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Keberhasilan pencegahan komplikasi Diabetes Melitus dapat dicapai salah satunya melalui kepatuhan dalam terapi farmakologi yaitu penggunaan Obat Hipoglikemik Oral. Keberhasilan suatu pengobatan pada pasien DM memerlukan kemampuan dan keyakinan yang tinggi pada diri sendiri atau yang disebut dengan Self efficacy. Tujuan penelitian ini adalah untuk mengetahui hubungan Self efficacy dengan kepatuhan minum obat hipoglikemik oral pada penderita diabetes melitus tipe II. Desain penelitian yang digunakan adalah deskriptif korelasional dengan rancangan cross sectional. Teknik sampling digunakan consecutive sampling dengan jumlah sampel sebanyak 60 orang penderita DM tipe II. Hasil penelitian didapatkan yaitu 25 orang (41,7%) memiliki Self efficacy dalam kategori tinggi dan 31 orang (51,7%) memiliki kepatuhan minum obat hipoglikemik oral dalam kategori tinggi. Hasil uji Rank Spearman dengan α = 0,05 didapatkan angka p value = 0,000 dan koefisien korelasi (r) = 0,936 yang berarti ada hubungan antara Self efficacy dengan kepatuhan minum obat hipoglikemik oral dengan kekuatan hubungan kuat dan berarah positif. Self efficacy akan berpengaruh terhadap kemampuan menyesuaikan diri, memahami dan mengenal masalah yang dihadapi dan memotivasi dirinya untuk suatu perubahan perilaku salah satunya kepatuhan berobat.

As a result of the pharmacoepidemiological study, factors have been established that make it possible to increase the effectiveness of hypoglycemic therapy and the compliance of patients with diabetes mellitus in Kyrgyzstan. The structure of the prescribed oral hypoglycemic agents was investigated; the assessment, according to the results of the questionnaire of patients, was given of the effectiveness of the hypoglycemic therapy they received, as well as the level of its compliance with modern medical guidelines for the diagnosis and treatment of diabetes. At the time of filling out the questionnaire, only 44% of respondents had a target fasting glucose level (≤7 mmol/l). According to the data obtained, it can be concluded that in real clinical practice, the effectiveness of diabetes treatment remains low. We have obtained data that 47.8% of patients with diabetes are not adherent to treatment, which may also contribute to a rather low percentage of patients among the respondents who have reached the target blood glucose level. As for the use of drugs, the analysis of the data showed that the majority of patients (62.81%) receive monotherapy with oral hypoglycemic agents. According to the analysis, metformin is the most commonly used drug among the oral hypoglycemic agents. It is accepted by 60.1% of the respondents. Most diabetic patients spend 1000 som or more per month on oral hypoglycemic agents. Taking into account the cost of living in the country, it can be concluded that the acquisition of oral hypoglycemic agents significantly affects the budget of citizens and that there are problems with the economic availability of oral hypoglycemic agents. The results of our research indicate the insufficient effectiveness of the treatment and prophylactic measures for type 2 diabetes in our country, requiring more active work in this direction. The work was carried out in the design of a simple one-step prospective descriptive epidemiological study within the framework of a pharmacoepidemiological study.

Glibenclamide, an oral hypoglycemic BCS class II drug that gets completely metabolized in the liver, serves as a suitable candidate for buccal drug delivery. The study aims to formulate and evaluat...

Background The objective is to understand why physicians order tests or treatments in older adults contrary to published recommendations. Methods Participants: Physicians above the median for ≥ 1 measures of overuse representing 3 Choosing Wisely topics. Measurements: Participants evaluated decisions in a semi-structured interview regarding: 1) Screening men aged ≥ 76 with prostate specific antigen 2) Ordering urine studies in women ≥ 65 without symptoms 3) Overtreating adults aged ≥ 75 with insulin or oral hypoglycemic medications. Two investigators independently coded transcripts using qualitative analysis. Results Nineteen interviews were conducted across the three topics resulting in four themes. First, physicians were aware and knowledgeable of guidelines. Second, perceived patient preference towards overuse influenced physician action even when physicians felt strongly that testing was not indicated. Third, physicians overestimated benefits of a test and underemphasized potential harms. Fourth, physicians were resistant to change when patients appeared to be doing well. Conclusions Though physicians expressed awareness to avoid overuse, deference to patient preferences and the tendency to distort the chance of benefit over harm influenced decisions to order testing. Approaches for decreasing unnecessary testing must account for perceived patient preferences, make the potential harms of overtesting salient, and address clinical inertia among patients who appear to be doing well.

