2-hour Postprandial Plasma Glucose Research Articles

Adjunctive Effect of Doxycycline with Conventional Periodontal Therapy on Glycemic Level for Chronic Periodontitis with Type 2 Diabetes Mellitus Subjects

This study aimed to assess the use of doxycycline in adjunct to periodontal therapy on the glycemic levels for chronic periodontitis patients with type 2 diabetes mellitus (DM). Fifty-one diabetic subjects with chronic periodontitis were selected and randomly assigned into 3 groups with 17 subjects each. Scaling and root planing (SRP) was done in group I, SRP and doxycycline was given in group II, and group III did not receive any periodontal treatment till 3 months. Probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and metabolic parameters were evaluated at baseline (day 0) and after 3 months (day 90). The statistical analysis was carried out using SPSS 17.0 software with significance fixed at 95% CI (p < 0.05). The mean difference between baseline and day 90 for all periodontal parameters was significantly higher (p < 0.01) in group I and group II compared to control (group III). The metabolic parameters such as fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c%) level were reduced in groups I and II compared to group III; however, only HbA1c% values were found significantly reduced (p < 0.01) at day 90. Group II showed significantly better metabolic parameters than group I at day 90. The adjunct of doxycycline to conventional periodontal therapy provides additional benefit in reducing glycemic level and improves periodontal health. The prevalence of diabetes as well as periodontitis is increasing nowadays in the world. With treatment of periodontitis, it is found that there is reduction of glycemic level in diabetes. So it is an alert to health professionals about the relation of diabetes and periodontitis and so that they conduct a multidisciplinary treatment.

PRISMA-efficacy and safety of lixisenatide for type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

We aimed to systematically evaluate the efficacy and safety of lixisenatide in patients with type 2 diabetes mellitus. PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Google, Web of Science and the Chinese Science Citation Database were searched up to March 2018. Randomized controlled trials determining the efficacy and safety of lixisenatide in patients with type 2 diabetes mellitus were eligible for inclusion. Two authors independently extracted the data in a prespecified Microsoft Excel spreadsheet. A meta-analysis was performed using Review Manager 5.3 software. Weighted mean difference (WMD) and relative risk (RR) together with their corresponding 95% confidence intervals (CIs) were estimated, and only the random effects model was used in order to achieve a more conservative estimate of the efficacy and safety. Fourteen multicenter randomized controlled trials involving 11,947 patients were eligible for inclusion. Compared to placebo, lixisenatide could more significantly reduce the level of HbA1c (WMD=-0.44; 95% confidence interval [CI] [-0.55,-0.33]), and a higher proportion of lixisenatide-treated patients achieved the HbA1c level of < 7.0% (RR = 1.89, 95% CI [1.75-2.03]) and < 6.5% (RR = 3.03, 95% CI [2.54-3.63]) than the placebo-treated patients. Lixisenatide was also associated with a significant reduction in fasting plasma glucose and 2-hour postprandial plasma glucose levels. The risks for any adverse events, gastrointestinal adverse events, and symptomatic hypoglycemia significantly increased in the lixisenatide-treatedment group compared to those in the placebo group. However, lixisenatideit did not increase the risks of serious adverse events, death, or severe hypoglycemia. Lixisenatide was more effective than placebo in patients with type 2 diabetes mellitus, and the mild-to-moderate adverse events were found to be tolerated during the follow-up.

Psychosocial intervention for patients with type 2 diabetes mellitus and comorbid depression: a meta-analysis of randomized controlled trials.

BackgroundThe efficacy of psychosocial intervention has been proven in treatment of diabetic patients with depression in some studies. This meta-analysis was conducted to explore the efficacy as well as additional effects of this method during diabetic management in patients with type 2 diabetes mellitus (T2DM) and comorbid depression.MethodsElectronic databases were searched from March 2000 to March 2017 for randomized controlled trials (RCTs) studying the effects of psychosocial intervention on T2DM patients with depression. There was no language limitation. Outcome measurements were symptoms of depression and anxiety, as well as glycemic control. A random effects model was conducted.ResultsIn total, 31 RCTs composed of 2,616 patients were eligible for this analysis. The psychosocial intervention was effective for depression symptoms with pooled standardized mean difference (SMD) of −1.50 (95% CI =−1.83, −1.18) and anxiety symptoms with SMD of −1.18 (95% CI =−1.50, −0.85). Meanwhile, the additional effects indicated a better improvement of glycemic control, including the fasting blood-glucose with SMD of −0.93 (95% CI =−1.15, −0.71), 2-hour postprandial plasma glucose with SMD of −0.84 (95% CI =−1.13, −0.56), and hemoglobin A1c with SMD of −0.81 (95% CI =−1.10, −0.53).ConclusionThese results demonstrate that the psychosocial intervention is very effective in treating T2DM patients with depression.

