4 research outputs found
The Effects of DPP IV Inhibitor on Glycemic Variability in Type 2 Diabetic Patients Treated with Twice Daily Premixed Human Insulin
Glycemic variability (GV) is emerging as an exciting therapeutic target for diabetes mellitus (DM) with recent
evidences showing association of GV with hypoglycemia
risk as well as chronic complications.(1,2) Twice daily
human premixed insulin is commonly used in developing
countries and Asia for treatment of type 2 DM (T2DM). (3)
Downloaded from https://academic.oup.com/jes/article/4/Supplement_1/MON-653/5833510 by UNIVERSITI MALAYSIA SARAWAK user on 09 September 2020
doi: 10.1210/jendso/bvaa046 | Journal of the Endocrine Society | A397
A397 JESOCI, Volume 4, Abstract Supplement, 2020
While more convenient and cost saving, human premixed
insulin regime may increase GV due to lesser flexibility
and less physiological pharmacokinetic profile. Dipeptidyl
peptidase IV inhibitors (DPPIV-I) have been shown to
improve GV when used for treatment of T2DM but the
effects of DPPIV-I when added on human premixed insulin
is limited. We therefore evaluated the changes in GV following addition of DPP IV-I among T2DM patients treated
with premixed human insulin with or without metformin
therapy. This was a prospective study involving adult
patients with T2DM on stable doses of premixed human
insulin with or without metformin for at least 3 months
from two state hospitals in Malaysia. Blinded continuous
glucose monitoring (CGM) were performed at baseline and
following 6 weeks of adding Vildagliptin to their insulin
regime. A total of 12 patients were recruited (50% male).
Mean (SD) age was 55.8 (13) years with mean duration of
disease of 14 (6.6) years. The addition of Vildagliptin significantly reduced GV indexes including SD 2.98 (1.17) to 2.33
(0.82), p=0.017; MAGE 6.94 (2.61) to 5.72 (1.87), p=0.018;
MAG 1.60 (0.76) to 1.23 (0.48), p=0.009 and M Value 13.96
(13.01) to 6.52 (7.45), p=0.037. In addition there were
improvements in terms of parameters for glycemic control. Time spent in optimal glycemic range (4-8 mmol/l)
improved from 38.33 (19.69) to 58.17 (5.95) %, p=0.001 with
reduction in AUC for hyperglycemia from 2.09 (1.73) to 1.06
(1.09) mmol/day, p=0.010. Hypoglycemia events were infrequent and the reduction in time spent in hypoglycemia
[5.92(9.74) to 1.91 (2.54)%, p=0.191] as well as AUC for
hypoglycemia [0.03(0.54) to 0.01(0.02) mmol/day, p=0.163]
were found although these did not reach statistical significance. We concluded that addition of DPP IV-I to commonly
prescribed twice daily premixed human insulin regime in
patients with T2DM may improve GV and glycemic control
and warrant further exploratio
The Effects of DPP IV Inhibitor on Glycemic Variability in Type 2 Diabetic Patients Treated with Twice Daily Premixed Human Insulin
Glycemic variability (GV) is emerging as an exciting therapeutic target for diabetes mellitus (DM) with recent evidences showing association of GV with hypoglycemia risk as well as chronic complications.(1,2) Twice daily human premixed insulin is commonly used in developing countries and Asia for treatment of type 2 DM (T2DM). (3) While more convenient and cost saving, human premixed insulin regime may increase GV due to lesser flexibility and less physiological pharmacokinetic profile. Dipeptidyl peptidase IV inhibitors (DPPIV-I) have been shown to improve GV when used for treatment of T2DM but the effects of DPPIV-I when added on human premixed insulin is limited. We therefore evaluated the changes in GV following addition of DPP IV-I among T2DM patients treated with premixed human insulin with or without metformin therapy. This was a prospective study involving adult patients with T2DM on stable doses of premixed human insulin with or without metformin for at least 3 months from two state hospitals in Malaysia. Blinded continuous glucose monitoring (CGM) were performed at baseline and following 6 weeks of adding Vildagliptin to their insulin regime. A total of 12 patients were recruited (50% male). Mean (SD) age was 55.8 (13) years with mean duration of disease of 14 (6.6) years. The addition of Vildagliptin significantly reduced GV indexes including SD 2.98 (1.17) to 2.33 (0.82), p=0.017; MAGE 6.94 (2.61) to 5.72 (1.87), p=0.018; MAG 1.60 (0.76) to 1.23 (0.48), p=0.009 and M Value 13.96 (13.01) to 6.52 (7.45), p=0.037. In addition there were improvements in terms of parameters for glycemic control. Time spent in optimal glycemic range (4-8 mmol/l) improved from 38.33 (19.69) to 58.17 (5.95) %, p=0.001 with reduction in AUC for hyperglycemia from 2.09 (1.73) to 1.06 (1.09) mmol/day, p=0.010. Hypoglycemia events were infrequent and the reduction in time spent in hypoglycemia [5.92(9.74) to 1.91 (2.54)%, p=0.191] as well as AUC for hypoglycemia [0.03(0.54) to 0.01(0.02) mmol/day, p=0.163] were found although these did not reach statistical significance. We concluded that addition of DPP IV-I to commonly prescribed twice daily premixed human insulin regime in patients with T2DM may improve GV and glycemic control and warrant further exploration
The effect of DPP4 Inhibitor on glycemic variability in patients with type 2 diabetes treated with twice daily premixed human insulin
Objective. To evaluate the effect of adding DPP4 inhibitor (DPP4-i) on glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) treated with premixed human insulin (MHI).
Methodology. We conducted a prospective study in patients with T2DM on twice-daily MHI with or without metformin therapy. Blinded continuous glucose monitoring was performed at baseline and following 6 weeks of Vildagliptin therapy.
Results. Twelve patients with mean (SD) age of 55.8 (13.1) years and duration of disease of 14.0 (6.6) years were recruited. The addition of Vildagliptin significantly reduced GV indices (mmol/L): SD from 2.73 (IQR 2.12-3.66) to 2.11 (1.76-2.55), p=0.015; mean amplitude of glycemic excursions (MAGE) 6.94(2.61) to 5.72 (1.87), p=0.018 and CV 34.05 (8.76) to 28.19 (5.36), p=0.010. In addition, % time in range (3.9-10 mmol/l) improved from 61.17 (20.50) to 79.67 (15.33)%, p=0.001; % time above range reduced from 32.92 (23.99) to 18.50 (15.62)%, p=0.016; with reduction in AUC for hyperglycemia from 1.24 (1.31) to 0.47 (0.71) mmol/day, p=0.015. Hypoglycemic events were infrequent and the reduction in time below range and AUC for hypoglycemia did not reach statistical significance.
Conclusion. The addition of DPP4-I to commonly prescribed twice-daily MHI in patients with T2DM improves GV and warrants further exploration
Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia
Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naïve or insulin-naïve patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal–bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%–50% and taken during sahur, while the pre-Ramadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp