Comprehensive efficacy of ipragliflozin on various conditioned type 2 diabetes compared with dipeptidyl peptidase-4 inhibitors and with both agents, based on a real-world multicenter trial.

AIMS: The effects of ipragliflozin, the first sodium-glucose co-transporter 2 inhibitors (SGLT2i) launched in Japan in 2014, and with dipeptidyl peptidase-4 inhibitors (DPP-4i) on glycemic control and metabolic changes were investigated comprehensively on various conditioned type 2 diabetes (T2DM) by evaluating various clinical parameters in a real-world setting. MATERIALS AND METHODS: A total of 101 patients with T2DM aged 20-80 years with 7.0% ≤ HbA1c < 10.0% were followed in this 52-week, open-label, prospective, real-world, multicenter study. RESULTS: HbA1c decreased significantly in all groups. In ipragliflozin using groups, body weight, waist circumference, blood pressure, HOMA-IR, AST, ALT, γ-GTP, uric acid and leptin levels decreased, in contrast, HDL-cholesterol, total ketone bodies, blood urea nitrogen, creatinine, RBC, hemoglobin and hematocrit levels increased, however, in DPP-4i sole group, no significant trends were observed in these parameters. Change in leptin positively correlated with insulin, while change in total ketone bodies inversely correlated with ALT in ipragliflozin using groups. Fasting active gastric inhibitory polypeptide levels decreased in ipragliflozin sole group. Glucagon showed no changes. No significant safety concerns were observed in this study. CONCLUSIONS: Ipragliflozin is useful and safe, showing some contrastive effects on several clinical parameters which are not shown with DPP-4i, resulting several clinical benefits. The co-administration of ipragliflozin and a DPP-4i has a better clinical outcome than either single-agent therapy.

[Premixed insulin and intermediate-acting insulin].

Intermediate-acting insulin and premixed insulin have a long history. They were widely used till the 1990s. However, due to the emergence of long-acting solubility insulin analogue and recent expanding EBM, premixed insulin became mainly used for type 2 patients who have stable lifestyles like elderly people. In the consensus algorithm for type 2 patients reached at ADA/EASD2012, premixed insulin is considered moderately complex but not so flexible. Instead, basal-bolus therapy is recommended because it is more flexible than other regimens. Although not recommended strongly by the guideline, premixed insulin can be adopted after considering the condition, lifestyle and situation of patients. As for intermediate-acting insulin, the spread of long-acting insulin analogues has rendered its therapeutic role no longer significant today.