Evaluation of blood glucose controlling efficacy of various oral hypoglycemic drugs in Type 2 diabetes mellitus patients: A prospective, randomized, and control study

Background: This study was conducted to evaluate the effect of various oral hypoglycemic agents in the control of plasma blood glucose levels among Type 2 diabetes mellitus (T2DM) patients. Aims and Objectives: This study is aimed to evaluate the blood glucose controlling efficacy of various oral hypoglycemic drugs in T2DM patients. Materials and Methods: This randomized and control study was conducted among the cases attending Department of General Medicine at Research cell of Chennai Medical College Hospital and Research Centre, during the period of June 2014 to July 2015. A total of 180 cases were randomly allotted to six groups. Group I was treated with Glibenclamide, Group-II was treated with Glibenclamide + Sitagliptin, Group-III was treated with Glibenclamide + Vildagliptin, Group-IV was treated with Metformin, Group-V was treated with Metformin + Sitagliptin, and Group-VI was treated with Metformin + Vildagliptin. Fasting, postprandial, and glycated hemoglobin (HbA1c) levels were assessed before and at 4, 8, and 12th weeks and the data were analyzed using Statistical Package for the Social Sciences. Results: Fasting and postprandial sugars were significantly reduced in Group V and Group VI during 4th, 8th, and 12th weeks. However, HbA1c levels were significantly reduced after 12 weeks of treatment in Group III, Group V, and Group VI. Conclusion: We conclude that metformin in combination with either Vildagliptin or Sitagliptin can help to reduce fasting, postprandial, and HbA1c levels (both in short-term and in long-term); however, Glibenclamide along with Vildagliptin could reduce only HbA1c levels (long-term alone).

Biochemical evaluation of DPP4 inhibitors on lipid profile in type 2 diabetes mellitus patients: A hospital-based prospective study

Background: Lipid lowering action of oral hypoglycemic drugs is still unclear. Hence, this study was conducted to address the same using monotherapy and with combination of oral hypoglycemic in patients suffering with type 2 diabetes. Aims and Objectives: The main aim and objective of the study was to evaluate the DPP4 inhibitors inducted changes in low-density lipoprotein (LDL), VLSL, high-density lipoprotein (HDL), and total cholesterol (TC) in patients suffering with type 2 diabetes. Materials and Methods: This randomized control study was done in the Department of General Medicine, Chennai Medical College Hospital and Research Center, Irungalur, Tiruchirappalli, between June 2014 and July 2015. Cases with type 2 diabetes mellitus (T2DM) aged 30–70 years who had been on glibenclamide or metformin for the past 3 months and had uncontrolled blood glucose levels were selected for the study. Total 180 patients are fulfilling the inclusion and exclusion criteria were divided into six groups (Each with 30 patients.) At the 0th and 12th weeks, fasting lipid profile was assessed. The data were expressed in number, percentage, mean, and standard deviation. Results: Oral hypoglycemic drug either as monotherapy or in combination has significant effect on lipid profile among the cases with T2DM. Furthermore, the significant decrease in TC and maximum improvement in HDL was noted with the use of glibenclamide in combination with Sitagliptin and maximum reduction in triglycerides and LDL was noted with the use of Metformin in combination with Sitagliptin. Conclusion: Oral hypoglycemic agents have an additional favorable effect on lipid profile among the cases with T2DM.

Evaluación de la prescripción de hipoglucemiantes orales en población adulta con Diabetes Mellitus Tipo 2 / Evaluation of the prescription of oral hypoglycemic agents in the adult population with type 2 diabetes mellitus

En el nivel primario de atención se detectan errores en la prescripción del tratamiento farmacológico de la diabetes tipo 2. El objetivo de este estudio fue evaluar la calidad de la prescripción de hipoglucemiantes orales en pacientes atendidos en consultorios del médico de la familia del Policlínico Universitario Hermanos Cruz, municipio Pinar del Río, Cuba. Se realizó un estudio de utilización de medicamentos de tipo descriptivo y transversal clasificado dentro de estos como de indicación-prescripción con elementos de esquema terapéutico y de factores que condicionan los hábitos de prescripción. El universo estuvo conformado por 1575 pacientes con diagnóstico de diabetes mellitus tipo 2 tratados con hipoglucemiantes orales que pertenecían a los 20 consultorios médicos de la familia.La muestra de estudio se obtuvo por el método de muestreo no probabilístico (por conveniencia) (n=846). La información se obtuvo de la historia clínica y tarjeta control de los pacientes para adquirir estos medicamentos. Predominó la edad de 40-49 años, el sexo femenino y entre 5-10 años de evolución de la enfermedad. No se usó la primera línea de tratamiento en el 43,6 % de los casos, ningún caso tenía estudios de laboratorio para el uso de la Metformina. La prescripción y dosis fue adecuada no así su uso racional. Las interacciones más frecuentes fueron las farmacocinéticas.El uso racional de hipoglucemiantes orales fue deficiente lo que hace necesario ampliar la divulgación de un protocolo de tratamiento para mejorar el uso de estos fármacos en el nivel primario de atención.

Errors in the prescription of drug treatment for type 2 diabetes are detected at the primary level of care. the purpose of this study was to evaluate the quality of the prescription of oral hypoglycemic agents in patients attended in the family doctor's offices of the Hermanos Cruz University Polyclinic, Pinar del Río distrit, Cuba. A descriptive and cross-sectional study of the use of medications was carried out, classified within these as indication-prescription with elements of the therapeutic scheme and factors that condition prescription habits. The universe was made up of 1575 patients diagnosed with type 2 diabetes mellitus treated with oral hypoglycemic agents who belonged to the 20 family medical offices. The study sample was carried out by the non-probabilistic sampling method (for convenience) (n = 846). The information was obtained from the clinical history and control card of the patients to acquire these medications. The age of 40-49 years, the female sex and between 5-10 years of evolution of the disease predominated. The first line of treatment was not used in 43.6% of the cases; no case had laboratory studies for the use of Metformin. The prescription and dose was adequate, but not its rational use. The most frequent interactions were pharmacokinetic ones.The rational use of oral hypoglycemic agents was deficient, which makes it necessary to expand the dissemination of a treatment protocol to improve the use of these drugs at the primary level of care.

Tratamento para o diabetes mellitus gestacional: uma revisão de literatura / Treatment for gestational diabetes mellitus: a literature review

O diabetes mellitus gestacional (DMG) é uma complicação que atinge o metabolismo da gestante, resultando em intolerância à glicose e consequente hiperglicemia, originada pela insuficiência de insulina materna. Este estudo tem como objetivo identificar os tratamentos disponíveis e mais utilizados para o DMG. Trata-se de um uma revisão de literatura, feita a partir de 22 referências, acerca dos tratamentos para o DMG. As bases de dados escolhidas foram Google Acadêmico, UpToDate, SciELO e o acervo da Universidade do Planalto Catarinense. Estudos apontam a insulina humana ­ NPH e regular ­ como a principal escolha, quando comparada aos seus análogos, apesar de ainda existirem muitas controvérsias quanto ao início do tratamento, o esquema terapêutico e os ajustes das doses. Pesquisas têm demonstrado bons resultados sobre a eficácia e a segurança dos hipoglicemiantes orais ­ gliburida e metformina ­ no tratamento de gestantes diabéticas, mas é evidente a necessidade de mais estudos para confirmar a efetividade deles e garantir um bom desenvolvimento do concepto. Concluiu-se que o controle dietético e o exercício físico são a primeira opção de tratamento para o DMG. Todavia, caso a euglicemia não seja atingida, opta-se pelo tratamento medicamentoso por meio da insulinoterapia ou hipoglicemiantes orais, o que possibilita a redução da incidência dos efeitos adversos ao binômio materno-fetal.(AU)

