Follow-up of Glycemic Control and Cardiovascular Outcomes in Type 2 Diabetes

Hayward, Rodney A.; Reaven, Peter D.; Wiitala, Wyndy L.; Bahn, Gideon; Reda, Domenic J.; Ge, Lan; McCarren, Madeline; Duckworth, William C.; Emanuele, Nicholas V.

doi:10.1056/nejmoa1414266

Cited by 564 publications

(345 citation statements)

References 22 publications

Supporting

Mentioning

326

Contrasting

Unclassified

Order By: Relevance

“…In a recent ACCORD substudy examining the relationship between glycaemic control and CV risk, a consistent reduction of CV events associated with better glycaemic control was reported 20. The VADT study reported a non‐significant 12% reduction in the risk of a MACE+ outcome (which differed in components from that in CREDIT) associated with a 1.5% reduction in HbA1c 2, a finding that became significant with a 17% reduction in events at 10 years in the extension phase 21. The ADVANCE study saw a 6% non‐significant reduction in MACE events associated with a 0.8% reduction in HbA1c 4.…”

Section: Discussionmentioning

confidence: 91%

Relationship of glycaemic control and hypoglycaemic episodes to 4‐year cardiovascular outcomes in people with type 2 diabetes starting insulin

Freemantle

Danchin

Calvi-Gries³

et al. 2015

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

AimsTo examine the relationships between glycated haemoglobin (HbA1c) and cardiovascular (CV) events in people beginning insulin in routine clinical practice in Europe, North America and Asia in a non‐interventional study, the Cardiovascular Risk Evaluation in people with Type 2 Diabetes on Insulin Therapy (CREDIT) study.MethodsData on 2999 people were collected prospectively over 4 years from physician reports. The primary outcome was the composite of stroke or myocardial infarction (MI) or CV‐specific death. Events were blindly adjudicated. The relative hazards of CV events were described from Cox proportional hazards models incorporating patient risk factors, with updated average HbA1c as a time‐dependent covariate. The relationship of severe and symptomatic hypoglycaemia (collected during the 6 months before yearly ascertainment) with CV and all‐cause mortality was examined.ResultsA total of 147 primary events were accrued during up to 54 months of follow‐up. In all, 60 CV‐specific deaths, 44 non‐fatal MIs and 57 non‐fatal strokes occurred, totalling 161 events. There was a significant positive relationship between updated mean HbA1c and primary outcome: hazard ratio (HR) 1.25 [95% confidence interval (CI) 1.12–1.40; p < 0.0001]. CV death [HR 1.31 (95% CI 1.10–1.57); p = 0.0027] and stroke [HR 1.36 (95% CI 1.17–1.59); p < 0.0001] were both strongly associated with HbA1c, while MI was not [HR 1.05 (95% CI 0.83–1.32)]. One or more severe hypoglycaemic episodes affected 175 participants, while 1508 participants experienced one or more symptomatic hypoglycaemic events. We found no relationship between severe/symptomatic hypoglycaemic events and CV‐specific/all‐cause death.ConclusionsOngoing poorer glucose control was associated with CV events; hypoglycaemia was not associated with CV‐specific/all‐cause death.

show abstract

Section: Discussionmentioning

confidence: 91%

Relationship of glycaemic control and hypoglycaemic episodes to 4‐year cardiovascular outcomes in people with type 2 diabetes starting insulin

Freemantle

Danchin

Calvi-Gries³

et al. 2015

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…2,37 The few favorable demonstrations of reduced rates of cardiovascular events with predominantly glucose-lowering therapies have required more protracted follow-up than routinely occurs in clinical trials. 4,7 Although our study had only approximately 2 years of follow-up, sufficient numbers of cardiovascular events were observed so that we could reasonably exclude a major nonglycemic cardiovascular benefit 21 as well as an unanticipated harm of lixisenatide.…”

