Insulin sparing effect of hydroxychloroquine in uncontrolled diabetes mellitus

Hydroxychloroquine (HCQ) has a favorable glycemic effect that provides a rationale for its use in diabetes mellitus. Decreased insulin degradation and increased insulin sensitivity is suggested to contribute to the reduction in serum glucose levels. Herein, we present a case on the beneficial impact of HCQ on glycemic control in diabetes mellitus. A 69-year old female suffering from type 2 diabetes mellitus presented to the clinic for routine follow up. For management of diabetes she was taking glimepiride 4mg once daily, combination of metformin and sitagliptin (1000/50 mg) twice daily and 94 units of insulin/day. Baseline fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels were 183 and 222 mg/dL respectively and glycosylated hemoglobin A (HbA1c) level was 8.4%. To achieve glycemic control HCQ 400 mg once daily was initiated as an add on antidiabetic drug. HBA1c level decreased to 6.9% at four months and to 6.8% at eight months after HCQ was utilized. FPG level decreased to 110 mg/dL at six months and to 114 mg/dL at eight months. PPG level decreased to 178 mg/dL at six months and 130 mg/dL at eight months. Thus the FPG level decreased by 69 mg/dL and PPG level decreased by 92 mg/dL respectively from baseline. Acknowledging the progressive positive response to antidiabetic agents, the insulin dose was decreased to 56 units/day at four months, 42 units/day at six months and 28 units/day at eight months. The case highlights the potential ability of HCQ to lower HbA1c and decrease insulin requirement in uncontrolled diabetic patients

Oszczędzające insulinę działanie hydroksychlorochiny w źle wyrównanej cukrzycy typu 2

Hydroxychloroquine (HCQ) has a favorable glycemic effect that provides a rationale for its use in diabetes mellitus. Decreased insulin degradation and increased insulin sensitivity is suggested to contribute to the reduction in serum glucose levels. Herein, we present a case on the beneficial impact of HCQ on glycemic control in diabetes mellitus. A 69-year old female suffering from type 2 diabetes mellitus presented to the clinic for routine follow up. For management of diabetes she was taking glimepiride 4 mg once daily, combination of metformin and sitagliptin (1000/50 mg) twice daily and 94 units of insulin/day. Baseline fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels were 183 and 222 mg/dL respectively and glycosylated hemoglobin A (HbA1c) level was 8.4%. To achieve glycemic control HCQ 400 mg once daily was initiated as an add on antidiabetic drug. HBA1c level decreased to 6.9% at four months and to 6.8% at 8 months after HCQ was utilized. FPG level decreased to 110 mg/dL at 6 months and to 114 mg/dL at 8 months. PPG level decreased to 178 mg/dL at 6 months and 130 mg/dL at 8 months. Thus the FPG level decreased by 69 mg/dL and PPG level decreased by 92 mg/dL respectively from baseline. Acknowledging the progressive positive response to antidiabetic agents, the insulin dose was decreased to 56 units/day at 4 months, 42 units/day at 6 months and 28 units/day at 8 months. The case highlights the potential ability of HCQ to lower HbA1c and decrease insulin requirement in uncontrolled diabetic patients.Hydroksychlorochina (HCQ) ma korzystny wpływ na poziom glikemii, co może stanowić podstawę dla jej zastosowania w cukrzycy. Obniżenie poziomu glikemii ma prawdopodobnie związek ze zwiększoną wrażliwością na insulinę oraz zmniejszoną jej degradacją. W niniejszej pracy przedstawiamy przypadek obrazujący korzystny wpływ HCQ na wyrównanie glikemii w przebiegu cukrzycy. Pacjentka w wieku 69 lat, chorująca na cukrzycę typu 2, zgłosiła się na rutynową wizytę kontrolną. Dotychczas leczona była glimepirydem w dawce 4 mg/dobę oraz lekiem zawierającym połączenie metforminy i sitagliptyny (1000/50 mg) 2 razy dziennie. Przyjmowała również insulinę — 94 jednostek/dobę. Poziomy glikemii na czczo (FBG) oraz glikemii poposiłkowej (PPG) wynosiły odpowiednio 183 oraz 222 mg/dl, a stężenie hemoglobiny glikowanej (HbA1c) — 8,4%. W celu osiągnięcia założonego poziomu kontroli glikemii do leczenia włączono 400 mg HCQ raz dziennie. Stężenie HbA1c obniżyło się do 6,9% po 4 miesiącach terapii i do 6,8% po 6 miesiącach od rozpoczęcia leczenia HCQ. Poziom FBG zmniejszył się do 110 mg/dl po 6 miesiącach i wynosił 114 mg/dl po 8 miesiącach leczenia. Glikemia poposiłkowa po pół roku obniżyła się do 178 mg/dl, a po 8 miesiącach — do 130 mg/dl. Tak więc poziom FBG zmniejszył się o 69 mg/dl, a PPG — o 92 mg/dl w stosunku do wartości wyjściowych. W związku z postępującą w czasie pozytywną odpowiedzią na leki dawkę insuliny zmniejszono do 56, 42 i 28 jednostek/dobę odpowiednio po 4, 6 i 8 miesiącach. Przedstawiony przypadek przedstawia potencjalną możliwość obniżenia poziomu HbA1c i zmniejszenia zapotrzebowania na insulinę u pacjenta ze źle wyrównaną cukrzycą po zastosowaniu HCQ

