Diabetes

From Memora Health (Dr. Flyckt and Dr. Colbert), San Francisco, CA; and Harvard Medical School (Dr. Colbert), Boston, MA.

A close relative was recently diagnosed with follicular lymphoma. He was cared for at a high-ranked cancer center by physicians with demonstrated expertise, and even had the support of a care navigator. Still, he was often left feeling overwhelmed and confused, holding an inch-thick stack of papers, instructions, and pamphlets. As he left his treatment planning visit, reeling from the emotional burden of his diagnosis and all the unfamiliar terminology, he didn’t know what to do or what to expect. Later, when he experienced early signs of tumor lysis syndrome, he struggled to reach his care team for triage and guidance. When he went to the emergency room, his oncologist was never informed.

This scenario is unfortunately common, and versions of this scenario play out thousands of times each day across the US health system. Within the clinic and hospital setting, patients receive excellent care from their providers, but a disconnect emerges once the patient leaves these medical settings: patients at home struggle to find guidance and support, while care teams lack the tools to engage patients between visits or monitor their health across care settings, providers, or episodes of care.

Leveraging Technology to Move From Episodes of Care to Complex Care Journeys

The use of automated messaging, artificial intelligence and natural language processing–driven chat experiences, and text-based support is becoming more common. However, health care lags behind other industries in the adoption of these technologies.^1,2 The slow pace can be warranted, given that health care is more complicated and higher risk than inquiring about a lost package, ordering groceries, or applying for a mortgage. At the same time, many of the consumer engagement tools used to guide an applicant through the multiple steps and complexities of their home loan process or to prompt viewers to select new shows to binge have applications in health care.

Over the past few years, technologies have emerged that guide patients through complex care journeys and allow care teams to monitor and engage patients between visits. These solutions come in different formats, but generally patients can receive messages on their phones that contain disease-specific educational content, prompts to fill prescriptions and take medications, and reminders and guidance on how to prepare for appointments and procedures. These programs also collect relevant data from patients through survey and electronic patient-reported outcomes instruments, as well as connected patient monitoring devices, that help track patient progress and identify issues as they arise. Many programs also incorporate symptom triage pathways and use natural language processing to respond automatically to patient questions and concerns.^3,4

These technology solutions can automate many tasks that in the past required a care team member to spend hours on the phone. Newly freed from such repetitive tasks, care teams can now focus on more in-depth interactions with those patients who are most in need—the types of interactions that are more satisfying and rewarding. Such assistance is particularly needed today with the staffing shortages faced by most health systems.⁵

In addition, technology allows teams to see the panel of patients they are caring for and to quickly identify and take action on any specific needs or issues. Care teams can focus on any patient and see where they are in their journey. When appropriate, some solutions also allow care teams to engage directly with patients through text-messaging, creating a seamless experience and unified communication channel. Ideally, these solutions should be linked or embedded within the electronic health record or other primary system of record, so that teams can easily access these tools through their existing workflows and avoid creating yet another interface to navigate.

The Impact of Low-Tech Solutions to Deliver High-Touch Support

There is evidence showing that digital patient navigation tools impact patient care. In the oncology setting, patients with a digital navigator have achieved over 95% adherence rates with complex oral chemotherapy regimens (Memora Health Unpublished Data. 2022.). In the postpartum setting, a text message–based program improved screening rates for postpartum depression and did so with very high patient satisfaction ratings.⁶ Particularly notable is the fact that this depression screening program achieved these results in a population that was predominantly low income, with more than half belonging to underrepresented minority populations.⁶

We believe these digital patient navigation technologies, specifically low-tech solutions that don’t require app downloads, portal log-ins, or high-speed internet, will transform care delivery over the next 5 to 10 years. Successful management of complex conditions like diabetes or cancer requires more than 3 hours of care each day,⁷ yet most patients spend only 1 or 2 hours per month directly interacting with their health care providers. However, most patients carry their phones with them at all times, and artificial intelligence–enabled text support is “always on” to provide support, monitoring, and guidance, wherever a patient happens to be when assistance is needed.

Shifting the Model to Support a Lifetime of Care

While still in the early stages of development, these tools have the potential to radically alter the practice of medicine, shifting the focus from episodic interactions to continuous journey-based care delivery. Outside of an acute event bringing a patient into the clinic or emergency room, many patients go a year or more without seeing their primary care providers.⁸ During that time, an immense amount of information is underreported or completely lost. Capturing this information in real-time and more holistically over a person’s lifetime of care could provide physicians better insight to both better manage and more fully evaluate the success of treatment plans by tracking patient symptoms, pain, and functional status over time. With this more longitudinal view of the patient, we see a pathway towards achieving the Quadruple Aim: patients who are more supported will achieve better outcomes at lower cost, they will have a better experience, and care teams will be empowered to focus their time on more satisfying activities rather than repetitive administrative tasks.

Corresponding author: James A. Colbert, MD, MBA; [email protected]

Disclosures: Dr. Flyckt and Dr. Colbert are employed by Memora Health, an organization that helps health care systems digitize and automate care journeys.

From Memora Health (Dr. Flyckt and Dr. Colbert), San Francisco, CA; and Harvard Medical School (Dr. Colbert), Boston, MA.

A close relative was recently diagnosed with follicular lymphoma. He was cared for at a high-ranked cancer center by physicians with demonstrated expertise, and even had the support of a care navigator. Still, he was often left feeling overwhelmed and confused, holding an inch-thick stack of papers, instructions, and pamphlets. As he left his treatment planning visit, reeling from the emotional burden of his diagnosis and all the unfamiliar terminology, he didn’t know what to do or what to expect. Later, when he experienced early signs of tumor lysis syndrome, he struggled to reach his care team for triage and guidance. When he went to the emergency room, his oncologist was never informed.

