Dapagliflozin add-on to metformin in type 2 diabetes inadequately controlled with metformin:a randomized, double-blind, placebo-controlled 102-week trial

Background: Management of type 2 diabetes with metformin often does not provide adequate glycemic control, thereby necessitating add-on treatment. In a 24-week clinical trial, dapagliflozin, an investigational sodium glucose cotransporter 2 inhibitor, improved glycemic control in patients inadequately controlled with metformin. The present study is an extension that was undertaken to evaluate dapagliflozin as long-term therapy in this population.Methods: This was a long-term extension (total 102 weeks) of a 24-week phase 3, multicenter, randomized, placebo-controlled, double-blind, parallel-group trial. Patients were randomly assigned (1:1:1:1) to blinded daily treatment (placebo, or dapagliflozin 2.5 to 5, or 10 mg) plus open-label metformin (=1,500 mg). The previously published primary endpoint was change from baseline in glycated hemoglobin (HbA1c) at 24 weeks. This paper reports the follow-up to week 102, with analysis of covariance model performed at 24 weeks with last observation carried forward; a repeated measures analysis was utilized to evaluate changes from baseline in HbA1c, fasting plasma glucose (FPG), and weight.Results: A total of 546 patients were randomized to 1 of the 4 treatments. The completion rate for the 78-week double-blind extension period was lower for the placebo group (63.5%) than for the dapagliflozin groups (68.3% to 79.8%). At week 102, mean changes from baseline HbA1c (8.06%) were +0.02% for placebo compared with -0.48% (P = 0.0008), -0.58% (P

Behind the scenes:a week in the life of a Senior Pro-Vice Chancellor

Helen Higson graduated from Cambridge University in 1982 and followed this up with an MSc with the Open University and a PhD at Birkbeck College London. She started working in HE at Southampton University and has spent the last 25 years at Aston University. Her roles there have been various, starting as PA to the Pro-Vice-Chancellor External Relations and spending 20 years with Aston Business School. Helen was awarded a Personal Chair in Higher Education Learning and Management in 2008 and is currently Senior Pro-Vice-Chancellor, with responsibility for International Relations, Employability, Schools Liaison, Registry and Planning. Helen was awarded an AUA Fellowship in 2010 and an OBE in the 2011 New Year Honours list.

Novel glucagon-like peptide-1 (GLP-1) analog (Val8)GLP-1 results in significant improvements of glucose tolerance and pancreatic β-cell function after 3-week daily administration in obese diabetic (ob/ob) mice

This study evaluates the antidiabetic potential of an enzyme-resistant analog, (Val8)GLP-1. The effects of daily administration of a novel dipeptidyl peptidase IV-resistant glucagon-like peptide-1 (GLP-1) analog, (Val8)GLP-1, on glucose tolerance and pancreatic β-cell function were examined in obese-diabetic (ob/ob) mice. Acute intraperitoneal administration of (Val8)GLP-1 (6.25-25 nmol/kg) with glucose increased the insulin response and reduced the glycemic excursion in a dose-dependent manner. The effects of (Val8)GLP-1 were greater and longer lasting than native GLP-1. Once-daily subcutaneous administration of (Val8)GLP-1 (25 nmol/kg) for 21 days reduced plasma glucose concentrations, increased plasma insulin, and reduced body weight more than native GLP-1 without a significant change in daily food intake. Furthermore, (Val8)GLP-1 improved glucose tolerance, reduced the glycemic excursion after feeding, increased the plasma insulin response to glucose and feeding, and improved insulin sensitivity. These effects were consistently greater with (Val8)GLP-1 than with native GLP-1, and both peptides retained or increased their acute efficacy compared with initial administration. (Val8)GLP-1 treatment increased average islet area 1.2-fold without changing the number of islets, resulting in an increased number of larger islets. These data demonstrate that (Val8)GLP-1 is more effective and longer acting than native GLP-1 in obese-diabetic ob/ob mice.

Efficacy and safety of dapagliflozin monotherapy in people with Type 2 diabetes:a randomized double-blind placebo-controlled 102-week trial

Aims: To assess initial pharmacotherapy of Type 2 diabetes with the sodium-glucose cotransporter-2 inhibitor dapagliflozin. Methods: This double-blind, placebo-controlled trial, randomly allocated people with Type 2 diabetes aged 18-77 years and inadequate glycaemic control on diet and exercise [HbA1c 53-86 mmol/mol (7.0-10.0%)] to receive placebo (n = 75) or dapagliflozin monotherapy 2.5 mg (n = 65), 5 mg (n = 64) or 10 mg (n = 70) once daily in the morning. After 24 weeks, low-dose double-blind metformin 500 mg/day was added to the placebo group regimen (placebo+low-dose metformin group). Changes in HbA1c level, fasting plasma glucose and body weight, as well as adverse events, were assessed over 102 weeks. Results: Of the 274 participants randomized, 167 completed the study (60.9%). At 102 weeks, significant differences vs placebo+low-dose metformin with dapagliflozin 5 and 10 mg were observed for HbA1c (-5.8 mmol/mol [-0.53%], P = 0.018; and -4.8 mmol/mol [-0.44%], P = 0.048), respectively); and for FPG (-0.69 mmol/L, P = 0.044; and -1.12 mmol/l, P = 0.001, respectively). For body weight, the difference between the dapagliflozin 10-mg group and the placebo+low-dose metformin group was significant (-2.60 kg; P = 0.016). Hypoglycaemic events were uncommon, with rates of 5.3% for placebo+low-dose metformin group and 0-4.6% for the dapagliflozin groups. Genital infections and urinary tract infections were more common in the dapagliflozin groups than in the placebo+low-dose metformin group. Conclusions: Dapagliflozin as monotherapy in treatment-naïve people with early Type 2 diabetes improved glycaemic control and reduced weight without increasing hypoglycaemia over 102 weeks. Dapagliflozin may provide an alternative initial pharmacotherapy in such people.

Lymphocyte peroxiredoxin-2 levels are depleted one week after ultra-endurance exercise

Peroxiredoxin-2 (PRDX-2) belongs to a family of thiol containing proteins and is important for antioxidant defense, redox signaling and cell function. This study examined whether lymphocyte PRDX-2 levels are altered over one month following ultra-endurance exercise. Nine middle-aged men participated in a 145 mile ultra-endurance running race event. Blood drawing was undertaken immediately before, upon completion/retirement, and at one, seven and twenty eight-days following the race. PRDX-2 levels were examined at each time-point, for all participants (n=9) by reducing SDS-PAGE and western blotting. Further analysis using non-reducing SDS-PAGE and western blotting was undertaken in a sub-group of men who completed the race (n = 4) to investigate PRDX-2 oligomeric state (indicative of oxidation state). Ultra-endurance exercise caused a significant alteration in lymphocyte PRDX-2 levels (F(4,32) 3.409, p=0.020, η2 =0.299): seven-days after the race PRDX-2 levels fell by 70% (p=0.013) and at twenty eight-days after the race returned to near-normal levels. PRDX-2 dimers (intracellular reduced PRDX-2 monomers) in three of the four participants, who finished the race, were increased upon race completion. Furthermore, PRDX-2 monomers (intracellular over-oxidized PRDX-2 monomers) in two of these four participants were present upon race completion, but absent seven-days after the race. This study found that PRDX-2 levels in lymphocytes were reduced below normal levels seven-days after an ultra-endurance running race. We suggest that excessive reactive oxygen species production, induced by ultra-endurance exercise may, in part, explain the depletion of lymphocyte PRDX-2 by triggering its turnover after oxidation.