Gliptins: a new class of oral hypoglycaemic agent. From the Department of Diabetes and Metabolism, The Royal London Hospital, London, UK

Size: px
Start display at page:

Download "Gliptins: a new class of oral hypoglycaemic agent. From the Department of Diabetes and Metabolism, The Royal London Hospital, London, UK"

Transcription

1 Q J Med 2007; 100: doi: /qjmed/hcm081 Review Gliptins: a new class of oral hypoglycaemic agent H. CHAHAL and T.A. CHOWDHURY From the Department of Diabetes and Metabolism, The Royal London Hospital, London, UK Summary The epidemic of type 2 diabetes worldwide continues unabated. Despite a number of existing therapies, treatment goals are seldom fully achieved. While insulin resistance and beta cell failure remain important in the pathogenesis of the condition, the role of incretin hormones in glucose homeostasis has recently become clearer. Incretins have several glucoregulatory mechanisms, and a novel approach to the treatment of type 2 diabetes focuses on enhancing and prolonging the physiological actions Introduction Diabetes mellitus is a growing health problem. It currently affects 246 million people worldwide (5.9% of all adults), and is predicted to increase to 380 million adults within 20 years. 1 In the UK, over 2.2 million people have the condition, of whom 90% have type 2 diabetes. 2 Complications related to diabetes can lead to serious morbidity, and significantly reduced life expectancy. 3 With the rise in incidence of type 2 diabetes over the next 20 years, the management of this chronic condition will present a serious clinical and financial burden to all health-care systems. 4 The pathophysiology of type 2 diabetes involves a complex interplay of genetic and environmental factors. The condition is characterized by peripheral insulin resistance (muscle, liver and adipocytes), and associated defects in insulin secretion due to decline in beta-cell function, and ultimately beta-cell failure 5 (Figure 1). Insulin resistance is a phenomenon that appears to occur early, with of these hormones. Gliptins inhibit the enzyme dipeptidyl peptidase-iv (DPP-IV), which degrades incretin hormones. These drugs are a promising new class of oral hypoglycaemic medication, which appear to be weight-neutral and have few sideeffects, although the published clinical studies are mainly regulatory licensing studies. As these drugs now are available for clinical use, we discuss the mechanism of action, efficacy and potential adverse effects of this new class of oral hypoglycaemic agent. seeds sown in childhood, while pancreatic beta-cell function declines over time, eventually leading to hyperglycaemia. 3 Physiological mechanisms proposed for insulin resistance include an elevation in free fatty acids, decrease in adiponectin levels, involvement of inflammatory cytokines and defects in mitochondrial function. Decline in beta-cell function may be due to glucotoxicity, (glucose reversibly modifies the function of the beta-cell), lipotoxicity (increased circulating free fatty acids cause beta-cell damage), and the involvement of islet amyloid polypeptide (amylin). 3 Many other pathogenic factors have been suggested for the development of type 2 diabetes, including peroxisome proliferator-activated receptor-gamma (PPARg) activation 6 and glucagon excess. 7 Current strategies for the treatment of type 2 diabetes have focused on reducing insulin resistance and increasing insulin secretion (Table 1). Biguanides (metformin) and sulphonylureas have Address correspondence Dr T.A. Chowdhury, 7th Floor, John Harrison House, The Royal London Hospital, Whitechapel, London E1 1BB, UK. tahseen.chowdhury@bartsandthelondon.nhs.uk! The Author Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please journals.permissions@oxfordjournals.org

2 672 H. Chahal and T.A. Chowdhury Figure 1. Pathophysiology of type 2 diabetes. Table 1 Current licensed therapies for type 2 diabetes in the UK Drug class Site of action Common side-effects Biguanide Liver, muscle, periphery Gastrointestinal side-effects (diarrhoea, nausea), metallic taste Sulphonylurea b-cells of pancreas Weight gain, hypoglycaemia Thiazolidinedione Muscle, fat, liver Weight gain, fluid retention, anaemia Meglitinide b cells of pancreas Hypoglycaemia, weight gain, gastrointestinal side-effects Alpha-glucosidase Intestine Gastrointestinal side-effects (flatulence, diarrhoea) inhibitor Insulin Muscle, fat, liver Hypoglycaemia, weight gain, injection-site sensitivity been the mainstay of therapy for diabetes for many years. More recently, thiazolidinediones have found an important role in augmenting the amelioration of insulin resistance, although there have been recent concerns over safety. 8 Meglitinide analogues and alpha-glucosidase inhibitors have some role in treatment of diabetes, although their role is limited by cost and side-effects. Insulin therapy is frequently required in many people with long duration of type 2 diabetes, due to inexorable beta cell decline. Despite current therapeutic options, only 22% of diabetes patients in England achieve a glycated haemoglobin (HbA 1c ) <6.5%, with 42% having an HbA 1c 47.5%. 9 This may in part be due to the fact that traditional treatments for type 2 diabetes do not address the progressive decline in beta-cell function. 10 Incretin hormones The role of the gastrointestinal tract in regulating the secretion of insulin is demonstrated by the observation that insulin secretion is substantially increased in response to oral glucose, compared Figure 2. The incretin effect. to intravenous glucose administration. 11 This difference is known as the incretin effect (Figure 2). These peptides are secreted from endocrine cells (L-cells) in the gastrointestinal tract, and are released in response to ingestion of food. The two main incretin hormones are glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP),

3 Gliptins 673 Figure 3. Physiology of GLP-1 secretion and action. Reprinted with permission from Elsevier (Lancet 2006; 368: ) (reference 12). with GLP-1 being responsible for most of the incretin effect on pancreatic beta-cell function. 10 GLP-1 regulates glucose homeostasis in the postprandial period by a number of mechanisms, including stimulation of insulin synthesis, inhibition of glucagon secretion, delay in gastric emptying, and promotion of satiety 12 (Figure 3). Following oral ingestion of nutrient, patients with type 2 diabetes have a decreased incretin effect, due to a reduction in the secretion of GLP-1, resulting in inappropriately low insulin secretion, inadequate for glucose homeostasis. 13 GLP-1 administration is effective in people with type 2 diabetes, with an increase in insulin secretion and reduction of both fasting and post-prandial blood glucose. 14 Administration of GLP-1 in vivo, however, is problematic, as it is rapidly inactivated by the proteolytic enzyme dipeptidyl peptidase-iv (DPP-IV). DDP-IV cleaves the N-terminal amino acids of GLP-1, 15 and is widely expressed in many tissues, including the capillary bed of the gut mucosa. Its close presence to GLP-1-secreting endocrine cells results in the rapid degradation of GLP-1 within minutes of release. 13 Two main therapeutic strategies have been developed to overcome this. The first involves the use of a long acting GLP-1 receptor agonist, resistant to the cleavage of DPP-IV. Exendin-4, or Exenatide (Lilly), is one such analogue that is licensed for use in patients with type 2 diabetes who have inadequate glucose control with metformin, sulphonylurea or both. It is administered as a twicedaily fixed-dose injection, and leads to a modest reduction in HbA 1c (0.8%), and around 2.5 kg weight loss. 16 The second strategy is to use DPP-IV inhibitors (gliptins), which lead to inhibition of the degradation of GLP-1, thus enhancing the incretin effect.

