ABSTRACT
Type 2 diabetes mellitus is a chronic metabolic disorder that results from defects in both insulin secretion and insulin action. Tight glycemic control is considered to be important in the therapy of type 2 diabetes mellitus, but treatment with a single agent is not sufficient to achieve this for the majority of patients. So, there is a need for new antidiabetic agents with favorable side effect profiles to use in combination therapy. The gliptins, an emerging new class of oral drugs for type 2 diabetes mellitus, lower blood glucose levels by a novel mechanism of inhibiting the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretin, released from the intestine following a meal to increase pancreatic insulin secretion. Gliptins enhance the circulating levels of incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) and improve glycemic control. This therapeutic approach carries a low-risk of interprandial hypoglycemia, does not cause weight gain and is well-tolerated. The first gliptin, sitagliptin (Januvia), was introduced in the UK in April 2007 as add-on therapy for patients with type 2 diabetes inadequately controlled with oral hypoglycemic agents. Other gliptins, notably vildagliptin (Galvus), saxagliptin and melogliptin are advanced in clinical development. This article reviews the current evidence on the effectiveness of gliptins and suggests several ways in which these agents could be used in diabetes treatment.
ABSTRACT
Congestive heart failure (CHF) is becoming an increasingly prevalent healthcare problem. Hypertension (HT) is a major risk factor for CHF and it commonly coexists with other cardiovascular risk factors. The quality of risk that HT represents has to be thoroughly compared with other risk factors. This could have significant implications for primary prevention strategies including drug treatment. A study was conducted in 137 heart failure patients, to assess the contribution of cardiovascular risk factors like age, sex, obesity, HT, diabetes, dyslipidemia, alcohol, smoking and family history, individually and in combination, in the progression of CHF using multivariate logistic regression analysis and odds ratio (OR) (95% confidence interval). Of the various individual factors, HT showed 3.8 times greater risk (p = 0.003; OR-3.773) for heart failure; dyslipidemia exhibited 2.5 times risk (p = 0.07; OR-2.49), followed by others. Patients with HT, but no diabetes or dyslipidemia had 1.2 times risk (OR-1.17) for CHF; patients with hypertension and diabetes had 1.7 times risk (OR-1.69) and patients with HT, diabetes and dyslipidemia had two times greater risk (OR-1.87). Though, the present study emphasizes that HT is the most common risk factor in the progression of heart failure, the risk is high when it coexists with other risk factors like diabetes and dyslipidemia. A clinical pharmacist can work in collaboration with healthcare team in achieving the goal of long-term control of hypertension and other cardiovascular risk factors in millions of patients, by providing services ranging from monitoring drug therapy and improving patients compliance to drug therapy, to, health maintenance care such as ordering screening procedures and counseling regarding lifestyle modification.