Insulin-dependent diabetes treatment

Meglitinide contains a benzamide group. Meglitinide-related compounds such as nateglinide are non-sulfonylurea oral hypoglycemic drugs used in the treatment of type 2 (non-insulin dependent) diabetes mellitus. 

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl I Med 1993 329 977-986. 

At present, antioxidants are extensively studied as supplements for the treatment diabetic patients. Several clinical trials have been carried out with vitamin E. In 1991, Ceriello et al. [136] showed that supplementation of vitamin E to insulin-requiring diabetic patients reduced protein glycosylation without changing plasma glucose, probably due to the inhibition of the Maillard reaction. Then, Paolisso et al. [137] found that vitamin E decreased glucose level and improved insulin action in noninsulin-dependent diabetic patients. Recently, Jain et al. [138] showed that vitamin E supplementation increased glutathione level and diminished lipid peroxidation and HbAi level in erythrocytes of type 1 diabetic children. Similarly, Skyrme-Jones et al. [139] demonstrated that vitamin E supplementation improved endothelial vasodilator function in type 1 diabetic children supposedly due to the suppression of LDL oxidation. Devaraj et al. [140] used the urinary F2-isoprostane test for the estimate of LDL oxidation in type 2 diabetics. They also found that LDL oxidation decreased after vitamin E supplementation to patients. 

Therapy for insulin-dependent diabetes mellitus is usually achieved by daily subcutaneous injections of insulin, and insulin-mimetics which can be orally administered may be useful for the treatment of type I diabetes (insulin dependent) if suitable complexes of low toxicity can be identified (510, 511). 

There are two types of diabetes, insulin-dependent and non-insulin-dependent. Between 90-95% of the estimated 13-14 million people in the United States with diabetes have noninsulin-dependent, or Type 11, diabetes. Because this form of diabetes usually begins in adults over the age of 40 and is most common after the age of 55, it used to be called adult-onset diabetes. Its symptoms often develop gradually and are hard to identify at first therefore, nearly half of all people with diabetes do not know they have it. For instance, someone who has developed Type II diabetes may feel tired or ill without knowing why. This can be particularly dangerous because untreated diabetes can cause damage to the heart, blood vessels, eyes, kidneys, and nerves. While the causes, short-term effects, and treatments of the two types of diabetes differ, both types can cause the same longterm health problems. 

Captopr/V- Treatment of diabetic nephropathy (proteinuria greater than 500 mg/day) in patients with type 1 insulin-dependent diabetes mellitus and retinopathy. 

In the treatment of diabetic nephropathy associated with type I insulin-dependent diabetes mellitus, captopril decreases the rate of progression of renal insufficiency and retards the worsening of renal function. 

Cyclosporine appears to have promise in the treatment of autoimmune diseases. It has a beneficial effect on the course of rheumatoid arthritis, uveitis, insulin-dependent diabetes, systemic lupus erythematosus, and psoriatic arthropathies in some patients. Toxicity is more of a problem in these conditions than during use in transplantation, since higher doses of cyclosporine are often required to suppress autoimmune disorders. 

Treatment of insulin-dependent type 1 diabetes mellitus and non-insulin-dependent type 2 diabetes mellitus when diet or weight control has failed to maintain satisfactory blood glucose levels or in event of fever, infection, surgery, ortrauma, or severe endocrine, hepatic, or renal dysfunction emergency treatment of ketoacidosis (regular insulin) to... 

It is indicated in non-insulin dependent diabetes mellitus (type II, maturityonset diabetes) whenever treatment by diet alone proves to be inadequate. 

Although b-blockers are considered the treatment of choice for akathisia, low doses of clonazepam, diazepam, or lorazepam may also reduce its severity ( 172, 389, 445, 447, 448, 449 and 450). These BZDs may be a useful alternative when a-blockers are contraindicated (e.g., in patients with asthma, insulin-dependent diabetes meilitus, cardiac conduction abnormalities) or as an adjunct when akathisia persists despite stepwise escalation of these agents ( 177). 

Gentile S, Turco S, Guarino G, Oliviero B, Annunziata S, Cozzolino D, Sasso FC, Turco A, Salvatore T, Torella R. Effect of treatment with acarbose and insulin in patients with non-insulin-dependent diabetes mellitus associated with non-alcoholic liver cirrhosis. Diabetes Obes Metab 2001 3(1) 33 10. 

Chantelau E, Spraul M, Muhlhauser I, Gause R, Berger M. Long-term safety, efficacy and side-effects of continuous subcutaneous insulin infusion treatment for type 1 (insulin-dependent) diabetes mellitus a one centre experience. Diabetologia 1989 32(7) 421-6. 

Hanas R, Ludvigsson J. Side effects and indwelling times of subcutaneous catheters for insulin injections a new device for injecting insulin with a minimum of pain in the treatment of insulin-dependent diabetes mellitus. Diabetes Res Clin Pract 1990 10(l) 73-83. 

Insulin-dependent diabetes mellitus has been reported after 2 weeks to 6 months of treatment with interferon alfa in four patients with chronic hepatitis C (536). All discontinued interferon alfa, and one woman who restarted treatment had a subsequent increase in insulin requirements. 

Autoimmune polyglandular syndrome with progressive thyroid autoimmunity, type 1 diabetes mellitus, amenorrhea, and adrenal insufficiency has been reported in a 51-year-old woman treated with interferon alfa for chronic hepatitis C (545). Pancreas and pituitary gland autoantibodies, which were undetectable before interferon alfa treatment, were present at the time of diagnosis. After withdrawal, she recovered normal thyroid function, but was still insulin dependent with amenorrhea and adrenal insufficiency. 

Insulin-dependent diabetes mellitus (IDDM) is an example of a metabolic disease under active consideration for inducible gene therapy strategies. In this disorder, inflammatory cytokines have been shown to activate apoptosis in pancreatic beta cells. Experimental studies indicate that expression of insulinlike growth factor-1 (IGF-1) can prevent the cytokine-mediated destruction of beta cells of the pancreas (Giannoukakis et al., 2001). Regulated expression of IGF-1 in human pancreatic islets, to preserve beta cell function, may be a useful approach in the treatment of certain types of diabetes (Demeterco and Levine, 2001). 

Models of autoimmune diabetes in nonobese diabetic mice (NOD) mice, insulin-dependent diabetes, and experimental allergic encephalyomyelitis (EAE) were also used to evaluate naked pDNA therapy. In the latter models, a predominant Thl cytokine response is thought to play a role in disease symptoms and etiology. Treatment of these mouse models with a TH2 type cytokine, such as IL-10 or IL-4, has been found to shift the immune response and lessen the severity of disease. Therefore, the efficacy of pDNA delivery of a Th2 cytokine was explored in these specific models. 

---