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494 Cardio Diabetes Medicine 2017

Drugs on Pipeline For Management of Diabetes -

An Overview

Dr. P. Rajavel Murugan, M.D(Gen),DCH
Associate Professor in General Medicine
Govt.Thoothukudi Medical College, Thoothukudi, Tamilnadu

Introduction is being investigated in various clinical trials in order
Among all the non communicable diseases occurring to further expand its role in diabetes management.
worldwide, diabetes is being placed in the first place. In VERTIS Factorial study, a phase 3 randomized,
India, harboring second most population in the world, double-blind clinical trial with 1233 patients assigned
faces a great threat of increasing trend of non com- to five different treatment arms in order to see the
municable disease especially diabetes. The estimat- effects of this SGLT-2 inhibitor on glucose control , on
ed number of adults with diabetes in 2007 was 246 A1c and fasting glucose levels,conducted last year by
million, of these, 80% live in developing countries, N.B. Amin and colleagues at Pfizer, it was seen that
the largest numbers on the Indian subcontinent and ertugliflozin provided significant reduction HbA1c,
in China. India has 41 million diabetics and this num- fasting plasma glucose, and body weight when com-
ber is expected to increase to 70 million by 2025. pared to sitagliptin. Sitagliptin provided similar A1c re-
As medical fraternity is finding difficult to curtail di- ductions and fasting blood glucose reductions,how-
abetes and its complications, more research is being ever, it did not provide any effect on blood pressure
done to introduce newer drugs with high efficacyinto as opposed to ertugliflozin alone.. This study during
the market. As, the economic burden of treating dia- a 26-week period compared effects of ertugliflozin
betes and its complications is considerable and high, and sitagliptin given alone and in combination. Re-
we need drugs with good therapeutic efficacy, low sults from the study showed greater reductions in
side effect profile and less cost. Though many fasting blood glucose with ertugliflozin 15 mg plus
oral anti diabetic drugs are being used, drugs which sitagliptin 100 mg, when compared to each individu-
2
have many therapeutic effects other than lowering al treatment. Patients taking ertugliflozin 15 mg ex-
glycemic status such as weight reduction, blood perienced the most weight reduction (8.1 lbs) when
pressure reduction and effect over dyslipidemia are compared to the other treatment groups in addition
gaining more popularity among practitioners. So phy- to blood pressure reduction. The incidence of adverse
sicians need to have good update on newer therapies events was similar across all groups with the most
in diabetes to impart cost effective therapy with high common adverse event being genital fungal infec-
therapeutic profile to the patients. Oral hypoglyce- tions predominantly in women .
mic agents and insulin which areyet to meet market
sooner will be highlighted in this article. Sotagliflozin
This is a Dual SGLT1 and SGLT2 Inhibitor, being in-
Ertugliflozin vestigated for use as adjunct therapy to Insulin in
Type 1 Diabetes. Many studies show that use of new
SGLT-2 inhibitors have shown to decrease blood
pressure and provide weight reduction benefits when fast-acting and basal insulin analogs in type 1 diabe-
used in conjunction with other medications. Because tes are associated with weight gain, hypoglycemia
SGLT-2 inhibitors do not work in an insulin-dependent and severehypoglycemic episodes. Several longitu-
manner, these agents can be incorporated with other dinal studies, indicating that between 4 and 10% of
agents like metformin for management of hypergly- deaths can be attributed to hypoglycemia indicating
cemia. Ertugliflozin, a highly selective SGLT2 inhibitor clear need for the development of new adjunct ther-

GCDC 2017