Monotherapy with the once-weekly GLP-1 analogue dulaglutide for 12 weeks in patients with Type 2 diabetes: dose-dependent effects on glycaemic control in a randomized, double-blind, placebo-controlled study

Diabet. Med. 29, 1260-1267 (2012) ABSTRACT: Aims Evaluate dose-dependent effects of once-weekly dulaglutide, a glucagon-like peptide-1 analogue, on glycaemic control in patients with Type?2 diabetes treated with lifestyle measures with or without previous metformin. Methods This 12-week, double-blind, placebo-controlled, dose-response trial randomized 167 patients who were anti-hyperglycaemic medication-na?ve or had discontinued metformin monotherapy [mean baseline HbA(1c) 59?±?8 to 61?±?8?mmol/mol (7.6?±?0.7 to 7.8?±?0.8%)] to once-weekly injections of placebo or dulaglutide (0.1, 0.5, 1.0 or 1.5?mg). Results A significant dose-dependent reduction in HbA(1c) (least squares mean?±?se) was observed across doses (P?相似文献   

Multifactorial risk factor intervention in patients with Type 2 diabetes improves arginine bioavailability ratios

Diabet. Med. 29, e365-e368 (2012) ABSTRACT: Aim Endothelial dysfunction is defined by reduced bioavailability of nitric oxide and has been shown to be associated with cardiovascular risk. The global arginine bioavailability ratio and the arginine to ornithine ratio have recently been shown to be associated with cardiovascular outcome in patients with coronary artery disease. The aim of our study was to investigate the impact of a multifactorial risk factor intervention in subjects with Type?2 diabetes on these two potential new cardiovascular surrogate parameters. Methods In a single-centre and prospective study, we investigated 41 patients with Type?2 diabetes not reaching treatment targets according to current local diabetes guidelines in two out of three of the following measurements: HbA(1c) LDL cholesterol 2.6 or blood pressure. Within 3?months, therapy was intensified according to current guidelines aiming to reach the treatment targets. At baseline and 3?months, arginine, ornithine and citrulline were chromatographically determined after pre-column-derivatization followed by fluorescent detection, and arginine bioavailability ratios were calculated. Results Intensified risk factor management significantly improved the global arginine bioavailability ratio (0.33?±?0.12 at baseline vs. 0.38?±?0.14 after 3?months; P?=?0.018). A significant improvement was only seen in patients with short diabetes duration (相似文献   

Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study

Diabet. Med. 29, e326-e333 (2012) ABSTRACT: Aims To evaluate the impact of a pharmacist-led patient education and diabetes monitoring programme on HbA(1c) and other cardiovascular risk factors in the community setting. Methods Patients with Type?2 diabetes (n?=?46) attending two community pharmacies in Hertfordshire, UK were randomized to one of two groups. Patients in the intervention group (n?=?23) received a programme of education about diabetes, its treatment and associated cardiovascular risk factors. These patients were seen for monitoring/counselling by a community pharmacist on six occasions over a 12-month period. Measures included HbA(1c) , BMI, blood pressure, blood glucose and lipid profile. Patients in the control group (n?=?23) underwent these measurements at baseline and at 12?months only, without specific counselling or education over and above usual care. Results HbA(1c) fell from 66?mmol/mol (8.2%) to 49?mmol/mol (6.6%) (P?相似文献   

A randomized non-inferiority study comparing the addition of exenatide twice daily to sitagliptin or switching from sitagliptin to exenatide twice daily in patients with Type 2 diabetes experiencing inadequate glycaemic control on metformin and sitagliptin

