scholarly journals Review of the results of the EASYDia international observational study. The effect of dose titration of diabeton MR on the effectiveness of treatment of type 2 diabetes

2019 ◽  
Vol 22 (2) ◽  
pp. 159-164
Author(s):  
Natalia Р. Trubitsyna ◽  
Marina V. Shestakova
Keyword(s):  
Type 2 Diabetes ◽  
International Study ◽  
Dose Titration ◽  
Good Tolerability ◽  
Treatment Algorithms ◽  
Glucose Lowering ◽  
Target Values ◽  
Glucose Lowering Therapy

Although the number of antihyperglycemic agents has expanded significantly, sulfonylureas (in particular gliclazide MR) remain an important option in the treatment algorithms of type 2 diabetes mellitus (DM2). A large observational international study EASYDia in real clinical practice, assessing effectiveness of gliclazide MR 60 mg in patients with long-term DM2 on standard glucose-lowering therapy, showed that step-by-step intensification of therapy with gliclazide MR 60mg allows to achieve and maintain the target values of glycemia, with good tolerability even in maximum doses, low risk of hypoglycemia and no weight gain.

scholarly journals Type 2 diabetes: evidence-based medicine approach to glucose-lowering therapy

2021 ◽  
pp. 160-168
Author(s):  
E. V. Biryukova ◽  
I. A. Morozova ◽  
S. V. Rodionova
Keyword(s):  
Type 2 Diabetes ◽  
Drug Therapy ◽  
Glycemic Control ◽  
Initial Therapy ◽  
Clinical Inertia ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

Type 2 diabetes mellitus is a serious medical and social problem. The danger of the disease is associated with epidemic growth rates and chronic complications, leading to early disability, decreased quality of life and mortality. The prevention of diabetes complications is based on the optimal glucose-lowering therapy with the achievement of target metabolic parameters from the date the diagnosis of T2DM was established and throughout the patient’s life. The complex pathogenetic mechanisms of T2DM are the underlying rationale for drug therapy with a simultaneous effect on various disorders, which will provide a greater hypoglycemic potential and maintain effective glycemic control as T2DM progresses. The main reasons for poor disease control include clinical inertia, untimely intensification of drug therapy, and the use of treatment regimens that are insufficiently effective given the progressive course of the disease. The therapy for T2DM is based on clinical guidelines. The pathogenetic therapy options associated with the use of vildagliptin and metformin are considered. Much attention in modern diabetology is paid to the study of the influence of various therapeutic approaches on the disease progression rates from the perspective of improving prognosis and long-term maintenance of target glycemic control. The advantages of combined glucose-lowering therapy at the onset of T2DM are considered in comparison with the stepwise intensification of glucose-lowering therapy. The VERIFY study examined the long-term efficacy and safety of two treatment approaches: early vildagliptin and metformin combination therapy versus the traditional stepwise approach starting with metformin as initial therapy. The combined glucose-lowering therapy is an important direction in the treatment of patients with newly diagnosed type 2 diabetes.

scholarly journals What are new opportunities for clinical practice the VERIFY study opens and which values for native diabetes patients? Joint conclusion on the advisory board results. November 6, 2019

2020 ◽  
Vol 23 (1) ◽  
pp. 106-110
Author(s):  
Marina V. Shestakova ◽  
Mikhail B. Antsiferov ◽  
Alexander S. Ametov ◽  
Gagik R. Galstyan ◽  
Tatiana Y. Demidova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Combination Therapy ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Clinical Benefits ◽  
Glucose Lowering Therapy ◽  
Diabetes Patients

According to key diabetic studies, the early use of metformin glucose lowering therapy is associated with a reduced risk of developing micro- and, in the long term, 10-year follow-up, macrovascular complications and cardiovascular mortality. Short-term studies results on combined glucose lowering therapy with metformin suggests that combination therapy can have several advantages on the one side from the effectiveness of glycemic control and on another side from positive effect on the development of complications of type 2 diabetes. The question of the start time of combined hypoglycemic therapy remains open. According to the results of recent large-scale studies, real world evidence data, careful glycemic control during the first year from the moment of diagnosis of type 2 diabetes is crucial for further management of the disease and slow the progression of complications. However, due to the fact that the clinical benefits of early combination therapy were not demonstrated in randomized clinical trials, this approach, despite the theoretical background, was not recommended for widespread use in international guidelines for the treatment diabetes patients. Russian algorithms on the treatment diabetes patients recommend combined glucose lowering therapy at the start of treatment at a HbA1c level of 1% higher than the target. A 5-year VERIFY study results were demonstrated long-term sustained glycemic control in combination with vildagliptin + metformin prescribed for native diabetes patients with relatively low HbA1c values, as well as the advantages of this approach in comparison with the standard strategy for phased intensification of monotherapy. The results of the VERIFY study provided a wealth of information to discuss early treatment intensification, the clinical benefits of this approach and a possible review of the treatment strategy for native diabetes patients.

