Intensification of Gla-100 with Prandial Insulin: A Stepwise Progression Toward Glycemic Control

The inadequate control of postprandial glucose (PPG) excursions, are linked in some studies with cardiovascular disease. Even though basal insulins, such as insulin glargine 100 U/mL (Gla-100), maintain overall glycemic control, effective PPG control eventually requires intensification of therapy by adding prandial insulins. Compared to conventional basal-bolus or premixed approaches, a stepwise basal-plus or basal-prandial intensification regimen involving the addition of one, two, or three prandial insulins to basal therapy such as Gla-100, has received much attention in recent times. This intensification approach is comparable to other conventional approaches in terms of glycemic control, and offers the additional advantages of fewer hypoglycemic events, personalization of therapy, and a simple self-management algorithm for titration. Owing to such benefits, recent guidelines recommend its use over other approaches for initiating intensification. It is preferred by both physicians and patients and is a better alternative to immediately embarking on a full basal-bolus regimen or introducing premixed insulin preparations for intensification of therapy.

Adherence, satisfaction, and experience with metformin 500 mg prolonged release formulation in Indian patients with type 2 diabetes mellitus: a postmarketing observational study

Purpose

The aim of this study was to understand patient adherence, satisfaction, and experience with the smaller sized metformin 500 mg prolonged release (PR) tablet that has been manufactured with the help of technological advancement (Gluformin I 500 mg), in comparison with metformin 500 mg extended-release (ER) tablet, in patients with type 2 diabetes mellitus (T2DM).

Patients and methods

In this postmarketing observational study, T2DM patients who were on a stable dose of metformin 500 mg PR tablet for at least 1 month and had previously received metformin 500 mg ER tablet were recruited from 50 sites in India. The medication adherence and patients’ experience, satisfaction, and perception with metformin 500 mg PR tablets were compared with metformin 500 mg ER tablets. The patients’ experience was determined based on the external appearance of tablet, ease of swallowing, the presence of gastrointestinal discomfort, and ghost pill effect.

Results

A total of 1,000 patients were enrolled. The majority had medium adherence to metformin 500 mg PR tablet (54%) and did not report swallowing difficulties (66.2%) due to its small size (64.4%) and oval shape (64.3%). The PR formulation of metformin was more acceptable than ER formulation due to no aftertaste (63%). The ghost pill effect was reported in 0.7% of patients with metformin 500 mg PR tablet against 8.5% with ER tablet. More than 60% of patients were “comfortable” (67.9%), had “much effect on their well-being” (61.8%), and were “satisfied” (69%) with metformin 500 mg PR tablet compared with ER tablet. Patient’s dissatisfaction (42.7%) and taste (24.9%) were the common reasons cited by physicians and patients, respectively, for changing the treatment from metformin 500 mg ER to metformin 500 mg PR formulation. A total of 10 adverse events (nonserious) were reported, and all of them were resolved.

Conclusion

The technologically advanced formulation of metformin 500 mg PR tablets is more effective than that of metformin 500 mg ER tablets in improving adherence, compliance, satisfaction, and perception to medication in Indian patients with T2DM.

Prevalence of insulin resistance syndrome in a selected south Indian population--the Chennai urban population study-7 [CUPS-7]

BACKGROUND & OBJECTIVES

Although earlier studies had shown socio-economic factors to be strongly associated with the insulin resistance syndrome (IRS) and its components, there is still a paucity of data on Indians who have increased insulin resistance. In this study, we assessed the prevalence of IRS in two socio-economic groups in an urban south Indian population.

METHODS

The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennal in south India. Of the 1262 eligible subjects (age > or = 20 yr) who participated in the study, 1070 (76.5%) subjects who had a complete set of data were recruited for this study. Insulin resistance was calculated using the homeostasis assessment (HOMA) model. Insulin resistance syndrome was defined as the presence of insulin resistance in combination with at least 2 of the following conditions: hyperglycaemia, hypertension, dyslipidemia or central body obesity.

RESULTS

The overall prevalence of IRS was 11.2 per cent (95% confidence interval: 9.4-13.3). The prevalence of the IRS in the middle-income group (18.7%) was significantly higher compared to the low income group (6.5%; P < 0.001). Multiple logistic regression analysis revealed age (P < 0.001), body mass index (P < 0.05) and socio-economic status (P = 0.014) to be associated with IRS.

INTERPRETATION & CONCLUSION

The overall prevalence rate of IRS was 11.2 per cent. Age and higher socio-economic status were the risk factors for insulin resistance in this selected urban south Indian study population.

Intra-urban differences in the prevalence of the metabolic syndrome in southern India -- the Chennai Urban Population Study (CUPS No. 4)

AIMS

To assess the influence of socioeconomic status on the prevalence of the metabolic syndrome in an urban south Indian population in Chennai.

METHODS

The Chennai Urban Population Study is an epidemiological study involving two residential colonies in Chennai (formerly Madras) in south India representing the middle and lower income groups. All individuals > or = 20 years of age living in the colonies were invited to participate in the study. Of the total 1399 eligible subjects, 1262 individuals (479 belonging the middle income group colony and 783 from the low income group colony) participated in the study. The overall response rate was 90.2%. The main outcome measures were the prevalence rates of the various components of the metabolic syndrome.

RESULTS

There were significant differences in the socioeconomic status and lifestyle of the inhabitants of the two areas. The mean monthly income of the Tirumangalam (middle income) group (Rs8075 +/- 3859) was significantly higher than the T. Nagar (low income) group (Rs1399 +/- 916). The dietary profile of the middle income group showed higher intake of calories, fat and sugar compared to low income group (P < 0.001). The age-standardized prevalence rates of the various components of the metabolic syndrome were significantly higher in the middle compared to the low income group - diabetes (12.4 vs. 6.5%), impaired glucose tolerance (7.5 vs. 2.9%), hypertension (14.9 vs. 8.4%), obesity (males 38 vs. 13.4%, females 33.1 vs. 24.2%), hypercholesterolaemia (24.2 vs. 14.2%) and hyperinsulinaemia (16.7 vs. 6.6%) P < 0.001). Although the prevalence of coronary artery disease and hypertriglyceridaemia were higher in the middle income group, the differences did not reach statistical significance. The relative odds ratio for diabetes and impaired glucose tolerance increased significantly with increase in income while hypercholesterolaemia, hypertriglyceridaemia, hypertension and coronary artery disease showed no significant changes. Logistic regression analysis revealed that geographical area (higher social class) had a strong association with the components of the metabolic syndrome even after inclusion of other risk factors like age and body mass index in the model.

CONCLUSIONS

Significant differences exist in the prevalence of various components of the metabolic syndrome even within an urban environment and this appears to be influenced by socioeconomic status.

Lipoprotein(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India

OBJECTIVE

Asian Indians have been reported to have very high prevalence rates of coronary artery disease (CAD) in the absence of traditional risk factors. Recently, elevated levels of lipoprotein(a) [Lp(a)] have been reported to be associated with premature CAD in migrant Asian Indians. However, there are very little data regarding Lp(a) in CAD patients from the Indian subcontinent and virtually none in individuals with NIDDM. The objective of this study was to assess the role of Lp(a) as a marker for CAD in South Indian NIDDM patients.

RESEARCH DESIGN AND METHODS

We estimated serum Lp(a) in 100 control subjects, 100 NIDDM patients without CAD, and 100 NIDDM patients with CAD. Lp(a) values were transformed into natural logarithms. Statistical analysis included Student's t test, one-way analysis of variance, and chi2 test. Multiple logistic regression analysis was used to identify associations with CAD.

RESULTS

Lp(a) levels were significantly higher in NIDDM patients with CAD compared with NIDDM patients without CAD and control subjects (geometric mean 24.6, 15.1, and 19.4 mg/dl, respectively, P < 0.05). Results of logistic regression analysis showed that Lp(a), age, and HDL were associated with CAD. In NIDDM patients with CAD, there was no correlation between Lp(a) and serum cholesterol, triglyceride, or HDL cholesterol levels, but there was a weak association with LDL cholesterol and systolic blood pressure.

CONCLUSIONS

The data suggests that serum Lp(a) is an independent risk factor for CAD in NIDDM patients in South India.

Autonomic dysfunction in non-insulin-dependent diabetes mellitus and fibrocalculous pancreatic diabetes in south India

The prevalence of cardiovascular autonomic dysfunction in non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) and fibrocalculous pancreatic diabetes (FCPD) was assessed by a standard battery of autonomic dysfunction tests involving heart rate responses and blood pressure responses. Three hundred and thirty-six patients with NIDDM and 40 patients with FCPD were studied. Logistic regression analysis was done to look for risk factors associated with autonomic dysfunction. Abnormalities of autonomic function tests were detected in 120 NIDDM patients (35.7%) and 9 FCPD patients (22.5%). There was no significant difference in severity of autonomic dysfunction between NIDDM and FCPD groups. There was an increase in prevalence of autonomic dysfunction with age and duration of diabetes both in NIDDM and FCPD. In the 0-5 years duration group, 28.2% of NIDDM and 16.6% of FCPD had evidence of disordered autonomic function and these figures increased to 56.2% and 60% respectively, after 16-20 years duration of diabetes. Logistic regression analysis showed that only peripheral dysfunction was associated with autonomic dysfunction in NIDDM patients (r = 0.66, p = 0.02).

Peripheral vascular disease in non-insulin-dependent diabetes mellitus in south India

The prevalence of peripheral vascular disease (PVD) was assessed in terms of ankle/brachial index by doppler studies in a large cohort of non-insulin-dependent diabetes mellitus (NIDDM) patients in South India. One hundred and ninety-two out of 4941 patients (3.9%) had evidence of PVD. There was a slight female excess in PVD patients. There was a linear increase in prevalence of PVD with increasing duration of diabetes. Multiple logistic regression analyses showed that serum cholesterol, serum creatinine, systolic BP, duration of diabetes and ishaemic heart disease are strong predictive factors for PVD. The prevalence of PVD in South Indians is lower than that reported in European populations.