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Bonadonna RC, Giaccari A, Buzzetti R, Aimaretti G, Cucinotta D, Avogaro A, Perseghin G, Larosa M, Bolli GB, Fanelli CG. Corrigendum to "Italian Titration Approach Study (ITAS) with insulin glargine 300 U/mL in insulin-naïve type 2 diabetes: Design and population" [Nutr Metabol Cardiovasc Dis 29 (5) (May 2019) 496-503]. Nutr Metab Cardiovasc Dis 2019; 29:869-870. [PMID: 31257093 DOI: 10.1016/j.numecd.2019.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- R C Bonadonna
- Division of Endocrinology and Metabolic Diseases, Department of Medicine and Surgery, University of Parma, AOU of Parma, Italy.
| | - A Giaccari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | | | | | - G B Bolli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Italy
| | - C G Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Italy
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Bonadonna RC, Giaccari A, Buzzetti R, Aimaretti G, Cucinotta D, Avogaro A, Perseghin G, Larosa M, Bolli GB, Fanelli CG. Italian Titration Approach Study (ITAS) with insulin glargine 300 U/mL in insulin-naïve type 2 diabetes: Design and population. Nutr Metab Cardiovasc Dis 2019; 29:496-503. [PMID: 30952575 DOI: 10.1016/j.numecd.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Fostering patient's self-managing of basal insulin therapy could improve glucose control, by removing patient's and physician's barriers to basal insulin initiation, titration and glucose monitoring. The Italian Titration Approaches Study (ITAS) aims at demonstrating non-inferiority (<0.3% margin) in efficacy of glucose control (change in glycated hemoglobin [HbA1c] after 24 weeks) by the same titration algorithm of insulin glargine 300 U/mL (Gla-300), managed by the (nurse assisted) patient versus the physician, in insulin naïve patients with Type 2 Diabetes Mellitus (T2DM), uncontrolled with previous treatments. METHODS AND RESULTS ITAS is a phase IV, 24-week, national, multicenter, open label, randomized (1:1) parallel group study. 458 patients were enrolled, 359 randomized, and 339 completed the study, in 46 Italian centers. Baseline characteristics and previous medications of the ITT population (N = 355) are reported. Mean ± SD age, T2DM duration, HbA1c, FPG and BMI were 64.0 ± 9.8 years, 11.6 ± 7.6 years, 8.79 ± 0.65%, 170.9 ± 42.3 mg/dL, and 30.3 ± 5.6 kg/m2, respectively. Vascular and metabolic disorders were most frequent (73.8% and 58.3%, respectively). More than 90% of patients were on metformin. CONCLUSION ITAS is the first study to compare two different managers (nurse-assisted patient vs physician) of the same titration algorithm of Gla-300 in insulin naïve patients with T2DM in unsatisfactory glucose control. This study might provide novel evidence on the efficacy/effectiveness of patient-managed titration algorithm of Gla-300 in a pragmatic setting and may reduce barriers to basal insulin initiation and its titration.
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Affiliation(s)
- R C Bonadonna
- Division of Endocrinology and Metabolic Diseases, Department of Medicine and Surgery, University of Parma, AOU of Parma, Italy.
| | - A Giaccari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | | | | | - G B Bolli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Italy
| | - C G Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Italy
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Ritzel R, Bolli G, Yale JF, Escalada J, Davies M, Landgraf W, Bertolini M, Hecquet C, Yki-Järvinen H, Rosenstock J. Hypoglykämierisiko und C-Peptid-Konzentrationen bei Menschen mit Typ-2-Diabetes und Therapie mit Insulin glargin 300 E/ml (Gla-300) oder Insulin glargin 100 E/ml (Gla-100). DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- R Ritzel
- Klinikum Schwabing und Klinikum Bogenhausen, Städtisches Klinikum München GmbH, München, Germany
| | - G Bolli
- Perugia University Medical School, Perugia, Italy
| | - JF Yale
- Department of Medicine, McGill University, Montreal, Canada
| | - J Escalada
- Clinic University of Navarra, Pamplona, Spain
| | - M Davies
- University of Leicester, Leicester, United Kingdom
| | - W Landgraf
- Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - M Bertolini
- Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - C Hecquet
- Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | | | - J Rosenstock
- Dallas Diabetes Research Center at Medical City, Dallas, TX, United States
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Ritzel R, Bailey T, Dahmen R, Pettus J, Roussel R, Bergmann K, Maroccia M, Nassr N, Klein O, Bolli G, Heise T. Insulin glargin 300 E/ml (Gla-300) liefert stabilere und gleichmäßiger verteilte Steady-State pharmakodynamische/pharmakokinetische Profile verglichen mit Insulin degludec bei Typ-1-Diabetes (T1DM). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- R Ritzel
- Städt. Klinikum München, Klinikum Schwabing, Klinik für Endokrinologie, Diabetologie und Suchtmedizin, München, Germany
| | - T Bailey
- AMCR Institute Inc., Escondido, United States
| | - R Dahmen
- Sanofi, Frankfurt am Main, Germany
| | - J Pettus
- Center for Metabolic Research, University of California, San Diego, United States
| | - R Roussel
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | | | - N Nassr
- Sanofi, Frankfurt am Main, Germany
| | - O Klein
- Profil Institut für Stoffwechselforschung, Neuss, Germany
| | - G Bolli
- University of Perugia, Perugia, Italy
| | - T Heise
- Profil Institut für Stoffwechselforschung, Neuss, Germany
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Bolli GB, Wysham CH, Fisher M, Chevalier S, Cali A, Leroy B, Riddle MC. Erweiterte Zeitfenster zur Evaluierung nächtlicher Hypoglykämien erfassen mehr Ereignisse und bestätigen ein geringeres Risiko für nächtliche Hypoglykämien mit Insulin glargin 300 E/ml (Gla-300) vs. 100 E/ml (Gla-100) bei Typ-2-Diabetes (T2DM). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- GB Bolli
- Perugia University Medical School, Perugia, Italy
| | - CH Wysham
- Rockwood Clinic, Spokane, United States
| | - M Fisher
- Royal Infirmary, Glasgow, United Kingdom
| | | | | | | | - MC Riddle
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, United States
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Terauchi Y, Koyama M, Cheng X, Sumi M, Riddle MC, Bolli GB, Hirose T. Glycaemic control and hypoglycaemia with insulin glargine 300 U/mL compared with glargine 100 U/mL in Japanese adults with type 2 diabetes using basal insulin plus oral anti-hyperglycaemic drugs (EDITION JP 2 randomised 12-month trial including 6-month extension). Diabetes Metab 2017; 43:446-452. [PMID: 28433560 DOI: 10.1016/j.diabet.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/22/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
AIMS To compare insulin glargine 300 U/mL (Gla-300) with glargine 100 U/mL (Gla-100) in Japanese adults with uncontrolled type 2 diabetes on basal insulin and oral anti-hyperglycaemic drugs over 12 months. METHODS EDITION JP 2 was a randomised, open-label, phase 3 study. Following a 6-month treatment period, participants continued receiving previously assigned once daily Gla-300 or Gla-100, plus oral anti-hyperglycaemic drugs, in a 6-month extension period. Glycaemic control, hypoglycaemia and adverse events were assessed. RESULTS The 12-month completion rate was 88% for Gla-300 and 96% for Gla-100, with comparable reasons for discontinuation. Mean HbA1c decrease from baseline to month 12 was 0.3% in both groups. Annualised rates of confirmed (≤3.9mmol/L [≤70mg/dL]) or severe hypoglycaemia were lower with Gla-300 than Gla-100 (nocturnal [00:00-05:59h]: rate ratio 0.41; 95% confidence interval: 0.18 to 0.92; anytime [24h]: rate ratio 0.64; 95% confidence interval: 0.44 to 0.94). Cumulative number of hypoglycaemic events was lower with Gla-300 than Gla-100. Adverse event profiles were comparable between treatments. CONCLUSION Over 12 months, Gla-300-treated participants achieved sustained glycaemic control and experienced less hypoglycaemia, particularly at night, versus Gla-100, supporting 6-month results.
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Affiliation(s)
- Y Terauchi
- Yokohama City University Graduate School of Medicine, Department of Endocrinology and Metabolism, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan.
| | - M Koyama
- Sanofi, 3-20-2 Nishi-Shinjuku, Shinjuku-ku, 163-1488 Tokyo, Japan.
| | - X Cheng
- Sanofi, 112 Jianguo Road, Chaoyang District, 100022 Beijing, China.
| | - M Sumi
- Sanofi, 3-20-2 Nishi-Shinjuku, Shinjuku-ku, 163-1488 Tokyo, Japan.
| | - M C Riddle
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, 97239 Portland, OR, USA.
| | - G B Bolli
- Perugia University School of Medicine, Ospedale Santa Maria della Misericordia, 06132 Perugia, Italy.
| | - T Hirose
- Toho University School of Medicine, 5 Chome-21-16 Omorinishi, Ota, 143-8540 Tokyo, Japan.
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Porcellati F, Lucidi P, Bolli GB, Fanelli CG. GLP-1 RAs as compared to prandial insulin after failure of basal insulin in type 2 diabetes: lessons from the 4B and Get-Goal DUO 2 trials. Diabetes Metab 2016; 41:6S16-6S20. [PMID: 26774015 DOI: 10.1016/s1262-3636(16)30004-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The add-on of a prandial (short-acting) GLP-1 RA to basal insulin in subjects with T2DM who fail to control A1C on basal insulin, stems from the physiological principles of post-prandial glucose homeostasis, and it is based on evidence from clinical trials. The 4B and GetGoal DUO 2 studies are the first to establish in head-to-head comparison, the efficacy and safety of short-acting GLP-1 RAs vs prandial insulin, when added-on to basal insulin glargine. In the 4B study (exenatide 2/d vs lispro 3/d) exenatide demonstrated similar efficacy vs lispro in reducing A1C to ~7.2%. However, exenatide reduced also body weight and hypoglycemia incidence as compared to lispro. In GetGoal DUO 2, the head-to-head comparison was between lixisenatide 1/d vs glulisine either 1/d (at the main meal, basal-plus) or 3/d (basal-bolus). Like in 4B, in GetGoal DUO 2 the A1C decreased to similar values with lixisenatide or glulisine 1/d (~7.2%), or glulisine 3/d (~7.0%). Again, as in the 4B, body weight and hypoglycemia incidence were lower with lixisenatide. In both studies a similar percentage of subjects reached the A1C <7.0% on GLP-1 RA or prandial insulin. A higher percentage of subjects reported adverse events on GLP-1 RAs, primarily gastrointestinal related. The studies 4B and GetGoal DUO 2 suggest that after failure of basal insulin in T2DM, the add-on of prandial GLP-1 RA is as effective as prandial insulin in lowering A1C, with added benefits of reducing body weight and risk for hypoglycemia. In addition, the GLP-1 RA + basal insulin is a simpler therapeutic option as compared to basal-plus and basal-bolus regimens.
