Christos Sampanis - Academia.edu (original) (raw)
Papers by Christos Sampanis
International journal of Research in Ayurveda & Pharmacy, 2013
Background: Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prev... more Background: Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prevalence of connective tissue disorders in these patients has increased in the recent years affecting significantly their quality of life. Methods-Results: We conducted a pilot study including 208 sequentially selected patients with type 2 diabetes mellitus regularly followed-up at the Diabetes Center of the Hippokration University Hospital. Among the diabetic patients who were screened according to the Short Musculoskeletal Function Assessment Questionnaire for musculoskeletal symptoms and findings, 82.6% were found to exhibit musculoskeletal abnormalities, mainly of the degenerative, noninflammatory type. Conclusions: Musculoskeletal disorders are a common finding among patients with type 2 diabetes. Obesity and accumulation of abnormally glycosylated byproducts have been proposed as potential pathogenetic mediators of these connective tissue abnormalities. Of particular interest is, however, the common association of osteoarthritis, involving even non-weight bearing joints in patients with type 2 diabetes, indicating a common pathophysiologic mechanism connecting these two clinical conditions.
Acta Diabetologica, 2009
OBJECTIVE-Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the me... more OBJECTIVE-Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the meal insulin of choice in both multiple daily insulin injection (MDII) therapy and continuous subcutaneous insulin infusion (CSII) for type 1 diabetes. Thus, a comparison of efficacy between CSII and MDII should be undertaken only in studies that used rapid-acting analogs for both intensive regimens. RESEARCH DESIGN AND METHODS-We performed a pooled analysis of the randomized controlled trials that compared CSII and optimized MDII therapy using rapid-acting analogs in adults with type 1 diabetes. RESULTS-The three studies that met inclusion criteria provided data on 139 patients, representing 596 patient-months for CSII and 529 patient-months for MDII. Mean age was 38.5 years, with duration of diabetes of 18.0 years. The studies differed significantly in mean baseline A1c (7.95, 8.20, and 9.27%). The pooled estimate of treatment effect comparing the percentage reduction in A1c by CSII with that by MDII (CSII Ϫ MDII) was 0.35% (95% CI Ϫ0.10 to 0.80, P ϭ 0.08) using a random effect to account for heterogeneity between studies. Importantly, the interaction between baseline A1c and treatment modality emerged as an independent predictor of treatment effect (CSII Ϫ MDII) (P ϭ 0.002). The relative benefit of CSII over MDII was found to increase with higher baseline A1c. A model derived from these data predicts that in a patient with a baseline A1c of 10%, CSII would reduce the A1c by an additional 0.65% compared with MDII. Conversely, there would be no A1c benefit of CSII compared with MDII if baseline A1c were 6.5%. There was no significant difference between CSII and MDII in the rate of hypoglycemic events. CONCLUSIONS-When using rapid-acting insulin analogs in CSII and MDII regimens in adult patients with type 1 diabetes, insulin pump therapy is associated with better glycemic control, particularly in those individuals with higher baseline A1c. Thus, CSII emerges as an important modality for implementing intensive therapy and may be uniquely advantageous in patients with poor glycemic control.
Hippokratia, 2008
Diabetes mellitus and arterial hypertension are two common diseases that often coexist. Patients ... more Diabetes mellitus and arterial hypertension are two common diseases that often coexist. Patients with diabetes have much higher rate of hypertension than that in general population. The co-existence of these disorders appears to accelerate microvascular and macrovascular complications and greatly increases the cardiovascular risk, risk of stroke and end stage renal disease. Arterial hypertension is clearly related to nephropathy in subjects with type 1 diabetes. In patients with type 2 diabetes insulin resistance seems to play a pivotal role in the pathogenesis of hypertension. Several well designed randomized controlled trials have provided evidence that patients with diabetes will benefit from a more aggressive treatment of hypertension. This benefit is seen at blood pressure level<130/80 mmHg. Moreover, most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Angiotensin-converting enzyme inhibitors, angiotensin-receptor blo...
Hippokratia, 2010
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or... more Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future. The global incidence of GDM is difficult to estimate, due to lack of uniform diagnostic criteria. Various diagnostic criteria have been proposed. The benefit of treating GDM has also been controversial. The clinical significance of treating maternal hyperglycemia was made evident in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The HAPO study demonstrated that there is a continuous association of maternal glucose levels with adverse pregnancy outcomes and served as the basis for a new set of diagnostic criteria, proposed in 2010 by the International Association of Diabetes and Pregnancy Groups (IADPSG). According to these criteria the diagnosis of GDM is made if there is at least one abnormal value (≥92, 180 and 153 mg/dl fo...
