A multicentric, double-blind, placebo-controlled, parallel- group, Phase III, randomized control trial was conducted to evaluate the efficacy and safety of teneligliptin in combina- tion with glimepiride. A total of 194 Japanese patients with T2DM receiving stable glimepiride (1–4 mg/d) monotherapy for ≥ 8 weeks and reporting inadequate glycemic control (HbA1c 7.3%–10.3%) were randomized to receive teneli- gliptin 20 mg or placebo once daily in addition to stable glimepiride therapy for 12 weeks. After 12 weeks of the randomized period, all patients followed an open-label period of 40 weeks. During open-label period, all patients received teneligliptin and glimepiride therapy (teneligliptin to teneli- gliptin and placebo to teneligliptin). At the end of 12 weeks, teneligliptin group reported 0.7% mean reduction in HbA1c and difference between placebo group was 1% (P< 0.001). Similarly, mean reduction in FPG and PPG was 17.4 mg/dL and 43.1 mg/dL, respectively, in the teneligliptin group. The mean difference of FPG and PPG between teneligliptin and placebo groups was 27.1 mg/dL (P< 0.001) and 49.1 mg/dL (P< 0.001), respectively, at the end of 12 weeks. The reduc- tion in HbA1c was maintained for 52 weeks, and HbA1c was significantly lower at 52 weeks compared to baseline in both the groups (P< 0.001 both groups). The mean reduction in HbA1c at 52 weeks was 0.6% and 0.9% in “teneligliptin to teneligliptin” group and “placebo to teneligliptin” group, respectively. Significant improvement in proinsulin/insulin ratio, HOMA- β , and postprandial glucagon was also noted in the teneligliptin group compared with the placebo group. The incidence of AEs/adverse drug reactions (ADRs) includ- ing hypoglycemia with teneligliptin was similar to placebo during the randomized period. Two patients (2.1%; 0.091 events/patient-years) in the teneligliptin group and three patients (3.1%; 0.226 events/patient-years) in the placebo group reported hypoglycemic symptoms. A similar trend of AEs/ADRs was noted in the open-label period. Only 0.5–0.7 kg increase in body weight was noted over the 52-week period. In patients with inadequate glycemic control
Background and aims: Teneligliptin was introduced in India in May 2015. It has gained popularity and is already widely prescribed in type2diabetesmellitus (T2DM). This “real life” data collection was conducted to assess the efficacy of teneligliptin in Indian T2DM patients. Methods: Predesigned structured proforma was used to collect information from the pre- scribing physicians regarding the efficacy of teneligliptin when prescribed as monotherapy as well as combination therapy with other antidiabetic drugs in T2DM patients. Information on the glycemic parameters at baseline prior to starting teneligliptin and at the end of 3 months therapy was collected. The efficacy was assessed by analyzing the mean change in 3-month values of glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG).
Left untreated, type2diabetesmellitus is a chronic, progressive condition, but there are well established treatments which can delay or prevent entirely the formerly inevitable consequences of the condition. Often, the condition is viewed as progressive since poor management of blood sugar leads to worsening complications. Managing their chronic illness and maintain quality of life depends primarily on what they are taught and learn about their conditions. Considering this, a study was conducted to find the effectiveness of structured teaching programme on self management of type2diabetesmellitus among patients with type2diabetesmellitus.
T2DM is a chronic disease which needs lifelong medical care and its treatment goal should be the prevention of short- and long-term complications, patient education, and support [6-7]. Although a number of oral antihyperglycemics agents are available, it is still difficult to maintain good glycemic control with the existing drugs and it cause significant problems like, lactic acidosis, gastrointestinal intolerance, weight gain, nausea, muscle weakness, etc [8,9]. Metformin and sulfonylureas are the most widely prescribed drugs in India due to their low cost and well-established safety and efficacy [10,11]. Dipeptidyl peptidase-4 (DPP-4) inhibitors work by increasing levels of active glucagon-like peptide-1 (GLP-1), thereby promoting insulin secretion and improving beta-cells sensitivity to glucose [7,12]. One meta-analysis report has suggested that DPP-4 inhibitors may be more potent in reducing glycated hemoglobin (HbA1c) levels in Asian T2DM patients than in non-Asian patients . Teneligliptin consist J-shaped structure formed by five rings, out of four directly connected to DPP-4 enzyme which leads to enhance the potency and selectivity of the drug as compared to other gliptins [14-16]. Teneligliptin is metabolized and excreted through liver and kidney . For the management of diabetes
Type2diabetesmellitus (T2DM) is a major public health concern, accounting for more than 90% of all diabetes cases. The deceptive and asymptomatic nature of the disease may result in patients not looking for early medical attention. This disease is comprised of a range of dysfunctions characterised by an increase in glucose levels in the body, and resulting from a combination of resistance to the actions of insulin, inadequate insulin secretion and excessive or inappropriate glucagon secretion. Genetic factors related to impaired insulin secretion, insulin resistance, social influences (e.g. obesity, overeating and aging), and environmental factors form part of the pathophysiology. Classic symptoms of T2DM include polydipsia, polyuria, polyphagia, and weight loss. The treatment approach is a combination of non-pharmacological measures, such as diet and exercise, and using pharmacological measures in the form of different medicines, including the biguanides, sulphonylureas, thiazolidinediones, alpha-glucosidase inhibitors, insulin, DPP4-inhibitors, GLP-1 agonists and SGLT2-inhibitors. Good control of glycaemia, blood pressure and dyslipidaemia, combined with frequent examinations for microvascular and macrovascular complications, with appropriate and timely interventions, is the only way to reduce morbidity and mortality associated with this disease. This article provides an overview of diabetesmellitustype2 and the management thereof.
Aims: Recently, beneficial pleiotropic effects with dipeptidyl peptidase-4 (DPP-4) inhibitors have been demonstrated in some studies. So this study was planned to investigate pleiotropic effect with recently approved Teneliglipitin in Indian population. The objective of our study was to find out the effect of teneligliptin as add on therapy on body weight, blood pressure, lipid profile, liver function test and renal function test. Methods: The study was a prospective follow up study conducted on type2diabetesmellitus patients. Forty patients having insufficient glycemic control with metformin and started on teneligliptin as add on therapy were enrolled for the study. The body weight, blood pressure, serum HBA1c, lipid profile, liver function test (GOT/GPT) and renal function test (Urea, Creatinine) were done at the baseline and follow up. Result: A total of 40 patients were enrolled for the study. Only 21 patients were available for follow up after 4 weeks and only one patient could be followed up after 8 weeks, so only 21 patients were included in the analysis at 4 weeks. The result of our study showed that there is pleotropic effect of teneligliptin on BP, body weight, lipid profile, liver function and renal function as seen with sitagliptin, though the results could not be proven statistically. Conclusion: This study concluded that teneligliptin has favourable effect on blood pressure, body weight, and renal function although the results were not statistically significant due to small sample size and short duration of study.
