Diabetes Monotherapies versus Metformin-Based Combination Therapy for the Treatment of Type 2 Diabetes

Brazil nut (Bertholletia excelsa) and metformin abrogate cardiac complication in fructose/STZ-induced type 2 diabetic rats by attenuating oxidative stress and modulating the MAPK-mTOR/NFkB/IL-10 signaling pathways

Background

The global prevalence of diabetic heart complication has been on the increase, and some of the drugs that are currently used to treat diabetes mellitus (DM) have not been able to mitigate this complication.

Objective

This study determines the effect of Brazil nut (Bertholletia excelsa) and metformin on diabetic cardiomyopathy (DCM) in fructose/streptozotocin (STZ)-induced type 2 diabetic rats and also characterizes using Gas Chromatography Mass Spectrophotometry and Fourier Transform Infrared the bioactive compounds in 50% aqueous ethanol extract of Brazil nut.

Design

After inducing type 2 DM, 30 male albino Wistar rats were separated into five groups that comprised of six rats per group, and they were treated as follows: groups 1 (Control) and 2 (Diabetic control) rats received rat pellets and distilled water; group 3 (Diabetic + Brazil nut) received rat pellets and Brazil nut extract (100 mg/kg, orally) dissolved in distilled water, group 4 (Diabetic + metformin) received metformin (100 mg/kg, orally) dissolved in distilled water, while group 5 (Diabetic + Brazil nut + metformin) received oral administrations of Brazil nut (100 mg/kg) and metformin (100 mg/kg) dissolved in distilled water. This study lasted for 6 weeks. The dose of Brazil nut used was selected from our pilot study on the minimum therapeutic dose of different concentrations of Brazil nut extract.

Results

STZ administration induced insulin resistance, hyperglycemia, loss of weight, dyslipidemia, oxidative stress, inflammation, apoptosis, alteration of mammalian target of rapamycin, mitogen-activated protein kinase, heart function markers (creatine kinase MB, lactate dehydrogenase, and aspartate amino transaminase), and heart histology of the diabetic control, which was ameliorated after treatment with Brazil nut and metformin, but their combined treatment was better than the single treatments.

Conclusion

This study shows that Brazil nut contains several bioactive compounds that support its biological properties as well as its candidature as a complementary therapy to metformin in mitigating cardiac complications arising from DM in rats.

Changes in the Sensitivity of MCF-7 and MCF-7/DX Breast Cancer Cells to Cytostatic in the Presence of Metformin

Multidrug resistance is a serious problem in modern medicine and the reason for the failure of various therapies. A particularly important problem is the occurrence of multidrug resistance in cancer therapies which affects many cancer patients. Observations on the effect of metformin-a well-known hypoglycemic drug used in the treatment of type 2 diabetes-on cancer cells indicate the possibility of an interaction of this substance with drugs already used and, as a result, an increase in the sensitivity of cancer cells to cytostatics. The aim of this study was to evaluate the effect of metformin on the occurrence of multidrug resistance of breast cancer cells. The MCF-7-sensitive cell line and the MCF-7/DX cytostatic-resistant cell line were used for this study. WST-1 and LDH assays were used to evaluate the effects of metformin and doxorubicin on cell proliferation and viability. The effect of metformin on increasing the sensitivity of MCF-7 and MCF-7/DX cells to doxorubicin was evaluated in an MDR test. The participation of metformin in increasing the sensitivity of resistant cells to the effect of the cytostatic (doxorubicin) has been demonstrated.

Combined administration of gallic acid and glibenclamide mitigate systemic complication and histological changes in the cornea of diabetic rats induced with streptozotocin

PURPOSE

To determine the effect of gallic acid or its combination with glibenclamide on some biochemical markers and histology of the cornea of streptozotocin (STZ) induced diabetic rats.

METHODS

Following induction of diabetes, 24 male albino rats were divided into four groups of six rats each. Groups 1 and 2 (control and diabetic) received rat pellets and distilled water; group 3 (gallic acid) received rat pellets and gallic acid (10 mg/kg, orally) dissolved in the distilled water; and group 4 (gallic acid + glibenclamide) received rat pellets, gallic acid (10 mg/kg, orally), and glibenclamide (5 mg/kg, orally) dissolved in the distilled water. The treatments were administered for three months after which the rats were sacrificed after an overnight fast. Blood and sera were collected for the determination of biochemical parameters, while their eyes were excised for histology.

RESULTS

STZ administration to the rats induced insulin resistance, hyperglycemia, microprotenuria, loss of weight, oxidative stress, inflammation, and alteration of their cornea histology, which was abolished following supplementation with gallic acid or its combination with glibenclamide.

CONCLUSIONS

The study showed the potentials of gallic acid and glibenclamide in mitigating systemic complication and histological changes in the cornea of diabetic rats induced with STZ.

Influence of different factors (duration of disease, gender, education, patients' history, job and age) in metformin response in type 2 diabetes mellitus patient

OBJECTIVE

Aim: This study aims to evaluate how various factors affect various aspects of glycemic control in individuals with type 2 diabetes who are undergoing metformin treatment.

