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Thupakula S, Nimmala SSR, Dawood SM, Padiya R. Synergistic anti-diabetic effect of phloroglucinol and total procyanidin dimer isolated from Vitisvinifera methanolic seed extract potentiates via suppressing oxidative stress: in-vitro evaluation studies. 3 Biotech 2024; 14:76. [PMID: 38371900 PMCID: PMC10866825 DOI: 10.1007/s13205-024-03929-4] [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: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Diabetes is often associated with increased oxidative stress caused by an imbalance between detoxification and ROS production. Unfortunately, many commercial drugs available today for treating this disease have adverse side effects and ultimately fail to restore glucose homeostasis. Therefore, finding a dietary anti-diabetic remedy that is safe, effective, and economical is crucial. In this study, GC-MS analysis, subsequent HPLC-assisted fractionation, and SPE-based purification led to identifying and purifying of key components such as phloroglucinol and total procyanidin dimer (procyanidin dimer and procyanidin dimer gallate) from methanolic seed extract of Vitis vinifera. In-vitro anti-diabetic screening of various fractions derived from methanolic extract along with individual components and their combinations revealed the potential synergistic behaviour of phloroglucinol and total procyanidin dimer with the lowest IC50 of 48.21 ± 3.54 µg/mL for α-glucosidase and 63.06 ± 5.38 µg/mL for α-amylase inhibition which is found to be superior to the effect shown by the standard Epigallocatechin gallate. Later Glucose utilization studies demonstrated the concentration-dependent effect of Phloroglucinol and total procyanidin dimer, and that has raised the glucose uptake by approximately 36-57% in HepG2 cells and 35-58% in L6 myocytes over a concentration of 50-100 µg/mL. The superior anti-diabetic effect of Phloroglucinol and total procyanidin dimer was proved by the suppression of oxidative stress with an IC50 of 7.92 ± 0.36 µg/mL for DPPH scavenging and 16.87 ± 1.24 µg/mL for SOD scavenging which is competent with the standard ascorbic acid. According to this study, suppressing ROS levels by phloroglucinol and total procyanidin dimer would be the underlying mechanism for the synergistic anti-diabetic effect of this combination. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-024-03929-4.
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Affiliation(s)
- Sreenu Thupakula
- Department of Biochemistry, University College of Science, Osmania University, Amberpet, Hyderabad, Telangana State 500007 India
| | - Shiva Shankar Reddy Nimmala
- Department of Biochemistry, University College of Science, Osmania University, Amberpet, Hyderabad, Telangana State 500007 India
| | - Shauq Mumtaz Dawood
- Department of Biochemistry, University College of Science, Osmania University, Amberpet, Hyderabad, Telangana State 500007 India
| | - Raju Padiya
- Department of Biochemistry, University College of Science, Osmania University, Amberpet, Hyderabad, Telangana State 500007 India
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Chang CW, Sung YW, Huang YT, Chung YC, Lee MY. Better Detection of Peripheral Arterial Disease with Toe-Brachial Index Compared to Ankle-Brachial Index among Taiwanese Patients with Diabetic Kidney Disease. J Clin Med 2023; 12:7393. [PMID: 38068443 PMCID: PMC10707373 DOI: 10.3390/jcm12237393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Ankle-brachial index (ABI) is a simple method for diagnosing peripheral artery disease (PAD) but has limited reliability in patients with diabetes mellitus (DM) because of medial artery calcification. Our study aims to investigate whether the toe brachial index (TBI) or the cardio-ankle vascular index (CAVI) has a better detection over the ABI for diagnosing PAD in diabetic kidney disease (DKD). MATERIALS AND METHODS A cohort of 368 patients (mean age 68.59 ± 13.14 years, 190 males and 178 females) with type 2 DM underwent ABI, TBI, and CAVI measurements at our outpatient clinic. RESULTS Of all enrolled patients, the TBI is significant in evaluating PAD, especially in patients whose chronic kidney disease (CKD) stage 3a with adjusted odds ratio (AOR) = 6.50, 95% confidence interval (CI) 1.63-25.97, p = 0.0080, stage 3b AOR = 7.47, 95% CI 1.52-36.81, p = 0.0135, and stage 4-5 AOR = 20.13, 95% CI 1.34-94.24, p = 0.0116. CAVI is also significant in CKD stage 1 with AOR = 0.16, 95% CI 0.03-0.77, p = 0.0223, stage 2 with AOR = 0.18, 95% CI 0.04-0.74, p = 0.0180, and stage 3a AOR = 0.31, 95% CI 0.10-0.93, p = 0.0375. CONCLUSION TBI has a better yield of detection of PAD compared to ABI among Taiwanese patients with DKD. CAVI may play a role in the early stage of DKD.
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Affiliation(s)
- Chia-Wei Chang
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Ya-Wen Sung
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Yu-Ting Huang
- Statistical Analysis Laboratory, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yong-Chuan Chung
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung 803, Taiwan;
- Administration Management Center, Kaohsiung Siaogang Municipal Hospital, Kaohsiung 812, Taiwan
| | - Mei-Yueh Lee
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Gangshan Hospital, Kaohsiung 820, Taiwan
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Lim LL, S H Lau E, Pheng Chan S, Ji L, Lim S, Sirinvaravong S, Unnikrishnan AG, O Y Luk A, Cortese V, Durocher A, C N Chan J. Real-world evidence on health-related quality of life in patients with type 2 diabetes mellitus using sulphonylureas: An analysis of the Joint Asia Diabetes Evaluation (JADE) Register. Diabetes Res Clin Pract 2023; 203:110855. [PMID: 37517776 DOI: 10.1016/j.diabres.2023.110855] [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: 04/13/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
AIMS To describe health-related quality of life (HRQoL) and identify associated factors in patients with type 2 diabetes mellitus (T2DM) treated with oral glucose-lowering drugs (OGLDs). METHODS This retrospective, cross-sectional analysis included adults with T2DM from 11 Asian countries/regions prospectively enrolled in the Joint Asian Diabetes Evaluation (JADE) Register (2007-2019) with available EuroQol-5D (EQ-5D-3L) data. RESULTS Of 47,895 included patients, 42,813 were treated with OGLDs + lifestyle modifications (LSM) and 5,082 with LSM only. Among those treated with OGLDs, 60% received sulphonylureas (SUs), of whom 47% received gliclazide. The OGLD + LSM group had a lower mean EQ-5D-3L index score than the LSM-only group (p < 0.001). The most affected EQ-5D-3L dimensions in OGLD + LSM-treated patients were pain/discomfort (26.2%) and anxiety/depression (22.6%). On multivariate analysis, good HRQoL was positively associated with male sex, education level, balanced diet and regular exercise, and negatively with complications/comorbidities, self-reported hypoglycaemia, smoking, HbA1c, age, body mass index and disease duration. Patients receiving gliclazide vs non-gliclazide SUs had lower HbA1c and better HRQoL in all dimensions (p < 0.001). CONCLUSIONS Demographic, physical and psychosocial-behavioural factors were associated with HRQoL in patients with T2DM. Our real-world data add to previous evidence that gliclazide is an effective OGLD, with most treated patients reporting good HRQoL. A plain language summary of this manuscript is available here.
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Affiliation(s)
- Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region
| | - Siew Pheng Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking, China
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sirinart Sirinvaravong
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - A G Unnikrishnan
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Viviana Cortese
- Global Medical and Patient Affairs, Servier Affaires Médicales, Suresnes, France
| | - Alexandra Durocher
- Global Medical and Patient Affairs, Servier Affaires Médicales, Suresnes, France
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
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Hassanein M, Akbar MAJ, Al-Shamiri M, Amir A, Amod A, Chudleigh R, Elhadd T, Heshmat H, Jibani M, Al Saleh YM. Management of Diabetes and Hypertension within the Gulf Region: Updates on Treatment Practices and Therapies. Diabetes Ther 2022; 13:1253-1280. [PMID: 35679010 PMCID: PMC9178531 DOI: 10.1007/s13300-022-01282-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of risk factors, such as diabetes and hypertension. As the prevalence of these risk factors is particularly high in the Gulf region, better diagnosis and management of type 2 diabetes (T2D) and hypertension has the potential to dramatically reduce adverse cardiovascular outcomes for individuals in that part of the world. This article provides a summary of presentations made during the EVIDENT summit, a virtual symposium on Evidence in Diabetes and Hypertension, held in September 2021, including a review of the various guidelines for both T2D and hypertension, as well as recent findings relevant to the safety and efficacy for therapies relating to these conditions. Of relevance to the Gulf region, the risk of hypoglycaemia with sulfonylureas during Ramadan was reviewed. For the management of T2D, sulfonylureas have been a long-standing medication used to achieve glycaemic control; however, differences have emerged between early and later generations, with recent studies suggesting improvements in the safety profiles of late-generation sulfonylureas. For patients with hypertension, incremental therapy changes are recommended to reduce the risk of cardiovascular complications that are associated with increasing blood pressure. For first-line therapy, angiotensin-converting enzyme inhibitors (ACEi), such as perindopril, have been demonstrated to reduce the risk of cardiovascular and all-cause mortality. The addition of calcium channel blockers and diuretics to ACEi has been shown to be effective in patients with poorly controlled hypertension. The different renin-angiotensin-aldosterone system inhibitors are reviewed, and the benefit of combination therapies, including amlodipine and indapamide in patients with difficult-to-control hypertension, is investigated. The benefits of lifestyle modifications for these patients are also discussed, with important clinical considerations that are expected to inform patient management in daily clinical practice.