After completion of the primary liter- ature review, at the request of the committee, a second literature review was conducted to identify evidence relating to screening, diagnosis, and treatment of comorbidities of T2DM in children and adolescents. Similar to inclusion criteria for the primary re- view, an article relating to comorbid- ities was eligible for inclusion if it was published in 1990 or later, was written in English, and included an abstract. Again, only primary research inquiries were considered; review articles were considered if they included primary data or opinion. Children and/or ado- lescents in whom either T1DM or T2DM was diagnosed were required to con- stitute the research population; stud- ies of adult patients were considered if ≥ 10% of the population was younger than 35 years. The focus of the re- search article must be hyperlipidemia, microalbuminuria, retinopathy, or “ comorbidities of diabetesmellitus. ” The electronic databases PubMed, Cochrane Collaboration, and Embase were searched using the following Medical Subject Headings, alone and in various combinations: diabetes,
Ayurveda accepts this disease as Yapya (Very difficult to cure) but effectively checks the ongoing pathogenesis of the disease. While studying this disease, we noticed the treatment advised by Acharya Yogratnakar in Prameha Prakarana Bhudhatrayadiyog – A combination of Bhumyamalaki Swaras with Maricha Churna is used as it acts on various factors in the Samprapti of Madhumeha. Bhumyamalaki is an Appetizer, Digestive, Hepatoprotective, Hypoglycemic, Laxative and Carminative. Maricha is Antioxidant, Hepatoprotective and Lipolytic. A combination of both these drugs has excellent results in the management of Madhumeha. It not only reduces the symptoms but also helps to check the pathology of the disease. Successful results encouraged to select this topic for research work. This research work is just a prototype study in the pathway of solution of Madhumeha or DiabetesMellitus. The trial has been made in the present study to make some new dimensions of treating Madhumeha. Present
The distinction between diagnostic testing and screening for diabetes is somewhat blurred. The same tests are used for “screening” and for diagnosis. Diabetes may be identified anywhere along a spectrum of clinical presentations, ranging from low-risk individuals who happen to undergo glucose testing incidentally (random screening), to individuals identified as being at high risk for diabetes during routine consultations for unrelated health matters (opportunistic screening), to those who are deliberately identified and tested because of their high-risk status (targeted screening). The spectrum then extends to the higher-risk individual with clinical features suggestive of diabetes (e.g. obese adult with recurrent urinary infections and nocturia) who undergoes testing because of a high suspicion of diabetes, and finally to the patient with classic symptoms or metabolic decompensation. The latter two scenarios would be considered diagnostic testing. Because of the need for follow-up, screening should only be carried out within the healthcare setting. Community screening outside a healthcare setting (e.g. at shopping centres) is not recommended, because individuals with abnormal (positive) tests may not seek or have access to appropriate follow-up testing and care. Or, for those who test negative, there may
Luteolin, a flavone type of flavonoid possesses various pharmacological activities and has been proved to exert its beneficial effects in several experimental disease models. Luteolin exhibits appreciable antidiabetic potential which has been well studied. The underlying mechanisms and the signalling pathways involved in its antidiabetic role are reported. However, the synergistic effect of luteolin and other flavonoids in management of diabetes needs more exploration and must be established in both invitro and invivo models. This will help to ascertain relatively safe doses of luteolin in the treatment for diabetes.
Competing interests – Author, Mahomed A.K. Omar: given lectures on behalf of, and/or acted as consultant by serving on the advisory boards of Abbot Laboratories, Astra Zeneca, Boehringer Ingelheim, Eli Lily, MSD, Merck, Medtronic, Novo Nordisk, Novartis, Pfizer, Servier, Sanofi Aventis. Author, Shaifali Joshi: speaker fees from Novo Nordisk, Sanofi, Lilly and MSD; participation in advisory boards of Lilly and Novo Nordisk. Author, Makepisi Lesiba Isaac Mashitisho: presentations for Novonordisk and Sanofi Aventis; participation in advisory board of Ryzodec; member of faculty for Advanced Institute of Insulin Management (Sanofi Aventis/deNovo medica). Author, Duma Khutsoane: participation in advisory boards and acted as a consultant for Novo Nordisk, Sanofi Aventis, Elli-Lilly, Boehringer- Ingelheim, Servier. Author, Adri Kok: participation in advisory boards of AstraZeneca, Abbott, BMS, Pfizer, Novartis, Janssen Pharmaceuticals, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Merck, MSD, Lilly, Mundipharma, AdcockIngram, GSK; speaker fees from Astrazeneca, Abbott, AdcockIngram, Boehringer- Ingelheim, BMS, Janssen Pharmaceuticals, Lilly, Novartis, Novo Nordisk, Merck, MSD, Sanofi, Aspen-GSK, Pharmaplan, Pfizer; provided opinion papers to Novo Nordisk, MSD, Astrazeneca, Pfizer; research involvement with Sanofi, Novo Nordisk, Novartis, MSD, Astrazeneca, Pfizer, Amgen.
estimate of disease prevalence, given the large num- ber of undiagnosed cases that long remain undetected owing to a lack of overt symptoms. The prevention, diagnosis, and management of type2diabetes, and its associated metabolic disorders, are likely to make ever greater demands upon health care professionals, with an increase in the case load of metabolic dysregula- tion driven by an aging population, a diversifying eth- nic milieu, and a growing prevalence of the condition in young people.
Teneligliptin is a novel oral DPP-4 inhibitor developed by Mitsubishi Tanabe Pharma Co. and approved in Japan in September 2012 for the management of T2DM (Kishimoto, 2013). Currently, teneligliptin is marketed in Japan (Teneria), Argentina (Teneglucon), and India (Tenepure; Teneza) (Table 5) (Kishimoto, 2013; Scott, 2015; https://aiocdawacs.com [homepage on the Internet). Presently, teneligliptin is registered in South Korea and is in the preregistration phase in Indonesia. Additionally, teneligliptin is in phase II clinical trials in Europe, and phase I clinical trials in the US (Xu et al., 1999). Teneligliptin, which is classified as peptidomimetic, has a unique structure having five consecutive rings (Edwards et al., 1999). Due to this unique structure, teneligliptin acts on S2 extensive sub site of DPP-4; this interaction enhances its potency and selectivity.
Background: There is an urgent need to overcome clinical inertia, as there is good evidence that effective management of diabetes can reduce long term costs, can benefit society and the economy, and can improve patients‘ outcomes and quality of life. Objectives: The main objective was to study clinical inertia in the management of type2diabetesmellitus in selected diabetes centres at Khartoum state. Method: A cross-sectional study was performed; on 160 type2 diabetic patients who were attending four selected diabetes centres in Khartoum state between November to December 2018. The Data were collected using questionnaire sheets then analyzed using statistical package for social science (SPSS) v 24.0 Result: Most patients (57.9%) had age ranged between 40-60y, 67.5% were female 32.5% had primary school education level, 78.8% were resident in Khartoum state, 59.5% were housewives, 13.8% employers, 6.1% teachers and 54% had low economic status, 39% had moderate, 30.5% had HTN, 8.6% CVD, 4.9% renal problems, 57.4% had family history of DM and 36.9% of HTN, 56.9% was fair in physical activity, 11.9% good, 51.9% had controlled diet. The average of HbA1c was 8.38, FBS was 175.75, and S Cr was 0.859, 14% were used insulin, and 95% were used oral antidiabetics. Of patients who were indicated for insulin and were not using it, there were 52% of patients did not use insulin because it was not prescribed by physicians, 22% phobia of injection. 41.3% were developed complication of neuropathy, 33.8% retinopathy, 70% had good medication adherence, 65% had regular follow up, 53.1% did not know target glycemic control. 27.70% of patients who were using insulin had reached the target glycemic control (HbA1C ≤ 7), and 53.70 % on non-insulin had not reached the target glycemic control. Conclusion: The study concluded that almost half of the patients with clinical inertia. More effort is required to improve
“Sweet is Sweet but until it is not too Sweet”. As the sweet spoon of diabetes challenges the global population, diabetic organizations across the globe call for unanimous resonance of Diabetes Voice to tackle diabetes with healthy living. With the discovery of new pathophysiology associated with diabetes, patients are gaining access to the newer therapeutic classes. Teneligliptin, a third gener- ation DPP-4 inhibitor exhibits unique “J-shaped” structure with “anchor-lock domain” mechanism which provides potent & long duration of action. It acts like an insulin/glucagon modulator con- trolling blood glucose over 24 hours. It is effective in tackling short-term glycemic fluctuations and improvement in β-cell parameters is observed soon after treatment. Half-life of 26.9 hours en- sures once a day administration. Because the metabolites of this drug are eliminated via renal and hepatic excretion, no dose adjustment is necessary in patients with renal impairment. Improve- ment in lipid profile, LV function, adiponectin levels & natriuretic effect is among the added pleio- tropic benefits. With the effective glycemic control & capability for improvement in β-cell function, Teneligliptin promises to be a preferable antidiabetic agent with long-term efficacy & safety in pa- tients with type2diabetes. The objective of this paper is to provide a comprehensive datum anal- ysis of Teneligliptin in the management of type2diabetes. It summarizes the unique pharmaco- dynamic & pharmacokinetic advantages of Teneligliptin and additionally its pleiotropic benefits of cardioprotection. It provides a comprehensive comparison of Teneligliptin vis-à-vis other gliptins in the class & provides a concise summary of all clinical trials till the date with Teneligliptin mo- notherapy & combination with other antidiabetic drugs.
