Endocrinologia Y Nutricion最新文献

Objectives

The main objective was to assess resource use and costs of starting treatment with insulin or injectable GLP-1 receptor analogs (GLP-1 RAs) in a Spanish population of patients with type 2 diabetes mellitus. Treatment adherence and persistence were also determined for both treatment groups.

Patients and methods

A retrospective, non-interventional, observational study was conducted. Patients aged ≥20 years who started treatment with insulin or GLP-1 RAs in the 2010–2012 period were recruited. Use of healthcare resources was estimated to evaluate healthcare costs in these two groups of patients (medical visits, hospital stay, emergency visits, diagnostic or treatment requests, medication). Clinical information including body mass index (BMI, kg/m²), metabolic control (HbA1c), adherence, persistence, and complications hypoglycemia, and cardiovascular events (CVE) was collected. The follow-up period was 12 months. Only direct healthcare costs were considered.

Results

A total of 1301 patients with a mean age of 67.6 years (51.6% males) were recruited. Of these, 71.9% and 28.1% were on treatment with insulin and GLP-1 RA respectively. After one year of follow-up, patients treated with GLP-1 RAs were found less visits to primary care (8 vs. 11; p < 0.001) and specialized care (1.0 vs. 1.8; p < 0.001), hospital stays (0.3 vs. 0.7; p = 0.030) and less visits to the emergency room (0.8 vs. 1.6; p < 0.001). Patients treated with GLP-1 showed greater adherence (88.1% vs. 82.7%; p < 0.001) and persistence (62.0% vs. 55.9%; p = 0.046), and had less hypoglycemia episodes (13.4% vs. 18.7%; p = 0.022), with similar metabolic control (HbA1c: 7.2% vs. 7.4%; p = 0.049), BMI (29.1 vs. 30.9 kg/m²), and CVE rate (9.1% vs. 11.5%; p = 0.330) respectively. The mean corrected direct healthcare cost per patient was €1787 vs. €2005 (p = 0.046.)

Conclusions

Patients treated with GLP-1 RAs caused lower direct healthcare costs for the National Health System than patients treated with insulin. The results may be explained by greater treatment adherence and lower hypoglycemia rates in patients treated with GLP-1 RAs. Additional studies are needed to confirm these possibilities.

Introduction

To analyze the efficacy and safety of empagliflozin combined with other oral hypoglycemic agents in patients with type 2 diabetes mellitus.

Methods

Pooled analysis of three phase III trials in patients with type 2 diabetes mellitus (n = 1801) who received placebo or empagliflozin 10 or 25 mg once daily for 24 weeks, in combination with metformin, metformin + sulphonylurea or pioglitazone ± metformin.

Results

Empagliflozin significantly decreased HbA1c (adjusted mean reduction vs placebo with empagliflozin 10 mg: −0.58% [95% CI: −0.66; −0.49]; p < 0.0001, and with empagliflozin 25 mg: −0.62% [95% CI: −0.70; −0.53], p < 0.0001), weight (adjusted mean reduction vs placebo with empagliflozin 10 mg: −1.77 kg [95% CI: −2.05; −1.48]; p < 0.0001, and with empagliflozin 25 mg: −1.96 kg [95% CI: −2.24; −1.67], p < 0.0001), and systolic and diastolic blood pressure (SBP/DBP). Adverse effect rates were 64% with placebo, 63.9% with empagliflozin 10 mg, and 60.9% with empagliflozin 25 mg. Documented episodes of hypoglycemia (≤70 mg/dL and/or requiring care) occurred in 3.9% of patients with placebo, 6.9% of patients with empagliflozin 10 mg, and 5.3% of patients with empagliflozin 25 mg. Urinary tract infections developed in 9.4% of patients with placebo, 10.2% of patients with empagliflozin 10 mg, and 8.3% of patients with empagliflozin 25 mg. Genital infections were reported in 1.0% of patients with placebo, 4.6% of patients with empagliflozin 10 mg, and 3.5% of patients with empagliflozin 25 mg.

Conclusions

Empagliflozin combined with other oral treatments decreased HbA1c, body weight, and SBP/DBP as compared to placebo, with a good safety and tolerability profile.

Objective

The aim of the study was to estimate the direct costs of healthcare provided to patients with type 2 diabetes mellitus (T2DM) in the Basque Country and to compare them with those of the population with chronic diseases.

Material and methods

A retrospective, cross-sectional, population-based study. Direct healthcare costs for patients aged over 35 years diagnosed with T2DM in the Basque Country (n = 126,894) were calculated, stratified by age, sex and deprivation index, and compared to the costs for the population diagnosed with a chronic disease other than T2DM (n = 1,347,043).

