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- Akalin, S., et al.
(författare)
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Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control
- 2009
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Ingår i: International Journal of Clinical Practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 63:10, s. 1421-1425
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (< 6.0%) may, in fact, be dangerous in certain patient populations. Aim: To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes. Methods: A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions. Results: Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (< 6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes. Conclusions: Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels.
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- Iastremska, Olena M., et al.
(författare)
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Investment and innovative development of industrial enterprises as the basis for the technological singularity
- 2019
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Ingår i: Problems & Perspectives in Management. - : LLC CPC Business Perspectives. - 1727-7051 .- 1810-5467. ; 17:3, s. 477-491
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Tidskriftsartikel (refereegranskat)abstract
- Investment and innovative development of industrial enterprises is driven by the influence on the sensitive indicators of their activity, which characterize technological singularity. Therefore, it is expedient to define them using adequate economic and mathematical methods that will identify the development and growth points that are characterized by the accumulation of information and are a manifestation of singularity. The purpose of the article is to determine the main sensitive indicators of the investment and innovative development of industrial enterprises, which are the points of technological singularity. The article proposes conceptual provisions for evaluating the investment-innovation activity of enterprises as a basis for their development. These provisions consider the activity of economic entities according to three states (functioning, growth, and development); evaluation of investment and innovation activities, both individually and in conjunction with the official statistical reporting of enterprises using a well-founded minimum sufficient system of partial indicators defined through the multidimensional factor analysis and combined into integral and summarizing indicators; determination of technological singularity points as a result of prediction of partial and summarizing indicators' values via the neural networks method. A methodological approach is developed to substantiate the technological singularity points, the managerial influence on which is provided by the development of enterprises. The methodological approach is based on considering the investment-innovation activity nonlinearity, both explicit and latent tendencies of development, situationality and variability of its goals, strategic orientation and possible technological singularity of an enterprise. The proposals submitted were implemented based on statistical reports of the machine-building enterprises for 2014-2018.
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- Khunti, K, et al.
(författare)
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Metformin discontinuation in patients beginning second-line glucose-lowering therapy: results from the global observational DISCOVER study programme
- 2020
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 10:8, s. e034613-
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the extent to which patients with type 2 diabetes discontinue metformin therapy when initiating second-line treatment and factors associated with metformin discontinuation, using baseline data from the DISCOVER study programme.DesignDISCOVER is a 3-year, prospective, observational study programme including data from 38 countries across 6 continents from 2014 to 2019.SettingPrimary and secondary healthcare centres, hospitals and specialist diabetes centres in both urban and rural locations.ParticipantsA total of 15 992 patients with type 2 diabetes initiating second-line glucose-lowering therapy.Primary and secondary outcome measuresThe proportion of patients who discontinued metformin as a second-line therapy and the factors associated with this treatment change.ResultsOf the 14 668 patients (from 37 countries) with valid treatment data, 11 837 (80.7%) received metformin as first-line glucose-lowering therapy; 8488 (71.7%) received metformin monotherapy and 3349 (28.3%) received metformin as part of a combination therapy. Overall, treatment with metformin was discontinued in 15.1% (1782) of patients who received first-line metformin (14.1% (1194) and 17.6% (588) in those who received metformin as monotherapy and as part of a combination, respectively); this proportion varied across regions from 6.9% (54) in Africa to 20.6% (628) in South-East Asia. On metformin discontinuation, 73.6% (1311) of patients received a non-insulin monotherapy at second line. Factors associated with an increased odds of metformin discontinuation were older age (≥75 years) and having a history of chronic kidney disease. The probability of metformin monotherapy discontinuation was lower in patients from Africa than in those from Europe.ConclusionsA substantial number of patients discontinued taking metformin when beginning second-line therapy. Most of these patients subsequently received a non-insulin monotherapy at second line, in contradiction to international guidelines and potentially leaving them at an increased risk of hyperglycaemia and associated adverse outcomes.Trial registration numbersNCT02322762 and NCT02226822.
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