Baseline Characteristics of Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: Findings from the J-DISCOVER Study

Katakami, Naoto; Mita, Tomoya; Takahara, Mitsuyoshi; Yajima, Toshitaka; Wada, Fumitaka; Kawashima, Masaru; Shimomura, Iichiro; Watada, Hirotaka

doi:10.1007/s13300-020-00846-6

Cited by 9 publications

(9 citation statements)

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“…Baseline data for the patients who were followed for the full 3-year study period were not significantly different from previously published data from a patient population with a 2-year follow-up [14]. The mean age of patients at baseline was 61.6 ± 12.8 years and 61.8% of patients were male (Supplemental Table S1).…”

Section: Baseline Patient Characteristicsmentioning

confidence: 68%

“…Second-line treatment was defined as adding or switching to a second oral or parenteral antidiabetic medication after first-line oral monotherapy. Definitions and diagnostic criteria for T2DM, objectives of J-DISCOVER, and the full inclusion and exclusion criteria for the study have been reported in detail elsewhere [ 11 , 14 ]. Standard treatment targets for HbA1c, body mass index (BMI), systolic blood pressure (SBP)/diastolic blood pressure (DBP), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were based on the JDS guidelines [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

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Three-Year Glycaemic Control and Management in Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER

et al. 2021

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Introduction: J-DISCOVER is a prospective, observational cohort study that aimed to understand characteristics, glycaemic control, comorbidities and real-world management of patients with early-stage type 2 diabetes mellitus (T2DM) in Japan, by enrolling patients initiating second-line treatment from both diabetes specialist and non-specialist care settings. Methods: As part of the global DISCOVER programme, J-DISCOVER enrolled 1798 patients with T2DM aged at least 20 years old from 142 sites across Japan, from September 2014 to December 2015, and followed these patients for 3 years. Glycaemic control, body mass index (BMI), blood pressure, lipid profiles, treatment patterns, and prevalence of CKD and retinopathy were examined from baseline to 6, 12, 24 and 36 months, stratified by class of second-line treatment.Results: At baseline, the median time after T2DM diagnosis was 3.1 years and mean glycated haemoglobin (HbA1c) was 7.7%. The mean individualized HbA1c target was 6.7 ± 0.5%, and 55.3% of patients were set the target of \ 7.0%. HbA1c reductions were noted from 6 months and mean HbA1c was 7.1% at 36 months. The proportion of patients with HbA1c \ 7.0% increased from 28.8% at baseline to 53.3% at 36 months, and the achievement rate of individualized HbA1c targets increased from 6.1% to 30.3%. Only two cases of severe hypoglycaemia occurred during the study. No major changes in BMI, blood pressure, lipid profile or prescription of antihypertensive or dyslipidaemia medications were observed. The frequencies of screening to detect retinopathy and chronic kidney disease (CKD) were 17.0-21.0% and 14.5-16.0%, respectively, during the follow-up period. The prevalence of CKD, but not retinopathy, increased over the follow-up period. Conclusions: This study provided an overview of the 3-year management of early-stage T2DM in patients initiating second-line treatment. Contemporary management improved

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Section: Baseline Patient Characteristicsmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Three-Year Glycaemic Control and Management in Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER

et al. 2021

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“…The healthcare systems differ between Japan and other countries, and the clinical characteristics differ between Japanese and Caucasian patients with T2DM [ 44 – 46 ]. In addition, biguanides are predominantly used as the first-line GLD in Western countries, whereas DPP4i are the most commonly prescribed initial GLD in Japan [ 47 , 48 ]. Considering these differences, the health economic impact of antidiabetic drugs in Japanese patients should be assessed using Japanese data.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Initiating Type 2 Diabetes Therapy with a Sodium–Glucose Cotransporter 2 Inhibitor Versus Conventional Therapy in Japan

