title: Evidence-based practice use of quick-release bromocriptine across the natural history of type 2 diabetes mellitus.
abstract: OBJECTIVE
  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.
authors.affiliation: a Main Line Health System , Wynnewood , PA , USA.|b University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Schwartz
authors.affiliation: c Endocrine, Diabetes & Osteoporosis Clinic , Sterling , VA , USA.
authors.forename: Farhad
authors.initials: F
authors.lastname: Zangeneh
mesh_terms: D000818:Animals; D001786:Blood Glucose; D001971:Bromocriptine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D057906:Circadian Clocks / Q000502:physiology; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology; D007333:Insulin Resistance / Q000502:physiology; D017448:Receptors, Dopamine D2 / Q000819:agonists; D013493:Suprachiasmatic Nucleus / Q000187:drug effects
chemical_list: D001786:Blood Glucose; D001971:Bromocriptine; D018491:Dopamine Agonists; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D017448:Receptors, Dopamine D2
keywords: Bromocriptine; cardiovascular risk; diabetes; dopamine; insulin resistance