The diabetes is one of the most pressing medical and social problems in the health care system of most countries, including Tajikistan. According to experts from the International Health Organization, this disease is a problem for all segments of the population and age groups. In this regard, the modernization of the price regulation system in order to provide consumers with highly effective, harmless and affordable antidiabetic drugs is an urgent task of the health care and public protection system of the Republic of Tajikistan. The aim of the work is to study the range of drugs registered in the Republic of Tajikistan for the treatment of diabetes. The object of the study were scientific sources, statistics, price indicators, official websites of authorized publications on registered medicines. The research was conducted using methods of analysis, systematization and generalization, mathematical and statistical calculations. The range of oral hypoglycemic drugs presented on the pharmaceutical market of the Republic of Tajikistan was studied and the analysis of the pharmaceutical market of oral antidiabetic drugs by countries-manufacturers, dosage forms, groups of anatomical-therapeutic-chemical (ATC) classification was carried out. On March 1, 2021, 70 trade names of oral hypoglycemic drugs were registered. The range of drugs is mainly represented by drugs from the group of sulfanylurea derivatives (21 trade names of drugs or 30% of the total number of drugs in this group), as well as drugs from the group of biguanide derivatives (17 trade names of drugs or 24.28% of their total quantity). In the structure of deliveries of oral hypoglycemic drugs the leading positions are occupied by India – 31.25% (15 LP), Pakistan – 22.91% (11 LP), Ukraine – 14.58% (7 LP), Belarus and Germany – 6.25% each. (3 LP each). Registered 8 names of insulin preparations for injection in the form of vials (5 ml and 10 ml) and cartridges made in Ukraine («Farmak», «Indar») and India («Wockhardt Limited») and in pre-filled syringe pens produced by the company «Indar», Ukraine.

OBJECTIVE: To determine the effect of patient immigrant status on physician trainees’ diabetes treatment decisions. METHODS: Participants were 140 physician trainees (‘providers’). Providers viewed videos and vignettes of virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group and individual levels. RESULTS: Providers were less likely to refer foreign-born (vs. U.S.-born) patients to endocrinology. Individual-level results showed an almost even split between treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add oral hypoglycemic agent, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). CONCLUSION: Physician trainees are less likely to refer foreign-born patients to endocrinology. Half of individual-level decisions were influenced by patient immigrant status, but group-level analyses mask these differences. Systematic treatment differences based on non-relevant factors could lead to adverse outcomes for immigrants.

Background : Diabetes mellitus is a disease that is included in the group of metabolic diseases, characterized by hyperglycemia that occurs due to abnormal insulin secretion. Generally, treatment of diabetes mellitus uses insulin injection and Oral Hypoglycemic Drugs (OHD). In addition there are also animals are trusted by public in healing diabetes mellitus. Antlions (Myrmeleon sp) is a useful animal to treat diabetes mellitus. The body of antlions contains sulfonylureas which is a substance that stimulates insulin secretion in pancreatic beta cells. Aim : The objective of this research was to analyze the effect of antlions extract on blood glucose level of male swiss mice induced by streptozotocin Methods: This research was a pure experimental laboratory study and the design used is the Pre Test and Post Test Control Group Design, which is done by comparing the results of observations in the control and treatment groups after the action was done. Sampling was done using the simple random sampling technique. The sample size used in this study amounted to 30 mice. The data obtained were analyzed using ANOVA test with a confidence level of 95%. Results: The administration of antlions extract could lower (p

In the literature of Ayurveda, Prameha (diabetes mellitus [DM]) is a disease where derangement is seen in urine with respect to its quantity and quality. The basic pathology involved in the disease is the Bahu, Abaddha Medas, and Kleda. Prameha can be well correlated to DM with respect to its pathology and symptoms. Here, we present the case of a 44-year-old male who came with complaints of restlessness, generalized weakness, giddiness, and pain in bilateral calf muscles for the past 4 months. Based on Ayurvedic examinations, he was diagnosed to have Margavarnajnya Madhumeha (~obese diabetic), suitable food, lifestyle, and medications were advised after assessing Prakriti, Dosha, etc. By Ayurvedic therapy, considerable improvement was seen in the quality of life. The case was followed up for 4 years and the patient’s condition was maintained well throughout, without any complications. This article reports a case of Type 2 DM on insulin therapy which was completely managed by Ayurvedic therapeutic modalities and all the oral hypoglycemic drugs along with insulin were withdrawn gradually during the course of the treatment.