This scenario is unfortunately common, and versions of this scenario play out thousands of times each day across the US health system. Within the clinic and hospital setting, patients receive excellent care from their providers, but a disconnect emerges once the patient leaves these medical settings: patients at home struggle to find guidance and support, while care teams lack the tools to engage patients between visits or monitor their health across care settings, providers, or episodes of care.

Leveraging Technology to Move From Episodes of Care to Complex Care Journeys

The use of automated messaging, artificial intelligence and natural language processing–driven chat experiences, and text-based support is becoming more common. However, health care lags behind other industries in the adoption of these technologies.^1,2 The slow pace can be warranted, given that health care is more complicated and higher risk than inquiring about a lost package, ordering groceries, or applying for a mortgage. At the same time, many of the consumer engagement tools used to guide an applicant through the multiple steps and complexities of their home loan process or to prompt viewers to select new shows to binge have applications in health care.

Over the past few years, technologies have emerged that guide patients through complex care journeys and allow care teams to monitor and engage patients between visits. These solutions come in different formats, but generally patients can receive messages on their phones that contain disease-specific educational content, prompts to fill prescriptions and take medications, and reminders and guidance on how to prepare for appointments and procedures. These programs also collect relevant data from patients through survey and electronic patient-reported outcomes instruments, as well as connected patient monitoring devices, that help track patient progress and identify issues as they arise. Many programs also incorporate symptom triage pathways and use natural language processing to respond automatically to patient questions and concerns.^3,4

These technology solutions can automate many tasks that in the past required a care team member to spend hours on the phone. Newly freed from such repetitive tasks, care teams can now focus on more in-depth interactions with those patients who are most in need—the types of interactions that are more satisfying and rewarding. Such assistance is particularly needed today with the staffing shortages faced by most health systems.⁵

In addition, technology allows teams to see the panel of patients they are caring for and to quickly identify and take action on any specific needs or issues. Care teams can focus on any patient and see where they are in their journey. When appropriate, some solutions also allow care teams to engage directly with patients through text-messaging, creating a seamless experience and unified communication channel. Ideally, these solutions should be linked or embedded within the electronic health record or other primary system of record, so that teams can easily access these tools through their existing workflows and avoid creating yet another interface to navigate.

The Impact of Low-Tech Solutions to Deliver High-Touch Support

There is evidence showing that digital patient navigation tools impact patient care. In the oncology setting, patients with a digital navigator have achieved over 95% adherence rates with complex oral chemotherapy regimens (Memora Health Unpublished Data. 2022.). In the postpartum setting, a text message–based program improved screening rates for postpartum depression and did so with very high patient satisfaction ratings.⁶ Particularly notable is the fact that this depression screening program achieved these results in a population that was predominantly low income, with more than half belonging to underrepresented minority populations.⁶

We believe these digital patient navigation technologies, specifically low-tech solutions that don’t require app downloads, portal log-ins, or high-speed internet, will transform care delivery over the next 5 to 10 years. Successful management of complex conditions like diabetes or cancer requires more than 3 hours of care each day,⁷ yet most patients spend only 1 or 2 hours per month directly interacting with their health care providers. However, most patients carry their phones with them at all times, and artificial intelligence–enabled text support is “always on” to provide support, monitoring, and guidance, wherever a patient happens to be when assistance is needed.

Shifting the Model to Support a Lifetime of Care

While still in the early stages of development, these tools have the potential to radically alter the practice of medicine, shifting the focus from episodic interactions to continuous journey-based care delivery. Outside of an acute event bringing a patient into the clinic or emergency room, many patients go a year or more without seeing their primary care providers.⁸ During that time, an immense amount of information is underreported or completely lost. Capturing this information in real-time and more holistically over a person’s lifetime of care could provide physicians better insight to both better manage and more fully evaluate the success of treatment plans by tracking patient symptoms, pain, and functional status over time. With this more longitudinal view of the patient, we see a pathway towards achieving the Quadruple Aim: patients who are more supported will achieve better outcomes at lower cost, they will have a better experience, and care teams will be empowered to focus their time on more satisfying activities rather than repetitive administrative tasks.

Corresponding author: James A. Colbert, MD, MBA; [email protected]

Disclosures: Dr. Flyckt and Dr. Colbert are employed by Memora Health, an organization that helps health care systems digitize and automate care journeys.

From Memora Health (Dr. Flyckt and Dr. Colbert), San Francisco, CA; and Harvard Medical School (Dr. Colbert), Boston, MA.

A close relative was recently diagnosed with follicular lymphoma. He was cared for at a high-ranked cancer center by physicians with demonstrated expertise, and even had the support of a care navigator. Still, he was often left feeling overwhelmed and confused, holding an inch-thick stack of papers, instructions, and pamphlets. As he left his treatment planning visit, reeling from the emotional burden of his diagnosis and all the unfamiliar terminology, he didn’t know what to do or what to expect. Later, when he experienced early signs of tumor lysis syndrome, he struggled to reach his care team for triage and guidance. When he went to the emergency room, his oncologist was never informed.

This scenario is unfortunately common, and versions of this scenario play out thousands of times each day across the US health system. Within the clinic and hospital setting, patients receive excellent care from their providers, but a disconnect emerges once the patient leaves these medical settings: patients at home struggle to find guidance and support, while care teams lack the tools to engage patients between visits or monitor their health across care settings, providers, or episodes of care.

Leveraging Technology to Move From Episodes of Care to Complex Care Journeys

The use of automated messaging, artificial intelligence and natural language processing–driven chat experiences, and text-based support is becoming more common. However, health care lags behind other industries in the adoption of these technologies.^1,2 The slow pace can be warranted, given that health care is more complicated and higher risk than inquiring about a lost package, ordering groceries, or applying for a mortgage. At the same time, many of the consumer engagement tools used to guide an applicant through the multiple steps and complexities of their home loan process or to prompt viewers to select new shows to binge have applications in health care.

Over the past few years, technologies have emerged that guide patients through complex care journeys and allow care teams to monitor and engage patients between visits. These solutions come in different formats, but generally patients can receive messages on their phones that contain disease-specific educational content, prompts to fill prescriptions and take medications, and reminders and guidance on how to prepare for appointments and procedures. These programs also collect relevant data from patients through survey and electronic patient-reported outcomes instruments, as well as connected patient monitoring devices, that help track patient progress and identify issues as they arise. Many programs also incorporate symptom triage pathways and use natural language processing to respond automatically to patient questions and concerns.^3,4

These technology solutions can automate many tasks that in the past required a care team member to spend hours on the phone. Newly freed from such repetitive tasks, care teams can now focus on more in-depth interactions with those patients who are most in need—the types of interactions that are more satisfying and rewarding. Such assistance is particularly needed today with the staffing shortages faced by most health systems.⁵

In addition, technology allows teams to see the panel of patients they are caring for and to quickly identify and take action on any specific needs or issues. Care teams can focus on any patient and see where they are in their journey. When appropriate, some solutions also allow care teams to engage directly with patients through text-messaging, creating a seamless experience and unified communication channel. Ideally, these solutions should be linked or embedded within the electronic health record or other primary system of record, so that teams can easily access these tools through their existing workflows and avoid creating yet another interface to navigate.

The Impact of Low-Tech Solutions to Deliver High-Touch Support

There is evidence showing that digital patient navigation tools impact patient care. In the oncology setting, patients with a digital navigator have achieved over 95% adherence rates with complex oral chemotherapy regimens (Memora Health Unpublished Data. 2022.). In the postpartum setting, a text message–based program improved screening rates for postpartum depression and did so with very high patient satisfaction ratings.⁶ Particularly notable is the fact that this depression screening program achieved these results in a population that was predominantly low income, with more than half belonging to underrepresented minority populations.⁶

We believe these digital patient navigation technologies, specifically low-tech solutions that don’t require app downloads, portal log-ins, or high-speed internet, will transform care delivery over the next 5 to 10 years. Successful management of complex conditions like diabetes or cancer requires more than 3 hours of care each day,⁷ yet most patients spend only 1 or 2 hours per month directly interacting with their health care providers. However, most patients carry their phones with them at all times, and artificial intelligence–enabled text support is “always on” to provide support, monitoring, and guidance, wherever a patient happens to be when assistance is needed.

Shifting the Model to Support a Lifetime of Care

While still in the early stages of development, these tools have the potential to radically alter the practice of medicine, shifting the focus from episodic interactions to continuous journey-based care delivery. Outside of an acute event bringing a patient into the clinic or emergency room, many patients go a year or more without seeing their primary care providers.⁸ During that time, an immense amount of information is underreported or completely lost. Capturing this information in real-time and more holistically over a person’s lifetime of care could provide physicians better insight to both better manage and more fully evaluate the success of treatment plans by tracking patient symptoms, pain, and functional status over time. With this more longitudinal view of the patient, we see a pathway towards achieving the Quadruple Aim: patients who are more supported will achieve better outcomes at lower cost, they will have a better experience, and care teams will be empowered to focus their time on more satisfying activities rather than repetitive administrative tasks.

Corresponding author: James A. Colbert, MD, MBA; [email protected]

Disclosures: Dr. Flyckt and Dr. Colbert are employed by Memora Health, an organization that helps health care systems digitize and automate care journeys.

Key clinical point: Serum level of 25-hydroxyvitamin D (25[OH]D) was inversely associated with albuminuria as an indicator of diabetic nephropathy in patients with type 2 diabetes mellitus (T2D), with the prevalence of macroalbuminuria increasing when the serum 25(OH)D level was <20 ng/mL.

Major finding: A strong negative association was observed between the serum 25(OH)D level and severity of albuminuria (r, −0.257; P < .001), with the prevalence of vitamin D deficiency being 61.8%, 33.3%, and 24.0% in patients with macroalbuminuria, microalbuminuria, and normoalbuminuria, respectively.

Study details: This was a cross-sectional study including 200 patients with T2D, of which 100, 66, and 34 had normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively.

Disclosures: This study was supported by Shiraz University of Medical Sciences, Iran. The authors declared no competing interests.

Source: Zomorodian SA et al. Assessment of the relationship between 25-hydroxyvitamin D and albuminuria in type 2 diabetes mellitus. BMC Endocr Disord. 2022;22:171 (Jul 4). Doi: 10.1186/s12902-022-01088-2

Key clinical point: Serum level of 25-hydroxyvitamin D (25[OH]D) was inversely associated with albuminuria as an indicator of diabetic nephropathy in patients with type 2 diabetes mellitus (T2D), with the prevalence of macroalbuminuria increasing when the serum 25(OH)D level was <20 ng/mL.

Major finding: A strong negative association was observed between the serum 25(OH)D level and severity of albuminuria (r, −0.257; P < .001), with the prevalence of vitamin D deficiency being 61.8%, 33.3%, and 24.0% in patients with macroalbuminuria, microalbuminuria, and normoalbuminuria, respectively.

Study details: This was a cross-sectional study including 200 patients with T2D, of which 100, 66, and 34 had normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively.

Disclosures: This study was supported by Shiraz University of Medical Sciences, Iran. The authors declared no competing interests.

Source: Zomorodian SA et al. Assessment of the relationship between 25-hydroxyvitamin D and albuminuria in type 2 diabetes mellitus. BMC Endocr Disord. 2022;22:171 (Jul 4). Doi: 10.1186/s12902-022-01088-2

Key clinical point: Serum level of 25-hydroxyvitamin D (25[OH]D) was inversely associated with albuminuria as an indicator of diabetic nephropathy in patients with type 2 diabetes mellitus (T2D), with the prevalence of macroalbuminuria increasing when the serum 25(OH)D level was <20 ng/mL.

