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By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Tushar Madaan, Mohd Akhtar, Abul Kalam Najmi
Diabetes mellitus is a disease that affects millions of people worldwide and its prevalence is estimated to rise in the future. Billions of dollars are spent each year around the world in health expenditure related to diabetes. There are several anti-diabetic drugs in the market for the treatment of non-insulin dependent diabetes mellitus. In this article, we will be talking about a relatively new class of anti-diabetic drugs called sodium glucose co-transporter 2 (SGLT2) inhibitors. This class of drugs has a unique mechanism of action focusing on inhibition of glucose reabsorption that separates it from other classes...
October 10, 2016: European Journal of Pharmaceutical Sciences
André J Scheen
Inhibitors of sodium-glucose co-transporter type 2 (SGLT2) are proposed as a novel approach for the management of type 2 diabetes mellitus (T2DM). Several compounds are already available in many countries (dapagliflozin, canagliflozin, empagliflozin and ipragliflozin) and some others are in a late phase of development. The available SGLT2 inhibitors share similar pharmacokinetic characteristics, with a rapid oral absorption, a long elimination half-life allowing once-daily administration, an extensive hepatic metabolism mainly via glucuronidation to inactive metabolites, the absence of clinically relevant drug-drug interactions and a low renal elimination as parent drug...
January 2015: Drugs
Paola Fioretto, Alberto Zambon, Marco Rossato, Luca Busetto, Roberto Vettor
Diabetic nephropathy (DN) is the most common cause of end-stage renal disease worldwide. Blood glucose and blood pressure control reduce the risk of developing this complication; however, once DN is established, it is only possible to slow progression. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, the most recent glucose-lowering oral agents, may have the potential to exert nephroprotection not only through improving glycemic control but also through glucose-independent effects, such as blood pressure-lowering and direct renal effects...
August 2016: Diabetes Care
Davide Capodanno, Dominick J Angiolillo
Daily administration of low-dose of aspirin has proven to be beneficial in preventing recurrent cardiovascular events. However, the role of aspirin for primary prevention in patients with no overt cardiovascular disease is more controversial. In fact, in lower risk patients, the modest benefit in reducing serious vascular events can be offset by the increased risk of bleeding, including intracranial and gastrointestinal hemorrhage. Diabetes mellitus (DM) has been associated with a substantially increased risk of both first and recurrent atherothrombotic events, which makes aspirin therapy of potential value in these subjects...
October 11, 2016: Circulation
Laurent Azoulay, Kristian B Filion, Robert W Platt, Matthew Dahl, Colin R Dormuth, Kristin K Clemens, Madeleine Durand, Nianping Hu, David N Juurlink, J Michael Paterson, Laura E Targownik, Tanvir C Turin, Pierre Ernst, Samy Suissa, Colin R Dormuth, Brenda R Hemmelgarn, Gary F Teare, Patricia Caetano, Dan Chateau, David A Henry, J Michael Paterson, Jacques LeLorier, Adrian R Levy, Pierre Ernst, Robert W Platt, Ingrid S Sketris
Importance: The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. Objective: To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic drugs, is associated with an increased risk of acute pancreatitis. Design, Setting, and Participants: A large, international, multicenter, population-based cohort study was conducted using combined health records from 7 participating sites in Canada, the United States, and the United Kingdom...
October 1, 2016: JAMA Internal Medicine
Abeer Anabtawi, John M Miles
Metformin is the most commonly prescribed drug for the treatment of type 2 diabetes because of its apparent robust effects in reducing cardiovascular risk. The United Kingdom Prospective Diabetes Study suggests that metformin reduces the risk of myocardial infarction, and more recent retrospective studies have shown an association between metformin and a reduction in stroke, atrial fibrillation and all-cause mortality. The mechanism(s) explaining these putative benefits are not clear but may involve decreased energy intake (with attendant weight loss), improvement in lipids, and lowering of blood pressure; a review of selected literature suggests that metformin lowers blood pressure when it is elevated, but not when it is normal...
