Second line therapy in type 2 diabetes: legacy effect activation

Type 2 diabetes causes hundred thousand deaths worldwide every year. Though new antidiabetic drugs appear annually and new classes of drugs are invented approximately every ten years still a lot of type 2 diabetic patients remain to be out of the target glycemic levels. According to most of the guidelines for type 2 diabetes,treatment metformin is the first line therapy for this disease. The choice of second-line antidiabetic drug usually depends on doctors preference. That is why defining the correct drug for exact patient is still an urgent question. This review provides data on antidiabetic drugspotential for preventing the progression of micro- and macrovascular complications.The question of the potential of early antidiabetic therapy intensification to activate legacy effect is debated. Early and lasting compensation of diabetes with the use of multiple drugs can become a basis for primary prevention of cardiovascular disease in such patients.

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Characteristics and treatment patterns of patients with type 2 diabetes in Lebanon: the DISCOVER study

Eastern Mediterranean Health Journal ◽

10.26719/2021.27.5.509 ◽

2021 ◽

Vol 27 (5) ◽

pp. 509-515

Author(s):

Sami T. Azar ◽

Akram Echtay ◽

Mireille Amm ◽

Hajar Ballout ◽

Iskandar Cheaib ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Practice ◽

Glycaemic Control ◽

Treatment Patterns ◽

Second Line ◽

First Line ◽

Second Line Therapy ◽

First Line Therapy ◽

Line Therapy

Background: Lebanon is part of the global DISCOVER study, a global, noninterventional, multicentre, prospective study with 3-years of follow-up. Aims: The aim of this study is to describe real-world clinical practice in terms of type 2 diabetes mellitus (T2DM) disease management and treatment patterns within Lebanon. Methods: Baseline demographic and clinical parameters were captured on a standardized case report form, according to routine clinical practice at each clinical site. Results: We recruited 348 patients. At the initiation of second-line therapy, mean duration of diabetes was 6.7 [standard deviation (SD) 6.5] years; mean HbA1c and fasting plasma glucose levels were 8.5% (SD 1.6%) and 178.7 (SD 56.5) mg/dL respectively. Almost half the patients were hypertensive (45.1%) or had dyslipidaemia (48.6%). Metformin monotherapy was used as first-line therapy in 56.9% of the patients and upfront dual therapy in 25%. The primary reason for changing first-line therapy was poor glycaemic control. The main factors in choosing the second-line therapy were efficacy, tolerability and hypoglycaemia. Conclusion: Clinical inertia was evident in this cohort of patients as they had suboptimal glycaemic control at the time of enrolment and the initiation of second-line therapy. Treatment intensification is required to reduce diabetes-related adverse outcomes.

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THE SEQUENTIAL TREATMENT FOR HELICOBACTER PYLORI ERADICATION AS A FIRST-LINE THERAPY IN TYPE 2 DIABETIC PATIENTS

Research and Science Today ◽

10.38173/rst.2020.20.2.18:175-179 ◽

2020 ◽

Vol 20 (1) ◽

pp. 175-179

Author(s):

Amelia GENUNCHE-DUMITRESCU ◽

Daniela BADEA ◽

Cristian MARINAS ◽

Smaranda MITRAN ◽

Tiberiu-Stefanita TENEA-COJAN

Keyword(s):

Helicobacter Pylori ◽

Sequential Treatment ◽

Diabetic Patients ◽

First Line ◽

Type 2 Diabetic Patients ◽

Helicobacter Pylori Eradication ◽

First Line Therapy ◽

Line Therapy ◽

Type 2 Diabetic

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Individualized HbA1c Targets in People with Type 2 Diabetes Initiating Second-Line Therapy—The Global DISCOVER Study

Diabetes ◽

10.2337/db18-1629-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1629-P

Author(s):

KAMLESH KHUNTI ◽

HUNGTA CHEN ◽

JAVIER CID-RUZAFA ◽

PETER FENICI ◽

MARILIA B. GOMES ◽

...

