Oral Hypoglycemic Medications Research Articles

Exploring the Awareness and Counseling Practices of Community Pharmacists in Libya Regarding Drug Interactions with Oral Hypoglycemic Medications

The increasing prevalence of polypharmacy increases the patient's risk of drug side effects and drug interactions, especially among patients with type 2 diabetes. Pharmacists are essential to provide effective education and counseling to these patients. This study aims to assess the awareness and counseling practice of community pharmacists in Libyan regarding potential drug interactions involving oral hypoglycemic agents in patients with type 2 diabetes. A cross-sectional descriptive study was adapted in 2020 in Tripoli, Libya, and included a questionnaire distributed to 150 community pharmacists. The majority of pharmacists (79%) had a bachelor’s degree, and (45%) of them had (2-4) years of experience. The vast majority (94%) of participants were familiar with the term drug interactions and counseling guidelines for patients with diabetes. (65%) of pharmacists advised diabetic patients on the appropriate times to check blood sugar levels. (84%) were aware of drugs that interact with oral hypoglycemic drugs. (60%) advised patients to visit their physician if a patient came to their community pharmacy to be dispensed sitagliptin and captopril, to avoid drug interactions with oral hypoglycemic drugs. The study revealed that the majority of Libyan pharmacists in community pharmacies were aware of the term drug interactions and advised diabetic patients, were aware of drugs that interact with oral hypoglycemic drugs.

Prevalence of Diabetic Foot Ulcer and Determinant Factors Among Adult Diabetic Patients Who Attend the Diabetic Follow‐Up at Adwa General Hospital, Ethiopia, 2019: A Cross‐Sectional Study

ABSTRACTBackground and AimsDiabetic foot ulcers are the main complication of diabetes mellitus. There is limited information on the prevalence and factors of diabetic foot ulcers in Ethiopia, particularly to the study setting. The study aimed to assess the prevalence of diabetic foot ulcers and determinant factors among adult diabetic patients who attend the diabetic follow‐up at Adwa General Hospital, Ethiopia, 2019.MethodsAn institutional‐based cross‐sectional study was conducted. The data was collected using face to face interviews, direct observation, and a patient's records reviews. Data were cleaned, entered, and analyzed using SPSS version 23. Bivariate and multivariable logistic regression was used to identify factors associated with a diabetic foot ulcer. Finally, p < 0.05 in multivariable logistic regression was used to declare statistical significance.ResultsThe prevalence of diabetic foot ulcer was 13%. Being a rural residence (AOR = 7.180, 95% CI: 2.663–19.359), oral hypoglycemic medication (AOR = 2.521, 95% CI: 1.001–6.349), medication nonadherence (AOR = 4.480, 95% CI: 1.954–10.269), poor diabetic foot self‐care practice (AOR = 4.350, 95% CI: 1.378–13.731), lost to follow‐up (AOR = 4.838, 95% CI: 1.828–12.801), neuropathy (AOR = 4.938, 95% CI: 1.565–15.580), and alcohol drink (AOR = 4.178, 95% CI: 1.592–10.966) were the determinant factors.ConclusionThe prevalence of diabetic foot ulcer was high. Being a rural residence, oral hypoglycemic medication, medication nonadherence, poor diabetic foot self‐care practice, lost to follow‐up, neuropathy, and alcohol drinks were the determinants of diabetic foot ulcer. Health education on diabetic foot self‐care practice, alcohol drink, and the other determinants are important to prevent diabetic foot ulcer.

Comprehensive Evaluation of the Cardiovascular Protective Effects of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Advanced Chronic Kidney Disease: A Real-World Evidence

