The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis

BACKGROUND: Although incretin therapy is clinically available in patients with type 2 diabetes undergoing hemodialysis, no study has yet examined whether incretin therapy is capable of maintaining glycemic control in this group of patients when switched from insulin therapy. In this study, we examined the efficacy of incretin therapy in patients with insulin-treated type 2 diabetes undergoing hemodialysis. METHODS: Ten type 2 diabetic patients undergoing hemodialysis received daily 0.3 mg liraglutide, 50 mg vildagliptin, and 6.25 mg alogliptin switched from insulin therapy on both the day of hemodialysis and the non-hemodialysis day. Blood glucose level was monitored by continuous glucose monitoring. After blood glucose control by insulin, patients were treated with three types of incretin therapy in a randomized crossover manner, with continuous glucose monitoring performed for each treatment. RESULTS: During treatment with incretin therapies, severe hyperglycemia and ketosis were not observed in any patients. Maximum blood glucose and mean blood glucose on the day of hemodialysis were significantly lower after treatment with liraglutide compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. The standard deviation value, a marker of glucose fluctuation, on the non-hemodialysis day was significantly lower after treatment with liraglutide compared with treatment with insulin and alogliptin (p < 0.05), but not with vildagliptin. Furthermore, the duration of hyperglycemia was significantly shorter after treatment with liraglutide on both the hemodialysis and non-hemodialysis days compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. CONCLUSIONS: The data presented here suggest that patients with type 2 diabetes undergoing hemodialysis and insulin therapy could be treated with incretin therapy in some cases

Engine Control System Development and Symbolic Manipulation : Application and Challenges in Modelling

The integrated use of symbolic and numeric technologies is presented through application examples in automotive industry. The effectiveness of such an integrated approach is emphasized by showing concrete uses of symbolic manipulation and numerical computation in Maple [1]. In the first of the two examples, the chemical equilibrium of combustion phenomena which is a constrained optimization problem is analysed symbolically and turned into an unconstrained optimization problem. As opposed to numeric-only approach, target equations for the minimization problem are explicitly shown, which facilitates the understanding of the problem. In the second example, a simple phenomenological model for the heat release process of an internal combustion engine is introduced where a differential equation containing a conditional branch is symbolically analysed and then numerically integrated to obtain some key physical quantities of the combustion dynamics. Finally, the paper is concluded with some remarks on challenges that modelling technologies in automotive industry are facing