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Prasad DK, Shukla R, Ahammad SZ. Pharmaceuticals and personal care products and heavy metals in the Ganga River, India: Distribution, ecological and human health risk assessment. ENVIRONMENTAL RESEARCH 2024; 263:119993. [PMID: 39276830 DOI: 10.1016/j.envres.2024.119993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 08/17/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024]
Abstract
In the present study, pharmaceuticals and personal care products (PPCPs), endocrine disrupting compounds (EDCs), and heavy metals (HMs), were measured in water and sediment of the Ganga River during summer and winter seasons for two consecutive years. Additionally, this study estimated the ecological and human health risks associated with PPCPs, EDCs, and HMs. HMs detected in the range of not detected (n.d.) to 23.59 μg/L and 0.01-391.44 μg/g in water and sediment samples, respectively. All studied HMs were within the permissible limits, except for As in water, and Cr and Ni in sediment. The geo-accumulation index (Igeo) indicated that Cr (0.71-5.98) and Pb (0.90-3.90) had high Igeo compared to other metals in sediment samples. Pb showed the highest ecological risk, followed by Cd, Co, Ni, Cu, Cr, As, and Zn. The maximum potential ecological risk index was observed at site G8. The hazard index (HI) value for water (0.08-0.89) and sediment (0.02-0.29) intake by adults remained within the acceptable limits, except at sites G8 (1.27) and G9 (1.34) for water intake. However, for children, the HI value was above the acceptable limit for water intake at sites G4 to G13 and for sediment at site G8. Among the studied compounds, metformin, triclosan, triclocarban, diclofenac, and methylparaben were the most abundant compounds present in the Ganga River. PPCPs and EDCs detected in the range of n.d. to 5850.04 ng/L and n.d. to 1080.41 ng/g in water and sediment samples, respectively. The environmental risk assessment identifies the maximum ecological risk in water exhibited by triclocarban followed by 17α-ethinylestradiol (EE2), diclofenac, and triclosan, while in sediment, the maximum ecological risk exhibited by triclocarban, followed by EE2, 17 β-estradiol (E2), triclosan, and diclofenac. However, none of the compounds showed human health risk, except for EE2, E2, and atenolol.
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Affiliation(s)
- Deepak Kumar Prasad
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Rishabh Shukla
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Shaikh Ziauddin Ahammad
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, 110016, India.
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Sivadas A, Sahana S, Jolly B, Bhoyar RC, Jain A, Sharma D, Imran M, Senthivel V, Divakar MK, Mishra A, Mukhopadhyay A, Gibson G, Narayan KV, Sivasubbu S, Scaria V, Kurpad AV. Landscape of pharmacogenetic variants associated with non-insulin antidiabetic drugs in the Indian population. BMJ Open Diabetes Res Care 2024; 12:e003769. [PMID: 38471670 PMCID: PMC10936492 DOI: 10.1136/bmjdrc-2023-003769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Genetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. Optimal control of plasma glucose is paramount to minimizing type 2 diabetes-related long-term complications. India's distinct genetic architecture and its exploding burden of type 2 diabetes warrants a population-specific survey of NIAD-associated pharmacogenetic (PGx) variants. The recent availability of large-scale whole genomes from the Indian population provides a unique opportunity to generate a population-specific map of NIAD-associated PGx variants. RESEARCH DESIGN AND METHODS We mined 1029 Indian whole genomes for PGx variants, drug-drug interaction (DDI) and drug-drug-gene interactions (DDGI) associated with 44 NIADs. Population-wise allele frequencies were estimated and compared using Fisher's exact test. RESULTS Overall, we found 76 known and 52 predicted deleterious common PGx variants associated with response to type 2 diabetes therapy among Indians. We report remarkable interethnic differences in the relative cumulative counts of decreased and increased response-associated alleles across NIAD classes. Indians and South Asians showed a significant excess of decreased metformin response-associated alleles compared with other global populations. Network analysis of shared PGx genes predicts high DDI risk during coadministration of NIADs with other metabolic disease drugs. We also predict an increased CYP2C19-mediated DDGI risk for CYP3A4/3A5-metabolized NIADs, saxagliptin, linagliptin and glyburide when coadministered with proton-pump inhibitors (PPIs). CONCLUSIONS Indians and South Asians have a distinct PGx profile for antidiabetes drugs, marked by an excess of poor treatment response-associated alleles for various NIAD classes. This suggests the possibility of a population-specific reduced drug response in atleast some NIADs. In addition, our findings provide an actionable resource for accelerating future diabetes PGx studies in Indians and South Asians and reconsidering NIAD dosing guidelines to ensure maximum efficacy and safety in the population.
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Affiliation(s)
- Ambily Sivadas
- St John's Research Institute, Bangalore, Karnataka, India
| | - S Sahana
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Bani Jolly
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Rahul C Bhoyar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abhinav Jain
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Disha Sharma
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohamed Imran
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vigneshwar Senthivel
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Mohit Kumar Divakar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Anushree Mishra
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | | | - Greg Gibson
- Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Sridhar Sivasubbu
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vinod Scaria
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Ziad E, Sadat S, Farzadfar F, Malekpour MR. Prescription pattern analysis of Type 2 Diabetes Mellitus: a cross-sectional study in Isfahan, Iran. BioData Min 2023; 16:29. [PMID: 37864248 PMCID: PMC10588025 DOI: 10.1186/s13040-023-00344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/20/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Patients with Type 2 Diabetes Mellitus (T2DM) are at a higher risk of polypharmacy and more susceptible to irrational prescriptions; therefore, pharmacological therapy patterns are important to be monitored. The primary objective of this study was to highlight current prescription patterns in T2DM patients and compare them with existing Standards of Medical Care in Diabetes. The second objective was to analyze whether age and gender affect prescription patterns. METHOD This cross-sectional study was conducted using the Iran Health Insurance Organization (IHIO) prescription database. It was mined by an Association Rule Mining (ARM) technique, FP-Growth, in order to find co-prescribed drugs with anti-diabetic medications. The algorithm was implemented at different levels of the Anatomical Therapeutic Chemical (ATC) classification system, which assigns different codes to drugs based on their anatomy, pharmacological, therapeutic, and chemical properties to provide an in-depth analysis of co-prescription patterns. RESULTS Altogether, the prescriptions of 914,652 patients were analyzed, of whom 91,505 were found to have diabetes. According to our results, prescribing Lipid Modifying Agents (C10) (56.3%), Agents Acting on The Renin-Angiotensin System (C09) (48.9%), Antithrombotic Agents (B01) (35.7%), and Beta Blocking Agents (C07) (30.1%) were meaningfully associated with the prescription of Drugs Used in Diabetes. Our study also revealed that female diabetic patients have a higher lift for taking Thyroid Preparations, and the older the patients were, the more they were prone to take neuropathy-related medications. Additionally, the results suggest that there are gender differences in the association between aspirin and diabetes drugs, with the differences becoming less pronounced in old age. CONCLUSIONS Almost all of the association rules found in this research were clinically meaningful, proving the potential of ARM for co-prescription pattern discovery. Moreover, implementing level-based ARM was effective in detecting difficult-to-spot rules. Additionally, the majority of drugs prescribed by physicians were consistent with the Standards of Medical Care in Diabetes.
