Motghare Vijay M

Abstract

Background: Diabetes Mellitus is a spreading pandemic to the countries around the globe, despite of scientific breakthroughs and better healthcare facilities. Sodium-Glucose Co-Transporter Type 2 inhibitors (SGLT2i) are the latest class of oral anti-hyperglycemic agents that have been approved for the treatment of type II diabetes mellitus. Aim: In this review, we have comprehended the evidence for antidiabetic and extra-glycaemic effects of SGLT2i. Materials and Methods: The information is collected based on safety trials, randomized controlled trials (RCT), meta-analyses and real-world data. Results: SGLT2i are rapidly establishing their role in the treatment of diabetes mellitus. The beneficial effects extend beyond glycaemic control, impressive cardio protective and Reno protective effects and included improvement in blood pressure, uric acid concentrations, body weight and oxidative stress. Conclusion: Especially in patients with type 2 diabetes, SGLT2 inhibitors may be another option in those patients requiring additional glucose lowering and in those with acceptable risk factors. More research on the long term outcomes of SGLT2i is warranted. Keywords: Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin, Sodium-glucose cotransporter-2 inhibitors, Sotagliflozin, Type 2 diabetes mellitus.

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Abstract

Objective: To estimate plasma olanzapine concentration (POC) using liquid chromatography-mass spectrometry (LCMS) and identify factors that contributes to pharmacokinetic variability of olanzapine. Materials and Methods: This was a prospective, observational study initiated after approval of institutional ethics committee. Stable patients of schizophrenia on olanzapine, above 18 years of age, of either gender, on olanzapine therapy for at least 12 weeks with no change in dose for at least one week were included. Plasma levels of olanzapine were assessed using HPLC based kit on LCMS. To assess response to treatment patients were subjected to Brief Psychiatric Rating Scale (BPRS) in which lower score indicates better response. Adherence to therapy was assessed by using Morisky 8-Item Medication Adherence Questionnaire in which lower score indicates better adherence. Graph pad prism version 6.0 was used for statistical analysis. Results: POC was higher in women compared to men. No correlation was observed between POC and age (r = 0.01343, p= 0.9470) or daily dose of olanzapine(r= -0.2765, P = 0.1626). Patients having POC more than 20 ng/ml had better adherence (Morisky’s score 1 or 2) to medication compared to those having POC less than 20 ng/ml. Significant correlation was observed between POC and clinical response(r = -0.4371, p=0.0226). Conclusion: TDM of olanzapine is important considering large interpatient variability in POCs at the same dosages. It can also help in improving efficacy, particularly when patients do not respond to therapeutic doses or when they develop adverse effects. Cost of the procedure is a major concern which needs to be considered before this can be established in routine practice. Keywords: TDM, Antipsychotics, BPRS, LCMS, Schizophrenia.

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