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Affiliation(s)
- F Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Italy
| | - P Lucidi
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Italy
| | - G B Bolli
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Italy.
| | - C G Fanelli
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Italy
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Terauchi Y, Koyama M, Cheng X, Takahashi Y, Riddle MC, Bolli GB, Hirose T. New insulin glargine 300 U/ml versus glargine 100 U/ml in Japanese people with type 2 diabetes using basal insulin and oral antihyperglycaemic drugs: glucose control and hypoglycaemia in a randomized controlled trial (EDITION JP 2). Diabetes Obes Metab 2016; 18:366-74. [PMID: 26662838 PMCID: PMC5066636 DOI: 10.1111/dom.12618] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/01/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022]
Abstract
AIMS To compare the efficacy and safety of insulin glargine 300 U/ml (Gla-300) with glargine 100 U/ml (Gla-100) in Japanese people with type 2 diabetes using basal insulin plus oral antihyperglycaemic drug(s) [OAD(s)]. METHODS The EDITION JP 2 study (NCT01689142) was a 6-month, multicentre, open-label, phase III study. Participants (n = 241, male 61%, mean diabetes duration 14 years, mean weight 67 kg, mean body mass index 25 kg/m(2), mean glycated haemoglobin (HbA1c) 8.02 %, mean basal insulin dose 0.24 U/kg/day) were randomized to Gla-300 or Gla-100, while continuing OAD(s). Basal insulin was titrated to target fasting self-monitored plasma glucose 4.4-5.6 mmol/l. The primary efficacy endpoint was HbA1c change over 6 months. Safety endpoints included hypoglycaemia and weight change. RESULTS Gla-300 was non-inferior to Gla-100 for HbA1c reduction [least squares (LS) mean difference 0.10 (95% confidence interval [CI] -0.08, 0.27) %]. The mean HbA1c at month 6 was 7.56 and 7.52 % with Gla-300 and Gla-100, respectively. Nocturnal confirmed (≤3.9 mmol/l) or severe hypoglycaemia risk was 38% lower with Gla-300 versus Gla-100 [relative risk 0.62 (95% CI 0.44, 0.88)]; annualized rates were 55% lower at night [rate ratio 0.45 (95% CI 0.21, 0.96)] and 36% lower at any time [24 h; rate ratio 0.64 (95% CI 0.43, 0.96)]. Severe hypoglycaemia was infrequent. A significant between-treatment difference in weight change favoured Gla-300 [LS mean difference -1.0 (95% CI -1.5, -0.5) kg; p = 0.0003]. Adverse event rates were comparable between groups. CONCLUSIONS Japanese people with type 2 diabetes using basal insulin plus OAD(s) experienced less hypoglycaemia with Gla-300 than with Gla-100, while glycaemic control did not differ.
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Affiliation(s)
- Y Terauchi
- Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | | | | | - M C Riddle
- Oregon Health & Science University, Portland, OR, USA
| | - G B Bolli
- Perugia University Medical School, Perugia, Italy
| | - T Hirose
- Toho University School of Medicine, Tokyo, Japan
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Matsuhisa M, Koyama M, Cheng X, Takahashi Y, Riddle MC, Bolli GB, Hirose T. New insulin glargine 300 U/ml versus glargine 100 U/ml in Japanese adults with type 1 diabetes using basal and mealtime insulin: glucose control and hypoglycaemia in a randomized controlled trial (EDITION JP 1). Diabetes Obes Metab 2016; 18:375-83. [PMID: 26662964 PMCID: PMC5066635 DOI: 10.1111/dom.12619] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/01/2015] [Accepted: 11/30/2015] [Indexed: 12/24/2022]
Abstract
AIM To compare efficacy and safety of new insulin glargine 300 U/ml (Gla-300) with that of insulin glargine 100 U/ml (Gla-100) in Japanese adults with type 1 diabetes. METHODS The EDITION JP 1 study (NCT01689129) was a 6-month, multicentre, open-label, phase III study. Participants (n = 243) were randomized to Gla-300 or Gla-100 while continuing mealtime insulin. Basal insulin was titrated with the aim of achieving a fasting self-monitored plasma glucose target of 4.4-7.2 mmol/l. The primary endpoint was change in glycated haemoglobin (HbA1c) over 6 months. Safety measures included hypoglycaemia and change in body weight. RESULTS Gla-300 was non-inferior to Gla-100 for the primary endpoint of HbA1c change over the 6-month period {least squares [LS] mean difference 0.13 % [95 % confidence interval (CI) -0.03 to 0.29]}. The annualized rate of confirmed (≤3.9 mmol/l) or severe hypoglycaemic events was 34 % lower with Gla-300 than with Gla-100 at night [rate ratio 0.66 (95 % CI 0.48-0.92)] and 20 % lower at any time of day [24 h; rate ratio 0.80 (95 % CI 0.65-0.98)]; this difference was most pronounced during the first 8 weeks of treatment. Severe hypoglycaemia was infrequent. The basal insulin dose increased in both groups (month 6 dose: Gla-300 0.35 U/kg/day, Gla-100 0.29 U/kg/day). A between-treatment difference in body weight change over 6 months favouring Gla-300 was observed [LS mean difference -0.6 kg (95 % CI -1.1 to -0.0); p = 0.035]. Adverse event rates were comparable between the groups. CONCLUSIONS In Japanese adults with type 1 diabetes using basal plus mealtime insulin, less hypoglycaemia was observed with Gla-300 than with Gla-100, particularly during the night, while glycaemic control did not differ.
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Affiliation(s)
| | | | | | | | - M C Riddle
- Oregon Health & Science University, Portland, OR, USA
| | - G B Bolli
- Perugia University Medical School, Perugia, Italy
| | - T Hirose
- Toho University School of Medicine, Tokyo, Japan
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Monnier L, Owens DR, Bolli GB. The new long-acting insulin glargine U300 achieves an early steady state with low risk of accumulation. Diabetes Metab 2015; 42:77-9. [PMID: 26688145 DOI: 10.1016/j.diabet.2015.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- L Monnier
- Institute of Clinical Research, University of Montpellier, 641, avenue Doyen-Giraud, 34093 Montpellier cedex 5, France.
| | - D R Owens
- Diabetes Research Group, Swansea University, United Kingdom
| | - G B Bolli
- Department of Medicine, Perugia University School of Medicine, Perugia, Italy
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Yki-Järvinen H, Bergenstal RM, Bolli GB, Ziemen M, Wardecki M, Muehlen-Bartmer I, Maroccia M, Riddle MC. Glycaemic control and hypoglycaemia with new insulin glargine 300 U/ml versus insulin glargine 100 U/ml in people with type 2 diabetes using basal insulin and oral antihyperglycaemic drugs: the EDITION 2 randomized 12-month trial including 6-month extension. Diabetes Obes Metab 2015; 17:1142-9. [PMID: 26172084 PMCID: PMC5049622 DOI: 10.1111/dom.12532] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/16/2015] [Accepted: 07/02/2015] [Indexed: 12/03/2022]
Abstract
AIMS To compare the efficacy and safety of new insulin glargine 300 U/ml (Gla-300) with insulin glargine 100 U/ml (Gla-100) over 12 months of treatment in people with type 2 diabetes using basal insulin and oral antihyperglycaemic drugs (OADs). METHODS EDITION 2 (NCT01499095) was a randomized, 6-month, multicentre, open-label, two-arm, phase IIIa study investigating once-daily Gla-300 versus Gla-100, plus OADs (excluding sulphonylureas), with a 6-month safety extension. RESULTS Similar numbers of participants in each group completed 12 months of treatment [Gla-300, 315 participants (78%); Gla-100, 314 participants (77%)]. The reduction in glycated haemoglobin was maintained for 12 months with both treatments: least squares (LS) mean (standard error) change from baseline -0.55 (0.06)% for Gla-300 and -0.50 (0.06)% for Gla-100; LS mean difference -0.06 [95% confidence interval (CI) -0.22 to 0.10)%]. A significant relative reduction of 37% in the annualized rate of nocturnal confirmed [≤3.9 mmol/l (≤70 mg/dl)] or severe hypoglycaemia was observed with Gla-300 compared with Gla-100: rate ratio 0.63 [(95% CI 0.42-0.96); p = 0.031], and fewer participants experienced ≥1 event [relative risk 0.84 (95% CI 0.71-0.99)]. Severe hypoglycaemia was infrequent. Weight gain was significantly lower with Gla-300 than Gla-100 [LS mean difference -0.7 (95% CI -1.3 to -0.2) kg; p = 0.009]. Both treatments were well tolerated with a similar pattern of adverse events (incidence of 69 and 60% in the Gla-300 and Gla-100 groups). CONCLUSIONS In people with type 2 diabetes treated with Gla-300 or Gla-100, and non-sulphonylurea OADs, glycaemic control was sustained over 12 months, with less nocturnal hypoglycaemia in the Gla-300 group.
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Affiliation(s)
- H Yki-Järvinen
- Division of Diabetes, Faculty of Medicine, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - R M Bergenstal
- International Diabetes Center at Park Nicollet, Minneapolis, MN, USA
| | - G B Bolli
- Department of Medicine, University of Perugia, Perugia, Italy
| | - M Ziemen
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | | | | | | | - M C Riddle
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA
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Riddle MC, Yki-Järvinen H, Bolli GB, Ziemen M, Muehlen-Bartmer I, Cissokho S, Home PD. One-year sustained glycaemic control and less hypoglycaemia with new insulin glargine 300 U/ml compared with 100 U/ml in people with type 2 diabetes using basal plus meal-time insulin: the EDITION 1 12-month randomized trial, including 6-month extension. Diabetes Obes Metab 2015; 17:835-42. [PMID: 25846721 PMCID: PMC4676922 DOI: 10.1111/dom.12472] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/11/2015] [Accepted: 03/30/2015] [Indexed: 01/06/2023]
Abstract
AIMS To evaluate the maintenance of efficacy and safety of insulin glargine 300 U/ml (Gla-300) versus glargine 100 U/ml (Gla-100) in people with type 2 diabetes mellitus (T2DM) using basal plus meal-time insulin for 12 months in the EDITION 1 trial. METHODS EDITION 1 was a multicentre, randomized, open-label, two-arm, phase IIIa study. Participants completing the initial 6-month treatment period continued to receive Gla-300 or Gla-100, as previously randomized, once daily for a further 6-month open-label extension phase. Changes in glycated haemoglobin (HbA1c) and fasting plasma glucose concentrations, insulin dose, hypoglycaemic events and body weight were assessed. RESULTS Of 807 participants enrolled in the initial phase, 89% (359/404) assigned to Gla-300 and 88% (355/403) assigned to Gla-100 completed 12 months. Glycaemic control was sustained in both groups (mean HbA1c: Gla-300, 7.24%; Gla-100, 7.42%), with more sustained HbA1c reduction for Gla-300 at 12 months: least squares mean difference Gla-300 vs Gla-100: HbA1c -0.17 [95% confidence interval (CI) -0.30 to -0.05]%. The mean daily basal insulin dose at 12 months was 1.03 U/kg for Gla-300 and 0.90 U/kg for Gla-100. Lower percentages of participants had ≥1 confirmed [≤3.9 mmol/l (≤70 mg/dl)] or severe hypoglycaemic event with Gla-300 than Gla-100 at any time of day [24 h; 86 vs 92%; relative risk 0.94 (95% CI 0.89-0.99)] and during the night [54 vs 65%; relative risk 0.84 (95% CI 0.75-0.94)], while the annualized rates of such hypoglycaemic events were similar. No between-treatment differences in adverse events were apparent. CONCLUSION During 12 months of treatment of T2DM requiring basal and meal-time insulin, glycaemic control was better sustained and fewer individuals reported hypoglycaemia with Gla-300 than with Gla-100. The mean basal insulin dose was higher with Gla-300 compared with Gla-100, but total numbers of hypoglycaemic events and overall tolerability did not differ between treatments.
