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Al Sayed N, Al Waili K, Alawadi F, Al-Ghamdi S, Al Mahmeed W, Al-Nouri F, Al Rukhaimi M, Al-Rasadi K, Awan Z, Farghaly M, Hassanein M, Sabbour H, Zubaid M, Barter P. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East. Int J Cardiol 2016; 225:268-283. [PMID: 27741487 DOI: 10.1016/j.ijcard.2016.09.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. METHODS A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. RESULTS The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. CONCLUSIONS These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East.
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Affiliation(s)
- Nasreen Al Sayed
- Gulf Diabetes Specialist Center, P.O. Box 21686, Manama, Bahrain.
| | - Khalid Al Waili
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Saeed Al-Ghamdi
- Department of Medicine, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
| | - Fahad Al-Nouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Mona Al Rukhaimi
- Dubai Medical College, P.O. Box 22331, Dubai, United Arab Emirates.
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Zuhier Awan
- King Abdulaziz University, Jeddah 22254, Saudi Arabia.
| | | | | | - Hani Sabbour
- Shaikh Khalifa Medical City, Cardiac Sciences Institute, Abu Dhabi, United Arab Emirates.
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
| | - Philip Barter
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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302
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Dailey G, Ahmad A, Polsky S, Shah V. A novel option for prandial insulin therapy: inhaled insulin. Postgrad Med 2016; 128:839-847. [DOI: 10.1080/00325481.2016.1229555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- George Dailey
- Division of Diabetes & Endocrinology, Scripps Clinic, La Jolla, CA, USA
| | - Aakif Ahmad
- Division of Diabetes & Endocrinology, Scripps Clinic, La Jolla, CA, USA
| | - Sarit Polsky
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
| | - Viral Shah
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
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303
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Marín-Peñalver JJ, Martín-Timón I, Sevillano-Collantes C, del Cañizo-Gómez FJ. Update on the treatment of type 2 diabetes mellitus. World J Diabetes 2016; 7:354-95. [PMID: 27660695 PMCID: PMC5027002 DOI: 10.4239/wjd.v7.i17.354] [Citation(s) in RCA: 368] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 02/05/2023] Open
Abstract
To achieve good metabolic control in diabetes and keep long term, a combination of changes in lifestyle and pharmacological treatment is necessary. Achieving near-normal glycated hemoglobin significantly, decreases risk of macrovascular and microvascular complications. At present there are different treatments, both oral and injectable, available for the treatment of type 2 diabetes mellitus (T2DM). Treatment algorithms designed to reduce the development or progression of the complications of diabetes emphasizes the need for good glycaemic control. The aim of this review is to perform an update on the benefits and limitations of different drugs, both current and future, for the treatment of T2DM. Initial intervention should focus on lifestyle changes. Moreover, changes in lifestyle have proven to be beneficial, but for many patients is a complication keep long term. Physicians should be familiar with the different types of existing drugs for the treatment of diabetes and select the most effective, safe and better tolerated by patients. Metformin remains the first choice of treatment for most patients. Other alternative or second-line treatment options should be individualized depending on the characteristics of each patient. This article reviews the treatments available for patients with T2DM, with an emphasis on agents introduced within the last decade.
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304
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Pafili K, Maltezos E, Papanas N. Pharmacokinetic and pharmacodynamic drug evaluation of tofogliflozin for the treatment of type 2 diabetes. Expert Opin Drug Metab Toxicol 2016; 12:1367-1380. [DOI: 10.1080/17425255.2016.1229302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kalliopi Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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305
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Oral EA. Closing the knowledge gap on cardiovascular disease in type 2 diabetes: the EMPA-REG OUTCOME trial and beyond. Drugs Context 2016; 5:212299. [PMID: 27648101 PMCID: PMC5017828 DOI: 10.7573/dic.212299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Indexed: 12/19/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with marked cardiovascular (CV) morbidity and mortality, including heart failure (HF). Until recently, an oral glucose-lowering agent that improved hyperglycemia as well as provided CV benefits in patients with T2DM and cardiovascular disease (CVD) was lacking. The newest class of glucose-lowering agents, sodium glucose cotransporter 2 (SGLT2) inhibitors, includes canagliflozin, dapagliflozin, and empagliflozin. Prior to the release of the LEADER trial results, the recent EMPA-REG OUTCOME study was the only dedicated CV trial to demonstrate a reduction in major adverse cardiac events, CV mortality, and all-cause mortality and a reduction in hospitalization for HF with empagliflozin, given on top of standard-of-care therapy in patients with T2DM and CVD. This paper summarizes the results from EMPA-REG OUTCOME and discusses their significance and clinical implications.
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Affiliation(s)
- Elif A Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Brehm Center for Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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306
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Black RL, Higbea AM, Duval C, Chastain LM. Pharmacological management of obesity in patients with type 2 diabetes. Expert Rev Endocrinol Metab 2016; 11:415-423. [PMID: 30058912 DOI: 10.1080/17446651.2016.1220300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity is a growing health concern worldwide. Multiple guidelines are available to clinicians to help guide treatment of obesity. Areas covered: In their 2016 update, the American Diabetes Association included recommendations for the use of pharmacological agents in the treatment of obesity in patients with concurrent diabetes. Five agents have been approved by the Food and Drug Administration and are recommended by guidelines for the long-term treatment of obesity: orlistat, lorcaserin, phentermine/topiramate ER, naltrexone/bupropion, and liraglutide. Expert commentary: This article summarizes the current evidence available on the use of these agents in patients with diabetes.
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Affiliation(s)
- Robin L Black
- a School of Pharmacy , Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Ashley M Higbea
- a School of Pharmacy , Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Courtney Duval
- a School of Pharmacy , Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Lisa M Chastain
- a School of Pharmacy , Texas Tech University Health Sciences Center , Dallas , TX , USA
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307
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Fodor A, Karnieli E. Challenges of implementing personalized (precision) medicine: a focus on diabetes. Per Med 2016; 13:485-497. [DOI: 10.2217/pme-2016-0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The concept of personalized (precision) medicine (PM) emphasizes the scientific and technological innovations that enable the physician to tailor disease prediction, diagnosis and treatment to the individual patient, based on a personalized data-driven approach. The major challenge for the medical systems is to translate the molecular and genomic advances into clinical available means. Patients and healthcare providers, the pharmaceutical and diagnostic industries manifest a growing interest in PM. Multiple stakeholders need adaptation and re-engineering for successful clinical implementation of PM. Drawing primarily from the field of ‘diabetes’, this article will summarize the main challenges to implementation of PM into current medical practice and some of the approaches currently being implemented to overcome these challenges.
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Affiliation(s)
- Adriana Fodor
- University of Medicine & Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - Eddy Karnieli
- Galil Center for Telemedicine, Medical Informatics & Personalized Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel
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308
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Malham SB, Herrick CJ. New Pharmacologic Agents for Diabetes Treatment. MISSOURI MEDICINE 2016; 113:361-366. [PMID: 30228501 PMCID: PMC6139836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Therapeutic options for diabetes management have expanded dramatically in the last five years. While there continues to be consensus that lifestyle modification aimed at 5-7% weight loss and metformin are the appropriate first line therapies for type 2 diabetes, there are many options for intensification of diabetes management. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) have released recent guidelines that prioritize use of the newer classes of medications.1,2 There are a number of considerations in selecting medications, including risk of hypoglycemia, effect on body weight, adverse event profile, renal function, and cost/insurance coverage. The objective of this article is to discuss mechanism, efficacy, and safety for each new class of medications. We conclude with a quick reference for the use of these medications in primary and specialty care, based on their various attributes and patient and provider preferences.
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Affiliation(s)
- Sarah Bou Malham
- Sarah Bou Malham, MD, is a Clinical Fellow, Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis
| | - Cynthia J Herrick
- Cynthia J. Herrick, MD, is an Assistant Professor, Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis
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309
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Lehrke M, Leiter LA, Hehnke U, Thiemann S, Bhandari A, Meinicke T, Johansen OE. Safety and efficacy of linagliptin in patients with type 2 diabetes mellitus and coronary artery disease: Analysis of pooled events from 19 clinical trials. J Diabetes Complications 2016; 30:1378-84. [PMID: 27396241 DOI: 10.1016/j.jdiacomp.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 12/15/2022]
Abstract
AIMS To examine the safety and efficacy of linagliptin in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) using pooled data from the global clinical trials program. METHODS Patient-level data were pooled from randomized, placebo-controlled clinical trials of linagliptin (5mg, monotherapy or combination therapy). Safety/efficacy analyses were conducted for patients with CAD and ≥12 and ≥24weeks of treatment, respectively. RESULTS The safety analysis included 19 trials (linagliptin, n=451; placebo, n=272) and the efficacy analysis, 12 trials (linagliptin, n=328; placebo, n=198); mean (± standard deviation) exposure to study treatment was 212 (144) days linagliptin and 245 (171) days placebo. Occurrence of cardiac adverse events (AEs) was similar for linagliptin- and placebo-treated patients (9.1% and 9.2%, respectively); exposure-adjusted incidence rates (per 100 patient-years) were 16.6 and 14.0, respectively. Overall incidence of AEs was numerically lower with linagliptin than placebo. After 24weeks, mean adjusted change (standard error) from baseline glycosylated hemoglobin was -0.64% (0.04) with linagliptin vs. -0.08% (0.05) with placebo (P<.001). CONCLUSIONS This comprehensive pooled analysis showed that addition of linagliptin to treatment regimens of patients with T2DM and CAD was not associated with an increased incidence of cardiac AEs, was well tolerated, and was effective.
