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Abstract
Thiazolidinediones (TZDs) are relatively new agents for the treatment of type 2 diabetes. They act as agonists at the PPAR-gamma nuclear receptor and their therapeutic effects include decreased insulin resistance and hyperglycaemia, an improved plasma lipid, inflammation and pro-coagulant profile, and amelioration of hypertension, microalbuminuria and hepatic steatosis. The most common side effects of TZDs include weight gain and oedema, with occasional reports of congestive heart failure (CHF). This review discusses the benefit-risk profile of TZDs in treating patients with type 2 diabetes, with particular reference to the heart. To provide context, we explore briefly the epidemiology and pathophysiology of heart failure in patients with type 2 diabetes, touch on the association of heart disease and cardiovascular mortality with antihyperglycaemic treatment modalities other than TZDs, and then focus on the effects of TZDs on the heart, cardiovascular risk factors and outcomes. We describe the cluster of host factors, which seems to predispose patients with type 2 diabetes to TZD-induced or TZD-exacerbated oedema and CHF and then provide an overview of the putative mechanisms of these TZD-related side effects. We also propose that certain diuretics (amiloride and spironolactone), by targeting the distal nephron that expresses PPARgamma in collecting duct cells, might be of benefit in ameliorating the fluid retention and oedema associated with TZDs.
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Affiliation(s)
- R E Buckingham
- Unit for Metabolic Medicine, Department of Diabetes & Endocrinology, Cardiovascular Division, King's College London School of Medicine, Guy's Hospital, King's College London, London UK.
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Kar P, Holt RIG. The effect of sulphonylureas on the microvascular and macrovascular complications of diabetes. Cardiovasc Drugs Ther 2008; 22:207-13. [PMID: 18288596 DOI: 10.1007/s10557-008-6090-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/24/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Type 2 diabetes mellitus is a chronic progressive disease that is characterised by hyperglycaemia and is associated with an increased risk of the development of microvascular complications, such as retinopathy, nephropathy and neuropathy, and cardiovascular disease. With the introduction of newer oral hypoglycaemic agents, there is a need to re-evaluate critically the effectiveness and safety of the older agents, including sulphonylureas, to assess their place in the modern management of type 2 diabetes. BACKGROUND Though no clear benefit of sulphonylureas has been shown with respect to large vessel disease, long term studies have, however, shown benefits in patients with microvascular complications. Studies such as the University Group Diabetes Project raised concerns about the safety profile of sulphonylureas, but large prospective studies such as the UK Prospective Diabetes Study have helped to assuage such concerns to a large degree. Their utility in the peri-infarct period continues to be debatable because of the potential effect on cardiac pre-conditioning. CONCLUSION Though sulphonylureas continue to be a mainstay of treatment in type 2 diabetes, future clinical trials addressing clinically relevant outcomes are indicated with the newer generation of sulphonylureas that are more beta cell-specific to address the concerns raised about sulphonylureas and cardiac myocytes.
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Affiliation(s)
- Partha Kar
- Development Origins of Health and Disease Division, School of Medicine, University of Southampton, Southampton, UK
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53
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Riddle MC. Combined therapy with insulin plus oral agents: is there any advantage? An argument in favor. Diabetes Care 2008; 31 Suppl 2:S125-30. [PMID: 18227472 DOI: 10.2337/dc08-s231] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matthew C Riddle
- Section of Diabetes L-345, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97201, USA.
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Pallardo Sánchez L. Sulfonilureas en el tratamiento del paciente con diabetes mellitus tipo 2. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1575-0922(08)76259-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Goldstein BJ. Clinical translation of "a diabetes outcome progression trial": ADOPT appropriate combination oral therapies in type 2 diabetes. J Clin Endocrinol Metab 2007; 92:1226-8. [PMID: 17409340 DOI: 10.1210/jc.2006-2858] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- Barry J Goldstein
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Suite 349, 1020 Locust Street, Philadelphia, Pennsylvania 19107-6799, USA.
