Clinical benefits of switching type 2 diabetes patients from human insulins to insulin analogs

2013 ◽  
Vol 59 (6) ◽  
pp. 77-79
Author(s):  
V I Kudinov ◽  
M S Nichitenko ◽  
V A Ibragimova
Keyword(s):  
Type 2 Diabetes ◽  
Weight Gain ◽  
Glycemic Control ◽  
Human Insulin ◽  
Insulin Analogues ◽  
Switching Type ◽  
Clinical Benefits ◽  
Glucose Lowering Therapy

Achievement and long-term maintenance of optimal glucose control is still a big problem in many patients with type 2 diabetes. Diabetes related complications and cardiovascular diseases also can do more difficult the choice of glucose lowering therapy. Insulin therapy is the most effective method of treatment in such patients. However treatment with human insulin is often associated with hypoglycemia and weight gain, which are additional barriers to achieve glycemic control. Presented clinical cases show that switching from human insulin for insulin analogues detemir (Levemir) and aspart (NovoRapid) provide a significant improvement in glycemic control without increasing of risk of hypoglycemia and weight gain.

scholarly journals What are new opportunities for clinical practice the VERIFY study opens and which values for native diabetes patients? Joint conclusion on the advisory board results. November 6, 2019

2020 ◽  
Vol 23 (1) ◽  
pp. 106-110
Author(s):  
Marina V. Shestakova ◽  
Mikhail B. Antsiferov ◽  
Alexander S. Ametov ◽  
Gagik R. Galstyan ◽  
Tatiana Y. Demidova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Combination Therapy ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Clinical Benefits ◽  
Glucose Lowering Therapy ◽  
Diabetes Patients

According to key diabetic studies, the early use of metformin glucose lowering therapy is associated with a reduced risk of developing micro- and, in the long term, 10-year follow-up, macrovascular complications and cardiovascular mortality. Short-term studies results on combined glucose lowering therapy with metformin suggests that combination therapy can have several advantages on the one side from the effectiveness of glycemic control and on another side from positive effect on the development of complications of type 2 diabetes. The question of the start time of combined hypoglycemic therapy remains open. According to the results of recent large-scale studies, real world evidence data, careful glycemic control during the first year from the moment of diagnosis of type 2 diabetes is crucial for further management of the disease and slow the progression of complications. However, due to the fact that the clinical benefits of early combination therapy were not demonstrated in randomized clinical trials, this approach, despite the theoretical background, was not recommended for widespread use in international guidelines for the treatment diabetes patients. Russian algorithms on the treatment diabetes patients recommend combined glucose lowering therapy at the start of treatment at a HbA1c level of 1% higher than the target. A 5-year VERIFY study results were demonstrated long-term sustained glycemic control in combination with vildagliptin + metformin prescribed for native diabetes patients with relatively low HbA1c values, as well as the advantages of this approach in comparison with the standard strategy for phased intensification of monotherapy. The results of the VERIFY study provided a wealth of information to discuss early treatment intensification, the clinical benefits of this approach and a possible review of the treatment strategy for native diabetes patients.

scholarly journals Type 2 diabetes: evidence-based medicine approach to glucose-lowering therapy

2021 ◽  
pp. 160-168
Author(s):  
E. V. Biryukova ◽  
I. A. Morozova ◽  
S. V. Rodionova
Keyword(s):  
Type 2 Diabetes ◽  
Drug Therapy ◽  
Glycemic Control ◽  
Initial Therapy ◽  
Clinical Inertia ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

Type 2 diabetes mellitus is a serious medical and social problem. The danger of the disease is associated with epidemic growth rates and chronic complications, leading to early disability, decreased quality of life and mortality. The prevention of diabetes complications is based on the optimal glucose-lowering therapy with the achievement of target metabolic parameters from the date the diagnosis of T2DM was established and throughout the patient’s life. The complex pathogenetic mechanisms of T2DM are the underlying rationale for drug therapy with a simultaneous effect on various disorders, which will provide a greater hypoglycemic potential and maintain effective glycemic control as T2DM progresses. The main reasons for poor disease control include clinical inertia, untimely intensification of drug therapy, and the use of treatment regimens that are insufficiently effective given the progressive course of the disease. The therapy for T2DM is based on clinical guidelines. The pathogenetic therapy options associated with the use of vildagliptin and metformin are considered. Much attention in modern diabetology is paid to the study of the influence of various therapeutic approaches on the disease progression rates from the perspective of improving prognosis and long-term maintenance of target glycemic control. The advantages of combined glucose-lowering therapy at the onset of T2DM are considered in comparison with the stepwise intensification of glucose-lowering therapy. The VERIFY study examined the long-term efficacy and safety of two treatment approaches: early vildagliptin and metformin combination therapy versus the traditional stepwise approach starting with metformin as initial therapy. The combined glucose-lowering therapy is an important direction in the treatment of patients with newly diagnosed type 2 diabetes.

