Pub Date : 2019-01-01DOI: 10.35248/2161-1017.19.8.303
A. Argaw, G TsegayeT, hiwet, Bodena B Derse
Background: Type 2 diabetes mellitus is a major public health problem which affects the large number of people worldwide. Diabetes mellitus patients are at high risk of experiencing drug therapy problems due to different factors. Involvement of pharmacists in the management of diabetes mellitus has been shown to reduce the incidence of drug therapy problems. Objectives: To assess the prevalence of drug therapy problems, pharmacists’ intervention and determinants of drug therapy problems in the management of type 2 diabetes mellitus patients. Methods: Facility based prospective cross sectional study was conducted among ambulatory type 2 diabetes mellitus patients at Madda Walabu University Goba Referral Hospital from April 1, 2017 to June 30, 2017. Data was analyzed using SPSS version 22. Descriptive statistics was performed to determine the proportion of drug therapy problems and pharmacist acceptance rate. Logistic regressions analysis was performed to identify determinants of drug therapy problems. A p-value of less than 0.05 was considered as statistically significant. Result: A total of 216 type 2 diabetes mellitus participants were included, of these 52.8% were males. The mean age of study participants was 57.07 ± 13.126 years. Among the study participants, 88% have at least one drug therapy problems. Needs additional drug therapy was the most frequent (50.2%) followed by non-compliance (21.7%). Metformin with glibenclimide and insulin were the most frequently prescribed anti diabetic drugs accounts for 40.3% and 27.8%, respectively. The recommendation done by pharmacists were 94%, the most common intervention done was to add new drug (50.2%). The acceptance rate for the interventions done was 72.6%. Conclusion: The prevalence of drug therapy problems among type 2 diabetes patients was high. Statin and metformin use not optimized. The involvement of clinical pharmacists in problems intervention should be promoted to decrease drug related risk and increase medication adherence of the diabetic patients.
背景:2型糖尿病是影响全球大量人群的主要公共卫生问题。由于各种因素的影响，糖尿病患者出现药物治疗问题的风险很高。药师参与糖尿病的管理已被证明可以减少药物治疗问题的发生率。目的:了解2型糖尿病患者药物治疗问题的发生率、药师干预及影响药物治疗问题的因素。方法:对2017年4月1日至6月30日在麦达瓦拉布大学戈巴转诊医院住院的非住院2型糖尿病患者进行基于设施的前瞻性横断面研究。数据分析使用SPSS version 22。通过描述性统计确定药物治疗问题的比例和药师接受率。进行逻辑回归分析以确定药物治疗问题的决定因素。p值小于0.05被认为具有统计学意义。结果:共纳入216例2型糖尿病患者，其中男性占52.8%。研究参与者的平均年龄为57.07±13.126岁。在研究参与者中，88%的人至少有一种药物治疗问题。需要额外的药物治疗是最常见的(50.2%)，其次是不依从性(21.7%)。二甲双胍联合格列苯利胺和胰岛素是最常用的抗糖尿病药物，分别占40.3%和27.8%。药师推荐的占94%，最常见的干预措施是添加新药(50.2%)。干预措施的接受率为72.6%。结论:2型糖尿病患者药物治疗问题的发生率较高。他汀和二甲双胍的使用没有优化。促进临床药师参与问题干预，降低糖尿病患者的药物相关风险，提高患者的用药依从性。
{"title":"Drug Therapy Problems and Determinants among Ambulatory Type 2 Diabetes Mellitus Patients: Pharmacists’ Intervention in South-East Ethiopia","authors":"A. Argaw, G TsegayeT, hiwet, Bodena B Derse","doi":"10.35248/2161-1017.19.8.303","DOIUrl":"https://doi.org/10.35248/2161-1017.19.8.303","url":null,"abstract":"Background: Type 2 diabetes mellitus is a major public health problem which affects the large number of people worldwide. Diabetes mellitus patients are at high risk of experiencing drug therapy problems due to different factors. Involvement of pharmacists in the management of diabetes mellitus has been shown to reduce the incidence of drug therapy problems. Objectives: To assess the prevalence of drug therapy problems, pharmacists’ intervention and determinants of drug therapy problems in the management of type 2 diabetes mellitus patients. Methods: Facility based prospective cross sectional study was conducted among ambulatory type 2 diabetes mellitus patients at Madda Walabu University Goba Referral Hospital from April 1, 2017 to June 30, 2017. Data was analyzed using SPSS version 22. Descriptive statistics was performed to determine the proportion of drug therapy problems and pharmacist acceptance rate. Logistic regressions analysis was performed to identify determinants of drug therapy problems. A p-value of less than 0.05 was considered as statistically significant. Result: A total of 216 type 2 diabetes mellitus participants were included, of these 52.8% were males. The mean age of study participants was 57.07 ± 13.126 years. Among the study participants, 88% have at least one drug therapy problems. Needs additional drug therapy was the most frequent (50.2%) followed by non-compliance (21.7%). Metformin with glibenclimide and insulin were the most frequently prescribed anti diabetic drugs accounts for 40.3% and 27.8%, respectively. The recommendation done by pharmacists were 94%, the most common intervention done was to add new drug (50.2%). The acceptance rate for the interventions done was 72.6%. Conclusion: The prevalence of drug therapy problems among type 2 diabetes patients was high. Statin and metformin use not optimized. The involvement of clinical pharmacists in problems intervention should be promoted to decrease drug related risk and increase medication adherence of the diabetic patients.","PeriodicalId":90490,"journal":{"name":"Endocrinology & metabolic syndrome : current research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69982238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.35248/2161-1017.19.8.301
S. Banzal, U. Kabadi
Background: Common causes of hypoglycemia include hypoglycemic agents including exogenous insulin and insulin secretagogues, increased endogenous insulin, decline in circulating cortisol, human growth hormone and enzymes required for glucose production as well as hepatic and renal dysfunction. Case presentation: Patient presented to emergency room with re-current seizures treated with Levetricatem and Topiramate for 10 years with increased frequency of 2-3/week during last 6 months. During ER visits to different hospitals for these episodes, plasma glucose, 1.5-1.8 mM/L and undetectable levels of insulin, C peptide, proinsulin, Insulin antibodies eliminated hyperinsulinemia due to insulinoma, insulin secretagogues as well as exogenous insulin as a cause of hypoglycemia. Normal HGH, ACTH and cortisol responses at onset of hypoglycemia excluded hypopituitarism with HGH and/or ACTH deficiency and primary adrenal insufficiency. Large tumor secreting IGF2 was eliminated by CT scans of chest and abdomen. Hepatic and renal disease as a cause of hypoglycemia were excluded as well by documentation of normal laboratory tests. Tramadol use in high daily dose confirmed by elevated urine levels and total remission of hypoglycemia and seizures following withdrawal of tramadol resulted in documenting this unique presentation of tramadol induced hypoglycemia. We believe lack of suppression of IGF2 in presence of hypoglycemia may indicate role of Tramadol in stimulating production or decreasing metabolism or clearance of IGF2 responsible for onset and perpetuation of hypoglycemia. Conclusion: A unique presentation of Tramadol induced hypoglycemia masquerading as a seizure disorder probably caused by IGF2 dysregulation.
