Author Reply: About the discrepancies between consensus documents, clinical practice guidelines, and legal regulations in the treatment of type 2 diabetes (original) (raw)
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International Journal of Applied Pharmaceutics, 2020
Objective: Renal disease complications in type 2 diabetes mellitus patients are characterized by progressive urinary albumin excretion and decreased glomerular filtration. The drugs most commonly prescribed as antidiabetic therapy in Indonesia are metformin and sulfonylurea. It is still unclear whether the effect of metformin-sulfonylurea on kidney is different from that of metformin monotherapy. Methods: We compared the effectiveness of metformin monotherapy and metformin-sulfonylurea combination to the urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) as renal function parameters. Study subjects were patients on either of these drug regimens for at least 1 year. We collected 88 samples from type 2 diabetes mellitus patients (37 patients on metformin and 51 on metforminsulfonylurea). The patients fasted for 8 h before urine and blood collection for UACR and eGFR analysis. We measured the eGFR using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, serum creatinine, and urine creatinine by colorimetric enzymatic assay, and urine albumin by immunoturbidimetry. Results: The eGFR level in the metformin and metformin-sulfonylurea groups was within the normal range, but lower in the metformin group (79.59±2.81) than in the metformin-sulfonylurea group (87.82±2.82) (p=0.018). In addition, hyperfiltration cases were more frequent in metforminsulfonylurea group (p=0.029). The UACR in patients taking metformin-sulfonylurea (177.95±60.92) was higher than that in the metformin group (49.58±14.19) but the difference between them was not significant (p=0.099). Conclusion: Metformin monotherapy was associated with a lower frequency of hyperfiltration and lower UACR level compared to metforminsulfonylurea combination.
… Journal of PharmTech …, 2009
The aim of the present study is to compare the effect of metformin in combination with Glimepiride and Glibenclamide In patient with type 2 Diabetes Mellitus. Subjects and method: This is an open-label, randomized study carried out to study the effect of metformin when it is given in combination with either glimepiride or glibenclamide on glycaemic control in patient with type 2 Diabetes Mellitus. Patients with Glycosylated Hemoglobin more than 7% were included in the study. 31 patients were randomly assigned for treatment based on metformin-glibenclamide 1000/10 mg tablets or metformin-glimepiride1000/2mg for 12 weeks. The comparisons were conducted between these two groups for HbA 1C , FPG, PPG and lipid profile. Result: At week 12, the significant reductions in HbA1c were found in both groups but the patients treated with metformin-glimepiride resulted in significantly greater reductions in HbA 1C (-1.4%) than metformin-glibenclamide (-1.2%). Also the greater significant reductions were observed in case of FPG, total cholesterole, serum triglyceride and LDL cholesterole in patient with metformin-glimepiride group. Conclusion: Metformin-glimepiride tablets resulted in significantly greater reductions in HbA 1C and fasting plasma glucose compared with metformin plus glibenclamide in patients with type 2 diabetes mellitus.
Use of metformin according to renal function in patients with type II diabetes
2021
Diabetes is a long-term condition that causes a person’s blood sugar level to become too high [1]. Chronic diabetes conditions include type I and type II diabetes [1]. Type II diabetes is due to a progressive insulin secretory defect on the background of insulin resistance [2]. It is the more common type of diabetes which can develop at any age [1]. Though it is more common in people older than 40s, ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance [1,3]. It accounts for 90%-95% of those with diabetes, previously referred as non-insulin-dependent diabetes, or adult-onset diabetes [1,3]. It encompasses individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency [4]. At least initially, and often throughout their lifetime, those individuals do not need insulin treatment to survive. There are probably many different causes of this form of dia...
Diabetes Treatment in Patients with Renal Disease—How Many Are Receiving Contraindicated Drugs?
Diabetes, 2018
Diabetes is the most important risk factors for chronic kidney disease (CKD). The risk of CKD attributable to diabetes continues to rise worldwide. Diabetic patients with CKD need complicated treatment for their metabolic disorders as well as for related comorbidities. They have to treat, often intensively, hypertension, dyslipidaemia, bone disease, anaemia, and frequently established cardiovascular disease. The treatment of hypoglycaemia in diabetic persons with CKD must tie their individual goals of glycaemia (usually less tight glycaemic control) and knowledge on the pharmacokinetics and pharmacodynamics of drugs available to a person with kidney disease. The problem is complicated from the fact that in many efficacy studies patients with CKD are excluded so data of safety and efficacy for these patients are missing. This results in fear of use by lack of evidence. Metformin is globally accepted as the first choice in practically all therapeutic algorithms for diabetic subjects. The advantages of metformin are low risk of hypoglycaemia, modest weight loss, effectiveness and low cost. Data of UKPDS indicate that treatment based on metformin results in less total as well cardiovascular mortality. Metformin remains the drug of choice for patients with diabetes and CKD provided that their estimate Glomerular Filtration Rate (eGFR) remains above 30 mL/min per square meter. For diabetic patients with eGFR between 30-60 mL/min per square meter more frequent monitoring of renal function and dose reduction of metformin is needed. The use of sulfonylureas, glinides and insulin carry a higher risk of hypoglycemia in these patients and must be very careful. Lower doses and slower titration of the dose is needed. Is better to avoid sulfonylureas with active hepatic metabolites, which are renally excreted. Very useful drugs for this group of patients emerge dipeptidyl peptidase 4 inhibitors. These drugs do not cause hypoglycemia and most of them (linagliptin is an exception) require dose reduction in various stages of renal disease.
Journal of Nephropathology, 2019
There are few publications reporting adverse effects of metformin for patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Although some of these reports have made big claims about the adverse effects of metformin in patients with renal failure, the majority of studies showed a superior safety profile for metformin compared with other antidiabetic medications in these patients. Further, metformin use is not contributing to an increased incidence of acute kidney injury (AKI). In conclusion, we suggest that a low dose of metformin is safe to use in patients with or without CKD. Multicenter randomized trials are required to further discover the benefits of the risk of metformin therapy in different stages of CKD and its effect on progression of CKD.
Diabetes, Obesity and Metabolism, 2009
Aim: To assess the efficacy and safety of a new repaglinide/metformin fixed-dose combination (FDC) tablet administered either twice a day (BID) or three times a day (TID) for the management of type 2 diabetes. Methods: This was a 26-week, multicentre, open-label parallel trial in which subjects poorly controlled with mono-or dual-oral antidiabetic therapy were randomized 1 : 1 : 1 to instead receive repaglinide/metformin FDC either BID or TID or a rosiglitazone/metformin FDC BID. Two primary hypotheses were tested in a hierarchical manner: (i) treatment with the repaglinide/metformin FDC BID is non-inferior to that of the rosiglitazone/metformin FDC BID as measured by changes in haemoglobin A1c (HbA1c) (results presented in companion paper) and (ii) repaglinide/ metformin BID is non-inferior to repaglinide/metformin TID (as measured by changes in HbA1c). Additional efficacy and safety end-points were also assessed. Results: A total of 561 subjects were randomized; 383 completed the study. Repaglinide/metformin FDC BID was non-inferior to repaglinide/metformin FDC TID with respect to HbA1c. Additionally, changes in mean fasting plasma glucose values from baseline to end of study were not significantly different between the BID and the TID dose groups. There were no major hypoglycaemic episodes reported in either group during the trial, and overall adverse event profiles were similar. Conclusion: The efficacy of twice-daily dosing of a repaglinide/metformin FDC tablet was non-inferior to that of threetimes-daily dosing.