Entries Tagged as 'Diabetes Res Clin Pract'
Differences in effects of insulin glargine or pioglitazone added to oral anti-diabetic therapy in patients with type 2 diabetes: what to add–insulin glargine or pioglitazone?
Diabetes Res Clin Pract. 2008 Dec;82(3):340-5
Authors: Dorkhan M, Frid A, Groop L
BACKGROUND: While metformin is the first line treatment in type 2 diabetes, the best way to escalate therapy is not always clear, particularly whether to add one or two oral agents or to introduce insulin. METHODS: Thirty-six patients inadequately controlled on metformin and sulfonylurea/meglitinide were randomized to receive add-on therapy with insulin glargine or pioglitazone for 26 weeks. Insulin was up-titrated to achieve fasting plasma glucose <6 mmol/l. Pioglitazone was increased to 45 mg/day after 16 weeks if HbA1c>6.2%. beta-Cell function and insulin sensitivity were assessed by measuring insulin, proinsulin and adiponectin, and in a subgroup using a combined glucagon-stimulated C-peptide test and insulin tolerance test (GITT). Lipids and natriuretic peptides were measured at start and end of study. RESULTS: The reduction in HbA1c was slightly greater in the insulin glargine group and used as co-variate when analysing other variables. The effect on beta-cell function was more favourable with insulin glargine measured by proinsulin (42+/-48 to 19+/-16, p=0.01 vs. 36+/-26 to 27+/-16 p=0.04) while the improvement in insulin sensitivity measured by adiponectin (7.5+/-3.7 to 15+/-10, p<0.01 vs. 8.7+/-4 to 7.6+/-3, p=0.04) and HDL cholesterol (1.10+/-0.24 to 1.24+/-0.3, p<0.01 vs. 1.08+/-0.35 to 1.04+/-0.33, ns) (all p between groups <0.01) was more favourable in pioglitazone group. Pioglitazone caused significant increase in natriuretic peptides (BNP pmol/l 6.6+/-5.2 to 13.7+/-16.1, p=0.04 vs. 8.8+/-11.6 to 8.6+/-10.6, ns, p between groups 0.028). CONCLUSIONS: The results demonstrate characteristic differences in the effects of insulin glargine vs. pioglitazone on measures of beta-cell function and insulin sensitivity as well as cardiac load.
PMID: 18926586 [PubMed - indexed for MEDLINE]
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Long-acting insulin analogues versus NPH human insulin in type 2 diabetes: a meta-analysis.
Diabetes Res Clin Pract. 2008 Aug;81(2):184-9
Authors: Monami M, Marchionni N, Mannucci E
BACKGROUND: Long-acting insulin analogues, in comparison with NPH insulin, should warrant a greater reproducibility of absorption after subcutaneous injection, providing better metabolic control with reduced hypoglycaemic risk. Aim of the present meta-analysis is the assessment of differences with respect to HbA1c, incidence of hypoglycaemia, weight gain, between NPH human insulin and each long-acting analogue. METHODS: All randomized controlled trials (RCTs) with a duration >12 weeks comparing long-acting insulin analogues (detemir or glargine) with NPH insulin in type 2 diabetic patients were retrieved; data on HbA1c and BMI at endpoint, and incidence of any, symptomatic, nocturnal, and severe hypoglycaemia, were extracted and meta-analysed. RESULTS: A total of 14 RCTs was retrieved and included in the analysis. Long-acting analogues did not produce any significant improvement of HbA1c, in comparison with NPH human insulin. When trials with different analogues were analysed separately, NPH showed a significant superiority (by 0.1%) over detemir, but not over glargine. When analysing the effect of long-acting analogues on body weight, detemir, but not glargine, was associated with a significantly smaller weight gain than human insulin Both analogues were associated with a reduced risk for nocturnal and symptomatic hypoglycaemia (OR: 0.46[0.38-0.55] and 0.69[0.60-0.80]; all p<0.01). CONCLUSIONS: Long-acting insulin analogues in type 2 diabetic patients does not seem to provide a better glycemic control in comparison with NPH insulin, whereas it reduces the risk of nocturnal and symptomatic hypoglycemia. Detemir, but not glargine, could be associated with smaller weight gain than NPH insulin.
PMID: 18495286 [PubMed - indexed for MEDLINE]
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CLD (chronic liver diseases)-HbA1C as a suitable indicator for estimation of mean plasma glucose in patients with chronic liver diseases.
