IDF21-0396 Effect of Teneligliptin on Glycemic Control Through Parameters of Time-In-Range in Indian type 2 DM patients: TOP-TIR
S. ErandeBanshi SabooA.G. UnnikrishnanMadhav S JadhavSachin SuryawanshiV. JadhaoMansi BridPrathmesh ParekhObaidullah KhanGauri DhanakiHanmant Barkate
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Nearly 25% of Canadians have either diabetes or prediabetes, with diabetes-associated health care costs reaching $12.2 billion in 2010.1 It has been reported that glycemic control in primary care is poor. Harris and colleagues2 conducted a study across the 10 provinces of Canada to assess the quality of care and treatment of type 2 diabetes patients in primary care settings. They reported that almost half of the patients with type 2 diabetes in primary care settings did not achieve their glycemic target (HbA1c ≤7%).2 Poor glycemic control puts diabetes patients at high risk of suffering from diabetes complications.3 Glycemic control testing plays an essential role not only in diabetes diagnosis,4 but it is also considered the first step in diabetes management.2 There are 3 different ways to measure glycemic control:
Fasting plasma glucose (FPG)
Oral glucose tolerance test (OGTT), in which the blood glucose concentration is measured 2 hours after taking a glucose solution (75 g anhydrous glucose dissolved in water)
Glycated hemoglobin (HbA1c) (the 2008 Canadian Diabetes Association Guidelines recommend diabetes patients to have HbA1c ≤7%)4
Prediabetes
Glycated hemoglobin
Diabetes management
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Improved glycemic control in people with diabetes delays the onset and progression of severe microvascular complications of diabetes (1,2). Despite advances in pharmacotherapy and diabetes treatment devices and the emphasis placed on treatment adherence over the last decade, National Health and Nutrition Examination Survey (NHANES) data showed 45% of patients with diabetes did not achieve glycemic targets of <7% (3). Although some patients with diabetes may be undertreated (e.g., inappropriate treatment regimens, psychosocial issues that require adjustment in therapeutic targets), one reason for poor glycemic control is patients' difficulty in following treatment prescriptions and recommendations for diabetes self-care.
The number of diabetes medications prescribed and the number of people using diabetes medications have increased exponentially as a result of increasing prevalence rates in type 2 diabetes. Insulin is an extremely effective glucose-lowering treatment that is a medical requirement for type 2 diabetes when the pancreas fails. Approximately 27% of all people with diabetes take insulin (4). Surprisingly little is known about factors related to adherence to medication prescriptions and, more specifically, intentional insulin omission and how underlying motivations for insulin omission differ by type of diabetes.
A recent study in this issue of Diabetes Care by Peyrot et al. (5) brings this issue to the forefront. The purpose of this study was to explore the frequency of intentional insulin omission and the factors associated with this behavior in a sample of 502 U.S. adults self-identified as taking insulin by injection to treat either type 1 or type 2 diabetes. Fifty-seven percent of the respondents reported omitting insulin injections, with 20% omitting insulin injections regularly. Regression analyses identified older age, lower income and education, type 2 diabetes, poor diet adherence, more frequently prescribed injections, interference with daily activities, pain, and embarrassment as independent risk factors for intentional insulin omission. …
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The phenomenal growth in the rate of type 2 diabetes presents an enormous burden to society. Diabetes and its complications cost billions and significantly impact quality of life in individuals with diabetes. Diabetes management has transitioned from focusing exclusively on glycemic control to an approach that addresses both glucose abnormalities and the chronic complications of the disease. Increased understanding of the underlying mechanisms of disease and the multifactorial basis of diabetes complications suggest the importance of early diagnosis and treatment of all diabetes complications. Preventive approaches emphasizing risk factor reduction strategies are essential. The American Diabetes Association Standards of Medical Care for People with Diabetes assist both the health care provider and the individual with diabetes to appreciate the comprehensive treatment goals in diabetes and provide specific guidelines for achieving these goals. This article presents these guidelines in an easy-to-remember ABC format.
Disease management
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Background Diabetes is a metabolic disease that increases the risk of cardiovascular and microvascular disease, particularly when glycemic blood levels are not well controlled. Poor glycemic control is commonly observed in as much as 60% to 80% of patients with diabetes, regardless of advances in diabetes care. The objective of this study was to identify correlates of poor glycemic control in a large multicenter survey of Brazilian patients with type 2 diabetes.