May 23, 2016: Endocrine Practice
James J Chamberlain, Andrew S Rhinehart, Charles F Shaefer, Annie Neuman
DESCRIPTION: The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. METHODS: The ADA Professional Practice Committee performed a systematic search on MEDLINE to revise or clarify recommendations based on new evidence. The committee assigns the recommendations a rating of A, B, or C, depending on the quality of evidence...
April 19, 2016: Annals of Internal Medicine
Sripal Bangalore, Robert Fakheri, Bora Toklu, Franz H Messerli
OBJECTIVE: To evaluate the outcomes with use of renin angiotensin system (RAS) blockers compared with other antihypertensive agents in people with diabetes. DESIGN: Meta-analysis. DATA SOURCES AND STUDY SELECTION: PubMed, Embase, and the Cochrane central register of controlled trials databases for randomized trials of RAS blockers versus other antihypertensive agents in people with diabetes mellitus. Outcomes were death, cardiovascular death, myocardial infarction, angina, stroke, heart failure, revascularization, and end stage renal disease...
2016: BMJ: British Medical Journal
Ruisheng Song
No abstract text is available yet for this article.
February 2016: Diabetes Care
D C Klonoff, D M Schwartz
The objective of this article is to stratify interventions for diabetes according to their economic impact. We conducted a review of the literature to select articles that performed a cost-benefit analysis for 17 widely practiced interventions for diabetes. A scale for categorizing interventions according to their economic impact was defined. The 17 interventions were classified as follows: 1) clearly cost-saving, 2) clearly cost-effective, 3) possibly cost-effective, 4) non-cost-effective, or 5) unclear. Clearly cost-saving interventions included eye care and pre-conception care...
March 2000: Diabetes Care
(no author information available yet)
No abstract text is available yet for this article.
January 2016: Diabetes Care
Mario Barbagallo, Ligia J Dominguez
Type 2 diabetes is frequently associated with both extracellular and intracellular magnesium (Mg) deficits. A chronic latent Mg deficit or an overt clinical hypomagnesemia is common in patients with type 2 diabetes, especially in those with poorly controlled glycemic profiles. Insulin and glucose are important regulators of Mg metabolism. Intracellular Mg plays a key role in regulating insulin action, insulin-mediated-glucose-uptake and vascular tone. Reduced intracellular Mg concentrations result in a defective tyrosine-kinase activity, postreceptorial impairment in insulin action and worsening of insulin resistance in diabetic patients...
August 25, 2015: World Journal of Diabetes
Gian Paolo Fadini, Angelo Avogaro, Luca Degli Esposti, Pierluigi Russo, Stefania Saragoni, Stefano Buda, Giuseppe Rosano, Sergio Pecorelli, Luca Pani
AIMS: Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. METHODS AND RESULTS: We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years...
September 21, 2015: European Heart Journal
Benjamin M Scirica, Deepak L Bhatt, Eugene Braunwald, P Gabriel Steg, Jaime Davidson, Boaz Hirshberg, Peter Ohman, Robert Frederich, Stephen D Wiviott, Elaine B Hoffman, Matthew A Cavender, Jacob A Udell, Nihar R Desai, Ofri Mosenzon, Darren K McGuire, Kausik K Ray, Lawrence A Leiter, Itamar Raz
BACKGROUND: The cardiovascular safety and efficacy of many current antihyperglycemic agents, including saxagliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor, are unclear. METHODS: We randomly assigned 16,492 patients with type 2 diabetes who had a history of, or were at risk for, cardiovascular events to receive saxagliptin or placebo and followed them for a median of 2.1 years. Physicians were permitted to adjust other medications, including antihyperglycemic agents...
