DOCSLIB.ORG

Treatment of Diabetes Mellitus

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment of Diabetes Mellitus TREATMENT OF DIABETES MELLITUS DIABETES is a condition that affects how the body makes energy from food. Food is broken down into sugar (glucose) in the body and released into the blood. When the blood sugar level rises after a meal, insulin responds to let the sugar into the cells to be used as energy. In diabetes, the body either does not make enough insulin or it stops responding to insulin as well as it should. This results in sugar staying in the blood and leads to serious health problems over time. DIAGNOSIS OF DIABETES1 • A1C Test: Lab test measuring average blood sugar over past two to three months • Fasting Blood Sugar Test: Lab test measuring blood sugar after eight hours of no food or drink • Oral Glucose Tolerance Test (OGTT): Measures blood sugar before and two hours after drinking a specific sugary liquid • Random Blood Sugar Test: Measures blood sugar at a moment in time, without any kind of preparation (like fasting) FASTING BLOOD ORAL GLUCOSE TOLERANCE RANDOM BLOOD RESULT A1C TEST SUGAR TEST TEST SUGAR TEST Diabetes ≥ 6.5% ≥126 mg/dL ≥ 200 mg/dL ≥ 200 mg/dL Prediabetes 5.7 – 6.4% 100 – 125 mg/dL 140 – 199 mg/dL N/A Normal < 5.7% ≤99 mg/dL < 140 mg/dL N/A NON-DRUG TREATMENTS2 THERAPY COST WHAT TO EXPECT Diet (Mediterranean diet) and exercise (30 minutes a day, five days a week of moderate- Weight loss $-$$ intensity exercise); 7% weight loss decreases risk of diabetes3 Psychological intervention $$-$$$ Psychotherapy may reduce diabetic distress and improve glycemic control4,5 nationalcooperativerx.com PRESCRIPTION TREATMENTS THERAPY SUB-CATEGORY NOTES FORMULARY TIER Insulins – increase uptake of sugar into cells; in general, vials are less expensive than pens for those who pay a percentage of prescription costs; exceptions are noted below Insulin Aspart (NOVOLOG©, Used just before meals (“bolus”) or in insulin FIASP©) Rapid-acting pumps; effect lasts about three to five hours Tier 2 ($$$$) Vials and Pens Used 30 minutes before meals; less convenient Insulin Regular (NOVOLIN R©) Short-acting but a lower-cost option Tier 2 ($$) Vials and Pens Insulin Regular (HUMULIN RU- Concentrated version of insulin regular; used 30 500) Short-acting minutes before meals Tier 2 ($$) Vials and Pens Doesn’t last as long as long-acting insulins; peak Insulin NPH (NOVOLIN N©) Intermediate-acting effect in four to 10 hours Tier 2 ($$) Vials and Pens Insulin Glargine (BASAGLAR©) Lasts about 24 hours with steady action Long-acting Pens throughout the day Tier 2 ($$) Doesn’t always last 24 hours (may need twice Insulin Detemir (LEVEMIR©) Long-acting daily dosing); vials and pens are same price per Tier 2 ($$$) Vials and Pens mL Insulin Degludec (TRESIBA©) Longest-acting (once daily dosing); vials and Ultra long-acting Vials, U100 Pens, U200 Pens pens same price per unit of insulin Tier 2 ($$$) Insulin Aspart Protamine and Insulin Aspart (NOVOLOG MIX Given 15 minutes before a meal, two to three Tier 2 ($$$) Combination 70/30©) times per day; can last up to 24 hours Vials and Pens Insulin NPH and Insulin Regular Given 30 minutes before a meal, two to three (NOVOLIN 70/30©) Combination times per day; can last up to 24 hours Tier 2 ($$$) Vials and Pens Amylin Analogs – slow stomach emptying, reduce appetite, lessens blood sugar spikes from meals Taken with meals; lowers appetite, slows stomach emptying, lessens mealtime sugar spikes; must take fast-acting oral medicines one Pramlintide (SYMLINPEN©) Tier 2 ($$$$) hour before or two hours after Symlin; not widely used because of side effects in the GI tract