Objective: To evaluate adherence to therapy and study factors associated with non-adherence in patients of type 2 diabetes mellitus (DM). Methods: A prospective, cross-sectional, questionnaire based study was conducted in a tertiary care teaching hospital. 150 patients suffering from type 2 DM since six months or more were interviewed using self-designed, semistructured questionnaire to get information about adherence to medication, diet/exercise schedule and self-monitoring of blood glucose. Morisky medication adherence questionnaire was used to calculate overall adherence. Results: Average number of medicines taken by each patient daily was 4.75 ± 1.73 (mean + SD). 70% patients reported non-adherence to medication schedule. Not buying all medicines (58.66%), not taking prescribed dose of medicines (34%), taking additional non-prescribed medicines (30%) and not taking medicines for required duration (25.33%) were common types of nonadherence. Unawareness about need of each medicine (55.66%), forgetfulness (50.66%) and high cost (43.33%) were the common causes of non-adherence. In Morisky medication adherence questionnaire high, medium and low adherence was reported by 0%, 26% and 74% of patients, respectively. Moderately positive correlation was observed between poor adherence and number of concurrent illnesses, number of medicines taken and female gender. Regular monitoring of blood glucose and diet schedule was followed by 46% and 68% patients respectively. Conclusion: Since, not buying all medicines, which was mostly due to high cost was the commonest type of non-adherence, measures to provide free medicines to non-affording patients need to be implemented. Majority of patients were not aware about need of taking each medicine, hence, creating awareness about the same is essential for improving adherence to therapy.

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To assess the impact of telmisartan on urine albumin to creatinine ratio (UACR) and blood pressure (BP) among Indian hypertensive patients on telmisartan monotherapy. Material and methods:This was a retrospective cohort study. Hypertensive patients prescribed with Telmisartan monotherapy with UACR records of at least two analysable visits were enrolled in the study. The study was approved by an independent ethics committee. The data of enrolled patients was analysed retrospectively to assess the change in UACR and BP from visit one to visit two.Results: Data of 1,095 patients was available for analysis. The average age was 54.0 ± 11.7 years. There was a significant reduction in UACR from 113.58 ± 443.74 mg/g at visit one to 77.29 ± 326.76 mg/g at visit two (p=0.0012) with telmisartan monotherapy in overall population (mean duration 278 days). Overall 48% patients reverted to normoalbuminuria (UACR<30 mg/g). Reductions in systolic BP and diastolic BP were −8.5 mmHg and −3.8 mmHg, respectively (both p<0.001, mean duration of 99.6 days between visits one and two). The UACR reduced from 83.3 ± 312.4 mg/g at visit one to 58.27 ± 231.47 mg/g at visit two in hypertensive patients with diabetes (n=945, mean duration 292 days). Significant reductions in systolic BP (−8.7 mmHg) and diastolic BP (−3.8 mmHg) were also found in diabetic hypertensive patients (mean duration 101.5 days). Conclusion:The present study demonstrated that telmisartan monotherapy prevents the progression of microalbuminuria along with causing significant reductions in BP.

Background The antihypertensive agent telmisartan is an angiotensin II receptor blocker with a terminal elimination half-life of 24 h and has a high lipophilicity, thereby enhancing its bioavailability. Another antihypertensive agent, cilnidipine is a calcium antagonist and has dual mode of action on the calcium channels. This study aimed at determining effect of these drugs on ambulatory blood pressure (BP) levels. Methods A randomized, open-label, single-center study was conducted during 2021 - 2022 on newly diagnosed adult patients with stage-I hypertension, in a mega city of India. Forty eligible patients were randomized to telmisartan (40 mg) and cilnidipine (10 mg) groups, with once daily dose administered for 56 consecutive days. Ambulatory blood pressure monitoring (ABPM) (24 h) was performed pre- and post-treatment, and the ABPM-derived parameters were compared statistically. Results Statistically significant mean reductions were observed in all BP endpoints in telmisartan group but only in 24-h systolic blood pressure (SBP), daytime and nighttime SBP, and manual SBP and diastolic blood pressure (DBP) in cilnidipine group. The mean change from baseline to day 56 between two treatment groups showed statistical significance in last 6-h SBP (P = 0.01) and DBP (P = 0.014), and morning SBP (P = 0.019) and DBP (P = 0.028). The percent nocturnal drop within and between groups was statistically nonsignificant. Also, the between group mean SBP and DBP smoothness index differed nonsignificantly. Conclusions Telmisartan and cilnidipine once daily were effective and well tolerated in the treatment of newly diagnosed stage-I hypertension. Telmisartan provided sustained 24-h BP control and may offer advantages over cilnidipine in terms of BP reductions, particularly over the 18- to 24-h post-dose period or critical early morning hours.

Introduction: Diabetes Mellitus (DM) has become the leading health concern worldwide over the last few decades. But despite advances in both understanding of the pathophysiology of Type 2 Diabetes Mellitus (T2DM), and the development of new treatment strategies, current management of patients with T2DM remains suboptimal. Initial monotherapy is frequently inadequate in patients with high baseline Glycated Haemoglobin (HbA1c). Thus, initial combination therapy has emerged as an alternative approach. Aim: To assess INItiation and effecTiveness of dual combInation therapy with metformin And Teneligliptin in drug naïvE T2DM patients (INITIATE). Materials and Methods: In this retrospective, multicentre study, newly diagnosed drug naïve T2DM patients failed with diet and exercise prior to screening and initiated with dual therapy of metformin and teneligliptin were enrolled. Data of all the patients prescribed with any therapeutic dose of metformin (250 mg, 500 mg, 750 mg, 1000 mg, 1500 mg, 2000 mg) and teneligliptin (20 mg, 40 mg) was considered. The data was analysed to assess change in glycaemic parameters from baseline to 12 weeks. Paired t-test was applied for statistical results. Results: Data of 7857 patients were analysed. The mean change of Fasting Plasma Glucose (FPG) from baseline {202.29±52.2 mg/dL (11.23±2.89 mmol/L)} to 12 weeks {142.57±34.5 mg/dL (7.91±1.91 mmol/L)} was -59.72±17.7 mg/dL (-3.31±0.98 mmol/L) (p-value <0.0001). The absolute change in mean Postprandial Plasma Glucose (PPG) from baseline {(286.26±80.43 mg/dL (15.89±4.46 mmol/L)} to 12 weeks {(198.30±42.24 mg/dL (11±2.34 mmol/L)} was -87.96±38.19 mg/dL (-4.88±2.12 mmol/L) (p-value <0.0001). Mean HbA1c level was 8.11%±1% (65±10.9 mmol/mol) at baseline and decreased significantly to 7.15%±0.94% (55±10.3 mmol/mol) (p-value <0.0001) with a mean change of -0.96±0.06 (-10.5±0.7 mmol/mol) at 12 weeks. Total 42.83% (n=3365) patients achieved target HbA1c (<7%) at 12 weeks. Conclusion: Initiation of dual therapy with metformin and teneligliptin in drug naïve Indian T2DM patients significantly improved glycaemic control.