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Das AK, Saboo B, Chawla R, Aravind SR, Rajput R, Singh AK, Mukherjee JJ, Jhingan A, Shah P, Deshmukh V, Kale S, Jaggi S, Sridhar GR, Dhediya R, Gaurav K. Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach. Int J Diabetes Dev Ctries 2023:1-19. [PMID: 37360324 PMCID: PMC10113130 DOI: 10.1007/s13410-023-01192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/20/2023] [Indexed: 06/28/2023] Open
Abstract
Sulfonylureas (SU) continue to be a vital therapeutic category of oral hypoglycemic agents (OHAs) for the management of type 2 diabetes mellitus (T2DM). Physicians consider modern SU (gliclazide and glimepiride) as "safe and smart" choices for T2DM management. The presence of multiple international guidelines and scarcity of a national guideline may contribute to the challenges faced by few physicians in choosing the right therapeutic strategy. The role of SU in diabetes management is explicit, and the present consensus aims to emphasize the benefits and reposition SU in India. This pragmatic, practical approach aims to define expert recommendations for the physicians to improve caregivers' knowledge of the management of T2DM, leading to superior patient outcomes.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Banshi Saboo
- Department of Diabetology, DIA-CARE, Ahmedabad, India
| | | | - S. R. Aravind
- Department of Medicine, Diacon Hospital, Bengaluru, India
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana India
| | | | - J. J. Mukherjee
- Department of Endocrinology and Diabetes, Apollo Gleneagles Hospital, Kolkata, India
| | - Ashok Jhingan
- Department of Diabetology, Delhi Diabetes Education and Research Foundation, New Delhi, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Shailaja Kale
- Dr Shailaja Kale’s Diabetes & Speciality Clinic, Pune, India
| | | | | | - Rajnish Dhediya
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
| | - Kumar Gaurav
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
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Shrivastava A, Kesavadev J, Mohan V, Saboo B, Shrestha D, Maheshwari A, Makkar BM, Modi KD, Das AK. Clinical Evidence and Practice-Based Guidelines on the Utility of Basal Insulin Combined Oral Therapy (Metformin and Glimepiride) in the Current Era. Curr Diabetes Rev 2023; 19:e090123212444. [PMID: 36624650 PMCID: PMC10617787 DOI: 10.2174/1573399819666230109104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Basal insulin combined oral therapy consisting of insulin and oral anti-diabetic drugs (OADs) is recommended for type 2 diabetes uncontrolled on OADs. There is a lack of clear evidence and recommendations on the combined use of basal insulin analogues to more than one OADs (glimepiride plus metformin) in effective control of glycemic parameters and its safety in terms of reduced hypoglycemic events, weight gain and cardiovascular risk. In this context, a group of clinical experts discussed the utility of basal insulin combined oral therapy with metformin and glimepiride in the current era. METHODS The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists and diabetologists from India and Nepal. RESULTS The panel thoroughly reviewed existing literature on the subject and proposed clinical evidence and practice-based guidelines. CONCLUSION These current clinical practice guidelines highlight the efficacy and safety of basal insulin combination therapy with various available basal insulins including neutral protamine hagedorn, detemir, glargine and degludec in addition to metformin and glimepiride therapy.
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Affiliation(s)
| | - Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Konkalam Road, Mudavanmugal, Trivandrum, Kerala, India
| | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Dina Shrestha
- Norvic International Hospital and Medical College, and Hospital for Advanced Medicine and Surgery, Maharajganj, Kathmandu, Nepal
| | - Anuj Maheshwari
- Department of Medicine, American College of Physicians, BBD University, Lucknow, India
| | - Brij Mohan Makkar
- Dr. Makkar’s Diabetes & Obesity Centre, Paschim Vihar, New Delhi, India
| | | | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
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Zhao X, Huang P, Yuan J. Influence of glimepiride plus sitagliptin on treatment outcome, blood glucose, and oxidative stress in diabetic patients. Am J Transl Res 2022; 14:7459-7466. [PMID: 36398218 PMCID: PMC9641479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This research sets out to investigate the influence of glimepiride (GLIM) plus sitagliptin (SITA) on the treatment outcome, blood glucose (BG), and oxidative stress (OS) in diabetic patients. METHODS In this retrospective study, 189 patient cases of type 2 diabetes mellitus (T2DM) admitted from July 2017 to July 2021 to the Affiliated Hospital of Nantong University were selected, of whom 99 cases treated with GLIM + SITA were assigned to the research group (RG) and 90 cases receiving GLIM monotherapy were set as the control group (CG). The two cohorts of patients were compared in terms of treatment outcomes, BG, islet function, OS, inflammatory responses (IRs), and safety. The BG indexes detected mainly included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c). Islet function was mainly measured by Homeostasis Model Assessment of β-cell Function (HOMA-β) and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The OS parameters measured primarily included malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX). Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-18 were the inflammatory factors measured. RESULTS A statistically higher excellent or good rate of treatment was determined in the RG compared to the CG. After treatment, FBG, 2hPG, HbA1c, HOMA-IR, MDA, TNF-α, IL-6, and IL-18 were lower in the RG while HOMA-β, SOD, and GSH-PX were higher, compared to the levels before treatment and the CG. A non-significantly different incidence of adverse reactions between groups was determined. CONCLUSIONS Our findings demonstrated high efficacy of GLIM + SITA in the treatment of T2DM patients, which can effectively improve the BG and OS of patients and reduce inflammation without increasing the incidence of adverse reactions. This should have high clinical application value.
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Affiliation(s)
- Xiaoqin Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nantong University Nantong 226001, Jiangsu, PR China
| | - Ping Huang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nantong University Nantong 226001, Jiangsu, PR China
| | - Jie Yuan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nantong University Nantong 226001, Jiangsu, PR China
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Boullenger L, Quindroit P, Legrand B, Balcaen T, Calafiore M, Rochoy M, Beuscart JB, Chazard E. Type 2 diabetics followed up by family physicians: Treatment sequences and changes over time in weight and glycated hemoglobin. Prim Care Diabetes 2022; 16:670-676. [PMID: 35864077 DOI: 10.1016/j.pcd.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/07/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The treatment of type 2 diabetes mellitus (T2DM) is based on preventive hygiene and dietary measures (HDM), oral antidiabetic drugs (OADs), and insulin. The objective of the present study was to reuse general practice data from electronic health records and describe changes over time among patients with T2DM in primary care. METHODS We analyzed data on patients with T2DM collected by three family physicians in Tourcoing (France) from 2006 to 2018. RESULTS 403 patients, 1030 treatment sequences, 39,042 appointments, 2440 glycated hemoglobin (HbA1c) measurements, and 9722 wt measurements were included. On inclusion, the mean age was 57.0, the mean weight was 84.4 kg, the mean body mass index was 30.3 kg/m2, and the median HbA1c level was 6.8 % (51 mmol/mol). The patients were following appropriate HDM (40.7 %) and/or were being treated with OADs (54.1 %) or insulin (5.2 %). The median length of follow-up was 3.51 years. Overall, bodyweight was stable for two years during HDM and then increased. The HbA1c level decreased and then increased during HDM, was stable on OADs, and then decreased on insulin. DISCUSSION/CONCLUSION The present descriptive results may be of value in helping to predict changes over time in bodyweight and HbA1c in T2DM.
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Affiliation(s)
- Léna Boullenger
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, General Practice, F-59000 Lille, France
| | - Paul Quindroit
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Bertrand Legrand
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, General Practice, F-59000 Lille, France
| | - Thibaut Balcaen
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, CH St Quentin, St Quentin, F-02100, France
| | - Matthieu Calafiore
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, General Practice, F-59000 Lille, France
| | - Michaël Rochoy
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, General Practice, F-59000 Lille, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Emmanuel Chazard
- Univ. Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France.
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Kalra S, A K D, Md F, K S, P S, A A R, M J, S S, A O, M R S, Selim S, M P B, Gangopadhyay KK, Y A L, T N, D D, S D T, V D, Dutta D, H K, R M, S D, A D, A B, G P, S C, Dhingra A, N P, A AA, M M. Glucodynamics and glucocracy in type 2 diabetes mellitus: clinical evidence and practice-based opinion on modern sulfonylurea use, from an International Expert Group (South Asia, Middle East & Africa) via modified Delphi method. Curr Med Res Opin 2021; 37:403-409. [PMID: 33319626 DOI: 10.1080/03007995.2020.1864309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guidelines, the management protocol of T2DM includes lowering of blood glucose, along with preventing disease-related complications and maintaining optimal quality of life. Further, the guidelines recommend the use of a patient-centric approaches for the management of T2DM; however, Asian population is underrepresented in landmark cardiovascular outcome trials (CVOTs). There are several guidelines available today for the diagnosis and management of T2DM, and hence there is much confusion among practitioners about which guidelines to follow. A group of thirty international clinical experts comprising of endocrinologists, diabetologists and cardiologist from South Asia, Middle East and Africa met at New Delhi, India on February 8 and 9, 2020 and developed an international expert opinion statements via a structured modified Delphi method on the glucodynamic properties of OADs and the glucocratic treatment approach for the management of T2DM. In this modified Delphi consensus report, we document the glucodynamic properties of Modern SUs in terms of glucoconfidence, glucosafety, and gluconomics. According to glucodynamics theory, an ideal antidiabetic drug should be efficacious, safe, and affordable. Modern SUs as a class of OADs that have demonstrated optimal glucodynamics in terms of glucoconfidence, glucosafety, and gluconomics. Hence, modern SUs are most suitable second line drug after metformin for developing countries. Based on the current evidence, we recommend a glucocratic approach for the treatment of T2DM, where an individualized treatment plan with phenotype, lifestyle, environmental, social, and cultural factors should be considered for persons with T2DM in the South Asian, Middle Eastern and African regions.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Das A K
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Fariduddin Md
- Department of Endocrinology, Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shaikh K
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Shah P
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Rehim A A
- Department of Endocrinology & Medicine, Alexandria University, Alexandria, Egypt
| | - John M
- Department of Endocrinology, Providence Endocrine & Diabetes Specialty Centre, Thiruvananthapuram, India
| | - Shaikh S
