This document summarizes a study comparing the effects of two corticosteroids - triamcinolone acetonide and prednisolone - on blood glucose levels in diabetic patients being treated for various skin diseases. The study divided patients into groups receiving either triamcinolone acetonide or prednisolone and measured their blood glucose levels before treatment and over subsequent weeks. It found that while blood glucose levels increased in both groups after treatment, the increase was smaller in the triamcinolone acetonide group and their levels remained better controlled. The study concluded that triamcinolone acetonide has less impact on blood glucose than prednisolone and is therefore a better choice for treating skin
ued2011 metformin the gold standard-d.adelueda2015
This document discusses insulin sensitizers, focusing on metformin and thiazolidinediones (TZDs). It summarizes the mechanisms of action and clinical benefits of metformin, including its cardiovascular benefits shown in UKPDS. It also discusses the mechanisms of TZDs in increasing insulin sensitivity and their role in beta cell preservation and diabetes prevention. However, it notes problems with TZDs including increased risks of heart failure, myocardial infarction and fractures that have been observed in clinical trials.
The relationship between gastrin hormone level and microalbumin urea in patie...Alexander Decker
This study examined the relationship between gastrin hormone levels and microalbumin urea in 67 patients with type 2 diabetes mellitus and 25 controls. The patients were divided into three groups based on diabetes duration: less than 10 years, 10-20 years, and over 20 years. Both gastrin hormone levels and microalbumin urea levels were measured. There were significant differences found between gastrin levels and microalbumin urea levels for each diabetes duration group compared to controls. Specifically, gastrin levels were higher in patients with microalbuminuria compared to those without, and this difference increased with longer diabetes duration.
This document summarizes a study examining the effect of continuing or discontinuing metformin treatment for patients with diabetes and cirrhosis. The study found that of 250 diabetic patients on metformin at cirrhosis diagnosis, 172 (68.8%) continued metformin while 78 (31.2%) discontinued. Patients who continued metformin had a 57% reduced risk of death compared to those who discontinued. The study concludes that metformin should be continued for diabetic patients with cirrhosis without contraindications due to a survival benefit, especially for those with NASH-related cirrhosis. However, the study had limitations such as sample size and inability to assess dose/duration effects of metformin. Further research is needed to validate these results in a larger cohort
ABSTRACT
Over the last decade, diabetes mellitus has emerged as an important clinical and public health
problem throughout the world. The aim of the study is perceive the Potentiality of a newer oral
Antihyperglycemic combination therapy over conventional therapy in type 2 diabetes. The
prospective study was conducted over a period of six months in the department of Medicine,
Guntur City Hospital. The prevalence of type2 diabetes was high in male 65.79 % than female
34.21%. Majority of the patients (23.68 %) belonged to age group of 51–55 years. Majority of
patients (55.26%) having a family history of Diabetes. Majority of patients receiving Combination
of Glibenclamide + Metformin (60.53%), evaluated for effect on FPG for both combinations. The
mean changes in FPG were noted. In the same way effect on HbA1c also noted. Mean changes in
for every month HbA1c will be noted. Our study reveals that Combination therapy with Metformin
plus Glimepiride is more effective than Glibenclamide plus Metformin; in improving glycemic
control in type 2 diabetes, while also allowing a reduction of the dosage of each drug.
Role of metformin in dm2 & glibenclamide combinationDr. Adel El Naggar
This document discusses metformin and add-on therapies for type 2 diabetes management. It begins with an overview of diabetes and metformin's roles and benefits, including reducing cardiovascular events and mortality. It then discusses various add-on therapy options to metformin, including their effects on HbA1c levels and advantages/disadvantages like risk of hypoglycemia, weight gain, and safety issues. Guidelines for treating diabetes and selecting add-on therapies based on patient factors are also summarized.
This study compared the effects of two treatment regimens for type 2 diabetes: dual therapy of metformin and glimepiride (Group A) versus triple therapy of metformin, glimepiride, and voglibose (Group B). Both regimens led to significant decreases in BMI, fasting blood glucose, post-prandial blood glucose, and HbA1c after 3 months of treatment. However, the triple therapy was more effective at lowering post-prandial glucose and had protective effects on kidney function. The results suggest that adding voglibose to metformin and glimepiride dual therapy provides better glucose control and management of diabetes.
Interested in learning more about Metformin, here's all you need to know!
Brought to you by the MedSimple Team.
MedSimple is a unified medication management platform designed to help patients two or more meds through the following features:
• 1. A Med List to document prescribed and over-the-counter medications, dosage, frequency and strength
• 2. A customizable list of prescribers and pharmacies
• 3. Cost savings via coupons (Premium feature)
• 4. Generic Alternatives: Links to information about generic alternatives, fixed price (such as $4) lists
• 5. Long-term cost savings via Patient Assistance Programs and forms for requesting assistance (Premium feature)
• 6. Dosage reminders (such as alarms and notifications)
• 7. Refill reminders for picking up prescriptions prior to refill dates (Premium feature)
• 8. Drug information and complete look-up on drug side affects, interactions, warnings and more
• 9. Ready-to-use digital MedSimple Drug Discount Card
• 10. Access to and synchronized data with browser-based partner site, MedSimpleApp.com
ued2011 metformin the gold standard-d.adelueda2015
This document discusses insulin sensitizers, focusing on metformin and thiazolidinediones (TZDs). It summarizes the mechanisms of action and clinical benefits of metformin, including its cardiovascular benefits shown in UKPDS. It also discusses the mechanisms of TZDs in increasing insulin sensitivity and their role in beta cell preservation and diabetes prevention. However, it notes problems with TZDs including increased risks of heart failure, myocardial infarction and fractures that have been observed in clinical trials.
The relationship between gastrin hormone level and microalbumin urea in patie...Alexander Decker
This study examined the relationship between gastrin hormone levels and microalbumin urea in 67 patients with type 2 diabetes mellitus and 25 controls. The patients were divided into three groups based on diabetes duration: less than 10 years, 10-20 years, and over 20 years. Both gastrin hormone levels and microalbumin urea levels were measured. There were significant differences found between gastrin levels and microalbumin urea levels for each diabetes duration group compared to controls. Specifically, gastrin levels were higher in patients with microalbuminuria compared to those without, and this difference increased with longer diabetes duration.
This document summarizes a study examining the effect of continuing or discontinuing metformin treatment for patients with diabetes and cirrhosis. The study found that of 250 diabetic patients on metformin at cirrhosis diagnosis, 172 (68.8%) continued metformin while 78 (31.2%) discontinued. Patients who continued metformin had a 57% reduced risk of death compared to those who discontinued. The study concludes that metformin should be continued for diabetic patients with cirrhosis without contraindications due to a survival benefit, especially for those with NASH-related cirrhosis. However, the study had limitations such as sample size and inability to assess dose/duration effects of metformin. Further research is needed to validate these results in a larger cohort
ABSTRACT
Over the last decade, diabetes mellitus has emerged as an important clinical and public health
problem throughout the world. The aim of the study is perceive the Potentiality of a newer oral
Antihyperglycemic combination therapy over conventional therapy in type 2 diabetes. The
prospective study was conducted over a period of six months in the department of Medicine,
Guntur City Hospital. The prevalence of type2 diabetes was high in male 65.79 % than female
34.21%. Majority of the patients (23.68 %) belonged to age group of 51–55 years. Majority of
patients (55.26%) having a family history of Diabetes. Majority of patients receiving Combination
of Glibenclamide + Metformin (60.53%), evaluated for effect on FPG for both combinations. The
mean changes in FPG were noted. In the same way effect on HbA1c also noted. Mean changes in
for every month HbA1c will be noted. Our study reveals that Combination therapy with Metformin
plus Glimepiride is more effective than Glibenclamide plus Metformin; in improving glycemic
control in type 2 diabetes, while also allowing a reduction of the dosage of each drug.
Role of metformin in dm2 & glibenclamide combinationDr. Adel El Naggar
This document discusses metformin and add-on therapies for type 2 diabetes management. It begins with an overview of diabetes and metformin's roles and benefits, including reducing cardiovascular events and mortality. It then discusses various add-on therapy options to metformin, including their effects on HbA1c levels and advantages/disadvantages like risk of hypoglycemia, weight gain, and safety issues. Guidelines for treating diabetes and selecting add-on therapies based on patient factors are also summarized.
This study compared the effects of two treatment regimens for type 2 diabetes: dual therapy of metformin and glimepiride (Group A) versus triple therapy of metformin, glimepiride, and voglibose (Group B). Both regimens led to significant decreases in BMI, fasting blood glucose, post-prandial blood glucose, and HbA1c after 3 months of treatment. However, the triple therapy was more effective at lowering post-prandial glucose and had protective effects on kidney function. The results suggest that adding voglibose to metformin and glimepiride dual therapy provides better glucose control and management of diabetes.
Interested in learning more about Metformin, here's all you need to know!
Brought to you by the MedSimple Team.
MedSimple is a unified medication management platform designed to help patients two or more meds through the following features:
• 1. A Med List to document prescribed and over-the-counter medications, dosage, frequency and strength
• 2. A customizable list of prescribers and pharmacies
• 3. Cost savings via coupons (Premium feature)
• 4. Generic Alternatives: Links to information about generic alternatives, fixed price (such as $4) lists
• 5. Long-term cost savings via Patient Assistance Programs and forms for requesting assistance (Premium feature)
• 6. Dosage reminders (such as alarms and notifications)
• 7. Refill reminders for picking up prescriptions prior to refill dates (Premium feature)
• 8. Drug information and complete look-up on drug side affects, interactions, warnings and more
• 9. Ready-to-use digital MedSimple Drug Discount Card
• 10. Access to and synchronized data with browser-based partner site, MedSimpleApp.com
Metformin has cardiovascular benefits beyond glycemic control alone. Studies have shown metformin is associated with reduced mortality in patients with diabetes and cardiovascular disease. The REACH study found metformin use was associated with a 24% reduction in all-cause mortality over 2 years in patients with diabetes and atherosclerosis. Metformin also improved outcomes in patients with diabetes and heart failure, showing a survival benefit over 2 years. The Cochrane review found intensive metformin therapy reduced risks of clinical endpoints related to diabetes as well as death from diabetes, all-cause mortality, and myocardial infarction.
This document summarizes a study evaluating the efficacy of combination therapy for treating melasma in Iraqi patients. 113 female patients with melasma aged 25-40 were divided into three groups based on the primary cause of their melasma and treated with different combinations of retinoic acid, steroids, and hydroquinone. The results showed a marked and significant decrease in melasma severity for all groups as measured by MASI scores. No side effects were reported. The conclusion is that combination therapy using retinoic acid, steroids and hydroquinone is an effective treatment for reducing melasma if applied properly.
Study of Ischemia Modified Albumin in Type 2 Diabetes as a Marker of Severityiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ueda2015 metformin xr, a rational destination in type2 dr.mesbah kamel.pptxueda2015
This document discusses the benefits of metformin XR (extended release) for the treatment of type 2 diabetes. It provides historical context on metformin, outlines its mechanisms of action, and reviews clinical guidelines that recommend metformin as first-line therapy. The document argues metformin XR has advantages over immediate release formulations, including once-daily dosing, reduced GI side effects, and potential for improved adherence. It presents evidence that metformin improves glycemic control and reduces cardiovascular risk when used with insulin and may provide anti-cancer benefits as well. The conclusion is that metformin XR is an optimal treatment for type 2 diabetes.
This document discusses the benefits of continuing metformin XR when insulin is added for treatment of type 2 diabetes. It notes that metformin is recommended as first-line therapy in treatment guidelines and can provide cardiovascular benefits when used long-term. When used in combination with insulin, metformin can help control blood glucose levels better while limiting weight gain and insulin requirements compared to insulin alone. The document recommends metformin XR over other formulations due to its once daily dosing and reduced gastrointestinal side effects.
This study examined the effects of supplementing type 2 diabetic patients with drumstick (Moringa oleifera) leaf tablets over 3 months. The experimental group that received the leaf tablets showed a significant reduction in post-prandial blood glucose levels and glycated hemoglobin levels compared to the control group. Post-prandial blood glucose in the experimental group decreased from 210 mg/dl initially to 150 mg/dl after 3 months of supplementation. Glycated hemoglobin levels decreased from 7.81% to 7.40% in the experimental group. The results indicate that drumstick leaf supplementation can help reduce blood glucose levels and diabetic complications in patients with type 2 diabetes.
This document discusses atopic dermatitis (eczema), including its pathophysiology, epidemiology, treatment recommendations, and evidence. Key points:
1. Atopic dermatitis is a chronic, relapsing inflammatory skin disease caused by genetic and immune mechanisms resulting in dry, itchy skin.
2. Treatment recommendations include topical corticosteroids and calcineurin inhibitors based on severity, with more potent topical/oral steroids, phototherapy, immunosuppressants for refractory cases.
3. Evidence suggests ultra-potent topical steroids should not be used continuously for more than 3 weeks to avoid side effects like skin atrophy.
This document summarizes the evidence from clinical trials on the efficacy of insulin therapy in patients with type 2 diabetes. It discusses two major randomized controlled trials, UGDP and UKPDS 33, that evaluated insulin therapy versus other treatments. The summary finds that insulin therapy did not significantly reduce mortality, microvascular complications, or macrovascular complications based on the results of these two trials. It concludes that the current evidence for recommending insulin therapy to prevent patient-oriented outcomes in type 2 diabetes is weak given uncertainties about its long-term safety and known adverse effects like hypoglycemia and weight gain.