4 674 H. Chahal and T.A. Chowdhury patients, comparing monotherapy with vildagliptin 50 mg twice daily vs. rosiglitazone 8 mg daily showed a similar significant HbA 1c reduction (1.1 vs. 1.3%). 23 One 24-week trial in drug-naive patients given vildagliptin at doses of 50 mg, 50 mg twice a day and 100 mg showed significant reductions in HbA 1c of 0.8%, 0.8% and 0.9%, respectively. At higher baseline HbA 1c, there was a greater improvement in glycaemic control at the higher dose of vildagliptin 100 mg. 24 Another 24-week trial in drug-naive patients treated with vildagliptin doses of 50 mg, 50 mg twice a day and 100 mg showed reductions in HbA 1c of 0.5%, 0.7% and 0.9%, respectively. 25 Figure 4. Gliptins targeting DPP-IV. Gliptins Gliptins are a novel class of oral anti-diabetic agent that enhance and prolong the physiological actions of incretin hormones by competitively antagonizing the enzyme DPP-IV (Figure 4). Animal studies demonstrate the anti-diabetic properties of DPP-IV inhibitors, with a delay of progression from impaired glucose tolerance to type 2 diabetes, 17 an improvement in glucose tolerance and insulin secretion, 18,19 an improvement in beta-cell function and an increase in hepatic and peripheral insulin sensitivity. 20 A number of DDP-IV inhibitors are under investigation for the treatment of type 2 diabetes in humans. Vildagliptin (Novartis) and sitagliptin (Merck) are currently the only two gliptins with clinical trial data looking at their use as monotherapy and combination therapy with existing oral hypoglycaemics. These randomized, controlled, multicentre trials have shown a modest statistically significant reduction in HbA 1c, when used as monotherapy or in combination. Vildagliptin Monotherapy In a 12-week study, vildagliptin (at doses of 50 and 100 mg) significantly decreased HbA 1c by % when given to patients who had not been treated with anti-diabetes medications for at least 12 weeks. 21 A further 12-week study of vildagliptin, at a dose of 25 mg twice a day in drugnaive patients with type 2 diabetes, demonstrated a reduction in HbA 1c of 0.6%, with a greater response of 1.2% occurring in those patients with an HbA 1c 48%. 22 A 24-week study in drug-naive Combination therapy In a 52-week trial, vildagliptin 50 mg was given to patients already treated with metformin ( mg daily), and resulted in a reduction in HbA 1c at 12 weeks of 0.6%. 26 A 24-week trial in patients inadequately controlled on metformin monotherapy showed that vildagliptin as an add-on therapy at a dose of 50 mg or 100 mg reduced HbA 1c by 0.7% and 1.1%, respectively. 27 In a 24-week trial of patients inadequately controlled by prior pioglitazone 45 mg monotherapy, vildagliptin was used as add-on therapy at doses of 50 mg and 100 mg, resulting in reductions in HbA1c of 0.8% and 1.0%, respectively. 28 A more recent 24-week trial in drug-naive patients demonstrated that combination therapy with vildagliptin and pioglitazone provided better glycaemic control than either monotherapy component. A combination of vildagliptin 100 mg and pioglitazone 30 mg reduced HbA 1c by 1.9%, compared to 1.1% with vildagliptin monotherapy and 1.4% with pioglitazone monotherapy. 29 Sitagliptin Monotherapy In a 12-week study in drug-naive patients, sitagliptin 50 mg reduced HbA 1c by 0.8%. 30 Over an 18-week study in drug-naive patients, sitagliptin, at doses of 100 and 200 mg, reduced HbA 1c by 0.6% and 0.5%, respectively. Those patients with a baseline HbA 1c 49% had the greatest reduction (1.2%). 31 In a 24-week study, sitagliptin 100 and 200mg produced reductions in HbA 1c of 0.8% and 0.9%, respectively. Again, patients with a baseline HbA 1c 49% had the greatest reduction (1.5%). 32 Combination therapy In a 24-week trial in patients inadequately control on metformin therapy (41500 mg/day), the addition

5 Gliptins 675 of sitagliptin 100 mg led to a HbA 1c reduction of 0.7% compared to placebo. 33 In another 24-week trial, sitagliptin 100 mg was given to patients inadequately controlled on pioglitazone 30 and 45 mg. This resulted in HbA 1c reductions of 0.7% and 0.9%, respectively. 34 In a 52-week study in patients already treated with metformin (51500 mg/day) add-on therapy with sitagliptin 100 mg compared to glipizide 5 mg (up-titrated to a potential dose of 20 mg/day) provided similar HbA 1c -lowering efficacy (0.7%). 35 In the US, sitagliptin has been licensed for use in monotherapy, or combination therapy with metformin or a PPARg agonist. The dose recommended orally is 100 mg, which should be adjusted in patients with moderate to severe renal disease. 36 In the UK, a licence was obtained in April 2007 at a dose of 100 mg, but only as combination therapy with metformin or a PPARg agonist. 37 Limitations of the clinical trials While the studies described are randomized, multicentre trials, they are pharmaceutically-sponsored, short-term studies, which describe proof of efficacy and lack of adverse effects over a very short time period. To date, only around 7000 patients have been exposed to gliptins. With recent concerns expressed over the cardiovascular effects of rosiglitazone, 8 it is clear that further large, longerterm outcome studies will be required to ensure that these drugs are safe, effective and reduce complications in patients with type 2 diabetes. Adverse effects Unlike incretin hormones, DPP-IV inhibitors do not act through specific targets on target tissues. 38 DPP-IV is expressed in many tissues besides the gut mucosa, including T-cells, endothelium, liver, kidney and lung. 12 A variety of chemokines, cytokines, growth factors and neuropeptides (pituitary adenylate cyclase-activating polypetide, vasoactive intestinal polypeptide, gastrin-releasing peptide, neuropeptide Y, growth-hormone-releasing hormone, GLP2, peptide YY, substance P), are inactivated by this enzyme. 13 Thus given the wide spread substrates of DPP-IV and the prolongation of GLP-1 activity, DPP-IV inhibitors could have adverse effects in many systems. However, the small number of clinical studies have so far reported no significant adverse effects. In general, gliptins appear to be safe and well tolerated, with few reported side-effects, and the overall incidence of side-effects being similar to placebo. With vildagliptin, the most common side-effects were cold/flu-like symptoms, headache and dizziness. With sitagliptin, the most common side-effects were stuffy or runny nose, sore throats, headache, diarrhoea, upper respiratory infection, joint pains and urinary tract infection (differences ranging from % vs. placebo). In these trials, the overall incidence of hypoglycaemia has been similar to placebo and the gliptins appear to be weightneutral, although in one study sitagliptin led to a 1.5 kg loss in weight. 35 However, given the potential widespread targets for DPP-IV inhibitors, the full metabolic effects may not be apparent in these limited studies. Although DPP-IV inhibitors and long-acting GLP-1 agonists both prolong the action of GLP-1, they have important differences with regards to weight loss and gastrointestinal side-effects. Compared to GLP-1 agonists, DPP-IV inhibitors are weight-neutral and have fewer gastrointestinal side-effects. This may be explained by the dosedependent action on GLP-1 receptors, with DPP-IV inhibitors only causing a modest stabilization of post-prandial GLP-1 levels, resulting in minimal weight loss, as compared to more chronically elevated GLP-1 levels with GLP-1 agonists, resulting in delayed gastric emptying. 12 The role of gliptins in the treatment of type 2 diabetes While the improvement in glycaemic control with gliptins is moderate and no more effective than with metformin, sulphonylurea or thiazolidinedione treatment, they are potentially an attractive therapeutic option in the treatment of type 2 diabetes. They appear to be well tolerated, have a low risk of hypoglycaemia, do not cause weight gain and can be given orally once a day. These features are in contrast to the common side-effects of existing oral hypoglycaemic medications. While they may achieve a monotherapy licence, it would not be appropriate to use these drugs first line, due to their cost, and lack of long-term safety data. In obese patients, however, a case could be argued for gliptins to be used second line to metformin or third line to glitazones, especially as they are weight-neutral. Raised levels of GLP-1 may have a role in beta-cell growth and proliferation, hence it is important to investigate the potential role of gliptins in preventing progression of diabetes to the beta-cell failure. The role of gliptins in prevention of progression of impaired glucose tolerance also needs further study.

