Management Of Diabetes Mellitus Research Articles

Resource constraints, patient emotions, and therapy: experiences of healthcare providers in the screening and management of gestational diabetes mellitus in northern Ghana

Abstract Background Studies on healthcare providers’ experiences in screening and managing Gestational Diabetes Mellitus (GDM) are rare in northern Ghana. Understanding the experiences of healthcare providers in the screening and management of GDM has the potential to identify best practices to improve GDM care. Hence, this study sought to explore the experiences of healthcare providers in screening and managing GDM. Materials and methods This was a qualitative study of five key informants involved in the screening and management of GDM, specifically an obstetrician, a dietician/nutritionist, a nurse, and two midwives in the northern region of Ghana. Face-to-face interviews were conducted with the aid of an interview guide, and the data were analysed via thematic analysis. We ensured trustworthiness through reflexivity, member checking, peer-debriefing, providing rich text, and keeping an audit trail. Results Two main themes and six subthemes were generated. The first theme was resource-centred experiences, which explored events at the Antenatal Care (ANC) and the challenges in GDM screening and management, with subthemes namely: ANC setups, inadequate resources, and non-compliance. The second theme was care-centred experiences, which explored patient emotions during GDM care, and the care they receive post-GDM diagnosis, with subthemes namely: raw emotions, non-pharmacological therapy, and pharmacotherapy. Conclusion Findings suggest the need for health system strengthening through the training and recruitment of dedicated skilled personnel, as well as government intervention through policy revision to cover the cost of GDM diagnostic tests. Healthcare providers should also consider the psycho-emotional impact of diagnosis when managing GDM. The findings could be relevant for health policy, planning, advocacy, and social and behaviour change communication aimed at effective screening and management of GDM.

Blue applicability grade index assessment and response surface modelling to synchronous determination of metformin hydrochloride, vildagliptin and dapagliflozin propanediol monohydrate by HPTLC method

Diabetes mellitus is major chronic disease found in human due to stressful lifestyle and bad food habit. Recently, the Central Drugs Standard Control Organization of India has approved combination of metformin hydrochloride, vildagliptin and dapagliflozin propanediol monohydrate for the management of diabetes mellitus. Numerous chromatographic methods have been published in the literature for estimation of these anti-diabetic drugs on individual basis and their combinations. But these chromatographic analyses promoted usage of toxic organic solvents which are harmful to the environment and aquatic animal lives. In addition, no chromatographic method was found in the literature for simultaneous estimation of these anti-diabetic drugs using green solvents. In recent days, white analytical chemistry approach has been introduced in the literature for development and assessment of green, accurate, precise, cost-effective and user-friendly chromatographic methods. Hence, white analytical chemistry-driven risk-based HPTLC method was developed for synchronous estimation of these anti-diabetic drugs using green solvents and response surface modelling. The analytical quality risk assessment was applied for identification of critical method variables and response variables using risk priority number ranking and filtering method. The critical method variables were linked with critical response variables using response surface modelling by Box–Behnken design. The analytical design space was navigated control strategy was framed for robust densitometric estimation of anti-diabetic drugs. The chromatographic method was validated as per ICH Q2 (R2) guideline. The developed method was applied for synchronous assay of multiple combinations of metformin, vildagliptin and dapagliflozin using single chromatographic condition to save time, cost and resources for analysis. The assay results of these anti-diabetic drug combinations were found to be complied with the respective labelled claim of the drugs. The developed and published chromatographic methods were assessed for their redness, greenness, blueness and whiteness profiles using green analytical metrics and RGB model scoring system. The proposed method was found to be green, cost-effective, robust and user-friendly for synchronous estimation of metformin, vildagliptin and dapagliflozin.

