Diabetes mellitus is a devastating chronic metabolic disease. Since the majority of type 2 diabetes mellitus patients are overweight or obese, a novel term-diabesity-has emerged. The gut-brain axis ...plays a critical function in maintaining glucose and energy homeostasis and involves a variety of peptides. Amylin is a neuroendocrine anorexigenic polypeptide hormone, which is co-secreted with insulin from β-cells of the pancreas in response to food consumption. Aside from its effect on glucose homeostasis, amylin inhibits homeostatic and hedonic feeding, induces satiety, and decreases body weight. In this narrative review, we summarized the current evidence and ongoing studies on the mechanism of action, clinical pharmacology, and applications of amylin and its analogs, pramlintide and cagrilintide, in the field of diabetology, endocrinology, and metabolism disorders, such as obesity.
Aims
In the EMPA‐REG OUTCOME® trial, the sodium‐glucose cotransporter 2 inhibitor empagliflozin when given in addition to standard care improved cardiovascular (CV) and renal outcomes, and reduced ...mortality. Trial participants were on a variety of glucose‐lowering therapies at baseline, some of which could potentially affect CV risk. This analysis investigated whether the use of background diabetes therapy affected the risk of CV death, hospitalizations for heart failure, and progression of chronic kidney disease, among patients treated with empagliflozin.
Materials and methods
Patients meeting inclusion and exclusion criteria were randomized to placebo, empagliflozin 10 mg or empagliflozin 25 mg; glucose‐lowering therapy was to remain unchanged for 12 weeks and then adjusted to achieve glycaemic control according to local guidelines. Differences in risk of cardio‐renal outcomes between empagliflozin and placebo by baseline use of metformin, sulphonylurea (SU) and insulin were assessed using a Cox proportional hazards model.
Results
Of 7020 eligible patients, 74% were receiving metformin, 43% SU and 48% insulin at baseline (each alone or in combination); the most common regimens were metformin plus SU (20%) and metformin plus insulin (20%). Empagliflozin reduced the risk of CV death irrespective of the use of: metformin with: hazard ratio (HR) 0.71 (95% confidence interval, CI, 0.54–0.94); without: 0.46 (0.32–0.68); Pinteraction = 0.07; SU with: HR 0.64 (0.44–0.92); without: 0.61 (0.46–0.81); Pinteraction = 0.85; or insulin with: HR 0.63 (0.46–0.85); without: 0.61 (0.44–0.85); Pinteraction = 0.92. Reductions in three‐point major adverse CV events, hospitalizations for heart failure, and all‐cause mortality were consistent across subgroups of baseline therapies. Empagliflozin reduced the risks of incident or worsening nephropathy versus placebo irrespective of the use of SU or insulin at baseline (Pinteraction > 0.05), but there was a greater reduction in this risk for patients not using metformin HR 0.47 (95% CI 0.37–0.59) versus those using metformin HR 0.68 (95% CI 0.58–0.79) at baseline (Pinteraction = 0.01).
Conclusions
The addition of empagliflozin to antihyperglycaemic regimens of patients with type 2 diabetes and CV disease consistently reduced their risks of adverse CV outcomes and mortality irrespective of baseline use of metformin, SU or insulin. For chronic kidney disease progression, there may be a larger benefit from empagliflozin in those patients who are not using metformin.
Aims
To describe glycaemic control and diabetes management in adults with type 1 diabetes (T1DM), in a real‐life global setting.
Materials and Methods
Study of Adults' GlycEmia (SAGE) was a ...multinational, multicentre, single visit, noninterventional, cross‐sectional study in adult patients with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26–44, 45–64 and ≥65 years) and reported across different regions. The primary endpoint was the proportion of participants achieving HbA1c less than 7.0 % in each age group. Secondary endpoints included incidence of hypoglycaemia, severe hypoglycaemia and severe hyperglycaemia leading to diabetic ketoacidosis (DKA) and therapeutic management of T1DM.
