Insulin refusal in Iranian patients with poorly controlled type 2 diabetes mellitus

To achieve tight glycemic control in diabetic patients, it may be necessary to introduce insulin therapy much earlier in the disease course. Poor glycemic control is a risk factor for the development of diabetic complications. Many patients require insulin therapy after several years of disease in order to maintain good glycemic control and prevent complications. But many patients do not receive insulin therapy in a timely manner because of a negative appraisal of this treatment. Understanding the cause of this negative attitudes is necessary for better evaluation to overcome for this problem. The purpose of this study was to evaluate the reasons for insulin refusal among patients with type 2 diabetes. This is a descriptive crosssectional study from Yazd Diabetes Research Center. 400 patients with type 2 diabetes who had an HbA1c >/= 8.0% despite optimal oral therapy were identified that participated in this study. Data were obtained by patient interview using validated questionnaires. This study showed that Insulin refusal was common. 77% of participant reported being unwilling to take insulin if prescribed. Fear of injection is an important cause for insulin refusal among patients. Insulin refusal is an important problem among our patients with type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin use should focus on injection-related concerns, education and correction of misconceptions.

Comparing effects of continuous insulin infusion with or without subcutaneous glargine insulin on glycemic control in diabetic patients undergoing coronary artery bypass graft [CABG]

Hyperglycemia is associated with increased morbidity and mortality in diabetic patients following coronary artery bypass grafting. Tight glycemic control in perioperative period can reduce these events. The goal of this study was to determine whether combination of continuous infusion and subcutaneous glargine as a basal insulin could improve glycemic control. Diabetic patients who were candidate for CABG were randomized to receive continuous insulin infusion with or without subcutaneous Glargine insulin for at least 72 hours which started 24 hours before surgery and continued for 48 hours after surgery. A total 84 subjects were required. In group A [n=45] continuous insulin infusion was used for glycemic control and in group B [n=39] we used continuous infusion with subcutaneous glargine insulin. Blood glucose level was significantly better in desirable range in group B in comparison to group A. Total mean blood glucose level in group A was 186.1 mg/dl and in group B was 174.3 mg/dl [P=0.008]. Frequency of hypoglycemia [blood glucose <70 mg/dl] was 0.66% in group A and 0.5% in group B that was similar [P=0.530]. The mean length of stay in the hospital was not different between two groups [P=0.288]. We found out that a combination of continuous insulin infusion and glargine insulin as main basal insulin can improve glycemic control in diabetic patients undergoing coronary artery bypass grafting

Comparison of the effects of sodium metavanadate and zinc sulfate supplementation on lipid and glucose in patients with type 2 diabetes

Type 2 diabetes mellitus is a chronic illness causing considerable morbidity and mortality. Enormous advances have been made in medical care but more people are still having tendency to use herbal or alternative remedies. This study is a randomized, controlled trial on type 2 diabetic patients. The subject consisted of 60 patients divided randomly into three groups and supplemented daily with 100 mg sodium metavanadate and 660 mg zinc sulfate or placebo for six weeks. The following were checked at baseline of the study and after six weeks: Body Mass Index [BMI], Blood Pressure [BP], Fasting Blood Sugar [FBS], 2-h postprandial glucose [2hpp], Glycated hemoglobin [HbA1c], Triglyceride [TG], Total Cholesterol [TC], Low-Density Lipoproteins, and High-Density Lipoproteins. Also HbA1c, BMI and BP were measured after 12 weeks to evaluate the long-term effects of drugs. Statistical analysis was performed using SPSS 11.5. Data of continuous variables are expressed as means +/- standard deviation. Differences between groups were assessed by the paired T-test. Comparison between three groups was done by Post Hoc Tests. Mean age of patients was 51.39 +/- 8.60 years. The results of this study show a significant decrease in TG [P=0.01] and BMI [P=0.03]. After 12 weeks, there was a significant decrease in BMI [P=0.01] in Sodium metavanadate group. Due to zinc sulfate administration, significant decrease was seen in TG [P=0.005], TC [P=0.02], LDL [P=0.01] and systolic blood pressure [P=0.02]. After 12 weeks, there was a significant decrease in HbA1c [P=0.04] with zinc sulfate consumption. Consumption of zinc sulfate in type 2 diabetic patients could be effective in lipid profile. It is recommended to use another vanadium compound to achieve better results

Effects of cisapride on QTc interval in children

Cisapride is a prokinetic drug with different reports on its cardiac side effects. As there might be a genetic susceptibility for the effects of this drug, we studied its effects on QTc interval of children in our region. This semi-experimental study was performed on children aged over one month, who attended Amirkola Children's Hospital from October 2004 to March 2005 and needed to be treated with Cisapride. Patients with risk factors such as cardiac disease, electrolyte disturbance and drug usage interfering with Cisapride metabolism were excluded from the study. Cisapride was prescribed orally 0.6mg/kg/day in 3 doses. ECG was taken in lead II before drug administration and after one week. QTc intervals before and after treatment were compared. P-value >0.05 was considered significant. Among 135 admitted children needing Cisapride, 118 cases fulfilled inclusion criteria and were enrolled in the study. Their mean age was 14.1 [1.5] months. The mean QTc intervals before and after treatment were 377 [20] msec and 380 [22] msec, respectively [P=0.1]. No child had a QTc interval more than 450 msec. Cisapride [0.6mg/kg/day] did not cause a significant prolonged QTc interval in children with no risk factor