Evaluating the effect of antidiabetic treatment on haemostatic and fibrinolytic parameters among type 2 diabetics in Ilorin, Nigeria

Background:Type 2 Diabetes Mellitus is a disease of epidemic proportions and many patients are at a great risk of premature mortality and complication of atherothrombotic disorders affecting coronary, cerebral and peripheral arterial trees. Increased Plasminogen Activator Inhibitor Type 1 inhibits fibrinolysis and predicts cardiovascular risk in those living with Type 2 Diabetes. This study aimed to determine the effect of antidiabetic treatment on haemostatic and fibrinolytic parameters among Type 2 Diabetic subjects in Ilorin.Methods:This was a comparative cross-sectional study involving 78 Type 2 diabetic patients, (39 treatment naïve, 39 treatment experienced). Full blood count was performed using Sysmex XP300 while Prothrombin time was determined using one stage test of Owren. Activated partial thromboplastin time was determined by method of Proctor and Rapaport. Fibrinogen and Plasminogen Activator Inhibitor type-1 were assayed using AssayMax Human Fibrinogen ELISAand AssayMax Human PAI-1 ELISAkit. Data Analysis was done using SPSS version 25.0.Results:Mean PAI-1 levels were significantly higher in treatment naïve diabetics when compared to treatment experienced diabetics (2.44 ±2.57 vs 2.51±1.47 ng/ml p=0.002) as were fibrinogen levels (434.65±366.15 vs 482.24± 299.64mg /dl; p = 0.048). PAI -1 levels were lowest among diabetics treated with Metformin + DPP4 inhibitors, while fibrinogen levels were lowest among those treated with Metformin + sulfonylurea combination.Conclusion:Oral hypoglycaemic treatment, combination therapy in particular, improves fibrinolysis in type 2 diabetics thereby reducing the risk of cardiovascular disease in type 2 diabetes mellitus patients

Etude de la variation de l'épaisseur centrale de la cornée au cours d'une hyperglycémie de novo / Study of the variation of the central thickness of the horn during de novo hyperglycemia

Introduction : L'épaisseur centrale de la cornée peut être modifiée au cours d'une hyperglycémie chronique. En dehors d'une hyperglycémie chronique, nous pensons que les modifications de l'épaisseur cornéenne surviennent également lors des hyperglycémies de novo.Objectif: Déterminer la variation de l'épaisseur centrale de la cornée au cours d'une hyperglycémie de novo.Patients et Méthodes : Il s'agissait d'une étude observationnelle et transversale à visée analytique réalisée de juillet à novembre 2021, auprès de 222 personnes (444 yeux) présentant une hyperglycémie récente. L'ECC a été comparée entre le moment du diagnostic (J0) et 30 jours (J30) après l'initiation du traitement hypoglycémiant (Chi-2). La variation de l'ECC entre J0 et J30 a été corrélée à celle de la glycémie (Spearman ; p<0,05).Résultats : A J0, la moyenne de l'ECC était de 552,5±39,2 µm contre 538,0±34,2 µm à J30 (p=0,001) et celle de la glycémie de 18,1±8,2 mmo/L contre 6,9±3,0 mmol/L (p = 0,001). A J0, 57,0% avaient une ECC > 550µm et à J30, 19,4% avaient diminué cette épaisseur entre 520 et 550 µm et 3,4% à moins de 520 µm. Sur un effectif de 444 yeux, 28,2% (n = 125) ont diminué leur ECC de 25 µm et plus après initiation du traitement hypoglycémiant. Aucune corrélation n'existait entre la variation de l'ECC et celle de la glycémie (r=0,018; p=0,704).Conclusion : Ces résultats montrent qu'il existe une variation de l'ECC en cas de déséquilibre glycémique récent

