1
|
Laeeq T, Ahmed M, Sattar H, Zeeshan MH, Ali MB. Role of SGLT2 Inhibitors, DPP-4 Inhibitors, and Metformin in Pancreatic Cancer Prevention. Cancers (Basel) 2024; 16:1325. [PMID: 38611003 PMCID: PMC11011099 DOI: 10.3390/cancers16071325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/08/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Pancreatic carcinoma is a highly aggressive tumor that usually presents when it has already metastasized. Therapeutic options for cure remain scarce and rely on combination chemotherapy with limited sustainability. Diabetes is considered an important risk factor for the development of pancreatic cancer due to the production of proinflammatory cytokines, which result in increased cell proliferation. More than half of patients diagnosed with pancreatic cancer eventually develop diabetes due to the destruction of insulin-producing cells. The interlinkage of both diseases might identify a possible preventative strategy for reducing the incidence of pancreatic carcinoma. This study reviewed the recent literature on the association between pancreatic cancer risk and SGLT2 inhibitors, GLP-1 RA, DPP-4 inhibitors, and biguanides. There are mixed data regarding the relationship between GLP-1 RA and DPP-4 inhibitors and pancreatic cancer, with some trials suggesting that they might increase the risk. In contrast, studies have mostly revealed that SGLT2 inhibitors have an antiproliferative effect on various tumors, such as liver, pancreatic, prostate, bowel, lung, and breast carcinoma, which might be due to their mechanism of blockage of reabsorption of glucose by cells, lowering the amount of available glucose for the growth of tumor cells. Metformin, the first-line agent for diabetes, has also been shown to be associated with decreasing pancreatic cancer risk and improving prognosis in those who already have the disease. Dedicated trials are needed to further delineate the association of antidiabetic drugs with the risk of pancreatic cancer in the general population, as previous studies have mostly focused on diabetic patients.
Collapse
Affiliation(s)
- Tooba Laeeq
- Internal Medicine, University of Nevada, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Maheen Ahmed
- Internal Medicine, Dow University of Health Sciences, Mission Rd., New Labour Colony, Karachi 74200, Pakistan; (M.A.); (M.H.Z.)
| | - Hina Sattar
- Internal Medicine, Dow University of Health Sciences, Mission Rd., New Labour Colony, Karachi 74200, Pakistan; (M.A.); (M.H.Z.)
| | - Muhammad Hamayl Zeeshan
- Internal Medicine, Dow University of Health Sciences, Mission Rd., New Labour Colony, Karachi 74200, Pakistan; (M.A.); (M.H.Z.)
| | - Meher Binte Ali
- Internal Medicine, University of Maryland Medical Center, 827 Linden Ave., Baltimore, MD 21201, USA
| |
Collapse
|
2
|
Naja K, Anwardeen N, Malki AM, Elrayess MA. Metformin increases 3-hydroxy medium chain fatty acids in patients with type 2 diabetes: a cross-sectional pharmacometabolomic study. Front Endocrinol (Lausanne) 2024; 15:1313597. [PMID: 38370354 PMCID: PMC10869496 DOI: 10.3389/fendo.2024.1313597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Metformin is a drug with a long history of providing benefits in diabetes management and beyond. The mechanisms of action of metformin are complex, and continue to be actively debated and investigated. The aim of this study is to identify metabolic signatures associated with metformin treatment, which may explain the pleiotropic mechanisms by which metformin works, and could lead to an improved treatment and expanded use. Methods This is a cross-sectional study, in which clinical and metabolomic data for 146 patients with type 2 diabetes were retrieved from Qatar Biobank. Patients were categorized into: Metformin-treated, treatment naïve, and non-metformin treated. Orthogonal partial least square discriminate analysis and linear models were used to analyze differences in the level of metabolites between the metformin treated group with each of the other two groups. Results Patients on metformin therapy showed, among other metabolites, a significant increase in 3-hydroxyoctanoate and 3-hydroxydecanoate, which may have substantial effects on metabolism. Conclusions This is the first study to report an association between 3-hydroxy medium chain fatty acids with metformin therapy in patients with type 2 diabetes. This opens up new directions towards repurposing metformin by comprehensively understanding the role of these metabolites.
Collapse
Affiliation(s)
- Khaled Naja
- Biomedical Research Center, Qatar University, Doha, Qatar
| | | | - Ahmed M. Malki
- Biomedical Science Department, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Mohamed A. Elrayess
- Biomedical Research Center, Qatar University, Doha, Qatar
- Biomedical Science Department, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| |
Collapse
|
3
|
Roohi TF, Faizan S, Shaikh MF, Krishna KL, Mehdi S, Kinattingal N, Arulsamy A. Beyond drug discovery: Exploring the physiological and methodological dimensions of zebrafish in diabetes research. Exp Physiol 2024. [PMID: 38279951 DOI: 10.1113/ep091587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 01/29/2024]
Abstract
Diabetes mellitus is a chronic disease that is now considered a global epidemic. Chronic diabetes conditions include type 1 and type 2 diabetes, both of which are normally irreversible. As a result of long-term uncontrolled high levels of glucose, diabetes can progress to hyperglycaemic pathologies, such as cardiovascular diseases, retinopathy, nephropathy and neuropathy, among many other complications. The complete mechanism underlying diabetes remains unclear due to its complexity. In this scenario, zebrafish (Danio rerio) have arisen as a versatile and promising animal model due to their good reproducibility, simplicity, and time- and cost-effectiveness. The Zebrafish model allows us to make progress in the investigation and comprehension of the root cause of diabetes, which in turn would aid in the development of pharmacological and surgical approaches for its management. The current review provides valuable reference information on zebrafish models, from the first zebrafish diabetes models using genetic, disease induction and chemical approaches, to the newest ones that further allow for drug screening and testing. This review aims to update our knowledge related to diabetes mellitus by gathering the most authoritative studies on zebrafish as a chemical, dietary and insulin induction, and genetic model for diabetes research.
Collapse
Affiliation(s)
- Tamsheel Fatima Roohi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Syed Faizan
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Mohd Farooq Shaikh
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia
| | - Kamsagara Linganna Krishna
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Seema Mehdi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Nabeel Kinattingal
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| |
Collapse
|
4
|
Ahmad BA, Sanghani IM, Sayabugari R, Biju H, Siddegowda A, Ittiachen Kinattingal M, Yartha SGR, Gaonkar PM, Andrabi SS, Vaghamashi YK, Korwar A. Beyond Blood Sugar: Investigating the Cardiovascular Effects of Antidiabetic Drugs. Cureus 2023; 15:e46373. [PMID: 37920618 PMCID: PMC10618835 DOI: 10.7759/cureus.46373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/04/2023] Open
Abstract
Cardiovascular disease is a major comorbidity associated with diabetes mellitus. Various antidiabetic drugs are currently used to treat type 2 diabetes mellitus and have varying effects on the cardiovascular system. Some drugs, such as glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose cotransporter 2 (SGLT-2) inhibitors, are cardioprotective, whereas others, such as insulin, have deleterious effects on the cardiovascular system. This narrative review assessed the impact of antidiabetic drugs on cardiovascular health in the management of diabetes mellitus. It critically examines various classes of these medications, including conventional options such as metformin and newer agents such as incretin-based therapies and SGLT-2.
