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Background: Metabolic and bariatric surgery (MBS) reduces glomerular hyperfiltration. The renoprotective effects of GLP‐1 analogs were derived from clinical studies in type 2 diabetes (T2D). The objective of this study was to evaluate the changes in glomerular filtration rate (GFR) over time associated with weight loss in patients with a BMI ≥ 35 kg/m2 treated with liraglutide compared with patients treated with MBS. Methods: A longitudinal study derived from a retrospective cohort of patients with BMI ≥ 35 kg/m2 treated with either MBS or liraglutide 3 mg/day, with follow‐up ≥1 year. Clinical variables, baseline GFR, and 1‐year GFR were analyzed. A generalized estimating equation (GEE) model was used to compare changes in GFR between both groups while controlling for confounding variables. Results: A total of 159 patients were included in the analysis. Of these, 129 patients underwent MBS (median age 60.5 years [IQR 51.8–66.6], body mass index (BMI) 40.9 kg/m2 [IQR 0.68–0.89]), and 30 patients were treated with liraglutide (median age 56 years [IQR 46–62], BMI 37.4 kg/m2 [IQR 0.69–0.93]). No difference in baseline GFR or at 12 months of follow‐up was found between the two interventions. GEE analysis revealed an increase of 0.32 mL/min/1.73 m2 per month of follow‐up. Factors associated with a greater increase in GFR were the percentage total weight loss (%TWL) (0.12 mL/min/1.73 m2, p = 0.023) and baseline GFR (0.69 mL/min/1.73 m2, p > 0.001) for both interventions, independent of a history of T2D. Conclusion: In patients with BMI ≥ 35 kg/m2, changes in GFR are related to %TWL and baseline GFR, regardless of the presence of diabetes or the type of intervention used. [ABSTRACT FROM AUTHOR]

Objective: Hypoglycemia is a serious complication of type 2 diabetes (DM2), but its severity and incidence and the healthcare services used are usually underreported in clinical practice. We aimed to describe the severity and frequency of hypoglycemia episodes, the proactive behaviors adopted, and healthcare services used by administering the Hypoglycemia Awareness Questionnaire (HypoA-Q). Methods: In this cross-sectional, multicenter, validation study, demographic data and clinical variables were retrieved from electronic records, and the HypoA-Q questionnaire was filled out. Questions 1 and 2 assessed the frequency of hypoglycemia events and the healthcare services used. Questions 4c, 4d, 9, 16b, and 16c evaluated the proactive behaviors of the patient and/or caregiver during the occurrence of hypoglycemic events. Results: In total, 502 DM2 patients treated with insulin and with a history of hypoglycemia were included in this study [54.6% women, median age: 65 years (interquartile range: 58–73); 55.4% receiving the basal-bolus regimen]. 281 (56%) patients reported at least one hypoglycemic event in the last year; 25% reported at least one severe hypoglycemia event; and 8.7% required hospitalization. Only 52% of patients monitored their capillary blood glucose levels to assess for hypoglycemia. Conclusion: The use of HypoA-Q questionnaire in usual clinical practice could facilitate the characterization of hypoglycemia events and the identification of at-risk populations by healthcare professionals and payers. [ABSTRACT FROM AUTHOR]

Given the implications of impaired hypoglycemia awareness in patients with type 2 diabetes (T2D), it is necessary to identify reliable and valid instruments for its measurement. The Hypoglycemia Awareness Questionnaire (HypoA-Q) measures impaired awareness, symptom severity, and symptom frequency. The present study evaluated the HypoA-Q validity for assessing awareness of hypoglycemia in patients with T2D treated with insulin. The questionnaire was administered to 406 patients diagnosed with T2D on insulin treatment at four centers in Bogotá, Colombia. The internal structure of the questionnaire was analyzed using exploratory and confirmatory factor analyses, internal consistency and test–retest reliability were evaluated, and criterion validity was rated by assessing its correlation with the Clarke scale. Factor analysis identified an empirical structure of four domains that adequately represented the construct. Cronbach's alpha and McDonald's Omega coefficients yielded values between 0.75 and 0.79 for the impaired awareness scale. Lin and intraclass correlation coefficients were 0.86 and 0.85, respectively. The correlation between the impaired awareness subscale and Clarke scale was 0.654, and differences were found between patients with good and poor awareness of hypoglycemia. The HypoA-Q is a valid and reliable tool for measuring the awareness of hypoglycemia in patients with T2D who are treated with insulin. • Hypoglycemia Unawareness (HU) is a risk factor for severe hypoglycemia in patients with type 2 diabetes (T2D). • Existing scales for the diagnosis of HU have not been validated in patients with T2D specifically treated with insulin. • HypoA-Q is a valid and reliable instrument for measuring hypoglycemia awareness in insulin-treated patients with T2D. • A cutoff point of 10 on the impaired awareness subscale identified patients at risk of undetected hypoglycemia. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend insulin alone for in-hospital management of diabetes, but growing information suggests that new oral or injectable agents may be as effective and safe.Methods: Systematic review and meta-analysis with evidence from randomized (RCT) and non-randomized (NRS) studies in PubMed, EMBASE and LILACS databases up to February 10, 2022, for studies including hospitalized type 2 diabetes patients, comparing dipeptidyl peptidase 4 inhibitors (DPP4i), sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP1Ra) with insulin alone for glycemic control and safety outcomes.Findings: 7 RCT and 3 NRTs were included. There were no differences in mean blood glucose, measurements within range or rate of hypoglycemia between DPP4i and insulin. We found a lower mean glucose for GLP1Ra plus insulin subgroup (-16.36 mg/dL, 95 % CI -27.31, -5.41; I2 = 0 %) with lower incidence of hypoglycemia < 70 mg/dL with GLP1Ra (RR 0.31, CI 95 % 0.14-0.70, I2 = 0 %). SGLT2i data was limited. Adverse events rates were similar between treatments.Conclusion: Our review suggests that inpatient management in the general ward with DPP4i and GLP1Ra is as effective and safe as management with insulin. More randomized studies are required to support these findings before they could be recommended as usual practice. [ABSTRACT FROM AUTHOR]