A Systematic Review on the Comparison of Avandia and Actos in Treatment of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a condition that is characterized by a chronic onward motion in the glucose directs of the course. It can lead to changes of the rail line vessels of the retina, nephron, centerfield, nerves, etc, cause a lot of complications.Individuals, who suffer from lawsuit 2 diabetes, may or may non pray insulin (as the condition primarily occurs due to insulin vindication or improper utilization of insulin by the declension cells). In some(prenominal) courtships, people who suffer from sheath 2 diabetes, argon ultimately attached insulin, even though the drug is not very effective in control the high smear sugar levels (Ligaray, two hundred8).Studies conducted in the UK efficaciously base that 25 % of the patients who suffer from eccentric person II diabetes require insulin at heart 6 years of initiating therapy with oral hypoglycaemic progressnts (Edelman, 2005).In clinical practice, event 2 diabetes mellitus is angiotensin-converting enzy me of the commonest diseases that are seen. The insulin levels may be low, defective in nature or the very utilisation of insulin by the fat, colorful and the muscle cells may be hampered. The individual may not depend on insulin for bringing blanket the blood glucose levels back to normal. Ketosis seldom develops, but is common infra stressful conditions (Inzucchi, 2007).Today, in the US, the screening for diabetes is usually performed in elders or forged individuals, and as such in that respect may be several members of the commonplace population who may be silently suffering from the disorder.The prevalence of diabetes mellitus in the US is approximately 7 %, but in individuals above the age of 50 years, the incidence may be about 15 %. authoritative minority groups including the Hispanics, African-Americans, Native Americans, etc, are at a higher insecurity of developing the disorder. The mean age of incidence of the disorder in unsound populations usually occur at a younger age compared to the bloodless American populations. If we look at the prevalence of diabetes mellitus type 2 throughout the world, the incidence is high in Indians, Polynesians, Micronesians, Latin Americans, etc.In Australians, Africans, Aborigines, Asians, etc, the incidence is relative debase when they live in the native countries. However, when they migrate to the US, the prevalence of the disorder is relatively higher, owing to the change in lifestyle, poor control over risk of infection factors, etc.A great proportion of diabetic patients die from cardiac diseases such as heart attacks, stroke, etc. Studies drive home effectively demonstrate that the risk for cardiac disease raises two-folds in men, and up to four folds in women (Ligaray, 2008).The main pathophysiology of diabetes is the rise in the blood glucose levels (hyperglycaemia) due to the low insulin levels in the blood, improper utilisation of insulin by the cells, defective run of the insulin or saf eguard to insulin. The pancreatic of import islet cells may not produce sufficient enumerates of insulin required by the system or several groups of cells present in the body such as the fat, muscle, liver, etc, may be resistant to the action of insulin.Studies conducted during autopsy have effectively demonstrated that the beta cell mass in type 2 diabetics are reduced to about half the normal size. The body cells find it seemingly difficult to utilize glucose resulting in lower measuring stick of glucose transportation to the muscles, greater production of glucose by the liver and greater dislocation of fat (Ligaray, 2008).Other causes of diabetes type 2 include production of substance by the body that hamper the action of insulin, glucotoxicity and lipotoxicity. When the individual consumes carbohydrates, there are chances that the blood glucose level would raise further, as insulin is not available to control (Inzucchi, 2007).The baron of the body to use insulin immediate ly to control carbohydrate and sugar level following ingestion is difficult (Ligaray, 2008). Studies may have shown that although the insulin deficiency may be mild, the ability of the insulin to stop an immediate rise in the blood glucose level would be absent. When the individual suffers from mild type 2 diabetes during the initial stages, there are chances that the insulin secretion would respond to other secretogogues such as amino acids.However, in severe type 2 diabetes, the condition does not respond to other secretogogues resulting in a severe deficiency of insulin. In individuals suffering from type 2 diabetes, there may be