To compare the role of drugs glibenclamide and pioglitazone in type 11 non-insulin-dependent diabetic patients. Authors: Raj Kumar Chohan, Mashor Ghulam Rasool, Ghulam Rasool Bhurgri, Shamim-u-Rehman, Mustafa DahriGhulam, Anis-u-Rehman. Introduction: —
To compare the role of drugs glibenclamide and pioglitazone in type 11 non-insulin-dependent diabetic patients.
Authors: Raj Kumar Chohan, Mashor Ghulam Rasool, Ghulam Rasool Bhurgri, Shamim-u-Rehman, Mustafa DahriGhulam, Anis-u-Rehman.
Introduction: —
Diabetes comes from the Greek word for 'TRAP' that one is the first term implies much urine is made. The TRM "mellitus" comes from a word latón, "met" which means "honey" and was used because the urine was low (Wheeler, 2004)
Ketaocidosis diabetes is a life threatening condition requiring that certain data hospitalization and treatment. Recognition of this condition is almost important as even slight delays can have an impact on survival (Nattrass, 2006). Hypoglycemia is involved in insulin-induced episodes in people with diabetes. Probably the major limitation factor, insulin-treated patients from achieving the objectives of glucose necessary to prevent diabetic complications. The incidence of hypoglycemia reflects inadequancy Mathod delievery of current insulin that lead OT for the inappropriately high insulin levels, including some people after eating foods at the onset of night blindness and also an important risk factor for heart disease and stroke
(Heller, 2003).
TYPES OF DIABETES MELLITUSTYPE 1 diabetes mellitus (IDDM) Type I diabetes affects children of all ages, both sexes and all groups athenic. Type 1 diabetes usually occurs by mechanisms. It is most common metabolic status in children and adolescents (Bui, 2004). Type1diabetes is characterized by an immune-mediated destruction of pancreatic beta cells causing insulin deficiency. It follows a common biochemical end of hyperglycemia and the risk of ketoacidosis, but the clinical presentaion varies widely depending on the rate and degree of B-cell failure (Lambert & Bingley. 2005). Diabetes mellitus type II (NIDDM):
TYPES OF DIABETES MELLITUS
TYPE 1 DIABETES MELLITUS (IDDM):
Diabetes mellitus type II (NIDDM):
Diabetes type II is a complex metabolic disorder associated with dysfunction of B cells and with different degrees of insulin resistance major pathogenic factors leading to insulin resistance leading to type 2 diabetes and reduced the insulin secretion faced with abnormalities in liver, skeletal muscle and pancreatic B cells (Charles & Clark, 1996).
GESTATIONAL Diabetes Mellitus Mellitus: The women who develop glucose intolerance in late pregnancy and that women with previously undiagnosed diabetes.
SWEET GESTATIONAL Diabetes Mellitus
Women who develop impaired glucose tolerance in late pregnancy and that women with previously undiagnosed diabetes.
SECONDARY mellitus diabetes mellitus:
SECONDARY mellitus diabetes mellitus:
Secondary diabetes is caused by disease and pancreatic system endocrime, genetic disorders, or exposure to chemical agents.
Type – I diabetes, formerly called insluin dependent diabetes mellitus (IDDM) is characterized by destruction of pancreatic beta cells that produced inslulin
- Diabetes Type I diabetes, formerly called insulin-dependent (IDDM) is characterized by destruction of pancreatic beta cells that produce insulin. Type 1 diabetes occurs most often in children and young adults but it can be at any age. (Anderson et al 2007).
Type-11 diabetes uprward is not right. A pancreas that does not produce enough insulin. That liver glucose output too, the muscle cells that do not readily as glucose. (McCarren 2008)
Many genetic factors are involved in the development of diabetes. Because researchers new genetic methodology are firm to identify all candidate genes for non-insulin dependent diabetes and insulin-dependent (Bernhard, 1995).
Women who had gestational diabetes are more likely to develop type 11diabetes themselves. Pergnant women with diabetes are another disadvantaged group. They need much more intensive prenatal care and close monitoring of blood glucose, blood pressure and weight. (jawed2006)
On children's weight progression of childhood obesity in adulthood is associated with early development of complications, including diabetes IgpG2 and cardiovascular disease. The diabetes is the form most common clinical accountingforabout of diabetes by 90% of all cases, it is currently undergoing epidemic worldwide. 11diabetes mellitus type is caused by the infectious body use insulin, it is often the result of excess weight and physical inactivity (WHO 2007).
