1
|
Xie X, Wu C, Hao Y, Wang T, Yang Y, Cai P, Zhang Y, Huang J, Deng K, Yan D, Lin H. Benefits and risks of drug combination therapy for diabetes mellitus and its complications: a comprehensive review. Front Endocrinol (Lausanne) 2023; 14:1301093. [PMID: 38179301 PMCID: PMC10766371 DOI: 10.3389/fendo.2023.1301093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Diabetes is a chronic metabolic disease, and its therapeutic goals focus on the effective management of blood glucose and various complications. Drug combination therapy has emerged as a comprehensive treatment approach for diabetes. An increasing number of studies have shown that, compared with monotherapy, combination therapy can bring significant clinical benefits while controlling blood glucose, weight, and blood pressure, as well as mitigating damage from certain complications and delaying their progression in diabetes, including both type 1 diabetes (T1D), type 2 diabetes (T2D) and related complications. This evidence provides strong support for the recommendation of combination therapy for diabetes and highlights the importance of combined treatment. In this review, we first provided a brief overview of the phenotype and pathogenesis of diabetes and discussed several conventional anti-diabetic medications currently used for the treatment of diabetes. We then reviewed several clinical trials and pre-clinical animal experiments on T1D, T2D, and their common complications to evaluate the efficacy and safety of different classes of drug combinations. In general, combination therapy plays a pivotal role in the management of diabetes. Integrating the effectiveness of multiple drugs enables more comprehensive and effective control of blood glucose without increasing the risk of hypoglycemia or other serious adverse events. However, specific treatment regimens should be tailored to individual patients and implemented under the guidance of healthcare professionals.
Collapse
Affiliation(s)
- Xueqin Xie
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Changchun Wu
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuduo Hao
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Tianyu Wang
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuhe Yang
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Peiling Cai
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Yang Zhang
- Innovative Institute of Chinese Medicine and Pharmacy, Academy for Interdiscipline, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Huang
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Kejun Deng
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Yan
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Lin
- Center for Informational Biology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
2
|
Tan X, Yang X, Xu X, Peng Y, Li X, Deng Y, Zhang X, Qiu W, Wu D, Ruan Y, Zhi C. Investigation of anti-diabetic effect of a novel coenzyme Q10 derivative. Front Chem 2023; 11:1280999. [PMID: 37927560 PMCID: PMC10620959 DOI: 10.3389/fchem.2023.1280999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction: The rising incidence of type 2 diabetes has seriously affected international public health. The search for more drugs that can effectively treat diabetes has become a cutting-edge trend in research. Coenzyme Q10 (CoQ10) has attracted much attention in the last decade due to its wide range of biological activities. Many researchers have explored the clinical effects of CoQ10 in patients with type 2 diabetes. However, CoQ10 has low bio-availability due to its high lipophilicity. Therefore, we have structurally optimized CoQ10 in an attempt to exploit the potential of its pharmacological activity. Methods: A novel coenzyme Q10 derivative (L-50) was designed and synthesized by introducing a group containing bromine atom and hydroxyl at the terminal of coenzyme Q10 (CoQ10), and the antidiabetic effect of L-50 was investigated by cellular assays and animal experiments. Results: Cytotoxicity results showed that L-50 was comparatively low toxicity to HepG2 cells. Hypoglycemic assays indicated that L-50 could increase glucose uptake in IR-HepG2 cells, with significantly enhanced hypoglycemic capacity compared to the CoQ10. In addition, L-50 improved cellular utilization of glucose through reduction of reactive oxygen species (ROS) accumulated in insulin-resistant HepG2 cells (IR-HepG2) and regulation of JNK/AKT/GSK3β signaling pathway, resulting in hypoglycemic effects. Furthermore, the animal experiments demonstrated that L-50 could restore the body weight of HFD/STZ mice. Notably, the findings suggested that L-50 could improve glycemic and lipid metabolism in HFD/STZ mice. Moreover, L-50 could increase fasting insulin levels (FINS) in HFD/STZ mice, leading to a decrease in fasting blood glucose (FBG) and hepatic glycogen. Furthermore, L-50 could recover triglycerides (TG), total cholesterol (T-CHO), lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) levels in HFD/STZ mice. Discussion: The addition of a bromine atom and a hydroxyl group to CoQ10 could enhance its anti-diabetic activity. It is anticipated that L-50 could be a promising new agent for T2DM.
Collapse
Affiliation(s)
- Xiaojun Tan
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Xinyi Yang
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Xun Xu
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Yuwei Peng
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Xin Li
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Yongxing Deng
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Xueyang Zhang
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Wenlong Qiu
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Dudu Wu
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Yongdui Ruan
- The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Chen Zhi
- School of Pharmacy, Guangdong Medical University, Dongguan, China
| |
Collapse
|
3
|
Sun R, Yuan L, Shen Y, Shen Z, Ding B, Ma J. Impact of Fixed Combination of Metformin and Pioglitazone on Insulin Resistance of Patients with Type 2 Diabetes: Results of a Randomized Open-Label Study. Diabetes Metab Syndr Obes 2023; 16:2911-2919. [PMID: 37753480 PMCID: PMC10518260 DOI: 10.2147/dmso.s423322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Aim To compare the effect of metformin, a fixed combination of metformin and pioglitazone, or dapagliflozin on insulin resistance in patients with newly diagnosed type 2 diabetes. Methods In this 6-week randomized open-label trial, 58 patients were randomly assigned to insulin with metformin, a fixed combination of metformin and pioglitazone, or dapagliflozin for 4 weeks. Hyperinsulinemic euglycemic clamp tests and FreeStyle Libre Pro Sensor were used to evaluate the insulin sensitivity represented by glucose-infusion rate (M value) and glycemic control, respectively. The main outcome was changes in insulin resistance compared with baseline. Results The baseline characteristics were well matched among the three groups. When compared to baseline, insulin sensitivity after treatment was significantly improved. Further study revealed that the fixed combination of metformin and pioglitazone provided superior M-value improvement compared with metformin, but not different from dapagliflozin. Moreover, a greater reduction in insulin dose was observed in the fixed combination of metformin and pioglitazone group than the metformin or dapagliflozin group. However, there were no significant differences in the parameters of glycemic control within the groups. Conclusion In patients with newly diagnosed type 2 diabetes, a fixed combination of metformin and pioglitazone provided greater improvement in insulin resistance than metformin alone and similar changes in insulin resistance to dapagliflozin.
Collapse
Affiliation(s)
- Rui Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Lu Yuan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yun Shen
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ziyang Shen
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| |
Collapse
|
4
|
Lee D, Hwang BS, Choi P, Kim T, Kim Y, Song BG, Yamabe N, Hwang GS, Kang KS, Ham J. Hypoxylonol F Isolated from Annulohypoxylon annulatum Improves Insulin Secretion by Regulating Pancreatic β-cell Metabolism. Biomolecules 2019; 9:biom9080335. [PMID: 31382473 PMCID: PMC6723394 DOI: 10.3390/biom9080335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
Insulin plays a key role in glucose homeostasis and is hence used to treat hyperglycemia, the main characteristic of diabetes mellitus. Annulohypoxylon annulatum is an inedible ball-shaped wood-rotting fungus, and hypoxylon F is one of the major compounds of A. annulatum. The aim of this study is to evaluate the effects of hypoxylonol F isolated from A. annulatum on insulin secretion in INS-1 pancreatic β-cells and demonstrate the molecular mechanisms involved. Glucose-stimulated insulin secretion (GSIS) values were evaluated using a rat insulin ELISA kit. Moreover, the expression of proteins related to pancreatic β-cell metabolism and insulin secretion was evaluated using Western blotting. Hypoxylonol F isolated from A. annulatum was found to significantly enhance glucose-stimulated insulin secretion without inducing cytotoxicity. Additionally, hypoxylonol F enhanced insulin receptor substrate-2 (IRS-2) levels and activated the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) pathway. Interestingly, it also modulated the expression of peroxisome proliferator-activated receptor γ (PPARγ) and pancreatic and duodenal homeobox 1 (PDX-1). Our findings showed that A. annulatum and its bioactive compounds are capable of improving insulin secretion by pancreatic β-cells. This suggests that A. annulatum can be used as a therapeutic agent to treat diabetes.
