Endocrinology, diabetes and metabolism journal最新文献_第8页

First Fabulous Fifty – An Initial Experience of Dulaglutide from a Tertiary Care Centre in Eastern India 第一个神奇的五十岁——杜拉鲁肽在印度东部一家三级护理中心的初步体验

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-11-22 DOI: 10.31038/edmj.2018244

S. Chaudhuri, A. Majumder, D. Sanyal

Objective: This retrospective single centred real world observational study was undertaken with the aim to introspect the glycaemic control, weight loss, changes in lipid parameters, adverse events and treatment adherence with Dulaglutide therapy. Methodology: Single centered, retrospective, real world, observational study conducted on subjects taking liraglutide for a mean duration of 41 weeks in the endocrine out-patient department. Results : Data of 45 subjects were available. Mean age was 46.67 ± 5.53years. Glycosylated haemoglobin (HbA1c) significantly decreased from 8.68 ± 0.43% at baseline to 7.58 ± 0.19% at end of therapy. Body weight significantly reduced from 74.2 ± 8.07 kg at baseline to 69.27 ± 4.74kg at end of therapy and BMI significantly declined from 33.06 ± 4.5 to 30.09 ± 0.93 at end of therapy respectively. Nausea, vomiting and diarrhoea (15.55%) were the major adverse events noted in the study. Only one patient developed acute pancreatitis (2.22%). Conclusion: Treatment with Dulaglutide resulted in clinically meaningful HbA1c, FPG and weight reductions. The overall safety profile is consistent with the GLP ‐ 1 receptor agonist class. However, Dulaglutide did not show statistically greater reduction of glycaemic parameters in the subset of Indian patients compared to RCT data of Western population.

目的:本回顾性单中心现实世界观察性研究旨在反思血糖控制、体重减轻、脂质参数变化、不良事件和杜拉鲁肽治疗依从性。方法:单中心、回顾性、真实世界、观察性研究，对内分泌门诊服用利拉鲁肽的受试者进行平均持续时间41周的研究。结果:获得45名受试者的资料。平均年龄46.67±5.53岁。糖化血红蛋白(HbA1c)从基线时的8.68±0.43%显著下降到治疗结束时的7.58±0.19%。治疗结束时，体重从基线的74.2±8.07 kg显著下降到69.27±4.74kg, BMI从治疗结束时的33.06±4.5显著下降到30.09±0.93。恶心、呕吐和腹泻(15.55%)是研究中发现的主要不良事件。仅1例发生急性胰腺炎(2.22%)。结论:杜拉鲁肽治疗可显著降低HbA1c、FPG和体重。总体安全性与GLP‐1受体激动剂类一致。然而，与西方人群的RCT数据相比，Dulaglutide在印度患者亚群中并未显示出统计学上更大的血糖参数降低。

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引用次数: 0

Impact of Chronic Disease State Management by Clinical Pharmacists on Diabetes Outcomes: Interim Results of a Prospective Pilot Study 临床药师慢性疾病状态管理对糖尿病结局的影响:一项前瞻性试点研究的中期结果

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-11-22 DOI: 10.31038/edmj.2018245

C. McCarthy, M. Bateman

Objective: To provide program methodology and outcomes data identifying the impact of clinical pharmacy services provided to patients with diabetes mellitus. Design: Prospective pilot study. Patients: Adult patients with diabetes mellitus identified by a member of the primary care team were referred to the pharmacist-led disease state management program, a patient-centered medication therapy management (MTM) program developed through university collaboration with a local Federally Qualified Health Center. Interventions: Pharmacist-delivered disease state management and medication therapy management across three or more face-to-face encounters over the course of six months. Main outcome measures: Clinical outcomes were followed for 6 months from the time of referral and enrollment into the program. The primary diabetes endpoint, glycosylated hemoglobin, and patient-reported experience with care were collected at baseline and the end of the study. Clinical pharmacists documented the content of clinical visits, including the number of visits per patient, duration of encounters, number and proportion of identified medication therapy problems, and the number and proportion of associated interventions to optimize pharmacotherapy. Results: Glycosylated hemoglobin was significantly reduced versus baseline at the 6-month assessment in both the intent-to-treat (−2.7%; P < 0.0001) and the per-protocol groups (−3.0%; P < 0.0001). Patient-reported satisfaction with care was higher for the pharmacists as compared to the primary care providers with significantly more patients rating the care received from the pharmacist as excellent ( P = 0.001). The pharmacists completed 158 visits, identifying and resolving an average of 7.7 medication therapy problems for each subject included in the analysis. Conclusion: In this model of MTM, the clinical pharmacists were able to identify and resolve interventions which subsequently resulted in statistically significant reductions observed in the primary diabetes endpoint and high levels of satisfaction with care.

