ABSTRACT
Background: To evaluate the comparison of clinical outcomes of sitagliptin +metformin and glimepiride in uncomplicated Type-2 diabetics.Methods: This one year (July 2016 to August 2017) prospective, open label, observational clinical cohort study was carried out on type-2 diabetics. In this study 299 Type-2 diabetics patients were enrolled and were randomly allocated to two groups viz Group A and Group B. Group A received sitaglitin+metformin (50+500) mg/day and Group B received glimepiride 1mg/day respectively. The follow up started after 10 days of stabilization of the patient and data recorded on 10th day was considered Zero month data and follow up continued up to Six month in each group. Comparison of FPG, PPG and HbA1c was evaluated between zero and six months within group and at six month between groups. Adverse events were recorded and summarized by treatment group.Results: At the end of six months follow up the patients of Group A who received sitaglitin+metformin (50+500) mg/day had greater reduction in FPG, PPG and HbA1c (all P<0.001) was recorded when compared between zero and six month within group. A significant reduction in FPG, PPG and HbA1c (all P<0.01) also recorded in Group B who received glimepiride 1mg/day when compared between zero and six months within group. A statically significant difference (all P<0.05) was recorded at six months between group. The adverse events like hypoglycemic episodes, gastrointestinal adverse events etc were greater in Group B than Group A. Changes in weight also noted in both Groups. Weight loss in Group A and weight gain in Group B was recorded.Conclusions: The present study suggests that a significant difference may be existing in the clinical outcome interm of glycemia control and adverse events between sitagliptin+metformin combination and glimepiride in type-2 diabetic patients.
ABSTRACT
Objective To explore the effect and possible mechanism of 12 weeks of progressively resistive exercises on the autonomic nervous function of patients with type 2 diabetes mellitus ( T2DM) fasting and after an oral glucose tolerance test ( OGTT) . Methods Fifty T2DM patients were randomly divided into an exercise group ( E, n=30) and a control group ( C, n=20) . Group E performed progressively resistive exercises for 12 weeks, while group C maintained their normal lifestyle. Blood glucose, insulin, glycosylated hemoglobin, an insulin resist-ance index ( IRI) , heart rate variability, blood pressure variability and baroreflex sensitivity were measured after fasting and after an OGTT before and after the intervention. Results After the intervention, in the fasting state and after an OGTT, all of group E's glycemic control variables except insulin levels were significantly lower than be-fore the intervention ( P≤0.05) . No significant changes were observed in the autonomic nervous function parame-ters. However, after the intervention total power (LnTP), a comprehensive indicator of autonomic nervous system activity, normalized low frequency power (LFn), LnLF/high frequency power (LnLR/HF) and the low-frequency component of systolic blood pressure (LFSBP) increased significantly after OGTT in group E (P≤0.05), while there were no significant changes in the control group. Moreover, after the intervention there were no significant differences between the two groups in the indicators of autonomic nervous system functioning after fasting, but the LnTP, LFn, LnLF/HF and LFSBP2 of group E were significantly higher than those of group C after an OGTT (P≤0.05). In addition, the △LnLF/HF of group E was negatively correlated with △IRI (r=-0.469, P≤0.05). Conclusions Twelve weeks of progressively resistive exercises has no effect on autonomic nervous functioning after fasting for patients with T2DM, but it improves sympathetic neural responses after an OGTT. This may be related to its ameliorating insulin resistance.
ABSTRACT
El paciente diabético requiere con frecuencia algún tipo de cirugía o la realización de un proceder diagnóstico invasivo, que puede, incluso, ser realizado de urgencia. En la actualidad el riesgo quirúrgico del diabético ha disminuido gracias a los avances en las técnicas anestésicas y al control metabólico perioperatorio, aunque las complicaciones aún son más frecuentes, y generan una hospitalización prolongada y una tasa mayor de invalidez. En la evaluación preoperatoria se deben precisar las características de la diabetes, el tipo de proceder quirúrgico, el riesgo anestésico quirúrgico, y realizar los ajustes necesarios al tratamiento habitual. La infusión continua de insulina endovenosa con aporte de glucosa es el método más racional y fisiológico en la mayoría de las intervenciones quirúrgicas, lo que implica monitoreo glucémico frecuente con ajustes inmediatos. Algunas situaciones especiales, como las cirugías complejas o las de urgencia, requieren esquemas terapéuticos específicos, por lo que cada equipo debe tener su protocolo de trabajo, según las particularidades de las intervenciones quirúrgicas que realicen. El control metabólico perioperatorio es esencial para evitar las alteraciones metabólicas e hidroelectrolíticas agudas y favorecer la evolución satisfactoria en el posoperatorio. Por su importancia, se realiza una revisión con un enfoque actual, que ayude a mejorar la calidad de la atención al paciente diabético que requiere de una intervención quirúrgica(AU)
The diabetic patients require frequently some type of surgery or the implementation of an invasive diagnostic procedure which may even be carried out as an emergence. Nowadays the surgical risk of the diabetic patient has decrease thanks to the advances in the anesthetic techniques and to the perioperative metabolic control, although the complications are more frequent and to generate a lengthy hospitalization and a great disability rate. In the preoperative assessment it is necessary to specify exactly the diabetes's features, the type of surgical procedure, surgical anesthetic risk and to perform the fitting necessary in the habitual treatment. The continuous infusion of intravenous insulin with glucose is the more rational and physiologic method in most of surgical interventions, involving the frequent glycemia monitoring with immediate fittings. Some special situations including complicated surgeries or those of emergence, require specific therapeutical schemes, thus each staff must to have its work protocol, according the peculiarities of the surgical interventions performed. The perioperative metabolic control is essential to avoid the metabolic and acute hydroelectrolytic alterations and to favor the satisfactory course during the postoperative period. Due its significance, authors carried out a review with the current approach helping to improve the quality of care of diabetic patient requiring a surgical intervention(AU)
Subject(s)
Humans , Glycemic Index/physiology , Diabetes Mellitus/surgery , Preoperative Care , Surgical Procedures, Operative/methodsABSTRACT
La diabetes mellitus 2 (DM 2) y la enfermedad renal crónica (ERC) son considerados problemas de salud pública a nivel mundial. Los pronósticos de ambas enfermedades están estrechamente relacionados, por lo que las acciones terapéuticas son complementarias. Un buen control glicémico revierte las alteraciones renales en sus etapas iniciales disminuyendo el deterioro microangiopático y a su vez elintento de obtener un control óptimo de glicemias requiere conocer y tratar las alteraciones provocadas por el ambiente urémico. Es muy importante considerar la existencia de cambios en la interpretación de los análisis de laboratorio, cambios en la farmacocinética y farmacodinamia de los medicamentos hipoglicemiantes e insulinas y finalmente la existencia de dificultades para realizar ejercicios y administrar una alimentación adecuada. Los esquemas de hipoglicemiantes utilizados, tanto medicamentos orales como insulinas, deben ser cuidadosamente personalizados. Se debe evitar la indicación de medicamentos de excreción renal exclusiva por el riesgo de hipoglicemias. Tanto las insulinas análogas como convencionales pueden ser administradas, con precaución en su dosificación y reconociendo la necesidad de un estricto automonitoreo de glicemia digital.
Diabetes Mellitus 2 (DM 2) and the chronic renal disease (CRD) are considered health public problems around the world. The prognoses of both illnesses are narrowly related, so the therapeutic actions are complementary. An appropriate level of glycemia reverses renal alterations in its former stages decreasing the microangiopatic deterioration and, at the same time, the attempt to get an optimal blood sugar control requires to know and treat the alterations caused by the uremic environment. It is very important to consider the existence of changes in the laboratory analyses, the pharmacokinetic and pharmacodynamic changes of the hypoglycemic drugs and insulins and, finally, the existenceof complications to practice physical exercises and to administrate an appropriate nutrition. The hypoglycemic schemes used, whether oral drugs or insulin, must be carefully personalized. It must be avoided excretion renal drug prescriptions, exclusively to avoid hypoglycemic risks. Both analog and conventional insulins can be administrated, being precautious in the dosage and recognizing the needof a strict digital glycemia self-monitoring.