Metformin in gestational diabetes mellitus

An observational multi-center study on type 2 diabetes treatment prescribing pattern and patient adherence to treatment

In 2021, the International Diabetes Federation (IDF) reported that the prevalence of diabetes in Pakistan was 9.6%, higher than the global average. However, adherence to treatment guidelines, e.g., American Diabetes Association and Pakistan Endocrine Society and prescription patterns for Oral anti-diabetes (OAD), is poorly understood in Pakistan. Therefore, this study aimed to examine the prescribing practices of anti-diabetic medications, an association of lifestyle modification with drugs prescribed, and their effectiveness in preserving ideal glycemic levels in diabetic patients undergoing treatment in tertiary care teaching hospitals in rural and urban Pakistan. In this cross-sectional study, data were collected from prescriptions of outpatient diabetic patients from different rural and urban tertiary care hospitals between October 2021 and February 2022. 388 participants were enrolled in the study for a detailed interview on prescription evaluation and glycemic control. The coinvestigators conducted an interview with the patient and used a pre-validated questionnaire to collect the data. The relationship between following treatment guidelines and clinical and demographic factors was found using chi-square tests for bivariate analyses. The study reported that out of 388, the mean ages of the patients were 48 ± 12.4, and the majority were female. It was observed that 60.1% and 66.5% have uncontrolled fasting and random blood glucose, respectively. The education level of the study participants was also below par to have a complete understanding of the medical condition and self-management therapy. Even though they were taking the right medications-an average prescription regimen included 5.08 medications-52.1% of the studied people had glycated haemoglobin (HbA1c) levels higher than the therapeutic threshold set by the International Diabetes Federation. In this modern era, it was observed that the prescribing trend was still focused on traditional therapeutic options Biguanides, sulfonylureas, and dipeptidyl peptidase-4 inhibitors were prescribed in 64.6% of the patients. A significant association was found between glycemic control and body mass index, adherence to lifestyle modifications, and the number of medications prescribed (p-value < 0.05). The study reveals that Pakistan's prescribing practices do not align with international and national guidelines, leading to a high prevalence of uncontrolled diabetes and widespread use of polypharmacy among patients. To address this issue, policymakers should prioritize establishing a comprehensive national diabetes action plan. Additionally, there is a pressing need to develop diabetes education and awareness programs emphasizing the importance of lifestyle modifications for effective diabetes management.

Orthosiphon stamineus as a potential antidiabetic drug in maternal hyperglycemia in streptozotocin-induced diabetic rats

Background

Maternal hyperglycemia is associated with increased risk of adverse outcomes for both mother and offspring. Insulin is the standard treatment of hyperglycemia with the aim to reduce risks of complications, however, due to several restrictions, the search for more effective drugs from traditional medicinal plants continues.

Methods

The antidiabetic effects of Orthosiphon stamineus (O . stamineus ) in non-pregnant and pregnant streptozotocin-induced Sprague Dawley rats were identified. The effect of different concentrations of O. stamineouson insulin level using isolated pancreatic islets in response to low and high concentrations of glucose was identified. Oral glucose tolerance test was performed in both pregnant and non-pregnant rats prior to and after treatment with O. stamineus (0.1 g/100 g of body weight). O. stamineus was given orally daily for 2 weeks in non-pregnant and 10 days in pregnant rats.

Results

Oral glucose tolerance test indicated that treatment with O. stamineus in non-pregnant and pregnant rats significantly reduced blood glucose level and stimulated glucose-induced insulin secretion. No mortality was recorded throughout the study and no signs of toxicity during the experimental period including in both mother and foetus. For plasma analysis, the interactions of peptides such as GLP-1 and ghrelin level might contribute to the glucose lowering effect by O. stamineus via stimulation of insulin. The incubation of islets showed that O . stamineussignificantly stimulated insulin release in response to high glucose.

Conclusion

O. stamineus could be a potential source of a specific oral hypoglycaemic agent to treat glucose intolerance in pregnancy.