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Help! I need to teach my course online and I’ve never done this before

By: Yvonne Lai, University of Nebraska-Lincoln Ray Levy, Mathematical Association of America This is cross-posted in MathValues and Abbe Herzig has written a companion post. Additional resources and future meetings are also available here: https://tinyurl.com/OnlineTalkshop. In times of crisis we … Continue reading




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Surprise! Transitioning to online teaching

 By Abbe Herzig, AMS Director of Education Many of us are experiencing stress as schools, colleges and universities move instruction out of the classroom. Fortunately, even if distance learning is new to you, it isn’t new, and there is a … Continue reading




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Online learning in the time of Coronavirus: Tips for students and the instructors who support them

Abbe Herzig, AMS Director of Education In the midst of the upheaval due to the Coronavirus, students and faculty are transitioning to new virtual classrooms. Many of us haven’t chosen to learn or teach, but here we are, making the … Continue reading




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Case Study: A 43-Year-Old Man With Perineal Pain and Swelling

David J. Meier
Oct 1, 2001; 19:
Case Studies




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Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

OBJECTIVE

Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises.

RESEARCH DESIGN AND METHODS

We analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality.

RESULTS

There were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P = 0.0019). In all groups, hypoglycemia (<40 mg/dL) during treatment was associated with a 4.8-fold increase in mortality (aOR 4.8; 95% CI 1.4, 16.8). Hypokalemia ≤3.5 mEq/L was frequent (55%). Severe hypokalemia (≤2.5 mEq/L) was associated with increased inpatient mortality (aOR 4.9; 95% CI 1.3, 18.8; P = 0.02).

CONCLUSIONS

Combined DKA-HHS is associated with higher mortality compared with isolated DKA or HHS. Severe hypokalemia and severe hypoglycemia are associated with higher hospital mortality in patients with hyperglycemic crises.




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Similar Breast Cancer Risk in Women Older Than 65 Years Initiating Glargine, Detemir, and NPH Insulins

OBJECTIVE

To assess whether initiation of insulin glargine (glargine), compared with initiation of NPH or insulin detemir (detemir), was associated with an increased risk of breast cancer in women with diabetes.

RESEARCH DESIGN AND METHODS

This was a retrospective new-user cohort study of female Medicare beneficiaries aged ≥65 years initiating glargine (203,159), detemir (67,012), or NPH (47,388) from September 2006 to September 2015, with follow-up through May 2017. Weighted Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for incidence of breast cancer according to ever use, cumulative duration of use, cumulative dose of insulin, length of follow-up time, and a combination of dose and length of follow-up time.

RESULTS

Ever use of glargine was not associated with an increased risk of breast cancer compared with NPH (HR 0.97; 95% CI 0.88–1.06) or detemir (HR 0.98; 95% CI 0.92–1.05). No increased risk was seen with glargine use compared with either NPH or detemir by duration of insulin use, length of follow-up, or cumulative dose of insulin. No increased risk of breast cancer was observed in medium- or high-dose glargine users compared with low-dose users.

CONCLUSIONS

Overall, glargine use was not associated with an increased risk of breast cancer compared with NPH or detemir in female Medicare beneficiaries.




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New Insulin Glargine 300 Units/mL Versus Glargine 100 Units/mL in People With Type 2 Diabetes Using Oral Agents and Basal Insulin: Glucose Control and Hypoglycemia in a 6-Month Randomized Controlled Trial (EDITION 2)

Hannele Yki-Järvinen
Dec 1, 2014; 37:3235-3243
Emerging Technologies and Therapeutics




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New Insulin Glargine 300 Units/mL Versus Glargine 100 Units/mL in People With Type 2 Diabetes Using Basal and Mealtime Insulin: Glucose Control and Hypoglycemia in a 6-Month Randomized Controlled Trial (EDITION 1)

Matthew C. Riddle
Oct 1, 2014; 37:2755-2762
Emerging Technologies and Therapeutics




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Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations: A Systematic Review and Meta-analysis

Alison J. Dunkley
Apr 1, 2014; 37:922-933
Current Concepts of Type 2 Diabetes Prevention




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Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association

Richard A. Insel
Oct 1, 2015; 38:1964-1974
Scientific Statement




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Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society

Elizabeth R. Seaquist
May 1, 2013; 36:1384-1395
Scientific Statement




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Latin American business leaders optimistic about region’s post-pandemic economy

Despite worrying economic projections, business leaders in Latin America remain optimistic about post-pandemic economy.




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Bank of England: British economy could decline 14 percent

A Bank of England report said Thursday the British economy could fall as much as 14 percent this year, which would be its worst showing in more than 300 years.




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Chinese exports up in April, Beijing’s data show

China's exports rebounded in April, growing 3.5 percent, according to the latest data from Beijing's General Administration of Customs on Thursday.




