scholarly journals Role of Sodium-Glucose Cotransporter 2 (SGLT 2) Inhibitors in the Treatment of Type 2 Diabetes

2011 ◽  
Vol 32 (4) ◽  
pp. 515-531 ◽  
Author(s):  
Muhammad A. Abdul-Ghani ◽  
Luke Norton ◽  
Ralph A. DeFronzo
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Microvascular Complications ◽  
Tight Glycemic Control ◽  
Β Cell ◽  
Oral Antidiabetic Agents ◽  
Oral Antidiabetic ◽  
Sodium Glucose Cotransporter

Hyperglycemia plays an important role in the pathogenesis of type 2 diabetes mellitus, i.e., glucotoxicity, and it also is the major risk factor for microvascular complications. Thus, effective glycemic control will not only reduce the incidence of microvascular complications but also correct some of the metabolic abnormalities that contribute to the progression of the disease. Achieving durable tight glycemic control is challenging because of progressive β-cell failure and is hampered by increased frequency of side effects, e.g., hypoglycemia and weight gain. Most recently, inhibitors of the renal sodium-glucose cotransporter have been developed to produce glucosuria and reduce the plasma glucose concentration. These oral antidiabetic agents have the potential to improve glycemic control while avoiding hypoglycemia, to correct the glucotoxicity, and to promote weight loss. In this review, we will summarize the available data concerning the mechanism of action, efficacy, and safety of this novel antidiabetic therapeutic approach.

Sodium–Glucose Co-transporter 2 Inhibition—A Novel Strategy for Glucose Control in Type 2 Diabetes

2010 ◽  
Vol 06 (01) ◽  
pp. 42 ◽  
Author(s):  
Luke Norton ◽  
Ralph A DeFronzo ◽  
Muhammad A Abdul-Ghani ◽  
◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Beta Cell ◽  
Mechanism Of Action ◽  
Microvascular Complications ◽  
Oral Antidiabetic Agents ◽  
Oral Antidiabetic ◽  
Tissue Sensitivity ◽  
Novel Strategy

In addition to its central role in the development of microvascular complications, hyperglycemia plays an important role in the pathogenesis of type 2 diabetes, i.e. glucotoxicity. Thus, effective glycemic control not only reduces the incidence of microvascular complications, but also corrects the metabolic abnormalities that contribute to the progression of the disease. Progressive beta-cell failure and side effects associated with therapy, such as hypoglycemia and weight gain, present obstacles to the achievement of optimal durable glycemic control in subjects with type 2 diabetes. Most recently, inhibitors of the renal sodium glucose co-transporter have been developed to produce glucosuria and reduce the plasma glucose concentration. Because the mechanism of action of these oral antidiabetic agents is independent of beta-cell and tissue sensitivity to insulin, they improve glycemic control while avoiding hypoglycemia and promoting weight loss. In this article, we will summarize the available data concerning the mechanism of action, efficacy, and safety of this novel antidiabetic therapeutic approach.

CONCENTRATED INSULINS: CLINICAL UPDATE OF THERAPEUTIC OPTIONS

2020 ◽  
Vol 26 (Supplement 3) ◽  
pp. 1-12
Author(s):  
Guillermo E. Umpierrez ◽  
Elizabeth H. Holt ◽  
Daniel Einhorn ◽  
Janet B. McGill
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Infusion ◽  
Cell Function ◽  
Total Daily Dose ◽  
Β Cell ◽  
Oral Antidiabetic Agents

Improved glycemic control is associated with a reduced risk of diabetic complications. Optimal management of patients with type 2 diabetes includes nutritional therapy, physical activity, and pharmacotherapy for glycemic control. Most patients with type 2 diabetes are initially managed with oral antidiabetic agents, but as β-cell function declines and the disease progresses, insulin therapy is frequently needed to maintain glycemic control. Insulin therapy given with multidose insulin injection regimen or by continuous insulin infusion is needed for patients with type 1 diabetes to achieve control. Obesity and its associated insulin resistance contribute to greater insulin requirements in patients with both type 1 and type 2 diabetes to achieve glycemic control, creating a need for concentrated insulin. Concentrated insulin formulations can be prescribed as an alternative to 100 unit/mL insulin and provide the advantage of low injection volume, leading to less pain and possibly fewer insulin injections. This review includes a stepwise analysis of all currently available concentrated insulin products, analyzes the most up-to-date evidence, and presents this in combination with expert guidance and commentary in an effort to provide clinicians with a thorough overview of the characteristics and benefits of concentrated insulins in patients with type 1 and type 2 diabetes–instilling confidence when recommending, prescribing, and adjusting these medications. Abbreviations: A1C = glycated hemoglobin; β-cell = pancreatic betacell; BG = blood glucose; CI = confidence interval; CSII = continuous subcutaneous insulin infusion; MDI = multiple daily injections; NHANES = National Health and Nutrition Examination Survey; PD = pharmacodynamic; PK = pharmacokinetic; TDD = total daily dose; U100 = 100 units/mL; U200 = 200 units/mL; U300 = 300 units/mL; U500 = 500 units/mL; USD = United States dollars

