Drugs In Diabetic Patients Research Articles

Medication Adherence and Treatment Satisfaction With Lipid-Lowering Drugs Among Patients With Diabetes and Dyslipidemia.

Poor adherence to lipid-lowering drugs in diabetic patients with dyslipidemia increases has been linked with an increased cardiovascular risk. A better understanding of the determinants of adherence to lipid-lowering drugs and treatment satisfaction among people with diabetes and dyslipidemia is crucial. We aimed to assess the prevalence of adherence to lipid-lowering drugs, identify its determinant factors, and evaluate treatment satisfaction among users of lipid-lowering drugs who have diabetes and dyslipidemia. We surveyed 398 adult patients with diabetes and dyslipidemia, using a validated medication adherence survey (Adherence to Refills and Medications Scale) and a validated treatment satisfaction survey (Treatment Satisfaction Questionnaire for Medication, TSQM). Sociodemographic and medical history data were collected through questionnaires. The prevalence of poor medication adherence was 36%. Factors associated with poor adherence included adverse reactions to medications, lack of medication availability, and lack of family support. Adherent patients reported lower low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels, higher treatment satisfaction, and a higher prevalence of cardiovascular disease and comorbidities. Having a family history of dyslipidemia was negatively associated with adherence, while the number of comorbidities positively influenced it. The scores of TSQM components such as effectiveness, global satisfaction, and convenience were significantly higher in people who were adherent or achieved the LDL-C target. Our findings highlight the need for interventions targeting several factors impacting adherence to lipid-lowering drugs in patients with diabetes and dyslipidemia. Managing adverse effects, leveraging family support, and ensuring medication access represent crucial aspects of improving adherence and potentially mitigating cardiovascular risks in this high-risk population.

Drug Safety Evaluation of Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic Comorbid Patients by Review of Systemic Extraglycemic Effects.

The aim of this study is to evaluate the safety of this drug in diabetic patients with comorbidities of all systems. In this review, the beneficial effects of this drug and its mechanism on the disorders of every system of humans in relation to diabetes have been studied, and finally, its adverse effects have also been discussed. The search for relevant information is carried out in the PubMed and Google Scholar databases by using the following terms: diabetes mellitus type 2, SGLT, SGLT2 inhibitors, (SGLT2 inhibitors) AND (Pleiotropic effects). All English-published articles from 2016 to 2023 have been used in this study. It should be noted that a small number of articles published before 2016 have been used in the introduction and general informations. Its beneficial effects on improving cardiovascular disease risk factors and reducing adverse events caused by cardiovascular and renal diseases have proven in most large clinical studies that these effects are almost certain. It also has beneficial effects on other human systems such as the respiratory system, the gastrointestinal system, the circulatory system, and the nervous system; more of them are at the level of clinical and pre-clinical trials but have not been proven in large clinical trials or meta-analyses. With the exception of a few adverse effects, this drug is considered a good choice and safe for all diabetic patients with comorbidities of all systems.

Drug interactions and drug-food interactions in patients receiving diabetes mellitus treatment

Drug interaction is the change of a drug's effects by the preceding and/or concurrent administration of a different substance (precipitant drug). Drug interactions may either intensify or weaken the effects that one or both medications are supposed to have. Any drug's therapeutic, preventative, or diagnostic capabilities may change as a result. A major contributing factor to the prevalence and occurrence of adverse medication responses and adverse drug events might be drug interactions. Patients receiving drug combinations or polypharmacy or suffering from co-morbid diseases like diabetes, hypertension, peptic ulcer, fungal infections, and neurodegenerative disorders have a much higher rate of occurrence and incidence of drug interactions. As these patients receive prolonged and multiple treatments, the risk of drug interactions rises. Conclusion: Drug interactions are more likely to occur in diabetes patients who are also getting a mix of medications for diabetic complications. As a result, the frequency of drug interactions is fast increasing. Because of its increasing incidence and the corresponding rise in morbidity and mortality, diabetes mellitus has been regarded as a major public health concern globally. The major goal of this review study is to highlight the different medication interactions that may occur between drugs and foods, as well as to record any unfavorable side effects of other treatments used in conjunction with antidiabetic drugs in diabetic patients.

