Top PDF Pharmacologic Therapy for Type 2 Diabetes Mellitus

Pharmacologic Therapy for Type 2 Diabetes Mellitus

Pharmacologic Therapy for Type 2 Diabetes Mellitus

About 75% of patients with type 2 diabetes treated with a sulfonylurea will not reach the de- sired goal (fasting plasma glucose level ⬍ 7.8 mmol/L [⬍140 mg/dL]) and will require addition of a second oral agent or bedtime insulin. Patients in whom sulfonylurea therapy fails can be subdivided into two groups. Ten percent to 20% will have a poor initial response (decrease in fasting glucose level ⬍ 1.1 mmol/L [⬍20 mg/dL]) (65, 66); these patients are considered to have primary failure (70). Such patients usually have a low fasting C-peptide level and a fasting plasma glucose level that exceeds 15.5 to 16.6 mmol/L (280 to 300 mg/dL). In some of these patients, the disease represents slowly evolving type 1 diabetes (71). Fifty percent to 60% of pa- tients with type 2 diabetes have a good initial re- sponse to sulfonylurea (decrease in fasting plasma glucose level ⬎ 1.7 mmol/L [⬎30 mg/dL]), but they do not reach the desired treatment goal (fasting plasma glucose level ⬍ 7.8 mmol/L [⬍140 mg/dL]). Such patients are considered to have partial response. After a good initial response to sulfonylurea ther- apy, the secondary failure rate is about 5% to 7% per year (28, 29, 50, 72, 73), and after 10 years, most sulfonylurea-treated patients require a second oral agent (28, 29, 50, 74). Secondary treatment failure is divided into patient-related factors (weight gain, lack of exercise, failure to comply with pre- scribed treatment regimen, or coexisting medial dis- orders), therapy-related factors (use of concomitant medications that antagonize insulin action or insulin secretion, ␤-cell desensitization secondary to long- term sulfonylurea exposure, inadequate drug dos- age, or impaired sulfonylurea absorption secondary to hyperglycemia), and disease-related problems (progression of insulin resistance and increasing in- sulin deficiency). It is commonly stated that the high rate of secondary failure is related to the pancreas’s inability to maintain its augmented insulin secretory rate in response to long-term sulfonylurea stimula- tion. However, the UKPDS (28, 29, 50) has cast doubt on this theory because a similar rate of sec- ondary failure was observed with metformin ther- apy. Metformin, by improving insulin sensitivity and decreasing plasma insulin levels, would have been expected to preserve ␤-cell function (Figure 2). The UKPDS results suggest that once the fasting plasma glucose level exceeds a certain value (⬎7.8 to 8.9 mmol/L [⬎140 to 160 mg/dL]), ␤-cell failure inexo- rably progresses.
Show more

23 Read more

Clinical and biochemical profile of newly diagnosed type 2 diabetes mellitus patients: A Study from Rural Tertiary Care Hospital of South Karnataka

Clinical and biochemical profile of newly diagnosed type 2 diabetes mellitus patients: A Study from Rural Tertiary Care Hospital of South Karnataka

1. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR- INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017; 5:585–596.

5 Read more

ASSOCIATION OF OCT1 GENE POLYMORPHISM WITH GLYCEMIC STATUS AND SERUM METFORMIN LEVELS IN TYPE II DIABETES MELLITUS PATIENTS

ASSOCIATION OF OCT1 GENE POLYMORPHISM WITH GLYCEMIC STATUS AND SERUM METFORMIN LEVELS IN TYPE II DIABETES MELLITUS PATIENTS

CONCLUSION: In summary, we demonstrated that the common SLC22A1 rs122083571 C/T (Arginine 61 Cys variant) significantly alters uptake of endogenous compounds and drugs. Those subjects with T allele had better response to Metformin therapy and had better glycemic status when compared to that of the C allele. In those subjects with C allele, the Metformin levels were increased probably due to poor transport of metformin to its sites, resulting in elevated fasting plasma glucose, insulin, HbA1c, total cholesterol, LDL levels.
Show more

7 Read more

<p>Plasma Adipsin as a Biomarker and Its Implication in Type 2 Diabetes Mellitus</p>

