Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update

Lipscombe, Lorraine L.; Butalia, Sonia; Dasgupta, Kaberi; Eurich, Dean T.; MacCallum, Lori; Shah, Baiju R.; Simpson, Scot H.; Senior, Peter

doi:10.1016/j.jcjd.2020.08.001

Cited by 118 publications

(135 citation statements)

References 75 publications

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“…The pharmacological management of type 2 diabetes (T2D) typically begins with metformin monotherapy, which is followed by the sequential addition of other glucose-lowering medications whenever glycaemic targets are no longer achieved. 1,2 In practice, metformin monotherapy has a 17% annual rate of failure, as defined by HbA1c exceeding the therapeutic target of 7.0% or less. 3 This failure rate and the typical clinical course necessitating increased antidiabetic therapy over time reflects the inability of the current treatment paradigm to prevent the progressive deterioration of pancreatic beta-cell function that underlies the natural history of T2D.…”

Section: Introductionmentioning

confidence: 99%

“…The pharmacological management of type 2 diabetes (T2D) typically begins with metformin monotherapy, which is followed by the sequential addition of other glucose‐lowering medications whenever glycaemic targets are no longer achieved 1,2 . In practice, metformin monotherapy has a 17% annual rate of failure, as defined by HbA1c exceeding the therapeutic target of 7.0% or less 3 .…”

Section: Introductionmentioning

confidence: 99%

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Short‐term intensive insulin as induction and maintenance therapy for the preservation of beta‐cell function in early type 2 diabetes (RESET‐IT Main): A 2‐year randomized controlled trial

Retnakaran

Emery

et al. 2021

Diabetes Obesity Metabolism

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Aim: To test the hypothesis that the addition of periodic courses of short-term intensive insulin therapy (IIT) could enhance the effect of metformin (MET) maintenance therapy on preservation of beta-cell function following induction IIT.Methods: In this multicentre, randomized controlled trial, 108 adults with type 2 diabetes (median 1.3 years' duration; HbA1c 6.6% ± 0.6%) were randomized to 3 weeks of induction IIT (glargine, lispro) followed by MET maintenance, either with or without periodic 2-week courses of IIT every 3 months for 2 years. Beta-cell function was assessed by the Insulin Secretion Sensitivity Index-2 (ISSI-2) at an oral glucose tolerance test every 3 months.Results: In both arms, induction IIT increased ISSI-2, improved whole-body insulin sensitivity and reduced hepatic insulin resistance (all P ≤ .0004). The primary outcome of baseline-adjusted ISSI-2 at 2 years was not improved by the addition of intermittent IIT (MET + IIT) and was slightly higher in the MET arm (baseline-adjusted difference À35 [95% CI: À66, -3]), with three additional beta-cell measures showing no significant differences. Baseline-adjusted HbA1c at 2 years did not differ between MET and MET + IIT (6.3% ± 0.1% vs. 6.4% ± 0.1%, P = .46), with 32.6% of participants in each arm maintaining HbA1c of 6.0% or less at 2 years. Conclusion:Although initial induction IIT induces metabolic improvement, subsequent repeat courses of IIT every 3 months do not further enhance the effect of MET maintenance therapy on beta-cell function.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short‐term intensive insulin as induction and maintenance therapy for the preservation of beta‐cell function in early type 2 diabetes (RESET‐IT Main): A 2‐year randomized controlled trial

Retnakaran

Emery

et al. 2021

Diabetes Obesity Metabolism

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“…Only 29 COR-DM subjects were taking a DPP-4i and none were taking a GLP1-RA. Since then, SUs and TZDs have fallen out of favor, while DPP-4is, GLP1-RAs and sodium-glucose transport protein 2 inhibitors (SGLT2is) are among the add-on therapies most commonly recommended by current guidelines for type 2 diabetes [ 10 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

