Quality measure and weight loss assessment in patients with type 2 diabetes mellitus treated with canagliflozin or dipeptidyl peptidase-4 inhibitors

Quality measure and weight loss assessment in patients with type 2 diabetes mellitus treated with canagliflozin or dipeptidyl peptidase-4 inhibitors

• Carol H. Wysham,
• Patrick Lefebvre,
• Dominic PilonEmail authorView ORCID ID profile,
• Mike Ingham,
• Marie-Hélène Lafeuille,
• Bruno Emond,
• Rhiannon Kamstra,
• Wing Chow,
• Michael Pfeifer and
• Mei Sheng Duh

BMC Endocrine DisordersBMC series – open, inclusive and trusted201717:32
DOI: 10.1186/s12902-017-0180-8
© The Author(s). 2017
Received: 12 December 2016
Accepted: 24 May 2017
Published: 8 June 2017
Open Peer Review reports

Abstract

Background

Achieving control of glycated hemoglobin (HbA1c), blood pressure (BP), and body weight (BW) remains a challenge for most patients with type 2 diabetes mellitus (T2DM). In clinical trials, canagliflozin (CANA), an inhibitor of sodium-glucose co-transporter 2, has shown significant improvement compared to some dipeptidyl peptidase-4 (DPP-4) inhibitors in the achievement of such quality measures. This study used recent electronic medical records (EMR) data to assess quality measure achievement of HbA1C, BP, and BW loss in patients treated with CANA versus DPP-4 inhibitors.

Methods

Adult patients with ≥1 T2DM diagnosis and ≥12 months of clinical activity (baseline) before first CANA or DPP-4 prescription (index) were identified in the QuintilesIMS Health Real-World Data EMRs–US database (03/29/2012–10/30/2015). Patients were observed from the index to last encounter. Inverse probability of treatment weighting (IPTW) was used to adjust for observed baseline confounders between groups. Kaplan-Meier (KM) rates and Cox proportional hazard models were used to compare achievement of HbA1c < 7% (among patients <65 years old), HbA1c < 8%, systolic BP < 140 mmHg, diastolic BP < 90 mmHg, and BW loss ≥ 5% among patients not meeting these respective targets at baseline.

Results

A total of 10,702 CANA and 17,679 DPP-4 patients were selected. IPTW resulted in balanced baseline demographic, comorbidity, and disease characteristics (CANA: N = 13,793, mean age: 59.0 years; DPP-4: N = 14,588, mean age: 58.9 years). Up until 24 months post-index, CANA patients were more likely to reach an HbA1c < 7% (hazard ratio [HR] = 1.10, P = 0.007, KM rates: 42.8% vs. 40.3%), an HbA1c < 8% (HR = 1.16, P < 0.001, KM rates: 63.7% vs. 60.0%), and a BW loss ≥ 5% (HR = 1.46, P < 0.001, KM rates: 55.2% vs. 46.2%), compared to DPP-4 patients. Up until 12 months post-index, CANA patients were more likely to reach a systolic BP < 140 mmHg (HR = 1.07, P = 0.04, KM rates: 87.8% vs. 83.9%). but not a diastolic BP < 90 mmHg (HR = 0.95, P = 0.361), compared to DPP-4 patients.

Conclusions

This retrospective study of EMR data covering up to 30 months after CANA approval (March 2013) suggests that patients initiated on CANA were more likely to reach HbA1c, systolic BP, and weight loss objectives specified by general diabetes care guidelines than patients initiated on DPP-4 inhibitors.

Read the entire study here.

Posted by Danielle Heiderich in science
Does consuming low-fat dairy increase the risk of Parkinson's disease?

Does consuming low-fat dairy increase the risk of Parkinson's disease?