PREVALACES & IINCIDENCE:
PREVALACES & IINCIDENCE
Diabetes mellitus increases with age, in 200, the prevalence of diabetes was estimated at 0. 19% people20 years. It is considered a geographic variation in the incidence of both type 1 and type-11 diabetes mellitus. Scavandinvian has the highest incidence of type 1 diabetes mellitus e. g in Finland, the incidence is 35/100, 000 per year, the Pacific region has a much lower rate in Japan and China, the incidence is 1 to 3 / 100, 00 year Type 1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100, 000 per year). The prevalence of type 11 diabetes mellitus is higher in some Pacific islands, intermediate in countries like India and the United States, and relatively low in Russia and China. This variability is probably due to genetic resources, beharioral and environmental factors (Power, 2005). Diabetes mellitus is prevalent also raises ethical people in different countries in a given, it is common in all ethnic groups in its prevalent with increasing age and more than 5% of people over 65 have diabetes mellitus (David Owerback 1988). The prevalence of diabetes worldwide has increased dramatically over the last two decades. The prevalence of diabetes mellitus diabetes TYPE11 is expected, type 11 diabetes mellitus is more prevalent among Hispanic America indigenous, African, American and Asian Pacific Islanders than in non-Hispanic whites, the incidence is substantially equal in Women and men in all populations. Diabetes Type 11 is becoming more common as people live longer, and the prevalence of diabetes increases with age, it is also seen more frequently now than before youth, in association with the rise of childhood obesity prevalenceof Although diabetes TYPE11 still countries with Nuber estimates of diabetes cases in 2000and 2030.
Rank Country
2000 individuals with diabetes countries (milloin)
Country
2030 Individuals with diabtes (Million)
India
31. 7
India
79. 47
China
20. 8
China
42. 3
United States
17. 7
United States
30. 3
Indonesia
8. 4
Indonesia
21. 3
Japan
6. 8
Pakistan
13. 9
Pakistan
5. 2
Brazil
11. 3
Russian Federation
4. 6
Bangladesh
11. 1
Brazil
4. 6
Japan
8. 9
Italy
4. 3
Philippines
7. 8
Bangladesh
3. 2
Egypt
6. 7
(Wareham & Forouhi 2OO6)
DRUG TREATMENT OF DIABETES MELLITUS:
DRUG TREATMENT OF DIABETES MELLITUS
Biguanides lower blood glucose levels, they increase the absorption of glucose use in skeletal muscle including reducing insulin resistance and reduce hepatic glucose production (gluconeogenesis). Lowering blood glucose reduces additionally denisity lipoproteins and low denisity very low (LDL and VLDL), respectively. Metformin has a half-life of approximately 3 hours and is excreted unchanged in urine. Metformin has been clinically used in type 2 diabetes who are obese and who fail treatment with diet alone. Adverse effects are produced dose-related gastro-intestinal e. g anorexia, diarrhea, nausea, lactic acidosis, a rare but potentially fatal toxic effects. (Dale, 2003).
Improving insulin sensitivity by activating certain genes involved in the synthesis of fat and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved. Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone, but they are usually taken in combination with sulfonylurease.
In some studies incouraging, thaiazolidiniones have produced very positive effects on the heart, including reducing blood pressure and triglycerides and improved levels Cholestrol including increased levels of HDL, the good Cholestrol. They may also block a molecule called 11 Best HSK that may play an important role in the metabolic syndrome and diabetes TYPE11. One study also sugessted that rosiglitazone May even improve the function of beta cells and thus help prevent the progression of diabetes. , Gain weight, anemia, increased risk of fluid accumulation, May worson heart failure. Troglitazone, was withdrawn after some reports of heart failure. Liver failure, death Abd. Don Thiazoldinediones present does not seem the same effects on the liver, although there have been few reports of liver damage.
In patients with failure-dietry choice of an agent of sulfonylurea or insulin therapy has been controversial and empric for insulin therapy are studies that have reported a marked improvement after receiving a diagnosis post intensive treatment in the short term untreated type 2 diabetes mellitus (Scarlett et al, 1984) sulfonylureas further classified into two groups and generations in terms of their power, duration, drug interactions, patterns of side effects. Sulfonylureas improve insulin action in cultured cells and stimulating the synthesis of glucose transporters (Jacobs et al 1998). A sulfonylurea should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) recommends also that a generic drug should be perscribed (Scsade and al1998).
