Pramlintide in the Management of Obesity

Obesity is a common problem that can lead to numerous comorbid conditions, including Type 2 diabetes. Currently, there are few pharmacologic options available to help obese patients lose weight. Pramlintide is an injectable, amylin analogue that is indicated in patients with Type 1 and Type 2 diabetes for use in conjunction with insulin to improve glycemic control. In addition to helping patients decrease hemoglobin A1c levels, pramlintide has also been shown to minimize weight gain, especially in patients with Type 2 diabetes. Studies have been conducted in various patient types, including those patients without diabetes, and the drug tends to have a positive effect on weight loss. It appears that the drug is well tolerated in patients without diabetes; however, current studies have been conducted in small patient populations. Additional research needs to be carried out to determine if the drug is a viable option for obese patients who have failed to respond to other weight loss products

Amylin Analogues in the Treatment of Diabetes Mellitus: Medicinal Chemistry and Structural Basis of its Function

Amylin, (islet amyloid polypeptide) or diabetes-associated peptide is co-secreted with insulin in the islet of Langerhans of diabetic patients in approximately 1:100, amylin-insulin ratio. The soluble form of amylin, an analogue of amylin, is used as a supplement to insulin in the treatment of type 1 diabetes. Co-administration of amylin analogue with insulin to patients with type 1 diabetes induced a larger reduction in proprandial hyperglycemia, with a concomitant reduction in the level of glucagon when compared to insulin monotherapy. The actions of amylin analogues appear to be synergistic to insulin, with which it is co-released from insulin-producing beta cells after a meal. Amylin analogues such as pramlintide has been shown to significantly reduce body weight, HbA1c values and even the dosage of insulin. A moderate weight loss can also be achieved in obese patients with or without diabetes. A major side effect of some amylin analogues includes nausea and excitation of the area postrema. This review examines the medicinal chemistry of amylin and its analogues and their effects

STUDI DRUG-RELATED PROBLEMS PADA TERAPI DIABETES MELITUS TIPE 2 DENGAN KOMPLIKASI DI PUSKESMAS SIKUMANA KUPANG.

Diabetes merupakan penyakit kronis yang membutuhkan perawatan medis jangka panjang dengan tujuan untuk mencegah timbulnya komplikasi. Penatalaksanaan terhadap hiperglikemi, komplikasi mikrovaskular dan makrovaskular, sindroma geriatri yang terkait dengan diabetes dan timbulnya efek samping obat memberikan kontribusi pada peningkatan jumlah penggunaan obat pada pasien diabetes, sehingga pasien diabetes beresiko tinggi untuk mendapatkan polifarmasi pada pengobatannya. Polifarmasi dapat menyebabkan masalah pada terapi pasien diabetes melitus yang di kenal dengan drug-related problems (DRP). Penelitian ini merupakan penelitian non-eksperimen dengan rancangan penelitian deskriptif dengan pendekatan secara retrospektif. Teknik sampling yang digunakan adalah purposive sampling. Pada penelitian ini dilakukan pencatatan data rekam medik pasien DM tipe 2 dengan komplikasi tahun 2018 yang berkaitan dengan semua kategori DRP. Tujuan penelitian ini adalah untuk mengetahui jenis DRP (drug related problems) apa saja yang timbul pada penderita diabetes melitus tipe 2 di Puskesmas Sikumana Kota Kupang. Total sampel pasien yang mengalami kejadian DRP 17 pasien dengan masing-masing kategori dari yang paling banyak adalah kategori DRP interaksi obat sebanyak 9 kasus (20%), drug choice problems dengan masalah ada indikasi tetapi tidak di terapi sebanyak 7 kasus (15,6%) dan dosing problems dengan masalah dosis kurang sebanyak 1 kasus (2,2%)

Off-label pharmacological treatment of obesity: a systematic review of clinical studies

Introduction: There are 2.0 billion overweight and obese people in the world, and Brazil ranks fifth in the world. The World Health Organization (WHO) advises that the use of drugs to combat obesity is indicated for patients who have a body mass index (BMI) above 30 kg/m2 or when the BMI is 25 kg/m2 associated with comorbidities. that permeate excess weight. A variety of drug classes approved for other indications have been used off-label in an attempt to promote weight loss. Objective: It was to list and present the main off-label drugs for obesity in adults, as well as to show the scientific evidence of clinical studies. Methods: The present study followed a concise systematic review (PRISMA) model. The literary search process was carried out from July 2022 to September 2022 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2002 to 2022. The low quality of evidence was attributed to reports of cases, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument using the Funnel Plot. Results and Conclusion: We found 98 studies that underwent eligibility analysis, and then 15 of the 12 total studies were selected. Most studies showed homogeneity in their results, with I2 =96.5% >50%. The Funnel Plot showed a symmetrical behavior, not suggesting a significant risk of bias in the studies. Off-label prescribing is very common among physicians who treat obesity. However, randomized controlled studies should be increasingly encouraged and increased to clearly present the scientific evidence and, thus, propose a scientific formalism for the safe and effective use of off-label anti-obesity drugs. Physicians, however, have adopted a more pragmatic approach, giving much greater credibility to shared clinical experience, particularly in situations where favorable outcomes have been consistently observed over decades. International medical bodies do not recommend the off-label use of drugs approved for the exclusive use of weight loss. In Brazil, the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) recommends that drugs approved for the treatment of obesity be prescribed preferentially over off-label treatments. In addition, the patient must be well informed and aware that the drug is not approved by Anvisa for this indication or chronic use

