Diabetes Monotherapies versus Metformin-Based Combination Therapy for the Treatment of Type 2 Diabetes

Combined administration of gallic acid and glibenclamide mitigate systemic complication and histological changes in the cornea of diabetic rats induced with streptozotocin

PURPOSE

To determine the effect of gallic acid or its combination with glibenclamide on some biochemical markers and histology of the cornea of streptozotocin (STZ) induced diabetic rats.

METHODS

Following induction of diabetes, 24 male albino rats were divided into four groups of six rats each. Groups 1 and 2 (control and diabetic) received rat pellets and distilled water; group 3 (gallic acid) received rat pellets and gallic acid (10 mg/kg, orally) dissolved in the distilled water; and group 4 (gallic acid + glibenclamide) received rat pellets, gallic acid (10 mg/kg, orally), and glibenclamide (5 mg/kg, orally) dissolved in the distilled water. The treatments were administered for three months after which the rats were sacrificed after an overnight fast. Blood and sera were collected for the determination of biochemical parameters, while their eyes were excised for histology.

RESULTS

STZ administration to the rats induced insulin resistance, hyperglycemia, microprotenuria, loss of weight, oxidative stress, inflammation, and alteration of their cornea histology, which was abolished following supplementation with gallic acid or its combination with glibenclamide.

CONCLUSIONS

The study showed the potentials of gallic acid and glibenclamide in mitigating systemic complication and histological changes in the cornea of diabetic rats induced with STZ.

Cardiovascular and Renal Outcomes with SGLT-2 inhibitors and DPP-4 inhibitors Combination Therapy: A Meta-analysis of Randomized Cardiovascular Outcome Trials

OBJECTIVE

The cardiovascular (CV) and renal benefits of SGLT-2 inhibitors (SGLT2i) in people with type 2 diabetes (T2D) are well known. However, similar beneficial effects of SGLT2i in combination with DPP-4 inhibitors (DPP4i) are not known. It is of interest to explore a trial-level meta-analysis to find out this knowledge gap.

METHODS

A literature search was carried out in PubMed and Embase databases until January 31, 2023. All CV outcome trials (CVOTs) reporting the CV and renal outcomes of SGLT2i with or without background DPP4i therapy against the placebo were retrieved. A meta-analysis was subsequently conducted by applying the inverse variance-weighted averages of pooled logarithmic hazard ratio using random effects analysis, primarily.

RESULTS

This meta-analysis showed that the beneficial three-point major adverse cardiovascular events (3P-MACE) composite (three CVOTs; N = 32,418), the composite of CV death or heart failure hospitalization (hHF) (four CVOTs; N = 37,687), hHF (three CVOTs; N = 27,545), CV death (four CVOTs; N = 34,565), and renal outcomes (two CVOTs; N = 25,406) with SGLT2i are similar with or without background DPP4i therapy against the placebo (P_{heterogeneity} = 0.71, 0.07, 0.87, 0.72, and 0.25; respectively). However, against the placebo, the summary estimates for 3P-MACE composite, hHF, and renal outcomes were stronger with SGLT2i alone whilst the summary estimates for CV death or hHF composite were larger with SGLT2i with background DPP4i therapy.

CONCLUSION

Beneficial CV and renal effects of SGLT2i are similar against placebo regardless of background DPP4i therapy.

The influence of SLC22A3 rs543159 and rs1317652 genetic variants on metformin therapeutic efficacy in newly diagnosed patients with type 2 diabetes mellitus: 25 weeks follow-up study

BACKGROUND AND AIMS

Among anti-diabetic medications, metformin has been proven to be the preferred initial pharmacologic agent for type 2 diabetes mellitus (T2DM) treatment. Despite its safety and efficacy, the response to metformin varies between individuals. Genetic variations, especially within genes involved in pharmacokinetics and pharmacodynamics of metformin (e.g SLC22A3), have been suggested to be responsible for the observed inter-individual differences. By considering the undeniable role of organic cation transporter 3 in hepatic uptake of metformin, this study was aimed to investigate the association of rs543159 and rs1317652 variants in SLC22A3 gene with response to metformin monotherapy in newly diagnosed patients with T2DM.

METHODS

The study included 200 T2DM patients who received metformin monotherapy for 25 weeks. The patients were classified into 2 groups according to their HbA1c values: the responders (reduction in HbA1c levels by at least 1% after 25 weeks treatment with metformin) and non-responders (less than 1% reduction in HbA1c levels after 25 weeks treatment with metformin). We used tetra ARMS-PCR method to determine genotypes of the target variants.

RESULTS

For the rs543159, CA and AA genotypes were more frequent in responders as compared to non-responders (OR = 2.48; 95% CI = 1.28-4.78, P-value = 0.0057) under the dominant model. In case of rs1317652 CC and CT genotypes were more frequent in metformin responders as compared to non-responder group (OR = 2.49; 95% CI = 1.32-4.70, P-value = 0.0043) under the dominant model. Parameters such as fasting blood sugar (FBS), HbA1c, and total cholesterol (TC) levels were significantly lower in the responder group after 25 weeks of metformin monotherapy. Moreover, according to the result of multiple linear regression rs543159 and base line HbA1c values are significantly associated with response to metformin monotherapy.

CONCLUSION

Our results suggested that rs543159 and rs1317652 in SLC22A3 gene might be associated with variability in response to metformin therapy in T2DM patients.