Classes Of Diabetes Medications Research Articles

Elevated liver enzymes in individuals with undiagnosed diabetes in the U.S.

ObjectiveWe investigated the association of diabetes diagnosis and medication type with liver injury in individuals with clinical diabetes. MethodsWe analyzed 2426 patients with clinical diabetes in the National Health and Nutrition Examination Survey conducted from 1999 to 2008. Elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels were used as markers of liver injury. Participants were categorized into one of three categories: 1) clinical diabetes without physician’s diagnosis or diabetes medication; 2) diagnosed diabetes without diabetes medication; or 3) diagnosed diabetes with diabetes medication, further divided by classes of diabetes medications prescribed. We conducted logistic regression analysis to examine the relationship between diabetes diagnosis and medication type and elevated ALT and AST, adjusting for race/ethnicity, education, health insurance status, BMI category, alcohol consumption, physical activity, antihyperlipidemic agents, glycohemoglobin, C-reactive protein, viral hepatitis and liver disease. ResultsParticipants with undiagnosed diabetes were more likely to have elevated ALT and AST levels (OR=1.82, 95% CI 1.47, 2.42; OR=1.99, 95% CI 1.46, 2.71, respectively). In contrast, there was no association between specific diabetes medication (i.e., sulfonylureas, biguanides/thiazolidinediones) and elevated ALT or AST levels among the treated. Our findings were confirmed in sensitivity analyses employing a lower threshold for ALT, and excluding individuals with viral hepatitis or liver disease. ConclusionWe found that undiagnosed diabetes is associated with liver injury, compared to diagnosed diabetes with treatment. The effect of diabetes treatment on liver injury in individuals with diabetes remains uncertain.

Diabetes and Aging

This gets personal. Not only do I now reluctantly meet the definition of an older adult, I also have a family history of type 2 diabetes, which means I have at least a 25% chance of developing the disease any day now. But as an endocrinologist/diabetologist who has been working in this area for more than 20 years, I feel lucky. I know how to delay the onset of this disorder with a combination of diet and exercise, and if I do develop diabetes, I know what drugs I would want to take (metformin would be high on the list) and which ones I would decline (glyburide and thiazolidinediones). I also know that, at my age, keeping my A1C ≤ 7.5% would be a reasonable way of minimizing my risk for micro- and macrovascular complications, as well as mortality1 and, hopefully, the diabetes-associated risk for cognitive decline, which in some ways is of more concern than diabetes itself.2 But the personal extends beyond me. My father has had type 2 diabetes for more than 30 years. His doctor started him on glyburide when he was diagnosed—and he has been on this drug ever since. To me, this is one of the worst diabetes medications he could take. The risk of hypoglycemia is higher with glyburide than with any other secretogogue or any other class of diabetes medications, including appropriately dosed insulin. …

Proportion of patients at HbA1c target

We assessed the efficacy of eight classes of diabetes medications used in current clinical practice [metformin, sulphonylureas, α-glucosidase inhibitors, thiazolidinediones, glinides, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 (GLP-1) analogues and insulin analogues] to reach the HbA1c target <7% in type 2 diabetes. MEDLINE, EMBASE and the Cochrane CENTRAL were searched from inception through April 2011 for randomized controlled trials (RCTs) involving antidiabetic drugs. RCTs had to report the effect of any diabetes medication on the HbA1c levels, to include at least 30 subjects in every arm of the study, and to report the effect of therapy after a minimum of 12 weeks. Data were summarized across studies using random-effects meta-regression. A total of 218 RCTs (339 arms and 77 950 patients) met the inclusion criteria. The proportion of patients who achieved the HbA1c goal ranged from 25.9% (95% CI 18.5-34.9) with α-glucosidase inhibitors to 63.2% (54.1-71.5) with the long-acting GLP-1 analogue. There was a progressive decrease of the proportion of patients at target for each 0.5% increase in baseline HbA1c, ranging from 57.8% for HbA1c ≤7.5% to 20.8% for HbA1c ≥10% (p for trend <0.0001), with some difference between insulin and non-insulin drugs: for insulin, the proportion of patients at goal reached a plateau for basal HbA1c value >9.0% with no further decrease, whereas for non-insulin drugs the relationship was continuous without any evidence of plateau. There is a considerable variability with regard to attainment of HbA1c goal of <7% among the different classes of diabetes medications; baseline HbA1c is an important determinant of observed efficacy.

