Using Sglt 2 Inhibitors With Insulin Essay - 729 Words

USING SGLT-2 INHIBITORS WITH INSULIN IN TYPE 2 DIABETES: CLINICAL IMPLICATIONS Mathew John, Deepa Gopinath Introduction Diabetes and its complications account for significant healthcare costs in developed countries. The control of hyperglycemia forms the cornerstone in managing diabetes. United Kingdom Prospective Diabetes Study (UKPDS) has shown that improving blood sugars can result in reduction in onset of retinopathy, microalbuminuria and neuropathy. Follow up of the subjects in UKPDS after 10 years have shown a distinct improvement in outcomes like mortality, microvascular disease and macrovascular disease in subjects who were intensively controlled. Various classes of oral anti diabetic agents, insulin and GLP-1 agonists form the armamentarium against hyperglycaemia. Despite the availability of these agents, the overall control of hyperglycaemia remains suboptimal. Sodium linked Glucose Co- Transporter-2 (SGLT-2) inhibitors form a new class of agents that act on the kidney by competitively blocking the SGLT-2 channels. These agents are approved by FDA to be used as monotherapy or in combination with Metformin, Sulphonylurea (SU), Pioglitazone, or insulin. The ADA practice guidelines have added SGLT-2 inhibitors as the first add on to Metformin along with other drugs like SU, Dipeptyl Peptidase 4 (DPP4) inhibitors, thiazolidinedione and basal insulin. SGLT-2 inhibitors also finds a place as a second add on drug after 2 of the other drugs areShow MoreRelatedDiabetes Type 2 Meta Analysis1011 Words   |  5 PagesDiabetes Type 2 meta-analysis Abstract Objective To compare treatment options of type2 diabetes. In reference to this a systematic review and meta-analysis of controlled trials, observation-based studies and published information was carried out in an attempt to investigate the difference of efficacy between pharmacologic treatment in Diabetes type 2, specifically the newer oral class known as the SGLT-2 Inhibitors. Research designs and methods A literature search was conducting using the keywordsRead MoreThe Effect Of Empagliflozin ( Jardiance ), An Inhibitor Of Sodium Glucose Cotransporter 2944 Words   |  4 Pagesempagliflozin(JARDIANCE), an inhibitor of sodium–glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk. Background According to the International Diabetes Federation (IDF), more than 371 million people across the globe have diabetes and this figure is predicted to rise to over 550 million by 2030. Type 2 diabetes occurs when the hormone insulin is not used effectively by theRead MoreDiabetes : The Most Common Type Of Diabetes2258 Words   |  10 PagesDiabetes is an endocrine disorder characterized by elevated glucose due to insulin resistance or deficiency. About 29.1 million people in America are reported to have diabetes with the highest prevalence occurring in men; about 25.9% of adults 65 years and older have diabetes.1 Type 2 diabetes (T2DM) is the most common type of diabetes, often due to insulin resistance. Metformin is the treatment of choice in patients with T2DM, a second agent such as a sulfonylurea is added to metformin in patients

Burden Of Overweight Shifting Poor Health And Social Care Essay Free Essays

Background: Overweight and fleshiness prevalence has increased globally ; nevertheless, current prevalence and tendencies of fleshy by societal category in low- and middle-income states are unknown. Methods: Repeated cross-sectional, nationally representative informations from adult females aged 18-49 ( n=556,352 ) in 41 low- and middle-income states were used to find the prevalence of corpulence ( body mass index a†°?25 ) at each study moving ridge by wealth quintile and educational attainment ( individually ) . The SES-specific prevalence difference and prevalence growing rate for each state were compared for the lowest and highest SES groups. We will write a custom essay sample on Burden Of Overweight Shifting Poor Health And Social Care Essay or any similar topic only for you Order Now Linear arrested development estimated the association between state wealth and fleshy prevalence growing. Consequences: In the bulk of country-years the highest wealth and instruction groups still have the highest age-standardized prevalence of corpulence and fleshiness ( 97 of 111 entire country-years ) . However, in about half of the