Diabetes Therapy最新文献

{"title":"Advances in Imaging Techniques for Assessing Myocardial Microcirculation in People with Diabetes : An Overview of Current Techniques, Emerging Techniques, and Clinical Applications.","authors":"Tine Willum Hansen, Rasmus S Ripa","doi":"10.1007/s13300-025-01710-1","DOIUrl":"10.1007/s13300-025-01710-1","url":null,"abstract":"<p><p>Microangiopathy is a key complication of diabetes, adversely effecting several organs including the heart, kidneys, eyes, and nerves. This review focuses on myocardial microvascular dysfunction, a condition characterized by altered vasomotion and long-term structural changes to coronary arterioles, resulting in impaired regulation of blood flow in response to varying oxygen demands of cardiomyocytes. Presence of myocardial microvascular dysfunction is associated with increased risk of cardiovascular disease, even in the absence of obstructive coronary artery disease. Several noninvasive imaging techniques to assess coronary physiology have significantly enhanced our understanding of the myocardial microcirculation. These methods allow for detailed visualization and quantification of blood flow, endothelial function, and inflammation in the microvasculature, providing critical insights into the early stages of microvascular disease in diabetes. A significant area of development is the use of advanced hybrid imaging techniques such as positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI). The integration of advanced imaging technologies with artificial intelligence is also a key future direction. Overall, these advancements aim to improve the early detection and management of microvascular complications in diabetes, ultimately enhancing outcomes and quality of life. The aim of this review is to provide an overview of both established and emerging noninvasive imaging techniques for assessing myocardial microvascular dysfunction.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"785-797"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Once-Weekly Semaglutide Versus Sodium-Glucose Co-transporter 2 Inhibitors: Real-World Impact on Weight, HbA1c, and Healthcare Resource Utilization in Type 2 Diabetes (PAUSE).","authors":"James Amamoo, Riddhi Doshi, Joshua Noone, Lin Xie, Cory Gamble, Mico Guevarra, Victoria Divino, Justin Chen, Aaron King","doi":"10.1007/s13300-025-01721-y","DOIUrl":"10.1007/s13300-025-01721-y","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical trials have demonstrated greater glycemic control and weight loss with once-weekly (OW) semaglutide versus other anti-diabetes medications, including sodium-glucose co-transporter 2 inhibitors (SGLT2is) in adults with type 2 diabetes (T2D), yet real-world evidence is limited.</p><p><strong>Methods: </strong>This observational study of adults with uncontrolled T2D (HbA1c ≥ 7.0%) initiating semaglutide OW or SGLT2is (January 2018-February 2022; first prescription = index) utilized linked data from IQVIA PharMetrics® Plus adjudicated claims and Ambulatory Electronic Medical Records databases. Among the all semaglutide OW cohort and subgroups (1: persistent [≤ 60-day gap in semaglutide OW supply]; 2: receiving maximum dose ≥ 1 mg; and 3: persistent and ≥ 1 mg dose), changes in weight, body mass index (BMI), and glycated hemoglobin (HbA1c) outcomes from baseline to 1 year post index were descriptively compared. For the main analysis, changes in weight, BMI, HbA1c, and all-cause healthcare resource utilization (HCRU) after 1 year were compared among adjusted semaglutide OW and comparator SGLT2i cohorts, following inverse probability of treatment weighting (IPTW).</p><p><strong>Results: </strong>The all semaglutide OW cohort included 772 patients, and IPTW adjusted cohorts included 416 semaglutide OW patients and 1093 SGLT2i patients. Significant (P < 0.0001) mean changes from baseline were observed in the all semaglutide OW cohort and all subgroups, in weight (kg [all: - 4.4; 1: - 5.0; 2: - 4.9; 3: - 5.2]), BMI (kg/m² [all: - 1.5; 1: - 1.8; 2: - 1.8; 3: - 1.9]), and HbA1c (% [all: - 1.5; 1: - 1.7; 2: - 1.5; 3: - 1.6]). Post-IPTW adjustment, the semaglutide OW cohort had significantly greater mean reductions versus the SGLT2i cohort in weight (- 4.4 versus - 3.4 kg, P = 0.0061), BMI (- 1.5 versus - 1.1 kg/m², P = 0.0013), and HbA1c (- 1.6 versus - 1.2%, P < 0.0001), with similar all-cause HCRU.</p><p><strong>Conclusion: </strong>Adults with T2D initiating semaglutide OW in the real-world had significant decreases in weight, BMI, and HbA1c after 1 year, with greater improvements versus SGLT2i, and similar HCRU.