Collapse
Affiliation(s)
- Dahae Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea
| | - Buyng Su Hwang
- Freshwater Bioresources Utilization Bureau, Nakdonggang National Institute of Biological Resources, Sangju 37242, Korea
| | - Pilju Choi
- Natural Products Research Institute, Korea Institute of Science and Technology, Gangneung 25451, Korea
| | - Taejung Kim
- Natural Products Research Institute, Korea Institute of Science and Technology, Gangneung 25451, Korea
| | - Youngseok Kim
- Natural Products Research Institute, Korea Institute of Science and Technology, Gangneung 25451, Korea
| | - Bong Geun Song
- Natural Products Research Institute, Korea Institute of Science and Technology, Gangneung 25451, Korea
| | - Noriko Yamabe
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea
| | - Gwi Seo Hwang
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea
| | - Ki Sung Kang
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
| | - Jungyeob Ham
- Freshwater Bioresources Utilization Bureau, Nakdonggang National Institute of Biological Resources, Sangju 37242, Korea.
- Division of Bio-Medical Science and Technology, University of Science and Technology, Daejeon 34114, Korea.
| |
Collapse
|
5
|
Seo YJ, Lee K, Chei S, Jeon YJ, Lee BY. Ishige okamurae Extract Ameliorates the Hyperglycemia and Body Weight Gain of db/db Mice through Regulation of the PI3K/Akt Pathway and Thermogenic Factors by FGF21. Mar Drugs 2019; 17:E407. [PMID: 31323977 PMCID: PMC6669686 DOI: 10.3390/md17070407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes mellitus and related metabolic disorders, such as dyslipidemia, present increasing challenges to health worldwide, as a result of urbanization, the increasing prevalence of obesity, poor lifestyle, and other stress-related factors. Ishige okamurae extract (IOE) is known to be effective at lowering blood glucose and ameliorating metabolic disease. However, detailed mechanisms for these effects have yet to be elucidated. Here, we show that IOE ameliorates substrate (IRS)/ phosphatidylinositol 3-kinase (PI3K)/Akt pathway and increasing glucose transporter 4 (GLUT4) expression in skeletal muscle and white adipose tissue (WAT). We also demonstrate that IOE increases the expression of fibroblast growth factor (FGF)21, a regulator of glucose and energy metabolism in muscle and WAT. In addition, IOE administration increased peroxisome proliferator-activated receptor γ coactivator 1α expression, which regulates expression of the key thermogenic molecule uncoupling protein 1 in WAT. Thus, the effects of IOE to ameliorate hyperglycemia and adiposity may be mediated through FGF21 activating insulin signaling and increasing the expression of GLUT4 and pro-thermogenic factors.
Collapse
Affiliation(s)
- Young-Jin Seo
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam, Kyeonggi 13488, Korea
| | - Kippeum Lee
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam, Kyeonggi 13488, Korea
| | - Sungwoo Chei
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam, Kyeonggi 13488, Korea
| | - You-Jin Jeon
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam, Kyeonggi 13488, Korea
| | - Boo-Yong Lee
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam, Kyeonggi 13488, Korea.
| |
Collapse
|
6
|
Reich D, Gallucci G, Tong M, de la Monte SM. Therapeutic Advantages of Dual Targeting of PPAR-δ and PPAR-γ in an Experimental Model of Sporadic Alzheimer's Disease. ACTA ACUST UNITED AC 2018; 5. [PMID: 30705969 PMCID: PMC6350901 DOI: 10.13188/2376-922x.1000025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Alzheimer’s disease (AD) is associated with progressive impairments in brain responsiveness to insulin and insulin-like growth factor (IGF). Although deficiencies in brain insulin and IGF could be ameliorated with trophic factors such as insulin, impairments in receptor expression, binding, and tyrosine kinase activation require alternative strategies. Peroxisome proliferator-activated receptor (PPAR) agonists target genes downstream of insulin/IGF stimulation. Furthermore, their anti-oxidant and anti-inflammatory effects address other pathologies contributing to neurodegeneration. Objectives: The goal of this research was to examine effects of dual delivery of L165, 041 (PPAR-δ) and F-L-Leu (PPAR-γ) agonists for remediating in the early stages of neurodegeneration. Model: Experiments were conducted using frontal lobe slice cultures from an intracerebral Streptozotocin (i.c. STZ) rat model of AD. Results: PPAR-δ+ PPAR-γ agonist treatments increased indices of neuronal and myelin maturation, and mitochondrial proliferation and function, and decreased neuroinflammation, AβPP-Aβ, neurotoxicity, ubiquitin, and nitrosative stress, but failed to restore choline acetyl transferase expression and adversely increased HNE(lipid peroxidation) and acetylcholinesterase, which would have further increased stress and reduced cholinergic function in the STZ brain cultures. Conclusion: PPAR-δ + PPAR-γ agonist treatments have substantial positive early therapeutic targeting effects on AD-associated molecular and biochemical brain pathologies. However, additional or alternative strategies may be needed to optimize disease remediation during the initial phases of treatment.
Collapse
Affiliation(s)
- D Reich
- Brandeis University, Waltham University, USA
| | - G Gallucci
- Department of Medicine, University of Brown University, USA
| | - M Tong
- Department of Medicine, University of Brown University, USA
| | - S M de la Monte
- Department of Medicine, University of Brown University, USA.,Departments of Neurology, University of Brown University, USA
| |
Collapse
|
7
|
Tong M, Deochand C, Didsbury J, de la Monte SM. T3D-959: A Multi-Faceted Disease Remedial Drug Candidate for the Treatment of Alzheimer's Disease. J Alzheimers Dis 2016; 51:123-38. [PMID: 26836193 DOI: 10.3233/jad-151013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND T3D-959, a dual PPAR-δ/PPAR γ nuclear receptor agonist and former diabetes drug candidate, has been repositioned as an Alzheimer's disease (AD)-modifying therapy. OBJECTIVE This study examines the effectiveness and mechanisms of T3D-959's therapeutic effects using in vivo and ex vivo rat models of sporadic AD. METHODS A sporadic AD model was generated by intracerebral (i.c.) administration of streptozotocin (STZ). Control and i.c. STZ treated rats were gavaged with saline or T3D-959 (0.3 to 3.0 mg/kg/day) for 28 days. Spatial learning and memory were evaluated using the Morris water maze test. Frontal lobe slice cultures generated 24 hours after i.c. STZ or vehicle were used to study early effects of T3D-959 (0.5-1.0 μM) on viability and molecular markers of AD. RESULTS T3D-959 significantly improved spatial learning and memory in i.c STZ-treated rats. Mechanistically, T3D-959 significantly improved culture viability and brain morphology, reduced levels of oxidative stress and Aβ, and normalized expression of phospho-tau, choline acetyltransferase, and myelin-associated glycoprotein. Protective effects occurred even at the lowest tested dose of T3D-959. CONCLUSIONS Pre-clinical proof of concept has been demonstrated that T3D-959 can improve multiple pathologies of AD resulting in significant improvements in cognitive function and molecular and biochemical indices of neurodegeneration. These results support the theses that (1) effective disease modification in AD can be achieved by targeting relevant nuclear receptors, and (2) treating AD as a metabolic disease has the potential to be disease remedial. A Phase 2a trial of T3D-959 in mild-to-moderate AD patients has been initiated (ClinicalTrials.gov identifier NCT02560753).
