Diabetes in Older Adults and Its Management
K. Rao Poduri in Geriatric Rehabilitation, 2017
Bile acid sequestrants are nonabsorbable resins that bind and sequester bile acids in the intestine, thus diverting them from the enterohepatic cycle. As a consequence, low-density lipoprotein (LDL) delivery to the liver is increased to compensate for the reduction of the bile acid pool (reviewed in Reference 123). These events translate into a 10%–15% reduction of LDL levels and led to the approval of bile acid sequestrants for the therapy of hypercholesterolemias (reviewed in Reference 123). The first evidence of a glucose-lowering effect of bile aid sequestrants, in particular cholestyramine, dates back to 1994 (124). Colesevelam was later approved for diabetes therapy. The exact mechanisms of the hypoglycemic actions of bile acid sequestrants are not entirely understood but may involve the bile acid receptor FXR (nuclear farnesoid X receptor) and FGF19 pathway (fibroblast growth factor 19), stimulation of incretin secretion through TGR5 (also known as GPBAR1 or G protein-coupled bile acid receptor 1), and possibly modulation of gut microbiota composition (reviewed in Reference 123).
Dyslipidemia
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
The bile acid sequestrants block reabsorption of intestinal bile acid. This forces the up-regulation of liver LDL receptors to recruit the circulating cholesterol and synthesize bile. These sequestrants reduce cardiovascular-related deaths. They are usually used along with statins or nicotinic acid. The sequestrants are the medications of choice for women planning to become pregnant, or who are already pregnant. Though safe, the sequestrants cause bloating, constipation, cramping, and nausea. They can also increase triglycerides, so they cannot be used if hypertriglyceridemia is present. The drugs called cholestyramine and colestipol interfere with absorption of thiazides, beta-blockers, digoxin, thyroxine, and warfarin. Colesevelam also interferes with these, but not as much. The interference between the drugs can be reduced by administration that is 4 or more hours before or 1 hour after. Bile acid sequestrants are more effective if they are taken during a meal.
Personalized Nutrition in Hypercholesterolemia
Nilanjana Maulik in Personalized Nutrition as Medical Therapy for High-Risk Diseases, 2020
Medicines can help lower cholesterol levels but it can’t guarantee to cure it, so it is recommended to continue taking medicine to keep cholesterol levels in the recommended stage. Five major types of cholesterol-lowering medicines commercially available include: Statins: reported to lower LDL cholesterol levels.Bile acid sequestrants which also help lower LDL cholesterol.Nicotinic acid documented to lower LDL cholesterol and triglycerides and raise HDL cholesterol levels.Fibrates lower triglycerides, and also can raise HDL cholesterol levels.Ezetimibe lowers LDL cholesterol levels.
Consideration of quality of life in the treatment decision-making for patients with advanced gastroenteropancreatic neuroendocrine tumors
Published in Expert Review of Anticancer Therapy, 2023
Boris G. Naraev, Josh Mailman, Thorvardur R. Halfdanarson, Heloisa P. Soares, Erik S. Mittra, Julie Hallet
NET-related diarrhea is one of the most common and impactful symptoms affecting patient QoL [24,62]. There are several symptomatic treatments depending on the underlying pathophysiology: carcinoid syndrome, steatorrhea, short GI transit time, or excessive bile acids. For diarrhea due to carcinoid syndrome, SSA therapy is beneficial [72]. However, some patients with serotonin-producing tumors experience diarrhea that is inadequately controlled by SSAs. In these patients, telotristat ethyl should be considered as add-on therapy based on results from TELESTAR. Patients with poorly controlled diarrhea due to carcinoid syndrome may also benefit from RLT. Chronic SSA use may cause pancreatic insufficiency and steatorrhea [62,73], which can be addressed with pancreatic enzyme therapy and dietary adjustments. Additionally, patients with NETs who have undergone small bowel resection can develop diarrhea resulting from shortened GI transit time or decreased bile acid resorption [74]. Diarrhea resulting from short GI transit time can be improved with dietary adjustments, adjustment of fluid consumption, and certain medications. Bile acid sequestrants can address bile acid malabsorption. More generally, nutritional assessments and dietary modifications have the potential to improve patient symptoms (including but not limited to diarrhea) and QoL [75].
Managing dyslipidemia in patients with Type 2 diabetes
Published in Expert Opinion on Pharmacotherapy, 2021
Brian Tomlinson, Nivritti Gajanan Patil, Manson Fok, Christopher Wai Kei Lam
Bile acid sequestrants are one of the earliest groups of lipid-lowering therapies, but nowadays, they are rarely used because of poor tolerability with frequent gastrointestinal adverse effects [50]. Colesevelam may be better tolerated than cholestyramine and colestipol, and it can lower glucose levels and does have the indication for T2DM as well as hypercholesterolemia [108]. The bile acid sequestrants, and particularly colesevelam, can be taken in combination with statins and other lipid-modifying drugs in patients with T2DM to help achieve LDL-C and non-HDL-C targets, but they may result in an increase in triglyceride levels in some patients [50]. A meta-analysis of 15 studies with bile acid sequestrants found that therapy significantly improves HDL-C, LDL-C, and glycemic markers including fasting blood glucose and HbA1c levels [109,155].
Choosing an ideal pharmacotherapeutic strategy for dyslipidemia in children
Published in Expert Opinion on Pharmacotherapy, 2019
Dragana Nikolic, Andreea Corina, Peter. P. Toth, Lubna Hammad, Manfredi Rizzo
There is an urgent need for diagnosing pediatric dyslipidemia. It is important to increase awareness and to offer better education of young FH subjects and their parents. In secondary dyslipidemia, first line treatment must be changes in lifestyle. If despite 6 months of lifestyle intervention LDL cholesterol levels do not improve in children over 8–10 years of age, pharmacologic treatment should be considered. Statins and ezetimibe are well tolerated in children and adolescents. Bile acid sequestrants can also be considered. A new class of drugs, PCSK9 inhibitors, is the most promising therapy in children with homozygous FH. The biggest challenge is to institute adequate treatment for children with HeFH and nonFH and to evaluate the cost-effectiveness of treatment. To this end, long-term, well-design, randomized clinical trials are needed.
Related Knowledge Centers
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