Therapy of Type 2 diabetes: more gliflozines and less metformin?

Metformin is a frequently used anti-diabetic drug. In addition to the well-known modulating properties on glyco-metabolic control, metformin reduces cardiovascular (CV) risk partly independently of its anti-hyperglycaemic effect. The use of 'new' anti-diabetic drugs, inhibitors of the renal Na-glucose co-transporter (SGLTs-I or 'gliflozines') and GLP-1 receptor agonists (GLP1-RAs), has further contributed to challenge the strictly 'gluco-centric' view of diabetic CV disease. Several controlled trials have demonstrated that the cardio-renal benefits of gliflozines and GLP1-RAs are present regardless of the presence of metformin as 'background' therapy. The impact on the 'cardio-renal continuum' exerted by SGLTs-I was also noted in non-diabetic patients with heart failure and reduced or preserved ventricular function and different levels of renal function. These drugs reduced re-hospitalization, CV mortality, and progression to end-stage renal disease. These clinical acquisitions, implemented by Scientific Societies, have led to a change in the therapeutic approach to diabetic cardio-renal disease. Although metformin still represents a valid therapeutic option to be offered particularly to 'naïve' diabetic patients without previous cardio-renal events, SGLTs-I and/or GLP1-RAs emerge as 'first-line' drugs in diabetic patients with previous CV events, or at high CV risk, without having to request 'on board' metformin therapy.

Effects of Electrical Remodeling on Atrial Fibrillation in Diabetes Mellitus.

Atrial fibrillation (AF) is one of the most common arrhythmias in medical practice. Diabetes mellitus (DM) is one of the independent risk factors for atrial fibrillation. The increased morbility of atrial fibrillation in diabetes mellitus is related to both structural and electrical remodeling of atrium. Based on studies of atrial electrophysiological changes in diabetes mellitus, this article focuses on the electrical remodeling of atrial cardiomyocytes, including remodeling of sodium channels, calcium channels, potassium channels and other channels, to provide the basis for the clinical management of antiarrhythmic drugs in diabetic patients with atrial fibrillation.

Lipids-Diagnosis and therapy in diabetes mellitus (Update 2023)

Hyper- and dyslipidemia contribute to cardiovascular morbidity and mortality in diabetic patients. Pharmacological therapy to lower LDL cholesterol has convincingly shown to reduce cardiovascular risk in diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the use of lipid-lowering drugs in diabetic patients according to current scientific evidence.

Tirzepatide-Friend or Foe in Diabetic Cancer Patients?

It is a well-accepted fact that obesity and diabetes increase the risk of incidence of different cancers and their progression, leading to a decrease in the quality of life among affected cancer patients. In addition to decreasing the risk of cancers, maintaining a healthy body mass index (BMI)/body weight and/or blood glucose levels within the normal range critically impacts the response to anti-cancer therapy among affected individuals. A cancer patient managing their body weight and maintaining blood glucose control responds better to anti-cancer therapy than obese individuals and those whose blood glucose levels remain higher than normal during therapeutic intervention. In some cases, anti-diabetic/glucose-lowering drugs, some of which are also used to promote weight loss, were found to possess anti-cancer potential themselves and/or support anti-cancer therapy when used to treat such patients. On the other hand, certain glucose-lowering drugs promoted the cancer phenotype and risked cancer progression when used for treatment. Tirzepatide (TRZD), the glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide/gastric inhibitory peptide (GIP) agonist, has recently gained interest as a promising injectable drug for the treatment of type 2 diabetes and was approved by the FDA after successful clinical trials (SURPASS 1/2/3/4 and 5, NCT03954834, NCT03987919, NCT03882970, NCT03730662, and NCT04039503). In addition, the reports from the SURMOUNT-1 clinical trial (NCT04184622) support the use of TRZD as an anti-obesity drug. In the current review article, we examine the possibility and molecular mechanisms of how TRZD intervention could benefit cancer therapeutics or increase the risk of cancer progression when used as an anti-diabetic drug in diabetic patients.

