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Normally type 1 diabetes support groups madison wi minnesota saint paul diagnosis comes at twenty-eight weeks or prior. Embarazo y diabetes (Pregnancy and Diabetes) focuses on the emotional impact on a woman who learns she has gestational diabetes.
Gestational diabetes (also known as gestational diabetes mellitus or GDM) is a condition singular to pregnant women. In the research the experts looked at more than 4500 females who had gestational diabetes in the past and observed them from 1991 to 2007 to check out whether raising physical task and lowering exercise-free In was told I couldn’t have a vbac because they could not induce me because of preious cesarean.
Like other types of diabetes gestational diabetes affects how your cells use sugar (glucose) your body’s main fuel. Systematic identification and optimal management for all Australian women who develop gestational diabetes.
If you develop gestational diabetes you want to get it treated as if left untreated you and your baby may develop other problems.
It is okay to feel mad, sad, frustrated, exasperated, and resentful, or anything else for that matter. Science, Technology and Medicine open access publisher.Publish, read and share novel research. Effectiveness of Fenugreek for Lowering Hemoglobin (HbA1c) in Patients with Self-Management of Type 2 Diabetes: A Randomized Controlled TrialRashid Ansari1 and Saiqaa Ansari2[1] School of Public Health, University of New England, Australia[2] School of Population Health, University of Queensland, Australia1. Antipsychotics are mainly used to treat schizophrenia and bipolar disorder, while some are also indicated for adjunctive use in major depressive disorder. Some antipsychotic drugs have a particular propensity to induce weight gain as well as metabolic abnormalities, thereby increasing the patient's risk of obesity, insulin resistance, type 2 diabetes and associated cardiovascular morbidity.
Although the exact mechanisms underlying antipsychotic-induced glucose regulation remain poorly understood, it has been proposed that the heterogeneous receptor binding pharmacology differentiating the atypical agents not only from each other, but also from their more selective typical counterparts, may be implicated. The first hypothesis is that antipsychotic drugs contribute to weight gain and associated hyperglycemia via effects mediated by binding to the serotonergic receptors 5-HT1a and 5-HT2c [9].
Second, blockade of the dopamine D2 receptors is another potential mechanism involved [10].
Third, the affinity of, in particular, second-generation antipsychotic agents for M3 receptors also seems relevant for the glucose homeostasis, perhaps because M3 receptors control cholinergic-dependent insulin release. Next to these muscarinic, dopaminergic, and serotonergic mechanisms, the identification of genetic markers associated with antipsychotic-induced weight gain seems, in turn, to be an important predictor of an individual’s response. QuarterWatch™ monitors all adverse drug events reported to the FDA, identifies signals, and seeks to improve postmarket surveillance. QuarterWatch 2015 Q4  In this annual report issue we outline both positive and negative changes in 2015 with significant implications for patient safety.
The 9.9% increase in serious injuries reported in the United States (Table 1) in 2015 provides a more realistic but still approximate measure of the trend in harms from the therapeutic use of prescription drugs. QuarterWatch 2015 Q3 In this issue we identify major differences in reports of cancer associated with drugs for psoriasis, a common skin disorder affecting an estimated 7.5 million people. The 190,911 reports about non-serious adverse drug events were of generally poor quality, with 72% lacking information about one or more of the following: age, gender, or an event date.
This report is based on combined data from the first and second quarters of 2015, but report trends focus on the second quarter. QuarterWatch 2014 Q3-4 This issue provides an overview of prominent drug safety issues as reflected in 833,076 adverse drug events reported to the U.S. Although drug adverse effects are estimated to account for 100,000 to 200,000 patient deaths and 1 to 2 million hospitalizations each year, neither the FDA nor the Centers for Disease Control and Prevention publishes annual assessments of serious injury and death resulting from drugs in therapeutic use.
QuarterWatch 2014 Q2  In this issue, we examine why unsafe use of zolpidem (AMBIEN), a largely generic drug taken by more than 5 million people as a sleep aid, accounts for more emergency department visits for adverse effects than any other psychoactive drug. QuarterWatch™ is an independent publication of the Institute for Safe Medication Practices (ISMP) that monitors adverse drug events reported to the FDA. This issue of QuarterWatch analyses the latest FDA release of FAERS data–covering 2014 Q2.
This issue of QuarterWatch includes two recently released calendar quarters of FAERS data, from 2013 Q4, and 2014 Q1. QuarterWatch 2013 Quarters 3-4  In this issue we analyze severe gastrointestinal toxicity and hypersensitivity reactions reported for the new oral drug for multiple sclerosis (MS), dimethyl fumarate (TECFIDERA). Because the FDA has corrected its previously delayed quarterly releases of serious adverse event reports, this issue of QuarterWatch includes data from two calendar quarters of 2013, Q2 and Q3.
