Poor Drug Compliance Research Articles

Post-transplant complications in alcohol- and metabolic-associated steatotic liver disease

Alcohol-associated liver disease (ALD) and metabolic-associated steatotic liver disease (MASLD)/metabolic-associated steatohepatitis (MASH) are severe liver diseases, with liver transplant being the primary curative treatment option. Transplant recipients with ALD suffer from alcohol use disorder (AUD) and poor drug compliance, which can result in graft injury and even graft loss. Relapse of alcohol consumption, lack of drug compliance, and smoking negatively impact the graft and clinical outcome of ALD-related transplantation patients. Furthermore, these patients are at a higher risk of developing non-hepatic complications such as malignancies, cardiovascular diseases, and other metabolic conditions. The management of these conditions requires pharmacological and behavioral strategies to manage complications as soon as they arise. Critical monitoring of these conditions is also advocated. In patients undergoing transplants for MASLD/MASH, early complications arise in obese and diabetic patients. Late post-transplant complications such as cardiovascular diseases, chronic kidney disease, recurring MASLD/MASH, immunosuppression, and arterial hypertension are reported. Integrating behavioral strategies with diet modification and physical activity is crucial to balance underlying metabolic disorders and improve clinical outcomes. Early steroid withdrawal and low calcineurin inhibitor doses can decrease the risk of post-transplant diabetes, hypertension, and dyslipidemia. Lifestyle modifications and tailored immunosuppression are helpful in the prevention and management of post-transplant recurrent MASLD/MASH.

An analysis of demographic, socio-economic and clinical variables for mental illness and mental illness relapse in south-east nigeria

Mental health has come into the front burner of development challenges amid declining socio-economic outcomes, especially in developing countries. Insecurity, conflicts and extremely threatening events, which trigger mental disorders, are common in South-East Nigeria, with many military operations, unknown gunmen attacks and kidnapping leading to the cold-blood assassination and kidnap of dear ones. The study aimed to analyze the demographic, socio-economic and clinical variables for mental illness in South-East Nigeria. Consecutive sampling technique was used to obtain a three-year records of the cases of 380 index and 180 post-index points data of mental illness cases that met the inclusion criteria in a purposively selected public mental health hospital. Data were analyzed using both descriptive and inferential statistics, including frequency count, percentages, chi-square and multinomial logistic regression. Results showed that over a half (55.0%) of the patients were males, and 65.27% had post-primary education. The mean age of patients was 39.87 years. Slightly above half of the cases (55.26%) were single and 56.84% were unemployed. Schizophrenia (68.42%) topped the list of the cases. The rate of relapse was 52.1%, with males being in the majority (61.62%). About 61.62% of those who relapsed were unemployed, 9.60% were into business/trading, and 5.05% were professionals. Those with 5 years and above illness duration had a higher percentage of relapse (52.02%) as well as those with poor drug compliance (66.16%). The mean relapse age was 34.23 years. Educational status, employment status/social class, marital status, and age were socio-economic/clinical factors that associated strongly with relapse at p-value of 0.10. Patients with ≥ 5 and ≤ 3 years duration of illness were 1.17 times on the average more likely to have relapse than those with three or less than 3 years. Onset age for illness predicted 2.479 times more likelihood of relapse. Being employed and having more family support, as against being unskilled/unemployed and not having family support, reduce the likelihood of relapse by 1.110 times on the average. The study recommended policy formulation and implementation for protection against mental illness and mental healthcare provision and access; for tackling unemployment head-on; for improvement of the access to effective treatment of mental illness; and mass education, especially among unemployed, uneducated, singles, and under-35 years of age, to help reduce the high rate of relapse of mental illness in South-East Nigeria.