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Air Force, Marines train near China amid heightened tensions

The Air Force and Marines have both reported engaging in training maneuvers in the East and South China Sea in recent weeks amid escalating tensions in the region.




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Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association

Richard A. Insel
Oct 1, 2015; 38:1964-1974
Scientific Statement




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Guideline Approach to Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Itamar Raz
Aug 1, 2013; 36:S139-S144
Diabetes Pathophysiology




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Treatment of Type 2 Diabetes: From "Guidelines" to "Position Statements" and Back: Recommendations of the Israel National Diabetes Council

Ofri Mosenzon
Aug 1, 2016; 39:S146-S153
II. Diabetes Treatment Options




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Association of Urine Haptoglobin With Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Transethnic Collaborative Work

OBJECTIVE

Haptoglobin is an acute-phase reactant with pleiotropic functions. We aimed to study whether urine haptoglobin may predict risk of mortality in people with type 2 diabetes.

RESEARCH DESIGN AND METHODS

We employed a transethnic approach with a cohort of Asian origin (Singapore) (N = 2,061) and a cohort of European origin (France) (N = 1,438) included in the study. We used survival analyses to study the association of urine haptoglobin with risk of all-cause and cause-specific mortality.

RESULTS

A total of 365 and 525 deaths were registered in the Singapore cohort (median follow-up 7.5 years [interquartile range 3.5–12.8]) and French SURDIAGENE cohort (median follow-up 6.8 years [interquartile range 4.3–10.5], respectively. Singapore participants with urine haptoglobin in quartiles 2 to 4 had higher risk for all-cause mortality compared with quartile 1 (unadjusted hazard ratio [HR] 1.47 [95% CI 1.02–2.11], 2.28 [1.62–3.21], and 4.64 [3.39–6.35], respectively). The association remained significant in quartile 4 after multiple adjustments (1.68 [1.15–2.45]). Similarly, participants in the French cohort with haptoglobin in quartile 4 had significantly higher hazards for all-cause mortality compared with quartile 1 (unadjusted HR 2.67 [2.09–3.42] and adjusted HR 1.49 [1.14–1.96]). In both cohorts, participants in quartile 4 had a higher risk of mortality attributable to cardiovascular disease and infection but not malignant tumor.

CONCLUSIONS

Urine haptoglobin predicts risk of mortality independent of traditional risk factors, suggesting that it may potentially be a novel biomarker for risk of mortality in patients with type 2 diabetes.




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Explainer: Illegal Immigration in the United States

How has the size of the unauthorized population in the United States changed over time? How is illegal immigration changing, and where do unauthorized immigrants come from? This explainer answers basic questions about illegal immigration, the changing patterns from Mexico, and more.




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ADA standard on treating biofilm in waterlines available for comment

The American Dental Association Standards Committee on Dental Products has approved the document for circulation and comment.




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February JADA examines connection between healthy eating habits, untreated caries

Greater compliance with dietary guidelines may reduce the chance of untreated caries in adults, according to a study published in the February issue of The Journal of the American Dental Association.




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Abstract deadline for smokeless tobacco summit at end of February

The deadline for abstracts for the upcoming National Summit on Smokeless Tobacco Prevention is Feb. 29.




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ADA releases coronavirus handout for dentists based on CDC guidelines

The handout covers strategies for helping prevent the transmission of suspected respiratory disease in the dental health care setting and answers frequently asked questions related to the virus, based on guidelines from the Centers for Disease Control and Prevention.




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FDI World Dental Congress abstract deadline in late March

The deadline for submission of abstracts for the FDI World Dental Congress is March 25.




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Oral medicine recognized as a dental specialty

Oral medicine becomes the 11th dental specialty recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards. The recognition comes after the National Commission on March 2 adopted a resolution based on an application from the American Academy of Oral Medicine to recognized oral medicine as a dental specialty.




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Illinois orthodontist wins ADA Stanford Award for retainer research

An Illinois orthodontist won the American Dental Association's 2019 John W. Stanford New Investigator Award for her research paper evaluating the effects of eight cleaning methods on copolyester polymer, a material commonly used in clear thermoplastic retainers.




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ADA, other dental organizations ask Labor Department to help small businesses

The ADA, along with a large group of other dental organizations, told the U.S. Department of Labor that they are concerned about provisions in HR 6201, the Families First Coronavirus Response Act as related to family and medical leave and paid sick leave.




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ADA urges Congress to increase relief for small businesses, dentist owners

As Congress works on a third legislation package in response to the coronavirus pandemic, the ADA is asking lawmakers to include provisions on how to assist dental practices and other small businesses facing economic burdens.




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ADA, other organizations outline economic response needs to survive pandemic

The ADA and nearly 100 other organizations are asking Congress and the White House to help businesses survive the coronavirus crisis by reducing their costs and increasing their cash flow as much as possible in the coming weeks.




