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Tabak AG, Kempler P, Guja C, Eldor R, Haluzik M, Klupa T, Papanas N, Stoian AP, Mankovsky B. Expert Opinion on Current Trends in the Use of Insulin in the Management of People with Type 2 Diabetes from the South-Eastern European Region and Israel. Diabetes Ther 2024; 15:897-915. [PMID: 38472626 DOI: 10.1007/s13300-024-01556-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
Despite the availability of various antihyperglycaemic therapies and comprehensive guidelines, glycaemic control in diabetes management has not improved significantly during the last decade in the real-world clinical setting. Treatment inertia arising from a complex interplay among patient-, clinician- and healthcare-system-related factors is the prime reason for this suboptimal glycaemic control. Also, the key factor leading to inadequate glycaemic levels remains limited communication between healthcare professionals (HCPs) and people with type 2 diabetes (PwT2D). Early insulin administration has several advantages including reduced glucotoxicity, high efficacy and preserved β-cell mass/function, leading to lowering the risk of diabetes complications. The current publication is based on consensus of experts from the South-Eastern European region and Israel who reviewed the existing evidence and guidelines for the treatment of PwT2D. Herein, the experts emphasised the timely use of insulin, preferably second-generation basal insulin (BI) analogues and intensification using basal-plus therapy, as the most-potent glucose-lowering treatment choice in the real-world clinical setting. Despite an increase in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the experts urged timely insulin initiation for inadequate glycaemic control in PwT2D. Furthermore, the combination of BI and GLP-1 RA addressing both fasting plasma glucose and post-prandial excursions as a free- or fixed-ratio combination was identified to reduce treatment complexity and burden. To minimise discontinuation and improve adherence, the experts reiterated quality, regular interactions and discussions between HCPs and PwT2D/carers for their involvement in the diabetes management decision-making process. Clinicians and HCPs should consider the opinions of the experts in accordance with the most recent recommendations for diabetes management.
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Affiliation(s)
- Adam G Tabak
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 2/a Korányi S. Str., 1083, Budapest, Hungary.
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
- UCL Brain Sciences, University College London, London, UK.
| | - Peter Kempler
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 2/a Korányi S. Str., 1083, Budapest, Hungary
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roy Eldor
- Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomasz Klupa
- Center for Advanced Technologies in Diabetes & Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre, Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Boris Mankovsky
- Department of Diabetology, National Healthcare University of Ukraine, Kiev, Ukraine
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Giorgino F, Guja C, Aydın H, Lauand F, Melas-Melt L, Rosenstock J. Consistent glycaemic efficacy and safety of concomitant use of iGlarLixi and sodium-glucose co-transporter-2 inhibitor therapy for type 2 diabetes: A patient-level pooled analysis of three randomised clinical trials. Diabetes Res Clin Pract 2024; 209:111604. [PMID: 38447911 DOI: 10.1016/j.diabres.2024.111604] [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] [Received: 01/17/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
AIMS Sodium glucose co-transporter 2 inhibitors (SGLT2is) and/or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardio- and reno-protective benefits are recommended in people with type 2 diabetes (T2D) at high risk of cardiovascular disease, chronic kidney disease, and/or heart failure. This pooled analysis compared efficacy and safety outcomes of iGlarLixi with or without SGLT2is in people with T2D. METHODS This post hoc analysis evaluated outcomes in participants who were receiving an SGLT2i when initiating iGlarLixi (SGLT2i users) and those who were not (SGLT2i non-users) in a pooled dataset from three trials: LixiLan-G (advancing from a GLP-1 RA), SoliMix and LixiLan ONE CAN (advancing from basal insulin). RESULTS Baseline characteristics were generally similar between 219 users and 746 non-users. Least squares mean changes in HbA1c from baseline to Week 26 were similar for users (-1.2 % [95 % confidence intervals: -1.4 %, -1.1 %]) and non-users (-1.2 % [-1.2 %, -1.1 %]). Changes in body weight, fasting glucose and post-prandial glucose were similar between groups, as were hypoglycaemic events. CONCLUSIONS Pooled results from three studies of adults with T2D demonstrated that iGlarLixi provided similar clinically meaningful improvements in glycaemic control without increased hypoglycaemia risk, regardless of concomitant use of SGLT2is.
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Affiliation(s)
- Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari 70124, Italy.
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest 030167, Romania.
| | - Hasan Aydın
- Department of Endocrinology, Yeditepe University School of Medicine, Istanbul 34724, Turkey.
| | | | | | - Julio Rosenstock
- Velocity Clinical Research at Medical City, 75230 Dallas, TX, USA.
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Nemecz M, Stefan DS, Comarița IK, Constantin A, Tanko G, Guja C, Georgescu A. Microvesicle-associated and circulating microRNAs in diabetic dyslipidemia: miR-218, miR-132, miR-143, and miR-21, miR-122, miR-155 have biomarker potential. Cardiovasc Diabetol 2023; 22:260. [PMID: 37749569 PMCID: PMC10521428 DOI: 10.1186/s12933-023-01988-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/09/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Circulating MicroRNAs (miRNAs) carried by microvesicles (MVs) have various physiological and pathological functions by post-transcriptional regulation of gene expression being considered markers for many diseases including diabetes and dyslipidemia. We aimed to identify new common miRNAs both in MVs and plasma that could be predictive biomarkers for diabetic dyslipidemia evolution. METHODS For this purpose, plasma from 63 participants in the study (17 type 2 diabetic patients, 17 patients with type 2 diabetes and dyslipidemia, 14 patients with dyslipidemia alone and 15 clinically healthy persons without diabetes or dyslipidemia) was used for the analysis of circulating cytokines, MVs, miRNAs and MV-associated miRNAs. RESULTS The results uncovered three miRNAs, miR-218, miR-132 and miR-143, whose expression was found to be significantly up-regulated in both circulating MVs and plasma from diabetic patients with dyslipidemia. These miRNAs showed significant correlations with important plasma markers, representative of this pathology. Thus, MV/plasma miR-218 was negatively correlated with the levels of erythrocyte MVs, plasma miR-132 was positively connected with MV miR-132 and negatively with uric acid and erythrocyte plasma levels, and plasma miR-143 was negatively related with creatinine levels and diastolic blood pressure. Also, three miRNAs common to MV and plasma, namely miR-21, miR-122, and miR-155, were identified to be down-regulated and up-regulated, respectively, in diabetic dyslipidemia. In addition, MV miR-21 was positively linked with cholesterol plasma levels and plasma miR-21 with TNFα plasma levels, MV miR-122 was negatively correlated with LDL-c levels and plasma miR-122 with creatinine and diastolic blood pressure and positively with MV miR-126 levels, MV miR-155 was positively associated with cholesterol and total MV levels and negatively with HDL-c levels, whereas plasma miR-155 was positively correlated with Il-1β plasma levels and total MV levels and negatively with MV miR-223 levels. CONCLUSIONS In conclusion, miR-218, miR-132, miR-143, and miR-21, miR-122, miR-155 show potential as biomarkers for diabetic dyslipidemia, but there is a need for more in-depth studies. These findings bring new information regarding the molecular biomarkers specific to diabetic dyslipidemia and could have important implications for the treatment of patients affected by this pathology.
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Affiliation(s)
- Miruna Nemecz
- Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, Bucharest, Romania.
| | - Diana Simona Stefan
- National Institute of Diabetes, Nutrition and Metabolic Disease 'Prof. Dr. Nicolae Constantin Paulescu', Bucharest, Romania
| | - Ioana Karla Comarița
- Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, Bucharest, Romania
| | - Alina Constantin
- Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, Bucharest, Romania
| | - Gabriela Tanko
- Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, Bucharest, Romania
| | - Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Disease 'Prof. Dr. Nicolae Constantin Paulescu', Bucharest, Romania
| | - Adriana Georgescu
- Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, Bucharest, Romania.
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Haluzík M, Seufert J, Guja C, Bonnemaire M, Bigot G, Tournay M, Kis JT, Freemantle N. Effectiveness and Safety of iGlarLixi (Insulin Glargine 100 U/mL Plus Lixisenatide) in Type 2 Diabetes According to the Timing of Daily Administration: Data from the REALI Pooled Analysis. Diabetes Ther 2023; 14:639-652. [PMID: 36787044 PMCID: PMC10064361 DOI: 10.1007/s13300-023-01375-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION iGlarLixi (insulin glargine 100 U/mL plus lixisenatide) has demonstrated glycaemic efficacy and safety in adults with inadequately controlled type 2 diabetes mellitus (T2DM). Per the European Medicines Agency's product label, iGlarLixi should be injected once a day within 1 h prior to a meal, preferably the same meal every day when the most convenient meal has been chosen. It is however unknown whether iGlarLixi administration timing affects glycaemic control and safety, as clinical trial evidence is mainly based on pre-breakfast iGlarLixi administration. Therefore, we assessed the effectiveness and safety of iGlarLixi in clinical practice, according to its administration timing. METHODS Data were pooled from two prospective observational studies including 1303 European participants with T2DM inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi therapy for 24 weeks. Participants were classified into four subgroups based on daily timing of iGlarLixi injection: pre-breakfast (N = 436), pre-lunch (N = 262), pre-dinner (N = 399), and those who switched iGlarLixi injection time during the study (N = 206). RESULTS No meaningful differences in baseline characteristics were observed between the study groups. Least-squares mean reductions in haemoglobin A1c (HbA1c) from baseline to week 24 were substantial in all groups, with the numerically largest decrease observed in the pre-breakfast group (1.57%) compared with the pre-lunch (1.27%), pre-dinner (1.42%), or changed injection time (1.33%) groups. Pre-breakfast iGlarLixi injection also resulted in a numerically greater proportion of participants achieving HbA1c < 7.0% at week 24 (33.7% versus 19.0% for pre-lunch, 25.6% pre-dinner, and 23.2% changed injection time). iGlarLixi was well tolerated across all groups, with low rates of gastrointestinal disorders and hypoglycaemia. Mean body weight decreased similarly in all groups (by 1.3-2.3 kg). CONCLUSION iGlarLixi was effective and safe regardless of its daily administration time. However, pre-breakfast iGlarLixi injection resulted in a more effective glycaemic control.
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Affiliation(s)
- Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Mathilde Tournay
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - János Tibor Kis
- Department of Internal Medicine Centrum, Szent János Hospital, Budapest, Hungary
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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Guja C, Kis JT, Haluzík M, Bonnemaire M, Bigot G, Tournay M, Freemantle N, Seufert J. iGlarLixi (insulin glargine 100 U/ml plus lixisenatide) is effective and well tolerated in people with uncontrolled type 2 diabetes regardless of age: A REALI pooled analysis of prospective real-world data. Diabetes Obes Metab 2023; 25:1723-1730. [PMID: 36810874 DOI: 10.1111/dom.15027] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
AIM To evaluate the effectiveness and safety in routine clinical practice of insulin glargine/lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D) according to age. METHODS Patient-level data were pooled from 1316 adults with T2D inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi for 24 weeks. Participants were classified into age subgroups of younger than 65 years (N = 806) and 65 years or older (N = 510). RESULTS Compared with participants aged younger than 65 years, those aged 65 years or older had a numerically lower mean body mass index (31.6 vs. 32.6 kg/m2 ), a longer median diabetes duration (11.0 vs. 8.0 years), were more likely to receive prior basal insulin (48.4% vs. 43.5%) and had a lower mean HbA1c (8.93% [74.10 mmol/mol] vs. 9.22% [77.28 mmol/mol]). Similar and clinically relevant reductions in HbA1c and fasting plasma glucose from baseline to week 24 of iGlarLixi therapy were observed regardless of age. At 24 weeks, least-squares adjusted mean (95% confidence interval [CI]) change in HbA1c from baseline was -1.55% (-1.65% to -1.44%) in those aged 65 years or older and -1.42% (-1.50% to -1.33%) in those aged younger than 65 years (95% CI: -0.26% to 0.00%; P = .058 between subgroups). Low incidences of gastrointestinal adverse events and hypoglycaemic episodes were reported in both age subgroups. iGlarLixi decreased mean body weight from baseline to week 24 in both subgroups (-1.6 kg in those aged ≥ 65 years and -2.0 kg in those aged < 65 years). CONCLUSIONS iGlarLixi is effective and well tolerated in both younger and older people with uncontrolled T2D.
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Affiliation(s)
- Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - János Tibor Kis
- Department of Internal Medicine Centrum, Szent János Hospital, Budapest, Hungary
| | - Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | | | | | - Mathilde Tournay
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, Medical Centre - Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Diaconu CT, Guja C. Nonalcoholic Fatty Liver Disease and Its Complex Relation with Type 2 Diabetes Mellitus—From Prevalence to Diagnostic Approach and Treatment Strategies. J Clin Med 2022; 11:jcm11175144. [PMID: 36079070 PMCID: PMC9456683 DOI: 10.3390/jcm11175144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes Mellitus (T2DM) are increasing rapidly worldwide, reaching epidemic proportions. Their association, based on common metabolic risk factors (obesity, insulin resistance (IR), unhealthy lifestyle), brings an additional risk of both hepatic and cardiovascular (CV) adverse clinical outcomes. The terminology of “NAFLD” is stigmatizing to some but not all patients, and a more practical one should be announced soon. Medical strategies can address both diseases simultaneously, as they have crossing pathophysiological mechanisms, mainly IR. Strategies vary from lifestyle intervention and pharmacological options, as more molecules designated for T2DM treatment may be helpful in NAFLD, to surgical procedures. This review focuses on the coexistence of NAFLD and T2DM, pointing out the utility of the appropriate terminology, its prevalence, and mortality rates among the diabetic population. Briefly, we have discussed the main pathophysiological mechanisms and the risk stratification algorithm for the development of NAFLD and nonalcoholic steatohepatitis (NASH) as well as the tools for evaluation of fibrosis. Finally, we have focused on the current therapeutic options for the treatment of NAFLD associated with T2DM.
