). Of those with obesity, 19.4% received GLP-1RAs and/or SGLT2 inhibitors (without obesity, 9.0%).
Conclusions: In this retrospective claims database study, more than two thirds of patients with T2D also had CVD, obesity, or both CVD and obesity. GLP-1 RA and SGLT2 inhibitor use remained low.
{"title":"Prevalence of obesity and cardiovascular disease in adults with type 2 diabetes and use of diabetes medication in Germany: A claims data study.","authors":"Nora Hennies, Sven W Görgens, Jonas Killer, Thorsten Otto, Lena M Richter, Dirk Müller-Wieland, Dennis Häckl","doi":"10.1111/dom.15931","DOIUrl":"https://doi.org/10.1111/dom.15931","url":null,"abstract":"<p><strong>Aims: </strong>To identify the prevalence of cardiovascular disease (CVD) and obesity in patients with type 2 diabetes (T2D) in Germany and to evaluate if antidiabetic treatment patterns varied by comorbidity status.</p><p><strong>Materials and methods: </strong>Patients with T2D (aged ≥18 years) were identified during the study period (2014-2020) from medical claims of 4.5 million publicly insured German residents and divided into different cohorts based on CVD and/or obesity diagnosis. Annual prevalence and incidence were estimated for each study year, while characteristics and treatments were assessed in 2020. Data were extrapolated to the German population by age and sex.</p><p><strong>Results: </strong>The prevalence of T2D in 2020 was 11.4%. Among patients with T2D, 53.0% had CVD, 39.3% had obesity, and 20.9% had CVD and obesity. Since 2014, CVD increased by 1.4%, obesity by 4.5%, and CVD with obesity by 2.7% in patients with T2D. The incidence of T2D in 2020 was 1.0% (42.9% had CVD, 37.9% had obesity, and 15.8% had CVD and obesity). Among the prevalent T2D population in 2020, 4.9% received glucagon-like peptide-1 receptor agonists (GLP-1RAs), 9.7% received sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 13.0% received GLP-1 RAs and/or SGLT2 inhibitors. Of those with CVD, 12.9% received GLP-1 RAs and/or SGLT2 inhibitors (without CVD, 13.2%). Of those with obesity, 19.4% received GLP-1RAs and/or SGLT2 inhibitors (without obesity, 9.0%).</p><p><strong>Conclusions: </strong>In this retrospective claims database study, more than two thirds of patients with T2D also had CVD, obesity, or both CVD and obesity. GLP-1 RA and SGLT2 inhibitor use remained low.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The development of automated insulin delivery (AID) systems, which connect continuous glucose monitoring (CGM) systems with algorithmic insulin delivery from an insulin pump (continuous subcutaneous insulin infusion, [CSII]), has led to improved glycaemia and quality of life benefits in those with insulin-treated diabetes. This review summarizes the benefits gained by the connectivity between insulin pumps and CGM devices. It details the technical requirements and advances that have enabled this, and highlights the clinical and user benefits of such systems. Clinical trials and real-world outcomes from the use of AID systems in people with type 1 diabetes (T1D) will be the focus of this article; outcomes in people with type 2 diabetes (T2D) and other diabetes subtypes will also be discussed. We also detail the limitations of current technological approaches for connectivity between insulin pumps and CGM devices. While recognizing the barriers, we discuss opportunities for the future.
