Type 2 Diabetes Mellitus Management in Canada: Is It Improving?

Leiter, Lawrence A.; Berard, Lori; Bowering, C. Keith; Cheng, Alice; Dawson, Keith; Ekoé, Jean‐Marie; Fournier, Carl; Goldin, Lianne; Harris, Stewart B.; Lin, Peter; Ransom, Thomas; Tan, Mary; Teoh, Hwee; Tsuyuki, Ross T.; Whitham, Dana; Woo, Vincent; Yale, Jean‐François; Langer, Anatoly

doi:10.1016/j.jcjd.2013.02.055

Cited by 141 publications

(114 citation statements)

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“…The fact that the HbA 1c levels in both arms remained above target is not surprising given the consistent demonstration that guidelines-recommended HbA 1c goals are rarely achieved in practice (40)(41)(42). Furthermore, newer guidelines now endorse personalizing diabetes management for the elderly patient in whom the general HbA 1c goal of ,7.0% (53 mmol/mol) may or may not be appropriate (5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Saxagliptin in Older Participants in the SAVOR-TIMI 53 Trial

Leiter

Teoh²,

Braunwald

et al. 2015

Diabetes Care

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OBJECTIVETo examine the safety and cardiovascular (CV) effects of saxagliptin in the predefined elderly ( ‡65 years) and very elderly ( ‡75 years) subpopulations of the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) trial. RESEARCH DESIGN AND METHODSIndividuals ‡40 years (n = 16,492; elderly, n = 8,561; very elderly, n = 2,330) with HbA 1c ‡6.5% (47.5 mmol/mol) and £12.0% (107.7 mmol/mol) were randomized (1:1) to saxagliptin (5 or 2.5 mg daily) or placebo in a double-blind trial for a median follow-up of 2.1 years. RESULTSThe hazard ratio (HR) for the comparison of saxagliptin versus placebo for the primary end point (composite of CV mortality, myocardial infarction, or ischemic stroke) was 0.92 for elderly patients vs. 1.15 for patients <65 years (P = 0.06) and 0.95 for very elderly patients. The HRs for the secondary composite end points in the entire cohort, elderly cohort, and very elderly cohort were similar. Although saxagliptin increased the risk of hospitalization for heart failure in the overall saxagliptin population, there was no age-based treatment interaction (P = 0.76 for elderly patients vs. those <65 years; P = 0.34 for very elderly patients vs. those <75 years). Among saxagliptin-treated individuals with baseline HbA 1c ‡7.6% (59.6 mmol/mol), the mean change from baseline HbA 1c at 2 years was 20.69%, 20.64%, 20.66%, and 20.66% for those ‡65, <65, ‡75, and <75 years old, respectively. The incidence of overall adverse events (AEs) and serious AEs was similar between saxagliptin and placebo in all cohorts; however, hypoglycemic events were higher for saxagliptin versus placebo regardless of age. CONCLUSIONSThe SAVOR-TIMI 53 trial supports the overall CV safety of saxagliptin in a robust number of elderly and very elderly participants, although the risk of heart failure hospitalization was increased irrespective of age category. AEs and serious AEs as well as glycemic efficacy of saxagliptin in elderly patients are similar to those found in younger patients.Estimates place the global prevalence of diabetes in individuals between 60 and 79 years old at ;19%, with the number of these individuals projected to almost double by 2035 (1). Despite ongoing emphasis on the importance of practicing evidencebased medicine (2), older patients have been underrepresented in type 2 diabetes

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Saxagliptin in Older Participants in the SAVOR-TIMI 53 Trial

Leiter

Teoh²,

Braunwald

et al. 2015

Diabetes Care

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“…A1C ≤7.0% was met by approximately 50% of 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. (33) An important factor in diabetes risk and poor glycemic control is overweight and obesity. (3) Most studies done in gulf countries showed that only a few rate of diabetic patients have been of normal body weight.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to body weight among diabetic patients in Canada, the results are near to those reported in gulf countries in which 14%, 29% and 57% of patients were within the normal weight range, overweight and obese, respectively. (33) Although the adherence to lifestyle changes among diabetic patients is important in the management, low rate of adherence was reported in some studies. One study found a high rate of poor adherence to diet (68%) and poor adherence to exercise (79.4%).…”

Section: Discussionmentioning

confidence: 99%

“…diet, physical activity, medication, blood glucose monitoring) was the most commonly found barrier to managing type 2 diabetes patients in Canada. (33) Some studies showed no difference in glycemic control between male and female patients, (13) while others demonstrated better control among females. (5,15,18) The adherence to lifestyle changes appeared better among males in some studies.…”

Section: Discussionmentioning

confidence: 99%

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Glycemic Control among Patients with Type 2 Diabetes Mellitus in Countries of Arabic Gulf

Alrasheedi¹

2015

IJHS

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Type 2 diabetes mellitus is a growing, worldwide public health concern. The countries of Arabic Gulf appear to have a higher prevalence of diabetes than the global average. The recent and rapid socio-economic development of these countries has been associated with this rising prevalence. Although the rate of type 2 diabetes management based on glycosylated hemoglobin level in the countries of Arabic Gulf is labeled as poor, the outcomes are almost similar to those reported from elsewhere. Unfortunately, overweight and obesity are driving the global diabetes epidemic. A minority of patients with type 2 diabetes had a normal body weight which might make the control of diabetes difficult. Anyhow, Greater efforts are urgently needed to properly manage diabetes early in order to prevent short and long-term complications. Practical strategies aimed at more effective management of type 2 diabetes patients are strongly needed.

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“…The main goal in clinical practice for management of diabetes regarding blood glucose, lipid and blood pressure is to achieve predefined levels according to the practice guidelines to reduce the burden of illness and complications due to diabetes [1][2][3]. Numerous studies have demonstrated that a large proportion of patients with diabetes in the community do not reach the predefined goals for optimal management of blood glucose, lipids and blood pressure [4][5][6]. This failure to attain therapeutic goals has been reported in several studies from around the globe, despite different patient populations, different clinical practice guidelines and different time frames [7].…”

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confidence: 99%

Sex/Gender -Based Pharmacology and Statin Utilization Amongst Elderly Patients with Diabetes

Farahani

Johnson²,

Whitehead³

et al. 2015

CIM

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Purpose: The purpose of this study was to explore the ten-year trends in utilization of bioequivalent doses of statin amongst elderly patients with diabetes according to sex/ gender in Ontario, Canada. Methods:A cohort of patients with diabetes (>65 years) was constructed using the Ontario Diabetes Database Statin utilization data (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) was obtained from the Ontario Drug Benefit Program for both women and men. Bioequivalent doses for statins were calculated according to the dosing conversion factor in therapeutic interchange programs in clinical practice. Utilization pattern of high potency (Atorvastatin and Rosuvastatin) vs. low potency statins (Simvastatin, Lovastatin, Fluvastatin, Pravastatin) were also analyzed. Results:The average bioequivalent Simvastatin utilization in 2003 was 29.22 mg/day for women and 30.35 mg/day for men. By 2008, this gap in dosing was higher for both women and men and by 2013 it had increased to 47.75 mg/day for women and 52.98 mg/day for men. For average number of day supply per year, there was no significant trend of changes over the 10-year period, although the use of high potency statins increased significantly (P<0.001) for both women and men. No differences were seen for sex/gender; either for the 10-year period or for each year.Conclusions: There has been significant increase in bioequivalent statin utilization amongst elderly patients with diabetes in Ontario; for both men and women. In a publiclyfunded healthcare system such as Ontario, there were no sex/gender differences in the utilization of high potency statin (Atorvastatin and Rosuvastatin) amongst elderly patient with diabetes.

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Type 2 Diabetes Mellitus Management in Canada: Is It Improving?

Cited by 141 publications

References 22 publications

Efficacy and Safety of Saxagliptin in Older Participants in the SAVOR-TIMI 53 Trial

Efficacy and Safety of Saxagliptin in Older Participants in the SAVOR-TIMI 53 Trial

Glycemic Control among Patients with Type 2 Diabetes Mellitus in Countries of Arabic Gulf

Sex/Gender -Based Pharmacology and Statin Utilization Amongst Elderly Patients with Diabetes

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