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Affiliation(s)
- Mohamed Hassanein
- Endocrine Department, Dubai Hospital/Dubai Health Authority, Alkhaleej Road, PO Box 7272, Dubai, United Arab Emirates.
- Gulf Medical University, Ajman, United Arab Emirates.
| | | | - Mostafa Al-Shamiri
- Cardiac Sciences Department, Medical College, King Saud University, Riyadh, Saudi Arabia
| | - Ashraf Amir
- International Medical Center Hospital (IMC), Jeddah, Saudi Arabia
| | - Aslam Amod
- Nelson R. Mandela School of Medicine & Life Chatsmed Garden Hospital, Durban, South Africa
| | | | | | - Hussien Heshmat
- Cardiology Department, Cairo University, Cairo, Egypt
- Fujairah Hospital Emirates Health Service, Fujairah, United Arab Emirates
| | | | - Yousef M Al Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Gurad Health Affairs, Riyadh, 14611, Saudi Arabia
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Habas E, Errayes M, Habas E, Farfar KL, Alfitori G, Habas AE, Rayani A, Elzouki ANY. Fasting Ramadan in Chronic Kidney Disease (CKD), Kidney Transplant and Dialysis Patients: Review and Update. Cureus 2022; 14:e25269. [PMID: 35755525 PMCID: PMC9218841 DOI: 10.7759/cureus.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a common disease in the Islamic regions. Dehydration occurs after prolonged fasting, particularly in hot and humid climates. In the Arabic months’ calendar, Ramadan is a month of maximum given deeds, where Muslims are required to fast from dawn till sunset. Depending on where you live and when the Ramadan month falls, fasting might last anywhere from 10 to 20 hours or more. In certain circumstances, such as poorly controlled diabetes and advanced CKD patients who are allowed to break their fast, the Ramadan fasting amendment is viable. Some Muslims, however, continue fasting despite these circumstances, placing themselves at risk, which is not allowed in the Islamic religion. There are no medical recommendations that specify who should and should not fast. Nonetheless, the recommendations have been extracted from several published studies. The authors searched EMBASE, PubMed, Google Scholar, and Google for publications, research, and reviews. All authors debate and analyze the related articles. Each author was assigned a part or two of the topics to read, study, and summarize before creating the final draft of their given section. Then this comprehensive review was completed after discussion sessions. In conclusion, by the Islamic religion view, fasting Ramadan is mandatory for every wise adult person. People who have chronic diseases or that may deteriorate by fasting are exempted from fasting. It seems that fasting and the associated disease hours are determinant factors to fasting or not fasting. Up to our knowledge, there are no established guidelines for CKD patients and physicians to follow; however, the International Diabetes Federation and Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 have been issued for CKD diabetic patients and fasting.
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Akizawa T, Tanaka-Amino K, Otsuka T, Yamaguchi Y. Clinical parameters among patients in Japan with anemia and non-dialysis-dependent chronic kidney disease with and without diabetes mellitus who received roxadustat. Clin Exp Nephrol 2022; 26:843-850. [PMID: 35462610 PMCID: PMC9385792 DOI: 10.1007/s10157-022-02225-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/05/2022] [Indexed: 12/14/2022]
Abstract
Background Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for treating anemia of chronic kidney disease (CKD). This post hoc analysis of a Japanese, open-label, partially randomized, phase 3 study in patients with non-dialysis-dependent (NDD) CKD evaluated disease state–related parameters among patients with and without diabetes mellitus who received roxadustat. In the 1517-CL-0310 study (NCT02988973), roxadustat was noninferior to darbepoetin alfa for change in average hemoglobin levels at Weeks 18–24 from baseline who received roxadustat. Methods Patients enrolled in the 1517-CL-0310 study who received roxadustat were included in this post hoc analysis. Hematologic (hemoglobin, reticulocyte/erythrocyte ratio, mean corpuscular volume [MCV], and mean corpuscular hemoglobin [MCH]), iron-related (ferritin, total iron-binding capacity, transferrin, ceruloplasmin, and hepcidin), metabolic (HbA1c, glycated albumin, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), and renal (eGFR) parameters were summarized descriptively by visit through Week 52. Results Among 201 included patients, 105 (52.2%) and 96 (47.8%) were in the Diabetes and No Diabetes subgroups, respectively. There were no clinically meaningful differences through Week 52 for most hematologic, iron-related, metabolic, or renal parameters between patients in the Diabetes and No Diabetes subgroups. MCV and MCH remained lower and HbA1c and glycated albumin remained higher in patients in the Diabetes subgroup through Week 52. Both subgroups experienced a similar benefit from roxadustat in maintaining hemoglobin levels in the target range of 10–12 g/dL. Conclusion Roxadustat maintained hemoglobin levels in the target range with similar clinical parameters irrespective of diabetes mellitus presence at baseline. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-022-02225-w.
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Affiliation(s)
- Tadao Akizawa
- Department of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Keiko Tanaka-Amino
- Medical Specialty, Japan Medical Affairs, Astellas Pharma, Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Tetsuro Otsuka
- Japan-Asia Clinical Development, Astellas Pharma, Inc., Tokyo, Japan
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. 2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care. Prim Care Diabetes 2022; 16:223-244. [PMID: 35183458 DOI: 10.1016/j.pcd.2022.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to treatment and therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provenҫals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Winnsboro, SC, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
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Affiliation(s)
| | - Serafim Kastanakis
- Emergency Care Department, Agios Georgios General Hospital of Chania, Crete, Greece
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9
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Abhyankar M, Das A, Wangnoo S, Chawla R, Shaikh A, Bantwal G, Kalra P, Jaggi S, Prasad A, Sarda P. Expert consensus on triple combination of glimepiride, metformin, and voglibose usage in patients with type 2 diabetes mellitus in Indian settings. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Atia T, Iqbal MZ, Fathy Ahmed H, Sakr HI, Abdelzaher MH, Morsi DF, Metawee ME. Vitamin D Supplementation Could Enhance the Effectiveness of Glibenclamide in Treating Diabetes and Preventing Diabetic Nephropathy: A Biochemical, Histological and Immunohistochemical Study. J Evid Based Integr Med 2022; 27:2515690X221116403. [PMID: 35942573 PMCID: PMC9393666 DOI: 10.1177/2515690x221116403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Diabetes mellitus is an oxidative stress-related disease characterized by hyperglycemia and a variety of complications, including nephropathy. Vitamin D has variable functions extending beyond the calcium metabolism to prevent oxidative tissue damage. We aimed to investigate whether vitamin D supplements could enhance Glibenclamide's effectiveness in treating diabetes and minimize the risk of associated pathology. Wistar rats were divided into normal control (n = 10) and diabetic (n = 30), where animals received two low doses of Streptozotocin 30 mg/kg/BW intraperitoneally to develop diabetes. The diabetic rats were then randomly divided into three equal groups: untreated, treated with Glibenclamide (0.6 mg/kg), and treated with Glibenclamide and Vitamin D3 (500 IU/kg). After eight weeks, the animals were sacrificed, and blood samples and kidney tissues were collected to evaluate biochemical, anti-oxidant, and pro-inflammatory cytokine levels and histological and immunohistochemical changes. Diabetic animals had significantly increased fasting blood glucose, lipid profile, blood urea, serum creatinine, and Malondialdehyde levels, whereas serum insulin, albumin, and the anti-oxidant enzymes superoxide dismutase and catalase were significantly decreased compared to normal control (p < 0.01). Furthermore, some renal histological changes were observed together with significantly increased immunoreactivity of anti-p53, anti-TNF-α, and anti-IL-6 antibodies when compared to the normal control. All abnormal parameters improved significantly with Glibenclamide therapy (p < 0.01), but combination therapy with vitamin D produced a much better result. In conclusion, vitamin D supplementation along with anti-diabetic medication can help prevent or reduce the severity of diabetic nephropathy due to its potent antioxidant, anti-inflammatory, and anti-apoptotic properties.
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Affiliation(s)
- Tarek Atia
- Department of Medical Laboratory Sciences, College of Applied
Medical Sciences, Prince Sattam bin Abdulaziz University in Al-Kharj, Saudi
Arabia
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
- Tarek Atia, College of Applied Medical
Sciences, Prince Sattam bin Abdulaziz University in Alkharj, Saudi Arabia;
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Mohammad Zahidul Iqbal
- Department of Medical Laboratory Sciences, College of Applied
Medical Sciences, Prince Sattam bin Abdulaziz University in Al-Kharj, Saudi
Arabia
| | - Hassan Fathy Ahmed
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
| | - Hader I. Sakr
- Department of Medical Physiology, Faculty of Medicine, Cairo
University, Egypt
- Medicine Program, Batterjee Medical College, Jeddah, Saudi
Arabia
| | - M. H. Abdelzaher
- Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar
University, Assiut, Egypt
- Faculty of Medicine, Prince Sattam Bin Abdulaziz University in
AlKharj, Saudi Arabia
| | - Deaa Fekri Morsi
- Department of Pathology, Faculty of Medicine, Helwan University,
Cairo, Egypt
- Pathology lab., Prince Sattam bin Abdulaziz University Hospital in
Al-Kharj, Saudi Arabia
| | - Mostafa E. Metawee
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
- Medicine Program, Batterjee Medical College, Jeddah, Saudi
Arabia
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Hasnani D, Chavda V, Agrawal D, Patni B, David A, Gathe S, Chawla R, Kesavadev J, Gupta S, Hasnani S, Saboo B. Validation of RSSDI therapeutic wheel with clinical experience of Indian physicians. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Eliaschewitz FG, Canani LH. Advances in GLP-1 treatment: focus on oral semaglutide. Diabetol Metab Syndr 2021; 13:99. [PMID: 34526121 PMCID: PMC8442336 DOI: 10.1186/s13098-021-00713-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is currently a large arsenal of antidiabetic drugs available to treat type 2 diabetes (T2D). However, this is a serious chronic disease that affects millions of adults worldwide and is responsible for severe complications, comorbidities, and low quality of life when uncontrolled due mainly to delays in initiating treatment or inadequate therapy. This review article aims to clarify the therapeutic role of the oral formulation of the glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide in treating typical T2D patients. The discussion focused on metabolic, glycemic, and weight alteration effects and the safety of the therapy with this drug. MAIN TEXT Therapy with glucagon-like peptide 1 receptor agonist (GLP-1 RA) promotes strategic changes in the pathophysiological pathway of T2D and improves the secretion of glucagon and insulin, which results in a reduction in blood glucose levels and the promotion of weight loss. Until recently, the only route for semaglutide administration was parenteral. However, an oral formulation of GLP-1 RA was recently developed and approved by the Brazilian Health Regulatory Agency (ANVISA) and the Food and Drug Administration (FDA) based on the Peptide Innovation for Early Diabetes Treatment (PIONEER) program results. A sequence of 10 clinical studies compared oral semaglutide with placebo or active standard-of-care medications (empagliflozin 25 mg, sitagliptin 100 mg, or liraglutide 1.8 mg) in different T2D populations. CONCLUSIONS Oral semaglutide effectively reduces glycated hemoglobin (HbA1c) levels and body weight in a broad spectrum of patients with T2D and shows cardiovascular safety. Oral semaglutide broadens therapy options and facilitates the adoption of earlier GLP-1 RA treatment once T2D patients present low rates of treatment discontinuation. The main adverse events reported were related to the gastrointestinal tract, common to GLP-1 RA class drugs.
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Affiliation(s)
- Freddy G Eliaschewitz
- CPClin/DASA Clinical Research Center, Avenida Angélica, 2162, São Paulo, CEP 01228-200, Brazil.
| | - Luis Henrique Canani
- Endocrinology Division of Hospital de Clínicas de Porto Alegre and Department of Internal Medicine, Medical School of Federal, University of Rio Grande Do Sul, Porto Alegre, Brazil
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Wangnoo S, Shunmugavelu M, Reddy SVB, Negalur V, Godbole S, Dhandhania VK, Krishna N, Gaurav K. Role of Gliclazide in safely navigating type 2 diabetes mellitus patients towards euglycemia: Expert opinion from India. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Harris ST, Patorno E, Zhuo M, Kim SC, Paik JM. Prescribing Trends of Antidiabetes Medications in Patients With Type 2 Diabetes and Diabetic Kidney Disease, a Cohort Study. Diabetes Care 2021; 44:dc210529. [PMID: 34344714 PMCID: PMC8929186 DOI: 10.2337/dc21-0529] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess changes in antidiabetes medication class prescriptions over time among patients with diabetic kidney disease (DKD), characteristics of patients prescribed these medications, and prescribers' specialty. RESEARCH DESIGN AND METHODS We conducted a cohort study design using insurance claims data between 2013 and the first quarter of 2020 (2020Q1). Included are adult patients with DKD who initiated a new antidiabetes medication between 2013 and 2020Q1 (N = 160,489 patients). The primary outcome is the yearly and quarterly percent of medication initiation for each antidiabetes medication class over all antidiabetes medication initiations. RESULTS For patients with DKD, sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucago-like peptide 1 receptor agonist (GLP-1RA) initiations steadily increased between 2013 and 2020Q1. Internists and endocrinologists were the most frequent prescriber specialties. Patients <65 years of age had a larger percentage of all initiations that were SGLT2i or GLP-1RA, 16% and 23%, respectively, in 2019, and patients >75 years of age had a smaller percentage of all initiations that were SGLT2i or GLP-1RA, 11% and 13%, in 2019. CONCLUSIONS For patients with DKD, SGLT2i and GLP-1RA prescriptions have increased over time, likely reflecting evolving prescribing patterns in response to the results of recent clinical trials and new clinical guidelines.
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Affiliation(s)
- Samantha T Harris
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard Business School, Boston, MA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Min Zhuo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. A disease state approach to the pharmacological management of Type 2 diabetes in primary care: A position statement by Primary Care Diabetes Europe. Prim Care Diabetes 2021; 15:31-51. [PMID: 32532635 DOI: 10.1016/j.pcd.2020.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Los Angeles, CA, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, Atasehir 34752, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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16
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Nedyalkova M, Madurga S, Ballabio D, Robeva R, Romanova J, Kichev I, Elenkova A, Simeonov V. Diabetes mellitus type 2: Exploratory data analysis based on clinical reading. OPEN CHEM 2020. [DOI: 10.1515/chem-2020-0086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AbstractDiabetes mellitus type 2 (DMT2) is a severe and complex health problem. It is the most common type of diabetes. DMT2 is a chronic metabolic disorder that affects the way your body metabolizes sugar. With DMT2, your body either resists the effects of insulin or does not produce sufficient insulin to continue normal glucose levels. DMT2 is a disease that requires a multifactorial approach of controlling that includes lifestyle change and pharmacotherapy. Less than ideal management increases the risk of developing complications and comorbidities such as cardiovascular disease and numerous social and economic penalties. That is why the studies dedicated to the pathophysiological mechanisms and the treatment of DMT2 are extremely numerous and diverse. In this study, exploratory data analysis approaches are applied for the treatment of clinical and anthropometric readings of patients with DMT2. Since multivariate statistics is a well-known method for classification, modeling and interpretation of large collections of data, the major aim of the present study was to reveal latent relations between the objects of the investigation (group of patients and control group) and the variables describing the objects (clinical and anthropometric parameters). In the proposed method by the application of hierarchical cluster analysis and principal component analysis it is possible to identify reduced number of parameters which appear to be the most significant discriminant parameters to distinguish between four patterns of patients with DMT2. However, there is still lack of multivariate statistical studies using DMT2 data sets to assess different aspects of the problem like optimal rapid monitoring of the patients or specific separation of patients into patterns of similarity related to their health status which could be of help in preparation of data bases for DMT2 patients. The outcome from the study could be of custom for the selection of significant tests for rapid monitoring of patients and more detailed approach to the health status of DMT2 patients.
