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Why 100-Years After the Discovery of Insulin and the Appearance of Insulin-Induced Lipodystrophy: Are We Still Struggling with this Nasty Complication?
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Abstract [+]
Since a century ago, insulin extracted from the animal pancreas has been used for therapeutic purposes. Lipoatrophy (LA) lesions came up first due to the impurities of preparations. However, as technology has progressed, we have had more purified insulin preparations available, now reduced to less than 5%. The 95% of local complications was represented by lipohypertrophy (LH), due to the recourse to narrow areas of skin, reuse of the same needle, injection of cold insulin. The average frequency of LH in the world is 47%, with peaks of 75%, reflecting the inappropriate educational activity of the diabetic teams. In this brief review, the causes of this failure are described, and feasible rehabilitative solutions are proposed.
Keywords
Diabetes; Insulin; Injection technique; Lipoatrophy; Lipohypertrophy; Education; Rehabilitation.
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Current Issue
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First Year Student Pharmacists’ Views on the Opioid Epidemic
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Abstract [+]
Objective
To determine first-year student pharmacists’ views on the opioid epidemic.
Methods
First-year pharmacy students were asked to complete an online survey to assess their views and opinions on the current opioid crisis using Likert-scale type questions.
Results
Forty-four pharmacy students were surveyed, and all participants completed survey questions, 100% response rate. Majority of participants were female (N=34, 77.3%), with more than half of participants falling in the age range of 18-24 (N=25, 56.8%). Geographically, most of the participants home residences are in other states out of the DC, Maryland, Virginia (N=25, 56.9%). In addition, majority of participants worked before starting pharmacy school (N=42, 95.5%) and a majority had a pharmacy and health related occupations before pharmacy school (N=36; 81.9%). Most study participants reported an annual income of less than $10,000 (N=17, 38.6%) and obtained a bachelor’s degree (N=26, 59.1%). Majority of participants strongly agree that the opioid epidemic is becoming a severe crisis for society (N=42; 95.5%) and that opioid should be readily available when it is medically necessary to people (N=27; 61.4%). When asked if they know anyone personally who suffers from the opioid crisis, over three-quarter (N=34; 77.3%) said no. However, over two-third (N=29; 65.9%) of participants said that they have taken opioids in the past themselves to relieve pain. Although, almost all of them strongly agree that prescription opioids are addictive (N=42; 95.5.%); about eighty percent (N=35; 79.5%) agree that taking opioids is an effective way to alleviate severe pain.
Conclusion
Our results indicate that pharmacy students perceive the opioid epidemic as a crisis and despite their views that opioids are addictive and knowing someone who suffers from opioid use disorder, they believe opioids are a clinically effective way to alleviate pain.
Keywords
Survey; Opioids; Epidemic; Students; Pharmacy.
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Lycopene for Hypertension and Factors Affecting Its Use: A Survey of Pharmacy Students
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Abstract [+]
Purpose
To better understand and assess the potential obstacles to the adoption of lycopene for treating high blood pressure.
Methods
A cross-sectional observational study was conducted by administering a survey to 42 Howard University College of Pharmacy students. Descriptive statistics and risk estimates were calculated using statistical package for social studies (SPSS) software.
Results
Only 33.3% of students had ever heard of lycopene, and lycopene knowledge score was poor among 88% of respondents. Non-D.C. residence, dietary supplement use and the belief that dietary supplements such as lycopene interact with prescription drugs and should be used cautiously, were all correlated with a lesser risk of having poor lycopene knowledge. Annual income >$40,000 was correlated with a greater risk of being in the poor lycopene knowledge group. Despite this data, 59.5% report that will incorporate more lycopene into their diet.
Conclusion
Lycopene knowledge is generally poor among the observed cohort; however, this does not seem to be a great obstacle in the path of adoption.
Keywords
Lycopene; Dietary supplement; Hypertension; Cardiovascular.
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Dual Action Mechanism of Insulin Resistance and Insulin Secretion by Imeglimin for Diabetic Treatment
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Abstract [+]
Imeglimin (Twymeeg) is novel oral hypoglycemic agent (OHA) developed in the glimin category. It has dual action mechanisms of reducing insulin resistance and increasing insulin secretion. Trials of imeglimin for efficacy and safety 1 (TIMES 1), TIMES 2 and TIMES 3 were performed with significant clinical efficacy. Among them, HbA1c decrease for 52 weeks showed single imeglimin -0.46%, combined therapy of dipeptidyl peptidase-4i (DPP-4i)-0.92%, Glucagon-like peptide-1 receptor agonists (GLP-1RA)-0.12% and insulin -0.63%. From physiological and pharmacological points of view, the mechanism may include the enhancement action of glucose-stimulated insulin secretion (GSIS). For GSIS progress, transient receptor potential melastatin 2 (TRPM2) channel is activated.
