Suchergebnisse

Diabetes is the most worldwide common chronic disease, according the International Diabetes Federation [1], more than 32 million citizens living in the European Union have diabetes, representing nearly 10% of the population, to which we should add equal number of people suffering from impaired glucose tolerance. Diabetes prevalence is growing at alarming rate worldwide, being of particular relevance the type 2 diabetes. Nowadays 285 million people worldwide live with diabetes and it is expected that this numbers will increase by 20% until 2030 due to obesity and the ageing of the population [1]. This growth leads to an increasing consumption of drugs such as oral antidiabetics. Metformin is one of the active principles most commonly used for this purpose being among the pharmaceuticals with the highest production numbers worldwide to treat type 2 diabetes because is cheap, has high level of tolerance and when used in the prescribed dosage is very secure with minimal side effects. However, in case of overdose of metformin upon a ingestion of more than 10 times the prescribed dosage, accidentally or on propose, lactic acidosis and low blood pressure can occur. Overdoses with metformin are relatively uncommon, but may have serious consequences, if medical attention is not given on time, it may lead to coma and ultimately death Because of its spread use another problem must be taken into consideration, which needs to be addressed, the occurrence of metformin residues in sewage and surface waters due to improper discharge of the non-used tablets to regular garbage [2]. This situation is becoming a serious problem of environmental pollution and public health. This paper reports the use of activated carbon produced from biomass for the removal of metformin in 2 different settings. On one hand, from aqueous solutions and, in another hand, from simulated biological fluids (gastric and intestinal) conjugated with in vivo testing.

The role of vanadium as a micronutrient and hypoglycaemic agent has yet to be fully clarified. The present study was undertaken to investigate changes in the metabolism of iron and in antioxidant defences of diabetic STZ rats following treatment with vanadium. Four groups were examined: control; diabetic; diabetic treated with 1 mgV/day; and Diabetic treated with 3 mgV/day. The vanadium was supplied in drinking water as bis(maltolato) oxovanadium (IV) (BMOV). The experiment had a duration of five weeks. Iron was measured in food, faeces, urine, serum, muscle, kidney, liver, spleen, and femur. Superoxide dismutase, catalase, NAD(P)H: quinone-oxidoreductase-1 (NQO1) activity, and protein carbonyl group levels in the liver were determined. In the diabetic rats, higher levels of Fe absorbed, Fe content in kidney, muscle, and femur, and NQO1 activity were recorded, together with decreased catalase activity, in comparison with the control rats. In the rats treated with 3 mgV/day, there was a significant decrease in fasting glycaemia, Fe content in the liver, spleen, and heart, catalase activity, and levels of protein carbonyl groups in comparison with the diabetic group. In conclusion BMOV was a dose-dependent hypoglycaemic agent. Treatment with 3 mgV/day provoked increased Fe deposits in the tissues, which promoted a protein oxidative damage in the liver. ; The authors are grateful for support received from the Consejería de Innovación, Ciencia y Empresa, Andalusian Regional Government (Project P06-CTS-01435).

Consejería de Innovacion, Ciencia y Empresa, Andalusian Regional Government (Project P06-CTS-01435).

Diabetes is a metabolic disease that affected 9.3% of adults worldwide in 2019. Its co- occurrence is suspected to increase mortality from COVID-19. The treatment of diabetes is mainly based on the long-term use of pharmacological agents, often expensive and causing unpleasant side effects. There is an alarming increase in the number of pharmaceuticals taken in Europe. The aim of this paper is to concisely collect information concerning the few antidiabetic or hypoglycaemic raw plant materials that are present in the consciousness of Europeans and relatively easily accessible to them on the market and sometimes even grown on European plantations. The following raw materials are discussed in this mini-review: Morus alba L., Cinnamomum zeylanicum J.Presl, Trigonella foenum-graecum L., Phaseolus vulgaris L., Zingiber officinale Rosc., and Panax ginseng C.A.Meyer in terms of scientifically tested antidiabetic activity and the presence of characteristic biologically active compounds and their specific properties, including antioxidant properties. The characteristics of these raw materials are based on in vitro as well as in vivo studies: on animals and in clinical studies. In addition, for each plant, the possibility to use certain morphological elements in the light of EFSA legislation is given.

