Diabetic Medicine Research Articles

Preclinical updates of the homoeopathic medicines used in diabetes mellitus: A narrative review

Introduction: Homoeopathy, one of the most commonly employed alternative medicines globally, has a wide range of role in the management of diabetes. Screening of the action of homoeopathic medicines in diabetes on animal model not only helps in validating their antidiabetic potential but also aids in understanding their effect on living systems and their mechanism of action. The present review focusses on the collection of results of pre-clinical studies carried out on homoeopathic medicines employed in the management of diabetes. Methodology: PubMed, HomBRex portal, and published literature such as library catalogue were searched up to November 2019. The search terms employed were 'Homoeopathy', 'Diabetes' and their MeSH variations in PubMed and in HomBrex search was made using the condition 'Diabetes'. Results: Fifteen studies were included in the review. Twenty medicines were evaluated for their antidiabetic efficacy either in vivo or in vitro. Most of the preclinical research on diabetes was carried out on Syzygium jambolanum and Cephalandra indica in mother tincture form and potencies, substantiating their effectiveness in the management of diabetes. Apart from the medicines discussed in the current review, there are many other medicines in Homoeopathy which are used to treat diabetes and these also should be validated scientifically for global acceptance by the scientific fraternity. Conclusion: Considering the hypoglycaemic potential, availability and cost-effectiveness of homoeopathic medicines, future research should focus on screening their effectiveness in the management of diabetic complications and other metabolic disorders.

CLINICAL TRIAL EVIDENCE ON CURCUMIN POTENTIAL FOR TYPE 2 DIABETES MELLITUS TREATMENT: A SYSTEMATIC REVIEW FROM 2015-2020

Regardless of the availability of diabetes medicines, diabetes mellitus and its complications are increasing and still a major global problem. This study aims to review the potential of curcumin to prevent diabetes mellitus complications in humans. A literature search with a systematic method was carried out across four databases (PubMed, Cochrane, ScienceDirect, and Taylor and Francis) from 2015-2020. Triglyceride (TG), Low-Density Lipoprotein-cholesterol (LDL-c), Body Mass Index (BMI), and body weight are the top four outcome parameters that have significant changes compared with the baseline condition. Meanwhile, when comparing the results with the control group, only TG, BMI, and body weight were observed to be significantly improved. Curcumin supplements administered through oral route, with their medicinal properties such as anti-inflammatory and antioxidant, have a significant role in preventing the development of cardiovascular, neurological, and nephrological complications in the diabetic patient through improving lipid profile, vascular stiffness, inflammation, and oxidative stress.

The Potency of Senggani (Melastoma malabathricum L) Leaves in Repair of Pancreatic Beta Cells for Diabetes Mellitus Patients: A Narrative Review

Diabetes mellitus is often caused by damage to pancreatic beta cells which play a role in secreting insulin in the body. Damage to pancreatic beta cells causes the body to lack insulin. Dipeptidyl peptidase-4 (DPP-4) is a peptidase enzyme complex located on the surface of the cell membrane. Inhibition of the DPP4 enzyme will increase blood GLP-1 levels and induce regeneration of pancreatic beta cells. Senggani leaf (Melastoma malabathricum) boiled water is believed by the people of the Ciamis area to be used as a diabetes medicine. There have been many studies and reviews related to Senggani (Melastoma malabathricum) and its potential. This review focuses on the discussion of Senggani as an antidiabetic by analyzing the reduction in glucose levels and the repair ability of pancreatic beta cells. The results of the literature study that show that senggani leaves have the ability to reduce blood glucose levels and repair activity of pancreatic beta cells through the DPP-4 enzyme inhibition mechanism supported by molecular docking simulation data. There are 12 active compounds that have a binding site similarity above 50% with the comparison compound vildagliptin. Rutin is the best active compound which has a 100% similarity of the binding site. Based on in vivo research and toxicity analysis on the admetsar database, senggani leaf extract and active compounds of senggani leaves have low toxicity, making it safe to be used as antidiabetic herbal preparations.

