Oral Hypoglycemic Drugs Research Articles

Percutaneous injection of autologous platelet gel accelerate healing in diabetic tibial non union: On going longitudinal study

IntroductionIn this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection. Material and methodsThis present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views. ResultsUnion was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003). ConclusionThis investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.

Efficacy and safety of switching from a dipeptidyl peptidase-4 inhibitor to oral semaglutide in Japanese patients with type 2 diabetes mellitus.

Dipeptidyl peptidase-4 inhibitors (DPP-4is) are the most widely used oral hypoglycemic drugs in Japan. However, once-daily oral semaglutide has been reported to reduce glycated hemoglobin (HbA1c) and body weight (BW) without causing significant hypoglycemia. Here, we aimed to evaluate the efficacy and safety of switching from a DPP-4i to oral semaglutide in Japanese patients with type 2 diabetes (T2D). We performed a single-center retrospective study of the changes in HbA1c and BW in 68 patients with T2D who were switched from a DPP-4i and took oral semaglutide for ≥ 6months, without changes in any other oral hypoglycemic agent. Mean HbA1c decreased from 7.8 to 7.0% (p < 0.001) and BW decreased from 74.2 to 71.2kg (p < 0.001) over 6months. The decrease in HbA1c was more pronounced in participants with high baseline HbA1c (r = - 0.542, p < 0.001). There was also a trend (r = 0.236, p = 0.052) toward a decrease in BW in individuals with shorter disease duration. There were reductions in either HbA1c or BW in 65 participants (95.6%). In addition, the larger the decrease in HbA1c was, the greater was the decrease in BW (r = 0.480, p < 0.001). Eighteen participants (20.1%)discontinued the drug within 6months, of whom 10 (11.6%of the total) did so because of suspected adverse effects and the discontinuation rate was the highest in older, non-obese patients. Switching from a DPP-4i to oral semaglutide may be useful for Japanese patients with T2D who have inadequate glycemic or BW control. However, its utility may be limited by gastrointestinal adverse effects in certain patients.

Opinion of medical and pharmaceutical professionals on the quality of pharmaceutical care for patients with diabetes mellitus in the Novosibirsk region: a comparative sociological study

Relevance. Patients with diabetes mellitus (DM) in the Russian Federation have the right to receive free medications. Despite this, some patients with DM experiencing difficulties at various stages of preferential treatment are forced to purchase medications at their own expense. Medical workers (MW) who receive patients and pharmaceutical workers (PW) of preferential dispensing points (PDP), who dispense drugs on preferential terms and provide pharmaceutical information (PI) to patients, are of considerable interest as competent sources of opinion about the quality of the organization of drug provision.Objective. To conduct a comparative sociological study of the organization of PDP for patients with DM in the Novosibirsk region (NSR) using the method of questioning MW and PW.Materials and methods. The materials used were the MW and PW questionnaires developed by the authors. During the study, the following methods were used: sociological survey (questioning), content analysis, comparative analysis, induction, and logical method.Results and discussion. 71% of MW must deal with various difficulties when issuing preferential prescriptions for drugs. These include: absence of drugs in the preferential list (29%), funding limit (29%), and absence of drugs in the PDP (35%). An average level of compliance in taking medications by patients with DM according to the MW was revealed, with a low interest in PI according to PDP workers. 45% of PW experience difficulties when conducting PI of patients with DM. The majority of PW (88%) consider the range of PDP in which they work to be rich in international nonproprietary names, trade names, and release forms of both oral hypoglycemic drugs and insulins.Conclusions. The results obtained allow us to conclude that the drug provision system for patients with DM in the NSR needs to be optimized. Based on the results of the survey, the main directions of optimization can be identified: increasing the availability of drugs in the PDP and increasing the competence of the PDP’s PW through the development of additional training materials and activities.