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Affiliation(s)
- Elnaz Ziad
- School of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Somayeh Sadat
- Centre for Analytics and Artificial Intelligence Engineering, University of Toronto, Toronto, Canada.
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Das AK, Kalra S, Joshi S, Mithal A, Kumar KMP, Unnikrishnan AG, Thacker H, Sethi B, Chowdhury S, Sugumaran A, Satpathy A, Gadekar A, Menon SK, Neogi R, Chodankar D, Trivedi C, Wangnoo SK, Zargar AH, Rais N. The LongitudinAl Nationwide stuDy on Management And Real-world outComes of diabetes in India over 3 years (LANDMARC trial). Endocrinol Diabetes Metab 2023; 6:e422. [PMID: 37392036 PMCID: PMC10495555 DOI: 10.1002/edm2.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION LANDMARC (CTRI/2017/05/008452), a prospective, observational real-world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan-India regions over a period of 3 years. METHODS Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. RESULTS Of the 6234 participants enrolled, 5273 completed 3 years follow-up. At the end of 3-years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3-years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c <7%, respectively. At 3-years, population with macrovascular and microvascular complications had higher proportion of participants with uncontrolled glycemia (78.2% [79/101] and 70.3% [463/659], respectively) than those without complications (61.6% [1839/2985]). Over 3-years, majority (67.7%-73.9%) of the participants were taking only OADs (biguanides [92.2%], sulfonylureas [77.2%] and DPP-IV inhibitors [62.4%]). Addition of insulin was preferred in participants who were only on OADs at baseline, and insulin use gradually increased from 25.5% to 36.7% at the end of 3 years. CONCLUSION These 3-year trends highlight the burden of uncontrolled glycemia and cumulative diabetes-related complications, emphasizing the importance of optimizing diabetes management in India.
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Affiliation(s)
- Ashok K. Das
- Mahatma Gandhi Medical College and Research InstituteSri Balaji VidyapeetPuducherryIndia
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- Apollo Hospital Education and Research FoundationNew DelhiIndia
| | - A. H. Zargar
- Center for Diabetes & Endocrine CareSrinagarIndia
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Pande AK, Dutta D, Singla R. Prevention of Type 1 Diabetes: Current Perspective. Indian J Endocrinol Metab 2023; 27:277-285. [PMID: 37867976 PMCID: PMC10586562 DOI: 10.4103/ijem.ijem_78_23] [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] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 10/24/2023] Open
Abstract
People living with type 1 Diabetes (T1D) and their families have poor perception of health related quality of life. Therapies for T1D are becoming better with time, but they still involve a lot of effort. Prevention of T1D, if successful, has potential to change lives of millions of families across the globe. Type 1 diabetes is an autoimmune disease with underlying genetic predisposition for autoimmunity against beta cell antigens upon exposure to an environmental trigger. Identifying underlying primary antigen responsible for initiating autoimmune cascade, avoiding environmental trigger and modifying immunity has all been used as strategies for preventing or delaying onset of type 1 diabetes. Primary prevention for type 1 diabetes is hindered by difficulty in identifying at-risk population and also due to lack of effective preventive strategy. Secondary prevention, in children with presence of autoimmunity, has recently received a boost with approval of Teplizumab, an immunity modifying drug by its Anti-CD3 action. Application of preventive strategies would also change based on country specific incidence, prevalence and availability of health resources. In current review, an update on preventive strategies for type 1 diabetes is being discussed as well as their applicability in Indian context.
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Affiliation(s)
- Arun K Pande
- Consultant Endocrinologist, Lucknow Endocrine Diabetes and Thyroid Clinic, Lucknow, Uttar Pradesh, India
| | - Deep Dutta
- Consultant Endocrinologist, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India
| | - Rajiv Singla
- Consultant Endocrinologist, Kalpavriksh Healthcare, Dwarka, Delhi, India
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Kansra P, Oberoi S. Cost of diabetes and its complications: results from a STEPS survey in Punjab, India. Glob Health Res Policy 2023; 8:11. [PMID: 37029445 PMCID: PMC10080818 DOI: 10.1186/s41256-023-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Diabetes mellitus is an obtrusive universal health emergency in developed and developing countries, including India. With the exponential rise of epidemiological conditions, the costs of treating and managing diabetes are on an upsurge. This study aimed to estimate the cost of diabetes and determine the determinants of the total cost among diabetic patients. METHODS This cross-sectional study was executed in the northern state of Punjab, India. It involves the multi-stage area sampling technique and data was collected through a self-structured questionnaire adapted following the "WHO STEPS Surveillance" manual. Mann-Whitney U and Kruskal-Wallis tests were performed to compare the cost differences in socio-demographic variables. Lastly, multiple linear regression was conducted to determine and evaluate the association of the dependent variable with numerous influential determinants. RESULTS The urban respondents' average direct and indirect costs are higher than rural respondents. Age manifests very eccentric results; the highest mean direct outpatient care expenditure of ₹52,104 was incurred by the respondents below 20 years of age. Gender, complications, income, history of diabetes and work status were statistically significant determinants of the total cost. Study reports a rapid increase in the median annual direct and indirect cost from ₹15,460 and ₹3572 in 1999 to ₹34,100 and ₹4200 in 2021. CONCLUSIONS The present study highlights that the economic jeopardy of diabetes can be managed by educating people about diabetes and its associated risk factors. The economic burden of diabetes could be restrained by formulating new health policies and promoting the use of generic medicines. The result of the study directs that expenditure on outpatient care is to be reimbursed under the 'Ayushman Bharat-Sarbat Sehat Bima Yojana'.
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Affiliation(s)
- Pooja Kansra
- Department Head of Economics, Mittal School of Business, Lovely Professional University, Punjab, India
| | - Sumit Oberoi
- Symbiosis School of Economics, Symbiosis International University, Pune, India.
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Chang YW, Shen FC, Chen CY. Investigation of treatment satisfaction and health-related quality of life after add-on to metformin-based therapy in patients with type 2 diabetes. Front Public Health 2023; 11:1152284. [PMID: 37113185 PMCID: PMC10126269 DOI: 10.3389/fpubh.2023.1152284] [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: 01/27/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Background The complexity of oral antidiabetic drug (OAD) regimens affects the quality of life (QOL) and treatment satisfaction. However, data on the QOL of patients with type 2 diabetes mellitus (T2DM) receiving metformin-based OAD treatment in Asia are limited. Therefore, this study aimed to evaluate the QOL and treatment satisfaction and explore the influencing factors and their correlations among patients with T2DM receiving metformin-based OADs. Methods This was a cross-sectional study conducted at the Outpatient Department of Metabolism and Endocrinology at a medical center in Taiwan. Data were collected using the Audit of Diabetes-Dependent Quality of Life (ADDQoL) and the Chinese version of the Satisfaction with Oral Anti-Diabetic Agent Scale (C-SOADAS) questionnaires from patients with T2DM using metformin. The outcomes were analyzed by group and stratified based on the use of two, three, and more than three OADs. The level of agreement between the questionnaires was analyzed using Spearman's rank correlation coefficient. Results A total of 153 patients with T2DM using metformin were included in this study. The average weighted impact score in the ADDQoL was -2.11, with no significant differences between the three groups. The C-SOADAS score showed a significant difference between the groups using two, three, and more than three OADs (21.42 [1.98] vs. 20.43 [2.09] vs. 19.00 [2.24], p < 0.0001). The ADDQoL and C-SOADAS scores showed low correlations between patients' QOL and treatment satisfaction. However, the impact of diabetes on specific aspects of life was negatively correlated with the total C-SOADAS scores. Conclusion In Taiwan, a significantly greater effect on QOL was observed among patients with fewer OAD classes and higher treatment satisfaction. This study provides local evidence from self-reporting outcomes of patients with T2DM. Further studies focusing on different populations and treatment regimens for QOL are needed.