Prescription pattern, glycemic control status, and predictors of poor glycemic control among diabetic patients with comorbid chronic kidney disease in Ethiopia: a facility-based cross-sectional study

BackgroundAchieving optimal glycemic control is vital for managing diabetes mellitus and preventing its complications, yet it is particularly challenging for individuals with diabetes and concurrent chronic kidney disease. Chronic kidney disease disrupts glucose metabolism and excretion, leading to pronounced and variable blood glucose fluctuations, thereby complicating diabetes management. So far, the intricate impact of chronic kidney disease on the glycemic control status of diabetic patients remains obscure, especially in Sub-Saharan Africa where both diseases pose an escalating burden.ObjectiveThis study aimed to assess prescription patterns, glycemic control status, and the contributing factors to poor glycemic control among diabetic patients with comorbid chronic kidney disease at Tikur Anbessa Specialized Hospital, Ethiopia.MethodsA facility-based cross-sectional study was conducted from March 15 to May 15, 2024, from the electronic medical records of diabetic patients with comorbid chronic kidney disease who had received regular treatment and follow-up at the adult diabetes mellitus clinic of Tikur Anbessa Specialized Hospital. The sample size was calculated by using a single population proportion formula and accordingly, a total of 384 patients were recruited randomly and enrolled in this study. Descriptive statistics was employed for analyzing quantitative variables. Logistic regression analysis was performed to identify predictors of poor glycemic control status. Statistical significance was established at p-value < 0.05.ResultsThis study found that 98.2% of patients had type 2 diabetes, with a mean diabetes duration of 16.36 years. Only 4.4% achieved good glycemic control (glycated hemoglobin [HbA1c] < 7%), while 95.6% had poor glycemic control (HbA1c ≥ 7%). Insulin, metformin, and sodium glucose cotransporter-2 (SGLT-2) inhibitors were the most frequently prescribed anti-diabetic drug classes which accounted for 80.2%, 59.1%, and 41.4%, respectively. Presence of hypertension (AOR: 3.70, 95% CI: 1.08–12.71, P = 0.038) and regimen change in the past 01year (AOR: 0.34, 95% CI: 0.11–1.01, P = 0.050) were predictors of poor glycemic control status.ConclusionThis study reveals significant challenges in glycemic control among diabetic patients with comorbid chronic kidney disease (CKD). With only 4.4% of participants achieving optimal HbA1c levels, the findings underscore a critical public health concern regarding the management of diabetes in this vulnerable population.Clinical trial numberNot applicable.

A Comprehensive Review on GLP-1 Signaling Pathways in the Management of Diabetes Mellitus - Focus on the Potential Role of GLP-1 Receptors Agonists and Selenium among Various Organ Systems.

Diabetes Mellitus develops when the body becomes unable to fuel its cells with glucose, which results in the accumulation of sugar excess in the bloodstream. Because it has diverse pathophysiological impacts on the body, diabetes mellitus represents a significant issue of concern in an attempt to find suitable treatment modalities and medications for afflicted diabetic patients. Glucagon-like peptide 1 (GLP-1) plays a pivotal role in the incretin effect, emerging as a prospective treatment for diabetes mellitus and a promising means of regenerating pancreatic cells, whether directly or through its receptor agonists. It has been shown that GLP-1 efficiently increases insulin production, lowers blood sugar levels in patients with type 2 diabetes mellitus, and decreases appetite, craving, and hunger, therefore amplifying the sensation of fullness and satiety. Moreover, since they are all dependent on GLP-1 effect, intricate signaling pathways share some similarities during specific phases, although the pathways continue to exhibit significant divergence engendered by specific reactions and effects in each organ, which encompasses the rationale behind observed differences. This triggers an expanding range of GLP-1 R agonists, creating new unforeseen research and therapeutic application prospects. This review aims to explain the incretin effect, discuss how GLP-1 regulates blood glucose levels, and how it affects different body organs, as well as how it transmits signals, before introducing selenium's role in the incretin impact.

Moringa oleifera in a modern time: A comprehensive review of its nutritional and bioactive composition as a natural solution for managing diabetes mellitus by reducing oxidative stress and inflammation.

