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The pharmacologic properties and clinical efficacy of dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor for the treatment of type 2 diabetes, are reviewed.
We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene.
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The effect of piperine on the pharmacokinetics and pharmacodynamics of glimepiride in normal as well as diabetic rats was studied. In normal and streptozotocin induced diabetic rats the combination of glimepiride with piperine increased all the pharmacokinetic parameters, such as Cmax, AUC0-n, AUCtotal, t1/2, and MRT, and decreased the clearance, Vd, markedly as compared with the control group. In pharmacodynamic studies, the combination of glimepiride with piperine provided significant protection against the diabetes induced alterations in the biochemical parameters. In addition, the combination of glimepiride with piperine also improved the total antioxidant status significantly in diabetic rats compared with piperine and glimepiride treated groups. The results revealed that a combination of glimepiride with piperine led to the enhancement of the bioavailability of glimepiride by inhibiting the CYP2C9 enzyme, which suggested that piperine might be beneficial as an adjuvant to glimepiride in a proper dose, in diabetic patients.
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This study explored the immediate effect of supplementary insulin therapy on beta- cell function in patients with glimepiride monotherapy (five women, 15 men; 61.8 +/- 6.4 years old; body mass index, 31.1 +/- 4.4 kg/m(2); hemoglobin A1c, 7.0 +/- 1.3%). After 1 week of continued glimiperide therapy, the patients were randomized either to continue with their oral treatment or to switch to a fixed-dose supplementary insulin therapy (8 U of insulin aspart subcutaneously before each meal) for another week. Oral glucose tolerance tests (OGTTs) after drug uptake were performed at days 7 and 14, with measurement of glucose, insulin, C-peptide, intact and total proinsulin, glucagon, lactate, free fatty acids, and adiponectin.
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Glimepiride is a modern hypoglycaemic agent, which belongs to the group of sulfonylurea derivates. In this paper, simple, specific and accurate RP-HPLC method was developed in order to study decomposition of glimepiride under the hydrolytic stress conditions (acid, neutral, alkaline and oxidative). The best separation of glimepiride and its degradation products was achieved on reverse phase C18 column. The mobile phase was composed of acetonitrile-phosphate buffer (pH 3.5, 0.03 M) (48:52, v/v). Employing RP-HPLC method, five main degradation products were detected in the exposed samples. It was found that the susceptibility of glimepiride to hydrolytic decomposition increased in following manner: neutral condition < alkaline condition < acid condition < oxidative condition.
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The study was conducted open with randomized two-period crossover design and a 14-day washout period. Samples were obtained over a 48-hour interval. Glimepiride concentrations were analyzed by LC-MS-MS. From the glimepiride plasma concentration versus time curves the following pharmacokinetic parameters were obtained: AUC(0-last), AUC(0-t), AUC(0-infinity), Ke, T1/2, Cmax, and Tmax.
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The possibility of an insulin-independent blood glucose decreasing activity of sulfonylureas was re-evaluated. Single dose studies in dogs with different sulfonylureas revealed a ranking in the ratio of plasma insulin release/blood glucose decrease with glimepiride exhibiting the lowest and glibenclamide the highest ratio. This ranking suggests that sulfonylureas have extrapancreatic activity and that this is most pronounced for glimepiride. Further evidence for this was derived from single dose studies in rabbits, euglycemic hyperinsulinemic clamp studies in rats and subchronic studies in manifestly diabetic KK-AY mice. Extrapancreatic activity of sulfonylureas as deduced from the ranking in vivo between glimepiride and glibenclamide directly on peripheral tissues would imply a similar ranking between the two drugs in glucose utilizing processes in isolated muscle and fat cells. Indeed, glimepiride exhibits a higher potency compared to glibenclamide with respect to stimulation of glucose transport, glucose transporter isoform 4 (GLUT4) translocation and lipid and glycogen synthesis in normal and insulin-resistant adipocytes and in muscle cells, as well as of the potential underlying signalling processes examined at the molecular level. The molecular basis for the sulfonylurea-induced increase of glucose transport and non-oxidative glucose metabolism may rely on the dephosphorylation of key metabolic proteins/enzymes, like GLUT4 as demonstrated in isolated rat adipocytes. Activation of certain serine/threonine-specific protein phosphatases by insulin has been postulated to be mediated by the mitogen-activated protein kinase (MAPK) pathway and phosphatidylinositol (P1)-3'-kinase. However, there was no evidence that these pathways are