Effect of Teneligliptin 20 mg Twice Daily on Glucagon-Like Peptide-1 Levels and Its Influence on Non-Glycemic Components in Non-Diabetic Obese Individuals

Background and Aims: Teneligliptin is an oral antidiabetic agent, it can persevere glucagon-like peptide-1 (GLP-1) by inhibiting dipeptidyl peptidase enzyme. In addition, it has rare incidence of hypoglycemia. Hence, this study aimed to test the effect of teneligliptin 20 mg twice daily along with low carbohydrate diet and physical exercise on change of body weight and insulin resistance in nondiabetic obese subjects. Materials and Methods: It is a prospective, randomized, double-blind, placebo-controlled, parallel group study carried out at outpatient department of an endocrinology hospital over the period of 48 weeks. Teneligliptin 20 mg twice daily 30 min before food (low carbohydrate diet [LCD]) with regular physical exercise, and control group was kept with placebo twice daily 30 min before food LCD with regular physical exercise. This study was registered in clinical trial registry of India [CTRI/2020/02/023329]. Results: A total of 150 nondiabetic obese subjects were randomized into test (n = 75) and control groups (n = 75). At the end of 48 weeks there was significant improvement in GLP-1, simplified nutrition assessment questionnaire (SNAQ) score, homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides (TG), and body weight. The mean difference and 95% confidence interval of GLP-1 (pg/mL) was 76.42 (44.42-148.41) (P = 0.37); SNAQ score, -1.64 (-2.48 to -0.81) (P = 0.000); HOMA-IR, -0.9 (-0.59 to -0.38) (P = 0.000); TG (mg/dL) -29.37 (-44.46 to -14.07) (P = 0.000); reduction of body weight (kilograms) -3.09 (-6.11 to -0.07) (P = 0.043). Conclusion: Findings of this study reveals that teneligliptin-treated group showed significant improvement in GLP-1 levels, reduced insulin resistance, body weight, TG, appetite, and metabolic syndrome. Teneligliptin is well tolerated, except in upper respiratory tract infections. CTR number: CTRI/2020/02/023329.

Systematic review and meta-analysis of teneligliptin for treatment of type 2 diabetes

BACKGROUND AND AIM

There are efficacy and safety concerns related to teneligliptin treatment. A systematic review of randomized controlled trials (RCTs) was undertaken to comprehensively profile the efficacy and safety of teneligliptin in the treatment of type 2 diabetes mellitus (T2DM).

METHODS

Thirteen studies were chosen from a search of scientific databases for RCTs using teneligliptin as a monotherapy or as an adjunct to other glycemic agents with pre-specified inclusion criteria. We calculated weighted mean differences (WMDs) and 95% confidence intervals (CIs) in each included trial and pooled the data using a random-effects model.

RESULTS

Thirteen studies enrolled 2853 patients were identified. Teneligliptin treatment was associated with weight gain (vs. placebo, weighted mean difference (WMD) 0.28 kg; 95% CI - 0.20-0.77 kg; I² = 86%; P = 0.25). Compared to monotherapy, add on therapy with teneligliptin showed significant improvement in FPG mg/dl levels (WMD - 16.75 mg/dl; 95% CI - 19.38 to - 14.13 mg/dl), HOMA-β (WMD 7.91; 95% CI 5.38-10.45) and HOMA-IR (WMD - 0.27; 95% CI - 0.46 to - 0.07). The improvement in HbA1c was greater with monotherapy (WMD - 8.88 mmol/mol; 95% CI - 9.59 to - 8.08 mmol/mol). There was no significant risk of any hypoglycemia with teneligliptin compared to placebo (OR 0.84; 95% CI 0.44-1.60; I² = 0%; P = 0.60). However, the risk was 1.84 times high when combined with other glycemic agents. The risk of cardiovascular events was comparable, regardless of treatment duration when compared to placebo or any other active comparator (OR 0.79; 95% CI 0.40-1.57; I² = 0%; P = 0.50). [PROSPERO, CRD42022360785].

CONCLUSIONS

Teneligliptin is an effective and safe therapeutic option for patients with T2DM, both as monotherapy and as add-on therapy. However, additional large-scale, high-quality, long-term follow-up clinical trials with diverse ethnic populations are required to confirm its long-term efficacy and safety.

Factors associated with health-related quality of life of south indian population with chronic venous leg ulcers - A hospital based pilot study

OBJECTIVE

Venous leg ulcers (VLU) are chronic, recurrent and have a significant impact on the patients' health- related quality of life (HRQoL). This study assessed the association of patient-specific factors on the HRQoL of patients with chronic venous leg ulcers.

MATERIALS AND METHODS

The study included 21 males and 21 females aged 18 years and above, with chronic VLU. Data on demographics, education, occupation, per capita income, duration of ulcer were subjectively recorded. The socio-economic status was scored based on the Modified Kuppuswamy scale 2019, ulcer severity was assessed using M.A.I.D. Scale and the HRQoL of the patients were assessed using the 36-Item Short-Form Health Survey Version 1.0. The differences in the mean HRQoL scores between patients based on their gender and socio-economic class were assessed using an unpaired sample t-test. The association of age, severity, duration of the ulcer with the HRQoL were assessed using Pearson's correlation. A probability value of < 0.05 was considered statistically significant.

RESULTS

There were 21 (50%) males and 21 (50%) females with a mean age of 55.45 ± 7.73 years. The mean duration of ulcers was 7.26 ± 3.34 months and the mean ulcer severity score was 2.16 ± 0.96. Role limitations due to the physical health were found to be most impacted due to the disease condition with the least mean score of 26.78 ± 31.90 %. There were no significant differences in the mean scores of the physical and the mental components of HRQoL based on gender but there were significant differences based on socio-economic status. The lower the socio-economic status, the poorer the HRQoL. Age, severity of ulcers and ulcer duration had a significant negative correlation with HRQoL.

CONCLUSION

The study observed a low HRQoL of patients in physical aspects reflecting on the extensive limitation on the performance of daily physical activities. Patient-specific factors such as age, socio-economic status, severity, and chronicity of ulcers were found to influence HRQoL.

Association between physical activity knowledge and attitude on diabetes among normal weight and overweight/obese type-2 diabetic patients: a rural community-based cross-sectional study

Background

Physical activity is one of the most important regimens for the treatment of diabetes. Hence, we aimed to examine the association between physical activity knowledge (PAK), knowledge and attitude on diabetes among rural T2DM patients.

Objectives

The PAK, knowledge and attitude on diabetes were targeted to evaluate in rural Indian T2DM patients.

Methodology

A cross-sectional community-based survey was carried out with eighty-four patients with known T2DM in rural population of India

Results

Among 84 patients, 46 were overweight/obese and 38 patients with normal weight were participated in our study. The odds of smoking were found to be a significant socio-demographic risk factor (OR: 4.42, 95% CI 0.93–20.33 and P<0.001) compared to non-smokers. The PAK categories such as A, B & D had associated with BMI. The OR, 95% CI and P. Value are (5.610, 2.18–14.38 and P<0.001; 1.72, 0.72–4.12 and P 0.030; 2.55, 1.05–6.20 and P 0.047) except in category C. Iilliterates, low annual income, poor knowledge on T2DM and negative attitude, OR (4.50; 12.87; 10.80 and 47.66) were reported disagree or don't know with PAK questionnaire.

Conclusion

The results have impact on the design of new education programs will assist in preventing and managing complications related to T2DM.

Impact of patient education on KAP, medication adherence and therapeutic outcomes of metformin versus insulin therapy in patients with gestational diabetes: A Hospital based pilot study in South India

BACKGROUND AND AIM

The study assessed the impact of continuous patient education on Knowledge, Attitude, Practice (KAP), medication adherence and extent of glycemic control in pregnant women with gestational diabetes on insulin or metformin therapy.

METHODS

81 women with gestational diabetes (37 on insulin and 44 on metformin) were assessed for KAP using a validated questionnaire and medication adherence using the 8-items Morisky medication adherence scale, fasting, and postprandial blood glucose levels at the baseline and after two education sessions on drug therapy at one and three months intervals. The difference in mean KAP, medication adherence scores, fasting, and postprandial blood glucose levels and the extent of glycemic control with insulin or metformin therapy were assessed statistically.

RESULTS

There was a highly significant difference in the mean KAP, medication adherence scores, fasting and postprandial blood glucose levels from baseline to follow-up after three months, (P < 0.0001) indicating that continuous patient education had a positive impact on their KAP, medication adherence, blood glucose levels.

CONCLUSION

The study identified that continuous patient education improved their knowledge and practice of medication adherence which reflected on lowered fasting and postprandial blood glucose levels. Glycemic control was found to be the same with metformin and insulin in gestational diabetes.