Gestational diabetes mellitus (DMG) is a complication that affects the pregnant woman's metabolism, resulting in glucose intolerance and consequent hyperglycemia, caused by insufficient maternal insulin. This study aims to identify the available and most used treatments for DMG. This is a literature review, based on 22 references, about treatments for Gestational Diabetes; the databases chosen were Google Scholar, UpToDate, SciELO and the collection of the Universidade do Planalto Catarinense. Studies point to human insulin ­ NPH and regular ­ as the main choice when compared to its analogues, although there are still many controversies about the beginning of treatment, therapeutic scheme and dose adjustments. Researches have shown good results on the efficacy and safety of oral hypoglycemic agents ­ glyburide and metformin ­ in the treatment of diabetic pregnant women, but it is evident the need for further studies to confirm their effectiveness and to guarantee a good development of the fetus. It was concluded that dietary control and physical exercise are the first treatment option for DGM. However, if euglycemia is not achieved, drug treatment is chosen through insulin therapy or oral hypoglycemic agents, which makes it possible to reduce the incidence of adverse effects to the maternal-fetal binomial.(AU)

Review on Metformin Effect on Male Reproductive System

Male infertility and issues of impaired fecundity have been currently a global problem. Diabetes mellitus caninfluence male fertility either directly or indirectly due to abnormal spermatogenesis, which results in reducedsperm quality. Most reported cases of diabetes are of type 2 DM cases, frequently treated with oral anti-diabeticdrugs. Metformin is considered first-line therapy for the treatment of T2DM. This drug is an oral insulinsensitizing agent that can elevate insulin sensitivity and reduce plasma fasting insulin. The main metabolic actionof metformin target the liver. However, it was indicated that metformin acts on many organs of the body whichinclude the male reproductive system. With the increasing numbers of diabetic individuals among younger people,there is an enhancement in the utilizaton of metformin in individuals of this age group. Therefore, it is critical torecognize the role of metformin in male fertility. In this review, we are presented with the most recent dataaccessible regarding the investigation of the influences of metformin on the male reproductive system. Togetherwith the discussion of these influences, their importance to male fertility is also argued.

Comparative toxicological analysis of Metformin (Biguanide) and Glibenclamide (Sulfonylureas), using Zebrafish Embryotoxicity Test (ZFET)

Background and Objective@#Type 2 (T2DM) and gestational diabetes mellitus (GDM) among pregnant Filipinos have been increasing over the years because of lifestyle westernization. While insulin has been the safe mainstay when dietary measures fail to maintain normoglycemia during pregnancy, recent studies have suggested oral hypoglycemic agents (OHAs) such as metformin and glibenclamide, may offer cheaper and efficacious alternatives. The problem however, is the passage of these drugs through the placenta which may pose possible danger towards the development of the growing embryo. The proposed study aims to evaluate and compare the embryotoxic and teratogenic potentials of the varying concentrations of the two PhilHealth covered oral hypoglycemic agents in the Philippines, namely metformin (biguanide) and glibenclamide (sulfonylureas). @*Methodology@#In this study, a comparison on embryotoxic potentials of metformin and glibenclamide was conducted using zebrafish embryotoxicity test (ZFET) across concentrations found in fetal (10, 20, 100, 500, 1000, 2000 μg/L) and maternal serum (10, 20, 100, 500, 1000, 2000 mg/L). @*Results and Conclusions@#Results revealed that metformin showed no significant (p>0.05) lethal effects, but revealed significant risk for teratogenicity, specifically decreased head and tail lengths and advanced hatching. Conversely, glibenclamide revealed significant potential for lethal (e.g., coagulation) and teratogenic effects including pericardial and yolk sac edema, spinal deformity and increased tail length. Comparative evaluation between the two OHAs reveal that glibenclamide has significantly (p<0.05) higher lethal and teratogenic effects. Together, our results suggest that the use of metformin over glibenclamide is favorable for safety testing in pregnant women suffering T2DM and GDM for the benefit of expanding treatment options for these diseases.

Prescribing Trend And Drug Cost Analysis Of Oral Hypoglycemic Agents Using Drug Utilisation Review

@#Drug utilization of oral hypoglycemic agents (OHAs) in a private healthcare setting is useful to examine the prescribing pattern of OHAs, especially the newer fixed dose combination (FDC) products. This study was aimed to evaluate the prescribing pattern of OHAs indicated for Type 2 diabetes mellitus (T2DM), to determine the costs of OHAs prescribed and total cost per prescription in the treatment of T2DM in an outpatient department of a private hospital located in central Malaysia. Retrospective review of electronic medical record (EMR) study design was adopted. Patient’s demographic characteristics, medications prescribed, prescribers’ details and cost per prescription were documented. Defined daily dose (DDD) of OHAs and drug cost were calculated. Research ethics protocol was approved and no personal data was collected. Out of the 396 EMR screened, 135 fulfilled the inclusion criteria and subsequently were analysed. In term of demography, mean age of the sample was 51 years old with 59% were male and ethnicity composition of 71% Malay and 19% Chinese. Metformin and “metformin+dipeptidyl peptidase-4 inhibitor” (DPP-4i) were the most commonly prescribed single-drug and FDC OHA, respectively. Average cost of OHAs and total cost per prescription was less than USD 68 and USD 185, respectively. Meanwhile, FDC covered 28.91% of incidences of prescriptions, but 44.6% of cost and SGTL-2i covered 9% incidences of prescriptions and 16.29% of cost. Prescribing pattern of OHA was appropriate based on patient’s T2DM diagnosis, however, dosage given were not in accordance with WHO DDD.

Comparative Evaluation of DPP-IV Inhibitors and other Oral Hypoglycaemic Agents used Either Alone or in Combination with Reference to Glycemic Targets in Patients with Type 2 Diabetes Mellitus

Introduction: This study assumes significance as it compareshead on DPP-IV inhibitors along with other oral hypoglycemicagents with respect to glycemic and non-glycemic targets.Study was done to evaluate the DPP-IV inhibitors andother oral hypoglycemic agents (OHA) either alone or incombination, with reference to glycemic targets like fastingplasma glucose (FPG), post prandial glucose (PPG) andglycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus.Material and Methods: This was an open labelledcomparative study and included 90 patients with Type 2 DM.These patients were divided into 3groups: Each group wascontaining 30 patients i.e. Group A: DPP-IV inhibitors (n=30); Group B: Oral hypoglycemic agents other than DPP-IVinhibitors (n= 30) and Group C: DPP-IV inhibitors + other oralhypoglycemic agents (n= 30). The patients were given drugson the basis of physician’s discretion, depending upon theglycemic of the patients at the time of presentation. A detailedhistory regarding age, sex, profession, duration of disease,treatment history, family history and personal history wastaken for each patient. After stabilization patients observed at0 weeks, 6 weeks, 12 weeks and 24 weeks.Results: Mean duration of diabetes was 5.35±0.53 years, andthe mean age of onset of diabetes was 46.98±0.91years. Therewas no significant difference between the study groups withrespect to FPG, PPG, and HbA1c levels. The HbA1c showedsignificant improvement in each group at the end of studyperiod.Conclusion: In summary, this study showed that treatmentwith sitagliptin, either alone or in combination with other oralhypoglycemic agent led to clinically meaningful reductionsin HbA1c, FPG and PPG over a 24 week period. Sitagliptinpresents an alternative therapeutic strategy for patientswith type 2 diabetes and, in general, showed significantimprovements in glycemic control and is well tolerated,particularly with regard to weight change and hypoglycemia.

Caracterización oftalmológica de diabéticos tipo II con catarata senil bilateral / Ophthalmological characterization of type 2 diabetics with bilateral senile cataract

Objetivo: Determinar las características oculares de los diabéticos tipo II con catarata senil bilateral. Métodos: Se realizó un estudio descriptivo transversal a 248 diabéticos tipo II con catarata senil bilateral, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, desde septiembre del año 2015 a septiembre de 2016. Resultados: Predominó el sexo femenino (69,6 Ophthalmological characterization of type 2 diabetics with bilateral senile cataract), la edad de 70,6 años, el índice de masa corporal en pacientes con sobrepeso (46,5 por ciento), el tiempo de evolución de 5-9 años (52,2 por ciento), el tratamiento con hipoglucemiantes orales (95,2 por ciento), la mejor agudeza visual sin corrección con daño retinal 0,1 y sin daño 0,3; y corregida sin daño 0,5 y con daño retinal 0,2, todas con la cartilla de Snellen; promedio de densidad celular endotelial de 2 143,15 ± 326,08 cel/mm2, un coeficiente de variabilidad de 53,18 ± 7,14 por cientoy una hexagonalidad de 42,68 ± 18,70 por ciento. Conclusiones: La asociación de diabetes mellitus tipo 2 y catarata senil bilateral es más frecuente en mujeres mayores de 70 años, sobrepeso u obesa con un tiempo de evolución de la diabetes mellitus de 5 a 9 años y controladas con hipoglucemiantes orales. La peor agudeza visual está relacionada con el daño en la retina; sin embargo, presentan queratometrías, biometrías y tensión ocular normal. No hay alteraciones en la densidad endotelial, pero sí pleomorfismo y polimegatismo(AU)

ABSTRACT Objective: Determine the ocular characteristics of type 2 diabetics with bilateral senile cataract. Methods: A descriptive cross-sectional study was conducted of 248 type 2 diabetics with bilateral senile cataract at Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2015 to September 2016. Results: A predominance of the female sex (69.6 percent), mean age 70.6 years, body mass index in overweight patients 46.5 percent, time of evolution 5-9 years (52.2 percent), treatment with oral hypoglycemic agents 95.2 percent, best visual acuity without correction with retinal damage 0.1 and without damage 0.3; best corrected visual acuity without retinal damage 0.5 and with damage 0.2, all according to the Snellen chart; average endothelial cell density 2 143.15 ± 326.08 cell/mm2, coefficient of variability 53.18 ± 7.14 percent and hexagonality 42.68 ± 18.70 percent. Conclusions: Coexistence of type 2 diabetes mellitus and bilateral senile cataract is more common among women aged over 70 years, overweight or obese, with a time of evolution of diabetes mellitus of 5 to 9 years, and controlled with oral hypoglycemic agents. The worst visual acuity is related to retinal damage. However, keratometries, biometries and ocular tension results were all normal. There were no endothelial density alterations, but there was pleomorfism and polymegethism(AU)

Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus

The Korean Diabetes Association (KDA) recently updated the Clinical Practice Guidelines on antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus (T2DM). In combination therapy of oral hypoglycemic agents (OHAs), general recommendations were not changed from those of the 2015 KDA guidelines. The Committee on Clinical Practice Guidelines of the KDA has extensively reviewed and discussed the results of meta-analyses and systematic reviews of effectiveness and safety of OHAs and many clinical trials on Korean patients with T2DM for the update of guidelines. All OHAs were effective when added to metformin or metformin and sulfonylurea, although the effects of each agent on body weight and hypoglycemia were different. Therefore, selection of a second agent as a metformin add-on therapy or third agent as a metformin and sulfonylurea add-on therapy should be based on the patient's clinical characteristics and the efficacy, side effects, mechanism of action, risk of hypoglycemia, effect on body weight, patient preference, and combined comorbidity. In this review, we address the results of meta-analyses and systematic reviews, comparing the effectiveness and safety among OHAs. It will help to choose the appropriate drug for an individual patient with T2DM.

Combination therapy of oral hypoglycemic agents in patients with type 2 diabetes mellitus

The Korean Diabetes Association (KDA) recently updated the Clinical Practice Guidelines on antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus (T2DM). In combination therapy of oral hypoglycemic agents (OHAs), general recommendations were not changed from those of the 2015 KDA guidelines. The Committee on Clinical Practice Guidelines of the KDA has extensively reviewed and discussed the results of meta-analyses and systematic reviews of effectiveness and safety of OHAs and many clinical trials on Korean patients with T2DM for the update of guidelines. All OHAs were effective when added to metformin or metformin and sulfonylurea, although the effects of each agent on body weight and hypoglycemia were different. Therefore, selection of a second agent as a metformin add-on therapy or third agent as a metformin and sulfonylurea add-on therapy should be based on the patient’s clinical characteristics and the efficacy, side effects, mechanism of action, risk of hypoglycemia, effect on body weight, patient preference, and combined comorbidity. In this review, we address the results of meta-analyses and systematic reviews, comparing the effectiveness and safety among OHAs. It will help to choose the appropriate drug for an individual patient with T2DM.

Omarigliptin: A new kind of long acting DPP-4 inhibitor / 药物评价研究

Diabetes is a kind of metabolic disease characterized by hyperglycemia The oral hypoglycemic agents used currently are required to take every day,which brings inconvenience to patients.Omarigliptin is a small molecule DPP-4 (depeptidyl peptidase-4) inhibitor.The drug is developed by the Merck Co,mainly for the treatment of type two diabetes.The drug only need to be taken once a week,so as to improve the patient's compliance and adherence,thereby improving the therapeutic effect.This article introduces the information of omarigliptin from the aspects of synthesis,pharmacology,pharmacokinetics,and clinical research,which provides valuable information for pharmaceutical workers.

Sobrevida de los islotes β pancreáticos y uso de hipoglucemiantes orales: un gran reto para el médico actual / Survival of pancreatic islet β and use of oral hypoglycemic agents: a challenge for the current doctor

La célula β no sólo es capaz de fabricar y secretar la insulina, sino además, hace que dicha secreción sea en el momento justo y en la cantidad adecuada. Las elevaciones postprandiales de glucosa generan una respuesta secretora aguda en la célula β, pero en ciertas patologías como la diabética, el escenario cambia radicalmente, resultando en una disfunción caracterizada por un proceso secretor alterado y múltiples cambios fenotípicos. En estos, los nutrientes, glucosa y ácidos grasos, están elevados de forma crónica, convirtiéndose en sustancias tóxicas que pueden llevar a la muerte de la propia célula β. Por lo tanto, cualquier aproximación terapéutica a la cura de esta enfermedad debe afrontar la necesidad de reemplazar o evitar esta disminución celular, siendo imperativo mencionar el papel de los hipoglucemiantes orales como los inhibidores de la DPP-4 y los análogos de la GLP-1 en la protección contra el fracaso de la masa de células β.

The beta cell is not only able to produce and secrete insulin, but also makes this secretion is at the right time and in the right amount. Postprandial glucose elevations produce an acute secretory response in the beta cell, but in certain diseases such as diabetes mellitus, the scene changes dramatically, resulting in dysfunction, characterized by an altered secretion process and multiple phenotypic changes. In these, nutrients like glucose and fatty acids are chronically elevated, becoming toxic substances that can lead to death of the beta cell itself. Therefore, any therapeutic approach to cure this disease must face the need to replace or avoid this cell decline, it is imperative to mention the role of oral hypoglycemic agents as inhibitors of DPP-4 and analogs of the GLP-1 in protection against failure of the β cell mass.

Effect of Tinospora cordifolia as an add - on therapy on the blood glucose levels of patients with Type 2 diabetes.

Background: Type 2 diabetes is a fast growing epidemic affecting people globally. Good glycemic control helps in reducing the risk of macro and microvascular complications in diabetics. Alternative medicines have been used since ancient times in India to achieve good glycemic control. Tinospora cordifolia (Tc) is a well reported plant possessing anti-diabetic property. Therefore, we undertook this study to evaluate the effectivity of Tc in reducing the blood glucose levels of Type 2 diabetic patients in the form of add-on therapy. Methods: In the present study, we enrolled 100 Type 2 diabetic patients who met our inclusion criteria. These patients were then randomly divided into two Groups, A and B. Patients in Group A were treated as controls and they continued with their anti-diabetic medications. In Group B, Tc was added to the conventional treatment at a dose of 500 mg 3 times daily along with meals. The fasting and postprandial blood glucose levels and glycosylated hemoglobin (HbA1c) were recorded baseline and after 6 months. Results: During the course of study, we observed a decrease in the fasting, postprandial, and HbA1c levels of the patients. However, this decrease was found to be more statistically significant (p≤0.005) in Group B. Conclusion: The results obtained from the present study conclude that Tc, when given in the form of add-on therapy, was found to be synergistic and effective in the better management of Type 2 diabetes. The drug was well tolerated by the patients and no adverse drug event was recorded.

Factors Associated with Glycemic Variability in Patients with Type 2 Diabetes: Focus on Oral Hypoglycemic Agents and Cardiovascular Risk Factors

BACKGROUND: The role of glycemic variability (GV) in development of cardiovascular diseases remains controversial, and factors that determine glucose fluctuation in patients with diabetes are unknown. We investigated relationships between GV indices, kinds of oral hypoglycemic agents (OHAs), and cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). METHODS: We analyzed 209 patients with T2DM. The GV index (standard deviation [SD] and mean absolute glucose change [MAG]) were calculated from 7-point self-monitoring of blood glucose profiles. The patients were classified into four groups according to whether they take OHAs known as GV-lowering (A) and GV-increasing (B): 1 (A only), 2 (neither), 3 (both A and B), and 4 (B only). The 10-year risk for atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Equations. RESULTS: GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors. In hierarchical regression analysis, the use of SUs remained independent correlates of the SD (beta=0.209, P=0.009) and MAG (beta=0.214, P=0.011). In four OHA groups, GV indices increased progressively from group 1 to group 4. However, these did not differ according to quartiles of 10-year ASCVD risk. CONCLUSION: GV indices correlated significantly with the use of OHAs, particularly SU, and differed significantly according to combination of OHAs. However, cardiovascular risk factors and 10-year ASCVD risk were not related to GV indices. These findings suggest that GV is largely determined by properties of OHAs and not to cardiovascular complications in patients with T2DM.

Analysis of the Utilization of Oral Hypoglycemic Agents in 34 Hospitals from Wuhan Area during 2011-2013 / 中国药房

OBJECTIVE:To analyze the utilization and variation tendency of oral hypoglycemic agents in Wuhan area,and to provide reference for drug selection and enterprise production and sale. METHODS:The utilization of oral hypoglycemic agents in 34 hospitals from Wuhan area during 2011-2013 was analyzed statistically in respects of consumption sum,DDDs and DDC etc. RESULTS:The consumption sum and DDDs of oral hypoglycemic agents increased by 20% and 7% respectively year by year. Acarbose had a market share of over 40%. The drug use frequency of metformin ranked the second place only to acarbose. DPP-4 inhibitor had a promising future,with a consumption sum proportion of more than 10%,while the market share of traditional Chi-nese medicine had fallen below 3%. Except for repaglinide,gliclazide,glimepiride,Xiaoke pills,etc.,the selling of other medica-tions are consistent with the user. CONCLUSIONS:The utilization of oral hypoglycemic drugs is basically rational in 34 hospitals from Wuhan area during 2011-2013.

Oral Anti-Diabetic Agents-Review and Updates.

Diabetes is a chronic metabolic disorder with high mortality rate and with defects in multiple biological systems. Two major types of diabetes are recognized, type 1 and 2 with type 2 diabetes (T2D) being by far the more prevalent type. As diabetes affects multiple biological functions, the use of multiple drug classes having different mode of actions is required in order to optimize therapy in diabetic patients. Five major classes of oral antidiabetic agents (OHA) have traditionally been used for the management of patients with T2D. These include the sulphonylureas, meglitinides, biguanides, thiazolidinediones and the alpha-glucosidase inhibitors. Several newer classes of agents have also been introduced recently in the pharmacotherapy of T2D, including the incretin mimetics, the dipeptidy peptidase 4 (DPP-4) inhibitors, the sodium glucose co-transporter 2 (SGLT 2) inhibitors and more recently, the dual peroxisome proliferator-activated receptor (PPAR) agonists. Each of these agents has been shown in various experimental and clinical settings to be efficacious in T2D, but each is also associated with a number of adverse effects. Despite the vastarray of drugs introduced, metformin, a biguanide, largely remains the first choice mono therapy in T2D patients but several combination options are also available in poly pharmacy when mono therapy fails to produce the required glycemic control. The increasing number of drugs, together with numerous combination options in poly pharmacy, presents with the clinician an increasing complexity of therapeutic options. The likely pathogenetic mechanism of diabetes operating in the patient, as well as the mode of action, efficacy and safety of the drugs are some of the major considerations in the choice of any given agent or its combinations. This review therefore focuses on the mode of action, pharmacokinetics, indications, efficacy and adverse effects of the OHA used in T2D.