Value in Health, 2016
A677 p= < 0.05. Results: A total of 209 specialists and 198 PCPs completed questionnaires for 358... more A677 p= < 0.05. Results: A total of 209 specialists and 198 PCPs completed questionnaires for 3585 T2DM patients currently receiving insulin and/or GLP-1 therapy, who also provided patient-reported questionnaires. Patients were classified into 4 quadrants based on their perceived need versus concern around injectables: low concern/low need (LCLN) 11%, low concern/high need (LCHN) 72%, high concern/low need (HCLN) 7%, high concern/high need (HCHN) 9%. Compared to the other 3 quadrants, HCLN patients were most likely to be female (49%), worst HbA1c (8.4%), most comorbidities (4.3), physician-reported very high cardiovascular risk (12%) and highest pill burden (8.8). Both needs and concerns with injectables are significant predictors of adherence; HCLN drives worst adherence (4.5-5), HCHN and LCLN drive higher adherence (5-6) and LCHN drives best adherence (6.5-7). ConClusions: Patient-reported needs versus concerns towards injectable therapy influence adherence. Patients with HCLN towards injectables appear least adherent with poor HbA1c, highest CV-risk and pill burden, suggesting they do not understand their high clinical need. Such lack of patient understanding coupled with high concerns warrants attention.
Hippokratia, 2008
Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal ... more Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal failure. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreased insulin degradation. Both of these abnormalities are partially reversed with the institution of dialysis. Except for diet with protein restriction, patients with diabetes should be preferably treated with insulin. The management of the patients with hyperglycemia and chronic renal failure calls for close collaboration between the diabetologist and the nephrologists. This collaboration is very important so that the patient will not be confused and will not lose confidence to the doctors. Furthermore good glycemic control in these patients seems to reduce microvascular and macrovascular complications.
AGREEMENT Investigators. Table S1. Stratification of patients according to sites capacity, treatm... more AGREEMENT Investigators. Table S1. Stratification of patients according to sites capacity, treatment strategy and gender. Table S2a. Percentage % of patients received Oral antidiabetic agents OADs. b Percentage % of patients received any Injectable treatments, not including Insulin. c Percentage % of patients received Insulin treatment. d Daily dose of treatment (total). e Daily dose per treatment strategy. Table S3. Risk Factors per treatment strategy at current period. Table S4. Distribution of FPG values across
Experimental and Clinical Endocrinology & Diabetes, 2017
Aim To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 d... more Aim To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 diabetes mellitus (T2DM) in Greece and its influence on glycaemic control, treatment adherence and quality of life (QoL). Patients and methods This was a retrospective cross-sectional study. We included 383 T2DM patients ≥30 years old on treatment with SU in monotherapy or in combination with metformin for at least 6 months. Patients were requested to fill in retrospective questionnaires on hypoglycaemia experience, adherence, weight gain and lifestyle/behavioural factors along with QoL (EQ-5D-3L), treatment satisfaction (TSQM), and fear of hypoglycaemia (HFS-II Worry scale). Results HbA1c<7% was found in 161 (42.0%) patients. In total, 165 (43.1%) patients reported hypoglycaemic symptoms during the previous 6 months: 41.6% (67/161) of those with HbA1c <7% and 44.1% (98/222) of those with HbA1c ≥7%. Glycaemic control was achieved by 43.1% (94/218) of patients without hypoglycaemia a...
Diabetes Care, 2019
OBJECTIVE Efficacy and safety of the glucagon-like peptide 1 (GLP-1) analog oral semaglutide and ... more OBJECTIVE Efficacy and safety of the glucagon-like peptide 1 (GLP-1) analog oral semaglutide and the sodium–glucose cotransporter 2 inhibitor empagliflozin were compared in patients with type 2 diabetes uncontrolled on metformin. RESEARCH DESIGN AND METHODS Patients were randomized to once-daily open-label treatment with oral semaglutide 14 mg (n = 412) or empagliflozin 25 mg (n = 410) in a 52-week trial. Key end points were change from baseline to week 26 in HbA1c (primary) and body weight (confirmatory secondary). Two estimands addressed efficacy-related questions: treatment policy (regardless of trial product discontinuation or rescue medication) and trial product (on trial product without rescue medication) in all randomized patients. RESULTS Four hundred (97.1%) patients in the oral semaglutide group and 387 (94.4%) in the empagliflozin group completed the trial. Oral semaglutide provided superior reductions in HbA1c versus empagliflozin at week 26 (treatment policy –1.3% vs. –...
