Patients' reports of hypoglycaemic symptoms are common in European outpatients with type 2 diabetes and are associated with significantly lower treatment satisfaction and with barriers to adherence. In addition, being at HbA1C goal is associated with treatment satisfaction and adherence.

OBJECTIVE -We sought to develop stroke risk equations for Chinese patients with type 2 diabetes in Hong Kong. RESEARCH DESIGN AND METHODS -A total of 7,209Hong Kong Chinese type 2 diabetic patients without a history of stroke at baseline were analyzed. The data were randomly and evenly divided into the training subsample and the test subsample. In the training subsample, stepwise Cox models were used to develop the risk equation. Validation of the U.K. Prospective Diabetes Study (UKPDS) stroke risk engine and the current stroke equation was performed in the test dataset. The life-table method was used to check calibration, and the area under the receiver operating characteristic curve (aROC) was used to check discrimination.RESULTS -A total of 372 patients developed incident stroke during a median of 5.37 years (interquartile range 2.88 -7.78) of follow-up. Age, A1C, spot urine albumin-to-creatinine ratio (ACR), and history of coronary heart disease (CHD) were independent predictors. The performance of the UKPDS stroke engine was suboptimal in our cohort. The newly developed risk equation defined by these four predictors had adequate performance in the test subsample. The predicted stroke-free probability by the current equation was within the 95% CI of the observed probability. The aROC was 0.77 for predicting stroke within 5 years. The risk score was computed as follows: 0.0634 ϫ age (years) ϩ 0.0897 ϫ A1C ϩ 0.5314 ϫ log 10 (ACR) (mg/mmol) ϩ 0.5636 ϫ history of CHD (1 if yes). The 5-year stroke probability can be calculated by: 1 Ϫ 0.9707 EXP (Risk Score Ϫ 4.5674) .CONCLUSIONS -Although the risk equation performed reasonably well in Chinese type 2 diabetic patients, external validation is required in other populations. Diabetes Care 30:65-70, 2007S troke is among the most common causes of death worldwide (1). Chinese individuals have a higher incidence of stroke and related mortality than Caucasians, as shown in the World Health Organization MONICA project (2). Diabetic patients have a two-to fivefold increased risk of stroke, in part due to interactions between multiple risk factors (3). The Framingham Study (4) and U.K. Prospective Diabetes Study (UKPDS) (5) have developed risk equations based on data collected from the Caucasian community and diabetic patients. Although a stroke risk equation has been developed in a small cohort of Chinese men recruited from a workforce (6), there is currently no risk equation applicable to Chinese individuals with diabetes, despite this number being projected to 42.3 million by 2030 (7). In this study, we validate and develop stroke risk equations to predict first stroke in Chinese type 2 diabetic patients based on data from the Hong Kong Diabetes Registry. RESEARCH DESIGN AND METHODS-Since 1995, all newly referred diabetic patients to the Prince of Wales Hospital in Hong Kong underwent comprehensive assessments of complications and risk factors based on the European DiabCare protocol (7a). Patients with hospital admissions within 6 -8 weeks before assessment accounted for...

Estimated GFR, haematocrit and ACR were independent predictors of ESRD and the derived risk equation performed well in Chinese patients with type 2 diabetes.

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3 years showed that GLM had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

The occurrence and severity of hypoglycaemic symptoms were associated with increased patient worry about hypoglycaemia and lower health-related quality of life among type 2 diabetic patients being treated with both metformin and a sulphonylurea.