Diabetes is a metabolic disease that affected 9.3% of adults worldwide in 2019. Its co-occurrence is suspected to increase mortality from COVID-19. The treatment of diabetes is mainly based on the long-term use of pharmacological agents, often expensive and causing unpleasant side effects. There is an alarming increase in the number of pharmaceuticals taken in Europe. The aim of this paper is to concisely collect information concerning the few antidiabetic or hypoglycaemic raw plant materials that are present in the consciousness of Europeans and relatively easily accessible to them on the market and sometimes even grown on European plantations. The following raw materials are discussed in this mini-review: Morus alba L., Cinnamomum zeylanicum J.Presl, Trigonella foenum-graecum L., Phaseolus vulgaris L., Zingiber officinale Rosc., and Panax ginseng C.A.Meyer in terms of scientifically tested antidiabetic activity and the presence of characteristic biologically active compounds and their specific properties, including antioxidant properties. The characteristics of these raw materials are based on in vitro as well as in vivo studies: on animals and in clinical studies. In addition, for each plant, the possibility to use certain morphological elements in the light of EFSA legislation is given.

Objective: To ascertain and meet current and anticipated needs for residential care and other services by older Indigenous people in the Australian Capital Territory (ACT) and region. Methods: With advice from a reference group, qualitative and quantitative data were gathered from 98 older (45 years and over) Indigenous people in the ACT and region during 1999/2000. Indigenous and non-indigenous researchers worked closely throughout all phases of the research. We helped participants with immediate problems identified during the interviews and worked directly with the Government funding body to implement the findings. Results: No one expressed a current need for residential services. In terms of future needs, 50% of respondents favoured an arrangement where an existing mainstream provider of aged care accommodated a cluster of Indigenous people in the same facility as non-Indigenous people. Thirty-two per cent preferred an Indigenous-run organisation. Our study also revealed a broad range of health problems and needs. Assessment using the Resident Classification Scale showed that 70% required a low level of care and 4% needed a high level of care. Conclusion: The research identified the needs and provided a health profile of older Indigenous people in the ACT and region. This then provided policymakers with evidence on which they acted to provide appropriate aged care services. Implications: Collaboration between Indigenous and non-Indigenous researchers can access high-quality information, and partnership between researchers and policymakers can improve Indigenous services.

Objective: To ascertain and meet current and anticipated needs for residential care and other services by older Indigenous people in the Australian Capital Territory (ACT) and region. Methods: With advice from a reference group, qualitative and quantitative data were gathered from 98 older (45 years and over) Indigenous people in the ACT and region during 1999/2000. Indigenous and non-indigenous researchers worked closely throughout all phases of the research. We helped participants with immediate problems identified during the interviews and worked directly with the Government funding body to implement the findings. Results: No one expressed a current need for residential services. In terms of future needs, 50% of respondents favoured an arrangement where an existing mainstream provider of aged care accommodated a cluster of Indigenous people in the same facility as non-Indigenous people. Thirty-two per cent preferred an Indigenous-run organisation. Our study also revealed a broad range of health problems and needs. Assessment using the Resident Classification Scale showed that 70% required a low level of care and 4% needed a high level of care. Conclusion: The research identified the needs and provided a health profile of older Indigenous people in the ACT and region. This then provided policymakers with evidence on which they acted to provide appropriate aged care services. Implications: Collaboration between Indigenous and non-Indigenous researchers can access high-quality information, and partnership between researchers and policymakers can improve Indigenous services.

