scholarly journals Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)–Treated Diabetes

2015 ◽  
Vol 10 (2) ◽  
pp. 378-382 ◽  
Author(s):  
Shin-ichi Harashima ◽  
Akiko Nishimura ◽  
Kaori Ikeda ◽  
Yu Wang ◽  
Yanyan Liu ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Self Monitoring ◽  
Once Daily

scholarly journals SUN-692 Comprehensive and Structured Care Program for Patients with Type 2 Diabetes Mellitus: A Preliminary Report from Raipur, Chhattisgarh State of India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kalpana Dash ◽  
Surekha Tippisetty ◽  
Samba Siva Rao ◽  
Vamsi Krishna Kolukula
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Care Program ◽  
Mobile App ◽  
Phone Call ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Self Monitoring ◽  
Structured Care ◽  
Glycemic Outcomes

Abstract Aim: To assess the glycemic outcomes of T2DM patients enrolled in comprehensive structured care program at the outpatient clinic of Apollo Sugar at Raipur, India. Methods: This is a preliminary, prospective, single-center, observational study on T2DM patients from Jan 2018 to December 2018. Uncontrolled diabetes or patients with comorbid conditions with the duration of disease for more than one year and age ≥18 years and who gave consent to enroll in the program were included in the study. The structured care program is a 6 months program where patients were continuously engaged by counseling them on diabetes management- diet and exercise, self-monitoring of blood glucose, health interactions with the remote health coach through a mobile app. Baseline demographics and clinical data were collected at the time of enrollment and were followed up for 6 months. HbA1c reduction is the target measurement of this program. Descriptive statistics were used to analyze and report the data. A paired t-test is used to check the significant reduction in HbA1c from baseline to follow up Results: Total 102 patients were included in this study. Mean (SD) age was 50.7 (10.5) years, males were 78 (76%) and females were 24 (24%). The mean (SD) duration of diabetes and BMI were 7.9 (7.0) years and 27.5 (4.5) kg/m2 respectively. At the time of enrollment, patients were at mean HbA1c of 9.0(2.1)%, fasting (F) and post-prandial (PP) blood (BG) glucose was 194(68) mg/dL and 247(94) mg/dL respectively. Among these patients 38% had neuropathy and 15% had retinopathy as their complications. These patients were regularly followed up over the phone call to counsel on diabetes management with a healthy diet, exercise, self-monitoring of blood glucose, and medication compliance. After 6 months followup the HbA1c, FBG, and PPBG were 7.6 (1.5) %, 139 (50) mg/dL, and 196 (75) mg/dL, respectively with a significant mean reduction of 1.4%, 56 mg/dL, and 51 mg/dL (p <0.001). Further analysis of glycemic outcomes between these patients on oral hypoglycemic agents (OHAs) and OHAs+insulin, the reduction in HbA1c (1.5%) was not significant. Conclusion: Our study demonstrates that a structured care program might bring a clinically significant glycemic control through tight adherence to SMBG, diet, exercise, and medication. To establish these results a study in large sample is in progress.

scholarly journals Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels

2015 ◽  
Vol 11 (3) ◽  
pp. 226-232 ◽  
Author(s):  
SS Shrestha ◽  
R Shakya ◽  
BM Karmacharya ◽  
P Thapa
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Special Reference ◽  
Clinical Outcomes ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Age Group ◽  
Oral Hypoglycemic Agents

Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12508 Kathmandu Univ Med J 2013; 43(3):226-232

Real-World Clinical Effectiveness and Tolerability of Hydroxychloroquine 400 Mg in Uncontrolled Type 2 Diabetes Subjects who are not Willing to Initiate Insulin Therapy (HYQ-Real-World Study)

2019 ◽  
Vol 15 (6) ◽  
pp. 510-519 ◽  
Author(s):  
Amit Gupta
Keyword(s):  
Body Weight ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Real World ◽  
Antidiabetic Drugs ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Good Glycemic Control ◽  
Hs Crp ◽  
Change In Mean

Objective: The epidemic of T2DM is rising across the globe. Systemic inflammation plays a pivotal role in the pathogenesis and complications of T2DM. Combination of two or more oral hypoglycemic agents (OHA) is widely prescribed in patients with T2DM, however many patients have poor glycemic control despite receiving combination therapy. The new antidiabetic drugs are relatively costly or many patients have anxiety over the use of injectable insulin. The objective of this observational study was to investigate the effectiveness and tolerability of hydroxychloroquine (HCQ) in T2DM patients uncontrolled on multiple OHA and despite high sugar level not willing to initiate insulin therapy in a real-world clinical setting. Methods: A prospective, investigator-initiated, observational, single-centred study was conducted where 250 patients (18-65 years) with T2DM for more than 5 years, with uncontrolled glycemia despite on a combination of multiple OHA, HbA1c between ≥7% and <10.5%, FPG >130 mg/dL or PPG >180 mg/dL and BMI between >25 and <39 kg/m2, were prescribed hydroxychloroquine sulphate 400 mg once daily for 48 weeks. Percentage of drugs used at the baseline were as follows: metformin 2000 mg (100%), glimepiride 4 mg (100%), pioglitazone 30 mg (100%), sitagliptin 100 mg (100%), canagliflozin 300 mg (52.4%), empagliflozin 25 mg (22.8%), dapagliflozin 10 mg (17.6%) and voglibose 0.3 mg (62%). Mean change in HbA1c, blood glucose and hs-CRP at baseline, week 12, 24 and 48 were assessed using the paired t-test. Results: After 48 weeks of add-on treatment with HCQ, almost all SGLT-2 inhibitors were withdrawn; metformin dose was reduced to 1000 mg, glimepiride reduced to 1 mg and sitagliptin reduced to 50 mg OD. Patients continued to have good glycemic control. HbA1c was reduced from 8.83% to 6.44%. Reduction in FPG was 40.78% (baseline 177.30 mg/dL) and PPG was reduced by 58.95% (baseline 329.86 mg/dL). Change in mean body weight was -4.66 Kg. The reduction in glycemic parameters and mean body weight was significant (p < 0.0001). Hs-CRP was significantly reduced from 2.70±1.98 mg/L to 0.71±0.30 mg/L 9 (p < 0.0001). More reduction in glycemic parameters and body weight was observed among the patients with higher hs-CRP (> 3 mg/L) as compared to patients with baseline hs- CRP ≤ 3 mg/L. Most common adverse events reported with the drug therapy were GI irritation (3.6%) and hypoglycemia (2%). None of the patients required medical assistance for hypoglycemia. Conclusion: Add-on treatment of HCQ effectively improved glycemic control in T2DM patients uncontrolled on multiple antidiabetic drugs. By virtue of its antidiabetic and anti-inflammatory properties, it may emerge as a valuable therapeutic intervention for the patients with T2DM.

scholarly journals A Male with Extreme Subcutaneous Insulin Resistance: A Case Report

2016 ◽  
Vol 23 (2) ◽  
pp. 209-213 ◽  
Author(s):  
Zuhayer Ahmed ◽  
Indrajit Prasad ◽  
Hafizur Rahman ◽  
Jalil Ansari ◽  
Khaled Hassan
Keyword(s):  
Insulin Resistance ◽  
Blood Glucose ◽  
Underdeveloped Country ◽  
Hypoglycemic Agents ◽  
High Dose ◽  
Subcutaneous Insulin ◽  
Oral Hypoglycemic Agents ◽  
Glucose Levels ◽  
Medical Issues ◽  
Insulin Autoantibody

AbstractIntroduction: Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day.Case presentation: A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative.Conclusion: This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.

scholarly journals A Randomized Trial of Insulin Glargine plus Oral Hypoglycemic Agents versus Continuous Subcutaneous Insulin Infusion to Treat Newly Diagnosed Type 2 Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Shuo Lin ◽  
Mu Chen ◽  
Wanling Chen ◽  
Keyi Lin ◽  
Panwei Mu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Glargine ◽  
Basal Insulin ◽  
Insulin Infusion ◽  
Cell Function ◽  
Hypoglycemic Agents ◽  
Newly Diagnosed ◽  
Oral Hypoglycemic Agents

Aims. Basal insulin plus oral hypoglycemic agents (OHAs) has not been investigated for early intensive antihyperglycemic treatment in people with newly diagnosed type 2 diabetes. This study is aimed at comparing the short-term (over a period of 12 days) effects of basal insulin glargine plus OHAs and continuous subcutaneous insulin infusion (CSII) on glycemic control and beta-cell function in this setting. Methods. An open-label parallel-group study. Newly diagnosed hospitalized patients with type 2 diabetes and fasting plasma glucose (FPG) ≥11.1 mmol/L or glycated hemoglobin (HbA1c) ≥9% (75 mmol/mol) were randomized to CSII or insulin glargine in combination with metformin and gliclazide. The primary outcome measure was the mean amplitude of glycemic excursions (MAGE), and secondary endpoints included time to reach glycemic control target (FPG < 7 mmol/L and 2-hour postprandial plasma glucose < 10 mmol/L), markers of β-cell function, and hypoglycemia. Results. Subjects in the CSII (n=35) and basal insulin plus OHA (n=33) groups had a similar significant reduction from baseline to end of treatment in glycated albumin (−6.44 ± 3.23% and− 6.42 ± 3.56%, P=0.970). Groups A and B have comparable time to glycemic control (3.6 ± 1.2 days and 4.0 ± 1.4 days), MAGE (3.40 ± 1.40 mmol/L vs. 3.16 ± 1.38 mmol/L; p=0.484), and 24-hour mean blood glucose (7.49 ± 0.96 mmol/L vs. 7.02 ± 1.03 mmol/L). Changes in the C-peptide reactivity index, the secretory unit of islet in transplantation index, and insulin secretion-sensitivity index-2 indicated a greater β-cell function improvement with basal insulin plus OHAs versus CSII. Conclusions. Short-term insulin glargine plus OHAs may be an alternative to CSII for initial intensive therapy in people with newly diagnosed type 2 diabetes.

scholarly journals Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

2017 ◽  
Vol 6 (6) ◽  
pp. 2252
Author(s):  
Leena Das ◽  
Bijay Kumar Meher ◽  
Sagar Parida ◽  
Deepti Damayanty Pradhan ◽  
Lucy Das ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Perinatal Outcomes ◽  
Educational Background ◽  
Diabetic Mother ◽  
Hypoglycemic Agents ◽  
Care Hospital ◽  
Oral Hypoglycemic Agents ◽  
Significant Difference

Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups.Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia.Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018).Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.

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