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Affiliation(s)
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Research Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Uwe Hehnke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Sandra Thiemann
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Amit Bhandari
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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310
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Schwartz SS, Zangeneh F. Evidence-based practice use of quick-release bromocriptine across the natural history of type 2 diabetes mellitus. Postgrad Med 2016; 128:828-838. [PMID: 27458683 DOI: 10.1080/00325481.2016.1214059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide an evidence-based practice overview on the clinical use of bromocriptine-quick release (QR) across the natural history of type 2 diabetes mellitus (T2DM). METHODS Articles for inclusion were selected after a comprehensive literature search of English-language PubMed articles and identification of other relevant references through other sources. Inclusion criteria were animal studies examining the mechanism of action and efficacy of bromocriptine, and clinical studies examining the safety and efficacy of bromocriptine-QR in patients with T2DM, without a time limitation. RESULTS The brain plays a key role in total body metabolism, in particular ensuring that sufficient levels of glucose are available for proper neural functioning. The hypothalamic suprachiasmatic nucleus (SCN), the body's biological clock, plays a key role in the regulation of seasonal and diurnal variations of insulin sensitivity. A daily surge of dopaminergic activity in the SCN upon waking enables insulin sensitivity throughout the day. When this is disrupted (e.g. by a high fat/sugar diet, stress, altered [diminished] exercise, altered sleep/wake cycle, diabetes), insulin resistance persists throughout the day and overnight. Improving the morning surge in dopaminergic activity with the short-acting dopamine D2 receptor agonist bromocriptine-QR can safely and effectively improve glycemic control, while improving cardiovascular disease risk factors and related adverse events, and reducing sympathetic tone, as demonstrated by 5 reports of the Cycloset Safety Trial and 3 additional clinical studies of bromocriptine-QR. CONCLUSIONS In patients with T2DM, the dopamine D2 receptor agonist bromocriptine-QR has been shown to be well tolerated, efficacious, and a logical treatment option.
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Affiliation(s)
- Stanley S Schwartz
- a Main Line Health System , Wynnewood , PA , USA.,b University of Pennsylvania , Philadelphia , PA , USA
| | - Farhad Zangeneh
- c Endocrine, Diabetes & Osteoporosis Clinic , Sterling , VA , USA
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311
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Davidson JA, Manghi FP, Yu M, Linetzky B, Landó LF. EFFICACY AND SAFETY OF DULAGLUTIDE IN HISPANIC/LATINO PATIENTS WITH TYPE 2 DIABETES IN THE AWARD CLINICAL PROGRAM. Endocr Pract 2016; 22:1406-1414. [PMID: 27540883 DOI: 10.4158/ep161337.or] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this post hoc analysis was to assess the efficacy and safety of once-weekly dulaglutide in Hispanic/Latino patients with type 2 diabetes (T2D) in phase 3 AWARD trials 1 to 6. METHODS Hispanic/Latino data at Week 26 were pooled across studies for each dulaglutide dose to analyze the change from baseline in glycosylated hemoglobin (HbA1c), percent to HbA1c goal, and adverse events (AEs). Change from baseline in HbA1c, change from baseline in weight and hypoglycemia were analyzed by Hispanic/Latino and non-Hispanic/Latino subgroups for each study. RESULTS Of the 3,136 patients randomized to dulaglutide 1.5 or 0.75 mg, 949 were reported as having Hispanic/Latino ethnicity. Baseline characteristics were similar for Hispanic/Latino and overall populations, except there were slightly more Hispanic/Latino females and weight was slightly lower for Hispanic/Latino patients. Hispanic/Latino patients receiving dulaglutide 1.5 mg had a reduction in HbA1c of 1.25% (95% confidence interval [CI]: -1.35, -1.15); dulaglutide 0.75 mg had a reduction of 1.07% (95% CI: -1.18, -0.96). Reductions in HbA1c and percent to goal HbA1c <7% and ≤6.5% were similar between Hispanic/Latino patients and the overall population. Weight change and hypoglycemia were similar between Hispanic/Latino and non-Hispanic/Latino subgroups for all studies. Treatment-emergent AEs were consistent with the overall population. CONCLUSION Dulaglutide improved glycemic control with the potential for weight loss in Hispanic/Latino patients with T2D. Dulaglutide was well tolerated and had a low risk of hypoglycemia when used without insulin secretagogues or insulin. In the Hispanic/Latino population, dulaglutide efficacy and safety was consistent with that of the overall population. ABBREVIATIONS AE = adverse event AWARD = Assessment of Weekly AdministRation of dulaglutide in Diabetes BID = twice daily CARMELA = The Cardiovascular Risk Factor Multiple Evaluation of Latin America CI = confidence interval GLP-1 RA = glucagon-like peptide-1 receptor agonist HbA1c = glycosylated hemoglobin T2D = type 2 diabetes.
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312
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Yang P, Heredia VO, Beltramo DM, Soria NW. Pharmacogenetics and personalized treatment of type 2 diabetes mellitus. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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313
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Carlson CJ, Santamarina ML. Update review of the safety of sodium-glucose cotransporter 2 inhibitors for the treatment of patients with type 2 diabetes mellitus. Expert Opin Drug Saf 2016; 15:1401-12. [PMID: 27449721 DOI: 10.1080/14740338.2016.1216100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Curt J. Carlson
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Marile L. Santamarina
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
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314
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Abstract
IN BRIEF Six million people with diabetes use insulin either alone or in combination with an oral medication. Many barriers exist that lead to poor adherence with insulin. However, there is an underwhelming amount of data on interventions to address these barriers and improve insulin adherence. Until pharmacological advancements create easier, more acceptable insulin regimens, it is imperative to involve patients in shared decision-making.
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Affiliation(s)
- G Blair Sarbacker
- University of the Incarnate Word Feik School of Pharmacy, San Antonio, TX
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315
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Affiliation(s)
- Julio A Rebolledo
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL
| | - Regina Arellano
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL
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316
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317
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Milligan S. Combination therapy for the improvement of long-term macrovascular and microvascular outcomes in type 2 diabetes: Rationale and evidence for early initiation. J Diabetes Complications 2016; 30:1177-85. [PMID: 27149916 DOI: 10.1016/j.jdiacomp.2016.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/01/2016] [Accepted: 03/13/2016] [Indexed: 12/25/2022]
Abstract
Diabetes is a leading cause of macrovascular and microvascular complications that can increase the risk of mortality if not properly managed. Proper glucose control can reduce the incidence of these complications, in particular those of the microvasculature. Over the last~10years, the cardiovascular safety of glucose-lowering drugs has come to the forefront of diabetes management and clinical trial design. While early combination therapy improves glycemic control, its impact on long-term outcomes, is not as clearly understood. The objective of this review is to examine the evidence of early combination therapy for the treatment of type 2 diabetes mellitus as it relates to studies of long-term microvascular and macrovascular outcomes.