目的：提供项目方法和结果数据，以确定临床药学服务对糖尿病患者的影响。设计：前瞻性试点研究。患者：初级保健团队的一名成员确定的成年糖尿病患者被转介至药剂师领导的疾病状态管理计划，这是一个以患者为中心的药物治疗管理（MTM）计划，是通过大学与当地联邦合格健康中心的合作开发的。干预措施：药剂师在六个月的时间里，通过三次或三次以上的面对面交流，提供疾病状态管理和药物治疗管理。主要结果指标：从转诊和纳入该项目开始，对临床结果进行了6个月的随访。在基线和研究结束时收集主要糖尿病终点、糖化血红蛋白和患者报告的护理经验。临床药剂师记录了临床就诊的内容，包括每位患者的就诊次数、就诊持续时间、发现的药物治疗问题的数量和比例，以及优化药物治疗的相关干预措施的数量和比率。结果：在6个月的评估中，意向治疗组（-2.7%；P<0.0001）和方案组（-3.0%；P<0.0001优秀（P=0.001）。药剂师完成了158次就诊，为分析中的每个受试者确定并解决了平均7.7个药物治疗问题。结论：在这种MTM模型中，临床药剂师能够识别和解决干预措施，这些干预措施随后导致原发性糖尿病终点的统计学显著降低和对护理的高满意度。

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引用次数: 0

Klinefelter Syndrome in a Patient with Type 1 Diabetes and Growth Arrest: An Atypical Combination Klinefelter综合征合并1型糖尿病和生长停止:一个非典型的组合

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-11-10 DOI: 10.31038/edmj.2018242

Jacqueline Chan, Claudia Boucher-Berry

Klinefelter Syndrome (KS) occurs in about 1 in 1,000 males. Affected individuals with this condition have an additional X chromosome or 47, XXY. Clinical findings are usually not evident at birth and are non-specific such as tall stature, learning disabilities and gynecomastia during childhood. Diagnosis is commonly made in adulthood when they present with infertility or gynecomastia. Tall stature is also one of the most common findings in affected individuals. Patients are also at increased risk of developing autoimmune conditions such as type-1 diabetes, thyroiditis and rheumatological disorders. We present a case of a patient with type-1 diabetes subsequently diagnosed with Klinefelter syndrome after presenting with growth arrest. Physical exam revealed testicular volume of 5ml bilaterally with sexual maturity rating of 5. This emphasizes the importance of pubertal exam in every adolescent patient.

Klinefelter综合征(KS)在男性中发病率约为千分之一。患有这种疾病的人有一条额外的X染色体或47xxy。临床表现通常在出生时不明显，也是非特异性的，如身材高大、学习障碍和儿童时期的男性乳房发育。诊断通常是在成年时，当他们出现不孕或男性乳房发育。高身材也是受影响个体中最常见的发现之一。患者患自身免疫性疾病(如1型糖尿病、甲状腺炎和风湿病)的风险也在增加。我们提出了一例1型糖尿病患者在出现生长停止后被诊断为Klinefelter综合征。体格检查显示双侧睾丸体积5ml，性成熟等级5。这强调了青春期检查对每个青少年患者的重要性。

引用次数: 0

Is Metformin a Drug or a Buffer and why is this Significant? Further Evidence that the Brain Regulates the Autonomic Nervous System, in Particular Prevailing Levels of Intercellular pH 二甲双胍是药物还是缓冲剂?为什么这很重要?进一步的证据表明，大脑调节自主神经系统，特别是细胞间pH值的普遍水平

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-11-10 DOI: 10.31038/edmj.2018243

G. Ewing

This paper builds upon a body of research which illustrates that the main function of the brain is to modulate the coherent function of the organ networks more commonly known as physiological systems and hence ensure our optimum physiological stability and function. The aim of this article is to further develop this hypothesis and illustrate examples which support it. Moreover the existence of the neurological paradigm i.e. the mechanism by which the brain regulates the coherent function of the physiological systems, by comparison to the contemporary biological paradigm, illustrates fundamental conceptual limitations of biomedicine and, in particular, of the most widely used diabetes drug metformin; in particular that at normal dosage metformin does not appear to function as a drug but instead as a biological buffer which regulates plasma pH at indicatively 6.9–7.1 thereby adversely changing plasma pH to a level which, for many, ensures that their diabetes persists for as long as they are taking this medication and which for the obese may defer the progression of more severe diabetic comorbidities. Such an observation requires a fundamental rethink of what exactly is diabetes and has significant implications re what is diabetes, how it should be measured, and how it should be treated i.e. by dealing with the neurological origins of the condition or by treating the biomedical consequences, or by a combination of both approaches.

