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Assess the efficacy differences of using long-acting insulin and oral hypoglycemic agents in type 2 diabetes patients
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Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
enhances GLP-1 secretion, whereas acarbose improves postprandial dyslipidemia in patients with T2DM. PD-21 Influence on urination of SGLT2 inhibitor in type 2 diabetes Junko SASAKI1 *, Junpei SHIKUMA1, Rokuro ITO1, Masato ODAWARA1. 1The Department of Diabetes, Endocrinoligy and Metabolism, Tokyo Medical University Hospital, Japan Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors are new antidiabetic drugs that increase urinary excretion of glucose. They have polyuria and pollakiuria as adverse events because of their diuretic effect. Therefore we investigated influence on urinary disorder of ipragliflozin (Ipra) and tofogliflozin (Tofo). Method: A prospective randomized study was conducted on 35 patients with type 2 diabetes [male: n = 22, female: n = 13, age: 55 ± 9, BMI: 27.9 ± 3.6, HbA1c: 7.7 ± 1.0%]. Twenty one patients received Ipra and 14 patients receiverd Tofo daily for 1 month. International Prostate Symptom Score (IPSS), overactive Bladder Symptom Score (OABSS), International Consultation on Incontinence Question- Short Form (ICIQ-SF) were evaluated at before the treatment and after 1 month. Results: After 1 month of the treatment, body weight (75.3 ± 13.2→74.2 ± 13.2 kg, p < 0.001), BMI (28.0 ± 3.6→27.5 ± 4.0, p < 0.001), HbA1c (7.7 ± 1.0→7.5 ± 0.8%, p < 0.001) and γ-GTP (42.6 ± 32→36.5 ± 24.0, p < 0.001) improved significantly. In each total score of IPSS, OABSS and ICIQ-SF, there was no significant change. In each question of scores, there were significant increases in “How often do you usually urinate during the day?” (0.4 ± 0.6→0.7 ± 0.5, p = 0.008) of OABSS, “How often do you leak urine?” (0.5 ± 0.9→0.8 ± 1.3, p = 0.031) and “Overall, how much does leaking urine interfere with your everyday life?” (0.3 ± 0.9→0.8 ± 1.5, p = 0.016) of ICIQ-SF. In patients taking Ipra, there was no significant change in all scores. But in patients taking Tofo, there were significant changes in total scores of IPSS and ICIQ-SF. In the male patients with IPSS more than eight points which moderate benign prostatic hyperplasia is doubted (n = 3), there was no meaningful change in each score. In the patients with OABSS score more than 3 points which overactive bladder was doubted (n = 11), there was no meaningful change neither. Conclusion: In type 2 diabetes, it was shown that SGLT2 inhibitors can make their glucose control better and make their body weight decrease without any urinary disorder. Some studies were shown that Ipra makes nocturia worse. However in our study, there was no significant change. We may suggest that SGLT2 inhibitors were useful for diabetes patients with and without any urinary disorder. There are going to be more cases to present by the day of meeting. PD-22 Assess the efficacy differences of using long-acting insulin and oral hypoglycemic agents in type 2 diabetes patients Chiu-Ju CHEN1 *, Hui-Chen SU1. 1Department of Pharmacy, ChiMei Hospital, Taiwan Background: Type 2 diabetes patients usually use two to three kinds of oral hypoglycemic agents, but the treatment effects are poor. According to the latest clinical studies that longacting insulin and oral hypoglycemic agents can control blood sugar, decrease the risk of blood vessels, and improve quality of life in diabetes. Objectives: This study evaluated the efficacy of five kinds of oral hypoglycemic agents with long-acting insulin. Methods: Using retrospective mode to analyze a medical center of outpatient cases in 2014, the subjects are 65 years old with type 2 diabetes, the serum of HbA1C level greater than 7 or more, using insulin glargine and oral hypoglycemic drug to treatment. According to the oral hypoglycemic agents, we
divided into five groups: glibenclamide (5 mg), glimepiride (2 mg), pioglitazone (15 mg), sitagliptin (100 mg), saxagliptin (5 mg). We used SPSS statistical software for ANOVA analysis and assessed the correlation of HbA1C level and the five groups before and after treatment. Results: In this study, the patients have received 174 cases. We found the mean deviation of HbA1C level for the five groups before and after treatment, it had statistical significant disparity ( p < 0.05). The HbA1C level is reduced 0.32% using insulin glargine and glibenclamide, and the HbA1C level is reduced 0.15% using insulin glargine and glimepiride, and the HbA1C level is reduced 0.49% using insulin glargine and pioglitazone, and the HbA1C level is reduced 0.51% using insulin glargine and sitagliptin, and the HbA1C level is reduced 0.79% using insulin glargine and saxagliptin. Conclusions: We recommended the best treatment that using insulin glargine with saxagliptin (DPP-4 enzyme inhibitor) in the type 2 diabetes patients. PD-23 The use and the appropriateness of antidiabetic agents in primary referral hospital Nikko DARNINDRO1 *, Ahmad Fariz Malvi Zamzam ZEIN2. 