scholarly journals Efficacy of dapagliflozin versus sitagliptin on cardiometabolic risk factors in Japanese patients with type 2 diabetes: a prospective, randomized study (DIVERSITY-CVR)

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ayako Fuchigami ◽  
Fumika Shigiyama ◽  
Toru Kitazawa ◽  
Yosuke Okada ◽  
Takamasa Ichijo ◽  
...  

Abstract Background Few prospective studies have compared the cardiovascular benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors. We aimed to clarify the efficacy of dapagliflozin versus sitagliptin for modulating cardiometabolic risk factors including high glycated hemoglobin (HbA1c) levels, hypoglycemia, and body weight. Methods This prospective, randomized, open-label, blinded-endpoint, parallel-group trial enrolled 340 Japanese patients with early-stage type 2 diabetes receiving metformin alone or no glucose-lowering agents, who were randomized to receive dapagliflozin or sitagliptin for 24 weeks. The primary endpoint was the proportion of patients who achieved the composite endpoint of HbA1c level maintenance < 7.0% (53 mmol/mol), avoidance of hypoglycemia (maintenance of sensor glucose ≥ 3.0 mmol/L or ≥ 54 mg/dL), and ≥ 3.0% body weight loss from baseline. Secondary endpoints included components of the primary endpoint, other metabolic indices, and glucose variability indices measured using flash glucose monitoring. Results Clinical characteristics of patients were age, 58.1 ± 12.2 years; known duration of diabetes, 5.8 ± 6.1 years; body weight, 74.7 ± 14.2 kg; body mass index, 27.9 ± 4.1 kg/m2; and HbA1c level, 7.8 ± 0.8% at baseline. The achievement ratio of primary endpoint was significantly higher in the dapagliflozin group than in the sitagliptin group (24.4% vs. 13.8%, P < 0.05). While the rates of HbA1c level maintenance < 7.0% (53 mmol/mol) and avoidance of hypoglycemia were comparable between the groups (49.4 vs. 50.0% and 88.7 vs. 92.3% for dapagliflozin vs. sitagliptin, respectively), body weight loss of ≥ 3.0% was significantly achieved in the dapagliflozin group (54.4 vs. 19.6%, P < 0.001). Moreover, dapagliflozin was superior to sitagliptin regarding several secondary endpoints that modulate cardiometabolic risk, namely reducing fasting plasma glucose, insulin, uric acid, increasing high-density lipoprotein cholesterol, and suppressing the increase in serum creatinine and the decrease in estimated glomerular filtration rate. On the other hand, sitagliptin was superior to dapagliflozin in suppressing glucose variability. Conclusions Compared to sitagliptin, dapagliflozin was significantly more effective at improving cardiometabolic risk factors, suggesting that SGLT2 inhibitors might be more suitable than DPP-4 inhibitors for preventing cardiovascular events in patients with early-stage but inadequately controlled type 2 diabetes. Trial registration Trial number, UMIN000028014; registered on June 30, 2017

2018 ◽  
Vol 103 (7) ◽  
pp. 985-994 ◽  
Author(s):  
Ciarán E. Fealy ◽  
Stephan Nieuwoudt ◽  
Julie A. Foucher ◽  
Amanda R. Scelsi ◽  
Steven K. Malin ◽  
...  

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 80-OR
Author(s):  
ROBERT F. KUSHNER ◽  
MELANIE J. DAVIES ◽  
JOHN DEANFIELD ◽  
W. TIMOTHY GARVEY ◽  
OLE JEPPESEN ◽  
...  

Author(s):  
John Sebastião Cardoso da Silva ◽  
Maria Sebastiana Silva ◽  
Maria Margareth Veloso Naves

Background: Type 2 diabetes mellitus (T2DM) is a disease associated with several cardiometabolic risk factors (CMRF). There is strong evidence about the benefits of oilseeds intake and the practice of resistance training (RT) in the prevention and treatment of T2DM and its associated CMRF. However, no study has evaluated the combination of these interventions yet. Baru nut, an oilseed native to the Brazilian Cerrado, stands out among oilseeds due to its healthy nutritional composition, which have the potential to reduce CMRF in T2DM. RT, in turn, provides positive changes in the composition and metabolism of muscle cells, which contributes to improving cardiometabolic health. Objective: This review aimed to summarize the effects and mechanisms related to the intake of baru nut and the practice of RT in reducing CMRF in T2DM. Method: Literature research was performed using the keywords "type 2 diabetes mellitus", "Dipteryx alata Vog", "nuts", "physical exercise" and "resistance training", isolated or associated, in Web of Science and Pubmed databases. Results: Baru nut is an oilseed with high density of nutrients and bioactive compounds with antioxidant and antihypercholesterolemic properties, and the RT is associated with beneficial effects on CMRF in T2DM individuals. Thus, the consumption of baru nut and the RT have potential to improve the insulin sensitivity, glycemic control, body composition, and serum lipid profile. Conclusion: The baru nut consumption and the RT have potential to reduce the cardiometabolic risk factors in T2DM. Both interventions are innovative and promising approaches to preserve the health of T2DM individuals.


