scholarly journals The backbone of oral glucose-lowering therapy: time for a paradigm shift?

2009 ◽  
Vol 23 (6) ◽  
pp. 651-667
Author(s):  
Jochen Seufert
Keyword(s):  
Paradigm Shift ◽  
Oral Glucose ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

scholarly journals MON-668 The Content of Serum Clusterin in Patients with Diabetic Macular Edema Depending on the Kind of Glucose Lowering Therapy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mykhailo L Kyryliuk ◽  
Sviatoslav A Suk
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Neurovascular Unit ◽  
Oral Glucose ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

Abstract Relevance. Insight into the pathophysiology of diabetic macular edema (DME) has led to novel treatments, including anti-VEGF, corticosteroid-based treatment strategies and novel therapies, such as a clusterin blood retina barrier (BRB) cytoprotection. It has been shown the protective effect of clusterin on oxidative stress-induced cell death and its emerging roles in reduction of both BRB breakdown and neural retina damage. Goal. To assess the content of serum clusterin in patients with type 2 diabetes (T2D) and diabetic macular edema depending on the type of glucose lowering therapy. Material and methods. This study was conducted in 82 patients with T2D and DME. The average age of patients was 65.25 ± 10.85 years (±SD) [25; 84], the average duration of diabetes was 14.0 ± 7.05 years (±SD) [1; 35], the average level of HbA1c was 8.40 ± 1.58% (±SD). The criteria for inclusion in the open study was voluntary informed consent, age 18 years and more, the presence of T2DM. Non-inclusion criteria were the presence of endocrine diseases, which can lead to type 2 diabetes, T1D, acute infectious diseases, cancer, decompensation of comorbid pathology, mental disorders, antipsychotics, antidepressants, neurodegenerative diseases of the central nervous system, proteinuria, damage to the optic nerve, glaucoma and mature cataracts. 43 patients received oral glucose lowering drugs (OGLD: sulfonylureas, biguanides), 39 patients received insulin therapy. All patients had instrumental ophthalmological examinations. The concentration of serum clusterin was measured by «Human Clusterin ELISA» kits. Statistical analysis was performed by one-way ANOVA analysis. Results. A study of level variability of blood clusterin in patients with DME showed its dependence from the type of glucose lowering therapy. Comparison of mean values of strum clusterin in patients with DME and T2DM revealed the following statistically significant differences: OGLD 87,08 ± 3,15 mcg/ml [95% CI 82,63 - 91,54 mcg/ml]; insulin therapy 74,79±2,98 mcg/ml [95% CІ 70,58 - 78,99 mcg/ml] (р=0,006). Apparently, clusterin is involved in the pathogenesis of DME and may have a potential in reducing of the pathogenic effect of diabetes on the neurovascular unit. The data obtained make it possible to discuss the neuroprotective role of clusterin in DME with the use of voiced oral hypoglycemic drugs, which usually prescribe for patients with mild form of T2D or for the patients with moderate severity T2D (i. e. at the initial stages of development of diabetes). Conclusion. Against the background of glucose lowering drugs in patients with type 2 diabetes and diabetic macular edema statistically significant (р=0,006) increases the content of serum clusterin compared to insulin therapy.

Combined use of polypill components in patients with type 2 diabetes mellitus

2018 ◽  
Vol 25 (14) ◽  
pp. 1523-1531 ◽  
Author(s):  
Vivi E Janssen ◽  
Frank L Visseren ◽  
Anthonius de Boer ◽  
Diederick E Grobbee ◽  
Jan Westerink ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vascular Disease ◽  
Antiplatelet Agent ◽  
Patient Characteristics ◽  
Oral Glucose ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Combined Use ◽  
Glucose Lowering Therapy

Objectives A polypill containing aspirin, a statin and blood pressure (BP)-lowering agents has been proposed for the prevention of cardiovascular disease. To increase adherence and reduce the gaps between indicated and used therapy, a polypill might be of interest for patients with type 2 diabetes (T2DM). Our aim was to assess the prevalence of the combined use of polypill components in patients with T2DM over time. Methods The combined use of polypill components was assessed between 1996 and 2015 in patients with T2DM in the prospective SMART cohort ( n = 1828). The results were dichotomized into patients without ( n = 568) and with ( n = 1260) vascular disease. The patient characteristics associated with the use of polypill components were evaluated. Results In total, 19% of patients with T2DM without vascular disease received a statin and ≥2 BP-lowering agents (‘cardiovascular polypill’) and 13% received additional oral glucose-lowering therapy (‘diabetic polypill’). Of the patients with T2DM with vascular disease, 42% received the combination of an antiplatelet agent, a statin and ≥2 BP-lowering agents (‘cardiovascular polypill’) and 30% received additional glucose-lowering therapy (‘diabetic polypill’). The prevalence of the use of the cardiovascular and diabetic polypill combination has substantially increased between 1996 and 2015 to 36 and 32% in patients without vascular disease and to 67 and 57% in patients with vascular disease. Conclusions Patients with T2DM frequently use polypill components, often together with oral glucose-lowering agents, and this rate of use has increased steadily between 1996 and 2015. Introducing a cardiovascular or diabetic polypill for patients with T2DM seems to be highly relevant.

scholarly journals Dynamic monitoring of HbA1c in Russian regions: data comparison of mobile medical center (Diamodul) and national diabetes register of Russian Federation

