two common anti-diabetic treatments used are sitagliptin and sulphonylureas however evidence examining their comparative effectiveness in older people is limited.to evaluate effectiveness of sitagliptin vs sulphonylureas when added to metformin in older (aged ≥75) vs younger people (18-75).retrospective cohort study.UK Primary Care.2,904 individuals prescribed sitagliptin (223 aged≥75) and 13,683 prescribed sulphonylureas (1,725 aged ≥75).multivariable regression to analyse difference in HbA1c and weight, 12 months after add-on initiation and proportion achieving different glycaemic targets.after multivariate adjustment to remove baseline differences, the HbA1c after 12 months of treatment was on average 1 mmol/mol (95%CI -0.7 to 2.8) higher with sitagliptin vs sulphonylureas in older people though this was not statistically significant. The weight however, was significantly lower -1.4 kg (95%CI -2.1 to -0.7) with sitagliptin vs sulphonylureas. A lower proportion prescribed sitagliptin vs sulphonylureas recorded HbA1c < 48 mmol/mol by study end: Odds Ratio 0.63 (95%CI 0.42-0.95). In younger people, similar HbA1c reductions were also observed with both treatments, however weight after 12 months was even lower with sitagliptin vs sulphonylureas: -2.3 kg (95%CI -2.5 to -2.0).similar HbA1c reduction was observed when sitagliptin or sulphonylureas were added to metformin in older and younger age-groups. Sitagliptin use led to modest comparative weight loss. There may be greater risk of over-treatment with sulphonylureas evidenced by greater proportion recording HbA1c < 48 mmol/mol by study end. This evidence supporting use of sitagliptin when add-on therapy is selected in older adults should be considered alongside the wider evidence-base and patient-preference.
This article provides the context for the ambition outlined in the the National Institute for Health and Care Excellence (NICE) 2021-2026 strategy to 'lead globally on the potential to include environmental impact data in its guidance to reduce the carbon footprint of health and care'. Anthropogenic environmental changes pose a catastrophic risk to human health, with potential to widen national and global health inequalities. Recognising the fact that NICE guidance influences the way health and care is delivered and its consequent environmental impact, NICE has included environmental sustainability among its strategic priorities. This article outlines the work underway to meet this sustainability agenda at NICE.
Background: Di-peptidyl peptidase-4 inhibitors when used as monotherapy or in combination with other drugs such as metfomin, thiazolidinedione or sulphonylurea are effective and well tolerated in diabetes management. The aim was to evaluate the safety and efficacy of sitagliptin compared to glimepiride as a dual therapy for the treatment of type-2 diabetes patients inadequately controlled with metformin.Methods: It was an observational, open, comparative and multiple follow up study, included 70 patients visiting department of medicine and department of pharmacology at Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh, India for the period of 1 year. Patients of type 2 diabetes who were on metormin at least for last 3 months and were with inadequate glycemic control (HbA1C levels >7% and <10%) were included. All the patients were divided into two groups: Group G (35 patients; received glimepiride 2 mg per day) and Group S (35 patients received sitagliptin 100 mg per day). Treatment was provided for the period of 18 weeks and patients were called for 3 follow ups at the end of 4, 12 and 18 weeks. All the patients were investigated for glycated hemoglobin (HbA1c), fasting blood glucose (FBG) and post prandial glucose (PPG) along with adverse drug reaction if any.Results: Female predominance was observed with mean age of study population being 48.07±10.07 years. Mean duration of diabetes and weight at baseline in Group G was 4.56±1.24 years and 48.23±2.15 kgs respectively and in Group S was 4.34±1.12 years and 49.61±3.21 kgs respectively. Mean dose of Metformin was 1819 mg/day. Mean glycated hemoglobin (HbA1c), fasting plasma glucose (FBG) and post prandial glucose (PPG) at baseline and 18th week in Group G was 8.31±0.12 % and 7.42±0.22%, 186.34±58.09 mg/dl and 109.9±17.69 mg/dl, 261.9±67.92 mg/dl and 159.21±15.96 mg/dl respectively whereas in Group S was 8.56±0.11% and 7.75±0.31%, 194±48.24 mg/dl and 112.3±15.58, 287.27±62.04 mg/dl and 162.6±.16.42 mg/dl respectively. In Group G weight of the patients increased from 64.59±7.9 kgs at baseline to 66.06±8.02 kg at 18 weeks of treatment whereas in Group S body weight of patients decreased from 62.06±7.02 kgs to 60.57±6.66 kgs at 18 weeks of sitagliptin treatment. The incidence of hypoglycemia (0%), nausea (6.06%) and vomiting (3.03%) in sitagliptin group was low as compared to glimepiride group (hypoglycemia (3.12%), nausea (12.5%) and vomiting (6.25%)).Conclusions: Addition of sitagliptin in patients who are inadequately controlled with metformin monotherapy provide similar efficacy but better safety as compared to glimepiride.