Introduction: Diabetes, kidney disease, and cardiovascular disease have complex interactions and coexistences that significantly worsen a patient’s overall health. Previous research results have shown that SGLT2i hypoglycemic drugs can not only effectively control blood sugar in diabetic patients but also protect the kidneys and heart. This study further focuses on diabetic patients with kidney disease to explore the effectiveness of using SGLT2i hypoglycemic drugs in avoiding heart-related complications or death. Methods: This is a multicenter retrospective cohort study using the Taipei Medical University Clinical Research Database (TMUCRD) as the data source. This study selected patients who suffered from both type 2 diabetes and chronic kidney disease from 1 January 2008 to 31 December 2020, as the research team. Integrated or separate 4-point major adverse cardiovascular events (4P-MACE) and mortality were the outcomes of this study. The Kaplan-Meier curves method and Cox proportional hazard regression analysis were used to explore the association between each influencing factor and the outcome. Results: A total of 5,005 patients with type 2 diabetes and CKD were included in this study, of which 524 patients were stably treated with SGLT2i, 3,952 patients were treated with DPP4i, and 529 patients were treated with TZD. The results showed that the SGLT2i user group had a significantly lower risk of 4P-MACE compared with the SGLT2i nonuser group (hazard ratio [HR]: 0.68, 95% CI [0.49, 0.95], p = 0.024). The SGLT2i group had a significantly lower risk of cardiovascular mortality compared with the DPP4i and TZD groups (HR: 0.37, 95% CI [0.21, 0.65], p < 0.001; HR: 0.42, 95% CI [0.20, 0.90], p = 0.025). Conclusion: This study found that for patients with both diabetes and kidney disease, SGLT2i is a better option than other oral hypoglycemic medications because it can significantly avoid the occurrence of heart-related complications. The results of this study can be used as a reference for clinical medication selection practice.

Ameliorative Review on Exploration of Spices in Aspects of Phytochemical Screening for their Antidiabetic Action

Diabetes is a diverse group of disorder characterized by hyperglycemia due to an deficiency in insulin production. Diabetes mellitus's chronic hyperglycemia is linked to end organ damage, dysfunction, and failure, including blood vessel, kidney, retina, and nervous system. With over 62 million cases of diabetes being identified in India, the disease is rapidly turning into a true epidemic. The majority of synthetic oral hypoglycemic medications available for the disease's treatment are costly, have significant adverse effects, and/or cannot be used while pregnant. As a result, a growing number of people worldwide are turning to traditional herbal remedies to prevent and treat diabetes. Spices having antioxidant, hypoglycemic, and hypolipidemic characteristics may be effective in the therapy of diabetes. As a result, these spices are growing in popularity due to their potential efficacy, little to nonexistent adverse effects, and synergistic effects. Spices are compounds used in food as coloring, flavoring, or preservation. They might be fresh or dried seeds, bark, roots, fruits, or even vegetables. This paper includes phytochemical screening of spices which have crucial role in the treatment of diabetis mellitus.

Self-Care Activities Among Diabetic Patients in an Urban Health Centre in Thirumazhisai, Tamil Nadu: A Cross-Sectional Study.

Background Diabetes is a long-term medical condition characterized by consistently high blood glucose levels, which can be attributed to both genetic and environmental factors. Global diabetes prevalence is predicted to reach 10.4% by 2040, impacting over 642 million people. Diabetes is becoming more common in India; by 2030, an estimated 87 million individuals are predicted to have the disease. Self-care activities are essential for managing diabetes, yet adherence to these practices is often low in developing countries like India due to socioeconomic, cultural, and healthcare barriers. Objective In this study, the self-care practices of diabetic patients who visited an Urban Health Center in Thirumazhisai, Tamil Nadu, were assessed, along with the factors influencing these practices. Methods A three-month cross-sectional study was conducted in a facility with 200 type 2 diabetic patients who had been unwell, for a minimum of a year. The participants were selected via purposeful sampling, and interviews were conducted using the most recent version of the Summary Diabetes Self-Care Activities (SDSCA) questionnaire. The data was analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA) to discover connections between the duration of diabetes and self-care practices using descriptive statistics and chi-square tests. Results The study found that 136 (68%) of participants tested their blood sugar levels at least once in the preceding three months, 104 (52%) exercised for at least 30 minutes each day, and 96 (48%) of individuals maintained a balanced diet. On the other hand, adherence to insulin injections and oral hypoglycemic medications was lower, at 98 (49%) and 79 (39.5%), respectively. Foot hygiene was also not at its best; only 85 (42.5%) people washed their feet daily. Considerable correlations have been shown between the length of diabetes and particular self-care behaviors, including eating patterns, exercise routines, and foot hygiene. Conclusion The results emphasize the necessity of focused interventions, especially in developing nations, to enhance diabetic patients' self-care behaviors.Tailored, patient-centered strategies are essential to address the complex factors influencing diabetes management, ultimately improving glycemic control and patient outcomes.