involved in the regulation of protein phosphatase activity by sulfonylureas. Binding and photoaffinity studies showed that glimepiride associates in a time- and concentration dependent non-saturable manner with detergent-insoluble complexes of the plasma membrane which may correspond to caveolae. This association seems to be based on the interaction of glimepiride with glycosyl-phosphatidylinositol (GPI) lipids and membrane protein anchors. These were found to be enriched in detergent-insoluble complexes together with a GPI-specific phospholipase (PLC), the caveolae-specific coast protein, caveolin, and acylated tyrosine kinases of the src family. Sulfonylureas were found to stimulate the GPI-PLC and tyrosine phosphorylation of caveolin. This is presumably caused by direct interaction of the sulfonylurea into caveolar glycolipids and stimulation of a caveolar src tyrosine kinase, respectively. In accordance with the higher potency of glimepiride in vivo and in glucose transport/metabolism in vitro, the EC50 values for GPI-PLC activation and caveolin phosphorylation were lower for glimepiride than those for glibenclamide. The stimulation of protein tyrosine phosphorylation by sulfonylureas via this pathway not involving the insulin signaling cascade may be coupled to activation of specific protein phosphatases regulating glucose transport and metabolism. The concentrations required in vitro were higher than the reported therapeutic plasma concentrations. However, provided that the observed time-dependent accumulation of glimepiride in caveolae of peripheral cells were of functional relevance for stimulation of glucose transport/metabolism and would also occur in vivo, due to the longer exposure times even at lower drug concentrations the insulin-independent blood glucose decreasing activity of sulfonylureas might become effective in vivo.
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Carbonate extracts from purified plasma membranes of basal and stimulated adipocytes were analyzed by high-resolution sucrose gradient centrifugation.
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A prospective, 24-week, single-center, open-label comparative study enrolled 20 Japanese patients with type 2 diabetes (male: 11, female: 9) with a BMI≥25 kg/m(2) or fatty liver. Subjects were randomly assigned to receive treatment with sitagliptin (25 mg titrated up to 50 mg: S) or glimepiride (0.5 mg titrated up to 1 mg: G). After starting each treatment, IHL and total fat mass were evaluated by (1)H-magnetic resonance spectroscopy ((1)H-MRS) and dual energy X-ray absorptiometry (DEXA), respectively at baseline and at 12 weeks and 24 weeks.
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Dipeptidyl peptidase-4 inhibitor (DPP-4i) is commonly used worldwide for the treatment of type 2 diabetes mellitus. In addition to its hypoglycemic activity, DPP-4i might have anti-inflammatory effects. In this study we examined the effects of DPP-4i on the serum levels of soluble CD163 (sCD163), a marker for activated macrophages, in individuals with type 2 diabetes mellitus. We compared these anti-inflammatory effects with those of α glucosidase inhibitor (αGI).
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A substantial dose reduction of glibenclamide (25%), gliclazide (25%), glimepiride (22%), and metformin (5%) in geriatrics compared to nongeriatrics was observed. Smaller dosage formulations like 0.75 mg glibenclamide, 0.5 mg glimepiride, 20 mg gliclazide, and 250 mg metformin may be of value in geriatric diabetic practice.
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To investigate the cost-effectiveness of liraglutide as add-on to metformin vs. glimepiride or sitagliptin in patients with Type 2 diabetes uncontrolled with first-line metformin.
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This was an open-label pilot study in which type-2 diabetic patients were randomly assigned to the mitiglinide/voglibose (fixed-dose combination of mitiglinide 10 mg and voglibose 0.2 mg, n=14) or glimepiride (0.5 mg, n=16).
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EMPA as add-on to MET was well tolerated and provided additional benefits beyond glucose lowering, such as weight loss and blood pressure reduction. However, high-quality trials with large samples are still needed in order to confirm their long-term safety.
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Over the median observational time of 744 (Inter Quartile Range 268-1451) days, 2242 patients (64%) died. The analysis demonstrated similar hazard ratio (HR) for mortality for treatment with glimepiride (1.10 [95% confidence interval 0.92-1.33]), glibenclamide (1.12 [0.93-1.34]), glipizide (1.14 [0.93-1.38]), tolbutamide (1.04 [0.85-1.26]), and gliclazide (reference). Grouped according to pancreatic specificity, i.e., with tolbutamide, glipizide, and gliclazide as specific, and glibenclamide, and glimepiride as non-specific agents, no differential prognosis was found between the two groups (HR 1.04 [0.96-1.14], for non-specific, compared to pancreas specific agents). The prognosis was not dependent on prior acute myocardial infarction or ischemic heart disease (p for interactions >0.3).