Globally, diabetes mellitus (DM) and its complications are considered among the most significant public health problems. According to numerous scientific studies, Plants and their bioactive compounds may reduce inflammation and oxidative stress (OS), leading to a reduction in the progression of DM. Moringa oleifera (MO), widely used in Ayurvedic and Unani medicine for centuries because of its health-promoting characteristics, particularly its ability to control DM and its related complications. MO is a multi-purpose plant that has an impressive range of nutritional components including proteins, amino acids (Essential and non-essential amino acids), carbs, fats, fiber, vitamins, and phenolic compounds. In the modern era, scientists have paid close attention to the anti-diabetic, anti-oxidative and anti-inflammatory attributes and other medicinal properties, of MO leaves and seeds. MO leaves and seeds have modulatory effects on DM that are likely influenced by multiple mechanisms. Some of these mechanisms include direct effects, but other mechanisms involve inhibition the production of inflammatory markers, modulation of the gut microbiome, reduction of OS, enhancement of glucose metabolism through hexokinase and glucose 6-phosphate dehydrogenase, improve insulin sensitivity and glucose uptake in the liver and muscles. Overall, these findings suggest that MO may play a role in lowering the risk of DM and its related outcomes. The purpose of this review is to provide a comprehensive overview of the nutritional and bioactive profiles of MO leaves and seeds, as well as to investigate their possible anti-diabetic effects by modulating oxidative stress and inflammation. Our results indicate that MO may be a beneficial natural resource for management of DM and related issues by lowering oxidative stress and inflammation. Furthermore, studies on MO has yielded promising findings in diabetic animal models, indicating antioxidant and anti-inflammatory properties. However, human trials have shown less solid results, most likely due to a lack of studies, different techniques, and dosages. More clinical research is needed to fully understand MO's anti-diabetic potential, notably in lowering oxidative stress and inflammation, both of which are critical in controlling diabetes complications.

Out-of-pocket Expenditure on Treatment of Diabetes Mellitus and its Complications among Residents of Slum Areas of Agra City—A Community-based Study

Abstract India ranks second in the world after China with 74.2 million living with diabetes currently and is projected to see 124.9 million living with diabetes by 2045. Diabetics need extensive self-management support, medications, regular screening for management of complications and comorbidities, which can increase out-of-pocket (OOP) expenditure for patients and their families. The aim of this article is to estimate the OOP expenditure for the management of diabetes mellitus and its complications among residents of slum areas of Agra city and to find out the association of OOP expenditure with sociodemographic and diabetic profile and compliance to treatment among the study participants. A cross-sectional study through face-to-face interviews using predesigned, pretested, and semistructured questionnaires were conducted from October 2020 to September 2022. A sample of 360 known diabetics was included. Statistical analysis was done using IBM SPSS version 24 and descriptive statistics were reported wherever applicable. Male, female ratio was 3:2, 66% of participants were between 35 and 60 years, 28% were illiterates, 54% were unemployed and 44% were from upper lower socioeconomic class. Nearly 96% were type 2 diabetics and 74% were on oral hypoglycemic agents. Monthly median direct and indirect OOP expenses were INR 1,500 and INR 505, respectively. OOP expenses were borne by 98% of the study participants.

A systematic review of plant-based therapy for the management of diabetes mellitus in the East Africa community

A systematic review of plant-based therapy for the management of diabetes mellitus in the East Africa community

Using Pharmacoepidemiology to Examine the Interplay of Sulfonylureas and Infection Risk in Patients With Diabetes Mellitus.

Sulfonylureas (SU) are commonly prescribed as oral hypoglycemic agents for the management of diabetes mellitus (DM). We postulated that SU possess antimicrobial properties due to their structural resemblance to the antimicrobial agent sulfamethoxazole. Using data from Taiwan's National Health Insurance Research Database, we enrolled patients diagnosed with DM between 2000 and 2013 and followed them for a three-year period. Patients who consistently used SU were categorized into the SU cohort, while those who had never used SU formed the non-sulfonylurea (non-SU) cohort. The primary study endpoints were diagnoses of pneumonia and urinary tract infections (UTIs). Within the database, we identified a total of 15,458,554 patients with DM, with 754,601 (4.88%) in the SU cohort and 2,244,436 (14.52%) in the non-SU cohort. After individual matching based on age, gender, index day, and propensity score of comorbidities, we included 663,056 patients in each cohort. The cumulative incidence of pneumonia and UTI was 29,239 (4.41%) and 60,733 (9.16%) in the SU cohort, respectively, and 24,599 (3.71%) and 56,554 (8.53%) in the non-SU cohort, respectively. Our findings indicated that the use of SU increased the risk of pneumonia (1.26-1.60 times) and UTI (1.13-1.22 times), while also potentially offsetting the protective effects of metformin. This pharmacoepidemiological study represents a concerted effort to assess latent drug properties that may have a significant impact on the clinical management of patients with DM.

