Pub Date : 2024-10-03DOI: 10.1016/j.pcd.2024.09.007
Setor K. Kunutsor , Borenyi S. Seidu , Samuel Seidu
Background
Whether the cardiovascular treatment benefits of sodium–glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by baseline use of statins/lipid lowering therapy is unclear. This systematic review and meta-analysis investigated whether baseline statin use (users vs non-users) influences the cardiovascular and kidney benefits of SGLT-2is and GLP-1RAs in patients with type 2 diabetes (T2D).
Methods
We identified relevant cardiovascular outcome trials (CVOTs) and observational cohort studies from MEDLINE, Embase, the Cochrane Library, and bibliographic searches up to March 2024. The analysis pooled study-specific hazard ratios (HRs) with 95 % confidence intervals (CIs) for outcomes, categorized by baseline statin use status. We also assessed the interactions between these medications and baseline statin use by calculating and pooling the ratio of HRs (RHRs) within each trial.
Results
Twenty-five articles (13 articles comprising 6 unique CVOTs and 12 articles comprising 9 unique cohort studies) were eligible. In CVOTs of SGLT-2is, the HRs (95 % CIs) of MACE; composite of CVD death or hospitalisation for heart failure; stroke; and kidney events in statin users were 0.90 (0.82–1.00), 0.78 (0.60–1.02), 1.00 (0.77–1.31), and 0.60 (0.53–0.69), respectively. The corresponding estimates were similar in non-statin users. In CVOTs of GLP-1RAs, the HRs (95 % CIs) for MACE in statin and non-statin users were 0.81 (0.73–0.90) and 0.92 (0.77–1.11), respectively. In observational cohort studies, SGLT-2is similarly reduced the risk of several cardiovascular and kidney outcomes in both statin and non-statin users. The estimated RHRs and p-values for interaction indicated that baseline statin use status did not significantly modify the cardio-kidney benefits of SGLT-2is and GLP-1RAs.
Conclusions
Aggregate analyses of intervention and real-world evidence show that SGLT-2is and GLP-1RAs provide comparable cardio-kidney benefits in patients with T2D, regardless of baseline statin use status. PROSPERO Registration: CRD42024498939
{"title":"Cardiovascular effectiveness of newer glucose-lowering agents, with and without baseline lipid-lowering therapy in type 2 diabetes: A systematic meta-analysis of cardiovascular outcome trials and real-world evidence","authors":"Setor K. Kunutsor , Borenyi S. Seidu , Samuel Seidu","doi":"10.1016/j.pcd.2024.09.007","DOIUrl":"10.1016/j.pcd.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Whether the cardiovascular treatment benefits of sodium–glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by baseline use of statins/lipid lowering therapy is unclear. This systematic review and meta-analysis investigated whether baseline statin use (users vs non-users) influences the cardiovascular and kidney benefits of SGLT-2is and GLP-1RAs in patients with type 2 diabetes (T2D).</div></div><div><h3>Methods</h3><div>We identified relevant cardiovascular outcome trials (CVOTs) and observational cohort studies from MEDLINE, Embase, the Cochrane Library, and bibliographic searches up to March 2024. The analysis pooled study-specific hazard ratios (HRs) with 95 % confidence intervals (CIs) for outcomes, categorized by baseline statin use status. We also assessed the interactions between these medications and baseline statin use by calculating and pooling the ratio of HRs (RHRs) within each trial.</div></div><div><h3>Results</h3><div>Twenty-five articles (13 articles comprising 6 unique CVOTs and 12 articles comprising 9 unique cohort studies) were eligible. In CVOTs of SGLT-2is, the HRs (95 % CIs) of MACE; composite of CVD death or hospitalisation for heart failure; stroke; and kidney events in statin users were 0.90 (0.82–1.00), 0.78 (0.60–1.02), 1.00 (0.77–1.31), and 0.60 (0.53–0.69), respectively. The corresponding estimates were similar in non-statin users. In CVOTs of GLP-1RAs, the HRs (95 % CIs) for MACE in statin and non-statin users were 0.81 (0.73–0.90) and 0.92 (0.77–1.11), respectively. In observational cohort studies, SGLT-2is similarly reduced the risk of several cardiovascular and kidney outcomes in both statin and non-statin users. The estimated RHRs and <em>p</em>-values for interaction indicated that baseline statin use status did not significantly modify the cardio-kidney benefits of SGLT-2is and GLP-1RAs.</div></div><div><h3>Conclusions</h3><div>Aggregate analyses of intervention and real-world evidence show that SGLT-2is and GLP-1RAs provide comparable cardio-kidney benefits in patients with T2D, regardless of baseline statin use status. PROSPERO Registration: CRD42024498939</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 589-598"},"PeriodicalIF":2.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.pcd.2024.09.009
Buse Tüngür Türker , Esra Oksel
Aims
The study was conducted with the aim of investigating the impact of personality traits on the risk of developing type 2 diabetes and eating awareness among adult individuals.