Short-Term Supplementation of a Moderate Carbohydrate Diet with Psyllium Reduces Fasting Plasma Insulin and Tumor Necrosis Factor-α in Patients with Type 2 Diabetes Mellitus

ABSTRACTThe purpose of this study was to compare effects of a moderate carbohydrate diet supplemented with psyllium with those of a lower carbohydrate diet supplemented with placebo powder on glycemic control in patients with type 2 diabetes (T2D). In an open randomized controlled trial, 37 patients with T2D with body mass index (BMI) 25–35 kg/m2 received either a low-energy, moderate carbohydrate diet plus 7 grams of psyllium powder (MoCyllium group) or a low-energy, lower carbohydrate diet plus placebo powder (LoCarb group) for 2 weeks. Fasting and 2-hour postprandial plasma glucose, insulin, and tumor necrosis factor-α (TNF-α) as well as the homeostasis model assessment of insulin resistance (HOMA-IR) were determined at the beginning and end of the 2-week period. Postprandial samples were obtained after ingestion of a standardized breakfast meal in both groups. Body weight change did not differ between the two groups. There was no significant intervention effect on fasting plasma glucose. Fasting plasma insulin and TNF-α significantly decreased from baseline in the MoCyllium group (p = .01). The differences of absolute change of insulin and TNF-α between the groups were statistically significant (p = .002 and p = .017, respectively). Insulin sensitivity, evaluated by HOMA-IR, increased significantly in the MoCyllium group (p = .016), and comparison of absolute change between the groups showed a trend toward statistical significance. No statistical differences were detected among postprandial glucose, insulin, and TNF-α concentrations. The finding supports the concept that in diabetic patients with cultural preferences to a higher carbohydrate diet, an increase in soluble fiber intake should be encouraged.

The association of long-term glycaemic variability versus sustained chronic hyperglycaemia with heart rate-corrected QT interval in patients with type 2 diabetes.

ObjectivesProlonged heart rate-corrected QT(QTc) interval is related to ventricular arrhythmia and cardiovascular mortality, with considerably high prevalence of type 2 diabetes. Additionally, long-term glycaemic variability could be a significant risk factor for diabetic complications in addition to chronic hyperglycaemia. We compared the associations of long-term glycaemic variability versus sustained chronic hyperglycaemia with the QTc interval among type 2 diabetes patients.MethodsIn this cross-sectional study, 2904 type 2 diabetes patients were recruited who had undergone at least four fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPG) measurements (at least once for every 3 months, respectively) during the preceding year. Long-term glycaemic variabilities of FPG and 2-hour PPG were assessed by their standard deviations (SD-FPG and SD-PPG, respectively), and chronic fasting and postprandial hyperglycaemia were assessed by their means (M-FPG and M-PPG, respectively). HbA1c was also determined upon enrolment to assess current overall glycaemic control. QTc interval was estimated from resting 12-lead electrocardiograms, and more than 440 ms was considered abnormally prolonged.ResultsPatients with prolonged QTc interval (≥440 ms) had greater M-FPG, M-PPG, SD-PPG and HbA1c than those with normal QTc interval but comparable SD-FPG. QTc interval was correlated with M-FPG, M-PPG, SD-PPG and HbA1c (r = 0.133, 0.153, 0.245 and 0.207, respectively, p = 0.000) but not with SD-FPG (r = 0.024, p = 0.189). After adjusting for metabolic risk factors via multiple linear regression analysis, SD-PPG, M-PPG and HbA1c (t = 12.16, 2.69 and 10.16, respectively, p = 0.000) were the major independent contributors to the increased QTc interval. The proportion of prolonged QTc interval increased significantly from 10.9% to 14.2% to 26.6% for the first (T1) to second (T2) to third (T3) tertiles of SD-PPG. After adjusting via multiple logistic regression analysis, the odd ratios of prolonged QTc interval of the T2 and T3 versus the T1 of SD-PPG were 1.15 (95% CI, 0.82–1.60) and 2.62 (1.92–3.57), respectively.ConclusionsIncreased long-term variability of PPG is a strong independent risk factor for prolonged QTc interval in type 2 diabetes patients, in addition to long-term postprandial hyperglycaemia and current HbA1c.

