BACKGROUND: Individuals initially diagnosed with type 2 diabetes (T2D) might exhibit positivity for diabetes-associated autoantibodies (DAA +). We investigated the prevalence of DAA positivity in a group of individuals with T2D who were referred to a tertiary diabetes centre within a pre-specified period of time. We aimed to identify characteristics linked with DAA positivity by comparing DAA + individuals with their DAA-negative counterparts. METHODS: This was a cross-sectional study into which all T2D patients referred to the National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia, between 1 January and 30 June 2016 were included. Data on > 70 participants' characteristics, including antibodies against glutamic acid decarboxylase (anti-GAD65), insulinoma-associated antigen IA-2 (IA-2A) and insulin (IAA), were collected. RESULTS: Six hundred and ninety-two individuals (387, 55.6% female) with a median (range) age of 62 (24-83) years, HbA1c of 8.9 (5.0-15.7)% [74 (31-148 mmol/mol)] and diabetes duration of 13.0 (0-42) years were analysed. One hundred and forty-five (145/692, 21.0%) tested positive for at least one DAA; 136/692 (19.7%) were positive for anti-GAD65, 21/692 (3.0%) were positive for IA-2A and 9/692 (1.3%) were positive for IAA. Only 84.9% of the DAA + individuals aged > 30 years at the time of diabetes diagnosis met the current diagnostic criteria for latent autoimmune diabetes of adults (LADA). DAA + differed from DAA - individuals in multiple characteristics, including the incidence of hypoglycaemia. CONCLUSION: Several pathological processes linked with distinct types of diabetes can develop in parallel, including insulin resistance and autoimmune insulitis. In this single-centre cross-sectional study from Slovakia, we report a higher than previously published prevalence of DAA positivity in a group of individuals with a formal diagnosis of T2D.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
INTRODUCTION: Recent development of novel antidiabetic drugs with proven cardiovascular (CV) and renal benefit and positive effect on body weight enable to take a more complex approach toward the management of type 2 diabetes mellitus (T2DM). Fixed-ratio combinations of insulin-GLP-1 receptor agonist (FRC) utilize complementary mechanisms of action of their individual components and address multiple pathologies linked with T2DM at the same time. AREAS COVERED: There are currently three FRCs on the market: iGlarLixi (glargine and lixisenatide in 2 different formulations) and IDegLira (degludec and liraglutide). We provide an up-to-date review on the rationale for the use of FRCs and their current position in the management of T2DM. We discuss the available evidence from randomized controlled trials, post hoc analyses, indirect comparative studies and real-world data on their effect on glycemic control, risk of hypoglycemia, body weight, CV safety, and their safety profile. EXPERT OPINION: FRCs represent an efficacious option for treatment intensification from basal insulin or even the first insulin-based therapy in T2DM. Their excellent glucose-lowering efficacy is complemented with lower risk of hypoglycemia in comparison to basal insulin, neutral effect on body weight and the lower risk of gastrointestinal adverse effects in comparison to GLP-1 receptor agonists.
- MeSH
- diabetes mellitus 2. typu * farmakoterapie MeSH
- fixní kombinace léků MeSH
- glykovaný hemoglobin MeSH
- hypoglykemie * chemicky indukované MeSH
- hypoglykemika škodlivé účinky MeSH
- inzulin glargin terapeutické užití MeSH
- krevní glukóza MeSH
- lidé MeSH
- receptor pro glukagonu podobný peptid 1 agonisté MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Progresívny, nie statický charakter priebehu diabetes mellitus 2. typu (DM2T) predurčuje toto ochorenie na pravidelný monitoring a úpravu (intenzifikáciu) terapie. Cieľom je optimálna glykemická kompenzácia v každom čase. V článku prezentujem racionále pre optimálnu glykemickú kompenzáciu a včasnú intervenciu v manažmente DM2T vrátane kauzálneho vzťahu glykemickej kompenzácie a rizika diabetických komplikácií, efektu metabolickej pamäti a klinickej inercie so zameraním sa na rozhodovanie o ďalšej terapii v situácii nedostatočne kompenzovaného DM2T na liečbe perorálnymi antidiabetikami a bazálnym inzulínom. Fixné kombinácie bazálnych inzulínov a agonistov GLP1-RA pozitívne ovplyvňujú 7 z 8 patologických procesov ominózneho oktetu, a predstavujú tak preferovanú voľbu v takýchto situáciách. Posledné klinické štúdie podávajú dôkazy aj pre ich nasadenie ako prvej na inzulíne založenej terapii.
The progressive, not static nature of the course of type 2 diabetes mellitus (T2DM) predisposes this disease to regular monitoring and adjustment (intensification) of therapy. The goal is optimal glycaemic control at all times. In this article, I present the rationale for optimal glycaemic compensation and early intervention in the management of T2DM. I discuss the causal relationship of glycaemic compensation and risk of diabetic complications, the effect of metabolic memory, and clinical inertia, with a focus on decision making for further therapy intensification in the setting of poorly compensated T2DM on oral antidiabetic agents and basal insulin. Fixed-ratio combinations of basal insulins and GLP-1 receptor agonists positively affect 7 of the 8 pathological processes of the ominous octet, and thus represent the preferred choice in such situations. Recent clinical trials also provide evidence for their use as first-line insulin-based therapy.
- MeSH
- diabetes mellitus 2. typu * farmakoterapie MeSH
- dlouhodobě působící inzulin farmakologie terapeutické užití MeSH
- fixní kombinace léků MeSH
- glykovaný hemoglobin analýza MeSH
- hypoglykemika farmakologie terapeutické užití MeSH
- inzulin terapeutické užití MeSH
- lidé MeSH
- receptor pro glukagonu podobný peptid 1 terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF REVIEW: To review the currently available data on the effect of Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) on postprandial lipaemia. RECENT FINDINGS: Out of the available studies that examined the respective lipid parameter, exenatide reduced postprandial triacyglycerol (TAG) in 4/6, apolipoprotein B-48 in 3/3, non-esterified fatty acids in 2/2, and apolipoprotein C-III and very low-density lipoprotein cholesterol (VLDL-C) in 1/1 studies. Liraglutide reduced postprandial TAG in 2/2, apolipoprotein B-48 in 3/3 and apolipoprotein C-III, chylomicron-TAG and VLDL1-TAG in 1/1 studies. Lixisenatide reduced postprandial chylomicron-TAG and apolipoprotein B-48 in 1 study. Semaglutide reduced postprandial TAG, apolipoprotein B-48 and VLDL in 1 study. Dulaglutide reduced postprandial apolipoprotein B-48 in 1 study. GLP-1 RAs have consistent beneficial effects on postprandial lipaemia with most of the data coming from studies with exenatide and liraglutide. Reduction of postprandial lipaemia might be one of the mechanisms behind the pleiotropic effects of GLP-1 RAs.
- MeSH
- apolipoprotein B-48 MeSH
- apolipoprotein C-III MeSH
- chylomikrony MeSH
- diabetes mellitus 2. typu * MeSH
- exenatid terapeutické užití MeSH
- glukagonu podobný peptid 1 MeSH
- hyperlipidemie * farmakoterapie MeSH
- hypoglykemika MeSH
- lidé MeSH
- liraglutid farmakologie terapeutické užití MeSH
- receptor pro glukagonu podobný peptid 1 agonisté MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
