Skip to content


  • by

Today October 4 is the second birthday of my dear granddaughter Anushka, so a very Happy Birthday to Anushka Baba.

Good morning everyone this is the 4th of october 2022. it is uh an eventful day because this is the birthday of my dear granddaughter anushka anushka turns two years today and therefore a very very happy birthday to anushka and also one wishes i wish her the best in her life and that she has a spectacular life ahead of her i take this opportunity to discuss the

Great trial which has been published around 10 days ago in the new england general medal this is a trial on patients with diabetes now diabetes has a massive footprint in india there is a huge burden in 2019 there were around 77 million people with diabetes in india 90 to 95 percent of them were type 2 diabetes and we have data on the prevalence in different

States chandigarh has the highest prevalence with 13.6 percent tamil nadu comes second with 10.4 percent punjab has a prevalence of 10 where these cities were concerned delhi has a very high prevalence of 26 percent and uh chennai has a prevalence of 22 percent so you clearly see that there is a very large number of people suffering from diabetes in this country

Now diabetes has massive complications these could be divided into microvascular complications and macrovascular complications the macro vascular complications are heart attacks strokes or heart failure the microvascular complications are retinopathy nephropathy neuropathy which means that a person if he has a retinopathy can develop blindness if the person has a

Nephropathy then the person can develop kidney failure and if there is neuropathy then the person has loss of sensation which leads to amputation in the future as far as the macro vascular complications are concerned these could be as i’ve just said heart attacks strokes and heart failure now we have data we have randomized data in thousands of patients which tell

Us that there are two classes of drugs which are effective in preventing macrovascular cardiovascular complications in patients with diabetes these two classes are an sg lg2 inhibitor i have already spoken about this class of drug in my videos on heart failure and also we have what are known as uh glp receptor analogues that is a leraclotide or semiclotide these

Are injections and which also apart from controlling diabetes also prevent atherosclerotic diseases now there is a gap in how to treat a diabetic which is of recent onset which means that the diabetes has developed in the last five or ten years we all know based on the uk pds study that metformin is the first drug of choice so between you and me by and large one

Would begin treating a patient with diabetes with metformin it is a cheap drug it is given orderly it can be given once a day or twice a day a single tablet of about 1000 milligrams of metformin in india costs just about three rupees so there you have you have a a cost of just three rupees a day in treating initial diabetes now apart from metformin which is a

Bigonide which sensitizes the body to the to the effect of insulin the the second drug is still unclear what do we introduce once we’ve introduced metformin in a person with the low risk for a cardiovascular complications or who has not developed established a cardiovascular disease what is the second drug so the great trial which is published in the new england of

General medicine provides us some data this compares four classes of drugs the first is a long-acting insulin that is insulin clarion and then we have a glp receptor analog which is a regular tide we have a sulfonyl urea which is a glimepiride and we have a dpp4 innovator which is acetoglyptin this trial included more than 4040 patients with diabetes the amine age

Was about 57 years around 63 percent were males and around 65 percent were white caucasians only three to four percent were asians which means that strictly speaking which cannot extrapolate data from this study however this is the best we have right now these patients were followed for a mean of five years and what was found was all four anti-diabetic drugs were

Almost more or less equally effective in controlling the glycerated hemoglobin which tells us the level of glucose in the previous three months now the important thing is that which between these four drugs two drugs were slightly more effective in controlling the glycerated hemoglobin and these were insulin insulin glargen which is begun at a dose of 20 units per

Day and gradually built up and the reglotide which is the glp receptor analog now these two drugs were able to reduce the glyceride hemoglobin more than the other two drugs that is glimepiride the sulfurylurea and the dpp4 inhibitor which was cytic lipton which is called januvia in india now this is very important because if you have to begin a second drug then i

Would use these of these two i would use i would the second drug which i would use would be either an insulin or it would be a glp receptor analog the problem is that both are injections now apart from this there was hypoglycemia hypoglycemia was maximum with the glimepiride at about 2.2 percent insulin glargine cause hypoglycemia in about 1.3 percent the regular

Diet caused hypoglycemia in one percent cytical predictably reduce a produced hypoglycemia and just about 0.7 percent which means again the acetylchton is a a weaker drug it is the weakest of these four drugs however one must bear in mind that when this study was begun the sg lt2 inhibitors had yet not been approved by the fda and therefore that class of drug was

Not included in this study so as far as i’m concerned if i was to start if i was to begin treating a patient with diabetes who has developed diabetes in the last 10 years and would be considered a low risk for a cardiovascular complication i would begin with metformin or in fact i would begin with the lesser t2 inhibitor or i would begin with a metformin and and

Energy h2 inhibitor because naclt2 inhibitor is is known by randomized trials not only to prevent heart failure but if heart failure has developed it is also known to reduce mortality or hospitalizations following heart failure now apart from this in the great trial there was a suggestion that the regular tide which is a glp receptor analog reduced cardiovascular

Complications by about 29 as opposed to the other three drugs apart from this the microvascular complications were more or less the same by these four drugs so what is the take-home message the take-home message is that if you have a patient of diabetes the the common sense approach would be to begin treatment with metformin and once metformin is found not to be

Effective in controlling the glycerate hemoglobin it would be safe to add unless we have to inhibitor or as per the great trial uh uh a long-acting insulin such as insulin glargine or a glp receptor analog with this i i end this video and once again a very very happy birthday to anushka baba thank you very much for watching this video

Transcribed from video
THE GRADE TRIAL ON LOW RISK PATIENTS WITH DIABETES By Dr. Deepak NatarajanliveBroadcastDetails{isLiveNowfalsestartTimestamp2022-10-04T040304+0000endTimestamp2022-10-04T041240+0000}