{"title":"The promise of tirzepatide: A narrative review of metabolic benefits","authors":"Sara Sokary, Hiba Bawadi","doi":"10.1016/j.pcd.2025.03.008","DOIUrl":"10.1016/j.pcd.2025.03.008","url":null,"abstract":"<div><div>Obesity and type 2 diabetes mellites (T2DM) are intertwined epidemics that continue to pose significant challenges to global public health. We aim to review the available evidence on the metabolic effects of tirzepatide, focusing on weight loss and maintenance of lost weight, body composition alterations, appetite regulation, glycemic control, and lipid profile modulation. Tirzepatide administration for 72 weeks elicited significant weight reduction ranging from 5 % to 20.9 % across different trials in a dose-dependent manner. Furthermore, limited evidence showed that lost body weight may be primarily due to fat mass reduction. Tirzepatide also significantly decreased food intake, reduced overall appetite scores and increased fasting visual analog scale scores for satiety and fullness across different clinical trials. Moreover, tirzepatide exhibited favorable effects on glycemic control, with notable reductions in HbA1c levels ranging from 20.4 mmol/mol with the 5 mg dose to 28.2 mmol/mol with the 15 mg dose, following treatment durations lasting 40–52 weeks. Additionally, tirzepatide exerts a beneficial impact on lipid profile parameters, including reductions in total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, while increasing high-density lipoprotein cholesterol concentrations. Despite its efficacy, tirzepatide is associated with gastrointestinal adverse effects, which requires dose escalation strategies to enhance tolerability. Mild to moderate adverse events are commonly reported at higher doses, with discontinuation rates ranging from 4 % to 10 % across different dosages. In conclusion, tirzepatide has shown multifaceted metabolic effects, along with manageable adverse profiles, which makes it a promising therapeutic agent for addressing both obesity and T2DM. However, further long-term randomized controlled trials are warranted to reveal long-term efficacy and safety outcomes, particularly in diverse patient populations.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 229-237"},"PeriodicalIF":2.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kirsty Winkley , Isabel Graham , Yvonne Tylor , Mark Chamley , Caroline Rook , Alan Simpson , Khalida Ismail
{"title":"The psychosis and type 2 diabetes service model (PODS) population profile study","authors":"Kirsty Winkley , Isabel Graham , Yvonne Tylor , Mark Chamley , Caroline Rook , Alan Simpson , Khalida Ismail","doi":"10.1016/j.pcd.2025.03.007","DOIUrl":"10.1016/j.pcd.2025.03.007","url":null,"abstract":"<div><h3>Objective</h3><div>To describe diabetes care received and views of people with severe mental illness (SMI) and type 2 diabetes (T2D) in an inner-city primary care setting.</div></div><div><h3>Design</h3><div>A cross-sectional study of adults with SMI and T2D from two primary care localities in south London.</div></div><div><h3>Methods</h3><div>Medical record data was extracted on annual diabetes review and participants invited for telephone interview.</div></div><div><h3>Results</h3><div>125 adults participated, 37 completed interviews. 43 % were female, 48 %, 35 % and 16 % were: Black African/Caribbean, White, Asian/other ethnicity. Mean age= 59.47 years (SD:12.68), diabetes duration= 8.62 years (SD:6.10), systolic blood pressure (BP)= 133.42 mmHg (SD:17.28), diastolic BP= 81.42 mmHg (SD:8.93), BMI= 33.17 m/kg<sup>2</sup> (SD:7.22), HbA1c= 61.64 mmol/mol (SD:25.18). Older age (OR:1.06, 95 % C.I.:1.0, 1.10), shorter diabetes duration (OR:0.90, 95 % C.I.:0.84, 0.97) were associated with target HbA1c< /= 58 mM. Younger age and Black ethnicity were associated with BP> 140 mmHg (OR:0.94, 95 % C.I.:0.90, 0.98; OR:0.08 (95 % C.I.:0.01, 0.56). Being older was associated with cholesterol, < 5.0 mmol/mol (OR:1.06, 95 % C.I.:1.01, 1.11). Questionnaires demonstrated low physical activity, alcohol/drug use, diabetes distress, psychiatric symptoms. Interviews indicated that > 50 % wanted more support with SMI and T2D.</div></div><div><h3>Conclusions</h3><div>Younger, black people with SMI and T2D are potentially at greater cardiometabolic risk. Interviews suggest people with T2D and SMI group require more mental health and diabetes support.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 329-333"},"PeriodicalIF":2.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yenifer Diaz Montes , Luis A. Anillo Arrieta , Juan Jose Espitia De La Hoz , Tania Acosta-Vergara , Jorge Acosta-Reyes , Karen C. Flórez Lozano , Rafael Tuesca Molina , Pablo Aschner , Sandra Rodríguez Acosta , Noël C. Barengo
