Antidiabetic Drugs In Patients Research Articles

Cross Sectional Study of Acute Toxicity with Anti Diabetic Drugs in Patients Presented to Poisoning Center During 2022

Cross Sectional Study of Acute Toxicity with Anti Diabetic Drugs in Patients Presented to Poisoning Center During 2022

Association of Antidiabetic Drug Target Genes with Inflammatory Bowel Disease: A Mendelian Randomization Study.

An unmet medical need for the treatment of inflammatory bowel disease (IBD) exists. A part of antidiabetic drugs had potential effects on IBD in various observational research. To investigate the potential of antidiabetic drugs on IBD. We undertook a summary-data-based Mendelian randomization (SMR) using the expression quantitative trait loci (eQTL) expressed in the blood or colon and a two sample Mendelian randomization (TSMR) utilizing single nucleotide polymorphism (SNP) of antidiabetic drug target genes mediated by blood glucose traits. Participants encompassed patients with IBD (25,042 cases/34,915 controls), UC (12,366 cases/33,609 controls), and CD (12,194 cases/28,072 controls). Data on eQTL in the blood or the colon were from the eQTLGen consortium (31,684 individuals) or GTEx Consortium V8, respectively. SMR was performed by SMR software (20,220,322); the primary method for TSMR was inverse-variance weighted (IVW) or Wald ratio through R studio (2023.06.0+421). Sensitivity analyses were carried out. A 1-SD upper expression of the KCNJ11 gene (target gene of sulfonylureas) in the blood reduced the risk of CD (OR per 1-SD = 0.728, 95% CI = 0.586-0.903, P = 0.004) according to the result of SMR. ABCC8 (target gene of sulfonylureas) expressed in the colon did not affect CD, UC, or IBD. T2D-mediated KCNJ11 has a protective effect on CD (OR = 0.475, 95% CI = 0.297-0.761, P = 0.002). Gene predicted no relationship between T2D and CD. Sulfonylureas (SUs) may have side effects on CD. This work provides some suggestions for the selection of antidiabetic drugs in patients with CD.

De-indexed estimated glomerular filtration rates for the dosing of oral antidiabetic drugs in patients with chronic kidney disease.

Introduction: Adjusting drug dose levels based on equations that standardize the estimated glomerular filtration rate (eGFR) to a body surface area (BSA) of 1.73m2 can pose challenges, especially for patients with extremely high or low body mass index (BMI). The objective of the present study of patients with CKD and diabetes was to assess the impact of deindexing creatinine-based equations on estimates of kidney function and on the frequency of inappropriate prescriptions of oral antidiabetic drugs (OADs). Methods: The prospective CKD-REIN cohort is comprised of patients with eGFR <60mL/min/1.73m2. The inclusion criteria for this study were the use of OADs and the availability of data on weight, height and serum creatinine. We compared data for three BMI subgroups (group 1 <30kg/m2; group 2 30-34.9kg/m2; group 3 ≥35kg/m2). Inappropriate prescriptions (contraindicated or over-dosed drugs) were assessed with regard to the summary of product characteristics and the patient's kidney function estimated with the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the 2021 CKD-EPI equation, the Modification of Diet in Renal Disease (MDRD) equation, the European Kidney Function Consortium (EKFC) equation, their deindexed estimates, and the Cockcroft-Gault (CG) formula. The impact of deindexing the equations was evaluated by assessing 1) the difference between the indexed and deindexed eGFRs, and 2) the difference in the proportion of patients with at least one inappropriate OAD prescription between the indexed and deindexed estimates. Results: At baseline, 694 patients were receiving OADs. The median BMI was 30.7kg/m2, the mean BSA was 1.98m2, and 90% of patients had a BSA >1.73m2. Deindexing the kidney function estimates led to higher eGFRs, especially in BMI group 3. The proportion of patients with at least one inappropriate prescription differed greatly when comparing indexed and deindexed estimates. The magnitude of the difference increased with the BMI: when comparing BMI group 1 with BMI group 3, the difference was respectively -4% and -10% between deindexed 2021 CKD-EPI and indexed CKD-EPI. Metformin and sitagliptin were the most frequent inappropriately prescribed OADs. Conclusion: We highlight significant differences between the BSA-indexed and deindexed versions of equations used to estimate kidney function, emphasizing the importance of using deindexed estimates to adjust drug dose levels - especially in patients with an extreme BMI.

Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra

Background: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra. Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages. Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination. Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs.

Does Therapy with Glucagon-like Peptide 1 Receptor Agonists Have an Effect on Biochemical Markers of Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD)? Pleiotropic Metabolic Effect of Novel Antidiabetic Drugs in Patients with Diabetes-Interventional Study.

Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) is associated with the excessive collection of lipids in hepatocytes. Over 75% of diabetes patients typically have MASLD, and, at the same time, the presence of MASLD increases the risk of diabetes by more than two times. Type 2 diabetes and MASLD are independent cardiovascular disease (CVD) risk factors. New diabetes treatment should also take into account pleiotropic effects that reduce cardiovascular risk. The aim of our study is to investigate whether analogs of GLP1 receptors have a pleiotropic metabolic effect and global impact to decrease cardiovascular risk, and also reduce the risk of hepatic fibrosis in patients with MASLD. This study involved 41 patients with diabetes and dyslipidemia who also had atherosclerotic plaque and hepatic steatosis verified by ultrasonography and who were eligible to begin one of the GLP1 receptor agonists treatments. We observed a statistically significant decrease in: BMI (p < 0.001) waist and hip circumference (p < 0.001), glycated hemoglobin (p < 0.001) and creatinine (p < 0.05). Additionally, we obtained a decrease in FIB-4 (p < 0.001) and in the De Ritis (AST/ALT aminotransferase ratio) (p < 0.05). The positive correlation between the FIB-4 value and BMI, WHR, waist circumference and the De Ritis index was observed. In conclusion, semaglutide and dulaglutide had a beneficial effect on metabolic and cardiovascular risk factors in patients with type 2 diabetes. These medications had a positive effect on MASLD biochemical markers.

Possibilities of transition of the strategy from glucosecentricity to organoprotection when prescribing antidiabetic drugs in patients with type 2 diabetes mellitus in the perimenapause

Obesity, type 2 diabetes mellitus and cardiovascular diseases associated with these conditions remain one of the largest global health problems. According to statistics, at least 90 % of patients with type 2 diabetes mellitus are obese or at least overweight (BMI &gt; 25). Very often, the cause of death in this cohort of patients is the development of a cardiovascular catastrophe. Currently, there is a gradual rejection of the exclusively glucose-centric concept of type 2 diabetes mellitus therapy in favor of an organoprotective one. In this article, we examined the possibility of using various groups of incretinomimetics (DPP-4 inhibitors and GLP-1 agonists) in the primary prevention of cardiovascular diseases in patients with type 2 diabetes mellitus in perimenopause, and comparing their effects with traditional metformin therapy.The aim of the study was to evaluate the effect of non – insulin antidiabetic drugs from the class of incretinomimetics on risk factors for the development of cardiovascular diseases in patients with type 2 diabetes mellitus in perimenopause.Object and methods. A dynamic examination of three groups of patients was carried out. The first group (n = 22) received therapy with the GLP-1 agonist semaglutide, the second group (n = 30) metformin therapy and the third (n = 19) with the DPP-4 inhibitor linagliptin. All patients, in addition to general clinical examination, assessment of the dynamics of weight loss and insulin resistance, underwent a dynamic study of triglyceride levels, low – density lipoprotein cholesterol, as well as markers of general inflammation – C-reactive protein and interleukin-6.Results. The results of the study showed that semaglutide and metformin were equally effective in reducing body weight, but metformin and linagliptin did not significantly affect the level of atherogenic fractions of the lipidogram, unlike semaglutide. Nevertheless, both semaglutide, linagliptin, and metformin reduced the level of markers of general inflammation.Conclusions. The results of the study allow us to discern a certain cardioprotective potential not only in agonists of GLP-1, but also in representatives of the class of DPP-4 inhibitors, which requires further research.

Influence of antidiabetic drugs on glucose metabolism and immune response in patients with metastatic pancreatic ductal adenocarcinoma receiving gemcitabine plus nab-paclitaxel as first-line treatment.