Collapse
Affiliation(s)
- Binish A Ahmad
- Department of Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Isha M Sanghani
- Department of Internal Medicine, Punyashlok Ahilyadevi Holkar Government Medical College, Baramati, IND
| | | | - Hannah Biju
- Department of Internal Medicine, Kristu Jayanti College, Bengaluru, IND
| | | | - Minnu Ittiachen Kinattingal
- Department of Internal Medicine, New Hope Clinical Research, Charlotte, USA
- Department of Internal Medicine, Karuna Medical College, Palakkad, IND
| | | | - Prajyoth M Gaonkar
- Department of Internal Medicine, Punyashlok Ahilyadevi Holkar Government Medical College, Baramati, IND
| | - Syed Shireen Andrabi
- Department of Internal Medicine, School of Medicne, Tehran University of Medical Sciences, Tehran, IRN
| | | | - Arunika Korwar
- Department of Internal Medicine, KJ Somaiya Medical College, Mumbai, IND
| |
Collapse
|
5
|
Pari B, Gallucci M, Ghigo A, Brizzi MF. Insight on Infections in Diabetic Setting. Biomedicines 2023; 11:971. [PMID: 36979949 PMCID: PMC10046483 DOI: 10.3390/biomedicines11030971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
The correlation between diabetes mellitus and infectious diseases is widely recognized. DM patients are characterized by the impaired function of the immune system. This translates into the occurrence of a variety of infections, including urinary tract, skin and surgical site infections, pneumonia, tuberculosis, and, more recently, SARS-CoV-2. Hyperglycemia has been identified as a relevant factor contributing to unfavorable outcomes in hospitalized patients including SARS-CoV-2 patients. Several studies have been performed proving that to maintain the proper and stringent monitoring of glycemia, a balanced diet and physical activity is mandatory to reduce the risk of infections and their associated complications. This review is focused on the mechanisms accounting for the increased susceptibility of DM patients to infections, with particular attention to the impact of newly introduced hypoglycemic drugs in sepsis management.
Collapse
Affiliation(s)
| | | | | | - Maria Felice Brizzi
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| |
Collapse
|
6
|
Shrivastava A, Kesavadev J, Mohan V, Saboo B, Shrestha D, Maheshwari A, Makkar BM, Modi KD, Das AK. Clinical Evidence and Practice-Based Guidelines on the Utility of Basal Insulin Combined Oral Therapy (Metformin and Glimepiride) in the Current Era. Curr Diabetes Rev 2023; 19:e090123212444. [PMID: 36624650 PMCID: PMC10617787 DOI: 10.2174/1573399819666230109104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Basal insulin combined oral therapy consisting of insulin and oral anti-diabetic drugs (OADs) is recommended for type 2 diabetes uncontrolled on OADs. There is a lack of clear evidence and recommendations on the combined use of basal insulin analogues to more than one OADs (glimepiride plus metformin) in effective control of glycemic parameters and its safety in terms of reduced hypoglycemic events, weight gain and cardiovascular risk. In this context, a group of clinical experts discussed the utility of basal insulin combined oral therapy with metformin and glimepiride in the current era. METHODS The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists and diabetologists from India and Nepal. RESULTS The panel thoroughly reviewed existing literature on the subject and proposed clinical evidence and practice-based guidelines. CONCLUSION These current clinical practice guidelines highlight the efficacy and safety of basal insulin combination therapy with various available basal insulins including neutral protamine hagedorn, detemir, glargine and degludec in addition to metformin and glimepiride therapy.
Collapse
Affiliation(s)
| | - Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Konkalam Road, Mudavanmugal, Trivandrum, Kerala, India
| | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Dina Shrestha
- Norvic International Hospital and Medical College, and Hospital for Advanced Medicine and Surgery, Maharajganj, Kathmandu, Nepal
| | - Anuj Maheshwari
- Department of Medicine, American College of Physicians, BBD University, Lucknow, India
| | - Brij Mohan Makkar
- Dr. Makkar’s Diabetes & Obesity Centre, Paschim Vihar, New Delhi, India
| | | | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| |
Collapse
|
7
|
Muacevic A, Adler JR, Phatak P, Shah HB, Phatak I, Shah DB. Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors and Genital Infections in Patients With Diabetic Mellitus and Concomitant Coronary Artery Disease: A Single-Center Experience. Cureus 2022; 14:e31842. [PMID: 36579232 PMCID: PMC9788992 DOI: 10.7759/cureus.31842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the incidence of genital infection due to the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with type 2 diabetes mellitus (T2DM) concomitant coronary artery diseases (CAD). Methods A single-center, physician-initiated study was conducted at a tertiary-care center in India. The study enrolled patients with T2DM who were taking SGLT-2 inhibitors for at least two months and divided them into two groups: patients with concomitant CAD as the case group and without CAD as the control group. Demographic data and medical history of patients were documented using a standard questionnaire. Itching and swelling were the signs used for the diagnosis of genital infection. Results A total of 270 consecutive patients with T2DM were enrolled and divided into two groups: 48 patients with CAD as the case group and 222 patients without CAD as the control group. The mean age of patients with CAD was 63.27±7.53 years and without CAD was 58.32±14.89 years. The mean HbA1C levels were 8.40±1.71% in the case group and 8.60±7.20% in the control group. A total of 14.6% of patients with CAD and 12.6% of patients without CAD were found to have genital infections (p=0.712). SGLT-2 inhibitors were stopped in only six patients who had genital infections and all the patients were managed using anti-fungal cream and via maintenance of proper hygiene. The overall incidence of genital infection was about 12.96%, of which only 2.7% required discontinuation of this crucial therapy. Conclusion In conclusion, the incidence of genital infection with the use of SGLT-2 inhibitors is similar among patients with T2DM with concomitant CAD and without CAD. The measures to prevent genital infection should be strongly emphasized. However, larger, well-designed studies are required to validate the current findings.
Collapse
|
8
|
Martínez-López YE, Esquivel-Hernández DA, Sánchez-Castañeda JP, Neri-Rosario D, Guardado-Mendoza R, Resendis-Antonio O. Type 2 diabetes, gut microbiome, and systems biology: A novel perspective for a new era. Gut Microbes 2022; 14:2111952. [PMID: 36004400 PMCID: PMC9423831 DOI: 10.1080/19490976.2022.2111952] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The association between the physio-pathological variables of type 2 diabetes (T2D) and gut microbiota composition suggests a new avenue to track the disease and improve the outcomes of pharmacological and non-pharmacological treatments. This enterprise requires new strategies to elucidate the metabolic disturbances occurring in the gut microbiome as the disease progresses. To this end, physiological knowledge and systems biology pave the way for characterizing microbiota and identifying strategies in a move toward healthy compositions. Here, we dissect the recent associations between gut microbiota and T2D. In addition, we discuss recent advances in how drugs, diet, and exercise modulate the microbiome to favor healthy stages. Finally, we present computational approaches for disentangling the metabolic activity underlying host-microbiota codependence. Altogether, we envision that the combination of physiology and computational modeling of microbiota metabolism will drive us to optimize the diagnosis and treatment of T2D patients in a personalized way.