6 676 H. Chahal and T.A. Chowdhury Conclusions Diabetes is a long-term condition leading to macrovascular and microvascular complications, resulting in significant morbidity and premature mortality. The pathogenesis of type 2 diabetes has traditionally been thought to be related to insulin resistance and beta-cell failure. Newer insights, however, suggest that the pathogenesis of type 2 diabetes is much more complex, with the role of incretin hormones having been recently described. Enhancement of the incretin effect is now a potential therapeutic target in type 2 diabetes, using GLP-1 analogues and DPP-IV inhibitors. Gliptins are a new class of oral anti-diabetic medication that prolong the physiological actions of GLP-1. Short term clinical trials show that gliptins cause a modest reduction in glycated haemoglobin when used as monotherapy or combination therapy, of around 0.7 1%. They appear to be more potent when baseline glycated haemoglobin is higher. They appear to be well-tolerated, and are taken orally once daily. They may be useful in treating obese patients with type 2 diabetes, in combination with metformin, or a glitazone, or both. The recent safety concerns over glitazones should remind all physicians using new drugs for any chronic disease that long-term pharmacovigilance is necessary, and long-term outcome studies are required to evaluate the effects of cardiovascular mortality and morbidity. References 1. Diabetes epidemic out of control. Diabetes Atlas, 4 December [ Accessed 17 June Diabetes UK. Diabetes: State of the Nations Progress made in delivering the national diabetes frameworks. [ SOTN2006_full.pdf] Accessed 17 June Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005; 365: Bagust A, Hopkinson PK, Maslove L, Currie CJ. The projected health care burden of Type 2 diabetes in the UK from 2000 to Diabet Med 2002; 19 (Suppl. 4): Mahler RJ, Adler ML. Clinical review 102: Type 2 diabetes mellitus: update on diagnosis, pathophysiology, and treatment. J Clin Endocrinol Metab 1999; 84: Semple RK, Chatterjee VK, O Rahilly S. PPAR gamma and human metabolic disease. J Clin Invest 2006; 116: Gromada J, Franklin I, Wollheim CB. Alpha-cells of the endocrine pancreas: 35 years of research but the enigma remains. Endocr Rev 2007; 28: Nissen SE, Wolski K. Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes. N Engl J Med 2007; 356: National Diabetes Audit. Key findings about the quality of care for people with diabetes in England incorporating registrations from Wales 2004/5. NHS Information centre and National Clinical Audit Support Programme, Barnett A. DPP-4 inhibitors and their potential role in the management of type 2 diabetes. Int J Clin Pract 2006; 60: Nauck MA, Homberger E, Siegel EG, et al. Incretin effects of increasing glucose loads in man calculated from venous insulin and C-peptide responses. J Clin Endocrinol Metab 1986; 63: Drucker DJ, Nauck MA. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet 2006; 368: Idris I, Donnelly R. Dipeptidyl peptidase-iv inhibitors: a major new class of oral antidiabetic drug. Diabetes Obes Metab 2007; 9: Deacon CF. Therapeutic strategies based on glucagon-like peptide 1. Diabetes 2004; 53: Reimer MK, Holst JJ, Ahren B. Long-term inhibition of dipeptidyl peptidase IV improves glucose tolerance and preserves islet function in mice. Eur J Endocrinol 2002; 146: Buse JB, Henry RR, Han J, Kim DD, Fineman MS, Baron AD. Effects of exenatide (exendin-4) on glycemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care 2004; 27: Sudre B, Broqua P, White RB, et al. Chronic inhibition of circulating dipeptidyl peptidase IV by FE delays the occurrence of diabetes in male zucker diabetic fatty rats. Diabetes 2002; 51: Pederson RA, White HA, Schlenzig D, Pauly RP, McIntosh CH, Demuth HU. Improved glucose tolerance in Zucker fatty rats by oral administration of the dipeptidyl peptidase IV inhibitor isoleucine thiazolidide. Diabetes 1998; 47: Ahren B, Holst JJ, Martensson H, Balkan B. Improved glucose tolerance and insulin secretion by inhibition of dipeptidyl peptidase IV in mice. Eur J Pharmacol 2000; 404: Pospisilik JA, Stafford SG, Demuth HU, McIntosh CH, Pederson RA. Long-term treatment with dipeptidyl peptidase IV inhibitor improves hepatic and peripheral insulin sensitivity in the VDF Zucker rat: a euglycemic-hyperinsulinemic clamp study. Diabetes 2002; 51: Ristic S, Byiers S, Foley J, Holmes D. Improved glycaemic control with dipeptidyl peptidase-4 inhibition in patients with type 2 diabetes: vildagliptin (LAF237) dose response. Diabetes Obes Metab 2005; 7: Pratley RE, Jauffret-Kamel S, Galbreath E, Holmes D. Twelve-week monotherapy with the DPP-4 inhibitor vildagliptin improves glycemic control in subjects with type 2 diabetes. Horm Metab Res 2006; 38: Rosenstock J, Baron MA, Dejager S, Mills D, Schweizer A. Comparison of vildagliptin and rosiglitazone monotherapy in patients with type 2 diabetes: a 24-week, double-blind, randomized trial. Diabetes Care 2007; 30:

7 Gliptins Dejager S, Razac S, Foley JE, Schweizer A. Vildagliptin in drug-naive patients with type 2 diabetes: a 24-week, doubleblind, randomized, placebo-controlled, multiple-dose study. Horm Metab Res 2007; 39: Pi-Sunyer FX, Schweizer A, Mills D, Dejager S. Efficacy and tolerability of vildagliptin monotherapy in drug-naive patients with type 2 diabetes. Diabetes Res Clin Pract 2007; 76: Ahren B, Gomis R, Standl E, Mills D, Schweizer A. Twelveand 52-week efficacy of the dipeptidyl peptidase IV inhibitor LAF237 in metformin-treated patients with type 2 diabetes. Diabetes Care 2004; 27: Bosi E, Camisasca RP, Collober C, Rochotte E, Garber AJ. Effects of vildagliptin on glucose control over 24 weeks in patients with type 2 diabetes inadequately controlled with metformin. Diabetes Care 2007; 30: Garber AJ, Schweizer A, Baron MA, Rochotte E, Dejager S. Vildagliptin in combination with pioglitazone improves glycaemic control in patients with type 2 diabetes failing thiazolidinedione monotherapy: a randomized, placebocontrolled study. Diabetes Obes Metab 2007; 9: Rosenstock J, Baron MA, Camisasca RP, Cressier F, Couturier A, Dejager S. Efficacy and tolerability of initial combination therapy with vildagliptin and pioglitazone compared with component monotherapy in patients with type 2 diabetes. Diabetes Obes Metab 2007; 9: Scott R, Wu M, Sanchez M, Stein P. Efficacy and tolerability of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy over 12 weeks in patients with type 2 diabetes. Int J Clin Pract 2007; 61: Raz I, Hanefeld M, Xu L, Caria C, Williams-Herman D, Khatami H. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy in patients with type 2 diabetes mellitus. Diabetologia 2006; 49: Aschner P, Kipnes MS, Lunceford JK, Sanchez M, Mickel C, Williams-Herman DE. Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycemic control in patients with type 2 diabetes. Diabetes Care 2006; 29: Charbonnel B, Karasik A, Liu J, Wu M, Meininger G. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing metformin therapy in patients with type 2 diabetes inadequately controlled with metformin alone. Diabetes Care 2006; 29: Rosenstock J, Brazg R, Andryuk PJ, Lu K, Stein P. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing pioglitazone therapy in patients with type 2 diabetes: a 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther 2006; 28: Nauck MA, Meininger G, Sheng D, Terranella L, Stein PP. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, noninferiority trial. Diabetes Obes Metab 2007; 9: [ januvia_pi.pdf] Accessed 17 June Electronic Medicines Compendium [ medicines.org.uk/emc/assets/c/html/displaydoc.asp? documentid¼19609] Accessed 17 June Green BD, Flatt PR, Bailey CJ. Dipeptidyl peptidase IV (DPP IV) inhibitors: A newly emerging drug class for the treatment of type 2 diabetes. Diab Vasc Dis Res 2006; 3:

Clinical Efficacy of Gliptins for Glycemic Control in Type 2 Diabeties Mellitus

Clinical Efficacy of Gliptins for Glycemic Control in Type 2 Diabeties Mellitus World Applied Sciences Journal 7 (1): 01-06, 2009 ISSN 1818-4952 IDOSI Publications, 2009 REVIEW ARTICLE Clinical Efficacy of Gliptins for Glycemic Control in Type 2 Diabeties Mellitus 1 2 3 1 2 Atif Sitwat

More information

Dipeptidyl Peptidase-IV Inhibitors: A New Drug in the Therapeutic Armamentarium for Treatment of Type 2 Diabetes Mellitus

Dipeptidyl Peptidase-IV Inhibitors: A New Drug in the Therapeutic Armamentarium for Treatment of Type 2 Diabetes Mellitus REVIEW ARTICLE JIACM 2009; 10(3): 128-33 Dipeptidyl Peptidase-IV Inhibitors: A New Drug in the Therapeutic Armamentarium for Treatment of Type 2 Diabetes Mellitus Rajesh Rajput* Introduction The incidence

More information

New Treatments for Type 2 Diabetes

New Treatments for Type 2 Diabetes New Treatments for Type 2 Diabetes Dr David Hopkins Clinical Director, Division of Ambulatory Care King s College Hospital NHS Foundation Trust Treatments for type 2 diabetes - old & new insulin sulphonylureas

More information

Overview of the Gliptin Class (Dipeptidyl Peptidase-4 Inhibitors) in Clinical Practice

Overview of the Gliptin Class (Dipeptidyl Peptidase-4 Inhibitors) in Clinical Practice clinical features Overview of the Gliptin Class (Dipeptidyl Peptidase-4 Inhibitors) in Clinical Practice Nancy Bohannon, MD 1 1 Monteagle Medical Center, San Francisco, CA Correspondence: Nancy Bohannon,

More information

SHORT CLINICAL GUIDELINE SCOPE

SHORT CLINICAL GUIDELINE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SHORT CLINICAL GUIDELINE SCOPE 1 Guideline title Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes 1.1 Short title Type 2

More information

Harmony Clinical Trial Medical Media Factsheet

Harmony Clinical Trial Medical Media Factsheet Overview Harmony is the global Phase III clinical trial program for Tanzeum (albiglutide), a product developed by GSK for the treatment of type 2 diabetes. The comprehensive program comprised eight individual

More information

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT?

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? MARTHA M. BRINSKO, MSN, ANP-BC CHARLOTTE COMMUNITY HEALTH CLINIC CHARLOTTE, NC Diagnosed and undiagnosed diabetes in the United

More information

Effi cacy and Safety of Sitagliptin in the Treatment of Type 2 Diabetes

Effi cacy and Safety of Sitagliptin in the Treatment of Type 2 Diabetes REVIEW Effi cacy and Safety of Sitagliptin in the Treatment of Type 2 Diabetes Roger Gadsby GP Nuneaton, Warwickshire U.K. and Associate Clinical Professor, Warwick Medical School, University of Warwick,

More information

linagliptin, 5mg film-coated tablet (Trajenta ) SMC No. (746/11) Boehringer Ingelheim / Eli Lilly and Company Ltd

linagliptin, 5mg film-coated tablet (Trajenta ) SMC No. (746/11) Boehringer Ingelheim / Eli Lilly and Company Ltd linagliptin, 5mg film-coated tablet (Trajenta ) SMC No. (746/11) Boehringer Ingelheim / Eli Lilly and Company Ltd 09 December 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of

More information

DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS

DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS Section Two DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS This section will: Describe oral agents (pills) are specific for treating type 2 diabetes. Describe other hypoglycemic agents used

More information

Available online through www.ijrap.net

Available online through www.ijrap.net Review Article Available online through www.ijrap.net GLUCAGON LIKE PEPTIDE 1: A NEW ERA IN TREATMENT OF TYPE- 2 DIABETES MELLITUS Singhal Manmohan* 1, Dave Rahul 1, Paul Arindam 2 * 1 School of Pharmaceutical

More information

DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES

DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES Page 1 DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES Drugs to know are: Actrapid HM Humulin R, L, U Penmix SUNALI MEHTA The three principal hormones produced by the pancreas are: Insulin: nutrient metabolism:

More information

Subcutaneous Infusion of GLP-1 for 7 Days Improves Glycemic Control Over a Broad Dose Range in Patients with Type 2 Diabetes

