目的探讨二甲双胍血糖控制不佳的2型糖尿病患者联合沙格列汀或吡格列酮的疗效。方法选择2015年1月至2016年1月安徽医科大第二附属医院内分泌门诊符合入选条件的2型糖尿病患者70例,随机被分为两组,观察组35例采用沙格列汀+二甲双胍治疗,...目的探讨二甲双胍血糖控制不佳的2型糖尿病患者联合沙格列汀或吡格列酮的疗效。方法选择2015年1月至2016年1月安徽医科大第二附属医院内分泌门诊符合入选条件的2型糖尿病患者70例,随机被分为两组,观察组35例采用沙格列汀+二甲双胍治疗,对照组35例患者采用吡格列酮+二甲双胍治疗,观察两组治疗前后的空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、空腹血清胰岛素水平、胰岛素抵抗指数(HOMA-IR)、体质指数(BMI)等。结果与治疗前比较,治疗16周后观察组、对照组患者的FPG、餐后2 h PG与Hb A1c明显降低,HOMA-IR改善,差异有统计学意义(P<0.05);但两组间差异无统计学意义(P>0.05)。与治疗前比较,治疗16周后观察组BMI无明显变化,差异无统计学意义(P>0.05),对照组患者BMI明显上升,差异有统计学意义(P<0.05),两组间差异有统计学意义(P<0.05)。结论沙格列汀或吡格列酮联合二甲双胍可有效控制2型糖尿病患者血糖、改善胰岛素敏感性,沙格列汀不增加体质量且不良反应小,联合二甲双胍治疗是一种安全可靠的治疗方法。展开更多
Glucagon-like peptide-1(GLP-1)-based therapies have demonstrated efficacy and safety in treating type 2 diabetes, which shares a similar pathophysiological mechanism with non-alcoholic fatty liver disease(NAFLD). Rece...Glucagon-like peptide-1(GLP-1)-based therapies have demonstrated efficacy and safety in treating type 2 diabetes, which shares a similar pathophysiological mechanism with non-alcoholic fatty liver disease(NAFLD). Recent studies showed that glucose-induced GLP-1 secretion was decreased in patients with NAFLD and that the level of dipeptidyl peptidase-4, which inactivates intact GLP-1, was upregulated. Moreover, the expression of the GLP-1 receptor was downregulated in livers from patients with NAFLD, indicating an association of defective GLP-1 signalling with NAFLD. Notably, GLP-1-based therapies are reported to be effective in improving hepatic endpoints in patients with NAFLD, such as reducing hepatic fat content, hepatic steatosis and plasma transaminase levels, and preventing fibrosis. GLP-1-based therapies are beneficial for body weight control and glycaemic normalisation, which are important for the management of NAFLD. Moreover, clinical and preclinical studies showed that GLP-1-based agents might directly exert their actions on the liver through activation of functional GLP-1 receptors in hepatocytes.The possible mechanisms involve regulating gene expression that is associated with insulin resistance and lipid metabolism, and suppressing oxidative stress in the liver cells, thus preventing the development and progression of NAFLD. Based on these promising data, large-scale randomised controlled trials are warranted to assess the efficacy and safety of GLP-1-based therapies in treating NAFLD.展开更多
Non-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome(MS).The current treatment of non-alcoholic fatty liver disease(NAFLD)principally includes amelioration of MS components by ...Non-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome(MS).The current treatment of non-alcoholic fatty liver disease(NAFLD)principally includes amelioration of MS components by lifestyle modifications but the lack of success in their implementation and sustainment arises the need for effective pharmacological agent in fatty liver treatment.Incretins are gut derived hormones secreted into the circulation in response to nutrient ingestion that enhances glucose-stimulated insulin secretion.Glucagon-like peptide-1(GLP-1)is the most important incretin.Its receptor agonist and inhibitors of dipeptidyl peptidase-4(DPP-4)are used in treatment of type2 diabetes mellitus.DPP-4 serum activity and hepatic expression are shown to be elevated in several hepatic diseases.There are several experimental and clinical trials exploring the efficacy of incretin based therapies in NAFLD treatment.They suggest that GLP-1 analogues might have beneficial effect on hepatic steatosis acting as insulin sensitizers and directly by stimulating GLP-1 receptors expressed on hepatocytes.The use of DPP-4 inhibitors also results in hepatic fat reduction but the mechanism of action remains unclear.There is growing evidence that incretin based therapies have beneficial effects on hepatocytes,however further study analysis are needed to assess the long term effect of incretin based therapies on NAFLD.展开更多
AIM:To evaluate the efficacy and safety of the addition of vildagliptin to low-dose metformin and compare it to an uptitration of metformin in type 2 diabetes mellitus(T2DM) patients who have inadequate control with m...AIM:To evaluate the efficacy and safety of the addition of vildagliptin to low-dose metformin and compare it to an uptitration of metformin in type 2 diabetes mellitus(T2DM) patients who have inadequate control with metformin monotherapy.METHODS:Eligible patients were randomized to receive vildagliptin 100 mg qd or metformin(500 mg qd for 2 wk and then 500 mg bid) added to open label me tformin 500 mg bid for the 24 wk.The primary endpoi nt was baseline to endpoint hemoglobin A1c(HbA1c) change.RESULTS:The adjusted mean change from baseline in HbA1c at the 24th wk was-0.51% in the vildagliptin/metformin group(mean baseline HbA1c:7.4%) and-0.37% in the metformin monothera py group(mean baseline HbA1c:7.3%).The mean diffe rence was-0.14% with 95% Confidence Interval(-0.24%,-0.05%).As non-inf e riority(margin of 0.4%) was achieved,a test for superiority was performed.This test showed statistically significant superiority of the combination over monotherapy group(P = 0.002).Gastrointestinal(GI) adverse events were signif icantly more frequent in the metformin group than the combin ation group(21.0% vs 15.4%,P = 0.032).CONCLUSION:In patients with T2DM inadequately controlled with metformin up to 1000 mg daily,the addition of vildagliptin 100 mg daily achieved larger HbA1c reduction with fewer GI events than with increa sing the metformin dose.展开更多
