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.

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.

Pharmacologic Treatment Using Non-Hypoglycemic Agents for Nonalcoholic Fatty Liver Disease / 임상당뇨병

Nonalcoholic fatty liver disease (NAFLD) is a common condition that may progress to end-stage liver disease. Recently, NAFLD has been recognized as a hepatic manifestation of metabolic syndrome and an independent risk factor for cardiovascular disease. Therefore, appropriate management of this common disorder is an important public health issue. The management of NAFLD is based on gradual weight loss through lifestyle modification. Reducing total calorie intake and carbohydrates in the diet is beneficial for NAFLD patients. Regular exercise reduces hepatic fat content independent of weight loss. However, such lifestyle changes are difficult to maintain long term for most patients. Despite the growing need for pharmacologic therapy, there is currently no effective agent for the treatment of NAFLD. Several large clinical trials have shown promising but inconsistent effects of pioglitazone and vitamin E for improving NAFLD. However, larger clinical trials are required before definitive conclusions can be drawn.

Beetle (Ulomoides dermestoides) fat improves diabetes: effect on liver and pancreatic architecture and on PPARgamma expression

Ulomoides dermestoides is a beetle traditionally consumed to treat diabetes. In this study, we performed a composition analysis of U. dermestoides to obtain the principal fractions, which were used to assess the effect on glycemia, liver and pancreatic architecture, and PPARγ and GLUT4 expression. Normal mice and alloxan-induced diabetic mice were administered fractions of chitin, protein or fat, and the acute hypoglycemic effect was evaluated. A subacute study involving daily administration of these fractions to diabetic mice was also performed over 30 days, after which the liver and pancreas were processed by conventional histological techniques and stained with hematoxylin and eosin to evaluate morphological changes. The most active fraction, the fat fraction, was analyzed by gas chromatography-mass spectrometry (GC-MS), and PPARγ and GLUT4 mRNA expressions were determined in 3T3-L1 adipocytes. The protein and fat fractions exhibited hypoglycemic effects in the acute as well as in the 30-day study. Only the fat fraction led to elevated insulin levels and reduced glycemia, as well as lower intake of water and food. In the liver, we observed recovery of close hepatic cords in the central lobule vein following treatment with the fat fraction, while in the pancreas there was an increased density and percentage of islets and number of cells per islet, suggesting cellular regeneration. The GC-MS analysis of fat revealed three fatty acids as the major components. Finally, increased expression of PPARγ and GLUT4 was observed in 3T3-L1 adipocytes, indicating an antidiabetic effect.

Therapeutic effect of Acarbose in combination with other hypoglycemic drugs / 中国糖尿病杂志

[Summary] Acarbose is a kind of α-glucosidases that binds competitively to the complex oligosaccharide at the brush border of the small intestine,thus delaying the breakdown of sucrose and starch and the absorption of glucose and fructose. During the exacerbation of T2DM,Acarbose mono therapy gradually failed to control blood glucose,and should be combined with other oral hypoglycemic agents,such as Metformin,insulin secretagogues,dipeptidyl peptidase-4 (DPP-4)inhibitors,glucagon-like peptide (GLP-1),sodium-glucose cotransporter 2 (SGLT-2)inhibitors or insulin. Here we reviewed recent researches about the therapeutic effect of Acarbose in combination with other anti-diabetic agents.

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.

Efficacy of combined metformin and other hypoglycemic drugs / 中国糖尿病杂志

Metformin was widely recommended as a first‐line drug for patients with type 2 diabetes mellitus(T2DM ). However ,studies have shown that patients who start metformin as monotherapy often required additional agents to maintain glycaemic control with the natural progression of T 2DM. Anti‐diabetic agents may be used in combination with metformin ,including sulfonylureas ,glinides , thiazolidinediones(TZDs) ,α‐glucosidase inhibitor (AGDI) ,dipeptidyl peptidase‐4 inhibitor (DPP‐4) and glucagon‐like peptide‐1 (GLP‐1 ) or insulin. This paper mainly reviews the recent studies about the therapeutic effect of metformin in combination with other anti‐diabetic agents.

The new choice for the treatment of type 2 diabetes-DPP-4 inhibitors / 中国药学杂志

OBJECTIVE: To review the epidemiological status of type 2 diabetes (T2DM) and therapeutic applications of incre-tin-based novel oral hypoglycemic agents. METHODS: Based on the literatures in recent years, the mechanism and clinical evidence of DPP-4 inhibitors, particularly sitagliptin, in diabetes management were reviewed and introduced, especially sitagliptin. RESULTS AND CONCLUSION: DPP-4 inhibitors have many advantages and a good future in diabetes care, as either monotherapy or combination therapy. DPP-4 inhibitors have good safety profile and are recommend by some academic organizations.

INITIATE STUDY: Insulin versus oral hypoglycemic agent as Initial therapy for newly diagnosed diabetes mellitus Type 2: A systematic review and meta-analysis / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#This study aims to evaluate the effectiveness of initial insulin therapy versus oral hypoglycemic agents in glucose control among newly diagnosed Type 2 diabetes patients. @*Methodology@#This is a systematic review and meta-analysis of RCTs with quality grade B searched using the medical subject headings (MeSH): diabetes mellitus type 2, insulin, oral hypoglycemic agent, with adults newly diagnosed with type 2 DM as subjects and given insulin (± metformin) vs. OHA. Results were summarized as graphs and forest plots using the random effects due to foreseen sources of heterogeneity using Review Manager version 5.1. @*Results@#Presence of substantial heterogeneity prevents us from making a conclusion. All four studies showed lower post treatment BMI among participants in the insulin treatment arm. An opposite finding was expected as insulin is known to cause weight gain. Main adverse effect was hypoglycemia. @*Conclusion@#Among newly diagnosed type 2 DM patients, there is insufficient evidence for or against the use of insulin compared to oral hypoglycemic agents as initial management in terms of improvement in glycemic control, decrease in insulin resistance, and improvement in beta cell function.

Effect of petroleum ether extract of Sesbania sesban (Merr.) roots in streptozotocin (STZ) induced diabetes in mice

Objective: The present study was carried out to investigate the hypoglycemic effects of the petroleum ether extract of Sesbania sesban (SS)(Merr.) roots, which are widely used in inflammation, fever, ulcers, leucoderma and diabetes in various parts of India. Methods: SS was administered orally at different doses (250, 500 and 1000mg/kg) to normal and streptozotocin (STZ) induced type- 2 diabetic mice. The fasting blood glucose (FBG), biochemical parameters in serum, change in body weight, internal organs weight, food intake, water intake and glycogen level in livers were performed for the evaluation of hypoglycemic effects.Results: All the doses of SS caused a marked decrease of FBG in STZ induced type -2 diabetic mice. SS decreased the cholesterol, triglyceride (TG), urea, creatinine level and increased the insulin, HDL cholesterol, and total protein level. Decrease in body weight and glycogen level induced by STZ was restored. Increase in water and food intake induced by STZ was decreased. Conclusions: The results suggest that SS may have hypoglycemic potential for the type 2- diabetes and support the traditional use of the roots of plant as a hypoglycemic agent.

Factors Associated with Long-Term Oral Hypoglycemic Agent Responsiveness in Korean Patients with Type 2 Diabetes Mellitus

BACKGROUND: This study was performed to determine the factors associated with long-term oral hypoglycemic agent (OHA) responsiveness in Korean type 2 diabetic patients. METHODS: Two groups of patients were selected among the type 2 diabetic patients who were followed for more than two years at a university hospital diabetes clinic. The OHA responsive group consisted of 197 patients whose HbA1c levels were maintained at 8% in spite of optimal combined OHA therapy or patients who required insulin therapy within the two years of the study. RESULTS: The OHA failure group had higher baseline values of fasting and postprandial glucose, HbA1c, and lower fasting, postprandial, and delta C-peptide compared to those of the OHA responsive group. The OHA failure group also had a higher proportion of female patients, longer diabetic duration, and more family history of diabetes. There were no significant differences in body mass index (BMI) or insulin resistance index between the two groups. Multiple logistic regression analysis showed that the highest quartile of baseline fasting, postprandial glucose, and HbA1c and the lowest quartile of postprandial and delta C-peptide were associated with an increased odds ratio of OHA failure after adjustment for age, sex, body mass index, and family history of diabetes. CONCLUSION: Lower baseline values of postprandial and delta C-peptide and elevated fasting glucose and HbA1c are associated with long-term OHA responsiveness in Korean patients with type 2 diabetes mellitus.

Caracterização do fármaco hipoglicemiante glibenclamida / Characterization of the hypoglycemic drug glibenclamide

A glibenclamida (GLIB) é um fármaco de segunda geração, administrado por via oral na forma de comprimidos, utilizado para o tratamento de Diabetes mellitus. GLIB possui baixa solubilidade aquosa, o que pode levar a uma baixa liberação a partir de formas farmacêuticas sólidas no teste de dissolução e, portanto, a variabilidades no tratamento. Neste estudo, avaliam-se as características da matéria-prima GLIB, que podem influenciar o perfil de dissolução, e conseqüentemente, a biodisponibilidade, por meio de técnicas tais como, adsorção de nitrogênio, difração de raio laser, análise térmica, espectroscopia por IV/UV e difração de raios X.