Sodium-glucose cotransporter 2 inhibitors attenuate vascular calcification by suppressing endoplasmic reticulum protein thioredoxin domain containing 5 dependent osteogenic reprogramming

AimsVascular calcification is strongly linked to the development of major adverse cardiovascular events, but effective treatments are lacking. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an emerging category of oral hypoglycemic drugs that have displayed marked effects on metabolic and cardiovascular diseases, including recently reported vascular medial calcification. However, the roles and underlying mechanisms of SGLT2 inhibitors in vascular calcification have not been fully elucidated. Thus, we aimed to further determine whether SGLT2 inhibitors protect against vascular calcification and to investigate the mechanisms involved. Methods and resultsA computed tomography angiography investigation of coronary arteries from 1554 patients with type 2 diabetes revealed that SGLT2 inhibitor use was correlated with a lower Agatston calcification score. In the vitamin D3 overdose, 5/6 nephrectomy chronic kidney disease-induced medial calcification and Western diet-induced atherosclerotic intimal calcification models, dapagliflozin (DAPA) substantially alleviated vascular calcification in the aorta. Furthermore, we showed that DAPA reduced vascular calcification via Runx2-dependent osteogenic transdifferentiation in vascular smooth muscle cells (VSMCs). Transcriptome profiling revealed that thioredoxin domain containing 5 (TXNDC5) was involved in the attenuation of vascular calcification by DAPA. Rescue experiments showed that DAPA-induced TXNDC5 downregulation in VSMCs blocked the protective effect on vascular calcification. Furthermore, TXNDC5 downregulation disrupted protein folding-dependent Runx2 stability and promoted subsequent proteasomal degradation. Moreover, DAPA downregulated TXNDC5 expression via amelioration of oxidative stress and ATF6-dependent endoplasmic reticulum stress. Consistently, the class effects of SGLT2 inhibitors on vascular calcification were validated with empagliflozin in intimal and medial calcification models. ConclusionsSGLT2 inhibitors ameliorate vascular calcification through blocking endoplasmic reticulum stress-dependent TXNDC5 upregulation and promoting subsequent Runx2 proteasomal degradation, suggesting that SGLT2 inhibitors are potentially beneficial for vascular calcification treatment and prevention.

Type 1 diabetes: Diagnosis rectified years after treatment with oral hypoglycemic drugs

Type 1 diabetes: Diagnosis rectified years after treatment with oral hypoglycemic drugs

DOCUMENTATION OF CASE REPORT ON CLINICAL SAFETY CONCERNS OF AYURVEDIC POLY HERBO-MINERAL DRUGS

Heavy metals in Ayurvedic formulations have been used for centuries with claimed efficacy and safety. In the past few decades, although Ayurveda has gained popularity in the health care system, it has also been under the scanner for its safety and quality aspects of specific formulations due to the toxicity involved, especially of Herbo-mineral preparations containing heavy metals and other elements which is often alarming. Here, we are reporting a case of a male patient aged 53 years who presented to our CARI OPD with a pre-diagnosed case of diabetes for eight years. He was on Allopathic oral hypoglycemic drugs, but due to poor glycemic control, he also opted for Ayurvedic treatment. He was treated with Nishamalaki, Chandraprabha vati, and Ashwagandha for seven months and Sutashekhara rasa for three months. As the patient was concerned about the toxic fate of the drug due to the prolonged use of both Allopathic and Ayurvedic medicines, he got lab investigations done for 22 toxic elements like Arsenic, Mercury and Lead to evaluate the toxicity of the drugs. The reports showed that all toxic elements, including safety profiles, were within the average value. The heavy metals used in the Ayurvedic formulations are not delivered in elemental form. The formulation's physicochemical state differs from that of the natural heavy metal form. Furthermore, they are subjected to samskara (processing), which contributes to the purification, detoxification, and restoration of their therapeutic properties, making them safe for consumption.

Antidiabetic and antihyperlipidemic effects of crude fractions from Chlorophytum borivilianum root methanolic extract on streptozotocin induced diabetic rats and phytochemical investigation by LCMS analysis.

