Ochsner Medical Center

About: Ochsner Medical Center is a healthcare organization based out in New Orleans, Louisiana, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

Lixisenatide as add-on treatment among patients with different β-cell function levels as assessed by HOMA-β index

Abstract: Background The effect of lixisenatide—a prandial once-daily glucagon-like peptide-1 receptor agonist—on glycaemic control in patients with inadequately controlled type 2 diabetes mellitus (T2DM), stratified by baseline β-cell function, was assessed. Methods The 24-week GetGoal-M, -P and -S trials evaluated the efficacy and safety of lixisenatide in combination with oral antidiabetic agents. This post hoc analysis used data from patients receiving lixisenatide in these trials, divided into matched cohorts by propensity scoring, and stratified according to baseline homeostasis model assessment of β-cell function (HOMA-β) index levels, high HOMA-β: > median HOMA-β (28.49%); low HOMA-β: ≤ median. Results The matched “low” and “high” HOMA-β index cohorts (N = 546 patients) had comparable baseline parameters. Mean change from baseline in glycated haemoglobin (HbA1c) was −0.85% and −0.94% for low and high HOMA-β cohorts, respectively (P = .2607). Reductions from baseline in fasting plasma glucose (FPG; −0.77 vs −1.04 mmol/L; P = .1496) and postprandial plasma glucose (PPG; −5.82 vs −5.61 mmol/L; P = .7511) were similar in the low versus high HOMA-β index cohorts. Reduction in body weight was significantly greater in the low versus high HOMA-β index cohort (–2.06 vs –1.13 kg, respectively; P = .0006). Conclusions In patients with T2DM, lixisenatide was associated with reduction in HbA1c and improvements in both FPG and PPG, regardless of β-cell function, indicating that lixisenatide is effective in reducing hyperglycaemia, even in patients with more advanced stages of T2DM and poor residual β-cell function.

Combination Glucose-Lowering Therapy Plans in T2DM: Case-Based Considerations.

Abstract: Type 2 diabetes mellitus (T2DM) is a complex disease, and while lifestyle interventions remain the cornerstone of therapy, most patients will also require pharmacotherapy. Current diabetes treatment guidelines and algorithms recommend an individualized approach to setting glycemic goals and selecting treatment. Although a single antihyperglycemic agent may be appropriate as the initial T2DM pharmacotherapy, the progressive nature of the disease due to declining pancreatic β-cell function will result in the vast majority of T2DM patients eventually requiring two or more antihyperglycemic agents. The American Association of Clinical Endocrinologists/American College of Clinical Endocrinology T2DM management algorithm recommends initial dual agent combination therapy when a single agent is unlikely to achieve their target glycemia, i.e., for those patients with an HbA1c ≥ 7.5 and an individualized HbA1c target of < 7.5%. The American Diabetes Association Standards of Care recommend combination pharmacotherapy for those patients presenting with very elevated HbA1c levels (e.g., ≥ 9% and < 10%). Metformin (if well tolerated and not contraindicated) is the initial pharmacologic choice for most patients; selection of another antihyperglycemic agent to the regimen will depend on the presence of atherosclerotic cardiovascular disease and other patient-specific factors (e.g., age, known duration of T2DM, history of or risk for hypoglycemia and/or adverse consequences from hypoglycemia, other comorbidities, and available resources), along with drug-specific factors (e.g., risk for hypoglycemia, potential effects on weight, drug adverse event profiles, and cost). Combination therapy may be administered as a multi-pill regimen, a single-pill combination (i.e., fixed-dose combination oral therapy), or as a combination of oral and/or injectable therapies. This paper provides two illustrative case presentations to demonstrate how current treatment recommendations and algorithms can be used to guide the selection of non-insulin-based combination therapy for patients with T2DM in primary care settings and discusses the relative merits of several possible approaches for each patient. Funding: Boehringer Ingelheim Pharmaceuticals, Inc.

Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children

Abstract: Importance There is not a consensus on the best diagnostic algorithm for children with a potential peritonsillar abscess. The association of computed tomographic (CT) scanning in children with a pertonsillar abscess and intervention chosen by the treating physician, or the potential delay of treatment associated with such imaging, has not yet been explored. Objectives To determine if use of a CT scan is associated with a difference in clinical intervention for peritonsillar abscess and to determine if use of a CT scan is associated with delay of this intervention. Design, Setting, and Participants A retrospective case-control study examined therapeutic interventions, based on the presence or absence of a diagnostic CT scan, in children diagnosed with peritonsillar abscess from November 1, 2006, to November 1, 2015. Children who presented either to the emergency department or to their pediatrician with a peritonsillar abscess were divided into 2 groups: those diagnosed without the use of a CT scan (controls; n = 38) and those diagnosed with the use of a CT scan (cases; n = 30). Main Outcomes and Measures Patients were examined for 2 outcomes: admission or no admission. The groups were also examined for type of intervention performed: bedside procedure (needle aspiration or incision and drainage), surgical procedure in the operating room (needle aspiration, incision and drainage, or tonsillectomy), no procedure, or both bedside and surgical procedure. In addition, the time to an otolaryngology consultation and to each of the above interventions was calculated. Results Thirty children underwent a CT scan, while 38 did not. The mean age of children who underwent a CT scan was 14.3 years (range, 3-18 years) and 11.3 years (range, 1-18 years) for those who did not, for an absolute difference of 3 years (95% CI, 0.38-5.62). Among 68 patients (27 boys and 41 girls), there was no significant association between CT scan and admission or between CT scan and type of procedural intervention. However, there was a clinically significant association between CT scan and time to intervention. Mean time to an otolaryngology consultation was 369 minutes in the CT scan group and 63.4 minutes in the control group for an absolute difference of 305.6 minutes (95% CI, 208-404). Mean time to admission was 340 minutes in the CT scan group vs 166 minutes in the control group for an absolute difference of 174 minutes (95% CI, 65.3-283). Mean time to bedside procedure was 493 minutes in the CT scan group compared with 175 minutes in the control group for an absolute difference of 368 minutes (95% CI, 130-606). No significant association was found between use of CT scan and mean time to surgical intervention: mean time to surgical intervention in the CT scan group and the control group was 1.71 days and 1.64 days, respectively, for an absolute difference of 0.06 days (95% CI, –1.54 to 1.66). Conclusions and Relevance Use of a CT scan is not associated with a difference in intervention in children with peritonsillar abscesses. It is, however, associated with a clinically significant delay in treatment; namely, time to an otolaryngology consultation, time to admission, and time to bedside procedure.

Achievement of Target A1C <7.0% (<53 mmol/mol) by U.S. Type 2 Diabetes Patients Treated With Basal Insulin in Both Randomized Controlled Trials and Clinical Practice

Abstract: Objective. Many patients with type 2 diabetes do not reach glycemic goals despite basal insulin treatment. This study assessed the achievement of a target A1C Methods. This was a retrospective analysis of pooled randomized controlled trial (RCT) data, from 11 24-week studies of patients initiating basal insulin performed between 2000 and 2005 and of outpatient electronic medical record (EMR) data from the General Electric Centricity database for insulin-naive patients initiating basal insulin between 2005 and 2012. Baseline characteristics stratified by target A1C and fasting plasma glucose (FPG) attainment were compared descriptively. Results. In the RCT dataset, 49.0% of patients failed to achieve the target A1C at 6 months versus 72.4% and 72.9% at 6 and 12 months in the EMR dataset, respectively. Despite this, in the RCT dataset, 79.4% of patients achieved the target A1C and/or an FPG 7.0% had a longer diabetes duration and were more likely to be female, nonwhite, and self-funding or covered by Medicaid. Among patients with an A1C >7.0%, more RCT patients (58.0%) had an FPG Conclusion. Unmet needs remain after basal insulin initiation, particularly in real-world settings, where many patients require further insulin titration. In both populations, patients failing to achieve the target A1C despite attaining an FPG