Medicine
Are Vaginal Suppositories of Quercus infectoria fruit hulls Effective on the Signs and Symptoms of Vulvovaginal Candidiasis? A Triple-Blind Controlled Clinical Trial
This study aims to compare the effects of Quercus Infectoria Fruit Hulls (QIFH) with Clotrimazole vaginal suppositories on the signs and symptoms of vulvovaginal candidiasis.
Vulvovaginal Candidiasis (VVC) is an infection caused by Candida species. Although the antimicrobial effects of QIFH have been confirmed there is no clinical study on its effects on VVC.
One hundred married women (aged 18-45 years) with complaints of vulvar pruritus or burning were recruited for a triple-blind clinical trial at a health center affiliated with Khorramabad University of Medical Sciences. After a definitive diagnosis of vulvovaginal candidiasis the eligible women were randomly divided into two groups: one receiving QIFH vaginal suppositories (n=45) and the other receiving Clotrimazole vaginal suppositories (n=45). The patients were instructed to use the medications for 7-10 nights. The symptoms and signs of VVC were compared before and after treatment within each group and between the two groups. The data were analyzed using SPSS 24 employing both parametric and non-parametric tests with a 95 percent confidence interval.
The symptoms and signs of VVC including pruritus burning and irritation vaginal discharge vaginal redness and swelling with white thick discharge significantly improved in both groups after treatment (p<0.001). There were no significant differences between the two groups of QIFH vaginal suppository users and Clotrimazole users regarding the relief of signs and symptoms after treatment (p>0.05).
A study comparing Clotrimazole and QIFH vaginal suppositories found that Quercus infectoria extract effectively treated candida and reduced its growth. Treatment with QIFH significantly improved pruritus symptoms. The tannin ingredient in QIFH's tannins acted through various mechanisms providing therapeutic and antioxidant effects. QIFH could be an alternative for VVC treatment for women.
The QIFH vaginal suppository was as effective as Clotrimazole in treating the symptoms and signs of VVC without any adverse effects. Given the prevalence of VVC and the similarities in the treatment processes with QIFH and Clotrimazole it can be concluded that QIFH may be an appropriate alternative for VVC treatment for women who prefer to use herbal medicine.
Clinical Trial Registration No. IRCT20190306042943N2.
Investigating the Potential Quality Markers of Danxi Granule against Ischemic Stroke Using an Absorbed into Blood-Fingerprint-Network-Verification Approach
Cerebral ischemic stroke (CIS) severely endangers health and there is an urgent need for effective therapeutic drugs and in-depth research on its mechanism of action. Danxi Granule has potential application in the relevant treatment.
This study aimed to explore the potential quality markers therapeutic targets and molecular mechanisms of Danxi Granule in treating CIS through the “Absorbed into Blood- Fingerprint-Network-Verification” paradigm.
An MCAO rat model was established. Serum samples from three groups were analyzed by UPLC-MS to identify blood-absorbed prototype components. The fingerprint and measurable chemical components of Danxi Granule were obtained using specific chromatographic conditions. Potential quality markers were determined by cross-referencing. Network pharmacology with databases like GeneCards and OMIM and relevant software were used for gene identification and pathway enrichment analysis. Five identified compounds were tested in an OGD/R-induced HT22 cell model.
A total of 207 blood-absorbed prototype components were identified. Ten-batch fingerprint analysis of Danxi Granules showed high similarity with 15 common peaks (8 corresponding to measurable constituents). Five potential quality markers were determined. These compounds targeted 184 genes intersecting with 73 disease-related ones. Network analysis revealed 10 key genes and cellular experiments confirmed the protection of HT22 cells with TNF as a core target.
In this study an HPLC fingerprint was established using UPLC-MS technology and five potential Q-markers were screened out. Through network pharmacology and cell experiments these markers were validated to exert anti-CIS effects via mechanisms such as anti-inflammation thereby revealing the material basis of the pharmacological effects of Danxi Granules. The findings of this study provide a basis and new perspectives for quality standard research clinical application and the modernization of complex traditional Chinese medicine (TCM) systems. However the current mechanistic investigation remains at a superficial level and subsequent studies should further deepen the systematic exploration of the underlying action mechanisms.
