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Xia X, Xu M, Gu Y, Li Y, Li L, Yin J. Low-carbohydrate diet in the treatment of type 2 diabetes mellitus (LoCaT): study protocol for a multicenter, randomized controlled trial. Trials 2023; 24:411. [PMID: 37337229 DOI: 10.1186/s13063-023-07427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Low-carbohydrate diet (LCD) is an emerging therapy for type 2 diabetes mellitus (T2DM). Although its effect on glucose control has been confirmed in previous clinical trials, most of those studies have focused on comparing calorie-restricted LCD to iso-caloric low-fat diets. In this study, we aim to compare the effects of LCD and canagliflozin, a sodium-glucose cotransporter 2 inhibitor, in patients with T2DM. METHODS This is a multicenter, randomized controlled trial. We will recruit 120 patients with poor-controlled T2DM. Participants will be randomly divided into canagliflozin and LCD groups in a 1:1 ratio. The primary outcome is the change in hemoglobin A1C levels after the 3-month intervention. The secondary outcomes are the time in range and cost of antihyperglycemic agents. Exploratory outcomes include physical examination, body composition, glucose variability, appetite, glycolipid metabolism, liver lipid content, and urine glucose threshold. DISCUSSION No previous study has compared an LCD with antihyperglycemic agents. In LoCaT, participants' metabolism will be assessed from multiple perspectives. It is believed that the finding obtained from this trial will optimize the treatments for patients with T2DM. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900027592. Registered on November 20, 2019.
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Affiliation(s)
- Xinyi Xia
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Rd, Shanghai, 200233, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, 59 Liuting Street, Ningbo, 315000, Zhejiang Province, China
| | - Yunjie Gu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Rd, Shanghai, 200233, China
| | - Yangxue Li
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, 8 Caobao Road, Shanghai, 200235, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, 59 Liuting Street, Ningbo, 315000, Zhejiang Province, China.
| | - Jun Yin
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Rd, Shanghai, 200233, China.
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, 8 Caobao Road, Shanghai, 200235, China.
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Wang Y, Shao X, Liu Z. Efficacy and safety of sodium-glucose co-transporter 2 inhibitors in the elderly versus non-elderly patients with type 2 diabetes mellitus: a meta-analysis. Endocr J 2022; 69:669-679. [PMID: 35314533 DOI: 10.1507/endocrj.ej21-0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This meta-analysis was performed to compare the influence of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on the efficacy and safety of elderly patients with type 2 diabetes with the young ones. PubMed, Medline, Web of Science, EMbase, and Cochrane Library were searched for literature published before March 2020 to identify studies comparing efficacy and safety of SGLT2i in elderly diabetes patients (≥65 years) and young controls (<65 years). A fixed or random-effect model was used to calculate the summary standard means difference and odds ratios. A total of 13 articles with data for 86,433 participants were included. Old patients receiving SGLT2i had a smaller reduction in hemoglobin A1c (SMD = -0.07, 95% CI -0.14 to -0.00, p = 0.044) than young ones. They had higher incidence of serious adverse events (SAEs) (OR 1.78, 95% CI 1.25-2.55, p = 0.001), AE leading to discontinuation (OR 2.34, 95%CI 1.53-3.59, p = 0.000), volume depletion (OR 2.80, 95% CI 1.82-4.32, p = 0.000) , and urinary tract infections (OR 1.37, 95% CI 1.18-1.60, p = 0.000), and renal function impairment (OR 2.61, 95% CI 1.78-3.81, p = 0.000) than young patients, and there was a opposite result in genital mycotic infections (OR 0.69, 95% CI 0.55-0.87, p = 0.002). No significant differences were recorded in the reduction of fasting blood glucose, blood pressure, body weight, and in incidence of overall AEs and fracture. In summary, relatively satisfying efficacy was observed in the elderly patients receiving SGLT2i. Although some AEs were more prevalent among older patients, the majority of them were generally mild.
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Affiliation(s)
- Yao Wang
- Department of Endocrinology and Metabolism, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, 610081, P.R. China
| | - Xian Shao
- NHC Key Laboratory of Hormones and Development (Tianjn Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjn Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin 300134, P.R. China
| | - Zewen Liu
- Tianjin First Central Hospital, Tianjin 300134, P.R. China
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Lin S, Chen C, Wang K, Wu K, Li S. Association of Dietary Fish and n-3 Unsaturated Fatty Acid Consumption with Diabetic Nephropathy from a District Hospital in Northern Taiwan. Nutrients 2022; 14:2148. [PMID: 35631289 PMCID: PMC9145694 DOI: 10.3390/nu14102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/10/2022] Open
Abstract
Nephropathy caused by diabetes mellitus (DM) is the main cause of end-stage renal disease (ESRD). To understand the association of dietary intake with renal function indicators among patients with diabetic nephropathy (DN), this cross-sectional study was conducted at the dietetic consultation clinic of the Taoyuan Armed Forces General Hospital in Taiwan. In total, 317 participants were recruited for this study. Patients with diabetes who had a urinary albumin–creatinine ratio (UACR) of ≥30 mg/g were defined as having DN. The anthropometric characteristics, blood biochemistry, and renal function of the participants were assessed. Furthermore, a semiquantitative food frequency questionnaire (SQFFQ) was administered to investigate the dietary intake of the participants in the DM and DN groups. The result showed that participants in the DN group were older, had longer diabetes duration and poorer glycemic control and renal function than those in the DM group. Logistic regression models revealed that intake of high-fat marine fishes had the lowest odds ratio (OR) for DN risk compared with other fishes (OR: 0.868; 95% CI: 0.781–0.965, p = 0.009). Shellfish, soybean products, and skim milk also provided better protective effects to decrease the risk of DN. A further analysis of polyunsaturated fatty acids revealed that Σn-3 PUFAs significantly reduced DN risk, while Σn-6 PUFAs did not, especially EPA (OR: 0.821; 95% CI: 0.688–0.979, p = 0.029) and DHA (OR: 0.903; 95% CI: 0.823–0.992, p = 0.033) regardless of whether the variables were adjusted, including diabetes duration, age, and HbA1c. Our findings suggest that a diet that incorporates high-fat fish, shellfish, soybean products, and a lower Σn-6/Σn-3 ratio can mitigate DN risk.
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Boselli L, Pomili T, Donati P, Pompa PP. Nanosensors for Visual Detection of Glucose in Biofluids: Are We Ready for Instrument-Free Home-Testing? Materials (Basel) 2021; 14:ma14081978. [PMID: 33920934 PMCID: PMC8071272 DOI: 10.3390/ma14081978] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022]
Abstract
Making frequent large-scale screenings for several diseases economically affordable would represent a real breakthrough in healthcare. One of the most promising routes to pursue such an objective is developing rapid, non-invasive, and cost-effective home-testing devices. As a first step toward a diagnostic revolution, glycemia self-monitoring represents a solid base to start exploring new diagnostic strategies. Glucose self-monitoring is improving people's life quality in recent years; however, current approaches still present vast room for improvement. In most cases, they still involve invasive sampling processes (i.e., finger-prick), quite discomforting for frequent measurements, or implantable devices which are costly and commonly dedicated to selected chronic patients, thus precluding large-scale monitoring. Thanks to their unique physicochemical properties, nanoparticles hold great promises for the development of rapid colorimetric devices. Here, we overview and analyze the main instrument-free nanosensing strategies reported so far for glucose detection, highlighting their advantages/disadvantages in view of their implementation as cost-effective rapid home-testing devices, including the potential use of alternative non-invasive biofluids as samples sources.
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Affiliation(s)
- Luca Boselli
- Nanobiointeractions and Nanodiagnostics, Italian Institute of Technology (IIT), Via Morego 30, 16163 Genova, Italy; (T.P.); (P.D.)
- Correspondence: (L.B.); (P.P.P.); Tel.: +39-010-2896-837 (P.P.P.)
| | - Tania Pomili
- Nanobiointeractions and Nanodiagnostics, Italian Institute of Technology (IIT), Via Morego 30, 16163 Genova, Italy; (T.P.); (P.D.)
- Department of Chemistry and Industrial Chemistry, University of Genova, Via Dodecaneso 31, 16146 Genova, Italy
| | - Paolo Donati
- Nanobiointeractions and Nanodiagnostics, Italian Institute of Technology (IIT), Via Morego 30, 16163 Genova, Italy; (T.P.); (P.D.)
| | - Pier P. Pompa
- Nanobiointeractions and Nanodiagnostics, Italian Institute of Technology (IIT), Via Morego 30, 16163 Genova, Italy; (T.P.); (P.D.)
- Correspondence: (L.B.); (P.P.P.); Tel.: +39-010-2896-837 (P.P.P.)
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Ganorkar SB, Sharma SS, Patil MR, Bobade PS, Dhote AM, Shirkhedkar AA. Pharmaceutical Analytical Profile for Novel SGL-2 Inhibitor: Dapagliflozin. Crit Rev Anal Chem 2020; 51:835-847. [PMID: 32544345 DOI: 10.1080/10408347.2020.1777524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Dapagliflozin (DPG) is a novel drug from class of sodium glucose co-transporter 2 (SGL-2) inhibitors which has been evolved as profound treatment option for the type-2diabetes mellitus (T2DM). Considering the severity of the disease the drug is of crucial significance for the therapy and associated research. As a pharmaceutical dosage form DPG has immense importance as an individual drug and with other antidiabetic drugs as combinations. The drugs existing in combination with DPG are Metformin (MET) and Saxagliptin (SXG). The existence of the Dapagliflozin in combinations further created more interest in reviewing its pharmaceutical, analytical and bio-analytical profile. Such estimations are always in need of precise pharmacological and physicochemical information; hence authors have presented it beforehand. Authors hereby wish to present an essential update pertaining to emergence of gliflozins and DPG. The article further presents a simultaneous and comparative assessment of the analytical investigations published in literature for pharmaceutical estimation to assist future analysis. The thorough literature searches revealed fifty three research papers in total till date. A comprehensive presentation of typical; hyphenated and unique methods used for analysis are outlined effectively. The percentile utilization of analytical approaches since appearance of first publication in 2010 is investigated to report trend in determination. The present review explores the pharmaceutical estimation of DPG to scientifically potentiate analytical research and therapeutic future of DPG as a novel SGL-2 Inhibitor antidiabetic.
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Affiliation(s)
- Saurabh B Ganorkar
- Central Instruments Facility (CIF), Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Shweta S Sharma
- Central Instruments Facility (CIF), Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Mangesh R Patil
- Central Instruments Facility (CIF), Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Preeti S Bobade
- Department of Quality Assurance, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Ashish M Dhote
- Central Instruments Facility (CIF), Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Atul A Shirkhedkar
- Central Instruments Facility (CIF), Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
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Hieshima K, Sugiyama S, Yoshida A, Kurinami N, Suzuki T, Ijima H, Miyamoto F, Kajiwara K, Jinnouchi K, Jinnouchi T, Jinnouchi H. Elevation of the renal threshold for glucose is associated with insulin resistance and higher glycated hemoglobin levels. J Diabetes Investig 2020; 11:617-625. [PMID: 31770476 PMCID: PMC7232275 DOI: 10.1111/jdi.13191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS/INTRODUCTION The renal threshold for glucose (RTg) corresponds to a blood glucose level of ~180 mg/dL; however, in hospitals, patients are often encountered who are hyperglycemic, but urine glucose test strip-negative, who remain negative for urine glucose even at blood glucose concentrations >180 mg/dL, implying a high RTg value. In this study, we aimed to identify factors determining high RTg in Japanese patients with type 2 diabetes mellitus. MATERIALS AND METHODS We estimated RTg (eRTg) using urinalysis data from 67 type 2 diabetes mellitus patients for whom the glucose infusion rate (GIR) was determined by hyperinsulinemic-euglycemic clamp. After allocating patients to two groups according to their baseline eRTg (<180 mg/dL or ≥180 mg/dL), we identified the factors affecting eRTg using simple and multiple linear regression analyses. RESULTS GIR, glycated hemoglobin (HbA1c), insulin use and dyslipidemia differed significantly between the groups. In simple regression analysis, GIR, HbA1c, body muscle-to-fat ratio and insulin use were significantly correlated with eRTg; and in multiple regression analysis, GIR and HbA1c remained independent negative and positive determinants, respectively, with the contribution of GIR being substantial. In receiver operating characteristic curve analysis, when GIR <5.7 was used as the insulin resistance threshold, the cut-off value of eRTg was 189 mg/dL (P = 0.0001). Furthermore, in receiver operating characteristic analysis using eRTg ≥189 mg/dL, the cut-off value for HbA1c was 8.0% (P = 0.0006). CONCLUSIONS High eRTg is associated with low GIR and high HbA1c, with GIR making a substantial contribution.
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Affiliation(s)
| | - Seigo Sugiyama
- Diabetes Care CenterJinnouchi HospitalKumamotoJapan
- Cardiovascular DivisionDiabetes Care CenterJinnouchi HospitalKumamotoJapan
| | | | | | | | - Hiroko Ijima
- Diabetes Care CenterJinnouchi HospitalKumamotoJapan
| | | | | | | | | | - Hideaki Jinnouchi
- Diabetes Care CenterJinnouchi HospitalKumamotoJapan
- Cardiovascular DivisionDiabetes Care CenterJinnouchi HospitalKumamotoJapan
- Division of Preventive CardiologyDepartment of Cardiovascular MedicineKumamoto University HospitalKumamotoJapan
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Sokolov V, Yakovleva T, Chu L, Tang W, Greasley PJ, Johansson S, Peskov K, Helmlinger G, Boulton DW, Penland RC. Differentiating the Sodium-Glucose Cotransporter 1 Inhibition Capacity of Canagliflozin vs. Dapagliflozin and Empagliflozin Using Quantitative Systems Pharmacology Modeling. CPT Pharmacometrics Syst Pharmacol 2020; 9:222-229. [PMID: 32064793 PMCID: PMC7180004 DOI: 10.1002/psp4.12498] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023]
Abstract
The aim of this research was to differentiate dapagliflozin, empagliflozin, and canagliflozin based on their capacity to inhibit sodium‐glucose cotransporter (SGLT) 1 and 2 in patients with type 2 diabetes using a previously developed quantitative systems pharmacology model of renal glucose filtration, reabsorption, and excretion. The analysis was based on pooled, mean study‐level data on 24‐hour urinary glucose excretion, average daily plasma glucose, and estimated glomerular filtration rate collected from phase I and II clinical trials of SGLT2 inhibitors. Variations in filtered glucose across clinical studies were shown to drive the apparent differences in the glucosuria dose–response relationships among the gliflozins. A normalized dose–response analysis demonstrated similarity of dapagliflozin and empagliflozin, but not canagliflozin. At approved doses, SGLT1 inhibition by canagliflozin but not dapagliflozin or empagliflozin contributed to ~ 10% of daily urinary glucose excretion.
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Affiliation(s)
| | | | - Lulu Chu
- Clinical Pharmacology & Safety Sciences, R&D, Astrazeneca, Boston, Massachusetts, USA
| | - Weifeng Tang
- Clinical Pharmacology & Safety Sciences, R&D, Astrazeneca, Gaithersburg, USA
| | - Peter J Greasley
- Early Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Susanne Johansson
- Clinical Pharmacology & Safety Sciences, R&D, Astrazeneca, Gothenburg, Sweden
| | - Kirill Peskov
- M&S Decisions, Moscow, Russian Federation.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Gabriel Helmlinger
- Clinical Pharmacology & Safety Sciences, R&D, Astrazeneca, Boston, Massachusetts, USA
| | - David W Boulton
- Clinical Pharmacology & Safety Sciences, R&D, Astrazeneca, Gaithersburg, USA
| | - Robert C Penland
- Clinical Pharmacology & Safety Sciences, R&D, Astrazeneca, Boston, Massachusetts, USA
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Wang S, Zhao X, Zhang R, Wang C, Han Y, Shao L. Identification of ten novel SLC5A2 mutations and determination of the renal threshold for glucose excretion in Chinese patients with familial renal glucosuria. Clin Chim Acta 2018; 490:102-106. [PMID: 30593819 DOI: 10.1016/j.cca.2018.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Familial renal glucosuria (FRG) is a rare renal tubular disorder characterized by isolated persistent glucosuria without both abnormal glucose metabolism and any signs of proximal tubular dysfunction. SLC5A2 gene mutations are responsible for most FRG cases. METHODS Quantitative test for 24-hour urine glucose and RTG were determined in 9 families (totaling 25 subjects). All coding regions, including intron-exon boundaries, were analyzed with PCR followed by direct sequence analysis. RESULTS Ten novel mutations were identified (c.331 T > C, p.W111R; c.374T>C, p.M125T; c.394C>T, p.R132C; c.612G>C, p.Q204H; c.829C>T, p.P277S; c.880G>A, p.D294N; c.1129G>A, p.G377S; c.1194C>A, p.F398L; c.1540C > T, p.P514S and c.1573C>T, p.H525Y). c.886(-10_-31)del that is specific to Chinese population was found in 5 out of 9 families, with a mutation rate of 28% (5/18). The compound heterozygotes presented with much lower RTG values (1.28 ± 0.10 mmol/L), compared with the carriers of heterozygous variants (5.14 ± 0.77 mmol/L) (p<0.01); c.886(-10_-31)del heterozygotes had significant lower RTG values than others (4.43 ± 0.37 vs 5.7 ± 0.51 mmol/L; p<0.01). CONCLUSIONS Ten novel SLC5A2 mutations are found and c.886(-10-31)del may be a hot spot mutation in Chinese population. Compound heterozygotes had much lower RTG values than simple heterozygotes. Mixed-meal tolerance test is a simple method for determining RTG in FRG patients.
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Affiliation(s)
- Sai Wang
- Department of Nephrology, The Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, PR China
| | - Xiangzhong Zhao
- Central Laboratory, The Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Qingdao 266555, PR China
| | - Ruixiao Zhang
- Department of Nephrology, The Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, PR China
| | - Cui Wang
- Department of Nephrology, The Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, PR China
| | - Yue Han
- Department of Nephrology, The Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, PR China
| | - Leping Shao
- Department of Nephrology, The Affiliated Qingdao Municipal Hospital of Qingdao University, No.5 Donghai Middle Road, Qingdao 266071, PR China.
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Garcia-Ropero A, Badimon JJ, Santos-Gallego CG. The pharmacokinetics and pharmacodynamics of SGLT2 inhibitors for type 2 diabetes mellitus: the latest developments. Expert Opin Drug Metab Toxicol 2018; 14:1287-1302. [PMID: 30463454 DOI: 10.1080/17425255.2018.1551877] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder associated with high cardiovascular (CV) risk. Some of the therapeutic strategies are contraindicated in patients with concomitant heart disease. However, the newest antidiabetic medications, sodium-glucose cotransporter 2 (SGLT2) inhibitors, have shown to significantly reduce CV mortality and heart failure (HF) hospitalizations. The mechanism behind these surprising cardiac benefits remains unclear. Areas covered: This article reviews the pharmacokinetic, pharmacodynamics, efficacy, and safety data for the different SGLT2 inhibitors. Specific attention is devoted to the postulated mechanisms of action for their benefit. The therapeutic efficacy and potential use in different indications outside T2DM such as HF, T1DM, and renal disease are also discussed. Expert opinion: SGLT2 inhibitors have an excellent pharmacokinetic and pharmacodynamic profile. Importantly, SGLT2 inhibitors are a safe and efficacious treatment option for T2DM. Given their cardiac benefits (reduction in HF and death) and the low incidence of adverse events, SGLT2 inhibitors are being currently studied as a treatment for HF also in nondiabetic individuals. These agents seem to represent a shift in the treatment of HF patients regardless their glycemic profile.
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Affiliation(s)
- Alvaro Garcia-Ropero
- a Atherothrombosis Research Unit, Cardiovascular Institute , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Juan J Badimon
- a Atherothrombosis Research Unit, Cardiovascular Institute , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Carlos G Santos-Gallego
- a Atherothrombosis Research Unit, Cardiovascular Institute , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Du F, Hinke SA, Cavanaugh C, Polidori D, Wallace N, Kirchner T, Jennis M, Lang W, Kuo GH, Gaul MD, Lenhard J, Demarest K, Ajami NJ, Liang Y, Hornby PJ. Potent Sodium/Glucose Cotransporter SGLT1/2 Dual Inhibition Improves Glycemic Control Without Marked Gastrointestinal Adaptation or Colonic Microbiota Changes in Rodents. J Pharmacol Exp Ther 2018; 365:676-687. [PMID: 29674332 DOI: 10.1124/jpet.118.248575] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
The sodium/glucose cotransporters (SGLT1 and SGLT2) transport glucose across the intestinal brush border and kidney tubule. Dual SGLT1/2 inhibition could reduce hyperglycemia more than SGLT2-selective inhibition in patients with type 2 diabetes. However, questions remain about altered gastrointestinal (GI) luminal glucose and tolerability, and this was evaluated in slc5a1-/- mice or with a potent dual inhibitor (compound 8; SGLT1 Ki = 1.5 ± 0.5 nM 100-fold greater potency than phlorizin; SGLT2 Ki = 0.4 ± 0.2 nM). 13C6-glucose uptake was quantified in slc5a1-/- mice and in isolated rat jejunum. Urinary glucose excretion (UGE), blood glucose (Sprague-Dawley rats), glucagon-like peptide 1 (GLP-1), and hemoglobin A1c (HbA1c) levels (Zucker diabetic fatty rats) were measured. Intestinal adaptation and rRNA gene sequencing was analyzed in C57Bl/6 mice. The blood 13C6-glucose area under the curve (AUC) was reduced in the absence of SGLT1 by 75% (245 ± 6 vs. 64 ± 6 mg/dl⋅h in wild-type vs. slc5a1-/- mice) and compound 8 inhibited its transport up to 50% in isolated rat jejunum. Compound 8 reduced glucose excursion more than SGLT2-selective inhibition (e.g., AUC = 129 ± 3 vs. 249 ± 5 mg/dl⋅h for 1 mg/kg compound 8 vs. dapagliflozin) with similar UGE but a lower renal glucose excretion threshold. In Zucker diabetic fatty rats, compound 8 decreased HbA1c and increased total GLP-1 without changes in jejunum SGLT1 expression, mucosal weight, or villus length. Overall, compound 8 (1 mg/kg for 6 days) did not increase cecal glucose concentrations or bacterial diversity in C57BL/6 mice. In conclusion, potent dual SGLT1/2 inhibition lowers blood glucose by reducing intestinal glucose absorption and the renal glucose threshold but minimally impacts the intestinal mucosa or luminal microbiota in chow-fed rodents.
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Affiliation(s)
- Fuyong Du
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Simon A Hinke
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Cassandre Cavanaugh
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - David Polidori
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Nathanial Wallace
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Thomas Kirchner
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Matthew Jennis
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Wensheng Lang
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Gee-Hong Kuo
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Micheal D Gaul
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - James Lenhard
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Keith Demarest
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Nadim J Ajami
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Yin Liang
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
| | - Pamela J Hornby
- Cardiovascular and Metabolism Discovery (F.D., S.A.H., C.C., N.W., T.K., M.J., G.-H.K., M.D.G., J.L., K.D., Y.L., P.J.H.) and Analytical Sciences (W.L.), Janssen R&D LLC, Spring House, Pennsylvania; Cardiovascular and Metabolism Experimental and Translational Medicine, Janssen R&D LLC, San Diego, California (D.P.); and Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas (N.J.A.)