Diabetes Striatopathy , also known as Non-ketotic hyperglycemic hemichorea or Chorea Hyperglycemia Basal Ganglia Syndrome is rare complication of uncontrolled diabetes. This syndrome has been reported more frequently in elderly Asian womenand symptom resolution is typically associated with serum glucose levels and plasma osmolarity normalization.Herein, we report a case of 75 years old female with CAD-TVD, Hypertension & Type -2 Diabetes Milletus under oral hypoglycemic drugs presented with intermittent involantary movement of face and upper limb who was managed for diabetic striatopathy and showed symptomatic improvement in third day of admission.

Type 2 diabetes mellitus and its complications, decreases the quality of life in diabetic patients. Thiazolidine-2,4-diones are found to be better insulin sensitizing agents, acting on peroxisome proliferator activated receptor-γ (PPAR-γ) and decrease blood glucose level in diabetic patient. Therefore, in the present work, we synthesized 5-[4-(substituted) sulphonylbenzylidene]thiazolidine-2,4-diones and evaluated for their oral hypoglycemic activity. The synthesized compounds were further studied for their find out interactions with 2PRG protein with the help of docking score and also find out their predicated ED25 values. The results of synthesized compounds were showed significant decrease in blood glucose level as compared to positive control group. All synthesized compounds have shown good hydrogen bond interactions with 2PRG protein, docking score and predicted ED25 value as compared with reference drug, pioglitazone and rosiglitazone, respectively. Thus, sulphonyl linked thiazolidine-2,4-diones may be used as promising oral hypoglycemic agent.

A metformina é um hipoglicemiante oral da classe das biguanidas muito utilizado no tratamento de diabetes mellitus tipo 2. Os estudos de equivalência farmacêutica destinam-se à avaliação de alguns parâmetros de qualidade dos medicamentos por meio de análise comparativa entre o(s) medicamento(s) teste e o medicamento de referência. Dessa maneira, o presente trabalho teve como objetivo avaliar a equivalência farmacêutica de comprimidos de duas marcas de medicamento genérico e duas marcas de similar frente ao medicamento referência de cloridrato de metformina 850 mg. Os testes realizados nas amostras foram peso médio, teor de substância ativa, friabilidade, desintegração e dissolução. As amostras testadas foram aprovadas em todos os testes, encontrando-se dentro dos limites preconizados pela farmacopeia brasileira 5ª edição. Assim pode-se afi rmar que todos os medicamentos testados são equivalentes farmacêuticos do medicamento referência.

The utilization of herbal medicines for the management of diseases has provided admirable results. Plant extracts are rich in like polyphenols, alkaloids, glycosides, flavonoids, and terpenoids having specific health benefits. Diabetes mellitus (DM) is a non-communicable disease with a worldwide occurrence, characterized by persistent hyperglycemic conditions. Several oral hypoglycemic drugs viz. sulfonylureas, biguanides, α-glucosidase inhibitors, and non-sulfonylureas secretagogues are common medical recommendations for controlling diabetes. Consumption of oral hypoglycemic drugs demonstrate prominent side effects and to date, no permanent effective remedy for the complete recovery of DM is available. Until effective medication procedures are established; complementary and alternative medicines must be utilized to reduce the disease incidence. WHO has put herbal medicines on their priority list to treat various illnesses as they have lesser side effects, ease of access, affordability and low cost. Their administration can impart comparative functionality like medicine, if extracted in pure forms. Herbal antidiabetic formulations like dia-care, diabecure, syndrex, quath, churna, arth, vati etc are commercially available in the market. Identification of particular bioactive compound, minimum effective doses and effect on metabolic pathway needs to be verified to increase their acceptability by the medical practitioners. This provides an opportunity for the research personals to develop herbal foods or medicines which are nutritional, economic and have improved functionality. Keeping in view the potential of herbals for treating DM this review has been compiled to provide an overview on effect of antidiabetic herbal ingredients on metabolic pathway, their safety, bioavailability and future thrust areas for scientific developments.

The case was a 41-year-old male patient with obesity and hypertension until 2015. He became 102 kg with body mass index (BMI) of 32.5 and HbA1c value increased to 6.6% in January 2016. Then, he started a low carbohydrate diet (LCD) and continued successfully. His body weight was decreased to 77 kg within nine months with 5.7% in HbA1c. His lipid profiles were improved as follows: triglyceride 143 to 33 mg/dL, LDL-C 130 to 102 mg/dL, HDL-C 40 to 76 mg/dL. After that, he has continued LCD but has always meals with excess calories. Then, his weight became 88 kg in January 2020 with 6.4% in HbA1c. During three years, values of HbA1c and lipid profiles became gradually worse. He has been prescribed for antihypertensive drugs and not for an oral hypoglycemic agent (OHA) so far. The adequate treatment would be discussed from now.

