Diabetes mellitus (DM) is a group of common metabolic disorders that share the phenotype of hyperglycemia. India is emerging as the world diabetic capital. Insulin is a therapeutic option to treat either type 1 and type 2 DM. Inadequate awareness about the use of insulin is likely to influence its acceptance and adherence. The present study was done to assess the knowledge, attitude, and practice regarding insulin use among diabetic patients at Victoria Hospital, Bangalore, India. Knowledge, attitude, and practice of sixty diabetic patients (either inpatients or outpatients) were assessed by using a validated questionnaire consisting of 24 items. Scores were allotted to each question and evaluated after applying appropriate statistical tests. The mean age of the patients was 53.51±6.48 years (58.33% males). The mean knowledge score was 9.06±1.88 out of 22, attitude score was 4.78±1.37 out of 12 and practice score was 7.75±1.24 out of 11. The mean score of attitude was better in females compared to male patients (5.32±1.34 vs. 4.4±1.28). Male patients scored 38.57% compared to female patients (41.33%) for the question regarding symptoms of hypoglycemia. 57.14% of male patients and 72% of female patients carried simple carbohydrates when going out. Despite good practice scores, the knowledge and attitude scores regarding insulin use were inadequate. Potential adverse effects of insulin can be avoided and better knowledge, attitude, and practice can be achieved by providing proper education to patients. Keywords: knowledge, attitude, practice, diabetic, insulin
Background: Pressures from animal right organizations like PETA lead to stringent animal handling guidelines by CPCSEA, UGC, MCI which resulted in limitation of animal experiments in postgraduate practical pharmacology. So, this study is designed to know the perceptions and alternative suggestions of pharmacology postgraduate students about animal experiments in their practical curriculum.Methods: 127 pharmacology postgraduate students who participated southern regional conference of IPS -2016 at Belgaum, Karnataka were included in this questionnaire based study. The data was analysed using descriptive statistics.Results: Majority 79% students favoured animal experiments even though only 53% of students were conducting animal experiments at their institute. Some of the reasons quoted by the students to favour animal experiments were, provide better understanding of drug effects (66%), interested in preclinical research & drug development (60%), provides hands on experience (56%) etc. Some of the virtual experiments suggested by students which can be used in parallel to animal experiments to reduce animal sacrifice were computer simulated animal experiments (78%), preformed graphs/charts (65%), video films (53%) and so on. Main reasons to like CAL were effects of drug can be clearly visualized (72%), can be repeated (63%), avoids error (57%), saves time (54%) etc.Conclusions: There is a need to incorporate CAL along with continuation of animal experiments in postgraduate practical pharmacology, so that both will compliment, enhance, reinforce the learning from each other and also drastically reduce the number of animals sacrificed.
Background: India is the world’s diabetic capital. Oral antidiabetic therapy is still incomplete. Prior studies have shown that hydroxychloroquine (HCQ), a commonly used antimalarial, anti-rheumatic drug reduces the risk of developing diabetes mellitus. It probably acts by decreasing insulin metabolism- a novel mechanism of action.Methods: A systematic search was done in MEDLINE database with key words ‘Type 2 Diabetes Mellitus’, ‘Hydroxychloroquine’. Articles assessing the antidiabetic efficacy of hydroxychloroquine were reviewed and their results summarized.Results: With extensive literature search, we found out three RCTs and four Cohort studies assessing the efficacy of HCQ on glycaemic markers in patients with type 2 diabetes mellitus. Two randomized controlled trials done by Gerstein H C et al, Pareek A et al, comparing hydroxychloroquine with established antidiabetic drugs showed that there is significant reduction in glycaemic parameters with comparable similarity in both the groups (HbA1c: -0.91%±0.4%). Solomon et al in their study on patients with RA concluded that HCQ improved insulin sensitivity. Two cohort studies by Chen Y M et al and Wasko MCM et al respectively showed reduced incidence of diabetes mellitus in Systemic lupus erythematosus (Hazard ratio=0.26) and rheumatologic disease (relative risk=0.23) patients who received hydroxychloroquine. In a cohort study by Rekedal LR et al, HCQ reduced HbA1c by 0.66% compared to baseline in patients with RA. These studies also showed that hydroxychloroquine has favourable effect on lipid profile and good tolerabilityConclusions: Hydroxychloroquine has a potential to enter antidiabetic armamentarium due to its efficacy and low toxicity profile. More studies are required to confirm this.
