Combination Of Glimepiride Research Articles

Ambulatory glucose profile in managing hypoglycemia in patients with type 2 diabetes mellitus: a case report

Continuous glucose monitoring (CGM) was done in a 41 years-old female patient with type 2 diabetes mellitus (T2DM) to evaluate the glucose fluctuations, to achieve better glycemic control. The patient presented to the clinic with lethargy, on/off episodes of extreme weakness, sweating, and tingling sensation in the feet (B/L), with leg pains for the past 3 months. She did not have any history of hypertension and cardiovascular disease. On examination, her blood pressure was found to be 120/70 mm Hg. The fasting plasma glucose was 96 mg/dL, postprandial glucose was 160 mg/dL, and glycosylated hemoglobin was 6.8%. The patient was on metformin (500mg)- glimepiride (2mg) combination, once daily, before breakfast, and metformin (500mg) after dinner. Since the symptoms were related to glucose fluctuations and hypoglycemia, the patient was consequently recommended professional CGM to analyze the complete glycemic profile. The profile obtained from Ambulatory Glucose Profile (AGP) revealed glucose fluctuations observed as hypoglycaemia and hyperglycemic episodes. Consequently, the patient’s treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with vildagliptin (50 mg) and metformin combination (1000 mg) bid with meals. This case study indicates that the use of CGM may help in improving our understanding of glycemic patterns and may have a beneficial effect on glycemic control.

A cross-sectional observational study on drug utilisation pattern, prevalence and risk factors for the development of diabetic nephropathy among type 2 diabetic patients in a south indian tertiary care hospital

Diabetic nephropathy is the leading cause of the end-stage renal disease (ESRD) worldwide, and it is estimated that ~ 20% of type 2 diabetic patients reach ESRD during their lifetime. The objective of the present study was to assess the drug utilization pattern, risk factors, and prevalence of diabetic nephropathy in patients with type 2 diabetes mellitus in a south Indian tertiary care hospital. A cross-sectional observational study was conducted on 613 subjects (254 with and 359 without diabetic nephropathy). Prevalence of diabetic nephropathy was measured, and risk factors for the development of diabetic nephropathy were determined by calculating odds ratios using graph-pad prism statistical software, and drug utilization pattern was assessed. Nephropathy was significantly higher in subjects who are married (98.8%, OR, 3.903; 95% CI, 1.125-13.54, P=0.0211), poorly educated (61%, OR, 0.3670;95%CI, 0.2635-0.5112, P<0.0001), house wives (44.4%, OR, 0.5492; 95% CI, 0.3432 - 0.8789, P=0.0120), rural residents (51.2%, OR, 0.3943; 95% CI, 0.2820-0.5513, P<0.0001) and risk factors were hypertension (37.44%, OR, 4.131; 95% CI, 2.687-6.350, P<0.0001), other diseases (36.51%, OR, 4.963; 95% CI, 3.202 -7.692, P<0.0001), Endocrine diseases (9.53%, OR, 2.460; 95% CI, 1.433- 4.224, P=0.0009), history of CVD (7.90%, OR, 17.20; 95% CI, 7.049- 41.95, P<0.0001), HbA1c (36.1%, OR, 3.380; 95% CI, 2.157- 5.295, P<0.0001), low HDL (23%, OR, 0.5961; 95% CI, 0.3572 - 0.9947 , P=0.0470), high FBS levels (29.3%, OR, 6.111; 95%CI, 1.283 -29.10, P=0.0113), high triglyceride levels (39.8%, OR, 0.6077; 95%CI, 0.3878 -0.9523, P=0.0293), high serum creatinine (28.3%, OR, 154.3; 95% CI, 37.92- 627.7, P<0.0001), duration of T2DM(5-10years 39.8%, OR, 2.653;95% CI, 1.778 - 3.958, & > 10 years 37%, OR, 3.606 ; 95% CI, 2.362-5.504, P<0.0001), physical inactivity(64.9%, OR, 0.5188;95% CI, 0.3727-0.7220 , P<0.0001), soft drinks occasionally (31.9%, OR, 2.253; 95% CI, 1.531-3.315, P<0.0001), habit of taking tea /coffee twice without sugar(42.3%, OR, 1.845; 95% CI, 1.094 to 3.112, P=0.0208) were significant risk factors for development of nephropathy. Metformin (47.05%), a combination of Glimepiride and Metformin (30.71%), a combination of insulin isophane and insulin regular (29.41%), teneligliptin (10.45%), insulin regular (9.80%) were the anti-diabetic medications mostly given to the T2DM patients with nephropathy. The present study revealed that the risk factors for the development of diabetic nephropathy were multiple.