Does consuming low-fat dairy increase the risk of Parkinson’s disease?
Consuming at least three servings of low-fat dairy a day is associated with a greater risk of developing Parkinson’s disease compared to consuming less than one serving a day, according to a large study.
Does consuming low-fat dairy increase the risk of Parkinson’s disease?
Source: Science Daily Mind & Brain

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Radiation therapy vital to treating brain tumors, but it exacts a toll

Radiation therapy vital to treating brain tumors, but it exacts a toll

Radiation therapy vital to treating brain tumors, but it exacts a toll
Radiation therapy (RT) using high-energy particles is a common and critical component in successfully treating patients with brain tumors but it is also associated with significant adverse effects. In a new study, researchers report that irradiation can cause broader adverse effects, altering the structural network properties in impacted brains and perhaps contributing to delayed cognitive impairments observed in many patients following brain RT.
Radiation therapy vital to treating brain tumors, but it exacts a toll
Source: Science Daily Mind & Brain

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Improving adolescents' social and emotional lives must go beyond teaching them skills

Improving adolescents' social and emotional lives must go beyond teaching them skills

Improving adolescents’ social and emotional lives must go beyond teaching them skills
School programs designed to educate children and adolescents on how to understand and manage emotions, relationships and academic goals must go beyond improving the skills of the individuals to create a respectful climate and allow adolescents more autonomy in decision making, according to psychology research.
Improving adolescents’ social and emotional lives must go beyond teaching them skills
Source: Science Daily Mind & Brain

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Complementary and conventional providers in cancer care: experience of communication with patients and steps to improve communication with other providers

Complementary and conventional providers in cancer care: experience of communication with patients and steps to improve communication with other providers

  • Trine Stub,
  • Sara A. Quandt,
  • Thomas A. Arcury,
  • Joanne C. Sandbergand
  • Agnete E. Kristoffersen

BMC Complementary and Alternative MedicineBMC series – open, inclusive and trusted201717:301

DOI: 10.1186/s12906-017-1814-0

©  The Author(s). 2017

Received: 21 February 2017

Accepted: 31 May 2017

Published: 8 June 2017

Abstract

Background

Effective interdisciplinary communication is important to achieve better quality in health care. The aims of this study were to compare conventional and complementary providers’ experience of communication about complementary therapies and conventional medicine with their cancer patients, and to investigate how they experience interdisciplinary communication and cooperation.

Method

This study analyzed data from a self-administrated questionnaire. A total of 606 different health care providers, from four counties in Norway, completed the questionnaire. The survey was developed to describe aspects of the communication pattern among oncology doctors, nurses, family physicians and complementary therapists (acupuncturists, massage therapists and reflexologists/zone-therapists). Between-group differences were analyzed using chi-square, ANOVA and Fisher’s exact tests. Significance level was defined as p < 0.05 without adjustment for multiple comparisons.

Result

Conventional providers and complementary therapists had different patterns of communication with their cancer patients regarding complementary therapies. While complementary therapists advised their patients to apply both complementary and conventional modalities, medical doctors were less supportive of their patients’ use of complementary therapies. Of conventional providers, nurses expressed more positive attitudes toward complementary therapies. Opportunities to improve communication between conventional and complementary providers were most strongly supported by complementary providers and nurses; medical doctors were less supportive of such attempts. A number of doctors showed lack of respect for complementary therapists, but asked for more research, guidelines for complementary modalities and training in conventional medicine for complementary therapists.

Conclusion

For better quality of care, greater communication about complementary therapy use is needed between cancer patients and their conventional and complementary providers. In addition, more communication between conventional and complementary providers is needed. Nurses may have a crucial role in facilitating communication, as they are positive toward complementary therapies and they have more direct communication with patients about their treatment preferences.

 

 

Read the entire article here.

Posted by Danielle Heiderich in science
Antimicrobial activity, toxicity and anti-inflammatory potential of methanolic extracts of four ethnomedicinal plant species from Punjab, Pakistan

Antimicrobial activity, toxicity and anti-inflammatory potential of methanolic extracts of four ethnomedicinal plant species from Punjab, Pakistan

  • Rabia Naz,
  • Hafsa Ayub,
  • Sajid Nawaz,
  • Zia Ul Islam,
  • Tayyaba Yasmin,
  • Asghari Bano,
  • Abdul Wakeel,
  • Saqib Ziaand
  • Thomas H. Roberts

BMC Complementary and Alternative MedicineBMC series – open, inclusive and trusted201717:302

DOI: 10.1186/s12906-017-1815-z

©  The Author(s). 2017

Received: 8 November 2016

Accepted: 31 May 2017

Published: 8 June 2017

Abstract

Background

The plant species Aristolochia indica (AI), Melilotus indicus (MI), Tribulus terrestris (TT) and Cuscuta pedicellata (CP) are widely used in folk medicine in the villages around Chowk Azam, South Punjab, Pakistan. The aim of this study was to evaluate the antioxidant activity, phytochemical composition, and the antibacterial, antifungal, cytotoxic and anti-inflammatory potential of the four medicinal plants listed above.

For CP stem, this study represents (to the best of our knowledge) the first time phytochemicals have been identified and the antioxidant and anti-inflammatory potential determined.

Methods

Phytochemicals were analyzed through chemical tests, thin layer chromatography (TLC) and spectrophotometric methods. Antioxidant activities (DPPH and H2O2) were also determined through spectrophotometric methods. Extracts were evaluated for antibacterial potential via the agar well diffusion method against Staphylococcus aureus, Pseudomonas aeruginosaKlebsiella pneumonia and Acinetobacter baumannii. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined by the microdilution method. Antifungal activities were tested using the agar tube dilution method against three species: Aspergillus fumigatus, Aspergillus flavus and Rhizopus oryzae. The cytotoxic potential of the plant extracts was checked using the brine shrimp assay. In vitro anti-inflammatory activity of the selected plant extracts was evaluated using albumin denaturation, membrane stabilization and proteinase inhibitory assays.

Results

Of all the methanolic extracts tested, those from CP (stem) and TTF (T. terrestris fruit) had the highest phenolic, flavonoid and flavonol contents (497±4 mg GAE/g, 385±8 mg QE/g and 139±4 mg QE/g; 426±5 mg GAE/g, 371±8 mg QE/g and 138±6 mg QE/g, respectively) and also exhibited strong antioxidant potential in scavenging DPPH and hydrogen peroxide (IC50 values; 20±1 and 18±0.7 μg/mL; 92±2 and 26±2 μg/mL, respectively). CP, TTF and TTL (T. terrestris leaf) extracts substantially inhibited the growth of the bacteria A. baumannii, S. aureus, and K. pneumonia and also exhibited the highest antifungal potential. The ranking of the plant extracts for cytotoxicity was TTF > TTL > AI > CP > MI, while the ranking for in vitro anti-inflammatory potential at a concentration of 200 μg/mL of the selected plant extracts was CP > TTL, TTF > AI > MI. The lowest IC50 (28 μg/mL) observed in the albumin denaturation assay was for CP. Positive correlations were observed between total phenolics, antioxidants, antibacterial, antifungal and anti-inflammatory potential of the selected plant extracts, indicating a significant contribution of phenolic compounds in the plant extracts to these activities.

Conclusions

This study revealed the strong antimicrobial, antioxidant, cytotoxic and anti-inflammatory potential of the plant species CP and TT used in folk medicine.

 

Read the entire study here.

 

Posted by Danielle Heiderich in Latest News
Take a coffee or tea break to protect your liver

Take a coffee or tea break to protect your liver

Take a coffee or tea break to protect your liver
Researchers found that drinking coffee and herbal tea may protect against liver fibrosis, estimated as the degree of liver stiffness, which is high in extensive scarring of the liver. Because these beverages are popular, widely available, and inexpensive, they could have the potential to become important in the prevention of advanced liver disease.
Take a coffee or tea break to protect your liver
Source: Science Daily Alternative Medicine

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Waist-to-height ratio more accurate than BMI in identifying obesity, new study shows

Waist-to-height ratio more accurate than BMI in identifying obesity, new study shows

Waist-to-height ratio more accurate than BMI in identifying obesity, new study shows
Calculating a person’s waist-to-height ratio is the most accurate and efficient way of identifying whether or not they are at risk of obesity in clinical practice, a new study shows.
Waist-to-height ratio more accurate than BMI in identifying obesity, new study shows
Source: Science Daily Fitness

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