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Lyssenko V, Vaag A. Genetics of diabetes-associated microvascular complications. Diabetologia 2023; 66:1601-1613. [PMID: 37452207 PMCID: PMC10390394 DOI: 10.1007/s00125-023-05964-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/27/2023] [Indexed: 07/18/2023]
Abstract
Diabetes is associated with excess morbidity and mortality due to both micro- and macrovascular complications, as well as a range of non-classical comorbidities. Diabetes-associated microvascular complications are those considered most closely related to hyperglycaemia in a causal manner. However, some individuals with hyperglycaemia (even those with severe hyperglycaemia) do not develop microvascular diseases, which, together with evidence of co-occurrence of microvascular diseases in families, suggests a role for genetics. While genome-wide association studies (GWASs) produced firm evidence of multiple genetic variants underlying differential susceptibility to type 1 and type 2 diabetes, genetic determinants of microvascular complications are mostly suggestive. Identified susceptibility variants of diabetic kidney disease (DKD) in type 2 diabetes mirror variants underlying chronic kidney disease (CKD) in individuals without diabetes. As for retinopathy and neuropathy, reported risk variants currently lack large-scale replication. The reported associations between type 2 diabetes risk variants and microvascular complications may be explained by hyperglycaemia. More extensive phenotyping, along with adjustments for unmeasured confounding, including both early (fetal) and late-life (hyperglycaemia, hypertension, etc.) environmental factors, are urgently needed to understand the genetics of microvascular complications. Finally, genetic variants associated with reduced glycolysis, mitochondrial dysfunction and DNA damage and sustained cell regeneration may protect against microvascular complications, illustrating the utility of studies in individuals who have escaped these complications.
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Affiliation(s)
- Valeriya Lyssenko
- Department of Clinical Science, Mohn Research Center for Diabetes Precision Medicine, University of Bergen, Bergen, Norway.
- Department of Clinical Sciences, Lund University Diabetes Center, Lund University, Lund, Sweden.
| | - Allan Vaag
- Department of Clinical Sciences, Lund University Diabetes Center, Lund University, Lund, Sweden
- Steno Diabetes Center Copenhagen, Herlev, Denmark
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Khan RA, Patel N, Folajimi A, Raveena Bai B, Patel V, Komminni PK, Palleti SK, Hirani S. Comparison of the Efficacy and Safety of Metformin-Based Combination Therapy Versus Metformin Alone in Children and Adolescents With Type 2 Diabetes Mellitus: A Meta-Analysis. Cureus 2023; 15:e35014. [PMID: 36938239 PMCID: PMC10022241 DOI: 10.7759/cureus.35014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of this meta-analysis is to synthesize and critically evaluate the available evidence on the comparison of the efficacy and safety of metformin-based combination therapy versus metformin alone in children and adolescents with type 2 diabetes mellitus (T2DM). We performed the present meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies were identified using electronic searches for randomized controlled trials (RCTs) using PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrial.gov from inception to 31 January 2023. The outcomes examined in this meta-analysis included change from baseline in glycated hemoglobin (HbA1C) (%), fasting plasma sugar (FPG) (mg/dl), and the number of individuals experiencing adverse events. Three studies met the criteria and were included in the meta-analysis. The reduction of HbA1C was significantly higher in metformin-based combination therapy (MD: -1.19, 95% CI: -2.05, -0.33, p-value: 0.007). No significant difference was reported between patients randomized in metformin-based combination therapy and metformin alone (MD: -18.67, 95% CI: -50.17, 12.84, p-value: 0.25). In conclusion, the present meta-analysis found that the reduction in HbA1C was significantly higher in patients receiving metformin-based combination therapy compared to metformin alone. No significant difference was found between the two groups in terms of the change in fasting plasma glucose (FPG) from the baseline. In relation to safety, no significant difference was found in the incidence of adverse events and serious adverse events between the two groups.
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Affiliation(s)
- Raza A Khan
- General Medicine, The University Hospital of South Manchester NHS Foundation Trust, Manchester, GBR
| | - Nidhi Patel
- Internal Medicine, Gujarat Medical & Education Research Society (GMERS), Vadodara, IND
| | | | - Bansari Raveena Bai
- Internal Medicine, Peoples University of Medical and Health Sciences For Women, Nawabshah, PAK
| | - Vrushak Patel
- Internal Medicine, Gujarat Medical & Education Research Society (GMERS), Vadodara, IND
| | | | - Sujith K Palleti
- Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, USA
- Nephrology, Loyola University Medical Center, Maywood, USA
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Cornejo-Estrada A, Nieto-Rodríguez C, León-Figueroa DA, Moreno-Ramos E, Cabanillas-Ramirez C, Barboza JJ. Efficacy of Liraglutide in Obesity in Children and Adolescents: Systematic Review and Meta-Analysis of Randomized Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020208. [PMID: 36832337 PMCID: PMC10010327 DOI: 10.3390/children10020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/10/2022] [Accepted: 12/25/2022] [Indexed: 01/27/2023]
Abstract
In the past few decades, childhood obesity has become a significant global health issue, impacting around 107.7 million children and adolescents globally. There is currently minimal usage of pharmacological therapies for childhood obesity in the pediatric population. This research assessed the efficacy of liraglutide in treating childhood and adolescent obesity. Until 20 October 2022, a systematic literature review was done utilizing PubMed, Scopus, Web of Science, and Embase databases. The search phrases "liraglutide", "pediatric obesity", "children", and "adolescents" were utilized. Using the search method, a total of 185 articles were found. Three studies demonstrating liraglutide's effectiveness in treating child and adolescent obesity were included. The selected research was done in the United States. As an intervention, liraglutide was administered to 296 participants at a maximal dosage of 3.0 mg. All examined trials were in phase 3. This comprehensive analysis revealed no clinically significant differences between liraglutide and body weight (kg; MD -2.62; 95%CI -6.35 to 1.12; p = 0.17) and body mass index (kg/m2; MD -0.80; 95%CI -2.33 to 0.73, p = 0.31). There was no evidence that liraglutide increased hypoglycemia episodes (RR 1.08; 95%CI 0.37 to 3.15; p = 0.79), or side consequences. However, it was shown that the medicine might help reduce BMI and weight combined with a healthy diet and regular exercise. A lifestyle change may have favorable consequences that will be assessed in the future for adjunctive therapy. PROSPERO database (CRD42022347472).
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Affiliation(s)
- Alejandra Cornejo-Estrada
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.C.-E.); (C.N.-R.); (C.C.-R.)
| | - Carlos Nieto-Rodríguez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.C.-E.); (C.N.-R.); (C.C.-R.)
| | - Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru;
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
| | - Emilly Moreno-Ramos
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima 15046, Peru
| | - Cielo Cabanillas-Ramirez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.C.-E.); (C.N.-R.); (C.C.-R.)
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
| | - Joshuan J. Barboza
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru;
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima 15046, Peru
- Correspondence: ; Tel.: +51-992108520
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Wu S, He Y, Wu Y, Ji Y, Hou L, Liu X, Ge Y, Yu Y, Yu Y, Wei Y, Qian F, Luo Q, Feng Y, Feng Y, Wang J, Huo M, Li H, Xue F, Liu Y. Comparative efficacy and safety of glucose-lowering drugs in children and adolescents with type 2 diabetes: A systematic review and network meta-analysis. Front Endocrinol (Lausanne) 2022; 13:897776. [PMID: 36034458 PMCID: PMC9402979 DOI: 10.3389/fendo.2022.897776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Type 2 diabetes is more common in adults, but is becoming the major concern in children and adolescent recently. This study aimed to provide additional pharmaceutical management for children and adolescents with type 2 diabetes by assessing the efficacy and safety of several glucose-lowering drugs. METHODS Searches were performed in PubMed, Medline, Ovid, Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov that reported the efficacy and safety of drugs for children and adolescents with type 2 diabetes. Pooled effects were calculated by frequentist fixed effects network meta-analyses and additive network meta-analyses. RESULTS A total of 12 trials assessing eight glucose-lowering drugs were included, which compose of seven trials with monotherapy and five trials with combination therapies. Network meta-analysis results showed compared to placebo, saxagliptin+metformin (mean difference (MD) -1.91% [-2.85%, -0.97%]), liraglutide+metformin (MD -1.45% [-1.65%, -1.26%]), and liraglutide (MD -0.90% [-1.35%, -0.45%]) were the top 3 drugs that significantly reduced hemoglobin A1c (HbA1c). Sitagliptin+metformin, dapagliflozin, exenatide-2mcg, linagliptin-5mg, metformin, exenatide-5/10mcg, glimepiride, and sitagliptin also showed significant reduction in HbA1c. There were no significant differences between treatments in the incidence of adverse events, except that liraglutide+metformin had significant adverse effect such as abdominal pain. In addition, dapagliflozin, sitagliptin+metformin, and saxagliptin+metformin showed better efficacy compared with FDA-approved drugs. CONCLUSIONS The top 10 treatments of type 2 diabetes in children and adolescents aged 10-17 years were saxagliptin+metformin, liraglutide+metformin, liraglutide, dapagliflozin, exenatide-2 mcg, sitagliptin+metformin, linagliptin-5 mg, linagliptin-1 mg, metformin, and exenatide-5/10 mcg. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284897, identifier CRD42021284897.
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Affiliation(s)
- Sijia Wu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yina He
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yutong Wu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yiman Ji
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Hou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinhui Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yilei Ge
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuanyuan Yu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yifan Yu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yun Wei
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengtong Qian
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingxin Luo
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yue Feng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yiping Feng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiongjiong Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meiling Huo
- Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Hongkai Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Hongkai Li, ; Fuzhong Xue, ; Yunxia Liu,
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Hongkai Li, ; Fuzhong Xue, ; Yunxia Liu,
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Hongkai Li, ; Fuzhong Xue, ; Yunxia Liu,
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Yaribeygi H, Farrokhi FR, Abdalla MA, Sathyapalan T, Banach M, Jamialahmadi T, Sahebkar A. The Effects of Glucagon-Like Peptide-1 Receptor Agonists and Dipeptydilpeptidase-4 Inhibitors on Blood Pressure and Cardiovascular Complications in Diabetes. J Diabetes Res 2021; 2021:6518221. [PMID: 34258291 PMCID: PMC8263148 DOI: 10.1155/2021/6518221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
Glucagon-like peptide-1 receptor (GLP-1R) agonists are a class of newly introduced antidiabetic medications that potentially lower blood glucose by several molecular pathways. DPP-4 inhibitors are the other type of novel antidiabetic medications which act by preventing GLP-1 inactivation and thereby increasing the activity levels of GLP-1, leading to more glucose-induced insulin release from islet β-cells and suppression of glucagon release. Most patients with diabetes have concurrent hypertension and cardiovascular disorder. If antihyperglycemic agents can attenuate the risk of hypertension and cardiovascular disease, they will amplify their overall beneficial effects. There is conflicting evidence on the cardiovascular benefits of GLP-1R induction in laboratory studies and clinical trials. In this study, we have reviewed the main molecular mechanisms by which GLP-1R induction may modulate the cardiovascular function and the results of cardiovascular outcome clinical trials.
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Affiliation(s)
- Habib Yaribeygi
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Farin Rashid Farrokhi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, Lodz, Poland
| | - Tannaz Jamialahmadi
- Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan, Iran
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Alruwaili H, Dehestani B, le Roux CW. Clinical Impact of Liraglutide as a Treatment of Obesity. Clin Pharmacol 2021; 13:53-60. [PMID: 33732030 PMCID: PMC7958997 DOI: 10.2147/cpaa.s276085] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
Obesity is defined as a chronic, complex, relapsing disease characterized by excessive adipose tissue. Obesity impacts an individual's health by increasing complications such as prediabetes, type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, metabolic syndrome, cardiovascular disease, nonalcoholic fatty liver disease (NAFLD), cancers (eg endometrial), and obstructive sleep apnea (OSA). With the increase of obesity prevalence and its negative influences on individuals' quality of life, there is a great need for therapy with a purpose to produce sustainable weight loss of more than 10% in order to improve or even reverse the progress of obesity related complications. The GLP-1 analogue, liraglutide reduce food consumption, promote weight reduction and improve metabolic functions. The primary mechanism of GLP-1 effect on food intake, metabolism, and weight reduction is mainly due to its actions on peripheral (vagal) and central pathways and activation of hindbrain and hypothalamus. The average weight reduction induced by liraglutide was significant and the weight loss was maintained as long as the patients on therapy. Liraglutide has advantages on weight loss maintenance and promoting cardiovascular disease (CVD) risk reduction, by decreasing systolic blood pressure and glycemic index. In this review, we aim to explain the mechanism of action of Liraglutide, its pharmacokinetic properties, its clinical impact on obesity and its safety and tolerability.