2020 ◽  
Vol 23 (2) ◽  
pp. 104-112
Author(s):  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Mikhail А. Isakov ◽  
Alexey A. Serkov ◽  
Marina V. Shestakova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Center ◽  
Clinical Situation ◽  
Dynamic Monitoring ◽  
Random Group ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy ◽  
Diabetes Register

BACKGROUND: Glikogemoglobin (HbA1c) is a key clinical marker for evaluating the effectiveness of glucose-lowering therapy for patients with diabetes mellitus (DM) and the quality of diabetic care. AIMS: to conduct dynamic monitoring of the quality of glycemic control in DM patients based on a comprehensive examination in mobile medical center (Diamodul) during repeated visits to the regions in 2019 compared with visits of Based Federal program Diabetes Mellitus (20052010) and data of the National diabetes register (NDR). MATERIALS AND METHODS: The object of the study: patients with T1DM and T2DM examined in Diamodul in 2019 in Voronezh region (Vr), Krasnodar region (Kr) (n = 600), there were dynamic group of re-examined (Vr n = 224; Kr n = 113), random group of new patients (Vr n = 72; Kr n = 191); group of adult patients from NDR with indicated HbA1c in 2019 (n = 2410067). RESULTS: According to Diamodul, the HbA1c levels are significantly worse than they were reported to NDR: the proportion of patients achieved HbA1c 7% for T1DM is 13.3% and 11.7%; T2DM 25.1% and 28.6%, in Kr and Vr, respectively; in NDR: T1DM 37.4%, T2DM 52.2%. The average HbA1c values in the Diamodul are higher than in NDR by 0.95% for T1DM, 1.41% for T2DM patients. The proportion of patients with HbA1c9% decrease in dynamic of examinations through years in T1: in Vr from 53.1% in 2005 and 55.8% in 2010 to 42.9% in 2019, in Kr from 53.2% in 2006 to 43.8% in 2019; also there were decreases in the average HbA1c values in Vr from 9.3% in 2005 and 9.4% in 2010 to 8.8% in 2019; in Kr from 9.1% in 2006 to 8.7% in 2019. In T2DM patients with the best parameters of DM control in a whole, the positive trends were less pronounced and are assessed as non-deterioration: the proportion of HbA1c9 % in Vr: 34.7%34.7%36.4%, in Kr 40.1%28.4%; average values of HbA1c: 8.2%8.4%8.5% and 8.6%8.4%, respectively. CONCLUSIONS: The data of the research clearly indicates the need for 100% inclusion of HbA1c in the examination standards in all DM patients at the primary level at least 1 time per year, in order to monitor the real clinical situation, the effectiveness of glucose-lowering therapy and its timely intensification to prevent development of complications.

scholarly journals Metformin discontinuation in patients beginning second-line glucose-lowering therapy: results from the global observational DISCOVER study programme

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034613
Author(s):  
Kamlesh Khunti ◽  
Marilia B Gomes ◽  
Mikhail Kosiborod ◽  
Antonio Nicolucci ◽  
Stuart Pocock ◽  
...  
Keyword(s):  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
Glucose Lowering ◽  
Factors Associated ◽  
Lowering Therapy ◽  
Metformin Monotherapy ◽  
Study Programme ◽  
Glucose Lowering Therapy

ObjectivesTo evaluate the extent to which patients with type 2 diabetes discontinue metformin therapy when initiating second-line treatment and factors associated with metformin discontinuation, using baseline data from the DISCOVER study programme.DesignDISCOVER is a 3-year, prospective, observational study programme including data from 38 countries across 6 continents from 2014 to 2019.SettingPrimary and secondary healthcare centres, hospitals and specialist diabetes centres in both urban and rural locations.ParticipantsA total of 15 992 patients with type 2 diabetes initiating second-line glucose-lowering therapy.Primary and secondary outcome measuresThe proportion of patients who discontinued metformin as a second-line therapy and the factors associated with this treatment change.ResultsOf the 14 668 patients (from 37 countries) with valid treatment data, 11 837 (80.7%) received metformin as first-line glucose-lowering therapy; 8488 (71.7%) received metformin monotherapy and 3349 (28.3%) received metformin as part of a combination therapy. Overall, treatment with metformin was discontinued in 15.1% (1782) of patients who received first-line metformin (14.1% (1194) and 17.6% (588) in those who received metformin as monotherapy and as part of a combination, respectively); this proportion varied across regions from 6.9% (54) in Africa to 20.6% (628) in South-East Asia. On metformin discontinuation, 73.6% (1311) of patients received a non-insulin monotherapy at second line. Factors associated with an increased odds of metformin discontinuation were older age (≥75 years) and having a history of chronic kidney disease. The probability of metformin monotherapy discontinuation was lower in patients from Africa than in those from Europe.ConclusionsA substantial number of patients discontinued taking metformin when beginning second-line therapy. Most of these patients subsequently received a non-insulin monotherapy at second line, in contradiction to international guidelines and potentially leaving them at an increased risk of hyperglycaemia and associated adverse outcomes.Trial registration numbersNCT02322762 and NCT02226822.

scholarly journals Combination Glucose-Lowering Therapy Plans in T2DM: Case-Based Considerations

2018 ◽  
Vol 35 (7) ◽  
pp. 939-965 ◽  
Author(s):  
Lawrence Blonde ◽  
Susana Dipp ◽  
Daniel Cadena
Keyword(s):  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy ◽  
Case Based
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