scholarly journals The Comparison of the Kidney Effects of Dipeptidyl Peptidase 4 Inhibitors and Glucagon-Like Peptide 1 Agonist-Administered Concomitant with Sodium-Glucose Cotransporter 2 Inhibitors in Japanese Patients with Type Diabetes Mellitus and Chronic Kidney Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Kazuo Kobayashi ◽  
Masao Toyoda ◽  
Nobuo Hatori ◽  
Kazuyoshi Sato ◽  
Masaaki Miyakawa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Japanese Patients ◽  
Dipeptidyl Peptidase ◽  
Concomitant Treatment ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Background and Aim. Strong evidence exists supporting the utility of sodium glucose cotransporter inhibitors (SGLT2is) for treating not only cardiovascular events but also renal events. We previously reported that SGLT2is improved the urine albumin-to-creatine ratio (ACR) in Japanese patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Only 8% of patients were treated with SGLT2is alone, and more than 70% of them additionally received incretin-related agents, such as dipeptidyl peptidase 4 inhibitor (DPP4i) and glucagon-like peptide 1 agonist (GLP1Ra). Both agents reduce the plasma glucose level with an incretin effect, but the differences in the renoprotective effects between these agents are poorly understood. Methods. We retrospectively constructed database of 763 Japanese patients with T2DM and CKD who received sSGLT2is for more than 1 year. Among these SGLT2i-treated patients, 338 were receiving concomitant DPP4i (DPP4i group), and 99 were receiving concomitant GLP1Ra (GLP1Ra group). The two groups were compared using the propensity score matching method. Results. In the matched model including 86 cases per group, the decrease in the logarithmic value of the ACR and rate of reduction in the estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) of the GLP1Ra group showed no significant difference from those in the DPP4i group ( − 0.12 ± 0.48 vs. − 0.13 ± 0.45 and − 2.3 ± 18.5 vs. − 6.2 ± 13.8 , respectively, P = 0.10 ). However, the incidence of a >6.4% decrease in the eGFR was significantly lower in the GLP1Ra group than in the DPP4i group (35% vs. 52%, respectively, P = 0.03 ). The level of hemoglobin A1c (mmol/mol) after SGLT2i treatment was significantly lower in the DPP4i group than in the GLP1Ra group in the matched model ( 58.3 ± 11.8 and 62.7 ± 14.8 , respectively, P = 0.02 ). Conclusion. Among the SGLT2i-treated patients with T2DM and CKD, concomitant treatment with GLP1Ra has a marked improving effect on the change in the eGFR.

scholarly journals The effect of modern hypoglycemic therapy on the course of chronic kidney disease in patients with type 2 diabetes mellitus

2021 ◽  
Vol 17 (8) ◽  
pp. 624-632
Author(s):  
V.I. Katerenchuk
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Sodium Glucose Cotransporter ◽  
Combined Use ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

The article presents the literature review of the possibilities of modern antidiabetic therapy in the prevention of chronic kidney disease in patients with type 2 diabetes mellitus. The mechanisms of development and features of kidney disease in type 2 diabetes mellitus are described. The results of most recent clinical trials for studying the possibility of nephroprotection with new groups of hypoglycemic agents are reviewed: dipeptidyl peptidase-4 inhi-bitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors. The advantages of usage and the nephroprotective effects of agonists of glucagon-like peptide-1 receptors and sodium-glucose loop cotransporter-2 inhibitors are determined. Particular attention is paid to the nephroprotective effect of sodium-glucose loop co-transporter inhibitors as the only class of drugs that have demonstrated a reduction in the rate of decrease in glomerular filtration rate in patients with diabetes. The expediency of further study of the efficacy of the combined use of sodium-glucose cotransporter-2 inhibitors and agonists of glucagon-like peptide-1 receptors in diabetic chronic kidney disease is indicated. For a long time, approaches to the treatment of diabetic kidney disease did not differ for patients with type 1 and type 2 diabetes. The stu­dies of recent years have shown that new hypoglycemic drugs can not only lower blood glucose levels but also have a beneficial effect on renal function. The mechanisms of nephroprotective effects have not been fully studied, but it is clear that they are beyond the scope of improved glycemic control. The possibility of the nephroprotective effect of these drugs on a glomerular filtration rate in the range of 30–15 ml/min/1.73 m2 and below remains unexplored. The effect of the combined use of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors is also unclear: will this combination predominate over monotherapy, and, if so, to what extent?