A prospective study on drug utilization pattern & rationality in treatment of type II diabetes mellitus: a population based analysis.

Background: Diabetes a chronic disease is associated with significant morbidity, complications with poor glycemic control. Hence, meticulous management is necessary. Comorbid conditions increase chances of polypharmacy and irrational prescriptions in diabetic patients. This prospective non interventional study aimed to gather and study the drug utilization pattern in diabetic patients. Methods: The study was conducted in 50 diabetic patients admitted in medicine ward. Patients were included in the study only after obtaining written informed consent form; all relevant data were collected from case record forms and were analyzed. Results: Diabetes mellitus was observed to be highest in patients with the age group of 60-70 years, affecting 66% males and 34% females. Among the participants 42 (84%) were already on treatment for diabetes while 8 (16%) were diagnosed at the time of admission. We observed that 27 (54%) patients were treated with insulin + oral hypoglycemic agents, 13 (26%) were treated with only Insulin while 10 (20%) patients were prescribed only oral hypoglycemic agents. The most common comorbid conditions observed by us were hypertension, chronic renal disease, diabetic foot, septicemia, urinary tract infections and other susceptible infections. Conclusion: To conclude, the study reveals that Metformin continues to be the choice of oral hypoglycemic agents with least adverse effects and insulin was used to treat uncontrolled state, where physicians have greatly considered the socio-economic status while prescribing which is obvious with least use of costly insulin preparations.

Consumption Analysis of Oral Hypoglycemic Agents of 32 Hospitals in Wuhan Area during 2010-2012 / 中国药师

Objective:To analyze the utilization and tendency of oral hypoglycemic agents in some hospitals of Wuhan from 2010 to 2012. Methods:The relative data of oral hypoglycemic agents used in 32 hospitals of Wuhan area during 2010-2012 were analyzed using consumption sum, DDDs and defined daily dose as the indices. Results:The consumption sum of oral hypoglycemic agents was increased year after year;acarbose and gliclazide were widely used and occupied front places among the drugs. However, the percent-age of traditional Chinese medicine used for decreasing blood sugar was declined. Conclusion:During 2010-2012, the DDDs value and the consumption sum of oral hypoglycemic agents in Wuhan area are stable and normal, and the application will be further developed.

Perinatal Outcome of Infants Born to Diabetic Mothers in a Developing Country- Comparison of Insulin and Oral Hypoglycemic Agents.

Objective: To study the perinatal outcomes of infants born to mothers with gestational diabetes treated with insulin or oral hypoglycemic agents in a developing country. Design: Prospective observational cohort study. Setting: Tertiary-care perinatal center in southern India. Participants: Babies born to mothers with gestational diabetes. Methods: Maternal details were obtained and physical examination was performed on the neonates. Babies were given hourly feeds soon after birth and blood glucoses checked at 1, 3, 5, 9 and 12 hours of life; hematocrit and calcium levels were also measured. Perinatal outcomes were compared between mothers who required insulin or an oral hypoglycemic agent for treatment of diabetes. Results: Of the 10,394 mothers who delivered during the study period, 574 (5.5%) were diagnosed to have gestational diabetes. 137 were treated with insulin and 141 with oral hypoglycemic agents. 44 (15.8%) babies were born preterm, 97 (35%) were large for gestational age, 13 (4.7%) were small for gestational age and 9 (3.2%) were macrosomic. Hypoglycemia was seen in 26 (9.3%) babies, congenital anomalies in 15 (5.4%) and birth injuries in 7 (2.5%). There was no difference between the two groups in any of the outcomes except for hyperbilirubinemia, which was more in the insulin group (13.7% vs 6.5%, P=0.04). Conclusions: There was no difference in the perinatal outcome whether the mother received insulin or an oral hypoglycemic agent for treatment of gestational diabetes other than the increased incidence of hyperbilirubinemia in the insulin group.