Keyword(s):

Type 2 Diabetes ◽

Second Line ◽

Second Line Therapy ◽

Line Therapy

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Metabolic and endothelial effects of trimetazidine on forearm skeletal muscle in patients with type 2 diabetes and ischemic cardiomyopathy

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00083.2005 ◽

2006 ◽

Vol 290 (1) ◽

pp. E54-E59 ◽

Cited By ~ 35

Author(s):

Lucilla D. Monti ◽

Emanuela Setola ◽

Gabriele Fragasso ◽

Riccardo P. Camisasca ◽

Pietro Lucotti ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lipid Oxidation ◽

Ischemic Cardiomyopathy ◽

Glucose Oxidation ◽

Diabetic Patients ◽

Vascular Effects ◽

Type 2 Diabetic Patients ◽

Double Blind ◽

Endothelin 1

The aim of the present study was to evaluate the effect of prolonged inhibition of β-oxidation on glucose and lipid muscle forearm metabolism and cGMP and endothelin-1 forearm release in patients with type 2 diabetes mellitus and ischemic cardiomyopathy. Fifteen patients were randomly allocated in a double-blind cross-over parallel study with trimetazidine (20 mg tid) or placebo lasting 15 days. At the end of each period, all patients underwent euglycemic hyperinsulinemic clamps with forearm indirect calorimetry and endothelial balance of vasodilator and vasoconstricor factors. Compared with placebo, trimetazidine induced 1) an increase in insulin-induced forearm glucose uptake and glucose oxidation accompained by a reduction in forearm lipid oxidation and citrate release and 2) a decrease of endothelin-1 release paralleled by a significant increase in forearm cGMP release. Forearm glucose oxidation significantly correlated with cGMP release ( r = 0.37, P < 0.04), whereas forearm lipid oxidation positively correlated with endothelin-1 release ( r = 0.40, P < 0.03). In conclusion, for the first time, we demonstrated that insulin-induced forearm glucose oxidation and forearm cGMP release were increased whereas forearm endothelin-1 release was decreased during trimetazidine treatment. Muscle's metabolic and vascular effects of trimetazidine add new interest in the use of trimetazidine in type 2 diabetic patients with cardiovascular disease.

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Association of Plasma Myeloperoxidase Level with Risk of Coronary Artery Disease in Patients with Type 2 Diabetes

Disease Markers ◽

10.1155/2015/761939 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Ping Song ◽

Jin Xu ◽

Yongfeng Song ◽

Shiliang Jiang ◽

Haitao Yuan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Logistic Analysis ◽

Artery Disease

Aims. This study aimed to investigate whether the change of plasma myeloperoxidase (MPO) level would be associated with the incidence of coronary artery disease (CAD) among diabetic patients.Methods. 339 patients with type 2 diabetes mellitus (DM) underwent coronary angiography. Of them, 204 cases had CAD and were assigned to CAD group and 135 cases without CAD were assigned to non-CAD group.Results. Compared to non-CAD group, CAD group had higher level of plasma MPO (p<0.01). Multiple linear regression analysis showed that plasma MPO level was correlated with Gensini score. Multiple logistic analysis showed that the odds ratios for CAD across increasing tertiles of MPO level were 1.191 (0.971–1.547) and 1.488 (1.115–2.228) (p=0.048,p=0.009versus 1st tertile of MPO level, resp.) by adjusting for age, sex, and other conventional risk factors for CAD. The subjects were stratified into nine groups according to tertiles of MPO and HbA1c. The odds ratio for CAD was significantly higher in group with highest levels of MPO and HbA1c (OR = 4.08,p<0.01).Conclusion. Plasma MPO level was positively correlated with the degree of coronary artery stenosis in type 2 diabetic patients, and increasing blood glucose might amplify the association between MPO and CAD.

