The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care

Russo, Giuseppina T.; Bartolo, Paolo Di; Candido, Riccardo; Lucisano, Giuseppe; Manicardi, Valeria; Giandalia, Annalisa; Nicolucci, Antonio; Rocca, Alberto; Rossi, Maria Chiara; Cianni, Graziano Di

doi:10.1016/j.diabres.2023.110672

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…Many classes of drugs are in the therapeutic algorithm [ 3 ] and are easily available for patients. However, many of these patients are not at target in terms of metabolic control and cardiovascular risk factors [ 4 ]. In patients on basal-bolus schemes, prevalence of patients not at target is particularly high because of the fear of hypoglycemia, poor compliance, and unavailability of a caregiver.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, at the start of IDegLira, the use of secretagogues was reduced from 49.4% to 6.9%. Use of sulfonylureas is no longer recommended in Italian guidelines [ 3 ] and prevalence of use has substantially decreased in recent years; however, at the national level 8.8% are still treated with these drugs [ 4 ]. Our approach represents an example of a strategy to facilitate the discontinuation of this class of drugs.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the different innovations and treatment options now available for diabetes care, many people do not reach the recommended targets [ 4 ]. Barriers to achievement of these targets are multifactorial and are summarized under the term “inertia”.…”

Section: Introductionmentioning

confidence: 99%

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Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type 2 Diabetes Therapy: A Real-Life Experience

Romano,

Serra

2023

Diabetes Ther

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Introduction Fixed ratio combination of insulin degludec and liraglutide (IDegLira) represents an option to revise inappropriate therapies in patients with poorly controlled type 2 diabetes. This study aimed to assess the pattern of use and 1-year effectiveness of IDegLira. Methods A retrospective chart review was performed to assess changes in glycated hemoglobin (HbA1c) (primary endpoint), fasting blood glucose (FBG), body weight, estimated glomerular filtration rate (eGFR), and lipid profile following IDegLira initiation. Previous versus concomitant diabetes treatments were also compared. Results Overall, 87 patients (mean age 73.9 ± 9.2 years, diabetes duration 18.2 ± 6.7 years, 62.1% men, HbA1c 8.3 ± 1.3%, BMI 30.4 ± 5.5 kg/m 2 ) initiated IDegLira. Previously, 21.8% of patients were treated with oral hypoglycemic agents (OHA group), 47.1% with basal insulin ± OHA (BOT group), 5.8% with GLP-1 RA ± basal insulin (GLP1-RA group), and 25.3% with basal-bolus schemes (BB group). At the first prescription of IDegLira, secretagogues and schemes including two or more OHA were substantially reduced, leaving metformin as the most prevalent OHA (81.6%) used in combination with IDegLira. Starting dose of IDegLira ranged from 18.7 ± 3.1 U (OHA group) to 24.1 ± 4.4 U (BB group). After 1 year, HbA1c was significantly reduced by 1.25% (95% CI − 1.48; − 1.03), FBG by 52.9 mg/dl, and body weight by 2.0 kg. Also, eGFR levels and lipid profile significantly improved. No severe hypoglycemia occurred. Conclusion It is possible to proactively review suboptimal or inappropriate diabetes treatment according to the most recent guidelines. Results suggest that initiation of IDegLira was associated with a reduction in drugs to be administered daily and relevant improvements in clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-023-01489-z.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type 2 Diabetes Therapy: A Real-Life Experience

Romano,

Serra

2023

Diabetes Ther

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“…Conversely, a noteworthy 17.8% of patients exhibit HbA1c levels exceeding 8.0%. Intriguingly, only 32.3% of these patients are currently undergoing insulin treatment, either as a sole intervention or in conjunction with oral agents and/or Glucagon-Like Peptide-1 Receptor Agonists (GLP1-RAs) [3]. A recent meta-analysis evaluated the overall achievement of the targets recommended by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the National Institute for Health and Care Excellence (NICE) for T2DM.…”

Section: Introductionmentioning

confidence: 99%

Overcoming Therapeutic Inertia in Type 2 Diabetes: Exploring Machine Learning-Based Scenario Simulation for Improving Short-Term Glycemic Control