The “absorbed into blood-fingerprint” paradigm identified five potential quality markers namely cryptotanshinone tanshinone IIA aurantio-obtusin icariin and paeoniflorin. Validation through the “network-verification” paradigm confirmed their quality marker status and demonstrated that their anti-CIS mechanisms likely involve suppressing TNF-α IL-6 and IL-1β expressions thereby exerting anti-inflammatory effects.
New Kampo Improves Cognitive Decline in Alzheimer’s Disease and Mild Cognitive Impairment and Renal Function Decline in Chronic Kidney Disease
Alzheimer’s disease (AD)-related dementia and mild cognitive impairment (MCI) are often complicated by CKD. This study aims to identify a therapeutic agent that can improve cognitive function and alleviate chronic kidney disease (CKD) in patients. It also explores the effectiveness of the combination of Ryoukeijutsukanto and Ourengedokuto (RO-8) a Kampo medicine for treating cognitive decline and renal function impairment in patients with co-morbid CKD.
In this retrospective single-center study patients with AD who visited the clinic were selected. Cognitive function and kidney function of all participants in the control and treatment groups were assessed using Hasegawa’s Dementia Scale (HDS-R) and the estimated glomerular filtration rate (eGFR) respectively. Statistical analyses were performed to measure the differences in the HDS-R scores and eGFR values before and after the observation or treatment period.
The Kampo medicine RO-8 improved cognitive function in 90.9% (70/77) of patients and cognitive decline in 3.9% (3/77) of patients with AD and MCI. At the same time 38.7% (29/75) of the patients with AD and MCI who were treated had chronic kidney disease (CKD) 65.5% (19/29) of which exhibited an improvement in the eGFR.
Despite being a single-center and retrospective study the findings underscore the potential of mixed Kampo medicine in restoring both cognitive and kidney function in patients with AD or MCI and CKD.
RO-8 may exert beneficial effects on cognitive decline in patients with Alzheimer’s dementia and MCI through an anti-inflammatory pathway and can be further explored as an alternative anti-inflammatory drug to treat AD.
Saudi Clinical Studies on Traditional Herbal Medicines for Diabetes: A Systematic Review
Diabetic patients in Saudi Arabia commonly use herbal medicines (HMs) to manage their condition. Research studies indicate that up to 70% of this population has tried HMs with popular choices including Cinnamomum verum Zingiber officinale Trigonella foenum-graecum Allium sativum Aloe vera Olea europaea and Nigella sativa. More clinical trials evaluating their safety and effectiveness are needed to increase the adoption of these herbal remedies.
This systematic review aims to review clinical research in the Saudi Arabian context on the efficacy of commonly used HMs for diabetes.
A comprehensive search of medical literature was conducted to identify the most popular herbs used by Saudi diabetic patients. The PubMed Cochrane Medline and ScienceDirect databases were utilized to find research studies published in Saudi Arabia that examined the effectiveness of traditional herbal remedies for managing diabetes.
Only four relevant studies from Saudi Arabia were identified with three specific herbs (Trigonella foenum-graecum Zingiber officinale and Nigella sativa) used in all four studies. Two of the studies were blind clinical trials but only one was double-blinded. The methodological quality of these studies was assessed using the Jadad score with scores ranging from 1 to 3.
Although Saudi Arabia has a large population of diabetic patients its contribution to clinical research in this field remains limited. Establishing research groups and developing a sustainable infrastructure could help to address this problem and promote more rigorous studies on HMs.
Systematic Review Registration: PROSPERO CRD 42024602747.
Effectiveness and Safety of Astragalus-containing Chinese Medicine Combined with Western Medicine for Diabetes: A Systematic Review and Meta-Analysis
This study aims to comprehensively summarize the clinical evidence comparing the effectiveness and safety of integrating astragalus-containing Chinese medicines with western medicines for T2DM.
Six databases were searched for eligible studies from inception to June 2023. The aggregated outcomes were expressed as odds ratio (OR) or standardized mean difference (SMD). Random effect model was used for statistical analyses. The risk of bias for included studies was assessed with the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed with the Grades of Recommendations Assessment Development and Evaluation approach.
