Avoiding hypoglycaemia while achieving good glycaemic control in type 2 diabetes through optimal use of oral agent therapy

Barnett, Anthony

doi:10.1185/03007991003738063

Cited by 29 publications

(24 citation statements)

References 67 publications

(95 reference statements)

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“…Maximum dose of glimepiride may lead to severe hypoglycemia and weight gain. 2 Combination therapy using sulfonylurea and metformin, which respectively promotes insulin secretion and improves insulin resistance, is an effective and has complementary mechanisms that improves both of the main causes of type 2 diabetes and has been reported by UKPDS and other clinical studies to be more effective than monotherapy of either drugs. 4,5 Hydroxychloroquine is approved by DCGI (Drug Controller General of India) in 2014 as a third line add on treatment in T2DM patient uncontrolled on metformin and sulfonylurea.…”

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confidence: 99%

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Effect of early addition of hydroxychloroquine in type 2 diabetic patients inadequately controlled on metformin and sulfonylurea combination therapy

Baidya¹,

Ahmed

2018

Int J Res Med Sci

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Background: Present study assessed the effect of early addition of hydroxychloroquine to metformin and sulfonylurea in inadequately controlled T2DM patients as compared to up titration of the metformin or sulfonylurea (glimepiride) doses.Methods: Patients with glycated haemoglobin (HbA1c) between ≥7.0 to ≤9.0% and on metformin 1000mg/day and glimepiride 2mg/day for at least 12 weeks were analysed for this study. Patients were randomized into three groups, in one group (n=55) metformin dose was up titrated to 2000mg daily and in second group (n=55) hydroxychloroquine (HCQ) 400mg was added along with other and in third group (n=55) glimepiride dose was up titrated to 4mg. Fasting plasma glucose (FPG), post prandial plasma glucose (PPG) and glycated haemoglobin (HbA1c) were measured at baseline and after 12 and 24 weeks. Low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and Triglyceride were measured at baseline and after 6 months. Authors have analysed the data of 150 patients as rest were either lost in follow up or discontinue therapy.Results: After 24 weeks, the mean HbA1c was 6.5% in hydroxychloroquine group (p<0.001) versus 6.8% in metformin 2000mg group (p<0.001) and 6.7% in glimepiride 4mg group (p<0.001). There was also a modest reduction in lipid parameters (p<0.001) with no change in serum creatinine level and a marginal reduction in body weight in the HCQ group. Incidence of confirmed hypoglycemia was significantly lower in patients of HCQ group compared to glimepiride group in this study.Conclusions: Hydroxychloroquine as add on to metformin and glimepiride combination during the early course of treatment helps in achieving glycaemic target and can consider as an option rather up titrating the dose of metformin or glimepiride.

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confidence: 99%

“…1,2 Oral hypoglycemic drugs with various mechanisms, such as enhancing the pancreatic function to secrete insulin, reducing insulin resistance of the body tissues or increasing glucagon-like peptide-1, have been developed and are currently in use.…”

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confidence: 99%

Effect of early addition of hydroxychloroquine in type 2 diabetic patients inadequately controlled on metformin and sulfonylurea combination therapy

Baidya¹,

Ahmed

2018

Int J Res Med Sci

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“…Severe hypoglycemia may exert even more serious side effects, such as seizures, unconsciousness (which may be particularly debilitating in the elderly), coma and even death (48). In older patients with type 2 diabetes and a history of severe hypoglycemia, an increased risk of dementia has been reported, particularly for patients who have a history of multiple episodes (49).…”

Section: The Importance Of Controlling Postprandial Hyperglycemia Andmentioning

confidence: 99%

“…In the UKPDS, recurrent hypoglycemia was associated with decreased quality of life in patients treated with insulin (50). Moreover, the unpleasant symptoms and negative consequences of hypoglycemia may result in fear and anxiety, lower treatment satisfaction, which in turn may negatively impact the diabetes management and adherence to therapy, precluding a full attainment of the benefits offered by improved glycemic control (48). Evidence exist that hypoglycemic episodes, especially severe ones, are associated with adverse cardiovascular events (such as prolongation of the QT interval, cardiac arrhythmias, sudden cardiac arrest, and acute myocardial infarction), which are triggered by the stimulation of the sympathetic nervous system and the catecholamine surge (51,52).…”

Section: The Importance Of Controlling Postprandial Hyperglycemia Andmentioning

confidence: 99%

Insulin Therapy and Hypoglycemia - Present and Future

Nagar¹,

Bitton²

2011

Diabetes - Damages and Treatments

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“…Importantly, metformin does not affect insulin secretion nor induces hypoglycemia in normal patients [163], aside from the fact that no teratogenic effects have been reported in the newborn of drug users. The main limited side effect of metformin is gastrointestinal discomfort, such as nausea and diarrhea, which are usually self-limited [164].…”

Section: Dual Mtor/ Pi3k Inhibitorsmentioning

confidence: 99%

Metformin and mTOR Inhibitors: Allies against Ovarian and Breast Cancers

Guimarães¹,

Tessarollo²,

Santos³

et al. 2017

J Carcinog Mutagen

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Cancer is one of the leading causes of death worldwide. Every year 8.2 million people die from the disease. In this context, breast and ovarian cancer are the most incidental among women. Elucidation of cell growth pathways and the observation that these pathways are altered in human cancer have encouraged the search for specific inhibitors. The phosphatidylinositol-3cinase (PI3K)/Protein kinase b (AKT)/Mammalian Target of Rapamycin (mTOR) is an important pathway involved in cell growth, tumorigenesis, cell invasion, and resistance to therapies. This pathway is often activated in breast and ovarian cancers and the deregulation of its signaling can contribute to tumor growth, angiogenesis and metastasis. Metformin is one of the most commonly prescribed antidiabetic drugs in the world whose anticancer effects, mediated by reduced mTOR signaling, have become notable. Therefore, this review provides an overview of signaling pathway PI3K/AKT/mTOR in the ovarian and breast cancers as well as for target therapies of mTOR signaling, with an emphasis on its mechanisms, clinical applicability and future perspectives.

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Avoiding hypoglycaemia while achieving good glycaemic control in type 2 diabetes through optimal use of oral agent therapy

Abstract: Metformin, thiazolidinediones and DPP-4 inhibitors appear to be the most appropriate oral options for minimising the risk of hypoglycaemia. Early and ongoing attention to hypoglycaemia should form an integral part of any long-term glucose control strategy.

Cited by 29 publications

References 67 publications

Effect of early addition of hydroxychloroquine in type 2 diabetic patients inadequately controlled on metformin and sulfonylurea combination therapy

Effect of early addition of hydroxychloroquine in type 2 diabetic patients inadequately controlled on metformin and sulfonylurea combination therapy

Insulin Therapy and Hypoglycemia - Present and Future

Metformin and mTOR Inhibitors: Allies against Ovarian and Breast Cancers

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