Background Dietary intake of antioxidative vitamin C plays a protective role in the prevention of oxidative damage in diabetics, demanding increased requirement of vitamin C. Hyperglycemia results in impaired uptake of vitamin C in the cell. The present study was conducted to compare the plasma ascorbate levels in type 2 diabetic patients and controls consuming adequate dietary vitamin C. Methodology Fifty consented type 2 diabetes mellitus (T2DM) patients who were on treatment with oral hypoglycemic drugs and consuming adequate vitamin C in diet were taken in the study and 50 healthy controls equitably matched for age, gender between 40 and 70 years, and dietary intake of vitamin C were compared. Dietary intake of vitamin C was estimated by a food frequency questionnaire. Subjects consuming more than 35 mg/d of vitamin C were included in the study. Fasting blood sugar was estimated by glucose oxidase and peroxidase method and estimation of ascorbic acid was done by using 2, 4 dinitro phenyl hydrazine method. Result The mean ± standard deviation levels of plasma ascorbate levels in diabetic subjects were 0.22 ± 0.12 mg/dL, which were significantly lower as compared with controls with plasma ascorbate level of 0.47 ± 0.15 mg/dL. In diabetic subjects, insignificant positive correlation was observed between these parameters with r-value 0.168 and p-value 0.245. Conclusion This study concludes that even with the recommended dietary intake of vitamin C low plasma ascorbate levels were found among T2DM patients, which necessitates increased demand and dietary advice to diabetic patients on consuming foods rich in vitamin C more than the recommended daily allowance.

Defining type of diabetes using survey data is challenging, although important, for determining national estimates of diabetes. The purpose of this study was to compare the percentage and characteristics of US adults classified as having type 1 diabetes as defined by several algorithms.This study included 6331 respondents aged ≥18 years who reported a physician diagnosis of diabetes in the 2016-2017 National Health Interview Survey. Seven algorithms classified type 1 diabetes using various combinations of self-reported diabetes type, age of diagnosis, current and continuous insulin use, and use of oral hypoglycemics.The percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/mEstimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification.

In this work, the prevalence of obesity among two groups of pregnant women with diabetes will be studied, separatingbetween those who need drug therapy and those who achieve good control with non-drug management. Gestationaldiabetes is the intolerance to carbohydrates first diagnosed during pregnancy. It is the most common metabolic problem during this period. Being, obesity one of the main risk factors for the development of this pathology, which generates innumerable harms for both the patient and the fetus. When diabetes is diagnosed, may be through fasting glucose numbers or by 75g OGTT test, one can obtain an adverse pregnancy outcome, requiring blood glucose regulation. For this, different strategies can be employed such as non-medication with physical exercise and balanced diet or medication with the use of oral hypoglycemic agents or insulin. En este trabajo se estudiará la prevalencia de obesidad entre dos grupos de mujeres embarazadas con diabetes, separando entre aquellas que necesitan terapia con medicamentos y aquellas que tienen buen control con un manejo no farmacológico. El diabetes gestacional es la intolerancia a los carbohidratos que se diagnostica por primera vez durante el embarazo. Es el problema metabólico más común durante este período. La obesidad es uno de los principales factores de riesgo para el desarrollo de esta patología, que genera innumerables daños tanto para el paciente como para el feto. Cuando se diagnostica diabetes, a través de los niveles de glucosa en sangre en ayunas o mediante el examen TOTG 75g, se puede obtener un resultado gestacional desfavorable, requiriendo lo antes posible la regulación de glucosa en sangre. Para ello, se pueden utilizar diferentes estrategias, como no medicamentosa, a través del ejercicio y dieta equilibrada o medicación con el uso de hipoglucemiantes orales o insulina. Neste trabalho será estudada a prevalência de obesidade entre dois grupos de gestantes com diabetes, separando entreaquelas que necessitam de terapêutica medicamentosa e as que conseguem bom controle com manejo não medicamentoso. O diabetes gestacional é a intolerância aos carboidratos diagnosticada pela primeira vez durante a gestação. É o problema metabólico mais comum durante esse período, sendo a obesidade um dos principais fatores de risco para o desenvolvimento dessa patologia, a qual gera inúmeros malefícios tanto para a paciente quanto para o concepto. Quando o diabetes é diagnosticado, podendo ser através dos números da glicemia em jejum ou através do exame TOTG 75g, pode-se obter um desfecho gestacional desfavorável, necessitando o mais breve possível da regulação da glicemia sanguínea. Para isso, diferentes estratégias podem ser empregadas, como a não medicamentosa, por meio do exercício físico e da alimentação balanceada, e a medicamentosa com o uso dos hipoglicemiantes orais ou da insulina.