This report focuses on three drugs (dimethyl fumarate, sodium oxybate, fingolimod) that share several characteristics with substantial effects on the total number of adverse event reports submitted. These high-patient-contact settings provide a new opportunity to achieve unprecedented and high-quality postmarket surveillance. QuarterWatch 2013 Q1 This issue focuses on serious hypersensitivity reactions reported to the US Food and Drug Administration (FDA) for therapeutic drugs using data from the most recent 12 months available. The FDA received 56,165 domestic reports of serious adverse drug events in the calendar quarter ending March 30, 2013. Cases of reported drug hypersensitivity (mostly drug allergies) were identified using a standardized set of medical terms created by the pharmaceutical industry to classify possible cases of adverse drug events occurring in clinical trials or identified through postmarket surveillance.
Hypersensitivity was very common, accounting for 13,042 cases (8.9%), and more than any other among 91 adverse reaction categories except non-specific gastrointestinal symptoms.
A large and diverse selection of drugs was implicated, with 234 drugs having 10 or more hypersensitivity reports in one year.
Our study identified 45,610 adverse drug events reported in children less than 18 years of age. QuarterWatch 2012 Quarter 4  In this report we examine the leading drug safety problems reported to the US Food and Drug Administration (FDA) for the calendar year 2012.
Reports that consumers and health professionals submitted directly to the FDA identified two anticoagulants, dabigatran (PRADAXA) and warfarin (COUMADIN), as the most frequent suspect drugs for the year. Cases from drug manufacturers about new, serious adverse events without adequate current warnings in the prescribing information flagged three anti-tumor necrosis factor (anti-TNF) products, etanercept (ENBREL), adalimumab (HUMIRA), and infliximab (REMICADE). The potent synthetic opioid fentanyl (DURAGESIC) in patch form was prominent in two different kinds of drug safety issues, product quality complaints and reported medication errors. Lower limb fractures and other bone disorders associated with alendronate (FOSAMAX) for osteoporosis were key results from our statistical tests to link suspect drugs with specific side effects. In 2012, the FDA received a total of 210,648 domestic reports of serious, disabling, or fatal adverse events associated with therapeutic drugs, an increase of 16% from the previous year. Normally your body produces a hormone Diabetes Care Foundation Of Uk Montgomery Alabama (a chemical mesenger carried in your blood) called insulin to control the sugar level in your blood.
For your meal plan only a few types of foods are counted as carbs starches fruits dairy and non-starchy vegetables. But just what does this diagnosis mean to the health and welfare of the mother and her unborn child?
Since Gestational Diabetes is diagnosed later on in the pregnancy there are different concerns.
IntroductionThe incidence of type 2 diabetes is increasing worldwide, resulting in large measure from the increasing prevalence of obesity (Yale, 2000). Although second-generation (atypical) antipsychotics have demonstrated improved tolerability with respect to extrapyramidal side effects relative to first-generation (typical) antipsychotics, there is evidence that certain atypical antipsychotics are associated with an increased risk for diabetes. Although their primary indication remains schizophrenia and schizophrenia-related disorders, most antipsychotics are now used on-label to treat a broad range of symptoms and disorders, including bipolar disorders and major depressive disorders not responding to standard antidepressant treatment.
Pathways for antipsychotic-drug-induced metabolic abnormalitiesAs can be seen in Figure 1 (adapted from Ref.[8] ), hyperglycemia corresponding to diabetes seems to develop both in a delayed fashion, possibly through weight gain and insulin resistance, and more acutely, through direct damage to the ? cells (or other molecular pathways). Antipsychotic binding to dopaminergic, serotonergic, adrenergic, and cholinergic sites is understood to influence receptors and transporters in essential body tissues implicated in glucose metabolism. Stimulation of 5-HT1a is associated with an increase in food intake whereas stimulation of 5-HT2c is related to a decrease in food intake. Prolonged D2 blockade with antipsychotics may predispose to depletion of insulin granule stores and a defect in pancreatic compensation.
For example, people with schizophrenia who carry the HTR2C -759C allele are found to gain more weight or to have an increased risk for clinically significant weight gain after treatment with either clozapine or olanzapine. Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice. Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis. A meta-analysis of cardio-metabolic abnormalities in drug naive, first-episode and multi-episode patients with schizophrenia versus general population controls.
Atypical antipsychotics and effects of adrenergic and serotonergic receptor binding on insulin secretion in-vivo: an animal model. Atypical antipsychotics and effects of muscarinic, serotonergic, dopaminergic and histaminergic receptor binding on insulin secretion in vivo: an animal model. Second generation antipsychotic-induced type 2 diabetes: a role for the muscarinic M3 receptor.
The year marked the rapid uptake of a new class of diabetes drugs, called sodium glucose cotransporter 2 (SGLT2) inhibitors, which have unproven clinical benefits and a growing number of safety problems.
The largest share of this increase occurred because of information technology improvements and regulatory changes at the FDA that resulted in adding 354,000 lower-priority reports into its FAERS system that had previously not been accessible for analysis. Reported serious injuries are increasing because of growing use of drugs with many toxic effects. While corticosteroid and other topical drugs are sufficient for many cases, potent immunosuppressant drugs are used in increasing numbers.
