Lege Artis Medicinae

[Antidiabetic therapy of patients with type 2 diabetes - The place of administration of acarbose]


JUNE 20, 2011

Lege Artis Medicinae - 2011;21(06-07)

[Administration of the alpha-glucosidase enzyme inhibitor acarbose leads to a prolonged absorption of carbohydrates, which has a smoothing effect on blood glucose excursions, and results in a more even daily blood glucose profile. The glucose lowering effect is mainly due to the reduction of postprandial blood glucose levels. Non-glycaemic effects of acarbose, including those on blood pressure, lipids and the coagulation system are also clearly beneficial. According to the available data, the preparation also reduces cardiovascular risk. If used as a monotherapy, acarbose does not cause hypoglycaemia. Flatulence and diaorrhea represent the main side effects. From a professional point of view, acarbose should be given if postprandial blood glucose excursions exceed 2.2 mmol/l.]



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[Due to the prevalence and significant mortality of peripheral vascular diseases, their treatment requires special attention. PATIENTS - We examined 45 patients awaiting vascular surgery at the Department of Cardiovascular Surgery at Semmelweis University. RESULTS - We have demonstrated that the routine administration of acetylsalicylic acid was ineffective in the majority (60%) of patients, especially in the at-risk groups. In contrast, clopidogrel therapy was ineffective in only 11% of patients. CONCLUSIONS - On the basis of the literature and our own studies, we consider clopidogrel as the first-choice drug for the inhibition of thrombocyte aggregation in all patients with vascular disease, and for primary prevention in at-risk groups.]

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Lege Artis Medicinae

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Lege Artis Medicinae

[Cost minimization analysis of basal insulin analogues in the treatment of type 2 diabetes]

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[INTRODUCTION - Basal insulin analogues are essential drugs for the treatment of type 2 diabetes mellitus. Basal insulin analogues have been shown to reduce the frequency of hypoglycaemia versus NPH insulin, and thus may be beneficial in the treatment of type 2 diabetes. Here we present a cost-minimisation analysis of basal insulin analogues, comparing insulin glargine and insulin detemir available in Hungary. METHODS - A literature review was conducted to identify randomized, controlled clinical trials with a duration of 12 weeks or more in which a direct comparison of insulin glargine and insulin detemir was made in patients with type 2 diabetes. In a meta-analysis of the eligible trials, the following endpoints were investigated: metabolic status, body weight, frequency of hypoglycaemia, insulin doses administered and the number of insulin injections required. If a high heterogeneity (I2>75%) was found, meta-regression was performed to identify the underlying reasons. The funder’s perspective was applied in the cost-minimization analysis by taking into account the cost of the drug and of medical devices necessary for its administration, based on the daily number of insulin injections. RESULTS - No further studies were found in addition to those included in a metaanalysis published by The Cochrane Library. On the basis of three eligible studies, insulin detemir was injected more frequently compared with glargine (weighted mean difference: 0.42 95% CI 0.14-0.69 injections/day). High heterogeneity was present in case of two endpoints: the incidence of overall hypoglycaemia per patient-year (I2=83%), and daily basal insulin dose in units per body weight (I2=94%). The reason for the high heterogeneity in hypoglycaemia rates was not identified by meta-regression; however, the difference in insulin doses per body weight was negatively associated with body weight (-0.027 IU/kg per 1 kg, 95%CI: -0.051; -0.004). On the basis of the present meta-analysis and meta-regression, our calculations suggest that treating an average weight (90 kg) patient with type 2 diabetes with insulin glargine would result in an annual cost reduction of 93 452 HUF compared with insulin detemir by employing gross public drug prices. CONCLUSION - On the basis of the available clinical evidence, insulin glargine might be a cost-saving alternative of insulin detemir in an average-weight patient with type 2 diabetes. In an era of scarce resources, the role of therapeutic alternatives offering cost savings with the same efficacy become more important. The generalisability of our conclusions might be influenced by potential differences in the manufacturers’ claw-back rate of detemir vs glargine insulin.]

Lege Artis Medicinae



[Oral antidiabetic drugs are used in type 2 diabetic patients when diet and physical exercise have failed. The oral antidiabetic drugs available in Hungary can be classified according to their main effect. In this regard, antihyperglycaemic drugs with no hypoglycaemic potential (alfaglucosidase inhibitors, biguanides, thiazolidinedions) and drugs with a potential of insulin secretion (sulfonylureas, prandial glucose regulators) can be distinguished. Acarbose is mainly used in order to decrease the postprandial glucose excursion. Metformin is the drug of choice for obese, insulin resistant diabetic subjects while buformin is not preferable anymore since the availability of metformin. Rosiglitazone, the only thiazolidine-dion derivative in Hungary, can be used in combination therapy in diabetic subjects with clinical characteristics of the metabolic syndrome. The list of sulfonylureas contains five drugs in Hungary which enables differential therapeutical strategies to be performed. The prandial glucose regulators can be used either in monotherapy or in combination with other drugs at the relatively early stage of the disease. At present, the recommendations for treating diabetic patients with oral antidiabetic drugs can be based on clinical evidences.]

Image challenge

What do you see on the feet of the diabetic patient?