Sodium–Glucose Co-transporter 2 Inhibition – A Novel Strategy for Glucose Control in Type 2 Diabetes

2010 ◽  
Vol 7 (1) ◽  
pp. 30
Author(s):  
Luke Norton ◽  
Ralph A DeFronzo ◽  
Muhammad A Abdul-Ghani ◽  
◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Beta Cell ◽  
Mechanism Of Action ◽  
Microvascular Complications ◽  
Oral Antidiabetic Agents ◽  
Oral Antidiabetic ◽  
Tissue Sensitivity ◽  
Novel Strategy

In addition to its central role in the development of microvascular complications, hyperglycaemia plays an important role in the pathogenesis of type 2 diabetes, i.e. glucotoxicity. Thus, effective glycaemic control not only reduces the incidence of microvascular complications, but also corrects the metabolic abnormalities that contribute to the progression of the disease. Progressive beta-cell failure and side effects associated with therapy, such as hypoglycaemia and weight gain, present obstacles to the achievement of optimal durable glycaemic control in subjects with type 2 diabetes. Most recently, inhibitors of the renal sodium glucose co-transporter have been developed to produce glucosuria and reduce the plasma glucose concentration. Because the mechanism of action of these oral antidiabetic agents is independent of beta-cell and tissue sensitivity to insulin, they improve glycaemic control while avoiding hypoglycaemia and promoting weight loss. In this article, we will summarise the available data concerning the mechanism of action, efficacy and safety of this novel antidiabetic therapeutic approach.

scholarly journals Indian consensus on durability of glycemic control in type 2 diabetes management and role of oral antidiabetic drugs

2021 ◽  
Vol 9 (12) ◽  
pp. 3745
Author(s):  
Manoj Chawla ◽  
Pramila Kalra ◽  
A. K. Khanna ◽  
Sisir Kumar Mahapatro
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Combination Therapy ◽  
Diabetes Management ◽  
Antidiabetic Drugs ◽  
Oral Antidiabetic Drugs ◽  
Related Factors ◽  
Oral Antidiabetic

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in an alarming way in India as well as across the globe. In order to minimize complications, there is a need to maintain good glycemic control in patients with T2DM and long-term durable glycemic control remains a challenge. Clinically, this challenge was addressed by step-wise intensification of therapy with additional antidiabetic drugs to maintain glycemic control. Various disease and patient-related factors as well as different antidiabetic agents influenced the durability of glycemic control differently. While understanding of the factors that influenced therapeutic outcomes had evolved, there was paucity of information about the durability of glycemic control and the role of oral antidiabetic drugs (OADs) in achieving it. With an objective to understand the role of durability of glycemic response in the management of Indian patients with T2DM, 4 advisory board meetings attended by 48 physicians from across the country were conducted in Mumbai, Delhi, Kolkata and Bengaluru. There was consensus to consider durability of glycemic control as an important goal in the management of T2DM. Personalized approach in T2DM management along with early initiation of dual combination therapy were recommended to achieve durability. Age group of patients, body mass index, glycated hemoglobin levels at diagnosis, presence or absence of comorbidities and complications are important factors that need to be considered before initiating dual combination therapy for patients with T2DM.

scholarly journals Microvascular complications in type 2 diabetes and associated factors: a telephone survey of self-reported morbidity

2015 ◽  
Vol 20 (3) ◽  
pp. 761-770 ◽  
Author(s):  
Aliny de Lima Santos ◽  
Hellen Pollyanna Mantelo Cecílio ◽  
Elen Ferraz Teston ◽  
Guilherme Oliveira de Arruda ◽  
Fabiana Magalhães Navarro Peternella ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Nutritional Status ◽  
Telephone Survey ◽  
Microvascular Complications ◽  
Oral Antidiabetic Agents ◽  
Cross Sectional ◽  
Delay In Diagnosis ◽  
Oral Antidiabetic ◽  
Time Since Diagnosis