witness of an amyeloid-like substance in the beta-cells of the pancreatic islets. The beta-cells begin to malfunction following the depository of amyloid (Inzucchi, 2007).In some of the type 2 diabetics the insulin secretion may be defective in nature. The ability of the cells to respond to insulin is reduced and the normal retort is less.The cells ma y not be able to use the insulin effectively to check utilization of glucose by the cells. In an environment of hyperglycaemia, the cells find it very difficult to utilize the insulin and the glucose. The body finds it difficult to produce glycogen from glucose in the liver and breakdown of fats, as a result of the decreased sensitivity of the insulin.The hire reason for the poor response of the cells to insulin is not understood clearly, but scientists stir that it has to do with the defective mitochondrial functioning and the accumulation of go off fatty acids in the cells that are usually supposed to respond to insulin. The insulin receptors in such cells may be normal, but the insulin pathways that are related to the insulin receptors may go haywire.The functioning of the glucose transporting agent GLUT may become abnormal. Scientists also feel that the defects in insulin use and glucose transportation may be due to a heritable defect. Obesity also increases the risk of the individual developing resistivity to insulin. The front man of free fatty acids in the body would suggest greater amount of lipid deposition in the liver and the muscles thus playing a major role in developing insulin resistance (Inzucchi, 2007).When the blood glucose levels are high, the sensitivity of the cell to insulin and the ability of the cell to utilize glucose are earnestly hazarded. Besides, a rise in the lipids in the blood can affect glucose metabolism, causing a raise in hepatic gluconeogenesis, and raising the free fatty acid levels. The pancreas functions abnormally and the muscles are unable to utilize glucose effectively (Inzucchi, 2007).It may be difficult to assert whether the primary defect in type 2 diabetics is due to insulin insufficiency or insulin resistance. Studies have demonstrated that in high-risk populations, the initial defect is primarily due to insulin resistance and a decrease in the insulin sensitivity.However, diabetes would not occur only w ith insulin resistance alone. Studies have shown that frequently due to the secretory defects, the beta cells seem to ticktock exhausted. It may also be that chronic stimulation of the beta-cells along with the genic defects would result in insulin insufficiency (Inzucchi, 2007).Evidence strongly supports that genetics and environmental factors both(prenominal) play a major role in the development of diabetes mellitus type 2 (some even suggest complex genetic factors). Most of the forms of type 2 diabetes mellitus have been polygenic in nature, whereas maturity-onset diabetes of the young (MODY) has been monogenic in nature. There is a clear familial linkage seen in diabetes mellitus type 2, but there seems to be no classical Mendelian inheritance (Inzucchi, 2007).Diabetes mellitus patients are at the risk of high mortality in case their condition worsens and complications develop. Hence, one the keys to ensure a longer lifespan in diabetes patients is effective management using drugs and medications.Studies have clearly demonstrated that diabetes patients require an aggressive, intensive and early intervention that would be able to identify a rise in the blood sugar level and ensure that it is brought within normal range. One of the most difficult complications of diabetes patients would be developing is heart disease.The mortality from heart disease is quite high (70 %) in diabetics. Besides, the cost of managing a patient suffering from diabetes and heart disease are about three times higher (Unger, 2008).Diabetes mellitus is mainly diagnosed on the basis of the germ plasm glucose levels. The fasting blood glucose level should be more than 126 mg per dl of blood. The post prandial blood glucose level should be greater than 200 mg per dl of blood (typically taken 2 hours after a meal). The impaired glucose tolerance levels include 140 to 199 post-prandially.In diabetes, a random blood glucose test should demonstrate reading above 200 mg per dl along wit h the presence of symptoms of diabetes. For the individual to be classified as diabetic, the blood glucose tests should demonstrate consistent results. Haemoglobin A-1c is also useful in demonstrating the retrospective glucose levels, but cannot be taken as standard as there are several potential errors that may be associated with this test (Buse, 2008).