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Affiliation(s)
- M C Riddle
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - H Yki-Järvinen
- Department of Medicine, University of Helsinki, Helsinki, Finland
| | - G B Bolli
- Department of Medicine, Perugia University Medical School, Perugia, Italy
| | - M Ziemen
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | | | - S Cissokho
- Keyrus Biopharma, Levallois-Perret, France
| | - P D Home
- Department of Medicine, Newcastle University, Newcastle upon Tyne, UK
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Ritzel R, Roussel R, Bolli GB, Vinet L, Brulle-Wohlhueter C, Glezer S, Yki-Järvinen H. Patient-level meta-analysis of the EDITION 1, 2 and 3 studies: glycaemic control and hypoglycaemia with new insulin glargine 300 U/ml versus glargine 100 U/ml in people with type 2 diabetes. Diabetes Obes Metab 2015; 17:859-67. [PMID: 25929311 PMCID: PMC4676914 DOI: 10.1111/dom.12485] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 12/12/2022]
Abstract
AIMS To conduct a patient-level meta-analysis of the EDITION 1, 2 and 3 studies, which compared the efficacy and safety of new insulin glargine 300 U/ml (Gla-300) with insulin glargine 100 U/ml (Gla-100) in people with type 2 diabetes (T2DM) on basal and mealtime insulin, basal insulin and oral antihyperglycaemic drugs, or no prior insulin, respectively. METHODS The EDITION studies were multicentre, randomized, open-label, parallel-group, phase IIIa studies, with similar designs and endpoints. A patient-level meta-analysis of the studies enabled these endpoints to be examined over 6 months in a large population with T2DM (Gla-300, n = 1247; Gla-100, n = 1249). RESULTS No significant study-by-treatment interactions across studies were found, enabling them to be pooled. The mean change in glycated haemoglobin was comparable for Gla-300 and Gla-100 [each -1.02 (standard error 0.03)%; least squares (LS) mean difference 0.00 (95% confidence interval (CI) -0.08 to 0.07)%]. Annualized rates of confirmed (≤3.9 mmol/l) or severe hypoglycaemia were lower with Gla-300 than with Gla-100 during the night (31% difference in rate ratio over 6 months) and at any time (24 h, 14% difference). Consistent reductions were observed in percentage of participants with ≥1 hypoglycaemic event. Severe hypoglycaemia at any time (24 h) was rare (Gla-300: 2.3%; Gla-100: 2.6%). Weight gain was low (<1 kg) in both groups, with less gain with Gla-300 [LS mean difference -0.28 kg (95% CI -0.55 to -0.01); p = 0.039]. Both treatments were well tolerated, with similar rates of adverse events. CONCLUSION Gla-300 provides comparable glycaemic control to Gla-100 in a large population with a broad clinical spectrum of T2DM, with consistently less hypoglycaemia at any time of day and less nocturnal hypoglycaemia.
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Affiliation(s)
- R Ritzel
- Klinikum Schwabing, Städtisches Klinikum München GmbH, Munich, Germany
| | - R Roussel
- Diabetology Endocrinology Nutrition, DHU FIRE, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - G B Bolli
- Department of Medicine, University of Perugia, Perugia, Italy
| | - L Vinet
- EXPERIS IT, Nanterre, France
| | | | | | - H Yki-Järvinen
- Division of Diabetes, Faculty of Medicine and Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Ritzel R, Roussel R, Bolli GB, Vinet L, Yki-Järvinen H. New insulin glargine 300 U/mL: Glycemic control and hypoglycemia in a meta-analysis of EDITION clinical trials in people with T2DM. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ziemen M, Riddle MC, Bergenstal RM, Sestakauskas K, Goyeau H, Home PD, Bolli GB. New insulin glargine 300 U/mL: glycaemic control and hypoclycaemia in insulin-naïve people with type 2 diabetes mellitus (EDITION 3). DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hasslacher C, Bergenstal RM, Bolli GB, Wardęcki M, Riddle MC, Yki-Järvinen H. Weniger Nächtliche Hypoglykämien und Geringere Gewichtszunahme mit dem Neuen Insulin glargin 300 verglichen mit glargin 100: Einjahresdaten von Typ-2-Diabetikern unter basalunterstützter oraler Therapie (EDITION 2). DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Becker R, Jeandidier N, Riddle MC, Bolli GB, Home PD, Bergenstal RM, Wardęcki M, Vinet L, Yki-Järvinen H. Neues Insulin glargin 300 E/ml – Wirksamkeit und Sicherheit von fixen vs. flexiblen Injektionsintervallen bei Patienten mit Typ-2-Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ziemen M, Bergenstal RM, Riddle MC, Rojeski M, Espinasse M, Bolli GB, Home PD. Glycaemic control and hypoglycaemia with new insulin glargine 300 U/mL in people with type 1 diabetes (EDITION 4). DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ritzel R, Yki-Järvinen H, Bolli GB, Cissokho S, Home PD, Riddle MC. Sustained glycemic control and less hypoglycemia with new insulin glargine 300 U/mL vs. 100 U/mL: 1-year results in T2DM with basal+mealtime insulin (EDITION 1). DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bolli GB, Riddle MC, Bergenstal RM, Ziemen M, Sestakauskas K, Goyeau H, Home PD. New insulin glargine 300 U/ml compared with glargine 100 U/ml in insulin-naïve people with type 2 diabetes on oral glucose-lowering drugs: a randomized controlled trial (EDITION 3). Diabetes Obes Metab 2015; 17:386-94. [PMID: 25641260 PMCID: PMC4409854 DOI: 10.1111/dom.12438] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/08/2015] [Accepted: 01/10/2015] [Indexed: 12/11/2022]
Abstract
AIMS To compare the efficacy and safety of new insulin glargine 300 U/ml (Gla-300) with that of glargine 100 U/ml (Gla-100) in insulin-naïve people with type 2 diabetes using oral glucose-lowering drugs. METHODS The EDITION 3 study was a multicentre, open-label, parallel-group study. Participants were randomized to Gla-300 or Gla-100 once daily for 6 months, discontinuing sulphonylureas and glinides, with a dose titration aimed at achieving pre-breakfast plasma glucose concentrations of 4.4-5.6 mmol/l (80-100 mg/dl). The primary endpoint was change in glycated haemoglobin (HbA1c) from baseline to month 6. The main secondary endpoint was percentage of participants with ≥1 nocturnal confirmed [≤3.9 mmol/l (≤70 mg/dl)] or severe hypoglycaemia from week 9 to month 6. Other measures of glycaemia and hypoglycaemia, weight change and insulin dose were assessed. RESULTS Randomized participants (n = 878) had a mean (standard deviation) age of 57.7 (10.1) years, diabetes duration 9.8 (6.4) years, body mass index 33.0 (6.7) kg/m(2) and HbA1c 8.54 (1.06) % [69.8 (11.6) mmol/mol]. HbA1c levels decreased by equivalent amounts with the two treatments; the least squares mean difference in change from baseline was 0.04 [95% confidence interval (CI) -0.09 to 0.17] % or 0.4 (-1.0 to 1.9) mmol/mol. Numerically fewer participants reported ≥1 nocturnal confirmed (≤3.9 mmol/l) or severe hypoglycaemia from week 9 to month 6 [relative risk (RR) 0.89 (95% CI 0.66 to 1.20)] with Gla-300 versus Gla-100; a significantly lower risk of hypoglycaemia with this definition was found over the 6-month treatment period [RR 0.76 (95% CI 0.59 to 0.99)]. No between-treatment differences in adverse events were identified. CONCLUSIONS Gla-300 is as effective as Gla-100 in reducing HbA1c in insulin-naïve people with type 2 diabetes, with lower hypoglycaemia risk.
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Affiliation(s)
- G B Bolli
- Department of Medicine, Perugia University Medical School, Hospital Santa Maria della MisericordiaPerugia, Italy
- Correspondence to: Geremia B. Bolli, MD, Department of Medicine, Perugia University Medical School, Hospital Santa Maria della Misericordia, 06156 Perugia, Italy. E-mail:
| | - M C Riddle
- Department of Medicine, Oregon Health & Science UniversityPortland, OR, USA
| | - R M Bergenstal
- International Diabetes Center at Park NicolletMinneapolis, MN, USA
| | - M Ziemen
- Sanofi-Aventis Deutschland GmbHFrankfurt am Main, Germany
| | | | | | - P D Home
- Institute of Cellular Medicine, Newcastle UniversityNewcastle upon Tyne, UK
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Home PD, Bolli GB, Mathieu C, Deerochanawong C, Landgraf W, Candelas C, Pilorget V, Dain MP, Riddle MC. Modulation of insulin dose titration using a hypoglycaemia-sensitive algorithm: insulin glargine versus neutral protamine Hagedorn insulin in insulin-naïve people with type 2 diabetes. Diabetes Obes Metab 2015; 17:15-22. [PMID: 24957785 PMCID: PMC4282751 DOI: 10.1111/dom.12329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/21/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
Abstract
AIMS To examine whether insulin glargine can lead to better control of glycated haemoglobin (HbA1c) than that achieved by neutral protamine Hagedorn (NPH) insulin, using a protocol designed to limit nocturnal hypoglycaemia. METHODS The present study, the Least One Oral Antidiabetic Drug Treatment (LANCELOT) Study, was a 36-week, randomized, open-label, parallel-arm study conducted in Europe, Asia, the Middle East and South America. Participants were randomized (1:1) to begin glargine or NPH, on background of metformin with glimepiride. Weekly insulin titration aimed to achieve median prebreakfast and nocturnal plasma glucose levels ≤5.5 mmol/l, while limiting values ≤4.4 mmol/l. RESULTS The efficacy population (n = 701) had a mean age of 57 years, a mean body mass index of 29.8 kg/m², a mean duration of diabetes of 9.2 years and a mean HbA1c level of 8.2% (66 mmol/mol). At treatment end, HbA1c values and the proportion of participants with HbA1c <7.0 % (<53 mmol/mol) were not significantly different for glargine [7.1 % (54 mmol/mol) and 50.3%] versus NPH [7.2 % (55 mmol/mol) and 44.3%]. The rate of symptomatic nocturnal hypoglycaemia, confirmed by plasma glucose ≤3.9 or ≤3.1 mmol/l, was 29 and 48% less with glargine than with NPH insulin. Other outcomes were similar between the groups. CONCLUSION Insulin glargine was not superior to NPH insulin in improving glycaemic control. The insulin dosing algorithm was not sufficient to equalize nocturnal hypoglycaemia between the two insulins. This study confirms, in a globally heterogeneous population, the reduction achieved in nocturnal hypoglycaemia while attaining good glycaemic control with insulin glargine compared with NPH, even when titrating basal insulin to prevent nocturnal hypoglycaemia rather than treating according to normal fasting glucose levels.