This document discusses the history and uses of the diabetes medication metformin. It traces metformin back to galega officinalis which was used in the Middle Ages to reduce diabetes symptoms. Metformin was first identified and studied in the 1950s and approved for use in the US in 1994. The document highlights that metformin is now recommended as a first-line treatment for type 2 diabetes and has been shown to reduce cardiovascular events and mortality in diabetes patients. Metformin is also effective in preventing or delaying the onset of diabetes in patients with prediabetes.
ueda2012 comparison of glibenclamide and mtaformin_d.ma_mostafa abdel khalek.ueda2015
This study compared the use of glibenclamide/metformin combination versus insulin for managing diabetes during pregnancy. 43 pregnant women with gestational or type 2 diabetes were randomly assigned to receive either the oral hypoglycemic combination or insulin therapy. Both groups achieved similar levels of glycemic control and resulted in equivalent maternal and neonatal outcomes, including birth weight, rates of cesarean section, and neonatal complications. The study concluded that treatment of diabetes in pregnancy with either the oral hypoglycemic combination or insulin alone was found to be equally effective and safe for mothers and newborns. However, larger studies were recommended to confirm these findings.
The document discusses various aspects of metformin, including:
- Metformin's mechanisms of action involve both direct and indirect activation of AMPK, leading to effects like decreased glucose, lipid, and protein synthesis.
- Studies have shown metformin may be associated with better cardiac outcomes compared to other glucose-lowering drugs and should not be withheld in patients with stable heart disease or heart failure.
- Infants exposed to metformin in utero had increased subscapular skinfolds but similar body fat compared to unexposed infants, potentially signaling healthier fat distribution.
- Metformin may lower B12 levels but does not necessarily cause deficiency if metabolic markers remain normal, as cellular B12 uptake may increase with metformin therapy
Abstract—Abnormalities that characterizes lipoprotein metabolism in non-insulin dependent diabetes mellitus (NIDDM) patients, fasting concentration of triglyceride rich lipoprotein especially very low density lipoprotein (VLDL) are higher and those of HDL, commonly measured as HDL-c, are lower than among people without diabetes, which leads to increased triglyceride HDL-c ratio and insulin resistance. This type of diabetic dyslipidemia is a major cause of oxidative stress which promote and accelerate atherosclerosis and thus, end organ damage AMI. This present study was carried at the Central Clinical Laboratory MIMSR Medical College Latur, with the aim to find out the role of lipoprotein-triglyceride in myocardial infarction in NIDDM. For this study, patient with myocardial infarction with NIDDM were selected after admitting in MIMSR Medical College Latur. These 25 cases were included in study group and age-matched to these cases 50 healthy subjects were selected as Control group. The lipid profile and total serum lipid peroxides (malondialdehyde) of study and control groups were assessed & compared. It was found that in the control group mean values of total cholesterol was 180.21 ± 18.13 mg % whereas it was 229.21± 23.58 in study group, which was significantly higher in study group. Likewise, mean Serum Triglycerides and Serum Lipid Peroxides (MDA) of study group were also found significantly (p<0.001) higher that of control group (228.14 v/s 99.9 and 410.22 v/s 180.96 respectively). It was also revealed in this study that mean Serum HDL-Cholesterol was found significantly lower in study group whereas LDL-Cholesterol (28.72 v/s 53.83) and VLDL-Cholesterol were found significantly higher in study group that control group (150.61 v/s 106.60 and 46.30 v/s 19.8). So it can be concluded that AMI patients with NIDDM have higher Total Serum Cholesterol, Serum Triglycerides, Serum Lipid Peroxides (MDA), LDL- Cholesterol and VLDL- Cholesterol with lower HDL- Cholesterol.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Study of Serum Omentin-1 in Relation to Insulin Resistance in Type II Diabete...iosrjce
This study examined the relationship between serum Omentin-1 levels and insulin resistance in type 2 diabetes mellitus patients. It found that type 2 diabetes patients had significantly lower serum Omentin-1 levels compared to healthy controls. Serum Omentin-1 levels were negatively correlated with fasting blood sugar, fasting insulin levels, and insulin resistance (as measured by HOMA-IR) in diabetes patients. This suggests that higher insulin resistance is associated with lower serum Omentin-1 levels. The study concludes that Omentin-1 may play a role in insulin resistance and have potential as a future therapeutic target for diabetes.
This pilot study assessed the effects of camel milk consumption on blood sugar, lipid profile, and blood pressure in patients with type 2 diabetes (T2DM). Twenty participants with T2DM were randomly assigned to drink either 500 mL of pasteurized camel milk or cow milk daily for two months. While insulin levels significantly increased in the camel milk group, fasting blood sugar, lipid profiles, and blood pressure did not see statistically significant changes between the two groups after the trial. The study suggests that camel milk may help control insulin levels in T2DM patients, but larger and longer studies are still needed to make definitive conclusions.
The document describes the benefits of joining the Association of Information Technology Professionals (AITP) student organization at Kent State University, which allows students to network with IT professionals, learn leadership skills through organizing activities, and have fun while giving back to the community through food drives and other events. Members can also attend regional and national conferences on technology and certification testing.
Metformin has cardiovascular benefits beyond glycemic control alone. Studies have shown metformin is associated with reduced mortality in patients with diabetes and cardiovascular disease. The REACH study found metformin use was associated with a 24% reduction in all-cause mortality over 2 years in patients with diabetes and atherosclerosis. Metformin also improved outcomes in patients with diabetes and heart failure, showing a survival benefit over 2 years. The Cochrane review found intensive metformin therapy reduced risks of clinical endpoints related to diabetes as well as death from diabetes, all-cause mortality, and myocardial infarction.
This document summarizes a study evaluating the efficacy of combination therapy for treating melasma in Iraqi patients. 113 female patients with melasma aged 25-40 were divided into three groups based on the primary cause of their melasma and treated with different combinations of retinoic acid, steroids, and hydroquinone. The results showed a marked and significant decrease in melasma severity for all groups as measured by MASI scores. No side effects were reported. The conclusion is that combination therapy using retinoic acid, steroids and hydroquinone is an effective treatment for reducing melasma if applied properly.
Study of Ischemia Modified Albumin in Type 2 Diabetes as a Marker of Severityiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ueda2015 metformin xr, a rational destination in type2 dr.mesbah kamel.pptxueda2015
This document discusses the benefits of metformin XR (extended release) for the treatment of type 2 diabetes. It provides historical context on metformin, outlines its mechanisms of action, and reviews clinical guidelines that recommend metformin as first-line therapy. The document argues metformin XR has advantages over immediate release formulations, including once-daily dosing, reduced GI side effects, and potential for improved adherence. It presents evidence that metformin improves glycemic control and reduces cardiovascular risk when used with insulin and may provide anti-cancer benefits as well. The conclusion is that metformin XR is an optimal treatment for type 2 diabetes.
This document discusses the benefits of continuing metformin XR when insulin is added for treatment of type 2 diabetes. It notes that metformin is recommended as first-line therapy in treatment guidelines and can provide cardiovascular benefits when used long-term. When used in combination with insulin, metformin can help control blood glucose levels better while limiting weight gain and insulin requirements compared to insulin alone. The document recommends metformin XR over other formulations due to its once daily dosing and reduced gastrointestinal side effects.