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Affiliation(s)
- Yu-Wen Chang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Feng-Chin Shen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- *Correspondence: Chung-Yu Chen,
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Malhotra B, Hiteshi P, Khalkho P, Malik R, Bhadada SK, Bhansali A, Shafiq N, Malhotra S, Kumar N, Rajput R, Rastogi A. Bladder cancer with pioglitazone: A case-control study. Diabetes Metab Syndr 2022; 16:102637. [PMID: 36270237 DOI: 10.1016/j.dsx.2022.102637] [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: 05/20/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Varied reports suggest a contentious relationship of bladder malignancy with pioglitazone in patients with type 2 diabetes. AIM To study an association (prevalence and predictors) of bladder malignancy with pioglitazone therapy in Asian-Indian type 2 diabetes patients. METHOD In this observational multicenter study, type 2 diabetic patients attending out-patient diabetes-clinic were evaluated. A detailed history of anti-diabetic medication, dose, duration, pioglitazone usage, time since initiation of pioglitazone, physical examination, biochemical tests and details pertaining to prevalent neuropathy, retinopathy and nephropathy were recorded. Details of bladder cancer or any malignancy (if present), time since diagnosis, risk factors for bladder cancer and histopathology records were noted. The study cohort was divided into two groups-pioglitazone ever users (Group A) and never users (Group B). RESULTS A total of 8000 patients were screened out of which 1560 were excluded. Among 6440 included patients, 1056 (16.3%) patients were in group A and 5384 (83.6%) group B. Patients on pioglitazone were older (59.1 vs 57.7 years, p < 0.001), had longer duration of diabetes (12.7 vs 10.6 years, p < 0.001) with poor glycemic control (HbA1c 8.5 vs 8.3%, p < 0.01). A total of 74 patients had prevalent bladder cancer [16 (1.5%) in Group A and 58 in Group B (1.0%)]. Prevalent bladder cancer was not significantly greater in ever-users (odds ratio OR = 1.29, 95% confidence interval CI, 0.83-2.00) compared to never-users (odds ratio OR = 0.94, 95% confidence interval CI, 0.834-1.061) of pioglitazone (p = 0.207). However, history of hematuria in pioglitazone-users; while older age (>58 year), history of smoking and hematuria in the whole cohort were significant associated with bladder cancer. In the entire study cohort, 254 patients; 3.5% of males (128 out of 3575) and 4.6% of females (126 out of 2713) developed any malignancy. Age was significantly associated with prevalent malignancy in people with diabetes (odds ratio OR 1.036, 95% confidence interval CI: 1.022-1.051, p = 0.00) on multivariate forward regression. CONCLUSION Pioglitazone use in Asian-Indians is not associated with an increased bladder cancer risk. However, pioglitazone should be restricted in individuals with history of hematuria. Age more than 58 years is a significant risk factor for development of any malignancy, particularly bladder cancer.
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Affiliation(s)
- Bhanu Malhotra
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Priya Hiteshi
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Persis Khalkho
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Ritu Malik
- Deptt of Endocrinology, PGIMS, Rohtak, Haryana, 124001, India
| | | | - Anil Bhansali
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Nusrat Shafiq
- Deptt of Pharmacology, PGIMER, Chandigarh, 160012, India
| | | | - Narendra Kumar
- Deptt of Radiotherapy and Oncology, PGIMER, Chandigarh, 160012, India
| | - Rajesh Rajput
- Deptt of Endocrinology, PGIMS, Rohtak, Haryana, 124001, India
| | - Ashu Rastogi
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India.
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Tiwari K, Bisht M, Kant R, Handu SS. Prescribing pattern of anti-diabetic drugs and adherence to the American Diabetes Association's (ADA) 2021 treatment guidelines among patients of type 2 diabetes mellitus: A cross-sectional study. J Family Med Prim Care 2022; 11:6159-6164. [PMID: 36618206 PMCID: PMC9810884 DOI: 10.4103/jfmpc.jfmpc_458_22] [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: 02/24/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Glycemic control is the major therapeutic objective in diabetes. Poor glycemic control in diabetes mellitus can be prevented by using rational use of anti-diabetic medication, which needs to be evaluated for effectiveness by prescription pattern studies. The objective of this study was to assess the prescribing pattern and adherence to the American Diabetic Association's (ADA) treatment guidelines in type 2 diabetes mellitus patients in a tertiary care teaching hospital in Uttarakhand, India. Methodology This cross-sectional study was conducted on 206 type 2 diabetic patients who were prescribed anti-diabetic therapy. Patient's demographic details and drugs prescribed, with their dosage, were recorded to study the prescription pattern. Results Oral anti-diabetic drugs were most commonly prescribed in 149 (72.33%) type 2 diabetic mellitus patients. Five of these patients (3.35%) were on metformin monotherapy, whereas majority of patients (81, 54.36%) were on a fixed dose combination of Glimepiride (SU) + Metformin (MET). Forty-five patients (30.20%) were on MET + Dipeptidyl peptidase 4 inhibitors (DPP4I) combination; 5 (3.35%) were on MET + SU + alpha-glucosidase inhibitors (AGI) combination; 7 (4.69%) were on MET + SU + Pioglitazone (PIO) (Thiazolidinediones) combination; 6 (4.02%) were on sodium/glucose cotransporter-2 inhibitors (SGLT2I) and 57 (27.66%) were on insulin therapy. Out of 206 patients, the prescriptions of 185 patients (89.8%) were adherent and of 21 patients (10.19%) were not adhering to ADA 2021 treatment guidelines. Conclusion Oral anti-diabetic agents predominate the prescribing pattern practices for type 2 DM but there was a shift in trend towards the use of fixed-dose combinations (FDC) in the management of type 2 DM, and majority of prescriptions were adherent to ADA treatment guidelines.
