Advantages and Disadvantages of the Oral Diabetes Drugs | |
The sulfonylureas (glyburide, glimepiride, glipizide) | |
Advantages: | |
Fast onset of action | |
No affect on blood pressure | |
No affect on LDL cholesterol | |
Convenient dosing | |
Low cost | |
Lower risk of GI side effects than metformin | |
Disadvantages: | |
Weight gain (5 to 10 pounds on average) | |
Heightened risk of hypoglycemia | |
Glyburide has slightly higher risk of hypoglycemia | |
compared with glimepiride and glipizide | |
Metformin | |
Advantages: | |
Low risk of hypoglycemia | |
Not linked to weight gain | |
Good effect on LDL cholesterol | |
Good effect on triglycerides | |
No effect on blood pressure | |
Low cost | |
Disadvantages: | |
Higher risk of GI side effects (nausea and diarrhea) | |
Cannot be taken by people with diabetes who have | |
moderate or severe kidney disease or heart failure | |
because of risk of lactic acid build-up | |
Less convenient dosing | |
The alpha-glucosidase inhibitors (acarbose, miglitol) | |
Advantages: | |
Slightly lower risk of hypoglycemia compared to | |
sulfonylureas | |
Not associated with weight gain | |
Decreases triglycerides | |
No effect on cholesterol | |
Disadvantages: | |
Less effective than most other diabetes pills in lowering | |
HbA1c. | |
Higher risk of GI side effects than other diabetes pills except | |
metformin | |
Inconvenient dosing | |
High cost | |
The thiazolidinediones (Actos, Avandia) | |
Advantages: | |
Low risk of hypoglycemia | |
Slight increase in “good” (HDL) cholesterol | |
Actos linked to decreased triglycerides | |
Convenient dosing | |
Disadvantages: | |
Higher risk of heart failure | |
Weight gain (5 to 10 pounds) | |
Linked to higher risk of edema (fluid build-up) | |
Linked to higher risk of anemia | |
Increase in “bad” (LDL) cholesterol | |
Avandia linked to increased triglycerides and | |
higher risk of heart attack | |
Actos linked to increased risk of bladder cancer | |
Slower onset of action | |
Rare risk of liver problems; requires monitoring | |
Linked to increased risk of upper and | |
lower limb fractures | |
High cost | |
The meglitinides (nateglinide, repaglinide) | |
Advantages: | |
No bad effect on cholesterol | |
Rapid onset of action | |
Disadvantages: | |
Repaglinide associated with risk of hypoglycemia and | |
weight gain similar to sulfonylureas | |
Nateglinide has less effect on HbA1c | |
Inconvenient dosing | |
High cost | |
The DPP-inhibitors (Januvia, Onglyza) | |
Advantages: | |
When added to metformin, lower risk of hypoglycemia | |
compared with a sulfonylurea | |
Few known side effects (but they are new drugs) | |
Lower risk of GI side effects than metformin | |
Convenient dosing | |
Disadvantages: | |
Reduce HbA1c less than several other diabetes drugs | |
May only be valuable as second drugs added to another | |
medication | |
Less data on potential side effects compared to older drugs | |
High cost | |
Monday, 21 May 2012
Oral Diabetes Drugs
Oral Diabetes Drugs
Advantages and Disadvantages of the Oral Diabetes Drugs | |
The sulfonylureas (glyburide, glimepiride, glipizide) | |
Advantages: | |
Fast onset of action | |
No affect on blood pressure | |
No affect on LDL cholesterol | |
Convenient dosing | |
Low cost | |
Lower risk of GI side effects than metformin | |
Disadvantages: | |
Weight gain (5 to 10 pounds on average) | |
Heightened risk of hypoglycemia | |
Glyburide has slightly higher risk of hypoglycemia | |
compared with glimepiride and glipizide | |
Metformin | |
Advantages: | |
Low risk of hypoglycemia | |
Not linked to weight gain | |
Good effect on LDL cholesterol | |
Good effect on triglycerides | |
No effect on blood pressure | |
Low cost | |
Disadvantages: | |
Higher risk of GI side effects (nausea and diarrhea) | |
Cannot be taken by people with diabetes who have | |
moderate or severe kidney disease or heart failure | |
because of risk of lactic acid build-up | |
Less convenient dosing | |
The alpha-glucosidase inhibitors (acarbose, miglitol) | |
Advantages: | |
Slightly lower risk of hypoglycemia compared to | |
sulfonylureas | |
Not associated with weight gain | |
Decreases triglycerides | |
No effect on cholesterol | |
Disadvantages: | |