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Affiliation(s)
- Miroslava Nedyalkova
- Department of Inorganic Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Ohridski”, 1164 Sofia, 1, Ave. J. Bourchier, Bulgaria
| | - Sergio Madurga
- Department of Physical Chemistry and the Research Institute of Theoretical and Computational Chemistry (IQTCUB) of the University of Barcelona (UB), 08028 Barcelona, C/Martí i Franquès, 1, Spain
| | - Davide Ballabio
- Department of Earth and Environmental Sciences, Chemometrics and QSAR Research Group, University of Milano-Bicocca, Piazza della Scienza, 1, 20126 Milano, Italy
| | - Ralitsa Robeva
- Faculty of Medicine, Medical University – Sofia, Department of Endocrinology, 1431 Sofia, USHATE Acad. Iv. Penchev, Bulgaria
| | - Julia Romanova
- Department of Inorganic Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Ohridski”, 1164 Sofia, 1, Ave. J. Bourchier, Bulgaria
| | - Ilia Kichev
- Department of Inorganic Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Ohridski”, 1164 Sofia, 1, Ave. J. Bourchier, Bulgaria
| | - Atanaska Elenkova
- Faculty of Medicine, Medical University – Sofia, Department of Endocrinology, 1431 Sofia, USHATE Acad. Iv. Penchev, Bulgaria
| | - Vasil Simeonov
- Department of Analytical Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia “St. Kl. Ohridski”, 1164 Sofia, 1, Ave. J. Bourchier, Bulgaria
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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18
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Rhee JJ, Han J, Montez-Rath ME, Kim SH, Cullen MR, Stafford RS, Winkelmayer WC, Chertow GM. Antidiabetic medication use in patients with type 2 diabetes and chronic kidney disease. J Diabetes Complications 2019; 33:107423. [PMID: 31537413 PMCID: PMC6823164 DOI: 10.1016/j.jdiacomp.2019.107423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
AIMS To quantify patterns of conventional and newer antidiabetic medication use in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHODS We used data from a large claims and integrated dataset that includes employed and commercially insured patients in the US to select patients who had T2DM and CKD with information on laboratory values and prescriptions for antidiabetic medications from January 1, 2014 to January 1, 2015. We stratified the analyses by sociodemographic variables. RESULTS In a cohort of 38,577 patients with T2DM and CKD, we found wide variation in the treatment of T2DM by CKD stage as well as by several sociodemographic factors. Although metformin was the most commonly prescribed medication, only about half of patients in the cohort and fewer than two-thirds of patients with early stage CKD were prescribed metformin. Approximately 10.6% of patients with CKD stage 4 and 2.1% of the patients with CKD stage 5 were prescribed metformin. Sulfonylureas with active metabolites that accumulate with impaired kidney function were prescribed in more than one-third of patients with CKD stages 3b, 4, and 5. Only 3.4% and 12.3% of patients were prescribed GLP-1 and DPP-4 respectively. CONCLUSIONS Prescriptions for metformin were lower than expected among patients with mild to moderate CKD. Prescriptions for newer antidiabetic medications with known safety and efficacy across the spectrum of CKD remained low. Prescriptions for agents contraindicated in advanced CKD continued to be written in a sizeable fraction of patients.
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Affiliation(s)
- Jinnie J Rhee
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States.
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States
| | - Sun H Kim
- Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Mark R Cullen
- Division of Primary Care and Population health, Stanford University School of Medicine, Stanford, CA, United States
| | - Randall S Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
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20
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Comparing the Effect of Dipeptidyl-Peptidase 4 Inhibitors and Sulfonylureas on Albuminuria in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A Prospective Open-Label Study. J Clin Med 2019; 8:jcm8101715. [PMID: 31627406 PMCID: PMC6832118 DOI: 10.3390/jcm8101715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 01/07/2023] Open
Abstract
Diabetic kidney disease (DKD) leads to substantial morbidity in patients with type 2 diabetes mellitus (T2DM). Evidence suggests that antidiabetic drug dipeptidyl-peptidase 4 (DPP-4) inhibitors may be able to attenuate albuminuria, whereas the influence of sulfonylureas on albuminuria remains unclear. This prospective open-label study investigated the effect of DPP-4 inhibitors and sulfonylureas on urinary albumin excretion, which is a marker of renal microvascular abnormality. A total of 101 participants with newly diagnosed T2DM were enrolled. In addition to metformin therapy, 45 patients were assigned to receive DPP-4 inhibitors and 56 to receive sulfonylureas. Urinary albumin-to-creatinine ratio (ACR) was significantly reduced in recipients of DPP-4 inhibitors after 24 weeks (29.2 µg/mg creatinine vs. 14.9 µg/mg creatinine, P < 0.001), whereas urinary ACR was not significantly changed by sulfonylureas (39.9 µg/mg creatinine vs. 43.2 µg/mg creatinine, P = 0.641). The effect on albuminuria occurred even though both treatment groups had a similar change in serum glycated hemoglobin A1c (-1.87 % vs.-2.40 %, P = 0.250). Therefore, in diabetic patients the addition of DPP-4 inhibitors lowered urinary albumin excretion compared to sulfonylureas, and attenuation of albuminuria may be a consideration when choosing between antidiabetic medications.
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21
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Wang J, Huang J, Li W, Tang S, Sun J, Zhang X, Liu J, Yi B, Liu J, Zhang X, Yang Q, Yang X, Yang S, Yang G, Zhang H. Polyethylene glycol loxenatide (PEX168) in subjects with renal impairment: A pharmacokinetic study. Br J Clin Pharmacol 2019; 85:2714-2720. [PMID: 31396983 PMCID: PMC6955414 DOI: 10.1111/bcp.14091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/13/2019] [Accepted: 07/26/2019] [Indexed: 12/29/2022] Open
Abstract
Aims Type 2 diabetes mellitus (T2DM) is commonly complicated by renal impairment. Polyethylene glycol loxenatide (PEX168) is a novel long‐acting glucagon‐like peptide‐1 receptor agonist for T2DM. PEX168 pharmacokinetics was studied to identify requirements for dose‐modification in T2DM complicated by renal impairment. Methods This was a single‐centre, open‐labelled, parallel‐group, single‐dose, phase I clinical trial of patients with mild and moderate renal impairment, and with or without T2DM. Age‐, sex‐ and body mass index‐matched subjects with normal renal function, and with or without T2DM were recruited as controls. Subjects received a single abdominal subcutaneous injection of PEX168 200 μg. Pharmacokinetic samples were taken at 0, 24, 48, 72, 96, 120, 144, 216, 312, 480, 648 and 720 hours. Results Twenty‐three patients were included in the pharmacokinetics analysis. Vz/F and CL/F were lower in the moderate impairment group than in the other groups. The mean t1/2 (163 hours) in the moderate impairment group was prolonged compared to the mild impairment (117 hours) and normal (121 hours) groups. AUC0–inf increased by 13 and 100.7% in patients with mild and moderate renal impairment, respectively. Most adverse events were mild gastrointestinal disorders, with only 1 serious adverse event observed. Conclusion A single dose of 200 μg of PEX168 was in general well tolerated in patients with renal impairment. The in vivo clearance rate of PEX168 in patients with moderate renal impairment is slower than in patients with mild renal impairment and normal renal function and dose adjustment might be required (http://ClinicalTrials.org #NCT02467790).
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Affiliation(s)
- Jianwen Wang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Li
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shiqi Tang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Sun
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xianming Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Yi
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jishi Liu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingfei Zhang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoyan Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuang Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Center of Drug Clinical Evaluation of Central South University, Changsha, Hunan, China.,Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, China
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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22
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Spanopoulos D, Okhai H, Zaccardi F, Tebboth A, Barrett B, Busse M, Webb J, Khunti K. Temporal variation of renal function in people with type 2 diabetes mellitus: A retrospective UK clinical practice research datalink cohort study. Diabetes Obes Metab 2019; 21:1817-1823. [PMID: 30941882 PMCID: PMC6767485 DOI: 10.1111/dom.13734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/19/2019] [Accepted: 03/31/2019] [Indexed: 11/27/2022]
Abstract
AIM To characterize the longitudinal variability of estimated glomerular filtration rate (eGFR) in people with type 2 diabetes mellitus (T2DM), including variation between categories and individuals. METHODS People with T2DM and sufficient recorded serum creatinine measurements were identified from the Clinical Practice Research Datalink (T2DM diagnosis from 1 January 2009 to 1 January 2011 with 5 years follow-up); eGFR was calculated using the CKD-EPI equation. RESULTS In total, 7766 individuals were included; 32.8%, 50.2%, 12.4%, 4.0% and 0.6% were in glomerular filtration rate (GFR) categories G1, G2, G3a, G3b and G4, respectively. Overall, eGFR decreased by 0.44 mL/min/1.73 m2 per year; eGFR increased by 0.80 mL/min/1.73 m2 between index and year 1, then decreased by 0.75 mL/min/1.73 m2 annually up to year 5. Category G1 showed a steady decline in eGFR over time; G2, G3a and G3b showed an increase between index and year 1, followed by a decline. Category G4 showed a mean eGFR increase of 1.85 mL/min/1.73 m2 annually. People in categories G3-G4 moved across a greater number of GFR categories than those in G1 and G2. Individual patients' eGFR showed a wide range of values (change from baseline at year 5 varied from -80 to +59 mL/min/1.73 m2 ). CONCLUSION Overall, eGFR declined over time, although there was considerable variation between GFR categories and individuals. This highlights the difficulty in prescribing many glucose-lowering therapies, which require dose adjustment for renal function. The study also emphasizes the importance of regular monitoring of renal impairment in people with T2DM.
