ABSTRACT
Among various insulinotropic agents used in treatment of Type 2 DM, inclusion of DPP4 inhibitors are considered as major breakthrough as far as new drug development is concerned. In this review article we have discussed in detail about the pathogenesis of diabetes mellitus especially the role of incretin, DPP4 enzyme and implication of its inhibitors in treatment of DM. Also, various clinical studies regarding use of DPP4 inhibitors as monotherapy and as combination therapy with other antidiabetic agents were discussed. DPP-4 inhibitors control glucose in fasting as well as in postprandial state both in monotherapy and in combination with other oral antidiabetic agents. Significant reduction in HbA1c observed with DPP4 inhibitors as monotherapy. On combining DPP 4 inhibitor as add-on therapy to metformin, glitazone or sulphonylurea therapy in patients with type 2 diabetes not reaching therapeutic goals, DPP-4 inhibitors reduce HbA1c, fasting plasma glucose and 2-h postprandial plasma glucose up to the desired level. Various DPP-4 inhibitors have been proven to be as safe and tolerable both as monotherapy and combination with other antidiabetic agents. Inhibition of DPP-4 enzyme has been proven as a promising aspect in the treatment of type 2 diabetes and various drugs inhibiting DPP4 enzymes have been developed now. They are highly recommended in the treatment of Type 2 DM both as monotherapy as well as combination therapy.
ABSTRACT
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and represents a substantial socioeconomic burden. Co-morbidities are more in COPD patients. Cardiovascular disease is one of the co-morbid conditions in COPD. Arterial stiffness has a strong predictive value for cardiovascular events, which can be assessed non-invasively. Various predictors of arterial stiffness between stable COPD patients and healthy volunteers were measured and compared.Methods: COPD patients attending pulmonary medicine outpatient services were screened for enrolment. It was a prospective case control study with enrolment of fifty COPD stable cases and fifty healthy control, who were matched for their age and sex. All eligible participants were subjected to focused history and physical examination as per structured questionnaire, followed by spirometric examination, periscope test, arterial blood gas analysis and six- minute walk test (6MWT).Results: Increased arterial stiffness was observed in COPD patients over a wide range of severity of airway obstruction. Distance walked in 6MWT and spirometric values were significantly lower in COPD group as compared to healthy group.Conclusions: It was concluded that vascular changes, which are predictive of cardiovascular disease remain as cardiovascular risks in mild or early lung disease. A strong relationship between COPD, systemic inflammation, arterial stiffness and cardiovascular disease had been found which needs to be explored further. It was finally concluded that targeted therapeutic approach has broad aspect in reducing cardiovascular risks and has potential for improved prognosis in COPD.
ABSTRACT
Background: Hypertension, a common cardiovascular disorder accounts for 20-50% of all deaths. This risk can be greatly ameliorated by creating awareness about disease and its effective treatment alongside regular medical check-ups. Therapeutic failures result from patient non-compliance, manifested as intentional or unintentional errors in dosage or schedule, overuse or underuse of prescribed drugs and early termination of therapy. Adherence is helpful for management of hypertension and cost minimization. Non-adherence to the drug treatment is an important factor for uncontrolled hypertension and its complications.Methods: Patients were interviewed individually after taking informed consent, using pretested, predesigned, self- administered and closed ended questionnaire both before and 4 weeks after creating awareness about hypertension and its complications. Compliance measured by self-reporting in which knowledge of the patient about number of antihypertensive drugs being used, formulations of drugs, frequency of administration, duration of taking the drugs and knowledge of complications due to uncontrolled and untreated hypertension were assigned 1 score each. Patient having score of at least 4 out of total 5 was considered compliant.Results: No significant association of compliance with demographic and other variables like age, sex, marital status, economic status, education, urbanization, duration of treatment and drug procurement were noted. A significant increase in compliance in patients on antihypertensive medication was found 4 weeks after creating awareness about hypertension and its complication. A significant increase in compliance scores was also seen in non-compliant patients showing their shifting from non-compliance to compliance group. Overall compliance increased from 59.38% to 84.38%. A percentage decrease from 58.82% to 25% in patients having uncontrolled hypertension was also observed after the awareness about hypertension.Conclusions: Demographic variables, duration of hypertension and drug procurement have no significant effect on compliance to antihypertensive medication. There is persistence and improvement in compliance to antihypertensive medications after an education of the patients about hypertension and its complications.
ABSTRACT
Trigonella foenum graecum (Fenugreek) was administered at 2 and 8 g/kg dose orally to normal and alloxan induced diabetic rats. It produced a significant fall (P < 0.05) in blood glucose both in the normal as well as diabetic rats and the hypoglycemic effect was dose related.