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Evolution of Type 2 Diabetes Management from a Glucocentric Approach to Cardio-Renal Risk Reduction: The New Paradigm of Care. Drugs 2021; 81:1373-1379. [PMID: 34302636 DOI: 10.1007/s40265-021-01554-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
For many years, clinical studies could not show that lowering glucose in patients with type 2 diabetes leads to better macrovascular outcomes. In the past few years, new data have shown that treatment with two classes of dugs developed as "glucose-lowering agents," SGLT2 inhibitors and GLP-1 receptor agonists, can reduce macrovascular and renal complications. These studies have prompted debate about the main aim of type 2 diabetes management. In this review, three eras of diabetes management are described according to the treatment recommendations, such as the ADA/EASD consensus, moving from a pure glucocentric view into the present cardio-renal outcome-oriented approach, this has been endorsed by major diabetes and cardiology societies. While in the first era normalizing HbA1c was the only focus (e.g., UK Prospective Diabetes Study), failing to show a reduction in cardiovascular morbidity and mortality, further studies analyzing the pros and cons of intensified control such as ACCORD, VADT, ADVANCE recognized that treatment intensification was associated with weight gain and hypoglycemia, thereby potentially reducing the benefits of glycemic control. Therefore, the focus in the second area was on controlling HbA1c without these unwanted effects. The consistent beneficial results of several cardiovascular outcome trials with SGLT2 inhibitors and GLP-1 receptor agonists showing significantly improved cardio-renal outcomes, induced a paradigm shift: a change from (only) control of HbA1c to an organ-protective approach with the main focus now on cardio-renal risk; this is now considered as the third era. Recent data indicating beneficial effects of glucose-lowering agents in particular SGLT2 inhibitors even in subjects without diabetes, improving hospitalization for heart failure and renal outcomes might reveal another new era, which could then be considered a fourth era. While current international guidelines call for this paradigm shift, registry data show that we are still far from translating this objective into real-world practice.
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Kwon CS, Seoane-Vazquez E, Rodriguez-Monguio R. Cost-effectiveness analysis of metformin+dipeptidyl peptidase-4 inhibitors compared to metformin+sulfonylureas for treatment of type 2 diabetes. BMC Health Serv Res 2018; 18:78. [PMID: 29391064 PMCID: PMC5796582 DOI: 10.1186/s12913-018-2860-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/18/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) typically use several drug treatments during their lifetime. There is a debate about the best second-line therapy after metformin monotherapy failure due to the increasing number of available antidiabetic drugs and the lack of comparative clinical trials of secondary treatment regimens. While prior research compared the cost-effectiveness of two alternative drugs, the literature assessing T2D treatment pathways is scarce. The purpose of this study was to evaluate the long-term cost-effectiveness of dipeptidyl peptidase-4 inhibitors (DPP-4i) compared to sulfonylureas (SU) as second-line therapy in combination with metformin in patients with T2D. METHODS A Markov model was developed with four health states, 1 year cycle, and a 25-year time horizon. Clinical and cost data were collected from previous studies and other readily available secondary data sources. The incremental cost-effectiveness ratio (ICER) was estimated from the US third party payer perspective. Both, costs and outcomes, were discounted at a 3% annual discount rate. One way and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainty on the base-case results. RESULTS The discounted incremental cost of metformin+DPP-4i compared to metformin+SU was $11,849 and the incremental life-years gained were 0.61, resulting in an ICER of $19,420 per life-year gained for patients in the metformin+DPP-4i treatment pathway. The ICER estimated in the probabilistic sensitivity analysis was $19,980 per life-year gained. Sensitivity analyses showed that the results of the study were not sensitive to changes in the parameters used in base-case. CONCLUSIONS The metformin+DPP-4i treatment pathway was cost-effective compared to metformin+SU as a long-term second-line therapy in the treatment of T2D from the US health care payer perspective. Study findings have the potential to provide clinicians and third party payers valuable evidence for the prescription and utilization of cost-effective second-line therapy after metformin monotherapy failure in the treatment of T2D.
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Affiliation(s)
- Christina S Kwon
- International Center for Pharmaceutical Economics & Policy, MCPHS University, 179 Longwood Ave, Boston, MA, 02115-5804, USA
| | - Enrique Seoane-Vazquez
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus RK 94-271, 9401 Jeronimo Road, Irvine, CA, 92618-1908, USA
| | - Rosa Rodriguez-Monguio
- Medication Outcomes Center, School of Pharmacy, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143-0622, USA.