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HPI poll examines impact of COVID-19 on dental practices

The ADA Health Policy Institute launched an ongoing biweekly poll the week of March 23 that shows 76% of dentists surveyed had closed their offices to all but emergency patients during the COVID-19 pandemic. Another 19% indicated their offices are closed completely.




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JADA’s new CSA Corner highlights ACE Panel survey results on HPV vaccine

Dentists’ comfort levels and perceived roles in discussing and administering the human papillomavirus vaccine appear to vary, according to the results of an American Dental Association Clinical Evaluators Panel survey published in The Journal of the American Dental Association.




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ADA asks Treasury Department, Small Business Administration to clarify intent of interim rule

The Association continues to wait for clear guidance from the U.S. Department of Treasury and Small Business Administration on the best way to help dentists considering applying for Paycheck Protection Program 7(a) loans and Economic Injury Disaster Loans.




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Small Business Administration: Dentists can apply for both economic injury disaster and paycheck protection program loans

Dentists can apply for both Economic Injury Disaster Loans and Paycheck Protection Program 7(a) loans, the Small Business Administration told the American Dental Association on April 6.




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Webinar on Small Business Administration loans available online

The ADA webinar, Small Business Administration Loans: Understanding the Options for Dentist Owners, is available online.




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ADA asks Congress to increase funding, extend dates for Small Business Administration loans

The ADA is urging Congress to continue supporting small businesses during the COVID-19 pandemic by increasing funding and streamlining the application process for Small Business Administration loans.




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Index shows that dentists slowly but surely embracing electronic means of doing business

Despite the ADA Council on Dental Benefits’ efforts, the practice of using automated electronic means for verifying eligibility and benefits, checking claim status or receiving and reconciling payment remains underutilized by many dental providers according to an index, said Dr. Randall Markarian, council chair.




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Amalgam separator deadline remains intact

The deadline for dental offices to install amalgam separators remains intact but the Environmental Protection Agency announced March 26 that it will be initiating “a new temporary enforcement discretion policy” during the COVID-19 pandemic.




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ADA antibiotics guideline authors to discuss C. diff infections in dentistry during Peggy Lillis Foundation conference

Two of the authors of the American Dental Association's antibiotics guideline will discuss C. diff infections and antibiotic stewardship in dentistry April 21 as part of a free, online conference organized by the Peggy Lillis Foundation.




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Senate votes to expand small business aid

The Senate passed new coronavirus relief legislation April 21 calling for much-needed funding for depleted federal loan programs that could help businesses nationwide, including dentists and dental practices, recover from the economic fallout of the pandemic.




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American College of Emergency Physicians endorses ADA's antibiotics guideline

The American College of Emergency Physicians has endorsed the American Dental Association's clinical practice guideline on the use of antibiotics for the management of pulpal- and periapical-related pain and swelling.




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Agencies submit final rule extending ERISA deadlines during pandemic

The U.S. Department of Labor said April 28 that it is extending the Employee Retirement Income Security Act of 1974 filing deadlines for certain notice and disclosure requirements in the wake of the COVID-19 pandemic.




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Maine law eliminates insurance waiting periods for kids

D 1975, An Act to Facilitate Dental Treatment for Children, enacted on March 17, enables children with private dental insurance to receive care without having to wait up to several months for coverage to start.




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Venezuelan crude production continued to decline in December

Venezuelan crude oil production continued its steady decline and hit a new low in December with just 1.15 million barrels per day produced.




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Refineries, investors fear crude shortages over possible Venezuela sanctions

An unexpected rise in U.S. crude inventories offset fears of potential risk to Venezuelan crude supply because of possible U.S. sanctions.




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U.S. rural areas soon might be on front lines in COVID-19 pandemic

The COVID-19 pandemic has left a path of destruction in urban centers throughout the northeastern United States, but the next outbreak hotspots could have even deadlier effects in rural areas.




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2017 American Academy of Pediatrics Clinical Practice Guideline: Impact on Prevalence of Arterial Hypertension in Children and Adolescents With Type 1 Diabetes

OBJECTIVE

In 2017, the American Academy of Pediatrics introduced a new guideline (2017 Clinical Practice Guideline of the American Academy of Pediatrics [AAP 2017]) to diagnose arterial hypertension (HTN) in children that included revised, lower normative blood pressure (BP) values and cut points for diagnosing high BP in adolescents. We studied the impact of the new AAP 2017 guideline on prevalence of HTN in children with type 1 diabetes mellitus (T1DM).

