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Sahin I, Bakiner O, Demir T, Sari R, Atmaca A. Current Position of Gliclazide and Sulfonylureas in the Contemporary Treatment Paradigm for Type 2 Diabetes: A Scoping Review. Diabetes Ther 2024; 15:1687-1716. [PMID: 38935188 PMCID: PMC11263312 DOI: 10.1007/s13300-024-01612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
The increasing burden of type 2 diabetes (T2D), in relation to alarming rise in the prevalence; challenges in the diagnosis, prevention, and treatment; as well as the substantial impact of disease on longevity and quality of life, is a major concern in healthcare worldwide. Sulfonylureas (SUs) have been a cornerstone of T2D pharmacotherapy for over 60 years as oral antidiabetic drugs (OADs), while the newer generation SUs, such as gliclazide modified release (MR), are known to be associated with low risk of hypoglycemia in addition to the cardiovascular neutrality. This scoping review aimed to specifically address the current position of gliclazide MR among other SUs in the contemporary treatment paradigm for T2D and to provide a practical guidance document to assist clinicians in using gliclazide MR in real-life clinical practice. The main topics addressed in this paper include the role of early and sustained glycemic control and use of SUs in T2D management, the properties of gliclazide MR in relation to its effectiveness and safety, the use of gliclazide therapy in special populations, and the place of SUs as a class and gliclazide MR specifically in the current T2D treatment algorithm.
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Affiliation(s)
- Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Okan Bakiner
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ramazan Sari
- Department of Endocrinology and Metabolism, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Andraos J, Muhar H, Smith SR. Beyond glycemia: Comparing tirzepatide to GLP-1 analogues. Rev Endocr Metab Disord 2023; 24:1089-1101. [PMID: 37526853 PMCID: PMC10697893 DOI: 10.1007/s11154-023-09825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
Glucagon-like peptide-1 receptor analogs (GLP-1 RAs) have been an innovative and instrumental drug class in the management of both type 2 diabetes and obesity. Tirzepatide is a novel agent that acts as an agonist for both GLP-1 receptors and gastric inhibitory polypeptide (GIP) receptors, another incretin that lowers glucose and appetite. Although previous studies showed a lack of therapeutic benefit for GIP agonists, current studies show that the glucose lowering and weight loss effects of tirzepatide are at least as effective as GLP-1 RAs with a similar adverse effect profile. Some studies, though not conclusive, predict that tirzepatide may in fact be more potent than GLP-1 RAs at reducing weight. A thorough review of the studies that led to tirzepatide's approval allows for comparisons between tirzepatide and GLP-1 RAs; it also allows for predictions of tirzepatide's eventual place in therapy - an agent used preferentially over GLP-1 RAs in patients with or without diabetes desiring to lose weight.
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Affiliation(s)
- John Andraos
- College of Pharmacy, Western University of Health Sciences, 91766, Pomona, CA, USA.
| | | | - Shawn R Smith
- College of Pharmacy, Western University of Health Sciences, 91766, Pomona, CA, USA
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Park S, Jeong J, Woo Y, Choi YJ, Shin S. Incident infection risks depending on oral antidiabetic exposure in insulin-treated type 2 diabetes patients. Sci Rep 2023; 13:18462. [PMID: 37891260 PMCID: PMC10611756 DOI: 10.1038/s41598-023-45793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
Dipeptidyl peptidase-4 inhibitors (DPP4is) and sodium glucose cotransporter-2 inhibitors (SGLT2is) have been speculated to have a potential to increase infection risks in type 2 diabetes mellitus (T2DM) patients. We performed a cohort study using the Korean health insurance data to investigate infection risks with each drug class relative to metformin in insulin-treated T2DM patients. After propensity score matching, we included 1,498 and 749 patients in DPP4i + insulin vs metformin + insulin and 300 and 549 patients in SGLT2i + insulin vs metformin + insulin, respectively. In stratified analyses per patient factor, none of the odds ratios (ORs) were associated with a statistical significance across respiratory, genital, and urinary tract infections (UTIs), except that of the male stratum for respiratory infections (OR 0.77, p = 0.04). With regard to SGLT2is, a higher risk of genital infections was analyzed with their use than with metformin therapy (OR 1.76, p = 0.03). In stratified analyses, the OR for genital infections remained significant in the baseline cardiovascular disease stratum (OR 2.29, p = 0.01). No increased UTI risk was detected with SGLT2is compared against metformin. In this study on insulin-receiving T2DM patients, DPP4is were not associated with increased infection risks, whereas SGLT2is led to a higher risk for genital infections, but not for UTIs, relative to metformin.
