The role of incretin-based therapies in the management of type 2 diabetes mellitus: perspectives on the past, present and future

The ever-increasing burden of type 2 diabetes mellitus (T2DM) worldwide, has led to the emergence of several antidiabetes drugs with different modes of action. Incretin hormones and their effect on glucose metabolism and pathogenesis of T2DM has been a landmark discovery in the management of this increasingly prevalent metabolic disorder. Glucagon like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are the two major classes of incretin-based therapies that regulate glucose mechanism through multiple pathways, demonstrate weight loss (GLP-1 receptor agonists) or a weight-neutral effect (DPP-4 inhibitors), and are associated with a low risk of hypoglycaemia and other adverse events. In addition, evidence reflects their possible therapeutic potential in the treatment of other clinical conditions such as obesity, cardiovascular disease and liver disorders. This review explores the availability and the impact of GLP-1 receptor agonists and DPP-4 inhibitors as potential therapeutic strategies for T2DM along with their future in the landscape of diabetes management and other clinical conditions.

Download Full-text

Impact of an Advanced Practice Pharmacist Type 2 Diabetes Management Program: A Pilot Study

INNOVATIONS in pharmacy ◽

10.24926/iip.v10i4.2237 ◽

2019 ◽

Vol 10 (4) ◽

pp. 20

Author(s):

Jelena Lewis ◽

Tiffany Nguyen ◽

Hana Althobaiti ◽

Mona Alsheikh ◽

Brad Borsari ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetes Management ◽

Drug Dose ◽

Advanced Practice ◽

Dose Increase ◽

Therapeutic Decisions ◽

The Impact

Background: The purpose of this study was to describe the impact of an Advanced Practice Pharmacist (APh) on lowering hemoglobin A1c (HbA1c) in patients with type 2 diabetes within a patient centered medical home (PCMH) and to classify the types of therapeutic decisions made by the APh. Methods: This was a retrospective study using data from electronic health records. The study evaluated a partnership between Chapman University School of Pharmacy and Providence St. Joseph Heritage Healthcare that provided diabetes management by an Advanced Practice Pharmacist in a PCMH under a collaborative practice agreement. Change in the HbA1c was the primary endpoint assessed in this study. The type of therapeutic decisions made by the APh were also evaluated. Descriptive analysis and Wilcoxon signed rank test were used to analyze data. Results: The study included 35 patients with diagnosis of type 2 diabetes mellitus managed by an APh from May 2017 to December 2017. Most of the patients were 60-79 years old (68.5%), 45.7% were female, and 45.7% were of Hispanic/Latino ethnicity. The average HbA1c was 8.8%±1.4% (range=6.0%-12.4%) and 7.5%±1.4% (range=5.5%-12.4%) at the initial and final APh visit, respectively (p<0.0001). Therapeutic decisions made by the APh included drug dose increase (35.5% of visits), drug added (16.4%), drug dose decrease (6.4%), drug switch (5.5%), and drug discontinuation (1.8%). Conclusion: The Advanced Practice Pharmacist’s interventions had a significant positive impact on lowering HbA1c in patients with type 2 diabetes mellitus in a PCMH. The most common therapeutic decisions made by the APh included drug dose increase and adding a new drug. Article Type: Pharmacy Practice

Download Full-text

'It's a Dance between Managing Both': A Qualitative Study Exploring Perspectives of Persons With Knee Osteoarthritis and Type 2 Diabetes Mellitus on the Impact of Osteoarthritis on Diabetes Management and Daily Life

SSRN Electronic Journal ◽

10.2139/ssrn.3991623 ◽

2021 ◽

Author(s):

Lauren K. King ◽

Esther J. Waugh ◽

Crystal Mackay ◽

Ian Stanaitis ◽

Jane Stretton ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Qualitative Study ◽

Knee Osteoarthritis ◽

Diabetes Management ◽

Daily Life ◽

The Impact

Download Full-text

Vildagliptin: ten years in the service for type 2 diabetes mellitus patients. The journey of discovery, innovation and success in clinical practice

Problems of Endocrinology ◽

10.14341/probl9746 ◽

2018 ◽

Vol 64 (5) ◽

pp. 336-347

Author(s):