Collapse
Affiliation(s)
- Yoscelina Estrella Martínez-López
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN). México City, México,Programa de Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México (UNAM). Ciudad de México, México,Metabolic Research Laboratory, Department of Medicine and Nutrition. University of Guanajuato. León, Guanajuato, México
| | | | - Jean Paul Sánchez-Castañeda
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN). México City, México,Programa de Maestría en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM). Ciudad de México, México
| | - Daniel Neri-Rosario
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN). México City, México,Programa de Maestría en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM). Ciudad de México, México
| | - Rodolfo Guardado-Mendoza
- Metabolic Research Laboratory, Department of Medicine and Nutrition. University of Guanajuato. León, Guanajuato, México,Research Department, Hospital Regional de Alta Especialidad del Bajío. León, Guanajuato, México,Rodolfo Guardado-Mendoza Metabolic Research Laboratory, Department of Medicine and Nutrition. University of Guanajuato. León, Guanajuato, México
| | - Osbaldo Resendis-Antonio
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN). México City, México,Coordinación de la Investigación Científica – Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México (UNAM). Ciudad de México, México,CONTACT Osbaldo Resendis-Antonio Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México (UNAM), Periferico Sur 4809, Arenal Tepepan, Tlalpan, 14610 Ciudad de México, CDMX
| |
Collapse
|
9
|
Ma M, Li W, Xu L, Ping F, Zhang H, Li Y. Diabetes duration and weight loss are associated with onset age and remote metastasis of pancreatic cancer in patients with diabetes mellitus. J Diabetes 2022; 14:261-270. [PMID: 35167190 PMCID: PMC9060030 DOI: 10.1111/1753-0407.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of patients with pancreatic cancer (PC) and diabetes and to explore the impact of diabetes duration, weight loss, and hypoglycemic drugs on the tumor biological behavior of PC. METHODS This is a retrospective study on patients with PC and diabetes. Subjects were grouped according to the onset age of PC, distant metastasis, duration of diabetes, degree of weight loss (∆Wt), and type of hypoglycemic drugs. Logistic regression analysis was used to evaluate the association between diabetes duration, weight loss, hypoglycemic drugs, and early-onset PC, distant metastasis. RESULTS Compared with late-onset PC, patients with early-onset PC had a higher proportion of new-onset DM (35 [79.5%] vs. 217 [46.9%], p < 0.001), smoker, drinker, and more obvious weight loss (8.5 [3.8, 15] kg vs. 5 [0, 10] kg, p < 0.001). Patients with remote metastasis had an earlier diagnosis age, heavier weight loss, lower body mass index, and were more likely to be smokers but had cancer less likely to be localized in the head of pancreas. Regression analysis showed that new-onset diabetes and weight loss were independently correlated to early-onset PC: odds ratio (OR) = 3.38 (95% CI 1.36-8.4, p = 0.09; OR = 1.56 (95% CI 1.16-2.1), p = 0.003, respectively. In contrast, long-term diabetes, and heavy weight loss were independently associated with remote metastasis: OR = 3.38 (95% CI 1.36-8.4, p = 0.09; OR = 1.56 (95% CI 1.16-2.1), p = 0.003, respectively. CONCLUSION New-onset diabetes and weight loss were common presentation and risk factors of early-onset PC, which required more attention. Long-term diabetes and heavy weight loss were risk factors contributing to distant metastases, indicating potential risk factors contributing to the adverse prognosis of patients with PC.
Collapse
Affiliation(s)
- Minglei Ma
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
- Department of Endocrinology, Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| |
Collapse
|
10
|
Al Kury LT, Abdoh A, Ikbariah K, Sadek B, Mahgoub M. In Vitro and In Vivo Antidiabetic Potential of Monoterpenoids: An Update. Molecules 2021; 27:182. [PMID: 35011414 DOI: 10.3390/molecules27010182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) is a chronic metabolic condition characterized by persistent hyperglycemia due to insufficient insulin levels or insulin resistance. Despite the availability of several oral and injectable hypoglycemic agents, their use is associated with a wide range of side effects. Monoterpenes are compounds extracted from different plants including herbs, vegetables, and fruits and they contribute to their aroma and flavor. Based on their chemical structure, monoterpenes are classified into acyclic, monocyclic, and bicyclic monoterpenes. They have been found to exhibit numerous biological and medicinal effects such as antipruritic, antioxidant, anti-inflammatory, and analgesic activities. Therefore, monoterpenes emerged as promising molecules that can be used therapeutically to treat a vast range of diseases. Additionally, monoterpenes were found to modulate enzymes and proteins that contribute to insulin resistance and other pathological events caused by DM. In this review, we highlight the different mechanisms by which monoterpenes can be used in the pharmacological intervention of DM via the alteration of certain enzymes, proteins, and pathways involved in the pathophysiology of DM. Based on the fact that monoterpenes have multiple mechanisms of action on different targets in in vitro and in vivo studies, they can be considered as lead compounds for developing effective hypoglycemic agents. Incorporating these compounds in clinical trials is needed to investigate their actions in diabetic patients in order to confirm their ability in controlling hyperglycemia.
Collapse
|
11
|
Ren F, Huang J, Dai T, Gan F. Retrospective analysis of factors associated with serum levels of fibroblast growth factor-21 in patients with diabetes. Ann Palliat Med 2021; 10:3258-3266. [PMID: 33849110 DOI: 10.21037/apm-21-525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fibroblast growth factor-21 (FGF-21) plays multiple roles in pathophysiological processes of the human body. Previous studies have evidenced FGF-21 to be an inhibitor of vascular calcification through a variety of mechanisms. Increased levels of serum FGF-21 are known to be associated with an elevated risk of coronary heart disease; however, the factors affecting the expression of FGF-21 are currently unclear. This study aimed to observe the effects of some medications and other factors on serum FGF-21 levels in patients with diabetes. METHODS Baseline characteristics of patients with diabetes, including body mass index (BMI), medication, level of exercise, and other information, were collected and analyzed, and their baseline levels of serum FGF-21 were tested. The relationship of serum FGF-21 levels with these characteristics was analyzed. RESULTS A total of 2118 patients were enrolled in the final analysis. Results revealed that the serum levels of FGF-21 in patients with a high BMI were elevated compared to those in patients with a normal or low BMI. Furthermore, the serum levels of FGF-21 in patients who engaged in regular exercise were higher than those in patients who exercised intermittently or not at all. No significant differences existed between patients who received different anti-diabetic drugs, or between patients treated with different antihyperlipidemic drugs. Also, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers had no obvious effects on serum levels of FGF-21 in patients with diabetes. CONCLUSIONS Drugs used in the treatment of patients with diabetes have no significant effects on serum levels of FGF-21. Obese patients had higher serum levels of FGF-21 than did non-obese patients. Participating in sports might increase the levels of FGF-21 in patients with diabetes.
Collapse
Affiliation(s)
- Fang Ren
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China
| | - Jiafang Huang
- Laboratory Department, Beijing Aerospace General Hospital, Beijing, China
| | - Tianran Dai
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China
| | - Feng Gan
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China.
| |
Collapse
|
12
|
Shanmugam KR, Shanmugam B, Subbaiah GV, Ravi S, Reddy KS. Medicinal Plants and Bioactive Compounds for Diabetes Management: Important Advances in Drug Discovery. Curr Pharm Des 2021; 27:763-774. [PMID: 32988345 DOI: 10.2174/1381612826666200928160357] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes is a major public health problem in the world. It affects each and every part of the human body and also leads to organ failure. Hence, great progress is made in the field of herbal medicine and diabetic research. OBJECTIVES Our review will focus on the effect of bioactive compounds of medicinal plants which are used to treat diabetes in India and other countries. METHODS Information regarding diabetes, oxidative stress, medicinal plants and bioactive compounds was collected from different search engines like Science direct, Springer, Wiley online library, Taylor and francis, Bentham Science, Pubmed and Google scholar. Data was analyzed and summarized in the review. RESULTS Anti-diabetic drugs that are in use have many side effects on vital organs like heart, liver, kidney and brain. There is an urgent need for alternative medicine to treat diabetes and their disorders. In India and other countries, herbal medicine was used to treat diabetes. Many herbal plants have antidiabetic effects. The plants like ginger, phyllanthus, gymnea, aswagandha, aloe, hibiscus and curcuma showed significant anti-hyperglycemic activities in experimental models and humans. The bioactive compounds like Allicin, azadirachtin, cajanin, curcumin, querceitin, gingerol possess anti-diabetic, antioxidant and other pharmacological properties. This review focuses on the role of bioactive compounds of medicinal plants in the prevention and management of diabetes. CONCLUSION Moreover, our review suggests that bioactive compounds have the therapeutic potential against diabetes. However, further in vitro and in vivo studies are needed to validate these findings.
