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Background: Diabetes mellitus (DM) is a chronic progressive metabolic disorder associated with microvascular and macrovascular complications in type 2 DM. Oral anti-diabetic drugs (OADs) play an important role in regulating raised blood glucose levels and compliance to treatment. Aims and Objectives: The aims of this study were to evaluate cost variations of different brands of drug formulations in the management of DM. Materials and Methods: This study was an analytical study. Costs of various OADs were obtained from January to March 2022 edition of current index of medical specialties India. The cost ratio and percentage of variation among different drugs in the treatment of DM available in Indian Market and Manufactured by different pharmaceutical companies were analyzed. Results: The percentage variation in cost among commonly prescribed single OADs was found to be highest for sulfonylurea group of dugs Glimepiride 1 mg tablet (1.366%), followed by Biguanides, Metformin 500 mg tablet (809%), ?-Glucosidase inhibitors, and Voglibose 0.3 mg tablet (571%), while it was lowest for Glibenclamide 5 mg tablet (36%) and Acarbose 25 mg tablet (36%) of sulfonylurea drugs and ?-Glucosidase inhibitors group of drugs, respectively. In combination drug therapy, Glibenclamide and Metformin combination (1.25 + 250 mg tablet) shows maximum variation (132%). Conclusion: There is a wide difference existing in the cost of various oral anti-diabetics available in Indian Market by different brands. The physicians must be aware of these variations and prescribe medicines accordingly, while considering the financial status of patient and also to promote adherence to treatment.
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Diabetes mellitus is a metabolic disease characterized by hyperglycemia. It is found that the incidence and mortality of abdominal aortic aneurysm (AAA) in diabetes mellitus patients are lower than that in non-diabetes mellitus patients. This review will present the protective role of diabetes mellitus and its treatment on the aortic disease process, aiming to provide more support for the clinical treatment of AAA.
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Colorectal cancer (CRC) is one of the common deadly cancers worldwide. The incidence of CRC has been increasing nowadays and new therapy agents are still being investigated for the treatment. Metformin (1, 1-dimethyl biguanide), an oral antidiabetic drug from Galega officinalis mostly used in the treatment of type 2 diabetes, has gained considerable research interest in cancer prevention and therapy for many types of cancer including CRC. By targeting the specific pathways involved in cell differentiation, metabolism and metastasis, different mechanisms of action of metformin are tried to be elucidated using CRCs in studies.METHODSWe searched 3 electronic bibliographic databases (Web of Science, PubMed, and Google Scholar) and research in progress using ClinicalTrials.gov from inception to September 20, 2019. Subject headings and key words included ‘metformin’ and/or ‘metformin in colon cancer’, and related terms, and various terms related to colon cancer treatment.RESULTSAlthough it seems justified on the basis of the results of a large number of studies, there is much we do not know about the effect of metformin on CRC.CONCLUSIONSIn this review, we focused on studies showing the potential effects of metformin in CRC, especially its possible mechanisms of action in chemoprevention therapy for colorectal cancers.
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Background: Diabetes mellitus is a chronic disease with a high mortality and morbidity. Knowledge regarding the disease is required for the management of drug adherence in diabetes, hence the present study was taken to assess the effectiveness of health education on knowledge regarding oral anti-diabetic drug adherence.Methods: The study was conducted at urban health training centre of a medical college, Bengaluru from October 2015 to July 2016. A total of 70 type 2 diabetes mellitus patients were involved in this descriptive and interventional study. The study subjects included only on oral anti-diabetic drugs and willing to give informed consent. A pre-tested semi-structured proforma was administered and information about socio-demographic profile, and impact of health education intervention on knowledge was obtained.Results: Most of the subjects were female (80%), in the age group of 35-45 years (34%), illiterate (40%), unemployed (67%) with class IV (78%) socio-economic status according to Modified Kuppuswamy classification 2014. The mean±SD age was 52.47±11.06 years. Significant improvement in knowledge regarding adherence to oral anti-diabetic medication was found in study subjects following health education intervention.Conclusions: The study revealed that health education regarding the importance of drug adherence is needed in study subjects and there was significant improvement in knowledge after health education.