Sistem Pendukung Keputusan Menggunakan Fuzzy Logic Tahani Untuk Penentuan Golongan Obat Sesuai Dengan Penyakit Diabetes

Abstract: Consuming foods and drinks that contain a lot of Glucose, allows the risk of developing Diabetes. Diabetes is a disorder of the metabolic system of carbohydrates, proteins, and fats in the body due to disturbances that occur in insulin secretion that cause a decrease in insulin performance. Please be aware that Diabetes can lead to death, blindness, heart disease and kidney failure. According to data from the International Diabetes Federation in 2019, Indonesia is ranked 7th, where 10.7% of the total population suffers from Diabetes. For this reason, we are interested in making fuzzy logic on determining drug classes in diabetes based on the patient's blood glucose levels. The purpose of this study is to prove that fuzzy logic can be a solution for classifying drugs in diabetic patients. We'll create a fuzzy Logic that uses The Hard Way graphic model on each variable membership function. For the fuzzy manufacturing process toolbox we used a Jupyter Notebook on anaconda Navigator.The limitation of the study is the use of doses on drugs. This research can contribute to the field of health.
 Keywords: Fuzzy Logic, Artificial Intelligence, Diabetes, Jupyter Notebook, Tahani Method.

Single center observational drug utilization study of oral antidiabetic agents in type 2 diabetic patients

Diabetes mellitus is a major healthcare problem in India. Oral anti diabetic agents are the most commonly prescribed drugs for type 2 diabetes. The aim of the study was to evaluate the recent pattern of drug utilization of anti-diabetic drugs in diabetic patients and observe adverse drug events (ADEs) associated with anti-diabetic therapy. Methods: A prospective study was carried out in diabetic patients visiting the Diabetic OPD and those fulfilling inclusion criteria were included in study. Demographic data, drug utilization pattern and ADEs due to Anti-diabetic drugs were summarized. Results: In the present study, 110 (58.25%) were males and 96 (46.60%) were females. Majority of patients, Metformin was the most commonly prescribed drug. 71.1 % of patients were prescribed with triple therapy. Co-morbid condition was found in 91 patients where hypertension (18.44%) being the most common co-morbid condition. 81 ADRs were observed with GIT upset being the most common ADR reported. Conclusions: The present study helps to find out recent prescribing pattern of oral diabetic medications with different co-morbidities. Therefore, understanding of the existing prescribing patterns, trends of antidiabetic drugs their beneficial effect and mechanism can help to overcome progression of disease.

879-P: Effect of Combined SGLT2 Inhibitor and DPP-4 Inhibitor Therapy on the Production of Advanced Glycation End Products