PATIENTS AND METHODS

Materials and Methods: A cross-sectional study involved 150 participants who met specific criteria, including being aged between 30 and 70, having a type 2 diabetes diagnosis, and using 1000 mg of metformin as the monotherapy for at least three months. Collected data encompassed various measures, such as levels of glycated hemoglobin (HbA1c), fasting blood glucose concentrations, fasting serum insulin levels, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and insulin sensitivity.

RESULTS

Results: Our research reveals that when it comes to factors such as several socio-demographic variables, there is no statistically significant difference (p-value ≥ 0.05) between patients who exhibit a positive response to metformin and those who do not. Nevertheless, distinctions were noted in patients' previous history and the duration of their illness, which did influence their treatment response.

CONCLUSION

Conclusions: Glycemic parameters in individuals with type 2 diabetes can be impacted by a range of factors, such as age, gender, and occupation also it's important to note that these outcomes influenced by additional variables like the adherence for medication, and the existence of diabetes-related complications.

Cardiovascular and Renal Outcomes with SGLT-2 inhibitors and DPP-4 inhibitors Combination Therapy: A Meta-analysis of Randomized Cardiovascular Outcome Trials

OBJECTIVE

The cardiovascular (CV) and renal benefits of SGLT-2 inhibitors (SGLT2i) in people with type 2 diabetes (T2D) are well known. However, similar beneficial effects of SGLT2i in combination with DPP-4 inhibitors (DPP4i) are not known. It is of interest to explore a trial-level meta-analysis to find out this knowledge gap.

METHODS

A literature search was carried out in PubMed and Embase databases until January 31, 2023. All CV outcome trials (CVOTs) reporting the CV and renal outcomes of SGLT2i with or without background DPP4i therapy against the placebo were retrieved. A meta-analysis was subsequently conducted by applying the inverse variance-weighted averages of pooled logarithmic hazard ratio using random effects analysis, primarily.

RESULTS

This meta-analysis showed that the beneficial three-point major adverse cardiovascular events (3P-MACE) composite (three CVOTs; N = 32,418), the composite of CV death or heart failure hospitalization (hHF) (four CVOTs; N = 37,687), hHF (three CVOTs; N = 27,545), CV death (four CVOTs; N = 34,565), and renal outcomes (two CVOTs; N = 25,406) with SGLT2i are similar with or without background DPP4i therapy against the placebo (P_{heterogeneity} = 0.71, 0.07, 0.87, 0.72, and 0.25; respectively). However, against the placebo, the summary estimates for 3P-MACE composite, hHF, and renal outcomes were stronger with SGLT2i alone whilst the summary estimates for CV death or hHF composite were larger with SGLT2i with background DPP4i therapy.

CONCLUSION

Beneficial CV and renal effects of SGLT2i are similar against placebo regardless of background DPP4i therapy.

The influence of SLC22A3 rs543159 and rs1317652 genetic variants on metformin therapeutic efficacy in newly diagnosed patients with type 2 diabetes mellitus: 25 weeks follow-up study

BACKGROUND AND AIMS

Among anti-diabetic medications, metformin has been proven to be the preferred initial pharmacologic agent for type 2 diabetes mellitus (T2DM) treatment. Despite its safety and efficacy, the response to metformin varies between individuals. Genetic variations, especially within genes involved in pharmacokinetics and pharmacodynamics of metformin (e.g SLC22A3), have been suggested to be responsible for the observed inter-individual differences. By considering the undeniable role of organic cation transporter 3 in hepatic uptake of metformin, this study was aimed to investigate the association of rs543159 and rs1317652 variants in SLC22A3 gene with response to metformin monotherapy in newly diagnosed patients with T2DM.

METHODS

The study included 200 T2DM patients who received metformin monotherapy for 25 weeks. The patients were classified into 2 groups according to their HbA1c values: the responders (reduction in HbA1c levels by at least 1% after 25 weeks treatment with metformin) and non-responders (less than 1% reduction in HbA1c levels after 25 weeks treatment with metformin). We used tetra ARMS-PCR method to determine genotypes of the target variants.

RESULTS

For the rs543159, CA and AA genotypes were more frequent in responders as compared to non-responders (OR = 2.48; 95% CI = 1.28-4.78, P-value = 0.0057) under the dominant model. In case of rs1317652 CC and CT genotypes were more frequent in metformin responders as compared to non-responder group (OR = 2.49; 95% CI = 1.32-4.70, P-value = 0.0043) under the dominant model. Parameters such as fasting blood sugar (FBS), HbA1c, and total cholesterol (TC) levels were significantly lower in the responder group after 25 weeks of metformin monotherapy. Moreover, according to the result of multiple linear regression rs543159 and base line HbA1c values are significantly associated with response to metformin monotherapy.

CONCLUSION

Our results suggested that rs543159 and rs1317652 in SLC22A3 gene might be associated with variability in response to metformin therapy in T2DM patients.