Diabetes, treatment blood glucose-lowering agents

Because diabetes is a heterogeneous disease, each patient must be treated individually. More studies, however, are necessary to determine which of several available sulphonylureas is most appropriate in clinical treatment. The evidence of the relative efficacy of sulphonylureas, however, is still inconclusive. The blood glucose-lowering effect has always been primarily attributed to their insulinotropic action. In subjects not previously exposed to sulphonylureas, close association between the appearance of the drug in the plasma after a single dose and the release of insulin has been amply demonstrated. Sulphonylureas, however, also seem to exert potent extra-pancreatic effects. This may explain why, in two recent reports, these agents were found to also be beneficial in the management of insulin-dependent diabetes. 

Glycosidase inhibitors (Table 1.9) delay the digestion of dietary carbohydrate in the form of starch and sucrose into monosaccharides, which can be absorbed from the small intestine. By delaying absorption, these agents lower postprandial blood glucose and insulin levels and are used for this purpose in the treatment of type 2 diabetes. 

Acetohexamide is used as an oral antidiabetic agent for the treatment of ketoacidosis-resistant diabetes. It is an intermediate acting sulfonylurea derivative. The clinical effects of lowering elevated blood glucose levels Is similar for all of the sulfonylurea derivatives. Acetohexamide, however. Is the only one to also possess uricosuric activity and therefore Is a preferable agent to treat diabetic patients with gout. 

Recently, resveratrol was found to reverse fat-induced insulin resistance [McCarty, 2005]. This observation provides more enthusiasm for researchers to use resveratrol as an antidiabetic agent. Su and associates [2006] showed that resveratrol significantly reduced the plasma glucose concentration as well as the dramatic reduction of triglyceride concentration in streptozotocin (STZ)-induced diabetic mellitus rats in 14 days treatment. They concluded from this observation that resveratrol possesses hypoglycemic and hypolipidemic properties [Su et al., 2006]. Baur et al., [2006] added more value to this conclusion by showing that resveratrol increases insulin sensitivity by lowering the blood... 

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