DOCSLIB.ORG

Antidiabetic Drugs in NAFLD: the Accomplishment of Two Goals at Once?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Antidiabetic Drugs in NAFLD: the Accomplishment of Two Goals at Once? pharmaceuticals Review Antidiabetic Drugs in NAFLD: The Accomplishment of Two Goals at Once? Matteo Tacelli , Ciro Celsa , Bianca Magro, Aurora Giannetti, Grazia Pennisi, Federica Spatola and Salvatore Petta * Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, 90127 Palermo, Italy; [email protected] (M.T.); [email protected] (C.C.); [email protected] (B.M.); [email protected] (A.G.); [email protected] (G.P.); [email protected] (F.S.) * Correspondence: [email protected], Tel.: +39-091-655-2170; Fax: +39-091-655-2156 Received: 17 October 2018; Accepted: 3 November 2018; Published: 8 November 2018 Abstract: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease in Western countries, accounting for 20–30% of general population and reaching a prevalence of 55% in patients with type 2 diabetes mellitus (T2DM). Insulin resistance plays a key role in pathogenic mechanisms of NAFLD. Many drugs have been tested but no medications have yet been approved. Antidiabetic drugs could have a role in the progression reduction of the disease. The aim of this review is to summarize evidence on efficacy and safety of antidiabetic drugs in patients with NAFLD. Metformin, a biguanide, is the most frequently used drug in the treatment of T2DM. To date 15 randomized controlled trials (RCTs) and four meta-analysis on the use of metformin in NAFLD are available. No significant improvement in histological liver fibrosis was shown, but it can be useful in the treatment of co-factors of NAFLD, like body weight, transaminase or cholesterol levels, and HbA1c levels. A possible protective role in various types of cancer has been reported for Metformin. Thiazolidinediones modulate insulin sensitivity by the activation of PPAR-γ. The RCTs and the meta-analysis available about the role of these drugs in NAFLD show an improvement in ballooning, lobular inflammation, and perhaps fibrosis, but some side effects, in particular cardiovascular, were showed. GLP-1 analogues stimulate insulin secretion by pancreatic beta cell and inhibit glucagon release; Liraglutide is the most used drug in this class and significantly improves steatosis, hepatocyte ballooning and transaminase levels. Scanty data about the role of DPP-4 and SGLT inhibitors were published. No data about insulin effects on NAFLD are available but it was showed a possible association between insulin use and the development of solid neoplasms, in particular HCC. In conclusion, antidiabetic drugs seem to be promising drugs, because they are able to treat both NAFLD manifestations and diabetes, preventing worsening of hepatic damage, but data are still conflicting. All antidiabetic drugs can be safely used in patients with compensated cirrhosis, while insulin is the preferred drug in decompensated Child C cirrhosis. Keywords: non-alcoholic fatty liver disease; non-alcoholic steatohepatitis; Metformin; Thiazolidinediones; Liraglutide; hepatic cirrhosis 1. Introduction Non-Alcoholic Fatty Liver Disease (NAFLD), a spectrum of conditions ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) and liver cirrhosis, is the most common cause of chronic liver disease in Western countries [1]. Prevalence of NAFLD is roughly 20–30% in the general population, but it reaches 55% in patients affected by type 2 diabetes mellitus (T2DM) [2,3]. Cohort studies suggest that presence of NAFLD at baseline is an independent predictor of the occurrence of T2DM [4,5]. At same time, presence of T2DM independently predicts the occurrence Pharmaceuticals 2018, 11, 121; doi:10.3390/ph11040121 www.mdpi.com/journal/pharmaceuticals Pharmaceuticals 2018, 11, x FOR PEER REVIEW 2 of 18 Pharmaceuticals 2018, 11, 121 2 of 19 [6,7]. Insulin resistance plays a key role in pathogenic mechanisms of NAFLD and it acts as a trigger forof fattyprogression liver [6 ,7of]. steatosis Insulin resistancetowards steatohepati plays a keytis, role cirrhosis, in pathogenic and end-stage mechanisms complications of