Extended-release naltrexone/bupropion is safe and effective among subjects with type 2 diabetes already taking incretin agents: a post-hoc analysis of the LIGHT trial

et al. 2021

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Background Extended-release naltrexone/bupropion (NB) is indicated for chronic weight management. Incretin agents are recommended for patients with type 2 diabetes. This analysis looked at the add-on of NB to incretins to see if weight loss could occur in patients already stabilized on incretin agents. Methods This was a post-hoc analysis of NB vs. placebo (PL) among subjects with type 2 diabetes stable on an incretin agent prior to randomization in a double-blind, PL-controlled cardiovascular outcome trial (N = 1317). Results Over 1 year, mean weight loss was significantly greater among NB patients vs. PL among those taking DPP-4i (mean absolute difference 4.6% [p < 0.0001]) and those taking GLP-1RAs (mean absolute difference 5.2%, p < 0.0001). Proportions of subjects achieving 5% weight loss were significantly greater for NB vs. PL at weeks 26 and 52 among those taking DPP-4is or GLP-1RAs. There were no significant differences in effectiveness observed between NB + DPP-4i and NB + GLP-1RA or between PL + DPP-4i and PL + GLP-1RA in any of the analyses. Serious adverse events were reported by 9.1% and 11.1% for PL + DPP-4i and PL + GLP-1RA, respectively, and 13.3% and 12.4% of NB + DPP-4i and NB + GLP-1RA, respectively. Conclusion NB appears to be effective in reducing weight in patients with T2DM and obesity/overweight who are taking DPP-4ihibitors or GLP-1RA. The SAE rates in all arms of this analysis were lower than have been reported in other cardiovascular outcome trials in type 2 diabetes.

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“…Due to their cardiorenal benefits, SGLT-2 inhibitors are recommended as an addition to metformin in case of atherosclerotic cardiovascular disease, heart failure, chronic kidney diseases, or if weight reduction is necessary. 75 , 76 …”

Section: Ipragliflozin In the Management Of Type 2 Diabetesmentioning

confidence: 99%

Profile of Ipragliflozin, an Oral SGLT-2 Inhibitor for the Treatment of Type 2 Diabetes: The Evidence to Date

Alkabbani¹,

Gamble²

2021

DDDT

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Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a novel class of pharmacotherapeutics for type 2 diabetes management that work by reducing renal reabsorption of glucose. Ipragliflozin is a potent, selective SGLT-2 inhibitor used for the management of type 2 diabetes. Objective: The primary aim of this review is to summarize the available evidence on the efficacy and safety of ipragliflozin for the management of type 2 diabetes. We also review the discovery, pharmacokinetic, and pharmacodynamic profile of ipragliflozin. Methods: To inform our review, we searched MEDLINE, International Pharmaceutical Abstracts, and Embase to identify relevant papers to ipragliflozin use in type 2 diabetes. Clinical trial registries were also searched. Results: Findings from randomized clinical trials demonstrate that compared to placebo, ipragliflozin significantly reduces glucose as measured via Hemoglobin A1c and fasting plasma glucose levels. Ipragliflozin is also associated with weight reduction and an improvement in some, but not all, cardiovascular risk markers. Ipragliflozin has a favourable safety profile with a low risk of hypoglycemia and the rates of common adverse events are not significantly different than placebo. Limited data are available to assess rare and long-term adverse effects. Conclusion:Current evidence shows that ipragliflozin is an effective therapeutic option for the management of glucose control in type 2 diabetes. However, no cardiovascular outcome trials have been conducted to date. Real-world observational studies are still needed to accurately capture any possible rare or long-term adverse events.

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Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update

Cited by 118 publications

References 75 publications

Short‐term intensive insulin as induction and maintenance therapy for the preservation of beta‐cell function in early type 2 diabetes (RESET‐IT Main): A 2‐year randomized controlled trial

Short‐term intensive insulin as induction and maintenance therapy for the preservation of beta‐cell function in early type 2 diabetes (RESET‐IT Main): A 2‐year randomized controlled trial

Extended-release naltrexone/bupropion is safe and effective among subjects with type 2 diabetes already taking incretin agents: a post-hoc analysis of the LIGHT trial

Profile of Ipragliflozin, an Oral SGLT-2 Inhibitor for the Treatment of Type 2 Diabetes: The Evidence to Date

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