Alive
Pharmaceuticals offer a multitude of hypoglycaemic drugs which can be used for
the treatment of type II diabetes, such as metformin, glimepiride and
voglibose. Our most recent offering in our endocrinology range of products
is Siglip-M, a combination metformin/sitagliptin product available in an
array of dosages in tablet form.
How is type II
diabetes treated?
Lifestyle
changes such as a balanced diet, regular exercise and moderate weight loss has
been shown to be so effective in the treatment of type II diabetes, in many
cases the pathology of the disease can be reversed. However, where more
intensive treatment is needed, metformin remains the first line therapeutic
agent in the management of type II diabetes. This is due to its lack of
associated side effects such as hypoglycaemia and weight gain. Hypoglycaemic
effects via direct stimulation of insulin secretion by other agents can hinder
the safety of the patient in the operation of machinery as well as driving, not
to mention antithesising the desired reduction of BMI in patients in the
management of glycosylated hemoglobin (HbA1c).
However,
although metformin is typically titrated upwards slowly to a therapeutic dose,
its use is often contraindicated due to potential interactions with concurrent
medicines such as beta blockers, its gastrointestinal side effects can overrule
its use in particular patients and there is often a need for more intensive
therapy to reduce blood sugar levels, with two hypoglycaemics generally needed
to optimally achieve target levels.
How does Siglip-M
work?
Siglip-M is a
DPP-4 inhibitor, which is classed as an ‘incretin’ drug. This drug inhibits an
enzyme which generally breaks down glucagon like peptide 1 (GLP-1), which has
positive effects on glycaemic homeostasis in vivo, by reducing glucose and
glucagon levels, decreases gastric emptying and stimulates insulin release.
What is the advantage
of using a product such as Siglip-M?
According to
NICE guidelines, where metformin is inadequate in controlling glycaemic levels,
a sulfonylurea may be introduced to the patient’s therapeutic regimen. However,
due to issues involved with hypoglycaemia, this may not be the most ideal
treatment option in certain cases, due to the dizziness associated with this
side effect. This is of particular concern in elderly patients which are at
higher risk of falls due to osteoporosis being more prevalent in this cohort.
Part of falls risk assessment in healthcare teams for vulnerable patients often
includes a medicines review to assess the likelihood of a medicine causing
dizziness which may increase the risk of a fall occurring, and substitution may
occur in order to lower risk. A typical transition would be the introduction of
an SSRI such as citalopram in the use of anxiety with elderly patients as
opposed to a benzodiazepine. Likewise, sitagliptin is considered a second line
option to metformin as opposed to a sulfonylurea in elderly patients as it does
not cause dizziness, thus preventing the likelihood of hip or vertebral
fracture, which can have a detrimental impact on a patient’s quality of life.
Likewise, a patient which presents with obesity may be more suited to
sitagliptin due to its lack of impact on weight gain and relatively acceptable
side effect profile.
Research on
Sitagliptin:
Two research
papers recently published in the Lancet and American Diabetes Association
Journal have commended the use of a combination therapy such as Siglip-M in the
management of type II diabetes.
- Combination therapy with sitagliptin and metformin in combination therapies has shown successful glycaemic control in tandem with patient acceptability when compared to monotherapy with metformin or sitagliptin.
- Sitagliptin in combination with metformin was also compared to metformin/liraglutide. Liraglutide is a subcutaneously administered GLP-1 agonist which has daily or weekly dosing regimens which is recommended for patients with a BMI above 30 with a desire to lose weight, although it is a costly medicine. Although liraglutide was found to be superior in this particular study, a 0.9 % reduction in HbA1c was achieved with sitagliptin, which is a more acceptable and cost effective route for patients without requiring refrigeration or injection.
Siglip-M is
available in tablet form by Alive Pharmaceuticals, in 50 mg/500 mg and 50 mg/1000
mg dosages (expressed as dosage of sitagliptin/metformin in miligrams). Please
contact our sales team for more information by emailing sales@alivenepal.com
References:
NICE Guideline
CG87: The Management of Type II Diabetes
