Control Of Diabetic Complications Research Articles

Effects of Berberis vulgaris fruit extract on oxidative stress status in the kidney and liver of diabetic rats.

Oxidative stress has a key role in the diabetes pathogenesis and complications. Berberis vulgaris is known in folk medicine for curing several diseases. The current research aimed to assess the influences of Berberis vulgaris fruit extract against oxidative stress in streptozotocin-induced diabetic rats. Streptozotocin (60 mg/kg, ip) was injected to male rats. After diabetes confirmation, animals received the Berberis vulgaris fruit extract daily at amounts of 3.5 and 7.5 % of drinking water (v/v) for six weeks. Total thiol and lipid peroxidation levels were assessed in the serum, liver, kidney and spleen at the end of the study. Diabetic rats exhibited hyperglycemia along with enhancement of lipid peroxidation levels in the serum, liver, kidney and spleen, and decrement of total thiol content in the kidney and liver tissues. Chronic administration of Berberis vulgaris fruit extract at amount of 3.5 % of drinking water decreased the lipid peroxidation level in the serum and liver, and enhanced total thiol level in the liver and kidney. Berberis vulgaris fruit extract exerts antioxidant activity in the serum, liver and kidney organs of diabetic rats. Therefore, it might be used in the prevention and control of diabetes complications.

Observation on the Effect of Health Education on the Prevention and Control of Diabetic Complications

Observation on the Effect of Health Education on the Prevention and Control of Diabetic Complications

Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus.

BackgroundIn Italy, the adoption of a total lockdown has generated almost total suspension of outpatient visits except for emergencies. Even after lockdown, the pandemic fear created additional barriers to access the health services. The aim of our study is to evaluate the economic impact of the lockdown for COVID-19 on public health in Italy, focusing on its effects on diabetic population.Materials and MethodsWe analyzed the impact of the lockdown on excess mortality and morbidity in the Italian diabetic population during 2020. The analysis was divided into several steps: a quantification of specialist visit reduction, the calculation of excess mortality in the diabetic population, the economic evaluation of the slowdown in the use of innovative diabetic therapies. Furthermore, the impact of the lockdown on the reduction of procedures and follow-up visits in diabetic population was evaluated. The overall impact of the pandemic and lockdown effects on costs and quality of life was then calculated.ResultsDuring 2020, a drop of 28% in patient access has been observed. Diabetic patients recorded a twice higher mortality value compared to general population (20.4% vs 10.2%). The analysis of market data revealed a slowdown in consumption of new antidiabetic therapies (−14%, 27% vs 41%). We estimated an expense of €26.6 million for NHS and a loss of 257 utilities in diabetic population due to the missed benefits related to slowdown in innovative antidiabetic drugs use and non-optimal follow-up and control of diabetes complications. In simulation scenarios, we also estimated an overall expenditure ranging from €38.7 to 94.0 million and a loss of 294–836 utilities.ConclusionDiabetic population paid a high tribute to pandemic and lockdown, both in terms of number of deaths and burden of diabetic complications, together with an overall deterioration of quality of life.

Evaluation of antioxidants capacity of non-enzymatic antioxidants and its effect in glucose level in diabetic patients

Background: Oxidative stress might participate in the pathophysiology of diabetes type 2. Systems of nonenzymatic antioxidants are made up of scavenging molecules that are formed endogenously.The Study Objective: This study’s aims were evaluation of the non-enzymatic antioxidants and their effectin levels of glucose among diabetic patients.Methodology: A total of eighty patients with DM type 2 and forty healthy persons (control) were enrolledwithin this study. Serum and plasma were obtained from collected blood samples. The Ferric ReducingAbility of Plasma (FRAP) method was used for detection of the total antioxidant capacity (TAC). Ellman’smethod was used to determine the level of reduced glutathione. The serum CAT activity was detected by thetechnique explained by Sinha.Results: The findings revealed that, among diabetic groups, there was a significant elevation in glycosylatedhemoglobin and glucose levels; HbA1c and FBG levels were significantly higher; MDA, NO, LPI, TAC andGSH showed significant greater values. The activity of SOD showed significantly greater mean value amongthe control group.Conclusion: The results suggest that antioxidants defense might be decreased in T2DM, as TAC levelswere decreased. The increased levels of MDA, NO, LPI, TAC and GSH were associated with oxidativestress. Assessment of GSH could help in recognition of the extent of oxidative stress in diabetes as well asprevention and control of diabetic complications.

