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OBJECTIVETo test the safety and efficacy of exenatide once weekly (EQW) compared with metformin (MET), pioglitazone (PIO), and sitagliptin (SITA) over 26 weeks, in suboptimally treated (diet and exercise) drug-naive patients with type 2 diabetes.RESEARCH DESIGN AND METHODSPatients were randomized to subcutaneous (SC) EQW 2.0 mg + oral placebo (n = 248), MET 2,000 mg/day + SC placebo (n = 246), PIO 45 mg/day + SC placebo (n = 163), or SITA 100 mg/day + SC placebo (n = 163) for 26 weeks. MET and PIO therapies were increased to maximum-tolerated dosages. Injections with EQW or placebo were administered weekly, while oral medication or placebo was administered daily.RESULTSBaseline characteristics were as follows: 59% men, 67% Caucasian, mean age 54 years, HbA1c 8.5%, fasting serum glucose 9.9 mmol/L, body weight 87.0 kg, and diabetes duration 2.7 years. HbA1c reductions (%) at 26 weeks (least-squares means) with EQW versus MET, PIO, and SITA were −1.53 vs. −1.48 (P = 0.620), −1.63 (P = 0.328), and −1.15 (P < 0.001), respectively. Weight changes (kg) were −2.0 vs. −2.0 (P = 0.892), +1.5 (P < 0.001), and −0.8 (P < 0.001), respectively. Common adverse events were as follows: EQW, nausea (11.3%) and diarrhea (10.9%); MET, diarrhea (12.6%) and headache (12.2%); PIO, nasopharyngitis (8.6%) and headache (8.0%); and SIT, nasopharyngitis (9.8%) and headache (9.2%). Minor (confirmed) hypoglycemia was rarely reported. No major hypoglycemia occurred.CONCLUSIONSEQW was noninferior to MET but not PIO and superior to SITA with regard to HbA1c reduction at 26 weeks. Of the agents studied, EQW and MET provided similar improvements in glycemic control along with the benefit of weight reduction and no increased risk of hypoglycemia.

This study evaluated the long-term safety and efficacy of dapagliflozin as an adjunct to adjustable insulin in patients with type 1 diabetes and inadequate glycemic control. RESEARCH DESIGN AND METHODS DEPICT-1 (Dapagliflozin Evaluation in Patients With Inadequately Controlled Type 1 Diabetes) was a randomized (1:1:1), double-blind, placebo-controlled phase 3 study of dapagliflozin 5 mg and 10 mg in patients with type 1 diabetes (HbA 1c 7.5-10.5% [58-91 mmol/mol]) (NCT02268214). The results of the 52-week study, consisting of the 24-week short-term and 28-week extension period, are reported here. RESULTS Of the 833 patients randomized into the study, 708 (85%) completed the 52-week study. Over 52 weeks, dapagliflozin 5 mg and 10 mg led to clinically significant reductions in HbA 1c (difference vs. placebo [95% CI] 20.

( Χ =36,94, dp=15,14). Encontrou-se correlação significativa entre o autocuidado e a hemoglobina glicolisada (HbA1c) (r s = -0,379, p<0,001), triglicerídeos (r s = -0,208, p=0,040), IMC (r s = -0,248, p=0,014) e gordura corporal (r s = -0,221, p=0,029). A análise multivariada revelou influência do autocuidado em HbA1c, IMC e gordura corporal com variâncias explicadas de 9 a 41% (p<0,05). Das dimensões do autocuidado, a dieta foi o principal fator de predição moderado pelo gênero e a compreensão dos conceitos sobre o diabetes (p<0,05).Descritores: Autocuidado; Indicadores Basicos de Saúde; Diabetes Mellitus Tipo 2. Conductas de autocuidado e indicadores de salud en adultos con diabetes tipo 2Se trata de un estudio descriptivo y correlacional que tuvo como objetivo analizar las conductas de autocuidado y su relación con indicadores de salud, representados por el control de la glucemia, perfil de lípidos, IMC, circunferencia de cintura y porcentaje de grasa corporal, en una muestra aleatoria de 98 adultos con diabetes tipo 2 de un zona -0,221, p=0,029). El análisis multivariado reveló influencia del autocuidado en HbA1c, IMC y grasa corporal con varianzas explicadas de 9% a 41% (p <0,05). De los factores del autocuidado, la dieta fue el principal factor de predicción moderado por el género y la comprensión de los aspectos de la diabetes (p<0,05).

Abstract. The standard explicit time scheme (e.g. the central difference method) in finite element analysis is not able to keep accuracy of stress distribution through meshes with different local Courant numbers for each finite element. Therefore in this paper, we suggest and test a two-time step explicit scheme with local time stepping for direct time integration in finite element analysis of wave propagation in heterogeneous solids. The nominated two-time step scheme with the diagonal mass matrix is based on the modification of the central difference method with pullback interpolation and local time stepping. It means that we integrate stress situation on each finite element with local stable time step size. With local time stepping, it is possible to track more accurately a movement of wavefronts for finite element meshes with different local Courant numbers. We present numerical examples of one-dimensional wave propagation in layered and graded elastic bars under shock loading. Based on numerical tests, the presented time scheme is able to eliminate spurious oscillations in stress distribution in numerical modelling of shock wave propagation in heterogeneous materials.