To evaluate the in vitro and in vivo pharmacological efficacy of the plant Chlorophytum borivilianum in diabetes and hyperlipidemia and to confine and describe the synthetic constituents from the roots that are in charge of the action. The present study was carried out to investigate the ethno-medical use of Chlorophytum borivilianum root methanolic extract as a potential anti-diabetic and antihyperlipidemic agent in STZ-induced diabetic rats. Extract was tested for in vitro and in vivo biological activities. Soxhlet extraction was carried out using methanol as a solvent, and TLC and column chromatography were used for fractionation. Liquid Chromatography and Mass Spectroscopic study confirmed the structures of isolated compounds. Chlorophytum borivilianum root methanolic extract showed the presence of phytoconstituents as Dihydrocapsaicin, Reserpine, Deserpidine, Biliverdin-IX-α, and Cassiamin C having a therapeutic effect. Dihydrocapsaicin was identified at RT 7.572 and the Chlorophytum borivilianum root chloroform methanolic extract fraction noticeably depleted increased blood glucose levels and had positive effects on altered lipid profile after administering a dose of 150 mg/kg orally compared with oral hypoglycemic drug metformin. All the results are dose-dependent. Active chloroform-methanol fraction from methanol extract showed the presence of anti-diabetic compound, Dihydrocapsaicin. The chloroform-methanol fraction from the methanolic extract of Chlorophytum borivilianum root can inhibit the parameters linked to diabetes and hyperlipidemia.

Investigation of α-glucosidase and α-amylase inhibition for antidiabetic potential of agarwood (Aquilaria malaccensis) leaves extract

Diabetes mellitus is a metabolic disorder characterized by high blood sugar. The most common treatment is taking oral hypoglycemic drugs such as acarbose, but long-term use of acarbose has dangerous side effects. Thus, alternative therapies using herbal medicines are of interest to researchers. Aquilaria malaccensis leaves have been used as an herbal tea for their high antioxidant and antimicrobial activity. This research aimed to analyze the antidiabetic potential of A. malaccensis leaves extract in vitro and in silico. The research utilized a methodology that included the analysis of the inhibitory activity of α-amylase and α-glucosidase enzymes through spectrophotometry. Furthermore, the study examined the inhibition of glucose diffusion in the dialysis bag. Additionally, an in silico investigation on α-glucosidase inhibition was conducted, involving toxicity analysis of selected compounds, molecular docking, molecular dynamic simulation, and density functional theory. The results showed that chloroform extract of A. malaccensis leaves had the best result on each test parameter with an IC50 of 3.22 mg/mL for α-amylase inhibition and 3.65 mg/mL for α-glucosidase inhibition. The chloroform extract of A. malaccensis leaves is the best for inhibiting glucose diffusion in the first 30 min. All in silico models supported by density functional theory showed that some secondary metabolites of A. malaccensis leaves extract, such as 5-Hydroxy-4′,7-dimethoxyflavone and followed by epifriedelanol, are better than acarbose in terms of inhibiting α-glucosidase. Based on the results, agarwood's extract demonstrates anti-diabetic potential through the inhibition of α-amylase and exhibits a slightly superior efficacy in inhibiting α-glucosidase activity. This observation is substantiated by both in-laboratory and in-silico data.

Linagliptin decreased the tumor progression on glioblastoma model

PurposeDipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic drugs and are used for type II diabetes. Previous studies showed that DPP-4 expression is observed in several tumor types and DPP-4 inhibitors suppress the tumor progression on murine tumor models. In this study, we evaluated the role of DPP-4 and the antitumor effect of a DPP-4 inhibitor, linagliptin, on glioblastoma (GBM). MethodsWe analyzed DPP-4 expression in glioma patients by the public database. We also analyzed DPP-4 expression in GBM cells and the murine GBM model. Then, we evaluated the cell viability, cell proliferation, cell migration, and expression of some proteins on GBM cells with linagliptin. Furthermore, we evaluated the antitumor effect of linagliptin in the murine GBM model. ResultsThe upregulation of DPP-4 expression were observed in human GBM tissue and murine GBM model. In addition, DPP-4 expression levels were found to positively correlate with the grade of glioma patients. Linagliptin suppressed cell viability, cell proliferation, and cell migration in GBM cells. Linagliptin changed the expression of phosphorylated NF-kB, cell cycle, and cell adhesion-related proteins. Furthermore, oral administration of linagliptin decreases the tumor progression in the murine GBM model. ConclusionInhibition of DPP-4 by linagliptin showed the antitumor effect on GBM cells and the murine GBM model. The antitumor effects of linagliptin is suggested to be based on the changes in the expression of several proteins related to cell cycle and cell adhesion via the regulation of phosphorylated NF-kB. This study suggested that DPP-4 inhibitors could be a new therapeutic strategy for GBM.