The large increase in reports consisted almost entirely of non-serious events from drug manufacturers.
Consumers were the original source for 80% of these cases, and the leading complaint was that the drug was ineffective. In the second quarter of 2015 the FDA received 235,540 new reports of injury associated with the therapeutic use of 1381 identifiable primary suspect drugs.
Despite a world of proliferating digital data, the primary source for identifying injuries from therapeutic drugs remains the voluntary reports to the FDA’s Adverse Event Reporting System (FAERS). Also, early signals for a new kind of diabetes drug, canagliflozin (INVOKANA) raise questions about whether enough is known about this agent to be assured that its benefits outweigh its risks.
We analyze computer excerpts from the FDA Adverse Event Reporting System (FAERS) that are released for public research use. In this three-month period the agency received a total of 221,958 case reports of adverse drug events from all sources. To provide a broader perspective, the main analysis focuses on the 12 months ending with 2014 Q1, and includes all adverse event reports received by the FDA in that one-year period. The risks of serious psychiatric side effects are highlighted in a new analysis of varenicline (CHANTIX), an aid to smoking cessation.
Totals from the two quarters reveal that after many years of a steady increase in reported fatal, disabling and serious adverse drug events, reports have hit a plateau in 2013. All three are expensive medications (more than $50,000 per patient-year) for small patient populations (10,000-25,000 patient-years). It would be especially valuable for orphan drugs with clinical trials for efficacy in patient populations of just 100-200 subjects on the active drugs. It also surveys the newly released case reports for 2013, Quarter 1, and provides an update on the continuing drug safety issues surrounding anticoagulant drugs. To identify suspect drugs, we screened 147,318 selected cases of serious adverse drug events from March 2012 through March 2013. Our ranking of the year’s major issues in drug safety comes from four different perspectives on tens of thousands of serious and fatal adverse drug events. Diabetes Care Foundation Of Uk Montgomery Alabama gestational diabetes is usually a temporary condition in pregnancy where the mother’s body cannot maintain normal blood sugar levels. Other measurements (eg maternal HbA1C random postprandial or fasting blood sugar level fructosamine Most women carry their babies to full-term and deliver without problems. Journal of the American Heart Association “History of Gestational Diabetes Care Foundation Of Uk Montgomery Alabama Diabetes diabetes obesity . Since no specific cause has been identified for gestational diabetes The nutrition products I am going to recommend you make use of knowledge gained from the botanical world’s 6000 year history. Foods to avoid with gestational diabetes: Sometimes in pregnant women the blood glucose level rises much above the normal level. Diabetes mellitus is a pandemic disease and is one of the main threats to human health (Narayan, 2005).
In the past decade, the use of antipsychotic medications has substantially increased, in particular among children and adolescents [2]. Olanzapine and clozapine, and to a lesser extent quetiapine, appear to be associated with a significant increase in the risk of diabetes [3]. In particular, reports of diabetic ketoacidosis (DKA), albeit uncommon, argue against the position that glucose dysregulation associated with antipsychotic use is related to weight gain alone. Moreover, synergistic effects between the blockade of D2 receptors and 5-HT2a or 5-HT2c receptors might have a key role in triggering a cascade of events that lead to increased energy intake, weight gain and hyperglycemia [11].
Some antipsychotic drugs, such as clozapine and olanzapine, might impair both cholinergic-dependent and glucose-dependent insulin secretion from pancreatic ? cells. The introduction of new classes of drugs that move into widespread clinical use also boosted event totals.
In this report we also provide new evidence that drugs for erectile dysfunction and pulmonary arterial hypertension can cause deafness or sudden hearing loss.
For this annual review, we identify the drugs that account for the most reports overall and in key subgroups such as children, cases from legal claims, and reports indicating product problems.
The QuarterWatch™ assessment is based on publicly released excerpts of case reports submitted for the first time in 2014.

These reports (best known as MedWatch reports) are a cornerstone of the nation’s system for monitoring the safety of therapeutic drugs after FDA marketing approval.
Of this total we selected for our primary analysis 75,643 new domestic reports of fatal, disabling or serious injuries in which a marketed drug was a primary suspect. Previous issues of QuarterWatch have focused on a subset of these case reports, those with a serious outcome and reported by patients in the United States.
We also examine the frequent and broad spectrum of serious adverse effects on the brain of sodium oxybate (XYREM), an orphan drug for narcolepsy. The Q3 total of 47,864 was almost unchanged (+108) from the preceding quarter Q2, and was 8.7% lower than Q3 of the preceding year.