Aims To test the hypothesis that glycaemic control achieved when switching sitagliptin to exenatide twice daily plus metformin is non-inferior to adding exenatide twice daily to sitagliptin and metformin. Methods Patients with Type?2 diabetes inadequately controlled with sitagliptin plus metformin were randomly assigned to 20?weeks of treatment with twice-daily exenatide plus placebo and metformin (SWITCH, n?=?127) or twice-daily exenatide plus sitagliptin and metformin (ADD, n?=?128). Results Non-inferiority (0.4% margin) of SWITCH to ADD treatment, measured by change in HbA(1c) from baseline to week?20, was not shown {between-treatment difference in least-squares mean [95%?CI 3?mmol/mol (0.30%)] [0.8-5.8 (0.07-0.53)]}. A greater reduction (P?=?0.012) in HbA(1c) [least-squares mean (se)] was experienced by patients in the ADD group {-7?mmol/mol [-0.68%] [0.9 (0.08)]}, compared with those in the SWITCH group {-4?mmol/mol [-0.38%] [1.0 (0.09)]} and a greater proportion (P?=?0.027) of patients in the ADD group (41.7%) reached 相似文献   

Vildagliptin in drug-na?ve patients with type 2 diabetes: a 24-week, double-blind, randomized, placebo-controlled, multiple-dose study.

This 24-week double-blind, randomized, multicenter, placebo-controlled, parallel-group study was performed in 632 drug-na?ve patients with type 2 diabetes to assess efficacy and tolerability of vildagliptin (50 mg qd, 50 mg bid, or 100 mg qd). HbA1c decreased modestly in patients receiving placebo (Delta=-0.3+/-0.1%) and to a significantly greater extent in patients receiving vildagliptin 50 mg qd (Delta=-0.8+/-0 .1%), 50 mg bid (Delta=-0.8+/-0.1%), or 100 mg qd (Delta=-0.9+/-0.1%, p<0.01 for all groups VS. placebo) from an average baseline of 8.4%. In patients diagnosed >or=3 months before enrollment, HbA1c increased with placebo (Delta=+0.2+/-0.2%) and between-treatment differences (vildagliptin-placebo) were -0.8+/-0.2% (p<0.001), -0.7+/-0.2% (p=0.003), and -0.9+/-0.2% (p<0.001) with vildagliptin 50 mg qd, 50 mg bid, and 100 mg qd, respectively. There was no apparent dose-response in the overall population; however, in patients with high baseline HbA1c, there were greater reductions with either 100 mg dose regimen (Delta=-1.3+/-0.2% and -1.4+/-0.2%) compared to 50 mg qd (Delta=-0.8+/-0.1%). Body weight decreased modestly in all groups (by 0.3 to 1.8 kg). The incidence of adverse events was similar across all groups and 相似文献   

Is subclinical hypothyroidism contributing dyslipidemia and insulin resistance in women with polycystic ovary syndrome?

We aimed to analyze lipid parameters and determine the need for a 2-hour oral glucose tolerance test (OGTT) for the identification of IR and impaired glucose tolerance test (IGT) in subclinical hypothyroidism (SCH) women with and without polycystic ovary syndrome (PCOS). 20 patients with PCOS and SCH consisted of Group I and 39 patients with PCOS and normal thyroid function consisted of Group II and 53 healthy women with normal thyroid function consisted of Group III. Triglyceride levels were 143.26?±?99.86?mg/dL in group 1 and 88.56?±?37.56?mg/dL in group 2 and 83.71?±?31.94?mg/dL in group 3 which were statistically significant. Total cholesterol, HDL- cholesterol, LDL-cholesterol were found similar between the groups. Fasting insulin levels were 12.45?±?8.62 μU/mL in group 1 and 8.60?±?5.35 μU/mL in group 2 and 7.04?±?3.55 μU/mL in group 3 which were statistically significant (P?=?0.027). HOMA-IR were 2.92?±?2.34 in group 1 and 1.95?±?1.52 in group 2 and 1.60?±?0.86 in group 3 which were statistically significant (P?=?0.046). This study showed that women with PCOS and subclinical hypothyroidism should be evaluated for dyslipidemia and Insulin resistance.     