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1033-1048"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Efficacy of Chiglitazar, Pioglitazone, and Semaglutide in Type 2 Diabetes: A Retrospective Study.","authors":"Wenxuan Li, Yangang Wang, Chuanfeng Liu, Yongzhuo Yu, Lili Xu, Bingzi Dong","doi":"10.1007/s13300-025-01724-9","DOIUrl":"10.1007/s13300-025-01724-9","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes (T2D) is a complex chronic metabolic disease characterized by insulin resistance, dyslipidemia, inflammation, and visceral fat accumulation, leading to complications, such as cardiovascular disease and kidney damage. Emerging metabolic regulators, including chiglitazar, semaglutide, and pioglitazone, have gained prominence in managing T2D and associated metabolic disorders. However, their relative efficacy and optimal clinical applications remain unclear. This study's objective was to compare the effects of chiglitazar, semaglutide, and pioglitazone on glycemic control, lipid metabolism, insulin resistance, inflammatory response, liver function, kidney function, and dawn phenomenon intensity in T2D participants, and to explore their relative efficacy and clinical value.</p><p><strong>Methods: </strong>This retrospective study was conducted from October 2024 to November 2024 to compare the effects of chiglitazar, semaglutide, and pioglitazone in managing type 2 diabetes (T2D) and associated metabolic disorders.This retrospective cohort study included 175 participants with T2D divided into three groups: chiglitazar (n = 55), semaglutide (n = 57), and pioglitazone (n = 63). participants underwent a 4-week treatment period. Core metrics, including blood glucose, lipid metabolism indicators, urinary albumin-to-creatinine ratio (UACR), and metabolic insulin resistance score (METS-IR), were assessed before and after treatment to evaluate drug efficacy.</p><p><strong>Results: </strong>Dawn phenomenon: chiglitazar significantly improved dawn phenomenon intensity (Δ0.004 ± 0.80 to -0.77 ± 0.67, p < 0.01), outperforming other drugs. Lipid metabolism: semaglutide demonstrated superior efficacy in reducing total cholesterol (TC) and free fatty acids (FFA) (p < 0.05). Kidney function: both semaglutide and chiglitazar significantly lowered UACR (p < 0.01), with semaglutide showing greater efficacy (-0.13 ± 0.02 versus -0.08 ± 0.01, p < 0.05). Insulin resistance and cardiovascular protection: all three drugs significantly improved METS-IR, with no statistical differences between groups (p > 0.05).</p><p><strong>Safety: </strong>all drugs exhibited good tolerability with no severe adverse events.</p><p><strong>Conclusions: </strong>Chiglitazar is particularly effective for participants with pronounced dawn phenomenon, semaglutide excels in lipid metabolism improvement and kidney protection, while pioglitazone remains effective for insulin resistance and glycemic control. These findings provide evidence-based guidance for individualized T2D management.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"993-1017"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Treatment Patterns in Individuals with Type 2 Diabetes and Chronic Kidney Disease Who Initiate a GLP-1 Receptor Agonist: A Multinational Cohort Study.","authors":"Manel Pladevall-Vila, Ryan Ziemiecki, Catherine B Johannes, Anam M Khan, Daniel Mines, Natalie Ebert, Csaba P Kovesdy, Reimar W Thomsen, Brenda N Baak, Aníbal García-Sempere, Hiroshi Kanegae, Craig I Coleman, Michael Walsh, Ina Trolle Andersen, Clara Rodríguez Bernal, Celia Robles Cabaniñas, Christian Fynbo Christiansen, Alfredo E Farjat, Alain Gay, Patrick Gee, Ron M C Herings, Isabel Hurtado, Naoki Kashihara, Frederik Pagh Bredahl Kristensen, Fangfang Liu, Suguru Okami, Jetty A Overbeek, Fernie J A Penning-van Beest, Satoshi Yamashita, Yuichiro Yano, J Bradley Layton, David Vizcaya, Nikolaus G Oberprieler","doi":"10.1007/s13300-025-01717-8","DOIUrl":"10.1007/s13300-025-01717-8","url":null,"abstract":"<p><strong>Introduction: </strong>Novel therapies are emerging for the prevention of chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2D). Within the FOUNTAIN platform (NCT05526157; EUPAS48148), this real-world study aimed to characterize cohorts of adults with CKD and T2D starting therapy with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in Europe, Japan, and the United States (US) during 2012-2021.