Collapse
Affiliation(s)
- Kondeti R Shanmugam
- Department of Zoology, T.R.R. Government Degree College, Kandukur, A.P, India
| | - Bhasha Shanmugam
- Division of Molecular Biology and Ethanopharmacology, Department of Zoology, Sri Venkateswara University, Tirupati - 517 502, India
| | - Ganjikunta V Subbaiah
- Division of Molecular Biology and Ethanopharmacology, Department of Zoology, Sri Venkateswara University, Tirupati - 517 502, India
| | - Sahukari Ravi
- Division of Molecular Biology and Ethanopharmacology, Department of Zoology, Sri Venkateswara University, Tirupati - 517 502, India
| | - Kesireddy S Reddy
- Division of Molecular Biology and Ethanopharmacology, Department of Zoology, Sri Venkateswara University, Tirupati - 517 502, India
| |
Collapse
|
13
|
Lian J, Fu J. Efficacy of Various Hypoglycemic Agents in the Treatment of Patients With Nonalcoholic Liver Disease With or Without Diabetes: A Network Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:649018. [PMID: 33841337 PMCID: PMC8024567 DOI: 10.3389/fendo.2021.649018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To comprehensively evaluate and compare the therapeutic effects of various hypoglycemic agents in NAFLD patients with or without diabetes. Methods All literature from the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Clinical Trials was searched, and the language was limited to English. Two reviewers independently assessed study eligibility, continuous data extraction, and independent assessment of bias risk. Our primary outcomes were alanine aminotransferase (ALT), aspartate aminotransferase (AST) and triglyceride levels, while our secondary outcomes were high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels, body weight, BMI, and fasting glucose and glycosylated hemoglobin (HbA1c) levels. Results The review identified 20 eligible trials that met the inclusion criteria. We found that, compared to other drugs, thiazolidinediones, especially pioglitazone, had a greater effect on the levels of ALT (-8.01 (95% CI -14.3 to 2.02)) and AST (-5.0 (95% CI -9.21 to -1,22)) and other biological indicators, but they were also associated with an increased risk of weight gain (3.62 (95% CI 2.25 to 4.99) and increased BMI (0.59 (95% Cl -0.13 to 1.29). GLP1 RAs and metformin also had better therapeutic effects than other drugs as measured by the levels of ALT (liraglutide: -9.36 (95% Cl -18 to -0.34), metformin: -2.84 (95% CI -11.09 to 5.28)) and AST (liraglutide: -5.14 (95% CI -10.69 to 0.37), metformin: -2.39 (95% CI -7.55, 2.49)) and other biological indicators. Conclusion Despite the significant risk of weight gain, thiazolidinediones, especially pioglitazone, are beneficial in normalizing liver and glucose metabolism in NAFLD patients. In clinical practice, we believe that GLP1 RAs such as liraglutide and exenatide or metformin can be used in combination to offset the risk of weight gain associated with thiazolidinediones. However, long-term studies are still needed to verify the efficacy and safety of individual hypoglycemic agents. Systematic Review Registration [PROSPERO], identifier [CRD42020212025].
Collapse
Affiliation(s)
| | - Jianfang Fu
- Department of Endocrinology, Xijing Hospital of Air Force Medical University, Xi’an, China
| |
Collapse
|
14
|
Yaribeygi H, Atkin SL, Jamialahmadi T, Sahebkar A. A Review on the Effects of New Anti-Diabetic Drugs on Platelet Function. Endocr Metab Immune Disord Drug Targets 2021; 20:328-334. [PMID: 31612835 DOI: 10.2174/1871530319666191014110414] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/05/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiovascular complications account for the majority of deaths caused by diabetes mellitus. Platelet hyperactivity has been shown to increase the risk of thrombotic events and is a therapeutic target for their prevention in diabetes. Modulation of platelet function by diabetes agents in addition to their hypoglycemic effects would contribute to cardiovascular protection. Newly introduced antidiabetic drugs of sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon like peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 inhibitors may have anti-platelet effects, and in the case of SGLT2i and GLP-1RA may contribute to their proven cardiovascular benefit that has been shown clinically. OBJECTIVE Here, we reviewed the potential effects of these agents on platelet function in diabetes. RESULTS AND CONCLUSION GLP-1RA and DPP-4i drugs have antiplatelet properties beyond their primary hypoglycemic effects. Whilst we have little direct evidence for the antiplatelet effects of SGLT2 inhibitors, some studies have shown that these agents may inhibit platelet aggregation and reduce the risk of thrombotic events in diabetes.
Collapse
Affiliation(s)
- Habib Yaribeygi
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Tannaz Jamialahmadi
- Halal Research Center of IRI, FDA, Tehran, Iran.,Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
15
|
Rayapu L, Chakraborty K, Valluru L. Marine Algae as a Potential Source for Anti-diabetic Compounds - A Brief Review. Curr Pharm Des 2021; 27:789-801. [PMID: 32912118 DOI: 10.2174/1381612826666200909124526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) is a major chronic metabolic disorder characterized by hyperglycemia that leads to several complications such as retinopathy, atherosclerosis, nephropathy, etc. In 2019, it was estimated that about 463 million people had diabetes, and it may increase up to 700 million in 2045. Marine macroalgae are the rich source of bioactive compounds for the treatment of diabetes mellitus. OBJECTIVE This review summarizes the recent epidemiology and possible use of marine macroalgae-derived bioactive compounds for the protection against chronic metabolic disease, diabetes mellitus and marine macroalgae as a nutraceutical supplement. CONCLUSION The present therapies available for diabetes treatment are oral medicines and insulin injections. But continuous use of synthetic medicines provides low therapeutic with many side effects. In continuing search of anti-diabetic drugs, marine macroalgae remain as a promising source with potent bioactivity. Among existing marine algae, red and brown algae are reported to show anti-diabetic activity. Hence, the present review focuses on the epidemiology, diabetes biomarkers and different secondary bioactive compounds present in marine macroalgae to treat diabetes mellitus.
Collapse
Affiliation(s)
- Lavanya Rayapu
- Department of Biotechnology, Dravidian University, Kuppam-517426, A.P, India
| | - Kajal Chakraborty
- Marine Biotechnology Division, Central Marine Fisheries Research Institute (CMFRI), Ernakulum, Cochin-682001, Kerala, India
| | - Lokanatha Valluru
- Department of Biotechnology, Dravidian University, Kuppam-517426, A.P, India
| |
Collapse
|
16
|
Ding Y, Xia S, Zhang H, Chen Q, Niu B. Loureirin B activates GLP-1R and promotes insulin secretion in Ins-1 cells. J Cell Mol Med 2020; 25:855-866. [PMID: 33300675 PMCID: PMC7812269 DOI: 10.1111/jcmm.16138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
Loureirin B (LB) is a natural product derived from Sanguis draconis, which has hypoglycaemic effects. In order to research the possible target of LB in the treatment of diabetes, molecular docking was used to simulate the interaction between LB and potential targets, and among them, glucagon‐like peptide‐1 receptor (GLP‐1R) had the optimal results. Further, spectroscopy and surface plasmon resonance (SPR) experiments were applied to detect the interaction between LB and GLP‐1R. Ultimately, after GLP‐1R siRNA interfering the expression of GLP‐1R in Ins‐1 cell, the promoting insulin secretion of LB was weaken, which directly proved that GLP‐1R plays an important role. These results show that LB promotes insulin secretion of Ins‐1 cells through GLP‐1R. Hence, the strategy of LB as a prodrug will provide a potential approach for non‐peptide GLP‐1R agonist.