Methods
It was planned and carried out as a descriptive-correlational study. The data collection process of the study was conducted using online communication methods and using Google Forms. These forms included Patient Identification Form, the Big Five Inventory to examine personality traits, the Mindful Eating Questionnaire to assess the level of eating awareness, and The Finnish Type 2 Diabetes Risk Assessment Questionnaire to determine the risk of type 2 diabetes. A total of 390 individuals were included in the study.
Results
Significant differences were found among the sub-dimensions of personality traits and the levels of eating awareness. Extraversion, agreeableness, and conscientiousness were found to affect eating awareness, but no effect of personality traits on the risk of developing type 2 diabetes was found. Increasing eating mindfulness was found to reduce the risk of diabetes.
Conclusions
The study provides evidence of the relationship between personality traits and eating awareness and highlights the importance of eating awareness in reducing the risk of developing type 2 diabetes.
{"title":"Investigation of the effect of personality traits on type 2 diabetes risk and eating awareness in adults","authors":"Buse Tüngür Türker , Esra Oksel","doi":"10.1016/j.pcd.2024.09.009","DOIUrl":"10.1016/j.pcd.2024.09.009","url":null,"abstract":"<div><h3>Aims</h3><div>The study was conducted with the aim of investigating the impact of personality traits on the risk of developing type 2 diabetes and eating awareness among adult individuals.</div></div><div><h3>Methods</h3><div>It was planned and carried out as a descriptive-correlational study. The data collection process of the study was conducted using online communication methods and using Google Forms. These forms included Patient Identification Form, the Big Five Inventory to examine personality traits, the Mindful Eating Questionnaire to assess the level of eating awareness, and The Finnish Type 2 Diabetes Risk Assessment Questionnaire to determine the risk of type 2 diabetes. A total of 390 individuals were included in the study.</div></div><div><h3>Results</h3><div>Significant differences were found among the sub-dimensions of personality traits and the levels of eating awareness. Extraversion, agreeableness, and conscientiousness were found to affect eating awareness, but no effect of personality traits on the risk of developing type 2 diabetes was found. Increasing eating mindfulness was found to reduce the risk of diabetes.</div></div><div><h3>Conclusions</h3><div>The study provides evidence of the relationship between personality traits and eating awareness and highlights the importance of eating awareness in reducing the risk of developing type 2 diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 644-648"},"PeriodicalIF":2.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1016/j.pcd.2024.09.006
Zhiqun Liu , Xiaohan Sang , Yanhui Liu , Chuochuo Yu , Huan Wan
Aim
There is an ongoing debate regarding the influence of psychological interventions on glycemic control in middle-aged and elderly patients diagnosed with type 2 diabetes. To establish evidence-based medical support for the therapeutic application of these interventions, this meta-analysis seeks to assess the impact of psychological interventions on glycemic control in middle-aged and elderly individuals with type 2 diabetes.
Methods
This study systematically searched six electronic databases for randomized controlled studies of psychological interventions applied to middle-aged and elderly patients with type 2 diabetes, and the search time frames were all from the time of database creation to the search period from the establishment to March 2023. Two evaluators independently screened the literature evaluated the included studies' risk of bias, and carried out a meta-analysis using the RevMan5.4 program.
Results
A total of 7 studies with 728 participants complied with the eligibility criteria. Meta-analysis showed that glycated glucagon was reduced in the psychological intervention group compared to the control group (MD = -0.26, 95 %CI:-0.51,-0.01,p = 0.01) with a statistically significant difference (p < 0.05). and their sensitivity analyses all showed stable and credible results.
