Predicting factors of hypoglycaemia in elderly type 2 diabetes patients: Contributions of the GERODIAB study

Buysschaert, Martin; Vague, V. Lassmann; Floch, J.-P. Le; Fagot-Campagna, A.; Lassmann-Vague, V.; Tessier, Daniel; Vischer, Ulrich M.; Affres, Hélène; Alix, M; Archambeaud, F.; Barrou, Zina; Bauduceau, B.; Beau, P; Beltrán, Sourik; Benoit, Christine; Beressi, J-P; Bernachon, F; Berne, Christian; Berrut, Gilles; Blaimont, Aude; Blicklé, J. F.; Boda-Buccino, M.; Bohatier, Jérôme; Böhme, Philip; Bordier, L.; Bouchou, K; Bouillet, Benjamin; Bouilloud, F.; Bouix, R; Boulanger, Éric; Bourdel‐Marchasson, Isabelle; Bourgon, C.; Bourrinet, E; Brocker, P.; Bruckert, Isabelle; Capet, C.; Carette, Claire; Cariou, Bertrand; Carreau, Anne‐Marie; Vaurie, Charles.; Chamouni, S; Ciangura, C.; Collet-Gaudillat, C.; Combes-Moukhovsky, M-E; Constans, T.; Cordonnier, M.; Cuperlier, A.; Dambre, D; D'Avigneau, J; Botton, P De; Degros, V.; Delamarre-Damier, Florence; Denat, S; Desbiez, F.; Deumier, B; Dorey, Fred; Doucet, J.; Dresco, E.; Drutel, A.; Germain, E.; Dubois‐Laforgue, Danièle; Duly-Bouhanick, B.; Dupuy, O.; Dusselier, L.; Faucher-Kareche, S; Fendri, S.; Fontaine, P; Galinat, S.; Gentric, A.; Gin, H.; Glaise, F; Godeau, T; Gonzales, B.; Got, I.; Guerci, Bruno; Pj, Guillausseau; Hadjadj, Samy; Hadjali, Y; Halbron, M.; Halimi, Serge; Halter, C.; Hanaire, H.; Hardy, Victoria Ponce; Hartemann–Heurtier, Agnès; Haulot, J-P; Hequet, Fanny; Issa-Sayegh, M; Jan, P; Jeandidier, N.; Joseph-Henri, H; Julier, Ingrid; Kaloustian, E; Kerlan, V.; Kharitonnoff, T.; Ladsous, M.; Lahaxe, L.; Lamaraud, M-P; Lassenne, E; Lecerf, J. M.; Lecomte, P.; Leroux, I.; Lesven, S.; Lévy, Marc; Lopez, S.; Makiza, F; Manckoundia, Patrick; Pomeau, C Marquis; Mayaudon, H.; Micheli, Serena; Mira, R; Monnier, F; Mosnier-Pudar, Helen; Neri, Natividad; Normand, I; Pocard, Marc; Pagu, C; Pâris, Dominique; Penfornis, A.; Perie, J-L; Petit, J.-M.; Petit-Aubert, Gwenaelle; Pichot-Duclos, B; Pivois, L; Popelier, M.; Poulingue, G; Priner, M.; Quipourt, Valérie; Rasamisoa, M; Jl, Richard; Rigalleau, Vincent; Roudat, N; Sanz, C.; Jm, Serot; Sifi, D; Sirvain, S.; Slimani, Alisson; Sonnet, E.; Sosset, C; Soualah, A; Stroea, A; Tauveron, Igor; Timsit, José; Tschudnowsky, M.; Vambergue, A.; Vérier-Mine, O.; Verny, Christiane; Virally, Marie

doi:10.1016/j.diabet.2015.03.001

Cited by 18 publications

(6 citation statements)

References 9 publications

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“…Additionally, incorporating fear of hypoglycemia surveys and recent studies identifying predictors of hypoglycemia would also be clinically useful and relevant. 8182 This will help to provide clinicians with an updated and more precise portrait of the long-term effects of hypoglycemia and contemporary intensive glycemic control.…”

Section: Expert Commentarymentioning

confidence: 99%

Understanding the impact of hypoglycemia on the cardiovascular system

Davis

Ahmadizadeh

Randell

et al. 2017

Expert Review of Endocrinology & Metabolism

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Introduction Hypoglycemia occurs commonly in insulin requiring individuals with either Type 1 or Type 2 Diabetes. Areas Covered This article will review recent information on the pro-inflammatory and pro-atherothrombotic effects of hypoglycemia. Additionally, effects of hypoglycemia on arrhythmogenic potential and arterial endothelial dysfunction will be discussed. Effects of hypoglycemia on cardiovascular morbidity and mortality from large clinical studies in Type 1 and Type 2 DM will also be reviewed. Expert Commentary The relative and absolute risk of severe hypoglycemia leading to death and serious adverse events in both cardiovascular and other organ systems has been highlighted following the publication of recent large clinical trials focused on glucose control and outcomes. It would be helpful if future studies could develop broader end points to include minor and moderate hypoglycemia as well as more robust methods for capturing hypoglycemia contemporaneously with adverse events. In addition, perhaps consideration of including hypoglycemia as a primary outcome, may help identify the possible cause and effect of hypoglycemia on cardiovascular morbidity and mortality.

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Section: Expert Commentarymentioning

confidence: 99%

Understanding the impact of hypoglycemia on the cardiovascular system

Davis

Ahmadizadeh

Randell

et al. 2017

Expert Review of Endocrinology & Metabolism

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“…However, glycemic control in the elderly population proposes a big challenge. In this population, the incidences of hypoglycemia increase while hypoglycemia is related to increasing morbidity,3,4 which significantly affects the quality of life of patients.…”

Section: Introductionmentioning

confidence: 99%

Chitosan oligosaccharide improves the therapeutic efficacy of sitagliptin for the therapy of Chinese elderly patients with type 2 diabetes mellitus

Zhao¹,

Sun²,

Wang³

2017

TCRM

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Sitagliptin improves glycemic control in type 2 diabetes mellitus (T2DM) patients but its side effects are undesirable. Chitosan oligosaccharide (COS) is expected to improve the therapeutic result as a natural product. A total of 200 elderly T2DM patients were evenly assigned into four groups: sitagliptin group (SG), receiving sitagliptin 100 mg/day; COS group (CG), receiving COS 100 mg/day; combination therapy of sitagliptin and COS group (SCG), receiving both sitagliptin and COS 100 mg/day; and placebo group (PG), receiving placebo 100 mg/day. After 42-week therapy, biochemical indices and clinical parameters for the alterations from start points were analyzed. The related molecular mechanism was tested by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot at cell level. Lower risk of hypoglycemia was found in the SCG group when compared with SG and other groups (P<0.05). More patients from the SCG group than other groups attained hemoglobin A1c (HbA1c) reduction >2.5% (P<0.05). Weight reduction of 1.2±0.9, 2.6±0.8, 4.7±1.3, and 0.9±0.6 kg was observed in the patients from SG, CG, SCG, and PG groups, respectively (P<0.05). The combined treatment of COS and sitagliptin presented better therapeutic results by improving insulin sensitivity, lipid profile, adiponectin levels, and glucagon-like peptide 1 and reducing side effects, insulin resistance, HbA1c, body mass index, resistin, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) (P<0.05). qRT-PCR and Western blot analysis also showed that COS treatment reduced the levels of resistin, TNF-α, and CRP, and increased the level of adiponectin. The combination of COS and sitagliptin provided better glycemic control with fewer side effects and with more weight reduction in the elderly participants with T2DM.

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“…Average values of hemoglobin A1c, body mass index, and glomerular function rate in diabetic adults aged 65–79 years versus 80 year olds were obtained from the literature [ 20 ]. The average type 2 diabetes duration in the two age groups was estimated at 15.6 years for 65 to 79 year olds [ 21 ], and 17.8 years for those individuals aged 80 years and older [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada

2016

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BackgroundThe costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.MethodsAn economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65–79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted.FindingsIncidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65–79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65–79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.ConclusionsOptimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

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Predicting factors of hypoglycaemia in elderly type 2 diabetes patients: Contributions of the GERODIAB study

Cited by 18 publications

References 9 publications

Understanding the impact of hypoglycemia on the cardiovascular system

Understanding the impact of hypoglycemia on the cardiovascular system

Chitosan oligosaccharide improves the therapeutic efficacy of sitagliptin for the therapy of Chinese elderly patients with type 2 diabetes mellitus

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada

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