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Obesity and type 2 diabetes in the USA: a) mean body weight in American men and women; b) changing prevalences of type 2 diabetes 9
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he rising prevalence of type 2 diabetes will impose an increasing burden of diabetic complications on healthcare systems worldwide. The results of the UK Prospective Diabetes Study (UKPDS), and other studies, confirm the potential of effective glycaemic control to improve and extend the lives of people with type 2 diabetes. However, current managem...
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Objectives. To estimate the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) in a population aged over sixty years with type 2 diabetes and to study the impact of anxiety and depression on glycemic balance and disease outcome. Results. The prevalence of anxiety and depression in the 62 subjects included in...
Background The prevalence of diabetes-related complications is quite high among the Thai Population. Poor glycemic control exacerbates the diabetes; consequently initiate the process of complications. Thailand has already integrated diabetic care in primary health care settings under the Universal Health Care (UHC) coverage. But the provision of eq...
Conclusions:
Although alcohol and cigarette consumption is lower than in controls, it is common among teenagers with type 1 diabetes, effecting metabolic control and causing the risk of acute diabetes complications. Better prevention strategies should be implemented in this group of patients in their early teen years. What is Known: • Substance us...
Citations
... As diabetes is a chronic disease without a definite cure, treatments focus on controlling BG levels and preventing complications (Shrivastava et al., 2013). The majority of patients fail to achieve optimal control of their diabetes, so it appears that combined drug therapy and self-management techniques are more effective in the control of this condition (Reasner & Göke, 2002;Sarkar et al., 2006). Controlling BG is essential to diabetes selfmanagement, as it delays the onset of physical and mental complications (Ko et al., 2019). ...
... The focus of managing and preventing T2DM can be physical activity. Physical activity used for the treatment of diabetes and its complications have been known for many years [17]. Physical activity and muscle contraction increase blood glucose uptake into muscle through glucose transporter proteins (GLUT4), whose activity is influenced by muscle contraction and insulin [18]. ...
PurposeThe effects of exercise training on meteorin-like protein (METRNL), one of the newest factors involved, is one of the treatment strategies for diabetes. The present study aimed to investigate the effects of circuit resistance training on METRNL and insulin resistance in people with Type 2 Diabetes Mellitus (T2DM).Methods
Twenty eligible diabetics volunteered to participate and were randomly divided into control (n = 10, age = 51 ± 1 years, BMI = 27.43 ± 0.98 kg/m2) and experimental groups (n = 10, age = 51 ± 1 years, BMI = 30.12 ± 0.92 kg/m2). The circuit resistance training (10 exercises) used in this study was performed for eight weeks (3 non-consecutive sessions/week, 2–4 circuits, 40%-80% 1RM, 15–6 repetitions). The rest period between each exercise was 20–30 s, and the rest between each circuit was 3 min. Participants in the control groups were asked to maintain their daily physical activities and not to engage in any systematic training program throughout the study.ResultsMETRNL did not change significantly in the control group (0.66 ± 0.06 to 0.7 ± 0.04), but it increased significantly in the experimental group (0.3 ± 0.06 to 0.71 ± 0.03, p = 0.001); In contrast, FBS increased significantly in the control group (122.8 ± 7.5 to 192.8 ± 14.9) and decreased significantly in the experimental group (197.2 ± 7.1 to 135.00 ± 14.00, p = 0.001). Insulin in control and experimental groups did not change significantly (p = 0.96); However, the IR of the control group increased significantly (6.37 ± 1.46 to 9.6 ± 1.53), but its level was significantly attenuated in the experimental group (4.89 ± 1.37 to 4.38 ± 1.44, p = 0.028).Conclusion
Eigth weeks of circuit resistance training with low to high intensities can increase the resting levels of METRNL in men with T2DM, which can be significantly associated with the improved fasting blood glucose levels and insulin resistance.
