Efficacy Of Oral Antidiabetic Drugs Research Articles

Comparison of Efficacy of Oral Antidiabetic Drugs versus Combination of Oral Antidiabetic Drugs along with Insulin in Management of Diabetes Mellitus - A Retrospective Study

Objective: To compare the efficacy of oral antidiabetic drugs (OADs) versus combination of OADs along with insulin in Type 2 Diabetes Mellitus patients. Methods: A retrospective study was conducted in which data was extracted from the electronic medical records. Two groups were formed, Group I comprised of nineteen patients who were prescribed OADs while in Group II, five patients were prescribed combination of OADs and insulin therapy from January 2020 to June 2021. Blood glucose parameters (HbA1c, FBS, PPBS) were noted at baseline and subsequent next three follow-ups. The statistical analysis was done using SPSS version 26.0. Results: The diabetic patients on the combination therapy showed better improvement as compared to the diabetic patients who were prescribed only OADs. However, the differences between the blood glucose parameters were found to be non-significant. Conclusion: In the case of patients where targeted glucose levels are not achieved with OADs alone, combination therapy can be prescribed comprising of OADs and insulin therapy to get better-controlled results. Keywords: Oral antidiabetic drugs (OADs), combination of OADs & insulin, Type 2 Diabetes Mellitus, T2DM, diabetic patients.

Joint effects of diabetic-related genomic loci on the therapeutic efficacy of oral anti-diabetic drugs in Chinese type 2 diabetes patients.

Previous pharmacogenomic studies of oral anti-diabetic drugs have primarily focused on the effect of a single site. This study aimed to examine the joint effects of multiple loci on repaglinide or rosiglitazone efficacy in newly diagnosed type 2 diabetes mellitus (T2DM) patients. A total of 209 newly diagnosed T2DM patients were randomly assigned to treatment with repaglinide or rosiglitazone for 48 weeks. The reductions in fasting glucose (ΔFPG), 2h glucose (Δ2hPG) and glycated hemoglobin (ΔHbA1c) levels were significantly associated with genetic score that was constructed using the sum of the effect alleles both in the repaglinide (P = 0.0011, 0.0002 and 0.0067, respectively) and rosiglitazone cohorts (P = 0.0002, 0.0014 and 0.0164, respectively) after adjusting for age, gender, body mass index and dosage. Survival analyses showed a trend towards a greater attainment rate of target HbA1c level in individuals with a high genetic score in the repaglinide cohort and rosiglitazone cohort (Plog-rank = 0.0815 and 0.0867, respectively) when the attainment of treatment targets were defined as more than 20% decrease of FPG, 2hPG, and HbA1c levels after treatment. In conclusion, we identified the joint effects of several T2DM-related loci on the efficacy of oral anti-diabetic drugs; moreover, we built a model to predict the drug efficacy.

Relationship between the efficacy of oral antidiabetic drugs and clinical features in type 2 diabetic patients (JDDM38).

Aims/IntroductionWe carried out an observational cohort study to examine the relationship between the efficacy of oral antidiabetic drugs and clinical features in type 2 diabetics.Materials and MethodsWe analyzed the CoDiC® database of the Japan Diabetes Data Management Study Group across 67 institutions in Japan. In a total of 3,698 drug‐naïve patients who were initiated with metformin, dipeptidyl peptidase‐4 inhibitor (DPP‐4i) or sulfonylurea (SU) from 2007 to 2012, we evaluated body mass index (BMI) and hemoglobin A1c (HbA1c). The patients were stratified according to their clinical features, and matched using a propensity score to adjust for baseline factors.ResultsHbA1c was reduced with all drugs, with the largest effect elicited by DPP‐4i and the smallest by SU (P = 0.00). HbA1c increased with SU after 6 months in the patients stratified by an age‐of‐onset of <50 years (P = 0.00). BMI increased with SU in the patients stratified by a BMI of <25 (P = 0.00), and decreased with metformin in the patients with a BMI >25 (P = 0.00). The reduction in HbA1c was larger in patients with HbA1c of ≥8%, compared with that in patients with HbA1c of <8% (P = 0.00). HbA1c during the study period was higher in patients who were added to or swapped with other drug(s), than in patients continued on the original drug (P = 0.00).ConclusionsThe effect on bodyweight and glycemic control differed among metformin, DPP‐4i and SU, and the difference was associated with clinical features.

