Efforts have been made to lay down analytical standards for Mehamudgara vati (MMV), which were not found reported till date. Weight variation showed that 90% tablets of MV manufactured in the Gujarat Ayurved University Pharmacy were within acceptable range (323 mg ± 10%), pH 4.58, and disintegration time 17 min, whereas hardness was 1.25 kg/cm2. Loss on drying was found to be 9.3% w/w, acid insoluble ash was 0.9 %w/w, water soluble extract was 24.06% w/w and methanol soluble extract 14.1% w/w. Determination of iron as Fe2O3 was done as Lauha bhasma being the major ingredient of MMV. The result showed that iron content was reduced in the formulation (28.67%) as compared to that in Lauha bhasma (61.19%). In TLC, 5 spots each at 254 nm and 366 nm were found.
Lauha-bhasma; Mehamudgara vati; standardization; thin layer chromatography
Diabetic nephropathy is a specific form of renal disease. It is a major cause of renal insufficiency and ultimately of death. The present study has been carried out to prove the efficacy of Ayurvedic drugs in the management of diabetic nephropathy, which can be helpful in reducing the need of dialysis and avoiding or delaying renal transplantation. A total of 130 patients of this disease were treated in IPD (Group A) and OPD (Group B). Ayurvedic formulations including Gokshuradi Guggulu, Bhumyamalaki, Vasa and Shilajatvadi Vati were given to all the patients for 2 months. Group A patients were given special planned food. Results were analyzed statistically using “t” test. In group A patients, highly significant reduction was found in the values of serum creatinine, blood urea and urinary excretion of albumin. Marked improvement was found in the patients’ general physical well-being, together with reduction in symptoms, in group A patients. This shows the importance of Pathyapathya in Ayurvedic management of the disease. This management may bring some new hope to the patients of diabetic nephropathy, which usually terminates to chronic renal failure and ultimately to death. Further studies are being carried out in this regard.
Ayurveda; diabetic nephropathy; albuminuria
Mice minute virus (MMV) and mouse parvovirus (MPV) type 1 are the two parvoviruses known to naturally infect laboratory mice and are among the most prevalent infectious agents found in contemporary laboratory mouse colonies. Serologic assays are commonly used to diagnose MMV and MPV infections in laboratory mice; however, highly accurate, high-throughput serologic assays for the detection of MMV- and MPV-infected mice are needed. To this end, the major capsid viral protein (VP2) genes of MMV and MPV were cloned and MMV recombinant VP2 (rVP2) and MPV rVP2 proteins were expressed by using a baculovirus system. MMV rVP2 and MPV rVP2 spontaneously formed virus-like particles that were morphologically similar to empty parvovirus capsids. These proteins were used as antigens in enzyme-linked immunosorbent assays (ELISAs) to detect anti-MMV or anti-MPV antibodies in the sera of infected mice. Sera from mice experimentally infected with MMV (n = 43) or MPV (n = 35) and sera from uninfected mice (n = 30) were used to evaluate the ELISAs. The MMV ELISA was 100% sensitive and 100% specific in detecting MMV-infected mice, and the MPV ELISA was 100% sensitive and 98.6% specific in detecting MPV-infected mice. Both assays outperformed a parvovirus ELISA that uses a recombinant nonstructural protein (NS1) of MMV as antigen. The MMV rVP2 and MPV rVP2 proteins provide a ready source of easily produced antigen, and the ELISAs developed provide highly accurate, high-throughput assays for the serodiagnosis of MMV and MPV infections in laboratory mice.
The present study was aimed to assess the clinical effectiveness of Rasona Rasnadi Ghanavati and Simhanada Guggulu along with Rasona Rasnadi Lepa in Amavata, and to compare the effect of these two therapies in the treatment. Total 101 patients of Amavata were registered for the present study and were randomly divided into two groups. In group A- Rasona Rasnadi Ghanavati 2 Vati thrice/day was given for 3 months, while in group B- Simhanada Guggulu 2 Vati thrice a day for 3 months was adminstered. Along with this, Rasona Rasnadi Lepa was applied locally over affected joints twice daily in both groups. The effects of therapy in both groups were assessed by a specially prepared proforma. The results of the study showed that both the groups showed significant relief in symptoms; however, compared to Simhanada Guggulu, Rasona Rasnadi Ghanavati showed better result in the management of Amavata. Simhanada Guggulu or Rasona Rasnadi Ghanavati along with Rasona Rasnadi Lepa can be used as an effective ayurvedic intervention in the treatment for rheumatoid arthritis.