</p><p><strong>Methods: </strong>This multinational, multicohort study was conducted in five data sources: the Danish National Health Registers (DNHR) (Denmark), PHARMO Data Network (PHARMO) (The Netherlands), Valencia Health System Integrated Database (VID) (Spain), Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex) (Japan), and Optum's de-identified Clinformatics® Data Mart Database (CDM) (US). Eligible patients had T2D (defined by data source-specific algorithms) and CKD (based on diagnosis codes, estimated glomerular filtration rate values, and/or urine albumin-to-creatinine ratio) and initiated an GLP-1 RA during 2012-2021. Baseline demographic, lifestyle, and clinical characteristics were analyzed, and treatment patterns were described.</p><p><strong>Results: </strong>Study cohorts included 18,929 GLP-1 RA initiators in DNHR; 476 in PHARMO; 11,798 in VID; 329 in J-CKD-DB-Ex; and 70,158 in CDM. Across cohorts, mean age ranged from 66.1 years in J-CKD-DB-Ex to 67.9 years in CDM, and between 46.6% (PHARMO) and 59.6% (J-CKD-DB-Ex) of patients were men. There was a steady increase in GLP-1 RA initiators from 2012 (when 1.6-4.8% of GLP-1 RA initiators started therapy) to 2019 (when 19.8-31.5% started therapy). The median duration of initial treatment with a GLP-1 RA ranged from 2.3 months (PHARMO) to 12.4 months (VID). At 1-year follow-up, between 52% (CDM) and 78% (DNHR) of patients were receiving treatment. Findings suggested that GLP-1 RA use was independent of CKD severity.</p><p><strong>Conclusions: </strong>During 2012-2021, GLP-1 RA use steadily increased across multinational cohorts of patients with T2D and CKD, and persistence with treatment was high. GLP-1 use was independent of CKD severity.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"931-954"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Composite Maternal and Fetal Outcomes among Pregnant Women with Early-Onset Type 2 Diabetes: A Cross-Sectional Study.","authors":"Aleksandra Z Jotic, Milica M Stoiljkovic, Tanja J Milicic, Katarina S Lalic, Ljiljana Z Lukic, Marija V Macesic, Jelena N Stanarcic Gajovic, Mina M Milovancevic, Marko H Obradovic, Miroslava G Gojnic, Djurdja P Rafailovic, Nebojsa M Lalic","doi":"10.1007/s13300-025-01713-y","DOIUrl":"10.1007/s13300-025-01713-y","url":null,"abstract":"<p><strong>Introduction: </strong>The most common form of pregestational diabetes in pregnancy is type 2 diabetes, requiring strict metabolic monitoring owing to the risk of adverse pregnancy outcomes. Our study aimed to identify predictors of composite maternal outcome (CMO) and fetal outcome (CFO) separately in pregnant women with early-onset type 2 diabetes (PwEOT2D).</p><p><strong>Methods: </strong>The cross-sectional pilot study included 60 PwEOT2D by recording age, socioeconomic determinants, preconception body mass index (pBMI), preconception (pHbA1c) and trimester-specific glycated hemoglobin (HbA1c), gestational weight gain (GWG), and pregnancy outcomes. We defined CMO as at least one of the following: gestational hypertension, preeclampsia, eclampsia, preterm delivery, or emergency section. CFO included at least one of the following: small or large for gestational age, macrosomia, neonatal hypoglycemia, or admission to the neonatal intensive care unit.</p><p><strong>Results: </strong>CMO was detected in 55% and CFO in 35% of PwEOT2D. The majority of PwEOT2D with CMO lived in suburban areas (73.1%), while those without CMO mostly lived in rural areas (51.9%, p = 0.014). Moreover, PwEOT2D with CMO had comparable pBMI to those without CMO (31.45 ± 6.27 versus 28.99 ± 6.28 kg/m², p = 0.136). However, PwEOT2D with CMO had higher pHbA1c (7.28 ± 0.95 versus 6.46 ± 0.96%, p = 0.002) and first trimester HbA1c (7.24 ± 1.08 versus 6.42 ± 0.97%, p = 0.003). Similarly, PwEOT2D with CFO had higher pHbA1c (7.84 ± 0.95 versus 6.41 ± 0.67%, p < 0.001) and first trimester (7.29 ± 1.07 versus 6.65 ± 1.07%, p = 0.032) and second trimester HbA1c (6.45 ± 0.87 versus 5.96 ± 0.82%, p = 0.038). Additionally, GWG was higher in the second (4.38 ± 2.01 versus 3.33 ± 1.61 kg, p = 0.032) and third trimester (5.66 ± 2.93 versus 3.89 ± 2.61 kg, p = 0.002) compared with those without CMO. Regression analysis identified pHbA₁c, first trimester of pregnancy, and community type as predictors of CMO, while pHbA1c and the occurrence of CMO were predictors of CFO.