Association between pancreatic ductal adenocarcinoma (PDAC) and type 2 diabetes mellitus (DM2) has long been evaluated. Indeed, DM2 can be both an epiphenomenon of PDAC and a risk factor. The present study aimed to investigate the correlation between overall survival (OS) and antidiabetic drugs in patients with metastatic pancreatic ductal adenocarcinoma and DM2. Data from 232 patients were collected retrospectively from 2014 to 2021. 174 from AOU Cagliari Medical Oncology and 58 from AOU Ancona Medical Oncology. All patients received gemcitabine plus nab-paclitaxel first-line chemotherapy. We aimed to evaluate the correlation between DM2, anti-diabetic medications and overall survival. Survival distribution was assessed by Kaplan-Meier curves. Median age was 68±9, 127 (55%) were male. 138/232 (59%) patients were not affected by DM2, 94/232 (41%) were affected by DM2. 57 were insulin-treated and 37 were metformin-treated. DM2 treated patients showed an higher median overall survival (26vs 12 months, p=0,0002). Among DM2 patients insulin-treated and metformin-treated showed an mOS of 21 months and 33 months, respectively. Results showed a correlation between treated DM2 and higher mOS in patients with mPDAC. Limitations due to retrospective data collection must be considered. Further studies in this setting are needed.

Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis.

Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.

EVALUASI DRUG RELATED PROBLEMS PENGGUNAAN OBAT ANTIDIABETES PADA PASIEN DIABETES MELITUS TIPE 2 DI INSTALASI FARMASI RAWAT INAP RUMAH SAKIT TK.III DR. R. SOEHARSONO

Diabetes mellitus is a disease characterized by hyperglycemia and disturbances of carbohydrate, fat and protein metabolism associated with absolute or relative deficiency of insulin action and/or secretion. The purpose of this study was to determine the characteristics of type 2 DM patients and whether there were DRPs (Drug Related Problems) using antidiabetic drugs in patients with Type 2 Diabetes Mellitus at the Inpatient Pharmacy Installation of Tk.III Hospital Dr. R. Soeharsono period 2019-2020. This research is a non-experimental research with a descriptive research design with a retrospective approach. The sampling technique used was total sampling with a sample of 42 patients taken from the medical records of type 2 DM patients who received antidiabetic drugs at the Inpatient Pharmacy Installation of Tk.III Hospital Dr. R. Soeharsono Banjarmasin. From the results of this study, type 2 diabetes was mostly experienced by women, 25 patients (60%) with an age range of 41-60 years (62%), with the most diabetes complications being hypertension (59.5%). There were 22 patients (52.3%) who experienced DRPs by category in a row, namely drug interactions (33.3%), drugs without indications (14%), indications without drugs (4 ,7%), wrong drug (2.4%), under dose (4.7%), and over dose (0%).

Prescriber Uncertainty as Opportunity to Improve Care of Type 2 Diabetes with Chronic Kidney Disease: Mixed Methods Study.

Over 5 million patients in the United States have type 2 diabetes mellitus (T2D) with chronic kidney disease (CKD); antidiabetic drug selection for this population is complex and has important implications for outcomes. To better understand how providers choose antidiabetic drugs in T2D with CKD DESIGN: Mixed methods. Interviews with providers underwent qualitative analysis using grounded theory to identify themes related to antidiabetic drug prescribing. A provider survey used vignettes and direct questions to quantitatively assess prescribers' knowledge and preferences. A retrospective cohort analysis of real-world prescribing data assessed the external validity of the interview and survey findings. Primary care physicians, endocrinologists, nurse-practitioners, and physicians' assistants were eligible for interviews; primary care physicians and endocrinologists were eligible for the survey; prescribing data were derived from adult patients with serum creatinine data. Interviews were qualitative; for the survey and retrospective cohort, proportion of patients receiving metformin was the primary outcome. Interviews with 9 providers identified a theme of uncertainty about guidelines for prescribing antidiabetic drugs in patients with T2D and CKD. The survey had 105 respondents: 74 primary care providers and 31 endocrinologists. Metformin was the most common choice for patients with T2D and CKD. Compared to primary care providers, endocrinologists were less likely to prescribe metformin at levels of kidney function at which it is contraindicated and more likely to correctly answer a question about metformin's contraindications (71% versus 41%) (p < .05). Real-world data were consistent with survey findings, and further showed low rates of use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists (<10%) in patients with eGFR below 60 ml/min/1.73m2. Providers are unsure how to treat T2D with CKD and incompletely informed as to existing guidelines. This suggests opportunities to improve care.

