Key Factors for Glucose Control Explored in Presentation by Professor Park Jeong-hwan
In a recent presentation at the ICOMES (International Conference on Obesity and Metabolic Syndrome), Professor Park Jeong-hwan from Hanyang University Hospital shed light on the key factors affecting glucose management in type 2 diabetes patients. Professor Park emphasized the importance of a combination therapy involving the DPP-4 inhibitor Januvia (sitagliptin) and metformin.
Januvia, developed by Merck (MSD) in the United States and distributed domestically by Chong Kun Dang, has shown promising results in combating the decrease in pancreatic beta cells that often leads to type 2 diabetes in Koreans. This combination therapy has become the most widely prescribed treatment option, accounting for 56% of diabetes combination therapy prescriptions in Korea.
Insights on Type 2 Diabetes in Koreans
Professor Park highlighted the differences in type 2 diabetes characteristics between Western populations and Koreans. These disparities can be attributed to abnormal insulin secretion and resistance, resulting in the higher incidence rate of type 2 diabetes in Koreans compared to Westerners.
Research data presented by Professor Park revealed the significance of mutations in the ‘PAX4 gene’ and the ‘GLP-1 receptor gene’ in Koreans. Specifically, a substitution in the 192nd protein amino acid of the PAX4 gene was found to increase the risk of developing diabetes. On the other hand, a substitution in the 131st protein amino acid of the GLP-1 receptor gene was associated with a lower risk of diabetes.
These findings highlight the importance of personalized treatment strategies that address the unique genetic factors influencing type 2 diabetes in Koreans.
Januvia and its Efficacy
Professor Park emphasized the effectiveness of Januvia as a treatment option for type 2 diabetes. Not only does Januvia exhibit minimal side effects such as hypoglycemia and weight gain, but it is also suitable for patients with reduced kidney function. This versatility has contributed to Januvia becoming the most commonly prescribed diabetes drug in Korea.
Clinical trials comparing Januvia combined with metformin to other treatment options demonstrated significant improvements in glycated hemoglobin levels. Moreover, combining Januvia with insulin showcased synergistic effects, resulting in better glycemic control compared to insulin alone.
Furthermore, a study published in ‘Lancet Diabetes and Endocrinology’ recommended Januvia as a well-tolerated drug for diabetes patients with COVID-19, even during severe stages of the disease.
A Tailored Approach to Diabetes Treatment
Professor Park underscores the importance of adopting a tailored patient-centered approach to blood sugar management. By considering the individual patient’s disease duration and risk factors such as obesity, a more personalized prescription can be developed. The combination of Januvia and metformin offers economic benefits, including reducing insulin administration, while minimizing the risks of hypoglycemia and weight gain.
These insights provided by Professor Park’s research shed new light on the underlying factors of glucose control in type 2 diabetes and offer valuable guidance for clinicians in devising effective treatment strategies.
Park Jeong-hwan, a professor in the Department of Endocrinology and Metabolism at Hanyang University Hospital, gives a presentation on the topic ‘Key factors on Perspective-based glucose control.’ / Photo = Reporter Hwang Jae-seon
It is known that the majority of Korean type 2 diabetes patients are caused by a decrease in the number of pancreatic Bepa cells, and the best possible combination to improve this is ‘Januvia (sitagliptin ingredient)‘ and metformin combination therapy was recommended. Sitagliptin, the main ingredient in Januvia, is a DPP-4 inhibitor class diabetes treatment. Januvia is an original drug developed by Merck (MSD) in the United States, and the domestic sales rights are held by Chong Kun Dang.
Korean Obesity AssociationAt the ‘ICOMES (International Conference on Obesity and Metabolic Syndrome)’ held for 3 days from the 7th. Park Jeonghwan, Professor, Department of Endocrinology and Metabolism, Hanyang University Hospitalgive a presentation on the 8th on the topic ‘Key factors on Glucose management in an evidence-based Perspective’.
Professor Jeong-Hwan Park explained, “Similar to the global trend, the number of patients with type 2 diabetes in Korea is also gradually increasing,” adding, “However, patients with type 2 diabetes have 2 in the West and in Korea different characteristics. “
According to research data presented by Professor Park, mutations in the ‘PAX4 gene’ and the ‘GLP-1 receptor gene’, which are involved in the differentiation of insulin-secreting pancreatic beta cells, were found to be important in Koreans .