The results showed a significant improvement in the FPG (SMD -0.98; 95%CI -1.23 -0.72) 2hPG (SMD -0.94; 95%CI -1.13 -0.76) HbA1c (SMD -0.97; 95%CI -1.18 -0.75) HOMA-IR (SMD -1.07; 95%CI -1.47 -0.66) HOMA-β (SMD 0.84; 95%CI 0.38 1.31) HDL (SMD 0.41; 95%CI 0.17 0.66) LDL (SMD -1.17; 95%CI -1.62 -0.72) TC (SMD -0.83; 95%CI -1.06 -0.59) and TG (SMD -0.93 95%CI -1.20 -0.65) with astragalus-containing TCMs plus conventional therapy comparing to conventional therapy alone. The incidence of hypoglycemia and gastrointestinal tract adverse events was significantly reduced in the combination group. Subgroup analyses based on the type of western medicines type of traditional Chinese medicines baseline glucose level follow-up duration and disease subtypes all indicated the similar results regarding the superior effectiveness in the combination group.
The meta-analyses suggested the astragalus-containing TCMs plus WMs surpassed WMs monotherapy in terms of decreasing the FPG 2hPG and HbA1c level. Our results were limited by the quality of trials included in the meta-analyses.
Add-on therapy of astragalus-containing TCMs was generally more effective in ameliorating the glycolipid metabolism and improving insulin resistance. The clinical benefits of integrative therapies remained in different subgroup patients.
Postpartum Medicinal Plants of the Malay Tribe in Bentunai Village, Selakau Sub-District, Sambas District
Bentunai Village is located in Selakau District Sambas Regency West Kalimantan. The majority of the villagers are Malay tribes who have local wisdom regarding the use of medicinal plants after childbirth. Hence this study aimed to determine the types of plants plant parts and processing methods used by the Malay tribe in postpartum care.
The materials used were medicinal plants 70% alcohol for plant fixation plastic packing size 30x60 cm merang paper thick cardboard and tape. This research used triangulation techniques namely interviews observation and documentation.
There are 14 types of plants used by the Malay tribe of Bentunai Village for postpartum care namely sembung (Blumea balsamifera) balik angin (Mallotus paniculata (Lam.) M) patikan cina (Euphorbia sp.) cengkeh (Syzygium aromaticum (L.) Merr & L. M. Perry) lada (Piper nigrum L.) cabe jawa (Piper retrofractum Vahl.) ciplukan (Physalis angulata L.) kunyit (Curcuma longa L.) temulawak (Curcuma zanthorrhiza Roxb) lempuyang (Zingiber zerumbet (L.) Roscoe ex Sm.) jahe (Zingiber officinale Roscoe.) banglai (Zingiber purpureum Roscoe) kencur (Kaempferia galangan L.) and lengkuas hutan (Zingiber sp.).
In conclusion the most widely used plant family is Zingiberaceae the most widely used part is the leaves and there are three ways of processing plants namely boiled brewed and pounded.
Diabetes Mellitus: Exploring Biomarkers, Complications, and Therapeutic Strategies with a Spotlight on Cyanobacterial Bioactive Compounds - A Comprehensive Review
Diabetes regarded as a prevalent metabolic disorder with multifactorial origins contributes to a myriad of global complications. These cumulate an elevated susceptibility to kidney failure nerve impairment blindness atherosclerosis heart ailments and even strokes. Recent investigations underscore the diverse roles of associated biomarkers in diabetes progression. Among these are biomarkers for diabetes mellitus such as DPP-4 PPAR-ϒ SGLT-2 α-amylase and α-glucosidase which are linked to the onset of diabetes and its related problems. As a result of undesirable adverse consequences linked to extant synthetic antidiabetic medications research attention is increasingly directed towards formulating natural antidiabetic drugs aiming for enhanced efficacy and reduced complications. Cyanobacteria stand out as a pivotal repository of natural bioactive metabolites extensively harnessed for pharmaceutical and nutraceutical development. The potent bioactive compounds sourced from cyanobacteria hold substantial promise kindling high expectations in scientific research and presenting vast prospects for drug discovery and advancement. Some of these bioactive compounds have demonstrated impressive effectiveness displaying successful applications across various phases of clinical trials. This review strives to provide a more precise understanding of diabetes mellitus encompassing its clinical manifestation epidemiological data complications and prevailing treatment modalities. The objective of this review is to contribute researchers and readers an enhanced and accurate understanding of diabetes mellitus by covering its clinical manifestation epidemiological evidence difficulties and prevailing therapeutics possibilities.
