The Effect of Type 2 Diabetes Mellitus and Treatment  Regimens on the Success of Drug Resistant Tuberculosis  Treatment in 2014-2018 in Riau Province

Pharmacoepidemiological research is the first stage of the clinical and economical evaluation of treatment with pharmaceutical agents. It plays an important role in providing reliable information about treatment regimens for patients with type 2 diabetes mellitus (T2DM). The results of the analysis of the utilisation of hypoglycaemic drugs are country specific and are associated with different epidemiological characteristics of the disease, cost of drugs and financing of the healthcare system. Analytical pharmacoeconomic studies allow the evaluation of the rational use of drugs, characteristics of treatment in clinical practice and their conformity to national and international clinical guidelines. Aim. To study the characteristics of treatment with insulin and oral hypoglycaemic drugs in Moscow-based patients with T2DM and to calculate the average cost of hypoglycaemic drugs per person per year. Materials and methods. A retrospective cohort pharmacoepidemiological study was performed by analysing information from the national register of diabetic patients from two administrative districts in Moscow. In total, 48,978 adult patients (older than 18 years) were registered with T2DM between 2000 and 2012. The study of treatment regimens was conducted using the standard international ATC/DDD methodology, and the correlation of fixed dose to appointed daily dose was calculated. The annual average cost of treatment for patients with T2DM, including different hypoglycaemic drugs (insulin and oral hypoglycaemic drugs) in the form of monotherapy and different combinations, was calculated. The average annual cost of hypoglycaemic therapy for patients with T2DM was calculated for the first time in the Russian Federation. Results. The majority of study patients received hypoglycaemic drugs (98.5%), and only 1.5% of the patients diagnosed with T2DM were on dietetic therapy. Of the patients receiving drugs, 90% received oral hypoglycaemic drugs, and 10% received insulin (basal-bolus regimen 4.6%, basal insulin with oral hypoglycaemic drugs 3.8% and ?MIX-insulin? 1.1%). The most frequently prescribed oral hypoglycaemic drugs were derivatives of sulphonyl urea and metformin (87% and 71%, respectively), and 12% of the patients received premixed combinations of these drugs. Other groups of oral hypoglycaemic drugs accounted for only a small proportion of oral hypoglycaemic drugs (approximately 2%) and included glinide (1.8% of the patients), thiazolidinedione (0.4%) and inhibitors of alpha-glucosidase (0.17%). In the group of derivatives of sulphonyl urea, the most frequently prescribed drugs were glibenclamide (46.4%), gliclazide (38.7%) and glimepiride (14%). The average annual treatment cost per patient was 7,467 rubles. Conclusion. The pharmacoeconomic analysis revealed that the treatment of T2DM was insufficiently effective in 48% of the patients (HbA1c>7%). Most patients received monotherapy with metformin or derivatives of sulphonyl urea, among which glibenclamide was the most frequently prescribed drug. The treatment of patients with T2DM in 2011 was characterized by a low frequency of insulin prescription, rare usage of other groups of oral hypoglycaemic drugs (only 2%) and a mismatch between fixed dose and appointed daily dose. The average annual cost of hypoglycaemic drugs per patient with T2DM in 2011 in Moscow was 7,467 rubles.

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Abstract 557: Blood-Pressure Lowering Effects of Canagliflozin Across a Range of Background Antihyperglycemic Treatment Regimens Used in Patients with Type 2 Diabetes Mellitus

Hypertension ◽

10.1161/hyp.64.suppl_1.557 ◽

2014 ◽

Vol 64 (suppl_1) ◽

Author(s):

Matthew R Weir ◽

Jacqueline Yee ◽

Ujjwala Vijapurkar ◽

Gary Meininger

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Heart Rate ◽

Type 2 Diabetes Mellitus ◽

Sglt2 Inhibitor ◽

Treatment Regimens ◽

Antihyperglycemic Agents ◽

Change In Mean

Hypothesis/Research overview: Hypertension is a common comorbidity in patients with Type 2 Diabetes Mellitus (T2DM) and is an important risk factor for cardiovascular disease. Therefore, lowering blood pressure in patients with T2DM without meaningfully increasing heart rate is of benefit in reducing the risk of cardiovascular complications. In this analysis, the effect of the SGLT2 inhibitor canagliflozin (CANA) on blood pressure and heart rate was studied in patients with T2DM across a broad range of antihyperglycemic treatment regimens. Methods: In four Phase 3 clinical trials and two substudies, CANA 100 mg and 300 mg was compared to placebo (PBO) as monotherapy, dual therapy (add-on to metformin [MET] or sulfonylurea [SU]), triple therapy (add-on to MET + SU or MET + pioglitazone [PIO]), and add-on to insulin (± other antihyperglycemic agents). Efficacy and safety endpoints reported here include change from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate. Last observation carried forward imputation method was employed. Results: Treatment with CANA 100 mg and 300 mg was associated with reductions in SBP and DBP, with no change in mean heart rate, across the range of treatment regimens evaluated. PBO-subtracted changes (least square mean change from baseline and 95% confidence intervals) are reported for each endpoint (Table). Conclusions: Cana reduces blood pressure without changing heart rate whether used alone, in combination with oral antihyperglycemic agents, and with insulin in patients with T2DM.

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Diabetes Mellitus Tipe 2 sebagai Faktor Predisposisi dan Komorbid Tuberkulosis Multi Drug Resisten Primer

YARSI Medical Journal ◽

10.33476/jky.v28i2.1422 ◽

2020 ◽

Vol 28 (2) ◽

pp. 041-050

Author(s):

Ulfahimayati Ulfahimayati ◽

Irvan Medison ◽

Dessy Mizarti

Keyword(s):

Diabetes Mellitus ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

High Burden ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Dm Type 2

Multi Drug Resistant Tuberculosis (MDR-TB) merupakan masalah kesehatan di Dunia saat ini. Indonesia termasuk 27 negara dengan high burden MDR TB di dunia, diperkirakan 6800 kasus baru per tahun, 2,8% merupakan kasus baru dan 16% pernah mendapatkan obat anti tuberculosis (OAT) sebelumnya. MDR TB primer terjadi pada pasien yang sebelumnya tidak pernah mendapat pengobatan OAT. Diabetes mellitus merupakan faktor predisposisi dan komorbid yang dapat mempercepat terjadinya penyakit TB dan mempersulit pengobatannya. Tujuan laporan kasus ini untuk melaporkan kasus MDR TB primer pada pasien dengan DM type 2. Kasus pasien laki-laki 58 tahuh dengan gejala batuk produktif dengan sputum kekuningan sejak 2 bulan, keringat malam dan penurunan berat badan. Hasil tes cepat molekuler menunjukkan MTB detected medium dan rifampicin resistant detected. Rontgen toraks infiltrate dan cavitas di apex paru. Pasien denga DM type-2 tidak terkontrol selama 12 tahun dengan HbA1c 10,5 %. Kami menyimpulkan bahwa DM merupakan salah satu konkommitant faktor predisposisi dan komorbid MDR TB primer. Pada pasien dengan DM perlu dilakukan skrining TB dan sebaliknya pasien TB juga perlu dilakukan skrining DM. Terapi MDR TB dengan DM sesuai dengan paduan standar nasional terapi MDR TB dan menjaga kadar gula darah tetap terkontrol.

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