Introduction : The central thickness of the cornea can be changed during chronic hyperglycemia. Apart from chronic hyperglycemia, we believe that changes in corneal thickness also occur during de novo hyperglycemia.Objective: To determine the variation in the central thickness of the cornea during de novo hyperglycemia.Patients and Methods: This was an observational and cross-sectional analytical study conducted from July to November 2021, involving 222 people (444 eyes) with recent hyperglycemia. ECC was compared between the time of diagnosis (D0) and 30 days (Day 30) after initiation of hypoglycemic (Chi-2) therapy. The change in ECC between J0 and J30 was correlated with that of blood glucose (Spearman ; p<0,05).Results: ON D0, the mean ECC was 552.5±39.2 µm versus 538.0± 34.2 µm on D30 ( p=0.001) and the blood glucose mean was 18.1±8.2 mmo/l versus 6.9±3.0 mmol/l ( p=0.001). On D0, 57.0% had an ECC ˃ 550µm and on D30, 19.4% had decreased this thickness between 520 and 550 µm and 3.4% to less than 520 µm. On a population of 444 eyes, 28.2% ( n=125) decreased their ECC by 25 µm and more after initiation of hypoglycemic therapy. There was no correlation between the change in ECC and the change in blood glucose (r=0.018; p=0.704).Conclusion : These results show that there is a variation in ECC in case of recent glycemic imbalance

Antidiabetics and antihypertensive medications use in Morocco: a pharmacoepidemiological descriptive study

Background: In Morocco, and many other African countries, there is a paucity of antihypertensive and antidiabetics use amongst the general population. Aim: To investigate the epidemiological profile of antihypertensive and antidiabetics use and analysis their adverse reactions. Setting: This study was conducted in the prefecture of Figuig, Morocco. Methods: A cross-sectional descriptive study. Data was collected using semi-structured questionnaire about their pharmacological treatment and presented using descriptive statistical analysis. Results: Sample of 244 subjects, predominantly women 58.15% (p < 0.03) composed of diabetic patients 56.96% (n = 139) and hypertensive patients 43.03% (n = 105). After adjustments, 60.24% of all patients were under monotherapy. The diabetics were being treated using the Biguanide class (26.92%), insulin (20.0%) and sulfonylureas (10.0%) while hypertensive patients were treated by Calcium Channel Blockers (27.36%), Angiotensin Converting Enzyme Inhibitors (21.05%), Angiotensin T-Blockers (16.84%), Diuretics (7.36%) and ß-adrenergic receptors blockers (3.15%). In total, 23.00% of all subjects have experienced negative side-effects, mostly, reported (90.38%) to health professionals and 23.52% of them have interrupted temporarily or try to change their treatment. Gastro-intestinal problems were the most adverse reactions reported (11.11%) followed by headache, dizziness and tinnitus (6.66%) and asthenia, feeling sick and feeling of faintness (5.33%). Conclusion: Managing diabetes and hypertension entails a lot of public challenges and requires more focus and interest, especially amongst the illiterate population in remote areas. Some of the suggested ways to help face the problem include the introduction of new innovative measures, systems of fellow-up and adverse reactions

Accuracy and precision of four main glucometers used in a Sub-Saharan African Country: a cross-sectional study

Introduction: capillary glucose measurement using point-of-care glucometers is an essential part of diabetes care. We determined the technical accuracy, clinical accuracy and precision of commonly available glucometers against standard spectrophotometry in Cameroon.Methods: a sample of four glucometers was selected. In the 108 diabetic and non-diabetic participants, blood glucose values obtained by glucometers were compared to the reference laboratory method to determine their technical and clinical accuracies. Precision was determined by repeated measurements using standard solutions of different concentrations.Results: accu-Chek® Active, CodeFree™, Mylife™ Pura™ and OneTouch® Ultra® 2 values had correlation coefficients of 0.96, 0.87, 0.97 and 0.94 respectively with reference values, and biases of 18.7%, 29.1%, 16.1% and 13.8% respectively. All glucometers had ≥ 95% of values located within the confidence limits except OneTouch® Ultra®2. Accu-Chek® Active, CodeFree™, Mylife™ Pura™ and OneTouch® Ultra® 2 had 99%, 93.1%, 100% and 98.0% of values in Parke's zones A and B. The coefficients of variation of the glucometers were all below 5% at all standard concentrations, except for Accu-Chek® Active for glucose concentrations at100 and 200mg/dL.Conclusion: no glucometer met all the international recommendations for technical accuracy. Accu-Chek™ Active and Mylife™, Pura™ met the International Organization for Standardization 2013 recommendations for clinical accuracy based on Parke's consensus error grid analysis. All glucometers assessed except Accu-Chek® Active showed a satisfactory level of precision at all concentrations of standard solutions used

Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using interviewer-administered questionnaires were analyzed using SPSS version 20.0, and pvalue <0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26­70 years. The majority of the study subjects (72%) were in the active working age group (25­60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized

Optimal Utilisation of Sulphonylureas in Resource-Constrained Settings :Review

Sulphonylureas (SUs) are oral anti-diabetic drugs (OADs) that were introduced more than 60 years ago. Clinicians are familiar with their use and they remain extensively used. However; the SU class is associated with adverse effects of weight gain and hypoglycaemia. In addition; their effects on cardiovascular events remain contentious. Newer classes of anti-diabetic agents have been developed and these agents are weight neutral (di-peptidyl peptidase IV inhibitors); while others reduce weight (glucagon-like peptide analogues and sodium glucose co-transporter inhibitors). Furthermore; the newer agents are less likely to cause hypoglycaemia and have a potentially better cardiovascular safety profile. However; the newer agents are more costly than SUs and their long-term safety is unknown. It is therefore likely that SUs will continue to be used; and more so in resource-limited settings. One may mitigate the adverse effects of weight gain and hypoglycaemia associated with the SU class by using members within this class that are less probable to cause these adverse effects. Furthermore; the specific SU must be used at the lowest effective therapeutic dose. In patients at high risk of SU-induced hypoglycaemic episodes (frail; clinically significant renal impairment); or patients in whom hypoglycaemic episodes may have devastating effects (bus drivers); newer anti-diabetic agents may be a justifiable alternative option

Production des medicaments traditionnels ameliores au Cameroun : cas d'un hypoglycemiant oral

Introduction/but de l'etude.Le diabete est une affection metabolique chronique; multifactorielle; aux complications fatales en recrudescence dans le monde en general et au Cameroun en particulier. Le cout eleve des traitements conventionnels; ainsi que la modicite des revenus des populations suscitent depuis quelques annees; un interet croissant et une forte demande pour les medicaments traditionnels a base de plantes. Cet enorme potentiel medical souffre malheureusement du manque de preuves scientifiques de l'innocuite et de l'efficacite therapeutique de ces phytomedicaments. Methodes:Des etudes ethnobotaniques et ethnopharmacologiques et des analyses de laboratoire realisees sur Laportea ovalifolia ont permis d'etablir la preuve de son innocuite et la confirmation de ses activites hypoglycemiantes chez les rats. Le choix de la recette a base de cette plante parmi tant autres recensees au Cameroun en 2008 a ete fait a travers les indices de credibilite. Resultats:Cette recette a permis de produire un medicament traditionnel ameliore (MTA) antidiabetique sous quatre formes : les comprimes; les gelules; la poudre en sachets et le solute buvable. Conclusion: La determination de la posologie et le conditionnement non reconnus en medecine traditionnelle et obeissant aux methodes de fabrication modernes des formes galeniques; facilitent l'administration et la conservation du produit

Pattern of diabetic retinopathy in Kano, Nigeria

BACKGROUND:The aim of the study is to determine the pattern of retinopathy seen in diabetic patients attending the outpatient clinic in Aminu Kano Teaching Hospital, Kano, Nigeria. MATERIALS AND METHODS: Consecutive patients who were attending the diabetic clinic and who consented were examined over a three-month period. Information obtained includes patient's bio data, type and duration of disease, and findings on eye examination. The fundus was examined with direct and indirect ophthalmoscopes, +90 D with slit lamp and fundal photography. Retinopathy was graded using the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDRDSS). RESULTS: A total of 214 patients were examined during the study period. There were 88 males and 126 females (M: F = 1: 1.43). The mean age of the study population was 52.14 ± 13.23 years. The mean age of patients without diabetic retinopathy (DR) was 49.14 ± 13.17 years and the mean age of patients with DR was 58.51 ± 10.94 years. Forty nine patients (23%) had insulin-dependent diabetes mellitus (IDDM) while 165 patients (77%) had non insulin dependent diabetes mellitus (NIDDM). There was statistically significant difference in presence of retinopathy in patients with IDDM compared to those with NIDDM [X(2) =29.77 {95% CI}, P=0.000]. DR was significantly more common in patients with disease duration of 15 years or more compared with those with disease duration of 14 years or less [X(2) = 65.85, {95% CI} P= 0.000]. Based on ICDRDSS scale, 136 patients (64%) had no retinopathy and 78 patients (36%) had retinopathy. Some patients were visually impaired and the cause of blindness was DR in 6 patients (2.8%). Cataract and glaucoma were the cause in 6 patients (2.8%).CONCLUSION:Diabetic retinopathy is common in our environment and is more frequent in IDDM and those with long disease duration. DR is a cause of visual disability although diabetic patients are not exempted from blindness from other eye diseases such as cataract and glaucoma. A screening program needs to be developed to facilitate early detection and prompt treatment

Clinical Hypoglycemic Effects of Allium Cepa (Red Onion) in Type 1 Diabetic Patients

Background: Type 1 diabetes mellitus is an autoimmune disease caused by destruction of pancreatic islet beta cells and characterized by defect in insulin secretion. Objectives: The present study was carried out to investigate the hypoglycemic effects of Allium cepa in patients with type 1 diabetic patients. Results: In the assessment of the hypoglycaemic activity of Allium cepa in type 1 diabetic patients (n=21); crude Allium cepa (100g) caused a considerably lowered value in the fasting blood glucose levels by about 89 mg/dl in relation to insulin (145 mg/dl) after 4 hours. Also the ingestion of crude Allium cepa by type 1 diabetic patients produced a significant reduction in the induced hyperglycemia (GTT) by about 120 mg/dl in relation to water (77 mg/dl) and the standard drug insulin (153 mg/dl). Conclusion: Crude Allium cepa produced hypoglycemic effects; thus it could be used as a dietary supplement in management of diabetes

The Mechanism of Action of the Oral Anti-Diabetic Drugs: a Review of Recent Literature

Type 2 diabetes mellitus (DM) is a disorder that is placing an increasing burden on health service delivery worldwide. Consequently; it has become increasingly important that physicians who treat such patients have a good knowledge of antidiabetic drugs that are currently available or will come onto the market. This article presents an overview of all the major drug classes as well as some information on pharmacokinetics; pharmacodynamics; side-effect profiles and indications for use

Effect of Centella Asiatica Extract on Nociception; Experimental Diabetes and Hyperlipidemia in Mice and Rats

This study was undertaken to determine the effect of Centella asiatica aqueous extract (CAEt) on nociception; experimental diabetes and hyperlipidemia in mice and rats. The extract was administered orally and the effects of different doses of the extract on nociception in mice; on blood glucose; glucose-6-phosphatase; and serum and tissue lipids in rats with alloxan-induced diabetes were studied. Diclofenac and chlopropamide were used as standard drugs for nociception and diabetes; respectively. The doses of extract administered were 150; 300; 500 mg/kg body weight. The data obtained indicated that the aqueous extract of Centella asiatica exhibited anti-nociceptive activity in mice. Results of the anti-diabetic study indicated that the extract suppressed the elevated blood glucose. In anti-hyperlipidemic study; lipid levels didn't change in diabetic rats treated with CAEt. These findings show that the extract possesses anti-nociceptive and anti-diabetic activities

Antidiabetic Effect of Ceiba Pentandra Extract on Streptozo-Tocin-Induced Non-Insulin-Dependent Diabetic (niddm) Rats

The aim of this work was to investigate the effect of daily oral administration of root bark methylene chloride/methanol extract of Ceiba pentandra (Linn) in streptozotocin-induced type-2 diabetic rats; and the effect of this treatment on the physiological and metabolic parameters that are related in diabetic animals. The diabetic rats were separated into four groups and each given the following samples by gavage; daily for 28 days: vehicle (diabetic control); Ceiba pentandra extract at the dose of 40 mg/kg; Ceiba pentandra extract at the dose of 75 mg/kg and glibenclamide (5 mg/kg). All the parameters were also determined in healthy (non diabetic) rats for comparison. The methylene chloride/methanol extract of Ceiba pentandra treatment significantly reduced the intake of both food and water as well as the levels of blood glucose; serum cholesterol; triglyceride; creatinine and urea; in comparison with diabetic controls. The treatment also improves impaired glucose tolerance but no effect was observed in the level of hepatic glycogen. The effect of Ceiba pentandra (40 mg/kg) was more prominent when compared to glibenclamide in lowering blood glucose; with the added benefit of considerably reducing serum cholesterol and triglyceride concentrations. The results of this experimental animal study indicated that Ceiba pentandra possesses antidiabetic activity; and thus is capable of ameliorating hyperglycaemia in streptozotocin-induced type-2 diabetic rats and is a potential source for isolation of new orally active agent(s) for anti-diabetic therapy

Investigation into the Prescribing Patterns and Cost of Antidiabetic Medicine in South Africa

"The general objective of this study was to investigate the prescribing patterns and cost of antidiabetic medicine in the private health care sector in South Africa by using a medicine claims database. A quantitative; retrospective drug utilisation study was performed on data for the year 2004. Oral antidiabetic medicine accounted for 81 (n =143 447) and 39 (R29 734 360.61) respectively of the total prevalence and cost of all antidiabetic products prescribed. Metformin was the most frequently prescribed oral antidiabetic medicine; with an average cost of R58.42 (SD = 31.78). The three most frequently prescribed classes of insulin (insulin lispro; soluble insulin and isophane; and soluble insulin aspartame and protamine) together accounted for 63 of all the insulin prescribed; and 67 of the total cost of prescribed insulin. Almost 39 (n = 62 717) of the ""combination therapy"" prescriptions were for a sulfonylurea in combination with a biguanide plus at least one other antidiabetic product. A trend towards combination therapy away from monotherapy was observed. Prescribed Daily Doses (PDDs) calculated for oral antidiabetic medicines were more or less in line with recommended treatment guidelines. Drug utilisation review studies thus provide valuable insight into the treatment of diabetes - indicating areas of possible over- and under usage; providing decision-makers with critical information to curb unnecessary costs."

Antidiabetic and hypolipidemic effects of Laportea ovalifolia (urticaceae) in alloxan-induced diabetic rats

Laportea ovalifolia (Scham and Thonn) is widly use in Cameroon for the treatment of diabetes mellitus. The present study was designed to evaluate the antidiabetic and hypolipidaemic effects of aqueous extract of Laportea ovalifolia aerial part in normal and alloxan diabetic rats. Diabetes was induced by intraperitoneal injection of alloxan (150 mg kg -1 body weight). The treatment was given for 2 weeks. After the treatment a significant reduction was observed in fasting serum glucose levels in the treated diabetics rats. L. ovalifolia treatment showed considerable lowering of serum total cholesterol; triglycerides; LDL cholesterol; T.C/HDL.C and an increase in HDL cholesterol in the treated diabetic group. These results suggest that the Laportea ovalifolia aqueous extract of the aerial part possesses antidiabetic and hypolipideamic effects in alloxan-induced diabetic rats