ABSTRACT
Type 2 diabetes is a hypermetabolic disease characterized with disorders of glucose/lipid metabolism, absolute or relative lack of insulin, and can induce skeletal muscle atrophy. Hyperglycemia, hyperlipidemia, insulin resistance, and abnormal release of inflammatory factors can lead to abnormal signal transduction in skeletal muscle, thus make protein synthesis and degradation imbalance and eventually causing muscle atrophy. Under normal conditions, insulin-like growth factor 1 (IGF-1)/insulin can activate phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT). AKT not only increases protein synthesis through mammalian target protein of rapamycin (mTOR), but also phosphorylates forkhead box O (FoxO) transcription factor and then inhibits the transcription of several ubiquitin ligases (such as MAFbx/atrogin-1 and MuRF1), or autophagy related genes. The weakened IGF-1/PI3K/AKT pathway in type 2 diabetes is an important factor leading to skeletal muscle atrophy. Studies have shown that the commonly used anti-type 2 diabetic drugs have different effects in regulating the synthesis and degradation of skeletal muscle protein. Studies reported that drugs with effect of anti-diabetic muscle atrophy include thiazolidinediones, glucagon-like peptide analogs, glucose-sodium cotransporter 2 inhibitors, etc.; drugs that are still in controversial or even promote skeletal muscle atrophy include metformin, and some sulfonylurea or non-sulfonylurea insulin secretagogues. This article overviewed and analyzed the currently commonly used drugs for type 2 diabetes and summarized the related mechanisms, with the aim to provide references for the rational applications of drugs for type 2 diabetes.
ABSTRACT
One thousand and forty-six patients with type 2 diabetes mellitus (T2DM) aged >18 years from 11 community health service centers in Beijing Chaoyang district were enrolled in the study. The body weight, height, fasting plasma glucose level and glycosylated hemoglobin A1c (HbAlc) were measured. A door-to-door questionnaire survey on the use of oral antidiabetic drugs and insulin was conducted between January to December 2017. Of 1 046 T2DM patients, 182 (17.4%) received lifestyle intervention, 257 (24.6%) used single oral antidiabetic drug (OAD), 326 (31.2%) with combined OAD, and 281(26.9%) with insulin and OAD. The average HbA1c in T2DM patients with lifestyle intervention, single OAD drug, combined OAD, and insulin and OAD were (8.1±2.3)%, (7.6±2.0)%, (7.8±2.0)%, and (8.7±2.1)%, respectively (F=18.35, P<0.01). Proportions of the T2DM patients with HbAlc lower than 7.0% were 45.1%, 55.6%, 43.6% and 36.8% in groups, respectively (χ2=55.55, P<0.01). Patients with single or combined OAD aged 18-<45 years had a worse HbA1c control than those aged 45-<65 years and≥65 years. It was found that 59.4%, 52.6%and 30.8%of the patients receiving one OAD, two OADs and three or more OADs achieved glucose control target. The proportion of drug use was 62.6% for α-glucosidase inhibitors, 50.8% for metfomain, 32.5% for insulin, 18.2% for sulfonylureas, 4.9% for glinides, 3.2% for thiazolidinediones and 3.1% for dipeptidyl peptidase-Ⅳs. Among the combined treatment regimens, metfomain+a-glucosidase inhibitors was the most frequently used as compared with α-glucosidase inhibitors+sulfonylureas and metfomain+sulfonylureas. The survey showed that the target-reaching rate of HbA1c was 44.9%, and α-glucosidase inhibitors were frequently used for patients with T2DM in community health service centers in Beijing Chaoyang district south medical alliance.
ABSTRACT
One thousand and forty-six patients with type 2 diabetes mellitus (T2DM) aged ＞18 years from 11 community health service centers in Beijing Chaoyang district were enrolled in the study.The body weight,height,fasting plasma glucose level and glycosylated hemoglobin A 1c (HbAlc) were measured.A door-to-door questionnaire survey on the use of oral antidiabetic drugs and insulin was conducted between January to December 2017.Of 1 046 T2DM patients,182 (17.4％) received lifestyle intervention,257 (24.6％) used single oral antidiabetic drug (OAD),326 (31.2％) with combined OAD,and 281(26.9％) with insulin and OAD.The average HbA1c in T2DM patients with lifestyle intervention,single OAD drug,combined OAD,and insulin and OAD were (8.1±2.3) ％,(7.6±2.0) ％,(7.8±2.0) ％,and (8.7±2.1) ％,respectively (F=18.35,P＜0.01).Proportions of the T2DM patients with HbAlc lower than 7.0％ were 45.1％,55.6％,43.6％ and 36.8％ in groups,respectively (x2=55.55,P＜0.01).Patients with single or combined OAD aged 18-＜45 years had a worse HbA1c control than those aged 45-＜65 years and≥65 years.It was found that 59.4％,52.6％and 30.8％of the patients receiving one OAD,two OADs and three or more OADs achieved glucose control target.The proportion of drug use was 62.6％ for α-glucosidase inhibitors,50.8％ for metfomain,32.5％ for insulin,18.2％ for sulfonylureas,4.9％ for glinides,3.2％ for thiazolidinediones and 3.1％ for dipeptidyl peptidase-Ⅳs.Among the combined treatment regimens,meffomain+a-glucosidase inhibitors was the most frequently used as compared with α-glucosidase inhibitors + sulfonylureas and metfomain + sulfonylureas.The survey showed that the target-reaching rate of HbA1c was 44.9％,and α-glucosidase inhibitors were frequently used for patients with T2DM in community health service centers in Beijing Chaoyang district south medical alliance.