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Affiliation(s)
- Heshma Alruwaili
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Babak Dehestani
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
- Diabetes Research Group, School of Biomedical Sciences, Ulster University, Belfast, UK
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Kalra S, Unnikrishnan AG, Bantwal G, Das S, Polavarapu NK, Gaurav K. The Position of Gliclazide in the Evolving Landscapes and Disease Continuum of T2DM: A Collaborative Delphi Survey-Based Consensus from India. Diabetes Ther 2021; 12:679-695. [PMID: 33511553 PMCID: PMC7947040 DOI: 10.1007/s13300-021-01002-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION This Delphi study aims to provide evidence-based expert opinion on the usage and current position of gliclazide in type 2 diabetes mellitus (T2DM) management in India. METHODS The single interaction modified Delphi-based methodology was used to collect opinions on gliclazide usage and its position in diabetes management from 338 endocrinologists/diabetologists who have had clinical experience with gliclazide. Participants, using a 9-point scale, were asked to rate eight statements comprising a total of 52 items on the related topics. RESULTS The Delphi consensus suggests that in drug-naïve patients with T2DM, intolerant to metformin or in whom metformin is contraindicated, dual therapy of gliclazide/gliclazide-modified release (MR) should be considered along with a dipeptidyl peptidase 4 (DPP4) inhibitor if glycated hemoglobin A1c level is greater than 7.5% and with insulin if the A1c level is greater than 9%. If the patients are inadequately controlled with metformin (A1c greater than 6.5% after 3 months of therapy), gliclazide/gliclazide-MR shall be added on to the treatment regimen to achieve greater and sustained reductions in A1c levels. However, it was not preferred over other antidiabetic classes in such clinical settings except alpha-glucosidase inhibitors (AGI). Early addition of gliclazide/gliclazide-MR shall be preferred over the up-titration of metformin beyond half-maximal dose for effective management of T2DM. Gliclazide/gliclazide-MR can be used safely in patients with diabetes and cardiovascular and chronic kidney disease. It can be used in older patients with T2DM as it does not have active metabolites and has a low risk of hypoglycemia. CONCLUSION The expert panel proposed consideration of monotherapy or dual therapy of gliclazide as an ideal choice in patients with T2DM because of its efficacy, long-term glycemic control, favorable renal outcomes, cardiovascular safety, and an optimal safety profile.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - A G Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St John's Medical College, Bangalore, Karnataka, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | | | - Kumar Gaurav
- Medical Affairs, Dr. Reddy's Laboratories Limited, Hyderabad, India
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Guo L, Zhang B, Hou J, Zhou Z. Evaluation of Characteristics of Gastrointestinal Adverse Events with Once-Weekly Dulaglutide Treatment in Chinese Patients with Type 2 Diabetes: A Post Hoc Pooled Analysis of Two Randomized Trials. Diabetes Ther 2020; 11:1821-1833. [PMID: 32621083 PMCID: PMC7376772 DOI: 10.1007/s13300-020-00869-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gastrointestinal (GI) events are a common side effect of glucagon-like peptide 1 (GLP-1) receptor agonists (RA) class. This post hoc analysis assessed the characteristics of GI adverse events in Chinese patients with type 2 diabetes (T2D) who were treated with once-weekly dulaglutide from two randomized clinical trials. METHODS Chinese patients with T2D, treated with once-weekly dulaglutide (1.5 mg and 0.75 mg) from two phase III multicenter trials (AWARD-CHN1 and AWARD-CHN2) were included. Descriptive statistics were used to present the data. The characteristics (incidence, severity, onset, duration, and time of occurrence) of GI adverse events reported through 26 weeks in a Chinese subpopulation from the two trials were investigated. RESULTS A total of 787 Chinese patients with T2D were included in this analysis. Up to week 26, 225 patients (28.6%) reported at least one GI treatment-emergent adverse event (TEAE). The most frequently reported GI TEAEs were diarrhea (13.1%), nausea (6.6%), abdominal distension (6.4%), and vomiting (3.0%), with most being categorized as mild to moderate in severity in proportions of 92%, 88%, 94%, and 83%, respectively. A total of 12 patients (1.5%) discontinued the dulaglutide treatment as a result of GI TEAEs. The median duration of the first reported GI TEAEs was 4.0, 5.0, 12.5, and 4.0 days for diarrhea, nausea, abdominal distension, and vomiting, respectively. The incidence of GI TEAEs was more frequent during the first 2 weeks of dulaglutide treatment; however, the incidence declined rapidly after 2 weeks and remained low until week 26. CONCLUSIONS Most of the GI TEAEs associated with once-weekly dulaglutide (1.5 mg and 0.75 mg) were mild to moderate in severity. The incidence of GI TEAEs was more pronounced during the first 2 weeks of dulaglutide treatment but declined rapidly as treatment continued, and was low at week 26, indicating that dulaglutide was well tolerated in Chinese patients with T2D. TRIAL REGISTRATION NCT01648582 and NCT01644500.
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Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, No.1, Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Bin Zhang
- Lilly Suzhou Pharmaceutical Co., Ltd, 19F, Tower 1 HKRI, Taikoo Hui, No. 288, Shi Men No. 1 Rd, Shanghai, 200041, China
| | - Jianing Hou
- Lilly Suzhou Pharmaceutical Co., Ltd, 19F, Tower 1 HKRI, Taikoo Hui, No. 288, Shi Men No. 1 Rd, Shanghai, 200041, China.
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, China.
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Shi LX, Liu XM, Shi YQ, Li QM, Ma JH, Li YB, Du LY, Wang F, Chen LL. Efficacy and safety of dulaglutide monotherapy compared with glimepiride in Chinese patients with type 2 diabetes: Post-hoc analyses of a randomized, double-blind, phase III study. J Diabetes Investig 2020; 11:142-150. [PMID: 31102326 PMCID: PMC6944837 DOI: 10.1111/jdi.13075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/29/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION To investigate the efficacy/safety of dulaglutide once-weekly monotherapy versus glimepiride in Chinese patients with type 2 diabetes. MATERIALS AND METHODS This was a post-hoc analysis of a Chinese randomized, double-blind, non-inferiority, phase III study. Patients (n = 572) with inadequate glycemic control received dulaglutide 1.5 mg (n = 189) or 0.75 mg (n = 194) once-weekly or glimepiride (1-3 mg/day; n = 189) for 26 weeks. The primary objective of the study was to investigate the non-inferiority of dulaglutide 1.5 mg versus glimepiride by the change from baseline to week 26 in glycated hemoglobin (non-inferiority margin 0.4%). RESULTS Dulaglutide 1.5 mg and 0.75 mg were non-inferior (P < 0.001) and superior (P ≤ 0.002) versus glimepiride for the change in glycated hemoglobin from baseline to week 26. The least-squares mean differences (95% confidence interval) versus glimepiride were dulaglutide 1.5 mg, -0.53% (-0.74, -0.32) and dulaglutide 0.75 mg, -0.32% (-0.53, -0.12). Significantly more patients attained glycated hemoglobin <7.0% at week 26 in the dulaglutide 1.5 mg (71.7%) versus the glimepiride (57.5%; P = 0.005) group. The decrease from baseline to week 26 in fasting blood glucose was significantly more pronounced in both the dulaglutide groups versus the glimepiride group (P < 0.01). The overall incidence and rate of hypoglycemia were lower in both of the dulaglutide groups versus the glimepiride group. At week 26, bodyweight had increased from baseline in the glimepiride group and decreased from baseline in both dulaglutide groups. The most frequent gastrointestinal drug-related adverse events with dulaglutide were diarrhea, abdominal distension, nausea and vomiting. CONCLUSIONS These findings support once-weekly dulaglutide monotherapy as a treatment for Chinese patients with early stage type 2 diabetes.
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Affiliation(s)
- Li Xin Shi
- Department of Endocrinology and MetabolismAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Xiao Min Liu
- Department of EndocrinologyFirst Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | | | | | | | - Yan Bing Li
- The First Affiliated HospitalSun‐Yat Sen UniversityGuangzhouChina
| | - Li Ying Du
- Lilly Suzhou Pharmaceutical Co. Ltd.ShanghaiChina
| | - Feng Wang
- Lilly Suzhou Pharmaceutical Co. Ltd.ShanghaiChina
| | - Lu Lu Chen
- Department of EndocrinologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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10
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Kalra S, Das AK, Sahay RK, Baruah MP, Tiwaskar M, Das S, Chatterjee S, Saboo B, Bantwal G, Bhattacharya S, Priya G, Chawla M, Brar K, Raza SA, Aamir AH, Shrestha D, Somasundaram N, Katulanda P, Afsana F, Selim S, Naseri MW, Latheef A, Sumanatilleke M. Consensus Recommendations on GLP-1 RA Use in the Management of Type 2 Diabetes Mellitus: South Asian Task Force. Diabetes Ther 2019; 10:1645-1717. [PMID: 31359367 PMCID: PMC6778554 DOI: 10.1007/s13300-019-0669-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 12/17/2022] Open
Abstract
The advent of incretin mimetics such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has enriched the armamentarium for diabetes management owing to their glycaemic as well as extra-glycaemic benefits. The approval status and availability of this class of drugs vary widely across the globe. Being a relatively newer class of drug with numerous benefits, several national and international guidelines are working towards addressing clinical questions pertaining to the optimal use of GLP-1 RAs for the management of diabetes. Although the newer class of drugs are associated with significant benefits such as patient-centric approach, these drugs demand the providers to be vigilant and knowledgeable about the medication. The South Asian population is at higher risk of type 2 diabetes mellitus (T2DM) because of their genetic predisposition and lifestyle changes. Hence, prevention and management of T2DM and its associated complications in this population are of paramount importance. The current report aims to present an overview of current knowledge on GLP-1 RAs based on pragmatic review of the available clinical evidence. In addition, this report is a consensus of expert endocrinologists representing South Asian countries including India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan and the Maldives on essential recommendations related to the use of GLP-1 RAs in a real-world scenario.
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Affiliation(s)
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | | | | | | | - Sambit Das
- Hi Tech Medical College and Hospital, Bhubaneshwar, India
| | | | | | | | | | | | | | | | - Syed Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Centre and National Defence Hospital, Lahore, Pakistan
| | | | | | | | | | | | - Shahjada Selim
- Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | | | - Ali Latheef
- Department of Medicine, Indra Gandhi Hospital, Male, Maldives
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11
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Jia W, Weng J, Zhu D, Ji L, Lu J, Zhou Z, Zou D, Guo L, Ji Q, Chen L, Chen L, Dou J, Guo X, Kuang H, Li L, Li Q, Li X, Liu J, Ran X, Shi L, Song G, Xiao X, Yang L, Zhao Z. Standards of medical care for type 2 diabetes in China 2019. Diabetes Metab Res Rev 2019; 35:e3158. [PMID: 30908791 DOI: 10.1002/dmrr.3158] [Citation(s) in RCA: 388] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 02/05/2023]
Abstract
The prevalence of diabetes in China has increased rapidly from 0.67% in 1980 to 10.4% in 2013, with the aging of the population and westernization of lifestyle. Since its foundation in 1991, the Chinese Diabetes Society (CDS) has been dedicated to improving academic exchange and the academic level of diabetes research in China. From 2003 to 2014, four versions of Chinese diabetes care guidelines have been published. The guidelines have played an important role in standardizing clinical practice and improving the status quo of diabetes prevention and control in China. Since September 2016, the CDS has invited experts in cardiovascular diseases, psychiatric diseases, nutrition, and traditional Chinese medicine to work with endocrinologists from the CDS to review the new clinical research evidence related to diabetes over the previous 4 years. Over a year of careful revision, this has resulted in the present, new version of guidelines for prevention and care of type 2 diabetes in China. The main contents include epidemiology of type 2 diabetes in China; diagnosis and classification of diabetes; primary, secondary, and tertiary diabetes prevention; diabetes education and management support; blood glucose monitoring; integrated control targets for type 2 diabetes and treatments for hyperglycaemia; medical nutrition therapy; exercise therapy for type 2 diabetes; smoking cessation; pharmacologic therapy for hyperglycaemia; metabolic surgery for type 2 diabetes; prevention and treatment of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes; hypoglycaemia; chronic diabetic complications; special types of diabetes; metabolic syndrome; and diabetes and traditional Chinese medicine.