Background: Heart failure (HF) is associated with type 2 diabetes mellitus (T2DM). Antihyperglycemic drugs have interaction with heart failure among diabetic patients. To date, the data on real world use of diabetic medication in Malaysian heart failure patients with T2DM has not been elucidated. Objective: This study aims to identify the prescribing pattern of antihyperglycemic regimens in HF patients with T2DM, and to investigate the association between glycemic control and other factors such as demographic and clinical characteristics with left ventricular ejection fraction (LVEF) in these patients. Methods: This retrospective observational study involved patients diagnosed to have HF and T2DM who were seen in the outpatient clinic in a government tertiary hospital in Malaysia. Patients receiving at least one oral antidiabetic agent and/or insulin for at least 3 months prior were included. The differences and association between study outcomes were examined and analyzed using Pearson's Chi-square test, One-Way ANOVA, Binary Logistic Regression and multiple Multinomial Logistic Regression models. Results: From July to December 2019, 194 patients were included in this study. The majority (52.1%) of the patients had HF with preserved ejection fraction (HFpEF), 20.6% had HF with mid-range EF (HFmrEF), and 27.3% had HF with reduced EF (HFrEF). Overall, metformin (59.8%) was the commonest antihyperglycemic agent prescribed, followed by insulins (54.0%), and sulphonylureas (44.9%). The most prescribed agents for HFpEF, HFmrEF, and HFrEF patients were metformin (65.3%), insulins (62.5%), and sulphonylureas (60.4%), respectively. The prescribing trend of sulphonylureas was found to be significantly associated with patients' LVEF status (p = 0.033). The odds for sulphonylurea prescription among the HFrEF patients were 2.42 times higher compared to the HFpEF patients [95% confidence interval [CI], 1.23–4.79]. There was no association found between glycemic control with patients' LVEF. Conclusion: Our findings reported ...

Aim: This paper aims to unobtrusively identify gender patterns in diabetics' adherence to their medication regimen. Subjects and methods: Non-adherence is a major problem in health care as it affects both the patient's individual health as well as public health. Seen worldwide, the problem of non-adherence is even more important due to the increasing numbers of the elderly population and of chronic diseases such as diabetes, asthma, HIV, etc. It is estimated that in Germany alone, non-adherence is responsible for costs of €10 billion per year. Finding useful health behaviour patterns could be especially important for the increasing number of patients with chronic diseases such as diabetes, where costs are high and consequences such as retino-, nephro- and neuropathy severe for 180 million diabetics worldwide. This paper analyses the records of two German pharmacies, P1 and P2, regarding gender patterns in adherence to oral antidiabetics as this analysis method has a high specificity. Out of 4,474 (P1) respectively 2,650 (P2) datasets, those were selected that showed the use of medication with oral drugs for diabetes based on ATC code level A10B. The selected medication datasets were fully analysed, also the respective adherence rate for drugs used for hypertension, ATC code level C. Results: Average adherence rates for oral antidiabetic agents varied, with 25.4% (P1 women) and 34.6% (P1 men), and 27.8% (P2 women) and 26.1% (P2 men). In contrast, average adherence rates with drugs for the cardiovascular system were high, with 73.4% (P1 women) and 74.2% (P1 men), and 57.0% (P2 women) and 70.2% (P2 men). Conclusion: Adherence rates for oral antidiabetic agents showed no gender patterns. This finding is supported by varying adherence rates for medication for hypertension. In both cases, the chi-square test showed no significant correlation between gender and adherence classification, and also Cramer's V only showed a small effect of gender on adherence behaviour.

Enicostemma hyssopifolium is a perineal herb widely used as an antidiabetic agent in folklore medicine. The present work was focused on the assessment of its anti-inflammatory and cytotoxic properties. Its methanolic extract was evaluated for anti-inflammatory activity using murine monocytic macrophage RAW 264.7 cells, and screened for its cytotoxic property in different cancer cell lines. The methanolic extract was able to potentially inhibit the bacterial lipopolysaccharides-induced inflammatory response in RAW 264.7 cells. Results of the cytotoxicity studies revealed that the methanolic extract effectively induced the cytotoxicity at considerably lower concentration in MCF-7, A-549, and COLO-205 cell lines, while the viability of HeLa, CasKi, and HT-29 cells were inhibited at comparatively higher concentrations. Results thus indicated that E. hyssopifolium possessed potent anti-inflammatory and cytotoxic properties. This necessitates further exploration of bioactive phytochemical compounds responsible for these properties for therapeutic applications.