Glycaemic control efficacy of oral antidiabetic drugs in treating type 2 diabetes: a protocol for network meta-analysis

IntroductionPast studies of network meta-analysis focused on evaluating drug combinations in treating type 2 diabetes but not on evaluating antidiabetic drugs in monotherapy. Clinical guidelines (eg, NICE (National Institute of...

Oral Antidiabetic Drugs and Regression from Prediabetes to Normoglycemia: A Meta-Analysis

Impaired glucose tolerance, impaired fasting glucose, and elevated hemoglobin A(1c) are intermediate stages, considered prediabetes, a precursor to overt type 2 diabetes mellitus. Prediabetes is associated with increased risk for cardiovascular disease, independent of diabetes development. Data have shown that various oral antidiabetic drugs can help people regress from prediabetes to normoglycemia. To evaluate the efficacy of oral antidiabetic drugs in promoting regression from prediabetes to normoglycemia. MEDLINE (1950-November 2011), EMBASE (1990-November 2011), and Cochrane Central Register of Controlled Trials (indexed September 2011) were systematically searched. A manual search of references from reports of clinical trials and review articles was performed to identify additional relevant studies. Randomized controlled trials 12 weeks or more in duration evaluating any of the oral antidiabetic drugs and studying regression from prediabetes to normoglycemia were included. A random-effects model was used to calculate pooled odds ratios with 95% confidence intervals. Thirteen studies (N = 11,600 participants) were included in the meta-analysis. Use of oral antidiabetic drugs in prediabetic patients was shown to double the odds of achieving normoglycemia compared to controls (OR 2.03, 95% CI 1.54 to 2.67). When individual classes of oral antidiabetic drugs were evaluated, use of thiazolidinediones (OR 2.33, 95% CI 1.93 to 2.81) and α-glucosidase inhibitors (OR 2.02, 95% CI 1.26 to 3.24) was associated with significantly increased odds. However, biguanides (OR 2.04) and sulfonylureas (OR 1.84) failed to reach statistical significance (p = 0.06 and p = 0.39, respectively). In patients with prediabetes, oral antidiabetic drugs were associated with increased odds of regression to normoglycemia versus placebo/control. Only thiazolidinediones and α-glucosidase inhibitors provided a statistically significant increase in odds of regressing to normoglycemia.

Oral anti‐diabetic drugs for the prevention of Type 2 diabetes

To determine the comparative efficacy of oral anti-diabetic drugs in preventing the development of Type 2 diabetes. A systematic literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted for randomized controlled trials evaluating oral anti-diabetic drugs in patients at high risk for developing Type 2 diabetes. Mixed-treatment comparison meta-analysis methods were used to evaluate the relative risks and risk differences of developing Type 2 diabetes, along with associated 95% credible intervals. Overall, 20 trials (n = 23 230 participants) were included. Upon mixed-treatment comparison meta-analysis, thiazolidinediones, alpha-glucosidase inhibitors and biguanides significantly reduced the relative risk of developing diabetes by 64, 40 and 27%, respectively, compared with control. Sulphonylureas and glinides showed no significant effect. Moreover, thiazolidinediones significantly reduced the relative risk of diabetes by 50% compared with biguanides and trended towards a 40% risk reduction vs. alpha-glucosidase inhibitors [relative risk 0.60 (95% credible intervals 0.34-1.02)]. None of the results were appreciably altered upon subgroup or sensitivity analyses. When evaluating risk differences compared with control, thiazolidinediones (-9%, number needed to treat = 11), alpha-glucosidase inhibitors (-7%, number needed to treat = 14) and biguanides (-7%, number needed to treat = 14) continued to show significant benefit. Of the oral anti-diabetic drugs evaluated to prevent Type 2 diabetes, thiazolidinediones were associated with the greatest risk reduction compared with control and associated with greater risk reduction than biguanides. Alpha-glucosidase inhibitors and biguanides performed similarly, and better than control, while sulphonylureas and glinides provided no significant benefit.