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Affiliation(s)
- Kalpana Tiwari
- Department of Pharmacology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Manisha Bisht
- Department of Pharmacology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India,Address for correspondence: Dr. Manisha Bisht, Additional Professor (Pharmacology), AIIMS Rishikesh, Virbhadra Road, Rishikesh - 249 203, Uttarakhand, India. E-mail:
| | - Ravi Kant
- Department of General Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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Zargar AH, Kalra S, K M PK, Murthy S, Negalur V, Rajput R, Rastogi A, Saboo B, Sharma SK, Sahay R, Aravind SR, Shaikh S, Tiwaskar M, Ingole S, Kamble S. Rising cost of insulin: A deterrent to compliance in patients with diabetes mellitus. Diabetes Metab Syndr 2022; 16:102528. [PMID: 35863268 DOI: 10.1016/j.dsx.2022.102528] [Citation(s) in RCA: 2] [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] [Received: 11/27/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS The rapid increase in burden of type 2 diabetes mellitus (T2DM), poses a huge medico-economic challenge, especially when the cost of care is funded by out-of-pocket expenses. The aim of this review is to highlight various issues associated with rising cost of insulin, prevalence of cost-related insulin underuse, insulin related cost-saving behaviors, and viable solutions for the benefit of patients with T2DM receiving insulin. METHODS Electronic databases (PubMed and Google Scholar) from 2000 to 2020 were searched using the key terms uncontrolled diabetes mellitus, insulin therapy, glycemic control, direct cost, indirect cost, out-of-pocket expenses, cost-related insulin underuse, cost-saving behaviors, and biosimilar insulin in developed countries and India. RESULTS In majority of the patients with T2DM on monotherapy, addition of another oral antidiabetic agent is required. Despite these measures, the target glycemic goals are not achieved in majority of the patients resulting in various complications. These complications can be prevented and target glycemic goals can be achieved with early initiation of insulin therapy. However, rising cost is a major deterrent to the lifelong use of insulin. This results in non-compliance and further deterioration of glycemic control. Recently, biosimilar insulins have revolutionized the management of T2DM and look promising from the economic point of view. CONCLUSIONS Biosimilar insulins are likely to further enhance the compliance of patients and should be used whenever feasible in patients with DM. However, the patient, along with prescriber should be allowed to make shared, informed decisions regarding the insulin they wish to use.
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Affiliation(s)
- Abdul Hamid Zargar
- Centre for Diabetes and Endocrine Care, Gulshan Nagar, Chanpora, Srinagar, 190015, Jammu and Kashmir, India.
| | - Sanjay Kalra
- Bharati Hospital, Karnal, 132001, Haryana, India.
| | - Prasanna Kumar K M
- Centre for Diabetes & Endocrine Care & Diabetacare, Kalyan Nagar Post, Bangalore, 560043, Karnataka, India.
| | - Sreenivasa Murthy
- Lifecare Hospital and Research Centre, Sahakaranagara, Bangalore, 560092, Karnataka, India.
| | - Vijay Negalur
- Dr Negalur's Diabetes & Thyroid Specialty Centre, Gloria Chambers, Thane, 400603, Maharashtra, India.
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS Rohtak, Rohtak, 124001, Haryana, India.
| | - Ashu Rastogi
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Banshi Saboo
- Dia Care (Diabetes Care & Hormone Clinic), Department of Diabetology, Near Nehru Nagar Circle, Ahmedabad, Gujrat, India.
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, 500095, Telangana, India.
| | - S R Aravind
- Diacon Hospital, Rajajinagar, Bangalore, 560019, Karnataka, India.
| | - Shehla Shaikh
- K.G.N. Clinic, Patel Arcade, Nagpada Junction, Mumbai, 400008, Maharashtra, India.
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Dahisar East, Mumbai, 400068, Maharashtra, India.
| | - Shahu Ingole
- Department of Medical Affairs, Wockhardt Towers Bandra Kurla Complex, Bandra (East), Mumbai, 400051, Maharashtra, India.
| | - Sanjay Kamble
- Department of Medical Affairs, Wockhardt Towers Bandra Kurla Complex, Bandra (East), Mumbai, 400051, Maharashtra, India.
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11
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Ke C, Narayan KMV, Chan JCN, Jha P, Shah BR. Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations. Nat Rev Endocrinol 2022; 18:413-432. [PMID: 35508700 PMCID: PMC9067000 DOI: 10.1038/s41574-022-00669-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/08/2023]
Abstract
Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower β-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium-glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while α-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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12
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Real-world assessment of effectiveness and safety profile of remogliflozin etabonate in management of type 2 diabetes mellitus. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Singla R, Gupta G, Dutta D, Raizada N, Aggarwal S. Diabetes reversal: Update on current knowledge and proposal of prediction score parameters for diabetes remission. Diabetes Metab Syndr 2022; 16:102452. [PMID: 35306265 DOI: 10.1016/j.dsx.2022.102452] [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: 07/30/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM The field of diabetes reversal is continuously evolving. Strategies for implementing diabetes care towards diabetes reversal are still being worked out. We aim to analyse data from available literature to ascertain factors allowing patient centric dietary approach to achieve diabetes reversal in clinical practice. METHODS In this exploratory review, an update on current knowledge is presented to delineate factors driving diabetes remission in an individual based on major studies in the field. This knowledge is then applied to subtypes of type 2 diabetes to optimise dietary approach for reversal of diabetes. RESULTS AND CONCLUSION Shorter duration of diabetes, lesser number of medicines needed to achieve euglycemia and 15 kg weight loss are common factors favouring diabetes remission in all major studies. A patient centric approach to diabetes reversal taking into account the recently described diabetes subtypes is being proposed to improve the proportion of patients achieving remission. We also propose the parameters of a novel diabetes remission prediction score, based on patient motivation, interaction with the care-team, level of diabetes self-care and the intent of the care-team.
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Affiliation(s)
- Rajiv Singla
- Onliv Health, USA and Consultant Endocrinologist, Kalpavriksh Healthcare, Dwarka, New Delhi, India.
