scholarly journals Efficacy of complex pathogenic therapy of diabetic distal neuropathy in patients with type 2 diabetes mellitus

2016 ◽  
Vol 19 (4) ◽  
pp. 315-321
Author(s):  
Inessa I. Dubinina ◽  
Svetlana V. Berstneva ◽  
Vadim V. Baranov ◽  
Larisa V. Azimkova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Combined Therapy ◽  
Mcgill Pain Questionnaire ◽  
Alpha Lipoic Acid ◽  
M Wave ◽  
Pain Questionnaire ◽  
Type 2 Dm ◽  
Antihyperglycemic Therapy

Aim. To study the influence of combined therapy on carbohydrate and lipid metabolism and neurological status in patients with type 2 diabetes mellitus (DM) and diabetic neuropathy (DN).Materials and methods. Seventy-eight patients with type 2 DM and DN were examined. The first group included 58 patients who were prescribed alpha-lipoic acid drugs (Octolipen, Thioctacid, Thiogamma and Berlithion) at 600 mg/day dropwise as antihyperglycemic therapy and B group vitamins (combilipen and milgamma) at 2 mL/day with further oral intake of octolipen, thioctacid HR and berlithion at 600 mg/day and liposoluble formulations, such as combilipen tabs, milgamma compositum or benfogamma, for 12 weeks. The second group included 20 patients with type 2 DM and DN who received antihyperglycemic therapy. All of the patients were comparable in age, DM status, DN duration, body mass index and concomitant diseases. The third group (control) included 18 healthy individuals. The efficacy of therapy was determined by assessing HbA1c dynamics, glycaemic control, lipid spectrum and sensorimotor symptoms under the TSS and NIS-LL scales; measuring pain levels with the McGill Pain Questionnaire and visual analogue scale (VAS); and performing stimulation electroneuromyography of n. tibialis and n. peroneus to analyse M-wave characteristics, nerve conduction velocity (NCV) and residual latency (RL). All analyses were performed before the administration of combined therapy and at the completion of the 12-week treatment.Results. Comparative analysis of the combined therapy of patients with type 2 DM and DN demonstrated an improvement in positive neurological symptomatology according to the TSS scale and reduced negative symptoms according to the NIS-LL scales as well as reductions in neuropathy symptoms according to the McGill Pain Questionnaire and trends toward M-wave growth with reduced RL and increased NCV. Furthermore, individual-targeted glycaemic control (HbA1c 7.5%) was achieved of 78% with consistent reduction in the atherogenicity index. Correlation analysis determined an average direct link between the HbA1c level and negative neurologic manifestations on the NIS-LL scale (r = 0.42, p = 0.027) and an inverse link between the McGill Pain Questionnaire score and NCV (r = -0.36, p = 0.019).Conclusions. The complex diagnostics of neurological changes (TSS, NIS-LL, McGill and VAS scales) allows the assessment of the severity of distal DN after combined therapy with alpha-lipoic acid drugs (600 mg) and liposoluble forms of B group vitamins. These methods are also recommended for use in outpatient settings for the early detection and prevention of the diabetic foot development.

scholarly journals Current Management of Type 2 Diabetes Mellitus: What to Pay Attention to in Outpatient Settings

Doctor Ru ◽  
2021 ◽  
Vol 20 (2) ◽  
pp. 40-44
Author(s):  
N.A. Chernikova ◽  
◽  
O.A. Knyshenko ◽  
◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Combined Therapy ◽  
Individual Characteristics ◽  
Antihyperglycemic Agents ◽  
Number Of Patients ◽  
Antihyperglycemic Therapy ◽  
Selection Of

Objective of the Review: To discuss the problem of selecting antihyperglycemic drugs; to identify the trends in prescription of various groups of oral antihyperglycemic agents. Key Points. When type 2 diabetes mellitus (DM2) is diagnosed, a number of patients need prompt combined antihyperglycemic therapy because of a marked carbohydrate metabolism disorder. The prescription paradigm of initial therapy has shifted towards antihyperglycemic agents with established nephro- and cardioprotective effects (sodium-glucose linked transporter-2 inhibitors, glucagon-like peptide-1 receptor agonists). Drugs are recommended depending on presence or absence of a comorbid cardiovascular disease (CVD) and cardiovascular risk factors, and safety as regards hypoglycaemic events; therefore, very often selection of a therapeutic regimen can be challenging. Still, the first-line treatment for patients without CVD is metformin; however, a combined therapy is required in the majority of cases. Poor compliance, continued use of monotherapy, despite the need to boost the therapy, patient’s reluctance to take additional drugs can facilitate occurrence and progression of a lot of associated complications. In such cases, combined medications reducing the amount of tablets and improving compliance are useful. The most common combination of antihyperglycemic drugs is metformin and sulfonylureas. Still, care should be taken because of differences in pharmacokinetics and pharmacodynamics of the molecules in the latter group. High selectivity of some sulfonylureas can evidence their milder effect for glucose level reduction. Sulfonylureas are also cost-effective as compared to other antidiabetic medications. Conclusion. A wide choice of drugs allows a medical professional selecting an optimal antihyperglycemic regimen, taking into account individual characteristics of a patient. Prompt combined medications are a treatment of choice for the majority of patients with DM. Selection of antihyperglycemic drugs is affected by the cost as well. The most important thing is that the drugs are well-studied, efficient and safe. Keywords: type 2 diabetes mellitus, combined therapy, sulphonylurea, Glimepiride, metformin.

scholarly journals Evaluation of the prognostic significance of leptin, adiponectin and resistin in the development of diabetic retinopathy in type 2 diabetes mellitus patients

2021 ◽  
Vol 17 (3) ◽  
pp. 209-213
Author(s):  
M.L. Kyryliuk
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Prognostic Significance ◽  
Discriminant Functions ◽  
Serum Leptin ◽  
Type 2 Dm ◽  
Antihyperglycemic Therapy

Background. There is evidence of the participation of adipose tissue hormones leptin, adiponectin and resistin in the formation of metabolic disorders in the retina, retinal neovascularization, and diabetic microangiopathy. The development of methods for the mathematical evaluation of the prognosis of diabetic retinopathy (DR) formation with the participation of adipokines is a relevant problem in modern diabetology. Aim. Elaboration of a mathematical model for assessing the prognostic significance of serum leptin, adiponectin and resistin to study the likelihood of deve­loping and progressing DR in patients with type 2 diabetes mellitus (DM). Materials and methods. An open observational single-center one-stage selective study was conducted among patients with type 2 DM and DR. The blood serum concentration of leptin, adiponectin and resistin, HbA1с, lipid metabolism findings were determined, the results of an instrumental examination of the fundus were analyzed. The diagnostic predictive value of serum leptin, adiponectin and resistin was assessed using discriminant analysis. Statistical analyses were conducted using Statistica 9.0 (StatSoft, Tulsa, OK, USA) software. The differences were considered statistically signifi­cant at p < 0.05. A model with linear combinations of the serum leptin, adiponectin and resistin, triglyceride (TG), HbA1с, type of antihyperglycemic therapy (oral anti-hyperglycemic medication or insulin therapy) were developed, and, subsequently, formulas for classification-relevant discriminant functions were derived. Results. Fifty-nine patients (107 eyes) with type 2 DM and DR (men and women; mean age, 58.20 ± 0.18 years; mean diabetes duration, 9.19 ± 0.46 years; mean HbA1с 9.10 ± 0.17 %) were assigned to the basic group and underwent the study. They were divided into three DR groups based on the stage of DR. When performing the ran­king of patients for discriminant analysis, the stage 2 DR group was aggregated with the stage 3 DR group for convenience to form the stage 2 + 3 DR group based on the pathognomonic sign (portents of proliferation or actual proliferation). Anti-diabetic therapy (ADT) included metformin, either alone (type 1 ADT) or in combination with oral anti-hyperglycemic medication (metformin + OAHGM, type 2 ADT) or insulin therapy (metformin + IT, type 3 ADT). Inclusion criteria were informed consent, age above 18 years, pre­sence of T2DM and DR. Exclusion criteria were endocrine or body system disorders leading to obesity (Cushing’s syndrome, hypothyroidism, hypogonadism, polycystic ovarian syndrome, or other endocrine disorders, including hereditary disorders, and hypothalamic obesity), type 1 DM, acute infectious disorders, history of or current cancer, decompensation of comorbidities, mental disorders, treatment with neuroleptics or antidepressants, proteinuria, clinically significant maculopathy, glaucoma or cataract. The study followed the ethical standards stated in the Declaration of Helsinki and was approved by the Local Ethics Committee. The formulas for classification-relevant discriminant functions were derived based on the results of physical examination, imaging and laboratory tests, and subsequent assessment of clinical signs of DM (HbA1с), DR stage and serum leptin, adiponectin, resistin, TG concentrations and taking into account the type of antihyperglycemic therapy. The classification functions (CF) computed based on the variables found from the above developed models provided the basis for predicting the development of DR. The formulas for CF from model are as follows: CF1 = 0.29 • TG + 1.55 • HbA1С + 1.81 • ADT_Type + 0.04 • Leptin + 0,34 • Adiponectin + 0,91 • Resistin – 13,82. CF2= 0.05 • TG + 1.36 • HbA1С + 3.01 • ADT_Type + 0.08 • Leptin + 0,35 • Adiponectin + 1,01 • Resistin – 15.95. A step-by-step approach to a diagnostic decision should be used. First, blood samples are tested for serum leptin, adiponectin and resistin, TG, blood HbA1c, and the patient is assigned a code for ADT Type (metformin only, 1; metformin + OAHGM, 2; or metformin + IT, 3). Second, CF1 and CF2 values are calculated based on clinical and laboratory data. Finally, the two values are compared to determine which is greater. The predictive decision is made by selecting the classification function with the greater value. Thus, if CF1 > CF2, the process can be stabilized at this stage given adequate glycemic control (through compensation of carbohydrate metabolism) and body mass control as well as patient compliance. If CF1 < CF2, the pathological process may progress to the next stage or even within stage 3, and there is an urgent need to reduce BMI, and to correct the ADT and the blood lipid profile. Conclusions. The informative value and statistical significance of the model were 71.4 % and p = 0.040, respectively. Using the formulas, one can determine the probability of progression of DR.

