Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized cont...Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.展开更多
The detrimental effects of constant hyperglycemia on neural function have been quantitatively and qualitatively evaluated in the setting of diabetes mellitus. Some of the hallmark features of diabetic encephalopathy (...The detrimental effects of constant hyperglycemia on neural function have been quantitatively and qualitatively evaluated in the setting of diabetes mellitus. Some of the hallmark features of diabetic encephalopathy (DE) are impaired synaptic adaptation and diminished spatial learning capacity. Chronic and progressive cognitive dysfunction, perpetuated by several positive feedback mechanisms in diabetic subjects, facilitates the development of early-onset dementia and Alzheimer’s disease. Despite the numerous clinical manifestations of DE having been described in detail and their pathophysiological substrate having been elucidated in both type 1 and type 2 diabetes mellitus, an effective therapeutic approach is yet to be proposed. Therefore, the aim of this review is to summarize the growing body of evidence concerning the effect of current antidiabetic treatment options on diabetic and non-DE.展开更多
The reciprocal relationship between hyperglycemia and inflammation in the setting of diabetes mellitus has been the subject of extensive research. Insulin resistance, the hallmark of diabetic metabolic dysregulation, ...The reciprocal relationship between hyperglycemia and inflammation in the setting of diabetes mellitus has been the subject of extensive research. Insulin resistance, the hallmark of diabetic metabolic dysregulation, has been linked to the inflammatory cascade occurring mainly in adipose tissue. The main pathophysiologic processes facilitating the aforementioned interplay, is a phenotype switch of macrophages to the M1 class following gluco- and lipotoxicity and gut microbial remodeling. Given the correlation between inflammation and metabolic abnormalities, the elucidation of the exact mechanisms linking the two along with exploring the possible role of modulation of one in order to alter the other, could open up the possibility of novel therapeutic approaches for diabetes mellitus and its complications. Therefore, the aim of this review is to summarize the growing body of evidence concerning the molecular basis and results of pro-inflammatory processes in diabetic subjects along with the effect of current antidiabetic treatment options on tissue inflammation.展开更多
Chronic liver disease (CLD) often coexists with type 2 diabetes mellitus, making diabetes management a challenge to the clinician. It is well known that liver is the major site of drug metabolism, and, therefore, its ...Chronic liver disease (CLD) often coexists with type 2 diabetes mellitus, making diabetes management a challenge to the clinician. It is well known that liver is the major site of drug metabolism, and, therefore, its impairment affects hepatic metabolism of many antidiabetic agents. Furthermore, patients with CLD have serious comorbidities such as impaired renal function, hypoalbuminemia, lactic acidosis, hypoglycemia and malnutrition, making their treatment even more difficult. On the other hand, most of the antidiabetic agents, with the exception of insulin, need dosage titration due to alterations to their pharmacokinetics in patients with CLD. For well-established antidiabetic treatments, like metformin and sulfonylureas there are studies regarding their dosage chance in these patients. However, despite the growing problem of management of diabetes in patients with CLD the existing literature data, especially on newer antidiabetic agents, are limited and, furthermore, no direct guidelines exist. Therefore, in the present review article we try to summarize the existing literature data regarding management of diabetes in patients with CLD.展开更多
Salacca zalacca(Gaertn.) Voss(family Arecaceae) is the snake fruit commonly known in Malay language as salak in Malaysia. This exotic fruit has diverse and potential pharmacological properties due to its high antioxid...Salacca zalacca(Gaertn.) Voss(family Arecaceae) is the snake fruit commonly known in Malay language as salak in Malaysia. This exotic fruit has diverse and potential pharmacological properties due to its high antioxidant content. It is often consumed due to its sweet taste. The abundant natural sugar and fibre along with minerals and vitamin makes it a nutritious fruit. Phytochemical investigation on this fruit has revealed the presence of flavonoids, phenolics, glycosides as well as some volatile and aromatic compounds, including gallic acid, quercetin, chlorogenic acid, epicatechin, proanthocyanidins, lycopene and β-carotene. Pharmacological studies on the fruit flesh and peel have shown some tremendous antioxidant, anti-inflammatory, anticancer and antidiabetic potential. This review provides the botanical information of Salacca zalacca as well as its scientific investigations involving the distinct pharmacological and phytochemical benefits. This could help in highlighting the lacking data and research gaps on this plant.展开更多
