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Quast DR, Breuer TGK, Nauck MA, Janot-Matuschek M, Uhl W, Meier JJ. Insulinbedarf und Glukosehomöostase bei Menschen nach partieller und totaler Pankreatektomie im Vergleich zu Menschen mit anderen Diabetesformen. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1344-0323] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Zusammenfassung
Einleitung Pankreasresektionen werden bei schwerwiegenden Pankreaserkrankungen durchgeführt. Bei Komplikationen einer chronischen Pankreatitis, teilweise jedoch auch bei Raumforderungen, kann eine Pankreasteilresektion sinnvoll sein. Eine totale Pankreatektomie führt zum absoluten Insulinmangel und der Notwendigkeit einer Insulintherapie. Bei Teilresektionen (partielle Pankreatektomie) werden weniger gravierende Konsequenzen für den Glukosemetabolismus erwartet. Es ist das Ziel der vorliegenden Arbeit, die Insulinregime nach Pankreatektomie mit denen anderer Diabetesformen zu vergleichen.
Material und Methodik Es wurden Patientencharakteristika und Details der postoperativen Insulintherapie von pankreasoperierten Patienten einer spezialisierten Universitätsklinik für Viszeralchirurgie ausgewertet. Diese Daten wurden mit Kohorten nicht operierter Patienten mit Typ-1-Diabetes (T1DM; absoluter Insulinmangel) bzw. Typ-2-Diabetes (T2DM; Insulinresistenz und relativer Insulinmangel), jeweils unter Insulintherapie, verglichen. Ergänzt wurde diese Datenanalyse durch eine Literaturrecherche zu den Stichworten „pancreatogenic diabetes“, „type 3c diabetes“ und „pancreatectomy diabetes“.
Ergebnisse Daten von 32 (68,8 % Frauenanteil) bzw. 41 (43,9 % Frauenanteil) Patienten nach totaler bzw. partieller Pankreatektomie wurden analysiert. Vor der totalen Pankreatektomie hatten 56,3 % der Patienten einen Diabetes mellitus, postoperativ bestand bei allen Patienten eine Insulinpflichtigkeit. Dabei waren die Insulindosierungen im Vergleich mit Patienten mit T1DM (unter intensivierter Insulintherapie) signifikant niedriger (p < 0,0001). Die Dosierungen von Basal- (48,6 % weniger) und Mahlzeiteninsulin (38,1 % weniger) waren gleichermaßen betroffen. Eine partielle Pankreatektomie führte deutlich seltener zu einem Diabetes mellitus, und eine Insulintherapie war nur bei 26,8 % der Patienten erforderlich.
Diskussion Der basale und prandiale Insulinbedarf nach Pankreatektomie ist niedriger als bei einem T1DM und einem T2DM. Dies sollte bei der Blutzuckereinstellung nach Pankreatektomie berücksichtigt werden.
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Affiliation(s)
- Daniel Robert Quast
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Thomas Georg Karl Breuer
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Michael Albrecht Nauck
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz
| | - Monika Janot-Matuschek
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
| | - Juris Jendrik Meier
- Diabeteszentrum Bochum/Hattingen, St. Josef-Hospital Bochum, Klinikum der Ruhr-Universität Bochum, Bochum
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Nauck MA, Holle H, Kahle M, Tytko A, Deacon CF, Holst JJ, Meier JJ. No evidence of tachyphylaxis for insulinotropic actions of glucose-dependent insulinotropic polypeptide (GIP) in subjects with type 2 diabetes, their first-degree relatives, or in healthy subjects. Peptides 2020; 125:170176. [PMID: 31669136 DOI: 10.1016/j.peptides.2019.170176] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND, AIMS In patients with type 2 diabetes, the lost insulinotropic effect of the incretin hormone glucose-dependent insulinotropic polypeptide (GIP) is more apparent after continuous versus bolus administration. To test whether the difference might be explained by rapid tachyphylaxis in response to elevated concentrations of GIP, and whether patients with type 2 diabetes and their relatives are more susceptible to tachyphylaxis than healthy subjects. PATIENTS AND METHODS In a two-way crossover design, insulinotropic responses to repeated bolus injection (50 pmol/kg body weight at 30 and 120 min) and continuous infusion of GIP (2 pmol.kg-1.min-1 from 30 to 180 min) under hyperglycaemic clamp conditions (8.5 mmol/l) was compared in age- gender- and weight-matched patients with type 2 diabetes, first degree relatives of such patients, and healthy subjects. RESULTS Insulin secretory responses to the first and second GIP bolus were not significantly different in any of the subject groups. Subjects with type 2 diabetes had a significant relative impairment versus healthy subjects with continuous (C-peptide, -13.2 %, p < 0.05), but not with repeated bolus administration of GIP (+11.1 %, n.s.). First-degree relatives tended to hyper-secrete insulin with bolus or continuous administrations of GIP. CONCLUSIONS Rapid tachyphylaxis in response to continuous exposure to slightly supraphysiological concentrations of GIP does not explain the reduced insulinotropic response to GIP infusions in patients with type 2 diabetes or their first-degree relatives.
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Affiliation(s)
- M A Nauck
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; Diabetes Center Bochum-Hattingen, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
| | - H Holle
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
| | - M Kahle
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; Diabetes Center Bochum-Hattingen, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A Tytko
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
| | - C F Deacon
- Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - J J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - J J Meier
- Diabetes Center Bochum-Hattingen, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Müller TD, Finan B, Bloom SR, D'Alessio D, Drucker DJ, Flatt PR, Fritsche A, Gribble F, Grill HJ, Habener JF, Holst JJ, Langhans W, Meier JJ, Nauck MA, Perez-Tilve D, Pocai A, Reimann F, Sandoval DA, Schwartz TW, Seeley RJ, Stemmer K, Tang-Christensen M, Woods SC, DiMarchi RD, Tschöp MH. Glucagon-like peptide 1 (GLP-1). Mol Metab 2019; 30:72-130. [PMID: 31767182 PMCID: PMC6812410 DOI: 10.1016/j.molmet.2019.09.010] [Citation(s) in RCA: 796] [Impact Index Per Article: 159.2] [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: 07/17/2019] [Revised: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The glucagon-like peptide-1 (GLP-1) is a multifaceted hormone with broad pharmacological potential. Among the numerous metabolic effects of GLP-1 are the glucose-dependent stimulation of insulin secretion, decrease of gastric emptying, inhibition of food intake, increase of natriuresis and diuresis, and modulation of rodent β-cell proliferation. GLP-1 also has cardio- and neuroprotective effects, decreases inflammation and apoptosis, and has implications for learning and memory, reward behavior, and palatability. Biochemically modified for enhanced potency and sustained action, GLP-1 receptor agonists are successfully in clinical use for the treatment of type-2 diabetes, and several GLP-1-based pharmacotherapies are in clinical evaluation for the treatment of obesity. SCOPE OF REVIEW In this review, we provide a detailed overview on the multifaceted nature of GLP-1 and its pharmacology and discuss its therapeutic implications on various diseases. MAJOR CONCLUSIONS Since its discovery, GLP-1 has emerged as a pleiotropic hormone with a myriad of metabolic functions that go well beyond its classical identification as an incretin hormone. The numerous beneficial effects of GLP-1 render this hormone an interesting candidate for the development of pharmacotherapies to treat obesity, diabetes, and neurodegenerative disorders.
