Managing Type 2 Diabetes: Going Beyond Glycemic Control

Stolar, Mark W.; Hoogwerf, Byron J.; Gorshow, Stephen M; Boyle, Patrick J.; Wales, Dirk O

doi:10.18553/jmcp.2008.14.s5-b.1

Cited by 57 publications

(75 citation statements)

References 76 publications

(146 reference statements)

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“…Treatments such as metformin, which decrease insulin resistance, are thought to reduce the risk of tumour development [9][10][11][12][13][14]. On the other hand, treatments that increase circulating insulin levels, such as sulfonylureas and exogenous insulin, are thought to increase the risk of cancer [15,16]. Of particular interest, is the recent epidemiological evidence surrounding different types of insulin and the different mitogenic potencies of insulin analogues [17].…”

Section: Introductionmentioning

confidence: 99%

Glucose-lowering agents and cancer mortality rates in type 2 diabetes: assessing effects of time-varying exposure

et al. 2010

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Aims/hypothesis We explored the relationship between glucose-lowering agents and cancer mortality rates in type 2 diabetes patients, hypothesising a decreased risk of cancer mortality with metformin use and a dose-risk gradient for insulin therapy. Methods This was a population-based cohort study using administrative data from Saskatchewan Health, Canada. We identified new users of metformin or sulfonylureas from 1 January 1991 to 31 December 1996, with follow-up until death, departure from the province or 31 December 1999. Cox regression analyses were used to estimate the HR of death from cancer, accounting for time-varying exposure to metformin, sulfonylurea, and exogenous insulin therapy. Results We identified 10,309 new users of metformin or sulfonylurea. The average follow-up was 5.4 (1.9) years, during which 407 (4.0%) cancer deaths occurred. Adjusting for age, sex and chronic disease score, the adjusted HR for metformin use was 0.80 (95% CI 0.65-0.98) compared with sulfonylurea monotherapy users. Adjusted HRs for subsequent insulin use were 2.22 (0.99-5.00), 3.33 (2.26-4.89) and 6.40 (4.69-8.73) for <3, 3 to 11 and ≥12 insulin dispensations/year, respectively, compared with patients not on insulin. We observed a similar risk gradient among the sub-cohort of new insulin users. Conclusions/interpretation Our results support previous reports of a decreased risk of cancer outcomes associated with metformin use relative to sulfonylurea monotherapy.We also provide new evidence of a gradient of cumulative insulin dispensations and cancer mortality rates.

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Section: Introductionmentioning

confidence: 99%

Glucose-lowering agents and cancer mortality rates in type 2 diabetes: assessing effects of time-varying exposure

et al. 2010

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“…In the light of these findings, rigorous prevention strategies and therapeutic interventions should be implemented in this group of patients, aimed at optimizing metabolic control and early detection of bacteremia by taking a blood culture on admission of all diabetic patients diagnosed with infection. 36 …”

Section: Discussionmentioning

confidence: 99%

Type, course and outcome of community acquired infections in hospitalized diabetics

Tsakiridou¹,

Argyriou²,

Makris³

et al. 2010

Microbiol Res (Pavia)

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Diabetes mellitus has been associated with increased frequency of serious infections which are attributed to immune deficiencies. The aims of this study were to investigate the type, course and outcomes of community acquired infections, and especially bacteremia in diabetics hospitalized for infection. One hundred and thirty-four consecutive patients (67 diabetics and 67 non-diabetics) matched for age, who were admitted to a general District Hospital in Greece due to infection, were included in this case control study. Diabetics presented urinary infections (46.3% vs. 26.8%, P=0.006), skin infections (9% vs. 0%, P=0.007) and bacteremia (11.1% vs.

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“…151 At present, different classes of drugs with different mechanisms of action are available, and these drugs can be used alone or in various combination therapies. 150 Many patients do not achieve adequate glycemic control with the use of a single drug and require long-term combinations of two or more oral agents, [151][152][153] sometimes as a prelude to insulin therapy.…”

Section: Introductionmentioning

confidence: 99%

“…157,160 It is well known that most individuals will not sustain an adequate level of glycemic control based on behavioral measures or oral monotherapy. 151 In addition, even if traditional oral therapies are usually effective in reducing hyperglycemia, they do not prevent or impede the progression of the disease, and thus, many patients require the administration of insulin. 148 Other individuals may also have allergies or contraindications to the medications, and they may not adhere or be resistant to continuity of the treatment in the presence of undesirable side effects such as weight gain and hypoglycemia, which are associated with many conventional therapies.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, thiazolidinediones may cause or exacerbate congestive heart failure and even ischemic cardiac events, mitigating the risks associated with the increase in body fat. 151,152,161 Recent data also suggest that thiazolidinediones can reduce mineral bone density. 151 Thus, the therapeutic strategy must consider the effects on the associated comorbidities and associated costs, in addition to the decrease in glycated hemoglobin, the tolerability and the non-glycemic effects of antidiabetic agents.…”

Section: Introductionmentioning

confidence: 99%

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Organic consequences of ileal transposition in rats with diet-induced obesity

et al. 2011

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INTRODUCTION:The clinical management of metabolic syndrome -especially diabetes mellitus type 2 -is notoriously complex due to the progressive nature of this disease. At present, there is a need for a surgical procedure that is effective for the treatment of diabetes mellitus type 2, even in non-obese individuals. The isolated ileal transposition theory could lead to an effective alternative therapy. This intervention has not yet been performed in humans, and there are no reports of its use in an experimental model of diet-induced metabolic syndrome. OBJECTIVES:The objective of this study is to evaluate the physiological effects of ileal transposition in rats with diet-induced metabolic syndrome. The effects of this procedure on glucose and lipid metabolism will be assessed. METHODS:Forty 12-week-old male rats (albino Rattus norvegicus, Wistar, 2BAW, heterogeneous) will be divided into four groups of 10 animals each: the ileal transposition group (TG) comprising animals on a hypercaloric-hyperlipidic diet; the sham group (SG) containing animals that receive the same diet and undergo the sham surgery; control group 1 (CG1), which will receive a hypercaloric-hyperlipidic diet and will not undergo surgery; and control group 2 (CG2), which will consume standard feed and will not undergo surgery. The surgeries will be performed in 20-week-old animals.Blood samples for laboratory testing will be collected from 12-week-old animals on the day of surgery and after eight postoperative weeks, following determination of the weights of the animals and the administration of anesthesia. The levels of serum glucose, insulin, triglycerides, total cholesterol and fractions, glucagon-like peptide-1, C-peptide and glycated hemoglobin will be assessed in all of the animals. The insulin tolerance test will be performed using PRISMA software, and insulin resistance will be calculated by the HOMA-IR indirect test. On specific days, two 20-week-old rats will be separated and randomly distributed in TG and SG. These animals will be followed until the eighth postoperative week. Subsequently, they will be euthanized, and the retroperitoneal and periepididymal fat deposits will be collected and weighed using a precision scale. In addition, the pancreas, liver and intestinal segments will be sent for pathological and immunohistochemical studies.

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Managing Type 2 Diabetes: Going Beyond Glycemic Control

Cited by 57 publications

References 76 publications

Glucose-lowering agents and cancer mortality rates in type 2 diabetes: assessing effects of time-varying exposure

Glucose-lowering agents and cancer mortality rates in type 2 diabetes: assessing effects of time-varying exposure

Type, course and outcome of community acquired infections in hospitalized diabetics

Organic consequences of ileal transposition in rats with diet-induced obesity

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