NAFLD and[2]. NAFLDit acts as is aassociated trigger for with progression higher risk of of steatosisdeath, ma towardsinly due steatohepatitis, to cardiovascular cirrhosis, disease and(CVD), end-stage cancer andcomplications liver-related [2]. death NAFLD and is the associated risk increases with higher accordin risk ofg to death, fibrosis mainly stage due [8]. to In cardiovascular spite of increasing disease epidemiological(CVD), cancer and burden, liver-related to date death no andmedication the risk increaseshas been according approved to for fibrosis treatment stage [ 8of]. InNAFLD. spite of Althoughincreasing healthy epidemiological diet and burden, habitual to physical date no medication activity resulting has been in approved weight forloss treatment is advisable of NAFLD. in all NAFLDAlthough patients, healthy dietpharmacological and habitual physicaltreatment activity of prog resultingressive inor weight active lossNASH is advisable remains inan all urgently NAFLD unmetpatients, medical pharmacological need. Treatment treatment should of progressive aim to orreduce active NASHliver-related remains mortality an urgently and unmet progression medical towardsneed. Treatment cirrhosis shouldand its complications aim to reduce [9]. liver-related Identification mortality of adequate and progression surrogate towardsendpoints cirrhosis is essential and toits measure complications efficacy [9]. and Identification effectiveness of adequateof pharmaco surrogatelogical endpoints treatments is essentialof NASH, to so measure regression efficacy or improvementand effectiveness of NASH of pharmacological histological lesions treatments should of be NASH, the goal so regression to reach when or improvement new pharmaceutical of NASH approacheshistological are lesions tested. should be the goal to reach when new pharmaceutical approaches are tested. TheThe aim aim of of this this review review is is to to summarize summarize evidence evidence on on efficacy efficacy and and safety safety of of antidiabetic antidiabetic drugs drugs in in patientspatients with with NAFLD NAFLD (T (Tableable 11 andand FigureFigure1 1).). FigureFigure 1. 1. EffectEffect of of antidiabetic antidiabetic drugs drugs on on metabolic metabolic and and liver liver outcomes outcomes in in patients patients with with non-alcoholic non-alcoholic fattyfatty liver liver disease. disease. SGLT-2: SGLT-2: sodium-glucose sodium-glucose cotransporter cotransporter 2; 2; DPP-4: DPP-4: Dipeptidyl Dipeptidyl peptidase-4; peptidase-4; GLP-1: GLP-1: Glucagon-likeGlucagon-like pepide-1. pepide-1. Pharmaceuticals 2018, 11, 121 3 of 19 Table 1. Studies assessing the effect of antidiabetic drugs on metabolic and liver outcomes in patients with nonalcoholic fatty liver disease. First Name Author, Therapy Dosage Histological Lobular Hepatocellular Antidiabetic Class Trial Design Patients Age Male (%) BMI Diabetes Body Weight HOMA-Index Liver Enzymes Fibrosis Year of Publication and Duration Steatosis Inflammation Ballooning 100 mg/die, 24 Cui, 2016 Sitagliptin vs. Placebo 25 52.9 52 31.9 48 Not Improved Not Improved Not Improved Not Assessed Not Assessed Not Assessed Not Assessed weeks 100 mg/die, 24 Joi, 2017 Sitagliptin vs. Placebo 6 56.7 50 35.9 100 Not Improved Not Improved Not Improved Not Improved Not Improved Not Improved Not Improved weeks DPP-4 inhibitors Sitagliptin vs. 50 mg/die, 16 Sayari, 2018 138 42.9 60 29.6 NA Improved Not Assessed Improved Not Assessed Not Assessed Not Assessed Not Assessed Sitagliptin + Placebo weeks Vildagliptin vs. 100 mg/die, 12 Hussain, 2016 29 28 62 30.7 NA Improved Not Assessed Improved Not Assessed Not Assessed Not Assessed Not Assessed Placebo weeks Metformin plus diet Uygun, 2004 versus diet alone in 18 41 62 29.2 0 1.5 g, 6 months Improved Improved Improved Not Assessed Not Improved Not Assessed Not Improved NASH Metformin versus vit. Bugianesi, 2005 E versus diet in 55 42 73 28.7 0 2 g, 12 months Improved Improved Improved Improved * Improved * Not Assessed Improved * NAFLD Metformin versus Rosiglitazone vs. diet Idilman, 2008 74 47 59 31.5 NA 1.7 g, 12 months Improved Improved Improved Improved Improved Not Assessed Not Improved and exercise alone. 