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Montanya E. A comparison of currently available GLP-1 receptor agonists for the treatment of type 2 diabetes. Expert Opin Pharmacother 2012; 13:1451-67. [PMID: 22725703 DOI: 10.1517/14656566.2012.692777] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Glucagon-like peptide-1 (GLP-1) receptor agonists are a valuable addition to the type 2 diabetes armamentarium. They increase insulin secretion and reduce glucagon secretion in a glucose-dependent manner, posing a relatively low hypoglycemia risk. GLP-1 receptor agonists also offer weight-loss benefits. Because GLP-1 receptor agonists are relatively new agents, there is limited direction on their use. AREAS COVERED This article aims to provide guidance to physicians when considering GLP-1 receptor agonist use in individual patients. It examines the clinical profiles of the currently available GLP-1 receptor agonists: exenatide twice-daily (BID), liraglutide once daily and exenatide extended release (ER) once weekly. Phase III clinical trial data on efficacy, safety and patient satisfaction are compared, with a primary focus on head-to-head trials. EXPERT OPINION Liraglutide seems to be the most effective GLP-1 receptor agonist in terms of HbA(1c) reduction and weight loss. Exenatide BID may offer an advantage where postprandial glucose control is a primary concern. Exenatide ER generally outperforms exenatide BID and is a good option for patients who struggle to adhere to more frequent regimens. The future may hold interesting developments in terms of reduced dosing frequency, oral formulations and alternative therapeutic uses.
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Affiliation(s)
- Eduard Montanya
- Endocrine Unit, Hospital Universitari Bellvitge-IDIBELL, Barcelona, Spain.
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Pencek R, Brunell SC, Li Y, Hoogwerf BJ, Malone J. Exenatide once weekly for the treatment of type 2 diabetes mellitus: clinical results in subgroups of patients using different concomitant medications. Postgrad Med 2012; 124:33-40. [PMID: 22913892 DOI: 10.3810/pgm.2012.07.2568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE In this pooled analysis, the efficacy and tolerability of exenatide once weekly (EQW) in patients categorized by baseline concomitant glucose-lowering therapy were evaluated. METHODS This post hoc analysis included data from the intent-to-treat populations of 7 randomized controlled trials in which patients with type 2 diabetes mellitus were treated with EQW for 24 to 30 weeks. Patients were classified into subgroups on the basis of their baseline glucose-lowering therapy: diet and exercise only, metformin (MET) only, MET + sulfonylurea (SU), SU ± other (thiazolidinedione [TZD] only or MET + TZD), or TZD ± MET. Changes from baseline in key efficacy endpoints and tolerability were analyzed by baseline concomitant glucose-lowering therapy group. RESULTS A total of 1719 patients were included. Treatment with EQW was associated with significant improvements from baseline in glycated hemoglobin levels, fasting glucose levels, and body weight in all of the groups. There were significant decreases from baseline for both systolic blood pressure and diastolic blood pressure in the MET and MET + SU groups, and a significant decrease in systolic blood pressure in the diet and exercise group. Lipid profiles generally improved in the diet and exercise, MET only, MET + SU, and TZD ± MET groups. Overall, the most frequent adverse events with EQW treatment, other than hypoglycemia, were nausea (14.7%), diarrhea (10.9%), and nasopharyngitis (7.2%). There was a higher incidence of hypoglycemia when EQW was added to regimens that included an SU. CONCLUSION The addition of EQW for 24 to 30 weeks to regimens that included a wide variety of background glucose-lowering therapies was associated with significant improvements in glycemic control and weight loss. The tolerability profile of EQW appeared to be similar regardless of background therapy, except for a higher incidence of minor hypoglycemia when EQW was added to regimens that included an SU.
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Pencek R, Blickensderfer A, Li Y, Brunell SC, Anderson PW. Exenatide twice daily: analysis of effectiveness and safety data stratified by age, sex, race, duration of diabetes, and body mass index. Postgrad Med 2012; 124:21-32. [PMID: 22913891 DOI: 10.3810/pgm.2012.07.2567] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exenatide, a glucagon-like peptide-1 receptor agonist, is used twice daily (BID) as monotherapy or adjunctive therapy for the improvement of glycemic control in patients with type 2 diabetes mellitus. The purpose of this pooled analysis was to evaluate the safety and efficacy of exenatide BID in patients stratified by various demographic characteristics. METHODS This post hoc analysis included data from 16 randomized controlled trials in which patients with type 2 diabetes mellitus were treated with 10-μg exenatide BID. Each patient was classified into subgroups on the basis of his or her baseline values for age (< 65 or ≥ 65 years), sex (male or female), race (white, black, Asian, or Hispanic), duration of diabetes (< 10 years or ≥ 10 years), and body mass index (BMI; ≥ 20 to < 25, ≥ 25 to < 30, ≥ 30 to < 35, or ≥ 35 kg/m(2)). RESULTS A total of 2067 patients were included. All groups experienced significant improvements in glycated hemoglobin, fasting plasma glucose levels (other than black patients, who had a relatively low baseline fasting plasma glucose level), and body weight from baseline to endpoint. Most groups had significant improvements in systolic blood pressure. All of the age, sex, and duration of diabetes groups experienced significant improvements in lipid levels (other than high-density lipoprotein cholesterol). Whites and Asians generally experienced significant improvements in lipid levels, whereas blacks and Hispanics did not. Significant improvements in lipid levels were generally seen across BMI groups. The most common adverse events overall were nausea (38.6%), hypoglycemia (28.4%), and vomiting (14.0%). Hypoglycemia was more common overall in patients who were taking a concomitant sulfonylurea than it was in patients who were not. CONCLUSION In this pooled analysis, exenatide BID improved glycemic control and body weight, and had generally beneficial effects on blood pressure and lipid levels in patients regardless of baseline age, sex, race, duration of diabetes, or BMI. Gastrointestinal events were the most common adverse events. TRIAL REGISTRATION www.ClinicalTrials.gov [NCT00039026, NCT00039013, NCT00082381, NCT00035984, NCT00082407, NCT00381342, NCT00360334, NCT00375492, NCT00603239, NCT00765817, NCT00577824, NCT00434954].