Conclusions
This review concludes that psychological interventions, when applied to middle-aged and elderly individuals with type 2 diabetes, proved to be more effective in reducing HbA1c levels compared to standard care. Nevertheless, further evidence-based research is essential to elucidate the specific types of psychological interventions that contribute to improved glycemic control outcomes in middle-aged and older adults with type 2 diabetes.
{"title":"Effect of psychological intervention on glycemic control in middle-aged and elderly patients with type 2 diabetes mellitus: A systematic review and meta-analysis","authors":"Zhiqun Liu , Xiaohan Sang , Yanhui Liu , Chuochuo Yu , Huan Wan","doi":"10.1016/j.pcd.2024.09.006","DOIUrl":"10.1016/j.pcd.2024.09.006","url":null,"abstract":"<div><h3>Aim</h3><div>There is an ongoing debate regarding the influence of psychological interventions on glycemic control in middle-aged and elderly patients diagnosed with type 2 diabetes. To establish evidence-based medical support for the therapeutic application of these interventions, this meta-analysis seeks to assess the impact of psychological interventions on glycemic control in middle-aged and elderly individuals with type 2 diabetes.</div></div><div><h3>Methods</h3><div>This study systematically searched six electronic databases for randomized controlled studies of psychological interventions applied to middle-aged and elderly patients with type 2 diabetes, and the search time frames were all from the time of database creation to the search period from the establishment to March 2023. Two evaluators independently screened the literature evaluated the included studies' risk of bias, and carried out a meta-analysis using the RevMan5.4 program.</div></div><div><h3>Results</h3><div>A total of 7 studies with 728 participants complied with the eligibility criteria. Meta-analysis showed that glycated glucagon was reduced in the psychological intervention group compared to the control group (MD = -0.26, 95 %CI:-0.51,-0.01,p = 0.01) with a statistically significant difference (p < 0.05). and their sensitivity analyses all showed stable and credible results.</div></div><div><h3>Conclusions</h3><div>This review concludes that psychological interventions, when applied to middle-aged and elderly individuals with type 2 diabetes, proved to be more effective in reducing HbA1c levels compared to standard care. Nevertheless, further evidence-based research is essential to elucidate the specific types of psychological interventions that contribute to improved glycemic control outcomes in middle-aged and older adults with type 2 diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 574-581"},"PeriodicalIF":2.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.pcd.2024.09.005
Ramón A. Castaño , Maria A. Granados , Natalia Trujillo , Juan P. Bernal , Juan F. Trujillo , Patrizia Trasmondi , Angel F. Maestre , Juan S. Cardona , Rossmary Gonzalez , María A. Larrarte , Derly C. Hernandez , Noël C. Barengo , Humberto Reynales
Aims
Early detection of type 2 diabetes mellitus is key to reducing micro and macrovascular complications associated with this disease. However, a lab-based process for diagnosis entails the risk of loss-to-follow-up. The objective of this study was to demonstrate if performing a point-of-care test of HbA1c immediately after a screening questionnaire will increase the proportion of individuals showing up for a lab-based confirmatory test as Point-of-care (POC) provides immediate availability, which is expected to reduce loss-to-follow-up.
Research design and methods
This trial was a two-arm, randomized controlled, open-label study. Participants were recruited using the FINDRISC Score in a primary care and community setting. All 902 eligible participants were randomized into the intervention (n=511) and control (n=391) group. The intervention group was given information on healthy lifestyles, and a Point-of-care POC-HbA1c test was performed during the same visit. The control group was only given information on healthy lifestyles. Participants in both groups received a written prescription to have an oral glucose tolerance test (OGTT) performed within the next 30 days. Follow-up phone calls were made at 30 and 90 days to check if participant had undergone the test. The total duration of the intervention was 8 months. The posterior data analysis was made by using the Kolmogorov-Smirnoff test for the quantitative variables, and the descriptive statistics were expressed as means and standard deviation, or median and interquartile range 25 %-75 %, as appropriate.
Results
At 30 days, 28 % of participants in the intervention group and 26.1 % in the control group undertook the OGTT (RD 1.90 %; 95 % CI −3.94; 7.73). At 90 days, 35.8 % of participants in the intervention group and 37.1 % in the control group undertook the OGTT. There was no statistically significant difference (RD – 3.17 %; 95 % CI −7.04; 0.70) between both groups.
Conclusions
The data suggest that performing a POC-HbA1c test after the FINDRISC did not increase the percentage of individuals showing up for the OGTT.