Less effective than most other diabetes pills in lowering | |
HbA1c. | |
Higher risk of GI side effects than other diabetes pills except | |
metformin | |
Inconvenient dosing | |
High cost | |
The thiazolidinediones (Actos, Avandia) | |
Advantages: | |
Low risk of hypoglycemia | |
Slight increase in “good” (HDL) cholesterol | |
Actos linked to decreased triglycerides | |
Convenient dosing | |
Disadvantages: | |
Higher risk of heart failure | |
Weight gain (5 to 10 pounds) | |
Linked to higher risk of edema (fluid build-up) | |
Linked to higher risk of anemia | |
Increase in “bad” (LDL) cholesterol | |
Avandia linked to increased triglycerides and | |
higher risk of heart attack | |
Actos linked to increased risk of bladder cancer | |
Slower onset of action | |
Rare risk of liver problems; requires monitoring | |
Linked to increased risk of upper and | |
lower limb fractures | |
High cost | |
The meglitinides (nateglinide, repaglinide) | |
Advantages: | |
No bad effect on cholesterol | |
Rapid onset of action | |
Disadvantages: | |
Repaglinide associated with risk of hypoglycemia and | |
weight gain similar to sulfonylureas | |
Nateglinide has less effect on HbA1c | |
Inconvenient dosing | |
High cost | |
The DPP-inhibitors (Januvia, Onglyza) | |
Advantages: | |
When added to metformin, lower risk of hypoglycemia | |
compared with a sulfonylurea | |
Few known side effects (but they are new drugs) | |
Lower risk of GI side effects than metformin | |
Convenient dosing | |
Disadvantages: | |
Reduce HbA1c less than several other diabetes drugs | |
May only be valuable as second drugs added to another | |
medication | |
Less data on potential side effects compared to older drugs | |
High cost | |
Thursday, 17 May 2012
Acacia Arabica-Indian Arabic Tree
Latin
Name: Acacia Arabica/Nilotica
Snskrit
Name: Barbura
Indian
Name: Babul, Kikar, Bava
English
Name: Indian Gum, Indian Arabic Tree
Family
Name: Fabaceae
Acacia Arabica possesses tonic,
demulcent, carminative, astringent, antipyretic, antispasmodic,
anti-inflammatory, anti-hypertensive and anti-stress properties.
Phytochemical investigations of Acacia arabica found
that phenolic compounds are presents in Acacia arabica extracts. Acacia arabica
contains flavonoids, sterols, triterpenoids, alkaloids and phenolics which
possess various health benefits. The isolation and characterization of
quercetin, gallic acid, (+)-catechin, (-)-epicatechin, (-)-dicatechin, and
(+)-leucocyanidin gallate from the acetone extract of Acacia arabica, is
reported (1). The seeds of Acacia arabica contain 5.2% oil. Physico-chemical
constants and fatty acid composition of the refined seed oil were estimated.
The oil was rich in linoleic acid, oleic acid and trace quantities of epoxy and
hydroxy fatty acids. Acacia arabica bark is reported to contain catechin,
epicatechin, dicatechin, quercetin, gallic acid, leucocyanidin gallate, sucrose
and catechin 5-gallate.
Acacia has been used to treat high cholesterol, diabetes, cancer,
gingivitis, stomatitis (mouth sores) and pharyngitis. The powdered seeds of A. arabica were administered in doses of
2, 3 and 4 gm/kg body-weight to normal and alloxan-diabetic rabbits. 2, 4, 6
and 8 hours after the administration the blood glucose levels were estimated.
It exerted a significant (p<0.05) hypoglycemic effect in normal rabbits. It
acts through release of insulin from pancreatic beta cells.
Acacia arabica is reported to possess many beneficial
properties. It is reported for In vitro antibacterial activity, antimicrobial
and immuno modulatory activities. Flavonoids, triterpenoids, alkaloids and
phenolics are known to be bioactive anti diabetic principles present in Acacia
arabica. Acacia Arabica is commonly known as babul, used in traditional Indian
medicine to treat diabetes mellitus. The hypoglycemic effect of aqueous extract
and hydroalcoholic extract of Acacia arabica was investigated and proved
scientifically. Oral administration of aqueous extract of Acacia arabica bark
to diabetic and normal rats resulted in significant reduction of blood glucose,
cholesterol and triglycerides. The aqueous extract of Acacia arabica was found
to reduce blood glucose level to its normal level with in seven days.