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Mannucci E. Insulin therapy and cancer in type 2 diabetes. ISRN ENDOCRINOLOGY 2012; 2012:240634. [PMID: 23209929 PMCID: PMC3504371 DOI: 10.5402/2012/240634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/03/2012] [Indexed: 01/27/2023]
Abstract
Despite the availability of many other agents, insulin is widely used as a treatment for type 2 diabetes. In vitro, insulin stimulates the growth of cancer cells, through the interaction with insulin-like growth factor-1 (IGF-1) receptors and its own receptors. In observational surveys on type 2 diabetes, insulin therapy is associated with an increased incidence of several forms of cancer, although it is difficult to discriminate the effect of confounders from that of insulin itself. Randomized trials do not confirm the increased risk associated with insulin therapy, although they do not allow to rule out some negative effects on specific forms of cancer, at least at higher doses. Among insulin analogues, glargine has a higher affinity for the IGF-1 receptor and a greater mitogenic potency in vitro than human insulin, but it is extensively metabolized in vitro to products with low IGF-1 receptor affinity. Overall, epidemiological studies suggest a possible increase of risk with glargine, with respect to human insulin, only at high doses and for some forms of cancer (i.e., breast). Data from clinical trials do not confirm, but are still insufficient to totally exclude, such increased risk. However, beneficial effects of insulin outweigh potential cancer risks.
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Affiliation(s)
- Edoardo Mannucci
- Agenzia Diabetologia, Ponte Nuovo, Ospedale di Careggi, Via delle Oblate, 4-50141 Firenze, Italy
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Lajara R. Use of the dipeptidyl peptidase-4 inhibitor linagliptin in combination therapy for type 2 diabetes. Expert Opin Pharmacother 2012; 13:2663-71. [DOI: 10.1517/14656566.2012.741591] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wang CCL, Reusch JEB. Diabetes and cardiovascular disease: changing the focus from glycemic control to improving long-term survival. Am J Cardiol 2012; 110:58B-68B. [PMID: 23062569 PMCID: PMC3480668 DOI: 10.1016/j.amjcard.2012.08.036] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diabetes mellitus (DM) is the fifth-leading cause of death worldwide and contributes to leading causes of death, cancer and cardiovascular disease, including CAD, stroke, peripheral vascular disease, and other vascular disease. While glycemic management remains a cornerstone of DM care, the co-management of hypertension, atherosclerosis, cardiovascular risk reduction, and prevention of long-term consequences associated with DM are now well recognized as essential to improve long-term survival. Clinical trial evidence substantiates the importance of glycemic control, low-density cholesterol-lowering therapy, blood pressure lowering, control of albuminuria, and comprehensive approaches targeting multiple risk factors to reduce cardiovascular risk. This article presents a review of the role of DM in the pathogenesis of atherosclerosis and cardiac dysfunction, recent evidence on the degree of glycemic control and mortality, and available evidence for a multifaceted approach to improve long-term outcomes for patients.
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Affiliation(s)
- Cecilia C Low Wang
- University of Colorado Anschutz Medical Campus, Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Aurora, Colorado, and Denver Veterans Affairs Medical Center, Denver, Colorado 80045, USA.
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Joshi PH, Kalyani RR, Blumenthal RS, Donner TW. Cardiovascular effects of noninsulin, glucose-lowering agents: need for more outcomes data. Am J Cardiol 2012; 110:32B-42B. [PMID: 23062565 DOI: 10.1016/j.amjcard.2012.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Macrovascular complications of type 2 diabetes mellitus (DM) are primarily driven by the combination of underlying atherosclerosis and propensity for thrombosis. Prevention of macrovascular complications in DM relies on therapies directed at multiple coexisting intermediary pathophysiologies that contribute to cardiovascular events, including hyperglycemia, lipoprotein abnormalities, hypertension, inflammation, and propensity for thrombosis. Multiple noninsulin, glucose-lowering agents have been developed that effectively lower blood glucose levels. This review explores the literature on the cardiovascular benefits and harms associated with these therapies, with an emphasis on cardiovascular outcomes when available. The lack of long-term data on cardiovascular outcomes regarding safety and efficacy of available traditional glucose-lowering agents has led to recommendations for more thorough evaluations of new therapies before approval. Furthermore, recent data suggest harm from intensive hemoglobin A(1c) reductions. Accordingly, there are multiple, large, cardiovascular-event driven phase 3-4 trials of therapies from the incretin axis currently enrolling. Recommendations for a therapeutic approach with noninsulin, glucose-lowering agents for the prevention of cardiovascular events in patients with type 2 DM are provided based on current data. Ultimately, multifactorial risk interventions, including lifestyle modifications, antihyperglycemic agents, antihypertensives, statins, and aspirin remain the primary focus to prevent macrovascular complications in patients with type 2 DM.
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Affiliation(s)
- Parag H Joshi
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Abstract
Diabetes mellitus (DM) and congestive heart failure (HF) commonly coexist in the same patient, and the presence of DM in HF patients is associated with increased adverse events compared with patients without DM. Recent guidelines regarding glycemic control stress individualization of glycemic therapy based on patient comorbid conditions and potential adverse effects of medical therapy. This balance in glycemic control may be particularly relevant in patients with DM and HF. In this review, we address data regarding the influence that certain HF medications may have on glycemic control. Despite potential modest changes in glycemic control, clinical benefits of proven pharmacologic HF therapies extend to patients with DM and HF. In addition, we review potential benefits and challenges associated with commonly used glycemic medications in HF patients. Finally, recent data and controversies on optimal glycemic targets in HF patients are discussed. Given the large number of patients with DM and HF and the health burden of these conditions, much needed future work is necessary to define the optimal glycemic treatment in HF patients with DM.