Major finding: A strong negative association was observed between the serum 25(OH)D level and severity of albuminuria (r, −0.257; P < .001), with the prevalence of vitamin D deficiency being 61.8%, 33.3%, and 24.0% in patients with macroalbuminuria, microalbuminuria, and normoalbuminuria, respectively.

Study details: This was a cross-sectional study including 200 patients with T2D, of which 100, 66, and 34 had normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively.

Disclosures: This study was supported by Shiraz University of Medical Sciences, Iran. The authors declared no competing interests.

Source: Zomorodian SA et al. Assessment of the relationship between 25-hydroxyvitamin D and albuminuria in type 2 diabetes mellitus. BMC Endocr Disord. 2022;22:171 (Jul 4). Doi: 10.1186/s12902-022-01088-2

Key clinical point: The sarcopenia index (SI; serum creatinine/serum cystatin C ratio) is significantly associated with the prevalence of subclinical atherosclerosis in patients with type 2 diabetes mellitus (T2D).

Major finding: After adjusting for all confounders, SI was significantly associated with the prevalence of subclinical atherosclerosis (adjusted odds ratio 0.95; P  =  .015).

Study details: The data come from a cross-sectional study of 174 patients with T2D, of which 43.7% were diagnosed with subclinical atherosclerosis.

Disclosures: The study received no specific funding. Some authors declared receiving honoraria, personal fees, r research grants from various sources.

Source: Hashimoto Y et al. Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2022;10:e002910 (Jun 23). Doi: 10.1136/bmjdrc-2022-002910

Key clinical point: The sarcopenia index (SI; serum creatinine/serum cystatin C ratio) is significantly associated with the prevalence of subclinical atherosclerosis in patients with type 2 diabetes mellitus (T2D).

Major finding: After adjusting for all confounders, SI was significantly associated with the prevalence of subclinical atherosclerosis (adjusted odds ratio 0.95; P  =  .015).

Study details: The data come from a cross-sectional study of 174 patients with T2D, of which 43.7% were diagnosed with subclinical atherosclerosis.

Disclosures: The study received no specific funding. Some authors declared receiving honoraria, personal fees, r research grants from various sources.

Source: Hashimoto Y et al. Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2022;10:e002910 (Jun 23). Doi: 10.1136/bmjdrc-2022-002910

Key clinical point: The sarcopenia index (SI; serum creatinine/serum cystatin C ratio) is significantly associated with the prevalence of subclinical atherosclerosis in patients with type 2 diabetes mellitus (T2D).

Major finding: After adjusting for all confounders, SI was significantly associated with the prevalence of subclinical atherosclerosis (adjusted odds ratio 0.95; P  =  .015).

Study details: The data come from a cross-sectional study of 174 patients with T2D, of which 43.7% were diagnosed with subclinical atherosclerosis.

Disclosures: The study received no specific funding. Some authors declared receiving honoraria, personal fees, r research grants from various sources.

Source: Hashimoto Y et al. Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2022;10:e002910 (Jun 23). Doi: 10.1136/bmjdrc-2022-002910

Key clinical point: In patients with type 2 diabetes (T2D), initiating or switching to insulin degludec/ aspart (IDegAsp) from other antidiabetic treatments was associated with improved glycemic control, lower basal insulin dose requirement in insulin-experienced patients, and lower rates of hypoglycemia.

Major finding: Patients with T2D initiating or switching to IDegAsp had a significant reduction in glycated hemoglobin (estimated difference [Δ] −1.4%; P < .0001), basal insulin dose requirements in insulin-experienced participants (Δ −2.3 units; P  =  .0004), and rates of hypoglycemia (P < .001).

Study details: Findings are from a real-world, prospective study including 1102 patients with T2D who initiated or switched to IDegAsp from other antidiabetic treatments.

Disclosures: This study was funded by Novo Nordisk. Some authors declared being employees and shareholders of Novo Nordisk. Some authors declared receiving speaker or consulting honoraria, research contracts, and teaching or research sponsorships; being consultants; or serving as advisory board or speaker panel members for various sources, including Novo Nordisk.

Source: Fulcher GR et al. Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes: A real-world, prospective, non-interventional study across six countries. Adv Ther. 2022 (Jun 25). Doi: 10.1007/s12325-022-02212-3

Key clinical point: In patients with type 2 diabetes (T2D), initiating or switching to insulin degludec/ aspart (IDegAsp) from other antidiabetic treatments was associated with improved glycemic control, lower basal insulin dose requirement in insulin-experienced patients, and lower rates of hypoglycemia.

Major finding: Patients with T2D initiating or switching to IDegAsp had a significant reduction in glycated hemoglobin (estimated difference [Δ] −1.4%; P < .0001), basal insulin dose requirements in insulin-experienced participants (Δ −2.3 units; P  =  .0004), and rates of hypoglycemia (P < .001).

Study details: Findings are from a real-world, prospective study including 1102 patients with T2D who initiated or switched to IDegAsp from other antidiabetic treatments.

Disclosures: This study was funded by Novo Nordisk. Some authors declared being employees and shareholders of Novo Nordisk. Some authors declared receiving speaker or consulting honoraria, research contracts, and teaching or research sponsorships; being consultants; or serving as advisory board or speaker panel members for various sources, including Novo Nordisk.

Source: Fulcher GR et al. Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes: A real-world, prospective, non-interventional study across six countries. Adv Ther. 2022 (Jun 25). Doi: 10.1007/s12325-022-02212-3

Key clinical point: In patients with type 2 diabetes (T2D), initiating or switching to insulin degludec/ aspart (IDegAsp) from other antidiabetic treatments was associated with improved glycemic control, lower basal insulin dose requirement in insulin-experienced patients, and lower rates of hypoglycemia.

