Hypoglycaemia with Oral Antidiabetic Drugs

Vlckova, Veronika; Cornelius, Victoria; Kasliwal, Rachna; Wilton, Lynda V.; Shakir, Saad

doi:10.2165/00002018-200932050-00004

Cited by 29 publications

(5 citation statements)

References 34 publications

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“…When we examined the use of TZD in conjunction with sulfonylureas and insulin (two of the most commonly used medications in ACCORD), we found the highest rates of hypoglycemia among those who were prescribed TZDs in combination with insulin as compared to the combination of TZD with sulfonylureas. Among those participants who were prescribed TZD but not sulfonylurea or insulin, the incidence rate of severe hypoglycemia was similar to that reported in a prescription monitoring program [16]. Although the mechanism for this finding is not clear, it is possible that the insulin sensitizing action of the TZD accentuates the risk of hypoglycemia of insulin when these two are used in combination.…”

Section: Discussionsupporting

confidence: 69%

Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage: Secondary analysis of the ACCORD clinical trial data

et al. 2012

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BackgroundHypoglycemia is a common complication of diabetes treatment. This paper describes symptoms, predecessors, consequences and medications associated with the first episode of severe hypoglycemia among ACCORD participants with type 2 diabetes, and compares these between intensive (Int: goal A1C <6.0%) and standard (Std, goal A1C 7–7.9%) glycemia intervention groups.MethodsInformation about symptoms, antecedents, and consequences was collected at the time participants reported an episode of severe hypoglycemia. Data on medications prescribed during the clinical trial was used to determine the association of particular diabetes drug classes and severe hypoglycemia.ResultsThe most frequently reported symptoms in both glycemia group were weakness/fatigue (Int 29%; Std 30%) and sweating (Int 26%; Std 27%), followed by confusion/disorientation (Int 22%; Std 29%) and shakiness (Int 21%; Std 19%). Approximately half of all events were preceded by a variation in food intake (Int 48%; Std 58%). The most common consequences were confusion (Int 37%; Std 34%), loss of consciousness (Int 25%; Std 25%), and hospitalization (Int 18%; Std 24%). The highest rates of hypoglycemia were found among those participants treated with insulin only (Int 6.09/100 person yrs; Std 2.64/100 person yrs) while the lowest were among those prescribed oral agents only (Int 1.93/100 person yrs; Std 0.20/100 person yrs).ConclusionsSevere hypoglycemia episodes were frequently preceded by a change in food intake, making many episodes potentially preventable. Symptoms of confusion/disorientation and loss of consciousness were frequently seen. The highest rates of hypoglycemia were seen with prescription of insulin, either alone or in combination with other medications.Clinical Trial RegistrationNumber: NCT00000620

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Section: Discussionsupporting

confidence: 69%

Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage: Secondary analysis of the ACCORD clinical trial data

et al. 2012

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“…The preferred drugs in MetS are those that do not have a direct effect on pancreatic β-cells, such as biguanides (metformin), thiazolidinediones (rosiglitazone), and α-glucosidase inhibitors (acarbose) (Mamedov and Shishkova, 2007 ). The main advantage of these euglycemic agents is avoiding hypoglycemia as a side effect (Vlckova et al, 2009 ).…”

Section: Neuroprotectionmentioning

confidence: 99%

Metabolic Syndrome and Neuroprotection

et al. 2018

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Introduction: Over the years the prevalence of metabolic syndrome (MetS) has drastically increased in developing countries as a major byproduct of industrialization. Many factors, such as the consumption of high-calorie diets and a sedentary lifestyle, bolster the spread of this disorder. Undoubtedly, the massive and still increasing incidence of MetS places this epidemic as an important public health issue. Hereon we revisit another outlook of MetS beyond its classical association with cardiovascular disease (CVD) and Diabetes Mellitus Type 2 (DM2), for MetS also poses a risk factor for the nervous tissue and threatens neuronal function. First, we revise a few essential concepts of MetS pathophysiology. Second, we explore some neuroprotective approaches in MetS pertaining brain hypoxia. The articles chosen for this review range from the years 1989 until 2017; the selection criteria was based on those providing data and exploratory information on MetS as well as those that studied innovative therapeutic approaches.Pathophysiology: The characteristically impaired metabolic pathways of MetS lead to hyperglycemia, insulin resistance (IR), inflammation, and hypoxia, all closely associated with an overall pro-oxidative status. Oxidative stress is well-known to cause the wreckage of cellular structures and tissue architecture. Alteration of the redox homeostasis and oxidative stress alter the macromolecular array of DNA, lipids, and proteins, in turn disrupting the biochemical pathways necessary for normal cell function.Neuroprotection: Different neuroprotective strategies are discussed involving lifestyle changes, medication aimed to mitigate MetS cardinal symptoms, and treatments targeted toward reducing oxidative stress. It is well-known that the routine practice of physical exercise, aerobic activity in particular, and a complete and well-balanced nutrition are key factors to prevent MetS. Nevertheless, pharmacological control of MetS as a whole and pertaining hypertension, dyslipidemia, and endothelial injury contribute to neuronal health improvement.Conclusion: The development of MetS has risen as a risk factor for neurological disorders. The therapeutic strategies include multidisciplinary approaches directed to address different pathological pathways all in concert.

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“…A recent observational study from the U.K. studying the incidence of hypoglycemia in patients using different oral anti-diabetic drugs concluded that the incidence rate of hypoglycemia was 50%–100% less in pioglitazone treated patients as opposed to those who were on nateglinide or repaglinide 23. An interesting observation was that hypoglycemia was more common in women on TZDs (pioglitazone and rosiglitazone) than men on similar drugs 23. Pioglitazone monotherapy was associated with much less hypoglycemia than glyburide treated patients with newly diagnosed type 2 diabetes (24.3% in glyburide group vs. 4.4% in pioglitazone group, P = 0.0001) 24.…”

Section: Introductionmentioning

confidence: 99%

Pioglitazone in the Treatment of Type 2 Diabetes: Safety and Efficacy Review

Desouza

Shivaswamy

2010

Clin Med Insights Endocrinol Diabetes

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The increase in obesity and the aging of the population has lead to an increase in the incidence of type 2 diabetes. This has led to the development of new drugs such as thiazolidinediones (TZDs) which are Peroxisome Proliferator-Activated Receptor (PPARgamma) agonists, to treat type 2 diabetes. TZDs have recently been at the center of a controversy with regards to their cardiovascular safety. Pioglitazone is a TZD which has been shown to be effective in glycemic control by lowering insulin resistance. Pioglitazone also has beneficial effects on lipid metabolism and cardiovascular risk. The safety and efficacy of pioglitazone including its pleotropic effects are discussed at length in this article.

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Hypoglycaemia with Oral Antidiabetic Drugs

Cited by 29 publications

References 34 publications

Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage: Secondary analysis of the ACCORD clinical trial data

Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage: Secondary analysis of the ACCORD clinical trial data

Metabolic Syndrome and Neuroprotection

Pioglitazone in the Treatment of Type 2 Diabetes: Safety and Efficacy Review

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