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Affiliation(s)
- Saifullah Nasir
- Winters Center for Heart Failure Research, and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
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2510
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Sprinzl MF, Weinmann A, Lohse N, Tönissen H, Koch S, Schattenberg J, Hoppe-Lotichius M, Zimmermann T, Galle PR, Hansen T, Otto G, Schuchmann M. Metabolic syndrome and its association with fatty liver disease after orthotopic liver transplantation. Transpl Int 2012; 26:67-74. [DOI: 10.1111/j.1432-2277.2012.01576.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lamos EM, Stein SA, Davis SN. Combination of glibenclamide-metformin HCl for the treatment of type 2 diabetes mellitus. Expert Opin Pharmacother 2012; 13:2545-54. [PMID: 23116560 DOI: 10.1517/14656566.2012.738196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Combination of glibenclamide (glyburide in the U.S.) and metformin hydrochloride simultaneously addresses two different but complimentary mechanisms to improve glycemic control in type 2 diabetes. AREAS COVERED The pharmacokinetics, efficacy, and side effect profile of the oral combination of glibenclamide-metformin are reviewed. EXPERT OPINION Those patients, uncontrolled with single oral agent sulfonylurea or metformin alone, benefit from combination glibenclamide-metformin. There is improvement in fasting plasma glucose, HbA(1C), and post-prandial glucose control, and patients are more likely to achieve a HbA(1C) < 7%. Initiation should be started at the lowest doses and titrated to get the desired effect. Combination therapy allows for reduced pill burden while treating a multifactorial disease by two different mechanisms. Practitioners should be cognizant of risks of hypoglycemia and the theoretical potential for lactic acidosis in the elderly and those with renal impairment. We caution the use of glibenclamide-metformin in patients at risk for cardiovascular disease. Therapy should be individualized, but overall, combination of glibenclamide-metformin should be considered in patients, without renal or cardiovascular impairment, who are not controlled on monotherapy alone. Alternatively, practitioners may want to weigh the efficacy and safety of available dipeptidyl-peptidase-4 inhibitor-metformin combinations to those of glibenclamide-metformin when considering combination therapy.
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Affiliation(s)
- Elizabeth Mary Lamos
- University of Maryland Medical Center, Endocrinology, Diabetes and Metabolism, Baltimore, Maryland 21201, USA
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Liebl A, Jones S, Goday A, Benroubi M, Castell C, Haupt A, Nicolay C, Smith HT. Clinical Outcomes After Insulin Initiation in Patients with Type 2 Diabetes: 24-Month Results from INSTIGATE. Diabetes Ther 2012; 3:9. [PMID: 22926918 PMCID: PMC3508108 DOI: 10.1007/s13300-012-0009-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION To examine changes in insulin regimens and glycemic control during the 24 months after initiation of insulin in patients with type 2 diabetes mellitus. METHODS Data were collected over a 24-month period from patients requiring insulin initiation as part of usual care, in a prospective, observational study. Changes in insulin regimens and hemoglobin A(1c) (HbA(1c)) were examined within countries (Germany, Greece, Spain) and overall. RESULTS Prandial insulin only was most commonly initiated in Germany, while basal or premixed formulations were initiated in Greece and Spain. In Germany, compared with Greece or Spain, the patients were slightly younger and had a shorter diabetes duration when initiating insulin. For patients overall, 76.1% did not change their insulin regimen between initiation and 24 months. The most obvious change was a shift from prandial to basal/bolus in Germany, with almost doubling of mean daily insulin dose; in Greece and Spain, more patients stopped using insulin and the trend to more complex regimens was not seen. Overall, mean (SD) HbA(1c) decreased from baseline (9.4 [1.7]%) to 6 months (7.2 [1.0]%), but with little further change through 24 months (7.2 [1.1]%). HbA(1c) change with basal/bolus insulin (-2.6 [2.0]%, baseline 10.1%) was greater than with basal only (-2.0 [1.8]%, baseline 9.3%). Mean HbA(1c) less than 7% was achieved and maintained over 24 months in Germany, but was not achieved at any time in Greece or Spain. CONCLUSIONS Within 24 months of insulin initiation, the majority of patients with type 2 diabetes remained on the same insulin regimen initially instigated, despite the well-established progressive loss of prandial and basal endogenous insulin secretion. Adequate glycemic control was best achieved where insulin dosage adjustments and insulin intensification took place.
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Affiliation(s)
- Andreas Liebl
- Centre for Diabetes and Metabolism, Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany
| | - Steven Jones
- The Academic Centre, James Cook University Hospital, Middlesbrough, UK
| | - Alberto Goday
- Servicio de Endocrinología, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marian Benroubi
- Department of Diabetes, Polyclinic General Hospital, Athens, Greece
| | - Conxa Castell
- Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Axel Haupt
- Lilly Deutschland GmbH, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Claudia Nicolay
- Lilly Deutschland GmbH, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
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2514
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Haas L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, Fisher EB, Hanson L, Kent D, Kolb L, McLaughlin S, Orzeck E, Piette JD, Rhinehart AS, Rothman R, Sklaroff S, Tomky D, Youssef G. National standards for diabetes self-management education and support. Diabetes Care 2012; 35:2393-401. [PMID: 22995096 PMCID: PMC3476915 DOI: 10.2337/dc12-1707] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Linda Haas
- From the VA Puget Sound Health Care System Hospital and Specialty Medicine, Seattle, Washington; the
| | | | - Joni Beck
- Pediatric Diabetes and Endocrinology, The University of Oklahoma Health Sciences Center College of Medicine, Edmond, Oklahoma; the
| | | | - Paulina Duker
- Diabetes Education/Clinical Programs, American Diabetes Association, Alexandria, Virginia; the
| | - Laura Edwards
- Center for Healthy North Carolina, Apex, North Carolina
| | - Edwin B. Fisher
- Peers for Progress, American Academy of Family Physicians Foundation and Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lenita Hanson
- Ultracare Endocrine and Diabetes Consultants, Venice, Florida; the
| | - Daniel Kent
- Group Health Central Specialty Clinic, Seattle, Washington; the
| | - Leslie Kolb
- Diabetes Education Accreditation Program, American Association of Diabetes Educators, Chicago, Illinois
| | | | - Eric Orzeck
- Endocrinology Associates, Main Medical Plaza, Houston, Texas; the
| | - John D. Piette
- VA Center for Clinical Management Research and the University of Michigan Health System, Ann Arbor, Michigan
| | | | - Russell Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Donna Tomky
- Department of Endocrinology and Diabetes, ABQ Health Partners, Albuquerque, New Mexico; and
