172 Int J Diab Dev Ctries | July-September 2010 | Volume 30 | Issue 3 lifestyle, viz., healthy diet, physical activity, tobacco and alcohol related health problems, environment, yoga, stress management, high blood pressure, diabetes, cancers, heart atacks and strokes. [10] To conclude with, considering the ever increasing burden of NCDs such as diabetes mellitus in India, a health system strengthening approach with standards of care at all levels; nationally accepted management protocols and regulatory framework are needed. [1] The Government of India has taken certain initiatives at national level as discussed above, which is appreciable but it is more important to implement these initiatives efectively and sustain them in future. H. T. Pandve, P. S. Chawla, K. Fernandez, S. A. Singru Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune, India Correspondence to: Dr. Harshal T. Pandve, Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune - 411 041, India. E-mail: dr_harshalpandve@yahoo.co.in DOI: 10.4103/0973-3930.66515 References 1. Venkataraman K, Kannan AT, Mohan V. Challenges in diabetes management with particular reference to India. Int J Diabetes Dev Ctries 2009;29:103-9 2. Gupta R, Deedwania PC, Gupta A, Rastogi S, Panwar RB, Kothari K. Prevalence of metabolic syndrome in an Indian urban population. Int J Cardiol 2004;97:257-61. 3. Shukla HC, Gupta PC, Mehta HC, Herbert JR. Descriptive epidemiology of body mass index of an urban adult population in western India. J Epidemiol Community Health 2002;56:876-80. 4. Das M, Bose K. Presence of high rates of overweight and obesity among adult Marwaris of Howrah, West Bengal, India. Coll Antropol 2006;30:81-6 5. Tiwari R, Srivastava D, Gour N. A cross-sectional study to determine prevalence of obesity in high income group colonies of Gwalior city. Indian J Community Med 2009;34:218-22. 6. Park K. National Diabetes Control Programme: Health programmes in India, from Park’s textbook of Preventive and Social Medicine. 19 th ed. Jabalpur: Banarasidas Bhanot Publishers; 2007. p. 374 7. Park K. National Diabetes Control Programme: Health programmes in India, from Park’s textbook of Preventive and Social Medicine. 20 th Ed. Banarasidas Bhanot Publishers, Jabalpur. 2009: 390-91 8. National Rural Health Mission 2005-2012, Mission document, Ministry of Health and Family welfare, Government of India 2005. pg no. 5 9. National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS). As available from htp://mohfw.nic.in/for%20websitediabetes.htm(last accessed on 19/08/2009) 10. About Healthy India Website. Available from: http://healthy- india.org/aboutus.asp. [Accessed on 2009 Aug 19]. Choice within sulfonylurea drugs in ischemic heart disease patients Dear Sir, Sulfonylurea drugs (SUDs) continue to be the mainstay of treatment for type 2 diabetes mellitus (T2DM). Studies have highlighted diferences between SUDs in terms of their potential to produce hypoglycemia and their impact on ischemic preconditioning (IPC) of myocardium. [1,2] We wanted to investigate if our medical practitioners had any preference among SUDs while considering treatment for T2DM patients with ischemic heart disease (IHD), as specifc treatment guidelines were not available at the time of this survey. Afer obtaining approval from Institutional Ethics Commi tee, a structured questionnaire was administered to 89 practicing physicians of the town who verbally consented to participate in the study. Forty-four percent of respondents opted for “no choice” among SUDs. Remaining 56% expressed preference for one or more of the four SUDs mentioned in the questionnaire. Glimepiride and gliclazide were preferred by 39 and 15%, respectively. Glibenclamide and glipizide were opted by 5% each. The major adverse efect of SUDs is hypoglycemia. Glibenclamide is more likely to give rise to severe hypoglycemic episodes than glimepiride. [2] Concern was raised about an increase in the cardiovascular mortality due to direct cardiotoxic potential of glibenclamide. In vitro and in vivo evidences suggest that acute or chronic administration of glibenclamide induces potentially harmful cardiovascular efects in both diabetic and nondiabetic patients with IHD, by blocking ATP sensitive potassium (K ATP ) channels in cardiomyocytes that are involved in IPC, whereas the pancreas-specific glimepiride may actually preserve the benefcial efects of IPC. [1-4] An editorial article even suggests to consider retiring Letters to editor [Downloaded free from http://www.ijddc.com on Monday, October 11, 2010, IP: 59.183.141.47]