胰岛素自动给药系统(AID)将连续血糖监测(CGM)系统与胰岛素泵(连续皮下胰岛素输注)的胰岛素给药算法连接起来,从而改善了胰岛素治疗糖尿病患者的血糖水平,提高了他们的生活质量。本综述总结了胰岛素泵和 CGM 设备之间的连接所带来的益处。它详细介绍了实现连接的技术要求和进步,并强调了此类系统的临床和用户益处。本文将重点介绍在 1 型糖尿病(T1D)患者中使用 AID 系统的临床试验和实际效果;同时还将讨论在 2 型糖尿病(T2D)和其他糖尿病亚型患者中使用 AID 系统的效果。我们还将详细介绍当前连接胰岛素泵和 CGM 设备的技术方法的局限性。在认识到这些障碍的同时,我们还讨论了未来的机遇。
{"title":"Automating insulin delivery through pump and continuous glucose monitoring connectivity: Maximizing opportunities to improve outcomes.","authors":"Ananthi Anandhakrishnan, Sufyan Hussain","doi":"10.1111/dom.15920","DOIUrl":"https://doi.org/10.1111/dom.15920","url":null,"abstract":"<p><p>The development of automated insulin delivery (AID) systems, which connect continuous glucose monitoring (CGM) systems with algorithmic insulin delivery from an insulin pump (continuous subcutaneous insulin infusion, [CSII]), has led to improved glycaemia and quality of life benefits in those with insulin-treated diabetes. This review summarizes the benefits gained by the connectivity between insulin pumps and CGM devices. It details the technical requirements and advances that have enabled this, and highlights the clinical and user benefits of such systems. Clinical trials and real-world outcomes from the use of AID systems in people with type 1 diabetes (T1D) will be the focus of this article; outcomes in people with type 2 diabetes (T2D) and other diabetes subtypes will also be discussed. We also detail the limitations of current technological approaches for connectivity between insulin pumps and CGM devices. While recognizing the barriers, we discuss opportunities for the future.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik Stenberg, Yang Cao, Johan Ottosson, Suzanne Hedberg, Erik Näslund
Aim: To compare weight and glucometabolic outcomes of semaglutide and metabolic and bariatric surgery (MBS) for patients with type 2 diabetes and obesity.
Materials and methods: Patients treated with either semaglutide for a duration of ≥2 years or MBS in Sweden were identified within the Scandinavian Obesity Surgery Registry and the National Diabetes Registry and matched in a 1:1-2 ratio using a propensity score matching with a generalized linear model, including age, sex, glycated haemoglobin before treatment, duration of type 2 diabetes, use of insulin, presence of comorbidities and history of cancer, with good matching results but with a remaining imbalance for glomerular filtration rate and body mass index, which were then adjusted for in the following analyses. Main outcomes were weight loss and glycaemic control.
Results: The study included 606 patients in the surgical group matched to 997 controls who started their treatment from 2018 until 2020. Both groups improved in weight and glucometabolic control. At 2 years after the intervention, mean glycated haemoglobin was 42.3 ± 11.18 after MBS compared with 50.7 ± 12.48 after semaglutide treatment (p < 0.001) with 382 patients (63.0%) and 139 (13.9%), respectively, reaching complete remission without other treatment than the intervention (p < 0.001). Mean total weight loss reached 26.4% ± 8.83% after MBS compared with 5.2% ± 7.87% after semaglutide (p < 0.001).
Conclusion: Semaglutide and MBS were both associated with improvements in weight and improved glycaemic control at 2 years after the start of the intervention, but MBS was associated with better weight loss and glucometabolic control.
{"title":"Glycaemic and weight effects of metabolic surgery or semaglutide in diabetes dosage for patients with type 2 diabetes.","authors":"Erik Stenberg, Yang Cao, Johan Ottosson, Suzanne Hedberg, Erik Näslund","doi":"10.1111/dom.15952","DOIUrl":"https://doi.org/10.1111/dom.15952","url":null,"abstract":"<p><strong>Aim: </strong>To compare weight and glucometabolic outcomes of semaglutide and metabolic and bariatric surgery (MBS) for patients with type 2 diabetes and obesity.</p><p><strong>Materials and methods: </strong>Patients treated with either semaglutide for a duration of ≥2 years or MBS in Sweden were identified within the Scandinavian Obesity Surgery Registry and the National Diabetes Registry and matched in a 1:1-2 ratio using a propensity score matching with a generalized linear model, including age, sex, glycated haemoglobin before treatment, duration of type 2 diabetes, use of insulin, presence of comorbidities and history of cancer, with good matching results but with a remaining imbalance for glomerular filtration rate and body mass index, which were then adjusted for in the following analyses. Main outcomes were weight loss and glycaemic control.</p><p><strong>Results: </strong>The study included 606 patients in the surgical group matched to 997 controls who started their treatment from 2018 until 2020. Both groups improved in weight and glucometabolic control. At 2 years after the intervention, mean glycated haemoglobin was 42.3 ± 11.18 after MBS compared with 50.7 ± 12.48 after semaglutide treatment (p < 0.001) with 382 patients (63.0%) and 139 (13.9%), respectively, reaching complete remission without other treatment than the intervention (p < 0.001). Mean total weight loss reached 26.4% ± 8.83% after MBS compared with 5.2% ± 7.87% after semaglutide (p < 0.001).</p><p><strong>Conclusion: </strong>Semaglutide and MBS were both associated with improvements in weight and improved glycaemic control at 2 years after the start of the intervention, but MBS was associated with better weight loss and glucometabolic control.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: To investigate the relationship between the weight-adjusted-waist index (WWI) and all-cause mortality as well as cardiovascular mortality in individuals with type 2 diabetes.
Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and the UK Biobank database. Restricted cubic spline curves and Cox proportional hazards models were employed to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality.
Results: In the UK Biobank database, compared with the lowest WWI quartile, the HR for all-cause and cardiovascular death in the highest quartile was 1.846 (95% CI 1.687-2.019) and 2.118 (95% CI 1.783-2.517), respectively, in the fully adjusted model. In the NHANES database, compared with the lowest WWI quartile, the highest quartile had an HR of 1.727 (95% CI 1.378-2.163) for all-cause death and 1.719 (95% CI 1.139-2.595) for cardiovascular death in the fully adjusted model.
Conclusions: Our study indicates that WWI has a long-term synergistic negative impact on all-cause mortality and cardiovascular mortality in individuals with type 2 diabetes. The WWI is an independent predictor of mortality in individuals with type 2 diabetes.
目的:研究2型糖尿病患者的体重调整腰围指数(WWI)与全因死亡率以及心血管死亡率之间的关系:我们使用的数据来自 1999 年至 2018 年的美国国家健康与营养调查(NHANES)和英国生物库数据库。采用限制性三次样条曲线和Cox比例危险模型评估全因死亡率的危险比(HRs)和95%置信区间(CIs):在英国生物库数据库中,与一战最低四分位数相比,在完全调整模型中,最高四分位数的全因死亡和心血管死亡的危险比分别为 1.846(95% CI 1.687-2.019)和 2.118(95% CI 1.783-2.517)。在NHANES数据库中,与WWI最低四分位数相比,在完全调整模型中,最高四分位数的全因死亡HR为1.727(95% CI 1.378-2.163),心血管死亡HR为1.719(95% CI 1.139-2.595):我们的研究表明,WWI 对 2 型糖尿病患者的全因死亡率和心血管死亡率具有长期协同负面影响。WWI是预测2型糖尿病患者死亡率的一个独立指标。
{"title":"Relationship between weight-adjusted-waist index and all-cause and cardiovascular mortality in individuals with type 2 diabetes.","authors":"Tian-Yu Zhang, Zi-Meng Zhang, Xue-Ning Wang, Hong-Yu Kuang, Qian Xu, Hong-Xue Li, Cheng-Ye Xu, Kang-Qi Zhao, Cong Zhang, Ming Hao","doi":"10.1111/dom.15929","DOIUrl":"https://doi.org/10.1111/dom.15929","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the relationship between the weight-adjusted-waist index (WWI) and all-cause mortality as well as cardiovascular mortality in individuals with type 2 diabetes.</p><p><strong>Methods: </strong>We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and the UK Biobank database. Restricted cubic spline curves and Cox proportional hazards models were employed to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality.</p><p><strong>Results: </strong>In the UK Biobank database, compared with the lowest WWI quartile, the HR for all-cause and cardiovascular death in the highest quartile was 1.846 (95% CI 1.687-2.019) and 2.118 (95% CI 1.783-2.517), respectively, in the fully adjusted model. In the NHANES database, compared with the lowest WWI quartile, the highest quartile had an HR of 1.727 (95% CI 1.378-2.163) for all-cause death and 1.719 (95% CI 1.139-2.595) for cardiovascular death in the fully adjusted model.</p><p><strong>Conclusions: </strong>Our study indicates that WWI has a long-term synergistic negative impact on all-cause mortality and cardiovascular mortality in individuals with type 2 diabetes. The WWI is an independent predictor of mortality in individuals with type 2 diabetes.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Susanna Wiegand, Marianne Becker, Stefanie Schmid, Daniel Weghuber, Susann Weihrauch-Blüher, Thomas Reinehr, Rudolf Oeverink, Thomas Michael Kapellen, Christian Denzer, Martin Tauschmann, Antje Körner, Reinhard W Holl, Nicole Prinz
{"title":"Trends in pharmacological management of paediatric patients with type 2 diabetes from 2000 to 2023 in German-speaking countries: Analysis based on the Diabetes Prospective Follow-up Registry.","authors":"Susanna Wiegand, Marianne Becker, Stefanie Schmid, Daniel Weghuber, Susann Weihrauch-Blüher, Thomas Reinehr, Rudolf Oeverink, Thomas Michael Kapellen, Christian Denzer, Martin Tauschmann, Antje Körner, Reinhard W Holl, Nicole Prinz","doi":"10.1111/dom.15930","DOIUrl":"https://doi.org/10.1111/dom.15930","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: To determine if estimated glucose disposal rate (eGDR) can predict cardiovascular disease mortality risk at different levels of glycaemic tolerance.