Collapse
Affiliation(s)
- Ming Tong
- Liver Research Center, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Gastroenterology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Chetram Deochand
- Liver Research Center, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Gastroenterology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - John Didsbury
- T3D Therapeutics, Inc., Research Triangle Park, NC, USA
| | - Suzanne M de la Monte
- Liver Research Center, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Gastroenterology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Neuropathology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Pathology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurology, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
8
|
Kakara M, Nomura H, Ezaki M, Fukae M, Hirota T, Matsubayashi S, Hirakawa M, Ieiri I. Population pharmacodynamic analysis of hemoglobin A1c-lowering effects by adding treatment of DPP-4 inhibitors (sitagliptin) in type 2 diabetes mellitus patients based on electronic medical records. J Diabetes Complications 2016; 30:1282-6. [PMID: 27338508 DOI: 10.1016/j.jdiacomp.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/19/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
AIM To develop a population pharmacodynamic (PPD) model describing the time course for the hemoglobin A1c (HbA1c)-lowering effects of adding treatment of DPP-4 inhibitors and to assess the efficacy of combination therapy in type 2 diabetes mellitus patients based on electronic medical records. METHODS Information on patients was collected retrospectively from electronic medical records. Of the 4 DPP-4 inhibitors used, we focused on sitagliptin as it had the best time-response relationships. A physiological indirect response model was developed to describe changes in HbA1c levels. RESULTS An indirect response model, based on the 1300 HbA1c levels of 160 patients, described the time course for the HbA1c-lowering effects of adding sitagliptin. The combination with pioglitazone decreased the HbA1c synthesis rate by 7.74% relative to without pioglitazone. Bayesian forecasting based on the final PDD model using the first two HbA1c observations, before and within 30days after the addition of sitagliptin, gave a precise prediction of HbA1c-lowering effects individually. CONCLUSIONS Our PPD model quantitatively described the beneficial effects of combination therapy with pioglitazone and sitagliptin. The proposal methodology is also expected to be applicable to other medicines based on electronic medical records in clinical practice.
Collapse
Affiliation(s)
- Makoto Kakara
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroko Nomura
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Osaka Headquarters, Tokushukai General Incorporated Association, Osaka 530-0001, Japan; Hospital Pharmacy, Fukuoka Tokushukai Medical Center, Fukuoka 816-0864, Japan
| | - Mai Ezaki
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masato Fukae
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takeshi Hirota
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Sunao Matsubayashi
- Department of Psychosomatic Medicine, Fukuoka Tokushukai Medical Center, Fukuoka 816-0864, Japan
| | - Masaaki Hirakawa
- Hospital Pharmacy, Fukuoka Tokushukai Medical Center, Fukuoka 816-0864, Japan
| | - Ichiro Ieiri
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
| |
Collapse
|
9
|
Derosa G, D’Angelo A, Maffioli P. Sitagliptin in type 2 diabetes mellitus: Efficacy after five years of therapy. Pharmacol Res 2015. [DOI: 10.1016/j.phrs.2015.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Yokoyama H, Araki S, Kawai K, Hirao K, Oishi M, Sugimoto K, Sone H, Maegawa H, Kashiwagi A. Pioglitazone treatment and cardiovascular event and death in subjects with type 2 diabetes without established cardiovascular disease (JDDM 36). Diabetes Res Clin Pract 2015; 109:485-92. [PMID: 26261056 DOI: 10.1016/j.diabres.2015.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/23/2015] [Accepted: 06/28/2015] [Indexed: 01/26/2023]
Abstract
AIMS The protective association of pioglitazone with cardiovascular events and death was investigated over 6-years in large-scale type 2 diabetic subjects without established cardiovascular disease in a primary care setting. METHODS A six-year observational cohort study including 2864 subjects with type 2 diabetes without established cardiovascular disease was performed. The primary endpoint was a composite of first occurrence of cardiovascular disease or death. The effect of pioglitazone use at a baseline year with a Cox proportional hazard model and the time-dependent use in each one-year examination interval with a pooled logistic regression model were analyzed. RESULTS Baseline use of pioglitazone (n=493) did not show a statistically protective effect on the primary endpoint (n=175), although it tended to reduce the risk (adjusted hazard ratio 0.67 [95% CI: 0.43-1.05]). However, pooled logistic regression analysis indicated a significant protective association of pioglitazone with the primary endpoint (0.58 [0.38 to 0.87] and cardiovascular disease (0.54 [0.33-0.88]), independent of concurrent levels of blood glucose, blood pressure, lipids, albuminuria, and renal function. In particular, this protective association was observed in those with diabetic nephropathy regardless of the daily dose of pioglitazone. Among a total of 898 subjects who took pioglitazone during the period, 43% experienced a discontinuation at least once; however, serious adverse effects were rare. CONCLUSIONS This observational study indicated a protective association of pioglitazone with cardiovascular disease and death in type 2 diabetic subjects without established vascular disease, particularly those with nephropathy.
Collapse
Affiliation(s)
- H Yokoyama
- Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
| | - S Araki
- Shiga University of Medical Science, Department of Medicine, Otsu, Shiga, Japan
| | - K Kawai
- Kawai Clinic, Tsukuba, Japan
| | - K Hirao
- HEC Science Clinic, Yokohama, Japan
| | | | | | - H Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Japan
| | - H Maegawa
- Shiga University of Medical Science, Department of Medicine, Otsu, Shiga, Japan
| | - A Kashiwagi
- Shiga University of Medical Science, Department of Medicine, Otsu, Shiga, Japan
| |
Collapse
|
11
|
Sola D, Rossi L, Schianca GPC, Maffioli P, Bigliocca M, Mella R, Corlianò F, Fra GP, Bartoli E, Derosa G. Sulfonylureas and their use in clinical practice. Arch Med Sci 2015; 11:840-8. [PMID: 26322096 PMCID: PMC4548036 DOI: 10.5114/aoms.2015.53304] [Citation(s) in RCA: 289] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 03/17/2013] [Accepted: 10/27/2013] [Indexed: 12/16/2022] Open
Abstract
Many anti-diabetic drugs with different mechanisms of action are now available for treatment of type 2 diabetes mellitus. Sulfonylureas have been extensively used for treatment of type 2 diabetes for nearly 50 years and, even in our times, are widely used for treatment of this devastating chronic illness. Here, we review some of the available data on sulfonylureas, evaluating their mechanism of action and their effects on glycemic control. We can conclude that sulfonylureas are still the most used anti-diabetic agents: maybe this is due to their lower cost, to the possibility of mono-dosing and to the presence of an association with metformin in the same tablet. However, sulfonylureas, especially the older ones, are linked to a greater prevalence of hypoglycemia, and cardiovascular risk; newer prolonged-release preparations of sulfonylureas are undoubtedly safer, mainly due to reducing hypoglycemia, and for this reason should be preferred.