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine.

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020. This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs. A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant. More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration. This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

Camel milk; A potent superfood for diabetes complications

Currently, camel milk has been considered around the world due to awareness of its unique health benefits. Camel milk is considered a superfood with special nutrients and therapeutic values. In diabetes or hyperglycemia, the cells may not respond properly to insulin or defects in insulin secretion by the pancreas, therefore glucose level of blood is excessive. Chronic hyperglycemia is associated with dysfunction in the eyes, heart, nerves, kidneys, liver, and blood vessels. Insulin and oral hypoglycemic drugs are used for diabetes, but a high percentage of patients cannot use allopathic drugs and rely on natural alternative healings. Furthermore, coagulation of oral insulin in an acidic environment neutralizes and decreases the efficacy of insulin. Camel milk contains insulin-like proteins and may be an effective alternative for insulin to treat type 1 and 2 and gestational diabetes. Camel milk may prepare about 60% of the insulin in diabetic patients and reduce blood sugar and required insulin doses of about 30% - 35% in type 1 diabetes patients. This milk is believed to be a suitable hypoglycemic agent in improving long-term glycemic control in experimental animals and diabetic patients, as well as improving diabetes risk factors such as liver and kidney failures and cardiovascular challenges. It appears that more scientific studies are needed to confirm the efficacy of processed camel milk on diabetes. This review represents scientific studies on how camel milk as a superfood can be effective in diabetes.

Diagnosis of artificial hypoglycemia due to oral hypoglycemic drugs by high-performance liquid chromatography with tandem mass spectrometric detection

BACKGROUND: Artificial hypoglycemia (ArH) is a decrease of blood glucose levels less than 3 mmol/l due to the deliberate use of hypoglycemic drugs by a patient outside of medical appointments. Timely diagnosis of this kind of hypoglycemia avoids unnecessary numerous examinations and hospitalizations. However, the detection of ArH still remains an extremely difficult task for both the healthcare facility and the attending physician. The foreign literature describes cases of successful detection of deliberate intake of oral hypoglycemic drugs (OHD) using high-performance liquid chromatography with tandem mass spectrometric detection (HPLC-MS/MS). Thus, it is relevant to develop and validate a method for determining OHD using HPLC-MS/MS.AIM: To optimize the diagnosis of ArH due to the use of OHD.MATERIALS AND METHODS: A total of 92 patients were examined. The development of the HPLC-MS/MS method for the detection of the studied OHD (sOHD; n=1-glibenclamide, n=1-gliquidone, n=1-gliclazide, n=1-glimepiride, n=1-glipizide, n=1-nateglinide and n=1-repaglinide) in the blood was carried out in a group of patients with diabetes mellitus type 2 (n=7) who received sOHD, and a group of conditionally healthy people who did not receive any medications (n= 7). To validate the method, the determination of sOHD substances was carried out on groups of patients with hyperinsulinemic nondiabetic hypoglycemia (NDH) of unknown origin (n=11) and with insulinoma (n=67).RESULTS: In the study of blood samples by HPLC-MS/MS in the group of patients with diabetes mellitus type 2, was confirmed in 100% of the cases the use of the drug that the patient received, in the group of conditionally healthy — sOHD were not detected. A false positive result was not obtained in any conditionally healthy and in any patient with insulinoma. ArH was diagnosed in 5 out of 11 patients in the group with hyperinsulinemic NDH of unknown origin, the method identified sOHD glibenclamide and gliclazide in the patients’ blood samples. In the remaining 6 patients of this group, examinations were continued and other causes of NDH were diagnosed. The sensitivity of the method was 100% [74%; 100%], specificity — 100% [95%; 100%].CONCLUSION: The HPLC-MS/MS method has high diagnostic accuracy in the detection and identification of sOHD (glibenclamide, gliquidone, gliclazide, glimepiride, glipizide, nateglinide and repaglinide) in blood samples of patients receiving these drugs. Currently, due to the low availability of the method, this study is advisable to use in patients with hyperinsulinemic hypoglycemia with negative results of first-line insulinoma imaging methods (computed tomography with contrast enhancement, ultrasound and magnetic resonance imaging of the abdominal cavity).

