Assessment of Clinical and Biochemical Profile of Prediabetic Subject in Bangladesh, Attending in BIRDEM and results of Intervention by Lifestyle Modification, Metformin, and DPP4 Inhibitor
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 2
Abstract
Prediabetes is a reversible condition that increases an individual’s risk for progress to diabetes.The aim of the study is to assess prediabetic profile before and after life style modification only, lifestyle with metformin and lifestyle with DPP-4 inhibitor. This prospective interventional study was carried out at Endocrine OPD of BIRDEM general hospital over the period of 12(twelve) months from Jan 2017 to Dec 2017. The subjects who were screened for DM by OGTT according to WHO criteria, were approach whose value are in the range of IGT, IFG or combined. The subjects are randomly selected as first person in group A (lifestyle only), second person in group B (lifestyle with metformin) and third person in group C (lifestyle with DPP4i). Drug compliance are 84%, 88%, and 76% and drop out are 16%, 12%, and 26% in lifestyle only, lifestyle plus Metformin, and lifestyle plus DPP4i respectively. Mean drop out is 18% and most of them are due to non adherence to study protocol and drug adverse effect. In Group A 50 subjects were advised with lifestyle, 42 were follow up with the results showed that highly significant change in BMI (p-0.002), Fasting (p-0.001) & 2 hr plasma glucose level (p-0.003) serum triglyceride level (p-0.012) and reduced HbA1c level (p-0.0075) respectively, reduction rate of DM is 43%. There is no effect on systolic and diastolic blood pressure and also on total cholesterol, HDL and LDL. In Group B 50 subjects were advised with lifestyle plus metformin, 44 were follow up with the results showed that significant change in BMI (p-0.003) Fasting (p-0.0001) & 2 hr plasma glucose level (p-0.0001) serum triglyceride level (p-0.04) and reduced HbA1c level (p-0.0003) respectively and reduction rate of DM is 58%. There is no effects on systolic & diastolic blood pressure and also in HDL, LDL and total cholesterol level. In Group C 50 subjects were advised with lifestyle plus DPP4i, 37 were follow up with the results showed that significantly change in BMI (p-0.05) Fasting (p-0.0001) & 2 hr plasma glucose level (p-0.0001) serum triglyceride level Fasting (p-0.03) and reduced HbA1c level (p-0.0004) respectively and reduction rate of DM is 43%. There is no effects on systolic & diastolic blood pressure and also in HDL, LDL and total cholesterol level. There is no significant outcome difference in BMI in between B & C group but outcome difference in between A vs. B (P-0.05) and A vs. C group (P-0.04).There is no significant outcome difference in SBP, DBP, HbA1c and fasting blood sugar in between three intervention group. But more mean changed in 2hrs after blood sugar level in group A vs. group B (p-0.02) and B vs. C group (p-0.04). Mean changed in fasting blood sugar and 2 hrs after blood sugar, the outcome is same in between A and C group (p0.73). There is no outcome difference in LDL, HDL and total cholesterol level in between intervention group but there is significant outcome difference in TG level in A vs. B (P-0.04), B vs. C group (P-0.05) but no significant difference in A vs. C group ( p-0.24). Nausea (10%), abdominal distension (16%), diarrhea (12%) were the common adverse effects lifestyle plus metformin group where as nausea (8%), headache (10%) and abdominal discomfort (10%) were the common adverse effect in lifestyle plus DPP4i intervention group. No serious adverse effects were reported in the study group. No significant difference in DM reduction among the three group is seen.This study provides evidence that type 2 diabetes can be prevented by significant improvement in clinical and biochemical profile with metformin and DPP4 inhibitors along with lifestyle intervention.
Authors and Affiliations
Milton Barua, Faruque Pathan, Masud Un Nabi, Mahmudul Kabir
Keywords
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- EP ID EP467792
- DOI 10.9790/0853-1802164452.
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