The Effect of Pharmacist Counseling on Adherence to Antidiabetic Medications and Glycemic Control

Purpose: To assess the impact of pharmacist-led multifactorial interventions on health parameters, medication adherence, and disease-related knowledge among type 2 diabetic patients in southern Punjab, Pakistan.Methods: The effect of intervention was evaluated by randomly assigning patients into control group (n = 170), receiving conventional medical care, and intervention group (n = 178), receiving predefined specialized care. The primary outcome of this intervention study was improvement in glycemic control which was assessed by measuring fasting blood glucose and glycosylated haemoglobin (HbA1c) values.Results: The outcomes obtained clearly show the role of pharmacist counseling in the control of type 2 diabetes while improving fasting blood glucose (FBG) and HbA1c levels, reduction in Body Mass Index (BMI), improvement in disease knowledge as well as reduction in smoking. The intervention significantly reduced BMI and waist circumference by a difference of 1.87 (p = 0.014) and 1.27 (p = 0.002) between control and intervention groups. Glycemic control was significant within the intervention group, as evident by a reduction in fasting blood glucose level {-19.26 mg/dL (p = 0.003)} and HbA1c level {-1.01 % (p < 0.001)} compared to control group. The mean difference in glycemic control between both groups was insignificant but mild reductions were seen in fasting blood glucose (-11.95 mg/dL, p = 0.11) and HbA1c (-0.43 %, p = 0.12). A significant increase in disease-related knowledge was seen in the intervention group, compared to the control group which was evident by mean differences in compliance (p = 0.003), foot-care (p < 0.001) and self-monitoring of blood glucose (p = 0.001).Conclusion: The purpose of study was achieved in that it demonstrates that pharmacists can play a pivotal role in improving glycemic control in diabetic patients and that involvement of pharmacists in diabetic clinics is beneficial to the patients in terms of medication adherence and promotion of healthy lifestyle.Keywords: Diabetes, Intervention, Medication adherence, Glycemic control, BMI, HbA1c

Introduction: Type 2 diabetes mellitus (T2DM) known as Mathumegam is a significant health concern in the twenty-first century. Despite great advances in contemporary science, there is a lack of moderately safe and effective drugs for treatment. The purpose of this study was to evaluate the efficacy of a poly herbal traditional decoction containing 10 herbs such as Senna auriculata (root & bark), Cissampelos pareira (root), Ficus racemosa (bark), Terminalia arjuna (bark), Acacia arabica (bark), Syzygium cumini (bark), Curcuma longa (rhizome), Terminalia chebula (fruit pulp), Phyllanthus emblica (dry fruit), and Terminalia bellirica (fruit pulp) in the management of T2DM. Materials and Methods: It was a double-blind, randomized controlled trial involving 100 T2DM patients who were not well managed by diet or exercise. For a period of 12 weeks, 50 patients in group A were administered 5g of the test medication mixed with 100ml (one tumbler) of hot water for 10 to 15 min, as well as standard Western therapy. Group B patients (n=50) received a placebo in addition to normal Western therapy. The main focus of the study was to achieve a 3-month decrease in glycosylated hemoglobin (HbA1c) levels from the starting point, with additional objectives including lowering fasting blood glucose (FBG) levels and observing changes in diabetic symptoms. Results: At the end of the trial, mean fasting blood glucose levels decreased to 119.04 ± 11.52 and 176.90 ± 13.91 mg/dL in the test and control groups, respectively. Group A showed a more significant decrease in mean fasting blood glucose levels compared to group B. This indicates that the daily use of poly herbal traditional decoction along with standard allopathic medical therapy for 3 months led to notable reductions in FBG levels. Similarly, group A showed greater improvement in the measured signs and symptoms of diabetes, such as polydipsia, polyuria, polyphagia, weariness, and burning sensation in the hands and feet compared to group B throughout the trial. At baseline, the mean HbA1c (%) in group A and group B was 7.47 ± 0.70 and 7.39 ± 0.66, respectively. After 12 weeks of investigation, the levels of glycated hemoglobin were lowered to 5.03 ± 0.53 and 6.79 ± 0.51 respectively. There were no adverse events reported during the trial period. Conclusion: This study found that the experimental medication was beneficial in T2DM, radically lowering FBG and HbA1c levels in diabetic individuals after 12 weeks of treatment.

