Optimal management of type 2 diabetes in patients with increased risk of hypoglycemia

Anderson, Morgan; Powell, Jason; Campbell, Kendall M.; Taylor, James R.

doi:10.2147/dmso.s48896

Cited by 17 publications

(7 citation statements)

References 71 publications

(93 reference statements)

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“…An important concern relating to the intensification of insulin therapy in patients with type 2 diabetes is the increased risk of hypoglycemia. 14 , 15 In addition to being a cause of morbidity and worsening quality of life, recurrent hypoglycemia may compromise the long-term maintenance of glycemia. 16–19 It is important that, in this study, the reduction in exposure to hyperglycemia in the CSII group was not associated with an increase in time spent in hypoglycemia (SG<70 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study

Conget¹,

Castañeda

Petrovski

et al. 2016

Diabetes Technology & Therapeutics

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Background: The OpT2mise randomized trial was designed to compare the effects of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) on glucose profiles in patients with type 2 diabetes.Research Design and Methods: Patients with glycated hemoglobin (HbA1c) levels of ≥8% (64 mmol/mol) and ≤12% (108 mmol/mol) despite insulin doses of 0.7–1.8 U/kg/day via MDI were randomized to CSII (n=168) or continued MDI (n=163). Changes in glucose profiles were evaluated using continuous glucose monitoring data collected over 6-day periods before and 6 months after randomization.Results: After 6 months, reductions in HbA1c levels were significantly greater with CSII (−1.1±1.2% [−12.0±13.1 mmol/mol]) than with MDI (−0.4±1.1% [−4.4±12.0 mmol/mol]) (P<0.001). Similarly, compared with patients receiving MDI, those receiving CSII showed significantly greater reductions in 24-h mean sensor glucose (SG) (treatment difference, −17.1 mg/dL; P=0.0023), less exposure to SG >180 mg/dL (−12.4%; P=0.0004) and SG >250 mg/dL (−5.5%; P=0.0153), and more time in the SG range of 70–180 mg/dL (12.3%; P=0.0002), with no differences in exposure to SG<70 mg/dL or in glucose variability. Changes in postprandial (4-h) glucose area under the curve >180 mg/dL were significantly greater with CSII than with MDI after breakfast (−775.9±1,441.2 mg/dL/min vs. −160.7±1,074.1 mg/dL/min; P=0.0015) and after dinner (−731.4±1,580.7 mg/dL/min vs. −71.1±1,083.5 mg/dL/min; P=0.0014).Conclusions: In patients with suboptimally controlled type 2 diabetes, CSII significantly improves selected glucometrics, compared with MDI, without increasing the risk of hypoglycemia.

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Section: Discussionmentioning

confidence: 99%

The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study

Conget¹,

Castañeda

Petrovski

et al. 2016

Diabetes Technology & Therapeutics

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“…The effective treatment of diabetes is a delicate balance between good glycemic control and managing the risk of hypoglycemia, an established risk of treatment with insulin [ 23 , 24 ]. Hence, our finding that insulin-only treatment was associated with an increased incidence of hypoglycemia in Chinese patients with T2DM compared with OAM-only treatment is unsurprising.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Control in Chinese Patients with Type 2 Diabetes Mellitus Receiving Oral Antihyperglycemic Medication-Only or Insulin-Only Treatment: A Cross-Sectional Survey

Chen

Liu

et al. 2015

Diabetes Ther

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IntroductionThe primary aim of this analysis was to explore whether glycemic control (glycated hemoglobin [HbA1c] <7%) and the incidence of hypoglycemia are different between Chinese patients with type 2 diabetes mellitus (T2DM) receiving oral antihyperglycemic medication (OAM)-only or insulin-only regimens.MethodsPhysicians in nine Chinese cities completed surveys (Adelphi Real World Diabetes Disease Specific Programme) from October 2011 to March 2012. Key information collected included patients’ demographic and clinical characteristics, HbA1c levels, and hypoglycemia incidence. Patients receiving OAM-only (n = 1077) or insulin-only (n = 292) regimens for ≥6 months who had most recent HbA1c results available and measured within 3 months of survey completion were included. The primary and secondary outcomes were glycemic control and the incidence of hypoglycemia. Primary (multivariate logistic regression analysis with adjustment for potential confounders) and sensitivity analyses (propensity score matching method) were performed.ResultsA higher proportion of patients in the insulin-only group achieved glycemic control than patients in the OAM-only group (41.8% vs 35.9%). Insulin-only treatment was associated with significantly (P = 0.013) better glycemic control than OAM-only treatment (odds ratio [95% confidence interval]: 1.48 [1.09, 2.01]). A higher proportion of patients in the insulin-only group experienced hypoglycemia (overall) than patients in the OAM-only group (33.3% vs 14.4%). Insulin-only treatment was associated with significantly (P < 0.001) increased overall hypoglycemia compared with OAM-only treatment (odds ratio [95% confidence interval]: 2.38 [1.72, 3.29]). Sensitivity analysis results were consistent with the primary analysis results.ConclusionsThe results of this analysis provide important real-world information on glycemic control and hypoglycemia in Chinese patients with T2DM, which may be useful for guiding evidenced-based management. Notably, Chinese patients with T2DM receiving OAM-only had poorer glycemic control compared with those receiving insulin-only therapy, although patients receiving OAM-only were less likely to experience hypoglycemic events.The online version of this article (doi:10.1007/s13300-015-0114-2) contains supplementary material, which is available to authorized users.