October 3, 2013: New England Journal of Medicine
Akira Tamura, Yoshiyuki Kawano, Toru Watanabe, Junichi Kadota
OBJECTIVE: We sought to clarify the association between the severity of obstructive sleep apnea (OSA) and hemoglobin A1c (HbA1c) levels. METHODS: HbA1c levels were measured in 330 subjects who were suspected of having OSA and who underwent polysomnography. A 75-g oral glucose tolerance test was performed in 308 subjects who had not been diagnosed to have diabetes mellitus. Patients with use of hypoglycemic agents were excluded. The 330 subjects were divided into three subgroups: 164 with normal glucose tolerance, 111 with impaired glucose tolerance, and 55 with diabetes mellitus (DM)...
September 2012: Sleep Medicine
Claire K Mulvey, Ann M McNeill, Cynthia J Girman, Timothy W Churchill, Karen Terembula, Jane F Ferguson, Rachana Shah, Nehal N Mehta, Atif N Qasim, Michael R Rickels, Muredach P Reilly
OBJECTIVE We evaluated relationships of oral glucose tolerance testing (OGTT)-derived measures of insulin sensitivity and pancreatic β-cell function with indices of diabetes complications in a cross-sectional study of patients with type 2 diabetes who are free of overt cardiovascular or renal disease. RESEARCH DESIGN AND METHODS A subset of participants from the Penn Diabetes Heart Study (n = 672; mean age 59 ± 8 years; 67% male; 60% Caucasian) underwent a standard 2-h, 75-g OGTT. Insulin sensitivity was estimated using the Matsuda Insulin Sensitivity Index (ISI), and β-cell function was estimated using the Insulinogenic Index...
2014: Diabetes Care
María José Picón, Mora Murri, Araceli Muñoz, José Carlos Fernández-García, Ricardo Gomez-Huelgas, Francisco J Tinahones
OBJECTIVE: To determine the usefulness of measuring hemoglobin A(1c) (A1C), alone or combined with the fasting glucose test, compared with the oral glucose tolerance test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and A1C tests in 231 postpartum women with prior GDM 1 year after delivery...
August 2012: Diabetes Care
Louise Kelstrup, Tine D Clausen, Elisabeth R Mathiesen, Torben Hansen, Jens J Holst, Peter Damm
CONTEXT: Fetal exposure to maternal diabetes is associated with increased risk of type 2 diabetes mellitus (T2DM) later in life. The pathogenesis of T2DM involves dysfunction of the incretin hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), as well as hyperglucagonemia. OBJECTIVE: Our aim was to investigate circulating plasma levels of GLP-1, GIP, and glucagon during the oral glucose tolerance test (OGTT) in adult offspring of women with diabetes in pregnancy...
May 2015: Journal of Clinical Endocrinology and Metabolism
Jie Li, Hao Ma, Lixin Na, Shuo Jiang, Lin Lv, Gang Li, Wei Zhang, Guanqiong Na, Ying Li, Changhao Sun
CONTEXT: It is unclear why the prevalence of diabetes and prediabetes, especially prediabetes, between diagnosed by oral glucose tolerance test (OGTT) and hemoglobin A1c (HbA1c) criteria, is substantially discordant. OBJECTIVE: We aimed to evaluate the effects of obesity on the agreement between HbA1c and OGTT for diagnosing diabetes and prediabetes and identify the optimal HbA1c cutoff values in different body mass index (BMI) classifications. DESIGN SETTING AND PARTICIPANTS: In a population-based, cross-sectional study in Harbin, China, 4325 individuals aged 20-74 years without a prior diagnosed diabetes were involved in this study...
May 2015: Journal of Clinical Endocrinology and Metabolism
Christine L Chan, Laura Pyle, Lindsey Newnes, Kristen J Nadeau, Philip S Zeitler, Megan M Kelsey
CONTEXT: The optimal screening test for diabetes and prediabetes in obese youth is controversial. OBJECTIVE: We examined whether glycosylated hemoglobin (HbA1c) or the oral glucose tolerance test (OGTT) is a better predictor of free-living glycemia as measured by continuous glucose monitoring (CGM). DESIGN: This was a cross-sectional study of youth 10-18 years old, body mass index (BMI) 85th percentile or greater, with diabetes risk factors...
March 2015: Journal of Clinical Endocrinology and Metabolism
2015-03-19 15:39:58
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