Ama; Amavata; Rasona Rasnadi Ghanavati; Rheumatoid arthritis; Simhanada Guggulu; Vata
Diabetes mellitus is a common chronic metabolic disorder prevalent all over the world. Virechana is the Shodhana procedure that is specific for the elimination of vitiated Pitta and Kapha doshas. Thus, in the present study, the Virechana process has been selected prior to the administration of Shamana drug. Nyagrodhadi churna is mentioned in Chakradatta, which is modified into Ghana form for easy administration and dose maintenance. The present study was conducted in two groups: Group A, Nyogrodhadi Ghana vati (Shamana therapy) and Group B, Virechana and Nyogrodhadi Ghana vati (combined therapy). A total of 42 patients were registered for the present study, in which 34 patients completed the and eight patients were dropouts. After evaluating the total effect of the therapies, it was observed that the Virechana and Nyagrodhadi Ghanavati (combined therapy) provided better relief in the patients of Madhumeha in comparison with Nyagrodhadi Ghanavati (Shamana therapy) alone.
Madhumeha; Prameha; Diabetes mellitus; Shodhana; Virechana; Shamana
Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide. The present clinical study deals with the effect of Makandi (Coleus forskohlii (Willd.) Briq.) Ghana vati and tablets of its powder in hypertension found in the geriatric age group (50-80 years). A total of 49 hypertensive patients fulfilling the diagnostic criteria were registered in two groups-Group I (Ghana vati) and Group II (Churna tablet). Out of 27 enrolled patients of group I, 21 patients completed the treatment. In Group II, out of 22 registered patients, a total of 20 patients completed the treatment. The effect of the therapy was assessed on the basis of changes in the systolic and diastolic blood pressures, in both sitting and supine positions; with Manasa Bhava Pariksha, Manasa Vibhrama Pariksha, symptomatology, geriatric signs and symptoms, and a brief psychiatric rating scale. Analysis of the results showed that the treatment in both the groups had been found to be good. It can be stated that Makandi, either in Ghana vati form or in churna tablet form, is an effective remedy for the treatment of hypertension. On analyzing the overall effect, 76.19% patients in Group I and 75.00% patients in Group II were mildly improved. Comparatively the overall treatment with group I was found to be better.
Makandi; Coleus forskohlii; forskolin; Ghana vati; geriatric hypertension
Childhood period is considered as the period of rapid growth and development, as it is the crucial stage of establishing future. Gastro-intestinal disorders show high prevalence in pediatric practice. These conditions generally produce chronic illness. Grahanidosha is a disease related with Agnidushti. This condition is seen more in childhood period due to faulty dietary habit and changing lifestyle. The present paper deals with study on etiopathogenesis of Grahanidosha and evaluates the efficacy of Deavadarvyadi-Vati. The etiological factors and symptoms were observed carefully to make clear etiopathogenesis. Total 32 patients (3-12 years) were registered and randomly divided into two groups. In Group A Devadarvyadi-Vati (treated group) and in Group B Bhunimbadi-Vati (control group) given for 4 weeks with Koshna Jala. In Group A (Devadarvyadi-Vati), marked improvement was observed in 21.43% of the patients, moderate improvement was observed in 57.14% of patients and mild improvement was observed in 21.43% of patients.
Bhunimbadivati; Devadarvyadivati; Grahani Dosha
To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life (QOL) in patients with diabetes.
Materials and Methods:
This is a prospective randomized controlled intervention trial. Patients having HbA1c between 6 and 9% for at least 3 months with lifestyle modification and oral antidiabetic medication were included. They were followed-up and randomized at 6 months into two groups: one group receiving standard treatment of diabetes and the other group receiving standard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program (Sudarshan Kriya Yoga and Pranayam). Change in fasting and post-prandial blood sugars, glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF questionnaire were assessed.
There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following standard treatment alone, although this was not significant. There was significant improvement in physical, psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following standard treatment alone.
There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following standard treatment alone.
Comprehensive yogic breathing program; diabetes mellitus; quality of life
Lymphocyte microvilli mediate initial adhesion to endothelium during lymphocyte transition from blood into tissue but their molecular organization is incompletely understood. We modified a shear-based procedure to prepare biochemical fractions enriched for membrane/microvilli (MMV) from both human peripheral blood T-lymphocytes (PBT) and a mouse pre-B lymphocyte line (300.19). Enrichment of proteins in MMV relative to post nuclear lysate was determined by LC/MS/MS analysis and label-free quantitation. Subsequent analysis emphasized the 291 proteins shared by PBT and 300.19 and estimated by MS peak area to be highest abundance. Validity of the label-free quantitation was confirmed by many internal consistencies and by comparison with Western blot analyses. The MMV fraction was enriched primarily for subsets of cytoskeletal proteins, transmembrane proteins and G-proteins, with similar patterns in both lymphoid cell types. The most enriched cytoskeletal proteins were microfilament-related proteins NHERF1, Ezrin/Radixin/Moesin (ERMs), ADF/cofilin and Myosin1G. Other microfilament proteins such as talin, gelsolin, myosin II and profilin were markedly reduced in MMV, as were intermediate filament- and microtubule-related proteins. Heterotrimeric G-proteins and some small G-proteins (especially Ras and Rap1) were enriched in the MMV preparation. Two notable general observations also emerged. There was less overlap between the two cells in their transmembrane proteins than in other classes of proteins, consistent with a special role of plasma membrane proteins in differentiation. Second, unstimulated primary T-lymphocytes have an unusually high concentration of actin and other microfilament related proteins, consistent with the singular role of actin-mediated motility in the immunological surveillance performed by these primary cells.
Lymphocyte microvilli initiate adhesion to endothelium during movement from blood into tissue. Using LC/MS/MS and label-free quantitation, we identify proteins enriched in membrane/microvilli (MMV) fractions from lymphocytes (primary human T-lymphocytes and mouse pre-B lymphocyte line). The cytoskeletal proteins most enriched in both lymphocyte types are microfilament-related proteins NHERF1, Ezrin/Radixin/Moesin (ERMs), ADF/cofilin and Myosin1G. Heterotrimeric G-proteins and some small G-proteins (especially Ras and Rap1) are also enriched. Complementary approaches provide confirmation.
lymphocyte; microvillus; proteome; LC-MS/MS; label-free quantitation; cytoskeleton; small-GTP-binding protein; Myo1G; NHERF1; cofilin
OBJECTIVE—Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) is a multinational, randomized, controlled trial designed to compare the effects of prandial versus fasting glycemic control on risk for cardiovascular outcomes in patients with type 2 diabetes after acute myocardial infarction (AMI).
RESEARCH DESIGN AND METHODS—Patients (type 2 diabetes, aged 30–75 years) were randomly assigned within 21 days after AMI to the 1) prandial strategy (PRANDIAL) (three premeal doses of insulin lispro targeting 2-h postprandial blood glucose <7.5 mmol/l) or the 2) basal strategy (BASAL) (NPH twice daily or insulin glargine once daily targeting fasting/premeal blood glucose <6.7 mmol/l).
RESULTS—A total of 1,115 patients were randomly assigned (PRANDIAL n = 557; BASAL n = 558), and the mean patient participation after randomization was 963 days (range 1–1,687 days). The trial was stopped for lack of efficacy. Risks of first combined adjudicated primary cardiovascular events in the PRANDIAL (n = 174, 31.2%) and BASAL (n = 181, 32.4%) groups were similar (hazard ratio 0.98 [95% CI 0.8–1.21]). Mean A1C did not differ between the PRANDIAL and BASAL groups (7.7 ± 0.1 vs. 7.8 ± 0.1%; P = 0.4) during the study. The PRANDIAL group showed a lower daily mean postprandial blood glucose (7.8 vs. 8.6 mmol/l; P < 0.01) and 2-h postprandial blood glucose excursion (0.1 vs. 1.3 mmol/l; P < 0.001) versus the BASAL group. The BASAL group showed lower mean fasting blood glucose (7.0 vs. 8.1 mmol/l; P < 0.001) and similar daily fasting/premeal blood glucose (7.7 vs. 7.3 mmol/l; P = 0.233) versus the PRANDIAL group.
CONCLUSIONS—Treating diabetic survivors of AMI with prandial versus basal strategies achieved differences in fasting blood glucose, less-than-expected differences in postprandial blood glucose, similar levels of A1C, and no difference in risk for future cardiovascular event rates.
