Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes

Inzucchi, Silvio E.; Bergenstal, Richard M.; Buse, John B.; Diamant, Michaëla; Ferrannini, Ele; Nauck, Michael A.; Peters, Anne L.; Τσάπας, Απόστολος; Wender, Richard C.; Matthews, David R.

doi:10.2337/dc14-2441

Cited by 2,457 publications

(2,683 citation statements)

References 63 publications

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“…Renal impairment complicates the management of diabetes because it increases the risk of hypoglycaemia, is associated with increased risk of cardiovascular morbidity and mortality, and limits the options for glucose‐lowering therapy 6, 7, 8, 9. For example, cardiovascular disease has been reported in 53% of people with CKD,10 and as many as 59% of people who also have T2DM 4.…”

Section: Introductionmentioning

confidence: 99%

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Escalada

Halimi

Senior

et al. 2018

Diabetes Obesity Metabolism

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AimTo investigate the impact of renal function on the safety and efficacy of insulin glargine 300 U/mL (Gla‐300) and insulin glargine 100 U/mL (Gla‐100).Materials and MethodsA meta‐analysis was performed using pooled 6‐month data from the EDITION 1, 2 and 3 trials (N = 2496). Eligible participants, aged ≥18 years with a diagnosis of type 2 diabetes (T2DM), were randomized to receive once‐daily evening injections of Gla‐300 or Gla‐100. Pooled results were assessed by two renal function subgroups: estimated glomerular filtration rate (eGFR) <60 and ≥60 mL/min/1.73 m2.ResultsThe decrease in glycated haemoglobin (HbA1c) after 6 months and the proportion of individuals with T2DM achieving HbA1c targets were similar in the Gla‐300 and Gla‐100 groups, for both renal function subgroups. There was a reduced risk of nocturnal (12:00‐5:59 am) confirmed (≤3.9 mmol/L [≤70 mg/dL]) or severe hypoglycaemia with Gla‐300 in both renal function subgroups (eGFR <60 mL/min/1.73 m2: relative risk [RR] 0.76 [95% confidence interval {CI} 0.62‐0.94] and eGFR ≥60 mL/min/1.73 m2: RR 0.75 [95% CI 0.67‐0.85]). For confirmed (≤70 mg/dL [≤3.9 mmol/L]) or severe hypoglycaemia at any time of day (24 hours) the hypoglycaemia risk was lower with Gla‐300 vs Gla‐100 in both the lower (RR 0.94 [95% CI 0.86‐1.03]) and higher (RR 0.90 [95% CI 0.85‐0.95]) eGFR subgroups.ConclusionsGla‐300 provided similar glycaemic control to Gla‐100, while indicating a reduced overall risk of confirmed (≤3.9 and <3.0 mmol/L [≤70 and <54 mg/dL]) or severe hypoglycaemia, with no significant difference between renal function subgroups.

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Section: Introductionmentioning

confidence: 99%

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Escalada

Halimi

Senior

et al. 2018

Diabetes Obesity Metabolism

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show abstract

“…The ADA recommends that Type 2 diabetes treatment be aimed at achieving an HbA 1c concentration of either <53 mmol/mol (<7.0%) or <48 mmol/mol (<6.5%), depending on an individual's characteristics 5. If initial lifestyle modifications are ineffective, oral monotherapy with metformin is the recommended first‐line therapy for most people 1. If HbA 1c concentration is still above target after 3 months, a second glucose‐lowering medication may be added.…”

Section: Intensification Processmentioning

confidence: 99%

“…insulin lispro, insulin aspart, or insulin glulisine) or premixed insulin (e.g. 70/30 aspart mix, 75/25 or 50/50 lispro mix) 1 may be used for treatment intensification for those unable to achieve appropriate postprandial glycaemic control with basal insulin 8. In a study of participants who did not achieve glycaemic control (HbA 1c ≤53 mmol/mol [≤7.0%]) after 14 weeks with basal insulin glargine, prandial insulin glulisine was added once, twice or three times daily 10.…”

Section: Basal Insulin Intensification With Bolus Insulinmentioning

confidence: 99%

Use of glucagon‐like peptide‐1 receptor agonists among individuals on basal insulin requiring treatment intensification

Trautmann¹,

Vora

2018

Diabet. Med.