<p>Plasma Adipsin as a Biomarker and Its Implication in Type 2 Diabetes Mellitus</p>

β -cell function, which is important to boost insulin secretion. 30 According to a study by Gómez-Banoy et al 31 , restoration of Adipsin in diabetic mice did not merely improve hyperglycemia, rather it also preserves β -cell mass by improving β -cell survival and maintaining β -cell transcriptional identity. Additionally, increased Adipsin level is associated with lower risk of diabetes in humans. 31 Patients with newly diagnosed diabetes and known T2DM show a decreased levels of Adipsin; and there is an independent negative association between Adipsin and HOMA-IR. It was concluded that the negative association might be due to the expression of in fl ammatory cytokines like IL-17 in T2DM. 36 The plasma concentrations of Adipsin were reduced in T2DM patients with impaired glucose tolerance; which is associated with the fi rst-phase Table 1 (Continued).
Show more

7 Read more

Redefining the role of thiazolidinediones in the management of type 2 diabetes

Redefining the role of thiazolidinediones in the management of type 2 diabetes

A wealth of clinical data attest to the effi cacy of piogli- tazone and rosiglitazone mono- and combination therapies in achieving and sustaining glycemic control, both in patients with newly diagnosed disease and in those with more advanced disease who are not well controlled on other therapies. Conventional glucose-lowering agents such as sulfonylureas or metformin are often unable to maintain durable glycemic control when used as monotherapy. As agents that can preserve β -cell function and reduce insulin resistance either as monotherapy or in combination, the TZDs address fundamental mechanisms in the develop- ment and progression of type 2 diabetes, and complement existing treatments. Current data also hold the promise that early therapy with TZDs may decrease cardiovascular risk independently of glycemic control. Pioglitazone and (to a lesser extent) rosiglitazone have demonstrated favorable effects on surrogate markers of cardiovascular disease such as lipid profi les, infl ammatory markers, and CIMT, and recently published data for pioglitazone also demonstrate a signifi cant reduction in atheroma volume. 83 Documented
Show more

12 Read more

Effects of Cognitive Functioning on Diabetes Self-Care in Adults with Type 2 Diabetes Mellitus

Effects of Cognitive Functioning on Diabetes Self-Care in Adults with Type 2 Diabetes Mellitus

The first study identified on the subject looked at the capabilities of individuals with diabetes (most had T2DM) to complete DSMB and other related behaviours (Sinclair et al., 2000). The Mini-Mental State Exam (MMSE) was used to measure cognitive functioning. The MMSE is a measure of cognitive functioning used to screen for the presence of dementia; scores below 23 out of a possible 30 indicate the possibility of dementia (Folstein et al., 1975). In the Sinclair and colleagues study, 113 individuals with MMSE scores ≤ 23 were compared to 283 individuals with MMSE ≥24. Those with poorer cognitive functioning were statistically significantly less likely to be solely responsible for their medication intake and blood glucose monitoring, to attend a specialized diabetes clinic, to have adequate diabetes knowledge, and to complete their activities of daily living. They were also statistically significantly more likely than those with higher cognitive function to have been hospitalized in the last year, to have received help with personal care, to have had a needs assessment completed in the past year, and to be living in a long-term care home (Sinclair et al., 2000). This study did not evaluate the ability of individuals to complete their DSMB, only if they were completing them independently or not given their cognitive status. The study also used a cognitive
Show more

178 Read more

Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population

Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population

is also seen. These individuals are prone to infections and their health condition is associated with complications that would require a change in medications or diet. Therefore, moderately to well-controlled patients were evaluated in this study. A significant decrease in the HbA1c level with 3 months of periodontal treatment was seen in the test group when compared to the control group. The improvement seen may be due to the impact of local oral infection and periodontal inflammation that was reduced after the therapy in the test group. This was further maintained by oral hypo- glycemic medications taken by the patients. Our study is in agreement with the study done by Kiran et al 29 in 44 patients
Show more

8 Read more

Association of mean platelet volume with incident type 2 diabetes mellitus risk: the Dongfeng–Tongji cohort study

Association of mean platelet volume with incident type 2 diabetes mellitus risk: the Dongfeng–Tongji cohort study

