The Effect Of Antidiabetic Agent Glibenclamide And Meltformine On Lipids And Glycatedhaemoglobin In Type 2 Diabetes Patient Attending Uith Ilorin

Description

 

TABLE OF CONTENTS

COVER PAGE

TITLE PAGE

APPROVAL PAGE

DEDICATION

ACKNOWELDGEMENT

ABSTRACT

CHAPTER ONE

1.0      INTRODUCTION

1.1      BACKGROUND TO THE STUDY

1.2      STATEMENT OF THE PROBLEM

1.3     AIM OF STUDY

1.4     SPECIFIC OBJECTIVE

1.5     SIGNIFICANCE OF THE STUDY

1.6     RESEARCH HYPOTHESIS

CHAPTER TWO

LITERATURE REVIEW

2.1   EPIDEMIOLOGY AND ETIOLOGY OF TYPE 2 DIABETES (NIDDM)

2.2     ENVIRONMENTAL FACTORS IN THE PATHOGENESIS OF TYPE 2 DIABETES

2.3     PATHOPHYSIOLOGY OF TYPE 2 DIABETES (NIDDM)

2.4     LIPIDS

2.5      GLYCATED HEMOGLOBIN (HEMOGLOBIN A1C, HBA_1C, A1C, OR HB_1C

2.6      HDL

2.7      ANTIDIABETIC AGENTS

CHAPTER THREE

3.1     MATERIAL AND METHOD

3.2   STUDY AREA

3.3    SAMPLE SIZE DETERMINATION

3.4     COLLECTION OF SAMPLE

3.5     MEASUREMENT OF VARIABLES

3.6    STATISTICAL ANALYSIS

3.7      ETHICAL CONSIDERATION AND INFORMED CONSENT

CHAPTER FOUR

4.1     RESULT

CHAPTER FIVE

5.0    DISCUSSION

5.1    CONCLUSION

5.2    RECOMMENDATION

5.3    REFERENCES

CHAPTER ONE

1.0  INTRODUCTION

• BACKGROUND OF STUDY

Diabetes mellitus (DM) has been defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both (Akinmokunet al.,1992). Insulin is a hormone produced in pancreas and enables body cells to absorb glucose that is converted into energy when the body is in need. If the body cell does not absorb the glucose, it will accumulate in the blood causing “hyperglycemia”, chronic hyperglycemia however leads to various potential complication (Pasquali, 2000).

Under normal physiological conditions, plasma glucose concentrations are maintained within a narrow range, despite wide fluctuations in supply and demand, through a tightly regulated and dynamic interaction between tissue sensitivity to insulin (especially in liver) and insulin secretion (DeFronzo and Goodman, 1995). In type 2 diabetes these mechanisms break down, with the consequence that the two main pathological defects in type 2 diabetes are impaired insulin secretion through a dysfunction of the pancreatic β-cell, and impaired insulin action through insulin resistance (Holt, 2004). Type 2 Diabetes mellitus has a greater genetic association than type 1 DM, the pathogenesis of type 2 Diabetes mellitus is characterized by impaired insulin secretion and insulin resistance.Some causes of insulin resistance are:

1. Obesity/overweight (especially excess visceral adiposity)
2. Excess glucorticoids (cushing’s syndrome or steroid therapy)
3. Excess growth hormone (acromegaly)
4. Pregnancy, gestational diabetes
5. Polycystic ovary disease
6. Lipodystrophy (acquired or genetic, associated with lipid accumulation in liver)
7. Autoantibodies to the insulin receptor
8. Mutations of insulin receptor
9. Mutations of the peroxisome proliferators’ activator receptor γ (PPAR γ)
10. Mutations that cause genetic obesity (e.g., melanocortin receptor mutations)
11. Hemochromatosis (a hereditary disease that causes tissue iron accumulation) (Guyton and Hall, 2006).

The metabolic syndrome (MS), or insulin resistance syndrome accommodates the clustering together of certain cardiovascular risk factors associated with insulin resistance and hyperinsulinemia (Campbell, 2005). It was first identified in 1988 by Gerald Reaven, a Stanford University endocrinologist, in a lecture to the American Diabetes Association. At various times, this syndrome has been called dysmetabolic syndrome, insulin resistance syndrome or syndrome X. Now simply known as metabolic syndrome (Reavenet al., 2005).  Metabolic syndrome is associated with a high risk of coronary heart disease and premature mortality (Isomaaet al., 2001). Besides resulting in macrovascular complications, there is growing evidence that metabolic syndrome, like Diabetes mellitus, causes micro vascular complications in patients with type 2 Diabetes mellitus (Knowleret al., 1990). Nearly 70-80% of the population with Diabetes mellitus is diagnosed with metabolic syndrome. Metformin is a biguanideeuglycemic agent, has been approved by the food and drug administration for the treatment of type 2 Diabetes mellitus (Drouinet al., 2004). Although metformin is as effective as sulfonylureas, the drug differs in several respects: Metformin reduces insulin resistance without directly affecting insulin secretion, causes weight loss rather than weight gain, and has lactic acidosis rather than hypoglycemia as its most serious side effect (Kaku, 2010). Glibenclamide is a second-generation sulfonylurea drug. It is at least as effective as the first-generation agents and is effective in doses that are considerably less than those needed with first generation sulfonylureas (Charles ,2010). It is a useful medication for patients with type 2 diabetes whose hyperglycemia is not adequately reduced by dietary management and exercise. It can be used as the initial drug in these patients or as the replacement drug for those with primary or secondary failure during therapy with first generation sulfonylureas (Charles, 2010). Side effects are minimal, and the most important is hypoglycemia. Although no difference persists between the treatment groups for total-cholesterol, triglycerides, HDL-cholesterol, and LDL-cholesterol, the antidiabetic agents seem to lower serum lipids most effectively, which may help prevent coronary events in T2DM patient (Penbeet al.,2003).

