Hypolipidemic effect of sitagliptin, voglibose and glimepiride in combination with metformin in patients with type 2 diabetes mellitus at a tertiary care teaching hospital: a comparative study

Background: The prevalence of coronary artery disease has been increased in diabetic dyslipidemia; hence the present study would like to compare the dyslipidemic effects of Sitagliptin, Voglibose, and Glimepiride in combination with Metformin in type 2 diabetes mellitus patients.Methods: This study was a Prospective, Randomized Clinical trial conducted at SRM medical College Hospital and Research centre. Potheri, Kancheepuram District in diabetic outpatient department after obtaining approval from Institutional Ethics Committee. The patients receiving antidiabetic drugs were divided into three groups. Patients received Metformin with Sitagliptin were grouped as I, Metformin with Voglibose were named as Group II and Metformin with Glimepiride were marked as Group III. Based on the inclusion and exclusion criteria, in each group, 40 patients were assigned as per simple randomization method. The level of lipid profile and BMI was evaluated at the end of 6 months.Results: There was a significant reduction of Total Cholesterol (TC) in Group II and Group III (p value- <0.001, <0.006). Group I showed significant elevation of HDL-C level with the p value of <0.03. Group III showed significant reduction of Triglyceride (TG) level with the p value of <0.04, significant reduction of Low Density Lipoprotein Cholesterol (LDL-C) level with the p value of <0.02 and significant reduction in Very Low Density Lipoprotein Cholesterol (VLDL-C) level with the p value of <0.05. There was no significant reduction in Body Mass Index (BMI) among the groups. On multiple comparisons, Group III showed higher efficacy in reducing TC, TG, LDL-C and VLDL-C levels.Conclusions: The results of this study were analysed and it could be concluded as Metformin with Glimepiride combination (Group III) showed significant reduction of TC, TG, LDL-C and VLDL-C levels.

Rosuvastatin plus fenofibrate in diabetic dyslipidemia: a hospital record based study

Background: Cardiovascular diseases (CVD) are the leading cause of death throughout world population each and every year. Focus on dyslipidemia management is urgently required in India to halt the rising tide of CVD. The purpose of diabetic dyslipidemia study is a record based one, to find out the effect of Rosuvastatin plus Fenofibrate, in adult Type 2 diabetes with dyslipidemia, with high TGL/HDL ratio in Lipid profiles, in a tertiary care hospital in the Union territory of Puducherry.Methods: There were 101 patients hospital records were analysed in which male were 45 and females were 56. The various biochemical parameters like serum Total Cholesterol, HDL, LDL, TGL, Non-HDL, TCL/HDL Ratio and TGL/HDL ratio reports were collected before and after 12-weeks of Rosuvastatin 10 mg with Fenofibrate 145 mg combination, for the treatment period once daily for their lipid-lowering therapy.Results: The combination therapies of Rosuvastatin plus Fenofibrate were safe and feasible to achieve more TG goal and proved that has predominately decreased the elevated lipid profiles from the medical resources of our record based study. The use of combination medications of rosuvastatin (10mg) plus Fenofibrate (145mg) is often needed to effectively treat the lipid triad, by the potency of rosuvastatin to lower LDL-C and Fenofibrates effectiveness in lowering TG in treating mixed diabetic dyslipidemia.Conclusions: After Rosuvastatin (10mg) plus Fenofibrate (145mg), the lipid profile data proved that the importance of TGL/HDL ratio apart from the TCL/HDL ratio, for good lipid control in diabetic dyslipidemic patients.

Interaction between Glucose and Lipid Metabolism: More than Diabetic Dyslipidemia

Glucose and lipid metabolism are linked to each other in many ways. The most important clinical manifestation of this interaction is diabetic dyslipidemia, characterized by elevated triglycerides, low high density lipoprotein cholesterol (HDL-C), and predominance of small-dense LDL particles. However, in the last decade we have learned that the interaction is much more complex. Hypertriglyceridemia and low HDL-C cannot only be the consequence but also the cause of a disturbed glucose metabolism. Furthermore, it is now well established that statins are associated with a small but significant increase in the risk for new onset diabetes. The underlying mechanisms are not completely understood but modulation of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA)-reductase may play a central role as genetic data indicate that mutations resulting in lower HMG CoA-reductase activity are also associated with obesity, higher glucose concentrations and diabetes. Very interestingly, this statin induced increased risk for new onset type 2 diabetes is not detectable in subjects with familial hypercholesterolemia. Furthermore, patients with familial hypercholesterolemia seem to have a lower risk for type 2 diabetes, a phenomenon which seems to be dose-dependent (the higher the low density lipoprotein cholesterol, the lower the risk). Whether there is also an interaction between lipoprotein(a) and diabetes is still a matter of debate.

Peroxisome Proliferator-Activated Receptor (PPAR) alpha/gamma Agonist / 대한내과학회지

Peroxisome proliferator-activated receptor (PPAR) agonists improve glucose control and insulin sensitivity, reduce concentrations of atherogenic lipoproteins, and decrease circulating levels of inflammatory mediators. PPAR activation is considered an important pharmacologic target for patients with type 2 diabetes. However, the PPAR agonists in clinical use have undesirable side effects, including weight gain, heart failure, and bone fractures. PPAR alpha/gamma dual agonists each target one or more of the key cardiometabolic risk factors of diabetic dyslipidemia, insulin resistance, hyperglycemia, and inflammation; thus, combining their benefits to provide glucose control and ameliorate cardiovascular risks has emerged as an attractive treatment option. Aleglitazar, which was designed to balance the activation of PPAR alpha/gamma, proved efficacious in improving glycemic control and lipid homeostasis and is anticipated to minimize PPAR-related side effects. Whether the effects of aleglitazar on cardiometabolic risk factors translate into improved cardiovascular outcomes, particularly in high-risk patients, is currently being evaluated by AleCardio, a large, long-term, time-, and event-driven outcome study of type 2 diabetics with recent acute coronary syndrome.