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Karki N, Kandel K, Shah K, Prasad P, Khanal J. Combination Therapy in Diabetes Mellitus Patients Attending Outpatient Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:1016-1020. [PMID: 36705114 PMCID: PMC9795118 DOI: 10.31729/jnma.7642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Assessing anti-diabetic drug use patterns in hospitals is an important activity which helps to promote the rational use of drugs and may suggest measures to change prescribing habits for the better. This study aimed to find the use of combination therapy in diabetes mellitus patients attending the outpatient department of a tertiary care centre. Methods A descriptive cross-sectional study was conducted among 201 diabetes mellitus patients in the internal medicine department from 2 March 2022 to 30 June 2022 for a duration of four months after approval from the Institutional Review Committee (Protocol No: IRC-LMC-01/R-022). Diabetic patients prescribed at least one anti-diabetic drug in prescription forms were included. Socio-demographic profiles, clinical characteristics and anti-diabetic drug use pattern-related data were collected. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results Among 201 patients, 134 (66.66%) (60.14-73.18, 95% Confidence Interval) patients were given combination therapy. The most common combination therapy was metformin 500 mg and sitagliptin 50 mg. A total of 324 anti-diabetic drugs were used. The average number of drugs prescribed per patient was 1.6±0.7. The number of anti-diabetic drugs prescribed by generic name and from the national essential drugs list was 74 (22.83%) and 188 (58.02%) respectively. Biguanides were used in 176 (87.56%) patients. Conclusions These findings were similar to some other studies conducted in similar settings. In most patients, combination drug therapy was more prevalent. Among combination therapy, two drug combinations were more prevalent. Keywords diabetes mellitus; drug combinations; outpatients; teaching hospital.
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Affiliation(s)
- Naresh Karki
- Department of Pharmacology, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal,Correspondence: Dr Naresh Karki, Department of Pharmacology, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal. , Phone: +977-9844028216
| | - Kamal Kandel
- Department of Pharmacology, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal
| | - Kyushu Shah
- Department of Pharmacology, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal
| | - Pravin Prasad
- Department of Pharmacology, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Jeevan Khanal
- Department of Internal Medicine, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal
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Khanal P, Duttaroy AK. Prospect of potential intrauterine programming impacts associated with COVID-19. Front Public Health 2022; 10:986162. [PMID: 36091565 PMCID: PMC9451506 DOI: 10.3389/fpubh.2022.986162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 01/26/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - 2019 (COVID-19) has led to a worldwide public health concern. In addition to immediate impacts on human health and well-being, COVID-19 can result in unfortunate and long-term health consequences for future generations. In particular, pregnant women and developing fetuses in low-income settings could be prone to a higher risk of undernutrition, often due to an inadequate supply of food and nutrition during a pandemic outbreak like COVID-19. Such situations can subsequently lead to an increased risk of undesirable health consequences, such as non-communicable diseases, including obesity, metabolic syndrome, hypertension, and type 2 diabetes, in individuals born to exposed mothers via fetal programming. Moreover, COVID-19 infection or related stress during pregnancy can induce long-term programming outcomes on neuroendocrinological systems in offspring after birth. However, the long-lasting consequences of the transplacental transmission of COVID-19 in offspring are currently unknown. Here we hypothesize that a COVID-19 pandemic triggers intrauterine programming outcomes in offspring due to multiple maternal factors (e.g., nutrition deficiency, stress, infection, inflammation) during pregnancy. Thus, it is crucial to establish an integrated lifetime health information system for individuals born in or around the COVID-19 pandemic to identify those at risk of adverse pre-and postnatal nutritional programming. This approach will assist in designing specific dietary or other nutritional interventions to minimize the potential undesirable outcomes in those nutritionally programmed individuals.
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Affiliation(s)
- Prabhat Khanal
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Asim K. Duttaroy
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Shrestha DB, Budhathoki P, Sedhai YR, Marahatta A, Lamichhane S, Nepal S, Adhikari A, Poudel A, Nepal S, Atreya A. Type 2 Diabetes Mellitus in Nepal from 2000 to 2020: A systematic review and meta-analysis. F1000Res 2021; 10:543. [PMID: 34621512 PMCID: PMC8459622 DOI: 10.12688/f1000research.53970.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
Aims: To evaluate the prevalence and risk factors of type 2 diabetes mellitus (T2DM) from 2000-2020 in various parts of Nepal. Methods: PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence of T2DM and/or details such as risk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted using Comprehensive Meta-Analysis Software v.3. Results: A total of 15 studies met the inclusion criteria. The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence of T2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24% between 2015-2020 (CI, 7.89-15.77). There were 2.19 times higher odds of having T2DM if the body mass index was ≥24.9 kg/m 2. Analysis showed normal waist circumference, normal blood pressure, and no history of T2DM in a family has 64.1%, 62.1%, and 67.3% lower odds of having T2DM, respectively. Conclusion: The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.