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Kwon CS, Seoane-Vazquez E, Rodriguez-Monguio R. FDA safety actions for antidiabetic drugs marketed in the US, 1980–2015. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2017; 28:197-211. [DOI: 10.3233/jrs-170734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christina S. Kwon
- International Center for Pharmaceutical Economics and Policy, MCPHS University, Boston, MA, USA
| | - Enrique Seoane-Vazquez
- International Center for Pharmaceutical Economics and Policy, MCPHS University, Boston, MA, USA
- Brigham and Women’s Hospital, Division of General Medicine and Primary Care, Boston, MA, USA
| | - Rosa Rodriguez-Monguio
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
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Affiliation(s)
- Scott D Solomon
- From Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Marc A Pfeffer
- From Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Sun G, Wei M, Luo Z, Liu Y, Chen Z, Wang Z. An Alternative Scalable Process for the Synthesis of the Key Intermediate of Omarigliptin. Org Process Res Dev 2016. [DOI: 10.1021/acs.oprd.6b00295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Guodong Sun
- HEC Research and Development
Center, HEC Pharm Group, Dongguan 523871, P. R. China
| | - Mingjie Wei
- HEC Research and Development
Center, HEC Pharm Group, Dongguan 523871, P. R. China
| | - Zhonghua Luo
- HEC Research and Development
Center, HEC Pharm Group, Dongguan 523871, P. R. China
| | - Yongjun Liu
- HEC Research and Development
Center, HEC Pharm Group, Dongguan 523871, P. R. China
| | - Zhijun Chen
- HEC Research and Development
Center, HEC Pharm Group, Dongguan 523871, P. R. China
| | - Zhongqing Wang
- HEC Research and Development
Center, HEC Pharm Group, Dongguan 523871, P. R. China
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Xing X, Han Y, Zhou X, Zhang B, Li Y, Wang Z, Liao L, Su L. Association between DPP4 gene polymorphism and serum lipid levels in Chinese type 2 diabetes individuals. Neuropeptides 2016; 60:1-6. [PMID: 27585937 DOI: 10.1016/j.npep.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 06/08/2016] [Accepted: 08/14/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The goal of the genetic investigation was to identify the associations of serum lipid levels and DPP-4 variants in Chinese type 2 diabetes patients. METHODS We detected four variants of the DPP4 gene in 190 Chinese individuals with type 2 diabetes and tested for an association with dyslipidemia in 82 selected samples. Data including basic information, HbA1c, FPG, serum lipid parameters were collected. Statistical analysis was performed by SPSS 13.0 through ANOVA and χ2 test. RESULTS The genetic polymorphism of rs4664443, rs3788979, rs7608798 and rs1558957 in Chinese type 2 diabetes were consistent with Hardy-Weinberg equilibrium. The CT genotype of rs4664443 suffered from higher serum TG (P=0.013), LDL (P=0.044) and ApoB (P=0.006) levels, whereas the TT genotype of rs7608798 exhibited a lower serum TG level (P=0.037). For rs3788979, the serum TG level (P=0.034) and BMI (P=0.04) were significantly different among genotypes. Moreover, serum TG and TC levels and BMI showed a positive correlation with the number unfavorable alleles, and individuals with more than two unfavorable alleles had higher TG (P=0.004), TC (P=0.011), and BMI (P=0.044) values. CONCLUSIONS This is the first study to investigate DPP4 allelic distributions and their association with dyslipidemia in Chinese type 2 diabetes patients, which may have clinical significance.
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Affiliation(s)
- Xiaomin Xing
- School of Pharmacy, Shandong University, Jinan, Shandong Province, PR China; Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, PR China
| | - Yi Han
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, PR China
| | - Xiaojun Zhou
- School of Medicine, Shandong University, Jinan, Shandong Province, PR China
| | - Bo Zhang
- School of Pharmacy, Shandong University, Jinan, Shandong Province, PR China
| | - Yan Li
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, PR China
| | - Zhongsu Wang
- Department of Cardiovascular, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, PR China
| | - Lin Liao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, PR China.
| | - Lequn Su
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, PR China.
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Abstract
The burden of type 2 diabetes and its major complication cardiovascular disease is rapidly increasing worldwide. Understanding the underlying pathogenic mechanisms of these diseases is crucial to develop novel therapeutics. Recent work using genetic and biochemical methods in mouse models and human samples have identified disturbed calcium signalling and endoplasmic reticulum stress as emerging factors involved in the pathogenesis of many metabolic diseases. In this review, we will highlight the specific roles of calcium signalling and endoplasmic reticulum stress response in the development of insulin resistance and atherosclerosis.
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Affiliation(s)
- L Ozcan
- Department of Medicine, Columbia University, New York, NY, USA.
| | - I Tabas
- Department of Medicine, Columbia University, New York, NY, USA.,Department of Physiology and Cellular Biophysics, Columbia University, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
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Assessing Risks of Glucose Lowering Therapy in Heart Failure: Should We Rely on Post-hoc Analyses? CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zafon C. [New therapeutic approaches in type 2 diabetes mellitus]. Med Clin (Barc) 2015; 145:485-7. [PMID: 26142571 DOI: 10.1016/j.medcli.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Carles Zafon
- Unidad de Investigación en Diabetes y Metabolismo, Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Instituto de Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Barcelona, España.