This study examined the effects of supplementing type 2 diabetic patients with drumstick (Moringa oleifera) leaf tablets over 3 months. The experimental group that received the leaf tablets showed a significant reduction in post-prandial blood glucose levels and glycated hemoglobin levels compared to the control group. Post-prandial blood glucose in the experimental group decreased from 210 mg/dl initially to 150 mg/dl after 3 months of supplementation. Glycated hemoglobin levels decreased from 7.81% to 7.40% in the experimental group. The results indicate that drumstick leaf supplementation can help reduce blood glucose levels and diabetic complications in patients with type 2 diabetes.
This document discusses atopic dermatitis (eczema), including its pathophysiology, epidemiology, treatment recommendations, and evidence. Key points:
1. Atopic dermatitis is a chronic, relapsing inflammatory skin disease caused by genetic and immune mechanisms resulting in dry, itchy skin.
2. Treatment recommendations include topical corticosteroids and calcineurin inhibitors based on severity, with more potent topical/oral steroids, phototherapy, immunosuppressants for refractory cases.
3. Evidence suggests ultra-potent topical steroids should not be used continuously for more than 3 weeks to avoid side effects like skin atrophy.
This document summarizes the evidence from clinical trials on the efficacy of insulin therapy in patients with type 2 diabetes. It discusses two major randomized controlled trials, UGDP and UKPDS 33, that evaluated insulin therapy versus other treatments. The summary finds that insulin therapy did not significantly reduce mortality, microvascular complications, or macrovascular complications based on the results of these two trials. It concludes that the current evidence for recommending insulin therapy to prevent patient-oriented outcomes in type 2 diabetes is weak given uncertainties about its long-term safety and known adverse effects like hypoglycemia and weight gain.
This document discusses the history and uses of the diabetes medication metformin. It traces metformin back to galega officinalis which was used in the Middle Ages to reduce diabetes symptoms. Metformin was first identified and studied in the 1950s and approved for use in the US in 1994. The document highlights that metformin is now recommended as a first-line treatment for type 2 diabetes and has been shown to reduce cardiovascular events and mortality in diabetes patients. Metformin is also effective in preventing or delaying the onset of diabetes in patients with prediabetes.
ueda2012 comparison of glibenclamide and mtaformin_d.ma_mostafa abdel khalek.ueda2015
This study compared the use of glibenclamide/metformin combination versus insulin for managing diabetes during pregnancy. 43 pregnant women with gestational or type 2 diabetes were randomly assigned to receive either the oral hypoglycemic combination or insulin therapy. Both groups achieved similar levels of glycemic control and resulted in equivalent maternal and neonatal outcomes, including birth weight, rates of cesarean section, and neonatal complications. The study concluded that treatment of diabetes in pregnancy with either the oral hypoglycemic combination or insulin alone was found to be equally effective and safe for mothers and newborns. However, larger studies were recommended to confirm these findings.
The document discusses various aspects of metformin, including:
- Metformin's mechanisms of action involve both direct and indirect activation of AMPK, leading to effects like decreased glucose, lipid, and protein synthesis.
- Studies have shown metformin may be associated with better cardiac outcomes compared to other glucose-lowering drugs and should not be withheld in patients with stable heart disease or heart failure.
- Infants exposed to metformin in utero had increased subscapular skinfolds but similar body fat compared to unexposed infants, potentially signaling healthier fat distribution.
- Metformin may lower B12 levels but does not necessarily cause deficiency if metabolic markers remain normal, as cellular B12 uptake may increase with metformin therapy
Abstract—Abnormalities that characterizes lipoprotein metabolism in non-insulin dependent diabetes mellitus (NIDDM) patients, fasting concentration of triglyceride rich lipoprotein especially very low density lipoprotein (VLDL) are higher and those of HDL, commonly measured as HDL-c, are lower than among people without diabetes, which leads to increased triglyceride HDL-c ratio and insulin resistance. This type of diabetic dyslipidemia is a major cause of oxidative stress which promote and accelerate atherosclerosis and thus, end organ damage AMI. This present study was carried at the Central Clinical Laboratory MIMSR Medical College Latur, with the aim to find out the role of lipoprotein-triglyceride in myocardial infarction in NIDDM. For this study, patient with myocardial infarction with NIDDM were selected after admitting in MIMSR Medical College Latur. These 25 cases were included in study group and age-matched to these cases 50 healthy subjects were selected as Control group. The lipid profile and total serum lipid peroxides (malondialdehyde) of study and control groups were assessed & compared. It was found that in the control group mean values of total cholesterol was 180.21 ± 18.13 mg % whereas it was 229.21± 23.58 in study group, which was significantly higher in study group. Likewise, mean Serum Triglycerides and Serum Lipid Peroxides (MDA) of study group were also found significantly (p<0.001) higher that of control group (228.14 v/s 99.9 and 410.22 v/s 180.96 respectively). It was also revealed in this study that mean Serum HDL-Cholesterol was found significantly lower in study group whereas LDL-Cholesterol (28.72 v/s 53.83) and VLDL-Cholesterol were found significantly higher in study group that control group (150.61 v/s 106.60 and 46.30 v/s 19.8). So it can be concluded that AMI patients with NIDDM have higher Total Serum Cholesterol, Serum Triglycerides, Serum Lipid Peroxides (MDA), LDL- Cholesterol and VLDL- Cholesterol with lower HDL- Cholesterol.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Study of Serum Omentin-1 in Relation to Insulin Resistance in Type II Diabete...iosrjce
This study examined the relationship between serum Omentin-1 levels and insulin resistance in type 2 diabetes mellitus patients. It found that type 2 diabetes patients had significantly lower serum Omentin-1 levels compared to healthy controls. Serum Omentin-1 levels were negatively correlated with fasting blood sugar, fasting insulin levels, and insulin resistance (as measured by HOMA-IR) in diabetes patients. This suggests that higher insulin resistance is associated with lower serum Omentin-1 levels. The study concludes that Omentin-1 may play a role in insulin resistance and have potential as a future therapeutic target for diabetes.
This pilot study assessed the effects of camel milk consumption on blood sugar, lipid profile, and blood pressure in patients with type 2 diabetes (T2DM). Twenty participants with T2DM were randomly assigned to drink either 500 mL of pasteurized camel milk or cow milk daily for two months. While insulin levels significantly increased in the camel milk group, fasting blood sugar, lipid profiles, and blood pressure did not see statistically significant changes between the two groups after the trial. The study suggests that camel milk may help control insulin levels in T2DM patients, but larger and longer studies are still needed to make definitive conclusions.
The document describes the benefits of joining the Association of Information Technology Professionals (AITP) student organization at Kent State University, which allows students to network with IT professionals, learn leadership skills through organizing activities, and have fun while giving back to the community through food drives and other events. Members can also attend regional and national conferences on technology and certification testing.
Tejaswi Drushti Bestseller For Super Eyesight Dr. Shriniwas Kashalikardocpalep
This document provides a 3-step morning yoga routine for overall health and wellness. It involves splashing the eyes with cold water, visualizing peaceful images, and focusing the eyes and breath in different parts of the face. The routine is recommended to be practiced for 10 repetitions to start the day in a relaxed manner.