20 NASH Metformin versus Haukeland, 2009 20 47 73 30.8 20 2.5–3 g, 6 months Improved Not Improved Improved Improved Not Improved Not Improved Unchanged Placebo in NASH Metformin plus diet 0.5–1 g, 12 Shields, 2009 versus diet alone in 19 47 68 32.6 0 Improved Improved Improved Not Improved Not Improved Not Improved Not Improved months NASH Metformin plus diet Nar, 2009 versus diet alone in 34 47 26 31 100 1.7 g, 6 months Improved Improved Improved Not Assessed Not Assessed Not Assessed Not Assessed NAFLD Improved (NS) Worsed (NS) in Worsed (NS) in Worsed (NS) in Worsed (NS) in Metformin versus in Metformin Metformin Metformin Metformin Metformin Rosiglitazione versus Improved in group. group. group. group. group. Omer, 2010 Metformin plus 44 ** 49 59 31.6 70 1.7 g, 12 months Not Improved both Improved in Improved in Improved in Improved in Improved in Rosiglitazone in combination combination combination combination combination NAFLD group group group group group Metformin Metformin versus Krakoff, 2010 1073 51 34 34 IFG 1.7 g, 36 months Improved Not Assessed Improved Not Assessed Not Assessed Not Assessed Not Assessed Placebo in NAFLD Metformin plus diet Garinis, 2010 versus diet alone in 20 41 10 36.5 0 1 g, 6 months Improved Improved Not Improved Not Assessed Not Assessed Not Assessed Not
Load more

Recommended publications
  • CDR Clinical Review Report for Soliqua
    CADTH COMMON DRUG REVIEW Clinical Review Report Insulin glargine and lixisenatide injection (Soliqua) (Sanofi-Aventis) Indication: adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus inadequately controlled on basal insulin (less than 60 units daily) alone or in combination with metformin. Service Line: CADTH Common Drug Review Version: Final (with redactions) Publication Date: January 2019 Report Length: 118 Pages Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. While patients and others may access this document, the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular purpose. The information in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services. While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date the material was first published by CADTH, CADTH does not make any guarantees to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in any third-party materials used in preparing this document.
    [Show full text]
  • A Prospective Cohort Study on Effects of Gemigliptin On
    www.nature.com/scientificreports OPEN A prospective cohort study on efects of gemigliptin on cardiovascular outcomes in patients with type 2 diabetes (OPTIMUS study) Eun Heui Kim1,9, Sang Soo Kim1,9, Dong Jun Kim2, Young Sik Choi3, Chang Won Lee4, Bon Jeong Ku5, Kwang Soo Cha1, Kee Ho Song6, Dae Kyeong Kim7 & In Joo Kim1,8* This study was performed to evaluate the long-term cardiovascular safety of gemigliptin in patients with type 2 diabetes mellitus (T2DM). After screening, eligible patients with T2DM were enrolled, received gemigliptin, and were followed up for a median of 2.50 years. The primary outcome was a composite of confrmed cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke (3-point major adverse cardiovascular event [MACE]). The key secondary outcomes were incidence of all-cause mortality and any other cardiovascular events. A total of 5179 patients were included in the study and 5113 were treated with gemigliptin. Overall, the primary outcome occurred in 26 patients within 12 months (estimated incidence by Cox proportional hazard model 0.49%, 95% CI 0.29–0.69%) and in 54 patients within 54 months (estimated incidence from Cox proportional hazard model 1.35%, 95% CI 0.92–1.77%). During the study period, the incidence rates of each component of the primary composite outcome were 0.04% (0.2 events per 1000 person-years) for cardiovascular death, 0.51% (2.2 events per 1000 person-years) for nonfatal myocardial infarction, and 0.61% (2.5 events per 1000 person-years) for nonfatal ischemic stroke. The incidence of all-cause mortality was 0.82% (3.2 events per 1000 person-years) and the incidences of other cardiovascular events were all less than 0.3%.