| | - Geetu Gupta
- Kalpavriksh Healthcare, Dwarka, New Delhi, India
| | - Deep Dutta
- CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India
| | - Nishant Raizada
- Department of Endocrinology, UCMS and GTB Hospital, New Delhi, India
| | - Sameer Aggarwal
- Endocrinology and Metabolism, Apex Plus Superspeciality Hospital, Rohtak, India
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14
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Anjana RM, Siddiqui MK, Jebarani S, Vignesh MA, Kamal Raj N, Unnikrishnan R, Pradeepa R, Panikar VK, Kesavadev J, Saboo B, Gupta S, Sosale AR, Seshadri KG, Deshpande N, Chawla M, Chawla P, Das S, Behera M, Chawla R, Nigam A, Gupta A, Kovil R, Joshi SR, Agarwal S, Bajaj S, Pearson ER, Doney ASF, Palmer CNA, Mohan V. Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians. Diabetes Technol Ther 2022; 24:190-200. [PMID: 34609928 DOI: 10.1089/dia.2021.0277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Moneeza Kalhan Siddiqui
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Saravanan Jebarani
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mani Arun Vignesh
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Nithyanantham Kamal Raj
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Vijay K Panikar
- Department of Diabetology, Dr. Panikars Speciality Care Centre, Mumbai, Maharashtra, India
| | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes and Research Centre, Kerala, India
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care & Hormone Clinic, Ahemedabad, Gujarat, India
| | - Sunil Gupta
- Department of Diabetology, Sunil's Diabetic Care & Research Center, Nagpur, Maharashtra, India
| | - Aravind R Sosale
- Department of Diabetology, Diacon Hospital, Bangalore, Karnataka, India
| | - Krishna G Seshadri
- Department of Endocrinology, Chennai Diabetes and Endocrine Clinic, Chennai, Tamilnadu, India
| | - Neeta Deshpande
- Department of Diabetology, Belgaum Diabetes Centre, Belgaum, Karnataka, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care, Mumbai, Maharashtra, India
| | - Purvi Chawla
- Department of Diabetology, Lina Diabetes Care, Mumbai, Maharashtra, India
| | - Sidhartha Das
- Department of Diabetology, Prof.S.Das Clinic, Cuttack, Odisha, India
| | - Manoranjan Behera
- Department of General Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Rajeev Chawla
- Department of Diabetology, North Delhi Diabetes Centre, Delhi, India
| | - Anant Nigam
- Department of Diabetology, Nigam Diabetes Centre, Jaipur, Rajasthan, India
| | - Arvind Gupta
- Department of Diabetology, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Rajiv Kovil
- Department of Diabetology, Dr. Kovil's Diabetes Care Centre, Mumbai, Maharashtra, India
| | - Shashank R Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sanjay Agarwal
- Department of Medicine Aegle Clinic-Diabetes Care, Pune, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Ewan R Pearson
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Alexander S F Doney
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Colin N A Palmer
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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15
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Fatima Z, Atal S, Joshi R, Sadasivam B. Implications and Economic Impact of Applying International Guidelines and Recommendations to the Management of High-Risk Group of Type 2 Diabetes Mellitus Patients in India. Cureus 2022; 14:e22141. [PMID: 35308676 PMCID: PMC8920807 DOI: 10.7759/cureus.22141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/05/2022] Open
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16
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Dahlén AD, Dashi G, Maslov I, Attwood MM, Jonsson J, Trukhan V, Schiöth HB. Trends in Antidiabetic Drug Discovery: FDA Approved Drugs, New Drugs in Clinical Trials and Global Sales. Front Pharmacol 2022; 12:807548. [PMID: 35126141 PMCID: PMC8807560 DOI: 10.3389/fphar.2021.807548] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) continues to be a substantial medical problem due to its increasing global prevalence and because chronic hyperglycemic states are closely linked with obesity, liver disease and several cardiovascular diseases. Since the early discovery of insulin, numerous antihyperglycemic drug therapies to treat diabetes have been approved, and also discontinued, by the United States Food and Drug Administration (FDA). To provide an up-to-date account of the current trends of antidiabetic pharmaceuticals, this review offers a comprehensive analysis of the main classes of antihyperglycemic compounds and their mechanisms: insulin types, biguanides, sulfonylureas, meglitinides (glinides), alpha-glucosidase inhibitors (AGIs), thiazolidinediones (TZD), incretin-dependent therapies, sodium-glucose cotransporter type 2 (SGLT2) inhibitors and combinations thereof. The number of therapeutic alternatives to treat T2DM are increasing and now there are nearly 60 drugs approved by the FDA. Beyond this there are nearly 100 additional antidiabetic agents being evaluated in clinical trials. In addition to the standard treatments of insulin therapy and metformin, there are new drug combinations, e.g., containing metformin, SGLT2 inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors, that have gained substantial use during the last decade. Furthermore, there are several interesting alternatives, such as lobeglitazone, efpeglenatide and tirzepatide, in ongoing clinical trials. Modern drugs, such as glucagon-like peptide-1 (GLP-1) receptor agonists, DPP4 inhibitors and SGLT2 inhibitors have gained popularity on the pharmaceutical market, while less expensive over the counter alternatives are increasing in developing economies. The large heterogeneity of T2DM is also creating a push towards more personalized and accessible treatments. We describe several interesting alternatives in ongoing clinical trials, which may help to achieve this in the near future.
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Affiliation(s)
- Amelia D. Dahlén
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Giovanna Dashi
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Ivan Maslov
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Department of Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Misty M. Attwood
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jörgen Jonsson
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Vladimir Trukhan
- Russia Institute of Translational Medicine and Biotechnology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Helgi B. Schiöth
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Russia Institute of Translational Medicine and Biotechnology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
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17
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Patro BK, Taywade M, Mohapatra D, Mohanty RR, Behera KK, Sahoo SS. Cost of Ambulatory Care in Diabetes: Findings From a Non-Communicable Disease Clinic of a Tertiary Care Institute in Eastern India. Cureus 2022; 14:e21206. [PMID: 35165639 PMCID: PMC8840803 DOI: 10.7759/cureus.21206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: This study was conducted to evaluate the cost of ambulatory care of diabetes in a non-communicable disease (NCD) clinic in eastern India. Methods: This hospital-based cross-sectional cost description study was conducted from July to August 2018. A total of 192 diagnosed cases aged 18-70 years with a minimum history of one year since diagnosis attending the NCD clinic for the first time were included. Information was collected using a pre-tested schedule based on the cost of illness approach that consisted of socio-demographic details, disease status, and cost of ambulatory care. Cost of the drugs was calculated using a standardized repository of drug costs. The estimated expenditure of previous three months was calculated and extrapolated to one year to calculate yearly expenditure. Results: The mean age of the study participants was 43.93±10.41 years and the mean duration of diabetes was 6.64±6.08 years. The median direct cost due to diabetes was Rs 9560 (136.57 USD) annually. It was higher in females (Rs 10,056, 143.45 USD) than in males (Rs 9020, 128.85 USD). In direct medical costs, a major part was constituted by the drugs, oral hypoglycemic agents, and/or insulin (approximately 70%). Conclusions: In an ambulatory framework too, diabetes causes a substantial financial burden on the individual in India. In the wake of resource constraints in Indian health settings, the public health system needs to be adequately strengthened by policymakers to address the growing number of diabetics and long-standing complications.
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18
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Kalra S, Mittal A, Rathod RM, Pinto C, Rathod R, Mane A. Knowledge, Attitude and Practice for Pruritus Management in Physicians and Patients with Diabetes. Clin Pract 2022; 12:27-36. [PMID: 35076499 PMCID: PMC8788288 DOI: 10.3390/clinpract12010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
Pruritus is a common dermatological condition observed in patients with diabetes, making it a dermatometabolic condition. Being multiaethiological, pruritis is caused by autoimmune, genetic, infectious and various systemic diseases. The present survey aimed to understand the knowledge, attitude and practice toward pruritus among Indian physicians and patients with diabetes presenting with pruritus. A telephonic, cross-sectional, qualitative survey was conducted among physicians and patients across five cities in India from July-August 2020. An open-ended discussion guide was used for the interview; the data were analyzed to check for common themes and trends. A majority of the consulting physicians (CPs) believed that uncontrolled diabetes is the main causal factor for pruritus in patients with diabetes and reported that currently there are no standard tests or treatment guidelines for its management. CPs emphasized proper monitoring and counseling to overcome current challenges. Patients reported a negative impact of pruritus on their daily activities and quality of life. The survey concluded that poor management of diabetes is one of the main causal factors for patients with diabetes presenting with pruritus in India. CPs emphasized controlling diabetes along with symptomatic treatment. For patients, pruritus has multifaceted effects on their health, overall well-being, and quality of life.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India;
| | - Asit Mittal
- Department of Dermatology, R.N.T Medical College and Attached Hospitals, Udaipur 313001, India;
| | - Roheet M. Rathod
- Medical Affairs, Dr. Reddy’s Laboratories Pvt Ltd., Ameerpet, Hyderabad 500016, India; (C.P.); (R.R.); (A.M.)
| | - Colette Pinto
- Medical Affairs, Dr. Reddy’s Laboratories Pvt Ltd., Ameerpet, Hyderabad 500016, India; (C.P.); (R.R.); (A.M.)
| | - Rahul Rathod
- Medical Affairs, Dr. Reddy’s Laboratories Pvt Ltd., Ameerpet, Hyderabad 500016, India; (C.P.); (R.R.); (A.M.)
| | - Amey Mane
- Medical Affairs, Dr. Reddy’s Laboratories Pvt Ltd., Ameerpet, Hyderabad 500016, India; (C.P.); (R.R.); (A.M.)
