Role of vildagliptin and its combination in type 2 diabetes mellitus management: a knowledge, attitude, and practice survey among Indian healthcare professionals

Background: Type 2 diabetes mellitus (T2DM) is a prevalent condition, with a significant burden in India, affecting approximately 74.2 million individuals. Vildagliptin, a selective dipeptidyl peptidase 4 (DPP-4) inhibitor, is approved globally for monotherapy and combination therapy. Recently, it became available as a generic product, which increased its accessibility to patients. This study aimed to assess the knowledge, attitude, and practice (KAP) regarding vildagliptin and its combination in T2DM management. Methods: A pan-India cross-sectional KAP survey was conducted from February 2022 to March 2023. The survey utilized a specially designed questionnaire focusing on various aspects of vildagliptin treatment. A total of 1,440 healthcare professionals (HCPs) with recognized qualifications and experience in diabetes management participated. Descriptive statistics were employed for data analysis. Results: HCPs reported initiating Vildagliptin monotherapy at an HbA1c 6.5-7.5%, while combination therapy with vildagliptin and metformin at HbA1c 7-8%. Vildagliptin was primarily preferred as an add-on to metformin. Inadequate HbA1c control with existing therapy emerged as the primary trigger for switching to vildagliptin and metformin combination. Treatment-na飗e T2DM patients with HbA1c 1.5% above target and those uncontrolled on metformin monotherapy or dual therapy were reported to benefit most from combination therapy. Combination therapy was reported to result in a glycemic reduction of 1.0-1.5%. HCPs perceived vildagliptin better than other DPP4 inhibitors due to its efficacy in reducing HbA1c and a lower risk of hypoglycemia. Conclusions: The KAP survey highlights the value Indian HCPs place on the effectiveness and tolerability of vildagliptin and their attitudes and practices in its use, highlighting its clinical utility in routine practice.

Transcatheter closure of aortopulmonary window.

Aortopulmonary window is an uncommon congenital cardiac defect. Most infants presenting with aortopulmonary window will require conventional surgical repair. Experience with transcatheter closure of aortopulmonary window is limited. We report the case of a 9-year-old girl with aortopulmonary window, in whom transcatheter closure was performed successfully using Amplatzer ductal occluder device.

Effect of losartan on albuminuria, peripheral and autonomic neuropathy in normotensive microalbuminuric type 2 diabetics.

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitors are emerging as effective agents for preventing microvascular complications of diabetes. Losartan (angiotensin II antagonist) has an antihypertensive efficacy equivalent to ACE inhibitors, however its role in microvascular complications is not yet known. MATERIAL AND METHODS: We studied the efficacy of losartan (50 mg once daily for 12 weeks) on albuminuria, peripheral and autonomic neuropathy in 25 normotensive microalbuminuric type 2 diabetics who were asymptomatic for neuropathy. RESULTS: Mean age was 46.6 +/- 4.34 years with the average duration of diabetes being 8.1 +/- 1.54 years. Albuminuria improved significantly from 54 +/- 9.35 mg/L to 32.8 +/- 25 mg/L (Paired student's t-test, P=0.0005) after therapy. Autonomic neuropathy was observed in 64% while 76% had peripheral neuropathy; but there was no improvement with losartan. The duration of diabetes had a negative correlation with autonomic neuropathy. It also had a similar negative correlation with median and common peroneal nerve motor conduction velocities (Pearson's correlation coefficient, r = -0.53, P<0.01 and r = -0.56, P<0.01 respectively) implying that autonomic and peripheral neuropathy worsen as a diabetic ages. However, no correlation existed between albuminuria and autonomic or peripheral nerve function. CONCLUSION: Autonomic and peripheral neuropathy are highly prevalent in normotensive microalbuminuric diabetic patients. Losartan remarkably improves albuminuria but a similar benefit in autonomic or peripheral neuropathy is not seen over 12 weeks. The future may see a defining role for losartan in microvascular complications in normotensive diabetics.

Mediastinitis presenting as pyrexia of unknown origin.

A 55 year old female was admitted as a case of pyrexia of unknown origin (PUO) of 2 months duration. She had developed throat ache, progressive dysphagia for both solids and liquids, dry cough and retrosternal pain for one week. Examination revealed fever, tachycardia, tachypnoea and a soft tissue warm tender, erythematous, non-fluctuant swelling in lower anterior neck with chest findings suggestive of bilateral pleural effusion. Plain X-rays of the neck and chest strengthened the clinical suspicion of cellulitis of lower neck with bilateral pleural effusion. CT scan confirmed the radiologic findings and also revealed pericardial effusion and thickening; small mediastinal lymphadenopathy and mediastinitis. Patient responded to parenteral antibiotics (ceftriaxone and metronidazole) and hydrocortisone with complete resolution in 10 days.

Familial occurrence of cancer in Basel city.

The Basel Familial Cancer Study was established in 1982. Data collection and statistical analysis suggest that genetic mechanisms play an important role in most cancer types. This is illustrated in breast and colorectal cancer patients whose first degree relatives were studied. The establishment of a familial cancer registry is most helpful for cancer risk determinations, surveillance and management programmes, identification of new cancer prone genotypes and etiological family studies. The family history should be included into future cancer control activities.