Journal of Hypertension, 2021
Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose... more Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose concentration and the health complications resulting from uncontrolled hyperglycemia such as hyperlipidemia, cardiovascular problems, stroke, ketoacidosis, kidney failure and blindness but have different etiology. DM1 is practically an autoimmune disease. Genetic susceptibility together with environmental factors leads to disease development. The main characteristics of Diabetes type II (DM2) is insulin resistance in muscle and liver cells accompanied by loss of β-cell function. However, adipose tissue, gastro-intestinal tract, pancreatic a-cell activity, may be involved in disease development. In parallel to the impairment of endocrine pancreatic function, a reduction in exocrine function has also been observed in all types of Diabetes Mellitus. A decrease in amylase and lipase activity has been mentioned by many authors, although cases with elevated amylase have been referred. Most re...
Journal of Hypertension, 2019
Objective:Most studies describe a high prevalence of sexual problems in patients with heart failu... more Objective:Most studies describe a high prevalence of sexual problems in patients with heart failure (HF). On the other hand, hypertension and diabetes mellitus (DM) are known to cause sexual dysfunction and are highly prevalent among HF patients; therefore, the aim of this study was to investigate t
Endocrine Abstracts, 2015
Hellenic journal of nuclear medicine
Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose... more Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose concentration and the health complications resulting from uncontrolled hyperglycemia such as hyperlipidemia, cardiovascular problems, stroke, ketoacidosis, kidney failure and blindness but have different etiology. DM1 is practically an autoimmune disease. Genetic susceptibility together with environmental factors leads to disease development. The main characteristics of Diabetes type II (DM2) is insulin resistance in muscle and liver cells accompanied by loss of β-cell function. However, adipose tissue, gastro-intestinal tract, pancreatic a-cell activity, may be involved in disease development. In parallel to the impairment of endocrine pancreatic function, a reduction in exocrine function has also been observed in all types of Diabetes Mellitus. A decrease in amylase and lipase activity has been mentioned by many authors, although cases with elevated amylase have been referred. Most re...
HORMONES, 2014
oBJecTIve: To evaluate the effect of dipeptidyl-peptidase-4 (dPP-4) inhibitor vildagliptin on hig... more oBJecTIve: To evaluate the effect of dipeptidyl-peptidase-4 (dPP-4) inhibitor vildagliptin on high sensitivity c-reactive protein (hscrP) and arterial stiffness (As) in patients with type 2 diabetes (T2dM). desIgN: sixty-four drug-naive diabetic patients, with inadequate glycemic control, participated in this randomized, open-label study. Half of the patients received metformin 1700 mg/d and the other half of them received metformin 1700 mg/d plus vildagliptin 100 mg/d. As was measured by carotid-femoral Pulse Wave velocity (cfPWv). Body weight (BW), body mass index (BMI), blood pressure (BP), hscrP, glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPg), lipid profile, albumin/creatinine ratio (Acr), fasting insulin, c-peptide, homeostasis model assessment of insulin resistance (HoMA-Ir) and homeostasis model assessment of β-cell function (HOMA-β) were also assessed at baseline and after 6 months. resUlTs: vildagliptin in combination with metformin had a beneficial influence on hsCRP, HbA1c, C-peptide and HOMA-β index (p <0.05) but had no effect on cfPWV, BP, BW, BMI, lipid profile, Acr and HoMA-Ir compared with metformin alone (p=Ns). coNclUsIoNs: We have found that the addition of vildagliptin to metformin for a period of six months decreased hsCRP, improved glycemic control and β-cell function but had no effect on As in drug-naive patients with T2dM.
Erectile Dysfunction in Hypertension and Cardiovascular Disease, 2014
Diabetes mellitus, a contemporary growing pandemic, causes severe complications and provokes dimi... more Diabetes mellitus, a contemporary growing pandemic, causes severe complications and provokes diminishing effects on the patient’s quality of life. Erectile dysfunction is one of the most common and earliest presented morbidity affecting diabetic men. Erectile dysfunction in diabetics is more severe and resistant to treatment, and its prevalence is two to three times higher than in nondiabetics. The etiology of this disorder induced by diabetes is multifactorial and complex. Ongoing research is focused on elucidating the physiology of the erectile mechanism and unraveling the mystery of the pathogenesis implicated in the development of erectile dysfunction. Endothelial dysfunction, autonomic and peripheral neuropathy, and endocrinological and psychological disorders are involved in the pathogenesis of diabetes-induced erectile dysfunction. The progress achieved in the comprehension of these mechanisms has led to the introduction of novel and promising molecule-based treatment options. Evidence suggests that combination therapy tailored to the individual is of high efficacy and results in the improvement of the sex-related daily life of men with diabetes.