    [Show full text]
  • Pharmacokinetics and Pharmacodynamics of a Fixed-Dose
    Transl Clin Pharmacol. 2020 Mar;28(1):43-54 https://doi.org/10.12793/tcp.2020.28.e2 pISSN 2289-0882·eISSN 2383-5427 Original Article Pharmacokinetics and pharmacodynamics of a fixed-dose combination of gemigliptin/metformin sustained release 25/500 mg compared to the loose combination in healthy male subjects Xuanyou Jin , Eunwoo Kim , Ki Young Huh , Inyoung Hwang , * Received: Feb 20, 2020 Joo-Youn Cho , Kyung-Sang Yu , and SeungHwan Lee Revised: Mar 18, 2020 Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Accepted: Mar 19, 2020 Hospital, Seoul 03080, Korea *Correspondence to SeungHwan Lee Department of Clinical Pharmacology and ABSTRACT Therapeutics, Seoul National University College of Medicine and Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. A fixed-dose combination (FDC) of gemigliptin/metformin can improve the medication E-mail: [email protected] adherence in patients with type 2 diabetes mellitus (T2DM). In this study, the pharmacokinetic (PK) and pharmacodynamic (PD) profiles of gemigliptin and metformin were compared Copyright © 2020 Translational and Clinical between FDC and the corresponding loose combination under fasted and fed states. A Pharmacology It is identical to the Creative Commons two-part, randomized, open label, single-dose, two-way crossover study was conducted in Attribution Non-Commercial License (https:// healthy male subjects. Under fasted (part 1) or fed (part 2) state, 2 FDC tablets of gemigliptin/ creativecommons.org/licenses/by-nc/4.0/). metformin sustained release (SR) 25/500 mg or loose combination with one tablet of gemigliptin 50 mg and two tablets of metformin extended release (XR) 500 mg were orally ORCID iDs Xuanyou Jin administered in each period with a 7-day washout.
    [Show full text]
  • Pharmacological Treatment in Diabetes Mellitus Type 1 – Insulin and What Else? Ewa Otto-Buczkowska,1,* and Natalia Jainta2
    Int J Endocrinol Metab. 2018 January; 16(1):e13008. doi: 10.5812/ijem.13008. Published online 2017 November 20. Review Article Pharmacological Treatment in Diabetes Mellitus Type 1 – Insulin and What Else? Ewa Otto-Buczkowska,1,* and Natalia Jainta2 1Medical Specialist Centre in Gliwice, Poland 2Medical University of Silesia in Katowice, Poland *Corresponding author: Ewa Otto-Buczkowska MD PhD, Jasnogorska 16/2144-100 Gliwice, Poland. E-mail: [email protected] Received 2017 May 11; Revised 2017 September 18; Accepted 2017 October 31. Abstract The basis of treatment in autoimmune diabetes is insulin therapy; however, many clinical cases have proven that this method does not solve all problems. Trials of causal treatment including blocking the autoimmune processes and insulin-producing cells trans- plants were carried out. Those methods require more research to be concerned as efficient and safe ways of treatment in type 1 diabetes. The use of non-insulin adjunct treatment is a new trend. It has been successfully used in laboratories as well as clinical tri- als. Metformin is the most widely used drug, together with sodium-glucose co-transporters 2 (SGLT2) inhibitors, amylin analogues, glucagon-like peptide 1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors. The results of administration of these medicaments give good outcomes in patients with diabetes mellitus type 1. Most likely, in the near future, they will progres- sively be used in both adult and adolescent patients with type 1 diabetes. Further multicenter, randomized studies are required to evaluate the efficacy of treatment and long term safety of these drugs.