Histological studies of the β-cells show its action on pancreas. Phenolics
present in Acacia arabica are found to be effective as anti hyperglycemic
agents. The gum of Acacia arabica is described in the British pharmacopoeia as
a source of useful medicaments. Acacia arabica is a good antibacterial agent.
In a clinical trial report implies the presence of substances in Acacia gum
which, compared with ordinary gum, primarily inhibit the early deposition of
plaque.
Wednesday, 16 May 2012
Avandia Banned In India
Avandia (rosiglitazone) banned in India, times of India News
rosiglitazone marketed by drug major GalxoSmithKline as Avandia in many countries, has reported an increasing evidence of heart risk in studies worldwide. While Europe withdrew the highly controversial drug from its shelves last month, US regulators announced tight curbs on its use.
The union health ministry formed a six member committee to take decision on the widely prescribed drug. The committee on Thursday decided to ban the drug with immediate effect all over India. An estimated five million diabetics in India are still using the drug, mainly in smaller cities.
"With this decision, the drug will be pulled out of retail shelves across the country. But, there is no worry as a safer alternative like pioglitazone is available. Though, it is not entirely free from side-effects. These include weight gain, fluid retention and increase risk of fractures. Therefore, it is important that this replacement is done only in consultation with your doctor. Besides, other classes of anti-diabetic drug are also available," said Yajnik.
Sharing the view, paediatrician Sharad Agarkhedkar, president of the city chapter of Indian Medical Association (IMA) said, "We use only insulin in children suffering from diabetes. In adults, there is a role of oral hypoglycaemic (sugar lowering) drug. Those who have been taking rosiglitazone can use other drug in glitazone family with due consultation with diabetologists."
"There are two basic issues in the causative factors of diabetes. One is dysfunction of pancreatic beta cells which leads to insulin deficiency. Second, reduced sensitivity of different tissues to circulating insulin (the so-called insulin resistance)," Yajnik said.
Indians are perceived to be more insulin resistant as compared to Europeans and, therefore, drugs which will improve insulin resistance are attractive for the management of diabetes in Indian patients. The commonest drug which reduces insulin resistance is Metformin which predominantly acts on the liver. The other class of drug molecule which reduces insulin resistance is glitazones. The first glitazone to be marketed in the world, including India, was rosiglitazone in the late 1990s. This drug has been a focus of controversy since 2007 after publication of a report which stated that it can cause heart attacks, said Yajnik.
"The decision is welcome. There are still many medicine and drug molecules which are banned in most countries, but still in use in India. The ministry should take proactive steps towards banning them. Besides, many irrational drug combinations are available over the counter (OTC) in India. A few of them are really harmful," said Avinash Bhondwe, former president of IMA, Pune branch.
rosiglitazone marketed by drug major GalxoSmithKline as Avandia in many countries, has reported an increasing evidence of heart risk in studies worldwide. While Europe withdrew the highly controversial drug from its shelves last month, US regulators announced tight curbs on its use.
The union health ministry formed a six member committee to take decision on the widely prescribed drug. The committee on Thursday decided to ban the drug with immediate effect all over India. An estimated five million diabetics in India are still using the drug, mainly in smaller cities.
"With this decision, the drug will be pulled out of retail shelves across the country. But, there is no worry as a safer alternative like pioglitazone is available. Though, it is not entirely free from side-effects. These include weight gain, fluid retention and increase risk of fractures. Therefore, it is important that this replacement is done only in consultation with your doctor. Besides, other classes of anti-diabetic drug are also available," said Yajnik.
Sharing the view, paediatrician Sharad Agarkhedkar, president of the city chapter of Indian Medical Association (IMA) said, "We use only insulin in children suffering from diabetes. In adults, there is a role of oral hypoglycaemic (sugar lowering) drug. Those who have been taking rosiglitazone can use other drug in glitazone family with due consultation with diabetologists."
"There are two basic issues in the causative factors of diabetes. One is dysfunction of pancreatic beta cells which leads to insulin deficiency. Second, reduced sensitivity of different tissues to circulating insulin (the so-called insulin resistance)," Yajnik said.
Indians are perceived to be more insulin resistant as compared to Europeans and, therefore, drugs which will improve insulin resistance are attractive for the management of diabetes in Indian patients. The commonest drug which reduces insulin resistance is Metformin which predominantly acts on the liver. The other class of drug molecule which reduces insulin resistance is glitazones. The first glitazone to be marketed in the world, including India, was rosiglitazone in the late 1990s. This drug has been a focus of controversy since 2007 after publication of a report which stated that it can cause heart attacks, said Yajnik.
