A comparative clinical study on the effect of virechana karma and panchtikta pancha prashritika basti karma in the management of prameha w.s.r. to type ii diabetes

is a chronic disorder of origin with the vitiation of various body elements like and Diabetes mellitus is similar to which is a subtype of Here the patient voids excessive quantity of urine having concordance with with sweet taste. Insulin and other oral hypoglycaemic drugs are associated with several side effects and they have limited role in preventing the complications like neuropathy, nephropathy, retinopathy etc. Hence an ideal therapy which corrects the basic pathology and prevents the progress of the disease and complications is the need of time. So The explained in Ayurveda seems to be an appropriate solution for the treatment of Prameha.Aacharya Charaka and Sushruta has advised for here accumulate in the lower part of the body owing to the incompetence of the The major factor involved in the of are the in general and in particular hence to remove the and to eliminate the from nearest root is best. is best to improve Agni and is the best treatment to correct Vata.The present clinical study was conducted to evaluate the efficacy of Virechana karma and Basti karma in 90 patients (equally distributed in three group) of diagnosed case of Madhumeha for periods of 3 month. Group comparison was done by ANNOVA test showed that the Virechana was found better to reduce FBS and PPP Basti was found better to reduce PPBS

Role and Efficacy of “Katankateriyadi Kwatha” in Patients of Madhumeha (Diabetes Mellitus Type 2): A Clinical Trial

Madhumeha (Diabetes Mellitus) is a by-product of urbanization, proclaimed thousands of years back by Acharya Charaka. India has a high prevalence of diabetes which is increasing in number at an alarming rate. The introduction of oral hypoglycaemic drugs in modern therapeutics materialize to be a breakthrough in the treatment of Diabetes Mellitus initially but subsequently, it was experienced that most of the hypoglycaemic drugs were inadequately effective and were associated with many major side effects. To get rid of this problem, here we aimed to find out an effective and safe remedy to control the disease. This study is an Open-label, standard control, randomized and comparative clinical study with the 3-month assessment of the response of the trial drug “Katankateriyadi Kwatha” on the diabetic patients through subjective and objective parameters. Keywords: Diabetes mellitus, Clinical study, Madhumeha, Katankateriyadi Kwatha.

Unusual case of recurrent hypoglycaemia in multiple bee sting envenomation

A bee sting can result in allergic and toxin-mediated local manifestations like pain, swelling, redness and itching to serious systemic effects like acute kidney injury (AKI), pancreatitis, Kounis syndrome and stroke. Melittin and phospholipase A2, which make up 62% of honeybee venom, have vasoactive, haemolytic properties causing severe AKI. Its role in lowering blood glucose in diabetics is an interesting research topic. We report an elderly herdsman, a known diabetic on irregular oral hypoglycaemic drugs, who presented with altered mental status due to hypoglycaemia. On further prodding, a recent multiple bee sting attack 5 days ago was found which was followed by altered coloured urine for 2 days for which no medical attention was sought. Additional analyses revealed reticulocytosis, azotemia and high serum creatine phosphokinase. The patient was treated with dextrose infusion, antihistamines, fluids and haemodialysis. Renal failure resolved completely and the patient was discharged in a stable condition.

Evaluation of Pattern of Use of Prescribed Oral Hypoglycaemic Drugs in Newly Diagnosed Diabetic Nephropathy Patients Visiting a Tertiary Care Hospital of Southern Bihar

BACKGROUND Diabetes is the most important risk factor for chronic kidney disease. Because of this, clearance of many oral hypoglycaemic drugs from our body is hampered and time of exposure to these drugs increases. Therefore, patients of diabetes need to be assessed frequently for the development of diabetic nephropathy and the dosage of oral hypoglycaemic drugs should also be modified accordingly. So, the purpose of this study was to evaluate the doses of prescribed OHAs in newly diagnosed diabetic nephropathy patients. METHODS A hospital based observational study was conducted at Narayan Medical College and Hospital, Sasaram, Bihar, India. A total of 600 diagnosed patients of diabetic nephropathy of age more than 18 years visiting for the 1 st time in OPD of general medicine / nephrology department were included in the study after obtaining an informed consent. The results were expressed as a percentage of the assessed population. RESULTS Only about 38% of the total study population was taking doses of Oral Hypoglycaemic Agents (OHAs) according to their GFR status. 62% were taking wrong doses of OHAs with their respective renal function. CONCLUSIONS Treatment of diabetes in a CKD patient is more difficult than in non-CKD patient. GFR status should be monitored on regular basis in patients of diabetes with CKD. A significant number of these patients are still treated with wrong dosage of OHAs for their respective renal function. KEYWORDS Wrong Dose of OHA, Diabetic Nephropathy, Oral Hypoglycaemic Drugs

Intensive initiation of insulin therapy in patients with newly diagnosed type 2 diabetes mellitus: a different take on current stepwise approaches

Type 2 diabetes mellitus (T2DM), previously regarded as being a disease borne exclusively from following a poor lifestyle, affects at least 415 million individuals worldwide, a number which is believed will increase to 640 million by 2040. As our understanding of T2DM improved over time, it became clear that the condition is underpinned by interactions between poor lifestyle choices and highly varying genetic constructs that involve more than 400 genes. Although a comprehensive review of the genetic architecture of T2DM falls beyond the scope of the current paper, it suffices to say that failure to regard the pathophysiology of T2DM and its subsequent treatment from a drastically different perspective, will result in an increasing burden of the condition on society. This is especially realistic, since despite the fact that oral hypoglycaemic drugs have been used since 1955, current approaches fail to arrest the continuous global rise in the number of T2DM cases.

Presentation of pulmonary tuberculosis in diabetics and response to anti-tuberculosis therapy

Background: Diabetes and Tuberculosis are known to be mutually affective. In high tuberculosis and Diabetes burden country like ours, it is essential that we understand all the aspects concerning both these diseases individually and in mutual coexistence, in order to improve the management of this unhealthy partnership.Methods: This is a prospective hospital based observational study, in which 100 patients with coexisting Diabetes and new sputum confirmed pulmonary tuberculosis with no other comorbidities were included. Detailed history, examination and appropriate investigations were done evaluating the clinical and radiological presentation and treatment response in terms of sputum conversion at follow up visits.Results: Predominant symptoms were anorexia, fever and cough with sputum, majority with duration of more than 4 weeks. About half of them had diabetes duration of less than 1 year, most being newly diagnosed. All cases had upper lobe involvement; two thirds of them had lower lung field and multiple lobe involvement. Confluent consolidation, cavitary lesions and fluffy infiltrates were common. 27 of the 100 cases had a delayed sputum conversion. Longer duration of diabetes, maintenance on oral hypoglycaemic drugs alone and uncontrolled diabetes had delayed sputum conversion.Conclusions: Presenting symptoms of tuberculosis in diabetics is more or less similar to that in non-diabetics. Atypical radiological presentation with lower lung field involvement and confluent consolidation mimicking pneumonia is common. Delay in sputum conversion is common in dual disease and is increased with increasing DM duration and poor glycemic control. Better results may be obtained with insulin therapy.

Metformin: A Drug of Choice for Gestational Diabetes Mellitus in Near Future- Hope or Despair?

Pregnancy is a potentially glucose intolerant condition. Insulin sensitivity decreases as the pregnancy advances. At the later stage of pregnancy, some women develop Gestational Diabetes Mellitus (GDM) particularly obese with pre-existing insulin resistance. Insulin is recognized as the “gold standard” for the treatment of GDM. However, difficulty in administration with multiple daily injections, potential for hypoglycemia, and increase in appetite and weight, make this therapeutic option troublesome for many pregnant patients. Oral hypoglycaemic drugs have been viewed with suspicion for many years in the management of women with diabetes during pregnancy or breastfeeding. However, recent data from well designed trials and meta-analysis may contribute a visible change in practice in terms of oral agents, especially metformin in gestational diabetes. Some cohort data are available and randomized trials are currently in progress to compare metformin with insulin. Evidence is emerging that metformin may improve insulin sensitivity during pregnancy. This may be beneficial in GDM. Use of metformin in pregnancy has opened a new horizon for GDM management. The aim of this article is to review the safety, efficacy and future of metformin in diabetic pregnancy, thus contributing meaningfully in safe motherhood.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 70-77

Pharmacoepidemiological and pharmacoeconomic analyses of the utilization of hypoglycaemic drugs in patients with type 2 diabetes mellitus in Moscow

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.