Collapse
Affiliation(s)
- Yanting Ding
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China.,Shanghai Key Laboratory of Bio-Energy Crops, School of Life Sciences, Shanghai University, Shanghai, China
| | - Sijing Xia
- Shanghai Key Laboratory of Bio-Energy Crops, School of Life Sciences, Shanghai University, Shanghai, China
| | - Han Zhang
- Shanghai Key Laboratory of Bio-Energy Crops, School of Life Sciences, Shanghai University, Shanghai, China
| | - Qin Chen
- Shanghai Key Laboratory of Bio-Energy Crops, School of Life Sciences, Shanghai University, Shanghai, China
| | - Bing Niu
- Shanghai Key Laboratory of Bio-Energy Crops, School of Life Sciences, Shanghai University, Shanghai, China
| |
Collapse
|
17
|
Gonzalez CD, Perkins VI, de Lima AA, Fogar R, Frechtel GD, Di Girolamo G. Pregnancy Complicated by the Most Frequent Forms of Maturity Onset Diabetes of the Young: A Narrative Review on Its Pharmacological Implications. Curr Rev Clin Exp Pharmacol 2020; 16:228-234. [PMID: 32914719 DOI: 10.2174/1574884715666200910160007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Monogenic Diabetes (MFD) represents close to 2% of all the cases of diabetes diagnosed in people younger than 45 years old. Maturity-Onset Diabetes of the Young (MODY), neonatal diabetes, and several syndromic forms of diabetes are included among the most accounts for about typical forms of MDF. MODY is the most frequent type of MFD, with MODY 1, 2, 3, and 5 being the most prevalent forms. The aim of this narrative review is to describe pregnancy associated changes in the pharmacological profile of the antidiabetic drugs used in women with the most frequent MODY subtypes. METHODS A comprehensive literature search was carried out to identify eligible studies from MEDLINE/ PubMed, EMBASE, and SCIELO databases from 1970 to 2019 first semester. RESULTS Pregnancy introduces changes in the pharmacodynamic and pharmacokinetic profile of some of the treatments used in MODY. MODY 3 (also known as HNF1-A MODY) is the most frequent MDF. MODY 3 patients are highly sensitive to Sulfonylureas (SU). This is also the case for MODY pregnant women. This high sensitivity to SU is also registered in patients with MODY 1 (HNF4-A MODY). Pharmacodynamic changes have been proposed to explain this behavior (Epac2 hyperactivity). However, changes in expression/activity of the metabolizing CYP2C9 cytochrome and/or alterations in the drug transporters oatp1 (Slc21a1), Lst-1 (Slc21a6), OATPD (SLC21A11), and oat2 may better explain, at least in part, this phenomenon by an increase in the concentration of the active drug. CONCLUSION The impact of changes in the pharmacological behavior of drugs like SU and other metabolized/transported by mechanisms altered in a pregnancy complicated by MODY is unknown. However, switching-to-insulin recommendation formulated for MODY 1 and 3 seems to be justified. Further research in this field is needed for a better understanding of changes in drug activity associated with this particular subset of patients with MFD.
Collapse
Affiliation(s)
- Claudio Daniel Gonzalez
- Universidad de Buenos Aires, Facultad de Medicina, Centro de Vigilancia y Seguridad de Medicamentos, Buenos Aires, Argentina
| | | | - Agustina Alves de Lima
- Departamento de Farmacología, Escuela de Medicina, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Rocio Fogar
- Departamento de Farmacología, Escuela de Medicina, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Gustavo D Frechtel
- Laboratorio de Diabetes y Metabolismo, Instituto de Inmunología, Genética y Metabolismo, Universidad de Buenos Aires-CONICET, CABA, Buenos Aires, Argentina
| | - Guillermo Di Girolamo
- Universidad de Buenos Aires, Facultad de Medicina, Centro de Vigilancia y Seguridad de Medicamentos, Buenos Aires, Argentina
| |
Collapse
|
18
|
Singh M, Sharma R, Kumar A. Safety of SGLT2 Inhibitors in Patients with Diabetes Mellitus. Curr Drug Saf 2020; 14:87-93. [PMID: 30727912 DOI: 10.2174/1574886314666190206164647] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Recently, Food and Drug Administration (FDA) has approved sodium/ glucose co-transporter 2 (SGLT2) inhibitors for the treatment of diabetes mellitus. However, regarding adverse drug reactions (ADRs) of SGLT2 inhibitors in large group of population, very less information is available. Thus, we have tried to find out the risk profile of SGLT2 inhibitors. MATERIALS AND METHODS A total of 1,042 studies have been published from Nov. 2012-Nov. 2017 regarding SGLT2 inhibitors. After inclusion and exclusion criteria, 27 studies have been selected for the analysis of risk. RESULTS AND DISCUSSION The emerging evidence indicates various adverse drug reactions such as foot and toe amputation, cancer, diabetic ketoacidosis, bone fracture risk and urinary as well as mycotic genital infection. The causality assessment has shown a correlation between SGLT2 inhibitors and diabetic ketoacidosis and urinary tract infection. CONCLUSION In conclusion, Marketing Authorization Holder (MAH) and Regulatory Authorities (RA) should monitor various adverse drug reactions such as diabetic ketoacidosis and urinary tract infection with the use of SGLT2 inhibitor.
Collapse
Affiliation(s)
- Mahakpreet Singh
- Department of Pharmacy Practice, Indo-Soviet Friendship Pharmacy College (ISFCP), Moga, Punjab, India
| | - Ruchika Sharma
- Department of Biotechnology, Indo-Soviet Friendship Institute of Professional Studies (ISFIPS), Moga, Punjab, India
| | - Anoop Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPERRaebareli), Lucknow, UP, India
| |
Collapse
|
19
|
Saxena M, Ali D, Modi DR, Almarzoug MHA, Hussain SA, Manohrdas S. Association of TNF-α Gene Expression and Release in Response to Anti-Diabetic Drugs from Human Adipocytes in vitro. Diabetes Metab Syndr Obes 2020; 13:2633-2640. [PMID: 32801814 PMCID: PMC7399456 DOI: 10.2147/dmso.s265362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION TNF-α, a proinflammatory cytokine secreted by activated immune cells, and overexpression of it in adipocytes, has an important role in insulin resistance progression and diabetes development. AIM AND OBJECTIVE Subcutaneous adipocytes derived from mesenchymal stem cells were used for in vitro analysis to find the role of antidiabetic drugs on TNF-α in high glucose-fed adipocytes. METHODS In vitro adipocytes were used along with variable concentration of anti-diabetic drugs. The level of TNF-α was measured by ELISA and the mRNA level was quantified using SYBR-Green real-time PCR. All data were statistically analyzed. RESULTS The level of TNF-α and the mRNA expression were observed and analyzed with normal adipocytes. TNF-α level and expression of it showed agonistic behavior, ie no change at low concentration while enhances with the increase of glucose. The level was decreased significantly when the adipocytes were treated with metformin (p=0.015) and pioglitazone (p=0.020). A combination of drugs showed that the expression of TNF-α was almost the same as for metformin alone. However, insulin increases the TNF-α expression as for pioglitazone. DISCUSSION Such a report on adipocytes may be helpful for clinical benefits to understand the additional mechanism of adipocytes on the release and expression of TNF-α. However, anti-diabetic drugs including insulin up-regulate the TNF-α gene expression in mild or severe glucose load.
