Rising cost of insulin: A deterrent to compliance in patients with diabetes mellitus.

BACKGROUND AND AIMS: The rapid increase in burden of type 2 diabetes mellitus (T2DM), poses a huge medico-economic challenge, especially when the cost of care is funded by out-of-pocket expenses. The aim of this review is to highlight various issues associated with rising cost of insulin, prevalence of cost-related insulin underuse, insulin related cost-saving behaviors, and viable solutions for the benefit of patients with T2DM receiving insulin. METHODS: Electronic databases (PubMed and Google Scholar) from 2000 to 2020 were searched using the key terms uncontrolled diabetes mellitus, insulin therapy, glycemic control, direct cost, indirect cost, out-of-pocket expenses, cost-related insulin underuse, cost-saving behaviors, and biosimilar insulin in developed countries and India. RESULTS: In majority of the patients with T2DM on monotherapy, addition of another oral antidiabetic agent is required. Despite these measures, the target glycemic goals are not achieved in majority of the patients resulting in various complications. These complications can be prevented and target glycemic goals can be achieved with early initiation of insulin therapy. However, rising cost is a major deterrent to the lifelong use of insulin. This results in non-compliance and further deterioration of glycemic control. Recently, biosimilar insulins have revolutionized the management of T2DM and look promising from the economic point of view. CONCLUSIONS: Biosimilar insulins are likely to further enhance the compliance of patients and should be used whenever feasible in patients with DM. However, the patient, along with prescriber should be allowed to make shared, informed decisions regarding the insulin they wish to use.

Comparison of effects of olanzapine and risperidone on body mass index and blood sugar level in schizophrenic patients.

Schizophrenia is one of the most debilitating disorders with devastating effects on its victims and their families. Atypical antipsychotics (AAPs) because of their superior efficacy, reduced side effects, & better compliance, have rapidly become the mainstay of treatment. But, because of paucity of research & literature on the long-term metabolic side effect profile of these AAPs in Indian setup, this prospective study has been carried out to compare the effects of olanzapine & risperidone on body weight, body mass index, & blood sugar level in schizophrenic patients. Among 60 newly diagnosed DSM-IV patients of schizophrenia enrolled, it was observed that mean body weight & BMI were significantly increased from baseline to 6 & 12 weeks in both olanzapine (n = 30) & risperidone groups (n = 30) (P < 0.001). Also, mean blood sugar was found to be significantly elevated after 6 & 12 weeks of treatment with olanzapine (P < 0.001) but not in risperidone group. Thus, the present study underscores the need for baseline and six weekly monitoring of body weight and blood glucose in routine clinical practice with AAPs.

Salt sensitivity and its implication in clinical practice.

Hypertension (HTN) is a complex multi-factorial disease and is considered one of the foremost modifiable risk factors for stroke, heart failure, ischemic heart disease and renal dysfunction. Over the past century, salt and its linkage to HTN and cardiovascular (CV) mortality has been the subject of intense scientific scrutiny. There is now consensus that different individuals have different susceptibilities to blood pressure (BP)-raising effects of salt and this susceptiveness is called as salt sensitivity. Several renal and extra-renal mechanisms are believed to play a role. Blunted activity of the renin-angiotensin-aldosterone system (RAAS), adrenal Rac1-MR-Sgk1-NCC/ENaC pathway, renal SNS-GR-WNK4-NCC pathway, defect of membrane ion transportation, inflammation and abnormalities of Na+/Ca2+ exchange have all been implicated as pathophysiological basis for salt sensitive HTN. While salt restriction is definitely beneficial recent observation suggests that treatment with Azilsartan may improve salt sensitivity by selectively reducing renal proximal tubule Na+/H+ exchange. This encourages the future potential benefits of recognizing and therapeutically addressing the salt sensitive phenotype in humans.