Hypoglycemia is associated with adrenergic and various neurological symptoms including hemiparesis. Though not common, movement disorders such as chorea and ballism have been reported in hypoglycemia. This case was of an elderly lady, a known diabetic, who developed two episodes of hemiparesis and single episode of jerky head movement with preserved sensorium lasting for few seconds, associated with hypoglycemia on different occasions, 1 week after increasing the dosage of oral hypoglycemic agent with complete recovery each time with correction of sugar levels. Magnetic resonance imaging showed transient bilateral diffusion restriction in posterior limb of internal capsule.

Diabetes mellitus (DM) is a worldwide rising concern that leads to an increased rate of morbidity, mortality, and health-care costs. DM is a chronic, endocrine disorder associated with hyperglycemia. The current estimated DM prevalence is over 422 million and has been progressively increasing over the past decades. Consequently, it is considered a significant problem in health-care settings. Health-care professionals who deal with such patients need to have an adequate information and drug therapy management including drugs and its regimen that are presently available in the market. This review provides an overview of potential diabetic drugs and their mechanisms. Hence, it will be proved beneficial for health-care professionals.

Introduction: Pioglitazone has been a cornerstone of oral hypoglycemic therapy. Concerns have been raised about its association with urinary bladder cancer. Considering the wide usage of this drug, concrete and multiple population-based studies are needed to establish the safety of this drug. The present retrospective study is aimed to assess the association of pioglitazone with urinary bladder cancer. Materials and Methods: Clinical records of 4170 patients (2085 pioglitazone users and similar number of nonpioglitazone users) attending the diabetes clinic at a tertiary level teaching hospital were accessed, and the patients were subjected to symptom-directed questionnaire, urine examination, and cystoscopy and bladder biopsy (whenever clinically indicated). The risk of bladder cancer was also assessed with respect to cumulative dose and duration of pioglitazone. Results: We did not observe any increased risk of bladder malignancy with pioglitazone exposure; furthermore, there was no association with cumulative dose and duration of pioglitazone therapy. Pioglitazone was found to be effective and safe in managing glycemic control in diabetic patients.

The global deaths due to colorectal cancer and diabetes mellitus have increased by 57% and 90%, respectively. The relationship between various cancers and diabetes mellitus has been shown in multiple epidemiological studies. Hence, better management of diabetes mellitus is expected to reduce the risk of various cancers. This review focuses on colorectal cancer and aims to summarize recent findings on the antitumor effects of various oral hypoglycemic drugs on colorectal cancer and their estimated mechanisms. Of the seven classes of oral hypoglycemic agents, only metformin was found to have suppressive effects on colorectal cancer in both clinical and basic research. Clinical and basic researches on suppressing effects of glinides, dipeptidyl peptidase-4 inhibitors, thiazolidinedione, α-glucosidase inhibitors, and sodium glucose cotransporter-2 inhibitors against colon carcinogenesis have been insufficient and have not arrived at any conclusion. Therefore, further research regarding these agents is warranted. In addition, the suppressive effects of these agents in healthy subjects without diabetes should also be investigated.

Type 2 diabetes (T2DM) is a metabolic disorder disease and DPP-4 inhibitors are a class of oral hypoglycemic that blocks the dipeptidyl peptidase-4 (DPP-4) enzyme. DPP-4 inhibitors reduce glucagon and blood glucose levels and don’t have side effects such as hypoglycemia or weight gain. In this paper, a series of imidazolopyrimidine amides analogues as DPP4 inhibitors were selected for quantitative structure-activity relationship (QSAR) analysis and docking studies. A collection of chemometric methods such as multiple linear regression (MLR), factor analysis-based multiple linear regression (FA-MLR), principal component regression (PCR), genetic algorithm for variable selection-MLR (GA-MLR) and partial least squared combined with genetic algorithm for variable selection (GA-PLS), were conducted to make relations between structural features and DPP4 inhibitory of a variety of imidazolopyrimidine amides derivatives. GA-PLS represented superior results with high statistical quality (R2 = 0.94 and Q2 = 0.80) for predicting the activity of the compounds. Docking studies of these compounds reveals and confirms that compounds 15, 18, 25, 26, and 28 are introduced as good candidates for DPP-4 inhibitors were introduced as a good candidate for DPP-4 inhibitory compounds.