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Canagliflozin 100 and 300 mg provided sustained reductions in body weight, BMI, and waist circumference in a greater proportion of patients with T2DM versus glimepiride or placebo over 104 weeks.
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clinicaltrials.gov Identifier: NCT00225277.
Patients with type 2 diabetes who are failing on oral agents will generally gain a large amount of body fat when switched to insulin treatment. This adverse effect may be related to chronic hyperinsulinism induced by long-acting insulin compounds.
The fixed metformin + pioglitazone combination treatment showed an overall improvement of laboratory surrogate markers, indicating improvement of platelet function and of chronic systemic inflammation, which was not seen with metformin + glimepiride.
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Levetiracetam (LEV) is an approved drug for the treatment of some epileptic disorders. With few and controversial reports addressing its possible pharmacodynamic interactions, the current study aimed at studying the effect of LEV on isolated rat duodenal strips to enlighten its possible intestinal adverse effects using the isolated smooth muscle strips of rat duodenum. LEV showed a dose-dependent inhibition in KCl (80 mm)-induced contractions in normal Tyrode's solution. Moreover, preincubation with LEV (3 mm) in K(+) -rich/Ca(2+) -free medium led to a significant decrease in the maximum contractions (Emax ) coupled to a right shift of the cumulative CaCl2 concentration curves implying a possible Ca(2+) channel blocking potential. In addition, LEV exhibited a typical noncompetitive inhibition in the cumulative carbachol concentration curves evidenced as a decrease in Emax without the alteration of EC50 , thus eliminating any possible role of the muscarinic receptors in the relaxant effect. To rule out other possible relaxant mechanisms, tests were conveyed in Tyrode's solution containing either 100 μm l-NAME or 10 μm glimepiride to test the possible relaxant roles exhibited by nitric oxide (NO) and KATP channel opening, respectively. None of the tested pathways was involved in LEV-mediated relaxation. Taken altogether, the results of the current study entail that LEV might exert a relaxant effect on intestinal smooth muscles through blocking L-type voltage-operated calcium channels, but not involving either NO release or KATP channel opening.
UMIN Clinical Trials Registry System UMIN 000004955.
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In an observational study, eligible subjects were Muslims with type 2 diabetes (age ≥18 years) who were treated with glimepiride, gliclazide, or glibenclamide with or without metformin and who expressed their intention to fast during Ramadan in 2009. Subjects were recruited by clinicians in India, Malaysia, Israel, the United Arab Emirates (UAE), and Saudi Arabia. Each day during Ramadan, patients completed diary cards, which collected information regarding hypoglycaemic symptoms and complications, time from last meal and from last medication, self-monitored blood glucose measurements, and need for assistance. The overall incidence of symptomatic hypoglycaemia recorded during Ramadan was the primary endpoint of interest.
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Compliance over the whole study was generally good, but the MDC was significantly better with glimepiride (87+/-16%) than with glibenclamide (80+/-17%;P < 0.0001). The ratios of DAC for glimepiride and glibenclamide were 87+/-16% and 67+/-24% respectively (P < 0.0001). The adjusted final HbA1c, and the incidence of hypoglycemia were similar in the two groups. Treatment satisfaction on the DTSQc was greater with glimepiride than with glibenclamide (P = 0.0034).
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The two-step hyperglycemic clamp appears to be a precise method to assess β-cell function by taking the effect of incretins into consideration. The oral glucose consumption adds to the i.v. glucose infusion, amplifying the differences in the effects of DPP-4 inhibitors and glimepiride on insulin secretion.
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The 2 groups did not differ in age (mean+/-S.D., 63.6+/-7.3 years vs 62.8+/-7.2 years respectively), or any measured variable at baseline. Fasting glucose and glycated haemoglobin improved similarly in both groups. There were significant differences between the 2 groups in the absolute changes observed at follow-up in waist circumference, +1.86+/-3.11 cm vs -1.86+/-1.88 cm in groups A and B respectively; fasting insulin levels, +14.79+/-12.56 pmol/L vs -25.84+/-28.09 pmol/L; homeostasis model assessment (HOMA), +0.66+/-1.01 vs -1.83+/-1.38; HDL cholesterol levels, -0.07+/-0.22 mmol/L vs +0.14+/-0.20 mmol/L and FMD, +0.14+/-1.09% vs +2.02+/-2.05% (p<0.05 for all). The only independent predictor factor of the FMD improvement was treatment-induced changes in HOMA (R(2): 0.488, slope: -0.782, [95% CI: -1.128, -0.436], p=0.0001).