| | | | - on behalf of the 2012 Standards Revision Task Force
- From the VA Puget Sound Health Care System Hospital and Specialty Medicine, Seattle, Washington; the
- Joslin Diabetes Center, Boston, Massachusetts
- Pediatric Diabetes and Endocrinology, The University of Oklahoma Health Sciences Center College of Medicine, Edmond, Oklahoma; the
- Western Montana Clinic, Missoula, Montana; the
- Diabetes Education/Clinical Programs, American Diabetes Association, Alexandria, Virginia; the
- Center for Healthy North Carolina, Apex, North Carolina
- Peers for Progress, American Academy of Family Physicians Foundation and Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Ultracare Endocrine and Diabetes Consultants, Venice, Florida; the
- Group Health Central Specialty Clinic, Seattle, Washington; the
- Diabetes Education Accreditation Program, American Association of Diabetes Educators, Chicago, Illinois
- On Site Health and Wellness, LLC, Omaha, Nebraska
- Endocrinology Associates, Main Medical Plaza, Houston, Texas; the
- VA Center for Clinical Management Research and the University of Michigan Health System, Ann Arbor, Michigan
- Johnston Memorial Diabetes Care Center, Abingdon, Virginia; the
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
- Technical Writer, Washington, DC; the
- Department of Endocrinology and Diabetes, ABQ Health Partners, Albuquerque, New Mexico; and
- MedStar Diabetes Institute/MedStar Health, Washington, DC
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Rodbard HW, Jellinger PS. Physicians' prescribing patterns for patients with diabetes are changing for the better. Am J Med 2012; 125:e11-2. [PMID: 23098867 DOI: 10.1016/j.amjmed.2012.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 10/27/2022]
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De Block CE, Van Gaal LF. Efficacy and safety of exenatide once weekly: an overview of the DURATION trials. Expert Rev Endocrinol Metab 2012; 7:611-623. [PMID: 30754123 DOI: 10.1586/eem.12.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetes management involves controlling glycemia and cardiometabolic risk factors. In the DURATION trials, the efficacy and safety of exenatide (EX) once weekly (q.w.), a new long-acting glucagon-like-peptide-1 receptor agonist, was studied as monotherapy or as add-on to metformin with or without sulfonylurea, and compared with oral (metformin, pioglitazone or sitagliptin) and injectable antidiabetic drugs (EX twice daily [EX b.i.d.], liraglutide and insulin glargine). EX q.w. reduced HbA1c by 1.3-1.9% and showed better overall glycemic control compared with EX b.i.d., sitagliptin, pioglitazone and insulin glargine, but not liraglutide. Fasting plasma glucose was reduced more by EX q.w. than by EX b.i.d. or sitagliptin, whereas postprandial glycemia was better controlled by EX b.i.d. Weight loss was achieved by EX q.w. and EX b.i.d., in contrast to pioglitazone and insulin glargine. EX q.w. improved systolic blood pressure, lipids and cardiovascular risk markers. EX q.w. was well tolerated without safety issues. The most common adverse events were nausea, vomiting and constipation. Injection-site reactions were present in 5-13%. The risk of hypoglycemia of EX q.w. was similar to EX b.i.d., sitagliptin and pioglitazone. Hypoglycemia risk was not increased when EX q.w. was not combined with sulfonylurea.
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Affiliation(s)
- Christophe Em De Block
- b Department of Diabetology-Endocrinology and Metabolism, Faculty of Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Luc F Van Gaal
- a Department of Diabetology-Endocrinology and Metabolism, Faculty of Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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Singh-Franco D, Elrod S, Harrington C, McLaughlin-Middlekauff J. Response letter. Effects of linagliptin. Diabetes Obes Metab 2012; 14:1056-7. [PMID: 23034011 DOI: 10.1111/j.1463-1326.2012.01622.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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2518
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Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS. Diabetes in older adults. Diabetes Care 2012. [PMID: 23100048 DOI: 10.2337/dc12‐1801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M Sue Kirkman
- Medical Affairs and Community Information, American Diabetes Association, Alexandria, Virginia, USA.
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Gerber BS, Rapacki L, Castillo A, Tilton J, Touchette DR, Mihailescu D, Berbaum ML, Sharp LK. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with diabetes. BMC Public Health 2012; 12:891. [PMID: 23088168 PMCID: PMC3571948 DOI: 10.1186/1471-2458-12-891] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Given the increasing prevalence of diabetes and the lack of patients reaching recommended therapeutic goals, novel models of team-based care are emerging. These teams typically include a combination of physicians, nurses, case managers, pharmacists, and community-based peer health promoters (HPs). Recent evidence supports the role of pharmacists in diabetes management to improve glycemic control, as they offer expertise in medication management with the ability to collaboratively intensify therapy. However, few studies of pharmacy-based models of care have focused on low income, minority populations that are most in need of intervention. Alternatively, HP interventions have focused largely upon low income minority groups, addressing their unique psychosocial and environmental challenges in diabetes self-care. This study will evaluate the impact of HPs as a complement to pharmacist management in a randomized controlled trial. METHODS/DESIGN The primary aim of this randomized trial is to evaluate the effectiveness of clinical pharmacists and HPs on diabetes behaviors (including healthy eating, physical activity, and medication adherence), hemoglobin A1c, blood pressure, and LDL-cholesterol levels. A total of 300 minority patients with uncontrolled diabetes from the University of Illinois Medical Center ambulatory network in Chicago will be randomized to either pharmacist management alone, or pharmacist management plus HP support. After one year, the pharmacist-only group will be intensified by the addition of HP support and maintenance will be assessed by phasing out HP support from the pharmacist plus HP group (crossover design). Outcomes will be evaluated at baseline, 6, 12, and 24 months. In addition, program and healthcare utilization data will be incorporated into cost and cost-effectiveness evaluations of pharmacist management with and without HP support. DISCUSSION The study will evaluate an innovative, integrated approach to chronic disease management in minorities with poorly controlled diabetes. The approach is comprised of clinic-based pharmacists and community-based health promoters collaborating together. They will target patient-level factors (e.g., lack of adherence to lifestyle modification and medications) and provider-level factors (e.g., clinical inertia) that contribute to poor clinical outcomes in diabetes. Importantly, the study design and analytic approach will help determine the differential and combined impact of adherence to lifestyle changes, medication, and intensification on clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01498159.
