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AIM :To evaluate the antihyperglycemic or antihypoglycemic or hypoglycemic in the treatment of Type-2 Diabetes Mellitus in a tertiary care hospital.OBJECTIVE : To compare the effect of Silymarin on Fasting blood sugar levels- FBAS , Post prandinal  glucose test-PPBS , Haemoglobin A1c – HbA1c, in Type-2 Diabetes mellitus patients with Pioglitazone.INTRODUCTION – type 2 diabetes mellitus is the fastest growing health problem in the world , reaching higher epidemic proportions, the incidence of diabetes has soared in India in recent years , and is expected to keep greasing with a greatest increase seen in metabolic forms of diabetes notably type 2 . Type 2 diabetes is by far the most common form of diabetes Accounting for 85- 95% of cases in the developed countries and an even higher percent in the developing countries . Diabetes currently affect  more than 62 million Indians which is more than 7.1% of the adult population . The average age age on onset is 42.5 years . Nearly 1 million Indians die due to diabetes every year, which is a grave issue and highlights the  importance of continued research and the need for novel methods to both prevent and treat this pa this pandemic . Though there are many available drugs as well as treatments there is a need to compare between the drugs which have a potent use in the treatment of diabetes. Silymarin and Pioglitazone are two two such drugs which have been scientifically proved for the role in the treatment of diabetes mellitus.Silymarin is a powder extract if the seeds from silybum marianum , a plant form the asteraceace family . It is native to Mediterranean, and grows all through Europe , North America, , South America , India , China, Australia and Africa .Thebmajor active ingredients include four isomaers – Silybin , Isosilybin , and silydianin . Silymarin posssess anti-oxidant activity. Evidences from previous studies explain that silymarin anti-oxidant activity may help lower some of the oxidant stress caused by elevated glucose and free fatty acid levels. Silymarin inhibits lipid peroxidation , prevents glutathione depletion and activates anti-oxidant enzyme that protect DNA degradation.The thiazolidinediones were introduced about a decade ago. They are also known as glutazones or peroxysome proliferator activated receptors agonists. They improve glycemic control by increasing insulin sensitivity in fat, liver , muscle, etc.Troglitazone, rosiglitazone,Pioglitazone are a class of drugs of glitazones. Pioglitazone aims to improve glycemic control in adults with Type-2 Diabetes Mellitus primarily by reducing insulin resistance. Recently a controversy has been raised of an apparent risk  of bladder cancer in patients on Pioglitazone. But the after math studies suggest that there’s no clear evidence of an association between use of Pioglitazone and risk of incident cancers. Given the benefit of Pioglitazone , alone and in combination, judicious use of the drug may continue in patients who may benefit from its uses use. METHODOLOGY:The patients attending general medicine OPD having Type-2 Diabets Mellitus will be included in the study. Ages eligible for study : 18 years and olderSexes eligible for study : AllAccepts healthy volunteers :Eligibility criteria :- INCLUSION Type-2 Diabetes Willing to monitor blood glucose levels EXCLUSIONPregnancyMalignant cancerSevere psychiatric illnessType-1 DiabetesSevere renal ,liver and heart diseasesAcute or chronic hepatitis or pancreatitis Informed consent form will be taken before starting the clinical study. A total of 60 patients will be divided into four groups of 15 patients each.GROUP 1- 15 patients will be administered : glimepride – 1mgGROUP 2- 15 patients will be administered : glimepride – 1mg + Pioglitazone-75 mgGROUP 3- 15 patients will be administered: glimepride -1mg + silymarin -75 mgGROUP 4- 15 patients will be administered: glimepride-1mg + silymarin -140 mgThe patients will be tested for FBAS, PPBS, HbA1c periodically.FBAS,PPBS,HbA1c will be tested and recorded on day 0 – at the start of the study.FBAS,PPBS will be done every month After two months of study again FBAS,PPBS and HbA1c will be recorded.IMPLICATIONS- India has a higher prevalence of Diabetes mellitus , compared to western counties , given the disease is now highly visible across all the sections of the society within India . Further studies are required for better drugs , which can aid in the control of diabetes mellitus . The currently available drugs have some or the other side effects , there are very few drugs which reverses the insulin resistance . Pioglitazone is one such drug which act on peroxisome proliferator- activated receptor and reduce insulin resistance . Silymarin is known for its use as a hepatopancreatic drug widely and has Been recently found to reverse the insulin resistance by the similar Peroxisome proliferator – activated receptor activation . This study will try to establish the hypothesis and if proven this will become a standard and safe therapy for insulin resistant patients . REFERENCES

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