Collapse
Affiliation(s)
- Madhukar Saxena
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Lucknow, India
- Correspondence: Madhukar Saxena Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Rai Bareilly Road, Lucknow, India Email
| | - Daoud Ali
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Dinesh Raj Modi
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Lucknow, India
| | | | - S A Hussain
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - S Manohrdas
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Bonaventura A, Carbone S, Dixon DL, Abbate A, Montecucco F. Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT-2 inhibitors and GLP-1 receptor agonists. J Intern Med 2019; 286:16-31. [PMID: 30888088 DOI: 10.1111/joim.12890] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with type 2 diabetes mellitus (T2D) present an increased risk for cardiovascular (CV) complications. In addition to improvement in glycaemic control, glucose-lowering therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-dependent glucose cotransporter (SGLT)-2 inhibitors, have been shown to significantly reduce CV events. In 2008, the US Food and Drug Administration mandated that all new glucose-lowering drugs undergo CV outcomes trials (CVOTs) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP-1RAs and SGLT-2 inhibitors have been found to be not only safe, but also cardioprotective compared to placebo. The SGLT-2 inhibitors have opened a new perspective for clinicians treating patients with T2D and established CV disease in light of their 'pleiotropic' effects, specifically on heart failure, while GLP-1RAs seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP-1RAs and SGLT-2 inhibitors to reduce CV risk in T2D patients and suggest an individualized therapeutic approach in this population based on the presence of metabolic and CV comorbidities.
Collapse
Affiliation(s)
- A Bonaventura
- the First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - S Carbone
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - D L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - A Abbate
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino -Italian Cardiovascular Network, Genoa, Italy
| |
Collapse
|
21
|
Mohsin S, Baniyas MM, AlDarmaki RS, Tekes K, Kalász H, Adeghate EA. An update on therapies for the treatment of diabetes-induced osteoporosis. Expert Opin Biol Ther 2019; 19:937-948. [PMID: 31079501 DOI: 10.1080/14712598.2019.1618266] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Currently, 424 million people aged between 20 and 79 years worldwide are diabetic. More than 25% of adults aged over 65 years in North America have Type 2 diabetes mellitus (DM). Diabetes-induced osteoporosis (DM-OS) is caused by chronic hyperglycemia, advanced glycated end products and oxidative stress. The increase in the prevalence of DM-OS has prompted researchers to develop new biological therapies for the management of DM-OS. Areas covered: This review covered the current and novel biological agents used in the management of DM-OS. Data were retrieved from PubMed, Scopus, American Diabetes Association and International Osteoporosis Foundation websites, and ClinicalTrials.gov. The keywords for the search included: DM, osteoporosis, and management. Expert opinion: Several biological molecules have been examined in order to find efficient drugs for the treatment of DM-OS. These biological agents include anti-osteoporosis drugs: net anabolics (parathyroid hormone/analogs, androgens, calcilytics, anti-sclerostin antibody), net anti-resorptive osteoporosis drugs (calcitonin, estrogen, selective estrogen receptor modulators, bisphosphonates, RANKL antibody) and anti-diabetic drugs (alpha glucosidase inhibitors, sulfonylureas, biguanides, meglitinides, thiazolidinediones, GLP-1 receptor agonists, dipeptidylpeptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, insulin). Biological medications that effectively decrease hyperglycemia and, at the same time, maintain bone health would be an ideal drug/drug combination for the treatment of DM-OS.
Collapse
Affiliation(s)
- Sahar Mohsin
- a Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
| | - May Myh Baniyas
- a Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
| | - Reem Smh AlDarmaki
- a Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
| | - Kornélia Tekes
- b Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University , Budapest , Hungary
| | - Huba Kalász
- c Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University , Budapest , Hungary
| | - Ernest A Adeghate
- a Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
| |
Collapse
|
22
|
Mikhael EM, Hussain SA, Shawky N, Hassali MA. Validity and reliability of anti-diabetic medication adherence scale among patients with diabetes in Baghdad, Iraq: a pilot study. BMJ Open Diabetes Res Care 2019; 7:e000658. [PMID: 31354953 PMCID: PMC6626478 DOI: 10.1136/bmjdrc-2019-000658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Medication non-adherence is a common problem among patients with diabetes. Patient-reported medication adherence scales are the most commonly used method to assess patient medication adherence, but up to today there is no specific tool for assessing medication adherence among patients with diabetes in Arab countries. This study aimed to develop and validate a new tool for assessment of adherence to antidiabetic medications among Iraqi patients with diabetes. METHODS The Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) consists of eight items. The face and content validity of the IADMAS were established via an expert panel. For convergent validity, the IADMAS was compared with the Medication Adherence Questionnaire (MAQ). For concurrent validity, the IADMAS was compared with glycosylated hemoglobin. A total of 84 patients with types 2 diabetes were recruited from a diabetes center in Baghdad, Iraq. Test-retest reliability was measured by readministering the IADMAS to the same patients 4 weeks later. RESULTS Only 80 patients completed the study (response rate: 95%). Reliability analysis of the IADMAS showed a Cronbach's alpha value of 0.712, whereas that of the MAQ was 0.649. All items in the IADMAS showed no significant difference in the test-retest analysis, indicating that the IADMAS has stable reliability. There was no difference in the psychometric properties of the IADMAS and the MAQ. The sensitivity and specificity of the IADMAS were higher than that of the MAQ (100% vs 87.5% and 33.9% vs 29.7%, respectively). CONCLUSION The IADMAS developed in this study is a reliable and valid instrument for assessing antidiabetic medication adherence among Iraqi patients.
Collapse
Affiliation(s)
- Ehab Mudher Mikhael
- Clinical Pharmacy Department, College of Pharmacy, University of Baghdad, Baghdad, Iraq
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Saad A Hussain
- School of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
| | - Nizar Shawky
- National Diabetes Center, Al-Mustansiriyah University, Baghdad, Iraq
| | - Mohamed Azmi Hassali
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| |
Collapse
|
23
|
Gottlieb A, Yanover C, Cahan A, Goldschmidt Y. Estimating the effects of second-line therapy for type 2 diabetes mellitus: retrospective cohort study. BMJ Open Diabetes Res Care 2017; 5:e000435. [PMID: 29299328 PMCID: PMC5730938 DOI: 10.1136/bmjdrc-2017-000435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Metformin is the recommended initial drug treatment in type 2 diabetes mellitus, but there is no clearly preferred choice for an additional drug when indicated. We compare the counterfactual drug effectiveness in lowering glycated hemoglobin (HbA1c) levels and effect on body mass index (BMI) of four diabetes second-line drug classes using electronic health records. STUDY DESIGN AND SETTING Retrospective analysis of electronic health records of US-based patients in the Explorys database using causal inference methodology to adjust for patient censoring and confounders. PARTICIPANTS AND EXPOSURES Our cohort consisted of more than 40 000 patients with type 2 diabetes, prescribed metformin along with a drug out of four second-line drug classes-sulfonylureas, thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide-1 agonists-during the years 2000-2015. Roughly, 17 000 of these patients were followed for 12 months after being prescribed a second-line drug. MAIN OUTCOME MEASURES HbA1c and BMI of these patients after 6 and 12 months following treatment. RESULTS We demonstrate that all four drug classes reduce HbA1c levels, but the effect of sulfonylureas after 6 and 12 months of treatment is less pronounced compared with other classes. We also estimate that DPP-4 inhibitors decrease body weight significantly more than sulfonylureas and thiazolidinediones. CONCLUSION Our results are in line with current knowledge on second-line drug effectiveness and effect on BMI. They demonstrate that causal inference from electronic health records is an effective way for conducting multitreatment causal inference studies.
Collapse
Affiliation(s)
- Assaf Gottlieb
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| | - Chen Yanover
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| | - Amos Cahan
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| | - Yaara Goldschmidt
- Machine Learning for Healthcare and Life Sciences, IBM Research, Haifa, Israel
| |
Collapse
|
24
|
Zeidan M, Rayan M, Zeidan N, Falah M, Rayan A. Indexing Natural Products for Their Potential Anti-Diabetic Activity: Filtering and Mapping Discriminative Physicochemical Properties. Molecules 2017; 22:molecules22091563. [PMID: 28926980 PMCID: PMC6151781 DOI: 10.3390/molecules22091563] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM) poses a major health problem, for which there is an unmet need to develop novel drugs. The application of in silico techniques and optimization algorithms is instrumental to achieving this goal. A set of 97 approved anti-diabetic drugs, representing the active domain, and a set of 2892 natural products, representing the inactive domain, were used to construct predictive models and to index anti-diabetic bioactivity. Our recently-developed approach of ‘iterative stochastic elimination’ was utilized. This article describes a highly discriminative and robust model, with an area under the curve above 0.96. Using the indexing model and a mix ratio of 1:1000 (active/inactive), 65% of the anti-diabetic drugs in the sample were captured in the top 1% of the screened compounds, compared to 1% in the random model. Some of the natural products that scored highly as potential anti-diabetic drug candidates are disclosed. One of those natural products is caffeine, which is noted in the scientific literature as having the capability to decrease blood glucose levels. The other nine phytochemicals await evaluation in a wet lab for their anti-diabetic activity. The indexing model proposed herein is useful for the virtual screening of large chemical databases and for the construction of anti-diabetes focused libraries.
Collapse
Affiliation(s)
- Mouhammad Zeidan
- Molecular Genetics and Virology Laboratory, QRC-Qasemi Research Center, Al-Qasemi Academic College, P.O. Box 124, Baka EL-Garbiah 30100, Israel.
| | - Mahmoud Rayan
- Institute of Applied Research-Galilee Society, P.O. Box 437, Shefa-Amr 20200, Israel.
| | - Nuha Zeidan
- Clalit Health Service, Diet and Nutrition Unit, P.O. Box 789, Arara 30026, Israel.
| | - Mizied Falah
- Eliachar Research Laboratory, Galilee Medical Center, P.O. Box 21, Nahariya 22100, Israel.
- Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan 52900, Israel.
| | - Anwar Rayan
- Institute of Applied Research-Galilee Society, P.O. Box 437, Shefa-Amr 20200, Israel.
- Drug Discovery Informatics Laboratory, QRC-Qasemi Research Center, Al-Qasemi Academic College, P.O. Box 124, Baka EL-Garbiah 30100, Israel.
| |
Collapse
|
25
|
Kitada M, Tsuda SI, Konishi K, Takeda-Watanabe A, Fujii M, Kanasaki K, Nishizawa M, Nakagawa A, Koya D. Anagliptin ameliorates albuminuria and urinary liver-type fatty acid-binding protein excretion in patients with type 2 diabetes with nephropathy in a glucose-lowering-independent manner. BMJ Open Diabetes Res Care 2017; 5:e000391. [PMID: 28761658 PMCID: PMC5530236 DOI: 10.1136/bmjdrc-2017-000391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/21/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The objective of this study is to elucidate the effect of anagliptin on glucose/lipid metabolism and renoprotection in patients with type 2 diabetic nephropathy. METHODS Twenty-five patients with type 2 diabetic nephropathy received anagliptin 200 mg/day for 24 weeks, and 20 patients who were switched to anagliptin from other dipeptidyl peptidase-4 (DPP-4) inhibitors were analyzed regarding primary and secondary endpoints. The primary endpoint was change in hemoglobin A1c (HbA1c) during treatment with anagliptin. Additionally, we evaluated changes in lipid data (low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and triglyceride), blood pressure (BP), urinary albumin to creatinine ratio (UACR), liver-type fatty acid-binding protein to creatinine ratio (ULFABP) and renal function (estimated glomerular filtration rate and serum cystatin C) as secondary endpoints. RESULTS After switching to anagliptin from other DPP-4 inhibitors, the levels of HbA1c in the 20 participants showed no significant change, 7.5%±1.2% at 24 weeks compared with 7.3%±0.9% at baseline. The levels of the log10-transformed UACR were significantly reduced from 1.95±0.51 mg/g creatinine (Cr) at baseline to 1.76±0.53 mg/g Cr at 24 weeks after anagliptin treatment (p<0.01). The percentage change in the UACR (Δ%UACR) from baseline to 24 weeks was also significantly lower by -10.6% (p<0.001). Lipid data, systolic BP and renal function were not changed during anagliptin treatment. Additionally, ULFABP in eight participants, who had ≥5 µg/g Cr at baseline, was significantly decreased from baseline (8.5±2.8 µg/g Cr) to 24 weeks (3.1±1.7 µg/g Cr, p<0.01) after anagliptin treatment, and the percentage change in the ULFABP during anagliptin treatment was -58.1% (p<0.001). CONCLUSIONS Anagliptin induced no significant change in HbA1c, lipid data, systolic BP and renal function. However, anagliptin reduced the UACR and ULFABP, although without a corresponding change in HbA1c, indicating direct action of anagliptin on renoprotection in patients with type 2 diabetic nephropathy.
Collapse
Affiliation(s)
- Munehiro Kitada
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shin-ichi Tsuda
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
| | - Kazunori Konishi
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
| | - Ai Takeda-Watanabe
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
| | - Mizue Fujii
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
| | - Keizo Kanasaki
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Makoto Nishizawa
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
| | - Atsushi Nakagawa
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
| | - Daisuke Koya
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| |
Collapse
|
26
|
Rizvi SMD, Shaikh S, Waseem SMA, Shakil S, Abuzenadah AM, Biswas D, Tabrez S, Ashraf GM, Kamal MA. Role of anti-diabetic drugs as therapeutic agents in Alzheimer's disease. EXCLI J 2015; 14:684-96. [PMID: 27152105 PMCID: PMC4849108 DOI: 10.17179/excli2015-252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
Recent data have suggested a strong possible link between Type 2 Diabetes Mellitus and Alzheimer's disease (AD), although exact mechanisms linking the two are still a matter of research and debate. Interestingly, both are diseases with high incidence and prevalence in later years of life. The link appears so strong that some scientists use Alzheimer's and Type 3 Diabetes interchangeably. In depth study of recent data suggests that the anti diabetic drugs not only have possible role in treatment of Alzheimer's but may also arrest the declining cognitive functions associated with it. The present review gives an insight into the possible links, existing therapeutics and clinical trials of anti diabetic drugs in patients suffering from AD primarily or as co-morbidity. It may be concluded that the possible beneficial effects and usefulness of the current anti diabetic drugs in AD cannot be neglected and further research is required to achieve positive results. Currently, several drug trials are in progress to give conclusive evidence based data.
Collapse
Affiliation(s)
| | | | - Shah Mohammad Abbas Waseem
- Department of Physiology, Integral Institute of Medical Sciences & Research, Integral University, Lucknow, India
| | - Shazi Shakil
- Center of Innovation in Personalized Medicine, Faculty of Applied Medical Sciences,King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel M Abuzenadah
- Center of Innovation in Personalized Medicine, Faculty of Applied Medical Sciences,King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad Amjad Kamal
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Enzymoic, 7 Peterlee Pl, Hebersham, NSW 2770, Australia
| |
Collapse
|
27
|
Kaiser D, Oetjen E. Something old, something new and something very old: drugs for treating type 2 diabetes. Br J Pharmacol 2015; 171:2940-50. [PMID: 24641580 DOI: 10.1111/bph.12624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/13/2014] [Accepted: 01/30/2014] [Indexed: 12/28/2022] Open
Abstract
Diabetes mellitus belongs to the most rapidly increasing diseases worldwide. Approximately 90-95% of these patients suffer from type 2 diabetes mellitus, which is characterized by peripheral insulin resistance and the progressive loss of beta-cell function and mass. Considering the complications of this chronic disease, a reliable anti-diabetic treatment is indispensable. An ideal oral anti-diabetic drug should not only correct glucose homeostasis but also preserve or even augment beta-cell function and mass, ameliorate the subclinical inflammation present under insulin-resistant conditions and prevent the macro- and microvascular consequences of diabetes in order to reduce the mortality. Despite the many anti-diabetic drugs already in use, there is an ongoing research for additional drugs, guided by different concepts of the pathogenesis of type 2 diabetes. This review will briefly summarize current oral anti-diabetic drugs. In addition, emerging strategies for the treatment of diabetes will be described, among them the inhibition of glucagon action and anti-inflammatory drugs. Their suitability as 'ideal anti-diabetic drugs' will be discussed.
Collapse
Affiliation(s)
- D Kaiser
- Department of Clinical Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
28
|
Abstract
Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a newly developed class of oral anti-diabetic drugs (OADs) with a unique mechanism of action. This review describes the biochemistry and physiology underlying the use of SGLT2 inhibitors, and their clinical pharmacology, including mechanism of action and posology. The pragmatic placement of these molecules in the existing OAD arena is also discussed.
Collapse
|
29
|
Duso T, Herr A, Suppliet M. The welfare impact of parallel imports: a structural approach applied to the German market for oral anti-diabetics. Health Econ 2014; 23:1036-1057. [PMID: 25139795 DOI: 10.1002/hec.3068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/28/2014] [Accepted: 04/29/2014] [Indexed: 06/03/2023]
Abstract
We investigate the welfare impact of parallel imports using a large panel dataset containing monthly information on sales, ex-factory prices, and further product characteristics for all 649 anti-diabetic drugs sold in Germany between 2004 and 2010. We estimate a two-stage nested logit model of demand, and on the basis of an oligopolistic model of multi-product firms, we then recover the marginal costs and markups. We finally evaluate the effect of the parallel imports' policy by calculating a counterfactual scenario without parallel trade. According to our estimates, parallel imports reduce the prices for patented drugs by 11% and do not have a significant effect on prices for generic drugs. This amounts to an increase in the demand-side surplus by €19 million per year (or €130 million in total), which is relatively small compared with the average annual market size of around €227 million based on ex-factory prices. The variable profits for the manufacturers of original drugs from the German market are reduced by €18 million (or 37%) per year when parallel trade is allowed, yet only one third of this difference is appropriated by the importers.
Collapse
Affiliation(s)
- Tomaso Duso
- Deutsches Institut für Wirtschaftsforschung (DIW Berlin), Berlin, Germany; Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-Universität, Düsseldorf, Germany
| | | | | |
Collapse
|
30
|
Rwegerera GM. Adherence to anti-diabetic drugs among patients with Type 2 diabetes mellitus at Muhimbili National Hospital, Dar es Salaam, Tanzania- A cross-sectional study. Pan Afr Med J 2014; 17:252. [PMID: 25309652 PMCID: PMC4189860 DOI: 10.11604/pamj.2014.17.252.2972] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 03/23/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction Adherence to diabetes mellitus treatment regimens among Type 2 diabetes patients in Tanzania has not been well documented. This study sought to assess adherence to antidiabetic drugs and associated factors among patients with Type 2 diabetes mellitus. Methods A cross-sectional study was conducted among type 2 diabetes mellitus patients who were attending the Diabetic clinic of Muhimbili National hospital between May 2009 and February 2010. Assement ofadherence to antidiabetic medications was based on patients’ self-reported recall of skipped days without taking medications, over the past one week and three months. Data wereentered and analyzed using Statistical Package for Social Sciences (SPSS Inc. Chicago, Illinois version 16). The crude and adjusted odds ratio (COR/ AOR) and 95% Confidence Interval (CI) were performed to determine factors associated with anti-diabetic medications adherence and a p-value of 0.05 or less was considered statistically significant. Results Adherence rates to antidiabetic drugs were found to be 60.2% and 71.2% at one week and three months respectively. High cost of medication was significantly associated with anti-diabetic non-adherence. Adherence to anti-diabetic drugs significantly increased with an increase in number of non-diabetic medications. Conclusion Adherence to antidiabetic drugs was found to be suboptimal. Patients with other medical conditions in addition to diabetes mellitus are more likely to adhere to anti-diabetic medications. There is a need for the responsible authorities to set policies that subsidize cost of anti-diabetic drugs to improve adherence and reduce associated complications.
Collapse
|
31
|
ARIFULLA M, JOHN LJ, SREEDHARAN J, MUTTAPPALLYMYALIL J, BASHA SA. Patients' Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE. Malays J Med Sci 2014; 21:44-49. [PMID: 24639611 PMCID: PMC3952347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 11/12/2012] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. METHODS This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. RESULTS A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor's and Master's degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. CONCLUSION The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.
Collapse
Affiliation(s)
- Mohammed ARIFULLA
- Department of Pharmacology, Gulf Medical University, PO Box 4184 Ajman, United Arab Emirates
| | - Lisha Jenny JOHN
- Department of Pharmacology, Gulf Medical University, PO Box 4184 Ajman, United Arab Emirates
| | - Jayadevan SREEDHARAN
- Statistical Support Facility, Centre for Advanced Biomedical Research and Innovation, Gulf Medical University, PO Box 4184 Ajman, United Arab Emirates
| | | | - Sheikh Altaf BASHA
- Department of Internal Medicine, Gulf Medical College Hospital, PO Box 4184 Ajman, United Arab Emirates
| |
Collapse
|
32
|
Abstract
Linagliptin, one of the five dipeptidyl peptidase-4 inhibitors available, has recently entered the market both in the US and in most European countries for treatment of type 2 diabetes mellitus. It presents a xanthine-based structure, and is characterized by unique pharmacokinetics, with non-linear profile, long terminal half-life allowing prolonged exposure to the drug. It is eliminated predominately through the intestinal tract and only minimally into urine, so that it can be administered, without any dose adjustment, in conditions of renal impairment. Linagliptin is effective in modifying all parameters of hyperglycemia either in monotherapy, or as add-on therapy, together with metformin or a sulfonylurea. It also exhibits a good tolerability profile with few side effects, absence (when used in monotherapy), or low risk (when in combination with a sulfonylurea) of hypoglycemia. More importantly it has a weight neutral effect. A comprehensive report of the literature on linagliptin is provided, paying attention in particular to preclinical studies, interactions with other drugs, safety and tolerability, and results obtained in animal models that highlight properties of linagliptin suggestive of potential additional uses. Particularly promising appear the data demonstrating a positive effect of linagliptin on metabolic dysfunction and renal and/or cardiovascular damage together with more recently reported effects of linagliptin on tissue repair and neuroprotection.
Collapse
Affiliation(s)
- Maria Angela Sortino
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of CataniaCatania, Italy
- *Correspondence: Maria Angela Sortino, Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy. e-mail:
| | - Tiziana Sinagra
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of CataniaCatania, Italy
| | - Pier Luigi Canonico
- Department of Scienze del Farmaco, University of Piemonte OrientaleNovara, Italy
| |
Collapse
|