Results
Of 3903 included participants, 3858 (98.8%) were eligible for the study. Overall, 24.3% (95% confidence interval CI: 22.9–25.6) of participants achieved the glycaemic target of HbA1c less than 7.0 %, with more participants achieving this target in the 26–44 years group (27.6% 95% CI: 25.5–29.8). Target achievement was highest in Eastern and Western Europe, and lowest in the Middle East. The incidence of hypoglycaemia and of severe hyperglycaemia leading to DKA tended to decrease with age, and varied across regions. Age and regional differences were observed in therapeutic management, including types of device/insulin usage, frequency of insulin dose adjustment and technology usage.
Conclusions
Glycaemic control remains poor in adults with T1DM globally. Several areas of treatment may be optimised to improve outcomes, including supporting patient self‐management of insulin therapy, increasing use of technologies such as CGM, and greater provision of healthcare support.
Aims
To conduct a secondary analysis of the SAGE study to evaluate the association between glycaemic control and patient‐reported outcomes (PROs), in adults with type 1 diabetes (T1DM) across ...different age groups and regions.
Materials and methods
SAGE was a multinational, cross‐sectional, observational study in adults with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26‐44, 45‐64, and ≥65 years), and reported across different regions. PRO questionnaires were applied to assess hypoglycaemia fear (Hypoglycemia Fear Survey‐II), diabetes‐related distress (Problem Areas In Diabetes questionnaire), insulin treatment satisfaction (Insulin Treatment Satisfaction Questionnaire), and diabetes‐specific quality of life (QoL; Audit of Diabetes‐Dependent Quality of Life). Multivariable analysis was performed to evaluate the relationship between glycated haemoglobin (HbA1c) target achievement (<7% and individualised targets) with PRO scores.
Results
The PRO scores showed relatively low levels of diabetes‐related emotional distress and fear of hypoglycaemia, moderate to high treatment satisfaction, and low diabetes‐related impact on QoL. Results were generally comparable across age groups with some regional variability. Achievement of the HbA1c <7% target was associated with less worry about hypoglycaemia, lower diabetes‐related emotional distress, higher insulin treatment satisfaction, and higher QoL. Achievement of individualised HbA1c targets was associated with lower diabetes‐related emotional distress and higher insulin treatment satisfaction.
Conclusions
Better glycaemic control was most closely associated with low emotional distress due to diabetes and high patient‐reported insulin treatment satisfaction.
Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of glucose-lowering agent for type 2 diabetes (T2D) that are commonly used in clinical practice. With the recent disclosure of data from the ...CARMELINA cardiovascular outcomes trial (CVOT), which investigated linagliptin, CV and renal outcomes data are now available for four agents in the DPP-4 inhibitor class that are approved in most markets. To consider how the CARMELINA study may be interpreted, and the relevance for our clinical practice, we convened as an expert group of diabetes specialists from the Central and Eastern Europe region to discuss the new disclosures. Our discussions revealed a general confidence in safety across the class that is further supported by CARMELINA. However, we also concluded that there are important differences in the available evidence level between agents in the setting of heart failure and data on renal outcomes. Here, we noted the clinical relevance to our practice of the study population in CARMELINA, which is unique among CVOTs in including a majority of patients with chronic kidney disease (CKD). Given the risk for future development of renal impairment that is associated with T2D even in patients without current overt CKD, we believe that the CARMELINA study provides important new insights that are clinically relevant for a broad range of patients. Finally, we discuss how these insights can be integrated into the approach to the pharmacotherapeutic management of hyperglycaemia that is recommended in newly updated guidelines.
Radna skupina Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora pripremila je smjernice za postupanje u pandemiji COVID-19 za osobe sa šećernom bolešću i za ...zdravstvene
djelatnike. U preporukama su naglašeni razmjeri pandemije i moguće posljedice za oboljele od šećerne bolesti. Opisana je klinička slika i ponovljene smjernice Nacionalnog stožera civilne zaštite kako se osobe od šećerne bolesti mogu zaštititi i što trebaju činiti za dobru regulaciju glikemije. Predložene su mjere koje trebaju provoditi zdravstvene
ustanove koje skrbe o bolesnicima sa šećernom bolešću i načela zbrinjavanja glikemije u hitnom prijemu i tijekom hospitalizacije.