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318
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Rodbard HW, Seufert J, Aggarwal N, Cao A, Fung A, Pfeifer M, Alba M. Efficacy and safety of titrated canagliflozin in patients with type 2 diabetes mellitus inadequately controlled on metformin and sitagliptin. Diabetes Obes Metab 2016; 18:812-9. [PMID: 27160639 PMCID: PMC5089595 DOI: 10.1111/dom.12684] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/11/2016] [Accepted: 05/01/2016] [Indexed: 01/14/2023]
Abstract
AIMS To evaluate the efficacy and safety of titrated canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin and sitagliptin. METHODS In this randomized, double-blind study, patients with T2DM (N = 218) on metformin ≥1500 mg/day and sitagliptin 100 mg received canagliflozin 100 mg or placebo. After 6 weeks, the canagliflozin dose was increased from 100 to 300 mg (or from placebo to matching placebo) if all of the following criteria were met: baseline estimated glomerular filtration rate ≥70 ml/min/1.73 m(2) ; fasting self-monitored blood glucose ≥5.6 mmol/l (≥100 mg/dl); and no volume depletion-related adverse events (AEs) within 2 weeks before dose increase. Endpoints included change in glycated haemoglobin (HbA1c) at week 26 (primary); proportion of patients achieving HbA1c <7.0%; and changes in fasting plasma glucose (FPG), body weight and systolic blood pressure (SBP). Safety was assessed using AE reports. RESULTS Overall, 85.4% of patients were titrated to canagliflozin 300 mg or matching placebo (mean ± standard deviation time to titration 6.2 ± 0.8 weeks). At week 26, canagliflozin (pooled 100 and 300 mg) demonstrated superiority in HbA1c reduction versus placebo (-0.91% vs. -0.01%; p < 0.001). Canagliflozin provided significant reductions in FPG, body weight and SBP compared with placebo (p < 0.001). The overall AE incidence was 39.8 and 44.4% for canagliflozin and placebo, respectively. Canagliflozin was associated with an increased incidence of genital mycotic infections. CONCLUSIONS Titrated canagliflozin significantly improved HbA1c, FPG, body weight and SBP, and was generally well tolerated over 26 weeks in patients with T2DM as add-on to metformin and sitagliptin.
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Affiliation(s)
- H W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, USA
| | - J Seufert
- Department of Endocrinology and Diabetology, Clinic for Internal Medicine II, University Medical Center, Freiburg, Germany
| | - N Aggarwal
- Aggarwal and Associates Ltd, Brampton, ON, Canada
| | - A Cao
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - A Fung
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - M Pfeifer
- Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - M Alba
- Janssen Research & Development, LLC, Raritan, NJ, USA
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319
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Scheen AJ. DPP-4 inhibitor plus SGLT-2 inhibitor as combination therapy for type 2 diabetes: from rationale to clinical aspects. Expert Opin Drug Metab Toxicol 2016; 12:1407-1417. [PMID: 27435042 DOI: 10.1080/17425255.2016.1215427] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Type 2 diabetes (T2D) is a complex disease with multiple defects, which generally require a combination of several pharmacological approaches to control hyperglycemia. Combining a dipeptidyl peptidase-4 inhibitor (DPP-4i) and a sodium-glucose cotransporter type 2 inhibitor (SGT2i) appears to be an attractive approach. Area covered: An extensive literature search was performed to analyze the pharmacokinetics, pharmacodynamics and clinical experience of different gliptin-gliflozin combinations. Expert opinion: There is a strong rationale for combining a DPP-4i and a SGLT2i in patients with T2D because the two drugs exert different and complementary glucose-lowering effects. Dual therapy (initial combination or stepwise approach) is more potent than either monotherapy in patients treated with diet and exercise or already treated with metformin. Combining the two pharmacological options is safe and does not induce hypoglycemia. The additional glucose-lowering effect is more marked when a gliflozin is added to a gliptin than when a gliptin is added to a gliflozin. Two fixed-dose combinations (FDCs) are already available (saxagliptin-dapagliflozin and linagliptin-empagliflozin) and others are in current development. Bioequivalence of the two compounds given as FDC tablets was demonstrated when compared with coadministration of the individual tablets. FDCs could simplify the anti-hyperglycaemic therapy and improve drug compliance.
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Affiliation(s)
- André J Scheen
- a Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine , CHU Liège , Liège , Belgium.,b Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM) , University of Liège , Liège , Belgium
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320
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Rosenblit PD. Common medications used by patients with type 2 diabetes mellitus: what are their effects on the lipid profile? Cardiovasc Diabetol 2016; 15:95. [PMID: 27417914 PMCID: PMC4946113 DOI: 10.1186/s12933-016-0412-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022] Open
Abstract
Dyslipidemia is the most fundamental risk factor for atherosclerotic cardiovascular disease (ASCVD). In clinical practice, many commonly prescribed medications can alter the patient's lipid profile and, potentially, the risk for ASCVD-either favorably or unfavorably. The dyslipidemia observed in type 2 diabetes mellitus (T2DM) can be characterized as both ominous and cryptic, in terms of unrecognized, disproportionately elevated atherogenic cholesterol particle concentrations, in spite of deceptively and relatively lower levels of low-density lipoprotein cholesterol (LDL-C). Several factors, most notably insulin resistance, associated with the unfavorable discordance of elevated triglyceride (TG) levels and low levels of high-density lipoprotein cholesterol (HDL-C), have been shown to correlate with an increased risk/number of ASCVD events in patients with T2DM. This review focuses on known changes in the routine lipid profile (LDL-C, TGs, and HDL-C) observed with commonly prescribed medications for patients with T2DM, including antihyperglycemic agents, antihypertensive agents, weight loss medications, antibiotics, analgesics, oral contraceptives, and hormone replacement therapies. Given that the risk of ASCVD is already elevated for patients with T2DM, the use of polypharmacy may warrant close observation of overall alterations through ongoing lipid-panel monitoring. Ultimately, the goal is to reduce levels of atherogenic cholesterol particles and thus the patient's absolute risk.
