Oral Hypoglycemic Medications Research Articles

Exploring The Differences : A Comparative Analysis of Pharmaceutical Quality of Different Brands of Metformin Hydrochloride Tablets

Type 2 diabetic patients can regulate their increased blood sugar levels using metformin, an antidiabetic medicine approved by the FDA. It decreases the quantity of glucose produced by the liver, lessens the glucose absorption from the intestines, and raises insulin sensitivity. For best effects, metformin should be used in conjunction with dietary modifications and physical activity. The first-line oral hypoglycemic medication for type 2 DM(Diabetes Mellitus) is thought to be metformin. The recommended medication for obese people is MET. AMPK- Adenosine monophosphate-activated protein kinase, a liver enzyme crucial to insulin signaling, is triggered by metformin. Metformin’s inhibitory effect on hepatic cell glucose synthesis necessitates AMPK activation. This study aims to compare the pharmaceutical quality of three different brands of metformin hydrochloride tablets. All the three brands were evaluated for uniformity of weight, friability, hardness, dissolution, disintegration and assay was performed. All the brands tested were within the specification, thus all the tablets passed the pharmaceutical quality test, however, variations exist between brands, which could be due to differences in excipients, pressure during compression, manufacturing procedure etc.

Recovery From Homonymous Hemianopia in Hyperglycemia-Induced Occipital Lobe Electroclinical Seizures Following Glycemic Control.

Visual changes due to hyperglycemia in diabetes are not uncommon. While blurred vision is a well-established sequela of chronic hyperglycemia, homonymous hemianopia with or without electroclinical seizures is much rarer and can be mistaken for migraine, temporal arteritis, or ischemia of the central nervous system. This article analyzed case studies for 3 patients (67M, 68M, 52F) presenting with complex visual phenomena, from 3 to 42 days duration, including pathogenesis, clinical findings, management, and follow-up. Examinations demonstrated dense left homonymous hemianopias in 2 patients and a left inferior homonymous quadrantanopia in one, with no other abnormalities. Patients described vivid, nonstereotyped intermittent hallucinations in the affected fields. Blood glucose levels ranged from 13.5 to 35.0 mmol/L (243-630 mg/dL) without ketosis and HbA1c from 14.6% to 16.8%. Computed tomography of the brain showed no acute intracranial pathology. MRI of the brain either detected no abnormalities or demonstrated changes consistent with seizure activity. Electroencephalogram (EEG) demonstrated seizures over the right occipital region in each patient. EEG seizures coincided with patients' hallucinations, while they remained otherwise conscious. Oral hypoglycemic and antiepileptic medications were commenced with rapid and complete reversal of the seizures and visual field deficits, confirmed by repeat Automated 30-2 and MRI. Hyperglycemia-induced occipital lobe seizures with visual hallucinations and interictal homonymous visual field defects represent a rare but clinically important diagnosis. This article highlights the importance of prompt recognition and treatment to facilitate recovery.

Novel Approaches for the Management of Type 2 Diabetes Mellitus: An Update.

Diabetes mellitus is an irreversible, chronic metabolic disorder indicated by hyperglycemia. It is now considered a worldwide pandemic. T2DM, a spectrum of diseases initially caused by tissue insulin resistance and slowly developing to a state characterized by absolute loss of secretory action of the β cells of the pancreas, is thought to be caused by reduced insulin secretion, resistance to tissue activities of insulin, or a combination of both. Insulin secretagogues, biguanides, insulin sensitizers, alpha-glucosidase inhibitors, incretin mimetics, amylin antagonists, and sodium-glucose co-transporter-2 (SGLT2) inhibitors are the main medications used to treat T2DM. Several of these medication's traditional dosage forms have some disadvantages, including frequent dosing, a brief half-life, and limited absorption. Hence, attempts have been made to develop new drug delivery systems for oral antidiabetics to ameliorate the difficulties associated with conventional dosage forms. In comparison to traditional treatments, this review examines the utilization of various innovative therapies (such as microparticles, nanoparticles, liposomes, niosomes, phytosomes, and transdermal drug delivery systems) to improve the distribution of various oral hypoglycemic medications. In this review, we have also discussed some new promising candidates that have been approved recently by the US Food and Drug Administration for the treatment of T2DM, like semaglutide, tirzepatide, and ertugliflozin. They are used as a single therapy and also as combination therapy with drugs like metformin and sitagliptin.