The use of herbal medicine for hypertension in rural and urban Thailand: a cross sectional study

IntroductionUsing herbal medicine to treat hypertension is common in Thailand. However, there is variation in the use of herbs between rural and urban areas. This study aims to observe the prevalence of herb use, describe herb users’ behaviours, and describe anti-hypertensive drug compliance among the users. MethodsA cross-sectional survey among hypertensive patients visiting primary care services in Tak (rural) and Chiang Mai (urban) provinces was conducted between March and April 2019. Patients were assessed by using questionnaires that gathered information about patient demographic data, history of hypertension, herb use behaviours, and the concurrent use of standard treatment. ResultsIn total, 400 participants were included in this study—200 from rural and 200 from urban areas. Sixty-two percent were female. The prevalence of herb use was 13.0% in urban areas and 17.5% in the rural areas. Rural participants reported a significantly longer duration of herb use (P < 0.01), and a significantly higher proportion of using unapproved herbal products (91% vs 54%, P < 0.001). Participants mostly use herbs along with standard treatment (86.9%); nevertheless, poor drug compliance was similar in both areas, with rural participants more frequently taking their medications at the wrong time (P = 0.03). ConclusionThere was a trend of higher use of unapproved herbals in rural participants. Drug compliance among herb users was poor. It is recommended that a comprehensive assessment of herb use is conducted during care for hypertensive patients in this and similar contexts.

Nephrotic Syndrome: From Pathophysiology to Novel Therapeutic Approaches.

Nephrotic edema stands out as one of the most common complications of nephrotic syndrome. The effective management of hypervolemia is paramount in addressing this condition. Initially, "the underfill hypothesis" suggested that proteinuria and hypoalbuminemia led to fluid extravasation into the interstitial space, causing the intravascular hypovolemia and activation of neurohormonal compensatory mechanisms, which increased the retention of salt and water. Consequently, the recommended management involved diuretics and human-albumin infusion. However, recent findings from human and animal studies have unveiled a kidney-limited sodium-reabsorption mechanism, attributed to the presence of various serine proteases in the tubular lumen-activating ENaC channels, thereby causing sodium reabsorption. There is currently no standardized guideline for diuretic therapy. In clinical practice, loop diuretics continue to be the preferred initial choice. It is noteworthy that patients often exhibit diuretic resistance due to various factors such as high-sodium diets, poor drug compliance, changes in pharmacokinetics or pharmacodynamics, kidney dysfunction, decreased renal flow, nephron remodeling and proteasuria. Considering these challenges, combining diuretics may be a rational approach to overcoming diuretic resistance. Despite the limited data available on diuretic treatment in nephrotic syndrome complicated by hypervolemia, ENaC blockers emerge as a potential add-on treatment for nephrotic edema.

Clinicodemographic Profile Of Recurrent Stroke And Secondary Prevention At Tertiary Care Centre Of North-West India

Background and Aims: Stroke is a major public health problem worldwide. The risk of recurrence is highest in the first year after the stroke, majority of the recurrent cases are due to atherosclerosis of the large arteries. The present study was conducted to evaluate clinico-bio-demographic profile of recurrent stroke patient in respect of risk factor and secondary prevention of stroke. Methods: A hospital-based cross-sectional study was conducted on 300 recurrent ischemic/hemorrhagic stroke (age 18-85 yrs.) from August 2015 to March 2017. Stroke mimic were excluded. Risk factors studied were hypertension, diabetes mellitus, hyperlipidemia, cardiac causes and cigarette smoking. Results: Mean age of recurrent stroke was 60±13 years with male preponderance (M: F=5.3). Ischemic stroke was found in 93% cases. About one third (33%) patients had their first recurrence within three months of index stroke. Active smoking, uncontrolled hypertension and diabetes were found in 71%, 62%, and 65 % cases respectively. There was association between first ever stroke and recurrence showing P value &gt; .05, &lt;.001 and &lt;.01 for uncontrolled hypertension, diabetes and active smoking respectively. Extra cranial stenosis (&gt;70%) was found in 29% of recurrent stroke. Out of all stroke cases 40% were drug defaulters. Conclusions: In our study commonest cause of recurrent stroke was active smoking followed by uncontrolled diabetes, uncontrolled hypertension, poor drug compliance and symptomatic carotid stenosis. Frequency of recurrence was more within 3 months.

