Monotherapy in Patients with Type 2 Diabetes Mellitus

Rhee, Sang Youl; Kim, Hyun Jin; Ko, Seung Hyun; Hur, Kyu Yeon; Kim, Nan Hee; Moon, Min Kyong; Park, Seok O; Lee, Byung Wan; Choi, Kyung Mook; Kim, Jin Hwa

doi:10.4093/dmj.2017.41.5.349

Cited by 14 publications

(8 citation statements)

References 54 publications

(52 reference statements)

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“…Metformin, for example, is generally the antidiabetic of choice because of its efficacy in glycemic control, low incidence of adverse effects, proven safety and favorable impact on weight gain. However, from the time of diagnosis, treatment should include changes in lifestyle (18) .…”

Section: Discussionmentioning

confidence: 99%

Cardiometabolic diseases and active aging - polypharmacy in control

et al. 2020

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Objectives: To estimate the prevalence of cardiometabolic diseases and their association with polypharmacy in elderly people at the University of the Third Age (Portuguese acronym: UnATI). Methods: A cross-sectional, descriptive, analytical study with 121 elderly patients. The prevalence ratio, Pearson’s Chi-square test and Fisher’s exact test were used as measures of association. Results: At the mean age of 68.3, most elderly had at least one cardiometabolic disease (82.6%), of which hypertension was the most prevalent (71.1%), and consumed prescription drugs of continuous use (92.6%). Almost half of the elderly (48.2%) used combinations of drugs, which suggests a high cardiovascular risk. Polypharmacy due to prescription was observed in almost one-third (28.6%) of the sample, associated with the use of antihypertensives (p=0.004), antidiabetics (p=0.000) or lipid-lowering agents (p<0.000). Conclusions: Clinical guidelines recommend changes in lifestyle, but increased pharmacotherapy prevails in practice, which increases the risk of adverse events, especially in old age.

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Section: Discussionmentioning

confidence: 99%

Cardiometabolic diseases and active aging - polypharmacy in control

et al. 2020

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“…3 Both dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose co-transporter 2 (SGLT2) inhibitors are widely used as add-on therapy for patients with type 2 diabetes who are inadequately controlled with metformin, 6 or as first-line therapy for those who are unable to tolerate metformin. 7 However, it is not clear which of the two would be preferential in the absence of increased cardiovascular risk or a previous event of cardiovascular disease. One of the major strengths of these two classes of antidiabetic medications is that they are associated with a minimal risk of hypoglycaemia when used as monotherapy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of gemigliptin and dapagliflozin on glycaemic variability in type 2 diabetes: A randomized, open‐label, active‐controlled, 12‐week study (STABLE II study)

Kwak

Hwang

Won

et al. 2019

Diabetes Obesity Metabolism

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Aims The aim of this study was to compare the effect of gemigliptin, a dipeptidyl peptidase‐4 inhibitor, and dapagliflozin, a sodium glucose co‐transporter‐2 inhibitor, on glycaemic variability in type 2 diabetes patients. Materials and methods In this randomized, blinded end point, multicentre clinical trial, we enrolled 71 patients with type 2 diabetes who were inadequately controlled with metformin alone or were drug naïve. The participants were randomized to receive gemigliptin 50 mg (n = 35) or dapagliflozin 10 mg (n = 36) daily for 12 weeks. Glycaemic variability was estimated by mean amplitude of glycaemic excursions (MAGE), standard deviation (SD) and coefficient of variation (CV) using a 6‐day continuous glucose monitoring system. The primary efficacy endpoint was change in MAGE after 12 weeks compared to baseline. Results Intergroup differences in baseline characteristics were not significant. The adjusted mean change (± standard error) in MAGE after 12 weeks in the gemigliptin and dapagliflozin groups was −27.2 ± 4.4 mg/dL and −7.9 ± 4.9 mg/dL, respectively. Between‐group comparisons showed a significantly larger reduction in MAGE in the gemigliptin group (−19.2 mg/dL; 95% CI, −31.3 to −7.2; P = .002). Measures of SD and CV also showed a significantly larger reduction in the gemigliptin group. Average glycaemic control, estimated by HbA1c, fasting glucose and safety profiles, was comparable between the two groups. Conclusions Compared to dapagliflozin, gemigliptin significantly improved glycaemic variability, with similar glucose‐lowering efficacy and safety profiles in patients with type 2 diabetes who were inadequately controlled with metformin alone or were drug naïve.

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“…The Korean Diabetes Association (KDA) recommends an hemoglobin A1c (HbA1c) level of <6.5% as the general goal of blood glucose level management. [1][2][3][4][5][6][7][8] Most guidelines, such as those of the American Diabetes Association (ADA), [9][10][11][12][13][14] American Association of Clinical Endocrinologists (AACE), 15) European Association for the Study of Diabetes (EASD), 16) and International Diabetes Federation (IDF), 17,18) recommend an HbA1c level of <7.0% based on the stipulation that lowering the HbA1c level to its normal range reduces the risk of diabetes mellitus (DM)-associated complications. Some doctors often perceive this value as an absolute target for hyperglycemic control, but it is not.…”

Section: Introductionmentioning

confidence: 99%

Increasing Individual Target Glucose Levels to Prevent Hypoglycemia in Patients with Diabetes

Shin

Kim

et al. 2021

Korean J Fam Med

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Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients' contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians' factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%-7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%-8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%-9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

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Monotherapy in Patients with Type 2 Diabetes Mellitus

Cited by 14 publications

References 54 publications

Cardiometabolic diseases and active aging - polypharmacy in control

Cardiometabolic diseases and active aging - polypharmacy in control

Comparison of the effects of gemigliptin and dapagliflozin on glycaemic variability in type 2 diabetes: A randomized, open‐label, active‐controlled, 12‐week study (STABLE II study)

Increasing Individual Target Glucose Levels to Prevent Hypoglycemia in Patients with Diabetes

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