Herbal Insights: Exploring the Therapeutic Potential of Indian Dietary Herbs in Diabetic Cardiomyopathy Management
Diabetic Cardiomyopathy (DCM) poses a substantial healthcare challenge necessitating innovative therapeutic strategies. This review delves into the evolving role of traditional Indian dietary herbs in managing DCM aiming to shed light on their potential contributions.
A comprehensive examination of the existing body of literature was conducted synthesizing data from studies exploring the effects of various Indian dietary herbs on DCM. Molecular mechanisms clinical outcomes and safety profiles were scrutinized to establish a holistic perspective on their therapeutic potential.
The review illuminates the multifaceted benefits of Indian dietary herbs in DCM management. These herbs have demonstrated efficacy in mitigating cardiac dysfunction reducing oxidative stress and modulating inflammatory responses. Molecular insights highlight their role in the intricate signaling pathways underlying DCM. Furthermore their safety profiles render them promising candidates for adjunct therapy.
Indian dietary herbs emerge as promising allies in the battle against DCM offering a holistic approach to the management of this intricate condition. Their cardioprotective effects coupled with their ability to address the underlying molecular mechanisms herald a new era in DCM therapy. This review underscores the need for further research to harness the potential of these herbs fully and provides a beacon of hope for individuals affected by DCM.
Phloridzin's Diabetic Wound Healing Potential through DPP-4 Enzyme Inhibition: A Review Article
Diabetic wound healing is a dynamic medical process that takes place in an environment within the body that is complex and contains elevated sugar levels oxygen deprivation and cellular oxidative stress. Phloridzin (Phlorizin) is one of the most well-known polyphenols found in apples because of its anti-inflammatory antioxidant antibacterial antidiabetic and antiseptic properties; it can also play a significant part in the healing of diabetic wounds.
The study aimed to investigate the role of phloridzin as an efficient DPP-4 inhibitor with additional therapeutic effects in diabetic wound healing as Dipeptidyl Peptidase-4 (DPP-4) expression increases in response to increases in glucose Reactive Oxygen Species (ROS) and inflammation. Phloridzin inhibiting DPP-4 preserves Stromal cell-derived Factor-1α (SDF-1α) Insulin-like Growth Factor (IGF) and Glucagon-like Peptide-1 (GLP-1) which are possible DPP-4 substrates involved in wound healing.
The accessible material from systemic searches in PubMed Scopus and published articles was reviewed with no period of limitation.
The in silico study showed strong binding of phloridzin with DPP-4 protein (2P8S); also in vitro DPP-4 inhibition assay has shown better inhibition by phloridzin. This study offers new research directions for examining phloridzin’s capacity to withstand oxidative stress as well as for redefining its tactical function as a powerful DPP-4 inhibitor to regulate the process involved in the healing of diabetic wounds.
Evidence of a Bi-Directional Relationship between Arterial Stiffness and Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies
There are numerous cross-sectional studies showing an association between arterial stiffness and diabetes but the temporality of the association is unclear.
To investigate the temporal relationship between arterial stiffness and diabetes.
We searched MEDLINE and Embase from inception to 31 August 2023 to identify cohort studies that assessed whether arterial stiffness as measured by pulse wave velocity (PWV) was predictive of the development of diabetes and vice versa. We summarised study data and where possible undertook meta-analysis.
We identified 19 studies that included people with type 1 type 2 and gestational diabetes. All 11 studies investigating arterial stiffness as a predictor of diabetes found a significant relationship. Six of those studies were suitable for meta-analysis. The risk of developing diabetes was greater in people with higher PWV at baseline than lower PWV (RR = 2.14 95%CI 1.65 to 2.79 p < 0.00001) and the mean difference in baseline PWV was higher in people who developed diabetes than those who did not (mean difference: 0.77 m/s 95%CI 0.47 to 1.06 p < 0.00001). Of 8 studies investigating diabetes as a predictor of arterial stiffness 7 found a significant relationship.
There is evidence of a bidirectional relationship between arterial stiffness and diabetes. Arterial stiffness may provide a causal link between diabetes and future cardiovascular disease.
CRD42019129563.
The Effect of COVID-19 Lockdown Among Adolescents with Type 1 Diabetes: A Systematic Review and Meta-Analysis
The aim of this study was to assess how the lockdown of the COVID-19 pandemic had affected the glycaemic control of adolescents aged 10-19 with type 1 diabetes.