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56
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Abstract
Sulfonylureas and similarly acting rapid insulin secretagogues have long been available to manage type 2 diabetes. These agents have a well understood mechanism of action and are in large part well tolerated. However, sulfonylurea therapy is unlikely to sustain adequate long-term glycemic control and has potential side effects, including hypoglycemia and weight gain. Additional concerns exist regarding detrimental effects of certain sulfonylureas on ischemic preconditioning and cardiac outcomes. Fortunately, newer agents such as glimepiride appear less likely to adversely affect the myocardium. These agents can often be used successfully as one component of combination therapy for diabetes management.
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Affiliation(s)
- Jennifer B Green
- Duke University Medical Center, Division of Endocrinology, DUMC Box 3222, Baker House, Room 280, Durham, NC 27710, USA.
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57
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Magee MF, Isley WL. Rationale, design, and methods for glycemic control in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial. Am J Cardiol 2006; 97:20G-30G. [PMID: 16813735 DOI: 10.1016/j.amjcard.2006.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A major therapeutic question in considering accelerated atherogenesis in patients with type 2 diabetes mellitus is whether reducing insulin resistance, as a proximal defect of a host of proatherogenic abnormalities including hyperglycemia, will be superior for decreasing mortality and coronary artery disease (CAD) risk compared with treating hyperglycemia to overcome insulin resistance with insulin-providing agents. This question is highly relevant, since earlier targeted glycemic control trials utilizing conventional glucose-lowering strategies that increase insulin levels have generally failed to reduce CAD risk despite markedly reducing microvascular risk. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial seeks to determine whether primarily using an insulin-sensitizing strategy for treatment of type 2 diabetes is superior when compared with primarily using an insulin-providing strategy with regard to cardiovascular outcomes. This article presents the rationale, design, and methods being used to test the glycemic control hypothesis in BARI 2D.
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Affiliation(s)
- Michelle F Magee
- MedStar Diabetes Institute, MedStar Research Institute at Washington Hospital Center and Georgetown University Hospital, Washington, DC 20010, USA.
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58
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Rosenberg DE, Jabbour SA, Goldstein BJ. Insulin resistance, diabetes and cardiovascular risk: approaches to treatment. Diabetes Obes Metab 2005; 7:642-53. [PMID: 16219008 DOI: 10.1111/j.1463-1326.2004.00446.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of diabetes is increasing worldwide. Insulin resistance and diabetes mellitus are major predictors of cardiovascular ischaemic disease. Other risk factors for cardiovascular death including hypertension, dyslipidaemia, smoking and visceral obesity are especially lethal in diabetics. C-reactive protein, plasminogen activator inhibitor-1, matrix metalloproteinases and other emerging risk factors and their roles are continually being researched and discovered. Treatment of this syndrome must be aimed at lifestyle modification, glycaemic control and management of concomitant risk factors. Diet and exercise play a vital role in the treatment of diabetes and the metabolic syndrome. Weight reduction and increased physical activity will improve insulin resistance, hyperglycaemia, hypertension and dyslipidaemia. Hypertension management has been shown to be especially important in diabetics to prevent cardiovascular events. Likewise, multiple clinical trials show that reduction of cholesterol is even more vital in diabetics than the general population for risk reduction of coronary disease. There is a great deal of evidence that tight control of glycaemia is essential to treatment of this condition. There are a variety of available pharmacological agents available including metformin, insulin secretagogues, alpha-glucosidase inhibitors, thiazolidinediones and insulin. The mechanisms and side effects of these medications are discussed. As macrovascular disease is the major cause of morbidity and mortality, an early, aggressive, multi-factorial approach to treatment of the metabolic syndrome and diabetes is vital to prevent adverse cardiac outcomes.
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Affiliation(s)
- Daniel E Rosenberg
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA
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59
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Flynn DM, Smith AH, Treadway JL, Levy CB, Soeller WC, Boettner WA, Wisniecki P, Plowchalk DR, Gernhardt SS, Tracey WR, Knight DR. The Sulfonylurea Glipizide Does Not Inhibit Ischemic Preconditioning in Anesthetized Rabbits. Cardiovasc Drugs Ther 2005; 19:337-46. [PMID: 16382296 DOI: 10.1007/s10557-005-4970-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The K(ATP) channel blocker glibenclamide inhibits cardioprotection afforded by ischemic preconditioning (IPC), raising concern about sulfonylurea use by patients with cardiovascular disease. We examined the effects of the widely prescribed sulfonylurea glipizide (Glucotrol XL(R) ) on IPC in anesthetized rabbits. Initially, in parallel studies in pentobarbital-anesthetized rabbits, we identified doses of glipizide (GLIP, 0.17 mg/kg + 0.12 mg/kg/h, IV) and glibenclamide (GLIB, 0.05 mg/kg + 0.03 mg/kg/h, IV) that produced steady-state, clinically relevant plasma levels of both drugs; these doses also significantly increased plasma insulin by 51 +/- 17% (GLIP) and by 57 +/- 17% (GLIB, both p < 0.05 vs. their respective baseline levels). Subsequent parallel studies in ketamine-xylazine-anesthetized rabbits examined the effects of these doses of GLIP and GLIB on IPC. Myocardial injury (30 min coronary occlusion/120 min reperfusion), either with or without IPC (5 min occlusion/10 min reperfusion) was induced midway during a 2 h infusion of vehicle (VEH), GLIP or GLIB (n = 10-11 each). Infarct area (IA) normalized to area-at-risk (%IA/AAR) was 62 +/- 3% in the VEH group, and was significantly reduced to 39 +/- 5% by IPC (p < 0.05 vs. VEH). Neither GLIP nor GLIB treatment had any effect on %IA/AAR in the absence of IPC (p > 0.05). IPC-induced cardioprotection was preserved in the GLIP + IPC treatment group (45 +/- 4%) when compared to VEH alone (p < 0.05), but was attenuated in the presence of GLIB (GLIB+IPC: 53 +/- 4% IA/AAR, p > 0.05 vs. VEH). Thus, at a clinically relevant plasma concentration, glipizide did not limit the cardioprotective effects of IPC, and is unlikely to increase the severity of cardiac ischemic injury.
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Affiliation(s)
- David M Flynn
- Department of Cardiovascular, Metabolic and Endocrine Diseases, Pfizer Global Research and Development, Pfizer Inc., Groton, CT 06340, USA
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60
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Deedwania PC, Fonseca VA. Diabetes, prediabetes, and cardiovascular risk: shifting the paradigm. Am J Med 2005; 118:939-47. [PMID: 16164876 DOI: 10.1016/j.amjmed.2005.05.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 05/04/2005] [Accepted: 05/04/2005] [Indexed: 02/08/2023]
Abstract
As the prevalence of diabetes continues to increase worldwide, diabetes-related macrovascular morbidity and mortality are becoming major health care problems. Epidemiologic evidence suggests this relationship begins early in the progression from normal glucose tolerance to frank diabetes. This report reviews this epidemiologic evidence linking early stages of glucose dysregulation with cardiovascular disease and discusses the results of major clinical trials demonstrating that lifestyle or pharmacologic intervention can reduce the incidence of diabetes in high-risk individuals. These observations indicate that early identification and aggressive treatment of subjects with impaired fasting glucose or impaired glucose tolerance have the potential to reduce both the incidence of diabetes and its related cardiovascular disease. Three clinical trials are being conducted to test whether early pharmacotherapy can reduce or delay the incidence of diabetes, and their results may well begin to shift the treatment paradigm toward earlier intervention.
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Affiliation(s)
- Prakash C Deedwania
- Division of Cardiology, Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco Medical Education Program, Fresno, 93703, USA.
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61
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Kristiansen SB, Nielsen-Kudsk JE, Bøtker HE, Nielsen TT. Effects of KATP channel modulation on myocardial glycogen content, lactate, and amino acids in nonischemic and ischemic rat hearts. J Cardiovasc Pharmacol 2005; 45:456-61. [PMID: 15821441 DOI: 10.1097/01.fjc.0000159045.35241.95] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ATP-sensitive potassium (KATP) channels are involved in the mechanisms underlying ischemic preconditioning. KATP channels open during ischemia, presumably secondary to intracellular metabolic alterations. The direct effects of KATP channel modulation on myocardial metabolism have not been studied. The aim of the present study was to investigate whether a KATP opener (diazoxide) and blocker (glibenclamide) modulates myocardial glycogen, lactate, and amino acid content before, during, and after ischemia. In isolated perfused rat hearts, we investigated the effect of diazoxide (30 microM) and glibenclamide (10 microM) administered 15 minutes before ischemia on myocardial glycogen, lactate, and amino acid content before, during, and after ischemia. Diazoxide increased left-ventricular developed pressure during reperfusion (P < 0.05) and decreased myocardial glycogen depletion (P < 0.05) and lactate accumulation (P < 0.05) during ischemia compared with the control group. Glibenclamide decreased myocardial glycogen content (P < 0.05) and increased myocardial lactate (P < 0.05) and alanine (P < 0.05) content before ischemia and reduced myocardial glycogen content after ischemia (P < 0.05) compared with control. KATP channel activation by diazoxide modulates myocardial metabolism. These findings suggest that activation of KATP channels protects against ischemia-reperfusion injury by a mechanism that involves decreased energy depletion.
