scholarly journals Comparative efficacy of once-weekly semaglutide versus SGLT-2 inhibitors in patients inadequately controlled with one to two oral antidiabetic drugs: a systematic literature review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023458 ◽  
Author(s):  
Steve Kanters ◽  
Lars Wilkinson ◽  
Hrvoje Vrazic ◽  
Rohini Sharma ◽  
Sandra Lopes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Glucose ◽  
North America ◽  
Systolic Blood Pressure ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Postprandial Blood Glucose ◽  
Comparative Efficacy ◽  
Fasting Plasma

ObjectiveTo determine the comparative efficacy of once-weekly semaglutide relative to sodium-glucose cotransporter 2 inhibitors (SGLT-2is) licensed in Europe and North America among patients with type 2 diabetes (T2D) inadequately controlled with 1–2 oral antidiabetics (OADs), using a network meta-analysis (NMA). Design systematic review and network meta-analysis. Data Sources EMBASE, MEDLINE and CENTRAL were searched from January 1994 to August 2017.MethodsRandomised controlled trials with ≥20 weeks of treatment evaluating once-weekly semaglutide or SGLT-2is. Primary outcomes included change from baseline in: HbA1c, weight, systolic blood pressure, postprandial blood glucose and fasting plasma glucose. Fixed-effect and random-effect Bayesian NMA were used to indirectly compare treatment effects at 26 (±4) weeks. Metaregression and sensitivity analyses were conducted. Model selection was performed using the deviance information criterion and consistency was assessed by comparing indirect (edge-splitting) to direct evidence.ResultsForty-eight publications representing 21 trials were included. The mean differences (MD) in change from baseline in HbA1c of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −0.56% for canagliflozin 300 mg (95% credible interval (CrI): −0.76 to −0.33%), to −0.95% for dapagliflozin 5 mg (95% CrI: −1.20 to −0.69%). The MD in change from baseline in weight of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −1.35 kg for canagliflozin 300 mg to −2.48 kg for dapagliflozin 5 mg, while change from baseline in fasting plasma glucose ranged from −0.41 mmol/L for canagliflozin 300 mg to −1.37 mmol/L for dapagliflozin 5 mg. Once-weekly semaglutide was not statistically differentiable than all SGLT-2is in reducing systolic blood pressure. NMA was not feasible for postprandial blood glucose and safety outcomes.ConclusionOnce-weekly semaglutide demonstrated statistically significant and clinically meaningful reductions in HbA1c and body weight in T2D patients inadequately controlled with 1–2 OADs compared to all SGLT-2is licensed in Europe and North America.

P4663Hyperinsulinemia, hypertension and two clusters of biomarkers predict aortic stenosis in 10,144 Finnish men

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ojanen ◽  
R Jauhiainen ◽  
J Vangipurapu ◽  
T Kuulasmaa ◽  
J Kuusisto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Glucose Tolerance ◽  
Systolic Blood Pressure ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Plasma Insulin ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Fasting Plasma