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Affiliation(s)
- Cosmina-Theodora Diaconu
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
- Doctoral School of “Carol Davila” University of Medicine and Pharmacy, Dionisie Lupu 37, 020021 Bucharest, Romania
- Correspondence:
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Janez A, Muzurovic E, Stoian AP, Haluzik M, Guja C, Czupryniak L, Duvnjak L, Lalic N, Tankova T, Bogdanski P, Papanas N, Nunes JS, Kempler P, Fras Z, Rizzo M. Translating results from the cardiovascular outcomes trials with glucagon-like peptide-1 receptor agonists into clinical practice: Recommendations from a Eastern and Southern Europe diabetes expert group. Int J Cardiol 2022; 365:8-18. [PMID: 35905827 DOI: 10.1016/j.ijcard.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/29/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 02/06/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists mimic the action of the endogenous GLP-1 incretin hormone, improving glycaemic control in type 2 diabetes mellitus (T2DM) by increasing insulin secretion and decreasing glucagon secretion in a glucose-dependent manner. However, as cardiovascular (CV) morbidity and mortality is common in patients with T2DM, several trials with the use of GLP-1 receptor agonists (RAs) have been performed focusing on endpoints related to cardiovascular disease rather than metabolic control of T2DM. Following the positive cardiovascular effects of liraglutide, dulaglutide and semaglutide observed in these trials, major changes in T2DM management guidelines have occurred. This document from a Eastern and Southern European Diabetes Expert Group discusses the results of GLP-1 RA CV outcomes trials, their impact on recent clinical guidelines for the management of T2DM, and some selected combination regimens utilising GLP-1 RAs. We also propose an algorithm for guiding GLP-1 RA-based treatment according to patients' characteristics, which can be easily applied in every day clinical practice.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Slovenia.
| | - Emir Muzurovic
- Faculty of Medicine, University of Montenegro, Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Haluzik
- Diabetes Centre and Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine and Institute of Endocrinology, Prague, Czech Republic
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Poland
| | - Lea Duvnjak
- School of Medicine University of Zagreb, Vuk Vrhovac University Clinic, Zagreb, Croatia
| | - Nebojsa Lalic
- Faculty of Medicine University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Pawel Bogdanski
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, University of Medical Sciences, Poznan, Poland
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Josè Silva Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Peter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zlatko Fras
- Preventive Cardiology Unit, Division of Medicine, University Medical Centre Ljubljana and Chair of Internal Medicine, Medical Faculty, University of Ljubljana, Slovenia
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Italy
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Stoica RA, Drăgana N, Ancuceanu R, Geicu OI, Guja C, Pantea-Stoian A, Gheorghe DC, Stefan-van Staden RI, Serafinceanu C, Costache A, Ionescu-Tîrgoviște C. Interleukin-8, CXCL10, CXCL11 and their role in insulin resistance in adult females with subclinical hypothyroidism and prediabetes. J Clin Transl Endocrinol 2022; 28:100299. [PMID: 35433269 PMCID: PMC9006329 DOI: 10.1016/j.jcte.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
In obesity, the hormonal secretion of the thyroid gland switches from homeostasis to type 2 allostasis in order to adapt to persistent modifications of adipose tissue and inflammation. Previous meta-analyses have linked obesity with an increased risk of developing thyroid diseases, prediabetes, and type 2 diabetes mellitus. We designed an observational cross-sectional study including all female patients presenting consecutively in an ambulatory clinic for 16 months. This study aimed to describe the level of serum cytokines and chemokines in relation to TSH, fT4 and insulin resistance (IR) indexes in patients with subclinical hypothyroidism (SCH). The study included 72 women with a median age of 59 ± 17.75 years, and a mean BMI (Body Mass Index) of 31.48 ± 6.75 kg/m2. Modelling homeostasis model assessment of IR indices (HOMA-IR) based on chemokines (IL-8, CXCL10, CXCL11, leptin), C-reactive protein, the presence or absence of SCH, taking into account age, BMI, abdominal circumference, glycated haemoglobin (HbA1c), and anti-thyroid peroxidase antibodies (ATPO) as covariates, identified a single chemokine that was significantly associated with the dependent variable (IL-8). IR indices are negatively associated with IL-8 in female patients with subclinical hypothyroidism, but the effect of the cytokine is minimal. BMI rather than TSH influences the level of CXCL11 in our population. CXCL10 has a tendency to increase in patients with SCH, obesity and prediabetes, with no association with TSH.
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Affiliation(s)
- Roxana Adriana Stoica
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020475 Bucharest, Romania
- Corresponding author.
| | - Nicoleta Drăgana
- “Francisc I. Rainer” Anthropological Research Centre, Romanian Academy, 076241 Bucharest, Romania
| | - Robert Ancuceanu
- Department of Botanical Pharmaceutics, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Ovidiu Ionuț Geicu
- Department of Preclinical Sciences, University of Agricultural Sciences and Veterinary Medicine of Bucharest, 011464 Bucharest, Romania
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Anca Pantea-Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Damaris-Cristina Gheorghe
- Laboratory of Electrochemistry and PATLAB, National Institute of Research for Electrochemistry and Condensed Matter, 060021 Bucharest, Romania
| | - Raluca-Ioana Stefan-van Staden
- Laboratory of Electrochemistry and PATLAB, National Institute of Research for Electrochemistry and Condensed Matter, 060021 Bucharest, Romania
| | - Cristian Serafinceanu
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Constantin Ionescu-Tîrgoviște
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020475 Bucharest, Romania
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Bala C, Cerghizan A, Mihai BM, Moise M, Guja C. Real-world evidence on the use of a fixed-ratio combination of insulin glargine and lixisenatide (iGlarLixi) in people with suboptimally controlled type 2 diabetes in Romania: a prospective cohort study (STAR.Ro). BMJ Open 2022; 12:e060852. [PMID: 35623748 PMCID: PMC9150149 DOI: 10.1136/bmjopen-2022-060852] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and safety of insulin glargine and lixisenatide (iGlarLixi) fixed-ratio combination on a cohort of Romanian adults with type 2 diabetes (T2D). DESIGN Open-label, 24-week, prospective cohort study. SETTING 65 secondary care diabetes centres in Romania. PARTICIPANTS The study included 901 adults with T2D suboptimally controlled with previous oral antidiabetic drugs (OADs)±basal insulin (BI) who initiated treatment with iGlarLixi upon the decision of the investigator. Major exclusion criteria were iGlarLixi contraindications and refusal to participate. 876 subjects received at least one dose of iGlarLixi (intention-to-treat/safety population). PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was change in glycated haemoglobin (HbA1c) from baseline to week 24 in the modified intention-to-treat population (study participants with HbA1c available at baseline and week 24). Secondary efficacy outcomes were percentage of participants reaching HbA1c targets and change in fasting plasma glucose (FPG). RESULTS Mean baseline HbA1c was 9.2% (SD 1.4) and FPG was 10.8 mmol/L (2.9). Mean HbA1c change was -1.3% (95% CI: -1.4% to -1.2%, p<0.0001) at week 24. HbA1c levels ≤6.5%, <7% and<7.5% at week 24 were achieved by 72 (8.9%), 183 (22.6%) and 342 (42.3%) participants, respectively. Mean FPG change was -3.1 mmol/L (95% CI: -3.3 to -2.8, p<0.001) at week 24. Mean body weight change was -1.6 kg (95% CI: -1.9 to -1.3, p<0.001) at 24 weeks. Mean iGlarLixi dose increased from 19.5 U (SD 7.7) and 30.1 U (10.0) to 30.2 U (8.9) (ratio 2/1 pen) and 45.0 U (11.6) (ratio 3/1 pen). Adverse events (AEs) were reported by 43 (4.9%) participants (18 (2.1%) gastrointestinal) with 4 (0.5%) reporting serious AEs. 13 (1.5%) participants reported at least one event of symptomatic hypoglycaemia, with one episode of severe hypoglycaemia reported. CONCLUSIONS In a real-world setting, 24-week treatment with iGlarLixi provided a significant reduction of HbA1c with body weight loss and low hypoglycaemia risk in T2D suboptimally controlled with OADs±BI treatment.
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Affiliation(s)
- Cornelia Bala
- Department of Diabetes, Nutrition and Metabolic Diseases, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Cerghizan
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Bogdan-Mircea Mihai
- Department of Diabetes, Nutrition and Metabolic Diseases, Grigore T Popa University of Medicine and Pharmacy Faculty of Medicine, Iasi, Romania
| | | | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
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Guja C, Giorgino F, Blonde L, Ali A, Prázný M, Meier JJ, Souhami E, Lubwama R, Ji C, Rosenstock J. Concomitant iGlarLixi and Sodium-Glucose Co-transporter-2 Inhibitor Therapy in Adults with Type 2 Diabetes: LixiLan-G Trial and Real-World Evidence Results. Diabetes Ther 2022; 13:205-215. [PMID: 34894329 PMCID: PMC8776928 DOI: 10.1007/s13300-021-01180-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION iGlarLixi, the once-daily fixed-ratio combination of insulin glargine 100 U/ml and lixisenatide, robustly improves glycaemic control in adults with type 2 diabetes irrespective of previous treatment [oral antihyperglycaemic drugs (OADs), basal insulin or glucagon-like peptide-1 receptor agonists (GLP-1 RAs)]. Sodium-glucose co-transporter-2 inhibitors (SGLT2is) are a recommended treatment option for people with type 2 diabetes with cardiovascular disease, kidney disease and/or heart failure because of their cardio- and renoprotective benefits. Herein, we assessed the effects of concomitant iGlarLixi and SGLT2i therapy. METHODS We conducted subgroup analyses according to SGLT2i use in: (1) adults with suboptimally controlled type 2 diabetes on GLP-1 RAs and OADs switching to iGlarLixi in the 26-week LixiLan-G randomised controlled trial (RCT; NCT02787551) and (2) adults switching to or adding iGlarLixi in a 6-month, retrospective real-world evidence (RWE) observational study using data from the US Optum-Humedica electronic medical records database. Changes in HbA1c and hypoglycaemia prevalence and event rates were assessed. RESULTS There were no major differences in baseline characteristics for those who initiated iGlarLixi while already using SGLT2i (n = 346) and those initiating iGlarLixi without concomitant SGLT2i therapy (n = 1285). HbA1c reductions from baseline to time of assessment and hypoglycaemia prevalence and event rates were similar for iGlarLixi users regardless of SGLT2i therapy. CONCLUSION Evidence from an RCT and an RWE analysis supports the efficacy/effectiveness and safety of iGlarLixi when used concomitantly with SGLT2i. TRIAL REGISTRATION NCT02787551.
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Affiliation(s)
- Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Lawrence Blonde
- Department of Endocrinology, Ochsner Medical Center, Frank Riddick Diabetes Institute, New Orleans, LA, USA
| | - Amar Ali
- Oakenhurst Medical Practice, Blackburn, UK
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Juris J Meier
- Diabetes Division, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | | | | | - Julio Rosenstock
- Dallas Diabetes Research Center at Medical City, Dallas, TX, USA
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Stoica RA, Ancuceanu R, Costache A, Ștefan SD, Stoian AP, Guja C, Ștefan-van Staden RI, Popa-Tudor I, Serafinceanu C, Ionescu-Tîrgoviște C. Subclinical hypothyroidism has no association with insulin resistance indices in adult females: A case-control study. Exp Ther Med 2021; 22:1033. [PMID: 34373719 DOI: 10.3892/etm.2021.10465] [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] [Received: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 12/16/2022] Open
Abstract
Longitudinal studies have indicated an association between thyroid function and insulin resistance (IR) or a neutral relationship. Both the lowest tertile of free thyroxine (fT4) and the highest tertile of free triiodothyronine (fT3) were found to be associated with IR in cross-sectional studies. The aim of the present study was to analyze the association between IR and subclinical hypothyroidism in a female adult population from Bucharest, Romania. This is a retrospective pilot case-control study that included female patients examined by two endocrinologists and a diabetologist in an outpatient clinic. The retrospective follow-up had a one-year duration and included the evaluation of thyroid function tests and IR indices based on fasting insulinemia and C-peptide. The study included 176 women, 91 with subclinical hypothyroidism, with a median age of 60±17 years and a mean body mass index (BMI) of 27.79±4.76 kg/m2. The majority of the population (50%) was diagnosed with autoimmune thyroiditis, and 17.05% with goitre. The univariate logistic regression using hypothyroidism as the explaining variable found no evidence of a significant relationship between a decreased thyroid function and IR (OR 1.32; P=0.36). Metabolic syndrome was probably the most important determinant of IR in the population group studied. Thus, it was not the thyroid function per se, but the coexistence of other elements of this syndrome that prevailed in determining IR. Advantages to the study are the design that permitted evaluation of IR and the thyroid function at different moments in time as well as the uniformity of the blood tests. The multivariate analyses were adjusted for age, lipid profile and treatment; however, one limiting factor was the absence of other hormonal blood tests. In summary, there was no association between the thyroid function tests (TSH, fT4) and IR indices in adult Romanian women in a case-control study with one-year retrospective follow-up.
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Affiliation(s)
- Roxana Adriana Stoica
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Robert Ancuceanu
- Department of Botanical Pharmaceutics, 'Carol Davila' University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Simona Diana Ștefan
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Ioana Ștefan-van Staden
- Laboratory of Electrochemistry and PATLAB, National Institute of Research for Electrochemistry and Condensed Matter, 060021 Bucharest, Romania
| | - Ioana Popa-Tudor
- Laboratory of Electrochemistry and PATLAB, National Institute of Research for Electrochemistry and Condensed Matter, 060021 Bucharest, Romania
| | - Cristian Serafinceanu
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Constantin Ionescu-Tîrgoviște
- Department of Diabetes, Nutrition and Metabolic Diseases, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Stegaru D, Nicodim S, Vladu D, Guțu O, Onaca A, Pîrvu F, Moise M, Guja C. Effectiveness and safety of insulin glargine Gla-300 in insulin-naïve type 2 diabetes subjects in a real-life setting-the GOAL_RO trial. Ann Transl Med 2021; 9:105. [PMID: 33569407 PMCID: PMC7867914 DOI: 10.21037/atm-20-4533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 01/01/2023]
Abstract
Background Basal insulin is the first choice for insulin initiation in type 2 diabetes (T2DM), with the second generation of basal insulin analogues having a lower risk of hypoglycemia compared to the first generation of basal insulins. The aim of our study was to assess on a large cohort of insulin-naïve T2DM subjects the effectiveness and safety of insulin glargine 300 U/mL (Gla-300) in a real-life setting. Methods This was a multicenter, prospective, non-interventional, 24 weeks, 3 visits (baseline, 3 and 6 months) trial performed in adult T2DM subjects not achieving glycemic target (HbA1c >7%) with prior oral or GLP-1 RA therapy. The study included 1,095 subjects (55.2% M/44.8% F) in 124 study sites. Mean (±SD) age was 61.1±8.5 years while mean duration of diabetes was 8.8±5.2 years. Mean BMI was 31.7±5.4 kg/m2 with 91.2% being overweight or obese. Baseline diabetes treatment included metformin (88.4% of subjects), sulphonylureas (75.4%), DPP-4i (16.7%) and GLP-1 RAs (8%). Comparison between quantitative variables was made with the paired sample t test. Results Mean HbA1c at baseline was 9.8%±1.7% with a mean fasting plasma glucose (FBG) of 231.5±67.4 mg/dL. Mean HbA1c decreased to 7.7%±1.2% at 6 months with a mean change from baseline of -2.1% (P<0.001). Overall, 30.7% of subjects reached the HbA1c target of 7%. Final mean dose of Gla-300 was 0.4 IU/kg/day. Mean weight gain was 0.4 kg over 6 months. Adverse events (AEs) were reported by 11.1% of subjects with 2.3% reporting serious adverse events (SAEs). Overall, 4.4% of subjects reporting at least one event of symptomatic or confirmed hypoglycemia. Only 7 episodes of nocturnal and one of severe hypoglycemia were reported. Conclusions In conclusion, a significant 2.1% decrease of HbA1c was recorded after 6 months of treatment with Gla-300 with no unexpected safety signals, low risk of hypoglycemia and modest weight gain.
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Affiliation(s)
- Daniela Stegaru
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Nicodim
- Emergency Clinical County Hospital Constanța, Constanța, Romania
| | - Delia Vladu
- Emergency Clinical County Hospital Craiova, Craiova, Romania
| | | | | | - Florina Pîrvu
- Municipal Hospital "Dr. Gheorghe Marinescu" Târnăveni, Mureș, Romania
| | | | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Guja C, Frías JP, Suchower L, Hardy E, Marr G, Sjöström CD, Jabbour SA. Correction to: Safety and Efficacy of Exenatide Once Weekly in Participants with Type 2 Diabetes and Stage 2/3 Chronic Kidney Disease. Diabetes Ther 2020; 11:3011-3013. [PMID: 33011938 PMCID: PMC7644701 DOI: 10.1007/s13300-020-00842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In the original article, the Table 1 has published with error.
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Affiliation(s)
- Cristian Guja
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Juan P Frías
- National Research Institute, Los Angeles, CA, USA
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Jabbour SA, Frías JP, Ahmed A, Hardy E, Choi J, Sjöström CD, Guja C. Efficacy and Safety Over 2 Years of Exenatide Plus Dapagliflozin in the DURATION-8 Study: A Multicenter, Double-Blind, Phase 3, Randomized Controlled Trial. Diabetes Care 2020; 43:2528-2536. [PMID: 32816874 PMCID: PMC7510043 DOI: 10.2337/dc19-1350] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 07/09/2019] [Accepted: 07/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In patients with type 2 diabetes uncontrolled with metformin, exenatide once weekly (QW) plus dapagliflozin produced greater reductions in glycemic parameters (glycated hemoglobin [HbA1c], fasting plasma glucose [FPG], and 2-h postprandial glucose [2-h PPG]), weight, and systolic blood pressure (SBP) than exenatide QW or dapagliflozin alone after 28 weeks of treatment in DURATION-8. Following a 24-week extension period, improvements were sustained at 52 weeks. In this study, we investigated efficacy and safety at 104 weeks after randomization. RESEARCH DESIGN AND METHODS DURATION-8 was a 104-week, multicenter, double-blind, randomized, active-controlled, phase 3 trial. In total, 695 adults (aged ≥18 years) with type 2 diabetes and inadequate glycemic control (HbA1c 8.0-12.0% [64-108 mmol/mol]) despite stable metformin monotherapy (≥1,500 mg/day) were randomly assigned (1:1:1) to receive exenatide 2 mg QW plus once-daily dapagliflozin 10 mg, exenatide QW plus placebo, or dapagliflozin plus placebo. All 104-week evaluations were exploratory. RESULTS At week 104, 431 (62.0%) patients completed treatment. The adjusted least squares mean change (SE) from baseline to week 104 in HbA1c was greater with exenatide QW plus dapagliflozin (-1.70% [0.11]) versus exenatide QW plus placebo (-1.29% [0.12]; P = 0.007) and dapagliflozin plus placebo (-1.06% [0.12]; P < 0.001). Clinically relevant changes in FPG, 2-h PPG, weight, and SBP were also observed with exenatide QW plus dapagliflozin. There were no unexpected safety findings, and exenatide QW plus dapagliflozin was well tolerated, with no episodes of major hypoglycemia. CONCLUSIONS In this exploratory analysis, among those individuals who completed the trial without rescue therapy, there was clinically relevant efficacy over 2 years with exenatide QW plus dapagliflozin, with no unexpected safety findings.
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Affiliation(s)
| | | | | | | | | | | | - Cristian Guja
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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van der Aart ‐ van der Beek AB, van Raalte DH, Guja C, Hoogenberg K, Suchower LJ, Hardy E, Sjöström CD, Heerspink HJ. Exenatide once weekly decreases urinary albumin excretion in patients with type 2 diabetes and elevated albuminuria: Pooled analysis of randomized active controlled clinical trials. Diabetes Obes Metab 2020; 22:1556-1566. [PMID: 32329160 PMCID: PMC7496075 DOI: 10.1111/dom.14067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/30/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 12/28/2022]
Abstract
AIMS To examine the albuminuria-lowering effect of exenatide once weekly (EQW) compared with active glucose-lowering comparators in patients with type 2 diabetes and elevated urinary albumin-to-creatinine ratio (uACR). METHODS Six randomized double-blind and open-label phase III studies were pooled in a post hoc, exploratory analysis to evaluate the efficacy and safety of EQW versus non-glucagon-like peptide-1 receptor agonist comparators in patients with type 2 diabetes and baseline uACR ≥30 mg/g. Treatment groups were EQW versus all comparators pooled. Efficacy outcomes were percent change from baseline to week 26/28 in uACR and absolute change in glycated haemoglobin (HbA1c), systolic blood pressure (SBP), body weight and estimated glomerular filtration rate (eGFR). RESULTS Baseline characteristics were generally similar between the two treatment groups (EQW: N = 194, all comparators: N = 274). Relative to the comparator group, EQW changed albuminuria by -26.2% (95% confidence interval [CI] -39.5 to -10). Similar improvements were observed with EQW versus oral glucose-lowering drugs (-29.6% [95% CI -47.6 to -5.3) or insulin (-23.8% [95% CI -41.8 to -0.2]). The effect of EQW on uACR was independent of baseline renin-angiotensin system inhibitor usage. Adjusted mean decreases in HbA1c, SBP and body weight were more pronounced in the EQW versus the comparator group. Adjustment for changes in HbA1c, eGFR and SBP did not substantially affect the uACR-lowering effect of EQW. When also adjusting for changes in body weight, the uACR-lowering effect was reduced to (-13.0% [95% CI -29.9 to 7.8]). CONCLUSION Exenatide once weekly reduced uACR in patients with type 2 diabetes and elevated albuminuria compared to commonly used glucose-lowering drugs.
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Affiliation(s)
| | - Daniel H. van Raalte
- Diabetes Centre, Department of Internal MedicineAmsterdam UMC location VUMCAmsterdamThe Netherlands
| | - Cristian Guja
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - Klaas Hoogenberg
- Department of Internal MedicineMartini HospitalGroningenThe Netherlands
| | | | - Elise Hardy
- Clinical Metabolism, Late‐stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&DAstraZenecaGaithersburgMaryland
| | - C. David Sjöström
- Clinical Metabolism, Late‐stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&DAstraZenecaGothenburgSweden
| | - Hiddo J.L. Heerspink
- Clinical Pharmacy and PharmacologyUniversity of GroningenGroningenThe Netherlands
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Guja C, Frías JP, Suchower L, Hardy E, Marr G, Sjöström CD, Jabbour SA. Safety and Efficacy of Exenatide Once Weekly in Participants with Type 2 Diabetes and Stage 2/3 Chronic Kidney Disease. Diabetes Ther 2020; 11:1467-1480. [PMID: 32306296 PMCID: PMC7324446 DOI: 10.1007/s13300-020-00815-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The safety and efficacy of exenatide once weekly (EQW) is overall well established. EQW is primarily renally eliminated. In this study, the efficacy and renal and gastrointestinal tolerability of EQW were summarised in participants with type 2 diabetes and chronic kidney disease stage 3 (CKD3; moderate renal impairment; estimated glomerular filtration rate [eGFR] ≥ 30 to < 60 mL/min/1.73 m2) or CKD stage 2 (CKD2; mild renal impairment; eGFR ≥ 60 to < 90 mL/min/1.73 m2). METHODS Data on participants with type 2 diabetes and baseline CKD3 or CKD2 from eight phase 3, double-blind or open-label studies with 26- or 28-week controlled treatment periods were pooled. Participants received EQW or a placebo/non-glucagon-like peptide-1 receptor agonist comparator (sitagliptin, metformin, pioglitazone, dapagliflozin and insulin). RESULTS Participants with baseline CKD3 (N = 182) or CKD2 (N = 772) receiving EQW differed in a number of baseline characteristics, such as age < 65 years, race, mean body mass index and mean type 2 diabetes duration, whereas mean blood pressure and glycated haemoglobin (HbA1c) were similar. Mean reductions in HbA1c, body weight and systolic blood pressure from baseline to week 26/28 in participants receiving EQW were similar between the CKD subgroups. The proportions of participants (CKD3 and CKD2) with any adverse event (AE) were 81% and 72%, respectively, for EQW and 74% and 68%, respectively, for all comparators; those for serious AEs were 2.7% and 3.4%, respectively, for EQW and 6% and 5%, respectively, for all comparators. Gastrointestinal AE rates were higher in the EQW CKD3 subgroup (42.2% of participants) than in the CKD2 (32.8%) subgroup, although rates for nausea and vomiting were similar. There were no dehydration events; one participant in each treatment group had a serious AE of acute kidney injury (EQW with CKD3, n = 1; pioglitazone with CKD2, n = 1). CONCLUSION Exenatide once weekly was well tolerated and demonstrated similar efficacy in participants with type 2 diabetes with mild and moderate renal impairment. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00637273, NCT00676338, NCT02229383, NCT02229396, NCT00641056, NCT01652729, NCT00935532, NCT01003184.
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Affiliation(s)
- Cristian Guja
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Juan P Frías
- National Research Institute, Los Angeles, CA, USA
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Constantin A, Dumitrescu M, Nemecz M, Picu A, Smeu B, Guja C, Alexandru N, Georgescu A, Tanko G. Sera of Obese Type 2 Diabetic Patients Undergoing Metabolic Surgery Instead of Conventional Treatment Exert Beneficial Effects on Beta Cell Survival and Function: Results of a Randomized Clinical Study. Obes Surg 2020; 29:1485-1497. [PMID: 30701387 DOI: 10.1007/s11695-019-03710-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/19/2022]
Abstract
BACKGROUND Pancreatic beta cells are highly sensitive to oxidative and endoplasmic reticulum (ER) stress, commonly occurring in type 2 diabetes (T2D) and obesity. OBJECTIVE We aimed at investigating cellular responses of human beta cells exposed to sera from obese T2D patients treated differently, namely by conventional therapy or laparoscopic sleeve gastrectomy (LSG). METHODS Serum samples from obese T2D men randomized to conventional treatment or LSG were taken at baseline and 6 months later. After exposing 1.1B4 cells to study patients' sera, the following were assessed: cellular viability and proliferation (by MTT and xCELLigence assays), reactive oxygen species (ROS) production (with DCFH-DA), and expression of ER stress markers, oxidative- or autophagy-related proteins and insulin (by real-time PCR and Western blot). RESULTS At 6-month follow-up, patients undergoing LSG achieved an adequate glycemic control, whereas conventionally treated patients did not. As compared to 1.1B4 cells incubated with baseline sera (control), cells exposed to sera from LSG-treated participants exhibited (i) increased viability and proliferation (p < 0.05); (ii) diminished levels of ROS and p53 (p < 0.05); (iii) enhanced protein expression of autophagy-related SIRT1 and p62/SQSTM1 (p < 0.05); (iv) significantly decreased transcript levels of ER stress markers (p < 0.05); and (v) augmented insulin expression (p < 0.05). Conversely, the 6-month conventional therapy appeared not to impact on circulating redox status. Moreover, 1.1B4 cells exposed to sera from conventionally treated patients experienced mild ER stress. CONCLUSION Circulating factors in patients with improved diabetes after metabolic surgery exerted favorable effects on beta cell function and survival.
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Affiliation(s)
- Alina Constantin
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Mădălina Dumitrescu
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Miruna Nemecz
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Ariana Picu
- Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. Dr N. Paulescu", Bucharest, Romania
| | | | - Cristian Guja
- Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. Dr N. Paulescu", Bucharest, Romania
| | - Nicoleta Alexandru
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Adriana Georgescu
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania
| | - Gabriela Tanko
- Pathophysiology and Pharmacology Department, Institute of Cellular Biology and Pathology 'Nicolae Simionescu' of the Romanian Academy, 8, BP Hasdeu Street, PO Box 35-14, 050568, Bucharest, Romania.