Potential mechanisms that underlying this positive association remains unclear. However, several mecha- nisms might involve in these associations. Firstly, acti- vated platelets could express soluble CD40 ligand (CD40L) [29] and CD40L and its receptor CD40 exten- sively involved in oxidative stress and inflammatory pathways [30], which may play a role in the develop- ment of diabetes [5]. Secondly, higher MPV might partly be due to the regulation of some cytokines, such as IL-6 [31],which could increase the incident diabetes risk by damaging the body’s glucose stability and β-cell func- tion [32]. Notably, the aforementioned associations were more evident in females. Previous studies suggested that gender could influence platelet biology [33]. In the pre- sent study, we found a significantly higher level of MPV in females (8.79 fL) than males (8.63 fL), which was con- sistent with other observations [34]. Oral contraceptives intake and menstruation were strongly associated with higher MPV levels in females [35] which might contrib- ute to sex differences in the MPV level. However, in the present analysis, further adjustment for the number of children, menopausal status, hormone replacement ther- apy and contraception status did not materially change the positive associations of MPV with incident DM risk in females.
Show more

8 Read more

Incidence of hypoglycaemia among insulin-treated patients with type 1 or type 2 diabetes mellitus: South African cohort of International Operations Hypoglycaemia Assessment Tool (IO HAT) study

Incidence of hypoglycaemia among insulin-treated patients with type 1 or type 2 diabetes mellitus: South African cohort of International Operations Hypoglycaemia Assessment Tool (IO HAT) study

The results from this sub-group analysis can help eliminate current obstacles to insulin therapy observed in South Africa by educating patients on signs and symptoms of hypoglycaemia and by optimising healthcare resources such that good glycaemic control is achieved with a low risk of hypoglycaemia. In conclusion, results from this sub-group analysis showed that hypoglycaemia might be under-reported in insulin-treated patients in South Africa. Therefore, it is vitally important to provide continuous medical education programmes to healthcare providers and patients in the African region.
Show more

8 Read more

Effectiveness of structured teaching programme on self management of type 2 diabetes mellitus among patients with type 2 diabetes mellitus.

Effectiveness of structured teaching programme on self management of type 2 diabetes mellitus among patients with type 2 diabetes mellitus.

India leads the world with largest number of diabetic patients. India is termed as “Diabetes capital of the world”. The rising incidence of diabetes mellitus and its complications are going to pose a grave health care burden on our country. Timely effective interventions or measures and screening tests for complications at the time of diagnosis becomes imperative not only for early detection, but also to prevent progression to end stage disease. Simple interventional strategies like “Eat less, Eat on time and Walk more” can go a long way in preventing these chronic disorders among present as well as in the future generations.
Show more

146 Read more

Macular choroidal thickness in pregnant women with type 1, type 2 and gestational diabetes mellitus measured by spectral-domain optical coherence tomography

Macular choroidal thickness in pregnant women with type 1, type 2 and gestational diabetes mellitus measured by spectral-domain optical coherence tomography

Comparing the 10 CT measurements of the four groups, adjusted for the presence of hypertension, the choroid always tended to be thinner in patients with type 1 DM. There was no significant differences between nondiabetic, GDM and type 2 DM groups. From macular points T5 to T1, macular thickness was significantly higher in pregnant women with GDM in comparison with pregnant women with type 1 DM. In the subfoveal measurement, however, macular thickness was significantly higher in pregnant women with type 2 DM in comparison with pregnant women with type 1 DM. No measures nasal to the fovea were statistically different between the groups. All measurements and p-values are shown in Table 2.
Show more

7 Read more

DIABETES MELLITUS, ITS COMPLICATIONS AND MANAGEMENT

DIABETES MELLITUS, ITS COMPLICATIONS AND MANAGEMENT

Ketoacidosis is a major medical emergency and remains a serious cause of morbidity, principally in people with type 1 diabetes. A significant number of newly diagnosed diabetic patients present in ketoacidosis. In established diabetes a common course of events is that patients develop an intercurrent infection, lose their appetite, and either stop or reduce their dose of insulin in the mistaken belief that under these circumstances less insulin is required. Any form of stress particularly that produced by infection, may precipitate severe ketoacidosis, even in patients with type 2 diabetes. No obvious precipitating cause can be found in many cases. [23]
Show more