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Background and Aims: In Japan, early hospitalization for diabetes care is widely diffused, and keeps glycemic control good for the long term through intensive diabetes education in the short term. In recent years, new classes of antidiabetes medicine have been launched. Glycemic control in patients with type 2 diabetes, especially reserved insulin secretion, becomes easier. We aimed to know whether recent early diabetes hospitalization is still work for glycemic control of type 2 diabetes patients reserved insulin secretion. Methods: Japanese type 2 diabetes patients ware without medication, with HbA1c >8.0 in their first visit and with good insulin secretion (δCPR >2.0 in glucagon stimulation test) within 3 months. Their first visits ware from April 2012 to Oct 2017 We retrospectively compared between 36 patients with early hospitalization and 35 patients without hospitalization. In our diabetes hospitalization, patients get a diabetes education. Most patients are canceled glucose toxicity by insulin and then changed any other applicable antidiabetic medicines without insulin possible. Results: At baseline, HbA1c of patients in early hospitalization group was higher than no hospitalization group (11.6±1.9%, 10.3±1.4%, p=0.002). δCPR was no significant difference. HbA1c of early hospitalization group was lower than no hospitalization group over 3years(1y: 6.4±0.8%, 7.4±1.1%, p<0.001, 2y: 6.5±0.8%, 7.3±0.9%, p=0.008, 3y: 6.2±0.6%, 7.5±0.8%, p<0.001). Numbers of diabetic medicine classes in early hospitalization group ware smaller than no hospitalization group after 2 years (1.8±0.8, 2.5±0.9, p=0.010). Two patient in early hospitalization group interrupted to visit our hospital, although 9 patients in no hospitalization group. Conclusion: Diabetes hospitalization is still one of very effective therapeutic method today. Education and earlier glycemic control may contribute to keep glycemic control good over a long lifetime. Disclosure D. Ikeda: None.
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Introduction: The majority of patients with type 2 diabetes also have obesity. Obesity increases the risk of developing diabetes and is associated with worsened glycemic control and increased morbidity and mortality in individuals with diabetes. Sustained weight loss is associated with improved glycemic control, potential for diabetes remission, and decreased medical expenditures.Areas covered: Herein, the impact of commonly utilized, non-insulin, glucose-lowering drugs on body weight in patients with type 2 diabetes is discussed. The weight change magnitudes, mechanisms, and any within-class differences are also explored.Expert opinion: The weight impact of diabetes medications should be considered when designing treatment regimens, especially in patients who are overweight or have obesity. Lifestyle modification is paramount for optimal diabetes management. Therapeutic regimens should ideally be designed to maximize weight loss and at least minimize or avoid weight gain. Future glucose-lowering medications should continue to offer improvement in cardiovascular risk factors, including weight, in order to be accepted into the armamentarium of diabetes therapy. Therapeutic regimens should be designed to help patients with diabetes and obesity achieve both glycemic and weight goals. Management of these disease states is expected to become increasingly integrated.
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BACKGROUND AND PURPOSE:
The relationship between glycemic control in patients with type 2 diabetes mellitus and intracranial atherosclerotic plaque features has remained understudied. This study aimed to investigate the association of type 2 diabetes mellitus and glycemic control with the characteristics of intracranial plaques using vessel wall MR imaging.MATERIALS AND METHODS:
In total, 311 patients (217 [69.8%] men; mean age, 63.24 ± 11.44 years) with intracranial atherosclerotic plaques detected on vessel wall MR imaging were enrolled and divided into 3 groups according to type 2 diabetes mellitus and glycemic control statuses: the non-type 2 diabetes mellitus group, the type 2 diabetes mellitus with good glycemic control group, and the type 2 diabetes mellitus with poor glycemic control group. The imaging features of intracranial plaque were analyzed and compared among the groups. The clinical risk factors for atherosclerosis were also analyzed using logistic regression analysis.RESULTS:
The plaque length and thickness were significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus group. The prevalence of strongly enhanced plaques was significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus and type 2 diabetes mellitus with good glycemic control groups (92.9%, 63.4%, and 72.7%, respectively; P < .001). Multivariate logistic regression analysis showed a significant association of poor glycemic control with the plaque length (OR = 1.966; 95% CI, 1.170–3.303; P = .011), plaque thickness (OR = 1.981; 95% CI, 1.174–3.340; P = .010), and strongly enhanced plaque (OR = 5.448; 95% CI, 2.385–12.444; P < .001).CONCLUSIONS:
Poor glycemic control, compared with the history of diabetes, might have a greater impact on the burden and vulnerability of intracranial atherosclerotic plaques.Cite
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