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Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.
Diabetes care (Impact Factor: 8.42). 04/2012; 35(6):1364-79. DOI: 10.2337/dc12-0413
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    • "Ideally, the treatment of T2DM reduced HbA1c levels for a person without diabetes, but this must be balanced against the risk of inducing side effects, particularly hypoglycemia[37][38]. Due to their glucose-dependent action, GLP-1 RAs are associated with a low risk of hypoglycemia. For most individuals with T2DM, the glycemic targets set by the American Diabetes Association/European Association for the Study of Diabetes and the American Association of Clinical Endocrinologists are less than 53 mmol/mol (7.0%) and less than 47 mmol/mole (6.5%) respectively[37][38]. It is estimated that for a reduction of 11 mmol/mol (1%) in HbA1c reduce cardiovascular complications by approximately 40%[39]. "

    Full-text · Article · Jan 2016 · Open Journal of Endocrine and Metabolic Diseases
    • "; International Diabetes Federation Guideline Development Group, 2014, Handelsman et al., 2015; Inzucchi et al., 2015) and by obesity [body mass index (BMI) >30 kg/m 2 ) (Apovian et al., 2015; Handelsman et al., 2015). To qualify for our study, men were required to have two early morning T values <300 ng/dL and calculated free T (FT) levels <65 pg/mL (Wang et al., 2008; Bhasin et al., 2010), whereas, those with two serum T levels <150 ng/dL were assessed if they were suffering from the organic forms of pre-or post-pubertal onset of hypogonadism (Wang et al., 2008; Bhasin et al., 2010). "
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    ABSTRACT: The aim of this retrospective observational study was to evaluate whether adding liraglutide to lifestyle changes, metformin (Met) and testosterone replacement therapy (TRT), by means of improving weight and glycaemic control, could boost erectile function in type 2 diabetic obese men with overt hypogonadism and erectile dysfunction (ED) in a 'real-life setting'. Forty-three obese, diabetic and hypogonadal men (aged 45-59 years) were evaluated because of complaining about the recent onset of ED. They were subdivided into two groups according to whether hypogonadism occurred after puberty (G1; n = 30: 25 with dysfunctional hypogonadism and 5 with acquired hypogonadotropic hypogonadism) or before puberty (G2; n = 13: 10 with Klinefelter's syndrome and 3 with idiopathic hypogonadotropic hypogonadism). Both G1 and G2 patients were given a combination of testosterone (T) [testosterone undecanoate (TU) 1000 mg/every 12 weeks] and Met (2000-3000 mg/day) for 1 year. In the poor responders (N) to this therapy in terms of glycaemic target (G1N: n = 16; G2N: n = 10), liraglutide (L) (1.2 μg/day) was added for a second year, while the good responders (Y) to T + Met (G1Y: 14/30 and G2Y: 3/13) continued this two drugs regimen therapy for another year. All patients were asked to fill in the International Index of Erectile Function (IIEF 15) questionnaire before starting TU plus Met (T1) and after 12 months (T2) and 24 months (T3) of treatment. Patients underwent a clinical examination and a determination of serum sex hormone binding globulin (SHBG), total testosterone (T) and glycosylated haemoglobin (HbA1c) at T1, T2 and T3. At T2, each patient obtained an improvement of ED (p < 0.01) and of the metabolic parameters without reaching, however, the glycaemic goals [HbA1c = >7.5% (>58 mmol/mol)], while T turned out to be within the range of young men. L added to TU and Met regimen in G1N and G2N allowed these patients to reach not only the glycaemic target [HbA1c = <7.5% (<58 nmol/mol)] and a significant reduction in body weight (p < 0.01), but also a further increase in SHBG (p < 0.05) and T (p < 0.01) plasma levels as well as a significant increment of IIEF score (T3). Conversely, at T3 G1Y and G2Y, who received the combined therapy with TRT and Met for the second year, showed a partial failure of that treatment given that there was no improvement of the IIEF score and they showed a significant rise in serum HbA1c (p < 0.05) and weight (p < 0.04) compared with the assessments at T2. These results suggest that TRT could improve clinical and metabolic parameters in obese, type 2 diabetic men with ED and overt hypogonadism (independently of when T deficit occurred). Furthermore, in case of insufficient metabolic control the addition of L to TRT and Met regimen allows to achieve serum T levels in the range of healthy men, as well as to reach glycaemic target and to lower weight, leading to a considerable improvement of ED.
    No preview · Article · Oct 2015 · Andrology
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    • "One strategy initiated insulin therapy with one injection a day of the basal insulin, insulin glargine, and added one injection of insulin glulisine, a rapid-acting insulin before the main meal if glycemic control was insufficient. This strategy (basal-plus) is a recommended second step when basal insulin is insufficient to achieve the therapeutic goal (Handelsman et al., 2011; International Diabetes Federation: IDF Clinical Guidelines Task Force, 2012; Inzucchi et al., 2012). The other strategy initiated insulin therapy with one or two injections of premixed insulin as needed. "

    Full-text · Dataset · Jul 2015
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