Diabetic Presentation Corrected
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Transcript of Diabetic Presentation Corrected
EVALUATION OF THERAPEUTIC RESPONSE OF METFORMIN HCl AND ITS RATIONALE COMBINATIONS ON
GLYCEMIC VALUE IN DIABETICS
C SUJANIB UMA MAHESH
B SUNIL GAVASKARD SIVA SANKAR
K V HIMA BINDUK V GOPINATH & B PUSHPA KUMARI
DEPARTMENT OF PHARMACOLOGY SRI PADMAVATHI SCHOOL OF PHARMACY
TIRUPATI - 517 503 (A.P.)INDIA
Aim
To evaluate the therapeutic response of Metformin HCl & it’s rationale combinations
Objectives
• To assess the therapeutic response
• To appropriately counsel patients & evaluate the outcome of the same
• Adverse drug reactions
• Diabetic complications
• BMI & Demographic data
Plan of Work
Design of Study
Retrospective and prospective
Study Site
T.T.D Central hospital, SVIMS
Study Period
October, 06 to March, 2007
Inclusive Criteria
Type 1 diabetic and Type 2 diabetics
Age group 12 to 60 and above
Glucometer tests
Sign written informed consent
Exclusive Criteria
• Patients with chronic diseases
• Less than 90%compliant in drug usage
• Voluntary withdrawal
• Pregnant women and children
Plan of Work
Phase I
Provide basic diabetic facts
Written and verbal instructions
Advise on use of ER
Medications
Plan of Work
Phase II
Patients having clinical symptoms of diabetic
Diabetic diagnosis on basis of glucometer test
Prescribing diabetic drugs
Signing consent form by the patient
Designing of a standard data collection
Patient Counseling
Plan of Work
Phase III
Establish therapeutic goals
Provide instructions for monitoring and reporting
Practice use of glucometer test
Plan of Work
Follow-up
See patients every 30 days interval
Assess attainment of goals Make necessary adjustments to
treatment Updated written Diabetic (self)
Action Plan Check patient’s Glucometer test Assessment of outcome variables
by Standard statistical analysis
Data on diseases
5 14
14
7
17
5 23
7
11
32
32
0
23
4
0
200
400
600
800
1000
1200
DM
HT
TB
Ep
ilep
sy
Ast
hm
a
DM
& H
T
Mis
cella
ne
ou
s
To
tal
Name of the Disease
Nu
mb
er
of P
atie
nts
Demographic data based on sex(n=320)
155165
320
0
50
100
150
200
250
300
350
Male Female Total
Sex
Pe
rce
nta
ge
of P
atie
nts
Demographic data based on age(n=320)
217
71
101
129
0
20
40
60
80
100
120
140
20-29 30-39 40-49 50-59 >60
Age in Years
% o
f P
atie
nts
Demographic data based on education (n=320)
103
7377
57
19
0
20
40
60
80
100
120
Illeterates Middle School High School College Higher
Education
% o
f P
atients
Demographic data based on Occupation
Employee50%House w ife
44%
Unemployee5%Cultivation
1%
Demographic data based on Smoking (n=320)
35
285
0
50
100
150
200
250
300
Yes No
Smoking
% o
f P
atients
Demographic data based on Alcohol social habit (n=320)
37
283
0
50
100
150
200
250
300
Yes No
Alcohol
% o
f P
atie
nts
Demographic data based on Mean + SD (n=206)
020406080
100120140160180
Age Height Weight BMI
Demographic Data Parameters
Mea
n Va
lue
+ SD
Causes of diabetes (n=320)
89
67
48
10
20
40
60
80
100
Genetic Sedentory Obesity DrugInduced
Causes of Diabetes
% o
f Pat
ient
s
Risk factor - BMI
Normal, 89( 43%)
Overweight 85 (40%)
Obesity, 36 (17%)
Demographic data based on treatment profile (n=210)
41
130
36
30
20
40
60
80
100
120
140
One Two Three Four
Number of Drugs
% o
f P
atie
nts
Effect of anti-diabetic drug(s) 0n glycemic value (%change)
Met + Pioz + Acar25%
Met + Pioz + glim19%
Met + Insu7%
Met 5%
Met + Glib 15%
Met + Glip19%
Met + Pioz10%
Percentage change in glycemic value of Metformin HCl
13.5
07
33.2
4.8
01
24.4
81
0
5
10
15
20
25
30
35
% C
hange in
Gly
cem
ic V
alu
e
baseline Follow up
Glycemic Value
Fasting
PP
Percentage change in glycemic value of Metformin + Glibenclamide treatment
23.8
968
53.0
437
20.8
095
48.6
5
0
10
20
30
40
50
60
% C
hang
e
Base line Follow up
Glycemic Value (mg/dl)
Fasting
PP
Percentage change in glycemic value of Metformin + Glipizide treatment
30.7
698
26.0
952
55.3
811
52.2
8
0
10
20
30
40
50
60
Base line Follow up
Glycemic Value (mg/dl)
% C
hange
Fasting
PP
Percentage change in glycemic value of Met + Pioz + Acarbose treatment
-12.6
9
-25.4
9
7.5
0
-30
-25
-20
-15
-10
-5
0
5
10
Base line Follow up
Glycemic Value (mg/dl)
% C
hange in G
lycem
ic V
alu
e
Fast
PP
Therapeutic response of anti-diabetic drug(s) on glycemic value
200
239
192
166
116
282
126
132
102
14215
9
152
138
120
160
200
0
50
100
150
200
250
300
Normal Met Met +Glib
Met +Glip
Met +Pioz
Met +Pioz +Acar
Met +Pioz +glimer
Met +Insu
Drug(s)
Gly
cem
ic V
alue
(m
g/dl
)
Fast
PP
Adverse Drug Reactions of Anti-Diabetic Drugs (n=320)
47
93
111
4
44
54
120
0
20
40
60
80
100
120
140
Hypo/h
yper
Sw
eating
Appetite
Asth
neia
Dia
rrhoea
Tre
mors
Mala
ise
Adverse Drug Reaction
% o
f P
atients
Data on diabetic complications
6
13
20
4
11
00
5
10
15
20
25
Hypo/Hyper Risk of Infections Diabetic Retinopathy
Complications
Num
ber
of P
atie
nts
Total Diabetics
Diabetics using Metformin
Conclusion
Glimepride, pioglitazone and metformin or Acarbose, pioglitazone and metformin have a complementary mechanisms of action combination therapy with these agents result in improved glycemic control and improved tolerability at lower doses of individual agents.
Diabetes is more common in overweight or obese persons.
The impact of patient counseling on management of Diabetes was studied and it is very significant.
Conclusion
Improves confidence, and patient compliance
Cuts cost of therapy
Minimize the usage of medication per day
Reduces side effects, and diabetic complications
Faculty members, SPSP
The Principal, SPSP
The Chairman, SPSP, Tirupati
Medical &Para Medical Staff, TTD Hospitals