Materials and methods: The eGDR levels of 11 656 individuals aged 45-79 years from the National Health and Nutrition Examination Survey cycles 1999 to 2010 were analysed. Associations between eGDR levels and all-cause and cardiovascular mortality were examined using Cox proportional hazards and Fine and Gray models, respectively.
Results: After a median follow-up of 12.8 years, a total of 2852 participants died, with 777 of those deaths attributed to cardiovascular causes. When comparing participants with eGDR values of ≤4 mg/kg/min to those with eGDR values falling within the ranges of 4-6, 6-8 and >8 mg/kg/min, it was found that the latter groups exhibited lower hazard ratios for both all-cause mortality (0.61 [0.52-0.72], 0.61 [0.52-0.72] and 0.46 [0.39-0.55]) and cardiovascular mortality (0.44 [0.33-0.57], 0.45 [0.34-0.59] and 0.30 [0.23-0.40]). A U-shaped relationship between eGDR and all-cause mortality was observed, with an inflection point at an eGDR of 9.54 mg/kg/min.
Conclusions: In the general population, the association between reduced eGDR and all-cause and cardiovascular mortality was independently significant, contributing to the identification of individuals at high risk for different levels of glucose tolerances.
{"title":"Association between estimated glucose disposal rate and cardiovascular mortality across the spectrum of glucose tolerance in the US population.","authors":"Rubing Guo, Jingjing Tong, Yongtong Cao, Wei Zhao","doi":"10.1111/dom.15954","DOIUrl":"https://doi.org/10.1111/dom.15954","url":null,"abstract":"<p><strong>Aims: </strong>To determine if estimated glucose disposal rate (eGDR) can predict cardiovascular disease mortality risk at different levels of glycaemic tolerance.</p><p><strong>Materials and methods: </strong>The eGDR levels of 11 656 individuals aged 45-79 years from the National Health and Nutrition Examination Survey cycles 1999 to 2010 were analysed. Associations between eGDR levels and all-cause and cardiovascular mortality were examined using Cox proportional hazards and Fine and Gray models, respectively.</p><p><strong>Results: </strong>After a median follow-up of 12.8 years, a total of 2852 participants died, with 777 of those deaths attributed to cardiovascular causes. When comparing participants with eGDR values of ≤4 mg/kg/min to those with eGDR values falling within the ranges of 4-6, 6-8 and >8 mg/kg/min, it was found that the latter groups exhibited lower hazard ratios for both all-cause mortality (0.61 [0.52-0.72], 0.61 [0.52-0.72] and 0.46 [0.39-0.55]) and cardiovascular mortality (0.44 [0.33-0.57], 0.45 [0.34-0.59] and 0.30 [0.23-0.40]). A U-shaped relationship between eGDR and all-cause mortality was observed, with an inflection point at an eGDR of 9.54 mg/kg/min.</p><p><strong>Conclusions: </strong>In the general population, the association between reduced eGDR and all-cause and cardiovascular mortality was independently significant, contributing to the identification of individuals at high risk for different levels of glucose tolerances.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cléo Nicolier, Juri Künzler, Aritz Lizoain, Daniel Kerber, Stefanie Hossmann, Martina Rothenbühler, Markus Laimer, Lilian Witthauer
Aim: To evaluate the relationship between breath volatile organic compounds (VOCs) and glycaemic states in individuals with type 1 diabetes (T1D), focusing on identifying specific VOCs as biomarkers for hypoglycaemia to offer a non-invasive diabetes-monitoring method.