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Haluzík M, Flekač M, Lengyel C, Taybani Z, Guja C, Mihai BM, Cerghizan A, Martinka E, Kovacs G, Kempler P. Expert Opinion on the Therapeutic Use of the Fixed-Ratio Combination of Insulin Glargine 100 U/mL and Lixisenatide: a Central/Eastern European Perspective. Diabetes Ther 2020; 11:1029-1043. [PMID: 32144742 PMCID: PMC7136377 DOI: 10.1007/s13300-020-00777-2] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Indexed: 01/19/2023] Open
Abstract
The fixed-ratio combination (FRC) of a basal insulin and a GLP-1 receptor agonist (GLP-1 RA) has proven to be an effective therapeutic approach. However, physicians face numerous practical questions that cannot be answered by recently published trial results, current guidelines and summaries of product characteristics. In April 2019, a scientific meeting was held with the participation of nine experts from four Central and Eastern European countries to provide expert consensus on the optimal daily use of the insulin glargine and lixisenatide FRC (iGlarLixi). Topics included the positioning and initiation of iGlarLixi and the management of treatment. This paper summarizes the outcomes of the meeting.
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Affiliation(s)
- Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Milan Flekač
- Third Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Csaba Lengyel
- First Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Taybani
- 1st. Department of Endocrinology, Békés County Central Hospital, Dr Réthy Pál Member Hospital, Békéscsaba, Hungary
| | - Cristian Guja
- Romania National Institute of Diabetes, Nutrition and Metabolic Diseases "NC Paulescu", Carol Davila University of Medicine and Pharmacy, Bucharest, Bucharest, Romania
| | - Bogdan-Mircea Mihai
- Unit of Diabetes, Nutrition and Metabolic Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
- "Sf. Spiridon" Emergency Hospital, Iaşi, Romania
| | - Anca Cerghizan
- Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania
| | - Emil Martinka
- National Institute for Endocrinology and Diabetology, Lubochna, Slovak Republic
| | | | - Péter Kempler
- First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Gastaldelli A, Repetto E, Guja C, Hardy E, Han J, Jabbour SA, Ferrannini E. Exenatide and dapagliflozin combination improves markers of liver steatosis and fibrosis in patients with type 2 diabetes. Diabetes Obes Metab 2020; 22:393-403. [PMID: 31692226 PMCID: PMC7064910 DOI: 10.1111/dom.13907] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 08/08/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
Abstract
AIM To assess the efficacy of exenatide (EXE) once weekly + dapagliflozin once daily (DAPA) versus each drug alone in reducing biomarkers of fatty liver/steatosis and fibrosis in a post hoc analysis of DURATION-8, a 104-week study in 695 patients with type 2 diabetes uncontrolled by metformin monotherapy. MATERIALS AND METHODS We evaluated the impact of the study treatments on non-invasive markers of hepatic steatosis (fatty liver index [FLI] and non-alcoholic fatty liver disease [NAFLD] liver fat score), fibrosis (fibrosis-4 index [FIB-4]) and severe fibrosis (NAFLD fibrosis score), along with liver enzymes and insulin resistance, at weeks 28 and 52. All outcomes in this analysis were exploratory, with nominal P values reported. RESULTS At week 28, biomarkers of fatty liver/steatosis and fibrosis were reduced from baseline in all treatment groups. At week 28, EXE once weekly + DAPA effects for decrease in FLI were stronger than those of EXE once weekly + placebo (PLB; -2.92, 95% confidence interval [CI] -5.11, -0.73; P = 0.0092) or DAPA+PLB (-2.77 [95% CI -4.93, -0.62]; P = 0.0119), and stronger than those of EXE once weekly + PLB at week 52 (-3.23 [95% CI -5.79, -0.68]; P = 0.0134). FIB-4 showed reduction versus baseline only in the EXE once weekly + DAPA group at both week 28 (-0.06 [95% CI -0.11, -0.01]; P = 0.0135) and week 52 (-0.05 [95% CI -0.09, -0.004]; P = 0.0308). CONCLUSIONS The EXE once weekly + DAPA combination showed stronger effects than EXE once weekly + PLB or DAPA + PLB in ameliorating markers of hepatic steatosis and fibrosis in patients with type 2 diabetes. Prospective trials are needed to validate these findings.
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Affiliation(s)
| | - Enrico Repetto
- Global Medical CVRM, BioPharmaceuticals Medical, AstraZenecaGaithersburgMarylandUnited States
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic DiseasesCarol Davila University of Medicine and PharmacyBucharestRomania
| | - Elise Hardy
- Late CVRM, BioPharmaceuticals R&DGaithersburgMarylandUnited States
| | - Jenny Han
- Pharmapace Inc., San DiegoCaliforniaUnited States
| | - Serge A. Jabbour
- Division of Endocrinology, Diabetes and Metabolic DiseasesSidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUnited States
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20
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Janež A, Guja C, Mitrakou A, Lalic N, Tankova T, Czupryniak L, Tabák AG, Prazny M, Martinka E, Smircic-Duvnjak L. Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. Diabetes Ther 2020; 11:387-409. [PMID: 31902063 PMCID: PMC6995794 DOI: 10.1007/s13300-019-00743-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Here, we review insulin management options and strategies in nonpregnant adult patients with type 1 diabetes mellitus (T1DM). Most patients with T1DM should follow a regimen of multiple daily injections of basal/bolus insulin, but those not meeting individual glycemic targets or those with frequent or severe hypoglycemia or pronounced dawn phenomenon should consider continuous subcutaneous insulin infusion. The latter treatment modality could also be an alternative based on patient preferences and availability of reimbursement. Continuous glucose monitoring may improve glycemic control irrespective of treatment regimen. A glycemic target of glycated hemoglobin < 7% (53 mmol/mol) is appropriate for most nonpregnant adults. Basal insulin analogues with a reduced peak profile and an extended duration of action with lower intraindividual variability relative to neutral protamine Hagedorn insulin are preferred. The clinical advantages of basal analogues compared with older basal insulins include reduced injection burden, better efficacy, lower risk of hypoglycemic episodes (especially nocturnal), and reduced weight gain. For prandial glycemic control, any rapid-acting prandial analogue (aspart, glulisine, lispro) is preferred over regular human insulin. Faster-acting insulin aspart is a relatively new option with the advantage of better postprandial glucose coverage. Frequent blood glucose measurements along with patient education on insulin dosing based on carbohydrate counting, premeal blood glucose, and anticipated physical activity is paramount, as is education on the management of blood glucose under different circumstances.Plain Language Summary: Plain language summary is available for this article.
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Affiliation(s)
- Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
| | - Cristian Guja
- Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Dionisie Lupu Street No. 37, 020021, Bucharest, Romania
| | - Asimina Mitrakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nebojsa Lalic
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University of Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Adam G Tabák
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, 2/a Korányi S. Str, 1083, Budapest, Hungary
| | - Martin Prazny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Emil Martinka
- Department of Diabetology, National Institute for Endocrinology and Diabetology, Kollarova 2/283, 034 91, Lubochna, Slovakia
| | - Lea Smircic-Duvnjak
- Vuk Vrhovac University Clinic-UH Merkur, School of Medicine, University of Zagreb, Dugi dol 4A, Zagreb, Croatia
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Ferrannini E, Baldi S, Frías JP, Guja C, Hardy E, Repetto E, Jabbour SA, DeFronzo RA. Hormone-substrate changes with exenatide plus dapagliflozin versus each drug alone: The randomized, active-controlled DURATION-8 study. Diabetes Obes Metab 2020; 22:99-106. [PMID: 31469220 DOI: 10.1111/dom.13870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 01/17/2023]
Abstract
AIM To determine the effects of individual and combined therapies on plasma insulin, glucagon, β-hydroxybutyrate (β-OH) and associated metabolites. MATERIALS AND METHODS In DURATION-8, the combination of once-weekly exenatide (EQW) + 10 mg dapagliflozin (Dapa) in patients with type 2 diabetes poorly controlled with metformin-reduced HbA1c levels and body weight (at weeks 28 and 52) was compared with EQW + placebo (Plb) or Dapa + Plb. The study included 678 patients randomized 1:1:1 to EQW + Dapa, EQW + Plb, or Dapa + Plb. Plasma insulin and glucagon were measured at fasting and 2 hours after a mixed meal. Fasting plasma free fatty acids (FFA) and β-OH concentrations were measured. RESULTS The fasting insulin-to-glucagon molar ratio (I/Glg) increased with EQW + Plb only; postprandial I/Glg increased in all groups but significantly more with EQW + Plb. β-OH, FFA, and glycerol concentrations showed a parallel response: larger increments with Dapa + Plb, larger decrements with EQW + Plb, and intermediate changes with EQW + Dapa. β-OH levels and I/Glg were inversely related to one another. Patients in the top quartile of β-OH changes from baseline [median (interquartile range): +207 (305) vs. -65 (-154) μmol/L; P < .0001] were more frequently treated with Dapa + Plb, had higher urine glucose-to-creatinine ratios, and lower fasting insulin [52 (51) vs. 68 (53) pmol/L; P = .0013) and I/Glg [1.76 (1.49) vs. 2.23 (1.70) mol/mol; P = .0020]. Haematocrit increased only in the Dapa group. CONCLUSIONS The EQW + Dapa combination abolished the Dapa-induced rise in β-OH, reduced the EQW-induced increase in I/Glg, maintained glycosuria, and increased haematocrit in patients with poorly controlled type 2 diabetes. The drug combination may preserve any putative benefits while mitigating the risk of ketoacidosis.
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Affiliation(s)
| | - Simona Baldi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Juan P Frías
- National Research Institute, Los Angeles, California
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Serge A Jabbour
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
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22
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Abstract
Type 2 diabetes, one of the most frequent chronic diseases, has an important effect on bone metabolism, with most studies reporting an increased prevalence of fractures in these patients despite an apparently increased bone mineral density. Most probable explanation is an alteration of bone structure/quality with increased fragility but the different diabetes medications influence the risk of fracture. While metformin and incretin-based therapies are safe, thiazolidinediones and canagliflozin (sodium-glucose cotransporter-2 inhibitor) negatively impact bone metabolism and should be avoided in subjects at increased risk of fractures. Insulin and sulphonylureas are generally safe but can increase the risk of hypoglycemia and falls with subsequent traumatic fractures. Their combination should be avoided, especially in elderly subjects.
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Affiliation(s)
- Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N.C. Paulescu", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Loreta Guja
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Rucsandra Dănciulescu Miulescu
- National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N.C. Paulescu", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
Aims: To study the age and sex-dependent mortality rates and causes of death in a large Romanian diabetes cohort as compared with the general population. Methods: All adult patients aged 20-64 years, receiving a free diabetes prescription in a major urban area during 2001-2008 were included and followed-up for death until December 31, 2011. Crude mortality rates and standardized mortality rate ratios (SMR) against general population (data from the National Institute of Statistics) were calculated. Years lost due to diabetes were computed assuming the general population mortality rates for ages below 20 and above 64 years. Results: During the 11 years study period, 49,328 diabetes patients (mean age at baseline 53.0 ± 8.8 years) contributed 297,370 person-years and 5,053 deaths. All cause mortality rates (per 1000 person years) increased with age and was 3.4 in 20-24 years age group and 25.7 in 60-64 year age group, while the corresponding SMR decreased from 6.0 to 1.5. Diabetes patients aged 20-24 years had a life expectancy of 48.6 years, which was 6.6 years less compared with the corresponding general population (55.2 years). The gap was 7.0 years in women and 5.8 years in men. Diabetes patients aged 20-24 years lost 196 minutes of life daily due to diabetes in women and 182 minutes in men. Conclusions: Mortality rates increased, while mortality rate ratios against general population decreased with age. Men had higher mortality rates, but women had higher mortality rate ratios in the gender analysis.
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Affiliation(s)
- Sorin Ioacara
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Cristian Guja
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- c Neurology , "N. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases , Bucharest , Romania
| | | | - Sorina Martin
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Cristina Tiu
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- d University Emergency Hospital , Bucharest , Romania
| | - Simona Fica
- a Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
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24
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Schernthaner G, Wanner C, Jurišić-Eržen D, Guja C, Gumprecht J, Jarek-Martynowa IR, Karasik A, Lalić N, Mankovsky BN, Prázný M, Tankova T, Tsur A, Wascher TC, Wittmann I. CARMELINA: An important piece of the DPP-4 inhibitor CVOT puzzle. Diabetes Res Clin Pract 2019; 153:30-40. [PMID: 31121272 DOI: 10.1016/j.diabres.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 04/01/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022]
Abstract
Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of glucose-lowering agent for type 2 diabetes (T2D) that are commonly used in clinical practice. With the recent disclosure of data from the CARMELINA cardiovascular outcomes trial (CVOT), which investigated linagliptin, CV and renal outcomes data are now available for four agents in the DPP-4 inhibitor class that are approved in most markets. To consider how the CARMELINA study may be interpreted, and the relevance for our clinical practice, we convened as an expert group of diabetes specialists from the Central and Eastern Europe region to discuss the new disclosures. Our discussions revealed a general confidence in safety across the class that is further supported by CARMELINA. However, we also concluded that there are important differences in the available evidence level between agents in the setting of heart failure and data on renal outcomes. Here, we noted the clinical relevance to our practice of the study population in CARMELINA, which is unique among CVOTs in including a majority of patients with chronic kidney disease (CKD). Given the risk for future development of renal impairment that is associated with T2D even in patients without current overt CKD, we believe that the CARMELINA study provides important new insights that are clinically relevant for a broad range of patients. Finally, we discuss how these insights can be integrated into the approach to the pharmacotherapeutic management of hyperglycaemia that is recommended in newly updated guidelines.
