Effective Management Of Diabetes Mellitus Research Articles

Glucose to Complications: Understanding Secondary Effects in Diabetes Mellitus

Diabetes Mellitus (DM) is a complex metabolic disorder characterized by persistent hyperglycemia, impacting millions globally. While glucose control is central to its management, understanding secondary complications is crucial for comprehensive care. This paper explores the intricate relationship "From Glucose to Complications" in DM, elucidating the pathophysiological mechanisms and organ system involvement. Hyperglycemia-induced damage, driven by glycation and oxidative stress, underpins the cascade of complications. Microvascular complications encompass diabetic retinopathy, nephropathy, and neuropathy, each posing significant morbidity and mortality risks. Macrovascular complications, including atherosclerosis and stroke, contribute substantially to cardiovascular morbidity in diabetic individuals. Metabolic derangements such as dyslipidemia and obesity further exacerbate the risk profile. Endocrine disturbances, neurological sequelae, and cognitive impairments represent additional burdens in DM management. This paper emphasizes preventive strategies and holistic management approaches to mitigate complications. Glycemic control remains paramount, supported by lifestyle interventions emphasizing diet, exercise, and weight management. Pharmacological therapies targeting secondary complications, alongside emerging therapies, hold promise in improving outcomes. Furthermore, addressing comorbidities and mental health concerns is integral to comprehensive care in DM. In conclusion, effective management of Diabetes Mellitus (DM) and its associated complications necessitates a multifaceted approach encompassing glycemic control, lifestyle interventions, and pharmacological therapies.

Physical Activity Detection for Diabetes Mellitus Patients Using Recurrent Neural Networks.

Diabetes mellitus (DM) is a persistent metabolic disorder associated with the hormone insulin. The two main types of DM are type 1 (T1DM) and type 2 (T2DM). Physical activity plays a crucial role in the therapy of diabetes, benefiting both types of patients. The detection, recognition, and subsequent classification of physical activity based on type and intensity are integral components of DM treatment. The continuous glucose monitoring system (CGMS) signal provides the blood glucose (BG) level, and the combination of CGMS and heart rate (HR) signals are potential targets for detecting relevant physical activity from the BG variation point of view. The main objective of the present research is the developing of an artificial intelligence (AI) algorithm capable of detecting physical activity using these signals. Using multiple recurrent models, the best-achieved performance of the different classifiers is a 0.99 area under the receiver operating characteristic curve. The application of recurrent neural networks (RNNs) is shown to be a powerful and efficient solution for accurate detection and analysis of physical activity in patients with DM. This approach has great potential to improve our understanding of individual activity patterns, thus contributing to a more personalized and effective management of DM.

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.

Innovative technologies in the management of diabetes mellitus: prevention of hypoglycemia

One of the strategies for preventing hypoglycemia, along with structured patient education and the use of modern hypoglycemic agents, is self-control of glycemia with the achievement of individual therapeutic goals. Frequently recurring hypoglycemic episodes are associated with impaired recognition of hypoglycemia and increase the risk of severe hypoglycemia up to six times. Prevention of the development of severe hypoglycemia may be of key importance for the prevention of adverse cardiovascular events and the risk of sudden death in patients with diabetes mellitus. Repeated hypoglycemic episodes can lead to impaired recognition of hypoglycemia, as a result of which a lower blood glucose level is necessary for the development of clinical symptoms of hypoglycemia. The use of individual glucose meters is currently relevant, despite the active introduction into clinical practice of continuous monitoring of glycemia and flash monitoring. ccording to the Russian “Algorithms of specialized medical care for patients with diabetes mellitus”, patients are recommended to conduct self-monitoring using individual glucose meters at least 4 times a day when using continuous monitoring of glycemia in real time and at least 2 times a day when using flash monitoring of glycemia to assess accuracy and / or calibration monitoring data and in order to resolve the issue of correction of ongoing therapy. The desire for strict and adequate self-control dictates the need to use the latest means of glycemia control – intelligent glucose meters with high accuracy, ease of use and reliability of blood glucose measurements. The introduction of intelligent technologies – “smart” glucose meters using a mobile application, with the functions of “no coding”, “second chance”, data transmission to the attending physician – makes it possible to carry out remote monitoring, providing more effective management of diabetes mellitus.