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Affiliation(s)
- T D Müller
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany.
| | - B Finan
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN, USA
| | - S R Bloom
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - D D'Alessio
- Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - D J Drucker
- The Department of Medicine, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Ontario, M5G1X5, Canada
| | - P R Flatt
- SAAD Centre for Pharmacy & Diabetes, Ulster University, Coleraine, Northern Ireland, UK
| | - A Fritsche
- German Center for Diabetes Research (DZD), Neuherberg, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, Department of Internal Medicine, University of Tübingen, Tübingen, Germany
| | - F Gribble
- Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, Wellcome Trust-Medical Research Council, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - H J Grill
- Institute of Diabetes, Obesity and Metabolism, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - J F Habener
- Laboratory of Molecular Endocrinology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - J J Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - W Langhans
- Physiology and Behavior Laboratory, ETH Zurich, Schwerzenbach, Switzerland
| | - J J Meier
- Diabetes Division, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - M A Nauck
- Diabetes Center Bochum-Hattingen, St Josef Hospital (Ruhr-Universität Bochum), Bochum, Germany
| | - D Perez-Tilve
- Department of Internal Medicine, University of Cincinnati-College of Medicine, Cincinnati, OH, USA
| | - A Pocai
- Cardiovascular & ImmunoMetabolism, Janssen Research & Development, Welsh and McKean Roads, Spring House, PA, 19477, USA
| | - F Reimann
- Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, Wellcome Trust-Medical Research Council, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - D A Sandoval
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - T W Schwartz
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, DL-2200, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, DK-2200, Copenhagen, Denmark
| | - R J Seeley
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - K Stemmer
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - M Tang-Christensen
- Obesity Research, Global Drug Discovery, Novo Nordisk A/S, Måløv, Denmark
| | - S C Woods
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - R D DiMarchi
- Novo Nordisk Research Center Indianapolis, Indianapolis, IN, USA; Department of Chemistry, Indiana University, Bloomington, IN, USA
| | - M H Tschöp
- German Center for Diabetes Research (DZD), Neuherberg, Germany; Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Quast DR, Nauck MA, Bechara FG, Meier JJ. A case series of verrucae vulgares mimicking hyperkeratosis in individuals with diabetic foot ulcers. Diabet Med 2017; 34:1165-1168. [PMID: 28523836 DOI: 10.1111/dme.13387] [Citation(s) in RCA: 4] [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] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetic foot ulcers are a common complication in the advanced stages of diabetes mellitus. Certain lesions may be refractory to usual treatments with prolonged healing. In these cases, differential diagnoses to classical ulcers should be considered. Although plantar warts are a common and easy-to-diagnose finding in the general population, diagnosis can be challenging in people with diabetic foot ulcers, as they mimic hyperkeratosis in these people. CASE REPORT We report seven cases of people with diabetic foot ulcers and verrucae vulgares mimicking treatment-refractory hyperkeratosis, presenting to our centre between 2014 and 2016. Diagnosis was aided by the clinical presentation, followed by dermoscopy and punch biopsy. Treatment included topical application of 5-fluoruracil and salicylic acid (four people), cryotherapy (three people) and surgical excision (three people), all in combination with local pressure offloading. In five people, the verrucae were completely removed after a mean treatment period of 9.4 months; two individuals were lost to follow-up. CONCLUSION Verrucae may be more common in people with diabetic foot lesions and polyneuropathy than generally assumed. Typical findings include small, pinhead-sized bleedings within and surrounding hyperkeratous lesions. These findings should alert the clinician for the potential presence of a verruca. In such cases, biopsy should be performed to enable specific diagnosis and treatment.
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Affiliation(s)
- D R Quast
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - M A Nauck
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - F G Bechara
- Department of Dermatology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - J J Meier
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Germany
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Nauck MA, Kragh N, Mann JF, Lüdemann J, Jacob S, Rieck M, Bosch-Traberg H, Pocock S. Bewertung des Gesundheitszustandes mithilfe des EQ-5D bei Teilnehmern der LEADER Studie mit Typ 2 Diabetes (T2D). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601617] [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)
- MA Nauck
- Ruhr-Universität Bochum, St. Josef Hospital, Klinische Forschung, Abteilung Diabetologie, Medizinische Klinik I, Bochum, Germany
| | - N Kragh
- Novo Nordisk A/S, Soeborg, Denmark
| | - JF Mann
- Friedrich Alexander Universität Erlangen, Abteilung Nephrologie, Erlangen, Germany
| | - J Lüdemann
- Diabetes- und Fußzentrum 'diabetes falkensee', Falkensee, Germany
| | - S Jacob
- Praxis für Prävention und Therapie, Villingen-Schwenningen, Germany
| | - M Rieck
- Novo Nordisk Pharma GmbH, Mainz, Germany
| | | | - S Pocock
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Mann JF, Nauck MA, Jacob S, Lüdemann J, Brown-Frandsen K, Daniels GH, Kristensen P, Nissen SE, Pocock S, Poulter NR, Ravn LS, Rasmussen S, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Rieck M, Baeres FM, Marso SP, Buse JB. Liraglutid und renale Endpunkte bei Typ 2 Diabetes: Ergebnisse der LEADER Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
- JF Mann
- Friedrich Alexander Universität Erlangen, Abteilung Nephrologie, Erlangen, Germany
| | - MA Nauck
- Ruhr-University Bochum, St. Josef Hospital, Klinische Forschung, Abteilung Diabetologie, Medizinische Klinik I, Bochum, Germany
| | - S Jacob
- Praxis für Prävention und Therapie, Villingen-Schwenningen, Germany
| | - J Lüdemann
- Diabetes- und Fußzentrum 'diabetes falkensee', Falkensee, Germany
| | | | - GH Daniels
- Massachusetts General Hospital, Boston, United States
| | | | - SE Nissen
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States
| | - S Pocock
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - NR Poulter
- Imperial College London, London, United Kingdom
| | - LS Ravn
- Novo Nordisk A/S, Soeborg, Denmark
| | | | - WM Steinberg
- George Washington University Medical Center, Department of Medicine, Rockville, United States
| | | | - B Zinman
- University of Toronto, Mount Sinai Hospital, Sinai Centre for Diabetes, Toronto, Canada
| | - RM Bergenstal
- Park Nicollet Institute for Research and Education, International Diabetes Center, Minneapolis, United States
| | - M Rieck
- Novo Nordisk Pharma GmbH, Mainz, Germany
| | | | - SP Marso
- University of Texas Southwestern, Department of Internal Medicine, Dallas, United States
| | - JB Buse
- University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, United States
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Nauck MA, di Domenico M, Patel S, Kobe M, Toorawa R, Woerle HJ. Linagliptin and pioglitazone combination therapy versus monotherapy with linagliptin or pioglitazone: A randomised, double-blind, parallel-group, multinational clinical trial. Diab Vasc Dis Res 2016; 13:286-98. [PMID: 27190087 DOI: 10.1177/1479164116639229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Linagliptin plus pioglitazone single-pill combinations were evaluated. Patients (n = 936) with insufficient glycaemic control, despite lifestyle interventions, were randomised for 30 weeks to either monotherapy with linagliptin 5 mg; pioglitazone 15, 30 or 45 mg; or single-pill combination with linagliptin 5 mg plus pioglitazone 15, 30 or 45 mg. An extension (⩽54 weeks) planned to evaluate linagliptin plus pioglitazone 30 or 45 mg single-pill combinations was not completed due to a protocol amendment. Adjusted mean (95% confidence interval) differences in HbA1c change from baseline at week 30 for linagliptin plus pioglitazone 15, 30 and 45 mg were -0.17% (-0.41, 0.07), -0.37% (-0.60, -0.14) and -0.41% (-0.64, -0.18) versus pioglitazone monotherapies, respectively, and -0.44% (-0.67, -0.20), -0.68% (-0.91, -0.44) and -0.89% (-1.12, -0.66) versus linagliptin monotherapy, respectively. Single-pill combinations were generally well tolerated. Hypoglycaemia frequency was ⩽1.5% per group. Linagliptin plus pioglitazone combinations were efficacious, with safety profiles comparable to the individual monotherapies.
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Affiliation(s)
- Michael Albrecht Nauck
- Diabetes Centre Bad Lauterberg, Bad Lauterberg im Harz, Germany Division of Diabetology, Medical Department I, St. Josef-Hospital (Ruhr-University Bochum), Bochum, Germany
| | | | | | - Maureen Kobe
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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Seufert J, Bailey T, Barkholt Christensen S, Nauck MA. Impact of diabetes duration on achieved reductions in glycated haemoglobin, fasting plasma glucose and body weight with liraglutide treatment for up to 28 weeks: a meta-analysis of seven phase III trials. Diabetes Obes Metab 2016; 18:721-4. [PMID: 26679282 PMCID: PMC5324626 DOI: 10.1111/dom.12623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/08/2015] [Accepted: 12/14/2015] [Indexed: 12/20/2022]
Abstract
This meta-analysis of seven randomized, placebo-controlled studies (total 3222 patients) evaluated whether type 2 diabetes (T2D) duration affects the changes in blood glucose control and body weight that can be achieved with liraglutide and placebo. With liraglutide 1.2 mg, shorter diabetes duration was associated with a significantly greater, but clinically non-relevant, difference in glycated haemoglobin (HbA1c) reduction (p < 0.05), i.e. a 0.18% (1.96 mmol/mol) reduction in HbA1c per 10 years shorter diabetes duration. With liraglutide 1.8 mg, shorter diabetes duration was associated with a small but statistically significant trend for greater fasting plasma glucose (FPG) reduction (p < 0.05), i.e. a 0.38 mmol/l reduction in FPG per 10 years shorter diabetes duration. Neither the liraglutide 1.8 mg nor placebo results showed a significant association between HbA1c and diabetes duration and neither the liraglutide 1.2 mg nor placebo results showed a significant association between FPG and diabetes duration. Likewise, neither liraglutide nor placebo showed a significant association between change in weight and diabetes duration. These results suggest diabetes duration has a clinically negligible effect on achievable blood glucose control and weight outcomes with liraglutide and placebo in patients with T2D.
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Affiliation(s)
- J Seufert
- Division of Endocrinology and Diabetology Department of Internal Medicine II, University Hospital of Freiburg, Freiburg, Germany
| | - T Bailey
- AMCR Institute Inc, Escondido, CA, USA
| | | | - M A Nauck
- Division of Diabetology Medical Department, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
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Abd El Aziz M, Kahle M, Meier JJ, Nauck MA. Metaanalyse von direkten Vergleichsstudien zwischen Therapie mit GLP-1 Rezeptor-Agonisten oder Insulin: Unterschied für kurz- und lang-wirksame Medikamente? DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1584101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kahle M, Schulze H, Meier JJ, Nauck MA. Vorhersage des Insulinpumpen-Basalratenprofils einschließlich individueller zirkadianer Rhythmen anhand klinischer Charakteristika bei Patienten mit Typ 1-Diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Buchholz C, Kahle M, Nauck MA. Basalinsulin-Therapie bei Typ 2-Diabetes: Welche Patientencharakteristika entscheiden über Erfolg bzw. die Notwendigkeit zu einer weiteren Therapie-Intensivierung? DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Becht FS, Walther K, Martin E, Nauck MA. Fasting C-peptide and Related Parameters Characterizing Insulin Secretory Capacity for Correctly Classifying Diabetes Type and for Predicting Insulin Requirement in Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2016; 124:148-56. [PMID: 26824281 DOI: 10.1055/s-0035-1565177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND/AIMS C-peptide allows estimation of insulin secretion even in the presence of insulin treatment. C-peptide may be suitable for the differential diagnosis of type 1 and type 2 diabetes, and, within type 2 diabetes, of insulin-requiring vs. non-insulin-requiring patients. Relating C-peptide concentrations to ambient glucose levels might improve its diagnostic potential. PATIENTS/METHODS The diagnostic value (a) fasting C-peptide, (b) C-peptide/glucose ratios, and (c) the HOMA-ßC-peptide-index for predicting a diagnosis of type 1 (vs. type 2) diabetes were assessed. SETTING Specialised hospital for the care of diabetic patients (inpatient treatment). 303 patients with type 1 diabetes and 841 patients with type 2 diabetes. MAIN OUTCOME MEASURE Odds ratios and 95% confidence intervals for a clinical diagnosis of type 1 diabetes or for insulin treatment by deciles of (a) fasting C-peptide, (b) C-peptide/glucose ratios, and (c) HOMA-ßC-peptide-index. RESULTS Low C-peptide concentrations were associated with a high odds ratio for type 1 diabetes and vice versa (p<0.0001). Concentrations of 0.13-0.36 nmol/l did not discriminate. C-peptide/glucose ratios or HOMA-ßC-Peptide did not perform better. The ability of all 3 parameters to predict the necessity for insulin treatment within the population of type 2-diabetic patients was low. CONCLUSIONS Fasting C-peptide and derived parameters help to differentiate type 1 from type 2 diabetes, but there is a range of C-peptide concentrations that does not help discriminate. Relating C-peptide to glucose did not improve diagnostic accuracy. C-peptide does not help predicting a need for insulin treatment in patients with type 2 diabetes.
