Diabetes Drug Notes

Foreword xx Preface xxi Editors and Contributors xxii Introduction 1 1 Clinical Pharmacology of Antidiabetic Drugs 2 Andrea Llano, Gerry McKay, and Ken Paterson Introduction 2 Clinical Pharmacology 3 Drug Metabolism and Elimination 6 Drug Development and Clinical Trials 7 Drug Licensing of Antidiabetic Drugs 12 Development and Licensing of Insulin 14 Development and Approval of Biosimilar Insulin 16 Pharmacovigilance 19 Pharmacoeconomics 21 Future Developments in Diabetes Clinical Pharmacology 26 2 Metformin 30 Joseph Timmons and James Boyle Introduction 30 Pharmacology 32 Mechanism of Action 32 Glycaemic Efficacy 36 Safety and Side Effects 37 Metformin in Type 1 Diabetes 45 Place of Metformin in Current and Future Practice 46 3 Sulfonylureas and Meglitinides 49 Joseph Timmons and James Boyle Introduction 49 Pharmacology 51 Glycaemic Efficacy 53 Safety and Side Effects 55 Outcome Trials 56 Meglitinides 61 Place of Sulfonylureas and Meglitinides in Current and Future Practice 65 4 DPP-4 Inhibitors 67 Sharon Mackin and Gemma Currie Introduction 67 Pharmacology 68 Glycaemic Efficacy 75 Safety and Side Effects 79 Outcome Trials 82 Renal Outcomes 89 The Place of DPP-4 Inhibitors in Current and Future Practice 91 5 SGLT2 Inhibitors 95 Miles Fisher, Andrea Llano, and Gerry McKay Introduction 96 Pharmacology 96 Glycaemic Efficacy 100 Side Effects and Safety 103 Outcome Trials 105 Renal Outcome Trials 110 Heart Failure Outcome Trials 116 SGLT2 Inhibitors in Type 1 Diabetes 119 Use of SGLT2 Inhibitors in Other Diseases 123 Dare- 19 123 Place of SGLT2 Inhibitors in Current and Future Practice 124 6 GLP-1 Receptor Agonists 130 Catherine Russell and John Petrie Introduction 130 Pharmacology 131 Glycaemic Efficacy and Effect on Weight 137 Side Effects and Safety 142 Outcome Trials 143 Use of GLP-1 Receptor Agonists in Other Diseases 153 Place of GLP-1 Receptor Agonists in Current and Future Practice 155 7 Animal and Human Insulins 161 Ken Paterson Introduction 161 Production and Pharmacokinetic Modifications 165 Hypoglycaemia and Human Insulin 170 Intensified Insulin Therapy 173 Place of Human Insulin in Current and Future Therapy 176 8 Short-acting Insulin Analogues 179 Kate Hughes and Gerry McKay Introduction 179 Factors Affecting Absorption and Metabolism of Short-acting Insulin 180 Manufacturing Insulin Analogues 180 Short-acting Insulin Analogues 182 Second-generation Ultrafast-acting Insulin Analogues 186 Other Attempts to Improve Insulin Absorption and Inhaled Insulin 189 Place of Short-acting Insulin Analogues in Current and Future Practice 190 9 Long-acting Insulin Analogues 194 Robert Lindsay Introduction 195 Development of Long-acting Insulin Analogues 196 Long-acting Insulin Analogues 197 Meta-analysis of Glycaemic Efficacy of Long-acting Insulin Analogues 207 Safety of Long-acting Insulin Analogues 209 The Place of Long-acting Insulin Analogues in Current and Future Practice 209 10 Devices 214 David Carty Introduction 214 Insulin Pens 215 Insulin Pumps 215 Self-monitoring of Blood Glucose 218 Linkage of Continuous Glucose Monitoring to Insulin Pumps 223 Guidelines on the Use of Devices 225 Place of Devices in Current and Future Practice 227 11 Acarbose and Alpha Glucosidase Inhibitors 229 Miles Fisher Introduction 229 Pharmacology 230 Glycaemic Efficacy 231 Place of Alpha Glucosidase Inhibitors in Current and Future Practice 237 12 Glitazones and Glitazars 239 Miles Fisher Introduction 239 Pharmacology 240 Glycaemic Efficacy 241 Safety and Side Effects 242 Glitazars 252 Place of Glitazones and in Current and Future Practice 253 13 Other Antidiabetic Drugs 257 Maroria Oroko, Andrea Llano, and Miles Fisher Introduction 257 Pramlintide 258 Colesevelam 260 Bromocriptine 262 Hydroxychloroquine 264 Antiobesity Drugs 265 Place of Other Drugs in Current and Future Practice 270 14 Future Antidiabetic Drugs 274 Emma Johns and Miles Fisher Introduction 274 Dual and Triple Agonists 275 Imeglimin 288 Place of New Antidiabetic Drugs in Future Practice 291 15 Guidelines on Antidiabetic Drugs 294 Miles Fisher and Russell Drummond Introduction 295 Guidelines on the Use of Antidiabetic Drugs in Type 2 Diabetes 298 Guidelines on the Management of Type 1 Diabetes 308 Special Patient Groups 311 Place of Guidelines in Current and Future Practice 318 16 Prescribing Antidiabetic Drugs 322 Andrea Llano, Gerry McKay, Frances McManus, Catriona McClements, Joyce McKenzie, and Deborah Morrison Introduction 322 Therapeutic Inertia 323 Polypharmacy 326 Nonadherence 329 The Patient with Problematic Hypoglycaemia 330 Prescribing in Renal Impairment 333 Prescribing in Liver Disease 337 Prescribing in Cardiovascular Disease 340 Prescribing in Pregnancy 347 Prescribing in the Young 348 Prescribing in the Elderly 349 The Patient with Type 1 Diabetes: a Therapeutic Journey (an Illustrative Case) 350 The Patient with Type 2 Diabetes: a Therapeutic Journey (an Illustrative Case) 351 Future Developments in Prescribing in Diabetes 353 Appendix 357 Index 359