Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are well established as effective treatments for patients with type 2 diabetes. GLP-1 RAs augment insulin secretion and suppress glucagon release ...via the stimulation of GLP-1 receptors. Although all GLP-1 RAs share the same underlying mechanism of action, they differ in terms of formulations, administration, injection devices and dosages. With six GLP-1 RAs currently available in Europe (namely, immediate-release exenatide, lixisenatide, liraglutide; prolonged-release exenatide, dulaglutide and semaglutide), each with its own characteristics and administration requirements, physicians caring for patients in their routine practice face the challenge of being cognizant of all this information so they are able to select the agent that is most suitable for their patient and use it in an efficient and optimal way. The objective of this review is to bring together practical information on the use of these GLP-1 RAs that reflects their approved use.
Funding
: Eli Lilly and Company.
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•In Spain, diabetic retinopathy (DR) prevalence in type 2 diabetic patients was 14.9%.•DR was higher in women and older patients.•eGFR, duration of disease, HbA1c≥7% and high blood pressure were ...associated with DR.•DR was also higher in patients taking insulin.•Patients with DR used to have comorbidities more frequently.
Diabetic retinopathy (DR) is the leading cause of blindness in working age population in developed countries. Albuminuria and estimated glomerular filtration rate (eGFR) have been considered biomarkers for DR. This study aimed to investigate the prevalence of DR and its relationship with eGFR and other risk factors in type 2 diabetic patients (T2DM) in Spain.
A cross-sectional and descriptive study has been performed in 14,266 patients. Clinical records were reviewed. Demographic data, clinical diagnoses, clinical variables, and results from laboratory tests were recorded. Prevalence rates of DR were calculated. Logistic regression analysis was applied to assess predictors of the DR presence/absence.
DR prevalence was 14.9%, being more prevalent in women (p=0.0087) and in older patients (p<0.0001). Duration of disease (OR=5.3, IC95%=3.8–7.4; p<0.0001), eGFR<60ml/min/1.73m2 (OR=2.0, IC95% 1.6–2.4; p<0.0001), levels of HbA1c≥7% (OR=1.9, IC95%=1.5–2.3; p<0.0001) and high blood pressure (OR=1.6, IC95%=1.2–2.1; p=0.0032) were associated with higher risk of DR. DR was also more frequent in patients taking insulin (32,6% vs. 10,2%; p<0.0001).
Around one in seven patients with T2DM has DR after nine years since diagnosis. Time since diagnosis, insulin therapy, cardiovascular profile, and renal dysfunction are associated with DR in patients with T2DM in Spain.
Background
The aim of this study was to assess the clinical implications of calculating an individualized HbA1c target using a recently published algorithm in a real‐life clinical setting.
Methods
...General practitioners (GPs) from the Spanish Society of Family Medicine Diabetes Expert Group were invited to participate in the study. Each GP selected a random sample of patients with diabetes from his or her practice and submitted their demographic and clinical data for analysis. Individualized glycaemic targets were calculated according to the algorithm. Predictors of good glycaemic control were studied. The rate of patients attaining their individualized glycaemic target or the uniform target of HbA1c < 7.0% was calculated.
Results
Forty GPs included 408 patients in the study. Of the 8 parameters included in the algorithm, “comorbidities,” “risk of hypoglycaemia from treatment,” and “diabetes duration” had the greatest impact on determining the individualized glycaemic target. Number of glucose‐lowering agents and adherence were independently associated with glycaemic control. Overall, 60.5% of patients had good glycaemic control per individualized target, and 56.1% were well controlled per the uniform target of HbA1c < 7.0% (P = .20). However, 12.8% (23 of 246) of the patients with HbA1c ≥ 7.0% were adequately controlled per individualized target, and 2.6% (6 of 162) of the patients with HbA1c < 7.0% were uncontrolled since their individualized target was lower.
Conclusions
In a real‐life clinical setting, applying individualized targets did not change the overall rate of patients with good glycaemic control yet led to reclassification of 7.1% (29 of 408) of the patients. More studies are needed to validate these results in different populations.
This study aimed to assess multicausal mortality due to diabetes from 2016–2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered ...cause on the death certificate.
A cross-sectional descriptive study taking a multicausal approach.
Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases.
In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.
•This study evaluated multi-causal mortality due to DM between 2016 and 2018 in Spain.•Diabetes Mellitus was the underlying cause of 2.3% of total deaths in Spain.•In 6.2% of cases, Diabetes Mellitus appeared as one of the multiple causes of death
To evaluate the association between patient-reported hypoglycemic symptoms with ratings of their health-related quality of life state and patient-reported adverse events in patients with type 2 ...diabetes mellitus (T2DM).
This observational, multicenter, cross sectional study was based on a sample of patients with T2DM from seven European countries who added sulfonylurea or thiazolidinedione to metformin monotherapy between January 2001 and January 2006. Included patients were required to have at least one hemoglobin A1c (HbA1c) measurement in the 12 months before enrollment and to not be receiving insulin. Demographic and clinical data from medical records were collected using case report forms. Questionnaires measured patient-reported hypoglycemic symptoms, health-related quality of life (EuroQol visual analogue scale, EQ-5D VAS), and treatment-related adverse events.
A total of 1,709 patients were included in the study. Mean patient age was 63 years, 45% were female, mean HbA1c was 7.06%, and 28% were at HbA1c goal (HbA1c < 6.5%). Hypoglycemic symptoms during the 12 months before enrollment were reported by 38% of patients; among whom 68% reported their most severe symptoms were mild, 27% moderate, and 5% severe. Adjusted linear regression analyses revealed that patients reporting hypoglycemic symptoms had significantly lower EQ-5D VAS scores indicating worse patient-reported quality of life (mean difference -4.33, p < 0.0001). Relative to those not reporting symptoms, the adjusted decrement to quality of life increased with greater hypoglycemic symptom severity (mild: -2.68, p = 0.0039; moderate: -6.42, p < 0.0001; severe: -16.09, p < 0.0001). Patients with hypoglycemia reported significantly higher rates of shakiness, sweating, excessive fatigue, drowsiness, inability to concentrate, dizziness, hunger, asthenia, and headache (p < 0.0001 for each comparison).
Hypoglycemic symptoms and symptom severity have an adverse effect on patients' rating of their health related quality of life state. Hypoglycemic symptoms are correlated with treatment-related adverse effects. Minimizing the risk and severity of hypoglycemia may improve patients' quality of life and clinical outcomes. Results are subject to limitations associated with observational studies including the potential biases due to unobserved patient heterogeneity and the use of a convenience sample of patients.
Treatment of diabetes mellitus type2 (DM2) includes healthy eating and exercise (150minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except ...contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used.
•Information about HbA1c and cardiovascular disease in elderly patients is scarce.•The incidence of events in patients≥70 years was 20.6 per 1000/person/year.•HbA1c>7% is associated with ...cardiovascular events in elderly patients.
Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years.
Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008–2012. We included men and women aged≥70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted.
5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables.
These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.
The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to ...assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (
= 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72;
= 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.
•La pandemia de COVID-19 nos ha obligado a diseñar nuevas formas de dispensar cuidados médicos. En este contexto, la telemedicina se propone como principal alternativa a la clásica atención sanitaria ...presencial.•El colapso de los centros sanitarios durante la pandemia ha dificultado el seguimiento de los problemas crónicos de salud como la diabetes tipo 2, impidiendo un seguimiento o tratamiento adecuado.•Adaptar las guías de práctica clínica en forma de recomendaciones y algoritmos de decisión adaptados al nuevo escenario profesional permite homogeneizar y estandarizar la atención sanitaria que se ofrece a los pacientes con diabetes tipo 2.
Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
ResumenEl adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la ...metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo 2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia.
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