Materials and methods: Ten individuals with T1D underwent induced hypoglycaemia in a clinical setting. Breath samples, collected every 10-15 minutes, were analysed using gas chromatography-ion mobility spectrometry (GC-IMS). Correlation analysis and machine learning models, including Partial Least Squares Discriminant Analysis (PLS-DA) and Support Vector Machine classifiers, were used to classify glycaemic states based on VOC profiles.
Results: Statistical analysis revealed moderate correlations between specific VOCs (e.g. isoprene, acetone) and venous blood glucose levels. Machine learning models showed high accuracy in classifying glycaemic states, with the best performance achieved by a two-class PLS-DA model showing an accuracy of 93%, sensitivity of 92% and specificity of 94%. Key biomarkers identified included isoprene, acetone, 2-butanone, methanol, ethanol, 2-propanol and 2-pentanone.
Conclusions: This study shows the potential of breath VOCs to accurately classify glycaemic states in individuals with T1D. While key biomarkers such as isoprene, acetone and 2-butanone were identified, the analysis emphasizes the importance of using overall VOC patterns rather than individual compounds, which can be markers for multiple conditions. Machine learning models leveraging these patterns achieved high accuracy, sensitivity and specificity. These findings suggest that breath analysis using GC-IMS could be a viable non-invasive method for monitoring glycaemic states and managing diabetes.
{"title":"Detection of hypoglycaemia in type 1 diabetes through breath volatile organic compound profiling using gas chromatography-ion mobility spectrometry.","authors":"Cléo Nicolier, Juri Künzler, Aritz Lizoain, Daniel Kerber, Stefanie Hossmann, Martina Rothenbühler, Markus Laimer, Lilian Witthauer","doi":"10.1111/dom.15944","DOIUrl":"https://doi.org/10.1111/dom.15944","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the relationship between breath volatile organic compounds (VOCs) and glycaemic states in individuals with type 1 diabetes (T1D), focusing on identifying specific VOCs as biomarkers for hypoglycaemia to offer a non-invasive diabetes-monitoring method.</p><p><strong>Materials and methods: </strong>Ten individuals with T1D underwent induced hypoglycaemia in a clinical setting. Breath samples, collected every 10-15 minutes, were analysed using gas chromatography-ion mobility spectrometry (GC-IMS). Correlation analysis and machine learning models, including Partial Least Squares Discriminant Analysis (PLS-DA) and Support Vector Machine classifiers, were used to classify glycaemic states based on VOC profiles.</p><p><strong>Results: </strong>Statistical analysis revealed moderate correlations between specific VOCs (e.g. isoprene, acetone) and venous blood glucose levels. Machine learning models showed high accuracy in classifying glycaemic states, with the best performance achieved by a two-class PLS-DA model showing an accuracy of 93%, sensitivity of 92% and specificity of 94%. Key biomarkers identified included isoprene, acetone, 2-butanone, methanol, ethanol, 2-propanol and 2-pentanone.</p><p><strong>Conclusions: </strong>This study shows the potential of breath VOCs to accurately classify glycaemic states in individuals with T1D. While key biomarkers such as isoprene, acetone and 2-butanone were identified, the analysis emphasizes the importance of using overall VOC patterns rather than individual compounds, which can be markers for multiple conditions. Machine learning models leveraging these patterns achieved high accuracy, sensitivity and specificity. These findings suggest that breath analysis using GC-IMS could be a viable non-invasive method for monitoring glycaemic states and managing diabetes.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linong Ji, Yibing Lu, Zewei Shen, Ping Hu, Wenyan Liu, Qiu Zhang, Bimin Shi
Aims: To investigate the impact of baseline characteristics on the efficacy of once-weekly subcutaneous semaglutide 0.5 and 1.0 mg in participants with type 2 diabetes (T2D) from the SUSTAIN China trial.
