Diabetes epidemiology and management最新文献

Background

Many works are ongoing with the aim of obtaining a more convenient way than the parenteral injection for administering insulin.

Purpose

To review the biopharmaceutics and clinical outcomes of the various emerging dosage forms of insulin so as to identify the promising formulations.

Method

A systematic literature search with analysis was carried out to obtain information on the biopharmaceutics and clinical outcomes of the emerging dosage forms.

Results

Intraperitoneal insulin was found to be characterized by direct drug delivery through the portal vein to the liver having bioavailability of 60%, but its clinical application is limited by the high risk of infection. The bioavailability of transdermal insulin has been enhanced using electrical, mechanical and physical techniques; and such formulations could achieve up to 39.5% blood glucose reduction. Oral insulin, known to be the most convenient, has its bioavailability limited to 1% by enzymatic degradation and poor absorption. Its challenges however, have been addressed by various interventions to achieve different levels of bioavailability up to 73.1%. Buccal insulin has shown potentials in managing postprandial hyperglycaemia without posing hypoglycaemic risk but its clinical applicability has not been established; whereas the long transit time, lower levels of peptidases and incorporation of permeation-enhancers have been shown to be responsible for the good treatment outcome of colon-targeted insulin. Rectal insulin with bioavailability of 11% has been shown to be considerably safe but not cost-effective while the ocular insulin is limited by poor absorption. Nasal tolerance and high rate of treatment failures were shown to be limiting intranasal insulin while the pulmonary insulin is being limited by peripheral drug retention and insulin resistance.

Conclusion

The biopharmaceutical profiles and clinical outcomes of transdermal, oral and colon-targeted insulin are superior to those of the other dosage forms. Further research works could be done towards the full development of these promising formulations.

Aims

The objective of the study was to compare screening performances of HbA1c, fasting plasma glucose (FPG), and two-hour plasma glucose (2hPG) in heart failure (HF) patients.

Methods

We included 237 HF patients aged >20 years without history of diabetes, using National Health and Nutrition Examination Survey data (2005–2016). American Diabetes Association diabetes screening criteria were used: (1) HbA1c ≥6.5%, (2) FPG ≥126 mg/dL, and (3) 2hPG ≥200 mg/dL. Sensitivity, specificity, predictive values, and Receiver Operating Characteristic (ROC) curves for HbA1c and FPG were examined against reference methods.

Results

N = 50 patients (20.5%) met at least 1 of 3 clinical criteria for diabetes. 2hPG alone identified 70.5% of patients, whereas HbA1c alone identified only 27.0% of patients. Sensitivity and specificity using a HbA1c cutoff at ≥6.5% were 24.4% and 97.6%, respectively. The Youden's J statistic for HbA1c was maximized at 6.1%. The area under the ROC curve of HbA1c against 2hPG was significantly lower compared to FPG (0.79, 95% CI 0.70-0.88; 0.89, 95% CI 0.84-0.94, respectively; p = 0.04).

Conclusions

Blood glucose criteria are more sensitive than HbA1c when screening HF patients for diabetes. Future studies should test performance of a HbA1c cutoff at 6.1% when FPG or 2hPG cannot be completed.

Background

Patients’ acceptance of artificial intelligence (AI) based health-related technologies depend strongly on their perception and trust of AI. This research field has not been studied extensively, especially among people living with diabetes. A large proportion of them frequently use health technologies in their everyday lives to manage their condition, which may make them more prepared to adopt AI-based solutions. Our study aimed to investigate the perception of AI-based solutions in healthcare, and characteristics associated with positive attitudes towards AI among people with and without diabetes.

Methods

An online survey was sent to 12,755 participants in the Health in Central Denmark cohort, including 10 questions and six scenarios related to current technology use, data sharing, and AI. The question on benefits and risks of AI, and the responses to the scenarios were used as outcomes. Multinomial logistic regression was used to examine which characteristics were associated with seeing the benefit of AI over the risks, including diabetes status, age, sex, education, health literacy, the use of wearable devices, and views on data sharing. A similar analysis was conducted on the acceptance of AI-based solutions in healthcare-related scenarios.

Findings

8,420 participants responded to the survey. Most participants (88%) had previously heard about AI. 46% of participants agreed with the statement that the benefits of AI outweigh the risks, while only 2% agreed with the opposite statement, and 30% were unsure. We did not find evidence for a differential opinion by diabetes status. Having diabetes was associated with less openness to replace healthcare professionals by AI-based technologies, although most people were still open to AI if controlled by humans.

Interpretation

Despite the generally positive perception of AI and its benefits to healthcare, human interaction seemed to play an important role in defining positive attitudes to AI across different healthcare scenarios, especially among people with diabetes. This highlights the pressing need for a patient-centered development process of AI-based solutions in the future.

Patient Reported Outcome Measures (PROMs) are recognized by health authorities as fundamental and can be evaluated by several questionnaires. The main complexity of evaluating PROMs in People with Diabetes (PwD), be it type 1 (PwT1D) or type 2 (PwT2D), is choosing the right tool (generic or specific) with the right constructs. This study explores the use of PROMs in PwD. The main objective was to compare generic and specific QoL PROMs in a diabetic population. The secondary objective was to assess potential overlaps of assessed constructs in the different PROMs frequently used in diabetes.

PRODIAB was an online quantitative survey conducted between January and February 2022. The scientific committee selected the following oft-used questionnaires: EuroQol 5-Dimensions 5-Level (EQ-5D-5L), Audit of Diabetes Dependent Quality of Life (ADDQOL), Treatment Burden Questionnaire (TBQ), Hospital Anxiety and-Depression Scale (HADS-A; HADS-D) and Patient-Health-Questionnaire-9 (PHQ-9). All PROMs used were validated in French.

Responses from 2,796 French PwD were analyzed. Compared to PwT2D, PwT1D reported a better general Quality of Life (QoL) on the EQ-5D-5L index (0.75 vs 0.66; p < 0.001) and a lower specific QoL on the ADDQOL (-2.8 vs -2.5; p < 0.001). Adjusted analysis showed that age was inversely associated with EQ-5D-5L index score (-0.11; p < 0.001) and a positively associated with ADDQOL score (0.14; p < 0.001). All PROMs were significantly correlated with each other and the HADS-A, HADS-D and PHQ9 (r 0.60 to 0.72) even more so. While principal component analyses suggested that all PROMs measured only one dimension (mental health) (eigenvalue=3.39; first dimension percentage of variance 56.5), adjusted analyses suggested that the EQ-5D-5L is not adequate for assessing the specific impact of diabetes on QoL.

Our study emphasizes the importance of identifying the constructs assessed by each PROM as well as the target population in order to choose the best-suited questionnaire type with the most appropriate constructs.

Background

Dipeptidyl peptidase-4 inhibitors (DPP4I) may be associated with higher risks of acute pancreatitis and pancreatic cancer. This study compared the risks of acute pancreatitis and pancreatic cancer between sodium glucose cotransporter 2 inhibitors (SGLT2I) and DPP4I users.

Methods

This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus on either SGLT2I or DPP4I between January 1^st, 2015, and December 31^st 2020 in Hong Kong. The primary outcome was new-onset acute pancreatitis and pancreatic cancer. Propensity score matching (1:1 ratio) using the nearest neighbour search was performed. Univariable and multivariable Cox regressions were applied to identify significant predictors.

Results

This cohort included 31609 Type 2 Diabetes Mellitus patients (median age: 67.4 years old [SD: 12.5]; 53.36% males). 6479 patients (20.49%) used SGLT2I, and 25130 patients (70.50%) used DPP4I. After matching, the rate of acute pancreatitis was significantly lower in SGLT2I users compared to DPP4I users. Multivariable Cox regression showed that SGLT2I use was associated with lower risks of acute pancreatitis (Hazard ratio, HR: 0.11; 95% Confidence interval, CI: 0.02-0.51; P=0.0017) and pancreatic cancer (HR: 0.22; 95% CI: 0.039-0.378; P=0.0003). The results were consistent using competing risk models and different propensity score approaches.

Conclusions

SGLT2I use was associated with lower risks of new-onset acute pancreatitis and pancreatic cancer after propensity score matching and multivariable adjustment, underscoring the need for further evaluation in the randomised controlled trial setting.

Background

Mobile Health i.e. m-Health Education (MHE) and Traditional Health Education (THE) interventions are both used for education of diabetic patients. However, it is not yet reported which one is the most effective. This study was designed to compare the effectiveness of these two types of intervention on adherence to the seven dimensions of diabetes' self-management in a peripheral district of Bangladesh.

Methods

A randomized controlled trial was conducted in Thakurgaon district, in Bangladesh, with two intervention arms (-MHE and THE- and one control group. All groups received an initial educational session including the control group. During the educational session pictorial materials was used and patients received a logbook to register their different activities related to diabetes. The intervention was conducted over a period of 12 months. MHE group received additionally a monthly reminder and monitoring through mobile phone calls. THE group received a monthly home visit reminder and monitoring through personal visits. 330 adult diabetics patients were included in each group. Data were collected by face-to-face interview using a semi-structured questionnaire at baseline and endline. Adherence to the seven self-management dimensions was measured and compared in the different groups before and after the intervention using analysis of co-variance (ANCOVA) and logistic regression technique.