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19
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Shyam S, Yadav V, Jaiswal S. Prescription analysis of rheumatology and endocrinology departments of a teaching hospital in Western India. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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20
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Singla R, Aggarwal S, Bindra J, Garg A, Singla A. Developing Clinical Decision Support System using Machine Learning Methods for Type 2 Diabetes Drug Management. Indian J Endocrinol Metab 2022; 26:44-49. [PMID: 35662766 PMCID: PMC9162252 DOI: 10.4103/ijem.ijem_435_21] [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] [Received: 10/04/2021] [Revised: 12/08/2021] [Accepted: 01/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Application of artificial intelligence/machine learning (AI/ML) for automation of diabetes management can enhance equitable access to care and ensure delivery of minimum standards of care. Objective of the current study was to create a clinical decision support system using machine learning approach for diabetes drug management in people living with Type 2 diabetes. METHODOLOGY Study was conducted at an Endocrinology clinic and data collected from the electronic clinic management system. 15485 diabetes prescriptions of 4974 patients were accessed. A data subset of 1671 diabetes prescriptions of 940 patients with information on diabetes drugs, demographics (age, gender, body mass index), biochemical parameters (HbA1c, fasting blood glucose, creatinine) and patient clinical parameters (diabetes duration, compliance to diet/exercise/medications, hypoglycemia, contraindication to any drug, summary of patient self monitoring of blood glucose data, diabetes complications) was used in analysis. An input of patient variables were used to predict all diabetes drug classes to be prescribed. Random forest algorithms were used to create decision trees for all diabetes drugs. RESULTS AND CONCLUSION Accuracy for predicting use of each individual drug class varied from 85% to 99.4%. Multi-drug accuracy, indicating that all drug predictions in a prescription are correct, stands at 72%. Multi drug class accuracy in clinical application may be higher than this result, as in a lot of clinical scenarios, two or more diabetes drugs may be used interchangeably. This report presents a first positive step in developing a robust clinical decision support system to transform access and quality of diabetes care.
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Affiliation(s)
- Rajiv Singla
- Department of Endocrinology and Health Informatics, Kalpavriksh Healthcare, Dwarka, Delhi, India
| | - Shivam Aggarwal
- Department of Health Informatics, Kalpavriksh Healthcare, Dwarka, Delhi, India
| | - Jatin Bindra
- Department of Health Informatics, Kalpavriksh Healthcare, Dwarka, Delhi, India
| | - Arpan Garg
- Department of Health Informatics, Kalpavriksh Healthcare, Dwarka, Delhi, India
| | - Ankush Singla
- Department of Health Informatics, Kalpavriksh Healthcare, Dwarka, Delhi, India
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Prasad N, Yadav AK, Kundu M, Sethi J, Jaryal A, Sircar D, Modi GK, Kamboj K, Sahay M, Gopalakrishnan N, Kaur P, Vikrant S, Varughese S, Baid-Agrawal S, Singh S, Gang S, Parameswaran S, Kumar V, Ghosh A, Jha V. Prescription Practices in Patients With Mild to Moderate CKD in India. Kidney Int Rep 2021; 6:2455-2462. [PMID: 34514206 PMCID: PMC8418981 DOI: 10.1016/j.ekir.2021.06.011] [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: 05/09/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) require multiple medications. There is no information on prescription patterns or the use of evidence-based therapies for management of CKD from low-middle-income countries. Using baseline data from the Indian CKD (ICKD) cohort, we describe the drug prescription practices in patients with mild to moderate CKD. METHODS The ICKD study is a prospective, observational cohort study of mild to moderate kidney disease across 11 centers in India. We analyzed all the prescriptions captured at enrollment in the ICKD study. Drugs were categorized into 11 different groups. We provide descriptive data on prescription details and evaluate the appropriateness of medication use. RESULTS Complete prescription data were available in 3966 out of 4056 (97.8%) subjects enrolled in the ICKD database. Most patients had stage 3 CKD, 24.9% had diabetic kidney disease, 87% had hypertension, and 25.5% had moderate to severe proteinuria. Renin-angiotensin-aldosterone system blockers were prescribed in less than half (47.9%) and in 58.8% of patients with proteinuric CKD. Metformin was prescribed in 25.7% of diabetic subjects with CKD. Only 40.4% of patients were taking statins; 31.1% and 2.8% subjects with anemia were receiving iron and erythropoiesis-stimulating agents, respectively. CONCLUSION This study highlights the missed opportunities for improving outcomes through appropriate prescriptions of drugs in patients with CKD. There is need for dissemination of evidence-based guidelines and institution of sustainable implementation practices for improving the overall health of patients with CKD.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
| | - Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Monica Kundu
- George Institute for Global Health India, New Delhi, India
| | - Jasmin Sethi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Jaryal
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Dipankar Sircar
- Department of Nephrology Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Gopesh K. Modi
- Samarpan Kidney Institute and Research Center, Bhopal, India
| | - Kajal Kamboj
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Osmania General Hospital, Hyderabad, India
| | | | - Prabhjot Kaur
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | | | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Shivendra Singh
- Department of Nephrology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpita Ghosh
- George Institute for Global Health India, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Atal S, Joshi R, Misra S, Fatima Z, Sharma S, Balakrishnan S, Singh P. Patterns of drug therapy, glycemic control, and predictors of escalation - non-escalation of treatment among diabetes outpatients at a tertiary care center. J Basic Clin Physiol Pharmacol 2021; 33:803-814. [PMID: 34449177 DOI: 10.1515/jbcpp-2021-0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). METHODS This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients' prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. RESULTS A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA's and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. CONCLUSIONS Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.
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Affiliation(s)
- Shubham Atal
- Department of Pharmacology, AIIMS Bhopal, Bhopal, India
| | - Rajnish Joshi
- Department of General Medicine, AIIMS Bhopal, Bhopal, India
| | - Saurav Misra
- Department of Pharmacology, AIIMS Bhopal, Bhopal, India
| | - Zeenat Fatima
- Department of Pharmacology, AIIMS Bhopal, Bhopal, India
| | - Swati Sharma
- Department of Pharmacology, AIIMS Bhopal, Bhopal, India
| | | | - Pooja Singh
- Department of Pharmacology, R.N.T. Medical College, Udaipur, India
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Das AK, Shah S, Singh SK, Juneja A, Mishra NK, Dasgupta A, Deka N, Abhyankar M, Revankar S. Real-World Clinical Experience on the Usage of High-Dose Metformin (1500-2500 mg/day) in Type 2 Diabetes Management. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2021; 14:11795514211030513. [PMID: 34345194 PMCID: PMC8280839 DOI: 10.1177/11795514211030513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
Background: To evaluate the clinical characteristics, treatment patterns, and clinical
effectiveness and safety of high doses of metformin (1500-2500 mg/day) in
Indian adults with type 2 diabetes mellitus (T2DM). Materials and methods: A retrospective, multicentric (n = 241), real-world study included patients
with T2DM (aged >18 years) receiving high doses of metformin. Details
were retrieved from patient’s medical records. Results: Out of 5695 patients, 62.7% were men with median age was 50.0 years.