By day 84 of the study, the HbA1c dropped significantly from 10.5 + 2.1 to 7.9 + 1.2 (p<0.0001), and the percent change of HbA1c ranged between 0.8% to 65% with average of 23.7% + 14.0 and a median of 19.7%. This result is considered clinically significant success, as 29.4% (n=15) of patients achieved euglycemia as per the ADA definition by the study end with no Insulin related side effects other than minor hypoglycemia episodes defined to be due to non- adherence to the diet plan. This shows the importance of integrating improved insulin therapies into clinical practice to help more patients reach their glycaemic goals safely. The study also demonstrated that adding Insulin to an OAD in insulin naïve patients with type II diabetes was found to reduce the incidence of nocturnal hypoglycemia as well as overall hypoglycemia which is consistent with the findings from other clinical trials 24 . Similar studies assessing the effectiveness of combining insulin (basal) with OADs, compared with conventional insulin therapy, for the treatment of patients with type II diabetesmellitus not adequately controlled by OADs showed similar results 25 . Diabetes burden on patients and communities is a growing problem that should be tackled by both early and aggressive treatment with insulin therapy to avoid excessive glycaemic exposure complications and achieve a near normal glycaemic target 27 . Evidence from various clinical trials suggests that insulin therapy not only leads to symptomatic improvements, but also helped correct the underlying pathogenetic mechanisms responsible for type II diabetes (insulin resistance and impaired insulin secretion). Insulin therapy greatly improved insulin secretion by reducing hyperglycemia 28, 29 . Research evidence has shown that insulin protects islets from apoptosis and may even augment cell regeneration. 29, 30 . Short-term insulin therapy appears to result in long-term improvement in blood-glucose control, especially when administered in the earliest stages of diabetes 18, 27, 28 . A review article proved that continuing metformin and/or sulphonylurea at the start of therapy with a long-acting insulin results in better glycaemic control with less insulin requirements, less weight gain and less hypoglycaemic events. And it seems evident that the start of insulin therapy should not mean the discontinuation of at least metformin 4 .
This to certify that this dissertation titled, “A STUDY TO ASSESS THE EFFECTIVENESS OF FENUGREEK SEED POWDER IN CONTROL OF BLOOD SUGAR LEVEL AMONG TYPE II DIABETESMELLITUS CLIENTS ATTENDING DIABETIC OUT PATIENT DEPARTMENT IN GOVERNMENT RAJAJI HOSPITAL, MADURAI” is a bonafide work done by Ms. J. Poornima Mary Rodriguez, College of Nursing, Madurai Medical College, Madurai – 20, submitted to The Tamilnadu Dr. M.G.R. Medical University, Chennai in partial fulfillment of the university rules and regulations towards the award of degree of Master of Science in Nursing Branch IV Community Health Nursing under our guidance and supervision during the academic period from 2010 – 2011.
Ethical approval was granted from the Research Ethics Committees at the Western Sydney Local Health District and The University of Sydney. The study population was defined as the total number of patients with Type 1 DiabetesMellitus (Type 1 DM) and Type2DiabetesMellitus (Type2 DM) with foot ulcers at initial visit attending our outpatient Foot Wound Clinic at Westmead Hospital between January to December 2011. DiabetesMellitus was defined according to the criteria set by the World Health Organisation (WHO). The current WHO diagnostic criteria for DiabetesMellitus includes a fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl) or 2-hour plas- ma glucose ≥ 11.1 mmol/l (200 mg/dl) . A foot ulcer was defined as a full-thickness wound located distal to the ankle (level of malleoli) .
Efficacy and Tolerability of Dianex in Type 2 Diabetes Mellitus A Non Randomized, Open Label Non Comparative Study ORIGINAL ARTICLE Efficacy and Tolerability of Dianex in Type 2 Diabetes Mellitus A No[.]