Gender differences in the blood glucose type 2 diabetes patients with combination rapid and long acting insulin therapy.

OBJECTIVES: Previous research suggests that there may be intergender differences in the profile of glycemic control achievable during the treatment of type 2 diabetes mellitus. This preliminary study was conducted to determine differences in glycemic outcomes in type 2 diabetes mellitus patients amongst men and women in an Indonesian hospital. METHODS: The study was conducted at the outpatient internal medicine polyclinic of Universitas Airlangga Teaching Hospital Surabaya. This observational prospective cohort study examining outcomes for 64 patients (32 men and 32 women) treated with insulin therapy. The primary outcome measure was the extent to which subjects achieved concordance with the target blood glucose parameters based on the American Diabetes Association (ADA) guidance. RESULTS: After 3 months of combination basal-bolus insulin treatment, the proportion of subjects who had fasting blood glucose values in the target range did not increase for either gender. For women, there was a significantly higher proportion of subjects who achieved a postprandial glucose value within the target range (p=0.04). CONCLUSIONS: In this study, patients achieved postprandial glycemic outcomes for women but not men. More research is required to elucidate the possible intergender difference in results for subjects treated with basal-bolus insulin for type 2 diabetes mellitus.

Study on dosage range evaluation opioid analgesic for breakthrough pain in cancer patients: a retrospective study.

BACKGROUND: Breakthrough pain is an exacerbation of pain occurring in patients with chronic pain who receive opioid therapy every day. Breakthrough pain has not been routinely recognized, evaluated and treated. This study aimed to analyze the utilization of opiates analgesics, including dose regimentation, frequency of use, and the actual adverse effects in cancer patients with breakthrough pain. METHODS: Data were collected by the retrospective method in the period from January to December 2017. Patients involved received opioids around the clock for treating background pain and rescue medication for treating breakthrough pain. The percentage of the rescue medication dose was calculated based on the total daily opioid dose to treat background pain. Descriptive analysis was used. RESULTS: From 335 visits, there were 334 of patient visit where the patient received immediate-release morphine as a rescue medication with a dose percentage between 6.67-60%, and 1 visit where the patient received codeine with a dose percentage of 16.67%. Of 335 visits, 233 patient visits received the right proportion of opioid rescue medication doses, while 102 patient visits received a greater dose proportion than the recommended dose of 5-20%. CONCLUSIONS: Immediate-release morphine is the most commonly prescribed analgesic to treat breakthrough pain and used at 6.67-60% of daily dose with the frequency of use between 2 to 6 times a day. There were 189 (56.42%) patient visits when the patient experienced the adverse effects of the opioid. The identified actual adverse effects are constipation, nausea, and vomiting.

Video-based health education to support insulin therapy in diabetes mellitus patients.

Background: The improper use of insulin usually leads to some unexpected effects, hence, there is a need for right usage. Lack of knowledge and of understanding are key factors leading to the occurrence of medication errors, which could be avoided with proper education. Therefore, an appealing education alternative, such as video, is needed to improve patient's knowledge and attitudes towards insulin therapy. Design and Methods: One-group pretest and posttest design were conducted on 100 patients with type 2 diabetes mellitus who were receiving subcutaneous insulin therapy at Internal Medicine Unit in Universitas Airlangga Teaching Hospital. The patients filled the provided questionnaires to measure their knowledge and attitudes, before and after watching the video on insulin therapy education. Then, data obtained were analysed with SPSS using Wilcoxon Signed Rank Test Method. Results: Based on the results, there was an increase in the value of the patient's knowledge, with the value of Z=-8.212 and P<0.05. Similarly, there was an increase in the patient's attitudes with the value of Z=-8.234 and P<0.05. Conclusions: Insuline therapy video increases the knowledge and improves the attitude of diabetes mellitus patients towards insulin therapy.

The effect of premixed insulin to blood glucose concentration in patients with type 2 diabetes mellitus.

Background One of the therapies used to treat type 2 diabetes mellitus (T2DM) disease is combination insulin which consists of rapid-acting insulin and intermediate-acting insulin (premixed). This study aimed to examine the profile of premixed insulin related to blood glucose concentration and to identify the drug interactions due to the combination of premixed insulin with other drugs taken by T2DM patients. Methods This study was a prospective observational study with cross-sectional data that were analyzed descriptively. The respondents invited were T2DM patients with or without complication or comorbid disease who received premixed insulin with or without a combination of oral antidiabetic therapy in the Outpatient Unit of Universitas Airlangga Hospital, Surabaya. The research instruments used are data sheet, patient medical record, and fasting and postprandial blood glucose concentration. Results A total of 118 patients received premixed insulin therapy, but only 80 patients were included in the inclusion criteria. Based on types of insulin, the combination of 30% aspart and 70% protamine aspart was used by 91.25% T2DM patients, and a combination of 25% insulin lispro and 75% protamine lispro was used by 8.75% T2DM patients. There were 30.3% of patients who could achieve the target of 80-130 mg/dL in fasting blood glucose concentrations, and 35.1% of patients achieved the target of ≤180 mg/dL in postprandial blood glucose concentration. Drug interactions may occur in patients who use premixed insulin with glimepiride, lisinopril, fenofibrate, candesartan, irbesartan, and gemfibrozil. Conclusions In this study, premixed insulin have not reached the target of fasting and postprandial blood glucose concentrations in most patients.

Overview of therapeutic changes in antiepileptic drugs in adult patients.

Background Previous studies suggest a highly variable response of antiepileptic drugs (AEDs). This may be because the response to AEDs has been changed to sustained period of freedom from seizures. This study was conducted to determine whether therapeutic changes of AEDs in the treatment of seizure would be observable in an Indonesian population. Methods The study was conducted at the outpatient neurology polyclinic at the Universitas Airlangga Hospital, Surabaya, Indonesia. This was an observational retrospective cohort study, examining the outcomes of 41 cases of switching AEDs (increase or decrease of the dose, switch to branded or generic, or added or reduced type of AEDs). Results After treatment with the switched AED, seizure did not show any significant improvement. However, the incidence of seizure during and after the therapeutic change showed a downward trend (from 44% to 32%). Conclusions According to the present study, mere optimization of antiepileptic therapy may not result in a steep decrease in seizure events, particularly in polytherapy with AEDs. On the other hand, monotherapy with AEDs evidences to decreasing tendency of seizures.