When the 192nd protein amino acid of the PAX4 gene was substituted from arginine to histidine or serine, the risk of developing diabetes increased 1.48 times. This mutation trend was found in Koreans with histidine substitutions in 8% and serine substitutions in 4%, but there was not found in Europeans Additionally, among Korean diabetic patients, those with a PAX4 gene mutation had a lower age at onset of diabetes.
On the other hand, when the 131st protein amino acid of the GLP-1 receptor gene was replaced from arginine to glutamine, the risk of diabetes was 0.84 times lower. This mutation had a frequency of 21.1% in Koreans, but did not appear in Europeans. In addition, those with GLP-1 receptor gene mutations were less likely to develop heart and cerebrovascular diseases.
In other words, Koreans have a higher rate of developing type 2 diabetes than Westerners due to abnormal insulin secretion and insulin resistance. Professor Park said, “It is believed that type 2 diabetes in Koreans is caused by a small pancreas and excessive accumulation of fat, which causes a decrease in the number of beta cells. In fact, as a result of imaging the pancreas of people with similar BMI and age, we found that Koreans had “The size of the pancreas was smaller,” he explained. He added, “In order to treat the primary type 2 diabetes in Koreans, it is important to restore pancreatic function and prevent exacerbations.”
DPP-4 inhibitor + metformin, accounts for 56% of diabetes combination therapy prescriptions in Korea
Professor Park chose ‘Januvia’ as the most commonly used drug for this purpose. In fact, looking at the proportion of diabetes drugs prescribed in Korea, the DPP-4 inhibitor and metformin combination therapy is the most common at 56%, and the SGLT-2 inhibitor and metformin combination therapy is only 3%.
Professor Park said, “Not only is January a diabetes treatment that has been confirmed to have few side effects such as hypoglycemia and weight gain, but it can also be used in patients with reduced kidney function, so it is the drug is most commonly used.” He added, “Many diabetes guidelines state that the age limit is 65 years. “We recommend prescribing it to patients with diabetes.”
According to Professor Park, 50.2% of type 2 diabetes patients have a glycated hemoglobin level of 7% or higher. In a clinical trial comparing sitagliptin + metformin combination therapy with the sulfone drug treatment group ‘glimepiride’ in this patient, the combination group showed a 0.78% difference in glycated hemoglobin level compared to the control group based on the least squares (LS) method at 30 weeks of combined treatment. In addition, in a clinical trial comparing sitagliptin monotherapy with a placebo group, a 0.41% improvement in glycated hemoglobin compared to the placebo group was confirmed.
The latest trend is to establish a tailored patient-centred blood sugar lowering strategy,
Januvia + metformin/insulin has excellent synergy
Clinical results comparing insulin alone group and insulin + Januvia combination for 24 weeks / Photo = Reporter Hwang Jae-seon
There are also studies that have proven the effectiveness of combining insulin and Januvia. Compared to increasing insulin administration by more than 20%, the glycated hemoglobin lowering effect was greater when taken together with Januvia, and the fasting blood glucose level was also reduced to a similar level.
Januvia therapy research was also conducted on COVID-19 patients. According to a study (Practical recommendations for the management of diabetes in patients with COVID-19) published in the international academic journal ‘Lancet Diabetes and Endocrinology’ in 2020, Januvia is recommended as a well-tolerated drug even for patients with COVID-19 with diabetes. In addition, it is recommended that Januvia can be used continuously whether or not COVID-19 is severe (pre-infection to the emergency stage) as there is no risk of hypoglycaemia or weight gain.
Professor Park said, “The latest trend in diabetes treatment is to devise a ‘tailored patient-centred blood sugar lowering strategy’ which prescribes a prescription that takes into account the patient’s disease duration and risk factors such as obesity, ” and added, “As various Korean clinical. the results show, Januvia “There is no risk of hypoglycemia or weight gain in patients with glycated hemoglobin abnormalities or renal impairment, and it can be an excellent treatment option with economic effects such as synergy with metformin and the ability to reduce insulin administration,” he said. He said.
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