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Affiliation(s)
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, Würzburg University Clinic, Würzburg, Germany.
| | - Dubravka Jurišić-Eržen
- Department of Endocrinology and Diabetology, University Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Avraham Karasik
- Sheba Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Nebojša Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Anat Tsur
- Endocrinology Clinic, Clalit Health Services, Jerusalem, Israel
| | | | - István Wittmann
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Hungary
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25
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Bain SC, Mosenzon O, Arechavaleta R, Bogdański P, Comlekci A, Consoli A, Deerochanawong C, Dungan K, Faingold MC, Farkouh ME, Franco DR, Gram J, Guja C, Joshi P, Malek R, Merino‐Torres JF, Nauck MA, Pedersen SD, Sheu WH‐H, Silver RJ, Tack CJ, Tandon N, Jeppesen OK, Strange M, Thomsen M, Husain M. Cardiovascular safety of oral semaglutide in patients with type 2 diabetes: Rationale, design and patient baseline characteristics for the PIONEER 6 trial. Diabetes Obes Metab 2019; 21:499-508. [PMID: 30284349 PMCID: PMC6587508 DOI: 10.1111/dom.13553] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 12/25/2022]
Abstract
AIMS To assess the cardiovascular (CV) safety of oral semaglutide, the first tablet formulation of a glucagon-like peptide-1 receptor agonist. MATERIALS AND METHODS PIONEER 6 is a multinational, randomized, placebo-controlled, double-blind trial in patients with type 2 diabetes at high risk of CV events (defined as being aged ≥50 years and having established CV disease [CVD] or moderate [stage 3] chronic kidney disease [CKD], or being aged ≥60 years with ≥1 other CV risk factor). Patients were randomized to once-daily oral semaglutide (up to 14 mg) or placebo added to standard of care. The primary composite endpoint is time to first occurrence of CV death or non-fatal myocardial infarction or non-fatal stroke. The primary hypothesis was to exclude an excess in CV risk with oral semaglutide by assessing non-inferiority versus placebo for the primary endpoint (non-inferiority margin of 1.8 for the upper boundary of the 95% confidence interval of the hazard ratio). PIONEER 6 is event-driven, with follow-up continuing until accrual of at least 122 primary outcome events. There is no pre-defined minimal duration. RESULTS Overall, 3183 patients have been enrolled (mean age 66.1 years, 31.6% females) in 214 sites across 21 countries. At baseline, the mean duration of diabetes was 14.9 years, mean glycated haemoglobin concentration was 66 mmol/mol (8.2%), and 84.6% of patients had established CVD/moderate CKD. CONCLUSIONS PIONEER 6 will provide evidence regarding the CV safety of oral semaglutide in patients with type 2 diabetes and high CV risk.
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Affiliation(s)
- Stephen C. Bain
- Diabetes Research Unit CymruSwansea University Medical SchoolSwanseaUK
| | - Ofri Mosenzon
- Diabetes Unit, Division of Internal MedicineHadassah Hebrew University HospitalJerusalemIsrael
| | | | - Pawel Bogdański
- Department of Education and Obesity Treatment and Metabolic DisordersPoznan University of Medical SciencesPoznanPoland
| | - Abdurrahman Comlekci
- Department of EndocrinologyDokuz Eylul University Faculty of Medicine, BalcovaIzmirTurkey
| | - Agostino Consoli
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI‐Met)"G. d'Annunzio" University of Chieti‐PescaraChietiItaly
| | | | - Kathleen Dungan
- Division of Endocrinology, Diabetes and MetabolismOhio State UniversityColumbusOhio
| | - Maria C. Faingold
- Department of Endocrinology and MetabolismDr Cesar Milstein HospitalBuenos AiresArgentina
| | - Michael E. Farkouh
- Peter Munk Cardiac Centre, University Health Network, Department of Medicine and the Heart and Stroke Richard Lewar CentreUniversity of TorontoTorontoOntarioCanada
| | | | - Jeppe Gram
- Department of EndocrinologyHospital of Southwest DenmarkEsbjergDenmark
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic DiseasesUniversity of Medicine and Pharmacy 'Carol Davila'BucharestRomania
| | - Pankaj Joshi
- Diabetes Care and Clinical Trials CentrePretoriaSouth Africa
| | - Rachid Malek
- Department of Internal MedicineCHU SétifSétifAlgeria
| | | | - Michael A. Nauck
- Diabetes Center Bochum‐Hattingen, Medical Department ISt Josef‐Hospital, Ruhr‐University BochumBochumGermany
| | - Sue D. Pedersen
- C‐ENDO Diabetes and Endocrinology ClinicCalgaryAlberta, Canada
| | - Wayne H. ‐H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- School of MedicineNational Defense Medical CentreTaipeiTaiwan
| | - Robert J. Silver
- Southern New Hampshire Diabetes and EndocrinologyNashuaNew Hampshire
| | - Cees J. Tack
- Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Nikhil Tandon
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia
| | | | | | | | - Mansoor Husain
- Peter Munk Cardiac Centre, University Health Network, Department of Medicine and the Heart and Stroke Richard Lewar CentreUniversity of TorontoTorontoOntarioCanada
- Toronto General Hospital Research Institute, and the Ted Rogers Centre for Heart ResearchTorontoCanada
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26
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Schernthaner G, Lotan C, Baltadzhieva-Trendafilova E, Ceponis J, Clodi M, Ducena K, Goncalvesova E, Guja C, Honka M, Janež A, Lalić N, Lehmann R, Nyolczas N, Pauklin P, Rynkiewicz A, Sergienko I, Duvnjak LS. Unrecognised cardiovascular disease in type 2 diabetes: is it time to act earlier? Cardiovasc Diabetol 2018; 17:145. [PMID: 30463621 PMCID: PMC6247507 DOI: 10.1186/s12933-018-0788-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/04/2018] [Accepted: 11/13/2018] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease (CVD) is the most significant prognostic factor in individuals with type 2 diabetes (T2D). However, a significant number of individuals may develop CVD that does not present with the classic angina-related or heart failure symptoms. In these cases, CVD may seem to be ‘silent’ or ‘asymptomatic’, but may be more accurately characterised as unrecognised diabetic cardiac impairment. An initial step to raise awareness of unrecognised CVD in individuals with T2D would be to reach a consensus regarding the terminology used to describe this phenomenon. By standardising the terminologies, and agreeing on the implementation of an efficient screening program, it is anticipated that patients will receive an earlier diagnosis and appropriate and timely treatment. Given the availability of anti-diabetic medications that have been shown to concomitantly reduce CV risk and mortality, it is imperative to improve early identification and initiate treatment as soon as possible in order to enable as many patients with T2D as possible to benefit.
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Affiliation(s)
| | - Chaim Lotan
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | | | - Jonas Ceponis
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Martin Clodi
- Department of Internal Medicine, St. John Hospital, Linz, Austria
| | - Kristine Ducena
- Faculty of Internal Medicine, University of Latvia, Riga, Latvia
| | - Eva Goncalvesova
- Department of Heart Failure and Transplantation, National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Marek Honka
- Fakultní Nemocnice Ostrava, Poruba, Czech Republic
| | - Andrej Janež
- National Institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | - Nebojša Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Roger Lehmann
- Division of Endocrinology and Diabetes of the University Hospital, Zurich, Switzerland
| | - Noémi Nyolczas
- Department of Cardiology, Hungarian Defence Forces-Medical Centre, Budapest, Hungary
| | - Priit Pauklin
- Department of Cardiology, Tartu University Hospital, Tartu, Estonia
| | - Andrzej Rynkiewicz
- Department of Cardiology and Cardiosurgery, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Lea Smirčić Duvnjak
- Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, Endocrinology and Metabolic Diseases, University of Zagreb, Zagreb, Croatia
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27
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Ionescu-Tirgoviste C, Gagniuc P, Guja C. A COMMENTARY ON CLASSIFICATION OF DIABETES: LATENT AUTOIMMUNE DIABETES IN ADULTS (LADA) OR INTERMEDIARY DIABETES MELLITUS (IDM)? Acta Endocrinol (Buchar) 2018; 14:520-524. [PMID: 31149306 PMCID: PMC6516414 DOI: 10.4183/aeb.2018.520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Diabetes Mellitus is a huge syndrome which can be detected from the first day of life until the last year of life of a centenarian. In the current classification of diabetes among the so-called "idiopathic phenotypes", apart Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) has been included provisionally term "Latent Autoimmune Diabetes in Adults" (LADA). This has unclear characterization regarding the age at onset, the presence of anti-β-cell antibodies and the level of insulin secretory function, in conformity with C-peptide levels. According to several recent publications, there are no specific biochemical or genetic markers for Latent Autoimmune Diabetes in Adults (LADA), but only a gradual transition from T1D to T2D. In addition, the word "latent" in the construction of "LADA" term is inaccurate because in this phenotype nothing is latent: both the autoimmunity and diabetes are present and are even parts of the diagnosis. So that, the best term should be what in reality this sub-phenotype is: an Intermediary Diabetes Mellitus (IDM). Some recent genetic data strongly support this designation.
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Affiliation(s)
| | - P. Gagniuc
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C. Guja
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Jabbour SA, Frías JP, Hardy E, Ahmed A, Wang H, Öhman P, Guja C. Safety and Efficacy of Exenatide Once Weekly Plus Dapagliflozin Once Daily Versus Exenatide or Dapagliflozin Alone in Patients With Type 2 Diabetes Inadequately Controlled With Metformin Monotherapy: 52-Week Results of the DURATION-8 Randomized Controlled Trial. Diabetes Care 2018; 41:2136-2146. [PMID: 30082326 PMCID: PMC6150435 DOI: 10.2337/dc18-0680] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Among patients with type 2 diabetes uncontrolled with metformin, exenatide once weekly (QW) plus dapagliflozin combination produced greater reductions in glycemia, weight, and systolic blood pressure (SBP) at 28 weeks than exenatide QW or dapagliflozin alone (DURATION-8). Here, we investigated the safety and maintenance of efficacy at 52 weeks, after a 24-week extension. RESEARCH DESIGN AND METHODS This phase 3, multicenter, double-blind study randomized adults with type 2 diabetes (with glycated hemoglobin [HbA1c] 8.0-12.0% [64-108 mmol/mol] and on metformin ≥1,500 mg/day) to exenatide QW (2-mg subcutaneous injection) plus once-daily dapagliflozin (10-mg oral tablet), exenatide QW plus oral placebo, or dapagliflozin plus injected placebo. Extension-period P values were nominal. RESULTS Of 1,375 patients screened, 695 were randomized (mean baseline HbA1c 9.3% [78 mmol/mol]); 81.2% completed the study, and 75.3% completed treatment. At 52 weeks, HbA1c reductions were greater with exenatide QW plus dapagliflozin (least squares mean change -1.75% [-19.1 mmol/mol]) versus exenatide QW (-1.38% [-15.1 mmol/mol]; P = 0.006) or dapagliflozin (-1.23% [-13.4 mmol/mol]; P < 0.001); mean HbA1c values were 6.9% (52 mmol/mol), 7.2% (55 mmol/mol), and 7.4% (57 mmol/mol), respectively. Weight and SBP reductions were greater with exenatide QW plus dapagliflozin (-3.31 kg and -4.5 mmHg) versus exenatide QW (-1.51 kg and -0.7 mmHg; both P < 0.001) but similar to those with dapagliflozin (-2.28 kg and -2.7 mmHg; P = 0.057 and P = 0.100, respectively). The exenatide QW plus dapagliflozin regimen was well tolerated with no unexpected safety findings; more patients treated with exenatide QW experienced gastrointestinal and injection site-related adverse events. No major hypoglycemia occurred. CONCLUSIONS Among patients with type 2 diabetes uncontrolled with metformin, exenatide QW plus dapagliflozin provided sustained improvements in glycemia, weight, and SBP over 52 weeks, with no unexpected safety findings.
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Affiliation(s)
- Serge A Jabbour
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | | | - Cristian Guja
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"N. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
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Guja C, Frías JP, Somogyi A, Jabbour S, Wang H, Hardy E, Rosenstock J. Effect of exenatide QW or placebo, both added to titrated insulin glargine, in uncontrolled type 2 diabetes: The DURATION-7 randomized study. Diabetes Obes Metab 2018; 20:1602-1614. [PMID: 29473704 PMCID: PMC6032936 DOI: 10.1111/dom.13266] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 12/08/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 02/07/2023]
Abstract
AIMS To compare the efficacy and safety of adding the glucagon-like peptide-1 receptor agonist exenatide once weekly (QW) 2 mg or placebo among patients with type 2 diabetes who were inadequately controlled despite titrated insulin glargine (IG) ± metformin. METHODS This multicentre, double-blind study (ClinicalTrials.gov identifier: NCT02229383) randomized (1:1) patients with persistent hyperglycaemia after an 8-week titration phase (glycated haemoglobin [HbA1c] 7.0%-10.5% [53-91 mmol/mol]) to exenatide QW or placebo. The primary endpoint was HbA1c change from baseline to week 28. Secondary endpoints included body weight, 2-hour postprandial glucose, and mean daily IG dose. RESULTS Of 464 randomized patients (mean: age, 58 years; HbA1c, 8.5% [69 mmol/mol]; diabetes duration, 11.3 years), 91% completed 28 weeks. Exenatide QW + IG vs placebo + IG significantly reduced HbA1c (least-squares mean difference, -0.73% [-8.0 mmol/mol]; 95% confidence interval, -0.93%, -0.53% [-10.2, -5.8 mmol/mol]; P < .001; final HbA1c, 7.55% [59 mmol/mol] and 8.24% [67 mmol/mol], respectively); body weight (-1.50 kg; -2.17, -0.84; P < .001); and 2-hour postprandial glucose (-1.52 mmol/L [-27.5 mg/dL]; -2.15, -0.90 [-38.7, -16.2]; P < .001). Significantly more exenatide QW + IG-treated patients vs placebo + IG-treated patients reached HbA1c <7.0% (<53 mmol/mol) (32.5% vs 7.4%; P < .001); daily IG dose increased by 2 and 4 units, respectively. Gastrointestinal and injection-site adverse events were more frequent with exenatide QW + IG (15.1% and 7.8%, respectively) than with placebo + IG (10.8% and 3.0%, respectively); hypoglycaemia incidence was similar between the exenatide QW + IG (29.7%) and placebo + IG (29.0%) groups, with no major hypoglycaemic events. CONCLUSIONS Among patients with inadequate glycaemic control, exenatide QW significantly improved glucose control and decreased body weight, without increased hypoglycaemia or unexpected safety findings.