Background and objectives: Chronic disorders such as diabetes mellitus type II and hypertension have been associated with cognitive decline in older adults. It is unclear whether adherence to antihypertensive and oral hypoglycemic agents impact cognitive health. The objectives are to study the association between adherence to antihypertensive and oral hypoglycemic agents and cognitive status in community-living older adults. Methods: We used data from a large representative sample of older adults (N=2,286) covered under a public drug insurance plan in Quebec and participating in Quebec's health survey on older adults (ESA-study) with a Mini-Mental State Examination (MMSE) score ≥22 at baseline (T1) and examined one year later (T2). Participants with hypertension and diabetes mellitus type II were identified according to criteria used in the Canadian Chronic Disease Surveillance System. Antihypertensive and oral hypoglycemic prescriptions delivered were ascertained via Quebec's pharmaceutical database (RAMQ). Medication adherence was calculated using the medication possession ratio as a continuous variable in the year prior to and following baseline interview. Multivariate linear regressions were used to study the percentage change in MMSE scores between interviews (T1,T2) as a function of adherence to antihypertensive and oral hypoglycemic agents (before and after T1) controlling for potential confounders. Results: In participants with diabetes mellitus type II only, adherence to oral hypoglycemics was not associated with a change in MMSE scores. In participants with hypertension only, the change in MMSE scores was associated with adherence to antihypertensives (β 1.23; 95%CI: 0.29-2.17). In participants with comorbid hypertension and diabetes mellitus type II, the change in MMSE scores was associated with adherence to both antihypertensive and oral hypoglycemic agents (β 0.75; 95%CI: 0.01-1.48). Conclusions: Adherence to oral hypoglycemic agents and antihypertensive agents among older adults with hypertension and comorbid diabetes mellitus type II can have a preserving effect on cognitive health in older adults. Further research on the long-term impact on cognition is recommended.

Background/Aim: The worldwide prevalence of diabetes is high including Saudi Arabia. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. Associations between B12 deficiency and age, duration of type 2 diabetes mellitus (T2DM), duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. Results: Of 363 T2DM patients, 206 (56.7%) were males and 157 (43.3%) were females, mean age was 53.72 ± 11.31 years, the mean duration of T2DM was 9.89 ± 7.32 years, and the mean duration of metformin use was 9.84 ± 7.29 years. There were 205 patients 56.5% who had a daily dose of 750 mg of metformin. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. There were 107 patients (29.5%) who were on PPIs. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. Conclusion: Routine testing for serum vitamin B12 level is not practiced in our institution. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications.

A clinical decision report using: Søfteland E, Meier JJ, Vangen B, Toorawa R, Maldonado-Lutomirsky M, Broedl UC. Empagliflozin as Add-on Therapy in Patients With Type 2 Diabetes Inadequately Controlled With Linagliptin and Metformin: A 24-Week Randomized, Double-Blind, Parallel-Group Trial. Diabetes Care. 2016;40(2):201-209. https://doi.org/10.2337/dc16-1347 for a patient with uncontrolled type 2 diabetes on metformin and sitagliptin and hesitant to begin insulin therapy.

A 70-year-old man presented 1 week prior to removal of an osteosarcoma of the proximal humerus. He had been diagnosed with idiopathic pulmonary fibrosis (IPF) 8 years previously. He described having dyspnea on moderate exertion, and he had a chronic, mild, nonproductive cough. He did not require home oxygen. In addition, he had a history of hypertension and diabetes mellitus type 2, well controlled on oral hypoglycemic medication. He led a sedentary lifestyle with an estimated MET score ≤3. He was an ex-smoker since the time of the original diagnosis of IPF.

Globally and nationally the Diabetes mellitus with its complications become the most important contemporary and challenging health problem. It should be treated with diet and exercise, typically in conjunction with oral hypoglycemic drugs (OHD) and the complications are so critical and hazardous, and oral hypoglycemic agents and insulin which is used for the treatment of diabetes mellitus by the allopathic system of medicine have numerous side effects. In spite of available treatment number of patients is on rise. It is convincing that the herbal or mineral remedies stated in ayurveda used singly or in combination have potency in the treatment of madhumeha. However, our country is indeed rich in its vast variety of flora, throught variegated physical feature of the land, extending from mountains to the oceans. The practitioners of Indian system of medicine have been using the plant materials and are claiming success in treatment of madhumeha even today. Therefore, taking a lead it will be worthwhile to reappraise the commonly used plant remedies in the treatment of madhumeha, with an unbiased scientific spirit. In Ayurveda kaidarya is mentioned as parvata nimba. Nimba is the best drug used in Prameha. Edible variety of Nimba i.e curry leaves can be useful. Kaidarya is having katu, tikta, and kashaya rasa and sheeta veerya. It pacifies vitiated kapha and pitta. Kaidarya has been used traditionally since few years for treatment of prameha. Placebo control may not be ethical in the disease hence single arm study along with modern medicine is preffered. Keywords: Diabetes mellitus, kaidarya, Oral Hypoglycemic agents