... Вследствие неудовлетворительного контроля гликемии развиваются и прогрессируют сосудистые и неврологические осложнения СД, ухудшается течение сопутствующих заболеваний. Учитывая многофакторный патогенез СД 2 типа, можно предположить, что эффективного, долгосрочного контроля гликемии можно достичь с помощью препаратов, которые воздействуют на фундаментальные патофизиологические нарушения [4,5]. В этой связи важнейшим этапом на пути совершенствования стратегии фармакотерапии стало создание фиксированных комбинаций сахароснижающих препаратов. ...
... The result for this study was higher but it may be connected with the methods used for the assessment which were self report questionnaires, daily diary reports and electronic monitors in children with cystic fibrosis. Though, compliance has been shown to drop sharply as the number of drugs taken daily increases [42][43] , increasing the number of prescribed drugs may not always result in poor compliance 44 . ...
This study assessed the level of compliance using three different methods: pill count, self report and peak expiratory flow rate, in asthmatic patients attending a secondary health care facility. Self report (using a pre-tested structured questionnaire), peak expiratory flow rate and pill count were used to assess patient's compliance and identify the factors which may be responsible for non compliance. Measurement of peak expiratory flow rate and the pill count were done at two different occasions. The data obtained was analysed using descriptive statistics. The study showed that the patients were prescribed a range of one to four drugs: 54% (3 drugs), 32% (2 drugs), 8% (4 drugs) and 2% (1 drug). The levels of compliance were 86.57% for self report and 83.56% for pill count (p > 0.05). Reasons given for non compliance were: apparent wellness (33.31%), forgetfulness (26.67%), cost of drugs (6.67%), dysphagia (6.67%), presence of non-disturbing symptoms (6.67%), side effects (6.67%), ignorance/fear of addiction (6.67%), perceived lack of benefit from treatment (6.67%), and lethargy towards chronic medication (6.67%). However, there was a significant difference in the readings of the peak expiratory flow rate measured at two different occasions (p < 0.05). The study showed no significant difference in the methods used to assess the level of compliance. Non compliance can be overcome by proper education of patients on the importance of complying with the administration of medication and proper usage of metered dose devices. INTRODUCTION: Asthma is a reactive and sometimes reversible airway disease with attacks occurring episodically with varied intensity 1 . Despite the various forms of treatment/management that are available, ranging from oral medications to parenteral medications, asthma morbidity is still considerable 2 and poor management has been associated with impaired quality of life 3, 4 . According to World Health Organisation (WHO) estimates, 300 million people suffer from asthma and 255,000 people died of asthma
... 11 Insulin resistance usually precedes glucose abnormalities and facilitates the progression of impaired fasting glucose or impaired glucose tolerance to type 2 diabetes by accelerating b-cell functional deterioration. [12][13][14] The initial response to insulin resistance is compensatory hyperinsulinemia. 15,16 As long as the b cells can compensate for the reduced insulin sensitivity by increasing insulin synthesis, glucose metabolism remains normal. ...
... Nutrition Reviews® Vol. 69(12):720-729 ...
Glucose is transported across the cell membrane by two different types of glucose transporters: glucose-facilitated transporters and sodium-dependent glucose transport (SGLT) proteins. Regulation of SGLT activity (namely, inhibition of SGLT1 and SGLT2 activity and stimulation of SGLT3 activity) represents a potential means of managing hyperglycemia and diabetes, thus preventing complications of diabetes. The purpose of the present review is to discuss the role of SGLT proteins in the pathophysiology of diabetes and to describe the mechanisms by which these transporters may be used for glycemic control and the treatment of diabetes. The regulatory processes involved in SGLT-mediated glucose uptake are also described briefly. This information provides new insight into the complementary mechanisms involved in the regulation of SGLT-mediated glucose transport as well as a basis for further investigation.
... Several studies have already demonstrated this point. 27,28 As healthcare providers, we can help patients overcome some of these obstacles that lead to medication non-adherence. Osterberg and Blaschke advised practitioners to always assess for poor adherence. ...
Background
Medication adherence is an integral aspect of disease state management for patients with chronic illnesses, including diabetes mellitus. It has been hypothesized that patients with diabetes who have poor medication adherence may have less knowledge of overall therapeutic goals and may be less likely to attain these goals.
