AI Article Synopsis
- Metformin is the first-line treatment for type 2 diabetes, but if it's not effective, choosing a second-line drug is unclear since none show a significantly better overall glycemic response.
- A real-world study analyzed electronic health records to compare the effectiveness of four second-line medications (DPP4i, SU, TZD, SGLT2i) on lowering HbA1c levels after 6 and 12 months, considering various patient characteristics.
- Results indicated that the treatments were similarly effective in achieving the HbA1c target of <7.5%, with specific demographic trends suggesting better outcomes for younger patients with SGLT2i and older patients with SU, emphasizing the need for personalized treatment decisions based on individual patient profiles
Article Abstract
Introduction: Metformin is the recommended initial treatment in type 2 diabetes mellitus (T2DM), but when this does not give adequate glucose control the choice of which second-line drug to use is uncertain as none have been found to have a better overall glycaemic response. In this real-world study dipeptidyl peptidase 4 inhibitors (DPP4i), sulphonylureas (SU), thiazolidinediones (TZD) and sodium glucose co-transporter 2 inhibitors (SGLT2i) were compared for their effectiveness in lowering glycated haemoglobin (HbA1c) levels for a particular individual based on their clinical characteristics.
Methods: A retrospective analysis was undertaken of electronic health records of people with T2DM prescribed metformin alongside a DPP4i, SU, TZD or SGLT2i at second-line. Regression modelling was used to model the changes in HbA1c from baseline at month 6 and month 12 for the individual therapies, adjusting for demographic and clinical characteristics.
Results: There were 7170 people included in the study. Treatment at second-line with SUs, DPP4i, TZDs and SGLT2i resulted in similar percentages of people achieving the recommended HbA1c target of < 7.5% (58 mmol/mol) at both 6 and 12 months. For those receiving SGLT2i and SUs, the greatest improvement in HbA1c was observed in relatively younger and older people, respectively. Trends were detected between other baseline characteristics and HbA1c improvement by drug class, but they were not statistically significant. Non-adherence rates were low for all drug classes. People with a higher medication possession ratio (≥ 80%) also had greater improvements in HbA1c at 12 months.
Conclusion: This study identified patients' phenotypic characteristics that may have the potential to influence individual treatment response. Accounting for these characteristics in clinical treatment decisions may facilitate individualised prescribing by being able to select the right drug for the right patient.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261289 | PMC |
| http://dx.doi.org/10.1007/s13300-020-00834-w | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Type 2 Diabetes Mellitus Exacerbates Pathological Processes of Parkinson's Disease: Insights from Signaling Pathways Mediated by Insulin Receptors.
Neurosci Bull
January 2025
Center for Translational Neuromedicine and Neurology, School of Life Sciences, Institute for Brain Sciences Research, Henan University, Huaihe Hospital of Henan University, Kaifeng, 475004, China.
Parkinson's disease (PD), a chronic and common neurodegenerative disease, is characterized by the progressive loss of dopaminergic neurons in the dense part of the substantia nigra and abnormal aggregation of alpha-synuclein. Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by chronic insulin resistance and deficiency in insulin secretion. Extensive evidence has confirmed shared pathogenic mechanisms underlying PD and T2DM, such as oxidative stress caused by insulin resistance, mitochondrial dysfunction, inflammation, and disorders of energy metabolism.
View Article and Find Full Text PDFBasic Science and Pathogenesis.
Alzheimers Dement
December 2024
UNAM, School of Medicine, Department of Physiology, CDMX, DF, Mexico.
Background: Longitudinal population-based studies have consistently revealed an expedited cognitive decline in the elderly population with type 2 diabetes mellitus (DM2). Additionally, there is a documented increased risk of developing vascular dementia and Alzheimer's disease in individuals with DM2. Conversely, recent research has pointed to metformin (MET), a widely prescribed medication for type 2 diabetes mellitus (T2DM), potentially mitigating age-related cognitive dysfunction (Madhu et al.
View Article and Find Full Text PDF[Not Available].
Tunis Med
December 2024
Endocrinology-Diabetology Department, Hédi Chaker Hospital, Sfax, Tunisia.
Introduction: Metabolic syndrome (MS) is responsible for the increased cardiovascular risk in patients with type 2 diabetes. Few studies have focused on MS in type 1 diabetes mellitus (T1DM).
Aim: To describe the clinical, biochemical and therapeutic characteristics of T1DM patients affected by MS.
Prescribing Trends of Antidiabetes Medications Near End-of-Life Among Adults With Type 2 Diabetes: A Cohort Study.
Diabetes Care
January 2025
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Objective: To assess prescribing trends of antidiabetes medications in the last year of life among older adults with type 2 diabetes (T2D) and explore whether frailty is associated with differential prescribing.
Research Design And Methods: In this observational cohort study of Medicare beneficiaries aged ≥67 years (2015-2019) with T2D, we assessed temporal trends in prescribing an antidiabetes medication, stratified by frailty. The main outcome included antidiabetes medication fills within 1 year of death.
Predictive models of post-prandial glucose response in persons with prediabetes and early onset type 2 diabetes: A pilot study.
Diabetes Obes Metab
January 2025
Department of Medicine, Division of Endocrinology, Diabetes Research Center, Columbia University Irving Medical Center, New York, New York, USA.
Article Synopsis
- The study investigates how personalized dietary approaches using continuous glucose monitoring (CGM) can effectively manage post-prandial glucose response (PPGR) in older adults with prediabetes or early type 2 diabetes.
- Data collected over two weeks indicated that measures like the mean amplitude of glucose excursions (MAGE) and fasting glucose levels were strong predictors of glucose response during meals and oral glucose tolerance tests.
- The findings suggest CGM-based strategies could enhance personalized nutrition and medical interventions for better controlling glucose levels in this demographic.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!