Variability in the therapeutic response of metformin treatment in patients with type 2 diabetes mellitus

Objective: To assess the glycemic response of metformin in patients with Type-2 Diabetes Mellitus [T2DM] as well as to see its association with reductions in BMI and GIT intolerance

Methods: This Quasi, Experimental study was conducted at Jinnah-Allama Iqbal Institute of Diabetes and Endocrinology [JAIDE] Jinnah Hospital, Lahore from 1st March 2016 to 30th September 2016. Newly diagnosed T2DM patients were given metformin for duration of three months and later on they were categorized into Responders and Non-Responders on the basis of HbA1c [A1C] reductions, which were estimated by Hemoglobin [A1C] analyzer [TD4611A TAIDoc Tech. Taiwan] through photometry. Similarly, baseline BMI and BMI after three months therapy with metformin was also recorded

Results: Among total of 200 patients, 40.5% of the patients were classified as Non-Responders whereas; 59.5% of the patients as Responders. The baseline BMI [26.09 kg/m2] was also decreased significantly after metformin therapy [25.40 kg/m2]. It was found that metformin reduced the A1C in all the patients. However, the glycemic control was much better in patients with higher baseline A1C [1.13% ± 0.08] as compared to lower baseline levels [0.61% ± 0.07]. Regarding GIT intolerance, 140 patients lacked the symptoms, out of which 60.7% were responders and 39.3% were non-responders

Conclusions: Metformin lead to improvement in glycemic control in 59.5% of newly diagnosed T2DM patients after taking metformin for three months but in 40.5% it did not which may be because of combined effects of various gene polymorphisms and their interaction with non-genetic factors. Metformin reduced the BMI in all the patients; however, BMI lowering activity of metformin was same regardless of its effect on HbA1C. Moreover, the signs and symptoms of GIT intolerance did not differ between the two groups

Heerfordt-waldenstrom syndrome uveoparotid fever: review of the literature and a case presentation

Heerfordt-Waldenstr?m syndrome is also referred to as uveoparotid fever. In our patient physical examination showed bilateral parotid gland enlargement. Chest X-ray showed bilateral hilar lymph adenopathy. Biopsy specimen from the right parotid gland revealed scattered granulomas with focal central necrosis. Stains for acid-fast bacilli and fungi were negative. He was diagnosed as a case of Heerfordt- Waldenstr?m syndrome, a rare form of sarcoidosis in which the compression of the facial nerve results in palsy. He was treated with 60 mg of prednisone daily, and at follow-up after two weeks later, the swelling and uveitis was resolved