Major finding: Patients with T2D initiating or switching to IDegAsp had a significant reduction in glycated hemoglobin (estimated difference [Δ] −1.4%; P < .0001), basal insulin dose requirements in insulin-experienced participants (Δ −2.3 units; P  =  .0004), and rates of hypoglycemia (P < .001).

Study details: Findings are from a real-world, prospective study including 1102 patients with T2D who initiated or switched to IDegAsp from other antidiabetic treatments.

Disclosures: This study was funded by Novo Nordisk. Some authors declared being employees and shareholders of Novo Nordisk. Some authors declared receiving speaker or consulting honoraria, research contracts, and teaching or research sponsorships; being consultants; or serving as advisory board or speaker panel members for various sources, including Novo Nordisk.

Source: Fulcher GR et al. Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes: A real-world, prospective, non-interventional study across six countries. Adv Ther. 2022 (Jun 25). Doi: 10.1007/s12325-022-02212-3

Key clinical point: Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use in patients with type 2 diabetes mellitus (T2D) is associated with a significantly lower risk for all-cause and cause-specific death compared with dipeptidyl peptidase 4 inhibitor (DPP4i) use.

Major finding: Patients receiving SGLT2i vs DPP4i had a lower risk for all-cause death (adjusted hazard ratio [aHR] 0.66; P < .001), cardiovascular death (aHR 0.68; P < .001), cancer death (aHR 0.73; P  =  .003), and noncancer and nonvascular death (aHR 0.62; P < .001).

Study details: This nationwide retrospective cohort study matched patients with T2D who initiated SGLT2i (n = 53,264) with those who initiated DPP4i (n = 53,264) using propensity score matching.

Disclosures: This study was partly supported by grants from China Medical University Hospital, Ditmanson Medical Foundation Chiayi Christian Hospital, and the Ministry of Science and Technology of Taiwan. No competing interests were declared.

Source: Chung M-C et al. Efficacy and safety of DBPR108 (prusogliptin) as an add-on to metformin therapy in patients with type 2 diabetes mellitus: A 24-week, multi-center, randomized, double-blind, placebo-controlled, superiority, phase III clinical trial. Sci Rep. 2022;12:10147 (Jun 16). Doi: 10.1038/s41598-022-13760-7

Key clinical point: Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use in patients with type 2 diabetes mellitus (T2D) is associated with a significantly lower risk for all-cause and cause-specific death compared with dipeptidyl peptidase 4 inhibitor (DPP4i) use.

Major finding: Patients receiving SGLT2i vs DPP4i had a lower risk for all-cause death (adjusted hazard ratio [aHR] 0.66; P < .001), cardiovascular death (aHR 0.68; P < .001), cancer death (aHR 0.73; P  =  .003), and noncancer and nonvascular death (aHR 0.62; P < .001).

Study details: This nationwide retrospective cohort study matched patients with T2D who initiated SGLT2i (n = 53,264) with those who initiated DPP4i (n = 53,264) using propensity score matching.

Disclosures: This study was partly supported by grants from China Medical University Hospital, Ditmanson Medical Foundation Chiayi Christian Hospital, and the Ministry of Science and Technology of Taiwan. No competing interests were declared.

Source: Chung M-C et al. Efficacy and safety of DBPR108 (prusogliptin) as an add-on to metformin therapy in patients with type 2 diabetes mellitus: A 24-week, multi-center, randomized, double-blind, placebo-controlled, superiority, phase III clinical trial. Sci Rep. 2022;12:10147 (Jun 16). Doi: 10.1038/s41598-022-13760-7

Key clinical point: Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use in patients with type 2 diabetes mellitus (T2D) is associated with a significantly lower risk for all-cause and cause-specific death compared with dipeptidyl peptidase 4 inhibitor (DPP4i) use.

Major finding: Patients receiving SGLT2i vs DPP4i had a lower risk for all-cause death (adjusted hazard ratio [aHR] 0.66; P < .001), cardiovascular death (aHR 0.68; P < .001), cancer death (aHR 0.73; P  =  .003), and noncancer and nonvascular death (aHR 0.62; P < .001).

Study details: This nationwide retrospective cohort study matched patients with T2D who initiated SGLT2i (n = 53,264) with those who initiated DPP4i (n = 53,264) using propensity score matching.

Disclosures: This study was partly supported by grants from China Medical University Hospital, Ditmanson Medical Foundation Chiayi Christian Hospital, and the Ministry of Science and Technology of Taiwan. No competing interests were declared.

Source: Chung M-C et al. Efficacy and safety of DBPR108 (prusogliptin) as an add-on to metformin therapy in patients with type 2 diabetes mellitus: A 24-week, multi-center, randomized, double-blind, placebo-controlled, superiority, phase III clinical trial. Sci Rep. 2022;12:10147 (Jun 16). Doi: 10.1038/s41598-022-13760-7

Key clinical point: Prusogliptin as an add-on therapy to metformin was superior to metformin monotherapy in improving glycemic control and was safe and well tolerated in patients with type 2 diabetes mellitus (T2D) inadequately controlled with metformin.

Major finding: At week 24, prusogliptin + metformin vs metformin + placebo led to significantly higher reductions in glycated hemoglobin (least squares mean change [LSM] −0.70% vs −0.07%; P < .001), fasting plasma glucose (LSM −0.63 vs 0.07 mmol/L; P  =  .025), and 2-hour postprandial plasma glucose (LSM −2.43 vs −0.70 mmol/L; P < .001) levels, with the incidence of adverse events being similar between the treatment groups.

Study details: Findings are from a 24-week, superiority, phase 3 trial including 206 patients with T2D with blood glucose levels inadequately controlled on metformin who were randomly assigned to receive prusogliptin + metformin (n = 138) or placebo + metformin (n = 68).