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Affiliation(s)
| | - Hajra Okhai
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | | | | | | | | | - Joanne Webb
- Medical AffairsEli Lilly and CompanyBasingstokeUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
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23
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Mosenzon O, Blicher TM, Rosenlund S, Eriksson JW, Heller S, Hels OH, Pratley R, Sathyapalan T, Desouza C. Efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment (PIONEER 5): a placebo-controlled, randomised, phase 3a trial. Lancet Diabetes Endocrinol 2019; 7:515-527. [PMID: 31189517 DOI: 10.1016/s2213-8587(19)30192-5] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral semaglutide is the first oral glucagon-like peptide-1 (GLP-1) receptor agonist for glycaemic control in patients with type 2 diabetes. Type 2 diabetes is commonly associated with renal impairment, restricting treatment options. We aimed to investigate the efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment. METHODS This randomised, double-blind, phase 3a trial was undertaken at 88 sites in eight countries. Patients aged 18 years and older, with type 2 diabetes, an estimated glomerular filtration rate of 30-59 mL/min per 1·73 m2, and who had been receiving a stable dose of metformin or sulfonylurea, or both, or basal insulin with or without metformin for the past 90 days were eligible. Participants were randomly assigned (1:1) by use of an interactive web-response system, with stratification by glucose-lowering medication and renal function, to receive oral semaglutide (dose escalated to 14 mg once daily) or matching placebo for 26 weeks, in addition to background medication. Participants and site staff were masked to assignment. Two efficacy-related estimands were defined: treatment policy (regardless of treatment discontinuation or rescue medication) and trial product (on treatment without rescue medication) in all participants randomly assigned. Endpoints were change from baseline to week 26 in HbA1c (primary endpoint) and bodyweight (confirmatory secondary endpoint), assessed in all participants with sufficient data. Safety was assessed in all participants who received at least one dose of study drug. This trial is registered on ClinicalTrials.gov, number NCT02827708, and the European Clinical Trials Registry, number EudraCT 2015-005326-19, and is now complete. FINDINGS Between Sept 20, 2016, and Sept 29, 2017, of 721 patients screened, 324 were eligible and randomly assigned to oral semaglutide (n=163) or placebo (n=161). Mean age at baseline was 70 years (SD 8), and 168 (52%) of participants were female. 133 (82%) participants in the oral semaglutide group and 141 (88%) in the placebo group completed 26 weeks on treatment. At 26 weeks, oral semaglutide was superior to placebo in decreasing HbA1c (estimated mean change of -1·0 percentage point (SE 0·1; -11 mmol/mol [SE 0·8]) vs -0·2 percentage points (SE 0·1; -2 mmol/mol [SE 0·8]); estimated treatment difference [ETD]: -0·8 percentage points, 95% CI -1·0 to -0·6; p<0·0001) and bodyweight (estimated mean change of -3·4 kg [SE 0·3] vs -0·9 kg [SE 0·3]; ETD, -2·5, 95% CI -3·2 to -1·8; p<0·0001) by the treatment policy estimand. Significant differences were seen for the trial product estimand: mean change in HbA1c -1·1 percentage points (SE 0·1; -12 mmol/mol [SE 0·8] versus -0·1 percentage points (SE 0·1; -1 mmol/mol [SE 0·8]; ETD -1·0 percentage points, 95% CI -1·2 to -0·8; p<0·0001); mean change in bodyweight -3·7 kg (SE 0·3) versus -1·1 kg (SE 0·3; ETD -2·7 kg, 95% CI -3·5 to -1·9; p<0·0001). More patients taking oral semaglutide than placebo had adverse events (120 [74%] of 163 vs 105 [65%] of 161), and discontinued treatment as a result (24 [15%] vs eight [5%]). Gastrointestinal events, mainly mild-to-moderate nausea, were more common with oral semaglutide than with placebo. Three deaths occurred during the treatment period that were not condsidered to be treatment related, one in the semaglutide group and two in the placebo group. INTERPRETATION Oral semaglutide was effective in patients with type 2 diabetes and moderate renal impairment, potentially providing a new treatment option for this population. Safety, including renal safety, was consistent with the GLP-1 receptor agonist class. FUNDING Novo Nordisk A/S.
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Affiliation(s)
- Ofri Mosenzon
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel.
| | | | | | - Jan W Eriksson
- Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Richard Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Cyrus Desouza
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Niezen S, Diaz del Castillo H, Mendez Castaner LA, Fornoni A. Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease. Endocrinol Diabetes Metab 2019; 2:e00072. [PMID: 31294086 PMCID: PMC6613230 DOI: 10.1002/edm2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 12/24/2022] Open
Abstract
Diabetic kidney disease (DKD) is the major contributor to the mortality and the financial burden of diabetes, accounting for approximately 50% of the cases of end-stage renal disease (ESRD) in the developed world. Several studies have already demonstrated that achieving blood pressure targets in DKD with agents blocking the renin-angiotensin system confer superior renoprotection when compared to other agents. However, the effects on renal outcomes of antihyperglycaemic agents in these patients have not been reported or studied broadly until recent years. The intent of this article is to review the available data on safety, efficacy, impact on renal outcomes and pathophysiology implications of the most utilized antihyperglycaemic agents in DKD/ESRD.
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Affiliation(s)
| | | | | | - Alessia Fornoni
- Katz Family Division of Nephrology and HypertensionUniversity of MiamiMiamiFlorida
- Peggy and Harold Katz Family Drug Discovery CenterUniversity of Miami Miller School of MedicineMiamiFlorida
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25
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Tentolouris A, Eleftheriadou I, Tzeravini E, Athanasakis K, Anastasiou IA, Kyriopoulos J, Tentolouris N. Management of diabetes mellitus and patients' attitude towards the disease: Data from a nationwide study in Greece. Diabetes Metab Syndr 2019; 13:1159-1164. [PMID: 31336459 DOI: 10.1016/j.dsx.2019.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
AIM To examine management of diabetes mellitus (DM) and patients' attitude towards DM in a random sample of the adult Greek population. METHODS s: We selected a random sample of adults with self-reported DM (n = 1002) from a population-based nationwide study using the effective random sampling technique. Collection of data was performed through phone interviews. RESULTS Prevalence of type 1 DM was 3.5% and of type 2 DM 96.5%. Prevalence of type 1 DM declined while of type 2 DM increased with age. No gender or residency differences were found between type 1 and type 2 DM. A total of 72.0% of subjects with type 2 DM were treated with oral antidiabetic drugs (OAD), 11.5% were treated with insulin and 7.1% were treated with both OAD and insulin. Internists specialized in DM were mainly doctors who started insulin treatment. Almost half of insulin naive subjects were skeptical towards insulin initiation and their main concern was the needle punch. CONCLUSIONS In a random nationwide sample of the adult population in Greece the majority of subjects with self-reported DM had type 2 DM. Most patients with type 2 were treated with OAD. Almost half of insulin naive subjects were skeptical towards insulin initiation.
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Affiliation(s)
- Anastasios Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Ioanna A Anastasiou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
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Mohan V, Cooper ME, Matthews DR, Khunti K. The Standard of Care in Type 2 Diabetes: Re-evaluating the Treatment Paradigm. Diabetes Ther 2019; 10:1-13. [PMID: 30758834 PMCID: PMC6408564 DOI: 10.1007/s13300-019-0573-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 01/01/2023] Open
Abstract
There is currently a worldwide epidemic of type 2 diabetes (T2D) that is predicted to increase substantially in the next few years. With 80% of the global T2D population living in low to middle-income countries, there are issues with cost and of access to appropriate medicines. The objective of this symposium was to provide an overview of the efficacy and safety of glucose-lowering drugs, focussing in particular on sulfonylureas (SUs) in patients with T2D using data taken from both randomised controlled trials (RCTs) and real-world studies, the application of strategies to ensure optimal patient adherence and clinical outcomes, and the optimal use of SUs in terms of dose adjustment and agent choice to ensure the best clinical outcome. The symposium began by exploring a profile of the typical patient seen in diabetes clinical practice and the appropriate management of such a patient in the real world, before moving on to an overview of the risks associated with T2D and how the currently available agents, including newer antidiabetic medications, mitigate or exacerbate those risks. The final presentation provided an overview of real-world studies, the gap between RCTs and the real world, and the use of available glucose-lowering agents in daily clinical practice. Clinical evidence was presented demonstrating that tight glucose control improved both microvascular and macrovascular outcomes, but that aggressive treatment in patients with a very high cardiovascular risk could lead to adverse outcomes. Real-world data suggest that older agents such as SUs and metformin are being used in a large proportion of patients with T2D with demonstrable effectiveness, indicating that they still have a place in modern T2D management. The symposium, while acknowledging the need for newer antidiabetic drugs in specific situations and patient groups, recommended the continuation of SUs and metformin as the primary oral antidiabetic agents in resource-constrained regions of the world.Funding:Servier.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
| | - Mark E Cooper
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, and Harris Manchester College, Oxford, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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27
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Melzer-Cohen C, Karasik A, Leuschner PJ, Azuri J, Shalev V, Chodick G. Dose adjustment of metformin and dipeptidyl-peptidase IV inhibitors in diabetic patients with renal dysfunction. Curr Med Res Opin 2018; 34:1849-1854. [PMID: 29611727 DOI: 10.1080/03007995.2018.1459529] [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] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This analysis of real-world data aimed to (a) determine the proportion of Type II diabetes (T2DM) patients treated with metformin or dipeptidyl peptidase-4 inhibitors (DPP-4i) that require dose adjustment or therapy discontinuation due to chronic kidney disease (CKD), and (b) to assess the time required to dose adjustment from the time of worsening of CKD. METHODS In this retrospective study, two study populations were defined in a large healthcare organization. In the cross-sectional analysis, the distribution of CKD stages and the appropriate dosage of metformin and DPP-4i in 2013 was examined according to renal function among T2DM patients. In the longitudinal analysis, a cohort was defined to assess the time elapsed from first indication worsening of CKD to dose adjustment, among patients treated with those medications during years 2006-2013. RESULTS Among patients treated with metformin or DPP-4i, one third of patients with CKD failed to adjust the dosage or to discontinue metformin or DPP-4i as indicated. Median time for dose adjustment or discontinuation was significantly longer for DPP-4i than for metformin (9.8 compared to 16.8 months for metformin and DPP-4i, respectively; p-value <.001). CONCLUSIONS This real-world data analysis showed that adjustment of dose or discontinuation of metformin or DPP-4i in patients with worsening CKD occurred less often in DPP-4i users than metformin users and took a longer time.
