Use of medications on the elderly

The elderly constitute a growing world population group, with more than 200 million people over 60 years of age. This fact has increased the detection of chronic-degenerative diseases, as well as the prescription and consumption of medicines. The elderly are particularly susceptible to adverse drug events or interactions with other drugs due to their physiological changes, genetic predisposition and environmental exposure. It becomes necessary to adapt the health systems with integral and multidisciplinary approaches suitable to this demographic change, as the knowledge about appropriate prescription, clinical pharmacology and medication use in the elderly has become essential. It has been shown that about two thirds of elderly patients receive inappropriate drug doses, and a substantial percentage of their hospital admissions are associated with potentially preventable toxic effects of drugs. To date, expert criteria, error detection tools and educational prescription plans have been developed by expert consensus for the safe use of drugs in the geriatric population. The objective of this study is a brief review of the principal physiological changes in an older adult, and summarize the contributions of the consensuses on prescription

SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

Abstract Background: Type 2 diabetes mellitus (T2DM) is a progressive chronic disease associated with severe microvascular and macrovascular complications. Our aim is to assess the real world effectiveness of SGT" inhibitors in achieving metabolic therapeutic goals. Methods: A retrospective, observational study. Inclusion criteria for patients were a previous diagnosis of type 2 diabetes mellitus, age > 18 years, patients receiving either dapagliflozin 10 mg and/or canagliflozin 300 mg. We excluded pregnant patients, patients with type 1 diabetes mellitus and acute metabolic complications of diabetes. Patients included in the analysis were enrolled in a health plan at least 6 months prior to the index date (baseline period) and in the 6 months following the index date (follow-up period). Achievement of glycated hemoglobin goals were established as <7%. Results: We screened 2870 Mexican patients; 288 (10.03% received SGLT2 inhibitors). Mean age for both groups of patients was 57.68±11.06 years. The dapagliflozin control rate was 19.56% and the canagliflozin control rate 18.96%. Monotherapy with SGLT2 inhibitors was used in 21 patients (6.25%). Overall HbA1c goals were met in 56 patients (19. 44%) with similar results with dapagliflozin or canagliflozin. The combination of SGLT2 inhibitors and sulfonylureas had the highest control rate (30.30%) compared to other regimens. Monotherapy was present in 6.25%. Insulin requirement was associated with poor control (2.8% vs. 18.05%, P<0.05, 95% CI [0.07, 0.84]). Combination therapy with DPP4 inhibitors was associated with better control (P<0.05, 95% CI, [1.10, 3.92]). Conclusion: No difference between the drugs was observed. Real-world effectiveness data of SGLT2 inhibitors show that the percentage of patients reaching metabolic goals is low. SLGT2 inhibitors were used more frequently as combined therapy. Keywords: Dapagliflozin, Canagliflozin, Diabetes Mellitus, Type 2, Effectiveness research, comparative, Hemoglobin A, Glycosylate

Tendencies in medical publications

To describe the trends of research design in publications from high-impact medical journals. Methods: A cross-sectional, descriptive study was conducted by searching the 2011 electronic publications of the journals: New England Journal of Medicine, Journal of the American Medical Association, The Lancet, British Medical Journal, and Annals of Internal Medicine. Studies were classified as primary and secondary. The journal impact factor was taken from the Journal Citation Report website. Descriptive statistics were used to analyze and interpret the data. Results: We analyzed 1130 publications: 804 primary and 326 secondary studies, which represented 71.2% and 28.8% of the total publications, respectively. Among the primary studies, randomized clinical trials (30.4%) were the most prevalent, followed by cohort studies (21.9%) and case reports (9.0%). Conclusions: These findings can have implications in Evidence-Based Medicine programs. Literature review should focus on reviewing secondary articles first, then experimental studies and finally, observational studie

Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses

Objective: Methylprednisolone pulses are used in a variety of disease conditions, both for acute and chronic therapy. Although well tolerated, they increase glucose levels in both non-diabetic and diabetic patients. They may also be considered a significant risk for acute metabolic alterations. The purpose of this report is to determine the metabolic changes in blood glucose levels in non-diabetic patients receiving methylprednisolone pulses and identify the presence of predictive factors for its development. Methods: Observational, prospective study in 50 non-diabetic patients receiving 1 g intravenous methylprednisolone pulses for three consecutive days as an indication for diverse autoimmune disorders. Demographic, anthropometric, and metabolic variables were analyzed, and glucose, insulin and C-peptide levels after each steroid pulse were identified. Different variables and the magnitude of hyperglycemia were analyzed using Pearson’s correlation. Results: 50 patients were included, predominantly women (66%, n = 33). The average age was 41 ± 14 years with a BMI of 26 ± 3 kg/m2 . Baseline glucose was 83 ± 10 mg/dL. After each steroid pulse, glucose increased to 140 ± 28, 160 ± 38 and 183 ± 44, respectively (p <0.001). C-peptide and insulin concentrations increased significantly (p <0.001). The prevalence of fasting hyperglycemia after each pulse was 68%, 94% and 98%, respectively. We found no correlation between the magnitude of hyperglycemia and the studied variables. Conclusion: Methylprednisolone pulses produced significant increases in fasting glucose in most patients without diabetes. Further studies are needed to define its role in long-term consequences