المؤلفون: Björn Eliasson, Andrew J. Palmer, Ann-Marie Svensson, Josh Knight, Thomas Lung, Philip Clarke, An Tran-Duy, Dennis Petrie, William H. Herman

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Male, Research design, medicine.medical_specialty, Adolescent, Cost-Benefit Analysis, Endocrinology, Diabetes and Metabolism, Statistics as Topic, Population, 030209 endocrinology & metabolism, Cohort Studies, Diabetes Complications, Young Adult, 03 medical and health sciences, Life Expectancy, 0302 clinical medicine, Risk Factors, Internal Medicine, Humans, Medicine, Longitudinal Studies, Registries, 030212 general & internal medicine, Epidemiology/Health Services Research, Risk factor, Child, education, Sweden, Advanced and Specialized Nursing, Type 1 diabetes, education.field_of_study, Proportional hazards model, business.industry, Absolute risk reduction, Middle Aged, Models, Theoretical, Prognosis, medicine.disease, Patient Outcome Assessment, Diabetes Mellitus, Type 1, Emergency medicine, Linear Models, Life expectancy, Female, business, Cohort study

الوصف: OBJECTIVE To develop a patient-level simulation model for predicting lifetime health outcomes of patients with type 1 diabetes and as a tool for economic evaluation of type 1 diabetes treatment based on data from a large, longitudinal cohort. RESEARCH DESIGN AND METHODS Data for model development were obtained from the Swedish National Diabetes Register. We derived parametric proportional hazards models predicting absolute risk of diabetes complications and death based on a wide range of clinical variables and history of complications. We used linear regression models to predict risk factor progression. Internal validation was performed, estimates of life expectancies for different age-sex strata were computed, and the impact of key risk factors on life expectancy was assessed. RESULTS The study population consisted of 27,841 patients with type 1 diabetes with a mean duration of follow-up of 7 years. Internal validation showed good agreement between predicted and observed cumulative incidence of death and 10 complications. Simulated life expectancy was approximately 13 years lower than that of the sex- and age-matched general population, and patients with type 1 diabetes could expect to live with one or more complications for approximately 40% of their remaining life. Sensitivity analysis showed the importance of preventing renal dysfunction, hypoglycaemia and hyperglycaemia, and lowering HbA1c in reducing the risk of complications and death. CONCLUSIONS Our model was able to simulate risk factor progression and event histories that closely match the observed outcomes, and project events occurring over patients’ lifetimes. The model can serve as a tool to estimate the impact of changing clinical risk factors on health outcomes to inform economic evaluations of interventions in type 1 diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::337652e89f041fa27c77a8a3d1ce12f3Test
https://doi.org/10.2337/dc19-2249Test

المؤلفون: Adam Hulman, Marit E. Jørgensen, Stuart J. McGurnaghan, Dorte Vistisen, Reimar W. Thomsen, Jan Erik Henriksen, Peter Rossing, Helen M. Colhoun, Frederik Persson, Gregers S. Andersen

المصدر: Vistisen, D, Andersen, G S, Hulman, A, McGurnaghan, S J, Colhoun, H M, Henriksen, J E, Thomsen, R W, Persson, F, Rossing, P & Jørgensen, M E 2021, ' A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes ', Diabetes Care, vol. 44, no. 3, dc202586. . https://doi.org/10.2337/dc20-2586Test
Vistisen, D, Andersen, G S, Hulman, A, McGurnaghan, S J, Colhoun, H M, Henriksen, J E, Thomsen, R W, Persson, F, Rossing, P & Jørgensen, M E 2021, ' A validated prediction model for end-stage kidney disease in type 1 diabetes ', Diabetes Care, vol. 44, no. 4, pp. 901-907 . https://doi.org/10.2337/dc20-2586Test
Vistisen, D, Andersen, G S, Hulman, A, Mcgurnaghan, S J, Colhoun, H M, Henriksen, J E, Thomsen, R W, Persson, F, Rossing, P & Jørgensen, M E 2021, ' A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes ', Diabetes Care, vol. 44, no. 4, pp. 901-907 . https://doi.org/10.2337/dc20-2586Test
Vistisen, D, Andersen, G S, Hulman, A, McGurnaghan, S J, Colhoun, H M, Henriksen, J E, Thomsen, R W, Persson, F, Rossing, P & Jørgensen, M E 2021, ' A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes ', Diabetes Care, vol. 44, no. 4, pp. 901-907 . https://doi.org/10.2337/dc20-2586Test