2019 ◽  
Vol 57 (3) ◽  
pp. 381-384 ◽  
Author(s):  
Kyung Mook Choi ◽  
Soon Young Hwang ◽  
Kyungdo Han ◽  
Hye Soo Chung ◽  
Nam Hoon Kim ◽  
...  

2019 ◽  
Vol 7 (1) ◽  
pp. e000787 ◽  
Author(s):  
Rianneke de Ritter ◽  
Simone J S Sep ◽  
Carla J H van der Kallen ◽  
Miranda T Schram ◽  
Annemarie Koster ◽  
...  

ObjectiveTo investigate whether adverse differences in levels of cardiovascular risk factors in women than men, already established when comparing individuals with and without diabetes, are also present before type 2 diabetes onset.Research design and methodsIn a population-based cohort study of individuals aged 40-75 years (n=3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated associations with cardiometabolic and lifestyle risk factors of (1) pre-diabetes and type 2 diabetes (reference category: normal glucose metabolism) and (2) among non-diabetic individuals, of continuous levels of hemoglobin A1c (HbA1c). Age-adjusted sex differences were analyzed using linear and logistic regression models with sex interaction terms.ResultsIn pre-diabetes, adverse differences in cardiometabolic risk factors were greater in women than men for systolic blood pressure (difference, 3.02 mm Hg; 95% CI:−0.26 to 6.30), high-density lipoprotein (HDL) cholesterol (difference, −0.10 mmol/L; 95% CI: −0.18 to −0.02), total-to-HDL cholesterol ratio (difference, 0.22; 95% CI: −0.01 to 0.44), triglycerides (ratio: 1.11; 95% CI: 1.01 to 1.22), and inflammation markers Z-score (ratio: 1.18; 95% CI: 0.98 to 1.41). In type 2 diabetes, these sex differences were similar in direction, and of greater magnitude. Additionally, HbA1c among non-diabetic individuals was more strongly associated with several cardiometabolic risk factors in women than men: per one per cent point increase, systolic blood pressure (difference, 3.58 mm Hg; 95% CI: −0.03 to 7.19), diastolic blood pressure (difference, 2.10 mm Hg; 95% CI: −0.02 to 4.23), HDL cholesterol (difference, −0.09 mmol/L; 95% CI: −0.19 to 0.00), and low-density lipoprotein cholesterol (difference, 0.26 mmol/L; 95% CI: 0.05 to 0.47). With regard to lifestyle risk factors, no consistent pattern was observed.ConclusionOur results are consistent with the concept that the more adverse changes in cardiometabolic risk factors in women (than men) arise as a continuous process before the onset of type 2 diabetes.


BMC Nutrition ◽  
2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Dina Goodman ◽  
Juan P. González-Rivas ◽  
Lindsay M. Jaacks ◽  
Maritza Duran ◽  
María Inés Marulanda ◽  
...  

Abstract Background Increasing trends in global obesity have been attributed to a nutrition transition where healthy foods are replaced by ultra-processed foods. It remains unknown if this nutrition transition has occurred in Venezuela, a country undergoing a socio-political crisis with widespread food shortages. Methods We described dietary intake of Venezuelans from a nationally representative study conducted between 2014 and 2017. We conducted a cross-sectional analysis of dietary, sociodemographic, and clinical data from Venezuelans ≥20 years of age (n = 3420). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Standardized clinical and anthropometric measurements estimated obesity, type 2 diabetes, and hypertension. A Dietary Diversity Score (DDS) was calculated using an amended Minimum Dietary Diversity for Women score where the range was 0 to 8 food groups, with 8 being the most diverse. Analyses accounted for complex survey design by estimating weighted frequencies of dietary intake and DDS across sociodemographic and cardiometabolic risk-based subgroups. Results The prevalence of obesity was 24.6% (95% CI: 21.6–27.7), type 2 diabetes was 13.3% (11.2–15.7), and hypertension was 30.8% (27.7–34.0). Western foods were consumed infrequently. Most frequently consumed foods included coffee, arepas (a salted corn flour cake), and cheese. Mean DDS was 2.3 food groups (Range: 0–8, Standard Error: 0.07) and this score did not vary among subgroups. Men, younger individuals, and those with higher socioeconomic status were more likely to consume red meat and soft drinks once or more weekly. Women and those with higher socioeconomic status were more likely to consume vegetables and cheese once or more daily. Participants with obesity, type 2 diabetes, and hypertension had lower daily intake of red meat and arepas compared to participants without these risk factors. Conclusions Despite high prevalence of cardiometabolic risk factors, adults in Venezuela have not gone through a nutrition transition similar to that observed elsewhere in Latin America. Dietary diversity is low and widely consumed food groups that are considered unhealthy are part of the traditional diet. Future studies are needed in Venezuela using more comprehensive measurements of dietary intake to understand the effect of the socio-political crisis on dietary patterns and cardiometabolic risk factors.


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