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Affiliation(s)
- F S Becht
- Diabeteszentrum Bad Lauterberg (Harz), Germany (where work was performed)
| | - K Walther
- Diabeteszentrum Bad Lauterberg (Harz), Germany (where work was performed)
| | - E Martin
- Diabeteszentrum Bad Lauterberg (Harz), Germany (where work was performed)
| | - M A Nauck
- Diabeteszentrum Bad Lauterberg (Harz), Germany (where work was performed)
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Ahmann A, Rodbard HW, Rosenstock J, Lahtela JT, de Loredo L, Tornøe K, Boopalan A, Nauck MA. Efficacy and safety of liraglutide versus placebo added to basal insulin analogues (with or without metformin) in patients with type 2 diabetes: a randomized, placebo-controlled trial. Diabetes Obes Metab 2015; 17:1056-64. [PMID: 26179619 PMCID: PMC5054929 DOI: 10.1111/dom.12539] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [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: 04/09/2015] [Revised: 06/24/2015] [Accepted: 07/02/2015] [Indexed: 02/06/2023]
Abstract
AIM To confirm the superiority, compared with placebo, of adding liraglutide to pre-existing basal insulin analogue ± metformin in adults with inadequately controlled type 2 diabetes [glycated haemoglobin (HbA1c) 7.0-10.0% (53-86 mmol/mol)]. METHODS In this 26-week, double-blind, parallel-group study, conducted in clinics or hospitals, 451 subjects were randomized 1 : 1 to once-daily liraglutide 1.8 mg (dose escalated from 0.6 and 1.2 mg/day, respectively, for 1 week each; n = 226) or placebo (n = 225) added to their pre-existing basal insulin analogue (≥20 U/day) ± metformin (≥1500 mg/day). After randomization, insulin adjustments above the pre-study dose were not allowed. The primary endpoint was HbA1c change. RESULTS After 26 weeks, HbA1c decreased more with liraglutide [-1.3% (-14.2 mmol/mol)] than with placebo [-0.1% (-1.2 mmol/mol); p < 0.0001]. More subjects on liraglutide reached HbA1c targets: <7.0% (59% vs 14%; p < 0.0001) and ≤6.5% (43% vs 4%; p < 0.0001) using slightly less insulin (35.8 IU vs 40.1 IU). Greater decreases from baseline (estimated treatment differences vs placebo; p < 0.0001) occurred in fasting plasma glucose (-1.3 mmol/l), seven-point glucose profiles (-1.6 mmol/l), body weight (-3.1 kg) and systolic blood pressure (-5.0 mmHg). Transient gastrointestinal adverse events (nausea: 22.2% vs 3.1%) and minor hypoglycaemia (18.2% vs 12.4%) were more frequent with liraglutide than placebo, and pulse increased (4.5 beats/min) compared with placebo. No severe hypoglycaemia or pancreatitis occurred. CONCLUSIONS Adding liraglutide to a basal insulin analogue ± metformin significantly improved glycaemic control, body weight and systolic blood pressure compared with placebo. Typical gastrointestinal symptoms and minor hypoglycaemia were more frequent with liraglutide.
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Affiliation(s)
- A Ahmann
- Oregon Health and Science University, Portland, OR, USA
| | - H W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, USA
| | - J Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA
| | - J T Lahtela
- University Hospital, Tampere University, Tampere, Finland
| | - L de Loredo
- Servicio Diabetología y Nutrición, Hospital Privado de Córdoba S.A., Córdoba, Argentina
| | - K Tornøe
- Medical and Science, GLP-1 and Obesity, Novo Nordisk A/S, Søborg, Denmark
| | - A Boopalan
- Novo Nordisk Service Centre, India Pvt Ltd, Bangalore, India
| | - M A Nauck
- Division of Diabetology, Medical Department I, St. Josef-Hospital (Ruhr-Universität Bochum), Bochum, Germany
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Weinstock RS, Guerci B, Umpierrez G, Nauck MA, Skrivanek Z, Milicevic Z. Safety and efficacy of once-weekly dulaglutide versus sitagliptin after 2 years in metformin-treated patients with type 2 diabetes (AWARD-5): a randomized, phase III study. Diabetes Obes Metab 2015; 17:849-58. [PMID: 25912221 PMCID: PMC5008205 DOI: 10.1111/dom.12479] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [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: 01/19/2015] [Revised: 04/10/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
Abstract
AIMS To compare the once-weekly glucagon-like peptide-1 (GLP-1) receptor dulaglutide with the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin after 104 weeks of treatment. METHODS This AWARD-5 study was a multicentre, double-blind trial that randomized participants to dulaglutide (1.5 or 0.75 mg) or sitagliptin 100 mg for 104 weeks or placebo (reported separately) for 26 weeks. Change in glycated haemoglobin (HbA1c) concentration from baseline was the primary efficacy measure. A total of 1098 participants with HbA1c concentrations ≥7.0% (≥53.0 mmol/mol) and ≤9.5% (≤80.3 mmol/mol) were randomized, and 657 (59.8%) completed the study. We report results for dulaglutide and sitagliptin at the final endpoint. RESULTS Changes in HbA1c at 104 weeks were (least squares mean ± standard error) -0.99 ± 0.06% (-10.82 ± 0.66 mmol/mol), -0.71 ± 0.07% (-7.76 ± 0.77 mmol/mol) and -0.32 ± 0.06% (-3.50 ± 0.66 mmol/mol) for dulaglutide 1.5 mg, dulaglutide 0.75 mg and sitagliptin, respectively (p < 0.001, both dulaglutide doses vs sitagliptin). Weight loss was greater with dulaglutide 1.5 mg (p < 0.001) and similar with 0.75 mg versus sitagliptin (2.88 ± 0.25, 2.39 ± 0.26 and 1.75 ± 0.25 kg, respectively). Gastrointestinal adverse events were more common with dulaglutide 1.5 and 0.75 mg versus sitagliptin (nausea 17 and 15% vs 7%, diarrhoea 16 and 12% vs 6%, vomiting 14 and 8% vs 4% respectively). Pancreatic, thyroid, cardiovascular and hypersensitivity safety were similar across groups. CONCLUSIONS Dulaglutide doses provided superior glycaemic control and dulaglutide 1.5 mg resulted in greater weight reduction versus sitagliptin at 104 weeks, with acceptable safety.