Sleeve gastrectomy with duodenojejunal end-to-side anastomosis in the treatment of type 2 diabetes: the initial experiences in a Chinese population with a more than 4-year follow-up

BackgroundGastric bypass has been thought to be associated with a risk of gastric cancer, particularly in Asia. Sleeve gastrectomy with duodenojejunal end-to-side anastomosis (SG-DJESA) was suggested to be a better-designed procedure to avoid this risk, and it also has other advantages. ObjectiveWe aimed to evaluate the clinical efficacy and feasibility of SG-DJESA in the treatment of nonobese patients with type 2 diabetes (T2D). SettingUniversity Hospital, China. MethodsWe present prospective data from 7 consecutive T2D patients with gastric precancerosis who underwent SG-DJESA from December 15, 2011 to June 8, 2013. The group had a mean body mass index of 27.7 kg/m2. The glycometabolic parameters, including fasting plasma glucose, 2-hour postprandial plasma glucose, fasting insulin, fasting C-peptide, glycated hemoglobin, lipometabolic parameters, and anemia-related indicators were collected at baseline and at 1, 3, 6, 12, 24, and 48 months postoperatively. Remission was defined according to the “outcome reporting standards” conducted by the American Society for Metabolic and Bariatric Surgery. ResultsAlong with a decrease in antidiabetic medication requirements, body mass index, fasting plasma glucose, 2-hour postprandial plasma glucose, and glycated hemoglobin decreased significantly at each postoperative time point, compared with the preoperative baseline (P<.05, respectively). Four patients (4/7, 57.1%) achieved a complete remission of T2D at 12 months and maintained remission at the 4-year follow-up time; 1 patient (1/7, 14.3%) achieved a partial remission at 6 months but had recurrence at 12 months postoperatively; and the other 2 patients (2/7, 28.6%) achieved improvement during the follow-up time. There were no deaths during the follow-up period. One patient had a postoperative anastomotic bleed and recovered under conservative treatment. Another patient had iron deficiency anemia 8 weeks after surgery and recovered after taking an oral iron supplement for 1 month. No other serious perioperative complications or postoperative malnutrition occurred. ConclusionsSG-DJESA is an effective and safe procedure for nonobese patients with T2D and could be recommended as a treatment option for T2D patients with gastric precancerosis. A larger sample size may be required for better evaluation.

Telemedicine in the Management of Type 2 Diabetes Mellitus

ObjectiveTo explore a model of Internet-based integrated management of diabetes, we established a remote diabetes medical service platform (U-Healthcare) and evaluated its effectiveness and practicality. Materials and MethodsIn total, 212 patients with type 2 diabetes mellitus were randomly assigned to 2 groups. Data from the intervention group were automatically transmitted through a glucometer; furthermore, this group received information regarding medicines, diet, exercise and other management through U-Healthcare. The control group received conventional medical treatment without any additional intervention. All patients were regularly followed up every 3 months for half a year. ResultsAt the 3-month follow-up, fasting plasma glucose levels of the intervention group were significantly lower than those at the baseline as well as those of the control group. Triglyceride levels of the intervention group were much lower than those at the baseline. At the 6-month follow-up, 2-hour postprandial plasma glucose levels of the intervention group significantly improved compared with those of the control group. HbA1c levels gradually decreased every 3 months in the intervention group, and the mean change in the levels was significantly greater in this group than in the control group (from 1.27-0.68%). At the end of the study, more than 80% of the patients in the intervention group adhered to blood glucose monitoring 2-3 days per week, and their compliance degree was 72%. ConclusionsThe Internet-based U-Healthcare system of integrated management in diabetes not only achieved better glycemic control, effectively improved HbA1c levels and decreased triglyceride levels but also enhanced patients’ adherence to the medical team’s instructions.

Randomized, Double-Blinded, Double-Dummy, Active-Controlled, and Multiple-Dose Clinical Study Comparing the Efficacy and Safety of Mulberry Twig (Ramulus Mori, Sangzhi) Alkaloid Tablet and Acarbose in Individuals with Type 2 Diabetes Mellitus.

