Differences in glycemic control across world regions: a post-hoc analysis in patients with type 2 diabetes mellitus on dual antidiabetes drug therapy.

OBJECTIVE: This post-hoc analysis of the EDGE (Effectiveness of Diabetes control with vildaGliptin and vildagliptin/mEtformin) study assessed inter-regional differences in baseline characteristics and response to treatment intensification with dual oral antidiabetes drugs (OADs) in patients with type 2 diabetes mellitus (T2DM). METHODS: Patients with T2DM inadequately controlled with first-line monotherapy were assigned to receive a dipeptidyl peptidase-4 (DPP-4) inhibitor, vildagliptin, or comparator OADs as add-on dual therapy. The primary effectiveness end point (PEP) was achieving glycated hemoglobin (HbA1c) reduction >0.3% without hypoglycemia, peripheral edema, discontinuation owing to gastrointestinal events or weight gain ⩾5% at 12 months. The secondary effectiveness end point (SEP) was achieving HbA1c of <7% without hypoglycemia or weight gain ⩾3% at 12 months. RESULTS: Baseline characteristics of patients (N=43 791), including mean HbA1c (8.2%), varied across regions. Baseline age (62.3 years) and T2DM duration (6.3 years) were greater in patients from Europe than those from India and the Middle East (age: 51.8 and 52.1 years; T2DM duration: 4.3 and 4.2 years, respectively). The probability of achieving PEP with dual therapy was higher in India (odds ratio (OR): 1.5), Latin America (OR: 1.2) and Middle East (OR: 2.0) than in Europe (OR: 0.8) and East Asia (OR: 0.3). Achievement of SEP in patients receiving dual therapy was greater in Latin America (OR: 1.7) and Middle East (OR: 1.7). Vildagliptin add-on therapy allowed more patients to achieve SEP across regions. Women aged ⩾45 years less often attained glycemic target (HbA1c<7%) without significant weight gain ⩾5% compared with women aged <45 years (OR: 0.876, 95% confidence interval: 0.774, 0.992; P=0.037). CONCLUSIONS: Baseline HbA1c and T2DM duration differed considerably across all regions. Treatment intensification with second OAD, particularly with a DPP-4 inhibitor vildagliptin, resulted in good treatment response without tolerability issues despite delayed intensification of failing monotherapy across regions.

Septic course of chronic pancreatitis caused by infected visceral pseudoaneurysm content.

Visceral pseudoaneurysms occur in approximately 4-10% of all patients with chronic pancreatitis and in untreated cases the mortality rate can reach 90% of cases. The septic course of visceral pseudoaneurysm formation adds major problems to the complex treatment of these patients: Namely the removal of infected material and the occlusion of the ruptured visceral artery significantly complicate treatment strategy. The aim of this report is to present the case of a patient with severe sepsis due to chronic pancreatitis complicated by pseudoaneurysm formation of the gastroduodenal artery in the head of the pancreas. A 32-year-old man underwent semi-urgent surgery after initial haemodynamic stabilization and urgent diagnostic processing including color-coded abdominal duplex sonography, angio-CT, angiography and endoscopic retrograde cholangio-pancreaticography. The removal of infected pseudoaneurysm content was performed and preceded by the extra-pancreatic ligatures of the gastroduodenal and right-sided gastro-epiploic arteries. Blood transfusions could be avoided and the postoperative outcome was uneventful. The rare septic course of visceral pseudoaneurysm complicating chronic pancreatitis may be treated successfully by open surgical technique, with consecutive elimination of the septic focus and the occlusion of ruptured and feeding arteries performed as a one-step procedure.