Poor glycemic control in type 2 diabetes mellitus (T2DM) causes damage to various organs and leads to the development of disabling and life-threatening complications. To find out the prevalence of glycemic control and medication adherence (MA) and the factors affecting them. A cross-sectional study was conducted among patients with T2DM. The patients were categorized as good glycemic control (HbA1c <7.0%) and poor glycemic control (HbA1c ≥7.0%). MA was categorized as low (score <6), medium (score 6 or 7), and high (score 8). The Statistical Package for Social Science (version 11.5) was used for statistical analysis at a P value less than 0.05. Of 129 patients, 65 (50.39%) were females. The mean age was 48.33 ± 12.86 years. The combination of metformin and glimepiride was prescribed to 37 (28.68%) patients. Diabetic knowledge was poor in 84 (65.12%) patients. Glycemic control was good in 108 (83.72%) patients. MA was medium in 72 (55.81%) patients. Patients taking regular fruit, having shorter duration of drug therapy, and having good diabetic knowledge had good glycemic control and were statistically significant (P value < 0.05). Patients having family support, nonalcoholic, taking regular fruit, being involved in daily jogging, having shorter duration of drug therapy, and having good diabetic knowledge had high MA and were statistically significant (P value < 0.05). The majority of the diabetic patients had good glycemic control and medium MA. Patients taking regular fruit, being involved in daily jogging, having a shorter duration of drug therapy, and having good diabetic knowledge were identified as factors that affect both glycemic control and MA.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) is among the most frequent chronic diseases in virtually all countries, posing a global health threat. Therefore, Preventive interventions are critical for reducing the enormous burden of diabetes. Flavanols may assist people with metabolic disorders to maintain glucose homeostasis by inhibiting digestive enzymes and glucose transporters. Green Tea (GT) and cocoa have gotten much attention since their flavanols are high. OBJECTIVES: To investigate the effects of polyphenols from GT and cocoa (&gt;4 weeks) on reducing the incidence of complications and improving glycaemic control and insulin sensitivity in adult patients with T2DM through outcomes Fasting Blood Glucose (FBG), Fasting Blood Insulin (FBI), Haemoglobin A1c (HbA1c) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). METHODOLOGY: An electronic research programme was applied, using different databases (including Web of Science, PubMed/Medline, Scopus, and Cochrane Reviews) to find studies that have evaluated the impact of polyphenols from GT and cocoa on reducing the incidence of complications and improving glycaemic control and insulin sensitivity in adult patients with T2DM. Articles published between 2005 and 2021 in English were selected. RESULTS: 15 and 7 studies involved 738 participants on GT (348 male/390 female). In contrast, the ones focused on cocoa had 331 participants (83 male/ 248 female) with T2DM aged 18–65 years, and a BMI range of 25–34.9 kg/m2 was identified and included in the present review. 43 and 27% of studies were low-risk bias in cocoa and GT, respectively. The results of the meta-analysis showed no significant difference in FBG levels following GT and cocoa consumption compared to the control group (SMD: –0.08; 95% CI: –0.43 to 0.28; P = 0.68 and SMD: –0.65; 95% CI, –1.40 to 0.10; P = 0.09, respectively). Also, the results showed no significant difference for GT and cocoa intervention (SMD: 0.18; 95% CI: –0.27 to 0.64; P = 0.43 and SMD: –0.80; 95% CI: –1.92 to 0.31; P = 0.16, respectively). In addition, the results of the HbA1c analysis showed no significant reduction after GT and cocoa consumption (SMD: –0.41; 95% CI: –0.85 to 0.03; P = 0.07 and SMD, –0.37; 95% CI, –0.77 to 0.04; P = 0.08, respectively). There was no evidence that GT and cocoa interventions effectively improved HOMA-IR (SMD: 0.02; 95% CI: –0.16 to 0.20; P = 0.80 and SMD, –1.65; 95% CI, –3.77 to 0.46; P = 0.13, respectively CONCLUSION: The evidence shows that the short-term administration of cocoa and GT did not significantly reduce the FBG, FBI, HbA1c, and HOMA-IR levels in adult patients with T2DM.