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Affiliation(s)
- Paul D Rosenblit
- Diabetes/Lipid Management & Research Center, 18821 Delaware St, Suite 202, Huntington Beach, CA, 92648, USA.
- Division of Endocrinology, Diabetes, Metabolism, Department of Medicine, University of California, Irvine (UCI) School of Medicine, Irvine, CA, USA.
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321
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Abstract
Personalized medicine aims at better targeting therapeutic intervention to the individual to maximize benefit and minimize harm. Type 2 diabetes (T2D) is a heterogeneous disease from a genetic, pathophysiological and clinical point of view. Thus, the response to any antidiabetic medication may considerably vary between individuals. Numerous glucose-lowering agents, with different mechanisms of action, have been developed, a diversified armamentarium that offers the possibility of a patient-centred therapeutic approach. In the current clinical practice, a personalized approach is only based upon phenotype, taking into account patient and disease individual characteristics. If this approach may help increase both efficacy and safety outcomes, there remains considerable room for improvement. In recent years, many efforts were taken to identify genetic and genotype SNP's (Single Nucleotide Polymorphism's) variants that influence the pharmacokinetics, pharmacodynamics, and ultimately the therapeutic response of oral glucose-lowering drugs. This approach mainly concerns metformin, sulphonylureas, meglitinides and thiazolidinediones, with only scarce data concerning gliptins and gliflozins yet. However, the contribution of pharmacogenetics and pharmacogenomics to personalized therapy still needs to mature greatly before routine clinical implementation is possible. This review discusses both opportunities and challenges of precision medicine and how this new paradigm may lead to a better individualized treatment of T2D.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, Liège, Belgium; Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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322
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Abstract
ABBREVIATIONS CKD = chronic kidney disease DM = diabetes mellitus eGFR = estimated glomerular filtration rate FDA = Food & Drug Administration.
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323
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Huang ES, Nathan AG, Cooper JM, Lee SM, Shin N, John PM, Dale W, Col NF, Meltzer DO, Chin MH. Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial. Med Decis Making 2016; 37:611-617. [PMID: 27311651 DOI: 10.1177/0272989x16654142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. The aim of this study was to assess a personalized Web-based decision support tool. METHODS We randomized physicians and their patients with type 2 diabetes (≥65 years of age) to a support tool or educational pamphlet (75:25 patients). Prior to a visit, intervention patients interacted with the tool, which provided personalized risk predictions and elicited treatment preferences. Main outcomes included 1) patient-doctor communication, 2) decisional conflict, 3) changes in goals, and 4) intervention acceptability. RESULTS We did not find significant differences in proportions of patients who had an A1C discussion (91% intervention v. 76% control; P = 0.19). Intervention patients had larger declines in the informed subscale of decisional conflict (-20 v. 0, respectively; P = 0.04). There were no significant differences in proportions of patients with changes in goals (49% v. 28%, respectively; P = 0.08). Most intervention patients reported that the tool was easy to use (91%) and helped them to communicate (84%). A limitation was that this was a pilot trial at one academic institution. CONCLUSIONS Web-based decision support tools may be a practical approach to facilitating the personalization of goals for chronic conditions. TRIAL REGISTRATION NCT02169999 ( https://clinicaltrials.gov/show/NCT02169999 ).
