Insulin Initiation with Insulin Degludec/Insulin Aspart versus Insulin Glargine in Oral Antidiabetic Drugs Failure Patients with Type 2 Diabetes Mellitus: A Real-World Study from India

Context: Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, but there is still a dilemma as to whether basal insulin or a premixed/co-formulation analog should be the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjects with type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting and design: Retrospective study. Methods and material: Data was retrieved from the author’s clinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100, n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) from baseline and at last follow-up visits were collected. Statistical analysis used: Baseline characteristics and change in study parameters during the follow-up period were computed between two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively. ANCOVA test was used to compute percentage reduction in body weight, body mass index (BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results: IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared to the IGlar U100 arm. There was no significant difference in the proportion of patients with hypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severe hypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD in T2DM patients indicated that both were relatively safe but the former controlled FPG and PPG levels more effectively.

The Non-glycemic Effects of SGLT2 Inhibitor / 임상당뇨병

Sodium glucose cotransporter 2 (SGLT2) inhibitors have recently been introduced as a new class of anti-diabetic agents. In addition to their glycemic action, SGLT2 inhibitors also have a number of non-glycemic effects that may contribute to renal and/or cardiovascular benefits. These include effects on tubuloglomerular feedback in the kidney, body weight, blood pressure, and serum uric acid. Other non-glycemic effects of SGLT2 inhibitors that need to be further studied include the effects on lipid profiles, food intake, and secretion of hormones such as leptin, incretins, and aldosterone. Also, the exact mechanisms of various non-glycemic actions should be further studied. Additionally, SGLT2 inhibitor therapy in combination with other drugs may have beneficial glycemic and non-glycemic effects.

Progress in liver transporter-mediated drug interactions with oral antidiabetic agents / 中国药学杂志

OBJECTIVE: To summarize the liver transporter-mediated drug interactions with oral antidiabetic agents.

Comparative Evaluation of Glycemic Control & Changes in Lipid Profile with Combined Oral Hypoglycemics (A Sulfonylurea Plus Pioglitazone Versus a Sulfonylurea Plus Metformin) in Patients with Type 2 Diabetes Mellitus.

Emerging datas have shown a high failure rate of longterm monotherapy in preventing the vascular complications of DM II. It establishes the significance of meal time hyperglycemia and the role of post-prandial glucose excursions in the development and progression of vascular complications. This prospective, randomized, open parallel group study was conducted on patients selected from those who were attending O.P.D. of Department of Endocrinology and Human Metabolism of SVBP Hospital, L.L.R.M. Medical College, Meerut. The study have demonstrated that the combination therapy with Sulfonylurea plus Pioglitazone (SUP) is an effective regimen for patients who are insufficiently treated with Sulfonylurea mono-therapy. This regimen may provide a possible positive effect on other coronary risk factors/ dyslipidemias associated with the type 2 Diabetes.

Congenital Malformations In The Fetuses Of Type 2 Diabetic Women Treated with Oral Antidiabetic Agents During Embryogenesis / 대한산부인과학회잡지

OBJECTIVE: The use of oral hypoglycemic drugs in pregnant women has been limited and therefore there is scanty information on their safety. Concern about possible adverse effects of these drugs on the fetus led us to collect the cases of unintentional fetal exposure to oral antidiabetic agent during embryogenesis for comparision with an appropriately matched control group from the same clinic population. METHODS: Eight type 2 diabetic pregnant women with accidental exposure to oral antidiabetic agent during early pregnancy and 20 type 2 diabetic pregnant women matched for age, weight, and glycemic control but not exposed to oral antidiabetic agent were studied retrospectively. RESULTS: Three neonates (38%) in the exposed group had congenital malformations and still birth, compared with 5 (25%) in the control group (Odds ratio 1.8 (0.2-13.8), P>0.05). In the control group, the mean of HbA1c of 5 mothers of neonates with anomalies and stillbirth were higher than that of 15 mothers of neonates without anomaly (8.8% vs 6.2%, p=0.1) and the anomalies were major congenital malformation including three congenital heart diseases (1 ventricular septal defect, 2 patent ductus arteriosus) and one renal agenesis. In the exposed group, the mean of HbA1c of 3 mothers of neonates with anomalies and stillbirth were higher than that of 5 mothers of neonates without anomaly (9.0% vs 6.3%, p=0.4) and the anomlies were urachal sinus and facial palsy which was not commonly described in diabetic embryopathy. CONCLUSION: Although this study, due to the limited number of pregnancies examined, does not exclude an association between treatment with oral antidiabetic agent at the time of embryogenesis and congenital malformations in the offspring, the risk of our results is lower than that of others. The final answer will demand a much larger number of pregnancies studied prospectively.

Analysis of Antidiabetic Agents Consumed in18Hospitals of Chongqing During the Period2000～2002 / 中国药房

OBJECTIVE:To survey and evaluate the present situation and trends of antidiabetic drugs used in18hospitals of Chongqing during the period2000～2002.METHODS:Data of antidiabetic agents used in18hospitals of Chongqing were collected and analysed concerning the consumptive sum and main kinds.RESULTS:The consumption sums of antidiabetic a?gents in the years2000,2001and2002were498,643and649tenthousand yuans(RMB),respectively,with an annual increase rate of15.03%.The cost for insulin injections accounted for38.56%of the total consumption sum of antidiabetic agents,and that for mixed insulin took59.02%of the consumption sum for insulin.CONCLUSION:Antidiabetic agent was an important kind of drug with developing potential.The consumption of mixed insulin injection and new kind of oral antidiabetic agents is increasing fast year by year.

Analysis of the Antidiabetic Agents Used in 47 Hospitals of Shanghai During the Period 1998～2001 / 中国药房

OBJECTIVE:To find out the situation of antidiabetic drugs used in 47 hospitals of Shanghai and to make objective evaluation as reference for production,sale and consumption departments.METHODS:To investigate the hypoglycemic drugs used in 47 hospitals of Shanghai during the period 1998～2001 in respect to the sum of money of consumption,kinds of drugs,DDDs and DDC.RESULTS:In recent 4 years,the annual rate of growth of antidiabetic drugs were 11.98% in DDDs?6.32% in DDC and 19.05% in sum.Among the increasing ranges of antidiabetic drugs in DDDs,joint venture drugs occupied the first place,imported drugs came second,and domestic drugs got the least.CONCLUSION:Antidiabetic drug is a kind of common drug which has developmental future.

Analysis of the Antidiabetic Agents Used in60Hospitals of Southwest China During the Period 2000～2002 / 中国药房

OBJECTIVE:To survey and evaluate the present situation and trends of antidiabetic agents used in hospitals of southwest China so as to provide information for the production,sale and consumption units.METHODS:To investigate the antidiabetic agents used in60hospitals of southwest China during the period2000～2002in respect to the sum of money of consumption,Kinds of drugs,DDDs and DDC.RESULTS:In recent3years,the annual increasing rates of consumption of oral antidiabetic agents and insulin injection were14.12%and42.09%,the proportions of costs for the oral antidiabetic agents and insulin injections in total consumption of antidiabetic agents were67.20%and32.78%respectively.CONCLUSION:The use of insulin is increasing quickly and the new dosage has developmental future.The Metformin and Glipizide are the important oral antidiabetic agents.