scholarly journals Prevalence of Incretin-Mimetic and Sodium-Glucose-Transporter-2-Inhibitor Therapy in German Hospitalized Type-2 Diabetics Following Myocardial Revascularization: An Observational Study

2020 ◽  
Author(s):  
Rainer U. Pliquett ◽  
Linda Golle ◽  
Andreas Wienke ◽  
Matthias Girndt
Keyword(s):  
Observational Study ◽  
Glucose Transporter ◽  
Myocardial Revascularization ◽  
Inhibitor Therapy ◽  
Glucose Transporter 2 ◽  
Type 2 Diabetics

scholarly journals Prevalence of Incretin-mimetic and Sodium-Glucose-Transporter-2-Inhibitor Therapy in Hospitalized Type-2-Diabetics following Myocardial Revascularization: an Observational Study

2020 ◽  
Author(s):  
Rainer U. Pliquett ◽  
Linda Golle ◽  
Andreas Wienke ◽  
Matthias Girndt
Keyword(s):  
Observational Study ◽  
Glucose Transporter ◽  
Inhibitor Therapy ◽  
Glucose Transporter 2 ◽  
Type 2 Diabetics ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background: We hypothesized that the recommended incretin-mimetic therapy associates with a better outcome (1-year mortality after discharge, rehospitalizations within 12 months) and with less hypoglycemic events in type − 2 diabetics following myocardial revascularization. Methods: Hospitalized type-2 diabetics of the Departments of Cardiology and Cardiothoracic Surgery (University Hospital Halle), who had percutaneous coronary intervention (29.4%) or coronary artery bypass graft (70.6%) in 2016, were included in this observational study: Group 1 (incretin-mimetic therapy), Group 2 (insulin therapy without incretin mimetics) or Group 3 (oral diabetes medication without incretins or insulin). They were asked to mail in a questionnaire on medical therapy, number of hypoglycemic episodes and rehospitalizations 2 years following discharge. In non-responders, the vital status was obtained by local registries 2.4 years after discharge. Results: 204 patients were recruited in this prospective observational study. At discharge, only 3.9% of all type-2 diabetics had an incretin mimetic, 39.7% were on insulin, and 56.4% on oral medication. In all patient groups together, the prevalence of incretin-mimetic therapy did not change (3.9% at discharge, 2.9% at follow-up). The prevalence of sodium glucose transporter-2–inhibitor therapy slightly increased from 6.8% at discharge to 9.2% at follow-up. However, 85 out of 173 patients (49.1%) did not provide follow-up questionnaires. In hospital mortality (Group 1: 0%, Group 2: 0%, Group 3: 5.2%; p = 0.092), 1-year mortality after discharge ( Group 1: 12.5%, Group 2: 13.6%, Group 3: 11.9%; p = 0.944), and number of rehospitalizations within 12 months after discharge (Group 1: 1.0 per capita, Group 2: 1.0, Group 3: 1.1; p = 0.697) were similar among groups. Hypoglycemic events 6 months prior to follow-up were highest in Group 2 (0.9 ± 2.3) in comparison to Group 1 (0 ± 0) and Group 3 (0.1 ± 0.3; p = 0.017). Conclusion: Even after adjusting for surviving patients not sending back questionnaires, the adherence to the recommendations regarding incretin-mimetic and sodium-glucose transporter-2–inhibitor therapy was poor. With the limitation of a low patient number, both 1-year mortality after discharge and rehospitalizations were similar among groups. Self-reported hypoglycemic events occurred more often in insulin-treated diabetics than in the ones without.

Efficacy and cardiovascular safety of Thiazolidinediones

2020 ◽  
Vol 15 ◽  
Author(s):  
Raveendran Arkiath Veettil ◽  
Cornelius James Fernandez ◽  
Koshy Jacob
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Glucose Transporter ◽  
Cell Function ◽  
Cardiovascular Safety ◽  
Cardiovascular Outcome Trials ◽  
Glucose Transporter 2 ◽  
Insulin Sensitizers

: Type 2 diabetes mellitus (T2DM) is characterized by a progressive beta cell dysfunction in the setting of peripheral insulin resistance. Insulin resistance in subjects with type 2 diabetes and metabolic syndrome is primarily caused by an ectopic fat accumulation in liver and skeletal muscle. Insulin sensitizers are particularly important in the management of T2DM. Though, thiazolidinediones (TZDs) are principally insulin sensitizers, they possess an ability to preserve pancreatic β-cell function and thereby exhibit durable glycemic control. Cardiovascular outcome trials (CVOTs) have shown that Glucagon-like-peptide 1 receptor agonists (GLP-1 RAs) and sodium glucose transporter-2 inhibitors (SGLT2i) have proven cardiovascular safety. In this era of CVOTs, drugs with proven cardiovascular (CV) safety are often preferred in patients with preexisting cardiovascular disease or at risk of cardiovascular disease. In this review, we will describe the three available drugs belonging to the TZD family, with special emphasis on their efficacy and CV safety.

scholarly journals Impact of SGLT2 Inhibitors on Heart Failure: From Pathophysiology to Clinical Effects

2021 ◽  
Vol 22 (11) ◽  
pp. 5863
Author(s):  
Giuseppe Palmiero ◽  
Arturo Cesaro ◽  
Erica Vetrano ◽  
Pia Clara Pafundi ◽  
Raffaele Galiero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Glucose Transporter ◽  
The Elderly ◽  
Intracellular Sodium ◽  
Clinical Effects ◽  
Glucose Lowering ◽  
Beneficial Effects ◽  
Glucose Transporter 2 ◽  
Function Impairment

Heart failure (HF) affects up to over 20% of patients with type 2 diabetes (T2DM), even more in the elderly. Although, in T2DM, both hyperglycemia and the proinflammatory status induced by insulin resistance are crucial in cardiac function impairment, SGLT2i cardioprotective mechanisms against HF are several. In particular, these beneficial effects seem attributable to the significant reduction of intracellular sodium levels, well-known to exert a cardioprotective role in the prevention of oxidative stress and consequent cardiomyocyte death. From a molecular perspective, patients’ exposure to gliflozins’ treatment mimics nutrient and oxygen deprivation, with consequent autophagy stimulation. This allows to maintain the cellular homeostasis through different degradative pathways. Thus, since their introduction in the clinical practice, the hypotheses on SGLT2i mechanisms of action have changed: from simple glycosuric drugs, with consequent glucose lowering, erythropoiesis enhancing and ketogenesis stimulating, to intracellular sodium-lowering molecules. This provides their consequent cardioprotective effect, which justifies its significant reduction in CV events, especially in populations at higher risk. Finally, the updated clinical evidence of SGLT2i benefits on HF was summarized. Thus, this review aimed to analyze the cardioprotective mechanisms of sodium glucose transporter 2 inhibitors (SGLT2i) in patients with HF, as well as their clinical impact on cardiovascular events.

scholarly journals Studies of Genetic Variability of the Glucose Transporter 2 Promoter in Patients with Type 2 Diabetes Mellitus

2001 ◽  
Vol 86 (5) ◽  
pp. 2181-2186 ◽  
Author(s):  
Ann M. Møller ◽  
Niels M. Jensen ◽  
Julie Pildal ◽  
Thomas Drivsholm ◽  
Knut Borch-Johnsen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Genetic Variability ◽  
Glucose Transporter ◽  
Glucose Transporter 2

scholarly journals Impact of disease control and co-existing risk factors on heart rate variability in Gujarati type 2 diabetics: An observational study

2016 ◽  
Vol 5 (2) ◽  
pp. 393 ◽  
Author(s):  
JayeshDalpatbhai Solanki ◽  
SanketD Basida ◽  
HemantB Mehta ◽  
SunilJ Panjwani ◽  
BhaktiP Gadhavi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Observational Study ◽  
Disease Control ◽  
Type 2 Diabetics

scholarly journals The Emerging Role of SGLT2 Inhibitors in the Treatment of Type 2 Diabetes. Focus on Dapagliflozin