Epicardial adipose tissue is defined as a deposit of adipoSubmit cytes with pathophysiological properties similar to those of visceral fat,located in the space between the myocardial muscle and the pericardial sac.Whe...Epicardial adipose tissue is defined as a deposit of adipoSubmit cytes with pathophysiological properties similar to those of visceral fat,located in the space between the myocardial muscle and the pericardial sac.When compared with subcutaneous adipose tissue,visceral adipocytes show higher metabolic activity,lipolysis rates,increased insulin resistance along with more steroid hormone receptors.The epicardial adipose tissue interacts with numerous cardiovascular pathways via vasocrine and paracrine signalling comprised of pro-and anti-inflammatory cytokines excretion.Both the physiological differences between the two tissue types,as well as the fact that fat distribution and phenotype,rather than quantity,affect cardiovascular function and metabolic processes,establish epicardial fat as a biomarker for cardiovascular and metabolic syndrome.Numerous studies have underlined an association of altered epicardial fat morphology,type 2 diabetes mellitus(T2DM)and adverse cardiovascular events.In this review,we explore the prospect of using the epicardial adipose tissue as a therapeutic target in T2DM and describe the underlying mechanisms by which the antidiabetic drugs affect the pathophysiological processes induced from adipose tissue accumulation and possibly allow for more favourable cardiovascular outcomes though epicardial fat manipulation.展开更多
Objective: To study the chemical constituents from root bark of Morus alba and their α-glucosidase inhi-bition and DPPH radical scavenging activities.Methods: The chemical constituents were isolated and purified by...Objective: To study the chemical constituents from root bark of Morus alba and their α-glucosidase inhi-bition and DPPH radical scavenging activities.Methods: The chemical constituents were isolated and purified by repeated column chromatographies onsilica gel, Sephadex LH-20, and preparative HPLC. Their structures were elucidated by 1D and 2D NMRspectra and HR-ESI-MS.Results: Thirteen compounds 1-13 were isolated and identified. The bioactive assays revealed that com-pounds 1, 3 and 8 displayed strong α-glucosidase inhibitory activity with ICso values of (147.1±1.1),(314.1±0.8), and (207.6±0.1 ) μmol/L, respectively, which were stronger than the positive control of acar-bose (418.6±0.1 μmol/L). Compounds 10 and 11 displayed potent DPPH scavenging activity with ECsovalues of (2.9±0.1) and (5.0±0.1) μmol/L [ECso of positive control Vitamin C was (54.8±0.1) μmol/L],respectively.Conclusion: To the best of our knowledge, this is the first report about the compounds 1, 3, and 8 of M.alba with α-glucosidase inhibitory effects.展开更多
Development of type 2 diabetes has been linked to β-cell failure coupled with insulin resistance and obesity. Adipose tissue, known as the fat store, secretes a number of hormones and proteins collectively termed adi...Development of type 2 diabetes has been linked to β-cell failure coupled with insulin resistance and obesity. Adipose tissue, known as the fat store, secretes a number of hormones and proteins collectively termed adipokines some of which regulate insulin sensitivity. Dysregulation in the secretion of adipokines has been linked to insulin resistance and type 2 diabetes. In this review, we sum-marized evidence of the role of adipokines with focus on leptin, adiponectin, adipsin, visfatin and apelin in the pathogenesis of type 2 diabetes and discussed the potential of saponins to modify the ill-regulated adipokines secretions, which could promote the use of this class of phytochemicals as potential antidiabetics agents.展开更多
Plants have provided sources to find novel compounds. These plants are being used as therapeutic purposes since the birth of mankind. The traditional healers normally utilize medicinal plants as crude drugs while scie...Plants have provided sources to find novel compounds. These plants are being used as therapeutic purposes since the birth of mankind. The traditional healers normally utilize medicinal plants as crude drugs while scientists using the folk claim as guides to explore medicinal plants. Moringa oleifera is a famous edible plant having therapeutic and nutritive values. The present study was designed to cumulate the research data regarding to what extent, phytochemical, nutritional and glycemic control studies has been explored using its different extracts. The articles indicated that the powder, aqueous, methanol and ethanol extracts of Moringa oleifera(leaves, pods, seeds, stem and root bark) have significant therapeutic herbal potential to treat diabetes mellitus. Collectively, the mechanism behind is intestinal glucose inhibition, insulin release as well as decrease in insulin resistance probably regeneration of b-cells of pancreas, increase in glutathione and reduction in malondialdehyde. Conclusively, this article give descriptive information about antidiabetic effect, claimed marker compounds and proposed antihyperglycemic mechanism of a single plant. It can be suggested a potential herbal source to treat diabetes mellitus as being widely accepted by major population as nutrition and therapeutic agent.展开更多
Objective:To investigate the antidiabetic activity of Ocimum tenuiflorum L.(O.tenuiflorum) leaves used in the traditional medicine management of diabetes in Malaysia.Methods:O.tenuiflorum leaves were extracted sequent...Objective:To investigate the antidiabetic activity of Ocimum tenuiflorum L.(O.tenuiflorum) leaves used in the traditional medicine management of diabetes in Malaysia.Methods:O.tenuiflorum leaves were extracted sequentially with hexane,chloroform,ethyl acetate,methanol,and water.The extracts were evaluated in terms of antidiabetic activity by using acute,subcutaneous glucose tolerance,and sub-chronic tests in streptozotocininduced diabetic rats.The extracts were also subjected to phytochemical analyses.Results:With an acute dose(1 g/kg),the methanol extracts showed significant reduction(31%) in fasting blood glucose(FBG) of the streptozotocin-induced diabetic rats.The FBG-decreasing effect of ethyl acetate extract was more rapid than that of the other extracts;the decreasing rates were 20%after 2 h,21%after 3 h,and 8%after 5 and 7 h.After 7 h(31%),the effect of methanol extract on FBG was significantly lower than that of metformin.In the subcutaneous glucose tolerance test,only methanol and hexane extracts showed the similarity of metformin in diabetic rats.After 14 days,the effects of these extracts were similar to those of metformin(63.33%).The total flavonoid and phenolic contents of extracts decreased as the polarity of the extraction solvent increased.Conclusions:The results obtained provide support for a possible use of O.tenuiflorum leaves in managing hyperglycemia and preventing the complications associated with it in type 2 diabetic.展开更多
文摘Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.
文摘The detrimental effects of constant hyperglycemia on neural function have been quantitatively and qualitatively evaluated in the setting of diabetes mellitus. Some of the hallmark features of diabetic encephalopathy (DE) are impaired synaptic adaptation and diminished spatial learning capacity. Chronic and progressive cognitive dysfunction, perpetuated by several positive feedback mechanisms in diabetic subjects, facilitates the development of early-onset dementia and Alzheimer’s disease. Despite the numerous clinical manifestations of DE having been described in detail and their pathophysiological substrate having been elucidated in both type 1 and type 2 diabetes mellitus, an effective therapeutic approach is yet to be proposed. Therefore, the aim of this review is to summarize the growing body of evidence concerning the effect of current antidiabetic treatment options on diabetic and non-DE.
文摘The reciprocal relationship between hyperglycemia and inflammation in the setting of diabetes mellitus has been the subject of extensive research. Insulin resistance, the hallmark of diabetic metabolic dysregulation, has been linked to the inflammatory cascade occurring mainly in adipose tissue. The main pathophysiologic processes facilitating the aforementioned interplay, is a phenotype switch of macrophages to the M1 class following gluco- and lipotoxicity and gut microbial remodeling. Given the correlation between inflammation and metabolic abnormalities, the elucidation of the exact mechanisms linking the two along with exploring the possible role of modulation of one in order to alter the other, could open up the possibility of novel therapeutic approaches for diabetes mellitus and its complications. Therefore, the aim of this review is to summarize the growing body of evidence concerning the molecular basis and results of pro-inflammatory processes in diabetic subjects along with the effect of current antidiabetic treatment options on tissue inflammation.
