Diabetes Mellitus ( Dm )

Many organizations have developed practice guidelines for a myriad of clinical scenarios which include the use of specific drugs or classes of medications, typically in a step-wise pattern. These “Best Practice” guidelines are built on evidence based criteria and systematic reviews. It has been shown that these clinical guidelines, with their list of essential medications, improve the quality of care and lead to better outcomes, but have not been shown to reduce costs.4,5 The practice of medicine has moved dramatically towards the use of these guidelines in recent years. For example, best practices for diabetic care recommends that all patients be placed on an ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker) for prevention of diabetic nephropathy and a statin for prevention of coronary artery disease. However, each patient’s insurance may cover a different medication in this class

Beta-blockers have been recently reported to decrease mortality in heart failure patients. Mortality and hospitalization rates for patients with the disease are high and continue to rise. Despite the magnitude of the problem, treatment of congestive heart failure is often inadequate. Primary care physicians care for most patients with heart failure. Beta-blocker therapy is appropriate in patients with NYHA class II or class III symptoms resulting from left ventricular systolic dysfunction. Unless contraindicated, beta-blockers should be considered a mainstay of therapy in these patients to improve symptoms and mortality and to decrease hospitalizations. Beta-blockers should not be administered to patients with heart failure who have bradycardia, heart block or hemodynamic instability.

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

Diabetes mellitus (DM) is a pandemic that affects millions of people. The growth rate of unrecognized pre-diabetes in America is expected to rise up to 52% by 2020 (Lorenzo, 2013). As the prevalence of diabetes increases, so will the complications and burden of the disease. One of the leading causes for cardiovascular disease, renal failure, nontraumatic lower limb amputations, stroke, and new cases of blindness is DM (Lorenzo, 2013).

Hyperglycemia is a very serious risk for heart disease and strokes. Complications from hyperglycemic diabetes may include coronary heart disease (CHD), heart failure, stroke, arrhythmias, or even death. High blood glucose (sugar) levels over time can lead to excess fatty deposits on the insides of your blood vessel walls. These deposits often affect blood flow, which increases the possibility of blood vessels clogging and/or hardening. As a result, this leads to heart disease. Furthermore, those with diabetic heart disease (DHD) may have less success with heart disease treatments, such as angioplasty or artery bypass grafting. “The common clustering of these risk factors in a single individual has been called the metabolic syndrome.” (Scott 1134) Uncontrolled diabetes, the biggest contributor to heart disease, is almost four times higher for adults than those without diabetes. The best way to prevent diabetic heart disease is to control it by way of reducing the risk factors through diet and lifestyle changes.

This particular research was driven by the demand of the regulatory guidelines that deals with reduction of risks. The cases of cardiovascular risks among patients are have been reported to increase in the recent days. The regulatory guidance require being presented for the cardiovascular outcomes that can be used in the therapies of type 2 diabetes treatment. However, the

There is growing concern that intense glucose lowering or the use of certain agents may be associated with adverse cardiovascular outcomes.

Furthermore, with the pharma logical treatments included in this article for the treatment of Type 2 Diabetes, many individuals will be prevented from developing CVD complications. Studies have shown the importance of patients being compliant with treatment leading to positive health outcomes. With the continued care given to these patients with Type 2 Diabetes many are able to have healthier lifestyles

The study shows that disease-modifying medications were prescribed significantly more often in 2000 than in 1995, particularly in patients younger than 65 and in those aged 75 to 84 (Saczynski et al., 2009, p. 3). The study indicates that Beta-blockers and ACE inhibitors have been shown to improve survival and reduce hospitalizations in patients with Heart Failure. The second article mentioned about the elderly patients who have CHF not on or under dosage of Angiotensin Converting Enzyme (ACE) inhibitors. According to this article ACE inhibitors should be given for patients diagnosed asymptomatic left ventricular systolic dysfunction (LVSD) (EF<40%) and symptomatic heart failure with systolic dysfunction associated with other heart problems such as myocardial infarction, pulmonary hypertension. The suggested dosage for the CHF patients mentioned in the article and due to age-related changes in pharmacokinetic drugs, it also recommended the initial dosage must be half the standard dose and gradual increase after assessing renal function. After studying a group of elderly CHF patients revealed that higher or standard dose of ACE inhibitors reduce the risks of major clinical events. Results from the research display a decrease of hospitalizations due to cardiovascular reason, heart failure, and ischemic events in the standard-dose group. The study also found out that the adverse effects of high doses can be managed by reducing the dosage or by changing

