Family therapy: A systemic integration (7th ed.). Boston: Allyn & Bacon. Footnotes 1 http://dictionary.oed.com.cgi/entry_main.50077018? 2 http://dictionary.oed.com.cgi/entry_main.00307811?”
“1 Introduction Hyperglycemia in patients with type 2 diabetes mellitus (T2DM) occurs due to a lack of insulin release and/or an increase in insulin resistance. In Japan, sulfonylureas have been widely prescribed as first-choice drugs to treat T2DM because they enhance insulin secretion. However, the pathophysiology of T2DM is due to both
a relative decrease in insulin activity and a paradoxical elevation of eFT508 research buy glucagon, as reflected in the increase of glucagon after a glucose or meal tolerance test (MTT) [1]. Mechanisms underlying the paradoxical glucagon elevation are not clear, but the lack of insulin release
is considered a possible mechanism since insulin suppresses glucagon release [2]. Incretins are endogenous gut-derived peptide hormones that enhance insulin secretion and suppress glucagon release in a glucose-dependent manner [3]. Dipeptidyl peptidase (DPP)-4 inhibitors improve glycemic control in patients with T2DM by suppressing rapid cleavage of incretins, resulting in increased incretin concentration in the blood [4]. Based on this pharmacological background, DPP-4 Akt inhibitor inhibitors are currently prescribed for treating patients with T2DM. Although many studies have reported the glycated hemoglobin (HbA1c)-lowering effects and safety of DPP-4 inhibitors, the extent to which enhancing insulin secretion and suppressing glucagon release contribute to
glycemic control during treatment with DPP-4 inhibitors in actual clinical settings is unclear. In this study, we evaluated changes in glucose, insulin, and glucagon after an MTT. 2 Materials and Methods 2.1 Study Participants Participants were patients with T2DM at one medical clinic specific for diabetes treatment in Tokyo, Japan, who had HbA1c measurements over 6.9 % (National Glycohemoglobin Standardization Program [NGSP]) for more than 3 months, and were being treated with diet and exercise therapy and/or being treated with oral PAK5 antidiabetic agents (OADs) other than vildagliptin (Equa®, Novartis Pharma K.K., Tokyo, Japan). Patients who met the following exclusion criteria were excluded from the study: type 1 diabetes mellitus, severe cardiovascular diseases, end-stage renal disease, severe liver damage, dementia. Further aggressive therapy (addition of vildagliptin 50 mg twice daily [bid]) to manage glycemic controls was provided to the RXDX-101 manufacturer eligible patients. Informed consent was obtained from all patients. 2.2 Study Design The present study was carried out from April 2011 to April 2013. Patients were fasted beginning at 9 p.m. the day before the MTT and received a test meal for breakfast. The test meal was specially cooked according to Japanese Diabetes Society recommendations. We asked a meal delivery company (Seven-Eleven Japan Co., Ltd.