- Department of Endocrinology & Diabetes, Prince Aly Khan Hospital, Mumbai, India
| | - Orabi A
- Department of Internal Medicine, Zagazig University, Zagazig, Egypt
| | - Saraswati M R
- Department of Endocrinology and Metabolism, Udayana University/Sanglah Hospital, Bali, Indonesia
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Baruah M P
- Department of Endocrinology, Excelcare Hospital, Guwahati, India
| | | | - Langi Y A
- Department of Endocrinology and Metabolic, R. D. Kandou Hospital, Manado, Indonesia
| | - Nair T
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - Dhanwal D
- Department of Endocrinology, Diabetology and Metabolic Disorders, NMC Specialty Hospital, Abu Dhabi, UAE
| | - Thapa S D
- Department of Endocrinology and Metabolism, Grande International Hospital, Kathmandu, Nepal
| | - Deshmukh V
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - D Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatology (CEDAR), Superspeciality Clinic, New Delhi, India
| | - Khalfan H
- Department of Endocrinology, Metabolism, and Diabetes, King Hamad University Hospital, Al Sayh, Bahrain
| | - Maskey R
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Das S
- Department of Endocrinology, Apollo Hospitals in Bhubaneswar, Bhubaneswar, India
| | - Dasgupta A
- Department of Endocrinology, Rudraksh Superspeciality Care, Siliguri, India
| | - Bajaj A
- Department of Diabetes & Endocrinology, Al Seef Hospital, Salmiya, Kuwait
| | - Priya G
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - Chandrasekaran S
- Department of Endocrinology & Diabetes, Dr. Rela Institute of Medical Science, Chennai, Tamil Nadu, India
| | - A Dhingra
- Department of Endocrinology, Gangaram Bansal Hospital, Ganganagar, Rajasthan, India
| | - Pandey N
- Department of Endocrinology, Max Hospital, Gurgaon, India
| | - Al Ani A
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Moosa M
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male, Maldives
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Kalra S, Das AK, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Bajaj S, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-ani A, Hussein W, Kumar D, Shaikh K. Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. J Family Med Prim Care 2020; 9:5450-5457. [PMID: 33532378 PMCID: PMC7842427 DOI: 10.4103/jfmpc.jfmpc_843_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - A. K. Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - G. Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
| | - S. Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - R. N. Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - S. Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - P. Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - S. Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - V. Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - D. Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - S. Chandrasekaran
- Department of Endocrinology and Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D. Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A. Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Nepal
| | - T. Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - F. Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H. Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M. D. Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P. K. Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D. Shrestha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - S. Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - M. Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A. Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A. A. Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A. Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A. Al-ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - W. Hussein
- Department of Endocrinology and Diabetes, Dr. Wiam Clinic, Royal Hospital, Awali Hospital, Bahrain
| | - D. Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, UAE
| | - K. Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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7
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Type II diabetes mellitus: a review on recent drug based therapeutics. Biomed Pharmacother 2020; 131:110708. [DOI: 10.1016/j.biopha.2020.110708] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/15/2022] Open
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Rajput MA, Ali F, Zehra T, Zafar S, Kumar G. The effect of proton pump inhibitors on glycaemic control in diabetic patients. J Taibah Univ Med Sci 2020; 15:218-223. [PMID: 32647517 PMCID: PMC7336010 DOI: 10.1016/j.jtumed.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of proton pump inhibitors on glycaemic control amongst diabetic patients taking anti-diabetic medications. METHODS This randomised interventional clinical study was conducted in Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Eighty patients of either sex (aged 30-60 years) with type 2 diabetes mellitus and without any known comorbidities were equally divided into two groups (i.e., n = 40 for each group) and were included in this study. Group A received metformin and glimepiride, while Group B, metformin and glimepiride plus omeprazole. The efficacy of the combination medications was evaluated based on fasting blood sugar (FBS) and glycosylated haemoglobin (HbA1c) levels. Serum creatinine and liver function tests were reviewed to evaluate patients' safety profile at the initial visit and after 12 weeks. RESULTS After 12 weeks of omeprazole therapy, we observed a more significant improvement in glycaemic control in group B compared to group A based on the patients' FBS (108 ± 2.37 vs. 126 ± 2.9, P = 0.001) and HbA1c levels (7.29 ± 0.07 vs. 7.47 ± 0.04, P = 0.030). CONCLUSION The addition of a proton pump inhibitor along with anti-diabetic medications was considered effective in achieving better glycaemic control.