文摘Chronic liver disease (CLD) often coexists with type 2 diabetes mellitus, making diabetes management a challenge to the clinician. It is well known that liver is the major site of drug metabolism, and, therefore, its impairment affects hepatic metabolism of many antidiabetic agents. Furthermore, patients with CLD have serious comorbidities such as impaired renal function, hypoalbuminemia, lactic acidosis, hypoglycemia and malnutrition, making their treatment even more difficult. On the other hand, most of the antidiabetic agents, with the exception of insulin, need dosage titration due to alterations to their pharmacokinetics in patients with CLD. For well-established antidiabetic treatments, like metformin and sulfonylureas there are studies regarding their dosage chance in these patients. However, despite the growing problem of management of diabetes in patients with CLD the existing literature data, especially on newer antidiabetic agents, are limited and, furthermore, no direct guidelines exist. Therefore, in the present review article we try to summarize the existing literature data regarding management of diabetes in patients with CLD.
基金Kulliyyah of Pharmacy,International Islamic University Malaysia(IIUM)Ministry of Higher Education,Malaysia and Research Management Centre,IIUM,Kuantan,Malaysia(FRGS 16-042-0541)(RIGS 15-099-0099).
文摘Salacca zalacca(Gaertn.) Voss(family Arecaceae) is the snake fruit commonly known in Malay language as salak in Malaysia. This exotic fruit has diverse and potential pharmacological properties due to its high antioxidant content. It is often consumed due to its sweet taste. The abundant natural sugar and fibre along with minerals and vitamin makes it a nutritious fruit. Phytochemical investigation on this fruit has revealed the presence of flavonoids, phenolics, glycosides as well as some volatile and aromatic compounds, including gallic acid, quercetin, chlorogenic acid, epicatechin, proanthocyanidins, lycopene and β-carotene. Pharmacological studies on the fruit flesh and peel have shown some tremendous antioxidant, anti-inflammatory, anticancer and antidiabetic potential. This review provides the botanical information of Salacca zalacca as well as its scientific investigations involving the distinct pharmacological and phytochemical benefits. This could help in highlighting the lacking data and research gaps on this plant.
文摘Epicardial adipose tissue is defined as a deposit of adipoSubmit cytes with pathophysiological properties similar to those of visceral fat,located in the space between the myocardial muscle and the pericardial sac.When compared with subcutaneous adipose tissue,visceral adipocytes show higher metabolic activity,lipolysis rates,increased insulin resistance along with more steroid hormone receptors.The epicardial adipose tissue interacts with numerous cardiovascular pathways via vasocrine and paracrine signalling comprised of pro-and anti-inflammatory cytokines excretion.Both the physiological differences between the two tissue types,as well as the fact that fat distribution and phenotype,rather than quantity,affect cardiovascular function and metabolic processes,establish epicardial fat as a biomarker for cardiovascular and metabolic syndrome.Numerous studies have underlined an association of altered epicardial fat morphology,type 2 diabetes mellitus(T2DM)and adverse cardiovascular events.In this review,we explore the prospect of using the epicardial adipose tissue as a therapeutic target in T2DM and describe the underlying mechanisms by which the antidiabetic drugs affect the pathophysiological processes induced from adipose tissue accumulation and possibly allow for more favourable cardiovascular outcomes though epicardial fat manipulation.
基金The authors are thankful for financial support from programs of Shaanxi Education Commission (No. 13J5005) and Shaanxi Science and Technology Commission (No. 2014JM2058).