scholarly journals Efficacy and safety of treatment with human insulin analogues in daily management of insulin naive patients with type 2 diabetes mellitus: results of multicenter 52-week observational study A1chive

2012 ◽  
Vol 15 (4) ◽  
pp. 115-121
Author(s):  
Marina Vladimirovna Shestakova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Observational Study ◽  
Human Insulin ◽  
Negative Influence ◽  
Insulin Analogues ◽  
Insulin Regimen

Modern insulin analogues allow safe improvement of glycemic control (not accompanied with increase in body mass or rate of severe hypoglycemic events) and its efficient maintenance during long period of time. In this paper we present results of multicenter 52-week prospective observational study A1chive (Russian cohort, n=9342), designed to assess safety and efficacy of treatment with human insulin analogues (Levemir?, NovoMix? 30 and NovoRapid? (Novo Nordisk) in daily management of insulin naive patients with type 2 diabetes mellitus. Prescription of human insulin analogues resulted in clinically and statistically significant improvement of glycemic control irrespective of initial insulin regimen. Therapy by various regimens (Levemir?, NovoMix? 30 or Levemir? + NovoRapid?) under conditions of daily clinical practice leads to marked improvement in glycemic control as measured by HbA1c (-2.9% in 12 month) with no evidence for negative influence on tolerability and short-term safety of the treatment. Furthermore, decrease in HbA1c levels was associated with pronounced and stable decrease in fasting and postprandial glucose levels (-5.0 mmol/L and -5.7 mmol/L, respectively). By the end of the follow-up all regimen groups reported improvement of QoL by treatment satisfaction criterion.

Progression of Treatment Strategies in Type 2 Diabetes

2010 ◽  
Vol 06 (01) ◽  
pp. 34
Author(s):  
Richard IG Holt ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Gain ◽  
Glycemic Control ◽  
Adverse Events ◽  
Beta Cell Function ◽  
Cell Function ◽  
Treatment Strategies ◽  
New Agents

There is a global pandemic of diabetes and the progression of disease and long-term complications impose a major health burden. The older diabetes treatments improve glycemic control but have minimal effect on disease progression and long-term cardiovascular complications. Additionally, comorbid hypertension, hyperlipidemia and smoking significantly contribute to morbidity and mortality. Lifestyle changes remain the cornerstone of management, particularly as a large number of people with diabetes are obese and take little physical activity. Structured education interventions, dietary advice and exercise programs form the basis of changes that are necessary. Current guidelines for the management of type 2 diabetes suggest a glycated hemoglobin (HbA1c) treatment goal of 6.5–7.0% (48–53mmol/mol). The first-line pharmacological treatment is metformin. Second-line treatment strategies are varied and the subject for debate; generally, guidelines allow the clinician much flexibility. Until the past few years, drug therapy with metformin, sulfonylureas and thiazolidinediones, followed by treatment with insulin, has been the norm, but adverse events of hypoglycemia and weight gain have limited their effectiveness. There are now a number of new agents available with differing mechanisms of action. The glucagon-like peptide-1 receptor agonists have shown effective glycemic control and may preserve beta-cell function. Recently, a once-weekly parenteral incretin mimetic was shown to be more effective than daily insulin. Dipeptidyl peptidase-4 inhibitor agents are orally administered, as effective as metformin and not associated with hypoglycemia or weight gain. Human amylin analogs are effective agents when combined with insulin therapy. Long-term studies are not yet available for these new agents, but their effect on beta-cell function preservation in animal models leads to the hope that progression of diabetes may be delayed. Initiation of more intensive treatment at an earlier stage may be associated with reduced complications, but possibly at the expense of more adverse events.

