scholarly journals Metformin: Arguments for Maintaining its Position as First-Line Pharmacological Treatment in Type 2 Diabetes Mellitus

EMJ Diabetes ◽  
2021 ◽  
pp. 56-59
Author(s):  
Coen DA Stehouwer
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Pharmacological Treatment ◽  
First Line

scholarly journals New clusters of type 2 diabetes mellitus and their outcomes: relation between pharmacological treatment and previous cardiovascular events

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Claudio Santos ◽  
Sonia Brito-Costa ◽  
Luis Margalho ◽  
Pedro Monteiro
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Pharmacological Treatment ◽  
Cardiovascular Events ◽  
Glycated Haemoglobin ◽  
Research Unit ◽  
Clinical Research Unit ◽  
History Of

Abstract Background Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes in adults, with 90% to 95% of cases. This study aims to establish clusters and have knowledge about the relationship between previous cardiovascular events and pharmacological treatment for T2DM. Methods 191 participants (EG) with T2DM with the average of 70.3 years (SD = 8.3) and 36 with pre-diabetes (CG) with an average of 62 years (SD = 10.3) who participated in clinical trials at Clinical Research Unit in Cardiology of Coimbra Hospital and Universitary Centre without cognitive difficulties, were divided in 5 different clusters. These were established based on six different variables: body mass index (BMI), age of each individual, age at diagnosis of DMT2, glycated haemoglobin value (HbA1c), homeostatic model that estimates the function of β cells (HOMA2-B) and insulin resistance (HOMA2-IR). Results Cluster 1 presented pre-diabetic individuals (15.9%), while diabetic individuals were divided into clusters 2 (1.8%), 3 (17.6%), 4 (21.1%) and 5 (43.6%). Regarding the study of the prevalence of previous cardiovascular events, the majority of individuals present in the different clusters had history of acute myocardial infarction (AMI). As for the prevalence of pharmacological treatment for DMT2, it was found that metformin was the most used drug. It was observed a relationship between previous AMI and metformin administration in clusters 3 (P = 0.0027; P < 0.05) and 5 (P = 0.0059; P < 0.05). Conclusions It was possible to create different clusters in a sample of the Portuguese population and to observe the existence of dependency relationships between different previous cardiovascular events and pharmacological treatment.

Patterns and determinants of new first-line antihyperglycaemic drug use in patients with type 2 diabetes mellitus

2014 ◽  
Vol 106 (1) ◽  
pp. 73-80 ◽  
Author(s):  
A.S. Geier ◽  
I. Wellmann ◽  
J. Wellmann ◽  
H. Kajüter ◽  
O. Heidinger ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Drug Use ◽  
First Line

scholarly journals Pharmacological Management Evolution of Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials from 2013 to 2020 and Their Impact on Practice Guidelines

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Morales-Villegas EC
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Practice Guidelines ◽  
Pharmacological Treatment ◽  
Cardiovascular Outcomes ◽  
Renal Protection ◽  
Pharmacological Management ◽  
The World

In this brief review of the recent evolution of the pharmacological treatment of Type 2 Diabetes Mellitus (T2DM), we will analyze how different ways of living with diabetes coexist around the world. To define them, we will use the concept that we have called the three contemporary visions of T2DM, namely: dark vision, luminous vision, and bright vision. We will also discuss how the glucocentric paradigm of T2DM treatment led to the development, implementation, and publication of the Cardiovascular Outcomes Trials (CVOTs) in T2DM. Since June 2013, eighteen CVOTs have been published that have studied the cardiovascular safety of fifteen anti-diabetic drugs belonging to four new therapeutic classes. Together, these studies have included more than 150,000 individuals with a cumulative average follow-up of almost half a million patient-years. These studies have shown that beyond glycemic control, six drugs-Empagliflozin, Canagliflozin, Dapagliflozin, Liraglutide, Semaglutide, and Dulaglutide belonging to two new therapeutic classes, significantly reduce the cerebrovascular, cardiovascular, and renal morbidity and mortality of T2DM patients. Thus, establishing a new paradigm in the pharmacological treatment of T2DM, the paradigm of cerebral and cardio-renal protection of the diabetic individual. This substantial evidence has been transferred to the T2DM practice guidelines and, for the first time in this medical field, has been homologated around the world.