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Affiliation(s)
- Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC)
| | - Aviva G Nathan
- Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC)
| | - Jennifer M Cooper
- Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC)
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, IL (SML)
| | - Na Shin
- Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC)
| | - Priya M John
- Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC)
| | - William Dale
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL (WD)
| | - Nananda F Col
- Shared Decision Making Resources, Georgetown, ME (NFC)
| | - David O Meltzer
- Section of Hospital Medicine, University of Chicago, Chicago, IL (DOM)
| | - Marshall H Chin
- Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC)
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324
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Eckel RH, Bays HE, Klein S, Bade Horn D. Proactive and Progressive Approaches in Managing Obesity. Postgrad Med 2016; 128 Suppl 1:21-30. [DOI: 10.1080/00325481.2016.1181412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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325
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Barzilay JI, Whelton PK, Davis BR. Does renin angiotensin system blockade deserve preferred status over other anti-hypertensive medications for the treatment of people with diabetes? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:202. [PMID: 27294098 PMCID: PMC4885898 DOI: 10.21037/atm.2016.05.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022]
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326
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Yashdeep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
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327
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Bloomgarden Z, Drexler A. Treatment: Concepts and new developments. J Diabetes 2016; 8:297-9. [PMID: 26854013 DOI: 10.1111/1753-0407.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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328
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Morris JL, Sereika SM, Houze M, Chasens ER. Effect of nocturia on next-day sedentary activity in adults with type 2 diabetes. Appl Nurs Res 2016; 32:44-46. [PMID: 27969050 DOI: 10.1016/j.apnr.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/27/2016] [Accepted: 04/09/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Nocturia, a common cause of disturbed sleep quality and next-day fatigue, may contribute to difficulty with diabetes self-management. The purpose of this study was to examine the effect nocturia has on next-day subjectively measured mental and physical energy and objectively measured physical activity. METHODS This secondary analysis utilized sleep diaries over one week which measured nocturia frequency and other sleep quality indicators (wake after sleep onset, sleep quality and sleep duration) along with next-day reports of mental and physical energy. Next-day physical activity was measured with the BodyMedia Sensewear armband. RESULTS Sleep quality and sleep duration were associated with next-day physical and mental energy. Nocturia frequency (≥2 times per night) was associated with increased next-day sedentary activity. CONCLUSION These results suggest that nocturia could negatively affect next-day physical activity in people with diabetes.
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Affiliation(s)
| | - Susan M Sereika
- School of Nursing and Graduate School of Public Health, University of Pittsburgh
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329
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Tajuddin N, Shaikh A, Hassan A. Prescription omega-3 fatty acid products: considerations for patients with diabetes mellitus. Diabetes Metab Syndr Obes 2016; 9:109-18. [PMID: 27143943 PMCID: PMC4846047 DOI: 10.2147/dmso.s97036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and metabolic syndrome contribute to hypertriglyceridemia, which may increase residual risk of cardiovascular disease in patients with elevated triglyceride (TG) levels despite optimal low-density lipoprotein cholesterol (LDL-C) levels with statin therapy. Prescription products containing the long-chain omega-3 fatty acids (OM3FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are an effective strategy for reducing TG levels. This article provides an overview of prescription OM3FAs, including relevant clinical data in patients with T2DM and/or metabolic syndrome. Prescription OM3FAs contain either combinations of DHA and EPA (omega-3-acid ethyl esters, omega-3-carboxylic acids, omega-3-acid ethyl esters A) or EPA alone (icosapent ethyl). These products are well tolerated and can be used safely with statins. Randomized controlled trials have demonstrated that all prescription OM3FAs produce statistically significant reductions in TG levels compared with placebo; however, differential effects on LDL-C levels have been reported. Products containing DHA may increase LDL-C levels, whereas the EPA-only product did not increase LDL-C levels compared with placebo. Because increases in LDL-C levels may be unwanted in patients with T2DM and/or dyslipidemia, the EPA-only product should not be replaced with products containing DHA. Available data on the effects of OM3FAs in patients with diabetes and/or metabolic syndrome support that these products can be used safely in patients with T2DM and have beneficial effects on atherogenic parameters; in particular, the EPA-only prescription product significantly reduced TG, non-high-density lipoprotein cholesterol, Apo B, remnant lipoprotein cholesterol, and high-sensitivity CRP levels without increasing LDL-C levels compared with placebo. Ongoing studies of the effects of prescription OM3FAs on cardiovascular outcomes will help determine whether these products will emerge as effective add-on options to statin therapy for reduction of residual cardiovascular disease risk.