Keywords
Imeglimin; Twymeeg; Trials of imeglimin for efficacy and safety 2 (TIMES 2); Glucose-stimulated insulin secretion (GSIS); Transient receptor potential melastatin 2 (TRPM2) channel.
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Improved Insulin Resistance and Glucose Variability by Super-Low Carbohydrate Diet
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Abstract [+]
Background
Diabetes mellitus (DM) has been more prevalent. American Diabetes Association (ADA) proposed the Standards of Medical Care in Diabetes-2022. For nutritional therapy, low carbohydrate diet (LCD) has been recognized for its benefits. Authors have continued diabetic research concerning LCD and meal tolerance test (MTT).
Case Presentation
The case is 61-year-old male with type 2 diabetes mellitus (T2DM) for years. His hemoglobin A1c (HbA1c) increased to 7.8% in autumn 2021, and further evaluation and treatment was conducted including LCD, daily check of meal and carbohydrate amount, 75 g OGTT, glucagon stimulation test (GST) and others.
Results
He was on super-LCD method including 12% of carbohydrate. His carbohydrate intake amount and 45-minutes post-prandial blood glucose showed significant correlation. The results of 75 g OGTT twice in May 2020 and December 2021 showed that similar pattern of glucose and insulin responses and insulinogenic index (IGI). In contrast, they showed decreased fasting immuno-reactive insulin (IRI) and Homeostasis model assessment insulin resistance (HOMA-R). For GST, C-peptide showed normal response.
Discussion and Conclusion
Judging from the results of MTT, OGTT, GST and IGI, he seems to show rather decreased insulin resistance by LCD associated with preserved insulin secretion ability to some degree. Further investigation would be required from pathophysiological point of view.
Keywords
Super-low carbohydrate diet (LCD); Meal tolerance test (MTT); Type 2 diabetes mellitus (T2DM); Insulinogenic index (IGI); Glucagon stimulation test (GST); Homeostasis model assessment insulin resistance (HOMA-R).
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Dietary Supplements: A Survey of the Opinion of First-Year Professional Pharmacy Students
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Abstract [+]
Pharmacists need to be at the forefront in advising consumers of dietary supplements (DS) about quality, claims, labeling, safety, efficacy, DS-drug interactions, and other aspects. Yet, the knowledge base of pharmacists and pharmacists-in-training about DS appears to be below expectation.
Objective
The goal of the study is to evaluate pharmacy student opinions about DS.
Methodology
A survey questionnaire was developed, tested, and distributed among students who were enrolled in the Drug Information class, which is a 2-credit hour mandatory course for all first professional pharmacy students at Howard University, College of Pharmacy. The data was analyzed using SPSS statistical analysis software.
Results
A total of 42 students (15 male, 27 female) participated in the survey. Of these, 25 respondents (59.5%) felt comfortable about their knowledge of DS, while only 14 (33.4%) reported participation in counselling (p=0.0281). Most respondents (29; 69%) had used DS in the past, while 21 (50%) claimed they used DS at the time of the survey. To a specific query in the questionnaire regarding lycopene-containing food items, 28 (66.7%) agreed they would use such foods in the future for health benefits. Analysis of the survey data revealed no statistical differences between the responses of male and female students (p>0.05 for all the five questionnaire items).
Conclusion
In a survey of 42 pharmacy students at Howard University College Pharmacy, over half (59.5%) felt comfortable about their knowledge of DS. About one-third students (33%) reported they were involved in patient counseling and interaction. Over two-third respondents (69%) took DS in the past, while half were taking DS at the time of the survey.
Keywords
Dietary supplements; Knowledge; Counseling; Use; Lycopene.
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Current Perspectives for Oral Hypoglycemic Agents with Clinical Evidence of Larger Studies
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Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet
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Skin Autofluorescence a Non-Invasive Biomarker of Ages and Its Association to Metabolic Parameters in a Greek Diabetic Population
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Previous Issue
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Elevated White Blood Cell Count is Associated with Higher Hemoglobin A1C in Diabetic Patients from Bangladesh
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Abstract [+]
Background
Diabetes mellitus (DM) is associated with altered white blood cell (WBC) and glycated hemoglobin dysfunction.
Aim
In this study, we were aimed to compare the status of hemoglobin, glycated hemoglobin and WBC level between diabetic and nondiabetic patient’s group.