and low blood sugars when used with insulin GLP-1 Receptor Agonists – slow digestion and lower blood sugar; low risk of hypoglycemia; common side effects are nausea and diarrhea; rare occurrence of pancreatitis Shown to lower risk of cardiovascular Dulaglutide (TRULICITY©) Weekly injections events in people with and without Tier 2 ($$$) history of previous event Shown to lower risk of cardiovascular Liraglutide (VICTOZA©) Daily injections events in those with heart disease; Tier 2 ($$$$) may have risk of gallbladder disease TREATMENT OF DIABETES MELLITUS Shown to lower risk of cardiovascular Semaglutide (OZEMPIC©) Daily injections events in those with heart disease; Tier 2 ($$$) may have risk of retinopathy Only oral GLP-1 product; must be Semaglutide (Rybelsus®) Daily tablet Tier 2 ($$$) taken on empty stomach Sulfonylureas – helps body secrete more insulin; tends to lose effectiveness after a while Causes more hypoglycemia and weight gain than second generation Chlorpropamide First generation Tier 1 ($$) sulfonylureas; should not be used in the elderly or those with poor kidney function Once daily dosing; very little benefit Glimepiride Second generation Tier 1 ($) above 4mg daily Twice daily dosing; very little benefit Glipizide Second generation Tier 1 ($) above 10mg daily Causes more hypoglycemia and weight Glyburide Once or twice daily with food Tier 1 ($) gain than glipizide or glimepiride Cause more hypoglycemia and weight Tolazamide First generation gain than second generation Tier 1 ($$) sulfonylureas Cause more hypoglycemia and weight gain than second generation Tolbutamide First generation Tier 1 ($$) sulfonylureas; increased risk of death from cardiovascular events Biguanides – lowers the body’s sugar production and improves the body’s use of insulin First-line treatment for most people with diabetes type II; does not cause weight gain; can cause diarrhea, but usually goes away within a couple Metformin Tier 1 ($) weeks; start at low dose and slowly increase to minimize this; can cause vitamin B12 deficiency, so need to monitor Meglitinide Analogs – works like sulfonylureas, faster-acting; can cause hypoglycemia and weight gain; less hypoglycemia than sulfonylureas and more dosing flexibility Nateglinide Very little data on cardiovascular risk, but seems to be neutral Tier 1 ($$) Repaglinide No data on cardiovascular benefit or risk Tier 1 ($$) Alpha-Glucosidase Inhibitors – prevent digestion of sugars; may cause gas and diarrhea; low risk of hypoglycemia; do not cause weight gain nationalcooperativerx.com Acarbose Neutral effect on cardiovascular risk Tier 1 ($) Miglitol No data on cardiovascular risk Tier 1 ($$) Dipeptidyl Peptidase-4 (DPP-4) Inhibitors – help body secrete more insulin, slow digestion of food Sitagliptin (JANUVIA®) Seems to have neutral cardiovascular risk Tier 2 ($$$) Thiazolidinediones - improve body’s use of insulin; cause weight gain and risk of fracture; low risk of hypoglycemia May reduce risk of heart attack or stroke; may improve cholesterol; may Pioglitazone (Actos®) Tier 1 ($) increase risk of heart failure and bladder cancer Rosiglitazone (Avandia®) May increase LDL (bad cholesterol) and risk of heart failure Tier 3 ($$) Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors – prevent body from taking sugar into blood; may help with weight loss; may cause urinary tract and yeast infections, low blood pressure, increased LDL (bad cholesterol), increased potassium, increased risk of fractures and amputations Dapagliflozin (FARXIGA®) May increase risk of bladder cancer and kidney injury Tier 2 ($$$) Empagliflozin (JARDIANCE®) Lowers risk of cardiovascular events Tier 2 ($$$) Combinations - see notes about effectiveness and safety above for each drug Insulin Degludec and Liraglutide Combination of Tresiba® and Victoza®; more cost-effective than taking both Tier 2 ($$$) (XULTOPHY©) drugs separately Insulin Glargine and Lixisenatide Combination of Lantus/Basaglar® and Adlyxin®; more cost-effective than Tier 2 ($$$) (SOLIQUA©) taking both drugs separately Sitagliptin and Metformin Combination of Januvia® and metformin; combination tablet cost-neutral to Tier 2 ($$$) (JANUMET©) the separate products Dapagliflozin and Metformin Combination of Farxiga® and metformin; combination tablet cost-neutral to Tier 2 ($$$) (XIGDUO©) the separate products Empagliflozin and Metformin Combination of Jardiance® and metformin; combination tablet cost-neutral to Tier 2 ($$$) (SYNJARDY©) the separate products Empagliflozin and Linagliptin Combination of Jardiance® and Tradjenta®; combination tablet cost-neutral to Tier 2 ($$$) (GLYXAMBI©) the separate products Glipizide and Metformin Combination tablet more expensive than separate products Tier 1 ($$) Glyburide and Metformin Combination tablet more cost-effective than taking both drugs separately Tier 1 ($) Pioglitazone and Glimepiride Combination tablet more expensive than taking both drugs separately Tier 1 ($$$) Pioglitazone and Metformin Combination tablet more expensive than taking both drugs separately Tier 1 ($$) TREATMENT OF DIABETES MELLITUS 1. American Diabetes Association. Diagnosis. https://www.diabetes.org/a1c/diagnosis. Accessed March 10, 2020. 2. Wexler DJ. Initial management of blood glucose in adults with type 2 diabetes mellitus. In: UpToDate, Mulder JE, UpToDate, Waltham, MA, 2019. 3. Knowler WC, Barret-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. 4. Ismail K, Winkley K, Rabe-Hesketh S. Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet. 2004;363(9421):1589-97. 5. Safren SA, Gonzalez JS, Wexler DJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care. 2014;37(3):625-33. 6. Dispel Concerns About CV Safety With Sulfonylureas. Pharmacist’s Letter, December 2019. 7. Diabetes Medications and Cardiovascular Impact. Pharmacist’s Letter/Prescriber’s Letter. January 2019 nationalcooperativerx.com .
Load more

Recommended publications
  • LANTUS® (Insulin Glargine [Rdna Origin] Injection)
    Rev. March 2007 Rx Only LANTUS® (insulin glargine [rDNA origin] injection) LANTUS® must NOT be diluted or mixed with any other insulin or solution. DESCRIPTION LANTUS® (insulin glargine [rDNA origin] injection) is a sterile solution of insulin glargine for use as an injection. Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action), parenteral blood-glucose-lowering agent. (See CLINICAL PHARMACOLOGY). LANTUS is produced by recombinant DNA technology utilizing a non- pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Chemically, it is 21A- B B Gly-30 a-L-Arg-30 b-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular weight of 6063. It has the following structural formula: LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS (insulin glargine injection) contains 100 IU (3.6378 mg) insulin glargine. Inactive ingredients for the 10 mL vial are 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, 20 mcg polysorbate 20, and water for injection. Inactive ingredients for the 3 mL cartridge are 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, and water for injection. The pH is adjusted by addition of aqueous solutions of hydrochloric acid and sodium hydroxide. LANTUS has a pH of approximately 4. CLINICAL PHARMACOLOGY Mechanism of Action: The primary activity of insulin, including insulin glargine, is regulation of glucose metabolism.
