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Demidova TY, Titova VV, Izmaylova MY. [Advantages of glucagon-like peptide-1 receptor agonists in the treatment of patients with type 2 diabetes mellitus: A review]. TERAPEVT ARKH 2023; 95:876-880. [PMID: 38159021 DOI: 10.26442/00403660.2023.10.202425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
Glucagon-like peptide-1 receptor agonists (arGLP1) are an effective treatment for patients with type 2 diabetes mellitus (T2DM), mainly due to increasing insulin secretion and suppressing glucagon release by stimulating the respective receptors. Taking into account their positive effect on major cardiovascular events, drugs in this group with proven cardioprotective effects are recommended for patients with T2DM and clinical cardiovascular diseases or multiple cardiovascular risk factors. In this paper, we present an overview of current clinical studies on the clinical efficacy and safety of arGLP1 and discuss current prospects for arGLP1 as a therapy for patients with T2DM.
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Affiliation(s)
- T Y Demidova
- Pirogov Russian National Research Medical University
| | - V V Titova
- Pirogov Russian National Research Medical University
| | - M Y Izmaylova
- Pirogov Russian National Research Medical University
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2
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Paulose SK, Chakraborty K. Anti-hyperglycemic Δ 5 steroids, marginoids A-C from marine veined octopus Amphioctopus marginatus (Octopodidae): Prospective natural leads inhibit serineexopeptidase dipeptidyl peptidase-4. Steroids 2022; 186:109090. [PMID: 35850257 DOI: 10.1016/j.steroids.2022.109090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
Three Δ5 steroid analogues, marginoids A-C were purified from the organic extract of marine veined octopus Amphioctopus marginatus (Taki, 1964) (family Octopodidae) distributed on the Asian and Mediterranean coasts. Their structures were elucidated as (5Z)-3β-acetoxy-cholesta-5-en-25-ethylene-22β-hydroxy-23,26-lactone (marginoid A), (5Z, 25Z)-3β-yl-(1'-(E)-3'-hydroxy-4'-methyl-hex-5'-enoate)-22-oxo-26-furanyl-cholesta-5,25-diene (marginoid B), and (5Z)-3β-yl-(7'-methoxypropan-8'-yl)-tetrahydro-2H-pyran-2-one-cholesta-5,24-dien (marginoid C) based on extensive spectroscopic experiments. Marginoid B with hydroxyl-methyl-hexanoate at the C-3 position in conjunction with the heterocyclic furanyl ring displayed superior anti-hyperglycemic properties as acknowledged by its promising serine protease dipeptidyl peptidase-4 attenuation potential (IC50 3.49 µM) displaying comparable activity with the standard DPP-4 inhibitor (DPP-4i) diprotin A (IC50 4.53 µM). The anti-hyperglycemic properties were corroborated by the promising antioxidant activities (IC50 ∼ 0.8-1.0 mM) of these Δ5 steroids, marginoids A-C. Sizeably greater electronic properties, balanced hydrophobic-lipophilic properties (log POW 6.4-8.3), and comparatively lower steric factors were directly proportional to their bioactive properties. Molecular simulation studies in the binding sites of DPP-4 and lesser binding energy (-12.17 kcal/mol) and inhibition constant (Ki 1.20 nM) of marginoid B could be correlated with anti-hyperglycemic properties. Promising bioactivities of marginoid B isolated from A. marginatus are anticipated for nutraceutical applications against hyperglycemia.
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Affiliation(s)
- Silpa Kunnappilly Paulose
- Marine Bioprospecting Section of Marine Biotechnology, Fish Nutrition and Health Division, Central Marine Fisheries Research Institute, Ernakulam North, P.B. No. 1603, Cochin, India
| | - Kajal Chakraborty
- Marine Bioprospecting Section of Marine Biotechnology, Fish Nutrition and Health Division, Central Marine Fisheries Research Institute, Ernakulam North, P.B. No. 1603, Cochin, India.
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Paulose SK, Chakraborty K. Antioxidant spiropharanone, an undescribed variant of trans-decalin spiro-γ-lactone, from pharaoh cuttlefish Sepia pharaonis: Twin inhibitors of inflammatory 5-lipoxygenase and serine protease dipeptidyl peptidase-4. J Food Biochem 2021; 45:e13919. [PMID: 34486135 DOI: 10.1111/jfbc.13919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
Marine pharaoh cuttlefish Sepia pharaonis (family Sepiidae) is regarded as an economically important class of cephalopod in the coastal Mediterranean and Asian regions. Bioassay-guided chromatographic purification of solvent extract of S. pharaonis led to the identification of a trans-decalin based spirolactone, spiropharanone, which was characterized as 1-hydroxy-7-(4'-methoxy-3-methylbut-2-enyl)-3,9,15-trimethyl-8-oxo-octahydro-5H-spiro[furan-8,9-naphtho]-8-yl-acetate by spectroscopic techniques. Spiropharanone exhibited significantly greater anti-inflammatory activity by attenuating pro-inflammatory 5-lipoxygenase (IC50 1.02 mM) than the non-steroidal drug ibuprofen (IC50 4.61 mM, p ≤ .05). Superior antioxidant properties of spiropharanone against free radicals (EC50 ~1.20 mM) and other oxidants (hydroxyl [EC50 0.97 mM] and superoxide [EC50 1.47 mM] scavenging) also reinforced its promising anti-inflammatory activity. The studied spiropharanone also exhibited significant attenuation toward insulin secretion regulating enzyme dipeptidyl peptidase-4 (IC50 0.92 mM) recognizing its anti-hyperglycemic potential. Significantly higher electronic properties (topological polar surface area ~100) combined with balanced hydrophilic-lipophilic properties (partition coefficient of logarithmic octanol-water ~3) and lesser docking parameters of spiropharanone demonstrated that the compound could be utilized as an important bioactive lead against oxidative stress, inflammation, and hyperglycemic-related ailments. PRACTICAL APPLICATIONS: Nutritionally rich edible marine pharaoh cuttlefish Sepia pharaonis occupies a prominent place among seafood fisheries owing to the presence of bioactive nutrients and functional food ingredients. These marine cuttlefish are widely distributed along the Asian and Mediterranean coasts, and consumed as culinary delicacy for decades. An undescribed trans-decalin spirolactone, spiropharanone was isolated from the organic extract of S. pharaonis based on bioactivity-assisted sequential chromatographic fractionation. Spiropharanone displayed promising antioxidant potential along with attenuation properties against inducible pro-inflammatory 5-lipoxygenase and insulin secretion regulating enzyme dipeptidyl peptidase-4. This study established the ameliorating potential of a naturally derived marine food constituent against inflammatory and diabetic ailments, and thus anticipated as functional food lead in pharmaceutical formulations towards inflammation and maintaining glucose homeostasis.
