Advances in pharmacotherapy of type 2 diabetes [part-3: the gliptins]

Type 2 diabetes is witnessing major advances in pharmacotherapy. After a rather dormant period spanning the period from 1960s to the 1990's following the discovery of the sulphonylurea and biguanide groups of drugs in the 1950's, significant advances have been achieved in discovering new drugs. This has been possible because of the advances in biotechnology. In this part of the series of reviews we will be looking at the second group of the incretin-based therapies. These gliptins which include several agents, namely sitagliptin, vildagliptin and saxagliptin, with others still in development. The other group of the incretin-based agents the incretin mimetics have been discussed in more details in the previous issue of this journal

Metabolic syndrome in type 1 diabetes

The aim of this study was to assess the prevalence and effects of the presence of metabolic syndrome in patients with type 1 diabetes. Retrospective analysis of data from a one year period of patients attending annual review clinic was undertaken. Body weight, height and blood pressure were measured along with assessment of micro-/macro-vascular complications. HbAlc, urea, cholesterol, triglyceride, urinary albumin: creatinine ratios were also measured. Patients were divided into those with and those without metabolic syndrome. Data from 365 type 1 diabetic patients was analysed. Hundred and twelve had metabolic syndrome. There was no difference according to gender or smoking. Type 1 diabetic patients with metabolic syndrome had longer duration of diabetes, were significantly older, heavier, had higher blood pressure, higher triglyceride and lower HDL cholesterol levels. There were significant increases in mean BMI, urea, serum creatinine, urinary albumin: creatinine ratio, cholesterol and triglyceride in the group with metabolic syndrome even after controlling for both age and duration of diabetes. Neuropathy and macro-vascular complications were commoner in patients with metabolic syndrome. Patients with metabolic syndrome were more likely to be on statins, ACE inhibitors and angiotensin receptor blockers and had a significantly higher mean insulin dosage requirement per kg. This study highlights the importance of the presence of the metabolic syndrome in patients with type 1 diabetes. It shows that metabolic syndrome is associated with a higher incidence of diabetes-related complications, a need for higher insulin doses and a more aggressive multifactorial intervention