Inсretin-based therapy in patients with type 2 diabetes and chronic kidney disease

The program of renoprotection in patients with diabetes mellitus (DM) is based on a conceptual model of development and progressionof diabetic kidney disease, which is the result of combined impact of genetically modulated metabolic and hemodynamic factors. Compensationof carbohydrate metabolism, which is crucial at the clinical debut of nephropathy, becomes problematic at the late stages ofchronic kidney disease (CKD). ADA (American Diabetes Association) and EASD (European Association for the Study of Diabetes)recommendations formalized in a consensus on the treatment of patients with type 2 diabetes (T2D) should only be extrapolated topatients with CKD with great prudence. Incretin-based drugs gain reputation as promising and perspective therapy for metabolic controlin patients with type 2 DM and CKD. There is an obvious need for large-scale, long-term studies involving patients with various severityof renal disease and related complications to assess the potential of this new diabetes therapy trend.

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The Association Between Age of Onset of Type 2 Diabetes with Long-term Risk of End Stage Kidney Disease: A National Registry Study

10.2337/figshare.12273110.v1 ◽

2020 ◽

Author(s):

Jedidiah I Morton ◽

Danny Liew ◽

Stephen P McDonald ◽

Jonathan E Shaw ◽

Dianna J Magliano

Keyword(s):

Type 2 Diabetes ◽

Kidney Disease ◽

Cumulative Incidence ◽

Age Of Onset ◽

End Stage Kidney Disease ◽

Onset Of Diabetes ◽

End Stage ◽

Effect Of Age

Objective: The long-term risk of end-stage kidney disease (ESKD) in type 2 diabetes is poorly described, as is the effect that younger age of diabetes onset has on this risk. Therefore, we aimed to estimate the effect of age of onset on the cumulative incidence of ESKD from onset of type 2 diabetes. Research Design and Methods: This study included 1,113,201 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. Results: Between 2002 and 2013, there were 7,592 incident cases of ESKD during 7,839,075 person-years of follow up. In the first 10-15 years following onset of diabetes, the incidence of ESKD was highest in those with an older age of onset of diabetes, whereas over longer durations of diabetes the incidence of ESKD became higher in those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESKD was 11.8% and 9.3% in those diagnosed with diabetes aged 10-29 and 30-39 years, respectively. When death from ESKD without renal replacement therapy was included, incidence of ESKD remained higher in older onset diabetes for the initial 20 years, with no clear effect of age thereafter. Conclusions: The long-term risk of ESKD in type 2 diabetes is high, which disproportionately affects those with younger-onset of diabetes as they are more likely to survive to longer diabetes durations.

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Pasireotide in an insulin-requiring diabetic acromegalic patient without worsening of hyperglycemia

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-17-0003 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 2

Author(s):

Murray B Gordon ◽

Kellie L Spiller

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

List Type ◽

Effective Treatment Option ◽

Patients With Diabetes ◽

Long Acting ◽

Learning Points

Summary Long-acting pasireotide is an effective treatment option for acromegaly, but it is associated with hyperglycemia, which could impact its use in patients with diabetes. We present a case of a 53-year-old man with acromegaly and type 2 diabetes mellitus (glycated hemoglobin (HbA1c): 7.5%), who refused surgery to remove a pituitary macroadenoma and enrolled in a Phase 3 clinical trial comparing long-acting pasireotide and long-acting octreotide in acromegalic patients. The patient initially received octreotide, but insulin-like growth factor 1 (IGF-1) levels remained elevated after 12 months (383.9 ng/mL; 193.0 ng/mL; reference range: 86.5–223.8 ng/mL), indicating uncontrolled acromegaly. He switched to pasireotide 40 mg and subsequently increased to 60 mg. Within 6 months, IGF-1 levels normalized (193.0 ng/mL), and they were mostly normal for the next 62 months of treatment with pasireotide (median IGF-1: 190.7 ng/mL). Additionally, HbA1c levels remained similar to or lower than baseline levels (range, 6.7% to 7.8%) during treatment with pasireotide despite major changes to the patient’s antidiabetic regimen, which included insulin and metformin. Uncontrolled acromegaly can result in hyperglycemia due to an increase in insulin resistance. Despite having insulin-requiring type 2 diabetes, the patient presented here did not experience a long-term increase in HbA1c levels upon initiating pasireotide, likely because long-term control of acromegaly resulted in increased insulin sensitivity. This case highlights the utility of long-acting pasireotide to treat acromegaly in patients whose levels were uncontrolled after long-acting octreotide and who manage diabetes with insulin. Learning points Long-acting pasireotide provided adequate, long-term biochemical control of acromegaly in a patient with insulin-requiring type 2 diabetes mellitus who was unresponsive to long-acting octreotide. Glycemic levels initially increased after starting treatment with pasireotide but quickly stabilized as acromegaly became controlled. Long-acting pasireotide, along with an appropriate antidiabetic regimen, may be a suitable therapy for patients with acromegaly who also have insulin-requiring type 2 diabetes mellitus.

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Long-term quality-of-care score predicts incident chronic kidney disease in patients with type 2 diabetes

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx375 ◽

2018 ◽

Vol 33 (11) ◽

pp. 2012-2019 ◽

Cited By ~ 1

Author(s):

Pi-I Li ◽

Jian-Nan Wang ◽

How-Ran Guo

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Quality Of Care ◽

Kidney Disease ◽

Incident Chronic Kidney Disease

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Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023882 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023882 ◽

Cited By ~ 10

Author(s):

Vasileios Liakopoulos ◽

Stefan Franzén ◽

Ann-Marie Svensson ◽

Mervete Miftaraj ◽

Johan Ottosson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Gastric Bypass ◽

Kidney Disease ◽

Secondary Outcome ◽

Control Group ◽

Positive Effects ◽

All Cause Mortality

ObjectivesLong-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications.DesignThis is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases.SettingAfter merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models.ParticipantsWe identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18–65 years, with BMI >27.5 kg/m² and followed for up to 9 years.Primary and secondary outcome measuresWe assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions.ResultsThe results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group.ConclusionsThis nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.

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The Role of Anti-obesity Drugs in Patients with Type 2 Diabetes

US Endocrinology ◽

10.17925/use.2013.09.02.101 ◽

2013 ◽

Vol 09 (02) ◽

pp. 101 ◽

Cited By ~ 1

Author(s):

Priscilla Hollander ◽

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Lifestyle Changes ◽

Important Concern ◽

Increased Risk ◽

The Us ◽

Patients With Diabetes ◽

Obesity Drugs

The prevalence of diabetes continues to rise, following the rising rates of obesity. Obesity is not only associated with an increased risk for developing type 2 diabetes but also an elevated probability of developing long-term complications associated with the disease. Weight gain is also an important concern as a potential side effect of therapies that improve glycemic control in diabetes, including insulin therapy. As a result, patients with type 2 diabetes are at risk for a vicious circle of increasing weight and increasing insulin resistance, thus requiring further intensification of glycemic treatment. It is therefore important to address the problem of obesity in patients with type 2 diabetes. In 2012, the US Food and Drug Administration (FDA) approved two new anti-obesity medications: lorcaserin and phentermine/topiramate extended-release. Both agents have demonstrated clinically meaningful weight reduction as well as significant improvements in glycemic control in obese patients with diabetes. Liraglutide has also shown weight loss and improvements in glycemic control in patients with diabetes. Anti-obesity drugs, in conjunction with lifestyle changes, may play a valuable role in the management of diabetes.

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