Collapse
Affiliation(s)
- Daniele Sola
- Department of Translational Medicine, University “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Luca Rossi
- Department of Translational Medicine, University “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | | | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Marcello Bigliocca
- Department of Translational Medicine, University “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Roberto Mella
- Department of Translational Medicine, University “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Francesca Corlianò
- Department of Translational Medicine, University “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | | | - Ettore Bartoli
- Department of Translational Medicine, University “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy
| |
Collapse
|
12
|
Abstract
Pioglitazone is an inexpensive and effective oral drug for the treatment of Type 2 diabetes. It addresses insulin resistance, one of the core pathophysiological defects in Type 2 diabetes, at both the adipose tissue and skeletal muscle level. As a majority of Type 2 diabetics classically exhibit higher insulin resistance, pioglitazone may strike exactly at the Achilles heel in this core pathogenesis. However, with the emerging association of bladder cancer with pioglitazone, French and German regulators were the first to ban or restrict pioglitazone use in 2011. The Indian regulators also suspended pioglitazone, although this ban was revoked within a month. Recently, a 10-year longitudinal study commissioned by US FDA found no association between bladder cancer and pioglitazone. Nevertheless, this controversy created a huge outcry in the medical fraternity. This review article is an overview of the development of this topic and an attempt to provide perspective on this contemporary issue.
Collapse
|
13
|
Bohannon NJV. Individualized Treatment of Type 2 Diabetes Mellitus Using Noninsulin Agents: Clinical Considerations for the Primary Care Physician. Postgrad Med 2015; 124:95-108. [DOI: 10.3810/pgm.2012.07.2572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
14
|
Derosa G, Romano D, Bianchi L, D'Angelo A, Maffioli P. Metformin powder formulation compared to metformin tablets on glycemic control and on treatment satisfaction in subjects with type 2 diabetes mellitus. J Clin Pharmacol 2015; 55:409-14. [DOI: 10.1002/jcph.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/15/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
- Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research; University of Pavia; Pavia Italy
| | - Davide Romano
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Lucio Bianchi
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Angela D'Angelo
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
- Phd School in Experimental Medicine; University of Pavia; Pavia Italy
| |
Collapse
|
15
|
Larson CJ. The persistent need for insulin sensitizers and other disease-modifying anti-diabetic drugs. Expert Rev Endocrinol Metab 2014; 9:1-3. [PMID: 30743733 DOI: 10.1586/17446651.2014.868304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite significant advances in diabetes care since the introductions of insulin and metformin, disease burden continues to grow. Large gaps in standard of care remain, and no robustly disease-modifying pharmacotherapy exists. Substantial research has been directed towards beta cell preservation and regeneration with no translational success, while little drug discovery or development is aimed at the other major cause of diabetes, namely, insulin resistance. Given the absence of convincing evidence that human beta cells can be regenerated, the diabetes community must broaden its focus to include new therapeutic strategies to limit, and reverse, insulin resistance.
Collapse
Affiliation(s)
- Christopher J Larson
- a Cardiovascular & Metabolic Diseases Drug Discovery Unit, Takeda Pharmaceuticals, San Diego, CA, USA
| |
Collapse
|
16
|
Affiliation(s)
- Pamela Maffioli
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo , Pavia , Italy
| | | |
Collapse
|
17
|
Ultrasonography modifications of visceral and subcutaneous adipose tissue after pioglitazone or glibenclamide therapy combined with rosuvastatin in type 2 diabetic patients not well controlled by metformin. Eur J Gastroenterol Hepatol 2013; 25:1113-22. [PMID: 23524525 DOI: 10.1097/meg.0b013e3283608317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To compare pioglitazone or glibenclamide alone and in combination with rosuvastatin on hepatic steatosis in type 2 diabetic patients. MATERIALS AND METHODS After 3 months of metformin, patients were randomized to add pioglitazone 15 mg twice a day or glibenclamide 5 mg twice a day for 6 months, and then rosuvastatin 5 mg was added for other 6 months. Patients underwent an ultrasound examination for evaluation of steatosis degree, subcutaneous adipose tissue, and visceral adipose tissue diameter, an euglycemic hyperinsulinemic clamp, and blood sample collection for evaluation of glycemic control, fasting plasma insulin, lipid profile, adipocytokines at randomization, and after 6 and 12 months. RESULTS Both pioglitazone and glibenclamide improved glycemic control. Pioglitazone reduced fasting plasma insulin, whereas glibenclamide increased it. Pioglitazone increased the glucose infusion rate compared with glibenclamide. Pioglitazone, but not glibenclamide, improved the lipid profile, and, when rosuvastatin was added, there was a greater improvement with pioglitazone and rosuvastatin. Adiponectin was increased by pioglitazone (+0.5 μg/ml), with a further increase (+0.4 μg/ml) when rosuvastatin was added. A significant decrease in leptin (-3.1 ng/ml) and interleukin-6 (-0.4 pg/ml) was found only with pioglitazone; a similar trend (-2.5 ng/ml and -0.3 pg/ml, respectively) was maintained after the addition of rosuvastatin.Rosuvastatin+pioglitazone decreased tumor necrosis factor-α (-0.3 ng/ml) and were superior to glibenclamide+rosuvastatin in reducing high-sensitivity C-reactive protein (-0.4 mg/l).Pioglitazone decreased ultrasound parameters, and the addition of rosuvastatin further decreased them both compared with randomization and glibenclamide. CONCLUSION Pioglitazone was more effective than glibenclamide in improving inflammation and hepatic steatosis indices.
Collapse
|
18
|
Derosa G, Cicero AFG, Franzetti IG, Querci F, Carbone A, Piccinni MN, D'Angelo A, Fogari E, Maffioli P. A comparison between sitagliptin or glibenclamide in addition to metformin + pioglitazone on glycaemic control and β-cell function: the triple oral therapy. Diabet Med 2013; 30:846-54. [PMID: 23413771 DOI: 10.1111/dme.12158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 12/03/2012] [Accepted: 02/14/2013] [Indexed: 11/25/2022]
Abstract
AIMS To evaluate which triple oral therapy between metformin + pioglitazone + sitagliptin and metformin + pioglitazone + glibenclamide can be more useful in improving glycaemic control and should be preferred in clinical practice. METHODS During the 2-year run-in period, patients were instructed to take metformin monotherapy for the first year, then a combination of metformin and pioglitazone for the second year, then patients were randomized to add glibenclamide or sitagliptin to the dual combination of metformin and pioglitazone for another year. RESULTS Body weight reached with sitagliptin at 36 months was lower than that reached with glibenclamide. Fasting plasma insulin and homeostasis model assessment of insulin resistance were significantly increased by triple therapy with glibenclamide and decreased by that with sitagliptin. While sitagliptin did not change homeostasis model assessment of β-cell function, this value was significantly increased by glibenclamide. Fasting plasma proinsulin was not influenced by triple oral therapy including glibenclamide, while it was decreased by the therapy including sitagliptin compared to glibenclamide. Triple oral therapy with sitagliptin better improved β-cell function measures compared with the glibenclamide therapy. CONCLUSIONS Sitagliptin should be preferred to glibenclamide as an addition to the metformin + pioglitazone combination for its better protection of β-cell secretion and its neutral effect on body weight.