这篇论文建立在一系列研究的基础上，这些研究表明，大脑的主要功能是调节器官网络（通常称为生理系统）的连贯功能，从而确保我们的最佳生理稳定性和功能。本文的目的是进一步发展这一假设，并举例说明支持这一假设的例子。此外，与当代生物学范式相比，神经范式的存在，即大脑调节生理系统连贯功能的机制，说明了生物医学的基本概念局限性，特别是，使用最广泛的糖尿病药物二甲双胍；特别是在正常剂量下，二甲双胍似乎不是一种药物，而是一种生物缓冲液，将血浆pH调节在6.9–7.1，从而使血浆pH发生不利变化，对许多人来说，确保他们的糖尿病在服用这种药物的过程中持续存在，对于肥胖者来说，这可能会推迟更严重的糖尿病合并症的进展。这样的观察需要从根本上重新思考什么是糖尿病，并对什么是糖尿病、应该如何测量糖尿病以及应该如何治疗糖尿病具有重要意义，即通过处理疾病的神经起源或通过治疗生物医学后果，或通过两种方法的结合。

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引用次数: 6

The Past, Present, and Future of Pancreas Transplantation for Diabetes Mellitus 胰腺移植治疗糖尿病的过去、现在和未来

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-09-27 DOI: 10.31038/edmj.2018235

R. Stratta, A. Gruessner, R. Stratta

Pancreas transplantation was initially developed as a means to reestablish endogenous insulin secretion responsive to normal feedback controls and has evolved over time to a form of auto-regulating total pancreatic endocrine replacement therapy that can reliably achieve a durable euglycemic state without the need for either exogenous insulin therapy or close glucose monitoring. Pancreas transplantation is performed in patients who require administration of insulin because of type 1 or, less commonly, insulin-requiring type 2 diabetes, or following total pancreatectomy for benign disease [1]. Pancreas transplantation entails a major surgical procedure and the necessity for long-term immunosuppression so it is not offered universally to all patients with insulin-requiring diabetes but is usually directed to those that will already be committed to chronic immunosuppression [most commonly for kidney transplantation secondary to end stage diabetic nephropathy) [1]. In addition, candidates with potentially life-threatening metabolic complications from diabetes such as hypoglycemia unawareness or those who are failures of exogenous insulin therapy may benefit from pancreas transplantation in the absence of a kidney transplant [2]. A successful pancreas transplant is currently the only definitive long-term treatment that restores normal glucose homeostasis in patients with complicated diabetes without the risk of either severe hypo/hyperglycemia and may prevent, stabilize, or reverse progressive diabetic complications [1–3].

胰腺移植最初是作为一种重建内源性胰岛素分泌以响应正常反馈控制的手段而发展起来的，随着时间的推移，它已经发展成为一种自动调节的全胰腺内分泌替代疗法，可以可靠地实现持久的正血糖状态，而不需要外源性胰岛素治疗或密切的血糖监测。胰腺移植适用于因1型糖尿病或(较少见的)需要胰岛素的2型糖尿病患者，或因良性疾病bbb切除全胰腺后需要胰岛素的患者。胰腺移植需要一个大的外科手术，并且需要长期的免疫抑制，因此它不是普遍提供给所有需要胰岛素的糖尿病患者，而是通常针对那些已经患有慢性免疫抑制的患者[最常见的是继发于终末期糖尿病肾病的肾移植]。此外，患有潜在危及生命的糖尿病代谢并发症(如低血糖意识不清)或外源性胰岛素治疗失败的候选人可能在没有肾移植bbb的情况下从胰腺移植中获益。成功的胰腺移植是目前唯一确定的长期治疗方法，可以恢复复杂糖尿病患者的正常葡萄糖稳态，且没有严重低血糖/高血糖的风险，并可能预防、稳定或逆转进行性糖尿病并发症[1-3]。

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引用次数: 5

Serum 25-hydroxyvitamin D and Osteocalcin Levels and Insulin Sensitivity in Young Women 年轻女性血清25-羟基维生素D和骨钙素水平与胰岛素敏感性

