Evidence-based practice use of quick-release bromocriptine across the natural history of type 2 diabetes mellitus

ABSTRACT

Objectives: To provide an evidence-based practice overview on the clinical use of bromocriptine-quick release (QR) across the natural history of type 2 diabetes mellitus (T2DM).

Methods: Articles for inclusion were selected after a comprehensive literature search of English-language PubMed articles and identification of other relevant references through other sources. Inclusion criteria were animal studies examining the mechanism of action and efficacy of bromocriptine, and clinical studies examining the safety and efficacy of bromocriptine-QR in patients with T2DM, without a time limitation.

Results: The brain plays a key role in total body metabolism, in particular ensuring that sufficient levels of glucose are available for proper neural functioning. The hypothalamic suprachiasmatic nucleus (SCN), the body’s biological clock, plays a key role in the regulation of seasonal and diurnal variations of insulin sensitivity. A daily surge of dopaminergic activity in the SCN upon waking enables insulin sensitivity throughout the day. When this is disrupted (e.g. by a high fat/sugar diet, stress, altered [diminished] exercise, altered sleep/wake cycle, diabetes), insulin resistance persists throughout the day and overnight. Improving the morning surge in dopaminergic activity with the short-acting dopamine D2 receptor agonist bromocriptine-QR can safely and effectively improve glycemic control, while improving cardiovascular disease risk factors and related adverse events, and reducing sympathetic tone, as demonstrated by 5 reports of the Cycloset Safety Trial and 3 additional clinical studies of bromocriptine-QR.

Conclusions: In patients with T2DM, the dopamine D2 receptor agonist bromocriptine-QR has been shown to be well tolerated, efficacious, and a logical treatment option.

KEYWORDS:

• Bromocriptine
• dopamine
• diabetes
• cardiovascular risk
• insulin resistance

Declaration of interest

Technical editorial assistance was provided, under the direction of the authors, by Sophie Bolick, PhD, for Synchrony Medical Communications, LLC, West Chester, PA, USA. Funding for this support was provided by Salix Pharmaceuticals, Raleigh, NC, USA. SS Schwartz has served on the advisory board of or acted as a consultant for Salix Pharmaceuticals, Merck, Lilly, Novo, AZ-BMS, Janssen, Takeda, and BI-Lilly, and has participated in speaker’s bureaus for Salix Pharmaceuticals, Lilly, Merck, BI-Lilly, Novo, Takeda, Eisai, GSK, Amgen, and Janssen. F Zangeneh has served as a consultant and on the speakers’ bureaus for Abbvie, Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, Takeda, and Vivus. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

Technical editorial support for this article was funded by Salix Pharmaceuticals, Raleigh, NC, USA.