Trends in Method of Diagnosis of Type 2 Diabetes Mellitus: Results from SHIELD

Aims. This study assessed whether recent screening recommendations have led to increased diagnosis of type 2 diabetes mellitus (T2DM) through routine screening. Methods. Respondents to the 2006 US SHIELD survey reported whether a physician told them they had T2DM, age at diagnosis, specialty of the physician who made the diagnosis, and whether the diagnosis was made after having symptoms, during routine screening, or when being treated for another health problem. Results. Of 3 022 T2DM respondents, 36% of respondents reported that T2DM diagnosis was made during routine screening alone, 20% after having symptoms alone, and 6% when being treated for another health problem alone. The proportion of T2DM respondents reporting a diagnosis based only on screening increased approximately 42% over a 15+-year time span (absolute increase from 31% to 44%) (P < .001), whereas symptom-based diagnosis did not change significantly (P = .10). T2DM was diagnosed primarily by family physicians (88.3%). Conclusion. These findings highlight the importance of regular screening for diabetes and the vital role of primary care physicians in recognizing individuals with T2DM

Association of overweight and obesity with health status, weight management, and exercise behaviors among individuals with type 2 diabetes mellitus or with cardiometabolic risk factors

James R Gavin, III1, Helena W Rodbard2, Kathleen M Fox3, Susan Grandy4 for the SHIELD Study Group1Emory University School of Medicine, Atlanta, GA, USA; 2Endocrine and Metabolic Consultants, Rockville, MD, USA; 3Strategic Healthcare Solutions, LLC, Monkton, MD, USA; 4AstraZeneca LP, Wilmington, DE, USAObjectives: This investigation evaluated the role of obesity in health status and behaviors for weight management and exercise among individuals with type 2 diabetes mellitus (T2DM) or cardiometabolic risk factors.Methods: Self-reported health status, exercise behaviors, and weight management were assessed in the SHIELD study for respondents with T2DM or high risk (HR) for diabetes (ie, &amp;ge;3 of the following: abdominal obesity, body mass index [BMI] &amp;ge;28 kg/m2, self-reported diagnosis of dyslipidemia, hypertension, or history of cardiovascular disease). Respondents were stratified into three BMI categories: &amp;lt;25 kg/m2 (underweight or normal weight), 25.0&amp;minus;29.9 kg/m2 (overweight), and &amp;ge;30 kg/m2 (obese), with comparisons made using analysis of variance. Comparisons between T2DM and HR were made using chi-square tests.Results: T2DM (n = 3,918) and HR (n = 5,464) groups were similar for age (mean = 59 years), race (&amp;ge;85% white), and obesity. Overweight (31%) or obese T2DM (18%) respondents were significantly less likely to report excellent health compared with overweight or obese HR respondents (42% and 30%, respectively), p &amp;lt; 0.001. There were no differences between T2DM and HR groups for exercise behaviors. More obese respondents (20% T2DM, 21% HR) were &amp;ldquo;contemplating exercising&amp;rdquo;, and fewer (21%&amp;minus;23%) were currently &amp;ldquo;exercising regularly&amp;rdquo; compared with overweight and normal weight respondents, p &amp;lt; 0.001. More obese respondents (78% T2DM, 83% HR) attempted weight management than normal (28%&amp;minus;35%) or overweight (57%&amp;minus;61%) respondents, p &amp;lt; 0.001.Conclusions: Obesity was negatively associated with self-perception of current health, exercising regularly, and weight maintenance for those with or at risk for diabetes.Keywords: overweight, obesity, type 2 diabetes mellitus, exercise, weight managemen

Benefits of combination of insulin degludec and liraglutide are independent of baseline glycated haemoglobin level and duration of type 2 diabetes

