scholarly journals Glucose lowering and vascular protective effects of cycloset added to GLP-1 receptor agonists in patients with type 2 diabetes

2018 ◽  
Vol 1 (4) ◽  
pp. e00034 ◽  
Author(s):  
Mariam Alatrach ◽  
Christina Agyin ◽  
John Adams ◽  
Robert Chilton ◽  
Curtis Triplitt ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Protective Effects ◽  
Glucose Lowering ◽  
Receptor Agonists

Efficacy and Safety of GLP-1 Receptor Agonists Across the Spectrum of Type 2 Diabetes Mellitus

2017 ◽  
Vol 125 (07) ◽  
pp. 419-435 ◽  
Author(s):  
Lawrence Leiter ◽  
Michael Nauck
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Efficacy And Safety ◽  
Phase 3 ◽  
Glucose Lowering ◽  
Receptor Agonists ◽  
Glucagon Like Peptide 1 ◽  
Gastrointestinal Adverse Events

AbstractFor patients with type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonists (GLP-1RAs) generally exert robust glucose-lowering effects that are at least as effective as insulin. As monotherapies, changes from baseline in HbA1c with GLP-1RAs ranged from –1.9 to –0.7% in phase 3 trials. In addition, GLP-1RAs confer a low risk of hypoglycaemia and have a body-weight advantage (changes from baseline ranging from –4.0 to –0.4 kg). There is also evidence of significant reductions in risk for cardiovascular events with some of these agents, with a number of other trials underway. Gastrointestinal adverse events typically increase with GLP-1RAs, although these are generally mild to moderate in intensity and rarely require treatment discontinuation. The GLP-1RAs that are commercially available or in development vary in structure and pharmacokinetics. These differences affect the frequency of administration and can also affect their relative efficacy and safety. This review summarizes the findings of phase 3 glycaemic control trials of available GLP-1RAs and considers them in the context of the distinct clinical needs of individual patients.

Dispensation Patterns of Glucose-Lowering Drugs in Newly Diagnosed Type 2 Diabetes: Routine Data Analysis of Insurance Claims in Germany

2021 ◽  
Author(s):  
Brenda Bongaerts ◽  
Bianca Kollhorst ◽  
Oliver Kuss ◽  
Iris Pigeot ◽  
Wolfgang Rathmann
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Diagnosis ◽  
Research Database ◽  
Second Line ◽  
Newly Diagnosed ◽  
First Line ◽  
Glucose Lowering ◽  
Receptor Agonists ◽  
Metformin Monotherapy

Abstract Aims To describe dispensation patterns of glucose-lowering drugs in newly diagnosed type 2 diabetes in Germany. Materials and methods Based on claims data from four statutory health insurances (German Pharmacoepidemiological Research Database,>25 million insurants), all individuals with newly diagnosed type 2 diabetes were identified. Eligible patients had a first diagnosis for type 2 diabetes between January 2012 and December 2016. We analyzed the dispensation patterns of first-line glucose-lowering therapies initiated in the year after diabetes diagnosis and patterns of second-line therapies dispensed one year after first-line treatment. Results A total of 356,647 individuals with newly diagnosed type 2 diabetes were included (average age [SD]: 63.5 [13.4] years; 49.3% males). Of the 31.6% of individuals who were pharmacologically treated in the year after diagnosis, metformin monotherapy was most frequently dispensed (73.1%), followed by dual therapy of metformin and dipeptidyl peptidase-4 inhibitors (DPP-4is) (6.4%), and monotherapy with DPP-4is (2.9%). From 2012 through 2016, sulfonylurea dispensations were reduced by more than 50%. Dispensations for combination therapies with DPP-4is increased up to 10.6%. Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors contributed to 2% of all treatments. After a median of 5 months, 20.0% of individuals on pharmacological therapy initiated second-line glucose-lowering treatment. Conclusions Data from German statutory health insurances (2012 to 2016) showed that most individuals with newly diagnosed type 2 diabetes were dispensed metformin monotherapy in line with diabetes care guidelines. A substantial decrease in the use of sulfonylureas was observed after the introduction of DPP-4i and GLP-1 receptor agonists.

scholarly journals Glycaemic Control in Diabetes

2021 ◽  
Author(s):  
D. Müller-Wieland ◽  
J. Brandts ◽  
M. Verket ◽  
N. Marx ◽  
K. Schütt
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Blood Glucose ◽  
Kidney Disease ◽  
Treatment Guidelines ◽  
Glucose Lowering ◽  
Receptor Agonists ◽  
Cardiovascular Endpoint