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Affiliation(s)
- R S Weinstock
- Endocrinology, Diabetes and Metabolism, Upstate Medical University, Syracuse, NY, USA
| | - B Guerci
- Diabetology, Metabolic Disease and Nutrition, University of Lorraine, CIC Inserm ILCV, CHU, Nancy, France
| | - G Umpierrez
- Diabetes & Endocrinology, Emory University, Atlanta, GA, USA
| | - M A Nauck
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany
| | - Z Skrivanek
- Lilly Research Laboratories, Indianapolis, IN, USA
| | - Z Milicevic
- Lilly Research Laboratories, Vienna, Austria
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Inzucchi SE, Nauck MA, Hehnke U, Woerle HJ, von Eynatten M, Henry RR. Improved glucose control with reduced hypoglycaemic risk when linagliptin is added to basal insulin in elderly patients with type 2 diabetes. Diabetes Obes Metab 2015; 17:868-77. [PMID: 25974030 DOI: 10.1111/dom.12490] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 01/11/2015] [Revised: 04/14/2015] [Accepted: 05/07/2015] [Indexed: 01/21/2023]
Abstract
AIM To assess the efficacy, hypoglycaemia risk and other safety markers of linagliptin as an additional therapy in older patients (aged ≥70 years) inadequately controlled with basal insulin. METHODS A prespecified safety analysis from the linagliptin trials programme was carried out to explore the hypoglycaemia risk when linagliptin was added to background basal insulin therapy in elderly patients (≥70 years). To do this, two eligible, randomized, placebo-controlled, clinical trials (NCT00954447 and NCT01084005) of 24 and ≥52 weeks, respectively, were analysed. RESULTS A total of 247 elderly individuals [mean ± standard deviation (s.d.) age 74 ± 4 years, glycated haemoglobin (HbA1c) 8.2 ± 0.8%] on basal insulin (mean ± s.d. baseline dose 36 ± 25 IU/day) were identified. Alongside placebo-adjusted change in HbA1c with linagliptin of -0.77% [95% confidence interval (CI) -0.95 to 0.59; p < 0.0001] after 24 weeks, the hazard ratios (HRs) of both overall and confirmed hypoglycaemia [blood glucose ≤3.9 mmol/l (70 mg/dl)], were significantly lower with linagliptin than with placebo: HR 0.61 (95% CI 0.39-0.97) versus 0.59 (95% CI 0.37-0.94), respectively (both p < 0.05). Moreover, significantly less confirmed hypoglycaemia was present in linagliptin-treated patients with renal impairment [HR 0.45 (95% CI 0.27-0.76)], moderate hyperglycaemia [HbA1c 7.5 to <9.0%; HR 0.51 (95% CI 0.27-0.99)], lower fasting plasma glucose levels [<152 mg/dl; HR 0.49 (95% CI 0.28-0.86)] and those treated with higher insulin doses [insulin ≥35.6 IU/day; HR 0.46 (95% CI 0.23-0.91); p < 0.05 for all]. Severe hypoglycaemia was rare and the incidence was lower with linagliptin (0.8%) versus placebo (2.5%): HR 0.21 (95% CI 0.02-2.30). CONCLUSIONS Despite improvements in hyperglycaemia and no relevant on-trial insulin dose reductions, adding linagliptin to basal insulin appears to decrease hypoglycaemia risk. The biological basis of this phenomenon warrants further research but may involve counter-regulatory effects of incretin hormones.
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Affiliation(s)
- S E Inzucchi
- Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - M A Nauck
- Division of Diabetology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - U Hehnke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - H-J Woerle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - M von Eynatten
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - R R Henry
- Center for Metabolic Research, Veterans Affairs San Diego Healthcare System, University of California San Diego School of Medicine, San Diego, CA, USA
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Daniels GH, Hegedüs L, Marso SP, Nauck MA, Zinman B, Bergenstal RM, Mann JFE, Derving Karsbøl J, Moses AC, Buse JB, Tuttle RM. LEADER 2: baseline calcitonin in 9340 people with type 2 diabetes enrolled in the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial: preliminary observations. Diabetes Obes Metab 2015; 17:477-86. [PMID: 25656058 PMCID: PMC4405040 DOI: 10.1111/dom.12444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 10/14/2014] [Revised: 01/18/2015] [Accepted: 01/31/2015] [Indexed: 01/31/2023]
Abstract
AIMS To report preliminary data on baseline serum calcitonin concentrations and associated clinical characteristics in a global population with type 2 diabetes before liraglutide or placebo randomization. METHODS The ongoing LEADER trial has enrolled 9340 people with type 2 diabetes and at high risk of cardiovascular disease at 410 centres worldwide. People with baseline serum calcitonin ≤ 50 ng/l were randomized to liraglutide once daily or placebo and will be followed for up to 5 years. Serum calcitonin was measured at baseline and will be measured annually thereafter. An independent committee of thyroid experts will oversee calcitonin monitoring throughout the trial and will review all calcitonin concentrations ≥ 20 ng/l. RESULTS The mean age of participants was 64.3 ± 7.2 years, 64.3% were men, and mean the body mass index was 32.5 ± 6.3 kg/m(2). The median (interquartile range) baseline serum calcitonin values were 3.9 (1.0 to >7.6) ng/l in men and 1.0 (1.0 to >1) ng/l in women. Serum calcitonin was >10 ng/l in 14.6% of men and in 0.96% of women. In sex-specific multivariable linear analysis of covariance models, a reduced glomerular filtration rate (GFR) was associated with higher serum calcitonin concentrations that were statistically significant. A 20 ml/min/1.73 m(2) decrease in estimated GFR (eGFR) was associated with a 14% increase in serum calcitonin in women and an 11% increase in men. CONCLUSIONS In the LEADER population, the prevalence of elevated serum calcitonin concentrations at baseline was high, and there was an inverse association between eGFR and serum calcitonin concentrations.
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Affiliation(s)
- G H Daniels
- Thyroid Unit and Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, USA
- Correspondence to: Gilbert H. Daniels, MD, Massachusetts General Hospital, Thyroid Unit ACC 730, Boston, MA 02114, USA. E-mail:
| | - L Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern DenmarkOdense, Denmark
| | - S P Marso
- Division of Cardiology, Department of Internal Medicine, University of Texas SouthwesternDallas, TX, USA
| | - M A Nauck
- DiabeteszentrumBad Lauterberg, Germany
| | - B Zinman
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of TorontoToronto, Canada
| | - R M Bergenstal
- International Diabetes Center at Park NicolletMinneapolis, MN, USA
| | - J F E Mann
- Dept. of Nephrology, Hypertension & Rheumatology, Friedrich Alexander University of ErlangenMunchen, Germany
| | | | | | - J B Buse
- Department of Medicine, University of North Carolina School of MedicineChapel Hill, NC, USA
| | - R M Tuttle
- Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
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Nauck MA, Del Prato S, Durán-García S, Rohwedder K, Langkilde AM, Sugg J, Parikh SJ. Durability of glycaemic efficacy over 2 years with dapagliflozin versus glipizide as add-on therapies in patients whose type 2 diabetes mellitus is inadequately controlled with metformin. Diabetes Obes Metab 2014; 16:1111-20. [PMID: 24919526 DOI: 10.1111/dom.12327] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/28/2014] [Accepted: 06/05/2014] [Indexed: 01/10/2023]
Abstract
AIMS To assess the long-term glycaemic durability, safety and tolerability of dapagliflozin versus glipizide as add-on therapies in patients with type 2 diabetes inadequately controlled by metformin alone. METHODS This was a 52-week, randomised, double-blind study of dapagliflozin (n = 406) versus glipizide (n = 408), uptitrated over 18 weeks according to tolerability and glycaemic response to a maximum of 10 and 20 mg/day, respectively, as add-on therapies to metformin (≥ 1500 mg/day) with a 156-week double-blind extension period. Data over 104 weeks are reported here. RESULTS In total, 53.1% of patients completed 104 weeks of treatment. After the greater initial decrease (0-18 weeks) in glycated haemoglobin (HbA1c) with glipizide, the 18-104-week HbA1c coefficient of failure (CoF) was lower with dapagliflozin (0.13%/year) than with glipizide (0.59%/year), resulting in significant dapagliflozin versus glipizide differences of -0.46%/year (95% CI -0.60,-0.33; p = 0.0001) for CoF and -0.18%(-2.0 mmol/mol) [95% CI -0.33(-3.6),-0.03(-0.3); p = 0.021] for 104-week HbA1c. Dapagliflozin produced sustained reductions in weight and systolic blood pressure, whereas glipizide increased weight and systolic blood pressure, giving 104-week dapagliflozin versus glipizide differences of -5.1 kg (95% CI: -5.7,-4.4) and -3.9 mmHg (95% CI: -6.1,-1.7), respectively. Over 104 weeks, the hypoglycaemia rate was 10-fold lower with dapagliflozin than with glipizide (4.2 vs. 45.8%), whereas patient proportions with events suggestive of genital infection and of urinary tract infection (UTI) were greater with dapagliflozin (14.8 and 13.5%, respectively) than with glipizide (2.9 and 9.1%, respectively). CONCLUSIONS Over 2 years, compared with glipizide, dapagliflozin demonstrated greater glycaemic durability, sustained reductions in weight and systolic blood pressure and a low hypoglycaemia rate; however, genital infections and UTIs occurred more frequently.