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Population, Renal function, 030209 endocrinology & metabolism, Risk Assessment, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Interquartile range, Risk Factors, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Poisson regression, education, Advanced and Specialized Nursing, Glycated Hemoglobin, Type 1 diabetes, education.field_of_study, business.industry, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Cohort, symbols, Kidney Failure, Chronic, Female, business, Kidney disease, Glomerular Filtration Rate

الوصف: OBJECTIVE End-stage kidney disease (ESKD) is a life-threatening complication of diabetes that can be prevented or delayed by intervention. Hence, early detection of people at increased risk is essential. RESEARCH DESIGN AND METHODS From a population-based cohort of 5,460 clinically diagnosed Danish adults with type 1 diabetes followed from 2001 to 2016, we developed a prediction model for ESKD accounting for the competing risk of death. Poisson regression analysis was used to estimate the model on the basis of information routinely collected from clinical examinations. The effect of including an extended set of predictors (lipids, alcohol intake, etc.) was further evaluated, and potential interactions identified in a survival tree analysis were tested. The final model was externally validated in 9,175 adults from Denmark and Scotland. RESULTS During a median follow-up of 10.4 years (interquartile limits 5.1; 14.7), 303 (5.5%) of the participants (mean [SD] age 42.3 [16.5] years) developed ESKD, and 764 (14.0%) died without having developed ESKD. The final ESKD prediction model included age, male sex, diabetes duration, estimated glomerular filtration rate, micro- and macroalbuminuria, systolic blood pressure, hemoglobin A1c, smoking, and previous cardiovascular disease. Discrimination was excellent for 5-year risk of an ESKD event, with a C-statistic of 0.888 (95% CI 0.849; 0.927) in the derivation cohort and confirmed at 0.865 (0.811; 0.919) and 0.961 (0.940; 0.981) in the external validation cohorts from Denmark and Scotland, respectively. CONCLUSIONS We have derived and validated a novel, high-performing ESKD prediction model for risk stratification in the adult type 1 diabetes population. This model may improve clinical decision making and potentially guide early intervention.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5cf4729b5954603450330252c9f8d073Test
https://pubmed.ncbi.nlm.nih.gov/34016609Test

المؤلفون: Francisco J. Pasquel, Stephen R. Benoit, Giuseppina Imperatore, Ann L. Albright, Edward W. Gregg, Israel Hora

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Diabetic ketoacidosis, Adolescent, Endocrinology, Diabetes and Metabolism, Population, 030209 endocrinology & metabolism, Type 2 diabetes, History, 21st Century, Diabetic Ketoacidosis, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Patient Admission, Diabetes mellitus, Internal Medicine, medicine, National Health Interview Survey, Humans, 030212 general & internal medicine, Young adult, Epidemiology/Health Services Research, education, Advanced and Specialized Nursing, Type 1 diabetes, education.field_of_study, Inpatients, business.industry, Emergency department, History, 20th Century, Middle Aged, medicine.disease, United States, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Emergency medicine, Hyperglycemic Hyperosmolar Nonketotic Coma, Female, business, Emergency Service, Hospital

الوصف: OBJECTIVE To report U.S. national population-based rates and trends in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) among adults, in both the emergency department (ED) and inpatient settings. RESEARCH DESIGN AND METHODS We analyzed data from 1 January 2006 through 30 September 2015 from the Nationwide Emergency Department Sample and National Inpatient Sample to characterize ED visits and inpatient admissions with DKA and HHS. We used corresponding year cross-sectional survey data from the National Health Interview Survey to estimate the number of adults ≥18 years with diagnosed diabetes to calculate population-based rates for DKA and HHS in both ED and inpatient settings. Linear trends from 2009 to 2015 were assessed using Joinpoint software. RESULTS In 2014, there were a total of 184,255 and 27,532 events for DKA and HHS, respectively. The majority of DKA events occurred in young adults aged 18–44 years (61.7%) and in adults with type 1 diabetes (70.6%), while HHS events were more prominent in middle-aged adults 45–64 years (47.5%) and in adults with type 2 diabetes (88.1%). Approximately 40% of the hyperglycemic events were in lower-income populations. Overall, event rates for DKA significantly increased from 2009 to 2015 in both ED (annual percentage change [APC] 13.5%) and inpatient settings (APC 8.3%). A similar trend was seen for HHS (APC 16.5% in ED and 6.3% in inpatient). The increase was in all age-groups and in both men and women. CONCLUSIONS Causes of increased rates of hyperglycemic events are unknown. More detailed data are needed to investigate the etiology and determine prevention strategies.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1994979d7358d62de578492bb1cfa0e0Test
https://pubmed.ncbi.nlm.nih.gov/32161050Test

المؤلفون: John J. Isitt, Stéphane Roze, Mehdi Javanbakht, P. Lynch, Jayne Smith-Palmer

المصدر: Diabetes care. 43(10)

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, Cost effectiveness, Fingerstick, Endocrinology, Diabetes and Metabolism, Cost-Benefit Analysis, Population, 030209 endocrinology & metabolism, Glycemic Control, Hypoglycemia, State Medicine, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Life Expectancy, Quality of life, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Longitudinal Studies, education, Advanced and Specialized Nursing, Type 1 diabetes, education.field_of_study, business.industry, Blood Glucose Self-Monitoring, Middle Aged, medicine.disease, United Kingdom, Quality-adjusted life year, Self Care, Diabetes Mellitus, Type 1, Equipment and Supplies, Quality of Life, Female, Quality-Adjusted Life Years, business

الوصف: OBJECTIVEA long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in U.K.-based patients with type 1 diabetes (T1D).RESEARCH DESIGN AND METHODSThe analysis used the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with T1D. Simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol), and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the National Health Service health care payer perspective over a lifetime time horizon.RESULTSIn the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also pounds sterling (GBP) 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an incremental cost-effectiveness ratio of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality-of-life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use.CONCLUSIONSFor U.K.-based T1D patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG on the basis of a willingness-to-pay threshold of GBP 20,000 per QALY gained.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::38ea9fe8a461e9b9e882e8008aa8963cTest
https://pubmed.ncbi.nlm.nih.gov/32647050Test

المؤلفون: Luke A K Blackbourn, Helen M. Colhoun, Paul M. McKeigue, John M. McKnight, Stuart J. McGurnaghan, Anita Jeyam, Fiona Green, Andrew Collier

المصدر: 2020, ' Diabetic Neuropathy Is a Substantial Burden in People With Type 1 Diabetes and Is Strongly Associated With Socioeconomic Disadvantage : A Population-Representative Study From Scotland ', Diabetes Care . https://doi.org/10.2337/dc19-1582Test

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Diabetic neuropathy, Adolescent, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Population, 030209 endocrinology & metabolism, Vulnerable Populations, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Diabetic Neuropathies, Risk Factors, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Prevalence, Humans, 030212 general & internal medicine, Risk factor, education, Advanced and Specialized Nursing, Type 1 diabetes, education.field_of_study, business.industry, Odds ratio, Middle Aged, medicine.disease, Peripheral neuropathy, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Scotland, Socioeconomic Factors, Female, business

الوصف: OBJECTIVE To assess the contemporaneous prevalence of diabetic peripheral neuropathy (DPN) in people with type 1 diabetes (T1D) in Scotland and study its cross-sectional association with risk factors and other diabetic complications. RESEARCH DESIGN AND METHODS We analyzed data from a large representative sample of adults with T1D (N = 5,558). We assessed the presence of symptomatic neuropathy using the dichotomized (≥4) Michigan Neuropathy Screening Instrument Patient Questionnaire score. Logistic regression models were used to investigate associations between DPN and risk factors, as well as with other complications. RESULTS The burden of DPN is substantial with 13% prevalence overall. Adjusting for attained age, diabetes duration, and sex, the odds of DPN increased mainly with waist-to-hip ratio, lipids, poor glycemic control (odds ratio 1.51 [95% CI 1.21–1.89] for levels of 75 vs. 53 mmol/mol), ever versus never smoking (1.67 [1.37–2.03]), and worse renal function (1.96 [1.03–3.74] for estimated glomerular filtration rate levels CONCLUSIONS Diabetic neuropathy remains substantial, particularly affecting those in the most socioeconomically deprived groups. Those with clinically manifest neuropathy also have a higher burden of other complications and elevated levels of modifiable risk factors. These data suggest that there is considerable scope to reduce neuropathy rates and narrow the socioeconomic differential by better risk factor control.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a3f5e570204110e0a0a266324ec13b35Test
https://pubmed.ncbi.nlm.nih.gov/32198282Test

المؤلفون: Parmida Zarei, Aviva G. Nathan, Wen Wan, Elbert S. Huang, Aaron N. Winn, Michael J. O'Grady, Alexa Minc, M. Reza Skandari

المصدر: Diabetes Care. 41:1227-1234

مصطلحات موضوعية: Adult, Blood Glucose, Male, Pediatrics, medicine.medical_specialty, endocrine system diseases, Emerging Technologies and Therapeutics, Cost effectiveness, Cost-Benefit Analysis, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Population, Monitoring, Ambulatory, 030209 endocrinology & metabolism, Hypoglycemia, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Diabetes mellitus, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Insulin, 030212 general & internal medicine, education, Aged, Glycemic, Advanced and Specialized Nursing, education.field_of_study, Type 1 diabetes, business.industry, Blood Glucose Self-Monitoring, nutritional and metabolic diseases, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Female, business

الوصف: OBJECTIVE This study evaluated the societal cost-effectiveness of continuous glucose monitoring (CGM) in patients with type 1 diabetes (T1D) using multiple insulin injections. RESEARCH DESIGN AND METHODS In the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial, 158 patients with T1D and HbA1c ≥7.5% were randomized in a 2:1 ratio to CGM or control. Participants were surveyed at baseline and 6 months. Within-trial and lifetime cost-effectiveness analyses were conducted. A modified Sheffield T1D policy model was used to simulate T1D complications. The main outcome was cost per quality-adjusted life-year (QALY) gained. RESULTS Within the 6-month trial, the CGM group had similar QALYs to the control group (0.462 ± 0.05 vs. 0.455 ± 0.06 years, P = 0.61). The total 6-month costs were $11,032 (CGM) vs. $7,236 (control). The CGM group experienced reductions in HbA1c (0.60 ± 0.74% difference in difference [DiD]), P < 0.01), the daily rate of nonsevere hypoglycemia events (0.07 DiD, P = 0.013), and daily test strip use (0.55 ± 1.5 DiD, P = 0.04) compared with the control group. In the lifetime analysis, CGM was projected to reduce the risk of T1D complications and increase QALYs by 0.54. The incremental cost-effectiveness ratio (ICER) was $98,108 per QALY for the overall population. By extending sensor use from 7 to 10 days in a real-world scenario, the ICER was reduced to $33,459 per QALY. CONCLUSIONS For adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control, CGM is cost-effective at the willingness-to-pay threshold of $100,000 per QALY, with improved glucose control and reductions in nonsevere hypoglycemia.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ab656e8641eed19b999f72553b51a9aaTest
https://doi.org/10.2337/dc17-1821Test

المؤلفون: Gerry Rayman, Zoe A. Stewart, Eleanor M. Scott, Malgorzata E. Wilinska, Roman Hovorka, Helen R. Murphy, Leanne K O'Neil, Sara Hartnell, Conor Farrington, Katharine D. Barnard

المصدر: Diabetes Care. 41:1391-1399

مصطلحات موضوعية: Adult, Blood Glucose, medicine.medical_specialty, Time Factors, Adolescent, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Population, Pregnancy in Diabetics, 030209 endocrinology & metabolism, Hypoglycemia, Gastroenterology, Young Adult, 03 medical and health sciences, Insulin Infusion Systems, 0302 clinical medicine, Pregnancy, Hyperinsulinism, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Insulin, 030212 general & internal medicine, education, Advanced and Specialized Nursing, Type 1 diabetes, education.field_of_study, Cross-Over Studies, business.industry, Postpartum Period, Pregnancy Outcome, Middle Aged, Delivery, Obstetric, medicine.disease, Crossover study, Circadian Rhythm, Diabetes Mellitus, Type 1, Treatment Outcome, Female, business, Postpartum period

