- Safety of Once-weekly Glucagon-like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes. [Journal Article]
- JFJ Fam Pract 2018; 67(6 suppl):S25-S34
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been found efficacious in the treatment of type 2 diabetes (T2D), demonstrating the ability to lower HbA1c, and having the potential for ind...
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been found efficacious in the treatment of type 2 diabetes (T2D), demonstrating the ability to lower HbA1c, and having the potential for inducing weight loss and reducing the risk of hypoglycemia, compared with other antihyperglycemic agents. Currently, 4 once-weekly (OW) GLP-1 RAs are approved: albiglutide, dulaglutide, exenatide ER, and recently, semaglutide. This review compares the relative safety of OW GLP-1 RAs, as well as their safety in comparison to other antihyperglycemic agents, using safety data reported in key sponsor-led phase 3 studies of the 4 OW GLP-1 RAs. The favorable safety profiles of OW GLP-1 RAs, added to their efficacy and the favorable weekly dosing regimen, make these agents appropriate options for patients with T2D. However, there are key differences within this class of drugs in macrovascular, microvascular, gastrointestinal and injection-site reaction adverse events, and these should be considered when healthcare providers are prescribing therapy.
- The Pharmacokinetic Properties of Glucagon-like Peptide-1 Receptor Agonists and Their Mode and Mechanism of Action in Patients with Type 2 Diabetes. [Journal Article]
- JFJ Fam Pract 2018; 67(6 suppl):S8-S13
- Once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated improved glycemic control in patients with type 2 diabetes (T2D), and some have a number of other benefits, in...
Once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated improved glycemic control in patients with type 2 diabetes (T2D), and some have a number of other benefits, including weight loss, improvements in blood pressure and lipid profiles, and cardiovascular protection. They also provide a therapy option with a low risk of hypoglycemia, an attractive choice for many patients. Molecular structure and pharmacokinetic properties vary among GLP-1 RAs, with some more closely related than others to native glucagon-like peptide-1 (GLP-1). OW GLP-1 RAs have various modifications to their molecular structure that make the molecules resistant to degradation by dipeptidyl peptidase-4 (DPP-4), increasing the half-life of these drugs and making them suitable for OW administration. These differences in the molecular structures and pharmacokinetic properties between the various OW GLP-1 RAs help to explain the differences in efficacy, mechanisms, and safety profiles among the drugs, and these considerations can help primary care physicians to optimize prescribing practices.
- An Overview of the Burden of Illness and the Role of Once-Weekly Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Type 2 Diabetes. [Journal Article]
- JFJ Fam Pract 2018; 67(6 suppl):S3-S7
- Type 2 diabetes (T2D) is a debilitating condition and more people are being diagnosed each year. T2D increases patients' risk of developing disabling micro- and macrovascular complications, significa...
Type 2 diabetes (T2D) is a debilitating condition and more people are being diagnosed each year. T2D increases patients' risk of developing disabling micro- and macrovascular complications, significantly reduces patients' quality of life, and is a substantial global economic burden. The efficacy and safety of antihyperglycemic therapies have improved over the years and have increased the lifespan for these patients. Consequently, patients are living longer with the condition and the associated comorbidities, but with a lowered quality of life. Therefore, therapies should aim to provide both optimal glycemic control and improve quality of life. Glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy improves glycemic control, reduces body weight, and has a low risk for hypoglycemia. GLP-1 RAs are available as once-daily (OD), twice-daily (BD), or once-weekly (OW) injectable formulations; OW injections may increase patients' satisfaction and improve treatment adherence. In the last decade, concern has been raised about the cardiovascular (CV) safety of antihyperglycemic therapies. Clinical data have been limited on CV outcomes among OW GLP-1 RAs. However, a post hoc analysis of the SUSTAIN-6 trial suggested that semaglutide, the most recently US Food and Drug Administration (FDA)-approved OW GLP-1 RA therapy, may offer cardioprotection, addressing this previously unmet clinical need.
- A Case of Linezolid Induced Toxicity. [Journal Article]
- JPJ Pharm Pract 2018 Jan 01; :897190018782787
- Adverse effects of linezolid are typically limited to diarrhea, nausea, and headache when shorter durations are used; however, as extended durations of linezolid therapy are increasingly more common,...
Adverse effects of linezolid are typically limited to diarrhea, nausea, and headache when shorter durations are used; however, as extended durations of linezolid therapy are increasingly more common, additional monitoring parameters should be considered in these patients. We describe a unique case of hypoglycemia, lactic acidosis, and pancreatitis related to an extended duration of linezolid therapy. A 52-year-old woman presented with altered mental status, abdominal pain, and hypotension following six weeks of linezolid and ertapenem therapy. Laboratory data revealed an initial blood glucose of 40 mg/dL and metabolic acidosis secondary to lactic acidosis. Finally, her abdominal pain on admission was likely related to an enlarged pancreas noted on computed tomography of her abdomen. Due to suspected linezolid toxicity, the patient received two intermittent hemodialysis sessions to remove linezolid and correct the metabolic acidosis. Given limited data on long-term monitoring of patients receiving extended durations of linezolid therapy, we suggest periodic monitoring of lactate, arterial blood gas, and blood glucose. If patients present with this triad of symptoms secondary to linezolid therapy, adverse effects should be treated with dextrose and intravenous thiamine while reserving hemodialysis for those with metabolic acidosis refractory to thiamine.
- Hypoglycemia in dogs: Causes, management, and diagnosis. [Review]
- CVCan Vet J 2018; 59(6):642-649
- Hypogylcemia in dogs is defined as a blood glucose concentration of less than 3.3 mmol/L (60 mg/dL) and is a relatively common problem encountered in veterinary practice. This metabolic disorder can ...
Hypogylcemia in dogs is defined as a blood glucose concentration of less than 3.3 mmol/L (60 mg/dL) and is a relatively common problem encountered in veterinary practice. This metabolic disorder can have an array of clinical signs, ranging from subtle abnormalities to a life-threatening emergency. Hypoglycemia can be due to several physiological processes or etiologies. It is imperative that the clinician is astute in diagnosing hypoglycemia, proficient in providing rapid symptomatic treatment (if indicated) and has a clear diagnostic plan to elucidate the underlying cause. This article reviews the pathophysiology, most common etiologies, and emergency management of hypoglycemia, and presents a diagnostic approach for this problem.
- Are We Compensating for the Lack of Physical Activity in Our Diabetic Patients with Treatment Intensification? [Journal Article]
- SSports (Basel) 2017 Aug 07; 5(3)
- CONCLUSIONS: LTPA has an influence on the regulation of diabetes type 1, and intensification of medical treatment is compensating for the lack of lifestyle change-especially in type 2 diabetics.
- Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial. [Journal Article]
- LDLancet Diabetes Endocrinol 2018 Jun 14
- CONCLUSIONS: In patients with type 2 diabetes and moderate-to-severe chronic kidney disease, once-weekly dulaglutide produced glycaemic control similar to that achieved with insulin glargine, with reduced decline in eGFR. Dulaglutide seems to be safe to use to achieve glycaemic control in patients with moderate-to-severe chronic kidney disease.
- We Can Work (It) Out Together: Type 1 Diabetes Boot Camp for Adult Patients and Providers Improves Exercise Self-Efficacy. [Journal Article]
- CJCan J Diabetes 2018 Feb 21
- CONCLUSIONS: These findings suggest that a 4-week education- and exercise-focused program improves DCPs' self-efficacy in providing exercise advice to patients. People with type 1 diabetes did not experience an improvement in exercise self-efficacy; however, the study supports the use of continuous glucose monitoring and the grouping of DCPs and individuals with type 1 diabetes to facilitate experiential learning.
- Effect of telemedicine intervention on hypoglycaemia in diabetes patients: A systematic review and meta-analysis of randomised controlled trials. [Journal Article]
- JTJ Telemed Telecare 2018 Jan 01; :1357633X18776823
- Introduction Hypoglycaemia is a clinical syndrome from various causes, which happens when the blood glucose concentration is too low. Many studies show that telemedicine intervention can improve glyc...
Introduction Hypoglycaemia is a clinical syndrome from various causes, which happens when the blood glucose concentration is too low. Many studies show that telemedicine intervention can improve glycemic control and has a positive impact on the management of diabetic patients. The purpose of this study was to evaluate the effect of telemedicine intervention on hypoglycemic event occurrences and results on hemoglobin A1c (HbA1c) and body mass index (BMI). Methods We searched the Cochrane Library, PubMed, Web of Science, the EBSCO host, and OVID to identify relevant studies published from January 2006 to December 2017. The work of searching, selecting and assessing risk of bias was administrated by two independent reviewers. The primary outcomes were hypoglycemic event rate and HbA1c; the secondary outcome was BMI. Results From 1246 articles, we identified 14 eligible RCTs ( n = 1324). Compared to usual care, telemedicine was found to reduce the odds of hypoglycaemia (odds ratio ( OR) = 0.42; 95% confidence interval ( CI) = 0.29-0.59; I2 = 32%; p < 0.00001). We found that the clinical relevance declined in HbA1c level compared to control group (mean difference = -0.28; 95% CI = -0.45 to -0.12; I2 = 53%; p = 0.0005), but that telemedicine had no effect on BMI (mean difference = -0.27; 95% CI = -0.86-0.31; I2 = 40%; p = 0.35). Discussion Compared to usual care, the use of telemedicine was found to improve HbA1c and reduce the risk of moderate hypoglycaemia in diabetic patients, but without significant difference in BMI.
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- [Management of diabetes in patients with hypertension]. [Journal Article]
- HRHipertens Riesgo Vasc 2017; 34 Suppl 2:30-34
- The diabetes mellitus is a group of metabolic diseases whose common link is hyperglycemia secondary to a deficit of insulin secretion, the defect of metabolic activity or both, causing micro and / or...
The diabetes mellitus is a group of metabolic diseases whose common link is hyperglycemia secondary to a deficit of insulin secretion, the defect of metabolic activity or both, causing micro and / or macrovascular chronic complications. Its prevalence is 13.6% and the direct costs of 2,500 million euros annually. Proper management of diabetes in hypertensive patients includes reaching a comprehensive control of all cardiovascular risk factors present. Objectives should be individualized depending on various factors such as age, duration of diabetes, presence or absence of complications and frequency of hypoglycemia, the capacity of each patient based on their cognitive status, support socio-family and Life expectancy. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.