Diabetes Res Clin Pract. 2008 Aug;81(2):258-62
Authors: Koga M, Kasayama S, Kanehara H, Bando Y
In patients with chronic liver diseases (CLD), turnover of erythrocytes is increased whereas that of serum albumin is decreased. Thus, glycated hemoglobin (HbA(1C)) and glycated albumin (GA) cannot be used as adequate indicators for chronic plasma glucose control in diabetic patients with CLD. In this investigation, we have proposed CLD-HbA(1C), a novel long-term glycemic control marker by using measured HbA(1C) and GA. We studied 82 patients with CLD in whom glycemic control was regarded as to be stable. Daily plasma glucose profiles were monitored and estimated levels of HbA(1C) were calculated on the conversion formula established by Rohlfing et al. [C.L. Rohlfing, J.D. England, H.M. Wiedmeyer, A. Tennill, R.R. Little, D.E. Goldstein, Defining the relationship between plasma glucose and HbA1c, Diabetes Care 25 (2002) 275-278]. Cholinesterase (ChE) as an indicator for hepatic function was determined at the same time when HbA(1C) and GA levels were measured. CLD-HbA(1C) was defined as the average of measured HbA(1C) and GA/3, based upon the results that among healthy individuals, GA levels were roughly estimated at approximately threefold higher than HbA(1C) levels. While measured HbA(1C) levels in patients with CLD were generally lower than estimated HbA(1C) levels, GA/3 values were generally higher than estimated HbA(1C) levels. Such discrepancies lineally increased in accordance with a decrease in ChE levels. On the other hand, CLD-HbA(1C) levels were highly correlated with estimated HbA(1C) levels (R=0.883), while no significant correlation between CLD-HbA(1C) and ChE was noted. In conclusion, CLD-HbA(1C) has been found a superior chronic glycemic control marker than HbA(1C) or GA in diabetic patients with chronic liver diseases.
PMID: 18513821 [PubMed - indexed for MEDLINE]
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Factors associated with treatment failure in patients with diabetic foot infections: An analysis of data from randomized controlled trials.
Diabetes Res Clin Pract. 2008 Jun;80(3):344-51
Authors: Vardakas KZ, Horianopoulou M, Falagas ME
BACKGROUND: Although several antibiotics have been studied for the treatment of foot infections, their effectiveness has been considered to be similar. The scope of this analysis was the identification of factors that are associated with treatment failure based on evidence from randomized controlled trials (RCTs). METHODS: Two reviewers independently extracted data from published RCTs comparing different antibiotics for diabetic foot infections (DFIs). RESULTS: The combined observed treatment failure was 22.7% in the 18 RCTs included in the analysis. When different regimens of various antibiotics (penicillins, carbapenems, cephalosporins, and fluoroquinolones) were directly compared in the individual RCTs, they were associated with similar frequency of treatment failure. However, when all patients were combined, carbapenems were associated with fewer treatment failures. Also, treatment failure in patients with DFIs from whom methicillin-resistant S. aureus (MRSA) alone or as part of a polymicrobial infection was isolated was more common than in patients from whom other bacteria were isolated [24/68 (35.3%) versus 350/1522 (23%), p=0.02]. Among patients with DFIs due to MRSA the use of linezolid was not associated with better effectiveness in comparison to other antibiotics [treatment failure: 6/19 (31.6%) versus 18/49 (36.7%), p=0.69]. Of interest, treatment failure was similar in patients with and without osteomyelitis [44/169 (26.5%) versus 330/1424 (23.2%), p=0.34]. CONCLUSIONS: The isolation of MRSA seems to be a significant factor associated with treatment failure in patients with DFIs. Further research efforts are needed for the identification of additional risk factors for treatment failure and optimization of the management of patients with DFIs.
PMID: 18291550 [PubMed - indexed for MEDLINE]
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What glucose target should we aim for in myocardial infarction?
Diabetes Res Clin Pract. 2008 Jun;80(3):411-5
Authors: Cheung NW, Wong VW, McLean M
Hyperglycaemia in the period following myocardial infarction is associated with increased mortality and there is some evidence that its treatment can improve survival. However, it remains unclear as to what the ideal glucose targets might be. This study examined observational data taken from a previously reported randomised controlled trial of insulin therapy for myocardial infarction (The Hyperglycaemia: Intensive Insulin Infusion In Infarction Study), to determine optimal glucose levels for this period. Capillary glucose readings were recorded at 8 standard time points for 234 subjects in first 24h after myocardial infarction. Survival over 6 months was analysed according to whether 80% of each subject’s glucose readings were below specified glucose thresholds (Achievers) or not (Non-Achievers). We found that the glucose threshold at which there was greatest separation in mortality between Achievers and Non-Achievers was at 8mmol/L [144mg/dL] (6 month mortality 1.6% vs. 9.1%, p=0.05). Therefore subjects who maintained the majority of their blood glucose levels below 8mmol/L following myocardial infarction had optimal survival outcomes. We suggest that this might be an appropriate glucose target to aim for in the peri-infarct period.
