Metformin

Metformin has been combined chemically with antihypertensive agents like Propranolol and Furosemide by Williamson’s ether synthesis and direct amidation respectively with the objective of obtaining single chemical entity in the form of co-drugs. Structures and physicochemical parameters of all synthesized co-drugs were established by MP, BP, TLC, IR, 1H NMR and Mass spectral data. The co-drugs were then subjected to hydrolysis kinetics at different pH (1.2, 6.8 and 7.4). The drug release study of Metformin, Propranolol and Furosemide from the synthesized co-drugs proved that they hydrolyze significantly at pH 7.4 and are remain unhydrolysed at pH 1.2 and 6.8. This proves the stability of both the co-drugs at gastric and intestinal pH and easily gets hydrolyzed in blood. The co-drugs were then screened for their antidiabetic activity and antihypertensive activity and compared with parent drugs. Both the co-drugs PMCD, FMCD have shown significant antidiabetic activity with respect to duration as well as intensity of action. Co-drug of Metformin and Propranolol (PMCD) has shown delayed release and more prolonged antihypertensive action when compared to standard drug Propranolol where as co-drug of Metformin and Furosemide (FMCD) has shown immediate release and duration of antihypertensive action same as that of standard drug Furosemide.

Diabetic neuropathy (DN), one of the most common complications affects nerves in T2DM patients. This study was aimed to understand the clinical presentation of DN; types of neuropathies; associated co-morbidities, risk factors, treatment patterns etc. A single-visit, cross-sectional, multi-centric, epidemiological study conducted at 363 centres. Data collection included demographics, lifestyle habits, medical history, concomitant medications, laboratory investigations and treatment regimens in DN. A total of 7172 patients enrolled with mean age of 52.8 years. The median duration of T2DM was 6 years and neuropathy was about 2 years. The prevalence rates of painful and painless DN were 49.1% and 50.9%. The most common types of neuropathies reported were acute (32.3%) and chronic (31.4%) sensory neuropathy and reported symptoms were numbness (30.7%), paresthesia (29.2%), and burning sensation (28.0%). Majority of the patients had uncontrolled glucose parameters i.e FBG: 90.1%, PPG: 90.5%, HBA1c: 69.8% and uncontrolled lipid profile i.e LDL: 65.5% and TG: 61%. Almost 2/3rd (61.3%) were treated with metformin as monotherapy or in combination. More than half (52.3%) received mecobalamin for DN treatment. Higher proportions of patients with painful neuropathy were prescribed pregabalin as compared to painless (32.18% vs 19.79%).Diabetic neuropathy is painless in almost half of the Indian patients. Acute sensory neuropathy occurs in most of the patients. Onset of diabetic neuropathy could be much earlier than expected and hence, routine screening is recommended. Metformin and Mecobalamin are commonly prescribed for the treatment of diabetes and DN. Pregabalin is a preferred treatment option for painful DN.