Diabetes is a common disease in Malaysia, the number of Diabetes patients have increased to 3.5 million or 17.5 per cent of its citizens affecting Malaysians as early as 18 years of age. The increasing number of Diabetes disease is very worrying. I have seen my close relatives, friends and colleagues who are suffering from Diabetes. For example, one of my colleagues, has diagnosed with Type 2 Diabetes last year, his life has completely changed. He couldn’t works aggressively like how he did last time, and he gets tired easily hence he doesn’t have enough energy to take care of his 2 young sons. Indeed, he has to send his sons to child care every day. It is sad how Diabetes has affected one’s life, and how the situation get worsen from the amputation of legs escalating to other serious health complications.
Official Launch of xigduo™ XR by AstraZeneca Malaysia. From L-R: Professor Dr. Mark E Cooper (Deputy Director & Chief Scientific Officer Baker IDI Heart & Diabetes Institute Australia), Professor Dr. Chan Siew Pheng (Senior Consultant Endocrinologist), Ms. Kang Cheng Hui (Business Unit Director Cardiometabolic Disease AstraZeneca Malaysia), Dr. Viraj Rajadhyaksha (Medical Director AstraZeneca Malaysia) & Mr. Allen Patino (Country President AstraZeneca Malaysia)
It is important for us to take care of our daily intake of food, and exercise regularly to avoid Diabetes. Luckily, with the advancement of technology, Type 2 Diabetes patients have a new treatment choice for Diabetes.
In July 2016, AstraZeneca Sdn. Bhd. (AstraZeneca) launched its new combination drug, the once-daily xigduo™ XR (dapagliflozin+Metformin XR) tablet. Combining two anti-hyperglycaemic agents, Forxiga (dapagliflozin) and Metformin XR, xigduo™ XR helps to reduce glucose levels in the bloodstream and promote early glycaemic control among Malaysians with Type 2 Diabetes.
Professor Dr. Chan Siew Pheng presenting on Moving from Conventional Approach Towards Early Glycemic Control
Let me tell you more about the new treatment for Type 2 Diabetes. Dapagliflozin is a Sodium-glucose co-transporter 2 (SGLT2) inhibitor with a 4-year efficacy data that works to prevent glucose from being reabsorbed into the kidneys and to expel it from the body via urine. Metformin, a commonly used first-line treatment for Type 2 Diabetes, helps to decrease glucose production in the liver and prevents glucose reabsorption in the intestines and improves insulin sensitivity. In xigduo™ XR, the extended release Metformin formulation allows for a once-daily dose, which minimises common gastrointestinal (GI) side effects such as diarrhoea, nausea and stomach pain that are frequently associated with immediate release Metformin,.
Professor Dr. Mark E Cooper presenting on Introduction of xigduo™ XR
Together, Dapagliflozin and Metformin deliver HbA1c reduction of 2%, alongside two additional benefits of weight loss and blood pressure reduction. This in turn addresses the associated risk factors in developing cardiovascular issues among diabetes patients,. A chronic metabolic disorder, Type 2 Diabetes is characterized by high glucose levels in the blood due to the body's inability to produce or properly respond to insulin. It is a highly prevalent disease in Malaysia, affecting approximately 3.5 million adults1 (an increase from 2.6 million in 2011) and rising. The Second Burden of Disease Study for Malaysia ranked diabetes as one of the biggest contributors to both disability adjusted life-years (DALY) and deaths in the country.
Let’s see what the experts have shared on their view of daily xigduo™ XR. Professor Dr. Chan Siew Pheng, Senior Consultant Endocrinologist said, "Diabetes requires a multifaceted approach in its management5. This often includes lifestyle modifications such as increased physical activity and nutritious diet, in combination with oral agents to attain glycaemic control5 where the dosage and/or types of medication are slowly adjusted over time. This conventional treatment method may not be the most effective as diabetes is a complex disease that is frequently accompanied by other health issues such as obesity, heart disease, stroke and hypertension5."
Professor Dr. Chan added “there is an urgent need for a more intensive and innovative initial treatment plan such as combination therapy to address diabetes at the earliest stage14 to prevent its progression, complications and the development of associated cardiovascular risk factors."
In the same vein, Professor Mark E. Cooper, Deputy Director and Chief Scientific Officer of the Baker IDI Heart & Diabetes Institute in Australia said, "The main challenge for most Type 2 Diabetes patients is controlling their blood glucose levels3. Yet, only half of the people living with this disease are found to achieve the recommended HbA1c target3,. This is partly because of non-compliance to their treatment plan, particularly among patients with multiple medications and frequent dosing throughout the day.
By initiating a combination therapy such as once-daily xigduo™ XR, patients can have a much simpler and more convenient way to manage this disease from the outset."