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Affiliation(s)
- Silpa Kunnappilly Paulose
- Marine Bioprospecting Section of Marine Biotechnology Division, Central Marine Fisheries Research Institute, Cochin, India.,Department of Chemistry, Mangalore University, Mangalagangothri, India
| | - Kajal Chakraborty
- Marine Bioprospecting Section of Marine Biotechnology Division, Central Marine Fisheries Research Institute, Cochin, India
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Abubakar A, Nazifi AB, Maje IM, Tanko Y, Anuka JA, Abdurahman EM. Antihyperglycaemic activity of ethylacetate extract of Chlorophytum alismifolium in type 2 diabetes: The involvement of peroxisome proliferator-activated receptor-γ and dipeptidyl peptidase-4. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:78-84. [DOI: 10.1016/j.joim.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
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Rasalam R, Barlow J, Kennedy M, Phillips P, Wright A. GLP-1 Receptor Agonists for Type 2 Diabetes and Their Role in Primary Care: An Australian Perspective. Diabetes Ther 2019; 10:1205-1217. [PMID: 31183762 PMCID: PMC6612351 DOI: 10.1007/s13300-019-0642-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Indexed: 02/08/2023] Open
Abstract
The ever-increasing number of drugs available to treat type 2 diabetes and the complexity of patients with this condition present a constant challenge when it comes to identifying the most appropriate treatment approach. The more recent glucagon-like peptide-1 receptor agonists (GLP-1RAs) are non-insulin injectable options for the management of type 2 diabetes. Effective at improving glycaemic control with a low intrinsic risk of hypoglycaemia and the potential for weight reduction, this agent class is an important addition to the prescribing armamentarium. However, understanding their place in therapy may prove confusing for many primary care practitioners, especially given the common belief that 'injectables' are a last-resort treatment option, which puts them at risk of being niched alongside insulin. This review summarises the clinical evidence for GLP-1RAs and how they compare to other glucose-lowering agents in managing type 2 diabetes. It also provides practical and case-driven opinions and recommendations on the optimal use of GLP-1RAs by discussing important patient factors and clinical considerations that will help to identify those who are most likely to benefit from this class of agents.Funding: Eli Lilly Australia.
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Affiliation(s)
- Roy Rasalam
- James Cook University, Douglas, QLD, Australia.
| | - John Barlow
- Bankstown Medical Centre, Bankstown, NSW, Australia
| | | | - Pat Phillips
- Queen Elizabeth Specialist Centre, Woodville South, SA, Australia
| | - Alan Wright
- Lakes Medical Centre, South Lake, WA, Australia
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6
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Krishnan S, Chakraborty K, Joy M. First report of chromenyl derivatives from spineless marine cuttlefish Sepiella inermis: Prospective antihyperglycemic agents attenuate serine protease dipeptidyl peptidase-IV. J Food Biochem 2019; 43:e12824. [PMID: 31353519 DOI: 10.1111/jfbc.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
Spineless marine cuttlefish Sepiella inermis has been considered as a popular dietary cephalopod species in Asian and Mediterranean coasts. Bioassay-directed purification of organic extract of S. inermis ensued in the characterization of two chromenyl derivatives. The studied compounds exhibited significantly greater antioxidant potencies (IC50 ≤ 0.5 mg/ml) when compared with α-tocopherol. The substituted 1H-isochromenyloxy-11-hydroxyethyl pentanoate isoform (compound 1) efficiently inhibited the carbolytic enzymes along with key regulator of insulin secretion dipeptidyl peptidase-IV (IC50 0.16 mg/ml). The molecular docking simulations displayed optimum binding affinity of the compound 1 (-10.01 kcal/mol) with dipeptidyl peptidase-IV and lesser inhibition constant (Ki 46.41 nM), which along with its permissible hydrophobic-hydrophilic balance (log Pow ~ 2) appeared to play significant roles in its greater antihyperglycemic activity compared to other studied chromenyl isoform. The greater antioxidant and antidiabetic properties of compound 1 could be utilized as an important natural lead against hyperglycemic-related disorders. PRACTICAL APPLICATIONS: The edible spineless marine cuttlefish Sepiella inermis are ubiquitously available in Asian and Mediterranean coasts. The sequential chromatographic purification of the organic extract of S. inermis led to the identification of two pure chromenyl chemotypes. The metabolites with substituted 1H-isochromenyloxy-11-hydroxyethyl pentanoate isoform (compound 1) displayed potential antioxidative and antihyperglycemic activities compared to the chemotype (2) bearing 3H-isochromen-5-yl moiety. The attenuating potential of chromenyl chemotype 1 against carbohydrate hydrolyzing enzymes and insulin secretion regulator attributed towards its efficiency as an important natural lead against postprandial hyperglycemia and incretin hormone regulation to maintain glucose homeostasis in the biological system. The chromenyl metabolites isolated from S. inermis could be utilized as a functional food ingredient in the nutraceutical formulations against hyperglycemic-related disorders.