The present study was designed to investigate and compare the effects of glibenclamide and metformin on prevalence of metabolic syndrome in type 2 diabetic patients.

1.2    STATEMENT OF PROBLEM

To know if antidiabetic agents glibenclamide and meltformine has any effect on lipid and glycatedhaemoglobin in type 2 diabetes patients

1.3     AIM OF STUDY

To evaluate the effect of antidiabetic agent glibenclamide and meltformine on lipids and glycatedhaemoglobin in type 2 diabetes patient attending UITH Ilorin.

1.4     SPECIFIC OBJECTIVE

• To estimate concentration of lipid and glycatedhaemoglobin in type 2 diabetes patient on antidiabetic agents (glibenclamide and meltformine)
• To examined lipid parameters and glycatedhaemoglobin in pairs for their correlations for each study group.
• To compare the results obtained between the two groups

1.5 SIGNIFICANCE OF THE STUDY

This study showed the effect of two different antidiabetic agents (glibenclamide and meltformine) on lipid parameters and effect of long term management of type 2 Diabetes mellitus patients.

1.6 RESEARCH HYPOTHESIS

Plasma fasting lipid parameters will show no significant difference in both antidiabetic agents.

Glycatedhaemoglobin results pattern will show if the patients are adhering to the use of antidiabetic agents.

There will be a correlation between lipids and glycatedhaemoglobin based on the use of antidiabetic agents.

CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

Diabetes mellitus (DM) is a group of metabolic disorders characterized by a chronic hyperglycemic condition resulting from defects in insulin secretion, insulin action or both. Permanent neonatal diabetes is caused by glucokinase deficiency, and is an inborn error of the glucose-insulin signaling pathway (Njolstadet al., 2003).

The prevalence of diabetes is increasing rapidly worldwide and the World Health Organization (2003) has predicted that by 2030 the number of adults with diabetes would have almost doubled worldwide, from 177 million in 2000 to 370 million. Experts project that the incidence of diabetes is set to soar by 64% by 2025‚ meaning that staggering 53.1 million citizens will be affected by the disease (Rowley and Bezold, 2012). The estimated worldwide prevalence of diabetes among adults in 2010 was 285 million (6.4%) and this value is predicted to rise to around 439 million (7.7%) by 2030 (Shaw et al., 2010). There are two main types of Diabetes mellitus:

1. Type 1 diabetes, also called insulin dependent Diabetes mellitus (IDDM), is caused by lack of insulin secretion by beta cells of the pancreas.
2. Type 2 diabetes, also called non-insulin dependent Diabetes mellitus (NIDDM), is caused by decreased sensitivity of target tissues to insulin.

The reduced sensitivity to insulin is often called insulin resistance and its causes are shown in Table 1.

Table 1: Some causes of insulin resistance.

S/No.                                       Causes__________________

1. Obesity/overweight (especially excess visceral adiposity)
2. Excess glucorticoids (cushing’s syndrome or steroid therapy)
3. Excess growth hormone (acromegaly)
4. Pregnancy, gestational diabetes
5. Polycystic ovary disease
6. Lipodystrophy (acquired or genetic, associated with lipid accumulation in liver)
7. Autoantibodies to the insulin receptor
8. Mutations of insulin receptor
9. Mutations of the peroxisome proliferators’ activator receptor γ (PPAR γ)
10. Mutations that cause genetic obesity (e.g., melanocortin receptor mutations)
11. Hemochromatosis (a hereditary disease that causes tissue iron accumulation).

Source: Guyton and Hall (2006).

In both types of Diabetes mellitus, metabolism of all the main foodstuffs is altered. The basic effect of insulin lack or insulin resistance on glucose metabolism is to prevent the efficient uptake and utilization of glucose by most cells of the body, except those of the brain (Guyton and Hall, 2006). As a result of this, blood glucose concentration increases, cell utilization of glucose falls increasingly lower and utilization of fats and proteins increases…