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Affiliation(s)
- P D Home
- Institute for Cellular Medicine – Diabetes, Newcastle UniversityNewcastle upon Tyne, UK
- Correspondence to: Prof. Philip Home, Institute for Cellular Medicine – Diabetes, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. E-mail:
| | - G B Bolli
- Department of Medicine, University of PerugiaPerugia, Italy
| | - C Mathieu
- Department of Endocrinology, University Hospital GasthuisbergLeuven, Belgium
| | - C Deerochanawong
- Rajavithi Hospital, College of Medicine, Rangsit University, Ministry of Public HealthBangkok, Thailand
| | | | | | | | | | - M C Riddle
- Oregon Health & Science UniversityPortland, OR, USA
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Simon ACR, Bolli GB, Dain MP, Wang E, Holleman F. Physical characteristics that predict final basal insulin dose in type 2 diabetes mellitus, with a special focus on BMI. Nutr Metab Cardiovasc Dis 2014; 24:1354-1359. [PMID: 25261909 DOI: 10.1016/j.numecd.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/16/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS The possibility to predict final insulin dose based on patient's characteristics would allow for efficient titration for patients with higher dose needs. The primary aim of this post-hoc analysis of the L2T3 study was to determine predictors for final dose. Specifically, we focused on the relationship between BMI and dose. The secondary aims were to investigate (i) the predictive value of BMI and age on final dose and (ii) the possibility to tailor the starting dose of insulin based on BMI and age. METHODS AND RESULTS We performed two stepwise regression analyses, one using all baseline characteristics, and one using physical characteristics and FPG which can be assessed "at the bedside" only. Furthermore, median [min, max] final doses of groups stratified according to BMI and age were calculated. BMI clearly correlated with final dose in IU (Pearson correlation 0.42 [0.37; 0.48], p < 0.001). Characteristics which can be assessed "at the bedside" that predict high final dose were allocation to detemir, absence or discontinuation of insulin secretagogues, high BMI, low age, male gender and high FPG. Final dose varied among strata (BMI ≥30 kg/m(2): 64 IU; BMI <30 kg/m(2): 38 IU, p < 0.001 and age <59 years: 52 IU; age ≥59 years: 44 IU, p < 0.001). All groups stratified for both BMI and age showed similarly low minimal final dose (5-17 IU). CONCLUSION Our data showed a high predictive value of BMI on final dose. However, it does not seem possible to tailor starting dose based on BMI and age.
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Affiliation(s)
- A C R Simon
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
| | - G B Bolli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - E Wang
- Sanofi, Bridgewater, NJ, USA
| | - F Holleman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
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23
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Lucidi P, Porcellati F, Candeloro P, Cioli P, Andreoli AM, Marzotti S, Schmidt R, Bolli GB, Fanelli CG. Glargine metabolism over 24 h following its subcutaneous injection in patients with type 2 diabetes mellitus: a dose-response study. Nutr Metab Cardiovasc Dis 2014; 24:709-716. [PMID: 24702815 DOI: 10.1016/j.numecd.2014.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/29/2014] [Accepted: 02/10/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS After subcutaneous injection insulin glargine is rapidly metabolized to M1 and M2. In vitro, both M1 and M2 have metabolic effects and bind to IGF-1R similarly to human insulin, whereas glargine exhibits a higher affinity for the IGF-1R and greater mitogenetic effects. The present study was specifically designed to establish the dose-response metabolism of glargine over 24 h following s.c. injection in T2DM subjects on long-term use of glargine. METHODS AND RESULTS Ten subjects with T2DM were studied during 24 h after s.c. injection of 0.4 (therapeutic) and 0.8 (high dose) U/kg of glargine on two separate occasions during euglycaemic clamps (cross-over design). Glargine, M1 and M2 over 24 h period were determined in appropriately processed plasma samples by a specific liquid chromatography-tandem mass spectrometry assay. Plasma M1 concentration (AUC0-24 h) was detected in all subjects and increased by increasing the glargine dose from therapeutic to high dose (p = 0.008). Glargine was detectable in 6 (therapeutic dose) and 9 (high dose) out of the 10 subjects and also increased by increasing the dose (p = 0.031). However, glargine concentration (AUC0-24 h--high dose) represented at most only 9.7% (4.6-15%) of the total amount of insulin measured in the blood. M2 was not detected at all. CONCLUSION In T2DM people on long-term use of insulin glargine, even with higher doses (0.8 U/kg), glargine is nearly totally metabolized to the active metabolite M1. Glargine is often detectable in plasma, but its concentration remains well below that needed in vitro to potentiate IGF-1R binding and mitogenesis.
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Affiliation(s)
- P Lucidi
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - F Porcellati
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - P Candeloro
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - P Cioli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - S Marzotti
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - R Schmidt
- Diabetes Division, Sanofi, Frankfurt, Germany
| | - G B Bolli
- Department of Internal Medicine, University of Perugia, Perugia, Italy.
| | - C G Fanelli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
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Bolli GB, Owens DR. Lixisenatide, a novel GLP-1 receptor agonist: efficacy, safety and clinical implications for type 2 diabetes mellitus. Diabetes Obes Metab 2014; 16:588-601. [PMID: 24373190 DOI: 10.1111/dom.12253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/15/2013] [Accepted: 10/24/2013] [Indexed: 01/13/2023]
Abstract
Recent advances in therapies for the treatment of type 2 diabetes mellitus (T2DM) have led to the development of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which, unlike insulin and sulphonylurea, are effective, with a low risk of hypoglycaemia. Lixisenatide is recommended as a once-daily GLP-1 RA for the treatment of T2DM. In persons with T2DM, lixisenatide 20 µg once-daily given by bolus subcutaneous injection improves insulin secretion and suppresses glucagon secretion in a glucose-dependent manner. Compared with the longer-acting GLP-1 RA liraglutide, lixisenatide achieved a significantly greater reduction in postprandial plasma glucose (PPG) during a standardized test breakfast in persons with T2DM otherwise insufficiently controlled on metformin alone. This is primarily due to the greater inhibition of gastric motility by lixisenatide compared with liraglutide. The efficacy and safety of lixisenatide was evaluated across a spectrum of T2DM in a series of phase III, randomized, placebo-controlled trials known as the GetGoal programme. Lixisenatide monotherapy or as add-on to oral antidiabetic agents or basal insulin achieved significant reductions in glycated haemoglobin, PPG and fasting plasma glucose, with either weight loss or no weight gain. The most frequent adverse events were gastrointestinal and transient in nature. Lixisenatide provides an easy, once-daily, single-dose, add-on treatment to oral antidiabetic agents or basal insulin for the management of T2DM, with little or no increased risk of hypoglycaemia and a potential beneficial effect on body weight.
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Affiliation(s)
- G B Bolli
- Department of Medicine, University of Perugia, Hospital S.M. della Misericordia, Perugia, Italy
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Ritzel RA, Riddle MC, Bolli GB, Ziemen M, Muehlen-Bartmer I, Bizet F, Home PD. Neues Insulin glargin U300: Blutzuckerkontrolle und Hypoglykämiehäufigkeit bei Patienten mit Typ-2-Diabetes und einem Therapieschema aus Basal- und Mahlzeiteninsulin (EDITION 1). DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gastaldelli A, Balas B, Ratner R, Rosenstock J, Charbonnel B, Bolli GB, Boldrin M, Balena R. A direct comparison of long- and short-acting GLP-1 receptor agonists (taspoglutide once weekly and exenatide twice daily) on postprandial metabolism after 24 weeks of treatment. Diabetes Obes Metab 2014; 16:170-8. [PMID: 23911196 DOI: 10.1111/dom.12192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/21/2013] [Accepted: 07/29/2013] [Indexed: 01/06/2023]
Abstract
AIMS T-emerge 2 was a randomized, open-label, 24-week trial comparing subcutaneous taspoglutide 10 mg weekly (Taspo10), taspoglutide 20 mg weekly (Taspo20; titrated after 4 weeks of Taspo10), with exenatide 10 mcg BID (Exe; after 4 weeks of Exe 5 mcg) in patients inadequately controlled on metformin, a thiazolidinedione, or both. T-emerge 2 showed that once-weekly Taspo provided better glycaemic control than Exe. This report focuses on a subset of T-emerge 2 participants undergoing a standardized liquid meal comparing Taspo to Exe, which has been previously shown to lower postprandial glucose. METHODS Meal tolerance tests (MTT) were performed at baseline and at week 24 in a subset of Taspo10, Taspo20 and Exe patients (n = 42, 39 and 67, respectively). Blood samples for glucose, insulin, glucagon and C-peptide were obtained before and after (30, 60, 90, 120 and 180 min) ingestion of a standardized liquid meal. RESULTS The 2-h postprandial, mean 0-3 h and iAUC0-3 h glucose during the MTT was reduced to a similar extent in all groups and the time profile of the postprandial glucose showed a similar pattern. Taspo10 and Taspo20, but not Exe, significantly increased insulin from baseline (both mean and iAUC0-3 h). Although changes from baseline in C-peptide were not significant within any treatment group, the mean change from baseline (both mean 0-3 h and iAUC0-3 h) was significantly increased in Taspo10 vs. Exe. Mean glucagon showed significant decreases in all groups. CONCLUSION Taspoglutide and Exe improved postprandial glucose tolerance to a similar extent but possibly with different intimate mechanisms.
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Bolli GB, Munteanu M, Dotsenko S, Niemoeller E, Boka G, Wu Y, Hanefeld M. Efficacy and safety of lixisenatide once daily vs. placebo in people with Type 2 diabetes insufficiently controlled on metformin (GetGoal-F1). Diabet Med 2014; 31:176-84. [PMID: 24117597 DOI: 10.1111/dme.12328] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/31/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022]
Abstract
AIMS To assess the efficacy and safety of one- and two-step dose-increase regimens of lixisenatide once daily in participants with Type 2 diabetes mellitus insufficiently controlled with metformin. METHODS This was a randomized, double-blind, placebo-controlled, parallel-group, multi-centre study enrolling participants with Type 2 diabetes (n = 484) treated with metformin. Participants were randomized to receive either lixisenatide in a one-step dose increase or a two-step dose increase vs. placebo for 24 weeks, followed by a ≥ 52-week variable double blind period. Primary outcome was HbA1c reduction at week 24. RESULTS Lixisenatide one-/two-step once daily significantly improved HbA1c at week 24 compared with placebo (P < 0.0001) and allowed more participants to achieve HbA1c < 53 mmol/mol (< 7.0%) (P ≤ 0.0005). Improvements were observed in fasting plasma glucose (-0.5/-0.6 vs. +0.1 mmol/l; P < 0.001) and body weight (-2.6/-2.7 vs. -1.6 kg; P < 0.005). At week 24, adverse events were reported by 67.7/70.8/65.6% of participants treated with lixisenatide one-/two-step/placebo, respectively--nausea and vomiting being reported most frequently. Symptomatic hypoglycaemia occurred in 1.9/2.5% of participants on one-/two-step lixisenatide and 0.6% with placebo, with no severe episodes. Lixisenatide continued to be efficacious and well tolerated during the variable double-blind extension period of at least 52 weeks. CONCLUSIONS Lixisenatide one- or two-step dose-increase regimens significantly improved glycaemic control and decreased body weight over 24 weeks and during a long-term extension period without increasing hypoglycaemia. The study confirmed that tolerability in the one-step group was at least similar to the two-step dose increase, with nausea/vomiting and hypoglycaemia frequency being lower in the one-step regimen.