{"title":"Does performing a Point-Of-Care HbA1c test increase the chances of undertaking an OGTT among individuals at risk of diabetes? A randomized controlled trial","authors":"Ramón A. Castaño , Maria A. Granados , Natalia Trujillo , Juan P. Bernal , Juan F. Trujillo , Patrizia Trasmondi , Angel F. Maestre , Juan S. Cardona , Rossmary Gonzalez , María A. Larrarte , Derly C. Hernandez , Noël C. Barengo , Humberto Reynales","doi":"10.1016/j.pcd.2024.09.005","DOIUrl":"10.1016/j.pcd.2024.09.005","url":null,"abstract":"<div><h3>Aims</h3><div>Early detection of type 2 diabetes mellitus is key to reducing micro and macrovascular complications associated with this disease. However, a lab-based process for diagnosis entails the risk of loss-to-follow-up. The objective of this study was to demonstrate if performing a point-of-care test of HbA1c immediately after a screening questionnaire will increase the proportion of individuals showing up for a lab-based confirmatory test as Point-of-care (POC) provides immediate availability, which is expected to reduce loss-to-follow-up.</div></div><div><h3>Research design and methods</h3><div>This trial was a two-arm, randomized controlled, open-label study. Participants were recruited using the FINDRISC Score in a primary care and community setting. All 902 eligible participants were randomized into the intervention (n=511) and control (n=391) group. The intervention group was given information on healthy lifestyles, and a Point-of-care POC-HbA1c test was performed during the same visit. The control group was only given information on healthy lifestyles. Participants in both groups received a written prescription to have an oral glucose tolerance test (OGTT) performed within the next 30 days. Follow-up phone calls were made at 30 and 90 days to check if participant had undergone the test. The total duration of the intervention was 8 months. The posterior data analysis was made by using the Kolmogorov-Smirnoff test for the quantitative variables, and the descriptive statistics were expressed as means and standard deviation, or median and interquartile range 25 %-75 %, as appropriate.</div></div><div><h3>Results</h3><div>At 30 days, 28 % of participants in the intervention group and 26.1 % in the control group undertook the OGTT (RD 1.90 %; 95 % CI −3.94; 7.73). At 90 days, 35.8 % of participants in the intervention group and 37.1 % in the control group undertook the OGTT. There was no statistically significant difference (RD – 3.17 %; 95 % CI −7.04; 0.70) between both groups.</div></div><div><h3>Conclusions</h3><div>The data suggest that performing a POC-HbA1c test after the FINDRISC did not increase the percentage of individuals showing up for the OGTT.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 624-631"},"PeriodicalIF":2.6,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.pcd.2024.09.002
Badreya A. Al-Lahou, Reem Y. AlMatrook, Ali H. AlSarraf, Asmaa A. AlShammari, Durra K. AlSumaiti, Maria J. Al-Mahdi, Ebaa A. Alozairi
Aims
To examine the effectiveness of the culturally adapted Kids in Control Of Food (KICk OFF) structured educational program on glycemic control and BMI z-scores (BMIz) in adolescents with type 1 diabetes in Kuwait.
Methods
We conducted a retrospective analysis of 161 adolescents aged 11–16 years with type 1 diabetes who participated in the culturally adapted KICk OFF program at Dasman Diabetes Institute from 2019 to 2023. Changes in glycated hemoglobin (HbA1c) and BMIz were assessed from baseline to six months post-program using paired t-tests and Wilcoxon signed-rank tests, respectively.
Results
After six months post-program, there was a significant reduction in HbA1c levels (mean ± standard deviation) from 9.3 ± 1.8 % (78 ± 20 mmol/mol) to 8.9 ± 1.7 % (74 ± 19 mmol/mol), P <0.0001. The greatest improvements observed in participants with baseline HbA1c >9.5 % (reduction of 0.70 % [8 mmol/mol]) and those with HbA1c 7.5–9.5 % (reduction of 0.32 % [4 mmol/mol]). There was a slight increase in median BMIz by 0.08 (interquartile range –0.04–0.22).
Conclusions
The culturally adapted KICk OFF program shows a potential in improving glycemic control among adolescents with type 1 diabetes, particularly in those with initially suboptimal control. Future research through randomized controlled trials and over longer periods is recommended to validate these results.