Knowledge, Attitude and Practice of Diabetic Patients About Symptoms of Hypoglycaemia in Atbara Teaching Hospital, December 2022 – October 2023

Introduction: Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia, which can increase the risk of micro and macro vascular complications. Hypoglycemia strongly associated with increase mortality in diabetic patients. The American Diabetes Association defines the hypoglycaemia as “any abnormally low plasma glucose concentration that exposes the subject to potential harm”, and proposes a threshold of &amp;lt;70 mg/dl. Prevention of hypoglycaemia can occur if much efforts spent in patient education regarding risk factors, food &amp; physical activity, warning signs, and treatment of hypoglycaemia at an early stage. Objective: To identify Knowledge, Attitude and Practice of Diabetic patients about symptoms of Hypoglycaemia at Atbara teaching hospital. Method: A descriptive cross-sectional hospital-based study done in Atbara teaching hospital, River Nile state, Sudan. From December 2022 – October 2023. The study population were all diabetic patients who presented to the hospital during the period of the study. Exclusion criteria was severely ill patient or those who refuse to participate in the study. With total coverage sample size was 200. The data was collected by interviewing the respondents through close ended questionnaire. The collected data was analyzed by using SPSS. Result: The male to female ratio equal one. With the predominant age between 20 to 35. Most of the participants HBA1c were between 7%-10%. The duration of diabetes was not exceeding 10 years in 44% of the participants. Majority were on oral hypoglycemic drugs with good adherence to it. Tremor is the most reported symptoms of hypoglycemia. With most of the participants deal with the symptoms by them self. Conclusion: Over all the participants show acceptable level of knowledge toward hypoglycemia. Expressed through that most of them deal with the symptoms immediately by them self. Attitude of the participant need to be more investigated in the future with further studies.

Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus.

In China, the prevalence of type 2 diabetes mellitus (T2DM) among diabetic patients is estimated to be between 90%-95%. Additionally, China is among the 22 countries burdened by a high number of tuberculosis cases, with approximately 4.5 million individuals affected by active tuberculosis. Notably, T2DM poses a significant risk factor for the development of tuberculosis, as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis (T2DM-PTB), which has risen from 19.3% to 24.1%. It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature. To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis (T2DM-PTB), as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM. T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group, Simple DM patients presenting to our hospital in the same period were the control group, Controls and case groups were matched 1:2 according to the principle of the same sex, age difference ( ± 3) years and disease duration difference ( ± 5) years, patients were investigated for general demographic characteristics, diabetes-related characteristics, body immune status, lifestyle and behavioral habits, univariate and multivariate analysis of the data using conditional logistic regression, calculate the odds ratio (OR) values and 95%CI of OR values. A total of 315 study subjects were included in this study, including 105 subjects in the observation group and 210 subjects in the control group. Comparison of the results of both anthropometric and biochemical measures showed that the constitution index, systolic blood pressure, diastolic blood pressure and lymphocyte count were significantly lower in the case group, while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group. The results of univariate analysis showed that poor glucose control, hypoproteinemia, lymphopenia, TB contact history, high infection, smoking and alcohol consumption were positively associated with PTB in T2DM patients; married, history of hypertension, treatment of oral hypoglycemic drugs plus insulin, overweight, obesity and regular exercise were negatively associated with PTB in T2DM patients. Results of multivariate stepwise regression analysis found lymphopenia (OR = 17.75, 95%CI: 3.40-92.74), smoking (OR = 12.25, 95%CI: 2.53-59.37), history of TB contact (OR = 6.56, 95%CI: 1.23-35.03) and poor glycemic control (OR = 3.37, 95%CI: 1.11-10.25) was associated with an increased risk of developing PTB in patients with T2DM, While being overweight (OR = 0.23, 95%CI: 0.08-0.72) and obesity (OR = 0.11, 95%CI: 0.02-0.72) was associated with a reduced risk of developing PTB in patients with T2DM. T2DM-PTB patients are prone to worse glycemic control, higher infection frequency, and a higher proportion of people smoking, drinking alcohol, and lack of exercise. Lymphopenia, smoking, history of TB exposure, poor glycemic control were independent risk factors for T2DM-PTB, and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