Usage of Low-dose Glimepiride (0.5 mg) and Metformin Combination in the Management of Type 2 Diabetes Continuum in Indian Setting

Background: To understand the approach of clinicians about the treatment pattern, dosage, efficacy and safety of the combination of low-dose glimepiride (0.5 mg) and metformin fixed-dose combination (FDC) in the management of type 2 diabetes mellitus (T2DM) continuum in Indian settings. Methods: This case-based questionnaire survey included health care professionals (n = 112) across India, who were prescribing glimepiride and metformin FDC. Data were collected from the medical records and analyzed. Results: The data of 1,403 patients with T2DM were included. The mean age was 49.1 years and 68.4% of patients were males. The median duration of T2DM was 36 months. A total of 86.7% of patients received glimepiride and metformin FDC as first-line therapy. The most commonly prescribed (71.5%) dosage of glimepiride and metformin was 0.5 mg/500 mg. The titration of the dose was performed in 231 patients, of which 82.7% required up-titration and 17.3% required down-titration. The mean glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels reduced significantly (mean change: 1.2%, 36.5 mg/dL and 50.2 mg/dL,respectively) post-treatment. The hypoglycemic event and weight gain were reported in 7.7% and 9.5% of patients, respectively. Overall physician’s global evaluation of efficacy and tolerability was rated good to excellent in the majority of patients (>85%). Conclusion: Results demonstrate low-dose (0.5 mg) glimepiride and metformin FDC is effective in achieving glycemic control through lowering HbA1c, FPG and PPG levels with acceptable safety outcomes

A Pan-India, Knowledge, Attitudes and Practices (KAP) Study of Healthcare Practitioners in India Regarding Immunomodulatory Role of Vitamin D Supplementation in COVID-19

Introduction: Vitamin D has immunomodulatory effects and vitamin D deficiency has been associated with autoimmune responses and increased risk of infections. Vitamin D-mediated antimicrobial and anti-inflammatory responses play an effective role in the prevention of various respiratory tract infections including coronavirus disease 2019 (COVID-19). Aims and objective: To evaluate the therapeutic role of vitamin D via immunomodulation in COVID-19 through a Knowledge, Attitudes and Practices (KAP) study of pan India healthcare practitioners (HCPs) to arrive at a common consensus statement regarding dosage and duration of vitamin D for immune-modulatory function. Methods: A pan-India, online, questionnaire-based, KAP survey was conducted on vitamin D and its role in immunomodulation in COVID-19 from April 2021 to January 2022 followed by polling obtained from 2,338 HCPs through round table meetings (RTMs). Results: Approximately 64% of HCPs considered the use of vitamin D in COVID-19 patients for various reasons including prevention of illness, reduced ICU stay, reduction in morbidity and mortality along with decrease in the levels of inflammatory markers in COVID-19 patients. For the dosage regime, 47% of HCPs preferred vitamin D 60,000 IUweekly while 45% of HCPs preferred both 60,000 IU weekly and 2,000 IU daily dose for boosting immune system in their patients. Conclusion: The panel agreed that vitamin D levels of 40 ng/mL and above appear to confer better immune-protective response to several infections including COVID-19

Hypertension clinical care in the era of coronavirus disease 2019: Practical insights from India

Objective: The objective of this study was to seek the opinion of Indian health-care professionals (HCPs) about hypertension (HTN) care during coronavirus disease 2019 (COVID-19) era. Methods: HCPs' opinions (n = 2832) were recorded based on survey and round table meetings. Standard questionnaire consisting of nine questions pertaining to HTN care in COVID-19 was prepared, discussed, and evaluated by experts who treat patients with HTN during COVID-19 era. Results: Smoking/tobacco use, obesity, and comorbidities (diabetes/dyslipidemia) were ranked as the top three modifiable risk factors. A total of 37% and 33% of HCPs reported an increase in blood pressure (BP) during the lockdown period in 10%–20% and 20%–40% of hypertensive patients, respectively, who were on monotherapy. Around 35% of HCPs reported that 20%–30% of their patients with HTN showed uncontrolled BP (>150/100 mmHg). Dual-drug therapy in patients with uncontrolled BP was preferred by 56% of HCPs. Nearly 71% preferred dual combination for HTN management. In dual combination, 27% preferred angiotensin receptor blockers (ARBs) + diuretic, 26% preferred ARB + calcium channel blockers, and 18% preferred ARB + beta-blockers. The majority of HCPs (44%) consider that <30% of their patients with HTN check BP at home. A total of 47% of HCPs reported acute coronary syndrome as the most common HTN-related complication. The majority of HCPs (57%) considered that avoiding contamination during BP measurement is the challenging parameter. Around 32% considered self-BP monitoring (SBPM) as the best method to improve medication adherence. Conclusion: SBPM, combination therapies, and digital connect with patients are critical aspects of HTN management during COVID-19 pandemic

Resurgence of hypertension and cardiovascular diseases in patients recovered from COVID-19: An Indian perspective

Objective: The aim of this study was to understand the prevalence, extent, clinical approach of hypertension and cardiovascular disease (CVD) in patients recovered from COVID-19. Methods: The round table meetings (RTMs) and survey convened a diverse panel of specialists including cardiologists, endocrinologists, diabetologists, consultant physicians, and family physicians from various geographical zones of India. A standard questionnaire including 10 questions was developed pertaining to the resurgence of hypertension and CVD in patients recovered from COVID-19. The RTMs and survey were held virtually. The collected opinions and recommendations were compiled to derive a consensus document. Results: A stotal of 3066 health-care practitioners (HCPs) participated. Hypertension was the most prevalent comorbidity in patients recovered from COVID-19 followed by diabetes, dyslipidemia, and coronary artery disease. Almost two-thirds of HCPs reported that 10%–30% newly diagnosed hypertension in patients recovered from COVID-19. Uncontrolled hypertension in 10-20% of COVID-19 recovered patients opined by 45% of the HCPs. About, 35% HCPs reported CV complications in 10-20% of Covid-19 recovered patients and 63% HCPs reported exacerbations of CAD in 10-30% of patients. Majority of HCPs preferred to switch to dual combination therapy from monotherapy for hypertension management (52.0%) and ARBs and its combination is most preferred combination for hypertension control (60%). Majority of the HCPs suggested follow-up after 1-2 weeks (39.0%). Close monitoring on symptoms including chest pain and breathlessness (45.0%), adherence to medication and regular monitoring of lab parameters (25%) is recommended for these patients. Conclusion: Overall observations indicate an increased incidence of hypertension and CVDs post recovery from COVID-19. A dual therapy of ARBs was the preferred choice for management of hypertension. Regular follow-up and close monitoring of symptoms to prevent further CV complications in COVID-19 recovered patients is recommended