DOCSLIB.ORG

Efficacy and Safety of Dipeptidyl Peptidase-4 Inhibitors

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Efficacy and Safety of Dipeptidyl Peptidase-4 Inhibitors European Review for Medical and Pharmacological Sciences 2018; 22: 3502-3514 Efficacy and safety of dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes mellitus patients with moderate to severe renal impairment: a meta-analysis Y. CHEN1,2, K. MEN3, X.-F. LI4, J. LI4, M. LIU2, Z.-Q. FAN1 1Department of Endocrinology, The Second Hospital of Tianjin Medical University, Tianjin, China 2Department of Endocrinology and Metabolism, The General Hospital of Tianjin Medical University, Tianjin, China 3Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China 4Department of Endocrinology, Shanxi Provincial People’s Hospital, Xian, China Yu Chen and Kun Men are co-first authors Abstract. – OBJECTIVE: Dipeptidyl pepti- CONCLUSIONS: DPP-4 inhibitors significantly dase-4 (DPP-4) inhibitors are a new class of oral an- lowered HbA1c levels in T2DM patients with mod- tidiabetic agents for type 2 diabetes mellitus erate to severe RI. And the treatment of DPP-4 in- (T2DM) patients. However, the effects and safety of hibitors did not increase the risk of hypoglycemia DPP-4 inhibitors in T2DM patients with renal im- and adverse events. Considering the potential lim- pairment (RI) remain controversial. Therefore, we itations in this meta-analysis, more large-scale, conducted this meta-analysis to assess the effica- well-conducted RCTs are needed to identify our cy and safety of DPP-4 inhibitors in T2DM patients findings. with moderate to severe RI. MATERIALS AND METHODS: The PubMed, Key Words Embase, and Web of Science database were Type 2 diabetes mellitus, Dipeptidyl peptidase-4 in- searched for published randomized controlled tri- hibitor, Renal impairment, Meta-analysis. als (RCTs), which compared DPP-4 inhibitors with placebo or a control regimen. A fixed-model effect or random-effect model was used to assess the effects of DPP-4 inhibitors on T2DM patients with RI. Subgroup analysis or meta-regression analy- Introduction sis were performed to explore the potential sourc- es of heterogeneity among the included studies. Type 2 diabetes mellitus (T2DM) is the lead- RESULTS: 13 RCTs with a total of 2,940 patients ing cause of chronic kidney disease (CKD)1. were included in this meta-analysis. Compared with other treatments, DPP-4 inhibitors were as- Moderate to severe renal impairment (RI), which sociated with a greater change in HbA1c level defined as an estimated glomerular filtration rate (weight mean difference (WMD)=-0.50, 95%CI: (GFR) below 60 mL/min/1.73 m2, occurred in -0.61, -0.39; p<0.001), and a higher response rate 20-30% of patients2,3. Patients at this advantage of patients achieving the HbA1c goal of <7% (risk of RI is difficult to manage because of the high ratio (RR)=1.38, 95%CI: 1.12, 1.70; p=0.002). Sub- prevalence of co-morbidities, increased risk of group analysis suggested that the reduced HbA1c hypoglycemia4, and reduced drug elimination was observed in all types of DPP-4 inhibitors, and 5 in patients with moderate or severe RI, but not in rate . Insulin therapy combined with oral antihy- those with end-stage renal disease. DPP-4 inhibi- perglycemic drugs (OADs) is frequently used in tors did not significantly lower the FPG level patients with T2DM when their glycemic control (WMD=-0.36, 95%CI: -0.92, 0.20; p=0.204), and deteriorates3. However, commonly used OADs this was seen in all types of DPP-4 inhibitors ex- are either contraindicated or should be used at cept gemigliptin, which showed a significant re- reduced doses in individuals with RI3. Important- duction in FPG level. The prevalence of adverse ly, patients with T2DM and RI have an increased events (RR=0.98, 95%CI: 0.94, 1.02; p=0.256) in risk of hypoglycemia, which is commonly due the two groups was not significantly different, and 6 DPP-4 inhibitors did not induce a higher rate of hy- to decreased clearance of insulinotropic agents . poglycemia (RR=1.31, 95%CI: 0.97, 1.77; p=0.075). Moreover, most OADs are affected by kidney 3502 Corresponding Author: Xiao-Feng Li, MD; e-mail: [email protected] Efficacy and safety of dipeptidyl peptidase-4 inhibitors function and should, therefore, be either or used OR (“dipeptidyl peptidase 4”[MeSH Terms] OR at reduced doses in patients with CKD5,7. Conse- “dipeptidyl peptidase 4”[All Fields] OR (“dipep- quently, additional treatment options suitable for tidyl”[All Fields] AND “peptidase”[All Fields] patients with T2DM and CKD and which have a AND “iv”[All Fields]) OR “dipeptidyl pepti- low risk of hypoglycemia are needed. dase iv”[All Fields])) AND (“renal insufficien- Dipeptidyl peptidase-4 (DPP-4) inhibitors are cy”[MeSH Terms] OR (“renal”[All Fields] AND relatively new oral hypoglycemic drugs. They could “insufficiency”[All Fields]) OR “renal insuffi- modulate fasting plasma glucose, postprandial glu- ciency”[All Fields] OR (“renal”[All Fields] AND cose, and HbA1c levels by decreasing the inacti- “impairment”[All Fields]) OR “renal impair- vation of incretins such as glucagon-like peptide 1 ment”[All Fields]). The searches were limited to and glucose-dependent insulinotropic polypeptide human subjects, and no language restriction was to stimulate the release of insulin in a glucose-de- imposed. We did not include abstracts or meeting pendent manner8,9. These agents include sitagliptin, proceedings. In addition, we also searched the vildagliptin, saxagliptin, and linagliptin. For pa- reference lists of the included studies and reviews tients with T2DM and CKD, these agents are suit- to identify other potentially eligible papers that able since they show good tolerability, low risk of we may leave out of our primary search. hypoglycemia, and neutral effect on body effect. Two systematic reviews and meta-analysis10,11 Study Selection regarding the DPP-4 inhibitors on reducing We included full-text publications when the HbA1c level have been published. Both of them following inclusion criteria were met: (1) study showed that DPP-4 inhibitors were effective at design: RCT; (2) study population: patients diag- lowering HbA1c in T2DM patients with moder- nosed with T2DM and had RI; (3) intervention: ate or severe RI. However, one was only based on DPP-4 inhibitors; (4) comparison: placebo, or five randomized controlled trials (RCTs) and in- other glucose-lowering medications; (5) outcome cluded relatively small sample size10, and another measures: change from baseline in HbA1c, re- included half of the studies published in the form sponder rates: achieving an HbA1c of <7%, fast- of conferences abstracts, clinical trials registries, ing plasma glucose (FPG), adverse events; (6) company websites, and FDA and EMA websites, sample size: more than 50. without access to the full-data11. Moreover, the roles of different type of DPP-4 inhibitors on var- Data Extraction ious CKD stages have not been well established. Two independent investigators extracted the Recently, several relevant RCTs regarding DPP-4 following information from each trial: first au- inhibitors on reducing the HbA1c level have been thor’s name, year of publication, country of or- published. These reports were well-performed igin, sample size in each group, patients’ char- RCTs and included an additional more than 1,356 acteristics, methods of randomization and blind, patients. We, therefore, conducted this updated duration of follow-up, the change from baseline in meta-analysis of 13 RCTs to evaluate the efficacy HbA1c, FPG, prevalence of adverse events. When and safety of DPP-4 inhibitors for T2DM patients the same population appeared in several publi- with moderate or severe RI. cations, we only included the most informative study to avoid duplication of information. Any discrepancies were resolved by discussion and Materials and Methods consensus. Search Strategy Risk of Bias and Evidence This meta-analysis was conducted in accor- of Grade Assessment dance with the Preferred Reporting Items for Sys- The risk of bias in RCTs was assessed using tematic Reviews and meta-analysis (PRISMA) the method recommended by Cochrane Collab- criteria12. Two independent investigators searched oration13. The scale consists of seven items de- the literature collected in PubMed, Embase, and scribing random sequence generation; allocation Web of Science up to April 12, 2017. Electronical concealment; blinding of participants and person- search was performed using the following search nel; blinding of outcome assessment; incomplete algorithm: (“diabetes mellitus, type 2”[MeSH outcome data; selective reporting and other bias13. Terms] OR “type 2 diabetes mellitus”[All Fields]) Each study was classified as “high”, “unclear”, or AND (DPP-4[All Fields] OR dppiv[All Fields] “low” risk of bias13. 3503 Y. Chen, K. Men, X.-F. Li, J. Li, M. Liu, Z.-Q. Fan The quality of evidence for outcome measures was evaluated using the Grading of Recommen- dations Assessment, Development and Evaluation (GRADE) approach14. Through reviewing the in- consistency, indirectness, imprecision, and publi- cation bias, each outcome was regarded as very low, low, moderate, or high quality14. A summary table was constructed using the GRADE profiler (GRADE pro, version 3.6). Statistical Analysis We calculated weight mean difference (WMD) with 95% confidence intervals (95%CIs) for continuous outcomes, and risk ratio (RR) with 95%CIs for dichotomous outcomes. Before the data were pooled, we used the Cochrane Q chi-square test and I2 statistic to test the het- erogeneity across studies, in which p-value less than 0.1 or I2>50% indicated significant hetero- geneity15. A random-effects model (DerSimoni- an-Laird method)16 was used to pool data when significant heterogeneity was identified; other- wise, a fixed-effects model (Mantel-Haenszel method)17 was used. We also conducted sensi- tivity analysis, meta-regression, and subgroup analysis based on types of DPP-4 inhibitors, and severity of RI to explore the potential sources Figure 1.
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]
  • 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.
    [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]