{"title":"Tramadol Induced Hypoglycemia Masquerading as a Seizure Disorder","authors":"S. Banzal, U. Kabadi","doi":"10.35248/2161-1017.19.8.301","DOIUrl":"https://doi.org/10.35248/2161-1017.19.8.301","url":null,"abstract":"Background: Common causes of hypoglycemia include hypoglycemic agents including exogenous insulin and insulin secretagogues, increased endogenous insulin, decline in circulating cortisol, human growth hormone and enzymes required for glucose production as well as hepatic and renal dysfunction. Case presentation: Patient presented to emergency room with re-current seizures treated with Levetricatem and Topiramate for 10 years with increased frequency of 2-3/week during last 6 months. During ER visits to different hospitals for these episodes, plasma glucose, 1.5-1.8 mM/L and undetectable levels of insulin, C peptide, proinsulin, Insulin antibodies eliminated hyperinsulinemia due to insulinoma, insulin secretagogues as well as exogenous insulin as a cause of hypoglycemia. Normal HGH, ACTH and cortisol responses at onset of hypoglycemia excluded hypopituitarism with HGH and/or ACTH deficiency and primary adrenal insufficiency. Large tumor secreting IGF2 was eliminated by CT scans of chest and abdomen. Hepatic and renal disease as a cause of hypoglycemia were excluded as well by documentation of normal laboratory tests. Tramadol use in high daily dose confirmed by elevated urine levels and total remission of hypoglycemia and seizures following withdrawal of tramadol resulted in documenting this unique presentation of tramadol induced hypoglycemia. We believe lack of suppression of IGF2 in presence of hypoglycemia may indicate role of Tramadol in stimulating production or decreasing metabolism or clearance of IGF2 responsible for onset and perpetuation of hypoglycemia. Conclusion: A unique presentation of Tramadol induced hypoglycemia masquerading as a seizure disorder probably caused by IGF2 dysregulation.","PeriodicalId":90490,"journal":{"name":"Endocrinology & metabolic syndrome : current research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69981633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.35248/2161-1017.19.8.304
A. Thakur
Introduction: Hypothyroidism in adults has an insidious onset with a range of non-specific symptoms resulting in delayed diagnosis. Hypothyroidism is characterized by a broad clinical spectrum ranging from an overt state of myxedema, end-organ effects and multisystem failure to an asymptomatic or subclinical condition with normal levels of thyroxine and triiodothyronine and mildly elevated levels of serum thyrotropin. Thyroid dysfunction leads to altered glucose and lipid metabolism leading to insulin resistance, which is an important risk factor for cardio vascular diseases. This study attempts to study clinical and biochemical profile of patients with subclinical hypothyroidism or overt hypothyroidism. Aim of study: To study clinical and investigative profile of hypothyroidism in the newly diagnosed patients of hypothyroidism. Methods: All newly diagnosed hypothyroidism patients fulfilling inclusion and exclusion criteria were taken in to study. Demographic profile of all enrolled patients was recorded. They were subjected to detailed history and examination and the findings were recorded as a predesigned Performa. The clinical diagnosis of hypothyroidism was made as per Indian thyroid society guidelines. The following laboratory investigations were performed: serum lipid profile and serum uric acid using enzymatic assay, fasting insulin, creatinine, direct bilirubin, and the following liver function parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT). Thyroid-hormone profile, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), including anti-thyroid peroxidase (TPO). Observation and results: Between October 1, 2015 and September 30, 2016, 226 patients with newly diagnosed hypothyroidism were studied. Out of 226 patients, 48 patients excluded from the study. Central hypothyroidism was present in 4 patients and 44 were pregnant and lactating women. 178 patients with newly diagnosed hypothyroidism were enrolled in study. Out of 178 patients’ subclinical hypothyroidism was present in 29(16.9%) patients. Out of 178 patients, 131 (73.6%) were females and 47 (26.4%) were males and various parameters were studied. Conclusion: Our study confirms that dyslipidemia, insulin resistance and metabolic syndrome correlate positively with newly diagnosed hypothyroid patients.
{"title":"A Hospital-based Study for Clinico-investigative Profile of Newly Diagnosed Patients of Hypothyroidism","authors":"A. Thakur","doi":"10.35248/2161-1017.19.8.304","DOIUrl":"https://doi.org/10.35248/2161-1017.19.8.304","url":null,"abstract":"Introduction: Hypothyroidism in adults has an insidious onset with a range of non-specific symptoms resulting in delayed diagnosis. Hypothyroidism is characterized by a broad clinical spectrum ranging from an overt state of myxedema, end-organ effects and multisystem failure to an asymptomatic or subclinical condition with normal levels of thyroxine and triiodothyronine and mildly elevated levels of serum thyrotropin. Thyroid dysfunction leads to altered glucose and lipid metabolism leading to insulin resistance, which is an important risk factor for cardio vascular diseases. This study attempts to study clinical and biochemical profile of patients with subclinical hypothyroidism or overt hypothyroidism. Aim of study: To study clinical and investigative profile of hypothyroidism in the newly diagnosed patients of hypothyroidism. Methods: All newly diagnosed hypothyroidism patients fulfilling inclusion and exclusion criteria were taken in to study. Demographic profile of all enrolled patients was recorded. They were subjected to detailed history and examination and the findings were recorded as a predesigned Performa. The clinical diagnosis of hypothyroidism was made as per Indian thyroid society guidelines. The following laboratory investigations were performed: serum lipid profile and serum uric acid using enzymatic assay, fasting insulin, creatinine, direct bilirubin, and the following liver function parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT). Thyroid-hormone profile, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), including anti-thyroid peroxidase (TPO). Observation and results: Between October 1, 2015 and September 30, 2016, 226 patients with newly diagnosed hypothyroidism were studied. Out of 226 patients, 48 patients excluded from the study. Central hypothyroidism was present in 4 patients and 44 were pregnant and lactating women. 178 patients with newly diagnosed hypothyroidism were enrolled in study. Out of 178 patients’ subclinical hypothyroidism was present in 29(16.9%) patients. Out of 178 patients, 131 (73.6%) were females and 47 (26.4%) were males and various parameters were studied. Conclusion: Our study confirms that dyslipidemia, insulin resistance and metabolic syndrome correlate positively with newly diagnosed hypothyroid patients.","PeriodicalId":90490,"journal":{"name":"Endocrinology & metabolic syndrome : current research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69981799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.35248/2161-1017.19.8.302
M. Chege, C. Kunyanga, M. Mugambi
Objective: The socio-economic burden of diabetes is of increasing public health concern in Kenya and the world over. There have been unmet expectations with the current management of diabetes, which has led some to turn to honey for its therapeutic benefits. Honey is valuable in management of various infections, and has been associated with management of type 2 diabetes and related complications. This study sought to establish the knowledge and practices of people living with diabetes on the use of honey, and find any possible associations in management of diabetes and/or its complications. Methods: A cross-sectional study with a retrospective component was conducted on 139 respondents living with type 2 diabetes. This was done through a semi-structured interviewer-administered questionnaire to determine the respondents’ socio-economic status, their knowledge and attitude and how these influenced their use of honey, and the correlations to the disease management. Consecutive blood sugar readings recorded over three months prior to the study were obtained from the respondents’ hospital records. Health care providers were interviewed using a key informants guide to corroborate information obtained from respondents. Results: Knowledge on or perceived benefits of honey did not translate to its actual use (r=-0.064). The longer respondents consumed honey the more likely they were to have elevated blood glucose levels (>7.8 mmol/L). There were double the number of respondents using honey with elevated blood sugar levels than there were whose levels were within normal range (4.4-<7.8 mmol/L). However, only a third of the respondents using honey had associated complications of nephropathy, ketoacidosis and diabetic foot. Generally, the number of respondents ot using honey and experiencing any of the diabetes complications was at least two times more the number of those using honey. Conclusion: With continued use of prescription drugs, controlled use of honey could be associated with positive disease outcomes, for either diabetes and/or complications related to diabetes. However, further scientific studies on the topic may be warranted for stronger evidence to support the use of honey as a food intervention in the actual management of type 2 diabetes.
{"title":"Demystifying the Use of Honey in Diabetes Management: A Case of Type 2 Diabetes Patients at Kenyatta National Hospital, Nairobi, Kenya","authors":"M. Chege, C. Kunyanga, M. Mugambi","doi":"10.35248/2161-1017.19.8.302","DOIUrl":"https://doi.org/10.35248/2161-1017.19.8.302","url":null,"abstract":"Objective: The socio-economic burden of diabetes is of increasing public health concern in Kenya and the world over. There have been unmet expectations with the current management of diabetes, which has led some to turn to honey for its therapeutic benefits. Honey is valuable in management of various infections, and has been associated with management of type 2 diabetes and related complications. This study sought to establish the knowledge and practices of people living with diabetes on the use of honey, and find any possible associations in management of diabetes and/or its complications. Methods: A cross-sectional study with a retrospective component was conducted on 139 respondents living with type 2 diabetes. This was done through a semi-structured interviewer-administered questionnaire to determine the respondents’ socio-economic status, their knowledge and attitude and how these influenced their use of honey, and the correlations to the disease management. Consecutive blood sugar readings recorded over three months prior to the study were obtained from the respondents’ hospital records. Health care providers were interviewed using a key informants guide to corroborate information obtained from respondents. Results: Knowledge on or perceived benefits of honey did not translate to its actual use (r=-0.064). The longer respondents consumed honey the more likely they were to have elevated blood glucose levels (>7.8 mmol/L). There were double the number of respondents using honey with elevated blood sugar levels than there were whose levels were within normal range (4.4-<7.8 mmol/L). However, only a third of the respondents using honey had associated complications of nephropathy, ketoacidosis and diabetic foot. Generally, the number of respondents ot using honey and experiencing any of the diabetes complications was at least two times more the number of those using honey. Conclusion: With continued use of prescription drugs, controlled use of honey could be associated with positive disease outcomes, for either diabetes and/or complications related to diabetes. However, further scientific studies on the topic may be warranted for stronger evidence to support the use of honey as a food intervention in the actual management of type 2 diabetes.","PeriodicalId":90490,"journal":{"name":"Endocrinology & metabolic syndrome : current research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69981687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-17DOI: 10.4172/2161-1017.1000e107
Barry E Hurwitz
Compared with 4 decades ago, more than twice the adults (37%) are voluntarily restricting sleep from 8.5 hours to less than 7 hours per night [1–3]. Sleep curtailment has consequences that involve not just diminished daytime performance and enhanced sleepiness and fatigue [4], but may also facilitate disease mechanisms, manifesting in a high comorbidity of sleep dysfunction and subclinical cardiometabolic pathophysiology [5,6]. Indeed, epidemiological studies have linked chronic shortened and/or poor sleep with obesity [7,8], and then also with type2diabetes disease and cardiovascular [9–12]. Despite the attention of the health profession, the media, the public and mass educational campaigns about the benefits of healthier diets and increased physical activity, the prevalence of obesity in the United States has more than doubled over the past four decades [13,14]. This increasing prevalence constitutes a major public health challenge. In persons with obesity, cardiometabolic pathogenesis occurs prematurely, and is accelerated by factors that are likely to be a combination of the established risk factors, as well as underlying insulin and glucose metabolic dysfunction associated with prediabetes and metabolic syndrome (MetS) [15]. The impact of sleep curtailment on cardiometabolic processes has not been examined as a function of obesity, prediabetes, or MetS status. Sleep loss could contribute to the development of prediabetes and MetS by deleteriously affecting glycemic regulation and/or by influencing hunger, appetite, and feeding behavior and ultimately result in weight gain and obesity [5]. Evidence suggests that central obesity and insulin resistance may be central mediating pathways by which numerous biobehavioral factors, including sleep debt, drive subclinical cardiometabolic pathophysiology [16].
{"title":"Sleep Debt and Postprandial Metabolic Function in Subclinical Cardiometabolic Pathophysiology.","authors":"Barry E Hurwitz","doi":"10.4172/2161-1017.1000e107","DOIUrl":"https://doi.org/10.4172/2161-1017.1000e107","url":null,"abstract":"Compared with 4 decades ago, more than twice the adults (37%) are voluntarily restricting sleep from 8.5 hours to less than 7 hours per night [1–3]. Sleep curtailment has consequences that involve not just diminished daytime performance and enhanced sleepiness and fatigue [4], but may also facilitate disease mechanisms, manifesting in a high comorbidity of sleep dysfunction and subclinical cardiometabolic pathophysiology [5,6]. Indeed, epidemiological studies have linked chronic shortened and/or poor sleep with obesity [7,8], and then also with type2diabetes disease and cardiovascular [9–12]. Despite the attention of the health profession, the media, the public and mass educational campaigns about the benefits of healthier diets and increased physical activity, the prevalence of obesity in the United States has more than doubled over the past four decades [13,14]. This increasing prevalence constitutes a major public health challenge. In persons with obesity, cardiometabolic pathogenesis occurs prematurely, and is accelerated by factors that are likely to be a combination of the established risk factors, as well as underlying insulin and glucose metabolic dysfunction associated with prediabetes and metabolic syndrome (MetS) [15]. The impact of sleep curtailment on cardiometabolic processes has not been examined as a function of obesity, prediabetes, or MetS status. Sleep loss could contribute to the development of prediabetes and MetS by deleteriously affecting glycemic regulation and/or by influencing hunger, appetite, and feeding behavior and ultimately result in weight gain and obesity [5]. Evidence suggests that central obesity and insulin resistance may be central mediating pathways by which numerous biobehavioral factors, including sleep debt, drive subclinical cardiometabolic pathophysiology [16].","PeriodicalId":90490,"journal":{"name":"Endocrinology & metabolic syndrome : current research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32743112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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