A Review of Pramlintide in the Management of Diabetes

2009 ◽  
Vol 1 ◽  
pp. CMT.S2369
Author(s):  
Caroline Messer ◽  
Dina Green
Keyword(s):  
Microvascular Complications ◽  
Effective Means ◽  
Postprandial Glucose ◽  
Tight Glycemic Control ◽  
Minimal Risk ◽  
Patients With Diabetes ◽  
Insulin Dependent

Tight glycemic control in type 1 and type 2 diabetes reduces the risk for microvascular complications, including retinopathy, nephropathy, and neuropathy. Yet, despite intensive insulin regimens, many insulin-dependent patients are unable to achieve euglycemic states. This review will focus on pramlintide, an equipotent amylin analog, and its role in the management of diabetes. Pramlintide lowers glucose through the same mechanisms as amylin: it slows gastric emptying, suppresses the postprandial rise of glucagon in patients with diabetes, and promotes satiety. Long-term clinical trials have shown that the use of pramlintide as an adjunct to insulin minimizes postprandial glucose excursions and reduces both HbA1C and body weight when compared to placebo. Although its effects on HbA1C are modest, pramlintide has gained popularity as a result of its relatively few contraindications, limited side effects, minimal risk for hypoglycemia, and potential for weight loss. The combination of insulin and pramlintide may provide an effective means for patients with diabetes to meet their HbA1C goals.

scholarly journals Empowerment in the Treatment of Diabetes and Obesity

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Włodzimierz Łuczyński ◽  
Barbara Głowińska-Olszewska ◽  
Artur Bossowski
Keyword(s):  
Standard Of Care ◽  
Patients With Diabetes ◽  
Treatment Of Diabetes ◽  
Based Medicine ◽  
Diabetes And Obesity ◽  
Positive Effect

As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.

Diabetes Mellitus

2014 ◽  
pp. 505-516
Author(s):  
Rajesh K. Garg ◽  
Merri Pendergrass
Keyword(s):  
Diabetes Management ◽  
Microvascular Complications ◽  
Insulin Deficiency ◽  
Uncontrolled Diabetes ◽  
Absolute Insulin Deficiency ◽  
Delay Progression ◽  
Visual Changes

Acutely uncontrolled diabetes, characterized by hyperglycemia and tissue catabolism, can cause fatigue, polyuria, polydipsia, weight loss, visual changes, coma, and death. Although the risk for ketoacidosis is markedly higher in type 1 diabetes, characterized by absolute insulin deficiency, it can also occur in type 2 diabetes (usually in the setting of major stress). With the development of effective therapies to control symptomatic hyperglycemia, the chief concern of chronic diabetes management has moved on to the prevention of long-term complications associated with hyperglycemia, including the microvascular complications of retinopathy, nephropathy, and neuropathy, and macrovascular (cardiovascular) disease. Maintaining glycemia as close to normal as possible without unacceptable hypoglycemia and controlling blood pressure and cholesterol have been demonstrated to prevent or delay progression of complications of diabetes.

scholarly journals Once weekly semaglutide for treatment of obesity

2021 ◽  
Vol 2 (3) ◽  
pp. 01-04
Author(s):  
Nasser Mikhail
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Animal Studies ◽  
Search Terms ◽  
Patients With Diabetes ◽  
The Difference ◽  
Treatment Of Obesity

Background: Once weekly (OW) semaglutide 0.5-1.0 mg is a glucagon-like type-1 receptor agonist (GLR-1 RA) approved for treatment of type 2 diabetes and is currently under evaluation for treatment of obesity at a higher dose of 2.4 mg OW. Objective: to provide an appraisal of WO semaglutide 2.4 mg for treatment of obesity. Methods: Pubmed research up to March 22. Randomized trials, pertinent animal studies, and reviews are included. Search terms were glucagon-like type 1 receptor agonists, weight loss, obesity, semaglutide, safety, efficacy. Results: WO semaglutide 2.4 mg was evaluated as a weight loss agent in 3 well-designed clinical trials of 68 week-duration. In one trial including patients with type 2 diabetes, the difference in weight loss from baseline to week 68 between OW semaglutide and placebo was - 6.2 percentage points (95% CI, -7.3 to -5.2; P<0.0001). In the other 2 studies that excluded patients with diabetes, the difference in weight loss between OW semaglutide and placebo ranged between -10.3% and -12.4%. A significantly higher proportion of participants in the semaglutide groups vs placebo groups achieved at least 5% of weight loss. The most common adverse effects of semaglutide were related to the gastrointestinal (GI) system. Across these 3 trials, premature discontinuation of OW semaglutide occurred in 6-7% vs 3% in placebo groups. Conclusions: OW semaglutide may be a promising agent for treatment of obesity irrespective of presence of type 2 diabetes. Further studies are needed to establish its long-term safety and efficacy.

scholarly journals Current needs and new opportunities for glycemic control in type 2 DM. Focus on variability

2021 ◽  
Vol 2 (4) ◽  
pp. 14-18
Author(s):  
Tatiana Yu. Demidova ◽  
◽  
Olga D. Ostroumova ◽  
Keyword(s):  
Glycemic Control ◽  
Glycated Hemoglobin ◽  
Microvascular Complications ◽  
Microvascular Dysfunction ◽  
Postprandial Glucose ◽  
Diabetic Patients ◽  
Type 2 Dm ◽  
Modern Technologies

Hypoglycemia associated with diabetes mellitus results in numerous types of microvascular dysfunction and increases cardiovascular risk in patients with DM of all ages. The glycemic control improvement results in substantially decreased risk of any diabetes-associated outcomes or microvascular complications. The most important parameters for type 1 and type 2 DM control used by clinicians are the components of the indicators “classic triad”: glycated hemoglobin (HbA1c), postprandial glucose (PPG), fasting plasma glucose (FPG). It appears increasingly necessary to teach diabetic patients to self-monitor blood glucose in order to achieve the target ranges of these indicators. In that regard, the patients have been helped by modern technologies.

scholarly journals Review of current guidelines for the treatment of type 2 diabetes

2021 ◽  
pp. 7-12
Author(s):  
O. V. Kaminsky
Keyword(s):  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
First Line ◽  
Pharmacological Management ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Treatment Of Diabetes ◽  
New Guidelines

According to the WHO, diabetes is one of the five most dangerous chronic non-communicable diseases in the world. The annual increase in the number of patients with diabetes in Ukraine is about 5-10%. In 2020, the WHO published new guidelines for the diagnosis and treatment of diabetes and updated its classification. Along with the already familiar type 1 and 2 diabetes and gestational diabetes, a new category of disease has emerged – hybrid forms of diabetes. In the section «Pharmacological management of diabetes» the WHO gives priority to the level of glycemia, the control of which avoids the development of microvascular complications of type 2 diabetes. Initial treatment, according to the WHO 2020, should begin with the appointment of metformin - a drug of the first line of treatment of patients with this disease. It is important that metformin does not cause weight gain, does not provoke hypoglycemia and is recommended for the treatment of people who do not reach the desired level of glycemia through diet and physical activity. Secondgeneration sulfonylureas can be used as an initial first-line treatment when metformin is contraindicated or intolerant. However, this is quite rare: in most cases, metformin is well tolerated by patients if administered gradually. That is, metformin, and, if necessary, sulfonylureas - is an effective, safe and affordable choice compared to expensive novelties, the effectiveness and safety of which have not been proven in long-term studies. In addition, in type 2 diabetes, metformin drugs will form additional effects: cardioprotection, oncoprotection, hepatoprotection, nephroprotection, additional hypoglycemic effect and will fight insulin resistance.

scholarly journals Differential Effects of Empagliflozin on Microvascular Complications in Murine Models of Type 1 and Type 2 Diabetes