Aims/Hypothesis: Type 2 diabetes mellitus is associated with high levels of disease burden, including increased mortality risk and significant long-term morbidity. The prevalence of diabetes differs substantially among ethnic groups. We examined the prevalence of type 2 diabetes diagnoses in the UK primary care setting. Methods: We analysed data from 404,318 individuals in The Health Improvement Network database, aged 0–99 years and permanently registered with general practices in London. The association between ethnicity and the prevalence of type 2 diabetes diagnoses in 2013 was estimated using a logistic regression model, adjusting for effect of age group, sex, and social deprivation. A multiple imputation approach utilising population-level information about ethnicity from the UK census was used for imputing missing data. Results: Compared with those of White ethnicity (5.04%, 95% CI 4.95 to 5.13), the crude percentage prevalence of type 2 diabetes was higher in the Asian (7.69%, 95% CI 7.46 to 7.92) and Black (5.58%, 95% CI 5.35 to 5.81) ethnic groups, while lower in the Mixed/Other group (3.42%, 95% CI 3.19 to 3.66). After adjusting for differences in age group, sex, and social deprivation, all minority ethnic groups were more likely to have a diagnosis of type 2 diabetes compared with the White group (OR Asian versus White 2.36, 95% CI 2.26 to 2.47; OR Black versus White 1.65, 95% CI 1.56 to 1.73; OR Mixed/Other versus White 1.17, 95% CI 1.08 to 1.27). Conclusion: The prevalence of type 2 diabetes was higher in the Asian and Black ethnic groups, compared with the White group. Accurate estimates of ethnic prevalence of type 2 diabetes based on large datasets are important for facilitating appropriate allocation of public health resources, and for allowing population-level research to be undertaken examining disease trajectories among minority ethnic groups, that might help reduce inequalities. Keywords: ethnicity, type 2 diabetes, primary care database, electronic health records, multiple imputation, missing not at random
Background: Surgical Background: Impaired glucose tolerance is known precursor of type-2 diabetes mellitus and more prevalent in obese people, different studies have varied results and true prevalence is still debatable. Aims of this study to investigate the prevalence of IGT in different grades of obesity.Methods: Authors have studied100 patients with obesity Grade1 (BMI >25 kg/m2 but <30) and Grade2 (BMI >30 kg/m2) at Gandhi Medical College, Bhopal during April to June 2019. Complete physical examination and blood tests including fasting blood glucose and oral glucose tolerance test (OGTT) were done.Results: Results shows that 16% male and 14% female subjects had IGT. Male of age more than 60yrs and female aged between 51 to 60 were more pre-diabetic. Males having weight 71 to 80 kg and female of 51-60 kg were more pre-diabetic. Subjects with grade 1 obesity, 6.12% male and 5.88% female had IGT. Similarly, in grade 2-obese subjects 10.20% males and 7.84% females had IGT.Conclusion: IGT is more prevalent in grade-1 and grade-2 obese population and a strong indicator of diabetes.
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