Dyslipidemia is a well-recognized risk factor for the development of diseases associated with atherosclerosis, including coronary artery disease and stroke. Statins are the first choice hypolipidemic drug which are the most effective and best tolerated agents for treating dyslipidemia. Atorvastatin confers an HMG-CoA reductase inhibition up to 20-30 hours which makes it even effective on the next day. The present study is randomized open labeled study done at Victoria Hospital - Bangalore to compare efficacy and safety of daily dosing versus alternate-day atorvastatin therapy in patients with dyslipidemia. A total of 86 patients with dyslipidemia were randomized into 2 groups. Group A received 10 mg of atorvastatin daily (DS) and group B received 10 mg of atorvastatin on alternate day (AS) for six weeks. Among the 86 patients included in the study, mean age of the participants in the AS group was 53.12 ± 10.32 whereas that in the DS group was 52.26 ± 11.13. LDL-C decreased by 25.3% versus 22.4% (CI 0.95, P = 0.35) on daily and alternate-day dosing, respectively. Also 12.5% versus 15% (CI 0.95, P= 0.83) improvement was seen with HDL-C. Both dosage regimens provided reductions in total cholesterol (20.7% versus 20.2%) and triglyceride (20.7% versus 21.2%). There was no statistically significant difference in reduction in lipid parameters between two groups. Adverse effects were found less occurred in alternate day therapy than daily therapy. Gastrointestinal disturbances and myalgia were most commonly reported in both groups. Hence this study concludes alternate-day atorvastatin is as effective as daily atorvastatin in dyslipidemia.
Background: On June 18, 2013, India banned pioglitazone, a peroxisome proliferation activator gamma agonist, and a popular anti-diabetic drug used in the treatment of type 2 diabetes mellitus (T2DM), but on August 21, 2013, ban was revoked after stiff opposition from diabetologists and pioglitazone was reintroduced to the market again. Aim and Objective: The aim of this study was to assess the efficacy and safety of low-dose pioglitazone compared to standard dose pioglitazone in adults with T2DM. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, 50 patients with T2DM who were not under adequate glycemic control with metformin and glimepiride combination therapy are included in the study. The patients were randomly assigned (1:1) into pioglitazone 7.5 mg group and 15 mg group as an add on treatment to the existing therapy. Results: All the glycemic parameters such as FBS, post prandial blood glucose (PPBS), and hemoglobin (HbA1c) are significantly reduced in both groups from baseline to the end of 12 weeks. FBS reduced from 183.64 ± 20.9 to 152.08 ± 15.2 in the Pioglitazone 7.5 mg group and from 177.32 ± 16.89 to 145.2 ± 11.6 in the pioglitazone 15 mg group (P < 0.05), PPBS was reduced from 260.2 ± 31.09 to 213.8 ± 29.5 and from 256.24 ± 43.72 to 203.52 ± 27.5 (P < 0.05) in 7.5 mg and 15 mg group, respectively. HbA1c was reduced from 8.969 ± 0.88 to 8.508 ± 0.9 in 7.5 mg group (P < 0.05) and in 15 mg group, it was reduced from 8.796 ± 0.79 to 8.19 ± 0.72 (P < 0.05). In the study, Pioglitazone 7.5 mg efficaciously reduced glycemic parameters similar to pioglitazone 15 mg and there was no statistically significant difference between the groups. Three patients reported with pedal edema as adverse effect in pioglitazone 15 mg therapy, whereas only one in 7.5 mg pioglitazone therapy complained of ankle edema. Conclusion: Low-dose pioglitazone offers an attractive alternative option to standard dose pioglitazone as an add on therapy for T2DM due to its effectiveness in reducing glycemic markers and also fewer side effect profile.
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