Activity of isoflavones and berberine on vasomotor symptoms and lipid profile in menopausal women

The aim of this study was to evaluate the efficacy of a food supplement combination based on isoflavones and berberine (ISB) in the treatment of menopausal symptoms and dyslipidaemia. Isoflavones are extracted from soy and absorbed in the body after being activated by lactobacillus. Berberine, extracted from the plant Berberis aristata, lowers plasma cholesterol and triglycerides (TG) by increasing low-density lipoprotein (LDL) receptors and reducing hepatic synthesis of TG. One hundred twenty women with a mean age of 54.8?±?0.6 years were enrolled and randomized to treatment with ISB (estromineral lipid [EL]?=?60 cases) or calcium and vitamin D(3) (CaD?=?60 cases). Menopausal symptoms, plasma cholesterol, and TG were evaluated at baseline, and after 4 and 12 weeks. EL treatment significantly lowered plasma total cholesterol (-13.5% ± 0.7 vs -0.2% ± 0.5), LDL cholesterol (-12.4% ± 1.5 vs + 0.8 % ± 0.7) and TG (-18.9% ± 2.5 vs -1.3% ± 1.2) and improved menopausal symptoms compared with CaD treatment. Safety parameters were unchanged during the study. The combination of berberine and isoflavones was effective in lowering cardiovascular (CV) risk factors in menopausal women with moderate dyslipidaemia and in improving their quality of life.     

Cardiovascular risk in obese and nonobese patients with type 2 diabetes in the West Indies

OBJECTIVE: To evaluate the impact of obesity on glycemic control and the risk of progressing to cardiovascular disease (CVD) in obese and nonobese type 2 diabetic patients in primary care settings. METHODS: One hundred and ninety patients (64 men, 126 women) with type 2 diabetes (mean duration 9.2 years) were studied after an overnight fast. Weight, height, waist and hip circumferences and blood pressure were measured and blood samples were taken for glucose, glycated hemoglobin (HbA(1c)), total cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and creatinine determinations. RESULTS: About 85% of the patients had HbA(1c) levels > 7.0%, and 48% had a diastolic blood pressure (BP) >83 mm Hg, while 40% had a total cholesterol/HDL-cholesterol ratio greater than 6. The prevalence rates of hypercholesterolemia, hypertriglyceridemia, high BP and ratios of total cholesterol to HDL-cholesterol between the obese and nonobese patients were similar irrespective of sex (p > 0.05). Multiple linear regression analysis confirmed that ethnicity, sex, age and duration of diabetes had significant impact on the cardiovascular risk in this population. CONCLUSION: Both obese and nonobese diabetic patients had poor glycemic control and their risk of CVD was not independent of age, sex, ethnicity and duration of diabetes. We suggest strict metabolic control and improved diabetes health education at the primary care level.     

Angiotensin converting enzyme gene polymorphism is associated with severity of coronary artery disease in men with high total cholesterol levels

This study examines whether renin-angiotensin-aldosterone system gene polymorphisms: ACE (encoding for angiotensin converting enzyme) c.2306-117_404 I/D, AGTR1 (encoding for angiotensin II type-1 receptor) c.1080*86A>C and CYP11B2 (encoding for aldosterone synthase) c.-344C>T are associated with the extension of coronary atherosclerosis in a group of 647 patients who underwent elective coronary angiography. The extension of CAD was evaluated using the Gensini score. The polymorphisms were determined by PCR and RFLP assays. The associations between genotypes and the extent of coronary atherosclerosis were tested by the Kruskal-Wallis test, followed by pairwise comparisons using Wilcoxon test. The population has been divided into groups defined by: sex, smoking habit, past myocardial infarction, BMI (>, ≤ 25), age (>, ≤ 55), diabetes mellitus, level of total cholesterol (>, ≤ 200 mg/dl), LDL cholesterol (>, ≤ 130 mg/dl), HDL cholesterol (>, ≤ 40 mg/dl), triglycerides (>, ≤ 150 mg/dl). Significant associations between the ACE c.2306-117_404 I/D polymorphism and the Gensini score in men with high total cholesterol levels (P_{Kruskal-Wallis} = 0.008; P_adjusted = 0.009), high level of LDL cholesterol (P_{Kruskal-Wallis} = 0.016; P_adjusted = 0.028) and low level of HDL cholesterol (P_{Kruskal-Wallis} = 0.04; P_adjusted = 0.055) have been found. No association between the AGTR1 c.1080*86A>C and CYP11B2 c.-344C>T and the Gensini score has been found. These results suggest that men who carry ACE c.2306-117_404 DD genotype and have high total cholesterol, high LDL cholesterol and low HDL cholesterol levels may be predisposed to the development of more severe CAD.     

