statistically not significant. Conclusion: The SGLT -2 Inhibitors are safe and effective in the treatment of Uncontrolled Type 2 DM. It has a better glycemic control and has additional benefits like weight, BMI and BP reduction. These ensure the benefit of SGLT – 2 Inhibitors with insulin as compared to other OralHypoglycaemicagents with insulin in uncontrolled type2 DM.
hypoglycaemia (≤ 70 mg/dl and/or requiring care) occurred in 3.9% of patients with placebo, 6.9% of patients with empagliflozin 10 mg and 5.3% of patients with empagliflozin 25 mg. Urinary tract infections were reported in 9.4% of patients with placebo, 10.2% of patients with empagliflozin 10 mg and 8.3% of patients with empagliflozin 25 mg. Genital infections were reported in 1.0% of patients with placebo, 4.6% of patients with empagliflozin 10 mg and 3.5% of patients with empagliflozin 25 mg. Conclusions: Empagliflozin in combination with other oral treatments versus placebo significantly decreased HbA1c, body weight and SBP/DBP with an overall good safety and tolerability profile.
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’ , ‘oralhypoglycaemic’ , ‘oral antihyper- glycaemic’ , ‘treatment’ , ‘pharmacological’ , ‘medication’ , ‘antidiabetic’ , ‘metformin’ ‘glyburide’ , ’ outcome’ , ‘follow-up’
In the present ALOHA 2 Study, BOT with insulin glargine including DPP-4 inhibitors was suggested to be ef- fective and well tolerated. In addition, it is suggested to improve the patients’ satisfaction and their self-reported health in spite of the addition of injections to oralagents. From these points, BOT with insulin glargine includ- ing DPP-4 inhibitors is likely to be considered an important therapeutic option in diabetic patients. However, combination therapy needs to be continuously evaluated in clinical trials or large sample analysis mainly due to the limitations of observational study/post-marketing surveillance and because OADs with new mechanisms have recently become available.
Secondary outcomes: Proportion of patients achieving target HbA1c, changes in oralhypoglycaemicagents, 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, oralhypoglycaemicagents (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.
Drugs that belong to this class include acarbose, miglitol, and voglibose, but currently only acarbose is available in South Africa. They are mostly indicated in the management of T2DM, which is inadequately controlled by diet only, or diet in combination with other oralhypoglycaemicagents. These agents are especially useful in geriatric patients showing intolerance towards the other oralhypoglycaemicagents. They slow the intestinal absorption of glucose in a dosage-dependent manner, although dosages of more than 50 mg three times a day, show more adverse events, with a difficulty in achieving glycaemic control. Their use causes the postprandial glucose levels to rise slowly, with an ultimate decrease in glycated haemoglobin (HbA 1c ) levels. Efficacy is optimal if taken with the first bite of a meal. 17,20
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 oralhypoglycaemicagents usage, their cost-analyses and percentage cost variation among Type-2 diabetic patients in a tertiary care teaching hospital.
There is no any study about polio and MMR vaccines adventitious agents. Thus, the major focus of this discussion will be the approaches used in a regulatory setting to ensure that polio and MMR vaccines are devoid of adventitious agents. In in vitro systems the methods were based on the ability of cell cultures to grow a wide array of pathogens; also based on their extensive use in diagnostic laboratories to detect human pathogens. This cell-culture tests can detect a variety of adventitious viruses, including cytopathic viruses, hemadsorbing viruses, and hemagglutinating viruses Table 4. Summary results of the Viral Agents detection in Polio, Measles & Rubella by cell culture.
Background: Glyburide has replaced insulin as the first line of therapy in the treatment of gestational diabetes in the United States. Glyburide and metformin therapies were reported to be comparable to insulin yet also cost-effective, patient-friendly, and potentially compliance-enhancing. Recently, the efficacy of the use of these oral hypoglycemic drugs has been questioned. In this review, the questionable concerns will be addressed: Which diabetic drug(s) cross the placenta? What is the quality of evidence and the data source validity? Which treatment modalities are most effective in reducing the primary outcome in GDM? Which drug is most effective in improving secondary outcomes? Findings: This review documents the methodological issues in study design that have impacted the results for the provision of health care interventions in GDM. The review summarizes the contents of the articles qualitatively and assesses the theoretical and empirical evidence. Multiple types of studies exist and every study design serves a specific purpose. Different study designs addressing the same question can yield varying results. The risk of presenting uncertain results without categorically knowing the direction and magnitude of the effect holds true for both randomized and nonrandomized controlled trials. The review further emphasizes the importance of achieving the targeted levels of glycemic control.
