bluuebunny/crossref_metadata_2025_split huggingface dataset:
93-LB: Preferences and Health State Utilities Associated with Routes of Administration for Oral Semaglutide, Injectable Semaglutide, and Dulaglutide
Authors: BOYE KRISTINA , CUTTS KATELYN , STEWART KATIE , NORRBACKA KIRSI , GARCÍA-PÉREZ LUIS E. , MATZA LOUIS S. 
Published: June 2020

Objective: Previous studies have examined health state utilities (which are preference weightings for use in cost-effectiveness analyses) associated with injectable GLP-1 receptor agonists for treatment of type 2 diabetes (T2D). An oral formulation of semaglutide (sema) has recently become available. This study estimates health state utilities representing preferences associated with routes of administration for daily oral sema and two weekly injectable GLP-1 receptor agonists.
Methods: Participants with T2D in the UK valued four health state vignettes (drafted based on drug labels and device instructions for use) in time trade-off interviews to estimate preference-based utility scores. The vignettes had identical descriptions of T2D, but differed in treatment process: (1) daily simple oral treatment (tablets without specific administration requirements), (2) daily oral sema (tablet with administration requirements per product label), (3) weekly dulaglutide (dula) injection, (4) weekly sema injection.
Results: Interviews were completed by 201 participants (52.7% male; mean age=58.7). Preferences among routes of administration varied widely. Mean utilities were 0.890 for simple oral, 0.880 for oral sema, 0.878 for dula injection, and 0.859 for sema injection (with higher scores indicating greater preference). All pairwise comparisons found statistically significant differences among the four utility scores (p&lt;0.01), except the comparison between oral sema and dula which was not significant (p=0.49).
Conclusions: While some participants preferred daily oral treatment, others preferred one of the weekly injections. Results suggest that patient preferences for routes of administration cannot be compared using only the simplest descriptions (e.g., “oral” vs. “injectable”). The details of treatment administration and treatment frequency have an impact on preference and should be considered.

Disclosure
K. Boye: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Eli Lilly and Company. K. Cutts: Employee; Self; Evidera. K. Stewart: Employee; Self; Evidera. K. Norrbacka: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. L.E. García-Pérez: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. L.S. Matza: Employee; Self; Evidera.
930-P: Efficacy of Oral Semaglutide According to Race: An Exploratory Subgroup Analysis of the PIONEER Trial Program
Authors: DESOUZA CYRUS , AMOD ASLAM , KALLENBACH KLAUS , LIN PETER J. , NIELSEN MORTEN ABILDLUND , SØRRIG RASMUS , MONTANYA EDUARD 
Published: June 2020

The global PIONEER program investigated the efficacy and safety of oral semaglutide, a glucagon-like peptide-1 receptor agonist. Patients with type 2 diabetes were randomized to once-daily oral semaglutide (3, 7 or 14 mg, or flexibly dosed [flex]), placebo, or active comparator (empagliflozin 25 mg, sitagliptin 100 mg or liraglutide 1.8 mg). This exploratory subgroup analysis evaluated the effect of race on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of treatment (week 26, 52 or 78). Data were analyzed from PIONEER 1-5, 7 and 8 by race (White, Asian, Black/African American). Baseline characteristics were generally similar across subgroups except for BW, which was lower in Asian patients. Generally, greater HbA1c reductions were observed with oral semaglutide 14 mg/flex vs. comparators across subgroups (Table). In PIONEER 1, 4 and 8, there was a significant interaction between treatment and race, with greater HbA1c reductions and estimated treatment differences in Asian patients than in other subgroups (Table). Overall, BW reductions were greater for oral semaglutide vs. comparators, regardless of subgroup and without significant interactions between treatment and race. Our findings in this exploratory subgroup analysis suggest that, in some PIONEER trials, Asian patients achieve greater HbA1c reductions than other race groups when treated with oral semaglutide.

Disclosure
C. Desouza: Consultant; Self; AstraZeneca, Bayer AG, Novo Nordisk A/S. A. Amod: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis, Servier. Consultant; Self; Servier. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis, Servier. K. Kallenbach: None. P.J. Lin: Speaker’s Bureau; Self; Abbott, AstraZeneca, Bausch + Lomb, Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Mead Johnson Nutrition, Merck & Co., Inc., Novo Nordisk Inc., Sun Pharmaceutical Industries Ltd. Other Relationship; Self; Elsevier. M. Abildlund Nielsen: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. R. Sørrig: Employee; Self; Novo Nordisk A/S. E. Montanya: Advisory Panel; Self; Sanofi. Consultant; Self; Novartis Pharmaceuticals Corporation. Employee; Spouse/Partner; Almirall. Speaker’s Bureau; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S.

Funding
Novo Nordisk A/S
933-P: Greater Reductions in HbA1c and Body Weight with Once-Weekly Semaglutide vs. Comparators across Baseline BMI Subgroups: A Post Hoc Analysis of SUSTAIN 1-5 and 7-10
Authors: ARODA VANITA R. , FRENKEL OFIR , FRIAS JUAN P. , HINDSBERGER CHARLOTTE , GYLVIN SILAS H. , ROUX CAREL LE , MADSBAD STEN 
Published: June 2020

In the SUSTAIN trial program, once-weekly (OW) semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved for treatment of type 2 diabetes, significantly reduced HbA1c and body weight (BW) vs. all comparators, with a safety profile consistent with the GLP-1RA class. Patient factors (e.g., BMI) may impact therapeutic choices. This post-hoc analysis of SUSTAIN 1-5 and 7-10 evaluated change from baseline to end of treatment in HbA1c and BW with OW semaglutide vs. comparator by baseline BMI subgroup. On-treatment without rescue medication data were evaluated in the full analysis set. Mixed model for repeated measurements analyses evaluated interaction between treatment and BMI subgroup by trial. Overall, 572, 1,867, 2,103 and 2,217 subjects with BMI &lt;25, ≥25-&lt;30, ≥30-&lt;35 and ≥35 kg/m2, respectively, were evaluated. Estimated treatment difference for change in HbA1c favored semaglutide vs. comparator in most subgroups, and for BW favored semaglutide vs. comparator in all subgroups (Table). In general, treatment-by-subgroup interactions were nonsignificant (p&gt;0.05); however, BW reduction was greater with semaglutide 1.0 mg vs. insulin with increasing BMI (p=0.005).
In summary, semaglutide resulted in greater reductions in HbA1c and BW vs. comparators in SUSTAIN 1-5 and 7-10; this effect was generally observed across BMI subgroups.

Disclosure
V.R. Aroda: Consultant; Self; Duke, Novo Nordisk Inc., Sanofi. Employee; Spouse/Partner; Merck & Co., Inc. Research Support; Self; Applied Therapeutics, Fractyl Laboratories, Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; IMNE, Medscape. O. Frenkel: Employee; Self; Novo Nordisk A/S, Roche Pharma. J.P. Frias: Consultant; Self; Eli Lilly and Company, Gilead Sciences, Inc., LifeScan, Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; Allergan plc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb, Eli Lilly and Company, Intercept Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi. Speaker’s Bureau; Self; Merck & Co., Inc., Sanofi. C. Hindsberger: Consultant; Self; Novo Nordisk A/S. S.H. Gylvin: Employee; Self; Novo Nordisk A/S. C. le Roux: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., GI Dynamics Inc., Herbalife International of America, Inc., Johnson & Johnson, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; Lilly Diabetes. Stock/Shareholder; Self; Keyron. S. Madsbad: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S.

Funding
Novo Nordisk A/S
942-P: Treatment of Weight Regain after Bariatric Surgery: Real-World Comparative Outcomes
Authors: GAZDA CHELLSE , ALMANDOZ JAIME , LINGVAY ILDIKO , CLARK JOHN 
Published: June 2020

After bariatric surgery, people frequently do not achieve a healthy weight and/or regain weight. There is limited outcomes data on anti-obesity medications in patients with prior bariatric surgery. GLP-1RAs promote weight loss by decreasing gastric motility and appetite, yet post-prandial levels of GLP-1 are elevated after bariatric surgery. We evaluated weight outcomes in patients with prior bariatric surgery seen in an academic medical center’s weight management program. We compared the following groups: intensive lifestyle modification (ILM) vs. any GLP-1 RA (GLP-1) vs. any non-GLP-1 RA weight loss agents (non-GLP-1) vs. combination of weight loss agents including GLP-1 RA (GLP-1 combination). We included patients with a history of bariatric surgery, at least two clinic visits, and no anti-obesity medications at the initial visit. Data was extracted from the Electronic Medical Record and confirmed by manual chart review. All patients were counseled on lifestyle modification for weight loss. The two GLP-1-based treatment groups had significantly greater % weight loss at 3- and 6-months compared to the ILM group (Figure). In multivariable regression model, adjusting for baseline age and sex, surgery type did not (p=0.2 and p=0.97 for 3- and 6-mo analyses) influence outcome. GLP-1 RA therapies (alone or in combination) are effective for weight loss in patients with prior bariatric surgery, regardless of surgery type.

Disclosure
C. Gazda: None. J. Almandoz: None. I. Lingvay: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk A/S, Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Other Relationship; Self; Novo Nordisk A/S. J. Clark: None.
953-P: Real-World Effectiveness of Once-Weekly Semaglutide (Sema OW) from a U.S. Commercially Insured and Medicare Advantage Population
Authors: VISARIA JAY , UZOIGWE CHIOMA , SWIFT CAROLINE , PAPROCKI YUREK M. , WILLEY VINCENT 
Published: June 2020

Background: This study presents real-world evidence on effectiveness of sema OW in a large cohort of T2D patients.
Methods: Claims and lab result data were used to identify T2D patients who initiated sema OW between 2/1/18 - 4/30/19 (index as first claim). Patients selected had ≥1 A1c result within ≤3 months pre- and ≥3 months post-index. All patients and a group of patients persistent on sema OW (those with a sema OW prescription with days supply dispensed overlapping/in proximity of date of post-index A1c measurement) were assessed for A1c changes and were split into 4 subgroups: GLP-1 naïve, GLP-1 experienced and either group with pre-index A1c &gt;9%.
Results: Of 1,888 patients initiating sema OW, 57.8% were GLP-1 naïve. A1c was significantly reduced in all patients (-0.9%) and subgroups (p&lt;0.001, Figure 1). Persistent patients achieved a 1.1% A1c reduction, with similar or greater reductions across subgroups when compared to all patients. Attainment of A1c &lt;7% increased from 23% pre- to 49% post-index for all patients (20 to 30% pre to post increase in each subgroup, all p&lt;0.001).
Conclusion: Initiation of sema OW was associated with significant reduction in A1c and an increase in reaching A1c &lt;7% regardless of a prior history of GLP-1 use. Sema OW also provides significant change in A1c among patients whose A1c was not controlled on their previous GLP-1.

Disclosure
J. Visaria: None. C. Uzoigwe: Employee; Self; Novo Nordisk Inc. C. Swift: Employee; Self; Novo Nordisk Inc. Stock/Shareholder; Self; Novo Nordisk Inc. Y.M. Paprocki: Employee; Self; Novo Nordisk Inc. Stock/Shareholder; Self; Novo Nordisk A/S. V. Willey: Employee; Self; HealthCore.

Funding
Novo Nordisk
972-P: Liraglutide Attenuates Lipid-Induced Microvascular Insulin Resistance in Humans
Authors: LOVE KAITLIN , JAHN LINDA , HARTLINE LEE , LIU ZHENQI 
Published: June 2020

Insulin recruits skeletal and cardiac muscle microvasculature to increase insulin and nutrient delivery, but this action is lost in insulin resistant states. Glucagon-like peptide 1 (GLP-1) improves microvascular perfusion in humans with obesity and the GLP-1 receptor agonist liraglutide attenuates muscle microvascular insulin resistance (IR) in rodents. To examine whether GLP-1 receptor agonism improves insulin’s microvascular actions in humans with acute IR, 18 healthy human subjects randomly received a systemic infusion of either saline or lipid emulsion (20%, 45 mL x 1 h and then 30 mL x 4 h) for 5 h or lipid emulsion for 5 h + liraglutide pre-treatment (0.6, 1.2, then 1.8 mg daily SC each x 2 days) with euglycemic insulin clamp (1 mU/kg/min) superimposed for the last 120 min. Skeletal and cardiac muscle microvascular blood volume (MBV), flow-mediated dilation (FMD), pulse wave velocity (PWV), and augmentation index (AI) were determined before and after insulin clamp.
Compared with saline admission, insulin failed to increase MBV following lipid infusion in both skeletal (28.4 ± 14.1% vs. -1.3 ± 9.6% respectively, p=0.011) and cardiac (28.4 ± 14.1% vs. -1.3 ± 8.9%, p=0.027) muscle, consistent with acute IR induced by lipid infusion in both microvascular beds. Liraglutide pre-treatment improved insulin-mediated increases in MBV in the presence of lipid infusion in skeletal (8.9 ± 13.5%, p=0.117 vs. saline) and cardiac (12.6 ± 12.1%, p=0.101 vs. saline) muscle. There was no significant change in PWV, AI, or FMD amongst admissions. Glucose infusion rates were not significantly different amongst admissions (saline 6.02 ± 0.52, lipid 5.58 ± 0.62, vs. liraglutide + lipid 5.46 ± 0.46 mg/kg/min).
In conclusion, liraglutide pretreatment effectively ameliorates lipid-induced skeletal and cardiac muscle microvascular IR in healthy humans. These data provide a mechanistic insight into the metabolic and cardiovascular benefits of GLP-1 receptor agonism seen in humans with obesity and type 2 diabetes.

Disclosure
K. Love: None. L. Jahn: None. L. Hartline: None. Z. Liu: None.

Funding
American Diabetes Association (1-17-ICST-059 to Z.L.); National Institutes of Health (1R01DK102359-01A1)
974-P: Network Meta-analysis of Once Weekly Glucagon-Like Peptide-1 Receptor Agonists: A Focus on Cardiovascular Safety and Mortality
Authors: ALFAYEZ OSAMAH , ALMOHAMMED OMAR A. , ALKHEZI OMAR , AL YAMI MAJED S. 
Published: June 2020

Objective: To indirectly compare once weekly exenatide, semaglutide, albiglutide and dulaglutide regarding cardiovascular (CV) safety and mortality using network meta-analysis (NMA).
Methods: PubMed was searched to identify glucagon like peptide-1 receptor agonists (GLP-1RA) outcome trials (CVOTs) to date. The outcomes of interest were CV death, myocardial infarction (IM), nonfatal MI, stroke, nonfatal stroke, death from any cause, and hospitalizations for heart failure (HF). An NMA with binomial likelihood logit link model was used for the binary outcomes. We conducted both fixed effects and random effects models for each outcome, and selected the best model based on the deviance information and the average posterior residual deviance. Data were extracted by two independent reviewers and risk of bias was assessed in the same manner.
Results: The NMA results showed no significant differences among the four GLP-1RAs regarding most of the outcomes. However, albiglutide when compared to exenatide was associated with lower risk of MI (HR 0.76, 95% Cl: 0.60-0.96)] and nonfatal MI (HR 0.76, 95% Cl: 0.60-0.97). The ranking probability showed that semaglutide had the highest probability to be ranked first in reducing MI (55%), nonfatal MI (55%), stroke (87%), and nonfatal stroke events (87%). For CV death and death from any cause, exenatide had the highest probability to be ranked first at 30% and 45% respectively. Lastly, for hospitalizations for HF, albiglutide was ranked first with a probability of 55% followed by placebo.
Conclusion: This NMA did not show significant differences among the treatments. However, based on the ranking results, semaglutide seems to be the preferred agent over the other once weekly GLP-1RAs in patients with diabetes and CV risk.

Disclosure
O. Alfayez: None. O.A. Almohammed: None. O. Alkhezi: None. M.S. Al Yami: None.
975-P: Effect of Late Bolus Injections on Glycemic Variability Studied by Connected Pens
Authors: JENDLE JOHAN H. , HARTVIG NIELS V. , KAAS ANNE , MOLLER JONAS , MÅRDBY ANN-CHARLOTTE M. , CATRINA SERGIU-BOGDAN 
Published: June 2020

Mealtime injection of bolus insulin is critical for maintaining good glycemic control in patients with type 1 diabetes (T1D). It has previously been shown in a real-world setting that patients using connected pens had fewer missed mealtime injections of bolus doses as well as improved time-in-range (TIR) compared to baseline. This subgroup post-hoc study examined the effect of using connected pens on timing of bolus doses in adults and the relationship between timing of the insulin dose and glycemic variability. In a non-interventional study, conducted at 12 Swedish diabetes clinics, connected pens with bolus and/or basal insulin were prescribed to adults with T1D. Injection- and continuous glucose monitoring (CGM) data were collected at routine clinic visits. CGM data were also uploaded at home. These data were used by healthcare providers (HCPs) and patients during visits at the clinic. Meals were subsequently detected based on the CGM signals using the clinically validated Glucose Rate Increase Detector algorithm. A bolus dose given 60-120 minutes after the estimated start of the meal was defined as a late-bolus dose. In total 96 patients with 2238 days of acceptable CGM coverage (≥ 70%) were included in the analysis. The mean number of late-bolus doses decreased from 0.32 per day (95% CI [0.26;0.39]) at baseline to 0.18 per day [0.13;0.27] at follow-up, corresponding to a 42% reduction (p = 0.005). A significant correlation between the timing of the bolus dose and the coefficient of variation (CV) of the CGM signal was found; each 10-minute delay of the bolus dose was associated with an increase of 0.5% CV (p &lt; 0.0001) on average. This study confirms that timely injection of bolus doses relative to meals is correlated with a more stable glycemic control. Also, the results indicate that timely bolus dosing can be a challenge in everyday life but that data from connected pens may help support patient behavior through improved interaction with HCP.

Disclosure
J.H. Jendle: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Sanofi. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. N.V. Hartvig: Employee; Self; Novo Nordisk A/S. A. Kaas: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J. Moller: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. A.M. Mårdby: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. S. Catrina: None.
986-P: Assessment of Adhesive Patches for an Extended-Wear Infusion Set
Authors: ZHANG GINA , CHATTARAJ SARNATH , ANSELMO EVAN , HOFFMAN LANCE , TRAN MICHELLE , BONDY SHANNON 
Published: June 2020

Objective: The durability of wearable devices, e.g., insulin infusion sets (IIS), is challenged by external factors such as friction, movement, stretch, moisture, and skin viscoelasticity. Such factors are difficult to investigate in non-clinical settings. We assessed 3 new adhesive patches and compared them to those used with current Medtronic infusion sets to determine which would be suitable for an extended wear infusion set with intended wear time of up to 7 days.
Method: Seventy-five adults were recruited in 3 studies to wear 2 patch variants each on conventional IIS sites, for up to 8 days. Non-functional Medtronic pumps were used to simulate use conditions. The primary outcome was wear time. Secondary outcomes included edge lift and descriptive user feedback (e.g., appearance, comfort, irritation score, residue upon removal, and removal discomfort).
Results: The results (Figure 1) demonstrated that the 7-day survival rate for existing IIS patches varied from ∼70% to ∼90%. These data indicated that the hub form factor played an insignificant role in the adhesive patch wear time. Two of three new adhesive patches had a 7-day survival rate ≥95% without significantly impacting user experience (i.e., wear comfort or skin reactions).
Conclusion: In the simulated-use studies, two new adhesive patches met the primary and secondary outcomes for use with an extended wear infusion set.

Disclosure
G. Zhang: None. S. Chattaraj: Employee; Self; Medtronic. E. Anselmo: Employee; Self; Medtronic. L. Hoffman: None. M. Tran: None. S. Bondy: Employee; Self; Medtronic. Stock/Shareholder; Self; Medtronic.
989-P: Type 1 Diabetes: Real-World Insulin Injection Patterns
Authors: CATRINA SERGIU-BOGDAN , HARTVIG NIELS V. , KAAS ANNE , MOLLER JONAS , MÅRDBY ANN-CHARLOTTE M. , JENDLE JOHAN H. 
Published: June 2020

Multiple daily insulin injections are an integral part of life for patients with type 1 diabetes (T1D). Moreover, patients’ schedules can change from day-to-day, further complicating T1D management. This study aimed to analyze daily injection patterns for patients with T1D. This post-hoc observational study included children and adults with T1D from Sweden using NovoPen® 6 with bolus insulin (primarily insulin aspart) and/or basal insulin (primarily insulin degludec). Injection data were uploaded via the Glooko® cloud system. Daily bolus and basal injections timing profiles were documented, weighting each dose relative to the total daily dose. Time difference between two consecutive basal insulin injections was used to evaluate basal timing variation. In total 159 adults and 47 children were included in the analysis, with a total of 38678 days of bolus injections and 17869 days of basal injections. The mean bolus daily injection profile displayed peaks at typical mealtimes but with substantial variation across patients and between adults and children (Figure 1). In those receiving insulin degludec timing of consecutive basal injections differed by more than 6 hr in ∼9% of the injections for adults and 7% for children. These real-world data give a unique insight into the bolus and basal adherence of pediatric and adult patients with T1D. Furthermore, the results illustrate the flexibility needed for basal injections to enable optimal management of T1D.

Disclosure
S. Catrina: None. N.V. Hartvig: Employee; Self; Novo Nordisk A/S. A. Kaas: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J. Moller: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. A.M. Mårdby: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J.H. Jendle: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Sanofi. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S, Sanofi.