    [Show full text]
  • Essential Medicines List (EML) 2017 Application for the Revision Of
    Essential Medicines List (EML) 2017 Application for the revision of second line treatments of type II diabetes: considered agents that can be used in combination with metformin are sulfonylureas, meglitinides, alpha-glucosidase inhibitors, TZDs, DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 agonists, basal insulins, bolus insulins, and biphasic insulins. General items 1. Summary statement of the proposal for inclusion, change or deletion In type 2 diabetes, when initial therapy with lifestyle interventions and metformin monotherapy are unsuccessful, a second oral or injectable agent is recommended. This is referred to as ‘second-line therapy’. Historically, insulin or sulfonylureas have been preferred second-line agents because of efficacy, side-effect profiles, long-term safety, and relative cost. Both insulin and sulfonylurea are listed as essential medicines, along with metformin. In 2013 the Expert Committee of Essential Medicines Selection and Use evaluated evidence comparing four groups of oral hypoglycemics: (1) dipeptidyl peptidase-4 (DPP-4) inhibitors, (2) thiazolidinediones, (3) alpha-glucosidase inhibitors, such as acarbose, and (4) meglitinides, against metformin (biguanide) and sulfonylureas (WHO Technical Report Series 985). The results from the 2013 review indicated that there were no apparent differences in efficacy across drug classes, and that sulfonylureas were the most cost-effective treatment option. Based on these analyses, the Expert Committee recommended that “there was insufficient evidence to show that any of the medicines in the four groups (DPP-4 inhibitors, alphaglucosidase inhibitors, meglitinides, or thiazolidinediones) offered any efficacy or safety advantages over the existing medicines included in the EML”, (i.e. metformin first line and sulfonylurea second line). Since then, a new drug class has entered the market of several countries for the treatment of patients with T2D — sodium-glucose cotransporter-2 (SGLT-2) inhibitors.
    [Show full text]
  • Gemigliptin: an Update of Its Clinical Use in the Management of Type 2 Diabetes Mellitus
    Review Clinical Care/Education Diabetes Metab J 2016;40:339-353 http://dx.doi.org/10.4093/dmj.2016.40.5.339 pISSN 2233-6079 · eISSN 2233-6087 DIABETES & METABOLISM JOURNAL Gemigliptin: An Update of Its Clinical Use in the Management of Type 2 Diabetes Mellitus Sung-Ho Kim1, Jung-Hwa Yoo1, Woo Je Lee2, Cheol-Young Park3 1LG Life Sciences Ltd., R&D Park, Daejeon, 2Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of oral antidiabetic agent for the treatment of type 2 diabetes mellitus. They increase endogenous levels of incretin hormones, which stimulate glucose-dependent insulin secretion, decrease glucagon secretion, and contribute to reducing postprandial hyperglycemia. Although DPP-4 inhibitors have similar benefits, they can be differentiated in terms of their chemical structure, pharmacology, efficacy and safety profiles, and clinical considerations. -Gemi gliptin (brand name: Zemiglo), developed by LG Life Sciences, is a potent, selective, competitive, and long acting DPP-4 inhibitor. Various studies have shown that gemigliptin is an optimized DPP-4 inhibitor in terms of efficacy, safety, and patient compliance for treatment of type 2 diabetes mellitus. In this review, we summarize the characteristics of gemigliptin and discuss its potential benefits in clinical practice. Keywords: Diabetes mellitus, type 2; Dipeptidyl-peptidase IV inhibitors; LC15-0444 INTRODUCTION entiated in terms of pharmacology, efficacy and safety profiles, and clinical considerations along with their different chemical Type 2 diabetes mellitus (T2DM) is a complex and progressive structure [4].
    [Show full text]
  • Beneficial Effect of Anti-Diabetic Drugs for Nonalcoholic Fatty Liver Disease
    pISSN 2287-2728 eISSN 2287-285X https://doi.org/10.3350/cmh.2020.0137 Review Clinical and Molecular Hepatology 2020;26:430-443 Beneficial effect of anti-diabetic drugs for nonalcoholic fatty liver disease Kyung-Soo Kim1 and Byung-Wan Lee2 1Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder and is associated with various metabolic diseases, including type 2 diabetes mellitus. There are no approved drugs for NAFLD, and the only approved treatment option is weight reduction. As insulin resistance plays an important role in the development of NAFLD, many anti- diabetic drugs have been evaluated for the treatment of NAFLD. Improvement of liver enzymes has been demonstrated by many anti-diabetic drugs, but histological assessment still remains insufficient. Pioglitazone could become the first- line therapy for T2DM patients with NAFLD, based on evidence of histological improvement in patients with biopsy- proven nonalcoholic steatohepatitis (NASH). Liraglutide, another promising alternative, is not yet recommended in patients with NAFLD/NASH due to limited evidence. Therefore, well-designed randomized controlled trials should be performed in the near future to demonstrate if and how anti-diabetic drugs can play a role in the treatment of NAFLD. (Clin Mol Hepatol 2020;26:430-443) Keywords: Anti-diabetic drug; Diabetes mellitus; Metabolic diseases; Non-alcoholic fatty liver disease; Treatment INTRODUCTION hepatitis (NASH), advanced fibrosis, and hepatocellular carcinoma (HCC).
    [Show full text]
  • Clinical Therapeutics/New Technology—Glucose Monitoring and Sensing
    CLINICAL THERAPEUTICS/NEW TECHNOLOGY—GLUCOSECATEGORY MONITORING AND SENSING in the assessment and treatment of T1DM. Whether hope is valuable for risk study. Traditional methods to recruit lower income AA women into diabetes prediction models of future HbA1c remains to be determined. self-care interventions may be challenging due to the transient nature of the Supported by: KU Diabetes Institute population and women’s competing life and medical priorities. Finding ways to help women manage these priorities as part of the recruitment process as 2320-PO well as employing non-traditional recruitment methods, such as face-to-face Patterns of Complementary Therapy Use Among Rural Older Adults recruitment in community settings, may yield better recruitment results. With Diabetes RONNY BELL, SARA QUANDT, JOSEPH GRZYWACZ, REBECCA NEIBERG, WEI 2322-PO LANG, THOMAS ARCURY, Winston-Salem, NC The Effect of Diabetes and its Control on Susceptibility to Learned Previous studies on complementary therapy (CT) use among adults with Helplessness in Streptozotocin-Induced Diabetes Rats diabetes have been limited by crude measures of current use across broad YOSHIE GO, HARUKO KITAOKA, TATSUYA FUJIKAWA, Sakai, Japan CT categories, and by a lack of specifi city of CT use for treating diabetes. AIMS: In order to examine the mechanism linking diabetes to depression, Data for the current analysis are drawn from a study of CT use among rural hyper and hypoglycemia are different at risk of affective disorder. METH- African American and white older (age >65) adults in southeastern North ODS: Using the streptzotocin rats, totally 37 rats, were divided into 4 types Carolina. Among the 200 study participants, 71 (35.6%) reported having of glycemic control groups, Group A (good), B (hypo-hyper) ,C (untreated), D been told by a doctor that they have diabetes.