A current review of sulfonylureas as oral hypoglycemic agent in the treatment of diabetes mellitus type 2, particularly of the second and third generation sulfonylureas is performed. It is also reviewed its mechanism of action, cardiovascular risk, their adverse effects, the recommendation according to the ADA, AACE and ALAD guidelines and its use in patients infected with COVID-19. Se hace una revisión actual de las sulfonilureas como hipoglicemiantes orales en el tratamiento de la diabetes mellitus tipo 2, particularmente de las sulfonilureas de segunda y tercera generación; asi como de su mecanismo de acción, riesgo cardiovascular, sus efectos adversos y su recomendación según las guías de la ADA, AACE y ALAD y su indicación en pacientes infectados con COVID-19.

Objective: To estimate frequency of silent carotid artery stenosis and its associated factors in diabetic patients attending a tertiary care hospital. Methods: This cross-sectional study was conducted in tertiary care Civil Hospital, Karachi from March 2019 to September 2019,. A total of 166 patients with Diabetes Mellitus were included in this study. Brief history was taken for the duration of DM, treatment, and smoking habits. Carotid artery stenosis (CAS) wafrs measured by Doppler ultrasound of right and left common, internal, and external carotid arteries. Results: Frequency of silent carotid artery stenosis (CAS) in diabetic patients was observed in 28.92% (48/166) cases. The mean age ±SD of the patients was 54.8 ±7.96 years. 27 (22.29%) patients were smoker and all were male. Out of 166 diabetic patients, 59 (35.54%) were treated with insulin and 107 (64.46%) were treated with oral hypoglycemic. Conclusion: Substantial number of diabetic patients with increasing age, increased duration of diabetes and smoking habits have significant silent Silent Carotid Artery Stenosis (CAS). doi: https://doi.org/10.12669/pjms.36.6.2306 How to cite this:Ali FS, Bader N, Zuberi BF, Banu S. Frequency of silent carotid artery stenosis in diabetics and its associated factors: An analysis in tertiary care hospital. Pak J Med Sci. 2020;36(6):1270-1274. doi: https://doi.org/10.12669/pjms.36.6.2306 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aim: To study the adverse drug reactions (ADRs) occurring with the drug use in a tertiary care hospital. Materials and Method: This observational study conducted over a period of four months (01-Nov-2015 to 29—Feb-2016). The Central Drug Standard Control Organization (CDSCO) suspect ADR forms (15) were distributed to all clinical departments personally in Kerala medical college hospital and research center, Mangode, Cherpullaserry. Regular visits were carried out twice a week for collecting data reports. They were then analyzed, compared with state data, national data, and international data. Results A total of 25 suspected Adverse Drug Reactions forms were reported during the period of four months of the study of the out patients and in patients departments of the hospital. Among all drugs NSAIDS, followed by Antimicrobials, Antipsychotics, Bronchodilators, Antihypertensive and oral hypoglycemic agent etc.. were reported to have adverse drug reactions. Most common route of adverse drug reactions was oral, followed by IV, IM, S/C, Topical and Inhalational routes. Reactions mostly seen affecting Skin, Gastrointestinal systems, Central nervous system, and Hematological system Most patients recovered from adverse events taking suitable measures like complete stopping the offending agent, or were prescribed antihistamines, steroids in addition Conclusion: Awareness about ADR reporting is still poor amongst healthcare professionals in India. The incidence and severity of Adverse Drug Reactions documented in our study are lower than those reported in other studies. NSAIDS comprise the major drug family associated with adverse drug reactions so should be rationally prescribed. Improved communication between the physicians and nurses with the pharmacovigillance centre in the hospital is suggested.