Compliance with eye and foot preventive care in people with self-reported diabetes in Latin America and the Caribbean: Pooled, cross-sectional analysis of nine national surveys

AimsTo estimate the proportion of people with self-reported diabetes receiving eye and foot examinations in Latin America and the Caribbean (LAC). MethodsCross-sectional analysis of national health surveys in nine countries. Adults aged 25–64 years with self-reported diabetes. We quantified the proportion who reported having an eye examination in the last two years or a foot examination in the last year. We fitted multilevel Poisson regressions to assess socio-demographic (age and sex) and clinical (oral hypoglycemic medication and insulin treatment) variables associated with having had examinations. ResultsThere were 7435 people with self-reported diabetes included in the analysis. In three countries (Chile [64%; 95% CI: 56%-71%], British Virgin Islands [58%; 95% CI: 51%-65%], and Brazil [54%; 95% CI: 50%-58%]), >50% of people with diabetes reported having had an eye examination in the last two years. Fewer participants (<50% across all countries) reported having had a foot examination in the last year, with Ecuador having the lowest proportion (12%; 95% CI: 8%-17%). Older people, and those taking oral medication or insulin, were more likely to have eye/foot examinations. ConclusionsThe proportion of eye and foot examinations in people with self-reported diabetes across nine countries in LAC is low.

Association between Lifestyle and Biosocial Conditions with Erectile Dysfunction among Adult Patients in a Tertiary Hospital in Southern Nigeria

Erectile dysfunction is one of the most distressing often not discussed disorder affecting the male gender globally responsible for a lot of psychosocial distress. The objective of this study was to explore the association between lifestyle, biosocial conditions with erectile dysfunction among the adult males presenting at general outpatient clinic of our hospital. This was a study carried out at Federal Medical Center, Umuahia, Southern Nigeria. A well structured questionnaire was administered to 421 respondents. Results showed 219(52%) had erectile dysfunction while 202 (48%) didnot have erectile dysfunction. Factors associated with erectile dysfunction were age, tobacco use, alcohol intake, diabetes mellitus, hypertension, use of anti hypertensive and oral hypoglycaemic medications which were statistically significant. Body mass index, family functionality, use of illicit drugs and polypharmacy were not associated with erectile dysfunction. However, the independent risk factors were age, tobacco use and alcohol intake.Emphasis on health education and life style modificaation are highly recommended to reduce the burden of erectile dysfunction among our patients.

Chemometrics Assisted Formulation of Glimepiride Nanosuspension for Solubility Enhancement in Diabetic Therapy—A Systematic Approach

AbstractGlimepiride (GLM), a third‐generation sulfonylurea oral hypoglycemic medication, is used to treat type II diabetes. Admittedly, it has a low bioavailability, a relatively short half‐life (t1/2), and high toxicity. To address the issue, a nanosuspension of poorly soluble GLM is designed using a Quality‐by‐Design (QbD) method, to enhance its solubility. Prospective risk factors are identified and assessed using Critical Material Attribute (CMAs) and Critical Processing Parameter (CPPs) to evaluate the targets by Taguchi orthogonal array (OA) design and to study the effects of formulation and process variables on dependent variables. The amount of Polyvinylpyrrolidone (PVP) (X2), agitation time (X5), and concentration of Poloxamer (X7) are found as significant parameters (p &lt; 0.05), and are further optimized using the Box Behnken Design as response surface methodology model. The optimized GLM nanosuspension 1) has mean particle size (PS), zeta potential, viscosity (VS), and percentage cumulative drug release (CDR%) of 258.17 nm, −25.2 mV, 1.087cPs, and 98.52%, respectively. The pattern of drug release is fitted to Non‐Fickian kinetics. The study results in an economic and efficient nano formulation with enhanced solubility.

Insulin therapy among diabetic patients in rural communities of Sub-Saharan Africa: a perspective review.

In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.