et al. 2022

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Introduction Many patients with type 2 diabetes mellitus (T2DM) suffer from complications that impose substantial burdens on prognosis and medical costs. Accumulating evidence has demonstrated the clinical benefit of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular and renal complications. However, the health economic impact of SGLT2i remains unclear. The aim of this study was to evaluate the cost-effectiveness of initiating antidiabetic therapy with an SGLT2i using Japanese real-world data. Methods We constructed a natural history model incorporating heart failure (HF), myocardial infarction, stroke, chronic kidney disease, and end-stage renal disease (ESRD) as complications. The target population comprised patients with T2DM who newly initiated their first oral glucose-lowering drugs. By using a population-based microsimulation, we estimated the 10-year medical costs in Japanese yen (JPY) and outcomes (hospitalization for/development of complications and quality-adjusted life years [QALY]) for patients who initiated antidiabetic therapy with an SGLT2i or conventional therapy. Sensitivity analyses included a probabilistic sensitivity analysis (PSA) with 1,000,000 iterations. Results In the base-case analysis, the total medical cost per person was JPY 1,638,806 versus JPY 1,825,033 and the QALYs were 8.732 versus 8.513 for the SGLT2i strategy versus the conventional strategy, respectively. Thus, initiating treatment with an SGLT2i was dominant, more effective (QALY gain), and lower cost. When treating 10,000 patients, the SGLT2i strategy would reduce all-cause deaths by 410 (552 vs 962), HF events by 201 (897 vs 1098), and ESRD events by 16 (16 vs 32) versus the conventional strategy. The PSA revealed that the probability of dominance for initiating SGLT2i therapy was 90.5%, demonstrating the robustness of the results. Conclusion Our results suggest that initiating T2DM treatment with SGLT2i, aimed at managing cardiovascular and renal complications from the early stages of diabetes, can improve the clinical outcome and reduce cost burden of T2DM.

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“…Appropriate glycemic control in combination with multifactorial risk control is thus essential in order to avoid macrovascular complications that can lead to critical consequences in diabetic patients. Among multiple lines of anti-diabetic medications, dipeptidyl peptidase-4 inhibitors (DPP4i) are a major antidiabetic agent class in the United States 3 , European Union 4 , 5 and Japan 6 . Although accumulated experimental evidence has suggested an atheroprotective effects of DPP4 inhibition 7 – 9 , previous major large-scale cardiovascular outcome trials (CVOTs) of DPP4i which primarily aimed to establish their non-inferiority compared to conventional anti-diabetic therapy, have not demonstrated a clear benefit with respect to improving outcomes in populations which mainly consisted of diabetic individuals with a history of CV disease (secondary prevention) 10 – 13 .…”

Section: Introductionmentioning

confidence: 99%

Dipeptidyl peptidase-4 inhibitors reduced long-term cardiovascular risk in diabetic patients after percutaneous coronary intervention via insulin-like growth factor-1 axis

Chikata

Iwata

Miyosawa

et al. 2022

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Dipeptidyl-peptidase-4 inhibitors (DPP4i) have been the most used antidiabetic medications worldwide due to their good safety profiles and tolerability with a low risk of hypoglycemia, however, large cardiovascular outcome trials (CVOTs) have not shown any significant the prognostic superiority. On the contrary, since observational studies have suggested the effects of DPP4i are enhanced some populations, such as Asians and those who without overweight, their prognostic benefit is still under debate. The aim of this study was thus to assess the prognostic impact of DPP4i in patients with both diabetes and coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) through the insulin-like growth factor-1 (IGF-1) axis, a substrate of DPP4. This single-center analysis involved consecutive Japanese diabetic patients who underwent PCI for the first time between 2008 and 2018 (n = 885). Primary and secondary endpoints were set as cardiovascular (CV) death and the composite of CV death, non-fatal myocardial infarction and ischemic stroke (3P-MACE). Serum levels of IGF-1 and its main binding protein (insulin-like growth factor binding protein-3: IGFBP-3) were measured. In consequences, unadjusted Kaplan–Meier analyses revealed reduced incidences of CV-death and 3P-MACE by DPP4i, which was particularly enhanced in patients who were not overweight (BMI ≤ 25). Multivariate Cox hazard analyses consistently indicated reduced risks of CV death by DPP4i at PCI (hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.16–0.82, p = 0.01) and 3P-MACE (HR 0.47, 95% CI 0.25–0.84, p = 0.01), respectively. Moreover, elevated IGF-1 activity indicated by the IGF-1/IGFBP-3 ratio was associated with decreased risks of both endpoints and it was significantly higher in patients with DPP4i (p < 0.0001). In conclusion, the findings of the present study indicate beneficial effects of DPP4i to improve outcomes in Japanese diabetic patients following PCI, which might be mediated by DPP4–IGF-1 axis.

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Baseline Characteristics of Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: Findings from the J-DISCOVER Study

Cited by 9 publications

References 38 publications

Three-Year Glycaemic Control and Management in Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER

Three-Year Glycaemic Control and Management in Patients with Type 2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER

Cost-Effectiveness Analysis of Initiating Type 2 Diabetes Therapy with a Sodium–Glucose Cotransporter 2 Inhibitor Versus Conventional Therapy in Japan

Dipeptidyl peptidase-4 inhibitors reduced long-term cardiovascular risk in diabetic patients after percutaneous coronary intervention via insulin-like growth factor-1 axis

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