Combination of linagliptin and metformin for the treatment of patients with type 2 diabetes

Effect of metformin and metformin/linagliptin on gut microbiota in patients with prediabetes

Lifestyle modifications, metformin, and linagliptin reduce the incidence of type 2 diabetes (T2D) in people with prediabetes. The gut microbiota (GM) may enhance such interventions' efficacy. We determined the effect of linagliptin/metformin (LM) vs metformin (M) on GM composition and its relationship to insulin sensitivity (IS) and pancreatic β-cell function (Pβf) in patients with prediabetes. A cross-sectional study was conducted at different times: basal, six, and twelve months in 167 Mexican adults with prediabetes. These treatments increased the abundance of GM SCFA-producing bacteria M (Fusicatenibacter and Blautia) and LM (Roseburia, Bifidobacterium, and [Eubacterium] hallii group). We performed a mediation analysis with structural equation models (SEM). In conclusion, M and LM therapies improve insulin sensitivity and Pβf in prediabetics. GM is partially associated with these improvements since the SEM models suggest a weak association between specific bacterial genera and improvements in IS and Pβf.

Natural Compounds as DPP-4 Inhibitors: 3D-Similarity Search, ADME Toxicity, and Molecular Docking Approaches

Type 2 diabetes mellitus is one of the most common diseases of the 21st century, caused by a sedentary lifestyle, poor diet, high blood pressure, family history, and obesity. To date, there are no known complete cures for type 2 diabetes. To identify bioactive natural products (NPs) to manage type 2 diabetes, the NPs from the ZINC15 database (ZINC-NPs DB) were screened using a 3D shape similarity search, molecular docking approaches, and ADMETox approaches. Frequently, in silico studies result in asymmetric structures as “hit” molecules. Therefore, the asymmetrical FDA-approved diabetes drugs linagliptin (8-[(3R)-3-aminopiperidin-1-yl]-7-but-2-ynyl-3-methyl-1-[(4-methylquinazolin-2-yl)methyl]purine-2,6-dione), sitagliptin ((3R)-3-amino-1-[3-(trifluoromethyl)-6,8-dihydro-5H-[1,2,4]triazolo[4,3-a]pyrazin-7-yl]-4-(2,4,5-trifluorophenyl)butan-1-one), and alogliptin (2-[[6-[(3R)-3-aminopiperidin-1-yl]-3-methyl-2,4-dioxopyrimidin-1-yl]methyl]benzonitrile) were used as queries to virtually screen the ZINC-NPs DB and detect novel potential dipeptidyl peptidase-4 (DPP-4) inhibitors. The most promising NPs, characterized by the best sets of similarity and ADMETox features, were used during the molecular docking stage. The results highlight that 11 asymmetrical NPs out of 224,205 NPs are potential DPP-4 candidates from natural sources and deserve consideration for further in vitro/in vivo tests.

Sensitive Simultaneous Measurement of Metformin and Linagliptin in Plasma Samples by Couple of Nano Graphene Oxide-based Dispersive Solid Phase Extraction Method and Liquid Chromatography

A simple, rapid, and ultra sensitive dispersive solid phase extraction based on nano graphene oxide was developed for simultaneous measurement of trace amounts of metformin (MET) and linagliptin (LIN) in plasma samples by HPLC-UV-Vis. Affecting factors on the extraction of these drugs, including adsorbent weight, extraction time, organic solvent type, desorption situations, and composition of solvent were examined and optimized. In optimum conditions, the LOD (limit of detection) and LOQ (limit of quantification) of the suggested technique were 2.0 ngmL^-1 and 6.1 (ngmL^-1) for LIN and 3.0 ngmL^-1 and 9.2 ngmL^-1 for MET, respectively. Suitable linear behavior in the considered ranges of concentration (10-2000 ngmL^-1) and good correlation coefficient of 0.9901 and 0.9903 (r²) for LIN and MET were obtained, respectively. The RSD (relative standard deviations) according to three replicate measurements at 2, 20, 200 ngmL^-1 levels of these drugs was less than 8.0%. In the last step, applicability of the suggested technique was examined by analyzing the drugs in plasma samples and reasonable results were achieved.

Post-marketing Study of Linagliptin: A Pilot Study

INTRODUCTION

Linagliptin is a high-cost oral antidiabetic that has been widely used, and studies on its effectiveness and safety for the treatment of type 2 diabetes mellitus (DM2) in the real world is rare and necessary.

OBJECTIVE

To analyze the values of glycated hemoglobin (HbA1c) and adverse events before and after the use of linagliptin in the post-marketing context of a pilot study.

METHODS

This is a descriptive observational and exploratory study with a retrospective longitudinal approach, conducted between January 2014 and December 2016. All patients who participated in the study were over 18 years of age, with DM2, assisted by the Brazilian Public Health System (Sistema Único de Saúde - SUS) and had been indicated for use of linagliptin. The users were followed up and the variables of interest were collected from a computerized health information system (sistema informatizado de saúde - SIS) and patient records. For effectiveness analysis, HbA1c before (T0) and after (T1) the use of linagliptin was considered in patients registered as having collected linagliptin at the pharmacy for at least three consecutive months. For safety analysis, registered adverse events (AE) were verified in patients' records. The sample was stratified according to the pharmacotherapeutic scheme of the users. To compare the means before (T0) and after (T1), a paired t-test (data with normal distribution) and Wilcoxon Signed Rank Sum test (non-normal distribution data) were performed.