Psychometric properties of an instrument for assessing the experience of patients treated with inhaled insulin: the Inhaled Insulin Treatment Questionnaire (IITQ)

<p>Abstract</p> <p>Background</p> <p>Along with general measures of treatment satisfaction, treatment-specific and device-specific treatment satisfaction should be assessed in clinical trials, because these latter measures may be more strongly correlated with clinical outcomes.</p> <p>Methods</p> <p>Study participants were 1076 adults (type 1 = 509, type 2 = 567) in clinical trials of Technosphere Insulin^®, who completed the SF-36 health-related quality of life questionnaire and the Inhaled Insulin Treatment Questionnaire (IITQ), a new instrument assessing diabetes worries, perceptions of insulin therapy, treatment satisfaction, treatment preference, and inhaler performance. The IITQ was administered twice prior to treatment initiation in the clinical trials, 1-2 weeks apart, and several times during the trials. Inhaler performance was assessed at follow-up visits, after participants had used the device.</p> <p>Results</p> <p>IITQ subscales had acceptable reliability (alpha = 0.68-0.87, median 0.83) and test-retest correlations (intra-class correlation coefficient = 0.67-0.90, median 0.82); floor effects (0.2-2.8%) and ceiling effects (0-9.3%) were minimal. Reliabilities for inhaler performance measures were acceptable (alpha = 0.73-0.90, median 0.85); there were no floor effects (0.0%) and ceiling effects (4.9-39.0%) were moderate. There were several modest associations between IITQ scores and measures of health status. Diabetes worries were lower for participants who had better mental health (type 2) and for those with higher BMI; perceptions of insulin therapy were more favorable for participants who had better physical and mental health; treatment satisfaction was higher for patients who had lower BMI (type 2), lower A1c levels, and better physical health (type 2); treatment preference was higher for patients with lower BMI (type 2) and better mental health (type 1).</p> <p>Conclusions -</p> <p>Preliminary findings suggest that the IITQ is a comprehensive, reliable measure of the experience of patients treated with inhaled insulin.</p

Pramlintide, the synthetic analogue of amylin: physiology, pathophysiology, and effects on glycemic control, body weight, and selected biomarkers of vascular risk

Pramlintide is a synthetic version of the naturally occurring pancreatic peptide called amylin. Amylin and pramlintide have similar effects on lowering postprandial glucose, lowering postprandial glucagon and delaying gastric emptying. Pramlintide use in type 1 and insulin requiring type 2 diabetes mellitus (DM) is associated with modest reductions in HbA1c often accompanied by weight loss. Limited data show a neutral effect on blood pressure. Small studies suggest small reductions in LDL-cholesterol in type 2 DM and modest reductions in triglycerides in type 1 DM. Markers of oxidation are also reduced in conjunction with reductions in postprandial glucose. Nausea is the most common side effect. These data indicate that pramlintide has a role in glycemic control of both type 1 and type 2 DM. Pramlintide use is associated with favorable effects on weight, lipids and other biomarkers for atherosclerotic disease

Pramlintide in the Management of Insulin-Using Patients with Type 2 and Type 1 Diabetes

In patients with diabetes, dysregulation of multiple glucoregulatory hormones results in chronic hyperglycemia and an array of associated microvascular and macrovascular complications. Optimization of glycemic control, both overall (glycosylated hemoglobin [A1C]) and in the postprandial period, may reduce the risk of long-term vascular complications. However, despite significant recent therapeutic advances, most patients with diabetes are unable to attain and/or maintain normal or near-normal glycemia with insulin therapy alone. Pramlintide, an analog of amylin, is the first in a new class of pharmaceutical agents and is indicated as an adjunct to mealtime insulin for the treatment of patients with type 1 and type 2 diabetes. By mimicking the actions of the naturally occurring hormone amylin, pramlintide complements insulin by regulating the appearance of glucose into the circulation after meals via three primary mechanisms of action: slowing gastric emptying, suppressing inappropriate post-meal glucagon secretion, and increasing satiety. In long-term clinical trials, adjunctive pramlintide treatment resulted in improved postprandial glucose control and significantly reduced A1C and body weight compared with insulin alone. The combination of insulin and pramlintide may provide a more physiologically balanced approach to managing diabetes

Lifestyle Changes and Weight Loss: Effects in PCOS

Even though controversies surrounding the polycystic ovary syndrome are not yet close to be solved, its clinical manifestations are well known—insulin resistance and obesity, hirsutism, irregular and anovulatory menstrual cycles. The treatment of polycystic ovarian syndrome (PCOS) is mainly symptomatic as its etiology is not yet clear. Lifestyle changes are the primary therapy in overweight and obese women with PCOS. According to majority of the studies, lifestyle changes are the most effective form of treatment not only for weight loss but also for the improvement of insulin sensitivity, decreasing incidence of metabolic syndrome and type 2 diabetes. Studies also show that weight loss has fertility benefits by restoring ovulatory cycles. Although initial studies researching pharmacologic treatment were showing excellent results concerning the weight loss, maintenance of weight loss and reduction of cardiovascular risks, some of these drugs were in the end, has proven to actually increase the risk for cardiovascular events and were removed from the market. Bariatric surgery has been demonstrated to improve or even cure type 2 diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. More so, there are studies that reported complete resolution of all features of PCOS, even hirsutism, hyperandrogenism, anovulation, and menstrual irregularity