    [Show full text]
  • 2020 Diabetes Guideline Data Supplement
    Data Supplement Appendix A: Search strategies Table S1. Search strategies for systematic review topics Search dates – RCTs October 2018, Systematic reviews October 2018, Observational studies February 2019; Updated February 2020 Guideline chapter Comprehensive care in diabetes and CKD Systematic review topic RAS inhibitors in patients with diabetes and CKD Search strategy - 1. MeSH descriptor: [Angiotensin-Converting Enzyme Inhibitors] explode all trees CENTRAL 2. MeSH descriptor: [Angiotensin Receptor Antagonists] explode all trees 3. losartan:ti,ab,kw (Word variations have been searched) 4. irbesartan:ti,ab,kw (Word variations have been searched) 5. candesartan:ti,ab,kw (Word variations have been searched) 6. eprosartan:ti,ab,kw (Word variations have been searched) 7. valsartan:ti,ab,kw (Word variations have been searched) 8. olmesartan:ti,ab,kw (Word variations have been searched) 9. telmisartan:ti,ab,kw (Word variations have been searched) 10. captopril:ti,ab,kw (Word variations have been searched) 11. enalapril:ti,ab,kw (Word variations have been searched) 12. fosinopril:ti,ab,kw (Word variations have been searched) 13. lisinopril:ti,ab,kw (Word variations have been searched) 14. perindopril:ti,ab,kw (Word variations have been searched) 15. MeSH descriptor: [Diabetic Nephropathies] this term only 16. diabetic nephropath*:ti,ab,kw (Word variations have been searched) 17. diabetic kidney* or diabetic renal*:ti,ab,kw (Word variations have been searched) 18. MeSH descriptor: [Albuminuria] this term only 19. MeSH descriptor: [Proteinuria] this term only 20. proteinuria or albuminuria or microalbuminuria or macroalbuminuria:ti,ab,kw (Word variations have been searched) Search strategy - 1. exp Angiotensin-Converting Enzyme Inhibitors/ MEDLINE 2.
    [Show full text]
  • Diabetes Mellitus (1 of 42)
    Diabetes Mellitus (1 of 42) 1 Patient presents w/ symptoms of diabetes mellitus (DM) or asymptomatic patient is screened for DM 2 PREDIABETES A DIAGNOSIS/ Patient education SCREENING No* B Lifestyle modifi cation Is DM C Pharmacological therapy confi rmed? • Metformin Yes 3 E INITIAL EVALUATION Screening & management • Detect presence of of DM complications/ diabetic complications & comorbidities comorbid conditions 4 DM CLASSIFICATION TYPE 1 DM TYPE 2 DM OTHER SPECIFIC GESTATIONAL • β-cell destruction • Progressive loss TYPES DM GDM leading to complete of β-cell insulin • Uncommon causes; insulin defi ciency secretion underlying cause or concomitant w/ disease is identifi ed insulin resistance & relative insulin defi ciency Please see Gestational Diabetes Mellitus TREATMENT TREATMENT disease management See page 2 See pages 3-6 chart for further © MIMSinformation *For individuals w/ normal test results, lifestyle management, including counselling regarding diet, physical activity, weight loss & smoking cessation, is advised. Screening should be done annually for patients w/ pre-diabetes & every 3 years for patients negative for diabetes after screening. Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS. 2 © MIMS 2021 Diabetes Mellitus (2 of 42) TYPE 1 DM REFER TO DIABETES SPECIALIST/ ENDOCRINOLOGIST A Patient education B Lifestyle modifi cation • Medical nutrition therapy (MNT) - Match prandial insulin to carbohydrate intake, premeal blood glucose, & anticipated activity • Physical activity & exercise C Pharmacological therapy • Insulin (multiple daily injections or pumps) D CONTINUE ASSESSMENT OF MANAGEMENT GLYCEMIC CONTROL Yes PLAN Is patient able to achieve • Provide regular glycemic control? follow-up No FURTHER EVALUATION BY DIABETES SPECIALIST/ MIMSENDOCRINOLOGIST © Not all products are available or approved for above use in all countries.