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Affiliation(s)
- Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and PharmacyBucharestRomania
- National Institute of Diabetes, Nutrition and Metabolic Diseases, “NC Paulescu”BucharestRomania
| | | | - Aniko Somogyi
- 2nd Department of Internal Medicine, Semmelweis UniversityBudapestHungary
| | - Serge Jabbour
- Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvania
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Jabbour SA, Frías JP, Guja C, Hardy E, Ahmed A, Öhman P. Effects of exenatide once weekly plus dapagliflozin, exenatide once weekly, or dapagliflozin, added to metformin monotherapy, on body weight, systolic blood pressure, and triglycerides in patients with type 2 diabetes in the DURATION-8 study. Diabetes Obes Metab 2018; 20:1515-1519. [PMID: 29316164 PMCID: PMC5969082 DOI: 10.1111/dom.13206] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 10/17/2017] [Revised: 12/26/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023]
Abstract
This post hoc analysis assessed the effects on cardiovascular risk factors of body weight, systolic blood pressure (SBP) and triglycerides after 28 weeks' treatment with exenatide once weekly plus dapagliflozin, as compared with exenatide once weekly or dapagliflozin, in patient subpopulations from the DURATION-8 trial of patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin alone. Subgroups of patients were stratified according to their baseline body weight, SBP and triglyceride levels. Body weight, SBP and triglyceride levels were reduced across most respective subgroups, with no significant subgroup-by-treatment interactions. For each treatment, weight loss was numerically greater as baseline body mass index increased. SBP reductions were greater among patients with SBP ≥140 vs <140 mm Hg for exenatide once weekly plus dapagliflozin and exenatide once weekly. Reductions in triglyceride levels were greater among patients with baseline triglycerides <1.69 vs ≥1.69 mmol/L for each treatment. The combination of exenatide once weekly plus dapagliflozin reduced cardiovascular risk factors across baseline subgroups for each variable to a greater extent than did either individual drug; the greatest effects were observed in the high baseline subgroups for body weight and SBP.
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Affiliation(s)
- Serge A. Jabbour
- Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | | | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and PharmacyBucharestRomania
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Frías JP, Hardy E, Ahmed A, Öhman P, Jabbour S, Wang H, Guja C. Effects of exenatide once weekly plus dapagliflozin, exenatide once weekly alone, or dapagliflozin alone added to metformin monotherapy in subgroups of patients with type 2 diabetes in the DURATION-8 randomized controlled trial. Diabetes Obes Metab 2018; 20:1520-1525. [PMID: 29573139 PMCID: PMC5969323 DOI: 10.1111/dom.13296] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/17/2017] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 01/06/2023]
Abstract
This analysis assessed whether responses with exenatide once weekly plus dapagliflozin (n = 231), exenatide once weekly alone (n = 230), or dapagliflozin alone (n = 233) differed in key patient subpopulations of the DURATION-8 trial. Potential treatment-by-subgroup interactions for changes in glycated haemoglobin (HbA1c) and body weight after 28 weeks were evaluated among subgroups determined by baseline HbA1c, age, sex, body mass index, type 2 diabetes duration, race, ethnicity and estimated glomerular filtration rate (eGFR). Exenatide once weekly plus dapagliflozin reduced HbA1c and body weight across all subgroups: least-squares mean reductions ranged from -8.4 to -26.1 mmol/mol (-0.77% to -2.39%) for HbA1c and from -2.07 to -4.55 kg for body weight. Potential treatment-by-subgroup interactions (P < .10) were found for HbA1c change by age (P = .016) and eGFR (P = .097). Age subgroup analysis findings were not consistent with expected mechanistic effects, with the small number of patients aged ≥65 years (n = 74 vs n = 499 for patients aged <65 years) limiting the interpretability of the interaction term. In the exenatide once weekly plus dapagliflozin and dapagliflozin groups, but not the exenatide once weekly group, HbA1c reductions were greater among patients with eGFR ≥90 vs ≥60 to <90 mL/min/1.73 m2 (least-squares mean reductions of -23.6 vs -19.0 mmol/mol [-2.16% vs -1.74%], -17.3 vs -12.0 mmol/mol [-1.58% vs -1.10%], and -17.7 vs -16.9 mmol/mol [-1.62% vs -1.55%] for the respective treatments); this was consistent with the mechanism of action of dapagliflozin. A potential treatment-by-subgroup interaction was observed for change in body weight by sex (P = .099), with greater weight loss for women vs men across all treatments (range -2.56 to -3.98 kg vs -0.56 to -2.99 kg). In conclusion, treatment with exenatide once weekly plus dapagliflozin reduced HbA1c and body weight across all patient subgroups and was more effective than exenatide once weekly or dapagliflozin alone in all adequately sized subgroups.
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Affiliation(s)
| | | | | | | | - Serge Jabbour
- Division of Endocrinology, Diabetes and Metabolic DiseasesSidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | | | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic DiseasesCarol Davila University of Medicine and PharmacyBucharestRomania
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Abstract
PURPOSE To test the hypothesis that cumulative exposure to sulphonylurea (SU) or metformin (MET) have different effects on mortality when taken as a replacement or add-on of one for the other. METHODS All consecutive diabetes patients aged over 20 years were screened at their first diabetes outpatient visit between 2001 and 2008 (n = 79869). Only patients on MET (n = 11374) or SU (n = 18502) monotherapy were retained. All patients were followed up for death until December 31, 2011, but censored at first exposure to anything else besides MET/SU. Adjusted time-dependent Cox regression and competing risk regression analysis, with daily updates of treatment modalities were performed. RESULTS Mean age was 62.1 ± 11.2 years and follow-up was 4.6 ± 3.2 years (138496 person-years). Adjusted all-cause and cardiovascular mortality rates were significantly higher in MET as compared with SU group. All-cause mortality hazard ratios (HR) for cumulative time exposure were as follows: HR 0.956 (95%CI 0.951-0.962, p < 0.001) for SU added to MET, HR 1.092 (95%CI 1.087-1.096, p < 0.001) for SU replacing MET, HR 0.979 (95%CI 0.975-0.983, p < 0.001) for MET added to SU, and HR 1.127 (95%CI 1.118-1.136, p < 0.001) for MET replacing SU. CONCLUSION(S) The effect on all-cause mortality was beneficial for MET+SU combined therapy, but deleterious for either SU replacing MET, or MET replacing SU. There were no major outcome differences when analyzing individual SU, or specific mortality.
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Affiliation(s)
- Sorin Ioacara
- a Department of Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Department of Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Cristian Guja
- a Department of Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- c "I. Pavel" Outpatient clinic , Bucharest , Romania
| | - Aura Reghina
- a Department of Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Department of Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
- d "Victor Babes" National Research and Development Institute of Pathology and Biomedical Sciences , Bucharest , Romania
| | - Sorina Martin
- a Department of Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Department of Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Anca Sirbu
- a Department of Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Department of Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
| | - Simona Fica
- a Department of Endocrinology and diabetes , "Carol Davila" University of Medicine and Pharmacy , Bucharest , Romania
- b Department of Endocrinology and diabetes , "Elias" University Emergency Hospital , Bucharest , Romania
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Ferrannini E, Frias JP, Guja C, Hardy E, Öhman P, Jabbour S, DeFronzo R, Marbach S. Duration-8-Studie: Mechanismen der glykämischen Kontrolle unter Depot-Exenatide+Dapagliflozin im Vergleich zu den Einzelsubstanzen. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Ferrannini
- CNR Institute of Clinical Physiology, Pisa, Italy
| | - JP Frias
- National Research Institute, Los Angeles, United States
| | - C Guja
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - E Hardy
- AstraZeneca, Gaithersburg, United States
| | - P Öhman
- AstraZeneca, Gaithersburg, United States
| | - S Jabbour
- Thomas Jefferson University, Philadelphia, United States
| | - R DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, United States
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Frias JP, Rosenstock J, Somogyi A, Jabbour S, Wang H, Hardy E, Guja C, Müller D. Wirksamkeit und Verträglichkeit von Depot-Exenatide gegenüber Placebo als Add-on zu Insulin glargin bei Typ-2-Diabetes-Patienten mit unzureichender glykämischer Kontrolle unter Basalinsulin: Duration-7-Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- JP Frias
- National Research Institute, Los Angeles, United States
| | - J Rosenstock
- Dallas Diabetes Research Center at Medical City, Dallas, United States
| | - A Somogyi
- Semmelweis University, Budapest, Hungary
| | - S Jabbour
- Thomas Jefferson University, Philadelphia, United States
| | - H Wang
- AstraZeneca, Gaithersburg, United States
| | - E Hardy
- AstraZeneca, Gaithersburg, United States
| | - C Guja
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Guja C, Frias JP, Ahmed A, Hardy E, Wang H, Öhman P, Jabbour S, Löffler T. 1-Jahresergebnisse der randomisierten, kontrollierten Duration-8-Studie: Wirksamkeit und Verträglichkeit von Depot-Exenatide in Kombination mit täglichem Dapagliflozin gegenüber Monotherapie mit Depot-Exenatide oder Dapagliflozin. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C Guja
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - JP Frias
- National Research Institute, Los Angeles, United States
| | - A Ahmed
- Apex Medical Research, Chicago, United States
| | - E Hardy
- AstraZeneca, Gaithersburg, United States
| | - H Wang
- AstraZeneca, Gaithersburg, United States
| | - P Öhman
- AstraZeneca, Gaithersburg, United States
| | - S Jabbour
- Thomas Jefferson University, Philadelphia, United States
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Rosu MM, Popa SG, Mota E, Popa A, Manolache M, Guja C, Bala C, Mota C, Mota M. CARDIOVASCULAR RISK ASSESSMENT IN THE ADULT (AGED 40-79 YEARS) ROMANIAN POPULATION. Acta Endocrinol (Buchar) 2018; 14:227-234. [PMID: 31149262 DOI: 10.4183/aeb.2018.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Atherosclerotic Cardiovascular Diseases are the leading cause of death worldwide. Aim To estimate the prevalence of cardiovascular risk (CVR) categories in the adult population (aged 40-79 years) of Romania. Design The present study was part of the epidemiological, cross-sectional PREDATORR study (PREvalence of DiAbeTes mellitus, prediabetes, overweight, Obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romania). Subjects and Methods Exclusion criteria: age <40/or>79 years old and diagnosis of ischemic vascular disease. The CVR was evaluated using charts developed by the World Health Organization/ International Society of Hypertension (WHO/ISH) available for Europe B (epidemiological sub-region where Romania was included). The CVR was divided into 5 categories: <10%, 10-20%, 20-30%, 30-40%, > 40%. Results A total of 1631 subjects (57.0±10.7 years, 45.1% males) were included in the present study.The age and sex-adjusted prevalence of CVR >40% was 2.9% (95%CI 2.8-3.1%), CVR 30-40% was 1.85% (95%CI 1.8-1.9%), CVR 20-30% was 5.8% (95%CI 5.6-6.0%) and 13.0% (95%CI 12.8-13.3%) of the adult Romanian population has a 10-20% CVR, these CVR categories being more frequent in male and older age. Diabetes, overweight/obesity and smoking were associated with high CVR categories. Conclusion Romania is one of the countries with high CVR, requiring CVD prevention measures.
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Affiliation(s)
- M M Rosu
- Clinical County Emergency Hospital Craiova, Romania, Dept. of Diabetes, Nutrition and Metabolic Diseases, Craiova University of Medicine and Pharmcy, Romania
| | - S G Popa
- Dept. of Diabetes, Nutrition and Metabolic Diseases, Romania
| | - E Mota
- Dept. of Nephrology, Romania
| | - A Popa
- Clinical Emergency Hospital, Department of Diabetes, Nutrition and Metabolic Diseases - Craiova, Romania
| | | | - C Guja
- "N.C. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases - Bucharest, Romania
| | - C Bala
- "Iuliu Hatieganu" University of Medicine and Pharmacy - Diabetes, Nutrition and Metabolic Diseases - Cluj-Napoca, Romania
| | - C Mota
- "Iuliu Hatieganu" University of Medicine and Pharmacy - Diabetes, Nutrition and Metabolic Diseases - Cluj-Napoca, Romania
| | - M Mota
- Dept. of Diabetology, Romania.,Clinical Emergency Hospital, Department of Diabetes, Nutrition and Metabolic Diseases - Craiova, Romania
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Guja C, Mihai A. Exenatide QW – New Perspectives 5 Years after its First Use. Romanian Journal of Diabetes Nutrition and Metabolic Diseases 2017. [DOI: 10.1515/rjdnmd-2017-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Diseases “Prof. N.C. Paulescu” , Bucharest , Romania ; University of Medicine and Pharmacy “Carol Davila” , Bucharest , Romania
| | - Andrada Mihai
- National Institute of Diabetes, Nutrition and Metabolic Diseases “Prof. N.C. Paulescu” , Bucharest , Romania ; University of Medicine and Pharmacy “Carol Davila” , Bucharest , Romania
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Popa SG, Moţa M, Mihălţan FD, Popa A, Munteanu I, Moţa E, Serafinceanu C, Guja C, Hâncu N, Catrinoiu D, Lichiardopol R, Bala C, Mihai B, Radulian G, Roman G, Timar R. Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study. Eur J Gen Pract 2017; 23:164-170. [PMID: 28595498 PMCID: PMC5774259 DOI: 10.1080/13814788.2017.1324844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/24/2017] [Accepted: 04/05/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function. OBJECTIVES To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study. METHODS PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires. RESULTS Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6 ± 50.4 versus 213.9 ± 86.8 mg/dl, P = 0.017), LDL-cholesterol (137.8 ± 45.2 versus 130.7 ± 83.7 mg/dl, P = 0.004) and glomerular filtration rate (96.9 ± 16.8 versus 90.7 ± 19.1 ml/min/1.73 m2, P <0.001) in women and higher triglycerides (170.7 ± 129.8 versus 144.3 ± 94.2 mg/dl, P = 0.007), glomerular filtration rate (97.6 ± 17 versus 90.3 ± 18 ml/min/1.73 m2, P < 0.001) and lower HDL-cholesterol (48 ± 15.5 versus 50.4 ± 14.1 mg/dl, P = 0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01-1.96), P = 0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01-1.91), P = 0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48-0.94), P = 0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P = 0.02), hypertriglyceridaemia (43.6% versus 35.6%, P = 0.01), hypertension (64% versus 56.4%, P = 0.01) and ischaemic vascular disease (40.5% versus 30.9%, P = 0.003) than male non-smokers. CONCLUSION The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.