Journal of the American Society of Hypertension, 2014
Vasodilating b blockers possess a better metabolic profile than traditional b blockers. However, ... more Vasodilating b blockers possess a better metabolic profile than traditional b blockers. However, limited data exists onwhether this beneficialmetabolic profile is maintained in diabetic patients with resistant hypertension who are already on diuretic therapy. We aimed, therefore, to evaluate the effect of carvedilol, a vasodilating b blocker, on metabolic control in patients with type 2 diabetes mellitus (T2DM) and resistant hypertension. Fifty-one consecutive patients (15 male and 36 female) of age 51 to 84 years old (mean 68) with T2DM (duration 14 years, range 15-31,7 years) and blood pressure (BP) > 130/80 mmHg were studied. All patients were already receiving combination therapy of at least 3 antihypertensive drugs, including a diuretic, when carvedilol was added. Patients were followed up for 6 months. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), body mass index (BMI), HbA1c and lipids (TCHOL, Tg, HDL-C, LDL-C) were determined at baseline and after 6 months of therapy with carvedilol. A significant drop in TCHOL (194 + 58.8. vs 178.8 + 49.1 mg/dl, p<0.0001) and Tg (154.31 + 34.9 vs 133.96 + 42.1 mg/dl p<0.0001) was found, whereas there was a non significant change in HDL-C (50.8 + 10.2 mg/dl vs 50.3 + 9.5 mg/dl, p1⁄4NS), LDL-C (111.9 + 40.6 mg/dl vs 105.6 + 43.2 mg/dl, p1⁄4NS) and HbA1c (7.64 + 1.17 % vs 7,6 + 1,13%, p1⁄4NS). Additionally, a significant drop in SBP (158.4 + 13.5 vs 148.9 + 15.5 mmHg, p<0.001), DBP (86.6 + 12.2 vs 79.9 + 8.7 mmHg, p<0.001) and HR (86.7 + 12.2 vs 79.9 + 11.3 bpm, p<0.001) was noted. In patients with Type 2 Diabetes Mellitus and resistant hypertension carvedilol seems to maintain its positive effect on metabolic control even when added to diuretics. Further major long-term clinical trials are needed to prove the beneficial effect of carvedilol over non selective b-blockers on cardiovascular risk in these patients.
Journal of Vascular Surgery, 2013
Objective: To identify differences in postexercise phosphocreatine (PCr) recovery, an index of mi... more Objective: To identify differences in postexercise phosphocreatine (PCr) recovery, an index of mitochondrial function, in diabetic patients with and without lower extremity complications. Methods: We enrolled healthy control subjects and three groups of patients with type 2 diabetes mellitus: without complications, with peripheral neuropathy, and with both peripheral neuropathy and peripheral arterial disease. We used magnetic resonance spectroscopic measurements to perform continuous measurements of phosphorous metabolites (PCr and inorganic phosphate [Pi]) during a 3-minute graded exercise at the level of the posterior calf muscles (gastrocnemius and soleus muscles). Micro-and macrovascular reactivity measurements also were performed. Results: The resting Pi/PCr ratio and PCr at baseline and the maximum reached during exercise were similar in all groups. The postexercise time required for recovery of Pi/PCr ratio and PCr levels to resting levels, an assessment of mitochondrial oxidative phosphorylation, was significantly higher in diabetic patients with neuropathy and those with both neuropathy and peripheral arterial disease (P < .01 for both measurements). These two groups also had higher levels of tumor necrosis factor-a (P < .01) and granulocyte colony-stimulating factor (P < .05). Multiple regression analysis showed that only granulocyte colony-stimulating factor, osteoprotegerin, and tumor necrosis factor-a were significant contributing factors in the variation of the Pi/PCr ratio recovery time. No associations were observed between micro-and macrovascular reactivity measurements and Pi/PCr ratio or PCr recovery time. Conclusions: Mitochondrial oxidative phosphorylation is impaired only in type 2 diabetes mellitus patients with neuropathy whether or not peripheral arterial disease is present and is associated with the increased proinflammatory state observed in these groups.