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Affiliation(s)
- Sanghwa Park
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Jiseon Jeong
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Yunna Woo
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Yeo Jin Choi
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea.
| | - Sooyoung Shin
- College of Pharmacy, Ajou University, Suwon, Republic of Korea.
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, Republic of Korea.
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周 蓓, 李 静, 方 晨, 黄 亚, 桑 贵, 陶 少, 何 春. [Comparison of therapeutic effect of metformin hydrochloride/vildagliptin and liraglutide on type 2 diabetes mellitus in obese patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:436-442. [PMID: 37087589 PMCID: PMC10122729 DOI: 10.12122/j.issn.1673-4254.2023.03.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effects of two therapeutic strategies based on metformin hydrochloride/vildagliptin and liraglutide on type 2 diabetes mellitus (T2DM) in obese patients. METHODS We retrospectively collected the clinical data of 107 obese patients (BMI>25 kg/m2) with T2DM treated in Second Affiliated Hospital of Wannan Medical College (Wuhu, China) during 2019-2021, including 53 patients treated continuously with metformin hydrochloride/vildagliptin and 54 with liraglutide for 3 months. The changes in BMI, waist circumference, fasting blood glucose (FBG), postprandial blood glucose, HbA1C, fasting C-peptide, postprandial C-peptide, fasting insulin and postprandial insulin of the patients after treatment were compared between the two groups. RESULTS In both of the groups, the patients all showed significant reductions of BMI, waist circumference, FBG, postprandial blood glucose and HbA1C (all P < 0.05) with improved fasting and postprandial C-peptide levels after the treatments (P < 0.05). The two treatment regimens showed comparable blood glucoselowering effects, but liraglutide produced better effect in reducing waist circumference (P < 0.01). Neither of two regimens obviously affected insulin level of the patients (P>0.05). CONCLUSION Both metformin hydrochloride/vildagliptin and liraglutide have good therapeutic effects on T2DM in obese patients and can achieve good blood glucose and weight control, but liraglutide has a better effect for weight control.
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Affiliation(s)
- 蓓 周
- 皖南医学院第二附属医院内分泌科,安徽 芜湖 241001Department of Endocrinology, Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - 静 李
- 皖南医学院第二附属医院内分泌科,安徽 芜湖 241001Department of Endocrinology, Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - 晨圆 方
- 皖南医学院第二附属医院内分泌科,安徽 芜湖 241001Department of Endocrinology, Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - 亚楠 黄
- 皖南医学院第二附属医院内分泌科,安徽 芜湖 241001Department of Endocrinology, Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - 贵蕊 桑
- 皖南医学院第二附属医院内分泌科,安徽 芜湖 241001Department of Endocrinology, Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - 少平 陶
- 皖南医学院第二附属医院内分泌科,安徽 芜湖 241001Department of Endocrinology, Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - 春玲 何
- 皖南医学院第一附属医院内分泌科,安徽 芜湖 241004Department of Endocrinology, First Affiliated Hospital of Wannan Medical College, Wuhu 241004, China
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Leto G, Barchetta I, De Candia L, Magotti MG, Cianciullo M, Manti R, Negri C, Cimino V, Dodesini AR, Zerella F, Baratta R. Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy. Diabetes Ther 2021; 12:2645-2661. [PMID: 34415563 PMCID: PMC8478995 DOI: 10.1007/s13300-021-01137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Despite the development of several recommendations, glycemic control in a large proportion of patients with type 2 diabetes, including those treated with insulin, remains suboptimal. This study is aimed to identify a set of actions to promote the reduction of inappropriate clinical practices in type 2 diabetes failing basal insulin supported oral therapy (BOT). METHODS A panel of diabetes specialists was assembled to identify a list of ten corrective actions, "things not to do," for the management of type 2 diabetes: five concerning treatments, procedures and diagnostic tests and five about relationship, communication and information. The Choosing Wisely methodology and approach were the inspiration. RESULTS A total of 73/73 (100%) panelists responded to the survey. Twenty-four actions were proposed. The final list of inappropriate actions deemed most important to improve the management of patients with type 2 diabetes failing BOT were: (1) do not use secretagogues-do not neglect the use