Objective
The purpose of this study was to assess self-reported medication adherence, knowledge of therapeutic goals (hemoglobin A1C [A1C], low density lipoprotein cholesterol [LDL-C] and blood pressure [BP]), and goal attainment in adult patients with diabetes.
Methods
A survey was created to assess medication adherence, knowledge of therapeutic goals, and goal attainment for adult patients with diabetes followed at an internal medicine or a family medicine clinic. Surveys were self-administered prior to office visits. Additional data were collected from the electronic medical record. Statistical analysis was performed.
Results
A total of 149 patients were enrolled. Knowledge of therapeutic goals was reported by 14%, 34%, and 18% of survived patients for LDL-C, BP, and A1C, respectively. Forty-six percent, 37%, and 40% of patients achieved LDL-C, BP, and A1C goals, respectively. Low prescribing of cholesterol-lowering medications was an interesting secondary finding; 36% of patients not at LDL-C goal had not been prescribed a medication targeted to lower cholesterol. Forty-eight percent of patients were medication non-adherent; most frequently reported reasons for non-adherence were forgot (34%) and too expensive (14%). Patients at A1C goal were more adherent than patients not at goal (p=0.025).
Conclusion
The majority did not reach goals and were unknowledgeable of goals; however, most were provided prescriptions to treat these parameters. Goal parameters should be revisited often amongst multidisciplinary team members with frequent and open communications. Additionally, it is imperative that practitioners discuss the importance of medication adherence with every patient at every visit.
... Given the need for these patients to take a variety of medications, with different dosage frequencies and numbers of tablets at various times of the day, it is not surprising that nonadherence occurs. 27,28 As would be expected, there seems to be a negative impact of complex treatment regimens on routine adherence to drug therapy. On the other hand, the more information and understanding that patients have regarding their disease states and pharmacologic therapies, the more likely they are to adhere to those therapies. ...
There is limited information in the primary literature regarding the relationship of medication adherence to attainment of glycosylated hemoglobin A1c (A1c) goals. The 2 oral antihyperglycemic medications, sulfonylurea and/or metformin, were chosen for retrospective analysis because they are the 2 most common oral medications used by patients with diabetes.
To describe the relationship between adherence with 1 or both of 2 oral antihyperglycemic medications (sulfonylurea and metformin) and A1c goal attainment for health maintenance organization (HMO) patients enrolled in a diabetes disease management program.
This was a retrospective, descriptive evaluation of patients enrolled in a managed care diabetes disease management program in a 188,000-member independent practice association model HMO located in the Southeast. The dataset in this analysis contained demographic, enrollment, pharmacy claims, and clinical laboratory data. Continuously enrolled patients were included if there was a documented A1c value obtained at least 90 days after the initial oral antihyperglycemic medication (sulfonylurea or metformin) prescription index date. The medication possession ratio (MPR) was calculated from the pharmacy claim records and correlated with the A1c value.
A total of 42% of patients on sulfonylurea therapy and 46% of those on metformin reached an A1c goal of < or = 7.0%. For patients taking a sulfonylurea, the mean MPR for those who reached the predetermined A1c goal (< or = 7.0) was 0.82 (0.29) compared with 0.72 (0.31) for those patients who did not reach the A1c target goal (P < 0.001). For patients taking metformin, the mean MPR for those who reached the predetermined A1c goal was 0.77 (0.3) versus 0.62 (0.3) for those patients who did not reach the A1c target goal (P < 0.001). A Pearson correlation analysis revealed a positive relationship between the MPR and A1c for sulfonylurea (r = -0.295, P < 0.001) and for metformin (r = -0.285, P < 0.001). For those patients taking both sulfonylurea and metformin, the Pearson correlation analysis showed a positive relationship between the 2 MPRs (r = 0.65, P < 0.001).
Medication adherence as measured by the MPR was higher for patients taking a sulfonylurea or metformin who reached the target A1c goal of d7.0% compared with patients taking these drugs who did not reach the target A1c goal.
Background
The aim of the present prospective observational study was to assess the tolerability and antihyperglycemic efficacy of metformin extended-release (MXR) in the routine treatment of patients with type 2 diabetes mellitus (T2DM) from six Asian countries.
