Effect of Oral Semaglutide Compared with Placebo and Subcutaneous Semaglutide on Glycemic Control in Patients with Type 2 Diabetes

Julia Lvovich, Mercer University College of Pharmacy

Worldwide, type II diabetes affects 9% of male population and 7.9% of female population. [1] It has been shown that genetics, lifestyle, and environment factors can predispose adults and children to develop insulin resistance that leads to increased glucose levels in the blood. Overtime, prolonged exposure to high blood glucose levels causes damage to blood vessels and increases risk for coronary artery disease, kidney disease, and obstructive sleep apnea. [2] Treatment of type II diabetes can be targeted with lifestyle modifications (e.g. weight and diet management, exercise) and pharmacotherapy. When considering pharmacotherapy agents, the choices depend on the desired lower blood glucose hemoglobin A1C (HbA1C) reduction, weight gain/loss properties, and other comorbidities. [1]

Glucagon-like peptide -1 (GLP-1) receptor agonists are incretin mimetics and lower HbA1C level by 0.5-1.5%. [3] These drugs also possess weight loss property, which provides an added benefit in type II diabetic patients. However, they are only available in injection formulations due to degradation of the peptides by stomach acid. [4] To overcome the pharmacological limitation, an oral GLP-1 receptor agonist was co-formulated with an absorption enhancer, which increases the local pH to prevent the degradation in the stomach. The efficacy and safety of the new drug, semaglutide, has been evaluated in a phase II trial, which is summarized below.

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Canagliflozin Effect on Cardiovascular and Renal Events in Type 2 Diabetes

Kishan Patel, Mercer University College of Pharmacy

Canagliflozin is a sodium-glucose cotransporter 2 (SGLT-2) inhibitor that allows for lower blood glucose in patients with type 2 diabetes (T2D) by increasing the urinary excretion of glucose. [1] There is a large amount of data that suggests T2D is an independent risk factor for cardiovascular disease.  Furthermore, cardiovascular disease is also the cause of death for the majority of patients with T2D. [2] Current evidence suggests that canagliflozin may be more effective than comparative options such as dipeptidyl peptidase-4 (DPP-4) inhibitors in lowering glycated hemoglobin (HbA1C), body weight, and blood pressure when used as an add-on therapy with metformin. Canagliflozin also appears to be superior when used in combination with metformin than sulfonylureas (SU) in regard to lowering body weight, blood pressure, and risk of hypoglycemia. However, direct evidence from comparative studies is only limited to sitagliptan (DPP-4 inhibitor) and glimepiride (SU) for their respective drug classes.  Therefore, conclusions for canagliflozin’s comparative effectiveness against other agents in the same class as DPP-4 inhibitors and sulfonylureas have been deduced from indirect evidence in network meta-analyses. [3] Continue reading

Excess Mortality among Persons with Type 2 Diabetes

Sarah Vo, Mercer University College of Pharmacy

The prevalence of diabetes is suggested to have increased over the past two decades and is expected to affect more than 500 million adults by 2030, with most being type 2 diabetes. [1]

According to the World Health Organization, type 2 diabetes results from the body’s ineffective use of insulin.  With time, it is said that diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves. [2]

According to the American Diabetes Association, diabetes remains the seventh leading cause of death in the United States in 2010.  Complications or co-morbid conditions associated with diabetes are said to include hypertension, cardiovascular disease, and dyslipidemia. [3]

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A Randomized Clinical Trial to Evaluate the Efficacy and Safety of Co-Administration of Sitagliptin with Intensively Titrated Insulin Glargine

Kingsley Onokalah, PharmD candidate 2015, Mercer University College of Pharmacy

Type 2 diabetes mellitus (T2DM) is a group of metabolic disorders characterized by elevated blood glucose levels. The underlying cause may be due to lower insulin secretion, a decrease in insulin sensitivity, or both. It is a chronic condition that may result in microvascular, macrovascular, and neuropathic disorders if glycemic control is not achieved.1

The general approach to treatment for T2DM includes goal setting for blood glucose levels, blood pressure, lipid levels, and dietary and exercise modifications.1 Long-term glycemic control is measured through hemoglobin A1c (HbA1c), which reflects glycemic control for the prior two to three months.1 The ADA recommends a goal HbA1c of <7% in most patients.2

The American Diabetes Association (ADA) guidelines recommend that all patients with T2DM be initiated on metformin if it not contraindicated. If the HbA1c target is not achieved after three months, the ADA recommends that metformin be combined with one of the following six treatment options: dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium/glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, or basal insulin.1

The focus of the following study is on sitagliptin, a DPP-4 inhibitor, in addition to basal insulin.3 Sitagliptin and other drugs in its class work to inhibit the DPP-4 enzyme, leading to a decrease in the release of glucagon and subsequent increase in insulin secretion to decrease blood glucose levels.1 While the risk of hypoglycemia does not increase with this drug class, headache and nasopharyngitis may be slightly more common.1

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