Subcutaneous Infusion of GLP-1 for 7 Days Improves Glycemic Control Over a Broad Dose Range in Patients with Type 2 Diabetes Subcutaneous Infusion of GLP-1 for 7 Days Improves Glycemic Control Over a Broad Dose Range in Patients with Type 2 Diabetes Mario R. Ehlers, 1,2 Roderick E. Harley, 1 Annette L. Mathisen, 1 Roberta Schneider,

More information

Type 2 Diabetes - Pros and Cons of Insulin Administration

Type 2 Diabetes - Pros and Cons of Insulin Administration Do we need alternative routes of insulin administration (inhaled insulin) in Type 2 diabetes? Cons: Suad Efendic Karolinska Institutet, Sweden The Diabetes Management Situation Today Diabetes is a growing

More information

trends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223-

trends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223- Review Article Pharmacological trends in the treatment of Diabetes type 2 - New classes of antidiabetic Silvia Mihailova 1*, Antoaneta Tsvetkova 1, Anna Todorova 2 1 Assistant Pharmacist, Education and

More information

Type 2 Diabetes. Aims and Objectives. What did you consider? Case Study One: Miss S. Which to choose?!?! Modes of Action

Type 2 Diabetes. Aims and Objectives. What did you consider? Case Study One: Miss S. Which to choose?!?! Modes of Action Aims and Objectives This session will outline the increasing complexities of diabetes care, and the factors that differentiate the combinations of therapy, allowing individualisation of diabetes treatment.

More information

THE PATHOPHYSIOLOGIC BASIS FOR DIABETES TREATMENT: EVALUATING THE EFFECT OF INCRETIN-BASED THERAPIES * Jack Leahy, MD

THE PATHOPHYSIOLOGIC BASIS FOR DIABETES TREATMENT: EVALUATING THE EFFECT OF INCRETIN-BASED THERAPIES * Jack Leahy, MD THE PATHOPHYSIOLOGIC BASIS FOR DIABETES TREATMENT: EVALUATING THE EFFECT OF INCRETIN-BASED THERAPIES * Jack Leahy, MD ABSTRACT Type 2 diabetes is a persistent public health challenge that requires innovative

More information

Insulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust

Insulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Insulin or GLP1 How to make this choice in Practice Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Workshop Over View Considerations/barriers to treatments in type 2

More information

New and Future Treatments for Diabetes. Mary Charlton Specialty Doctor in Diabetes University Hospital Birmingham BARS Oct 2014

New and Future Treatments for Diabetes. Mary Charlton Specialty Doctor in Diabetes University Hospital Birmingham BARS Oct 2014 New and Future Treatments for Diabetes Mary Charlton Specialty Doctor in Diabetes University Hospital Birmingham BARS Oct 2014 Conflicts of interest Investigator Carmelina study of Linagliptin (Boehringer

More information

ADJUNCTIVE THERAPIES FOR TYPE 1 DIABETES

ADJUNCTIVE THERAPIES FOR TYPE 1 DIABETES ADJUNCTIVE THERAPIES FOR TYPE 1 DIABETES Dr. Mohammad Alhadj Ali, MD, PgDip, MSc, PhD (UK) with Prof. David Owens (UK) Outline Type 1 Diabetes Immunology of Type 1 Diabetes Treatment of Type 1 Diabetes

More information

Diabetes mellitus (DM) is one of the most common chronic

Diabetes mellitus (DM) is one of the most common chronic Review Article Emerging Role of Dipeptidyl Peptidase-IV (DPP-4) Inhibitor Vildagliptin in the Management of Type 2 Diabetes Sanjay Kalra * Abstract Diabetes mellitus (DM) is one of the most common chronic

More information

Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief

Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief March 7, 2016 Session Objective: The objective of this workshop is to assess the value of undertaking comparative effectiveness

More information

COMPASS Therapeutic Notes on the Newer Drugs used in the Management of Type 2 Diabetes Mellitus

COMPASS Therapeutic Notes on the Newer Drugs used in the Management of Type 2 Diabetes Mellitus COMPASS Therapeutic Notes on the Newer Drugs used in the Management of Type 2 Diabetes Mellitus In this issue Page Introduction and background 1 Thiazolidinediones 2 DPP-4 inhibitors (gliptins) 3 GLP-analogues

More information

Pharmaceutical Management of Diabetes Mellitus

Pharmaceutical Management of Diabetes Mellitus 1 Pharmaceutical Management of Diabetes Mellitus Diabetes Mellitus (cont d) Signs and symptoms 2 Elevated fasting blood glucose (higher than 126 mg/dl) or a hemoglobin A1C (A1C) level greater than or equal

More information

2011: New Drugs for Diabetes Treatment

2011: New Drugs for Diabetes Treatment Cardiology Update 2011 Davos, February 14, 2011 2011: New Drugs for Diabetes Treatment Roger Lehmann Department of Unresolved Problems in the Treatment of Type 2 Diabetes Diabetes Duration Consequences:

More information

Trends in Prescribing of Drugs for Type 2 Diabetes in General Practice in England (Chart 1) Other intermediate and long-acting insulins

Trends in Prescribing of Drugs for Type 2 Diabetes in General Practice in England (Chart 1) Other intermediate and long-acting insulins Type 2 Diabetes Type 2 diabetes is the most common form of diabetes, accounting for 90 95% of cases. 1 Charts 1 and 2 reflect the effect of increasing prevalence on prescribing and costs of products used

More information

Comparative Review of Oral Hypoglycemic Agents in Adults

Comparative Review of Oral Hypoglycemic Agents in Adults SECTION 18.5 Comparative Review of Oral Hypoglycemic Agents in Adults Harinder Chahal For WHO Secretariat Table of Contents Acronyms:... 3 I. Background and Rationale for the review:... 4 II. Medications

More information

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Anders Svensson MD, PhD Head of Global Clinical Development Metabolism, F Hoffmann LaRoche Ltd. Basel, Switzerland Overview of

More information

Sweet-taste receptors, glucose absorption and insulin release: Are LCS nutritionally active?

Sweet-taste receptors, glucose absorption and insulin release: Are LCS nutritionally active? Sweet-taste receptors, glucose absorption and insulin release: Are LCS nutritionally active? Samuel V. Molinary, Ph.D. Consultant, Scientific & Regulatory Affairs ILSI/NA April 6, 2011 Washington, DC Why

More information

Liraglutide for the treatment of type 2 diabetes

Liraglutide for the treatment of type 2 diabetes DOI: 10.3310/hta15suppl1/09 Health Technology Assessment 2011; Vol. 15: Suppl. 1 77 Liraglutide for the treatment of type 2 diabetes D Shyangdan, 1 * E Cummins, 2 P Royle 1 and N Waugh 1 1 Department of

More information

Therapeutic Choices within Diabetes. Abeer Alsaweer, MBBS, CABFM*

Therapeutic Choices within Diabetes. Abeer Alsaweer, MBBS, CABFM* Bahrain Medical Bulletin, Vol. 35, No. 2, June 2013 Education-Family Physician Corner Therapeutic Choices within Diabetes Abeer Alsaweer, MBBS, CABFM* The field of diabetes has experienced various evolutionary