Hypertension (67.5%) and dyslipidemia (48.7%) were the prevalent
comorbidities. Doses of 2000 mg (57.4%) and 1500 mg (29.1%) were the most
commonly used doses of metformin and median duration of high-dose metformin
therapy was 24.0 months. Metformin twice daily was the most frequently used
dosage pattern (94.2%). Up-titration of doses was done in 96.8% of patients.
The mean HbA1c levels were significantly decreased post-treatment (mean
change: 1.08%; P < .001). The target glycemic control
was achieved in 91.2% patients. A total of 83.0% had decreased weight.
Adverse events were reported in 156 patients. Physician global evaluation of
efficacy and tolerability showed majority of patients on a good to excellent
scale (98.2% and 97.7%). Conclusion: Clinical effectiveness and safety of a high-dose metformin was demonstrated
through significant improvement in HbA1c levels and weight reduction.
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Affiliation(s)
- Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Sanjiv Shah
- Apollo Sugar Clinic, Mumbai, Maharashtra, India
| | | | - Archana Juneja
- Kokilaben Dhirubhai Ambani Hospital of Medical Sciences, Mumbai, Maharashtra, India
| | | | | | | | - Mahesh Abhyankar
- Scientific Services, USV Private Limited, Mumbai, Maharashtra, India
| | - Santosh Revankar
- Scientific Services, USV Private Limited, Mumbai, Maharashtra, India
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Kalra S, Unnikrishnan AG, Bantwal G, Das S, Polavarapu NK, Gaurav K. The Position of Gliclazide in the Evolving Landscapes and Disease Continuum of T2DM: A Collaborative Delphi Survey-Based Consensus from India. Diabetes Ther 2021; 12:679-695. [PMID: 33511553 PMCID: PMC7947040 DOI: 10.1007/s13300-021-01002-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION This Delphi study aims to provide evidence-based expert opinion on the usage and current position of gliclazide in type 2 diabetes mellitus (T2DM) management in India. METHODS The single interaction modified Delphi-based methodology was used to collect opinions on gliclazide usage and its position in diabetes management from 338 endocrinologists/diabetologists who have had clinical experience with gliclazide. Participants, using a 9-point scale, were asked to rate eight statements comprising a total of 52 items on the related topics. RESULTS The Delphi consensus suggests that in drug-naïve patients with T2DM, intolerant to metformin or in whom metformin is contraindicated, dual therapy of gliclazide/gliclazide-modified release (MR) should be considered along with a dipeptidyl peptidase 4 (DPP4) inhibitor if glycated hemoglobin A1c level is greater than 7.5% and with insulin if the A1c level is greater than 9%. If the patients are inadequately controlled with metformin (A1c greater than 6.5% after 3 months of therapy), gliclazide/gliclazide-MR shall be added on to the treatment regimen to achieve greater and sustained reductions in A1c levels. However, it was not preferred over other antidiabetic classes in such clinical settings except alpha-glucosidase inhibitors (AGI). Early addition of gliclazide/gliclazide-MR shall be preferred over the up-titration of metformin beyond half-maximal dose for effective management of T2DM. Gliclazide/gliclazide-MR can be used safely in patients with diabetes and cardiovascular and chronic kidney disease. It can be used in older patients with T2DM as it does not have active metabolites and has a low risk of hypoglycemia. CONCLUSION The expert panel proposed consideration of monotherapy or dual therapy of gliclazide as an ideal choice in patients with T2DM because of its efficacy, long-term glycemic control, favorable renal outcomes, cardiovascular safety, and an optimal safety profile.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - A G Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St John's Medical College, Bangalore, Karnataka, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | | | - Kumar Gaurav
- Medical Affairs, Dr. Reddy's Laboratories Limited, Hyderabad, India
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Atal S, Joshi R, Balakrishnan S, Singh P, Fatima Z, Jain N. Pattern of Disease and Therapy for Diabetes along with Impact of Generic Prescribing on Cost of Treatment among Outpatients at a Tertiary Care Facility. J Pharm Bioallied Sci 2020; 13:93-101. [PMID: 34084054 PMCID: PMC8142908 DOI: 10.4103/jpbs.jpbs_405_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background: India has become the diabetes capital of the world. Analyzing trends in drug prescribing helps in judging rationality of prescriptions in different settings. This study aimed to assess disease and prescribing trends with a special emphasis on evaluating use of metformin, insulin, fixed dose combinations (FDCs), concomitant medications, pill burden, and costs of drug therapy in diabetes. Materials and Methods: This was a cross-sectional study in which patients of either sex who attended the diabetes clinic at a tertiary care center over 9 months were included consecutively. Basic demographic profile, clinical, and treatment details on the day of visit were collected from the prescription charts. Drug costs for prescriptions were calculated using generic and median brand prices of formulations using a recognized commercial drug directory and generic price list of the government, respectively. Data were analyzed by using Microsoft Excel and Open Epi online software to compare results with published studies. Results: Average age of diabetics was 53.9 ± 11.8 years and disease duration was 8.13 ± 7.78 years in 336 prescriptions analyzed. Dual drug regimens were seen in 32.7% prescriptions, most commonly metformin and sulfonylureas, followed by triple drug regimens (25%) with inhibition of dipeptidyl peptidase IV (DPP IV) inhibitor. Metformin was prescribed in 95% prescriptions (mean dose 1511 ± 559.87 mg) and insulin in 22.6% prescriptions. Angiotensin receptor blocker (ARBs) and statins were the most commonly prescribed concomitant drugs. One FDC per prescription (median) each for diabetes and comorbidities were prescribed. Daily pill burden was 4.59 ± 2.65 pills. The median monthly cost of drug therapy with branded prescribing was INR 870.43 and INR 393.72 with the use of generics. Inferences drawn by comparison with published data showed variable results for different parameters analyzed. Conclusion: Disease pattern was as expected for the region and trends of therapy showed concurrence with rational prescribing. Pill burden and cost of therapy remain high with a significant contribution of comorbidities.