scholarly journals Cost-Effectiveness of Saxagliptin Compared With Glibenclamide as a Second-Line Therapy Added to Metformin for Type 2 Diabetes Mellitus in Ethiopia

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832110057
Author(s):  
Mengistu Bekele ◽  
Ole Frithjof Norheim ◽  
Alemayehu Hailu
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
Line Therapy

Background. Metformin is a widely accepted first-line pharmacotherapy for patients with type 2 diabetes mellitus (T2DM). Treatment of T2DM with glibenclamide, saxagliptin, or one of the other second-line treatment agents is recommended when the first-line treatment (metformin) cannot control the disease. However, there is little evidence on the additional cost and cost-effectiveness of adding second-line drugs. Therefore, this study aimed to estimate the cost-effectiveness of saxagliptin and glibenclamide as second-line therapies added to metformin compared with metformin only in T2DM in Ethiopia. Methods. This cost-effectiveness study was conducted in Ethiopia using a mix of primary data on cost and best available data from the literature on the effectiveness. We measured the interventions’ cost from the providers’ perspective in 2019 US dollars. We developed a Markov model for T2DM disease progression with five health states using TreeAge Pro 2020 software. Disability-adjusted life year (DALY) was the health outcome used in this study, and we calculated the incremental cost-effectiveness ratio (ICER) per DALY averted. Furthermore, one-way and probabilistic sensitivity analysis were performed. Results. The annual unit cost per patient was US$70 for metformin, US$75 for metformin + glibenclamide, and US$309 for metformin + saxagliptin. The ICER for saxagliptin + metformin was US$2259 per DALY averted. The ICER results were sensitive to various changes in cost, effectiveness, and transition probabilities. The ICER was driven primarily by the higher cost of saxagliptin relative to glibenclamide. Conclusion. Our study revealed that saxagliptin is not a cost-effective second-line therapy in patients with T2DM inadequately controlled by metformin monotherapy based on a gross domestic product per capita per DALY averted willingness-to-pay threshold in Ethiopia (US$953).

scholarly journals Novel clusters of type 2 diabetes mellitus and their outcomes: relationship between pharmacological treatment and microvascular complications

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Claudio Santos ◽  
Sónia Brito-Costa ◽  
Luis Margalho ◽  
Pedro Monteiro
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Pharmacological Treatment ◽  
Microvascular Complications ◽  
Glycated Haemoglobin ◽  
Research Unit ◽  
Cognitive Difficulties ◽  
Clinical Research Unit

Abstract Background Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes in adults being characterized by an ineffective use of insulin or inefficient production by the pancreas. This study aims to study the relationship between microvascular complications and pharmacological treatment for T2DM. Methods 191 participants (EG) with T2DM with the average of 70.3 years (SD = 8.3) and 36 with pre-diabetes (CG) with an average of 62 years (SD = 10.3) who participated in clinical trials at Clinical Research Unit in Cardiology of Coimbra Hospital and Universitary Centre without cognitive difficulties, were divided in 5 different clusters. These were established based on six different variables: body mass index (BMI), age of each individual, age at diagnosis of DMT2, glycated haemoglobin value (HbA1c), homeostatic model that estimates the function of β cells (HOMA2-B) and insulin resistance (HOMA2-IR). Results Cluster 1 presented pre-diabetic individuals (15.9%), while diabetic individuals were divided into clusters 2 (1.8%), 3 (17.6%), 4 (21.1%) and 5 (43.6%). Regarding the study of the prevalence of microvascular complications, it was concluded that only chronic kidney disease (CKD) was found in most different groups. For the prevalence of pharmacological treatment for DMT2, it was found that metformin was the most used drug. It was observed a relationship between previous CKD and metformin administration in clusters 3 (P = 0.0012; P < 0.05), 4 (P = 9.41E-5; P < 0.05) and 5 (P = 0.0004; P < 0.05). Conclusions It was possible to observe the existence of dependency relationships between pharmacological treatment and different microvascular complications for DMT2.

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