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He X, Liu X, Liu W, Wang B, Liu Y, Li Z, Wang T, Tan R, Gao B, Zeng H. Association between Diabetes and Risk of Aortic Dissection: A Case-Control Study in a Chinese Population. PLoS One 2015; 10:e0142697. [PMID: 26562793 PMCID: PMC4643043 DOI: 10.1371/journal.pone.0142697] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/26/2015] [Indexed: 12/17/2022] Open
Abstract
Background It is well-recognized that diabetes represents a powerful independent risk factor for cardiovascular diseases. However, very few studies have investigated the relationship between diabetes and risk of aortic dissection (AD). Aim The aim of this case-control study was to evaluate the association between diabetes and risk of AD in Chinese population. Methods A hospital-based case-control study, consisting of 2160 AD patients and 4320 controls, was conducted in a Chinese population. Demographic, clinical characteristics and risk factors were collected. Diabetes rate of patients with overall AD, Stanford type A AD and type B AD group was compared with that of corresponding matched control groups. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for relationship between diabetes and AD risk. Results The prevalence of diabetes was lower in AD cases than that of control subjects, whether it is the overall AD, type A AD or type B AD group (4.7% vs. 10.0%, 2.9% vs. 8.8%, 5.9% vs. 10.9%, all P<0.001). Furthermore, in multivariate model, diabetes was found to be associated with lower AD risk, which not only applies to the overall AD (OR = 0.2, 95%CI: 0.15–0.26), but also type A AD (OR = 0.12, 95% CI: 0.07–0.20) and type B AD (OR = 0.25, 95%CI: 0.18–0.33). Conclusions We observed the paradoxical inverse relationship between DM and risk of AD in the Chinese population. These results suggest diabetes may play a protective role in the development of AD. However, further studies are needed to enrich related evidence, especially with regard to underlying mechanisms for these trends.
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Affiliation(s)
- Xingwei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bei Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuxi Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Tan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Gao
- Department of Cardiology, Suizhou Affiliated Hospital of Hubei Medical College, Suizhou, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Canneva F, Golub Y, Distler J, Dobner J, Meyer S, von Hörsten S. DPP4-deficient congenic rats display blunted stress, improved fear extinction and increased central NPY. Psychoneuroendocrinology 2015; 53:195-206. [PMID: 25635612 DOI: 10.1016/j.psyneuen.2015.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Inhibitors of dipeptidyl peptidase 4 (DPP4, CD26) are used for the treatment of type 2 diabetic patients and better glucose tolerance has been confirmed in functionally DPP4-deficient congenic rats (DPP4mut), along with immunological alterations and, interestingly, a stress-resilient phenotype. All these findings are in agreement with the "moonlighting" properties of DPP4, whose proteolytic action is responsible for the inactivation of a number of regulatory peptides including, but not limited to, neuropeptide Y (NPY). Among all candidate substrates, DPP4 displays highest affinity for NPY, an endogenous anxiolytic neurotransmitter that is suggested as a candidate biomarker in post-traumatic stress disorder (PTSD) and depression. METHODS AND RESULTS Central and peripheral NPY levels were measured by ELISA in DPP4mut and DAwt rats revealing a significantly higher concentration of the peptide in the CSF of DPP4mut animals. This finding positively correlated with the blunted stress phenotype measured on an analgesia-meter. Additionally, when a classical fear-conditioning paradigm was investigated, short-term fear extinction was significantly potentiated in DPP4mut rats as compared to wt controls. CONCLUSIONS Our findings indicate a positive correlation between reduced stress-responsiveness and increased central NPY, in DPP4mut rats. Most interestingly, the behavioral phenotype extends to facilitation of fear extinction. These observations raise further interest in DPP4-modulating drugs for the potential effect on NPY metabolism, as a therapeutic tool for psychiatric conditions such as anxiety disorders and PTSD.
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Affiliation(s)
- Fabio Canneva
- Department of Experimental Therapy, Präklinisches Experimentelles Tierzentrum, Univerisitätsklinikum Erlangen, 91054 Erlangen, Germany.
| | - Yulia Golub
- Department of Child and Adolescent Mental Health, University Clinic of Erlangen, 91054 Erlangen, Germany
| | - Joerg Distler
- Department of Experimental Therapy, Präklinisches Experimentelles Tierzentrum, Univerisitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Julia Dobner
- Department of Experimental Therapy, Präklinisches Experimentelles Tierzentrum, Univerisitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Sandra Meyer
- Department of Experimental Therapy, Präklinisches Experimentelles Tierzentrum, Univerisitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Stephan von Hörsten
- Department of Experimental Therapy, Präklinisches Experimentelles Tierzentrum, Univerisitätsklinikum Erlangen, 91054 Erlangen, Germany
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