Insulin-like growth factor-1 and cognition in normoglycemia, prediabetes, and type 2 diabetes mellitus

BackgroundThe relationship between insulin-like growth factor-1 (IGF-1) and cognition has been studied in healthy individuals, but not extensively with regards to insulin resistance and type 2 diabetes mellitus (T2DM). In this retrospective observational study, we investigated relationships of IGF-1 with memory and executive function across people with normoglycemia, prediabetes, and T2DM. MethodsData from the Midlife in the United States (MIDUS) study were used. Episodic memory and executive function were assessed using the Brief Test of Adult Cognition by Telephone approximately 21.42 ± 12.10 months prior to measuring IGF-1 levels from a fasting blood sample. Normoglycemia was identified as individuals without a physician diagnosis of diabetes and glycated hemoglobin (HbA1c) ≤5.6%. Prediabetes was identified as those without a physician diagnosis of diabetes and HbA1c between 5.7%−6.4%. T2DM was identified as anyone with a physician diagnosis of diabetes, or HbA1c ≥6.5%, or anyone using an oral hypoglycemic medication. The associations were assessed using linear regressions controlling for age, sex, education, body mass index, C-reactive protein, HbA1c or homeostatic model of insulin resistance, MIDUS wave, exercise, smoking status, sleep quality, alcohol intake, oral hypoglycemic use, and insulin use. ResultsThe study included 1400 participants, which consisted of 583 normoglycemic (48.4% female, mean age 51.0 ± 12.2 years), 512 prediabetes (58.4% female, mean age 57.3 ± 11.8 years), and 305 T2DM participants (53.8% female, mean age 57.6 ± 11.5 years). Peripheral IGF-1 concentrations were lower (F2,1397 = 28.29, p < 0.001) in people with prediabetes or T2DM, vs. normoglycemia. Participants with prediabetes or T2DM had lower episodic memory (F2,1397 = 9.21, p < 0.001) and executive function (F2,1397 = 20.29, p < 0.001) composite z-scores than people with normoglycemia. Higher IGF-1 concentrations were associated with better executive performance in individuals with prediabetes (β = 0.115 [0.028, 0.202], p = 0.010), but not in individuals with normoglycemia or T2DM. An interaction between IGF-1 and sex in predicting executive function was observed in the prediabetes group (β = −0.344, p = 0.042), where the relationship was weaker in females (β = 0.106 [−0.012, 0.224], p = 0.077) than males (β = 0.251 [0.123, 0.380], p < 0.001). No associations were seen between IGF-1 and memory. ConclusionThe results suggest that peripheral IGF-1 concentrations may be related to executive function, and that the relationship may be sex-specific and dependent on diabetes status.

Effectiveness and Safety of Sodium-Glucose Cotransporter2 Inhibitors Added to Dual or Triple Treatment in Patients with Type2 Diabetes Mellitus.

We evaluated the effectiveness and safety of sodium-glucose cotransporter2 inhibitor (SGLT2i) add-on treatment in patients with type2 diabetes mellitus (T2DM) in the real-world setting. This single-center retrospective study used the clinical database of Seoul National University Hospital in South Korea. Patients who received metformin monotherapy or combination therapy with ≥ 1 other oral hypoglycemic medication and had a baseline glycosylated hemoglobin (HbA1c) between 7.0% and 10.5% were included. Propensity score matching was applied between patients treated with and without SGLT2 inhibitors (SGLT2i and non-SGLT2i groups, respectively). Changes in HbA1c from baseline to week26 were compared between the SGLT2i and non-SGLT2i groups, and risk of adverse events (AE) were also assessed. A total of 1106 patients were included. At week26, HbA1c was significantly more reduced by 0.35 percentage points in the SGLT2i group than in the non-SGLT2i group (95%CI 0.30-0.41, P < 0.001). Likewise, the proportion of patients achieving HbA1c < 7% was also significantly higher (51.9% vs. 37.6%, P < 0.05) in the SGLT2i group than in the non-SGLT2i group. The risk of adverse events in the SGLT2i group was mostly comparable with those in the non-SGLT2i group except for diseases of the liver, pain, hypertensive diseases, and metabolic disorders, which showed significantly higher odds in the SGLT2i group. SGLT2i add-on treatment is an effective and safe therapeutic option for patients with T2DM in the real-world practice setting.