Glibenclamide (GLIB) or glyburide, a second-generation hypoglycemic agent is orally used in the form of tablets for the treatment of diabetes mellitus. Bulk GLIB has a low aqueous solubility and it may yield low drug release in the dissolution test, causing variabilility in the treatment. This work evaluates the bulk GLIB features, which may influence drug release profile, hence, bioavailability, by means of techniques such as nitrogen sorption analysis, laser diffraction, thermal analysis, IV/UV spectroscopy and X-ray analysis.

Teste de dissolução para avaliação de liberação de glibenclamida em comprimidos / Glibenclamide dissolution test for drug release evaluation in tablets

A glibenclamida (GLIB) ou gliburida, é um hipoglicemiante oral de segunda geração, da classe das sulfoniluréias, usado sob a forma de comprimidos para tratamento do diabetes mellitus. Variações no tratamento podem ocorrer, devido à baixa solubilidade do fármaco em comprimidos. A comparação de várias formulações de comprimidos piloto com comprimidos do medicamento referência (Daonil®, glibenclamida 5 mg comprimidos, Aventis Pharma Ltda.) foi avaliada por meio do desenvolvimento de um teste de dissolução sem adição de solventes orgânicos ou tensoativos no meio, que mostrou ser discriminativo para as diferentes formulações farmacêuticas propostas. A quantificação de GLIB foi realizada por meio de cromatografia líquida de alta eficiência em fase reversa (CLAE-FR), método previamente validado. A partir de vários ensaios de perfil de dissolução testados comparativamente àquele de comprimidos do medicamento referência, verificou-se o potencial de determinada formulação proposta (f1 4,04 and f2 69,35) como candidata a medicamento genérico no mercado brasileiro.

Glibenclamide (GLIB) or glyburide, a second-generation hypoglycemic agent is used per oral as tablets for the treatment of diabetes mellitus. Much variabilility in the treatment may occur because of the low drug aqueous solubility in tablets dosage forms. This work reports the comparison of several pilot formulation batches with the commercial reference drug dosage form (Daonil®, glibenclamide 5 mg per tablet, Aventis Pharma Ltda.). A feasible dissolution test, developed with no use of organic solvents or surfactants in the medium, showed to be discriminative regarding to different formulations tested. GLIB quantitation was performed by a previously validated reverse-phase high performance liquid chromatography (RP-HPLC). Among several dissolution profiles compared with that of a commercial reference, a potential for a generic candidate was evident (f1 4.04 and f2 69.35) for a proposed solid dosage formulation in the Brazilian market.

Correlations of Abnormal Involuntary Movements with Blood Glucose, Lipid Levels in Chronic Schizophrenics

OBJECTS: It has been reported that the incidence of tardive dyskinesia(TD), the remarkable abnormal involuntary movement, was higher in the schizophrenics with high blood sugar levels and that TD had been improved by small amount of insulin-injection for 90 days. And also it was generally known that the blood lipids were higher in the schizophrenics with tardive dyskinesia. Thus, we tried to replicate the correlations of abnormal involuntary movements with blood sugar levels and blood lipids in chronic schizophrenics treated with antipsychotics. METHODS: Thirty-eight male schizophrenic inpatients who were stable in clinical state with medications, were included. The patients who had been already diagnosed as diabetes mellitus(DM), organic brain disorder, substance-related disorder, physical illness were excluded and also we excluded female patients to remove the hormonal effect on TD. Eleven patients who ranked higher(above five) in the Abnormal Involuntary Movement Scale(AIMS) were assigned into 2 groups, a dibenese group and a placebo group. Diabinese or placebos were administrated for 3 weeks with antipsychotics and AIMS was rechecked. RESULTS: There were no correlations between the total AIMS scores and blood sugar and lipids levels in all subjects. The means of total and subscale scores(objective, face, and extremity) of AIMS did not reveal statistical significances between diabinese and placebo groups. However(total, jaw, face, upper arm, and objective feeling), were statistically higher in the diabinese group than those in the placebo group. And correlations of total cholesterol(TC) with fast blood sugar(FBS), weight with body mass index(BMI) and waist, total glycerol (TG) with BMI were statistically significant. CONCLUSION: In this study, there were statistical significances in the changes in ratings of AIMS scores between the diabinese group and the placebo group. Application of oral hypoglycemic agent might be a way of improving abnormal involuntary movements in schizophrenics with abnormal involuntary movements or TD. Althogugh it was not certain that there were correlations of abnormal involuntary movement with blood sugar and lipids, correlations of TC/TG with AIMS, of FBS with AIMS cautiously suggest that the regular check of HbA1C, waist, and weight are recommended for schizophrenics.