Methods
This study was conducted in the medicine department of Women’s Medical College and Hospital, Sylhet, Bangladesh. The number of participants was 142. All the patients enrolled were informed verbally about the study and written consent was taken from each patient. Ethical permission was obtained from the institute. All of the tests were performed according to the procedure adopted in the hospital for routine uses. Among the participants, 71 (male 47, female 24) were diagnosed as type-2 diabetics (T2DM) and the other was non-diabetes (male 32 and female 39).
Results
During this study, diabetic patients showed increased hemoglobin (Hb) and WBC level in diabetic blood than non-diabetic one. It has been supported by the study that, HbA1c is remarkably greater than that of New Delhi metallo-β-lactamase 1 (NDM-1) patients. So, our assumptions could be concluded as; diabetes mellitus is an inflammatory condition itself, which may play role in increased HbA1c and WBC count.
Conclusion
Therefore, elevated WBC count is independently associated with worsening of glucose metabolism and HbA1c may ameliorate the chronic low-grade inflammation such as type-2 diabetics (T2DM).
Keywords
Diabetes; Blood parameters; White blood cell (WBC); Glycated hemoglobin; Hemoglobin.
Current Perspectives for Oral Hypoglycemic Agents with Clinical Evidence of Larger Studies
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Current reports for oral hypoglycemic agents (OHAs) are described. As to the association of dipeptidyl peptidase-4 inhibitors (DPP-4i) and bullous pemphigoid (BP), odds ratio (OR) was vildagliptin 5.08, linagliptin 2.87, sitagliptin 1.29 (not significant). Regarding the comparative study between SGLT2i and DPP-4i, SGLT2i group showed lower hazard ratio (HR) as MACE 0.76, myocardial infarction 0.82, cardiovascular death 0.60, heart failure 0.43, all-cause mortality 0.60. Semaglutide showed reduced OR for cardiovascular death than exenatide 0.47, dulaglutide 0.46, albiglutide 0.45, lixisenatide 0.43. SGLT2i showed reduction risk of HR for MACE 0.90, hospitalization for heart failure (HHF)/cardiovascular death 0.78, renal outcomes 0.62.
Keywords
Oral hypoglycemic agents (OHAs); Sodium glucose cotransporter-2 inhibitor (SGLT-2i); Semaglutide; Bullous pemphigoid (BP); Hospitalization for heart failure (HHF); Major adverse cardiovascular event (MACE).
Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet
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Abstract [+]
Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(<86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research. Keywords Type 2 diabetes (T2D); Diabetic gastroparesis (DG); Gastric emptying (GE); Functional dyspepsia (FD); Low carbohydrate diet (LCD).
Skin Autofluorescence a Non-Invasive Biomarker of Ages and Its Association to Metabolic Parameters in a Greek Diabetic Population
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Abstract [+]
Objectives
This cross-sectional study aims to evaluate the association between advanced glycation end-products (AGEs) accumulation, assessed by skin autofluorescence (SAF) measured using the AGE Reader, and the prevalence of several metabolic variables in a diabetic population.
Methods
The measurement of SAF has become a non-invasive method of assessing the accumulation of AGEs as a marker of the long-term impact of glycemic and oxidative stress in humans. In contrast to blood glucose and to hemoglobin A1C (HbA1c), which reflect a short period of glucose levels, the AGE is a marker of the metabolic legacy effect and reflect a long period of glucose levels. AGEs play a pivotal role in the development and progression of diabetic complications. SAF has been validated as a simple, non-invasive method for assessment of AGEs accumulation in the body.
Results
In this study 100 diabetic patients were participated. We non-invasively measured SAF, in all the participants using the AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). We also measured the body mass index (BMI), the blood pressure and the patients underwent arterial duplex sonogram (Doppler examination) in the legs at the level of the ankle and calculated the ankle-branchial index (ABI), which is an important index for diagnosing peripheral artery disease, which is a severe complication of diabetes. The SAF was positive correlated with age, duration of diabetes and systolic blood pressure (BP) and was negative correlated with ABI.
Conclusion
The measurement of SAF has become a non-invasive and reliable method of assessing the accumulation of AGEs in humans. In contrast to blood glucose and to HbA1c, which reflect a short period of glucose levels, the AGEs reflect a long period of glucose levels, correlate with certain metabolic parameters and with peripheral artery disease.
Keywords
Diabetes mellitus (DM); Advanced glycation end-products (AGEs); Skin autofluorescence (SAF); Empirical findings.
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