Perceived barriers to the effective management of diabetes mellitus among the Wakhi people: A qualitative study

One of the effective strategies used to maintain the glucose level and prevent complications associated with diabetes is self-management. It is the responsibility of the diabetic person to manage their chronic condition. The management includes monitoring blood glucose levels, taking diabetic medicine timely, following a diabetic diet plan, and focusing on physical activities to keep the blood glucose level regular. These practices are necessary for the self-management of the disease; however, due to various barriers, patients cannot manage their disease. This study used a qualitative exploratory design to explore the perceived barriers to managing diabetes among the diabetic people of the Wakhi population in District Hunza. In-depth interviews were conducted with 16 participants to gain insight into the perception regarding barriers that impede diabetes mellitus self-management. The interviews were recorded and transcribed. The content analysis method was used to analyze the data. The analysis revealed four main themes, including Socio-demographic and cultural barriers, personal barriers, healthcare system-related, and diet-related barriers. Each core theme had sub-themes. The critical barrier to the management of diabetes included diet-related barriers and healthcare system issues, and social engagement in rural settings. The findings of this study may help healthcare providers educate their patients about self-management practices, design and develop interventions to educate the patients, and conduct awareness sessions by involving dietitians to educate the patients about culturally and socially suitable diet plans. The identified barriers in the study may help guide the concerned authorities for patient-specific self-care interventions.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

Impact of Blood Glucose Monitoring System Accuracy on Clinical Decision Making for Diabetes Management.

The accuracy of blood glucose monitoring systems (BGMS) is crucial for the safe and effective management of diabetes mellitus. Despite standardization of accuracy assessment procedures and requirements, various studies have shown that the accuracy of BGMS on the market can vary considerably. This article therefore provides health care professionals and users with an intuitive illustration of the impact of BGMS accuracy on clinical decision making. Several hypothetical patient scenarios based on blood glucose (BG) levels in the low, normal, and high BG range are devised. Using data from a recent BGMS accuracy study, a method for calculating the expected range of BG readings from four examined BGMS at the selected BG levels is introduced. Based on these ranges, it is illustrated how clinical decisions and subsequent outcomes of the hypothetical patients are affected by the expected inaccuracies of the BGMS. The range of expected BGMS readings for the same true BG level can vary considerably between different BGMS. The discussion of hypothetical patient scenarios revealed that the use of some BGMS could be associated with an increased risk of adverse events such as failure to detect hypoglycemia, driving with an unsafe BG level, delay of treatment intervention in diabetes during pregnancy, or the failure to prevent diabetic ketoacidosis. This article can support both health care professionals and patients to understand the impact of BGMS accuracy in a relatable, clinical context. Furthermore, it is suggested that current accuracy requirements might be insufficient for the prevention of adverse clinical outcomes in certain circumstances.

Evaluation of in vitro antioxidant activity of okra mucilage and its antidiabetic and antihyperlipidemic effect in alloxan-induced diabetic mice.

Okra (Abelmoschus esculentus) is a traditionally important vegetable herb used to treat numerous illnesses, including diabetes mellitus, in many rural parts of Bangladesh and the South Asian subcontinent. However, the scientific evidence for the aforementioned properties has not been adequately validated. Hence, the aim of this study was to explore the antidiabetic, antilipidemic activity of okra mucilage powder, and to compare its effectiveness with the isolated peel–seed of okra after mucilage extraction in Swiss albino mice. After extraction, both mucilage and peel–seed were made into powder. In addition, crude protein, mineral contents, and in vitro antioxidant activity of mucilage and peel–seed powder were assessed. After acute toxicity test, methanolic extracts of both powders were administered to alloxan‐induced diabetic mice for 3 weeks. Blood glucose levels were assessed weekly. Finally, blood samples were collected on day 21 to estimate blood glucose level, total protein (TP), and lipid profile levels. Okra mucilage powder showed less amount of protein, calcium, magnesium, phosphorus, potassium, sodium, and iron compared with peel–seed powder. In terms of antioxidant activity, the IC50 value and total phenolic content were found higher in okra mucilage powder in contrast to peel–seed powder. However, total flavonoid content was higher in peel–seed powder than mucilage powder. Three‐week administration of mucilage and peel–seed suspensions at a dose of 150 mg/kg and 200 mg/kg significantly (p < .05) reversed the abnormal changes of bodyweights, water consumption, feed consumption, and fasting blood glucose levels of diabetic subjects. Cholesterol, triglycerides, low‐density lipoproteins, high‐density lipoproteins, and total protein were found to be significantly (p < .05) improved after mucilage and peel–seed treatment. Thus, Okra can be recommended as a potential source of antidiabetic drug candidate for the effective management of diabetes mellitus and its complications.