Methods
Data from 3556 patients treated with once-daily MXR for 12 weeks, or until discontinuation, were analyzed.
Results
Treatment with MXR was well tolerated, with 97.4% of patients completing 12 weeks of treatment. Only 3.3% of patients experienced one or more gastrointestinal (GI) side-effects and only 0.7% of patients discontinued for this reason (primary endpoint). The incidence of GI side-effects and related discontinuations appeared to be considerably lower during short-term MXR therapy than during previous treatment (mean 2.71 years’ duration), most commonly with immediate-release metformin. A 12-week course of MXR therapy also reduced HbA1c and fasting glucose levels from baseline.
Conclusions
The present study provides new insights into the incidence of GI side-effects with MXR in Asian patients with T2DM and on the tolerability of MXR in non-Caucasian populations. Specifically, these data indicate that once-daily MXR not only improves measures of glycemic control in Asian patients with T2DM, but also has a favorable GI tolerability profile that may help promote enhanced adherence to oral antidiabetic therapy.
To evaluate the efficacy and incidence of hypoglycaemic symptoms associated with fixed combinations of metformin and glibenclamide (glyburide in the USA) formulated within a single tablet (tablet strengths 250 mg/1.25 mg, 500 mg/2.5 mg and 500 mg/5 mg), in comparison with metformin 500 mg and glibenclamide 2.5-5 mg monotherapy, in clinically important patient subgroups within the type 2 diabetic population.
A total of 1856 patients from three randomized, double-blind, multicentre, parallel-group clinical trials were stratified at baseline according to HbA1C (< 8% or > or = 8%), age (< 65 years or > or = 65 years) and body mass index (BMI; < 28 kg/m2 or > or = 28 kg/m2). The effects of study treatments on HbA1C and the incidence of hypoglycaemic symptoms were determined in each subgroup.
The combination treatments were more effective than either monotherapy irrespective of baseline HbA1C, age or BMI in each trial. Antihyperglycaemic effects were greater in patients with HbA1C > or = 8% at baseline, especially with the combinations. The majority of hypoglycaemic symptoms with glibenclamide-containing treatments occurred in patients with HbA1C < 8% at baseline. Neither age nor BMI had a marked effect on the efficacy of the combination treatments, and there was no increase in hypoglycaemic symptoms in older patients.
Single-tablet metformin-glibenclamide combination treatment is more effective than metformin or glibenclamide monotherapy, and is well tolerated in patients with hyperglycaemia inadequately controlled by diet and exercise or antidiabetic monotherapy, irrespective of their severity of hyperglycaemia at baseline, age or weight.
Type 2 diabetes is a chronic and progressive disease. Oral antidiabetic monotherapies directly address only one defect as their primary mechanism of action, and do not control blood glucose sufficiently well to meet current glycaemic targets. In consequence, most patients need combination therapy within a few years. However, the co-administration of two or more oral antidiabetic drugs may render treatment regimens difficult to follow. Combining oral antidiabetic agents into a single tablet provides a means of intensifying antidiabetic therapy while supporting good patient compliance. An insulin sensitiser and an insulin secretagogue represent a rational oral antidiabetic combination, as they address the dual endocrine defects of insulin resistance and impaired beta-cell function in type 2 diabetes. Nevertheless, the components of a combination tablet must be carefully chosen. Metformin (an insulin sensitiser) and glibenclamide (an insulin secretagogue) are well supported by decades of clinical evidence, and the pharmacokinetics of these agents support twice-daily co-administration. The final technical challenge is to optimise their delivery within a single-tablet combination. A recently-introduced metformin-glibenclamide combination tablet (Glucovance) has been extensively studied in well-designed clinical trials, where it has been shown to be more effective than its component monotherapies in controlling fasting and postprandial glycaemia. This treatment provides a case study in the development of a single-tablet oral antidiabetic combination, in terms of the pharmacokinetic issues facing the development of this preparation, and the implications of the pharmacokinetic properties of the components of the combination tablet on their pharmacodynamic actions and risk-benefit profile.