    [Show full text]
  • 295-304 Research Article Pulsatile Drug Delivery of Chitosan Co
    Available online www.jocpr.com Journal of Chemical and Pharmaceutical Research, 2015, 7(12):295-304 ISSN : 0975-7384 Research Article CODEN(USA) : JCPRC5 Pulsatile drug delivery of chitosan coated beads of miglitol with fast dissolving glimepiride tablet Bhise S. H.*, Surve B. S., Aloorkar N. H., Majumdar S. H. and Kulkarni A. S. Department of Pharmaceutics, Satara College of Pharmacy, Satara, Shivaji University, Maharashtra, India _____________________________________________________________________________________________ ABSTRACT : Pulsatile drug delivery system was developed which have three parts fast dissolving tablet of glimepiride, sustained release chitosan coated microbeads of miglitol and plug of HPMC E5 and spray dried lactose. After pre- formulation studies fast dissolving tablets were prepared by direct compression method; which shows instant drug release and % CDR of glimepiride fast dissolving tablet was found to be 70.81%. polymer plug have lag time 2.30 hr, chitosan coated miglitol beads shows sustained release upto 81.66% .this system is evaluated using different physicochemical parameters and in-vitro studies. Result suggests that the system can be applicable for diabetes treatment. Key words: Pulsatile, microbeads, sustained release, miglitol, glimepiride. _____________________________________________________________________________________________ INTRODUCTION Oral controlled drug delivery systems represent the most popular form of controlled drug delivery system which release the drug with constant or variable release rates.[1] Dose of drug, reduced dosage frequency, avoidance of side effects, and improved patient compliance. However, there are certain conditions for which such a release pattern is not suitable. These conditions demand release of drug after a lag time. In other words, it is required that the drug should not be released at all during the initial phase of dosage form administration.
    [Show full text]
  • Effect of the Α-Glucosidase Inhibitor Miglitol on the Glucose Profile in Japanese Type 2 Diabetic Patients Receiving Multiple Daily Insulin Injections
    Endocrine Journal 2012, 59 (4), 345-352 ORIGINAL Effect of the α-glucosidase inhibitor miglitol on the glucose profile in Japanese type 2 diabetic patients receiving multiple daily insulin injections Hiroyuki Kato, Akio Ohta, Suzuko Kobayashi, Satoshi Ishii, Yukiyoshi Sada, Hidetoshi Kobayashi, Shintaro Ohmori, Akihiko Kondo, Takuyuki Katabami, Junro Fuse, Hisashi Fukuda, Yoshio Nagai and Yasushi Tanaka Department of Internal Medicine, Division of Metabolism and Endocrinology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan Abstract. Strict postprandial glycemic control may have a preventive effect on atherogenesis in patients with type 2 diabetes. The α-glucosidase inhibitor (α-GI) miglitol is useful for controlling the early postprandial increase of glucose, but the combined effect of miglitol and multiple daily insulin injections (MDI) on glucose excursion has not been evaluated. First, we retrospectively compared the daily glucose profile, evaluated by self-monitoring of blood glucose (SMBG) at nine times on the day before discharge from hospital, between type 2 diabetic patients receiving MDI (n=81) or MDI plus miglitol at 150 mg daily (n=24). Second, we prospectively examined the effect of adding miglitol to MDI on the daily glucose profile (SMBG) in 19 other type 2 diabetic patients. Although the daily insulin dosage and the glucose level before meals did not differ between the two groups, the 1-h postprandial glucose level after each meal, 2-h glucose level after lunch and dinner, mean and standard deviation of glucose, and amplitude of glucose excursion were significantly lower or smaller in the MDI plus miglitol group than in the MDI group.