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As Type 2 diabetes progresses, treatment is intensified with additional therapies in an effort to manage hyperglycaemia effectively and therefore avoid complications. When greater efficacy is required, options for injectable treatments include glucagon‐like peptide‐1 receptor agonists and insulin, which may be added on to oral glucose‐lowering treatments. Among individuals receiving long‐acting basal insulin as their first injectable treatment, ~40−60% are unable to achieve or maintain their target HbA1c goals. For these people, treatment intensification options are relatively limited and include the addition of short‐acting prandial insulin or a glucagon‐like peptide‐1 receptor agonist. Glucagon‐like peptide‐1 receptor agonists vary in their effects, with short‐ and long‐acting agents having a greater impact on postprandial and fasting hyperglycaemia, respectively. Studies comparing treatment intensification options have found both glucagon‐like peptide‐1 receptor agonists and prandial insulin to be effective in reducing HbA1c concentrations; however, recipients of glucagon‐like peptide‐1 receptor agonists lost weight and had a greater frequency of gastrointestinal adverse events, whereas those receiving prandial insulin gained weight and had a greater incidence of hypoglycaemia. In addition to the separate administration of a glucagon‐like peptide‐1 receptor agonist and basal insulin, fixed‐ratio combinations of a glucagon‐like peptide‐1 receptor agonist and basal insulin offer a single administration for both treatments but have less flexibility in dose titration than treatment with their individual components. For individuals who require treatment intensification beyond basal insulin, use of these various options allows physicians to target the individual needs of their patients for the achievement of optimal long‐term glycaemic control.

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“…Whereas endogenous GLP‐1 has a half‐life in the order of a few minutes, the half‐life of incretin‐based compounds is several hours5, 6, thus enabling their application for diabetes treatment. GLP‐1 agonists and DPP‐4 inhibitors are currently used as second‐line therapies in type 2 diabetes mellitus, or in triple therapy regimens, and are also applied for first‐line use in the case of intolerance or contraindications to metformin7. Incretin‐based therapies have a favorable safety profile and a low risk of hypoglycemia8, 9, 10.…”

Section: Brief Background On Incretin‐based Therapiesmentioning

confidence: 99%

Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus

Groeneveld

Kappelle

Biessels

2015

J of Diabetes Invest

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Patients with type 2 diabetes mellitus are at risk for accelerated cognitive decline and dementia. Furthermore, their risk of stroke is increased and their outcome after stroke is worse than in those without diabetes. Incretin‐based therapies are a class of antidiabetic agents that are of interest in relation to these cerebral complications of diabetes. Two classes of incretin‐based therapies are currently available: the glucagon‐like‐peptide‐1 agonists and the dipeptidyl peptidase‐4 ‐inhibitors. Independent of their glucose‐lowering effects, incretin‐based therapies might also have direct or indirect beneficial effects on the brain. In the present review, we discuss the potential of incretin‐based therapies in relation to dementia, in particular Alzheimer's disease, and stroke in patients with type 2 diabetes. Experimental studies on Alzheimer's disease have found beneficial effects of incretin‐based therapies on cognition, synaptic plasticity and metabolism of amyloid‐β and microtubule‐associated protein tau. Preclinical studies on incretin‐based therapies in stroke have shown an improved functional outcome, a reduction of infarct volume as well as neuroprotective and neurotrophic properties. Both with regard to the treatment of Alzheimer's disease, and with regard to prevention and treatment of stroke, randomized controlled trials in patients with or without diabetes are underway. In conclusion, experimental studies show promising results of incretin‐based therapies at improving the outcome of Alzheimer's disease and stroke through glucose‐independent pleiotropic effects on the brain. If these findings would indeed be confirmed in large clinical randomized controlled trials, this would have substantial impact.

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Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes

Cited by 2,457 publications

References 63 publications

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild‐to‐moderate renal impairment

Use of glucagon‐like peptide‐1 receptor agonists among individuals on basal insulin requiring treatment intensification

Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus

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