More information

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center

More information

Clinical Medicine: Therapeutics. Metformin: A Review of Its Use in the Treatment of Type 2 Diabetes. N. Papanas and E. Maltezos

Clinical Medicine: Therapeutics. Metformin: A Review of Its Use in the Treatment of Type 2 Diabetes. N. Papanas and E. Maltezos Clinical Medicine: Therapeutics R e v i e w Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Metformin: A Review of Its Use in the Treatment of Type 2 Diabetes

More information

Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians

Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians Clinician Research Summary Diabetes Type 2 Diabetes Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians A systematic review of 166 clinical studies published between

More information

David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010

David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010 David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010 Objectives At the end of the talk, the participants will be able to: 1. Identify the increasing prevalence of type 2 diabetes

More information

Insulin myths and facts

Insulin myths and facts london medicines evaluation network Insulin myths and facts Statement 1 Insulin is the last resort for patients with Type 2 diabetes After initial metformin and sulfonylurea therapy, NICE and SIGN suggest

More information

嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯

嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 The Clinical Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Adults with Type 2 Diabetes Mellitus 嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 Diabetes Mellitus : A group of diseases characterized

More information

Imeglimin: A Potential New Multi-Target Drug for Type 2 Diabetes

Imeglimin: A Potential New Multi-Target Drug for Type 2 Diabetes Drugs R D (2015) 15:227 232 DOI 10.1007/s40268-015-0099-3 REVIEW ARTICLE Imeglimin: A Potential New Multi-Target Drug for Type 2 Diabetes Valerie Vuylsteke 1 Lisa M. Chastain 2 Geeta A. Maggu 3 Crystal

More information

Diabetes mellitus. Lecture Outline

Diabetes mellitus. Lecture Outline Diabetes mellitus Lecture Outline I. Diagnosis II. Epidemiology III. Causes of diabetes IV. Health Problems and Diabetes V. Treating Diabetes VI. Physical activity and diabetes 1 Diabetes Disorder characterized

More information

Sitagliptin, vildagliptin and saxagliptin dipeptidyl peptidase-4 inhibitors ( gliptins ) for add-on therapy in type 2 diabetes mellitus

Sitagliptin, vildagliptin and saxagliptin dipeptidyl peptidase-4 inhibitors ( gliptins ) for add-on therapy in type 2 diabetes mellitus 1 Sitagliptin, vildagliptin and saxagliptin dipeptidyl peptidase-4 inhibitors ( gliptins ) for add-on therapy in type 2 diabetes mellitus Effective for lowering blood glucose in type 2 diabetes in dual

More information

Antidiabetic Drugs. Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Antidiabetic Drugs. Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antidiabetic Drugs Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Diabetes Mellitus Two types Type 1 Type 2 Type 1 Diabetes Mellitus Lack of insulin production

More information

Pharmacological Glycaemic Control in Type 2 Diabetes

Pharmacological Glycaemic Control in Type 2 Diabetes Pharmacological Glycaemic Control in Type 2 Diabetes Aim(s) and Objective(s) This guideline aims to offer advice on the pharmacological management for those who require measures beyond diet and exercise

More information

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing

More information

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials A.J. Scheen Division of Diabetes, Nutrition and Metabolic Disorders, and Division of Clinical Pharmacology,

More information

Type 2 diabetes is among the most

Type 2 diabetes is among the most Clinical Care/Education/Nutrition/Psychosocial Research O R I G I N A L A R T I C L E Management of Type 2 Diabetes in Treatment-Naive Elderly Patients Benefits and risks of vildagliptin monotherapy RICHARD

More information

New Non-Insulin Therapies for Type 2 Diabetes Mellitus

New Non-Insulin Therapies for Type 2 Diabetes Mellitus New Non-Insulin Therapies for Type 2 Diabetes Mellitus Ally P.H. Prebtani Associate Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University Canada Disclosure Relationships

More information

Which drugs should be used to treat diabetes in cirrhotic patients?

Which drugs should be used to treat diabetes in cirrhotic patients? Which drugs should be used to treat diabetes in cirrhotic patients? Frankfurt am Main 10-12 September 2015 Jörg Bojunga Medizinische Klinik I Johann Wolfgang Goethe-Universität Frankfurt am Main Significance

More information

Medicines Used to Treat Type 2 Diabetes

Medicines Used to Treat Type 2 Diabetes Goodman Diabetes Service Medicines Used to Treat Type 2 Diabetes People who have type 2 diabetes may need to take medicine to help lower their blood glucose, in addition to being active & choosing healthy

More information

Workshop A Tara Kadis

Workshop A Tara Kadis Workshop A Tara Kadis Considerations/barriers in decision making about insulin verses GLP-1 use in people with type 2 diabetes Which Insulin regimes should we consider? Diabetes is a progressive multi-system

More information

Advances in Diabetes Therapy in the Elderly Fiona TH Lee

Advances in Diabetes Therapy in the Elderly Fiona TH Lee GERIATRIC THERAPEUTICS Editors: Michael Woodward, Head, Aged and Residential Care Services, Stephen Campbell, Consultant Geriatrician, Rohan Elliott, Clinical Pharmacist, Graeme Vernon, Drug Information

More information

Update on the management of Type 2 Diabetes

Update on the management of Type 2 Diabetes Update on the management of Type 2 Diabetes Mona Nasrallah M.D Assistant Professor, Endocrinology American University of Beirut 10 th Annual Family Medicine Conference October 14,2011 Global Prevalence

More information

Type 2 Diabetes Medicines: What You Need to Know

Type 2 Diabetes Medicines: What You Need to Know Type 2 Diabetes Medicines: What You Need to Know Managing diabetes is complex because many hormones and body processes are at work controlling blood sugar (glucose). Medicines for diabetes include oral

More information

Metformin plus saxagliptin for type 2 diabetes

Metformin plus saxagliptin for type 2 diabetes Treatment evaluation Metformin plus saxagliptin for type 2 diabetes André J. Scheen Division of Diabetes, Nutrition and Metabolic Disorders and Division of Clinical Pharmacology, Department of Medicine,

More information

Diabetes Subcommittee of PTAC meeting. held 18 June 2008. (minutes for web publishing)

Diabetes Subcommittee of PTAC meeting. held 18 June 2008. (minutes for web publishing) Diabetes Subcommittee of PTAC meeting held 18 June 2008 (minutes for web publishing) Diabetes Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology and Therapeutics

More information

medications for type 2 diabetes

medications for type 2 diabetes Talking diabetes No.25 Revised August 2010 medications for type 2 diabetes People with type 2 diabetes are often given medications including insulin to help control their blood glucose levels. Most of

More information

Type 2 Diabetes - Pramlintide and Exenatide

Type 2 Diabetes - Pramlintide and Exenatide Therapies for Diabetes: Pramlintide and Exenatide MELISSA C. JONES, PharmD, BCPS, South University School of Pharmacy, Savannah, Georgia The American Diabetes Association currently recommends an A1C goal