Biology ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 347
Author(s):  
Stephanie A. Eid ◽  
Phillipe D. O’Brien ◽  
Lucy M. Hinder ◽  
John M. Hayes ◽  
Faye E. Mendelson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Disease Risk ◽  
Microvascular Complications ◽  
Tight Glycemic Control ◽  
Systemic Oxidative Stress ◽  
Drug Classes ◽  
Sodium Glucose Cotransporter ◽  
Control Disease

Microvascular complications account for the significant morbidity associated with diabetes. Despite tight glycemic control, disease risk remains especially in type 2 diabetes (T2D) patients and no therapy fully prevents nerve, retinal, or renal damage in type 1 diabetes (T1D) or T2D. Therefore, new antidiabetic drug classes are being evaluated for the treatment of microvascular complications. We investigated the effect of empagliflozin (EMPA), an inhibitor of the sodium/glucose cotransporter 2 (SGLT2), on diabetic neuropathy (DPN), retinopathy (DR), and kidney disease (DKD) in streptozotocin-induced T1D and db/db T2D mouse models. EMPA lowered blood glycemia in T1D and T2D models. However, it did not ameliorate any microvascular complications in the T2D model, which was unexpected, given the protective effect of SGLT2 inhibitors on DKD progression in T2D subjects. Although EMPA did not improve DKD in the T1D model, it had a potential modest effect on DR measures and favorably impacted DPN as well as systemic oxidative stress. These results support the concept that glucose-centric treatments are more effective for DPN in T1D versus T2D. This is the first study that provides an evaluation of EMPA treatment on all microvascular complications in a side-by-side comparison in T1D and T2D models.

scholarly journals Androgen deficiency, erectile dysfunction and chronic microvascular complications in male diabetic patients

2013 ◽  
Vol 20 (4) ◽  
pp. 401-407 ◽  
Author(s):  
Olivia Georgescu ◽  
Aura Reghină ◽  
Sorin Ioacără ◽  
Cătălin Nica ◽  
Simona Fica
Keyword(s):  
Diabetes Mellitus ◽  
Erectile Dysfunction ◽  
Microvascular Complications ◽  
Free Testosterone ◽  
Diabetic Patients ◽  
Androgen Deficiency ◽  
Chronic Complications ◽  
Patients With Diabetes

Abstract Background and aim: Erectile dysfunction (ED) can be present in diabetic patients not only induced by androgen deficiency, but also as a consequence of diabetes chronic complications. The aim of our study was to evaluate androgen status and chronic microvascular complications in patients with diabetes mellitus (DM), with and without ED. Material and methods: 292 patients (44 Type 1 diabetes - T1DM/ 248 Type 2 diabetes - T2DM), were evaluated for androgen status: dehydroepiandrosterone (DHEA), free testosterone (FT) and presence of chronic complications. ED was diagnosed by a score under 22 of 5-item International Index of Erectile Function (IIEF). Patients with free-testosterone < 70 pg/ml were considered hypogonadal. Results: Prevalence of ED was higher in T2DM 87.5% than in T1DM 65.9%. In patients with ED the prevalence of hypogonadism was 31.3% in T1DM, 26.7% in T2DM. In older T2DM patients IIEF-score was significantly correlated with DHEA. There was a significant correlation between ED and retinopathy in T1DM, additionally with neuropathy in T2DM. Conclusions: ED is a common comorbidity in diabetic patients, associated with other microvascular complications. Hypogonadal status might explain up to 30% of ED. In older diabetic men, severity of ED is related to lower DHEA.

Issues Surrounding Tight Glycemic Control in People with Type 2 Diabetes Mellitus

1998 ◽  
Vol 32 (9) ◽  
pp. 896-905 ◽  
Author(s):  
Joli D Cerveny ◽  
Rachel D Leder ◽  
C Wayne Weart
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Macrovascular Disease ◽  
Tight Glycemic Control ◽  
Macrovascular Complications ◽  
Cooperative Study