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Affiliation(s)
- Weiping Jia
- Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianping Weng
- Department of Endocrinology, the First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dalong Zhu
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Juming Lu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhiguang Zhou
- Institute of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital and the Diabetes Center, Central South University, Changsha, China
| | - Dajin Zou
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, Beijing, China
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Xi'an, China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Liming Chen
- Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Jingtao Dou
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoying Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Liu
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Lixin Shi
- Department of Endocrinology, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Guangyao Song
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
| | - Xinhua Xiao
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Liyong Yang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhigang Zhao
- Department of Endocrinology, Yihe Hospital of Zhengzhou, Zhengzhou, China
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12
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Glucagon-Like Peptide-1 Receptor Agonist Attenuates Autophagy to Ameliorate Pulmonary Arterial Hypertension through Drp1/NOX- and Atg-5/Atg-7/Beclin-1/LC3β Pathways. Int J Mol Sci 2019; 20:ijms20143435. [PMID: 31336911 PMCID: PMC6678531 DOI: 10.3390/ijms20143435] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 01/01/2023] Open
Abstract
Mitochondrial dysfunction is associated with cardiovascular diseases and diabetes. Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling, and the abnormal proliferation, apoptosis and migration of pulmonary arterial smooth muscle cells (PASMCs). The glucagon-like peptide-1 (GLP-1) receptor agonist, liraglutide, has been shown to prevent pulmonary hypertension in monocrotaline-exposed rats. The aim of this study was to investigate the effect of liraglutide on autophagy, mitochondrial stress and apoptosis induced by platelet-derived growth factor BB (PDGF-BB). PASMCs were exposed to PDGF-BB, and changes in mitochondrial morphology, fusion-associated protein markers, and reactive oxygen species (ROS) production were examined. Autophagy was assessed according to the expressions of microtubule-associated protein light chain 3 (LC3)-II, LC3 puncta and Beclin-1. Western blot analysis was used to assess apoptosis, mitochondrial stress and autophagy markers. Liraglutide significantly inhibited PDGF-BB proliferation, migration and motility in PASMCs. PDGF-BB-induced ROS production was mitigated by liraglutide. Liraglutide increased the expression of α-smooth muscle actin (α-SMA) and decreased the expression of p-Yes-associated protein (p-YAP), inhibited autophagy-related protein (Atg)-5, Atg-7, Beclin-1 and the formation of LC3-β and mitochondrial fusion protein dynamin-related (Drp)1. Therefore, liraglutide can mitigate the proliferation of PASMCs via inhibiting cellular Drp1/nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (NOX) pathways and Atg-5/Atg-7/Beclin-1/LC3β-dependent pathways of autophagy in PAH.
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13
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Zhao X, Huang K, Zheng M, Duan J. Effect of liraglutide on blood pressure: a meta-analysis of liraglutide randomized controlled trials. BMC Endocr Disord 2019; 19:4. [PMID: 30616638 PMCID: PMC6323665 DOI: 10.1186/s12902-018-0332-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Several clinical trials have studied the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on glycometabolism and cardiovascular risk factors since they were identified. Because of their cardiovascular benefits and efficacy in lowering glucose, GLP-1RAs are becoming increasingly important in clinical therapy for patients with or without pathoglycaemia. The aim of this study was to assess the effect of the GLP-1RA liraglutide on blood pressure based on randomised controlled trials (RCTs). METHODS We searched PubMed for RCTs published from 2009 to 2018 comparing the effect of liraglutide on blood pressure with that of placebo in individuals with or without pathoglycaemia. RCTs in humans that included data describing blood pressure changes from baseline to the end of the trial were selected for inclusion in the meta-analysis. RESULTS A total of 18 RCTs that enrolled 7616 individuals in the liraglutide group and 6046 individuals in the control group were included in this meta-analysis. Compared with placebo, liraglutide reduced systolic blood pressure (SBP) by 3.18 mmHg (95% CI -4.32, - 2.05), P < 0.00001, but had no significant effect on diastolic blood pressure (DBP). Subgroup analysis showed that the degree of reduction in SBP was associated with the dose of liraglutide but that significance disappeared when the intervention lasted over 1 year. Liraglutide 3.0 mg/d significantly reduced DBP by 1.46 mmHg (95% CI -2.61, 0.32), P = 0.01, but liraglutide 1.8 mg/d slightly increased DBP by 0.47 mmHg (95% CI 0.11, 0.83), P = 0.01, compared with placebo. CONCLUSIONS This meta-analysis demonstrated that liraglutide significantly reduced SBP in individuals with or without pathoglycaemia compared with placebo, but the difference was no longer significant when the intervention lasted over 1 year. Moreover, the effect of liraglutide on blood pressure is associated with the dose. This finding may provide additional evidence for cardiovascular protection.
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Affiliation(s)
- Xu Zhao
- Civil Aviation General Hospital, Peking University, Beijing, China
| | - Kun Huang
- Civil Aviation General Hospital, Peking University, Beijing, China
| | - Meijie Zheng
- Civil Aviation General Hospital, Peking University, Beijing, China
| | - Junting Duan
- Civil Aviation General Hospital, Peking University, Beijing, China
- Endocrinology Department, Civil Aviation General Hospital, Chaoyang Road, Beijing, China
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14
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Avgerinos I, Karagiannis T, Malandris K, Liakos A, Mainou M, Bekiari E, Matthews DR, Tsapas A. Glucagon-like peptide-1 receptor agonists and microvascular outcomes in type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2019; 21:188-193. [PMID: 30058208 DOI: 10.1111/dom.13484] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022]
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on microvascular endpoints in adult patients with type 2 diabetes. We included 60 studies with 60 077 patients. GLP-1 RAs marginally reduced urinary albumin-to-creatinine ratio compared with placebo or other antidiabetic agents (weighted mean difference - 2.55 mg/g; 95% confidence interval [CI] -4.37 to -0.73 and -5.52; -10.89 to -0.16, respectively) and had no clinically relevant effect on change in estimated glomerular filtration rate. Treatment with GLP-1 RAs did not increase incidence of diabetic retinopathy, macular oedema, retinal detachment and retinal haemorrhage, irrespective of comparator. Nevertheless, incidence of vitreous haemorrhage was higher in subjects treated with GLP-1 RAs compared with placebo (odds ratios 1.93; 95% CI 1.09 to 3.42). In conclusion, GLP-1 RAs are safe regarding nephropathy- and retinopathy-related outcomes. Caution may be warranted for incidence of vitreous haemorrhage. The low overall quality of evidence highlights the need for consistent assessment and reporting of microvascular endpoints in future trials.
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Affiliation(s)
- Ioannis Avgerinos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Malandris
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Mainou
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
- Harris Manchester College, University of Oxford, Oxford, UK
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
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15
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Wu Z, Jin T, Weng J. A thorough analysis of diabetes research in China from 1995 to 2015: current scenario and future scope. SCIENCE CHINA-LIFE SCIENCES 2018; 62:46-62. [DOI: 10.1007/s11427-018-9377-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/26/2018] [Indexed: 12/16/2022]
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16
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Chen YH, Huang C, Cho YM, Li P, Gu L, Wang F, Yang J, Wang WQ. Efficacy and safety of dulaglutide monotherapy compared with glimepiride in East-Asian patients with type 2 diabetes in a multicentre, double-blind, randomized, parallel-arm, active comparator, phase III trial. Diabetes Obes Metab 2018; 20:2121-2130. [PMID: 29708650 PMCID: PMC6099453 DOI: 10.1111/dom.13340] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
AIMS To compare the efficacy and safety of once-weekly glucagon-like peptide-1 receptor agonist dulaglutide 1.5 and 0.75 mg with glimepiride in East-Asian patients with type 2 diabetes (T2D). MATERIALS AND METHODS In this phase III, multinational, multicentre, double-blind, randomized, parallel-arm, 26-week study, patients with inadequate glycaemic control were randomized 1:1:1 to once-weekly dulaglutide 1.5 or 0.75 mg or daily glimepiride (1-3 mg/d). The primary endpoint was assessment of the non-inferiority of dulaglutide (1.5 mg), as measured by change in glycated haemoglobin (HbA1c), compared with glimepiride using a 0.4% non-inferiority margin. RESULTS A total of 737 patients were randomized (dulaglutide 1.5 mg, n = 244; dulaglutide 0.75 mg, n = 248; glimepiride, n = 245). At week 26, both doses of dulaglutide were non-inferior and also superior to glimepiride for HbA1c reduction from baseline with a least squares mean difference of -6.34 mmol/mol (95% confidence interval [CI] -8.31, -4.26) or -0.58% (95% CI -0.76, -0.39) for dulaglutide 1.5 mg and -3.50 mmol/mol (95% CI -5.47, -1.42) or -0.32% (95% CI -0.50, -0.13) for dulaglutide 0.75 mg (P < .001). A greater proportion of patients in the dulaglutide 1.5 mg group achieved the HbA1c target of <53 mmol/mol (<7.0%) compared with the glimepiride group (74.1% vs 57.4%; P < .001). The mean body weight decreased (P < .005) and total hypoglycaemia rates were lower (P < .001) in the dulaglutide groups compared with the glimepiride group. The most common drug-related adverse events in both dulaglutide groups (≥5% of patients) included diarrhoea, nausea, increased lipase, decreased appetite, abdominal distension and vomiting. CONCLUSIONS Dulaglutide (both doses) demonstrated superior glycaemic control vs glimepiride, with a favourable tolerability and safety profile in East-Asian patients with T2D.
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Affiliation(s)
- Yu Hong Chen
- Ruijin HospitalShanghai Jiao Tong UniversityShanghaiChina
| | | | - Young Min Cho
- Seoul National University College of MedicineSeoulSouth Korea
| | - Pengfei Li
- Takeda Development Center AsiaShanghaiChina
| | - Liqun Gu
- Lilly Suzhou Pharmaceutical Co. LtdShanghaiChina
| | - Feng Wang
- Lilly Suzhou Pharmaceutical Co. LtdShanghaiChina
| | - Jun Yang
- Lilly Suzhou Pharmaceutical Co. LtdShanghaiChina
| | - Wei Qing Wang
- Ruijin HospitalShanghai Jiao Tong UniversityShanghaiChina
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Wharton S, Raiber L, Serodio KJ, Lee J, Christensen RA. Medications that cause weight gain and alternatives in Canada: a narrative review. Diabetes Metab Syndr Obes 2018; 11:427-438. [PMID: 30174450 PMCID: PMC6109660 DOI: 10.2147/dmso.s171365] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cause of the obesity epidemic is multifactorial, but may, in part, be related to medication-induced weight gain. While clinicians may strive to do their best to select pharmacotherapy(ies) that has the least negative impact on weight, the literature regarding the weight effects of medication is often limited and devoid of alternative therapies. RESULTS Antipsychotics, antidepressants, antihyperglycemics, antihypertensives and corticosteroids all contain medications that were associated with significant weight gain. However, there are several medication alternatives within the majority of these classes associated with weight neutral or even weight loss effects. Further, while not all of the classes of medication examined in this review have weight-favorable alternatives, there exist many other tools to mitigate weight gain associated with medication use, such as changes in dosing, medication delivery or the use of adjunctive therapies. CONCLUSION Medication-induced weight gain can be frustrating for both the patient and the clinician. As the use of pharmaceuticals continues to increase, it is pertinent for clinicians to consider the weight effects of medications prior to prescribing or in the course of treatment. In the case where it is not feasible to make changes to medication, adjunctive therapies should be considered.
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Affiliation(s)
- Sean Wharton
- The Wharton Medical Clinic, Toronto, Canada,
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | | | - Jasmine Lee
- The Wharton Medical Clinic, Toronto, Canada,
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18
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Cao B, Li R, Tian H, Ma Y, Hu X, Jia N, Wang Y. Effect on glycemia in rats with type 2 diabetes induced by streptozotocin: low-frequency electro-pulse needling stimulated Weiwanxiashu
(EX-B 3) and Zusanli (ST 36). J TRADIT CHIN MED 2018; 36:768-78. [PMID: 29949710 DOI: 10.1016/s0254-6272(17)30013-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the effect of low frequency electro-pulse acupuncture (EA) on blood
glucose in rats with streptozotocin-induced type 2 diabetes, and the possible mechanism underlying the action. METHODS Rat models were established with high fat feeding and intraperitoneal injection of
streptozotocin (STZ) (30 mg/kg). Rats with a random blood glucose > 16.7 mmol/L and blood glucose
at 2 h-point of oral glucose tolerance test (OGTT) > 11.1 mmol/L were included as diabetic
rats, and randomly divided into model group, EA Weiwanxiashu (EX-B 3) group, EA Zusanli (ST 36)
group, glimepiride group, and EA non-acupoint group (n = 12). EA (2 Hz continuous wave, 2 mA,
20 min/day, 6 days/week, 4 weeks) and intra-gastric administration of glimepiride were applied as
interventions. With fasting blood glucose and OGTT tested at the end of the intervention, the study observed the patterns of hypoglycemic effects. For mechanism study, it observes hematoxylin
and eosin staining and Masson staining of pancreas paraffin sections, protein expression of glucagon-
like peptide 1 receptor (GLP-1R) in the pancreas and skeletal muscle, glucose transporter 4
(GLUT4) protein expression in skeletal muscle membrane, to detect whether EA controls blood glucose
via regulation of GLP-1R. RESULTS EA Weiwanxiashu (EX-B 3) significantly increased model rats' pancreas GLP-1R, and GLUT4 of
skeletal muscle membrane; the therapy significantly decreased model rats' skeletal muscle GLP-1R, restored
pancreas morphology, and reduced fasting blood glucose and insulin resistance indices. CONCLUSION EA Weiwanxiashu (EX-B 3) alone has significant effect on glycemia. EA Weiwanxiashu
(EX-B 3) plus glimepiride further strengthen the effect. The regulation of the GLP-1R in pancreas and
skeletal muscle might be mechanism underpinning the effect.
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Yang SH, Xu RX, Cui CJ, Wang Y, Du Y, Chen ZG, Yao YH, Ma CY, Zhu CG, Guo YL, Wu NQ, Sun J, Chen BX, Li JJ. Liraglutide downregulates hepatic LDL receptor and PCSK9 expression in HepG2 cells and db/db mice through a HNF-1a dependent mechanism. Cardiovasc Diabetol 2018; 17:48. [PMID: 29618348 PMCID: PMC5885408 DOI: 10.1186/s12933-018-0689-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/17/2018] [Indexed: 02/06/2023] Open
Abstract
Background Proprotein convertase subtilisin/kexin type 9 (PCSK9), a major regulator of cholesterol homeostasis, is associated with glucose metabolism. Liraglutide, a glucagon-like peptide-1 receptor agonist, can increase insulin secretion in a glucose-dependent manner and lower blood glucose. We aimed to investigate the relationship between liraglutide and PCSK9. Methods At the cellular level, the expressions of PCSK9 and hepatocyte nuclear factor 1 alpha (HNF1α) protein in HepG2 cells stimulated by liraglutide was examined using Western blot. Seven-week old db/db mice and wild type (WT) mice were administered either liraglutide (200 μg/kg) or equivoluminal saline subcutaneously, twice daily for 7 weeks. Fasting glucose level, food intake and body weight were measured every week. After the 7-week treatment, the blood was collected for lipid and PCSK9 levels detection and the liver was removed from the mice for oil red O staining, immunohistochemical analysis, immunofluorescence test and Western bolt. Results Firstly, liraglutide suppressed both PCSK9 and HNF1α expression in HepG2 cells in a time and concentration dependent manner. Secondly, liraglutide induced weight loss in WT and db/db mice, decreased serum PCSK9, glucose and lipid levels and improved hepatic accumulation in db/db but not WT mice. Thirdly, liraglutide reduced both hepatic PCSK9 and low-density lipoprotein receptor (LDLR) expression with a decrease in HNF1α in db/db mice but not in WT mice. Conclusions Liraglutide suppressed PCSK9 expression through HNF1α-dependent mechanism in HepG2 cells and db/db mice, and decreased LDLR possibly via PCSK9-independent pathways in db/db mice. Electronic supplementary material The online version of this article (10.1186/s12933-018-0689-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheng-Hua Yang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.,Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Chuan-Jue Cui
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yin Wang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ying Du
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Zhi-Guo Chen
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yu-Hong Yao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Chun-Yan Ma
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Na-Qiong Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jing Sun
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Bu-Xing Chen
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
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Kalra S, Bahendeka S, Sahay R, Ghosh S, Md F, Orabi A, Ramaiya K, Al Shammari S, Shrestha D, Shaikh K, Abhayaratna S, Shrestha PK, Mahalingam A, Askheta M, A. Rahim AA, Eliana F, Shrestha HK, Chaudhary S, Ngugi N, Mbanya JC, Aye TT, Latt TS, Akanov ZA, Syed AR, Tandon N, Unnikrishnan AG, Madhu SV, Jawa A, Chowdhury S, Bajaj S, Das AK. Consensus Recommendations on Sulfonylurea and Sulfonylurea Combinations in the Management of Type 2 Diabetes Mellitus - International Task Force. Indian J Endocrinol Metab 2018; 22:132-157. [PMID: 29535952 PMCID: PMC5838894 DOI: 10.4103/ijem.ijem_556_17] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
For decades, sulfonylureas (SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Silver Bahendeka
- Department of Internal Medicine, Diabetes & Endocrinology, St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Fariduddin Md
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Abbas Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Kaushik Ramaiya
- Department of Internal Medicine, Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | | | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital and Medical College, and Hospital for Advanced Medicine and Surgery, Maharajganj, Kathmandu, Nepal
| | - Khalid Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Sachitha Abhayaratna
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Pradeep K. Shrestha
- Department of Medicine, Tribhuvan University Teaching Hospital, Maharajganj, Kathmandu, Nepal
| | | | | | - Aly Ahmed A. Rahim
- Department of Internal Medicine, Diabetes & Metabolism Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Fatimah Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Hari K. Shrestha
- Department of Internal Medicine, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | - Nancy Ngugi
- Department of Endocrinology, Kenyatta National Hospital, Nairobi, Kenya
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaounde, Cameroon
| | - Than Than Aye
- Department of Endocrinology, University of Medicine 2, Yangon, Myanmar
| | - Tint Swe Latt
- Department of Medicine, University of Medicine 2, Yangon, Myanmar
| | - Zhanay A. Akanov
- Center of Diabetes, Clinic of Internal Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - Abbas Raza Syed
- Department of Endocrinology, Shaukat Khanum Hospital and Research Center, Lahore, Pakistan
| | - Nikhil Tandon
- Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, Pune, Maharashtra, India
| | - A. G. Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - S. V. Madhu
- Department of Medicine, University of Delhi, New Delhi, India
| | - Ali Jawa
- Department of Endocrinology, Diabetes and Metabolism, Wilshire Cardiovascular and Endocrine Center of Excellence, Lahore, Pakistan
| | - Subhankar Chowdhury
- Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Ashok Kumar Das
- Department of General Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
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21
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Zhang F, Tang L, Zhang Y, Lü Q, Tong N. Glucagon-like peptide-1 mimetics, optimal for Asian type 2 diabetes patients with and without overweight/obesity: meta-analysis of randomized controlled trials. Sci Rep 2017; 7:15997. [PMID: 29167470 PMCID: PMC5700049 DOI: 10.1038/s41598-017-16018-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/07/2017] [Indexed: 02/05/2023] Open
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are desirable for diabetes, especially in patients with overweight/obesity. We aimed to determine whether GLP-1RAs exhibit different glucose-lowering efficacies between Asian type 2 diabetes (T2D) patients with and without overweight/obesity. Randomized controlled trials were searched in EMBASE, MEDLINE, CENTRAL, and ClinicalTrials.gov. Studies published in English with treatment duration ≥12 weeks and information on HbA1c changes were included. The studies were divided into normal body mass index (BMI) and overweight/obese groups according to baseline BMI. Among 3190 searched studies, 20 trials were included in the meta-analysis. The standardized mean differences in HbA1c change, fasting glucose change, and postprandial glucose change were equivalent between normal BMI and overweight/obese studies (p > 0.05). The relative risk of HbA1c < 6.5% target achievement in normal BMI trials (7.93; 95% confidence interval: 3.27, 19.20) was superior to that in overweight/obesity trials (2.23; 1.67, 2.97), with a significant difference (p = 0.020). Body weight loss (p = 0.572) and hypoglycemic risk(p = 0.920) were similar in the two groups. The glucose-lowering effects of GLP-1RAs were equivalent among Asian T2D patients. With their advantages for weight-loss or weight-maintenance, GLP-1RAs are optimal medicines for Asian T2D patients with and without overweight/obesity.
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Affiliation(s)
- Fang Zhang
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lizhi Tang
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuwei Zhang
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qingguo Lü
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Nanwei Tong
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Jacobsen LV, Flint A, Olsen AK, Ingwersen SH. Liraglutide in Type 2 Diabetes Mellitus: Clinical Pharmacokinetics and Pharmacodynamics. Clin Pharmacokinet 2017; 55:657-72. [PMID: 26597252 PMCID: PMC4875959 DOI: 10.1007/s40262-015-0343-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liraglutide is an acylated glucagon-like peptide-1 analogue with 97 % amino acid homology with native glucagon-like peptide-1 and greatly protracted action. It is widely used for the treatment of type 2 diabetes mellitus, and administered by subcutaneous injection once daily. The pharmacokinetic properties of liraglutide enable 24-h exposure coverage, a requirement for 24-h glycaemic control with once-daily dosing. The mechanism of protraction relates to slowed release from the injection site, and a reduced elimination rate owing to metabolic stabilisation and reduced renal filtration. Drug exposure is largely independent of injection site, as well as age, race and ethnicity. Increasing body weight and male sex are associated with reduced concentrations, but there is substantial overlap between subgroups; therefore, dose escalation should be based on individual treatment outcome. Exposure is reduced with mild, moderate or severe renal or hepatic impairment. There are no clinically relevant changes in overall concentrations of various drugs (e.g. paracetamol, atorvastatin, griseofulvin, digoxin, lisinopril and oral combination contraceptives) when co-administered with liraglutide. Pharmacodynamic studies show multiple beneficial actions with liraglutide, including improved fasting and postprandial glycaemic control (mediated by increased insulin and reduced glucagon levels and minor delays in gastric emptying), reduced appetite and energy intake, and effects on postprandial lipid profiles. The counter-regulatory hormone response to hypoglycaemia is largely unaltered. The effects of liraglutide on insulin and glucagon secretion are glucose dependent, and hence the risk of hypoglycaemia is low. The pharmacokinetic and pharmacodynamic properties of liraglutide make it an important treatment option for many patients with type 2 diabetes.
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Affiliation(s)
- Lisbeth V Jacobsen
- Clinical Pharmacology, Global Development, Novo Nordisk A/S, Vandtårnsvej 108-110, Søborg, 2860, Copenhagen, Denmark
| | - Anne Flint
- Clinical Pharmacology, Global Development, Novo Nordisk A/S, Vandtårnsvej 108-110, Søborg, 2860, Copenhagen, Denmark
| | - Anette K Olsen
- NCD Project Management, Non-clinical Development, Novo Nordisk A/S, Copenhagen, Denmark
| | - Steen H Ingwersen
- Clinical Pharmacology, Global Development, Novo Nordisk A/S, Vandtårnsvej 108-110, Søborg, 2860, Copenhagen, Denmark.
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23
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Chan WB, Luk A, Chow WS, Yeung VTF. What next after basal insulin? Treatment intensification with lixisenatide in Asian patients with type 2 diabetes mellitus. J Diabetes 2017; 9:562-574. [PMID: 27976513 DOI: 10.1111/1753-0407.12515] [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: 06/24/2016] [Revised: 11/25/2016] [Accepted: 12/06/2016] [Indexed: 12/15/2022] Open
Abstract
There is increasing evidence that the pathophysiology of type 2 diabetes mellitus (T2DM) in Asian patients differs from that in Western patients, with early phase insulin deficiencies, increased postprandial glucose excursions, and increased sensitivity to insulin. Asian patients may also experience higher rates of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as nausea and vomiting, compared with their Western counterparts. These factors should be taken into consideration when selecting therapy for basal insulin treatment intensification in Asian patients. However, the majority of studies to establish various agents for treatment intensification in T2DM have been conducted in predominantly Western populations, and the levels of evidence available in Chinese or Asian patients are limited. This review discusses the different mechanisms of action of short-acting, prandial, and long-acting GLP-1RAs in addressing hyperglycemia, and describes the rationale and available clinical data for basal insulin in combination with the short-acting prandial GLP-1RA lixisenatide, with a focus on treatment of Asian patients with T2DM.
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Affiliation(s)
- Wing B Chan
- Endocrinology, Diabetes & Metabolism, Qualigenics Diabetes Centre, Hong Kong, SAR China
| | - Andrea Luk
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR China
| | - Wing S Chow
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR China
| | - Vincent T F Yeung
- Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Hong Kong, SAR China
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24
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The efficacy and safety of liraglutide added to metformin in patients with diabetes: a meta-analysis of randomized controlled trials. Sci Rep 2016; 6:32714. [PMID: 27600499 PMCID: PMC5013324 DOI: 10.1038/srep32714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/12/2016] [Indexed: 01/25/2023] Open
Abstract
Liraglutide, a glucagon-like peptide (GLP-1) receptor agonist, has showed favorable effects in the glycaemic control and weight reduction in patients with type 2 diabetes mellitus (T2DM). The meta-analysis was to compare the efficacy and safety of liraglutide added to metformin with other treatments in patients with T2DM. A systematic literature search on PubMed, Embase, Web of Science and the Cochrane library databases were performed. Eligible studies were randomized controlled trials (RCTs) of patients with T2DM who received the combination treatment of liraglutide and metformin. Pooled estimates were performed using a fixed-effects model or random-effects model. A total of nine RCTs met the inclusion criteria. Compared with control (placebo, sitagliptin, glimepiride, dulaglutide, insulin glargine, and NPH), liraglutide in combination with metformin resulted in significant reductions in HbA1c, bodyweight, FPG, and PPG, and similar reductions in SBP, and DBP. Moreover, liraglutide combined with metformin did not increase the risk of hypoglycemia, but induced a higher incidence of gastrointestinal disorders. In conclusion, this meta-analysis confirmed the use of liraglutide as add-on to metformin appeared to be effective and safe for patients with T2DM. However, considering the potential limitations in this study, more large-scale, well-conducted RCTs are needed to identify our findings.
