Insulin degludec/liraglutide (IDegLira) was effective across a range of dysglycaemia and body mass index categories in the DUAL V randomized trial

This study assessed the efficacy of insulin degludec/liraglutide (IDegLira) vs insulin glargine U100 (IGlar) across categories of baseline glycated haemoglobin (HbA1c; ≤7.5%, >7.5% to ≤8.5% and >8.5%), body mass index (BMI; <30, ≥30 to <35 and ≥35 kg/m²) and fasting plasma glucose (FPG; <7.2 and ≥7.2 mmol/L) in patients with type 2 diabetes (T2D) uncontrolled on basal insulin, using post hoc analyses of the DUAL V 26‐week trial. With IDegLira, mean HbA1c was reduced across all baseline HbA1c (1.0%‐2.5%), FPG (1.5%‐1.9%) and BMI categories (1.8%‐1.9%), with significantly greater reductions compared with IGlar U100. For all HbA1c, FPG and BMI categories, IDegLira resulted in weight loss and IGlar U100 in weight gain; hypoglycaemia rates were lower for IDegLira vs IGlar U100. More patients achieved HbA1c <7% with IDegLira than IGlar U100 across all HbA1c (59%‐87% vs 31%‐66%), FPG (71%‐74% vs 40%‐51%) and BMI categories (71%‐73% vs 40%‐54%). IDegLira improved glycaemic control and induced weight loss in patients with T2D previously uncontrolled on basal insulin, across the categories of baseline HbA1c, FPG or BMI that were tested.     

Inappropriate utilization of SPECT myocardial perfusion imaging on the USA-Mexico border

Background

The American College of Cardiology/American Society of Nuclear Cardiology published revised appropriate use criteria (AUC) for SPECT MPI in 2009. We assessed adherence to these guidelines and factors associated with inappropriate utilization at the University Medical Center.

Methods

The AUC was applied retrospectively to 420 SPECT MPI studies. Two-sample t test, Fisher’s exact test, and multivariable logistic regression models were used for analysis.

Results

There were 322 appropriate (86%) and 54 (14%) inappropriate studies. The odds of having an inappropriate test increased with younger age (P < .001) and female gender (P < .001). Subjects with diabetes (P = .007) and chest pain (P < .001) were less likely to have an inappropriate test. Academic outpatients were three times more likely to have an inappropriate study (P = .123), while community PCPs were 5.6 times (P = .011) and community cardiologists eight times more likely to order inappropriate tests (P = .031).

Conclusions

Inappropriate SPECT MPI in low risk younger women is an important issue on the USA-Mexico border. Initiatives to reduce inappropriate SPECT MPI should focus on a few indications and evaluation of cardiovascular symptoms in younger age women in outpatient/community practices.     

Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation

OBJECTIVES: To evaluate the prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation. DESIGN: Prospective cohort study. SETTING: The National Population Health Survey of Canada, with frailty estimated at baseline (1994/95) and mortality follow‐up to 2004/05. PARTICIPANTS: Community‐dwelling older adults (N=2,740, 60.8% women) aged 65 to 102 from 10 Canadian provinces. During the 10‐year follow‐up, 1,208 died. MEASUREMENTS: Self‐reported health information was used to construct a frailty index (Frailty Index) as a proportion of deficits accumulated in individuals. The main outcome measure was mortality. RESULTS: The prevalence of frailty increased with age in men and women (correlation coefficient=0.955–0.994, P<.001). The Frailty Index estimated that 622 (22.7%, 95% confidence interval (CI)=21.0–24.4%) of the sample was frail. Frailty was more common in women (25.3%, 95% CI=23.2–27.5%) than in men (18.6%, 95% CI=15.9–21.3%). For those aged 85 and older, the Frailty Index identified 39.1% (95% CI=31.3–46.9%) of men as frail, compared with 45.1% (95% CI=39.7–50.5%) of women. Frailty significantly increased the risk of death, with an age‐ and sex‐adjusted hazard ratio for the Frailty Index of 1.57 (95% CI=1.41–1.74). CONCLUSION: The prevalence of frailty increases with age and at any age lessens survival. The Frailty Index approach readily identifies frail people at risk of death, presumably because of its use of multiple health deficits in multidimensional domains.