A comprehensive search of literature was performed in PubMed Scopus Web of Science and ProQuest. Published articles up to September 2022 were included. The Glucose Monitoring Index (GMI) and HbA1c level were defined as outcome variables. Average glucose level was found to be a common variable in both HbA1c levels and GMI; therefore HbA1c and GMI were converted to average glucose (mg/dL) using appropriate formulas. Studies reported the outcomes in two or three periods (pre-lockdown lockdown and post-lockdown) were included in the analysis. A paired wise meta-analysis was performed among the studies that reported all three periods. Homogeneity across studies was assessed using I2 statistic.
Fourteen studies were included in the study. The pooled average glucose during the lockdown decreased to 166.9 mg/dL (95% CI 153.78 180.02) from 205.793 mg/dL (95% CI 188.412 223.173) during the pre-lockdown period then it increased to 204.23 mg/dL (95% CI 186.17 222.29) during the post-lockdown period. A paired wise meta-analysis indicated a reduction in average glucose levels. However it was not statistically significant possibly due to the small number of studies that reported data from all three periods.
Although the descriptive analysis of our study showed that the lockdown had affected (decreased) the average glucose level among adolescents with type 1 diabetes this was not statistically significant in the pooled analysis.
The Impact of Low-Volume High-Intensity Interval Training (LV-HIIT) on Fatty Liver Index (FLI) and Estimated Glomerular Filtration Rate (eGFR) in Patients with Type 2 Diabetes Mellitus (T2DM)
Prevention and reduction of liver fat accumulation and maintenance of Glomerular Filtration Rate (GFR) have been proposed as important therapeutic goals in patients with Type 2 Diabetes Mellitus (T2DM).
This study aimed to determine the effect of Low-Volume High-Intensity Interval Training (LV-HIIT) on fatty liver index (FLI) and GFR estimation in patients with T2DM.
This randomized controlled trial included 80 patients with T2DM and a sedentary lifestyle randomly divided into HIIT (n=40) and a control group (n=40). Patients with a history of T2DM for at least one year and HbA1C levels between 6.4% and 10% were selected. The intervention group underwent a 4-week LV-HIIT course comprising 3 sessions per week while the control group did not receive any intervention. FLI eGFR anthropometric measurements and laboratory variables were assessed in all participants before and after the intervention.
FLI (62.0 at baseline 53.0 at follow-up) significantly decreased in the LV-HIIT group after the intervention while eGFR (71.0 at baseline 73.6 at follow-up) significantly increased (P<0.001). However the control group showed a significant reduction only in Fasting Blood Sugar (FBS) (P<0.05). After the intervention the LV-HIIT group had significantly lower FBS (129.0 at baseline 121.0 at follow-up) Alanine Aminotransferase (ALT) (24.0 at baseline 18.0 at follow-up) and Gamma-Glutamyl Transferase (GGT) (22.0 at baseline 19.0 at follow-up) as well as higher eGFR compared to the control group (P<0.05).
LV-HIIT exercise appears to be a promising and effective training method for improving FLI and eGFR in patients diagnosed with T2DM.
IRCT 20200 729048246N1.
Prevalence and Predictors of Albuminuria in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study from the United Arab Emirates
Albuminuria in Diabetes mellitus (DM) patients may lead to nephropathy and end-stage renal disease. Our study aimed to assess the prevalence of albuminuria and its associated predictors among type 2 DM patients in the United Arab Emirates.
A retrospective cross-sectional study was conducted among type 2 DM patients in the diabetic clinic at Fujairah Hospital from 1st January 2016 to 30th January 2020 after getting the ethical clearance. Data were collected electronically from the health information system and analyzed using SPSS version 26. Regression analysis and ANOVA were used for inferential analysis. A P-value of ≤0.05 was considered significant.
Among the 200 patients included in the study the mean age of the study population was 56 years and the majority of them were females (71%). The prevalence of albuminuria was found to be 44%. By using regression analysis glycated hemoglobin (HbA1c; P=0.038) and systolic blood pressure (SBP; P=0.003) were found to be predictors of albuminuria. One way ANOVA revealed that there were significant associations between the albumin levels and HbA1c (P=0.004) SBP (P= 0.002) diastolic blood pressure (DBP; P=0.028) serum creatinine (Scr) (P=0.039) and glomerular filtration rate (GFR; P=0.013).
