Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol

In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs.

HYPOMAGNESAEMIA AND HYPOCALCAEMIA THE MAJOR MISSED OUT CLINICAL CONDITION IN THE MANAGEMENT OF DIABETES

Magnesium (Mg) and Calcium (Ca) is one of the essential factors for the insulin to get released from the pancreatic cell. To evaluate the relation of hypomagnesemia and hypocalcaemia in the glycaemic control and to analyse the importance of both Mg and Ca in the insulin secretion mechanism. The study was conducted in the laboratory department, Billroth hospitals. A total of 239 individuals were selected for this study, HbA1c level, serum magnesium and calcium were assessed for all the individuals and in addition to this serum electrolytes were also checked. Out of 239 individuals, 79 were found out as uncontrolled diabetic by calculating HbA1c as a gold standard, males are higher in ratio compared to female. By studying serum magnesium and calcium level, hypocalcaemia is present in more individuals and females (31%) are much prone to both than males (20%). The different correlation was also analysed for hypomagnesemia and hypocalcaemia. The electrolytes like sodium (Na) and potassium (K) was analysed, females are highly affected by electrolyte imbalance but in hypomagnesemia diabetic individuals the males are high in electrolyte imbalance. Since Mg and Ca plays a vital role in insulin synthesis, secretion, repair, and the alteration, along with the hypoglycaemic agents the supplementation of magnesium or calcium could be suggested via, dietary or drug supplements. In addition to this, regular monitoring of electrolytes is essential to maintain fluid balance.

Diabetes mellitus in dialysis and renal transplantation

Diabetes mellitus is the commonest cause of end-stage kidney failure worldwide and is a proven and significant risk factor for the development of cardiovascular disease. Renal impairment has a significant impact on the physiology of glucose homeostasis as it reduces tissue sensitivity to insulin and reduces insulin clearance. Renal replacement therapy itself affects glucose control: peritoneal dialysis may induce hyperglycaemia due to glucose-rich dialysate and haemodialysis often causes hypoglycaemia due to the relatively low concentration of glucose in the dialysate. Autonomic neuropathy which is common in chronic kidney disease (CKD) and diabetes increases the risk for asymptomatic hypoglycaemia. Pharmacological options for improving glycaemic control are limited due to alterations to drug metabolism. Impaired glucose tolerance and diabetes are also common in the post-kidney-transplant setting and increase the risk of graft failure and mortality. This review seeks to summarise the literature and tackle the intricacies of glycaemic management in patients with CKD who are either on maintenance haemodialysis or have received a kidney transplant. It outlines changes to glycaemic targets, monitoring of glycaemic control, the use of oral hypoglycaemic agents, the management of severe hyperglycaemia in dialysis and kidney transplantation patients.

Hypoglycaemic Agents in Patients with Heart Failure

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