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The treatment of patients with diabetes mellitus, which is characterized by defective insulin secretion and/or the inability of tissues to respond to insulin, has been studied for decades. Many studies have focused on the use of incretin-based hypoglycemic agents in treating type 2 diabetes mellitus (T2DM). These drugs are classified as GLP-1 receptor agonists, which mimic the function of GLP-1, and DPP-4 inhibitors, which avoid GLP-1 degradation. Many incretin-based hypoglycemic agents have been approved and are widely used, and their physiological disposition and structural characteristics are crucial in the discovery of more effective drugs and provide guidance for clinical treatment of T2DM. Here, we summarize the functional mechanisms and other information of the drugs that are currently approved or under research for T2DM treatment. In addition, their physiological disposition, including metabolism, excretion, and potential drug-drug interactions, is thoroughly reviewed. We also discuss similarities and differences in metabolism and excretion between GLP-1 receptor agonists and DPP-4 inhibitors. This review may facilitate clinical decision making based on patients' physical conditions and the avoidance of drug-drug interactions. Moreover, the identification and development of novel drugs with appropriate physiological dispositions might be inspired.
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Hypoglycemic drugs in the dipeptidyl peptidase-4 (DPP-4) inhibitor class are used as a second-line treatment for type 2 diabetes mellitus. With DPP-4 inhibitors, there have been a few reports of cutaneous side effects such as bullous response, fixed drug eruption, and photosensitivity. There is no definitive pathophysiology for the above mentioned allergic reactions. Sitagliptin phosphate belongs to the DPP-4 inhibitor class. This is a case report of a sitagliptin-induced bullous drug reaction manifesting three weeks after starting therapy. He had bullous pemphigoid-like eruptions all over the body. The patient showed improvement once sitagliptin was discontinued alon with oral and topical steroid treatment.
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Objective: To compare the cost effectiveness and achievement of glycemic goals in patients inadequately controlled by conventional drugs receiving either intensified treatment or DPP4 inhibitor as an add on. It shall help us to identify a preferred choice of treatment. Materials and Methods: As per study protocol, 52 patients with inadequately controlled type 2 diabetes mellitus (DM) were included in the study. They received either intensified treatment or add-on with DPP4 inhibitor. Glycated hemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), adverse drug reactions, and their cost were calculated for the next 6 months of therapy. Results: Add on therapy with DPP4 inhibitor showed a greater achievement of glycemic goals. Target HbA1c was achieved by 58.6% (P < 0.0001) versus 40% (P < 0.05), FBS was achieved by 78.50% (P < 0.0001) versus 50% (P < 0.16), and PPBS was achieved by 63.6% (P < 0.0001) versus 42.8% (P < 0.03) in the add-on with DPP4 inhibitor versus intensified treatment group. No hypoglycemic episodes were documented in both the groups. Add-on with DPP4 inhibitor cost (×5.13) as compared to intensified treatment. Conclusions: Add-on with DPP4 inhibitor therapy achieved glycemic goals in greater proportion of patients as compared to treatment intensification but at 5 times the cost of therapy. Since the patent restrictions for DPP4 inhibitors such as vildagliptin and teneligliptin are over, the cost of therapy has come down. Hence their benefits should be extended to a greater proportion of patients with inadequately controlled type 2 DM.
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Background: Diabetes is a chronic metabolic disease which affects the quality of life. It leads to multiple complications due to metabolic involvement. Out of multiple drugs used to treat diabetes, dipeptidyl peptidase 4 (DPP-4) inhibitors are comparatively new drugs used for type-2-diabetes mellitus (DM) treatment. This study aimed to find out the drug utilization (DU) 90% and use of DPP-4 inhibitors in patients with type-2-DM.Methods: A prospective, cross-sectional, observational study was conducted at a private healthcare clinic of an endocrinologist in Nashik. Type-2-DM patients of both sexes were selected and a total of 199 patients were enrolled in the study. The consented patients were interviewed and prescription copies were collected. After studying them; statistical analysis was done and results and conclusions were drawn.Results: Out of total prescribed drugs, 58.77% of drugs were anti-diabetics. It was observed that the biguanides were most frequently (25.32%) prescribed while the least prescribed drugs were meglitinide analogues (0.08%). Most commonly utilized anti-diabetic found to be metformin. Vildagliptin 50 mg is the most commonly prescribed drug from DPP-4 inhibitors. Most of the drugs from the DPP-4 inhibitor group came under DU90%.Conclusions:DPP-4 inhibitors are showing wide acceptability by endocrinologists for type-2-DM management, according to this study. Performing repetitive drug utilization pattern study and circulation of standard treatment guidelines to practising physicians can be required. To emphasize the point on generic prescription, more awareness should be created. So that these can responses to further cost-effective and rational prescribing practices.