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Affiliation(s)
- Soumya Krishnan
- Marine Biotechnology Division, Central Marine Fisheries Research Institute, Cochin, India.,Department of Biosciences, Mangalore University, Mangalagangothri, India
| | - Kajal Chakraborty
- Marine Biotechnology Division, Central Marine Fisheries Research Institute, Cochin, India
| | - Minju Joy
- Marine Biotechnology Division, Central Marine Fisheries Research Institute, Cochin, India
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Tao Y, Fu H. Doubly robust estimation of the weighted average treatment effect for a target population. Stat Med 2018; 38:315-325. [DOI: 10.1002/sim.7980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 07/26/2018] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Yebin Tao
- Eli Lilly and Company; Indianapolis IN 46285
| | - Haoda Fu
- Eli Lilly and Company; Indianapolis IN 46285
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Heller SR, Pratley RE, Sinclair A, Festa A, Kiljański J, Brusko CS, Duan R, Heine RJ. Glycaemic outcomes of an Individualized treatMent aPproach for oldER vulnerable patIents: A randomized, controlled stUdy in type 2 diabetes Mellitus (IMPERIUM). Diabetes Obes Metab 2018; 20:148-156. [PMID: 28671753 PMCID: PMC5724506 DOI: 10.1111/dom.13051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 12/20/2022]
Abstract
AIMS To compare the glycaemic outcomes of 2 glucose-lowering treatment strategies in vulnerable (moderately ill and/or frail) patients aged ≥65 years with type 2 diabetes whose individual HbA1c targets were not met with diet/exercise and/or oral anti-hyperglycaemic medications (OAMs). METHODS The primary endpoint of this study was a composite of achieving/maintaining individualized HbA1c targets without "clinically significant" hypoglycaemia (severe hypoglycaemia or repeated hypoglycaemia causing interruption of patients' activities or blood glucose <54 mg/dL). Strategy-A comprised glucose-dependent therapies (n = 99) with a non-sulphonylurea OAM and a glucagon-like peptide-1 receptor agonist as the first injectable. Strategy-B comprised non-glucose-dependent therapies (n = 93) with sulphonylurea as the preferred OAM and insulin glargine as the first injectable. RESULTS There was no significant difference between Strategy-A and Strategy-B in percentages of patients achieving the primary endpoint (64.5% vs 54.9%; P = .190). Mean incidences (A vs B) of total (10.2% vs 53.8%), documented symptomatic (5.1% vs 36.6%), and asymptomatic (8.2% vs 32.3%) hypoglycaemia were lower for Strategy-A (P < .001 each). Proportions of patients achieving/maintaining HbA1c target (A, 63.3% vs B, 55.9%) were similar. CONCLUSION Similar proportions of older, vulnerable aged ≥65 years patients with type 2 diabetes achieved/maintained glycaemic treatment goals without clinically significant hypoglycaemia with Strategies A or B. However, Strategy-A resulted in lower risk of total, documented symptomatic, and asymptomatic hypoglycaemia. These results identify an approach of potential clinical benefit in this age group and will inform future clinical research in older patients with type 2 diabetes.
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Affiliation(s)
| | - Richard E. Pratley
- Florida Hospital and Sanford Burnham Prebys Translational Research InstituteOrlandoFlorida
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail LimitedDroitwichUK
| | | | | | | | - Ran Duan
- Lilly USA, LLCIndianapolisIndiana
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9
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Antidiabetic plant-derived nutraceuticals: a critical review. Eur J Nutr 2017; 57:1275-1299. [PMID: 29022103 DOI: 10.1007/s00394-017-1552-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022]
Abstract
Diabetes mellitus (DM) is one of the major health problems in the world, especially amongst the urban population. Chemically synthesized drugs used to decrease the ill effects of DM and its secondary complications cause adverse side effects, viz., weight gain, gastrointestinal disturbances, and heart failure. Currently, various other approaches, viz., diet control, physical exercise and use of antidiabetic plant-derived molecules/foods are advocated to manage DM, as they are economical with fewer or no side effects. This review mainly focuses on antidiabetic plants, chemically characterized plant molecules and plant-based foods in the treatment of DM. Very little science-based evidence is available on the mechanism of action of plant-derived food molecules on the DM targets. Critical DM targets include α-amylase, α-glucosidase, DPP-IV, aldose reductase, PPAR-γ, AMP kinase and GLUT4. In-depth studies carried out on a few of those targets with specific mechanisms of action are addressed in this review. This review may help future researchers in identifying a right plant molecule to treat DM or to develop food formulations for DM management.
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10
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Holden SE, Morgan CL, Qiao Q, Jenkins-Jones S, Berni ER, Currie CJ. Healthcare resource utilization and related financial costs associated with glucose lowering with either exenatide or basal insulin: A retrospective cohort study. Diabetes Obes Metab 2017; 19:1097-1105. [PMID: 28218819 DOI: 10.1111/dom.12916] [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: 11/14/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 12/28/2022]
Abstract
AIMS Type 2 diabetes is a major health problem placing increasing demands on healthcare systems. Our objective was to estimate healthcare resource use and related financial costs following treatment with exenatide-based regimens prescribed as once-weekly (EQW) or twice-daily (EBID) formulations, compared with regimens based on basal insulin (BI). MATERIALS AND METHODS This retrospective cohort study used data from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES). Patients with type 2 diabetes who received exenatide or BI between 2009 and 2014 as their first recorded exposure to injectable therapy were selected. Costs were attributed to primary care contacts, diabetes-related prescriptions and inpatient admissions using standard UK healthcare costing methods (2014 prices). Frequency and costs were compared between cohorts before and after matching by propensity score using Poisson regression. RESULTS Groups of 8723, 218 and 2180 patients receiving BI, EQW and EBID, respectively, were identified; 188 and 1486 patients receiving EQW and EBID, respectively, were matched 1:1 to patients receiving BI by propensity score. Among unmatched cohorts, total crude mean costs per patient-year were £2765 for EQW, £2549 for EBID and £4080 for BI. Compared with BI, the adjusted annual cost ratio (aACR) was 0.92 (95% CI, 0.91-0.92) for EQW and 0.82 (95% CI, 0.82-0.82) for EBID. Corresponding costs for the propensity-matched subgroups were £2646 vs £3283 (aACR, 0.80, 0.80-0.81) for EQW vs BI and £2532 vs £3070 (aACR, 0.84, 0.84-0.84) for EBID vs BI. CONCLUSION Overall, exenatide once-weekly and twice-daily-based regimens were associated with reduced healthcare resource use and costs compared with basal-insulin-based regimens.