The Potential Therapeutic Role of Metformin in Diabetic and Non-Diabetic Bone Impairment.

Metformin is a widely-used anti-diabetic drug in patients with type 2 diabetic mellitus (T2DM) due to its safety and efficacy in clinical. The classic effect of metformin on lowering blood glucose levels is to inhibit liver gluconeogenesis that reduces glucose production as well as increases peripheral glucose utilization. However, the factors such as hyperglycemia, insulin deficiency, reduced serum levels of insulin-like growth factor-1 (IGF-1) and osteocalcin, accumulation of advanced glycation end products (AGEs), especially in collagen, microangiopathy, and inflammation reduced bone quality in diabetic patients. However, hyperglycemia, insulin deficiency, reduced levels of insulin-like growth factor-1 (IGF-1) and osteocalcin in serum, accumulation of advanced glycation end products (AGEs) in collagen, microangiopathy, and inflammation, reduce bone quality in diabetic patients. Furthermore, the imbalance of AGE/RAGE results in bone fragility via attenuating osteogenesis. Thus, adequate glycemic control by medical intervention is necessary to prevent bone tissue alterations in diabetic patients. Metformin mainly activates adenosine 5′ -monophosphate-activated protein kinase (AMPK), and inhibits mitochondrial respiratory chain complex I in bone metabolism. In addition, metformin increases the expression of transcription factor runt-related transcription factor2 (RUNX2) and Sirtuin protein to regulate related gene expression in bone formation. Until now, there are a lot of preclinical or clinical findings on the application of metformin to promote bone repair. Taken together, metformin is considered as a potential medication for adjuvant therapy in bone metabolic disorders further to its antidiabetic effect. Taken together, as a conventional hypoglycemia drug with multifaceted effects, metformin has been considered a potential adjuvant drug for the treatment of bone metabolic disorders.

Sodium glucose co-transport 2 inhibitors for gout treatment.

Hyperuricemia remains the most prevalent cause of gout. Gout patients present with joint inflammation and uric acid crystals deposition manifesting as tophi. The association of gout with increased risk of insulin resistance, diabetes, metabolic disorders, increased cardiometabolic risk, and kidney disease is well established. These factors influence the treatment plan, and current treatment options have limited cardiovascular risk reduction. So the need for novel treatments with a broad range of coverage for the complications is warranted. Sodium-glucose co-transporter 2 inhibitors are novel drugs approved for treating type-2 diabetes. They prevent glucose reabsorption and lower serum uric acid levels. Recently few studies have studied their association with reducing the risk of gout. They may help address the gout related complications through their recorded benefit with weight loss, improved insulin resistance, and cardiovascular benefits in recent studies. . SGLT2-Is may be useful to reduce the risk of gout in individuals with type 2 diabetes. Limited literature is available on the safety and efficacy of these novel antidiabetic drugs in patients with gout. This review is aimed to summarize the current knowledge on the role and effectiveness of novel antidiabetic medication as an early therapeutic option in gout patients.

Defining explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A systematic review.