of innovative glucose-lowering agents; (2) do not underestimate the risk of lack of hypoglycemia awareness; (3) do not underestimate the benefit of personalization of therapy; (4) do not delay insulin intensification; (5) do not delay modification of the therapeutic regimen. In the area of patient communication, the following actions were identified: (1) do not fail to train in the management of hypoglycemia; (2) do not underestimate whether the patient has understood the modification of therapy; (3) do not prescribe injection therapy without adequately instructing the patient to titrate it; (4) do not ignore the patient's adherence; (5) do not stop listening to the patient and verify learning. CONCLUSION A set of corrective experience-based actions to enact in a timely manner, which can assist physicians in improving clinical outcomes and patients' needs in terms of communications and interaction, is proposed. The list is intended to promote discussions among diabetes specialists to provide high-value diabetes care.
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Affiliation(s)
- Gaetano Leto
- Diabetology Unit, Sapienza University of Rome, Polo Pontino, Santa Maria Goretti Hospital, Latina, Italy.
| | - Ilaria Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Maria Grazia Magotti
- Department of Intensive Treatment of Diabetes and its Complications, University Hospital of Parma, Parma, Italy
| | - Marco Cianciullo
- Department of Medicine, Nocera Inferiore Hospital, Salerno, Italy
| | - Roberta Manti
- Diabetology Unit, Santa Croce Hospital of Moncalieri, Turin, Italy
| | - Carlo Negri
- Department of Diabetology and Metabolic Diseases, Hospital of Verona, Verona, Italy
| | - Vincenzo Cimino
- Department of Biomedical and Clinical Sciences L. Sacco Endocrinology and Diabetology, Pio Albergo Trivulzio, Milan, Italy
| | - Alessandro R Dodesini
- Diabetology and Endocrine Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Zerella
- Diabetology, Metabolic Diseases and Clinical Nutrition, San Pio Rummo Hospital of Benevento, Benevento, Italy
| | - Roberto Baratta
- Endocrinology and Diabetology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Fadini GP, Disoteo O, Candido R, Di Bartolo P, Laviola L, Consoli A. Delphi-Based Consensus on Treatment Intensification in Type 2 Diabetes Subjects Failing Basal Insulin Supported Oral Treatment: Focus on Basal Insulin + GLP-1 Receptor Agonist Combination Therapies. Diabetes Ther 2021; 12:781-800. [PMID: 33550569 PMCID: PMC7947045 DOI: 10.1007/s13300-021-01012-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/23/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The aim of this study was to elaborate a consensus on treatment intensification strategies in patients with type 2 diabetes failing basal insulin supported oral therapy (BOT). The panel focused on glucagon-like peptide-1 receptor agonists (GLP-1RA) and basal insulin (BI) combinations. METHODS The authors developed a Delphi questionnaire organized into ten statements and 77 items that focused on: the definition of BOT and BOT failure, intensification strategies, fixed-dose combinations in general and the BI/GLP-1RA fixed combination. The survey was administered in two rounds to a panel of 80 Italian diabetes specialists, who rated their level of agreement with each item on a 5-point Likert scale. Consensus was predefined as > 66% of the panel agreeing/disagreeing on any given item. RESULTS Consensus was achieved for 71 of the 77 items. The panel agreed that the use of sulfonylureas in the BOT regimen is inappropriate. BOT failure was defined as individualized targets not being met for glycated hemoglobin, fasting plasma glucose and/or postprandial plasma glucose. There was agreement that postprandial hyperglycaemia and/or presence of nocturnal hypoglycaemia or weight gain define BOT failure. Addition of a GLP-1RA to BI therapy was considered to be the best option for BOT intensification. There was consensus for the use of BI/GLP-1RA fixed combinations as valuable options to increase compliance and safely improve glycaemic control. The panel agreed in considering the fixed-ratio combination insulin degludec/liraglutide (IDegLira) to be preferable to the fixed-ratio combination insulin glargine/lixisenatide (iGlarLixi) in the control of glycaemia, body weight and cardiovascular risk. CONCLUSION According to this Delphi consensus, the addition of a GLP-1RA may be the best option to intensify BOT. The BI/GLP-1RA fixed combinations may increase compliance and optimize the advantages of each of these molecules.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Padua, Italy.