A STUDY OF COST VARIATION ANALYSIS OF ORAL HYPOGLYCEMIC DRUGS AVAILABLE IN INDIAN PHARMACEUTICAL MARKET

Objectives: A large number of oral hypoglycemic drugs as single or fixed dose combinations are available for the treatment of diabetes mellitus which has a wide range of price variation and becomes a constraint in the treatment for both physician and patient. However, very few studies have been done to reveal such price variations. The objective of this study was to find out the cost variation among the different brands of various classes of oral hypoglycemic drugs in similar strength and dosage forms of single therapy and fixed-dose combinations. Methods: Cost of a particular drug being manufactured by different companies in the same strength, number, and dosage form was compared from the Current Index of Medical Specialties (CIMS) (January 2022–April 2022) and Indian Drug review 2022. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and the percentage variation in price was calculated. Results: Among single drug therapy, Glimepiride (1 mg) shows a maximum percentage variation in price of 3450%. Among Sulfonylureas-glimepiride (1 mg) shows a maximum price variation of 3450%, in Biguanides–metformin (500 mg), in Thiazolidinediones – Pioglitazone (15 mg) shows a maximum price variation of 900%, and 300%, respectively, and among the glucosidase inhibitors, Voglibose (0.3 mg) shows maximum price variation of 571.2%. Among combination formulation, glimepiride (1 mg) + metformin SR (500 mg) shows a maximum percentage of price variation of 262.1%. Conclusion: It is observed from our results that there is a wide variation in prices of drugs manufactured by different pharmaceutical companies. Hence, it is very necessary for regulatory authorities to regulate the wide variation in drug prices to maximize the benefits of the treatment. It is recommended that the appraisal and management of marketing drugs should be well-regulated.

GAMBARAN FUNGSI GINJAL PASIEN DIABETES MELITUS TIPE II DI PUSKESMAS TLOGOSARI KULON KOTA SEMARANG

Type II Diabetes Mellitus (DMTII) patients who are not treated properly can experience decreased renal function. The use of oral hypoglycemic drugs (OHG) can cause a decrease in renal function. Glomerular Filtration Rate (GFR) can describe a decrease in renal function. The aim of this study was to determine the description of renal function in DMTII patients at the Tlogosari Kulon Health Center, Semarang City. This research is a descriptive observational study. The sampling technique used was purposive sampling. Data was obtained from medical records of DMTII patients for the period September–December 2022. The inclusion criteria were patients with DMTII who received OHG therapy for at least one year, aged ≥45 years, had the most recent serum creatinine examination, with or without comorbidities. If the patient's data is incomplete or the patient has a history of renal problems, they will be excluded. Based on the research results, it was discovered that there were 55 DMTII patients, consisting of 39 patients (70.90%) women and 16 patients (29.10%) men. A total of 29 patients were aged between 60-69 years (52.73%). A total of 39 patients had comorbidities such as hypertension and/or dyslipidemia. A total of 76.36% received OHG combination therapy. Forty percent of patients experienced a decrease in GFR from mild-moderate to severe. The decrease in GFR is caused by the amount of OHG consumed and comorbid hypertension

Brisk Walking Untuk Menurunkan Kadar Glukosa Darah Pada Pasien Diabetes Mellitus Tipe 2: A Literature Review