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In perifused pancreatic islets from euglycemic rats, the secretory response to either glibenclamide or glimepiride (1.0 microM each) increases as a function of the concentration of D-glucose (2.8-16.7 mM) present in the perifusion medium. On the contrary, the sulfonylurea-induced increment in 45Ca efflux from prelabeled islets decreases at increasing concentrations of the hexose. Neither glibenclamide nor glimepiride affect D-glucose metabolism in isolated islets, as judged from the production of 3HOH from D-[5-3H]glucose or the generation of 14CO2, as well as 14C-labeled amino acids and acidic metabolites, from D-[3,4-14C]glucose, D-[2-14C]glucose and D-[6-14C]glucose. The insulinotropic action of the hypoglycemic sulfonylureas is not impaired in islets prepared from rats infused for 48 hr with a hypertonic solution of D-glucose. The dimethyl ester of succinic acid is more efficient than D-glucose in supporting the insulin-releasing effect of glibenclamide or glimepiride. Thus, although the insulinotropic action of hypoglycemic sulfonylureas appears unaffected in a model of B-cell glucotoxicity, a potentiation of their secretory effects might be expected, in non-insulin-dependent diabetes, from the combined administration of succinic acid methyl ester.
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Introducción: La diabetes mellitus tipo 2 (DM2) es una enfermedad multifactorial que puede ser abordada tanto con antidiabéticos orales como con insulina. Los antidiabéticos orales glimepirida y sitagliptina poseen mecanismos de acción diferentes que no se han comparado directamente en pacientes con DM2 de reciente diagnóstico en Latinoamérica. El objetivo primario de este estudio multicéntrico de 24 semanas, de dos brazos, randomizado (1:1) y abierto, en pacientes adultos con DM2 y niveles de hemoglobina glucosilada (HbA1c) > 8.5 % < 11 %, fue comparar la eficacia de glimepirida con sitagliptina en pacientes adultos vírgenes de tratamiento. Como objetivos secundarios se compararon los efectos sobre la glucosa plasmática de ayuno y postprandial, hipoglucemia, cambio de peso, porcentaje de pacientes que se retiraron del protocolo, la seguridad de ambos tratamientos, signos vitales y resultados de laboratorio. Resultados: No se encontraron diferencias significativas en la eficacia de ambos medicamentos en el control de glucosa, ni en ningún otro parámetro, con la excepción de la incidencia de hipoglucemia, que se reportó con una frecuencia significativamente mayor en los pacientes del grupo de glimepirida. No existieron fatalidades en ningún grupo. Conclusiones: Se concluye que la monoterapia de glimepirida y sitagliptina reducen niveles de HbA1c con eficacia similar.
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Among seventy male Wistar clean-grade rats, 8 rats were randomly selected into a control group; the rest rats were made T2DM model. Fifty-two rats which were successfully made T2DM model, according to randomized block method, were divided into a model group (10 rats), a medication group (10 rats), an electroacupuncture at "Shenshu" (BL 23) group (11 rats), an electroacupuncture at "Pishu" (BL 20) group (10 rats) and an electroacupuncture at "Yishu" (EX-B 3) group (11 rats). Seven days after successful establishment of model, the rats in the model group were fixed in the self-made rat bag without receiving any treatment; the rats in the medication group, according to body mass (10 mL/kg), were treated with intragastric administration of glimepiride; the rats in all the electroacupuncture groups were treated with electroacupuncture at "Shenshu" (BL 23), "Pishu" (BL 20) and "Yishu" (EX-B 3), respectively. The continuous wave was selected with a frequency of 15 Hz and a current intensity of 4 to 6 mA. The treatment was given 20 min per treatment, once a day, 5 treatments per week for continuous 4 weeks. Before the establishment of model and continuous 4 weeks after the intervention, blood samples were collected from rats' caudal vein, and fasting blood glucose (FBG) was measured with FBG device each week. After the last intervention, the rats were killed and hypothalamus, pituitary and adrenal gland were collected. The colorimetric method was applied to measure the contents of triglyceride (TG), cholesterol (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C); radioimmunoassay was used to test the contents of glycated serum protein (GSP), fasting insulin (FINS), corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortin (CORT).
In agreement with preclinical and clinical studies, AERS analysis is consistent with an association between pioglitazone and bladder cancer. This issue needs constant epidemiologic surveillance and urgent definition by more specific studies.
We measured plasma glucagon concentrations before and after ingestion of a formula mixed meal and, on a separate occasion, ingestion of the sulfonylurea glimepiride in 24 basal insulin-infused, demonstrably beta-cell-deficient patients with type 1 diabetes and 20 nondiabetic, demonstrably beta-cell-sufficient individuals; the latter were infused with glucose to prevent hypoglycemia after glimepiride.
