Diabetes/metabolism research and reviews
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Diabetes Metab. Res. Rev. · May 2005
ReviewCritical review of oral drug treatments for diabetic neuropathic pain-clinical outcomes based on efficacy and safety data from placebo-controlled and direct comparative studies.
The present review aims to evaluate the efficacy and safety of a selection of oral treatments for the management of painful diabetic neuropathy. A literature review was conducted retrieving placebo-controlled and direct comparative studies with a selection of oral treatments for painful diabetic neuropathy. All studies were analyzed with regard to efficacy and tolerability. ⋯ Validated questionnaires for evaluation of the efficacy and safety should be further developed. Based on the reviewed randomised controlled trials, gabapentin shows good efficacy, a favourable side-effect profile with lack of drug interactions and therefore it may be a first choice treatment in painful diabetic neuropathy, especially in the elderly. However, head to head trials of current treatments are lacking and therefore randomized controlled trials are required to address this issue.
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Diabetes Metab. Res. Rev. · Jan 2005
ReviewDiabetes: insulin resistance and derangements in lipid metabolism. Cure through intervention in fat transport and storage.
We present multiple findings on derangements in lipid metabolism in type 2 diabetes. The increase in the intracellular deposition of triglycerides (TG) in muscles, liver and pancreas in subjects prone to diabetes is well documented and demonstrated to attenuate glucose metabolism by interfering with insulin signaling and insulin secretion. The obesity often associated with type 2 diabetes is mainly central, resulting in the overload of abdominal adipocytes with TG and reducing fat depot capacity to protect other tissues from utilizing a large proportion of dietary fat. ⋯ The first step should be an attempt to effectively induce a lifestyle change. Next comes pharmacotherapy including acarbose, metformin, PPARgamma, or PPARgammaalpha agonists, statins and orlistat, estrogens in postmenopausal women or testosterone in men. Among surgical procedures, gastric bypass has been proven to produce beneficial results in advance of other surgical techniques, the evidence basis of which still needs strengthening.
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Diabetes Metab. Res. Rev. · May 2004
Achilles tendon lengthening, the panacea for plantar forefoot ulceration?
Recent reports on Achilles tendon lengthening (ATL) have documented rapid healing of chronic plantar neuropathic forefoot ulcers. ⋯ Lengthening of the Achilles tendon is effective in healing plantar neuropathic ulceration. Patients with complete anaesthesia of the heel pad should not undergo this procedure and extreme dorsiflexion should be avoided because of the risk of heel ulceration. Moreover, the procedure should be performed only in a multidisciplinary setting for immediate dealing with complications and for surveillance and treatment of future ulceration.
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Diabetes Metab. Res. Rev. · May 2004
Mortality in type 2 diabetic subjects prescribed metformin and sulphonylurea drugs in combination: cohort study.
In the UK Prospective Diabetes Study, treatment with sulphonylurea and metformin in combination was associated with increased mortality. We compared mortality in subjects treated either with metformin or sulphonylurea drugs alone, or in combination. ⋯ In this large non-randomized study, there was no evidence of increased mortality risk following prescription of sulphonylurea and metformin in combination, as compared to either drug prescribed singly.
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Diabetes Metab. Res. Rev. · Sep 2003
ReviewDevelopment of cell markers for the identification and expansion of islet progenitor cells.
Diabetes mellitus results from the anatomical or functional loss of insulin-producing beta cells of the pancreas. Despite significant advances in current treatment, patients with diabetes still do not maintain optimal glucose levels and therefore face debilitating complications such as hypoglycemia, retinopathy or cardiovascular diseases later in life. Islet transplantation therefore holds great promise as an ultimate cure for diabetes. ⋯ Recent successes in studying the organogenesis of pancreas as well as in vitro islet progenitor cell identification studies have provided tremendous insight for the cell markers that are essential in the isolation and characterization of these cells prospectively both in vivo and in vitro. If we can identify the markers that will aid the isolation and purification of islet progenitor cells, or factors that determine pancreatic cell fate, we might be able to coerce them from turning into specific endocrine cells or pancreas in vitro. This article will focus on this subject and will review the latest achievements in the study of cell markers for islet progenitor cells.