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Affiliation(s)
- M A Nauck
- Diabetes Centre, Bad Lauterberg, Germany
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18
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Bauer S, Nauck MA. Polypharmacy in people with Type 1 and Type 2 diabetes is justified by current guidelines--a comprehensive assessment of drug prescriptions in patients needing inpatient treatment for diabetes-associated problems. Diabet Med 2014; 31:1078-85. [PMID: 24824448 DOI: 10.1111/dme.12497] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 11/18/2013] [Revised: 03/20/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
Abstract
AIMS Our aim was to assess the number of medications prescribed to people with Type 1 or Type 2 diabetes mellitus and to compare these to recommendations by guidelines. PATIENTS AND METHODS Data from 155 and 154 people with Type 1 and Type 2 diabetes, respectively, were analysed. Prescribed medications (glucose-lowering drugs, blood pressure medications, drugs to treat cardiovascular risk or diseases, etc.) were counted as compounds per day, tablets per day, injections per day, or other modes of administration. RESULTS People with Type 2 diabetes were prescribed 8.4 ± 3.0 different drug compounds per day (maximum, 16), 8.6 ± 3.9 tablets per day (maximum, 22), 2.6 ± 1.6 injections per day (maximum, 7), in total 11.6 ± 4.5 doses of any medication per day (maximum, 27). The numbers for people with Type 1 diabetes were 5.5 ± 3.4 compounds per day (maximum, 15), 4.5 ± 4.3 tablets per day (maximum, 18), 3.9 ± 2.2 injections per day (maximum, 8), in total 8.5 ± 5.1 doses of any medication per day (maximum, 22). Over 97% of the prescriptions corresponded to recommendations by guidelines. CONCLUSIONS The number of prescribed drugs is high in people with diabetes mellitus, and higher for those with Type 2 than with Type 1 diabetes. The compatibility of prescriptions with guideline recommendations suggests that even this high number of prescriptions will provide a clinical benefit. The current analysis could provide a basis for a realistic judgement of the burden imposed by polypharmacy in people with diabetes mellitus.
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Affiliation(s)
- S Bauer
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany
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Nauck MA, Kahle M. Der direkte Vergleich von DPP-4-Hemmern mit Sulfonylharnstoffen: Eine Metaanalyse zum Einfluss auf kardiovaskuläre Ereignissen und Todesfälle. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Baranov O, Deacon CF, Holst JJ, Preuss K, Nauck MA. „Feed-Back“-Suppression der Nahrungs-induzierten GLP-1-Sekretion durch Erhöhung des intakten GLP-1 unter DPP-4-Inhibition: Ein Vergleich von Vildagliptin und Sitagliptin. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Jitschin A, Schleser-Mohr S, Stierling A, Nauck MA. Exposition gegenüber Hypoglykämie-Risiko-Situationen im Berufsleben, in der Freizeitgestaltung und im Straßenverkehr bei Patienten mit Typ 2-Diabetes. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Tepelmann S, Kahle M, Varnhorn A, Nawrodt B, Baranov O, Buss U, Nauck MA. Basalraten-Profile bei 339 Patienten mit Typ 1-Diabetes unter Insulinpumpenbehandlung: Unterschiede zum häufig verwendeten Basalraten-Schieber nach Dr. Rolf Renner. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nauck MA, Baranov O, Ritzel RA, Meier JJ. Do current incretin mimetics exploit the full therapeutic potential inherent in GLP-1 receptor stimulation? Diabetologia 2013; 56:1878-83. [PMID: 23748861 DOI: 10.1007/s00125-013-2953-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 02/05/2013] [Accepted: 05/14/2013] [Indexed: 01/06/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are incretin-derived glucose-lowering agents that have been used for the treatment of type 2 diabetes since 2007. Agents such as exenatide (short-acting and once weekly preparations), liraglutide, taspoglutide, albiglutide and lixisenatide lower fasting glucose and HbA1c upon subcutaneous injection, leading to glycaemic control that is equivalent to, or better than, that observed with other oral glucose-lowering agents or bedtime insulin. However, varying proportions of patients report nausea and vomiting, adverse events that typically narrow the therapeutic dose range. Furthermore, GLP-1 RAs reduce fasting glucose to a clinically meaningful extent, but not into the normal range. In contrast, where GLP-1 is administered as a short-term intravenous infusion, a full normalisation of glucose concentrations (approximately 5 mmol/l) has been observed without any risk of gastrointestinal side effects. Subcutaneous infusions or injections of GLP-1 are much less effective. The present analysis relates the proportion of patients who report nausea following treatment with GLP-1 and GLP-1 RAs to the clinical effectiveness of the treatment (represented by the fasting glucose concentration achieved with treatment). The results suggest that GLP-1 RAs injected into the subcutaneous compartment do not exploit the full potential inherent in GLP-1 receptor activation. Reasons for this may include modifications of the peptide molecules in the subcutaneous environment or high local concentrations triggering side effects through GLP-1 receptors on autonomic nerves in subcutaneous adipose tissue. Elucidation of the mechanisms underlying differential responses to GLP-1/GLP-1 RAs administered intravenously vs subcutaneously may help to develop improved agents or modes of administration that are more effective and have fewer side effects.
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Affiliation(s)
- M A Nauck
- Diabeteszentrum Bad Lauterberg, Kirchberg 21, 37431 Bad Lauterberg im Harz, Germany.
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24
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Frenzke H, Varnhorn A, Schulze H, Nauck MA. Empirische Ermittlung der Kohlenhydratmenge, die Hypoglykämien bei einstündiger körperlicher Aktivität mittlerer Intensität bei Patienten mit Typ 1-Diabetes vorbeugen kann. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Janert M, Lemmer L, Nauck MA. Depression: Ergebnisse eines Screenings bei stationären Patienten mit Typ 1- und Typ 2-Diabetes. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vardarli I, Arndt E, Deacon CF, Holst JJ, Köthe LD, Nauck MA. Einfluss der Sitagliptin- und Metformintherapie auf die GLP-1 Sekretion und den Inkretineffekt bei Patienten mit Typ-2-Diabetes. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bauer S, Nauck MA. Wie viele Medikamente (Wirkstoffe, Tabletten, Injektionen, andere Darreichungsformen) werden typischerweise bei Typ 1- und Typ 2-Diabetes verordnet? DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Becht FS, Walther K, Nauck MA. Nüchtern-C-Peptid und daraus abgeleitete Parameter zur Charakterisierung der Insulinsekretions-Kapazität zwecks korrekter Klassifizierung von Patienten als Typ 1- und Typ 2-Diabetes. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Liraglutide is a once-daily human glucagon-like peptide-1 analogue used in the treatment of type 2 diabetes (T2D). It has been prospectively investigated in a series of multinational, randomised, controlled phase 3 trials (the Liraglutide Effect and Action in Diabetes programme), as well as in an additional direct head-to-head study with sitagliptin. These trials were designed to clarify the use and safety of liraglutide in clinical practice across the treatment continuum of T2D, and consequently involved a large number and diverse range of patients. These studies also included active comparisons against antidiabetic agents including metformin, rosiglitazone, glimepiride, insulin glargine, exenatide and sitagliptin, and therefore have helped to examine clinical differences and similarities between liraglutide and these commonly used agents.
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Affiliation(s)
- M A Nauck
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany.
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Janert M, Weiss B, Lemmer L, Nauck MA. Psychologische Intervention in einer Diabetes-Spezialklinik: Unterschiede zwischen Patienten mit Typ 1- und Typ 2-Diabetes. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nauck MA, Kluge S, Pilzer J, Fehske CJ, Silbermann S, Froehlich H, Jahn E, Limberg R. Bewertung von Therapieerfolg und Kriterien für die Wahl einer Medikation add-on zu Metformin: Ergebnisse einer Erhebung bei niedergelassenen Ärzten. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Becker B, Vogtmeier S, Terhoeven L, Vardarli I, Nauck MA. Charakterisierung der Blutzucker-Einstellungsqualität unter intensivierter Insulintherapie bei Patienten mit Typ 1- und Typ 2-Diabetes. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vardarli MC, Nauck MA, Hammes HP, Vardarli I. Insulinsensitivität, Betazellfunktion und Adipokine während und nach Ramadan-Fasten bei gesunden Männern. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nauck MA, Vardarli I, Deacon CF, Holst JJ, Meier JJ. Secretion of glucagon-like peptide-1 (GLP-1) in type 2 diabetes: what is up, what is down? Diabetologia 2011; 54:10-8. [PMID: 20871975 DOI: 10.1007/s00125-010-1896-4] [Citation(s) in RCA: 328] [Impact Index Per Article: 25.2] [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: 04/03/2010] [Accepted: 07/30/2010] [Indexed: 01/08/2023]
Abstract
The incretin hormones gastric inhibitory polypeptide and especially glucagon-like peptide (GLP) have an important physiological function in augmenting postprandial insulin secretion. Since GLP-1 may play a role in the pathophysiology and treatment of type 2 diabetes, assessment of meal-related GLP-1 secretory responses in type 2 diabetic patients vs healthy individuals is of great interest. A common view states that GLP-1 secretion in patients with type 2 diabetes is deficient and that this applies to a lesser degree in individuals with impaired glucose tolerance. Such a deficiency is the rationale for replacing endogenous incretins with GLP-1 receptor agonists or re-normalising active GLP-1 concentrations with dipeptidyl peptidase-4 inhibitors. This review summarises the literature on this topic, including a meta-analysis of published studies on GLP-1 secretion in individuals with and without diabetes after oral glucose and mixed meals. Our analysis does not support the contention of a generalised defect in nutrient-related GLP-1 secretory responses in type 2 diabetes patients. Rather, factors are identified that may determine individual incretin secretory responses and explain some of the variations in published findings of group differences in GLP-1 responses to nutrient intake.
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Affiliation(s)
- M A Nauck
- Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany.
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Vardarli I, Fenske A, Nauck MA, Jäckel E, Leitolf H. 46-jähriger Patient mit Hypoglykämie nach Krampfanfall. Dtsch Med Wochenschr 2010; 135:913-4. [DOI: 10.1055/s-0030-1253677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mentis N, Vardarli I, Rommel M, Nauck MA. Klinische Performance durch Messgenauigkeit des Blutzuckermessgerätes „mylife Pura“ in der Steuerung der intensivierten Insulintherapie bei Patienten mit Typ 1 Diabetes. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1255190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Breuer TGK, Menge BA, Uhl W, Nauck MA, Schmidt WE, Meier JJ. Die Hyperproinsulinämie bei Patienten mit pankreatischem Diabetes mellitus ist eher mit funktionellen Defekten der Insulinsekretion als mit einer verminderten pankreatischen ß-Zell-Fläche assoziiert. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Becker B, Walther K, Schminkel S, Nauck MA. Einfluss des Nüchternblutzuckers auf die Magenentleerungsgeschwindigkeit bei Patienten mit Typ-1 Diabetes. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vardarli I, Becker L, Koethe L, Schweizer A, Foley JE, Nauck MA. Quantifizierung des Inkretineffekts bei Patienten mit Typ 2-Diabetes unter Therapie mit dem DPP-4-Inhibitor („Inkretin-Verstärker“) Vildagliptin bzw. Plazebo. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schulze H, Janert M, Becker B, Nauck MA. Evaluierung eines modularen Schulungskonzeptes für Schulungs-erfahrene Patienten mit Typ 1-Diabetes. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jendle J, Nauck MA, Matthews DR, Frid A, Hermansen K, Düring M, Zdravkovic M, Strauss BJ, Garber AJ. Weight loss with liraglutide, a once-daily human glucagon-like peptide-1 analogue for type 2 diabetes treatment as monotherapy or added to metformin, is primarily as a result of a reduction in fat tissue. Diabetes Obes Metab 2009; 11:1163-72. [PMID: 19930006 DOI: 10.1111/j.1463-1326.2009.01158.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM The effect on body composition of liraglutide, a once-daily human glucagon-like peptide-1 analogue, as monotherapy or added to metformin was examined in patients with type 2 diabetes (T2D). METHODS These were randomized, double-blind, parallel-group trials of 26 [Liraglutide Effect and Action in Diabetes-2 (LEAD-2)] and 52 weeks (LEAD-3). Patients with T2D, aged 18-80 years, body mass index (BMI) < or =40 kg/m(2) (LEAD-2), < or =45 kg/m(2) (LEAD-3) and HbA1c 7.0-11.0% were included. Patients were randomized to liraglutide 1.8, 1.2 or 0.6 mg/day, placebo or glimepiride 4 mg/day, all combined with metformin 1.5-2 g/day in LEAD-2 and to liraglutide 1.8, 1.2 or glimepiride 8 mg/day in LEAD-3. LEAD-2/3: total lean body tissue, fat tissue and fat percentage were measured. LEAD-2: adipose tissue area and hepatic steatosis were assessed. RESULTS LEAD-2: fat percentage with liraglutide 1.2 and 1.8 mg/metformin was significantly reduced vs. glimepiride/metformin (p < 0.05) but not vs. placebo. Visceral and subcutaneous adipose tissue areas were reduced from baseline in all liraglutide/metformin arms. Except with liraglutide 0.6 mg/metformin, reductions were significantly different vs. changes seen with glimepiride (p < 0.05) but not with placebo. Liver-to-spleen attenuation ratio increased with liraglutide 1.8 mg/metformin possibly indicating reduced hepatic steatosis. LEAD-3: reductions in fat mass and fat percentage with liraglutide monotherapy were significantly different vs. increases with glimepiride (p < 0.01). CONCLUSION Liraglutide (monotherapy or added to metformin) significantly reduced fat mass and fat percentage vs. glimepiride in patients with T2D.