Aims. To evaluate the efficacy and safety of mulberry twig alkaloid (SZ-A) tablet compared with acarbose in patients with type 2 diabetes. Methods. This clinical trial enrolled 38 patients who were randomized into two groups (SZ-A: 23; acarbose: 15) and were treated for 24 weeks. Patients and clinical trial staffs were masked to treatment assignment throughout the study. The primary outcome measures were glycated hemoglobin (HbA1c) and 1-hour and 2-hour postprandial and fasting plasma glucose levels from baseline to the end of treatment. Analysis included all patients who completed this study. Results. By the end of this study, HbA1c level in SZ-A group was decreased from baseline significantly (P < 0.001). No significant difference was found when compared with acarbose group (P = 0.652). Similarly, 1-hour and 2-hour postprandial plasma glucose levels in SZ-A group were decreased from baseline statistically (P < 0.05), without any significant differences compared with acarbose group (P = 0.748 and 0.558, resp.). The fasting plasma glucose levels were not significantly changed in both groups. One of 23 patients in SZ-A group (4.76%) and 5 of 15 patients in acarbose group (33.33%) suffered from gastrointestinal adverse events. Conclusions. Compared with acarbose, SZ-A tablet was effective and safe in glycemic control in patients with type 2 diabetes.

Adipose tissue distribution is associated with glycaemic control and microalbuminuria in Chinese patients with type 2 diabetes: a cross-sectional study

BackgroundAbdominal adipose tissue has an important role in the development of type 2 diabetes. It has also been suggested to be involved in the prognosis of the disease. Therefore, this study aimed to investigate the association between adipose tissue distribution by anthropometric measures, glycaemic control, and microalbuminuria in Chinese patients with type 2 diabetes. MethodsA cross-sectional study was done in 1738 patients with clinically diagnosed and new-onset type 2 diabetes (aged 40 years or older) from Shanghai, China. Anthropometric measures and personal information were collected using a standard protocol. Blood samples were obtained for biochemical measurement, and first-voided early-morning spot urine samples were collected for urinary albumin-to-creatinine ratio measurement. This study was approved by the institutional review board of Rui-Jin Hospital affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China. All participants signed consent forms before recruitment. FindingsBoth waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were significantly associated with fasting (WHR standardised β=0·122 [p<0·0001], WHtR standardised β=0·139 [p=0·003]), 2-hour postprandial plasma glucose (WHR standardised β=0·121 [p<0·0001], WHtR standardised β=0·181 [p=0·0001]), and HbA1c concentrations (WHR standardised β=0·135 [p<0·0001], WHtR standardised β=0·206 [p<0·0001]), independently of body-mass index. Stepwise linear regression showed that WHR was independently associated with HbA1c concentrations in patients with previously diagnosed (standardised β=0·105 [p=0·003]) and new-onset (standardised β=0·143 [p<0·0001]) disease. Overall, high WHR (>0·93 in men and >0·89 in women) increased the risk of poor glycaemic control (HbA1c >6·5%) by 63% (95% CI 1·31–2·03 [p<0·0001]). After further adjustment for HbA1c concentrations, WHR (standardised β=0·041 [p=0·040]) and WHtR (standardised β=0·172 [p<0·0001]) remained significantly associated with urinary albumin-to-creatinine ratio. WHtR was independently associated with urinary albumin-to-creatinine ratio in patients with previously diagnosed (standardised β=0·221; p<0·0001) and new-onset (standardised β=0·074; p=0·019) disease. InterpretationAbdominal adipose tissue has an independent role in the prognoses of type 2 diabetes irrespective of drugs and other intervention. The data also provided evidence on the value of clinical screening by anthropometric measures for identification of patients with type 2 diabetes who are more susceptible to poor glycaemic control and early-stage nephropathy. FundingThis study was supported by grants from the National Clinical Research Center for Metabolic Diseases, the National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology, the National High Technology Research and Development Program of China (863 Program), and the National Natural Science Foundation of China.

Optimal candidates for the switch from glimepiride to sitagliptin to reduce hypoglycemia in patients with type 2 diabetes mellitus.

BackgroundSitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.MethodsSixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked.ResultsHbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0±67.5 mg/dL at baseline to 197.1±69.9 mg/dL at 12 weeks and 192.3±67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c ≤7% after switching to sitagliptin.ConclusionGlycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

Serum Gamma-Glutamyltransferase and Ferritin are Related to Insulin Resistance: A Population-Based Study.