states ( 21 of 41 ) , the additions in fleshy prevalence over clip have been greater in the lowest SES group compared to the highest SES group. Higher country-level Gross Domestic Product per capita ( GDP ) was associated with a higher fleshy prevalence growing rate for the lowest wealth group compared to the highest ( aGDPper capita/1000= 0.24 ; 95 % CI -0.015, 0.46 ) . Decisions: Presently, higher SES groups have more fleshy than lower SES groups across most developing states. However, half the states show a faster growing rates in corpulence in the lowest Selenium groups, declarative mood of an on-going displacement in the fleshy load toward lower SES groups. Across states, this displacement toward faster fleshy growing among lower wealth groups is associated with higher GDP. ( Word Count: 250 ) Introduction Low socioeconomic position ( SES ) is associated with higher rates of chronic disease in high-income states 1-4. In lower-income states, chronic disease has merely late go a prima cause of morbidity and mortality 5, and less is known about the societal patterning of emerging chronic diseases in these contexts. In the yesteryear, corpulence was comparatively uncommon in lower-income states and was positively associated with SES 6. However, the prevalence of corpulence has increased dramatically in many lower-income states around the universe over the last 5-15 old ages 7-9. As the load of nutrition-related disease has shifted toward overnutrition 10, it is unknown whether the load of these emerging diseases is going comparatively heavier among lower SES groups. Recent cross-sectional grounds suggests that in the bulk of lower-income states wealthier groups have a higher odds of corpulence. However, within-country clip tendencies of the fleshy prevalence for high and low socioeconomic position groups have non been reported. Changes in the fleshy prevalence over clip by socioeconomic position group are of import for understanding which groups are sing an increasing load of corpulence which can assist expect emerging forms of disease. ( ? ) Based on ascertained relationships in higher income states and on the documented relentless associations between low socioeconomic position and the prima causes of disease in many contexts, experts have hypothesized that the load of chronic disease in lower income states will finally switch toward lower SES populations within these states ( believe I can mention yach and popkin, possibly others look at concluding disseration chapter ) . Brazil is one of the few middle-income states in which alterations over clip in the SES-specific fleshy prevalence are available. Nationally-representative informations between 1975 and 2003 indicate that, among adult females, the lowest income groups have experienced much more rapid additions in fleshiness prevalence compared to highest SES groups 11. Among the two most thickly settled parts in Brazil, the fleshiness prevalence in the lowest income group has really surpassed that in the highest income group 12. Such a form of alteration in SES-specif ic fleshiness rates is consistent with a switching load of fleshiness to the hapless. Similar forms have been reported among adult females in urban countries of sub-saharan Africa ( ref? ? ) †¦ Merely with faster fleshy prevalence growing rates for the low SES groups could the relationship between high SES and overweight finally go opposite in states with antecedently positive relationships. On the other manus, there is research to propose that higher SES populations in lower income states will go on to bear the largest load of chronic disease. In India†¦ Additionally, economic dazes frequently affect nutrient security and can go forth populations with the lowest socioeconomic position most vulnerable to inadequate nutrition in these circumstances.13 ( seek to happen some scientific rating of this, might get down by reading Sen article ) . Merely with faster fleshy prevalence growing rates for the low SES groups could the relationship between high SES and overweight finally go opposite in states with antecedently positive relationships. Such a displacement of the load of fleshiness to low SES groups in states come oning through epidemiologic passages would be consistent with the cardinal cause theory of disease ( 11, 12 ) . This theory is frequently invoked to explicate wellness disparities and high