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Affiliation(s)
- Muhammad Ali Rajput
- Department of Pharmacology, Multan Medical and Dental College, Multan, Pakistan
| | - Fizzah Ali
- Department of Pharmacology, Liaquat National Medical College, Karachi, Pakistan
| | - Tabassum Zehra
- Department of Pharmacology, Liaquat National Medical College, Karachi, Pakistan
| | - Shahid Zafar
- Department of Pathology, Liaquat College of Medicine & Dentistry, Karachi, Pakistan
| | - Gunesh Kumar
- Department of Pharmacology, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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Luthra A, Misra A. Escalating cost of oral and injectable antihyperglycemic drugs; are newer medications worth their price? A perspective from India and other developing countries. Diabetes Metab Syndr 2020; 14:167-169. [PMID: 32088648 DOI: 10.1016/j.dsx.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Atul Luthra
- Fortis C-DOC Center for Diabetes, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Anoop Misra
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Diabetes Foundation (India), New Delhi, India; Fortis C-DOC Center for Excellence for Diabetes, Metabolic Disease and Endocrinology, New Delhi, India.
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Tandon T, Dubey AK, Srivastava S, Manocha S, Arora E, Hasan N. A pharmacoeconomic analysis to compare cost-effectiveness of metformin plus teneligliptin with metformin plus glimepiride in patients of type-2 diabetes mellitus. J Family Med Prim Care 2019; 8:955-959. [PMID: 31041232 PMCID: PMC6482796 DOI: 10.4103/jfmpc.jfmpc_22_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background With the available evidence of early combined oral drug therapies being more effective in lowering blood glucose levels than maximal doses of a single drug, many clinicians are taking the aggressive approach of adding a sulfonylurea or a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin as the initial therapy in type 2 diabetes mellitus (T2DM). Pharmacotherapy for a chronic disease like diabetes has substantial economic implications for patients especially in a developing country like India. So it is important to scientifically evaluate the cost-effectiveness of these commonly practiced combination therapies in the management of T2DM. Materials and Methods This was a prospective observational randomized comparative study conducted over 8 weeks on patients of T2DM who were prescribed either of the two therapies of metformin (500 mg) plus glimepiride (1 mg) or metformin (500 mg) plus teneligliptin (20 mg). Cost-effectiveness analysis was done by calculating the expense incurred on 0.1% reduction in HbA1 c and 1 mg/dl reduction in fasting plasma glucose (FPG)/post-prandial plasma glucose (PPG) levels after 8 weeks and compared for both the groups. The same was also evaluated for differences in BMI levels. Results The cost-effectiveness for per unit reduction in HbA1c and FPG was significant in metformin plus glimepiride group as compared to the metformin plus teneligliptin group though it was comparable for both the groups for per unit PPG reduction. There was no significant change in BMI levels between the groups. Conclusion Compared to metformin plus teneligliptin, metformin plus glimepiride is a significantly cost-effective therapy when used as an initial combination therapy in patients of T2DM in lowering HbA1c and FPG.
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Affiliation(s)
- Tanya Tandon
- Department of Pharmacology, SMSR, Sharda University, NCR, Greater Noida, Uttar Pradesh, India
| | - Ashok K Dubey
- Department of Pharmacology, SMSR, Sharda University, NCR, Greater Noida, Uttar Pradesh, India
| | - Saurabh Srivastava
- Department of Medicine, SMSR, Sharda University, NCR, Greater Noida, Uttar Pradesh, India
| | - Sachin Manocha
- Department of Pharmacology, SMSR, Sharda University, NCR, Greater Noida, Uttar Pradesh, India
| | - Ekta Arora
- Department of Pharmacology, SMSR, Sharda University, NCR, Greater Noida, Uttar Pradesh, India
| | - Nazer Hasan
- Department of Pharmacology, SMSR, Sharda University, NCR, Greater Noida, Uttar Pradesh, India
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