O-12 A CASE OF DIABETES ASSOCIATED WITH A DE NOVO PAX4 MUTATION AND CONCURRENT SMAD6 GENE MUTATION

Abstract Introduction Monogenic diabetes constitutes approximately 1-5 % of all diabetes cases. While there is substantial information available about the more common MODY subtypes, the rarer subtypes remain much less understood. In this report, we present a rare case of diabetes with no family history, characterized by a pathogenic mutation in the PAX4 gene, which has been previously linked to MODY 9, along with a concurrent SMAD6 mutation. Clinical Case A 24-year-old male patient presented to our clinic for the management of diabetes mellitus. He was initially diagnosed with diabetes at the age of 17 and was initially managed with metformin alone. However, due to inadequate blood sugar control, basal insulin was later added to his treatment regimen. At his most recent visit, his treatment included a combination of sitagliptin+metformin (50/1000 mg, BID) and insulin glargine (16 units per day). His medical history revealed a childhood operation for congenital heart disease. Physical examination revealed nasal speech, a syndromic facial appearance (with downward-pointing ears and a flattened nasal root), and a limitation of internal rotation in the forearms. His BMI was 27.8 kg/m², and he had maintained a stable weight since the time of diagnosis. Laboratory evaluations revealed that anti-GAD was negative, with a C-peptide level of 0.6 ng/mL, HbA1c of 10.1%, and fasting blood glucose of 118 mg/dL. Kidney function tests and liver enzyme tests were within normal limits. Since diagnosis, HbA1c values have generally not been within the target range, fluctuating widely between 6.6% and 14%. The patient exhibited no microalbuminuria, no neuropathic findings, and no signs of retinopathy. Additionally, there was no family history of diabetes. Given the patient’s atypical diabetes history and syndromic findings, genetic analysis was undertaken. Whole exome sequencing, performed using next-generation sequencing, identified a PAX4 (c.1013C&amp;gt;T) mutation, which is potentially pathogenic (Figure 1 and Figure 2) and a homozygous pathogenic mutation in the SMAD6 gene. The patient’s diabetes history was attributed to the PAX4 gene mutation, which has been previously associated with MODY9, while the cardiac and extremity abnormalities were believed to be linked to the SMAD6 gene mutation. The 3D structures of the wild-type and mutant protein for PAX4 variant was predicted (Figure 2). Conclusion Diabetes cases resulting from PAX4 gene mutations are quite rare and often involve a form of diabetes that requires insulin. While most cases reported in the literature include a family history, there are instances, such as in our case, where a de novo mutation is identified. The presence of the SMAD6 gene mutation has contributed to the additional syndromic findings. Increasing the reporting of monogenic forms of diabetes, will enhance the recognition of diabetes-related genes and contribute to advances in understanding its etiopathogenesis.Figure 1-a:Visualization of the PAX4 c.1013C&amp;gt;T;p.A338V variant region using VarSome Figure 1-b:3D structures of PAX4 created using Swiss-Model and visualized with Chimera. A) Presents the mutated protein (Purple) superimposed on the WT protein (Pink). (B) The amino acid substitution is shown, with the wild-type amino acid in pink and the mutant amino acid in purple

Short-term outcome of metabolic surgery versus intensive medical therapy among obese type 2 diabetics: a quasi-experimental study

Objective: To compare the short-term outcomes of metabolic surgery and intensive medical therapy in the management of diabetes mellitus among obese persons with type 2 diabetes mellitus. Methods: The quasi-experimental study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from March 2018 to February 2019, and comprised obese type 2 diabetes mellitus patients of either gender aged 20-65 years. Those undergoing metabolic and bariatric surgery were assigned group A, while those undergoing intensive medical therapy formed control group B. All patients were followed up for 6 months to monitor their metabolic profile, including body mass index, glycosylated haemoglobin and fasting plasma glucose. Data was analysed using SPSS 20. Results: Of the 72 patients, 36(50%) were in group A; 23(63.9%) females and 13(36.1%) males with mean age 41.2 years (SD± 10.2). The remaining 36(50%) patients were in group B; 22(61.1%) males and 14(38.9%) females with mean age 42.5 years (SD ± 10.6) (p&gt;0.05). At 6 months, mean body mass index, glycosylated haemoglobin and fasting plasma glucose values were significantly lower in group A compared to group B (p&lt;0.001). There were 33(91.7%) patients in group A with remission of diabetes compared to 1(2.8%) patient in group B (p&lt;0.001). Conclusion: Bariatric surgery was found to produce a good early outcome in the management of diabetes in the obese population, leading to remission post-surgery. Key Words: Bariatric surgery, Metabolic surgery, Obese T2DM, Diabetes remission, Diabetes.