The Potential Efficacy of Stevia Extract, Glimepiride and Their Combination in Treating Diabetic Rats: A Novel Strategy in Therapy of Type 2 Diabetes Mellitus

Background: The currently therapy of type 2 diabetes is unsatisfactory. Nowadays, there is a great interest in using the medicinal plants for treatment of diabetes. Therefore, we studied the efficacy of stevia extract alone and in combination with commonly used sulfonylureas ”glimepiride” in a trial to introduce a new effective therapeutic regimen for type 2 diabetes mellitus. Methods: Nicotinamide (230 mg/kg, IP) followed by streptozotocin (65 mg/kg, IP) were injected for induction of type 2 diabetes in male rats. The diabetic groups were treated for 21 days as the following, the first with stevia extract (300 mg/kg), the second with glimepiride (1 mg/kg), and the third with a combination of glimepiride and stevia extract. Many parameters were measured to evaluate the alleviation of the toxic effect of streptozotocin by stevia and/or glimepiride. Immunohistochemical expression of endothelial nitric oxide (eNOS) was assessed in renal tissues. Results: The stevia extract reduced the blood glucose, triglycerides, cholesterol, ALT, AST, urea, creatinine, tumour necrosis factor (TNFα) levels and malondialdehyde concentration compared to control diabetic group. Stevia treatment improved insulin and adiponectin levels. Stevia reduced eNOS expression in renal tissues compared to the diabetic rats. All these changes were more significant with combined treatment. Conclusion: Stevia and glimepiride may be a new putative therapeutic regimen for management of type 2 diabetes and its complications.

Anti-diabetic drugs prescription pattern by postgraduate students among type 2 diabetes patients attending a tertiary care hospital

Background: The pattern of prescribing anti-diabetic drugs varies among different medical professionals due to the availability of numerous anti-diabetic drugs and demographic and have increasingly favoured for tighter control of glycemic index. Even with the available multiple therapies many patients are not in control. The reasons may be multi factorial and the one important factor is the drugs prescribed.Methods: This cross-sectional study involving 140 type 2 adult diabetes patients was done to assess the pattern of anti-diabetic drugs prescribed by the postgraduate students in a tertiary health care center using a specially designed questionnaire.Results: Oral medications were predominantly prescribed. Metformin and Glimepiride combination was prescribed in majority. Among insulin, combination of short and intermediate acting insulin was prescribed more and the number of insulin prescription increased with the duration of diabetes. Interestingly no newer classes of drugs are prescribed.Conclusions: There is a rational prescription pattern of antidiabetic drugs but newer antidiabetic drugs are not prescribed and life style changes are not discussed with the patients. There is a need to include life style changes as a part of prescription to all the patients.

Comparative study of control of hyperglycemia and dyslipidemia between two treatment- groups of diabetic patient (Metformin Monotherapy and Metformin + Glimepiride Combination)

Aim: The aim of the study is to examine whether the combination of metformin+ glimepiride is superior to metformin mono therapy to treat the newly diagnosed type 2 DM patients to control the HbA1C and dyslipidaemia in terms of LDL, total cholesterol, TG etc. Materials and Methods: A Prospective randomised study with four groups. The control comprises of 60 healthy volunteers. 120 newly diagnosed type 2 DM cases (Group 1) were enrolled in the study. These 120 patients were randomised into two groups; Group 2 with 60 patients to receive Metformin and Group 3 with 60 patients to receive Metformin + glimepiride combination. Both the Group 2 and Group 3 have received the same hypolipidemic and antihypertensive drugs. Results: After about 4 years of treatment, in Group 2 and Group 3, FPG, HbA1C% and lipid profile were improved significantly (p Conclusion: Metformin and Glimepiride combination therapy improves HbA1c, LDL-C, HDL-C more effectively. However, Group 2 patients had shown better AIP than Group 3 patients. Keywords: Monotherapy, Combination therapy, Glycaemic control, Dyslipidemia, Atherogenesis.