PMID: 18339441 [PubMed - indexed for MEDLINE]
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2-year effects of pioglitazone add-on to sulfonylurea or metformin on oral glucose tolerance in patients with type 2 diabetes.
Diabetes Res Clin Pract. 2008 Mar;79(3):453-60
Authors: Seufert J, Urquhart R
AIM: We report the effectiveness of the thiazolidinedione, pioglitazone, as add-on medication to metformin or sulfonylurea in reducing post-load serum glucose levels, as assessed by 3-h oral glucose tolerance testing (OGTT). METHODS: Adult patients with Type 2 diabetes took part in one of two large-scale, 2-year clinical trials. One study compared pioglitazone treatment as add-on to failing metformin therapy (N=317) with add-on gliclazide treatment to metformin (N=313). The other study compared combination therapy with pioglitazone added to existing failing sulfonylurea therapy (N=319) with metformin treatment in addition to sulfonylurea (N=320). HbA(1c) and fasting plasma glucose concentrations were measured at baseline and throughout the study and at the final visit at week 104. At selected centers (N=299 patients), a 3-h OGTT was performed at baseline and at week 104. RESULTS: At week 104, mean HbA(1c) reduction from baseline was 0.89% for pioglitazone and 0.77% for gliclazide addition to metformin (p=0.200) and 1.03% with pioglitazone and 1.16% with metformin addition to sulfonylurea (p=0.173) in the total patient cohort. In the 299 patients who underwent OGTT, 2 years of treatment with pioglitazone, whether added to existing metformin or sulfonylurea medication, resulted in decreases in glucose excursions after an oral glucose load without increasing post-load serum insulin concentrations. In contrast, gliclazide in combination with metformin therapy caused increases in both post-load serum glucose and insulin excursions after 2 years, whereas metformin add-on to sulfonylurea did not have a significant effect on post-load serum glucose concentrations and resulted in an increase in insulin levels. CONCLUSIONS: There were no significant differences in HbA(1c) levels between groups. However, 2-year treatment with pioglitazone as an add-on to either failing metformin or sulfonylurea therapy improved post-load glucose excursions without affecting insulin secretion. In contrast, glucose excursions were not improved by gliclazide or metformin add-on therapy, despite increases in post-load insulin levels. These data suggest that pioglitazone reduces peripheral insulin resistance via mechanisms different from those of metformin.
PMID: 18160120 [PubMed - indexed for MEDLINE]
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Comparison of different drugs as add-on treatments to metformin in type 2 diabetes: a meta-analysis.
Diabetes Res Clin Pract. 2008 Feb;79(2):196-203
Authors: Monami M, Lamanna C, Marchionni N, Mannucci E
BACKGROUND: Metformin is recommended as first-line treatment in type 2 diabetic patients. Several agents can be used as add-on treatments in metformin monotherapy failure. Most available clinical trials on the hypoglycemic efficacy of different drugs were performed either in monotherapy or in combination with agents other than metformin. Aim of the present meta-analysis is to collect available information on the efficacy of different hypoglycemic drugs, in combination with metformin, in patients failing to metformin, or to other oral monotherapies. METHODS: An extensive Medline search, together with manual search of references from retrieved articles, was performed to identify randomized clinical trials comparing the efficacy on HbA1c of different agents, compared with placebo or with other active drugs, in combination with metformin, in patients failing to oral hypoglycemic therapy. HbA1c reduction at 16-36 months was considered for meta-analysis. RESULTS: A total of 27 clinical trials were retrieved. Combining the results of different placebo-controlled trials, sulphonylureas, alpha-glucosidase inhibitors and thiazolidinediones induced a reduction [95%CI] of HbA1c of 0.85 [0.78; 0.94], 0.61 [0.55; 0.67], 0.42 [0.40; 0.44]%, respectively. In direct comparisons, sulphonylureas induced a greater reduction of HbA1c (of 0.17 [0.16; 0.18]%) than thiazolidinediones, and had a similar effect as insulin. CONCLUSIONS: When combined with metformin, sulphonylureas and alpha-glucosidase inhibitors show a similar efficacy on HbA1c. The effects of drugs used as add-on to metformin monotherapy could be different from those observed in monotherapy.
PMID: 17931733 [PubMed - indexed for MEDLINE]
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