History of Psychoactive Medication a Risk Factor for Neurocognitive Decline After Cardiac Surgery

IntroductionNeurocognitive decline (NCD) is a common complication after cardiac surgery with implications for outcomes and quality of life. Identifying risk factors can help surgeons implement preventative measures, optimize modifiable risk factors, and counsel patients about risk and prognosis. MethodsProspective cohort study at a single academic center. 104 patients planned to undergo cardiac surgery were enrolled. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to measure neurocognitive function preoperatively, on postoperative day four, and postoperative day 30. NCD is defined as a change in RBANS scaled score of < −8 from baseline to postoperative day 4. Patient charts were reviewed for medication history: beta-blockers, angiotensin-converting enzyme and angiotensin receptor blockers, calcium channel blockers, statins, oral hypoglycemic agents, and psychoactive medications. Charts were also reviewed to calculate postoperative opioid usage. ResultsNCD was detected in 42.9% of patients. Incidence of NCD was significantly higher in patients taking a psychoactive medication (56.8%) than patients not (31.9%), P < 0.03. There was no relationship between historical use of beta-blocker, calcium-channel blocker, statin, or oral hypoglycemic medications and incidence of NCD. Simple linear regression showed no relationship between change in RBANS total scaled score and opioid usage. There was no difference in incidence of NCD at 1 mo. ConclusionsPatients with a history of taking psychoactive medications prior to cardiac surgery have an increased risk of acute postoperative NCD.

Anti-Diabetic Potential of Natural Plant Sources: An Assessment of Awareness and Consumption among Diabetics

Diabetes is a leading cause of death in developing countries, and there is a growing interest in utilizing natural remedies to manage high blood sugar levels. This study aimed to evaluate the awareness and usage of traditional plant-based treatments among diabetes patients. A cross-sectional survey was conducted on 500 diabetic patients in Ludhiana hospitals' Outpatient Departments (OPDs). A structured questionnaire gathered data on demographics, socioeconomic status, medical history, hyperglycemia management, and awareness and utilization of 22 traditional anti-diabetic plants. The results showed that the majority (55.2%) focused on dietary control, followed by exercise (49.6%) and oral hypoglycemic medications (46.8%). Interestingly, a higher percentage of female diabetics (56.3%) engaged in exercise compared to males (44.2%), while insulin use was reported by 17.2%, and only 19.2% used herbal supplements. A majority (62.4%) of subjects reported awareness of the listed plant sources as potential anti-diabetic agents. Notably, fenugreek seeds, bittergourd, ginger, and holy basil were the most recognized plants, acknowledged by 55.2, 47.2, 44.4, and 40.8% of respondents, respectively. In the study, awareness of garlic as an anti-diabetic remedy was significantly (p&lt;0.05) higher among females (40.6%) compared to males (31.3%), while males exhibited significantly (p&lt;0.05) greater awareness of tulsi's anti-diabetic properties. Interestingly, a relatively higher percentage reported consuming garlic (34%) as part of their diabetes management, either as a remedy or in meal preparations, followed closely by holy basil (32.6%), bittergourd (31.4%), and fenugreek seeds (28.2%), it's apparent that only a small fraction actually incorporated these plants into their daily routines. This underutilization of readily available and cost-effective remedies in India may be attributed to the lack of substantial clinical data supporting their efficacy. The study highlights the gap between awareness and practical adoption of traditional medicinal plants among diabetics, despite their accessibility and affordability in India. Urgent efforts are needed to document ethnobotanical knowledge before it vanishes, and further initiatives should promote the utilization of traditional medicinal plants as a complementary approach to control hyperglycemia.

Associations between insulin‐like growth factor‐1 and executive function in normoglycemia, prediabetes, and type 2 diabetes mellitus

AbstractBackgroundThe relationship between insulin‐like growth factor‐1 (IGF‐1) and cognition has been studied in healthy individuals, yet the results have been inconclusive. The aim of this study was to determine whether the association between IGF‐1 and executive function differs in individuals with normoglycemia, prediabetes, and type 2 diabetes mellitus (T2DM).MethodThe Midlife in the United States (MIDUS) study used the Brief Test of Adult Cognition by Telephone (BTACT) to assess cognitive function. A composite z‐score for executive function was created from the following tests: Digits backward span, category fluency, number series, backward counting, and Stop and Go Switch Task (SGST). IGF‐1 levels were measured from fasting blood samples using an immunochemiluminescent assay. Normoglycemia was defined as individuals without a physician diagnosis of diabetes and glycated hemoglobin (HbA1c) &lt; 5.6%. Prediabetes was defined as those without a physician diagnosis of diabetes and HbA1c between 5.7%‐6.4%. T2DM was defined as anyone with a physician diagnosis of diabetes, or HbA1c ≥6.5%, or use of oral hypoglycemic medication. Multiple imputation was used to handle missing covariate data. A linear regression model controlling for demographic factors, homeostatic model of insulin resistance (HOMA‐IR), C‐reactive protein (CRP) levels, exercise, smoking, sleep disturbance, alcohol intake and medication use, was used to determine the cross‐sectional association between IGF‐1 and executive function across subgroups.ResultThe MIDUS dataset included 447 normoglycemia (47.0% female, mean age 53.4±9.6), 467 prediabetes (57.4% female, mean age 56.8±10.6), and 271 T2DM participants (53.1% female, mean age 57.5±9.8). In participants with prediabetes, IGF‐1 levels were associated with better executive function (β = 0.126, p = 0.007), particularly in males (β = 0.258, p&lt;0.001). This association was absent in individuals with normoglycemia or T2DM. Compared to males with prediabetes, the opposite trend was observed in males with T2DM (β = ‐0.181, p = 0.062).ConclusionThe findings of this study suggest that the association between IGF‐1 and executive function may be influenced by insulin resistance or T2DM. Gaining a better understanding of why the associations differ in T2DM compared to prediabetes may explain the inconsistency observed in the literature and help elucidate the mechanism behind cognitive decline in T2DM.