In China, the prevalence of type 2 diabetes mellitus (T2DM) among diabetic patients is estimated to be between 90%-95%. Additionally, China is among the 22 countries burdened by a high number of tuberculosis cases, with approximately 4.5 million individuals affected by active tuberculosis. Notably, T2DM poses a significant risk factor for the development of tuberculosis, as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis (T2DM-PTB), which has risen from 19.3% to 24.1%. It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature. To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis (T2DM-PTB), as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM. T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group, Simple DM patients presenting to our hospital in the same period were the control group, Controls and case groups were matched 1:2 according to the principle of the same sex, age difference ( ± 3) years and disease duration difference ( ± 5) years, patients were investigated for general demographic characteristics, diabetes-related characteristics, body immune status, lifestyle and behavioral habits, univariate and multivariate analysis of the data using conditional logistic regression, calculate the odds ratio (OR) values and 95%CI of OR values. A total of 315 study subjects were included in this study, including 105 subjects in the observation group and 210 subjects in the control group. Comparison of the results of both anthropometric and biochemical measures showed that the constitution index, systolic blood pressure, diastolic blood pressure and lymphocyte count were significantly lower in the case group, while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group. The results of univariate analysis showed that poor glucose control, hypoproteinemia, lymphopenia, TB contact history, high infection, smoking and alcohol consumption were positively associated with PTB in T2DM patients; married, history of hypertension, treatment of oral hypoglycemic drugs plus insulin, overweight, obesity and regular exercise were negatively associated with PTB in T2DM patients. Results of multivariate stepwise regression analysis found lymphopenia (OR = 17.75, 95%CI: 3.40-92.74), smoking (OR = 12.25, 95%CI: 2.53-59.37), history of TB contact (OR = 6.56, 95%CI: 1.23-35.03) and poor glycemic control (OR = 3.37, 95%CI: 1.11-10.25) was associated with an increased risk of developing PTB in patients with T2DM, While being overweight (OR = 0.23, 95%CI: 0.08-0.72) and obesity (OR = 0.11, 95%CI: 0.02-0.72) was associated with a reduced risk of developing PTB in patients with T2DM. T2DM-PTB patients are prone to worse glycemic control, higher infection frequency, and a higher proportion of people smoking, drinking alcohol, and lack of exercise. Lymphopenia, smoking, history of TB exposure, poor glycemic control were independent risk factors for T2DM-PTB, and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Poor and insufficient glycaemia management in people with Type 2 diabetes mellitus (DM) is a major public health issue that hastens the onset of diabetes related complications. Poor medication adherence among type2 diabetes mellitus patients is associated with inadequate glycaemia control, increased hospitalization, increase the risk of complications, increased mortality and morbidity. The main objectives of the study was to assess patient related factors associated with medication adherence and assess knowledge about diabetes and related complications among type II diabetes mellitus patients visiting an out-patient clinic, Bangalore. Data was entered and analyzed by using Microsoft excel and SPSS 22 version 29.0. It was found that, mean age of the study subjects was 49.89 years, majority of the subjects were male, of the respondents 30 (51.7%), 19 (32.75%) and 9 (15.5%) had good, average and poor level of diabetic knowledge respectively. 34 (59%) and 24 (41%) were adherent and non-adherent respectively. In this study, factors like male gender, having higher income, high socio-economic levels, following diabetic diet, maintaining physical activity on a regular basis, good knowledge about the disease and having stronger beliefs about medicines and their use were highly adherent to anti-diabetic medications indicating high medication adherence levels. Healthcare professionals such as pharmacists should implement effective health education interventions required to improve diabetes knowledge and beliefs regarding the disease and medications for better management of the disease which thereby results in improved quality of life, in addition medication compliance ensures a strategic diabetic management and

BackgroundBiotin is a water-soluble vitamin acting as a covalently bound coenzyme in regulating energy production. Previous studies have reported that biotin supplementation may influence blood glucose and lipid level in patients with type 2 diabetes mellitus (T2DM).MethodsWe searched Pubmed, Embase, and Cochrane library databases up to 8th August 2022 for studies examining the effects of biotin supplementation in T2DM patients. Pooled effects were measured by weighted mean differences (WMDs) with 95% confidence intervals (CI) using random effects models. Inter-study heterogeneity was assessed and quantified.ResultsA total of five random controlled trials (RCT), involving 445 participants were included. It was suggested that biotin supplementation for 28 to 90 days significantly decreased the level of fasting blood glucose (FBG) (MD: −1.21 mmol/L, 95% CI: −2.73 to 0.31), total cholesterol (TC) (MD: −0.22 mmol/L, 95% CI: −0.25 to −0.19) and triglycerides (TG) (MD: −0.59 mmol/L, 95% CI: −1.21 to 0.03). No significant beneficial effects were observed on insulin (MD: 1.88 pmol/L 95% CI: −13.44 to 17.21). Evidence for the impact of biotin supplementation on the levels of glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and very low-density lipoprotein cholesterol (VLDL-C) was limited to draw conclusion.ConclusionsBiotin supplementation may decrease FBG, TC and TG levels. However, its influence on insulin is not significant and further studies on the effects of biotin on HbA1c, LDL-C, HDL-C and VLDL-C are expected.

