Evaluation of prescription pattern and glycaemic control among diabetes patients in an ambulatory tertiary care setting in southwestern Nigeria

Background: Drug prescription in diabetes is complex, thereby making diabetes patients a high-risk group. Thus, treating the patient with diabetes remains a practice that entails constant re-evaluation and assessment of patient’s therapy and response.Objective: To evaluate pattern of antidiabetes and adjunctive medications prescribed for patients as well as extent of glycaemic control.Method: A cross-sectional concurrent review of case-notes of diabetes patients attending the endocrinology out-patient clinic of the University College Hospital, Ibadan, for 4-consecutive weeks. In-patient case-notes, newly diagnosed, and those with incomplete data were excluded. Data were summarised using descriptive statistics. Chi-square was used to investigate categorical variables at p<0.05.Results: Mean age and duration of diagnosis were 60.6±13.0 and 10.2±7.9 years, respectively. Type-1-diabetes accounted for 4 (6.9%) and type-2-diabetes (54; 93.1%). Co-administered combination of metformin and glimepiride (15; 25.9%) was most commonly prescribed. Mean glycosilated haemoglobin was 6.9±1.8%. Nineteen (59.4%) were adjudged to have good glycaemic control (HbA1c<7%). Calcium-channel-blockers (23; 19.5%), statins (23; 19.5%), angiotension-converting-enzyme inhibitors (22; 18.6%) and low-dose aspirin (20; 17.0%) were the commonly prescribed adjuncts. Of the 16 (27.6%) patients whose adherence status was documented, 8 (50.0%) who were regular on medication were subjectively adjudged adherent.Conclusion: Metformin-based regimen, specifically, the co-administered combination of metformin and glimepiride is mostly prescribed. Overall blood glucose profile indicates fair glycaemic control. There is a greater likelihood of evidence-based prescriptions for the patients. However, there is a need for concerted efforts by providers in ensuring improved medication adherence, in order to ensure better therapeutic outcomes.Keywords: Antidiabetes medication, glycaemic control, diabetes patients, ambulator

Effects of Thyroidectomy and Thyroxine on Glucose Transport Capacity in the Jejunum and Ileum of Rat

Thyroid hormone has been known to alter glucose metabolism. This study was conducted to investigate the effect of thyroidectomy and thyroxine on glucose transport in the small intestine. Forty rats were randomly selected into four groups o f ten rats. Groups one and two rats were thyroidectomised to mak e them hypothyroid after which group two rats received T4 replacement of 10ug/100g b/w for thirty-five days to make them euthyroid. Rats in groups three and four were sham operated thereafter group three rats received 10ug/100g b/w thyroxine for thirty -five days to make them hyperthyroid. 10mg/kg b/w Ketamine was administered intraperitoneally as anesthesia before the surgeries. On the thirty-fifth day post-surgery all the animals were sacrificed and their small intestines were harvested. 10cm length of jejunum and ileum respectively were used to make everted sacs for the in vitro study. Mucosa glucose transfer (MGT), Final glucose concentration gradient (FCG) and Gut glucose uptake (GGU) were significantly higher (P< 0.05) in the hyperthyroid group and lower (P< 0.05) in the hypothyroid group compared with the control with transport in the jejunum greater (P< 0.05) than the ileum in all groups. Serosal glucose transfer (SGT) was Negative in the hyperthyroid group. These findings suggest that thyroidectomy reduced glucose transport while thyroxine increased glucose transport in different segments of the small intestine with the transport in the jejunum greater than that of the ileum. But excess thyroxine may cause reverse glucose transport in the small intestine

Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome

Objective: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS).Materials and methods: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student’s t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant.Results: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values.Conclusion: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome.Keywords: Dietary modification, fibrinogen, interleukins, metabolic syndrome, plasminogen activator inhibito

Salivary flow and composition in diabetic and non-diabetic subjects

The study investigated the effects of type 2 diabetes mellitus on salivary flow and composition in humans compared to healthy sex and age matched controls. Forty adult human subjects divided into 20 diabetic and 20 non-diabetic healthy subjects were included. Saliva samples were collected and analysed for glucose, total protein, calcium, sodium, potassium, chloride and bicarbonate. Salivary flow rate was also determined. The results showed that salivary glucose and potassium levels were significantly higher (p = 0.01 and 0.002 respectively) in diabetic patients compared with non-diabetic participants. It was also found that the diabetic patients had significant reduction in salivary flow rate when compared with non-diabetic individuals. In contrast, there was no significant difference in levels of total protein, Na+, Ca++, Cl- and HCO3- between the two groups. These results suggest that some oral diseases associated with diabetes mellitus may be due to altered levels of salivary glucose, potassium and flow