BACKGROUND Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have shown efficacy in reducing heart failure(HF)burden in a very heterogeneous groups of patients,raising doubts about some contemporary assumptions...BACKGROUND Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have shown efficacy in reducing heart failure(HF)burden in a very heterogeneous groups of patients,raising doubts about some contemporary assumptions of their mechanism of action.We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy.Two groups of patients were included in the study:the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.AIM To evaluate the outcomes regarding natriuretic peptide,oxidative stress,inflammation,blood pressure,heart rate,cardiac function,and body weight.METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain(GLS),N-terminal pro-brain natriuretic peptide,myeloperoxidase(MPO),high-sensitivity C-reactive protein(hsCRP),and systolic and diastolic blood pressure.To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up,a rise in stroke volume index,body mass index(BMI)decrease,and lack of heart rate increase,linear regression analysis was performed.RESULTS There was a greater reduction of MPO,hsCRP,GLS,and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up.Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI,while the predictor of stroke volume index increase was SGLT2i therapy itself.CONCLUSION SGLT2i affect body composition,reduce cardiac load,improve diastolic/systolic function,and attenuate the sympathetic response.Glycemic control contributes to the improvement of heart function,blood pressure cont展开更多
The addition of the dipeptidyl peptidase-4 (DDP-4) inhibitor has been reported to achieve greater improvements in glucose metabolism with fewer adverse events compared to increasing the metformin dose in type 2 diabet...The addition of the dipeptidyl peptidase-4 (DDP-4) inhibitor has been reported to achieve greater improvements in glucose metabolism with fewer adverse events compared to increasing the metformin dose in type 2 diabetic patients. We present a patient with steroid-induced diabetes whose blood glucose levels were ameliorated by the use of the DPP-4 inhibitor, showing that the DPP-4 inhibitors may be an effective and safe oral anti-diabetic drug for steroid-induced diabetes.展开更多
文摘目的探讨二甲双胍血糖控制不佳的2型糖尿病患者联合沙格列汀或吡格列酮的疗效。方法选择2015年1月至2016年1月安徽医科大第二附属医院内分泌门诊符合入选条件的2型糖尿病患者70例,随机被分为两组,观察组35例采用沙格列汀+二甲双胍治疗,对照组35例患者采用吡格列酮+二甲双胍治疗,观察两组治疗前后的空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、空腹血清胰岛素水平、胰岛素抵抗指数(HOMA-IR)、体质指数(BMI)等。结果与治疗前比较,治疗16周后观察组、对照组患者的FPG、餐后2 h PG与Hb A1c明显降低,HOMA-IR改善,差异有统计学意义(P<0.05);但两组间差异无统计学意义(P>0.05)。与治疗前比较,治疗16周后观察组BMI无明显变化,差异无统计学意义(P>0.05),对照组患者BMI明显上升,差异有统计学意义(P<0.05),两组间差异有统计学意义(P<0.05)。结论沙格列汀或吡格列酮联合二甲双胍可有效控制2型糖尿病患者血糖、改善胰岛素敏感性,沙格列汀不增加体质量且不良反应小,联合二甲双胍治疗是一种安全可靠的治疗方法。
基金Supported by Chinese National 973 Program No.2012CB517502the Research Fund for the Doctoral Program of Higher Education of China No.20120001120069
文摘Glucagon-like peptide-1(GLP-1)-based therapies have demonstrated efficacy and safety in treating type 2 diabetes, which shares a similar pathophysiological mechanism with non-alcoholic fatty liver disease(NAFLD). Recent studies showed that glucose-induced GLP-1 secretion was decreased in patients with NAFLD and that the level of dipeptidyl peptidase-4, which inactivates intact GLP-1, was upregulated. Moreover, the expression of the GLP-1 receptor was downregulated in livers from patients with NAFLD, indicating an association of defective GLP-1 signalling with NAFLD. Notably, GLP-1-based therapies are reported to be effective in improving hepatic endpoints in patients with NAFLD, such as reducing hepatic fat content, hepatic steatosis and plasma transaminase levels, and preventing fibrosis. GLP-1-based therapies are beneficial for body weight control and glycaemic normalisation, which are important for the management of NAFLD. Moreover, clinical and preclinical studies showed that GLP-1-based agents might directly exert their actions on the liver through activation of functional GLP-1 receptors in hepatocytes.The possible mechanisms involve regulating gene expression that is associated with insulin resistance and lipid metabolism, and suppressing oxidative stress in the liver cells, thus preventing the development and progression of NAFLD. Based on these promising data, large-scale randomised controlled trials are warranted to assess the efficacy and safety of GLP-1-based therapies in treating NAFLD.
文摘Non-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome(MS).The current treatment of non-alcoholic fatty liver disease(NAFLD)principally includes amelioration of MS components by lifestyle modifications but the lack of success in their implementation and sustainment arises the need for effective pharmacological agent in fatty liver treatment.Incretins are gut derived hormones secreted into the circulation in response to nutrient ingestion that enhances glucose-stimulated insulin secretion.Glucagon-like peptide-1(GLP-1)is the most important incretin.Its receptor agonist and inhibitors of dipeptidyl peptidase-4(DPP-4)are used in treatment of type2 diabetes mellitus.DPP-4 serum activity and hepatic expression are shown to be elevated in several hepatic diseases.There are several experimental and clinical trials exploring the efficacy of incretin based therapies in NAFLD treatment.They suggest that GLP-1 analogues might have beneficial effect on hepatic steatosis acting as insulin sensitizers and directly by stimulating GLP-1 receptors expressed on hepatocytes.The use of DPP-4 inhibitors also results in hepatic fat reduction but the mechanism of action remains unclear.There is growing evidence that incretin based therapies have beneficial effects on hepatocytes,however further study analysis are needed to assess the long term effect of incretin based therapies on NAFLD.
基金Supported by Novartis Pharmaceuticals Corporation, NC-T00396357
文摘AIM:To evaluate the efficacy and safety of the addition of vildagliptin to low-dose metformin and compare it to an uptitration of metformin in type 2 diabetes mellitus(T2DM) patients who have inadequate control with metformin monotherapy.METHODS:Eligible patients were randomized to receive vildagliptin 100 mg qd or metformin(500 mg qd for 2 wk and then 500 mg bid) added to open label me tformin 500 mg bid for the 24 wk.The primary endpoi nt was baseline to endpoint hemoglobin A1c(HbA1c) change.RESULTS:The adjusted mean change from baseline in HbA1c at the 24th wk was-0.51% in the vildagliptin/metformin group(mean baseline HbA1c:7.4%) and-0.37% in the metformin monothera py group(mean baseline HbA1c:7.3%).The mean diffe rence was-0.14% with 95% Confidence Interval(-0.24%,-0.05%).As non-inf e riority(margin of 0.4%) was achieved,a test for superiority was performed.This test showed statistically significant superiority of the combination over monotherapy group(P = 0.002).Gastrointestinal(GI) adverse events were signif icantly more frequent in the metformin group than the combin ation group(21.0% vs 15.4%,P = 0.032).CONCLUSION:In patients with T2DM inadequately controlled with metformin up to 1000 mg daily,the addition of vildagliptin 100 mg daily achieved larger HbA1c reduction with fewer GI events than with increa sing the metformin dose.
文摘BACKGROUND Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have shown efficacy in reducing heart failure(HF)burden in a very heterogeneous groups of patients,raising doubts about some contemporary assumptions of their mechanism of action.We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy.Two groups of patients were included in the study:the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.AIM To evaluate the outcomes regarding natriuretic peptide,oxidative stress,inflammation,blood pressure,heart rate,cardiac function,and body weight.METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain(GLS),N-terminal pro-brain natriuretic peptide,myeloperoxidase(MPO),high-sensitivity C-reactive protein(hsCRP),and systolic and diastolic blood pressure.To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up,a rise in stroke volume index,body mass index(BMI)decrease,and lack of heart rate increase,linear regression analysis was performed.RESULTS There was a greater reduction of MPO,hsCRP,GLS,and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up.Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI,while the predictor of stroke volume index increase was SGLT2i therapy itself.CONCLUSION SGLT2i affect body composition,reduce cardiac load,improve diastolic/systolic function,and attenuate the sympathetic response.Glycemic control contributes to the improvement of heart function,blood pressure cont
文摘The addition of the dipeptidyl peptidase-4 (DDP-4) inhibitor has been reported to achieve greater improvements in glucose metabolism with fewer adverse events compared to increasing the metformin dose in type 2 diabetic patients. We present a patient with steroid-induced diabetes whose blood glucose levels were ameliorated by the use of the DPP-4 inhibitor, showing that the DPP-4 inhibitors may be an effective and safe oral anti-diabetic drug for steroid-induced diabetes.
