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).

Design and oral hypoglycemic activity of novel oral hypoglycemic peptide ODA / 中国药科大学学报

@#Incretin promotes insulin secretion through a glucose-dependent mechanism, involving glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). Therefore, their correspondingly specific receptors GLP-1R and GIPR are suitable targets for the treatment of type 2 diabetes. Based on the oral hypoglycemic peptide OHP2 designed by our team, we further designed a new oral hypoglycemic peptide, ODA to reduce glucose. Compared with OHP2, ODA exhibited better lipophilicity as well as the enhanced endocytosis and transcytosis in Caco-2 cells. In addition, ODA remained the ability to activate GLP-1R and enhanced the binding ability to GIPR. The hypoglycemic efficacy of the low-dose ODA (0.53 mg/kg) is comparable to that of OHP2 (1.06 mg/kg). These results indicated that ODA could be a new oral drug with potential for the treatment of type 2 diabetes.

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.

A study to assess the knowledge on hypoglycemia among the diabetic patient in selected hospital, Siliguri

Background:The prevalence of diabetes mellitus, is a major health concern that affects people around the world, and is increasing yearly. When blood glucose levels go below normal, a condition known as hypoglycemia, an immediate consequence of diabetes mellitus, occurs. The International Diabetes Federation reported thatthere were 451 million diabetics globally in 2017 and by 2045, it is anticipated that there will be 693 million. The objective of this study was to assess the level of knowledge of diabetic patient regarding hypoglycaemia and to find out the association between the levels of knowledge of diabetic patient on hypoglycaemia with their selected demographic variable.Methods:A descriptive cross-sectional study, was carried out in the month of June 2022. A semi-structured questionnaire was used to interview 100 study participants who were diabetes patients who had been admitted to the medical ward and who had visited the endocrinology outpatient department.Results:52% of the samples had fair knowledge on hypoglycemia, while 23% of them had poor knowledge. Demographic variable such as age, income, treatment, frequency of taking medicine, experience of symptoms of hypoglycemia and dietary habit were statistically significant with the level of knowledge, p<0.05.Conclusions:The study's findings highlighted the fact that most diabetes mellitus patients had a fair understanding of hypoglycemia. The health care personnel should also take time and efforts to educate patients about the sign of hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented at primordial level.

To assess the risk of obstructive sleep apnea in type 2 diabetes mellitus patients in a tertiary care center in Eastern India

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.

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.

Disparity in cost of oral hypoglycemic agents available in Indian market

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.

Exposição crônica ao cloridrato de metformina e à glibenclamida causa alterações comportamentais, glicêmicas e de mortalidade em Hemigrammus caudovittatus e Danio rerio / Chronic exposure to metformin chloridrate and glibenclamide causes behavioral, blood glucose and mortality changes of Hemigrammus caudovittatus and Danio rerio

Hemigrammus caudovittatus e Danio rerio foram expostos aos hipoglicemiantes orais (HOs) cloridrato de metformina a 40µg/L e 120µg/L e glibenclamida a 0,13µg/L e 0,39µg/L durante 100 dias. Foram avaliados os efeitos tóxicos dos fármacos em relação ao peso, ao comportamento animal, à glicemia e à mortalidade. H. caudovittatus expostos à menor concentração dos fármacos apresentaram aumento significativo (P<0,05) no evento Respiração Aérea. Ainda, foi observado aumento no comportamento Descansar quando os animais foram expostos à glibenclamida a 0,39µg/L. Em D. rerio expostos ao cloridrato de metformina a 120µg/L, foi observado aumento (P<0,05) no comportamento Descansar. A glibenclamida provocou redução (P<0,05) na glicemia de H. caudovittatus. Ambos os fármacos causaram efeito letal na espécie D. rerio, contudo a glibenclamida foi mais tóxica, causando 100% de mortalidade em 30 dias de exposição. Os animais que vieram a óbito apresentaram congestão nos arcos branquiais e hemorragia. Os HOs foram desenvolvidos para apresentarem efeitos fisiológicos em mamíferos, entretanto efeitos tóxicos foram encontrados nas duas espécies de peixe estudadas. Isso levanta a preocupação sobre possíveis efeitos tóxicos de HOs e sobre quais métodos serão utilizados para a sua degradação no ambiente aquático.(AU)

Hemigrammus caudovittatus and Danio rerio were exposed to oral hypoglycemic drugs (HOs) metformin hydrochloride at 40µg/L and 120µg/L and to glibenclamide at 0.13µg/L and 0.39µg/L during 100 days. Toxic effects of the drugs were evaluated based on weight, animal behavior, blood glucose and mortality. H. caudovittatus exposed to lowest concentration of the drugs showed significant increase (P< 0.05) in the Air breathing event. Furthermore, increase in Rest event was observed when animals were exposed to glibenclamide at 0.39µg/L. An increase (P< 0.05) in the frequency of Rest behavior in the D. rerio exposed to metformin hydrochloride at 120µg/L was observed. Glibenclamide caused decrease (P< 0.05) in the blood glucose of H. caudovittatus. Both drugs caused lethal effect against D. rerio. Nevertheless, glibenclamide was more toxic causing 100% of mortality after 30 days of exposure. The animals that died showed congestion on the branchial arches and hemorrhage. The HOs were developed to have physiological effects in mammals. However, toxic effects were found in both species of fish studied. This raises concerns about possible toxic effects of HOs and what methods will be used for their degradation in the aquatic environment.(AU)

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)

Effect of oral antidiabetic drugs on NGF mRNA expr（e）ssion in rats brain with diabetes / 重庆医学

Objective To observe the expression of NGF mRNA in rats brain with diabetes and the effects of hypoglycemia caused by oral antidiabetic drugs on NGF mRNA.Methods A total of 64 adult Wistar rats were randomly divided into control group(16)and diabetes model group(48).Using high fat and high sugar diet+intraperitoneal injection of streptozotocin to prepare type 2 diabetes model.The diabetes model group was randomly divided into non-medication group(16),oral medication group (16) and hypoglycemia group(16).The oral medication rats and hypoglycemia rats were given glibenclamide+metformin by intragastric administration once daily for 12 d,the dose of hypoglycemia rats was 5 times of treatment rats.The brain tissues of rats in each group were used respectively the RT-PCR method to detect NGF mRNA at 3,6,9 and 12 d.Results Compared with the control group,the expression of NGF mRNA in the brain tissues of the 3 groups of diabetic rats were decreased in different degrees and the non-medication group was the most obvious(P＜0.01).Compared with the non-medication group,the oral medication group was significantly increased(P＜0.01),the hypoglycemia group was further decreased(P＜ 0.01).Conclusion Oral hypoglycemic drugs can effectively enhance the expression of NGF mRNA in brain tissue of diabetic rats,but hypoglycemia caused by Oral antidiabetic drugs can make the expression of NGF mRNA further decreased.So hypoglycemia is not conducive to the repair of diabetic neuropathy.

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.

Comparison of Antidiabetic Regimens in Patients with Type 2 Diabetes Uncontrolled by Combination Therapy of Sulfonylurea and Metformin: Results of the MOHAS Disease Registry in Korea

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.

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.

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.