"The decision is welcome. There are still many medicine and drug molecules which are banned in most countries, but still in use in India. The ministry should take proactive steps towards banning them. Besides, many irrational drug combinations are available over the counter (OTC) in India. A few of them are really harmful," said Avinash Bhondwe, former president of IMA, Pune branch.
Metformin is 'best'
50-yr-old metformin is 'best' for diabetes, Times of India News
One of the oldest drugs used to treat diabetes, metformin, has emerged as the best option, compared to newer drugs introduced over the years.
The review by experts from top medical schools like John Hopkins University, John Hopkins Bloomberg School of Public Health and University of North Carolina, has concluded that metformin (brand names carbophage, glucophage, cetapin, glycomet) works the best, has the least side-effects and is affordable. The study, published in the international Annals of Internal Medicine journal has special relevance with India being the world's diabetes capital.
The review has examined all diabetes drugs and elaborated on their side-effects.
It advocates the use of the time-tested drug as first-line therapy also because it has beneficial effects on cholesterol levels. Other anti-diabetic drugs have serious side-effects like increase in weight or risk of congestive heart failure.
Dr Anoop Misra, chairman Fortis-C-DOC (Centre of Excellence for Diabetes, Obesity, Metabolic Diseases and Endocrinology), said: "In India, there is a trend to use newer drugs, even if they are costlier and may be less effective. The study's findings are apt for India: Use the time-tested drug metformin, it is effective, it is cheap, has few side effects, and has additional beneficial effects than just blood sugar control; on cholesterol, on liver, and recent data shows that it may have even anti-cancer effects."
Two reviewers independently screened reports and identified 140 trials and 26 observational studies of comparisons of monotherapy (single drug) or combination therapy that reported clinical outcomes on metformin, as against newer drugs like januvia, galvus, onglyza and glimepiride. Other anti-diabetic treatments includes injectables like byetta and victoza.
Experts pointed out that others like sulphonylureas (glimepiride) though cheap may cause a sudden drop in blood sugar levels, pioglitazone increases weight and the risk of congestive heart failure, while DPP-4 inhibitors (januvia, galvus), which are new, are expensive and need continuous monitoring due to their side-effects.
Dr Shashank Joshi, endocrinologist, Lilavati Hospital, said: "Metformin will remain the first step in diabetes treatment. It is off-patent and affordable. It has been around for almost 50 years but is still doing very well."
One of the oldest drugs used to treat diabetes, metformin, has emerged as the best option, compared to newer drugs introduced over the years.
The review by experts from top medical schools like John Hopkins University, John Hopkins Bloomberg School of Public Health and University of North Carolina, has concluded that metformin (brand names carbophage, glucophage, cetapin, glycomet) works the best, has the least side-effects and is affordable. The study, published in the international Annals of Internal Medicine journal has special relevance with India being the world's diabetes capital.
The review has examined all diabetes drugs and elaborated on their side-effects.
It advocates the use of the time-tested drug as first-line therapy also because it has beneficial effects on cholesterol levels. Other anti-diabetic drugs have serious side-effects like increase in weight or risk of congestive heart failure.
Dr Anoop Misra, chairman Fortis-C-DOC (Centre of Excellence for Diabetes, Obesity, Metabolic Diseases and Endocrinology), said: "In India, there is a trend to use newer drugs, even if they are costlier and may be less effective. The study's findings are apt for India: Use the time-tested drug metformin, it is effective, it is cheap, has few side effects, and has additional beneficial effects than just blood sugar control; on cholesterol, on liver, and recent data shows that it may have even anti-cancer effects."
Two reviewers independently screened reports and identified 140 trials and 26 observational studies of comparisons of monotherapy (single drug) or combination therapy that reported clinical outcomes on metformin, as against newer drugs like januvia, galvus, onglyza and glimepiride. Other anti-diabetic treatments includes injectables like byetta and victoza.
Experts pointed out that others like sulphonylureas (glimepiride) though cheap may cause a sudden drop in blood sugar levels, pioglitazone increases weight and the risk of congestive heart failure, while DPP-4 inhibitors (januvia, galvus), which are new, are expensive and need continuous monitoring due to their side-effects.
Dr Shashank Joshi, endocrinologist, Lilavati Hospital, said: "Metformin will remain the first step in diabetes treatment. It is off-patent and affordable. It has been around for almost 50 years but is still doing very well."
