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Cignarelli A, Genchi VA, D’Oria R, Giordano F, Caruso I, Perrini S, Natalicchio A, Laviola L, Giorgino F. Role of Glucose-Lowering Medications in Erectile Dysfunction. J Clin Med 2021; 10:jcm10112501. [PMID: 34198786 PMCID: PMC8201035 DOI: 10.3390/jcm10112501] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/11/2023] Open
Abstract
Erectile dysfunction (ED) is a long-term complication of type 2 diabetes (T2D) widely known to affect the quality of life. Several aspects of altered metabolism in individuals with T2D may help to compromise the penile vasculature structure and functions, thus exacerbating the imbalance between smooth muscle contractility and relaxation. Among these, advanced glycation end-products and reactive oxygen species derived from a hyperglycaemic state are known to accelerate endothelial dysfunction by lowering nitric oxide bioavailability, the essential stimulus of relaxation. Although several studies have explained the pathogenetic mechanisms involved in the generation of erectile failure, few studies to date have described the efficacy of glucose-lowering medications in the restoration of normal sexual activity. Herein, we will present current knowledge about the main starters of the pathophysiology of diabetic ED and explore the role of different anti-diabetes therapies in the potential remission of ED, highlighting specific pathways whose activation or inhibition could be fundamental for sexual care in a diabetes setting.
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Ferreira-Hermosillo A, Molina-Ayala MA, Molina-Guerrero D, Garrido-Mendoza AP, Ramírez-Rentería C, Mendoza-Zubieta V, Espinosa E, Mercado M. Efficacy of the treatment with dapagliflozin and metformin compared to metformin monotherapy for weight loss in patients with class III obesity: a randomized controlled trial. Trials 2020; 21:186. [PMID: 32059692 PMCID: PMC7023779 DOI: 10.1186/s13063-020-4121-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/30/2020] [Indexed: 01/10/2023] Open
Abstract
Background Mexico has one of the highest prevalence rates of obesity worldwide. New pharmacological strategies that focus on people with class III obesity are required. Metformin and dapagliflozin are two drugs approved for the treatment of diabetes. Beyond its effects on glucose, metformin has been suggested by some studies to result in weight loss. Therapy with dapagliflozin is associated with a mild but sustained weight loss in patients with diabetes. The primary outcome of the study is to determine if the combined treatment with dapagliflozin and metformin is more effective than monotherapy with metformin for weight loss in patients with class III obesity and prediabetes or diabetes who are awaiting bariatric surgery (including those patients who do have surgery). We also aimed to assess the effect of this combined treatment on waist circumference, triglycerides, blood pressure, and inflammatory cytokines. Methods This randomized phase IV clinical trial will include patients with diabetes or prediabetes who are between the ages of 18 and 60 years and exhibit grade III obesity (defined as body mass index ≥ 40 kg/m2). Patients using insulin will be excluded. Subjects will be randomized to one of two groups as follows: 1) metformin tablets 850 mg PO bid or 2) metformin tablets 850 mg PO bid plus dapagliflozin tablets 10 mg PO qd. The sample size required is 108 patients, which allows for a 20% dropout rate: 54 patients in the metformin group and 54 in the metformin/dapagliflozin group. All participants will receive personalized nutritional advice during the study. A run-in period of one month will be used to assess tolerance and adherence to treatment regimens. Anthropometric and biochemical variables will be recorded at baseline and at 1, 3, 6, and 12 months. A serum sample to determine glucagon, ghrelin, adiponectin, resistin, interleukin 6, and interleukin 10 will be collected at baseline and before surgery, or at 12 months (whatever happens first). Adherence to treatment and adverse and secondary events will be recorded throughout the study. An intention-to-treat analysis will be used. Discussion Forty-six percent of the patients in our Obesity Clinic have been diagnosed with prediabetes (32%) or diabetes (14%). The use of dapagliflozin in this population could improve weight loss and other cardiovascular factors. This effect could be translated into less time before undergoing bariatric surgery and better control of associated comorbidities. Trial registration Clinicaltrials.gov, ID: NCT03968224. Retrospectively registered on May 29, 2019.
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Affiliation(s)
- Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Mario Antonio Molina-Ayala
- Servicio de Endocrinología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Diana Molina-Guerrero
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Ana Pamela Garrido-Mendoza
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Claudia Ramírez-Rentería
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Victoria Mendoza-Zubieta
- Servicio de Endocrinología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Etual Espinosa
- Servicio de Endocrinología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico
| | - Moisés Mercado
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Doctores, 06720, Mexico City, Mexico.