Effects of KCNQ1 Polymorphisms on the Therapeutic Efficacy of Oral Antidiabetic Drugs in Chinese Patients With Type 2 Diabetes

The aim of this study was to explore the impact of KCNQ1 variants on the responses to oral antidiabetic drugs in a Chinese study population. A 48-week randomized pharmacogenetics study compared the effects of repaglinide and rosiglitazone in 209 newly diagnosed patients with type 2 diabetes. In the repaglinide cohort, individuals who were rs2237892 TT homozygotes exhibited lower 2-h glucose levels and significantly higher cumulative attainment rates of target 2-h glucose levels (P(log-rank) = 0.0383) than the C allele carriers; patients with a greater number of rs2237892 C alleles showed larger augmentations in both fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) (P = 0.0166 and 0.0026, respectively); moreover, the rs2237895 C allele was also associated with greater increments in both fasting insulin and HOMA-IR (P = 0.0274 and 0.0259, respectively). In contrast, only an association between rs2237897 and decrease in 2-h glucose levels was detected in the rosiglitazone cohort (P = 0.0321). Our results indicated that KCNQ1 polymorphisms are associated with repaglinide efficacy, and might also be associated with rosiglitazone response, in Chinese patients with type 2 diabetes.

How well do rapid‐acting insulins work in obese individuals?

Diabetes has reached epidemic proportions worldwide and most individuals with type 2 diabetes are obese. Therefore, there is a pressing need to carefully evaluate the impact of obesity on the efficacy of all diabetes therapies. Previously, obesity has been shown to adversely affect the efficacy of oral antidiabetic drugs; however, less is known about the impact of obesity on the properties of insulin and its analogues. As patients near target HbA1c, the more postprandial hyperglycaemia contributes to overall glycaemic control; thus, mealtime insulin, often supplied by a rapid-acting insulin analogue (RAI), becomes of increasing importance. As glycaemic targets set by professional bodies become lower and poor glycaemic control becomes increasingly less acceptable, earlier addition of RAIs to patients' treatment regimens may be required to meet these targets. However, in clinical practice, multiple barriers have challenged the acceptance and effective use of insulin therapy, including concern that it may cause weight gain. RAIs should ideally maintain their rapid-acting pharmacokinetic (PK) and pharmacodynamic (PD) profiles, irrespective of subcutaneous body fat, skin thickness and body mass index, in order to effectively meet intensive treatment goals. For example, initial PK/PD data with insulin glulisine in obese individuals suggest that this RAI may maintain its rapid-acting profile better than insulin lispro in the first 2 hours post-injection. However, data are preliminary and a thorough analysis of the impact of obesity on all RAIs in type 2 diabetes is warranted. This review focuses on the potential impact of obesity on RAIs and presents an overview of investigations in this area.

Le diabète de la mucoviscidose chez l’adulte

Cystic fibrosis is an autosomal recessive disorder affecting about 1/3500 case in France. The disease, that affects all epithelia, is responsible for pulmonary tract infections but also pancreas, gut, liver and genital tract abnormalities. It is linked to CFTR gene mutations, inducing unusually high increase of sodium chloride in sweat, used to track down the illness. deltaF508 CFTR mutation, encountered in 70% of cases, is nearly always associated to pancreatic insufficiency with early-onset lung attack. Around 10% of cystic fibrosis cases, whatever the age, are complicated with partially insulinopenic diabetes, favored by pancreatic fibrosis, while one third of patients shows glucose intolerance. After 20 years old, one third of patients suffers from diabetes and one half after 30 years. Diabetes diagnosis is difficult, and requires the fulfillment of oral glucose tolerance test (OGTT). One glycemia greater or equal to 2 g/l, two hours after a 75 g glucose load, established diabetes diagnosis. Indeed, fasting blood glucose and glycated hemoglobin appear as poor diagnosis markers. Despite histological arguments in favor of the mainly mechanical islet disturbances, an increased prevalence of anti-islets auto-antibodies and an increased frequency of HLA DR3/DR4 have been reported in cystic fibrosis population with glucose tolerance troubles. Also, glucose metabolism is influenced by specific factors linked to cystic fibrosis (infection, malnutrition, steroids...). In reason of the silent phase of diabetes, systematic tracking down of diabetes with a yearly OGTT is recommended, all the more so that hyperglycemia appears as a worsening factor of cystic fibrosis. The efficacy of oral anti-diabetic drugs has not been evaluated on large studies. By contrast, some studies argue for insulin therapy as soon as diabetes appears, insulin improving respiratory and nutritional prognosis. In conclusion, the aim of treatment of cystic fibrosis is to prevent the lung function decline by controlling inflammation and infection, to implement endo- and exo-crine pancreas insufficiency, and to improve nutritional status.