Comparison of metabolic effects of glimepride and sitagliptin with metformin in patients suffering from type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is one of the major causes of mortality & morbidity, and patient’s with better control of glycaemic parameters have lesser chronic complications associated with it. Though monotherapy with metformin is first choice for T2DM but is effective in less than 50% of patient and they should be managed with two drug therapy. Both Glimepiride and Sitagliptin are effective with metformin but there has been no study done in this region hence, we planned to study comparison of effects of glimepiride and sitagliptin with metformin in patient of T2DM.Methods: This prospective, open-label, randomized study was done in all patient diagnosed with T2DM, not adequately managed by metformin alone. The patient was divided into two group G (Glimepiride with Metformin) and Group S (Sitagliptin with Metformin) and had a follow up at 3 and 6 months. The biochemical parameters were assessed at 12 weeks and 24 weeks.Results: The result of this study show that both glimepiride and sitagliptin with metformin significantly (p<0.05) lowered both the fasting blood sugar as well as postprandial blood glucose at 3 and 6 months. Glimepiride was more effective in lowering (p<0.05) the plasma glucose at 3 months but both the drugs had comparable result at 6 months. This study also showed that glycosylated haemoglobin was lowered in both groups at three and six months as compared to Day 0 (p<0.05), with glimepiride having better control of glycosylated haemoglobin at 3 months with both groups having comparable result at 6 months.Conclusions: To conclude, this study compared effects of sitagliptin and glimepiride on glycaemic parameters in patients of T2DM and found that both drugs had comparable results.

Glycemic control with four way model approach in rural area patients

Background: It is very important to keep the Glucose levels under control continuously and without any holidays. Type 2 diabetes is increasingly common in the industrialized world. Tight glycemic control attempts to rigidly glucose control levels (A1c: 6.5% -7.0% or lower). Maintaining tight glycemic control is lifesaving. Proper counselling, proper nutrition and if regular exercise is done it can result is good glycemic control.Methods: In the present study a total of 350 diabetic patients were selected out of which only 208 participants were eligible for study. Inclusion criteria in the study were 1) Age: men and women between age group 30 years to 70 years and 2) Type 2 Diabetes mellitus with HbA1c between 8 to 10%. Exclusion criteria in the study were 1) Type 1diabetes mellitus, Pre-existing renal, hepatic or cardiac disease, Hba1c >10%. A quadriad was established between patients, personal health worker, dietician and doctor.Results: Participants had regularly followed up and were divided randomly into cases (n = 112) and controls (n = 96). Patient were followed up as per study design it was observed that at the end of 3 months period mean FBS (case group 168.2±26.4 control group 200.8±38.3 p value <0.001) , Mean PPBS (case group 204.8±53.0 control group 271.0±45.5 p value <0.001) and Mean Hba1c (case group 8.7±0.5 control group 8.9±0.6 p value .003) in cases was significantly lower than control group.at the end 6 months it was observed that the mean cholesterol, mean triglyceride, mean LDL and mean VLDL was significantly lower in the cases compared to controls.Conclusions: A systematic approach and close monitoring that increased the adherence to medication, diet, and counselling would help in better glycemic control and prevent long term complication.

Study of Plasma Glucose and HbA1c in Patients with Chronic Liver Disease

Background: Chronic liver disease (CLD) is a major cause of morbidity. In CLD high plasma glucose and HbA1c level are independently associated with severe disease and poor prognosis. The Child Pugh scoring is still the corner stone in prognostic evaluation of CLD patients. Aims & Objectives: The aim of this study was to evaluate plasma glucose (FBS, PPBS) & glycosylated haemoglobin (HbA1c) in patients with CLD and calculate the Child-Pugh score for each patient and correlate with each other. Methods: It was a cross sectional,observational hospital based study consisted of 100 patients with CLD whose FBS,PPBS and HbA1C were measured & it was correlated with Child-Pugh score. Results: There was significant association between impaired FBS & impaired OGTT &PPBS with the severity of CLD (p - 0.0487& 0.0476). However HbA1c & its correlation with Child Pugh score showed no significance (p- 0.142) but incidence of death with raised plasma glucose & with raised HbA1c were significant ( p - 0.043 & 0.042). Conclusion: Incidence of impaired FBS, OGTT & PPBS were more in-patient with CLD, which may be considered as prognostic marker for the severity of CLD. Impaired blood gucose may also adversely affect outcome of CLD& therefore, blood glucose should be determined in every CLD patients. Early detection & management can improve the overall outcome of CLD patients.

