Efficacy Of Oral Hypoglycemic Agents Research Articles

Reducing the intestinal side effects of acarbose by baicalein through the regulation of gut microbiota: An in vitro study

Combination of dietary flavonoid-baicalein and acarbose reduces the risk that prediabetes will develop into type 2 diabetes mellitus; however, the mechanism underlying this effect has not been clarified. In this study, the in vitro culture conditions of intestinal microorganisms from prediabetic mice were optimized to increase over 30% similarity between in vitro cultured and fecal samples. Baicalein and acarbose alone and in combination, and their corresponding starch hydrolysate were assayed by the in vitro model. The results indicated that the combination of baicalein with acarbose decreased gas production by reducing the residual starch ratio in starch hydrolysate and decreasing the dosage of acarbose, and that reducing the relative abundance of gut bacteria correlated with gas production is the main mechanism. This study provided a theoretical foundation for the development of flavonoid dietary supplements to enhance the efficacy of oral hypoglycemic agents with fewer side effects and higher efficacy.

Oral hypoglycemic drugs: An overview

The aim of this study was to evaluate safety and efficacy of oral hypoglycemic agents in obese Type-2 diabetic patients. The objectives are to compare fasting and postprandial blood sugar (PPBS) levels, to compare body mass index in all the groups and to identify glycosylated hemoglobin levels and adverse drug reaction in all the groups. Diabetes mellitus is one of the world’s major diseases. It currently affects an estimated143 million people worldwide and the number is growing rapidly. In the India, about 1-5% population suffer from diabetes or related complication. So there is need to cure this disease. Anti-diabetic drugs treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of insulin, exenatide, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral anti hyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors. Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in Type 1, which must be injected or inhaled. Diabetes mellitus type 2 is a disease of insulin resistance by cells. Treatments include agents which increase the amount of insulin secreted by the pancreas, agents which increase the sensitivity of target organs to insulin , and agents which decrease the rate at which glucose is absorbed from the gastrointestinal tract. Keywords: hypoglycemic, blood suger, insulin, diabetes mellitus, pancreas

Rationale, design, and methods for the Medical Optimization and Management of Pregnancies with Overt Type 2 Diabetes (MOMPOD) study

BackgroundAnnually in the US, over 100,000 pregnant women with overt type 2 diabetes give birth. Strict maternal glycemic control is the key to optimizing infant outcomes. Medical treatment of type 2 diabetes in pregnancy is generally restricted to insulin, as data on the safety and efficacy of oral hypoglycemic agents in pregnancy are limited. However, over one-third of infants born to women with type 2 diabetes experience an adverse outcome, such as premature delivery, large-for-gestational age, hypoglycemia, hyperbilirubinemia, or birth trauma, suggesting that current treatment regimens fall short of optimizing outcomes. Metformin is the pharmacologic treatment of choice for type 2 diabetes outside of pregnancy. Metformin is favored over insulin because it results in less weight gain, fewer hypoglycemic episodes, and is administered orally rather than injected. However, metformin is not typically used for treatment of type 2 diabetes complicating pregnancy, mainly because no large clinical studies have been conducted to examine its use in this context.Methods/designThis is a randomized double-blind multi-center clinical trial of insulin plus metformin versus insulin plus placebo for the treatment of type 2 diabetes complicating pregnancy. A total of 1200 women with type 2 diabetes will be randomized between 10 weeks 0 days’ and 20 weeks 6 days’ gestation and followed until 30 days after delivery. Neonate outcomes will be followed until 30 days of age. The primary aim is to compare the effect of insulin and metformin versus insulin and placebo on composite adverse neonatal outcomes, comprising perinatal mortality, preterm delivery, neonatal hypoglycemia, hyperbilirubinemia, large-for-gestational age small for gestational age, low birth weight, and/or birth trauma. Key secondary aims are to compare treatment groups for neonatal fat mass and rate of maternal hypoglycemia. Additional aims are to assess the side effects and safety of insulin and metformin among pregnant women with overt type 2 diabetes and to compare gestational weight gain among women treated with metformin plus insulin versus insulin alone.DiscussionSuccessful completion of this study will result in high-quality, contemporary evidence for management of overt type 2 diabetes complicating pregnancy to improve neonatal outcomes.Trial registrationNCT02932475 (05/17/2016).