El documento habla sobre la transmisión intencional de mensajes mediante signos, que pueden ser visuales, auditivos, lingüísticos o no lingüísticos. Explica que los signos están compuestos por un significante físico y un significado conceptual en la mente, y que el contexto rodea el acto de comunicación y puede modificar la conducta de quien recibe el mensaje.
Vruddha Trihi Samruddha Bestseller For Sexy Aging Dr. Shriniwas Kashalikardrphalgune
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Las redes sociales han crecido exponencialmente en los últimos años, con casi mil millones de usuarios. Los menores tienden a adoptar estas tecnologías más rápido que los adultos. Las redes sociales como Facebook han permitido que los usuarios no solo consuman contenido sino que también lo creen y compartan. Sin embargo, existen riesgos como el acoso cibernético, contactos con extraños y exposición de información personal que pueden poner en peligro a los menores. Se recomienda que los padres supervisen el uso que hacen sus hijos de
Shambhvi A Bestseller Marathi Novel Dr. Shriniwas Kashalikardrajit
The document discusses the history of chocolate, describing how it originated from cacao beans grown by the Olmecs and Mayans in Mexico and Central America. It then explains how Spanish conquistadors brought cacao back to Europe in the 16th century, where it eventually became popular as a drink among the elite. Now chocolate is enjoyed worldwide and its annual production is worth billions of dollars globally.
The document discusses the concept of Namasmaran, which is remembering the name of God, a guru, or other holy figures or objects. [1] It states that Namasmaran helps to reconnect one's physiological self with one's true self. [2] It is described as the "yoga of yoga" as it is the culmination of all consciousness and activities in the universe. [3] Namasmaran is an ocean of bliss that must be directly experienced to truly understand.
R E M E D I E S I F O U N D U S E F U L I N J O I N T P A I N S D R S...shriniwaskashalikar
Drinking 3-4 glasses of water in the morning on an empty stomach, drinking cow milk with dry ginger and turmeric, and taking fenugreek sprouted beans in the morning or evening can help with joint pains according to Dr. Shriniwas Kashalikar. He also recommends avoiding cold foods and drinks, eating chyavanaprash, gentle oil massages, breathing exercises, and practicing "superliving".
Digital Rethinking.
Faraón Llorens, profesor de la Universidad de Alicante.
Seminario Bienal: La universidad digital, 2013/2015
2ª jornada: Las nuevas formas de enseñanza en la universidad digital
5 de junio de 2014
Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and an inability to properly regulate blood sugar levels. The two most important risk factors for T2DM are a family history of diabetes and obesity, though age, race, diet, and exercise level also impact risk. Common symptoms include frequent urination, nerve damage, and dark skin patches. Treatment involves lifestyle changes like diet and exercise as well as medications like metformin, which improves insulin sensitivity and decreases glucose production in the liver. Patients are counseled on managing diabetes-related risks and provided support through organizations and groups.
Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose. It has many subclassifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycemia. This activity outlines the pathophysiology, evaluation, and management of DM and highlights the role of the interprofessional team in managing patients with this condition.
Objectives:
Describe the pathophysiology of diabetes mellitus.
Outline the epidemiology and risk factors of diabetes mellitus.
Review the treatment considerations and common complications of diabetes mellitus.
Identify the importance of improving collaboration and care coordination amongst the interprofessional team to enhance the delivery of care for patients affected by diabetes mellitus.
Access free multiple choice questions on this topic.
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Introduction
Diabetes mellitus is taken from the Greek word diabetes, meaning siphon - to pass through and the Latin word mellitus meaning sweet. A review of the history shows that the term "diabetes" was first used by Apollonius of Memphis around 250 to 300 BC. Ancient Greek, Indian, and Egyptian civilizations discovered the sweet nature of urine in this condition, and hence the propagation of the word Diabetes Mellitus came into being. Mering and Minkowski, in 1889, discovered the role of the pancreas in the pathogenesis of diabetes. In 1922 Banting, Best, and Collip purified the hormone insulin from the pancreas of cows at the University of Toronto, leading to the availability of an effective treatment for diabetes in 1922. Over the years, exceptional work has taken place, and multiple discoveries, as well as management strategies, have been created to tackle this growing problem. Unfortunately, even today, diabetes is one of the most common chronic diseases in the country and worldwide. In the US, it remains as the seventh leading cause of death.
Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. DM has several categories, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and secondary causes due to endocrinopathies, steroid use, etc. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM). T1DM presents in children or adolescents, while T2DM is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to poor lifestyle and dietary choices. The pathogenesis for T1DM and T2DM is drastically different, and therefore each type has various etiologies, presentations, and treatments.
This document presents a research project on developing a sustained release tablet formulation of the anti-diabetic drug metformin hydrochloride (Metformin HCl). The document includes an abstract, introduction on diabetes and metformin, a literature review on previous metformin formulations, drug profile, objectives of developing a sustained release formulation, and details of pre-formulation studies conducted. Pre-formulation studies included characterization of metformin and polymer compatibility studies. The experimental section outlines development of analytical methods including UV spectrophotometry to estimate metformin levels. The project aims to design an optimized sustained release metformin tablet to improve oral bioavailability and therapeutic efficacy with reduced dosing frequency.
Effect of emulin on blood glucose in type 2 diabetics - https://emulincanada.comAj Martirano
Effect of Emulin on Blood Glucose in Type 2 Diabetics https://emulincanada.com
,effect of emulin on blood glucose in type 2 diabet ,emulin diabetes ,igalen emulin diabetes ,emulin type 2 diabetes
This document outlines a thesis protocol on examining the relationship between serum uric acid level and microvascular and macrovascular complications in diabetes mellitus. The candidate is Dr. Sachinkumar Pandey from Aditya Birla Memorial Hospital in Pune, India. The study will examine 139 type 2 diabetes patients to determine if increased serum uric acid levels are associated with chronic complications like retinopathy, nephropathy, neuropathy, and dyslipidemia. Laboratory tests, medical history, and clinical examinations will be used to analyze the relationship between hyperuricemia and microvascular and macrovascular complication risk. Statistical analysis will then be performed on the collected data.
Imeglimin is a novel, first-in-class antidiabetic drug that targets mitochondrial function. It was shown to improve both insulin resistance and insulin secretion based on animal and human studies. Imeglimin received its first approval in Japan in 2021 based on positive results from the Phase III TIMES clinical trials program demonstrating its efficacy in lowering blood glucose levels and its safety both as monotherapy and in combination with other oral antidiabetic drugs or insulin. Imeglimin may also provide cardiovascular benefits given its effects on improving mitochondrial function in multiple tissues beyond just glycemic control.
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
Background: Diabetic Maculopathy (DME) does not compulsorily fi t the usual course of diabetic retinopathy advancement. This
work aimed to study the variables associated with DME in a cohort of patients with type 2 diabetes mellitus from Basrah (Southern Iraq).
Patients and Methods: This was a cross sectional study from Faiha Specialized Diabetes, Endocrine and Metabolism Center)
(FDEMC) done over the period of January - April 2014. The study enrolled 197 patients with type 2 diabetes mellitus with at least 10 years duration and aged >30 years.