A new classification of diabetes mellitus – current approaches and challenges

Diabetes is a chronic metabolic disorder with a rapidly growing incidence worldwide. It is currently classified into two main types, type 1 and type 2 diabetes, based on status of the autoantibodies directed at the β-cell. However, it does not reflect the complexity of diabetes and the broad spectrum of the clinical manifestations, particularly in type 2.
 In this review we present the evolution of the World Health Organization (WHO) classification of diabetes, with a focus on newly introduced categories – hybrid forms of diabetes and unclassified diabetes. We compare the WHO diabetes subgroups with the American Diabetes Association (ADA) approach to this issue. Since the current classification systems do not reflect all the factors leading to hyperglycaemia in type 2 diabetes, we present novel approach to phenotyping diabetes in adults based on six variables (age at diagnosis, body mass index [BMI], C-peptide based homeostasis model assessments of β-cell function and insulin resistance, haemoglobin A1c and glutamic acid decarboxylase antibodies [GADA] status) which allowed to distinguish five replicable groups of patients in Swedish cohort with different clinical presentations.
 The understanding heterogeneity of diabetes helps to classify the patients more adequately, but none of classifications is optimal. Including combination of genetic, metabolomic and clinical factors into classification schemas will pave the way towards personalized medicine in diabetes and will presumably result in more effective treatment of the patients.

Generation of Functional Insulin-Producing Cells from Mouse Embryonic Stem Cells Through Protein Transduction of Transcription Factors.

In this chapter, we describe a simple and unique method for the differentiation of mouse embryonic stem cells into insulin-producing cells. In addition to cytokines and growth factors, key transcription factors for pancreatic development are applied in this method through protein transduction technology. Furthermore, a combination of nanofiber plates and laminin coatings improves the yield of differentiated cells. The insulin-producing cells derived through this method express marker genes of mature β-cells and have an ability to secrete insulin; therefore, these cells are useful for fundamental studies on pancreatic development, drug development, and regenerative medicine for diabetes.

PHENOLIC ACID PROFILING BY RP-HPLC: EVALUATION OF ANTIBACTERIAL AND ANTICANCER ACTIVITIES OF CONOCARPUS ERECTUS PLANT EXTRACTS

Due to the versatile application of plants the utilization of plants and their inferred substances builds up day by day for the revelation of new curative agents. Conocarpus erectus has placed in the family Combretaceae, in one of the two species of Conocarpus genus and ordinarily exists in tropical and subtropical regions of the world. In some countries it is used as folk medicine for fever, anemia, diabetes, catarrh, diarrhea and conjunctivitis. The current study was carried out to investigate the antibacterial and anticancer properties of the plant. The four defatted methanol extracts of C. erectus different parts (leaves, stems, fruits and bark) showed high antibacterial and anticancer activity even with small quantity of dose. Antimicrobial assay was used to check out the antibacterial activity against 6 bacterial strains Escherichia coli, Staphylococcus Aureus and Klebstella Pneumoniae. The results show that gram positive bacteria show more sensitivity and zone of inhibition as compared to gram negative bacteria. For anticancer activity, MTT assay was performed on HepG2 cells for this purpose. Plant extorts show anticancer activity with a minute quantity. For phytochemical screening defatted methanol extract of Conocarpus erectus was subjected to the silica gel glass column go behind by (RP-HPLC–UV–ESI-MS). It contains phenol such as tannin and flavinoid as major component. Plant contain Ellagic acid; di-hexahydroxy diphenyl, Vascalgin isomer as foremost tannin component. Gallic Acid, Kaempferol on the base of mass spectra and time of retention. The extract of Conocarpus erectus (leaves, shoot, bark & fruit) parts shows high antibacterial, antioxidant and hepta-protective activities due to phenolic content. Tannin has high antibacterial activity than other compound. C.erectus is notable for its folkloristic curative potential. More in vivo and in vitro phytochemical studies are needed to use the plant for prevention and treatment of many diseases.

Precision medicine in diabetes-Finally some light at the end of the tunnel?

Precision medicine in diabetes-Finally some light at the end of the tunnel?

Antioxidant and antidiabetic properties of isolated fractions from methanolic extract derived from the whole plant of Cleome viscosa L.

BackgroundCleome viscosa is considered as an important medicinal plant extensively used in India, China, Bangladesh, and a few countries in Africa. In the present study, in vitro anti-radical and antidiabetic potential of isolated fractions of methanolic extract of C. viscosa whole plant (MeCV) has been investigated. The identification of polyphenols and their related functional groups in the bioactive fraction was categorized by using HPLC and FT-IR.ResultsThe total phenolic and flavonoid contents of F-D were higher than those of F-A, F-B, and F-C. The F-D exhibited superior antioxidant capacity when compared with the remaining three fractions. However, the F-D showed the highest glucose diffusion activity over the 30 min–27 h incubation period and also inhibited both α-glucosidase and α-amylase enzyme activity. HPLC analysis revealed the presence of the two known compounds (protocatechuic acid hexoside, rutin) and six unknown compounds in the F-D. FTIR spectrum confirmed the presence of phenol group.ConclusionThe isolated F-D obtained from MeCV displayed superior antioxidant and antidiabetic activity which indicate the presence of polyphenols in the fraction. The data findings of the present study support the traditional uses of the whole plant of C. viscosa as a promising natural source of biological medicines for oxidative stress and diabetes.