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Background: Teneligliptin is a DPP-4 inhibitor with unique chemical structure. Efficacy and safety of Teneligliptin is well established in the patients with type 2 diabetes mellitus (T2DM) in different randomized controlled trials. However, limited real-world data is available for Teneligliptin pertaining to Indian T2DM patient profile such as demographics, duration of disease, currently prescribed anti-hyperglycemic drugs, initiation of Teneligliptin as monotherapy or as an add on therapy.Methods: A cross-sectional, multicenter, non-interventional study was conducted to understand the demographics and clinical profile of Indian T2DM patients (n=5091) who were prescribed Teneligliptin.Results: Majority of patients were male (65.2%) with family history of T2DM present in 43.45% of cases. Age at onset of T2DM was 51.1±11.6 years. Among the T2DM patients, 36.2% of patients were newly diagnosed and more than half of them (54.7%) were uncontrolled with current anti-hyperglycemic drugs. Mean HbA1c level among these patients was 8.09±1.3%. Mean fasting and postprandial blood glucose levels were 170.2±46.9 mg/dl and 255.3±69.3 mg/dl respectively. Teneligliptin was prescribed as monotherapy in 2165 (41.66 %) of patients while as dual, triple and quadruple therapy in 2346 (46.08%) and 551 (10.82%) and 29 (0.56%) respectively. Among the patients on current anti-hyperglycemic treatment, most commonly prescribed drugs along with Teneligliptin were metformin (43.39%) followed by glimepiride (11%) and voglibose (3.42%).Conclusions: Teneligliptin is preferred as monotherapy and combination with metformin and sulfonylureas (mostly glimepiride) in newly diagnosed and uncontrolled T2DM patients in Indian scenario.
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La diabetes mellitus tipo 1 (DM1), es una enfermedad crónica caracterizada por la deficiencia de insulina debido a la pérdida de células ß pancreáticas, las alteraciones hormonales en la DM 1 no se limitan a la deficiencia de insulina; existiendo también secreción inadecuadada de glucagón en el período postprandial. Aunque el control glucémico con terapias intensivas con insulina ha reducido la incidencia de complicaciones microvascular y macrovasculares. La mayoría de las personas con DM1 tienen un control glucémico subóptimo; Por lo tanto, el uso de farmacoterapia adyuvante para mejorar el control ha sido de interés clínico. El uso de estos nuevos medicamentos brindaría la oportunidad de imitar más de cerca la fisiología pancreática normal, y contrarrestar otros mecanismos fisiopatológicos diferentes a Insulinopenia; contribuyendo a lograr un mejor control metabólico y expectativa de vida.
Type 1 diabetes mellitus (T1DM), is a chronic disease characterized by insulin deficiency due to the loss of pancreatic ß cells, the hormonal alterations in T1DM are not limited to insulin deficiency; there is also a deregulated glucagon secretion in the postprandial period. Although glycemic control with intensive therapies with insulin has reduced the incidence of microvascular and macrovascular complications, most people with T1DM1 glycemic control; therefore, the use of adjuvant pharmacotherapy to improve control has been of clinical interest. The use of these new drugs would offer the opportunity to imitate more closely the normal pancreatic physiology, and to counteract other physiopathological mechanisms different from insulinopenia; contributing to achieve better metabolic control and life expectancy.
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Humans , Diabetes Mellitus, Type 1/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Chemotherapy, Adjuvant , Glucagon-Like Peptide 1/therapeutic use , Sodium-Glucose Transporter 2/antagonists & inhibitors , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Metformin/therapeutic useABSTRACT
Among various insulinotropic agents used in treatment of Type 2 DM, inclusion of DPP4 inhibitors are considered as major breakthrough as far as new drug development is concerned. In this review article we have discussed in detail about the pathogenesis of diabetes mellitus especially the role of incretin, DPP4 enzyme and implication of its inhibitors in treatment of DM. Also, various clinical studies regarding use of DPP4 inhibitors as monotherapy and as combination therapy with other antidiabetic agents were discussed. DPP-4 inhibitors control glucose in fasting as well as in postprandial state both in monotherapy and in combination with other oral antidiabetic agents. Significant reduction in HbA1c observed with DPP4 inhibitors as monotherapy. On combining DPP 4 inhibitor as add-on therapy to metformin, glitazone or sulphonylurea therapy in patients with type 2 diabetes not reaching therapeutic goals, DPP-4 inhibitors reduce HbA1c, fasting plasma glucose and 2-h postprandial plasma glucose up to the desired level. Various DPP-4 inhibitors have been proven to be as safe and tolerable both as monotherapy and combination with other antidiabetic agents. Inhibition of DPP-4 enzyme has been proven as a promising aspect in the treatment of type 2 diabetes and various drugs inhibiting DPP4 enzymes have been developed now. They are highly recommended in the treatment of Type 2 DM both as monotherapy as well as combination therapy.
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Background: The prevalence of chronic kidney disease is increasing with diabetic nephropathy as the common underlying cause. Although numerous drugs are being used to improve glycaemic control, evidence in patients with diabetic nephropathy is sparse. The aim of the present was to evaluate the effectiveness of sitagliptin or vildagliptin addition on glycaemic control in patients with T2DM undergoing haemodialysis as part of their routine care in a rural tertiary care setting.Methods: Type 2 diabetic patients on maintenance haemodialysis as part of routine care and whose glycaemia was not controlled adequately and prescribed one of the oral gliptins once daily in addition to existing therapy for a period of 24 weeks were included in the present study. Effectiveness was assessed in terms of glycaemic control as measured by the change over time in glycated haemoglobin. Data analysis included glycated haemoglobin, body weight, serum creatinine, urine albumin creatinine ratio and the occurrence of hypoglycaemia.Results: Significant reduction in glycated haemoglobin values were noted after 24 weeks of therapy with gliptins similar to insulin glargine with a small weight loss. There was an insignificant decrease in the serum creatinine and urine albumin excretion levels after treatment with vildagliptin with Vildagliptin producing a slightly higher decrease but there was no correlation with changes in A1c levels. The overall incidence of adverse experiences was low and generally mild in both groups.Conclusions: In a group of Asian Indian patients with diabetic nephropathy due to T2DM undergoing haemodialysis in whom glycaemia was not controlled adequately, addition of gliptins helped to achieve glycaemic control to a similar extent as insulin glargine but with a marginal weight advantage.
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DPP-4 inhibitors are a new type of oral glucose lowering drugs based on pancreatic glucagon. There are 5 kinds of DPP-4 inhibitors that are approved in our country. Currently, DPP-4 inhibitors have been widely recommended by domestic and international diabetes treatment guidelines. The safety of DPP-4 inhibitors is particularly important in elderly patients because this is the main population in type 2 diabetes. Here, we reviewed the literatures, explore the effectiveness and safety of DPP-4 inhibitors in elderly population, and provide evidence for clinical practice.
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Objective To study the clinical curative effect of dipeptide base peptidase Ⅳ inhibitors (DPP-4) combined with insulin in the treatment of type 2 diabetes.Methods 100 patients with type 2 diabetes were selected as the research subjects,and they were randomly divided into two groups by single blind randomization method,50 cases in each group.The control group adopted the premixed insulin therapy for a month,the observation group received the DPP-4 inhibitors combined with premixed insulin therapy for a month.The blood sugar success rate,weight,incidence of hypoglycemia of the two groups were compared.Results After treatment,the fasting blood glucose value,2 h postprandial blood glucose of the two groups were significantly decreased(t=5.155,P=0.000;t=6.591,P=0.000;t=7.488,P=0.000;t=7.574,P=0.000).But there were no statistical differences between the two groups after treatment (all P>0.05).The incidence rate of hypoglycemic events of the observation group was obviously lower than that of the control group (x2=5.982,P=5.982).Before treatment,the ALT,AST,serum creatinine,urea nitrogen between the two groups had no significant differences(all P>0.05).The body weight,body mass index of the observation group were significantly lower than those of the control group (t=6.931,P=0.000;t=16.010,P=0.000).Conclusion The DPP-4 inhibitor combined premixed insulin therapy for type 2 diabetes has significant hypoglycemic effect,can effectively reduce hypoglycemic events,effectively control the weight,and its effect on liver and kidney function is relatively mild,safe and reliable.
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In recent years,the prevalence of diabetes is increasing year by year with the improvement of people's living standard.The traditional oral anti-hyperglycemic drugs as well as insulin injection therapy can not block the progress of the disease course.The deterioration of glycaemic control results in various acute and chronic complications which seriously affect patients' health and bring huge economic burden.The researchers have been seeking new therapeutic regimens to improve or even reverse diabetes process.This paper focuses on the following novel treatment options such as GLP-1 receptor agonist,DPP4 inhibitors, fixed-dose combination,SGLT2 inhibitors,amylin analogues,dopamine receptor agonist,bile acid sequestrant,bariatric surgery and pancreatic stem cell transplantation.
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BACKGROUND: Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch. METHODS: Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked. RESULTS: HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0+/-67.5 mg/dL at baseline to 197.1+/-69.9 mg/dL at 12 weeks and 192.3+/-67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c < or =7% after switching to sitagliptin. CONCLUSION: Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.
Subject(s)
Humans , Blood Glucose , Diabetes Mellitus, Type 2 , Fasting , Glycated Hemoglobin , Homeostasis , Hypoglycemia , Insulin Resistance , Logistic Models , Metformin , Sitagliptin PhosphateABSTRACT
Diabetes is a chronic metabolic disorder with high mortality rate and with defects in multiple biological systems. Two major types of diabetes are recognized, type 1 and 2 with type 2 diabetes (T2D) being by far the more prevalent type. As diabetes affects multiple biological functions, the use of multiple drug classes having different mode of actions is required in order to optimize therapy in diabetic patients. Five major classes of oral antidiabetic agents (OHA) have traditionally been used for the management of patients with T2D. These include the sulphonylureas, meglitinides, biguanides, thiazolidinediones and the alpha-glucosidase inhibitors. Several newer classes of agents have also been introduced recently in the pharmacotherapy of T2D, including the incretin mimetics, the dipeptidy peptidase 4 (DPP-4) inhibitors, the sodium glucose co-transporter 2 (SGLT 2) inhibitors and more recently, the dual peroxisome proliferator-activated receptor (PPAR) agonists. Each of these agents has been shown in various experimental and clinical settings to be efficacious in T2D, but each is also associated with a number of adverse effects. Despite the vastarray of drugs introduced, metformin, a biguanide, largely remains the first choice mono therapy in T2D patients but several combination options are also available in poly pharmacy when mono therapy fails to produce the required glycemic control. The increasing number of drugs, together with numerous combination options in poly pharmacy, presents with the clinician an increasing complexity of therapeutic options. The likely pathogenetic mechanism of diabetes operating in the patient, as well as the mode of action, efficacy and safety of the drugs are some of the major considerations in the choice of any given agent or its combinations. This review therefore focuses on the mode of action, pharmacokinetics, indications, efficacy and adverse effects of the OHA used in T2D.
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DPP-4 inhibitors are new oral hypoglycemic drugs and hot spots developed and launched in recent years, and they pro-vide new choices for the clinical treatment of type 2 diabetes. In China, DPP-4 inhibitors that are approved to use in the treatment of type 2 diabetes are all imported products currently. In the paper, the current intellectual property situation of DPP-4 inhibitors that are developed and approved at home and abroad is researched and analyzed. Reasonable use of the patent information of DPP-4 inhibitors that is about to expire or have failed can provide good guidance for the subsequent development of DPP-4 inhibitors in domestic with promising curative effect and good market prospects, and can generate new patents in order to enhance the market competitiveness.