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“…Hypoglycemia is an important concern whenever diabetes treatments are intensified to maintain strict glycemic control. 20 , 21 We found that patients treated with a DPP4I had a lower hazard for hypoglycemia compared with those treated with a sulfonylurea (sHR, 0.48 [95% CI, 0.36-0.65]; I 2 = 22.7%). Separately, we found that patients treated with a GLP1RA or SGLT2I had lower hazards for hypertension compared with those receiving a sulfonylurea (GLP1RA: sHR, 0.82 [95% CI, 0.68-0.97]; I 2 = 0%; SGLT2I: sHR, 0.73 [95% CI, 0.58-0.92]; I 2 = 38.5%) (eFigure in Supplement 1 ).…”

Section: Resultsmentioning

confidence: 89%

Second-Line Pharmaceutical Treatments for Patients with Type 2 Diabetes

Vashisht,

Patel,

Dahm

et al. 2023

JAMA Netw Open

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ImportanceAssessing the relative effectiveness and safety of additional treatments when metformin monotherapy is insufficient remains a limiting factor in improving treatment choices in type 2 diabetes.ObjectiveTo determine whether data from electronic health records across the University of California Health system could be used to assess the comparative effectiveness and safety associated with 4 treatments in diabetes when added to metformin monotherapy.Design, Setting, and ParticipantsThis multicenter, new user, multidimensional propensity score–matched retrospective cohort study with leave-one-medical-center-out (LOMCO) sensitivity analysis used principles of emulating target trial. Participants included patients with diabetes receiving metformin who were then additionally prescribed either a sulfonylurea, dipeptidyl peptidase-4 inhibitor (DPP4I), sodium-glucose cotransporter-2 inhibitor (SGLT2I), or glucagon-like peptide-1 receptor agonist (GLP1RA) for the first time and followed-up over a 5-year monitoring period. Data were analyzed between January 2022 and April 2023.ExposureTreatment with sulfonylurea, DPP4I, SGLT2I, or GLP1RA added to metformin monotherapy.Main Outcomes and MeasuresThe main effectiveness outcome was the ability of patients to maintain glycemic control, represented as time to metabolic failure (hemoglobin A1c [HbA1c] ≥7.0%). A secondary effectiveness outcome was assessed by monitoring time to new incidence of any of 28 adverse outcomes, including diabetes-related complications while treated with the assigned drug. Sensitivity analysis included LOMCO.ResultsThis cohort study included 31 852 patients (16 635 [52.2%] male; mean [SD] age, 61.4 [12.6] years) who were new users of diabetes treatments added on to metformin monotherapy. Compared with sulfonylurea in random-effect meta-analysis, treatment with SGLT2I (summary hazard ratio [sHR], 0.75 [95% CI, 0.69-0.83]; I2 = 37.5%), DPP4I (sHR, 0.79 [95% CI, 0.75-0.84]; I2 = 0%), GLP1RA (sHR, 0.62 [95% CI, 0.57-0.68]; I2 = 23.6%) were effective in glycemic control; findings from LOMCO sensitivity analysis were similar. Treatment with SGLT2I showed no significant difference in effectiveness compared with GLP1RA (sHR, 1.26 [95% CI, 1.12-1.42]; I2 = 47.3%; no LOMCO) or DPP4I (sHR, 0.97 [95% CI, 0.90-1.04]; I2 = 0%). Patients treated with DPP4I and SGLT2I had fewer cardiovascular events compared with those treated with sulfonylurea (DPP4I: sHR, 0.84 [95% CI, 0.74-0.96]; I2 = 0%; SGLT2I: sHR, 0.78 [95% CI, 0.62-0.98]; I2 = 0%). Patients treated with a GLP1RA or SGLT2I were less likely to develop chronic kidney disease (GLP1RA: sHR, 0.75 [95% CI 0.6-0.94]; I2 = 0%; SGLT2I: sHR, 0.77 [95% CI, 0.61-0.97]; I2 = 0%), kidney failure (GLP1RA: sHR, 0.69 [95% CI, 0.56-0.86]; I2 = 9.1%; SGLT2I: sHR, 0.72 [95% CI, 0.59-0.88]; I2 = 0%), or hypertension (GLP1RA: sHR, 0.82 [95% CI, 0.68-0.97]; I2 = 0%; SGLT2I: sHR, 0.73 [95% CI, 0.58-0.92]; I2 = 38.5%) compared with those treated with a sulfonylurea. Patients treated with an SGLT2I, vs a DPP4I, GLP1RA, or sulfonylurea, were less likely to develop indicators of chronic hepatic dysfunction (sHR vs DPP4I, 0.68 [95% CI, 0.49-0.95]; I2 = 0%; sHR vs GLP1RA, 0.66 [95% CI, 0.48-0.91]; I2 = 0%; sHR vs sulfonylurea, 0.60 [95% CI, 0.44-0.81]; I2 = 0%), and those treated with a DPP4I were less likely to develop new incidence of hypoglycemia (sHR, 0.48 [95% CI, 0.36-0.65]; I2 = 22.7%) compared with those treated with a sulfonylurea.Conclusions and RelevanceThese findings highlight familiar medication patterns, including those mirroring randomized clinical trials, as well as providing new insights underscoring the value of robust clinical data analytics in swiftly generating evidence to help guide treatment choices in diabetes.

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Optimal management of type 2 diabetes in patients with increased risk of hypoglycemia

Cited by 17 publications

References 71 publications

The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study

The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study

Glycemic Control in Chinese Patients with Type 2 Diabetes Mellitus Receiving Oral Antihyperglycemic Medication-Only or Insulin-Only Treatment: A Cross-Sectional Survey

Second-Line Pharmaceutical Treatments for Patients with Type 2 Diabetes

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