More information

Diabetes and Obesity. The diabesity epidemic

Diabetes and Obesity. The diabesity epidemic Diabetes and Obesity Frank B. Diamond, Jr. M.D. Professor of Pediatrics University of South Florida College of Medicine The diabesity epidemic Prevalence of diabetes worldwide was over 135 million people

More information

Liraglutide: First Once-daily human GLP-1 analogue

Liraglutide: First Once-daily human GLP-1 analogue Liraglutide: First Once-daily human GLP-1 analogue * Dr. Sreejith N Kumar Current status of type 2 diabetes in India and unmet needs As per the latest International Diabetes Federation (IDF) released in

More information

Diabetes Mellitus. Melissa Meredith M.D. Diabetes Mellitus

Diabetes Mellitus. Melissa Meredith M.D. Diabetes Mellitus Melissa Meredith M.D. Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose resulting from defects in insulin secretion, insulin action, or both Diabetes is a chronic,

More information

Endocrinology-Diabetology Unit, Corbeil-Essonnes Hospital, Essonnes, France

Endocrinology-Diabetology Unit, Corbeil-Essonnes Hospital, Essonnes, France Efficacy and safety of saxagliptin in combination with metformin compared with sitagliptin in combination with metformin in adult patients with type 2 diabetes mellitus André J. Scheen 1, Guillaume Charpentier

More information

Glucagon Receptor Antagonist: LGD-6972 Program Overview and Phase 1b Results

Glucagon Receptor Antagonist: LGD-6972 Program Overview and Phase 1b Results Glucagon Receptor Antagonist: LGD-6972 Program Overview and Phase 1b Results American Diabetes Association s 75th Scientific Sessions June 7, 2015 Boston 2 Safe Harbor Statement The following presentation

More information

Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.

Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational. Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,

More information

Diagnosis, classification and prevention of diabetes

Diagnosis, classification and prevention of diabetes Diagnosis, classification and prevention of diabetes Section 1 1 of 4 Curriculum Module II 1 Diagnosis, classification and presentation of diabetes Slide 2 of 48 Polyurea Definition of diabetes Slide 3

More information

Cochrane Quality and Productivity topics

Cochrane Quality and Productivity topics Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus NICE has developed the Cochrane Quality and Productivity (QP) topics to help the NHS identify practices

More information

Add: 2 nd generation sulfonylurea or glinide or Add DPP-4 inhibitor Start or intensify insulin therapy if HbA1c goals not achieved with the above

Add: 2 nd generation sulfonylurea or glinide or Add DPP-4 inhibitor Start or intensify insulin therapy if HbA1c goals not achieved with the above Guidelines for Type Diabetes - Diagnosis Fasting Plasma Glucose (confirm results if borderline) HbAIC Normal FPG < 00 < 5.5 Impaired Fasting Glucose (IFG) 00 to < 5.7%-.5% Diabetes Mellitus (or random

More information

Type 2 diabetes is a progressive. status

Type 2 diabetes is a progressive. status Type 2 diabetes is a progressive disease: its treatment the current status Associate Professor Jonathan Shaw Why is type 2 diabetes so hard to treat? How to choose the right glucose-lowering g drug? Page

More information

Treating dual defects in diabetes: Insulin resistance and insulin secretion

Treating dual defects in diabetes: Insulin resistance and insulin secretion Treating dual defects in diabetes: Insulin resistance and insulin secretion Nancy J.V. Bohannon, MD Am J Health-Syst Pharm. 2002; 59(Suppl 9):S9-13 ABSTRACT: The therapeutic goals in patients with type

More information

GLP-1 based therapies: differential effects on fasting and postprandial glucose

GLP-1 based therapies: differential effects on fasting and postprandial glucose Diabetes, Obesity and Metabolism 14: 675 688, 2012. 2012 Blackwell Publishing Ltd GLP-1 based therapies: differential effects on fasting and postprandial glucose review article M. S. Fineman 1,B.B.Cirincione

More information

Management of Type 2 Diabetes Mellitus in the Elderly

Management of Type 2 Diabetes Mellitus in the Elderly Management of Type 2 Diabetes Mellitus in the Elderly ANDREA FERENCZI, M.D. BANNER ARIZONA MEDICAL CLINIC DEPARTMENT OF ENDOCRINOLOGY Incidence and Prevalence of Diabetes in the United States County-level

More information

Noninsulin Diabetes Medications Summary Chart Medications marked with an asterisk (*) can cause hypoglycemia MED GROUP DESCRIPTOR

Noninsulin Diabetes Medications Summary Chart Medications marked with an asterisk (*) can cause hypoglycemia MED GROUP DESCRIPTOR Noninsulin Diabetes Medications Summary Chart Medications marked with an asterisk (*) can cause MED GROUP DESCRIPTOR INSULIN SECRETAGOGUES Sulfonylureas* GLYBURIDE* (Diabeta) (Micronase) MICRONIZED GLYBURIDE*

More information

Chapter 4 Type 2 Diabetes

Chapter 4 Type 2 Diabetes Chapter 4 Type 2 Diabetes (previously referred to as adult onset diabetes or non-insulin dependent diabetes) H. Peter Chase, MD Cindy Cain, RN, CDE Philip Zeitler, MD This is the most common type of diabetes

More information

COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL

COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL Malaysian Journal of Pharmaceutical Sciences, Vol. 5, No. 1, 19 23 (2007) COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL TRI MURTI ANDAYANI* AND IKE IMANINGSIH

More information

NEW THERAPEUTIC APPROACHES IN TYPE 2 DIABETES

NEW THERAPEUTIC APPROACHES IN TYPE 2 DIABETES - 1 - Submitted to Acta Clinica Belgica NEW THERAPEUTIC APPROACHES IN TYPE 2 DIABETES André J. Scheen Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, Liège,

More information

Volume 01, No. 08 November 2013

Volume 01, No. 08 November 2013 State of New Jersey Department of Human Services Division of Medical Assistance & Health Services New Jersey Drug Utilization Review Board Volume 01, No. 08 November 2013 TO: SUBJECT: PURPOSE: Physicians,

More information

Strengthening the Pharmacist Skills in Managing Diabetes Practice Based Program 27 Contact Hours

Strengthening the Pharmacist Skills in Managing Diabetes Practice Based Program 27 Contact Hours Strengthening the Pharmacist Skills in Managing Diabetes Practice Based Program 27 Contact Hours Presented by New York State Council of Health system Pharmacists October 18 19, 2013 St. John s University,

More information

Effective pharmacological treatment regimens for diabetes usually require

Effective pharmacological treatment regimens for diabetes usually require Medications Used in Diabetes in Patients Presenting for Anesthesia By Gabrielle O Connor, M.D., M.Sc., CCD, MRCP, FACP Dr. Gabrielle O Connor, a board certified endocrinologist who graduated from University

More information

Interventions for improving glycemic control in type 2 diabetic patients

Interventions for improving glycemic control in type 2 diabetic patients Interventions for improving glycemic control in type 2 diabetic patients Evgenia Vlachou 1, Zambia Vardaki 2, Urania Govina 1, Anna Kavga-Paltoglou 3, Vassiliki Kutsopoulou-Sofikiti 1, Martha Kelesi-Stavropoulou

More information

Exenatide (Byetta) for type 2 diabetes

Exenatide (Byetta) for type 2 diabetes Exenatide (Byetta) for type 2 diabetes This Medicine Update is for people who are using, or thinking about using, exenatide. Summary Exenatide is a new injectable medicine that reduces blood glucose levels.