Diabetes-related hospital mortality in the U.S.: A pooled cross-sectional study of the National Inpatient Sample

AimsDespite advancements in the diagnosis and treatment of diabetes in the U.S., place-based disparities still exist. The purpose of this study is to determine place-based and other individual-level variations in diabetes-related hospital deaths. MethodsA pooled cross-sectional study of the 2009–2015 National Inpatient Sample was conducted to examine the odds of a diabetes-related hospital death. The main predictors were rurality and census region. Individual-level socio-demographic factors were also examined. ResultsApproximately 1.5% (n = 147,069) of diabetes-related hospitalizations resulted in death. In multivariable analysis, the odds of diabetes-related hospital deaths increased across the urban-rural continuum, except for large fringe metropolitan areas, with the highest odds of such deaths occurring among residents of micropolitan (OR = 1.16, 95% C.I. = 1.14, 1.18) and noncore areas (OR = 1.21, 95% C.I. = 1.19, 1.24). Compared to residents of the Northeast, residents in the South, West and Midwest regions were significantly more likely to experience a diabetes-related hospital death. Asian or Pacific Islanders, Medicaid-covered patients and the uninsured were also more likely to die during a diabetes-related hospitalization. ConclusionsPlace-based disparities in diabetes-related hospital deaths exist. Targeted focus should be placed on the control of diabetic complications in the South, West and Midwest census regions, and among rural residents.

Role of silibinin in the management of diabetes mellitus and its complications.

Diabetes mellitus is globally approaching epidemic proportions and acts as a major cause of a number of serious health problems diagnosed as diabetic complications. The current oral drugs in the treatment of diabetes and its complications could meet some but not all of the patients' needs, and the development of novel drugs with a hypoglycemic effect is urgently required. Silibinin, a flavonolignan traditionally used for the treatment of gallbladder and hepatic diseases, was reported to improve glycemic homeostasis by improving the activity of pancreatic β-cells, increasing insulin sensitivity of liver and muscle cells, and decreasing lipid deposition in adipocytes. Researches also indicated the effectiveness of silibinin in controlling several diabetic complications including neuropathy, retinopathy, impaired healing, hepatopathy, cardiomyopathy, nephropathy, and osteoporosis. In this review, we summarize the recent anti-diabetes findings of silibinin and clarify the underlying pharmacological mechanisms, and update the knowledge in understanding the role of silibinin in control of diabetic complications.

Supplementation with Phycocyanobilin, Citrulline, Taurine, and Supranutritional Doses of Folic Acid and Biotin-Potential for Preventing or Slowing the Progression of Diabetic Complications.

Oxidative stress, the resulting uncoupling of endothelial nitric oxide synthase (eNOS), and loss of nitric oxide (NO) bioactivity, are key mediators of the vascular and microvascular complications of diabetes. Much of this oxidative stress arises from up-regulated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity. Phycocyanobilin (PhyCB), the light-harvesting chromophore in edible cyanobacteria such as spirulina, is a biliverdin derivative that shares the ability of free bilirubin to inhibit certain isoforms of NADPH oxidase. Epidemiological studies reveal that diabetics with relatively elevated serum bilirubin are less likely to develop coronary disease or microvascular complications; this may reflect the ability of bilirubin to ward off these complications via inhibition of NADPH oxidase. Oral PhyCB may likewise have potential in this regard, and has been shown to protect diabetic mice from glomerulosclerosis. With respect to oxidant-mediated uncoupling of eNOS, high-dose folate can help to reverse this by modulating the oxidation status of the eNOS cofactor tetrahydrobiopterin (BH4). Oxidation of BH4 yields dihydrobiopterin (BH2), which competes with BH4 for binding to eNOS and promotes its uncoupling. The reduced intracellular metabolites of folate have versatile oxidant-scavenging activity that can prevent oxidation of BH4; concurrently, these metabolites promote induction of dihydrofolate reductase, which functions to reconvert BH2 to BH4, and hence alleviate the uncoupling of eNOS. The arginine metabolite asymmetric dimethylarginine (ADMA), typically elevated in diabetics, also uncouples eNOS by competitively inhibiting binding of arginine to eNOS; this effect is exacerbated by the increased expression of arginase that accompanies diabetes. These effects can be countered via supplementation with citrulline, which efficiently enhances tissue levels of arginine. With respect to the loss of NO bioactivity that contributes to diabetic complications, high dose biotin has the potential to “pinch hit” for diminished NO by direct activation of soluble guanylate cyclase (sGC). High-dose biotin also may aid glycemic control via modulatory effects on enzyme induction in hepatocytes and pancreatic beta cells. Taurine, which suppresses diabetic complications in rodents, has the potential to reverse the inactivating impact of oxidative stress on sGC by boosting synthesis of hydrogen sulfide. Hence, it is proposed that concurrent administration of PhyCB, citrulline, taurine, and supranutritional doses of folate and biotin may have considerable potential for prevention and control of diabetic complications. Such a regimen could also be complemented with antioxidants such as lipoic acid, N-acetylcysteine, and melatonin—that boost cellular expression of antioxidant enzymes and glutathione—as well as astaxanthin, zinc, and glycine. The development of appropriate functional foods might make it feasible for patients to use complex nutraceutical regimens of the sort suggested here.