Medical Management of Type 2 Diabetes

More than 20 million Americans have type 2 diabetes. Managing blood glucose is an important component in delaying, slowing, or preventing acute and long-term diabetes complications. Numerous diabetes medications are on the market for this purpose, making it difficult for the advanced practice nurse to know where to begin. This article reviews published algorithms for glucose management of type 2 diabetes and the diabetes medication classes and agents within each class. Knowing how each class works and how to initiate, titrate, and combine diabetes medications is vital when customizing a diabetes medication regimen to meet target glycemic goals.

Medication Utilization and Annual Health Care Costs in Patients With Type 2 Diabetes Mellitus Before and After Bariatric Surgery

To examine the relationship of bariatric surgery with the use of diabetes medications and with total health care costs in patients with type 2 diabetes mellitus. We studied 2235 adults with type 2 diabetes and commercial health insurance who underwent bariatric surgery in the United States during a 4-year period from January 1, 2002, through December 31, 2005. We used administrative claims data to measure the use of diabetes medications at specified time intervals before and after surgery and total median health care costs per year. Seven states in the Blue Cross/Blue Shield Obesity Care Collaborative. Two thousand two hundred thirty-five patients with type 2 diabetes mellitus who underwent bariatric surgery. Surgery was associated with elimination of diabetes medication therapy in 1669 of 2235 patients (74.7%) at 6 months, 1489 of 1847 (80.6%) at 1 year, and 906 of 1072 (84.5%) at 2 years after surgery. Reduction of use was observed in all classes of diabetes medications. The median cost of the surgical procedure and hospitalization was $29,959. In the 3 years following surgery, total annual health care costs per person increased by 9.7% ($616) in year 1 but then decreased by 34.2% ($2179) in year 2 and by 70.5% ($4498) in year 3 compared with a preoperative annual cost of $6376 observed from 1 to 2 years before surgery. Bariatric surgery is associated with reductions in the use of medication and in overall health care costs in patients with type 2 diabetes. Health insurance should cover bariatric surgery because of its health and cost benefits.

Effect of glitazones on the progression of coronary artery disease in type 2 diabetes patients

The effect of thiazolidinediones (TZDs) on the progression of atherosclerosis in diabetes patients remains unclear. There has been heightened interest in recent years in this class of diabetes medications due to the non-glycemic lowering effects, such as altering lipids, inflammation and hematologic profiles. There have been several exciting studies over the past few years focused on the mechanism of action of the TZDs with respect to alteration in the cardio-metabolic profile in diabetes patients. New tools such as intravascular ultrasound have been used to follow plaques characteristics over time on a much more sensitive scale than has ever been possible in the past by coronary angiograms. These advances have enabled researchers to follow closely the macrovascular effects of different anti-atherosclerotic medications such as statins and TZDs. This article reviews the pathophysiology of atherosclerosis in diabetes, the role that TZDs play in this process and the imaging trials looking at the progression or regression of atherosclerosis in patients treated with TZDs.

Cardiovascular Effects of Thiazolidinediones: A Review of the Literature

Type 2 diabetes is a common problem with serious complications. Optimal glycemic control is a major challenge in diabetes, and inadequate control can lead to acute complications as well as end-organ damage. Cardiovascular disease is the primary cause of death in diabetes. Thiazolidinediones (TZDs), one of the newer classes of diabetes medications, are an important part of diabetes care and have recently been implicated in increased cardiovascular morbidity and mortality. There is convincing evidence that these drugs can cause fluid retention, but whether they are indeed precipitating agents for myocardial infarction and death is less clear. The multiple studies addressing these issues are the focus of this review.

Pharmacologic Interventions for Type 1 and Type 2 Diabetes

A variety of pharmacologic interventions are available to treat people with type 1 and type 2 diabetes. This article provides an update of pharmacologic interventions for diabetes, including a discussion of the drug classifications with specific examples of each, and their background, dosing, and side effects. Combination therapy is reviewed, and information is provided on two new therapeutic classes of diabetes medications: incretin mimetics and antihyperglycemics.