In-Silico Molecular Docking in Screening of Anti-Diabetic Therapeutics from Medicinal Plants

One of the most widely spreading diseases due to several lifestyle problems in the 21st century is diabetes mellitus. The management of diabetes mellitus is very important and essential. Plants are natural reservoir of many medicinal value added components help to overcome many chronic disorders including diabetes mellitus. Herbal drugs are prescribed in treatment of diabetes mellitus due to their good effectiveness, fewer side effects in clinical experience and relatively low costs. Screening of antidiabetic therapeutics is very important and essential for effective management of diabetes mellitus. Many researchers have worked on extraction, isolation, characterization of extracts and bioactive fractions from medicinal plant also they have established profile and data of interaction of active components against various targets and enzymes of diabetes mellitus using In-silico molecular docking tools. Molecular docking is an important computational tool to predict the plausible interactions between the drug and protein in a non-covalent fashion. Extensive in silico docking procedures have been carried out to examine whether the compound is a good ligand with diabetic targets. In the present review article we have thoroughly screened research articles published in various scientific, indexed, national and international journals on In-silico molecular docking based screening of Anti-Diabetic potentials and therapeutics from medicinal plant and extensively presented.

PDB23 Investigating Internists’ Endocrinologists’ and Paediatricians’ Attitudes in Regards to the VALUE of Innovative Diabetes Mellitus Self-Monitoring Technologies in Greece

Innovative technologies of continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) contribute significantly to metabolic control and improve quality of life of diabetic patients. In this study, the attitudes of expert physicians regarding the value of innovative glucose self-monitoring technologies in Greece were investigated. Two Advisory Boards (AdB) were set up by Key Opinion Leaders-KOLs (from Academia, National Health System Hospitals and Private Sector): the first consisted of Internists/ Diabetologists (N = 12) and the second consisted of Endocrinologists/Pediatricians (N = 11). Participants were asked to complete a structured questionnaire developed by experts on health services research, in which answers were given through a five-point Likert scale. A common data analysis (taken into consideration both internists/ diabetologists and endocrinologists/pediatricians answers) was conducted using the SPSS.20v. The vast majority of participants (96%) recognized the importance of innovative self-monitoring technologies for the effective management of diabetes mellitus (DM) and was willing to use them in their clinical practice. In particular, 96% of physicians considered as quite/very important the Ambulatory Glucose Profile (AGP) report provided by the FGM technology. Moreover, participants reported that FGM technology contributes to reducing fluctuations in glucose levels (100%), increasing the time in range (TIR) and reducing the time in hypoglycemia (96% of participants). Additionally, the majority of physicians (87%) stated that FGM technology contributes to achieving savings by reducing complications.Thus, 84% of physicians considered FGM technology should be reimbursed for patients with DM2, in addition to patients with DM1.However, participants highlighted the need for further development and improvements of FGM technology (e.g measurement accuracy at off charts values). The vast majority of participants considered the FGM technology as of high value and consequently recommended its coverage by social security schemes for patients with DM.

Novel Swellable/Expandable Gastroretentive Floating Films of Gliclazide Folded in Capsule Shell for the Effective Management of Diabetes Mellitus: Formulation Development, Optimization and In Vitro Evaluation

Background: Gliclazide (GLZ) belongs to the second-generation of sulphonylureas; it is a drug of choice for the management of type II DM. It belongs to BCS Class II. The major site of drug absorption for GLZ is the stomach; it displays variation in the drug absorption rate and bioavailability due to the shorter gastric retention time. The floating mechanism gets affected when the gastric fluid level is not sufficiently higher, which ultimately obstructs the floating behavior, which is the major limitation of reported formulations. This limitation can be overcome by folding the film into the capsule shell dissolved in the gastric fluid and the film swells/expands to dimensions higher than pylorus sphincter (12mm), thus preventing its evacuation. Objective: The study aims to explore the floating mechanism in the design of films along with a tendency to expand by swelling and unfolding by utilizing a mixture of hydrophilic and hydrophobic polymer to achieve the controlled drug delivery and prolonged gastric retention of drug. Methods: The gastroretentive floating films were formulated by the solvent casting technique using 32 full factorial designs and subjected to in vitro evaluation parameters, drug-excipient compatibility, Xray diffraction and accelerated stability study. Results: The pre-formulation study established the purity and identification of a drug. FTIR study confirmed no drug excipient interaction. F3, F6, and F9 were optimized based on in vitro floating characteristics, swelling/expanding ability, and unfolding time. All developed formulations were unfolded within 14-22 min after capsule disintegration. The F3 was selected as the final formulation as its ability to control the release of the drug for 24 hrs followed by zero-order kinetics having super case 2 transport. XRD confirmed the amorphousness of the drug within the formulation. The stability study results revealed that the formulation was quite stable at extreme storage conditions. Conclusion: The developed novel formulation has good potential for the effective management and treatment of diabetes mellitus.

