The Efficacy of Switching Basal-bolus Insulin Therapy to Basal Insulin-supported Oral Therapy with a Glinide and an α-glucosidase Inhibitor in Patients with Type 2 Diabetes Depends on Insulin Secretory Capacity, but Not on Blood Glucose Profiles And...

Overview

Journal Diabetol Int

Specialty Endocrinology

Date 2024 Jan 24

PMID 38264217

Authors

Toshihito Ando

Masaki Kondo

Yuriko Asada-Yamada

Miyuka Kawai

Emi Asano-Hayami

Tomohide Hayami

Mikio Motegi

Yohei Ejima

Eriko Nagao

Rina Kasagi

Hiromi Nakai-Shimoda

Saeko Asano

Makoto Kato

Yuichiro Yamada

Emiri Yura-Miura

Takahiro Ishikawa

Yukako Sugiura-Roth

Chika Kojima

Ena Naito

Tatsuhito Himeno

Shin Tsunekawa

Yoshiro Kato

Jiro Nakamura

Hideki Kamiya

Affiliations

Soon will be listed here.

Abstract

Aims: We aimed to identify patients who would benefit from basal insulin-supported oral therapy (BOT) with a glinide and an α-glucosidase inhibitor (a fixed-dose combination tablet of mitiglinide 10 mg and voglibose 0.2 mg) in Japanese type 2 diabetic patients.

Methods: Patients who were hospitalized to improve hyperglycemia received basal-bolus insulin therapy. After the reduction of glucose toxicity, a 75 g oral glucose tolerance test and a glucagon test were performed. Thereafter, the basal-bolus insulin therapy was switched to BOT with mitiglinide, followed by further addition of voglibose. Interstitial glucose levels were continuously monitored throughout the study period. Diurnal glucose profile was recorded and analyzed. Patients were divided into two groups according to whether their percentage of time in range (TIR, 70-180 mg/dL) under BOT with mitiglinide/voglibose was higher than 70% or not, and the differences in clinical characteristics between the groups were analyzed.

Results: Twenty patients were enrolled, and 19 of them completed the study. BOT with mitiglinide/voglibose achieved ≥ 70% of TIR in thirteen patients. The area under the curve of serum C-peptide levels during the oral glucose tolerance test was significantly higher in the patients with ≥ 70% of TIR. The daily insulin dosages and blood glucose profiles were comparable between the two groups.

Conclusions: The efficacy of BOT with mitiglinide/voglibose depended on residual insulin secretory abilities. This therapy would be a useful therapeutic option for patients with type 2 diabetes.

References

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

Rathmann W, Czech M, Franek E, Kostev K . Regional differences in insulin therapy regimens in five European countries . Int J Clin Pharmacol Ther. 2017; 55(5):403-408. DOI: 10.5414/CP202906. View

Bonds D, Miller M, Bergenstal R, Buse J, Byington R, Cutler J . The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010; 340:b4909. PMC: 2803744. DOI: 10.1136/bmj.b4909. View

Tsukube S, Ikeda Y, Kadowaki T, Odawara M . Improved Treatment Satisfaction and Self-reported Health Status after Introduction of Basal-Supported Oral Therapy Using Insulin Glargine in Patients with Type 2 Diabetes: Sub-Analysis of ALOHA2 Study. Diabetes Ther. 2015; 6(2):153-71. PMC: 4478177. DOI: 10.1007/s13300-015-0111-5. View

Quagliaro L, Piconi L, Assaloni R, Martinelli L, Motz E, Ceriello A . Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells: the role of protein kinase C and NAD(P)H-oxidase activation. Diabetes. 2003; 52(11):2795-804. DOI: 10.2337/diabetes.52.11.2795. View

Assaloni R, Da Ros R, Quagliaro L, Piconi L, Maier A, Zuodar G . Effects of S21403 (mitiglinide) on postprandial generation of oxidative stress and inflammation in type 2 diabetic patients. Diabetologia. 2005; 48(9):1919-24. DOI: 10.1007/s00125-005-1849-5. View

. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001; 161(3):397-405. DOI: 10.1001/archinte.161.3.397. View

ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D . 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2023. Diabetes Care. 2022; 46(Suppl 1):S140-S157. PMC: 9810476. DOI: 10.2337/dc23-S009. View

Danne T, Bluhmki T, Seufert J, Kaltheuner M, Rathmann W, Beyersmann J . Treatment intensification using long-acting insulin -predictors of future basal insulin supported oral therapy in the DIVE registry. BMC Endocr Disord. 2015; 15:54. PMC: 4597397. DOI: 10.1186/s12902-015-0051-0. View

10.

Abbatecola A, Rizzo M, Barbieri M, Grella R, Arciello A, Laieta M . Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics. Neurology. 2006; 67(2):235-40. DOI: 10.1212/01.wnl.0000224760.22802.e8. View

11.

Ono Y, Kameda H, Cho K . Mitiglinide/voglibose fixed-dose combination improves postprandial glycemic excursions in Japanese patients with type 2 diabetes mellitus. Expert Opin Pharmacother. 2013; 14(4):361-70. DOI: 10.1517/14656566.2013.770839. View

12.

Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A . Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care. 1999; 22(6):920-4. DOI: 10.2337/diacare.22.6.920. View

13.

Ihana N, Tsujimoto T, Yamamoto-Honda R, Kishimoto M, Kajio H, Noto H . Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study. Diabetol Metab Syndr. 2014; 6:48. PMC: 4025538. DOI: 10.1186/1758-5996-6-48. View

14.

Zoungas S, Patel A, Chalmers J, de Galan B, Li Q, Billot L . Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010; 363(15):1410-8. DOI: 10.1056/NEJMoa1003795. View

15.

Mazze R, Strock E, Borgman S, Wesley D, Stout P, Racchini J . Evaluating the accuracy, reliability, and clinical applicability of continuous glucose monitoring (CGM): Is CGM ready for real time?. Diabetes Technol Ther. 2009; 11(1):11-8. DOI: 10.1089/dia.2008.0041. View

16.

Chow E, Bernjak A, Williams S, Fawdry R, Hibbert S, Freeman J . Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk. Diabetes. 2014; 63(5):1738-47. DOI: 10.2337/db13-0468. View

17.

Takeshita Y, Takamura T, Kita Y, Takazakura A, Kato K, Isobe Y . Sitagliptin versus mitiglinide switched from mealtime dosing of a rapid-acting insulin analog in patients with type 2 diabetes: a randomized, parallel-group study. BMJ Open Diabetes Res Care. 2015; 3(1):e000122. PMC: 4553908. DOI: 10.1136/bmjdrc-2015-000122. View

18.

Mu P, Liu D, Lin Y, Liu D, Zhang F, Zhang Y . The Postprandial-to-Fasting Serum C-Peptide Ratio is a Predictor of Response to Basal Insulin-Supported Oral Antidiabetic Drug(s) Therapy: A Retrospective Analysis. Diabetes Ther. 2018; 9(3):963-971. PMC: 5984910. DOI: 10.1007/s13300-018-0404-6. View

19.

Chittari M, McTernan P, Bawazeer N, Constantinides K, Ciotola M, OHare J . Impact of acute hyperglycaemia on endothelial function and retinal vascular reactivity in patients with Type 2 diabetes. Diabet Med. 2011; 28(4):450-4. DOI: 10.1111/j.1464-5491.2010.03223.x. View

20.

Funakoshi S, Fujimoto S, Hamasaki A, Fujiwara H, Fujita Y, Ikeda K . Utility of indices using C-peptide levels for indication of insulin therapy to achieve good glycemic control in Japanese patients with type 2 diabetes. J Diabetes Investig. 2014; 2(4):297-303. PMC: 4014971. DOI: 10.1111/j.2040-1124.2010.00096.x. View