Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach

Inzucchi, Silvio E.; Bergenstal, Richard M.; Buse, John B.; Diamant, Michaëla; Ferrannini, Ele; Nauck, Michael A.; Peters, Anne L.; Τσάπας, Απόστολος; Wender, Richard C.; Matthews, David R.

doi:10.2337/dc12-0413

Cited by 3,096 publications

(2,782 citation statements)

References 134 publications

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“…First, these findings well documented the cardiovascular safety of SGLT2 inhibitors and provided strong support for the clinical use of these drugs, either as alternative therapy or as adjuncts to metformin, other oral antiglycemic agents, or insulin 37. Second, our findings strongly supported a new concept that was previously ignored by most cardiologists38: Selective glucose‐lowering treatment with SLGT2 inhibitors—for example, blood pressure‐lowering treatment with the use of renin–angiotensin–aldosterone system inhibitors or β‐blockers, lipid‐lowering therapy with statins or ezetimibe or PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, and anticoagulant treatment with acetylsalicylic acid—could significantly improve the cardiovascular outcomes of diabetic patients with established CVD or with high cardiovascular risk 39, 40.…”

Section: Discussionmentioning

confidence: 75%

Cardiovascular Safety, Long‐Term Noncardiovascular Safety, and Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta‐Analysis With Trial Sequential Analysis

Zhang

Zhu

Chen

et al. 2018

JAHA

108

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BackgroundThe cardiovascular and long‐term noncardiovascular safety and efficacy of SGLT2 (sodium–glucose cotransporter 2) inhibitors have not been well documented.Methods and ResultsFor cardiovascular outcomes, we performed a meta‐analysis with trial sequential analysis of randomized controlled trials and adjusted observational studies, each with a minimum of 26 weeks and 2000 patient‐years of follow‐up. For long‐term noncardiovascular safety and efficacy outcome analyses, we included only randomized controlled trials with at least 2 years and 1000 patient‐years of follow‐up. Five studies with 351 476 patients were included in cardiovascular outcomes analysis. Meta‐analyses showed that SGLT2 inhibitors significantly reduced the risks of major adverse cardiac events (hazard ratio [HR]: 0.80; 95% confidence interval [CI], 0.69–0.92; P=0.002), all‐cause mortality (HR: 0.67; 95% CI, 0.54–0.84; P<0.001), cardiovascular mortality (HR: 0.77; 95% CI, 0.60–0.98; P=0.03), nonfatal myocardial infarction (HR: 0.86; 95% CI, 0.76–0.98; P=0.02), hospitalization for heart failure (HR: 0.62; 95% CI, 0.55–0.69; P<0.001), and progression of albuminuria (HR: 0.68; 95% CI, 0.58–0.81; P<0.001). No significant difference in nonfatal stroke was found. Analyses limited to randomized controlled trials showed similar findings. Trial sequential analysis provided firm evidence of a 20% reduction in major adverse cardiac events, all‐cause mortality, and hospitalization for heart failure with SGLT2 inhibitors, but evidence remains inconclusive for cardiovascular mortality. Nine randomized controlled trials contributed to long‐term noncardiovascular and efficacy analyses. SGLT2 inhibitors reduced incidence of hypoglycemia and acute kidney injury but increased the risks of urinary tract and genital infections.Conclusions SGLT2 inhibitors showed remarkable cardiovascular‐ and renal‐protective effects and good long‐term noncardiovascular safety with sustained efficacy.

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Section: Discussionmentioning

confidence: 75%

Cardiovascular Safety, Long‐Term Noncardiovascular Safety, and Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta‐Analysis With Trial Sequential Analysis

Zhang

Zhu

Chen

et al. 2018

JAHA

108

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“…An additional 23% ( n = 12) reported taking oral agents alone, and 12% ( n = 6) patients reported having DM but denied taking any glucose‐lowering medications. To determine the extent to which adverse effects commonly associated with glucose‐lowering agents22 might impact outcomes in FA, we tabulated the number of participants taking these medications who reported commonly associated adverse effects. No patients reported hypoglycemia.…”

Section: Resultsmentioning

confidence: 99%

Impact of diabetes in the Friedreich ataxia clinical outcome measures study

McCormick

Farmer

Perlman

et al. 2017

Ann Clin Transl Neurol

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ObjectiveFriedreich ataxia (FA) is a progressive neuromuscular disorder caused by GAA triplet repeat expansions or point mutations in the FXN gene. FA is associated with increased risk of diabetes mellitus (DM). This study assessed the age‐specific prevalence of FA‐associated DM and its impact on neurologic outcomes.Research Design and MethodsParticipants were 811 individuals with FA from 12 international sites in a prospective natural history study (FA Clinical Outcome Measures Study, FACOMS). Physical function was assessed, using validated instruments. Multivariable regression analyses examined the independent association of DM with outcomes.ResultsMean age of participants was 30.1 years (SD 15.3, range: 7–82), 50% were female, and 94% were non‐Hispanic white. 9% (42/459) of adults and 3% (10/352) of children had DM. Individuals with FA‐associated DM were older (P < 0.001), had longer GAA repeat length on the least affected FXN allele (P = 0.037), and more severe FA (P = 0.0001). Of individuals with DM, 65% (34/52) were taking insulin. Even after accounting statistically for both age and GAA repeat length, DM was independently associated with greater FA symptom burden (P = 0.010), reduced capacity to perform activities of daily living (P = 0.021), and a decrease of 0.33 SDs on a composite performance measure (95% CI: −0.56–0.11, P = 0.004); the relative impact of DM was most apparent in younger individuals.Conclusions DM‐associated FA has an independent adverse impact on well‐being in affected individuals, particularly at younger ages. In future, evidence‐based approaches for identification and management of FA‐related DM may improve both health and function.

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“…The statement of the American Diabetes Association and the European Association for the Study of Diabetes (ADA/EASD) emphasized the importance of the timely addition of basal insulin in patients with type 2 diabetes after OAD18, 19. The clinical trials showed that the use of basal insulin as an add‐on to OAD in patients with type 2 diabetes achieved 7% HbA1c, and approximately half of the patients experienced symptomatic hypoglycemia20, 21, 22, 23, 24.…”

Section: Introductionmentioning

confidence: 99%

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Chien

Chen²,

Hung

et al. 2016

J of Diabetes Invest

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Aims/IntroductionThe aim of the present study was to assess the glycemic control, adherence and treatment satisfaction in a real‐world setting with basal insulin therapy in type 2 diabetes patients in Taiwan.Materials and MethodsThis was a multicenter, prospective, observational registry. A total of 836 patients with type 2 diabetes taking oral antidiabetic drugs with glycated hemoglobin (HbA1c) >7% entered the study. Basal insulin was given for 24 weeks. All treatment choices and medical instructions were at the physician's discretion to reflect real‐life practice.ResultsAfter 24‐week treatment, 11.7% of patients reached set HbA1c goals without severe hypoglycemia (primary effectiveness end‐point). HbA1c and fasting blood glucose were significantly decreased from (mean ± SD) 10.1 ± 1.9% to 8.7 ± 1.7% (−1.4 ± 2.1%, P < 0.0001) and from 230.6 ± 68.8 mg/dL to 159.1 ± 55.6 mg/dL (−67.4 ± 72.3 mg/dL, P < 0.0001), respectively. Patients received insulin therapy at a frequency of nearly one shot per day on average, whereas self‐monitoring of blood glucose was carried out approximately four times a week. Hypoglycemia was reported by 11.4% of patients, and only 0.7% of patients experienced severe hypoglycemia. Slight changes in weight (0.7 ± 2.4 kg) and a low incidence of adverse drug reactions (0.4%) were also noted. The score of 7‐point treatment satisfaction rated by patients was significantly improved by 1.9 ± 1.7 (P < 0.0001).ConclusionsBasal insulin therapy was associated with a decrease in HbA1c and fasting blood glucose, and an improved treatment satisfaction. Most patients complied with physicians' instructions. The treatment was generally well tolerated by patients with type 2 diabetes, but findings pointed out the need to reinforce the early and appropriate uptitration to achieve treatment targets.

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Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach

Cited by 3,096 publications

References 134 publications

Cardiovascular Safety, Long‐Term Noncardiovascular Safety, and Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta‐Analysis With Trial Sequential Analysis

Cardiovascular Safety, Long‐Term Noncardiovascular Safety, and Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta‐Analysis With Trial Sequential Analysis

Impact of diabetes in the Friedreich ataxia clinical outcome measures study

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

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