scholarly journals Imeglimin, a novel, first in-class, blood glucose-lowering agent: a systematic review and meta-analysis of clinical evidence

2020 ◽  
Vol 20 (1) ◽  
pp. 28-31 ◽  
Author(s):  
Thomas SJ Crabtree ◽  
Ralph A DeFronzo ◽  
Robert E J Ryder ◽  
Clifford J Bailey
Keyword(s):  
Systematic Review ◽  
Blood Glucose ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Total N ◽  
Glucose Lowering ◽  
Fasting Plasma ◽  
Increase Glucose Uptake ◽  
Glucose Output

Imeglimin is a novel, first in-class, blood glucose-lowering agent which acts via a mitochondrial mechanism to enhance glucose-induced insulin secretion, decrease hepatic glucose output and increase glucose uptake by skeletal muscle. A systematic review and meta-analysis of randomised controlled clinical trials (RCTs) with imeglimin in adults with type 2 diabetes was undertaken. Of 45 articles identified, five were RCTs but, due to the format of the data, only three could be combined in a meta-analysis (total n=180 participants). A random-effects model found that imeglimin 1500 mg twice daily as monotherapy and add-on to metformin or sitagliptin was associated with reductions of HbA1c by −0.63% (95% CI −0.84 to −0.42) (−6.6 mmol/mol, 95% CI −8.8 to −4.4) and reductions of fasting plasma glucose by −0.52 mmol/L (95% CI −0.80 to −0.24) compared with placebo. Adverse events were minimal, mostly gastrointestinal, and without hypoglycaemia. It is concluded that imeglimin displays promising improvements in HbA1c and fasting plasma glucose and is generally well tolerated.

scholarly journals Comparative efficacy of once-weekly semaglutide versus SGLT-2 inhibitors in patients inadequately controlled with one to two oral antidiabetic drugs: a systematic literature review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023458 ◽  
Author(s):  
Steve Kanters ◽  
Lars Wilkinson ◽  
Hrvoje Vrazic ◽  
Rohini Sharma ◽  
Sandra Lopes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Glucose ◽  
North America ◽  
Systolic Blood Pressure ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Postprandial Blood Glucose ◽  
Comparative Efficacy ◽  
Fasting Plasma

ObjectiveTo determine the comparative efficacy of once-weekly semaglutide relative to sodium-glucose cotransporter 2 inhibitors (SGLT-2is) licensed in Europe and North America among patients with type 2 diabetes (T2D) inadequately controlled with 1–2 oral antidiabetics (OADs), using a network meta-analysis (NMA). Design systematic review and network meta-analysis. Data Sources EMBASE, MEDLINE and CENTRAL were searched from January 1994 to August 2017.MethodsRandomised controlled trials with ≥20 weeks of treatment evaluating once-weekly semaglutide or SGLT-2is. Primary outcomes included change from baseline in: HbA1c, weight, systolic blood pressure, postprandial blood glucose and fasting plasma glucose. Fixed-effect and random-effect Bayesian NMA were used to indirectly compare treatment effects at 26 (±4) weeks. Metaregression and sensitivity analyses were conducted. Model selection was performed using the deviance information criterion and consistency was assessed by comparing indirect (edge-splitting) to direct evidence.ResultsForty-eight publications representing 21 trials were included. The mean differences (MD) in change from baseline in HbA1c of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −0.56% for canagliflozin 300 mg (95% credible interval (CrI): −0.76 to −0.33%), to −0.95% for dapagliflozin 5 mg (95% CrI: −1.20 to −0.69%). The MD in change from baseline in weight of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −1.35 kg for canagliflozin 300 mg to −2.48 kg for dapagliflozin 5 mg, while change from baseline in fasting plasma glucose ranged from −0.41 mmol/L for canagliflozin 300 mg to −1.37 mmol/L for dapagliflozin 5 mg. Once-weekly semaglutide was not statistically differentiable than all SGLT-2is in reducing systolic blood pressure. NMA was not feasible for postprandial blood glucose and safety outcomes.ConclusionOnce-weekly semaglutide demonstrated statistically significant and clinically meaningful reductions in HbA1c and body weight in T2D patients inadequately controlled with 1–2 OADs compared to all SGLT-2is licensed in Europe and North America.

