Long Term Evaluation of Glycemic Control in Patients with Type 2 Diabetes Receiving Either Alogliptin and Lansoprazole or Alogliptin Mono-therapy for 3 Months Followed by Alogliptin Mono-therapy:A Retrospective Analysis

Aims:This study was the retrospective analysis of the previous study named as APPLE study( study of combination effect of AlogliPtin and lansoPrazoLE on glycemic control in patients with type 2 diabetes), in which the effect of the combination therapy of alogliptin (a dipeptidyl peptidase-4 inhibitor, DPP4-I) and lansoprazole (a proton pump inhibitor, PPI) was compared with alogliptin mono-therapy without PPI on glycemic control in a randomized open-label study design. The aim of this study was to investigate whether so called legacy effect of proton pump inhibitor on glycemic control is observed. Patients and Methods:In the patients that participated in the APPLE study( 3 months observation;total: 100 patients), the patients who continued the intake of alogliptin at least more than 1 year after the registration(enrollment)in APPLE study was evaluated on glycemic control retrospectively. As a rule, the administration of lansoprazole in combination group was discontinued after the finish of 3 months- of the APPLE study. Twenty-six patients in the alogliptin mono-therapy group and 26 patients in combination group met the requirement in this analysis. Mean observation periods were respectively 16 months. In these patients, the number of patients in whom all diabetic drugs were not changed in observation-period was respectively 18 in alogliptin mono-therapy group and 17 in combination group.Results:The decrease of HbA1c was maintained also after long term observation (16 months) in both alogliptin mono-therapy and combination groups (the decrease was respectively -1.054±0.548 and - 1.123±0.723%), which was similar compared with that observed in 3 months-APPLE study. There were no significant differences in change of HbA1c and fasting plasma glucose (FPG) at the time in enrollment of APPLE study and at final visit( approximately 16 weeks) between these groups. The significant difference in change of HbA1c and FPG was not found also between alogliptin mono-therapy and combination group in the subgroup of patients where all diabetic drugs were unchanged during observation period.Conclusion:This study found that the legacy effect of PPI on glycemic control was not apparent more than 9 months after the APPLE study. Based on the results in the previous APPLE study and in this current retrospective study, we concluded that the add-on effect of PPI for DPP4-I on glycemic control in patients with type 2 diabetes is not clinically apparent

The Effect of Switching from Either Mitiglinide or Glimepiride to Repaglinide on Both Glycemic Control and Oxidative Stress in Patients with Type 2 Diabetes

Aims:The goal of this study was to investigate the effect of switching from either the low dose sulfonylurea glimepiride(1?mg once daily)or the glinide mitiglinide(10?mg three times daily)to repaglinide(0.5?mg three times daily)on both glycemic control and oxidative stress in patients with type 2 diabetes.Patients and Methods:Finally 17 patients(patients treated with either glimepiride:n=11 or mitiglinide:n=6)completed the study. The type and dose of all drugs, including the anti-diabetic treatments, were not changed for at least 1?month prior to the study.Results:Both groups showed a significant decrease in HbA1c levels. FPG showed a tendency(not significant)toward a decrease in the mitiglinide-treated group, while no change was found in the glimepiride-treated group. A significant decrease in 8-iso-PGF2α levels was found only in the glimepiride-treated group. There was a significant correlation between the difference in 8-iso-PGF2α levels and that in either FPG or HbA1c before and after the switch only in the mitiglinide-treated group.Conclusions:Repaglinide may have an anti-oxidative effect probably due to the strong postprandial glucose lowering observed in patients with type 2 diabetes

Association Between Nerve Conduction Velocity and Clinical Parameters Related to Diabetic Complications inPatients with Type 2 Diabetes

The main purpose of the study was to investigate the association of median motor nerve conduction velocity(MCV) and sural sensory nerve conduction velocity( SCV) with parameters related to diabetic complicationsin patients with type 2 diabetes. A total of 263 patients hospitalized for glycemic control from 1999to 2006 who underwent single or multiple nerve conduction velocity tests (at least a right median MCVtest) were enrolled in the study retrospectively. Right median MCV showed a significant negative correlationwith age and diabetic duration, and was also significantly negatively correlated with systolic blood pressure(SBP) and log urinary albumin excretion (UAE). Right median MCV showed strong positive correlationswith left median MCV and right median SCV, and significant but relatively mild positive correlationswith right peroneal MCV and right sural SCV. In multiple regression analysis, only SBP and diabetic durationshowed a significant association with right median MCV. Although right sural SCV showed significantnegative correlations with SBP and log UAE, the correlations were relatively weak compared with those forright median MCV. Of 215 patients who underwent complete sural SCV measurements, right and left suralSCV were detected in 159( 74%) and 163 patients( 76%), respectively. In conclusion, these results suggestthat median MCV is more closely associated with markers related to diabetic complications such as SBP orUAE, compared with sural SCV, but that sural SCV is more sensitive than median MCV for detection of diabeticneuropathy

SIADH induced by pneumonia in a patient with Shy-Drager syndrome

Patients with Shy-Drager syndrome have impaired baroreceptor-mediated vasopressin release when inan upright position. We report a case of Shy-Drager syndrome in which the syndrome of inappropriate secretionof antidiuretic hormone (SIADH) developed with pneumonia. It has been speculated that pneumonia-induced SIADH is caused by baroreceptor-mediated vasopressin release. Our case presents the possibilitythat pneumonia-induced SIADH is caused by non-baroreceptor-mediated ADH release

Strategies To Improve Control Of Blood A1C In Diabetics

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less. A root cause analysis identified several deficiencies to includelack of essential equipment, variations in staff education and the absence of daily reminders. Post KPI implementations, an overall decrease in the percentage of patients with poorly controlled diabetes was attained. Next steps include ongoing monthly reviews of patients with A1c \u3e9 or have not been seen in 12 month

Increasing Advanced Care Planning in an Ambulatory Care Setting

Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows. The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC. Baseline metrics demonstrated that ACP discussion rates were less than 12%. A root cause analysis demonstrated several reasons for this low percentage. Several countermeasures were instituted to include a KPI that addressed intern/resident education, daily reminders at morning huddles and email reminders that ACP should be included in pre-visit planning. In the seven months since the start of this performance improvement project, the documented ACP discussion rate increased to 22.2%. Next steps include continued compliance monitoring, teach providers to review ACP related reports and ongoing data vigilance