Usage Pattern of Glimepiride/Metformin Fixed-dose Combination in Type 2 Diabetes Patients with CVD or at Risk of CVD: An Experience in Indian Setting

Background: Diabetes is associated with almost twofold increased risk of cardiovascular diseases (CVD). The present case-based questionnaire survey evaluated the treatment pattern and clinical experience of healthcare professionals in prescribing glimepiride/metformin fixed-dose combination (FDC) to type 2 diabetes mellitus (T2DM) patients with CVD or those patients who are at risk of CVD in the Indian settings. Material and methods: A retrospective, multicenter, observational, case-based questionnaire survey was conducted in Indian healthcare centers using medical records of patients having T2DM, with CVD or are at risk of CVD, who were prescribed any strength of glimepiride/metformin FDC. Data was collected from the patients’ medical records and was analyzed using statistical tests. Results: A total of 680 patients with T2DM with CVD or at risk of CVD were included in this study. Mean duration of diabetes in the patients was 5.7 ± 4.8 years. About 68.5% patients had hypertension, 47.9% had dyslipidemia, 25.4% had coronary artery disease (CAD), 3.6% had transient ischemic attack (TIA), 4.8% had peripheral arterial disease (PAD) and 2.9% had heart failure. Around 18.1% patients had CVD after diabetes was diagnosed, while 81.9% presented with cardiovascular (CV) issues at the time of diabetes diagnosis. All patients received glimepiride/metformin FDC as first-line therapy. About 68.2% patients on glimepiride/metformin FDC had blood pressure within optimal limits. A large proportion of patients had improvement in glycemic parameters. Weight change was noted in 18.4% of the patients overall. Of these, 59.2% had reduction in weight. There were no major adverse events and treatment efficacy and tolerability were reported as good to excellent for 94.6% and 92.9% patients, respectively. Conclusion: This case-based questionnaire survey demonstrates the usage pattern of various strengths of glimepiride/metformin FDC and the clinicians’ practice approach regarding early initiation of this combination in Indian patients with diabetes who have or are at risk of CVD

Anemia profile in patients with congestive heart failure a hospital based observational study

Objectives: Iron deficiency (ID) is an emerging problem in patients with congestive heart failure (CHF) and can be a potential therapeutic target. As ID is highly prevalent in the society, it is hypothesized that Indian patients with CHF have high prevalence of ID. Methods: CHF patients (n = 275) were selected and underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin, ferritin, B12 and folate level. Results: Two hundred and seventy-five patients with heart failure (mean age - 62.72, mean Hb- 10.54 g/dl, 188 males [68.36%] and 87 females [31.64%]) were enrolled in the study. 211 out of 275 (76.7%) were found to be anemic. Out of 275 patients. 148 (53.8%) were diagnosed with iron deficiency. 12.7% (n = 35) were B12 deficient and 5.1% (n = 14) were folate deficient. In the anemic group, ID was present in 130 patients (61.61%), B12 deficiency in 32 patients (15.16%) and folate deficiency in 12 patients (5.68%). In the group of patients without anemia, ID was present in 18 patients (28.12%) while B12 and folate deficiency was present in 3 (4.68%) and 2 (3.12%) patients, respectively. Conclusion: Iron deficiency is present in substantial number while B12 and folate account for a few number of cases. Substantial number of patients without anemia were found to be iron deficient. Keywords: Anemia, Iron, B 12, Folate, Heart failur

Study on the Not-for-Profit Hospital Model in India

The “Not-for-Profit” Hospital Sector has the reputation of providing affordable and accessible healthcare for many years. This sector has done yeoman service over the years with some institutions from even before Independence. Although various institutions have been established for different purposes, this sector provides not only curative healthcare, but also preventive healthcare, and links healthcare with social reform, community engagement, and education. They utilize the resources and grants provided to them by the Government to provide cost effective healthcare to the population without being overly concerned about profits. However, this sector remains largely understudied, with a lack of awareness about its services in the public domain

Efficacy and safety of the intensive dose of rosuvastatin 40mg/day in patients with acute coronary syndrome and at high risk of cardiovascular disease-ROSUVEES-2

AbstractBackgroundRandomized clinical trials have established the benefits of statin therapy in acute coronary syndromes (ACS) via their pleiotropic effects.Aim of the studyThis was a 12-week, open-label, multicenter, postmarketing observational study evaluating the efficacy and safety of rosuvastatin 40 mg/day in very high-risk or high-risk Indian patients according to NCEP ATP III guidelines.MethodologyOne hundred and sixty two patients (age: 30 to 69 years) with evidence of coronary artery disease, hospitalized with chest pain with/without electrocardiogram changes and with non-ST segment elevation ACS and ST segment elevation ACS who received optimal reperfusion therapy were enrolled. The primary endpoint was the percent change from baseline in low-density lipoprotein cholesterol (LDL-C) levels at 6 and 12 weeks of treatment. Other lipid parameters, high sensitive C-reactive protein (hsCRP), glycosylated hemoglobin, and clinical biochemical parameters were also assessed.ResultsAt 12 weeks, intensive therapy with rosuvastatin 40mg/day significantly reduced LDL-C (p<0.001), total cholesterol (TC) (p<0.001), triglyceride (p<0.01), TC/high density lipoprotein cholesterol (HDL-C) ratio (p<0.001), non-HDL-C (p<0.001), LDL-C/HDL-C ratio (p<0.001), and hsCRP (p=0.034) in very high-risk and high–risk patients with ACS. Overall, 54.5% (61/112) patients achieved LDL-C goal of <70mg/dL. However, the change in HDL-C and very low density lipoprotein cholesterol (VLDL-C) were not significant. Few adverse events including myalgia were reported during the study.ConclusionResults of this study showed that 40mg dose of rosuvastatin, initiated early and continued for 12 weeks, was effective in terms of reducing LDL cholesterol and was well tolerated

To study the effect of high dose Atorvastatin 40 mg versus 80 mg in patients with dyslipidemia

Objective: Primary objective was to compare the effects of atorvastatin 40 mg vs 80 mg on LDL-C in Indian patients with atherosclerotic dyslipidemia. Secondary objectives were to compare the effects of atorvastatin 40 mg vs 80 mg on HDL-C and triglycerides and also comparing of side effects (myopathy, hepatotoxicity and new onset diabetes mellitus) of both doses. Method: This Study is A Prospective, randomized, open-label, comparative study. This study was conducted on 240 patients of dyslipidemia (as per ACC/AHA 2013 lipid guidelines) attending the OPD/wards/CCU of department of cardiology, Sir Ganga Ram Hospital. They were randomly divided into 2 groups of 120 each. Group A consisted patients who received Atorvastatin 40 mg daily and Group B Atorvastatin 80 mg daily. The follow up period was 6 months. Results: At 3 and 6 month follow up, Atorvastatin 40 mg leads to mean LDL cholesterol reduction of 47.18 ± 20.81 & 50.03 ± 18.06 respectively. While Atorvastatin 80 mg results in LDL reduction as 50.11 ± 15.85 & 52.30 ± 13.72. The comparison between two doses revealed a non-significant difference (p = .118 & p = .149 respectively).At 6 months of follow up, few patients reported myalgia (2 in group A and 7 in Group B). The difference between groups was significant (p = .045). Although none of our patient had significant elevation of CPK. Conclusion: This study concluded that both doses of atorvastatin (40 & 80 mg) are equally efficacious in improving dyslipidemia but higher dose leads to more incidence of myalgia. Keywords: Atherosclerosis, Atorvastatin, Dyslipidemia, Myalgi

Nutritional significance of finger millet and its potential for using in functional products

Finger millet (Eleusine coracana L.), ragi or mandua, is one of essential minor millets extensively grown in the Indian and African subcontinents. It is a staple food in India, particularly for people belonging to low-socioeconomic groups. Finger millet is highly valued for its content of macro- and micronutrients. It is rich in carbohydrates, protein, and fat. Its micronutrients include calcium (0.38%), dietary fiber (18%), and phenolic compounds (0.3–3%), such as catechin, epicatechin, as well as ferulic, salicylic, protocatechuic, cinnamic, and hydroxybenzoic acids, etc. Finger millet is also recognized as a source of vital amino acids, including isoleucine, leucine, methionine, and phenylalanine, which are otherwise deficient in starchy meals. In addition, finger millet is well appreciated for its pharmacological properties such as anti-diabetic, anti-tumorigenic, anti-atherosclerogenic, antioxidant, and antimicrobial effects. To improve its nutritional and sensory properties, this grain can be processed by various traditional and advanced methods (soaking, malting, cooking, fermentation, popping, and radiation). These processing techniques equally assist in the reduction of anti-nutritional factors (tannins, phytic acid, oxalic acid, protein inhibitors, glucans) and their inhibitory effects. In this review, we highlighted the nutritional composition, health attributes, and uses of finger millet for the development of functional food products. Researchers and producers can further explore the opportunities and scope for utilizing finger millet and develop more products in the same line to solve the current issues of food and nutrition security