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Affiliation(s)
| | - Avraham Karasik
- b Sackler Faculty of medicine , Tel Aviv University , Tel Aviv , Israel
- c Sheba Medical Center , Tel Hashomer , Israel
| | | | - Joseph Azuri
- a Maccabi Healthcare Services , Medical Division , Tel Aviv , Israel
- b Sackler Faculty of medicine , Tel Aviv University , Tel Aviv , Israel
| | - Varda Shalev
- a Maccabi Healthcare Services , Medical Division , Tel Aviv , Israel
- b Sackler Faculty of medicine , Tel Aviv University , Tel Aviv , Israel
| | - Gabriel Chodick
- a Maccabi Healthcare Services , Medical Division , Tel Aviv , Israel
- b Sackler Faculty of medicine , Tel Aviv University , Tel Aviv , Israel
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28
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Colagiuri S, Matthews D, Leiter LA, Chan SP, Sesti G, Marre M. The place of gliclazide MR in the evolving type 2 diabetes landscape: A comparison with other sulfonylureas and newer oral antihyperglycemic agents. Diabetes Res Clin Pract 2018; 143:1-14. [PMID: 29802958 DOI: 10.1016/j.diabres.2018.05.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023]
Abstract
The sulfonylureas are effective oral glucose-lowering agents with a long history of clinical use. While all have the same general mechanism of action, their pharmacokinetic properties are influenced by factors such as dosage, rate of absorption, duration of action, route of elimination, tissue specificity, and binding affinity for pancreatic β-cell receptor. The result is a class of agents with similar HbA1c-lowering efficacy, but well-documented differences in terms of effects on hypoglycemia, and cardiovascular and renal safety. This review examines the differences between currently available sulfonylureas with a focus on how gliclazide modified release (MR) differs from other members of this class and from newer oral antihyperglycemic agents in the form of dipeptidyl peptidase-4 (DPP4) and sodium- glucose cotransporter 2 (SGLT2) inhibitors. The first part focuses on major outcome trials that have been conducted with the sulfonylureas and new oral agents. Consideration is then given to factors important for day-to-day prescribing including efficacy and durability, weight changes, hypoglycemia, renal effects and cost. Based on current evidence, third-generation sulfonylureas such as gliclazide MR possess many of the properties desired of a type 2 diabetes drug including high glucose-lowering efficacy, once-daily oral administration, few side effects other than mild hypoglycemia, and cardiovascular safety.
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Affiliation(s)
- Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW, Australia.
| | - David Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, and Harris Manchester College, University of Oxford, Oxford, UK
| | - Lawrence A Leiter
- Division of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur 50603, W.P., Malaysia
| | - Giorgio Sesti
- Department of Medical and Surgical Science, University Magna-Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Michel Marre
- Diabetes Department, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, Université Denis Diderot Paris 7, and INSERM U1138, Paris, France
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Moonen L, D'Haese PC, Vervaet BA. Epithelial Cell Cycle Behaviour in the Injured Kidney. Int J Mol Sci 2018; 19:E2038. [PMID: 30011818 PMCID: PMC6073451 DOI: 10.3390/ijms19072038] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
Acute kidney injury (AKI), commonly caused by ischemia-reperfusion injury, has far-reaching health consequences. Despite the significant regenerative capacity of proximal tubular epithelium cells (PTCs), repair frequently fails, leading to the development of chronic kidney disease (CKD). In the last decade, it has been repeatedly demonstrated that dysregulation of the cell cycle can cause injured kidneys to progress to CKD. More precisely, severe AKI causes PTCs to arrest in the G1/S or G2/M phase of the cell cycle, leading to maladaptive repair and a fibrotic outcome. The mechanisms causing these arrests are far from known. The arrest might, at least partially, be attributed to DNA damage since activation of the DNA-damage response pathway leads to cell cycle arrest. Alternatively, cytokine signalling via nuclear factor kappa beta (NF-κβ) and p38-mitogen-activated protein kinase (p38-MAPK) pathways, and reactive oxygen species (ROS) can play a role independent of DNA damage. In addition, only a handful of cell cycle regulators (e.g., p53, p21) have been thoroughly studied during renal repair. Still, why and how PTCs decide to arrest their cell cycle and how this arrest can efficiently be overcome remain open and challenging questions. In this review we will discuss the evidence for cell cycle involvement during AKI and development of CKD together with putative therapeutic approaches.
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Affiliation(s)
- Lies Moonen
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium.
| | - Patrick C D'Haese
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium.
| | - Benjamin A Vervaet
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium.
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30
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Lovre D, Shah S, Sihota A, Fonseca VA. Managing Diabetes and Cardiovascular Risk in Chronic Kidney Disease Patients. Endocrinol Metab Clin North Am 2018; 47:237-257. [PMID: 29407054 PMCID: PMC5806139 DOI: 10.1016/j.ecl.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We discuss mechanisms of increased cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) and strategies for managing cardiovascular (CV) risk in these patients. Our focus was mainly on decreasing CV events and progression of microvascular complications by reducing levels of glucose and lipids. We searched PubMed with no limit on the date of the article. All articles were discussed among all authors. We chose pertinent articles, and searched their references in turn for additional relevant publications.
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Affiliation(s)
- Dragana Lovre
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA; Section of Endocrinology, Southeast Louisiana Veterans Health Care Systems, 2400 Canal Street, New Orleans, LA 70119, USA.
| | - Sulay Shah
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA
| | - Aanu Sihota
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA; Section of Endocrinology, Southeast Louisiana Veterans Health Care Systems, 2400 Canal Street, New Orleans, LA 70119, USA
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31
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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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32
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Advances in Managing Type 2 Diabetes in the Elderly: A Focus on Inpatient Care and Transitions of Care. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pan SW, Yen YF, Kou YR, Chuang PH, Su VYF, Feng JY, Chan YJ, Su WJ. The Risk of TB in Patients With Type 2 Diabetes Initiating Metformin vs Sulfonylurea Treatment. Chest 2017; 153:1347-1357. [PMID: 29253553 DOI: 10.1016/j.chest.2017.11.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/28/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Metformin and the sulfonylureas are common initial antidiabetic agents; the former has demonstrated anti-TB action in in vitro and animal studies. The comparative effect of metformin vs the sulfonylureas on TB risk in patients with type 2 diabetes mellitus (T2DM) remains unclear. METHODS In this retrospective cohort study, patients without chronic kidney disease who received a T2DM diagnosis during 2003 to 2013 were identified from the Taiwan National Health Insurance Research Database. Participants with ≥ 2 years of follow-up were reviewed and observed for TB until December 2013. Patients receiving metformin ≥ 60 cumulative defined daily dose (cDDD) and sulfonylureas < 15 cDDD in the initial 2 years were defined as metformin majors; it was the inverse for sulfonylurea majors. The two groups were matched 1:1 by propensity score and compared for TB risk by multivariate Cox regression analysis. RESULTS Among 40,179 patients with T2DM, 263 acquired TB (0.65%) over a mean follow-up of 6.1 years. In multivariate analysis, the initial 2-year dosage of metformin, but not that of the sulfonylureas, was an independent predictor of TB (60-cDDD increase (adjusted hazard ratio [HR], 0.931; 95% CI, 0.877-0.990) after adjustment by cofactors, including adapted diabetes complication severity index. Metformin majors had a significantly lower TB risk than that of sulfonylurea majors before and after matching (HR, 0.477; 95% CI, 0.268-0.850 and HR, 0.337; 95% CI, 0.169-0.673; matched pairs, n = 3,161). Compared with the reference group (initial 2-year metformin < 60 cDDD), metformin treatment showed a dose-dependent association with TB risk (60-219 cDDD; HR, 0.860; 95% CI, 0.637-1.161; 220-479 cDDD, HR, 0.706; 95% CI, 0.485-1.028; ≥ 480 cDDD, HR, 0.319; 95% CI, 0.118-0.863). CONCLUSIONS Metformin use in the initial 2 years was associated with a decreased risk of TB, and metformin users had a reduced risk compared with their sulfonylurea comparators.