Potentially inappropriate prescriptions (PIPs) of antidiabetic drugs (ADs) (PIPADs) to patients with type 2 diabetes mellitus (T2DM) have been reported in some studies. The detection of PIPs in electronic databases requires the development of explicit definitions. This approach is widely used in geriatrics but has not been extended to PIPADs in diabetes mellitus. The objective of the present literature review was to identify all explicit definitions of PIPADs in patients with T2DM. We performed a systematic review of the literature listed on Medline (via PubMed), Scopus, Web of Science, and, Embase between 2010 and 2021. The query included a combination of three concepts ("T2DM" AND "PIPs" AND "ADs") and featured a total of 86 keywords. Two independent reviewers selected publications, extracted explicit definitions of PIPADs, and then classified the definitions by therapeutic class and organ class. Of the 4,093 screened publications, 39 were included. In all, 171 mentions of PIPADs (corresponding to 56 unique explicit definitions) were identified. More than 50% of the definitions were related to either metformin (34%) or sulfonylureas (29%). More than 75% of the definitions were related to either abnormal renal function (56%) or age (22%). In addition, 20% (n = 35) mentions stated that biguanides were inappropriate in patients with renal dysfunction and 17.5% (n = 30) stated that sulfonylureas were inappropriate above a certain age. The definitions of PIPADs were heterogeneous and had various degrees of precision. Our results showed that researchers focused primarily on the at-risk situations related to biguanide prescriptions in patients with renal dysfunction and the prescription of sulfonylureas to older people. Our systematic review of the literature revealed a lack of consensus on explicit definitions of PIPADs, which were heterogeneous and limited (in most cases) to a small number of drugs and clinical situations.

Pharmacovigilance study of oral antidiabetic drugs in patients with type 2 diabetes mellitus

The aim of the study to to evaluate and analyse ADRs in type II diabetic patients and to determine the causality and safety profile of all the prescribed medicationsMethods: A prospective study was carried out in diabetic patients visiting the Diabetic OPD and those fulfilling inclusion criteria were included in study. ADR observed were obtained from their Diabetic Diary and were recorded in the Case Record Form to evaluate the incidence,frequency, severity and causalityResults: A total of 81 ADRs were reported from206 patients. The class of drug responsible for causing more ADRs was found to be biguanides. The mostcommonly affected organ system was GI System. The suspected ADRs were assessed for their causality,it wasrevealed that 26 were probable and 55 were possible as per WHO Scale. Conclusions: The present study helps to understand importance of ADR reporting to ensure maximum benefits of drugtherapy. As the cases of new onset diabetes is also increasing in Indian scenario as well as newer drugs are also developed to target the disease pathology, therefore active pharmacovigilance should be carried out for risk identification and management.

Evaluation of the Use of Antidiabetic Drugs in Patients of Back-Referral Program at the Demak District Pharmacy

Drugs are one of the important components of the Back-Referral Program (BRP), so the guarantee of the availability of BRP drugs in pharmacies is a factor in the success of BRP implementation. The purpose of this study was to determine the consumption of antidiabetic drugs using ATC/DDD and 90% DU methods, analyze the cost of consuming antidiabetic drugs, and determine the suitability of antidiabetic drugs with the National Formulary. This study was an observational study with a cross-sectional design and retrospective data collection. The study was conducted at 6 BRP pharmacies, namely Pharmacy A, Pharmacy B, Pharmacy C, Pharmacy D, Pharmacy E, and Pharmacy F in the area of Demak Regency. The antidiabetic drug consumption data was obtained from BRP patient prescriptions from July 2020 to June 2021. The cost data were obtained based on prices in the JKN drug e-catalog system at BRP pharmacies in the area of Demak Regency. In analyzing the data, the researcher calculated DU at 90%, the cost of drugs included in the DU segment at 90%, and the suitability of drugs with the National Formulary. The results showed that the highest consumption of antidiabetic drugs in Back-Referral Program (BRP) pharmacies in the area of Demak Regency was glimepiride (54.72%) and metformin (31.01%). The highest cost of consuming antidiabetic drugs per DDD was insulin (Rp.17,639.73), the lowest cost was glimepiride (Rp.65.35), the total cost of antidiabetic drugs was Rp.53,509,090 and an incompatible drug with National Formulary was pioglitazone. In general, the highest consumption of antidiabetic drugs in Back-Referral Program (BRP) 6th pharmacies in the area of Demak Regency, which was included in the DU segment 90%, were glimepiride, metformin and the suitability of drugs with the National Formulary has not reached 100%.