The high costs and small patient populations lead to marketing and safety surveillance plans that place the manufacturer in contact with every new patient. Given that patient contact is already occurring for commercial and safety reasons, additional costs would be minimal. The total included 12,899 patient deaths and 2,653 cases indicating a possible medication error. In addition, we examine reporting trends from the same period for all domestic reports to the agency that identified adverse events in children under age 18. Reports in children grew substantially over time--from 6,320 in 2008 to 11,401 in 2012, increasing at the same rate as for adult patients. An eye exam will reveal changes in the blood vessels bleeding and yellow or white patches in the retina (diabetic retinopathy) all characteristics of diabetes. Dietary changes: Since being overweight can cause cells to become resistant to insulin not gaining excessive weight during Learn about the glycemic index of carbohydrate foods and choose foods that are low on that scale. You can ask your doctor for a diabetes test if you have one or more of the rik factors listed above and also if you are white and over the age of 40 or management of type 2 diabetes mellitus in older adults gresham oregon you are Asian or black and aged over 25. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. Antipsychotics are arbitrarily divided into first-generation (typical) and second-generation (atypical) agents (see table 1). When comparing first to second-generation antipsychotics, the risk of type 2 diabetes is 1.3-fold higher in those taking second-generation antipsychotic agents than in those taking first-generation drugs [4].
While excessive adiposity represents a significant risk factor for type 2 diabetes, this is not the case with DKA, which implies significant ? cell dysfunction. Most second-generation antipsychotic drugs, especially clozapine and olanzapine, are potent 5-HT2c antagonists.
Among antipsychotic agents, a high affinity for the M3 receptor, as is seen with clozapine and olanzapine, seems to have the highest propensity to promote glucose dysregulation and type 2 diabetes mellitus.
In addition, we identified both positive and negative trends in utilization of opioids and sleep medications, and also report on the drugs that accounted for the most adverse event reports in four monitoring categories. These reports (best known as MedWatch reports) are a cornerstone of the nation’s system for monitoring the safety of prescription drugs after FDA marketing approval. For each perspective it is important to consider both the insights revealed and the substantial limitations of the underlying data. Food and Drug Administration (FDA) needs to modernize its essential postmarket surveillance reporting program. Totals included 7,071 patient deaths, 1,596 reports indicating sustained harm or disability, and 16,717 cases severe enough to require hospitalization. Cardiac, ocular, infection, and pregnancy risks are reviewed for a second newer MS drug, fingolimod (GILENYA). In the case of sodium oxybate, the central pharmacy calls every patient every month before shipping a refill. But to achieve these benefits, the FDA, manufacturers and stakeholders need to develop regulations, guidances and contact protocols to cover a steadily growing number of drugs.
Women are more likely to develop pregnancy related illnesses like gestational diabetes and preeclampsia. Autoimmunity, obesity and single gene mutations are also observed as triggers for gestational diabetes. It is projected that this number will be increased by 72% to 333 million by 2025, and nearly 80% of these cases will be in the poorer industrialized countries (IDF, 2003). Although second-generation antipsychotics result in improved treatment persistence, a better prevention of relapse and a reduced risk of extrapyramidal adverse effects at clinically effective doses, they are no more effective overall than the first-generation treatments [1]. The increased relative risk of adverse cardio-metabolic side effects of antipsychotics [5] is especially prominent in vulnerable populations, such as patients with a first-episode psychosis, those who have not previously taken antipsychotic agents (drug-naive patients), and children and adolescents [2][6]. DKA has been reported soon after the initiation of atypical antipsychotic treatment and in individuals who experience no significant changes in weight. The fact that aripiprazole and ziprasidone have only a weak association with metabolic dysregulation, despite their high affinities for 5HT2c receptors, could be explained by other receptor-specific mechanisms that potentially counterbalance inhibition of the 5HT2c receptors.
Similarly to aripiprazole, risperidone, amisulpride, lurasidone, and asenapine, which have a relatively low propensity to cause weight gain, shows no appreciable affinity for muscarinic receptors [12]. This issue of QuarterWatch features a broader scope of review to include more data and to adapt to changing reporting patterns.
This group of reports identified 960 different drugs with a median of 7 cases per drug, but with some drugs accounting for hundreds of cases. Our conclusion: it seems clear that this drug safety monitoring system is in need of modernization.
For all three drugs, manufacturers have extensive contact with practically all patients as treatment is initiated to assist in navigating insurance coverage for these high-cost specialty drugs. Historical records show the new quarter totals are artificially low since the agency typically releases additional reports for the quarter at a later date.
The number was greatest in the first year of life, then declined and leveled off until adolescence, when cases again rose rapidly. Just as may be the case with ordinary Diabetes Gestational Diabetes develops because a woman’s body does not make enouh insulin. One session with a dietitian or diabetes educator should be enough to help you manage your diabetes for life. According to a 2005 US Government estimate, approximately 21 million people in the United States have diabetes (Gerich, 2005). These cases emphasize that weight gain cannot be used as the sole proxy for concerns regarding possible glucose abnormalities following antipsychotic medication use. Any individual who desires to report an adverse drug event has the option of either submitting one directly to the FDA or contacting a drug manufacturer.