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Karim MN, Anderson SR, Singh S, Ramanathan R, Bansal V. Nanostructured silver fabric as a free-standing NanoZyme for colorimetric detection of glucose in urine. Biosens Bioelectron 2018; 110:8-15. [PMID: 29574249 DOI: 10.1016/j.bios.2018.03.025] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/22/2018] [Accepted: 03/12/2018] [Indexed: 11/23/2022]
Abstract
Enzyme-mimicking catalytic nanoparticles, more commonly known as NanoZymes, have been at the forefront for the development of new sensing platforms for the detection of a range of molecules. Although solution-based NanoZymes have shown promise in glucose detection, the ability to immobilize NanoZymes on highly absorbent surfaces, particularly on free-standing substrates that can be feasibly exposed and removed from the reaction medium, can offer significant benefits for a range of biosensing and catalysis applications. This work, for the first time, shows the ability of Ag nanoparticles embedded within the 3D matrix of a cotton fabric to act as a free-standing peroxidase-mimic NanoZyme for the rapid detection of glucose in complex biological fluids such as urine. The use of cotton fabric as a template not only allows high number of catalytically active sites to participate in the enzyme-mimic catalytic reaction, the absorbent property of the cotton fibres also helps in rapid absorption of biological molecules such as glucose during the sensing event. This, in turn, brings the target molecule of interest in close proximity of the NanoZyme catalyst enabling accurate detection of glucose in urine. Additionally, the ability to extract the free-standing cotton fabric-supported NanoZyme following the reaction overcomes the issue of potential interference from colloidal nanoparticles during the assay. Based on these unique characteristics, nanostructured silver fabrics offer remarkable promise for the detection of glucose and other biomolecules in complex biological and environmental fluids.
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Merton K, Davies MJ, Vijapurkar U, Inman D, Meininger G. Achieving the composite endpoint of HbA1c, body weight, and systolic blood pressure reduction with canagliflozin in patients with type 2 diabetes. Curr Med Res Opin 2018; 34:313-318. [PMID: 29022746 DOI: 10.1080/03007995.2017.1391759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In addition to achieving glycemic control, weight loss and blood pressure (BP) reduction are important components of type 2 diabetes mellitus (T2DM) management, as many patients with T2DM are overweight/obese and/or have hypertension. Canagliflozin, an SGLT2 inhibitor, has demonstrated improvements in HbA1c, body weight (BW), and systolic BP across a broad range of patients with T2DM. This analysis evaluated achievement of composite endpoints of HbA1c, BW, and systolic BP targets with canagliflozin versus placebo. METHODS This post hoc analysis evaluated the proportion of T2DM patients achieving the composite endpoint of HbA1c reduction ≥0.5%, BW reduction ≥3%, and systolic BP reduction ≥4mmHg with canagliflozin 100 and 300mg compared with placebo using pooled data from four 26-week, phase 3 studies (N = 2313; NCT01081834, NCT01106677, NCT01106625, NCT01106690). The proportion of patients achieving the composite endpoint of HbA1c <7.0%, BW reduction ≥3%, and BP <130/80 mmHg was also evaluated. RESULTS At week 26, greater proportions of patients met individual HbA1c, BW, and systolic BP targets with canagliflozin versus placebo. A greater proportion of patients treated with canagliflozin 100 or 300 mg versus placebo also achieved the composite endpoint of HbA1c reduction ≥0.5%, BW reduction ≥3%, and systolic BP reduction ≥4 mmHg at week 26 (21.1%, 25.3%, and 5.7%, respectively; odds ratios [95% CI] of 4.5 [3.1, 6.5] and 5.6 [3.8, 8.2]). A greater proportion of patients also achieved the composite endpoint of HbA1c <7.0%, BW reduction ≥3%, and BP <130/80 mmHg with canagliflozin 100 and 300 mg versus placebo (14.7%, 20.9%, and 3.3%, respectively; odds ratios [95% CI] of 5.2 [3.2, 8.4] and 8.4 [5.2, 13.5]). Canagliflozin was generally well tolerated, with a safety profile similar to that seen in other phase 3 studies. CONCLUSIONS Patients with T2DM were more likely to achieve clinically important reductions in HbA1c, BW, and systolic BP with canagliflozin versus placebo.
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Affiliation(s)
| | | | | | - Doreen Inman
- a Janssen Scientific Affairs LLC , Titusville , NJ , USA
| | - Gary Meininger
- b Janssen Research & Development LLC , Raritan , NJ , USA
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13
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Abe T, Matsubayashi Y, Yoshida A, Suganami H, Nojima T, Osawa T, Ishizawa M, Yamamoto M, Fujihara K, Tanaka S, Kaku K, Sone H. Predictors of the response of HbA1c and body weight after SGLT2 inhibition. Diabetes Metab 2017; 44:172-174. [PMID: 29128289 DOI: 10.1016/j.diabet.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 02/04/2023]
Affiliation(s)
- T Abe
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Y Matsubayashi
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - A Yoshida
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan; Medical Information and Product Advancement Department, Kowa Pharmaceutical Company Ltd., Tokyo, Japan
| | - H Suganami
- Clinical Data Science Department, Kowa Company Ltd., Tokyo, Japan
| | - T Nojima
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan; Clinical Data Science Department, Kowa Company Ltd., Tokyo, Japan
| | - T Osawa
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - M Ishizawa
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - M Yamamoto
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - K Fujihara
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - S Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - K Kaku
- Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - H Sone
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan.
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Yale JF, Xie J, Sherman SE, Garceau C. Canagliflozin in Conjunction With Sulfonylurea Maintains Glycemic Control and Weight Loss Over 52 Weeks: A Randomized, Controlled Trial in Patients With Type 2 Diabetes Mellitus. Clin Ther 2017; 39:2230-2242.e2. [DOI: 10.1016/j.clinthera.2017.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023]
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Yin W, Qin W, Gao Y. Urine glucose levels are disordered before blood glucose level increase was observed in Zucker diabetic fatty rats. Sci China Life Sci 2017; 61:844-848. [DOI: 10.1007/s11427-017-9134-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/23/2017] [Indexed: 01/19/2023]
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Al-Jobori H, Daniele G, Cersosimo E, Triplitt C, Mehta R, Norton L, DeFronzo RA, Abdul-Ghani M. Empagliflozin and Kinetics of Renal Glucose Transport in Healthy Individuals and Individuals With Type 2 Diabetes. Diabetes 2017; 66:1999-2006. [PMID: 28428225 PMCID: PMC7301160 DOI: 10.2337/db17-0100] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/13/2017] [Indexed: 01/09/2023]
Abstract
Renal glucose reabsorption was measured with the stepped hyperglycemic clamp in 15 subjects with type 2 diabetes mellitus (T2DM) and 15 without diabetes after 2 days and after more chronic (14 days) treatment with empagliflozin. Patients with T2DM had significantly greater maximal renal glucose transport (TmG) compared with subjects without diabetes at baseline (459 ± 53 vs. 337 ± 25 mg/min; P < 0.05). Empagliflozin treatment for 48 h reduced the TmG in both individuals with and without diabetes by 44 ± 7 and 53 ± 6%, respectively (both P < 0.001). TmG was further reduced by empagliflozin in both groups on day 14 (by 65 ± 5 and 75 ± 3%, respectively). Empagliflozin reduced the plasma glucose concentration threshold for glucose spillage in the urine similarly in individuals with T2DM and without diabetes to <40 mg/dL, which is well below the normal fasting plasma glucose concentration. In summary, sodium-glucose transporter-2 inhibition with empagliflozin reduces both TmG and threshold for glucose spillage in the urine in patients with T2DM and those without diabetes.
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Affiliation(s)
- Hussein Al-Jobori
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Giuseppe Daniele
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Eugenio Cersosimo
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Curtis Triplitt
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Rucha Mehta
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Luke Norton
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ralph A DeFronzo
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Muhammad Abdul-Ghani
- Texas Diabetes Institute and The University of Texas Health Science Center at San Antonio, San Antonio, TX
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Færch K, Amadid H, Nielsen LB, Ried-Larsen M, Karstoft K, Persson F, Jørgensen ME. Protocol for a randomised controlled trial of the effect of dapagliflozin, metformin and exercise on glycaemic variability, body composition and cardiovascular risk in prediabetes (the PRE-D Trial). BMJ Open 2017; 7:e013802. [PMID: 28592573 PMCID: PMC5734208 DOI: 10.1136/bmjopen-2016-013802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The primary aim of this study is to compare the efficacy of three short-term glucose-lowering interventions (exercise, metformin and dapagliflozin) on glycaemic variability in overweight or obese men and women with elevated diabetes risk (ie, prediabetes, defined as haemoglobin A1c (HbA1c)39-47 mmol/mol / 5.7%-6.4%). The secondary aims are to investigate the effects of the interventions on body composition and cardiometabolic risk factors. METHODS AND ANALYSIS The Pre-D Trial is an investigator-initiated, randomised, controlled, parallel, open-label, superiority trial. The study aims to assign 120 participants in a 1:1:1:1 ratio to receive one of four interventions for 13 weeks: (1) dapagliflozin (10 mg once daily); (2) metformin (850 mg twice daily); (3) exercise (interval training, 5 days a week, 30 min per session); or (4) control (lifestyle advice). After the 13 weeks of intervention, a follow-up period of 13 weeks will follow to study the long-term effects of the interventions. The primary endpoint is reduction from baseline to end-of treatment (13 weeks) in mean amplitude of glycaemic excursions measured by continuous glucose monitoring. The secondary endpoints include concomitant changes in various measures of glucose metabolism, body weight, cardiorespiratory fitness, blood pressure, plasma lipids, objectively measured physical activity and dietary intake. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the Capital Region and the Danish Medicines Agency. Approval of data and biobank storage has been obtained from the Danish Data Protection Board. The study will be carried out according to the Declaration of Helsinki and to the regulations for good clinical practice. The results from this trial will allow a number of research questions concerning the effect of exercise versus dapagliflozin or metformin in HbA1c-defined prediabetes to be addressed. TRIAL REGISTRATION NCT02695810.
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Affiliation(s)
- Kristine Færch
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
| | - Hanan Amadid
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
| | | | - Mathias Ried-Larsen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Kristian Karstoft
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
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Kim SR, Lee YH, Kang ES, Cha BS, Lee BW. The Relationship between Increases in Morning Spot Urinary Glucose Excretion and Decreases in HbA 1C in Patients with Type 2 Diabetes After Taking an SGLT2 Inhibitor: A Retrospective, Longitudinal Study. Diabetes Ther 2017; 8:601-609. [PMID: 28332143 PMCID: PMC5446375 DOI: 10.1007/s13300-017-0248-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Sodium glucose co-transporter 2 (SGLT2) inhibitors increase urinary glucose excretion (UGE) by reducing the renal threshold for glucose excretion, which results in decreased serum glucose concentrations in patients with type 2 diabetes mellitus (T2D). However, no study to date has determined whether larger increases in UGE after SGLT2 inhibitor treatment correspond to larger reductions in glycated hemoglobin (HbA1C). METHODS We enrolled participants who were newly prescribed an SGLT2 inhibitor (dapagliflozin 10 mg or ipragliflozin 50 mg, once daily) as an add-on therapy. Patients were tested for HbA1C and first morning spot urinary-creatinine and -glucose concentrations immediately prior to administration of the SGLT2 inhibitor and at a 12-week follow-up appointment. We investigated the relationship between increases in morning spot UGE and decreases in HbA1C. RESULTS A total of 101 participants with T2D were enrolled. The median age and diabetes duration were 61.0 and 12.8 years, respectively, and the median HbA1C was 8.10%. SGLT2 inhibitors significantly lowered the HbA1C level, with a median change from baseline to week 12 of -0.60% (p < 0.001). Robust increases from baseline were seen for the morning spot urinary glucose-to-creatinine ratio (UGCR), with a median change at week 12 of 47.3 mg/mg. In the correlation analysis, the ∆HbA1C level showed a significant positive correlation with ∆morning spot UGCR (r = 0.395, p < 0.001). In other words, a greater reduction in HbA1C was correlated with a smaller increase in UGE. After adjusting for confounding variables, ∆HbA1C was significantly associated with ∆morning spot UGCR. CONCLUSIONS Although SGLT2 inhibitor treatment leads to a reduced HbA1C level by augmenting UGE, larger increases in UGE do not correlate to larger reductions in HbA1C. This suggests that the increase in UGE might not be an indicator of the degree of reductions in blood glucose.