Effect of Ethanol Extract of Sala (Cynometra ramiflora Linn.) leaves for reducing Blood Glucose Levels in Male Wistar Rats Induced by Alloxan

Diabetes is a chronic illness brought on by either insufficient insulin production by the pancreas or inefficient insulin utilisation by the body. There is currently no proven diabetes treatment. The development of current therapies is solely focused on preserving and enhancing patients' quality of life. In addition to utilising oral hypoglycemic medications or insulin injections to control blood sugar, several medicinal plants have also undergone pharmacological testing and can be used experimentally. There were 5groups, namely negative control group (0.5% Na CMC), positive control (glibenclamide 0.9mg/kg), ethanol extract of Sala leaves at doses of 250, 500, and 1000mg/kgBW. Each group was induced by alloxan 150mg/kg intraperitoneal body weight before fasting blood glucose levels 200mg/dL. Each group's blood glucose levels were taken and checked as pre alloxan, post alloxan, 7 and 10 days after treatment. The results showed that the ethanol extract of Sala leaves with doses of 250, 500, and 1000mg/kg for 7 and 10 days after treatment showed glucose-lowering activity (p&lt;0.05) on all alloxan induction. The ethanolic extract of the leaves of the Sala plant (Cynometra ramiflora Linn.) with doses of 250, 500, and 1000mg/kgBW for 7 and 10 days showed significant glucose-lowering activity (p&lt;0 0.05) in alloxan-induced mice.

Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence. A report from the NOMED-AF prospective cross-sectional observational study

Abstract Introduction Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. The pathophysiological background underlying the frequent coexistence of diabetes and AF seems to be multifactorial, involving changes in left atrial size, abnormal proinflammatory mediators and endothelial dysfunction. Purpose This study aims to evaluate the impact of diabetes mellitus severity, expressed as its known duration, antihyperglycemic treatment regimen and glycaemic control reflected by HbA1c level on AF and its silent, asymptomatic form (SAF) prevalence. Methods The cross-sectional NOMED-AF trial schedule comprised multistage, stratified and clustered population sampling with subsequent clinical evaluation and long-term non-invasive AF screening. AF was screened using a telemonitoring vest for a mean of 21.9± 9.1 days. From the representative sample of 3014 participants (mean age 77.5, 49.1% female), 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. Results The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF and SAF prevalence was observed. There were also no differences in the course of DM treatment pattern (oral medication vs insulin vs both - oral + insulin) among the study population with and without concomitant AF (p=0.106). From the study population 72% (95% CI: 68.7-75.1) received only oral hypoglycaemic medication; 12.9% (95% CI: 10.7-15.5) was taking both oral treatment + insulin injections; and 15.1% (95% CI: 12.7-17.8) were administered with insulin only. Metabolic control reflected by HbA1c levels showed no significant association with AF prevalence (p=0.635; p=0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p&amp;lt;0.001), p=0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p=0.027) and LDL&amp;lt;100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p=0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p&amp;lt;0.001), LDL&amp;lt;100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p=0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p=0.031) and HbA1c ≤6.5 (OR 0.46, 95%CI: 0.25-0.85, p=0.013) were associated with silent AF prevalence. Conclusions Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤6.5 being additional independent predictors for SAF.

