Annual Report 2016
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GLP-1 Receptor Agonists
Cognitive Vitality Reports® are reports written by neuroscientists at the Alzheimer’s Drug Discovery Foundation (ADDF). These scientific reports include analysis of drugs, drugs-in- development, drug targets, supplements, nutraceuticals, food/drink, non-pharmacologic interventions, and risk factors. Neuroscientists evaluate the potential benefit (or harm) for brain health, as well as for age-related health concerns that can affect brain health (e.g., cardiovascular diseases, cancers, diabetes/metabolic syndrome). In addition, these reports include evaluation of safety data, from clinical trials if available, and from preclinical models. GLP-1 Receptor Agonists Evidence Summary GLP-1 agonists are beneficial for patients with type 2 diabetes and obesity. Some evidence suggests benefits for Alzheimer’s disease. It is unclear whether it is beneficial for individuals without underlying metabolic disease. Semaglutide seems to be most effective for metabolic dysfunction, though liraglutide has more preclinical data for Alzheimer’s disease. Neuroprotective Benefit: Evidence from many preclinical studies and a pilot biomarker study suggest some neuroprotective benefits with GLP-1 agonists. However, whether they may be beneficial for everyone or only a subset of individuals (e.g. diabetics) is unclear. Aging and related health concerns: GLP-1 agonists are beneficial for treating diabetes and cardiovascular complications relating to diabetes. It is not clear whether they have beneficial effects in otherwise healthy individuals. Safety: GLP-1 agonists are generally safe for most people with minor side effects. However, long-term side effects are not known. 1 Availability: Available Dose: Varies - see Chemical formula: C172H265N43O51 (Liraglutide) as a prescription chart at the end of MW: 3751.262 g/mol medicine. -
The Activation of the Glucagon-Like Peptide-1 (GLP-1) Receptor by Peptide and Non-Peptide Ligands
The Activation of the Glucagon-Like Peptide-1 (GLP-1) Receptor by Peptide and Non-Peptide Ligands Clare Louise Wishart Submitted in accordance with the requirements for the degree of Doctor of Philosophy of Science University of Leeds School of Biomedical Sciences Faculty of Biological Sciences September 2013 I Intellectual Property and Publication Statements The candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. The right of Clare Louise Wishart to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. © 2013 The University of Leeds and Clare Louise Wishart. II Acknowledgments Firstly I would like to offer my sincerest thanks and gratitude to my supervisor, Dr. Dan Donnelly, who has been nothing but encouraging and engaging from day one. I have thoroughly enjoyed every moment of working alongside him and learning from his guidance and wisdom. My thanks go to my academic assessor Professor Paul Milner whom I have known for several years, and during my time at the University of Leeds he has offered me invaluable advice and inspiration. Additionally I would like to thank my academic project advisor Dr. Michael Harrison for his friendship, help and advice. I would like to thank Dr. Rosalind Mann and Dr. Elsayed Nasr for welcoming me into the lab as a new PhD student and sharing their experimental techniques with me, these techniques have helped me no end in my time as a research student. -
Combining a Glucagon-Like Peptide-1 Receptor Agonist with Basal Insulin: the Why and How
Combining a Glucagon-like Peptide-1 Receptor Agonist with Basal Insulin: The Why and How Case Study Mary is a 61 year-old female diagnosed with type 2 diabetes mellitus (T2DM) 8 years ago. She was initially managed with the combination of lifestyle modification and metformin. Since that time she was treated with a sulfonylurea, but it was discontinued due to symptomatic hypoglycemia. She was also treated with pioglitazone, but significant fluid retention led to it discontinuation. A year-and-a- half ago, basal insulin was added to her lifestyle and metformin management. She now administers 52 units (0.62 units/kg) once daily at bedtime. Since starting basal insulin, she has experienced 3 