    [Show full text]
  • Dapagliflozin – Structure, Synthesis, and New Indications
    Pharmacia 68(3): 591–596 DOI 10.3897/pharmacia.68.e70626 Review Article Dapagliflozin – structure, synthesis, and new indications Stefan Balkanski1 1 Bulgarian Pharmaceutical Union, Sofia, Bulgaria Corresponding author: Stefan Balkanski ([email protected]) Received 24 June 2021 ♦ Accepted 4 July 2021 ♦ Published 4 August 2021 Citation: Balkanski S (2021) Dapagliflozin – structure, synthesis, and new indications. Pharmacia 68(3): 591–596.https://doi. org/10.3897/pharmacia.68.e70626 Abstract Dapagliflozin is a sodium-glucose co-transporter-2 (SGLT2) inhibitors used in the treatment of patients with type 2 diabetes. An aryl glycoside with significant effect as glucose-lowering agents, Dapagliflozin also has indication for patients with Heart Failure and Chronic Kidney Disease. This review examines the structure, synthesis, analysis, structure activity relationship and uses of the prod- uct. The studies behind this drug have opened the doors for the new line of treatment – a drug that reduces blood glucoses, decreases the rate of heart failures, and has a positive effect on patients with chronic kidney disease. Keywords Dapagliflozin, SGLT2-inhibitor, diabetes, heart failure Structure of dapagliflozin against diabetes (Lee et al. 2005; Lemaire 2012; Mironova et al. 2017). Embodiments of (SGLT-2) inhibitors include C-glycosides have a remarkable rank in medicinal chemis- dapagliflozin, canagliflozin, empagliflozin and ipragliflozin, try as they are considered as universal natural products shown in Figure 1. It has molecular formula of C24H35ClO9. (Qinpei and Simon 2004). Selective sodium-dependent IUPAC name (2S,3R,4R,5S,6R)-2-[4-chloro-3-[(4- glucose cotransporter 2 (SGLT-2) inhibitors are potent ethoxyphenyl)methyl]phenyl]-6-(hydroxymethyl)oxa- medicinal candidates of aryl glycosides that are functional ne-3,4,5-triol;(2S)-propane-1,2-diol;hydrate.
    [Show full text]
  • Hypoglycemia in Diabetes: Common, Often Unrecognized
    REVIEW ILAN GABRIELY, MD HARRY SHAMOON, MD CME Diabetes Research Center, Albert Einstein Professor of Medicine, Diabetes Research CREDIT College of Medicine, New York Center, Albert Einstein College of Medicine, New York Hypoglycemia in diabetes: Common, often unrecognized ■ ABSTRACT YPOGLYCEMIA poses a major barrier to H diabetes treatment. On one hand, we Hypoglycemic episodes in patients with diabetes often go want to maintain tight glycemic control to unrecognized, and over time, patients may lose the ability prevent the vascular complications of diabetes, to sense hypoglycemia, increasing their risk. Intensive but we also have to ensure the safety and com- diabetes control is beneficial for patients with diabetes, fort of the patient by avoiding hypoglycemia— but it increases their risk of hypoglycemia, underscoring and by recognizing and treating it if it occurs. the complexity of diabetes management. Hypoglycemic events are probably com- mon, especially in patients with type 1 diabetes. ■ KEY POINTS And when patients with type 2 diabetes receive insulin, they may become more prone to hypo- Epinephrine release during hypoglycemia becomes glycemic episodes. Unfortunately, the more progressively defective in type 1 diabetes. This decrease in episodes of hypoglycemia a patient has, the epinephrine response is accompanied by an attenuated more the body’s response is blunted, decreasing autonomic neural response, which results in the clinical the patient’s awareness of an episode. syndrome of impaired awareness of hypoglycemia (ie, Thus, we need to be vigilant in monitor- lack of the warning symptoms of prevailing ing patients for increasing episodes of hypo- glycemia, and for events that a patient may not hypoglycemia).
    [Show full text]
  • Januvia (Sitagliptin) Tablets
    CENTER FOR DRUG EVALUATION AND RESEARCH Approval Package for: APPLICATION NUMBER: NDA 021995/S-013 Trade Name: JANUVIA Generic Name: Sitagliptin Sponsor: Merck & Co., Inc. Approval Date: 12/28/2009 Indications: JANUVIA is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: NDA 021995/S-013 CONTENTS Reviews / Information Included in this NDA Review. Approval Letter X Other Action Letters X Labeling X Summary Review Officer/Employee List Office Director Memo Cross Discipline Team Leader Review Medical Review(s) X Chemistry Review(s) Environmental Assessment Pharmacology Review(s) X Statistical Review(s) Microbiology Review(s) Clinical Pharmacology/Biopharmaceutics Review(s) Risk Assessment and Risk Mitigation Review(s) X Proprietary Name Review(s) Other Review(s) X Administrative/Correspondence Document(s) X CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: NDA 021995/S-013 APPROVAL LETTER DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Silver Spring MD 20993 NDA 021995/S-013 SUPPLEMENT APPROVAL Merck & Co., Inc. Attention: Richard J. Swanson, Ph.D. Director, Regulatory Affairs P.O. Box 1000, UG2C-50 North Wales, PA 19454-1099 Dear Dr. Swanson: Please refer to your supplemental new drug application (S-013) dated and received March 5, 2009, submitted under section 505(b) of the Federal Food, Drug, and Cosmetic Act (FDCA) for Januvia (sitagliptin) tablets. We also refer to your supplemental new drug application (b) (4) dated and received November 13, 2009. Your submission of November 13, 2009, also constitutes a complete response to our October 16, 2009, action letter for supplemental application S-013.
    [Show full text]
  • Pharmacokinetics of Omarigliptin, a Once-Weekly Dipeptidyl Peptidase-4 Inhibitor
    Available online a t www.derpharmachemica.com ISSN 0975-413X Der Pharma Chemica, 2016, 8(12):292-295 CODEN (USA): PCHHAX (http://derpharmachemica.com/archive.html) Mini-review: Pharmacokinetics of Omarigliptin, a Once-weekly Dipeptidyl Peptidase-4 Inhibitor Nermeen Ashoush a,b aClinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, British University in Egypt, El- Sherouk city, Cairo 11837, Egypt. bHead of Health Economics Unit, Center for Drug Research and Development (CDRD), Faculty of Pharmacy, British University in Egypt, El-Sherouk city, Cairo 11837, Egypt. _____________________________________________________________________________________________ ABSTRACT The dipeptidyl peptidase-4 (DPP-4) inhibitors are novel oral hypoglycemic drugs which have been in clinical use for the past 10 years. The drugs are safe, weight neutral and widely prescribed. There are currently many gliptins approved by FDA, namely sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin with several more in advanced stages of development. The gliptins may possess cardiovascular protective effects and their administration may promote β-cell survival; claims currently being evaluated in clinical and preclinical studies. The gliptins are an optional second-line therapy after metformin; they are generally well tolerated with low risk of hypoglycemia. The various compounds differ with respect to their pharmacokinetic properties; however, their clinical efficacy appears to be similar. The clinical differences between the various compounds
    [Show full text]
  • In-Vitro Anti-Diabetic Activity and In-Silico Studies of Binding Energies
    Pharmacia 67(4): 363–371 DOI 10.3897/pharmacia.67.e58392 Research Article In-vitro anti-diabetic activity and in-silico studies of binding energies of palmatine with alpha-amylase, alpha-glucosidase and DPP-IV enzymes Patrick Okechukwu1, Mridula Sharma1, Wen Hui Tan1, Hor Kuan Chan1, Kavita Chirara1, Anand Gaurav1, Mayasah Al-Nema1 1 UCSI Universit, Kuala Lumpur, Malaysia Corresponding author: Patrick Okechukwu ([email protected]) Received 5 September 2020 ♦ Accepted 18 October 2020 ♦ Published 27 November 2020 Citation: Okechukwu P, Sharma M, Tan WH, Chan HK, Chirara K, Gaurav A, Al-Nema M (2020) In-vitro anti-diabetic activity and in-silico studies of binding energies of palmatine with alpha-amylase, alpha-glucosidase and DPP-IV enzymes. Pharmacia 67(4): 363–371. https://doi.org/10.3897/pharmacia.67.e58392 Abstract Palmatine a protoberberine alkaloid has been previously reported to possess in vivo antidiabetic and antioxidant property. The aim of the experiment is to evaluate the in vitro antidiabetic activity and in-silico studies of the binding energies