Anti-diabetic Therapies, Strategies for Diabetes Management, and Advancement ...PriyankaKilaniya
Diabetes Mellitus (DM) stands as a prominent metabolic disorder characterized by impaired insulin activity and/or secretion, leading to various pathological complications such as nephropathy, retinopathy, and cardiovascular issues. This review delves into the intricacies of Diabetes Mellitus (DM), exploring its sub-types, conventional treatment modalities, and the emerging role of nanotechnology in revolutionizing drug delivery for improved therapeutic outcomes. Pathophysiology of Diabetes Mellitus manifests through aberrations in insulin dynamics, leading to hyperglycemia and subsequent tissue damage. Understanding the underlying pathophysiological mechanisms is crucial for devising effective therapeutic strategies. Classification of Diabetes Mellitus is broadly categorized into Type 1 and Type 2, each with distinct etiological factors and treatment approaches. Type 1 DM necessitates insulin replacement therapy, whereas Type 2 DM is primarily managed through oral hypoglycemic agents. Insulin replacement therapy is the cornerstone of treatment for Type 1 DM. It involves administering exogenous insulin to mimic the physiological insulin secretion that is deficient in individuals with T1DM. This aims to maintain blood glucose levels within a normal range to prevent acute as well as long-term complications. Drug therapy for Type 2 Diabetes Mellitus : The pharmacological armamentarium for Type 2 DM includes Insulin Secretagogues, Biguanides, Insulin Sensitizers, α-Glucosidase Inhibitors, Incretin Mimetics, Amylin Antagonists, and SGLT2 Inhibitors. The Complex pathophysiology of DM demands innovatives therapeutic approaches to enhance drug efficacy and patient adherence. Nanotechology offers promising solutions by enabling targeted drug delivery, improved bioavailability, and reduced dosing frequency. Clinical Implications and Future Perspectives Nanotechnology holds immense potential in revolutionizing diabetes management by addressing the limitations of conventional therapies and enhancing therapeutic efficacy. Future research endeavors should focus on translational studies to validate the clinical utility of nanotechnology-based drug delivery systems. In Conclusion, the integration of nanotechnology into Diabetes management offers a paradigm shift in therapeutic approaches, promising targeted drug delivery, improved bioavailability, and enhanced patient outcomes. Continued research and development in this field are imperative to realize the full potential of nanotechnology in combating the global burden of Diabetes Mellitus. In this article, we endeavor to delve into the pathophysiolgy of Diabetes Mellitus (DM), traditional treatment methods for both Type 1 (T1DM) and Type 2 (T2DM) diabetes, alongside innovative drug delivery strategies for managing Diabetes Mellitus.
Impact of patient counseling on diabetes mellitus patients in the territory c...SriramNagarajan17
This study assessed the impact of patient counseling on 80 diabetes patients in Erode district, India over 6 months. After counseling on diet, exercise, medications and lifestyle changes, patients showed improved fasting blood glucose levels, blood pressure, and body mass index. Specifically, fasting blood glucose decreased from 148.40 mg/dl to 128.40 mg/dl. Body mass index and blood pressure also slightly decreased. The results suggest that patient counseling is effective for improving health outcomes for diabetes patients by helping them better manage their condition.
Association between polymorphisms of the DNA repair gene (OGG1) in Iraqi pati...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This document discusses subtypes of type 2 diabetes (T2D). It describes how T2D is a heterogeneous disease with varying characteristics, progression, and risk of complications. The document outlines research that identified five distinct subclusters within T2D based on clinical parameters like autoantibodies, age of onset, HbA1c, BMI, and measures of insulin resistance and secretion. These subclusters showed different risks for complications - for example, the severe insulin-deficient subtype had higher risk of retinopathy and neuropathy, while the severe insulin-resistant subtype had highest risk of diabetic kidney disease and fatty liver. Identifying these subtypes could help personalize treatment for diabetes patients.
This randomized controlled trial evaluated glycemic durability of rosiglitazone, metformin, and glyburide monotherapy in patients with recently diagnosed type 2 diabetes over 4 years. The primary outcome was time to treatment failure defined as fasting plasma glucose >180 mg/dL. Rosiglitazone showed a lower risk of treatment failure compared to metformin (32% lower) and glyburide (63% lower). Glyburide was associated with a lower risk of cardiovascular events than rosiglitazone, while metformin had a similar risk profile to rosiglitazone. All drugs showed differing adverse event profiles.
A Study of Knowledge and Practice of Foot Care in Patients with Diabetes Mell...Sunil Vadithya
A Study of Knowledge and Practice of Foot Care in Patients with Diabetes Mellitus A Study of Knowledge and Practice of Foot Care in Patients with Diabetes Mellitus
Anti diabetic drugs in patients with diabetespharmaindexing
This study evaluated 93 diabetic patients with comorbidities to assess rational use of antidiabetic medications. The most common comorbidity was hypertension (48% of patients). Insulin was the most prescribed antidiabetic drug (64.4% of patients). Patient information materials on diabetes management were provided. The study aims to improve treatment of diabetes and comorbidities through rational prescribing and patient education.
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose level caused by either absolute or relative deficiency of insulin. Classifications,sings and symptoms,complications,and prevalence of the disease particularly in Egypt are presented. Management of diabetic patients undergoing oral surgical procedures is discussed.
Presentation about Knowledge and medical and nursing Management , Dm types , clinical features, complications of diabetes mellitus
. King Saud university
Similar to Presentation On Diabetic With Skin Disease Treated By Steroids (20)
Presentation On Diabetic With Skin Disease Treated By Steroids
1. Estimation of Blood Glucose Levels in Diabetic Patients of Different Skin Diseases with the Treatment of TriamcinoloneAcetonide and Prednisolone – a Comparative Study. A Thesis paper submitted to the Department of Pharmacy, East West University in conformity with the requirements for the Degree of Bachelor of Pharmacy. A collaborative study between Department of Pharmacy, East West University and Skin Department, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders.
2. Summary Steroid, pharmacologically very important & useful that is essential and can be used for different indications & treatment of diseases. Steroid has different complications like folliculitis, steroid rosacea, perioral dermatitis, skin atrophy, delayed wound healing, striae, purpura, depigmentation, acneiform eruptions, allergic contact dermatitis, hyperglycemia, growth reterdation, cataract, Cushing’s syndrome, glaucoma etc. For these reasons, use of steroids should be very metticulous & rational to avoid those side effects and complications. Depending on substitution, subtraction, addition and replacement, pharmacologically steroid has been classified into two groups: a) mineralocorticoids (Aldosterone, Desoxycorticosterone, Corticosterone, Cortisol, Cortisone & 9-alpha fluorocortisol) and b) glucocorticoids (Corticosterone, Cortisol, Cortisone, Prednisone, Methylprednisone & Dexamethasone). In dermatology prednisolone and triamcinoloneacetonide are indicated in different skin diseases, drugs can be used in the same indications like Urticaria, Leprosy, Lichen Planus, sweet syndrome, Seborrheic Dermatitis, Pompholyx, PrurigoNodularis, Pemphigusvulgaris, Hand Eczema, Bullous, Vasculitis etc. Our purpose of this study is to see the variation of side effects of prednisolone and triamcinoloneacetonide in the skin diseases where both the steroids are indicated.