Lancet (London, England), 2018
Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and i... more Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30-50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be ...
International journal of Research in Ayurveda & Pharmacy, 2013
Background: Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prev... more Background: Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prevalence of connective tissue disorders in these patients has increased in the recent years affecting significantly their quality of life. Methods-Results: We conducted a pilot study including 208 sequentially selected patients with type 2 diabetes mellitus regularly followed-up at the Diabetes Center of the Hippokration University Hospital. Among the diabetic patients who were screened according to the Short Musculoskeletal Function Assessment Questionnaire for musculoskeletal symptoms and findings, 82.6% were found to exhibit musculoskeletal abnormalities, mainly of the degenerative, noninflammatory type. Conclusions: Musculoskeletal disorders are a common finding among patients with type 2 diabetes. Obesity and accumulation of abnormally glycosylated byproducts have been proposed as potential pathogenetic mediators of these connective tissue abnormalities. Of particular interest is, however, the common association of osteoarthritis, involving even non-weight bearing joints in patients with type 2 diabetes, indicating a common pathophysiologic mechanism connecting these two clinical conditions.
Acta Diabetologica, 2009
OBJECTIVE-Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the me... more OBJECTIVE-Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the meal insulin of choice in both multiple daily insulin injection (MDII) therapy and continuous subcutaneous insulin infusion (CSII) for type 1 diabetes. Thus, a comparison of efficacy between CSII and MDII should be undertaken only in studies that used rapid-acting analogs for both intensive regimens. RESEARCH DESIGN AND METHODS-We performed a pooled analysis of the randomized controlled trials that compared CSII and optimized MDII therapy using rapid-acting analogs in adults with type 1 diabetes. RESULTS-The three studies that met inclusion criteria provided data on 139 patients, representing 596 patient-months for CSII and 529 patient-months for MDII. Mean age was 38.5 years, with duration of diabetes of 18.0 years. The studies differed significantly in mean baseline A1c (7.95, 8.20, and 9.27%). The pooled estimate of treatment effect comparing the percentage reduction in A1c by CSII with that by MDII (CSII Ϫ MDII) was 0.35% (95% CI Ϫ0.10 to 0.80, P ϭ 0.08) using a random effect to account for heterogeneity between studies. Importantly, the interaction between baseline A1c and treatment modality emerged as an independent predictor of treatment effect (CSII Ϫ MDII) (P ϭ 0.002). The relative benefit of CSII over MDII was found to increase with higher baseline A1c. A model derived from these data predicts that in a patient with a baseline A1c of 10%, CSII would reduce the A1c by an additional 0.65% compared with MDII. Conversely, there would be no A1c benefit of CSII compared with MDII if baseline A1c were 6.5%. There was no significant difference between CSII and MDII in the rate of hypoglycemic events. CONCLUSIONS-When using rapid-acting insulin analogs in CSII and MDII regimens in adult patients with type 1 diabetes, insulin pump therapy is associated with better glycemic control, particularly in those individuals with higher baseline A1c. Thus, CSII emerges as an important modality for implementing intensive therapy and may be uniquely advantageous in patients with poor glycemic control.
Hippokratia, 2008
Diabetes mellitus and arterial hypertension are two common diseases that often coexist. Patients ... more Diabetes mellitus and arterial hypertension are two common diseases that often coexist. Patients with diabetes have much higher rate of hypertension than that in general population. The co-existence of these disorders appears to accelerate microvascular and macrovascular complications and greatly increases the cardiovascular risk, risk of stroke and end stage renal disease. Arterial hypertension is clearly related to nephropathy in subjects with type 1 diabetes. In patients with type 2 diabetes insulin resistance seems to play a pivotal role in the pathogenesis of hypertension. Several well designed randomized controlled trials have provided evidence that patients with diabetes will benefit from a more aggressive treatment of hypertension. This benefit is seen at blood pressure level<130/80 mmHg. Moreover, most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Angiotensin-converting enzyme inhibitors, angiotensin-receptor blo...
Hippokratia, 2010
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or... more Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future. The global incidence of GDM is difficult to estimate, due to lack of uniform diagnostic criteria. Various diagnostic criteria have been proposed. The benefit of treating GDM has also been controversial. The clinical significance of treating maternal hyperglycemia was made evident in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The HAPO study demonstrated that there is a continuous association of maternal glucose levels with adverse pregnancy outcomes and served as the basis for a new set of diagnostic criteria, proposed in 2010 by the International Association of Diabetes and Pregnancy Groups (IADPSG). According to these criteria the diagnosis of GDM is made if there is at least one abnormal value (≥92, 180 and 153 mg/dl fo...