Recent studies have reported the association of gamma-glutamyltransferase (GGT) or ferritin with metabolic disorders. However, there has been no large population-based study assessing the interrelationship of these two biomarkers and their association with insulin resistance. A population-based cross-sectional study was carried out in the Chinese Liangshan Yi ethnic group. 756 eligible subjects, aged 20 - 74 years, were included. Demographic characteristics, medical history, and lifestyle data were collected through questionnaires. An oral glucose tolerance test was performed. Laboratory tests, including GGT and ferritin measurements, were conducted. Spearman's rank-order correlation and multiple linear regression were used to calculate the correlation of GGT with ferritin and their relationship to the insulin resistance index determined by the homeostasis model assessment (HOMA-IR). A significant correlation between serum GGT and ferritin levels was found (r = 0.393, p < 0.05). GGT was independently correlated with ferritin after adjustment for age, gender, place of residence, education, income, leisure-time physical activity, drinking, smoking, body mass index, systolic pressure, diastolic pressure, hepatitis B surface antigen, anti-hepatitis C virus, aspartate aminotransferase, alanine aminotransferase, total cholesterol, low density lipoprotein-cholesterol, triglyceride, high density lipoprotein-cholesterol, fasting plasma glucose, 2-hour postprandial plasma glucose, uric acid, and urinary albumin to creatinine ratio (p < 0.05). Positive correlations were established between HOMA-IR and GGT (standard β = 0.252) or ferritin (standard β = 0.181) after adjustment for multiple confounders (p < 0.05). Insulin resistance is associated with elevated serum GGT and ferritin. A combined determination of GGT and ferritin might lead to better predictions in patients with insulin resistance.

Undiagnosed diabetes mellitus among residents in Taiwanese long-term care facilities: A comparison of fasting glucose, postprandial plasma glucose, and hemoglobin A1c

BackgroundThe prevalence of diabetes mellitus (DM) is escalating with an aging population, and the chances of diabetic older patients admitted to long-term care facilities (LTCFs) are increased because of DM-related complications. However, undiagnosed DM among LTCF residents is a recognized hidden problem in this setting and may result in adverse outcomes. MethodsIn May 2011, 10 private LTCFs in northern Taipei participated in this study. Trained research nurses reviewed the medical records and performed physical examinations and blood sampling for all participants. Diabetes mellitus was diagnosed, based on the levels of fasting glucose, 2-hour postprandial plasma glucose, and hemoglobin A1c (HbA1c). Patients were categorized as having DM if they met the diagnostic cut-offs of the aforementioned criteria. ResultsOne hundred and ninety-nine residents (mean age, 79.6 ± 10.5 years; 52.3% males) participated in this study. They were all moderately/severely disabled (Karnofsky Performance Scale mean score was 50 ± 13). Forty-six (23.1%) residents were diabetic, based on their medical records, or were current users of antidiabetic agents. The prevalence was 29.6% after testing with a mean HbA1c level of 6.9% ± 0.9%. The overall undiagnosed DM rate was 4%, 3.5%, and 4.5%, based on fasting glucose, 2-hour postprandial plasma glucose, and HbA1c criteria, respectively. Diabetic patients had significantly higher serum levels of prealbumin, compared to nondiabetic patients (220.8 ± 45.9 vs. 201.1 ± 62.2 mg/L; p = 0.03), but there were no differences in the levels of hemoglobin, serum albumin, or total cholesterol. Diabetic patients had a significantly higher serum triglyceride level, compared to the nondiabetic patients (1.6 ± 0.7 vs. 1.1 ± 0.5 mmol/L; p < 0.01) and a lower high-density lipoprotein level (1.0 ± 0.3 vs. 1.2 ± 0.3 mmol/L; p < 0.01). Among 43 pharmacologically treated diabetic patients, 65.1% (28/43) of patients were using oral antidiabetic agents and 41.9% (18/43) of patients had been prescribed insulin, whereas 32.6% of the patients were managed by combination therapy. ConclusionThe prevalence of DM among LTCF residents in Taipei was 29.6%, and the undiagnosed rate was no more than 5%, based on fasting glucose, 2-hour postprandial plasma glucose, or HbA1c. Further study is needed for the optimal treatment strategy of DM in LTCFs.

