Antidiabetic activity of Helicteres angustifolia root

Context The root of Helicteres angustifolia L. (Sterculiaceae) has been used as folk herbal drug to treat cancer, bacterial infections, inflammatory, and flu in China. However, there is no report on its antidiabetic activity.

Objective This study evaluates the antidiabetic activity of ethanol extract from H. angustifolia root.

Materials and methods The promoting effect of H. angustifolia root ethanol extract (25, 50, and 100 μg/mL) on glucose uptake was evaluated using HepG2 cell, differentiated C2C12 myotubes, and differentiated 3T3-L1 adipocytes. The antidiabetic activity of the extract was assessed in vivo using STZ-induced diabetic rats by orally administration of the extract (200 and 400?mg/kg b.w.) once per day for 28 d. Blood glucose, TG, TC, TP, HDL-C, UA, BUN, AST, ALT, insulin, and HOMA-IR were analyzed.

Results The results showed that the extract increased glucose uptake in C2C12 myotubes and 3T3-L1 adipocytes with an IC₅₀ value of 79.95 and 135.96 μg/mL, respectively. And about 12%, 19%, and 10% (p < 0.05) in HepG2 cells when compared with the control at the concentration of 25, 50, and 100 μg/mL, respectively. After 28 days’ treatment with the extract, significant reduction was observed in blood glucose, HOMA-IR, TC, TG, UA, BUN, AST, and ALT levels, while the levels of TP and HDL cholesterol increased.

Discussion and conclusion These results suggest that H. angustifolia root ethanol extract possess potent antidiabetic activity, which is the first report on antidiabetic activity of this plant.     

降糖口服液的降糖作用研究

目的：观察降糖口服液对实验性高血糖小鼠血糖的影响。方法：采用四氧嘧啶和肾上腺素制备高血糖模型，采用邻甲苯胺法测定血糖。结果：降糖口服液5，10，20g／kg小鼠连续ig10d，对正常小鼠血糖无明显影响；对由四氧嘧啶所致的糖尿病小鼠有明显降血糖作用，并可对抗由肾上腺素引起的小鼠血糖升高。结论：降糖口服液对实验性高血糖模型具有降糖作用。     

4种用药方案治疗2型糖尿病的成本-效果分析

目的:探讨4种用药方案治疗2型糖尿病的经济效果。方法:对格列齐特(A)、二甲双胍(B)、伏格列波糖(C)、罗格列酮(D)4种用药方案进行成本-效果分析。结果:A、B、C、D4组药物治疗成本分别为226.23、179.00、580.80、486.40元;总有效率分别为90.6%、81.5%、96.4%、82.8%;成本-效果比分别为249.7、219.6、602.5、587.4;A、C、D组相对于B组的增量成本-效果比分别为519.0、2696.6、2260.3。结论:B方案为4种用药方案中最具临床推广价值的治疗方案。     

Antidiabetic activity of Syzygium calophyllifolium in Streptozotocin-Nicotinamide induced Type-2 diabetic rats

The study was initiated to determine the antidaibetic activity of Syzygium calophyllifolium in Streptozotocin-Nicotinamide (STZ-NA) induced diabetic rats. The rats were treated with 100 and 200 mg/kg of the Syzygium calophyllifolium bark methanol extract (SCBM) and compared with the diabetic, normal and standard glibenclamide groups. The blood glucose level and body weight of the rats in different groups were monitored at regular intervals. The serum, blood biochemical and histopathological parameters of liver, kidney and pancreas were also analyzed. In vivo antioxidants like SOD, CAT, GST, GSH and GR levels were estimated in liver and kidney. SCBM (100 mg/kg) extract could reduce the blood glucose level from the 15th day itself (213.67 mg/dL) and the best reduction was observed till the end of the study with 259.25 mg/dL (200 mg/kg). Initial decrease in body weight was recovered after drug treatment and an increase in body weight was observed on the 4th week. The haematological parameters like total haemoglobin, packed cell volume percentage, total WBC and RBC content were found normal compared to that of normal untreated rats. Glibenclamide was also equally effective. The higher dose of SCBM extract could normalize the triglycerides, HDL, cholesterol and VLDL constituents in blood serum to the levels almost similar to that of normal rats. The results of the in vivo antioxidant levels showed that there are no significant difference in SOD, GSH and GR levels in all the groups compared to the normal control. SCBM and SMBM at 200 mg/kg dose were much effective over the lower dose. The histology revealed that SCBM 200 mg/kg could protect the cellular architecture of liver kidney and pancreas. The results from the study confirm ethnopharmacological significance of the plant and could be taken further for the development of an effective pharmaceutical drug against diabetes.     

Diabetes mellitus and COVID-19: Understanding the association in light of current evidence

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have posed a problematic healthcare situation worldwide since December 2019. Diabetes mellitus is associated with an increased risk and severity of coronavirus disease 2019 (COVID-19). While interacting with various other risk factors, high blood sugar was found to reduce immunity and increase the replication of SARS-CoV-2. Oxidative stress and the release of pro-inflammatory cytokines are greater in diabetic individuals than in healthy people, worsening the outcome of SARS-CoV-2 infection in diabetics. Increased expression of furin and angiotensin converting enzyme 2 (ACE-2) receptor in the hyperglycemic environment may promote the entry of SARS-CoV-2 in the host cell. COVID-19 infection primarily modulates immune and inflammatory responses, and may cause a cytokine storm, resulting in possible lethal outcomes in diabetics. An experimental report suggests that ACE expressed in the pancreas and the SARS-CoV-2 virus invariably destroy β-cells which contain ACE-2 receptors and results in acute diabetes. Moreover, COVID-19 also causes hyperglycemia in an individual with diabetes which may be related to insulin resistance and destruction of β-cells during SARS-CoV-2 infection. Early observations also suggest a correlation between oral hypoglycemic agents and the risk of COVID-19. This review focused on the possible cause and mechanism involved in SARS-CoV-2 infection in diabetics and the role of antidiabetic drugs in COVID-19.     

Clinical inertia in patients with type 2 diabetes treated with oral antidiabetic drugs: Results from a Japanese cohort study (JDDM53)

Aims/IntroductionTreatment intensification is commonly delayed in people with type 2 diabetes, resulting in poor glycemic control for an unacceptable length of time and increased risk of complications.Materials and MethodsThis retrospective study investigated clinical inertia in 33,320 Japanese adults with type 2 diabetes treated with oral antidiabetic drugs (OADs) between 2009 and 2018, using data from the Computerized Diabetes Care (CoDiC^®) database.ResultsThe median time from first reported glycated hemoglobin (HbA1c) ≥7.0% (≥53 mmol/mol) to treatment intensification was considerably longer and HbA1c levels were higher the more OADs the patient was exposed to. For patients receiving three OADs, the median times from HbA1c ≥7.0% (53 mmol/mol) to intensification with OAD, glucagon‐like peptide‐1 receptor agonist or insulin were 8.1, 9.1 and 6.7 months, with a mean HbA1c level at the time of intensification of 8.4%, 8.9% and 9.3%, respectively. The cumulative incidence for time since the first reported HbA1c ≥7.0% (≥53 mmol/mol) to intensification confirmed the existence of clinical inertia, identifying patients whose treatment was not intensified despite poor glycemic control. HbA1c levels ≥7.0% (≥53 mmol/mol) after ≥6 months on one, two or three OADs were observed in 42%, 51% and 58% of patients, respectively, showing that approximately 50% of patients are above HbA1c target regardless of how many OADs they take.ConclusionsReal‐world data here show clinical inertia in Japanese adults with type 2 diabetes from early diabetes stages when they are receiving OADs, and illustrate a need for earlier, more effective OADs or injectable treatment intensification and better communication around the existence of clinical inertia.     

Targeting ageing and preventing organ degeneration with metformin

BackgroundAgeing is characterized by a decline in cognitive and bodily functions. Metformin, the most commonly prescribed antidiabetic agent today, has proved to be able to modulate oxidative stress, several inflammatory pathways and cellular senescence to promote anti-ageing. This review aims to explore and summarize the effects of metformin on ageing.ResultsMetformin, a longstanding treatment for diabetes, has been shown to increase lifespan in both vertebrate and mammalian models. This pleiotropic effect is hypothesized to mimic calorie restriction, a currently proven means of slowing ageing, by decreasing insulin and insulin-like growth factor (IGF)-1 levels and improving insulin sensitivity. However, studies have shown that metformin is also able to target several other ageing pathways, thereby inhibiting mammalian target of rapamycin (mTOR), increasing AMPK activity and improving DNA repair. Clinical studies, such as those supported by the UK Clinical Practice Research Datalink service, have reported that diabetes patients treated with metformin live longer than patients without diabetes. Metformin use can also reduce type 2 diabetes mellitus (T2DM) incidence among those at risk, lower cancer incidence, and improve cognitive function, cardiovascular disease (CVD) risk factors and atherosclerosis.ConclusionVarious studies have found that metformin can target several nutrient-sensing, anti-ageing and immune pathways, leading to reductions in oxidative stress, inflammation and DNA damage as well as providing effects similar to those of calorie restriction. However, further trials are still needed to confirm these findings.     

The role of oral semaglutide in managing type 2 diabetes in Indian clinical settings: Addressing the unmet needs

AimsDespite their established benefits, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remain underutilized for type 2 diabetes mellitus (T2DM) management, which indicates that subcutaneous injection is an unfavorable mode of delivery from the patient's perspective. This review summarizes existing challenges related to medication adherence and the use of antihyperglycemia injectables, revisits the established safety and efficacy of oral semaglutide, and explores its features and considerations for use among the Indian T2DM population.MethodsWe performed a literature search using MEDLINE and the National Institutes of Health Clinical Trials Registry from July 1, 2016, to July 1, 2021, to identify publications on oral semaglutide approval, T2DM treatment guidelines, and clinical evidence for oral drug formulation.ResultsOral semaglutide is the first oral GLP-1 RA approved for T2DM patients based on phase 3, randomized PIONEER trials. The multitargeted action of this drug offers glycemic control, weight control, and cardiovascular, renal, and additional benefits, including patient convenience and enhanced medication adherence. In addition to achieving glycemic control, the cost of semaglutide is reported to be lower than other GLP-1 RA in the West, thus potentially mitigating the economic burden that appears to be high among the Indian population.ConclusionsCurrently, there is no data available on oral semaglutide in Indian clinical settings. However, significant improvements in glycemic control, cardiac and renal benefits, as well as weight loss across clinical trials should encourage clinicians to prioritize oral semaglutide over other antidiabetic agents.