Therapeutic efficacy and safety of initial triple combination of metformin, sitagliptin, and lobeglitazone in drug-naïve patients with type 2 diabetes: initial triple study

Objective To compare the efficacy and safety of an initial triple therapy using metformin, a dipeptidyl peptidase-4 (DPP4) inhibitor, and thiazolidinedione with a stepwise approach using sulfonylurea and metformin in new-onset, drug-naïve patients with type 2 diabetes. Research design and methods Among drug-naïve patients with 9.0%–12.0% glycated hemoglobin (HbA1c) but no hyperglycemic symptoms, 100 subjects who started triple medications (metformin 1000 mg/day, sitagliptin 100 mg/day, and lobeglitazone 0.5 mg/day) were selected as an initial triple therapy group. Age and body mass index-matched subjects (n=100) who started glimepiride (≥2 mg/day with uptitration) and metformin (≥1000 mg/day with uptitration) were selected as a conventional therapy group. We investigated changes in HbA1c level, dynamic indexes for insulin sensitivity and β-cell function, and hypoglycemia. Results After 12 months of treatment, HbA1c levels decreased significantly in both groups: from 10.7%±1.0% to 6.7%±1.3% in the triple group, and from 10.5%±1.0% to 7.3%±1.2% in the conventional therapy group. At 12 months, achievement of the HbA1c target ( Conclusions Initial triple combination therapy with the DPP4 inhibitor, metformin, and thiazolidinedione showed a higher achievement of the target HbA1c goal with a lower risk of hypoglycemia, better restoration of β-cell function, and multiple metabolic benefits, implying durable glycemic control. This strategy may be useful for patients presenting with type 2 diabetes and high HbA1c levels.</p

Development of a brushless HTS exciter for a 10 kW HTS synchronous generator

HTS synchronous generators, in which the rotor coils are wound from high-Tc superconducting wire, are exciting attention due to their potential to deliver very high torque and power densities. However, injection of the large DC currents required by the HTS rotor coils presents a technical challenge. In this paper we discuss the development of a brushless HTS exciter which operates across the cryostat wall to inject a superconducting DC current into the rotor coil circuit. This approach fundamentally alters the thermal load upon the cryogenic system by removing the need for thermally inefficient normal-conducting current leads. We report results from an experimental laboratory device and show that it operates as a constant voltage source with an effective internal resistance. We then discuss the design of a prototype HTS-PM exciter based on our experimental device, and describe its integration with a demonstration HTS generator. This 200 RPM, 10 kW synchronous generator comprises eight double pancake HTS rotor coils which are operated at 30 K, and are energised to 1.5 T field through the injection of 85 A per pole. We show how this excitation can be achieved using an HTS-PM exciter consisting of 12 stator poles of 12 mm YBCO coated-conductor wire and an external permanent magnet rotor. We demonstrate that such an exciter can excite the rotor windings of this generator without forming a thermal-bridge across the cryostat wall. Finally, we provide estimates of the thermal load imposed by our prototype HTS-PM exciter on the rotor cryostat. We show that duty cycle operation of the device ensures that this heat load can be minimised, and that it is substantially lower than that of equivalently-rated conventional current leads