News & Events

  • 1. "HONOURED WITH HONORARY.":
    "PROFESSOR & BRAND AMBASSODOR TO IMA" FROM INDIAN MEDICAL ASSOCIATION-2017.
    2. THE BEST DOCTOR OF INDIA-2013 "
    - MEDGATE TODAY SURVEY.
    3. LIBYAN Medical Council Award 1993
    4. Life Time Health Achievement Award, 2005
    5. Bharatiya Chikistak Ratna Award, 2005
    6. Bharat Jyoti Award, 2008
    7. Bharat Chikistak Jyoti Award, 2008
    8. Hon PhD, CU, Florida, USA-2010
    9. Subarta Award 2012
    10.Subarta Award 2012
    11.AWARDS FROM CHAIRPESON
  • 12. Prof. Panda AS GUEST AT 5TH WORLD DIABETES CONGRESS,LAS VEGAS(USA)

    PIOGLITAZONE VS VOGLIBOSE ON GLYCEMIC CONTROL STUDY IN TYPE II DIABETES IN INDIAN POPULATION

    AUTHOR:-DR PREMANIDHI PANDA,M.D(MED),HON PHD IN DIABETES(USA),MRCP,FRCP
    Prof. Panda DIABETES CENTRE,INDIA
    WEBSITE URL:-www.drpandadiabetes.com


    INTRODUCTION:- Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.
    In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will almost double. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030  The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet.

    Clinical research in the west has focused exclusively on diabetes as a physical disorder. Clinical research in India, by contrast, has recognized that diabetes is a psychosomatic disorder, in which the causative factors are sedentary habits, physical, emotional and mental stress and strain. It has studied the beneficial effects of the practice of yoga, which is much more than a physical exercise. In  India  most important factors  are   Sedentary habits, Stress & heavy consumption of polished rice Switch over to “ western style diet”. I early I have  already produce a Paper Prof. Panda, Ways for long life “Zero Rice, Zero  Oil,& Belly exercise”.

    Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagons secretion. It is with both Micro vascular & macro vascular complications. Type II diabetes is a progressive disease . It requires two to three drug combinations produce good effects and less side effects. Therefore these two drugs taken into consideration like Pioglitazone and Voglibose.It shows good glycemic control FBS,2hr PPBS & HbA1C and Cholesterol and Triglyceride. Particularly stdy has been seen whose Blood sugar was not controlled by Glimiperide and Metformin.
    INTENT: Intent of the study done By Author from 2012 February to July 2012over a period of 6Months over 2000 Cases Type –II Diabetes shows tremendous result in reduction of blood sugar, Maintenance of Blood sugar very stable as compared to with Pioglitazone or voglibose who are under Uncontrolled blood sugar with Glimeperide and Metformin .It shows good glycemic control Constant maintenance of HBA1C 5.8 to 6.5 range. Reduction in Lipid Profile Serum Cholesterol , Serum Triglyceride,LDL& VLDL.

    BRIEF DESCRIPTION:- Pioglitazone is a prescription drug of the class thiazolidinedione (TZD) with hypoglycemic (antihyperglycemic, antidiabetic) action to treat diabetes. It was the tenth-best selling drug in the U.S. in 2008, with sales exceeding $2.4 billion.This drug has got much cardiovascular safety.Pioglitazone is effective against atherogenic diabetic dyslipidemia.Reasult of an observational study (ECLA) showed that pioglitazone can be considered as a potential choice for the treatment of type II diabetes when life style modification and Metformin fails.An improvement of platelet function and chronic systemic inflammation was observed with fixed dose combination of Metformin and Piogltazone as against Metformin and Glimiperide combination.Additionally PPAR-y activation also inhibits adhesion cascades and vascular inflammattory events and have tendency to prevent vascular endothelial dysfunction associated cardiovascular disorders.It is ineffective and possibly harmful in diabetes mellitus type 1 and diabetic ketoacidosis. Its safety in pregnancy, lactation (breastfeeding) and people under 18 is not established.Acute Liver disease is also contraindication for pioglitazone therapy.Although bladder cancer is being given to Pioglitazone therapy First given by On June 9, 2011 the French Agency for the Safety of Health Products decided to withdraw pioglitazone in regards to high risk of bladder cancer.But as a clinician I am using this drug since 2006 till now.More than 20000 patients are with pioglitazone with or without combination.I have not got a single case of bladder cancer till now.In my View Formaldehyde mixed fish to keep fish fresh ,Organophosphorus poisioned vegetable ,and other things we have to blame rather than pioglitazone.In my opinion PIOGLITAZONE is golden drug in Diabetes.Till now I have not received a single case of Fracture,Heart failure,Bladder cancer,Eye Disorder,Liver toxicity Except only few cases of Weight gain & Pedal Oedema.
    VOGLIBOSE:- Voglibose is an alpha-glucosidase inhibitor used for lowering post-prandial blood glucose levels in people with diabetes mellitus. Voglibose delays the absorption of glucose thereby reduces the risk of macrovascular complications. Voglibose is a research product of Takeda Pharma, a Japan-based company.Side effects are Flatulence, abdominal distension, diarrhea, pain, skin reactions, low blood sugar, increased LFT.It should not be prescribed in gall stone,Liver and kidney disease.
    I took this two molecule as they both decreases postprandial blood sugar.

    BRIEF DESCRIPTION OF PIOGLITAZONE VS VOGLIBOSE:-
    There is great war for Pioglitazone.It Causes Bladder Cancer,Fracture,Heart Failure for which On June 9, 2011 the French Agency for the Safety of Health Products decided to withdraw pioglitazone in regards to high risk of bladder cancer. On June 10, 2011 Germany's Federal Institute for Drugs and Medical Devices also advised doctors not to prescribe the medication.
    On June 15, 2011 the U.S. FDA announced that pioglitazone use for more than one year may be associated with an increased risk of bladder cancer. April 2017 The U.S District Court in western Louisiana ordered a $6 billion penalty for Takeda Pharmaceutical Company. 2013 the health ministry of India has suspended the sale of Pioglitazone.But after one month on july 2013 ban lifted. Here I want to emphasize that till now only 8 cases of Bladder cancer found out.Why we will blame Pioglitazone.In my Institute I have given >20000 Patients are under pioglitazone. alone or Mixed with other drug. Including me I am under Pioglitazone for last 8Years Except Pedal oedema and few cases of Weight gain I have not found any other serious consequences. Rather I will tell Its an Golden drug as anti diabetic drug to reduce the Post Prandial Hyperglycemia.Pioglitazone gives good glycimic control than Voglibose.I choose Voglibose as it also reduces post Prandial hyperglycemia.

    VOGLIBOSE:-Voglibose is an an alpha-glucosidase inhibitor used for lowering post-prandial blood glucose levels in people with diabetes mellitus. Voglibose delays the absorption of glucose thereby reduces the risk of macrovascular complications. Voglibose is a research product of Takeda Pharma, a Japan-based company. Postprandial hyperglycemia (PPHG) is primarily due to first phase insulin secretion. Alpha glucosidase inhibitors delay glucose absorption at the intestine level and thereby prevent sudden surge of glucose after a meal. There are three drugs which belong to this class, acarobose, miglitoland vogliboseof which voglibose is the newest. Voglibose scores over both acarbose and miglitol in terms of side effect profile.Voglibose does not increase the weight or causes Pedal Oedema.
    Sideffects are Hypoglycemia, delay in digestion and absorption of disaccharides, abdominal pain and swelling, increased flatus, intestinal obstruction like symptoms, fulminant hepatitis, serious hepatic dysfunction with increased AST (GOT), ALT (GPT), LDH, gamma GTP or ALP, jaundice, diarrhea, loose stools, borborygmus, anorexia, nausea, vomiting, heartburn, anemia, numbness, edema, blurred vision, hot flushes, malaise, weakness hyperkalemia, increased serum amylase.But in my study mild loose stool is the common side effects.

    IN MY STUDY:-
    present study was open with 2000 cases , randomized parallel group comparison of two active treatment groups over a six months period. Sixty patients of either sex in the age group of 30-75 years, suffering from type 2 DM, with FBG> 126 mg/dl and HbA1c between 7- 10 % were taken.Pioglitazone and voglibose were given to 2000 cases given 3months & 3 months trial in each drug to all.Different parameters are taken into consideration like FBS,2Hr PPBS,HBA1C,Blood Urea,Serum Creatinine,Serum cholesterol & Triglyceride.It has been observed Piogltazone reduces FBS,2Hr PPBS,HBA1C,Blood Urea,Serum Creatinine ,Cholesterol,Triglyceride more than Voglibose.In my study also seen in mixed drug like Glimiperide+Metformin+Pioglitazone works better than Glimiperide+Metformin+Voglibose.One case was Under Inj Humalog 78Units Before breakfast 72 Before dinner Blood Sugar does not come to normal level.Only with Inj Novomixtard 14Units BBF & 8Units Before Dinner Plus Combined drug Glimeperide1Mg+Metformin500+Pioglitazone 15mg ½ Tab BID Blood sugar came down to 89FBS & 127Mg PPBS.
    Out of 2000 cases with voglibose FBS after taking for 3 months comes down to
    90 to 136mg/dl.But with same Patient with pioglitazne comes down to 80-120mg/dl.2Hr PPBS come down with voglibose 110- 168mg/dl.HBA1C comes down to 5.9 to 6.9.Urea,Creatinine,Cholesterol& Triglyceride remaining same .In few cases little low.
    But with Pioglitazone Maximum Patients FBS comes to 78-120mg/dl.2Hr PPBS to
    95 to 145mg/dl.HBA1C 6.1 to 5.4.Urea,Creatinine,Cholesterol,Triglyceride to low level. Side effects with Pioglitazone Side Effects limited to Pedal Oedema in all my Patient as description in the Many Text book. In My Opinion There is not necessary to have Panic to Patient that This will cause Bladder Cancer. In Every drugs many side effects are there.I have used this drug since Nine Years.I have discussed with
    Several Diabetologist and Endocrinologist all have supported me.
    With Voglibose diarrhea, loose stools, borborygmus, anorexia, nausea, vomiting, heartburn, anemia, numbness, edema are common side effects observed.

    CONCLUSION:-In my study shows there is no reason for any side effects OR banning this drug or writing Warning to make Patient in Panic.Pioglitazone works better than Voglibose in better control of blood sugar.Out of >45000Patients >20000Patients are under Pioglitazone.

    THANK YOU

    REFERENCES:-
    1:- Diabetes Med. 2007 Sep;24(9):962-8. Epub 2007 May 17.
    Comparison of the effects of pioglitazone and voglibose on circulating total and high-molecular-weight adiponectin, and on two fibrinolysis inhibitors, in patients with Type 2 diabetes.
    2:- King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections. Diabetes Care 1998;21:1414-31.
    3:- Zafar J, Bhatti F, Akhtar N, Rasheed U, Humayun S, Waheed A et al. Prevalence and risk factors for diabetes mellitus in a selected urban population of a city in Punjab. J Pak Med Assoc 2011;61:40-7.
    4:- Nathan DM, Meigs J, Singer DE. The epidemiology of cardiovascular disease in type 2 diabetes mellitus: how sweet it is...or is it? Lancet 1997;350 Suppl 1:S14-9.
    5:- United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703-13.
    6:-Pioglitone Wikipedia
    7:-Voglibose Wikipedia
    8;- Guillausseau PJ, Massin P, Charles MA et al. Glycaemic control and development of retinopathy in type 2 diabetes mellitus: a longitudinal study. Diabetes Med 1998;15:151-5.
    9:- Grundy SM. Dietary therapy in diabetes mellitus. Diabetes Care 1991;14:796-801.
    10:- Powers AC. Diabetes Mellitus. In: Fauci AS, Braunwald E, Kasper DL, Stephen LH, Dan LL, Jameson LL, Loscalzo J, eds. Harrison's principles of internal medicine. 17th ed. New York: Mc Graw Hill; 2008:2275-304.
    11:- Tripathi KD. Insulin, oral hypoglycaemic drugs and glucagon. In: Tripathi KD. Essentials of medical pharmacology. 6th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2008:254-74.