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Affiliation(s)
| | | | | | | | | | - Craig J Currie
- Pharmatelligence, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
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Abstract
INTRODUCTION Despite type 2 diabetes (T2D) management offers a variety of pharmacological interventions targeting different defects, numerous patients remain with persistent hyperglycaemia responsible for severe complications. Unlike resistant hypertension, treatment resistant T2D is not a classical concept although it is a rather common observation in clinical practice. Areas covered: This article proposes a definition for 'treatment resistant diabetes', analyses the causes of poor glucose control despite standard therapy, briefly considers the alternative approaches to glucose-lowering pharmacotherapy and finally describes how to overcome poor glycaemic control, using innovative oral or injectable combination therapies. Expert opinion: Before considering intensifying the pharmacotherapy of a patient with poorly controlled T2D, it is important to verify treatment adherence, target obesity and consider various non pharmacological improvement quality interventions. If treatment resistant diabetes is defined as not achieving glycated haemoglobin target despite oral triple therapy with a third glucose-lowering agent added to metformin-sulfonylurea dual treatment, the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor and a sodium glucose cotransporter type 2 (SGLT2) inhibitor may offer new opportunities before considering injectable therapies. Insulin basal therapy (± metformin) may be optimized by the addition of a SGLT2 inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist.
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Affiliation(s)
- André J Scheen
- a Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM) , University of Liège , Liège , Belgium.,b Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine , CHU Liège , Liège , Belgium
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12
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Duodenal GLP-1 signaling regulates hepatic glucose production through a PKC-δ-dependent neurocircuitry. Cell Death Dis 2017; 8:e2609. [PMID: 28182013 PMCID: PMC5386475 DOI: 10.1038/cddis.2017.28] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 12/25/2022]
Abstract
Intestinal glucagon-like peptide-1 (GLP-1) is a hormone that stimulates insulin secretion and acts as a neuropeptide to control glucose homeostasis, but little is known whether intestinal GLP-1 has any effect in the control of hepatic glucose production (HGP). Here we found that intraduodenal infusion of GLP-1 activated duodenal PKC-δ, lowered HGP and was accompanied by a decrease in hepatic expression of gluconeogenic enzymes and an increase in hepatic insulin signaling in rats. However, gut co-infusion of either the GLP-1 receptor antagonist Ex-9, or the PKC-δ inhibitor rottlerin with GLP-1, negated the ability of gut GLP-1 to lower HGP and to increase hepatic insulin signaling during clamps. The metabolic and molecular signal effects of duodenal GLP-1 were also negated by co-infusion with tetracaine, pharmacologic inhibition of N-methyl-d-aspartate receptors within the dorsalvagal complex, or hepatic vagotomy in rats. In summary, we identified a neural glucoregulatory function of gut GLP-1 signaling.
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Singh S, Wright EE, Kwan AYM, Thompson JC, Syed IA, Korol EE, Waser NA, Yu MB, Juneja R. Glucagon-like peptide-1 receptor agonists compared with basal insulins for the treatment of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Obes Metab 2017; 19:228-238. [PMID: 27717130 PMCID: PMC5299485 DOI: 10.1111/dom.12805] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 02/06/2023]
Abstract
AIMS Since 2005, several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been approved to treat people with type 2 diabetes. These agents are considered for use at the same point in the treatment paradigm as basal insulins. A comprehensive comparison of these drug classes, therefore, can help inform treatment decisions. This systematic review and meta-analysis assessed the clinical efficacy and safety of GLP-1 RAs compared with basal insulins. MATERIALS AND METHODS MEDLINE, EMBASE, CENTRAL and PubMed databases were searched. Randomized clinical trials (RCTs) of ≥16 weeks' duration comparing GLP-1 RAs vs basal insulins in adults with type 2 diabetes inadequately controlled with oral antihyperglycemic drugs were included. Data on the change from baseline to 26 weeks (±10 weeks) of treatment in hemoglobin A1c (HbA1c) and weight, as well as the proportion of patients experiencing hypoglycaemia, were extracted. Fixed-effect pairwise meta-analyses were conducted where data were available from ≥2 studies. RESULTS Fifteen RCTs were identified and 11 were meta-analysed. The once-weekly GLP-1 RAs, exenatide long acting release (LAR) and dulaglutide, led to greater, statistically significant mean HbA1c reductions vs basal insulins (exenatide: -0.31% [95% confidence interval -0.42, -0.19], dulaglutide: -0.39% [-0.49, -0.29]) whilst once-daily liraglutide and twice-daily exenatide did not (liraglutide: 0.06% [-0.06, 0.18], exenatide: 0.01% [-0.11, 0.13]). Mean weight reduction was seen with all GLP-1 RAs while mean weight gain was seen with basal insulins. Interpretation of the analysis of hypoglycaemia was limited by inconsistent definitions and reporting. Because of the limited number of available studies sensitivity analyses to explore heterogeneity could not be conducted. CONCLUSIONS Although weight reduction is seen with all GLP-1 RA's, only the once-weekly agents, exenatide LAR and dulaglutide, demonstrate significant HbA1c reductions when compared to basal insulins.