SGLT2 inhibitors (SGLT2is) prevent disease progression in diabetic patients with atherosclerotic disease. On the other hand, a similar beneficial effect on disease progression has not been reported for DPP-4 inhibitors (DPP-4is) , which are, however, widely used. To clarify the differences in effects between these two classes of drugs in diabetic patients, we focused on the production of advanced glycation end products (AGEs) and studied the effects of pretreatment with DPP-4i on the production of AGEs in patients who subsequently received SGLT2i. In the present study, Japanese patients with type 2 diabetes mellitus with unchanged glycemia control status for at least 6 months were administered SGLT2i (n = 11) for 3 months and then divided into a group that had already been receiving DPP-4i (n = 11) at the start of administration of the SGLT2i and the SGLT2i monotherapy group. We measured the blood levels of methylglyoxal-derived hydroimidazolone-1 (MG-H1) , which is an AGE, and also diabetes-related parameters before the start and after 3 months’ treatment with the SGLT2i. As a result, significant decreases of both HbA1c (from 8.6 ± 1.4 to 7.2 ± 1.4, P < 0.01) and circulating MG-H1 levels (from 0.48 ± 0.to 0.44 ± 0.07, P < 0.05) were observed in the SGLT2i monotherapy group. On the other hand, in the group that received SGLT2i in addition to a DPP-4i, the HbA1c value decreased significantly (from 7.2 ± 0.4 to 6.8 ± 0.5, P < 0.01) , whereas no significant change of the MG-H1 level was observed after the SGLT2i therapy. In conclusion, SGLT2i monotherapy decreased both the HbA1c and blood MG-H1 levels. However, no significant effect on the blood level of MG-H1 was observed in the combined DPP4i plus subsequent SGLT2i therapy group, suggesting that DPP4i possibly suppress the effect of the SGLT2i in reducing the production of MG-H1. Disclosure M.Kusunoki: Other Relationship; Taisho Pharmaceutical Holdings Co., Ltd. N.Wakazono: None. F.Hisano: None. T.Miyata: None.

Drug Utilization Pattern of Anti-Diabetic Medication: A Prospective Observational Study

Background: Diabetes mellitus is a chronic disease and is responsible for the significant morbidity and mortality. It is critical to conduct a drug use research of anti-diabetic medications in order to encourage rational drug use in diabetes.
 Objective: The purpose of this study was to analyze the pattern of drug use of antidiabetic drugs, as well as the prevalence of diabetes and related risk factors throughout treatment period in our sample group.
 Materials & methods: This is a prospective observational research involving 200 secondary care hospital in-patients. During a 6-month period, the prescribing pattern was studied and assessed, and drug-related difficulties in subsequent patients were report.
 Results: Among 200 patients, 111 (55.46%) were male and 89 (44.5%) were female. Subject of age 65-80 (n=73) were observed to be more suspected. Hypertension 130 (61.32%) was the most common risk factors. In 200 cases, the most commonly used therapy was monotherapy in 89 subjects (44.5%) followed by combination therapy 55(27.5%). Insulin 192(54.5%) was most commonly used followed by oral drugs 160 (45.4%). The most usually prescribed monotherapy was metformin, followed by glimepiride, while the most commonly prescribed combination therapy were metformin+glimepiride.
 Conclusion: Prescribing pattern of drugs in diabetic patients concluded that optimized drug therapy led to minimal ensuing DRPs. A continuous observation and reporting of the prescribing practice of anti-diabetic drugs can help the physicians result in therapeutically effective treatment for the patients.
 Keywords: Antidiabetics, Drug utilization pattern, Drug related problem, Comorbidities, metformin

Use of disease-modifying drugs in diabetic patients with heart failure with reduced ejection fraction.

Type 2 diabetes mellitus and heart failure are closely related, patients with type 2 diabetes mellitus have a higher risk of developing heart failure, and those with heart failure are at increased risk of developing type 2 diabetes. Although no specific randomized clinical trials have been conducted to test the effect of cardiovascular therapies (drugs and/or devices) in diabetic patients with heart failure, a lot of evidence shows that all interventions effective in improving prognosis in patients with heart failure reduced ejection fraction are equally beneficial in patients with and without diabetes. However, the use of disease-modifying drugs in patients with diabetes and heart failure reduced ejection fraction is a clinical challenge due to the increased risk of adverse effects. For example, β-blockers are underutilized in diabetic patients due to the theoretical unfavorable effects on glucose metabolism as well as the use of drugs that interact with the renin-angiotensin system can be challenged in patients with diabetic nephropathy because of the risk of hyperkalemia. This review outlines the current use of disease-modifying drugs in diabetic patients with heart failure reduced ejection fraction. In addition, the role of novel pharmacologic agents as type 2 sodium-glucose co-transporter inhibitors (SGLT2ii) is discussed.

