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BackgroundThe SAMe-TT2R2 score was developed to predict which patients on oral anticoagulation with vitamin K antagonists (VKAs) will reach an adequate time in therapeutic range (TTR) (> 65%-70%). Studies have reported a relationship between this score and the occurrence of adverse events.ObjectiveTo describe the TTR according to the score, in addition to relating the score obtained with the occurrence of adverse events in patients with nonvalvular atrial fibrillation (AF) on oral anticoagulation with VKAs.MethodsRetrospective cohort study including patients with nonvalvular AF attending an outpatient anticoagulation clinic of a tertiary hospital. Visits to the outpatient clinic and emergency, as well as hospital admissions to the institution, during 2014 were evaluated. The TTR was calculated through the Rosendaal´s method.ResultsWe analyzed 263 patients (median TTR, 62.5%). The low-risk group (score 0-1) had a better median TTR as compared with the high-risk group (score ≥ 2): 69.2% vs. 56.3%, p = 0.002. Similarly, the percentage of patients with TTR ≥ 60%, 65% or 70% was higher in the low-risk group (p < 0.001, p = 0.001 and p = 0.003, respectively). The high-risk group had a higher percentage of adverse events (11.2% vs. 7.2%), although not significant (p = 0.369).ConclusionsThe SAMe-TT2R2 score proved to be effective to predict patients with a better TTR, but was not associated with adverse events.

BackgroundAccording to the Global Diabetes Plan, a unified health system with preventive and educational strategies is essential to proper diabetes care and primary settings should be the main site of care. In Brazil, there is limited access to outpatient hospital diabetes services, while primary-care diabetes support is underutilized. Telemedicine can be a useful adjunct to support discharge of stable patients with type 2 diabetes to the primary care setting. In this paper, we present a randomized controlled trial (RCT) protocol designed to evaluate the effects of telehealth support for stable type 2 diabetes patients discharged from hospital outpatient diabetes clinics.MethodsWe designed a RCT. Patients with stable type 2 diabetes (glycated hemoglobin < 8%) considered eligible for discharge from specialized to primary care will be included. Those with uncontrolled ischemic heart disease, severe neuropathy, and stage IV/V nephropathy will be excluded. Enrolled patients will be randomized into two groups: follow-up supported by periodic phone calls by a nurse (intervention group) plus primary care or routine primary care only (control group). The intervention group will receive regular telephone calls (every three months for one year) and will have a toll-free number to call in case of questions about disease management. The main outcome measure is a comparison of glycemic control between groups (assessed by glycated hemoglobin) at one-year follow-up.DiscussionWe plan to evaluate the effectiveness of a telephone-based intervention on glycemic control in patients with type 2 diabetes followed by primary care teams. Telemedicine can be an important adjunct in type 2 diabetes management, improving patient education and knowledge about the disease. Furthermore, it can help the healthcare system by alleviating overload in specialized care settings and supporting the stewardship role of primary care.Trial registrationClinical Trials, NCT02768480. Registered on 29 April 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1954-z) contains supplementary material, which is available to authorized users.

Introduction New antihyperglycemic medications have proven cardiovascular and renal benefits in type 2 diabetes mellitus (T2DM); however, an evidence-based decision tree in specific clinical scenarios is lacking. Materials and Methods Systematic review and meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA). RCT inclusion criteria were patients with T2DM from one of these subgroups: elderly, obese, previous atherosclerotic cardiovascular disease (ASCVD), previous coronary-heart disease (CHD), previous heart failure (HF) or previous chronic kidney disease (CKD). RCTs describing those subgroups with at least 48 weeks were included. Outcomes: 3-point MACE; cardiovascular (CV) death; hospitalization due to HF; and renal outcomes. We performed direct meta-analysis with the number of events in the intervention and control groups in each subset, and the relative risk of events was calculated. Results SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1 RA) were the only anti-hyperglycemic agents related to reduction in CV events in different populations. For obese and elderly populations, GLP-1 RA were associated with benefits in 3-point MACE; for patients with ASCVD, both SGLT2i and GLP-1 RA had benefits in 3-point MACE, while for patients with CHD, only SGLT2i were beneficial. Conclusions SGLT2i and GLP-1 RA reduced CV events in selected populations: SGLT2i led to a reduction in events in patients with previous CHD, ASCVD and HF. GLP-1 RA led to a reduction in CV events in patients with ASCVD, elderly and patients with obesity. TSA shows that these findings are conclusive. This review opens a pathway towards evidence-based personalized treatment of T2DM.