scholarly journals Pharmacoepidemiological study of treatment managment in patients with type 2 diabetes mellitus in Omsk

2016 ◽  
Vol 62 (1) ◽  
pp. 25-34
Author(s):  
Elena Viktorovna Ananicheva ◽  
Sergey Viktorovich Skalskiy ◽  
Ludmila Vladimirovna Shukil ◽  
Miroslava Valer'evna Petunina ◽  
Svetlana Aleksandrovna Paruchikova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lipid Metabolism ◽  
Combined Therapy ◽  
Lipid Lowering ◽  
Antihyperglycemic Therapy ◽  
Efficiency And Effectiveness

Treatment management strategy for patients with type 2 diabetes mellitus (2DM) includes glycaemic control, blood pressure and lipid metabolism parameters. Pharmacoepidemiological monitoring allows evaluating the compliance of the treatment really provided for 2DM with the present guidelines.Aim.To study the actual implementation of pharmaceuticals control for patientswith type 2 diabetes, residents of the city of Omsk, in 2013—2014.Material and methods. It was a retrospective open cohort study based on the fragment data of the Regional Diabetes Register including 33 187 cases with prescription of oral antidiabetic drugs (OAD), 285 patient cases and OAD consumption and expenses data in 2014. The prescribed daily dose (PDD) was determined. It was assessed the efficiency and effectiveness of antihypertensive and lipid-lowering therapy.Results.In Omsk metformin prevails in OAD take-in that corresponds to the modern Clinical Guidelines. Prescribed daily doses of metformin (PDD) are significantly lower (by 34.71%) than the doses fixed by the WHO Centre. The second frequently prescribed drugs are sulfonylureas with gliclazide MB at the top. PDD of glimepiride and glibenclamide are considerably higher than DDD. DPP-4 medicines are quite often prescribed (up to 10.2% as a part of the combined therapy, including fixed combinations).Conclusion.The efficacy of antihyperglycemic therapy assessed upon achievement of HbA1c individual target in Omsk is 40.5%. Most patients with type 2 diabetes in the studied cohort have had the adequate antihypertensive therapy with reaching a target blood pressure in 75.8% of patients. Statin drugs are prescribed only in 39.3% of cases of dyslipidemia in type 2 diabetes, and only in 32.3% of them the targets of lipid metabolism parameters are achieved.

scholarly journals Efektivitas Kurma (Phoenix dactylifera) dalam menurunkan kadar HbA1c pada pasien diabetes mellitus tipe 2: Laporan Kasus Berbasis Bukti

