The study is a prospective observational study. The study population include the inpatients and Outpatients in the Department of General Medicine and Department of Endocrinology in a Teritiary Care Hospital. The total sample size recruited was 120 and divided into two different treatment groups so that each group consist of 60 patients. Group 1 consist of Patients receiving Oral Hypoglycaemicagents including SGLT2 Inhibitors along with Insulin. Group 2 consist of Patients receiving Oral Hypoglycaemicagents excluding SGLT2 Inhibitors with Insulin. Observe and collect data from patients in a well designed Data Collection Form (HbA1c, Blood Sugar, Weight, Blood Pressure, and Incidence of Hypoglycaemia). Regular follow up of patients in every 4 weeks for 6 month.
In addition to the significant improvement of glycaemic control, the treatment satisfaction scores of DTSQs and DTSQc, EQ-5D index and EQ-VAS scores were improved in this study although insulin was added to oral agents. The perceived frequency of hypoglycaemia score with DTSQc was a minus score that meant lower fre- quency of hypoglycaemia, and had a different trend from that of DTSQs. It is possible that patients did give these contrary responses due to halo effects of being pleased with other outcomes associated with BOT or be- cause different patients were included in the two analyses. In any case, the changes with each assessment were both small, so it was considered that the change of the frequency of hypoglycaemia was not as large as the pa- tients’ actual feeling. From the result of EQ-5D, little changes were observed throughout the study. It might be because most of the patients had “no problems” with their condition at baseline. The proportions of the patients who had “no problems” at baseline ranged from 75.3% to 94.4% in the 5 questions. However, one of the impor- tant points was that these scores were not decreased in spite of the addition of injections to oral agents; therefore, it might result in a high compliance rate of insulin glargine treatment. From these PROs results, BOT with insu- lin glargine was acceptable for the patients and could be a good option for diabetes.
Literature (CINAHL), PubMed, Embase and Web of Sci- ence. ClinicalTrials.gov will also be searched for relevant, ongoing trials. The advantages conferred by using CEN- TRAL in addition to the other databases are that trials from other sources of research are hand searched, and controlled trials from these are included. This improves the chances of identifying all relevant studies. Key terms used to guide the search will include ‘gestational dia- betes’ , ‘GDM’ , ‘insulin’ , ‘oral hypoglycaemic’ , ‘oral antihyper- glycaemic’ , ‘treatment’ , ‘pharmacological’ , ‘medication’ , ‘antidiabetic’ , ‘metformin’ ‘glyburide’ , ’ outcome’ , ‘follow-up’
patients, focus on cost-analyses was limited in South India. Only one study done in south India (2015) has stated that the trend in prescribing is moving towards combination therapy . Moreover, the above study failed to focus on Gliptin combinations available in the market and the cost analysis of the drugs was not performed. After the Indian Government’s price control and ban on various fixed dose combinations like Glibenclamide, Metformin, Pioglitazone and Gliclazide, Metformin, Voglibose, etc., there has been cost variations in the diabetic medications marketed in India and this information has to be gathered, analysed and dispersed to the practicing physicians to decrease the economic burden of Type-2 diabetic patients. Hence, this study was planned to evaluate the pattern of oral hypoglycaemicagents usage, their cost-analyses and percentage cost variation among Type-2 diabetic patients in a tertiary care teaching hospital.
Since Diabetes is a chronic metabolic disorder, has been treated with several medicinal plants or their extracts based on folklore medicine. 10 Synthetic hypoglycaemicagents can produce serious side effects and in addition, they are not suitable for use during preganacy. Therefore, the search for more effective and safer hypoglycaemicagents has continued to be an important area of active research. 11 Furthermore, after the recommendations made by WHO on diabetes mellitus,
Diabetes mellitus is the name given to a group of disorders characterized by chronic Hyperglycaemia, polyuria, polydipsia, polyphagia and weakness due to disturbance in carbohydrate, fat and protein metabolism associated with absolute or relative deficiency in insulin secretion and its action. These metabolic deregulations leads to secondary patho physiological changes in multiple organ system including both micro & macro vascular dysfunctions 25. The treatment strategies mainly include nutritional therapy, oral hypoglycaemicagents, insulin preparations and or combination of any of these strategies 26 . In this study, evaluated the effect of L.cristata leaves extract on fasting blood glucose estimation done in diabetic induced wistar rats. Diabetic induction was done by administrating alloxan monohydrate in the dose of 120mg/kg body wt by intra-peritoneal route. This chemical induces necrosis to islets β-cells through free radical mediated damage, thus producing partial destruction of pancreatic beta cells, so insulin deficiency will lead to marked increase in blood glucose level producing type 2 DM 27 . After stabilization of hyperglycaemia the study has been conducted for 21 days. Oral treatment with an ethanolic extract of leaves of L. cristata has produced significant fall in fasting blood glucose levels. The extract of leaves of L. cristata at the dose 400mg/kg has produced a highly significant decrease (p value< 0.001) in blood glucose levels as compared to the doses of L.cristata 100mg/kg and 200mg/kg body wt. Many traditional plant treatments for diabetes mellitus are using throughout the world. Few of the traditional plants treatments for diabetes have received scientific scrutiny as in the WHO has recommended 28 . Like Trigonella foenum graecum, Momordica charantia, Tinospora cordifolia, Enicostema littorae, Gymnema sylvestre, Azadirachta indica, Syzi-gium cumini are some of the most effective and the most commonly studied Indian plants in relation to diabetes 29,30 .
Secondary outcomes: Proportion of patients achieving target HbA1c, changes in oral hypoglycaemicagents, quality of life and patient satisfaction, persistence on insulin glargine, number of insulin dosage adjustments per patient and number of hypoglycaemic episodes. Results: We screened 365 patients of whom 111 were eligible. Of those, 100 (90%) were enrolled in the study; all 11 patients who did not consent refused to use insulin. Average age was 64 years (SD 10.4), while average diabetes duration was 10.2 years (SD 7). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9); a change of 1.8% (95% CI 1.4 to 2, p<0.001). Fasting plasma glucose was reduced from 11 (SD 3.3) to 6.9 mmol/L (SD 1.8); a change of 4.1 mmol/L (95% CI of 3.3 to 5, p=0.007). Fifty-one per cent of the patients achieved the target HbA1c of ≤ 7% at the end of the study. Conclusions: This is the first completed study of independent prescribing by pharmacists. Our results showed similar improvements in glycaemic control as previous physician-led studies. RxING provides further evidence for the benefit of pharmacist care in diabetes. Trial registration: clinicaltrials.gov; Identifier: NCT01335763.
A total of 58 eyes of 36 patients were included. Apart from 1 patient who was diagnosed with DM at presen- tation and had bilateral fibrinous uveitis and prolifera- tive diabetic retinopathy all other patients were known to have pre-existing DM. The mean age (±SD) at the onset of DM was 48.6 (±13.9) years (range: 8-78 years), and the age at onset of uveitis was 55.4(±13.9) years (range: 33-82 years). The mean period (±SD) between the onset of DM and uveitis was 6.8 (±8.3) years (range: 0-31 years). The mean (±SD) follow up period was 4.4 (±4.5) years (range: 1-18 years). There was an equal gender distribution; 17 patients were South Asian, 10 Caucasian and 9 African-Caribbean. The uveitis was bi- lateral in 22 patients and unilateral in 14 patients. There were 35 patients with Type 2 DM and 1 with Type 1 DM. Diabetic treatment at first presentation with uveitis comprised diet alone in 2 patients, oral hypoglycaemicagents (OHA) in 21 patients, and insulin in 13 patients (demographic data is summarised in Table 1). Impairment of glycaemic control had occurred in 10 patients with uveitis. 2 patients on diet control were started on OHAs, 2 patients on OHA had another agent added to their treatment, 1 patient who had stopped using OHA had to be restarted on it, 2 patients on OHA had to be started on insulin and 3 patients on insulin had to have their insulin dose increased to achieve better glycaemic control.
Diabetes mellitus is a non-communicable disease, which is considered one of the five leading causes of death in the world today. Recently, the search for appropriate hypoglycaemicagents has focused on plants used in traditional medicine, partly because of leads provided by traditional medicine to natural products that it may be better treatments than currently used drugs 1, 2, 3 . Drug such as sulphonylureas, lead to higher risk of hypoglycaemia, and metformin brings a higher risk of lactic acidosis 4 . Due to side effects of these drugs, many studies have been conducted to explore natural products derived from plants which have potential hypoglycaemic effect 5,6,7,8 .
synthetic oral hypoglycaemic. These herbal formulations may delay the development of diabetic complications. Plants are a potential source for hypoglycaemicagents, as proved by Ethno botanical information reports stating that nearly 800 plants possess anti-diabetic activity. This review represents the profile of Indian plants commonly used, which has been pharmacologically proven to be effective hypoglycaemicagents, as represented in Table 1.
In normal fasted rats, though the onset of hypoglycaemic effect was seen in a single dose, the maximum effect continued to increase with duration. Grover et al.,  reported that to obtain maximum effect, therapy with plant products be continued for longer duration. In glucose tolerance test, the oral administration of RCAE suppressed the increase in glucose level induced by glucose loading. It suggests that RCAE plays role in glucose homeostasis. This might be due to increased peripheral utilization of glucose. This was strongly supported by the potentiating effects of RCAE to exogenously injected insulin.
