Spend on hypoglycaemic agents is highly variable between practices and increased expenditure per patient is not associated with better glycemic control. Whilst newer, more expensive agents have additional benefits, in individuals where these advantages are more marginal widespread use of these agents have important cost implications (Diabetic Medicine)
Diabetes News
Category: Medication
Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials
Dipeptidyl peptidase-4 inhibitors increased the risk of cholecystitis in randomised controlled trials, especially with a longer treatment duration, which requires more attention from physicians in clinical practice (BMJ)
Putative protective effects of sodium-glucose cotransporter 2 inhibitors on atrial fibrillation through risk factor modulation and off-target actions: potential mechanisms and future directions
This review discusses the SGLT2 and its role in glucose homeostasis, molecules inhibiting the transporter, possible physiological mechanisms responsible for the decreased incident atrial fibrillation in patients treated with SGLT2 inhibitors and proposes mechanistic studies to further our understanding of the biological processes involved (Cardiovascular Diabetology)
A roadmap to achieve pharmacological precision medicine in diabetes
We propose a roadmap to achieve precision medicine as standard of care, to discuss current progress in relation to monogenic diabetes and type 2 diabetes, and to determine what additional work is required (Diabetologia)
Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk
We are therefore advising checking vitamin B12 serum levels in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency (Medicines and Healthcare products Regulatory Agency)
Effect of glucagon-like peptide 1 receptor agonists on albuminuria in adult patients with type 2 diabetes mellitus: A systematic review and meta-analysis
This meta-analysis indicates that GLP-1RAs are associated with a significant reduction in albuminuria in adult patients with T2DM when compared with placebo (Diabetes, Obesity and Metabolism)
Benefits of SGLT2i for the Treatment of Heart Failure Irrespective of Diabetes Diagnosis: A State-of-the-Art Review
Recent clinical studies (DAPA-HF, EMPEROR-Reduced and EMPEROR-Preserved, SOLOIST-WHF trial) and meta-analysis have demonstrated that sodium–glucose cotransporter-2 inhibitors (SGLT2i) are among the first antidiabetic drugs capable of reducing cardiovascular risks related to HF and improving the prognosis of patients with and without diabetes (Diabetes Therapy)
Review of SGLT2i for the Treatment of Renal Complications: Experience in Patients with and Without T2D
In this article, we briefly review the different mechanisms of action that may explain the renal beneficial effects of SGLT2i and disclose the results of the key renal outcome trials and the subsequent update of related clinical guidelines (Diabetes Therapy)
SGLT2 Inhibitors and the Cardiorenal Continuum: A Paradigm Shift in the Treatment of Patients with T2D
This supplement summarizes all the evidence of this therapeutic change and reviews the role of these drugs from prevention to management of patients who have already developed complications, such as patients with HF and chronic kidney disease (Diabetes Therapy)
Beyond the Glycaemic Control of Dapagliflozin: Impact on Arterial Stiffness and Macroangiopathy
Dapagliflozin can reduce arterial stiffness in people with T2DM, which is associated with an increased susceptibility to atherosclerosis regardless of age. Dapagliflozin is also associated with a significant decrease in BP and a favourable lipid profile, producing a decrease in the most atherogenic LDL fractions and an increase in HDL-C (Diabetes Therapy)
The selective serotonin reuptake inhibitor fluoxetine has direct effects at beta-cells to promote insulin secretion and increase beta-cell mass
These data are consistent with a role for fluoxetine in regulating glucose homeostasis through direct effects at beta-cells. Fluoxetine thus demonstrates promise as a preferential antidepressant for patients with concomitant occurrence of depression and diabetes (Diabetes, Obesity and Metabolism)
Gliflozins in the Management of Cardiovascular Disease
SGLT2 inhibitors are responsible for major paradigm shifts in the care of patients with or at high risk for heart failure, progression of chronic kidney disease, or both. SGLT2 inhibition improves cardiovascular outcomes in patients with heart failure over a wide range of ejection fractions, regardless of whether the patients have type 2 diabetes. In addition to having glucosuric and natriuretic properties, these agents also reduce the risk of end-stage kidney disease in patients with type 2 diabetes and chronic kidney disease (NEJM)
Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study
Neither metformin nor lifestyle reduced major cardiovascular events in DPPOS over 21 years despite long-term prevention of diabetes. Provision of group lifestyle intervention to all, extensive out-of-study use of statin and antihypertensive agents, and reduction in the use of study metformin together with out-of-study metformin use over time may have diluted the effects of the interventions (Circulation)
Once-Weekly Dulaglutide for the Treatment of Youths with Type 2 Diabetes
Treatment with dulaglutide at a once-weekly dose of 0.75 mg or 1.5 mg was superior to placebo in improving glycemic control through 26 weeks among youths with type 2 diabetes who were being treated with or without metformin or basal insulin, without an effect on BMI (NEJM)
Tirzepatide Once Weekly for the Treatment of Obesity
In this 72-week trial in participants with obesity, 5 mg, 10 mg, or 15 mg of tirzepatide once weekly provided substantial and sustained reductions in body weight (NEJM)
Fracture Risk of Sodium-Glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease
In this cohort study of older adults, starting a SGLT2 inhibitor versus DPP-4 inhibitor was not associated with a higher risk of skeletal fracture, regardless of eGFR (Clinical Journal of the American Society of Nephrology)
Additional Insulin Dosing for Fat and Protein in Children with Type 1 Diabetes using Multiple Daily Injections
We found no benefit in giving additional insulin as a split dose for HFHP meals in children using MDI, mild hypoglycaemia was common. Future studies would benefit from refinement of the insulin dose algorithm (Pediatric Diabetes)
Newer long-acting insulin prescriptions for patients with type 2 diabetes: prevalence and practice variation in a retrospective cohort study
The inter-practice variation in the prescription of newer insulins is large and could only be partially explained by patient- and practice-related differences. This indicates substantial opportunities for improvement (British Journal of General Practice)
The current role of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus management
The primary objective of this article is to examine the clinical benefit, safety, and tolerability of the four SGLT2 inhibitors approved by the US FDA. SGLT2 inhibitors increase urinary glucose excretion via inhibiting SGLT2 to decrease renal reabsorption of filtered glucose and reduce the renal threshold for glucose (Cardiovascular Diabetology)
Role of human organic cation transporter-1 (OCT-1/SLC22A1) in modulating the response to metformin in patients with type 2 diabetes
Taken together, our results corroborate the role of OCT-1 in the transport of metformin and also point at OCT1 genetic variations possibly affecting the transport of metformin into the cells and hence its subsequent action in responders and non-responders (BMC Endocrine Disorders)
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