2020 ◽  
Vol 3 (1) ◽  
pp. 31-45
Author(s):  
Muhammad Sobri Maulana ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Hba1c Level ◽  
Phoenix Dactylifera ◽  
Herbal Remedies ◽  
Cochrane Library ◽  
Time Treatment ◽  
Type 2 Dm

Type 2 Diabetes Mellitus or Type 2 DM is a metabolic disease that can cause severe complications so that adequate management which one of the targets is lowering HbA1c level is needed. Up to this time, treatment for Type 2 DM including antihiperglycemic and injection. Herbal remedies as well as dates (Phoenix datcylifera) has been limited even though it has well-known antihyperglycemic effect. To investigate the effectivity of Dates (Phoenix dactylifera) in lowering HbA1c level among Type 2 Diabetes Mellitus patients. Literature searching was conducted on four online databases which are PubMed, Scopus, EBSCO, and Cochrane Library based on inclusion and exclusion criterias. Based on the results of critical studies, seven studies have shown that there is effectiveness in the administration of Dates (Phoenix dactylifera) in patients with type 2 diabetes mellitus on Lowering HbA1c levels and restricition of date diet needed for type 2 diabetes mellitus patients in 3 dates per day that are statistically significant for lowering HbA1c level with value of NNT is 1. Administration of Dates (Phoenix dactylifera) can be used as an adjuvant therapy on Type 2 Diabetes mellitus patients

scholarly journals Correlation Between Lipid Profile with Type 2 Diabetes Mellitus Progression

2020 ◽  
Vol 8 (2) ◽  
pp. 66-72
Author(s):  
Angiesta Pinakesty ◽  
Restu Noor Azizah
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Lipid Profile ◽  
Cholesterol Levels ◽  
Type 2 Dm ◽  
Hba1c Levels

Introduction: Diabetes mellitus (DM) is a non-communicable disease that has increased from year to year. Type 2 diabetes mellitus is not caused by lack of insulin secretion, but is caused by the failure of the body's cells to respond to the hormone insulin (insulin resistance). Insulin resistance was found to be a major contributor to atherogenic dyslipidemia. Dyslipidemia in DM risks 2 to 4 times higher than non-DM. Although dyslipidemia has a great risk for people with type 2 diabetes mellitus, this conventional risk factor only explains a portion (25%) of excess cardiovascular risk in type 2 DM. Discussion: In uncontrolled type 2 DM patients, LDL oxidation occurs faster which results from an increase in chronic blood glucose levels. Glycemic control as a determinant of DM progressivity is determined through HbA1c examination. HbA1c levels are associated with blood triglyceride levels. Meanwhile, triglyceride levels are associated with total cholesterol and HDL cholesterol levels. HbA1c levels are also associated with LDL cholesterol levels. Conclusion: There is a relationship between lipid profile and the progression of type 2 diabetes mellitus.   Keywords: type 2 diabetes mellitus, dyslipidemia, HbA1c, glycemic control, lipid profile

scholarly journals COMPARATIVE STUDY OF SITAGLIPTINAND PIOGLITAZONE AS ADDONTHERAPY OVER PLASMA GLUCOSE LEVEL IN TYPE 2 DIABETES MELLITUS PATIENTS : AN OBSERVATIONAL COHORT STUDY

2020 ◽  
pp. 10-11
Author(s):  
Ravindra Kumar Das ◽  
Rahul Kumar Sinha ◽  
Debarshi Jana
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Plasma Glucose ◽  
Plasma Glucose Level ◽  
Observational Cohort Study ◽  
Type 2 Dm ◽  
Observational Cohort ◽  
Pioglitazone Group