Section: Discussionmentioning

confidence: 99%

Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Cardiovascular morbidity and mortality are higher among patients with type 2 diabetes, particularly those with concomitant cardiovascular diseases, than in most other populations. We assessed the effects of lixisenatide, a glucagon-like peptide 1-receptor agonist, on cardiovascular outcomes in patients with type 2 diabetes who had had a recent acute coronary event. METHODS: We randomly assigned patients with type 2 diabetes who had had a myocardial infarction or who had been hospitalized for unstable angina within the previous 180 days to receive lixisenatide or placebo in addition to locally determined standards of care. The trial was designed with adequate statistical power to assess whether lixisenatide was noninferior as well as superior to placebo, as defined by an upper boundary of the 95% confidence interval for the hazard ratio of less than 1.3 and 1.0, respectively, for the primary composite end point of cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina. RESULTS: The 6068 patients who underwent randomization were followed for a median of 25 months. A primary end-point event occurred in 406 patients (13.4%) in the lixisenatide group and in 399 (13.2%) in the placebo group (hazard ratio, 1.02; 95% confidence interval [CI], 0.89 to 1.17), which showed the noninferiority of lixisenatide to placebo (P<0.001) but did not show superiority (P=0.81). There were no significant between-group differences in the rate of hospitalization for heart failure (hazard ratio in the lixisenatide group, 0.96; 95% CI, 0.75 to 1.23) or the rate of death (hazard ratio, 0.94; 95% CI, 0.78 to 1.13). Lixisenatide was not associated with a higher rate of serious adverse events or severe hypoglycemia, pancreatitis, pancreatic neoplasms, or allergic reactions than was placebo. CONCLUSIONS: In patients with type 2 diabetes and a recent acute coronary syndrome, the addition of lixisenatide to usual care did not significantly alter the rate of major cardiovascular events or other serious adverse events. (Funded by Sanofi; ELIXA ClinicalTrials.gov number, NCT01147250.). Jean-Claude (2015). Lixisenatide in patients with type 2 diabetes and acute coronary syndrome.

show abstract

“…It is also a major risk factor for development of cardiovascular diseases (2). In patients with diabetic nephropathy, appropriate management of blood glucose level is important to delay the progression to end-stage renal disease and prevent the development of cardiovascular disease (3,4). Although many kinds of hypoglycemic agents are currently available for the management of blood glucose level, most agents cannot be used in patients with advanced-stage diabetic nephropathy because decreased renal function delays their elimination from the body, leading to adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Effects of Once-Weekly Dulaglutide on Glycemic Control and Renal Function in Patients with Advanced-Stage Diabetic Nephropathy

et al. 2017

View full text Add to dashboard Cite

Objectives: Dulaglutide and liraglutide are glucagon-like peptide-1 receptor agonists. We investigated the effects of once-weekly dulaglutide on glycemic control and renal function compared to once-daily liraglutide in patients with advanced-stage diabetic nephropathy. Methods: Changes over a 12-month period in levels of glycated hemoglobin, urine protein/creatinine ratio, and annual change in estimated glomerular filtration rate were retrospectively analyzed in 10 patients with advanced-stage diabetic nephropathy after changing from once-daily liraglutide (0.9 mg/day) to once-weekly dulaglutide (0.75 mg/week) (dulaglutide group). The control group comprised 10 patients with advanced-stage diabetic nephropathy who had continued once-daily liraglutide (0.9 mg/day) (liraglutide group). Results: The glycated hemoglobin level significantly decreased in the dulaglutide group after switching from liraglutide to dulaglutide (-0.81 ± 1.03% at 12 months from baseline, P < 0.05), but no change occurred in the liraglutide group. The urine protein/creatinine ratio and annual change in estimated glomerular filtration rate did not change in either groups. Conclusions: Once-weekly dulaglutide may be more advantageous for glycemic control compared to once-daily liraglutide in patients with advanced-stage diabetic nephropathy.

show abstract

Follow-up of Glycemic Control and Cardiovascular Outcomes in Type 2 Diabetes

Cited by 564 publications

References 22 publications

Relationship of glycaemic control and hypoglycaemic episodes to 4‐year cardiovascular outcomes in people with type 2 diabetes starting insulin

Relationship of glycaemic control and hypoglycaemic episodes to 4‐year cardiovascular outcomes in people with type 2 diabetes starting insulin

Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome

Effects of Once-Weekly Dulaglutide on Glycemic Control and Renal Function in Patients with Advanced-Stage Diabetic Nephropathy

Contact Info

Product

Resources

About