To examine the effect of “DeepaniyaVati”, a herbal formulation in the management of hyperlipidemia, a randomized group pre-test post-test study trial was carried out on fifty male (30 to 70 yrs) hyperlipidemic volunteers who were asked to follow their normal routine diet and activity pattern throughout the investigation period. The formulation, prepared by mixing nine plant products in equal proportion, when given in a daily dose of 2g, twice a day for a period of one month, brought about an observable improvement in all the lipid parameters by significantly reducing total cholesterol (10%), low density lipoprotein cholesterol (12.76%), very low density lipoprotein cholesterol (27.4%), triglycerides (34.7%) and bringing these values much nearer to the normal levels. In control group, no such effect was noticed. A concomitant significant increase in the HDL-C levels suggests the possible utility of “Deepaniya Vati” in the management of hyperlipidemia and the need for further detailed study.
Hyperlipidemia; herbal formulation; lipoproteins; cholesterol; triglycerides
Aim. Based on the previously established method, we developed a better and stable animal model of type 2 diabetes mellitus by high-fat diet combined with multiple low-dose STZ injections. Meanwhile, this new model was used to evaluate the antidiabetic effect of berberine. Method. Wistar male rats fed with regular chow for 4 weeks received vehicle (control groups), rats fed with high-fat diet for 4 weeks received different amounts of STZ once or twice by intraperitoneal injection (diabetic model groups), and diabetic rats were treated with berberine (100 mg/kg, berberine treatment group). Intraperitoneal glucose tolerance test and insulin tolerance test were carried out. Moreover, fasting blood glucose, fasting insulin, total cholesterol, and triglyceride were measured to evaluate the dynamic blood sugar and lipid metabolism. Result. The highest successful rate (100%) was observed in rats treated with a single injection of 45 mg/kg STZ, but the plasma insulin level of this particular group was significantly decreased, and ISI has no difference compared to control group. The successful rate of 30 mg/kg STZ twice injection group was significantly high (85%) and the rats in this group presented a typical characteristic of T2DM as insulin resistance, hyperglycemia, and blood lipid disorder. All these symptoms observed in the 30 mg/kg STZ twice injection group were recovered by the treatment of berberine. Conclusion. Together, these results indicated that high-fat diet combined with multiple low doses of STZ (30 mg/kg at weekly intervals for 2 weeks) proved to be a better way for developing a stable animal model of type 2 diabetes, and this new model may be suitable for pharmaceutical screening.
Amlapitta is a disease caused by increase of Amla Guna of Pitta. Starch obtained from the rhizomes of two plants viz., Curcuma angustifolia Roxb. (Fam. Zingiberaceae) and Maranta arundinacea Linn. (Fam. Marantaceae) are used as Tugaksheeree. In the present clinical study, the efficacy of Tugaksheeree was studied on 67 patients of Amlapitta. A 0 total of 84 patients suffering from Amlapitta were selected from the O.P.D. and I.P.D. sections in the department of Dravyaguna, I.P.G.T. and R.A., Hospital, Jamnagar, and were randomly divided into two groups. Thirty four patients completed the treatment course in Group I, and 33 patients completed the treatment course in Group II. The efficacy of drug Tugaksheeree was studied through internal administration of the starches of C. angustifolia Roxb. (Fam. Zingiberaceae) in Group I and M. arundinacea Linn. (Fam. Marantaceae) in Group II with the dose of 4 g TID with water for 30 days. Both the drugs were found highly effective in treating Amlapitta. They significantly relieved the cardinal symptoms viz., Avipaka, Tikta-amlodgara, Daha, Shoola, Chhardi and the associated symptoms viz., Aruchi, Gaurava, Udaradhmana, Antrakujana, Vit bheda, Shiroruja, Angasada, and Trit. Statistically significant increase in body weight was noticed in both the groups. This may be because the drugs corrected the Agni and acted as Brihmana and Dhatupushtikara. Both the drugs did not produce any side effects. Therefore, both these drugs (C. angustifolia Roxb. and M. arundinacea Linn.) can be used as substitutes for each other.
Tugaksheeree; Curcuma angustifolia Roxb. and Maranta arundinacea Linn. Starch; Amlapitta
In the present clinical study, 63 patients of Amavata were registered from the Kayachikitsa out patient department/indoor patient department (OPD/IPD) of Sir Sunder Lal Hospital (Indian Medicine Wing), IMS, BHU, Varanasi-5. In group I (Rasona Pinda), 27 patients completed the study of a total of 33patients registered in the group (six patients dropped out mid–therapy). In group II (control group), 23 patients completed all three follow-ups out of 30 patients (there were seven dropouts in mid–therapy). In group I, complete remission in 29.6%, major improvement in 59.3% and minor improvement in change font so as to appear 11.1% were observed. In group II, complete remission in 13%, major improvement in 21.7%, minor improvement in 39.1% and unchanged in 26.9% of the patients were observed.
Amavata; Rheumatoid Arthritis; Agni; Ama; Rasona Pinda; Visual Analog Scale
Grahani and Agni are having Adhara-Adheya-Sambandha. Grahani is described as an Agni Adhishthana by most of the acharyas. Mandagni is a root cause of Ama Dosha and it is the crucial factor for manifestation of most of the diseases. Among them, Grahani is the prime disease of gastro-intestinal tract and seen often in day-to-day practice. A total of 66 patients were randomly divided in three groups and treated with: A) Kalingadi Ghanavati, three vatis of 500 mg twice daily with takra, B) Tryushnadi Ghrita, 10 g twice daily before meal with lukewarm water and C) Combination of both the drugs for 14 days. An assessment was done on the basis of Rogabala, Dehabala, Agnibala, and Chetasabala. The study revealed that combination proved better results than those of individuals.
Ama Dosha; Grahani Roga; Agni; Kalingadi Ghanavati; Tryushnadi Ghrita; Rogabala; Dehabala; Agnibala; Chetasabala
Studies have shown that diabetes is accompanied by an increased oxidative damage to all the bimolecular. Enhanced oxidative stress contributes to the development of the diabetic complications. The key lipid soluble chain breaking antioxidant,-tocopherol, is known to be deficient in diabetes. Human intervention studies have indicated the role of vitamin E in improving the endothelial function, the retinal blood flow and the renal dysfunction. The aim of the study was to find the role of vitamin E in preventing the development and the progression of the diabetic complications.
Both type I and II DM patients with and without complications were included in this study. They were divided separately into the test (which received insulin/oral hypoglycemic and vitamin E) and the control groups (which received only insulin/oral hypoglycemic drugs). The Fasting Blood Sugar(FBS), Post-prandial Blood Sugar(PPBS) and the Total Cholesterol(TC) were estimated and the Blood Pressure (BP) was noted at 0(beginning),12,18 and 24 months. Cardiovascular disease, retinopathy, nephropathy and foot ulcer development and progression were monitored. The data was analyzed by the Z test for the means and for the proportions.
It was evident from the analysis of the data that the PPBS, TC and the Diastolic Blood Pressure (DBP) declined gradually and significantly in the test groups. This was a beneficial development for the diabetic patients. The patients who were on the vitamin E supplementation had a delayed development and a slow progression of the complications.
Vitamin E supplementation has an important role in delaying the onset of the diabetic complications as well as for slowing down the progression of the complications
Diabetes mellitus; Antioxidant; Diabetic complications
Real-time continuous glucose monitoring (RT-CGM) improves hemoglobin A1c (A1C) and hypoglycemia in people with type 1 diabetes mellitus and those with type 2 diabetes mellitus (T2DM) on prandial insulin; however, it has not been tested in people with T2DM not taking prandial insulin. We evaluated the utility of RT-CGM in people with T2DM on a variety of treatment modalities except prandial insulin.
We conducted a prospective, 52-week, two-arm, randomized trial comparing RT-CGM (n = 50) versus self-monitoring of blood glucose (SMBG) (n = 50) in people with T2DM not taking prandial insulin. Real-time continuous glucose monitoring was used for four 2-week cycles (2 weeks on/1 week off). All patients were managed by their usual provider. This article reports on changes in A1C 0–12 weeks.
Mean (±standard deviation) decline in A1C at 12 weeks was 1.0% (±1.1%) in the RT-CGM group and 0.5% (±0.8%) in the SMBG group (p = .006). There were no group differences in the net change in number or dosage of hypoglycemic medications. Those who used the RT-CGM for ≥48 days (per protocol) reduced their A1C by 1.2% (±1.1%) versus 0.6% (±1.1%) in those who used it <48 days (p = .003). Multiple regression analyses statistically adjusting for baseline A1C, an indicator for usage, and known confounders confirmed the observed differences between treatment groups were robust (p = .009). There was no improvement in weight or blood pressure.
Real-time continuous glucose monitoring significantly improves A1C compared with SMBG in patients with T2DM not taking prandial insulin. This technology might benefit a wider population of people with diabetes than previously thought.
type 2 diabetes mellitus; lifestyle; real-time continuous glucose monitoring; self-care of diabetes; self-monitoring of blood glucose
Hypertension is a major public health problem of this era. Hypertension related morbidity and mortality rates have dramatically increased over the last 25 years. Stressful life style is one of the leading causes of Hypertension. The treatment of hypertension remains a primary goal in the effort to reduce morbidity and mortality from cardiovascular disease, stroke and kidney disease. In this study, 20 patients were randomly divided in two groups and treated along with restricted diet pattern for 8 weeks. Patients of Group A received poly-herbal compound formulation Shankhapushpyadi Ghana Vati (2gm/day). It was found that, relief in overall symptoms (63.93%) elevated blood pressure (8.91% in Systolic blood pressure and 8.44% in diastolic blood pressure). In group-B, with Sarpagandhadi Ghana Vati (2gm/day) the percent relief was better on elevated blood pressure (12.00% in Systolic blood pressure and 11.02% in diastolic blood pressure). When data is subjected in between both the groups, it is found that, both drugs are equally effective.
Diastolic blood pressure; essential hypertension; Shankhapushpyadi Ghana Vati; Sarpagandhadi Ghana Vati; systolic blood pressure
To assess the effect of intraday glucose variability (GV) on cardiovascular outcomes in a reanalysis of Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) study data.
RESEARCH DESIGN AND METHODS
Type 2 diabetic patients after acute myocardial infarction were randomized to an insulin treatment strategy targeting postprandial (PRANDIAL; n = 557) or fasting/interprandial (BASAL; n = 558) hyperglycemia. GV was calculated as mean amplitude of glycemic excursions (MAGE), mean absolute glucose (MAG) change, and SD.
The PRANDIAL strategy resulted in an 18% lower MAG than BASAL (mean [SEM] difference 0.09 [0.04] mmol/L/h, P = 0.02). In addition, MAGE and SD were lower in the PRANDIAL group, however, not significantly. HbA1c levels and cardiovascular event rates were comparable between groups.
A PRANDIAL strategy demonstrated lower intraday GV vs. a BASAL strategy with similar overall glycemic control but did not result in a reduction in cardiovascular outcomes. This does not support the hypothesis that targeting GV would be beneficial in reducing subsequent secondary cardiovascular events.
The present work was undertaken to study interrelation of Fibrinogen, Lp(a) and LVMI in Type II diabetes patients with or without nephropathy. 100 Type II Diabetic patients attending OPD/IPD of DMC&H, Ludhiana were included. They were divided in two groups. Group I: 50 patients without microalbuminuria (MAU). Group II: 50 patients with MAU. Fibrinogen (Clauss method), Lp(a) and MAU were estimated on Multichannel Autoanalyzer Hitachi-911 (Roche). LVMI was estimated by echocardiography using formula of Devereux and Reicheck. Type II diabetes patients with MAU had significantly raised levels of Fibrinogen, Lp(a), and LVMI as compared to normoalbuminuric diabetics (P < 0.01). Group II patients had positive correlation between Lp(a) and LVMI but no relation between Fibrinogen and LVMI. MAU, marker of microangiopathy, is associated with higher Fibrinogen and Lp(a) levels. This becomes basis of increase cardiovascular risk as demonstrated by higher mean LVMI in Group II patients.
LVMI; Microalbuminuria; Cardiovascular disease
Basal-prandial insulin therapy is a physiologic approach to insulin delivery that utilizes multiple daily injections to cover both basal (ie, overnight fasting and between-meal) and prandial (ie, glucose excursions above basal at mealtime) insulin needs. While basal-prandial therapy with multiple daily injections is an important therapeutic option for patients with type 2 diabetes, there is a common perception that this therapy is difficult to initiate in the primary care setting. To address this issue, a panel of clinical experts convened to develop practical recommendations on how to initiate basal-prandial therapy in patients with type 2 diabetes, focusing on patient selection, simple dosing and titration, and monitoring. Patients with type 2 diabetes who are appropriate candidates for basal-prandial insulin therapy include those who: 1) are unable to achieve glycemic control on oral antidiabetic drugs, 2) are unable to achieve glycemic control on split-mixed/premixed insulin regimens, 3) are newly diagnosed but unlikely to respond to oral antidiabetic drugs alone (ie, the patient has severe hyperglycemia or a markedly elevated glycosylated hemoglobin A1C level for which oral antidiabetic drug therapy alone is unlikely to achieve goals), and 4) prefer this therapy due to socioeconomic or other individual considerations. Basal-prandial insulin can be initiated in a simple stepwise manner, starting first with the addition of basal insulin to the existing oral antidiabetic drug regimen, followed by the introduction of 1 prandial insulin injection to the basal insulin plus oral antidiabetic drug regimen (after basal insulin has been optimized). Subsequently, other injections of prandial insulin may be added when needed. Based on home glucose monitoring data, patients may be converted from split-mixed or premixed insulin regimens to basal-prandial regimens with similar ease. Basal-prandial therapy using newer insulin formulations, such as long- and rapid-acting insulin analogs, can be relatively simple to use in patients with type 2 diabetes and is an appropriate methodology for application by primary care clinicians.
To study the antidiabetic activity of Barleria prionitis Linn in normal and alloxan-induced diabetic rats.
Materials and Methods:
Alcoholic extract of leaf and root of B. prionitis was tested for their antidiabetic activity. Albino rats were divided into six groups of six animals each. In three groups, diabetes was induced using alloxan monohydrate (150 mg/kg b.w., i.p.) and all the rats were given different treatments consisting of vehicle, alcoholic extract of leaves, and alcoholic extract roots of B. prionitis Linn (200 mg/kg) for 14 days. The same treatment was given to the other three groups, comprising non-diabetic (normal) animals. Blood glucose level, glycosylated hemoglobin, liver glycogen, serum insulin, and body weight were estimated in normal and alloxan-induced diabetic rats, before and 2 weeks after administration of drugs.
Animals treated with the alcoholic extract of leaves of B. prionitis Linn showed a significant decrease in blood glucose level (P<0.01) and glycosylated hemoglobin (P<0.01). A significant increase was observed in serum insulin level (P<0.01) and liver glycogen level (P<0.05), whereas the decrease in the body weight was arrested by administration of leaf extract to the animals. The alcoholic extract of roots showed a moderate but non-significant antidiabetic activity in experimental animals.
The study reveals that the alcoholic leaf extract of B. prionitis could be added in the list of herbal preparations beneficial in diabetes mellitus.
Barleria prionitis; alloxan monohydrate; alcoholic extract
To improve glycemic control and prevent late complications, the patient and diabetes team need to adjust insulin therapy. The aim of this study is to evaluate the efficacy of thrice-daily versus twice-daily insulin regimens on HbA1c for type 1 diabetes mellitus by a randomized controlled trial in Hamedan, west of Iran.
The study included 125 patients under 19 years of age with type 1 diabetes mellitus over a 3-month period. All patients with glycohemoglobin (HbA1c) ≥8% were followed prospectively and randomized into two trial and control groups. The control group received conventional two insulin injections per day: a mixture of short-acting (regular) + intermediated acting (NPH) insulins pre-breakfast (twice daily), and the trial group was treated by an extra dose of regular insulin before lunch (three times daily). Main outcome measure was HbA1c at baseline and at the end of 3 months. The mean blood glucose level and number of hypoglycemia were recorded. All patients underwent monthly intervals follow up for assessing their home blood glucose records and insulin adjustment.
Overall, 100 patients completed the study protocol. 52% were females, mean ±SD of age of 12.91 ± 3.9 years. There were no significant differences in baseline characteristics including age, gender, pubertal stage, adherence to diet, duration of disease and total daily insulin dose (p>0.05). There was a significant decrease individually in both groups in HbA1c level (p<0.05), but there was no significant difference in HbA1c reduction in patients on twice-daily insulin injections and those on thrice-daily insulin injection groups (1.12 ± 2.12 and 0.98±2.1% respectively, p>0.05).
Compared with twice daily insulin, a therapeutic regimen involving the addition of one dose regular insulin before lunch caused no significant change in the overall glycemic control of patients with type 1 diabetes mellitus. Our results emphasize that further efforts for near normoglycemia should be focused upon education of patients in terms of frequent outpatient visits, more blood glucose monitoring and attention to insulin adjustments
HbA1C; insulin; Type 1 diabetes mellitus
The main objective of this study is to illustrate the various characteristics including care of patients and changes in lifestyle of type 2 diabetics during Ramadan in Dhahira region, Oman.
This was a hospital-based study conducted during the month of Ramadan in 2006. Of the 453 recruited, 334 (73.7%) with complete data were analyzed. Student t test was used for comparison of means and Chi-square test for proportions.
We analyzed 334 patients with type 2 diabetes. The common complication associated with diabetes was coronary artery disease (19.5%) and nearly 60% of the study subjects had hypertension as co-morbidity. There was little or no change in the lifestyle activities and Insulin/Oral AntiDiabetic Drug (OAD) doses during Ramadan. Majority of diabetics had poorly controlled Fasting Blood Sugar (FBS) and Body Mass Index (BMI). The overall mean weight change was -0.49 ± 1.54 SD. There was a significant weight loss during Ramadan (p<0.05).
The large proportions of uncontrolled type 2 diabetes patients in our region represent a challenge to our physicians during Ramadan. There is a need to improve diabetic management and intensive education before fasting. Clear guidelines for diabetic management including uncontrolled diabetics during Ramadan are essential in Oman.
Ramadan; fasting; Diabetes mellitus; lifestyle changes; weight; Oman
The V-Go™ is a once-daily disposable device that allows coverage of basal and prandial insulin requirements over a period of 24 hours. The aim of this proof-of-concept study was to evaluate the clinical functionality, safety, and pharmacodynamics of the V-Go delivering insulin aspart and redistributing a single basal dose of insulin glargine as a constant basal infusion supplemented with prandial insulin in subjects with type 2 diabetes mellitus.
In six subjects receiving once-daily subcutaneous (SC) injections of insulin glargine (≥15 U/day) with or without concomitant oral antidiabetic drugs, glargine was discontinued following a 3-day baseline phase. The V-Go was then applied to the lower abdomen of the subjects once daily for 7 days (days 1–3 inpatient, days 4–7 outpatient). Each V-Go provided a continuous 24-hour preset basal infusion rate of insulin aspart (0.6 U/h) and up to three daily prandial doses at mealtimes. Capillary blood glucose concentrations were measured at 11 time points per day during the baseline and inpatient phases and at 4 time points per day during the outpatient phase. Additionally, glucose profiles were measured continuously on all days.
The V-Go was well tolerated and operated as anticipated. The mean ± SEM prestudy daily dose of SC insulin glargine was 33.3 ± 13.8 U; the mean daily total insulin aspart dose infused with the V-Go was 31.5 ± 7.5 and 32.3 ± 7.8 U for the inpatient and outpatient periods, respectively. Fasting blood glucose values were similar to those observed at baseline throughout the study, with nonsignificant (NS) reductions in readings collected during the outpatient phase before lunch (-35 ± 27 mg/dl) and before dinner (-38 ± 25 mg/dl). The 2-hour postprandial glucose trended lower from 231 to 195 mg/dl (NS) at breakfast, 234 to 166 mg/dl (NS) at lunch, and 222 to 171 mg/dl (NS) at dinner. Bedtime blood glucose decreased (mean change from baseline -52 ± 21 mg/dl; P = 0.0313), as did nighttime (3:00 AM) measurements (-20 ± 9 mg/dl; P = 0.0313). Overall glycemic control tended to improve, as shown by continuous glucose monitoring changing from 173 to 157 mg/dl (P = 0.063, NS) and 156 mg/dl (P = 0.219) during inpatient and outpatient periods, respectively. Glycemic variability assessed by the M value similarly tended to decrease from 33 ± 9 to 25 ± 4 (NS) and 21 ± 4 (NS) for inpatient and outpatient periods, respectively.
These first data suggest that use of the V-Go is an attractive alternative to SC insulin injection therapy because metabolic control appears to be maintained or even improved without increasing daily insulin doses.
basal–prandial insulin; continuous subcutaneous insulin infusion; glycemic control; h-Patch; type 2 diabetes; V-Go