scholarly journals Pharmacotherapy for patients with diabetes mellitus

2020 ◽  
Vol 63 (12) ◽  
pp. 766-775
Author(s):  
Joon Ho Moon ◽  
Soo Lim
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Dipeptidyl Peptidase ◽  
Antidiabetic Agents ◽  
Dipeptidyl Peptidase 4 ◽  
Renal Outcomes ◽  
Sodium Glucose Cotransporter ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Diabetes mellitus (DM) is a complex, chronic illness requiring continuous medical care with multifactorial riskreduction strategies besides glycemic control. The pathophysiology of type 2 DM is characterized by a combination of insulin resistance in peripheral organs, including the liver, adipose tissues, and muscle, and inadequate insulin secretion from the pancreatic β-cells to compensate for insulin resistance, which eventually leads to β-cell failure. DM is accompanied by micro- and macro-vascular complications, including cardiovascular events and renal complications, resulting in high mortality rates. After insulin was first discovered in 1922, many antidiabetic agents including metformin, sulfonylureas, thiazolidinediones, and α-glucosidase inhibitors have been developed. Among them, metformin is the preferred pharmacologic agent for the initial treatment of DM. Recently, novel antidiabetic agents, such as dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists, were introduced and are currently available for clinical practice. Studies with dipeptidyl peptidase-4 inhibitors showed non-inferiority compared with placebo, in terms of cardiovascular safety. Some glucagon-like peptide-1 receptor agonists (liraglutide, semaglutide, albiglutide, and dulaglutide) showed favorable results in both cardiovascular and renal outcomes. Sodium-glucose cotransporter-2 inhibitors (empagliflozin, canagliflozin, and dapagliflozin) also showed beneficial effects on cardiovascular and renal outcomes. It is important for clinicians to study novel DM medications and prescribe them accordingly to improve patients’ clinical outcomes.

scholarly journals Study the effect of Dipeptidyl Peptidase 4 Inhibitors as an Antidiabetic in Type 2 Diabetes Mellitus (T2DM)

2021 ◽  
Vol 11 (5) ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Dpp Iv ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Dipeptidyl peptidase IV is a key regulator of insulin- stimulating hormones, glucagon-like peptide and glucose dependent insulinotrophic polypeptide. Thus it is a promising target for treatment of type 2 Diabetes mellitus. Inhibition of plasma Dipeptidyl peptidase IV enzyme lead to enhanced endogenous glucagon like peptide-1, GIP activity which ultimately results in the potentiating of insulin secretion by pancreatic cell and subsequent lowering blood glucose level, HbA [1c], glucose secretion, liver glucose production. One of the principal goals of diabetes management is to attain haemoglobin HbA [1c] treatment goals and prevent the onset or decrease the rate of occurrence of Microvascular conditions.2, 6 numerous treatment options are available for management of Type 2 Diabetes mellitus, various class of DPP IV inhibitor being explored such as Sitagliptin and Vildagliptin successfully launched. Several other novel DPP IV inhibitors are in pipeline, Unless there are clear contraindications, metformin monotherapy is prescribed, and if HbA [1c] targets are not attained after 3 months, 1 of several classes of agents could be added, such as sulfonylurea’s, Thiazolidinediones, dipeptidyl peptidase-4 inhibitors, - glucagon like peptide-1 receptor agonists, or basal insulin.2,6 Despite the broad range of therapeutic options, the attainment of HbA [1c] goals among patients with diabetes remains challenging, with just slightly more than half (52%) of diabetes patients attaining the common HbA [1c] goal of < 7.0%. The present review summarizes latest preclinical and clinical trial data of different DPP IV inhibitors with a special emphasis on their DPP8/9 fold selectivity and therapeutic advantages over GLP-1 based approach. Keywords: Diabetes 2, Dipeptidyl Peptidase-4, glucose-dependent insulinot

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