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Assaly R, Gorny D, Compagnie S, Mayoux E, Bernabe J, Alexandre L, Giuliano F, Behr-Roussel D. The Favorable Effect of Empagliflozin on Erectile Function in an Experimental Model of Type 2 Diabetes. J Sex Med 2018; 15:1224-1234. [DOI: 10.1016/j.jsxm.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022]
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Sugiyama S, Jinnouchi H, Kurinami N, Hieshima K, Yoshida A, Jinnouchi K, Nishimura H, Suzuki T, Miyamoto F, Kajiwara K, Jinnouchi T. The SGLT2 Inhibitor Dapagliflozin Significantly Improves the Peripheral Microvascular Endothelial Function in Patients with Uncontrolled Type 2 Diabetes Mellitus. Intern Med 2018; 57:2147-2156. [PMID: 29607968 PMCID: PMC6120841 DOI: 10.2169/internalmedicine.0701-17] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce cardiovascular events and decrease the body fat mass in patients with type 2 diabetes mellitus (T2DM). We examined whether or not the SGLT2-inhibitor dapagliflozin can improve the endothelial function associated with a reduction in abdominal fat mass. Methods We prospectively recruited patients with uncontrolled [hemoglobin A1c (HbA1c) >7.0%] T2DM who were not being treated by SGLT2 inhibitors. Patients were treated with add-on dapagliflozin (5 mg/day) or non-SGLT2 inhibitor medicines for 6 months to improve their HbA1c. We measured the peripheral microvascular endothelial function as assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) and calculated the natural logarithmic transformed value of the RH-PAT index (LnRHI). We then investigated changes in the LnRHI and abdominal fat area using computed tomography (CT). Results The subjects were 54 patients with uncontrolled T2DM (72.2% men) with a mean HbA1c of 8.1%. The HbA1c was significantly decreased in both groups, with no significant difference between the groups. Dapagliflozin treatment, but not non-SGLT2 inhibitor treatment, significantly increased the LnRHI. The changes in the LnRHI were significantly greater in the dapagliflozin group than in the non-SGLT2 inhibitor group. Dapagliflozin treatment, but not non-SGLT2 inhibitor treatment, significantly decreased the abdominal visceral fat area, subcutaneous fat area (SFA), and total fat area (TFA) as assessed by CT and significantly increased the plasma adiponectin levels. The percentage changes in the LnRHI were significantly correlated with changes in the SFA, TFA, systolic blood pressure, and adiponectin. Conclusion Add-on treatment with dapagliflozin significantly improves the glycemic control and endothelial function associated with a reduction in the abdominal fat mass in patients with uncontrolled T2DM.
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Affiliation(s)
- Seigo Sugiyama
- Diabetes Care Center, Jinnouchi Hospital, Japan
- Cardiovascular Division, Diabetes Care Center, Jinnouchi Hospital, Japan
| | - Hideaki Jinnouchi
- Diabetes Care Center, Jinnouchi Hospital, Japan
- Cardiovascular Division, Diabetes Care Center, Jinnouchi Hospital, Japan
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Japan
| | | | | | | | | | | | | | | | - Keizo Kajiwara
- Diabetes Care Center, Jinnouchi Hospital, Japan
- Cardiovascular Division, Diabetes Care Center, Jinnouchi Hospital, Japan
| | - Tomio Jinnouchi
- Diabetes Care Center, Jinnouchi Hospital, Japan
- Cardiovascular Division, Diabetes Care Center, Jinnouchi Hospital, Japan
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Gaviria-Mendoza A, Sánchez-Duque JA, Medina-Morales DA, Machado-Alba JE. Prescription patterns and costs of antidiabetic medications in a large group of patients. Prim Care Diabetes 2018; 12:184-191. [PMID: 29196125 DOI: 10.1016/j.pcd.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 11/01/2017] [Accepted: 11/10/2017] [Indexed: 12/26/2022]
Abstract
AIMS To determine the prescription patterns of antidiabetic medications and the variables associated with their use in a Colombian population. METHODS A cross-sectional study using a systematized database of approximately 3.5 million affiliates of the Colombian Health System. Patients of both genders and all ages treated uninterruptedly with antidiabetic medications for three months (June-August 2015) were included. A database was designed that included sociodemographic, pharmacological, comedication, and cost variables. RESULTS A total of 47,532 patients were identified; the mean age was 65.5 years, and 56.3% were women. Among the patients, 56.2% (n=26,691) received medication as monotherapy. The most prescribed medications were metformin, 81.3% (n=38,664), insulins, 33.3% (n=15,848), and sulfonylureas, 21.8% (n=10,370). Among the patients, 92.8% received comedications, including antihypertensives (79.7%), hypolipemiants (65.5%), antiplatelet drugs (56.3%), analgesics (33.9%), antiulcerants (33.1%), and thyroid hormone (17.3%). The cost per 1000 inhabitants/day was $1.21 USD for metformin, $3.89 USD for insulins, and $0.02 USD for glibenclamide. CONCLUSIONS Generally, rational prescription habits predominated, however in some cases an overuse of comedications (such as antiulcer drugs) and a large group of patients with high cost formulations were observed. Subsequent effectiveness and cost-benefit analyzes are required.