episodes of mild hypoglycemia. Since her diagnosis, Mary’s HbA1c has never been <7.0%; her current HbA1c is 7.9%. Over the past month, her fasting plasma glucose (FPG) has ranged from 103 mg/dL to 136 mg/dL and her postprandial glucose (PPG) from 164 mg/dL to 213 mg/dL. She has gained 2.6 kg since starting basal insulin and her body mass index is now 31 kg/m2. Her blood pressure is 134/82 mmHg. She experiences occasional tingling in her feet. Eye examination reveals grade 1 retinopathy. Current medications are: metformin 1000mg twice daily, basal insulin 52 units once daily at bedtime, and hydrochlorothiazide 25 mg once daily. Her family physician notes that Mary’s FPG is reasonably well-controlled, yet her HbA1c and PPG remain elevated. He is also concerned about her episodes of hypoglycemia and weight gain and the evidence indicating microvascular damage. -
Performance of the Insulin-Only Ilet Bionic Pancreas and The
e118 Diabetes Care Volume 44, June 2021 Performance of the Insulin-Only Luz E. Castellanos,1 Courtney A. Balliro,1 Jordan S. Sherwood,1 Rabab Jafri,1 iLet Bionic Pancreas and the Mallory A. Hillard,1 Evelyn Greaux,1 Rajendranath Selagamsetty,2 Hui Zheng,3 Bihormonal iLet Using Firas H. El-Khatib,2 Edward R. Damiano,2,4 and Dasiglucagon in Adults With Type Steven J. Russell1 1 Diabetes in a Home-Use Setting Diabetes Care 2021;44:e118–e120 | https://doi.org/10.2337/dc20-1086 Reductions in blood glucose levels in with insulin lispro (Eli Lilly) or aspart (Table 1). The mean CGM glucose and people with diabetes are often achieved (Novo Nordisk), the bihormonal iLet for time in range (70–180 mg/dL) were 149 at the expense of increased hypoglyce- 7dayswithdasiglucagon(4mg/mL) ±13mg/dLand72±8%,respectively,in mia. A novel approach is to automati- and insulin lispro or aspart, or both, us- the insulin-only period, and 139 ± 11 cally deliver microdose glucagon when ing the same glucose target (110 mg/ mg/dL and 79 ± 9%, respectively, in the automation of insulin delivery alone is dL), in random order. There were no re- bihormonal period. The mean daily car- not sufficient to prevent hypoglycemia. strictions on diet or exercise. The prima- bohydrates consumed to prevent or The approach requires a bihormonal de- ry outcomes were prespecified iLet treat hypoglycemia were 16 ± 13 g and vice and a stable form of glucagon or operational thresholds. The key second- 18 ± 21 g in the insulin-only and bihor- glucagon analog. -
Gattex Teduglutide Rdna Origin
Subject: Gattex (teduglutide [rDNA origin]) Original Effective Date: 5/30/2014 Policy Number: MCP-176 Revision Date(s): Review Date(s): 12/16/15; 9/15/2016; 6/22/2017 DISCLAIMER This Medical Policy is intended to facilitate the Utilization Management process. It expresses Molina's determination as to whether certain services or supplies are medically necessary, experimental, investigational, or cosmetic for purposes of determining appropriateness of payment. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Molina) for a particular member. The member's benefit plan determines coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusion(s) or other benefit limitations applicable to this service or supply. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. CMS's Coverage Database can be found on the CMS website. The coverage directive(s) and criteria from an existing National Coverage Determination (NCD) or Local Coverage Determination (LCD) will supersede the contents of this Molina medical coverage policy (MCP) document and provide the directive for all Medicare members. FDA INDICATIONS � ∑ Short bowel syndrome: For the treatment of adult patients with short bowel syndrome who are dependent on parenteral support. -
Glucose Regulation in Diabetes