To the best of our knowledge this is the first study from Fujairah emirate that explored the prevalence and predictors of albuminuria in type 2 DM patients. We found a high prevalence of albuminuria among type 2 DM patients. HbA1c and SBP directly contributed to albuminuria. To improve glycemic control patients need to improve physical activity reduce overweight and adherence to medications that improve overall therapeutic outcomes.
Design of a Low-Complexity Deep Learning Model for Diagnosis of Type 2 Diabetes
Recent research demonstrates that diabetes can lead to heart problems neurological damage and other illnesses.
In this paper we design a low-complexity Deep Learning (DL)-based model for the diagnosis of type 2 diabetes. In our experiments we use the publicly available PIMA Indian Diabetes Dataset (PIDD). To obtain a low-complexity and accurate DL architecture we perform an accuracy-versus-complexity study on several DL models.
The results show that the proposed DL structure including Convolutional Neural Networks and Multi-Layer Perceptron models (i.e. CNN+MLP model) outperforms other models with an accuracy of 93.89%.
With these features the proposed hybrid model can be used in wearable devices and IoT-based health monitoring applications.
Ultrasound Evaluations of Ankle and Foot Muscles in Diabetic Peripheral Neuropathy Systematic Review with Meta-Analysis
Diabetic peripheral neuropathy (DPN) is the prevalent microvascular complication of diabetes mellitus (DM). 30-50% of diabetics are likely to be affected by DPN. It significantly impacts the skeletal muscles resulting in an accelerated loss of muscle mass. The objective of this systematic review was to evaluate the ankle and foot muscle changes in diabetic peripheral neuropathy using ultrasound.
A comprehensive search was conducted in Scopus Embase and PubMed databases which yielded 64 studies out of which 5 studies are included in this meta-analysis.
The meta-analysis shows that the thickness and cross-section area of the extensor digitorum brevis muscle are reduced in DPN as compared to the control group with p-value<0.004 and p-value<0.001 respectively. The thickness of MIL muscle was also smaller in DPN p-value=0.02. Similarly the thickness and CSA of AH muscle are also reduced in DPN patients compared to the control group with p-values of 0.21 and 0.14.
Meta-analysis reveals that diabetic peripheral neuropathy (DPN) patients have reduced foot muscle thickness and cross-sectional area (CSA) compared to controls without neuropathy. This highlights the importance of ultrasound in detecting muscle atrophy early in diabetic patients since it provides objective measures beyond traditional screening with its real-time and non-invasive nature.
Blood Pressure Control Among Diabetic Patients in the Eastern Mediterranean Region: A Systematic Review and Meta-Analysis
The control of blood pressure (BP) is a challenge in diabetic patients and is associated with adverse outcomes of diabetes. In this systematic review and meta-analysis we investigated the BP control rate among hypertensive diabetic patients in the Eastern Mediterranean Region (EMR) countries.
We systematically searched PubMed Scopus Embase Cochrane and Web of Science databases up to January 2023 for observational studies on BP control among hypertensive diabetic patients in all EMR countries. We included studies reporting the proportion of hypertensive type 2 diabetic patients with controlled BP defined as systolic/diastolic BP < 140/90 or <130/80 mmHg. Study quality was assessed using modified STROBE guidelines and a random-effect meta-analysis was conducted to pool prevalence data and calculate overall rates. Subgroup analysis was performed by gender study design country and BP control cut-offs (140/90 and 130/80).
Among the 1949 retrieved studies 20 studies assessing 27956 individuals were included. The proportion of BP control regardless of cut-off points was 36.8% (95% CI=29.1%45.3%) based on the studies reported for both genders. The prevalence was 53.2% (95% CI=36.1%-69.6%) and 43.5% (95% CI=20.0%-70.3%) based on the studies reported just for women or men respectively.
Our findings indicate that BP control targets are not successfully achieved in hypertensive diabetic patients in the Eastern Mediterranean region. It is recommended to place greater emphasis on the quality of hypertension care in the management of type 2 diabetes.