Value in Health, 2016
A677 p= < 0.05. Results: A total of 209 specialists and 198 PCPs completed questionnaires for 358... more A677 p= < 0.05. Results: A total of 209 specialists and 198 PCPs completed questionnaires for 3585 T2DM patients currently receiving insulin and/or GLP-1 therapy, who also provided patient-reported questionnaires. Patients were classified into 4 quadrants based on their perceived need versus concern around injectables: low concern/low need (LCLN) 11%, low concern/high need (LCHN) 72%, high concern/low need (HCLN) 7%, high concern/high need (HCHN) 9%. Compared to the other 3 quadrants, HCLN patients were most likely to be female (49%), worst HbA1c (8.4%), most comorbidities (4.3), physician-reported very high cardiovascular risk (12%) and highest pill burden (8.8). Both needs and concerns with injectables are significant predictors of adherence; HCLN drives worst adherence (4.5-5), HCHN and LCLN drive higher adherence (5-6) and LCHN drives best adherence (6.5-7). ConClusions: Patient-reported needs versus concerns towards injectable therapy influence adherence. Patients with HCLN towards injectables appear least adherent with poor HbA1c, highest CV-risk and pill burden, suggesting they do not understand their high clinical need. Such lack of patient understanding coupled with high concerns warrants attention.
Hippokratia, 2008
Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal ... more Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal failure. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreased insulin degradation. Both of these abnormalities are partially reversed with the institution of dialysis. Except for diet with protein restriction, patients with diabetes should be preferably treated with insulin. The management of the patients with hyperglycemia and chronic renal failure calls for close collaboration between the diabetologist and the nephrologists. This collaboration is very important so that the patient will not be confused and will not lose confidence to the doctors. Furthermore good glycemic control in these patients seems to reduce microvascular and macrovascular complications.
AGREEMENT Investigators. Table S1. Stratification of patients according to sites capacity, treatm... more AGREEMENT Investigators. Table S1. Stratification of patients according to sites capacity, treatment strategy and gender. Table S2a. Percentage % of patients received Oral antidiabetic agents OADs. b Percentage % of patients received any Injectable treatments, not including Insulin. c Percentage % of patients received Insulin treatment. d Daily dose of treatment (total). e Daily dose per treatment strategy. Table S3. Risk Factors per treatment strategy at current period. Table S4. Distribution of FPG values across
Experimental and Clinical Endocrinology & Diabetes, 2017
Aim To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 d... more Aim To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 diabetes mellitus (T2DM) in Greece and its influence on glycaemic control, treatment adherence and quality of life (QoL). Patients and methods This was a retrospective cross-sectional study. We included 383 T2DM patients ≥30 years old on treatment with SU in monotherapy or in combination with metformin for at least 6 months. Patients were requested to fill in retrospective questionnaires on hypoglycaemia experience, adherence, weight gain and lifestyle/behavioural factors along with QoL (EQ-5D-3L), treatment satisfaction (TSQM), and fear of hypoglycaemia (HFS-II Worry scale). Results HbA1c<7% was found in 161 (42.0%) patients. In total, 165 (43.1%) patients reported hypoglycaemic symptoms during the previous 6 months: 41.6% (67/161) of those with HbA1c <7% and 44.1% (98/222) of those with HbA1c ≥7%. Glycaemic control was achieved by 43.1% (94/218) of patients without hypoglycaemia a...
Diabetes Care, 2019
OBJECTIVE Efficacy and safety of the glucagon-like peptide 1 (GLP-1) analog oral semaglutide and ... more OBJECTIVE Efficacy and safety of the glucagon-like peptide 1 (GLP-1) analog oral semaglutide and the sodium–glucose cotransporter 2 inhibitor empagliflozin were compared in patients with type 2 diabetes uncontrolled on metformin. RESEARCH DESIGN AND METHODS Patients were randomized to once-daily open-label treatment with oral semaglutide 14 mg (n = 412) or empagliflozin 25 mg (n = 410) in a 52-week trial. Key end points were change from baseline to week 26 in HbA1c (primary) and body weight (confirmatory secondary). Two estimands addressed efficacy-related questions: treatment policy (regardless of trial product discontinuation or rescue medication) and trial product (on trial product without rescue medication) in all randomized patients. RESULTS Four hundred (97.1%) patients in the oral semaglutide group and 387 (94.4%) in the empagliflozin group completed the trial. Oral semaglutide provided superior reductions in HbA1c versus empagliflozin at week 26 (treatment policy –1.3% vs. –...