Glucose Regulation in Diabetes Samantha Lozada Advised by Charles S. Peskin and Thomas Fai Glucose 1 Abstract Complicated and extensive models of glucose regulation, involving several variables, have been developed over the years. Our research specifically focuses on the feedback loop between insulin and glucagon. Although our model is simpler than a model including state variables such as non-esterified fatty acids concentration in the blood plasma, β-cell mass, TAG content of lipocytes, and/or leptin concentrations in the blood plasma, we are still able to simulate most of the key effects of diabetes and other health problems on glucose regulation; such as, hyperglycemia, hyperinsulinism, and insulin shock (hypoglycemia). We are even able to simulate eating a bowl of vanilla ice cream! 2 Introduction For most of our qualitative and quantitative experimentations we worked with MATLAB, a computer programming language and data visualization software, which offers a rich set of tools for solving problems in engineering, scientific, computing, and mathematical disciplines, such as a graphical user interface. Our model is a refinement of a realistic model developed by Cobelli et al. (1982). Despite the fact that the paper is nearly 28 years old, the experimental data of diagnostic tests used by medical professionals, such as the Intravenous Glucose Tolerance Test (IVGTT), correlates with our simulated graphs. From a Biological Perspective Regulation in a Healthy System In order for us to model any biological system, we need to first understand exactly what is happening within a human body. We need to ask what causes this effect and why. To answer these questions we need to identify the key organs and hormones, and then see how they interact within our bodies. -
Religious Fasting, Ramadan and Hypoglycemia in People with Diabetes
VOLUME 7 > ISSUE 01 > JUNE 30 2014 SPOTLIGHT ARTICLE Diabetic Hypoglycemia June 2014, Volume 7, Issue 1: page 15-19 Religious fasting, Ramadan and hypoglycemia in people with diabetes Alia Gilani1, Melanie Davies2, Kamlesh Khunti2 1 NHS Glasgow, United Kingdom 2 Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom Abstract Most Muslims with diabetes will take part in Ramadan even though they may be exempt from doing so. In some countries a religious fast can last between 10 and 21 hours. The main risk of fasting to people with diabetes is hypoglycemia. People with diabetes who fast may have to alter the dose of their medications or modify their therapeutic regimen to avoid hypoglycemia, which can have adverse effects on glycemic control. Therapies which pose a high risk of hypoglycemia when used during fasting are sulfonylureas and insulin therapy. Metformin, incretin therapies and the newer sodium glucose co-transporter 2 inhibitor class have a low risk of hypoglycemia. The practice of fasting during Ramadan is advocated for all healthy individuals. If deemed detrimental to health then a person can be considered exempt from fasting; this includes frail and elderly people, pregnant and breast feeding women, children and people with multi-morbidities. Keywords: diabetes, hypoglycemia, Ramadan, religious fasting Introduction the Islamic calendar, the risks associated with prolonged fasting and how it should be managed. Living in a diverse society, it is important that healthcare professionals are kept informed about cultural and religious Fasting during Ramadan practices, which can affect the control of diabetes. The practice of fasting by Muslims has implications for Muslim What does fasting entail? people with diabetes, in particular an increased risk of Ramadan in Arabic is translated as “sawm”, literally hypoglycemia during the period of Ramadan and at other meaning “abstention from”. -
A Network Meta-Analysis Comparing Exenatide Once Weekly with Other GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus
Diabetes Ther DOI 10.1007/s13300-016-0155-1 REVIEW A Network Meta-analysis Comparing Exenatide Once Weekly with Other GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus Sheena Kayaniyil . Greta Lozano-Ortega . Heather A. Bennett . Kristina Johnsson . Alka Shaunik . Susan Grandy . Bernt Kartman To view enhanced content go to www.diabetestherapy-open.com Received: December 17, 2015 Ó The Author(s) 2016. This article is published with open access at Springerlink.com ABSTRACT treatment of adults with T2DM inadequately controlled on metformin monotherapy. Introduction: Exenatide is a glucagon-like Methods: A systematic literature review was peptide-1 receptor agonist (GLP-1 RA), conducted to identify randomized controlled approved for treatment of type 2 diabetes trials (RCTs) that investigated GLP-1 RAs mellitus (T2DM). There is limited direct (albiglutide, dulaglutide, exenatide, liraglutide, evidence comparing the efficacy and and lixisenatide) at approved doses in the tolerability of exenatide 2 mg once weekly United States/Europe, added on to metformin (QW) to other GLP-1 RAs. A network only and of 24 ± 6 weeks treatment duration. meta-analysis (NMA) was conducted to A Bayesian NMA was conducted. estimate the relative efficacy and tolerability of Results: Fourteen RCTs were included in the exenatide QW versus other GLP-1 RAs for the NMA. Exenatide QW obtained a statistically significant reduction in glycated hemoglobin (HbA1c) relative to lixisenatide 20 lg once daily. No other comparisons of exenatide QW Electronic supplementary material The online version of this article (doi:10.1007/s13300-016-0155-1) to other GLP-1 RAs were statistically significant contains supplementary material, which is available to for change in HbA1c. -
Study Protocol
CLINICAL TRIAL REPORT ZP4207-16136 (ZEA-DNK-01711) 16.1 TRIAL INFORMATION 16.1.1 PROTOCOL AND PROTOCOL AMENDMENTS This appendix includes Document Date, Version Clinical Trial Protocol 18 January 2017, Version 1 Amendment 01 08 May 2017 Clinical Trial Protocol 08 May 2017, Version 2 Amendment 02 21 August 2017 Clinical Trial Protocol 21 August 2017, Version 3 Section 16.1.1: Protocol and Protocol Amendments Clinical Trial Protocol, final version 1 ZP4207-16136 (ZEA-DNK-01711) Clinical Trial Protocol A phase 3, Randomized, Double-Blind, Parallel Group Safety Trial to Evaluate the Immunogenicity of Dasiglucagon Compared to GlucaGen® Administered Subcutaneously in Patients with Type 1 Diabetes Mellitus (T1DM) Sponsor code: ZP4207-16136 SynteractHCR: ZEA-DNK-01711 EudraCT number: 2017-000062-30 Coordinating investigator: Linda Morrow, MD Prosciento 855 Third Avenue 91911 Chula Vista CA, USA Sponsor: Zealand Pharma A/S Smedeland 36 2600 Glostrup, Copenhagen Denmark Version: final version 1 Date: 18 January 2017 GCP statement This trial will be performed in compliance with Good Clinical Practice (GCP), the Declaration of Helsinki (with amendments) and local legal and regulatory requirements. 18 Jan 2017 CONFIDENTIAL Page 1/48 Clinical Trial Protocol, final version 1 ZP4207-16136 (ZEA-DNK-01711) Title: A phase 3, randomized, double-blind, parallel group safety trial to evaluate the immunogenicity of dasiglucagon compared to GlucaGen® administered subcutaneously in patients with type 1 diabetes mellitus (T1DM) I agree to conduct this trial according to the Trial Protocol. I agree that the trial will be carried out in accordance with Good Clinical Practice (GCP), with the Declaration of Helsinki (with amendments) and with the laws and regulations of the countries in which the trial takes place. -
Teduglutide for Treating Short Bowel Syndrome
Teduglutide for treating short bowel syndrome Produced by Aberdeen HTA Group Authors Graham Scotland1,2 Daniel Kopasker1 Neil Scott3 Moira Cruickshank1 Rodolfo Hernández 1 Cynthia Fraser1 Mairi McLean4 Alistair McKinlay5 Miriam Brazzelli2 1 Health Economics Research Unit, University of Aberdeen 2 Health Services Research Unit, University of Aberdeen 3 Medical Statistics Team, University of Aberdeen 4 School of Medicine, Medical Sciences & Nutrition, University of Aberdeen 5 Consultant Gastroenterologist, NHS Grampian Correspondence to Graham Scotland Senior Research Fellow University of Aberdeen Health Economics Research Unit Foresterhill, Aberdeen, AB25 2ZD Email: [email protected] Date completed 20 September 2017 Version 1 Copyright belongs to University of Aberdeen HTA Group, unless otherwise stated Copyright 2017 Queen's Printer and Controller of HMSO. All rights reserved. CONFIDENTIAL UNTIL PUBLISHED Source of funding: This report was commissioned by the NIHR HTA Programme as project number 15/07/04. Declared competing interests of the authors Alistair McKinley reports that he previously acted in a brief advisory capacity for Shire, through participation in an expert advisory meeting on short bowel syndrome in Scotland. All other authors have no competing interests to declare. Acknowledgements The authors are grateful to Lara Kemp for her administrative support. Copyright is retained by Shire for Tables 1, 3, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 24, 25, 26, 27, 28 , 29, 39, 31, 32, and 33, and for Figures 1, 2, 5, 6 , 7, 9, 10, 11, and 12. Rider on responsibility for report The view expressed in this report are those of the authors and not necessarily those of the NIHR HTA Programme. -