Impact of Persistent Medication Adherence and Compliance with Lifestyle Recommendations on Major Cardiovascular Events and One-Year Mortality in Patients with Type 2 Diabetes and Advanced Stages of Atherosclerosis: Results From a Prospective Cohort Study.

The aim of this study was to evaluate the impact of single and combined effects of persistent medication adherence and compliance with lifestyle recommendations on the incidence of major adverse cardiovascular events (MACE) and one-year all-cause mortality in patients with type 2 diabetes (T2D) and peripheral artery disease (PAD) after partial foot amputation (PFA), representing a unique cohort of patients with advanced stages of atherosclerosis. This is a prospective cohort study of 785 consecutive patients (mean age 60.9 ± 9.1 years; 64.1% males). Medication adherence was evaluated by using the proportion of days covered (PDC) measure calculation and was defined as a PDC ≥80%. It derived as an average of PDCs of the following four classes of drugs: a) antidiabetics (oral hypoglycemic medications and/or insulin); b) ACEI or ARBs; c) Statins; d) antiplatelet drugs. Lifestyle compliance was defined as a PDC ≥80% comprising of PDCs of a) physical activity of ≥30 minutes per day; b) healthy nutrition and weight management; c) non-smoking. Cox proportional hazard models adjusted for confounders were used. Total all-cause mortality was 16.9% (n = 133) at one-year follow-up. After adjusting for confounders, compared to adherent/compliant patients (n = 432), non-adherent and/or non-compliant patients had an increased risk of one-year mortality: HR = 8.67 (95% CI [5.29, 14.86] in non-adherent/non-compliant patients (n = 184), p < 0.001; HR = 3.81 (95% CI [2.03, 7.12], p < 0.001) in adherent/non-compliant patients (n = 101) and HR = 3.14 (95% CI [1.52, 6.45] p = 0.002) in non-adherent/compliant patients (n = 184). The incidence of MACE followed similar pattern (HR = 9.66 (95% CI [6.55, 14.25] for non-adherence/non-compliance; HR = 3.48 (95% CI [2.09, 5.77] and HR = 3.35 (95% CI [1.89, 5.91], p < 0.001 for single adherence or compliance. Medication adherence and compliance to lifestyle recommendations have shown to be equally effective to reduce the incidence of MACE and one-year mortality in patients with diabetes and PAD after PFA representing a population with highly advanced stages of atherosclerotic disease. Our findings underline the necessity to give lifestyle intervention programs a high priority and that costs for secondary prevention medications should be covered for patients under these circumstances. This study analyzed the single and combined effects of medication adherence and compliance with lifestyle recommendations on cardiovascular events and mortality in patients with type 2 diabetes and advances stages of atherosclerosis over a period of one year.Evaluation of medication adherence included antidiabetics, statins, dual antiplatelets and ACEI/ARBs, whereas lifestyle recommendations included healthy nutrition, physical activity and smoking cessation.Persistent medication adherence and lifestyle changes have shown to be equally effective to reduce the incidence of MACE and one-year mortality in patients representing a population with highly advanced stages of atherosclerotic disease, and positive effects added up to a double effect if patients were persistently adherent and compliant with both interventions.

Assessing the Impact of Primary Care-Led Optimisation Clinics in the Management of Type 2 Diabetes: A Service Redesign Pilot Study.

Background Many individuals diagnosed with type 2 diabetes (T2D) in the London Borough of Waltham Forest, treated solely with oral hypoglycaemic medications (OHAs), exhibit increased levels of glycated haemoglobin (HbA1c). While specialised community and secondary care clinics are at full capacity, a gap exists for dedicated diabetes optimisation services at the primary care level. This study aimed to launch a remote Primary Care Network (PCN)-based clinic during the coronavirus disease 2019 (COVID-19) pandemic to enhance the management of OHAs, introduce motivational interviewing, and incorporate patient empowerment strategies in tandem with a secondary care endocrinologist. The primary objective was to evaluate the impact on HbA1c levels and other metabolic parameters. Concurrently, the "behaviour change model" served to measure patient engagement. Methodology We recruited 43 patients in this study, each undergoing a 30-minute consultation focused on diabetes management. A dedicated administrator ensured patient engagement and a three-month follow-up with repeat metabolic profile testing. Sustained, high-quality care was upheld through bimonthly remote consultations, receiving expertise from an endocrinology consultant. Results Of the pilot's 38 patients managed solely with OHAs, 31 achieved an HbA1c reduction of more than 11 mmol/mol. The overall median reduction for the entire cohort was significant (initially 88 mmol/mol versus 70 mmol/mol, p < 0.0001). Triglyceride levels also saw a notable median decline (1.56 mmol/L down to 1.20 mmol/L, p = 0.0247). Of the 38 completing the pilot, 14 had behavioural stages recorded both initially and at follow-up. Employing motivational interviewing led to significant diabetes-related behavioural changes in 11 of the 14 patients. Conclusions A PCN-based optimisation clinic, augmented with active recall strategies, was a cost-effective method to boost awareness, self-management, and glycaemic control among individuals with T2D. These PCN-led clinics orchestrated by primary care clinicians offer a streamlined solution for achieving treatment benchmarks even amid the challenges of the COVID-19 pandemic.