Background: Type 2 diabetes mellitus (DM) is a progressive chronic disorder and sustained control of plasma glucose is essential to prevent complications. Pioglitazoneofthiazolidinedionesand sitagliptin of Dipeptidyl peptidase-4 inhibitors (DPP4I) have recently been used as add-on therapy to control type 2 DM. The aim of this study was to compare the plasma glucose and glycocelatedHb% level of both the group who had poor glycemic control with Metformin and sulfonylurea. MATERIAL AND METHODS: In this observational cohort study, 100 patients with uncontrolled type 2 DM on 2000 mg/day of Metformin and 4 mg/day of Glimepiride were enrolled. The patients were randomly allocated into two groups with fifty each. One group received two divided doses of pioglitazone (30 mg/day) and the other received two divided doses of sitagliptin (100 mg/day) as the third medication. Plasma glucose fasting and 2 hours after drug and meal along with HbA1c were assessed before and after three months of treatment. Results: Fasting plasma glucose level in the sitagliptin group was higher than the pioglitazone group; however, this difference was not statistically significant (130.30 ± 30.29 versus 124.58 ± 46.84, p=0.212). Significantdifferences were not observed in HbA1c (7.20±0.96 versus 7.43±0.99, p=0.563) and plasma glucose 2 hours after meal (194.56±66.22 versus 198.58±51.5, p=0.946) after treatment withsitagliptin and pioglitazone among the two groups. Mean weight in the sitagliptin group was lower compared to the pioglitazone group after treatment, however, this difference was not statistically significant (p=0.824). Conclusion: Both the molecule as third agent had similar efficacy in glycemic control. Sitagliptin is better choice to add-on therapy in obese overweight patients.

scholarly journals Renoprotective opportunities of Lespedeza capitata in patients with chronic kidney disease and type 2 diabetes mellitus

KIDNEYS ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 162-168
Author(s):  
S.V. Kushnirenko ◽  
D.D. Ivanov ◽  
S.A. Rotova ◽  
О.V. Kushnirenko
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Antihypertensive Therapy ◽  
Glucose Lowering ◽  
Type 2 Dm ◽  
Group I ◽  
Ckd Stage ◽  
Lespedeza Capitata ◽  
Group Ii

Background. Today, issues of renoprotection have gone beyond the use of antihypertensive therapy alone. Stable glucose-lowering and urate-lowering therapy are integral parts of modern renoprotection, which improve the functional state of the kidneys by increasing the glomerular filtration rate (GFR) and reducing the albumin excretion rate (AER) and the albumin-to-creatinine ratio (ACR). Nevertheless, hypoazotemic therapy aimed at reducing the content of nitrogenous wastes remains the leading component of the treatment of patients with chronic kidney disease (CKD). The aim of the study is the assessment of the renoprotective potential of the drug Libera (Lespedeza capitata) in patients with CKD stages 2–3 on the background of type 2 diabetes mellitus (DM). Materials and methods. The study included 107 patients with type 2 DM, aged 19 to 75 years (female — 41.1 %, male — 58.9 %), CKD stages 2–3, micro- and macroalbuminuria (category A2 and A3). The patients were divided into two groups: group I — traditional stable glucose-lowering and antihypertensive therapy (n = 50) and group II — traditional stable glucose-lowering and antihypertensive therapy in combination with Libera (Lespedeza capitata) (n = 57), which was prescribed 1 capsule t.i.d. regardless of food intake for 3 months. The criteria for the effectiveness of treatment were dynamics of GFR, AER/ACR in daily urine. The observation period for the patients was 3 months. Results. The renoprotective potential of Lespedeza capitata (Libera) was demonstrated after 3 months of treatment in the form of a significant increase in GFR in patients with CKD stage 2 in group II up to 79.0 ± 1.4 ml/min/1.73 m2 in comparison with the initial data (p < 0.01) and the results obtained in group I after 3 months of using only traditional stable glucose-lowering and antihypertensive therapy (p < 0.05). The use of Libera in the complex treatment of patients of the II group with CKD stage 3 against the background of type 2 DM for 3 months had a positive effect on nitrogen and water excretory kidney function, which manifested itself in an improvement in GFR to 56.6 ± 2.1 ml/min/1.73 m2 in comparison with the initial data (p < 0.05) and the results obtained in group I — 50.8 ± 1.9 ml/min/1.73 m2 (p < 0.05). In group I with traditional stable glucose-lowering and antihypertensive therapy, only 3 patients (9.1 %) transferred from category A2 to category A1 (normoalbuminuria) after 3 months and 2 patients (11.8 %) from category A3 to category A2. In group II, the appointment of Lespedeza capitata (Libera) in combination with stable glucose-lowering and antihypertensive therapy facilitated the transfer of 10 patients (27.8 %) from category A2 to A1 and 7 patients (33.3 %) from category A3 to A2 (p < 0.001). Conclusions. Lespedeza capitata (Libera) in combination with traditional stable glucose-lowering and antihypertensive therapy contributes to the preservation and improvement of the filtration function of the kidneys, a decrease in AER/ACR in patients with CKD stage 2–3 (3a і 3b) against the background of type 2 DM and proves renoprotective efficiency and safety.

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