Effect of Yoga on oxidative stress in type 2 diabetes mellitus: a systematic review and meta-analysis

2021 ◽  
Vol 17 ◽  
Author(s):  
V. Venugopal ◽  
S. Geethanjali ◽  
S. Poonguzhali ◽  
R. Padmavathi ◽  
Shriraam Mahadevan ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Fasting Plasma

Background: Diabetes mellitus has a significant impact on public health. Oxidative stress plays a major role in the pathophysiology of type 2 diabetes mellitus (T2DM), leading to various complications of T2DM. Yoga is being widely used in the management of T2DM. The primary objective of this systematic review and meta-analysis is to understand the effects of yoga on oxidative stress parameters among adult patients diagnosed with T2DM. Materials and methods: Electronic databases such as PubMed, Scopus, Cochrane Library and Science direct from inception till March 2020 were searched to obtain eligible studies. Study designs of all nature were included (except case studies and reviews). The primary outcome was malondialdehyde (MDA) and secondary outcomes included fasting plasma glucose, HbA1C and superoxide dismutase (SOD) levels. Results: A total of four trials with a total of 440 patients met the inclusion criteria. The results of meta-analysis indicated that yoga significantly reduced MDA (SMD: -1.4 ; 95% CI -2.66 to -0.13; P = 0.03; I2 = 97%), fasting plasma glucose levels (SMD: –1.87: 95% CI -3.83 to -0.09; P = 0.06;I2= 99%), and HbA1c (SMD: -1.92; 95% CI - 3.03 to -0.81; P = 0.0007; I2 = 92%) in patients with T2DM. No such effect was found for SOD (SMD: -1.01; 95% CI -4.41 to 2.38; P = 0.56; I2= 99%). Conclusion: The available evidence suggests that yoga reduces MDA, fasting plasma glucose and HbA1C, and thus would be beneficial in the management of T2DM as a complementary therapy. However, considering the limited number of studies and its heterogeneity, further robust studies are necessary to strengthen our findings and investigate the long-term benefits of yoga.

Use of high-normal levels of haemoglobin A1Cand fasting plasma glucose for diabetes screening and for prediction: a meta-analysis

2013 ◽  
Vol 29 (8) ◽  
pp. 680-692 ◽  
Author(s):  
Satoru Kodama ◽  
Chika Horikawa ◽  
Kazuya Fujihara ◽  
Reiko Hirasawa ◽  
Yoko Yachi ◽  
...  
Keyword(s):  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Diabetes Screening ◽  
Fasting Plasma

scholarly journals Comparison of glycated haemoglobin and fasting blood glucose in the diagnosis of diabetes mellitus and pre-diabetes in a cohort of obese patients

2017 ◽  
Vol 103 (1) ◽  
pp. 39-43
Author(s):  
D M L Chan ◽  
M Murphy
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Diagnostic Criteria ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Glycated Haemoglobin ◽  
World Health ◽  
Expert Committee ◽  
Obese Patients ◽  
Fasting Plasma