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Affiliation(s)
- Sheng-Wei Pan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Feng Yen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Vincent Yi-Fong Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Jia-Yih Feng
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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34
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Lioudaki E, Whyte M, Androulakis ES, Stylianou KG, Daphnis EK, Ganotakis ES. Renal Effects of SGLT-2 Inhibitors and Other Anti-diabetic Drugs: Clinical Relevance and Potential Risks. Clin Pharmacol Ther 2017; 102:470-480. [DOI: 10.1002/cpt.731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
Affiliation(s)
- E Lioudaki
- Renal Unit; Epsom and St Helier University Hospitals NHS Trust; London UK
- Department of Nephrology; University Hospital of Heraklion; Greece
| | - M Whyte
- Department of Clinical & Experimental Medicine; University of Surrey; Department of Medicine King's College Hospital
| | - ES Androulakis
- Cardiology Department; St George's University Hospital NHS; London UK
| | - KG Stylianou
- Department of Nephrology; University Hospital of Heraklion; Greece
| | - EK Daphnis
- Department of Nephrology; University Hospital of Heraklion; Greece
| | - ES Ganotakis
- Department of Internal Medicine; University Hospital of Heraklion; Greece
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Abstract
Patients with chronic kidney disease (CKD) are at risk for complications both inherent to the disease and as a consequence of its treatment. The dangers that CKD patients face change across the spectrum of the disease. Providers who are well-versed in these safety threats are best poised to safeguard patients as their CKD progresses.
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Affiliation(s)
- Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Carmona A, Agüera ML, Luna-Ruiz C, Buendía P, Calleros L, García-Jerez A, Rodríguez-Puyol M, Arias M, Arias-Guillen M, de Arriba G, Ballarin J, Bernis C, Fernández E, García-Rebollo S, Mancha J, Del Peso G, Pérez E, Poch E, Portolés JM, Rodríguez-Puyol D, Sánchez-Villanueva R, Sarro F, Torres A, Martín-Malo A, Aljama P, Ramírez R, Carracedo J. Markers of endothelial damage in patients with chronic kidney disease on hemodialysis. Am J Physiol Renal Physiol 2017; 312:F673-F681. [PMID: 28077371 DOI: 10.1152/ajprenal.00013.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 12/22/2022] Open
Abstract
Patients with Stage 5 chronic kidney disease who are on hemodialysis (HD) remain in a chronic inflammatory state, characterized by the accumulation of uremic toxins that induce endothelial damage and cardiovascular disease (CVD). Our aim was to examine microvesicles (MVs), monocyte subpopulations, and angiopoietins (Ang) to identify prognostic markers in HD patients with or without diabetes mellitus (DM). A total of 160 prevalent HD patients from 10 centers across Spain were obtained from the Biobank of the Nephrology Renal Network (Madrid, Spain): 80 patients with DM and 80 patients without DM who were matched for clinical and demographic criteria. MVs from plasma and several monocyte subpopulations (CD142+/CD16+, CD14+/CD162+) were analyzed by flow cytometry, and the plasma concentrations of Ang1 and Ang2 were quantified by ELISA. Data on CVD were gathered over the 5.5 yr after these samples were obtained. MV level, monocyte subpopulations (CD14+/CD162+ and CD142+/CD16+), and Ang2-to-Ang1 ratios increased in HD patients with DM compared with non-DM patients. Moreover, MV level above the median (264 MVs/µl) was associated independently with greater mortality. MVs, monocyte subpopulations, and Ang2-to-Ang1 ratio can be used as predictors for CVD. In addition, MV level has a potential predictive value in the prevention of CVD in HD patients. These parameters undergo more extensive changes in patients with DM.
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Affiliation(s)
- Andrés Carmona
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria L Agüera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Luna-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Buendía
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Calleros
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Biologia de Sistemas Department, Alcalá de Henares University, Madrid, Spain.,Biobanco Redes Temáticas de Investigación Cooperativa en Salud Red Renal, Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea García-Jerez
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Biologia de Sistemas Department, Alcalá de Henares University, Madrid, Spain.,Biobanco Redes Temáticas de Investigación Cooperativa en Salud Red Renal, Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Rodríguez-Puyol
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Biologia de Sistemas Department, Alcalá de Henares University, Madrid, Spain.,Biobanco Redes Temáticas de Investigación Cooperativa en Salud Red Renal, Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Arias
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marta Arias-Guillen
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Nefrologia y Trasplante Renal, Hospital Clinic de Barcelona, Institut D'Investigacions Biomediques August Pi I Sunyer, Universidad de Barcelona, Barcelona, Spain
| | - Gabriel de Arriba
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario de Guadalajara, Guadalajara, Spain.,Departamento de Medicina y Especialidades Médicas, Alcalá de Henares University, Madrid, Spain
| | - Jose Ballarin
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Fundació Puigvert, Barcelona, Spain
| | - Carmen Bernis
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario La Princesa Madrid, Madrid, Spain
| | - Elvira Fernández
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitari Arnau de Villanova de Lleida, Lleida, Spain
| | - Sagrario García-Rebollo
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Nefrología. Hospital Universitario de Canarias, Improving Biomedical Research and Innovation in the Canary Islands-Centro de Investigación Biomédica de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Javier Mancha
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Gloria Del Peso
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario La Paz, Madrid, Spain
| | - Estefanía Pérez
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Nefrología. Hospital Universitario de Canarias, Improving Biomedical Research and Innovation in the Canary Islands-Centro de Investigación Biomédica de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Esteban Poch
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Nefrologia y Trasplante Renal, Hospital Clinic de Barcelona, Institut D'Investigacions Biomediques August Pi I Sunyer, Universidad de Barcelona, Barcelona, Spain
| | - Jose M Portolés
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Puerta de Hierro, Madrid, Spain; and
| | - Diego Rodríguez-Puyol
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Rafael Sánchez-Villanueva
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario La Paz, Madrid, Spain
| | - Felipe Sarro
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitari Arnau de Villanova de Lleida, Lleida, Spain
| | - Armando Torres
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Nefrología. Hospital Universitario de Canarias, Improving Biomedical Research and Innovation in the Canary Islands-Centro de Investigación Biomédica de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Alejandro Martín-Malo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Aljama
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Ramírez
- Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Biologia de Sistemas Department, Alcalá de Henares University, Madrid, Spain
| | - Julia Carracedo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; .,Unidad de Gestión Clínica Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain.,Redes Temáticas de Investigación Cooperativa en Salud-Red Española de Investigación Renal, RD16/0009, Instituto de Salud Carlos III, Madrid, Spain.,Departament of Animal Physiology II, Faculty Biology, Complutense University, Madrid, Spain
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Offurum A, Wagner LA, Gooden T. Adverse safety events in patients with Chronic Kidney Disease (CKD). Expert Opin Drug Saf 2016; 15:1597-1607. [PMID: 27648959 DOI: 10.1080/14740338.2016.1236909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) confers a higher risk of adverse safety events as a result of many factors including medication dosing errors and use of nephrotoxic drugs, which can cause kidney injury and renal function decline. CKD patients may also have comorbidities such as hypertension and diabetes for which they require more frequent care from different providers, and for which standard, but countervailing treatments, may put them at risk for adverse safety events. Areas covered: In addition to the well-known agents such as iodinated radiocontrast, antimicrobials, diuretics and angiotensin converting enzyme (ACE) inhibitors which can directly affect renal function, safety considerations in the treatment of common CKD complications such as anemia, diabetes, analgesia and thrombosis will also be discussed. Expert opinion: Better outcomes in CKD may be achieved by alerting care providers to the special care needs of kidney patients and encouraging patients to self-manage their disease with the decision support of multidisciplinary patient care teams.
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Affiliation(s)
- Ada Offurum
- a General Internal Medicine , University of Maryland Medical System Ringgold standard institution , Baltimore , MD , USA
| | - Lee-Ann Wagner
- a General Internal Medicine , University of Maryland Medical System Ringgold standard institution , Baltimore , MD , USA
| | - Tanisha Gooden
- a General Internal Medicine , University of Maryland Medical System Ringgold standard institution , Baltimore , MD , USA
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Effect of Linagliptin on Structural Changes in the Kidney in Experimental Type 2 Diabetes Mellitus. Bull Exp Biol Med 2016; 161:501-4. [PMID: 27591880 DOI: 10.1007/s10517-016-3447-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Indexed: 12/16/2022]
Abstract
Effect of the dipeptidyl peptidase-4 inhibitor linagliptin on structural manifestations of diabetic nephropathy was studied in BKS.Cg-Dock7m+/+Leprdb/J mice (experimental model of type 2 diabetes mellitus). Linagliptin (10 mg/kg per day) or vehicle was administered by gavage over 8 weeks. Mesangial expansion, thickening of the basement membrane in glomerular capillaries and proximal tubules, and retraction of cytopodia were less pronounced in mice receiving linagliptin. The protective effect of linagliptin on the kidney structure was not associated with its hypoglycemic action.
