PHARMACOKINETIC ANALYSIS OF ANTIDIABETIC AGENTS IN SURGICAL PATIENTS
Main Article Content
Keywords
Pharmacokinetics, Antidiabetic Agents, Surgical Patients, Perioperative Management, Glycemic Control.
Abstract
Introduction: Diabetes mellitus is of great concern to the perioperative management of surgical patients, as it can affect pharmacokinetics in a variety of ways. Antidiabetic drugs are the necessary ones for the glycemic control but their pharmacokinetic profiles in surgical settings should be better understood.
Aim and Objective: This study was designed to provide a pharmacokinetic analysis of antidiabetic agents in the post-surgical patients to identify how these drugs are metabolized, distributed, and eliminated in this population. The main purpose was to find out if surgical stress changed the pharmacokinetics of drugs and then to develop individualized therapeutic strategies based on these findings.
Materials and Methods: An observational study of 80 surgical patients with diabetes mellitus taking different antidiabetic agents was carried out.
The pharmacokinetic parameters which involved absorption, distribution, metabolism, and excretion were analyzed using a blood sampling technique that was simplified. Blood samples were taken at preselected intervals. Drug concentrations were measured by means of the validated HPLC method.
Results: The results of pharmacokinetic analysis showed that drug metabolism and clearance were changed in a substantial manner in surgical patients in contrast to non-surgical populations. Particularly, slower clearance rates and prolonged half-lives were seen, suggesting that individualized dosing regimens are required to achieve the most effective glycemic control during the perioperative time frame.
Conclusion: In conclusion, the present study offers key knowledge of the pharmacokinetics of antidiabetic agents in patients who have undergone surgery, stressing the significance of comprehending drug dynamics in this context. It is of paramount importance that personalized therapeutic strategies, considering the altered pharmacokinetics, are applied in the management of diabetes as well as for the achievement of favorable surgical outcomes.
References
2. Asmussen, S., Schmucker, P., Busch, C. J., & Görlitz, A. (2007). Pharmacokinetics of orally administered drugs in postoperative patients. European Journal of Clinical Pharmacology, 63(11), 1015-1024.
3. Bellomo, R., Kellum, J. A., & Ronco, C. (1999). Acute renal failure: time for consensus. *Intensive Care Medicine, 25(2), 167-168.
4. Bergman, A. J., Stevens, C., Zhou, Y., Yi, B., Laethem, M., De Smet, M., ... & Depré, M. (2007). Pharmacokinetic and pharmacodynamic properties of multiple oral doses of sitagliptin, a dipeptidyl peptidase-IV inhibitor: A double-blind, randomized, placebo-controlled study in healthy male volunteers. Clinical Therapeutics, 29(7), 1399-1410.
5. Bode, B., Stenlöf, K., Sullivan, D., Fung, A., & Usiskin, K. (2015). Efficacy and safety of canagliflozin treatment in older subjects with type 2 diabetes mellitus: A randomized trial. Diabetes Therapy, 6(1), 33-40.
6. DeSantis, A. J., Schmeltz, L. R., & Schmidt, K. (2017). Perioperative management of diabetes: Translating evidence into practice. Cleveland Clinic Journal of Medicine, 84(7), S11–S19.
7. Frisch, A., Chandra, P., Smiley, D., Peng, L., Rizzo, M., Gatcliffe, C., ... & Umpierrez, G. E. (2010). Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care, 33(8), 1783-1788.
8. Garg, S. K., Smith, J., Beatson, C., & Lopez-Bresnahan, M. (2012). Liraglutide for weight management: A critical review of the evidence. Obesity Science & Practice, 1(1), 11-21.
9. Gedulin, B. R., Smith, P. A., Jodka, C. M., Chen, K., Bhavsar, S., Nielsen, L. L., ... & Parkes, D. G. (2005). Pharmacokinetics and pharmacodynamics of exenatide following alternate routes of administration. International Journal of Obesity, 29(6), 713-721.
10. Heise, T., Nosek, L., Spitzer, H., Heinemann, L., & Nielsen, L. L. (2012). Insulin glulisine: A faster onset of action compared with insulin lispro. Diabetes, Obesity & Metabolism, 9(5), 746-753.
11. Hermansen, K., Kipnes, M., Luo, E., Fan, L., Khatami, H., Stein, P. P., ... & Sitagliptin Study 021 Group. (2009). Efficacy and safety of the dipeptidyl peptidase‐4 inhibitor, sitagliptin, in patients with type 2 diabetes mellitus inadequately controlled on glimepiride alone or on glimepiride and metformin. Diabetes, Obesity and Metabolism, 9(5), 733-745.
12. Holford, N. H. G. (2005). Pharmacokinetics and pharmacodynamics: Rational dose selection and the time course of drug action. In McGraw-Hill Professional.
13. Kirpichnikov, D., McFarlane, S. I., & Sowers, J. R. (2002). Metformin: An update. Annals of Internal Medicine, 137(1), 25-33.
14. Mogensen, U. M., Andersson, C., Fosbøl, E. L., Schjerning, A. M., Charlot, M. G., Rasmussen, J. N., ... & Torp-Pedersen, C. (2017). Cardiovascular safety of combination therapies with incretin-based drugs and metformin compared with a combination of metformin and sulphonylurea in type 2 diabetes mellitus—a retrospective nationwide study. Diabetes, Obesity and Metabolism, 19(12), 1747-1757.
15. Nathan, D. M., & Buse, J. B. (2018). Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Diabetes Care, 41(2), 266-274.
16. Raju, B., & Leopold, J. A. (2018). Perioperative management of diabetes and hyperglycemia in patients undergoing elective surgery. F1000Research, 7, F1000 Faculty Rev–280.
17. Ruedy, K. J., & Tamborlane, W. V. (2016). Continuous glucose monitoring in patients with type 1 diabetes mellitus: Rationale and clinical practice. Diabetes Care, 39(6), 632-643.
18. Sambol, N. C., Chiang, J., Lin, E. T., Goodman, A. M., Liu, C. Y., Benet, L. Z., & Cefalu, W. T. (1995). Kidney function and age are both predictors of pharmacokinetics of metformin. The Journal of Clinical Pharmacology, 35(11), 1094-1102.
19. Sear, J. W., Hand, C. W., Moore, R. A., & Sharp, P. E. (1993). Pharmacokinetics of anaesthetic drugs in surgical patients. British Journal of Anaesthesia, 71(2), 1-7.
20. Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. Journal of Clinical Endocrinology & Metabolism, 87(3), 978-982.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Parmar Pradipkumar Vinubhai
Research Scholar, Sunrise University, Alwar, Rajasthan
Mr. Dawn V J
Associate Professor, Department of Pharmacy Practice, Sanjo College of Pharmaceutical Studies Palakkad, Kerala, 678702
Elareen BellJoy Donshiew
Research Scholar, Department of Biochemistry, Northeastern Hill University, Meghalaya, Shillong -793022
Dr Sukanta Bandyopadhyay
Associate Professor, Dept of Biochemistry, Rama Medical College Hospital & Research Centre, Mandhana, Kanpur (U.P) - 209217. India
Dr Seema Yadav
Principal, College of Nursing, Sarojini Naidu Medical College, Agra, UP.