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25
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Kaur P, Mahendru S, Mithal A. Long-term efficacy of liraglutide in Indian patients with Type 2 diabetes in a real-world setting. Indian J Endocrinol Metab 2016; 20:595-599. [PMID: 27730066 PMCID: PMC5040036 DOI: 10.4103/2230-8210.183825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Long-term efficacy of liraglutide, a glucagon-like peptide-1 analog, on body weight and glycemic control has not been studied in Indian Type 2 diabetes mellitus (T2DM) subjects. AIM To evaluate the effect of liraglutide on glycemic control and body weight for 1 year in Indian T2DM patients. METHODS Liraglutide was prescribed to 96 obese patients with T2DM and followed up for 1 year. Clinical parameters were measured at baseline and 3, 6, 9, and 12 months. Dosage of liraglutide and other medications was adjusted according to clinical judgment. RESULTS 1 year data were available for 74 patients. Mean age was 50.9 ± 9.6 years. Mean duration of diabetes was 11.6 ± 6.3 years. Glycosylated hemoglobin (HbA1c) significantly decreased from 8.9 ± 1.3% at baseline to 7.4 ± 1.2% at 1 year. Body weight significantly declined from 98.9 ± 16.0 kg at baseline to 93.8 ± 15.0 kg at 1 year. After an initial decline, subset of patients had an increase in mean HbA1c (n = 30/74) and mean body weight (n = 33/74) after 6 months of liraglutide initiation. Baseline HbA1c and baseline body weight were positively associated with a reduction of HbA1c and body weight at 1 year, respectively. No major side effects occurred. CONCLUSION Liraglutide treatment resulted in a significant and sustained reduction in HbA1c and body weight over 1 year in Indian T2DM patients. Magnitude of reduction of HbA1c and body weight at 1 year was positively associated with baseline HbA1c and baseline weight, respectively.
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Affiliation(s)
- Parjeet Kaur
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Shama Mahendru
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
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26
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Zang L, Liu Y, Geng J, Luo Y, Bian F, Lv X, Yang J, Liu J, Peng Y, Li Y, Sun Y, Bosch-Traberg H, Mu Y. Efficacy and safety of liraglutide versus sitagliptin, both in combination with metformin, in Chinese patients with type 2 diabetes: a 26-week, open-label, randomized, active comparator clinical trial. Diabetes Obes Metab 2016; 18:803-11. [PMID: 27060930 PMCID: PMC5084818 DOI: 10.1111/dom.12674] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 01/03/2023]
Abstract
AIMS To compare the efficacy and safety of liraglutide versus sitagliptin as add-on to metformin after 26 weeks of treatment in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS This 26-week open-label, active comparator trial (NCT02008682) randomized patients (aged 18-80 years) with T2DM inadequately controlled with metformin [glycated haemoglobin (HbA1c) 7.0-10.0% (53-86 mmol/mol)] 1 : 1 to once-daily subcutaneously administered liraglutide 1.8 mg (n = 184) or once-daily oral sitagliptin 100 mg (n = 184), both as add-on to metformin. The primary endpoint was change in HbA1c from baseline to week 26. RESULTS Liraglutide was superior to sitagliptin in reducing HbA1c from baseline [8.1% (65 mmol/mol)] to 26 weeks, as evidenced by estimated mean HbA1c change of -1.65% (-18.07 mmol/mol) versus -0.98% (-10.72 mmol/mol), respectively [estimated treatment difference for liraglutide vs sitagliptin of -0.67% (95% CI -0.86, -0.48) or -7.35 mmol/mol (95% CI -9.43; -5.26); p < 0.0001]. More patients receiving liraglutide (76.5%) than sitagliptin (52.6%) achieved the HbA1c target of <7.0% (53 mmol/mol) at week 26 [odds ratio 3.65 (95% CI 2.18, 6.12); p < 0.0001]. Reductions in fasting plasma glucose, 7-point self-measured plasma glucose and body weight were greater with liraglutide than with sitagliptin (p < 0.0001 for all). More patients experienced nausea (14.8% vs 0.5%), diarrhoea (8.2% vs 2.2%) and decreased appetite (10.9% vs 0.5%) with liraglutide than sitagliptin. Two hypoglycaemic episodes were confirmed for liraglutide and one for sitagliptin; none were severe or nocturnal. CONCLUSIONS Liraglutide provided better glycaemic control and greater body weight reduction than sitagliptin when administered as add-on to metformin. More patients had nausea, diarrhoea and decreased appetite with liraglutide versus sitagliptin.
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Affiliation(s)
- L Zang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Y Liu
- Department of Endocrinology, Second Hospital of Jilin University, Jilin, China
| | - J Geng
- Department of Endocrinology, Harrison International Peace Hospital, Hengshui, China
| | - Y Luo
- Department of Endocrinology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - F Bian
- Department of Endocrinology, Cangzhou People's Hospital, Cangzhou, China
| | - X Lv
- Department of Endocrinology, PLA, Military General Hospital of Beijing, Beijing, China
| | - J Yang
- Department of Endocrinology, Central Hospital of Minhang District, Shanghai, China
| | - J Liu
- Department of Endocrinology, Fifth People's Hospital of Shanghai, Shanghai, China
| | - Y Peng
- Department of Endocrinology, Shanghai First People's Hospital, Shanghai, China
| | - Y Li
- Department of Endocrinology, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Y Sun
- Novo Nordisk (China) Pharmaceuticals Co., Ltd, Beijing, China
| | | | - Y Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
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Weng J, Ji L, Jia W, Lu J, Zhou Z, Zou D, Zhu D, Chen L, Chen L, Guo L, Guo X, Ji Q, Li Q, Li X, Liu J, Ran X, Shan Z, Shi L, Song G, Yang L, Yang Y, Yang W. Standards of care for type 2 diabetes in China. Diabetes Metab Res Rev 2016; 32:442-58. [PMID: 27464265 PMCID: PMC5108436 DOI: 10.1002/dmrr.2827] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/11/2016] [Accepted: 06/09/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Jianping Weng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juming Lu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhiguang Zhou
- Institute of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital and the Diabetes Center, Central South University, Changsha, China
| | - Dajin Zou
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Liming Chen
- Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoying Li
- Department of Endocrinology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Liu
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongyan Shan
- Department of Endocrinology, The First Hospital of China Medical University, Shenyang, China
| | - Lixin Shi
- Department of Endocrinology, Affiliated Hospital of Guiyang Medical University, Guiyang, China
| | - Guangyao Song
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
| | - Liyong Yang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuzhi Yang
- Department of Endocrinology, Heilongjiang Provincial Hospital, Harbin, China
| | - Wenying Yang
- Department of Endocrinology, China Japan Friendship Hospital, Beijing, China
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Zhang X, Liu S, Li Y, Wang Y, Tian M, Liu G. Long-Term Effectiveness and Cost-Effectiveness of Metformin Combined with Liraglutide or Exenatide for Type 2 Diabetes Mellitus Based on the CORE Diabetes Model Study. PLoS One 2016; 11:e0156393. [PMID: 27304904 PMCID: PMC4909290 DOI: 10.1371/journal.pone.0156393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/15/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with β cell impairment. Agonists of the glucagon-like peptide 1 (GLP-1) receptor (such as liraglutide and exenatide) can increase the number of pancreatic β cells and improve cell function. These drugs contribute to the long-term control of T2DM. OBJECTIVE To evaluate the cost-effectiveness of metformin combined with liraglutide or exenatide in Chinese patient with T2DM. METHODS Patients with T2DM from the Third Hospital of Hebei Medical University were treated with oral metformin combined with liraglutide (0.6 mg/day, could be increased by 0.6 mg weekly until 1.2 or 1.8 mg) or exenatide (5 μg bid for four weeks, increased to 10 μg bid). The computer simulation model CORE was used to calculate the 30-year expected life expectancy, quality-adjusted life years (QALY), direct costs, HbA1c levels, body mass index (BMI), and the incidence of cardiovascular, renal, and ocular complications of T2DM. Patients were followed up for 52 weeks. Medication costs were calculated according to retail prices in China. A 3% annual discount was adopted in this study. RESULTS The 30-year simulation showed that the total direct medical costs were lower using liraglutide compared to exenatide by 2130 RMB/QALY yearly, while the expected life expectancy and QALY were increased by 0.471 years and 0.388, respectively, using liraglutide with an incremental cost-effectiveness of -11,550 RMB/QALYs. CONCLUSION Liraglutide 1.2 mg/day was superior to exenatide 10 μg bid with respect to cost-effectiveness in Chinese patients with T2DM.
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Affiliation(s)
- Xuesong Zhang
- CT Department, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sisi Liu
- Department of Pharmacy, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yukun Li
- Second Department of Endocrinology, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Wang
- Second Department of Endocrinology, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meimei Tian
- Second Department of Endocrinology, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoqiang Liu
- Department of Pharmacy, the Third Hospital of Hebei Medical University, Shijiazhuang, China
- * E-mail:
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Efficacy and Acceptability of Glycemic Control of Glucagon-Like Peptide-1 Receptor Agonists among Type 2 Diabetes: A Systematic Review and Network Meta-Analysis. PLoS One 2016; 11:e0154206. [PMID: 27158818 PMCID: PMC4861281 DOI: 10.1371/journal.pone.0154206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/11/2016] [Indexed: 12/26/2022] Open
Abstract
Objective To synthesize current evidence of the impact of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on hypoglycemia, treatment discontinuation and glycemic level in patients with type 2 diabetes. Design Systematic review and network meta-analysis. Data Sources Literature search (Medline, Embase, the Cochrane library), website of clinical trial, bibliographies of published systematic reviews. Eligibility Criteria Randomized controlled trials with available data comparing GLP-1 RAs with placebo or traditional anti-diabetic drugs in patients with type 2 diabetes. Data Synthesis Traditional pairwise meta-analyses within DerSimonian-Laird random effects model and network meta-analysis within a Bayesian framework were performed to calculate odds ratios for the incidence of hypoglycemia, treatment discontinuation, HbA1c<7.0% and HbA1c<6.5%. Ranking probabilities for all treatments were estimated to obtain a treatment hierarchy using the surface under the cumulative ranking curve (SUCRA) and mean ranks. Results 78 trials with 13 treatments were included. Overall, all GLP-1 RAs except for albiglutide increased the risk of hypoglycemia when compared to placebo. Reduction in the incidence of hypoglycemia was found for all GLP-1 RAs versus insulin (except for dulaglutide) and sulphonylureas. For the incidence of treatment discontinuation, increase was found for exenatide, liraglutide, lixisenatide and taspoglutide versus placebo, insulin and sitagliptin. For glycemic level, decrease was found for all GLP-1 RAs versus placebo. Dulaglutide, exenatide long-acting release (exe_lar), liraglutide and taspoglutide had significant lowering effect when compared with sitagliptin (HbA1c<7.0%) and insulin (HbA1c<6.5%). Finally, according to SUCRAs, placebo, thiazolidinediones and albiglutide had the best decrease effect on hypoglycemia; sulphanylureas, sitagliptin and insulin decrease the incidence of treatment discontinuation most; exe_lar and dulaglutide had the highest impact on glycemic level among 13 treatments. Conclusions Among 13 treatments, GLP-1 RAs had a significant reduction with glycemic level but a slight increase effect on hypoglycemia and treatment discontinuation. While albiglutide had the best decrease effect on hypoglycemia and treatment discontinuation among all GLP-1 RAs. However, further evidence is necessary for more conclusive inferences on mechanisms underlying the rise in hypoglycemia.
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Østergaard L, Frandsen CS, Madsbad S. Treatment potential of the GLP-1 receptor agonists in type 2 diabetes mellitus: a review. Expert Rev Clin Pharmacol 2016; 9:241-65. [PMID: 26573176 DOI: 10.1586/17512433.2016.1121808] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Over the last decade, the discovery of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) has increased the treatment options for patients with type 2 diabetes mellitus (T2DM). GLP-1 RAs mimic the effects of native GLP-1, which increases insulin secretion, inhibits glucagon secretion, increases satiety and slows gastric emptying. This review evaluates the phase III trials for all approved GLP-1 RAs and reports that all GLP-1 RAs decrease HbA1c, fasting plasma glucose, and lead to a reduction in body weight in the majority of trials. The most common adverse events are nausea and other gastrointestinal discomfort, while hypoglycaemia is rarely reported when GLP-1 RAs not are combined with sulfonylurea or insulin. Treatment options in the near future will include co-formulations of basal insulin and a GLP-1 RA.