2336-PUB: Treatment Effectiveness of Glimepiride Alone and in Combination with Other Oral Hypoglycemic Agents: Outcomes from Real Clinical Practice

Aim: To assess the treatment effect of glimepiride monotherapy and combination with metformin, DPP-4 inhibitors (DPP-4i) and SGLT2 inhibitor (SGLT2i) in patients with type 2 diabetes mellitus (T2DM). Methods: A retrospective cross-sectional data analysis of T2DM patients of Apollo Sugar Clinics, Pan India. An eligible glimepiride prescriptions with a diagnosis of T2DM from Jan 2016 to September 2018 were included in this analysis to assess the role of glimepiride as monotherapy and in combination therapy with metformin, DPP-4i and SGLT2i on glycemic variables- glycated haemoglobin (HbA1c), and fasting blood glucose (FBG), and on weight (Wt) and body mass index (BMI). Descriptive statistics were applied to analyze the data and paired t-test was used to identify the significant difference in the glycemic variable within groups. Results: Total 7059 T2DM patients were included in the analysis. Mean age was 52.9 year, 62.6% were males and 37.4% were females. At initiation the mean (SD) HbA1c was 8.1(1.7)%, FBG 158(55) mg/dL, Wt 69.3(12.5) kgs, and BMI was 26.6(4.7)kg/m2. Of the total, a majority of the patients were on glimepiride and metformin combination (86.3%) followed by glimepiride monotherapy (8.3%), glimepiride and DPP-4i (5%) and glimepiride and SGLT2i (0.4%). The analysis shows significant reduction in HbA1c (0.4%; p <0.001) and FBG (17mg/dL; p <0.001) in glimepiride and metformin combination treatment only compared to other combinations. Further, there was a considerable reduction in BMI in glimepiride and SGLT2i combination. Conclusions: Our current study shows glimepiride and metformin combination therapy is highly prescribed and is effective in glycemic control compared to monotherapy and other glimepiride combinations. Disclosure K.G. Seshadri: None. D. C.s.: None. M. R.m.: None. U. Ayyagari: None. B. T.s.: None. S. Das: None. N. N.k.: None. B. Jaganmohan: None. H. Reddy: None. J. Jayaprakashsai: None. S. Tippisetty: None. V.K. Kolukula: None.

Hypolipidemic effect of sitagliptin, voglibose and glimepiride in combination with metformin in patients with type 2 diabetes mellitus at a tertiary care teaching hospital: a comparative study

Background: The prevalence of coronary artery disease has been increased in diabetic dyslipidemia; hence the present study would like to compare the dyslipidemic effects of Sitagliptin, Voglibose, and Glimepiride in combination with Metformin in type 2 diabetes mellitus patients.Methods: This study was a Prospective, Randomized Clinical trial conducted at SRM medical College Hospital and Research centre. Potheri, Kancheepuram District in diabetic outpatient department after obtaining approval from Institutional Ethics Committee. The patients receiving antidiabetic drugs were divided into three groups. Patients received Metformin with Sitagliptin were grouped as I, Metformin with Voglibose were named as Group II and Metformin with Glimepiride were marked as Group III. Based on the inclusion and exclusion criteria, in each group, 40 patients were assigned as per simple randomization method. The level of lipid profile and BMI was evaluated at the end of 6 months.Results: There was a significant reduction of Total Cholesterol (TC) in Group II and Group III (p value- <0.001, <0.006). Group I showed significant elevation of HDL-C level with the p value of <0.03. Group III showed significant reduction of Triglyceride (TG) level with the p value of <0.04, significant reduction of Low Density Lipoprotein Cholesterol (LDL-C) level with the p value of <0.02 and significant reduction in Very Low Density Lipoprotein Cholesterol (VLDL-C) level with the p value of <0.05. There was no significant reduction in Body Mass Index (BMI) among the groups. On multiple comparisons, Group III showed higher efficacy in reducing TC, TG, LDL-C and VLDL-C levels.Conclusions: The results of this study were analysed and it could be concluded as Metformin with Glimepiride combination (Group III) showed significant reduction of TC, TG, LDL-C and VLDL-C levels.

