Lege Artis Medicinae

[The role of metformin in the glucose-lowering therapy of patients with type 2 diabetes]

JERMENDY György

NOVEMBER 20, 2011

Lege Artis Medicinae - 2011;21(11)

[Metformin is the oral antidiabetic drug of choice for patients with type 2 diabetes. Its effect is predominantly based on the reduction of insulin resistance by inhibiting hepatic glucose production. Metformin can be used as an initial oral antidiabetic drug at the start of, or in case of the failure of lifestyle modifications. Metformin is also used in dual or triple oral antidiabetic combinations, however, its use should not be suspended even if initiation of insulin therapy is indicated in patients with type 2 diabetes. Metformin does not increase bodyweight and the risk of hypoglycaemia, and recent data suggest that it decreases the risk of tumour development. Today, an extended- release (XR) formulation is also available besides the traditional one, which not only simplifies the treatment, but might also reduce the incidence of gastrointestinal adverse effects.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[50 years of tolperisone in clinical practice]

BÁLINT Géza

[Tolperisone is a centrally acting muscle relaxant that has both antispasticity and antispasmodic properties, but lacks the sedative effect of other muscle relaxants. In the past 50 years, millions of patients with spasticity due to neurological diseases and painful reflex muscle spasm have been treated with this drug. Although few welldesigned, double blind, controlled clinical trials have been published, the efficacy of tolperisone in the treatment of both spasticity and painful reflex muscle spasm is convincing. The tolerability and safety of the drug are well documented. In this respect, one of its greatest advantages is that it has no sedative effect, does not lengthen reaction time, and does not interfere with driving. Further, well-designed controlled trials are clearly required for widening the use of this excellent drug.]

Lege Artis Medicinae

[Reality and Mystery – The Art of El Greco]

NAGY Zsuzsanna

Lege Artis Medicinae

[The Ear Problem of Francis II and the British Empire ]

GERLINGER Imre

Lege Artis Medicinae

[Misconceptions and the Truth – On Hospice]

HEGEDÛS Katalin

Lege Artis Medicinae

[The Languages of Apologizing]

SZONDY Máté

All articles in the issue

Related contents

Lege Artis Medicinae

[30 years in diabetology reflected on the pages of Lege Artis Medicinae – 1990-2020]

WINKLER Gábor

[Commemorating the 30th anniversary of foundation the journal Lege Artis Me­di­cinae, the author endeavours to review the main developments of diabetology in the same period and arranges their reflections on the journal’s pages. He points out that similar to many other disciplines, the history of development has extremely been rich in the past three decades, thus he focused only on a few issues. The author analyses the changes in the treatment of type 2 diabetes and highlights specific aspects like the importance of early metabolic control, individualized treatment choices, a risk-oriented approach instead of a glucocentric direction, and the role of patient education and a health-conscious lifestyle, which have resulted in the holistic approach of our therapeutic strategy. While using relevant quotes, the author shows that the readers of the journal were also able to keep pace with all events and they were always provided with relevant information by au­thentic specialists of diabetology. ]

Lege Artis Medicinae

[THE WORLDWIDE EPIDEMIC OF TYPE 2 DIABETES - CAUSES AND CONSEQUENCES]

JERMENDY György

[The prevalence of type 2 diabetes mellitus has recently dramatically increased worldwide. While many factors contribute to the startling data, including changes in the diagnostic criteria of glucose intolerance, increase of life expectancy, manifestation of diabetes at younger ages, and increased detection of unrecognized diabetes due to more efficient screening, the genuine, steep rise in the incidence of diabetes is explained by the increasing prevalence of obesity. Among the late complications of both diabetes and obesity, cardiovascular diseases are particularly important. Insulin resistance due to visceral obesity plays a central role in the pathomechanism of type 2 diabetes. In the prevention of both type 2 diabetes and obesity, non-pharmacological intervention such as life style changes should be considered first. Supplementary pharmacological treatment should target all cardiovascular risk factors.]

Lege Artis Medicinae

[Antidiabetic therapy of patients with type 2 diabetes - The role of incretin mimetics]

GERŐ László

[Incretin mimetics represent a new group of antidiabetic drugs. They bind to their own receptor on the beta-cell membrane and increase insulin secretion in a glucosedependent manner. Thus, they rarely cause hypoglycaemia. Furthermore, they significantly reduce body weight and other cardiovascular risk factors. Accordingly, they can be considered as an optimal group of antidiabetic drugs. The author reviews the clinical efficacy and safety of currently available incretin mimetics.]

Lege Artis Medicinae

[Switching from human basal insulin to once daily insulin detemir in type 2 diabetic patients treated by basal-bolus regimen - Results from the LEONCET2, an observational, prospective, multicenter study]

JEMENDY György

[Insulin analogues have been developed in order to overcome some drawbacks of human insulins. Switching from a human insulin-based basal- bolus regimen to once daily detemir could result in improved metabolism and increased safety of the therapy. We assessed the effects of switching from human NPH-insulin to once daily detemir insulin in patients with type 2 diabetes mellitus treated with a basal-bolus insulin regimen. We evaluated the data of 1,474 patients with diabetes (age: 59.1±9.8 years, body weight 89.6±8.6 kg, BMI 31.6±5.4 kg/m2) in an observational, prospective, 24-week, multicenter study. All patients were treated with a basal-bolus regimen consisting of human NPH as basal insulin and a human or analogue insulin as bolus insulin. After enrollment, patients received once daily detemir insulin instead of NPH-insulin, while treatment with bolus insulin was continued. Patients were examined at weeks 12 and 24. By week 24, the mean HbA1c value, irrespective of BMI-categories, decreased significantly (p<0.0001) from 8.63±1.01% by 0.79±0.63%. Fasting blood glucose level decreased from 8.86±1.78 mmol/l to 7.09±1.31 mmol/l; p<0.0001). The target level of HbA1c (<7.0%) was reached by 194 patients (13.1%). The patients’ body weight decreased significantly by week 12 (-0.69±2.00 kg; p<0.0001) and by week 24 (-1.28±2.80 kg; p<0.0001). The changes were more pronounced in higher than in lower BMI-categories (p for trend <0.0001). The mean daily doses of basal insulin were increased from 0.28 IU/kg to 0.33 IU/kg while those of bolus insulins were not changed. The rate of severe hypoglycaemic events decreased significantly (p=0.048) from 2.95 [daytime 1.02, nocturnal 1.93] to 0.06 [daytime 0.04, nocturnal 0.02] episodes/patient-year. In patients with type 2 diabetes mellitus treated with basal-bolus regimen, switching from human basal insulin to once daily insulin detemir results in a significantly improved metabolism, as well as fewer hypoglycaemic events and decreased body weight. Nevertheless, the low rate of patients reaching the glycaemic target implicates that some factors other than an appropriate basal insulin substitution have a role in achieving an optimal metabolic control.]

Image challenge

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