An overview of the beneficial cardiovascular effects of thiazolidinediones

Pharmaceutical Drugs and Natural Therapeutic Products for the Treatment of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is the most widespread form of diabetes, characterized by chronic hyperglycaemia, insulin resistance, and inefficient insulin secretion and action. Primary care in T2DM is pharmacological, using drugs of several groups that include insulin sensitisers (e.g., biguanides, thiazolidinediones), insulin secretagogues (e.g., sulphonylureas, meglinides), alpha-glucosidase inhibitors, and the newest incretin-based therapies and sodium-glucose co-transporter 2 inhibitors. However, their long-term application can cause many harmful side effects, emphasising the importance of the using natural therapeutic products. Natural health substances including non-flavonoid polyphenols (e.g., resveratrol, curcumin, tannins, and lignans), flavonoids (e.g., anthocyanins, epigallocatechin gallate, quercetin, naringin, rutin, and kaempferol), plant fruits, vegetables and other products (e.g., garlic, green tea, blackcurrant, rowanberry, bilberry, strawberry, cornelian cherry, olive oil, sesame oil, and carrot) may be a safer alternative to primary pharmacological therapy. They are recommended as food supplements to prevent and/or ameliorate T2DM-related complications. In the advanced stage of T2DM, the combination therapy of synthetic agents and natural compounds with synergistic interactions makes the treatment more efficient. In this review, both pharmaceutical drugs and selected natural products, as well as combination therapies, are characterized. Mechanisms of their action and possible negative side effects are also provided.

Update on the prevention of type 2 diabetes

Diabetes has emerged as the modern day epidemic that is currently affecting over 220 million people worldwide and claiming at least 1.1 million lives in 2005 alone. The rise in diabetes is largely attributed to the epidemic of obesity together with sedentary lifestyle as well as unhealthy dietary habits. Despite evidence that glycemic control as well as control of other cardiovascular disease (CVD) risk factors such as hypertension and dyslipidemia decreases morbidity and mortality in the diabetic population, control of glycemia and other CVD risk factors remains largely suboptimal making the concept of prevention of diabetes very appealing to control CVD risk, especially that such a risk is already increased in people in the prediabetic stage. Several large controlled trials have been completed testing various options for diabetes prevention. In this paper we present an update on prevention of type 2 diabetes highlighting the major recent trials completed to date in this very important area of investigation.

Prevention of type 2 diabetes: an update

With the rising tide of the diabetes epidemic leading to increased morbidity and mortality (primarily from cardiovascular disease), together with failure to control the disease and its associated complications, prevention of diabetes appears to be the logical option for curbing this epidemic. Several trials have been completed, and others ongoing, using various strategies for diabetes prevention. In this review, we provide an update on diabetes prevention strategies, highlighting the rationale behind such interventions, together with an outlook of the ongoing efforts that are likely to provide additional options for patients at risk for diabetes.

Hypertension in Cushing's syndrome

Cushing's syndrome can be exogenous, resulting from the administration of glucocorticoids or adrenocorticotrophic hormone (ACTH), or endogenous, secondary to increased secretion of cortisol or ACTH. Hypertension is one of the most distinguishing features of endogenous Cushing's syndrome, as it is present in about 80% of adult patients and in almost half of children and adolescents patients. Hypertension results from the interplay of several pathophysiological mechanisms regulating plasma volume, peripheral vascular resistance and cardiac output, all of which may be increased. The therapeutic goal is to find and remove the cause of excess glucocorticoids, which, in most cases of endogenous Cushing's syndrome, is achieved surgically. Treatment of Cushing's syndrome usually results in resolution or amelioration of hypertension. However, some patients may not achieve normotension or may require a prolonged period of time for the correction of hypercortisolism. Therefore, therapeutic strategies for Cushing's-specific hypertension (to normalise blood pressure and decrease the duration of hypertension) are necessary to decrease the morbidity and mortality associated with this disorder. The various pathogenetic mechanisms that have been proposed for the development of glucocorticoid-induced hypertension in Cushing's syndrome and its management are discussed.

Novel therapeutic strategies for the prevention of stroke in patients with diabetes mellitus

Gastrectomy patients are always likely to face malnutrition because of a small volume intake, chemotherapy, recurrence of cancer, etc. Authors achieved "Seamless Nutritional Support" for gastrectomy patients using jejunostomy. We applied jejunostomy using a NCJ kit for 244 gastrectomy patients during the gastrectomy operation. Forty four patients did the night time home EN using jejunostomy. The patients maintained a good QOL because of this nutritional support at home. Sixty percent of the patients were performed outpatient chemotherapy with home EN. They could continue the chemotherapy safely on the basis of nutritional care.

Hypertension in patients with cushing’s disease: Pathophysiology, diagnosis, and management

Hypertension is a very common comorbidity in patients with Cushing's disease/syndrome, resulting from the interplay of several pathophysiologic mechanisms, including stimulation of mineralocorticoid and glucocorticoid receptors as well as the associated insulin resistance, sleep apnea, and overexpression of renin-angiotensin system. Although treatment of Cushing's disease results in resolution or amelioration of hypertension in these patients, a significant proportion of patients do not achieve complete cure or require a prolonged period of time for complete response to therapy. Therefore, therapeutic strategies for Cushing's-specific hypertension are necessary to decrease morbidity and mortality associated with this disease. In this review, we discuss the pathophysiology of hypertension in patients with Cushing's disease, highlighting the therapeutic options, including the exciting new developments in the role of peroxisome proliferator-activated receptor (PPAR)-g agonists in the management of this patient population.