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Affiliation(s)
- Shubham Atal
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Rajnish Joshi
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Sadasivam Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Pooja Singh
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Zeenat Fatima
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Nidhi Jain
- Department of Pharmacology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
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Polavarapu NK, Kale R, Sethi B, Sahay RK, Phadke U, Ramakrishnan S, Mane A, Mehta S, Shah S. Effect of Gliclazide or Gliclazide plus Metformin Combination on Glycemic Control in Patients with T2DM in India: A Real-World, Retrospective, Longitudinal, Observational Study from Electronic Medical Records. Drugs Real World Outcomes 2020; 7:271-279. [PMID: 32648242 PMCID: PMC7581661 DOI: 10.1007/s40801-020-00206-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
| | - Ravindra Kale
- Dr. Reddy's Laboratories Ltd, 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India
| | | | - R K Sahay
- Osmania Medical College and Osmania General Hospital, Hyderabad, Telangana, India
| | - Uday Phadke
- Hormones and Diabetes Care Clinic, Pune, Maharashtra, India
| | - Santosh Ramakrishnan
- Magna Centres for Obesity Diabetes and Endocrinology, BTM 2nd Stage, Bengaluru, Karnataka, India
| | - Amey Mane
- Dr. Reddy's Laboratories Ltd, 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India
| | - Suyog Mehta
- Dr. Reddy's Laboratories Ltd, 7-1-27, Ameerpet, Hyderabad, Telangana, 500016, India
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Oberoi S, Kansra P. Economic menace of diabetes in India: a systematic review. Int J Diabetes Dev Ctries 2020; 40:464-475. [PMID: 32837090 PMCID: PMC7299136 DOI: 10.1007/s13410-020-00838-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/27/2020] [Indexed: 12/23/2022] Open
Abstract
AIM Diabetes mellitus is recognised as a major chronic pandemic disease that does not consider any ethnic and monetary background. There is a dearth of literature on the cost of diabetes in the Indian context. Therefore, the present study aims to capture the evidence from the literature on the cost of diabetes mellitus in India. METHODS An extensive literature was reviewed from ACADEMIA, NCBI, PubMed, ProQuest, EBSCO, Springer, JSTOR, Scopus and Google Scholar. The eligibility criterion is based on 'PICOS' procedure, and only those studies which are available in the English language, published between 1999 and February 2019, indexed in ABDC, EBSCO, ProQuest, Scopus and peer-reviewed journals are included. RESULTS A total of thirty-two studies were included in the present study. The result indicates that the median direct cost of diabetes was estimated to be ₹18,890/- p.a. for the north zone, ₹10,585/- p.a. for the south zone, ₹45,792/- p.a. for the north-east zone and ₹8822/- p.a. for the west zone. Similarly, the median indirect cost of diabetes was ₹18,146/- p.a. for the north zone, ₹1198/- p.a. for the south zone, ₹18,707/- p.a. for the north-east and ₹3949/- p.a. for the west zone. CONCLUSION The present study highlighted that diabetes poses a high economic burden on individuals/households. The study directed the need to arrange awareness campaign regarding diabetes and associated risk factors in order to minimise the burden of diabetes.
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Affiliation(s)
- Sumit Oberoi
- Mittal School of Business, Lovely Professional University, Phagwara, Punjab India
| | - Pooja Kansra
- Mittal School of Business, Lovely Professional University, Phagwara, Punjab India
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Nagarathna R, Madhava M, Patil SS, Singh A, Perumal K, Ningombam G, Nagendra AHR. Cost of Management of Diabetes Mellitus: A Pan India Study. Ann Neurosci 2020; 27:190-192. [PMID: 34556959 PMCID: PMC8455003 DOI: 10.1177/0972753121998496] [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: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Diabetes mellitus is a major noncommunicable disease. While mortality rates are increasing, the costs of managing the disease are also increasing. The all-India average monthly expenditure per person (pppm) is reported to be ₹ 1,098.25, which translates to an annual expenditure of ₹13,179 per person. Purpose: While a number of studies have gone into the aspect of the cost of disease management, we do not find any study which has pan-India reach. We also do not find studies that focus on differences (if any) between rural and urban areas, age or on the basis of gender. We planned to report the cost of illness (COI) in diabetes individuals as compared to others from the data of a pan-India trial. Methods: Government of India commissioned the Indian Yoga Association to study the prevalence of diabetes mellitus in India in 2017. As part of the questionnaire, the cost of treatment was also captured. Data collected from 25 states and union territories were analyzed using the analysis of covriance (ANCOVA) test on SPSS version 21. Results: There was a significant difference (P < .05) between the average expenses per person per month (pppm) of individuals with self-reported known diabetes (₹1,357.65 pppm) and others (unknown and/or nondiabetes individuals–₹ 999.91 pppm). Similarly, there was a significant difference between rural (₹2,893 pppm) and urban (₹4,162 pppm) participants and between those below (₹1,996 pppm) and above 40 years (₹5,059 pppm) of age. Conclusion: This preliminary report has shown that the COI because of diabetes is significantly higher than others pointing to an urgent need to promote disease-preventive measures.
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Affiliation(s)
- Raghuram Nagarathna
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - M Madhava
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - Suchitra S Patil
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, Karnataka, India
| | - Amit Singh
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, Karnataka, India
| | - K Perumal
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - Ganga Ningombam
- Vivekananda Yoga Anusandhana Samsthana (VYASA), Kempegowda Nagar, Bengaluru, Karnataka, India
| | - And Hongasandra R Nagendra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bengaluru, Karnataka, India
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Bhadada S, Pal R, Banerjee M, Kumar A. Glycemic efficacy and safety of hydroxychloroquine in type 2 diabetes mellitus: A systematic review and meta.analysis of relevance amid the COVID-19 pandemic. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Singla R, Garg A, Surana V, Aggarwal S, Gupta G, Singla S. Vitamin B12 Deficiency is Endemic in Indian Population: A Perspective from North India. Indian J Endocrinol Metab 2019; 23:211-214. [PMID: 31161105 PMCID: PMC6540890 DOI: 10.4103/ijem.ijem_122_19] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Vitamin B12 deficiency is believed to be widespread in Indian population. However, more data is needed to fuel a meaningful debate on preventive and therapeutic strategies. AIMS AND OBJECTIVES Objective of the current study is to evaluate status of vitamin B12 levels in people from a tier 3 city and among people living in an urban area with or without diabetes. SETTINGS AND DESIGN Retrospective, cross-sectional study. METHODOLOGY Data captured in electronic medical records (EMR) of an endocrine practice and from a diagnostic laboratory was analysed. STATISTICAL ANALYSIS USED Statistical analysis was done using open source software "Jamovi". RESULTS Prevalence of vitamin B12 deficiency (Vitamin B12 levels <200 pg/ml) in tier 3 city was 47.19% (n = 267). From an urban endocrine practice, database of 11913 patients was searched for reports of vitamin B12 levels. Prevalence of vitamin B12 deficiency was 37.76% in people with pre-diabetes (n = 92), 31.23% in people with endocrine problems other than diabetes and pre-diabetes (n = 285) and 18.25% in people with diabetes (n = 378). Tier 3 city population had significantly lower vitamin B12 levels than people living in an urban area and attending an endocrine clinic. Vitamin B12 levels were significantly higher in people with diabetes as compared to people with other endocrine problems. CONCLUSION Prevalence of vitamin B12 deficiency is 47% in north Indian population. People with diabetes have higher vitamin B12 levels than general population though still have high prevalence of deficiency. This data shows that Vitamin B12 deficiency is widespread in Indian population.
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Affiliation(s)
- Rajiv Singla
- Department of Endocrinology, Kalpavriksh Healthcare, New Delhi, India
| | - Arpan Garg
- Department of Health Informatics, Kalpavriksh Healthcare, New Delhi, India
| | - Vineet Surana
- Department of Endocrinology, Manipal Hospitals, Dwarka, New Delhi, India
| | - Sameer Aggarwal
- Department of Endocrinology, Apex Superspeciality Clinic, Rohtak, Haryana, India
| | - Geetu Gupta
- Department of Nutrition, Kalpavriksh Healthcare, Dwarka, New Delhi, India
| | - Sweta Singla
- Department of Neurology, Kalpavriksh Healthcare, Dwarka, New Delhi, India
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