{"title":"Effectiveness of a community intervention program on healthy lifestyles (PREDICOL) among adults with prediabetes in two Latin American cities: A quasi-experimental study","authors":"Yenifer Diaz Montes , Luis A. Anillo Arrieta , Juan Jose Espitia De La Hoz , Tania Acosta-Vergara , Jorge Acosta-Reyes , Karen C. Flórez Lozano , Rafael Tuesca Molina , Pablo Aschner , Sandra Rodríguez Acosta , Noël C. Barengo","doi":"10.1016/j.pcd.2025.03.010","DOIUrl":"10.1016/j.pcd.2025.03.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to measure the impact of a community-based lifestyle modification intervention program on the Health-Related Quality of Life (HRQoL) of adults with prediabetes in two Latin American cities.</div></div><div><h3>Methods</h3><div>A quasi-experimental study was conducted with participants aged 30 and above in two Colombian cities between 2018 and 2022. The glycemic status of study participants was determined through the administration of an oral glucose tolerance test. Individuals exhibiting impaired glucose tolerance (IGT) were selected for inclusion in the intervention program. Of the 146 individuals identified with IGT, 91 completed the one-year intervention protocol. HRQoL was assessed utilizing the EQ-5D-3L questionnaire, both before and after the intervention. Logistic regression models were used to calculate the odds ratios (OR) and 95 % confidence intervals (CI), while classification models based on machine learning algorithms were utilized to identify factors associated with favorable changes in health-related quality of life (HRQoL).</div></div><div><h3>Results</h3><div>In Bogotá D.C., a significant improvement in HRQoL was documented (pre-intervention: 0.69 ± 0.17; post-intervention: 0.76 ± 0.16), attaining the threshold for clinically meaningful change (0.06<strong>).</strong> No changes in HRQoL were observed in the study participants. Logistic regression analysis revealed that the improvement in HRQoL was statistically significantly associated with sex (OR 8.75; 95 % CI 1.91–40.03), age (OR 11.61; 95 % CI 1.44–93.44), place of residence (OR 29.31; 95 % CI 5.26–163.54), and weight loss (OR 5.56; 95 % CI 1.15–26.76). According to the XGBoost model, return to normal glycemic status emerged as the most important variable for improvements in HRQoL.</div></div><div><h3>Conclusion</h3><div>Gender, age, place of residence, weight loss, and return to normoglycemic status were identified as significant predictors in lifestyle modification to improve HRQoL among participants at high risk of developing type 2 diabetes.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 277-287"},"PeriodicalIF":2.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carolina Guiriguet , Mercè Bustos , Roser Cantenys , Eduardo Hermosilla , Joan Camús , Manuel Medina , Carina Aguilar Martín , Alessandra Queiroga Gonçalves , Ester Gavaldà-Espelta , Francesc Xavier Cos , Núria Nadal , Mireia Fàbregas , Francesc Fina , Leonardo Méndez-Boo , Elisabet Balló , Margarita Garcia Canela , Magdalena Lladó , Ariadna Mas , Ermengol Coma , Sara Rodoreda
{"title":"Enhancing the follow-up for patients with type 2 diabetes mellitus using a proactive scheduling computer tool: A paired cohort study in primary care","authors":"Carolina Guiriguet , Mercè Bustos , Roser Cantenys , Eduardo Hermosilla , Joan Camús , Manuel Medina , Carina Aguilar Martín , Alessandra Queiroga Gonçalves , Ester Gavaldà-Espelta , Francesc Xavier Cos , Núria Nadal , Mireia Fàbregas , Francesc Fina , Leonardo Méndez-Boo , Elisabet Balló , Margarita Garcia Canela , Magdalena Lladó , Ariadna Mas , Ermengol Coma , Sara Rodoreda","doi":"10.1016/j.pcd.2025.03.009","DOIUrl":"10.1016/j.pcd.2025.03.009","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the impact of an electronic scheduling tool (Planificat) on the management of type 2 diabetes mellitus (T2DM) in primary care settings.</div></div><div><h3>Methods</h3><div>This paired cohort study used data from the Catalan primary care electronic health records. The intervention cohort, using Planificat, included all patients aged 15 years or older with T2DM and was matched 1:1 with a control cohort. The study period lasted one year. Mixed general linear models estimated Odds Ratios (OR) and 95 % confidence intervals (95 %CI) for primary outcomes, including T2DM clinical tests (LDL cholesterol, HbA1c), visit frequency, and non-attendance rates.</div></div><div><h3>Results</h3><div>A total of 51,619 patients (mean age 68.3 years, 42.1 % of female sex) and their paired controls were included. In the primary analysis, significant increases were observed in the Planificat group (N = 18,542) regarding several measures: cholesterol tests performed (83.5 % vs. 75.4 %; OR: 1.65 [95 %CI: 1.57–1.74]), HbA1c tests performed (83.7 % vs. 75.4 %; OR: 1.7 [95 %CI: 1.61–1.79]), and electrocardiograms (65 % vs. 52 %; OR: 1.72 [95 %CI: 1.65–1.8]). Additionally, there was a 36 % increase in patients achieving HbA1c levels < 8 % (OR: 1.36 [95 %CI: 1.3–1.42]). Statistically significant improvements of 30 % and 40 % were also observed in foot and retinopathy screenings, respectively. Face-to-face visits with general practitioners and non-attendance rates remained comparable between cohorts, while face-to-face nurse visits increased by 7 %.