Disclosures: This study was funded by the CSPC Zhongqi Pharmaceutical Technology Co., Ltd. Some authors are employees of CSPC Zhongqi Pharmaceutical Technology.

Source: Xu J et al. Efficacy and safety of DBPR108 (prusogliptin) as an add-on to metformin therapy in patients with type 2 diabetes mellitus: A 24-week, multi-center, randomized, double-blind, placebo-controlled, superiority, phase III clinical trial. Diabetes Obes Metab. 2022 (Jul 6). Doi: 10.1111/dom.14810

Key clinical point: Prusogliptin as an add-on therapy to metformin was superior to metformin monotherapy in improving glycemic control and was safe and well tolerated in patients with type 2 diabetes mellitus (T2D) inadequately controlled with metformin.

Major finding: At week 24, prusogliptin + metformin vs metformin + placebo led to significantly higher reductions in glycated hemoglobin (least squares mean change [LSM] −0.70% vs −0.07%; P < .001), fasting plasma glucose (LSM −0.63 vs 0.07 mmol/L; P  =  .025), and 2-hour postprandial plasma glucose (LSM −2.43 vs −0.70 mmol/L; P < .001) levels, with the incidence of adverse events being similar between the treatment groups.

Study details: Findings are from a 24-week, superiority, phase 3 trial including 206 patients with T2D with blood glucose levels inadequately controlled on metformin who were randomly assigned to receive prusogliptin + metformin (n = 138) or placebo + metformin (n = 68).

Disclosures: This study was funded by the CSPC Zhongqi Pharmaceutical Technology Co., Ltd. Some authors are employees of CSPC Zhongqi Pharmaceutical Technology.

Source: Xu J et al. Efficacy and safety of DBPR108 (prusogliptin) as an add-on to metformin therapy in patients with type 2 diabetes mellitus: A 24-week, multi-center, randomized, double-blind, placebo-controlled, superiority, phase III clinical trial. Diabetes Obes Metab. 2022 (Jul 6). Doi: 10.1111/dom.14810

Key clinical point: Prusogliptin as an add-on therapy to metformin was superior to metformin monotherapy in improving glycemic control and was safe and well tolerated in patients with type 2 diabetes mellitus (T2D) inadequately controlled with metformin.

Major finding: At week 24, prusogliptin + metformin vs metformin + placebo led to significantly higher reductions in glycated hemoglobin (least squares mean change [LSM] −0.70% vs −0.07%; P < .001), fasting plasma glucose (LSM −0.63 vs 0.07 mmol/L; P  =  .025), and 2-hour postprandial plasma glucose (LSM −2.43 vs −0.70 mmol/L; P < .001) levels, with the incidence of adverse events being similar between the treatment groups.

Study details: Findings are from a 24-week, superiority, phase 3 trial including 206 patients with T2D with blood glucose levels inadequately controlled on metformin who were randomly assigned to receive prusogliptin + metformin (n = 138) or placebo + metformin (n = 68).

Disclosures: This study was funded by the CSPC Zhongqi Pharmaceutical Technology Co., Ltd. Some authors are employees of CSPC Zhongqi Pharmaceutical Technology.

Source: Xu J et al. Efficacy and safety of DBPR108 (prusogliptin) as an add-on to metformin therapy in patients with type 2 diabetes mellitus: A 24-week, multi-center, randomized, double-blind, placebo-controlled, superiority, phase III clinical trial. Diabetes Obes Metab. 2022 (Jul 6). Doi: 10.1111/dom.14810

Key clinical point: Initiation of semaglutide in patients with type 2 diabetes mellitus (T2D) on high daily doses of insulin at baseline led to a significant improvement in glycemic control, body weight, and reduction in total daily dose (TDD) of insulin.

Major finding: From baseline to 6 months, the TDD of insulin (183 ± 98 to 143 ± 99 units, respectively), glycated hemoglobin level (8.9% ± 1.3% to 7.6% ± 1.5%, respectively), and body weight (123.9 ± 23.5 to 118.9 ± 22.9 kg, respectively; all P < .001) reduced significantly in patients on high daily doses of insulin who received semaglutide.

Study details: Findings are from a retrospective analysis including 72 patients with T2D on high TDD of insulin (≥100 units) who were prescribed semaglutide.

Disclosures: This study received no specific funding. The authors declared no conflicts of interest.

Source: Meyer J et al. The effects of adding semaglutide to high daily dose insulin regimens in patients with type 2 diabetes. Ann Pharmacother. 2022 (Jul 1). Doi: 10.1177/10600280221107381

Key clinical point: Initiation of semaglutide in patients with type 2 diabetes mellitus (T2D) on high daily doses of insulin at baseline led to a significant improvement in glycemic control, body weight, and reduction in total daily dose (TDD) of insulin.

Major finding: From baseline to 6 months, the TDD of insulin (183 ± 98 to 143 ± 99 units, respectively), glycated hemoglobin level (8.9% ± 1.3% to 7.6% ± 1.5%, respectively), and body weight (123.9 ± 23.5 to 118.9 ± 22.9 kg, respectively; all P < .001) reduced significantly in patients on high daily doses of insulin who received semaglutide.

Study details: Findings are from a retrospective analysis including 72 patients with T2D on high TDD of insulin (≥100 units) who were prescribed semaglutide.

Disclosures: This study received no specific funding. The authors declared no conflicts of interest.

Source: Meyer J et al. The effects of adding semaglutide to high daily dose insulin regimens in patients with type 2 diabetes. Ann Pharmacother. 2022 (Jul 1). Doi: 10.1177/10600280221107381

Key clinical point: Initiation of semaglutide in patients with type 2 diabetes mellitus (T2D) on high daily doses of insulin at baseline led to a significant improvement in glycemic control, body weight, and reduction in total daily dose (TDD) of insulin.