</p><p><strong>Conclusions: </strong>Our results imply that preconception and first trimester of pregnancy HbA₁c, as well as community disparities, are predictors of CMO, while the predictors of CFO were only preconception HbA1c and the occurrence of CMO in pregnant women with EOT2D. Therefore, tailoring preventive strategies, followed by achieving and sustaining trimester-specific metabolic control, might improve pregnancy outcomes in women with EOT2D.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"1049-1062"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of Atherosclerotic Cardiovascular Disease in Patients with Type 2 Diabetes in Jordan: The PACT-MEA Study.","authors":"Jihad A Haddad, Firas O Abbas Annabi, Hiba Abbasi, Muneer A Abu AlSamen, Fawaz L Ammari, Fares H Haddad, Suhair E Haddad, Mustafa Jaradat, Adi Khassawneh, Nidal Khatib, Arabieh Magableh, Eyas Al-Mousa","doi":"10.1007/s13300-025-01718-7","DOIUrl":"10.1007/s13300-025-01718-7","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the prevalence and clinical management of atherosclerotic cardiovascular disease (ASCVD) and ASCVD risk in patients with type 2 diabetes (T2D) in Jordan.</p><p><strong>Methods: </strong>PACT-MEA (NCT05317845) was a non-interventional, cross-sectional, observational study of adults with T2D recruited in seven countries across the Middle East and Africa. In Jordan, assessments were conducted at ten sites, three in primary care and seven in secondary care settings.</p><p><strong>Results: </strong>The Jordan cohort included 576 individuals (27.8% primary care, 72.2% secondary care settings), similarly represented by male and female patients, with a mean age of 59.7 ± 11.7 years and a median duration of diabetes of 10.0 years. The prevalence of established ASCVD (eASCVD) was 26.2% overall (95% CI: 22.8-30.0) and 21.9% and 27.9% in primary care and secondary care settings, respectively (95% CI: 16.1-28.9, 23.8-32.4), higher than that observed in the regional PACT-MEA analysis. By the European Society of Cardiology 2021 criteria, 66.0% of patients were classified as high risk and 33.3% as very high risk (which included eASCVD). Use of renin-angiotensin system inhibitors, statins, and cardioprotective antidiabetic medication was higher in secondary care settings. None of the participants achieved all guideline recommendations with respect to risk factor control, body mass index, exercise, and pharmacotherapy.</p><p><strong>Conclusions: </strong>More than one-quarter of patients with T2D in Jordan had ASCVD, and nearly all were at high/very high ASCVD risk. These findings suggest a need for multifactorial approaches to risk reduction in this population within Jordan in both primary and secondary care settings.</p><p><strong>Trial registration: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov ; Unique identifier: NCT05317845.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"899-913"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide Was Associated with Improved Health-Related Quality of Life in Adults with Obesity or Overweight and Type 2 Diabetes: Results from the Phase 3 SURMOUNT-2 Trial.","authors":"Theresa Hunter Gibble, Dachuang Cao, Xiaotian Michelle Zhang, Neena Agarwal Xavier, Jiat Ling Poon, Angela Fitch","doi":"10.1007/s13300-025-01723-w","DOIUrl":"10.1007/s13300-025-01723-w","url":null,"abstract":"<p><strong>Introduction: </strong>In SURMOUNT-2, a phase 3, randomized clinical trial, tirzepatide treatment resulted in clinically meaningful reduction in bodyweight among people with obesity or overweight and T2D. The current analysis evaluated the effects of tirzepatide treatment on self-reported health-related quality of life (HRQoL) outcomes among SURMOUNT-2 participants.</p><p><strong>Methods: </strong>SURMOUNT-2 participants were randomly assigned (1:1:1) to receive either tirzepatide 10 mg (n = 312), tirzepatide 15 mg (n = 311), or placebo (n = 315) for 72 weeks as an adjunct to diet and exercise. Self-reported HRQoL was assessed in terms of changes from baseline to week 72 in Short Form-36 Version 2 Health Survey acute form (SF-36v2), Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), EQ-5D 5-level Version (EQ-5D-5L) Health State Index (UK) and associated EQ visual analog scale (VAS), and Patient Global Impression of Status (PGIS) for Physical Activity. Post hoc analyses evaluated changes in HRQoL outcomes by categorical percent weight reduction targets (> 0 to < 5%, ≥ 5%, ≥ 10%, ≥ 15%, ≥ 20%, ≥ 25%, and ≥ 30%) and by self-reported baseline physical function limitations (based on PGIS) among tirzepatide-treated participants.