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Affiliation(s)
- Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
| | - Jorge Andrés Sánchez-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
| | - Diego Alejandro Medina-Morales
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
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Roca-Rodríguez MM, Muros de Fuentes MT, Piédrola-Maroto G, Quesada-Charneco M, Maraver-Selfa S, Tinahones FJ, Mancha-Doblas I. [Lixisenatide in patients with type 2 diabetes and obesity: Beyond glycaemic control]. Aten Primaria 2016; 49:294-299. [PMID: 27667144 PMCID: PMC6875984 DOI: 10.1016/j.aprim.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/17/2016] [Accepted: 06/03/2016] [Indexed: 01/30/2023] Open
Abstract
Objetivo Evaluar la tolerancia a lixisenatida y sus efectos sobre el peso y el control metabólico de pacientes con diabetes tipo 2 y obesidad. Diseño Estudio prospectivo. Emplazamiento Consultas de atención especializada de Endocrinología y Nutrición en Almería, Granada y Málaga. Participantes Pacientes con diabetes tipo 2 y obesidad. Intervenciones Respuesta y tolerancia al tratamiento con lixisenatida. Mediciones principales Se analizaron datos clínicos y analíticos con medidas de cambio intrasujeto antes-después del tratamiento. Resultados Evaluamos 104 pacientes (51% mujeres) con diabetes tipo 2 y obesidad (Almería 18,3%; Granada 40,4%; Málaga 41,3%). Edad media 58,4 ± 10,5 años y duración media de diabetes 11,2 ± 6,7 años. El tiempo medio desde la visita basal a la revisión tras inicio de tratamiento con lixisenatida fue de 3,8 ± 1,6 meses. Encontramos mejoría significativa del peso (p < 0,001), índice de masa corporal (p < 0,001), circunferencia de cintura (p = 0,002), presión arterial sistólica (p < 0,001) y diastólica (p = 0,001), glucemia en ayunas (p < 0,001), HbA1c (p = 0,022), colesterol total (p < 0,001), colesterol LDL (p = 0,046) y triglicéridos (p = 0,020). No se observó alteración de cifras de amilasa en relación con el tratamiento con lixisenatida, y el 7,9% no lo toleraron. Conclusiones Lixisenatida consigue: 1) mejoría significativa de parámetros antropométricos y control glucémico (glucemia basal y HbA1c); 2) descenso significativo de la presión arterial y del perfil lipídico, y 3) seguridad y buena tolerancia en la mayoría de los pacientes. Además, encontramos una significativa intensificación del tratamiento antihipertensivo e hipolipemiante.
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Affiliation(s)
- M Mar Roca-Rodríguez
- UGC de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España.
| | | | | | | | - Silvia Maraver-Selfa
- UGC de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Victoria y Hospital Regional Universitario, Málaga, España
| | - Francisco J Tinahones
- UGC de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Victoria y Hospital Regional Universitario, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Málaga; CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Málaga, España
| | - Isabel Mancha-Doblas
- UGC de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Victoria y Hospital Regional Universitario, Málaga, España
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Schwartz SS, Jellinger PS, Herman ME. Obviating much of the need for insulin therapy in type 2 diabetes mellitus: A re-assessment of insulin therapy’s safety profile. Postgrad Med 2016; 128:609-19. [DOI: 10.1080/00325481.2016.1191955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Cardiovascular disease is the principal cause of death in patients with type 2 diabetes (T2DM). Exposure of the vasculature to metabolic disturbances leaves a persistent imprint on vascular walls, and specifically on smooth muscle cells (SMC) that favours their dysfunction and potentially underlies macrovascular complications of T2DM. Current diabetes therapies and continued development of newer treatments has led to the ability to achieve more efficient glycaemic control. There is also some evidence to suggest that some of these treatments may exert favourable pleiotropic effects, some of which may be at the level of SMC. However, emerging interest in epigenetic markers as determinants of vascular disease, and a putative link with diabetes, opens the possibility for new avenues to develop robust and specific new therapies. These will likely need to target cell-specific epigenetic changes such as effectors of DNA histone modifications that promote or inhibit gene transcription, and/or microRNAs capable of regulating entire cellular pathways through target gene repression. The growing epidemic of T2DM worldwide, and its attendant cardiovascular mortality, dictates a need for novel therapies and personalised approaches to ameliorate vascular complications in this vulnerable population.
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Affiliation(s)
- Karen E Porter
- Division of Cardiovascular & Diabetes Research, Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM) and Multidisciplinary Cardiovascular Research Centre (MCRC), University of Leeds, Leeds, LS2 9JT, UK,
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