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Treatment strategy of type 2 diabetes used in Czech Republic after metformin therapy failure


Authors: Štěpán Svačina 1;  Petra Ovesná 2;  Matyáš Kuhn 2;  Martina Nováčková 2
Authors place of work: III. interní klinika 1. LF UK a VFN Praha 1;  Institut biostatistiky a analýz, s. r. o., Brno 2
Published in the journal: Vnitř Lék 2017; 63(10): 647-657
Category: Original Contributions

Summary

Introduction:
Type 2 diabetes is an enormous medical problem caused by increasing prevalence of the disease and increasing prevalence of severe chronic complications of diabetes. New ADA/EASD guidelines and also Czech diabetes society guidelines enable effective individual approach to the patient. Goal of the therapy is optimal compensation of diabetes and prevention of acute and chronic complications of diabetes and decrease of mortality. Diabetes therapy is started by education in diet a regime combined with metformin. According to the progressive character of the disease it is usually necessary to intensify the therapy by adding antidiabetics from other groups.

Aim:
This study was proposed to analyse the use of therapy algorithm in Czech Republic in patients with insufficient metformin therapy. Secondary objectives were to describe level of compensation of diabetes in time and level of components of the metabolic syndrome in different treatment combinations.

Methodic and results:
In the sample of 1 516 patients, frequency of use of antidiabetic medication after metformin it was gliflozins 33% and gliptins 28% in the first phase of the study and the number increased later during the study. Median of HbA1c in the beginning of the study was 65 mmol/mol, greatest decrease was found in patents using combination of incretine analogs with metformin – 89 % of them had the HbA1c level < 60 mmol/mol.

Conclusion:
The study showed also that antidiabetic drugs used after metformin in Czech Republic are very effective in reducing weight, and improving blood pressure and lipid profile. Therapy using combination of metformin with gliflozins, gliptins or incretin analogs is most effective when metformin is not effective enough.

Key words:
diabetes type 2 – gliflozins – gliptins – incretine analogs – metformin therapy failure


Zdroje

1. Češka R, Tesař V, Dítě P (eds) et al. Interna. Triton: Praha 2010. ISBN 978–80–7387–423–0.

2. Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012; 55(6): 1577–1596. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–012–2534–0>. Erratum in Diabetologia 2013; 56(3): 680.

3. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258): 405–412.

4. American Diabetes Association. Standards of medical care in diabetes – 2011. Diabetes Care 2011; 34(Suppl 1): S11-S61. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11-S011>

5. Rosolová H, Pelikánová T, Moťovská Z. Doporučené postupy ESC týkající se diabetu, prediabetu a kardiovaskulárních onemocnění, vytvořené ve spolupráci s EASD, publikováno online 13. 3. 2014. Dostupné z WWW: <http://www.kardio-cz.cz/doporucene-postupy-ceske-kardiologicke-spolecnosti-460/>.

6. Boule NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2011; 286(10): 1218–1227.

7. Bantle JP, Wylie-Rosett J, Albright AL et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008; 31(Suppl 1): S61-S78. Dostupné z DOI: <http://dx.doi.org/10.2337/dc08-S061>. Erratum in Diabetes Care 2010; 33(8): 1911.

8. Nissen SE, Wolski K. Rosiglitazone revisited: an updated meta-analysis of risk for myocardial infarction and cardiovascular mortality. Arch Intern Med 2010; 170(14): 1191–1201. Dostupné z DOI: <http://dx.doi.org/10.1001/archinternmed.2010.207>.

9. Colhoun HM, Livingstone SJ, Looker HC et al. [Scottish Diabetes Research Network Epidemiology Group]. Hospitalised hip fracture risk with rosiglitazone and pioglitazone use compared with other glucose-lowering drugs. Diabetologia 2012; 55(11): 2929–2937. Dostupné z DOI: http://dx.doi.org/10.1007/s00125–012–2668–0>.

10. Jabbour S. Primary care physicians and insulin initiation: multiple barriers, lack of knowledge or both? Int J Clin Pract 2008; 62(6): 845–847. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1742–1241.2008.01757.x>.

11. Vasilakou D, Karagiannis T, Athanasiadou E et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med 2013; 159(4): 262–274. Dostupné z DOI: <http://dx.doi.org/10.7326/0003–4819–159–4-201308200–00007>.

12. Drucker DJ, Nauck MA. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidylpeptidase-4 inhibitors in type 2 diabetes. Lancet 2006; 368(9548): 1696–1705.

13. Deacon CF. Dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes: a comparative review. Diabetes Obes Metab 2011; 13(1): 7–18. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1463–1326.2010.01306.x>.

14. Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach update to a position statement of the American diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38(1): 140–149. Dostupné z DOI: <http://dx.doi.org/10.2337/dc14–2441>.

15. Škrha J, Pelikánová T, Kvapil M. [Česká diabetologická společnost]. Doporučený postup péče o diabetes mellitus 2. typu. Doporučení české diabetologické společnosti ČSL JEP. Datum revize 1. 1. 2017. Dostupné z WWW: <http://www.diab.cz/standardy>.

16. De Fronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes 2009; 58(4): 773–795. Dostupné z DOI: <http://dx.doi.org/10.2337/db09–9028>.

17. Svačina Š. Antidiabetika – historie, současnost a perspektivy. Axonite: Praha 2016. ISBN 978–80–88046–08–0.

18. Garber AJ, Abrahamson MJ, Barzilay JI et al. Consensus Statement By The American Association Of Clinical Endocrinologists And American College Of Endocrinology On The Comprehensive Type 2 Diabetes Management Algorithm – 2016 Executive Summary. Endocr Pract 2016; 22(1): 84–113. Dostupné z DOI: <http://dx.doi.org/10.4158/EP151126.CS>.

19. Zinman B, Wanner C, Lachin JM et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1504720>.

20. Wanner C, Inzucchi SE, Lachin JM et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med 2016; 375(4): 323–334. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1515920>.

21. Buse JB. [LEADER Steering Committee]. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375(18): 1798–1799. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMc1611289>.

Štítky
Diabetology Endocrinology Internal medicine

Článok vyšiel v časopise

Internal Medicine

Číslo 10

2017 Číslo 10
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