AbstractReduction of glucose is the hallmark of diabetes therapy proven to reduce micro- and macro-vascular risk in patients with type 1 diabetes. However glucose-lowering efficacy trials in type 2 diabetes didn’t show major cardiovascular benefit. Then, a paradigm change in the treatment of patients with type 2 diabetes has emerged due to the introduction of new blood glucose-lowering agents. Cardiovascular endpoint studies have proven HbA1c-independent cardioprotective effects for GLP-1 receptor agonists and SGLT-2 inhibitors. Furthermore, SGLT-2 inhibitors reduce the risk for heart failure and chronic kidney disease. Mechanisms for these blood glucose independent drug target-related effects are still an enigma. Recent research has shown that GLP-1 receptor agonists might have anti-inflammatory and plaque stabilising effects whereas SGLT-2 inhibitors primarily reduce pre- and after-load of the heart and increase work load efficiency of the heart. In addition, reduction of intraglomerular pressure, improved energy supply chains and water regulation appear to be major mechanisms for renoprotection by SGLT-2 inhibitors. These studies and observations have led to recent changes in clinical recommendations and treatment guidelines for type 2 diabetes. In patients with high or very high cardio-renal risk, SGLT-2 inhibitors or GLP-1 receptor agonists have a preferred recommendation independent of baseline HbA1c levels due to cardioprotection. In patients with chronic heart failure, chronic kidney disease or at respective risks SGLT-2 inhibitors are the preferred choice. Therefore, the treatment paradigm of glucose control in diabetes has changed towards using diabetes drugs with evidence-based organ protection improving clinical prognosis.

scholarly journals Values, preferences and burden of treatment for the initiation of GLP-1 receptor agonists and SGLT-2 inhibitors in adult patients with type 2 diabetes: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049130
Author(s):  
José Gerardo González-González ◽  
Alejandro Díaz González-Colmenero ◽  
Juan Manuel Millán-Alanís ◽  
Lyubov Lytvyn ◽  
Ricardo Cesar Solis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Daily Injection ◽  
Cochrane Central Register ◽  
Cardiovascular Risk Reduction ◽  
Once Daily ◽  
Glucose Lowering ◽  
Receptor Agonists ◽  
Burden Of Treatment ◽  
Glucagon Like Peptide 1

ObjectivesAssess values, preferences and burden of treatment that patients with type 2 diabetes consider when initiating glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i) compared with other glucose-lowering options.MethodsPaired reviewers independently included studies reporting quantitative or qualitative methods to assess values, preferences and burden of treatment reported by patients with type 2 diabetes regarding the initiation of GLP-1 RA or SGLT-2i over other alternatives. A systematic search in MEDLINE, Scopus, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials from inception until May 2020 was performed by an experienced librarian. Risk of bias was assessed with a specifically designed tool for values and preferences studies.Results17 studies (7296 patients) proved eligible. Studies fulfilling criteria for SGLT-2i were not identified. Five studies (2662 patients) evaluated preferences for GLP-1 RA compared with other glucose-lowering medications. 12 studies (4634 patients) evaluated preferences between, at least, two kinds of GLP-1 RA or their injection devices based on the following attributes: efficacy, dose, application frequency, device characteristics. Among studies comparing GLP-1 RA to other glucose-lowering medications, some preferences were observed for dypeptil peptidase-4 inhibitors compared with once daily liraglutide. Comparing different attributes of GLP-1 RA drugs and devices, cardiovascular risk reduction, glucose lowering potential, once weekly and simple administered regimens were the most preferred.ConclusionsAs no evidence for preferences on SGLT-2i was available, only preferences for GLP-1 RA were assessed; however, evidence is still limited for the latter. Studies comparing preferences for GLP1-RA to other glucose-lowering alternatives only included twice daily or once daily injection regimens of GLP-1 RA drugs. According to our findings, once weekly alternatives are widely preferred than the formers. The extent to which patients with type 2 diabetes value reduced adverse cardiovascular and kidney outcomes, weighed benefits against harms and burden of treatment is limited and with very low certainty.PROSPERO registration numberCRD42020159284.

scholarly journals Effects of SGLT2 Inhibitors and GLP-1 Receptor Agonists on Renin-Angiotensin-Aldosterone System

2021 ◽  
Vol 12 ◽  
Author(s):  
Soraya Puglisi ◽  
Alessandro Rossini ◽  
Roberta Poli ◽  
Francesca Dughera ◽  
Anna Pia ◽  
...  
Keyword(s):  
Plasma Renin ◽  
Target Tissue ◽  
Protective Effects ◽  
Ang Ii ◽  
Osmotic Diuresis ◽  
Renin Angiotensin Aldosterone System ◽  
Glucose Lowering ◽  
Renin Angiotensin ◽  
Receptor Agonists

Sodium-glucose cotransporters inhibitors (SGLT2-i) and GLP-1 receptor agonists (GLP1-RA) are glucose-lowering drugs that are proved to reduce the cardiovascular (CV) risk in type 2 diabetes mellitus (T2DM). In this process, the renin-angiotensin-aldosterone system (RAAS) is assumed to play a role. The inhibition of SGLT2 improves hyperglycemia hampering urinary reabsorption of glucose and inducing glycosuria. This “hybrid” diuretic effect, which couples natriuresis with osmotic diuresis, potentially leads to systemic RAAS activation. However, the association between SGLT2-i and systemic RAAS activation is not straightforward. Available data indicate that SGLT2-i cause plasma renin activity (PRA) increase in the early phase of treatment, while PRA and aldosterone levels remain unchanged in chronic treated patients. Furthermore, emerging studies provide evidence that SGLT2-i might have an interfering effect on aldosterone/renin ratio (ARR) in patients with T2DM, due to their diuretic and sympathoinhibition effects. The cardio- and reno-protective effects of GLP-1-RA are at least in part related to the interaction with RAAS. In particular, GLP1-RA counteract the action of angiotensin II (ANG II) inhibiting its synthesis, increasing the inactivation of its circulating form and contrasting its action on target tissue like glomerular endothelial cells and cardiomyocytes. Furthermore, GLP1-RA stimulate natriuresis inhibiting Na+/H+ exchanger NHE-3, which is conversely activated by ANG II. Moreover, GLP1 infusion acutely reduces circulating aldosterone, but this effect does not seem to be chronically maintained in patients treated with GLP1-RA. In conclusion, both SGLT2-i and GLP1-RA seem to have several effects on RAAS, though additional studies are needed to clarify this relationship.

scholarly journals Hemostasis effects of various glucose-lowering medications and angiopathy prevention

2011 ◽  
Vol 10 (3) ◽  
pp. 66-71
Author(s):  
G. G. Petrik ◽  
S. A. Pavlishchuk
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Protective Effects ◽  
Platelet Activity ◽  
Glucose Lowering ◽  
Carbohydrate And Lipid Metabolism ◽  
Metabolic Compensation ◽  
Platelet Disaggregation ◽  
Metformin Group

Aim. To assess hemostasis effects of various glucose-lowering medications (GLM), such as sulphanilamides, biguanides, and insulin, in regard to micro- and microangiopathy progression over 5 years in patients with Type 2 diabetes mellitus (DM-2). Material and methods. The study included 72 patients with DM-2 (47 women, 25 men; median age 54,0 years (49,0-59,0 years); mean DM-2 duration 4,0 years (0,5-8,0 years)), receiving one of the following GLMs for 5 years: glibenclamide, gliclazide, metformin, insulin, or the combination of glibenclamide and metformin. Results. Various GLMs had different effects on platelet activity. In the gliclazide group, aggregant activity was decreased, compared to the glibenclamide and insulin groups. In the metformin group, aggregant activity and platelet disaggregation were similar to that in the gliclazide group. The microangiopathy progression over 5 years was related to GLM therapy, being minimal in the DM-2 patients receiving metformin, and maximal among participants administered glibenclamide. The microangiopathy progression was minimal in the metformin and gliclazide groups, and maximal — in the glibenclamide group. Conclusion. Carbohydrate and lipid metabolism compensation is not the only condition of angiopathy prevention. The latter should be based on the complex intervention, aimed at the complete metabolic compensation and hemostasis balance. The need for taking pleiotropic activity of specific agents into consideration when choosing GLM therapy is emphasized by protective effects of metformin (micro- and microangiopathy prevention) and gliclazide (microangiopathy prevention), but not glibenclamide.

Sign in / Sign up

Export Citation Format

Share Document