Effect of Hemodialysis on Plasma Glucose Profile and Plasma Level of Liraglutide in Patients with Type 2 Diabetes Mellitus and End-Stage Renal Disease: A Pilot Study

The effect of hemodialysis on the plasma glucose profile and liraglutide level after liraglutide injection was investigated in patients with diabetes and end-stage renal disease (ESRD). Either 0.6 mg or 0.9 mg liraglutide was subcutaneously administered daily to 10 Japanese type 2 diabetic patients with ESRD. Hemodialysis was conducted on days 1 and 3. Plasma liraglutide and glucose concentrations were measured by enzyme-linked immunosorbent assay and a continuous glucose monitoring system, respectively. The safety profile of liraglutide was also assessed. Hemodialysis had no effect on the pharmacokinetic parameters of liraglutide in patients with diabetes and ESRD; the maximum plasma concentration (Cmax), tmax, area under the concentration-time curve (AUC), and CL/f were unaltered. Similarly, hemodialysis did not affect the mean or minimum glucose levels, AUC, or duration of hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL) following liraglutide administration. However, significant increases in mean amplitude of glycemic excursions (MAGE) and standard deviation (SD) as markers of glucose fluctuation, and the maximum glucose level were observed during hemodialysis. No adverse events, including hypoglycemia, were observed after liraglutide injection, either off-hemodialysis (day 2) or on-hemodialysis (day 3). Liraglutide was well tolerated in patients with type 2 diabetes and ESRD undergoing hemodialysis. The present results suggested that hemodialysis did not affect the pharmacokinetic profile of liraglutide or most glycemic indices, with the exception of MAGE, SD, and the maximum glucose level. These results suggested that it may be possible to use liraglutide during hemodialysis for diabetes with ESRD, without dose adjustment. Trial Registration UMIN Clinical Trials Registry (UMIN-CTR) UMIN000010159.\ud \u

Patient disposition.

<p>Patient disposition.</p

Patient disposition.

<p>Patient disposition.</p

Relationships between lifestyle patterns and cardio-renal-metabolic parameters in patients with type 2 diabetes mellitus: A cross-sectional study.

INTRODUCTION:While individuals tend to show accumulation of certain lifestyle patterns, the effect of such patterns in real daily life on cardio-renal-metabolic parameters remains largely unknown. This study aimed to assess clustering of lifestyle patterns and investigate the relationships between such patterns and cardio-renal-metabolic parameters. PARTICIPANTS AND METHODS:The study participants were 726 Japanese type 2 diabetes mellitus (T2DM) outpatients free of history of cardiovascular diseases. The relationship between lifestyle patterns and cardio-renal-metabolic parameters was investigated by linear and logistic regression analyses. RESULTS:Factor analysis identified three lifestyle patterns. Subjects characterized by evening type, poor sleep quality and depressive status (type 1 pattern) had high levels of HbA1c, alanine aminotransferase and albuminuria. Subjects characterized by high consumption of food, alcohol and cigarettes (type 2 pattern) had high levels of γ-glutamyl transpeptidase, triglycerides, HDL-cholesterol, blood pressure, and brachial-ankle pulse wave velocity. Subjects characterized by high physical activity (type 3 pattern) had low uric acid and mild elevation of alanine aminotransferase and aspartate aminotransferase. In multivariate regression analysis adjusted by age, gender and BMI, type 1 pattern was associated with higher HbA1c levels, systolic BP and brachial-ankle pulse wave velocity. Type 2 pattern was associated with higher HDL-cholesterol levels, triglycerides, aspartate aminotransferase, ɤ- glutamyl transpeptidase levels, and diastolic BP. CONCLUSIONS:The study identified three lifestyle patterns that were associated with distinct cardio-metabolic-renal parameters in T2DM patients. TRIAL REGISTRATION:UMIN000010932

Pharmacokinetic parameters of liraglutide following subcutaneous administration of liraglutide to diabetic patients with ESRD on the day of on-hemodialysis and off-hemodialysis.

<p>-: not calculated, n = 10.</p><p>Pharmacokinetic parameters of liraglutide following subcutaneous administration of liraglutide to diabetic patients with ESRD on the day of on-hemodialysis and off-hemodialysis.</p

Plasma glucose profiles after subcutaneous administration of liraglutide in diabetic patients with ESRD on-hemodialysis and off-hemodialysis.

<p>Mean ± SD, n = 10.</p><p>*The analysis of 95% CI (log [CI]) could not be performed because zero values were included.</p><p>**p<0.05.</p><p>Plasma glucose profiles after subcutaneous administration of liraglutide in diabetic patients with ESRD on-hemodialysis and off-hemodialysis.</p

Prospective randomized comparative study of the effect of pemafibrate add‐on or double statin dose on small dense low‐density lipoprotein‐cholesterol in patients with type 2 diabetes and hypertriglyceridemia on statin therapy

Abstract Aims/Introduction Small dense low‐density lipoprotein (sdLDL) is a more potent atherogenic lipoprotein than LDL. As sdLDL‐cholesterol (C) levels are determined by triglyceride and LDL‐C levels, pemafibrate and statins can reduce sdLDL‐C levels. However, it remains unclear whether adding pemafibrate or increasing statin doses would more effectively reduce sdLDL‐C levels in patients receiving statin therapy. Materials and Methods A total of 97 patients with type 2 diabetes and hypertriglyceridemia who were treated with statins were randomly assigned to the pemafibrate 0.2 mg/day addition or statin dose doubled, and followed for 12 weeks. sdLDL‐C was measured by our established homogenous assay. Results The percentage and absolute reductions of sdLDL‐C levels were significantly greater in the pemafibrate add‐on group than the statin doubling group (−32.8 vs −8.1%; −16 vs −3 mg/dL, respectively). Triglyceride levels were reduced only in the pemafibrate add‐on group (−44%), and LDL‐C levels were reduced only in the statin doubling group (−8%), whereas levels of non‐high‐density lipoprotein‐C and apolipoprotein B were similarly decreased (7–9%) in both groups. The absolute reductions of sdLDL‐C levels were closely associated with decreased triglyceride, LDL‐C, non‐high‐density lipoprotein‐C and apolipoprotein B. In the subgroup analysis, the effect of pemafibrate add‐on on sdLDL‐C reductions was observed irrespective of baseline lipid parameters or statin type. No serious adverse effects were observed in both groups. Conclusions In patients with type 2 diabetes and hypertriglyceridemia, the addition of pemafibrate to a statin is superior to doubling a statin in reducing sdLDL‐C without increasing adverse effects

Characteristics according to quintile categories of type 3 life style pattern score.

<p>Characteristics according to quintile categories of type 3 life style pattern score.</p