The influence of SLC22A1 rs622342 and ABCC8 rs757110 genetic variants on the efficacy of metformin and glimepiride combination therapy in Egyptian patients with type 2 diabetes

Background: The incidence of Type 2 Diabetes Mellitus (T2DM) in Egypt is considered one of the highest in the world. Metformin and Sulfonylureas are usually prescribed together due to their efficacy and their relatively low cost. Organic cation transport 1, encoded by SLC22A1 gene, is the main transporter of metformin into hepatocytes, which is considered metformin site of action. Sulfonylureas enhance insulin release from pancreatic B-cells through binding to sulfonylurea receptor 1, encoded by ABCC8 gene. Single nucleotide polymorphisms in the SLC22A1 and ABCC8 genes might affect the response of each drug.Aims: To investigate the influence of SLC22A1 rs622342 (A>C) and ABCC8 rs757110 (A>C) genetic variants on the efficacy of metformin and glimepiride combination therapy in Egyptian T2DM patients.Methods: Observational cross-sectional study in which patients receiving metformin and glimepiride combination therapy for at least 6 months were included for genotyping and classified into either responders or non-responders, based on their HbA1C level.Results: A total of 127 patients were included and genotyped. They were divided into 93 responders (HbA1C<7%) and 34 non-responders (HbA1C≥7%). Minor allele frequencies for rs622342 and rs757110 were 0.189 and 0.271, respectively. Only SLC22A1 rs622342 variant was found to be associated with the response of combination therapy, in which AA alleles carriers were 2.7-times more responsive to metformin than C allele carriers (Recessive model, odds ratio = 2.718, p = 0.025, 95% CI = 1.112–6.385).Conclusion: Genotyping of rs622342 can be useful in predicting the response to metformin in combination therapy in Egyptian T2DM patients.

Hypoglycaemic effects of glimepiride in sulfonylurea receptor 1 deficient rat.

Sulfonylureas (SUs) have been suggested to have an insulin-independent blood glucose-decreasing activity due to an extrapancreatic effect. However, a lack of adequate in vivo evidence makes this statement controversial. Here, we aimed to evaluate whether glimepiride has extrapancreatic blood glucose-lowering activity in vivo. Sulfonylurea receptor 1 deficient (SUR1-/- ) rats were created by means of transcription activator-like effector nucleases (TALEN)-mediated gene targeting technology. Type 2 diabetic models were established by feeding a high-fat diet and administering a low-dose of streptozotocin. These rats were then randomly divided into four groups: glimepiride, gliclazide, metformin and saline. All rats were treated for 2weeks. Glimepiride decreased blood glucose levels and increased insulin sensitivity without elevating insulin levels. Gliclazide showed similar effects as glimepiride. Both agents were weaker than metformin. Further mechanistic investigations revealed that glimepiride increased hepatic glycogen synthesis and decreased gluconeogenesis, which were accompanied by the activation of Akt in the liver. Moreover, glimepiride increased both total and membrane glucose transporter 4 (GLUT4) levels in muscle and fat, which might be attributed to insulin receptor-independent IRS1/Akt activation. Glimepiride possesses an extrapancreatic blood glucose-lowering effect in vivo, which might be attributed to its direct effect on insulin-sensitive tissues. Therefore, the combination of glimepiride with multiple insulin injections should not be excluded per se.