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Background: The pattern of prescribing anti-diabetic drugs varies among different medical professionals due to the availability of numerous anti-diabetic drugs and demographic and have increasingly favoured for tighter control of glycemic index. Even with the available multiple therapies many patients are not in control. The reasons may be multi factorial and the one important factor is the drugs prescribed.Methods: This cross-sectional study involving 140 type 2 adult diabetes patients was done to assess the pattern of anti-diabetic drugs prescribed by the postgraduate students in a tertiary health care center using a specially designed questionnaire.Results: Oral medications were predominantly prescribed. Metformin and Glimepiride combination was prescribed in majority. Among insulin, combination of short and intermediate acting insulin was prescribed more and the number of insulin prescription increased with the duration of diabetes. Interestingly no newer classes of drugs are prescribed.Conclusions: There is a rational prescription pattern of antidiabetic drugs but newer antidiabetic drugs are not prescribed and life style changes are not discussed with the patients. There is a need to include life style changes as a part of prescription to all the patients.
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Background: Diabetes Mellitus is a chronic metabolic disorder, one of the major causes of morbidity, mortality and needs lifelong treatment. There are large numbers of oral anti-diabetic drugs available for the treatment of type 2 diabetes mellitus. There are numerous brands available for each of the individual oral anti-diabetic drug. Thus, a study was planned to find out cost variation among different brands of same active oral anti-diabetic drug.Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from the price list provided by the pharmaceutical companies in Current Index of Medical Specialities (CIMS) (October 2017- January 2018). The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was analyzed.Results: Percentage cost variation of the commonly used drugs found was seen highest with Sulfonylureas (Glimepiride - 562%) followed by Metformin (492%) which was followed by Pioglitazone (488%), DPP-4 inhibitor Teneligliptin (231%), α- glucosidase inhibitors (Voglibose 284%), Meglitinides (Repaglinide 0.5mg 154%) and lowest was seen with Repaglinide 2mg (15%).Conclusions: There is very wide cost variation among different brands of the same oral anti-diabetic drugs manufactured in India. The average percentage cost variation of different brands of the same oral anti diabetic drugs manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.
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Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.
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Background: Diabetes mellitus and hypertension frequently co-exist in a patient. In such patients, the risk of complications, morbidity and mortality increases. One should be careful in management and choosing drugs. Authors undertook this study to understand the prescribing pattern of the physicians in diabetic hypertensive patients.Methods: This cross sectional, observational study was conducted in type 2 diabetic outdoor patients with co-existing hypertension, for duration of one year. We used descriptive statistics to analyze data of 615 patients to determine prescribing pattern of drugs.Results: 93.17% of patients were more than 40 years of age. Ratio of female to male patients was 1.30. Mean duration of diabetes was 5.81 years. Multi drug anti diabetic regimes (54.47%) were common than monotherapy (43.90%). Commonly prescribed anti diabetic drug groups were biguanides (89.27%), Sulfonylureas (43.90%) and insulin (15.28%). Metformin (89.27%), glibenclamide (29.11%) and insulin (15.28%) were commonly prescribed anti diabetic drugs. Metformin was the most common monotherapy drug and biguanide + sulfonylurea was the most common two drug combination. Commonly prescribed drugs for co-morbid conditions were enalapril (83.41%), aspirin (30.41%), amlodipine (29.76%) atorvastatin (27.32%) and famotidine (26.34%). Average number of drugs prescribed in a prescription was 4.65. Prescriptions with injections were 15.93% and with brand names were 13.15%.Conclusions: Prescribing pattern of drugs was as per current practices and recommendations of guidelines. Still, there is room for improvement in choice of drug, prescribing drug with generic name and choosing drug from essential medicine list.
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Objective To investigate the risk factors and clinical significances in the patients with pancreatic cancer(PC). Methods The clinical data of 936 patients with PC in the Affiliated Hospital of Chongqing Medical University during the past 10 years were retrospectively analyzed,and contemporaneous 832 age and sex-matched cases of non-complicating tumor and disease of digestive system and metabolic abnormality were collected as the control group.The differences and correlation between the two groups were analyzed retrospectively,including the gender,age,incidence and course of diabetes mellitus(DM),category of hypogly-cemic drugs,body mass index(BMI),history of pancreatitis,family history of PC and family history of diabetes.Results (1)There were more males than females in PC group,moreover the male proportion was much higher than the female proportion with the age growing.In the PC group,251 cases(26.8%)were complicating DM,which was significantly higher than 13.0% of DM occurrence rate in the control group(P<0.01);in the PC group,new onset DM was up to 14.1%(132/936),which was obviously higher than 3.4% in the control group(P<0.01).The family history of PC,history of pancreatitis,family history of diabetes,overweight and obesity were the independent risk factors for PC.The risk of PC in new-onset DM patients was increased by 4.9 times.Metformin could decrease the risk of developing PC.The time from diagnosed DM to PC in the metformin group was longest[(18.86 ± 3.46) months],which in the non-medication group was shortest[(6.44 ± 1.07)months].Conclusion New-onset DM patients with fami-ly history of DM,family history of PC,history of pancreatitis,overweight and obese should be vigilant to develop PC.For the new-onset DM patients,anti-diabetic drugs influence the onset time of PC and metformin may have effect to delay the occurrence and de-velopment of PC.