Effect of Zinc Supplementation on Glycemic Control in Newly Diagnosed Patients With Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) is a spectrum of metabolic disorders primarily characterized by elevated blood glucose levels. Type 2 DM (T2DM), the most common form, often requires adjunctive therapies to improve glycemic control and mitigate associated risks. Zinc has been implicated in glucose metabolism and insulin function, prompting this study to evaluate the impact of zinc supplementation on glycemic control in newly diagnosed T2DM patients. A randomized, placebo-controlled trial was conducted involving 80 newly diagnosed T2DM patients. Participants were randomly assigned to receive either zinc supplementation (50 mg/day) or a placebo, in conjunction with standard oral hypoglycemic medication, metformin. Key indicators, including fasting blood glucose (FBG), postprandial blood glucose (PPBG), hemoglobin A1c (HbA1c), and lipid profiles, were measured at baseline and after the 12-month intervention period. The group receiving zinc supplementation demonstrated significant reductions in FBG, PPBG, and HbA1c levels compared to the placebo group. The mean FBG in the intervention group decreased by 21.52 mg/dL, PPBG decreased by 47.53 mg/dL, and HbA1c decreased by 0.79%. Additionally, zinc supplementation led to notable decreases in low-density lipoprotein (LDL) cholesterol by 25.06 mg/dL, triglycerides by 22.2 mg/dL, and total cholesterol levels by 26.67 mg/dL. However, no significant changes were observed in high-density lipoprotein (HDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, or erythrocyte sedimentation rate (ESR). The findings suggest that zinc supplementation may be a beneficial adjunctive therapy in the early management of T2DM, contributing to improved glycemic control and favorable changes in lipid profiles. However, its effect on HDL, VLDL, and ESR was insignificant, indicating the need for further research to better understand the broader implications of zinc in T2DM management.

Effects of postprandial exercise timing on blood glucose and fluctuations in patients with type 2 diabetes mellitus.

The aim of this study was to assess how moderate-intensity aerobic exercise performed 45 minutes and 90 minutes after a meal affects blood glucose levels and fluctuations in individuals diagnosed with type 2 diabetes mellitus (T2DM). Twenty-two patients with T2DM, who were solely receiving oral hypoglycemic medication, were enrolled and divided randomly into two categories: those exercising 45 minutes after a meal (45-minute postprandial exercise group) and those exercising 90 minutes post-meal (90-minute postprandial exercise group). Both groups engaged in a 30-minute session of moderate-intensity aerobic stationary bike exercise following breakfast. This aerobic exercise regimen consisted of two stages, with the groups switching exercise timings after the initial phase. Continuous glucose monitoring (CGM) was utilized to evaluate the blood glucose levels and fluctuations in the participants. After breakfast, both overall daily blood glucose levels and the area under the curve for blood glucose following breakfast were reduced in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. The 45-minute postprandial exercise group demonstrated greater time spent within the target glucose range and less time above the target range than the 90-minute postprandial exercise group. Additionally, measures such as standard deviation, mean amplitude of glycemic excursions, largest amplitude of glycemic excursions, and postprandial glucose excursion for breakfast, peak postprandial glucose levels, and duration of elevated glucose levels were all lower in the 45-minute postprandial exercise group compared to the 90-minute postprandial exercise group. Moderate-intensity aerobic exercise lasting 45 minutes after meals was found to be more efficient in decreasing blood glucose levels and minimizing fluctuations compared to exercising 90 minutes after meals in patients with T2DM. Additionally, it notably reduced the peak in blood glucose levels after meals.

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.

Managing Glycemic Control in Pregnancy: Comparing Antidiuretic Medications and Insulin Regimens"