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Bajaj S, Makkar BM, Abichandani VK, Talwalkar PG, Saboo B, Srikanta SS, Das A, Chandrasekaran S, Krishnan PV, Shah A, Abraham G, Tikku P, Kumar S. Management of anemia in patients with diabetic kidney disease: A consensus statement. Indian J Endocrinol Metab 2016; 20:268-81. [PMID: 27042425 PMCID: PMC4792030 DOI: 10.4103/2230-8210.176348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This consensus statement focuses on the window of opportunity, which exists while treating patients with diabetic kidney disease and anemia.
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Affiliation(s)
- Sarita Bajaj
- Director-Professor and Head, Department of Medicine, MLN Medical College, Allahabad, India
| | - Brij Mohan Makkar
- Sr. Consultant Physician and Diabetologist, Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | | | | | - Banshi Saboo
- Consultant Diabetologist, Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, India
| | - S. S. Srikanta
- Medical Director and Senior Consultant Endocrinology Diabetes, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Jnana Sanjeevini Diabetes Hospital and Medical Center, Bengaluru, India
| | - Ashok Das
- Professor of Medicine and Head of Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sruti Chandrasekaran
- Consultant Endocrinology, Diabetology and Metabolism, Global Hospitals, Adyar Cancer Institute, Vikas Center for Hormones and Mental Health, Chennai, India
| | - P. Venkata Krishnan
- Consultant, Division of Internal Medicine, Medanta - The Medicity Hospital, Gurgaon, Haryana, India
| | - Arun Shah
- Consultant Nephrologist, Lilavati Hospital and Bharatiya Arogyanidhi Hospital, Mumbai, India
| | - Georgi Abraham
- Professor of Medicine, Pondicherry Institute of Medical Sciences, Puducherry and Consultant – Nephrologist, Madras Medical Mission, Chennai, India
| | - Pankaj Tikku
- Executive Chief Editor and Editorial Head, Passi HealthCom Pvt. Ltd., Delhi, India
| | - Sushil Kumar
- Sr. Executive Editor, Passi HealthCom Pvt. Ltd, Delhi, India
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Naik H, Czerniak R, Vakilynejad M. Application of pharmacometric approaches to evaluate effect of weight and renal function on pharmacokinetics of alogliptin. Br J Clin Pharmacol 2016; 81:700-12. [PMID: 26617339 DOI: 10.1111/bcp.12853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/13/2015] [Accepted: 11/26/2015] [Indexed: 02/04/2023] Open
Abstract
AIMS The aims of the study were to characterize the pharmacokinetics (PK) of alogliptin in healthy and type 2 diabetes mellitus (T2DM) subjects using a population PK approach and to assess the influence of various covariates on alogliptin exposure. METHODS Plasma concentration data collected from two phase 1 studies and one phase 3 study following administration of alogliptin (12.5-400 mg) were used for the PK model development. One- and two-compartment models were evaluated as base structural PK models. The impact of selected covariates was assessed using stepwise forward selection and backward elimination procedures. The predictability and robustness of the final model was evaluated using visual predictive check and bootstrap analyses. The final model was used to perform simulations and guide appropriate dose adjustments. RESULTS A two-compartment model with first-order absorption and elimination best described the alogliptin concentration vs. time profiles. Creatinine clearance and weight had a statistically significant effect on the oral clearance (CL/F) of alogliptin. The model predicted a lower CL/F (17%, 35%, 80%) and a higher systemic exposure (56%, 89%, 339%) for subjects with mild, moderate and severe renal impairment, respectively, compared with healthy subjects. Effect of weight on CL/F was not considered clinically relevant. Simulations at different doses of alogliptin support the approved doses of 12.5 mg and 6.25 mg for patients with moderate and severe renal impairment, respectively. CONCLUSIONS The PK of alogliptin was well characterized by the model. The analysis suggested an alogliptin dose adjustment for subjects with moderate-to-severe renal impairment and no dose adjustments based on weight.
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Affiliation(s)
- Himanshu Naik
- Takeda Global Research & Development Center, Inc, One Takeda Parkway, Deerfield, IL, 60015, USA
| | - Richard Czerniak
- Takeda Global Research & Development Center, Inc, One Takeda Parkway, Deerfield, IL, 60015, USA
| | - Majid Vakilynejad
- Takeda Global Research & Development Center, Inc, One Takeda Parkway, Deerfield, IL, 60015, USA
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Zafon C. [New therapeutic approaches in type 2 diabetes mellitus]. Med Clin (Barc) 2015; 145:485-7. [PMID: 26142571 DOI: 10.1016/j.medcli.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Carles Zafon
- Unidad de Investigación en Diabetes y Metabolismo, Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Instituto de Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Barcelona, España.
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Magalhães FG, Goulart RMM. Doença renal crônica e tratamento em idosos: uma revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14132] [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] Open
Abstract
ResumoO envelhecimento populacional, juntamente com a crescente incidência de doenças crônicas, tem contribuído para o aumento mundial da prevalência da doença renal crônica (DRC). O objetivo deste estudo foi realizar uma revisão integrativa sobre os tratamentos propostos para idosos portadores de DRC na fase não dialítica. Foi efetuada uma busca na literatura, considerando-se o período entre janeiro de 2002 e maio de 2013, nas bases de dados eletrônicas MEDLINE, LILACS, SciELO e Science Direct, a partir das palavras-chave: chronic kidney disease, treatment e elderly. Foram incluídos os artigos livremente disponíveis e completos. Inicialmente, foram identificados 215 artigos. Após a etapa de elegibilidade, 13 artigos foram incluídos nessa revisão integrativa. As intervenções terapêuticas recomendadas para a gestão da DRC incluem o controle de hipertensão arterial, diabetes e dislipidemia, alterações alimentares, redução de peso e abstinência do fumo. Em relação ao tratamento, para muitos idosos com DRC, uma abordagem individualizada centrada no paciente pode ter mais a oferecer do que a abordagem tradicional orientada na doença. Quanto ao encaminhamento precoce ao nefrologista, esse parece ser um procedimento que apresenta benefícios na gestão da doença renal. Embora haja um esforço aparente dos pesquisadores em instituir abordagens terapêuticas mais adequadas, ainda são escassas as evidências de intervenções que melhorem a sobrevida de pacientes idosos com DRC. Contudo, algumas intervenções evitam agudizações e retardam a evolução da DRC. Nesse sentido, há necessidade da realização de estudos randomizados controlados de longo prazo incluindo indivíduos idosos com DRC, a fim de se conhecer procedimentos terapêuticos mais eficazes para o controle dessa doença.
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Zeisberg M, Zeisberg EM. Evidence for antifibrotic incretin-independent effects of the DPP-4 inhibitor linagliptin. Kidney Int 2015; 88:429-31. [DOI: 10.1038/ki.2015.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zhang M, Zhang Y, Li C, He L. Association between red blood cell distribution and renal function in patients with untreated type 2 diabetes mellitus. Ren Fail 2015; 37:659-63. [PMID: 25682974 DOI: 10.3109/0886022x.2015.1010938] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We assessed whether red cell distribution width (RDW) is associated with microalbuminuria (MAU) in a group of 320 patients with newly diagnosed type 2 diabetes mellitus (T2DM), recruited in Zhengzhou. Patients were divided into normal group and MAU group. Compared with the normal group, the patients with MAU had higher red blood cell count (p = 0.005) and RDW (p < 0.001). The multiple logistic regression indicated that RDW (OR = 3.89, 95% CI: 1.98-7.66, p < 0.001) was an independent risk factor of MAU in newly diagnosed T2DM. Other factors include smoking (OR = 4.44, 95% CI: 2.90-8.72, p < 0.001), higher waist index (OR = 2.17, 95% CI: 1.89-5.26, p = 0.002), FBG level (OR = 2.05, 95% CI: 1.21-3.84, p = 0.008) and uric acid level (OR = 2.18, 95% CI: 1.05-4.52, p = 0.037). The receiver operating characteristic (ROC) curves explored the relationship between MAU and RDW. The area under the curve was 0.79 (95% CI: 0.74-0.84; p < 0.001). Using a cut-off point of 12.8, the RDW predicted MAU in the T2DM patients with a sensitivity of 71.3% and specificity of 66.9%. RDW may be independently associated with MAU in patients with newly diagnosed T2DM. RDW may be treated as effective predictive index in the evaluation of diabetes nephropathy or diabetes-associated complications.
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Affiliation(s)
- Min Zhang
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan Province , China
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