Allodynia (skin tenderness) associated with semaglutide: A case series.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications are widely prescribed for management of diabetes mellitus as well as obesity or weight management. Although there have been rare reports of skin hypersensitivity associated with GLP-1RA medications, no published reports have documented allodynia or skin pain to the touch. We report 4 cases of allodynia associated with dose escalation of the GLP-1RA medication semaglutide. Each patient was prescribed semaglutide for management of obesity and developed symptoms of allodynia with the 2.4-mg subcutaneous once-weekly dose. Therapy was stopped in 2 patients, both of whom had resolution of symptoms. Two patients opted to continue semaglutide despite the adverse effect, with one experiencing resolution after 4 months. No pharmacological mechanism was identified for this unique adverse drug reaction. There was a clear temporal and dose-response relationship in each of the 4 cases. The 4 cases presented had scores of 5 or 6 (probable) on the Naranjo scale. It is not known whether this is a class effect of the GLP-1RA medications or if the adverse effect will consistently resolve or improve with continuation.

Sodium Alginate Beads Containing Epalrestat for Effective Management of Diabetic Mellitus

Sodium Alginate Beads Containing Epalrestat for Effective Management of Diabetic Mellitus

Therapeutic Potential of GLP-1 Receptor Agonists in Diabetes and Cardiovascular Disease: Mechanisms and Clinical Implications.

Glucagon-like peptide-1 (GLP-1) is a crucial incretin hormone secreted by intestinal endocrine L cells. Given its pivotal physiological role, researchers have developed GLP-1 receptor agonists (GLP-1 RAs) through structural modifications. These analogues display pharmacological effects similar to those of GLP-1 but with augmented stability and are regarded as an effective means of regulating blood glucose levels in clinical practice. This review aims to comprehensively summarize the role of GLP-1 RAs in the management of diabetes mellitus (DM) and cardiovascular disease (CVD), with a particular emphasis on the underlying signal transduction pathways and their therapeutic potential. A comprehensive review was carried out through literature research. In pancreatic β-cells, GLP-1 RAs regulate the secretion of insulin and glucagon in a glucosedependent manner by influencing signaling pathways such as cAMP, PI3K, and MAPK. They also contribute to the regulation of blood glucose levels by promoting the proliferation of β-cells and inhibiting apoptosis in these cells. Recent comprehensive studies have also demonstrated the favorable impact of GLP-1 RAs on cardiovascular wellbeing. In addition to the cardiovascular protection afforded by glucose metabolism regulation, a large body of evidence from animal and cellular studies has corroborated the beneficial effects of GLP-1 RAs on conditions such as heart failure (HF), hypertension, and ischemic cardiomyopathy. These benefits are mainly attributed to the alleviation of inflammatory responses, reduction of oxidative stress, and prevention of cell apoptosis. Clinical data shows that GLP-1 RAs can reduce the risk of major adverse cardiovascular events (MACE) in diabetic patients. GLP-1 RAs play an important role in the management of both diabetes and cardiovascular diseases. They show potential therapeutic value through the modulation of multiple signal transduction pathways. However, there may still be some issues in practical applications that require further research and resolution.

Penyegaran Kader ‘Aisyiyah tentang Diabetes Mellitus melalui Edukasi Kesehatan

Refreshing ‘Aisyiyah cadres about diabetes mellitus through health education is an important effort to improve cadres’ understanding in preventing and managing diabetes mellitus. The purpose of this community service is to provide refreshment to ‘Aisyiyah cadres through health education to improve knowledge about diabetes mellitus. In this activity, ‘Aisyiyah cadres are given the latest knowledge about risk factors, normal blood sugar values, symptoms, and control of diabetes, as well as preventive measures that can be implemented in daily life. Participants are evaluated by giving questions using a questionnaire during the pre and post tests. The results showed an increase in participant knowledge from 90.24% to 92.6% after health education was carried out. Through this activity, it is hoped that ‘Aisyiyah cadres can play an active role in preventing an increase in the incidence of diabetes mellitus in the community