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Affiliation(s)
- L Østergaard
- a Department of Endocrinology, Hvidovre Hospital , University of Copenhagen , Copenhagen , Denmark
| | - Christian S Frandsen
- a Department of Endocrinology, Hvidovre Hospital , University of Copenhagen , Copenhagen , Denmark
| | - S Madsbad
- a Department of Endocrinology, Hvidovre Hospital , University of Copenhagen , Copenhagen , Denmark
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Li D, Xu X, Zhang Y, Zhu J, Ye L, Lee KO, Ma J. Liraglutide treatment causes upregulation of adiponectin and downregulation of resistin in Chinese type 2 diabetes. Diabetes Res Clin Pract 2015; 110:224-8. [PMID: 26376464 DOI: 10.1016/j.diabres.2015.05.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 01/02/2023]
Abstract
AIMS To assess the effect of 16 weeks of liraglutide administration on the plasma levels of adiponectin and resistin in Chinese patients diagnosed with type 2 diabetes mellitus (T2DM). METHODS Forty-four subjects were recruited and randomly assigned to once-a-day dosage of either liraglutide, or glimepiride (4 mg) in a double-blinded double-dummy active-controlled study. All treatments were administered in combination with metformin (1 g, twice daily). The efficacy of liraglutide was estimated by measuring and comparing the levels of HbA1c, adiponectin and resistin in the plasma before and after the 16-week treatment. RESULTS The plasma level of adiponectin was significantly increased (0.74±0.19 ng/ml, p<0.05) and resistin was significantly lowered (-1.34±0.34 pg/ml, p<0.05) in a dose-dependent manner in the liraglutide group when compared with the glimepiride group (-0.44±0.09 ng/ml of adiponectin and 0.14±0.41 pg/ml of resistin). In contrast, we found no differences in the decrease in HbA1c between the two groups (8.3±1.2% to 7.2±1.1% in NGSP units vs. 8.3±1.0% to 7.3±1.2% in NGSP units; 67±13 mmol/mol to 55±12 mmol/mol vs. 67±11 mmol/mol to 56±13 mmol/mol in IFCC units). CONCLUSIONS In Chinese T2DM patients, liraglutide treatment led to increased adiponectin and decreased resistin levels compared to glimepiride-treated subjects, while inducing similar glycemic changes.
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Affiliation(s)
- Dongmei Li
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing First Hospital, No. 68 Changle Road, Nanjing, China
| | - Xiaohua Xu
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing First Hospital, No. 68 Changle Road, Nanjing, China
| | - Ying Zhang
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing First Hospital, No. 68 Changle Road, Nanjing, China
| | - Jian Zhu
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing First Hospital, No. 68 Changle Road, Nanjing, China
| | - Lei Ye
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kok Onn Lee
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Jianhua Ma
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing First Hospital, No. 68 Changle Road, Nanjing, China.
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Abstract
Subcutaneous liraglutide (Victoza(®)), a glucagon-like peptide 1 receptor agonist, is approved for the treatment of adult patients with type 2 diabetes mellitus. Once-daily liraglutide, as monotherapy or add-on therapy to other antidiabetic agents (including basal insulin), was an effective and generally well tolerated treatment in adult patients with type 2 diabetes in several well-designed phase III trials and in the real world clinical practice setting. In addition to improving glycaemic control, liraglutide had beneficial effects on bodyweight, systolic blood pressure and surrogate measures of β-cell function in clinical trials, with these benefits maintained during long-term treatment (≤2 years). Liraglutide has a convenient once-daily administration regimen, a low potential for drug-drug interactions and low propensity to cause hypoglycaemia. Thus, liraglutide continues to be a useful option for the management of type 2 diabetes. This article reviews the therapeutic use of liraglutide in adult patients with type 2 diabetes and summarizes its pharmacological properties.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand,
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Chiefari E, Capula C, Vero A, Oliverio R, Puccio L, Liguori R, Pullano V, Greco M, Foti D, Tirinato D, Vero R, Brunetti A. Add-On Treatment with Liraglutide Improves Glycemic Control in Patients with Type 2 Diabetes on Metformin Therapy. Diabetes Technol Ther 2015; 17:468-74. [PMID: 25844858 DOI: 10.1089/dia.2014.0412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Liraglutide is a glucagon-like peptide-1 receptor analog recently approved for the treatment of type 2 diabetes mellitus (T2DM). We aimed to assess the efficacy and safety of liraglutide versus glimepiride, as adjunct treatments to metformin, in achieving glycemic control in Italian patients with T2DM uncontrolled by metformin alone. SUBJECTS AND METHODS One hundred seventy-nine diabetes patients treated with metformin plus liraglutide (1.8 mg) or glimepiride (4 mg) were retrospectively assessed at baseline, during, and after 18 months of continuous therapy. RESULTS Treatment with liraglutide resulted in mean decreases in hemoglobin A1c (HbA1c) of -1.4%, when compared with glimepiride (-0.4%) (P < 0.001), and was followed by a significant reduction (P < 0.001) in fasting plasma glucose. Variations in HbA1c occurred independently from weight loss, which was significantly reduced (P < 0.001) in liraglutide-treated patients. The percentage of subjects reaching HbA1c levels below 7% or ≤ 6.5% was significantly different between the two treated groups (P < 0.001). Treatment with liraglutide reduced waist circumference (WC) (P < 0.001) and decreased both systolic and diastolic blood pressure (BP) (P < 0.001). It is interesting that the study also showed the impact of female gender in predicting a better glycemic response to liraglutide (P = 0.028). CONCLUSIONS Liraglutide was more effective than glimepiride in reducing HbA1c levels in treated patients with T2DM. This was evident in both genders, but particularly in women. Furthermore, liraglutide reduced body weight, WC, and BP, which are critical risk factors for cardiovascular disease.
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Affiliation(s)
- Eusebio Chiefari
- 1 Department of Health Sciences, University "Magna Græcia" of Catanzaro , Catanzaro, Italy
| | - Carmelo Capula
- 2 Complex Operative Structure of Endocrinology-Diabetology, Pugliese-Ciaccio Hospital , Catanzaro, Italy
| | - Ada Vero
- 2 Complex Operative Structure of Endocrinology-Diabetology, Pugliese-Ciaccio Hospital , Catanzaro, Italy
| | - Rosa Oliverio
- 1 Department of Health Sciences, University "Magna Græcia" of Catanzaro , Catanzaro, Italy
| | - Luigi Puccio
- 2 Complex Operative Structure of Endocrinology-Diabetology, Pugliese-Ciaccio Hospital , Catanzaro, Italy
| | - Rossella Liguori
- 1 Department of Health Sciences, University "Magna Græcia" of Catanzaro , Catanzaro, Italy
| | - Vittorio Pullano
- 2 Complex Operative Structure of Endocrinology-Diabetology, Pugliese-Ciaccio Hospital , Catanzaro, Italy
| | - Manfredi Greco
- 3 Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro , Catanzaro, Italy
| | - Daniela Foti
- 1 Department of Health Sciences, University "Magna Græcia" of Catanzaro , Catanzaro, Italy
| | | | - Raffaella Vero
- 2 Complex Operative Structure of Endocrinology-Diabetology, Pugliese-Ciaccio Hospital , Catanzaro, Italy
| | - Antonio Brunetti
- 1 Department of Health Sciences, University "Magna Græcia" of Catanzaro , Catanzaro, Italy
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Oh S, Chon S, Ahn KJ, Jeong IK, Kim BJ, Kang JG. The Role of Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes: Understanding How Data Can Inform Clinical Practice in Korea. Diabetes Metab J 2015; 39:177-87. [PMID: 26124987 PMCID: PMC4483602 DOI: 10.4093/dmj.2015.39.3.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce glycosylated hemoglobin (HbA1c, 0.5% to 1.0%), and are associated with moderate weight loss and a relatively low risk of hypoglycemia. There are differences between Asian and non-Asian populations. We reviewed available data on GLP-1RAs, focusing on Korean patients, to better understand their risk/benefit profile and help inform local clinical practice. Control of postprandial hyperglycemia is important in Asians in whom the prevalence of post-challenge hyperglycemia is higher (vs. non-Asians). The weight lowering effects of GLP-1RAs are becoming more salient as the prevalence of overweight and obesity among Korean patients increases. The higher rate of gastrointestinal adverse events amongst Asian patients in clinical trials may be caused by higher drug exposure due to the lower body mass index of the participants (vs. non-Asian studies). Data on the durability of weight loss, clinically important health outcomes, safety and optimal dosing in Korean patients are lacking. Use of GLP-1RAs is appropriate in several patient groups, including patients whose HbA1c is uncontrolled, especially if this is due to postprandial glucose excursions and patients who are overweight or obese due to dietary problems (e.g., appetite control). The potential for gastrointestinal adverse events should be explained to patients at treatment initiation to facilitate the promotion of better compliance.
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Affiliation(s)
- Seungjoon Oh
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyu Jeong Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - In-Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Byung-Joon Kim
- Department of Endocrinology, Gachon University College of Medicine, Incheon, Korea
| | - Jun Goo Kang
- Department of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Rotz ME, Ganetsky VS, Sen S, Thomas TF. Implications of incretin-based therapies on cardiovascular disease. Int J Clin Pract 2015; 69:531-49. [PMID: 25363540 DOI: 10.1111/ijcp.12572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/08/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Incretin-based therapies offer another treatment option for patients with type 2 diabetes. Agents that provide glycaemic control in addition to attenuating cardiovascular disease (CVD) risk factors are important for diabetes management. This review will focus on the off-target effects of incretin-based therapies on CVD risk factors [body weight, blood pressure (BP), lipid profile and albuminuria], major adverse cardiovascular events (MACE), heart failure (HF) and beta-cell preservation. METHODS A literature search was conducted to identify English-language publications for incretin-based therapies evaluating the following off-target end-points: body weight, BP, lipid profile, albuminuria, MACE, HF and beta-cell function. Randomised controlled trials (RCTs) were prioritised as the primary source of information. RESULTS Overall, incretin-based therapies have shown beneficial effects on CVD risk factors, and glucagon-like peptide 1 (GLP-1) receptor agonists appear to have a more pronounced effect compared with dipeptidyl peptidase-4 inhibitors. RCTs are being conducted to determine if these positive effects on CVD risk factors translate to a reduction in MACE. To date, these studies have not shown an increase in MACE. A signal of increased hospitalisations for HF was observed with saxagliptin, warranting continued evaluation and vigilance in high-risk patients. In addition, incretin-based therapies have shown positive effects on measures of beta-cell function supporting their durability in the management of diabetes. CONCLUSIONS Incretin-based therapies are an important treatment option for patients with type 2 diabetes, offering beneficial effects on CVD risk factors without increasing MACE.
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Affiliation(s)
- M E Rotz
- Temple University School of Pharmacy, Philadelphia, PA, USA
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Ingwersen SH, Petri KC, Tandon N, Yoon KH, Chen L, Vora J, Yang W. Liraglutide pharmacokinetics and dose-exposure response in Asian subjects with Type 2 diabetes from China, India and South Korea. Diabetes Res Clin Pract 2015; 108:113-9. [PMID: 25684604 DOI: 10.1016/j.diabres.2015.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/02/2014] [Accepted: 01/04/2015] [Indexed: 02/07/2023]
Abstract
AIMS To investigate the population pharmacokinetics and exposure-response relationship of liraglutide, a human glucagon-like peptide-1 (GLP-1) analogue, in Asian subjects with Type 2 diabetes mellitus. METHODS Data were derived from a published 16-week, randomized, double-blind, double-dummy, active-controlled, parallel-group trial of liraglutide in China, India and South Korea. The analysis utilized 2061 pharmacokinetic (PK) samples from 605 subjects exposed to liraglutide 0.6, 1.2 or 1.8 mg once daily. Demographic factors (body weight, age, gender, country) of importance for liraglutide clearance were evaluated. An exploratory exposure-response analysis was conducted to investigate effects on glycated haemoglobin (HbA1c) and body weight. RESULTS Estimated liraglutide exposure (area under the curve; AUC) appeared to increase proportionally with increasing liraglutide dose (0.6-1.8 mg). The covariate analysis confirmed previous findings in a global clinical trial. Body weight was a predictor of liraglutide exposure; compared to a reference subject of 67 kg, exposure was 32% lower for maximum (115 kg) and 54% higher for minimum (37 kg) observed body weights. Gender, age and country had no relevant effect on exposure. Exposure-response analysis supported the use of 1.2mg as maintenance dose with the option of individual dose escalation to 1.8 mg to optimize treatment outcomes. CONCLUSIONS Exposure appeared to increase proportionally with increasing liraglutide dose in Asian subjects with Type 2 diabetes mellitus. The only PK relevant predictor of exposure was body weight. The exposure-response relationships for HbA1c and body weight in Asian subjects were similar to observations in global populations.