Background: The disease known as gestational diabetes mellitus, or GDM, was first identified as a result of reduced glucose tolerance during pregnancy. Glycemic management must be maintained to prevent negative effects for both the mother and the foetus. We evaluate the efficacy of insulin and anti-diabetic regimens in the treatment of GDM in this research. Objectives: to assess the effectiveness of insulin regimens and anti-diabetic medications in controlling blood sugar levels during pregnancy in relation to the family objectives of the patient, such as a healthy baby, and to provide medical professionals with information on the best ways to treat gestational diabetes mellitus. Study design: A cross sectional study. Place and duration of study. Department of endocrinology hmc peshwar from 10-Feb 2022 to july Feb-2022 Methods:The study used a cross-sectional methodology. To locate relevant randomised controlled trials comparing different insulin regimens and antidiabetic drugs in pregnant women with gestational diabetes mellitus (GDM), a thorough search was carried out across major electronic databases. Included were studies that reported on glycemic control outcomes, such as HbA1c levels, fasting blood glucose levels, and the incidence of unfavourable outcomes for either the mother or the foetus. Both the quality evaluation and data extraction were carried out separately by two reviewers. To analyse the effectiveness of various therapies while taking both direct and indirect evidence into account, a network meta-analysis was carried out. Sensitivity analysis were carried out to evaluate how solid the results were. Based on variables such maternal health condition and gestational age, subgroup analyses were carried out. The objective of the synthesised data was to enhance the outcomes for women with gestational diabetes mellitus (GDM) by offering insights into the relative effectiveness of insulin regimens and antidiabetic drugs in glycemic management during pregnancy. Results:There were 100 participants in the research, with an average age of 28. The biggest impact on HbA1c levels was from insulin treatment (mean decrease = -1.5%), which was followed by oral hypoglycemic medications (mean reduction = -1.2%) and modifying one's lifestyle (mean reduction = -0.8%). The trends in fasting blood glucose levels were comparable. The results for mothers and foetuses, including birth weight and Apgar ratings, did not vary statistically across the treatment groups, suggesting that glycemic management is essential irrespective of the therapeutic approach. Conclusion: Our study emphasises the value of individualised methods to treating GDM, with a focus on the effectiveness of oral hypoglycemic medications, insulin therapy, and lifestyle changes in achieving glycemic control. Further investigation into the long-term impacts on maternal and foetal outcomes is necessary to enhance clinical practice. Keywords: gestational diabetes, glycemic control, antidiabetic medications, insulin therapy

Adherence to Self-Monitoring of Blood Glucose and Its Related Factors Among Type 2 Diabetic Patients Attending Al-Ahsa Primary Health Care Centers in Saudi Arabia.

Self-monitoring of blood glucose (SMBG) is a crucial component of diabetes management, but adherence remains suboptimal. This study aimed to evaluate adherence to SMBG among type 2 diabetic patients in Al-Ahsa, Saudi Arabia. A cross-sectional study was conducted among 398 type 2 diabetic patients attending primary healthcare centers. Data were collected through face-to-face or virtual interviews and electronic health records. Adherence levels were categorized as low, moderate, and high. The majority of participants exhibited moderate adherence to SMBG (58.5%), while 27.1% had low adherence, and 14.3% were highly adherent.The use of oral hypoglycemic medications and insulin injections was associated with higher adherence (p<0.001). Comorbidities, physical exercise, diet, frequency of medical visits, and attendance at diabetes education sessions did not significantly influence adherence. Suboptimal adherence to SMBG was observed among type 2 diabetic patients in Al-Ahsa. Targeted interventions addressing individual barriers and integrating technology may improve SMBG adherence and diabetes management.

Non-invasive laser therapy effect on lipid profile and renal function in metabolic syndrome: randomized control trial

INTRODUCTION. Metabolic syndrome (MetS) represents an assortment of interconnected metabolic risk factors, particularly central obesity, dyslipidemia, and hyperglycemia. These variables have a detrimental impact on renal function and contribute to increased mortality. This timeline necessitates a prompt approach that enables the deployment of safe and non-intrusive therapeutic equipment in conjunction with therapy for MetS patients. Accordingly, we aim to investigate whether using a low-level laser (LLL) watch device as a non-invasive instrument enhances multiple metabolic parameters, so it may be a practical therapeutic approach for managing metabolic disorders. AIM. To investigate the effect of non-invasive laser therapy on parameters of lipid profile and renal function in patients with metabolic syndrome. MATERIALS AND METHODS. This study enrolled 40 MetS patients of both genders aged 45–65 years. The study group received a 12-week treatment consisting of oral hypoglycemic medication and LLL therapy (LLLT), which involved three weekly sessions performed in the morning, targeting the wrist area using a continual output diode laser (skin contact mode, maximum power: 0.005 W, beam spot area: 0.03 cm2, energy density: 288 J/cm3, and radiation time: 1800 s). The control group only received hypoglycemia medications. Laboratory lipid profile and renal function measurements were conducted prior to and following the trial. RESULTS. Following a 12-week laser watch therapy, the results revealed a significant decline in total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) levels and an increase in high-density lipoprotein (HDL) levels, which was slightly improved in the control (p 0.00). Moreover, glomerular filtration rate (GFR) and creatinine levels were significantly improved, while the control group did not experience any significant improvement (p 0.5). DISCUSSION. Combining non-invasive laser therapy with hypoglycemic medications significantly improved the lipid profile in patients with MetS; however, kidney function, like GFR and creatinine levels, was enhanced. Furthermore, lower TC and TG levels might be due to the reduction of glycation and promoted LDL receptors which increased LDL catabolism. CONCLUSION. Non-invasive laser therapy enhances lipid profile and renal function in MetS patients. Furthermore, the control group had a minimal effect on the lipid profile and no effect on renal function.