of Palmatine, acarbose, and Sitagliptin with the three enzymes of alpha-amylase, alpha-glucosidase, and dipeptidyl peptidase-IV (DPP-IV). The in vitro antidiabetic study was done by evaluating the inhibitory effect of palmatine on the activities of alpha-amylase, alpha-glucosidase, and DPP-IV. Acarbose, and sitagliptin was used as standard drug. The molecular docking study was performed to study the binding interactions of palmatine with alpha-glucosidase, a-amylase, and DPP-IV. The binding interactions were compared with the standard compounds Sitagliptin and acarbose. Palmatine with IC50 (1.31 ± 0.27 µM) showed significant difference of (< 0.0001) higher inhib- iting effect on alpha-amylase and weak inhibiting effect on alpha-glucosidase enzyme with IC50 (9.39 ± 0.27 µM) and DPP-IV with IC50 (8.7 ± 1.82 µM).
    [Show full text]
  • Health Reports for Mutual Recognition of Medical Prescriptions: State of Play
    The information and views set out in this report are those of the author(s) and do not necessarily reflect the official opinion of the European Union. Neither the European Union institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. Executive Agency for Health and Consumers Health Reports for Mutual Recognition of Medical Prescriptions: State of Play 24 January 2012 Final Report Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Acknowledgements Matrix Insight Ltd would like to thank everyone who has contributed to this research. We are especially grateful to the following institutions for their support throughout the study: the Pharmaceutical Group of the European Union (PGEU) including their national member associations in Denmark, France, Germany, Greece, the Netherlands, Poland and the United Kingdom; the European Medical Association (EMANET); the Observatoire Social Européen (OSE); and The Netherlands Institute for Health Service Research (NIVEL). For questions about the report, please contact Dr Gabriele Birnberg ([email protected] ). Matrix Insight | 24 January 2012 2 Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Executive Summary This study has been carried out in the context of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross- border healthcare (CBHC). The CBHC Directive stipulates that the European Commission shall adopt measures to facilitate the recognition of prescriptions issued in another Member State (Article 11). At the time of submission of this report, the European Commission was preparing an impact assessment with regards to these measures, designed to help implement Article 11.
    [Show full text]
  • TREATMENT of TYPE 2 DIABETES with BIPHASIC INSULIN ANALOGUES *Ali A
    TREATMENT OF TYPE 2 DIABETES WITH BIPHASIC INSULIN ANALOGUES *Ali A. Rizvi Professor of Medicine, Department of Medicine and Director, Division of Endocrinology, University of South Carolina School of Medicine, Columbia, South Carolina, USA *Correspondence to [email protected] Disclosure: The author has received grant support, as principal investigator at the University of South Carolina site, from the National Institutes of Health (NIH) for the SPRINT Trial (Contract Number: HHSN268200900040C, ClinicalTrials.gov Identifier: NCT01206062). The contents of this paper do not necessarily represent the views of the NIH. Received: 29.03.16 Accepted: 09.09.16 Citation: EMJ Diabet. 2016;4[1]:74-83. ABSTRACT The majority of patients with Type 2 diabetes require insulin therapy for treating hyperglycaemia. There are several regimens available for insulin initiation and maintenance. Insulin analogues have been developed to mimic normal physiology as closely as possible. Biphasic analogues can target both fasting and postprandial hyperglycaemia, with the added advantage of being premixed and thus convenient for the patient. A practical and feasible option is to initiate insulin with one or more biphasic preparations at mealtimes, thus providing both basal and prandial coverage. Individual titration of dose and frequency of daily injections with biphasic insulin preparations has the potential for improving glycaemic control with a high degree of patient acceptance. Drawbacks include a more rigid regimen, a relative lack of flexibility, and a somewhat higher degree of glycaemic variability and hypoglycaemia when compared to multiple daily basal-bolus injections. Awareness of the advantages and limitations of biphasic insulin analogues can assist clinicians in their appropriate use for the treatment of patients with Type 2 diabetes.