Collapse
Affiliation(s)
- G Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Derosa G, Franzetti IG, Querci F, Carbone A, Ciccarelli L, Piccinni MN, Fogari E, Maffioli P. Variation in Inflammatory Markers and Glycemic Parameters After 12 Months of Exenatide Plus Metformin Treatment Compared with Metformin Alone: A Randomized Placebo-Controlled Trial. Pharmacotherapy 2013; 33:817-26. [DOI: 10.1002/phar.1301] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics; University of Pavia; Pavia Italy
- Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research; University of Pavia; Pavia Italy
| | | | | | | | | | | | - Elena Fogari
- Department of Internal Medicine and Therapeutics; University of Pavia; Pavia Italy
| | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics; University of Pavia; Pavia Italy
| |
Collapse
|
20
|
Derosa G, Cicero AFG, Franzetti IG, Querci F, Carbone A, Piccinni MN, D'Angelo A, Fogari E, Maffioli P. A randomized, double-blind, comparative therapy evaluating sitagliptin versus glibenclamide in type 2 diabetes patients already treated with pioglitazone and metformin: a 3-year study. Diabetes Technol Ther 2013; 15:214-22. [PMID: 23427864 DOI: 10.1089/dia.2012.0272] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study evaluated if triple oral therapy can be useful in improving glycemic control compared with metformin monotherapy and with a metformin and pioglitazone combination. Furthermore, we also compared a triple metformin+pioglitazone+glibenclamide combination with a metformin+pioglitazone+sitagliptin one. SUBJECTS AND METHODS After a 2-year run-in therapy-augmenting phase with metformin and pioglitazone, 453 overweight, type 2 diabetes patients were randomized to 1 year of sitagliptin versus 1 year of glibenclamide to evaluate, as the primary outcome, the variation of β-cell function both in a fasting state and after an euglycemic hyperinsulinemic and hyperglycemic clamp. As secondary outcomes we evaluated glycemic control and insulin resistance. RESULTS Both the triple therapy combinations were more effective in reducing glycated hemoglobin compared with metformin monotherapy and with dual therapy metformin+pioglitazone. Fasting plasma insulin level and the homeostasis model assessment insulin resistance index were significantly increased by triple therapy with glibenclamide and decreased by the one with sitagliptin. Although sitagliptin did not change the homeostasis model assessment β-function index, this value was significantly increased by glibenclamide. The fasting plasma proinsulin level was decreased by sitagliptin. Triple therapy with sitagliptin greatly improved β-cell function measures compared with the glibenclamide one and also compared with metformin monotherapy and with the metformin+pioglitazone combination. CONCLUSIONS Dual combination therapy is more effective than monotherapy in improving glycemic control. When double therapy is not enough to reach an adequate glycemic control, sitagliptin should be preferred to glibenclamide as the third agent because of its positive effect on β-cells.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Pratley RE, Urosevic D, Boldrin M, Balena R. Efficacy and tolerability of taspoglutide versus pioglitazone in subjects with type 2 diabetes uncontrolled with sulphonylurea or sulphonylurea-metformin therapy: a randomized, double-blind study (T-emerge 6). Diabetes Obes Metab 2013; 15:234-40. [PMID: 22958426 DOI: 10.1111/dom.12009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/02/2012] [Accepted: 09/02/2012] [Indexed: 01/24/2023]
Abstract
AIMS This study compared the efficacy and tolerability of taspoglutide versus pioglitazone in subjects with type 2 diabetes inadequately controlled with sulphonylurea ± metformin. METHODS In this double-blind, double-dummy, parallel-group trial, 760 subjects (49% male, age 56.4 years, diabetes duration 8.8 years, body mass index 32.7 kg/m(2) and haemoglobin A1c [HbA1c] 8.3%) were randomized (1 : 1 : 1) to subcutaneous injections of taspoglutide 10 or 20 mg once weekly or oral pioglitazone 45 mg daily. The primary endpoint was change in HbA1c after 24 weeks. RESULTS Mean (±s.e.) HbA1c reductions with taspoglutide 10 (-1.18 ± 0.08%) and 20 mg (-1.36 ± 0.08%) were non-inferior to pioglitazone (-1.30 ± 0.08%) (p = 0.21 and 0.37, respectively); mean treatment differences were 0.12 (95% confidence interval: -0.03, -0.26) and -0.06 (-0.20, 0.08) for taspoglutide 10 and 20 mg versus pioglitazone. Mean (±s.e.) changes in body weight (kg) were -0.8 ± 0.3, -1.0 ± 0.3 and 3.6 ± 0.3 for taspoglutide 10 and 20 mg and pioglitazone, respectively; 8, 11 and 1% of patients achieved ≥5% weight loss. A higher incidence of adverse events (AEs) occurred with taspoglutide, predominantly gastrointestinal disturbances and injection-site reactions, resulting in higher rates of discontinuation versus pioglitazone. No treatment differences in serious AEs were observed. CONCLUSIONS Taspoglutide offered good glycaemic control similar to pioglitazone, while achieving beneficial weight loss rather than weight gain, but was associated with more AEs. Due to the higher than expected discontinuation rates, mainly because of gastrointestinal intolerability, the taspoglutide clinical programme was stopped.
Collapse
Affiliation(s)
- R E Pratley
- Florida Hospital - Sanford-Burnham Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA.
| | | | | | | |
Collapse
|
22
|
Abstract
Post-prandial hyperglycemia still remains a problem in the management of type 2 diabetes mellitus. Of all available anti-diabetic drugs, α-glucosidase inhibitors seem to be the most effective in reducing post-prandial hyperglycemia. We conducted a review analyzing the clinical efficacy and safety of α-glucosidase inhibitors, both alone and in combination with other anti-diabetic drugs, with respect to glycemic control, inflammation and atherosclerosis. α-Glucosidase inhibitors proved to be effective and safe both in monotherapy and as an add-on to other anti-diabetic drugs. Compared to miglitol and voglibose, acarbose seems to have some additive effects such as stabling carotid plaques, and reducing inflammation. Acarbose also proved to reverse impaired glucose tolerance to normal glucose tolerance.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | |
Collapse
|
23
|
Cicero AF, Tartagni E, Ertek S. Metformin and its clinical use: new insights for an old drug in clinical practice. Arch Med Sci 2012; 8:907-17. [PMID: 23185203 PMCID: PMC3506244 DOI: 10.5114/aoms.2012.31622] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/19/2012] [Accepted: 10/28/2012] [Indexed: 01/19/2023] Open
Abstract
Metformin is generally recommended as first-line treatment in type 2 diabetes, especially in overweight patients, but in recent years new indications for its use have emerged. Metformin has been found to be safe and efficacious both as monotherapy and in combination with all oral antidiabetic agents and insulins. If metformin use during pregnancy and the lactation period is supported by few data, it could be indicated for women with polycystic ovary syndrome, since it could diminish circulating androgens and insulin resistance, thus ameliorating the ovulation rate. Metformin seems to reduce cancer risk, which appears to be increased in diabetics, and is a promising agent for oncoprevention and chemotherapy combinations. Moreover, metformin could find a place in the treatment of non-alcoholic fatty liver disease. Lactic acidosis could be decreased by avoiding metformin use in patients with hypovolemia, sepsis, renal impairment, hypoxic respiratory diseases and heart failure, in the preoperative period and before intravenous injection of contrast media.