الوصف: OBJECTIVE Despite advances in technology, optimal glucose control remains elusive and neonatal complications remain ubiquitous in type 1 diabetes (T1D) pregnancy. Our aim was to examine the safety, efficacy, and longer-term feasibility of day-and-night closed-loop insulin delivery. RESEARCH DESIGN AND METHODS We recruited 16 pregnant women (mean [SD]: age 32.8 [5.0] years, T1D duration 19.4 [10.2] years, HbA1c 8.0% [1.1], and BMI 26.6 [4.4] kg/m2) to an open-label, randomized, crossover trial. Participants completed 28 days of closed-loop and sensor-augmented pump (SAP) insulin delivery separated by a washout period. Afterward, participants could continue to use the closed-loop system up to 6 weeks postpartum. The primary end point was the proportion of time with glucose levels within the target range (63–140 mg/dL). RESULTS The proportion of time with glucose levels within target was comparable during closed-loop and SAP insulin delivery (62.3 vs. 60.1% [95% CI −4.1 to 8.3]; P = 0.47). Mean glucose and time spent hyperglycemic >140 mg/dL also did not differ (131.4 vs. 131.4 mg/dL [P = 0.85] and 36.6 vs. 36.1% [P = 0.86], respectively). During closed-loop, fewer hypoglycemic episodes occurred (median 8 [range 1–17] vs. 12.5 [1–53] over 28 days; P = 0.04) and less time at CONCLUSIONS Closed-loop insulin delivery was associated with comparable glucose control and significantly less hypoglycemia than SAP therapy. Larger, longer-duration multicenter trials are now indicated to determine clinical efficacy of closed-loop insulin delivery in T1D pregnancy and the impact on neonatal outcomes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bf8e6bc7429e7a2c5fc7744356f5cbd5Test
https://doi.org/10.2337/dc17-2534Test

المؤلفون: Axel Haupt, Kevin L. Duffin, Mark L. Hartman, Jonathan M. Wilson, Arun J. Sanyal, Chrisanthi A. Karanikas, Deborah A. Robins, Amir Nikooienejad, Rohit Loomba, Ross Bray

المصدر: Diabetes Care
Diabetes care, vol 43, iss 6

مصطلحات موضوعية: Liver Cirrhosis, Male, Endocrinology, Diabetes and Metabolism, Glucagon-Like Peptides, Type 2 diabetes, Medical and Health Sciences, Hepatitis, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Receptors, Medicine, 030212 general & internal medicine, education.field_of_study, Gastrointestinal Hormone, Liver Disease, Diabetes, Alanine Transaminase, Middle Aged, Novel Communications in Diabetes, Treatment Outcome, 6.1 Pharmaceuticals, Female, Type 2, medicine.drug, Agonist, Adult, medicine.medical_specialty, medicine.drug_class, Recombinant Fusion Proteins, Population, Clinical Trials and Supportive Activities, 030209 endocrinology & metabolism, Gastric Inhibitory Polypeptide, Glucagon-Like Peptide-1 Receptor, Receptors, Gastrointestinal Hormone, 03 medical and health sciences, Endocrinology & Metabolism, Clinical Research, Internal medicine, Diabetes mellitus, Internal Medicine, Diabetes Mellitus, Humans, Aspartate Aminotransferases, education, Glucagon-like peptide 1 receptor, Metabolic and endocrine, Advanced and Specialized Nursing, Adiponectin, business.industry, Type 2 Diabetes Mellitus, Evaluation of treatments and therapeutic interventions, nutritional and metabolic diseases, medicine.disease, Immunoglobulin Fc Fragments, Endocrinology, Diabetes Mellitus, Type 2, Dulaglutide, business, Digestive Diseases, Biomarkers

الوصف: OBJECTIVE To determine the effect of tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptors, on biomarkers of nonalcoholic steatohepatitis (NASH) and fibrosis in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Patients with T2DM received either once weekly tirzepatide (1, 5, 10, or 15 mg), dulaglutide (1.5 mg), or placebo for 26 weeks. Changes from baseline in alanine aminotransferase (ALT), aspartate aminotransferase (AST), keratin-18 (K-18), procollagen III (Pro-C3), and adiponectin were analyzed in a modified intention-to-treat population. RESULTS Significant (P < 0.05) reductions from baseline in ALT (all groups), AST (all groups except tirzepatide 10 mg), K-18 (tirzepatide 5, 10, 15 mg), and Pro-C3 (tirzepatide 15 mg) were observed at 26 weeks. Decreases with tirzepatide were significant compared with placebo for K-18 (10 mg) and Pro-C3 (15 mg) and with dulaglutide for ALT (10, 15 mg). Adiponectin significantly increased from baseline with tirzepatide compared with placebo (10, 15 mg). CONCLUSIONS In post hoc analyses, higher tirzepatide doses significantly decreased NASH-related biomarkers and increased adiponectin in patients with T2DM.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dbe944af79c8b004fdcbac47b00804d2Test
https://pubmed.ncbi.nlm.nih.gov/32291277Test