Self-monitoring of blood glucose can be misleading without periodic re-calibration of glucose Meters: A pilot study

Introduction/Background: Diabetes mellitus is highly prevalent in both developed and developing countries today affecting about 429 million adults globally and is expected to rise by 147% to 629 million in 2045. Effective management of diabetes mellitus requires the periodic measurement of fasting plasma glucose. Self-monitoring blood glucose has been used to achieve this for over three decades now. This study, therefore, assesses the performance of three blood glucose meters used by patients with diabetes in our environment. Materials and Methods: This study adopted a comparative analytical prospective design that involved three of the frequently used glucose meters in our environment namely RUBY®, ONCALL®, and FINETEST®. Glucose calibrators of increasing concentrations from 40 mg/dL to 200 mg/dL were prepared from a freshly constituted 1800 mg/dl stock solution of glucose. Sera obtained from five patients were assayed along with control sera using a routine laboratory method (glucose oxidase [GOX]) for standardization and the three glucose meters simultaneously and the results were compared for statistical differences on Microsoft Excel using means and standard deviation. P ≤ 0.05 was set as a level of significance. Results: The mean glucose values of calibrators (120 ± 63.3) were statistically significantly different from the mean glucose values of the RUBY (139.6 ± 80.9), (P = 0.0118) and the ONCALL (188.8 ± 82.1), (P ≤ 0.0001) glucose meters, respectively. The percentage increase in blood glucose estimation by the RUBY and ONCALL devices was 115.8% and 157.3% respectively. The FINETEST glucose meter overestimated glucose by 232.0% higher than the laboratory GOX method even though there was no statistical significance (P = 0.062) between the two means. The percentage imprecision for the different glucose meters was: RUBY 9.5%, FINETEST 14.8%, and ONCALL 18.2%. Conclusion: Quality control should be used routinely in the use of point of care testing glucose measurements and devices should be sent to the central laboratory periodically for recalibration to avoid mismanagement of diabetic patients on hypoglycaemic drugs.

Impact of Community Pharmacy Diabetes Care Program on Knowledge and Glycemic Control: An Unexplored Opportunity for Community Pharmacists in Pakistan

Background: Effective management of diabetes mellitus depends on efficacy of therapy as well as patient adherence to medication therapy and non-pharmacological approaches. One of the most important tools to improve patient adherence is counseling. Community pharmacists can effectively contribute to patient care as they have the expertise and accessibility to do the task appropriately. Objective: The objective of the study was to evaluate the impact of pharmacist counseling on glucose control and medication adherence of diabetic patients attending community pharmacies in Pakistan. Method: A randomized, controlled, single blinded, pre-post intervention study design was used. The respondents included patients diagnosed with both diabetes mellitus (Type I or II) visiting community pharmacies for purchasing their regular medicine. Simple random sampling technique by lottery method was used to select community pharmacies to be included in-group A (intervention n=4) and group B (control n=4). The total number of patients were 40 in each group while estimating a drop-out rate of 25%. Convenience sampling technique was used to select patients visiting community pharmacies. Patients in the intervention group received special counseling. Blood glucose was checked after every 15 days for a period of six months. Pre-validated tools such as diabetes knowledge questionnaire 24 and brief medication questionnaire were used. Data was cleaned, coded and analyzed in SPSS 21. Wilcoxon test (p≥0.05) was used to compare pre-post intervention knowledge regarding diabetes and. Mann-Whitney test (p≥0.05) was used to find differences among medication adherence among control and intervention groups as well as pre and post intervention. Results: The results of the present study showed that respondents having diabetes since the past 1-3 years had comparatively better knowledge scores (18.8, 3±2.04) after intervention. Mean knowledge scores regarding diabetes mellitus among intervention group at baseline was (16.02, ±2.93) which was improved after six months (19.97, ±2.66). Significant difference was observed (p≤0.05) in pre-post intervention knowledge regarding diabetes management. Knowledge of patients was improved regarding different aspects of diabetes management after counseling by community pharmacists. The fasting blood glucose improved at three months (9.32, ±1.92) and after six months (8.95, ±1.45) in intervention group. Conclusion: The results of the current study concluded that counseling by community pharmacist has a positive impact on blood glucose management among diabetic and patients. Educational programs should be initiated by community pharmacists as this can lead to improvement in glycemic control and enhance the image of pharmacist as a key health care member in management of chronic diseases.