Collapse
Affiliation(s)
| | - Elisa Tartagni
- Medical and Surgical Sciences Department, Bologna University, Italy
| | - Sibel Ertek
- Department of Endocrinology and Metabolic Diseases, Ufuk University, Ankara, Turkey
| |
Collapse
|
24
|
Derosa G, Ragonesi PD, Carbone A, Fogari E, D'Angelo A, Cicero AFG, Maffioli P. Vildagliptin action on some adipocytokine levels in type 2 diabetic patients: a 12-month, placebo-controlled study. Expert Opin Pharmacother 2012; 13:2581-91. [DOI: 10.1517/14656566.2012.734499] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
25
|
Derosa G, Ragonesi PD, Fogari E, Cicero AFG, Bianchi L, Bonaventura A, Romano D, Maffioli P. Sitagliptin added to previously taken antidiabetic agents on insulin resistance and lipid profile: a 2-year study evaluation. Fundam Clin Pharmacol 2012; 28:221-9. [PMID: 23039403 DOI: 10.1111/fcp.12001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 09/03/2012] [Indexed: 12/21/2022]
Abstract
The aim of this study was to evaluate whether the positive effects of sitagliptin on glycemic control and insulin resistance were maintained also after 2 years of therapy and whether sitagliptin could be effective also in improving lipid profile. In this randomized, double-blind, placebo-controlled trial, 205 patients with type 2 diabetes in therapy with different antidiabetic drugs were randomized to add sitagliptin 100 mg once a day or placebo to their current therapy. We evaluated at the baseline and after 6, 12, 18, and 24 months the following parameters: body mass index, glycated hemoglobin (HbA1c ), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (Tg). Sitagliptin, added to previously taken antidiabetic agents, proved to be effective in improving glycemic profile, reducing HbA1c by -17.5%, FPG by -12.7%, PPG by -20.5%. Regarding insulin resistance, sitagliptin decreased FPI by -8.3% and HOMA-IR by -20.0%, confirming that what have been already reported in short-term studies can be applied also after 2 years of treatment. Sitagliptin also reduced body weight by -4.3%. Our study also showed the positive effect of sitagliptin on lipid profile; in particular, sitagliptin decreased TC by -13.3%, LDL-C by -20.4%, and Tg by -32.3%, and also increased HDL-C by + 13.6%. Sitagliptin proved to be effective on glycemic profile and insulin resistance even after 2 years of therapy and to be effective in improving body weight and lipid profile.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Gallwitz B, Guzman J, Dotta F, Guerci B, Simó R, Basson BR, Festa A, Kiljański J, Sapin H, Trautmann M, Schernthaner G. Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with type 2 diabetes with metformin failure (EUREXA): an open-label, randomised controlled trial. Lancet 2012; 379:2270-8. [PMID: 22683137 DOI: 10.1016/s0140-6736(12)60479-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Glycaemic control deteriorates progressively over time in patients with type 2 diabetes. Options for treatment escalation remain controversial after failure of first-line treatment with metformin. We compared add-on exenatide with glimepiride for durability of glycaemic control in patients with type 2 diabetes inadequately controlled by metformin alone. METHODS We did an open-label, randomised controlled trial at 128 centres in 14 countries between Sept 5, 2006, and March 29, 2011. Patients aged 18-85 years with type 2 diabetes inadequately treated by metformin were randomly assigned via a computer-generated randomisation sequence to receive exenatide twice daily or glimepiride once daily as add-on to metformin. Randomisation was stratified by predetermined categories of glycated haemoglobin (HbA(1C)) concentration. The primary outcome was time to inadequate glycaemic control and need for alternative treatment, defined as an HbA(1c) concentration of more than 9% after the first 3 months of treatment, or more than 7% at two consecutive visits after the first 6 months. Analysis was by intention to treat. This trial is registered with EudraCT, number 2005-005448-21, and ClinicalTrials.gov, number NCT00359762. FINDINGS We randomly assigned 515 patients to the exenatide group and 514 to the glimepiride group, of whom 490 versus 487 were the intention-to-treat population. 203 (41%) patients had treatment failure in the exenatide group compared with 262 (54%) in the glimepiride group (risk difference 12·4 [95% CI 6·2-18·6], hazard ratio 0·748 [0·623-0·899]; p=0·002). 218 (44%) of 490 patients in the exenatide group, and 150 (31%) of 487 in the glimepiride group achieved an HbA(1c) concentration of less than 7% (p<0·0001), and 140 (29%) versus 87 (18%) achieved concentrations of 6·5% and less (p=0·0001). We noted a significantly greater decrease in bodyweight in patients given exenatide than in those given glimepiride (p<0·0001). Five patients in each treatment group died from causes unrelated to treatment. Significantly fewer patients in the exenatide group than in the glimepiride group reported documented symptomatic (p<0·0001), nocturnal (p=0·007), and non-nocturnal (p<0·0001) hypoglycaemia. Discontinuation because of adverse events (mainly gastrointestinal) was significantly higher (p=0·0005) in the exenatide group than in the glimepiride group in the first 6 months of treatment, but not thereafter. INTERPRETATION These findings provide evidence for the benefits of exenatide versus glimepiride for control of glycaemic deterioration in patients with type-2 diabetes inadequately controlled by metformin alone. FUNDING Eli Lilly and Company; Amylin Pharmaceuticals.
