Clinical Utilization Pattern of Multiple Strengths of Glimepiride and Metformin Fixed Dose Combinations in Indian Type 2 Diabetes Patients.

BACKGROUND: In Indian clinical set-up, modern sulfonylurea, particularly glimepiride is still preferred as an add-on to metformin due to its efficacy, safety and cost effectiveness. In view of this, a case-based questionnaire survey was conducted to analyze the clinical utility of multiple strengths of glimepiride and metformin fixed dose combination in type 2 diabetes mellitus (T2DM). METHODS: The case-based questionnaire survey was conducted with 174 health care professionals across India to assess the use of glimepiride and metformin fixed dose combination according to age, duration of diabetes, body mass index (BMI), diabetes complications, concomitant medications like insulin, and statin. RESULTS: Overall, data from 2248 patients taking multiple strengths of glimepiride and metformin fixed dose combination were analyzed. All the doses were prescribed across all the age groups and irrespective of duration of diabetes. Overall, 1429 diabetes patients had body mass index (BMI) ≥25 kg/m2, among which 1176 (81.6%) patients were receiving combination of glimepiride 1 or 2 mg and metformin 500 or 850 or 1000 mg. Glimepiride and metformin fixed dose combinations were among the preferred choices in various complications like neuropathy, retinopathy, nephropathy, peripheral vascular disease, diabetic foot and cardiovascular disease. Insulin and statins were co-prescribed in 17.3% and 28.8% patients, respectively. Hypoglycemic episodes were reported in only a minority of patients, even with higher doses of glimepiride and metformin fixed dose combinations. CONCLUSION: Multiple strengths of glimepiride and metformin fixed dose combinations are beneficial in T2DM, irrespective of age, duration of diabetes, BMI, diabetes complications, use of concomitant medications such as insulin and statin. Glimepiride and metformin fixed dose combinations were not associated with a significant risk of hypoglycemia.

Peri-operative management of glucose.

It is generally agreed that it is important to control blood glucose levels during the peri-operative period. However, there have been controversies surrounding the appropriateness of each regimen, as well as ideal glucose targets during surgery. This review focuses on a simple and practical strategy to control glucose during surgery, and sets out simple guidelines on instituting an insulin infusion protocol. From the available evidence, a fasting plasma glucose < 90 mg/dl, postprandial glucose < 180 mg/dl and an HbA1c < 7% is ideal before elective surgery. The blood glucose must be maintained between 140 and 180 mg/dl during the operative period as well as during the intensive care unit (ICU stay). Sliding scales are inappropriate for in-hospital glucose control. A basal-bolus insulin regimen is ideal for hospitalised peri-operative subjects outside the ICU. In the ICU, it is best to use an insulin infusion protocol for glucose control. The ideal regimen should be individualised for each patient. The success of peri-operative glucose control requires teamwork between the various medical personnel involved in patient care.