A Systematic Review on Synthetic Drugs and Phytopharmaceuticals Used to Manage Diabetes.

Diabetes is a multifactorial disease and a major cause for many microvascular and macrovascular complications. The disease will ultimately lead to high rate mortality if it is not managed properly. Treatment of diabetes without any side effects has always remained a major challenge for health care practitioners. The current review discusses the various conventional drugs, herbal drugs, combination therapy and the use of nutraceuticals for the effective management of diabetes mellitus. The biotechnological aspects of various antidiabetic drugs are also discussed. Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was sorted in terms of various approaches that are used for the treatment of diabetes. More than 170 papers including both research and review articles, were included in this review in order to produce a comprehensive and easily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose, mechanism of action and possible side effects. The article also focuses on combination therapies containing synthetic as well as herbal drugs to treat the disease. The role of pre and probiotics in the management of diabetes is also highlighted. Oral antihyperglycemics which are used to treat diabetes can cause many adverse effects and if given in combination, can lead to drug-drug interactions. The combination of various phytochemicals with synthetic drugs can overcome the challenge faced by the synthetic drug treatment. Herbal and nutraceuticals therapy and the use of probiotics and prebiotics are a more holistic therapy due to their natural origin and traditional use.

Glucagon and Glucagon-like Peptide-1 Receptors: Promising Therapeutic Targets for an Effective Management of Diabetes Mellitus

G-protein-coupled receptors (GPCRs) are membrane-bound proteins, which are responsible for the detection of extracellular stimuli and the origination of intracellular responses. Both glucagon and glucagon-like peptide-1 (GLP-1) receptors belong to G protein-coupled receptor (GPCR) superfamily. Along with insulin, glucagon and GLP-1 are critical hormones for maintaining normal serum glucose within the human body. Glucagon generally plays its role in the liver through cyclic adenosine monophosphate (cAMP), where it compensates for the action of insulin. GLP-1 is secreted by the L-cells of the small intestine to stimulate insulin secretion and inhibit glucagon action. Despite extensive research efforts and the multiple approaches adopted, the glycemic control in the case of type-2 diabetes mellitus remains a major challenge. Therefore, a deep understanding of the structure-function relationship of these receptors will have great implications for future therapies in order to maintain a normal glucose level for an extended period of time. The antagonists of glucagon receptors that can effectively block the hepatic glucose production, as a result of glucagon action, are highly desirable for the tuning of the hyperglycemic state in type 2 diabetes mellitus. In the same manner, GLP-1R agonists act as important treatment modalities, thanks to their multiple anti-diabetic actions to attain normal glucose levels. In this review article, the structural diversity of glucagon and GLP-1 receptors along with their signaling pathways, site-directed mutations and significance in drug discovery against type-2 diabetes are illustrated. Moreover, the promising non-peptide antagonists of glucagon receptor and agonists of GLP-1 receptor, for the management of diabetes are presented with elaboration on the structure-activity relationship (SAR).

Blood glucose monitoring in diabetes: rationale and procedure.

Diabetes mellitus is a condition that results in elevated blood glucose levels. Continued elevation can contribute to progressive micro- and macrovascular complications, leading to renal, nerve and ocular damage, representing a significant contributor to patient morbidity and mortality. The measurement of blood glucose provides information on the effectiveness of blood glucose metabolism and guides interventions to achieve optimal glucose control within the body. All nurses should be familiar with the importance of blood glucose monitoring and the procedure to carry out testing safely and effectively. Appropriate and timely monitoring of blood glucose will allow for the successful management of blood glucose that is out of the target range. This will ensure ongoing patient safety during episodes of acute illness or effective management of diabetes mellitus in the longer term, minimising future diabetic-related health complications.

Use of nutrition therapy in the management of diabetes mellitus

Effective management of diabetes mellitus requires lifelong adherence to a plan that incorporates lifestyle changes, exercise and diet. Following a dietary plan is a fundamental component of diabetes management because this can regulate the body's supply of glucose and lipids, resulting in weight reduction, an improved response to pharmacotherapies, and optimal control of the patient's glycaemic status and lipid profile. This article examines the components of nutrition therapy recommended for people with diabetes. Initially, the patient's daily calorie requirements should be determined, and therapeutic objectives should be decided that take into account the individual's clinical profile and personal preferences. Subsequently, a dietary plan should be negotiated with the patient that considers the carbohydrate, protein, fat and fibre content of each food item.