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OBJECTIVE: To compare the gastrointestional (GI) adverse events of glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors by systematic review and meta-analysis to provide reference for clinicians. METHODS: The following databases were searched: Pubmed, Embase, Cochrane, ClinicalTrials, and CNKI. And the following terms were used to search head to head studies comparing the GI adverse events of GLP-1 receptor agonists and DPP-4 inhibitors: "GLP-1 receptor agonist", "DPP-4 inhibitor", "incretin-based therapy", "adverse events", and "safety". Meta-analysis was performed by Revman 5.0 software, with results expressed as odds ratio (OR) and 95% confidence interval (CI) for GI adverse events. RESULTS: A total of 1 231 articles were obtained, among which six randomized clinical trials (RCTs) which include 884 GLP-1 receptor agonists users and 798 DPP-4 inhibitors users (total number=1 682), were included for the meta-analysis. The result showed that GLP-1 receptor agonists were associated with a higher incidence of GI adverse events, the ORs of high dose GLP-1 receptor agonists versus DPP-4 inhibitors for nausea, vomiting, diarrhea, and constipation were 4.68(3.36, 6.52), 4.66(2.51, 8.65), 2.17(1.54, 3.06) and 2.39(1.35, 4.24), respectively; the ORs of low dose GLP-1 receptor agonists versus DPP-4 inhibitors for nausea, vomiting, diarrhea, and constipation were 4.09(3.06, 5.48), 3.80(2.22, 6.50), 2.06(1.46, 2.93) and 2.39(1.35, 4.24), respectively. CONCLUSION: Compared to DPP-4 inhibitors, GLP-1 receptor agonists are associated with a higher incidence of GI side effects including nausea, vomiting, diarrhea, and constipation.
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Type 2 diabetes mellitus (DM) doubles the risk of major cardiovascular complications in both patients with and those without established cardiovascular disease (CVD), and the majority of patients with DM die of CVD. Therefore, prevention and early diagnosis for CVD are important for the improvement of quality of life and prognosis of patients with DM. Exercise stress tests, such as a treadmill test, are needed to detect myocardial ischemia, but such stress testing should be done by cardiologists. On the other hand, measurement of ankle brachial index (ABI) is quick and easy and has been used successfully to diagnose peripheral artery disease. Since ABI is known to be a good predictor of the risk of recurrent CV events and death, I strongly recommend that ABI be measured in all DM patients. Dipeptidyl peptidase 4 (DPP-4) inhibitors are oral agents with little risk of hypoglycemia and thus used widely. In 2013, two clinical studies (EXAMINE and SAVOR-TIMI53) showed that DPP-4 inhibitors were generally safe and well-tolerated but did not decrease or increase the rate of CV events in patients with high risk for CV. Although the study periods were short (1.5-2.0 years), it was shown that a reduction of CV events in DM patients with CV risk is difficult with glycemic control alone. Results of the Steno-2 study showed that optimal treatment of hypertension and dyslipidemia in addition to glycemic control are needed to reduce CV events.
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Dipeptidyl peptidase-4 (DPP-4) inhibitors, a new kind of oral hypoglycemic drugs, can significantly lower blood glu-cose levels in the patients with type 2 diabetes without common side effects such as body weight gain, hypoglycemia and gastrointestinal disturbances. Therefore, DPP-4 inhibitors play an increasingly important role in the treatment of type 2 diabetes. In this review, the re-search progress in the action mechanism, pharmacokinetics and clinical applications of DPP-4 inhibitors was summarized in order to provide reference for the clinical application.
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Aims: The aim of this study is to investigate the long-term efficacy of sitagliptin added to insulin in type 1 or type 2 diabetic patients with absolute insulin deficiency. Study Design: 48 weeks open-label, observational study. Place and Duration of Study: Department of Internal Medicine, Gyoda General Hospital, between June 2010 and December 2012. Methodology: Sitagliptin 25-100 mg/day was added to the ongoing insulin therapy in those without any detectable post-meal C-peptide levels. HbA1c and other parameters were followed for 48 weeks. Results: Effective reductions of HbA1c levels were already observed at 12 weeks and sustainable throughout the study period. However, 2 subjects had severe hypoglycemic evens. Post-meal C-peptide remained undetectable with all the subjects. Interestingly, significant increases of body weight were observed. Conclusion: Sitagliptin as an adjunct to insulin in patients with absolute insulin deficiency may be effective and sustainable for at least 48 weeks, allowing for less intense therapy. However, it should be noted that some patients may have severe hypoglycemic events. In spite of the significant glycemic effects of sitagliptin in the setting of this study, endogenous insulin secretory capacity remained absent, suggesting that the glucose lowering effect of this drug may be mediated through GLP-1 independent pathway as well.
