Effects of exenatide twice daily versus sitagliptin on 24-h glucose, glucoregulatory and hormonal measures: a randomized, double-blind, crossover study.

AIM: To compare exenatide and sitagliptin glucose and glucoregulatory measures in subjects with type 2 diabetes. METHODS: An 8-week, double-blind, randomized, crossover, single-centre study. Eighty-six subjects (58% female, body mass index 35 ± 5 kg/m², haemoglobin A1c 8.3 ± 1.0%) received either exenatide 10 µg (subcutaneous) twice daily or sitagliptin 100 mg (oral) daily for 4 weeks and crossed to the other therapy for an additional 4 weeks. Main outcome was time-averaged glucose during the 24-h inpatient visits. RESULTS: Both treatments decreased average 24-h glucose, but exenatide had a greater effect [between-group difference: -0.67 mmol/l, 95% confidence interval (CI): -0.9 to -0.4 mmol/l]. Both treatments decreased 2-h postprandial glucose (PPG), area under the curve of glucose above 7.8 mmol/l (140 mg/dl) and 11 mmol/l (200 mg/dl) and increased the time spent with glucose between 3.9 and 7.8 mmol/l (70 and 140 mg/dl) during 24 h, but exenatide had a significantly greater effect (p < 0.05). Both treatments decreased postprandial serum glucagon, with exenatide having a greater effect (p < 0.005). Both treatments decreased fasting blood glucose to a similar degree (p = 0.766). Sitagliptin increased, while exenatide decreased, postprandial intact glucagon-like peptide-1. Both drugs improved homeostasis model assessment of ß-cell function (HOMA-B), with exenatide having a significantly greater effect (p = 0.005). Both exenatide and sitagliptin decreased 24-h caloric intake, with exenatide having a greater effect (p < 0.001). There was no episode of major hypoglycaemia. Adverse events were mild to moderate and mostly gastrointestinal in nature with exenatide. No study withdrawals were due to an adverse event. CONCLUSION: Compared to sitagliptin, exenatide showed significantly lower average 24-h glucose, 2-h PPG, glucagon, caloric intake and improved HOMA-B.

Evaluation of psychosocial health care in quality assurance activities.

This article documents the extent to which one type of quality assurance activity--the medical audit--includes evaluation of psychosocial aspects of health and disease. The criteria used for 448 medical audits completed in the Minneapolis-St. Paul area from 1975 to 1979 are examined in terms of three kinds of psychosocial criteria--those dealing with impact of illness, psychosocial consultation and psychosocial history, plus a fourth kind of criteria concerned with patient education. The majority of medical audits examined address no psychosocial or patient education criteria whatsoever (78 and 63 percent, respectively). Audits of psychiatric diagnoses are more likely to include psychosocial criteria than those of surgical, pediatric, medical, or obstetrical-gynecological diagnoses; on the other hand, pediatrics and psychiatry are most likely to include patient-education criteria. Furthermore, of the four kinds of criteria studied, those concerned with patient education are the most frequently found. It is recommended that methods to evaluate psychosocial health care be developed and implemented within the sphere of quality assurance activities, in order to more comprehensively define the quality of medical care.

Psychosocial support of residents in family practice programs.

Family practice residency programs (N = 347) were surveyed to examine the frequency of 11 kinds of psychosocial support available to residents through their programs. Family practice programs offer a considerable number of support elements to residents, with programs showing much homogeneity in the kinds of support offered. The size of a program does influence the kinds of support available, with small programs less likely than medium or large programs to offer the formal kinds of support examined in this study. Four patterns of support emerge from the data, each reflecting a specific orientation: (1) the psychological orientation, (2) the "bare bones" of support, (3) the support group orientation, and (4) the family orientation. In general, the kinds of support that address the residents' family needs are least likely to be available. Because time away from work helps to relieve the pressures of residency training, length of vacation and frequency of night call were also examined. On the average, first year residents cover night call every 3.64 nights and have 2.4 weeks of vacation.

Psychosocial support in residency training programs.

A representative sample (n = 481) of residency training programs in six medical specialties (family practice, obstetrics/gynecology, pediatrics, psychiatry, internal medicine, and surgery) was surveyed to examine the frequency and kinds of psychosocial support offered to residents. Residency programs in family practice and psychiatry were generally more likely than programs in the other specialties surveyed to offer to residents the 10 types of support covered by the survey. In addition, the survey revealed residency programs were less likely to offer support related to personal or family problems as opposed to medical/professional issues.