</div></div><div><h3>Conclusions</h3><div>Planificat significantly improved T2DM management indicators, promoting proactive scheduling and enhancing follow-up in primary care without impacting face-to-face visits. These findings support its integration as a complementary strategy for optimizing chronic disease management.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 334-340"},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Barriers to glucagon use in patients with type 1 diabetes","authors":"Emma Mason, Kagan E. Karakus, Halis K. Akturk","doi":"10.1016/j.pcd.2025.03.004","DOIUrl":"10.1016/j.pcd.2025.03.004","url":null,"abstract":"<div><div>Glucagon use has been shown to be low in severe hypoglycemia events among adults with type 1 diabetes. In this study, we aimed to explore the barriers to using glucagon. We surveyed 576 adults with type 1 diabetes and demonstrated the barriers in using glucagon and speculated possible solutions.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 341-343"},"PeriodicalIF":2.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Social isolation, loneliness, and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis","authors":"Maheen Asif , Aliza Asif , Ummi Aiman Rahman , Hafsa Ajmal , Uzair Jafar , Oshaz Fatima","doi":"10.1016/j.pcd.2025.03.006","DOIUrl":"10.1016/j.pcd.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>Social isolation and loneliness are forms of social disconnection that have been linked to increased risk of many metabolic disorders, including Type 2 Diabetes Mellitus (T2DM). However, evidence to support this relation is lacking. This study aims to investigate the association between social isolation, loneliness, and the incidence risk of T2DM.</div></div><div><h3>Methods</h3><div>We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Google scholar to retrieve qualitative studies comparing the incidence of T2DM in patients with social isolation or loneliness. We performed statistical analysis on RevMan 5.4 using the random effect model.</div></div><div><h3>Results</h3><div>Loneliness was associated with a significantly increased incidence of T2DM (OR: 1.44; 95 % CI: 1.19–1.73; P:0.0001), with high heterogeneity (I² = 95 %). Sensitivity analysis indicated potential variability due to differences in loneliness measurements. Social isolation also showed a significant association with T2DM (OR: 1.88; 95 % CI: 1.38–2.58; P:<0.0001) with high heterogeneity (I² = 98 %).</div></div><div><h3>Conclusion</h3><div>In conclusion, we found social isolation and loneliness are independently associated with a higher incidence of T2DM. These findings underscore the need to address psychosocial elements like social isolation and loneliness in the management of T2DM. However, further studies with larger sample sizes, longer follow-up durations, and uniform criteria is warranted to better understand the association between social isolation, loneliness and T2DM.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 221-228"},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jesús Iturralde-Iriso , Aitana Lertxundi-Manterola , Iosu Delgado-Naranjo , Alfonso Barquilla-García , Rafael Manuel Micó-Pérez , José Polo-García , Sonsoles M. Velilla-Zancada , Naiara Cubelos-Fernández , Antonio Segura-Fragoso , Leovigildo Ginel-Mendoza , Vicente Pallares-Carratala , Miguel A. Prieto-Díaz , Sergio Cinza-Sanjurjo , Vicente Martín-Sanchez
{"title":"Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study","authors":"Jesús Iturralde-Iriso , Aitana Lertxundi-Manterola , Iosu Delgado-Naranjo , Alfonso Barquilla-García , Rafael Manuel Micó-Pérez , José Polo-García , Sonsoles M. Velilla-Zancada , Naiara Cubelos-Fernández , Antonio Segura-Fragoso , Leovigildo Ginel-Mendoza , Vicente Pallares-Carratala , Miguel A. Prieto-Díaz , Sergio Cinza-Sanjurjo , Vicente Martín-Sanchez","doi":"10.1016/j.pcd.2025.02.009","DOIUrl":"10.1016/j.pcd.2025.02.009","url":null,"abstract":"<div><div>The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.</div></div><div><h3>Material and methods</h3><div>Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.</div></div><div><h3>Results</h3><div>A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.</div></div><div><h3>Conclusions</h3><div>The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.</div></div>","PeriodicalId":48997,"journal":{"name":"Primary Care Diabetes","volume":"19 3","pages":"Pages 302-311"},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}