Journal of Hypertension, 2021
Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose... more Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose concentration and the health complications resulting from uncontrolled hyperglycemia such as hyperlipidemia, cardiovascular problems, stroke, ketoacidosis, kidney failure and blindness but have different etiology. DM1 is practically an autoimmune disease. Genetic susceptibility together with environmental factors leads to disease development. The main characteristics of Diabetes type II (DM2) is insulin resistance in muscle and liver cells accompanied by loss of β-cell function. However, adipose tissue, gastro-intestinal tract, pancreatic a-cell activity, may be involved in disease development. In parallel to the impairment of endocrine pancreatic function, a reduction in exocrine function has also been observed in all types of Diabetes Mellitus. A decrease in amylase and lipase activity has been mentioned by many authors, although cases with elevated amylase have been referred. Most re...
Journal of Hypertension, 2019
Objective:Most studies describe a high prevalence of sexual problems in patients with heart failu... more Objective:Most studies describe a high prevalence of sexual problems in patients with heart failure (HF). On the other hand, hypertension and diabetes mellitus (DM) are known to cause sexual dysfunction and are highly prevalent among HF patients; therefore, the aim of this study was to investigate t
Endocrine Abstracts, 2015
Hellenic journal of nuclear medicine
Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose... more Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose concentration and the health complications resulting from uncontrolled hyperglycemia such as hyperlipidemia, cardiovascular problems, stroke, ketoacidosis, kidney failure and blindness but have different etiology. DM1 is practically an autoimmune disease. Genetic susceptibility together with environmental factors leads to disease development. The main characteristics of Diabetes type II (DM2) is insulin resistance in muscle and liver cells accompanied by loss of β-cell function. However, adipose tissue, gastro-intestinal tract, pancreatic a-cell activity, may be involved in disease development. In parallel to the impairment of endocrine pancreatic function, a reduction in exocrine function has also been observed in all types of Diabetes Mellitus. A decrease in amylase and lipase activity has been mentioned by many authors, although cases with elevated amylase have been referred. Most re...
HORMONES, 2014
oBJecTIve: To evaluate the effect of dipeptidyl-peptidase-4 (dPP-4) inhibitor vildagliptin on hig... more oBJecTIve: To evaluate the effect of dipeptidyl-peptidase-4 (dPP-4) inhibitor vildagliptin on high sensitivity c-reactive protein (hscrP) and arterial stiffness (As) in patients with type 2 diabetes (T2dM). desIgN: sixty-four drug-naive diabetic patients, with inadequate glycemic control, participated in this randomized, open-label study. Half of the patients received metformin 1700 mg/d and the other half of them received metformin 1700 mg/d plus vildagliptin 100 mg/d. As was measured by carotid-femoral Pulse Wave velocity (cfPWv). Body weight (BW), body mass index (BMI), blood pressure (BP), hscrP, glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPg), lipid profile, albumin/creatinine ratio (Acr), fasting insulin, c-peptide, homeostasis model assessment of insulin resistance (HoMA-Ir) and homeostasis model assessment of β-cell function (HOMA-β) were also assessed at baseline and after 6 months. resUlTs: vildagliptin in combination with metformin had a beneficial influence on hsCRP, HbA1c, C-peptide and HOMA-β index (p <0.05) but had no effect on cfPWV, BP, BW, BMI, lipid profile, Acr and HoMA-Ir compared with metformin alone (p=Ns). coNclUsIoNs: We have found that the addition of vildagliptin to metformin for a period of six months decreased hsCRP, improved glycemic control and β-cell function but had no effect on As in drug-naive patients with T2dM.
Erectile Dysfunction in Hypertension and Cardiovascular Disease, 2014
Diabetes mellitus, a contemporary growing pandemic, causes severe complications and provokes dimi... more Diabetes mellitus, a contemporary growing pandemic, causes severe complications and provokes diminishing effects on the patient’s quality of life. Erectile dysfunction is one of the most common and earliest presented morbidity affecting diabetic men. Erectile dysfunction in diabetics is more severe and resistant to treatment, and its prevalence is two to three times higher than in nondiabetics. The etiology of this disorder induced by diabetes is multifactorial and complex. Ongoing research is focused on elucidating the physiology of the erectile mechanism and unraveling the mystery of the pathogenesis implicated in the development of erectile dysfunction. Endothelial dysfunction, autonomic and peripheral neuropathy, and endocrinological and psychological disorders are involved in the pathogenesis of diabetes-induced erectile dysfunction. The progress achieved in the comprehension of these mechanisms has led to the introduction of novel and promising molecule-based treatment options. Evidence suggests that combination therapy tailored to the individual is of high efficacy and results in the improvement of the sex-related daily life of men with diabetes.