spots the overall persistance of the relationship between SES and hapless wellness over clip, despite alterations in the T ( 1, 11, 13-15 ) . Brazil is one of the few middle-income states in which alterations over clip in the SES-specific fleshy prevalence are available. Nationally-representative informations between 1975 and 2003 indicate that, among adult females, the lowest income groups have experienced document within-country clip tendencies for growing in and, higher entire fleshy prevalence? ? ? ? is from the Demographic Health Surveys ( DHS ) , which are nationally representative family studies administered chiefly in low- and middle-income states ( henceforth referred to as lower-income states ) . The studies entail repeated cross-sections and roll up information about cardinal demographic features, birthrate, contraceptive method, wellness and nutrition. The DHS questionnaires are standardized to enable cross-country comparings 21. Since our primary involvement is in the clip trends in fleshy prevalence we included merely states that measured anthropometrics in at least two study moving ridges. beginnings that include anthropometric informations on at least two perennial steps over clip. The bulk are from Demographic Health AAdditionally, s 22, 232425 ) . Wealth and instruction were used individually to stand for SES. To stand for wealth, we used the DHS wealth index, which is derived from a chief constituents analysis ( PCA ) of some assets that were asked in all DHS studies, every bit good as some country-specific assets 26. The wealth index was used to make country- and year-specific quintiles of wealth mark, which were used as a categorical variable in the analyses. Education was categorized based on the educational mileposts: no schooling, primary, secondary, third school. If less than 2 % of the population fell into any one of the instruction classs, that class was combined with the following closest class to avoid unstable estimations. Results Age-standardized fleshy prevalence was determined for each wealth and instruction group in each state and in each study twelvemonth and SES ( wealth or instruction ) group. Sample weights to account for complex study design were used in all analyses. Analysiss were conduced individually by: 1 ) wealth quintile, 2 ) instruction group. Our results of involvement were 1 ) the difference in fleshy prevalence between the lowest and the highest wealth/education groups for each study moving ridge ( prevalence difference ( PD ) ) , and, to measure clip tendencies, 2 ) the annualized difference in the net alteration in fleshy prevalence between the first and last study moving ridge for the lowest and highest wealth/education groups ( annualized difference in fleshy prevalence alteration rate ) . To cipher the prevalence difference for wealth quintiles, we subtracted the prevalence in the highest wealth quintile from that of the lowest wealth quintile ( Overweightlowest- Overweighthighest ) in each study wave in each state. A positive corpulence prevalence difference would so bespeak that the lower wealth quintile had a higher prevalence of fleshy compared to the higher wealth quintile. To obtain the annualized difference in the fleshy prevalence growing rates between wealth quintiles, we took the difference between the net alteration in fleshy prevalence in the highest group and the net alteration in the lowest group ( Overweightlowest, lastwave- Overweightlowest, firstwave ) – ( Overweighthighest, lastwave – Overweighthighest, firstwave ) . A positive difference in prevalence growing rates indicated the lowest wealth quintile had a higher rate of prevalence growing rate than did the highest quintile. We repeat these analyses for each state by instruction group, classified by educational mileposts, lowest being no schooling and highest being third school. SES was represented by wealth and instruction, in separate analyses, to research the hardiness of the consequences to different indexs of SES. For DHS states, we used the DHS wealth index ; it is derived from a chief constituents analysis ( PCA ) of assets that were asked in all studies, every bit good as some country-specific variables 2727 Potentially do age-standardization as sensitiveness analysis merely. Make 90 % CI and site Davey-Smith article 27 619 1128 2930 14 19 hazard factors for obesityrisk factors for 1. Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. â€Å" Cardinal causes † of societal inequalities in mortality: a trial of the theory. J Health Soc Behav 2004 ; 45:265-85. 2. Antonovsky A. Social Class, Life Expectancy and Overall Mortality. The Milbank Memorial Fund Quarterly 1967 ; 45:31-73. 3. Adler NE, Boyce T, Chesney MA, et Al. Socioeconomic position and wellness: The challenge of the gradient. American Psychologist 1994 ; 49:15-24. 4. Marmot MG, Smith GD, Stansfeld S, et al. Health inequalities among British civil retainers: the Whitehall II survey. Lancet 1991 ; 337:1387-93. 5. WHO. The universe wellness study 2003: determining the hereafter. Geneva: World Health Organization ; 2003. 6. Sobal J, Stunkard AJ. Socioeconomic position and fleshiness: a reappraisal of the literature. Psychol Bull 1989 ; 105:260-75. 7. Popkin BM. The World Is Fat: The Fads, Trends, Policies, and Merchandises That Are Fattening the Human Race. New York: Avery-Penguin Group ; 2008. 8. Popkin BM. Global nutrition kineticss: the universe is switching quickly toward a diet linked with noncontagious diseases. Am J Clin Nutr 2006 ; 84:289-98. 9. Popkin BM, Conde W, Hou N, Monteiro C. Is there a slowdown globally in fleshy tendencies for kids compared with grownups? Obesity ( Silver Spring ) 2006 ; 14:1846-53. 10. Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds scraggy among adult females in most underdeveloped states. Am J Clin Nutr 2005 ; 81:714-21. 11. Monteiro CA, Conde WL, Popkin BM. Income-specific tendencies in fleshiness in Brazil: 1975-2003. Am J Public Health 2007 ; 97:1808-12. 12. Monteiro CA, Conde WL, Popkin BM. The load of disease from undernutrition and overnutrition in states undergoing rapid nutrition passage: a position from Brazil. Am J Public Health 2004 ; 94:433-4. 13. de Brauw A. Migration and child development during the nutrient monetary value crisis in El Salvador. Food Policy ; In Press, Corrected Proof. 14. Link BG, Phelan J. Social conditions as cardinal causes of disease. J Health Soc Behav 1995 ; Spec No:80-94. 15. Link BG, Phelan JC. Understanding sociodemographic differences in wellness — the function of cardinal societal causes. Am J Public Health 1996 ; 86:471-3. 16. Phelan JC, Link BG. Controling disease and making disparities: a cardinal cause position. J Gerontol B Psychol Sci Soc Sci 2005 ; 60 Spec No 2:27-33. 17. Miech R. The formation of a socioeconomic wellness disparity: the instance of cocaine usage during the 1980s and 1990s. J Health Soc Behav 2008 ; 49:352-66. 18. Chang VW, Lauderdale DS. Fundamental cause theory, technological invention, and wellness disparities: the instance of cholesterin in the epoch of lipid-lowering medicines. J Health Soc Behav 2009 ; 50:245-60. 19. Monteiro CA, Conde WL, Lu B, Popkin BM. Obesity and unfairnesss in wellness in the underdeveloped universe. Int J Obes Relat Metab Disord 2004 ; 28:1181-6. 20. McLaren L. Socioeconomic position and fleshiness. Epidemiologic Reviews 2007 ; 29:29-48. 21. DHS Model Questionnaires. Measure DHS Macro International. ( Accessed at hypertext transfer protocol: //www.measuredhs.com/aboutsurveys/dhs/questionnaires.cfm. ) 22. DHS. DHS Guidelines for Interviewer Training: Measure DHS. Macro International ; 2000. 23. Indonesian Family Life Survey. ( Accessed Janurary 10, 2010, at hypertext transfer protocol: //www.rand.org/labor/FLS/IFLS/hh.html. ) 24. WHO/FAO. Expert Consultation on Diet, Nutrition and the Prevention of Chronic DiseasesReport of the joint WHO/FAO expert audience. Geneva: World Health Organization ; 2003. 25. Ahmad O, Boschi-Pinto C, Lopez A, Murray C. Age standardisation of rates: a new WHO criterion. Geneva: World Health Organization ; 1999. 26. Rutstein SO, Johnson K. The DHS Wealth Index: Measure DHS, Macro International ; 2004. 27. Appropriate body-mass index for Asiatic populations and its deductions for policy and intercession schemes. The Lancet 2004 ; 363:157-63. 28. Ziraba AK, Fotso JC, Ochako R. Overweight and fleshiness in urban Africa: A job of the rich or the hapless? BMC Public Health 2009 ; 9:465. 29. Du S, Mroz TA, Zhai F, Popkin BM. Rapid income growing adversely affects diet quality in China — peculiarly for the hapless! Soc Sci Med 2004 ; 59:1505-15. 30. Monda KL, Gordon-Larsen P, Stevens J, Popkin BM. China ‘s passage: the consequence of rapid urbanisation on big occupational physical activity. Soc Sci Med 2007 ; 64:858-70. 1. How to cite Burden Of Overweight Shifting Poor Health And Social Care Essay, Essay examples