Collapse
Affiliation(s)
- Baptist Gallwitz
- Department of Medicine IV, Eberhard-Karls-University Tübingen, Tübingen, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Derosa G, Ragonesi PD, Carbone A, Fogari E, Bianchi L, Bonaventura A, Romano D, Cicero AFG, Maffioli P. Vildagliptin added to metformin on β-cell function after a euglycemic hyperinsulinemic and hyperglycemic clamp in type 2 diabetes patients. Diabetes Technol Ther 2012; 14:475-84. [PMID: 22512264 DOI: 10.1089/dia.2011.0278] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluated the effect of vildagliptin + metformin on glycemic control and β-cell function in type 2 diabetes patients. SUBJECTS AND METHODS One hundred seventy-one type 2 diabetes patients, naive to antidiabetes therapy and with poor glycemic control, were instructed to take metformin for 8±2 months up to a mean dosage of 2,500±500 mg/day; then they were randomly assigned to add vildaglipin 50 mg twice a day or placebo for 12 months. We evaluated at 3, 6, 9, and 12 months: body mass index, glycemic control, fasting plasma insulin, homeostasis model assessment insulin resistance index (HOMA-IR), homeostasis model assessment β-cell function index (HOMA-β), fasting plasma proinsulin, proinsulin/fasting plasma insulin ratio, C-peptide, glucagon, adiponectin, and high-sensitivity C-reactive protein. Before and at 12 months after the addition of vildagliptin, patients underwent a combined euglycemic hyperinsulinemic and hyperglycemic clamp, with subsequent arginine stimulation, to assess insulin sensitivity and insulin secretion. RESULTS After 12 months of treatment, vildagliptin + metformin gave a better decrease of body weight, glycemic control, HOMA-IR, and glucagon and a better increase of HOMA-β compared with placebo + metformin. Regarding the measures of β-cell function, treatment-induced changes in M-value, first- and second-phase C-peptide response to glucose, and C-peptide response to arginine were significantly higher in the vildagliptin + metformin group compared with the placebo + metformin group. CONCLUSION The addition of vildagliptin to metformin gave a better improvement of glycemic control, insulin resistance, and β-cell function compared with metformin alone.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Derosa G, Maffioli P. Efficacy and safety profile evaluation of acarbose alone and in association with other antidiabetic drugs: a systematic review. Clin Ther 2012; 34:1221-36. [PMID: 22560622 DOI: 10.1016/j.clinthera.2012.04.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Epidemiologic studies have revealed that postprandial hyperglycemia significantly contributes to high glycated hemoglobin concentrations and could be linked to the development of chronic diabetic complications. OBJECTIVE The purpose of our review was to evaluate the clinical efficacy and safety profile of treatment with acarbose alone and combined with other antidiabetic drugs. METHODS A systematic search strategy was developed to identify randomized controlled trials included in MEDLINE and the Cochrane Register of Controlled Trials. The terms acarbose, α-glucosidase inhibitors, type 2 diabetes, adverse events, combination therapy, and postprandial glucose were incorporated into an electronic search strategy that included the Dickersin filter for randomized controlled trials. To qualify for inclusion, clinical trials had to be randomized trials comparing treatment with acarbose at any dosage with any other antidiabetic drug in patients with type 2 diabetes mellitus or impaired glucose tolerance. Eligible trials had to present results on glycemic control or adverse events. Trial participants needed to be affected by type 2 diabetes mellitus or have impaired glucose tolerance, and the intervention had to include acarbose at any dosage as monotherapy or combined with other antidiabetic drugs. A validated 3-item scale was used to evaluate the overall reporting quality of the trials selected for inclusion in the present review. Nineteen trials were included. RESULTS Treatment with acarbose significantly reduced glycated hemoglobin levels when given as monotherapy and as an add-on to other antidiabetic drug treatment (P < 0.0001). Acarbose treatment was effective in patients with uncontrolled type 2 diabetes and in patients with apparently good metabolic control owing to its positive effect on postprandial hyperglycemia (P < 0.0001). Treatment with acarbose seemed to improve the lipid profile (P < 0.05), reduce circulating levels of cell adhesion molecules (P < 0.05), reduce intima-media thickness progression (P = 0.01), and reverse impaired glucose tolerance to normal glucose tolerance (P < 0.0001). CONCLUSIONS When current therapy is not adequate to obtain glycemic control, acarbose could be an option as monotherapy and as an add-on to other antidiabetic drug treatment, especially when postprandial hyperglycemia is the main concern. Long-term studies are needed to determine whether the effects observed with acarbose use are maintained over the years.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | | |
Collapse
|
29
|
Abstract
According to the latest American Diabetes Association guidelines, lowering glycated hemoglobin (HbA(1c)) to below or around 7% has been shown to reduce microvascular and neuropathic complications of diabetes and, if implemented soon after the diagnosis of diabetes, is associated with long-term reduction in macrovascular disease. Recently a new class of antidiabetes drugs has been developed, dipeptidyl peptidase-4 (DPP-4) inhibitors, which act by inhibiting DPP-4, the enzyme that inactivates glucagon-like peptide-1 (GLP-1). Through the inhibition of DPP-4, DPP-4 inhibitors enhance the effects of GLP-1 and glucose-dependent insulinotropic peptide, increasing glucose-mediated insulin secretion and suppressing glucagon secretion. We conducted a review analyzing clinical efficacy and safety of DPP-4 inhibitors, both alone and in combination with other antidiabetes drugs, including randomized controlled trials about sitagliptin, vildagliptin, saxagliptin, and linagliptin conducted in the latest 15 years. We concluded that, once metformin fails to maintain glycemic control, addition of DPP-4 inhibitors should be the logical choice: they seems to lower HbA(1c) levels by 0.6-0.9 percentage points and to have a comparable effect on HbA(1c) versus the addition of a sulfonylurea or glitazone. They also have positive effects on β-cell function, and they have neutral effects on body weight. Furthermore, DPP-4 inhibitors prevent the risk of hypoglycemia posed by sulfonylureas.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Foundation IRCCS Policlinico S. Matteo, Piazzale C. Golgi 2, Pavia, Italy.
| | | |
Collapse
|
30
|
Abstract
In 2000, two new thiazolidinediones, pioglitazone and rosiglitazone, were approved for the treatment of type 2 diabetes mellitus (T2DM). Administered as monotherapy or in combination with other antihyperglycemic agents, they represented an effective option for achieving or maintaining good glycemic control in patients with T2DM. Despite their efficacy, there was increasing concern regarding the potential of an increased cardiovascular risk with rosiglitazone. This resulted in the suspension of rosiglitazone from the European market by the European Medicines Agency in September 2010. This article focuses on the various steps that led to this important decision, and discusses a possible alternative for the treatment of patients receiving rosiglitazone.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy.
| |
Collapse
|
31
|
Shea MK, Nicklas BJ, Marsh AP, Houston DK, Miller GD, Isom S, Miller ME, Carr JJ, Lyles MF, Harris TB, Kritchevsky SB. The effect of pioglitazone and resistance training on body composition in older men and women undergoing hypocaloric weight loss. Obesity (Silver Spring) 2011; 19:1636-46. [PMID: 21233810 PMCID: PMC3091968 DOI: 10.1038/oby.2010.327] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Age-related increases in ectopic fat accumulation are associated with greater risk for metabolic and cardiovascular diseases, and physical disability. Reducing skeletal muscle fat and preserving lean tissue are associated with improved physical function in older adults. PPARγ-agonist treatment decreases abdominal visceral adipose tissue (VAT) and resistance training preserves lean tissue, but their effect on ectopic fat depots in nondiabetic overweight adults is unclear. We examined the influence of pioglitazone and resistance training on body composition in older (65-79 years) nondiabetic overweight/obese men (n = 48, BMI = 32.3 ± 3.8 kg/m(2)) and women (n = 40, BMI = 33.3 ± 4.9 kg/m(2)) during weight loss. All participants underwent a 16-week hypocaloric weight-loss program and were randomized to receive pioglitazone (30 mg/day) or no pioglitazone with or without resistance training, following a 2 × 2 factorial design. Regional body composition was measured at baseline and follow-up using computed tomography (CT). Lean mass was measured using dual X-ray absorptiometry. Men lost 6.6% and women lost 6.5% of initial body mass. The percent of fat loss varied across individual compartments. Men who were given pioglitazone lost more visceral abdominal fat than men who were not given pioglitazone (-1,160 vs. -647 cm(3), P = 0.007). Women who were given pioglitazone lost less thigh subcutaneous fat (-104 vs. -298 cm(3), P = 0.002). Pioglitazone did not affect any other outcomes. Resistance training diminished thigh muscle loss in men and women (resistance training vs. no resistance training men: -43 vs. -88 cm(3), P = 0.005; women: -34 vs. -59 cm(3), P = 0.04). In overweight/obese older men undergoing weight loss, pioglitazone increased visceral fat loss and resistance training reduced skeletal muscle loss. Additional studies are needed to clarify the observed gender differences and evaluate how these changes in body composition influence functional status.