Present study was designed to evaluate hypoglycaemic effect of aqueous extracts of Benincasa hispida stem. Rabbits of either sex weighing 2 – 2.5 kg were included in the study. Alloxan monohydrate was given 120mg/kg i.p. to induce experimental diabetes. The animals with fasting blood glucose levels 200-250mg/dl were included in the study. The animals were divided into five groups. Group one and two received 1ml of normal saline (negative control), 0.5mg/kg of glibenclamide (Positive control) and the other three groups were received graded doses of aqueous extract of test drug (Benincasa Hispida) i.e., 50mg/kg, 100mg/kg and 200mg/kg respectively. The glucose estimation was done by a glucometer (Accu-Chek, Roche Diagnostics, USA) and the blood was obtained by puncturing marginal vein of the rabbit’s ear. The extracts showed dose-dependent significant (P < 0.05) reduction in the blood glucose levels, when compared with that of the control rabbits. The most effective percentage reductions in blood glucose level were observed at 200mg/kg. From the experimental findings, it is possible to conclude that aqueous extracts of Benincasa hispida studied exhibited promising hypoglycaemic activity in alloxan-induced diabetic rabbits.
Diabetes mellitus is a multi-systemic disorder that affects almost every cell in the body and considered one of the most important health problems worldwide . It is a common metabolic disorder resulting from defects in insulin secretion or action or both, is characterized by hyperglycemia and often accompanied by glycosuria, polydipsia, and polyuria . During diabetes, persistent hyperglycemia causes increased production of free radicals especially reactive oxygen species as a result of glucose auto-oxidation and protein glycosylation that occurs [3,4]. This leads to secondary complications affecting eyes, kidneys, nerves and arteries . Diabetes mellitus is classified into two types namely: type 1 and type 2. Type 1, also known as insulin-dependent diabetes mellitus (IDDM), in which the body does not produce any insulin, most frequently occurs in children and young adults. This type of diabetes accounts for 5–10% of diabetes. Type 2, otherwise called non-insulin-dependent diabetes mellitus (NIDDM), in which the body does not produce enough, or properly uses insulin. It accounts for 90–95% of diabetes . Poor and inadequate glycemic control constitutes a major public health problem and thus research on new substances with hypoglycemic properties is required. So there has been an increasing interest in the search of hypoglycemic agents from natural products, especially those derived from plants. This is because they are usually considered to be non‐toxic, safe and with fewer side effects than synthetic sources. Several
Abstract: The aqueous extracts of ten selected herbal traditional medicinal plants namely, Catunaregam tormentosa, Raulfia serpentine, Moringa oleifera and Anisopus mannii among others from the North Eastern Nigeria were screened ab initio in albino mice (n = 5) using standard procedures. The fraction with the highest hypoglycaemic activity was later extracted with 80% v/v MeOH using soxhlet extractor. The crude MeOH extract was partitioned with CHCl 3 and other solvents after TLC, and sub-fractions obtained were tested in diabetic mice
In India, there are more than 4 crore diabetics and this number will increase around 9 crore by 2030. India has around 45,000 plant species which have medicinal properties. About 800-1000 plant species have anti-diabetic activity, e.g., Aconitium napeilus, Aloe vera, Carum carvi, Cichorium intybus, Allium cepa, Momordia charantia and many others.While screening plants for their anti-diabetic and hypoglycaemic activity, laboratory rats and mice are mostly used because they are easily available and economical. First of all, acute toxicity studies were carried out i.e., LD 50 and behavioural
The association between type 1 diabetes mellitus (T1DM) and bone health has garnered interest over the years. Fracture risk is known to be increased in individuals with T1DM, although bone health assessment is not often performed in the clinical setting. We describe the case of a 21-year-old male with longstanding T1DM with multilevel vertebral fractures on imaging, after presenting with acute back pain without apparent trauma. Dual-energy X-ray absorptiometry (DXA) revealed significantly reduced bone mineral density at the lumbar spine and femoral neck. Extensive investigations for other secondary or genetic causes of osteoporosis were unremarkable, apart from moderate vitamin D deficiency. High-resolution peripheral quantitative computed tomography and bone biospy revealed significant alterations of trabecular bone microarchitecture. It later transpired that the patient had sustained vertebral fractures secondary to unrecognised nocturnal hypoglycaemic seizures. Intravenous zoledronic acid was administered for secondary fracture prevention. Despite anti-resorptive therapy, the patient sustained a new vertebral fracture after experiencing another hypoglycaemic seizure in his sleep. Bone health in T1DM is complex and not well understood. There are significant challenges in the assessment and management of osteoporosis in T1DM, particularly in young adults, where fracture prediction tools have not been validated. Clinicians should be aware of hypoglycaemia as a significant risk factor for fracture in patients with T1DM.
Pterocarpus marsupium, also known as Vijayasar, is a moderate sized to large deciduous tree, upto 30 meters high. Extract of heartwood showed statistically hypoglycaemic action in fasting rabbits 3 and 5 hours after oral administration. No harmful effect was noticed in doses which showed hypoglycaemic action. Alcoholic extract of stem significantly lowered blood sugar and improved glucose tolerance of rabbits. Clinical trials on heartwood (extract, decoction, powder and infusion) showed encouraging hypoglycemic effects in a number of diabetic patients. Considerable reduction in sugar levels in blood and urine were observed 6 .