Abstract BACKROUND Recent studies show that hypertension predicts aortic stenosis (AS). Other predictors of AS are not established. Purpose To investigate a large panel of biomarkers as predictors of AS in the population-based METSIM cohort. Methods Anthropometric, metabolic and inflammatory biomarkers were measured at baseline in the cohort of 10,197 Finnish men. Subjects with AS at baseline (n=53) were excluded from the analyses. Cases of AS were identified from the medical records. Cox regression analysis was used to identify variables predicting AS. Principal components analysis was applied to investigate clustering of variables predicting AS. Uni- and multivariate logistic regression analysis were used to investigate the clusters of biomarkers as predictors of AS. Results Over a mean follow-up time of 10.8 years, incident AS was diagnosed in 116 (1.1%) men. In Cox regression analysis, fasting plasma insulin (9.8±12.8 in men without AS vs. 14.5±18.2 mU/l in men with incident AS; P=6.13 x 10–6) and systolic blood pressure (138.2±16.7 vs. 146.3±19.4 mmHg; P=3.8 x 10–7) were associated with higher risk of AS (HR 1.44 (95% CI 1.23–1.68); P=4.04 x 10–5 and HR 1.54 (1.30–1.83); P=3.01 x 10–7, respectively). Other biomarkers, which significantly predicted AS were age, body mass index, waist, waist/hip ratio, body fat mass percentage, urine albumin, CRP, blood GHbA1C, fasting plasma glucose and proinsulin, oral glucose tolerance test (OGTT) 30 min plasma insulin and proinsulin, OGTT 120 min plasma insulin and proinsulin, and serum C-peptide. Glucose tolerance (ADA 2003), and insulin resistance and insulin secretion indices based on HOMA were significant predictors of AS. After adjusting for age, the same biomarkers except for OGTT 120 min plasma proinsulin, blood GHbA1C and fasting plasma glucose significantly predicted AS. After exclusion of diabetic subjects, all biomarkers mentioned above except for GHbA1C, fasting plasma glucose and glucose tolerance predicted AS in unadjusted Cox models. Two clusters of risk factors were found in principal components analysis, one consisting of fasting plasma insulin, HOMA insulin resistance index, waist/hip ratio, GHbA1c and CRP, and another consisting of age, systolic blood pressure and urine albumin, explaining 38.33 and 15.37% of the total variance, respectively. In univariate logistic regression analysis both clusters predicted AS (HR 1.35 (1.15–1.59); P=2.47 x 10–4 and HR 1.73 (1.46–2.04); P=1.53 x 10–10, respectively), and were statistically significant when entered in the multivariate model (HR 1.30 (1.11–1.52); P=1.01 x 10–3 and HR 1.69 (1.43–1.99); P=5.84 x 10–10, respectively). Conclusion In the present large-scale population-based study, several biomarkers, particularly hyperinsulinemia and systolic blood pressure, predicted AS. In addition, two clusters of biomarkers, one with high loading on insulin and another on systolic blood pressure, independently predicted AS. Acknowledgement/Funding Kuopio University Hospital ja Academy of Finland

scholarly journals Imeglimin, a novel, first in-class, blood glucose-lowering agent: a systematic review and meta-analysis of clinical evidence

2020 ◽  
Vol 20 (1) ◽  
pp. 28-31 ◽  
Author(s):  
Thomas SJ Crabtree ◽  
Ralph A DeFronzo ◽  
Robert E J Ryder ◽  
Clifford J Bailey
Keyword(s):  
Systematic Review ◽  
Blood Glucose ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Total N ◽  
Glucose Lowering ◽  
Fasting Plasma ◽  
Increase Glucose Uptake ◽  
Glucose Output

Imeglimin is a novel, first in-class, blood glucose-lowering agent which acts via a mitochondrial mechanism to enhance glucose-induced insulin secretion, decrease hepatic glucose output and increase glucose uptake by skeletal muscle. A systematic review and meta-analysis of randomised controlled clinical trials (RCTs) with imeglimin in adults with type 2 diabetes was undertaken. Of 45 articles identified, five were RCTs but, due to the format of the data, only three could be combined in a meta-analysis (total n=180 participants). A random-effects model found that imeglimin 1500 mg twice daily as monotherapy and add-on to metformin or sitagliptin was associated with reductions of HbA1c by −0.63% (95% CI −0.84 to −0.42) (−6.6 mmol/mol, 95% CI −8.8 to −4.4) and reductions of fasting plasma glucose by −0.52 mmol/L (95% CI −0.80 to −0.24) compared with placebo. Adverse events were minimal, mostly gastrointestinal, and without hypoglycaemia. It is concluded that imeglimin displays promising improvements in HbA1c and fasting plasma glucose and is generally well tolerated.

Association of Triglyceride-glucose Index and the Risk of Incident Diabetes: a Secondary Analysis Based on a Chinese Cohort Study

2020 ◽  
Author(s):  
Xiaoli Li ◽  
Guilong Li ◽  
Tiantian Cheng ◽  
Jing Liu ◽  
Guangyao Song ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Incident Diabetes ◽  
Family History Of Diabetes ◽  
Tyg Index ◽  
Fasting Plasma ◽  
Increased Risk ◽  
The Relationship