2016 ◽  
Vol 23 (1) ◽  
pp. 113-120
Author(s):  
Bogdan Timar ◽  
Cristian Serafinceanu ◽  
Adrian Vlad ◽  
Romulus Timar
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Transporter ◽  
Diabetes Management ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Sglt2 Inhibitors ◽  
Glucose Transporter 2 ◽  
Target Blood Glucose ◽  
Attractive Therapeutic Target

AbstractType 2 diabetes is a progressive metabolic disorder, accounting for more than 90% of all cases of diabetes. Treatment strategies target blood glucose reduction and non-glycemic effects that can reduce long-term complications, such as cardiovascular disease. Although metformin is often initially effective as monotherapy, the progressive nature of diabetes frequently requires additional therapies. Sodium-glucose transporter 2 (SGLT2) became a very attractive therapeutic target in diabetes management. The mechanism of action of SGLT2 inhibitors is not dependent on insulin, thus making them attractive options anytime over the course of the disease. Dapagliflozin is a stable and highly selective inhibitor of SGLT2. The reductions in fasting plasma glucose concentration and bodyweight recorded during the first week of treatment in the dapagliflozin groups continued over weeks and years of treatment. Early weight loss with dapagliflozin might be partly due to a mild osmotic diuresis, while the gradual progressive reduction in bodyweight is consistent with a reduction of fat mass. Although dapagliflozin is well tolerated, signs and symptoms suggestive for urinary and/or genital infections were reported during clinical trials in more patients assigned to the drug than in placebo groups.

scholarly journals Contemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes

2021 ◽  
Author(s):  
Arash A Nargesi ◽  
Gini P Jeyashanmugaraja ◽  
Nihar Desai ◽  
Kasia Lipska ◽  
Harlan Krumholz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Clinical Trials ◽  
High Risk ◽  
Glucose Transporter ◽  
Survey Design ◽  
Atherosclerotic Cardiovascular Disease ◽  
Glucose Transporter 2 ◽  
Number Of Patients

Abstract Background Sodium glucose transporter‐2 (SGLT‐2) inhibitors and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) effectively lowered cardiovascular risk in large clinical trials for patients with type 2 diabetes at high risk for these complications, and have recommended by guidelines. To evaluate the contemporary landscape in which these recommendations would be implemented, we examined the use of these medications according to clinical guideline practice. Methods and Results In the National Health and Nutrition Examination Survey for 2017‐2018, we defined compelling indications for SGLT‐2 inhibitors by the presence of atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease (CKD), and for GLP‐1RAs by the presence of established or high risk ASCVD, based on large clinical trials that have been incorporated in guideline recommendations of the American College of Cardiology (ACC) and American Diabetes Association (ADA). We then evaluated utilization of these medications among patients with physician‐diagnosed type 2 diabetes. All analyses incorporated complex survey design to produce nationally representative estimates. A total 1104 of 9254 sampled individuals had type 2 diabetes, representing 10.6% (95% CI 9.7‐11.6) of the US population or 33.2 million adults nationally. Of these, 52.6% (47.7‐57.5) had an indication for SGLT‐2 inhibitors, 32.8% (28.8‐37.2) for GLP‐1RAs, and 26.6% (22.2‐31.7) for both medications. During 2017‐2018, 4.5% (2.4‐8.2) were treated with SGLT‐2 inhibitors and 1.5% (0.7‐3.2) with GLP‐1RAs. ASCVD, heart failure, or CKD were not independently associated with SGLT‐2 inhibitor or GLP‐1RA use in patients with diabetes. Conclusions Despite a large number of patients being eligible for guideline recommended cardiorenal protective therapies, there are substantial gaps in the use of SGLT‐2 inhibitors and GLP‐1RAs, limiting their public health benefits.

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