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Human umbilical vein endothelial cells (HUVECs) were first cultured for 48 h in the glucose-rich medium, and neutrophils from healthy volunteers were then added and allowed to adhere for 30 min. Adhered neutrophils were quantified by measuring myeloperoxidase (MPO) activities, and surface expression of endothelial adhesion molecules was determined using an enzyme immunoassay.
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SAXA + MET had lower predicted incidences of cardiovascular and hypoglycemia events and a decreased total cost compared with GLI + MET (¥241,072,807 vs ¥285,455,177). There were increased numbers of quality-adjusted life-years (QALYs; 1.01/patient) and life-years (Lys; 0.03/patient) gained with SAXA + MET compared with GLI + MET, and the incremental cost of SAXA + MET vs GLI + MET (-¥44,382) resulted in -¥43,883/QALY and -¥1,710,926/LY gained with SAXA + MET. Sensitivity analyses confirmed that the results were robust.
Addition of the long-acting basal human insulin analogue insulin glargine (LANTUS) to the treatment regimen of patients with inadequate glycaemic control on oral antidiabetic drugs (OADs) alone has previously been evaluated as effective, safe and convenient. This pilot study aimed to establish whether insulin glargine plus OADs is effective in Type 2 diabetes patients previously poorly controlled on premixed insulin therapy.
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When patients with type 2 diabetes fail to achieve strict HbA1c control with oral glucose-lowering drugs, insulin is the standard recourse. Exenatide, an injectable incretin analogue, should only be used when weight gain is a major problem. Liraglutide is another injectable incretin analogue recently authorised for use in this setting. Two randomised unblinded trials, one versus insulin glargine in 581 patients and the other versus exenatide in 464 patients, suggest that liraglutide has a slightly more potent effect on glycaemia. Weight loss was similar in the liraglutide and exenatide groups. In a trial including 1091 patients, liraglutide was not more or less effective than glimepiride on glycaemia. Like exenatide, liraglutide can cause pancreatitis. In the trial comparing liraglutide versus exenatide, one-quarter of patients experienced nausea. There is more evidence of a risk of thyroid cancer with liraglutide than with exenatide. Liraglutide is administered as a single daily subcutaneous injection, whereas exenatide requires two daily injections. In practice, when prescribing an incretin analogue seems justified, it is more prudent to continue using exenatide, while closely monitoring patients for adverse effects.
In this open-label, randomized, parallel, multinational, 24-week, non-inferiority study, 443 patients received either once-daily insulin glargine (n=220) or NPH insulin (n=223) at bedtime, plus glimepiride (Amaryl).
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Protection by PostC against endothelial IR injury in humans depends on K(ATP) channel activation and is mimicked by inhibition of the mPTP at reperfusion.
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High-performance affinity chromatography (HPAC) was used in a variety of formats to examine multi-site interactions between glimepiride, a third-generation sulfonylurea drug, and normal or in vitro glycated forms of the transport protein human serum albumin (HSA). Frontal analysis revealed that glimepiride interacts with normal HSA and glycated HSA at a group of high affinity sites (association equilibrium constant, or Ka, 9.2-11.8×10(5)M(-1) at pH 7.4 and 37°C) and a group of lower affinity regions (Ka, 5.9-16×10(3)M(-1)). Zonal elution competition studies were designed and carried out in both normal- and reversed-role formats to investigate the binding by this drug at specific sites. These experiments indicated that glimepiride was interacting at both Sudlow sites I and II. Allosteric effects were also noted with R-warfarin at Sudlow site I and with tamoxifen at the tamoxifen site on HSA. The binding at Sudlow site I had a 2.1- to 2.3-fold increase in affinity in going from normal HSA to the glycated samples of HSA. There was no significant change in the affinity for glimepiride at Sudlow site II in going from normal HSA to a moderately glycated sample of HSA, but a slight decrease in affinity was seen in going to a more highly glycated HSA sample. These results demonstrated how various HPAC-based methods can be used to profile and characterize multi-site binding by a drug such as glimepiride to a protein and its modified forms. The information obtained from this study should be useful in providing a better understanding of how drug-protein binding may be affected by glycation and of how separation and analysis methods based on HPAC can be employed to study systems with complex interactions or that involve modified proteins.
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To evaluate the safety and efficacy of once-weekly dulaglutide 1.5 mg, a long-acting glucagon-like peptide-1 receptor agonist, compared with placebo in patients with type 2 diabetes (T2D) on glimepiride monotherapy.