{"title":"Impact of the culturally adapted kids in control of food (KICk OFF) educational program on glycemic control and BMI in adolescents with type 1 diabetes in Kuwait: A retrospective study","authors":"Badreya A. Al-Lahou, Reem Y. AlMatrook, Ali H. AlSarraf, Asmaa A. AlShammari, Durra K. AlSumaiti, Maria J. Al-Mahdi, Ebaa A. Alozairi","doi":"10.1016/j.pcd.2024.09.002","DOIUrl":"10.1016/j.pcd.2024.09.002","url":null,"abstract":"<div><h3>Aims</h3><div>To examine the effectiveness of the culturally adapted Kids in Control Of Food (KICk OFF) structured educational program on glycemic control and BMI z-scores (BMIz) in adolescents with type 1 diabetes in Kuwait.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 161 adolescents aged 11–16 years with type 1 diabetes who participated in the culturally adapted KICk OFF program at Dasman Diabetes Institute from 2019 to 2023. Changes in glycated hemoglobin (HbA1c) and BMIz were assessed from baseline to six months post-program using paired t-tests and Wilcoxon signed-rank tests, respectively.</div></div><div><h3>Results</h3><div>After six months post-program, there was a significant reduction in HbA1c levels (mean ± standard deviation) from 9.3 ± 1.8 % (78 ± 20 mmol/mol) to 8.9 ± 1.7 % (74 ± 19 mmol/mol), <em>P</em> <0.0001. The greatest improvements observed in participants with baseline HbA1c >9.5 % (reduction of 0.70 % [8 mmol/mol]) and those with HbA1c 7.5–9.5 % (reduction of 0.32 % [4 mmol/mol]). There was a slight increase in median BMIz by 0.08 (interquartile range –0.04–0.22).</div></div><div><h3>Conclusions</h3><div>The culturally adapted KICk OFF program shows a potential in improving glycemic control among adolescents with type 1 diabetes, particularly in those with initially suboptimal control. Future research through randomized controlled trials and over longer periods is recommended to validate these results.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 632-636"},"PeriodicalIF":2.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetes mellitus is a chronic metabolic disease, potentially leading to dire complications. Although there are numerous pharmaceutical treatments available, management of the disease is frequently not optimal. Managing diabetes in daily clinical practice can be challenging, and several common mistakes may occur. Healthcare providers must be aware of these errors to provide adequate patient care. In this review, some frequent mistakes in diabetes management are analyzed, focusing on factors such as medication management, blood glucose level monitoring, inadequate addressing of complications and comorbidities, lifestyle choices, patient education, and overall health counselling.
{"title":"Common mistakes concerning diabetes management in daily clinical practice","authors":"Konstantinos Makrilakis, Eleftheria Papachristoforou","doi":"10.1016/j.pcd.2024.09.004","DOIUrl":"10.1016/j.pcd.2024.09.004","url":null,"abstract":"<div><div>Diabetes mellitus is a chronic metabolic disease, potentially leading to dire complications. Although there are numerous pharmaceutical treatments available, management of the disease is frequently not optimal. Managing diabetes in daily clinical practice can be challenging, and several common mistakes may occur. Healthcare providers must be aware of these errors to provide adequate patient care. In this review, some frequent mistakes in diabetes management are analyzed, focusing on factors such as medication management, blood glucose level monitoring, inadequate addressing of complications and comorbidities, lifestyle choices, patient education, and overall health counselling.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 582-588"},"PeriodicalIF":2.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1016/j.pcd.2024.09.003
Jari Delbaere , Ewoud Deboever , Bert Vaes , Frank Nobels , Pavlos Mamouris , Geert Goderis
Aims
The utilization of sulfonylurea (SU) for the management of Type 2 Diabetes Mellitus (T2DM) has witnessed a decline, attributed to the rising popularity of alternative medications and uncertainties surrounding the cardiovascular risk profile of SUs. This study aimed to investigate the potential association between SU intake and the incidence of cardiovascular events in patients with T2DM.
Methods
A retrospective cohort study, based on a general practice (GP) registry, was designed, encompassing patients diagnosed with T2DM between 2005 and 2014.Follow-up persisted until the occurrence of a cardiovascular event, loss to follow-up, or until December 31, 2022. Comparative analyses were conducted between patients, receiving SU treatment and those without
Results
Data from a cohort comprising 5589 patients revealed that 13 % and 13.1 % of individuals in the comparator group and the SU group, respectively, experienced a cardiovascular event. However, no statistically significant elevation in the risk of cardiovascular events was observed after SU usage. Furthermore, the glycated haemoglobin (HbA1c) levels were significantly higher in the SU group (7.0 % vs. 6.4 %,
p < 0.001).