</p><p><strong>Results: </strong>At week 72, tirzepatide treatment was associated with significantly larger improvements than placebo in the SF-36v2 Physical Component Summary score, SF-36v2 physical functioning, bodily pain, general health, vitality, and social functioning domain scores, all IWQOL-Lite-CT scores, and EQ VAS score. Tirzepatide-treated participants who achieved greater weight reduction targets showed numerically larger improvements in HRQoL scores relative to those with lower percent weight reduction. For all HRQoL measures, participants with physical function limitations at baseline showed greater improvements than those without limitations.</p><p><strong>Conclusions: </strong>Tirzepatide treatment was associated with improved self-reported HRQoL outcomes compared with placebo among people with obesity or overweight with T2D. Participants achieving greater bodyweight reductions and those with physical function limitations at baseline showed greater improvements in HRQoL. CLINICAL TRIAL REGISTRATION NUMBER FOR SURMOUNT-2: NCT04657003.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"977-991"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Comparisons Between Glucagon-Like Peptide-1 Receptor Agonists and Other Glucose-Lowering Agents in Type 2 Diabetes: Retrospective Analyses of Cardiovascular and Economic Outcomes in England.","authors":"Derek Connolly, Edward Collins, Hongye Ren, Simon Wan Yau Ming, Jennifer Davidson, Steve Bain","doi":"10.1007/s13300-025-01715-w","DOIUrl":"10.1007/s13300-025-01715-w","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes (T2D) who have established cardiovascular disease (CVD) or a high risk of CVD. Nevertheless, GLP-1RAs remain underutilized. This real-world, retrospective study compared cardiovascular and economic outcomes between individuals treated with GLP-1RAs and other glucose-lowering agents in England.</p><p><strong>Methods: </strong>Clinical Practice Research Datalink-registered people indexed on GLP-1RAs, dipeptidyl peptidase-4 (DPP4) inhibitors, or basal insulin between January 1, 2014 and December 31, 2018 for their fourth line of T2D treatment were stratified into six cohorts based on their: (1) cardiovascular risk (high or very high risk) and (2) indexed therapy. Cox proportional hazards regression was used to compare the risk of MACE and all-cause death between GLP-1RA and other treatment cohorts. Generalized linear regression was used to quantify differences in healthcare resource use (HCRU) and costs between groups.</p><p><strong>Results: </strong>Of 63,237 subjects, 10,607 were at high cardiovascular risk (GLP-1RA: 2709; DPP4 inhibitor: 2673; basal insulin: 5225) and 52,630 at very high cardiovascular risk (GLP-1RA: 14,692; DPP4 inhibitor: 18,461; basal insulin: 19,477). The crude incidence of all outcomes was lower in the GLP-1RA versus other treatment cohorts, regardless of cardiovascular risk. Among very-high-risk individuals treated with GLP-1RA, the adjusted risk of MACE was 33% (24-40%) and 23% (13-23%) lower versus DPP4 inhibitor and basal insulin cohorts, respectively. The adjusted total cardiovascular-related cost among very-high-risk individuals was £208.14 (£155.81-£260.47) and £151.74 (£110.69-£192.79) lower in the GLP-1RA versus DPP4 inhibitor or basal insulin cohorts, respectively.</p><p><strong>Conclusions: </strong>In a real-world setting, GLP-1RAs may be associated with a lower risk of MACE and reduced HCRU and costs than DPP4 inhibitors or basal insulin in individuals with T2D, particularly among those at very high cardiovascular risk.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"955-975"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining SGLT2is, GLP1-RAs and nsMRAs in Diabetes: A Scoping Review of Current and Future Perspectives.","authors":"Elisabeth Buur Stougaard, Viktor Rotbain Curovic, Tine Willum Hansen","doi":"10.1007/s13300-025-01726-7","DOIUrl":"10.1007/s13300-025-01726-7","url":null,"abstract":"<p><p>Combination therapy is a cornerstone of modern type 2 diabetes management, extending beyond traditional goals of glucose, blood pressure, and lipid control to focus on therapies protecting the heart and kidneys. The introduction of sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide receptor agonists (GLP-1RAs), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) has reshaped clinical guidelines in recent decades. However, the effects of combining these drug classes remain uncertain. This review evaluates the current evidence