ABSTRACT
AIM: To compare effectiveness of dapagliflozin versus DPP-4 inhibitors on individualized HbA1c targets and extra-glycaemic endpoints among elderly patients with type 2 diabetes (T2D). METHODS: This was a multicentre retrospective study on patients aged 70-80 years with HbA1c above individualized target and starting dapagliflozin or DPP-4 inhibitors in 2015-2017. The primary outcome was the proportion reaching individualized HbA1c targets. Confounding by indication was addressed by inverse probability of treatment weighting (IPTW), multivariable adjustment (MVA), or propensity score matching (PSM). RESULTS: Patients initiating dapagliflozin (n = 445) differed from those initiating DPP-4i (n = 977) and balance between groups was achieved with IPTW or PSM. The median follow-up was 7.5 months and baseline HbA1c was 8.3%. A smaller proportion of patients initiating dapagliflozin attained individualized HbA1c target as compared to those initiating DPP-4 inhibitors (RR 0.73, p < 0.0001). IPTW, MVA, and PSM yielded similar results. Between-group difference in the primary outcome was observed among patients with lower eGFR or longer disease duration. Dapagliflozin allowed greater reductions in body weight and blood pressure than DPP-4 inhibitors. CONCLUSIONS: Elderly patients with T2D initiating dapagliflozin had a lower probability of achieving individualized HbA1c targets than those initiating DPP-4 inhibitors but displayed better improvements in extra-glycaemic endpoints.
Subject(s)
Diabetes Mellitus, Type 2 , Dipeptidyl-Peptidase IV Inhibitors , Aged , Humans , Retrospective Studies , Glycated Hemoglobin , Benzhydryl Compounds , Hypoglycemic Agents , Treatment Outcome , Blood GlucoseABSTRACT
AIM: Type 2 diabetes (T2D) is a risk factor for metabolic dysfunction-associated fatty liver disease (MAFLD), which is becoming the commonest cause of chronic liver disease worldwide. We estimated MAFLD prevalence among patients with T2D using the hepatic steatosis index (HSI) and validated it against liver ultrasound. We also examined whether glucose-lowering medications (GLM) beneficially affected HSI. METHODS: We collected data from 46 diabetes clinics (n = 281,381 T2D patients), extracted data to calculate HSI and validated it against ultrasound-detected hepatic steatosis. We then examined changes in HSI among patients with a follow-up visit within 1 year after initiating newer GLMs. RESULTS: MAFLD (defined by HSI > 36, i.e., a high probability of steatosis) was present in 76.3% of the 78,895 included patients, while only 2.7% had HSI < 30 (low probability of steatosis). After age- and sex-adjusting, higher HSI was associated with higher prevalence of chronic kidney disease (odds ratio 1.35; 95%CI 1.22-1.51) and macroangiopathy (odds ratio 1.18; 95%CI 1.07-1.30). Among 2,179 subjects in the validation cohort, the prevalence of MAFLD was 67.8% and was greater in those with high HSI. Performance of HSI for ultrasound-detected MAFLD was moderate (AUROC 0.70), yet steatosis prevalence was > threefold higher among subjects with HSI > 36 than among those with HSI < 30. Notably, HSI declined significantly ~ 6 months after initiation of dapagliflozin or incretin-based therapies, but not gliclazide. CONCLUSION: About three quarters of patients with T2D have HSI values suggestive of MAFLD, a condition associated with macroangiopathy and nephropathy. Treatment with dapagliflozin or incretin therapies might improve MAFLD in T2D.
Subject(s)
Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Fatty Liver/complications , Fatty Liver/epidemiology , Hypoglycemic Agents/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Fatty Liver/therapy , Female , Follow-Up Studies , Gliclazide/therapeutic use , Humans , Incretins/therapeutic use , Italy/epidemiology , Male , Middle Aged , Prevalence , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , Treatment Outcome , Ultrasonography , Young AdultSubject(s)
Ambulatory Care Facilities , COVID-19 , Civil Defense , Communicable Disease Control , Diabetes Complications , Diabetes Mellitus, Type 2 , No-Show Patients , Telemedicine , Age Factors , Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Cardiotonic Agents/therapeutic use , Civil Defense/organization & administration , Civil Defense/standards , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Diabetes Complications/epidemiology , Diabetes Complications/etiology , Diabetes Complications/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Health Services Accessibility/organization & administration , Humans , Internet Use/statistics & numerical data , Italy/epidemiology , No-Show Patients/psychology , No-Show Patients/statistics & numerical data , Organizational Innovation , Physical Distancing , SARS-CoV-2 , Telemedicine/methods , Telemedicine/standardsSubject(s)
Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Diabetes Mellitus/physiopathology , Diabetes Mellitus/virology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Prevalence , SARS-CoV-2Subject(s)
Cardiac Output , Extracorporeal Circulation , Heart Defects, Congenital/surgery , Skin Temperature , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Monitoring, Physiologic , Postoperative CareABSTRACT
The Authors report on 20 patients who underwent definitive surgery for placement of artificial pacemaker with utilisation of acupuncture for analgesic purposes. The report in detail on the results obtained with even, in the light of a limited experience, can be considered positive.
Subject(s)
Acupuncture Therapy , Pacemaker, Artificial , Aged , Female , Humans , Male , Middle AgedABSTRACT
The Authors outline their clinical experience with 1800 patients, 1190 of which underwent definitive pacemaker implantation and 610 replacement of the impulse generator. They examine some parametres in detail, reporting on the results obtained.