AIM: To evaluate, using post hoc analyses, whether the novel combination of a basal insulin, insulin degludec, and a glucagon‐like peptide‐1 receptor agonist, liraglutide (IDegLira), was consistently effective in patients with type 2 diabetes (T2D), regardless of the stage of T2D progression. METHODS: Using data from the DUAL I extension [insulin‐naïve patients uncontrolled on oral antidiabetic drugs (OADs), n = 1660, 52 weeks] and DUAL II (patients uncontrolled on basal insulin plus OADs, n = 398, 26 weeks) randomized trials, the efficacy of IDegLira was investigated with regard to measures of disease progression stage including baseline glycated haemoglobin (HbA1c), disease duration and previous insulin dose. RESULTS: Across four categories of baseline HbA1c (≤7.5–9.0%), HbA1c reductions were significantly greater with IDegLira (1.1–2.5%) compared with IDeg or liraglutide alone in DUAL I. In DUAL II, HbA1c reductions were significantly greater with IDegLira (0.9–2.5%) than with IDeg in all but the lowest HbA1c category. In DUAL I, insulin dose and hypoglycaemia rate were lower across all baseline HbA1c categories for IDegLira versus IDeg, while hypoglycaemia was higher with IDegLira than liraglutide, irrespective of baseline HbA1c. In DUAL II, insulin dose and hypoglycaemia rate were similar with IDegLira and IDeg (maximum dose limited to 50 U) independent of baseline HbA1c. The reduction in HbA1c with IDegLira was independent of disease duration and previous insulin dose but varied depending on pre‐trial OAD treatment. CONCLUSIONS: IDegLira effectively lowered HbA1c across a range of measures, implying suitability for patients with either early or advanced T2D

Randomized Clinical Trial Comparing Basal Insulin Peglispro and Insulin Glargine in Patients With Type 2 Diabetes Previously Treated With Basal Insulin: IMAGINE 5

OBJECTIVE To evaluate the efficacy and safety of basal insulin peglispro (BIL) versus insulin glargine in patients with type 2 diabetes (hemoglobin A1c [HbA1c] ≤9% [75 mmol/mol]) treated with basal insulin alone or with three or fewer oral antihyperglycemic medications. RESEARCH DESIGN AND METHODS This 52-week, open-label, treat-to-target study randomized patients (mean HbA1c 7.42% [57.6 mmol/mol]) to BIL ( n = 307) or glargine ( n = 159). The primary end point was change from baseline HbA1c to 26 weeks (0.4% [4.4 mmol/mol] noninferiority margin). RESULTS At 26 weeks, reduction in HbA1c was superior with BIL versus glargine (−0.82% [−8.9 mmol/mol] vs. −0.29% [−3.2 mmol/mol]; least squares mean difference −0.52%, 95% CI −0.67 to −0.38 [−5.7 mmol/mol, 95% CI −7.3 to −4.2; P < 0.001); greater reduction in HbA1c with BIL was maintained at 52 weeks. More BIL patients achieved HbA1c <7% (53 mmol/mol) at weeks 26 and 52 ( P < 0.001). With BIL versus glargine, nocturnal hypoglycemia rate was 60% lower, more patients achieved HbA1c <7% (53 mmol/mol) without nocturnal hypoglycemia at 26 and 52 weeks ( P < 0.001), and total hypoglycemia rates were lower at 52 weeks ( P = 0.03). At weeks 26 and 52, glucose variability was lower ( P < 0.01), basal insulin dose was higher ( P < 0.001), and triglycerides and aminotransferases were higher with BIL versus glargine ( P < 0.05). Liver fat content (LFC), assessed in a subset of patients ( n = 162), increased from baseline with BIL versus glargine ( P < 0.001), with stable levels between 26 and 52 weeks. CONCLUSIONS BIL provided superior glycemic control versus glargine, with reduced nocturnal and total hypoglycemia, lower glucose variability, and increased triglycerides, aminotransferases, and LFC