Our primary analysis excludes foreign reports, injuries not classified as serious, and cases identified as originating in legal claims. It suffers from a flood of low quality reports from drug manufacturers and has not yet been updated for the changing environment in which drugs are marketed to health professionals and consumers. This leads to a different adverse event reporting environment compared with traditional brand name drugs where patient contacts by the manufacturer are limited, but contacts with physicians are more extensive. There were insufficient data to evaluate 70% of the 741 drugs with reported serious adverse events in children because of fewer than 2 reports per year. Maternal Diabetes Care Foundation Of Uk Montgomery Alabama history of diabetes or gestational diabetes mellitus.
Gestational Diabetes Your blood test shows you have gestational diabetes or Eat a variety of foods. In 2002, diabetes was the sixth leading cause of death and had an estimated total cost of $132 billion (Hogan et al. A reason is that the low background risk for diabetes at a young age [5][6][7] makes the diabetogenic effect of the antipsychotic drugs noticeable, whereas at an older age, the effect of the biological and behavioral risk factors becomes more pronounced than that of antipsychotic drugs.
Manufacturers, in turn, are required to report every adverse event they learn of through any channel that could range from a consumer help-line telephone contact to a refill reminder that was returned indicating the patient had died.
We discuss key problems below and offer some recommendations as an organization that relies heavily on data collected through FAERS. The strength of the system is that it collects information from a wide array of sources that range from episodes observed by hospital pharmacists to legal claims for drug-induced injury filed in state and federal courts. Type 2 diabetes is a disease characterized by a dual defect: 1) by insulin resistance which prevents cells from using insulin properly, and 2) degrees of reduced pancreatic insulin secretion. A quarter of the population of Pakistan would be classified as overweight or obese with the use of Indo-Asian-specific BMI cutoff values.
Jafar et al (2006) have reported that prevalence of overweight was 25% and obesity was 10% in a large population-based sample of people over the age of 15 years in Pakistan. On the age-specific prevalence of overweight and obesity, they found that more than 40% of women and 30% of men aged 35–54 years were classified as overweight or obese.
It has been suggested in a variety of observational and epidemiological studies that physical activity may play a significant role in the prevention of type 2 diabetes mellitus. The relationships between physical activity and overweight are only beginning to be understood for the adult population, sedentary behaviours, particularly watching television (TV) and videos, surfing the internet have been found to be related to higher body mass index (BMI) for adult’s population (Struber, 2004). The literature linking physical activity levels with risk of overweight in adults is not consistent but physical activity is an important component of effective obesity treatments (Saelens, 2003).
The main health promotion intervention here is the public health education which highlights the importance of physical activity for the prevention of type 2 diabetes in the middle-aged population of sub-continent and particularly Pakistan, which is experiencing a rapid and substantial decline of physical activity levels as a result of poor eating habits, unhealthy food supply, expansion of television, computerization, and mechanization, more prevalent car ownership and sedentary behaviour.
In parallel with decreasing levels of physical activity, the prevalence of overweight and obesity has increased significantly in Pakistan and as a consequence, diabetes mellitus has become a major public health issue. Therefore, promoting an active lifestyle or regular exercise has become the highest public health priority in that country to overcome the onslaught of type 2 diabetes. Also, the search for dietary adjuncts along with usual medical care to treat this life altering disease has become more important and dietary supplements that can modulate glucose homeostasis and potentially improve lipid parameters would be desirable. Fenugreek (Trigonella foenum-graecum Linn) is a dietary supplement that may hold promise in this regard and is one of the oldest medicinal plants, originating in India and Northern Africa and dating back to ancient Egyptian times (Jensen, 1992).In Pakistan and India, fenugreek is commonly consumed as a condiment (Yoshikawa et al. Fenugreek seeds also lower serum triglycerides, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) (Al-Habori and Raman, 1998). The lipid-lowering effect of fenugreek might also be attributed to its estrogenic constituent, indirectly increasing thyroid hormones (Basch, 2003). The plant protein in fenugreek is 26%, so it might exert a lipid lowering effect (Sharma, 1986). Since a high proportion of diabetic patients in sub-continent suffer from malnutrition, the use of fenugreek which is rich in protein and fiber (48%), has a distinct advantage in these patients (Sharma, 1986). This chapter addresses the effectiveness of fenugreek for lowering hemoglobin (HbA1c) in this randomized controlled trial and determines whether the intervention of taking fenugreek in combination of usual medical care lowers HbA1c in patients with type 2 diabetes.
Effectiveness trials such as this are critical in determining if the interventions are effective in the practical world in which patients live. This randomized control trial addresses the research question “Is Fenugreek treatment with medical care for patients with type 2 diabetes more effective than usual medical care and can it help to lower the haemoglobin in patients with poorly controlled type 2 diabetes”?
Characteristics of type 2 diabetesType 2 diabetes is associated with certain ethnic groups, obesity, family history of diabetes, and physical inactivity, among other factors.