Diabetes mellitus is defined as a group of metabolic diseases characterized by hyperglycemia, due to defective insulin secretion, action or both. Type 2 diabetics can be treated by using oral hypoglycemic drugs or insulin or both. Type 2 diabetics who do not respond to the treatment of oral hypoglycemic drugs or maybe insulin resistant over a period of time require supplemental insulin for adequate glycemic control. The reality is that diabetes influences patient’s lives. The mere presence of diabetes deteriorates a person’s quality of life. When diabetes co exists with other chronic illnesses, the effect is even worse. Aim and Objective of the Study - To compare quality of life in diabetics on insulin and oral hypoglycemic drugs. The objectives being assessing and comparing quality of life in Diabetics on insulin and oral hypoglycemic drugs using MDQol-17 on the components like Physical functioning, Role limitations due to physical health, Role limitations due to emotional health, Energy fatigue, Emotional well-being, Social functioning, and General health. Study design and methodology -Total of 124 subjects were included in the study. Of this, 62 were on insulin (Group A) and 62 were on oral hypoglycemic drugs (Group B).Outcome measure used was Modified Diabetes Quality of life questionnaire-17. Results and analysis - The data was collected and analyzed using statistical test – Unpaired t test for the comparison between two independent groups. The QOL score for insulin and OHD group was 60.96(±1.8) and 71.32(±1.5) respectively which was significant. With the p=

Basal insulin therapy in combination with oral hypoglycemic drugs has a special effect on fasting blood glucose. It is a simple way of introducing insulin therapy in patients with type 2 diabetes mellitus subjected to further prandial insulin therapy. Treatment with insulin mixtures reduces both fasting blood glucose and postprandial blood sugar, which has a negative effect on the development of vascular complications. With this simple therapy, there are limitations in everyday life and an adverse effect on the dynamics of body weight. Basal-bolus therapy focuses on pathophysiological changes, and with professional training and high-quality self-control provides good results with sufficient flexibility in everyday life. All insulin analogues have advantages over human insulins in terms of treatment outcomes, safety and patient compliance. All types of insulin therapy in clinical practice can be carried out by simple schemes, Базальная инсулинотерапия в сочетании с пероральными сахароснижающими препаратами оказывает особое воздействие на тощаковую гликемию. Она является простым способом интродукции инсулинотерапии больным сахарным диабетом 2-го типа. Терапия смесями инсулинов снижает как сахар крови натощак, так и постпрандиальную гликемию, которая оказывает негативное влияние на развитие сосудистых осложнений. При этой простой терапии существуют ограничения в повседневной жизни и неблагоприятное влияние на динамику массы тела. Базис-болюс-терапия ориентирована на патофизиологические изменения и при профессиональном обучении и качественном самоконтроле дает хорошие результаты при достаточной гибкости в повседневной жизни. Все аналоги инсулинов обладают преимуществами перед человеческими инсулинами в отношении результатов лечения, безопасности и комплайенса пациентов. Все виды инсулинотерапии в клинической практике могут осуществляться простыми схемами., Базальна інсулінотерапія в поєднанні з пероральними цукрознижувальними препаратами чинить особливий вплив на глікемію натще. Вона є досить простим способом інтродукції інсулінотерапії у хворих на цукровий діабет 2-го типу, яким у подальшому показана прандіальна інсулінотерапія. Терапія за допомогою сумішей інсулінів знижує як рівень глюкози натще, так і прандіальну глікемію, що негативно впливає на розвиток судинних ускладнень. За умов цієї спрощеної терапії існують обмеження в повсякденному житті і негативний вплив на динаміку маси тіла. Базис-болюсна терапія орієнтована на патофізіологічні зміни і за умов професійного навчання і якісного самоконтролю дає добрі результати. Усім аналогам інсулінів притаманні переваги порівняно з людськими інсулінами відносно результатів лікування, безпеки та комплайєнсу. Будь-які типи інсулінотерапії в клінічній практиці доцільно реалізовувати за допомогою простих схем терапії.

Objective: To evaluate the anti diabetic effect of cinnamon extract in alloxaninduced diabetic animal model (albino rats) in comparison with oral hypoglycemic drugs. StudyDesign: An Experimental study. Place of Study: Al Tibri Medical College, Isra University, KarachiCampus. Duration of Study: December 2012 to December 2013. Materials and Methods: Total60 Albino rats of both genders were divided into 6 groups consisting of 10 rats in each group.Each group of animals was further divided into two sub groups containing 5 rats in each groupResults: The results obtained from the data indicated that there is significant reduction in bloodglucose level rats treated with low dose of cinnamon extract. The animals of low dose cinnamonextract (200mg/kg. bw) when compared with other groups; there is a reduction in the bloodglucose level in alloxan induced diabetic rats. Also tolbutamide and acarbose treated groupsshowed better antidiabetic effects as compared with cinnamon extract treated groups (pvalue