Background: Glucagon-like peptide 1 agonists differ in chemical structure, duration of action and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. Methods: We randomly assigned patients with type 2 diabetes and cardiovascular disease to the addition of once-weekly subcutaneous injection of albiglutide (30 mg to 50 mg) or matching placebo to standard care. We hypothesized that albiglutide would be noninferior to placebo for the primary outcome of first occurrence of cardiovascular death, myocardial infarction, or stroke. If noninferiority was confirmed by an upper limit of the 95% confidence interval for the hazard ratio of less than 1.30, closed-testing for superiority was prespecified. Findings: Overall, 9463 participants were followed for a median of 1.6 years. The primary composite outcome occurred in 338 of 4731 patients (7.1%; 4.6 events per 100 person-years) in the albiglutide group and in 428 of 4732 patients (9.0%; 5.9 events per 100 person-years) in the placebo group (hazard ratio, 0.78; 95% confidence interval [CI ], 0.68 to 0.90), indicating that albiglutide, was superior to placebo (P<0.0001 for noninferiority, P=0.0006 for superiority). The incidence of acute pancreatitis (albiglutide 10 patients and placebo 7 patients), pancreatic cancer (6 and 5), medullary thyroid carcinoma (0 and 0), and other serious adverse events did not differ significantly between the two groups. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. (Funded by GlaxoSmithKline; Harmony Outcomes ClinicalTrials.gov number, NCT02465515.) noninferiority; P = 0.06 for superiority). There seems to be variation in the results of existing trials with GLP-1 receptor agonists, which if correct, might reflect drug structure or duration of action, patients studied, duration of follow-up or other factors.

Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3–1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels.

IntroductionImproper injection technique can negatively affect glycemic control and treatment tolerability. We assessed the impact of structured insulin injection training on glycemic control.MethodsWe compared changes in glycated hemoglobin (A1C) and fasting plasma glucose following structured insulin injection training in a 6-month pilot study in patients with type 1 or 2 diabetes. Patients were recruited from mobile clinics in Moscow, Russia, and randomized into three groups. Groups 1 and 2 received structured injection training, and group 3 did not. Group 1 received 4-mm needles sufficient for each injection; groups 2 and 3 provided their own needle supply. Changes in insulin total daily dose (TDD), injection technique, needle reuse, and lipohypertrophy (LH) were assessed.ResultsOf 120 patients enrolled, 116 were included in all analyses (group 1, n = 43; group 2, n = 35; group 3, n = 38). At 6 months, mean [95% CI] reductions in A1C were significant in groups 1 and 2 (− 1.00% [10.9 mmol/mol (− 1.3 to − 0.6)] and − 1.00% [10.9 mmol/mol (− 1.4 to − 0.7)], respectively; P < 0.001 for both), but not in group 3 (− 0.02% [0.2 mmol/mol (− 1.2 to 1.6)]). Increases in insulin TDD, however, were similar and significant across groups (approximately 6 IU; P < 0.05). Injection technique improved, and needle reuse and LH declined in groups 1 and 2, but not in group 3.ConclusionsLittle is known about the glycemic impact of insulin injection training. We found that structured training and the use of short pen needles can improve injection technique, leading to significant A1C reductions and decreased rates of LH.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0315-y) contains supplementary material, which is available to authorized users.

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We demonstrated the possibility of using LDF method to achieve predictive value in the detection of microcirculatory disorders in an individual patient with diabetes. This extends the perspectives of the method beyond the purely scientific research.

Medical treatment for acromegaly commonly involves receiving intramuscular or deep subcutaneous injections of somatostatin receptor ligands (SRLs) in most patients. In addition to side effects of treatment, acromegaly patients often still experience disease symptoms even when therapy is successful in controlling GH and IGF-1 levels. Symptoms and side effects can negatively impact patients’ health-related quality of life. In this study, we examine the disease- and treatment-related burden associated with SRL injections as reported through the use of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ ©) and clinician-reported symptom severity through the Acromegaly Index of Severity (AIS). Patients included in this analysis were enrolled in a randomized phase 3 study, were biochemically-controlled (an IGF-1 &lt; 1.3 × the upper limit of normal [ULN] and average GH &lt; 2.5 ng/ml) and receiving SRL injections for ≥6 months with a stable dose of either long-acting octreotide or lanreotide monotherapy for ≥4 months. The sample (N = 91) was 65% female, 91% Caucasian, with a mean [standard deviation (SD)] age of 53 (1) years. Two-thirds of patients reported that they still experience acromegaly symptoms; 82% of these said they experience symptoms all of the time. Three-fourths experienced gastrointestinal (GI) side effects after injections, and 77% experienced treatment-related injection site reactions (ISRs). Patients commonly reported that these interfered with their daily life, leisure, and work activities. Those with higher symptom severity, as measured by the AIS, scored significantly worse on several Acro-TSQ domains: Symptom Interference, GI Interference, Treatment Satisfaction, and Emotional Reaction. Despite being biochemically controlled with injectable SRLs, most patients reported experiencing acromegaly symptoms that interfere with daily life, leisure, and work. GI side effects and ISRs were also common. This study highlights the significant disease burden that still persists for patients with acromegaly that have achieved biochemical control with the use of injectable SRLs.

Background: The registry is the main source of information about patients with acromegaly for assessing the quality of medical care, treatment effectiveness, determining the compliance of real clinical practice with existing standards and patient management. Aims: To analyze epidemiological, demographic and clinical characteristics of acromegaly in the Russian Federation and the effectiveness of various treatment methods. Materials and methods: The object of the study was the database of Russian registry of patients with pituitary tumors with specific analysis of patients with acromegaly only. We analyzed the data of 4114 patients with acromegaly stored on the online system in February 2019. Results: Based on the data 32% of patients had complete clinical and laboratory remission of acromegaly; percentage of patients with no remission was 68%, among them 22.5% had significant improvements in clinical symptoms and a decrease in GH and IGF1 without IGF1 normalization. The average age of patients at the onset of the disease was 42.7 years and at diagnosis 45.8 years. Men to women ratio was 1:2.6. In patients with acromegaly hypopituitarism was registered in 14.7% of cases and among them hypothyroidism (66%) and hypogonadism (52%) were registered more often. Among other complications the leading were diabetes mellitus (15.7%) and acromegalic arthropathy (15%). The proportion of patients receiving neurosurgical treatment increased from 35.7% to 49.6% in 2012-2019; the percentage of patients undergoing radiation therapy decreased significantly from 17.7% in 2012 to 0.8% in 2019. Remission was achieved in 40.47% after neurosurgery and 28.95% after medical treatment as a first line therapy p0.01. The number of patients receiving medical treatment at the time of the study was 1209. Among them 51% of patients treated with long-acting lanreotide and 24% receiving long-acting octreotide achieved remission (p0.0001) Conclusions: The remission rate of acromegaly remains suboptimal despite increased surgical activity, which corresponds to global trends. Long-acting lanreotide was significantly superior versus long-acting octreotide in the rate of acromegaly remission, which does not correspond with clinical trials and can be explained by the usage of different generic forms of octreotide, regional differences in medical supply and difficulties in long-acting octreotide injection vs lanreotide.

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