Dipeptidyl Peptidase-4 Inhibitors and Cardiovascular Side Effects

Aim: WHO projects that diabetes will be the seventh leading cause of death in 2030. One of the macrovascular of diabetes is cardiovascular (CV) diseases, reported incidence of heart failure in diabetic patients is twice greater than control subjects and intensive use of antidiabetic drugs in diabetic patients increase CV mortality. This review will discusses the effect of DPP4 inhibitors (DPP-4i) on CV outcomes. Data sources: PubMed 32 journals, Google Scholar 17 journals, BioMed Central 5 journals and others 1 journal Method: A systemic search of all English-language articles up to 2020 was conducted using the following terms: dipeptidyl peptidase-4 inhibitors, sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin, gemigliptin, anagliptin, teneligliptin, alogliptin, trelagliptin, omarigliptin, cardiovascular, and mechanism on cardiovascular diseases. Results: Positive effect on CV of DPP-4i mediated by activate PI3K, CAMP, eNOS and PKA, and negative effect because their effects in modulate SP, peptide YY, and neuropeptide Y. CV outcomes of DPP-4i versus placebo are variated for MACEs, which are reported on sitagliptin HR 0.98, 95% CI 0.89 to 1.08; Vildagliptin RR 0.82, 95% CI 0.61 to 1.11; Saxagliptin HR 1.00, 95% CI, 0.89 to 1.12; Linagliptin HR 0.78, 95% CI, 0.55 to 1.12; Alogliptin HR 0.85, CI 95%, 0.66 to 1.10; and Omarigliptin HR=0.85, CI 95%, 0.66-1.10. Conclusion: Based on the mechanism DPP-4i inhibitors have either cardioprotective actions or poorer outcomes on CV because their activities are connected with the inhibition of various substrates. DPP-4i sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin, and omarigliptin did not significantly increase of MACE (major adverse cardiac events).

Prescribing pattern of antidiabetic drugs in tertiary care hospital

Background: The aim of the current study was to investigate the prescribing pattern of anti-diabetic drugs in diabetic patients attending tertiary care teaching hospital in Kurnool.Methods: A prospective, cross-sectional, observational survey was carried out in 100 patients of diabetes mellitus attending diabetes outpatient/medicine outpatient departments, to assess their prescribing pattern of anti-diabetic drugs.Results: Average number of anti-diabetic drugs per prescription was 1.4. Metformin (biguanide) was the commonest prescribed individual drug among oral hypoglycemic agents. Fixed dose combination of biguanide and sulfonylurea was prescribed commonly. Monotherapy dominated over polytherapy and there was a higher percentage of use of insulin in type 2 diabetics.Conclusions: OHAs still dominate the prescribing pattern, but there was a shifting trend toward the use of insulin preparations in the management of type 2 diabetes mellitus. Intensification of current drug treatment as well as planning multiple drug interventions with lifestyle modification is necessary.

Utilization of Antihypertensive Drugs in Diabetic Patients in Sultan Qaboos University Hospital

Hypertension is a major worldwide health issue causing cardiovascular morbidity that affects about 26% of all adults worldwide...

Effectiveness of Logotherapy on Death Anxiety, Hope, Depression, and Proper use of Glucose Control Drugs in Diabetic Patients with Depression.

Background:Logotherapy encourages the individual to find meaning in life, which is recognized as the driving force of every individual in their lifetime. Diabetes, caused by the impairment in metabolism of glucose, fat, and protein, is associated with lack of secretion or dysfunction of insulin. This study aims to investigate the effectiveness of logotherapy on death anxiety, hope, depression, and proper use of glucose control medication in diabetic patients with depression.Methods:The population in the present quasiexperimental pretest–posttest study with control group is comprised of diabetic patients with depression attending Baghban Endocrine Clinic in Sari. A sample of 40 diabetic patients (20 in the trial and 20 in the control group) entered the study. Data were collected using Templer Death Anxiety Scale, Miller Hope Scale, Beck's Depression Inventory, and Medication Adherence Scale. Covariance analysis was used to evaluate the effectiveness of logotherapy on death anxiety, hope, depression, and proper use of glucose control medication, where P value lower than 0.05 is considered significant.Results:Death anxiety and depression of diabetic patients with depression were reduced by following logotherapy training, and their hope was increased. The results confirmed the effectiveness of logotherapy training on death anxiety, hope, and depression in diabetic patients with depression (P < 0.05). Logotherapy was effective on proper use of blood- glucose drugs in depressed diabetic patients and 19% of changes in scores of proper use of medication were caused by the effectiveness of logotherapy (P < 0.05).Conclusions:Logotherapy appears to be a suitable psychological treatment for diabetic patients with depression.