OBJECTIVE: To review the prospective evidence surrounding the issue of tight glycemic control in people with type 2 diabetes mellitus and resultant long-term complications. DATA SOURCE: Conference proceedings and a MEDLINE search (1966–February 1998) identified pertinent English-language publications on type 2 diabetes in humans. Key search terms included insulin resistance, diabetes mellitus, non-insulin-dependent, macrovascular complications, microvascular complications, and intensive glycemic control. STUDY SELECTION: Selection of prospective epidemiologic and clinical studies were limited to those focusing on the management of type 2 diabetes. All articles with pertinent information relevant to the scope of this article were reviewed. DATA SYNTHESIS: The pathophysiology of type 1 and type 2 diabetes differ; however, both share chronic complications that significantly affect morbidity and mortality. People with type 1 diabetes have an absolute deficiency of insulin, whereas people with type 2 diabetes have varying degrees of insulin resistance and an inadequate compensatory insulin secretory response. The Diabetes Control and Complications Trial (DCCT) has clearly indicated that intense control of blood glucose in type 1 diabetes prevents and slows the progression of microvascular (i.e., retinopathy, nephropathy) and neuropathic complications. The Kumamoto study showed similar results in nonobese patients with type 2 diabetes. Intense insulin therapy in both populations has proven advantageous, thus supporting a common pathophysiologic process for the microvascular and neuropathic complications. Trends were seen toward fewer macrovascular (atherosclerotic disease) complications in the intensive insulin arm of the DCCT. Conversely, trends were seen toward an increase in macrovascular complications in the VA Cooperative study in people with type 2 diabetes using intensive insulin therapy. This may suggest a discordance in the pathophysiology of macrovascular disease between type 1 and type 2 diabetes. Additionally, it remains uncertain whether tight glycemic control prevents the onset or slows the progression of macrovascular disease. Two studies (the University Group Diabetes Program and the Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes) to date have examined pharmacotherapy options for patients with type 2 diabetes and resultant macrovascular complications. It has yet to be determined whether any therapeutic intervention will decrease the morbidity and mortality of macrovascular disease in this population. CONCLUSIONS: In type 2 diabetes, limited prospective evidence does support tight glycemic control to help prevent or slow the progression of microvascular and neuropathic complications. It is uncertain whether tight glycemic control decreases macrovascular complications and which pharmacotherapeutic agent(s) is/are the best options. However, therapy that improves glucose control in combination with aggressive risk factor management should be initiated and enforced in patients with type 2 diabetes in an effort to reduce long-term complications.

scholarly journals Endothelial progenitor cells in diabetes complications

2014 ◽  
Vol 18 (1) ◽  
pp. 24-32
Author(s):  
Marina Cergeevna Michurova ◽  
Victor Yur'evich Kalashnikov ◽  
Olga Michailovna Smirnova ◽  
Irina Vladimirovna Kononenko ◽  
Olga Nikolaevna Ivanova
Keyword(s):  
Bone Marrow ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Microvascular Complications ◽  
Cardiovascular Complications ◽  
Endothelial Progenitor ◽  
Patients With Diabetes ◽  
Endothelial Homeostasis

Patients with diabetes mellitus (DM) have a 2- to 4-times higher risk of developing cardiovascular complications compared with non-diabetic controls. Hyperglycemia activates pathophysiological mechanisms that damage the endothelium. According to the current views, circulating progenitor cells derived from bone marrow repair the damage. These cells, known as endothelial progenitor cells (EPCs), maintain endothelial homeostasis and contribute to the formation of new vessels. Many clinical studies have reported that EPC population is dysfunctional and declines in numbers in patients with type 1 and type 2 DM. In addition, bone marrow doesn?t respond adequately to mobilizing stimuli in DM. Therefore, EPC alterations might have a pathogenic role in the complications of DM. In this review, EPC alterations will be examined in the context of macrovascular and microvascular complications of DM, highlighting their roles and functions in the progression of the disease.

Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results

2019 ◽  
pp. 81-89
Author(s):  
Larisa Dmitrievna Popovich ◽  
Svetlana Valentinovna Svetlichnaya ◽  
Aleksandr Alekseevich Moiseev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Economic Benefits ◽  
Test Results ◽  
Self Monitoring ◽  
Patients With Diabetes ◽  
The Impact

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc). Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes. Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model. Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes. Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

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