Current Diabetes Reviews - Volume 10, Issue 6, 2014

Diabetes mellitus, an endocrine disorder affecting glucose metabolism, has been crippling mankind for the past two centuries. Despite the advancements in the understanding pertaining to its pathogenesis and treatment, the currently available therapeutic options are far from satisfactory. The growing diabetic population increases the gravity of the situation. The shortcomings of the conventional drug delivery systems necessitate the need to delve into other routes. On account of its merits over other routes, the transdermal approach has drawn the interest of the researchers around the world. The transdermal drug delivery systems are aimed to achieve therapeutic concentrations of the drug through skin. These systems are designed so that the drug can be delivered at a pre-determined and controlled rate. This makes it particularly conducive to treat chronic disorders like diabetes. Correspondingly, the adverse effects and inconvenience concomitant with oral and parentral route are circumvented. This article attempts to outline the development of transdermal drug delivery systems to optimize diabetes pharmacotherapy. It not only covers the transdermal approaches adopted to fine-tune insulin delivery, but also, discusses various transdermal drug delivery systems fabricated to improve the therapeutic performance of oral hypoglycaemic agents. Such formulations include the advanced drug delivery systems, namely, transferosomal gels, microemulsions, self-dissolving micropiles, nanoparticles, insulin pumps, biphasic lipid systems, calcium carbonate nanoparticles, lecithin nanoparticles; physical techniques such as iontophoresis and microneedles and, drugs formulated as transdermal patches. In addition to this, the authors have also shed light on the future prospects and patented and commercial formulations of antidiabetic agents.

Corticosteroid-induced hyperglycemia is a common medical problem which can cause frequent hospitalizations and therefore relates to an increase in morbidity. Metformin, sulfonylureas, thiazolidinediones and insulin are well known available therapies for the treatment of steroid induced hyperglycemia. Incretin based therapies are a newly developing strategies with a considerable importance in the treatment regimen as well. This review aims at discussing the pathophysiology of steroid induced hyperglycemia in addition to the available therapies used for treatment, focusing on incretin therapies.

Diabetes management is complex and requires significant effort from the person with diabetes to achieve recommended self-management behaviours. Achieving guideline concordant self-management is made easier when the person with diabetes is committed to the behaviours. Ambivalence is the psychological state in which a person experiences inconsistent drives; both toward and away from the recommended behaviour. Ambivalence about achieving recommended control over blood glucose is expected in situations of hypoglycaemia, due to the associated dangers. In this paper we demonstrate that hypoglycaemia is a fear event and is likely to elicit strong drives to avoid future hypoglycaemia as a fear coping strategy. For many, this results in hyperglycaemia. If hyperglycaemia to avoid hypoglycaemia is a fear management strategy, then hypoglycaemia management should involve fear management. Few diabetes healthcare providers are trained, skilled and confident in fear management. The purpose of this paper is to review the evidence on the psychological consequences of hypoglycaemia and to outline fear management strategies that can be implemented by diabetes care providers. A step-by-step guide is provided to facilitate understanding of the process of the intervention.

Diabetes mellitus (DM), an increasing health problem worldwide, is associated with severe cardiovascular complications. To date, the beneficial effects of physical activity in both prevention and treatment of DM and its complications are well established. Nevertheless, it appears that exercise training, depending on the load, exerts differential effects on the myocardium. Hence, in this review, the impact of exercise training, focusing on exercise modalities and adaptations in response to load, on diabetic cardiovascular function, are discussed. Molecular mechanisms that may be involved in these adaptions to exercise training are also addressed.

Dyslipidemia and inflammation are frequently found in some diseases, such as obesity, type 2 diabetes mellitus, and cancer cachexia. Recent literature has identified that lipids have a pivotal role in the activation of inflammatory pathways, increasing the production of inflammatory cytokines, mainly tumor necrosis factor alpha, interleukin 6 and 1β. On the other hand, cytokines can promote disruption of lipid metabolism, in special cholesterol reverse transport, which is linked to development of atherosclerosis. With this in mind, acute and chronic exercise trainings have been pointed as important tools to counteract both dyslipidemia symptoms and systemic inflammation. Moreover, physical activity has been recommended in the prevention/treatment of the above mentioned outcomes by important health organizations around the world, mainly because it costs less and generates fewer side effects than isolated medicine. Despite the well-documented capacity of acute and chronic exercise training to counteract sustained disease-related immunometabolism, we have chosen to take a look from a current perspective in molecular pathways and in the field of epidemiology. The aim of the present review was therefore to discuss the results of dyslipidemia and inflammatory conditions with acute and chronic exercise training, which underlies the field of molecular pathways and epidemiology. The mechanisms underlying the response to the treatment are considered.

Diabetes mellitus has been increasing rapidly worldwide, making it a huge health pressure on society in both the developed and developing countries. During the last thirty years, diabetes mellitus, a chronic metabolic disease characterized by hyperglycemia is proving itself to be fatal. Periodontitis was considered as one of the main, oral health problems encountered in patients with diabetes mellitus. There exists a direct relation between the risk of complications of diabetes and periodontitis over time. The present review gives an outline of the features that govern the interrelationship between zinc and diabetes mellitus with periodontal disease, including the physiologic mechanisms and clinical studies, and presents scientific evidences. The disturbance in the zinc micronutrient and increased oxidative stress in type 2 diabetes may bring about insulin resistance and the creation of diabetic complications. The progression of diabetes mellitus may bring about perturbation in micronutrient metabolism and status.

The purpose of this project was to identify the self-care needs of adults with diabetes who experience food insecurity. A cross-sectional study design and methodology were used to attain the study data. We invited 153 adults with diabetes who utilized the St Vincent de Paul Food Pantry to complete the diabetes knowledge test. The reliability of the sample was calculated using Cronbach's coefficient α. To determine validity, differences in test scores were examined by diabetes type and treatment, educational attainment, and receipt of diabetes education. Results: The coefficient α for the general test and the insulin-use subscale indicated that both were moderately reliable, α> 0.60. General test scores were significantly associated with educational attainment (p<0.01) and prior diabetes education (p<0.05). We found that participants who attained education beyond high school or previously received diabetes education scored significantly higher on the test compared to those with less than high school education or not receiving diabetes education (p<0.05). Adults with type 1 diabetes had higher general and insulin use scores compared to adults with type 2 diabetes, however the difference was not statistically significant. While general knowledge about diabetes is not a predictor of self-care behavior, it is needed to perform daily self-care activities. Health care providers should assess diabetes knowledge in low income patients who experience food insecurity regularly to identify any gaps in knowledge that can compromise self-care behaviors.