Background: One of the non-communicable diseases (NCDs) that has received a lot of attention is Diabetes Mellitus. Diabetes management is divided into two ways. The first way is with non-drug therapy (non-pharmacological) and second with drug therapy. Drug therapy in the form of oral hypoglycemic drugs or insulin. Non-pharmacological methods with food planning and physical exercise. The type of light physical exercise recommended for patients with type II diabetes mellitus is walking and brisk walking. Objective: To determine the effect of brisk walking to reduce blood glucose levels in patients with type 2 diabetes mellitus. Methods: This review uses the literature review method. Searches were conducted in PubMed, Garuda, and Google Scholar. The search strategy used keywords with "brisk walking", "physical exercise", "glycemic control", "diabetes mellitus, type II",. Results: Seven articles were reviewed in this literature review. Six articles discussed brisk walking, one article discussed the difference in glycemic control in low - high intensity interval training with endurance training. The overall results of this review show that doing physical activity brisk walking has an effect in reducing blood glucose levels, reducing blood glucose levels by 49.75 mg/dL. Physical activity sessions can be done for 3 - 7 sessions per week with a duration of 15 - 60 minutes. Conclusion: The effect of brisk walking is proven to reduce blood glucose levels in patients with type 2 diabetes mellitus.

P-21 Maturity onset diabetes of the young 7: Case report

Abstract Introduction Maturity Onset Diabetes of the Young (MODY) is a rare form of diabetes which is different from both type 1 and type 2 diabetes, and runs strongly in families. MODY is autosomal dominant inherited type of diabetes, caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child they have, has a 50% chance of inheriting it from them. Recently, 14 gene mutations have been found to be associated with MODY. The Krüppel-like factor 11 (KLF11) gene mutation is the pathogenic gene of MODY7. Clinical Case A 17-year-old female patient with a previous history of obesity was admitted at outpatient office for regular control of weight and body mass index (BMI). Two years ago the patient was diagnosed with obesity, hyperinsulinemia and insulin resistance, with body weight (BW) 90 kg, body height (BH) 167 cm and BMI 32,3. The patient is on therapy with Metformin 2×500 mg. Results of the moment of examination: BW 100 kg, BH 168 cm, BMI 35,4; HbA1c 5,96%; Fasting plasma glucose (FPG) 6.8 mmol/l; Insulinemia 13,17; C-peptide 1,00; oral glucose tolerant test (OGTT): 0’ 6,5 mmol/l 120’ 11,0 mmol/l; insulinemia during OGTT (μU/mL): 0’ 14,05; 120’ 98,75; C-peptide during OGTT (ng/mL): 0’ 1,00; 120’ 6.95; Fundus examination and Doppler ultrasonography of both lower limbs showed no abnormalities. Family history was positive for Diabetes mellitus type 2 (mother, grandmother). The Immunological tests for Diabetes mellitus type 1 were negative for antibodies: GAD65, IAA, ICA and IA-2; Because there was doubt for MODY, genetic tests were performed with targeted resequencing of 4800 clinically relevant genes. The presence in the KLF11 gene associated with MODY7 was determined, c.911&amp;gt;G, p.(Lys304Arg). Тhe change is found in heterozygous form and is inherited from the mother. The patient continued treatment with metformin and lifestyle changes and this resulted in weight loss and good glycoregulation. Control one year later showed weight loss and good glycoregulation, FPG 5.1 mmol/l; HbA1c 5.5%; BW 89 kg, BH 168 cm, BMI 31.5; The level of blood glucose was controlled and stable. The patient's mother and grandmother were also treated with metformin. Conclusion Young patients with signs of DM2 should be tested for genetic types of diabetes. The number of patients with MODY is small, especially regarding MODY7, which rarely occurs. MODY is the most common type of monogenic β-cell function defect. It accounts for 2% to 15% of young diabetic patients. Studies have found that oral hypoglycemic drugs and dietary interventions are beneficial for MODY7 patients, and the control of the intake of staple food carbohydrates helps to control blood glucose which was also shown in our patient (1). 1. Chen L, Hou X. Clinical and Functional Characteristics of a Novel KLF11 Cys354Phe Variant Involved in Maturity-Onset Diabetes of the Young. J Diabetes Res. 2021;2021:7136869