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Affiliation(s)
| | | | - N Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - K-H Yoon
- Catholic Medical Center, The Catholic University of Korea, South Korea
| | - L Chen
- Department of Endocrinology, Wuhan Union Hospital, Wuhan, Hubei, China
| | - J Vora
- Royal Liverpool University Hospitals, Liverpool, UK
| | - W Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
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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]
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Advani A, Bugyei-Twum A, Connelly KA. Cardiovascular effects of incretins in diabetes. Can J Diabetes 2015; 37:309-14. [PMID: 24500557 DOI: 10.1016/j.jcjd.2013.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 12/24/2022]
Abstract
Recent years have seen an enormous increase in the number of therapeutic agents available for lowering blood glucose levels in people with type 2 diabetes. Among these agents, the incretin mimetics glucagon-like peptide-1 (GLP-1) receptor (GLP-1R) agonists and dipeptidyl peptidase 4 (DPP4) inhibitors have received particular attention for the potential of these interventions to positively impact on cardiovascular outcomes. Although the results of large-scale cardiovascular outcome trials eagerly are anticipated, an increasing body of literature from preclinical and early phase clinical studies has indicated that both GLP-1R agonists and DPP4 inhibitors may exert glucose-independent cardiovascular effects. Despite its role in glucose homeostasis, the GLP-1R is surprisingly widely distributed throughout the body, including in the heart. GLP-1 may exert its effects through both receptor-dependent and receptor-independent mechanisms and through the actions of both the intact peptide and its metabolites. In addition, DPP4 inhibition not only augments the circulating levels of incretin hormones, but it also holds the capacity to augment the activity of other biologically important substrates, most notably the small protein stromal cell-derived factor 1 alpha. Whether these collective functions will act to reduce cardiovascular events in patients remains to be determined.
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Affiliation(s)
- Andrew Advani
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Ontario, Canada
| | - Antoinette Bugyei-Twum
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Ontario, Canada
| | - Kim A Connelly
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Ontario, Canada.
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Liraglutide reduces the body weight and waist circumference in Chinese overweight and obese type 2 diabetic patients. Acta Pharmacol Sin 2015; 36:200-8. [PMID: 25619391 DOI: 10.1038/aps.2014.136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/18/2014] [Indexed: 12/24/2022] Open
Abstract
AIM To investigate the effects of liraglutide, a glucagon-like peptide-1 (GLP-1) receptor activator, on body weight and waist circumference in Chinese overweight and obese type 2 diabetic patients. METHODS A total of 328 Chinese overweight and obese type 2 diabetic patients were included in this multi-center, open-labeled and self-controlled clinical study. The patients were subcutaneously injected with liraglutide once daily for 24 weeks as add-on therapy to their previous hypoglycemic treatments. Statistical analyses were performed using SPSS software package version 11.5 for Windows. RESULTS Liraglutide treatment caused significant reduction of the mean body weight (from 86.61±14.09 to 79.10±13.55 kg) and waist circumference (from 101.81±13.96 to 94.29±14.17 cm), resulting in body weight lose of 5%-10% in 43.67% patients, and body weight loss above 10% in 34.06% patients, who had significant lower plasma creatinine levels. Baseline waist circumference, BMI and HOMA-IR were independently correlated with the body weight loss. Furthermore, liraglutide treatment significantly decreased HbA1c levels (from 8.66%±2.17% to 6.92%±0.95%) with HbA1c<7.0% in 35.37% patients, who had a significantly lower baseline level of HbA1c, but higher baseline levels of C peptide and glucagon. Moreover, liraglutide treatment resulted in greater body weight loss in patients with a long duration of diabetes, and better glycemic control in patients with a short duration of diabetes. CONCLUSION Liraglutide significantly reduces body weight and waist circumference in Chinese overweight and obese type 2 diabetic patients. Patients with apparent visceral obesity, insulin resistance and a long duration of diabetes may have greater body weight loss; whereas patients with high insulin-secreting ability, hyperglucagonemia, and short-duration diabetes may obtain better glycemic control with liraglutide.
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Harris KB, McCarty DJ. Efficacy and tolerability of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus. Ther Adv Endocrinol Metab 2015; 6:3-18. [PMID: 25678952 PMCID: PMC4321868 DOI: 10.1177/2042018814558242] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Glucagon-like peptide-1 (GLP-1) has been evaluated for use in the treatment of type 2 diabetes mellitus (T2DM) due to its role in glucose regulation. Four GLP-1 receptor agonists (RAs) are currently indicated for T2DM in the USA. Exenatide and liraglutide are short-acting and require twice-daily and daily dosing, respectively. Two longer acting agents, exenatide long-acting release (LAR) and albiglutide, were formulated to allow for once-weekly dosing. All four GLP-1 RAs have demonstrated reductions in hemoglobin A1c, fasting blood glucose, and body weight both as monotherapy and in combination with first- and second-line diabetes agents including metformin, sulfonylureas, thiazolidinediones, and insulin. Greater glycemic control was seen with liraglutide compared with the other GLP-1 treatment options; however, the two long-acting agents were superior to exenatide twice daily. All agents were well tolerated with most adverse events being mild or moderate in nature. The most common adverse event was transient nausea which typically resolved 4-8 weeks after treatment initiation. Long-acting agents had lower rates of nausea but an increased incidence of injection site reactions. Trials have suggested GLP-1 RAs may improve cardiovascular risk factors including blood pressure, lipid parameters and inflammatory markers. Future trials are needed to confirm the clinical outcomes of these agents. Overall, GLP-1 RAs will provide benefit for patients with T2DM intolerable to or not reaching glycemic goals with first-line agents, especially in patients in need of weight loss.
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Affiliation(s)
- Kira B Harris
- Assistant Professor, Wingate University School of Pharmacy, 515 North Main Street, Wingate, NC 28174, USA
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Abstract
Incretin-based therapy has clearly emerged as one of the most sought out strategy in managing type 2 diabetes, primarily because they generally do not causes hypoglycemia and possess weight-neutral or weight losing properties. Efficacy-wise too, these agents, are more or less similar to commonly used drugs metformin and sulfonylureas. Interestingly, some studies recently suggested that glycemic response to these incretin-based therapies could also differ ethnicity-wise. Subsequently, meta-analysis from these studies also suggested that Asians may have better response to these incretin-based therapies. This review will be an attempt to critically analyze those studies available in literature and to address as to why East-Asians and South-Asians may have different incretin response compared to non-Asians.
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Affiliation(s)
- Awadhesh Kumar Singh
- Consultant Endocrinologist, G.D. Diabetes Hospital, Kolkata, West Bengal, and Sun Valley Diabetes Hospital, Guwahati, Assam, India
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Hanna A, Connelly KA, Josse RG, McIntyre RS. The non-glycemic effects of incretin therapies on cardiovascular outcomes, cognitive function and bone health. Expert Rev Endocrinol Metab 2015; 10:101-114. [PMID: 30289042 DOI: 10.1586/17446651.2015.972370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The incretin therapies, glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors, have been developed to lower blood glucose levels in patients with Type 2 diabetes. However, in addition to being a treatment strategy to improve metabolic control, incretin therapies have shown effects independent of glycemic control, including the potential to positively impact cardiovascular events, cognitive deficits and bone mineral density. This paper outlines the non-glycemic effects of incretin therapies on cardiovascular disease, cognitive function and bone health.
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Affiliation(s)
- Amir Hanna
- a 1 Department of Medicine, University of Toronto, Toronto, ON, Canada
- b 2 Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Kim A Connelly
- c 3 Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert G Josse
- a 1 Department of Medicine, University of Toronto, Toronto, ON, Canada
- b 2 Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Roger S McIntyre
- d 4 Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
- e 5 Department of Psychiatry and Pharmacology, and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Abstract
Although GLP-1 (glucagon like peptide-1) based therapies (GLP-1 agonists and dipeptidyl peptidase-4 inhibitors) is currently playing a cornerstone role in the treatment of type 2 diabetes, dilemma does exist about some of its basic physiology. So far, we know that GLP-1 is secreted by the direct actions of luminal contents on the L cells in distal jejunum and proximal ileum. However, there is growing evidence now, which suggest that other mechanism via "neural" or "upper gut" signals may be playing a second fiddle and could stimulate GLP-1 secretion even before the luminal contents have reached into the proximities of L cells. Therefore, the contribution of direct and indirect mechanism to GLP-1 secretion remains elusive. Furthermore, no clear consensus exists about the pattern of GLP-1 secretion, although many believe it is monophasic. One of the most exciting issues in incretin science is GLP-1 level and GLP-1 responsiveness. It is not exactly known as to what happens to endogenous GLP-1 with progressive worsening of dysglycemia from normal glucose tolerance to impaired glucose to frank diabetes and furthermore with increasing duration of diabetes. Although, conventional wisdom suggests that there may be a decrease in endogenous GLP-1 level with the worsening of dysglycemia, literature showed discordant results. Furthermore, there is emerging evidence to suggest that GLP-1 response can vary with ethnicity. This mini review is an attempt to put a brief perspective on all these issues.
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Affiliation(s)
- Awadhesh Kumar Singh
- Senior Consultant Endocrinologist, G.D Diabetes Hospital, Kolkata, West Bengal, India
- Sun Valley Diabetes Hospital, Guwahati, Assam, India
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Abstract
Diabetes is a huge burden in China, where about 100 million people have been diagnosed with the disease. Treatments are needed that are optimal for treating Chinese patients with diabetes. Chinese patients with type 2 diabetes are characterised by having relatively low bodyweight and significant β-cell deterioration. β-cell failure results in deficiency of insulin secretion, particularly at the early phase of insulin secretion in Chinese patients. As a result, postprandial hyperglycaemia is more pronounced in Chinese patients with early type 2 diabetes than most other ethnic groups. These characteristics point to the key strategies when considering early therapy for Chinese patients with type 2 diabetes, including control of postprandial hyperglycaemia and β-cell preservation. Besides metformin, insulin secretagogues and α-glucosidase inhibitors that target postprandial hyperglycaemia are recommended for drug-naive patients. Short-term intensive insulin therapy is suggested for patients with severe hyperglycaemia at diagnosis to help restore β-cell function. Use of incretin-based drugs is also recommended when treatment fails with metformin, insulin secretagogues, and α-glucosidase inhibitors. Although data on antidiabetic drugs in Chinese patients are growing, there are still gaps in the evidence base. Research is needed to strengthen the evidence-based treatment guidelines for Chinese patients with type 2 diabetes.
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Affiliation(s)
- Wenying Yang
- China-Japan Friendship Hospital, Beijing, China.
| | - Jianping Weng
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Flory JH, Mushlin AI. Observational and clinical trial findings on the comparative effectiveness of diabetes drugs showed agreement. J Clin Epidemiol 2014; 68:200-10. [PMID: 25432086 DOI: 10.1016/j.jclinepi.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/15/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study compares an observational study of diabetes treatment effectiveness to randomized controlled trials to assess their convergent validity. STUDY DESIGN AND SETTING Multivariate models were developed using observational data to describe change in hemoglobin A1c (HbA1c; % unit) and weight (kilograms) after addition of a second-line oral diabetes drug to metformin monotherapy. Randomized trials of these scenarios were systematically identified. The models were used to simulate each trial, and simulated and actual results were compared by linear regression and meta-analysis. RESULTS Thirty-two randomized trials of second-line diabetes oral therapy were identified. For all outcomes and drugs studied, simulation and actual results correlated (P < 0.001). There were no statistically significant differences between meta-analyzed randomized and simulated results for effect on HbA1c. For effect on weight, results were qualitatively comparable, but for sulfonylureas, the simulated weight gain was nominally greater than seen in the randomized controlled trials. CONCLUSION An observational study of diabetes drug effectiveness showed convergent validity with randomized data. This supports cautious use of the observational research to draw conclusions about drug effectiveness in populations not studied in clinical trials. This approach may be useful in other situations where observational and randomized data need integration.