Major finding: From baseline to 6 months, the TDD of insulin (183 ± 98 to 143 ± 99 units, respectively), glycated hemoglobin level (8.9% ± 1.3% to 7.6% ± 1.5%, respectively), and body weight (123.9 ± 23.5 to 118.9 ± 22.9 kg, respectively; all P < .001) reduced significantly in patients on high daily doses of insulin who received semaglutide.

Study details: Findings are from a retrospective analysis including 72 patients with T2D on high TDD of insulin (≥100 units) who were prescribed semaglutide.

Disclosures: This study received no specific funding. The authors declared no conflicts of interest.

Source: Meyer J et al. The effects of adding semaglutide to high daily dose insulin regimens in patients with type 2 diabetes. Ann Pharmacother. 2022 (Jul 1). Doi: 10.1177/10600280221107381

Key clinical point: Dipeptidyl peptidase-4 (DPP4) inhibitors significantly increased the risk for the composite of gallbladder or biliary diseases and cholecystitis but not for cholelithiasis and biliary diseases in patients with type 2 diabetes (T2D), especially those with a longer treatment duration.

Major finding: Compared with placebo or non-incretin drugs, DPP4 inhibitors were associated with a significantly higher risk for composite of gallbladder or biliary diseases (odds ratio [OR] 1.22; 95% CI 1.04-1.43) and cholecystitis (OR 1.43; 95% CI 1.14-1.79), but not for cholelithiasis (OR 1.08; 95% CI 0.83-1.39) and biliary diseases (OR 1.00; 95% CI 0.68-1.47), and the association remained significant with the long-term (≥26 weeks) use of DPP4 inhibitors.

Study details: The data come from a systematic review and pairwise meta-analysis of 82 randomized trials including 104,833 patients with T2D.

Disclosures: This study was partially supported by Beijing Natural Science Foundation, National Natural Science Foundation of China, and others. The authors declared receiving support from the funding institutions.

Source: He L et al. Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials BMJ. 2022;377:e068882 (Jun 28). Doi: 10.1136/bmj-2021-068882

Key clinical point: Dipeptidyl peptidase-4 (DPP4) inhibitors significantly increased the risk for the composite of gallbladder or biliary diseases and cholecystitis but not for cholelithiasis and biliary diseases in patients with type 2 diabetes (T2D), especially those with a longer treatment duration.

Major finding: Compared with placebo or non-incretin drugs, DPP4 inhibitors were associated with a significantly higher risk for composite of gallbladder or biliary diseases (odds ratio [OR] 1.22; 95% CI 1.04-1.43) and cholecystitis (OR 1.43; 95% CI 1.14-1.79), but not for cholelithiasis (OR 1.08; 95% CI 0.83-1.39) and biliary diseases (OR 1.00; 95% CI 0.68-1.47), and the association remained significant with the long-term (≥26 weeks) use of DPP4 inhibitors.

Study details: The data come from a systematic review and pairwise meta-analysis of 82 randomized trials including 104,833 patients with T2D.

Disclosures: This study was partially supported by Beijing Natural Science Foundation, National Natural Science Foundation of China, and others. The authors declared receiving support from the funding institutions.

Source: He L et al. Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials BMJ. 2022;377:e068882 (Jun 28). Doi: 10.1136/bmj-2021-068882

Key clinical point: Dipeptidyl peptidase-4 (DPP4) inhibitors significantly increased the risk for the composite of gallbladder or biliary diseases and cholecystitis but not for cholelithiasis and biliary diseases in patients with type 2 diabetes (T2D), especially those with a longer treatment duration.

Major finding: Compared with placebo or non-incretin drugs, DPP4 inhibitors were associated with a significantly higher risk for composite of gallbladder or biliary diseases (odds ratio [OR] 1.22; 95% CI 1.04-1.43) and cholecystitis (OR 1.43; 95% CI 1.14-1.79), but not for cholelithiasis (OR 1.08; 95% CI 0.83-1.39) and biliary diseases (OR 1.00; 95% CI 0.68-1.47), and the association remained significant with the long-term (≥26 weeks) use of DPP4 inhibitors.

Study details: The data come from a systematic review and pairwise meta-analysis of 82 randomized trials including 104,833 patients with T2D.

Disclosures: This study was partially supported by Beijing Natural Science Foundation, National Natural Science Foundation of China, and others. The authors declared receiving support from the funding institutions.

Source: He L et al. Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials BMJ. 2022;377:e068882 (Jun 28). Doi: 10.1136/bmj-2021-068882

Key clinical point: Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use was associated with a lower risk for new-onset atrial fibrillation (AF) in patients with type 2 diabetes (T2D) compared with the use of either glucagon-like peptide-1 receptor agonists (GLP-1RA) or dipeptidyl peptidase-4 inhibitors (DPP4i).

Major finding: Use of SGLT2i was associated with a lower risk for new-onset AF compared with the use of DPP4i (hazard ratio [HR] 0.90; P  =  .0028) or GLP-1RA (HR 0.74; P  =  .0007), with no significant difference being observed between the risk associated with GLP-1RA and DPP4i (HR 1.01; P  =  .8980).

Study details: This was a retrospective cohort study that included 344,893, 44,370, and 393,100 patients with T2D and without preexisting AF who were treated with SGLT2i, GLP-1RA, and DPP4i, respectively.

Disclosures: This study was supported by grants from the Ministry of Science and Technology and Chang Gung Memorial Hospital, Linkou, Taiwan. The authors declared no competing interests.

Source: Chan YH et al. The risk of incident atrial fibrillation in patients with type 2 diabetes treated with sodium glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors: A nationwide cohort study. Cardiovasc Diabetol. 2022;21:118 (Jun 28). Doi: 10.1186/s12933-022-01549-x

Key clinical point: Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use was associated with a lower risk for new-onset atrial fibrillation (AF) in patients with type 2 diabetes (T2D) compared with the use of either glucagon-like peptide-1 receptor agonists (GLP-1RA) or dipeptidyl peptidase-4 inhibitors (DPP4i).

Major finding: Use of SGLT2i was associated with a lower risk for new-onset AF compared with the use of DPP4i (hazard ratio [HR] 0.90; P  =  .0028) or GLP-1RA (HR 0.74; P  =  .0007), with no significant difference being observed between the risk associated with GLP-1RA and DPP4i (HR 1.01; P  =  .8980).

Study details: This was a retrospective cohort study that included 344,893, 44,370, and 393,100 patients with T2D and without preexisting AF who were treated with SGLT2i, GLP-1RA, and DPP4i, respectively.

Disclosures: This study was supported by grants from the Ministry of Science and Technology and Chang Gung Memorial Hospital, Linkou, Taiwan. The authors declared no competing interests.

Source: Chan YH et al. The risk of incident atrial fibrillation in patients with type 2 diabetes treated with sodium glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors: A nationwide cohort study. Cardiovasc Diabetol. 2022;21:118 (Jun 28). Doi: 10.1186/s12933-022-01549-x

Key clinical point: Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use was associated with a lower risk for new-onset atrial fibrillation (AF) in patients with type 2 diabetes (T2D) compared with the use of either glucagon-like peptide-1 receptor agonists (GLP-1RA) or dipeptidyl peptidase-4 inhibitors (DPP4i).

Major finding: Use of SGLT2i was associated with a lower risk for new-onset AF compared with the use of DPP4i (hazard ratio [HR] 0.90; P  =  .0028) or GLP-1RA (HR 0.74; P  =  .0007), with no significant difference being observed between the risk associated with GLP-1RA and DPP4i (HR 1.01; P  =  .8980).

Study details: This was a retrospective cohort study that included 344,893, 44,370, and 393,100 patients with T2D and without preexisting AF who were treated with SGLT2i, GLP-1RA, and DPP4i, respectively.

Disclosures: This study was supported by grants from the Ministry of Science and Technology and Chang Gung Memorial Hospital, Linkou, Taiwan. The authors declared no competing interests.

Source: Chan YH et al. The risk of incident atrial fibrillation in patients with type 2 diabetes treated with sodium glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors: A nationwide cohort study. Cardiovasc Diabetol. 2022;21:118 (Jun 28). Doi: 10.1186/s12933-022-01549-x

Key clinical point: Once-weekly semaglutide plus lifestyle intervention significantly improved glucose parameters with a greater likelihood of achieving normoglycemia compared with placebo in patients with baseline prediabetes.

Major finding: Semaglutide vs placebo led to a significant reduction in the glycated hemoglobin level, fasting plasma glucose level, and homeostasis model assessment of insulin resistance (all P < .01), in addition to a significant increase in the proportion of patients experiencing normoglycemia (STEP 1: 84.1% vs 47.8%; STEP 3: 89.5% vs 55.0%; STEP 4: 89.8% vs 70.4%; P < .0001).

Study details: This was a post hoc analysis data of the STEP 1, 3, and 4 trials including 1536 patients with prediabetes who were randomly assigned to received semaglutide or placebo.

Disclosures: The STEP trials were funded by Novo Nordisk. Some authors declared receiving personal fees, speaker fees, advisory or consulting fees, and research funding or other support from various organizations. Three authors are employees and shareholders of Novo Nordisk.

Source: Perreault L et al. Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the STEP program. Diabetes Care. 2022 (Jul 5). Doi: 10.2337/dc21-1785

Key clinical point: Once-weekly semaglutide plus lifestyle intervention significantly improved glucose parameters with a greater likelihood of achieving normoglycemia compared with placebo in patients with baseline prediabetes.

Major finding: Semaglutide vs placebo led to a significant reduction in the glycated hemoglobin level, fasting plasma glucose level, and homeostasis model assessment of insulin resistance (all P < .01), in addition to a significant increase in the proportion of patients experiencing normoglycemia (STEP 1: 84.1% vs 47.8%; STEP 3: 89.5% vs 55.0%; STEP 4: 89.8% vs 70.4%; P < .0001).

Study details: This was a post hoc analysis data of the STEP 1, 3, and 4 trials including 1536 patients with prediabetes who were randomly assigned to received semaglutide or placebo.

Disclosures: The STEP trials were funded by Novo Nordisk. Some authors declared receiving personal fees, speaker fees, advisory or consulting fees, and research funding or other support from various organizations. Three authors are employees and shareholders of Novo Nordisk.

Source: Perreault L et al. Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the STEP program. Diabetes Care. 2022 (Jul 5). Doi: 10.2337/dc21-1785

Key clinical point: Once-weekly semaglutide plus lifestyle intervention significantly improved glucose parameters with a greater likelihood of achieving normoglycemia compared with placebo in patients with baseline prediabetes.

Major finding: Semaglutide vs placebo led to a significant reduction in the glycated hemoglobin level, fasting plasma glucose level, and homeostasis model assessment of insulin resistance (all P < .01), in addition to a significant increase in the proportion of patients experiencing normoglycemia (STEP 1: 84.1% vs 47.8%; STEP 3: 89.5% vs 55.0%; STEP 4: 89.8% vs 70.4%; P < .0001).

Study details: This was a post hoc analysis data of the STEP 1, 3, and 4 trials including 1536 patients with prediabetes who were randomly assigned to received semaglutide or placebo.

Disclosures: The STEP trials were funded by Novo Nordisk. Some authors declared receiving personal fees, speaker fees, advisory or consulting fees, and research funding or other support from various organizations. Three authors are employees and shareholders of Novo Nordisk.

Source: Perreault L et al. Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the STEP program. Diabetes Care. 2022 (Jul 5). Doi: 10.2337/dc21-1785