Health Literacy in People Living with Human Immunodeficiency Virus Infection: A Narrative Review

Overall literacy talents comprise an individual’s capacity to read, write and recognise written information (print literacy), articulate and interpret oral language (oral literacy) and interpret and apply for numbers in everyday activities (numeracy). Health literacy, a subset of overall literacy talents, is relatively correlated with it and has been described as the extent to which people can gain, approach, and understand introductory medical information and services required to take health decisions. Concerning HIV, people with low health literacy have less information on the illness and their medical care needs. Moreover, they show poor drug compliance, potentially leading to treatment failure and lack of achievement of the target viral load reduction. The shortfall of non-conceptual models of health literacy is an issue in the utilization of general proficiency instruments. HIV disease-specific health literacy instruments would be more useful and likely to provide more meaningful results rather than those obtained through the use of general instruments. Further exploration of HIV health literacy is demanded. Prospective studies should involve different geographical areas with different socioeconomic characteristics, societal structures and regional healthcare settings. This narrative review has limitations. The vast majority of the HIV research referenced in this study was conducted among the western and African populations with HIV. The studies generally excluded individuals over 50 years of age, restricting the applicability of the study findings.

A case of Graves' disease relapse with high immunologic activity and recurrent refractory course precipitated by poor drug compliance - influence of carbimazole compliance on immunogenic activity

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Metformin Adherence Reduces the Risk of Dementia in Patients With Diabetes: A Population-based Cohort Study

ObjectiveMetformin is widely used as the first-line drug for type 2 diabetes mellitus and has numerous benefits apart from lowering blood glucose. However, metformin-retained regimen is challenged by newly launching, powerful glucose-lowering antiglycemic agents. This population-based cohort study examined the association between metformin adherence and the risk of dementia and Parkinson’s disease (PD). MethodsDiabetic patients with metformin-included combination antiglycemic therapy were identified from the National Health Insurance Research Database and categorized into metformin-adherent and -nonadherent groups according to the medical record of the first year prescription. Patients contraindicated with metformin, severe diabetic complications, and poor drug compliance were excluded. The study outcome was the diagnosis of dementia or PD. ResultsA total of 31 384 matched pairs were included after using propensity score matching and both groups were followed up for an average of 5 years. Metformin adherence was associated with a significantly lower risk of dementia (adjusted hazard risk ratio = 0.72, P < .001) but not PD (adjusted hazard risk ratio = 0.97, P = .825). Subgroup analysis revealed that the risk of dementia was significantly reduced in metformin-adherent patients, both male and female, aged >65 or ≤ 65 years, and with or without concurrent insulin treatment. This effect was not influenced by concurrent insulin treatment, which may eliminate the bias caused by the severity of diabetes mellitus. ConclusionDespite the launching of numerous new oral antiglycemic agents, metformin may provide further benefit on lowering risk of dementia beyond conventional glycemic control according to the real-world evidence.

Fitness to re-join job: Neuropsychiatric perspective.

Evaluating "Fitness to Re-join Job" and certification in persons with Neuro-Psychiatric Disorders is an indispensable professional responsibility. However, there is little documented guidance on clinically approaching this particular issue. This study aimed to study the sociodemographic, clinical, and employment profile of patients who sought fitness to re-join their job from the tertiary neuropsychiatric center. This study was carried out at the National Institute of Mental Health and Neurosciences in Bengaluru, India. A retrospective chart review was adapted for the purpose. One hundred and two case files referred to medical board for fitness to rejoin the duty were reviewed from January 2013 to December 2015. Apart from the descriptive statistics, the Chi-square test or Fisher exact test was used to test the association between categorical variables. Patients' mean (standard deviation) age was 40.1 (10.1) years; 85.3% were married, and 91.2% were male. Common reasons for seeking "fitness certification" were work absenteeism (46.1%), illness affecting the work (27.4%), and varied reasons (28.4%). The presence of neurological disorders, sensory-motor deficits, cognitive decline, brain damage/insult, poor drug compliance, irregular follow-ups, and poor or partial treatment response were associated with an unfitness to rejoin the job. This study shows that work absenteeism and the impact of illness on work are common reasons for referral. Irreversible neurobehavioural problems and deficits impacting work are common reasons for unfitness to rejoin the job. There is a need for a systematic schedule to assess the fitness for the job in patients with neuropsychiatric disorders.

Polymorphisms Affecting the Response to Novel Antiepileptic Drugs.