Desdemona the Modern Woman in the Classic Play Essay Example For Students

Desdemona: the Modern Woman in the Classic Play Essay William Shakespeare is the magician of language: his well-built plot and embellished dialogue lead readers into his virtual but reality-reflected world. Among many of his plays, Othello is one of the best tragedies which reflect the deepest nature of human beings: jealousy and love. In spite of its high quality as a masterpiece, many modern people are afraid of reading the original texts by Shakespeare because of its language; they tend to believe that Othello or any other Shakespeare plays are too classical in terms of both language and plot that modern people would not feel any sympathies toward. However, many readers found it surprising that Othello is rather modern especially in terms of social role of woman illustrated in Desdemona. Shakespeare portrays a woman who refuses to accept the socially expected arranged marriage by her father in his play Othello. Many literary critics assume that Othello is written approximately in 1603. During that era, the biggest virtue of women was the obedience: the obedience to their parents, their lords. The Scottish protestant leader in sixteenth century, John Knox, stated, Woman in her greatest perfection was made to serve and obey man (12). Women were not supposed to hold any personal opinions but to automatically follow the orders from their parents even for their marriage. However, Desdemona, the female protagonist, is a highly passionate woman who even stands against her father, Brabantio, in order to obtain her true love as many other modern women would do: BRABANTIO I pray you hear her speak. If she confess that she was half the wooer, Desturction on my had if my bad blame Light on the man.-come hither, gentle mistress. Do you perceive in all this noble company Where most you owe obedience? DESDEMONA My noble father, I do perceive here a divided duty. To you I am bound for life and education. My life and education both do learn me How to respect you. You are the lord of duty. I am hitherto your daughter. But heres my husband. And so much duty as my mother showed To you, preferring you before her father, So much I challenge that I may profess Due to the Moor my lord. (I.iii.202-218) Although she is obedient and respectful of her father for what he had provided for her, she is brave enough to choose her own husband who is worthy of reverence at the same time. If she was a woman who passively accepts her social duty as a daughter of nobleman, she would have given up her love toward Othello and marry one of her wealthy suitors that her father chooses for her. However, as smart as she is, she excuses herself with the situation her mother went through-preferring her husband before her father-to justify her behavior in the most reasonable way. After all, Desdemona is a profound and strongly independent lady who has chosen her own destiny. In addition, Desdemona, who is always loyal and faithful to herself as well as to her husband, stands strongly against her insane husband Othello to defend her rights as an individual. Unfortunately, the love between Desdemona and Othello seems to break down when Othello completely falls down to a devilish trap of Iago. To arrogate a place of Othello as a general, Iago installs a huge trap to all characters that eventually leads to the tragic ending. As a part of the trap, Iago successfully deceives Othello that Desdemona has an affair with Cassio, the lieutenant of Othello. Later, when Othello falsely accuses her of cheating on him in front of Lodovico, Desdemona states, I have not deserved this (IV. i. 268). Although she still looks up him as her lord, she does not completely give up her rights as a human being and accepts everything her husband does to her. Rather, she tries to correct Othello when he conducts any unjust actions to any individuals including herself and Cassio. .u809f325228382b9b63a4feda2ab15e5b , .u809f325228382b9b63a4feda2ab15e5b .postImageUrl , .u809f325228382b9b63a4feda2ab15e5b .centered-text-area { min-height: 80px; position: relative; } .u809f325228382b9b63a4feda2ab15e5b , .u809f325228382b9b63a4feda2ab15e5b:hover , .u809f325228382b9b63a4feda2ab15e5b:visited , .u809f325228382b9b63a4feda2ab15e5b:active { border:0!important; } .u809f325228382b9b63a4feda2ab15e5b .clearfix:after { content: ""; display: table; clear: both; } .u809f325228382b9b63a4feda2ab15e5b { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u809f325228382b9b63a4feda2ab15e5b:active , .u809f325228382b9b63a4feda2ab15e5b:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u809f325228382b9b63a4feda2ab15e5b .centered-text-area { width: 100%; position: relative ; } .u809f325228382b9b63a4feda2ab15e5b .