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Affiliation(s)
- So Ra Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
- Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
- Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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19
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Johnson JF, Parsa R, Bailey RA. Real-world Clinical Outcomes Among Patients With Type 2 Diabetes Receiving Canagliflozin at a Specialty Diabetes Clinic: Subgroup Analysis by Baseline HbA 1c and Age. Clin Ther 2017; 39:1123-1131. [DOI: 10.1016/j.clinthera.2017.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/27/2023]
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20
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Yue XD, Wang JY, Zhang XR, Yang JH, Shan CY, Zheng MY, Ren HZ, Zhang Y, Yang SH, Guo ZH, Chang B, Chang BC. Characteristics and Impact Factors of Renal Threshold for Glucose Excretion in Patients with Type 2 Diabetes Mellitus. J Korean Med Sci 2017; 32:621-627. [PMID: 28244288 PMCID: PMC5334160 DOI: 10.3346/jkms.2017.32.4.621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/03/2016] [Indexed: 01/04/2023] Open
Abstract
Sodium glucose co-transporter 2 (SGLT-2) inhibitors are newly developed but promising medicine for type 2 diabetes. However, patients with a different renal threshold for glucose excretion (RT(G)) may have a different reaction to this medicine. Therefore, the objective of this study was to investigate the characteristics of RT(G) and its impact factors in patients with type 2 diabetes mellitus (T2DM). The clinical and laboratory data of 36 healthy individuals and 168 in-hospital patients with T2DM were collected and analyzed, RT(G) was calculated using blood glucose (BG) measured by dynamic BG monitoring, urinary glucose excretion (UGE) and estimated glomerular filtration rate (eGFR). The characteristics of RT(G) were investigated. The risk factors for high RT(G) were analyzed using non-conditional logistic regression analysis. Our results found that RT(G) of the T2DM group was higher than that of the healthy individuals (P < 0.05); and 22.22% from the healthy individuals group but 58.33% from the T2DM group had high RT(G). Age, duration of diabetes, body mass index (BMI), and homeostasis model assessment insulin resistance index (HOMA-IR) were independently associated with high RT(G) (P < 0.05). Further stratified analysis revealed that RT(G) in T2DM patients increased with age, duration of diabetes, and BMI. In conclusion, RT(G) is increased in patients with T2DM, especially in those with longer diabetic duration, higher BMI, and those who are older. Therefore, these patients may be more sensitive to SGLT-2 inhibitors.
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Affiliation(s)
- Xiao Dan Yue
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Jing Yu Wang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xin Rong Zhang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Ju Hong Yang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Chun Yan Shan
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Miao Yan Zheng
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Hui Zhu Ren
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yi Zhang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Shao Hua Yang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Zhen Hong Guo
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Bai Chang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Bao Cheng Chang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
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Davies MJ, Merton K, Vijapurkar U, Yee J, Qiu R. Efficacy and safety of canagliflozin in patients with type 2 diabetes based on history of cardiovascular disease or cardiovascular risk factors: a post hoc analysis of pooled data. Cardiovasc Diabetol 2017; 16:40. [PMID: 28327140 PMCID: PMC5361783 DOI: 10.1186/s12933-017-0517-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/02/2017] [Indexed: 02/08/2023] Open
Abstract
Background Treatment of patients with type 2 diabetes mellitus (T2DM) and a history of cardiovascular (CV) disease or CV risk factors may present clinical challenges due to the presence of comorbid conditions and the use of concomitant medications. The sodium glucose co-transporter 2 inhibitor, canagliflozin, has been shown to improve glycaemic control and reduce body weight and blood pressure (BP) with a favourable tolerability profile in a broad range of patients with T2DM. This post hoc analysis assessed the efficacy and safety of canagliflozin in patients with T2DM based on CV disease history or CV risk factors. Methods Analyses were based on pooled data from four 26-week, placebo-controlled, Phase 3 studies that evaluated canagliflozin 100 and 300 mg in patients with T2DM (N = 2313; mean HbA1c, 8.0%; body weight, 89 kg; systolic BP, 128 mmHg). Changes from baseline to week 26 in HbA1c, body weight, and systolic BP were assessed based on history of CV disease, history of hypertension, baseline statin use, and number of CV risk factors. Safety was assessed based on adverse event (AE) reports. Results At week 26, both canagliflozin doses lowered HbA1c, body weight, and systolic BP compared with placebo in patients with and without CV disease history or risk factors. Placebo-subtracted HbA1c reductions with canagliflozin 100 and 300 mg were similar in patients with a history of CV disease (−0.95 and −1.07%) versus no history of CV disease (−0.71 and −0.90%), history of hypertension (−0.72 and −0.89%) versus no history of hypertension (−0.73 and −0.95%), baseline statin use (−0.77 and −0.99%) versus no statin use (−0.69 and −0.85%), and 0–1 CV risk factor (−0.72 and −0.87%) versus ≥2 CV risk factors (−0.74 and −1.02%). Similar body weight and systolic BP reductions were seen with canagliflozin versus placebo across subgroups. The incidence of AEs, AEs leading to discontinuation, and serious AEs was similar across subgroups. Conclusions The efficacy and safety of canagliflozin were generally consistent across subgroups of patients with T2DM and varying degrees of CV disease history or risk factors. Trial registration numbers and dates ClinicalTrials.gov: NCT01081834, 4 March 2010; NCT01106625, 1 April 2010; NCT01106677, 1 April 2010; NCT01106690, 1 April 2010 Electronic supplementary material The online version of this article (doi:10.1186/s12933-017-0517-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael J Davies
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Katherine Merton
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Ujjwala Vijapurkar
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
| | - Jacqueline Yee
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
| | - Rong Qiu
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
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Abstract
INTRODUCTION Deciding on an optimal medication choice for type 2 diabetes is often challenging, due to the increasing number of treatment options. Canagliflozin is a novel glucose-lowering agent belonging to sodium-glucose co-transporter 2 (SGLT2) inhibitors. AIM The aim of this study was to examine and summarize the evidence based on the efficacy, safety, and cost-effectiveness of canagliflozin for type 2 diabetes. EVIDENCE REVIEW Compared to placebo, canagliflozin 100 and 300 mg lower glycated hemoglobin (HbA1c) by ~0.6%-0.8%, respectively. Canagliflozin appears to be slightly more effective than dipeptidyl peptidase-4 (DPP-4) inhibitors in reducing HbA1c. It also has a favorable effect on body weight and blood pressure, both versus placebo and most active comparators. However, treatment with canagliflozin is associated with increased incidence of genital tract infections and osmotic diuresis-related adverse events. Based on short-term data, canagliflozin is not associated with increased risk for all-cause mortality and cardiovascular outcomes. Economic evaluation studies from various countries indicate that canagliflozin is a cost-effective option in dual- or triple-agent regimens. PLACE IN THERAPY As monotherapy, canagliflozin could be used in patients for whom metformin is contraindicated or not tolerated. For patients on background treatment with metformin, canagliflozin appears to be superior to sulfonylureas with respect to body weight, blood pressure and risk for hypoglycemia, and to DPP-4 inhibitors in terms of lowering HbA1c, body weight, and blood pressure. Canagliflozin also seems to be cost-effective compared with sulfonylureas and DPP-4 inhibitors as add-on to metformin monotherapy, and compared with DPP-4 inhibitors as add-on to metformin and sulfonylurea. CONCLUSION Current evidence on intermediate efficacy outcomes, short-term safety and cost-effectiveness support the use of canagliflozin in patients on background treatment with metformin. Robust long-term data regarding the effect of canagliflozin on cardiovascular endpoints will be available upon completion of the Canagliflozin Cardiovascular Assessment Study (CANVAS) trial.
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Affiliation(s)
- Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, United Kingdom
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23
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Pfeifer M, Townsend RR, Davies MJ, Vijapurkar U, Ren J. Effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on blood pressure and markers of arterial stiffness in patients with type 2 diabetes mellitus: a post hoc analysis. Cardiovasc Diabetol 2017; 16:29. [PMID: 28241822 PMCID: PMC5327537 DOI: 10.1186/s12933-017-0511-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/05/2017] [Indexed: 01/14/2023] Open
Abstract
Background Physiologic determinants, such as pulse pressure [difference between systolic blood pressure (SBP) and diastolic BP (DBP)], mean arterial pressure (2/3 DBP + 1/3 SBP), and double product [beats per minute (bpm) × SBP], are linked to cardiovascular outcomes. The effects of canagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, on pulse pressure, mean arterial pressure, and double product were assessed in patients with type 2 diabetes mellitus (T2DM). Methods This post hoc analysis was based on pooled data from four 26-week, randomized, double-blind, placebo-controlled studies evaluating canagliflozin in patients with T2DM (N = 2313) and a 6-week, randomized, double-blind, placebo-controlled, ambulatory BP monitoring (ABPM) study evaluating canagliflozin in patients with T2DM and hypertension (N = 169). Changes from baseline in SBP, DBP, pulse pressure, mean arterial pressure, and double product were assessed using seated BP measurements (pooled studies) or averaged 24-h BP assessments (ABPM study). Safety was assessed based on adverse event reports. Results In the pooled studies, canagliflozin 100 and 300 mg reduced SBP (−4.3 and −5.0 vs −0.3 mmHg) and DBP (−2.5 and −2.4 vs −0.6 mmHg) versus placebo at week 26. Reductions in pulse pressure (−1.8 and −2.6 vs 0.2 mmHg), mean arterial pressure (−3.1 and −3.3 vs −0.5 mmHg), and double product (−381 and −416 vs −30 bpm × mmHg) were also seen with canagliflozin 100 and 300 mg versus placebo. In the ABPM study, canagliflozin 100 and 300 mg reduced mean 24-h SBP (−4.5 and −6.2 vs −1.2 mmHg) and DBP (−2.2 and −3.2 vs −0.3 mmHg) versus placebo at week 6. Canagliflozin 300 mg provided reductions in pulse pressure (−3.3 vs −0.8 mmHg) and mean arterial pressure (−4.2 vs −0.6 mmHg) compared with placebo, while canagliflozin 100 mg had more modest effects on these parameters. Canagliflozin was generally well tolerated in both study populations. Conclusions Canagliflozin improved all three cardiovascular physiologic markers, consistent with the hypothesis that canagliflozin may have beneficial effects on some cardiovascular outcomes in patients with T2DM. Trial registration ClinicalTrials.gov Identifier: NCT01081834 (registered March 2010); NCT01106677 (registered April 2010); NCT01106625 (registered April 2010); NCT01106690 (registered April 2010); NCT01939496 (registered September 2013)
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Affiliation(s)
- Michael Pfeifer
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, 122 Founders Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Michael J Davies
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Ujjwala Vijapurkar
- Janssen Research & Development, LLC, 920 US Highway 202 South, Raritan, NJ, 08869, USA
| | - Jimmy Ren
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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Rodbard HW, Peters AL, Slee A, Cao A, Traina SB, Alba M. The Effect of Canagliflozin, a Sodium Glucose Cotransporter 2 Inhibitor, on Glycemic End Points Assessed by Continuous Glucose Monitoring and Patient-Reported Outcomes Among People With Type 1 Diabetes. Diabetes Care 2017; 40:171-180. [PMID: 27899497 DOI: 10.2337/dc16-1353] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the effects of canagliflozin, a sodium glucose cotransporter 2 inhibitor, on glycemic parameters and measures of glucose variability assessed by a 9-point self-monitoring blood glucose (SMBG) and continuous glucose monitoring (CGM) profiles, and patient-reported outcomes as an add-on to insulin among participants with type 1 diabetes. RESEARCH DESIGN AND METHODS In this randomized, double-blind study, 351 participants received canagliflozin 100 or 300 mg or placebo for 18 weeks. Change from baseline in daily mean glucose and SD was measured using a 9-point SMBG profile. In a subset of 89 participants who underwent CGM, the change from baseline in mean glucose, measures of glycemic variability (SD, coefficient of variation, and mean amplitude of glycemic excursions), and time spent in glycemic ranges were assessed. Change in treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire (n = 328). RESULTS At week 18, reductions in daily mean glucose and SD measured using the 9-point SMBG profile were seen with canagliflozin 100 and 300 mg versus placebo. Reductions in mean glucose (-1.2, -0.7, and 0.6 mmol/L) and measures of glycemic variability assessed by CGM, such as changes in glucose SD (-0.3, -0.7, and 0.1 mmol/L), were also seen with canagliflozin 100 and 300 mg versus placebo, respectively. Canagliflozin 100 and 300 mg were associated with increases in time spent within target (glucose >3.9 to ≤10.0 mmol/L) compared with placebo (11.6%, 10.1%, and -3.5%, respectively) and commensurate reductions in time spent above the target level (glucose >10.0 mmol/L; -12.7%,-7.6%, and 5.7%, respectively). Participants showed greater improvement in treatment satisfaction with canagliflozin versus placebo; reductions in insulin dose, SD of glucose, and body weight contributed to the relationship between canagliflozin and satisfaction change. CONCLUSIONS Canagliflozin improved indices of glycemic variability and was associated with improvement in treatment satisfaction versus placebo over 18 weeks among participants with type 1 diabetes. Although these data from this study demonstrate the potential benefits of canagliflozin in people with type 1 diabetes, canagliflozin is not approved for the treatment of type 1 diabetes and should not currently be used in people with type 1 diabetes.