2 型糖尿病合并高血压患者发生心房颤动的相关因素分析

目的:探讨2型糖尿病合并高血压住院患者发生心房颤动的相关因素。方法:选取我院收治的2型糖尿病合并高血压发生心房颤动的患者112例为研究对象(房颤组,n=112例),同期选取与房颤组年龄及性别相匹配的未发生房颤的2型糖尿病合并高血压患者150例为对照组(n=150例),比较两组患者的一般临床资料、实验室检查指标等的差异,用Logistic回归方程分析患者并发房颤的相关因素。结果:与对照组比较,房颤组患者收缩压(SBP)较高,高血压比例高、服用ACEI/ARB类药物偏低(P0.05)、左室射血分数(LVEF)偏低(P0.05)、左房内径(LAD)长(P0.05)、甘油三酯(TC)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、血肌酐(Scr)、B型脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)、尿酸均较高(P0.05);多因素Logistic回归方程分析提示:LAD、HbA1c、BNP、hs-CRP、尿酸是患者并发房颤的独立危险因素(P0.05),而服用ACEI/ARB类药物为保护性因素。结论:LAD、HbA1c、BNP、hs-CRP、尿酸均可能是2型糖尿病合并高血压患者发生心房颤动的独立危险因素。     

Predictors of decrease in ankle-brachial index among patients with diabetes mellitus

Diabet. Med. 29, e304-e307 (2012) ABSTRACT: Aim Screening for peripheral arterial disease, a complication among patients with diabetes, is performed by periodic assessment of ankle-brachial index. We aimed to study the degree of ankle-brachial index change over time and factors associated with significant change. Method We assessed difference between two ankle-brachial index measurements over time in a consecutive series of 82 patients with Type?2 diabetes. All patients had ankle-brachial index >?0.9 but ≤?1.3 for the first measurement, and significant ankle-brachial index decrease was defined as a decrease of >?0.1 in the follow-up measurement compared with the baseline. Results The mean follow-up duration was 27.6 (median 30.0) months. Significant ankle-brachial index decrease was seen in 20.7% of patients, including 5% with follow-up ankle-brachial index of ≤?0.9, consistent with the diagnosis of peripheral arterial disease. After adjusting for age and gender, higher baseline HbA(1c) and serum creatinine levels, increase in follow-up serum LDL cholesterol levels compared with baseline and history of retinopathy were predictors of significant ankle-brachial index decrease. Conclusions Our study suggests that, within two?years, one in five patients with diabetes and a normal ankle-brachial index may have significant progression of peripheral arterial disease. Annual ankle-brachial index assessment and better control of hyperlipidaemia may thus be required for at-risk patients with poor glycaemic control, renal impairment and retinopathy.     

Moderate weight loss improves heart rate variability in overweight and obese adults with type 2 diabetes

