RESUMEN
The gut enzymes are released in response to intake of meal, those are GLP-I (glucagon link peptide-I) & GIP (glucose-dependent insulin tropic polypeptide) along with DPP-4(Dipeptidylpeptidase-4). GLP-I has vital role in control of glucose levels and it may also has capacity reduce body weight and it can manage some micro & macro-vascular complications. Unfortunately it has very shorter half-life 1-2 min, and eventually it was degraded by DPP-4 enzyme. Therefore GLP-I has ineffective to perform its tasks. To overcome this incidence essential to inhibit DPP-4 enzyme is benefited in diabetics and in non diabetics suffering with micro, macro vascular complications. Ubiquitous Dipeptidyl peptidase (DPP) -4 has pleiotropic effects because it is widely distributed other than intestine. DPP-4 enzyme inhibition has a promising effect on glycemic control. DPP-4 inhibition is also involved in the improvement of non-glycemic effects as directly or indirectly the DPP-4 enzyme is linked with some pathological conditions of particular organs, such as DPP-4 is linked with the intestinal secretion of triglycerides, and DPP-4 is expressed in the glomerulus in uncontrolled diabetics which in turn leads to nephritis. DPP-4 release strongly correlates with adipocyte size, potentially representing an important source of DPP-4 in obesity. DPP-4 inhibition produces an anti-inflammatory activity because the activity of DPP-4 results in reduced production of cytokines including interleukins and interferon-G. All these anti-inflammatory agents are inhibited by the DPP-4 enzyme which can lead to pathogenesis of cardiovascular diseases and provokes atherosclerosis & psoriasis. Serum sodium and brain natriuretic peptide (BNP) levels are also regulated by inhibition of the DPP-4 enzyme and which can produce vascular protection & regulates blood pressure. Teneligliptin is a recently developed oral DPP-4 inhibitor indicated for the management of T2DM in adults along with diet and exercise. Teneligliptin is recently available in India and is also available in combination with other oral hypoglycemic agents at affordable prices. This review is aimed at exploring the status of teneligliptin with emphasis on its glycemic effects and non-glycemic clinical benefits associated with increasing GLP-1 & GIP
RESUMEN
Background: The prevalence of metabolic syndrome is increasing in Indian population, predisposing an increased risk for the development of diabetes mellitus and cardiovascular diseases. Methods: A case control study was conducted to assess the prevalence of MS and the association between the components of MS in 250 patients, diagnosed by angiography to have CAD (125 patients) as cases and no CAD (125 patients) as control group. MS was diagnosed based on the modified ATP III guidelines, if three or more of the following were present: abdominal obesity, hypertension, glucose intolerance, hypertriglyceridemia or low HDL-C levels. SPSS Version 15 was used for statistical analysis and Chi-square analysis was used to estimate the prevalence of MS with respect to the severity of CAD, family history of CAD and smoking history. The association between individual risk factor and outcome was estimated using univariate logistic regression. The multivariate logistic regression analysis was used to estimate the components of MS as a risk factor for CAD, controlling the other confounders. A P value of <0.05 was considered as statistically significant. Results: The prevalence of MS was higher in CAD (70.4%) than in subjects without CAD (66.4%). Diabetic subjects with (88.24%) and without (87.93%) CAD had significantly higher % of MS when compared with non-diabetic subjects with CAD (49.12%) and without CAD (47.76%) (P < 0.001). Of 125 patients with CAD, 3% patients had no functional markers of MS; 11.2 % had an expression of one; 20 % had two; 32 % had three and 33.8% had four functional markers of MS. The level of MS mounted high with the increasing severity of CAD when compared with normal coronary arteries but was not statistically significant (P=0.176). The percentage of MS was higher in patients with family history of CAD (78.18%) which was statistically significant (P<0.001) and was comparatively lower in non-smokers (46.7%) and ex-smokers (62.2%) than smokers (65.2%). Conclusion: A higher prevalence of MS was observed in diabetics with and without CAD. This is suggestive of an increased risk of CAD in diabetic patients with MS than in non-diabetic patients.
RESUMEN
Type 2 diabetes mellitus is a chronic metabolic disorder that results from defects in both insulin secretion and insulin action. Tight glycemic control is considered to be important in the therapy of type 2 diabetes mellitus, but treatment with a single agent is not sufficient to achieve this for the majority of patients. So, there is a need for new antidiabetic agents with favorable side effect profiles to use in combination therapy. The gliptins, an emerging new class of oral drugs for type 2 diabetes mellitus, lower blood glucose levels by a novel mechanism of inhibiting the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretin, released from the intestine following a meal to increase pancreatic insulin secretion. Gliptins enhance the circulating levels of incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) and improve glycemic control. This therapeutic approach carries a low-risk of interprandial hypoglycemia, does not cause weight gain and is well-tolerated. The first gliptin, sitagliptin (Januvia), was introduced in the UK in April 2007 as add-on therapy for patients with type 2 diabetes inadequately controlled with oral hypoglycemic agents. Other gliptins, notably vildagliptin (Galvus), saxagliptin and melogliptin are advanced in clinical development. This article reviews the current evidence on the effectiveness of gliptins and suggests several ways in which these agents could be used in diabetes treatment.
RESUMEN
Congestive heart failure (CHF) is becoming an increasingly prevalent healthcare problem. Hypertension (HT) is a major risk factor for CHF and it commonly coexists with other cardiovascular risk factors. The quality of risk that HT represents has to be thoroughly compared with other risk factors. This could have significant implications for primary prevention strategies including drug treatment. A study was conducted in 137 heart failure patients, to assess the contribution of cardiovascular risk factors like age, sex, obesity, HT, diabetes, dyslipidemia, alcohol, smoking and family history, individually and in combination, in the progression of CHF using multivariate logistic regression analysis and odds ratio (OR) (95% confidence interval). Of the various individual factors, HT showed 3.8 times greater risk (p = 0.003; OR-3.773) for heart failure; dyslipidemia exhibited 2.5 times risk (p = 0.07; OR-2.49), followed by others. Patients with HT, but no diabetes or dyslipidemia had 1.2 times risk (OR-1.17) for CHF; patients with hypertension and diabetes had 1.7 times risk (OR-1.69) and patients with HT, diabetes and dyslipidemia had two times greater risk (OR-1.87). Though, the present study emphasizes that HT is the most common risk factor in the progression of heart failure, the risk is high when it coexists with other risk factors like diabetes and dyslipidemia. A clinical pharmacist can work in collaboration with healthcare team in achieving the goal of long-term control of hypertension and other cardiovascular risk factors in millions of patients, by providing services ranging from monitoring drug therapy and improving patients compliance to drug therapy, to, health maintenance care such as ordering screening procedures and counseling regarding lifestyle modification.