8. Pharmacologic Approaches to Glycemic Treatment: <i>Standards of Medical Care in Diabetes—2018</i>

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doi:10.2337/dc18-s008

Cited by 632 publications

(327 citation statements)

References 60 publications

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“…However, some studies have reported that intensive glycemic control may not be enough to stop rapid deterioration in renal function in late CKD [30]. Our diabetic patients had good control of glucose that glycated hemoglobin level was under the recommendation value by American Diabetes Association (ADA) [31]. Therefore, we performed subgroup analysis to examine the effect of glycated hemoglobin on the association between serum Angpt2 and adverse renal outcomes in patients with diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Angiopoietin-2, Renal Deterioration, Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Diabetic Nephropathy

Tsai¹,

Lee²,

Chiu³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Diabetic nephropathy is the leading cause of end-stage renal disease and accounts for 30∼40% of patients requiring maintenance dialysis, thereby increasing the burden on health insurance programs. Diabetic nephropathy is also the strongest predictor of cardiovascular morbidity and mortality. The aim of this study was to examine whether angiopoietin-2 (Angpt2), a modulator of endothelial function, affects the clinical outcomes of diabetic patients. Methods: This study enrolled 236 patients with diabetes mellitus with estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m² from January 2006 to December 2011, who were followed until June 2017. Clinical outcomes included renal outcomes (commencing dialysis and rapid decline in renal function (eGFR decline > 3 ml/min per 1.73 m²/year)), major adverse cardiovascular events (MACEs), and all-cause mortality. Results: Over a mean follow-up period of 3.9±2.7 years, 135 (57.2%) patients commenced dialysis, 106 (44.9%) had rapid decline in renal function, and 50 (21.2%) had MACEs or died from all-causes. Log-formed Angpt2 was significantly associated with increased risks of commencing dialysis (HR: 3.91, 95% CI: 1.56-9.76), rapid renal function decline (OR: 6.81, 95% CI: 1.06-43.88), and MACEs or all-cause mortality (HR: 6.34, 95% CI: 1.18-33.97) in the adjusted analysis. Patients in the highest quartile had hazard ratios of 2.90 and 3.11 for commencing dialysis and rapid renal function decline, respectively, compared to those in the lowest quartile after adjustments. Similar significant dose-response results were found in composite outcomes of either MACEs or all-cause mortality. Conclusion: Angpt2 is an independent predictor of adverse clinical outcomes in diabetic patients. Further studies are needed to identify the pathogenic role of Angpt2 in renal deterioration and cardiovascular complications of diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Angiopoietin-2, Renal Deterioration, Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Diabetic Nephropathy

Tsai¹,

Lee²,

Chiu³

et al. 2018

Kidney Blood Press Res

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“…There was lower use of metformin in older adult visits, particularly for those individuals aged 75 years or older, likely due in part to a higher prevalence of chronic kidney disease among older adults, which is the major contraindication to metformin use. 8,29,30 In 2016, the US Food and Drug Administration adopted less restrictive guidelines on the use of metformin in chronic kidney disease. 31 Future studies should examine the impact of this change.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that GLP-1 receptor agonists are less desirable for older patients due to their side-effect profile or injectable mode of administration. 8,32 …”

Section: Discussionmentioning

confidence: 99%

“…4– 6 Older adults with diabetes often have multiple comorbid conditions that may present medication contraindications or interactions that limit the use of certain pharmacologic classes. 4–8 Functional and cognitive limitations become more common with aging which could limit the use of complex regimens. 4–6,9 Further, preventing hypoglycemia is critical for older patients, and guidelines recommend avoiding medications with the highest hypoglycemia risk, particularly long-acting sulfonylureas and sliding-scale insulin.…”

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confidence: 99%

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Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Pilla

Segal

Alexander

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES: The treatment of type 2 diabetes in older adults requires special considerations including avoidance of hypoglycemia, yet variation in diabetes treatment with aging is not well understood. In this study, we compared nationally representative diabetes treatment patterns and trends between older adults (≥65 y) and younger adults (30–64 y). DESIGN: Repeated cross-sectional physician surveys from 2006 to 2015. SETTING: The National Ambulatory Medical Care Survey, an annual probability sample of visits to office-based US physicians. PARTICIPANTS: Adults with type 2 diabetes using one or more diabetes medications. MEASUREMENTS: Proportions of visits in which patients treated with each diabetes medication class were compared between older and younger adults in 2-year intervals. RESULTS: From 2006 to 2015, the average number of yearly visits for older and younger adults was 25.4 million and 24.2 million, respectively. In 2014–2015, visits for older compared with younger adults involved less use of metformin (56.0% vs 70.0%; p < .001) and glucagon-like peptide 1 receptor agonists (2.9% vs 6.2%; p = .004), and more use of long-acting insulin (30.2% vs 22.4%; p = .017); other classes were used similarly. During the study period, long-acting insulin use increased markedly in older adults, particularly between 2010 and 2015 where it rose from 12.5% to 30.2% of visits (P-trend <.001). In younger adult visits, long-acting insulin use increased modestly (17.2% to 22.4%) and at a slower rate compared with older adult visits (p < .001). CONCLUSION: The ambulatory treatment of type 2 diabetes differs between older and younger adults, with the treatment of older adults characterized by low use of newer diabetes medications and a greater and rapidly increasing use of long-acting insulin. These findings call for further research clarifying the comparative effectiveness and safety of newer diabetes medications and long-acting insulin to optimize diabetes care for older patients.

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“…4 - 7 For this reason, these should be the drugs of choice to be used in combination with metformin in patients with established cardiovascular diseases according to the American Diabetes Association recommendations. 8 Nevertheless, few studies have been conducted on patients with recently diagnosed diabetes and low prevalence of cardiovascular diseases.…”

mentioning

confidence: 99%

VEGFR-2: One of Pioglitazone's Signaling Pathways in the Heart

Minicucci

Zornoff

2018

Arquivos Brasileiros De Cardiologia

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8. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018

Cited by 632 publications

References 60 publications

Angiopoietin-2, Renal Deterioration, Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Diabetic Nephropathy

Angiopoietin-2, Renal Deterioration, Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Diabetic Nephropathy

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

VEGFR-2: One of Pioglitazone's Signaling Pathways in the Heart

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