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Affiliation(s)
- G B Bolli
- University of Perugia, Perugia, Italy
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Owens DR, Monnier L, Bolli GB. Differential effects of GLP-1 receptor agonists on components of dysglycaemia in individuals with type 2 diabetes mellitus. Diabetes Metab 2013; 39:485-96. [PMID: 24156868 DOI: 10.1016/j.diabet.2013.09.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/13/2013] [Accepted: 09/22/2013] [Indexed: 12/11/2022]
Abstract
Metabolic consequences of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are the result of enhanced glucose-stimulated insulin secretion, inhibition of glucagon release, delayed gastric emptying and increased satiety. These attributes make GLP-1 agonists a treatment option in type 2 diabetes mellitus (T2DM). To optimise treatment choice, a detailed understanding of the effects of GLP-1 RAs on glucose homeostasis in individuals with T2DM is necessary. Although the various GLP-1 RAs share the same basic mechanisms of action, differences in pharmacokinetic/pharmacodynamic characteristics translate into differential effects on parameters of glycaemia. Head-to-head comparisons between long-acting non-prandial (liraglutide once daily and exenatide once weekly) and shorter-acting prandial (exenatide twice daily and lixisenatide once daily prandial) GLP-1 RAs confirm their differential effects on fasting plasma glucose (FPG) and post-prandial glucose (PPG). Liraglutide once daily and exenatide once weekly demonstrate greater reductions in FPG but lesser impacts on PPG excursions plasma than exenatide twice daily. Prandial GLP-1 RAs have a profound effect on post-prandial glycaemia, mediated by delaying gastric emptying, which is not subject to the tachyphylaxis occurring due to the sustained elevated plasma GLP-1 concentrations after treatment with long-acting GLP-1 RAs. Lixisenatide once-daily prandial, in contrast to liraglutide, strongly suppresses post-prandial glucagon secretion, further contributing to the more pronounced PPG-lowering effect found with lixisenatide. Evidence suggests that the GLP-1 RAs that predominantly target the prandial glucose excursions, such as exenatide twice daily and lixisenatide once-daily prandial, are therefore best used as combination therapy with basal insulin and will form an important new treatment option for individuals with T2DM.
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Affiliation(s)
- D R Owens
- Diabetes Research Group, Institute of Life Sciences College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
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Boyle P, Boniol M, Koechlin A, Bota M, Robertson C, Leroith D, Rosenstock J, Bolli GB, Autier P. Abstract P4-13-08: Diabetes, Related Factors and Breast Cancer Risk. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-13-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Diabetes and breast cancer are both extremely common conditions in women and may share common risk factors. It is natural to investigate any potential common risk factors and to seek biological clarification and improve prospects for prevention.
Therefore, in order to help clarify the potential association between diabetes, related factors and breast cancer risk, a comprehensive literature review and formal meta-analysis was carried out, planned, conducted and reported following PRISMA guidelines regarding meta-analysis of observational studies. Variables studies in relation to breast cancer risk were adiposity, physical activity, glycaemic load, glycaemic index, diabetes, IGF-1, fasting glucose, fasting insulin and C-peptide, adiponectin and metformin and glargine use among patients with diabetes. For all variables except diabetes and breast cancer, only prospective studies were included in meta-analyses. Summary Relative Risks (SRR) and corresponding 95% Confidence Intervals (CI) were calculated from random effect models.
For breast cancer at all ages, the calculated risks were as follows: diabetes (SRR = 1.27 95% CI (1.16, 1.39); physical activity (SRR = 0.88, 95% CI (0.85, 0.92)); glycaemic load (SRR = 1.06, 95% CI (1.00, 1.12)); glycaemic index (SRR = 1.04, 95% CI (0.99, 1.10)); fasting glucose (SRR = 1.12, 95% CI (1.01, 1.24)); serum insulin (SRR = 1.18, 95% CI (0.75, 1.85)); c-peptide (SRR = 1.29, 95% CI (0.91, 1.82)); adiponectin (SRR = 1.16, 95% CI (0.93, 1.46)); metformin (SRR = 1.00, 95% CI (0.69, 1.46)); and glargine (SRR = 1.11, 95% CI (1.00, 1.24)). An increase of 5 units in Body Mass Index (a weight increase if 14.5 kg in a person 1.70 metres tall) was associated in post-menopausal breast cancer (SRR = 1.12, 95% CI (1.08, 1.16)) but not at pre-menopausal ages (SRR = 0.83, 95% CI (0.72, 0.95)). Serum insulin was associated with breast cancer at post-menopausal ages but not at pre-menopausal ages whereas with c-peptide there was a significant association at pre-menopausal ages but not post-menopausal. For IGF-1, Hodge's Standardised Mean Difference (HSMD) was calculated in cohort studies and there was no significant association with breast cancer at all ages (HSMD = 0.003, 95% CI (−0.059, 0.065)), at post-menopausal ages (HSMD = −0.014, 95% CI (−0.106, 0.077)) or at pre-menopausal ages (HSMD = 0.039, 95% CI (−0.038, 0.117)).
The risk of breast cancer is increased among post-menopausal women who have diabetes. Among those factors related to diabetes, key risk factors for breast cancer appear to be adiposity and lack of physical activity which are both related to the risk of developing diabetes. Action on these lifestyle factors should form the basis of a common prevention strategy. There is a need to re-evaluate potential biological mechanisms to explain the increased risk in post-menopausal women with diabetes.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-08.
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Affiliation(s)
- P Boyle
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Boniol
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - A Koechlin
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Bota
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - C Robertson
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - D Leroith
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - J Rosenstock
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - GB Bolli
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - P Autier
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
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Boyle P, Koechlin A, Boniol M, Bota M, Robertson C, Rosenstock J, Bolli GB. Abstract P4-13-07: Meta-analysis of epidemiological studies of Insulin Glargine and Breast Cancer Risk. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-13-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
After having lain dormant for a while, the association between diabetes, its risk factors and treatments, and cancer risk and death is now high on the clinical and research agenda. The microscope is currently focused on the relationships between Pioglitazone and Bladder Cancer, Exenatide and Pancreas Cancer, Liraglutide and pancreas cancer and insulin use and lung cancer. The potential association between use of insulin glargine and breast cancer risk has been the subject of recent major studies.
All data regarding cancer risk and use of insulin glargine has been assembled and meta-analyses performed using state-of-the-art statistical methodology. A random effects model was employed with tests for heterogeneity (I2) and publication bias. These meta-analyses are based on reports from 21 epidemiological studies involving over one million patients and 3 million person-years of observation.
Based on independent estimates from these studies, the Summary Relative Risk (SRR) for all forms of cancer was (SRR = 0.91, 95% CI (0.84, 0.99)), and for breast cancer SRR = 1.11 (95% CI (1.00, 1.48)). For new users of glargine, the SRR for breast cancer was SRR = 1.22 (95% CI (1.00, 1.48)). For colorectal cancer the SRR = 0.83 (95% CI (0.74, 0.94)) and for prostate cancer SRR = 1.14 (95% CI (0.93, 1.39)). Overall, the risk of developing cancer among users of insulin glargine is reduced compared to the risk of users of other insulins. Similarly, the risk of colorectal cancer is reduced among users of glargine.
While the lower bound of the 95% confidence interval is 1.00, the risk of breast cancer does not increase with increasing duration of use of glargine. In some studies the trend in risk with increasing duration of use goes in opposite directions. The development of a detectable breast cancer from the initial carcinogenic event depends on the tumour doubling time. The time for a de novo breast cancer to become detectable ranges from 12.3 years for a doubling time of 150 days; 16.4 years for a doubling time of 200 days; and 20.5 years for a doubling time of 250 days. Most published studies have a maximum of 3–4 years of glargine use.
The databases employed in these analyses were not designed for such epidemiological investigation. A major limitation is the absence of knowledge as to why a potential treatment was prescribed for an individual and why a change in therapy was indicated. Further potential limitations to this meta-analysis include that the comparison group was not the same in all studies but this could also be seen as a strength. The meta-analysis of the randomized trials had several insulin comparators and the retinopathy study had NPH as the comparator. This is not likely to invalidate the findings of this analysis nor would the fact that different adjustments were made in the individual studies.
The current evidence gives no support to the hypothesis that insulin glargine is associated with an increased risk of cancer as compared to other insulins and should give reassurance to physicians and their patients. In respect to breast cancer, there is no indication of a causal association between use of insulin glargine and increased risk of breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-07.
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Affiliation(s)
- P Boyle
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - A Koechlin
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Boniol
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Bota
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - C Robertson
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - J Rosenstock
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - GB Bolli
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
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Bolli GB, Consoli A, Giaccari A. Early insulin treatment in type 2 diabetes: ORIGINal sin or valuable choice as ORIGINal treatment? An open debate on the ORIGIN study results. Nutr Metab Cardiovasc Dis 2012; 22:1007-1012. [PMID: 23199612 DOI: 10.1016/j.numecd.2012.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 10/21/2012] [Accepted: 10/23/2012] [Indexed: 11/27/2022]
Abstract
Diabetes is ultimately the result of relative or absolute insulin deficiency; insulin should therefore represent its "natural" treatment, from the very moment of diagnosis, or even earlier, such as any other hormonal deficiency. Insulin treatment, however, has been accused of the worst crimes, including that of fostering obesity, insulin resistance, atherosclerosis, and, lately, cancer. Are these charges real? Does insulin treatment truly carry in its nature the original sin of causing such terrible consequences? This unresolvable, past and present dispute has had important effects on our clinical behavior in insulin initiation in the management of Type 2 diabetes, and we all hoped that a specifically designed trial could help us on this controversy. The ORIGIN (Outcome Reduction with an Initial Glargine Intervention) trial aimed to establish whether an initial insulin treatment with glargine, as compared with standard treatments, was able to delay the onset of cardiovascular disease. Although the trial appeared negative, several viewpoints came out, alimenting the debate on how to analyze results from the ORIGIN trial and, ultimately, on the role of early insulin treatment in type 2 diabetes. In these pages we invited two experienced scientists to freely argument their interpretation of the trial, aiming to help our understanding of the consequences of the ORIGIN trial on insulin therapy.