Hydrogel-based Drug Delivery System in Diabetes Management.

It is estimated that there are over 200 million people living with diabetes mellitus (DM) all over the world. It is a metabolic condition caused by decreased insulin action or secretion. Diabetes Mellitus is also known as Type 2 Diabetes Mellitus. Type 1 diabetes mellitus and type 2 diabetes mellitus are the two most common types of DM. Treatment for type 1 diabetes often consists of insulin replacement therapy, while treatment for type 2 diabetes typically consists of oral hypoglycemics. Conventional dosing schedules for the vast majority of these medications come with a number of drawbacks, the most common of which are frequent dosing, a short half-life, and low bioavailability. Thus, innovative and regulated oral hypoglycemic medication delivery methods have been developed to reduce the limitations of standard dose forms. The studies and reviews published under the title were looked up in several databases (including PubMed, Elsevier, and Google Scholar). Hydrogels made from biopolymers are three-dimensional polymeric networks that can be physically or chemically crosslinked. These networks are based on natural polymers and have an inherent hydrophilic quality because of the functional groups they contain. They have a very high affinity for biological fluids in addition to a high water content, softness, flexibility, permeability, and biocompatibility. The fact that these features are similar to those of a wide variety of soft living tissues paves the way for several potentials in the field of biomedicine. In this sense, hydrogels offer excellent platforms for the transport of medications and the controlled release of those drugs. Additionally, biopolymer-based hydrogels can be put as coatings on medical implants in order to improve the biocompatibility of the implants and to prevent medical diseases. The current review focuses on the most recent advancements made in the field of using biopolymeric hydrogels that are physically and chemically crosslinked, in addition to hydrogel coatings, for the purpose of providing sustained drug release of oral hypoglycemics and avoiding problems that are associated with the traditional dosage forms of oral hypoglycemics.

Early evidence for inclusion of practice of morning ingestion of water as a lifestyle modification (adjuvant) in management of hypertension in patients of diabetes mellitus

Objectives: Researches reflecting the role of water in blood pressure (BP) regulation are documented to a lesser degree. A holistic approach, combining standard treatment protocols with lifestyle modifications, serves as the best approach to check the increasing prevalence and coexistence of hypertension (HTN) and diabetes mellitus. Thus, we aim to access the effects of morning ingestion of water on HTN in diabetic individuals when practiced adjuvant with antihypertensive and oral hypoglycemic medications. Materials and Methods: We conducted a prospective cohort with 68 patients having diabetes mellitus and HTN, with 34 participants each in the study and control group. The control group followed standard treatment protocol for HTN and diabetes mellitus. Study group in adjuvant to above practiced drinking 0.75–1 L of water altogether (within 5–10 min) in the morning immediately after waking up in a sitting (crossed leg or squatting) position. The changes in BP and other biochemical parameters were recorded. Results: For the study group (n = 34), repeated measured analysis of variance revealed a statistically significant lowering of systolic BP (SBP): F (2, 66) = 17.17, P ≤ 0.0001 and diastolic BP (DBP): F (2, 66) = 7.31, P = 0.0014. Moreover, post hoc analysis with Tukey–Kramer multiple comparisons found that the mean difference was statistically significant for baseline and end of 2 months – SBP: (14 [95% confidence interval, CI 8.23–19.77] mmHg, P &lt; 0.001) and DBP: (6.35 (95% CI 2.22–10.48) mmHg, P &lt; 0.01). The SBP and DBP at baseline versus the end of 2 months were 143.76 (13.40) versus 129.76 (14.27) mmHg and 84.35 (12.01) versus 78 (8.90) mmHg, respectively. In the study group, regression in the stage of HTN was observed where ten of 15 patients and 11 of 19 patients recovered from Stage I and Stage II HTN, respectively. Furthermore, 67.6% of the study group achieved a target BP of &lt;140/90 mmHg at the end of 2 months. Conclusion: The practice of morning ingestion of water does affect BP regulation and this practice can be a new potential lifestyle modification adjuvant with standard treatment guidelines for management of HTN in patients of diabetes mellitus.