Methods: In this post hoc analysis, data for semaglutide 0.5 and 1.0 mg versus sitagliptin 100 mg were analysed in the total (n = 868) and Chinese-only (n = 605) populations. Changes from baseline to end of treatment (EOT) in glycated haemoglobin (HbA1c) and body weight were analysed by baseline age, sex, body mass index, HbA1c, diabetes duration, and homeostatic model assessment of β-cell function (HOMA-β) tertile. Proportions of participants achieving HbA1c <7.0% (53 mmol/mol) by baseline HbA1c, change from baseline to EOT in standard deviation of seven-point self-monitored plasma glucose (SMPG), derived time-in-range (dTIR) of seven-point SMPG at Week 30, and HOMA-β ratio to baseline at Week 30 were assessed for both populations.
Results: In both populations the efficacy of once-weekly subcutaneous semaglutide 0.5 and 1.0 mg versus sitagliptin was not significantly affected by most of the baseline characteristics studied. The proportion of participants achieving the target HbA1c <7% was not affected by baseline HbA1c (pinteraction > 0.05). SMPG fluctuation and dTIR indicated less glucose variability in participants treated with semaglutide 0.5 and 1.0 mg versus sitagliptin, and the HOMA-β ratios to baseline at EOT were greater with semaglutide 0.5 and 1.0 mg versus sitagliptin (p < 0.05).
Conclusions: These results support the effectiveness of once-weekly subcutaneous semaglutide 0.5 and 1.0 mg across a broad range of baseline characteristics, in participants with T2D from SUSTAIN China.
{"title":"Impact of baseline characteristics on the efficacy of once-weekly subcutaneous semaglutide among participants with type 2 diabetes: A post hoc analysis of SUSTAIN China.","authors":"Linong Ji, Yibing Lu, Zewei Shen, Ping Hu, Wenyan Liu, Qiu Zhang, Bimin Shi","doi":"10.1111/dom.15888","DOIUrl":"https://doi.org/10.1111/dom.15888","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the impact of baseline characteristics on the efficacy of once-weekly subcutaneous semaglutide 0.5 and 1.0 mg in participants with type 2 diabetes (T2D) from the SUSTAIN China trial.</p><p><strong>Methods: </strong>In this post hoc analysis, data for semaglutide 0.5 and 1.0 mg versus sitagliptin 100 mg were analysed in the total (n = 868) and Chinese-only (n = 605) populations. Changes from baseline to end of treatment (EOT) in glycated haemoglobin (HbA1c) and body weight were analysed by baseline age, sex, body mass index, HbA1c, diabetes duration, and homeostatic model assessment of β-cell function (HOMA-β) tertile. Proportions of participants achieving HbA1c <7.0% (53 mmol/mol) by baseline HbA1c, change from baseline to EOT in standard deviation of seven-point self-monitored plasma glucose (SMPG), derived time-in-range (dTIR) of seven-point SMPG at Week 30, and HOMA-β ratio to baseline at Week 30 were assessed for both populations.</p><p><strong>Results: </strong>In both populations the efficacy of once-weekly subcutaneous semaglutide 0.5 and 1.0 mg versus sitagliptin was not significantly affected by most of the baseline characteristics studied. The proportion of participants achieving the target HbA1c <7% was not affected by baseline HbA1c (p<sub>interaction</sub> > 0.05). SMPG fluctuation and dTIR indicated less glucose variability in participants treated with semaglutide 0.5 and 1.0 mg versus sitagliptin, and the HOMA-β ratios to baseline at EOT were greater with semaglutide 0.5 and 1.0 mg versus sitagliptin (p < 0.05).</p><p><strong>Conclusions: </strong>These results support the effectiveness of once-weekly subcutaneous semaglutide 0.5 and 1.0 mg across a broad range of baseline characteristics, in participants with T2D from SUSTAIN China.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anton Pottegård, Jacob H Andersen, Jens Søndergaard, Lotte Rasmussen, Helene Kildegaard, Tina Vilsbøll, Reimar W Thomsen
Aim: To analyse patterns of glucose-lowering therapies among people with type 2 diabetes (T2D) in Denmark from 2016 to 2023.
Materials and methods: We examined time trends in the clinical profiles of people with T2D who initiated different glucose-lowering therapy classes for the first time. We furthermore investigated individual-level treatment trajectories following first-ever glucose-lowering therapy in people with or without cardiorenal disease. The study utilized data from the nationwide Danish health registries and included all individuals who filled a first-ever prescription for metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose co-transporter-2 inhibitors (SGLT-2is) or insulin, excluding those without HbA1c-confirmed T2D or probable type 1 diabetes.