Medicinal Plants

Introduction: In the recent decades, diabetes mellitus has emerged as a major health problem in the world and it is hampering the development economically and socially. Indeed, about 80% of the masses in the developing countries depend upon ancient systems of herbal formulations for their primary health concerns. Plants-based drugs and their constituents play a pivotal role in prevention and treatment of various diseases and are considered as rich resources that can be used in drug development and synthesis in future. The purpose of this systematic review is to analyze hypoglycemic properties of medicinal plants. Aim: The study is primarily focused to understand the historical and modern documentation related to treatment of diabetes and also to create the attention of pharmacologists, botanists, and phytochemists for further scientific research in the field. Results: This present review mainly focuses on 50 medicinal plants with hypoglycemic properties. Various research papers and studies have been reviewed on the role of diverse active chemical biomolecules associated with antidiabetic properties. Conclusion: Since time immemorial, plants have been the potential source of medicine and therefore the novel form of healthcare known. The hypoglycemic properties of medicinal plants verified by several researchers have confirmed the effective management of diabetes mellitus. This study concluded that the profiles of plant species were generally used for treatment of disease and having antidiabetic properties can be an effective source for the development of safer oral hypoglycemic agents.

Decision-making experiences of patients with end-stage kidney disease (ESKD) regarding treatment in Ghana: a qualitative study

BackgroundThis is the first qualitative study to explore patient decision-making regarding end-stage kidney disease (ESKD) treatment in sub-Saharan Africa. The study addresses an important gap in the literature concerning choice and decision-making in an international context.MethodsThe study employed a qualitative research design, using grounded theory methodology. In-depth interviews were conducted with twenty-two adult patients with ESKD in 3 clinical settings in Ghana. Data analysis involved coding and a constant comparative approach to generate key themes. Ethical approval was gained from relevant ethics committees both in Ghana and the United Kingdom.ResultsFour main factors (personal, financial, healthcare system, and support network) were identified to influence patient decision-making regarding ESKD treatment in Ghana. Treatment was initiated for various reasons, including, initially, the urgent need to avoid premature death. Many approached their condition hoping for a cure and did not always understand the chronic nature of their condition. Financial and geographical inaccessibility of renal replacement therapy (RRT), as well as a relative lack of biomedical treatment choices, made decision making daunting for the individual with ESKD in Ghana. The subject of death or conservative management was not openly discussed. Rather patients did everything possible to seek alternative forms of treatment, including the simultaneous use of other non-RRT and traditional or faith-based healing approaches.ConclusionsWhilst similarities exist, this study illuminates stark cultural and contextual differences which make decision-making on ESKD treatment a daunting experience for the individual with ESKD in Ghana - as compared to those in high-income countries. The challenges associated with ESKD management in Ghana calls for meticulous efforts at primary prevention of the disease, including interventions directed at effective management of diabetes mellitus, hypertension and other chronic kidney disease (CKD) precursor conditions. Enhancing information provision would promote informed decision making, particularly within the initial stages of patient decision-making.

GASTRO-FLOATING TABLETS OF REPAGLINIDE: PREPARATION AND IN VIVO EVALUATION

Objective: Current research concerns the expansion of repaglinide matrix floating tablets, which are designed to prolong the gastric residence time, increase the drug bioavailability, and diminish the side effects.Methods: Different formulations of repaglinide floating tablets were prepared with different grades of hydroxypropyl methylcellulose (HPMC) and other agents. Evaluation parameters and in vivo bioavailability studies were conducted in the suitable model.Results: Among all the formulations, F21 containing HPMC K1500 PH PRM, Polyox WSR 303, and sodium bicarbonate, as gas generating agent was selected as optimized formulation based on physicochemical properties, floating lag time (36 s), and total floating time (&gt;24 h). From in vitro dissolution studies, the optimized formulation F21 showed drug release of 98.92±5.19% within 24 h whereas 95.09±5.01% of the drug was released from the marketed product within 1 h.Conclusion: From in vitro and in vivo bioavailability studies repaglinide floating tablets expected to give a new choice for safe, economical, and increased bioavailability for effective management of diabetes mellitus.