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Affiliation(s)
- Sonal Singh
- Johns Hopkins University School of MedicineBaltimoreMaryland
| | - Eugene E. Wright
- Department of MedicineDuke University Medical Center at the Southern Regional Area Health Education Center (AHEC)FayettevilleNorth Carolina
- Department of Community and Family MedicineDuke University Medical Center at the Southern Regional Area Health Education Center (AHEC)FayettevilleNorth Carolina
| | | | | | - Iqra A. Syed
- ICON EpidemiologyVancouverBritish ColumbiaCanada
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14
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Abd El Aziz MS, Kahle M, Meier JJ, Nauck MA. A meta-analysis comparing clinical effects of short- or long-acting GLP-1 receptor agonists versus insulin treatment from head-to-head studies in type 2 diabetic patients. Diabetes Obes Metab 2017; 19:216-227. [PMID: 27717195 DOI: 10.1111/dom.12804] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/07/2016] [Accepted: 09/16/2016] [Indexed: 12/25/2022]
Abstract
AIMS To study differences in clinical outcomes between initiating glucagon-like peptide-1 receptor agonist (GLP-1 RAs) vs insulin treatment in patients with type 2 diabetes treated with oral glucose-lowering medications (OGLM). METHODS Prospective, randomized trials comparing GLP-1 RA and insulin treatment head-to-head as add-on to OGLM were identified (PubMed). Differences from baseline values were compared for HbA1c, fasting plasma glucose, bodyweight, blood pressure, heartrate and lipoproteins. Proportions of patients reporting hypoglycaemic episodes were compared. RESULTS Of 712 publications identified, 23 describing 19 clinical trials were included in the meta-analysis. Compared to insulin, GLP-1 RAs reduced HbA1c more effectively (Δ -.12%, P < .0001). Basal insulin was more effective in reducing fasting plasma glucose (Δ -1.8 mmol/L, P < .0001). GLP-1 RAs reduced bodyweight more effectively (Δ -3.71 kg; P < .0001). The proportion of patients experiencing hypoglycaemic episodes was 34% lower with GLP-1 RAs ( P < .0001), with a similar trend for severe hypoglycaemia. Systolic blood pressure was lower and heartrate was higher with GLP-1 RAs ( P < .0001). Triglycerides and LDL cholesterol were significantly lower with GLP-1 RAs. Long-acting GLP-1 RAs were better than short-acting GLP-1 RAs in reducing HbA1c and fasting glucose, but were similar regarding bodyweight. CONCLUSIONS Slightly better glycaemic control can be achieved by adding GLP-1 RAs to OGLM as compared to insulin treatment, with added benefits regarding bodyweight, hypoglycaemia, blood pressure and lipoproteins. These differences are in contrast to the fact that insulin is prescribed far more often than GLP-1 RAs.
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Affiliation(s)
- Mirna S Abd El Aziz
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Melanie Kahle
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Juris J Meier
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael A Nauck
- Division of Diabetology, Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Saidu Y, Muhammad SA, Abbas AY, Onu A, Tsado IM, Muhammad L. In vitro screening for protein tyrosine phosphatase 1B and dipeptidyl peptidase IV inhibitors from selected Nigerian medicinal plants. JOURNAL OF COMPLEMENTARY MEDICINE RESEARCH 2016; 6:154-157. [PMID: 28512596 PMCID: PMC5429074 DOI: 10.5455/jice.20161219011346] [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] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/04/2016] [Indexed: 12/17/2022]
Abstract
Background/Aim: Protein tyrosine phosphatase 1B (PTP 1B) and dipeptidyl peptidase IV (DPP IV) have been identified as one of the drug targets for the treatment of Type-2 diabetes. This study was designed to screen for PTP 1B and DPP-IV inhibitors from some Nigerian medicinal plants. Materials and Methods: PTP 1B and DPP-IV drug discovery kits from Enzo Life Sciences were used to investigate in vitro inhibitory effect of crude methanolic extract of 10 plants; Mangifera indica, Moringa oleifera, Acacia nilotica, Arachis hypogaea, Senna nigricans, Azadirachta indica, Calotropis procera, Leptadenia hastata, Ziziphus mauritiana, and Solanum incanum. Results: The results indicated PTP IB inhibition by S. nigricans (68.2 ± 2.29%), A. indica (67.4 ± 2.80%), A. hypogaea (57.2 ± 2.50%), A. nilotica (55.1 ± 2.19%), and M. oleifera (41.2 ± 1.87%) were significantly (P < 0.05) higher as compared with standard inhibitor, sumarin while that of L. hastata (18.1 ± 2.00%) was significantly lower as compared with sumarin. The PTB 1B inhibition by M. indica (31.5 ± 1.90%) was not significantly (P > 0.05) different from that of sumarin. The DPP-IV inhibition by S. incanum (68.1 ± 2.71%) was significantly higher as compared with a known inhibitor, P32/98. S. nigrican (57.0±1.91%), Z. mauritiana (56.6±2.01%), A. hypogaea (51.0±1.30%), M. indica (44.6 ± 2.40%), C. procera (36.2 ± 2.00%), A. nilotica (35.4 ± 2.10%), and A. indica (33.6 ± 1.50%) show significantly (P < 0.05) lower inhibitions toward DPP-IV. Conclusion: The work demonstrated that these plant materials could serve as sources of lead compounds in the development of anti-diabetic agent(s) targeting PTP 1B and/or DPP-IV.
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Affiliation(s)
- Yusuf Saidu
- Department of Biochemistry, Usmanu Danfodiyo University, Sokoto
| | | | | | - Andrew Onu
- Department of Biochemistry, Usmanu Danfodiyo University, Sokoto
| | | | - Luba Muhammad
- Department of Biochemistry, Usmanu Danfodiyo University, Sokoto
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Tahrani AA, Barnett AH, Bailey CJ. Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus. Nat Rev Endocrinol 2016; 12:566-92. [PMID: 27339889 DOI: 10.1038/nrendo.2016.86] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies.