    [Show full text]
  • Step Therapy
    UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2020 P 3086-9 Program Step Therapy – Diabetes Medications - SGLT2 Inhibitors Medication Farxiga (dapagliflozin)*, Glyxambi (empagliflozin/linagliptan), Invokana (canagliflozin)*, Invokamet (canagliflozin/metformin)*, Invokamet XR (canaglifloxin/metformin extended-release)*, Jardiance (empagliflozin), Qtern (dapagliflozin/saxagliptin)*, Segluromet (ertugliflozin/metformin)*, Steglatro (ertugliflozin)*, Steglujan (ertugliflozin/sitagliptin)*, Xigduo XR (dapagliflozin/metformin extended-release)* P&T Approval Date 10/2016, 10/2017, 4/2018, 8/2018, 12/2018, 2/2019, 2/2020, 5/2020; 7/2020 Effective Date 10/1/2020; Oxford only: 10/1/2020 1. Background: Farxiga (dapagliflozin)*, Invokana (canagliflozin)*, Jardiance (empagliflozin) and Steglatro (ertugliflozin)* are sodium-glucose co-transporter 2 (SGLT2) inhibitors indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Farxiga*, Invokana* and Jardiance have additional indications. Farxiga* is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure (NYHA class II-IV) with reduced ejection fraction. Invokana* is indicated to reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease (CVD), and to reduce the risk of end-stage kidney disease (ESKD), doubling of
    [Show full text]
  • Qtern (Dapagliflozin/Saxagliptin) – New Drug Approval
    Qtern® (dapagliflozin/saxagliptin) – New drug approval • On February 28, 2017, AstraZeneca announced the FDA approval of Qtern (dapagliflozin/saxagliptin) as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (T2DM) who have inadequate control with Farxiga® (dapagliflozin) or who are already treated with dapagliflozin and Onglyza® (saxagliptin). • Qtern is not indicated for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis, and it should only be used in patients who tolerate 10 mg of dapagliflozin. • Qtern combines two anti-hyperglycemic agents, dapagliflozin, a sodium-glucose co-transporter 2 (SGLT-2) inhibitor, and saxagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor. • The efficacy of Qtern was evaluated in a study of 315 T2DM patients. Patients were randomized to saxagliptin or placebo, in combination with dapagliflozin and metformin. — Patients treated with add-on saxagliptin therapy had significantly greater reductions in HbA1c from baseline vs. the placebo group (-0.5% vs. -0.2%, respectively; difference between groups in HbA1c: -0.4%, p < 0.0001). — The proportion of patients achieving HbA1c < 7% at week 24 was 35.3% in the saxagliptin group vs. 23.1% in the placebo group. • Qtern is contraindicated in patients with a history of a serious hypersensitivity reaction to dapagliflozin or to saxagliptin (eg, anaphylaxis, angioedema or exfoliative skin conditions), and in patients with moderate to severe renal impairment (eGFR < 45 mL/min/1.73 m2), end-stage renal disease, or on dialysis. • Warnings and precautions of Qtern include pancreatitis, heart failure, hypotension, ketoacidosis, acute kidney injury and impairment in renal function, urosepsis and pyelonephritis, hypoglycemia with concomitant use of insulin or insulin secretagogues, genital mycotic infections, increases in low- density lipoprotein cholesterol, bladder cancer, severe and disabling arthralgia, and bullous pemphigoid.
    [Show full text]