Epilepsy is one of the most frequent chronic neurologic disorders that affects nearly 1% of the population worldwide, especially in developing countries. Currently, several antiepileptic drugs (AEDs) are available for its therapy, and although the prognosis is good for most patients, 20%-30% amongst them do not reach seizure freedom. Numerous factors may explain AED-resistance such as sex, age, ethnicity, type of seizure, early epilepsy onset, suboptimal dosing, poor drug compliance, alcohol abuse, and in particular, genetic factors. Specifically, the interindividual differences in drug response can be caused by single nucleotide polymorphisms (SNPs) in genes encoding for drug efflux transporters, for the brain targets of AEDs, and for enzymes involved in drug metabolism. In this review, we used the PubMed database to retrieve studies that assessed the influence of SNPs on the pharmacokinetic (PK), pharmacodynamic (PD), and efficacy of new antiepileptic drugs. Our results showed that polymorphisms in the ABCB1, ABCC2, UGT1A4, UGT2B7, UGT2B15, CYP2C9, and CYP2C19 genes have an influence on the PK and efficacy of AEDs, suggesting that a genetic pre-evaluation of epileptic patients could help clinicians in prescribing a personalized treatment to improve the efficacy and the safety of the therapy.

Epidemiology and Risk Factors of Convulsive Status Epilepticus Patients Admitted in the Emergency Department of Tertiary Hospital in Mogadishu, Somalia.

Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu. This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0-18 years) and adult group (18 years and above).Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated. The mean age for pediatric patients was 6 (SD±4.7), while the mean age for adult patients was 38 (SD±10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years. CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.

3.101 Does Lithium With Antipsychotics Make Children and Adolescents With Bipolar Disorder Gain Weight?

Bipolar disorder in children and adolescents is a serious illness with a chronic course and a high recurrence rate. Drug compliance issues are very important to maintain therapy. Most antipsychotics and mood stabilizers cause weight gain and lead to poor drug compliance. Mood stabilizers and antipsychotics are usually used for treating bipolar disorder. However, weight gain is an adverse effect of these drugs. In this study, we tried to investigate whether lithium with antipsychotics causes more weight gain than lithium monotherapy and to determine which mood stabilizer causes more weight gain.

Forensic Analysis of 9 Cases of Sudden Unexpected Death in Epilepsy.

To analyze the case, scene and forensic pathological characteristics of sudden unexpected death in epilepsy (SUDEP), to provide a practical basis for forensic identification. A total of 9 autopsy cases of SUDEP were collected. The basic information of the cases, the scene characteristics, the forensic pathological changes, the common drugs and antiepileptic drug test results, and pericardial fluid biochemical test results were analyzed. All of the 9 cases were male epilepsy patients died during sleep at night, the age of death was (37.1±8.6) years, and the course of epilepsy was (21.3±5.6) years. Six corpses were in prone position and three in left lateral position. The hemorrhage of the sternocleidomastoid muscle, sternal thyroid muscle and sternohyoid muscle were found with 8 cases, 5 cases and 4 cases, respectively, all of them were unilateral. Six cases had bilateral hemorrhage of pectoralis minor muscle. Brain edema, phagocytosis of frontotemporal neurons and gliosis, cardiac fibers bend in wavy patterns and eosinophilic staining enhancement, pulmonary edema, pulmonary congestion, alveolar hemorrhage, pulmonary small bronchiole wall shrinking, tubular proteinuria and pancreatic parenchymal hemorrhage were the common histopathological changes. The biochemical test results of pericardial fluid indicated that there were myocardial ischemic damage. Young male, early onset, long course of disease, sleep in the prone position, poor drug compliance or combination, epileptic seizure may be the risk factors of SUDEP. Cardiac dysfunction and respiratory depression might be the main death mechanism of SUDEP.