Diabetes Allopathic Drugs
Diabetes Drugs, with their generic and brand
names rIndividual
Drugs(Brandand generic names)
a Generic?
1) Sulfonylureas
Brands: Amaryl, Diabeta, Glynase
Glucotrol, Glucotrol XL
Generics: Glimepiride, Glipizide,
Glyburide
2) Biguanides
Brands: Glucophage, Glucophage XR,
Generics: Metformin
3) Thiazolidinediones
Brands:
Actos,
Avandia
4) Alpha-glucosidase Inhibitors
Brands: Precose, Glyset
Generics: Acarbose
5) Meglitinides
Brands: Prandin, Starlix
Generics: Nateglinide
6) Dipeptidyl peptidase 4 inhibitors
Brands: Januvia, Onglyza
7) Combinations of
sulfonylureas plus
metformin
Brands: Glucovance
Generics: known by generic names
of the two drugs
Other Combinations Actosplus Met, Avandaryl,
Avandamet,
Duetact, Janumet, Kombiglyze XR
Action of drugs
sulfonylureas and meglitinides
increase the
secretion of insulin by the pancreas.
Metformin inhibits glucose production by the
liver and decreases insulin resistance.
The alpha-glucosidase inhibitors delay absorption
of glucose by the intestine.
The
thiazolidinediones decrease insulin resistance.
The dipeptidyl peptidase 4
inhibitors (Januvia
and Onglyza) promote the release of insulin
from the pancreas after eating a meal.
Tuesday, 15 May 2012
Type 1 and type 2 diabetes — the difference
what is the difference between type 1 and type 2 Diabetes
Diabetes is a disease characterized by elevation of blood glucose (a
sugar) caused by decreased production of the hormone insulin and/or
increased resistance to the action of insulin by certain cells. Glucose is
the body’s main fuel. When you eat carbohydrates (pasta, bread, rice,
grains, fruits, and vegetables), your digestive system breaks them down
into glucose, which is released into the bloodstream so your body can
use it for energy. Glucose also gets stored in the liver as glycogen,
which can later be broken down back into glucose when the bodyneeds fuel.
Insulin, which is produced in the pancreas, regulates both the movement
of glucose into the body’s cells and the breakdown in the liver of
glycogen into glucose. Both actions are critical to keeping blood sugar
levels within normal ranges.
type 1 diabetes. In this condition — usually diagnosed in childhood or the
early teen years – the pancreas, over a relatively brief period of time,
stops producing insulin altogether. The onset of the disease is usually
abrupt, with severe symptoms that require immediate attention. Type 1
diabetes is a so-called “autoimmune” disease, which means the body
attacks itself. Spe cifi cally, errant immune cells damage and destroy the
part of the pancreas that produces insulin. People with type 1 diabetes
must inject insulin every day.
In type 2 diabetes, the pancreas produces enough insulin, at least in the
early years that a person has the disease. But for reasons that are still
not well understood, the body’s cells become resistant or insensitive to
it. To compensate, the pancreas pumps out increasing amounts of
insulin to normalize blood glucose levels. Over time — as long as a
decade — this ever-increasing production becomes unsustainable, and
the pancreas’ ability to produce insulin declines
As a result, the telltale marker — and problem — of diabetes emerges: glucose
levels rise in the blood because it is unable to enter the body’s cells.
The excess glucose is damaging to the body’s tissues and leads to the
symptoms of diabetes. When the blood glucose level gets high enough,
the sugar begins to appear in the urine and causes increased urination.
Elevated blood sugar puts a strain on almost every organ and many
parts of the body. Over years, it is particularly toxic to the body’s
blood vessels; it causes them to thicken. This leads to problems in the
eyes and kidneys, the heart, the liver, and the blood circulation system.
High blood sugar also damages the nerves. Proper treatment that
keeps blood sugar in the normal range sharply reduces the risk of
these complications.
Again, there are many theories and ideas about the causes of type 2
diabetes, and the insulin resistance that characterizes it. Studies show
the disease runs in families, meaning it has a strong genetic (hereditary)
component. Another cause is being overweight or obese. In some
cases, this can occur due to a genetic propensity, but in most cases it
is due to overeating and lack of exercise.
While recent media attention surrounding the diabetes epidemic has
focused on its link to obesity, the statistic above shows that 45 percent
of people with diabetes are not overweight, meaning that there are
other causes of the disorder.
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