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Affiliation(s)
- James H Flory
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, 525 E 68th Street, 20th Floor Baker Pavilion, New York, NY 10021, USA.
| | - Alvin I Mushlin
- Department of Public Health, Weill Cornell Medical College, 425 E 61st Street, 3rd Floor, Suite 301, New York, NY 10065, USA
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Yu Pan C, Han P, Liu X, Yan S, Feng P, Zhou Z, Lv X, Tian H, Jin Kui Y, Su B, Shang S, Niemoeller E. Lixisenatide treatment improves glycaemic control in Asian patients with type 2 diabetes mellitus inadequately controlled on metformin with or without sulfonylurea: a randomized, double-blind, placebo-controlled, 24-week trial (GetGoal-M-Asia). Diabetes Metab Res Rev 2014; 30:726-35. [PMID: 24639432 DOI: 10.1002/dmrr.2541] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/05/2014] [Accepted: 02/17/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study assessed the efficacy and safety of the once-daily glucagon-like peptide-1 receptor agonist, lixisenatide, in Asian patients with type 2 diabetes mellitus inadequately controlled on metformin ± sulfonylurea. METHODS In this 24-week, double-blind, placebo-controlled, multinational study, patients were randomized to lixisenatide 20 µg once daily or placebo. The primary endpoint was absolute change in glycated haemoglobin (HbA1c ) from baseline to week 24. RESULTS A total of 391 patients were randomized. Lixisenatide significantly reduced HbA1c levels compared with placebo (LS mean difference: -0.36%, p = 0.0004). A significantly higher proportion of lixisenatide-treated patients achieved HbA1c targets of <7% (p = 0.003) and ≤6.5% (p = 0.001) versus placebo. Lixisenatide was associated with a statistically significant reduction in 2-h postprandial plasma glucose after a standardized breakfast versus placebo (LS mean difference: -4.28 mmol/L, p < 0.0001) and a significant reduction in fasting plasma glucose (p = 0.0109). There was no difference in weight loss versus placebo, with a modest reduction in body weight reported for both groups (lixisenatide: -1.50 kg, placebo: -1.24 kg; p = 0.296). The incidence of treatment-emergent adverse events (TEAEs) was 64.3% with lixisenatide versus 47.4% with placebo, with serious TEAEs reported in 1.5% versus 2.1% of patients, respectively. The most common TEAE in the lixisenatide group was nausea (16.3% vs 2.6% with placebo). The incidence of symptomatic hypoglycaemia was 5.6% with lixisenatide treatment and 2.6% with placebo (p = 0.1321), with no severe symptomatic hypoglycaemia events reported. CONCLUSIONS In Asian patients with type 2 diabetes mellitus insufficiently controlled on metformin ± sulfonylurea, lixisenatide significantly improved glycaemic control and was well tolerated during the 24-week study.
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Affiliation(s)
- Chang Yu Pan
- Chinese People's Liberation Army General Hospital, Beijing, China
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Zueger PM, Schultz NM, Lee TA. Cost effectiveness of liraglutide in type II diabetes: a systematic review. PHARMACOECONOMICS 2014; 32:1079-1091. [PMID: 25052903 DOI: 10.1007/s40273-014-0192-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND As novel treatments for type II diabetes enter the market, there is a need to assess their long-term clinical and economic outcomes against currently available treatment alternatives. Objective compilation and evaluation of current pharmacoeconomic evidence can assist payers and decision makers in determining the appropriate place in therapy of a new medication. OBJECTIVE Our objective was to review the existing pharmacoeconomic literature evaluating the cost effectiveness and overall costs of treatment associated with liraglutide in type II diabetes. DATA SOURCES Medical literature indexed in MEDLINE, EMBASE, PsycINFO, CINAHL, and EconLit through 1 June 2014 was searched. STUDY SELECTION Full-text, English-language cost-effectiveness, cost-utility, and other cost analyses in type II diabetes that compared liraglutide to one or more anti-diabetic agents were included. Initial screening was based on relevance of titles and abstracts followed by examination of the study methods of each remaining manuscript. Studies conducting original pharmacoeconomic analyses were chosen for inclusion. STUDY APPRAISAL METHODS Articles meeting the inclusion criteria were retrieved, and information on the study design and results was abstracted. Abstracted data elements were chosen and assessed based on the authors' experience as well as criteria set forth by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Health Economic Evaluation Publication Guidelines Task Force. Additionally, reported incremental cost-effectiveness ratios (ICERs) and selected sensitivity analysis results were converted to $US, year 2012 values, in order to facilitate comparison across studies. RESULTS A total of six cost studies and seven cost-utility studies were identified for inclusion. Across cost studies, liraglutide treatment resulted in costs ranging from a loss of $US2,730 (liraglutide 1.8 mg vs. sitagliptin; pharmacy costs only) over a 1-year time horizon to a savings of $US9,367 (liraglutide 1.8 mg vs. glimepiride; diabetes-related complication costs only) over a 30-year time horizon. Cost-utility analysis results reported base-case ICERs ranging from $US15,774 (vs. glimepiride) to $US40,128 (vs. rosiglitazone) per quality-adjusted life-year (QALY) ($US, year 2012) for liraglutide 1.2 mg and $US8,497 (vs. exenatide) to $US66,031 (vs. rosiglitazone)/QALY ($US, year 2012) for liraglutide 1.8 mg. Estimates were most sensitive to variations in time horizon and cardiovascular complication rates. Based on frequently cited, country-specific cost-utility thresholds, liraglutide was determined to have a probability of being cost effective of between 58 % (liraglutide 1.8 mg vs. sitagliptin) and 93 % (liraglutide 1.2 mg vs. glimepiride). LIMITATIONS Weaknesses of included studies related primarily to study model inputs that assumed long-term morbidity and mortality benefits in favor of liraglutide based on improvements in clinical biomarkers observed in short-term clinical trials. The exclusion of drug acquisition costs in two identified cost studies as well as the assumed lifetime duration of treatment with liraglutide in several cost-utility studies were also identified as weaknesses. The authors' review was limited by the possibility of incomplete literature retrieval, unintended omission of relevant data elements, and comparison of costs and ICERs generated from healthcare systems from differing countries. CONCLUSIONS The current literature presents liraglutide as a cost-effective adjunct treatment for type II diabetes that may also be associated with a reduction in diabetes-related complication costs; however, ICER values are largely dependent on assumptions regarding the benefits of long-term liraglutide treatment and the time horizon of the analysis. Real-world use may make liraglutide unattractive from a payer and policy-maker perspective.
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Affiliation(s)
- Patrick M Zueger
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood St., Room 164, M/C 886, Chicago, IL, 60612, USA,
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Yokoyama H, Hirao K, Yamaguchi K, Oishi M, Lee G, Yagi N, Takamura H, Kashiwagi A. Liraglutide Versus Sitagliptin in a 24-week, Multicenter, Open-label, Randomized, Parallel-group Study in Japanese Type 2 Diabetes Mellitus Patients Responding Inadequately to a Sulfonylurea and/or One or Two Other Oral Antidiabetic Drugs (JDDM 33). JAPANESE CLINICAL MEDICINE 2014; 5:33-41. [PMID: 25288908 PMCID: PMC4179438 DOI: 10.4137/jcm.s16585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/22/2014] [Accepted: 06/23/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Liraglutide (glucagon-like peptide-1 [GLP-1] receptor agonist) and sitagliptin (dipeptidyl peptidase-4 inhibitor) are approved in Japan for treating type 2 diabetes mellitus (T2DM). We compared the efficacy and safety of adding liraglutide or sitagliptin to a sulfonylurea in Japanese T2DM patients. METHODS Patients aged 18 to <80 years with hemoglobin A1c (HbA1c; National Glycohemoglobin Standardization Program [NGSP]) of 6.9–9.4%, body mass index ≤35 kg/m2, and treatment with a sulfonylurea and/or one or two non-sulfonylurea oral antidiabetic drugs for greater than or equal to eight weeks before enrollment were eligible. Patients were randomized in an open-label manner to either 0.9 mg/day liraglutide (n = 50) or 50–100 mg/day sitagliptin (n = 49) and were treated for 24 weeks. Non-sulfonylureas were discontinued before randomization. Patients using other oral antidiabetic drugs started sulfonylurea treatment. The primary endpoint was the change in HbA1c from baseline to Week 24. RESULTS HbA1c decreased in both groups, and the reduction was significantly greater throughout in the liraglutide group except for Week 24 (0.59 ± 0.80 vs. 0.24 ± 0.94%; P = 0.0525). Fasting plasma glucose (FPG) decreased significantly in the liraglutide group compared with the sitagliptin group (−21.15 ± 31.22 vs. +0.46 ± 39.39 mg/dL; P = 0.0014). Homeostasis model assessment of β cell function and C-peptide increased significantly in the liraglutide group but not in the sitagliptin group. Hypoglycemic symptoms and adverse events occurred in four and nine patients, respectively, in the liraglutide group, and in two and five patients, respectively, in the sitagliptin group. CONCLUSION Treatment with liraglutide or sitagliptin together with a sulfonylurea improved HbA1c in Japanese T2DM patients in primary care. Both drugs were associated with low rates of adverse events and hypoglycemia. The improvement in β cell function probably contributed to the improvement in glycemic control in the liraglutide group.
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Takeshita Y, Takamura T, Kita Y, Otoda T, Kato KI, Wakakuri H, Yamada M, Misu H, Matsushima Y, Kaneko S. Vildagliptin vs liraglutide as a second-line therapy switched from sitagliptin-based regimens in patients with type 2 diabetes: A randomized, parallel-group study. J Diabetes Investig 2014; 6:192-200. [PMID: 25802727 PMCID: PMC4364854 DOI: 10.1111/jdi.12269] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 06/13/2014] [Accepted: 07/15/2014] [Indexed: 01/18/2023] Open
Abstract
Introduction A step-up strategy for dipeptidyl peptidase (DPP)-4 inhibitor-based regimens has not yet been established. In addition, similarities and differences between DPP-4 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists remain to be elucidated in humans. We investigated the pleiotropic effects of vildagliptin vs liraglutide in patients with type 2 diabetes on sitagliptin-based regimens in an open-label, randomized, clinical trial. Materials and Methods A total of 122 patients with type 2 diabetes that was inadequately controlled by sitagliptin-based regimens were randomly assigned to either vildagliptin (50 mg, twice daily) or liraglutide treatment (0.9 mg, once daily) for 12 weeks. The primary outcomes were glycated hemoglobin and body mass index. Results Both vildagliptin and liraglutide significantly lowered glycated hemoglobin within 12 weeks after switching from sitagliptin, but liraglutide produced a greater reduction (−0.67 ± 0.12% vs −0.36 ± 0.53%). Liraglutide lowered body mass index, whereas vildagliptin did not affect body mass index. Vildagliptin lowered fasting C-peptide immunoreactivity, but liraglutide did not. Vildagliptin increased serum levels of adiponectin, arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid, whereas liraglutide had no effect on these levels. Quality of life, assessed using the diabetes treatment satisfaction questionnaire, was not impaired in either group. The most common adverse events were gastrointestinal symptoms, which occurred with similar frequencies in both groups. Conclusions Vildagliptin-mediated improvements in glycemic control did not correlate with indices for insulin secretion and insulin sensitivity. Switching from sitagliptin to liraglutide is useful in managing hyperglycemia and weight. Each agent exerts unique pleiotropic effects. This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (no. 000004953).
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Affiliation(s)
- Yumie Takeshita
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Toshinari Takamura
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Yuki Kita
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Toshiki Otoda
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Ken-Ichiro Kato
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Hitomi Wakakuri
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Masayuki Yamada
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Hirofumi Misu
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Yukiko Matsushima
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
| | - Shuichi Kaneko
- Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Sciences Kanazawa, Ishikawa, Japan
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Seino Y, Takami A, Boka G, Niemoeller E, Raccah D. Pharmacodynamics of the glucagon-like peptide-1 receptor agonist lixisenatide in Japanese and Caucasian patients with type 2 diabetes mellitus poorly controlled on sulphonylureas with/without metformin. Diabetes Obes Metab 2014; 16:739-47. [PMID: 24524806 PMCID: PMC4312941 DOI: 10.1111/dom.12276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/12/2013] [Accepted: 02/06/2014] [Indexed: 01/13/2023]
Abstract
AIMS The PDY6797 study evaluated efficacy, safety and pharmacodynamics of lixisenatide in Japanese and Caucasian patients with type 2 diabetes mellitus (T2DM) insufficiently controlled with sulphonylureas with/without metformin. METHODS This randomized, double-blind, placebo-controlled trial comprised a single-dose assessment of lixisenatide 5 and 10 µg, and a 5- to 6-week repeated dose-escalation assessment of lixisenatide 5 to 30 µg once (QD) or twice daily (BID). The primary endpoint was change in postprandial plasma glucose (PPG) area under the curve (AUC)[0:29-4:30 h] after a standardized breakfast at the highest tolerated lixisenatide dose. Change from baseline in glycated haemoglobin (HbA1c), 2-h PPG and fasting plasma glucose (FPG) were assessed, as were adverse events. RESULTS Change from baseline in PPG AUC[0:29-4:30 h] with lixisenatide QD and BID was significantly greater than placebo (p < 0.0001 for all study populations), with particularly prominent effects in Japanese patients. Greater reductions in PPG AUC[0:29-4:30 h] were seen with lixisenatide QD versus BID, while the totality of evidence suggested that the lixisenatide 20 µg dose was optimal. In the overall population, changes from baseline for 2-h PPG, HbA1c and FPG were significant with lixisenatide QD and BID versus placebo (p < 0.01 for all). Lixisenatide was well tolerated. CONCLUSIONS Lixisenatide significantly reduced PPG AUC[0:29-4:30 h] versus placebo at the highest well-tolerated dose in patients with T2DM treated with sulphonylureas with/without metformin and had a good safety and tolerability profile. Japanese patients experienced particular benefits with lixisenatide in terms of reductions in PPG excursions.
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Affiliation(s)
- Y Seino
- Kansai Electric Power Hospital, Osaka, Japan
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