More information

Practical Applications of Insulin Pump Therapy in Type 2 Diabetes

Practical Applications of Insulin Pump Therapy in Type 2 Diabetes Practical Applications of Insulin Pump Therapy in Type 2 Diabetes Wendy Lane, MD For a CME/CEU version of this article please go to www.namcp.org/cmeonline.htm, and then click the activity title. Summary

More information

Insulin and Other Glucose-Lowering Drugs

Insulin and Other Glucose-Lowering Drugs Insulin and Other Glucose-Lowering Drugs I. OVERVIEW The pancreas is both an endocrine gland that produces the peptide hormones insulin, glucagon, and somatostatin and an exocrine gland that produces digestive

More information

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Drug Class Review 68:20.06 Incretin Mimetics

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Drug Class Review 68:20.06 Incretin Mimetics Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Drug Class Review 68:20.06 Incretin Mimetics Exenatide (Byetta, Bydureon ) Liraglutide (Victoza ) Final Report May 2013 Review prepared by: Melissa Archer,

More information

10/30/2012. Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University of South Alabama Mobile, Alabama

10/30/2012. Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University of South Alabama Mobile, Alabama Faculty Medications for Diabetes Satellite Conference and Live Webcast Wednesday, November 7, 2012 2:00 4:00 p.m. Central Time Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University

More information

International Journal of Pharmacy and Pharmaceutical Sciences

International Journal of Pharmacy and Pharmaceutical Sciences International Journal of Pharmacy and Pharmaceutical Sciences Vol 2, Suppl 1, 2010 DIABETES MELLITUS TYPE II: REVIEW OF ORAL TREATMENT OPTIONS Review Article Rana Ibrahim Lecturer in Pharmacy Practice/

More information

Current Strategies for Evaluating, Monitoring, and Treating Type 2 Diabetes Mellitus

Current Strategies for Evaluating, Monitoring, and Treating Type 2 Diabetes Mellitus Supplement issue Current Strategies for Evaluating, Monitoring, and Treating Type 2 Diabetes Mellitus Jeff Unger, MD Chino Medical Group Diabetes and Headache Intervention Center, Chino, California, USA

More information

Treatment Approaches to Diabetes

Treatment Approaches to Diabetes Treatment Approaches to Diabetes Dr. Sarah Swofford, MD, MSPH & Marilee Bomar, GCNS, CDE Quick Overview Lifestyle Oral meds Injectables not insulin Insulin Summary 1 Lifestyle & DM Getting to the point

More information

Article: Treatment Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double-blind, randomized, crossover trial

Article: Treatment Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double-blind, randomized, crossover trial DIABETICMedicine Article: Treatment Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double-blind, randomized, crossover trial S. L. Ellis*, E. G. Moser*, J. K.

More information

JANUVIA sitagliptin phosphate 25 mg, 50 mg & 100 mg tablets

JANUVIA sitagliptin phosphate 25 mg, 50 mg & 100 mg tablets JANUVIA sitagliptin phosphate 25 mg, 50 mg & 100 mg tablets What is in this leaflet This leaflet answers some common questions about JANUVIA. It does not contain all the available information. It does

More information

Antihyperglycemic Agents Comparison Chart

Antihyperglycemic Agents Comparison Chart Parameter Metformin Sulfonylureas Meglitinides Glitazones (TZD s) Mechanism of Action Efficacy (A1c Reduction) Hepatic glucose output Peripheral glucose uptake by enhancing insulin action insulin secretion

More information

Tuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University

Tuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University Tuberculosis And Diabetes Dr. hanan abuelrus Prof.of internal medicine Assiut University TUBERCULOSIS FACTS More than 9 million people fall sick with tuberculosis (TB) every year. Over 1.5 million die

More information

Type 1 and Type 2 Diabetes in Pediatric Practice

Type 1 and Type 2 Diabetes in Pediatric Practice Type 1 and Type 2 Diabetes in Pediatric Practice Chirag R. Kapadia, MD Division of Endocrinology, Phoenix Children s Hospital Clinical Assistant Professor, U of A College of Medicine Presentation outline

More information

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Overview of Diabetes Management By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Objectives: Describe the pathophysiology of diabetes. From a multiorgan systems viewpoint. Identify the types of diabetes.

More information

Effect of liraglutide on body weight in overweight or obese subjects with type 2 diabetes: SCALE - Diabetes

Effect of liraglutide on body weight in overweight or obese subjects with type 2 diabetes: SCALE - Diabetes Effect of liraglutide on body weight in overweight or obese subjects with type 2 diabetes: SCALE - Diabetes This trial is conducted in Africa, Asia, Europe and the United States of America (USA). The aim

More information

Prescribing for type 2 diabetes in the elderly: issues and solutions

Prescribing for type 2 diabetes in the elderly: issues and solutions Prescribing for type 2 diabetes in the elderly: issues and solutions Roger Gadsby MBE, BSc, DRCOG, DCH, FRCGP Debbie Hicks MSc, BA, RGN, NMP, DN Cert, PWT Cert Richard Holt MA, PhD, FRCP, FHEA Over half

More information

My Doctor Says I Need to Take Diabetes Pills and Insulin... What Do I Do Now? BD Getting Started. Combination Therapy

My Doctor Says I Need to Take Diabetes Pills and Insulin... What Do I Do Now? BD Getting Started. Combination Therapy My Doctor Says I Need to Take Diabetes Pills and Insulin... What Do I Do Now? BD Getting Started Combination Therapy How Can Combination Therapy Help My Type 2 Diabetes? When you have type 2 diabetes,

More information

Jill Malcolm, Karen Moir

Jill Malcolm, Karen Moir Evaluation of Fife- DICE: Type 2 diabetes insulin conversion Article points 1. Fife-DICE is an insulin conversion group education programme. 2. People with greater than 7.5% on maximum oral therapy are

More information

Type 2 diabetes mellitus

Type 2 diabetes mellitus Type 2 diabetes mellitus CLINICAL PRACTICE Management Guidelines for initiating insulin therapy BACKGROUND Insulin is often indicated for patients with suboptimally controlled type 2 diabetes mellitus,

More information

Vildagliptin (Galvus) for type 2 diabetes

Vildagliptin (Galvus) for type 2 diabetes Vildagliptin (Galvus) for type 2 diabetes This Medicine Update is for people who are taking, or thinking about taking, vildagliptin. Summary Vildagliptin (brand name Galvus) is a new medicine. It is a

More information

Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment. Bruce Latham, M.D. Endocrine Specialists Greenville Health System

Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment. Bruce Latham, M.D. Endocrine Specialists Greenville Health System Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment Bruce Latham, M.D. Endocrine Specialists Greenville Health System Objectives for this presentation - Understand the thrifty genotype

More information