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1.
J Assoc Physicians India ; 67(4): 34-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309793

RESUMO

Objective: Widely used in the management of diabetes, insulin therapy is influenced by several patient preferences and physician choices. This article reports the findings of the IMPACT survey, designed to assess insights on various factors which influence the choice of insulin therapy in India. Methods: We administered a questionnaire which focused on the practice and patient profiles and the preferred regimens in specific clinical situations using a case scenario. Respondents were asked about preferred insulin regimens for various phases of life, comorbid conditions, dietary choices and psychological factors. Results: Overall, 314 doctors participated in the survey. Majority were general physicians (51%) and diabetologists (37%). In clinical practice, the most preferred regimens included premix insulin BD in adults (59%) and elderly (53%), and basal bolus therapy in pregnant women (>47%) and in acute illness (62%). Both regimens were equally preferred for symptomatic patients (41% basal bolus and 38% premix insulin) and those with renal or hepatic failure (36% each). Premix insulin was preferred for patients with high carbohydrate intake (73%) while basal bolus was preferred for patients with variable meal timings (39%) and in pronounced postprandial glucose excursions (45%). Insulin co-formulation and high-mix insulins were not a part of the survey questionnaire. Summary: Indian physicians exercise logic in the choice of insulin regimens. Preference is based on patient characteristics including glucophenotype, dietary patterns, psychosocial needs, clinical situations, and comorbid conditions.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Idoso , Glicemia , Feminino , Humanos , Índia , Gravidez
2.
High Blood Press Cardiovasc Prev ; 26(4): 345-350, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31352663

RESUMO

INTRODUCION: Treatment strategies for patients with pre-hypertension and low-moderate cardiovascular (CV) risk may include nutraceutical compounds (NCs). AIM: To investigate the efficacy and safety of a new-generation of NC in lowering BP values and improving metabolic profile, in a group of hyper-cholesterolemic subjects with pre-hypertension. METHODS: 131 subjects with pre-hypertension (systolic BP 130-139 mmHg and/or diastolic BP 85-89 mmHg) without organ damage and history of CV diseases were enrolled. 66 subjects were treated with a once-daily oral formulation of a NC (red yeast rice, Berberine, Coenzyme Q10, folic acid and chrome) added to diet for 3 months, while 65 patients followed a diet only. Differences in serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDLC and HDLC), triglycerides (TG), glycemia, creatine phosphokinase (CPK), aspartate aminotransferase (AST) alanine aminotransferase (ALT) and body mass index (BMI) were evaluated. RESULTS: At the end of treatment, significant reductions of TC, LDLC, TG glucose levels were observed in both treatment groups, while HDLC values increased in the active treatment group only. A greater reduction of TC, LDLC and glycemia was observed in the treatment group. TG levels were not different within the two groups. BP and BMI levels remained unchanged, as well AST, ALT; CPK slightly increased in both groups, but it remained in the normal range. CONCLUSIONS: In patients with pre-hypertension, NC supplementation was safe, well tolerated and effective in improving lipid pattern and glucose levels and in preventing the progression to overt hypertension.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Suplementos Nutricionais , Hipercolesterolemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Pré-Hipertensão/tratamento farmacológico , Idoso , Anti-Hipertensivos/efeitos adversos , Biomarcadores/sangue , Glicemia/metabolismo , Suplementos Nutricionais/efeitos adversos , Progressão da Doença , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipoglicemiantes/efeitos adversos , Hipolipemiantes/efeitos adversos , Itália , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/fisiopatologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Rev Med Chil ; 147(4): 451-457, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344206

