Do diabetologists choose a therapy rationally?
Basic results of the PROROK project (A prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy)
Authors:
Denisa Janíčková Žďárská 1; Pavlína Piťhová 1; Tomáš Pavlík 2; Milan Kvapil 1
Authors‘ workplace:
Interní klinika 2. LF UK a FN Motol Praha, přednosta prof. MUDr. Milan Kvapil, CSc., MBA
1; Institut biostatistiky a analýz LF MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D.
2
Published in:
Vnitř Lék 2015; 61(4): 295-300
Category:
Original Contributions
Overview
Introduction:
The PROROK project (A prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy) had a character of a non-interventional, prospective, multicentric observation project conducted for a period of 6 months, whose aim was to quantify the relevance of the difference between fasting and postprandial glycemia to the success of GLP1 receptor agonist treatment, or insulin therapy with basal or premixed insulin, or a combination of basal and bolus insulin. Physicians chose therapy for inadequately compensated patients at their own discretion, with 4 972 patients included.
Aim:
The study aimed at the assessment of the differences in basic anthropometric and biochemical parameters between the patient cohorts included in the PROROK project with regard to the therapy selected by the treating diabetologist.
Methodology and results:
The patients treated with GLP1 receptor agonists were quite young, they have suffered from diabetes for a shorter period of time and at the same time were more obese and had the highest concentration of triacylglycerols. The patients who underwent basal insulin therapy, had the highest fasting glycemia. The patients for whom premixed insulin therapy or basal/bolus insulin regimen were chosen, manifested the highest postprandial glycemia, those with basal/bolus insulin regimen had the highest initial glycated haemoglobin. The difference between fasting and postprandial glycemia was the smallest in the cohort for which basal insulin therapy was chosen and the greatest in the cohort chosen for the therapy with premixed insulin, or with the basal/bolus insulin combination. Average improvement in glycated haemoglobin values reached 1.6 % within the whole cohort, a median of the resulting glycated haemoglobin reached 5.9 % or 5.8 % (GLP1 receptor agonist treatment). All the differences amounted to p < 0.001.
Conclusion:
Bearing in mind that the differences established in the parameters describing the cohorts, although statistically relevant, are of smaller clinical relevance, we regard as an important finding that the choice of therapy is in accordance with the basic knowledge about the pathophysiology of type 2 diabetes and possibilities of an individually chosen targeted intervention with antidiabetic therapy. We may conclude that most of the physicians participating in the PROROK project choose their therapy in a rational manner.
Key words:
GLP1 receptor agonists – basal insulin – intensified insulin regimen – insulin – premixed insulin – type 2 diabetes mellitus therapy
Sources
1. DeFronzo RA. Lilly lecture 1987. The triumvirate: beta-cell, muscle, liver. A collusion responsible for NIDDM. Diabetes 1988; 37(6): 667–687.
2. Calanna S, Christensen M, Holst JJ et al. Secretion of glucagon-like peptide-1 in patients with type 2 diabetes mellitus: systematic review and meta-analyses of clinical studies. Diabetologia 2013; 56(5): 965–972.
3. Kvapil M, Perušičová J. Postprandiální glykémie. Triton: Praha 2006. ISBN 80–7254–785–2.
4. DeFronzo RA. Current issues in the treatment of type 2 diabetes. Overview of newer agents: where treatment is going. Am J Med 2010; 123(3 Suppl): S38-S48.
5. Niswender KD. Basal insulin: physiology, pharmacology, and clinical implications. Postgrad Med 2011; 123(4): 17–26.
6. Philis-Tsimikas A. Initiating basal insulin therapy in type 2 diabetes: practical steps to optimize glycemic control. Am J Med 2013; 126(9 Suppl 1): S21-S27.
7. Heine RJ, Van Gaal LF, Johns D et al. GWAA Study Group. Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. Ann Intern Med 2005; 143(8): 559–569.
8. Roubícek T, Mráz M, Bártlová M et al. The influence of 6-months treatment with exenatide on type 2 diabetes mellitus compensation, anthropometric and biochemical parameters. Vnitř Lék 2010; 56(1): 15–20.
9. Drucker DJ, Buse JB, Taylor K et al. DURATION-1 Study Group. Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study. Lancet 2008; 372(9645): 1240–1250.
10. Riddle MC, Aronson R, Home P et al. Adding once-daily lixisenatide for type 2 diabetes inadequately controlled by established basal insulin: a 24-week, randomized, placebo-controlled comparison (GetGoal-L). Diabetes Care 2013; 36(9): 2489–2496.
11. Degn KB, Juhl CB, Sturis J et al. One week’s treatment with the long-acting glucagon-like peptide 1 derivative liraglutide (NN2211) markedly improves 24-h glycaemia and alpha- and beta-cell function and reduces endogenous glucose release in patients with type 2 diabetes. Diabetes 2004; 53(5): 1187–1194.
12. Sun F, Chai S, Li L et al. Effects of Glucagon-Like Peptide-1 Receptor Agonists on Weight Loss in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis. J Diabetes Res 2015; 2015: 157201. Dostupné z WWW: <http://dx.doi.org/10.1155/2015/157201>.
13. Kvapil M. Premixované inzuliny v léčbě diabetu. Remedia 2013; 23(5): 2–8.
14. Moghissi E, King AB. Individualizing insulin therapy in the management of type 2 diabetes. Am J Med 2014; 127(10 Suppl): S3-S10.
15. Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38(1): 140–149.
16. Ferrannini E, Camastra S, Gastaldelli A et al. Beta-cell function in obesity: effects of weight loss. Diabetes 2004; 53(Suppl 3): S26-S33.
17. Kvapil M. Klinický význam postprandiální glykemie u diabetu 2. typu. Remedia 2011; 21(5): 14–18.
Labels
Anaesthesiology, Resuscitation and Inten Angiology Clinical biochemistry Paediatric gastroenterology Paediatric cardiology Paediatric nephrology Paediatric neurology Paediatric clinical oncology Paediatric pneumology Paediatric rheumatology Diabetology Endocrinology Pharmacy Clinical pharmacology Gastroenterology and hepatology Geriatrics Haematology Hygiene and epidemiology Medical virology Intensive Care Medicine Internal medicine Cardiology Nephrology Neurology Obesitology Clinical oncology Anatomical pathology Pneumology and ftiseology Medical assessment Occupational medicine General practitioner for children and adolescents General practitioner for adults Radiotherapy Rheumatology Nurse Sexuology Forensic medical examiner Toxicology Trauma surgery Home nurse Medical studentArticle was published in
Internal Medicine
2015 Issue 4
Most read in this issue
- Myokines – muscle tissue hormones
- The treatment of diabetes in patients with liver and renal impairment
- Treatment of GLP1 receptor agonists and body mass control
- Treatment of hypertension in diabetes mellitus