Tatiana Yu. Demidova

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetes Management ◽

Dipeptidyl Peptidase ◽

Good Glycemic Control ◽

Dipeptidyl Peptidase 4 ◽

Wide Range ◽

Dipeptidyl Peptidase 4 Inhibitors

Type 2 diabetes mellitus is a multifactorial multiorgan disease. Over the last decade, the implementation of brand-new therapeutic opportunities led to tremendous rise of research studies in the field of diabetes as well as to shift in priorities of the management of patients with type 2 diabetes from a glucocentric approach and towards holistic control of the key underlying pathophysiological processes of the disease development and progression. The use of dipeptidyl peptidase-4 inhibitors shows good glycemic control because of physiological glucose — dependent mechanism of action mediated with the improvement of incretin hormones effects. Moreover, dipeptidyl peptidase-4 inhibitors have a wide range of pleiotropic effects owning to additional properties of incretins and inhibition of dipeptidyl peptidase enzymatic activity, which leads to beneficial impact on metabolic and pathogenetic processes of type 2 diabetes mellitus. Dipeptidyl peptidase-4 inhibitors are effective drugs with good safety profile as for risks related to type 2 diabetes and have no limitative disadvantages such as hypoglycemia and weight gain. This publication reviews vildagliptin, the first developed dipeptidyl peptidase-4 inhibitor, with an emphasis on its use in different clinical settings of diabetes management.

Download Full-text

Prevalence of Hypoglycemia, Treatment Satisfaction, Adherence and Their Associations with Glycemic Goals in Patients with Type 2 Diabetes Mellitus Treated with Sulfonylureas: Findings from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) in Romania

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2019-0006 ◽

2019 ◽

Vol 26 (1) ◽

pp. 55-64

Author(s):

Simona Popoviciu ◽

Anca Alionescu ◽

Irma Sisic

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycaemic Control ◽

Diabetes Management ◽

Real Life ◽

Haemoglobin A1c ◽

The Mean ◽

The Impact

Abstract Background and aims: The aim of this study was to assess the prevalence and evaluate the impact on several treatment and quality of life parameters of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylureas (SU) in Romania. Secondary objective was to determine the proportion of patients attaining haemoglobin A1c (HbA1c) target of <7%. Material and method: This was a multi-center, observational study using retrospective clinical chart and laboratory parameters review, and a cross-sectional survey in Romania. The sample in this study consisted of 385 patients. Socio-demographic and clinical variables were compared between patients with inadequate and adequate control. Results: The mean age of all enrolled subjects was 65.37 (33-87) years. The average BMI was 30.44 kg/m2. Mean diabetes duration was 7.76 (6 months -32) years with the mean age of diabetes at diagnosis of 57.75 (31-85) years. HbA1c was recorded for 238 subjects with mean value of 7.12 (4.8-10.97) %. Conclusions: The prevalence of hypoglycaemia in SU treated patients was 42.2%. Highest prevalence was in the 50-60 age category, at 49.2% and lowest among the eldest subjects (>70 years), at 38.6%. Prevalence of patients at the goal of HbA1c<7% was 50.8 %. Patients with adequate glycaemic control had more acceptable BMI than those with inadequate glycaemic control. In patients not achieving a goal of HbA1c < 7%, higher level of plasma glucose and total cholesterol was determined compared to those with adequate glycaemic control. There were no significant differences in the HDL-C, triglycerides or albumin:creatinine ratios in patients with both adequate and inadequate glycaemic control.

Download Full-text

Association between dipeptidyl peptidase-4 inhibitors use and leptin in type 2 diabetes mellitus

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00703-x ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Xin Wei ◽

Yu Bai ◽

Zhuo Wang ◽

Xiaohong Zheng ◽

Zening Jin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Sensitivity Analysis ◽

Type 2 Diabetes Mellitus ◽

Dipeptidyl Peptidase ◽

Cochrane Library ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

The Impact

Abstract Background Dipeptidyl peptidase-4 inhibitors (DPP-4i) provide a unique antihyperglycemic effect by regulating incretin peptides in type 2 diabetes mellitus (T2DM) patients who are inadequately controlled with insulin therapy. The aim of this study was to investigate the impact of DPP-4i on leptin concentrations in subjects with T2DM. Methods Randomized controlled trials (RCTs) with comparators were systematically searched through PubMed, Embase, and the Cochrane Library. Quantitative analysis was performed with a fixed or random-effects model according to heterogeneity. Publication bias was evaluated by using the standard methods for sensitivity analysis. Results Ten trials with 698 patients with T2DM were included. Pooled analysis demonstrated that DPP-4i did not significantly change leptin concentrations (1.31 ng/mL, 95 % CI − 0.48 to 3.10). DPP-4i exerted effects on modulating leptin levels compared to active comparators (0.21 ng/mL, 95 % CI − 1.37 to 1.78). Meta-analysis was powerful and stable after sensitivity analysis. Conclusions DPP-4i did not modulate leptin concentrations in T2DM and exerted no stronger effects than traditional antidiabetic agents.

Download Full-text