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Affiliation(s)
- Abd A Tahrani
- Centre of Endocrinology, Diabetes and Metabolism, 2nd Floor, Institute of Biomedical Research, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - Anthony H Barnett
- Centre of Endocrinology, Diabetes and Metabolism, 2nd Floor, Institute of Biomedical Research, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - Clifford J Bailey
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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Paul SK, Agbeve J, Maggs D, Best JH. Comparison of trajectories of self-monitored glucose levels by hypoglycemia status over 52 weeks of treatment with insulin glargine or exenatide once weekly. J Diabetes 2016; 8:148-57. [PMID: 25586464 DOI: 10.1111/1753-0407.12269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/26/2014] [Accepted: 01/06/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is used as a means to detect and prevent hypoglycemia in patients with diabetes. However, information on the longitudinal measures (trajectory) of SMBG-based pre- and postprandial glucose fluctuations over time in relation to hypoglycemia is limited. Among patients treated with exenatide once weekly (EQW) or insulin glargine (IG), this study compared SMBG profiles over 52 weeks between patients who did and did not experience hypoglycemia. METHODS Pooled patient-level 52-week longitudinal data of treatment with EQW (n = 531) or IG (n = 219) from three controlled trials were analyzed. RESULTS The proportion of patients with at least one episode of hypoglycemia in the EQW and IG groups was 23% and 54%, respectively. The preprandial glucose measures from SMBG were significantly lower among patients who experienced hypoglycemia in both treatment groups compared with those who did not. In patients who experienced hypoglycemia, the average preprandial glucose levels over 52 weeks were lower by 0.64 and 0.66 mmol/L in the EQW and IG groups, respectively (P < 0.01 in both cases) compared with those without hypoglycemia. The average postprandial levels were not significantly different between patients who did and did not experience hypoglycemia in both treatment groups. Among patients with hypoglycemia, the average prebreakfast glucose trajectory was higher by 0.48 mmol/L in the EQW compared with the IG group. CONCLUSIONS This study has revealed differential trajectories of pre- and postprandial glucose profiles between patients with and without hypoglycemia. However, the SMBG trajectories were similar between patients treated with EQW and IG.
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Affiliation(s)
- Sanjoy K Paul
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Julius Agbeve
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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18
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Czech M, Rdzanek E, Pawęska J, Adamowicz-Sidor O, Niewada M, Jakubczyk M. Drug-related risk of severe hypoglycaemia in observational studies: a systematic review and meta-analysis. BMC Endocr Disord 2015; 15:57. [PMID: 26458540 PMCID: PMC4603823 DOI: 10.1186/s12902-015-0052-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/30/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) leads to multiple complications, including severe hypoglycaemia events (SHEs). SHEs can impact a patient's quality of life and compliance and may directly result in additional costs to the health care system. The aim of this review was to evaluate the risk of severe hypoglycaemia in patients with type 1 (T1) and 2 (T2) DM as observed in everyday clinical practice for various drug regimens. METHODS We conducted a systematic review of observational (retrospective or prospective) studies in the MEDLINE, Embase, and Cochrane Library databases that covered at least 100 children or adults with T1/T2 DM. In T1 DM, basal-bolus/pre-mix insulin (human or analogue) and insulin pump were reviewed, and in T2 DM, basal-bolus/pre-mix insulin (human or analogue), oral antidiabetic drugs supported with basal insulin (human or analogue), sulfonylureas in monotherapy, and combined oral treatment were reviewed. In order to estimate SHE rates, we extracted data on the time horizon of the study, number of patients, number of SHEs, and number of patients experiencing at least one SHE. We used a random effects model to estimate the annual SHE rate. We considered the risk for other antidiabetic medications in T2 DM to be negligible and the results of our main review yielded no observational data for premixes in T1 DM so they were assessed based on relative rates taken from additional systematic reviews. The study, being a desk research, did not involve any human subjects (including human material or human data) and no ethical committee approval was asked for. For the same reason there was no need to collect informed consent for participation in the study. RESULTS We identified 76 observational studies encompassing 707,722.30 patient-years. The estimated annual SHE rate varied from 0.168 (95 % CI 0.123-0.237) for insulin pump up to 1.628 for biphasic human insulin in T1 DM patients, and from 0.0035 for oral antidiabetic drugs up to 0.554 (95 % CI 0.157-7.534) for basal-bolus with human insulin in T2 DM patients. CONCLUSIONS Our review indicates that SHE rates differ between patients depending on treatment regimen. However, SHEs are also driven by other factors. Proper modelling techniques are needed to use various types of information in published studies.
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Affiliation(s)
- Marcin Czech
- Novo Nordisk Pharma sp. z o.o, Warsaw, Poland.
- Department of Pharmacoeconomics, Medical University of Warsaw, Warsaw, Poland.
- Business School, Warsaw University of Technology, Warsaw, Poland.
| | - Elżbieta Rdzanek
- HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K, Warsaw, Poland.
| | - Justyna Pawęska
- HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K, Warsaw, Poland.
| | | | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
| | - Michał Jakubczyk
- Decision Analysis and Support Unit, Warsaw School of Economics, Al. Niepodległości 162, 02-554, Warsaw, Poland.
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19
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Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min). Nephrol Dial Transplant 2015; 30 Suppl 2:ii1-142. [PMID: 25940656 DOI: 10.1093/ndt/gfv100] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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20
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Purnomo Y, Soeatmadji DW, Sumitro SB, Widodo MA. Anti-diabetic potential of Urena lobata leaf extract through inhibition of dipeptidyl peptidase IV activity. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/j.apjtb.2015.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Paul SK, Maggs D, Klein K, Best JH. Dynamic risk factors associated with non-severe hypoglycemia in patients treated with insulin glargine or exenatide once weekly. J Diabetes 2015; 7:60-7. [PMID: 25168883 DOI: 10.1111/1753-0407.12208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/11/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Glycemic control in patients with type 2 diabetes is a dynamic process, and changes in risk factors affecting the incidence of hypoglycemia are not well understood. This study explored the association of longitudinal interactive effects of clinical risk factors and concomitant medications on hypoglycemia risk in patients treated with insulin glargine (IG) or exenatide once weekly (EQW). METHODS Pooled patient-level 52-week longitudinal data of treatment with EQW (n = 541) or IG (n = 223) from three controlled trials were analyzed. RESULTS Proportions of patients with at least one episode of hypoglycemia in the EQW and IG groups were 23% and 54%, respectively. Compared with patients with HbA1c ≥7% (53 mmol/mol) over time, patients with HbA1c <7% had significantly higher hypoglycemia risk in both groups (95% confidence intervals [CI] of odds ratios [OR]: EQW-1.21, 2.81; IG- 6.26, 9.84). The patterns of interaction effect of changing body mass index (BMI) and HbA1c on hypoglycemia risk differed in the two treatment groups: patients with with BMI >35 kg/m(2) had a 119% increased hypoglycemia risk in the EQW group, but a 57% reduced risk in the IG group. Sulfonylurea-treated patients in the EQW and IG groups had 4.7- and 3-fold additional hypoglycemia risk, respectively, versus non-sulfonylurea-treated patients. CONCLUSION This study revealed differential effects of tight glycemic control and itsinteraction with treatment-induced changes in BMI on hypoglycemia risk its interaction in patients treated with EQW and IG. The residual adverse effect of sulfonylurea was higher in EQW-treated patients.