Nicoletta,

Zilich,

Masi

et al. 2024

MAKE

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Background: International guidelines for diabetes care emphasize the urgency of promptly achieving and sustaining adequate glycemic control to reduce the occurrence of micro/macrovascular complications in patients with type 2 diabetes mellitus (T2DM). However, data from the Italian Association of Medical Diabetologists (AMD) Annals reveal that only 47% of T2DM patients reach appropriate glycemic targets, with approximately 30% relying on insulin therapy, either solely or in combination. This artificial intelligence analysis seeks to assess the potential impact of timely insulin initiation in all eligible patients via a “what-if” scenario simulation, leveraging real-world data. Methods: This retrospective cohort study utilized the AMD Annals database, comprising 1,186,247 T2DM patients from 2005 to 2019. Employing the Logic Learning Machine (LLM), we simulated timely insulin use for all eligible patients, estimating its effect on glycemic control after 12 months within a cohort of 85,239 patients. Of these, 20,015 were employed for the machine learning phase and 65,224 for simulation. Results: Within the simulated scenario, the introduction of appropriate insulin therapy led to a noteworthy projected 17% increase in patients meeting the metabolic target after 12 months from therapy initiation within the cohort of 65,224 individuals. The LLM’s projection envisages 32,851 potential patients achieving the target (hemoglobin glycated < 7.5%) after 12 months, compared to 21,453 patients observed in real-world cases. The receiver operating characteristic (ROC) curve analysis for this model demonstrated modest performance, with an area under the curve (AUC) value of 70.4%. Conclusions: This study reaffirms the significance of combatting therapeutic inertia in managing T2DM patients. Early insulinization, when clinically appropriate, markedly enhances patients’ metabolic goals at the 12-month follow-up.

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“…SMBG is a valuable tool helping healthcare providers (HCPs) adjust insulin treatment, improve glucose control, and prevent complications [ 2 ]. Despite the recognized benefits of SMBG, roughly 54.6% of patients treated with insulin meet their desired target for glycated hemoglobin (HbA 1c ) [ 3 ]. Several patient-related factors contribute to this issue, including inadequate insulin dosing, inappropriate carbohydrate counting, fear of hypoglycemia, and use of an unstructured SMBG [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Digital technology and healthcare delivery in insulin-treated adults with diabetes: a proposal for analysis of self-monitoring blood glucose patterns using a dedicated platform

Irace,

Acmet,

Cutruzzolà

et al. 2023

Endocrine

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Purpose A remote platform for diabetes care (Roche Diabetes® Care Platform, RDCP) has been developed that allows combined face-to-face consultations and remote patient monitoring (RPM). Methods A dedicated flowchart is proposed as a clinical approach to help healthcare professionals in the appropriate interpretation of structured self-monitoring blood glucose data, as visualized on the RDCP during the visits, and in the optimal management of patients using the integrated RDCP-RPM tools. Results The platform organizes patterns in different blocks: (i) hypoglycemia; (ii) hyperglycemia; (iii) blood glucose variability; (iv) treatment adherence, which identifies a possible individual pattern according to glycemic control challenges, potential causal factors, and behavioral type patterns. The flowchart proposed for use of the RDCP-RPM is self-explanatory and entails 3 steps: (1) evaluation of quality and quantity of self-monitoring blood glucose data; (2) pattern analysis; (3) personalized suggestions and therapy changes. Conclusion The main aim of the remote treatment flowchart proposed is to support healthcare professionals in the identification of hypoglycemic and hyperglycemic patterns using the RDCP regardless of the HbA1c value and ongoing treatment, which however, become crucial in combination with pattern analysis in the therapeutical choice.

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The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care

Cited by 17 publications

References 25 publications

Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type 2 Diabetes Therapy: A Real-Life Experience

Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type 2 Diabetes Therapy: A Real-Life Experience

Overcoming Therapeutic Inertia in Type 2 Diabetes: Exploring Machine Learning-Based Scenario Simulation for Improving Short-Term Glycemic Control

Digital technology and healthcare delivery in insulin-treated adults with diabetes: a proposal for analysis of self-monitoring blood glucose patterns using a dedicated platform

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