Систематический обзор клинико-экономической эффективности применения вилдаглиптина у взрослых пациентов с сахарным диабетом 2 типа при неудовлетворительном гликемическом контроле на фоне монотерапии метформином

Aim: A study was conducted to assess the clinical and economic effectiveness of vildagliptin in adults with type 2 diabetes mellitus (T2DM) with poor glycemic control against the metformin monotherapy. Materials and methods: 280 sources were identified in accordance with the search strategy; 40 sources were subjected to critical analysis, of which 22 full-text publications were included in the present study. Results and discussion: Significant advantages of the use of vildagliptin in combination with metformin in improving glycemic control, regardless of the initial level of glycosylated hemoglobin (HbA1c), age or body mass index (BMI) compared with other dipeptidyl peptidase-4 inhibitors, were found; Combination therapy using 50 mg of vildagliptin and metformin twice daily significantly reduced the mean baseline HbA1c (-0.7 to -0.9%) and fasting blood glucose levels (-1.4 to 0.1 mmol/l) compared with placebo, as well as with other dipeptidyl peptidase-4 inhibitors; this combination also led to the greatest increase in QALYs (0.18 over the life span) among dipeptidyl peptidase-4 inhibitors compared to treatment with a combination of metformin and glimepiride. Thus, the combination of metformin and vildagliptin gives advantages in efficiency and additional mechanisms of action, since it does not increase the risk of hypoglycemia and does not contribute to weight gain. Conclusion: Combination therapy using metmorfin and vildagliptin is more cost-effective, since it does not increase the risk of hypoglycemia and does not lead to increasing weight.

Efficacy and safety of substituting teneligliptin with hydroxychloroquine in inadequately controlled type 2 diabetes subjects with combination therapy of teneligliptin, metformin and glimepiride with or without other antidiabetic therapy: The TENE-HYQ SHIFT Study

Introduction. To confirm the efficacy and safety of substituting teneligliptin with hydroxychloroquine in inadequately control type 2 diabetes patients (T2DM) despite treatment with teneligliptin, metformin and glimepiride with or without other antidiabetic therapy. Material and methods. This is a multicentre observational, retrospective, 24 week clinical study performed in type 2 diabetes patients with HbA1c in the range of 7.5% to 9.5%. This patients were on teneligliptin 20 mg in addition of metformin and glimepiride with or without other antidiabetic therapy. Teneligliptin 20 mg treatment was replaced by hydroxychloroquine 400 mg. The primary endpoint was change in fasting blood glucose (FBG), postprandial blood glucose (PPBG) and HbA1c from baseline to week 24. The secondary outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c Results. Total of 500 patients’ data was analysed and after 24 week of follow up these patients presented with significant decrease in HbA1c (–1.1 ± 0.17%; p = 0.000); FBG (–29.87 ± 8.9 mg/dl), PPBG (–56.89 ± 9.2 mg/dl) with 52% of patients had achieved HbA1c levels Conclusions. In T2DM patients inadequately controlled on teneligliptin 20 mg along with combination of metformin and glimepiride with or without other antidiabetic therapy, substitute with hydroxychloroquine 400 mg may be a simple yet effective therapeutic option with clinical benefit beyond strict glycemic control without compromising patient’s safety.

Glimepiride monotherapy versus combination of glimepiride and linagliptin therapy in patients with HNF1A-diabetes: a protocol for a randomised, double-blinded, placebo-controlled trial

IntroductionHepatocyte nuclear factor 1α (HNF1A)-diabetes is the most common monogenetic subtype of diabetes. Strict glycaemic control is crucial for a good prognosis for patients with HNF1A-diabetes. Sulfonylurea (SU) is used...

Safety and Efficacy of Fixed Dose Combination of Glimepiride and Metformin in Type 2 Diabetic Patients in Egypt: A Real-Life Study

AbstractBackground: Previous reports showed a significant im-provement in the glycemic control of patients with Type 2 Diabetes Mellitus (T2DM) following the use of Glimepiride/ Metformin Fixed-Dose Combination (G/M FDC), with a reasonable safety profile. In this real-life study on Egyptian population, we aim to investigate the safety and effectiveness of G/M FDC among patients with T2DM.Subjects and Methods: The present observational, multi-center study included 1211 T2DM patients from Egypt, for whom the investigator decided to prescribe G/M FDC. Patients started G/M FDC at the beginning of the study or one month earlier, and the combination dose was decided by the investi-gators to reflect the in-practice approach. Data were recorded at the initial assessment visit and six months later. Safety outcomes were measured throughout the course of treatment.Results: At the end of six months follow-up duration, 45.2% of the patients achieved the targeted HbA1c £7% and 79.5% achieved the targeted reduction in HbA1c by ³0.7%. The total percentage of patients who achieved either the targeted HbA1c £7% or reduction in HbA1c ³0.7% were 86.5%, while those who achieved both target HbA1c £7% and reduction in HbA1c ³0.7% constituted 38.3% of the patients. The mean HbA1c level reduced throughout the study period from 8.8±1.3% to 7.3±0.9% at the end sixth month (p<0.001). Hyperglycemia was the most commonly reported adverse events (3.5%), followed by hypoglycemia (1.2%).Conclusion: The prescription of G/M FDC in treating patients with T2DM in Egypt is effective in achieving the targeted glycemic control with tolerable safety profile.

Valvejet Technology for the Production of a Personalised Fixed Dose Combination of Ramipril and Glimepiride: an Investigative Study on the Stability of Ramipril.

To use valvejet technology for printing a fixed dose combination of ramipril and glimepiride, and to investigate the stability profile of ramipril, which is susceptible to a range of processing and storage conditions. Inks of ramipril and glimepiride were formulated and printed on to HPMC film and the films were evaluated for the chemical and solid-state integrity of the APIs using HPLC and XRPD. The stability of the APIs in the inks and in the printed samples was investigated using Raman and NMR techniques. The printed samples demonstrated excellent precision and accuracy in the doses of APIs deposited. Both drugs were chemically intact in the freshly printed samples and ramipril was found to be in its amorphous form. Ramipril in the printed samples has transformed into ramipril diketopiperazine when stored at 40°C with 75% RH, but remained stable when stored in a desiccator. Results from the stability study of ramipril ink show that the API has undergone degradation when stored both at room temperature and at 40°C but remained stable when stored in a refrigerator. An FDC of ramipril and glimepiride was successfully printed using valvejet technology. The significance of inkjet printing in producing amorphous dosage forms from solution based inks and personalised dosage forms of drugs susceptible to processing conditions was demonstrated using ramipril. This study illustrates the significance of examining the stability of the APIs in the inks and the importance of appropriate storing of both the inks and printed samples.

Treatment with combination of pioglitazone and glimepiride decreases levels of chemerin and asymmetric dimethylarginine (ADMA) in obese type 2 diabetic patients

Chemerin is an adipokine that plays a crucial role in adipocyte differentiation and development, as well as in glucose and lipid metabolism. High levels of asymmetric dimethylarginine (ADMA), a naturally occurring product of metabolism, inhibit nitric oxide (NO) synthesis and are related to endothelial dysfunction. The aim of this study was to investigate the effect of vildagliptin therapy and the combination of pioglitazone and glimepiride on the levels of NO, ADMA, and chemerin in diabetic patients. The study was conducted on 140 subjects, including 40 apparently healthy subjects, and 100 type 2 diabetic obese patients; 50 of them were treated with vildagliptin, and the other 50 patients revived combination of pioglitazone and glimepiride, both groups were treated for 12 months. For all participants, the levels of fasting blood glucose (FBG), fructosamine, HbA1c, lipid profile, ADMA, NO, and chemerin were determined. The levels of those parameters were compared before and after treatment. In both treated groups, levels of FBG, fructosamine, HbA1c, TC, and LDL-C decreased after treatment. Levels of chemerin and ADMA decreased significantly after treatment, whereas the levels of NO increased compared to the baseline values. Additionally, levels of chemerin and ADMA in the group treated with combination of pioglitazone and glimepiride were significantly lower compared to the group treated with vildagliptin. In conclusion, treatment with combination of pioglitazone and glimepiride had a favorable effect on chemerin and ADMA levels in obese type 2 diabetic patients.

Effects of Teneligliptin (Teneli) on Glycemic Indices in Type 2 Diabetes (T2DM) Subjects Uncontrolled with Metformin (Met) and Glimepiride (Glim) Combination

Objective: People with diabetes gradually require increasing dose of medications to achieve good control. We studied the glycemic response of adding Teneligliptin (Teneli) in T2DM subjects with high HbA1c despite being on stable doses of Met and Glim dose. Methods: In this retrospective study T2DM subjects, who were on fixed doses of Met 1000 to 2000mg and Glim 1 to 6mg daily for 3 months were considered. Subjects with an HbA1c between 8-11% and who were prescribed Teneli 20mg OD for at least 6 months, were shortlisted. Those taking insulin or antidiabetic drugs other than Glim+Met or those whose dose was up-titrated during the study period were excluded. We compared HbA1c, fasting (FPG), postprandrial (PPG) plasma glucose, total cholesterol (TC), triglyceride (TG), HDL, LDL, systolic (SBP) and diastolic (DBP) blood pressure at baseline and after 6months of Teneli initiation. Results: Data of 562 subjects (229, 41% females), who met the inclusion criteria were extracted for analysis from the hospital records. Mean age of the sample was 52.6 (95% CI: 51.7-53.4) years and duration of diabetes was 7.8 (6.6-8.3) years. Addition of Teneli resulted in a drop in HbA1c from 9.6% (8.2-10.6) to 8.8% (7.1-9.4) (p&amp;lt;0.05). FPG decreased from 158.8 (154.3-163.2) to 127.8 (124.5-131.1) and PPG from 236.4 (230.7-242.0) to 191.0 (186.0-196.0) respectively (p &amp;lt;0.05). Teneli also improved lipid parameters significantly, particularly TC and TG. With Tenali, SBP declined from 136.8 (134.8-137.9) to 129.5 (128.1-130.9) and DBP from 83.1 (82.2-83.9) to 81.0 (80.2-81.9). There was no incidence of severe hypoglycemia, though 18 (3.2%) cases of suspected hypoglycemia were managed at home. Conclusion: Adding Teneli to Met and Glim combination showed promising role in improving glycemic parameters, lipid components and blood pressure. Low hypoglycemia risk makes the drug a suitable add-on option for those with high HbA1c values. Disclosure H. Mahapatra: None. S. Mishra: None. M. Khuntia: None. B. Jena: None. S. Das: None. A.R. Jena: None. R.K. Padhi: None. A.K. Sahoo: None. R. Mahapatra: None. L. Mahapatra: None.

Characteristics of repaglinide effects on insulin secretion

The dynamics of insulin secretion stimulated by repaglinide, a glinide, and the combinatorial effects of repaglinide and incretin were investigated. At 4.4 mM glucose, repaglinide induced insulin secretion with a gradually increasing first phase, showing different dynamics from that induced by glimepiride, a sulfonylurea. In the presence of glucagon-like peptide-1 (GLP-1), insulin secretion by repaglinide was augmented significantly but to lesser extent and showed different dynamics from that by glimepiride. At 4.4 mM glucose, the intracellular Ca2+ level was gradually increased by repaglinide alone or repaglinide plus GLP-1, which differs from the Ca2+ dynamics by glimepiride alone or glimepiride plus GLP-1, suggesting that the difference in Ca2+ dynamics contributes to the difference in the dynamics of insulin secretion. At a higher concentration (8.8 mM) of glucose, the dynamics of insulin secretion stimulated by repaglinide was similar to that by glimepiride. Combination of repaglinide and GLP-1 significantly augmented insulin secretion, the amount of which was comparable to that by the combination of glimepiride and GLP-1. The Ca2+ dynamics was similar for repaglinide and glimepiride at 8.8 mM glucose. Our data indicate that repaglinide has characteristic properties in its effects on the dynamics of insulin secretion and intracellular Ca2+ and that the combination of repaglinide and GLP-1 stimulates insulin secretion more effectively than the combination of glimepiride and GLP-1 at a high concentration of glucose, providing a basis for its use in clinical settings.

