Evaluation of multiple drug use in patients with type 2 diabetes mellitus

The impact of sociodemographic determinants and diabetes type-2 on oral health outcomes: An analytical cross-sectional study

OBJECTIVES

This study compared adults with type 2 diabetes (T2DM) and those without diabetes (ND) from East London in terms of sociodemographic characteristics, oral health behaviors, dietary practices, and alcohol and tobacco-related habits.

MATERIALS AND METHODS

A total of 182 participants (n = 91 for each group) were recruited and requested to complete the validated questionnaire with 33 items.

RESULTS

Results showed that the mean ± SD age was 61 ± 11.7 in the T2DM, while 51 ± 11.2 in the ND group. The mean ± SD age at T2DM diagnosis was 43 ± 10. There was a significant gender difference, with more males in the T2DM group (67.7%) and more females in the ND group (64.8%). Asian-British (38.4%) were significantly high in the T2DM group when compared to other ethnicities. 92.3% of T2DM participants were significantly more likely to use medications in comparison to the ND group (29.7%). The T2DM participants' personal statements on general health were fair (34%) and good (46.2%) when compared with the ND group (15.4% and 59.3%, respectively). The majority of T2DM and ND participants (98%) lacked dental insurance. In the T2DM group, 31.8% were receiving benefits, and 39.5% were retired, while 46% of the ND group were full-time employees. Tooth brushing twice a day was slightly less common in T2DM (68%) when compared to the ND group (78%). Nearly half of the participants in both groups failed to carry out interdental cleaning (T2DM = 52%; ND = 47%), and 38.5% of the T2DM group used mouthwash occasionally, while 30% of the ND group had it twice daily. There was a weak association between chewing paan and annual income in ND participants (r = .90, p = .49). There were significant differences in the presence of removable prostheses, juice, and sweetened juice consumptions between the two groups (p < .05).

CONCLUSION

Within the confines of this study, being male, Asian British, retired due to disability, polypharmacy, and the presence of removable prostheses were all significant factors for T2DM.

Prevalence, Characteristics and Determinants of Polypharmacy Among Elderly Patients Attending Primary Healthcare Centres in Bahrain: A cross-sectional study

Objectives

This study aimed to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain.

Methods

This cross-sectional study was conducted between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as one aged ≥60 years and polypharmacy was defined as the concomitant use of 5 or more medications, with excessive polypharmacy defined as the concomitant use of 10 or more medications.

Results

A total of 977 patients were included, with more than half of them being females (n = 533, 54.55%) and the mean age of the participants at 67.90 ± 6.87 years. Essential hypertension, hyperlipidaemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Among the cohort, 443 (45.34%) were on 5 or more medications and of those 66 (6.76%) were on at least 10 medications. A multivariate analysis revealed that patients with diabetes (odds ratio [OR] = 5.836, 95% confidence interval [CI]: 4.061-8.385; P <0.001), hypertension (OR = 6.231, 95% CI: 4.235-9.168; P <0.001), hyperlipidaemia (OR = 3.999, 95% CI: 2.756-5.802; P <0.001), cardiovascular diseases (OR = 3.589, 95% CI: 1.787-7.205; P <0.001) and asthma (OR = 3.148, 95% CI: 1.646-6.019; P <0.001) were significantly more likely to suffer from polypharmacy.

Conclusion

Polypharmacy is prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering healthcare services to the elderly, especially those with non-communicable diseases.

Head-to-head comparison of BAM15, semaglutide, rosiglitazone, NEN, and calorie restriction on metabolic physiology in female db/db mice

Metabolic disorders such as type 2 diabetes, fatty liver disease, hyperlipidemia, and obesity commonly co-occur but clinical treatment options do not effectively target all disorders. Calorie restriction, semaglutide, rosiglitazone, and mitochondrial uncouplers have all demonstrated efficacy against one or more obesity-related metabolic disorders, but it currently remains unclear which therapeutic strategy best targets the combination of hyperglycaemia, liver fat, hypertriglyceridemia, and adiposity. Herein we performed a head-to-head comparison of 5 treatment interventions in the female db/db mouse model of severe metabolic disease. Treatments included ∼60 % calorie restriction (CR), semaglutide, rosiglitazone, BAM15, and niclosamide ethanolamine (NEN). Results showed that BAM15 and CR improved body weight and liver steatosis to levels superior to semaglutide, NEN, and rosiglitazone, while BAM15, semaglutide, and rosiglitazone improved glucose tolerance better than CR and NEN. BAM15, CR, semaglutide, and rosiglitazone all had efficacy against hypertriglyceridaemia. These data provide a comprehensive head-to-head comparison of several key treatment strategies for metabolic disease and highlight the efficacy of mitochondrial uncoupling to correct multiple facets of the metabolic disease milieu in female db/db mice.

Drug-Drug Interactions in Vestibular Diseases, Clinical Problems, and Medico-Legal Implications

Peripheral vestibular disease can be treated with several approaches (e.g., maneuvers, surgery, or medical approach). Comorbidity is common in elderly patients, so polytherapy is used, but it can generate the development of drug-drug interactions (DDIs) that play a role in both adverse drug reactions and reduced adherence. For this reason, they need a complex kind of approach, considering all their individual characteristics. Physicians must be able to prescribe and deprescribe drugs based on a solid knowledge of pharmacokinetics, pharmacodynamics, and clinical indications. Moreover, full information is required to reach a real therapeutic alliance, to improve the safety of care and reduce possible malpractice claims related to drug-drug interactions. In this review, using PubMed, Embase, and Cochrane library, we searched articles published until 30 August 2021, and described both pharmacokinetic and pharmacodynamic DDIs in patients with vestibular disorders, focusing the interest on their clinical implications and on risk management strategies.