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Affiliation(s)
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Anjun Cao
- Janssen Research & Development, LLC, Raritan, NJ
| | | | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
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Abstract
The kidney has a pivotal role in maintaining glucose homeostasis by using glucose as a metabolic fuel, by producing glucose through gluconeogenesis, and by reabsorbing all filtered glucose through the sodium-glucose cotransporters SGLT1 and SGLT2 located in the proximal tubule. In patients with diabetes, the maximum glucose reabsorptive capacity (TmG) of the kidney, as well as the threshold for glucose spillage into the urine, are elevated, contributing to the pathogenesis of hyperglycaemia. By reducing the TmG and, more importantly, the threshold of glucosuria, SGLT2 inhibitors enhance glucose excretion, leading to a reduction in fasting and postprandial plasma glucose levels and improvements in both insulin secretion and insulin sensitivity. The beneficial effects of SGLT2 inhibition extend beyond glycaemic control, however, with new studies demonstrating that inhibition of renal glucose reabsorption reduces blood pressure, ameliorates glucotoxicity and induces haemodynamic effects that lead to improved cardiovascular and renal outcomes in patients with type 2 diabetes mellitus. In this Review we examine the role of SGLT2 and SGLT1 in the regulation of renal glucose reabsorption in health and disease and the effect of SGLT2 inhibition on renal function, glucose homeostasis, and cardiovascular disease.
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Affiliation(s)
- Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Luke Norton
- Diabetes Division, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA
| | - Muhammad Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA
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Matthews DR, Zinman B, Tong C, Meininger G, Polidori D. Glycaemic efficacy of canagliflozin is largely independent of baseline β-cell function or insulin sensitivity. Diabet Med 2016; 33:1744-1747. [PMID: 26600115 DOI: 10.1111/dme.13033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - B Zinman
- Luenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C Tong
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - G Meininger
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - D Polidori
- Janssen Research & Development, LLC, San Diego, CA, USA
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Kim SR, Lee YH, Lee SG, Lee SH, Kang ES, Cha BS, Lee HC, Kim JH, Lee BW. Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes. Ann Lab Med 2016; 37:9-17. [PMID: 27834060 PMCID: PMC5107628 DOI: 10.3343/alm.2017.37.1.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/20/2016] [Accepted: 09/28/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND With the advent of sodium glucose co-transporter 2 inhibitors to control glucose and treat diabetes, laboratory data aided by either timed or spot glucose levels in the urine could be used as an alternative marker of drug response. The aim of this study was to assess the agreement between overnight urinary glucose excretion (UGE) and morning spot urinary glucose-to-creatinine ratio (UGCR). METHODS In this prospective cross-sectional study, we enrolled a total of 215 participants with either normal glucose tolerance (NGT), pre-diabetes, or type 2 diabetes mellitus (T2DM). To exclude external factors such as food intake and physical activity, urine samples collected overnight at an 8-hr interval and the first-voided morning spot urine were collected and compared. RESULTS The median values of overnight 8-hr UGE in participants with NGT (N=14), pre-diabetes (N=41), and T2DM (N=160) were 35.0 mg, 35.6 mg, and 653.4 mg, respectively. In participants with T2DM, the median values of overnight 8-hr UGCR and first-voided morning spot UGCR (M-UGCR) were 1.37 mg/mg and 0.16 mg/mg, respectively. Quantitative analyses using an intraclass correlation coefficient (ICC) demonstrated a good reliability of measurement of the overnight 8-hr UGCR and M-UGCR (ICC=0.943, P<0.001). The M-UGCR was also significantly related to the overnight 8-hr UGE (r=0.828, P<0.001). CONCLUSIONS M-UGCR and overnight 8-hr UGCR showed good agreement, suggesting that M-UGCR be used as a simple index for estimating overnight amounts of UGE in patients with T2DM.
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Affiliation(s)
- So Ra Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Diabetes Center, Severance Hospital, Seoul, Korea
| | - Yong Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Diabetes Center, Severance Hospital, Seoul, Korea
| | - Sang Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Hee Lee
- Diabetes Center, Severance Hospital, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Diabetes Center, Severance Hospital, Seoul, Korea
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Diabetes Center, Severance Hospital, Seoul, Korea
| | - Hyun Chul Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Diabetes Center, Severance Hospital, Seoul, Korea
| | - Jeong Ho Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Diabetes Center, Severance Hospital, Seoul, Korea.
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Xiong W, Xiao MY, Zhang M, Chang F. Efficacy and safety of canagliflozin in patients with type 2 diabetes: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95:e5473. [PMID: 27902600 PMCID: PMC5134817 DOI: 10.1097/md.0000000000005473] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Canagliflozin is a new SGLT2 inhibitor which has been approved as an adjunct to diet and exercise for the treatment of adults with type 2 diabetes (T2D) mellitus in more than 30 countries. To evaluate the efficacy and safety of canagliflozin in patients with T2D, we carried out a meta-analysis of phase III clinical trials to offer an additional evidence of the efficacy and safety of canagliflozin for evidence-based clinical practice, strictly restricting the treatment durations to 26 weeks (core period) and 52 weeks (extension period). METHODS Randomized controlled trials (RCTs) published in English were searched in PubMed, Embase, and the Cochrane Library database (before April 2016). The studies reporting the efficacy and safety of canagliflozin in patients with T2DM were considered. Two authors separately performed data extraction. The differences were discussed and resolved. Pooled weighted mean differences (WMDs) or relative risks and 95% confidence intervals (CIs) were computed by using either fixed- or random-effects models. RESULTS At the end of the selection process, 7 RCTs were collected and included in the present analysis. Placebo-subtracted WMDs (%) of glycosylated hemoglobin (HbA1c) were -0.63 (95% CI: -0.77, -0.49) and -0.80 (95% CI: -0.98, -0.62) for canagliflozin 100 and 300 mg, respectively, from baseline to week 26. At week 26, canagliflozin 100 and 300 mg significantly reduced the body weight from baseline when compared with that of placebo, with a WMD of -2.23 and -3.00 in percent changes (P < 0.001 for both). The fasting and postmeal glucose, blood pressure (BP), and triglycerides were also reduced. These reductions were sustained over 52 weeks but had no significant differences between the 100 and 300 mg doses. The overall safety of canagliflozin was good, with the exception of high incidence of genital mycotic infections and osmotic diuresis-related adverse events. CONCLUSION Canagliflozin was found to reduce HbA1c, fasting and postmeal glucose, body weight, BP, and triglycerides, and it was generally well tolerated in patients with T2DM.
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Mori K, Saito R, Nakamaru Y, Shimizu M, Yamazaki H. Physiologically based pharmacokinetic-pharmacodynamic modeling to predict concentrations and actions of sodium-dependent glucose transporter 2 inhibitor canagliflozin in human intestines and renal tubules. Biopharm Drug Dispos 2016; 37:491-506. [DOI: 10.1002/bdd.2040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/27/2016] [Accepted: 09/02/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Kazumi Mori
- Showa Pharmaceutical University; Machida Tokyo Japan
- Mitsubishi Tanabe Pharma Corporation; Toda Saitama Japan
| | - Ryuta Saito
- Showa Pharmaceutical University; Machida Tokyo Japan
- Mitsubishi Tanabe Pharma Corporation; Toda Saitama Japan
| | - Yoshinobu Nakamaru
- Showa Pharmaceutical University; Machida Tokyo Japan
- Mitsubishi Tanabe Pharma Corporation; Chuo-ku Tokyo Japan
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Schernthaner G, Lavalle-González FJ, Davidson JA, Jodon H, Vijapurkar U, Qiu R, Canovatchel W. Canagliflozin provides greater attainment of both HbA1c and body weight reduction versus sitagliptin in patients with type 2 diabetes. Postgrad Med 2016; 128:725-730. [DOI: 10.1080/00325481.2016.1210988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jaime A. Davidson
- Touchstone Diabetes Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Rong Qiu
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Prasanna Kumar KM, Mohan V, Sethi B, Gandhi P, Bantwal G, Xie J, Meininger G, Qiu R. Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus from India. Indian J Endocrinol Metab 2016; 20:372-380. [PMID: 27186557 PMCID: PMC4855968 DOI: 10.4103/2230-8210.179996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This post hoc analysis evaluated the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) from India. METHODS Changes from baseline in HbA1c, fasting plasma glucose (FPG), body weight, and blood pressure (BP) with canagliflozin 100 and 300 mg were evaluated in a subgroup of patients from India (n = 124) from 4 randomized, double-blind, placebo- and active-controlled, Phase 3 studies (N = 2313; Population 1). Safety was assessed based on adverse event (AE) reports in these patients and in a broader subgroup of patients from India (n = 1038) from 8 randomized, double-blind, placebo- and active-controlled, Phase 3 studies (N = 9439; Population 2). RESULTS Reductions in HbA1c with canagliflozin 100 and 300 mg were -0.74% and -0.88%, respectively, in patients from India, and -0.81% and -1.00%, respectively, in the 4 pooled Phase 3 studies. In the Indian subgroup, both canagliflozin doses provided reductions in FPG, body weight, and BP that were consistent with findings in the overall population. The incidence of overall AEs in patients from India was generally similar with canagliflozin 100 and 300 mg and noncanagliflozin. The AE profile in patients from India was generally similar to the overall population, with higher rates of genital mycotic infections and osmotic diuresis-related and volume depletion-related AEs with canagliflozin versus noncanagliflozin. CONCLUSION Canagliflozin provided glycemic control, body weight reduction, and was generally well tolerated in patients with T2DM from India.