RESULTS

Considering the total population of the study, in a different pharmacotherapeutic regimen, a median reduction in HbA1c of -0.86% (p < 0.05) was observed. After stratification by pharmacotherapeutic regimen, the most significant reduction of HbA1c was -1.07% (p = 0.014) for the linagliptin group associated with insulins and oral antidiabetic agents (n = 13). On the other hand, patients taking linagliptin in monotherapy had the lowest HbA1c reduction, -0.48% (p > 0.05). AE occurred in 12 (36.4%) patients, and 16.7% were in monotherapy.

CONCLUSION

Linagliptin did not presented, in real world, the desired performance as showed in randomized premarketing clinical trials and it should be carefully evaluated in public health services.

Linagliptin safety profile: A systematic review

OBJECTIVE

To describe the safety profile of linagliptin.

METHODOLOGY

Systematic review using PubMed/MEDLINE, BVS and Web of Science. The search strategy "Linagliptin" AND "safety" was used. The inclusion criteria were clinical trials with a control group composed of conventional DM2 pharmacotherapy.

RESULTS

We identified 16 studies, and the most frequent adverse events (AEs) were nasopharyngitis with linagliptin at 5 and 10mg in monotherapy (31.6% and 29.6%, respectively) and gastrointestinal events (>10.0%) with linagliptin in combination. Of the AEs, 14.9 (±3.1)% were associated with the use of linagliptin in monotherapy, and 17.6 (±6.0)% in combination. The linagliptin AEs have a varied occurrence and frequency, ranging from mild to moderate intensity.

Assessing the association of diabetes self-management education centers with age-adjusted diabetes rates across U.S.: Aspatial cluster analysis approach

The purpose of this study is to identify regions with diabetes health-service shortage. American Diabetes Association (ADA)-accredited diabetes self-management education (DSME) is recommended for all those with diabetes. In this study, we focus on demographic patterns and geographic regionalization of the disease by including accessibility and availability of diabetes education resources as a critical component in understanding and confronting differences in diabetes prevalence, as well as addressing regional or sub-regional differences in awareness, treatment and control. We conducted an ecological county-level study utilizing publicly available secondary data on 3,109 counties in the continental U.S. We used a Bayesian spatial cluster model that enabled spatial heterogeneities across the continental U.S. to be addressed. We used the American Diabetes Association (ADA) website to identify 2012 DSME locations and national 2010 county-level diabetes rates estimated by the Centers for Disease Control and Prevention and identified regions with low DSME program availability relative to their diabetes rates and population density. Only 39.8% of the U.S. counties had at least one ADA-accredited DSME program location. Based on our 95% credible intervals, age-adjusted diabetes rates and DSME program locations were associated in only seven out of thirty five identified clusters. Out of these seven, only two clusters had a positive association. We identified clusters that were above the 75th percentile of average diabetes rates, but below the 25th percentile of average DSME location counts and found that these clusters were all located in the Southeast portion of the country. Overall, there was a lack of relationship between diabetes rates and DSME center locations in the U.S., suggesting resources could be more efficiently placed according to need. Clusters that were high in diabetes rates and low in DSME placements, all in the southeast, should particularly be considered for additional DSME programming.

Budget Impact of Introducing Linagliptin into Bosnia and Herzegovina Health Insurance Drug Reimbursement List in 2016-2018

Introduction:

Diabetes is reaching epidemiological scales worldwide. Beside health implications diabetes bears significant financial impact on health systems. Different treatment options aiming to prevent diabetes complications are available. Dipeptidyl-peptidase-IV (DPP-4) inhibitors like linagliptin are usually add-on therapy to metformin in order to achieve glycemic control. Expenditure for oral antidiabetic medicines in Bosnia and Herzegovina (B&H) is low accounting for only 2.53% of the total drug market expenditure. Linagliptin is not reimbursed in B&H mainly due to it’s perception of high cost medication.

Aim:

To assess budget impact (BI) of introducing linagliptin into health insurance reimbursement list in B&H through development of the budget impact model (BIM).

Material and methods:

Budget impact model was developed using Microsoft Excel 2010 based on current legislation and practice in B&H. Local epidemiology data and data on drug consumption from government reports in 2014 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with linagliptin reimbursed and compared.

Results:

Inclusion of linagliptin into reimbursement list in Canton Sarajevo and Canton Tuzla would have positive budget impact on national level of B&H resulting in total savings of 18,194€, 235,570€ and 699,472€, in 2016, 2017 and 2018, respectively.

Conclusion:

Introduction of linagliptin into reimbursement list would decrease total costs for DPP-4 inhibitors and is favorable for positive decision on reimbursement in B&H. Applying BIM in decision making would assure better allocation and planning of resources at any region or administrative level in B&H.

Management of patients with type 2 diabetes and mild/moderate renal impairment: profile of linagliptin

Dipeptidyl-peptidase-IV (DPP-4) inhibitors are oral antidiabetic agents that can be administered as monotherapy in patients with contraindications to metformin or metformin intolerance, and in combination with other oral compounds and/or insulin. DPP-4 inhibitors act in a glucose-dependent manner and only increase insulin secretion and inhibit glucagon secretion under hyperglycemic conditions. Renal impairment is frequent in type 2 diabetes as a result of microvascular complications and diabetes treatment, and options in these patients are limited. Linagliptin is a DPP-4 inhibitor with a hepatobiliary route of elimination. In comparative studies, it was noninferior to metformin and sulfonylureas in lowering glycated hemoglobin (HbA_1c) and improving glycemic parameters. It can be used throughout all stages of renal impairment without dose adjustments. This review gives an overview of linagliptin in various stages of chronic kidney disease and has a focus on efficacy and safety parameters from clinical studies in patients with impaired renal function. These data are interpreted in the context of type 2 diabetes therapy in general.