The Use of SGLT2i and GLP-1 RA in Patients with Type 2 Diabetes in Thailand: Evidence Review and Recommendations

2021 ◽  
Vol 104 (11) ◽  
pp. 1850-1865
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Lowering ◽  
Sodium Glucose Cotransporter ◽  
Evidence Review ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Glucose Lowering Therapy ◽  
The Cost ◽  
Selection Of

Background: Cardiovascular (CV) and renal comorbidities are common among type 2 diabetes (T2D) patients, and significantly increase the cost and burden of care. Both sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve key outcomes including major CV events, hospitalization for heart failure, and renal outcomes, albeit to varying degrees in different T2D populations. Materials and Methods: The authors reviewed evidence from GLP-1 RA and SGLT2i CV outcomes trials and real-world studies in Thailand and elsewhere. Results: The authors formulated recommendations to guide selection of anti-diabetes medication based on patients’ clinical characteristics and CV or renal risk profile. Conclusion: These recommendations could help guide management of CV/renal comorbidities and risk alongside glucose-lowering therapy for individual patients. Keywords: Type 2 diabetes mellitus; Cardiovascular diseases; Chronic kidney disease; Clinical outcomes; SGLT2i; GLP-1 RA

Dynamics of cognitive disorders in patients with type 2 diabetes mellitus under effect of metabolic therapy

2016 ◽  
Vol 94 (7) ◽  
pp. 533-539
Author(s):  
Irina V. Gatckikh ◽  
M. M. Petrova ◽  
T. P. Shalda ◽  
E. L. Varygina ◽  
M. N. Kuznetsov ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sodium Chloride ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Abstract Thinking ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy ◽  
Hypoglycemic Therapy

The aim of thisstudy was to investigatethe efficiency ofmetabolic therapyincorrectionof cognitive impairmentin patientswith type 2 diabetes. We undertook the analysis of results of the treatment of cognitive dysfunction in 80 patients with a diagnosis of type 2 diabetes. All patients received basic hypoglycemic therapy. 32 patients (study group) received in addition to the basal glucose lowering therapy daily intravenous infusion of 10 mlcytoflavindiluted in 200 ml of a 0.9% sodium chloride solution for 10 days, followed by 2 tablets b.i.d. for 25 days.The group of comparison consisted of 29 patients given in addition to the basal glucose-lowering therapy daily intravenous infusion of 24 ml (600 mg) thioctacid diluted in 200 mL of a 0.9% sodium chloride solution for 10 days. Thereafter, they received 1 tablet ofthioctacid BV once dailyfor 30 days. The control group consisted of 19 patients who received basic hypoglycemic therapy without additional metabolic therapy.Inclusion of cytoflavin in the combined treatment ofpatients with type 2 diabetes ensured a more effective correction of cognitive impairment. There was a statistically significant improvement in optical-spatial activities (p = 0.001), attention (p = 0.001), abstract thinking (p = 0.046), and memory (p<0.001) compared to those in other groups, according to the MOS test. Positive dynamics was expressed as the improvement of the optical-spatial activities by 9,8 ± 10,3%, attention by 13,5 ± 11,8%, abstract thinking by 7,0 ± 8,9%, and memory by 23.0 ± 14 6%. The study of variations of the serum level of brain neurotrophic factor (BDNF) over time during the treatment with metabolic preparations revealedits statistically significant increase (p = 0.002) in the patients treated with cytoflavincompared with comparison (p = 0.139) and control (p = 0.078) groups. These results suggest the influence of cytoflavinon the processes of neuroplasticity under conditions of hyperglycemia, improvement of cerebral microcirculation and cerebroprotective action of this medication.

scholarly journals Pharmacoeconomic evaluation of ipragliflozin in combination with metformin in comparison with other regimens of therapy for type 2 diabetes mellitus

2021 ◽  
pp. 50-63
Author(s):  
A. S. Kolbin ◽  
A. A. Kurylev ◽  
Yu. E. Balykina ◽  
M. A. Proskurin
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Weighted Average ◽  
Sglt2 Inhibitors ◽  
Cost Effectiveness Ratio ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Sodium Glucose Cotransporter ◽  
Glucose Lowering Therapy

Ipragliflozin is a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor that reduce plasma glucose concentrations by inhibiting glucose reabsorption by the kidney through inhibiting SGLT2 sodium-glucose cotransporter and induce glycosuria. SGLT2 inhibitors are a new class of glucose lowering drugs most recently approved for treatment of type 2 diabetes mellitus (T2DM). Unlike other antidiabetic agents, SGLT2 inhibitors improve glycemic control (by HbA1c) and provide multiple additional benefits, including decreased body weight, blood pressure, and other multiple pleiotropic effects. The completed clinical trials and real world data have provided evidence that including of SGLT2 inhibitors in the treatment of T2DM has benefits of reduction of cardiovascular and renal outcomes. Goal. The aim of the study was to conduct a clinical and economic examination of ipragliflozin in comparison with other regimens of glucose-lowering therapy with other SGLT2 inhibitors. Methods. In carrying out the pharmacoeconomic analysis itself, a cost-effectiveness analysis (CEA) was applied with the calculation of the corresponding cost-effectiveness ratio (CER), incremental cost-effectiveness ratio (ICER) according to the formula, as well as an a «budget impact analysis». Multiple one-way sensitivity analysis, check the robustness of the results of the main scenario results to changes in key parameters such as the cost of drugs and complications of diabetes. The time horizon for analyzing the dynamics of economic consequences when using ipragliflozin as a glucose-lowering therapy for T2DM was 5 years. Results. The weighted average cost per patient per year when using the ipragliflozin treatment strategy is 31,182 rubles. The costs of the empagliflozin strategy are 61,291 rubles per patient. In the case of using dapagliflozin, the weighted average costs are 30,032 rubles per patient per year, the total direct medical costs for the current drug therapy option, calculated on the initial number of target practice in 72,143 patients with type 2 diabetes, amounted to 3,068,642,442 rubles. Analysis of the trend of changes in weighted average costs showed that the broader use of ipragliflozin for the treatment of T2DM in the target population leads to reducing in diabetes related direct medical costs by 6.7 %, while the total economic effect of ipragliflozin introduction over five years will be 501,539,327 rubles. Conclusions. Use of ipragliflozin + metformin in T2DM treatment is a cost-effective strategy compared to empagliflozin + metformin. The combination of ipragliflozin with metformin versus dapagliflozin + metformin is economically feasible in terms of cost-effectiveness.

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