1 Department of Internal Medicine, Cilincing General Hospital, 2 Departement of Health, Central Board of Nahdlatul Ulama, Indonesia Background: Diabetes mellitus (DM) is growing worldwide, especially in developing countries. The management of diabetes includes lifestyle modification, medical nutrition therapy, and life-long medication, in accordance with patient-centered approach. The caution and contraindication are highly warranted in considering the proper long term use of antidiabetic drugs. This study was aimed to identify profile and the appropriateness of antidiabetic agents in primary referral hospital. Methods: A cross-sectional study was conducted at Cilincing General Hospital between December 2015 and February 2016. The subjects were the patients who were referred from primary health cares with clinically suspected for DM during the study. Diabetes mellitus was diagnosed according to Indonesian Society of Endocrinology guideline. The medication was listed based on the regiment given. The appropriateness was assessed by matching the antidiabetic drug and the contraindications. Result: A total of 62 subjects were participated in the study (75.80% were females). The mean age was 59.58 ± 8.77 years old. Mean admission fasting blood sugar was 231.66 mg/dL (SD 94.01), mean body mass index was 25.23 ± 4.81 kg/m2, and mean serum creatine was 1.27 ± 0.73. The use of oral antidiabetic agents was metformin (96.80%), sulphonylureas (64.50%), and insulin (19.40%), respectively. The regiments were given as metformin monotherapy (14.5%), sulfonylurea monotherapy (4.8%), combination of metformin and sulfonylurea (61.3%), and combination of metformin and insulin (19.4%). Of subjects who received metformin, there were 4 subjects (6.67%) with eGFR (CKD-EPI) <30 mL/min/1.73 m2, because rejecting insulin therapy. There were 19 subjects (48.7%) receiving sulfonylurea with eGFR (CKD-EPI) <60 mL/min/1.73 m2. No history of hypoglycemia was reported by the subjects. Conclusion: Metformin is the most frequently prescribed drug. The use of metformin and sulfonylurea in renal dysfunction is high. The awareness and monitoring of antidiabetic drugs related their caution and contraindication are urgently needed. Abbreviations: DM: Diabetes Mellitus / eGFR: estimated Glomerular Filtratrion Rate / CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
enhances GLP-1 secretion, whereas acarbose improves postprandial dyslipidemia in patients with T2DM. PD-21 Influence on urination of SGLT2 inhibitor in type 2 diabetes Junko SASAKI1 *, Junpei SHIKUMA1, Rokuro ITO1, Masato ODAWARA1. 1The Department of Diabetes, Endocrinoligy and Metabolism, Tokyo Medical University Hospital, Japan Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors are new antidiabetic drugs that increase urinary excretion of glucose. They have polyuria and pollakiuria as adverse events because of their diuretic effect. Therefore we investigated influence on urinary disorder of ipragliflozin (Ipra) and tofogliflozin (Tofo). Method: A prospective randomized study was conducted on 35 patients with type 2 diabetes [male: n = 22, female: n = 13, age: 55 ± 9, BMI: 27.9 ± 3.6, HbA1c: 7.7 ± 1.0%]. Twenty one patients received Ipra and 14 patients receiverd Tofo daily for 1 month. International Prostate Symptom Score (IPSS), overactive Bladder Symptom Score (OABSS), International Consultation on Incontinence Question- Short Form (ICIQ-SF) were evaluated at before the treatment and after 1 month. Results: After 1 month of the treatment, body weight (75.3 ± 13.2→74.2 ± 13.2 kg, p < 0.001), BMI (28.0 ± 3.6→27.5 ± 4.0, p < 0.001), HbA1c (7.7 ± 1.0→7.5 ± 0.8%, p < 0.001) and γ-GTP (42.6 ± 32→36.5 ± 24.0, p < 0.001) improved significantly. In each total score of IPSS, OABSS and ICIQ-SF, there was no significant change. In each question of scores, there were significant increases in “How often do you usually urinate during the day?” (0.4 ± 0.6→0.7 ± 0.5, p = 0.008) of OABSS, “How often do you leak urine?” (0.5 ± 0.9→0.8 ± 1.3, p = 0.031) and “Overall, how much does leaking urine interfere with your everyday life?” (0.3 ± 0.9→0.8 ± 1.5, p = 0.016) of ICIQ-SF. In patients taking Ipra, there was no significant change in all scores. But in patients taking Tofo, there were significant changes in total scores of IPSS and ICIQ-SF. In the male patients with IPSS more than eight points which moderate benign prostatic hyperplasia is doubted (n = 3), there was no meaningful change in each score. In the patients with OABSS score more than 3 points which overactive bladder was doubted (n = 11), there was no meaningful change neither. Conclusion: In type 2 diabetes, it was shown that SGLT2 inhibitors can make their glucose control better and make their body weight decrease without any urinary disorder. Some studies were shown that Ipra makes nocturia worse. However in our study, there was no significant change. We may suggest that SGLT2 inhibitors were useful for diabetes patients with and without any urinary disorder. There are going to be more cases to present by the day of meeting. PD-22 Assess the efficacy differences of using long-acting insulin and oral hypoglycemic agents in type 2 diabetes patients Chiu-Ju CHEN1 *, Hui-Chen SU1. 