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Affiliation(s)
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Pramod Gandhi
- Gandhi Research Institute, Nagpur, Maharashtra, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - John Xie
- Janssen Research and Development, LLC, Raritan, NJ, USA
| | | | - Rong Qiu
- Janssen Research and Development, LLC, Raritan, NJ, USA
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Peters AL, Henry RR, Thakkar P, Tong C, Alba M. Diabetic Ketoacidosis With Canagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, in Patients With Type 1 Diabetes. Diabetes Care 2016; 39:532-8. [PMID: 26989182 DOI: 10.2337/dc15-1995] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the incidence of serious adverse events (AEs) of diabetic ketoacidosis (DKA) with canagliflozin, a sodium-glucose cotransporter 2 inhibitor, as an add-on to insulin in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS In this 18-week, randomized, double-blind, phase 2 study, patients (N = 351; HbA1c 7.0-9.0% [53-75 mmol/mol]) on multiple daily insulin injections or continuous subcutaneous insulin infusion received canagliflozin 100 or 300 mg or placebo once daily. The incidence of ketone-related AEs, defined as any event from a prespecified list of preferred terms (i.e., acidosis, blood ketone body increased, blood ketone body present, DKA, diabetic ketoacidotic hyperglycemic coma, ketoacidosis, ketonemia, ketonuria, ketosis, metabolic acidosis, urine ketone body present), including serious AEs of DKA, was assessed based on AE reports. RESULTS At week 18, the incidence of any ketone-related AE with canagliflozin 100 and 300 mg was 5.1% (n = 6 of 117) and 9.4% (n = 11 of 117), respectively; no patients in the placebo group experienced a ketone-related AE. The incidence of serious AEs of DKA was 4.3% (n = 5 of 117) with canagliflozin 100 mg and 6.0% (n = 7 of 117) with canagliflozin 300 mg; all serious events occurred in the presence of circumstances that are known to potentially precipitate DKA (e.g., infection, insulin pump failure). Among the 12 patients with a serious AE of DKA, blood glucose levels ranged from 9.4 to >44.4 mmol/L (170 to >800 mg/dL). Baseline characteristics were generally similar in patients with and without a ketone-related AE. CONCLUSIONS Canagliflozin was associated with an increased incidence of serious AEs of DKA in patients with type 1 diabetes inadequately controlled with insulin. Mitigation strategies are needed for use in future clinical trials to reduce the risk of DKA with canagliflozin treatment in patients with type 1 diabetes.
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Affiliation(s)
- Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Robert R Henry
- Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA University of California, San Diego, La Jolla, CA
| | | | - Cindy Tong
- Janssen Research & Development, LLC, Raritan, NJ
| | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
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Gilbert RE, Weir MR, Fioretto P, Law G, Desai M, Kline I, Shaw W, Meininger G. Impact of Age and Estimated Glomerular Filtration Rate on the Glycemic Efficacy and Safety of Canagliflozin: A Pooled Analysis of Clinical Studies. Can J Diabetes 2016; 40:247-57. [PMID: 27052454 DOI: 10.1016/j.jcjd.2015.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/28/2015] [Accepted: 11/10/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Reduced efficacy has been reported in the elderly; it may be a consequence of an age-dependent decline in estimated glomerular filtration rate (eGFR) rather than ageing per se. We sought to determine the impact of these 2 parameters, as well as sex and baseline body mass index (BMI), on the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in people with type 2 diabetes. METHODS Data were pooled from 6 randomized, double-blind, placebo-controlled studies (18 or 26 weeks; N=4053). Changes in glycated hemoglobin (A1C) and systolic blood pressure (BP) from baseline with canagliflozin 100 mg and 300 mg and placebo were evaluated in subgroups by sex, baseline BMI, baseline age and baseline eGFR. Safety was assessed by reports of adverse events. RESULTS Placebo-subtracted reductions in A1C with canagliflozin 100 mg and 300 mg were similar in men and women. A1C reductions with canagliflozin were seen across BMI subgroups and in participants aged <65 years and ≥65 years. Significantly greater placebo-subtracted reductions in A1C were seen with both canagliflozin doses in participants with higher baseline eGFR (≥90 mL/min/1.73 m(2)). Reductions in systolic BP were seen with canagliflozin across subgroups of sex, BMI, age and eGFR. A1C reductions with canagliflozin were similar for participants aged <65 or ≥65 years who had baseline eGFR ≥60 mL/min/1.73 m(2) and were smaller in older than in younger participants with baseline eGFR 45 to <60 mL/min/1.73 m(2). The overall incidence of adverse events was similar across treatment groups regardless of sex, baseline BMI, baseline age or baseline eGFR. CONCLUSIONS Canagliflozin improved glycemic control, reduced BP and was generally well tolerated in people with type 2 diabetes across a range of ages, BMIs and renal functions.
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Affiliation(s)
- Richard E Gilbert
- Keenan Research Centre, Li KaShing Knowledge Institute of St. Michael's Hospital, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Canada.
| | - Matthew R Weir
- University of Maryland Medical Center, Baltimore, Maryland, United States of America
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Gordon Law
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Mehul Desai
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Irina Kline
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Wayne Shaw
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Gary Meininger
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
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Mondick J, Riggs M, Sasaki T, Sarashina A, Broedl UC, Retlich S. Mixed-effects modelling to quantify the effect of empagliflozin on renal glucose reabsorption in patients with type 2 diabetes. Diabetes Obes Metab 2016; 18:241-8. [PMID: 26511213 DOI: 10.1111/dom.12597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 12/24/2022]
Abstract
AIMS To quantify the effect of the sodium-glucose co-transporter 2 inhibitor, empagliflozin, on renal glucose reabsorption in patients with type 2 diabetes, and to evaluate covariate effects, using a mechanistic population pharmacokinetic-pharmacodynamic (PK-PD) model. METHODS Four phase I/II trials were used for model development. Empagliflozin's PK characteristics were characterized by a two-compartmental model with sequential zero- and first-order absorption. Urinary glucose excretion (UGE) was described as dependent on renal glucose filtration and reabsorption; splay of the glucose reabsorption/excretion curves was considered. The modelling assumed that empagliflozin lowers the maximum renal glucose reabsorption capacity and, thereby, the renal threshold for glucose (RTg). Covariate effects were investigated using a full covariate modelling approach, emphasizing parameter estimation. RESULTS The PK-PD model provided a reasonable description of the PK characteristics of empagliflozin and its effects on UGE across a range of renal function levels. Its parameters are consistent with reported values for renal physiology. Using this model, the effect of empagliflozin on renal glucose reabsorption was quantified. Steady-state empagliflozin doses (1, 5, 10 and 25 mg) reduced RTg from 12.5 mmol/L [95% confidence interval (CI) 12.0, 13.1] to 5.66 (95% CI 4.62, 6.72), 3.01 (95% CI 2.33, 3.69), 2.53 (95% CI 1.83, 3.14) and 2.21 (95% CI 1.47, 2.84) mg/dl, respectively. Covariate analysis showed the effect of empagliflozin on UGE was not influenced, to a clinically relevant extent, by sex, age or race. CONCLUSIONS A method for characterizing renal glucose reabsorption was developed that does not require complex glucose clamp experiments. These analyses indicate that empagliflozin provided concentration-dependent RTg reductions, with 10 and 25 mg providing near-maximum RTg-lowering.
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Affiliation(s)
- J Mondick
- Metrum Research Group, Tariffville, CT, USA
| | - M Riggs
- Metrum Research Group, Tariffville, CT, USA
| | - T Sasaki
- Nippon Boehringer Ingelheim Co. Ltd, Hyogo, Japan
| | - A Sarashina
- Nippon Boehringer Ingelheim Co. Ltd, Hyogo, Japan
| | - U C Broedl
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - S Retlich
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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Sinclair AJ, Bode B, Harris S, Vijapurkar U, Shaw W, Desai M, Meininger G. Efficacy and Safety of Canagliflozin in Individuals Aged 75 and Older with Type 2 Diabetes Mellitus: A Pooled Analysis. J Am Geriatr Soc 2016; 64:543-52. [PMID: 27000327 PMCID: PMC4819884 DOI: 10.1111/jgs.14028] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM), in individuals younger than 75 and those aged 75 and older. DESIGN Randomized Phase 3 studies. SETTING International study centers. PARTICIPANTS Adults with T2DM. MEASUREMENTS Changes from baseline in glycosylated hemoglobin (HbA1c ), fasting plasma glucose (FPG), blood pressure (BP), and body weight were measured. Efficacy was evaluated using pooled data from six randomized, double-blind, placebo-controlled studies (N = 4,158; n = 3,975 aged <75, n = 183 aged ≥75). Safety was assessed based on adverse event (AE) reports from eight randomized, double-blind, placebo- and active-controlled studies (N = 9,439; n = 8,949 aged <75, n = 490 aged ≥75). RESULTS Canagliflozin 100 and 300 mg were associated with placebo-subtracted mean reductions in HbA1c in participants younger than 75 (-0.69% and -0.85%, respectively) and aged 75 and older (-0.65% and -0.55%, respectively). Dose-related reductions in FPG, body weight, and BP were seen with canagliflozin 100 and 300 mg in participants in both age groups. Overall AE incidence was 67.1% with canagliflozin 100 mg, 68.6% with canagliflozin 300 mg, and 65.9% with non-canagliflozin (pooled group of comparators in all studies) in participants younger than 75, and 72.4%, 79.1%, and 72.3%, respectively, in those aged 75 and older, with a similar safety profile in both groups. The incidence of volume depletion-related AEs was 2.2%, 3.1%, and 1.4% in participants younger than 75 with canagliflozin 100 and 300 mg and non-canagliflozin, respectively, and 4.9%, 8.7%, and 2.6%, respectively, in those aged 75 and older. CONCLUSION Canagliflozin improved glycemic control, body weight, and BP in participants aged 75 and older. The overall incidence of AEs was high across treatment groups in participants aged 75 and older and higher than in those younger than 75. The safety profile of canagliflozin was generally similar in both age groups, with a higher incidence of AEs related to volume depletion observed with canagliflozin in participants aged 75 and older than in those younger than 75. These findings support canagliflozin, starting with the 100-mg dose, as an effective therapeutic option for older adults with T2DM.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older PeopleDiabetes Frail, Gerrards CrossBucksUK
| | - Bruce Bode
- Atlanta Diabetes AssociatesAtlantaGeorgia
| | | | | | - Wayne Shaw
- Janssen Research & Development, LLCRaritanNew Jersey
| | - Mehul Desai
- Janssen Research & Development, LLCRaritanNew Jersey
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Bilezikian JP, Watts NB, Usiskin K, Polidori D, Fung A, Sullivan D, Rosenthal N. Evaluation of Bone Mineral Density and Bone Biomarkers in Patients With Type 2 Diabetes Treated With Canagliflozin. J Clin Endocrinol Metab 2016; 101:44-51. [PMID: 26580234 PMCID: PMC4701848 DOI: 10.1210/jc.2015-1860] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM). OBJECTIVE Our objective is to describe the effects of canagliflozin on bone mineral density (BMD) and bone biomarkers in patients with T2DM. DESIGN This was a randomized study, consisting of a 26-week, double-blind, placebo-controlled period and a 78-week, double-blind, placebo-controlled extension. SETTING This study was undertaken in 90 centers in 17 countries. PATIENTS Patients were aged 55-80 years (N = 716) and whose T2DM was inadequately controlled on a stable antihyperglycemic regimen. INTERVENTIONS Canagliflozin 100 or 300 mg or placebo were administered once daily. OUTCOME AND MEASURES BMD was assessed using dual-energy x-ray absorptiometry at weeks 26, 52, and 104. Bone strength was assessed using quantitative computed tomography and finite element analysis at week 52. Serum collagen type 1 β-carboxy-telopeptide, osteocalcin, and estradiol were assessed at weeks 26 and 52. RESULTS Canagliflozin doses of 100 and 300 mg were associated with a decrease in total hip BMD over 104 weeks, (placebo-subtracted changes: -0.9% and -1.2%, respectively), but not at other sites measured (femoral neck, lumbar spine, or distal forearm). No meaningful changes in bone strength were observed. At week 52, canagliflozin was associated with an increase in collagen type 1 β-carboxy-telopeptide that was significantly correlated with a reduction in body weight, an increase in osteocalcin, and, in women, a decrease in estradiol. CONCLUSIONS In older patients with T2DM, canagliflozin showed small but significant reductions in total hip BMD and increases in bone formation and resorption biomarkers, due at least in part to weight loss.
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Affiliation(s)
- John P Bilezikian
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
| | - Nelson B Watts
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
| | - Keith Usiskin
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
| | - David Polidori
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
| | - Albert Fung
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
| | - Daniel Sullivan
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
| | - Norm Rosenthal
- Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236; Janssen Research & Development, LLC (K.U., A.F., D.S., N.R.), Raritan, New Jersey 08869; and Janssen Research & Development, LLC (D.P.), San Diego, California 92121
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Watts NB, Bilezikian JP, Usiskin K, Edwards R, Desai M, Law G, Meininger G. Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab 2016; 101:157-66. [PMID: 26580237 PMCID: PMC4701850 DOI: 10.1210/jc.2015-3167] [Citation(s) in RCA: 283] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM). OBJECTIVE The purpose of this study was to describe the effects of canagliflozin on bone fracture risk. DESIGN AND SETTING This was a randomized phase 3 study in patients with T2DM. PATIENTS AND INTERVENTIONS Canagliflozin doses of 100 and 300 mg were evaluated in the overall population of patients from 9 placebo- and active-controlled studies (N = 10 194), as well as in separate analyses of a single trial enriched with patients with a prior history/risk of cardiovascular disease (ie, the CANagliflozin cardioVascular Assessment Study [CANVAS]; N = 4327) and a pooled population of 8 non-CANVAS studies (N = 5867). OUTCOME MEASURES The incidence of adjudicated fracture adverse events (AEs), fall-related AEs, and volume depletion-related AEs was assessed. RESULTS The incidence of fractures was similar with canagliflozin (1.7%) and noncanagliflozin (1.5%) in the pooled non-CANVAS studies. In CANVAS, a significant increase in fractures was seen with canagliflozin (4.0%) vs placebo (2.6%) that was balanced between the upper and lower limbs. The incidence of fractures was higher with canagliflozin (2.7%) vs noncanagliflozin (1.9%) in the overall population, which was driven by the increase of fractures in CANVAS. The incidence of reported fall-related AEs was low, but significantly higher with canagliflozin in CANVAS, potentially related to volume depletion-related AEs, but not significantly different in the pooled non-CANVAS studies and the overall population. CONCLUSIONS Fracture risk was increased with canagliflozin treatment, driven by CANVAS patients, who were older, with a prior history/risk of cardiovascular disease, and with lower baseline estimated glomerular filtration rate and higher baseline diuretic use. The increase in fractures may be mediated by falls; however, the cause of increased fracture risk with canagliflozin is unknown.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
| | - John P Bilezikian
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
| | - Keith Usiskin
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
| | - Robert Edwards
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
| | - Mehul Desai
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
| | - Gordon Law
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
| | - Gary Meininger
- Mercy Health Osteoporosis and Bone Health Services Clinical Trial Center (N.B.W.), Cincinnati, Ohio 45236; Division of Endocrinology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York, New York 10032; and Janssen Research & Development, LLC (K.U., R.E., M.D., G.L., G.M.), Raritan, New Jersey 08869
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Lavalle-González FJ, Eliaschewitz FG, Cerdas S, Chacon MDP, Tong C, Alba M. Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus from Latin America. Curr Med Res Opin 2016; 32:427-39. [PMID: 26579834 DOI: 10.1185/03007995.2015.1121865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This post hoc analysis evaluated the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) from Latin America. RESEARCH DESIGN AND METHODS Analyses were performed in subgroups of patients from Latin America based on data from three individual, 26-week, placebo-controlled studies of canagliflozin (monotherapy [n = 116/584], add-on to metformin [n = 199/918], and add-on to metformin plus sulfonylurea [n = 76/469]) and three individual, 52-week, active-controlled studies of canagliflozin (add-on to metformin versus sitagliptin [n = 240/1101], add-on to metformin versus glimepiride [n = 155/1450], and add-on to metformin plus sulfonylurea versus sitagliptin [n = 156/755]). MAIN OUTCOME MEASURES Changes from baseline in HbA1c, body weight, and systolic blood pressure (BP) with canagliflozin 100 and 300 mg versus placebo or active comparator (i.e., sitagliptin or glimepiride) were evaluated in the overall study populations and Latin American subgroups. Safety was assessed based on adverse event (AE) reports. RESULTS Canagliflozin 100 and 300 mg provided reductions in HbA1c, body weight, and systolic BP across studies in patients from Latin America that were generally similar to those seen in the overall populations of patients with T2DM. The AE profile in patients from Latin America was equivalent to that in the overall populations; higher rates of genital mycotic infections and osmotic diuresis-related AEs were seen with canagliflozin versus comparators. Limitations of this study include the post hoc analysis of data and the small sample size of patients from Latin America. CONCLUSION Canagliflozin improved glycemic control, reduced body weight and systolic BP, and was generally well tolerated in patients with T2DM from Latin America. CLINICAL TRIAL REGISTRATION NCT01081834; NCT01106677; NCT01106625; NCT00968812; NCT01137812.
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Affiliation(s)
| | - Freddy G Eliaschewitz
- b b Hospital Israelita Albert Einstein and CPClin Clinical Research Center , São Paulo , Brazil
| | - Sonia Cerdas
- c c Hospital Cima, Centro de Investigacíon Clínica San Agustín , San José , Costa Rica
| | | | - Cindy Tong
- e e Janssen Research & Development, LLC , Raritan, NJ , USA
| | - Maria Alba
- e e Janssen Research & Development, LLC , Raritan, NJ , USA
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Devineni D, Polidori D, Curtin C, Stieltjes H, Tian H, Wajs E. Single-dose Pharmacokinetics and Pharmacodynamics of Canagliflozin, a Selective Inhibitor of Sodium Glucose Cotransporter 2, in Healthy Indian Participants. Clin Ther 2016; 38:89-98.e1. [DOI: 10.1016/j.clinthera.2015.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/30/2015] [Accepted: 11/12/2015] [Indexed: 12/26/2022]
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Mudaliar S, Polidori D, Zambrowicz B, Henry RR. Sodium-Glucose Cotransporter Inhibitors: Effects on Renal and Intestinal Glucose Transport: From Bench to Bedside. Diabetes Care 2015; 38:2344-53. [PMID: 26604280 DOI: 10.2337/dc15-0642] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Type 2 diabetes is a chronic disease with disabling micro- and macrovascular complications that lead to excessive morbidity and premature mortality. It affects hundreds of millions of people and imposes an undue economic burden on populations across the world. Although insulin resistance and insulin secretory defects play a major role in the pathogenesis of hyperglycemia, several other metabolic defects contribute to the initiation/worsening of the diabetic state. Prominent among these is increased renal glucose reabsorption, which is maladaptive in patients with diabetes. Instead of an increase in renal glucose excretion, which could ameliorate hyperglycemia, there is an increase in renal glucose reabsorption, which helps sustain hyperglycemia in patients with diabetes. The sodium-glucose cotransporter (SGLT) 2 inhibitors are novel antidiabetes agents that inhibit renal glucose reabsorption and promote glucosuria, thereby leading to reductions in plasma glucose concentrations. In this article, we review the long journey from the discovery of the glucosuric agent phlorizin in the bark of the apple tree through the animal and human studies that led to the development of the current generation of SGLT2 inhibitors.
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Affiliation(s)
- Sunder Mudaliar
- Veterans Affairs Medical Center, San Diego, CA School of Medicine, University of California, San Diego, San Diego, CA
| | | | | | - Robert R Henry
- Veterans Affairs Medical Center, San Diego, CA School of Medicine, University of California, San Diego, San Diego, CA
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Henry RR, Thakkar P, Tong C, Polidori D, Alba M. Efficacy and Safety of Canagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, as Add-on to Insulin in Patients With Type 1 Diabetes. Diabetes Care 2015; 38:2258-65. [PMID: 26486192 DOI: 10.2337/dc15-1730] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/16/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed the efficacy and safety of canagliflozin, a sodium-glucose cotransporter 2 inhibitor, as add-on to insulin in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS This 18-week, double-blind, phase 2 study randomized 351 patients (HbA1c 7.0-9.0% [53-75 mmol/mol]) on multiple daily insulin injections or continuous subcutaneous insulin infusion to canagliflozin 100 or 300 mg or placebo. The primary end point was the proportion of patients achieving at week 18 both HbA1c reduction from baseline of ≥0.4% (≥4.4 mmol/mol) and no increase in body weight. Other end points included changes in HbA1c, body weight, and insulin dose, as well as hypoglycemia incidence. Safety was assessed by adverse event (AE) reports. RESULTS More patients had both HbA1c reduction ≥0.4% and no increase in body weight with canagliflozin 100 and 300 mg versus placebo at week 18 (36.9%, 41.4%, 14.5%, respectively; P < 0.001). Both canagliflozin doses provided reductions in HbA1c, body weight, and insulin dose versus placebo over 18 weeks. The incidence of hypoglycemia was similar across groups; severe hypoglycemia rates were low (1.7-6.8%). Overall incidence of AEs was 55.6%, 67.5%, and 54.7% with canagliflozin 100 and 300 mg and placebo; discontinuation rates were low (0.9-1.3%). Increased incidence of ketone-related AEs (5.1%, 9.4%, 0%), including the specific AE of diabetic ketoacidosis (DKA) (4.3%, 6.0%, 0%), was seen with canagliflozin 100 and 300 mg versus placebo. CONCLUSIONS Canagliflozin provided reductions in HbA1c, body weight, and insulin dose with no increase in hypoglycemia, but increased rates of ketone-related AEs, including DKA, in adults with type 1 diabetes inadequately controlled with insulin.
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Affiliation(s)
- Robert R Henry
- Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA University of California, San Diego, La Jolla, CA
| | | | - Cindy Tong
- Janssen Research & Development, LLC, Raritan, NJ
| | | | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
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Leiter LA, Forst T, Polidori D, Balis DA, Xie J, Sha S. Effect of canagliflozin on liver function tests in patients with type 2 diabetes. Diabetes Metab. 2016;42:25-32. [PMID: 26575250 DOI: 10.1016/j.diabet.2015.10.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/24/2015] [Accepted: 10/05/2015] [Indexed: 12/29/2022]
Abstract
AIMS To report changes in liver function tests observed with canagliflozin, a sodium glucose co-transporter 2 inhibitor, across phase 3 studies in patients with type 2 diabetes, and to examine the relationship between changes in liver function tests and the weight loss and glycaemic improvements observed with canagliflozin. METHODS Data were pooled from four 26-week, placebo-controlled studies of canagliflozin 100 and 300mg (n=2313) and two 52-week, active-controlled studies of canagliflozin 300mg versus sitagliptin 100mg (n=1488). Analysis of covariance was performed to determine the contribution of changes in body weight and HbA1c to the changes in liver function tests. RESULTS Reductions in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transferase, and increases in bilirubin were seen with canagliflozin 100 and 300mg versus placebo (nominal P<0.001 for alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase [both doses]; P<0.001 for alkaline phosphatase and P=0.015 for bilirubin [canagliflozin 300mg only]) at week 26 and with canagliflozin 300mg versus sitagliptin 100mg (nominal P<0.001 for alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase and bilirubin, and P<0.01 for alkaline phosphatase) at week 52. Few patients met predefined limits of change criteria for liver function tests, and none met Hy's law criteria. In both populations, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase reductions were fully explained by HbA1c and body weight reductions. CONCLUSIONS Canagliflozin provided improvements in liver function tests versus either placebo or sitagliptin treatments that were fully explained by the combined effects of HbA1c and body weight reductions with canagliflozin.
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Abstract
OBJECTIVE To evaluate the efficacy and safety of canagliflozin in combination therapy among patients with type 2 diabetes mellitus with inadequate glycemic control. METHODS Two review authors independently searched for the relevant randomized controlled clinical trials from the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, IndMed, LILACS, and clinical trials registry www.clinicaltrials.gov. Primary outcomes for this review included: change in hemoglobin A1c (HbA1c) levels, fasting plasma glucose (FPG) levels and risk of occurrence of genital mycotic infections at 26 weeks. We combined results using mean difference (MD) for continuous data, and risk ratio (RR) for dichotomous data. RESULTS Of the 124 identified reports, five RCTs with 3565 participants were eligible for the meta-analysis. All included studies had compared canagliflozin 100 mg and 300 mg once daily with placebo or sitagliptin 100 mg once daily. We judged that most of the studies had low risk of bias or unclear risk of bias in five major domains. Canagliflozin 300 mg once daily led to a significant decrease in HbA1c levels (IV Fixed -0.77, 95% CI [-0.90, -0.64] P < 0.00001) and FPG levels (IV Fixed -2.08; 95% CI [-2.32, -1.84], P <0.00001), body weight, systolic blood pressure and triglyceride levels after 26 weeks as compared to placebo. There was a also a significant difference in the efficacy of canagliflozin 300 mg and sitagliptin 100 mg once daily in favour of canagliflozin. Both doses of canagliflozin led to genital mycotic infections among males and females, urinary tract infections, pollakiuria, polyuria and postural dizziness. CONCLUSIONS Canagliflozin significantly decreases HbA1c and FPG levels and body weight as compared to placebo among patients with inadequate glycemic control with an earlier regime of glucose lowering agents. Long term safety studies are required to evaluate the incidence of adverse events.
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Affiliation(s)
- Kirandeep Kaur
- Department of Pharmacology, Dayanad Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Amit Dang
- Marksman Healthcare, Navi Mumbai, Maharashtra, India
| | - Gurpreet Kaur
- Department of Pharmacology, Dayanad Medical College and Hospital, Ludhiana, Punjab, India
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Nakamura Y, Nagai Y, Terashima Y, Nishine A, Ishii S, Kato H, Ohta A, Tanaka Y. Better response to the SGLT2 inhibitor dapagliflozin in young adults with type 2 diabetes. Expert Opin Pharmacother 2015; 16:2553-9. [PMID: 26479189 DOI: 10.1517/14656566.2015.1101450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM A variation of the response to Sodium glucose co-transporter 2 (SGLT2) inhibitors with age has not been investigated in patients with diabetes. The aim of this study was to assess renal threshold of glucose (RTg) before and after administration of an SGLT2 inhibitor in young adult patients (≤40 years) and older adult patients (>40 years) with type 2 diabetes (T2DM). SUBJECTS AND METHODS Twenty Japanese patients with T2DM were enrolled. Baseline data were obtained on the first day and dapagliflozin (5 mg) was administered at 6:00 on the second day. Glucose excursions were assessed by continuous glucose monitoring and urine samples were collected every hour during the daytime (7:00 to 15:00) on both days. RTg was estimated from the regression line of the scatter plot of the hourly mean glucose concentrations. RESULTS After a single dose of dapagliflozin, RTg decreased from 121.5 to 6.1 mg/dl in the young adult group and from 151.0 mg/dl to -15.8 mg/dl in the older group. After dapagliflozin, the slope of the regression line was significantly steeper in the young adult group. CONCLUSION Dapagliflozin was more effective in young patients because they showed a larger response of urinary glucose excretion.
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Affiliation(s)
- Yuta Nakamura
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Yoshio Nagai
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Yuko Terashima
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Ami Nishine
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Satoshi Ishii
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Hiroyuki Kato
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Akio Ohta
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
| | - Yasushi Tanaka
- a Division of Metabolism and Endocrinology, Department of Internal Medicine , St. Marianna University School of Medicine , 2-16-1, Sugao, Miyamae-ku, Kawasaki , Kanagawa 216-8511 , Japan
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Iijima H, Kifuji T, Maruyama N, Inagaki N. Pharmacokinetics, Pharmacodynamics, and Safety of Canagliflozin in Japanese Patients with Type 2 Diabetes Mellitus. Adv Ther 2015; 32:768-82. [PMID: 26280756 PMCID: PMC4569680 DOI: 10.1007/s12325-015-0234-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Indexed: 01/29/2023]
Abstract
Introduction Canagliflozin is a sodium glucose co-transporter 2 inhibitor approved worldwide for the treatment of patients with type 2 diabetes mellitus (T2DM). The present study evaluated pharmacokinetics, pharmacodynamics, and safety of canagliflozin in Japanese patients with T2DM. Methods Canagliflozin, at doses of 25, 100, 200, or 400 mg, was administered as a single dose and, after a washout of 1 day, in repeated doses for 14 consecutive days to 61 subjects in a randomized, double-blind, placebo-controlled study. Plasma concentrations of canagliflozin and urinary glucose excretion (UGE) were measured, and renal threshold for glucose excretion (RTG) was calculated. Safety was evaluated on the basis of adverse event (AE) reports, blood and urine laboratory parameters, and vital signs. Results Plasma canagliflozin maximum concentration and area under the concentration–time curve (AUC) values increased in a dose-dependent manner with the time to maximum concentration (tmax) of 1.0 h and elimination half-life (t1/2) of 10.22–13.26 h on Day 1. No significant changes in tmax and t1/2 were observed after multiple-dose administration. The linearity factors, as calculated from the ratios of AUC0–24h on Day 16 to AUC0–∞ on Day 1, were close to 1 in all canagliflozin groups. Canagliflozin increased UGE0–24h (80–110 g/day with canagliflozin ≥100 mg) and decreased RTG from the first day of treatment; these effects were sustained during the entire period of multiple administration. No significant AEs were noted. Urine volume was slightly increased on Day 1, but subsequent changes after repeated doses for 14 days were small. Urinary sodium tended to be higher in the early treatment period, whereas no particular change was observed in serum osmolality and hematocrit. Conclusion Canagliflozin increased UGE, decreased RTG, and was well tolerated throughout the entire period of multiple administrations in Japanese patients with T2DM. Funding Mitsubishi Tanabe Pharma Corporation. Trial registration ClinicalTrials.gov#NCT00707954. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0234-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroaki Iijima
- Medical Affairs Department, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan.
| | - Takayuki Kifuji
- Development Division, Clinical Pharmacology Department, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Nobuko Maruyama
- Development Division, Clinical Research Department II, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Chen X, Hu P, Vaccaro N, Polidori D, Curtin CR, Stieltjes H, Sha S, Weiner S, Devineni D. Pharmacokinetics, Pharmacodynamics, and Safety of Single-Dose Canagliflozin in Healthy Chinese Subjects. Clin Ther 2015; 37:1483-1492.e1. [DOI: 10.1016/j.clinthera.2015.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/11/2015] [Accepted: 04/30/2015] [Indexed: 01/07/2023]
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Devineni D, Polidori D. Clinical Pharmacokinetic, Pharmacodynamic, and Drug–Drug Interaction Profile of Canagliflozin, a Sodium-Glucose Co-transporter 2 Inhibitor. Clin Pharmacokinet 2015; 54:1027-41. [DOI: 10.1007/s40262-015-0285-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Aires I, Fila M, Polidori D, Santos AR, Costa AB, Calado J. Determination of the renal threshold for glucose excretion in Familial Renal Glucosuria. Nephron Clin Pract 2015; 129:300-4. [PMID: 25896487 DOI: 10.1159/000381677] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Familial Renal Glucosuria (FRG) is characterized by the presence of persistent isolated glucosuria in the absence of hyperglycemia. Mutations in SLC5A2, the gene coding for the sodium-glucose co-transporter 2 (SGLT2), are responsible for FRG. Phenotype/genotype correlations in FRG have mostly relied on the quantification of Urinary Glucose Excretion (UGE), which is dependent on both the filtered glucose load and the renal glucose reabsorptive capacity. In the current work, the renal threshold for glucose excretion (RTG) was determined in an FRG cohort, with the purpose of characterizing the impact of SGLT2 mutations on renal glucose transport. METHODS From January to December of 2013, eight FRG individuals with identified SLC5A2 mutations were enrolled. Patients were given a Mixed-Meal Tolerance Test during which blood glucose and UGE were measured over a 4 h period and the data was used to calculate RTG, according to a recently validated protocol. RESULTS In patients with homozygous mutations, RTG values were very low, with a mean (SD) of 0.95 (1.17) mmol/l, compared to commonly reported values of approximately 10-11.1 mmol/l in healthy subjects. In subjects with heterozygous mutations, mean (SD) RTG values were 4.91 (1.23) mmol/l, which are approximately one-half of the values in subjects without mutations. CONCLUSIONS In FRG, mutations in SLC5A2 lead to reductions in RTG and increases in UGE. Because determination of RTG is not influenced by the filtered glucose load, the calculated RTG values provide a more refined measure of the impact of mutations on renal glucose transport than can be obtained from UGE alone.
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Affiliation(s)
- Inês Aires
- Department of Nephrology, Hospital de Curry Cabral - CHLC, Lisbon, Portugal
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Wilding JPH, Blonde L, Leiter LA, Cerdas S, Tong C, Yee J, Meininger G. Efficacy and safety of canagliflozin by baseline HbA1c and known duration of type 2 diabetes mellitus. J Diabetes Complications 2015; 29:438-44. [PMID: 25660137 DOI: 10.1016/j.jdiacomp.2014.12.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 02/01/2023]
Abstract
AIMS Canagliflozin, a sodium glucose co-transporter 2 inhibitor, has demonstrated glycemic improvements across studies of patients with type 2 diabetes mellitus (T2DM). The impact of canagliflozin on HbA1c lowering was assessed by baseline HbA1c and known duration of T2DM. METHODS This post hoc analysis pooled data from patients with T2DM enrolled in four 26-week, placebo-controlled, Phase 3 studies of canagliflozin (N=2313). Change in HbA1c from baseline to Week 26 was assessed in the overall population and in subgroups by baseline HbA1c (<8.0%, 8.0%-<9.0%, and ≥9.0%) and known duration of T2DM (<5 years, 5-<10 years, and ≥10 years). RESULTS Relative to placebo, canagliflozin 100 and 300 mg provided greater HbA1c reductions in the overall population. Progressively larger placebo-subtracted reductions in HbA1c with canagliflozin 100 and 300 mg were seen with increasing baseline HbA1c. HbA1c reductions were similar across subgroups based on known duration of T2DM. Both canagliflozin doses were generally well tolerated across subgroups, with a safety and tolerability profile consistent with that seen in Phase 3 studies. CONCLUSIONS Canagliflozin provided glycemic improvements in patients with T2DM across a range of baseline HbA1c and known duration of T2DM.
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Affiliation(s)
- John P H Wilding
- Department of Obesity and Endocrinology, University of Liverpool, Liverpool, United Kingdom.
| | - Lawrence Blonde
- Department of Endocrinology, Diabetes, and Metabolic Diseases, Ochsner Medical Center, New Orleans, LA, USA
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital; Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada
| | - Sonia Cerdas
- Hospital Cima, Centro de Investigacíon Clínica San Agustín, San José, Costa Rica
| | - Cindy Tong
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Nicolle LE, Capuano G, Fung A, Usiskin K. Urinary Tract Infection in Randomized Phase III Studies of Canagliflozin, a Sodium Glucose Co-Transporter 2 Inhibitor. Postgrad Med 2015; 126:7-17. [DOI: 10.3810/pgm.2014.01.2720] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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