The scope of this article is to estimate the prevalence of microvascular complications of self-reported type 2 diabetes and the association with sociodemographic characteristics, nutritional status, treatment given and time since diagnosis. It involved a cross-sectional study with 318 people with type 2 diabetes living in Maringá in the State of Paraná. A telephone survey of self-reported morbidity was conducted in the months from January to June 2012. For the analysis descriptive statistics, univariate and multiple logistic regression were used. The prevalence of self-reported complications of diabetes was 53.8%, the most frequent being retinopathy (42.8%), followed by peripheral neuropathy (14.5%) and nephropathy (12.9%). The variables associated with the presence of complications were age (p = 0.008), overweight/obesity (p = 0.002), insulin (p < 0.001), insulin use linked to oral antidiabetic drug (p = 0.003) and time since diagnosis (p = 0.013). The prevalence of self-reported microvascular complications for people with diabetes was high, being more frequent among those of more advanced age, with inadequate nutritional status, a delay in diagnosis of the disease and those who were using insulin alone or in combination with oral antidiabetic agents.

scholarly journals Comparison of metformin, gliclazide MR and rosiglitazone in monotherapy and in combination for type 2 diabetes

2010 ◽  
Vol 54 (3) ◽  
pp. 311-318 ◽  
Author(s):  
Lucio Vilar ◽  
Viviane Canadas ◽  
Maria Juliana Arruda ◽  
Carla Arahata ◽  
Rodrigo Agra ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Combination Therapy ◽  
Lipid Profile ◽  
Oral Antidiabetic Agents ◽  
Antidiabetic Agents ◽  
Postprandial Glycemia ◽  
Oral Antidiabetic ◽  
Study Results

OBJECTIVE: To compare the efficacy and tolerability of metformin, rosiglitazone and gliclazide MR as monotherapy and in combination in the treatment of type 2 diabetes. SUBJECTS AND METHODS: 250 patients treated with oral antidiabetic agents for at least 24 weeks in monotherapy or in combination therapy were included in this retrospective study. RESULTS: As monotherapy the reduction of fasting plasma glucose (FPG), postprandial glycemia (PPG) and HbA1c was similar with the three drugs after 24 weeks. Among patients on combination therapy, the reduction in HbA1c, FPG and PPG was significantly lower with rosiglitazone plus metformin, as compared to metformin plus gliclazide MR or gliclazide MR plus rosiglitazone. Patients treated with rosiglitazone achieved less favorable changes in lipid profile. CONCLUSION: In monotherapy all drugs were equally effective in improving glycemic control, whereas the combination of metformin plus gliclazide MR provided the best results concerning the improvement of both, glycemic control and lipid profile.

scholarly journals Genetic variability in sodium-glucose cotransporter 2 influences glycemic control and risk for diabetic retinopathy in type 2 diabetes patients

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Jasna Klen ◽  
Katja Goričar ◽  
Vita Dolžan
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Glucose Homeostasis ◽  
Genetic Model ◽  
Microvascular Complications ◽  
Fasting Blood Glucose ◽  
Nonparametric Tests ◽  
Sodium Glucose Cotransporter

Summary Background Gluconeogenesis and renal glucose excretion in kidneys both play an important role in glucose homeostasis. Sodium-glucose cotransporter (SGLT2), coded by the SLC5A2 gene is responsible for reabsorption up to 99% of the filtered glucose in proximal tubules. SLC5A2 genetic polymorphisms were suggested to influence glucose homeostasis. We investigated if common SLC5A2 rs9934336 polymorphism influences glycemic control and risk for macro or microvascular complications in Slovenian type 2 diabetes (T2D) patients. Methods All 181 clinically well characterized T2D patients were genotyped for SLC5A2 rs9934336 G>A polymorphism. Associations with glycemic control and T2D complications were assessed with nonparametric tests and logistic regression. Results : SLC5A2 rs9934336 was significantly associated with increased fasting blood glucose levels (P<0.001) and HbA1c levels under the dominant genetic model (P=0.030). After adjustment for T2D duration, significantly higher risk for diabetic retinopathy was present in carriers of at least one polymorphic SLC5A2 rs9934336 A allele compared to non-carriers (OR=7.62; 95%CI=1.65–35.28; P=0.009). Conclusions Our pilot study suggests an important role of SLC5A2 polymorphisms in the physiologic process of glucose reabsorption in kidneys in T2D patients. This is also the first report on the association between SLC5A2 polymorphism and diabetic retinopathy.

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