AbstractBackgroundDiabetes mellitus (DM) has historically been diagnosed by measurement of blood glucose concentrations. More recently, the use of glycated haemoglobin (HbA1c) has been advocated in the diagnosis of diabetes, complementing its existing role in the monitoring of glycaemic control.A recent study has shown that obesity is an important problem in the UK Armed Forces. Obese patients are at increased risk of diabetes and intermediate hyperglycaemia (pre-diabetes). It is unclear whether the application of diagnostic criteria based on HbA1c would produce different categorisation of obese patients compared with standard glucose-based criteria. In the current study, we compared HbA1c with fasting plasma glucose in the diagnosis of type 2 diabetes and intermediate hyperglycaemia in a cohort of obese patients.MethodsPatients were recruited from the NHS Tayside Specialist Weight Management Service. They were classified into three categories (normoglycaemia, pre-diabetes, and diabetes) according to their fasting plasma glucose (FPG) and HbA1c. The diagnostic criteria of three organisations were applied: the World Health Organisation (WHO); the American Diabetes Association (ADA); and the International Expert Committee (IEC). Glucose, insulin, cholesterol, triglycerides, uric acid, liver function tests and sex hormone-binding globulin (SHBG) were measured.ResultsBy WHO (fasting glucose) criteria, 102 subjects were classified as normal, 13 as having impaired fasting glycaemia (IFG) and 5 as having diabetes mellitus (DM). By IEC (HbA1c) criteria, 89 subjects were classified as normal, 21 as pre-diabetes and 7 as DM. By ADA (HbA1c) criteria, 69 subjects were classified as normal, 41 as pre-diabetes and 7 as DM. Alkaline phosphatase was significantly higher in hyperglycaemic states compared with normal subjects, with ANOVA F statistics of 9.45 for WHO (p < 0.001), 9.24 for IEC (p < 0.001), and 6.87 for ADA (p < 0.01).ConclusionAlthough the numbers were small, more obese patients were categorised as hyperglycaemic (pre-diabetes and diabetes) when HbA1c-based criteria were applied, compared with WHO (glucose-based) criteria. Further studies are required to confirm this preliminary observation.

scholarly journals Efficacy and safety of short- and long-acting GLP-1 receptor agonists on a background of basal insulin in type 2 diabetes: A meta-analysis

2020 ◽  
Author(s):  
Jessica Annalena Huthmacher ◽  
Juris J. Meier ◽  
Michael A. Nauck
Keyword(s):  
Body Weight ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Basal Insulin ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Short Acting ◽  
Fasting Plasma ◽  
Long Acting

<b>Background/Purpose.</b> To compare efficacy and safety of short- and long-acting GLP-1 receptor agonists (GLP-1 RAs), both used in combination with basal insulin in patients with type 2 diabetes.<b></b> <p><b> </b></p> <p><b>Data Sources/Study Selection.</b><b><i> </i></b>Randomized controlled trials comparing the co-administration of short- or long-acting GLP-1 RAs and basal insulin with basal insulin ± placebo were identified (PubMed search). Of 974 identified publications 14 clinical trials were included. Eight trials examined short-acting and six long-acting GLP-1 RAs.<b></b></p> <p><b> </b></p> <p><b>Data Extraction/Data Synthesis.</b> Differences in HbA<sub>1c</sub>, fasting plasma glucose, body weight and adverse events were compared between studies using short- or long-acting GLP-1 RAs by random-effects meta-analysis.</p> <p><b> </b></p> <p><b>Limitations. </b>Relatively small numbers of available publications, some heterogeneity regarding protocols and differences in the GLP-1 RA compound used.</p> <p><b> </b></p> <p><b>Conclusions.</b> Long-acting GLP-1 RAs more effectively reduced HbA<sub>1c</sub> (∆ - 6 mmol/mol, [95 % CI - 10; - 2], p= 0.007), fasting plasma glucose (∆ - 0.7 mmol/l [- 1.2; - 0.3] p= 0.007) and body weight (∆ - 1.4 kg [- 2.2; - 0.6] p= 0.002) and raised the proportion of patients achieving an HbA<sub>1c</sub> target < 7.0% (< 53 mmol/mol; p= 0.03) more than the short-acting ones. Patients reporting symptomatic (p= 0.048), but not severe hypoglycemia (p= 0.96) were fewer with long- vs. short-acting GLP-1 RAs added to insulin. The proportion of patients reporting nausea (- 52 %; p < 0.0001) or vomiting (- 36 %; p= 0.0002) was lower with long-acting GLP-1 RAs.<b> </b>Overall, GLP-1 RAs improved HbA<sub>1c</sub>, fasting plasma glucose and body weight when added to basal insulin. However, long-acting GLP-1 RAs were significantly more effective for glycemic and body weight control and displayed better gastro-intestinal tolerability. </p>

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