Role of adjuvant metformin therapy on HA1C in type 1 diabetes

BackgroundAdequate glycaemic control ‎is a protective strategy against ‎diabetic complication that achieved manly with insulin therapy, ‎‎studies have shown that type 1 diabetic patients had ‎a reduced insulin sensitivity, on view of this fact, ‎‎metformin as an insulin sensitizing agent was used in ‎trials as an adjuvant medication to the insulin. AimsCurrent study aimed to summarize the benefit of adjuvant metformin on HA1C in type 1 diabetes on glycaemic control.Methods A systematic electronic search was conducted including ‎the Pub Med, Google ‎Scholar, and EBSCO using the ‎‎following terms in different combinations: metformin, diabetes, ‎HA1c, and C- peptide. Out of two hundred and four articles, only ‎six were included.Results Six randomized control trials were identified, aimed to investigate the role of adjuvant metformin on glycaemic control in type 1 diabetes patients. Metformin in dose ranging between 1–2g per day were used for at least three months. Significant HA1c reduction was shown in two out of six trials.ConclusionAdministering adjunctive metformin therapy in type ‎‎1 ‎diabetic patients ‎associated with modest reduction in ‎HA1c, improve insulin resistance as indicated ‎by reduce ‎daily insulin ‎requirement.

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely