Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2018 Executive Summary

Garber, Alan J.; Abrahamson, Martin J.; Barzilay, Joshua I.; Blonde, Lawrence; Bloomgarden, Zachary T.; Bush, Michael D.; Dagogo‐Jack, Samuel; DeFronzo, Ralph A.; Einhorn, Daniel; Fonseca, Vivian; Garber, Jeffrey R.; Garvey, W. Timothy; Grunberger, George; Handelsman, Yehuda; Hirsch, Irl B.; Jellinger, Paul S.; McGill, Janet B.; Mechanick, Jeffrey I.; Rosenblit, Paul D.; Umpiérrez, Guillermo E.

doi:10.4158/cs-2017-0153

Cited by 415 publications

(459 citation statements)

References 257 publications

(214 reference statements)

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“…2,14 An insulin dose of >0.4 IU/kg/d should be a signal to clinicians to start considering antidiabetic agents that better address PPG excursions, including prandial insulin, or oral or injectable incretin therapies, so that treatment intensification can be initiated before basal insulin doses exceed 0.5 IU/kg/d. Currently, the recommendations suggest intensification of therapy when the dose exceeds 0.5 IU/kg/d and HbA1c remains above target.…”

Section: Discussionmentioning

confidence: 99%

“…2,14 Recent updates to treatment guidelines also support the addition of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with existing cardiovascular disease, or in whom weight loss is desirable, and glycaemic targets are not being achieved. 2,14 Recent updates to treatment guidelines also support the addition of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with existing cardiovascular disease, or in whom weight loss is desirable, and glycaemic targets are not being achieved.…”

Section: Introductionmentioning

confidence: 99%

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When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control

Umpiérrez

Skolnik

Dex

et al. 2019

Diabetes Obesity Metabolism

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Aims A post‐hoc analysis to assess the impact in people with type 2 diabetes, of increasing doses of basal insulin on glycaemic measures, body weight and hypoglycaemia. Research Design and Methods We included data from prospective, randomized controlled treat‐to‐target trials of ≥24 weeks' duration in people with type 2 diabetes, uncontrolled on metformin and sulphonylureas, and treated with insulin glargine 100 units/mL (U100), who had at least six fasting plasma glucose (FPG) measurements. The impact of insulin dose on glycated haemoglobin (HbA1c) values, FPG, hypoglycaemia incidence (<3.9 mmol/L [70 mg/dL]), and body weight was analysed. A total of 458 participants from three eligible trials were included. Results The observed relationship between higher basal insulin doses and glycaemic control was non‐linear, with increasing insulin dose leading to smaller reductions in FPG and HbA1c for doses >0.3 IU/kg/d, with a plateauing effect at 0.5 IU/kg/d. Total daily dose of insulin >0.5 IU/kg/d resulted in greater weight gain, but without higher rates of hypoglycaemia, compared with insulin doses ≤0.5 IU/kg/d. Conclusions This analysis indicates that basal insulin doses >0.5 IU/kg/d have diminishing additional impact on improving glycaemic measures, with the disadvantage of additional weight gain. Clinicians should consider anti‐hyperglycaemic treatment intensification at doses approaching 0.5 IU/kg/d.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control

Umpiérrez

Skolnik

Dex

et al. 2019

Diabetes Obesity Metabolism

Self Cite

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“…Its mechanism of action involves activation of peroxisome proliferator-activated receptor (PPAR) gamma, a nuclear receptor that alters the transcription of genes involved in glucose and lipid metabolism and in energy balance. 1 , 2 Hence, pioglitazone increases insulin sensitivity, reduces glucose production by the liver and increases glucose uptake by peripheral tissues. 1 , 2 …”

mentioning

confidence: 99%

“…1 , 2 Hence, pioglitazone increases insulin sensitivity, reduces glucose production by the liver and increases glucose uptake by peripheral tissues. 1 , 2 …”

mentioning

confidence: 99%

“…1 , 2 The main side effects of the drug include weight gain, especially due to the risk of edema or heart failure, increased risk of bone fractures and its association with prostate cancer, which has been questioned in recent studies. 2 Pioglitazone is relatively potent in reducing glycated hemoglobin A1c levels; however, previous studies have shown no benefit in performing a more intensive control of glucose on cardiovascular mortality as compared with a less intensive control. 3 This is important since cardiovascular diseases are still the most common causes of diabetes.…”

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confidence: 99%

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VEGFR-2: One of Pioglitazone's Signaling Pathways in the Heart

Minicucci

Zornoff

2018

Arquivos Brasileiros De Cardiologia

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Association of Second-line Antidiabetic Medications With Cardiovascular Events Among Insured Adults With Type 2 Diabetes

et al. 2018

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IMPORTANCE Understanding cardiovascular outcomes of initiating second-line antidiabetic medications (ADMs) may help inform treatment decisions after metformin alone is not sufficient or not tolerated. To date, no studies have compared the cardiovascular effects of all major second-line ADMs during this early decision point in the pharmacologic management of type 2 diabetes. OBJECTIVE To examine the association of second-line ADM classes with major adverse cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study among 132 737 insured adults with type 2 diabetes who started therapy with a second-line ADM after taking either metformin alone or no prior ADM. This study used 2011-2015 US nationwide administrative claims data. Data analysis was performed from January 2017 to October 2018. EXPOSURES Dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, thiazolidinediones (TZDs), basal insulin, and sulfonylureas or meglitinides (both referred to as sulfonylureas hereafter). The DPP-4 inhibitors served as the comparison group in all analyses. MAIN OUTCOMES AND MEASURES The primary outcome was time to first cardiovascular event after starting the second-line ADM. This composite outcome was based on hospitalization for the following cardiovascular conditions: congestive heart failure, stroke, ischemic heart disease, or peripheral artery disease. RESULTS Among 132 737 insured adult patients with type 2 diabetes (men, 55%; aged 45-64 years, 58%; white, 63%), there were 3480 incident cardiovascular events during 169 384 person-years of follow-up. Patients were censored after the first cardiovascular event, discontinuation of insurance coverage, transition from International Classification of Diseases, Ninth Revision (ICD-9) to end of ICD-9 coding, or 2 years of follow-up. After adjusting for patient, prescriber, and health plan characteristics, the risk of composite cardiovascular events after starting GLP-1 receptor agonists was lower than DPP-4 inhibitors (hazard ratio [HR], 0.78; 95% CI, 0.63-0.96), but this finding was not significant in all sensitivity analyses. Cardiovascular event rates after starting treatment with SGLT-2 inhibitors (HR, 0.81; 95% CI, 0.57-1.53) and TZDs (HR, 0.92; 95% CI, 0.76-1.11) were not statistically different from DPP-4 inhibitors. The comparative risk of cardiovascular events was higher after starting treatment with sulfonylureas (HR, 1.36; 95% CI, 1.23-1.49) or basal insulin (HR, 2.03; 95% CI, 1.81-2.27) than DPP-4 inhibitors.

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Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2018 Executive Summary

Cited by 415 publications

References 257 publications

When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control

When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control

VEGFR-2: One of Pioglitazone's Signaling Pathways in the Heart

Association of Second-line Antidiabetic Medications With Cardiovascular Events Among Insured Adults With Type 2 Diabetes

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