Potential of Birds to Serve as Pathology-Free Models of Type 2 Diabetes, Part 2: Do High Levels of Carbonyl-Scavenging Amino Acids (e.g., Taurine) and Low Concentrations of Methylglyoxal Limit the Production of Advanced Glycation End-Products?

In our previous publication, we reported on the advantages of using birds as a pathology-free model of type 2 diabetes mellitus (T2DM). Using this new perspective, we observed that birds are missing the RAGE gene, considered an important factor in the development of diabetic complications. In this article, we identify two additional Maillard reaction-related characteristics of birds that have the potential to account, in part, for avian ability to cope successfully with chronic hyperglycemia. First, compared to mammals, blood plasma of birds has significantly higher concentrations of taurine and other free amino acids that act as scavengers of reactive carbonyls. Second, there are also indications that avian blood plasma contains lower concentrations of methylglyoxal (MG) due, in part, to its decreased production by avian erythrocytes. Our deductions are based on relatively meager experimental data and are therefore speculative. One certain outcome of our study, however, is the idea that birds can be a useful model for the study of Maillard reactions and etiology of diabetic complications. We anticipate and hope that results of future studies will support the hypothesis identifying MG as a key intermediate in the etiology of diabetic complications. If this is indeed the case, then prevention and control of diabetic complications may become transformed into a more circumscribed, defined, and tractable problem whose goals will be to minimize the production of MG and to maximize its elimination by detoxification or scavenging.

Correlation of Glycemic Status with Oxidative/Antioxidant Status in Diabetic Retinopathy

Context : Diabetes is a chronic disease and sustained hyperglycemia attacks both micro vessels and macro vessels throughout the body. It is the leading cause of retinopathy, nephropathy, end stage renal disease and cardiovascular diseases. In Diabetes and its complication, oxidative stress is caused by both increased production of reactive oxygen species, sharp reduction in antioxidant defenses and altered cellular redox status. Aims: The aim of the present study was to assess the correlation of glycemic status with lipid peroxidation and antioxidant vitamin levels in patient with diabetic retinopathy. Setting and design: 50 patients with diabetic retinopathy and 50 age and sex matched healthy controls were included in the study. Fasting blood glucose levels, post prandial blood glucose levels were estimated to assess the severity of Diabetes. Glycated haemoglobin was estimated to assess glycemic control. The degree of lipid peroxidation in terms of serum malondialdehyde (MDA) by Thiobarbituric acid method along with antioxidant defenses, vitamin A, vitamin C and vitamin E were estimated in cases and controls. Statistical analysis used: Student t test (two tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups (Inter group analysis) on metric parameters. Pearson correlation between HbA1c and other parameters was performed to assess the relationship in each group. Results: The serum FBS, PPBS, HbA1c and MDA were found to be increased significantly (p<0.001) in diabetic retinopathy patients while plasma Vitamin A, C and E levels were significantly reduced (p<0.001) as compared to controls. Correlation study conducted between HbA1c and other parameters revealed that there was statistically significant negative correlation between HbA1c and vitamin A and vitamin C. Conclusions: The present study concludes that sustained hyperglycemia leads to excessive peroxidation and antioxidant deficiency in diabetic retinopathy. Therapeutic measures to increase the antioxidant levels and to control lipid peroxidation are warranted for effective control of diabetic complications.