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Background: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. Methods: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. Results: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. Conclusion: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.
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Hypoglycemic Agents , Diabetes Mellitus , Physician-Patient Relations , ComplianceABSTRACT
Background: Diabetes mellitus (DM) is an important public health problem in developing countries. Drug utilisation study of antidiabetic agents is of paramount importance to promote rational drug use in diabetics and make available valuable information for the healthcare team. The aim of study was to investigate the drug utilization pattern in type-2 diabetic patients. Methods: A prospective, cross-sectional study was carried out in medicine outpatient clinic of tertiary care hospital, Ahmedabad for eight weeks. Patients with type-2 diabetes and on drug therapy for at least one month were included. Patients’ socio-demographic and clinical data were noted in a pre-designed proforma. Data was analysed by using SPSS version 20 and Excel 2007. Results: Total 114 patients were enrolled with mean (± standard deviation) age and duration of diabetes of 56.8 ± 10.5 and 8.3 ± 9.4 years respectively. Male: Female ratio was 0.72:1. Mean fasting and postprandial blood glucose levels were 147.5 ± 73.1 and 215.6 ± 97.3 mg/dl respectively. Most common symptom was weakness/fatigue (77.2%). Hypertension (70.2%) was most common co-morbid illness. Mean number of drugs prescribed were 7.8 ± 2.5. Total numbers of patients receiving more than five drugs were 89.5%. Most commonly used drug group was biguanides (87.7%) followed by sulphonylureas (68.4%). Conclusion: Metformin (biguanide) was the most utilized (87.7%) antidiabetic drug for type-2 diabetes. This study revealed that the pattern of antidiabetic prescription was rational and largely compliant with NICE (National Institute for Health and Clinical Excellence) guidelines.
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Objective To study the vibration frequencies and resonant peaks of different molecular groups in anti-diabetic drugs and to investigate the absorption spectra of these drugs in the range of terahertz, so as to accurately and efficiently identify similar drugs and provide foundation for understanding the contribution of such vibration in different molecular groups to pharmacology. Methods Using terahertz time domain spectroscopy (THz-TDS), six kinds of similar diabetes pills for treating diabetes mellitus (DM), including gliquidone, glipizide, gliclazide, glimepiride, repaglinide and metformin were tested to obtain their absorption spectra from 0.3~3.0 THz. Support vector machines (SVM) method was employed to separate these anti-diabetic drugs by selecting the experimental data from 1.5~2.0 THz. Results For gliquidone, glipizide, gliclazide, and glimepiride, an obvious resonance peak was found at 1.37 THz. According to the THz spectra, repaglinide and metformin could be easily separated from sulfonylurea drugs. Furthermore, with the help of SVM, the accuracy of discrimination for four kinds of sulfonylurea could reach 100%. Conclusions THz technology, as a new testing method, shall play a positive role in the drugs for their identification, quality control and distinguishing their chemical bonds/functional group.
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A comprehensive analytical method based on ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was developed for the simultaneous determination of active components and anti-diabetic) drugs in propolis health foods. The samples were extracted by ultrasound extraction with methanol). The insoluble residue of extract was removed by freeze-centrifuging. The analysis was performed on an ACQUITY UPLC C_(18)) column(50 mm ×1 mm, i.d., 1.7 μm) utilizing a gradient elution profile and a mobile phase of 0.3% formic acid in water and acetonitrile. The analytes were detected using an electro spray ionization tandem mass spectrometry with multiple reaction monitoring. Qualitative and quantitative analysis was based on the peak area of the parent ion and two fragment ions. The LOD and LOQ level for 14 active components ranged from 0.7 mg/kg to 42.0 mg/kg and 2.2 mg/kg to 140 mg/kg respectively, and recoveries were 77.8%-113.6%, with the intra- and inter-day precision less than 15%. The LOD and LOQ level for 9 anti-diabetics) ranged from 0.1 mg/kg to 0.9 mg/kg and 0.3 mg/kg to 2.5 mg/kg respectively, and recoveries) were 79.3%-108.5%, with the intra- and inter-day precision less than 15%. The method is simple) and sensitive, and can be used for quality control of propolis.