Conclusions
The findings from this study indicate that the use of sulfonylureas SUs is not associated with a statistically significant increase in the risk of cardiovascular events among patients with type T2DM. These results contribute to the ongoing discourse on the safety and efficacy of SU therapy in diabetes management.
目的:磺脲类药物(SU)用于治疗2型糖尿病(T2DM)的使用率有所下降,原因是替代药物越来越受欢迎,而且磺脲类药物的心血管风险也存在不确定性。本研究旨在调查 T2DM 患者的 SU 摄入量与心血管事件发生率之间的潜在关联:随访持续到发生心血管事件、失去随访机会或 2022 年 12 月 31 日。对接受 SU 治疗和未接受 SU 治疗的患者进行了对比分析 结果:由 5589 名患者组成的队列数据显示,对比组和 SU 组分别有 13% 和 13.1% 的患者发生了心血管事件。不过,使用 SU 后,心血管事件的风险并没有出现统计学意义上的明显升高。此外,糖化血红蛋白(HbA1c)水平在 SU 组明显更高(7.0% 对 6.4%,p < 0.001):本研究结果表明,使用磺脲类药物 SUs 与 T2DM 患者心血管事件风险的统计学显著增加无关。这些结果有助于继续讨论磺脲类药物治疗糖尿病的安全性和有效性。
{"title":"Assessment of cardiovascular risk with sulfonylurea use in type 2 diabetes mellitus: A retrospective cohort study","authors":"Jari Delbaere , Ewoud Deboever , Bert Vaes , Frank Nobels , Pavlos Mamouris , Geert Goderis","doi":"10.1016/j.pcd.2024.09.003","DOIUrl":"10.1016/j.pcd.2024.09.003","url":null,"abstract":"<div><h3>Aims</h3><div>The utilization of sulfonylurea (SU) for the management of Type 2 Diabetes Mellitus (T2DM) has witnessed a decline, attributed to the rising popularity of alternative medications and uncertainties surrounding the cardiovascular risk profile of SUs. This study aimed to investigate the potential association between SU intake and the incidence of cardiovascular events in patients with T2DM.</div></div><div><h3>Methods</h3><div>A retrospective cohort study, based on a general practice (GP) registry, was designed, encompassing patients diagnosed with T2DM between 2005 and 2014.Follow-up persisted until the occurrence of a cardiovascular event, loss to follow-up, or until December 31, 2022. Comparative analyses were conducted between patients, receiving SU treatment and those without</div></div><div><h3>Results</h3><div>Data from a cohort comprising 5589 patients revealed that 13 % and 13.1 % of individuals in the comparator group and the SU group, respectively, experienced a cardiovascular event. However, no statistically significant elevation in the risk of cardiovascular events was observed after SU usage. Furthermore, the glycated haemoglobin (HbA1c) levels were significantly higher in the SU group (7.0 % vs. 6.4 %,</div><div>p < 0.001).</div></div><div><h3>Conclusions</h3><div>The findings from this study indicate that the use of sulfonylureas SUs is not associated with a statistically significant increase in the risk of cardiovascular events among patients with type T2DM. These results contribute to the ongoing discourse on the safety and efficacy of SU therapy in diabetes management.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 599-605"},"PeriodicalIF":2.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1016/j.pcd.2024.09.001
Naresh Kanumilli , Martin Miszon , Oliver Schnell , Per-Henrik Groop
The prevalence of diabetes and chronic kidney disease (CKD) is increasing worldwide. Diabetic kidney disease is a chronic condition characterized by a gradual increase in urinary albumin excretion, blood pressure, cardiovascular risk, and a decline in glomerular filtration rate (GFR) that can progress to end-stage kidney disease (ESKD). Individuals with diabetes should be screened for CKD annually. Screening should include both measurement of albuminuria and estimation of GFR (eGFR). The structural changes in diabetic kidney disease in individuals with type 1 diabetes are rather uniform, but the histological picture in those with type 2 diabetes and CKD is on the contrary a mix of changes ranging from minor abnormalities to severe glomerulosclerosis, tubulointerstitial fibrosis, and arteriolohyalinosis. Scarring of the kidneys is closely related to the kidney function. Individuals with diabetes often require multiple therapies to prevent progression of CKD and its associated comorbidities and mortality. Management of cardiorenal risk factors, including lifestyle modification, control of blood glucose, blood pressure, and lipids, use of renin-angiotensin-aldosterone system (RAAS) blockers, use of sodium-glucose co-transporter 2 (SGLT2) inhibitors, and the non-steroidal mineralocorticoid receptor antagonist finerenone in individuals with T2D are the cornerstones of therapy. Primary care physicians (PCPs) play a critical role in identifying individuals with CKD, managing early stages of CKD, and referring those with moderate to severe CKD or rapidly declining kidney function to a nephrologist. Referral to a nephrologist should be considered when certain thresholds for eGFR, albuminuria, proteinuria, hematuria, or hypertension are exceeded. This review summarizes current guidelines for the management of CKD and its complications and highlights the role of PCPs in the care of individuals with CKD.
