Insulin degludec: a novel basal insulin analogue.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trial data, adverse effects, and potential role in therapy of insulin degludec. DATA SOURCES: Articles were identified using the MEDLINE database (January 1996-December 2012). Abstracts and posters were identified from respective congressional websites and published supplements of the American Diabetes Association, the European Association for the Study of Diabetes, and the American Association of Clinical Endocrinologists (January 2008-December 2012). Clinicaltrials.gov was used to identify any ongoing clinical trials or completed trials whose results had not been presented or published. STUDY SELECTION AND DATA EXTRACTION: All available studies were reviewed for inclusion; pharmacokinetic studies were limited to those reporting human data. DATA SYNTHESIS: Insulin degludec is a novel, ultra-long-acting basal insulin analogue that has a similar safety and efficacy profile when compared with insulin glargine in patients with type 1 or type 2 diabetes. Clinical trials have indicated that there is less hypoglycemia, particularly nocturnal hypoglycemia, associated with this agent. CONCLUSIONS: If insulin degludec is approved, it may offer an alternative basal insulin for patients needing more flexible dosing, having a history of nocturnal hypoglycemia, or those with severe insulin resistance needing a higher concentration of basal insulin.

An evaluation of low-dose simvastatin in achieving LDL goal: a retrospective chart review.

Treatment for hyperciholesterolemia targets low-density lipoprotein (LDL) cholesterol. In July 2004, an update to the existingcholesterol guidelines was published that recommended more intense lowering of LDL levels. This study, a retrospective chart review conducted at a multispecialty medical group practice, aimed to determine iflow-dose simvastatin (5 or 10 mg) was effective at achieving LDL goal, in light of these more aggressive guidelines. Demographic data, including risk factors and LDL levels, were collected on 173 patients identified as taking low-dose simvastatin. The review indicated that 66% of patients with low-to-rnoderate cardiovascular risk treated with low-dose simvastatin achieved their risk-appropriate LDL goalMore than 50% of patients who achieved this LDL goal on low-dose simvastatin fell into lower-risk cattegories. Therefore, low-dose simvastatin may be a beneficial treatment option for patients in lower cardiovascular-risk categories.

An update on the pharmacological treatment of obesity.

OBJECTIVE: To review the commonly utilized pharmacological options for the treatment of overweight and obese patients in the United States. METHODS: A MEDLINE and EMBASE search, in English, between January 1995 and November 2005 was conducted using the terms, "anti-obesity agents", "orlistat", "sibutramine", and "phentermine". References cited in relevant studies and reviews were also examined for additional clinical trials to be included in the review. RESULTS: There are several pharmacological options currently available for the treatment of overweight and obese individuals in the United States, including phentermine, sibutramine, and orlistat, with only sibutramine and orlistat being indicated for use in the long term (> 6 months). However, none of these medications have proven to be more effective than another for the indication of weight loss, each with a very similar maximum weight loss potential. Therefore choosing a weight loss medication should be patient specific and based on its pharmacological profile, including mechanism of action and potential adverse effects. Most importantly, it is imperative to realize that these agents are only indicated for use when combined with lifestyle modifications. Most studies have indicated that maximum benefits from any of these medications are only shown when taken in addition to a hypocaloric diet. CONCLUSION: It has been shown that the combination of lifestyle changes and pharmacological treatment leads to a greater decrease in total body weight loss. Treatment with anti-obesity agents is associated with side effects and an increased cost in health care. These factors must be weighed prior to initiating anti-obesity treatment.