Patient considerations and clinical utility of a fixed dose combination of saxagliptin/metformin in the treatment of type 2 diabetes

Giuseppe Derosa, Pamela MaffioliDepartment of Internal Medicine and Therapeutics, University of Pavia, Pavia, ItalyIntroduction: Targeting glycated hemoglobin (HbA1c) levels below 7.0% is considered a primary goal of diabetes care, given its importance in obtaining a sustained reduction in microvascular, and possibly macrovascular complications.Aim: The aim of this review was to evaluate the clinical utility of a fixed dose combination of saxagliptin/metformin in the treatment of type 2 diabetes.Evidence review: The combination of saxagliptin/metformin was well tolerated and produced sustained glycemic control for up to 76 weeks, with greater improvements in glycemic parameters compared with either drug alone. The saxagliptin/metformin combination also proved its non-inferiority compared with either sulfonylurea/metformin or sitagliptin/metformin combinations.Place in therapy: Clinical practice recommends lifestyle interventions together with starting metformin at the time that the type 2 diabetes mellitus is diagnosed. Once metformin fails to maintain glycemic control, the addition of DPP-4 inhibitors should be the logical choice because of their effects on HbA1c compared to the addition of a sulfonylurea or glitazone, and because of their positive effects on beta cell function and their neutral effects on body weight. Furthermore, DPP-4 inhibitors prevent the risk of hypoglycemia posed by sulfonylureas.Keywords: DPP-4 inhibitors, saxagliptin, glycemic control, insulin sensitivity, HOMA inde

Endothelial function, blood pressure control, and risk modification: impact of irbesartan alone or in combination

Irbesartan, an angiotensin II type 1 receptor antagonist, is approved as monotherapy, or in combination with other drugs, for the treatment of hypertension in many countries worldwide. Data in the literature suggest that irbesartan is effective for reducing blood pressure over a 24-hour period with once-daily administration, and slows the progression of renal disease in patients with hypertension and type 2 diabetes. Furthermore, irbesartan shows a good safety and tolerability profile, compared with angiotensin II inhibitors and other angiotensin II type 1 receptor antagonists. Thus, irbesartan appears to be a useful treatment option for patients with hypertension, including those with type 2 diabetes and nephropathy. Irbesartan has an inhibitory effect on the pressor response to angiotensin II and improves arterial stiffness, vascular endothelial dysfunction, and inflammation in hypertensive patients. There has been considerable interest recently in the renoprotective effect of irbesartan, which appears to be independent of reductions in blood pressure. In particular, mounting data suggests that irbesartan improves endothelial function, oxidative stress, and inflammation in the kidneys. Recent studies have highlighted a possible role for irbesartan in improving coronary artery inflammation and vascular dysfunction. In this review we summarize and comment on the most important data available with regard to antihypertensive effect, endothelial function improvement, and cardiovascular risk reduction with irbesartan

Paziente scompensato con comorbilità. approfondimento su scompenso e ipertensione

La prevalenza dello scompenso cardiaco in Italia è di 600.000 soggetti, di cui 170.000 nuovi casi all’anno. • Nel paziente scompensato, la presenza di comorbilità, in particolare l’ipertensione, può modificare sensibilmente la prognosi. • L’aldosterone è responsabile di molteplici effetti che provocano rimodellamento cardiaco e danno renale. • Il razionale per l’impiego degli MRA nel paziente scompensato e iperteso è l’azione antifibrotica che contrasta il rimodellamento cardiaco, vasale e renale. • Nello studio AREA IN-CHF (467 pazienti scompensati, di cui circa il 50% ipertesi), canrenone, in aggiunta alla terapia standard dello SC, ha migliorato la prognosi dei pazienti senza alterarne l’assetto renale. • Nei grandi studi sullo SC, i pazienti in trattamento con MRA, hanno fatto registrare una variazione della creatinina, tra inizio e fine studio, trascurabile in termini assoluti, confermando l’elevato profilo di tollerabilità renale degli M

Is it time to implement a standardized oral glucose and fat load test to detect high risk patients? Probably not yet

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