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Background: Obstructive sleep apnea (OSA) and type 2 diabetes mellitus have a major health impact because of their high prevalence worldwide. Obesity is a common risk factor for both OSA and type 2 diabetes mellitus in middle-aged persons. Aim: This study was conducted to assess the risk of OSA in type 2 diabetes mellitus patients. Materials and Methods: A cross-sectional study was performed at the tertiary care center of Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India. Type 2 diabetic patients were evaluated to assess the risk of OSA using the STOP-BANG sleep apnea questionnaire (consisting of eight questions). Results: Of the 150 type 2 diabetic patients, 53.8% had low risk, 28.6% had intermediate risk, and 17.6% had a severe risk for OSA based on questionnaires. Patients with comorbid conditions like hypertension (odds ratio 1.5) and obesity (odds ratio 1.06) have a high risk of OSA. There was a significant relationship between the type of medication and the risk of developing OSA (P < 0.05) in diabetic patients. The patients taking both insulin and oral drugs have a high-risk OSA as compared to those taking only insulin or only oral drugs. Conclusion: The prevalence of OSA is much higher in diabetics than in the general population, the risk is increasing with comorbid conditions like obesity and hypertension, patients who are receiving both oral hypoglycemic drugs and insulin. The screening of OSA among diabetic patients is necessary to identify those at high risk and manage this problem, which may remain undiagnosed in many patients.
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Background: Diabetes is one of the most common non-communicable disease worldwide, of which India has been crowned with the title of “diabetes capital of the world”. On an average a person spends 20% of his or her income for the treatment of diabetes per year. So, it’s become very important to conduct a complete cost disparity study among oral hypoglycemic agent available in the market. Information generated from the current analysis, will be helpful to doctors in choosing the right drug for their patient and for the health sector in successfully utilizing the available resources.Methods: The study was conducted in the department of pharmacology AIIMS, Patna 2019. Price of the drugs per tablet/capsule/vial were reviewed from “Current Index of Medical Specialties” January-April 2019 and “Drug Today” October-December, 2018 for analysis of different formulations of oral hypoglycemic agents.Results: The cost of total 16 drugs belonging to 6 different classes, available in 38 different formulations were analyzed. Total 44 different pharmaceutical companies were involved in the manufacture of oral hypoglycemic agents. Overall glibenclamide (5 mg) and bromocriptine (2.5 mg) showed maximum % price variation of 422.79 and 586.27 respectively. Dapagliflozin and canagliflozin both belonging to sodium glucose cotransporter-2 inhibitors shows minimum price variation of 9.86 and 0.9 respectively.Conclusions: The current study shows that there is a huge price variation among oral hypoglycemic agents manufactured by different companies and government needs to take essential steps to bring about the uniformity in the price.
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BACKGROUND: The aim of this study was to investigate the glucose-lowering efficacy of antidiabetic treatments in patients with type 2 diabetes mellitus (T2DM) uncontrolled by sulfonylurea plus metformin. METHODS: This open-label, multicenter, prospective, observational study was conducted in 144 centers in Korea, from June 2008 to July 2010, and included patients with T2DM who had received sulfonylurea and metformin for at least 3 months and had levels of glycosylated hemoglobin (HbA1c) >7.0% in the last month. Data of clinical and biochemical characteristics were collected at baseline and 6 months after treatment. The treatment option was decided at the physician's discretion. Subjects were classified into the following three groups: intensifying oral hypoglycemic agents (group A), adding basal insulin (group B), or starting intensified insulin therapy (group C). RESULTS: Of 2,995 patients enrolled, 2,901 patients were evaluated, and 504 (17.4%), 2,316 (79.8%), and 81 patients (2.8%) were classified into groups A, B, and C, respectively. Subjects in group C showed relatively higher baseline levels of HbA1c and longer duration of diabetes. The mean decrease in HbA1c level was higher in the insulin treated groups (−0.9%±1.3%, −1.6%±1.3%, and −2.4%±2.3% in groups A, B, and C, respectively, P=0.042). The proportion of patients who achieved target HbA1c <7.0% was comparable among the groups; however, intensified insulin therapy seemed to be the most effective in achieving the target HbA1c of 6.5%. CONCLUSION: These findings suggest that insulin-based therapy will be an important option in the improved management of Korean patients with T2DM whose glycemic control is not sufficient with sulfonylurea and metformin.
Subject(s)
Humans , Diabetes Mellitus, Type 2 , Glycated Hemoglobin , Hypoglycemic Agents , Insulin , Korea , Metformin , Observational Study , Prospective StudiesABSTRACT
Objectives@#This study aims to evaluate the effectiveness of initial insulin therapy versus oral hypoglycemic agents in glucose control among newly diagnosed Type 2 diabetes patients. @*Methodology@#This is a systematic review and meta-analysis of RCTs with quality grade B searched using the medical subject headings (MeSH): diabetes mellitus type 2, insulin, oral hypoglycemic agent, with adults newly diagnosed with type 2 DM as subjects and given insulin (± metformin) vs. OHA. Results were summarized as graphs and forest plots using the random effects due to foreseen sources of heterogeneity using Review Manager version 5.1. @*Results@#Presence of substantial heterogeneity prevents us from making a conclusion. All four studies showed lower post treatment BMI among participants in the insulin treatment arm. An opposite finding was expected as insulin is known to cause weight gain. Main adverse effect was hypoglycemia. @*Conclusion@#Among newly diagnosed type 2 DM patients, there is insufficient evidence for or against the use of insulin compared to oral hypoglycemic agents as initial management in terms of improvement in glycemic control, decrease in insulin resistance, and improvement in beta cell function.
Subject(s)
Diabetes Mellitus, Type 2 , Glycemic ControlABSTRACT
OBJECTIVE: To review the epidemiological status of type 2 diabetes (T2DM) and therapeutic applications of incre-tin-based novel oral hypoglycemic agents. METHODS: Based on the literatures in recent years, the mechanism and clinical evidence of DPP-4 inhibitors, particularly sitagliptin, in diabetes management were reviewed and introduced, especially sitagliptin. RESULTS AND CONCLUSION: DPP-4 inhibitors have many advantages and a good future in diabetes care, as either monotherapy or combination therapy. DPP-4 inhibitors have good safety profile and are recommend by some academic organizations.
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BACKGROUND: This study was performed to determine the factors associated with long-term oral hypoglycemic agent (OHA) responsiveness in Korean type 2 diabetic patients. METHODS: Two groups of patients were selected among the type 2 diabetic patients who were followed for more than two years at a university hospital diabetes clinic. The OHA responsive group consisted of 197 patients whose HbA1c levels were maintained at 8% in spite of optimal combined OHA therapy or patients who required insulin therapy within the two years of the study. RESULTS: The OHA failure group had higher baseline values of fasting and postprandial glucose, HbA1c, and lower fasting, postprandial, and delta C-peptide compared to those of the OHA responsive group. The OHA failure group also had a higher proportion of female patients, longer diabetic duration, and more family history of diabetes. There were no significant differences in body mass index (BMI) or insulin resistance index between the two groups. Multiple logistic regression analysis showed that the highest quartile of baseline fasting, postprandial glucose, and HbA1c and the lowest quartile of postprandial and delta C-peptide were associated with an increased odds ratio of OHA failure after adjustment for age, sex, body mass index, and family history of diabetes. CONCLUSION: Lower baseline values of postprandial and delta C-peptide and elevated fasting glucose and HbA1c are associated with long-term OHA responsiveness in Korean patients with type 2 diabetes mellitus.