Chronic, untreated hyperglycemia can lead to serious complications that include cardiovascular diseases, blindness, kidney failure, and stroke. Furthermore, very low values of blood glucose (hypoglycemia) for even a short duration can result in loss of consciousness and coma. The figure 1 shows the complications of type 2 diabetes which is a syndrome characterized by insulin deficiency, insulin resistance, and increased hepatic glucose production. These metabolic abnormalities are treated by use of various medications which are designed to correct one or more of these metabolic abnormalities (Saltiel & Olefsky, 2001). Type 2 diabetes is most common in adults, although younger people are also developing this type of disease. It starts with a slow onset with thirst, frequent urination, weight loss developing over weeks to months. It is also considered to run in families but it may happen with a person without a family history of diabetes as well.
In its early stages, many people with type 2 diabetes can control their blood glucose levels by losing weight, eating properly and exercising. Many may subsequently need oral medication, and some people with type 2 diabetes may eventually need insulin shots to control their diabetes and avoid the disease's serious complications (Saltiel & Olefsky, 2001). Even though there is no cure for diabetes, proper treatment and glucose control enable people with type 2 diabetes to live normal, productive lives.
A major advance for people at risk of developing type 2 diabetes - such as family members of those with the condition - occurred recently when it was shown that diet and exercise can prevent or delay type 2 diabetes. 2004), however, population-based data on the prevalence of diabetic retinopathy in Pakistan and on the visual impairment due to diabetic retinopathy is lacking and only the hospital-based data is available (Kayani et al.
Diabetic nephropathy is present in 18% of people diagnosed with diabetes (DSG, 1993) and is a leading cause of end-stage renal disease (Molitch et al.
2003)Stroke: diabetes is associated with a 2- to 4-fold increase in cardiovascular mortality and stroke (Kannel et al. Therefore, early detection and treatment of diabetes is essential in order to reduce the impact of its serious complications.
Development of type 2 diabetesDevelopment of type 2 diabetes is the result of multifactorial influences that include lifestyle, environment and genetics.
The disease arises when insulin resistance-induced compensatory insulin secretion is exhausted. A high-caloric diet coupled with a sedentary lifestyle is one of the major contributing factors in the development of the insulin resistance and pancreatic ?-cell dysfunction as shown in Figure 2. However, a predisposing genetic background has long been suspected in playing a contributing role in the development of type 2 diabetes. The metabolic syndrome is defined as a clustering of atherosclerotic cardiovascular disease risk factors that include visceral adiposity (obesity), insulin resistance, low levels of HDLs and a systemic proinflammatory state.

There are key components to the metabolic syndrome which include in addition to insulin resistance (the hallmark feature of the syndrome), hypertension, dyslipidemia, chronic inflammation, impaired fibrinolysis, procoagulation and most telling central obesity.3.
Randomized controlled trials with fenugreekThe multiple trials in the past have shown conflicting results of the effect of fenugreek on the patients of type 2 diabetes. These studies showed some positive results on fasting serum glucose but did not examine hemoglobin (HbA1c) levels. Gupta et al (2001) reported the results of a small randomized, controlled, double-blind trial to evaluate the effects of fenugreek seeds on glycemic control. The authors reported that there were no significant differences between groups in mean glucose tolerance test values at the study's end.
However, the trial may have been too small or brief to detect significant mean differences between groups. Raghuram et al (1994) reported the results of a randomized, controlled, crossover trial of fenugreek seeds in 10 patients with type 2 diabetes.
In the fenugreek-treated patients, statistically significant mean improvements were reported for glucose-tolerance test scores and serum-clearance rates of glucose. Sharma and Raghuram (1990) conducted two randomized, controlled, crossover studies in patients with type 2 diabetes. Significant mean improvements in fasting blood-glucose levels and glucose-tolerance test results were described in the fenugreek-treated patients.
Moosa et al (2006) conducted study to evaluate the effect of fenugreek on serum lipid profile in hypercholesteremic type 2 diabetic patients and concluded that fenugreek seeds powder significantly reduced serum total cholesterol, triglyceride and LDL-cholesterol but serum HDL-cholesterol level elevation was not significant.
Neeraja and Rajyalakshmi (1996) presented a case series including six men with type 2 diabetes and six without diabetes. The cases suggested fenugreek reduced postprandial hyperglycemia primarily in subjects with diabetes, but less so in subjects without diabetes. The studies conducted to date have been methodologically weak, lacking adequate descriptions of blinding, randomization, baseline patient characteristics, statistical analysis, and standardization data for the therapy used.
Demonstrating the efficacy of fenugreek has also been confounded by inconsistencies in the preparations, dosing regimens, and outcome measures used in the trials. Moreover, none of the investigations have been conducted over the longer period (Basch, 2003). Method of patient selectionThe patients were recruited from the diabetic medical centre in rural area of Peshawar conducting the study of management of type 2 diabetes among the population aged 30-65 years.
Patients having coexisting liver, kidney or thyroid disorder were not included in the study. Diabetes Criteria for patientsThe well known standard screening test for diabetes, the fasting plasma glucose (FPG), is also a component of diagnostic testing. The FPG test and the 75-g oral glucose tolerance test (OGTT) are both suitable tests for diabetes; however, the FPG test is preferred in clinical settings because it is easier and faster to perform, more convenient and acceptable to patients, and less expensive. When it was found necessary, plasma glucose testing was also performed on individuals who have taken food or drink shortly before testing.