In vivo antidiabetic and ex-vivo antioxidant activities of dichloromethane extract of Xerophyta spekei

BackgroundThe medicinal plant Xerophyta spekei is used among Embu and Mbeere communities to manage diabetes mellitus. However, its efficacy has never been evaluated in vivo. The purpose of this study was to investigate its quantitative phytochemical and antidiabetic potential. Extraction was done using Dichloromethane (DCM). Quantitative phytochemical analysis was conducted using GC-MS. To evaluate antidiabetic activity, groups of mice which included normal control, diabetic control, positive control, and extract-administered groups (50, 100, 150, and 200 mg/kg body weight) were used. Alloxan monohydrate was used to induce diabetes. Blood glucose of the mice was determined hourly for the first six hours, and once after 12 and 24 h on the first day. Thereafter, the blood glucose in mice was determined once a week for three weeks. During the experimental period of three weeks, body weights were determined. After 21 days, lipid profiles, kidney and liver function tests as well as ex vivo antioxidant assays were carried out.ResultsThe phytochemicals classes identified included flavonoids, phenolic compounds, phytosterols, terpenoids, fatty acids, tocopherols and alkaloids. Stigmasterol had the highest concentration (12.99 ± 2.56 mg/g). The extract decreased blood glucose dose-dependently, with 200 mg/kg bw dose resulting in the highest % mean change (40.10 ± 0.95). The extract gradually decreased blood glucose during 21 days of treatment. It attenuated loss of body weight and aberrant biochemical parameters including liver and renal function tests as well as lipid profiles in diabetic mice. Furthermore, it reduced levels of malondialdehyde and enhanced enzymatic antioxidant activities in diabetic mice.ConclusionsThe study confirms that DCM extract X. spekei contains phytochemicals with antioxidant and antidiabetic properties. The findings authenticate the folkloric use of X. spekei in managing diabetes mellitus. The medicinal plant also serves as a potential source for developing antidiabetic agents.

Risk of insulin initiation with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes mellitus: A real-world claims database study in Japan.

Insulin therapy is a cornerstone in type 2 diabetes mellitus (T2DM) management, but its use is associated with several barriers, including hypoglycaemia, fear of injections and high costs. We compared the risk of insulin initiation and other treatment intensification between patients with T2DM newly treated with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) versus those newly treated with a dipeptidyl peptidase-4 inhibitor (DPP4i). This Japanese retrospective cohort study was conducted between 1 January 2015 and 31 March 2023 using the JMDC Claims Database. Patients with T2DM newly treated with an SGLT2i or a DPP4i were matched 1:1 using propensity score (n = 18 488 each). Incidence rates (IR) of insulin initiation, other antidiabetic drugs (OAD) and antihypertensive drugs added onto baseline treatment were calculated for each treatment group. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using a Cox proportional hazards model. The IR of insulin initiation was 0.95 and 2.12 per 1000 person-years in the SGLT2i and DPP4i groups, respectively, with significantly lower risk in the SGLT2i group than in the DPP4i group (HR 0.46, 95% CI: 0.28-0.74, p = 0.001). The risks of OAD (HR 0.66, 95% CI: 0.64-0.69, p < 0.001) and antihypertensive drugs (HR 0.90, 95% CI: 0.85-0.95, p < 0.001) added onto baseline treatment were lower in the SGLT2i group than in the DPP4i group. The risk of insulin initiation was lower in patients with T2DM newly treated with an SGLT2i than in those newly treated with a DPP4i. SGLT2i may reduce or delay the need for insulin therapy.

The relationship between sexual health literacy and sexual function of women with diabetes mellitus: a cross-sectional study.