145-OR: Assessing the Current State of Diabetes Care in Long-Term Facilities Using Continuous Glucose Monitoring

Introduction: Recommendations for diabetes care in long term care facilities (LTCF) focuses on avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTCF residents with multiple comorbidities. Methods: We conducted a cross-sectional study using CGM in 8 LTC facilities in the United States. A masked Dexcom G6 pro CGM was placed for 10 days on residents with diagnosis of diabetes mellitus (DM) who were on any oral or injectable hypoglycemic medications. Clincial and demographic information were collected from medical records. Results: We evaluated 65 residents (mean age 65 years, 50% female). Fourteen percent of the cohort was on sulfonylurea medications and 68% were on insulin. CGM data showed 26% of the cohort with &amp;gt;1% time spent in hypoglycemia (time &amp;lt;70 mg/dL). A larger burden of hyperglycemia was seen with 54% of the cohort spending &amp;gt;10% time &amp;gt;250mg/dL, 37% spending &amp;gt;25% time &amp;gt;250 mg/dL, and 14% spending &amp;gt;90% time &amp;gt;250 mg/dL. Only 44% of the cohort had &amp;gt;50% Time-in-Range (70-180 mg/dL). The latest A1C was &amp;lt;7% in 45% of the cohort, 7-8% in 27%, 8.1-9% in 12%, and &amp;gt;9% in 16%. Fingerstick reading frequency was 2 or fewer times/day in 74% of the cohort, 3 times/day in 13%, and 4 or more times/day in 13%. On average, this cohort had 13 comorbidities, with 85% having functional disabilities. There was 14% with dementia and 42% with obesity (BMI&amp;gt;30). All 100% of the participants had polypharmacy(≥5 medications/day). Conclusions: In this multi-morbid cohort of residents with diabetes living in LTCF, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite fair control of A1C. More consistent use of CGM could help identify glycemic excursions to improve therapeutic decision-making. Disclosure C. Slyne: None. K. Roberts: None. C.D. Conery: None. H. Brabant: None. N. Krakoff: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi. M. Munshi: Consultant; Sanofi. Funding Supported by an investigator initiated grant from Dexcom

Temporal trends on the prevalence of renal disease and outcomes among patients with diabetes mellitus hospitalized by heart failure: findings from INCAex

ABSTRACT Background To assess 20-year time trends in the prevalence of diabetes mellitus (DM) among inpatients with heart failure (HF) and the influence of coexisting DM and kidney disease (KD) on outcomes. Research design and methods A retrospective study of patients was admitted due to HF, during the period 2000/2019. The period of follow-up was divided into three intervals according to the European Medical Agency approval of newer hypoglycemic drugs. We analyzed in-hospital mortality and outcomes during the follow-up period. Results A total of 4959 patients were included. Over time, prevalence of DM was significantly raising among women with HF (50 to 53.2%) and descending among men (50% to 46.8%, p = 0.02). Total mortality and readmissions were higher in patients with DM during the and second periods. However, no significant differences were found in the third-one (HR 1.14, 95% CI 0.94–1.39, p = 0.181). A protector role of oral hypoglycemic medications was observed in this last period. According to the presence of KD, the patients with both DM and KD were who presented most of the events. Conclusions Over the time analyzed, the prevalence of DM raised among women and decreased among men. DM influenced the prognosis of HF except in the third period when more protective hypoglycemic drugs started to be used.

Frequency of Hypoglycemia in Cirrhotic Patients Undergoing Endoscopy.

Liver cirrhosis isthe replacement of normal liver parenchyma by fibrous tissue and nodularity. Cirrhosis liver has a negative effect on the body's ability to regulate blood glucose levels because the liver cannot release the amount of glucose it wouldultimately cirrhotic patients are atrisk of hypoglycemia. To determine the frequency of hypoglycemia in cirrhotic patients just before endoscopy after being nil per mouth (NPO) for 6 hours. This cross-sectional study was done at the Department of Gastroenterology Lady Reading Hospital, Peshawar from 1st April 2023 to 30th September 2023.Patients aged > 20 years of both genders, having Child-Pugh class C cirrhosis, and undergoing upper gastrointestinal (GI) endoscopy were enrolled in the study while patients with a history of diabetes using oral or parenteral hypoglycemic medications, patients taking steroids, patients with hepatocellular carcinoma and patients with hepatic encephalopathy were excluded. Diagnosis of liver cirrhosis was based on clinical examination, serum albumin level, and prothrombin time followed by characteristic findings on ultrasound. Serum glucose level was determined in the blood sample of the patient from the hospital laboratory. Results:One hundred and ninety-six patients were enrolled including 130 (67.4%) males and 66 (32.6%) females. Age of the patients ranged from 20 to 60 years. The mean age of the participants was 46.68±10.239 years. Hypoglycemia was found in 48% of patients with liver cirrhosis. A significant association of hypoglycemia was found with disease duration and Child-Pugh class. Hypoglycemia is a frequent finding in patients with liver cirrhosis and needs urgent management to prevent complications. Prolonged illness and patients with Child-Pugh class C cirrhosis are more likely to have hypoglycemia.

Ensemble machine learning for predicting in-hospital mortality in Asian women with ST-elevation myocardial infarction (STEMI)

The accurate prediction of in-hospital mortality in Asian women after ST-Elevation Myocardial Infarction (STEMI) remains a crucial issue in medical research. Existing models frequently neglect this demographic's particular attributes, resulting in poor treatment outcomes. This study aims to improve the prediction of in-hospital mortality in multi-ethnic Asian women with STEMI by employing both base and ensemble machine learning (ML) models. We centred on the development of demographic-specific models using data from the Malaysian National Cardiovascular Disease Database spanning 2006 to 2016. Through a careful iterative feature selection approach that included feature importance and sequential backward elimination, significant variables such as systolic blood pressure, Killip class, fasting blood glucose, beta-blockers, angiotensin-converting enzyme inhibitors (ACE), and oral hypoglycemic medications were identified. The findings of our study revealed that ML models with selected features outperformed the conventional Thrombolysis in Myocardial Infarction (TIMI) Risk score, with area under the curve (AUC) ranging from 0.60 to 0.93 versus TIMI's AUC of 0.81. Remarkably, our best-performing ensemble ML model was surpassed by the base ML model, support vector machine (SVM) Linear with SVM selected features (AUC: 0.93, CI: 0.89–0.98 versus AUC: 0.91, CI: 0.87–0.96). Furthermore, the women-specific model outperformed a non-gender-specific STEMI model (AUC: 0.92, CI: 0.87–0.97). Our findings demonstrate the value of women-specific ML models over standard approaches, emphasizing the importance of continued testing and validation to improve clinical care for women with STEMI.

Lifestyle Modification for Prediabetes through Ayurvedic Interventions – A Case Study

Diabetes Mellitus is a metabolic disorder caused by an unhealthy lifestyle. Pre-diabetes is an asymptomatic condition, where blood sugar levels are elevated but are not high enough to be classified as T2DM and is considered a high-risk state for the development of diabetes. The estimated prevalence of prediabetes in India is 14 %. Early diagnosis and intervention with lifestyle modification can reduce the risk of Diabetes Mellitus. In the present case study 53 yrs. female patient with a raised blood sugar level and HbA1C is 6.4% which shows a prediabetic condition is treated with Ayurvedic medicine and Lifestyle modification. Diet and Yoga were advised. Ayurvedic Intervention reduces the elevated blood sugar level with an HbA1C value is 5.6% in 3 months. Lifestyle modification prevents the further progression of disease. Ayurvedic Interventions with lifestyle modification effectively control blood sugar levels in prediabetic conditions without any oral hypoglycaemic medication.

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.