3. Continue… Study subjects were divided into two groups: group1 (prednisolone) and group2 (triamcinoloneacetonide). Single dose of triamcinoloneacetonide was given to 15 patients and different amount of dose of prednisolone was given to 15 patients. Their glycemic status was measured before steroid (baseline) at 0 week which was compared with the blood sugar during period of week1, week2 and week3 after steroid. Blood glucose level (fasting & 2h ABF) in both groups (prednisolone and triamcinoloneacetonide) rose significantly after week1, week2 & week3. The study showed, triamcinoloneacetonide had little tendency to increase blood glucose level when compared with prednisolone. Fasting blood glucose ≥ 10 mmol/l was considered as an arbitrary line for control of blood glucose. Triamcinoloneacetonide did not cross arbitrary line 10 mmol/l but prednisolone crossed the arbitrary line. Thus control of blood glucose level remained static in triamcinolone. However blood glucose in prednisolone might remain uncontrolled. Both groups showed significant improvement of skin diseases. Thus triamcinoloneacetonide is the better choice in the treatment of skin diseases with diabetes mellitus.
4. Introduction Diabetes is a disease in which the body does not produce or properly use insulin. It has high blood sugar levels which if not well-controlled can lead to long-term complications affecting various organs in the body such as the eye, kidney, nervous system, skin and blood vessels. Skin problems are very common in diabetics and it is a common condition which frequently has skin manifestations. The attachment of glucose to protein may result in a profound effect on structure and function of that protein, and account for clinical manifestations of the disease. It has been suggested that increased cross linking of collagen in diabetic patients is responsible for the fact that their skin is generally thicker than that of non-diabetics. Advanced glycosylation end products are probably responsible for yellowing of skin and nails. Increased viscosity of blood due to stiff red blood cell membranes results in engorgement of the post-capillary venules in the papillary dermis, detected as erythema of the face, or periungualerythema. It is suggested that these skin changes may eventually be used as a reflection of the patient's current as well as past metabolic status (DermAtlas). Diabetic skin conditions include abnormal growths, ulcers, infections and changes in the skin itself (National skin centre). There are many reasons people with diabetes face increased risk of skin problems: Impaired circulation Hyperglycemia (high glucose) Hyperlipemia (high levels of fats in the blood) Suppressed immune system Diabetic neuropathy (nerve damage) High blood pressure
5. Continue.. The key to prevention of many types of diabetic skin conditions is regular good hygiene and control of risk factors. Treatments depend on the particular disorder but often include surgical incision or debridement (removal of damaged tissue) and antibiotics, antifungals or other medications (National skin centre). Some common skin diseases associated with Diabetes Mellitus are Urticaria, Leprosy, Lichen Planus, sweet syndrome, Seborrheic Dermatitis, Pompholyx, PrurigoNodularis, Pemphigusvulgaris, Hand Eczema, Bullous, Vasculitis etc. (ANDREWS’). Shortly after the synthesis of hydrocortisone in 1951, topical glucocorticoids and mineralocorticoids were recognized as effective agents for the treatment of skin diseases. It is also used to treat many inflammatory skin diseases. Maibach and Stonghton, 1973 have divided 20 dermatological disorders that are very responsive and those that require concentrations of steroids, occlusion or intralesional administration. Various side effects of these preparations are also associated with its different uses. So attention must be paid to the concentration of steroid used. In clinical trial found that glucocorticoids increase blood glucose level and cause hyperglycemia. As a result physicians do not use corticosteroids due to the metabolic deterioration of blood glucose level with diabetes. Glucocorticoids work on carbohydrate, lipid, and protein and produce glucose. As a result hyperglycemic episode occur (Goodman, Gilman). If our diabetes is well controlled, many of these skin problems can be averted. This requires compliance with a diabetic diet, medication and regular check-ups with our doctor. When there are serious complications such as bacterial skin infections, gangrene, seek immediate medical attention. Consult doctor early. We may need hospitalization. If left untreated, these complications may lead life-threatening. Infected ulcers and skin infections need to be treated with antibiotics, antifungals and glucocorticoids (prednisolone and triamcinoloneacetonide) (Reza B Zaid, 1996). Now, most commonly used drugs are corticosteroids, especially glucocorticoids (prednisolone and triamcinoloneacetonide) and others as a combination therapy. The aim of this controlled study was to determine the efficacy of steroids in treating diabetic with different dermatoses as well as to see the effects on glucose metabolism.
6. Materials and Methods A randomized, parallel- group study was conducted from March 2008 through December 2008 at the Bangladesh Institute of Research and Rehabilitation for Diabetes, Skin Department (BIRDEM), Shahbagh, Dhaka, Bangladesh. Patients In the study, 30 patients (both male and female) with NIDDM (cases) were taken between 30-70 years as healthy volunteers. They were selective and subdivided grouped as 1) group1; prednisolone (15 patients), the standard drug and 2) group2 (15 patients), the study, triamcinoloneacetonide. Blood sugar levels were estimated for different skin diseases (Urticaria, Leprosy, Lichen Planus, sweet syndrome, Seborrheic Dermatitis, Pompholyx, PrurigoNodularis, Pemphigusvulgaris, Hand Eczema, Bullous, Vasculitis etc.) where steroid was indicated in every weekly for four weeks. Pregnant, nursing women were excluded from the study. Patients with other clinical complication other than type2 diabetes and skin diseases were excluded from the study. Their state of blood pressure, weight was recorded before starting of steroid therapy. Their glycemic status as well as individual’s diet and exercise habit were recorded at the base line and every week for four weeks. To avoid other factors that are responsible for raising individual’s blood sugar all the patients were instructed to continue the same diet and exercise habit as they were in basal state. Statistical Analysis: Data were analyzed by manually. All the data of the study sample was entered from each patient’s history sheet and data of standard sample was entered from all enquiry sheets. Descriptive statistics were done for major variables of interest, including the population, age distribution, drug for skin diseases, drug for diabetes and different concentration of blood sugar levels using Student’s t-test. A probability level of 0.05 was considered statistically significant.
7. Results Total dose of steroid incase of triamcinoloneacetonide group is 69.32 mg/ml, of which 34.66 mg/ml was given IM on “0 week” and 34.66 mg/ml was given at the beginning of 3rd week. Patients with triamcinoloneacetonide had blood sugar before steroid was 7.6 mg/dl and 9.9 mg/dl at 1st week, 9.82 mg/dl at 2nd week and 9.05 mg/dl at 3rd week after giving steroid. Though patients were taken steroid, their blood glucose levels still remain controlled (shown in Fig1). Most of skin diseases were well controlled and cured by triamcinoloneacetonide. Antidiabetic drugs were no needed to change during treatment.