on combination therapies involving SGLT2is, GLP-1RAs, and nsMRAs in type 1 and type 2 diabetes, thereby focusing on treatments that in type 2 diabetes have shown cardio-renal protection, while exploring future research directions. In type 2 diabetes, much of the evidence comes from post hoc analyses of trials that primarily examine the effects of single drugs compared with placebo. This limits the ability to draw definitive conclusions about the efficacy and safety of combination therapy. Nonetheless, observational studies indicate that combining SGLT2is and GLP-1RAs may offer superior cardiovascular and mortality benefits compared with monotherapy. Data on kidney outcomes remain limited, but SGLT2is appear particularly effective when kidney protection is the primary goal, regardless of concurrent treatment. The use of nsMRAs is still emerging, and studies investigating their combination with SGLT2is and GLP-1RAs are scarce. In type 1 diabetes, combination therapies have primarily focused on glucose control and safety, with several randomized controlled trials investigating the effects of combining treatments such as SGLT2is and GLP-1RAs with insulin. No current studies have estimated the effects on heart and kidneys. Ongoing and planned studies aim to fill critical gaps in our understanding of combination therapy for type 1 diabetes. These studies hold the promise of determining whether similar risk reductions, as observed in type 2 diabetes, can be achieved, offering hope for improved outcomes in this high-risk population. Currently, in type 2 diabetes, only one ongoing study is testing combination with an SGLT2i and a nsMRA.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":"799-811"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Polyethylene Glycol Loxenatide in Combination with Basal Insulin in Patients with Type 2 Diabetes Mellitus: A Retrospective Real-World Study.","authors":"Xiaohuan Liu, Ying Zhang, Li-Ling Zhao, Yale Duan, Zhizhen Hu, Liya Bao, Ping Jin","doi":"10.1007/s13300-025-01737-4","DOIUrl":"10.1007/s13300-025-01737-4","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with type 2 diabetes mellitus (T2DM) who cannot achieve normal glycosylated hemoglobin (HbA1c) levels are sometimes given the combined therapeutic regimen of polyethylene glycol loxenatide (PEG-Loxe) + basal insulin. The aim of this study was to investigate the efficacy and safety of PEG-Loxe combined with basal insulin in patients with T2DM.</p><p><strong>Methods: </strong>This retrospective, real-world study included patients with T2DM aged ≥ 18 years for whom basal insulin therapy was ineffective, whose HbA1c levels were between 7.0% and 11.0%, and who were on either continued basal insulin dose adjustment or who had received PEG-Loxe + basal insulin combined therapy for at least 24 weeks. The primary endpoint was change in HbA1c level after 24 weeks treatment. Secondary endpoints included HbA1c achievement target rate, change in fasting plasma glucose and body weight, respectively, and change in HbA1c stratified by sex, age, disease duration, and baseline HbA1c level.</p><p><strong>Results: </strong>Overall, 307 patients were identified. After propensity score matching, 44 patients each were included in the basal insulin and PEG-Loxe + basal insulin group. After 24 weeks, a significant difference in Hb1Ac reduction between the groups (P = 0.003) was observed. Also, patients treated with PEG-Loxe + basal insulin combined therapy experienced greater body weight reduction compared those treated with basal insulin only (intergroup difference: - 3.2 kg; 95% confidence interval [95% CI] - 5.4, - 1.0]; P = 0.005). There was a significant intergroup difference in weight reduction in patients with body mass index ≥ 28 kg/m² (- 8.4 kg; 95% CI - 13.9, - 3.0; P = 0.004). HbA1c levels in female patients aged < 65 years with HbA1c ≥ 8.5% and with a disease duration ≥ 10 years were significantly different between the two treatment groups (P < 0.005). Hypoglycemic events occurred in 10.4% of patients treated with PEG-Loxe + basal insulin with no cases of level 3 hypoglycemia.</p><p><strong>Conclusion: </strong>PEG-Loxe + basal insulin combined therapy was safe and effective in patients with T2DM who did not achieve optimal glycemic control with insulin therapy alone.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: ChiCTR2400086699.</p>","PeriodicalId":11192,"journal":{"name":"Diabetes Therapy","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}