Background: Diabetes Mellitus is a chronic metabolic disorder that is one of the major causes of morbidity and requires lifelong treatment. Aim and Objectives: This study was conducted to determine prescribing pattern and frequency of single and combination antidiabetic drugs prescribed for type 2 DM and to compare their percentage cost variation. Materials and Methods: This was a prospective observational study carried out among in-patients of the general medicine department of a tertiary care hospital for a period of 6 months. Results: A total of 246 subjects were analyzed showing the main age group was between 60-70 years (28.9%). Polypharmacy was evident in the study as 178 (72.4%) prescriptions had greater than 5 drugs. Metformin 500mg in 38 (33.04%), Metformin 500mg + Glimepiride 2mg in 36 (25.35%) subjects and Insulin soluble 30% + Isophane 70% were the most prescribed single, combination, and insulin preparation respectively. The highest percentage cost difference was seen with Vildagliptin 50 mg (72.88%) out of 15 single antidiabetic drugs, Metformin 500mg + Dapagliflozin 10mg (79.93%) out of 20 combination antidiabetic drugs and Insulin soluble 30% + Isophane 70% (28.28%) out of 6 insulin preparations. Conclusion: Oral dosage form was the most prescribed and there is inclination towards prescribing combination therapy. The study concluded that inclusion of generic drugs to the therapy will be economical for the patient, as it can reduce the wider price variation of antidiabetic drugs by different brands available in the hospital pharmacy. KEYWORDS: Type 2 Diabetes mellitus, Anti-diabetic drugs, Drug utilization study, Polypharmacy, Comparative Pharmacoeconomics analysis, Cost analysis.

Background: Both human insulin and insulin analogue used in the treatment of type 1 diabetes mellitus. The modification in amino acids sequences of human insulin lead to produce analogue form which have a pharmacokinetic and pharmacodynamics effect near to normal human endogenous   insulin release. Aim of study: This study designed to compare between the effect of each type of insulin on high sensitive C-reactive protein and interleukin-6 and total antioxidant capacity in a sample of Iraqi type 1 diabetic children and adolescents. Study design: The study was enrolled on fifty-one Iraqi type 1 diabetic children and adolecence age range (6-18) year. The patients allocated into two groups, Group (1) includes 20 patients assigned to receive conventional human insulin (regular and NPH), and Group (2) includes 20 patients assigned to receive insulin analogue (insulin aspart and glargine) for three months. The inflammatory and antioxidant markers measured at baseline and after three months of intervention. Results: After three months of treatment, both insulin groups did not affect high sensetive C_reactive protein (hs-CRP) significantly from baseline to 3 months. Only insulin analogue reduced Interleukin-6 (IL-6) significantly, while human insulin reduced   level of IL-6 but it was not statistically significant. Both therapies reduced total antioxidant capacity (TAOC) significantly; however, insulin analogue had higher reduction percentage (15.1% vs. 5.7%) compared to the conventional insulin. Conclusion: Only insulin analogue reduced IL-6 significantly. Both types of insulins did not effect on hs-CRP. Both therapies reduce TAOC significantly.

Aims:To discuss the likelihood of severe hypokalaemia as a cause of reversible diabetes. Presentation of the Case: A 46 year old patient presented to the Accident and Emergency unit (A&E) with a history of polyuria and polydipsia of recent onset. He was severely hyperglycaemic (glucose = 40 mmol/L, HbA1c = 11%), hypokalaemic (serum potassium < 2.0 mmol/L) and hypertensive [Blood Pressure (BP) = 180/115]. Conn's syndrome was confirmed by finding a raised serum aldosterone (1650 pmol/L; normal value < 440 pmol/L), suppressed renin (< 0.2 ng/ml/h; normal range: 0.2-2.5 ng/ml/h) and a left sided adrenal tumour (2.0 x 2.0 cm) on CT scanning. He was managed initially with IV potassium and insulin (initially 100 units daily) together with oral potassium, spironolactone 100 mg daily, lisinopril 20 mg daily and amlodipine 10 mg daily. After six days his potassium was 3.4 mmol/L and the IV potassium infusion was stopped. Twelve days later his fasting blood glucose, serum potassium and BP's were normal and the insulin and antihypertensive medications, apart from spironolactone, were stopped. He was discharged on spironolactone alone for four months during which time his blood glucose, blood pressure, and serum potassium levels remained normal and his HbA1c had fallen from 11.0 to 5.2%. He then Case Studyunderwent successful laparoscopic adrenalectomy and his serum aldosterone came down to 127pmol/L (within normal range). Histology confirmed the diagnosis of a Conn's tumour. Conclusion:Although hyperaldosteronism per se predisposes to diabetes we suspect that this patient's rapidly reversible hyperglycaemia resulted primarily due to a failure of insulin secretion as a result of his severe potassium depletion

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Insulin analogue introduced to offer insulin replacement therapy mimic to normal human physiology. The aim of this study is to compare between the glycemic control of insulin analogue and conventional human insulin in a sample of type 1 diabetic Iraqi children and adolescents. Forty type 1 diabetic Iraqi children and adolescents age between (6-18) years enrolled in this study and divided into two groups. Group 1 contains 20 patients switched from human insulin to insulin analogue. Group 2 contain 20 patients continued with conventional human insulin. The results showed that both therapies reduced fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c %) but insulin analogue treated group had highly significant reduction. Both therapies did not affect on blood urea nitrogen and serum creatinine. Human insulin reduced triglyceride (TG) and very low-density lipoprotein (VLDL) significantly. The parameters measures at baseline and after three months of treatments. In conclusion insulin analogue is superior over conventional human insulin in reducing glycemic indices in a sample of type 1 diabetic Iraqi children and adolescents.