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-09-27 DOI: 10.31038/edmj.2018241

송도경

引用次数: 0

Plasma Visfatin is reduced in Subjects with the Metabolic Syndrome and Pre-Diabetes 代谢综合征和糖尿病前期患者血浆内脂素降低

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-09-27 DOI: 10.31038/edmj.2018234

Brema, Gasparro, Crowley, Storka, J. Nolan

The adipocytokine Visfatin (VF) has been linked with visceral adiposity, insulin resistance and Metabolic Syndrome (MS), however, studies have been inconsistent regarding its relationship with these metabolic enteties. The aim of this study was to explore the relationships between plasma VF, High Molecular Weight (HMW) Adiponectin and the MS. We measured fasting plasma VF and HMW Adiponectin in 29 males with the MS and 29 age-matched male controls. Plasma VF was significantly reduced in MS subjetcs compared to controls (98.2 ± 29.7 Vs.141.4 ± 39.1 ng/ml, respectively, P=0.04). One Way ANOVA showed that subjects with MS and pre-diabetes had extremely lower concentrations of plasma VF (60.8 ± 35.9 Vs141.4 ± 39.1 ng/ml ), for MS and controls, respectively, P < 0.009. HMW Adiponectin concentrations were similar in both groups and negatively correlated with HOMA-IR(r = -0.40, P= 0.03). Using Stepwise regression, WC was independently associated with plasma VF concentrations. There was no correlation between plasma VF and insulin sensitivty or beta cell function measured with HOMA-IR and HOMA % B, respectively. In conclusion: Reduced plasma VF concentrations may play a role in the pathophysiology of pre-diabetes and cardiometabolic risk, however, this will require further study.

脂肪细胞因子Visfatin（VF）与内脏肥胖、胰岛素抵抗和代谢综合征（MS）有关，然而，关于其与这些代谢疾病的关系的研究一直不一致。本研究的目的是探讨血浆VF、高分子量（HMW）脂联素与MS之间的关系。我们测量了29名患有MS的男性和29名年龄匹配的男性对照的空腹血浆VF和HMW脂联素。与对照组相比，MS亚组的血浆VF显著降低（分别为98.2±29.7 Vs141.4±39.1 ng/ml，P=0.04）。单向方差分析显示，患有MS和糖尿病前期的受试者血浆VF浓度极低（60.8±35.9 Vs141.14±39.1 mg/ml），MS和对照组分别为，P<0.009。HMW-Adiponectin浓度在两组中相似，并且与HOMA-IR呈负相关（r=-0.40，P=0.03）。使用逐步回归，WC与血浆VF浓度独立相关。血浆VF与分别用HOMA-IR和HOMA%B测量的胰岛素敏感性或β细胞功能之间没有相关性。总之：血浆VF浓度降低可能在糖尿病前期的病理生理学和心脏代谢风险中发挥作用，但这需要进一步研究。

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引用次数: 0

The durability of oral diabetic medications: Time to A1c baseline and a review of common oral medications used by the primary care provider. 口服糖尿病药物的持久性:到达A1c基线的时间和初级保健提供者常用口服药物的回顾。

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-09-01 Epub Date: 2018-07-08

Lavanya Cherukuri, Michael S Smith, John A Tayek

Introduction: Cost of generic medications has risen more in the past few years than any other time in history. While medical insurance covers much of these costs, health care professionals can better provide medications that have the longest duration of action when compared to placebo-treated controls. This will save health care costs and improve prescribing accuracy.

Methods: Papers in PubMed were identified with keywords placebo. The study must be at least 2 years in length to evaluate the change in A1c over time. The primary endpoint was time to A1c neutrality (return of A1c to baseline at a maximum dose of single oral agent). A medication would be considered at neutrality if the 95% CI crossed baseline. Time to neutrality was averaged for each medication within the class and each summarized for class effect.

Results: Effective therapy for the DPP-4 and sulfonylurea classes of medications are 3-4 years as compared to a 5-year time to A1c neutrality for metformin usage. In comparison, the projected time to A1c neutrality was approximately 6-8 years for rosiglitazone and pioglitazone. While only a few studies have been published in the SGLT-2 class of medication, the time to A1c neutrality was also 6-8 years with Canagliflozin and full dosage of Empagliflozin.

