ABSTRACT
AIMS: To evaluate whether there is a difference between the effects of dapagliflozin and gliclazide modified release (MR) on glycaemic variability (GV) and glycaemic control, as assessed by continuous glucose monitoring (CGM), in individuals with uncontrolled type 2 diabetes. MATERIALS AND METHODS: This randomized, open-label, active-controlled study was conducted in individuals with uncontrolled type 2 diabetes who were drug-naïve or on steady-dose metformin monotherapy. Participants were treated once daily with 10 mg dapagliflozin or 120 mg gliclazide MR. CGM and GV index calculations were performed at baseline and after 12 weeks. RESULTS: In total, 97 participants (age 57.9 ± 8.7 years, 50.5% men, baseline glycated haemoglobin 63 ± 9.8 mmol/mol [7.9 ± 0.9%]) were randomized, and 94 completed the 12-week protocol. Intention-to-treat (ITT) and per-protocol (PP) analyses showed that the reduction in GV, as measured by the mean amplitude of glycaemic excursions, was superior in the dapagliflozin group versus the gliclazide MR group (-0.9 mmol/L [95% CI -1.5, -0.4] vs -0.2 mmol/L [95% CI -0.6, 0.3]; P = 0.030 [ITT]). The reductions in GV estimated by the coefficient of variation and SD were greater in the dapagliflozin group. Moreover, dapagliflozin increased the glucose time in range (TIR; 3.9-10 mmol/L) by 24.9% (95% CI 18.6, 31.2) vs. 17.4% (95% CI 11.6, 23.3) in the gliclazide MR group (P = 0.089 [ITT]; P = 0.041 [PP]). CONCLUSIONS: Dapagliflozin improved GV and increased TIR more efficiently than gliclazide MR in individuals with type 2 diabetes over 12 weeks, as demonstrated by CGM.
Subject(s)
Diabetes Mellitus, Type 2 , Gliclazide , Aged , Benzhydryl Compounds , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 2/drug therapy , Female , Gliclazide/therapeutic use , Glucosides , Humans , Hypoglycemic Agents/therapeutic use , Male , Middle AgedABSTRACT
A ascite quilosa é entidade clínica rara, caracterizada por líquido ascítico de aparência leitosa, com conteúdo de triglicerídeos maior que 1000 mg/dl ou 2 a 8 vezes acima do nível plasmático. Nós relatamos o caso clínico de um paciente masculino, de 68 anos, com história de emagrecimento de 10 kg e aumento de volume abdominal. A paracentese demonstrou líquido ascítico quiloso, com triglicerídeos (TG) de 890 mg/dl (TG plasmático de 59 mg/dl). Realizou tomografia computadorizada, que revelou ascite volumosa e sinais de hepatopatia crônica. À endoscopia digestiva alta evidenciou-se lesão invasiva em antro gástrico, cuja biópsia foi diagnóstica de adenocarcinoma gástrico pouco diferenciado. Em conclusão, o adenocarcinoma gástrico deve ser incluído no diagnóstico diferencial de ascite quilosa em adultos, ao lado dos linfomas e outras doenças malignas.
