Comorbidity, hypoglycaemia and appropriate selection of antidiabetic pharmacotherapy in diabetic patients with heart failure in clinical practice in Germany

Gitt, Anselm K.; Bramlage, Peter; Binz, Christiane; Krekler, Michael; Deeg, Evelin; Tschöpe, D

doi:10.1007/s00059-012-3611-3

Cited by 7 publications

(6 citation statements)

References 21 publications

(23 reference statements)

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“…DiaRegis is a prospective, observational, non‐interventional, multicenter registry with a follow up of 2 years under the patronage of the foundation ‘Der herzkranke Diabetiker’ and with sponsorship by AstraZeneca and Bristol‐Myers Squibb. A detailed description of the design and baseline characteristics has been published . The registry was conducted in accordance with Good Epidemiology Practice and applicable regulatory requirements.…”

Section: Methodsmentioning

confidence: 99%

Prognostic implications of DPP-4 inhibitor vs. sulfonylurea use on top of metformin in a real world setting - results of the 1 year follow-up of the prospective DiaRegis registry

et al. 2013

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The present results confirm prior randomised controlled trial results in patients with type 2 diabetes from real world clinical practice demonstrating that DPP4-I on top of prior metformin monotherapy result in similar HbA1c reductions within 12 months but a significant reduction in hypoglycaemia compared with sulfonylurea added to metformin. The reduction in vascular events observed has to be verified in larger cohorts.

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Section: Methodsmentioning

confidence: 99%

Prognostic implications of DPP-4 inhibitor vs. sulfonylurea use on top of metformin in a real world setting - results of the 1 year follow-up of the prospective DiaRegis registry

et al. 2013

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“…The present analysis, based on data of the DiaRegis (Diabetes Treatment Patterns and Goal Achievement in primary diabetes care) registry [12-15], aims at determining patient characteristics and clinical variables in the elderly that are associated with an increased risk of hypoglycemia, taking into account specific age related issues such as co-morbid disease and underlying medical treatment.…”

Section: Introductionmentioning

confidence: 99%

Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia

Bramlage

Gitt

Binz

et al. 2012

Cardiovasc Diabetol

106

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BackgroundWe aimed at identifying variables predicting hypoglycemia in elderly type 2 diabetic patients and the relation to HbA1c values achieved.DesignProspective, observational registry in 3810 patients in primary care. Comparison of patients in different age tertiles: with an age < 60 (young, n=1,253), age 60 to < 70 (middle aged, n=1,184) to those ≥ 70 years (elderly, n=1,373). Odds Ratios (OR) with 95% confidence intervals (CI) were determined from univariable and multivariable regression analyses.ResultsElderly patients had a later diabetes diagnosis, a longer diabetes duration, better glucose control and more frequent co-morbid disease conditions. Overall 10.7% of patients experienced any severity hypoglycemia within the last 12 months prior to inclusion. Higher rates of hypoglycemia were observed in the elderly than in the young after adjusting for differences in HbA1c, fasting and post-prandial blood glucose (OR 1.68; 95%CI 1.16-2.45). This was particularly true for hypoglycemic episodes without specific symptoms (OR 1.74; 95%CI 1.05-2.89). In a multivariate model stroke / transitory ischemic attack, the presence of heart failure, clinically relevant depression, sulfonylurea use and blood glucose self-measurement were associated with hypoglycemic events.ConclusionElderly patients are at an increased risk of hypoglycemia even at comparable glycemic control. Therefore identified variables associated with hypoglycemia in the elderly such as heart failure, clinically relevant depression, the use of sulfonylurea help to optimize the balance between glucose control and low levels of hypoglycemia. Asymptomatic hypoglycemia should not be disregarded as irrelevant but considered as a sign of possible hypoglycemia associated autonomic failure.

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“…Table 2 gives an overview of those studies closely related to the objectives of DIALOGUE. These include DUTY [34], DIG [35-37] and DiaRegis [2,38-40]. DUTY (2001–2003) was among the first [34] to prospectively document the effect of a tailored intervention on blood glucose and CV risk factor target achievement.…”

Section: Discussionmentioning

confidence: 99%

“…A major secondary focus was to investigate the metabolic syndrome in Germany. DiaRegis [2,38-40] is a prospective registry focussing on the role of hypoglycaemia on subsequent vascular events. Throughout the follow-up a steady increase in the incidence of vascular events was documented, suggesting an association between hyperglycaemia and vascular events [41].…”

Section: Discussionmentioning

confidence: 99%

Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice -- study rationale and protocol of DIALOGUE

Gitt

Schmieder

Duetting

et al. 2012

Cardiovasc Diabetol

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BackgroundPatients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD.MethodsDIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1) individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2) individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE) and the rate of hospitalizations are the most important.ConclusionThe registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti-diabetic and anti-hypertensive drugs in clinical trials and their real world balance of effectiveness and safety.

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Comorbidity, hypoglycaemia and appropriate selection of antidiabetic pharmacotherapy in diabetic patients with heart failure in clinical practice in Germany

Cited by 7 publications

References 21 publications

Prognostic implications of DPP-4 inhibitor vs. sulfonylurea use on top of metformin in a real world setting - results of the 1 year follow-up of the prospective DiaRegis registry

Prognostic implications of DPP-4 inhibitor vs. sulfonylurea use on top of metformin in a real world setting - results of the 1 year follow-up of the prospective DiaRegis registry

Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia

Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice -- study rationale and protocol of DIALOGUE

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