Monday, 21 May 2012

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

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.

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."

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 body
needs 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.