Acromegaly and gigantism are hormonal disorders which develop as a consequence of chronic growth hormone hypersecretion. The prefix pseudo- is used to describe a certain clinical condition without a ...clearly proven characteristic of pathophysiological mechanism and basic biochemical features; pseudoacromegaly or acromegaloidism match the definition from above. In this case reports, we will try to provide a concise overview of diagnostic evaluation of acromegaloid physical appearance, while discussing two cases of patients who have similar clinical acromegaloid features as the first sign of the disease but have completely different etiologic backgrounds of their acromegalic appearance. The first case is of a 57-year-old male who presented with a marked acral growth and coarse facial features, but the diagnosis of secondary amyloidosis caused by multiple myeloma was confirmed just after biopsy of tongue and buccal mucosa. The second case is that of a 63-year-old male with an acromegaloid appearance caused by ectopic secretion of GH secreting lung carcinoma. The early diagnosis of ectopic acromegaly and pseudoacromegaly is still a challenging process. The key task is to confirm the GH axis abnormalities and establish the underlying disease, as a crucial step for faster treatment and need to avoid unnecessary therapeutic procedures to decreased mortality and improved quality of life.
Despite widespread use of technology, type one diabetes mellitus (T1DM) is still a great clinical challenge during pregnancy. This study aims to assess how prenatal variables of T1DM patients using ...continuous subcutaneous insulin infusion (CSII) influence pregnancy outcomes. We performed a retrospective study of 35 patients with T1DM treated with CSII during pregnancy. Alterable preconception variables (A1C, body mass index, basal and bolus insulin dose) were analysed as possible contributors to birth weight and large-for-gestational-age (LGA) prevalence. Inclusion criteria were presence of T1DM for more than two years, A1C < 7.4% and treatment with CSII for at least three months prior to conception. The preconception basal insulin dose and A1C had a significant correlation to the neonatal birth weight (
= 0.01, r = 0.4 and
= 0.04, r = 0.3, respectively) and were significant in regression analysis together contributing 22% of the variance in birth weight percentiles (sig = 0.17, R square = 0.22). Prevalence of LGA was 46%. Women who had LGA neonates also had a higher preconception basal insulin dose compared to women with non-LGA neonates (26 ± 9 vs. 18 ± 7 IU (international units),
= 0.01). The LGA group had a higher preconception A1C, but it did not reach statistical significance (6.5 ± 0.5% vs. 6.2 ± 0.9%, respectively,
= 0.2). Women with T1DM treated with CSII who had unregulated glycaemia and more basal insulin were at greater risk for development of LGA neonates.
Pretilost predstavlja jedan od najvećih zdravstveno-ekonomskih i socijalnih problema današnjice te se sve veća učestalost pretilosti povezuje s porastom incidencije i pobola niza drugih bolesti, ...prije svega šećerne bolesti, kardiovaskularnih i cerebrovaskularnih oboljenja te malignih bolesti. U održavanju ravnoteže unosa i potrošnje energije najvažniju regulatornu ulogu ima središnji živčani sustav, odnosno osovina mozak-crijevo, koja se temelji na funkciji niza gastrointestinalnih peptidnih hormona. Djelovanje navedenih peptida izrazito je raznoliko i ovisi o nizu čimbenika, posebno vrsti i količini hrane, energetskom stanju organizma te pratećim bolestima i metaboličkim poremećajima. Djelovanje ovih hormona usko je povezano s endokrinom funkcijom gušterače, lučenjem inzulina i regulacijom glikemije, što ujedno ukazuje i na jasnu povezanost pretilosti i šećerne bolesti. Velik napredak na području razvoja i primjene novih antidijabetika u klasi peptidnih hormona, odnosno inkretina, te utvrđivanje njihovih dodatnih svojstava u smislu redukcije tjelesne težine, otvorili su tijekom posljednjih godina čitavo novo područje istraživanja farmakoterapije pretilosti. Obećavajuće rezultate prije svega pružaju nove mogućnosti kombinacije više lijekova, čime se ponovno stvara mogućnost razvoja adekvatne farmakoterapije kao alternative kirurškom pristupu liječenju pretilosti.
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