A survey involving 600 diabetic patients found that only 16.6% were adherent to the prescribed anti-diabetic drugs, demonstrating a demand for less number of medications to be taken daily17. Similar results were found in an earlier study, where patients with twice-and thrice-daily medications were more likely to skip dosages compared to those in the single-dosage group; thus highlighting the need for minimised daily doses to improve patient compliance.
"The launch of xigduo™ XR in Malaysia is yet another step forward in improving the lives of those affected by this disease. It reflects our unceasing efforts in availing innovative and effective management solutions to address chronic diseases such as diabetes.
Allen Patino, Country President of AstraZeneca Malaysia
I hope this serves as an encouragement for both Health Care Professionals (HCPs) and Malaysians living with Type 2 Diabetes to ‘Start with the Right Duo’, xigduo™ XR, for early management of glucose levels, as well as weight and hypertension. In doing so, we may then be able to ultimately reverse the alarming prevalence of diabetes in the country," Allen Patino, Country President of AstraZeneca Malaysia concluded.
We shall fight the alarming diabetes among Malaysians together!
xigduo™ XR tablet
xigduo™ XR is available in Malaysia in three different dosages, which are 10/1000 mg, 5/1000mg and 10/500mg. Each xigduo™ XR tablet contains the following active ingredients:
· xigduo™ XR 10/1000 (MAL16045040ACRZ) - dapagliflozin 10 mg and metformin XR 1000 mg
· xigduo™ XR 5/1000 ((MAL16045043ACRZ) - dapagliflozin 5 mg and metformin XR 1000 mg
· xigduo™ XR 10/500 (MAL16045044ACRZ) – dapagliflozin 10mg & Metformin XR 500mg
For more information about xigduo™ XR tablet, please contact your local Health Care Professional.
 National Health and Morbidity Survey 2015 Factsheet
 Del Prato, S., Nauck, M., Durán-Garcia, S., Maffei, L., Rohwedder, K., Theuerkauf, A., & Parikh, S. (2015). Long-term glycaemic response and tolerability of dapagliflozin versus a sulphonylurea as add-on therapy to metformin in patients with type 2 diabetes: 4-year data. Diabetes Obes Metab, 17(6), 581-590. http://dx.doi.org/10.1111/dom.12459
 Anderson, S. (2014). Dapagliflozin efficacy and safety: a perspective review. Therapeutic Advances In Drug Safety, 5(6), 242-254. http://dx.doi.org/10.1177/2042098614551938
 Mosley, J. F., Smith, L., Everton, E., & Fellner, C. (2015). Sodium-Glucose Linked Transporter 2 (SGLT2) Inhibitors in the Management Of Type-2 Diabetes: A Drug Class Overview. Pharmacy and Therapeutics, 40(7), 451–462
 Kuecker, C. M., & Vivian, E. M. (2016). Patient considerations in type 2 diabetes – role of combination dapagliflozin–metformin XR. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 9, 25–35. http://doi.org/10.2147/DMSO.S81565
 Jabbour, S., Ziring, B. (2011). Advantages of extended-release metformin in patients with type 2 diabetes mellitus. Postgrad Med, 123(1), 15-23. doi: 10.3810/pgm.2011.01.2241
 Henry, R., Murray, A., Marmolejo, M., Hennicken, D., Ptaszynska, A., & List, J. (2012). Dapagliflozin, metformin XR, or both: initial pharmacotherapy for type 2 diabetes, a randomised controlled trial. International Journal Of Clinical Practice, 66(5), 446-456. http://dx.doi.org/10.1111/j.1742-1241.2012.02911.x
 Hardy, S. et. al. (2015). Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control. J Am Heart Assoc. doi: 10.1161/JAHA.115.002276
 Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 Diabetes Mellitus: A Review of Current Trends. Oman Medical Journal, 27(4), 269–273. http://doi.org/10.5001/omj.2012.68
 National Health and Morbidity Survey 2011 Factsheet
 National Health and Morbidity Survey 2015, Vol 2, pp 13 http://www.iku.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol2.pdf
 Del Prato, S. et. al. (2005). Improving glucose management: Ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract 59(11), 1345-1355. doi: 10.1111/j.1742-1241.2005.00674.x
 Zinman, B. (2011). Initial combination therapy for type 2 diabetes mellitus: is it ready for prime time? Am J Med, 124(1 Suppl), S19-34. doi:10.1016/j.amjmed.2010.11.003.
 Nyenwe, E., Jerkins, T., Umpierrez, G. & Kitabchi, A. (2011). Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism, 60(1), 1-23. http://dx.doi.org/10.1016%2Fj.metabol.2010.09.010
 Sharma, T., Kalra, J., Dhasmana, DC & Basera, H. (2014). Poor adherence to treatment: A major challenge in diabetes. Journal, Indian Academy of Clinical Medicine 15(1), 26-29
 Paes, A., Bakker, A., & Soe-Agnie, C. (1997). Impact of Dosage Frequency on Patient Compliance. Diabetes Care 20(10), 1512-1517