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Affiliation(s)
- J Jendle
- Faculty of Health Science, Orebro University, Orebro, Sweden.
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Becker B, Rehring E, Schminkel S, Nauck MA. Magenentleerungs-Untersuchung mit 13C-CO2-Oktanoat-Atemtests: Erfahrungen bei 259 Patienten mit Typ 1- und 52 Patienten mit Typ 2-Diabetes. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jendle J, Nauck MA, Matthews D, Frid A, Hermansen K, Düring M, Zdravkovic M, Strauss BJ, Garber A, Liebl A. Die Reduktion des Körpergewichtes mit Liraglutid, einem humanen GLP-1 Analogon zur einmal täglichen Gabe bei Typ 2 Diabetes, basiert in erster Linie auf dem Abbau von Fettgewebe, hauptsächlich von viszeralem Fett. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nauck MA, Frid A, Hermansen K, Shah NS, Tankova T, Mitha IH, Düring M, Zdravkovic M, Matthews D, Liebl A. Liraglutid, ein humanes Glucagon-like Peptide (GLP)-1 Analogon zur einmal täglichen Gabe bei Typ 2 Diabetes, bietet im Vergleich zu Glimepirid eine ähnliche Blutzuckereinstellung und reduziert außerdem das Körpergewicht, wenn es zusätzlich zu Metformin gegeben wird. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Köthe LD, Kjems L, Deacon CF, Holst JJ, Foley J, Rotenberger K, Nauck MA. Insulinotrope Effekte von exogenem GLP-1 [7–36] können durch Exendin [9–39] komplett blockiert werden – die Bedeutung der Zugabe von Albumin in GLP-1 Infusionen um einen schnellen GLP-1 Anstieg sicherzustellen. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vardarli I, Blettner M, Nauck MA, Klug SJ. Keine Hinweise für eine Assoziation zwischen dem Pro12Ala-Polymorphismus des PPARγ2-Gens und Typ-2-Diabetes: Eine Meta-Analyse mit 32 Fall-Kontroll-Studien mit 31.475 Personen und signifikanter Heterogenität zwischen den Studien. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vardarli I, Politz T, Schröter W, Nauck MA. Screening auf hereditäre Hämochromatose mittels Transferrinsättigung ist bei stationär behandelten Patienten mit Diabetes kosteneffektiv. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meier JJ, Baller B, Menge BA, Gallwitz B, Schmidt WE, Nauck MA. Excess glycaemic excursions after an oral glucose tolerance test compared with a mixed meal challenge and self-measured home glucose profiles: is the OGTT a valid predictor of postprandial hyperglycaemia and vice versa? Diabetes Obes Metab 2009; 11:213-22. [PMID: 18564177 DOI: 10.1111/j.1463-1326.2008.00922.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postprandial hyperglycaemia is often assumed in individuals with high glucose excursions during an oral glucose tolerance test (OGTT), but the relationship between glucose levels during the OGTT and after a mixed meal is yet unclear. We addressed whether (i) glucose concentrations after an oral glucose load are similar to those after a test meal or under daily life conditions and (ii) impaired glucose tolerance (IGT) predicts postprandial hyperglycaemia. PATIENTS AND METHODS A total of 60 subjects with normal (NGT), IGT or diabetic (DM) glucose tolerance were examined with an OGTT, a mixed meal challenge (3433 kJ) and a self-determined 10-point home glucose profile. RESULTS There was a significant correlation between the 120-min OGTT glucose levels and the glycaemic excursions after the test meal and during everyday conditions. However, glucose excursions during the OGTT exceeded those after the test meal and during everyday conditions by approximately 20 and approximately 30% respectively. Likewise, insulin and C-peptide levels rose to higher levels after oral glucose compared with mixed meal ingestion. The mean self-determined diurnal glucose levels were already 10% higher in subjects with IGT compared with NGT subjects (p < 0.0001). CONCLUSIONS Glucose levels reached after an oral glucose challenge and during real life are correlated to some extent, but the absolute levels of glycaemia greatly differ between both conditions. Therefore, 'postchallenge' glucose levels measured during an OGTT might be used as a predictor of 'postprandial hyperglycaemia', but caution should be taken when both terms are used synonymously. Furthermore, subjects with IGT during an OGTT already exhibit increased postprandial glucose levels under real-life conditions. This suggests that IGT should already be considered an overt disease condition rather than merely a high-risk situation.
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Affiliation(s)
- J J Meier
- Department of Medicine I, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Nauck MA, Ellis GC, Fleck PR, Wilson CA, Mekki Q. Efficacy and safety of adding the dipeptidyl peptidase-4 inhibitor alogliptin to metformin therapy in patients with type 2 diabetes inadequately controlled with metformin monotherapy: a multicentre, randomised, double-blind, placebo-controlled study. Int J Clin Pract 2009; 63:46-55. [PMID: 19125992 DOI: 10.1111/j.1742-1241.2008.01933.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To evaluate the efficacy and safety of alogliptin, a new dipeptidyl peptidase-4 inhibitor, for 26 weeks at once-daily doses of 12.5 and 25 mg in combination with metformin in patients whose HbA(1c) levels were inadequately controlled on metformin alone. METHODS AND PATIENTS Patients with type 2 diabetes and inadequate glycaemic control (HbA(1c) 7.0-10.0%) were randomised to continue a stable daily metformin dose regimen (> or = 1500 mg) plus the addition of placebo (n = 104) or alogliptin at once-daily doses of 12.5 (n = 213) or 25 mg (n = 210). HbA(1c), insulin, proinsulin, C-peptide and fasting plasma glucose (FPG) concentrations were determined over a period of 26 weeks. RESULTS Alogliptin at either dose produced least squares mean (SE) decreases from baseline in HbA(1c) of -0.6 (0.1)% and in FPG of -17.0 (2.5) mg/dl [-1.0 (0.1) mmol/l], decreases that were significantly (p < 0.001) greater than those observed with placebo. The between treatment differences (alogliptin - placebo) in FPG reached statistical significance (p < 0.001) as early as week 1 and persisted for the duration of the study. Overall, adverse events (AEs) observed with alogliptin were not substantially different from those observed with placebo. This includes low event rates for gastrointestinal side effects and hypoglycaemic episodes. There was no dose-related pattern of AE reporting between alogliptin groups and few serious AEs were reported. CONCLUSION Alogliptin is an effective and safe treatment for type 2 diabetes when added to metformin for patients not sufficiently controlled on metformin monotherapy.
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Affiliation(s)
- M A Nauck
- Diabeteszentrum Bad Lauterberg im Harz, Bad Lauterberg, Germany.
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Berndt C, Köthe L, Nawrodt B, Mraz B, Nauck MA. Blutzucker-Nachtprofile mit Wecker und Selbstmessungen gegenüber Fremdmessungen durch spezialisiertes Pflegepersonal: Eine Analyse mittels kontinuierlichem Glucose-Monitoring (GlucoDay® S). DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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