Usage of Glimepiride/Metformin Fixed-dose Combination with Insulin in Management of Type 2 Diabetes Mellitus: An Indian Experience

Background: Type 2 diabetes mellitus (T2DM) poses a major public health burden. The present case-based questionnaire survey evaluated the treatment pattern and clinical experience of healthcare professionals (HCPs) in prescribing glimepiride/metformin fixed-dose combination (FDC) with insulin, with or without other oral hypoglycemic agents (OHAs), to patients with T2DM in the Indian setting. Material and methods: A retrospective, multicenter, observational, case-based questionnaire survey was conducted at several healthcare centers in India with the help of medical records of patients having T2DM, who were prescribed different strengths of glimepiride/metformin FDC. Data was collected from the patients’ medical records and were analyzed using statistical tests. Results: A total of 1,013 patients with T2DM were included in this study. The mean (± standard deviation [SD]) age of patients was 53.5 ± 13.9 years. Mean duration of diabetes was 6.3 ± 4.8 years. About 70.1% of the patients received glimepiride/metformin FDC as first-line therapy and 29.9% received it as second-line therapy. Around 66.3% of the patients in first-line glimepiride/metformin FDC group received insulin once a day, and the proportion increased to 86.8% of the patients in second-line therapy group. Other OHAs were used in 754 (74.4%) patients. About 18.2% (n = 185) patients reported change in weight, with a slightly larger number of patients having reduction in weight. There was considerable reduction in HbA1c, FPG and PPG in patients receiving glimepiride/metformin FDC with insulin, irrespective of OHA use. Efficacy and tolerability were reported as good to excellent for 96.2% and 94.8% patients, respectively. Conclusion: This case-based questionnaire survey shows the usage pattern of various strengths of glimepiride/metformin FDC with insulin and the HCPs’ practice approach regarding early initiation of this combination in Indian patients with T2DM

Twin screw extrusion of conductive citrate-based biomaterials

The range of processing methods for thermoset bioelastomers is limited due to the insolubility of their highly crosslinked nature. In-line extrusion of biodegradable polyester elastomers and their composites would open new possibilities for high-precision manufacturing (i.e. 3D printing), solvent-free additive dispersion, and adhesion development for future clinical needs. An effective method to extrude elastomeric, conductive composites is demonstrated for the first time with polyoctanediol citrate/sebacate (POCS) as the bioelastomer. The POCS pre-polymer in its liquid form was blended with untreated multiwall carbon nanotubes (MWCNTs) and partially cured to produce the feedstock for twin-screw hot-melt extrusion. MWCNTs were mechanically sheered within the POCS matrix at a processing temperature of 120 °C, which thermocured from a viscoelastic liquid into an extrudable crosslinked composite rubber. Furthermore, the composite was thermally and electrically conductive with swelling and hydrolytic degradation kinetic properties dependent on MWCNT concentration. Extruded composite strings are classified as conductive polymers, with lowest resistivity of 3.5 kΩ cm measured for POCS-MWCNT-5% in comparison to POCS-MWCNT-1% at 22.7 kΩ cm. Extruded strings (∼2 mm in diameter) exhibit a tensile modulus of 5–7.5 MPa with an extensibility of 40–80%. The processing method lays the framework for rapid formulation development of citrate based biomaterial composites and scale-up production.Accepted versio