Prescribing Pattern and Potency of Anti-Diabetic Drugs in Diabetic Patients for Maintaining Optimal Glycemic Levels

Prescribing Pattern and Potency of Anti-Diabetic Drugs in Diabetic Patients for Maintaining Optimal Glycemic Levels

Effect of patients beliefs about medications on adherence to drugs in diabetic patients attending family medicine outpatient clinic in Ismailia, Egypt.

Adherence affected by many factors in the patient or in the treatment. One of these factors is beliefs about medicine, which is modifiable. This study aimed to assess the effect of beliefs about medicines on adherence to medications in diabetic patients. It is a cross-sectional descriptive-analytic study, conducted between March 2019 and June 2019, in Family medicine outpatient clinic, Suez Canal University, Egypt. A consecutive sample of diabetic patients presented to the clinic in the period of study was included until fulfilling sample size (82 patients). They filled validated questionnaires of the Morisky Medication Adherence Scale, Beliefs about Medicine, and socio-demographic characteristics. About half of the patients were non-adherent (54.9%). The necessity beliefs mean was 18.6, while the median was 20, concerns beliefs mean was 14.2, while the median was 14, overuse beliefs mean was 12.2, while the median was 13, finally mean and median of harm score was 11.0. There was a statistically significant relationship between age, education, concern, and harm score with adherence (p = 0.04, 0.02, < 0.001, and 0.03). Age was a positive predictor of adherence; and concern beliefs score was a negative predictor of adherence. Physicians should inquire about their patient medication beliefs and its effect on patient adherence to discover and solve concerns of diabetic patients to improve non-adherence.

P1033VALUE OF ADDING PENTOXIFYLLINE IN COMPARISON TO ANGIOTENSIN CONVERTING ENZYME INHIBITORS IN TYPE 2 DIABETIC PATIENTS AMONG EGYPTIAN POPULATION

Abstract Background and Aims Microalbuminuria is one of the early presentations of diabetic kidney disease that may progress to macroalbuminuria, progressive loss of glomerular filtration rate and eventually end stage renal disease. Early recognition and management of microalbuminuria can avert irreversible complications. Antihypertensive medications and antihyperlipidemic medications are medications that have been used to control diabetic nephropathy, but the reports of some side effects limited the usage of some of these drugs in diabetic patients. Pentoxifylline is an anti-inflammatory medication that have been experienced for clinical trials in diabetic patients with diabetic kidney disease. Effect of Pentoxifylline on albuminuria has been evaluated in several studies with different outcomes where a significant decrease in albuminuria in the Pentoxifylline group compared with placebo was the final conclusion. The aim of our study is the assessment of the value of Pentoxifylline addition in diabetic patients. Method Of 90 patients aged between 20 and 55 years old with a history of diabetes mellites type II for more than 5 years with normal serum creatinine and had a spot urinary albumin/creatinine ratio of &amp;gt; 300 mg/g on two consecutive measurements with HBA1C &amp;lt; 7% and lacking any history of glomerular disease, immunological, malignant nor cardiovascular disease in the previous 6 months nor using pentoxifylline for the past 3 month attending Ain Shams University clinics in Egypt from October 2017 to September 2018, 61 patients were eligible and randomly assigned in prospective, randomized, parallel-group, non-blind study after obtaining written informed consent from studied patients into 2 groups either the Pentoxifylline group (n = 30) receiving 400 mg thrice daily for 6 months or Ramipril group (n = 31) receiving 2.5 mg once daily on the same schedule. Blood samples and single first morning void urine samples were collected before breakfast after an 8–12 hours overnight fast. Plasma glucose, HbA1c, serum Creatinine, AST, ALT, and urinary protein / Creatinine levels were measured. All biochemical analyses were performed. Participants were followed up after 1, 3 and 6 months during the treatment period to evaluate the outcome Results Highly Statistically significant differences were noted as regard the reduction of the proteinuria levels at the same measurement points in both groups where the mean ranges of proteinuria in group 1 were found to be 2.2±1, 1.8±0.7, 1.4±0.6 mg\g at the start of the study, 3 and 6 month later respectively while in group 2 the mean range was found to be 2.6±1.2, 2±0.8, 1.6±0.7 mg\g with marked reduction of 20.6% after 3 month and 37.6% after 6 month from the start of the trial in group 1 in contrast to 20.7% and 40.2% respectively in group 2, also the effect of both drugs on the level of HbA1c has been studied in both group, in group 1 there was no reduction in the level of HbA1c after 6 month of drug administration in contrary to group 2 which showed a reduction of 4% where these results were found to be statistically significant in group 2 only. we also found statistically significant differences in both groups as regard the decline in eGFR throughout the trial duration which was 4% in group 1 and 6% in group 2. Conclusion We concluded that Pentoxifylline has a promising role as an antiproteinuric agent in comparison with ACEI from our statistical analysis of the study data with a more decline in eGFR throughout the trial duration in the study population using ACEI in comparison to Pentoxifylline. Due to restrictions of the study design these observations need further confirmation by prospective studies. Figure (1) showing comparison between both groups as regard the level of proteinuria and its reduction rate over 6 months Figure (2) showing eGFR levels at 0, 6 months in both groups Figure (3) showing comparison between both groups as regard HbA1C at baseline and after 6 months.

N-Acetylcysteine causes analgesia in a mouse model of painful diabetic neuropathy.

N-Acetylcysteine, one of the most prescribed antioxidant drugs, enhances pain threshold in rodents and humans by activating mGlu2 metabotropic glutamate receptors. Here, we assessed the analgesic activity of N-acetylcysteine in the streptozotocin model of painful diabetic neuropathy and examined the effect of N-acetylcysteine on proteins that are involved in mechanisms of nociceptive sensitization. Mice with blood glucose levels ≥250 mg/dl in response to a single intraperitoneal (i.p.) injection of streptozotocin (200 mg/kg) were used for the assessment of mechanical pain thresholds. Systemic treatment with N-acetylcysteine (100 mg/kg, i.p., either single injection or daily injections for seven days) caused analgesia in diabetic mice. N-acetylcysteine-induced analgesia was abrogated by the inhibitors, sulfasalazine (8 mg/kg, i.p.), erastin (30 mg/kg, i.p.), and sorafenib (10 mg/kg, i.p.), or by the mGlu2/3 receptor antagonist, LY341495 (1 mg/kg, i.p.). Repeated administrations of N-acetylcysteine in diabetic mice reduced ERK1/2 phosphorylation in the dorsal region of the lumbar spinal cord. The analgesic activity of N-acetylcysteine was occluded by the MEK inhibitor, PD0325901 (25 mg/kg, i.p.), the TRPV1 channel blocker, capsazepine (40 mg/kg, i.p.), or by a cocktail of NMDA and mGlu5 metabotropic glutamate receptor antagonists (memantine, 25 mg/kg, plus MTEP, 5 mg/kg, both i.p.). These findings offer the first demonstration that N-acetylcysteine relieves pain associated with diabetic neuropathy and holds promise for the use of N-acetylcysteine as an add-on drug in diabetic patients.