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Affiliation(s)
- Ben S Gerber
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
- Jesse Brown VA Medical Center, 820 South Damen Ave., Chicago, IL, 60612, USA
| | - Lauren Rapacki
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
| | - Amparo Castillo
- Midwest Latino Health Research, Training and Policy Center, 1640 West Roosevelt Road- Suite 636, Chicago, IL, 60608, USA
| | - Jessica Tilton
- Department of Pharmacy Practice, 833 S. Wood St. M/C 886, Chicago, IL, 60612, USA
| | - Daniel R Touchette
- Department of Pharmacy Practice, 833 S. Wood St. M/C 886, Chicago, IL, 60612, USA
| | - Dan Mihailescu
- Section of Endocrinology, Diabetes and Metabolism, 1819 West Polk Street, M/C 640, Chicago, IL, 60612, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
| | - Lisa K Sharp
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
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2520
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Kadowaki T, Tajima N, Odawara M, Nishii M, Taniguchi T, Ferreira JCA. Addition of sitagliptin to ongoing metformin monotherapy improves glycemic control in Japanese patients with type 2 diabetes over 52 weeks. J Diabetes Investig 2012; 4:174-81. [PMID: 24843649 PMCID: PMC4019272 DOI: 10.1111/jdi.12001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 07/19/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022] Open
Abstract
Aims/Introduction The efficacy and safety of sitagliptin, a highly selective dipeptidyl peptidase‐4 inhibitor, when added to metformin monotherapy was examined in Japanese patients with type 2 diabetes. Materials and Methods In this 52‐week, add‐on to metformin study, 149 patients were randomly assigned to receive sitagliptin 50 mg or placebo once daily in a double‐blind fashion for 12 weeks. Thereafter, all patients who completed the double‐blind period of the study received open‐label sitagliptin 50 mg once daily for 40 weeks, with the investigator option of increasing sitagliptin to 100 mg once daily for patients who met predefined glycemic thresholds. Results After 12 weeks of treatment, the mean change from baseline in glycated hemoglobin (HbA1c) significantly decreased with sitagliptin relative to placebo (between‐group difference [95% confidence interval] = −0.7% [−0.9 to −0.5] P < 0.001). At week 12, the mean changes in 2‐h post‐meal glucose (−2.6 mmol/L [−3.5 to −1.7]) and fasting plasma glucose (−1.0 mmol/L [−1.3 to −0.6]) also decreased significantly with sitagliptin relative to placebo (P < 0.001 for both). Significant improvements from baseline in glycemic control were also observed in the open‐label period through to week 52. There were no differences between treatment groups in the incidence of adverse events (AEs), including hypoglycemia and predefined gastrointestinal AEs (nausea, vomiting and diarrhea) during the double‐blind period, with similar findings in the open‐label period. Conclusions Over a period of 52 weeks, the addition of sitagliptin once‐daily to ongoing metformin therapy was efficacious and generally well tolerated in Japanese patients with type 2 diabetes. This trial was registered with ClinicalTrials.gov (no. NCT00363948).
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Affiliation(s)
| | | | - Masato Odawara
- The Third Department of Internal Medicine Tokyo Medical University Tokyo Japan
| | - Mikio Nishii
- Development Planning Ono Pharmaceutical Co., Ltd Osaka Tokyo Japan
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2521
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2522
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Giaccari A, Giorda CB, Riccardi G, De Micheli A, Bruno G, Monge L, Frontoni S. Comment on: Inzucchi et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364-1379. Diabetes Care 2012; 35:e71; author reply e72-3. [PMID: 22996185 PMCID: PMC3447846 DOI: 10.2337/dc12-0784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Andrea Giaccari
- From Endocrinology and Metabolic Diseases, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy; the
| | - Carlo B. Giorda
- Metabolism and Diabetes Unit, ASL Tourin 5, Ospedale Maggiore, Chieri, Italy; the
| | - Gabriele Riccardi
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy; the
| | | | - Graziella Bruno
- Department of Internal Medicine, University of Turin, Turin, Italy; the
| | - Luca Monge
- Diabetic Foot Unit, Orthopaedic and Trauma Center, Turin, Italy; and
| | - Simona Frontoni
- Endocrinology and Metabolism, Department of Internal Medicine, Fatebenefratelli Hospital, University of Rome Tor Vergata, Rome, Italy
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2523
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Response to Comments on: Inzucchi et al. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach. Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364–1379. Diabetes Care 2012. [PMCID: PMC3447838 DOI: 10.2337/dc12-1184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
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2524
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Rodbard HW, Jellinger PS. Comment on: Inzucchi et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364-1379. Diabetes Care 2012; 35:e70; author reply e72-3. [PMID: 22996184 PMCID: PMC3447834 DOI: 10.2337/dc12-0768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Paul S. Jellinger
- The Center for Diabetes and Endocrine Care, University of Miami, Hollywood, Florida
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2525
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Riddle MC, Karl DM. Individualizing targets and tactics for high-risk patients with type 2 diabetes: practical lessons from ACCORD and other cardiovascular trials. Diabetes Care 2012; 35:2100-7. [PMID: 22996182 PMCID: PMC3447843 DOI: 10.2337/dc12-0650] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA.
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2526
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Safety of exenatide once weekly in patients with type 2 diabetes mellitus treated with a thiazolidinedione alone or in combination with metformin for 2 years. Clin Ther 2012; 34:2082-90. [PMID: 23031623 DOI: 10.1016/j.clinthera.2012.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/29/2012] [Accepted: 09/10/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus are routinely treated with combinations of glucose-lowering agents. The adverse event (AE) profile and effects on glycemic control have not been assessed for the glucagon-like peptide-1 receptor agonist exenatide once weekly in combination with a thiazolidinedione (TZD) with or without metformin. OBJECTIVE This study was conducted to examine the long-term safety profile and changes in glycemic control and weight for exenatide once weekly with TZD with or without metformin in patients with type 2 diabetes mellitus over 2 years. METHODS In this single-arm, open-label trial with treatment up to 104 or 117 weeks, patients received 2 mg exenatide once weekly while continuing treatment with a TZD with or without metformin. Patients were either exenatide-naïve before this study or had previously received exenatide twice daily, which was discontinued on initiating exenatide once weekly. Patients were on a stable dosage of TZD (rosiglitazone or pioglitazone) and, if applicable, metformin. Treatment-emergent AEs were defined as those first occurring or worsening post baseline. Descriptive statistics were used for absolute and change-from-baseline data, and a one-sample t test for within-group change in glycosylated hemoglobin (HbA(1c)). RESULTS Of 134 patients in the intent-to-treat population (baseline mean [SD] HbA(1c),7.2% [1.0%]), 44 were exenatide-naïve (baseline HbA(1c), 7.8% [1.0%]) and 90 switched from exenatide twice daily (baseline HbA(1c), 7.0% [0.8%]). Of intent-to-treat patients, 106 (79%) completed the final treatment visit (week 104 or week 117). The most common AEs were nausea (17% of patients) and injection-site nodule (12% of patients). Serious AEs were reported in 14% of patients and 5% withdrew because of a treatment-emergent AE. No identifiable pattern of serious AEs was observed. There were 4 reports of edema and no reports of heart failure. No major hypoglycemia was reported; minor hypoglycemia was reported in 4% of patients. Exenatide-naïve patients experienced mean (SE) HbA(1c) reductions of -0.7% (0.2%) and weight reductions of -2.7 (0.8) kg, whereas patients with prior exposure to exenatide twice daily experienced a reduction of -0.4% (0.1%) in HbA(1c) and no change in weight. CONCLUSIONS Adverse events over 2 years were consistent with the reported safety profiles of exenatide once weekly and TZDs. Exenatide-naïve patients experienced improvements in HbA(1c) and weight, while patients with the benefit of prior exenatide therapy experienced an additional reduction from baseline in HbA(1c) and no additional change in weight after 2 years. ClinicalTrials.gov identifier: NCT00753896.
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2527
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Canales BK, Richards NG, Peck AB. Rapid oxalate determination in blood and synthetic urine using a newly developed oxometer. J Endourol 2012; 27:145-8. [PMID: 22973856 DOI: 10.1089/end.2012.0438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Blood and urine oxalate determinations have been limited to the laboratory setting because of complex sample storage and processing methods as well as the need for color spectrophotometry and ion chromatography. We hypothesized that glucometer test strips, impregnated with glucose oxidase and dyes that measure secondary hydrogen peroxide production, could be infused with oxalate oxidase and produce enhanced color changes in the presence of oxalate. By increasing the amount of sodium oxalate in fresh blood, we found that glucometer-measured oxalate increased on a linear scale. In addition, oxalate levels in synthetic urine could be measured using a visual scale, suggesting that strip dwell time or oxalate/oxalate oxidase concentrations could be manipulated to enhance optimal sensitivity. Although further testing is necessary, this simple, first-generation oxometer may eventually allow point of care testing in the home or office, empowering patients with oxalate-based medical conditions and giving healthcare providers real-time oxalate feedback.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida 32610, USA.
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2528
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Shin SJ. Glucagon-like peptide-1 receptor agonists and their effects on weight reduction. J Diabetes Investig 2012; 3:490-1. [PMID: 24843612 PMCID: PMC4015426 DOI: 10.1111/j.2040-1124.2012.00241.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shyi-Jang Shin
- Division of Endocrinology and Metabolism Department of Internal Medicine Kaohsiung Medical University Hospital and College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
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2529
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2530
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Bloomgarden ZT. Diabetes: East meets West. The Joint American Association of Clinical Endocrinologists-Chinese Society of Endocrinology (AACE-CSE) Symposium. J Diabetes 2012; 4:221-6. [PMID: 22898104 DOI: 10.1111/j.1753-0407.2012.00228.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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2531
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Rena G, Pearson ER, Sakamoto K. Molecular action and pharmacogenetics of metformin: current understanding of an old drug. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/dmt.12.42] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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2532
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2533
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Ross SA, Rafeiro E, Meinicke T, Toorawa R, Weber-Born S, Woerle HJ. Efficacy and safety of linagliptin 2.5 mg twice daily versus 5 mg once daily in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, placebo-controlled trial. Curr Med Res Opin 2012; 28:1465-74. [PMID: 22816729 DOI: 10.1185/03007995.2012.714360] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Glycaemic control in patients with type 2 diabetes (T2DM) is often not achieved or not sustained using monotherapy such as metformin, necessitating the addition of other antihyperglycaemic agents. Linagliptin, a dipeptidyl peptidase-4 inhibitor, is licensed for 5 mg once-daily dosing. As metformin is administered twice daily, a fixed-dose combination of these compounds would require twice-daily administration of linagliptin. This study evaluated whether 2.5 mg twice-daily dosing of linagliptin has comparable efficacy and safety to 5 mg once-daily dosing when given in addition to metformin twice daily in patients with inadequate glycaemic control. METHODS A total of 491 T2DM patients with glycated haemoglobin (HbA1c) 7.0-10.0% were randomised (5:5:1) to double-blind treatment with linagliptin 2.5 mg twice daily, 5 mg once daily or placebo, respectively, in addition to continuing metformin twice daily (≥1500 mg/day or maximally tolerated dose). The primary endpoint was change from baseline in HbA1c after 12 weeks. ClinicalTrials.gov, NCT01012037. RESULTS Mean baseline HbA1c for all patients was 7.97%. After 12 weeks, linagliptin 2.5 mg twice daily and 5 mg once daily both significantly reduced HbA1c (placebo-adjusted changes from baseline -0.74% (95% CI -0.97, -0.52) and -0.80% (95% CI -1.02, -0.58), respectively, both p<0.0001). The treatment difference (twice daily-once daily) between the linagliptin regimens was 0.06 (95% CI -0.07, 0.19), the upper bound of which was less than the predefined noninferiority margin (0.35%). The overall incidence of adverse events with linagliptin 2.5 mg twice daily, 5 mg once daily and placebo was 43.0%, 34.8%, and 38.6% respectively. Hypoglycaemia was rare (3.1% with linagliptin 2.5 mg twice daily, 0.9% with 5 mg once daily, 2.3% with placebo) with no severe episodes. Study limitations include duration, patient population (mainly white) and absence of postprandial glucose data. CONCLUSIONS Linagliptin 2.5 mg twice daily had non-inferior HbA1c-lowering effects after 12 weeks compared to 5 mg once daily, with comparable safety and tolerability, in T2DM patients inadequately controlled with metformin.
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Affiliation(s)
- Stuart A Ross
- University of Calgary, LMC Endocrinology Centres, Calgary, Alberta, Canada.
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2534
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Balogh Z, Mátyus J. Proposal for the administration of metformin in patients with chronic kidney disease. Orv Hetil 2012; 153:1527-35. [DOI: 10.1556/oh.2012.29448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.
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Affiliation(s)
- Zoltán Balogh
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Általános Orvostudományi Kar Belgyógyászati Intézet Debrecen Nagyerdei krt. 98. 4032
| | - János Mátyus
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Általános Orvostudományi Kar Belgyógyászati Intézet Debrecen Nagyerdei krt. 98. 4032
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2535
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Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT 06520, USA.
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2536
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Gallwitz B, Rosenstock J, Rauch T, Bhattacharya S, Patel S, von Eynatten M, Dugi KA, Woerle HJ. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial. Lancet 2012; 380:475-83. [PMID: 22748821 DOI: 10.1016/s0140-6736(12)60691-6] [Citation(s) in RCA: 257] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Addition of a sulphonylurea to metformin improves glycaemic control in type 2 diabetes, but is associated with hypoglycaemia and weight gain. We aimed to compare a dipeptidyl peptidase-4 inhibitor (linagliptin) against a commonly used sulphonylurea (glimepiride). METHODS In this 2-year, parallel-group, non-inferiority double-blind trial, outpatients with type 2 diabetes and glycated haemoglobin A(1c) (HbA(1c)) 6·5-10·0% on stable metformin alone or with one additional oral antidiabetic drug (washed out during screening) were randomly assigned (1:1) by computer-generated random sequence via a voice or web response system to linagliptin (5 mg) or glimepiride (1-4 mg) orally once daily. Study investigators and participants were masked to treatment assignment. The primary endpoint was change in HbA(1c) from baseline to week 104. Analyses included all patients randomly assigned to treatment groups who received at least one dose of treatment, had a baseline HbA(1c) measurement, and had at least one on-treatment HbA(1c) measurement. This trial is registered at ClinicalTrials.gov, number NCT00622284. FINDINGS 777 patients were randomly assigned to linagliptin and 775 to glimepiride; 764 and 755 were included in analysis of the primary endpoint. Reductions in adjusted mean HbA(1c) (baseline 7·69% [SE 0·03] in both groups) were similar in the linagliptin (-0·16% [SE 0·03]) and glimepiride groups (-0·36% [0·03]; difference 0·20%, 97·5% CI 0·09-0·30), meeting the predefined non-inferiority criterion of 0·35%. Fewer participants had hypoglycaemia (58 [7%] of 776 vs 280 [36%] of 775 patients, p<0·0001) or severe hypoglycaemia (1 [<1%] vs 12 [2%]) with linagliptin compared with glimepiride. Linagliptin was associated with significantly fewer cardiovascular events (12 vs 26 patients; relative risk 0·46, 95% CI 0·23-0·91, p=0·0213). INTERPRETATION The results of this long-term randomised active-controlled trial advance the clinical evidence and comparative effectiveness bases for treatment options available to patients with type 2 diabetes mellitus. The findings could improve decision making for clinical treatment when metformin alone is insufficient. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Baptist Gallwitz
- Department of Medicine IV, Universitätsklinikum Tübingen, Tübingen, Germany.
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2537
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Caspersen CJ, Thomas GD, Boseman LA, Beckles GLA, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health 2012; 102:1482-97. [PMID: 22698044 PMCID: PMC3464829 DOI: 10.2105/ajph.2011.300616] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2011] [Indexed: 12/22/2022]
Abstract
Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for $64.8 billion (56%) of direct diabetes medical costs, $41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults.
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Affiliation(s)
- Carl J Caspersen
- Epidemiology and Statistics Branch, Office of the Director of the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30341-3717, USA.
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2538
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Cheung NW. Individualising type 2 diabetes management: new treatment options and models of care. Med J Aust 2012; 197:196-7. [DOI: 10.5694/mja12.11041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW
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2539
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Berlie H, Hurren KM, Pinelli NR. Glucagon-like peptide-1 receptor agonists as add-on therapy to basal insulin in patients with type 2 diabetes: a systematic review. Diabetes Metab Syndr Obes 2012; 5:165-74. [PMID: 22826635 PMCID: PMC3402010 DOI: 10.2147/dmso.s27528] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence of obesity and diabetes continues to rise in the US. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is an effective treatment option for type 2 diabetes mellitus (T2DM) that promotes weight loss. Common and effective treatment options added to metformin therapy (basal insulin, sulfonylureas, and pioglitazone) contribute to weight gain, which makes the addition of GLP-1RAs advantageous. Exenatide was the first agent in this class and has recently been approved for use in combination with insulin glargine by the US Food and Drug Administration and the European Medicines Agency. Until recently, there was a lack of data examining basal insulin combined with these agents. The main purpose of this article is to review the prospective interventional data on the safety and efficacy of GLP-1RAs (exenatide, liraglutide, albiglutide, lixisenatide) combined with basal insulin therapy in nonpregnant adults with T2DM. Databases searched were PubMed, Cochrane Central Register of Controlled Trials and the Database of Systematic Reviews (inception to January 2012). Abstracts presented at relevant diabetes and endocrine meetings from 2009 to 2011 were also reviewed, as were reference lists of identified publications. A total of five studies met the criteria and were included in the review. Data from these studies demonstrated that this combination therapy offers advantages for the treatment of diabetes, such as additional lowering of A1c without major risk for hypoglycemia, lower basal insulin requirements, decreased postprandial glucose levels (with or without fasting plasma glucose decreases), and weight loss, or at the very least, less weight gain. However, the gastrointestinal side effects and high cost of these agents may limit their use. This review demonstrates that adding a GLP-1RA to an existing basal insulin regimen is a reasonable treatment strategy in nonpregnant adult patients with T2DM.