Objective To investigate the efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus. Methods From November 2008 to August 2009, 40 patients with gastric diseases and nonobese type 2 diabetes mellitus were admitted to the Changhai Hospital, and their clinical data were prospectively studied. All patients were randomly divided into 4 groups; 10 patients received Billroth I distal gastrectomy +gastroduodenal anastomosis (BⅠ group) , 10 received proximal gastrectomy + remanant gastric esophageal anastomosis ( PG group), 10 received total gastrectomy + esophagoduodenal Y-anastomosis ( RY group) and 10received subtotal gastrectomy Billroth Ⅱ gastro-jejunostomy (BⅡ group). The length of hospital stay, pre- and postoperative body mass indexes (BMIs) , waist circumferences, levels of fasting blood glucose (FBG) , glycated hemoglobin ( GHbA1) , fasting serum insulin (FSI) and fasting C-peptide (FCP) of patients in the 4 groups were compared. All data were analyzed using analysis of variance, LSD-t test, paired t test or chi-square test. Results The clinical effects of the 4 different operative procedures on the gastric diseases were similar. The levels of FBG were (8.0 ±2.9)mmol/L before operation and (5.9 ±0.7)mmol/L after operation in the RY group, with a significant difference (t = 2. 342, P < 0. 05). The preoperative level of GHbA1 in the RY group was 7.7% ± 1.1%, which was significantly higher than 6. 9% ± 0. 6% at 2 months after the operation and 6. 1 % ± 0. 4% at 6 months after the operation (t = 4. 920, 3.012, P < 0.05). The preoperative level of FCP in the RY group was (1.30 ±0.54) μg/L, which was significantly lower than (1.95 ± 0.86) μg/L at 2 months after the operation and (2.18 ± 0.63)μg/L at 6 months after the operation (t =6. 063, 4. 651, P < 0.05). The levels of FSI in the RY group at postoperative month 1, 2 and 6 were (18 ±5) , (19 ±3) , (21 ±3) mU/L, which were significantly higher than the level of FSI [(11 ±4) mU/L]before operation (t =3. 158, 4. 502, 7. 517, P <0. 05). Preoperative levels of FBG, GHbA1, FSI and FCP in the B Ⅱ group were (8. 3 ± 1. 3) mmol/L, 7. 7% ±0. 9% , (13±4)mU/L and (1.34±0.48) μg/L, which were ignificantly different from (6.7 ± 1.2)mmol/L, 6.8%± 0.8%, (18±4)mU/L and ( 1.68 ±0.46) μg/L at postoperative month 1, (6.4 ± 1.3)mmol/L, 6.3% ±0.6% ,(18±4)mU/L and (1. 96 ± 0. 67) μg/L at postoperative month 2, and (5. 6 ±0. 7) mmol/L, 6.0%±0.3%, (19 ± 4) mU/L and (2.27 ± 0. 59) |μg/L at postoperative month 6 (t = 2. 468, 2. 598, 6. 028; 3. 055, 4. 586,4.572; 3.618, 5.860, 8.577; 2.300, 3.511, 3.943, P<0.05). The levels of FBG,GHbA1 and FCP in the 4 groups at 2 months after surgery were significantly different from those at 6 months after surgery (F = 4. 699,14. 378; 7.411, 29. 192; 3. 335, 9. 334, P < 0.05). The levels of FSI in the 4 groups at different time points were significantly different (F =2. 896, 7. 012, 11. 998, P < 0.05). Conclusion The efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus is satisfactory. Key words: Diabetes mellitus, type 2; Gastric bypass surgery; Clinical controlled trials; Nonobese type

Low glucagon-like peptide-1 (GLP-1) concentration in serum is indicative of mild cognitive impairment in type 2 diabetes patients

Camellia oil alleviates type 2 diabetes mellitus through modulating gut microbiota and metabolites

Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia. Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data. GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01). GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

