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  • 1
    Online Resource
    Online Resource
    1104-P: Many Benefits of Empagliflozin Persist in Those with Reduced Renal Function: Updated Data from the Association of British Clinical Diabetologists (ABCD) Audit Programme
    American Diabetes Association ; 2020
    In:  Diabetes Vol. 69, No. Supplement_1 ( 2020-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 69, No. Supplement_1 ( 2020-06-01)
    Abstract: Background: Sodium-glucose linked transporter 2 inhibitors (SGLT2s) are currently favoured for their tolerability, cardiovascular benefit and renal protective effects. However, due to their mechanism of action, they are only licensed for use in those with preserved renal function at baseline. Previous analyses with other drugs in the class showed potential benefits even when used in those with estimated glomerular filtration rate (eGFR) below licensed level. Methods: Data was extracted from the ABCD nationwide empagliflozin audit and then stratified into groups, as follows, based on baseline eGFR (mL/min/1.73m2): CKD1 (n=2900, eGFR≥90), CKD2 (n=2753, eGFR & lt;90, eGFR≥60), CKD3a (n=210, eGFR & lt;60, eGFR≥45) and CKD3b+ (n=17, eGFR & lt;45). Data was analysed using paired t-tests and ANOVA in Stata 16. Results: 5880 datasets were included with mean (±SD) age 59.5yrs (±10.4), 61.1% male, 86% Caucasian (where known), BMI 33.1kg/m2 (±6.6), HbA1c 9.17% (±1.61) and median duration diabetes 7.3 years (2.2-12.1 IQR) and were broadly similar across groups apart from age: those with more impaired renal function being generally older (CKD1 55.4yrs±9.5 v CKD3b+ 69.6yrs±8.5) with a longer duration diabetes with median (IQR) in CKD1 6.6yrs (1.8-10.9) v CKD3b+ 14.5yrs (8.9-17.3). Reductions in HbA1c, weight and BMI occurred in all groups (P & lt;0.005); reductions in HbA1c were of a smaller magnitude as eGFR declined (ANOVA P & lt;0.01). Changes in systolic (SBP) and diastolic blood pressure (DBP) were significant in those in CKD1- CKD3a but not in CKD3b+ (SBP +2.6mmHg, 95% CI +14.9, -9.6). eGFR was observed to decrease in CKD1 and CKD2 (CKD1 eGFR -2.1mL/min/1.73m2, CI 95% -1.8, -2.3). Conclusion: The use of empagliflozin at eGFR & lt;45mL/min/1.73m2 may still confer HbA1c improvement (although perhaps of lower magnitude) and weight loss, though SBP and DBP reduction may be limited. More evidence is needed regarding its use at lower levels of eGFR. Disclosure T.S.J. Crabtree: None. K. Adamson: None. A. Bickerton: None. S.M. Phillips: None. A. Evans: Other Relationship; Self; AstraZeneca. A.M. Robinson: None. M. Atkin: Speaker’s Bureau; Self; AstraZeneca, Napp Pharmaceuticals. D.S. Morris: None. D.M. Williams: None. J.W. Stephens: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Napp Pharmaceuticals, Novo Nordisk A/S. D.K. Sennik: Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. A. Rohilla: None. M.L. Cull: None. R.P. Raghavan: Research Support; Self; Allergan plc. Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Napp Pharmaceuticals, Takeda UK. Other Relationship; Self; Napp Pharmaceuticals. M. Yadagiri: None. I.W. Gallen: None. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db20-1104-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
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  • 2
    Online Resource
    Online Resource
    2224-PUB: The Effect of Diabetes Duration on Response to Empagliflozin: Data from the Association of British Clinical Diabetologists (ABCD) Audit Programme
    American Diabetes Association ; 2020
    In:  Diabetes Vol. 69, No. Supplement_1 ( 2020-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 69, No. Supplement_1 ( 2020-06-01)
    Abstract: Background: Data previously presented from our audit programme showed that sodium-glucose co-transporter 2 inhibitors (SGLT2s) remain equally effective at reducing HbA1c irrespective of duration of diabetes. This analysis was performed to establish if the same held true for empagliflozin. Methods: Data extracted from the ABCD nationwide empagliflozin audit was stratified into groups based on duration of diabetes: group 1 ( & lt;5yrs; n=2320), group 2 (≥5yrs, & lt;10yrs; n=1516), group 3 (≥10yrs; n=2224). Data was analysed using paired t-tests and ANOVA in Stata 16. Results: 6060 datasets were included with mean (±SD) age 59.5yrs (±10.4), 61.1% male, 86% Caucasian (where known), BMI 33.2kg/m2 (±7.2), baseline HbA1c 9.2% (±1.6%) and weight 98.1kg (±21.0). These were broadly similar across all 3 sub-groups apart from age, which understandably increased with duration of diabetes (group 1 57.7yrs±10.8 v group 3 62.0yrs±9.7). Decreases in HbA1c (%) from baseline were observed in all groups, greatest in group 1 (-1.27%; 95% CI -1.19%, -1.35%) and least pronounced in group 3 (-0.9%; 95% CI -0.83%, -0.97%). ANOVA showed significant differences amongst the groups for HbA1c change (P & lt;0.001) but not for weight, BMI or blood pressure. Further analysis has demonstrated no significant difference between HbA1c reductions in group 1 and 2 (P=0.79) but very significant differences (P & lt;0.001) between both groups 1 and 2 and group 3, suggesting the change in response occurs at around the 10 year mark. Conclusions: This analysis demonstrates statistically significant differences in the magnitude of HbA1c change (due to empagliflozin use) in those with shorter v longer durations of diabetes, appearing to occur after 10 years. Although the pattern is generally comparable to other SGLT2s the statistical significance is likely to have been increased from previous data due to a larger sample. The clinical significance of such minor differences in effect is not clear. Disclosure T.S.J. Crabtree: None. K. Adamson: None. A. Bickerton: None. S.M. Phillips: None. A. Evans: Other Relationship; Self; AstraZeneca. A.M. Robinson: None. M. Atkin: Speaker’s Bureau; Self; AstraZeneca, Napp Pharmaceuticals. D.S. Morris: None. D.M. Williams: None. J.W. Stephens: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Napp Pharmaceuticals, Novo Nordisk A/S. D.K. Sennik: Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. A. Rohilla: None. M.L. Cull: None. R.P. Raghavan: Research Support; Self; Allergan plc. Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Napp Pharmaceuticals, Takeda UK. Other Relationship; Self; Napp Pharmaceuticals. M. Yadagiri: None. I.W. Gallen: None. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db20-2224-PUB
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
    detail.hit.zdb_id: 1501252-9
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  • 3
    Online Resource
    Online Resource
    1200-P: Predictors of Glycaemic and Weight Response to Empagliflozin Treatment: The ABCD Nationwide Empagliflozin Audit
    American Diabetes Association ; 2019
    In:  Diabetes Vol. 68, No. Supplement_1 ( 2019-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 68, No. Supplement_1 ( 2019-06-01)
    Abstract: Introduction: We investigated clinical parameters that are potentially associated with improved empagliflozin treatment response. Methods: We obtained data from a large-scale audit of empagliflozin use in the UK. We analyzed the association between patients’ baseline age, HbA1c, weight, diabetes duration, alanine aminotransferase (ALT), sex, chronic kidney disease (CKD) stage, empagliflozin dose (25 vs. 10mg), use of GLP-1RAs and use of insulin with HbA1c and weight changes at 26 weeks of treatment. Results: Among 1436 patients, HbA1c reduced by, mean[95% CI], 1.35%[1.27,1.42] (p & lt;0.0001) from a baseline of, mean±SD, 9.41±1.41%. Among 1381 patients, weight reduced by 3.6 kg[3.3,3.9] (p & lt;0.0001) from a baseline of 100.2±20.7 kg. Results of univariate analyses are shown in Table 1. In multivariate analysis, higher baseline HbA1c (p & lt;0.0001), lower CKD stage (p=0.002) and higher ALT (log transformed)(p=0.02) were associated with greater HbA1c reduction. Higher baseline weight (p & lt;0.001) and non-insulin use (p & lt;0.0001) were associated with greater weight reduction. Conclusion: As expected, HbA1c reduction was associated with baseline HbA1c and background renal function, while weight reduction was associated with baseline weight. The interactions between HbA1c reduction and ALT levels, and weight reduction with insulin treatment status warrant further investigations. Disclosure K. Thong: None. J. Chung-Wah-Cheong: None. M. Yadagiri: None. M.L. Cull: None. A. Bickerton: Employee; Self; MyWay Digital Health. S.M. Phillips: None. A. Evans: None. D.K. Sennik: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. A. Rohilla: None. H. Reid: None. D.S. Morris: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., NAPP Pharmaceuticals Limited, Novo Nordisk A/S, Sanofi-Aventis. M. Atkin: Advisory Panel; Self; NAPP Pharmaceuticals Limited. Consultant; Self; My mHealth. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk Inc. A.M. Robinson: Advisory Panel; Self; Takeda UK. D.M. Williams: None. J.W. Stephens: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, NAPP Pharmaceuticals Limited. I.W. Gallen: None. K. Adamson: None. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest. Funding Association of British Clinical Diabetologists
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db19-1200-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
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  • 4
    Online Resource
    Online Resource
    1201-P: Characteristics and Treatment Outcomes of Patients Treated with Empagliflozin in the ABCD Nationwide Empagliflozin Audit
    American Diabetes Association ; 2019
    In:  Diabetes Vol. 68, No. Supplement_1 ( 2019-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 68, No. Supplement_1 ( 2019-06-01)
    Abstract: Introduction: We investigated characteristics and treatment outcomes of patients treated with empagliflozin in a large-scale audit of routine clinical practice in the UK. Methods: Data was obtained from the Association of British Clinical Diabetologists Nationwide Empagliflozin Audit. Between December 2014 to September 2018, multiple sites submitted data through 10 major centers on 1947 patients with at least one follow-up visit after empagliflozin initiation. Results: Baseline characteristics of patients were, mean±SD, age 59.9±9.9 years, diabetes duration 6.4±5.4 years, HbA1c 9.41±1.43%, weight 99.6±20.8 years, BMI 33.6±9.1 kg/m2and 62.1% were male. Proportion of use of empagliflozin 25mg (vs. 10mg), GLP-1 receptor agonist, and insulin were 63.7%, 13.7% and 20.1%, respectively. There were 44.9%, 49.9%, 5.1% and 0.1% of patients with eGFR & gt;90, 60-89, 45-59 and & lt;45 ml/min/1.73m2, respectively. By 26 weeks, treatment with empagliflozin was associated with, mean±SD, HbA1c reduction of 1.35±1.49% (p & lt;0.0001), weight reduction of 3.6±5.1 kg (p & lt;0.0001) and systolic blood pressure reduction of 5±14 mmHg (p & lt;0.0001). Conclusions: An audit of empagliflozin use in the UK revealed poorly controlled diabetes being frequently encountered in practice in contrast to randomized clinical trials. There was a preponderance of empagliflozin 25mg dose use, disproportionate prescribing to men rather than women, and frequent co-prescription with GLP-1 receptor agonists and insulin. The audit showed excellent adherence to prescribing guidelines in relation to avoiding empagliflozin use in patients with eGFR & lt;45 ml/min/1.73m2. There was similar treatment efficacy with empaglilfozin as was seen in clinical trials. Disclosure K. Thong: None. J. Chung-Wah-Cheong: None. M. Yadagiri: None. M.L. Cull: None. A. Bickerton: Employee; Self; MyWay Digital Health. S.M. Phillips: None. A. Evans: None. D.K. Sennik: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. A. Rohilla: None. H. Reid: None. D.S. Morris: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., NAPP Pharmaceuticals Limited, Novo Nordisk A/S, Sanofi-Aventis. M. Atkin: Advisory Panel; Self; NAPP Pharmaceuticals Limited. Consultant; Self; My mHealth. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk Inc. A.M. Robinson: Advisory Panel; Self; Takeda UK. D.M. Williams: None. J.W. Stephens: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, NAPP Pharmaceuticals Limited. K. Adamson: None. I.W. Gallen: None. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest. Funding Association of British Clinical Diabetologists
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db19-1201-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
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  • 5
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    Online Resource
    Objectively Measured Physical Activity and Sedentary Time Are Associated With Cardiometabolic Risk Factors in Adults With Prediabetes: The PREVIEW Study
    American Diabetes Association ; 2018
    In:  Diabetes Care Vol. 41, No. 3 ( 2018-03-01), p. 562-569
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 41, No. 3 ( 2018-03-01), p. 562-569
    Abstract: The aim of the present cross-sectional study was to examine the association among physical activity (PA), sedentary time (ST), and cardiometabolic risk in adults with prediabetes. RESEARCH DESIGN AND METHODS Participants (n = 2,326; 25–70 years old, 67% female) from eight countries, with a BMI & gt;25 kg ⋅ m−2 and impaired fasting glucose (5.6–6.9 mmol ⋅ L−1) or impaired glucose tolerance (7.8–11.0 mmol ⋅ L−1 at 2 h), participated. Seven-day accelerometry objectively assessed PA levels and ST. RESULTS Multiple linear regression revealed that moderate-to-vigorous PA (MVPA) was negatively associated with HOMA of insulin resistance (HOMA-IR) (standardized β = −0.078 [95% CI −0.128, −0.027]), waist circumference (WC) (β = −0.177 [−0.122, −0.134] ), fasting insulin (β = −0.115 [−0.158, −0.072]), 2-h glucose (β = −0.069 [−0.112, −0.025] ), triglycerides (β = −0.091 [−0.138, −0.044]), and CRP (β = −0.086 [−0.127, −0.045] ). ST was positively associated with HOMA-IR (β = 0.175 [0.114, 0.236]), WC (β = 0.215 [0.026, 0.131] ), fasting insulin (β = 0.155 [0.092, 0.219]), triglycerides (β = 0.106 [0.052, 0.16] ), CRP (β = 0.106 [0.39, 0.172]), systolic blood pressure (BP) (β = 0.078 [0.026, 0.131] ), and diastolic BP (β = 0.106 [0.39, −0.172]). Associations reported between total PA (counts ⋅ min−1), and all risk factors were comparable or stronger than for MVPA: HOMA-IR (β = −0.151 [−0.194, −0.107] ), WC (β = −0.179 [−0.224, −0.134]), fasting insulin (β = −0.139 [−0.183, −0.096] ), 2-h glucose (β = −0.088 [−0.131, −0.045]), triglycerides (β = −0.117 [−0.162, −0.071] ), and CRP (β = −0.104 [−0.146, −0.062]). CONCLUSIONS In adults with prediabetes, objectively measured PA and ST were associated with cardiometabolic risk markers. Total PA was at least as strongly associated with cardiometabolic risk markers as MVPA, which may imply that the accumulation of total PA over the day is as important as achieving the intensity of MVPA.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc17-1057
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2018
    detail.hit.zdb_id: 1490520-6
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