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Affiliation(s)
- Sanjoy K Paul
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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22
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Liu R, Li L, Chen Y, Yang M, Liu H, Yang G. Effects of glucagon-like peptide-1 agents on left ventricular function: systematic review and meta-analysis. Ann Med 2014; 46:664-71. [PMID: 25134954 DOI: 10.3109/07853890.2014.949837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The cardiovascular safety of many glucagon-like peptide-1 agents (GLP-1 agents) is unclear. In this study, we assess the effects of the GLP-1 agents on left ventricular function in patients with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD). METHODS PubMed, EMBASE, and the Cochrane Library were searched for the relevant publications up to May 2013 without restriction by language. All clinical controlled trials assessing left ventricular function and cardiovascular outcomes with the GLP-1 agents were selected for eligibility. Fourteen trials (415 patients) were identified as eligible between 1966 and 2013. Twelve of the studies were randomized controlled trials (RCT). RESULTS The results showed that GLP-1 agent treatment in patients with T2DM and/or CVD led to significantly improved regional left ventricular contractile parameters (including peak left systolic tissue velocity and strain) and global left ventricular performance (including stroke volume, ejection fraction, and left ventricular chambers) compared with patients receiving placebo. CONCLUSIONS GLP-1 agent treatment in T2DM and/or CVD patients is associated with a modest but significant increase in the odds of left ventricular contractile parameters and left ventricular performance compared with patients having received placebo, which may be indicative of additional cardiovascular benefits for these patients.
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Affiliation(s)
- Rui Liu
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University , 400010 Chongqing , China
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23
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Yabe D, Seino Y. Defining the role of GLP-1 receptor agonists for individualized treatment of Type 2 diabetes. Expert Rev Endocrinol Metab 2014; 9:659-670. [PMID: 30736202 DOI: 10.1586/17446651.2014.949672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
With the advent of dipeptidyl peptidase (DPP)-4 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) over the past decade, incretin therapy has become established as an important treatment strategy for Type 2 diabetes mellitus (T2DM), with an efficacy and safety profile distinct from that of other anti-hyperglycemic agents. However, our understanding of the optimal clinical use of incretins remains incomplete. This review focuses on the use of GLP-1 RAs in the treatment of T2DM, with reference to the differing dominant mechanisms of action between short- and long-acting GLP-1 RAs and the clinical implications of this difference. The role of GLP-1 and the effects of GLP-1 RAs in various organs other than the pancreas will also be discussed.
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Affiliation(s)
- Daisuke Yabe
- a Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan
- b Center for Metabolism and Clinical Nutrition, Kansai Electric Power Hospital, Osaka, Japan
- c Division of Molecular and Metabolic Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Seino
- a Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan
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24
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Raccah D, Gourdy P, Sagnard L, Ceriello A. Lixisenatide as add-on to oral anti-diabetic therapy: an effective treatment for glycaemic control with body weight benefits in type 2 diabetes. Diabetes Metab Res Rev 2014; 30:742-8. [PMID: 24687427 DOI: 10.1002/dmrr.2548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/18/2014] [Accepted: 03/19/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Achieving recommended glycated haemoglobin (HbA1c ) targets in patients with type 2 diabetes mellitus (T2DM) requires effective control of fasting and post-prandial plasma glucose. As T2DM progresses, oral anti-diabetics are no longer sufficient to maintain glycaemic control. Five phase III studies in the GetGoal clinical trial programme assessed the efficacy of lixisenatide, a once-daily prandial glucagon-like peptide-1 receptor agonist, in combination with oral anti-diabetics in patients with T2DM insufficiently controlled using oral anti-diabetics. METHODS A meta-analysis was performed of the results of five 24-week clinical trials (comprising 2760 patients) concerning lixisenatide or placebo plus oral anti-diabetic therapy. The primary endpoint of these studies was change in HbA1c at week 24. Changes in fasting and post-prandial plasma glucose, and weight were also established as were the odds ratios for hypoglycaemia and composite safety and efficacy endpoints. Meta-analysis outcomes were assessed using a random effects model. All meta-analyses were performed using RevMan, version 5.1. RESULTS Lixisenatide was significantly better than placebo in terms of achieving all endpoints in this meta-analysis, including the primary endpoint change in HbA1c at week 24, with p < 0.0001 for all endpoints. The mean number of symptomatic hypoglycaemic events per patient year was increased for patients in the lixisenatide versus placebo groups (p = 0.04). However, compared with patients in the placebo group, patients treated with lixisenatide were more likely to achieve composite efficacy and safety endpoints. CONCLUSIONS This meta-analysis demonstrates that lixisenatide in combination with oral anti-diabetic therapy significantly improves outcomes combining efficacy and safety parameters in patients with T2DM.