8. Fig1: Mean value of fasting and 2hABF in triamcinolone in different weeks during treatment period. Total dose of oral prednisolone group is 44.4 mg, of which 18.3 mg was given at 0 week, 13 mg at 1st week, 7.8 mg 2nd week and 5.3 mg was given at 3rd week. Patients with prednisolone had blood sugar before steroid was 8.5mg/dl. After giving steroid blood sugar was 12.13mg/dl at 1st week, 11.54mg/dl at 2nd week and 11.37mg/dl at 3rd week. Here after administered prednisolone, blood glucose level was not controlled (shown in Fig2) but most of the diseases were cured properly. Antidiabetic drugs were changed during treatment.
9. Fig2: Mean value of prednisolone dose, fasting and 2hABF in prednisolone in different weeks during treatment period. Significance: In the study, I considered 95% significance. After giving drugs both prednisolone (15 patients) and triamcinoloneacetonide (15 patients), blood sugar level raised significantly from 0 week to 1st week, 0 week to 2nd week and 0 week to 3rd week in all patients. But prednisolone has tendency to increase blood sugar higher than that triamcinolone. In triamcinoloneacetonide patients’ blood sugar level rose from 2 to 3 mg/dl whereas in prednisolone patients’ blood sugar level raised 5 to 15 mg/dl than baseline or 0 week.
10. Comparison between blood sugar level in week 1, 2, 3 with baseline (week0) shown for prednisolone and triamcinolone
11. Tendency to increase blood sugar of prednisolone and triamcinoloneacetonide were observed from 0 week to 4th week and blood sugar was highest during 1st week. Later in subsequent weeks the blood sugar level declined gradually.The fasting blood sugar with group in triamcinoloneacetonide did not cross the arbitrary line of controlled blood sugar but prednisolone crossed the urbitary line and was remained uncontrolled state during treatment period. Thus fasting blood sugar control remains good with triamcinoloneacetonide when compared with prednisolone.Blood sugar level after breakfast was observed in both triamcinoloneacetonide and prednisolone. Pattern of blood glucose levels were similar in prednisolone and triamcinoloneacetonide (Fig3).Thus control of blood sugar in case of prednisolone is more important than triamcinolone actinide. Because prednisolone induced uncontrol state and it crossed the arbitrary controlled line (10 mmol/l) but triamcinoloneacetonide did not cross the arbitrary line of controlled blood sugar.
12. Fasting and 2h ABF in individual patient from week 0, 1, 2 and 3 in triamcinoloneacetonide
13. Fasting and 2h ABF in individual patient from week 0, 1, 2 and 3 in Prednisolone Graph below is showing, Fasting and 2h ABF in individual patient from week 0, 1, 2 and 3 in prednisolone and triamcinoloneacetonide.
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15. Patients of triamcinoloneacetonide; when they were in the treatment of skin, dose of antidiabetes drug would not change in most of patients. Dose modification was rare. Among fifteen patients one patient who took insulin, his dose was modified (decreased the dose unit) as his sugar level become controlled. On the other hand in prednisolone patients, antidiabetes drug dose would not change in most of patients but one patient who took insulin; their dose was adjusted by increasing or decreasing dose amount (±2) to control their blood sugar level. In both groups dose frequency was observed by Comparing drug treatment from 0 week to 1st week, 0 week to 2nd week & 0 week to 3rd week. For patients who took Prednisolone, dose adjustment is needed whereas in triamcinolone patients did not need to increase dose to control sugar level . Efficacy: During the study, signs and symptoms improved in both treatment groups except 7 out of 30 patients. Tolerability: Complication due to drug with prednisolone and triamcinolone, was followed up. Clinical follow up showed no complications such as peptic ulcer disease, myopathy, depression, acne, nausea, hypertention, osteoporosis, adrenal insufficiency and stria. All diseases were well tolerated by prednisolone and triamcinolone.
16. Discussion Corticosteroids have profound effects on carbohydrate metabolism: stimulating liver to form glucose from amino acids and glycerol [14]. In the periphery, corticoids decrease glucose utilization, increase protein breakdown and activate lipolysis, thereby providing amino acids and glycerol for gluconeogenesis [14]. The net result is increased in blood glucose levels because of these effects on glucose metabolism, treatment with glucocorticoid can worsen control in patients with overt diabetes and can precipitate onset of hyperglycemia in patients who are predisposed [14]. One case study showed that prednisolone 20 mg OD for two months followed by dose tapering to 10 mg OD as maintenance dose was given to a patient as an immunosuppressive agent and patient got steroid induced diabetes mellitus [14, 20]. Our study also showed that prednisolone 18.3 mg OD for one month followed by dose tapering to 5.3 mg OD was given to diabetes patients for the treatment of skin diseases and patients blood sugar levels increased significantly after administration of oral prednisolone. However, effects of glucocorticoids on hyperglycemia usually remit within 48 hours of discontinuation of oral administration [14]. In the study of tapering off prednisolone after renal transplantation showed that reduction in daily prednisolone dose leads to decline in blood glucose level [15]. Weight gain was associated with increasing blood glucose level [15]. Each 1mg reduction of prednisolone dose leads to an estimated decline in 2h ABF of 0.12 mmol/l based on multiple linear regression model [15]. We also observed that tapering off prednisolone dose leads to decline in blood glucose level (fasting and 2h ABF).
17. Continue.. The safety of steroids in diabetes has been a subject of debate. Skin diseases are very much common with diabetes patients and those are treated by steroids. Steroids are an effective treatment of different skin diseases in the subjects of diabetes [1]. In our study both groups showed significant improvement of skin diseases. Symptoms and improvement of skin diseases were observed by the physicians. Steroids are used in the treatment of erosive lichen planus with diabetes is of considerable concern because steroids can antagonize the action of insulin, lead to hyperglycemia and need self monitoring during steroid therapy [23]. Triamcinoloneacetonide treat oral lichen planus completely [28]. We observed that lichen planus was well treated by the apllication of intramascular injection, triamcinoloneacetonide. Systemic corticosteroids are usually chosen first to treat patients with generalized forms of any autoimmune bullous disease [26]. The efficacy of systemic steroids in patients is based on the study of patients with pemphigusvulgaris [26]. Before systemic steroids were available most of the patients with that condition died [26]. Prednisolone causes adverse effect after given high dose [26]. After given low dose patients were benefited [26]. Many early case reports showed that steroids therapy is beneficial as it treat disease by blocking further injury or inhibited the inciting cell mediated immunologic reaction [26]. Bullous disease and pemphigusvulgaris were well treated by the administration of oral prednisolone. Leprosy is a disease caused by Mycobacterium leprae that initially affects the peripheral nervous system with patients exhibiting contrasting clinical, immunological pathological manifestation and well treated by steroids (prednisolone) [31]. During treatment period we observed that reactive leprosy was improved after giving prednisolone.
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19. Diabetes patients who are in oral hypoglycemics can be treated by steroids with careful observation, twice per week.
20. Diabetes patients who are in insulin need grate care and daily observation while treating by steroids.
21. When increase the dose of steroids may need to modify dose of hypoglycemics either patients will face hyperglycemia.
22. When reduce the dose of steroids must reduce the dose of hypoglycemics either patients will face hypoglycemic episode. Effect of steroids on blood glucose level reduces with the improvement of skin diseases and when patients are not in stress.