Influence of type 2 diabetes mellitus and concomitant anti-diabetic medications in patients with metastatic pancreatic ductal adenocarcinoma.

e16301 Background: The association between pancreatic ductal adenocarcinoma (PDAC) and type 2 diabetes mellitus (DM2) has long been evaluated. Indeed, DM2 can be both an epiphenomenon of PDAC and a risk factor. However, the data on the influence of DM2 and concomitant drug therapy in the progression of pancreatic neoplasms are conflicting. The present study aimed to investigate the correlation between overall survival (OS) and antidiabetic drugs in patients with metastatic pancreatic ductal adenocarcinoma and DM2. Methods: Data from 232 patients were collected retrospectively from 2014 to 2021. 174 from the Department of Medical Oncology of the University Hospital of Cagliari and 58 from the Department of Medical Oncology, AOU Ospedali Riuniti of Ancona. All patients had stage IV disease and received gemcitabine plus nab-paclitaxel first-line chemotherapy. Statistical analysis was performed with the MedCalc package. We aimed to evaluate the correlation between DM2, anti-diabetic medications (ADMs) and median overall survival (mOS). Survival distribution was assessed by Kaplan-Meier curves. Finally, multivariate analysis was performed, taking into consideration the following prognostic factors: sex, ECOG-PS, LDH, Ca19.9, and metastatic sites. Results: The median age was 69 y.o. (range 40-84 y.o.), 127 (54,7%) were male. All patients received first-line treatment with gemcitabine plus nab-paclitaxel. 138 (59,4%) patients were not affected by DM2, 94/232 (40,6%) were affected by DM2. Among DM2 patients, 57 (%) were insulin-treated and 37 (%) were metformin-treated. DM2 patients showed a statistically significant higher median overall survival (26 versus 11 months, 95% CI, p = 0,0002). Furthermore, among DM2 patients insulin-treated and metformin-treated showed a mOS of 21 months and 33 months, respectively (95% CI, p = 0.0002). Finally, multivariate analysis showed that treated-DM2 is an independent prognostic factor ( p = 0.03). Conclusions: The results of our study showed a correlation between DM2 on treatment (with insulin or metformin) and higher mOSin patients with metastatic PDAC. However, the limitations due to retrospective data collection must be considered. The mechanisms underlying these findings could be explained by maintaining optimal insulin concentration and good glycemic control during treatments, or by the activity of anti-diabetic medication in neoplastic tissues. However, further studies in this setting are needed.

Influence of Age on the Effects of Sodium-Glucose Cotransporter 2 Inhibitors in Japanese Patients With Type 2 Diabetes Mellitus

Background: Selective inhibitors of sodium-glucose cotransporter 2 (SGLT2) inhibitors have been reported to improve glucose metabolism, lipid metabolism and liver dysfunction in patients with type 2 diabetes mellitus. However, few studies have investigated if the effects of this class of drugs vary according to the age of the patients. This study was conducted to determine the influence of age on the effects of SGLT2 inhibitors in Japanese patients with diabetes mellitus. Methods: SGLT2 inhibitors were administered for 6 months to 199 patients with type 2 diabetes mellitus. The body weight, body mass index (BMI), visceral fat area, serum glucose, hemoglobin A1c (HbA1c), blood lipid levels, serum uric acid, liver function parameters, and bone mineral density were measured before and after 6 months of treatment, and regression analysis was performed to examine the relationship between age and the effects of SGLT2 inhibitors. Results: The results of the regression analysis showed that the effects of SGLT2 inhibitors on the serum levels of high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (gamma-GTP) were influenced by the patient age. The effect of SGLT2 inhibitors in increasing the serum HDL-C was more pronounced in older patients. There was an interaction between age and the baseline levels of the serum AST and gamma-GTP; reductions of the serum AST and gamma-GTP levels by SGPLT2 inhibitors were more pronounced in younger patients with higher baseline levels of these parameters, but not pronounced in aged patients. Conclusions: The effects of SGLT2 inhibitor treatment on the serum HDL-C, AST and gamma-GTP levels were affected by the patient age: their beneficial effect on the serum HDL-C increased with the patient age and their effects in reducing the serum AST and gamma-GTP decreased with the patient age. The effects of SGLT2 inhibitor treatment on the blood glucose and serum HbA1c were not affected by the patient age, suggesting that SGLT2 inhibitors can be used as antidiabetic drugs in patients over a wide age range, from the young to the elderly. J Endocrinol Metab. 2022;12(2):53-58 doi: https://doi.org/10.14740/jem799

Novel Antidiabetic Medications in Polycystic Ovary Syndrome.