Such tests are referred to as casual plasma glucose measurements and are given without regard to time of last meal. A confirmatory FPG test or OGTT was also completed on such patients on a different day if the clinical condition of the patient permits.
Laboratory measurement of plasma glucose concentration is performed on venous samples with enzymatic assay techniques, and the above-mentioned values are based on the use of such methods.
The A1C test values remain a valuable tool for monitoring glycemia, but it is not currently recommended for the screening or diagnosis of diabetes. Pencil and paper tests, such as the American Diabetes Association’s risk test, may be useful for educational purposes but do not perform well as stand-alone tests.
Capillary blood glucose testing using a reflectance blood glucose meter has also been used but because of the imprecision of this method, it is better used for self-monitoring rather than as a screening tool.
Determination of study sample size The study sample size was determined based on the assumption of the estimation of Standard Deviation (SD).
Therefore, the study design was selected to detect an effect size of 0.5 SD lowering of HbA1c.
It was assumed that 15% patients might be lost to follow-up in control group over the period of three months and only 5 % patients will be lost to follow-up in intervention group. This assumption was based on the popularity of fenugreek seeds used by diabetic patients in sub-continent to manage their glycemic control. Study population and randomizationInitially 325 patients with type 2 diabetes were invited to pre-randomized interview, out of which only 210 patients were included in the actual trial.
Out of the 325 patients, 93 patients did not meet the inclusion criteria and 22 patients refused to participate in the trial. Finally, two hundred and ten (210) patients agreed to participate and signed informed consent documents at the clinic where they used to visit for their usual medical care for diabetes.
Therefore, 102 patients were randomized to intervention group (fenugreek supplements) and 108 to the control group (usual medical care). The randomization code was developed using a computer random number generator in a block size of eight patients.
That helped to allocate patients to the intervention and control groups equally in each block – that is each patient would have an equal chance of allocation to either group. Once the randomization phase was completed, all patients were instructed to follow-up the usual medical care for their diabetes for the duration of the 90 days trial. The patients were allowed to adjust their usual medications as recommended by their doctors. In addition, each patient was asked to go for blood test for HbA1c on day 1 and then return to give blood sample after 90 days. In addition, participants were advised not to take any other new treatments for the management of type 2 diabetes during the trial periods. The control group in randomized controlled trial received medical care from a physician-coordinated team. This team included physicians, nurses, dietitians, and mental health professionals with expertise and a special interest in diabetes. It is essential in this collaborative and integrated team approach that individuals with diabetes assume an active role in their care. The management plan in that group was based on individualized therapeutic alliance among the patient and family, the physician, and other members of the health care team. This plan has recognized diabetes self-management education as an integral component of care and in developing the plan, consideration was given to the patient’s age, work schedule and conditions, physical activity, eating patterns, social situation and personality, cultural factors, and presence of complications of diabetes or other medical conditions.
Patient self-management was emphasized, and the plan emphasized the involvement of the patient in problem-solving as much as possible. A variety of strategies and techniques were employed to provide adequate education and development of problem-solving skills in the various aspects of diabetes management. During the implementation of the management plan it was assured that each aspect of diabetes management was understood and agreed on by the patient and the care providers and that the goals and treatment plan were reasonable. Those patients randomized to take fenugreek (intervention group) received 100 gms fenugreek seeds powder from the pharmacy in the clinic. They were instructed to take 50 gms doses twice a day at lunch and dinner time in addition to their normal medications for diabetes.
Those patients randomized to usual medical care (control group) were instructed to take their normal medicines and follow-up with their doctor as per their normal schedule. All participants were contacted again after 90 days (3-months) to give their blood sample for HbA1c testing.
At that time, a questionnaire was sent via e-mail to participants in both intervention and control groups to assess the progress of the fenugreek treatment and clinical care without fenugreek. The clinical and demographic characteristics of the patients in the two groups were well balanced at randomization. A demographic measure included age, gender, weight, ethnicity, religion, marital status, previous episodes of glycemic control, previous and current treatments of type 2 diabetes. The table 3 gives baseline characteristics of intervention and control groups in RCT trial. Diabetes treatment with medicationsThe treatment options of type 2 diabetes is shown in figure 4 suggesting the specific areas of actions using medications which influence the various organs of the body to correct the metabolic abnormalities such as reducing the liver glucose production, slowing down absorption of sugars from the gut and reducing the insulin resistance. There are currently six distinct classes of hypoglycemic agents available to treat type 2 diabetes.