Abstract BackgroundTriglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance. However, study on the relationship between TyG index and incident diabetes remains limited. This study aimed to investigate the association between TyG index and incident diabetes in a large cohort of Chinese population.MethodsThe present study was a retrospective cohort study using healthy screening programme data in China. A total of 201,298 subjects free of baseline diabetes were included who received a health check with all medical records from 2010 to 2016. TyG index was calculated as Ln[fasting triglyceride level (mg/dl) x fasting plasma glucose (mg/dl)/2]. Diagnosis of diabetes was based on fasting plasma glucose ≥ 7.00 mmol/L and/or self-reported diabetes. Cox proportion-hazard model was used to assess the relationship between TyG index at baseline and the risk of incident diabetes. It should be noted that the data was uploaded to the DATADRYAD website, and we only used this data for secondary analysis.ResultsDuring a mean follow-up of 3.12 years of 201,298 individuals aged ≥ 20 years old, 3389 subjects developed diabetes. After adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, low density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, serum creatinine, smoking, drinking and family history of diabetes, multivariate cox hazards regression analysis indicated that TyG index was positive correlation with the risk of developing diabetes in Chinese population (HR, 3.34; 95% CI, 3.11 to 3.60). The risk of incident diabetes increased with increasing TyG index. Subjects with TyG index in the fourth quartile were 6.26 times more likely to develop diabetes than the lowest quartile (P trend < 0.001). Subgroup analysis showed the stronger association was observed in the population with age < 40, BMI (≥ 18.5, < 24 kg/m2), SBP < 140 mmHg or females (all P for interaction < 0.0001).Conclusions TyG index was independently correlated with the increased risk of diabetes in Chinese adults, suggesting that TyG index may be a useful marker for identifying individuals at high risk of developing diabetes.

Use of high-normal levels of haemoglobin A1Cand fasting plasma glucose for diabetes screening and for prediction: a meta-analysis

2013 ◽  
Vol 29 (8) ◽  
pp. 680-692 ◽  
Author(s):  
Satoru Kodama ◽  
Chika Horikawa ◽  
Kazuya Fujihara ◽  
Reiko Hirasawa ◽  
Yoko Yachi ◽  
...  
Keyword(s):  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Diabetes Screening ◽  
Fasting Plasma

scholarly journals Effects of Pleurotus ostreatus on Blood Pressure and Glycemic Status of Hypertensive Diabetic Male Volunteers

2013 ◽  
Vol 6 (1) ◽  
pp. 5-10 ◽  
Author(s):  
MBK Choudhury ◽  
T Rahman ◽  
AJ Kakon ◽  
N Hoque ◽  
M Akhtaruzzaman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Pleurotus Ostreatus ◽  
Pressure Control ◽  
Glycemic Status ◽  
Plasma Creatinine Level ◽  
Male Volunteers ◽  
Fasting Plasma ◽  
Regular Intake

Different species of mushrooms are being used increasingly for their nutritional and medicinal values. They are used in traditional medical practice in the treatment and prevention of diabetes, obesity, heart diesaes, hyperacidity, cancer and hypertension. This study was designed to see the effects of Pleurotus ostreatus on blood pressure and glycemic status of hypertensive diabetic male volunteers. The study was carried out in the National Mushroom development and Extension Center (NAMDEC) laboratory, Savar, Dhaka in collaboration with the Department of Pharmacy along with the Department of Biochemistry and Molecular Biology, Jahangirnagar University. A total of 27 hypertensive male volunteers suffering from type 2 diabetes mellitus with age range of 32 to 68 years, who were free from renal impairment and other known acute or chronic diseases were included in the study. Blood pressure, fasting plasma glucose, HbA1c and serum creatinine were measured before and after 3 months of regular intake of 3 grams mushroom powder capsule daily in in 3 divided doses. However they were allowed to continue the drugs they were taking already. The study showed that after 3 months of regular intake of Pleurotus ostreatus mushroom, both systolic and diastolic blood pressure decreased significantly (p<0.001). It was also observed that, Pleurotus ostreatus decreased fasting plasma glucose level significantly (p<0.001). Reduction of HbA1c % observed after 3 months of mushroom intake was found to be significant (p<0.001). But there was no significant change of plasma creatinine level (p>0.05) indicating Pleurotus ostreatus has no detrimental effect on renal system. From the study, it can be said that, Pleurotus ostreatus mushroom intake improves glycemic status and blood pressure control in diabetic hypertensive subjects. DOI: http://dx.doi.org/10.3329/bjmb.v6i1.13280 Bangladesh J Med Biochem 2013; 6(1): 5-10

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