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Affiliation(s)
- Nadeem Tajuddin
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali Shaikh
- Clinic of Endocrinology, Houston, TX, USA
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330
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Minze MG, Chastain LM. Combination therapies in the management of type 2 diabetes: the use of insulin degludec/liraglutide. Ther Clin Risk Manag 2016; 12:471-8. [PMID: 27099505 PMCID: PMC4820208 DOI: 10.2147/tcrm.s73579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The global burden of type 2 diabetes is estimated to currently affect over 350 million people worldwide and is anticipated to continue increasing over the next 20 years. Current treatment guidelines recommend the choice of pharmacotherapy based upon patient-specific parameters, with combination therapy for patients with a hemoglobin A1c level ≥9%. A new combination therapy of insulin degludec + liraglutide provides a long-acting basal insulin with a glucagon-like peptide agonist. In clinical trials, this combination product has reduced hemoglobin A1c and fasting plasma glucose more than the individual agents alone. Further advantages observed with this combination include weight loss and decrease in hypoglycemia compared to basal insulin alone.
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Affiliation(s)
- Molly G Minze
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA
| | - Lisa M Chastain
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA
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331
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Rodriguez-Gutierrez R, Lipska KJ, McCoy RG, Ospina NS, Ting HH, Montori VM. Hypoglycemia as an indicator of good diabetes care. BMJ 2016; 352:i1084. [PMID: 26951142 PMCID: PMC6886856 DOI: 10.1136/bmj.i1084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Rene Rodriguez-Gutierrez and colleagues argue that more attention should be paid to hypoglycemia when assessing management of diabetes
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Affiliation(s)
- Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA Division of Endocrinology, University Hospital Dr Jose E Gonzalez, Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Kasia J Lipska
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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332
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Affiliation(s)
- Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation , Chennai, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation , Chennai, India
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333
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334
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Korytkowski MT, Karslioglu French E, Brooks M, DeAlmeida D, Kanter J, Lombardero M, Magaji V, Orchard T, Siminerio L. Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy. BMJ Open Diabetes Res Care 2016; 4:e000206. [PMID: 27252874 PMCID: PMC4885282 DOI: 10.1136/bmjdrc-2016-000206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/30/2016] [Accepted: 05/02/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The increasing use of electronic health records (EHRs) in clinical practice offers the potential to investigate cardiovascular outcomes over time in patients with type 2 diabetes (T2D). OBJECTIVE To develop a methodology for identifying prevalent and incident cardiovascular disease (CVD) in patients with T2D who are candidates for therapeutic intensification of glucose-lowering therapy. METHODS Patients with glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol) while receiving 1-2 oral diabetes medications (ODMs) were identified from an EHR (2005-2011) and grouped according to intensification with insulin (INS) (n=372), a different class of ODM (n=833), a glucagon-like peptide receptor 1 agonist (GLP-1RA) (n=59), or no additional therapy (NAT) (n=2017). Baseline prevalence of CVD was defined by documented International Classification of Diseases Ninth Edition (ICD-9) codes for coronary artery disease, cerebrovascular disease, or other CVD with first HbA1c ≥7% (53 mmol/mol). Incident CVD was defined as a new ICD-9 code different from existing codes over 4 years of follow-up. ICD-9 codes were validated by a chart review in a subset of patients. RESULTS Sensitivity of ICD-9 codes for CVD ranged from 0.83 to 0.89 and specificity from 0.90 to 0.96. Baseline prevalent (INS vs ODM vs GLP-1RA vs NAT: 65% vs 39% vs 54% vs 59%, p<0.001) and incident CVD (Kaplan-Meier estimates: 58%, 31%, 52%, and 54%, p=0.002) were greater in INS group after controlling for differences in baseline HbA1c (9.2±2.0% vs 8.3±1.2% vs 8.2±1.3% vs 7.7±1.1% (77 vs 67 vs 66 vs 61 mmol/mol), p<0.001) and creatinine (1.15±0.96 vs 1.10±0.36 vs 1.01±0.35 vs 1.07±0.45 mg/dL, p=0.001). CONCLUSIONS An EHR can be an effective method for identifying prevalent and incident CVD in patients with T2D.
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Affiliation(s)
- Mary T Korytkowski
- Division of Endocrinology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Maria Brooks
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Dilhari DeAlmeida
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Justin Kanter
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Manuel Lombardero
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Vasudev Magaji
- Lehigh Valley Health Network, Diabetes and Endocrinology, Lehigh Valley, Pennsylvania, USA
| | - Trevor Orchard
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Linda Siminerio
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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