RESEARCH DESIGN AND METHODS

Up to September 2018, 1.4 million office BP measurements in 79,849 children and adolescents (aged 5–20 years) with T1DM have been documented in the DPV (Diabetes Prospective Follow-up) registry. BP values of the most recent year were aggregated, and BP values of 74,677 patients without antihypertensive medication were analyzed (median age 16 years and diabetes duration 5.3 years and 52.8% boys). BP values were classified according to AAP 2017 and the references of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2011) and the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (fourth report) (2004).

RESULTS

Of the patients, 44.1%, 29.5%, and 26.5% were hypertensive according to AAP 2017, KiGGS, and fourth report, respectively. Differences in prevalence of HTN were strongly age dependent: <10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to <15 years, AAP 2017 30.9%, KiGGS 31.2%, fourth report 22.4%; and ≥15 years, AAP 2017 53.2%, KiGGS 28.4%, fourth report 30.0%. Among teenagers ≥15 years, 59.1% of boys but only 46.3% of girls were classified as hypertensive by AAP 2017 but only 21.1%/26% of boys and 36.7%/34.4% of girls by KiGGS/fourth report, respectively.

CONCLUSIONS

Classification of BP as hypertension depends strongly on the normative data used. Use of AAP 2017 results in a significant increase in HTN in teenagers ≥15 years with T1DM, particularly in boys. AAP 2017 enhances the awareness of elevated BP in children, particularly in patients with increased risk for cardiovascular disease.




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Erratum. Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach. Diabetes Care 2020;43:852-859




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Clinical and Public Health Implications of 2019 Endocrine Society Guidelines for Diagnosis of Diabetes in Older Adults

OBJECTIVE

Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample.

RESEARCH DESIGN AND METHODS

We included 2,236 adults aged ≥65 years without known diabetes from the 2005–2016 National Health and Nutrition Examination Survey. Diabetes was defined using: 1) the Endocrine Society approach (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-h plasma glucose ≥200 mg/dL among those with HbA1c 5.7–6.4% or FPG 100–125 mg/dL); and 2) a standard approach (HbA1c ≥6.5% or FPG ≥126 mg/dL). Treatment eligibility was defined using HbA1c cut points (≥7 to ≥9%). OGTT screening costs were estimated using Medicare fee schedules.

RESULTS

Diabetes prevalence was 15.7% (~5.0 million) using the Endocrine Society’s approach and 7.3% (~2.3 million) using the standard approach. Treatment eligibility ranged from 5.4 to 0.06% and 11.8–1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c <6.5% and would not be recommended for glucose-lowering treatment. Screening all older adults with prediabetic HbA1c/FPG (~18.3 million) with OGTT could cost between $737 million and $1.7 billion.

CONCLUSIONS

Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.




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Efficacy and Safety of 1:1 Fixed-Ratio Combination of Insulin Glargine and Lixisenatide Versus Lixisenatide in Japanese Patients With Type 2 Diabetes Inadequately Controlled on Oral Antidiabetic Drugs: The LixiLan JP-O1 Randomized Clinical Trial

OBJECTIVE

To assess the efficacy and safety of a 1:1 fixed-ratio combination of insulin glargine and lixisenatide (iGlarLixi) versus lixisenatide (Lixi) in insulin-naive Japanese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on oral antidiabetic drugs (OADs).

RESEARCH DESIGN AND METHODS

In this phase 3, open-label, multicenter trial, 321 patients with HbA1c≥7.5 to ≤10.0% (58–86 mmol/mol) and fasting plasma glucose (FPG) ≤13.8 mmol/L (250 mg/dL) were randomized 1:1 to iGlarLixi or Lixi for 52 weeks. The primary end point was change in HbA1c at week 26.

RESULTS

Change in HbA1c from baseline to week 26 was significantly greater with iGlarLixi (–1.58% [–17.3 mmol/mol]) than with Lixi (–0.51% [–5.6 mmol/mol]), confirming the superiority of iGlarLixi (least squares [LS] mean difference –1.07% [–11.7 mmol/mol], P < 0.0001). At week 26, significantly greater proportions of patients treated with iGlarLixi reached HbA1c <7% (53 mmol/mol) (65.2% vs. 19.4%; P < 0.0001), and FPG reductions were greater with iGlarLixi than Lixi (LS mean difference –2.29 mmol/L [–41.23 mg/dL], P < 0.0001). Incidence of documented symptomatic hypoglycemia (≤3.9 mmol/L [70 mg/dL]) was higher with iGlarLixi (13.0% vs. 2.5%) through week 26, with no severe hypoglycemic events in either group. Incidence of gastrointestinal events through week 52 was lower with iGlarLixi (36.0% vs. 50.0%), and rates of treatment-emergent adverse events were similar.

CONCLUSIONS

This phase 3 study demonstrated superior glycemic control and fewer gastrointestinal adverse events with iGlarLixi than with Lixi, which may support it as a new treatment option for Japanese patients with T2DM that is inadequately controlled with OADs.