Sexual dysfunction (SD) is a complication of poorly managed diabetes mellitus (DM). To prevent SD, patients should develop sexual health literacy (SHL). This study investigated the relationship between SHL and SD in women with DM. This cross-sectional study was performed between 1 October 2023 and 1 June 2024. The sample comprised 400 participants. The inclusion criteria were (1) being 18-65years of age, (2) having been diagnosed with DM, and (3) having a sex partner. Data were collected using a personal information form, the Female Sexual Function Index (FSFI), and the Sexual Health Literacy Scale (SHLS). The data were analyzed using the Mann-Whitney test, Kruskal-Wallis H test, Spearman correlation coefficients, and binary logistic regression. Over half of the participants experienced SD (68,2%). Participants with higher education, those whose partners had higher education, those who did not have any chronic disease other than DM, and those who did not take hormone replacement therapy had a lower rate of SD (P < 0.05). Participants with higher income, those who used family planning, those with DM I, and non-menopausal participants had lower SD and higher SHL (P < 0.05). Insulin-only participants had higher SD and lower SHL than those who were on other types of medications (P < 0.05). There was a significant negative correlation between scale scores (FSFI and SHLS) and age (r = -0.388; P < 0.001 r = -0.326; P < 0.001, respectively), age of partner (r = -0.383; P < 0.001, r = -0.274; P < 0.001, respectively), duration of romantic relationship (r = -0.326; P < 0.001, r = -0.328; P < 0.001, respectively), number of children (r = -0.109; P < 0.001, r = -0.290; P < 0.001, respectively), and duration of DM (r = -0.254; P < 0.001, r = -0.125; P < 0.013, respectively). There was a significant positive correlation between scale scores (FSFI and SHLS) and number of sexual intercourse (r = 0,493; P < 0.001, r = 0.127; P < 0.011, respectively). A one-unit increase in DM duration resulted in a 3.7% increase in SD rate (OR = 1.037). A one-unit increase in the number of sexual intercourses reduced the SD rate by 35.5% (OR = 0.645). The data show that the prevalence of SD in diabetic women is directly affected by the number of sexual intercourses per week, menopausal status, and duration of DM. This is the first study to examine the relationship between SHL and SD in women with DM. Second, the results are sample-specific and cannot be generalized to all women with DM. Healthcare professionals should ensure that women with DM have high levels of SHL to prevent SD and improve their quality of sexual life.

Safety and efficacy of dapagliflozin versus empagliflozin as add-on therapy in type 2 diabetes mellitus management

Objectives: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are drugs used as the oral hypoglycaemic that have a significant effect in lowering blood glucose, glycated haemoglobin (HbA1c), weight and blood pressure in patients of type 2 diabetes mellitus (T2DM). SGLT-2 inhibitors, such as empagliflozin and dapagliflozin, are used in addition to diet and exercise to help persons with T2DM improve their glucose control. The drugs are combined with other antidiabetic medications or used as monotherapy. Materials and Methods: The aim of this study was to evaluate the efficacy and the safety of the drug dapagliflozin against empagliflozin in individuals with T2DM as an add-on treatment. The study is carried out in a Tertiary Care Hospital in Coimbatore using a prospective observational research design. T2DM patients with a HbA1c level of &gt;7% are included in the study. Patient information was collected by patient interviews and from the patient file. Participants in the study are categorised into two groups: one group consists of patients taking oral dapagliflozin in doses of 5 mg or 10 mg alongside other oral hypoglycemic agents (OHAs), while the other group comprises patients taking oral empagliflozin in doses of 10 mg or 20 mg alongside other OHAs. The endpoints were to assess the safety and effectiveness of each SGLT-2 inhibitor by monitoring changes in the diabetic profile, body weight, body mass index (BMI), blood pressure and cardiovascular risk. Results: The study included 100 patients, with 56 males and 44 females. Most participants were aged 51–60 years. In both treatment groups, A and B, significant reductions in body weight Group A: 3.14 kg and Group B: 2.29 kg and BMI Group A: 0.65 kg/m2 and Group B: 0.84 kg/m2 were observed after 6 months of treatment follow-up. Both groups experienced decreases in HbA1c levels from baseline to 6 months of treatment. The mean differences in HbA1c were 0.36% in Group A and 0.55% in Group B; empagliflozin led to a more significant reduction in HbA1c (0.19%) compared to dapagliflozin. Significant reductions were noted in fasting blood sugar (FBS) and postprandial blood sugar (PPBS) levels in both groups. Both dapagliflozin and empagliflozin were associated with reductions in systolic blood pressure (SBP) after 6 months of therapy. Dapagliflozin showed a greater reduction in SBP of 10.26 mmHg compared to 4.2 mmHg with empagliflozin. In addition, dapagliflozin increases diastolic blood pressure (DBP) by 2.25 mmHg, while empagliflozin reduces DBP by 3.61 mmHg. While both groups experienced reductions in SBP, only the group using empagliflozin showed a significant reduction in DBP. The Framingham risk score showed significant reductions in mean differences observed in both groups after 6 months of treatment, with a mean difference of 1.08% in Group A and 2.17% in Group B. However, the score is not statistically different between the groups. Both drugs exhibited equal effects on the prevention of cardiovascular risk. Both drugs exhibited a similar safety profile, with mild-to-moderate adverse events reported, including urinary tract infections (Group A: 18% and Group B: 12%) and hypoglycaemia (Group A: 24% and Group B: 20%) during the study period. Conclusion: SGLT-2 inhibitors dapagliflozin and empagliflozin have favourable efficacy and safety in the management of T2DM; both drugs show equal effects on HbA1c, FBS, PPBS, body weight and BMI. Empagliflozin led to a more significant reduction in HbA1c compared to dapagliflozin. In both hypertensive and non-hypertensive patients, dapagliflozin exhibited greater systolic blood pressure reduction compared to empagliflozin, whereas empagliflozin exhibited greater reduction in diastolic blood pressure compared to dapagliflozin; in contrast, dapagliflozin has shown to increase DBP. Further investigation is required to explore the blood pressure effects of SGLT-2 inhibitors in a large population. In addition, these drugs decreased cardiovascular risk. Both medications exhibited fewer instances of hypoglycaemic episodes and urinary tract infections.