ABSTRACT
Objective: In this study, we surveyed the attitudes of community pharmacists regarding oral antidiabetic drugs that need to be continuously administered, focusing especially on recently available oral‐combination antidiabetic drugs, in terms of their positioning and medication adherence. In addition, we identified relevant problems from the survey results and discussed the proper use of the combination drugs.Methods: We conducted a questionnaire‐based survey on health insurance‐covered dispensing pharmacies belonging to Kanazawa, Koga, Takasaki, Hitachi, and Hitachinaka Pharmaceutical Associations via fax or post from September 1, 2017 to November 30, 2017.Results: The overall response rate to the survey was 29.8%. Although combination drugs were considered useful in terms of improved motivation to take medication, i.e., medication adherence, there were also opinions claiming that combination drugs are not particularly useful due to the following reasons: there are problems in discarding residual drugs, they are less economical than individual drugs, it is difficult to ingest tablets of combination drugs because of their large size, it is difficult to adjust doses of combination drugs, and medication adherence does not change because of concomitant drug use.Conclusion: Based on the results there was the opinion that a combination oral diabetes drug improves medication adherence but problems such as the generation of leftover unused drugs due to switching and an increase in the risk of overuse when taking medication was pointed out. It is necessary for pharmacists to give advice in recognition of the risks with each active ingredient of the oral diabetes combination drug and to continuously monitor any development of side effects. Furthermore, as with other diabetes remedies, pharmacists need to advise regarding the patient's lifestyle as well as monitor laboratory test results such as kidney function. The patient's swallowing ability is also an important consideration at the time of medication instruction.
ABSTRACT
<p>Consultations with patients who bring drugs, especially on the high risk drug list, to a hospital is an important role of pharmacists. However, many incident reports occur though pharmacists generally make an effort to check such medications. In Japan, incidents are mostly reported just in terms of numbers but not in terms of the prevalence of a target group. We aim to reveal the prevalence of incidents related to medicine brought-in by patients undergoing surgery in National Hospital Organization (NHO) hospitals. For our study, we extracted patients undergoing surgery who were prescribed antidiabetic agents from the Medical data bank (MIA) in NHO. Chart reviews were performed on patients to evaluate the number of incidents in relation to brought-in medicine. The prevalence of incidents of interest was 4.4% (41/931, 95%CL : 3.2-5.9%). Pre-avoidable incidents represented 56.1% (23/41, p<0.0001). We found that pharmacists play a role in making incidents less severe.</p>
ABSTRACT
Objective: To assess the effectiveness and tolerability of vildagliptin in combination with another oral antidiabetic drug (OAD) versus any other two-agent OAD combinations in Indian patients with type 2 diabetes mellitus (T2DM) in a real-world setting. Study design: This was a post hoc analysis of a multicenter, prospective, 1-year, observational EDGE study for patients enrolled in India. The primary efficacy endpoint of the study was proportion of patients achieving glycosylated hemoglobin (HbA1C) reduction of >0.3% without peripheral edema, hypoglycemic event, discontinuation due to a gastrointestinal event or weight gain. One of the secondary efficacy endpoints was proportion of patients achieving HbA1C <7% without hypoglycemia and weight gain. Results: The mean age, body mass index, HbA1C and duration of T2DM were 51.8 years, 26.6 kg/m2, 8.6% and 4.3 years, respectively. The proportion of patients achieving the efficacy endpoints was significantly higher in the vildagliptin cohort compared with the comparator cohort (p < 0.0001). The vildagliptin cohort showed a numerically greater reduction in HbA1C than the comparator cohort (1.4 vs 1.1%; analysis not pre-specified). Adverse events were comparable in both groups (4.2% vs 4.9%). Conclusion: In India, in a real-world setting, vildagliptin showed better overall clinical benefits compared with comparator OADs in patients with T2DM.
ABSTRACT
Pterocarpus marsupium (Roxb.) is large deciduous tree, commonly called as Indian Kino or Malabar Kino, belonging to the family fabaceae (Leguminoceae). The tree is scared with novel antidiabetic properties. Along with as an antidiabetic drug, it is also used as astringent, anti-inflammatory, haemostatic, anthelmintic, in chest pain, body pain and in indigestion, in diabetic anaemia, elephantiasis, erysipelas, urethrorrhea and opthalmopathy etc. Phytochemicaly, many phenolic constituents of which flavonoid comprising major pool, are forming the basis of most pharmacological activities possessed by Pterocarpus marsupium. The present review summarizes the phyto-pharmacological role of this valuable medicinal plant.
ABSTRACT
In this study, we have carried out a verification of 3 hyperglycemic models to confirm their potential application and to determine a suitable dose for each hyperglycemic agent. Results from our verification showed that the following hyperglycemic models can be used in screening and evaluating hypoglycemic action of natural products: hyperglycemic action using oral glucoses at 3g/kg. Hyperglycemic action using IM Adrenalin at 0.5 mg/kg. Hyperglycemic action using IV Streptozocin, at 70mg/kg causing human type II diabetes, at 100 m/kg causing human type I diabetes.