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Affiliation(s)
- Simona Georgiana Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of CraiovaCraiovaRomania
| | - Maria Moţa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of CraiovaCraiovaRomania
| | | | - Adina Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Emergency Hospital of CraiovaCraiovaRomania
| | - Ioana Munteanu
- Pneumoftiziology Institute ‘Marius Nasta’ BucharestBucharestRomania
| | - Eugen Moţa
- Department of Nephrology, University of Medicine and Pharmacy of CraiovaCraiovaRomania
| | - Cristian Serafinceanu
- Department of Diabetes, University of Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
| | - Cristian Guja
- Department of Diabetes, University of Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
| | - Nicolae Hâncu
- Department of Diabetes, University of Medicine and Pharmacy ‘Iuliu Haţieganu’ Cluj-NapocaCluj-NapocaRomania
| | - Doina Catrinoiu
- Faculty of Medicine, ’Ovidius’ University ConstanţaConstanţaRomania
| | - Radu Lichiardopol
- Department of Diabetes, University of Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
| | - Cornelia Bala
- Department of Diabetes, University of Medicine and Pharmacy ‘Iuliu Haţieganu’ Cluj-NapocaCluj-NapocaRomania
| | - Bogdan Mihai
- Department of Diabetes, University of Medicine and Pharmacy ‘Gr. T. Popa’ IaşiIaşiRomania
| | - Gabriela Radulian
- Department of Diabetes, University of Medicine and Pharmacy ‘Carol Davila’ BucharestBucharestRomania
| | - Gabriela Roman
- Department of Diabetes, University of Medicine and Pharmacy ‘Iuliu Haţieganu’ Cluj-NapocaCluj-NapocaRomania
| | - Romulus Timar
- Department of Diabetes, University of Medicine and Pharmacy ‘Victor Babeş’ TimişoaraTimişoaraRomania
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Guja C, Dănciulescu Miulescu R. Semaglutide-the " new kid on the block" in the field of glucagon-like peptide-1 receptor agonists? Ann Transl Med 2017; 5:475. [PMID: 29285508 DOI: 10.21037/atm.2017.10.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N.C. Paulescu", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Rucsandra Dănciulescu Miulescu
- National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N.C. Paulescu", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Stefan DS, Mihai A, Bajko D, Lixandru D, Petcu L, Picu A, Smeu B, Copaescu C, Ionescu Tirgoviste C, Guja C. Comparison of Sleeve Gastrectomy and Conservatory Treatment Effect on Biochemical and Hormonal Profile of Obese Type 2 Diabetes Subjects: CREDOR Randomized Controlled Study Results. Rev Chim 2017. [DOI: 10.37358/rc.17.7.5730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Metabolic surgery is the most efficacious method for the treatment of morbid obesity and was recently included among the antidiabetes treatments recommended in obese type 2 diabetes (T2D) patients. The aim of this study was to compare in a randomized controlled trial the effect of sleeve gastrectomy (SG) to that of intensive lifestyle intervention plus pharmacologic treatment on some markers of insulin resistance and beta cell function as well as some appetite controlling hormones in a group of male obese T2D subjects. The study groups comprised 20 subjects for SG and 21 control subjects. Fasting blood glucose, insulin, proinsulin, adiponectin, leptin, ghrelin, HOMA-IR, HOMA-%B, proinsulin-to-insulin ratio and proinsulin-to-adiponectin ratio were evaluated at baseline and after one year follow-up. Overall, patients in the SG group lost 78.98% of excess weight loss (%EWL) in comparison with 9.45% in the control group. This was accompanied by a significant improvement of insulin resistance markers, including increase of adiponectin and decrease of HOMA-IR, while no changes were recorded in the control group. Weight loss was also associated with a significant improvement of proinsulin-to-insulin and proinsulin-to-adiponectin ratio, both surrogate markers of beta cell dysfunction. These also improved in the control group, but were only marginally significant. Our findings suggest that improved insulin resistance and decreased beta cell dysfunction after sleeve gastrectomy might explain diabetes remission associated with metabolic surgery.
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Ioacara S, Guja C, Georgescu O, Martin S, Sirbu A, Purcaru M, Fica S. PATIENTS TREATED WITH INSULIN AND SULPHONYLUREA ARE AT INCREASED MORTALITY RISK AS COMPARED WITH THOSE TREATED WITH INSULIN PLUS METFORMIN. Acta Endocrinol (Buchar) 2017; 13:329-333. [PMID: 31149195 PMCID: PMC6516581 DOI: 10.4183/aeb.2017.329] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the effect of sulphonylurea (SU) treatment on all-cause and cardiovascular mortality as compared with metformin (MET), when used in combination with insulin (INS) in type 2 diabetes. METHODS All type 2 diabetes patients aged ≥40 years were included at their first prescription of INS+MET or INS+SU, during 2001-2008. They were considered at risk until death or December 31st, 2011. Mortality rates were calculated per 1000 person-years. Crude and adjusted rate ratios (RR) were calculated using time dependent analysis with INS+MET as reference. RESULTS There were 7122 patients (60.8% women) included in the analysis, with a mean age at baseline of 62.0±9.9 years. During the 11 years of study, patients on INS+MET contributed 13620 person-years and 330 deaths (mortality rate 24, CI95% 22-27), while those on INS+SU contributed 8720 person-years and 393 deaths (mortality rate 45, CI95% 41-50). Adjusted all-cause mortality RR were: SU 1.6 (CI95% 1.21-2.11, p<0.001), glimepiride 1.18 (CI95% 0.73-1.91, p=0.51), gliclazide 1.78 (CI95% 1.07-2.95, p=0.024), glibenclamide 1.66 (CI95% 0.71-3.88, p=0.23), glipizide 1.24 (CI95% 0.68-2.27, p=0.49), and gliquidonum 2.32 (CI95% 1.54-3.50, p=0.001). CONCLUSIONS When combined with insulin as dual therapy, patients treated with SU were at increased mortality risk as compared with insulin + MET.
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Affiliation(s)
- S. Ioacara
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Elias” University Emergency Hospital, Bucharest, Romania
| | - C. Guja
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
| | - O. Georgescu
- “Elias” University Emergency Hospital, Bucharest, Romania
| | - S. Martin
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Elias” University Emergency Hospital, Bucharest, Romania
| | - A. Sirbu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Elias” University Emergency Hospital, Bucharest, Romania
| | - M. Purcaru
- “Elias” University Emergency Hospital, Bucharest, Romania
| | - S. Fica
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Elias” University Emergency Hospital, Bucharest, Romania
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Frias J, Guja C, Hardy E, Azazuddin A, Fang D, Öhman P, Jabbour S, Rodrigues Costa M. Exenatide einmal wöchentlich plus Dapagliflozin einmal täglich versus Exenatide oder Dapagliflozin allein bei Patienten mit Typ 2 Diabetes, für die eine Metformin-Monotherapie nicht ausreichend war (DURATION-8): Eine 28-wöchige, multizentrische, doppelblinde, randomisierte, kontrollierte Phase-3-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Frias
- National Research Institute, Los Angeles, United States
| | - C Guja
- University of Medicine and Pharmacy, Bucarest, Romania
| | - E Hardy
- AstraZeneca, Gaithersburg, United States
| | - A Azazuddin
- Rush University Medical Center, Chicago, United States
| | - D Fang
- AstraZeneca, Gaithersburg, United States
| | - P Öhman
- AstraZeneca, Gaithersburg, United States
| | - S Jabbour
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, United States
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Frías JP, Guja C, Hardy E, Ahmed A, Dong F, Öhman P, Jabbour SA. Exenatide once weekly plus dapagliflozin once daily versus exenatide or dapagliflozin alone in patients with type 2 diabetes inadequately controlled with metformin monotherapy (DURATION-8): a 28 week, multicentre, double-blind, phase 3, randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4:1004-1016. [PMID: 27651331 DOI: 10.1016/s2213-8587(16)30267-4] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [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] [Received: 08/12/2016] [Revised: 08/27/2016] [Accepted: 08/31/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce glycaemia and weight, and improve cardiovascular risk factors via different mechanisms. We aimed to compare the efficacy and safety of co-initiation of the GLP-1 receptor agonist exenatide and the SGLT2 inhibitor dapagliflozin with exenatide or dapagliflozin alone in patients with type 2 diabetes inadequately controlled by metformin. METHODS DURATION-8 was a 28 week, multicentre, double-blind, randomised, active-controlled phase 3 trial done at 109 sites in six countries. Adults (aged ≥18 years) with type 2 diabetes and inadequate glycaemic control (HbA1c 8-12% [64-108 mmol/mol]) despite stable metformin monotherapy (≥1500 mg/day) were randomly assigned (1:1:1), via an interactive voice and web-response system, to receive once-weekly exenatide 2 mg by subcutaneous injection plus once-daily dapagliflozin 10 mg oral tablets, exenatide with dapagliflozin-matched oral placebo, or dapagliflozin with exenatide-matched placebo injections. Randomisation was stratified by baseline HbA1c (<9·0% vs ≥9·0% [<75 mmol/mol vs ≥75 mmol/mol]). The primary endpoint was change in HbA1c from baseline to week 28. Secondary endpoints were the change from baseline in fasting plasma glucose at week 2 and week 28, and 2 h postprandial glucose at week 28; the proportion of patients with an HbA1c less than 7·0% (<53 mmol/mol) at week 28; change in weight at week 28; the proportion of patients with weight loss of 5% or more at week 28; and change in systolic blood pressure at week 28. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02229396. FINDINGS Between Sept 4, 2014, and Oct 15, 2015, we randomly assigned 695 patients to receive exenatide plus dapagliflozin (n=231), exenatide alone (n=231; n=1 untreated), or dapagliflozin alone (n=233). The intention-to-treat population comprised 685 participants (mean HbA1c 9·3% [SD 1·1]; 78 mmol/mol [12]), of whom 611 (88%) completed the study. After 28 weeks, the change in baseline HbA1c was -2·0% (95% CI -2·1 to -1·8) in the exenatide plus dapagliflozin group, -1·6% (-1·8 to -1·4) in the exenatide group, and -1·4% (-1·6 to -1·2) in the dapagliflozin group. Exenatide plus dapagliflozin significantly reduced HbA1c from baseline to week 28 compared with exenatide alone (-0·4% [95% CI -0·6 to -0·1]; p=0·004) or dapagliflozin alone (-0·6% [-0·8 to -0·3]; p<0·001). Exenatide plus dapagliflozin was significantly superior to either drug alone for all secondary efficacy endpoints, with greater reductions in fasting plasma and postprandial glucose, more patients with an HbA1c less than 7·0% (<53 mmol/mol), greater weight loss, a greater proportion of patients with weight loss of 5% or more, and greater reductions in systolic blood pressure (all p≤0·025). Adverse events were recorded in 131 (57%) of 231 patients in the exenatide plus dapagliflozin group, 124 (54%) of 230 patients in the exenatide group, and 121 (52%) of 233 patients in the dapagliflozin group. The most common adverse events (≥5% of patients in any group) were diarrhoea, injection-site nodules, nausea, and urinary tract infections. No episodes of major hypoglycaemia or minor hypoglycaemia were reported. INTERPRETATION Co-initiation of exenatide and dapagliflozin improved various glycaemic measures and cardiovascular risk factors in patients with type 2 diabetes inadequately controlled by metformin monotherapy. The dual treatment regimen was well tolerated, with the expected safety profile for this combination. Additional data from an ongoing study (eg, AWARD-10; NCT02597049) will further inform the use of these drug classes in combination. FUNDING AstraZeneca.
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Affiliation(s)
- Juan P Frías
- National Research Institute, Los Angeles, CA, USA.