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Affiliation(s)
- Helen Berlie
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Kathryn M Hurren
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Nicole R Pinelli
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
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2540
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Affiliation(s)
- Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital and University of Copenhagen, 2650 Hvidovre, Denmark.
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2541
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Affiliation(s)
- Alan J Garber
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
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2542
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Affiliation(s)
- Michaela Diamant
- Diabetes Centre, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands.
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2543
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Cefalu WT. American diabetes association-European association for the study of diabetes position statement: due diligence was conducted. Diabetes Care 2012; 35:1201-3. [PMID: 22619286 PMCID: PMC3357220 DOI: 10.2337/dc12-0564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William T. Cefalu
- Joint Program on Diabetes, Endocrinology and Metabolism, Pennington Biomedical Research Center, Louisiana State University (LSU) System, Baton Rouge, Louisiana; and the Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
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2544
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2545
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Haak T, Meinicke T, Jones R, Weber S, von Eynatten M, Woerle HJ. Initial combination of linagliptin and metformin improves glycaemic control in type 2 diabetes: a randomized, double-blind, placebo-controlled study. Diabetes Obes Metab 2012; 14:565-74. [PMID: 22356132 DOI: 10.1111/j.1463-1326.2012.01590.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the efficacy and safety of initial combination therapy with linagliptin plus metformin versus linagliptin or metformin monotherapy in patients with type 2 diabetes. METHODS In this 24-week, double-blind, placebo-controlled, Phase III trial, 791 patients were randomized to one of six treatment arms. Two free combination therapy arms received linagliptin 2.5 mg twice daily (bid) + either low (500 mg) or high (1000 mg) dose metformin bid. Four monotherapy arms received linagliptin 5 mg once daily, metformin 500 mg or 1000 mg bid or placebo. Patients with haemoglobin A1c (HbA1c) ≥11.0% were not eligible for randomization and received open-label linagliptin + high-dose metformin. RESULTS The placebo-corrected mean (95% confidence interval) change in HbA1c from baseline (8.7%) to week 24 was -1.7% (-2.0, -1.4) for linagliptin + high-dose metformin, -1.3% (-1.6, -1.1) for linagliptin + low-dose metformin, -1.2% (-1.5, -0.9) for high-dose metformin, -0.8% (-1.0, -0.5) for low-dose metformin and -0.6 (-0.9, -0.3) for linagliptin (all p < 0.0001). In the open-label arm, the mean change in HbA1c from baseline (11.8%) was -3.7%. Hypoglycaemia occurred at a similar low rate with linagliptin + metformin (1.7%) as with metformin alone (2.4%). Adverse event rates were comparable across treatment arms. No clinically significant changes in body weight were noted. CONCLUSIONS Initial combination therapy with linagliptin plus metformin was superior to metformin monotherapy in improving glycaemic control, with a similar safety and tolerability profile, no weight gain and a low risk of hypoglycaemia.
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Affiliation(s)
- Thomas Haak
- Diabetes Center Mergentheim, Bad Mergentheim, Germany.
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Oba K. [Management of the older person with diabetes mellitus]. Nihon Ronen Igakkai Zasshi 2012; 49:561-568. [PMID: 23459642 DOI: 10.3143/geriatrics.49.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Khardori R, Nguyen DD. Glucose control and cardiovascular outcomes: reorienting approach. Front Endocrinol (Lausanne) 2012; 3:110. [PMID: 22952467 PMCID: PMC3429887 DOI: 10.3389/fendo.2012.00110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/15/2012] [Indexed: 01/07/2023] Open
Abstract
Cardiovascular disease accounts for nearly 70% of morbidity and mortality in patients with diabetes mellitus. Strides made in diabetes care have indeed helped prevent or reduce the burden of microvascular complications in both type 1 and type 2 diabetes. However, the same cannot be said about macrovascular disease in diabetes. Several prospective trials so far have failed to provide conclusive evidence of the superiority of glycemic control in reducing macrovascular complications or death rates in people with advanced disease or those with long duration of diabetes. There are trends that suggest that benefits are restricted to those with lesser burden and shorter duration of disease. Furthermore, it is also suggested that benefits might accrue but it would take a longer time to manifest. Clinicians are faced with the challenge to decide how to triage patients for intensified care vs less intense care. This review focuses on evidence and attempts to provide a balanced view of the literature that has radically affected how physicians treat patients with macrovascular disease. It also takes cognizance of the fact that the natural course of the disease may be changing as well, possibly related to better overall awareness and possibly improved access to information about better individual healthcare. The review further takes note of some hard held notions about the pathobiology of the disease that must be interpreted with caution in light of new and emerging data. In light of recent developments ADA and EASD have taken step to provide some guidance to clinicians through a joint position statement. A lot more research would be required to figure out how best to manage macrovascular disease in diabetes mellitus. Glucocentric stance would need to be reconsidered, and attention paid to concurrent multifactorial interventions that seem to be effective in reducing vascular outcomes.
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Affiliation(s)
- Romesh Khardori
- *Correspondence: Romesh Khardori, Division of Endocrinology and Metabolism, The EVMS Strelitz Center for Diabetes and Endocrine Disorders, Department of Internal Medicine, Eastern Virginia Medical School, 855 West Brambleton Avenue, Norfolk, VA 23510, USA. e-mail:
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