Debate on Insulin vs Non-insulin Use in the Hospital Setting —Is It Time to Revise the Guidelines for the Management of Inpatient Diabetes?

AbstractPurpose of ReviewHyperglycemia contributes to a significant increase in morbidity, mortality, and healthcare costs in the hospital. Professional associations recommend insulin as the mainstay of diabetes therapy in the inpatient setting. The standard of care basal –bolus insulin regimen is a labor-intensive approach associated with a significant risk of iatrogenic hypoglycemia. This review summarizes recent evidence from observational studies and clinical trials suggesting that not all patients require treatment with complex insulin regimens.Recent FindingsEvidence from clinical trials shows that incretin-based agents are effective in appropriately selected hospitalized patients and may be a safe alternative to complicated insulin regimens. Observational studies also show that older agents (i.e., metformin and sulfonylureas) are commonly used in the hospital, but there are few carefully designed studies addressing their efficacy.SummaryTherapy with dipeptidyl peptidase-4 (DPP-4) inhibitors, alone or in combination with basal insulin, may effectively control glucose levels in patients with mild to moderate hyperglycemia. Further studies with glucagon-like peptide-1 (GLP-1) receptor analogs and older oral agents are needed to confirm their safety in the hospital.
Source: Current Diabetes Reports - Category: Endocrinology Source Type: research

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Authors: Srivastava S, Pandey H, Singh SK, Tripathi YB Abstract The earlier assessment of Pueraria tuberosa (PT) has shown anti-diabetic effects through enhancing incretin action and DPP-IV (Dipeptidyl peptidase-IV) inhibition. The aim of this work was to further explore the protective role of aqueous extract of Pueraria tuberosa tuber (PTY-2) against streptozotocin (STZ) induced islet stress in rats. Diabetes was induced by STZ (65 mg/kg body weight) in charles foster male rats. After 60 days of STZ administration, animals with blood glucose levels> 200 g/dL were considered as diabetic. All the rats were later ...
Source: BioScience Trends - Category: Biomedical Science Tags: Biosci Trends Source Type: research
ConclusionsSince its discovery, GLP-1 has emerged as a pleiotropic hormone with a myriad of metabolic functions that go well beyond its classical identification as an incretin hormone. The numerous beneficial effects of GLP-1 render this hormone an interesting candidate for the development of pharmacotherapies to treat obesity, diabetes, and neurodegenerative disorders
Source: Molecular Metabolism - Category: Endocrinology Source Type: research
In this study we evaluated if the intake of an oleuropein-enriched chocolate could have positive effects on glycaemia and insulin levels in patients with type 2 diabetes mellitus (T2DM) and healthy subjects (HS).
Source: Clinical Nutrition - Category: Nutrition Authors: Tags: Original article Source Type: research
Evidence about the treatment of hospitalized type  2 diabetes patients with incretin‐based therapy has emerged in the past 15 years. Based on this evidence, dipeptidyl peptidase‐4 inhibitors should be considered for hospitalized patients with type 2 diabetes and an algorithm for this is proposed. In relation to use of glucagon‐like peptide ‐1 and glucagon‐like peptide‐1 receptor agonist, further research is required to help define their role in the inpatient setting.
Source: Journal of Diabetes Investigation - Category: Endocrinology Authors: Tags: Letter to the Editor Source Type: research
IntroductionInsulin and glucagon are well-known peptide hormones that keep glucose levels within a healthy range in the body. But they are only part of a complex network that controls concentrations of this ubiquitous sugar in blood and tissues. Other molecules regulate glucose by controlling insulin secretion from the pancreas or protecting pancreatic β cells against stresses that lead to cellular dysfunction or cell death (1).One of these protective regulators is glucagon-like peptide 1 (GLP-1), a 30-amino-acid-long peptide produced in specialized epithelial cells of the intestine, called L cells, and also in the br...
Source: Journal of Biological Chemistry - Category: Chemistry Authors: Tags: Classics Source Type: research
Accumulating clinical data on incretin ‐based dipeptidyl peptidase‐4 inhibitors and glucagon‐like peptide‐1 receptor agonists in the past decade have clearly confirmed their safety and efficacy as antidiabetes drugs. However, the journey to understand the incretin system and its role in health and disease continues.
Source: Journal of Diabetes Investigation - Category: Endocrinology Authors: Tags: JDI Updates Source Type: research
In this study, we review the possible molecular mechanisms by which GLP-1RA and DPP-4i can improve insulin resistance and increase insulin sensitivity in insulin-dependent peripheral tissues.
Source: Life Sciences - Category: Biology Source Type: research
Abstract CONTEXT: It is not known whether GLP-1 and GIP levels correlate within individuals, nor whether levels change with age. Previous studies have all been cross-sectional in design. OBJECTIVE: To evaluate longitudinal changes in fasting and glucose-stimulated incretin hormone concentrations in healthy older subjects. PATIENTS AND DESIGN: 41 healthy older subjects had measurements of plasma GLP-1 and GIP while fasting and after a 75g oral glucose load on two occasions separated by 5.9 ± 0.1 years (mean age at the initial study was 71.2 ± 3.8 (SD) years). Breath samples were collected to...
Source: The Journal of Clinical Endocrinology and Metabolism - Category: Endocrinology Authors: Tags: J Clin Endocrinol Metab Source Type: research
In this study, the predicted compounds were suggested as potent anti-diabetic candidates. Chosen structures were applied following computational strategies: The generation of the three-dimensional quantitative structure-activity relationship (3D QSAR) pharmacophore models, virtual screening, molecular docking, and de novo Evolution. The method also validated by performing re-docking and cross-docking studies of seven protein systems for which crystal structures were available for all bound ligands. The molecular docking experiments of predicted compounds within the binding pocket of DPP-IV were conducted. By using 25 train...
Source: Molecules - Category: Chemistry Authors: Tags: Article Source Type: research
CONCLUSION: The present study does not provide evidence to support that dietary supplementation with the NAD+ precursor NR serves to impact glucose tolerance, β-cell secretory capacity, α-cell function, and incretin hormone secretion in obese, non-diabetic males. Moreover, bile acid levels in plasma did not change in response to NR supplementation. PMID: 31390002 [PubMed - as supplied by publisher]
Source: The Journal of Clinical Endocrinology and Metabolism - Category: Endocrinology Authors: Tags: J Clin Endocrinol Metab Source Type: research
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