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JUSTIFICATIVA E OBJETIVOS: A resistência à insulina (RI) desempenha papel fundamental na etiopatogenia do diabetes mellitus tipo 2 (DM2). A hiperinsulinemia compensatória impede a adequada metabolização dos ácidos graxos, levando ao acúmulo de gordura no hepatócito. A doença hepática gordurosa não alcoólica (DHGNA), na qual a esteatose hepática é a expressão clínica mais comum, têm alta incidência entre os portadores de DM2. Este estudo teve como objetivo discutir os riscos de lesão hepatocelular quando o fígado é exposto a doenças graves e o potencial de hepatotoxicidade de um grupo específico de fármacos.RELATO DO CASO: Paciente do sexo masculino, 51 anos, portador de DM2 e de psoríase numular. História de uso moderado de bebidas alcoólicas por longo período com risco de desenvolver doença hepática alcoólica (DHA). Acresce sorologia positiva para hepatite pelo vírus C (VHC). O fígado palpável, a confirmação da hepatomegalia em exame ultrassonográfico e a elevação das aminotransferases denunciam afecção hepática. CONCLUSÃO: As interações entre o DM2, DHGNA, DHA, VHC e a psoríase, bem como a toxicidade potencial cruzada dos fármacos indicados para o tratamento dessas comorbidades, representam risco real de agressão hepatocelular. A análise comparativa do perfil de segurança dos antidiabéticos orais (ADO) permite eleger os inibidores da dipeptidilpeptidase 4 (i DPP4) como os fármacos de menor potencial de lesão hepática, considerando que não são, em geral, substratos para o sistema do citocromo CYP450 e não atuam como indutores ou inibidores deste sistema com ações metabolicamente apreciáveis.
BACKGROUND AND OBJECTIVES: Insulin resistance (IR) plays a key role in the pathogenesis of type 2 diabetes mellitus (DM2). Compensatory hyperinsulinemia prevents the proper metabolism of fatty acids, leading to accumulation of fat in hepatocytes. The non-alcoholic fatty liver disease (NAFLD) in which hepatic steatosis is the most common clinical expression, has a high incidence among DM2 patients. This paper aims to discuss the risk of hepatocellular injury when the liver is exposed to serious diseases, and the potential hepatotoxicity of a specific group of drugs. CASE REPORT: Male, 51 year-old patient, with DM2 and nummular psoriasis with a history of moderate use of alcoholic beverages for long periods at risk of developing alcoholic liver disease (ALD), and positive serology for hepatitis C virus (HCV). The liver was palpable, the confirmation of hepatomegaly in ultrasound and elevated aminotransferases show liver disease. CONCLUSION: The interactions between DM2, NAFLD,ALD, HCV and psoriasis, as well as the potential cross-toxicity of drugs indicated for the treatment of these comorbidities, represent real risk of hepatocellular injury. The comparative analysis of the safety profile of oral antidiabetic (OAD) drugs allows the election of dipeptidyl peptidase 4 inhibitors (DPP4 i) as the drugs of lower liver damage potential, considering that generally they are not substrates for the CYP450 system and do not work as inducers or inhibitors of this system with substantial metabolic actions.
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Humans , Male , Middle Aged , Hepatitis C , Insulin Resistance , Liver Diseases, AlcoholicABSTRACT
Modern life style with present days technological advances have made human life sedentary. This is causing increasing prevalence of obesity and physical inactivity amongst population. The number of cases of diabetes worldwide in the year 2000 among adults 20 years of age is estimated to be 171 million in recent reports and is said to rise to more than 300 million by 2025. The raised plasma glucose levels give rise to complications in the form of microvascular and macrovascular complications diminished quality of life with reduced life expectancy. The currently available drugs used in the management of type II DM are not completely satisfactory in regard of controlling blood glucose level, many of the times they are associated with undesirable side effects. Hence there is continuous ongoing work in development of newer drugs, which are safe, efficacious and potent as well as free of undesirable effects such as sustained hypoglycaemia. Fortunately there are newer drug, few of them approved while other still knocking the door from the classes of drug such as GLP-1Mimetic, DPP-4 Inhibitors and others. Here we have tried to cover them in brief.