Background We aimed to understand how glycaemic control among COVID-19 patients may impact their disease progression, clinical complications and adversities. Methods We enrolled 2,366 COVID-19 patients from Huoshenshan hospital in Wuhan. We stratified the COVID-19 patients into four subgroups by current fasting blood glucose (FBG) levels and prior diabetic status, including patients with FBG<6.1mmol/L with no history of diabetes (group 1), patients with FBG<6.1mmol/L with a known history of diabetes diagnosed (group 2), patients with FBG≥6.1mmol/L with no history of diabetes (group 3) and patients with FBG≥6.1mmol/L with a known history of diabetes (group 4). A multivariate cause-specific Cox proportional hazard model was used to assess the associations between FBG levels or prior diabetic status and clinical adversities in COVID-19 patients. Results COVID-19 patients with higher FBG and unknown diabetes in the past (group 3) are more likely to progress to the severe or critical stage than patients in other groups (severe: 38.46% vs 23.46%-30.70%; critical 7.69% vs 0.61%-3.96%). These patients also have the highest abnormal level of inflammatory parameters, complications, and clinical adversities among all four groups (all p<0.05). On day 21 of hospitalisation, group 3 had a significantly higher risk of ICU admission (14.1% [9.6%-18.6%]) than group 4 (7.0% [3.7%-10.3%]), group 2 (4.0% [0.2%-7.8%]) and group 1 (2.1% [1.4%-2.8%]), (P<0.001). Compared with group 1 who had low FBG, group 3 demonstrated 5 times higher risk of ICU admission events during hospitalisation (HR=5.38, 3.46-8.35, P<0.001), while group 4, where the patients had high FBG and prior diabetes diagnosed, also showed a significantly higher risk (HR=1.99, 1.12-3.52, P=0.019), but to a much lesser extent than in group 3. Conclusion Our study shows that COVID-19 patients with uncontrolled current FBG levels accompanied by pre-existing but unaware diabetes, or possibly new onset diabetes as a result of COVID-19 infection, have a higher risk of more severe adverse outcomes.

IntroductionThe management of diabetes has become a critical public health issue in China. The development of community-based type 2 diabetes management in China has not yet reached an ideal state,...

To evaluate the therapeutic efficacy of lifetide biofeedback intervention in patients with type 2 diabetes mellitus (T2DM). We analyzed the changes in average blood glucose, estimated glycosylated hemoglobin (HbA1c), fasting blood glucose and HbA1c levels in 5 patients with T2DM undergoing lifetide biofeedback intervention without the use of hypoglycemic drugs. A transient blood glucose monitoring system was used for drug withdrawal management during the intervention. Compared with those before the intervention, the average blood glucose and fasting blood glucose and HbA1c levels showed no significant changes after the intervention without using hypoglycemic drugs (P>0.05), but the estimated HbA1c was significantly decreased after the intervention (P<0.05). Two patients achieved complete remission, two showed partial remission, and one had substantially improved blood glucose levels. One patient showed a marked increase in extremity temperature after the intervention (P<0.05). Another patient had a significantly increased heart rate variability index (P<0.05) without obvious changes in heart rate after the intervention (P>0.05). By reestablishing the balance in autonomic nervous system regulation and enhancing peripheral microcirculation, lifetide biofeedback intervention helps to maintain stable blood glucose levels, achieve disease remission, and reduce the occurrence of complications in T2DM patients after discontinuation of hypoglycemic drugs without changing their lifestyles.

Background: Diabetes mellitus encompasses metabolic disorders marked by chronic hyperglycemia, leading to various complications. It is considered a prothrombotic state associated with increased platelet reactivity. Parameters such as mean platelet volume (MPV) and platelet distribution width (PDW), which are indicative of platelet size, enzymatic activity, and prothrombotic risk, can be readily assessed during routine hematological analysis, facilitating early detection of this prothrombotic state. Aims and Objectives: The study aimed to investigate the varied alterations in platelet parameters in type 2 diabetes mellitus (T2DM) patients and tried to elucidate these parameters’ predictive role in diabetes complications. Materials and Methods: This prospective cross-sectional study was conducted between February 2022 and February 2024, involving 100 patients with T2DM and 100 healthy non-diabetic individuals. MPV, PDW, fasting blood glucose (FBS), and glycated hemoglobin (HbA1c) levels were measured and analyzed. Statistical analysis was carried out using the Student’s t-test, Mann–Whitney U-test, Chi-square test, and Spearman’s correlation tests in the Statistical Package for the Social Sciences software (version 21.0). Results: Most of the patients were in the age group of 40–70 years with male predominance. In comparing the 100 diabetics and 100 non-diabetics groups, MPV and PDW levels were notably higher in diabetics (11.46±1.75 vs. 9.40±1.02 fl, 21±2.57 vs. 16.72±1.48%) with statistical significance (P&lt;0.01). Similarly, FBS and HbA1C levels were elevated among diabetics (179.38±70.25 vs. 90.64±5.93, 7.83±2.24 vs. 5.02±0.64) along with a positive correlation between platelet indices (MPV and PDW) and FBS, HbA1c levels in patients with T2DM. In addition, diabetic patients with complications exhibit significantly higher MPV, PDW, FBS, and HbA1c levels compared to those without complications. Conclusion: MPV and PDW levels show significant alterations in T2DM patients, with consistently elevated values, especially in those with complications. This underscores their potential importance as key indicators alongside glycemic indices such as FBS and HbA1c, in monitoring diabetes progression and anticipating associated complications.