Prescription drugs in the competitive market offers a starting point allusion, which certain characteristics of medications and healthcare goods and services can be compared to unique goods and services. According to Carter, A, Pharm D Healthline.com say’s “By not taking care of your diabetes may damage your heart, kidneys, nervous system, and your eyes”. Such as, eating foods with a high content of sugar will extremely increase your blood sugar, or not taking medication to treat diabetes. He also states “metformin may need to be used with other medications to help regulate your blood sugar. Some patients with type 2 diabetes may have complications with hypertension as well. This leads us into an example of many prescription drugs to treat diseases. Such as, diabetes, and hypertension. According to Younossi, Z. M., et.al. (2013).authors of Alimentary Pharmacology & Therapeutics, wrote “Explanations for metabolic situations that have been used in the study have been formerly described. Briefly, type 2 diabetes was determined as fasting blood sugar level that is greater than 125 mg/dL , and hypertension was determined as blood pressure level that is greater than 140/90 mmHg .” With this being said the supply and demand of medications to treat diabetes and hypertension depends on the prescribing doctor and the incentives provided by the pharmaceutical company.

Cardiovascular disease has gained a global attention due to the overwhelming number of cases reported annually. Stakeholders from various health monitoring agencies, health care providers, and government agencies have come together to tackle the disease, and reduce morbidity and mortality. Organizations such as the Million Hearts Initiative, the American Heart Association (AHA) 2020 Goals, and the Healthy People 2020 goals have established public health objectives aimed at targeting cardiovascular risk factors, and improving the outcome of the disease (Sidney, Rosamond, Howard & Luepker, 2013). The aspirations of the AHA 2020 objectives are to enhance the cardiovascular well-being of all Americans by 20%, as well as decrease related deaths from cardiovascular diseases and stroke by 20% (Sidney et al., 2013). Statistical analysis of the predominance of cardiovascular health risk factors among Americans is overwhelming and therefore needs immediate action. According to Go et al. (2013), about 31.9 million adults 20 years or older have total serum cholesterol levels greater than or equals to 240 mg/dL. According to a statistical data recorded between 2007 to 2010, 33% of United States adults aged 20 years of age or older are hypertensive, that is about 78 million US adults, and 44% globally (Go et al., 2013). In 2010, an overwhelming 19.7 million people in the United States were diagnosed with diabetes mellitus, in addition to 8.2 million unconfirmed cases, and 38.2% people

A cross-sectional study included 100 SLE patients fulfilling the American college of Rheumatology (ACR) revised classification criteria for SLE(Hochberg, 1997). All patients were recruited randomly from the Rheumatology outpatient clinic and the inpatient ward of Internal Medicine and Rheumatology department, Ain Shams University hospital.

Lo C, Toyama T, Hirakawa Y, Jun M, Cass A, Hawley C, Pilemore H, Badev SV, Percovic V, Zoungas S. Insuline & Glucose lowering agents for treating people with diabetics and chronic Kidney disease. Cochrane Database of systematic reviews 2015, Issue 8. Art. No. CD011798. DOI:10.1002/14651858.CD011798.

Diabetes refers to a set of several different diseases. It is a serious health problem throughout the world and fourth leading cause of death by disease in the country. All types of diabetes result in too much sugar, or glucos in the blood. To understand why this happens it would helpful if we understand how the body usually works. When we eat, our body breaks down the food into simpler forms such as glucose. The glucose goes into the bloodstream, where it then travels to all the cells in your body. The cells use the glucose for energy. Insulin, a hormone made by the pancreas, helps move the glucose from bloodstream to the cells. The pathophysiology of diabetes mellitus further explains the concept on how this disease works. Pancreas

Diabetes is a systemic disease caused by a decrease in the secretion of insulin or reduced sensitivity or responsiveness to insulin by target tissue. (Beale, et al., 2011) The incidence of diabetes is growing rapidly in the United States and worldwide. An estimated 347 million people around the world are afflicted with diabetes. (Whalen, et al., 2012) According to World Health Organization (WHO), Diabetes prevalence among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. It is the major cause of blindness, kidney failure, heart attack, stroke and limbic amputation. World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death in 2030. It is a complex and costly disease that can affect nearly every organ in the body and result in devastating consequences. The leading cause of non-traumatic lower extremity amputations, renal failure, and blindness in working-age adults, diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations, perinatal mortality, and disability. (Cefalu, 2000) Insulin therapy and oral hypoglycemic agents have demonstrated improvement in glycaemic control. However, Insulin therapy has some disadvantages such as ineffectiveness following oral administration, short shelf life, of the need for constant refrigeration, and fatal hypoglycaemia, in the event of excess dosage.