Membrane-Tethered Ligands Are Effective Probes for Exploring Class B1 G Protein-Coupled Receptor Function
Membrane-tethered ligands are effective probes for exploring class B1 G protein-coupled receptor function Jean-Philippe Fortina, Yuantee Zhua, Charles Choib, Martin Beinborna, Michael N. Nitabachb, and Alan S. Kopina,1 aMolecular Pharmacology Research Center, Molecular Cardiology Research Institute, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111; and bDepartment of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT 06520 Edited by Solomon H. Snyder, Johns Hopkins University School of Medicine, Baltimore, MD, and approved March 6, 2009 (received for review January 6, 2009) Class B1 (secretin family) G protein-coupled receptors (GPCRs) peptide hormone complexes, providing important insight into modulate a wide range of physiological functions, including glu- the molecular mechanisms underlying PTH (3), corticotropin- cose homeostasis, feeding behavior, fat deposition, bone remod- releasing factor (CRF) (4), GIP (5), and exendin-4 (EXE4) (6) eling, and vascular contractility. Endogenous peptide ligands for interaction with their corresponding GPCRs. Notably, these these GPCRs are of intermediate length (27–44 aa) and include reports highlight that each of the peptides docks as an amphipathic receptor affinity (C-terminal) as well as receptor activation (N- ␣-helix in a hydrophobic groove present in the receptor ECD. terminal) domains. We have developed a technology in which a Peptide ligands that modulate class B1 GPCR function hold peptide ligand tethered to the cell membrane selectively modu- considerable promise as therapeutics. The peptidic GLP-1 mi- lates corresponding class B1 GPCR-mediated signaling. The engi- metic EXE4 (also known as exenatide or BYETTA) activates the neered cDNA constructs encode a single protein composed of (i)a GLP-1 receptor (GLP-1R) and represents the first incretin- transmembrane domain (TMD) with an intracellular C terminus, (ii) based pharmaceutical for the treatment of type 2 diabetes (7). -
GLP-1 Receptor Agonists Reference Number: CP.HNMC.16 Effective Date: 11.16.16 Last Review Date: 11.17 Revision Log Line of Business: Medicaid – Medi-Cal
Clinical Policy: GLP-1 Receptor Agonists Reference Number: CP.HNMC.16 Effective Date: 11.16.16 Last Review Date: 11.17 Revision Log Line of Business: Medicaid – Medi-Cal See Important Reminder at the end of this policy for important regulatory and legal information. Description The following are GLP-1 Receptor Agonists requiring prior authorization: lixisenatide (Adlyxin™), Exenatide Extended-Release (Bydureon®), Exenatide (Byetta®), Pramlintide Acetate (Symlin®), Albiglutide (Tanzeum®), Dulaglutide (Trulicity®), Liraglutide (Victoza®), Liraglutide and insulin degludec (Xultophy®),Insulin glargine and lixisenatide (Soliqua®). FDA approved indication Adlyxin, Bydureon, Byetta, Tanzeum, Trulicity, Victoza are indicated: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Adlyxin limitation of use: Has not been studied in patients with chronic pancreatitis or a history of unexplained pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Not for treatment of type 1 diabetes or diabetic ketoacidosis. Has not been studied in combination with short acting insulin. Has not been studied in patients with gastroparesis and is not recommended in patients with gastroparesis. Bydureon limitation of use: Not recommended as first-line therapy for patients inadequately controlled on diet and exercise. Should not be used to treat type 1 diabetes or diabetic ketoacidosis. Use with insulin has not been studied and is not recommended. Has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Byetta limitation of use: Not a substitute for insulin. Byetta should not be used for the treatment of type 1 diabetes or diabetic ketoacidosis.