1Department of Pharmacy, ChiMei Hospital, Taiwan Background: Type 2 diabetes patients usually use two to three kinds of oral hypoglycemic agents, but the treatment effects are poor. According to the latest clinical studies that longacting insulin and oral hypoglycemic agents can control blood sugar, decrease the risk of blood vessels, and improve quality of life in diabetes. Objectives: This study evaluated the efficacy of five kinds of oral hypoglycemic agents with long-acting insulin. Methods: Using retrospective mode to analyze a medical center of outpatient cases in 2014, the subjects are 65 years old with type 2 diabetes, the serum of HbA1C level greater than 7 or more, using insulin glargine and oral hypoglycemic drug to treatment. According to the oral hypoglycemic agents, we
divided into five groups: glibenclamide (5 mg), glimepiride (2 mg), pioglitazone (15 mg), sitagliptin (100 mg), saxagliptin (5 mg). We used SPSS statistical software for ANOVA analysis and assessed the correlation of HbA1C level and the five groups before and after treatment. Results: In this study, the patients have received 174 cases. We found the mean deviation of HbA1C level for the five groups before and after treatment, it had statistical significant disparity ( p < 0.05). The HbA1C level is reduced 0.32% using insulin glargine and glibenclamide, and the HbA1C level is reduced 0.15% using insulin glargine and glimepiride, and the HbA1C level is reduced 0.49% using insulin glargine and pioglitazone, and the HbA1C level is reduced 0.51% using insulin glargine and sitagliptin, and the HbA1C level is reduced 0.79% using insulin glargine and saxagliptin. Conclusions: We recommended the best treatment that using insulin glargine with saxagliptin (DPP-4 enzyme inhibitor) in the type 2 diabetes patients. PD-23 The use and the appropriateness of antidiabetic agents in primary referral hospital Nikko DARNINDRO1 *, Ahmad Fariz Malvi Zamzam ZEIN2. 1 Department of Internal Medicine, Cilincing General Hospital, 2 Departement of Health, Central Board of Nahdlatul Ulama, Indonesia Background: Diabetes mellitus (DM) is growing worldwide, especially in developing countries. The management of diabetes includes lifestyle modification, medical nutrition therapy, and life-long medication, in accordance with patient-centered approach. The caution and contraindication are highly warranted in considering the proper long term use of antidiabetic drugs. This study was aimed to identify profile and the appropriateness of antidiabetic agents in primary referral hospital. Methods: A cross-sectional study was conducted at Cilincing General Hospital between December 2015 and February 2016. The subjects were the patients who were referred from primary health cares with clinically suspected for DM during the study. Diabetes mellitus was diagnosed according to Indonesian Society of Endocrinology guideline. The medication was listed based on the regiment given. The appropriateness was assessed by matching the antidiabetic drug and the contraindications. Result: A total of 62 subjects were participated in the study (75.80% were females). The mean age was 59.58 ± 8.77 years old. Mean admission fasting blood sugar was 231.66 mg/dL (SD 94.01), mean body mass index was 25.23 ± 4.81 kg/m2, and mean serum creatine was 1.27 ± 0.73. The use of oral antidiabetic agents was metformin (96.80%), sulphonylureas (64.50%), and insulin (19.40%), respectively. The regiments were given as metformin monotherapy (14.5%), sulfonylurea monotherapy (4.8%), combination of metformin and sulfonylurea (61.3%), and combination of metformin and insulin (19.4%). Of subjects who received metformin, there were 4 subjects (6.67%) with eGFR (CKD-EPI) <30 mL/min/1.73 m2, because rejecting insulin therapy. There were 19 subjects (48.7%) receiving sulfonylurea with eGFR (CKD-EPI) <60 mL/min/1.73 m2. No history of hypoglycemia was reported by the subjects. Conclusion: Metformin is the most frequently prescribed drug. The use of metformin and sulfonylurea in renal dysfunction is high. The awareness and monitoring of antidiabetic drugs related their caution and contraindication are urgently needed. Abbreviations: DM: Diabetes Mellitus / eGFR: estimated Glomerular Filtratrion Rate / CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration