Diabetes Mellitus

With India and the United States having the highest rates of the disease, diabetes mellitus is becoming a global public health concern. In India, which is expected to have the world's biggest diabetic population (more than 101 million by 2023), accessibility and price are major concerns. A significant component of the antidiabetic medication market, which is projected to reach a valuation of USD 1.7 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 3.5% to reach USD 2.01 billion by 2029[1]. The primary treatment for Type 2 Diabetes (T2DM) is still metformin, which is augmented by sulfonylureas, DPP-4 inhibitors, and more recently, SGLT2 inhibitors. With new limitations on illogical fixed-dose combinations, regulatory bodies such as the CDSCO are actively trying to guarantee the safety and effectiveness of pharmaceuticals [2]. Diabetes is a chronic, metabolic disease characterized by elevated blood glucose levels or hyperglycaemia, which results from abnormalities in either insulin secretion or insulin action, or both. According to the report from CDC’s National Diabetes Statistics Report, there are about 37.3 million cases of diabetes in the US which is 11.3% of the US population. The kind of drug most frequently used to treat type 1 diabetes Insulin. Insulin, alpha-glucosidase inhibitors, biguanides, dopamine-2 agonists, DPP-4 inhibitors, GLP-1 receptor agonists, meglitinides and SGLT2 inhibitors, sulfonylureas, thiazolidinediones, and other drugs are commonly used orally to treat type 2 diabetes [3]. Keywords: Antidiabetics, Diabetes Mellitus, Regulatory Bodies, CDSCO, FDA, United States

Diabetes mellitus and Hypertension are a common disease that is suffered by a huge percentage of total population. The coexistence of these two diseases is at a greater frequency than alone. Hypertension in the diabetic individual potently increases the risk and accelerates the risk of cardiac disease, stroke, peripheral vascular disease, nephropathy and retinopathy. The management of both this disease is equally important and the reduction in cholesterol level have significant role in preventing diabetic complication. Diabetic associated diseases like nephropathy also lead to the development of hypertension particularly in type I diabetic patient. The coexistence of hypertension in both type I and type II diabetic patients can lead to be increased peripheral vascular resistance and the exchangeable sodium ion can be a reason for hypertension in diabetics. The insulin resistance or hyperinsulinemia or elevated insulin can be one of the major pathogenesis of hypertension. In the present study we have reviewed the various literatures related to the coexistence of to life threatening disease that is hypertension and diabetic and it was observed that these two diseases are most commonly associated in a person. Thus there should be some modified treatment procedures for this kind of life threatening associated diseases.   

Diabetes mellitus  is a chronic disease that is characterized by inadequate pancreatic insulin secretion or poor insulin directed mobilization of glucose by target cells. Population affected with diabetes has increased from 108 million in 1980 to 422 million till date. So, it is clearly evident that the rate is alarming and diabetes has now become a global problem. Diabetes is seventh leading cause of death globally. Insulin therapy in diabetes is the commonest and the most effective therapy. Conventional methods like subcutaneous or the oral route are having several shortcomings like the pain and invasion associated with injections, oral degradation of insulin, infection, etc. Among all the demerits hypoglycemia is the major issue especially nocturnal hypoglycemia as the patient cannot monitor the level of glucose at night. To overcome these detriments there is a need for insulin delivery through novel technologies.  Many novel technologies have been proposed like the painless smart patch, Clicksoft microinjection device, pens, pumps, modified oral delivery oral delivery, inhaled insulin, etc. for the delivery of insulin.  Many other novel devices and routes are being developed. This review discusses the glimpse of these novel technologies with their pros and cons.

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.

To assess the prevalence and types of lipid abnormalities, analyze the rationalein the drug therapy and drug interactions in the drug therapy. Each patient’s medication profile was reviewed and patients who met the inclusion criteria were briefed on the study. The data from medical charts of all the cases with lipid abnormality were recorded during ward rounds. The study population included patients with primary dyslipidemia (38.8%) and secondary dyslipidemia (61.2%). The major concomitant disease was systemic hypertension followed by Diabetes Mellitus. Majority of the patients were in non CHD category. 88.7% of non CHD patients had 2+ risk factors and 11.3% had 1 risk factor. The non CHD group were subjected for estimation of 10 year risk percentage for having CHD using Framingham’s scale in which 92% of non CHD patients had ≤ 20% ten year risks for having CHD. The drug interactions with lipid lowering agents were 33.3% and without lipid lowering agents were 66.7%. The major drug interactions with lipid lowering agents were high. Conclusion: Results revealed that Diabetes, Thyroid Disorders, Nephrotic Disorders are responsible for elevation of lipid profiles. Some dyslipidemias appear to be refractory to drug treatment in the presence of an ongoing unrecognized secondary cause.

Management of Diabetes mellitus type 2 with hypertension is very complex process as it is very difficult to find which therapy gives better action in diabetic and hypertensive patients  The patients with Diabetes Mellitus and Hypertension were identified and they are enrolled based on inclusion and exclusion criteria. Data was collected through standard data documentation form. A prospective study was carried out and cost effective analysis of those drugs was done. The scores obtained are evaluated & analyzed using statistical tools and Microsoft Excel software This study has shown that oral hypoglycemic drugs which are cheap i.e.  Is 1.0 rs, per day, per week it costs 7rs, per fifteen days it costs 15 rs, per month it costs 30.5 rs and per year it costs 365 rs. for diabetes and  for hypertension  Beta blockers were low priced  10.17 rs per day ,per week  it costs 71.19rs, per fifteen days it costs 152.55rs,  per month it is 315.27 rs,  per  year   it is  3712 rs, categorized  medication and at the same time it gives better therapeutic action in terms of  treatment  outcomes. Over all study has shown that combination therapy will attribute to the better treatment outcomes. Use of generic drugs should be encouraged than prescribing brand drugs because of same therapeutic out come and it cause more economic burden to patient and more complications. There is a need of educating patients to motivate them in order to make them realize the risk involved if untreated.

The present study was aimed to evaluate the effect of ellagic acid on physical and biochemical parameters and histopathological changes in tissues of streptozotocin (STZ) - induced diabetes in wistar rats. Diabetes was induced in wistar rats by single intraperitoneal injection of STZ (45mg/kg body weight). STZ-induced diabetic rats showed a significant increase in kidney weight, food intake, water intake, blood urea, serum uric acid and creatinine and a significant decrease in body weight, liver weight, plasma total protein and albumin when compared to normal rats. Oral administration of ellagic acid (50 and 100 mg/kg) in STZ-induced diabetic rats for a period of 35 days significantly improved body weight and reduced food intake and water intake when compared with diabetic control rats. Ellagic acid administration in STZ-induced diabetic rats restored the liver and kidney weight and also the biochemical parameters to near normal when compared to diabetic control rats. The results of the present study clearly show the preventive role of ellagic acid in STZ-induced diabetic rats. Results obtained from histopathological studies also supported the anti-diabetic effect of ellagic acid in STZ- induced diabetes.