| | - Olga Disoteo
- Diabetes Unit, SSD Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Candido
- Diabetes Center District 3, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Paolo Di Bartolo
- Ravenna Diabetes Clinic, Romagna Local Health Authority, Ravenna, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Transplants, University of Bari Aldo Moro, Bari, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences (DMSI) and Center for Research on Ageing and Translational Medicine (CeSI-Met), University of Chieti, Chieti, Italy
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Napoli R, Formoso G, Piro S, Targher G, Consoli A, Purrello F. Management of type 2 diabetes for prevention of cardiovascular disease. An expert opinion of the Italian Diabetes Society. Nutr Metab Cardiovasc Dis 2020; 30:1926-1936. [PMID: 32928628 DOI: 10.1016/j.numecd.2020.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 12/28/2022]
Abstract
AIMS Type 2 diabetes mellitus is characterized by an increased risk of developing long-term cardiovascular complications. Several underlying mechanisms have been proposed for the diabetes-related increase in cardiovascular risk, i.e. chronic hyperglycemia, duration of the disease, drug-induced hypoglycemia, coexistence of multiple cardiovascular risk factors, etc. In the last few years, new pharmacological approaches capable of treating chronic hyperglycemia without increasing the risk of hypoglycemia have emerged for the treatment of diabetes. DATA SYNTHESIS With data mainly obtained from randomized controlled trials recruiting patients with type 2 diabetes in secondary prevention of cardiovascular disease, some of these newer antihyperglycemic drugs have shown to significantly reduce the risk of cardiovascular disease. In addition, the combined control of traditional cardiovascular risk factors, e.g. dyslipidemia, hypertension, etc., has demonstrated to be effective in reducing the burden of cardiovascular diseases in patients with type 2 diabetes. CONCLUSIONS In this document written by some experts of the Italian diabetes society (SID), we will focus our attention on oral antihyperglycemic agents for people with type 2 diabetes in primary or secondary prevention of cardiovascular disease, excluding for brevity the injection therapies for diabetes, such as insulin and glucagon-like peptide-1 receptor agonists.
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Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical Sciences, Internal Medicine and Diabetes, Federico II University School of Medicine, Napoli, Italy.
| | - Gloria Formoso
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, ex CeSI-Met), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, ex CeSI-Met), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
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Morieri ML, Bonora BM, Longato E, Di Camilo B, Sparacino G, Tramontan L, Avogaro A, Fadini GP. Exposure to dipeptidyl-peptidase 4 inhibitors and the risk of pneumonia among people with type 2 diabetes: Retrospective cohort study and meta-analysis. Diabetes Obes Metab 2020; 22:1925-1934. [PMID: 32691492 DOI: 10.1111/dom.14142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
AIM Concerns have been raised that dipeptidyl-peptidase 4 inhibitors (DPP-4i) may increase the risk of pneumonia. We analysed observational data and clinical trials to explore whether use of DPP-4i modifies the risk of pneumonia. METHODS We identified patients with diabetes in the Veneto region administrative database and performed propensity score matching between new users of DPP-4 inhibitors and new users of other oral glucose-lowering medications (OGLMs). We compared the rate of hospitalization for pneumonia between matched cohorts using the Cox proportional hazard model. The same analysis was repeated using the database of a local diabetes outpatient clinic. We retrieved similar observational studies from the literature to perform a meta-analysis. Results from trials reporting pneumonia rates among patients randomized to DPP-4 inhibitors versus placebo/active comparators were also meta-analysed. RESULTS In the regional database, after matching 6495 patients/group, new users of DPP-4 inhibitors had a lower rate of hospitalization for pneumonia than new users of other OGLMs (HR 0.76; 95% CI 0.61-0.95). In the outpatient database, after matching 867 patients/group, new users of DPP-4 inhibitors showed a non-significantly lower rate of hospitalization for pneumonia (HR 0.65; 95% CI 0.41-1.04). The meta-analysis of observational studies yielded an overall non-significant lower risk of hospitalization for pneumonia among DPP-4 inhibitor users (RR 0.81; 95% CI 0.65-1.01). The meta-analysis of randomized controlled trials showed no overall effect of DPP-4 inhibitors on pneumonia risk (RR 1.06; 95% CI 0.93-1.20). CONCLUSION The use of DPP-4 inhibitors can be considered as safe with regard to the risk of pneumonia.
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Affiliation(s)
| | | | - Enrico Longato
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Barbara Di Camilo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Lara Tramontan
- Arsenàl.IT, Veneto's Research Centre for eHealth Innovation, Treviso, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Fadini GP, Li Volsi P, Devangelio E, Poli M, Cazzetta G, Felace G, Avogaro A. Predictors of early discontinuation of dapagliflozin versus other glucose-lowering medications: a retrospective multicenter real-world study. J Endocrinol Invest 2020; 43:329-336. [PMID: 31515744 DOI: 10.1007/s40618-019-01110-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS In routine clinical practice, early discontinuation of newly initiated glucose-lowering medications (GLM) is relatively common. We herein evaluated if the clinical characteristics associated with early discontinuation of dapagliflozin were different from those associated with early discontinuation of other GLM. METHODS The DARWIN-T2D was a multicenter retrospective study conducted at diabetes specialist outpatient clinics in Italy. We included 2484 patients who were initiated on dapagliflozin in 2015-2016 and 14,801 patients who were initiated on other GLM (DPP-4 inhibitors, GLP-1 receptor agonists, or gliclazide) in the same period. After excluding patients who had not (yet) returned to follow-up, we compared the characteristics of patients who persisted on drug versus those who were no longer on drug at the first available follow-up after at least 3 months. RESULTS As compared to those who persisted on drug, patients who discontinued dapagliflozin (51.7%) were more often female, had higher baseline fasting plasma glucose (FPG), HbA1c, and eGFR, and less common use of metformin. Upon multiple regression, higher HbA1c, higher eGFR, and lower metformin use remained independently associated with early discontinuation. Among patients who had been initiated on other GLM, 41.7% discontinued. Variables independently associated with discontinuation were older age, longer diabetes duration, higher HbA1c, eGFR, and albumin excretion, more common use of insulin and less metformin. CONCLUSION In routine clinical practice, all variables associated with dapagliflozin discontinuation were also associated with discontinuation of other GLM. Thus, despite a distinctive mechanism of action and a peculiar tolerability profile, no specific predictor of dapagliflozin discontinuation was detected.