Findings

Study participants took place from January 2016 to June 2017. Among the 990 included patients, 86 were lost to follow-up. Both MHE and THE groups showed significant (p< 0.01) improvement in knowledge, adherence to self-management and health outcomes compared to the control group. Bonferroni post-hoc comparison between groups showed that knowledge (regarding diet, physical exercise, follow-up visit and blood glucose test, stopping tobacco, basic and technical knowledge of diabetes) and waist circumference improved significantly more in the MHE group than in the THE group. Adherence to drug, physical exercise, follow-up visit and blood glucose test and stopping tobacco improved significantly more in the THE group than the MHE group. Furthermore, MHE was found to be more cost-effective.

Interpretation

The MHE intervention was more effective than the THE intervention in improving knowledge, adherence to most of the self-management recommendations and health outcomes for peripheral diabetic patients in Bangladesh. MHE intervention has a positive impact also in peripheral areas in LMICs. Thisintervention could be replicated for the self-management of diabetes and other non-communicable diseases in LMICs.

Funding

Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany and Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Introduction

The aim of the present study was to analyse the changes in antidiabetic drug prescription patterns during the follow-up of the GERODIAB cohort between 2009 and 2015 and to compare them with the available professional recommendations.

Patients and methods

The present study included 637 type 2 diabetic patients aged 70 years and over who have survived after 5 years. We compared the three main types of therapeutic modalities: (1) insulin only; (2) combination of insulin and one or more oral antidiabetic drugs (OADs) and/or glucagon-like peptide-1 receptor agonists (GLP-1RAs); and (3) treatment with one or more OADs and/or GLP-1RAs without insulin. We analysed changes in the antidiabetic drug classes, notably the antidiabetic drugs exposing patients to hypoglycaemia. Finally, we analysed changes in the prescriptions of patients initially treated with antidiabetic monotherapy.

Results

At inclusion, 25.6% patients were receiving only insulin, 30.9% patients were receiving insulin and OADs and/or GLP-1RAs, and 42.5% patients were receiving OADs and/or GLP-1RAs without insulin. At the final visit, 69.5% of patients continued to receive the same treatment modality. Only the number of patients treated with insulin alone increased (+9.9%). Prescriptions of insulin increased and prescriptions of OADs or GLP-1RAs decreased. The total drugs exposing patients to hypoglycaemia remained constant. Prescriptions of metformin remained high, prescriptions of sulfonylureas and glinides decreased and those of DPP-4 inhibitors increased.

Discussion - Conclusion

The increased prescription of insulin was predictable. Prescriptions of sulfonylureas and glinides remained relatively high, although recommendations for these drugs continue to decline.

Continuous Glucose Monitoring (CGM) has improved the diabetes follow up. The use of CGM can be expected to reduce the long-term complications of diabetes. To achieve this, education of physicians and diabetic individuals is essential. The latest CGMs have alarms to improve glycemic control by avoiding hypoglycemia and hyperglycemia, hence the importance of proper setting of these alarms. Although useful to signal these events, we have noted that these alarms do not necessarily meet with unanimity in consultations… Are alarms considered a comfort or a possible disturbance ?

Aims

Treatment intensification (TI) may help patients with type 2 diabetes mellitus (T2DM) achieve target hemoglobin A1c (A1c) < 7.0%. This study aimed to measure the influence of TI on A1c outcome in patients who insufficiently responded to two classes of oral antidiabetic drugs (2OADs).

Materials and methods

A retrospective observational study of patients with T2DM was performed using health plan claims and A1c records accrued between January 2010 and March 2017. The study population had an A1c ≥ 7.0% (baseline A1c) after treatment with 2OADs for one year. Patients who had TI with a third-class antidiabetic agent, including basal/biphasic insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), or OAD, within 365 days after baseline A1c were included. Patients who did not receive TI (NTI) within one year from the suboptimal A1c control were matched with TI patients using a propensity score approach. The odds ratio of achieving an A1c < 9.0% and < 7.0% for TI vs. NTI were calculated by logistic regressions.

Results

A1c values of 401 TI − NTI matched pairs were analyzed. TI patients achieved a significantly lower follow-up A1c than NTI patients (7.79% ± 1.45 vs. 8.02% ± 1.67, p = 0.03). The odds ratio [95% confidence interval] of achieving A1c < 9.0% and < 7.0% for TI was 1.50 [1.04−2.17] and 1.19 [0.87−1.63], respectively.

Conclusion

TI with a third-class agent further reduced A1c levels in patients whose A1c insufficiently responded with 2OADs; however, most patients failed to achieve an A1c < 7.0% on the intensified treatment.