{"title":"The role of finerenone in the management of CKD in T2D –Practical considerations for primary care","authors":"Naresh Kanumilli , Martin Miszon , Oliver Schnell , Per-Henrik Groop","doi":"10.1016/j.pcd.2024.09.001","DOIUrl":"10.1016/j.pcd.2024.09.001","url":null,"abstract":"<div><div>The prevalence of diabetes and chronic kidney disease (CKD) is increasing worldwide. Diabetic kidney disease is a chronic condition characterized by a gradual increase in urinary albumin excretion, blood pressure, cardiovascular risk, and a decline in glomerular filtration rate (GFR) that can progress to end-stage kidney disease (ESKD). Individuals with diabetes should be screened for CKD annually. Screening should include both measurement of albuminuria and estimation of GFR (eGFR). The structural changes in diabetic kidney disease in individuals with type 1 diabetes are rather uniform, but the histological picture in those with type 2 diabetes and CKD is on the contrary a mix of changes ranging from minor abnormalities to severe glomerulosclerosis, tubulointerstitial fibrosis, and arteriolohyalinosis. Scarring of the kidneys is closely related to the kidney function. Individuals with diabetes often require multiple therapies to prevent progression of CKD and its associated comorbidities and mortality. Management of cardiorenal risk factors, including lifestyle modification, control of blood glucose, blood pressure, and lipids, use of renin-angiotensin-aldosterone system (RAAS) blockers, use of sodium-glucose co-transporter 2 (SGLT2) inhibitors, and the non-steroidal mineralocorticoid receptor antagonist finerenone in individuals with T2D are the cornerstones of therapy. Primary care physicians (PCPs) play a critical role in identifying individuals with CKD, managing early stages of CKD, and referring those with moderate to severe CKD or rapidly declining kidney function to a nephrologist. Referral to a nephrologist should be considered when certain thresholds for eGFR, albuminuria, proteinuria, hematuria, or hypertension are exceeded. This review summarizes current guidelines for the management of CKD and its complications and highlights the role of PCPs in the care of individuals with CKD.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 6","pages":"Pages 565-573"},"PeriodicalIF":2.6,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1016/j.pcd.2024.08.005
Jose J. Estevez , Ebony Liu , Chirag Patel , Tania Roulston , Natasha J. Howard , Stewart Lake , Tim Henderson , Jonathan Gleadle , Louise J. Maple-Brown , Alex Brown , Jamie E. Craig
Aims
Diabetic nephropathy, vision loss and diabetic retinopathy (DR) are frequent comorbidities among individuals with type 2 diabetes (T2D). The Retinopathy in People Currently On Renal Dialysis (RiPCORD) study sought to examine the epidemiology and risk of vision impairment (VI) and DR among a cohort of Indigenous and non-Indigenous Australians with T2D currently receiving haemodialysis for end-stage renal failure (ESRF).
Methods
A total of 106 Indigenous and 109 non-Indigenous Australians were recruited in RiPCORD across five haemodialysis centres in urban and remote settings. Clinical assessments, questionnaires and medical record data determined the rates of ocular complications and risk factor profiles.