COMPARATIVE STUDY OF ORAL HYPOGLYCEMIC AGENTS IN TYPE-2 DIABETES OBESE PATIENTS

Objectives: The aim of this study was to evaluate safety and efficacy of oral hypoglycemic agents in obese Type-2 diabetic patients. The objectives are to compare fasting and postprandial blood sugar (PPBS) levels, to compare body mass index (BMI) in all the groups, and to identify glycosylated hemoglobin levels and adverse drug reactions (if present) in all the groups.Method: This is a prospective observational study conducted in care diabetic center over a period of 1 year. All the patients those are receiving only oral hypoglycemic agents continuously over a period of 3 months and BMI ≥30 were enrolled. The patients receiving insulin were excluded. Patients were followed over a period of 3 months and were reviewed on visit basis (every 30 days). All the necessary information was collected into the data collection form that includes demographic details (age, gender, etc.), past medication history, current treatment charts, and their relevant laboratory reports (fasting blood sugar levels [mg/dl], PPBS levels [mg/dl], glycosylated hemoglobin A1c [HbA1c] (%), and BMI [kg/m2]). Results: A total of 395 patients were recruited into the study and the drugs received by the population were found to be metformin+sulfonylureas (33%), metformin+pioglitazone (26%), and metformin+dipeptidyl peptidase inhibitors (DPI) (23%). A significant reduction in HbA1c was seen in all groups of patients. Adverse drug reactions observed were hypoglycemia, pedal edema, and itching distributed to drugs metformin+DPI, respectively. A significant reduction in BMI was seen in patients receiving DPI and BMI was found to be increased in other groups of patients.Conclusion: Overall, three classes of drugs were found to have similar efficacy. Sulfonylureas were commonly associated with hypoglycemia when compared to other drugs and weight reduction observed in dipeptidyl peptidase inhibitors.

The Assessment of the Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Glucocorticoid-induced Diabetes by Continuous Glucose Monitoring.

Objective The administration of glucocorticoids usually causes a mild increase in fasting glucose levels and a greater dose-dependent increase in postprandial values in patients without pre-existing diabetes mellitus. Patients with persistent hyperglycemia due to glucocorticoid therapy sometimes require insulin therapy, which might result in increased weight gain and more episodes of hypoglycemia, some of which are severe. On the other hand, scant evidence is available on the efficacy of oral hypoglycemic agents in treating glucocorticoid-induced diabetes. In this study, we evaluated the efficacy of dipeptidyl peptidase (DPP)-4 inhibitors in patients with glucocorticoid-induced diabetes by continuous glucose monitoring (CGM). Methods We examined the glycemic profiles using CGM at baseline and 1-4 weeks after initiating DPP-4 inhibitor treatment in patients with newly developed glucocorticoid-induced diabetes. Results Eleven patients who had been diagnosed with kidney disease or other diseases with renal involvement were recruited for the present retrospective study. After starting DPP-4 inhibitors, the mean and standard deviation (SD) of the glucose level, and the mean amplitude of glycemic excursion (MAGE) were significantly improved in comparison to baseline. Furthermore, the area over the curve (AOC) for the glucose levels <70 mg/dL was not increased in comparison to baseline after the initiation of DPP-4 inhibitor treatment. The results indicate that the treatment of patients with glucocorticoid-induced diabetes using DPP-4 inhibitors can minimize the risk of hypoglycemia and reduce glucose variability. Conclusion DPP-4 inhibitors are potentially useful for blood glucose control in patients with glucocorticoid-induced diabetes.

Study on clinical effect of glargine insulin combined with glimepiride in newly diagnosed T2DM patients

Objective To study the efficacy and safety of glargine insulin combined with glimepiride therapy in type 2 diabetes mellitus(T2DM). Methods According to the random number table,100 T2DM patients with unsatisfactory efficacy of oral hypoglycemic agents were randomly divided into treament group and control group, 50 cases in each group.Then,the treatment group was dealed with glargine insulin and glimepiride,the control group were treated with insulin glargine for our treatment protocol.12 weeks after treament,the fasting blood glucose(FPG),2 hours blood glucose(2hPG),body mass index(BMI),glycosylated hemoglobin(HbA1c),isletβ-cell function index(HOMA-β),insulin resistance index(Homa-IR),insulin dosage(INS),time requirds,weight gain and so on were observed. Meanwhile,The occurrence condition of hypoglycemia was also observed. Results In control groups,the post-treatment indexes of FPG,2hPG,HbAlc,HOMA-βand HOMA-IR[(5.7±0.8)mmol/L,(8.6±2.5)mmol/L,(6.5±0.7)%,(40.35±3.12),(2.68±1.41)]were much better than those in pre-treatment[(11.7±1.6)mmol/L,(15.1±6.1)mmol/L,(9.2 ±1.1)%,(19.01±2.79),(3.42±1.47)](t=23.717,6.971,14.642,36.052,2.568,P<0.01 or 0.05 for both).In the treatment group,the post-treatment indexes of FPG,2hPG,HbAlc,HOMA-β,HOMA-IR[(5.6±0.7)mmol/L,(7.3±2.3)mmol/L,(6.3±1.0)%,(54.18±3.23),(2.12±1.26)]improved obviously than those in pre-treatment[(11.8±1.7) mmol/L,(15.8±5.2)mmol/L,(9.3±1.2)%,(18.71±3.12),(3.36±1.56)](t=23.846,10.570,13.580,55.849,4.372,P< 0.01 for both).After treatment,the indexes of 2hPG,HOMA-β,HOMA-IR,insulin dose,time requirds and amplitude of weight gain[(7.3±2.3)mmol/L,(54.18±3.23),(2.12±1.26),(18.06±1.43)U/d,(10.1±2.4)d,(1.1±0.4kg)]etc in the treatment group were significantly ameliorated than those in the control group[(8.6±2.5)mmol/L,(40.35±3.12),(2.68±1.41),(22.46±1.77)U/d,(13.2±2.6)d,(2.1±0.6)kg](t=23.717,6.971,14.642,36.052,2.568,P<0.01 or 0.05 for both).Hypoglycemia events of treatment group were 4 cases(8.0%)and the same in the control group were 13 cases(26.0%),there were statistical significance between the two groups(χ2=5.535,P<0.05). Conclusion Treatment of glargine insulin combined with glimepiride can improve blood glucose level of T2DM patients,recover their isletβ-cell function, relieve the IR,shorten the time requirds,as well as reduce the insulin dosage,range of weight gain and rate of hypoglycemia events.Hence,treatment protocol of glargine insulin combined with glimepiride is an effective clinical treatment for newly diagnosed T2DM patients. Key words: Diabetes Mellitus,Type 2; Glargine Insulin; Glimepiride

Short-term Therapeutic Efficacy of Different Oral Hypoglycemic Agents Combined with Once Daily Insulin Glargine in Type 2 Diabetic Subjects with Failure of Sulfonylurea and Metformin Combination

Backgroud: Although the extended duration of action of insulin glargine supports a convenient once daily injection, the combination with other short acting insulins or oral hypoglycemic agents is required to control postprandial hyperglycemia in type 2 diabetes. The present study was designed to compare the short-term therapeutic efficacy of oral hypoglycemic agents with once daily insulin glargine, switching from a multiple daily injection regimen. Methods: After control with the intensive regimen (daily lispro insulin and glargine) during 5~7 days, 80 in-patients with type 2 diabetes were randomized and treated with four oral hypoglycemic agents (glimepiride 4 mg qd, metformin 500 mg bid, nateglinide 90 mg tid, or acarbose 100 mg tid) plus once daily insulin glargine during 5 days. Blood glucose concentration was recorded by seven daily estimations (before each meal, 2 hours after each meal, and bedtime). Blood glucose concentrations and area under the curves (AUCs) of blood glucose were compared among four groups. Results: The area under the curve of blood glucose of metformin, glimepiride, nateglinide, and acarbose groups were 165.5 ± 46.0, 178.5 ± 36.5, 209.9 ± 55.1, and 224.9 ± 55.8 mmol/L/hr respectively. Blood glucose concentrations and area under the curves of blood glucose of glimepiride and metformin groups were significantly lower than those of acarbose group. Also, those of metformin group were significantly lower than those of nateglinide group. Conclusions: Metformin or glimepiride are more effective oral hypoglycemic agent than nateglinide or acarbose in the combination with insulin glargine in type 2 diabetic subjects with failure of sulfonylurea and metformin combination. (J Kor Diabetes Assoc 31:336~342, 2007)

Combination Therapy With Insulin and Sulfonylureas for Type II Diabetes

Combination therapy for type II (non-insulin-dependent) diabetes mellitus with insulin and sulfonylureas has been a topic of interest since the latter were introduced to clinical use. In recent years, improved understanding of potential complications associated with hyperinsulinemia has led to resurgent interest in alternatives to insulin monotherapy for patients who have failed on a regimen of diet and sulfonylureas. A plethora of clinical trials have reported on the efficacy of oral hypoglycemic agents in limiting insulin requirements while achieving glycemic control in this subset of diabetic patients. However, few studies have been appropriate in both design and duration to provide convincing results. The randomized placebo-controlled double-blind trials that have used a parallel design and study periods of up to 1 yr have uniformly investigated second-generation sulfonylureas and yielded the most reliable information. In all instances, the combination regimen achieved reduction in insulin requirement with varying evidence of a pancreatic effect as the responsible mechanism. This treatment modality is becoming more widely accepted in the effort to achieve optimal glycemic control with minimum risk to the patient.