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MESH Headings
- Administration, Oral
- Clinical Trials, Phase III as Topic
- Combined Modality Therapy/adverse effects
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Drug Administration Schedule
- Drug Resistance, Multiple
- Drug Therapy, Combination/adverse effects
- Glucagon-Like Peptide-1 Receptor
- Glycated Hemoglobin/analysis
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Metformin/administration & dosage
- Metformin/adverse effects
- Metformin/therapeutic use
- Multicenter Studies as Topic
- Overweight/chemically induced
- Overweight/complications
- Overweight/prevention & control
- Peptides/administration & dosage
- Peptides/adverse effects
- Peptides/therapeutic use
- Pioglitazone
- Randomized Controlled Trials as Topic
- Receptors, Glucagon/agonists
- Receptors, Glucagon/metabolism
- Sulfonylurea Compounds/administration & dosage
- Sulfonylurea Compounds/adverse effects
- Sulfonylurea Compounds/therapeutic use
- Thiazolidinediones/administration & dosage
- Thiazolidinediones/adverse effects
- Thiazolidinediones/therapeutic use
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Affiliation(s)
- Denis Raccah
- Department of Diabetology, University Hospital Sainte-Marguerite, Marseille, France
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25
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Repas TB. Managing Loss of Glycemic Control in Middle-Aged Patients With Diabetes: The Role of GLP-1 Receptor Agonists in Combination-Therapy Regimens. J Osteopath Med 2014; 114:S14-21. [DOI: 10.7556/jaoa.2014.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Middle-aged patients with type 2 diabetes mellitus may have languished on monotherapy or a stable therapy for a substantial period without reconsideration of comorbidities or current control of glycated hemoglobin A1c (HbA1c). In many patients who lose glycemic control, postprandial hyperglycemia has not been addressed. This is especially true when HbA1c levels are close to—but not at—goal. Glucagon-like peptide-1 receptor agonists are injectable agents that can be added to oral therapy to address postprandial hyperglycemia. These agents may be a useful alternative to insulin therapy as add-on therapy when dual oral therapy is no longer sufficient and additional glucose lowering is required. Compared with insulin, glucagon-like peptide-1 receptor agonists have provided comparable glucose lowering with less hypoglycemia and without weight gain.
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Liatis S, Makrilakis K. Glucagon-like peptide-1 receptor agonists vs. insulin in inadequately controlled patients with type 2 diabetes. Is this meta-analysis miscalculated? Diabetes Obes Metab 2014; 16:284. [PMID: 24495116 DOI: 10.1111/dom.12213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Liatis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Athens University Medical School, Athens, Greece
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27
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Wu S, Sun F, Zhang Y, Yang Z, Hong T, Chen Y, Zhan S. The cardiovascular effects of glucagon-like peptide-1 receptor agonists: a trial sequential analysis of randomized controlled trials. J Clin Pharm Ther 2013; 39:7-13. [PMID: 24127768 DOI: 10.1111/jcpt.12102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of antidiabetic drugs. Their wider use for the treatment of patients with type 2 diabetes mellitus has led to concerns about its cardiovascular effects. However, the robustness of data leading to those concerns is unclear. The purpose of this study is to systematically assess the robustness of the available evidence on the adverse cardiovascular effects of GLP-1 receptor agonists in patients with type 2 diabetes. METHODS The Cochrane library, MEDLINE, EMBASE and www.clinicaltrials.gov were searched from inception through to 25 January 2013. Randomized controlled trials (RCTs) were selected if they compared GLP-1 receptor agonists with placebo or other drugs with a duration ≥12 weeks. Mantel-Haenszel odds ratio (MH-OR) of cardiovascular events with 95% confidence interval (CI) was estimated using a random effects model. Trial sequential analysis based on required information size with an assumption of plausible reductions in relative risk in the low-bias trials, 5% risk of a type I error and 20% risk of a type II error was used to explore the robustness of available evidence. RESULTS Fifty-eight trials were included in the analysis (10 466 patients receiving GLP-1 receptor agonists and 7138 patients receiving comparators, respectively). Overall, the OR for cardiovascular events with GLP-1 receptor agonists was 0·52 (95% CI: 0·27-0·99) compared with placebo and 0·84 (95% CI: 0·52-1·36) with active controls. Trial sequential analyses showed that the actual accumulated sample size was only 11% (7445 of 65 212) and 13% (10 157 of 79 198) of the required information size for placebo-controlled trials and active-controlled trials, respectively. These results indicate that there is still insufficient evidence on cardiovascular events. WHAT IS NEW AND CONCLUSION GLP-1 receptor agonists do not seem to show any increased risk of cardiovascular events However, the available data from RCTs remain insufficient to confirm an absence of detrimental effect. More long-term trials and population-based studies are required to provide the necessary reassurance on the cardiovascular safety of GLP-1 receptor agonists.
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Affiliation(s)
- S Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
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Gallwitz B, Bretzel RG. How do we continue treatment in patients with type 2 diabetes when therapeutic goals are not reached with oral antidiabetes agents and lifestyle? Incretin versus insulin treatment. Diabetes Care 2013; 36 Suppl 2:S180-9. [PMID: 23882044 PMCID: PMC3920781 DOI: 10.2337/dcs13-2012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Baptist Gallwitz
- Department of Medicine IV, Eberhard-Karls University, Tübingen, Germany.
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Camafort-Babkowski M. [Impact of anti-diabetic therapy based on glucagon-like peptide-1 receptor agonists on the cardiovascular risk of patients with type 2 diabetes mellitus]. Med Clin (Barc) 2013; 141:167-74. [PMID: 23332622 DOI: 10.1016/j.medcli.2012.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Abstract
Anti-diabetic drugs have, in addition to their well-known glucose lowering-effect, different effects in the rest of cardiovascular factors that are associated with diabetes mellitus. Glucagon-like peptide-1 (GLP-1) receptor agonists have recently been incorporated to the therapeutic arsenal of type 2 diabetes mellitus. The objective of this review is to summarize the available evidence on the effect of the GLP-1 receptor agonists on different cardiovascular risk factors, mediated by the effect of GLP-1 receptor agonists on the control of hyperglycaemia and the GLP-1 receptor agonists effect on other cardiovascular risk factors (weight control, blood pressure control, lipid profile and all other cardiovascular risk biomarkers). In addition, we present the emerging evidence with regards to the impact that GLP-1 receptor agonists therapy could have in the reduction of cardiovascular events and the currently ongoing studies addressing this issue.
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Affiliation(s)
- Miguel Camafort-Babkowski
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Instituto Clínico de Medicina y Dermatología, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, España.
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