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Affiliation(s)
- Steen B Kristiansen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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62
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Yuriev E, Kong DCM, Iskander MN. Investigation of structure-activity relationships in a series of glibenclamide analogues. Eur J Med Chem 2005; 39:835-47. [PMID: 15464617 DOI: 10.1016/j.ejmech.2004.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Revised: 06/11/2004] [Accepted: 06/14/2004] [Indexed: 12/25/2022]
Abstract
In this study, the synthesis of 15 new glibenclamide analogues is described. The conformational trends of these analogues were investigated using Monte Carlo conformational analysis. The conformational analysis results resolved the discrepancy between previous molecular modelling simulations of glibenclamide and allowed rationalizing the effect of aqueous environment on the overall conformation. The 3D-QSAR study was carried out with respect to the compounds' ability to antagonize the [(3)H]-glibenclamide binging in rat cerebral cortex. Superimposition of the antagonists was performed using the conformations derived from atom-by-atom fit to the glibenclamide crystal structure and this alignment was used to develop CoMFA models. CoMFA provided a good predictability: number of PLS components = 2, q(2) = 0.876, R(2) = 0.921, SEE = 0.455 and F = 70. Best CoMFA models showed the steric and lipophilic properties as the major interacting forces whilst the electrostatic property contribution was a minor factor.
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Affiliation(s)
- Elizabeth Yuriev
- Department of Medicinal Chemistry, Victorian College of Pharmacy, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
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63
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Riddle MC. Glycemic management of type 2 diabetes: an emerging strategy with oral agents, insulins, and combinations. Endocrinol Metab Clin North Am 2005; 34:77-98. [PMID: 15752923 DOI: 10.1016/j.ecl.2004.12.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The many antihyperglycemic preparations are best used for type 2 diabetes in a logical sequence, using combinations of agents, with clear targets for glycemic control. On the basis of long familiarity, proven benefit and known side effects, and low cost, the sulfonylureas, metformin, and insulin still deserve to be the standard treatments. As shown in the central shaded area of Fig. 4, standard treatment begins with monotherapy and progresses to oral combination therapy and then to two oral agents plus basal insulin. Several triggers for deviation from the standard methods are identified (see Fig. 4). The incidence of each of the conditions that require early individualized treatment has not been studied, but it seems reasonable to estimate no more than 10% each for a strongly symptomatic presentation, inability to use a sulfonylurea or metformin, inability to use insulin, or an early need for prandial therapy. If this estimate is correct, approximately two thirds of patients who are diagnosed with type 2 diabetes should do well with standard therapy for up to 10 years using the standard methods shown. Eventually, many more will need individualized treatment to maintain glycemic control. This scheme is certain to evolve as further information on the nonglycemic benefits (or hazards) of the various therapies appears and as new treatments are released. Notably, agents that mimic or potentiate the effects of gastrointestinal peptides, such as amylin and GLP- 1 analogues and dipeptidyl peptidase IV inhibitors, are likely to alter the current algorithm. For now, systematic application of the scheme (see Fig. 4) should improve the success of treatment greatly from its currently disappointing level.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, 3181 SW Sam Jackson Park Drive, Portland, OR 97239-3098, USA.