Collapse
Affiliation(s)
- M. Kyla Shea
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Barbara J. Nicklas
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anthony P. Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Denise K. Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gary D. Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Scott Isom
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael E. Miller
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - J. Jeffrey Carr
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Radiology and Translational Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mary F. Lyles
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, USA
| | - Stephen B. Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
32
|
Renal function during rofecoxib therapy in patients with metastatic cancer: retrospective analysis of a prospective phase II trial. BMC Res Notes 2011; 4:2. [PMID: 21208422 PMCID: PMC3038926 DOI: 10.1186/1756-0500-4-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 01/05/2011] [Indexed: 11/19/2022] Open
Abstract
Background Angiostatic/antiinflammatory therapy with COX-II inhibitors and pioglitazone seems to be a well tolerated and promising regimen in patients with metastatic cancer. COX-II inhibitors may have less gastrointestinal side effects than conventional non-steroidal antiinflammatory drugs, but their impact on renal function seems to be similar. Methods 87 patients with metastatic/advanced cancer were treated up to 12 months (mean 19.5 weeks) with rofecoxib, pioglitazone and either capecitabine (group A with gastrointestinal and urological cancer, n = 50) or trofosfamide (group B with non-gastrointestinal/non-urological cancer, n = 37) and followed for further 6 months. Results Baseline serum creatinine concentration was 0.81 ± 0.28 mg/dl, and increased by about 0.15 mg/dl during months 1-3. Accordingly estimated glomerular filtration rate (eGFR) decreased from 90.3 ml/min ± 3.6 ml/min at baseline by about 10 ml/min during months 1-3. Renal function decreased in 75 patients (86%) in the first month (p < 0.0001). This decrease went along with clinical signs of volume expansion. Renal function tended to recover after discontinuation of the study medication. Conclusions Therapy with rofecoxib in an antiangiogenic/antiinflammatory setting results in a decrease of renal function in nearly every patient. Trial registration number
German Clinical Trials Register DRKS: DRKS00000119
Collapse
|
33
|
|
34
|
Cavender MA, Nicholls SJ, Lincoff AM. Strategies for the development of new PPAR agonists in diabetes. ACTA ACUST UNITED AC 2010; 17 Suppl 1:S32-7. [PMID: 20489419 DOI: 10.1097/01.hjr.0000368196.17109.5e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diabetes is associated with a range of metabolic abnormalities including insulin resistance, atherogenic dyslipidemia, hypertension, and inflammation. These factors are likely to underlie the adverse cardiovascular outcome typically observed in diabetic cohorts. The family of peroxisome proliferator-activated receptors (PPARs) have been implicated in the regulation of a number of physiologic and metabolic pathways. Pharmacologic agonists directed against various PPARs have been shown to have a beneficial impact on these metabolic risk factors. The potential impact on cardiovascular risk with the use of PPAR agonists will be reviewed.
Collapse
Affiliation(s)
- Matthew A Cavender
- Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | |
Collapse
|
35
|
Kalra S, Kalra B, Unnikrishnan AG, Agrawal N, Kumar S. Optimizing weight control in diabetes: antidiabetic drug selection. Diabetes Metab Syndr Obes 2010; 3:297-9. [PMID: 21437098 PMCID: PMC3047980 DOI: 10.2147/dmsott.s11941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CLINICAL QUESTION Which antidiabetic drugs provide optimal weight control in patients with type 2 diabetes? RESULTS Metformin reduces weight gain, and may cause weight loss, when given alone or in combination with other drugs. Pioglitazone and rosiglitazone use is associated with weight gain. Use of the glucagon-like peptide-1 (GLP-1) analogs, liraglutide and exenatide, is associated with weight loss. Dipeptidyl peptidase-4 (DPP-4) inhibitors are considered weight-neutral. Results with insulin therapy are conflicting. Insulin detemir provides weight control along with glycemic control. IMPLEMENTATION Weight gain is considered an inevitable part of good glycemic control using conventional modalities of treatment such as sulfonylureas.1Use of metformin, weight-sparing insulin analogs such as insulin detemir, and liraglutide, should be encouraged as monotherapy, or in combination with other drugs.
Collapse
Affiliation(s)
| | - B Kalra
- Bharti Hospital, Karnal
- Correspondence: Sanjay Kalra, Department of Endocrinology, Bharti Hospital, Karnal, Haryana 132001, India, Tel +91 989 604 8555, Fax +91 184 226 7885, Email
| | | | | | - S Kumar
- Excel Life Sciences, Noida, India
| |
Collapse
|
36
|
Abstract
In the current literature there are different opinions about the use of thiazolidinediones or sulfonylureas. Some authors have reported that thiazolidinediones increase total body glucose disposal and reduce hepatic glucose production, reducing both peripheral and hepatic insulin resistance (or enhances both peripheral and insulin sensitivity). They consider thiazolidinediones a better drug compared to sulfonylureas because they do not induce hypoglycemia and they provide a protection for the pancreatic beta-cell. On the other side, some authors have reported that the improved glycemic control obtained with thiazolidinedione use is associated with an increase in body weight and a worsening of lipid profile, and they also warn providers to consider the potential for serious adverse cardiovascular effects of the treatment with rosiglitazone for type 2 diabetes mellitus, negating some of the benefits of the improved metabolic control. They have also reported that sulfonylureas are safer compared to thiazolidinediones because they give a better and faster improvement of glycated hemoglobin without giving the adverse effects reported with the use of thiazolidinediones. Considering the emerging discrepancies from these studies we decided to undertake a thorough literature search on Medline and Embase to evaluate the effects of thiazolidinediones and sulfonylureas in people with diabetes. In particular, this review examines the effects and the rationale and practicalities for the use of sulfonylureas or thiazolidinediones, alone and in combination therapy with other antidiabetes drugs, to treat type 2 diabetes mellitus considering, as primary end points, glycated hemoglobin, fasting plasma glucose, fasting plasma insulin, homeostasis model assessment indices, body weight, body mass index, blood pressure, and, when available, data on lipid profile. We also evaluated the effects of these two drugs on beta-cell function, insulin resistance, and inflammatory markers, also recording the frequency of adverse events such as edema and heart failure.
Collapse
Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | | |
Collapse
|
37
|
Zhao Y, He X, Shi X, Huang C, Liu J, Zhou S, Heng CK. Association between serum amyloid A and obesity: a meta-analysis and systematic review. Inflamm Res 2010; 59:323-34. [PMID: 20140694 DOI: 10.1007/s00011-010-0163-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 12/31/2009] [Accepted: 01/18/2010] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Emerging evidence indicates an association of the acute-phase protein serum amyloid A (SAA) with obesity. Here we review and summarize quantitatively the available data related to this association. METHODS PubMed was systematically searched using the terms "serum amyloid A" and "obesity." Eighty-one relevant studies between January 1966 and July 2009 were identified. Of these, only 11 cross-sectional studies and 10 prospective studies with successful interventions met our inclusion criteria for the meta-analysis. All analyses were conducted using the Comprehensive Meta-Analysis software. Literature pertaining to the relationship between SAA and other inflammatory markers, and the association between SAA and obesity-related disorders, such as cardiovascular diseases, atherosclerosis, diabetes, and insulin resistance was also reviewed. RESULTS A strong association between body mass index and SAA levels was found in the 11 cross-sectional studies. The overall correlation coefficient is 0.230 (95% CI 0.160-0.297, P < 0.0005). The ten prospective studies were subsequently analyzed, and the difference in SAA levels before and after weight loss, expressed as standardized mean difference was -0.480 (95% CI -0.678 to -0.283, P < 0.0005). We discuss some potential underlying mechanisms and clinical applications for reducing SAA levels in obesity.
Collapse
Affiliation(s)
- Yulan Zhao
- Advanced Institute of NBIC Integrated Drug Discovery and Development, East China Normal University, North Zhongshan Road #3663, Shanghai, 200062, People's Republic of China.
| | | | | | | | | | | | | |
Collapse
|