المؤلفون: Annika Hoyer, Ralph Brinks, Oliver Kuss, Wolfgang Rathmann, Esther Jacobs

المصدر: Diabetes Care. 40:1703-1709

مصطلحات موضوعية: Adult, Male, Research design, Pediatrics, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Population, 030209 endocrinology & metabolism, Type 2 diabetes, Danish, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Germany, Claims data, Environmental health, Diabetes mellitus, Prevalence, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Mortality, education, Survival analysis, Aged, Aged, 80 and over, Advanced and Specialized Nursing, education.field_of_study, Insurance, Health, business.industry, Mortality rate, Middle Aged, medicine.disease, Survival Analysis, language.human_language, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, language, Female, business

الوصف: OBJECTIVE In Germany, as in many other countries, nationwide data on mortality attributable to diagnosed diabetes are not available. This study estimated the absolute number of excess deaths associated with diabetes (all types) and type 2 diabetes in Germany. RESEARCH DESIGN AND METHODS A prevalence approach that included nationwide routine data from 64.9 million people insured in the German statutory health insurance system in 2010 was used for the calculation. Because nationwide data on diabetes mortality are lacking in Germany, the mortality rate ratio from the Danish National Diabetes Register was used. The absolute number of excess deaths associated with diabetes was calculated as the number of deaths due to diabetes minus the number of deaths due to diabetes with a mortality that was as high as in the population without diabetes. Furthermore, the mortality population-attributable fraction was calculated. RESULTS A total of 174,627 excess deaths were due to diabetes in 2010, including 137,950 due to type 2 diabetes. Overall, 21% of all deaths in Germany were attributable to diabetes and 16% were attributable to type 2 diabetes. Most of the excess deaths (34% each) occurred in the 70- to 89-year-old age-group. CONCLUSIONS In this first nationwide calculation of excess deaths related to diabetes in Germany, the results suggest that the official German estimates that rely on information from death certificates are grossly underestimated. Countries without national cohorts or diabetes registries could easily use this method to estimate the number of excess deaths due to diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::51ef3403cfcf45fd1a463b8a01114f0eTest
https://doi.org/10.2337/dc17-0954Test

المؤلفون: Richard M. Bergenstal, David M. Wesley, Roy W. Beck, Deborah M. Mullen, Crystal G. Connor

المصدر: Diabetes Care

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, endocrine system diseases, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Population, 030209 endocrinology & metabolism, law.invention, Perspectives in Care, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Diabetes management, Internal medicine, Blood Glucose Self-Monitoring, Diabetes mellitus, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Precision Medicine, Intensive care medicine, education, Aged, Glycemic, Glycated Hemoglobin, Advanced and Specialized Nursing, education.field_of_study, business.industry, Disease Management, nutritional and metabolic diseases, Middle Aged, medicine.disease, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Endocrinology, Diabetes Mellitus, Type 2, Female, Metric (unit), business

الوصف: HbA1c is a valuable metric for comparing treatment groups in a randomized trial, for assessing glycemic trends in a population over time, or for cross-sectional comparisons of glycemic control in different populations. However, what is not widely appreciated is that HbA1c may not be a good indicator of an individual patient’s glycemic control because of the wide range of mean glucose concentrations and glucose profiles that can be associated with a given HbA1c level. To illustrate this point, we plotted mean glucose measured with continuous glucose monitoring (CGM) versus central laboratory–measured HbA1c in 387 participants in three randomized trials, showing that not infrequently HbA1c may underestimate or overestimate mean glucose, sometimes substantially. Thus, if HbA1c is to be used to assess glycemic control, it is imperative to know the patient’s actual mean glucose to understand how well HbA1c is an indicator of the patient’s glycemic control. With knowledge of the mean glucose, an estimated HbA1c (eA1C) can be calculated with the formula provided in this article to compare with the measured HbA1c. Estimating glycemic control from HbA1c alone is in essence applying a population average to an individual, which can be misleading. Thus, a patient’s CGM glucose profile has considerable value for optimizing his or her diabetes management. In this era of personalized, precision medicine, there are few better examples with respect to the fallacy of applying a population average to a specific patient rather than using specific information about the patient to determine the optimal approach to treatment.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::db64f9929911719372a8c14f36e07cc5Test
https://doi.org/10.2337/dc17-0636Test