Conclusion: Metformin appears to have a 5-year duration of effect before the A1c returns to baseline. The sulfonylureas and DPP-4 inhibitors class of medications have one of the shortest durability which ranges between 3.3 to 4.4 years. In contrast, the SGLT-2 class of medication and the TZD class of medications has a projected time to A1c neutrality from 6-8 years. Diabetic duration of therapy as compared to placebo should be listed with those medications tested so the provider can choose wisely.

简介:在过去的几年里，仿制药的成本比历史上任何时候都要高。虽然医疗保险涵盖了这些费用的大部分，但与安慰剂相比，卫生保健专业人员可以更好地提供作用时间最长的药物。这将节省医疗费用，提高处方的准确性。方法:以安慰剂为关键词对PubMed中的论文进行检索。该研究必须至少持续2年才能评估A1c随时间的变化。主要终点是达到A1c中性的时间(在单次口服药物的最大剂量下，A1c恢复到基线)。如果95% CI超过基线，则认为该药物为中性。对类别中每种药物的中性时间进行平均，并对每种药物的类别效果进行总结。结果:DPP-4和磺脲类药物的有效治疗时间为3-4年，而使用二甲双胍达到A1c中性需要5年时间。相比之下，罗格列酮和吡格列酮达到A1c中性的预计时间约为6-8年。虽然只有少数关于SGLT-2类药物的研究发表，但使用卡格列净和全剂量恩帕格列净达到A1c中性的时间也为6-8年。结论:在A1c恢复到基线水平之前，二甲双胍似乎有5年的持续效果。磺脲类和DPP-4抑制剂类药物具有最短的耐久性，在3.3至4.4年之间。相比之下，SGLT-2类药物和TZD类药物达到A1c中性的预计时间为6-8年。与安慰剂相比，糖尿病治疗的持续时间应与测试的药物一起列出，以便提供者可以明智地选择。

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引用次数: 0

Improvement in Bone Density with Calcitriol Substitution for Cholecalciferol in Refractory Osteoporosis induced by Prednisone 骨化三醇替代胆钙化醇改善泼尼松诱导的难治性骨质疏松症的骨密度

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-08-27 DOI: 10.31038/edmj.2018233

U. Kabadi, Salina Esmail

Introduction/ Purpose: Decline in BMD following prednisone therapy is attributed to osteoporosis. However, osteomalacia due to low 125 OH Vitamin D and resulting hyperparathyroidism may also be contributors. Therefore, administration of 125 OH vitamin D3, Calcitriol on BMD was examined in subjects receiving chronic prednisone therapy and low BMD (T< 2.5) refractory to therapy with bisphosphanate, calcium and vitamin D3, Cholecalciferol. Methods: 21 subjects, ages 45–56 years receiving prednisone ≥3 years with declining BMD despite therapy with Cholecalciferol, CaCO3 and bisphosphanate were divided into 2 groups. Both groups continued Calcium and bisphosphanate. 10 subjects (group 1) received increased dose of Cholecalciferol, 2000 units daily while in 11 subjects (group 2), it was substituted by Calcitriol. Comprehensive metabolic panels (CMP) including serum calcium and alkaline phosphatase as well as 25 OH Vit D and 125 OH Vit D levels were determined every 6 months. BMD was determined at yearly interval. Results: CMP including calcium and phosphorus remained normal in both groups while alkaline phosphatase declined in group 2 alone. Serum 25 OH Vit D levels were subnormal (<20 pg/ml) in both groups and normalized (53 ±6 pg/ml) only in group 2. BMD continued to decline in group1 while improving (p<0.01) in group 2; BMD being significantly greater than group 1 (p<0.01). Conclusion: In subjects receiving chronic prednisone therapy, low BMD is induced by multiple mechanisms: osteomalacia caused by decreased 125 OH Vit D and osteoporosis caused by matrix collagen breakdown, hypogonadism and secondary hyperparathyroidism. Role of osteomalacia is confirmed by rising BMD on substituting active 125 OH vitamin D3, Calcitriol for inactive vitamin D3, Cholecalciferol.