RESEARCH DESIGN AND MATERIALS AND METHODS:
RESEARCH DESIGN AND MATERIALS AND METHODS:
This study was conducted in deprtment of Pharmacololgy and Therapeutics, Basic Medical Science Institute, Jinnah Postgraduate Medical Center, Karachi, under the supervision of a od RRC: GhulamRsool Mashor, Associate Professo and Head of Department of Pharmacology and Therapeutics in coworkers with Medical Outpatient Department and filter Unit111 Clinic, Medical Department, JPMC, Karachi.
Seventy NIDDM (type II) diabetic patients were initially enrolled in the study of the clinic of the filter input / output of the patient medical service unit III, and the diabetic clinic. Of these 60 patients were associated with diabetes throughout the study period, 10 patients remaining were abandoned due to poor comlpiance or relocation housing. All patients were divided into two main groups, Group I and Group II, these patients were selected in this study based on criteria of inclusion and exclusion.
Inclusion Criteria:
Inclusion Criteria
EXCLUSION CRIRERIA:
EXCLUSION CRIRERIA
EQUIPMENT:
EQUIPMENT:
DRUGS
DRUGS
Tab: 5 mg Daonil (Aventis Pharma)
Drug class: sulfonylurea.
Generic Name: Glibenclamide.
MFGLIC: 000,007 No. RegistrationNO. 000220
FG Date :0-06
EXP Date :7-10
Lot No: B230
Tab: Pioz (Hilton Pharm) PvtLTd.
Tab: Poizer 15mg
Drug class: Thaiazolinedione.
Generic name: Pioglitazone hydrochloride.
MFG LIC: O. 000,136 Registration No. 03,270
FG Date :3-06
EXP Date :3-o9
Lot No: 6287
Tab: Poizer (Hilton Pharma) Pvt Ltd..
PARAMETERS:
Fasting blood glucose (FBS).
Random Blood Sugar (RBS).
Weight.
Keywords: diabetes, non-insulin diabetes mellitus depedent insulin Daonil, poizer, insulin.
RESULTS:
RESULTS:
Table 1
Table 1
Weight and blood sugar levels observed on day reference: 0
In group 1 and group11
Group 1
Group 11
Pioglitazone n = 27
Glibenclamide n = 33
Weight
63. 37
+ 2. 25
¯
62. 7
+ 15. 56
¯
FPG
172. 7
+ 13. 32
¯
188. 42
+ 12. O5
¯
Random Blood Sugar
285. 11
+ 15. 532
¯
284. 18
+ 17. 07
¯
All values are expressed as mean ± SEM.
FIGURE 1-weight and blood glucose levels observed at baseline (Day-O)
In Table shpwing weight (Kg's) and blood sugar (msg/dl0 levels is observed at baseline (day 0) in both groups 9group: 1 & group11)
Group: 1 Weight (Kg's) mean ± SEM) is 63. 37 ± 2. 25 of fasting blood sugar 172. 7 ± 13. 32, and randomly
blood sugar 285. 11 ± 15. 32
Group: 11 Weight (KG's0 (mean + SEM) 62. 7 ± 1 56. FPG (mg/dl0 188. 42 ± 12. 05, Random blood sugar is 284. 18 ± 17. 03.
Group: 11
Figure 2 show the weight and blood glucose levels observed in the baseline (day 0) in group 1 and group 11 weight 9 kg), its average values are 63. 37.62. 7, blood sugar fasting (mg / dl) is 172. 71, 188. 42 Random blood sugar (mg / dl) is 285. 11 & 284. 18.
TABLE 2
Peroidic Observation In all Group1 Settings
Goup1 (pioglitazone) n = 27
P-value
Day-0
Day-45
Day-90
Day-0to45
Day-45-90
Weight
63. 37
± 2. 25
63. 63
± 2. 26
63. 63
± 2. 23
> 0. 05
(NS)
> 0. 05
(NS)
FPG
172. 7
± 13. 32
165. 04
± 8. 98
153. 37
± 7. 59
> 0. 05
(NS)
0. 05
(NS)
Randomblood sugar
285. 11
± 15. 32
279. 78
± 13. 63
255. 56
± 12. 65
> 0. 05
(NS)
> 0. 05
(NS)
All values are expressed as mean ± SEM. (NS) not significant.