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Affiliation(s)
- G P Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - P Li Volsi
- Ospedale di Pordenone - Azienda per l'Assistenza Sanitaria n.5, Friuli Occidentale, 33170, Pordenone, Italy
| | - E Devangelio
- Presidio Territoriale di Assistenza-Distretto Socio Sanitario di Massafra - Azienda Sanitaria Locale di Taranto, 74016, Massafra, Italy
| | - M Poli
- Ospedale Girolamo Fracastoro di San Bonifacio - Azienda ULSS n.9 Scaligera, 37047, San Bonifacio, Italy
| | - G Cazzetta
- Distretto Socio Sanitario Gagliano del Capo, sede Tricase - Azienda Sanitaria Locale di Lecce, 73039, Tricase, Italy
| | - G Felace
- Ospedale di Spilimbergo - Azienda per l'Assistenza Sanitaria n.5, Friuli Occidentale, 33170, Pordenone, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Sesti G, Avogaro A, Belcastro S, Bonora BM, Croci M, Daniele G, Dauriz M, Dotta F, Formichi C, Frontoni S, Invitti C, Orsi E, Picconi F, Resi V, Bonora E, Purrello F. Ten years of experience with DPP-4 inhibitors for the treatment of type 2 diabetes mellitus. Acta Diabetol 2019; 56:605-617. [PMID: 30603867 DOI: 10.1007/s00592-018-1271-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
Abstract
Achieving and maintaining recommended glycemic targets without causing adverse e ffects, including hypoglycemia, is challenging, especially in older patients with type 2 diabetes mellitus (T2DM). The introduction of dipeptidyl peptidase-4 (DPP-4) inhibitors, more than 10 years ago, has provided an alternative to conventional medications for the intensification of glucose-lowering treatment after failure of metformin monotherapy, and therefore, marked an important advance in the management of T2DM. By prolonging the activity of incretin hormones, DPP-4 inhibitors induce insulin release and decrease glucagon secretion in a glucose-dependent manner. This results in a more physiologic glycemic control as compared to that ensured by insulin secretagogues (sulfonylureas and glinides). Overall, DPP-4 inhibitors have a favorable safety profile and can be used without dose adjustments in older adults and in patients with mild renal impairment; they have a neutral effect on body weight and do not cause hypoglycemia by themselves. Safety issues, reported mainly in post-marketing surveillance programs and including cardiovascular outcomes and the risk of acute pancreatitis, are being extensively investigated. The aim of this review is to discuss the impact of DPP-4 inhibitors on the treatment of T2DM, after 10 years of experience, with an emphasis on diabetes care in Italy. We will first describe T2DM treatment in Italy and then provide an overview of the main findings from randomized controlled trials, real-world studies and post-marketing surveillance programs with DPP-4 inhibitors.
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Affiliation(s)
- Giorgio Sesti
- Department of Clinical and Surgical Science, University of Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
| | - Sara Belcastro
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Marina Croci
- Department of Medical Sciences and Rehabilitation, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Daniele
- Department of Clinical and Experimental Medicine A.O.U. Pisana, Pisa, Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Verona, Italy
| | - Francesco Dotta
- Diabetes Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Caterina Formichi
- Diabetes Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, Department of Systems Medicine, S. Giovanni Calibita Fatebenefratelli Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Invitti
- Department of Medical Sciences and Rehabilitation, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Emanuela Orsi
- Diabetes Unit, Fondazione IRCCS'Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, Department of Systems Medicine, S. Giovanni Calibita Fatebenefratelli Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Veronica Resi
- Diabetes Unit, Fondazione IRCCS'Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Verona, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Pappachan JM, Fernandez CJ, Chacko EC. Diabesity and antidiabetic drugs. Mol Aspects Med 2019; 66:3-12. [PMID: 30391234 DOI: 10.1016/j.mam.2018.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 02/06/2023]
Abstract
The prevalence of "diabesity" - diabetes related to obesity - has increased tremendously over the past few decades because of the global obesity epidemic. Although bariatric surgery is the best treatment option for patients with diabesity, a majority of patients are managed only with antidiabetic drugs for various reasons. Diabetes control with antidiabetic agents may affect diabesity outcomes positively or negatively because of their effects on body weight and other metabolic parameters. For this reason, rational use of anti-diabetic medications is imperative to optimise long-term management of diabesity. Understanding the molecular mechanisms of antidiabetic drugs and/or drug combinations on diabesity outcomes are therefore important not only for the basic scientists but also for clinicians. This review explores the molecular signalling cascades of antidiabetic medications in the management of diabesity.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology, Diabetes& Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, LE21 9QS, United Kingdom.
| | - Cornelius J Fernandez
- Department of Endocrinology, Diabetes& Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, LE21 9QS, United Kingdom
| | - Elias C Chacko
- Department of Endocrinology & Diabetes, Jersey Hospital, Jersey, JE1 4SE, United Kingdom
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