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 1st Clinic of Diabetes, N Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
| | | | - Azazuddin Ahmed
- Apex Medical Research, Chicago, IL, USA; John H Stroger Jr Hospital, Chicago, IL, USA; Rush University Medical Center, Chicago, IL, USA
| | | | | | - Serge A Jabbour
- Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Popa S, Moţa M, Popa A, Moţa E, Serafinceanu C, Guja C, Catrinoiu D, Hâncu N, Lichiardopol R, Bala C, Popa A, Roman G, Radulian G, Timar R, Mihai B. Prevalence of overweight/obesity, abdominal obesity and metabolic syndrome and atypical cardiometabolic phenotypes in the adult Romanian population: PREDATORR study. J Endocrinol Invest 2016; 39:1045-53. [PMID: 27126310 DOI: 10.1007/s40618-016-0470-4] [Citation(s) in RCA: 37] [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: 02/17/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The objectives were to assess the prevalence of overweight/obesity, abdominal obesity and metabolic syndrome (MetS), and to evaluate the characteristics of the metabolically unhealthy lean (MUHL) and metabolically healthy overweight/obese (MHO) phenotypes in a Romanian population-based sample from the PREDATORR study. METHODS PREDATORR was an epidemiological study with a stratified, cross-sectional, cluster random sampling design. Participants were classified into four cardiometabolic phenotypes based on the BMI, the cut-off value being 25 kg/m(2), and the presence of MetS (defined according to the Harmonization definition 2009): MUHL, MHO, metabolically healthy lean (MHL) and metabolically unhealthy overweight/obese (MUHO). RESULTS Overall, 2681 subjects aged 20-79 years were included in the analysis. The overall age and sex-adjusted prevalence of obesity was 31.90 %, overweight was 34.7 %, abdominal obesity was 73.90 % and MetS was 38.50 %. The age- and sex-adjusted prevalence of MHO phenotype was 31.60 %, while MUHL phenotype prevalence was 3.90 %. MUHL and MHO participants had a cardiometabolic profile, kidney function and CVD risk intermediary between MHL and MUHO. MUHL had higher odds of being associated with CVD risk (OR 5.8; p < 0.001), abdominal obesity, prediabetes, diabetes, hypertriglyceridemia and hypo-HDL cholesterolemia than MHL, while MHO phenotype was associated with hypo-HDL cholesterolemia (OR 3.1; p = 0.002), prediabetes (OR 2.9; p < 0.001) and abdominal obesity. CONCLUSIONS PREDATORR study showed a high prevalence of obesity/overweight, abdominal obesity and MetS in the adult Romanian population, and their association with kidney function and several cardiometabolic factors.
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Affiliation(s)
- S Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, 2-4 Petru Rares Street, Craiova, Romania
| | - M Moţa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, 2-4 Petru Rares Street, Craiova, Romania.
| | - A Popa
- Emergency Clinical Hospital Craiova, Craiova, Romania
| | - E Moţa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, 2-4 Petru Rares Street, Craiova, Romania
| | - C Serafinceanu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - C Guja
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - D Catrinoiu
- University "Ovidius"Constanţa, Constanţa, Romania
| | - N Hâncu
- University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania
| | - R Lichiardopol
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - C Bala
- University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania
| | - A Popa
- University Oradea, Oradea, Romania
| | - G Roman
- University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania
| | - G Radulian
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - R Timar
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - B Mihai
- University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
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Mota M, Popa SG, Mota E, Mitrea A, Catrinoiu D, Cheta DM, Guja C, Hancu N, Ionescu-Tirgoviste C, Lichiardopol R, Mihai BM, Popa AR, Zetu C, Bala CG, Roman G, Serafinceanu C, Serban V, Timar R, Veresiu IA, Vlad AR. Prevalence of diabetes mellitus and prediabetes in the adult Romanian population: PREDATORR study. J Diabetes 2016; 8:336-44. [PMID: 25850521 DOI: 10.1111/1753-0407.12297] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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] [Received: 03/16/2015] [Revised: 03/27/2015] [Accepted: 03/29/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The PREDATORR (PREvalence of DiAbeTes mellitus, prediabetes, overweight, Obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romania) study is the first national study analyzing the prevalence of diabetes mellitus (DM) and prediabetes, and their association with cardiometabolic, sociodemographic, and lifestyle risk factors in the Romanian population aged 20-79 years. METHODS This was an epidemiological study with a stratified, cross-sectional, cluster random sampling design. Sociodemographic, lifestyle, and anamnestic data were collected through self- and interviewer-administered questionnaires, and biochemical assays and oral glucose tolerance tests were performed. RESULTS In all, 2728 participants from 101 clinics of general practitioners were randomly selected, with a probability proportional to population size according to the 2002 Romanian Census. The participation rate was 99.6%. Impaired glucose regulation (prediabetes, known and unknown DM) was found in 28.1% of the study population. The overall age- and sex-adjusted prevalence of DM was 11.6% (95% CI 9.6%-13.6%), of which 2.4% (95% CI 1.7%-3.1%) had unknown DM. The prevalence of DM increased with age and was higher in men than in women. The age- and sex-adjusted prevalence of prediabetes was 16.5% (95%CI 14.8%-18.2%), with the highest percentage in the 60-79 year age group and in women. Obesity, abdominal obesity, dyslipidemia, low education level, and a family history of diabetes were associated with glucose metabolism disorders. CONCLUSIONS The PREDATORR study shows a high prevalence of impaired glucose regulation in the adult Romanian population, providing data on the prevalence of DM and prediabetes and their association with several risk factors.
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Affiliation(s)
- Maria Mota
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy, Craiova, Romania
| | - Simona Georgiana Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy, Craiova, Romania
| | - Eugen Mota
- Department of Nephrology, University of Medicine and Pharmacy, Craiova, Romania
| | - Adina Mitrea
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Emergency Hospital, Craiova, Romania
| | - Doina Catrinoiu
- Faculty of Medicine, "Ovidius" University, Constanţa, Romania
| | - Dan Mircea Cheta
- Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Cristian Guja
- Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Nicolae Hancu
- Diabetes and Nutrition Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | | | - Radu Lichiardopol
- Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Bogdan Mircea Mihai
- Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Gr. T. Popa", Iaşi, Romania
| | | | - Cornelia Zetu
- Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Cornelia Gabriela Bala
- Diabetes and Nutrition Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Gabriela Roman
- Diabetes and Nutrition Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Cristian Serafinceanu
- Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Viorel Serban
- Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania
| | - Romulus Timar
- Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania
| | - Ioan Andrei Veresiu
- Diabetes and Nutrition Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Adrian Radu Vlad
- Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania
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Ionescu-Tîrgovişte C, Gagniuc PA, Guja C. Structural Properties of Gene Promoters Highlight More than Two Phenotypes of Diabetes. PLoS One 2015; 10:e0137950. [PMID: 26379145 PMCID: PMC4574929 DOI: 10.1371/journal.pone.0137950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/25/2015] [Indexed: 01/20/2023] Open
Abstract
Genome-wide association studies (GWAS) published in the last decade raised the number of loci associated with type 1 (T1D) and type 2 diabetes (T2D) to more than 50 for each of these diabetes phenotypes. The environmental factors seem to play an important role in the expression of these genes, acting through transcription factors that bind to promoters. Using the available databases we examined the promoters of various genes classically associated with the two main diabetes phenotypes. Our comparative analyses have revealed significant architectural differences between promoters of genes classically associated with T1D and T2D. Nevertheless, five gene promoters (about 16%) belonging to T1D and six gene promoters (over 19%) belonging to T2D have shown some intermediary structural properties, suggesting a direct relationship to either LADA (Latent Autoimmune Diabetes in Adults) phenotype or to non-autoimmune type 1 phenotype. The distribution of these promoters in at least three separate classes seems to indicate specific pathogenic pathways. The image-based patterns (DNA patterns) generated by promoters of genes associated with these three phenotypes support the clinical observation of a smooth link between specific cases of typical T1D and T2D. In addition, a global distribution of these DNA patterns suggests that promoters of genes associated with T1D appear to be evolutionary more conserved than those associated with T2D. Though, the image based patterns obtained by our method might be a new useful parameter for understanding the pathogenetic mechanism and the diabetogenic gene networks.
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Affiliation(s)
| | - Paul Aurelian Gagniuc
- National Institute of Diabetes, Nutrition and Metabolic Diseases “N.C. Paulescu”, Bucharest, Romania
- National Institute of Pathology "Victor Babes", Bucharest, Romania
- Department of Genetics, University of Bucharest, Aleea Portocalelor 1–3, Sector 6, Bucharest, Romania
- * E-mail:
| | - Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Diseases “N.C. Paulescu”, Bucharest, Romania
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Moţa E, Popa SG, Moţa M, Mitrea A, Penescu M, Tuţă L, Serafinceanu C, Hâncu N, Gârneaţă L, Verzan C, Lichiardopol R, Zetu C, Căpuşă C, Vlăduţiu D, Guja C, Catrinoiu D, Bala C, Roman G, Radulian G, Timar R, Mihai B. Prevalence of chronic kidney disease and its association with cardio-metabolic risk factors in the adult Romanian population: the PREDATORR study. Int Urol Nephrol 2015; 47:1831-8. [PMID: 26377494 DOI: 10.1007/s11255-015-1109-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/05/2015] [Indexed: 01/02/2023]
Abstract
PURPOSE PREDATORR is the first national study analyzing the prevalence of chronic kidney disease and its prognosis and association with socio-demographic, cardio-metabolic and lifestyle risk factors in the adult Romanian population. METHODS Chronic kidney disease was defined according to the KDIGO 2012 criteria as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) and/or urinary albumin-to-creatinine ratio ≥30 mg/g. The socio-demographic, lifestyle and anamnestic data were collected through interviewer-administered questionnaires. Physical examination and biochemical assays were also performed. RESULTS This cross-sectional study conducted between December 2012 and February 2014 in Romania included 2717 adults. The overall age- and sex-adjusted prevalence of chronic kidney disease was 6.74 % (95 %CI 5.60-7.88 %), of which 3.31 % (2.50-4.13 %) had only reduced kidney function (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), 2.98 % (2.21-3.76 %) had only albuminuria, and 0.45 % (0.14-0.74 %) had both. The prevalence of chronic kidney disease increased with age and was similar in women and in men. Age, hyperuricemia, impaired glucose regulation (diabetes/prediabetes), hypertriglyceridemia and a family history of renal disease were independent risk factors for the presence of chronic kidney disease. CONCLUSIONS The PREDATORR study showed a high prevalence of chronic kidney disease in the adult Romanian population providing data on its prognosis and association with several cardio-metabolic risk factors.
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Affiliation(s)
- Eugen Moţa
- Department of Nephrology, University of Medicine and Pharmacy Craiova, 2-4 Petru Rares Street, Craiova, Romania
| | - Simona Georgiana Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, 2-4 Petru Rares Street, Craiova, Romania
| | - Maria Moţa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, 2-4 Petru Rares Street, Craiova, Romania. .,Emergency Clinical Hospital Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Romania, 1 Tabaci Street, Craiova, Romania.
| | - Adina Mitrea
- Emergency Clinical Hospital Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Romania, 1 Tabaci Street, Craiova, Romania
| | - Mircea Penescu
- Department of Nephrology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Liliana Tuţă
- Department of Nephrology, University "Ovidius" Constanta, 1 Aleea Universitatii, Constanta, Romania
| | - Cristian Serafinceanu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Nicolae Hâncu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, 2-4 Clinicilor Street, Cluj-Napoca, Romania
| | - Liliana Gârneaţă
- Department of Nephrology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Constantin Verzan
- Department of Nephrology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Radu Lichiardopol
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Cornelia Zetu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Cristina Căpuşă
- Department of Nephrology, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Dan Vlăduţiu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, 2 Victor Babes Street, Cluj-Napoca, Romania
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Doina Catrinoiu
- Department of Diabetes, Nutrition and Metabolic Diseases, University "Ovidius" Constanta, 1 Aleea Universitatii, Constanta, Romania
| | - Cornelia Bala
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, 2-4 Clinicilor Street, Cluj-Napoca, Romania
| | - Gabriela Roman
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, 2-4 Clinicilor Street, Cluj-Napoca, Romania
| | - Gabriela Radulian
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila" Bucharest, 8 Eroilor Sanitari Boulevard, Bucharest, Romania
| | - Romulus Timar
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Victor Babes" Timisoara, 2 Piata Eftimie Murgu, Timisoara, Romania
| | - Bogdan Mihai
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, 16 Universitatii Street, Iasi, Romania
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Guja C. Closed Loop Systems In Type 1 Diabetes – A Dream That Might Soon Come True? Romanian Journal of Diabetes Nutrition and Metabolic Diseases 2015. [DOI: 10.1515/rjdnmd-2015-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Diseases “Prof. NC Paulescu”, Bucharest
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Ionescu-Tîrgoviște C, Guja C. Editorial: Insulitis in Diabetes – History and Significance. Romanian Journal of Diabetes Nutrition and Metabolic Diseases 2015. [DOI: 10.1515/rjdnmd-2015-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Cristian Guja
- National Institute of Diabetes, Nutrition and Metabolic Diseases “Prof. NC Paulescu”, Bucharest
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Mihai A, Lixandru D, Alexandru P, Stoian I, Carniciu S, Mitu M, Guja C, Ionescu-Tirgoviste C. Negative association between paraoxonase 2, anthropometric markers and metabolic syndrome. Open Life Sci 2015. [DOI: 10.1515/biol-2015-0037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackground Metabolic syndrome (MS) has a great impact on cardiovascular mortality and morbidity. Our aim was to investigate the association of MS with some oxidant and antioxidant markers, including pro-and antioxidant status of peripheral blood mononuclear cells (PBMC) in newly diagnosed type 2 diabetic mellitus patients (ND-T2D). Methods 219 ND-T2D and 88 healthy subjects were divided in two groups according to the absence or presence of MS. Anthropometric measurements, routine blood tests, total oxidant status (TOS), total antioxidant status (TAS) and ELISA measurements were included. The PBMC capacity to release free radicals and to neutralize them was also determined by measuring the respiratory burst (RB) together with the lactonase activity of the intracellular antioxidant enzyme paraoxonase 2 (PON2). Results Comparing ND-T2D MS+ with those MS- the RB of the PBMC was significantly higher (p<0.05) while lactonase PON2 enzymatic activity was decreased (p < 0.001). A negative correlation of RB was found with TAS (r = -0.416, p < 0.05). PON2 was also negatively correlated with glycaemia (r = -0.275, p < 0.001), HbA1c (r = -0.308, p < 0.001), weight (r = -0.183; p < 0.05), waist circumference (r = -0.353, p < 0.001) and body mass index (r = -0.290, p < 0.001). Conclusion PON2 lactonase activity is negatively associated with anthropometric markers in ND-T2D with MS.
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