Bipolar bozukluk tip I hastalarının tedavisinde uzun etkili antipsikotiklerin klinik kullanımı

Purpose: This study aims to determine the usage frequency of long-acting injectable antipsychotics among bipolar disorder type 1 patients who presented to the Dicle University Faculty of Medicine Psychiatry and Mental Health outpatient clinic, the clinical characteristics of these patients, and the preferences of clinicians about these agents. &#x0D; Materials and Methods: Our study included 111 patients older than 18 years old with bipolar disorder. The ’data of the patients were retrospectively obtained from electronic data records. The data were recorded in the data collection form prepared by the researchers with the support of the literature. &#x0D; Results: The rate of the patients who used long-acting injectable antipsychotics was 21.6%. Among the patients who used long-acting injectable antipsychotics, the rate of those who used second-generation long-acting injectable antipsychotics was 58.3%, and the most frequently preferred agent was paliperidone palmitate. The patients who were using long-acting injectable antipsychotics had significantly higher rates of not working and numbers of hospitalizations.&#x0D; Conclusion: Our results showed that long-acting injectable antipsychotics are preferred by clinicians in our outpatient clinic in the later stages of bipolar disorders and for patients with poor drug compliance, poor functionality, and more hospitalizations. Starting long-acting injectable antipsychotics in the early stages of bipolar disorders, even following the first attack, may increase treatment compliance, reduce the duration of hospitalization, and contribute to the functionality of patients.

The effects of information platform-based nursing on preventing venous thromboembolism in patients with hip fractures

PurposeVenous thromboembolism (VTE) is a major health issue among hip fracture patients. This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient's drug compliance and reduce the incidence of VTE in hip fracture patients. MethodsThis study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform (study group) between January 2016 and September 2017. All the patients included in the both groups were hip fracture patients who had an age over 50 years, treated with surgery, and hospitalized ≥ 48 h. Patients were excluded if they admitted to hospital due to old fractures, had a severe bleeding after 72 h of admission, diagnosed with any type of VTE, or refused to participate in the study. The information platform was divided into medical, nursing, and patient interface. Based on the information platform, medical practitioners and nurses could perform risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up, and other aspects of nursing interventions for patients. This study compared essential characteristics, drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. SPSS 18.0 software (IBM Corp., NY, and USA) was used for statistical analysis. ResultsAltogether 1177 patients were included in the control group, and 491 patients in the study group. Regarding baseline data, patients in the study group had more morbidities than those in the control group (p < 0.05). The difference of drug compliance between the two groups was statistically significant (p < 0.001): 761 (64.7%) of the patients in the control group and only 30 (6.1%) patients in the study group had poor drug compliance. In terms of VTE, 10.7% patients (126/1177) in the control group had VTE, and the rate in the study group was 7.1% (35/491), showing a statistically significant difference (p = 0.02). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 days vs. 13.7 days, p < 0.001). Subgroup analyses of the study group showed that the incidence of VTE in patients with poor, partial, and good compliances were 56.7% (17/30), 5.8% (10/171), and 2.8% (8/290), respectively, revealing a significantly huge difference (p < 0.001). ConclusionsPoor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE. The mobile application may be an effective tool to prevent VTE in hip fracture patients.

Probiotics for gallstone prevention in patients with bariatric surgery: A prospective randomized trial

Gall stone disease was known to increase after bariatric surgery. Ursodeoxycholic acid (UDCA) might reduce the gallstone formation rate after bariatric surgery. However, other option for gallstone prevention was unclear. We reported the result of a randomized trial comparing the gallstone prevention efficacy of probiotics and digestive enzyme versus UDCA. This prospective, randomized trial was held in an institute of Taiwan. Patients were eligible for inclusion if their body-mass index (BMI) was 32.5kg/m2 or higher with the presence of comorbidity, or 27.5kg/mw or higher with not-well controlled type 2 diabetes, and were aged 18-65 years. Participant were randomized assigned (1:1:1) to probiotic, digestive enzyme or UDCA. The primary endpoint was assessed in the incidence of gallstone disease at 6 months after surgery. This study is registered with ClinicalTrials.gov. number NCT03247101, and is now completed. From January 2016 to December 2018, of 186 patients screened for eligibility, 152 were randomly assigned to probiotic (52) or digestive enzyme (52) or UDCA (52). In the per-protocol population, mean age was 35.9 years (SD 10.6), mean BMI was 40.3kg/m2 (SD 6.9), 57(58.2%) were female. After 6 months, the incidence of gall bladder diseased was 15.2%, in the probiotics group, 17.6% in UDCA group and 29.1% in digestive enzyme groups, confirming non-inferiority of probiotic (p=0.38). Female gender was identified as a risk factor for gall bladder disease after bariatric surgery (odds ratio=4.61, 95% confidence interval=1.05, 20.3, p=0.04). The poor drug compliance rate was 19.5%, 22.7% and 26.2% in probiotics, UDCA and digestive enzyme group respectively. UDCA group had a higher drug adverse effect than probiotic group (15.9% vs. 2.4%, p=0.03). Probiotic is not inferior to UDCA regarding gall bladder disease prevention after bariatric surgery at 6 months.

Abstract- Poster

Abstract- Poster

Pharmacokinetic Evaluation of a Novel Donepezil-Loaded Dissolving Microneedle Patch in Rats.

Research on the development of dissolving microneedles (DMNs) has focused on bolus drug delivery, with little attention on sustained release. Here, we evaluated the sustained release, absorption pattern, and effective drug permeation of a novel donepezil-loaded DMN patch through an in vivo investigation on rats. The applications of DMN patches to the shaved skin of rats for 1 week and 1 h were compared with oral donepezil administration to assess their sustained release capabilities. We used a validated liquid chromatography–tandem mass spectrometry method to quantify donepezil in the plasma. We found that the microneedle arrays effectively delivered donepezil across the skin, with dissolution observed within 1 h of application. Furthermore, skin irritation test showed that the patches produced no irritation response. The DMN arrays also effectively increased drug permeation and demonstrated sustained release and absorption of donepezil from DMN patches. These patches allow extended dosing intervals, reduced gastrointestinal adverse effects, and convenient self-administration to mitigate poor drug compliance, making them beneficial for the treatment of elderly patients with Alzheimer’s disease.

High-dose dual therapy versus bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection - A review of the strengths, weaknesses, and proposed solutions.

ABSTRACTHelicobacter pylori is the principal cause of peptic ulcers, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. The first treatment to H. pylori infection is dual therapy (a bismuth compound plus metronidazole). On the launch of omeprazole in 1988, dual therapy became omeprazole and amoxicillin (low dose). The poor H. pylori eradication rates by either bismuth-based or low-dose dual therapy drove more combinations of antibiotics were needed. Antibiotic resistance, especially clarithromycin and metronidazole, has made bismuth-containing quadruple therapy (BCQT) a savior for first-line and second-line treatments. However, its complicated dosing regimen commonly causes more adverse events and poor drug compliance. Thus, high-dose dual therapy (HDDT) has been re-arising. This article reviews the strengths and weaknesses of HDDT versus BCQT with proposed solutions.

Assessment of Vitamin B12 Deficiency Caused by Metformin in Type II Diabetic Patients

Metformin use over time reduces vitamin B12 levels, according to several studies, and its clinical manifestation can be mistaken as diabetic peripheral neuropathy. In order to investigate vitamin-B12 deficiency in type II diabetic patients with long-term metformin treatment, a link between vitamin B12 and peripheral neuropathy, and to evaluate the quality of life in (T2DM) patients, the current study was done. At Sree Balaji Medical College and Hospital's outpatient and inpatient departments, a prospective observational case-control research was done. The study included 35 healthy volunteers (controls) and 35 Type 2 diabetes patients who had been on metformin for more than six months (cases). Patients' venous blood samples were collected in K2 EDTA vacutainers and centrifuged at 1500 rpm for 10 minutes, settled plasma was transferred into cryo-vials, and parameters such as Vitamin-B12, HbA1c, and CBP were estimated and this is used to conduct the statistical analysis. The prevalence of blood vitamin B12 deficiency and borderline deficiency in T2DM patients is 20.5 percent, while the mean HbA1C values in our study T2DM subjects are 9.07 percent, indicating either poor diabetes control or poor metformin drug compliance. Vitamin B12 insufficiency was found in 83 percent of T2DM patients who had been using metformin for 1 to 10 years. The reliability test was used to assess their quality of life, and the results revealed that the study participants' quality of life was poor.