Comparative analysis of therapeutic efficiency and costs (experience in Bulgaria) of oral antidiabetic therapies based on glitazones and gliptins

Abstract

Type 2 diabetes mellitus is a serious, chronic, progressive and widespread disease. Metformin is the most commonly prescribed initial therapy, but combination with other antidiabetic agents usually becomes necessary due to the progression of the disease. Pioglitazone is recommended as a second-line therapy because of its strong antihyperglycemic effect and its ability to reduce insulin resistance. Treatment with pioglitazone is associated with a significantly lower risk of cardiovascular complications and hypoglycemia, while simultaneously improving the lipid profile and the symptomatic and histological changes in the liver. Gliptins (sitagliptin and vildagliptin) are a new class of oral antidiabetic drugs which reduce glycated hemoglobin by a different mechanism. Although the efficacy of sitagliptin and vildagliptin is close to that of pioglitazone, the lack of long-term safety data and the higher price question their predominant use. The objective of this review is to highlight the advantages of mono- and combination therapy with pioglitazone in comparison with gliptins and to underline the inconsistencies in the medicinal and reimbursement policy in Bulgaria.

Effective Reduction of Inflammatory and Coagulation Factors using Sitagliptin in Type 2 Diabetes

“…Metformin is known as the first-line therapeutic agent for diabetes. Thiazolidinediones, such as pioglitazone, have been reported to be effective in different aspects of insulin resistance in diabetic patients, including dyslipidemia, hyperglycemia, hypertension, cardiovascular diseases, coagulation, vasculopathy, facilitated atherosclerosis, and hepatic or ovarian changes (17,18). On the other hand, the beneficial effects of DPP-4 inhibitors, such as sitagliptin, on glycemic control are well-documented in single-drug or combination treatments with other therapeutic agents (19).…”

Pharmacotherapy of Diabetes Mellitus Type 2: A Review on Various Hypoglycemics

“…In normal conditions, there should be no presence of glucose in the urine due to the presence of these glucose transporters. However, when the transporters are too saturated with glucose, the glucose will overflow into the urine [15] . The amount of glucose transportation (~350 mg/min) exceeds from the value and comes to a concentration range of 10-11.1 mmol/lit resulting glycosuria.…”

“…Inhibition of breaking down of GLP-1 results in prolongation omits activity which facilitates secretion of insulin. DDP-4 inhibitors increase the concentration of Incretins (an alimentary system hormone acting as an insulin secretagogue) [15,18] .…”