Dual impact analysis of GSTT1 polymorphisms on the metformin response and cardiovascular risk: A novel integrated approach in type 2 diabetes mellitus management

Although genetic variations in glutathione S-transferase (GST) have been linked to type 2 diabetes mellitus (T2DM), the relationships among GSTT1 polymorphisms, metformin effectiveness, and cardiovascular risk remain unclear. This study investigated the association between the GSTT1 null genotype and the metformin monotherapy response while simultaneously assessing its impact on atherosclerotic cardiovascular disease risk. This case-control study examined 84 T2DM patients aged 30-70 years, categorized into metformin therapy responders and nonresponders. This study employed multiplex PCR for GSTT1 genotyping and utilized the pooled cohort equation for cardiovascular risk assessment, offering a comprehensive analysis of both genetic and clinical parameters. GSTT1 genetic variations were not significantly associated with metformin response (odds ratio [OR] 1.773, p=0.306) or cardiovascular risk (OR 1.086, 95% CI: 0.46-2.56, p=1.000). The analysis revealed distinct patterns in clinical parameters between the GSTT1 null and wild-type genotypes, particularly in terms of glycemic control indicators and lipid profiles, although these differences did not reach statistical significance. This study presents a novel approach by simultaneously examining both the therapeutic response and cardiovascular risk in relation to GSTT1 polymorphisms, distinguishing it from previous studies that typically focused on either aspect in isolation. These findings suggest that while genetic variations in GSTT1 may influence metabolic parameters, their direct impact on metformin effectiveness and cardiovascular risk may be more complex than previously thought.

Antidiabetic phytochemicals: an overview of medicinal plants and their bioactive compounds in diabetes mellitus treatment.

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia due to insufficient insulin secretion or action. Contributing factors include genetic predisposition, obesity, family history, inactivity, and environmental risks. Type 2 diabetes mellitus (T2DM), the most common form, involves impaired insulin secretion by pancreatic β-cells, leading to insulin resistance. By 2045, it is projected that India and China will have approximately 134.3 and 110.8 million diabetic individuals, respectively. Although synthetic drugs are effective in managing DM, they often come with side effects. Consequently, plant-based phytochemicals with antidiabetic properties are gaining attention. Research indicates that around 115 medicinal plants (MPs) have antidiabetic effects, particularly those from the Fabaceae, Liliaceae, and Lamiaceae families. Bioactive compounds like alkaloids, triterpenoids, flavonoids, and phenolics are known to combat DM. Traditional medicinal systems, particularly in developing countries, offer effective DM management. This review highlights the importance of MPs and their bioactive compounds in treating diabetes and underscores the need for further research to commercialize plant-based antidiabetic drugs.