介绍/目的:强的松治疗后骨密度下降归因于骨质疏松。然而，低125 OH维生素D导致的骨软化症和由此导致的甲状旁腺功能亢进也可能是原因之一。因此，在接受慢性强的松治疗和对双磷酸盐、钙和维生素D3、胆骨化醇治疗难治的低骨密度(T< 2.5)患者中，研究了125 OH维生素D3、骨化三醇对骨密度的影响。方法:21例患者，年龄45-56岁，接受强的松治疗≥3年，经胆骨化醇、碳酸钙和二磷酸盐治疗后骨密度下降，随机分为两组。两组均继续使用钙和双磷酸盐。10例(1组)增加胆骨化醇剂量，每日2000单位;11例(2组)用骨化三醇替代。每6个月测定一次综合代谢组(CMP)，包括血清钙和碱性磷酸酶以及25 OH Vit D和125 OH Vit D水平。骨密度每隔一年测定一次。结果:两组CMP包括钙、磷均保持正常，而单组碱性磷酸酶下降。两组血清25oh - Vit D水平均低于正常水平(<20 pg/ml)，仅在2组血清25oh - Vit D水平正常(53±6 pg/ml)。1组骨密度持续下降，2组骨密度升高(p<0.01);BMD显著大于1组(p<0.01)。结论:在慢性强的松治疗的受试者中，低骨密度是由多种机制引起的:由125 OH - Vit D降低引起的骨软化，由基质胶原分解、性腺功能减退和继发性甲状旁腺功能亢进引起的骨质疏松。骨软化症的作用是通过用活性125 OH维生素D3、骨化三醇取代非活性维生素D3、胆骨化醇来提高骨密度来证实的。

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引用次数: 1

The durability of oral diabetic medications: Time to A1c baseline and a review of common oral medications used by the primary care provider. 糖尿病口服药物的持久性：A1c基线的时间和初级保健提供者使用的常见口服药物的回顾。

Endocrinology, diabetes and metabolism journal

Pub Date : 2018-07-08 DOI: 10.31038/edmj.2018232

Lavanya Cherukuri, Michael S Smith, J. Tayek

IntroductionCost of generic medications has risen more in the past few years than any other time in history. While medical insurance covers much of these costs, health care professionals can better provide medications that have the longest duration of action when compared to placebo-treated controls. This will save health care costs and improve prescribing accuracy.MethodsPapers in PubMed were identified with keywords placebo. The study must be at least 2 years in length to evaluate the change in A1c over time. The primary endpoint was time to A1c neutrality (return of A1c to baseline at a maximum dose of single oral agent). A medication would be considered at neutrality if the 95% CI crossed baseline. Time to neutrality was averaged for each medication within the class and each summarized for class effect.ResultsEffective therapy for the DPP-4 and sulfonylurea classes of medications are 3-4 years as compared to a 5-year time to A1c neutrality for metformin usage. In comparison, the projected time to A1c neutrality was approximately 6-8 years for rosiglitazone and pioglitazone. While only a few studies have been published in the SGLT-2 class of medication, the time to A1c neutrality was also 6-8 years with Canagliflozin and full dosage of Empagliflozin.ConclusionMetformin appears to have a 5-year duration of effect before the A1c returns to baseline. The sulfonylureas and DPP-4 inhibitors class of medications have one of the shortest durability which ranges between 3.3 to 4.4 years. In contrast, the SGLT-2 class of medication and the TZD class of medications has a projected time to A1c neutrality from 6-8 years. Diabetic duration of therapy as compared to placebo should be listed with those medications tested so the provider can choose wisely.

引言在过去的几年里，非专利药物的成本比历史上任何时候都要高。虽然医疗保险涵盖了大部分费用，但与安慰剂治疗的对照组相比，医疗保健专业人员可以更好地提供起效时间最长的药物。这将节省医疗费用并提高处方的准确性。方法PubMed的论文以安慰剂为关键词进行检索。该研究必须至少持续2年，以评估A1c随时间的变化。主要终点是A1c中性的时间（在单次口服制剂的最大剂量下A1c恢复到基线）。如果95%置信区间超过基线，则认为药物为中性。对班内每种药物的中性时间进行平均，并对每种药物进行分类效果总结。结果DPP-4和磺酰脲类药物的有效治疗时间为3-4年，而二甲双胍的A1c中性使用时间为5年。相比之下，罗格列酮和吡格列酮达到A1c中性的预计时间约为6-8年。虽然只有少数研究发表在SGLT-2类药物中，但使用加格列净和全剂量恩帕列嗪，A1c中性的时间也为6-8年。结论二甲双胍在A1c恢复到基线之前似乎有5年的有效期。磺酰脲类和DPP-4抑制剂类药物的耐用性最短，在3.3至4.4年之间。相比之下，SGLT-2类药物和TZD类药物的A1c中性预计时间为6-8年。与安慰剂相比，糖尿病治疗的持续时间应与测试的药物一起列出，以便提供者能够明智地选择。

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引用次数: 15