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64
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Bethel MA, Alexander J, Lane J, Barkauskas C, Feinglos MN. Diabetes on a Cardiovascular Ward: Adherence to Current Recommendations. South Med J 2004; 97:1031-7. [PMID: 15586590 DOI: 10.1097/01.smj.0000140853.71806.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Improving diabetes and blood pressure control decreases the incidence and progression of microvascular disease. Likewise, screening for microvascular complications is beneficial in the early detection and treatment of these disorders. However, adherence to practice guidelines for screening and treatment in patients with diabetes is suboptimal. This study describes a group of patients with diabetes who were admitted to a cardiology service at an academic medical center. METHODS Patient interview and chart review were used to determine glycemic control and compliance with practice guidelines. RESULTS The mean hemoglobin A1c was 8.3%. Only 69% of patients received ophthalmologic examinations, and fewer were screened for nephropathy. Thirty-five percent of patients monitored home blood glucoses less than daily. Nearly 17% had no hemoglobin A1c or lipid checks during the 3 months before admission. CONCLUSIONS For a group of poorly controlled patients with diabetes who are at high risk for cardiovascular disease, adherence to practice guidelines and the level of diabetes control is inadequate.
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Affiliation(s)
- M Angelyn Bethel
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, and Duke University School of Medicine, Durham, NC 27710, USA
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Xu S, Zhu B, Teffera Y, Pan DE, Caldwell CG, Doss G, Stearns RA, Evans DC, Beconi MG. METABOLIC ACTIVATION OF FLUOROPYRROLIDINE DIPEPTIDYL PEPTIDASE-IV INHIBITORS BY RAT LIVER MICROSOMES. Drug Metab Dispos 2004; 33:121-30. [PMID: 15486074 DOI: 10.1124/dmd.104.001842] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The current study evaluated the potential for two dipeptidyl peptidase-IV (DPP-IV) inhibitor analogs (1S)-1-(trans-4-([(4-trifluoromethoxyphenyl)sulfonyl]amino)cyclohexyl)-2-[(3S)-3-fluoropyrrolidin-1-yl]-2-oxoethanaminium chloride and (1S)-1-(trans-4-([(2,4-difluorophenyl)sulfonyl]amino)cyclohexyl)-2-[(3S)-3-fluoropyrrolidin-1-yl]-2-oxoethanaminium chloride (MRL-A and MRL-B), containing a fluoropyrrolidine moiety in the structure, to undergo metabolic activation. The irreversible binding of these tritium-labeled compounds to rat liver microsomal protein was time- and NADPH-dependent and was attenuated by the addition of reduced glutathione (GSH) or N-acetylcysteine (NAC) to the incubation, indicating that chemically reactive intermediates were formed and trapped by these nucleophiles. Mass spectrometric analyses and further trapping experiments with semicarbazide indicated that the fluoropyrrolidine ring had undergone sequential oxidation and defluorination events resulting in the formation of GSH or NAC conjugates of the pyrrolidine moiety. The bioactivation of MRL-A was catalyzed primarily by rat recombinant CYP3A1 and CYP3A2. Pretreatment of rats with prototypic CYP3A1 and 3A2 inducers (pregnenolone-16alpha-carbonitrile and dexamethasone) enhanced the extent of bioactivation which, in turn, led to a higher degree of in vitro irreversible binding to microsomal proteins (5- and 9-fold increase, respectively). Herein, we describe studies that demonstrate that the fluoropyrrolidine ring is prone to metabolic activation and that GSH or NAC can trap the reactive intermediates to form adducts that provide insight into the mechanisms of bioactivation.
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Affiliation(s)
- Shiyao Xu
- Department of Drug Metabolism, Merck Research Laboratories, P.O. Box 2000, RY80E-200, Rahway, NJ 07065-0900, USA.
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Lien LF, Angelyn Bethel M, Feinglos MN. In-hospital management of type 2 diabetes mellitus. Med Clin North Am 2004; 88:1085-105, xii. [PMID: 15308391 DOI: 10.1016/j.mcna.2004.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The increasing prevalence of type 2 diabetes brings with it a need to understand the particular impact of hospitalization in this patient population. Type 2 diabetes has been shown to increase length of stay, infection, and mortality rates. To optimize inpatient care, it is important to understand target glycemic goals as well as in-hospital glucose monitoring and diabetes management goals. A practical review of regimens for subcutaneous insulin administration,intravenous insulin infusion, and inpatient use of oral agents is presented. Methods for achieving adequate preparation and education of the patient and family for discharge to the outpatient setting are also discussed.
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Affiliation(s)
- Lillian F Lien
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University Medical Center, Box 3921, Durham, NC 27710, USA.
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