Results
Prevalence rates include unilateral VI, 23.5 %; bilateral VI, 11.7 %; unilateral blindness, 14.2 %; and bilateral blindness, 3.7 %, with no significant differences between sub-cohorts (p=0.30). DR prevalence rates were 78.0 % among non-Indigenous Australians and 93.1 % among Indigenous Australians (p=<0.001). Non-Indigenous ethnicity (OR: 0.28) and pre-dialysis diastolic blood pressure (OR: 0.84 per 10-mmHg) were protective, while peripheral vascular disease (OR: 2.79) increased DR risk.
Conclusions
Ocular complications among individuals with T2D and ESRF are disproportionately high, especially for Indigenous Australians, and beyond what can be accounted for by risk factor variation. Findings suggest a need to improve screening and preventative efforts within this high-risk population group.
目的:糖尿病肾病、视力减退和糖尿病视网膜病变(DR)是 2 型糖尿病(T2D)患者的常见并发症。目前接受肾透析者视网膜病变(RiPCORD)研究旨在调查目前因终末期肾衰竭(ESRF)而接受血液透析治疗的澳大利亚土著和非土著 T2D 患者群体中视力损伤(VI)和糖尿病视网膜病变的流行病学和风险:方法:RiPCORD 在城市和偏远地区的五个血液透析中心共招募了 106 名土著澳大利亚人和 109 名非土著澳大利亚人。临床评估、问卷调查和医疗记录数据确定了眼部并发症的发病率和风险因素概况:发病率包括单侧 VI 23.5%;双侧 VI 11.7%;单侧失明 14.2%;双侧失明 3.7%,各亚组之间无显著差异(P=0.30)。非土著澳大利亚人和土著澳大利亚人的DR患病率分别为78.0%和93.1%(p=结论:患有 T2D 和 ESRF 的人眼部并发症的比例过高,尤其是澳大利亚土著人,而且超出了风险因素变化所能解释的范围。研究结果表明,有必要改进这一高风险人群的筛查和预防工作。
{"title":"Vision loss and diabetic retinopathy prevalence and risk among a cohort of Indigenous and non-Indigenous Australians with type 2 diabetes receiving renal haemodialysis treatment: The retinopathy in people currently on renal dialysis (RiPCORD) study","authors":"Jose J. Estevez , Ebony Liu , Chirag Patel , Tania Roulston , Natasha J. Howard , Stewart Lake , Tim Henderson , Jonathan Gleadle , Louise J. Maple-Brown , Alex Brown , Jamie E. Craig","doi":"10.1016/j.pcd.2024.08.005","DOIUrl":"10.1016/j.pcd.2024.08.005","url":null,"abstract":"<div><h3>Aims</h3><p>Diabetic nephropathy, vision loss and diabetic retinopathy (DR) are frequent comorbidities among individuals with type 2 diabetes (T2D). The Retinopathy in People Currently On Renal Dialysis (RiPCORD) study sought to examine the epidemiology and risk of vision impairment (VI) and DR among a cohort of Indigenous and non-Indigenous Australians with T2D currently receiving haemodialysis for end-stage renal failure (ESRF).</p></div><div><h3>Methods</h3><p>A total of 106 Indigenous and 109 non-Indigenous Australians were recruited in RiPCORD across five haemodialysis centres in urban and remote settings. Clinical assessments, questionnaires and medical record data determined the rates of ocular complications and risk factor profiles.</p></div><div><h3>Results</h3><p>Prevalence rates include unilateral VI, 23.5 %; bilateral VI, 11.7 %; unilateral blindness, 14.2 %; and bilateral blindness, 3.7 %, with no significant differences between sub-cohorts (p=0.30). DR prevalence rates were 78.0 % among non-Indigenous Australians and 93.1 % among Indigenous Australians (p=<0.001). Non-Indigenous ethnicity (OR: 0.28) and pre-dialysis diastolic blood pressure (OR: 0.84 per 10-mmHg) were protective, while peripheral vascular disease (OR: 2.79) increased DR risk.</p></div><div><h3>Conclusions</h3><p>Ocular complications among individuals with T2D and ESRF are disproportionately high, especially for Indigenous Australians, and beyond what can be accounted for by risk factor variation. Findings suggest a need to improve screening and preventative efforts within this high-risk population group.</p></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"18 5","pages":"Pages 547-554"},"PeriodicalIF":2.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1751991824001621/pdfft?md5=0f65c2d526383b5b9312adae2a1caa60&pid=1-s2.0-S1751991824001621-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}