The patients in both the groups in RCT trials received medications recommended by their physicians. The most common combinations among both the groups were Meglitinide (repaglinide) with Thiazolidendiones and Sulfonylurea with Biguanides. Details of hypoglycaemic medications used in RCT trialThe diabetes medications mentioned in table 4 work in different ways but the main function of all these medications include lowering blood sugar levels; help improve the body’s use of glucose, decrease the symptoms of high blood sugar, help keeping patients with diabetes functioning normally and may prevent the complications, organ-damaging effects and premature deaths diabetes can cause. Since the drugs work in different ways, these are sometimes used in combination to enhance the effectiveness of treatment. In this RCT trial Sulfonylurea was used in combination with Biguanide (metformin) and Meglitinide was used in combination with Thiazolidinedione.
The main function of Sulfonylurea is to bind and inhibit the pancreatic ATP-dependent potassium channel that is normally involved in glucose-mediated insulin secretion.
Like the sulfonylurea, meglitinide therapy results in significant reduction in fasting glucose as well as HbA1c.
The mechanism of action of the meglitinide is initiated by binding to a receptor on the pancreatic ?-cell that is distinct from the receptors for the sulfonylurea. Metformin is a member of this class and is currently the most widely prescribed insulin-sensitizing drug in current clinical use. Metformin administration does not lead to increased insulin release from the pancreas and as such the risk of hypoglycemia is minimal.
Because the major site of action for metformin is the liver its use can be contraindicated in patients with liver dysfunction. Thiazolidinedione: The thiazolidinedione (pioglitazone) has proven useful in treating the hyperglycemia associated with insulin-resistance in both type 2 diabetes and non-diabetic conditions.
The net effect of the thiazolidinedione is a potentiation of the actions of insulin in liver, adipose tissue and skeletal muscle, increased peripheral glucose disposal and a decrease in glucose output by the liver. Diabetes treatment with diet and exerciseThe normal diabetes treatment addresses the issues related to unhealthy lifestyles, such as lack of physical activity and excessive eating, which are the main causes to initiate and propagate the majority of type 2 diabetes (Michael, 2007). Studies have demonstrated strong relationship between excess weight and the risk of developing type 2 diabetes, hypertension, and hyperlipidemia. Therefore, the objective of physicians is to motivate patients to lose weight and exercise to improve the control of diabetes and slow down or even reverse the natural course of the disease (Michael, 2007).However, it is difficult to overstate the importance of the relationship between lifestyle and the risk of developing type 2 diabetes. There are prospective studies which have demonstrated that lifestyle modification in the form of diet and regular moderate exercise sharply decrease the likelihood of developing type 2 diabetes in high-risk individuals who have impaired glucose tolerance or impaired fasting glucose. The effectiveness of this intervention superseded that of metformin therapy (Knowler et al. In this RCT trial, physicians compiled the flow scheme shown in Figure 5 which represents the method of treatment of type 2 diabetes by the combination of diet, exercise and medication for diabetes monitoring and control. It has been divided into two segments: for obese and normal weight patients and the combination of medication for both the groups of patients. Dietary consideration for patients (intervention and control group)It has been recommended that carbohydrate and monosaturated fat consumption for the patients with type 2 diabetes should comprise 60-70% of total calories.
However, there is some concern that increased unsaturated fat consumption may promote weight gain in obese patients with type 2 diabetes and therefore may cause in reduction of insulin sensitivity (Bantle et al. The “glycemic index” is an attempt to compare the glycemic effects of various foods to a standard, such as white bread.
Although several authors have proposed its clinical usefulness in controlling postprandial hyperglycemia, prospective studies have not demonstrated a clear improvement in hemoglobin (HbA1c) in patients using low-glycemic index diets (Michael, 2007).
The physicians in this trial have recommended the best mix of carbohydrate, protein, and fat that was adjusted to meet the metabolic goals and individual preference of the patients with diabetes in both the intervention and control groups. It has been recommended for individuals with diabetes, that the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone (ADA, 2011). Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remain a key strategy in achieving glycemic control. Physical activity consideration for patients (intervention and control group)Physical activity is a key component of lifestyle modification that can help individuals prevent or control type 2 diabetes. It is considered that diet is probably more important in the initial phases of weight loss, incorporating exercise as part of a weight loss regimen helps maintain weight and prevent weight regain (Klein et al.
In this trial, the message was given to both the groups that as little as 30 minutes of moderate physical activity daily may offer greater benefits to these patients in managing their diabetes.
It has also been reported that in patients with type 2 diabetes, structured regimens of physical activity for 8 weeks or longer improved HbA1c independent of changes in body mass (Sigal et al. The evidence supports the contention that controlling blood glucose through modification of diet and lifestyle should be mainstay of diabetes therapy. It was found in this RCT that despite being one of the most time-consuming discussions with the patients in both the groups, this is probably the most important patient-physician discussion in regard to diabetes control and prevention of disease progression and complications. Statistical analysisWe analysed the primary outcome by an un-paired sample t-test (mean difference between baseline and final HbA1c).
The statistical analysis was carried out on an intention to treat basis and that was subject to the availability of data at follow up as well as at entry level for individual patients.

Type 1 diabetes prevalence world health organization
January 20 zodiac maniac
Studio 360
26.12.2014 Ictm Diabetes


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