scholarly journals Dynamic monitoring of HbA1c in Russian regions: data comparison of mobile medical center (Diamodul) and national diabetes register of Russian Federation

2020 ◽  
Vol 23 (2) ◽  
pp. 104-112
Author(s):  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Mikhail А. Isakov ◽  
Alexey A. Serkov ◽  
Marina V. Shestakova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Center ◽  
Clinical Situation ◽  
Dynamic Monitoring ◽  
Random Group ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy ◽  
Diabetes Register

BACKGROUND: Glikogemoglobin (HbA1c) is a key clinical marker for evaluating the effectiveness of glucose-lowering therapy for patients with diabetes mellitus (DM) and the quality of diabetic care. AIMS: to conduct dynamic monitoring of the quality of glycemic control in DM patients based on a comprehensive examination in mobile medical center (Diamodul) during repeated visits to the regions in 2019 compared with visits of Based Federal program Diabetes Mellitus (20052010) and data of the National diabetes register (NDR). MATERIALS AND METHODS: The object of the study: patients with T1DM and T2DM examined in Diamodul in 2019 in Voronezh region (Vr), Krasnodar region (Kr) (n = 600), there were dynamic group of re-examined (Vr n = 224; Kr n = 113), random group of new patients (Vr n = 72; Kr n = 191); group of adult patients from NDR with indicated HbA1c in 2019 (n = 2410067). RESULTS: According to Diamodul, the HbA1c levels are significantly worse than they were reported to NDR: the proportion of patients achieved HbA1c 7% for T1DM is 13.3% and 11.7%; T2DM 25.1% and 28.6%, in Kr and Vr, respectively; in NDR: T1DM 37.4%, T2DM 52.2%. The average HbA1c values in the Diamodul are higher than in NDR by 0.95% for T1DM, 1.41% for T2DM patients. The proportion of patients with HbA1c9% decrease in dynamic of examinations through years in T1: in Vr from 53.1% in 2005 and 55.8% in 2010 to 42.9% in 2019, in Kr from 53.2% in 2006 to 43.8% in 2019; also there were decreases in the average HbA1c values in Vr from 9.3% in 2005 and 9.4% in 2010 to 8.8% in 2019; in Kr from 9.1% in 2006 to 8.7% in 2019. In T2DM patients with the best parameters of DM control in a whole, the positive trends were less pronounced and are assessed as non-deterioration: the proportion of HbA1c9 % in Vr: 34.7%34.7%36.4%, in Kr 40.1%28.4%; average values of HbA1c: 8.2%8.4%8.5% and 8.6%8.4%, respectively. CONCLUSIONS: The data of the research clearly indicates the need for 100% inclusion of HbA1c in the examination standards in all DM patients at the primary level at least 1 time per year, in order to monitor the real clinical situation, the effectiveness of glucose-lowering therapy and its timely intensification to prevent development of complications.

scholarly journals Initiation of glucose-lowering therapy in Type 2 diabetes mellitus patients in general practice

2004 ◽  
Vol 21 (8) ◽  
pp. 896-900 ◽  
Author(s):  
J. A. Spoelstra ◽  
R. P. Stolk ◽  
O. H. Klungel ◽  
J. A. Erkens ◽  
G. E. H. M. Rutten ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
General Practice ◽  
Type 2 Diabetes Mellitus ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

scholarly journals Glucose-Lowering Therapy in Patients With Postpancreatitis Diabetes Mellitus: A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Rikke Viggers ◽  
Morten Hasselstrøm Jensen ◽  
Henrik Vitus Bering Laursen ◽  
Asbjørn Mohr Drewes ◽  
Peter Vestergaard ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Incidence ◽  
Secondary Diabetes ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

<p><i>Objective</i>: Postpancreatitis diabetes mellitus (PPDM) is a type of secondary diabetes that requires special considerations for management. The main objective was to examine prescription patterns of glucose-lowering therapy among adults with PPDM compared to type 1 and type 2 diabetes.</p> <p><i>Research Design and Methods:</i> In a Danish nation-wide population-based cohort study we identified all individuals with adult-onset diabetes mellitus in the period 2000-2018 and categorized them as type 1 diabetes, type 2 diabetes or PPDM. We ascertained diabetes incidence rates, clinical and demographic characteristics, classifications and prescription patterns of glucose-lowering therapy and compared these parameters across diabetes subgroups. </p> <p><i>Results</i><i>:</i> Among 398,456 adults with new-onset diabetes mellitus, 5,879 (1.5%) had PPDM, 9,252 (2.3%) type 1 diabetes and the remaining type 2 diabetes (96.2%). The incidence rate of PPDM was 7.9 (95% CI 7.7-8.1) per 100,000 person-years vs. 12.5 (95% CI 12.2-12.7) for type 1 diabetes (incidence-rate-ratio 0.6; 95% CI 0.6-0.7, p<0.001). A sizeable proportion of PPDM patients were classified as type 2 diabetes (44.9%) and were prescribed sulfonylureas (25.2%) and incretin-based therapies (18.0%) that can potentially be harmful in PPDM. In contrast, 35.0% of patients never received biguanides, which are associated with a survival benefit in PPDM. Increased insulin requirements were observed for patients with PPDM compared to type 2 diabetes (hazard ratio 3.10; 95% CI 2.96-3.23, p<0.001) in particular for PPDM associated with chronic pancreatitis (hazard ratio 4.30; 95% CI 4.01-4.56, p<0.001).</p> <p><i>Conclusions</i><i>:</i> PPDM is a common type of secondary diabetes in adults but is often misclassified and treated as type 2 diabetes, although PPDM requires special considerations for management.</p>

scholarly journals Relationship of clinical efficacy of glucose lowering agents, gut microbiota, diet, and patient’s genotype in diabetes mellitus type 2

2018 ◽  
Vol 16 (4) ◽  
pp. 11-18
Author(s):  
Aleksandr L. Urakov ◽  
Konstantin G. Gurevich ◽  
Iuliia A. Sorokina ◽  
Liubov V. Lovtsova ◽  
Olga V. Zanozina ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Diabetes Mellitus Type 2 ◽  
Intestinal Microflora ◽  
Hypoglycemic Agents ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy ◽  
Relationship Of

The review is devoted to revealing the connection between the intestinal microflora, diet and the effectiveness of glucose – lowering therapy in patients with type 2 diabetes. Potential targets and the effects of oral and injectable hypoglycemic agents on microbiota in this category of patients are considered. The work reflects modern views on hypoglycemic drugs from the standpoint of the science of metabolomics within the framework of personalized medicine.

scholarly journals Glycemic variability and oxidative stress in patients with type 2 diabetes mellitus during combined glucose-lowering therapy

2017 ◽  
Vol 89 (10) ◽  
pp. 36-39
Author(s):  
S G Butaeva ◽  
A S Ametov ◽  
A V Bugrov ◽  
V V Dolgov
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Glycated Hemoglobin ◽  
Glycemic Variability ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Group 2 ◽  
Glucose Lowering Therapy ◽  
Group 1

Aim. To evaluate the impact of intensified glucose-lowering therapy on carbohydrate metabolic indicator, such as glycated hemoglobin, fasting blood glucose level (BGL) (FBGL), postprandial BGL (PBGL), and glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) during metformin monotherapy before and 3 months after therapy intensification. Subjects and methods. The investigation enrolled 51 patients with T2DM treated with metformin 1000 mg twice daily, who failed to achieve satisfactory glycemic control. During randomization, the treatment was intensified by addition of sitagliptin 100 mg/day in Group 1 (n=25) or gliclazide MB 60 mg/day in Group 2 (n=26). Before and 3 months after the treatment, carbohydrate metabolic indicators were investigated, 24-hour BGL monitoring (continuous glucose monitoring system (GMS)) was performed, and the body’s antioxidant status was examined by determining the total antioxidant capacity of blood plasma (overall sound pressure levels (OASPL)). Results. During 3-month treatment, Group 1 had a significantly reduced FBGL compared to that before the therapy; in Group 2 this index did not change significantly. Both study groups showed a significant decrease in PBGL and glycated hemoglobin (HbA1c). The mean amplitude of glycemic excursion (MAGE) was significantly decreased in the sitagliptin intensification group. In both groups, the standard deviation (SD) reduced significantly by 26% in Group 1 and by 38% in Group 2. Both groups also displayed a significant increase in blood OASPL (p

scholarly journals Glucose-Lowering Therapy in Patients With Postpancreatitis Diabetes Mellitus: A Nationwide Population-Based Cohort Study

Diabetes Care ◽  
2021 ◽  
pp. dc210333
Author(s):  
Rikke Viggers ◽  
Morten Hasselstrøm Jensen ◽  
Henrik Vitus Bering Laursen ◽  
Asbjørn Mohr Drewes ◽  
Peter Vestergaard ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Population Based ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

scholarly journals Early intensification of glucose-lowering therapy: VERIFY lessons and real clinical practice on the example of the Moscow region diabetes register data

2020 ◽  
Vol 66 (5) ◽  
pp. 86-95
Author(s):  
I. V. Misnikova ◽  
Yu. A. Kovaleva ◽  
V. A. Gubkina
Keyword(s):  
Combination Therapy ◽  
The Elderly ◽  
Moscow Region ◽  
Newly Diagnosed ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
End Stage ◽  
Glucose Lowering Therapy ◽  
Diabetes Register ◽  
Clinical Cases

BACKGROUND: The prevalence of T2DM is steadily increasing not only among the elderly, but also at a young age. T2DM is preceded by a long period of significant metabolic changes with the development of insulin resistance and в-cell dysfunction. To reduce the prevalence of complications, treatment is needed which affects several pathophysiological mechanisms underlying the disease. Monotherapy with metformin at the onset of T2DM is often insufficient. The VERIFY study demonstrated the advantage of early administration of a combination of vildagliptin and metformin in relation to the glycemic durability compared to the sequential intensification of metformin with vildagliptin in patients with type 2 diabetes.AIMS: To assess the current situation in terms of the incidence of T2DM complications and the structure of the prescribing glucose lowering drugs based on the data from the Diabetes Register (DR) of the Moscow Region. To demonstrate the advantages of early combination therapy in patients with newly diagnosed T2DM using clinical cases.MATERIALS AND METHODS: The data from the DR of the Moscow region, which is part of the National Diabetes Register of the Russian Federation, were used for the analysis. The data of 6,096 patients with T2DM who died in 2019 were evaluated for building the structure of the causes of death of patients with T2DM. The pattern of glucose-lowering therapy was analyzed based on data of 226,327 patients with T2DM (for 2020), as well as separately of 14,379 patients with newly diagnosed T2DM in 2019. Clinical cases are described based on the data of two patients with T2DM, available in the DR database and outpatient records.RESULTS: In patients with young onset T2DM (<40 years), the prevalence of severe complications is higher than in the general population of patients with T2DM: blindness is in 5.9 times, end-stage chronic renal failure in 2.9 times, lower limb amputations in 6.4 times more. When prescribing glucose lowering drugs, monotherapy is prevalent, mostly metformin. In double combination, metformin is used in 96.22% of cases. In the structure of glucose lowering drugs, with newly diagnosed T2DM, combination therapy is used less frequently than in patients with T2DM in general. Of the drugs of the IDP-4 group, vildagliptin is most often prescribed — 46.25% (including of a fixed combination with metformin — 12.22%). Clinical cases reflect a rapid clinical outcome: a decrease in HbA1c to the target in 6 months, the absence of hypoglycemia or other side effects, and positive weight dynamics.CONCLUSIONS: A fairly large propotion of patients with T2DM are on monotherapy with glucouse lowering drugs. Early prescription of the combination of metformin plus vildagliptin provides a longer maintenance of glycemic control without increasing the risk of hypoglycemia and weight gain for patients with newly diagnosed T2DM.

scholarly journals The glucose-lowering therapy structure in special groups of type 2 diabetes mellitus patients based on data from the Moscow region register

2019 ◽  
Vol 22 (3) ◽  
pp. 206-216
Author(s):  
Inna V. Misnikova ◽  
Yulia A. Kovaleva ◽  
Mikhail А. Isakov ◽  
Alexander V. Dreval
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Insulin Therapy ◽  
Sglt2 Inhibitors ◽  
Moscow Region ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

BACKGROUND: Data of real clinical practice in diabetes mellitus (DM) register allow to evaluate features and trends in structure of glucose-lowering therapy (GLT). AIM: Тo analyze of structure of GLT received by patients with type 2 diabetes mellitus (T2DM) in Moscow region for 2018 and to evaluate its dynamics over 15 years. METHODS: Analysis of GLT structure was carried out on basis of data from register of patients with DM in Moscow region, which is part of National register of diabetes mellitus in Russian Federation. In March 2018 it contained data on 211,792 T2DM patients of Moscow region. Structure of GLT administration was evaluated according T2DM duration, patients age and presence of cardiovascular diseases (CVD). Dynamics of GLT is analyzed from 2004 to 2018 yrs. RESULTS: In 2018 non-insulin glucose-lowering drugs (NIGD) prescription prevailed (78.3%), insulin therapy was prescribed in 18.5% of patients, 3.2% of patients did not receive drug therapy. Most commonly prescribed NIGD were metformin (69.3%) and sulfonylurea (51.3%). Older patients more often than younger did not use GLT at all and less frequently received insulin therapy and iDPP-4. Insulin therapy was prescribed twice as often in patients with CVD compared with patients without CVD (29.6% and 15.5%). NIGD monotherapy has been less commonly used in patients with CVD (67.3% and 81.2%). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) were prescribed to patients with CVD GLP-1 RA in 0.1% of cases, without CVD in 0.3% of cases, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in 1.1% and 0.6%. correspondently. CONCLUSION: Metformin was most commonly prescribed drug in GLT structure for T2DM patients in the Moscow region in 2018 yr. Percentage of new drugs in the structure of GLT increased mainly due to iDPP-4, and secondly due to SGLT2 inhibitors. New classes of GLT were more often prescribed to patients of younger age, with diabetes duration up to 10 years, overweight or obese. Administration of NIGD with proven cardiovascular protection in presence of CVD is almost two times less than for those without CVD.

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