The objective of this study was to determine the effects of weight loss on heart rate variability (HRV) and its association with traditional cardiovascular disease risk factors in overweight and obese patients with type 2 diabetes. Forty five patients [body mass index (BMI) 35.4 ± 0.7 kg/m2; age 56.5 ± 1.1 yr] with type 2 diabetes followed an energy-restricted diet (6-7 MJ/day) for 16 wk. Body weight, blood pressure, glucose, insulin, insulin resistance [homeostasis model assessment index 2 (HOMA2)], glycosylated hemoglobin (HbA1c), total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, resting HR, and HRV were measured before and after the intervention period. Mean reduction in body weight was 11.1 ± 1.0 kg (10%), with significant reductions in blood pressure (-10%), total cholesterol (-15.9%), LDL (-17.7%), HDL (-7.5%), triglycerides (-21.2%), glucose (-23.4%), insulin (-37.6%), HOMA2 (-40.1%), and HbA1c (-14.5%) (P ≤ 0.05 for all variables). There were increases in several HRV components, including total power (1,370 ± 280 to 2,045 ± 280 ms2), low-frequency power (345 ± 70 to 600 ± 108 ms2), SD of normal to normal intervals (SDNN; 35.0 ± 2.5 to 43.0 ± 2.7 s), and square root of the mean squared differences of successive normal to normal intervals (RMSSD; 23.0 ± 3.5 to 32.0 ± 3.1 s), and a decrease in HR (69.0 ± 1.3 to 60.0 ± 1.2 beats/min) (P ≤ 0.03 for all variables). Changes in HR, SDNN, total power, and low-frequency power correlated with change in BMI (P < 0.05). In addition to improvements in traditional cardiovascular and metabolic risk factors, weight loss improves HRV in overweight and obese patients with type 2 diabetes.     

2型糖尿病患者血清LDL，CysC与动脉粥样硬化的相关性研究

目的:分析2型糖尿病(T2DM)患者血清低密度脂蛋白(LDL)、胱抑素C(CysC)与动脉粥样硬化(AS)的相关性。方法:选取2型糖尿病患者300名,根据颈动脉内膜中膜厚度分为非动脉粥样硬化斑块组(n=109)和动脉粥样硬化斑块组(n=191),并对动脉粥样硬化斑块的相关危险因素进行多因素Logistic回归分析。结果:(1)Pearson相关分析显示,LDL、CysC水平与IMT值呈正相关(P0.05)。(2)单因素分析示,非AS组和AS组两组间LDL(t=8.876,P0.05)、CysC(t=7.985,P0.05)、HbA1c(t=9.912,P0.05)、Hs-CRP(t=12.461,P0.05)、年龄(t=7.114,P0.05)、UA((t=8.618,P0.05)间差异有统计学意义;(3)多因素Logistic回归分析示,LDL、CysC、HbA1c、年龄是T2DM并AS的独立危险因素(P0.05);结论:LDL与CysC水平是T2DM并AS的独立危险因素。     

Effects of taspoglutide on glycemic control and body weight in obese patients with type 2 diabetes (T‐emerge 7 study)

Objective:

Therapies that lower blood glucose and provide weight loss may provide meaningful benefits for obese patients with type 2 diabetes mellitus (T2DM). This study assessed the efficacy of taspoglutide compared with placebo on glycemic control and weight in obese patients with T2DM inadequately controlled with metformin monotherapy.

Design and Methods:

In a 24‐week, randomized, double‐blind, placebo‐controlled, multicenter trial, obese adults with T2DM were randomized (1:1) to weekly subcutaneous taspoglutide 20 mg (10 mg for first 4 weeks) (n = 154) or placebo (n = 151) for 24 weeks. Efficacy measures included hemoglobin A1c (HbA1c) levels, body weight, percentage of patients achieving HbA1c ≤6.5 and ≤7.0%, and fasting plasma glucose (FPG). Adverse events (AEs) were assessed.

Results:

Mean baseline HbA1c was 7.55% and mean baseline BMI was 36.7 kg/m². HbA1c reductions from baseline were significantly greater with taspoglutide than placebo (least square mean [LSMean], ?0.81% vs. ?0.09%; P < 0.0001). Weight loss at week 24 was significantly greater with taspoglutide than placebo (LSMean, ?3.16 vs. ?1.85 kg; P < 0.01). In the taspoglutide and placebo groups, target HbA1c levels (≤6.5%) were achieved by 49 and 16% of patients, respectively, while 72 and 36% achieved HbA1c levels ≤7%. Decreases in FPG were significantly greater with taspoglutide than placebo (?23.59 vs. 0.09 mg/dl; P < 0.0001). Nausea and vomiting were the most common AEs associated with taspoglutide, but tended to be transient and generally mild or moderate.

Conclusions:

In obese patients with T2DM, once‐weekly taspoglutide provided the combined benefits of glycemic control and weight loss.

     

2型糖尿病患者APPL1、AFABP与胰岛素抵抗指数的相关性研究

目的:分析2型糖尿病(T2DM)患者磷酸酪氨酸衔接蛋白(APPL1)、脂肪细胞型脂肪酸结合蛋白(AFABP)与稳态模型评估胰岛素抵抗指数(HOMA-IR)的相关性。方法:选择2015年6月~2016年5月至我院就诊T2DM患者100例作为患病组,选取同期在我院健康体检者100例作为健康组,对研究对象进行指标如空腹血糖(FPG)、空腹血清胰岛素(FINS)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、APPL1、AFABP等检测,并根据公式计算HOMA-IR、及体重指数(BMI),分析APPL1、AFABP与各指标相关性。结果:患病组与健康组TC、HDL、LDL水平无明显差异(P0.05),患病组BMI、FPG、FINS、Hb A1c、TG、HOMA-IR、APPL1、AFABP与健康组比较明显较高(P0.05);APPL1与BMI、FINS、Hb A1c、HOMA-IR呈负相关性(P0.05),与FPG呈正相关性;AFABP与BMI、FPG、FINS、Hb A1c、HOMA-IR呈正相关性(P0.05)。结论:T2DM患者APPL1、AFABP较高,APPL1、AFABP与HOMA-IR呈直线相关性,表明APPL1、AFABP与T2DM患者胰岛素抵抗密切相关,该研究为APPL1、AFABP可以作为T2DM治疗的新靶点提供了理论依据。     

Adding pharmacists to primary care teams reduces predicted long-term risk of cardiovascular events in Type 2 diabetic patients without established cardiovascular disease: results from a randomized trial

Aim To determine the impact of adding pharmacists to primary care teams on predicted 10-year risk of cardiovascular events in patients with Type?2 diabetes without established cardiovascular disease. Methods This was a pre-specified secondary analysis of randomized trial data. The main study found that, compared with usual care, addition of a pharmacist resulted in improvements in blood pressure, dyslipidaemia, and hyperglycaemia for primary care patients with Type?2 diabetes. In this sub-study, predicted 10-year risk of cardiovascular events at baseline and 1?year were calculated for patients free of cardiovascular disease at enrolment. The primary outcome was change in UK Prospective Diabetes Study (UKPDS) risk score; change in Framingham risk score was a secondary outcome. Results Baseline characteristics were similar between the 102 intervention patients and 93 control subjects: 59% women, median (interquartile range) age 57 (50-64) years, diabetes duration 3 (1-6.5) years, systolic blood pressure 128 (120-140) mmHg, total cholesterol 4.34 (3.75-5.04) mmol/l and HbA(1c) 54?mmol/mol (48-64?mmol/mol) [7.1% (6.5-8.0%)]. Median baseline UKPDS risk score was 10.2% (6.0-16.7%) for intervention patients and 9.5% (5.8-15.1%) for control subjects (P?=?0.80). One-year post-randomization, the median absolute reduction in UKPDS risk score was 1.0% greater for intervention patients compared with control subjects (P?=?0.032). Similar changes were seen with the Framingham risk score (median reduction 1.2% greater for intervention patients compared with control subjects, P?=?0.048). The two risk scores were highly correlated (rho?=?0.83; P?相似文献   

A study comparing insulin lispro mix 25 with glargine plus lispro therapy in patients with Type 2 diabetes who have inadequate glycaemic control on oral anti-hyperglycaemic medication: results of the PARADIGM study

Diabet. Med. 29, e263-e272 (2012) ABSTRACT: Aims To test the hypothesis that initiation and intensification with 25% insulin lispro, 75% insulin lispro protamine suspension (LM25), is non-inferior to initiation and intensification with glargine?+?insulin lispro therapy on change from baseline in HbA(1c) . Methods In this randomized, non-inferiority (margin of 0.4%), parallel, prospective, multi-country, 48-week, open-label study, patients (n?=?426) with Type?2 diabetes inadequately controlled with oral anti-hyperglycaemic medications were assigned to either initiating therapy with one daily LM25 injection, progressing up to three daily injections (full analysis set n?=?211; per protocol set n?=?177) or initiating therapy with one daily glargine injection and progressing up to three daily insulin lispro injections (full analysis set n?=?212; per protocol set n?=?184). Results LM25 therapy was found to be non-inferior to glargine?+?insulin lispro therapy by study end (upper limit of 95%?CI 相似文献   

Type 1 diabetes in pre-school children - long-term metabolic control, associated autoimmunity and complications

Diabet. Med. 29, 1291-1296 (2012) ABSTRACT: Aims To identify clinical characteristics and co-morbidity rates of children diagnosed with Type 1 diabetes mellitus at younger than 6?years of age. Methods Data were obtained from a retrospective chart review of 103 patients diagnosed with Type 1 diabetes at younger than 6?years (study group) and 220 patients at older than 6?years (comparison group). Measures of glycaemic control and occurrence of co-morbidities (coeliac disease, autoimmune thyroid disease, hypertension, nephropathy and retinopathy) were compared. Results The mean follow-up period was more than 8?years. For the study group, mean HbA(1c) levels ranged from 64?mmol/mol to 66?mmol/mol (8.0-8.2%) until age 10?years, and then rose to 73?mmol/mol (8.8%). The HbA(1c) levels were higher in the study than in the comparison group for comparable ages (P?=?0.003). After adjustment for duration of diabetes this difference was not significant. The overall rate of severe hypoglycaemic events was greater in the study group than in the comparison group (P?=?0.03). Kaplan-Meier diagnosis rates of celiac disease, 10?years after Type 1 diabetes diagnosis, were 14.4% and 4.2% in the study and comparison groups, respectively (P log-rank?=?0.03). There were no differences in rates of autoimmune thyroid disease, hypertension, nephropathy or retinopathy. Conclusions Children diagnosed with Type 1 diabetes before the age of 6?years were in greater risk of developing celiac disease, compared with children diagnosed after the age of 6?years. For children diagnosed with Type 1 diabetes aged under 6?years, good metabolic control was achievable until age 10?years, after which it deteriorated. Higher HbA(1c) levels observed in children diagnosed before the age of 6?years were associated with longer duration of disease.     

Effect of sitagliptin on blood glucose control in patients with type 2 diabetes mellitus who are treatment naive or poorly responsive to existing antidiabetic drugs: the JAMP study

Background

To investigate the ameliorating effect of sitagliptin, a dipeptidyl peptidase-4 inhibitor, on blood glucose control in patients with type 2 diabetes mellitus who were previously untreated with or who have a poor responsive to existing antidiabetic drugs.

Methods

Sitagliptin (50 mg/day) was added on to the pre-existing therapy for type 2 diabetes and changes in the glycated hemoglobin (HbA1c) level after 3 months of treatment were compared with the baseline and performed exploratory analysis.

Results

HbA1c levels were significantly decreased after 1 month of treatment compared to baseline, with a mean change in HbA1c level from baseline of ?0.73% (range, ?0.80 to ?0.67) in the entire study population at 3 months. Patients who received a medium dose of glimepiride showed the least improvement in HbA1c levels. The percentage of patients who achieved an HbA1c level of <7.0% significantly increased after 1 month of treatment, reaching 53.1% at 3 months. The percentage of patients who achieved a fasting blood glucose level of <130 mg/dL significantly increased after 1 month of treatment, reaching 50.9% at 3 months.

Conclusions

Sitagliptin improved the HbA1c level and rate of achieving the target control levels in patients with type 2 diabetes mellitus who were previously untreated with, or poorly responsive to, existing antidiabetic drugs. Thus, sitagliptin is expected to be useful in this patient group. However, the additional administration of sitagliptin in patients treated with medium-dose glimepiride only slightly improved blood glucose control when corrected for baseline HbA1c level.