Polycystic ovary syndrome is a very common endocrine disorder prevalent in premenopausal women. Patients with polycystic ovary syndrome present with abnormal menstruation, ovulation disorders, and hyperandrogenemia. They are often accompanied by insulin resistance, metabolic disorders, and other cardiovascular abnormalities. Also, they have comorbidities, such as dyslipidemia, obesity, diabetes type 2, non-alcoholic fatty liver disease, which all influence the treatment plan. Metformin has been defined as a treatment option in patients with polycystic ovary syndrome. However, the clinical responses to metformin are limited. Thus, the need for novel treatments with a broad range of coverage for the complications is warranted. Sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, incretin analogs are novel drugs approved for treating type-2 diabetes. Because of their recorded benefit with weight loss, improved insulin resistance, and cardiovascular benefits in recent studies, they may help polycystic ovary syndrome women address the polycystic ovary syndrome-related risk of metabolic, reproductive, and psychological consequences. Limited literature is available on the safety and efficacy of these novel antidiabetic drugs in patients with polycystic ovary syndrome. Thus, this review is investigating the role and effectiveness of novel antidiabetic medication as an early therapeutic option in polycystic ovary syndrome.

Study of potential interactions of oral antidiabetic drugs in patients with type 2 diabetes mellitus with comorbidities: A retrospective study

Background: Diabetes mellitus (DM) has many complications, such as microvascular and macrovascular complications. Patients are given polypharmacy therapy to combat these issues, which can cause drug interactions. Oral antidiabetic drugs were chosen based on their risk profile. Risk assessment aided treatment intensity targeting. The number of drugs taken can increase the risk of drug interactions causing health issues. Objective: To identify potential drug interactions based on their severity (major, moderate and minor) and the mechanism of the drug interaction (pharmacokinetics and pharmacodynamics), in type two diabetes mellitus patients with comorbidities at the Lamongan Health Center. Methods: This was a cross-sectional study using medical records and patient prescriptions from October 2020 to June 2021 at Puskesmas (Primary Health Centers) Deket, Karanggeneng, and Babat. The data were descriptively analysed. Drug interactions were analysed using drugs.com and Stockley. Purposive sampling was used to select 194 patients for inclusion. Results: From October 2020 to June 2021, 110 out of 194 outpatients at Lamongan Regional Health Center had potential drug interactions (56.7 %). The most common type of drug interaction was of moderate severity, with 120 cases (93.0%), and the most common mechanism was pharmacodynamics (61.2%). Conclusion: Polypharmacy is a difficult problem to avoid, so drug therapy monitoring is required in diabetic patients to minimise unwanted effects. Preventing potential drug interactions requires a system for early detection of potential drug interactions that may occur in patient prescribing and maximising pharmaceutical care. This system would allow for the community to be more proactive in finding out about potential drug interactions.

Future perspective in diabetic patients with pre- and post-capillary pulmonary hypertension.

Pulmonary hypertension is a clinical syndrome that may include multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. Pulmonary hypertension secondary to left heart disease is the prevalent clinical condition and accounts for two-thirds of all cases. Type 2 diabetes mellitus, which affects about 422 million adults worldwide, has emerged as an independent risk factor for the development of pulmonary hypertension in patients with left heart failure.While a correct diagnosis of pulmonary hypertension secondary to left heart disease requires invasive hemodynamic evaluation through right heart catheterization, several scores integrating clinical and echocardiographic parameters have been proposed to discriminate pre- and post-capillary types of pulmonary hypertension.Despite new emerging evidence on the pathophysiological mechanisms behind the effects of diabetes in patients with pre- and/or post-capillary pulmonary hypertension, no specific drug has been yet approved for this group of patients. In the last few years, the attention has been focused on the role of antidiabetic drugs in patients with pulmonary hypertension secondary to left heart failure, both in animal models and in clinical trials.The aim of the present review is to highlight the links emerged in the recent years between diabetes and pre- and/or post-capillary pulmonary hypertension and new perspectives for antidiabetic drugs in this setting.