Evaluation of 13-week subchronic toxicity of Platycodon grandiflorus (Jacq.) A.DC. root extract in rats

Ethnopharmacological relevancePlatycodi radix is widely used in traditional herbal medicine for bronchitis, asthma, pulmonary tuberculosis, hypertension, hyperlipidemia, and diabetes. However, data on safety of Platycodi radix are insufficient. Aim of the studyThe present study was performed to evaluate the potential subchronic toxicity of Platycodi radix water extract through a 13-week repeated oral dose experiment in Sprague–Dawley rats. Materials and methodsForty male and 40 female rats were randomly assigned to four experimental groups: three treatment groups receiving 300, 1000, and 3000 mg/kg/day of Platycodi radix water extract and a vehicle control group receiving sterile distilled water for 13 weeks. ResultsRepeated oral administration of the Platycodi radix water extract to rats resulted in an increased incidence of centrilobular hepatocellular hypertrophy in the liver, diffuse follicular cell hypertrophy in the thyroid gland, and squamous hyperplasia of the limiting ridge in the stomach at dose levels of ≥500 mg/kg/day of both genders. However, these findings are considered be adaptive non-adverse changes because these findings were observed without organ weight change or clinical pathology alterations. No treatment-related effects on clinical signs, body weight, food and water consumption, ophthalmic examination, urinalysis, hematology, serum biochemistry, necropsy findings, and organ weights were observed at any dose tested. ConclusionUnder the present experimental conditions, the no-observed-adverse-effect level of the Platycodi radix water extract was considered to be ≥ 3000 mg/kg/day in rats, and no target organs were identified.

Monogenic Diabetes: From Genetic Insights to Population-Based Precision in Care. Reflections From a Diabetes Care Editors' Expert Forum.

Individualization of therapy based on a person’s specific type of diabetes is one key element of a “precision medicine” approach to diabetes care. However, applying such an approach remains difficult because of barriers such as disease heterogeneity, difficulties in accurately diagnosing different types of diabetes, multiple genetic influences, incomplete understanding of pathophysiology, limitations of current therapies, and environmental, social, and psychological factors. Monogenic diabetes, for which single gene mutations are causal, is the category most suited to a precision approach. The pathophysiological mechanisms of monogenic diabetes are understood better than those of any other form of diabetes. Thus, this category offers the advantage of accurate diagnosis of nonoverlapping etiological subgroups for which specific interventions can be applied. Although representing a small proportion of all diabetes cases, monogenic forms present an opportunity to demonstrate the feasibility of precision medicine strategies. In June 2019, the editors of Diabetes Care convened a panel of experts to discuss this opportunity. This article summarizes the major themes that arose at that forum. It presents an overview of the common causes of monogenic diabetes, describes some challenges in identifying and treating these disorders, and reports experience with various approaches to screening, diagnosis, and management. This article complements a larger American Diabetes Association effort supporting implementation of precision medicine for monogenic diabetes, which could serve as a platform for a broader initiative to apply more precise tactics to treating the more common forms of diabetes.

Rury Holman: the science of diabetes and a life of trials

Although he doesn't recommend formal retirement as a career move, Rury Holman appreciates its benefits. He is now Emeritus Professor of Diabetic Medicine at the University of Oxford, UK, and former Director of Oxford's hugely successful Diabetes Trials Unit (DTU), which he founded in 1985. But in many respects his work in the past year has continued much as ever. Less time on administration has created more time for science. “I'm still collaborating with people globally, writing up manuscripts, working with statisticians”, he says. “I don't have the problems of running the unit, so in some ways it's done me a favour. It's made me more productive.” The Lancet Commission on diabetes: using data to transform diabetes care and patient lives2020 will go down in history as the year when the global community was awakened to the fragility of human health and the interdependence of the ecosystem, economy, and humanity. Amid the COVID-19 pandemic, the vulnerability of people with diabetes during a public health emergency became evident by their at least 2 times increased risk of severe disease or death, especially in individuals with poorly controlled diabetes, comorbidities, or both. The disease burden caused by COVID-19, exacerbated by chronic conditions like diabetes, has inflicted a heavy toll on health-care systems and the global economy. Full-Text PDF

Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India.

