Optimizing management of glycaemia

Chatterjee, Sudesna; Khunti, Kamlesh; Davies, Melanie J.

doi:10.1016/j.beem.2016.06.002

Cited by 10 publications

(12 citation statements)

References 92 publications

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“…These observations, along with acknowledgement of the high cost of measures aimed at reducing hypoglycaemia (i.e. structured education, psychological support, glucose self-monitoring, expensive glucoselowering drugs associated with a lower risk of hypoglycaemia compared with sulfonylureas and insulin) [27][28][29][30], would point to the opposite hypothesis, underlying the relevance of socioeconomic status as a determinant of country differences.…”

Section: Discussionmentioning

confidence: 99%

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

et al. 2018

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Aims/hypothesis In the context of increasing prevalence of diabetes in elderly people with multimorbidity, intensive glucose control may increase the risk of severe hypoglycaemia, potentially leading to death. While rising trends of severe hypoglycaemia rates have been reported in some European, North American and Asian countries, the global burden of hypoglycaemia-related mortality is unknown. We aimed to investigate global differences and trends of hypoglycaemia-related mortality. Methods We used the WHO mortality database to extract information on death certificates reporting hypoglycaemia or diabetes as the underlying cause of death, and the United Nations demographic database to obtain data on mid-year population estimates from 2000 to 2014. We calculated crude and age-standardised proportions (defined as number of hypoglycaemia-related deaths divided by total number of deaths from diabetes [i.e. the sum of hypoglycaemia-and diabetes-related deaths]) and rates (hypoglycaemia-related deaths divided by mid-year population) of hypoglycaemia-related mortality and compared estimates across countries and over time.Results Data for proportions were extracted from 109 countries (31 had data from all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised proportion of hypoglycaemia-related deaths was 4.49 (95% CI 4.44, 4.55) per 1000 total diabetes deaths. Compared with the overall mean, most Central American, South American and (mainly) Caribbean countries reported higher proportions (five more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths in Chile, six in Uruguay, 11 in Belize and 22 in Aruba), as well as Japan (11 more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths). In comparison, lower proportions were noted in most European countries, the USA, Canada, New Zealand and Australia. For countries with data available for all years analysed, trend analysis showed a 60% increase in hypoglycaemia-related deaths until 2010 and stable trends onwards. Rising trends were most evident for Argentina, Brazil, Chile, the USA and Japan. Data for rates were available for 105 countries (30 had data for all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised hypoglycaemia-related death rate was 0.79 (95% CI 0.77, 0.80) per 1 million person-years. Most Central American, South American and Caribbean countries similarly reported higher rates of hypoglycaemia-related death, whilst virtually all European countries, the USA, Canada, Japan, New Zealand and Australia reported lower rates compared with the overall mean. Age-standardised rates were very low for most countries (lower than five per 1 million person-years in 89.5% of countries), resulting in small absolute differences among countries. As noted with the proportions analysis, trend analysis sho...

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Section: Discussionmentioning

confidence: 99%

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

et al. 2018

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“…However, poor control of diabetes and obesity is an international problem, and studies from Saudi Arabia and developing and developed countries have similar results. [ 13 14 15 16 17 ]…”

Section: Discussionmentioning

confidence: 99%

Five-year comparison of diabetic control between community diabetic center and primary health-care centers

Ferwana

Alshamlan

Madani

et al. 2016

J Family Med Prim Care

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Context:Hyperglycemia is the most important factor for development of complications. A high level of hemoglobin A1c (HbA1c) is linked with such complications of diabetes.Aims:The aim of this study was to compare diabetic care between community diabetic center (CDC) and primary health centers.Settings and Design:This was a retrospective cohort study conducted at King Abdulaziz Medical City for National Guard Health Affairs at Riyadh, Saudi Arabia.Subjects and Methods:Data were retrieved from electronic medical records for diabetes mellitus Type 2 patients who were treated at two settings: CDCs and primary healthcare.Statistical Analysis Used:SPSS (V21) was used to analyze the univariate and bivariate analysis, Student's t-test for continuous variables and Chi-square test for binary variables were used. P value was set as statistically significant if it is <0.05.Results:The mean difference for HbA1c from first to last visits increased significantly +0.2 ± 1.67 with P = 0.002 while the low-density lipoprotein (LDL) on the other way around improved by decrease of −0.159 ± 0.74 and P < 0.000. Body mass index (BMI) among the sample increased by +0.134 ± 1.57 with no significant, P = 0.078. Among the sample, 39.5% improved their HbA1c while 56.8% deteriorated and 3.6% of the samples’ readings remain the same. 55.3% of the sample improved in LDL and 52.4% in the high-density lipoprotein while 53.7% improved in triglycerides. The BMI was improved among 43.4% of diabetic patients.Conclusions:The 5-year management of diabetic patients failed to improve the A1c or BMI, at both CDC and primary health-care centers.

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“…A tendency of T2DM hypertherapy has been noticed, especially of older patients [36,37], which may be economically motivated. A tight glycemic control is hard to maintain for long time without undesirable side effects, whereas a benefit from such control is not always evident [38][39][40]. The polypragmasia elevates the risk especially in older patients [10].…”

Section: Issn: 2056-8827mentioning

confidence: 99%

Recent advances in the drug therapy of type 2 diabetes mellitus with overweight

Jargin¹

2018

Integr Obesity Diabetes

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Optimizing management of glycaemia

Cited by 10 publications

References 92 publications

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

Five-year comparison of diabetic control between community diabetic center and primary health-care centers

Recent advances in the drug therapy of type 2 diabetes mellitus with overweight

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