FOR THE GLAL STUDY GROUPOBJECTIVE -The hypothesis that pioglitazone treatment is superior to gliclazide treatment in sustaining glycemic control for up to 2 years in patients with type 2 diabetes was tested.RESEARCH DESIGN AND METHODS -This was a randomized, multicenter, double-blind, double-dummy, parallel-group, 2-year study. Approximately 600 patients from 98 centers participated. Eligible patients had completed a previous 12-month study and consented to continue treatment for a further year. To avoid selection bias, all patients from all centers were included in the primary analysis (a comparison of the time-to-failure distributions of the two groups by using a log-rank test) regardless of whether they continued treatment for a 2nd year. By using repeated-measures ANOVA, time course of least square means of HbA 1c and homeostasis model of assessment (HOMA) indexes (HOMA-%S and HOMA-%B) were analyzed.RESULTS -A greater proportion of patients treated with pioglitazone maintained HbA 1c Ͻ8% over the 2-year period than those treated with gliclazide. A difference between the KaplanMeier curves was apparent as early as week 32 and widened at each time point thereafter, becoming statistically significant from week 52 onward. At week 104, 129 (47.8%) of 270 pioglitazone-treated patients and 110 (37.0%) of 297 gliclazide-treated patients maintained HbA 1c Ͻ8%. Compared with gliclazide treatment, pioglitazone treatment produced a larger decrease in HbA 1c , a larger increase in HOMA-%S, and a smaller increase in HOMA-%B during the 2nd year of treatment.CONCLUSIONS -Pioglitazone is superior to gliclazide in sustaining glycemic control in patients with type 2 diabetes during the 2nd year of treatment. Diabetes Care 28:544 -550, 2005T ype 2 diabetes, with its core defects of insulin resistance and relative insulin deficiency, is a progressive disease. Insulin resistance remains generally stable throughout the natural history of the disease, but there is a progressive loss of glycemic control due to the continuing loss of -cell function. The U.K. Prospective Diabetes Study (1) showed that at diagnosis, patients have already lost ϳ50% of their -cell function, which was further reduced to ϳ30% at 5 years.The standard approach at initial diagnosis for many patients with type 2 diabetes is a prescription of diet and physical activity to correct their hyperglycemia. When glycemic targets cannot be attained or maintained with this approach, an oral antihyperglycemic medication (OAM) is added to the lifestyle regimen. When monotherapy fails, treatment is changed to combination OAM therapy, OAMs plus insulin, or insulin therapy (2). Most patients initially respond to OAM monotherapy when they use it. However, with continued therapy, some patients can no longer achieve their glycemic target. The inability to maintain the glycemic target may indicate progression of disease rather than lack of response to a drug (3,4).Sulfonylureas, first introduced in the mid-1950s, are commonly used as monotherapy in patients with type 2 diabete...
Background: Presence of macro-and microvascular complications in patients with diabetes mellitus (DM) is not only related to chronic hyperglycemia represented by glycated hemoglobin (HbA1c) but also to acute glycemic fl uctuations (glycemic variability, GV). The association between GV and DM complications is not completely clear. Aim of our study was to evaluate GV by MAGE index in patients with type 2 DM and to verify association of MAGE index with presence of macro-and microvascular DM complications. Methods: 99 patients with type 2 DM were included in the study. Every patient had done big glycemic profi le, from which MAGE index was calculated. Anthropometric measurements, evaluation of HbA1c and fasting plasma glucose (FPG) and assessment for macrovascular (coronary artery disease -CAD; peripheral artery disease -PAD; cerebral stroke -CS) and microvascular (diabetic retinopathy -DR; nephropathy -DN; peripheral neuropathy -DPPN) DM complications were done. Results: Average MAGE index value was 5.15 ± 2.88 mmol/l. We found no signifi cant diff erences in MAGE index values in subgroups according to presence of neither CAD, CS, PAD nor DR, DN, DPPN. MAGE index value signifi cantly positively correlated with FPG (p < 0.01) and HbA1c (p < 0.001) and negatively with weight (p < 0.05). Conclusion: In our study we failed to show association of MAGE index with presence of macrovascular and microvascular complications in patients with type 2 DM. However, this negative result does not necessarily disprove importance of glycemic variability in pathogenesis of diabetic complications. BACKGROUND
Diabetic nephropathy is becoming an increasingly important cause of morbidity and mortality worldwide as a consequence of increasing prevalence of type 2 diabetes and obesity. The glomeruli of patients with diabetes are characterized by glomerular hypertrophy, widening of the glomerular basement membrane, mesangial expansion, podocytopenia leading to nodular (Kimmelstiel-Wilson) glomerulosclerosis. Many studies have reported the initiation and progression of incipient nephropathy in type 1 diabetes patients, but only limited data are available in type 2 diabetes patients. The information on the risk factors and conversion rate of normal renal function to proteinuria in type 2 diabetes patients is sparse. In this report, we review risk factors of diabetic nephropathy progression in type 2 diabetes patients (Ref. 50). Text in PDF www.elis.sk.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.