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u809f325228382b9b63a4feda2ab15e5b .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u809f325228382b9b63a4feda2ab15e5b .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u809f325228382b9b63a4feda2ab15e5b:hover .ctaButton { background-color: #34495E!important; } .u809f325228382b9b63a4feda2ab15e5b .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u809f325228382b9b63a4feda2ab15e5b .u809f325228382b9b63a4feda2ab15e5b-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u809f325228382b9b63a4feda2ab15e5b:after { content: ""; display: block; clear: both; } READ: A woman killed with kindness - A monologue from the play by Thomas Heywood EssayDESDEMONA Alas the heavy day, why do you weep? Am I the motive of these tears, my lord? If haply you my father do suspect An instrument of this your calling back, Lay not your blame on me. If you have lost him, I have lost him too. (IV. ii. 51-56) In above excerpt from the play, Desdemona clarifies that Othello cannot blame others for what he chose to do. She also makes sure that she is willing to take a full responsibility for what she has done. Although Desdemona is a faithful Christian during the Elizabethan era when womens not being obedient to their husbands was regarded as a crime, she tries to amend Othellos behavior to enlighten him on an equal treatment of women and men. Last but not least, unlike Othello who easily turns his back and seeks for revenge toward his believed-to-be unfaithful wife, Desdemona keeps loyal and respectful of herself and husband although her foresight predicts the tragic ending of her love: DESDEMONA Alls one. Good faith, how foolish are our minds! If I do die before thee, prithee, shroud me In one of those same sheets. EMILIA Come, come, you talk! DESDEMONA My mother had a maid called Barbary. She was in love, and he she loved proved mad And did forsake her. She had a song of willow, An old thing twas, but it expressed her fortune, And she died singing it. That song tonight Will not go from my mind. [I have much to do, But to go hang my head all at one side And sing it like poor Barbary. Prithee, dispatch. (IV.iii.23-35) The above expert foreshadows the incoming doom of Desdemona. She tells Emilia that she wants to die with the wedding sheets and indeed at the end, she dies on the bed with those same sheets. Besides, she now sympathizes with Barbary who encountered with tragic ending because of her proved-to-be-mad love. However, her remaining faithful toward Othello is not exactly being passively obedient to her husband; rather, she acknowledges her responsibility of abandoning her own father to obtain her proved-to-be-mad love and that she is trying to take a responsibility for what she had done. When Iago lies about the relationship between Desdemona and Cassio, Othello believes what Iago told him without filtering. His blind love distracts him from being conscious. On the other hand, Desdemona remains loyal and defends Othello even after Emilia suspects of Othellos insanity and disbelief toward Desdemona since she is responsible enough not to blame others for what she chose to do. Therefore, Desd emona proved herself to be as responsible as other modern individuals. In conclusion, in his tragic play, Othello, William Shakespeare illustrates a woman who is fully responsible for herself and independent as an individual as contrary to other Elizabethan women at that era who were raised to believe that they are inferior to men, thus, followed their orders. Desdemona chose whom she married to, stood against any unequal treatments toward her and took entire responsibility to her behaviors. Therefore, although Othello is classified as classic literature, in terms of role of women in this play, the play contains many modern factors that even current readers can easily feel sympathy toward.