Treatment of Diabetes

The search for the bisindole derivatives (22) was originally (81) initiated on the basis of folklore. A brew made from Jamacian periwinkle had estabhshed itself in local medicine as a treatment for diabetes and it was this material that was investigated and found to contain the cytotoxic compounds (22), among others. No materials useful in the treatment of diabetes have been reported from this source. 

Used in treatment of diabetic neuropathy and retinopathy ponalrestat [72702-95-5] C2yH22BrFN202... 

Direct laser-assisted myocardial revascularization (DMR) is an approved technique in the US, Europe, and parts of Asia to create numerous myocardial channels. This results in the induction of a massive inflammatory reaction, which in turn induces angiogenesis. The other FDA-approved pro-angiogenic therapy is the use of recombinant human platelet-derived growth factor (Regranex) for use in the treatment of diabetic neuropathic foot ulcer s. 

Antidiabetic drugs is the general term for drugs that lower blood glucose concentrations and are used in the treatment of diabetes mellitus. Antidiabetic drugs are... 

Vasopressin and its derivatives are used in die treatment of diabetes insipidus, a disease resulting from die failure of the pituitary to secrete vasopressin or from surgical removal of die pituitary. Diabetes insipidus is characterized by marked increase in urination (as much as 10 L in 24 hours) and excessive tiiirst by inadequate secretion of die antidiuretic hormone or vasopressin. Treatment with vasopressin therapy replaces die hormone in the body and restores normal urination and thirst Vasopressin may also be used for die prevention and treatment of postoperative abdominal distention and to dispel gas interfering with abdominal roentgenography. 

Diabetic patients have reduced antioxidant defences and suffer from an increased risk of free radical-mediated diseases such as coronary heart disease. EC has a pronounced insulin-like effect on erythrocyte membrane-bound acetylcholinesterase in type II diabetic patients (Rizvi and Zaid, 2001). Tea polyphenols were shown to possess anti-diabetic activity and to be effective both in the prevention and treatment of diabetes (Choi et al, 1998 Yang et al, 1999). The main mechanism by which tea polyphenols appear to lower serum glucose levels is via the inhibition of the activity of the starch digesting enzyme, amylase. Tea inhibits both salivary and intestinal amylase, so that starch is broken down more slowly and the rise in serum glucose is thus reduced. In addition, tea may affect the intestinal absorption of glucose. 

Several studies have demonstrated that treatment of diabetic patients with the sulphonylurea, gliclazide, is associated with a fall in lipid peroxidation, protein fluorescence and beneficial effects on platelet function (Florkowski et al., 1988 Jennings et al., 1992). These changes were seen to be independent of changes in giycaemic control. 

Aminoguanidine has been shown to prevent the formation of AGEs (Brownlee et al., 1986) and treatment with this drug prevents retinal pericyte loss in STZ-induced diabetic rats (Hammes et al., 1990). More recendy, functional and structural impairments in peripheral nerves are ameliorated by aminoguanidine in male Wistar rats (Yagihashi et al., 1992). These data surest that inhibitors of non-enzymatic glycosyiation may have a future role in the treatment of diabetic complications. 

Morel, D.W. and Chisolm, G.M. (1989). Antioxidant treatment of diabetic rats inhibits lipoprotein oxidation and cytotoxicity. J. Lipid Res. 30, 1827-1834. 

TABLE 40-10. Non-insulin Injectible Agents for the Treatment of 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. 

The nonpharmacologic treatment of diabetic foot ulcers may include off-loading, chemical or surgical debridement of necrotic tissue, wound dressings, hyperbaric oxygen, vascular or orthopedic surgery, and the use of human skin equivalents.30... 

Multiple antibiotic options exist for the treatment of diabetic wound infections. Table 70-6 provides both general treatment strategies and specific, though not all-inclusive, antibiotic recommendations. The duration of therapy correlates with infection severity. Grade 2 infections require 7 to 14 days of therapy, whereas grade 3 to 4 wounds necessitate treatment durations of 14 to 28 days. If osteomyelitis is present, treatment should continue for at least 6 weeks.31... 

TABLE 70-6. Empirical Pharmacologic Treatment of Diabetic Foot Infection31... 

Tigecycline is not currently approved for the treatment of diabetic foot infections. 

Lipsky BA, Berendt AR, Deery G, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004 39 885-910. Livesley NJ, Chow AW. Pressure ulcers in elderly individuals. Clin Infect Dis 2002 35 1390-1396. 

Insulin 0.2 Oral and intramuscular delivery for treatment of diabetes Insulin... 

Peroxisome Proliferator activated receptor (PPAR-GAMMA-2) Insulin Variation of insulin efficacy in the treatment of diabetes (93) Susceptibility to type II diabetes (93)... 

Pope E.J.A., Peterson K., Peterson C., Sol-gel bioatificial organs for the treatment of diabetes mellitus, in proc.on SOL-GEL 97 9th International Workshop on Glasses, Ceramics, Hybrids and Nanocomposites from Gels, Sheffield, UK, 1997. 

G. Reach and G.S. Wilson, Can continuous glucose monitoring be used for the treatment of diabetes Anal. Chem. 64, 381A-389A (1992). 

We still need much better medicines to cure cancer, heart disease, stroke, and Alzheimer s disease. We need better drugs to deal with obesity, diabetes, arthritis, and schizophrenia. The treatments of diabetes, arthritis, and mental defects such as schizophrenia or manic depression are not yet cures, just ways to keep the symptoms under control. Cures are needed. Insights from genetics may help guide us toward elegant and rational cures, but we will also make use of screens to identify natural products and libraries of randomly generated synthetic compounds (combinatorial chemistry). A semi-empirical approach may be the best hope over the next two decades to yield drugs to alleviate these diseases. 

As in the case of other cardiovascular diseases, the possibility of antioxidant treatment of diabetes mellitus has been studied in both animal models and diabetic patients. The treatment of streptozotocin-induced diabetic rats with a-lipoic acid reduced superoxide production by aorta and superoxide and peroxynitrite formation by arterioles providing circulation to the region of the sciatic nerve, suppressed lipid peroxidation in serum, and improved lens glutathione level [131]. In contrast, hydroxyethyl starch desferrioxamine had no effect on the markers of oxidative stress in diabetic rats. Lipoic acid also suppressed hyperglycemia and mitochondrial superoxide generation in hearts of glucose-treated rats [132],... 

---