Results: We included 260 393 individuals initiating a new glucose-lowering therapy class from 2016 to 2023, during which there were 6- and 3-fold increases in initiators of GLP-1RAs and SGLT-2is, respectively. The median HbA1c level at treatment initiation with GLP-1RAs or SGLT-2is decreased, from 67-68 mmol/mol in 2016-2017 to 57-58 mmol/mol in 2022-2023. Among individuals who initiated metformin as first-line therapy, the proportion who started additional glucose-lowering therapy within 2 years increased from 25% in 2016 to 40% in 2021. Among the 38% of individuals who had established cardiorenal disease when they initiated first-ever glucose-lowering therapy in 2020, 22% used SGLT-2is and 18% GLP-1RAs after 2.5 years, compared with 17% and 21% among initiators without cardiorenal disease, respectively.
Conclusions: Our study documents a trend towards earlier T2D treatment intensification and an increase in the use of GLP-1RAs and SGLT-2is in Denmark. However, optimal T2D treatment is still not received by most individuals with early T2D and established cardiorenal disease.
{"title":"Treatment trajectories for Danish individuals with type 2 diabetes in the era of emerging glucose-lowering therapies.","authors":"Anton Pottegård, Jacob H Andersen, Jens Søndergaard, Lotte Rasmussen, Helene Kildegaard, Tina Vilsbøll, Reimar W Thomsen","doi":"10.1111/dom.15912","DOIUrl":"https://doi.org/10.1111/dom.15912","url":null,"abstract":"<p><strong>Aim: </strong>To analyse patterns of glucose-lowering therapies among people with type 2 diabetes (T2D) in Denmark from 2016 to 2023.</p><p><strong>Materials and methods: </strong>We examined time trends in the clinical profiles of people with T2D who initiated different glucose-lowering therapy classes for the first time. We furthermore investigated individual-level treatment trajectories following first-ever glucose-lowering therapy in people with or without cardiorenal disease. The study utilized data from the nationwide Danish health registries and included all individuals who filled a first-ever prescription for metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose co-transporter-2 inhibitors (SGLT-2is) or insulin, excluding those without HbA1c-confirmed T2D or probable type 1 diabetes.</p><p><strong>Results: </strong>We included 260 393 individuals initiating a new glucose-lowering therapy class from 2016 to 2023, during which there were 6- and 3-fold increases in initiators of GLP-1RAs and SGLT-2is, respectively. The median HbA1c level at treatment initiation with GLP-1RAs or SGLT-2is decreased, from 67-68 mmol/mol in 2016-2017 to 57-58 mmol/mol in 2022-2023. Among individuals who initiated metformin as first-line therapy, the proportion who started additional glucose-lowering therapy within 2 years increased from 25% in 2016 to 40% in 2021. Among the 38% of individuals who had established cardiorenal disease when they initiated first-ever glucose-lowering therapy in 2020, 22% used SGLT-2is and 18% GLP-1RAs after 2.5 years, compared with 17% and 21% among initiators without cardiorenal disease, respectively.</p><p><strong>Conclusions: </strong>Our study documents a trend towards earlier T2D treatment intensification and an increase in the use of GLP-1RAs and SGLT-2is in Denmark. However, optimal T2D treatment is still not received by most individuals with early T2D and established cardiorenal disease.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hertzel C Gerstein, Mu Yang, Shun Fu Lee, Kelley R H Branch, Stefano Del Prato, Carolyn S P Lam, Renato D Lopes, Richard Pratley, Julio Rosenstock, Naveed Sattar
{"title":"Do nonglycaemic effects such as weight loss account for HbA1c lowering with efpeglenatide?: Insights from the AMPLITUDE-O trial.","authors":"Hertzel C Gerstein, Mu Yang, Shun Fu Lee, Kelley R H Branch, Stefano Del Prato, Carolyn S P Lam, Renato D Lopes, Richard Pratley, Julio Rosenstock, Naveed Sattar","doi":"10.1111/dom.15957","DOIUrl":"https://doi.org/10.1111/dom.15957","url":null,"abstract":"","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}