P-23 Insulin autoimmune syndrome possibly induced by Alpha-Lipoic acid

Abstract Introduction Insulin autoimmune syndrome (IAS) is a relative rare cause of hypoglycemia due to the presence of extremely high circulating insulin levels and elevated serum concentrations of autoantibodies to human insulin despite no prior exposure to exogenous insulin, insulin analogues or oral hypoglycemic agents. It is characterized by repeated fasting hypoglycemia or episodes of hypoglycemia late after meals in non-diabetic, non-acutely ill patients. Increasing the titer of insulin autoantibodies and immune reactive insulin occurs owing to both genetic influences and environmental triggers such as medication, genetic instability and other factors. It is associated with the use of drugs comprising sulfhydryl groups, such as methimazole, clopidogrel and alpha lipoic acid, mostly. Insulin autoantibodies appear a few weeks after the exposure of sulfhydryl radicals. Here, we summarize the case of IAS caused by drug administration. Clinical Case A 60-year-old female patient who has a history of migraine for 30 years was referred to our hospital for feeling of hunger, dizziness, sweating, tremor, and palpitations for 1 month. These symptoms had commenced episodically, soon after starting 600 mg/day of alpha lipoic acid. She was diagnosed with hypoglycemia based on a plasma glucose concentration of 31 mg/dL. There was no personal or family history of diabetes mellitus, or previous use of oral hypoglycemic drugs such as sulfonylureas or exogenous insulin. No abnormality was detected in the systemic examination. She had no smoking and alcohol abuse. Her regular medication was tricyclic antidepressant (amitriptyline). Laboratory results are presented in Table 1. On our evalution, the serum levels of insulin, C-peptide, and anti-insulin antibody titers were inappropriately elevated in the presence of hypoglycemia, confirming the diagnosis of hyperinsulinemic hypoglycemia. Thyroid function, human growth hormone, insulin growth factor-1 (IGF-1), and cortisol result were within normal limits. Screening for antinuclear factor, serum protein electrophoresis, serology for viral hepatitis, and other autoimmune diseases were negative. Insulinoma was excluded with computed tomography. In light of the above results, a diagnosis of IAS was made with possible alpha lipoic acid. Because, alpha lipoic acid was the only medication being taken associated with a sulfhydryl group. The patient was prescribed oral methylprednisolone (32 mg once daily), alpha lipoic acid was withdrawn. Hypoglycemia did not occur after methylprednisolone treatment of follow-up. Methylprednisolone treatment was tapered to 4 mg once daily within 2 months. The insulin, and anti-insulin antibody titers had decreased. Conclusion We report a rare case of IAS. Sulfhydryl group containing drugs such as alpha lipoic acid might induce or exacerbate hypoglycemia in patients with a history of IAS. For this reason, the use of alpha lipoic acid should be questioned in patients with IAS. Table 1. Laboratory test results

A Fluid Approach to Type 2 Diabetes Management: Recent Advances in Medication Therapy from Tradition to Novelty

This review navigates the evolving landscape of Type 2 Diabetes (T2D) management by examining recent advancements in medication therapy, spanning from conventional approaches to groundbreaking innovations. Recognizing the dynamic nature of diabetes treatment, we delve into the traditional antidiabetic agents, such as metformin and sulfonylureas, and evaluate their sustained relevance in the context of contemporary therapeutic regimens. The synthesis of established treatments with novel pharmacological interventions takes center stage as we explore the transformative impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2Is). These agents not only address glycemic control but also demonstrate cardiovascular and renal benefits, reshaping the paradigm of T2D management. Additionally, we investigate promising emerging therapies, including dual and triple combination therapies, personalized medicine approaches, and the potential role of oral hypoglycemic drugs in optimizing treatment strategies. By embracing a fluid and integrative perspective, this review aims to provide healthcare professionals and researchers with a comprehensive understanding of the diverse pharmacotherapeutic options available, fostering informed decision-making and paving the way for enhanced personalized care in the dynamic landscape of T2D management