Diabetes and its Silent Partner: A Critical Review of Hyperinsulinemia and its Complications
In this complex realm of diabetes hyperinsulinemia is no longer regarded as just a compensatory response to insulin resistance but rather has evolved into an integral feature. This comprehensive review provides a synthesis of the current literature including various aspects associated with hyperinsulinemia in diabetic complications. Hyperinsulinemia has been shown to be more than just a compensatory mechanism and the key findings demonstrate how hyperinsulinism affects the development of cardiovascular events as well as microvascular complications. Additionally recognizing hyperinsulinemia as a modifiable factor the diabetes management paradigm shifts towards cognitive ones that consider the use of lifestyle modifications in combination with newer pharmacotherapies and precision medicine approaches. These findings have crucial implications for the clinical work requiring a careful appreciation of hyperinsulinemia's changing aspects as well as incorporation in personalized treatment protocol. In addition the review focuses on bigger issues related to public health showing that prevention and early diagnosis will help reduce the burden of complications. Research implications favor longitudinal studies biomarker discovery and the study of emerging treatment modalities; clinical practice should adopt global evaluations patient education and precision medicine adaptation. Finally this critical review provides an overview of the underlying processes of hyperinsulinemia in diabetes and its overall health effects.
Exploring the Therapeutic Potential of Anti-VEGF Drugs for the Management of Diabetic Retinopathy: An Overview
The discovery of antivascular endothelial growth factor medications has resulted in a substantial change in diabetic retinopathy treatment. The most common cause of diabetic retinopathy blindness is Diabetic Macular Edema. The pathophysiology of Diabetic Macular Edema is thought to include the well-known pro-angiogenic and pro-permeability factor vascular endothelial growth factor. Over the past decade drugs that impede the functions of vascular endothelial growth factors have established themselves as a standard-of-care treatment for a range of ocular ailments and improved patients' clinical results with diabetic retinopathy and Diabetic Macular Edema and their frequency has grown exponentially with the introduction of these agents Pegaptanib Ranibizumab and Aflibercept which are approved for ophthalmic indications while Bevacizumab is used off-label. These medications delivered intravitreally have halted the vascular development of diabetic retinopathy. Various randomized trials have proven that antivascular endothelial growth factor medication is safe and effective in preserving vision. Following an extensive period of preclinical development aimed at enhancing and defining its biological impacts these drugs were shown in clinical trials to be effective in treating diabetic retinopathy and other ophthalmic conditions. Data from various sources suggest that Pegaptanib Ranibizumab and Aflibercept are costly while Bevacizumab is cost-effective and in low and middle-income nations it is thus a desirable therapy choice. However issues with compounding counterfeiting and off-label usage restrict its availability in many nations. The pharmacology pharmacokinetics pharmacodynamics adverse effects and contraindications of antivascular endothelial growth factor agents are discussed and the results of clinical trials evaluating their efficacy are summarized.
An Updated Review on Diabetic Nephropathy: Potential Mechanisms, Biomarkers, Therapeutic Targets and Interventional Therapies
Diabetic nephropathy (DN) the primary risk factor for end-stage kidney disease (ESKD) that requires dialysis or renal transplantation affects up to 50% of individuals with diabetes.
In this article potential mechanisms biomarkers and possible therapeutic targets will be discussed as well as their interventional therapies.
A literature review was done from databases like Google Scholar PUBMED-MEDLINE and Scopus using standard keywords “Diabetic Nephropathy” “Biomarkers” “Pathophysiology” “Cellular Mechanism” “Cell Therapy” “Treatment Therapies” from 2010-2023. It has been studied that metabolic as well as hemodynamic pathways resulting from hyperglycemia act as mediators for renal disease.
We identified 270 articles of which 210 were reviewed in full-text and 90 met the inclusion criteria. Every therapy regimen for the prevention and treatment of DN must include the blocking of ANG-II action. By reducing inflammatory and fibrotic markers brought on by hyperglycemia an innovative approach to halting the progression of diabetic mellitus (DN) involves combining sodium-glucose cotransporter-2 inhibitors with renin-angiotensin-aldosterone system blockers. When compared to taking either medicine alone this method works better. AGEs protein kinase C (PKC) and the renin-angiotensin aldosterone system (RAAS) are among the components that are inhibited in DN management strategies.
Thus it can be concluded that the multifactorial condition of DN needs to be treated at an early stage. Novel therapies with a combination of cell therapies and diet management are proven to be effective in the management of DN.