An Aqueous-Ethanol Extract ofLiriope spicatavar.proliferaAmeliorates Diabetic Nephropathy through Suppression of Renal Inflammation

The tuberous root of Liriope spicata var. prolifera (TRLS; Liliaceae family) is valued for the ability to promote glucose homeostasis, and it may therefore be utilized as an adjuvant therapy in the control of diabetic complications. The aim of the present study was to examine the effects of an aqueous ethanol extract from TRLS (TRLS-ext) (100 or 200 mg kg−1 per day for eight weeks) on rats with streptozotocin-induced diabetic nephropathy (DN). Renal dysfunction in diabetic rats was ameliorated by TRLS-ext as evidenced by reduced creatinine clearance, as well as increased blood urea nitrogen and proteinuria. Treatment with TRLS-ext was found to markedly improve histological architecture in the diabetic kidney. Hyperglycemia induced degradation of inhibitory kappa B and reduced nuclear factor kappa B activation, leading to increased infiltration of macrophages and increased levels of proinflammatory cytokines, including interleukin-1 and tumor necrosis factor-α. All of the above abnormalities were reversed by TRLS-ext treatment, which also decreased the expression of intercellular adhesion molecule-1, monocyte chemoattractant protein-1, and fibronectin in the diabetic kidneys. These findings provide a perspective on the renoprotective effects of TRLS-ext in DN.

Enzymes Inhibitors From Plants: An Alternate Approach To Treat Diabetes

Diabetes is one of the major medical complications the world faces today. It is a common metabolic disease characterized by abnormally high plasma glucose levels, leading to major complications such as diabetic neuropathy, retinopathy, and cardiovascular diseases. The management of blood glucose levels is a critical strategy in the control of diabetes complications. Inhibitors of carbohydrate hydrolyzing enzymes (such as α-glucosidase and α-amylase) have been useful as oral drugs for the control of hyperglycemia, especially in patients with type II diabetes mellitus. Other enzymes such as DPP4, aldose reductase and angiotensin converting enzyme also play an important role in diabetes. Inhibition of these factors plays an important role in management of diabetes. Various research studies have been performed to examine the effectiveness of natural sources as the inhibitors of all these enzymes. In the present review, we discuss the various constituents isolated from plants which have inhibitory properties against these enzymes.

Vitamin E, diabetes and related diseases: an update

Natural vitamin E is a mixture of tocopherols and tocotrienols synthesized only by plants. It is very difficult to determine the optimal dietary intake of vitamin E, but there is a general agreement indicating a level of 8 mg/day (12–15 IU). This value seems to be sufficient only to prevent deficiency syndromes of vitamin E. In humans, vitamin E is absorbed together with nutritional lipids in the proximal part of the intestine and released in the lymph within chylomicrons. Vitamin E supplementation, as other minerals and vitamins, is able to participate in the decrease of oxidative stress in diabetic patients by improving glycemic control and/or by other mechanisms related to its antioxidant activity, therefore cooperating to the control of diabetic complications. Many interventional trials evaluating the effect of antioxidant supplementation on insulin resistance, plasma glucose levels and risk of T2D give inconsistent results. At present, a controversial hypothesis about the role played by vitamin E supplementation still exists. In fact, while laboratory data report great cellular and biochemical beneficial actions, clinical trials have failed to support these claims. Concerning clinical trials, the discrepancies have been attributed to differences in selection of individuals, dosage, chemical forms of vitamin E, duration of treatment, stage of the disease and geographical area. Because of these variables, further studies aimed to clarify the relationship between diabetes, cardiovascular risk factors and vitamin E are necessary.

Inhibitory Effects of Six Allium Species on α-Amylase Enzyme Activity

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. The management of the blood glucose level is a critical strategy in the control of diabetes complications. Inhibitors of carbohydrate hydrolyzing enzymes have been useful as oral hypoglycemic drugs for the control of hyperglycemia especially in patients with type II disables mellitus. The goal of the present study was to investigate the inhibitory effects of six selected Allium species (A. akaka, A. ampeloprasum subsp. iranicum, A. cepa, A. hirtifolium, A. porrum and A. sativum) on α-amylase enzyme using an in vitro model. According to the results, ethanol extracts of A. akaka, A. sativum, A. porrum and A. cepa were found to have a favorable α-amylase inhibitory activity with IC50 values of 16.74, 17.95, 15.73 and 16.36 mg/ml, respectively and they did not reveal any significant differences in their IC50 values (p>0.05). However, the two other Allium species tested (A. ampeloprasum subsp. iranicum and A. hirtifolium) did not show valuable inhibitory activity.