RESUMO

BACKGROUND: Few studies have evaluated the details of insulin therapy for type 1 diabetes mellitus (T1D) in Chile. AIM: To describe clinical features and treatment details of adults with T1D and its association with metabolic control. MATERIAL AND METHODS: Review of medical records of patients with T1D treated in a clinical network. Demographic and clinical features, types and doses of insulin and glycated hemoglobin levels were registered. The use flash glucose monitors (FGM) and insulin pumps (CSII) were also recorded. RESULTS: 205 records were reviewed, with T1d lasting 12 ± 10 years. Twenty six percent had hypothyroidism, 1% had celiac disease, 12% had hypertension, 20% had dyslipidemia; 13% had diabetic retinopathy, 2% had diabetic nephropathy, 8% had neuropathy and 2% cardiovascular diseases. Mean body mass index was 25 kg/ m2 and mean glycated hemoglobin was 8%. Eighty-two percent used multiple daily injections, 18% used CSII and 24% used FGM. As basal insulin, 35% used slow acting analogs and 65% used ultra-slow analogs. As rapid acting insulin, 69 patients used Lispro, 79 Aspart and 50 Glulisin. Bolus doses were calculated using only capillary glucose in 22%, while 78% also considered carbohydrate consumption. Variables significantly associated to better control were the use of carbohydrates for dosing rapid insulin (A1c 7,85% vs 8,59%, p = 0,008), use of CSII (A1c 7,36% vs 8,16%, p = 0,008), and basal dose < 0,4 U/kg (A1c 7,81% vs 8,58%, p = 0,003). There were no differences regarding insulin type or use of FGM. CONCLUSIONS: The use of formulas considering carbohydrates for dosing rapid insulin, use of infusion pumps and physiological doses of basal insulin are significantly associated with a better metabolic control in adults with T1d.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/prevenção & controle , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Análise de Variância , Chile , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Hemoglobina A Glicada/análise , Humanos , Sistemas de Infusão de Insulina , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Medicine (Baltimore) ; 98(28): e16428, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305464

RESUMO

CONTEXT: Alarin has been reported to be relative to food intake and an increase in body weight. However, to date, no report has demonstrated the relationship between circulating alarin and diabetes in humans. OBJECTIVE: The objective of this study is to gain insight into the possible role of alarin in humans. DESIGN AND METHODS: 164 patients with newly diagnosed type 2 diabetes mellitus (nT2DM), 112 IGT and 134 healthy subjects were recruited for this study. In an interventional study, 29 nT2DM patients were treated by a weekly GLP-1RA for 6 months. Plasma alarin concentrations were measured by ELISA. RESULTS: Circulating alarin concentrations were significantly higher in both IGT and nT2DM subjects than in healthy individuals (0.40 ±â€Š0.14 and 0.54 ±â€Š0.24 vs 0.37 ±â€Š0.10 µg/L, P < .05 or P < .01), whereas in T2DM patients, circulating alarin levels were higher than in IGT subjects. Circulating alarin positively correlated with FBG, HbA1c, HOMA-IR, AUCglucose and TNFα (P < .05 or P < .01). Multivariate logistic regression revealed that circulating alarin levels were correlated with IGT and T2DM. GLP-1RA treatment for 6 months increased circulating alarin levels in T2DM patients (from 0.34 ±â€Š0.10 for baseline, to 0.39 ±â€Š0.14 for 12 weeks, and finally to 0.38 ±â€Š0.15 µg/L for 24 weeks; vs. pre-treatment P < .05). CONCLUSIONS: These data suggest that alarin might be involved in the pathogenesis of T2DM in humans. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR-OCS-13003185 (18/03/2013 ).


Assuntos
Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo Semelhante a Galanina/sangue , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Hipoglicemiantes/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Transversais , Citocinas/sangue , Método Duplo-Cego , Feminino , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(30): e16575, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348290

RESUMO

BACKGROUND: Dapagliflozin, a novel inhibitor of sodium-glucose cotransporter-2 (SGLT-2), lowers blood glucose level by specifically inhibiting the activity of SGLT-2. Previous studies showed efficacy and safety of dapagliflozin combined with other antihyperglycemic agents in type 2 diabetes (T2DM), however, there are few studies for dapagliflozin as monotherapy. The aim of this study was to assess the efficacy and safety of dapagliflozin as a monotherapy in T2DM and provide theoretical basis for clinical rational use of drugs. METHODS: We did a systematic review and meta-analysis of randomized, placbo-controlled clinical studies in patients with type 2 diabetes. We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP database through October 2018, we also manually screened list of references to the previous meta-analysis of dapagliflozin in the treatment of type 2 diabetes. Data search and extraction were completed with a standardized data form and any discrepancies were resolved by consensus. A meta-analysis was conducted by using RevMan 5.3 software. RESULTS: Six randomized controlled trials (RCTs) including 2033 patients were analyzed. Compared with placebo, dapagliflozin monotherapy was associated with a reduction in glycosylated hemoglobin A1c (HbA1c) (weighted mean difference [WMD]: -0.60%; 95% confidence interval [CI]: -0.67%, -0.52%; P < .00001), fasting plasam glucose (FPG) (WMD: -1.30 mmol/L; 95% CI: -1.52, -1.08; P < .00001), and body weight (WMD: -1.50 kg; 95% CI: -1.67, -1.32; P < .00001). Dapagliflozin was associated with an increased risk of urinary tract infections (relative risk [RR]: 1.74; 95% CI: 1.21, 2.49; P = .003) and genital tract infections (RR: 3.52; 95% CI: 2.06, 6.03; P < .00001). CONCLUSIONS: Dapagliflozin monotherapy was well tolerated and effective in reducing the level of HbA1c, FPG, and body weight in patients with T2DM without increasing hypoglycaemia, although it may increase the risk of urinary tract infections and genital tract infections. This meta-analysis provides an evidence for the treatment in patients with T2DM. However, more randomized clinical evidences are still needed to verify the results.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Compostos Benzidrílicos/administração & dosagem , Compostos Benzidrílicos/efeitos adversos , Glicemia/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Glucosídeos/administração & dosagem , Glucosídeos/efeitos adversos , Hemoglobina A Glicada , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos
6.
Chem Commun (Camb) ; 55(61): 8975-8978, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31290492
7.
Rev Med Suisse ; 15(653): 1106-1111, 2019 May 29.
Artigo em Francês | MEDLINE | ID: mdl-31148421

RESUMO

Diabetic nephropathy is a leading cause of chronic kidney disease and dialysis. We know that a good diabetes control slows the progression of kidney disease, but the risk of hypoglycemia is greater in patients with chronic kidney disease and contributes to their mortality. Chronic kidney disease and diabetes are major cardiovascular risk factors with additive effects. Decreasing cardiovascular mortality is a major aim in chronic kidney disease. The ideal antidiabetic molecule in these patients should reduce the risk of dialysis, reduce cardiovascular mortality and carry no risk of hypoglycaemia. This article aims to summarize for the general practician the nephrological implications of new antidiabetic drugs and their use in chronic kidney disease patients.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Hipoglicemiantes , Falência Renal Crônica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/prevenção & controle , Humanos , Hipoglicemiantes/uso terapêutico , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/prevenção & controle , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/prevenção & controle
8.
Rev Med Suisse ; 15(653): 1117-1123, 2019 May 29.
Artigo em Francês | MEDLINE | ID: mdl-31148423

RESUMO

GLP-1 analogues are a well-established treatment for type 2 diabetes. They act by improving glycemic control through several mechanisms. They also have the advantage of inducing weight loss without the risk of associated hypoglycemia. This class of molecules has also shown a benefit in cardiovascular events such as cardiovascular mortality, stroke and myocardial infarction, and albuminuria. These favorable effects place them, like SGLT-2 inhibitors, as a second option in the case of unsatisfactory glycemic control after metformin and dietary and lifestyle measures. This article provides an overview of the current knowledge of GLP-1 analogue therapy in patients with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Peptídeo 1 Semelhante ao Glucagon , Hipoglicemiantes , Metformina , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon/análogos & derivados , Humanos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico
9.
Rev Med Suisse ; 15(653): 1132-1139, 2019 May 29.
Artigo em Francês | MEDLINE | ID: mdl-31148425

RESUMO

Hemodialysis (HD) centers are facing an increasing number of patients with diabetes. These cases require an intensive multidisciplinary approach of the consequences of renal failure, glycemic control and nutrition and the management of frequent co-morbidities, in particular the diabetic foot. A major challenge is to decrease glycemic variability and the risk of hypoglycemia. Because of increased risk of hypoglycemia-associated mortality, the HbA1C target is loosened in the majority of HD patients. Continuous glucose monitoring technology has identified important glycemic fluctuations during and after dialysis. However, their reliability in HD needs to be improved. New therapeutic pathways that decrease glucose excursions and hypoglycemia, such as GLP1 receptor agonists and sensor-coupled insulin pumps, have yet to be validated in HD.


Assuntos
Complicações do Diabetes , Falência Renal Crônica , Diálise Renal , Glicemia , Automonitorização da Glicemia , Complicações do Diabetes/terapia , Diabetes Mellitus/tratamento farmacológico , Hemoglobina A Glicada , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Reprodutibilidade dos Testes
10.
Medicine (Baltimore) ; 98(23): e15971, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169727

RESUMO

BACKGROUND: To evaluate the impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c (HbA1c) control in type 2 diabetes. METHODS: We searched relevant publications in English and Chinese database and conducted meta-analysis by Stata 12.0. We divided the case groups of included studies into 2 categories according to the role of nurse: nurse-led clinic and nurse-led prescription. Nurse-led clinic was implemented on the basis of standard diabetes care provided by doctor, and control group also receive the standard diabetes care but without nurse-led clinic. The doctor mentioned above might work alone or in a health care team. Nurse-led prescription was prescribed by nurse independently and compared with that of doctor. RESULTS: The meta-analysis shown that, compared with the standard diabetes care, nurse-led clinic significantly decreases HbA1c level (standard mean difference [SMD] = -0.767; 95% confidence interval [CI]: -1.062, -0.471; P < .001). In subgroup analysis, nurse-led clinic also had positive impacts on controlling HbA1c level, no matter in developed countries (SMD = -0.353; 95% CI: -0.6, -0.106; P = .005) or developing countries (SMD = -1.114; 95% CI: -1.498, -0.73; P < .001). Additionally, there was no significant difference between nurse-led prescription and doctor prescription in controlling HbA1c levels (SMD = -0.203; 95% CI: -0.434, 0.029; P = .086). CONCLUSION: The nurse-led clinic had positive significance for HbA1c control. Meanwhile, the impact of nurse-led prescription on controlling HbA1c is comparable to that of doctor. It is valuable to provide nurse-led clinic on the basis of standard diabetes care provided by doctor to better control HbA1c, and nurse-led prescription should be provided when doctor-led service is limited.


Assuntos
Diabetes Mellitus Tipo 2/enfermagem , Hemoglobina A Glicada/metabolismo , Hipoglicemiantes/uso terapêutico , Padrões de Prática em Enfermagem/estatística & dados numéricos , Prescrições/enfermagem , Adulto , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Medicine (Baltimore) ; 98(25): e16038, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232936

RESUMO

INTRODUCTION: The purpose of this protocol is to provide a network meta-analysis methodology that compares the effects of metformin and physical exercise in the prevention and treatment of gestational diabetes mellitus (GDM) and its associated fetal and maternal morbidity. METHODS AND ANALYSIS: This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science and the Cochrane Library, from the inception until July 2019. There will be no language restrictions. The Cochrane Collaboration tool for assessing risk of bias (RoB2) and the quality assessment tool for quantitative studies will be used. The Grading of Recommendations, Assessment, Development and Evaluation scale will be used to evaluate the strength of the evidence. A Bayesian network meta-analysis will be carried out, which allows direct and indirect comparison of the interventions, for the risk of GDM, prematurity, caesarean section, macrosomia, hypertensive disorders, insulin requirement, and differences in basal glucose, maternal weight, and weight of the newborn. DISCUSSION: With this protocol, a methodology is established that resolves the limitations of previous meta-analysis. It will be possible to determine the difference of effect between physical exercise and metformin in the main outcomes of the GDM, as well as the type and intensity of the exercise, and the dose of metformin, more effective. ETHICS AND DISSEMINATION: The data included in the network meta-analysis will be obtained from trials that meet accepted ethical standards and the Declaration of Helsinki. The results will be published in a peer-reviewed journal. The evidence obtained could be included in the guidelines of clinical practice in pregnancy. STRENGTHS AND LIMITATIONS: A comprehensive methodology is established for the analysis, through network meta-analysis, of the comparative efficacy of metformin and physical exercise in gestational diabetes mellitus. The results obtained could help medical professionals by establishing the best evidence-based interventions which may be recommended for these population groups. REGISTRATION NUMBER: PROSPERO CRD42019121715.


Assuntos
Diabetes Gestacional/terapia , Exercício , Hipoglicemiantes/uso terapêutico , Metanálise como Assunto , Metformina/uso terapêutico , Revisão Sistemática como Assunto , Feminino , Macrossomia Fetal , Humanos , Meta-Análise em Rede , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal
12.
Medicine (Baltimore) ; 98(25): e16076, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232947

RESUMO

RATIONALE: In recent years, there are more new insights into the clinical susceptibility, pathophysiological mechanism, and progression of classification and treatment of ketosis-prone diabetes mellitus (KPDM), which was once described as Idiopathic Type 1 Diabetes, Type 1B Diabetes or Flatbush Diabetes. ketosis-prone diabetes mellitus is still a heterogeneous syndrome reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian. PATIENT CONCERNS: An obese 17-year-old student was admitted to a tertiary referral hospital (teaching hospital), presenting with thirst, polyuria fatigue, and a 9 kg weight loss in the preceding two weeks. DIAGNOSES: Physical examination showed body mass index (BMI) was 32.77 kg/m, arterial blood gas revealed a pH of 7.31. Serum glucose was 27.8 mmol/L with strong positive uric ketones (++++). Hemoglobin A1c (HbA1c) was 13.6%. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and M value was 2.87 mg/kg/min during hyperglycemic clamp test. Those findings were sufficient to establish a diagnosis of ketosis-prone diabetes mellitus. INTERVENTIONS: This obese patient with KPDM received intensive insulin therapy and fluids infusion, and during the remainder of hospitalization his insulin requirement was approximately 1.5 U per kilogram of body weight per day. Blood glucose monitoring was rigorous until the diabetic ketoacidosis under control. OUTCOMES: He achieved the near-nomalglycemic remission uneventfully. At 12-month follow-up, his treatment was adjusted from insulin subcutaneous injection to oral hypoglycemic drugs. LESSON: The present study of this obese adolescent with negative auto-antibodies but unprovoked diabetic ketoacidosis and partially preserved beta cell functional reserve after the acute of diabetic ketosis suggested that he has the phenotype of "A-ß" KPDM. Further study of this syndrome will help illustrate the inadequacy of current classification and targeted therapies.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/etiologia , Obesidade/complicações , Adolescente , Índice de Massa Corporal , China , Diabetes Mellitus Tipo 1/metabolismo , Cetoacidose Diabética/metabolismo , Glucose/análise , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Sede
13.
Top Curr Chem (Cham) ; 377(4): 19, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31165274

RESUMO

This review is an effort to summarize recent developments in synthesis of O-glycosides and N-, C-glycosyl molecules with promising antidiabetic potential. Articles published after 2000 are included. First, the O-glycosides used in the treatment of diabetes are presented, followed by the N-glycosides and finally the C-glycosides constituting the largest group of antidiabetic drugs are described. Within each group of glycosides, we presented how the structure of compounds representing potential drugs changes and when discussing chemical compounds of a similar structure, achievements are presented in the chronological order. C-Glycosyl compounds mimicking O-glycosides structure, exhibit the best features in terms of pharmacodynamics and pharmacokinetics. Therefore, the largest part of the article is concerned with the description of the synthesis and biological studies of various C-glycosides. Also N-glycosides such as N-(ß-D-glucopyranosyl)-amides, N-(ß-D-glucopyranosyl)-ureas, and 1,2,3-triazolyl derivatives belong to the most potent classes of antidiabetic agents. In order to indicate which of the compounds presented in the given sections have the best inhibitory properties, a list of the best inhibitors is presented at the end of each section. In summary, the best inhibitors were selected from each of the summarizing figures and the results of the ranking were placed. In this way, the reader can learn about the structure of the compounds having the best antidiabetic activity. The compounds, whose synthesis was described in the article but did not appear on the figures presenting the structures of the most active inhibitors, did not show proper activity as inhibitors. Thus, the article also presents studies that have not yielded the desired results and show directions of research that should not be followed. In order to show the directions of the latest research, articles from 2018 to 2019 are described in a separate Sect. 5. In Sect. 6, biological mechanisms of action of the glycosides and patents of marketed drugs are described.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Descoberta de Drogas/métodos , Glicosídeos/química , Glicosídeos/farmacologia , Hipoglicemiantes/química , Hipoglicemiantes/farmacologia , Animais , Diabetes Mellitus/enzimologia , Diabetes Mellitus/metabolismo , Inibidores Enzimáticos/química , Inibidores Enzimáticos/farmacocinética , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/uso terapêutico , Glicogênio Fosforilase/antagonistas & inibidores , Glicogênio Fosforilase/metabolismo , Glicosídeos/farmacocinética , Glicosídeos/uso terapêutico , Humanos , Hipoglicemiantes/farmacocinética , Hipoglicemiantes/uso terapêutico , Proteína Tirosina Fosfatase não Receptora Tipo 1/antagonistas & inibidores , Proteína Tirosina Fosfatase não Receptora Tipo 1/metabolismo , Inibidores do Transportador 2 de Sódio-Glicose/química , Inibidores do Transportador 2 de Sódio-Glicose/farmacocinética , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Relação Estrutura-Atividade
14.
BMC Health Serv Res ; 19(1): 422, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238950

RESUMO

BACKGROUND: Medication non-adherence is a major contributor to poor outcomes in diabetes. Previous research has shown an association between use of mail order pharmacy delivery and better medication adherence, but little is known about the barriers and facilitators to mail order pharmacy use in diabetes patients. This qualitative study examined factors related to mail order pharmacy use versus traditional "brick and mortar" pharmacies to refill prescriptions. METHODS: We conducted four 90-min focus groups in 2016 among 28 diabetes patients in the Hawaii and Northern California regions of Kaiser Permanente, a large integrated health care delivery system. We queried participants on their preferred mode for refilling prescriptions and perceived barriers and facilitators of mail order pharmacy use. One researcher independently coded each focus group transcript, with two of these transcripts double-coded by a second researcher to promote reliability. We employed thematic analysis guided by the Capability, Opportunity, Motivation, and Behavior (COM-B) framework using NVivo 11 software. RESULTS: A total of 28 diabetes patients participated. Participants' average age was 64.1 years; 57% were female; and racial/ethnic backgrounds included Asian/Native Hawaiian/Pacific Islander (36%), Black/African-American (21%) Hispanic/Latino (7%), and non-Hispanic White (36%). Analysis uncovered 26 themes related to the decision to use mail order pharmacy, with each theme representing a barrier or facilitator mapped to the COM-B framework. Most themes (20/26) fell into the COM-B category of 'Opportunity.' Opportunity barriers to mail order pharmacy use included unpredictability of medication delivery date, concerns about mail security, and difficulty coordinating refill orders for multiple prescriptions. In contrast, facilitators included greater access and convenience (e.g., no need to wait in line or arrange transportation) compared to traditional pharmacies. Motivational facilitators to mail order pharmacy use included receiving a pharmacy benefit plan incentive of a free one-month supply of prescriptions. CONCLUSIONS: This study found that while patients with diabetes may benefit from mail order pharmacy use, they perceive numerous barriers to using the service. These findings will inform the design of interventions and quality improvement initiatives to increase mail order pharmacy use, which in turn may improve medication adherence and outcomes in diabetes patients, across health care systems.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Assistência Farmacêutica/estatística & dados numéricos , Serviços Postais/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Feminino , Grupos Focais , Hawaii , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa Qualitativa
15.
Arch Endocrinol Metab ; 63(4): 445-448, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31166366

RESUMO

Heterotaxy syndrome (HS) is a rare congenital condition with multifactorial heritance, characterized by an abnormal arrangement of thoraco-abdominal organs and vessels. Patients present with multiple cardiac, gastrointestinal, hepatosplenic, pancreatic, renal, neurological and skeletal disorders without any pathognomonic alteration. Despite the described increased risk of diabetes mellitus (DM) in patients with altered pancreatic anatomy, just one case was reported in Korea regarding the association of HS and DM in a 13-year-old girl. Our report refers to a 40-year-old female Brazilian patient with a history of DM and HS with polysplenia and agenesis of dorsal pancreas without cardiac abnormalities. She presented a worsening glycemic control associated with weight gain and signs of insulin resistance. After a proper clinical management of insulin and oral medications, our patient developed an improvement in glycemic control. Although it is a rare disease, HS with polysplenia and pancreatic disorders can be associated with an increased risk of DM. This case highlights the importance of investigating DM in patients with HS, especially those with pancreatic anatomical disorders, for proper clinical management of this rare condition.


Assuntos
Anormalidades Congênitas/terapia , Diabetes Mellitus/terapia , Síndrome de Heterotaxia/terapia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Pâncreas/anormalidades , Adulto , Glicemia/análise , Dieta com Restrição de Carboidratos , Feminino , Síndrome de Heterotaxia/complicações , Humanos , Resistência à Insulina
16.
Food Chem Toxicol ; 131: 110562, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181236

RESUMO

Brown seaweed Sargassum confusum (C. Agardh) has been used in traditional Chinese medicine to treat a variety of diseases. The aim of the present study was to evaluate the anti-diabetic effect of oligosaccharides from brown seaweed S. confusum (SCO). The anti-diabetic effect of SCO was evaluated in vivo using high-fat/high-sucrose fed hamsters. Molecular mechanisms of modulating gene expression of specific members of insulin signaling pathways were determined. The components of the intestinal microflora in diabetic animals were also analyzed by high-throughput 16S rRNA gene sequencing. And it was found that SCO had a sequence of sulfated anhydrogalactose and methyl sulfated galactoside units. Fasting blood glucose levels were significantly decreased after SCO administration. Histology showed that SCO could protect the cellular architecture of the liver. SCO could also significantly increase the relative abundance of Lactobacillus and Clostridium XIVa and decrease that of Allobaculum, Bacteroides and Clostridium IV. The active role of SCO in anti-diabetic effect was revealed by its regulation of insulin receptor substrate 1/phosphatidylinositol 3-kinase and c-Jun N-terminal kinase pathways. These results suggested that SCO might be used as a functional material to regulate gut microbiota in obese and diabetic individuals.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Oligossacarídeos/uso terapêutico , Sargassum/química , Animais , Bactérias/genética , Sequência de Bases , Glicemia/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Dieta da Carga de Carboidratos , Dieta Hiperlipídica , Hipoglicemiantes/isolamento & purificação , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Mesocricetus , Oligossacarídeos/isolamento & purificação , Substâncias Protetoras/isolamento & purificação , Substâncias Protetoras/uso terapêutico , RNA Ribossômico 16S/genética , Alga Marinha/química
17.
Vasc Endovascular Surg ; 53(6): 452-457, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31170884

RESUMO

BACKGROUND: Metformin is the most commonly used drug for type 2 diabetes. Research has shown that metformin also has a protective effect on endothelium by decreasing endothelial vascular reactivity. We hypothesize that metformin will decrease restenosis/reintervention rates in patients receiving lower extremity non-drug-eluting stents (nDESs) in the superficial femoral artery(SFA) and/or popliteal artery. MATERIALS/METHODS: Retrospective study was performed on 187 patients from October 2012 to December 2015 who received an nDES in the SFA and/or popliteal artery. Patients were divided into 3 groups (Table 1) and compared against for duplex based restenosis (>60%) rates, limb loss rates, and reintervention rates. Each patient's Trans-Atlantic-Inter-Society-Consensus II (TASC-II) class was collected. Postoperative duplex was performed 1 week after the procedure, then every 3 months for the first year, then, every 6 months to check for patency. IBM-SPSS-22 was used for all analyses. RESULTS: Average age of the patients was 64.65 ± 73.4 years. 101 patients had 101 procedures performed on the left lower extremity; 86 patients had 86 procedures performed on the right lower extremity; 123 patients were male and 64 were female. Average length of follow-up was 13.1±9.7 months. Most common indication for intervention was claudication, followed by critical limb threatening ischemia. Restenosis and reintervention by groups can be seen in Table 1. No patients experienced limb loss. There were no statistically significant differences between any of the 3 groups and their limb loss, restenosis, or reintervention rates. CONCLUSIONS: Despite having multiple proven effects in improving certain clinical outcomes and a proven protective effect on endothelium by decreasing endothelial vascular reactivity, metformin does not appear to reduce restenosis or reintervention rates in patients receiving lower extremity nDESs in the SFA and/or popliteal artery.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Stents , Grau de Desobstrução Vascular/efeitos dos fármacos , Idoso , Constrição Patológica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla
19.
Eur J Med Chem ; 178: 108-115, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31176093

RESUMO

As dual regulators, the PTP-1B signaling pathway and α-glucosidase slow glucose release and increase the degree of insulin sensitivity, representing a promising therapeutic target for type 2 diabetes. In this study, we systematically examined the in vivo and in vitro anti-diabetic activities of natural flavonoids 1-6 from Chrysanthemum morifolium. Flavonoids 1-6 increased glucose consumption-promoting activity and the phosphorylation of GSK-3ß and Akt, and decreased PTP-1B protein level along with slightly inhibitory activity of the PTP-1B enzyme. Moreover, flavonoids 1-2 treatment induced insulin secretion in INS-1 cells. Besides, in vivo study revealed that flavonoids 2 and 5 demonstrated potent anti-hyperglycemic and anti-hyperlipidemic activity, and improved maltose and glucose tolerance. Although flavonoid 2 exhibited lower inhibitory activity against α-glucosidase in vitro, it could deglycosylated in vivo to diosmetin to function as an α-glucosidase inhibitor. Taken together, these results led to the identification of the natural flavonoids 1-6 from C. morifolium as dual regulators of α-glucosidase and the PTP-1B signaling pathway, suggesting their potential application as new oral anti-diabetic drugs or functional food ingredients.


Assuntos
Chrysanthemum/química , Diabetes Mellitus Experimental/tratamento farmacológico , Flavonoides/uso terapêutico , Inibidores de Glicosídeo Hidrolases/uso terapêutico , Hipoglicemiantes/uso terapêutico , Transdução de Sinais/efeitos dos fármacos , Animais , Linhagem Celular Tumoral , Colesterol/sangue , Cricetulus , Diabetes Mellitus Experimental/induzido quimicamente , Flavonoides/isolamento & purificação , Glucose/metabolismo , Inibidores de Glicosídeo Hidrolases/isolamento & purificação , Hipoglicemiantes/isolamento & purificação , Masculino , Camundongos , Proteína Tirosina Fosfatase não Receptora Tipo 1/metabolismo , Ratos , Estreptozocina , Triglicerídeos/sangue
20.
Expert Rev Cardiovasc Ther ; 17(5): 377-387, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31055989

RESUMO

Introduction: The GLP-1 receptor agonist (GLP-1 RA) liraglutide has a half-life of approximately 13 h and is suitable for subcutaneous administration once daily. The use of liraglutide in people with type 2 diabetes has become popular because of the efficacy and durability in relation to glycemic control in combination with weight loss in most patients. Areas covered: PubMed searches were completed using the terms 'GLP-1 receptor agonist', 'Liraglutide', 'Liraglutide and CVD', 'Liraglutide and CVD risk factors'. The reference list of articles subsequently identified was searched and articles of interest were selected. Expert commentary: Liraglutide has been found superior to oral antidiabetic drugs and other GLP-1 RAs with greater reductions in both HbA1c and weight except when compared with semaglutide. Liraglutide has beneficial effects on blood pressure, weight, postprandial lipids, low-grade inflammation and on the myocardium. In the cardiovascular endpoint trial LEADER liraglutide reduced the composite endpoint of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke as well as cardiovascular and total mortality but had no effect on heart failure. Liraglutide reduces the progression of diabetic kidney disease. In the recent 2018 consensus report from EASD/ADA liraglutide is recommended to patients with established cardiovascular diseases after metformin.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Liraglutida/uso terapêutico , Glicemia/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Peptídeos Semelhantes ao Glucagon/farmacologia , Humanos , Fatores de Risco
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