Endocrine Abstracts

JOINT1184

Background and Aim: Guidelines of diabetes societies for type II DM in terms of dose and drug escalation are misleading. Fear of hypoglycemia has prevented early elaboration of multiple effective drugs. Clever, circadian based combination of drugs with low hypoglycemia risk added to slow release Glyclazide, suppressing Gut microbia, targeting Glut-4 expression, adding appetite suppressors have shown new horizons in DM treatment with complete normalization of HbA1C irrespective of baseline HbA1C, possibility of treatment cessation.

Methods: Auditory Insulin tolerance test explained before was used to predict effectiveness. In eight years of study, hundred and thirty eight thousands patients received Sitagliptin 100mg at noon, Glucophage 500mg and Empagliflozin 12.5mg BID, slow release Gliclazide 60mg TID. In small pilot studies of 30 patient groups superiority of Sitagliptin at noon, morning and afternoon for Empagliflozin and Metformin, TID slow release Gliclazide were shown based on circadian rhythm. Two weeks later addition of Metronidazole, Bismuth and Doxycycline for ten days suppressed the gut diabetogenic flora. A1C below 6, 5.5 and 5 were reacted by omitting 1, 2 or 3 gliclazide after each 3 months cycle.

Results: Ninety-four and 87% attained HBA1C under 6.5 and 6 within 3 to six months. These values remained for a mean of 24 months (range 6-78). At least 23% i.e. 14490 patients could discontinue their medication with a relapse rate of 32%. Less than 0.2% needed additional insulin. Four to eight percent did not respond enough and were regarded as special refractory subgroups due to MODY, Glut mutations or downstream genes. Neither response nor side effects were correlated with duration of disease, previous drug exposure, A1C at begin, inter current disease, age, sex… Thousands of patients were lost from follow up above 36 months but results remain reliable for the rest.

Discussion: We have shown that type II diabetes is a potentially curable disease with an acceptable percentage. This treatment may become the gold standard of type II diabetes at any stage as it is easy with good compliance, abolishes additional insulin, very cost effective, very low need for surveillance and uniformly effective. It covers all theoretical and empirical sorts of resistance. All patients maintain on 2 tablets every 8h. Gliclazide 60 1 1 1 (Empagliflozin+ Metformin) 500/12.5 1 1 Sitapliptin 100 1