8 Read more

The effectiveness of diabetes medication therapy adherence clinic to improve glycaemic control among patients with type 2 diabetes mellitus: a randomised controlled trial

The effectiveness of diabetes medication therapy adherence clinic to improve glycaemic control among patients with type 2 diabetes mellitus: a randomised controlled trial

intervention) managed to delay the diabetes progression with a slight non-significant improvement of HbA1c and the intervention group significantly improve patients’ glycaemic control. Both patients in the control group and intervention group had additional blood tests and pharmacist counselling during baseline, blood test reminder at 6th month and study endpoint. Patients were aware that their glycaemic control was being monitored more closely during the study period. All these factors would have contributed slightly to the patient HbA1c improvement in both groups. This was further supported by several randomised controlled trials of intervention versus placebo as a slight improvement in HbA1c of around 0.4% was also seen in the placebo group (no intervention but increased frequency of clinic visits and Table IV: Summary of multiple linear regression analysis for changes of HbA1c in 12 months
Show more

8 Read more

Prediabetes and type 2 diabetes mellitus

Prediabetes and type 2 diabetes mellitus

Thorough systematic review of the published literature on exercise testing and training in patients with predia- betes and type 2 diabetes revealed no evidence of any PA-related deaths and a very low incidence of non–life- threatening adverse events. This seems to suggest that nonvigorous (mild to moderate) PA is relatively safe in these individuals, despite their increased baseline risk of microvascular and macrovascular conditions, including CVD, nephropathy, and retinopathy. However, probably because of the perceived risks of exercise in this population, most published randomized control research studies carefully screened out their “high- risk” participants and included only those patients with few comorbidities (and specifically excluded individuals with advanced CVD). Moreover, exercise was generally limited to either mild or moderate intensity, with close clinical supervision. These caveats must be considered when assessing the evidence on the risks of PA for this class of patients.
Show more

5 Read more

Depressive symptoms are associated with poor glycemic control among women with type 2 diabetes mellitus

Depressive symptoms are associated with poor glycemic control among women with type 2 diabetes mellitus

This study has some limitations. Firstly, potential bio- logical or psychological processes, link depression and T2DM. Hypothalamic–pituitary–adrenal axis, the innate immune response and the autonomic nervous system, and the burden with diabetes and unhealthy lifestyle behaviors, such as diet, physical activity and smoking [30], were not evaluated in our study. Secondly, the cross-sectional nature of the study does not allow for causality inferences. Chronic hyperglycemia can also affect depressive symptoms rather than vice versa, namely by the increase of diabetes burden [31]. Only with a longitudinal design would it be possible to deter- mine the associative direction between hyperglycemia and depressive symptoms. Thirdly, depressive symptoms were analyzed with a Likert scale, but a psychiatric inter- view remains the gold standard for depression diagnosis in clinical practice.
Show more

6 Read more

Effect of Anti Diabetic Drugs on Lipid Profile in Patients with Type 2 Diabetes Mellitus

Effect of Anti Diabetic Drugs on Lipid Profile in Patients with Type 2 Diabetes Mellitus

by American Diabetes Association (ADA) and World Health Organization (WHO). It comprises four etiological types: Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency), Type 2 diabetes (due to a progressive insulin secretary defect on the background of insulin resistance), Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) [3]. It was previously called insulin- dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells resulting in failure of insulin production. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5-10% of all diagnosed cases of diabetes [4]. This type of diabetes usually presents acutely with hyperglycemic symptoms include polyuria, thirst, tiredness, weight loss and drowsiness usually denote impending ketoacidosis [5]. Type 2 diabetes: Named non-insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes. It was account for 90 -95% of those with diabetes. Type 2 diabetes mellitus is a heterogeneous disease which is characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production [6]. Insulin resistance occurs when the cells become less sensitive to the effects of insulin [7]. In continuation of previous studies [8–22], herein we are reporting study lipid profile level were quantitatively determining by enzymatic methods, in addition to that fasting plasma glucose (FPG), Glycated hemoglobin (HbA1c%) and body mass index (BMI) were identified.
Show more

9 Read more

Antimicrobial photodynamic therapy combined with periodontal treatment for metabolic control in patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

Antimicrobial photodynamic therapy combined with periodontal treatment for metabolic control in patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

Randomized clinical trials have shown that nonsurgical PT (oral hygiene counseling, scaling, polishing and root planing) leads to a significant reduction in plasma levels of acute-phase proteins, such as C-reactive protein and fibrinogen [14, 15]. The best results in studies that asso- ciate systemic markers of diabetes and inflammation with PT are found when some type of antimicrobial ther- apy, especially doxycycline, is employed. However, the American Academy of Periodontology (AAP) recom- mends caution in the use of antibiotics for PT due to the side effects, the risk of favoring resistant microor- ganisms and difficulty in completely reaching the dental biofilm, which further favors the selection of microor- ganisms [5]. Antimicrobial therapy is a field of investiga- tion that faces constant challenges due mainly to the increase in risk factors related to infection. The develop- ment of resistance to antimicrobial agents in pathogenic microorganisms is an evolutional process initiated by ex- posure to these drugs, which makes this issue all the more challenging. The indiscriminant use of antibiotics in recent decades has accelerated the natural selection of resistant microbial strains by allowing the rapid evolu- tion of the genetic recombination of resistance and mu- tation factors [16–18]. In Brazil, the National Health Surveillance Agency (ANVISA) has adopted a number of measures aimed at monitoring microbial resistance in healthcare services and preventing the situation from be- coming worse. Such actions have the direct participation of the Pan American Health Organization (PAHO), which held a conference with a number of countries in 2005 to discuss and define strategies aimed at combating microbial resistance [18].
Show more

6 Read more

Results: The mean value of Serum HDL was lower in off-springs of both diabetic parents than offspring of

Results: The mean value of Serum HDL was lower in off-springs of both diabetic parents than offspring of

Type 2 Diabetes mellitus is a metabolic syndrome which is relatively common in most countries including India which is now being referred to as “Diabetes Capital of the world” and risk of becoming diabetic for individual increases by two to four times if he has positive family history. The present study in offspring of diabetic parents suggests the presence of certain risk factor of the disease at an early age.

7 Read more

PIOGLITAZONE AND GLIMEPIRIDE- OVERVIEW

PIOGLITAZONE AND GLIMEPIRIDE- OVERVIEW

After oral administration, Glimepiride is completely (100%) absorbed from the GI tract. Studies with single oral doses in normal subjects and with multiple oral doses in patients with type 2 diabetes mellitus (NIDDM) have shown significant absorption of Glimepiride within 1 hour after administration and peak drug levels (C max ) at 2 to 3 hours. When Glimepiride was given with meals, the mean T max (time to reach C max) was slightly increased (12%) and the mean C max and AUC (area under the curve) were slightly decreased (8% and 9%, respectively). Distribution
Show more

13 Read more

Validation of a symphysis-fundal height chart developed for pregnancy complicated by diabetes and hyperglycemia: an observational study

Validation of a symphysis-fundal height chart developed for pregnancy complicated by diabetes and hyperglycemia: an observational study

gestation, in 422 pregnant women with type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM) [17] and mild gestational hyperglycemia (MGH) [18] under adequate glycemic control, with maternal gly- cemic mean < 120 mg/dL and/or HbA1c < 6,5 % [17, 18]. The Basso SFH-chart [16] differs significantly from the national reference SFH-chart [1, 2] and those developed by Oppermannn et al. [3] and Freire et al. [15] for Brazilians with low risk pregnancy. It was shown to be more appropriate than the others in pre- dicting large for gestational age newborns (LGA-NB) because its percentiles exhibit higher values for most pregnancy weeks (P10 to P90). It is therefore more suitable for accompanying pregnancies complicated by DM2, GDM and MGH, which commonly result in larger babies. However, the diagnostic performance of the SFH-chart has yet to be tested on pregnant women with the aforementioned disorders [16]. In this sense, the present study aimed at validating the Basso SFH-chart [16] developed for pregnant women with DM2, GDM and MGH. To that end, the Basso SFH-chart was tested in a population that fits the described profile.
Show more

7 Read more

Show all 10000 documents...