Table No: 2
Table No: 2
List of periodic observations in all parameters in group 1 (piogiltazone) (n 27) weight P. value (day 0 to day 45)> 0. 05 (NS). FPG> 0. 05 (NS), random blood sugar> 0. 05 (NS) p. Values 90 days of weight> 0. 05 (N. S), FBS> 0. 05 (N. S) 7RBS> 0. 05 (N. S) not significant
FIGURE 2 This is the periodic observation of all parameters in group 1 day0 Day 45 & Day-90. The mean values of weight (Kg) is 63. 37.63. 26.63. 63, FBS (mg / dl) 172. 7165. 04,153. 37, RBS (mg / dl) 285. 11,279. 78,255. 56.
TABLE NO3
Peroidic observation in All group11 Settings
Group 11 (glibenclamide)
N = 33
P-value
Day-0
Day-45
Day-90
Day-0-45
Day-45-90
Weight
62. 7
± 1. 56
65. 64
± 2. 10
64. 55
± 1. 92
> 0. 05 (NS)
0. 05 (NS0
FPG
188. 42
± 12. 05
168. 45
± 10. 99
140. 06
± 5. 68
> 0. 05 (NS)
> 0. 05 (S)
Random blood sugar
284. 18
± 17. 03
220. 12
± 13. 39
170. 94
± 5. 80
0. 002 (MS0
(s) significant (MS) significantly moderate
All values are expressed as mean ± SEM.
Table 3:
Table 3:
Showing comments in all regular parameters in Goup: 11 Group: 11 containing drugs (glibenclamide), none of the patients (n = 33). It's P-value on day 0 to 45 days on the weight> 0. 05 (NS), FBS> 0. 05 (N. S) RBS
Figure 3: Shwing periodic observations in all parameters in group 11 Weight 62. 7.65. 64.64. 55, FBS (mg / dL) 188. 42,168. 45 140. 06, RBS (mg / dl) 284. 18 220. 12, 170. 94 (the day 0-day 45 to 90).
DISCUSSION:
DISCUSSION:
In Denmark, Beck-al Nielsenet, Skillman TG (1981) published studies demonstation that glyburide increased number of E receptors on monocytes of patients with diabetes mellitus type 11. Some patients were treated with a diet and Cobin second-generation agents sulfonyureas Wie. The number of insulin receptors all patients were measured before and after treatment. Test glucose Intrvenous shows impairent persistent afterthe secretion of insulin from the drug. However, those patients who were on drug Pioglitazone some results have been obtained from the secretion of insulin in the early treatment drug impairment. Clinical observations have suggested that second-generation sulfonylureas May exert their effects by potentiating insulin released by the promoters of other primary insulin secreting drugs.
According to the study of WilliamC Dukworth et al (1972), aftr chronic treatment with sulfonylureas, it is well established that plasma insulin levels were reduced in response to glucose load orally. This place, apparently, even if glucose tolerance is improved over pre-treatment levels, this study clearly support this study.
The result of the group GL 11 is correlated with research conducted by Kimmel & Bonnie (2005) produced the same results as FBS reduced from baseline, and at the end of the study, with an overall 23. 44% reduction, whereas with the results showed at the end of the study Peroid p-values were (p
Similarly, Michael Alvarsson et al (2003) conducted a similar study and found the changes and overall change of 22. 11% FBS and 40. 88% in rubles at the end of the trial p-values were (p
However, a study conducted by (Stone & Brown (2003) didnot correspond to our results in the setting of FBS and observer for a reduction of 26 years. 22%.
CONCLUSION:
CONCLUSION:
In light of the discussion paper, it is obiovus glibenclamide was more effective, tolerable and safer than pioglitzone in a short time. Diabetes mellitus is a chronic disease to prolong the whole life. Poor communities can afford it easily, based on the marketing of this drug in diabetic patients Pakistan easily go and buy economically, in fact, most people buy it in pharmacies without perscription dr, because the pharmacist and patient both know about this disease. Like dispirin as an analgesic, it is famous anti-diabetic drugs in our countries compared to other anti-diabetic.
Refernces:
Refernces: