Initial therapy with the fixed-dose combination of sitagliptin and metformin results in greater improvement in glycaemic control compared with pioglitazone monotherapy in patients with type 2 diabetes

AIMS

To evaluate the efficacy and safety of initial therapy with a fixed-dose combination (FDC) of sitagliptin and metformin compared with pioglitazone in drug-naÏve patients with type 2 diabetes.

METHODS

After a 2-week single-blind placebo run-in period, patients with type 2 diabetes, HbA1c of 7.5-12% and not on antihyperglycaemic agent therapy were randomized in a double-blind manner to initial treatment with a FDC of sitagliptin/metformin 50/500 mg twice daily (N = 261) or pioglitazone 30 mg per day (N = 256). Sitagliptin/metformin and pioglitazone were up-titrated over 4 weeks to doses of 50/1000 mg twice daily and 45 mg per day, respectively. Both treatments were then continued for an additional 28 weeks.

RESULTS

From a mean baseline HbA1c of 8.9% in both groups, least squares (LS) mean changes in HbA1c at week 32 were -1.9 and -1.4% for sitagliptin/metformin and pioglitazone, respectively (between-group difference = -0.5%; p < 0.001). A greater proportion of patients had an HbA1c of <7% at week 32 with sitagliptin/metformin vs. pioglitazone (57% vs. 43%, p < 0.001). Compared with pioglitazone, sitagliptin/metformin treatment resulted in greater LS mean reductions in fasting plasma glucose (FPG) [-56.0 mg/dl (-3.11 mmol/l) vs. -44.0 mg/dl (-2.45 mmol/l), p < 0.001] and in 2-h post-meal glucose [-102.2 mg/dl (-5.68 mmol/l) vs. -82.0 mg/dl (-4.56 mmol/l), p < 0.001] at week 32. A substantially greater reduction in FPG [-40.5 mg/dl (-2.25 mmol/l) vs. -13.0 mg/dl (-0.72 mmol/l), p < 0.001] was observed at week 1 with sitagliptin/metformin vs. pioglitazone. A greater reduction in the fasting proinsulin/insulin ratio and a greater increase in homeostasis model assessment of β-cell function (HOMA-β) were observed with sitagliptin/metformin than with pioglitazone, while greater decreases in fasting insulin and HOMA of insulin resistance (HOMA-IR), and a greater increase in quantitative insulin sensitivity check index (QUICKI) were observed with pioglitazone than with sitagliptin/metformin. Both sitagliptin/metformin and pioglitazone were generally well tolerated. Sitagliptin/metformin led to weight loss (-1.4 kg), while pioglitazone led to weight gain (3.0 kg) (p < 0.001 for the between-group difference). Higher incidences of diarrhoea (15.3% vs. 4.3%, p < 0.001), nausea (4.6% vs. 1.2%, p = 0.02) and vomiting (1.9% vs. 0.0%, p = 0.026), and a lower incidence of oedema (1.1% vs. 7.0%, p < 0.001), were observed with sitagliptin/metformin vs. pioglitazone. The between-group difference in the incidence of hypoglycaemia did not reach statistical significance (8.4 and 4.3% with sitagliptin/metformin and pioglitazone, respectively; p = 0.055).

CONCLUSION

Compared with pioglitazone, initial therapy with a FDC of sitagliptin and metformin led to significantly greater improvement in glycaemic control as well as a higher incidence of prespecified gastrointestinal adverse events, a lower incidence of oedema and weight loss vs. weight gain.

Evaluation of Pakgen 99mTc generators loaded with indigenous fission 99Mo

Fission produced 99Mo/99mTc generators, called Pakgen, have been manufactured at the PINSTECH generator production facility since 2000 for nuclear medicine applications in Pakistan. These generators were loaded with fission 99Mo imported from NTP South Africa. Recently production of fission 99Mo has begun in the Molybdenum-99 Production Facility at PINSTECH. Prior to use in the clinic, eight sets of generators were produced, 23 GBq and 74 GBq at time of calibration, and they were subjected to various quality control procedures recommended in the pharmacopoeia to assess their performance. The elution profile, volume, activity, pH, radionuclidic, chemical, radiochemical and biological purity, and expiry time of the eluates were examined. Labeling efficiency tests were also carried out with a number of the more widely used in vivo radiopharmaceutical kits like DTPA, MDP and MIBI. Performance of 99mTc generators loaded with locally produced and imported fission 99Mo was comparable, and the users of Pakgen generators were fully satisfied. The effect of a wet vs. a dry column on 99mTc yields of generators loaded with low and high activity was also studied for the first time.

The discovery of the soluble N-ethylmaleimide-sensitive factor attachment protein receptor complex and the molecular regulation of synaptic vesicle transmitter release: the 2010 Kavli Prize in neuroscience

Brain function depends on a crucial feature: The ability of individual neurons to share packets of information, known as quantal transmission. Given the sheer number of tasks the brain has to deal with, this information sharing must be extremely rapid. Synapses are specialized points of contact between neurons, where fast transmission takes place. Though the basic elements and functions of the synapse had been established since the 1950s, the molecular basis for regulation of fast synaptic transmitter release was not known 20 years ago. However, around 1990, crucial discoveries were made by Richard Scheller, James Rothman, and Thomas Südhof, leading a few years later to the formulation of the SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptor) hypothesis and a new understanding of the molecular events controlling vesicular release of transmitter in synapses. The 2010 Kavli Prize in neuroscience was awarded to these three researchers, "for their work to reveal the precise molecular basis of the transfer of signals between nerve cells in the brain."

Measurement of natural radioactivity from soil samples of Sind, Pakistan

Natural radioactivity has been measured from the soil samples collected from the Sind province of Pakistan. The measured activities of ²²⁶Ra, ²³²Th and ⁴⁰K were found in the range of 18-47, 24-69 and 254-769 Bq kg⁻¹, respectively. The calculated values of the absorbed dose rate in air and the annual effective dose were in the range of 33-87 nGy h⁻¹ and 0.16-0.43 mSv, respectively. The measured results of activity were found compatible with the worldwide findings.

Limits on neutrino emission from gamma-ray bursts with the 40 string IceCube detector

IceCube has become the first neutrino telescope with a sensitivity below the TeV neutrino flux predicted from gamma-ray bursts if gamma-ray bursts are responsible for the observed cosmic-ray flux above 10(18)  eV. Two separate analyses using the half-complete IceCube detector, one a dedicated search for neutrinos from pγ interactions in the prompt phase of the gamma-ray burst fireball and the other a generic search for any neutrino emission from these sources over a wide range of energies and emission times, produced no evidence for neutrino emission, excluding prevailing models at 90% confidence.

Reconstruction of a chronic late post-nephrectomy wound with an extended free latissimus dorsi flap

This report describes the case of a 74-year-old man who spontaneously developed a chronic loin and posterior thoracic wound 28 years after a nephrectomy and adjuvant radiotherapy for renal cell carcinoma. His wound was successfully managed surgically, with an ipsilateral free latissimus dorsi myocutaneous flap, the vascular pedicle of which was extended using 15cm saphenous vein grafts.