The purpose of this study was to determine the adherence to oral hypoglycemic medications and associated factors in type 2 Diabetes Mellitus patients who were referred to the Isfahan Endocrinology and Metabolism Research Centre (IEMRC). Convenience sampling was used to enroll 248 patients with type 2 diabetes in a prospective study at IEMRC from January 2007 to January 2008. Patients had to be on a stable dose of oral hypoglycemic medications (glyburide and metformin) or for 3 months prior to the study and willing to participate in consultation sessions with a pharmacist. Pill count and self report methods were used to measure the adherence. Mean (SD) of patients studied was 56.6 (8.9) years and 62% were females. The mean (SD) duration of diabetes in the study patients was 10.8 (6.1) years and 81.9% of them were literate with basic education. Non-adherence rates to metformin and glyburide were recorded in 39.7% and 35.3% of the study population respectively. Lower HbA1C levels and higher education were associated with higher adherence rates. Forgetfulness, confusion, fasting, adverse effects, complexity of medication regimen and disruption of routines were most commonly reported causes of non adherence. Prevalence of adherence to these two medications did not differ significantly between pill count (62.3%) and self report (62.8%), (p>0.05). Adherence rates did not vary by pill count and self report significantly. It was concluded that good adherence to medications was associated with a lower HbA1C profile; so it seems that pill count is a useful method in the clinical practice to identify non-adherent patients. Further studies are needed to find out efficient interventions to improve the patient’s adherence.

BACKGROUND: Both metformin and sulfonylurea (SU) drugs are among the most widely-used anti-hyperglycemic medications in patients with type 2 diabetes mellitus (T2DM). Previous studies have shown that treatment with SUs might be associated with decreased survival compared with metformin. This study aimed to evaluate all-cause and cardiovascular mortality rates between glyburide and metformin in patients diagnosed with T2DM. METHODS: This was a cohort study on 717 patients with T2DM (271 undergoing monotherapy with glyburide and 446 with metformin). Data were gathered from 2001 to 2014. All-cause and cardiovascular mortality were end-points. RESULTS: During the follow-up، 24 deaths were identified، of which 13 were cardiovascular in nature. The group with glyburide monotherapy had greater all-cause mortality (17 (6. 3%) in glyburide vs. 7 (1. 6%) in metformin، P = 0. 001) and cardiovascular mortality (11 (4. 1%) in glyburide vs. 2 (0. 4%) in metformin; P = 0. 001). Metformin was more protective than glyburide for both all-cause (HR: 0. 27 [0. 10 – 0. 73] P-value = 0. 01) and cardiovascular mortality (HR: 0. 12 [0. 20 – 0. 66]، P-value = 0. 01) after multiple adjustments for cardiovascular risk factors. Among adverse cardiovascular events، non-fatal MI was higher in glyburide compared to metformin monotherapy group (3. 2% vs. 0. 8%; P-value = 0. 03)، but not coronary artery bypass grafting (P-value = 0. 85)، stenting (P-value = 0. 69)، need for angiography (P-value = 0. 24)، CCU admission (P-value = 0. 34) or cerebrovascular accident (P-value = 0. 10). CONCLUSION: Treatment with glyburide is associated with increased all-cause and cardiovascular mortality in patients with T2DM.

Introduction: Factitious hypoglycemia, caused by the surreptitious use of insulin and sulfonylureas, is one of the most challenging differential diagnoses of hypoglycemia. Diagnosis is usually established via exclusion with respect to the special patterns of plasma insulin and C-peptide during hypoglycemic episodes. Case Presentation: We report a case of recurrent hypoglycemic episodes and confusing patterns of insulin and C-peptide levels. In the primary evaluations, insulinoma was suspected considering the high plasma concentrations of insulin and C-peptide, besides negative urine and plasma sulfonylureas during hypoglycemic episodes. Considering the normal imaging studies and refractory hypoglycemia to medical therapy, distal pancreatectomy was performed. The patient had no episodes of hypoglycemia after the surgery. Fivemonthslater, similar episodes recurred. Further investigations revealed different plasma concentrations of insulinand C-peptide in each hypoglycemic episode. Regarding various biochemical patterns during hypoglycemia and absence of evidence supporting other differential diagnoses, we suspected factitious causes. Close observation revealed that the patient had a history of intermittent glyburide consumption and analog insulin injection. Discussion: Most commercial insulin immunoassays can only detect human insulin and lack the ability to identify synthetic analog insulin. In addition, common detection methods for sulfonylureas and meglitinides are of low diagnostic value in the human plasma and urine. These laboratory defects can lead to the misdiagnosis of insulinoma or noninsulin-mediated hypoglycemia due to the surreptitious use of insulin secretagogues or analog insulin, respectively. Therefore, due to the lack of any definitive laboratory findings, clinical suspicion is the best strategy for diagnosis.

Insulin is currently the drug of choice in treating patients with gestational diabetes mellitus but insulin is expensive, inconvenient to store and use and probably associated with more risks of asymptomatic hypoglycemia in comparison with some oral agents. This randomized clinical trial was conducted to evaluate the efficacy and safety of glyburide in patients with gestational diabetes mellitus in comparison with insulin therapy. Pregnant women aged between 18-45 years with singleton pregnancies and in their 24-36 weeks of gestation were assessed for eligibility. Women with gestational diabetes mellitus were randomly allocated to two insulin and glyburide groups and compared with maternal and neonatal outcome. Ninety-six women with gestational diabetes mellitus enrolled in the study. At screen and treated fasting and post-prandial blood glucose levels were similar in both groups. Time for beginning the treatment to control the glycemic index was 28.30 (±20.60) days in the insulin group and 22.56 (±18.86) in the glyburide group. There was no statistically significant difference in time-to-control the blood glucose level in two studied group. Time, between beginning the treatment of GDM and delivery, was 53.22 (±28.96) days in the insulin group and 56.67 (±30.47) in the glyburide group. There was no statistically significant difference between the times of treatment-to-delivery in two studied groups. There were no statistically significant differences between maternal and neonatal outcomes in two studied groups. Glyburide can effectively and safely control the glycemic index in women with gestational diabetes mellitus in comparison with insulin.

Objective: Diabetes has been known to decrease follicular growth. Although antihyperglycemic drugs decrease the serum level of glucose, the ovarian tissue impairments as follicular atresia remain unchanged. On the other hand the glucose transporter type I (GLUT I) expression and ovarian cortical angiogenesis play critical role on theca cells endocrine function and follicular growth, respectively. Thus, present study aimed to evaluate protective effects of glyburide and parsley extract on diabetes-induced damages on the ovary.Materials and Methods: Thirty Mature female rats were divided into five (N=6) test and control-sham groups. The test group subdivided into four groups. The experimental diabetes induced in all test groups. the test group I (D), test group II (GLY) received glyburide at dose of 5 mg/kg, test group III (P) received parsley extract at the dose of 2g/kg and the simultaneous administration of parsley and glyburide was performed in last test group (P+GLY). After 30 days, the immu nohistochemical and immunofluorescent analyses were performed to estimate the GLUT I distribution and ovarian angiogenesis, respectively.Results: The ovaries from animals in P and P+GLYadministrated group exhibited higher number of GLUT I expressed follicular cells versus other test groups. Interestingly, the follicular cells of diabetic animals exhibited lower GLUT I protein which were accumulated in one apex of the cells. Co-administration of parsley and glyburide significantly (p<0.05) up-regulated the cortical vessels distribution.Conclusion: Our data suggest that parsley inhibits the diabetes-induced damages both by promoting vascular remodeling and by up-regulating the GLUT I protein expression.