文摘Objective: To study the chemical constituents from root bark of Morus alba and their α-glucosidase inhi-bition and DPPH radical scavenging activities.Methods: The chemical constituents were isolated and purified by repeated column chromatographies onsilica gel, Sephadex LH-20, and preparative HPLC. Their structures were elucidated by 1D and 2D NMRspectra and HR-ESI-MS.Results: Thirteen compounds 1-13 were isolated and identified. The bioactive assays revealed that com-pounds 1, 3 and 8 displayed strong α-glucosidase inhibitory activity with ICso values of (147.1±1.1),(314.1±0.8), and (207.6±0.1 ) μmol/L, respectively, which were stronger than the positive control of acar-bose (418.6±0.1 μmol/L). Compounds 10 and 11 displayed potent DPPH scavenging activity with ECsovalues of (2.9±0.1) and (5.0±0.1) μmol/L [ECso of positive control Vitamin C was (54.8±0.1) μmol/L],respectively.Conclusion: To the best of our knowledge, this is the first report about the compounds 1, 3, and 8 of M.alba with α-glucosidase inhibitory effects.
文摘Development of type 2 diabetes has been linked to β-cell failure coupled with insulin resistance and obesity. Adipose tissue, known as the fat store, secretes a number of hormones and proteins collectively termed adipokines some of which regulate insulin sensitivity. Dysregulation in the secretion of adipokines has been linked to insulin resistance and type 2 diabetes. In this review, we sum-marized evidence of the role of adipokines with focus on leptin, adiponectin, adipsin, visfatin and apelin in the pathogenesis of type 2 diabetes and discussed the potential of saponins to modify the ill-regulated adipokines secretions, which could promote the use of this class of phytochemicals as potential antidiabetics agents.
基金Supported by Ministry of Education,Malaysia(Grant No.203/PFARMASI/6711451)Faculty Development Scholarship provided by University of Sargodha,Sargodha,Punjab,Pakistan
文摘Plants have provided sources to find novel compounds. These plants are being used as therapeutic purposes since the birth of mankind. The traditional healers normally utilize medicinal plants as crude drugs while scientists using the folk claim as guides to explore medicinal plants. Moringa oleifera is a famous edible plant having therapeutic and nutritive values. The present study was designed to cumulate the research data regarding to what extent, phytochemical, nutritional and glycemic control studies has been explored using its different extracts. The articles indicated that the powder, aqueous, methanol and ethanol extracts of Moringa oleifera(leaves, pods, seeds, stem and root bark) have significant therapeutic herbal potential to treat diabetes mellitus. Collectively, the mechanism behind is intestinal glucose inhibition, insulin release as well as decrease in insulin resistance probably regeneration of b-cells of pancreas, increase in glutathione and reduction in malondialdehyde. Conclusively, this article give descriptive information about antidiabetic effect, claimed marker compounds and proposed antihyperglycemic mechanism of a single plant. It can be suggested a potential herbal source to treat diabetes mellitus as being widely accepted by major population as nutrition and therapeutic agent.
文摘Objective:To investigate the antidiabetic activity of Ocimum tenuiflorum L.(O.tenuiflorum) leaves used in the traditional medicine management of diabetes in Malaysia.Methods:O.tenuiflorum leaves were extracted sequentially with hexane,chloroform,ethyl acetate,methanol,and water.The extracts were evaluated in terms of antidiabetic activity by using acute,subcutaneous glucose tolerance,and sub-chronic tests in streptozotocininduced diabetic rats.The extracts were also subjected to phytochemical analyses.Results:With an acute dose(1 g/kg),the methanol extracts showed significant reduction(31%) in fasting blood glucose(FBG) of the streptozotocin-induced diabetic rats.The FBG-decreasing effect of ethyl acetate extract was more rapid than that of the other extracts;the decreasing rates were 20%after 2 h,21%after 3 h,and 8%after 5 and 7 h.After 7 h(31%),the effect of methanol extract on FBG was significantly lower than that of metformin.In the subcutaneous glucose tolerance test,only methanol and hexane extracts showed the similarity of metformin in diabetic rats.After 14 days,the effects of these extracts were similar to those of metformin(63.33%).The total flavonoid and phenolic contents of extracts decreased as the polarity of the extraction solvent increased.Conclusions:The results obtained provide support for a possible use of O.tenuiflorum leaves in managing hyperglycemia and preventing the complications associated with it in type 2 diabetic.