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Impact of a Booklet about Diabetes Genetic Susceptibility and Its Prevention on Attitudes towards Prevention and Perceived Behavioral Change in Patients with Type 2 Diabetes and Their Offspring

Advances in Preventive Medicine ◽

10.4061/2011/365132 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Masakazu Nishigaki ◽

Eiko Sato ◽

Ryota Ochiai ◽

Taiga Shibayama ◽

Keiko Kazuma

Keyword(s):

Type 2 Diabetes ◽

Genetic Susceptibility ◽

Behavioral Change ◽

Behavioral Changes ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

The Patient’S View ◽

Self Administered Questionnaire ◽

Type 2 Diabetic

Background. Offspring of type 2 diabetic patients are at a high risk of type 2 diabetes. Information on diabetes genetic susceptibility and prevention should be supplied to the offspring.Methods. A six-page booklet on diabetes genetic susceptibility and prevention was distributed to 173 patients who ere ordered to hand it to their offspring. The patients answered a self-administered questionnaire on booklet delivery and attitudinal and behavioral changes toward diabetes and its prevention in themselves and their offspring.Results. Valid responses were obtained from 130 patients. Forty-nine patients had actually handed the booklet. Booklet induces more relief than anxiety. From the patient's view, favorable attitudinal and/or behavioral changes occurred in more than half of the offspring who were delivered the booklet.Conclusion. The booklet worked effectively on attitudes and behaviors toward diabetes and its prevention both in patients and their offspring. However, the effectiveness of patients as information deliverers was limited.

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Combination of Empagliflozin and Linagliptin as Second-Line Therapy in Subjects With Type 2 Diabetes Inadequately Controlled on Metformin

Diabetes Care ◽

10.2337/dc14-2364 ◽

2015 ◽

Vol 38 (3) ◽

pp. 384-393 ◽

Cited By ~ 184

Author(s):

Ralph A. DeFronzo ◽

Andrew Lewin ◽

Sanjay Patel ◽

Dacheng Liu ◽

Renee Kaste ◽

...

Keyword(s):

Type 2 Diabetes ◽

Second Line ◽

Second Line Therapy ◽

Line Therapy

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Awareness of Complications in Diabetic Patients - Study in a Tertiary Care Centre in Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/605 ◽

2021 ◽

Vol 8 (37) ◽

pp. 3334-3338

Author(s):

Satish Kumar

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Tertiary Care ◽

Diabetic Patients ◽

Tertiary Care Centre ◽

Type 2 Diabetic Patients ◽

Complications Of Diabetes ◽

Type 2 Diabetic

BACKGROUND Type 2 diabetes mellitus is common in the Indian population and awareness regarding the disease and its complications is low among the patients with diabetes. There is lack of studies regarding awareness of complications of diabetes among type 2 diabetic patients. The purpose of this study was to assess the awareness of diabetic complications among type 2 diabetic patients. METHODS This is an institutional based observational study. The sample comprised of 150 adult patients with type 2 diabetes mellitus who underwent treatment in the Department of Medicine, Medical College Kottayam and the patient’s age ranged from 18 - 77 years. RESULTS Majority of patients were in the age group 38 to 57 and the sample comprised of 56 % males and 44 % female patients. Out of 150 patients involved in the study, 120 patients (80 %) were aware of the complications of diabetes mellitus. Among the male patients, 70 (83.33 %) and among females, 50 (75.75 %) were aware of the complications in diabetes. In the study sample, 92 (61.33 %) were aware of the foot problems, 120 patients (80 %) were aware of renal complications, 91 patients were aware regarding eye problems of diabetes, 38 (25.33 %) regarding development of hypertension, 62 (41.33 %) regarding heart attack, 42 (28 %) patients were aware regarding development of stroke and 78 patients (52 %) had awareness regarding occurrence of recurrent infections. CONCLUSIONS Awareness regarding diabetes and its complications is fairly good among the diabetic patients in Kerala. Awareness regarding all complications of diabetes was higher among males than females. Providing awareness to type 2 diabetic patients by various educational programs may be of further help to prevent complications and to decrease the mortality and morbidity in type 2 diabetes patients. KEYWORDS Awareness, Diabetes

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