| 1. |
- Ahrén, Bo, et al.
(author)
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The islet enhancer vildagliptin: mechanisms of improved glucose metabolism.
- 2008
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In: International journal of clinical practice. Supplement. - : Hindawi Limited. - 1368-504X .- 1368-5031. ; 62, s. 8-14
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Journal article (peer-reviewed)abstract
- Vildagliptin is a potent, selective and reversible inhibitor of dipeptidyl peptidase-4 (DPP-4), the enzyme responsible for rapid inactivation of the incretin hormones glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP). GLP-1 and GIP are important for the maintenance of normal glucose homeostasis as they enhance the sensitivity of insulin (beta-cell) and glucagon (alpha-cell) secretion to glucose. The delicate balance that is achieved by the incretin hormones is disturbed in type 2 diabetes mellitus (T2DM). Mechanistic studies of vildagliptin performed to characterise the effects of DPP-4 inhibition on pancreatic islet function and glucose metabolism have found that vildagliptin produces dose-dependent reductions in DPP-4; these result in persistent levels of active GLP-1 and GIP in the circulation leading to improved beta-cell sensitivity to glucose and glucose-dependent insulin secretion, and improved alpha-cell sensitivity to glucose and reduction in inappropriate glucagon secretion. These islet effects in turn lead to a reduction of the inappropriate endogenous glucose production and glucose utilisation during meals, resulting in improved glucose tolerance, and to a reduction of the inappropriate endogenous glucose production during the postabsorptive period that contributes to a reduced fasting hyperglycaemia. These islet effects are associated with improved insulin sensitivity and reduced meal-related hypertriglyceridaemia. In contrast, the GLP-1 effect of significantly delaying gastric emptying was not evident with vildagliptin treatment. The metabolic benefits of vildagliptin observed in T2DM are also evident in subjects with impaired glucose tolerance. Hence, vildagliptin improves glucose metabolism mainly by improving islet function.
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| 2. |
- Danne, T, et al.
(author)
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New insulins and insulin therapy
- 2011
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In: International journal of clinical practice. Supplement. - : Hindawi Limited. - 1368-504X .- 1368-5031. ; 65:170, s. 26-30
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Journal article (peer-reviewed)
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| 3. |
- Garg, S, et al.
(author)
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Self-monitoring of blood glucose
- 2010
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In: International journal of clinical practice. Supplement. - : Hindawi Limited. - 1368-504X .- 1368-5031 .- 1742-1241. ; 64:166, s. 1-69
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Journal article (peer-reviewed)
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| 4. |
- Decramer, M, et al.
(author)
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Asthma and COPID: differences and similarities - With special reference to the usefulness of budesonide/formoterol in a single inhaler (Symbicort (R)) in both diseases
- 2005
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In: International Journal of Clinical Practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 59:4, s. 385-398
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Research review (peer-reviewed)abstract
- Asthma and chronic obstructive pulmonary disease (COPD) both have a high prevalence worldwide and yet each condition remains underdiagnosed. Despite a number of common features, these inflammatory respiratory syndromes have distinct clinical outcomes. COPD represents a greater economic burden than asthma because it has a less favourable prognosis and is associated with greater morbidity and mortality. Therefore, it is important to distinguish between these two diseases at an early stage, so that appropriate therapy can be prescribed to prevent deterioration. However, effective treatments that may be used in both conditions can minimise the effects of misdiagnosis and maximise the impact of treatment without the associated complexity when both conditions occur together. The current review summarises the differences and similarities of asthma and COPD, in terms of risk factors, pathophysiology, symptoms and diagnosis, to provide greater understanding of the role of budesonide/ formoterol in a single inhaler in both diseases.
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| 5. |
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| 6. |
- Wagg, A., et al.
(author)
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Nocturia: morbidity and management in adults
- 2005
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In: Int J Clin Pract. - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 59:8, s. 938-45
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Journal article (peer-reviewed)abstract
- Nocturia is an increasingly prevalent and bothersome urinary symptom associated with considerable impact and morbidity in later life. Nocturnal frequency is associated with a number of underlying pathologies, both related and unrelated to the lower urinary tract. Following careful assessment, diagnosis and management, the condition is amenable to amelioration, if not complete cure in the majority of cases. This paper outlines the epidemiology, underlying pathophysiology and diseases associated with nocturia and reviews current treatment strategies.
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| 7. |
- Quilici, S, et al.
(author)
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Cost-effectiveness of acarbose for the management of impaired glucose tolerance in Sweden.
- 2005
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In: International journal of clinical practice (Esher). - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 59:10, s. 1143-1152
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Journal article (peer-reviewed)abstract
- We assessed the cost-effectiveness of acarbose in the management of patients with impaired glucose tolerance (IGT) in Sweden, based on progression to type 2 diabetes (T2D) and cardiovascular (CV) events reported in the STOP-NIDDM trial population, including high-risk subgroups. The cost per patient free from T2D was SEK28 000 or SEK1260 per diabetes free month prior to progression to T2D. The cost per patient free from CV events was SEK101 000 or SEK5000 per CV event free month. For the high CV risk subgroups, acarbose treatment dominated placebo (i.e. acarbose was more effective, less costly).Acarbose significantly reduces the incidence of diabetes and CV events in IGT patients. We predict this may translate into healthcare cost savings that partially or, in patients at high CV risk, fully offset the cost of acarbose. We conclude that acarbose is likely to be cost-effective in the management of impaired glucose tolerance.
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| 8. |
- Akalin, S., et al.
(author)
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Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control
- 2009
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In: International Journal of Clinical Practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 63:10, s. 1421-1425
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Journal article (peer-reviewed)abstract
- Background: There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (< 6.0%) may, in fact, be dangerous in certain patient populations. Aim: To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes. Methods: A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions. Results: Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (< 6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes. Conclusions: Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels.
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| 9. |
- Alander, Ture, et al.
(author)
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Functional gastrointestinal disorder is associated with increased non-gastrointestinal healthcare consumption in the general population
- 2008
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In: International journal of clinical practice (Esher). - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 62:2, s. 234-240
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Comparison of comorbidity and healthcare consumption in primary healthcare subjects with persistent functional gastrointestinal disorder (FGID) and a strictly gastrointestinal (GI) symptom-free group (SSF). METHODS: A stratified sample (n=1428, 21-86 years) of subjects living in the Osthammar community, Sweden, was limited to half of the community and classified through the Abdominal Symptom Questionnaire (ASQ) into two study groups, one with persistent FGID (n=71), another SSF (n=48). Symptoms were re-evaluated by means of the ASQ at a surgery visit, as was healthcare consumption during 2 years, and the levels of anxiety and depression, as measured with the Hospital Anxiety and Depression Scale. Diagnoses were set according to The International Classification of Diseases (ICD)-9 and the 14 diagnostic groups. RESULTS: Of the FGID patients, 97% had a non-GI diagnosis, compared with 100% of SSF (ns). The mean number of doctors' consultations (OR=3.5), phone calls to doctors (OR=3.4), number of prescriptions (OR=2.4) and number of set diagnoses (OR=3.9), anxiety level (OR=11.5) and depression (OR=5.2) were all statistically significantly higher (p<0.05) for FGID than for SSF, while the number of referrals and sick leave were not. Besides a GI diagnosis, there was no significant difference (p>0.05) in the spectrum of morbidity in terms of ICD-9 subgroup classification, except an increased proportion of older SSF subjects with circulatory disorders and hypertension. CONCLUSIONS: Functional gastrointestinal disorders are related to an increased demand on primary healthcare because of an increased overall comorbidity, which signifies a need for a holistic healthcare approach.
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