• Objectives: To determine persistence with therapy in patients newly starting oral hypoglycemic treatment for management of type 2 diabetes, and to determine differences in persistence according to sex, age, and initial agent. • Design: Retrospective medication claims analysis. • Setting and participants: 46,884 patients from a large U.S. pharmacy benefits manager (PBM) database who were older than 18 years of age and who newly started monotherapy with an oral agent for type 2 diabetes. • Methods: All patients were followed for 10 months for refill persistence patterns with their initial drug. Agents included in the analysis were glimepiride, immediaterelease glipizide, glipizide GITS (gastrointestinal therapeutic system), glyburide, metformin, pioglitazone, repaglinide, and rosiglitazone. • Results: The overall average length of therapy was 167 days out of 300 days of follow-up. Women were significantly less persistent than men (161 days versus 173 days, respectively). Persistence significantly increased with patient age, from a low of 126 days (18‐34 years) to 179 days (50‐64 years), but then fell to 161 days (≥ 65 years). Significant differences were also identified for the oral agents, with persistence ranging from 126 days with repaglinide to 177 days with glipizide GITS. • Conclusions: Overall persistence with the initial oral hypoglycemic drug treatment appears to be low in type 2 diabetes and differs within sex, age, and individual drug categories. Careful selection of the initial oral agent to minimize adverse events and reduce dosing frequency may improve persistence, enhance glycemic control, and reduce the economic burden of type 2 diabetes.
P. G. McCracken, C. G. Ferguson, D. Vizitiu, C. S. Walkinshaw, Y. Wang and G. R. J. Thatcher, J. Chem. Soc., Perkin Trans. 2, 1999, 911 DOI: 10.1039/A901121H
Derivatives of the cyclodextrins, αCD, βCD, and γCD, in which all primary hydroxyls are substituted by amine pendant groups, may be synthesized efficiently from the per-6-bromo-6-deoxy-CD derivatives by direct reaction with amines. These ACD derivatives, which bear six, seven, or eight amine pendent groups, represent interesting biomimetic receptors and catalysts. The synthetic strategy relies on quantitative transformation and efficient purification as is demonstrated by preparation of 11 homogeneous ACD derivatives. The limitations of the synthesis and potential adaptations are illustrated by the synthesis of several more ACD derivatives to >95% purity. A synthetic route to a CD persubstituted with primary amine functionalities at the primary face, per-6-(aminomethyl)-6-deoxy-CD, yields an alternative reagent to the simple per-6-amino-6-deoxy-CD, which is more suitable for further synthetic transformations. The synthetic strategy is further adapted to preparation of a prototypical (6 + 1)-ACD derivative in which one primary position is substituted with a sulfide group and the remaining six primary face positions are substituted with amine pendent groups.
The Analysis and Understanding of Diabetes and Dyslipidaemia: Improving Treatment (AUDIT) study was a confidential, web-based, cross-sectional survey involving 2,043 diabetes specialists in 50 countries. The study investigated the attitudes of physicians specialising in the treatment of patients with type 2 diabetes mellitus towards the management of dyslipidaemia and other cardiovascular risk factors in these patients. Physicians reported obtaining lipid profiles in 91% of patients with type 2 diabetes and estimated that 62% of type 2 diabetic patients have dyslipidaemia. Across all regions, stated low-density lipoprotein cholesterol (LDL-C), triglyceride and total cholesterol targets were lower for type 2 diabetic patients with than without cardiovascular disease (CVD). Fewer physicians reported having an LDL-C target of < 2.6 mmol/L (≤100 mg/dL) for patients without CVD (59%) than with CVD (85%). Physicians reported that 54% of patients achieve LDL-C targets, with significantly more estimated to achieve their LDL-C goal in North America (69%) than in any other region (43—61%; p<0.001). When setting targets, 58% of physicians stated that they were most influenced by lipid management guidelines, although a large proportion of physicians from Eastern Europe (54%) and Africa/Middle East (50%) cited a personal read of the literature. Patient compliance was the most commonly perceived barrier to lipid goal attainment in most regions (42—61%); financial constraints were cited most often in South America (76%), Africa/Middle East (65%) and Eastern Europe (63%). The AUDIT study revealed a disparity between lipid screening and control in type 2 diabetic patients. Physicians reported that they treated patients without CVD less intensively than patients with CVD, suggesting that type 2 diabetes was not widely considered a coronary heart disease risk equivalent. A reassessment of guideline implementation is needed for physicians worldwide to improve lipid control to decrease cardiovascular risk in type 2 diabetes.
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