Vitis Pedata Nanoformulation in the Management of Alloxan Induced Experimental Diabetes

Vitis pedata is a woody climber of the Vitaceae family with a multitude of pharmacological effects like anti-inflammatory, antibacterial, anti-nociceptive, anti-arthritic, anti-oxidant, astringent, and hemostatic qualities. The research targets to assess the anti-diabetic efficacy of Vitis pedata aqueous extract nanoformulation in alloxan-induced diabetes rats. Biocompatible polycationic polymer chitosan is used for nanoformulation development. The aqueous extract loaded chitosan nanoparticle formulation displayed a particle size of 186± 5.37 nm with a polydispersity index of 0.226 and zeta potential value of 23 ± 1.93 mV. The nanoformulations were assessed for its anti-diabetic properties in comparison to aqueous extracts for the first time by in- vivo methodologies. Several parameters like body weight, blood glucose level, blood and serum biomarkers, were examined. Changes in tissue histoarchitecture, liver glycogen content, oxidative stress response and antioxidant status were also studied. In diabetic rats, the nano-scale formulation significantly reduced blood glucose levels, glucose tolerance, lipid profiles, and serum biomarkers, comparable to the oral hypoglycemic medication glibenclamide. The restoration of antioxidant status and pancreatic histoarchitecture through by size assisted delivery may be related to the improved control of diabetes by the nanoformulation than the extract alone. The work marks the first report of Vitis pedata nanoformulation for diabetes management and can serve as a prelude for further preclinical/clinical evaluations.

Effects of low-versus high-volume high-intensity interval training on glycemic control and quality of life in obese women with type 2 diabetes: A randomized controlled trial

Background/objectiveComparison between different training volumes of high-intensity interval training (HIIT) is understudied in type 2 diabetes. This study aimed to compare the effects of low- and high-volume HIIT on glycemic control, blood lipids, blood pressure, anthropometric adiposity measures, cardiorespiratory fitness, and health-related quality of life (HRQoL) in women with type 2 diabetes. MethodsSeventy-two obese women with type 2 diabetes aged 36–55 were randomly assigned to a low-volume HIIT group (i.e., 2 × 4-min high-intensity treadmill exercise at 85%–90% of peak heart rate, with a 3-min active recovery interval in between), a high-volume HIIT group (i.e., 4 × 4-min high-intensity treadmill exercise at 85%–90% of peak heart rate, with three 3-min active recovery intervals in between), and a non-exercising control group. Patients in HIIT groups exercised three days a week for 12 weeks. All patients received oral hypoglycemic medications with no calorie restrictions. The outcome measures were glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2-hr PPBG), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC), waist-to-hip ratio, time to maximal exhaustion determined from a maximal treadmill exercise test (i.e., a measure of cardiorespiratory fitness), and HRQoL assessed by the 12-item Short Form (SF-12) Health Survey. ResultsThe low- and high-volume HIIT groups showed significant improvements in all outcome measures compared to the baseline and the non-exercising group (P < 0.05), except for DBP in the low-volume HIIT group (p > 0.05). Also, both low- and high-volume HIIT groups showed similar improvements in TC, HDL, SBP, DBP, BMI, WC, waist-to-hip ratio, and the SF-12 scores, with no significant between-groups difference (p > 0.05). The high-volume HIIT group, however, showed more significant improvements in HbA1c, FBG, 2-hr PPBG, TG, LDL, and treadmill time to maximal exhaustion than the low-volume HIIT group (p < 0.05). The non-exercising group showed non-significant changes in all outcome measures (p > 0.05). ConclusionLow-volume HIIT could be equally effective as high-volume HIIT for improving TC, HDL, blood pressure, anthropometric adiposity measures, and HRQoL in obese women with type 2 diabetes. Nevertheless, high-volume HIIT could have a greater impact on glycemic control, TG, LDL, and cardiorespiratory fitness in these patients. Trial registrationClinicalTrials.gov, NCT05110404.