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Abstract Diabetic mellitus is an emerging disease in Saudi Arabia. In this regard, a cross-sectional retrospective study was conducted to evaluate drug utilization pattern and the cost associated with non-insulin-dependent diabetes mellitus disease management in Saudi Arabia. Data retrieved from the electronic pharmacy records during the last one year were employed in this study. World Health Organization (WHO) Defined Daily Dose (DDD) method was employed to compute the daily price of each oral hypoglycaemic agent. The American Diabetes Association (ADA) guidelines and protocols were used to evaluate the level of adherence. A total of 17057 patients were enrolled in the study. Out of the 17057 patients enrolled in the study, 60.06 % (10246) were males and the rest females. In monotherapy, biguanides (metformin) were the most recommended and utilised drugs among 5673 patients (33.25%). The most commonly used drug combination was found to be sitagliptin+metformin (1754 units). The cost per unit dose was highest for liraglutide (A10BJ02) 258.32SR (68.79USD), and lowest for metformin (A10BA02) 0.49SR (0.13 USD). Metformin was the choice drug for the diabetes patients; biguanides (metformin) and DPP-4 (sitagliptins) were the most familiar established dose combination employed. Generic drugs should be used in order to reduce overall cost.
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RESUMEN La diabetes mellitus tipo 2 se asocia a un incremento del riesgo de mortalidad por enfermedad cardiovascular y es una afección frecuente dentro de los pacientes con enfermedad cardiovascular establecida. El tratamiento adecuado permite mejorar la calidad de vida del paciente y disminuir la morbilidad y la mortalidad por esta y otras causas. La rehabilitación cardiovascular ha demostrado ser una terapéutica eficaz y beneficiosa en los pacientes con diabetes mellitus tipo 2. Por eso, se revisaron 70 referencias bibliográficas con el objetivo de describir elementos importantes sobre su tratamiento, que incluye estrategias farmacológicas, no farmacológicas y la rehabilitación cardiovascular.
ABSTACT Type 2 diabetes mellitus is associated with an increased risk of mortality from cardiovascular disease and it is a common condition within patients with established cardiovascular disease. Appropriate treatment can improve the patient's quality of life and decrease morbidity and mortality from this and other causes. Cardiovascular rehabilitation has been shown to be an effective and beneficial therapy in patients with type 2 diabetes mellitus. For this reason, 70 bibliographic references were reviewed with the aim of describing important elements of its treatment, which includes pharmacological and non-pharmacological strategies and cardiovascular rehabilitation.
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Los eventos cardiovasculares representan la mayor complicación de la diabetes. La evidencia sugiere que la metformina mejora los resultados cardiovasculares en pacientes con diabetes, especialmente en el United Kingdom Prospective Diabetes Study (UKPDS) y otros estudios posteriores, por distintos mecanismos. Hay pocos estudios de seguridad cardiovascular para sulfonilureas aunque no tendrían un perfil seguro a este nivel. La gliclazida parece ser la de mejor performance de las drogas de este grupo. Algo similar ocurre con las meglitinidas, para las cuales los datos indican que no aumentarían el riesgo pero tampoco mejorarían la incidencia de eventos cardiovasculares. Las tiazolidinedionas son las drogas más cuestionadas, aunque los estudios y metaanálisis son contradictorios no habría dudas que aumentan el riesgo de insuficiencia cardíaca. Los inhibidores de la DPPIV mostraron resultados neutros a excepción de saxagliptina que aumentaría el riesgo de internación por insuficiencia cardíaca. Existen datos convincentes que los inhibidores de los receptores SGLT-2 a nivel renal y los análogos del GLP-1 intestinal tienen efectos positivos a nivel cardiovascular, con algunas diferencias entre los integrantes de esta familia. En cuanto a las insulinas, los estudios sugieren que tanto los análogos lentos como rápidos tendrían un mejor perfil cardiovascular, ligado principalmente a la menor incidencia de hipoglucemias severas, que insulina NPH y regular respectivamente.
Cardiovascular events represent the greatest complication of diabetes. Evidence suggests that metformin improves CV outcomes in patients with diabetes, especially in the United Kingdom Prospective Diabetes Study (UKPDS) and other subsequent studies, by different mechanisms. There are few cardiovascular safety studies for sulfonylureas although they would not have a safe profile at this level. Gliclazide appears to be the best performing drug in this group. Something similar occurs with meglitinides for which the data indicates that they would not increase the risk but neither would they improve the incidence of cardiovascular events. Thiazolidinediones are the most questioned drugs, although the studies and meta-analyzes are contradictory, there would be no doubt that they increase the risk of heart failure. DPPIV inhibitors showed neutral results except for saxagliptin, which would increase the risk of hospitalization for heart failure. There is convincing data that SGLT-2 receptor inhibitors at the renal level and intestinal GLP-1 analogues have positive effects at the cardiovascular level with some differences between the members of these families. Regarding insulins, studies suggest that both slow and fast analogues would have a better cardiovascular profile, mainly linked to the lower incidence of severe hypoglycemia, than NPH and regular insulin, respectively
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Humans , Diabetes Mellitus , Heart Failure , InsulinABSTRACT
@#Background: Older persons with diabetes are the major demographic of diabetic patients followed up in primary health clinics. Despite their increasing age and morbidities, they are still being managed strictly towards good sugar control in order to achieve the ideal HbA1c level without taking their quality of life into consideration. This study aimed to determine the prevalence in the use of antidiabetic drugs among older persons with diabetes and its association with their quality of life. Methodology: A cross-sectional study was conducted among 269 older persons with diabetes in all government health clinics in Kuantan using Diabetes Quality of Life questionnaire. SPSS version 23 was used for the statistical analysis. Results: Majority of the respondents were females (61%), Malays (84.8%), pensioners (54.3%) with education up to primary school (52%) and are staying with family members (93.7%). Most of the patients were on two antidiabetic agents (48%) followed by a single antidiabetic agent (32%). Despite the risk of hypoglycaemia, 0.4% of them are on glibenclamide. The use of insulin is still common among 21% of them that are on intermediate-acting insulin, 15.6% on premixed insulin and 7.8% on short-acting insulin. Those taking a higher number of antidiabetic agents were found to be associated with poorer quality of life (p=0.001) compared to those taking one or two antidiabetic medications. Those on insulin also have significantly poorer quality of life score (p=0.012). Conclusion: Despite aiming for controlled diabetes, older persons suffer poor quality of life with further intensification of their antidiabetic medications according to the guidelines. This includes the complexity of insulin usage and polypharmacy, which contribute to the low quality of life score.
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Objective:To evaluate the standardized usage of oral antidiabetic agents in inpatients to provide reference for the pre -scription standardization .Methods:A retrospective study was used to evaluate the prescriptions of oral antidiabetic agents in inpatients during January and March in 2017 , and statistical analysis was conducted on drug usage and standardization evaluation .Results:There were 886 medication plans including 4,397 prescriptions, which involved in 13 kinds of antidiabetic agents .Metformin and acarbose a-gents were used most frequently .The non-standardization rate was 70.54％with 66.03％unlabeled accurate time for oral administra-tion and 4.51％ labeled wrong time for oral administration .Twelve antidiabetic agents existed non-standardized applications ( >50％) .Conclusion:The main problem in the non-standardized usage of antidiabetic agents is leaving the special time for oral adminis -tration of antidiabetic agents out of account , which not only affect the best efficacy , but also reduce patients ' compliance .It' s neces-sary to standardize the prescriptions of antidiabetic agents to improve the standardization of medication therapy .
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This paper describes a practical process for a SGLT2 inhibitor dapagliflozin. The target product was synthesized from 1-chloro-2-( 4-ethoxybenzyl)-4-iodobenzene and 2, 3, 4, 6-tetra-O-acetyl-alpha-D-glucopyranosyl bromide by iodine-magnesium exchange, and coupling and acetyl removing reactions with the total yield of 50%. This practical process highlights fewer reaction steps, less waste and mild reaction conditions.
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[Summary] The prevalence of diabetes mellitus and osteoporosis is rapidly growing and pose a serious threat to human health,. Accumulating evidence indicates that diabetes mellitus is a risk factor for osteoporosis and they could be linked by similar pathophysiological mechanisms. Antidiabetic agents may not only help to control the chronic hyperglycemia state but can also effect bone, This article reviewed the correlation between diabetes mellitus and bone metabolism and summarized the available data on skeletal effects of clinically approved antidiabetic therapies, aimed to provide the basis for clinical medicine use.
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Background: Drug utilization studies are powerful exploratory tools to ascertain the role of drugs in society. They create a sound sociomedical and health economic basis for healthcare decision making. The study was aimed to find out the changing pattern of prescribing the antidiabetic agents in patients suffering from diabetes mellitus type 1 and 2. Methods: It was a cross sectional study done on 200 patients suffering from type 1 and 2diabetes. Indoor patients and diabetes mellitus due to secondary cause were excluded. Each patient was followed up over a period of 1 year and the analysis of the prescriptions was done during that period. At end of study only 129 patients could be included for analysis. Results: In this study the maximal change in medicine was with pioglitazone which was discontinued as a 1st change in 6.2% of patients followed by metformin [5.4%], insulin [4.6%], and glipizide [3.8%]. The drug most commonly added as a first change was glipizide [11.6%] followed by metformin [10.0%] and pioglitazone [7.7%]. In order of 2nd change the most common drug discontinued was insulin [4.6%] followed by pioglitazone [3.8%] whereas drug commonly added as second change was insulin [2.3%] followed by glipizide [1.5%] and pioglitazone [1.5%]. In our cross sectional study average onset of 1st change was found to be at 4.38±2.75 months for discontinuation of drug and 3.75±2.42 months in adding the drugs. Conclusions: Due to lack of certain records, it is envisaged that the change of medicine both discontinuation as well as addition was done because of blood glucose control, cost factor [in case of pioglitazone] as well as patient’s compliance.
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OBJECTIVE:To probe into the status quo and tendency of the utilization of oral hypoglycemic agents in university-affiliated hospitals in Beijing area.METHODS:As one of the zero-difference rate drugs that won the bid,the oral hypoglycemic drugs purchased between 2007 and 2008 by 18 university hospitals in Beijing area were analyzed statistically in respect of the drug variety,DDDs and DDC etc.RESULTS:Of all the oral hypoglycemic agents purchased,?-glycosidase inhibitors took the lead in terms of purchase sum,DDDs as well as DDC.Gliquidone Tablets ranked at the second place and metformin enteric-coated tablets(0.25 g)the third place in terms of DDDs while the DDC of the two drugs ranked at the fifth and the sixth,respectively.CONCLUSION:?-glycosidase inhibitors are the first choice drugs for patients with diabetes in university hospitals in Beijing area.However,the purchase sum and medication person-time of it showed poor synchronism.The utilization of Gliquidone Tablets and Metformin Enteric-coated Tablets(0.25 g)were rational and economicalwhich thus deserve to be used preferably in clinical practice.