The Fuzzy System as a Promising Tool for Drugs Selection in Medical Practice

The aim of this paper was to demonstrate the potential of the fuzzy system approach to the analysis of healthcare databases for clinicians in their routine daily practice. The healthcare data about 50000 medical prescription items for 38990 individual patients and 2601 various codes of diagnoses categorized according to Slovak version of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems were used for the retrospective study. The fuzzy system approach was applied to the analysis of medical prescription items for I10.90 and E11.90 comorbid patients as the most frequently identified cardiovascular and endocrine codes of diagnoses. Nearly 64% of co-identified I10.90 and E11.90 patients were associated with other additional diagnose. According to the fuzzy system approach, the metformin or glimepiride in combination with moxonidine, metoprolol, or amlodipine was identified as the mainstream drug preferences and/or individual “know-how” of clinicians in pharmacotherapy of mentioned polymorbid patients from 21 various active substances. The results of this paper suggest that the fuzzy system approach to healthcare data obtained from insurance companies may be a helpful way of generating information useful for final decision process in the drugs selection for similar polymorbid patients in medical practice. The obtained data can be used as recommendations for other and/or for less experienced clinicians in drugs selection for patients with similar (or unusual) combinations of diagnoses as well as in clinical situations where the “golden” pharmacotherapeutic standards have not been precisely specified or are totally absent for multi-comorbid patients.

Study of lipid lowering effects of oral antidiabetic drugs in type 2 diabetes mellitus patients

Background: Type 2 diabetes mellitus (T2DM) is one of the most common non-communicable diseases associated with ‘atherogenic dyslipidemia’ The treatment of T2DM often is initiated with oral antidiabetic drugs, most of which not only decrease blood sugar levels effectively but also decrease the lipid levels. Hence the current study is aimed to determine the effectiveness of oral hypoglycemic agents in dealing with associated dyslipidemia.Methods: 150 T2DM patients were divided equally into five groups depending upon the oral antidiabetic drugs they received in solo or in combination for 24 weeks, with equal number of males and females in each group. After the written consent, a detail clinical history, clinical examination, Biochemical investigations including, glycosylated haemoglobin and lipid profile, chest X-ray and ECG were done.Results: After 24 weeks of study, the mean total cholesterol and mean triglycerides decreased significantly (p &lt;0.05 to p &lt;0.01) with monotherapy of metformin and teneligliptin as well as with combination of either metformin and glimepiride or metformin and teneligliptin. The decrease of LDL-C and VLDL-C was not statistically significant with any of the OAD drugs in solo or in combination. Similarly, HDL-C increased significantly (p &lt;0.05) in Group I, III, IV and V; but was most effective with combination therapy. The atherogenic index of plasma also decreased (p &lt;0.05) with metformin or its combination with either teneligliptin or glimepiride.Conclusions: Oral antidiabetic drugs are not only affordable and effective hypoglycemic agents but can also decrease serum lipids and thereby aids in the prevention and management of atherosclerosis and its complications in T2DM.

Simultaneous spectrophotometric determination of glimepiride and pioglitazone in binary mixture and combined dosage form using chemometric-assisted techniques

In the present work, pioglitazone and glimepiride, 2 widely used antidiabetics, were simultaneously determined by a chemometric-assisted UV-spectrophotometric method which was applied to a binary synthetic mixture and a pharmaceutical preparation containing both drugs. Three chemometric techniques – Concentration residual augmented classical least-squares (CRACLS), principal component regression (PCR), and partial least-squares (PLS) were implemented by using the synthetic mixtures containing the two drugs in acetonitrile. The absorbance data matrix corresponding to the concentration data matrix was obtained by the measurements of absorbencies in the range between 215 and 235nm in the intervals with Δλ=0.4nm in their zero-order spectra. Then, calibration or regression was obtained by using the absorbance data matrix and concentration data matrix for the prediction of the unknown concentrations of pioglitazone and glimepiride in their mixtures. The described techniques have been validated by analyzing synthetic mixtures containing the two drugs showing good mean recovery values lying between 98 and 100%. In addition, accuracy and precision of the three methods have been assured by recovery values lying between 98 and 102% and R.S.D. % ˂0.6 for intra-day precision and ˂1.2 for inter-day precision. The proposed chemometric techniques were successfully applied to a pharmaceutical preparation containing a combination of pioglitazone and glimepiride in the ratio of 30: 4, showing good recovery values. Finally, statistical analysis was carried out to add a value to the verification of the proposed methods. It was carried out by an intrinsic comparison between the 3 chemometric techniques and by comparing values of present methods with those obtained by implementing reference pharmacopeial methods for each of pioglitazone and glimepiride.