A randomized controlled trial to compare the effects of sulphonylurea gliclazide MR (modified release) and the DPP-4 inhibitor vildagliptin on glycemic variability and control measured by continuous glucose monitoring (CGM) in Brazilian women with type 2 diabetes.

AIMS: This study aims to evaluate whether there is a difference between the effects of vildagliptin and gliclazide MR (modified release) on glycemic variability (GV) in women with type 2 diabetes (T2DM) as evaluated by continuous glucose monitoring (CGM). METHODS: An open-label, randomized study was conducted in T2DM women on steady-dose metformin monotherapy which were treated with 50 mg vildagliptin twice daily or 60-120 mg of gliclazide MR once daily. CGM and GV indices calculation were performed at baseline and after 24 weeks. RESULTS: In total, 42 patients (age: 61.9 ±â€¯5.9 years, baseline glycated hemoglobin (HbA1c): 7.3 ±â€¯0.56) were selected and 37 completed the 24-week protocol. Vildagliptin and gliclazide MR reduced GV, as measured by the mean amplitude of glycemic excursions (MAGE, p = 0.007 and 0.034, respectively). The difference between the groups did not reach statistical significance. Vildagliptin also significantly decreased the standard deviation of the mean glucose (SD) and the mean of the daily differences (MODD) (p = 0.007 and 0.030). CONCLUSIONS: Vildagliptin and gliclazide MR similarly reduced the MAGE in women with T2DM after 24 weeks of treatment. Further studies are required to attest differences between vildagliptin and gliclazide MR regarding glycemic variability.

Vildagliptin has the same safety profile as a sulfonylurea on bone metabolism and bone mineral density in post-menopausal women with type 2 diabetes: a randomized controlled trial.

BACKGROUND: Several antidiabetic therapies affect bone metabolism. Sulfonylureas have the lowest impact on bone among oral antidiabetics. The objective of this study is to compare the effects of vildagliptin and gliclazide modified release (MR) on bone turnover markers (BTMs) and bone mineral density (BMD) in postmenopausal women with uncontrolled type 2 diabetes (T2D). METHODS: Forty-two postmenopausal women with uncontrolled T2D were randomly allocated into vildagliptin or gliclazide MR (control) groups. The primary endpoint was the change in the BTMs in months 6 and 12 compared with the baseline. The secondary endpoint was the variation in the BMD, which was assessed via dual-energy X-ray absorptiometry at the lumbar spine, femoral neck and total hip at baseline and month 12. RESULTS: After a 12-month treatment, the BTM serum carboxy-terminal telopeptide of type 1 collagen increased 0.001 ± 0.153 ng/mL in the vildagliptin group versus 0.008 ± 0.060 ng/mL in the gliclazide MR group (p = 0.858). The serum osteocalcin, serum amino-terminal propeptide of procollagen type I and urinary amino-terminal telopeptide of type 1 collagen remained stable in both groups, and there was no statistically significant difference between the effect of vildagliptin and gliclazide MR on these variables. The lumbar spine BMD did not change in the vildagliptin or gliclazide MR groups after a 12-month treatment (0.000 ± 0.025 g/cm2 versus -0.008 ± 0.036, respectively, p = 0.434). Furthermore, there was a similar lack of change in the femoral neck and total hip BMD values in both treatments. CONCLUSIONS: Bone turnover markers and BMD remained unchanged after a 12-month treatment in both groups, which suggests that vildagliptin has the same safety profile as gliclazide MR on bone metabolism. Trial Registration ClinicalTrials.gov number NCT01679899.

Análise de fatores de risco clínico-laboratoriais para aterosclerose em idosos segundo escore de Framingham / Clinical and laboratorial analysis for risk factors for atherosclerosis in elderly population according to the Framingham score

A aterosclerose contribui significativamente para a taxa de mortalidade e morbidade no mundo ocidental. Os fatores de risco que predispõem à aterosclerose e consequente cardiopatia isquêmica foram identificados por vários estudos prospectivos em grupos definidos da população, mais especificamente o estudo Framingham Heart Study. Objetivos: Avaliar os fatores de risco clínicos e laboratoriais que acometem pacientes idosos e realizar análise associativa dos fatores de risco que acometeram esta população através dos cores de Framingham e a classificação dos indivíduos em baíxo, médio e alto risco para doença arterial coronariana. Material e Métodos: O presente estudo se desenvolveu no Asilo Dom Bosco de Itajaí (SC). A coleta de dados foi realizada na forma de anamnse clínica e anãlise clínica laboratorial para avaliação da glicemia, níveis de colesterol toral e HDL- colesterol. Foram analisados 51 idosos, sendo 19 homens e 32 mulheres com uma média de idade de 83,9 anos. Resultados: Os fatores de risco mais prevalentes observados foram hipertensão arterial sistêmica (HAS) e níveis alterados de colesterol total em ambos os sexos. Mais da metade dos homens, 52% apresentaram alto risco, 37% médio e 11% baixo risco, enquanto nas mulheres os valores encontrados foram 72% baixo e 28% médio risco, não sendo observado alto risco. Conclusão: Apesar da idade avançada ser um fator de risco não modificável, pode-se diminuir o risco cardíaco na população idosa através do controle dos demais fatores, como HAS e colesterol total, que neste estudo, foram determinantes na estratificação de risco da população avaliada.