Limited access to essential medicines (EMs) for cardiovascular disease (CVD) and diabetes is a major concern in low- and middle-income countries. We aimed to generate data on availability, price and affordability of EMs for CVD and diabetes in India. Using WHO/HAI survey methodology, we evaluated availability and prices of 23 EMs in 30 public sector facilities (government hospitals and semi-public/government-subsidised-discount-pharmacies (GSDPs)) and 60 private retail pharmacies across six districts in Kerala state, India (November 2018 - May 2019). Median Price Ratios (MPRs) were calculated by comparing consumer prices with international reference prices. We also analysed data (collected in July 2020) on six anti-hypertensive fixed-dose-combinations (FDCs) that were designated as 'essential' by the WHO in 2019. Mean availability of surveyed generic EMs was 45.7% in government hospitals, 64.7% in GSDPs and 72.0% in private retail pharmacies. On average, the most-sold and highest-priced generics, respectively, were 6.6% and 8.9% costlier than the lowest-priced generics (LPG). Median MPR for LPG was 2.71 in private retail and 2.25 in GSDPs. Monthly supply of LPG would cost the lowest-paid worker 1.11 and 0.79days' wages in private retail and GSDPs, respectively. Mean availability of the surveyed FDCs was poor (private retail: 15-85%; GSDPs: 8.3-66.7%), and the private retail prices of FDCs were comparable to the sum of corresponding constituent monotherapies. Availability of CVD and diabetes EMs fall short of WHO's 80% target in both sectors. Although availability in the private retail pharmacies was near-optimal, prices appear unaffordable compared to GSDPs. Initiatives such as mandating generic prescribing, adding the WHO-approved FDCs in local EM lists, improving price transparency, and streamlining medicine supply to ensure equitable access to EMs, especially in the public sector, are crucial in tackling Kerala's ever-increasing CVD burden.

Impact of Traditional and Modern Clinics on Diabetes Control in Zanzibar: A Case of Urban West Region- Unguja

This study aimed at examining the impact of traditional and modern clinics on diabetes management in Urban West Region of Unguja. The sample size for this study consisted of 80 geriatrics diabetes patients. Survey questionnaire was used as a data collection instrument. Descriptive as well as inferential statistics were used to analyse the collected data from relevant respondents. The findings showed that, diabetes medicines are available in the clinics for almost (73.8%). It was found out that, much of the geriatrics diabetes patients around (56.3%) believed in modern rather than traditional medicines. However, both of them were used and have positive impact on diabetes control in the Urban West Region of Unguja - Zanzibar. Finally, the study recommends that, provision of education concerning diabetes should be prioritized. The authorities responsible for the supervision of drugs especially ZFDA and Ministry of Health must conduct more research on the traditional medicines. The medicines used for the treatment of the diabetes administered to the geriatrics diabetes patients must be procured in adequate quantities. School curricula should include several topics of diabetes. National multi-sectorial committees should be formulated to review the policy and regulation of traditional services provision and delivery in Zanzibar. Keywords: Geriatrics, Traditional clinics, Modern clinics and Diabetes Control DOI: 10.7176/JHMN/82-05 Publication date: November 30 th 2020

Genetic Studies for Diabetes in Asia – The Key to Precision Medicine (Vol. 24, No. 11, Full Issue)

For the month of November 2020, APBN takes a dive into the genetic links behind the diabetes epidemic in Asia. Looking specifically at genetic markers for diabetes in Asian populations, researchers have discovered unique identifiers that could promote development precision medicine for diabetes in the Asia Pacific region. In the Spotlights, we explore innovative research from the 2020 Tokyo Tech Research Showcase and how they are helping to build a greener and sustainable future. Check out in our columns the future of commercial space flight and how space tourism is becoming a reality.

Priorities and practicalities of prescribing diabetes medicines with cardiovascular and renal protective effects: an Australian perspective.

Recent cardiovascular safety trials on sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists have demonstrated the significant cardiovascular and renal benefits of these medications. Diabetes organisations have revised their medication guidelines to include a focus on disease outcomes for cardiovascular disease, heart failure and renal disease. This article summarises latest evidence, guideline recommendations and current Australian Pharmaceutical Benefits Scheme requirements.

Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya

Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC...

Association between faecal occult bleeding and medicines prescribed for chronic disease: a data linkage study

AimsThe presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal...

R&D leaders at Merck and Sanofi move on

After 7 years leading Merck Research Laboratories, Roger Perlmutter will retire at the end of 2020. Under his leadership, Merck has achieved some 100 regulatory approvals for treatments, including medicines for cancer and diabetes. Perlmutter will be succeeded by Dean Li, currently head of discovery sciences and translational medicine. And after 8 years at Sanofi, Chief Scientific Officer Gary Nabel is leaving. His replacement is Frank Nestle, who was named head of Sanofi’s immunology and inflammation programs this summer.

In Vivo Studies of Inoculated Plants and In Vitro Studies Utilizing Methanolic Extracts of Endophytic Streptomyces sp. Strain DBT34 Obtained from Mirabilis jalapa L. Exhibit ROS-Scavenging and Other Bioactive Properties.

Reactive oxygen species (ROS) and other free radicals cause oxidative damage in cells under biotic and abiotic stress. Endophytic microorganisms reside in the internal tissues of plants and contribute to the mitigation of such stresses by the production of antioxidant enzymes and compounds. We hypothesized that the endophytic actinobacterium Streptomyces sp. strain DBT34, which was previously demonstrated to have plant growth-promoting (PGP) and antimicrobial properties, may also have a role in protecting plants against several stresses through the production of antioxidants. The present study was designed to characterize catalase and superoxide dismutase (SOD), two enzymes involved in the detoxification of ROS, in methanolic extracts derived from six endophytic actinobacterial isolates obtained from the traditional medicinal plant Mirabilis jalapa. The results of a preliminary screen indicated that Streptomyces sp. strain DBT34 was the best overall strain and was therefore used in subsequent detailed analyses. A methanolic extract of DBT34 exhibited significant antioxidant potential in 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2′-azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS) assays. The cytotoxicity of DBT34 against liver hepatocellular cells (HepG2) was also determined. Results indicated that methanolic extract of Streptomyces sp. strain DBT34 exhibited significant catalase and SOD-like activity with 158.21 U resulting in a 55.15% reduction in ROS. The IC50 values of a crude methanolic extract of strain DBT34 on DPPH radical scavenging and ABTS radical cation decolorization were 41.5 µg/mL and 47.8 µg/mL, respectively. Volatile compounds (VOC) were also detected in the methanolic extract of Streptomyces sp. strain DBT34 using GC-MS analysis to correlate their presence with bioactive potential. Treatments of rats with DBT34 extract and sitagliptin resulted in a significant (p ≤ 0.001) reduction in total cholesterol, LDL-cholesterol, and VLDL-cholesterol, relative to the vehicle control and a standard diabetic medicine. The pancreatic histoarchitecture of vehicle control rats exhibited a compact volume of isolated clusters of Langerhans cells surrounded by acinies with proper vaculation. An in-vivo study of Streptomyces sp. strain DBT34 on chickpea seedlings revealed an enhancement in its antioxidant potential as denoted by lower IC50 values for DPPH and ABTS radical scavenging activity under greenhouse conditions in relative comparison to control plants. Results of the study indicate that strain DBT34 provides a defense mechanism to its host through the production of antioxidant therapeutic agents that mitigate ROS in hosts subjected to biotic and abiotic stresses.

Gardenia ternifolia Schum. & Thonn. (Rubiaceae): Review of medicinal uses, phytochemistry and biological activities

Gardenia ternifolia Schum. & Thonn. is a shrub or small tree widely used as a traditional medicine throughout its distributional range in tropical Africa. Gardenia ternifolia is widespread in tropical Africa, extending from Senegal eastwards to Ethiopia and Kenya, through the Democratic Republic of Congo (DRC) southwards to Namibia, South Africa and Mozambique. This study was aimed at providing a critical review of the medicinal uses, phytochemistry and biological activities of G. ternifolia. Documented information on the medicinal uses, phytochemistry and biological activities of G. ternifolia was collected from several online sources which included Scopus, Google Scholar, PubMed and Science Direct. Additional information was gathered from pre-electronic sources such as book chapters, books, journal articles and scientific publications obtained from the university library. This study showed that the species is widely used as an aphrodisiac and protective charm, and traditional medicine for headache, migraine, respiratory infections, sore eyes, hypertension, diabetes, gastro-intestinal problems, erectile dysfunction, malaria, convulsions and epilepsy. Phytochemical compounds identified from the species include alkaloids, anthocyanins, coumarins, flavonoids, phenols, quinones, saponins, steroids, stereoisomeric neolignans, tannins and terpenoids. Pharmacological research revealed that G. ternifolia extracts and compounds isolated from the species have antibacterial, antiviral, anti-inflammatory, antileishmanial, antioxidant, antiplasmodial, antisickling, antitheilerial, hepatotoxicity, larvicidal and cytotoxicity activities. Future research on G. ternifolia should focus on detailed phytochemical evaluations, including toxicological, in vivo and clinical studies to corroborate the traditional medical applications of the species.