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Objective To systematically evaluate the clinical effect and safety of repaglinide and metformin for treating diabetes mellitus (MD) of secondary failure of sulfonylurea (SFS).Methods The randomized controlled trials (RCT) at home and abroad on the comparison of effect and safety of repaglinide and metformin in treating MD with SFS were retrieved.The modified Jadad scale was employed to evaluate the literature quality.The RevMan5.3.1 software was used for conducting the meta analysis.Results A total of 10 RCT were included.The meta-analysis results showed that compared with metformin for treating MA with SFS,repaglinide decreased the fasting blood glucose effectively (MD=-2.30,95 ％ CI:-2.53--2.06,P＜0.01),increased the fasting C-peptide (MD=0.06,95％CI:0.02-0.11,P=0.01),reduced the postprandial 2 h blood glucose (MD=-2.17,95 ％CI:-2.44-1.89,P＜0.01) and decreased glycosylated hemoglobin (MD=-2.60,95％CI:-3.21--2.00,P＜0.01) as well as the adverse reactions (RR=0.05,95％CI:0.02-0.09,P＜0.01).However,there was no statistical difference in fasting insulin between the repaglinide and metformin groups (MD=0.18,95％CI:-0.18-0.54,P=0.32).Conclusion Currently evidences suggest that repaglinide is superior to metformin for treating MD with SFS.
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Objective To observe the effect of sitagliptin combined with insulin aspart 30 in the treatment of secondary failure of sulphonylurea in type 2 diabetes mellitus. Methods Fifty-six cases were divided into group A and group B in random block design, with 28 cases of each group. The patients in group A was treated with sitagliptin combined with insulin aspart 30, while the patients in group B was given subcutaneous injection of insulin aspart 30R. All patients were treated for 12 weeks. Fasting plasma glucose(FPG), 2-hour postprandial plasma glucose(2 hPG), glycosylated hemeglobin(HbA1c), insulin secretion index (HOMA-β), body mass index (BMI), and incidence of low blood glucose before and after treatment were compared. Results Compared with that in group B, FPG [(5.61 ± 1.14) mmol/L vs. (7.8 ± 1.22) mmol/L], 2 hPG [(7.62 ± 1.35) mmol/L vs(9.72 ± 1.41) mmol/L] and HbA1c [(7.11 ± 0.83)%vs.(8.32 ± 1.04)%] in group A had a significant decrease;HOMA-β[(50.31 ± 5.12) vs. (41.86 ± 4.53)] of group A was higher than that of group B (P
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PURPOSE: This study was performed to evaluate the patterns of secondary failure, and the prognostic factors for survival, following surgical treatment of an isolated locoregional recurrence after a mastectomy in breast cancer patients. METHODS: Forty-nine patients, who had undergone an excision, or a wide excision, either with or without radiation therapy, for an isolated locoregional recurrence following a mastectomy, between 1991 and 2001, were retrospectively analyzed according to the secondary recurrence patterns, the time to the secondary failure, survival rate, and prognostic factors for survival. RESULTS: During the 33 month median follow-up, 28 patients (57%) developed a secondary recurrence; an isolated locoregional failure in 7 (25%), a systemic dissemination in 20 (71%), and both in 1 (4%). The median times from the first recurrence to the second failure, according to the pattern of the secondary failure, were 16, 14 and 6 months for locoregional, for systemic dissemination, and for both, respectively. The disease-free interval (DFI) from first surgery to the recurrence was a significant independent prognostic factor for the second failure. A Univariate analysis identified the DFI, and hormone therapy administered due to a recurrence, as significant prognostic factors for overall survival, but these were not from a multivariate analysis. The 5-year disease- free and overall survival rates for an isolated locoregional recurrence were 27% and 79%, respectively, compared with 0% for both these rates for a recurrence combined with a systemic recurrence (P=0.002). CONCLUSION: A secondary failure, following treatment of an isolated locoregional recurrence, developed in more than half the patients, with a locoregional failure in 25%, and a systemic dissemination in the remainder. DFI and hormone therapy for a recurrence were independent prognostic factors of the overall survival. The survival rates after surgical treatment of isolated locoregional recurrences were increased compared with those for a recurrence combined with a systemic recurrence.
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Humans , Breast Neoplasms , Breast , Follow-Up Studies , Mastectomy , Multivariate Analysis , Recurrence , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Recently, the usefulness of metformin as an oral hypoglycemic agent has been re-evaluated, while secondary failure of long-term treatment with sulfonylurea (SU) has become a serious problem. In this study, the usefulness of combination therapy with metformin was evaluated in patient with non-obese type 2 diabetes mellitus showing secondary failure of treatment with SU.<BR>PATIENTS AND METHODS: Twenty non-obese patients with type 2 diabetes mellitus showed HbA<SUB>1c</SUB> levels of 7% or over despite more than 5 years of treatment with SU. Metformin was administered to these patients at a dose of 500 mg/day for 3 months in combination with SU, and glycemic control was compared before and after combination therapy.<BR>RESULTS: After combination therapy, the mean plasma glucose level obtained 2 hours postprandial was significantly decreased by 20.0% (216±41.7 mg/dl vs. 172.0±47.7 mg/dl, p<0.001) . In addition, the mean HbA<SUB>1c</SUB> level was significantly decreased by 8.8% (8.0±0.8% vs. 7.3±0.8%, p<0.001) . However, the mean IRI level, the mean body mass index, and mean plasma lipid levels did not significantly change after combination therapy.<BR>CONCLUSIONS: These findings suggest that combination therapy with metformin is useful for improving blood glucose levels without enhancing insulin secretion in patients with non-obese type 2 diabetes mellitus who showed secondary failure of treatment with SU. However, further studies are needed to confirm whether this combination therapy will contribute to delaying the introduction of insulin therapy.
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OBJECTIVE:To compare the cost-effectiveness and quality of survival among different therapeutic regimens for diabetic patients with sulfonylureas secondary failure(SSF).METHODS:The cost-effectiveness and the effects on patients life quality of four therapeutic schemes(group A: mixed-human insulin;group B:repaglinide and metformin;group C:repaglinide and acarbose;group D:glipizide,metfonmin and novolin N) were compared using cost-effectiveness analysis in pharmacoeconomics and DSQOL(diabetic patients’ score on quality of life).RESULTS:Group A showed the best clinical efficiency,with cost-effectiveness ratio significantly lower,physiological and psychological dimension scores significantly higher and social dimension score significantly lower than in all the other 3 groups,and all were of significant differences,but no significant differences were noted in therapeutic dimension score as compared with the other 3 groups.CONCLUSION:Insulin is optimal among four schemes in the treatment of diabetic patients with sulfonylureas secondary failure in the cost-effectiveness analysis, and it has the best efficacy in the improvement of patients’ physiology and psychology.