Dyslipidemias in diabetes

Cardiovascular diseases (CVD) are responsible for 75% of the morbidity and mortality in patients with type 2 diabetes. Diabetes accelerates plaque formation and progression in coronary, cerebrovascular and peripheral arteries. Patients with diabetes obtain less benefit from invasive procedures such as angioplasty and coronary revascularization than do patients without diabetes. Survival following a cardiovascular event is lower in patients with diabetes, particularly in women. It is estimated that 50% of patients have CVD at the time of diagnosis with diabetes. This emphasizes the importance of early diagnosis and aggressive treatment of comorbidities and risk factors. Dyslipidemias in diabetes are characterized by elevated triglycerides, small dense LDL, and decreased HDL. The atherosclerotic process is associated with inflammatory changes with deposition of lipids in the arterial walls. Diabetes also accelerates this process by altering the structure and function of circulating lipoproteins. In a seven year study in a population in Finland, the incidence of myocardial infarctions (MI) in patients with diabetes without a prior MI was similar to patients without diabetes but with a previous MI. Thus, there is a linkage between diabetes and CVD at epidemiologic and pathophysiologic levels, and the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP-III) designated diabetes as a CVD risk equivalent. Treatment of LDL cholesterol is the first priority, followed by HDL and triglycerides: the goals are LDL 40 mg/dL in men or HDL > 50 mg/dL in women, and triglycerides < 150 mg/dL. Statins are the drugs of choice. Benefits of aggressive lipid management with statins have been shown in primary prevention studies (AFCAPS /TexCAPS, ASCOT) and secondary prevention studies (4S, CARE, LIPID, HPS) in patients with varying degrees of dyslipidemias and other risk factors. The Heart Protection Study (HPS) has shown that high risk patients benefit from statins regardless of the LDL levels. Other drugs, e.g., fibrates, nicotinic acid, bile acid sequestrants have a role in selected patients. A new class of drag, ezetimibe, blocks cholesterol absorption in the gastrointestinal tract: it is synergistic with the statins and effective as a single agent when statins are contraindicated. Aggressive therapy to treat diabetic dyslipidemias has been shown to reduce the risk of CVD

Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: A review of their kidney and heart protection.

IMPORTANCE: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, testing for albuminuria among patients with T2D is substantially underutilized in clinical practice; many patients with CKD go unrecognized. For patients with T2D at high cardiovascular risk, or with established CVD, the glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to reduce ASCVD in cardiovascular outcome trials, while potential kidney outcomes are being explored. OBSERVATIONS: A recent meta-analysis found that GLP1-RA reduced 3-point major adverse cardiovascular events by 14% [HR, 0.86 (95% CI, 0.80-0.93)] in patients with T2D. The benefits of GLP1-RA to reduce ASCVD were at least as large among people with estimated glomerular filtration rate (eGFR)/min/1.73 m CONCLUSIONS AND RELEVANCE: Despite their well-described ASCVD benefits and potential kidney protective mechanisms, GLP1-RA remain underutilized in clinical practice. This highlights the need for cardiovascular clinicians to influence and implement use of GLP1-RA in appropriate patients, including those with T2D and CKD at higher risk for ASCVD

Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: A review of their kidney and heart protection.

IMPORTANCE: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, testing for albuminuria among patients with T2D is substantially underutilized in clinical practice; many patients with CKD go unrecognized. For patients with T2D at high cardiovascular risk, or with established CVD, the glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to reduce ASCVD in cardiovascular outcome trials, while potential kidney outcomes are being explored. OBSERVATIONS: A recent meta-analysis found that GLP1-RA reduced 3-point major adverse cardiovascular events by 14% [HR, 0.86 (95% CI, 0.80-0.93)] in patients with T2D. The benefits of GLP1-RA to reduce ASCVD were at least as large among people with estimated glomerular filtration rate (eGFR)/min/1.73 m CONCLUSIONS AND RELEVANCE: Despite their well-described ASCVD benefits and potential kidney protective mechanisms, GLP1-RA remain underutilized in clinical practice. This highlights the need for cardiovascular clinicians to influence and implement use of GLP1-RA in appropriate patients, including those with T2D and CKD at higher risk for ASCVD