Results

The annual average healthcare cost of a person with T2DM was €3432. Cost gradually increased with age to €4313 in patients aged 80–84 years. Cost in males were €161 higher as compared to costs in females (P < 0.001). In the most socioeconomically disadvantaged areas, cost per patient was €468 (14.9%) greater than in the most privileged areas (P < 0.001). Moreover, cost was 68.5% higher (P < 0.001) for patients with T2DM than for patients with other chronic diseases. Total annual direct costs amounted to €435.5 million, or 12.78% of total public health expenditure in the region.

Conclusions

Direct mean healthcare costs in the Basque Country for patients with T2DM were higher in males, in the most underprivileged areas, in patients with comorbidities, and in older age groups, and represented €3432 per person per year.

Introduction

Diabetes education is an essential tool to achieve treatment objectives in type 1 diabetes mellitus (T1DM). The aim of this study was to determine if understanding of diabetes by caregivers/patients or sociodemographic factors affect blood glucose control in children and adolescents with T1DM.

Patients and methods

The level of knowledge of 105 caregivers of children and adolescents with T1DM was assessed using a survey adapted to the type of treatment used (multiple dose insulin [MDI] or continuous subcutaneous insulin infusion [CSII]). Mean HbA1c levels in the previous year was considered as metabolic control marker.

Results

Mean HbA1c levels were similar in both treatment groups, with slightly higher values in children over 12 years of age. Patients on CSII had a longer time since disease onset and had poorer results, maybe because the items were more difficult due to the higher level of knowledge required for this treatment modality (p = 0.005). Caregivers with lower educational levels achieved poorer scores in the survey, but mean HbA1c levels of their children were lower, probably because of their greater involvement in disease care.

Conclusions

The level of knowledge of caregivers and/or patients with T1DM was high, and this was associated to good metabolic control. Studies to assess the impact of caregiver knowledge on metabolic control of children are needed.

In recent years, many studies have related gut microbiome to development of highly prevalent diseases such as type 2 diabetes and obesity. Obesity itself is associated to changes in the composition of gut microbiome, with a trend to an overgrowth of microorganisms more efficiently obtaining energy from diet. There are several mechanisms that relate microbiota to the onset of insulin resistance and diabetes, including changes in bowel permeability, endotoxemia, interaction with bile acids, changes in the proportion of brown adipose tissue, and effects associated to use of drugs like metformin.

Currently, use of pro and prebiotics and other new techniques such as gut microbiota transplant, or even antibiotic therapy, has been postulated to be useful tools to modulate the development of obesity and insulin resistance through the diet.

Background and aim

The current guidelines for treatment of high blood pressure do not include any section dedicated to hypertension in children and adolescents or to cardiovascular disease (CVD) prevention strategies in that age group. Our study was aimed at identifying cardiovascular risk factors (CVRFs) in an adolescent sample.

Subjects and methods

A cross-sectional study of a sample of adolescents aged 12–17 years (n = 630), conducted from October 2014 to February 2015 in four schools in Cangas do Morrazo (Pontevedra). Sociodemographic variables: age, sex, personal and family history of hypertension and diabetes (DM). Anthropometric variables: body mass index (BMI, kg/m²), waist circumference (WC, cm), waist/height index (WHI), blood pressure (mmHg).

Results

The study sample consisted of 295 female and 335 male adolescents (mean age: 13.8 ± 1.4). CVR-related conditions: hypercholesterolemia (7.1%), CVD (1.7%), hypertension (0.8%) and diabetes (0.3%). BMI (22.0 ± 3,8) was higher in males (22.4 ± 3.8 vs 21.0 ± 3.2; p < .01). Overweight was greater in females (27.6% vs 19.7%; p < .05). Seven percent of subjects were obese, 63.8% had systolic BP > P90 and 23.7% had diastolic BP > P90.

Waist circumference positively correlated with age (r = 0.1669; p < .0001) and was greater in males (75.4 ± 10.9 vs 72.9 ± 8.9; p < 0.01); 27.1% of adolescents had a waist circumference > P75, and 7.5% > P90. Eighty-four (13.3%) adolescents had two CVRFs (overweight + another).

Conclusions

Despite their young age, more than 10% of school children had two CVRFs. Abnormal SBP levels were seen in more than 50%, 20% were overweight, and only 75% had normal waist circumference values.

High weight is a protective factor against osteoporosis and risk of fracture. In obesity, however, where overweight is associated to excess fat, this relationship does not appear to be so clear, excess weight has sometimes been associated to decreased bone mass. Obesity interferes with bone metabolism through mechanical, hormonal, and inflammatory factors. These factors are closely related to weight, body composition, and dietary patterns of these patients. The net beneficial or harmful effect on bone mass or risk of fracture of the different components of this condition is not well known. We need to recognize patients at a greater risk of bone disease related to obesity to start an adequate intervention.