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP – Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP – Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

Purpose. The financial impact of intensive medical interventions for weight loss has not been fully studied. Design. A randomized pragmatic clinical trial. Setting. Seven primary care clinics and one research center in Louisiana. Subjects. Severely obese individuals (body mass index 40–60 kg/m2) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses. Intervention. Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. Measures. Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs. Analysis. Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories. Results. Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197). Conclusion. An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.

Introduction: Diabetes mellitus (DM) is a common endocrinopathy and assumes significance for its ability to adversely affect the various internal organs. It can also derail the immune system of the affected. Abnormal insulin secretion and/or utilization, leads to hyperglycemia which has adverse effects on the heart, blood vessels, kidney, nervous system, eye and skin. To assess the effectiveness of structured vs unstructured lifestyle modification therapy in glycemic control (change in HbA1c value from baseline to the end of the intervention) in people with T2DM. Methods: This study is a randomized, controlled, parallel-group study with lifestyle modifications as intervention. Study was conducted for between Feb 2019 to Dec 2019 in the Department of General Medicine, Government Headquarters hospital, Tirupur. Results: A total of 70 participants, 30 to 60-year-old, diagnosed with T2DM for more than a year with HbA1c levels > 6.5 %, on a background of oral antidiabetic agents were enrolled after obtaining the informed consent. Mean age of Group A and Group B found 49.17±7.42 and 51.92±9.1. Male were predominant in the study. Mean weight, Mean FBS, Mean PPBS and Mean HbA1c are statistically significant between groups (p<0.05) at baseline. Group B with unstructured physical activity with walking, was beneficial (HbA1c reduction 0.30 %; p = 0.024), but no significant decline in HbA1c, whereas, in Group A with structured antigravity exercise, is associated with a significant HbA1c decline of 1.2 %. (p = 0.07865). Conclusion: Structured antigravity exercise training was more efficacious than unstructured physical activity in achieving controlled HbA1c levels. Although both structured and unstructured training provide benefits, only the former was associated with significant reductions in HbA1c levels. Hence, T2DM patients should be advised to follow structured antigravity exercise training & focused dietary intervention program.

Background: Common deterrents to insulin therapy for both physicians and patients are the complexity and burden of daily injections. In January 2006, the first inhaled human insulin (INH, Exubera(R) (insulinhuman [ rDNA origin]) InhalationPowder) was approved for use in adult patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) in the United States and European Union. Results from the INH clinical trial program have shown comparable efficacy of INH to subcutaneous (SC) insulin and superior efficacy versus oral antidiabetic agents; thus providing effective glycemic control in adult patients with T2DM without the requirement for preprandial injections. However, because subjects in those trials were randomized to either INH or an alternative, the studies could not estimate the effect of INH on patient acceptance of insulin therapy. Therefore, traditional study designs cannot provide answers to important and practical questions regarding real world effectiveness, which is influenced by psychological and other access barriers.Methods: To overcome these limitations, the Real World Trial was designed to estimate the effect of the availability of INH as a treatment option for glycemic control. A total of approximately 700 patients from Canada, France, Germany, Italy, Spain, United Kingdom, and the United States with T2DM poorly controlled by oral agent therapy will be randomized to two different treatment settings. Patients and clinicians in both groups ( A & B) may choose from all licensed therapies for diabetes including SC insulin delivered by pens; INH will be an additional treatment option only available in Group A. The Real World Trial ( Protocol A2171018) has been registered with ClincalTrials. gov, registration id NCT00134147.Results: The primary outcome for the trial will be the difference in mean glycosylated hemoglobin (HbA(1c)) at 6 months between groups. The design was based on a preceding feasibility study examining the theoretical effects of inhaled insulin availability on treatment choice in 779 patients. In that study, patients were three times more likely to choose insulin therapy when inhaled insulin was available.Conclusion: Innovations in study designs may provide an opportunity to reveal unbiased answers to important treatment questions that are more relevant to prescribers, funding agencies, and healthcare policymakers.