Journal of the American Society of Hypertension, 2014
Vasodilating b blockers possess a better metabolic profile than traditional b blockers. However, ... more Vasodilating b blockers possess a better metabolic profile than traditional b blockers. However, limited data exists onwhether this beneficialmetabolic profile is maintained in diabetic patients with resistant hypertension who are already on diuretic therapy. We aimed, therefore, to evaluate the effect of carvedilol, a vasodilating b blocker, on metabolic control in patients with type 2 diabetes mellitus (T2DM) and resistant hypertension. Fifty-one consecutive patients (15 male and 36 female) of age 51 to 84 years old (mean 68) with T2DM (duration 14 years, range 15-31,7 years) and blood pressure (BP) > 130/80 mmHg were studied. All patients were already receiving combination therapy of at least 3 antihypertensive drugs, including a diuretic, when carvedilol was added. Patients were followed up for 6 months. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), body mass index (BMI), HbA1c and lipids (TCHOL, Tg, HDL-C, LDL-C) were determined at baseline and after 6 months of therapy with carvedilol. A significant drop in TCHOL (194 + 58.8. vs 178.8 + 49.1 mg/dl, p<0.0001) and Tg (154.31 + 34.9 vs 133.96 + 42.1 mg/dl p<0.0001) was found, whereas there was a non significant change in HDL-C (50.8 + 10.2 mg/dl vs 50.3 + 9.5 mg/dl, p1⁄4NS), LDL-C (111.9 + 40.6 mg/dl vs 105.6 + 43.2 mg/dl, p1⁄4NS) and HbA1c (7.64 + 1.17 % vs 7,6 + 1,13%, p1⁄4NS). Additionally, a significant drop in SBP (158.4 + 13.5 vs 148.9 + 15.5 mmHg, p<0.001), DBP (86.6 + 12.2 vs 79.9 + 8.7 mmHg, p<0.001) and HR (86.7 + 12.2 vs 79.9 + 11.3 bpm, p<0.001) was noted. In patients with Type 2 Diabetes Mellitus and resistant hypertension carvedilol seems to maintain its positive effect on metabolic control even when added to diuretics. Further major long-term clinical trials are needed to prove the beneficial effect of carvedilol over non selective b-blockers on cardiovascular risk in these patients.
Journal of Vascular Surgery, 2013
Objective: To identify differences in postexercise phosphocreatine (PCr) recovery, an index of mi... more Objective: To identify differences in postexercise phosphocreatine (PCr) recovery, an index of mitochondrial function, in diabetic patients with and without lower extremity complications. Methods: We enrolled healthy control subjects and three groups of patients with type 2 diabetes mellitus: without complications, with peripheral neuropathy, and with both peripheral neuropathy and peripheral arterial disease. We used magnetic resonance spectroscopic measurements to perform continuous measurements of phosphorous metabolites (PCr and inorganic phosphate [Pi]) during a 3-minute graded exercise at the level of the posterior calf muscles (gastrocnemius and soleus muscles). Micro-and macrovascular reactivity measurements also were performed. Results: The resting Pi/PCr ratio and PCr at baseline and the maximum reached during exercise were similar in all groups. The postexercise time required for recovery of Pi/PCr ratio and PCr levels to resting levels, an assessment of mitochondrial oxidative phosphorylation, was significantly higher in diabetic patients with neuropathy and those with both neuropathy and peripheral arterial disease (P < .01 for both measurements). These two groups also had higher levels of tumor necrosis factor-a (P < .01) and granulocyte colony-stimulating factor (P < .05). Multiple regression analysis showed that only granulocyte colony-stimulating factor, osteoprotegerin, and tumor necrosis factor-a were significant contributing factors in the variation of the Pi/PCr ratio recovery time. No associations were observed between micro-and macrovascular reactivity measurements and Pi/PCr ratio or PCr recovery time. Conclusions: Mitochondrial oxidative phosphorylation is impaired only in type 2 diabetes mellitus patients with neuropathy whether or not peripheral arterial disease is present and is associated with the increased proinflammatory state observed in these groups.
Lancet (London, England), 2018
Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and i... more Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30-50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be ...