Renal insufficiency and linagliptin therapy: a case report

The presence of severe renal insufficiency in type 2 diabetes patients often challenges the diabetologist to prescribe a drug therapy, leading to a satisfactory glycemic balance with the minimal risk of hypoglycaemia. Diabetics with renal dysfunction present an increased risk of hypoglycemic episodes, and oral drugs are often ìcontraindications in these patients , especially if they are eliminated by the kidney. This last class of drugs requires a reduction in dosages to avoid the risk of prolonged hypoglycaemic episodes. In particular, in patients with severe renal insufficiency, metformin must be suspended in order to avoid the risk of lactic acidosis. Here we report the case of a young woman with type 2 diabetes, who quickly developed severe renal failure, unfortunately without remission. This case emphasizes the efficacy and safety of insulin-associated linagliptin for good glycemic control in patients with severe renal impairment, with marked reduction in hypoglycaemic episodes (Diabetology).

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Type 2 Diabetes Mellitus. From the start – combination therapy

Diabetes Mellitus ◽

10.14341/dm9867 ◽

2018 ◽

Vol 21 (5) ◽

pp. 386-394 ◽

Cited By ~ 1

Author(s):

Francesco Indovina ◽

Pierpaolo Falcetta ◽

Stefano Del Prato

Keyword(s):

Type 2 Diabetes ◽

Combination Therapy ◽

Diabetes Diagnosis ◽

Good Glycemic Control ◽

Chronic Hyperglycemia ◽

Increased Risk ◽

History Of ◽

First Time ◽

Early Combination Therapy

Modern treatment of T2DM requires a shift in paradigm with appropriate intensification of therapy from the very first time of diabetes diagnosis. This is supported by data showing how even a moderate delay in achieving good glycemic control can translate into a later increased risk of developing diabetic complications. The recognition of the complexity of the pathogenesis of T2DM leads to the appreciation of the importance of attacking the disease from different angles, i.e. simultaneous tackling of multiple mechanisms contributing to hyperglycemia. From the turn of century a growing number of new anti-hyperglycemic agents have been made available. As compared to the older ones, these new medicines have a more targeted mechanism of action as they act at the level of the specific pathophysiologic disturbances accounting the development and progression of hyperglycemia. Because of that drugs can be use in combination taking advantage of their complementary mechanisms of action and synergistic. If introduced earlier in the natural history of the disease combination therapy may contribute avoiding undesirable exposure to even mild chronic hyperglycemia and provide early benefits. With respect to that in this review we will discuss advantages, disadvantages and still unanswered questions related to the use of early combination therapy in type 2 diabetes.

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Advantage of Insulin Glulisine Over Regular Insulin in Patients With Type 2 Diabetes and Severe Renal Insufficiency

Journal of Renal Nutrition ◽

10.1053/j.jrn.2014.07.011 ◽

2015 ◽

Vol 25 (2) ◽

pp. 129-134 ◽

Cited By ~ 13

Author(s):

Hiromi Urata ◽

Katsuhito Mori ◽

Masanori Emoto ◽

Yuko Yamazaki ◽

Koka Motoyama ◽

...

Keyword(s):

Type 2 Diabetes ◽

Renal Insufficiency ◽

Regular Insulin ◽

Severe Renal Insufficiency ◽

Insulin Glulisine

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Timed Bromocriptine-QR Therapy Reduces Progression of Cardiovascular Disease and Dysglycemia in Subjects with Well-Controlled Type 2 Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2015/157698 ◽

2015 ◽

Vol 2015 ◽

pp. 1-13 ◽

Cited By ~ 19

Author(s):

Bindu Chamarthi ◽

J. Michael Gaziano ◽

Lawrence Blonde ◽

Aaron Vinik ◽

Richard E. Scranton ◽

...

Keyword(s):

Metabolic Disease ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycemic Control ◽

Dopamine D2 Receptor ◽

Double Blind Study ◽

Good Glycemic Control ◽

Increased Risk ◽

The Impact

Background.Type 2 diabetes (T2DM) patients, including those in good glycemic control, have an increased risk of cardiovascular disease (CVD). Maintaining good glycemic control may reduce long-term CVD risk. However, other risk factors such as elevated vascular sympathetic tone and/or endothelial dysfunction may be stronger potentiators of CVD. This study evaluated the impact of bromocriptine-QR, a sympatholytic dopamine D2 receptor agonist, on progression of metabolic disease and CVD in T2DM subjects in good glycemic control (HbA1c ≤7.0%).Methods.1834 subjects (1219 bromocriptine-QR; 615 placebo) with baseline HbA1c ≤7.0% derived from the Cycloset Safety Trial (this trial is registered with ClinicalTrials.gov Identifier:NCT00377676), a 12-month, randomized, multicenter, placebo-controlled, double-blind study in T2DM, were evaluated. Treatment impact upon a prespecified composite CVD endpoint (first myocardial infarction, stroke, coronary revascularization, or hospitalization for angina/congestive heart failure) and the odds of losing glycemic control (HbA1c >7.0% after 52 weeks of therapy) were determined.Results.Bromocriptine-QR reduced the CVD endpoint by 48% (intention-to-treat; HR: 0.52 [0.28−0.98]) and 52% (on-treatment analysis; HR: 0.48 [0.24−0.95]). Bromocriptine-QR also reduced the odds of both losing glycemic control (OR: 0.63 (0.47−0.85),p=0.002) and requiring treatment intensification to maintain HbA1c ≤7.0% (OR: 0.46 (0.31−0.69),p=0.0002).Conclusions.Bromocriptine-QR therapy slowed the progression of CVD and metabolic disease in T2DM subjects in good glycemic control.

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