scholarly journals Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic

2021 ◽  
Vol 9 (1) ◽  
pp. e002035
Author(s):  
Merel M Ruissen ◽  
Hannah Regeer ◽  
Cyril P Landstra ◽  
Marielle Schroijen ◽  
Ingrid Jazet ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Weight Gain ◽  
Glycemic Control ◽  
Perceived Stress ◽  
Medical Center ◽  
Short Term ◽  
Design And Methods

IntroductionLockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.Research design and methodsWe performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.ResultsIn total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).ConclusionsAn increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

scholarly journals Exploring early combination strategy in Latin American patients with newly diagnosed type 2 diabetes: a sub-analysis of the VERIFY study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Sérgio Vencio ◽  
Juan P. Manosalva ◽  
Chantal Mathieu ◽  
Pieter Proot ◽  
Hernan Yupanqui Lozno ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Latin American ◽  
Primary Endpoint ◽  
Standard Of Care ◽  
Newly Diagnosed ◽  
Combination Strategy ◽  
Treatment Approaches ◽  
Clinical Benefits

Abstract Background Patients with type 2 diabetes mellitus (T2DM) from Latin American countries face challenges in access to healthcare, leading to under-diagnosis, under-achievement of glycemic target, and long-term complications. Early diagnosis and treatment initiation are of paramount importance in this population due to the high prevalence of risk factors such as obesity and metabolic syndrome. The VERIFY study in patients with newly diagnosed T2DM (across 34 countries), assessed the normoglycemic durability (5 years), with early combination (EC) therapy approach versus the traditional stepwise approach of initiating treatment with metformin monotherapy (MET). Here we present the results from the VERIFY study for participants from eight countries in Latin America. Methods Newly diagnosed adult patients with T2DM, HbA1c 6.5–7.5% and body-mass index (BMI) of 22–40 kg/m2 were enrolled. The primary endpoint was time to initial treatment failure (TF; HbA1c ≥ 7.0% at two consecutive scheduled visits 13 weeks apart). Time to second TF was evaluated when patients in both groups were receiving and failing on the vildagliptin combination. Safety and tolerability were also assessed for both treatment approaches during the study. Results A total of 537 eligible patients (female, 58.8%) were randomly assigned to receive either EC (n = 266) or MET (n = 271). EC significantly reduced the relative risk of time to initial TF by 47% versus MET [HR (95% CI) 0.53 (0.4, 0.7) p < 0.0001]. Overall, 46.4% versus 66.3% of patients achieved the primary endpoint in the EC and MET groups, with a median [interquartile range (IQR)] time to TF of 59.8 (27.5, not evaluable) and 33.4 (12.2, 60.1) months, respectively. The risk for time to second TF was 31% lower with EC (p < 0.0092). A higher proportion of patients receiving EC maintained durable HbA1c < 7.0%, < 6.5%, and < 6.0%. Both treatment approaches were well tolerated, and only 3.2% of participants discontinued the study due to adverse events. All hypoglycemic events (EC: n = 7 and MET: n = 3) were single, mild episodes and did not lead to study discontinuation. Conclusion Similar to the global population, long-term clinical benefits were achieved more frequently and without tolerability issues with EC versus standard-of-care MET in this Latin American sub-population. This study is registered with ClinicalTrials.gov, NCT01528254.

Effects of Long-term Treatment of Linagliptin on Glycemic Control in Japanese Patients with Type 2 Diabetes

2018 ◽  
Vol 14 (8) ◽  
pp. 1153-1159
Author(s):  
Masataka Kusunoki ◽  
Yukie Natsume ◽  
Hideyo Tsutsui ◽  
Tetsuro Miyata ◽  
Kazuhiko Tsutsumi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Japanese Patients ◽  
Term Treatment ◽  
Long Term Treatment

In type 2 diabetes, smoking cessation is associated with deterioration in glycemic control and this is unrelated to weight gain

2016 ◽  
Vol 120 ◽  
pp. S79
Author(s):  
Takako Kikuchi ◽  
Kenichiro Enooku ◽  
Akifumi Kushiyama ◽  
Yoko Yoshida ◽  
Sayaka Wakabayashi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Smoking Cessation ◽  
Weight Gain ◽  
Glycemic Control
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