Duodenal-jejunal bypass for the treatment of type 2 diabetes in Chinese patients with an average body mass index

BackgroundIt is frequently reported that bariatric surgery often leads to resolution of type 2 diabetes mellitus (T2 DM). Limited experience with duodenal-jejunal bypass (DJB) for the treatment of T2 DM has shown controversial results. We present the first study of DJB for T2 DM patients in China. The objective of this study was to evaluate the effects of DJB in nonobese Chinese patients with T2 DM. MethodsFrom March 2009 to March 2011, a total of 10 T2 DM patients with an average body mass index (BMI) of 23.8±1.2 kg/m2 were enrolled in the study. DJB was performed in all patients. BMI and glycometabolic parameters were collected at baseline and 1, 3, 6, 12, and 24 months postoperatively. Remission of T2 DM was defined as a glycosylated hemoglobin (HbA1c) level of<7% without diabetic medication. ResultsRemission of T2 DM was observed in 1 (10%) of 10 T2 DM patients at 6 months. Without increasing antihyperglycemic agents, fasting plasma glucose (FPG), 2-hour postprandial plasma glucose, and HbA1c decreased significantly at each postoperative time point, compared with the preoperative baseline. BMI statistically decreased at 1 and 3 months, but did not reach statistical significance at 6, 12, and 24 months. ConclusionsDJB can improve glycemic control in nonobese T2 DM patients without significant weight loss but may not be effective enough to induce remission of T2 DM in nonobese Chinese patients. A larger sample size and more constrictive inclusion criteria may be required for better evaluation.

Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome: a randomized, placebo-controlled trial

Patients with hypertension coupled with metabolic syndrome (MetS) are among the high risk population in cardiovascular and cerebrovascular diseases. To reduce the prevalence of cardiovascular and cerebrovascular diseases, it is essential to appropriately control blood pressure together with other cardiovascular risk factors. The current study was designed to investigate the therapeutic effects on blood pressure, blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula, a compound traditional Chinese herbal medicine, in addition to routine treatment to hypertensive patients coupled with MetS. A total of 43 patients with hypertension coupled with MetS were recruited into this study. The enrolled patients were randomly divided into the Chinese herbal formula group (anti-hypertensive drugs plus Yiqi Huaju Formula, CHF) and the control group (anti-hypertensive drugs plus placebo). The CHF group enrolled 22 patients while the control group received 21 cases. Treatments were given for 12 weeks in both groups. Parameters examined include 24-hour ambulatory blood pressure monitoring, body mass index, waist circumference, waist-to-hip ratio, homeostatic model assessment for insulin resistance (HOMA-IR), fasting glycosylated hemoglobin (HbA1c), fasting plasma glucose, 2-hour postprandial plasma glucose (PPG), fasting plasma insulin, serum lipid, etc. Compared with the control group, the CHF group had significant improvement (P<0.01) in anthropometric parameters, FPG, HOMA-IR, blood pressure amplitude, blood pressure variability and blood pressure load. This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors. The mechanism of controlling of blood pressure may be associated with the improvement of insulin sensitivity due to the Yiqi Huaju intervention. TRIAL REGISTRATION IDENTIFIER: ChiCTR-TRC-11001633.

Effects of Chinese herbal medicine Yiqi Huaju Qingli Formula in metabolic syndrome patients with microalbuminuria: a randomized placebo-controlled trial

Microalbuminuria (MAU) is a key component of metabolic syndrome (MetS) and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment. Sixty patients with MetS were randomized into the Chinese herbal formula group (CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine) and control group (placebo in combination with Western medicine). All treatments were administered for 12 weeks. Urinary microalbumin (MA), urinary albumin-to-creatinine ratio (UACR), 24-hour total urine protein (24-hTP), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2-hPPG), glycosylated hemoglobin (HbA1c), homeostasis model assessment for insulin resistance (HOMA-IR), blood lipid profile and blood pressure were observed. Compared with the control group, CHF treatment significantly decreased BMI (P<0.05), WC (P<0.01) and WHR (P<0.01). Both groups had significant decreases in FPG, 2-hPPG, HbA1c, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment (P<0.05). Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol (TAG), and a greater reduction in TAG was observed with CHF treatment (P<0.05). The level of high-density lipoprotein cholesterol did not change in the control group after treatment (P>0.05), whereas it significantly increased with CHF treatment (P<0.01). Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups (P<0.01). However, there was no significant difference between the two groups (P>0.05). Combined treatment of Yiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER: This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.

Relationship between Fasting and 2-Hour Postprandial Plasma Glucose Levels and Vascular Complications in Patients with Type 2 Diabetes Mellitus

To investigate the relationship between fasting and 2-h postprandial plasma glucose concentrations and vascular complications in type 2 diabetes. Consecutive patients with type 2 diabetes admitted for blood glucose control were grouped according to their fasting and 2-h postprandial plasma glucose levels. Frequency and severity of diabetic retinopathy and nephropathy, number of carotid artery plaques, coefficient of variation of R-R intervals (CVRR), brachial-ankle pulse wave velocity (baPWV), intima-media thickness, brain natriuretic peptide level, ankle-brachial index, and high-sensitivity C-reactive protein levels were compared. In the 206 patients studied, mean±SD age, glycosylated haemoglobin and duration of diabetes were 63.4±13.7 years, 9.8±1.8% and 13.4±8.9 years, respectively. Patients with high fasting plasma glucose levels had a higher frequency of proliferative retinopathy than those with low fasting levels. Patients with medium or high 2-h postprandial plasma glucose levels had higher baPWV and lower CVRR, respectively, than those with low 2-h levels. There was an inverse correlation between baPWV and CVRR. Elevated fasting and postprandial plasma glucose levels are risk factors for vascular complications in type 2 diabetes mellitus.

New Medication Approvals and Tips on Resident Discharge

Indacaterol inhalation powder (Arcapta Neohaler) is soon to be available for chronic obstructive pulmonary disease (COPD). The long-acting beta-2-adrenergic agonist provides once-daily dosing from a 75-mcg capsule, not to be ingested orally. I found the drug's unique inhalation device, with no moving parts, easy to load with the capsule and to manipulate. The drug is not indicated for asthma, nor is it intended for acute exacerbations of COPD. There is no dose adjustment necessary for geriatric patients. However, care must be taken when administering indacaterol with inhibitors of CYP3A4, such as verapamil, ketoconazole, erythromycin, and ritonavir. As with any beta-2-adrenergic agonist, typical side effects are headache, nausea, and cough. The average wholesale price per capsule is $6.53. Linagliptin (Tradjenta) is a new adjunct to diet and exercise for the treatment of type 2 diabetes. The drug, a dipeptidyl peptidase-4 (DPP-4), is the only one approved for once-daily dosing in type 2 diabetes. The 5-mg oral dose requires no adjustment for renal or hepatic impairment. In two double-blind, placebo-controlled studies including 730 patients with type 2 diabetes, monotherapy with 5-mg tablets of linagliptin improved hemoglobin A1C (HbA1C) during fasting, and 2-hour postprandial plasma glucose concentrations didn't differ. One quarter of the patients taking linagliptin achieved an HbA1C concentration of less than 7%. The only side effect showing up in more than 5% of study participants receiving the drug was nasopharyngitis. Linagliptin has not been studied in combination with insulin. The new drug's efficacy may decline when it is administered with a strong P-glycoprotein or CYP3A4 inducer. The average wholesale price per tablet is $8.53. A move from a nursing facility to home can burden patients and caregivers with the procurement and coordination of medications. I have experienced this twice as a caregiver. Although I'm a pharmacist, on both occasions I found it daunting to obtain and organize the needed drugs. A big reason was that the nursing facilities wouldn't send medications home. This policy often leads to missed doses, relapses, and rehospitalizations, I believe. I suggest that all facilities work with their pharmacy providers and medical directors to better serve discharged patients in this area by sending patients home with supplies of their prescription drugs. It's a win-win policy First and foremost, the family or other caregiver thus relieved of one frustrating task has more time to make the transition as smooth as possible. The process is simple. The facility can provide an inventory of all of a patient's drugs, doses, and quantities to be sent home and can provide drug information sheets to guide caregivers. The discharging nurse should review the administration times and other pertinent information with the involved parties. Then, the medications should be packaged in a bag or box and handed to the responsible person. Remember, a physician's order to discharge with medications is required. If the pharmacy is working closely with the facility, the inventory can be used to transfer some charges to the patient's Part D provider. One major long-term care pharmacy chain has begun a unique program to facilitate all these steps. Coattail effects of sending patients’ drugs home with them include less waste and less time destroying drugs. Let's do this simple thing to make more patients’ transitions home as smooth and stress-free as possible.

Association of Common Variants of CDKN2A/2B Rs10811661 (C/T)and WFS1 Rs6446482 (C/G) to Type 2 Diabetes Mellitus in the Indian Population of Eastern Uttar Pradesh

Aim: Recent genome-wide association studies (GWAS) have identified several unsuspected genes that significantly increase the risk of type 2 diabetes mellitus (T2DM). We aimed to replicate the association of a common variant each in CDKN2A/2B (rs10811661) and WFS1 (rs6446482) in the population of Eastern Uttar Pradesh, India. These variants have been identified to be differentially associated with T2DM in different ethnic groups in previous GWAS. Results: We found SNP rs10811661 of CDKN2A/2B (OR 1.50, 95% CI 1.109-2.032, P=0.009) and SNP rs6446482 of WFS1 (OR 1.43, 95% CI 1.074-1.896, P=0.014) as significant risk factors for T2DM in Eastern Uttar Pradesh population. Normal Glucose-Tolerant (NGT) subjects carrying risk allele of rs10811661 (C/T) and rs6446482 (C/G) polymorphisms had significantly higher Fasting Plasma Glucose (FPG) and 2-hour Postprandial Plasma Glucose (2h-PPPG) levels compared to non-carriers. Conclusion: Our study replicates the association of well established common variants of CDKN2A/2B rs10811661 (C/T) and WFS1 rs6446482 (C/G) with type 2 diabetes in the population of Eastern Uttar Pradesh, India. Interestingly, our data show larger effect size for both of the SNPs than those reported in European populations.

Exenatide Reduces Urinary Transforming Growth Factor-β1 and Type IV Collagen Excretion in Patients with Type 2 Diabetes and Microalbuminuria

Aims: It was reported that exenatide ameliorated renal injury in diabetic rats. The present study was carried out to evaluate the effect of exenatide on 24-hour urinary albumin, urinary transforming growth factor-β₁ (TGF-β₁) and type IV collagen excretion in patients with type 2 diabetes and microalbuminuria. Methods: 31 type 2 diabetic patients with microalbuminuria were randomly allocated to receive exenatide (group Exe, n = 13) or glimepiride treatment (group Glm, n = 18) for 16 weeks. Body mass index (BMI), fasting plasma glucose, 2-hour postprandial plasma glucose, glycated hemoglobin A_1c, systolic blood pressure, diastolic blood pressure, 24-hour urinary albumin, urinary TGF-β₁ and type IV collagen concentration were analyzed between the two treatment groups. 20 age- and BMI-matched healthy subjects were chosen as the normal control group (group NC, n = 20). Results: After 16 weeks of treatment, 24-hour urinary albumin, urinary TGF-β₁ and type IV collagen in group Exe were significantly lower than those of group Glm (p < 0.01), while glycemic control had no statistical difference between the two groups. Conclusions: Our results indicate that exenatide reduces urinary TGF-β₁ and type IV collagen excretion in patients with type 2 diabetes and microalbuminuria, which may be partly contributory to its directly renoprotective role.

Effects and patient compliance of sustained‐release versus immediate‐release glipizides in patients with type 2 diabetes mellitus: a systematic review and meta‐analysis

This review aimed to address effects of sustained-release versus immediate-release glipizide on glucose control, insulin secretion, and compliance. We searched Medline, EMBASE, the Cochrane Library, and Chinese Biomedical database from inceptions to May 31, 2011, screened reference lists of relevant studies, and contacted pharmaceutical companies. Randomized trials and cohort studies were included. We pooled data using a random-effect model. Nineteen trials involving a total of 1440 patients and 2 retrospective cohort studies with a total of 13452 patients were included. Trials were of low quality. No trials reported patient important outcomes. The reduction of fasting plasma glucose from the baseline appeared larger for sustained-release than for immediate-release glipizide (mean difference -0.26 mmol/L, 95% CI -0.52 to -0.01). The reduction was not significantly different between the two drugs for HbA1c (-0.03%, -0.20% to 0.14%) or 2-hour postprandial plasma glucose (-0.21 mmol/L, -0.96 to 0.55). Sustained-release glipizide appeared to reduce insulin secretion from the baseline, whereas the immediate-release formulation increased the secretion (fasting insulin: -1.04 vs. 0.88 μIU/ml; 2-hour postprandial insulin: -2.94 vs. 0.24 μIU/ml). Patients administering sustained-release glipizide had less hypoglycemia (Peto odds ratio 0.21, 95% CI 0.08 to 0.52) and lower missed dosing (Peto odds ratio 11. 42, 95% CI 6.47 to 20.18). The cohort studies showed patient compliance results consistent with those of the trials. Sustained-release glipizide appears to achieve similar glucose control with decreased insulin secretion, fewer hypoglycemic episodes, and higher patient compliance than immediate-release glipizide. However, these findings are inconclusive due to inadequate study quality, short follow up, and unavailability of patient important outcomes.