The present study investigates the effect of oral administration of the aqueous extract of Gynura procumbens on blood glucose levels in normal and streptozotocin (STZ) diabetic rats. However, the mechanism of its action is still not known. Hence, in vivo and in vitro studies were carried out to study the role of G. procumbens on blood glucose lowering effect. In in vivo studies, single administrations of aqueous extract 1g/kg b.w. to 16-h fasted streptozotocin (STZ)-induced diabetic rats reduced the mean blood glucose level at hour 2, 5, 6, 7 (P<0.05) but not in normal rats when administered by gastric intubation. The plasma insulin of STZ-induced diabetic rats was also measured using rat insulin ELISA kits. The result showed that plasma insulin has not elevated in these rats, which suggested that the hypoglycaemic activity was not due to an insulinotropic effect of G. procumbens. In glucose tolerance test where the rats were loaded with glucose (500mg/kg b.w.) intraperitoneally to induce hyperglycaemia, the extract did not reduce the glucose levels (P>0.05) in both normal and STZ-induced diabetic rats. The activity of G. procumbens was also tested on RIN-5F cell line, clonal pancreatic β-cells. It was found that the extract did not produce a stimulation of insulin secretion. Taken together, these findings indicate that the hypoglycaemic activity of the aqueous extract of G. procumbens leaves involves an extra-pancreatic action and not due to its insulinotropic activity.
improve the child's dental health habit. Health professionals, who are the first to come into contact with expectant and new mothers, need to disseminate appropriate and accurate information about oral health care for infants, especially the use of nursing bottle at night, the value of tooth brushing and regular dental visits. A matter of high priority is therefore the development and implementation of wide-scale, long-term programs of health education and promotion for expectant new mothers (Komro et al., 2011). Intervention program should be developed targeting parents, so that unnecessary loss of permanent tooth due to avulsion injury can be avoided and the tooth be retained in function for life. Integration of parental awareness can be achieved by different means. A lecture of 30- min duration was found to have significantly increased the knowledge level, yet it is also resource-consuming as the professional is required to visit the audiences personally (Loo et al., 2014). A recent study (Wicks, 2004) has stated healthcare professionals as the most preferred sources of information by all population segments. Elderly preferred television as the source of information the most. On the contrary, younger generation and population with higher educational level have opted for internet as their most preferred source. Al-Asfour and Andersson (Al ‐ Sane, 2011) have concluded that though it has its limitation in conveying the message for a complete understanding, a simple leaflet is able to raise the knowledge level of parents to 46%- 74% by conveying important basic information. Majority of the interviewees were surprised when health educational leaflets were given and explained by the authors. Information about the important steps to be taken by parents as first-aid managements, including
Most often a hemostatic matrix such as oxidized regenerated cellulose, absorbable gelatin, or collagen with suture is applied to the extraction socket to manage post-operative bleeding. The hemostatic properties of these agents are based on their ability to activate the coagulation cascade locally. They have no intrinsic coagulation factors or activity but are designed to stimulate clot formation by providing a 3D scaffold used for clot organization [16-18]. Initially, placing these agents in a heme-rich environment raised concerns regarding the potential for infection. However, it has been shown in vitro that the agents might confer protective bacterial resistance against a variety of bacterial pathogens, perhaps owing to the decrease in pH in the local environment in which the agent is placed . However, it is important to remember that these agents are not effective in coagulopathic patients without a functional coagulation cascade [16-18]. The efficacy of passive hemostats varies among products. The research found that microfibrillar collagen was the most effective of the passive topical hemostatic agents, followed by collagen sponge, gelatin sponge, and then oxidized regenerated cellulose [19,20]. In a study on an animal model which compared various hemostatic agents, early bone healing was significantly impaired by the presence of microfibrillar collagen and impeded by the presence of oxidized regenerated cellulose. Alkylene oxide copolymer (ostene) did not inhibit bone healing when compared to untreated (control) defects and thus may be a good clinical agent in cases where bony fusion is critical and where immediate hemostasis is required .
In the light of these results, three trials were designed in order to assess the effectiveness of oral cladribine in RRMS. In the first, CLARITY (CLAdRIbine Tablets Treating MS OrallY), 1326 patients were enrolled in a 1:1:1 ratio to receive one of two cumulative doses of cladribine tablets (either 3.5 mg or 5.25 mg/kg body weight) or matching placebo, given in two or four short courses for the first 48 weeks, then in two short courses starting at week 48 and week 52 (for a total of 8 to 20 days per year). During the 96-week study, patients receiving 3.5 and 5.25 mg/kg showed, respectively, versus placebo, a relative reduction in annualized relapse rate of 57.6% and 54.5%, a higher relapse-free rate (odds ratio: 2.53 and 2.43), an increased time to first relapse (hazard ratio [HR] 0.44 and 0.46), a lower risk of 3-month sustained progression of disability (HR 0.67 and 0.69), and a relative reduction of enhancing lesions of 85.7% and 87.9% and of active T2 lesions of 73.4% and 76.9%. 23 This study has been
CONCLUSION: Effect of vit. A and its possible interaction with oral antidiabetic agents (i.e. glimepiride, gliclazide and metformin) on blood glucose levels in rabbits have been reported in the present study. We observed that in studied conditions Vit A produced significant effect on blood glucose levels at 4 and 6 hr intervals in experimental rabbits. Administration of Vit A with glimepiride exhibited antagonistic effects on blood glucose levels.
The purpose of present research work is to develop osmotic drug delivery system of glibenclamide. The oral route of administration is considered as the most widely accepted route but the most evident drawback of the commonly used oral dosage forms like tablets and capsules is difficulty in swallowing, leading to patient’s incompliance particularly in case of paediatric, geriatric patients, dysphasic, bed ridden, and psychic patients. Also, solid oral delivery systems do not require sterile conditions and are, therefore less expensive to manufacture. The aim of this study was to develop a new delivery system as in situ pore former osmotic drug delivery system.
deprivation, as assessed by the Neighborhood Socioeconomic Status Index comprised of census tract measures, and self-reported adherence. Their findings suggest that social environment as well as related costs may contribute to nonadherence (Billimek & August, 2013). In our work we enrolled patients who already had filled prescriptions for oral hypoglycemic agents and we adjusted for individual financial status, thus minimizing the influence of cost on adherence to medication regimens, and supporting evidence that neighborhood social environment and adherence may be linked by factors other than financial pressure. Our work is further delineated from prior work by a focus on features of neighborhood social environment derived from the work of Sampson et al. (Sampson et al., 1999; Sampson & Raudenbush, 1999; Sampson et al., 1997). Our findings provide insight into the social mechanisms and process that link neighborhood environment to health. Furthermore, we used an objective measure of adherence, and our use of general growth curve mixture models allowed us to distinguish distinct patterns of adherence over time instead of assessing adherence through proportions at singular point(s) in time with no assessment of variation over time and group classification. Our findings extend prior work by demonstrating that features of the social environment are associated with longitudinal patterns of adherence as assessed by objective measures of medication adherence among primary care patients with type 2 DM.
To date, most pharmacogenetic studies of OHAs adopted a candidate gene approach. Based on the PK and PD knowl- edge of the agents, genetic polymorphisms in transporter genes, metabolizing enzyme genes, and target genes were investigated. Apart from the largely consistent associations observed between CYP2C9*2/*3, Potassium Channel, Inwardly Rectifying Subfamily J, Member 11 (KCNJ11)/ ABCC8, and TCF7L2 for response to SU, no other phar- macogenetic impact has been robustly established by these candidate gene studies. The existence of gene–gene interac- tion, as suggested by a few recent pharmacogenetic studies of metformin response, could be the explanation for some of the replication failure as the marginal impact of each individual variant would be much smaller and difficult to detect than in a true interaction model.
ransdermal drug delivery (TDD) is the delivery of the drugs through the skin to elicit a systemic effect. TDDS offers many advantages over conventional injection and oral methods. It reduces the load that the oral route commonly places on the digestive tract and liver. This aspect makes it different from topical formulations, where the drug is expected to display only local activity The administration of drugs by transdermal route offers the advantage of being relatively painless. The appeal of using the skin as a portal of drug entry lies in case of access, its huge surface area,