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Affiliation(s)
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr. Iwamura Memorial Hospital, Bhaktapur, 44800, Nepal
| | - Yub Raj Sedhai
- Department of Internal Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, 23298, USA
| | - Achyut Marahatta
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Samit Lamichhane
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Sarbin Nepal
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Anurag Adhikari
- Department of Emergency Medicine, Nepal National Hospital, Kathmandu, Bagmati, 44600, Nepal
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital, Lalitpur, Bagmati, 44600, Nepal
| | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
| | - Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
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Shrestha DB, Budhathoki P, Sedhai YR, Marahatta A, Lamichhane S, Nepal S, Adhikari A, Poudel A, Nepal S, Atreya A. Type 2 Diabetes Mellitus in Nepal from 2000 to 2020: A systematic review and meta-analysis. F1000Res 2021; 10:543. [PMID: 34621512 PMCID: PMC8459622 DOI: 10.12688/f1000research.53970.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 04/19/2024] Open
Abstract
Aims: To evaluate the prevalence and risk factors of type 2 diabetes mellitus (T2DM) from 2000-2020 in various parts of Nepal. Methods: PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence of T2DM and/or details such as risk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted using Comprehensive Meta-Analysis Software v.3. Results: A total of 15 studies met the inclusion criteria. The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence of T2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24% between 2015-2020 (CI, 7.89-15.77). There were 2.19 times higher odds of having T2DM if the body mass index was ≥24.9 kg/m 2. Analysis showed normal waist circumference, normal blood pressure, and no history of T2DM in a family has 64.1%, 62.1%, and 67.3% lower odds of having T2DM, respectively. Conclusion: The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.
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Affiliation(s)
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr. Iwamura Memorial Hospital, Bhaktapur, 44800, Nepal
| | - Yub Raj Sedhai
- Department of Internal Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, 23298, USA
| | - Achyut Marahatta
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Samit Lamichhane
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Sarbin Nepal
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Anurag Adhikari
- Department of Emergency Medicine, Nepal National Hospital, Kathmandu, Bagmati, 44600, Nepal
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital, Lalitpur, Bagmati, 44600, Nepal
| | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
| | - Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
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Shrestha N, Mishra SR, Ghimire S, Gyawali B, Mehata S. Burden of Diabetes and Prediabetes in Nepal: A Systematic Review and Meta-Analysis. Diabetes Ther 2020; 11:1935-1946. [PMID: 32712902 PMCID: PMC7434818 DOI: 10.1007/s13300-020-00884-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Unhealthy behaviors, such as energy-dense food choices and a sedentary lifestyle, both of which are established risk factors for diabetes, are common and increasing among Nepalese adults. Previous studies have reported a wide variation in the prevalence of prediabetes and diabetes in Nepal, and thus a more reliable pooled estimate is needed. Furthermore, Nepal underwent federalization in 2015, and the province-specific prevalence, which is necessary for the de novo provincial government to formulate local health policies, is lacking. This study aims to provide a comprehensive summary of the current literature on various aspects of diabetes in Nepal, i.e., the prevalence of prediabetes and diabetes as well as of the awareness, treatment, and control of diabetes in Nepal. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three electronic databases-PubMed, Scopus, and Web of Science-using a comprehensive search strategy to identify eligible studies published up to April 2, 2020. Data on prevalence estimates of prediabetes and diabetes were extracted and pooled in a meta-analysis using a random effect model. Subgroup analyses and meta-regression were conducted to assess heterogeneity across the studies. The quality of included studies was assessed using the New Castle-Ottawa scale. RESULTS We included 14 eligible studies that comprised a total of 44,129 participants and 3517 diabetes cases. Half of the included studies had good quality. Overall, the prevalence of prediabetes and diabetes was 9.2% (95% CI 6.6-12.6%) and 8.5% (95% CI 6.9-10.4%), respectively. Among the participants with diabetes, only 52.7% (95% CI 41.7-63.4%) were aware of their diabetes status, and 45.3% (95% CI 31.6-59.8%) were taking antidiabetic medications. Nearly one-third of those under antidiabetic treatment (36.7%; 95% CI 21.3-53.3%) had their blood glucose under control. The prevalence of prediabetes and diabetes gradually increased with increasing age and was more prevalent among males and urban residents. There was a wide variation in diabetes prevalence across the provinces in Nepal, the lowest 2% in Province 6 to the highest 10% in Province 3 and Province 4. CONCLUSIONS The prevalence of prediabetes and diabetes was high in Nepal, while its awareness, treatment, and control were low. Our findings call for urgent nationwide public health action in Nepal.
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Affiliation(s)
- Nipun Shrestha
- Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia
| | | | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Bishal Gyawali
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
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