scholarly journals Management Strategies for Posttransplant Diabetes Mellitus after Heart Transplantation: A Review

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Matthew G. Cehic ◽  
Nishant Nundall ◽  
Jerry R. Greenfield ◽  
Peter S. Macdonald
Keyword(s):  
Diabetes Mellitus ◽  
Heart Transplantation ◽  
Clinical Evidence ◽  
Management Strategies ◽  
Published Data ◽  
Glucose Lowering ◽  
Sodium Glucose Cotransporter ◽  
Multicentre Trials ◽  
Glucagon Like Peptide

Posttransplant diabetes mellitus (PTDM) is a well-recognized complication of heart transplantation and is associated with increased morbidity and mortality. Previous studies have yielded wide ranging estimates in the incidence of PTDM due in part to variable definitions applied. In addition, there is a limited published data on the management of PTDM after heart transplantation and a paucity of studies examining the effects of newer classes of hypoglycaemic drug therapies. In this review, we discuss the role of established glucose-lowering therapies and the rationale and emerging clinical evidence that supports the role of incretin-based therapies (glucagon like peptide- (GLP-) 1 agonists and dipeptidyl peptidase- (DPP-) 4 inhibitors) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of PTDM after heart transplantation. Recently published Consensus Guidelines for the diagnosis of PTDM will hopefully lead to more consistent approaches to the diagnosis of PTDM and provide a platform for the larger-scale multicentre trials that will be needed to determine the role of these newer therapies in the management of PTDM.

scholarly journals The role of metformin in the light of the most recent Guidelines

2020 ◽  
Vol 23 (1) ◽  
pp. 61
Author(s):  
Corigliano, G.
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Newly Diagnosed ◽  
High Cardiovascular Risk ◽  
Glucose Lowering ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
The Moment

Metformin was introduced in the market about 60 years ago and is definitely the most used drug in people with type 2 diabetes mellitus at the moment. In fact, it has insulin-sensitizing properties, through which it provides not only doubtless glucose lowering effects but also some protection against ADRD and cancer and especially significant cardiovascular benefits. We hereby briefly review the literature behind the above mentioned extra-glycemic effects and, based on expected additional benefits, suggest to refrain from delaying metformin utilization in addition to first class drugs like inhibitors of type 2 sodiumglucose cotransport (SGLT-2i) and /or glucagon-like peptide 1 receptor agonists (GLP1-RA) in people at high cardiovascular risk with newly diagnosed type 2 diabetes. KEY WORDS metformin; diabetes mellitus; cardiovascular disease; ADRD; cancer

The Use of SGLT2i and GLP-1 RA in Patients with Type 2 Diabetes in Thailand: Evidence Review and Recommendations

2021 ◽  
Vol 104 (11) ◽  
pp. 1850-1865
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Lowering ◽  
Sodium Glucose Cotransporter ◽  
Evidence Review ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Glucose Lowering Therapy ◽  
The Cost ◽  
Selection Of

Background: Cardiovascular (CV) and renal comorbidities are common among type 2 diabetes (T2D) patients, and significantly increase the cost and burden of care. Both sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve key outcomes including major CV events, hospitalization for heart failure, and renal outcomes, albeit to varying degrees in different T2D populations. Materials and Methods: The authors reviewed evidence from GLP-1 RA and SGLT2i CV outcomes trials and real-world studies in Thailand and elsewhere. Results: The authors formulated recommendations to guide selection of anti-diabetes medication based on patients’ clinical characteristics and CV or renal risk profile. Conclusion: These recommendations could help guide management of CV/renal comorbidities and risk alongside glucose-lowering therapy for individual patients. Keywords: Type 2 diabetes mellitus; Cardiovascular diseases; Chronic kidney disease; Clinical outcomes; SGLT2i; GLP-1 RA

scholarly journals How Do SGLT2 (Sodium-Glucose Cotransporter 2) Inhibitors and GLP-1 (Glucagon-Like Peptide-1) Receptor Agonists Reduce Cardiovascular Outcomes?

2020 ◽  
Vol 40 (3) ◽  
pp. 506-522 ◽  
Author(s):  
Matthew M.Y. Lee ◽  
Mark C. Petrie ◽  
John J.V. McMurray ◽  
Naveed Sattar
Keyword(s):  
Diabetes Mellitus ◽  
Mechanisms Of Action ◽  
Left Ventricular ◽  
Sglt2 Inhibitors ◽  
Left Ventricular Ejection ◽  
Cardiac Effects ◽  
Receptor Agonists ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Objective: There is substantial interest in how GLP-1RA (glucagon-like peptide-1 receptor agonists) and SGLT2 (sodium-glucose cotransporter 2) inhibitors reduce cardiovascular and renal events; yet, robust mechanistic data in humans remain sparse. We conducted a narrative review of published and ongoing mechanistic clinical trials investigating the actions of SGLT2 inhibitors and GLP-1RAs to help the community appreciate the extent of ongoing work and the variety and design of such trials. Approach and Results: To date, trials investigating the mechanisms of action of SGLT2 inhibitors have focused on pathways linked to glucose metabolism and toxicity, hemodynamic/volume, vascular and renal actions, and cardiac effects, including those on myocardial energetics. The participants studied have included those with established cardiovascular disease (including coronary artery disease and heart failure), liver disease, renal impairment, obesity, and hypertension; some of these trials have enrolled patients both with and without type 2 diabetes mellitus. GLP-1RA mechanistic trials have focused on glucose-lowering, insulin-sparing, weight reduction, and blood pressure–lowering effects, as well as possible direct vascular, cardiac, and renal effects of these agents. Very few mechanisms of action of SGLT2 inhibitors or GLP-1RAs have so far been convincingly demonstrated. One small trial (n=97) of SGLT2 inhibitors has investigated the cardiac effects of these drugs, where a small reduction in left ventricular mass was found. Data on vascular effects are limited to one trial in type 1 diabetes mellitus, which suggests some beneficial actions. SGLT2 inhibitors have been shown to reduce liver fat. We highlight the near absence of mechanistic data to explain the beneficial effects of SGLT2 inhibitors in patients without diabetes mellitus. GLP-1RAs have not been found to have major cardiovascular mechanisms of action in the limited, completed trials. Conflicting data around the impact on infarct size have been reported. No effect on left ventricular ejection fraction has been demonstrated. Conclusions: We have tabulated the extensive ongoing mechanistic trials that will report over the coming years. We report 2 exemplar ongoing mechanistic trials in detail to give examples of the designs and techniques employed. The results of these many ongoing trials should help us understand how SGLT2 inhibitors and GLP-1RAs improve cardiovascular and renal outcomes and may also identify unexpected mechanisms suggesting novel therapeutic applications.

Dapagliflozin

2015 ◽  
Vol 29 (2) ◽  
pp. 165-171 ◽  
Author(s):  
Portia N. Davis ◽  
Uche Anadu Ndefo ◽  
Ashley Oliver
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Evidence ◽  
Hypoglycemic Agents ◽  
Controlled Clinical Trials ◽  
Data Synthesis ◽  
Glucose Lowering ◽  
Medline Search ◽  
Sodium Glucose Cotransporter ◽  
Clinical Trial Results

Objective: To review clinical evidence for the efficacy, safety, and tolerability of dapagliflozin (Farxiga-AstraZeneca), a sodium glucose cotransporter 2 inhibitor, as monotherapy or in combination with other hypoglycemic agents for the treatment of type 2 diabetes. Data Sources: Literature was identified through a systematic MEDLINE search of clinical trial results for dapagliflozin. Data Synthesis: Multiple controlled clinical trials have established the efficacy, safety, and tolerability of dapagliflozin as monotherapy or in combination with other therapies for type 2 diabetes. Dapagliflozin is approved by Food and Drug Administration as monotherapy or as an add-on to other glucose lowering agents including insulin for the treatment of type 2 diabetes. Conclusion: Dapagliflozin is effective for the treatment of type 2 diabetes.

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