Effects of Resistant Maltodextrin on the on Post-Prandial Blood Glucose Elevation in Japanese Individuals / 医薬品情報学

<b>Objective: </b>We conducted a meta-analysis on the suppressive effect of resistant maltodextrin on post-prandial blood glucose elevation, which is approved in Japan as food for specified health use, and the following is allowed to be indicated on the label “it is suitable for consumption by those who are concerned about their post-prandial blood glucose levels because the absorption of sugars is abated by the action of dietary fiber (resistant maltodextrin).”<br><b>Method: </b>Our literature search covered Ichushi-Web (Japan Medical Abstracts Society), Japan Science and Technology Information Aggregator, Electronic (J-stage), Google Scholar, and PubMed databases and extracted English and Japanese publications on randomized, double-blind, controlled studies comparing resistant maltodextrin and a control in Japanese subjects for the reduction of areas under the blood glucose response curves at 30, 60, and 120 min after eating as an efficacy index.<br><b>Result: </b>Among these publications, four articles with a Jadad score (an assessment of the quality of randomized controlled studies) of ≥ 3 were included in the meta-analysis.  Significant inhibitory effects were confirmed from areas under the blood glucose response curves at 30, 60, and 120 min after eating in the meta-analysis that was performed to evaluate the effects of resistant maltodextrin on post-prandial blood glucose elevation in Japanese individuals.<br><b>Conclusion: </b>However, we were not able to test for publication bias because the number of extracted publications was small, and thus, additional research and case studies are warranted.

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients

BACKGROUND: Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference. METHODS: Thirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. RESULTS: A significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76) and nighttime (r=0.82). The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity. CONCLUSION: We showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day.

Respuesta de glucosa e insulina: Comparación entre dos tipos de desayunos y prueba de tolerancia oral con 75g. De glucosa

Objetivos: Comparar las respuestas glucémicas e insulinémicas de dos desayunos, con la prueba estándar de tolerancia a la glucosa oral (PTGO). Métodos: En 14 sujetos sanos se realizó la PTGO, con 75 gr de glucosa. Luego, con un intervalo de una semana, se efectuaron las pruebas de tolerancia con dos tipos de desayunos, elaborados con alimentos de uso común en nuestro medio y cuya principal diferencia fue el tipo de carbohidrato. A los 0, 30, 60 y 120 minutos se cuantificó la concentración de glucosa, por el método de glucosa-oxidasa y la insulina por radioinmunoanálisis. Se calculó el área bajo la curva para la respuesta de glucosa e insulina. Para el análisis estadístico se aplicó un análisis de varianza y las pruebas post-test, para determinar la diferencia entre los grupos. Resultados: Se observó que la respuesta de glucosa con el desayuno 1 fue significativamente menor (p<0,05) a los 30 y 60 minutos y con el desayuno 2 a los 60 minutos (p<0.05) en comparación con la obtenida con la PTGO. El área bajo la curva (ABC) de glucemia no fue diferente entre los 2 tipos de desayunos y fue significativamente menor que con la PTGO. La respuesta de insulina fue significativamente mas baja a los 120 minutos (p<0.05) con el desayuno 1 (arepa) en relación con el desayuno 2 (pan) y con la PTGO. El ABC de insulinemia no fue diferente entre los desayunos y la PTGO. Conclusiones: La respuesta de glucemia postprandial con mezcla de nutrientes es menor que la obtenida con la PTGO, por lo que no debe ser usada con fines diagnósticos.

Objectives: To compare the glycemic and insulinemic responses of two breakfasts with the standard oral glucose tolerance test (OGTT). Methods: In 14 healthy subjects, the OGTT with 75 g of glucose was performed. After an interval of one week, tolerance tests with two types of breakfasts elaborated with common food in our country, and whose main difference was the type of carbohydrate, were carried out. At 0, 30, 60 and 120 minutes, glucose concentration by the glucose oxidase method and insulin by radioimmunoassay were measured. Areas under the curve (AUC) for glucose and insulin response were calculated. An analysis of variance test was applied to determine the difference between the groups. Results: It was noted that the glucose response to breakfast 1 was significantly lower (p <0.05) at 30 and 60 minutes and to breakfast 2 at 60 minutes (p <0.05) compared with that obtained with OGTT. The glucose AUC was not different between the 2 types of breakfasts and was significantly lower than the obtained with OGTT. The insulin response was significantly lower at 120 minutes (p <0.05) with breakfast 1 (arepa) in relation to breakfast 2 (bread) and the OGTT. The insulin AUC was not different between breakfasts and the OGTT. Conclusions: The postprandial blood glucose response to mix of nutrients is lower than that obtained with the OGTT, so it should not be used for diagnostic purposes.