    [Show full text]
  • Pharmaceutical Composition for Preventing Or Treating Diabetes, Containing Zinc Salt, Cyclo-Hispro and Antidiabetic Drug As Active Ingredients
    (19) *EP003698801A2* (11) EP 3 698 801 A2 (12) EUROPEAN PATENT APPLICATION published in accordance with Art. 153(4) EPC (43) Date of publication: (51) Int Cl.: 26.08.2020 Bulletin 2020/35 A61K 33/30 (2006.01) A61K 38/43 (2006.01) A61K 31/427 (2006.01) A61K 31/155 (2006.01) (2006.01) (21) Application number: 18867498.0 A61K 31/702 (22) Date of filing: 19.10.2018 (86) International application number: PCT/KR2018/012392 (87) International publication number: WO 2019/078663 (25.04.2019 Gazette 2019/17) (84) Designated Contracting States: • JEON, Jong Su AL AT BE BG CH CY CZ DE DK EE ES FI FR GB Pohang-si GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO Gyeongsangbuk-do 37664 (KR) PL PT RO RS SE SI SK SM TR • KIM, Bo Bae Designated Extension States: Seoul 01368 (KR) BA ME • LEE, Heon Jong Designated Validation States: Incheon 21048 (KR) KH MA MD TN • SONG, Moon Ki Northridge (30) Priority: 20.10.2017 KR 20170136242 California 91326 (US) • LEE, Do Hyun (71) Applicant: Novmetapharma Co., Ltd. Pohang-si Seoul 06050 (KR) Gyeongsangbuk-do 37669 (KR) (72) Inventors: (74) Representative: Dehns • JUNG, Hoe Yune St. Bride’s House Pohang-si 10 Salisbury Square Gyeongsangbuk-do 37668 (KR) London EC4Y 8JD (GB) (54) PHARMACEUTICAL COMPOSITION FOR PREVENTING OR TREATING DIABETES, CONTAINING ZINC SALT, CYCLO-HISPRO AND ANTIDIABETIC DRUG AS ACTIVE INGREDIENTS (57) The present invention relates to a pharmaceu- tical composition for preventing or treating diabetes, com- prising, as active ingredients: (a) a zinc salt, comprising a zinc cation and anion, and cyclo-hispro, or a pharma- ceutically acceptable salt thereof; and (b) an antidiabetic drug (particularly, an insulin sensitizer, an insulin sensi- tizer, a sodium-glucose co-transporter (a sodium-glu- cose co-transporter 2 (SGLT2) inhibitor), or a DPP-4 in- hibitor).
    [Show full text]
  • Clinical Therapeutics/New Technology— Glucose Monitoring and Sensing 2348‑Pub
    CLINICAL THERAPEUTICS/NEW TECHNOLOGY—GLUCOSECATEGORY MONITORING AND SENSING CLINICAL THERAPEUTICS/NEW TECHNOLOGY— Figure. GLUCOSE MONITORING AND SENSING 2348‑PUB Impact of CME on Improving Understanding of Advances in Glucose Data Interpretation AMY LARKIN, MICHAEL LACOUTURE, ANNE LE, New York, NY A substantial advance in the field of glucose monitoring is the develop- ment of CGM devices. We sought to determine if online continuing medical education (CME) could improve the clinical knowledge and competence of diabetologists/endocrinologists (D/Es) and nurses regarding advances in glu- cose data interpretation. A CME activity was developed as an online video discussion between 2 experts. The effects of education were assessed using a 4-question linked pre-/post-assessment study design, McNemar’s chi-squared test, and Cramer’s V for effect size. Baseline knowledge was higher among D/E compared to nurses: ∙ 63% of D/Es compared to 20% of nurses recognized similarities in glucose monitoring devices. 2350‑PUB ∙ 47% of D/Es compared to 22% of nurses recognized clinical applica- Efficacy of PHR Integrated with EHR and Self‑Monitoring Devices tion of glucose data. on Self‑Care in Patients with Type 2 Diabetes SATOSHI TANIGUCHI, JIN TEMMA, AKIO KURODA, TORU HORIE, HIROYASU ∙ 55% of D/Es compared to 36% of nurses recognized an effective MORI, REIKO SUZUKI, YAYOI ASANO, MICHIKO ARAKI, YU TAMAKI, MUNEHIDE strategy for patient engagement using glucose data. MATSUHISA, Tokushima, Japan Significant overall improvements (P < .05) were seen for both D/Es (n = 137; Background: Digital Personal Health Records (PHR) with tele-medicine medium effect V= 0.171) and nurses (n = 763; small-medium effect V= 0.15).
    [Show full text]