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Affiliation(s)
- G B Bolli
- Clinica di Medicina Interna e Scienze Endocrine e Metaboliche, University of Perugia, Department of Medicine, Hospital Santa Maria della Misericordia, 06129 Sant'Andrea delle Fratte, Perugia, Italy
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Boyle P, Koechlin A, Boffetta P, Boniol M, Bolli G, Rosenstock J. Meta-analysis of insulin glargine and cancer risk. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bolli GB, Luzio S, Marzotti S, Porcellati F, Sert-Langeron C, Charbonnel B, Zair Y, Owens DR. Comparative pharmacodynamic and pharmacokinetic characteristics of subcutaneous insulin glulisine and insulin aspart prior to a standard meal in obese subjects with type 2 diabetes. Diabetes Obes Metab 2011; 13:251-7. [PMID: 21205115 PMCID: PMC3132447 DOI: 10.1111/j.1463-1326.2010.01343.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS A multinational, randomized, double-blind, two-way crossover trial to compare the pharmacokinetic and pharmacodynamic properties of bolus, subcutaneously administered insulin glulisine (glulisine) and insulin aspart (aspart) in insulin-naÏve, obese subjects with type 2 diabetes. METHODS Thirty subjects [9/21 females/males; mean ± SD age: 60.7 ± 7.7 years; body mass index (BMI): 33.5 ± 3.3 kg/m(2) ; duration of diabetes: 6.8 ± 4.6 years; HbA1c: 7.1 ± 0.8%] were included in the analysis. They fasted overnight and then received a 0.2 U/kg subcutaneous dose of glulisine or aspart 2 min before starting a standardized test meal, 7 days apart, according to a randomization schedule. Blood samples were taken every 15 min, starting 20 min before the meal and ending 6 h postprandially. RESULTS The area under the absolute glucose concentration-time curve between 0 and 1 h after insulin injection and maximal glucose concentration was significantly lower with glulisine than with aspart (p = 0.0455 and 0.0337, respectively). However, for the total study period, plasma glucose concentration was similar for glulisine and aspart. Peak insulin concentration was significantly higher for glulisine than for insulin aspart (p < 0.0001). Hypoglycaemic events (≤ 70 mg/dl with or without symptoms) occurred in 13 and 16 subjects treated with glulisine and aspart, respectively, but there were no cases of severe hypoglycaemia requiring intervention. CONCLUSIONS Glulisine was associated with lower glucose levels during the first hour after a standard meal; the remaining glucose profiles were otherwise equivalent, with higher insulin levels observed throughout the study period.
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Affiliation(s)
- G B Bolli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
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Bolli GB, Songini M, Trovati M, Del Prato S, Ghirlanda G, Cordera R, Trevisan R, Riccardi G, Noacco C. Lower fasting blood glucose, glucose variability and nocturnal hypoglycaemia with glargine vs NPH basal insulin in subjects with Type 1 diabetes. Nutr Metab Cardiovasc Dis 2009; 19:571-579. [PMID: 18676131 DOI: 10.1016/j.numecd.2008.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 05/06/2008] [Accepted: 05/24/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS To compare switching from NPH insulin (NPH) to insulin glargine (glargine) with continuing NPH for changes in fasting blood glucose (FBG) in patients with Type 1 diabetes on basal-bolus therapy with insulin lispro as bolus insulin. Secondary objectives included self-monitoring blood glucose, mean daily blood glucose (MDBG) and mean amplitude glucose excursion (MAGE) values alongside changes in HbA(1c) and safety profiles. METHODS AND RESULTS This was a 30-week, parallel, open-label, multicentre study. Seven-point profiles were used to calculate MDBG and MAGE. Hypoglycaemia and adverse events were recorded by participants. FBG improved significantly with both glargine (baseline-endpoint change: -28.0 mg/dL; 95% CI: -37.3, -18.7 mg/dL; p<0.001) and NPH (-9.8 mg/dL; 95% CI: -19.1, -0.5 mg/dL; p=0.0374). The improvement was significantly greater with glargine than NPH (mean difference: -18.2 mg/dL; 95% CI: -31.3, -5.2 mg/dL; p=0.0064). MDBG (-10.1 mg/dL; 95% CI: -18.1, -2.1 mg/dL; p=0.0126) and MAGE (-20.0 mg/dL; 95% CI: -34.5, -5.9 mg/dL; p=0.0056) decreased significantly with glargine, but not NPH although endpoint values were no different with the two insulins. Baseline to endpoint change in HbA(1c) was similar (-0.56 vs -0.56%) with no differences at endpoint. Overall hypoglycaemia was no different, but glargine reduced nocturnal hypoglycaemia ("serious episodes" with BG < 42 mg/dl, p=0.006) whereas NPH did not (p=0.123), although endpoint values were no different. CONCLUSION Switching from NPH to glargine is well tolerated and results into lower FBG, and lower glucose variability while reducing nocturnal hypoglycaemia. These data provide a rationale for more aggressive titration to target with glargine in Type 1 diabetes.
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Affiliation(s)
- G B Bolli
- Department of Internal Medicine, Endocrinology and Metabolism, University of Perugia, Italy.
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Abstract
AIM To compare the tolerability and efficacy of vildagliptin to pioglitazone as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin monotherapy over 1-year duration. METHODS This 52-week, multicentre, randomized, active-controlled study compared vildagliptin (50 mg b.i.d., n = 295) and pioglitazone (30 mg daily, n = 281) in patients with inadequate glycaemic control [haemoglobin A1c (HbA(1c)) 7.5-11%] receiving a stable dose of metformin (>or=1500 mg). The primary objective was to demonstrate non-inferiority of vildagliptin at 24 weeks in the change in HbA(1c) from baseline. The objective of the additional 28 weeks of the study was to assess long-term safety, while also assessing mean change from baseline to study end in HbA(1c), fasting plasma glucose and body weight. RESULTS When added to a stable dose of metformin (mean baseline dose approximately 2 g/day), the non-inferiority of HbA(1c) lowering of vildagliptin to pioglitazone over 24 weeks was established at the non-inferiority margin of 0.3% (between-group difference = 0.1%). During the remaining 28 weeks, comparable HbA(1c) decreases were recorded in both groups. Overall adverse event (AE) rates were similar in both groups, as was the occurrence of peripheral oedema. Hypoglycaemia occurred rarely in both groups. Serious AEs occurred more frequently with pioglitazone group. While mean body weight increased significantly in the pioglitazone group (+2.6 kg) from baseline, there was no significant weight gain with vildagliptin (+0.2 kg). CONCLUSIONS When added to metformin, vildagliptin demonstrates favourable safety and tolerability over 1 year. Vildagliptin provided additional HbA(1c) lowering to that achieved with metformin alone and comparable to that achieved with pioglitazone, with only pioglitazone causing weight gain.
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Affiliation(s)
- G Bolli
- Section of Internal Medicine, Endocrinology and Metabolism, University of Perugia, Perugia, Italy
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Abstract
The new rDNA and DNA-derived "basal" insulin analogs, glargine and detemir, represent significant advancement in the treatment of diabetes compared with conventional NPH insulin. This review describes blood glucose homeostasis by insulin in people without diabetes and outlines the physiological application of exogenous insulin in patients with type 1 and type 2 diabetes. The requirements for optimal basal insulin treatment are discussed and the methods used in the evaluation of basal insulins are presented. An essential criterion in the development of an "ideal" basal insulin preparation is that the molecular modifications made to the human insulin molecule do not compromise safety. It is also necessary to obtain a clear understanding of the pharmacokinetic and pharmacodynamic characteristics of the two currently available basal insulin analogs. When comparing glargine and detemir, the different molar concentration ratios of the two insulin formulations should be considered along with the nonspecificity of assay systems used to determine insulin concentrations. However, euglycemic clamp studies in crossover study design provide a good basis for comparing the pharmacodynamic responses. When the latter is analyzed by results of intervention clinical trials, it is concluded that both glargine and detemir are superior to NPH in type 1 and type 2 diabetes. However, there is sufficient evidence to demonstrate that these two long-acting insulin analogs are different in both their pharmacokinetic and pharmacodynamic profiles. These differences should be taken into consideration when the individual analogs are introduced to provide basal insulin supplementation to optimize blood glucose control in patients with type 1 and type 2 diabetes as well. PubMed-Medline was searched for articles relating to pharmacokinetics and pharmacodynamics of glargine and detemir. Articles retrieved were reviewed and selected for inclusion if (1) the euglycemic clamp method was used with a duration >or=24 h, (2) a single subcutaneous dose of glargine/detemir was used, and (3) area under the curve for insulin concentrations or glucose infusion rates were calculated.
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Affiliation(s)
- D R Owens
- Diabetes Research Unit, Cardiff University, University Hospital Llandough, Penarth, United Kingdom.
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Bolli G, Dotta F, Rochotte E, Cohen SE. Efficacy and tolerability of vildagliptin vs. pioglitazone when added to metformin: a 24-week, randomized, double-blind study. Diabetes Obes Metab 2008; 10:82-90. [PMID: 18034842 DOI: 10.1111/j.1463-1326.2007.00820.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to compare the efficacy and tolerability of vildagliptin vs. pioglitazone as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin monotherapy. METHODS This 24-week, multicentre, double-blind, randomized, active-controlled study compared vildagliptin (100 mg daily, given as equally divided doses, n = 295) and pioglitazone (30 mg daily, given as a single q.d. dose, n = 281) in patients with inadequate glycaemic control (A1C 7.5-11%) while receiving a stable metformin dose (> or =1500 mg daily). The adjusted mean changes from baseline to study endpoint (AMDelta) in A1C, fasting plasma glucose (FPG), fasting lipids and body weight were compared by analysis of covariance. RESULTS When added to a stable dose of metformin (mean dose at baseline >2000 mg/day), both vildagliptin and pioglitazone decreased A1C (AMDelta = -0.9 +/- 0.1% and -1.0 +/- 0.1%, respectively) from identical baseline values (8.4 +/- 0.1%). The between-group difference in AMDelta A1C was 0.1 +/- 0.1%, and non-inferiority of vildagliptin to pioglitazone was established at both 0.4 and 0.3% margins for upper limit of the 95% confidence intervals. Pioglitazone decreased FPG (AMDelta = -2.1 +/- 0.1 mmol/l) to a greater extent than vildagliptin (AMDelta = -1.4 +/- 0.1 mmol/l), but only pioglitazone increased body weight (AMDelta = +1.9 +/- 0.2 kg: between-group difference = -1.6 +/- 0.3 kg, p < 0.001). Adverse events (AEs) were reported by 60% of vildagliptin-treated patients and by 56.4% of pioglitazone-treated patients; serious AEs were reported by 2.0 and 4.6% of patients receiving vildagliptin and pioglitazone respectively. Mild hypoglycaemia was reported by one patient (0.3%) in the vildagliptin group and by no patients receiving pioglitazone. CONCLUSIONS When added to metformin, the efficacy of vildagliptin is non-inferior to that of pioglitazone. The treatments were similarly well tolerated, but only pioglitazone increased body weight.
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Affiliation(s)
- G Bolli
- Section of Internal Medicine, Endocrinology and Metabolism, University of Perugia, Perugia, Italy
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Torlone E, Gennarini A, Ricci NB, Bolli GB. Successful use of insulin glargine during entire pregnancy until delivery in six Type 1 diabetic women. Eur J Obstet Gynecol Reprod Biol 2007; 132:238-9. [PMID: 16806646 DOI: 10.1016/j.ejogrb.2006.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 05/22/2006] [Accepted: 05/26/2006] [Indexed: 11/22/2022]
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Porcellati F, Pampanelli S, Rossetti P, Busciantella Ricci N, Marzotti S, Lucidi P, Santeusanio F, Bolli GB, Fanelli CG. Effect of the amino acid alanine on glucagon secretion in non-diabetic and type 1 diabetic subjects during hyperinsulinaemic euglycaemia, hypoglycaemia and post-hypoglycaemic hyperglycaemia. Diabetologia 2007; 50:422-30. [PMID: 17160672 DOI: 10.1007/s00125-006-0519-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Accepted: 09/18/2006] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of our study was to establish whether the well-known defective or absent secretion of glucagon in type 1 diabetes in response to hypoglycaemia is selective or includes lack of responses to other stimuli, such as amino acids. MATERIALS AND METHODS Responses of glucagon to hypoglycaemia were measured in eight patients with type 1 diabetes and six non-diabetic subjects during hyperinsulinaemic (insulin infusion 0.5 mU kg(-1) min(-1)) and eu-, hypo- and hyperglycaemic clamp studies (sequential steps of plasma glucose 5.0, 2.9, 5.0, 10 mmol/l). Subjects were studied on three randomised occasions with infusion of low- or high-dose alanine, or saline. RESULTS With saline, glucagon increased in hypoglycaemia in non-diabetic subjects but not in diabetic subjects. Glucagon increased further with low-dose (181 +/- 16 ng l(-1) min(-1)) and high-dose alanine (238 +/- 20 ng l(-1) min(-1)) in non-diabetic subjects, but only with high-dose alanine in diabetic subjects (area under curve 112 +/- 5 ng l(-1) min(-1)). The alanine-induced glucagon increase in diabetic subjects paralleled the spontaneous glucagon response to hypoglycaemia in non-diabetic subjects not receiving alanine. The greater responses of glucagon to hypoglycaemia with alanine infusion were offset by recovery of eu- or hyperglycaemia. CONCLUSIONS/INTERPRETATION In type 1 diabetes, the usually deficient responses of glucagon to hypoglycaemia may improve after increasing the concentration of plasma amino acids. Amino acid-enhanced secretion of glucagon in response to hypoglycaemia remains under physiological control since it is regulated primarily by the ambient plasma glucose concentration. These findings might be relevant to improving counter-regulatory defences against insulin-induced hypoglycaemia in type 1 diabetes.
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Affiliation(s)
- F Porcellati
- Department of Internal Medicine, University of Perugia, Via E. Dal Pozzo, 06126, Perugia, Italy
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41
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Rossetti P, Porcellati F, Fanelli CG, Bolli GB. Evaluation of the accuracy of a microdialysis-based glucose sensor during insulin-induced hypoglycemia, its recovery, and post-hypoglycemic hyperglycemia in humans. Diabetes Technol Ther 2006; 8:326-37. [PMID: 16800754 DOI: 10.1089/dia.2006.8.326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND These studies were designed to evaluate the accuracy of a microdialysis-based subcutaneous glucose sensor (GlucoDay, A. Menarini Diagnostics, Firenze, Italy) compared with a standard reference method of plasma glucose measurement during insulin-induced hypoglycemia. RESEARCH DESIGN AND METHODS Nine subjects without diabetes were studied in eu-, hypo-, and hyperglycemia (clamp technique). The GlucoDay was calibrated against one arterialized plasma glucose measurement (Glucose Analyzer, Beckman, Brea, CA), and plasma glucose estimates every 3 min were compared with paired plasma glucose values. RESULTS Accuracy of glucose estimates was not homogeneously distributed among subjects and depended on stability of the sensor's current signal during spontaneous euglycemia (R +/- -0.68). Linear regression analysis showed a good correlation between the two methods of measurement (R = 0.9), Deming regression showed the inclusion of the unit in the confidence interval of the slope (slope 0.95, 95% confidence interval 0.87-1.02), and the accuracy of the GlucoDay reached 40 +/- 15% (American Diabetes Association criteria). The mean relative difference was 6 +/- 8% in euglycemia, 13 +/- 14% during plasma glucose fall, 5 +/- 22% in the hypoglycemic plateau, and -14 +/- 16% during recovery from hypoglycemia. The Bland-Altman analysis indicated a bias of -1.9 +/- 16.6 mg/dL, whereas the Error Grid Analysis showed 94% of the Gluco- Day measurements in the acceptable zones of the grid. The time to reach the glycemic nadir was longer when measured with the GlucoDay (90 +/- 5 vs. 72.5 +/- 9 min, P < 0.05). However, absolute values of glycemic nadir, time spent in hypoglycemia, and the rate of fall of glycemia and the rate of recovery from the hypoglycemia were not statistically different. CONCLUSIONS GlucoDay closely monitors changes in plasma glucose before, during, and after hypoglycemia. However, these results can be achieved only if calibration of the GlucoDay is performed under conditions of sensor signal stability. Similar studies have to be performed in subjects with diabetes to validate the GlucoDay system.
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Affiliation(s)
- P Rossetti
- Department of Internal Medicine, Endocrinology and Metabolism, University of Perugia, Perugia, Italy
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Fanelli CG, Porcellati F, Rossetti P, Bolli GB. Glucagon: the effects of its excess and deficiency on insulin action. Nutr Metab Cardiovasc Dis 2006; 16 Suppl 1:S28-S34. [PMID: 16530126 DOI: 10.1016/j.numecd.2005.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 10/20/2005] [Accepted: 10/20/2005] [Indexed: 10/25/2022]
Abstract
AIM To review the role that glucagon plays in physiology, physiopathology and clinical medicine. DATA SYNTHESIS Glucagon assays employing specific radioimmunoassay (RIA) techniques are now widely used to characterize pathologic conditions where the effect of the excess or deficiency of glucagon on insulin actions might play a role. Glucagon excess counteracts the action of insulin on glucose metabolism by stimulating glycogenolysis and gluconeogenesis. Aside from glucagon excess in association with glucagonoma, glucagon excess is found in several metabolic disturbances. In diabetes mellitus, hyperglycaemia is the consequence of the glycogenolytic and gluconeogenic effects of glucagon excess occurring in the setting of a relative insulin deficiency (i.e. Type 2 diabetes), whereas excess of glucagon and absent insulin levels are typical features of diabetic ketoacidosis. Although plasma glucagon levels of patients with diabetes are usually increased relative to the prevailing plasma glucose concentrations, it is a paradox that in those patients glucagon levels fail to rise when hypoglycaemia develops. Since glucagon release is considered the primary defence against insulin-induced hypoglycaemia, the defective response of glucagon to hypoglycaemia may favour the development of severe hypoglycaemia. Such defective response to hypoglycaemia in diabetes can be regarded as a condition of selective glucagon deficiency the mechanisms of which remain to be elucidated. CONCLUSION The most common condition associated with glucagon excess or deficiency is diabetes mellitus. Glucagon excess contributes to hyperglycaemia whereas reduced glucagon response to insulin-induced hypoglycaemia promotes severe hypoglycaemia. It is expected that drugs that are able to reduce glucagon secretion in concert with strategies directed to recover glucagon secretion to hypoglycaemia might contribute to improve the overall glycaemic control in diabetes.
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Affiliation(s)
- C G Fanelli
- Department of Internal Medicine, Section of Endocrinology and Metabolism, University of Perugia, Via E. Dal Pozzo, I-06126 Perugia, Italy
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43
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Hoogma RPLM, Hammond PJ, Gomis R, Kerr D, Bruttomesso D, Bouter KP, Wiefels KJ, de la Calle H, Schweitzer DH, Pfohl M, Torlone E, Krinelke LG, Bolli GB. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med 2006; 23:141-7. [PMID: 16433711 DOI: 10.1111/j.1464-5491.2005.01738.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The goal of the study was to determine whether continuous subcutaneous insulin infusion (CSII) differs from a multiple daily injection (MDI) regimen based on neutral protamine hagedorn (NPH) as basal insulin with respect to glycaemic control and quality of life in people with Type 1 diabetes. METHODS The 5-Nations trial was a randomized, controlled, crossover trial conducted in 11 European centres. Two hundred and seventy-two patients were treated with CSII or MDI during a 2-month run-in period followed by a 6-month treatment period, respectively. The quality of glycaemic control was assessed by HbA(1c), blood glucose values, and the frequency of hypoglycaemic events. For the evaluation of the quality of life, three different self-report questionnaires have been assessed. RESULTS CSII treatment resulted in lower HbA(1c) (7.45 vs. 7.67%, P < 0.001), mean blood glucose level (8.6 vs. 9.4 mmol/l, P < 0.001) and less fluctuation in blood glucose levels than MDI (+/- 3.9 vs. +/- 4.3 mmol/l, P < 0.001). There was a marked reduction in the frequency of hypoglycaemic events using CSII compared with MDI, with an incidence ratio of 1.12 [95% confidence interval (CI): 1.08-1.17] and 2.61 (95% CI: 1.59-4.29) for mild and severe hypoglycaemia, respectively. The overall score of the diabetes quality of life questionnaire was higher for CSII (P < 0.001), and an improvement in pump users' perception of mental health was detected when using the SF-12 questionnaire (P < 0.05). CONCLUSION CSII usage offers significant benefits over NPH-based MDI for individuals with Type 1 diabetes, with improvement in all significant metabolic parameters as well as in patients' quality of life. Additional studies are needed to compare CSII with glargine- and detemir-based MDI.
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Porcellati F, Rossetti P, Pampanelli S, Fanelli CG, Torlone E, Scionti L, Perriello G, Bolli GB. Better long-term glycaemic control with the basal insulin glargine as compared with NPH in patients with Type 1 diabetes mellitus given meal-time lispro insulin. Diabet Med 2004; 21:1213-20. [PMID: 15498088 DOI: 10.1111/j.1464-5491.2004.01323.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glargine is a long-acting insulin analogue potentially more suitable than NPH insulin in intensive treatment of Type 1 diabetes mellitus (T1 DM), but no study has proven superiority. The aim of this study was to test superiority of glargine on long-term blood glucose (BG) as well as on responses to hypoglycaemia vs. NPH. METHODS One hundred and twenty-one patients with T1 DM on intensive therapy on four times/day NPH and lispro insulin at each meal, were randomized to either continuation of NPH four times/day (n = 60), or once daily glargine at dinner-time (n = 61) for 1 year. Lispro insulin at meal-time was continued in both groups. In 11 patients from each group, responses to stepped hyperinsulinaemic-hypoglycaemia were measured before and after 1 year's treatment. RESULTS Mean daily BG was lower with glargine [7.6 +/- 0.11 mmol/l (137 +/- 2 mg/dl)] vs. NPH [8.1 +/- 0.22 mmol/l (146 +/- 4 mg/dl)] (P < 0.05). HbA(1c) at 4 months did not change with NPH, but decreased with glargine (from 7.1 +/- 0.1 to 6.7 +/- 0.1%), and remained lower than NPH at 12 months (6.6 +/- 0.1%, P < 0.05 vs. NPH). Frequency of mild hypoglycaemia [self-assisted episodes, blood glucose < or = 4.0 mmol/l (72 mg/dl)] was lower with glargine vs. NPH (7.2 +/- 0.5 and 13.2 +/- 0.6 episodes/patient-month, P < 0.05). After 1 year, NPH treatment resulted in no change of responses to hypoglycaemia, whereas with glargine plasma glucose, thresholds and maximal responses of plasma adrenaline and symptoms to hypoglycaemia improved (P < 0.05). CONCLUSIONS The simpler glargine regimen decreases the percentage of HbA(1c) and frequency of hypoglycaemia and improves responses to hypoglycaemia more than NPH. Thus, glargine appears more suitable than NPH as basal insulin for intensive treatment of T1 DM.
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Affiliation(s)
- F Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, University of Perugia, Via E. Dal Pozzo, I-06126 Perugia, Italy
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Di Loreto C, Ranchelli A, Lucidi P, Murdolo G, Parlanti N, De Cicco A, Tsarpela O, Annino G, Bosco C, Santeusanio F, Bolli GB, De Feo P. Effects of whole-body vibration exercise on the endocrine system of healthy men. J Endocrinol Invest 2004; 27:323-7. [PMID: 15233550 DOI: 10.1007/bf03351056] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whole-body vibration is reported to increase muscle performance, bone mineral density and stimulate the secretion of lipolytic and protein anabolic hormones, such as GH and testosterone, that might be used for the treatment of obesity. To date, as no controlled trial has examined the effects of vibration exercise on the human endocrine system, we performed a randomized controlled study, to establish whether the circulating concentrations of glucose and hormones (insulin, glucagon, cortisol, epinephrine, norepinephrine, GH, IGF-1, free and total testosterone) are affected by vibration in 10 healthy men [age 39 +/- 3, body mass index (BMI) of 23.5 +/- 0.5 kg/m2, mean +/- SEM]. Volunteers were studied on two occasions before and after standing for 25 min on a ground plate in the absence (control) or in the presence (vibration) of 30 Hz whole body vibration. Vibration slightly reduced plasma glucose (30 min: vibration 4.59 +/- 0.21, control 4.74 +/- 0.22 mM, p=0.049) and increased plasma norepinephrine concentrations (60 min: vibration 1.29 +/- 0.18, control 1.01 +/- 0.07 nM, p=0.038), but did not change the circulating concentrations of other hormones. These results demonstrate that vibration exercise transiently reduces plasma glucose, possibly by increasing glucose utilization by contracting muscles. Since hormonal responses, with the exception of norepinephrine, are not affected by acute vibration exposure, this type of exercise is not expected to reduce fat mass in obese subjects.
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Affiliation(s)
- C Di Loreto
- Department of Internal Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (IMISEM), University of Perugia, Perugia, Italy
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Abstract
Attempts at replicating physiological insulin secretion, as a means of restoring the normal metabolic milieu and thereby minimizing the risk of diabetic complications, has become an essential feature of insulin treatment. However, despite advances in the production, purification, formulation and methods of delivery of insulin which have occurred in recent years, this has met with limited success. The current advocacy of intensive insulin therapy regimens involving multiple daily subcutaneous injection places a heavy burden of compliance on patients and has prompted interest in developing alternative, less invasive routes of delivery. To date, attempts to exploit the nasal, oral, gastrointestinal and transdermal routes have been mainly unsuccessful. The respiratory tree, with a large surface area, offers the greatest potential for the delivery of polypeptide drugs and there is renewed interest in administrating insulin by the intrapulmonary route. Current pulmonary drug delivery systems include a variety of pressurized metered dose inhalers, dry powder inhalers, nebulizers and aqueous mist inhalers. Recent clinical studies suggest a possible role for inhaled insulin in fulfilling meal-related insulin requirements in persons with Type 1 and Type 2 diabetes. Most experience with inhaled insulin has been obtained using either dry powder formulation in the Nektar Pulmonary Inhaler/Exubera device (Nektar Therapeutics Inc., San Carlos, CA, Aventis, Bridgewater, NJ, Pfizer, NY) or a liquid aerosol formulation in the AERx Insulin Diabetes Management System (Aradigm Corp., Hayward, CA, NovoNordisk A/S, Copenhagen, Denmark). If long-term safety and efficacy is confirmed, inhalation may become the first non-subcutaneous route of insulin administration for widespread clinical use. Despite overwhelming interest and investment in administering insulin via the oral route, success is not expected in the short term. Attempts at utilizing the buccal mucosa and skin are also continuing. Pancreatic transplantation will remain limited to those patients receiving a kidney transplant and immunotherapy. Islet cell transplantation is at an early though encouraging stage following the availability of new less toxic immunosuppressive agents. True insulin independence will require further advances in the combined fields of cell biology and genetics to ensure freedom from both the need for lifelong administration of insulin and the complications of diabetes.
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Affiliation(s)
- D R Owens
- University of Wales College of Medicine, Cardiff, UK.
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47
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Fanelli CG, Pampanelli S, Porcellati F, Bartocci L, Scionti L, Rossetti P, Bolli GB. Rate of fall of blood glucose and physiological responses of counterregulatory hormones, clinical symptoms and cognitive function to hypoglycaemia in Type I diabetes mellitus in the postprandial state. Diabetologia 2003; 46:53-64. [PMID: 12637983 DOI: 10.1007/s00125-002-0948-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2002] [Accepted: 08/29/2002] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to establish the effect of a rate of decreasing plasma glucose concentrations on responses to hypoglycaemia, i.e. release of counterregulatory hormones, perception of symptoms, deterioration of cognitive function, and rates of forearm noradrenaline spillover, in the postprandial condition and in the sitting position. METHODS We studied 11 subjects with Type I (insulin-dependent) diabetes mellitus, twice during clamped insulin-induced hypoglycaemia (2.4 mmol/l) after eating in the sitting position. On one occasion, plasma glucose was decreased at the rate of 0.1+/-0.003 mmol x min(-1) x l(-1) (fast fall), on the other at the rate of 0.03+/-0.001 mmol x min(-1) x l(-1) (slow fall). Subjects underwent a control euglycaemic clamp study as well. RESULTS In response to fast-fall as compared to slow-fall hypoglycaemia, which was about 30 min longer, cognitive tasks were performed as follows: Trail-Making B, PASAT 2 s, Digit Vigilance Test and Verbal Memory deteriorated more, adrenaline increased less (2.8+/-0.5 vs 3.5+/-0.7 nmol/l, p=0.03), forearm noradrenaline spillover was greater (6.5+/-1.0 vs 5.2+/-0.4 pmol x min(-1) x 100 ml(-1), p=0.04), and symptoms were no different. After recovery from hypoglycaemia, cognitive function was still deteriorated compared to the baseline with no difference between fast and slow-fall hypoglycaemia. The evident response of glucagon to postprandial hypoglycaemia contrasted with the blunted or absent response in the fasting state. CONCLUSION/INTERPRETATION In the postprandial condition and sitting position, fast-fall hypoglycaemia is more dangerous than slow-fall, because it deteriorates cognitive function more, and activates responses of counterregulatory hormones less than slow-fall hypoglycaemia.
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Affiliation(s)
- C G Fanelli
- University of Perugia, Department of Internal Medicine, Perugia, Italy
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48
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Bolli GB, Pampanelli S, Porcellati F, Fanelli CG. Recovery and prevention of hypoglycaemia unawareness in type 1 diabetes mellitus. Diabetes Nutr Metab 2002; 15:402-9; discussion 409. [PMID: 12678458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- G B Bolli
- Department of Internal Medicine, University of Perugia, Perugia, Italy.
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Herz M, Arora V, Sun B, Ferguson SC, Bolli GB, Frier BM. Basal-bolus insulin therapy in Type 1 diabetes: comparative study of pre-meal administration of a fixed mixture of insulin lispro (50%) and neutral protamine lispro (50%) with human soluble insulin. Diabet Med 2002; 19:917-23. [PMID: 12421428 DOI: 10.1046/j.1464-5491.2002.00830.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To ascertain whether pre-meal administration of 50% insulin lispro and 50% neutral protamine lispro (NPL), given as a fixed mixture (Humalog Mix50, human soluble (regular) insulin as a basal-bolus regimen in people with Type 1 diabetes. Both regimens included bedtime human isophane (NPH) insulin. METHODS This was a multinational, multicentre, randomized, open-label, two-period crossover comparison of two insulin treatments for two 12-week periods in 109 patients with Type 1 diabetes. The protocol provided preliminary evaluations of dose requirements and recommendations for insulin dose adjustment when switching regimens on the basis of blood glucose (BG) values. Eight-point BG profiles, frequency of hypoglycaemia, HbA1c, insulin dose, time of injection, and frequency of snacking were assessed during each treatment. RESULTS Total daily insulin dose was similar for both treatments, but the total pre-meal doses were higher (P < 0.001) and the bedtime dose of isophane was lower (P < 0.001) with Mix50. The pre-meal dose before breakfast and lunch, although statistically different (P = 0.006 and P < 0.001, respectively), was of similar magnitude, but the pre-evening meal dose was higher with Mix50 (P < 0.001). Median (interquartile range) time of insulin injection before meals was: Mix50 4.2 (25th percentile = 1.0; 75th percentile = 6.3) min, human soluble insulin 24.6 (25th percentile = 16.6; 75th percentile = 30.0) min. Pre-meal and bedtime BG concentrations did not differ between treatments. The BG 2 h after the evening meal was lower with Mix50 (8.40 +/- 2.95 mmol/l vs. 9.60 +/- 3.47 mmol/l) (P = 0.049). BG after breakfast and lunch, mean HbA1c, frequency of hypoglycaemia, frequency of snacks, and body weight were not different. CONCLUSION The use of Mix50 in a basal-bolus regimen achieved similar control of pre-meal BG to human soluble insulin, and overall glycaemic control and hypoglycaemia risk were equivalent. This suggests that Mix50 can provide an adequate supply of insulin to control BG between meals while providing the convenience of injecting immediately before meals.
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Affiliation(s)
- M Herz
- Diabetes Product Team, Eli Lilly and Company, Indianapolis, IN, USA.
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50
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De Feo P, Pampanelli S, Porcellati F, Rossetti P, Fanelli CG, Bolli GB. Adrenaline vs glucagon in the primacy of glucose counterregulation. Diabetes Nutr Metab 2002; 15:323-7; discussion 328. [PMID: 12625479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- P De Feo
- Department of Internal Medicine, University of Perugia, Perugia, Italy
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