An association between diet, metabolic syndrome and lower urinary tract symptoms

Diet is a key factor in the aetiology of many diseases, including metabolic syndrome and lower urinary tract disorders. Metabolic syndrome is a growing and increasingly expensive health problem in both the developed and the developing world, with an associated rise in morbidity and mortality. On the other hand, lower urinary tract symptoms affect millions of individuals worldwide, lowering their quality of life. Associations have been established between both conditions in existing literature and the various components of the metabolic syndrome have been linked with the onset and aggravation of symptoms in various forms of LUTS. This current review explores the relationships between these in detail, focusing on their inter-relationships particularly vis-a-vis dietary macronutrient and micronutrient intake

Phase II study of the antibody-drug conjugate TAK-264 (MLN0264) in patients with metastatic or recurrent adenocarcinoma of the stomach or gastroesophageal junction expressing guanylyl cyclase C

Background The first-in-class antibody–drug conjugate TAK-264 (formerly MLN0264) consists of an antibody targeting guanylyl cyclase C (GCC) conjugated to monomethyl auristatin E (MMAE) via a peptide linker. This phase II study evaluated the efficacy and safety of TAK-264 in patients with adenocarcinoma of the stomach or gastroesophageal junction expressing GCC, who had progressed on ≥1 line of prior therapy. Methods This study used a two-stage design, with an interim analysis conducted after stage I to determine whether to continue to stage II or discontinue on the grounds of futility. Adult patients with gastric and gastroesophageal junction adenocarcinoma expressing low, intermediate, or high GCC levels received TAK-264 1.8 mg/kg as a 30-min intravenous infusion once every 21 days, for up to 1 year. The primary endpoint was objective response rate. Radiographic assessments of tumor burden were performed every 2 cycles (6 weeks). Results A total of 38 patients participated in the study. Patients received a median of 2 (range 1–14) cycles; 8 (21%) received at least 6 cycles. The most common adverse events were nausea (53%), fatigue (32%), and decreased appetite (29%). Grade ≥3 events including anemia, diarrhea, and neutropenia were seen in 14 (37%) patients. Systemic exposure to TAK-264 was maintained throughout each treatment cycle. Two patients (6%) with intermediate GCC expression had objective responses. Conclusions TAK-264 demonstrated a manageable safety profile in this patient population. The stage I interim analysis did not support continuation to stage II of the study.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A phase II study of antibody-drug conjugate, TAK-264 (MLN0264) in previously treated patients with advanced or metastatic pancreatic adenocarcinoma expressing guanylyl cyclase C

Background This phase II open-label, multicenter study evaluated the efficacy, safety, and tolerability of TAK-264 in previously treated patients with advanced or metastatic pancreatic adenocarcinoma expressing guanylyl cyclase C (GCC). Methods Patients with advanced or metastatic pancreatic adenocarcinoma expressing GCC (H-score ≥ 10) received TAK-264 1.8 mg/kg on day 1 of a 21-day cycle as a 30-min intravenous infusion for up to 1 year or until disease progression or unacceptable toxicity. The primary objective was overall response rate (ORR [complete response + partial response (PR)]). Secondary objectives included evaluations of the safety and pharmacokinetic profile of TAK-264 (NCT02202785). Results 43 patients were enrolled and treated with 1.8 mg/kg TAK-264: 11, 15, and 17 patients with low, intermediate, and high GCC expression, respectively. Median number of treatment cycles received was two (range 1–10). The ORR was 3%, including one patient with intermediate GCC expression who achieved a PR. All patients experienced ≥1 adverse events (AE). The majority of patients experienced grade 1/2 AEs affecting the gastrointestinal tract. Fifteen (35%) patients experienced ≥grade 3 drug-related AEs; five (12%) patients had a serious AE. The most common (≥10% of patients) all-grade drug-related AEs were nausea (33%), fatigue (28%), neutropenia (23%), decreased appetite (23%), vomiting (16%), asthenia (16%), and alopecia (14%). Conclusions TAK-264 demonstrated a manageable safety profile; however, the low efficacy of TAK-264 observed in this study did not support further clinical investigation.SCOPUS: ar.jinfo:eu-repo/semantics/publishe