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PubMed1998

Pharmacological intervention: the antidiabetic approach.

Impaired glucose tolerance (IGT) progresses to non-insulin-dependent diabetes mellitus (NIDDM) in many but not all IGT subjects. It remains unsettled whether long-term antidiabetic (i.e. antihyperglycaemic) pharmacotherapy delays the development of NIDDM, and whether such treatment influences macrovascular morbidity and mortality. This report summarizes the results from long-term (> 4 years) antihyperglycaemic interventions addressing these issues. In an American study, tolbutamide (0.5 g 2-3 times daily) promoted a 4-year improvement of glucose tolerance in young, non-obese, mildly diabetic asymptomatic subjects who apparently comprised a mixture of IGT and NIDDM. In a Swedish 5-year study on 178 survivors of myocardial infarction, of whom 79 had intravenous IGT, tolbutamide treatment was associated with improved glucose tolerance, reduced triglyceride levels, and improved 18-month survival. A British 5-year study on a subgroup of about 200 middle-aged men from the Whitehall cohort indicated that phenformin (50 mg once daily) did not influence the deterioration of glucose levels. In a 10-year British study, 241 middle-aged men and women were 4-square randomized to control, weight reduction, placebo and tolbutamide (0.5 g twice daily). A non-lasting reduction of arterial disease was recorded in those on tolbutamide. No reduction of NIDDM development was seen. In a Swedish 10-year study on middle-aged men with IGT, follow-up comprised 59 controls, 98 on diet advice with or without placebo, and 23 on tolbutamide (0.5 g three times daily) added to diet advice. A total of 29% developed NIDDM among controls and 13% in the diet group. In contrast, no subject maintaining tolbutamide treatment developed NIDDM. Moreover, the tolbutamide-treated subjects had reduced blood pressure, triglyceride and cholesterol levels, as well as fewer macrovascular complications. Recently, a lower mortality rate at 22 years after the start of tolbutamide treatment has been recorded. To summarize, treatment with insulin-releasing drugs might help to reduce the development of NIDDM and macrovascular disease in IGT subjects. However, further studies are needed to verify or refute this notion.

Controlled Clinical Trials as Topic↗
PubMed2000

Leptin concentrations are related to glycaemic control, but do not change with short-term oral antidiabetic therapy in female patients with type 2 diabetes mellitus.

This study evaluated the relation of leptin with glycaemic control and the effect of 14 days of diet, or diet combined with gliclazide, glipizide-GITS or metformin treatment, on leptin concentration in 51 female patients with type 2 diabetes mellitus. Leptin levels were similar both at baseline and after treatment in diabetic and control groups. Diabetic patients with basal fasting plasma glucose (FPG) < 10 mmol/l or with basal postprandial plasma glucose (PPPG) < 13.9 mmol/l had significantly higher leptin levels than diabetic patients with basal FPG > or = 10 mmol/l or with basal PPPG > or = 13.9 mmol/l (19.6+/-8.7 vs. 13.65+/-5.4 microg/l, p < 0.05; and 20.2+/-7.9 vs. 12.9+/-5.2 microg/l, p < 0.05, respectively). Mode of treatment did not influence leptin levels. Delta leptin showed a weak correlation with basal FPG (r = 0.346; p < 0.05), basal and post-treatment PPPG (r = 0.335, p < 0.05 and r = 0.325, p < 0.05, respectively) and a moderate correlation with post-treatment FPG (r = 0.391, p < 0.01). In conclusion, leptin level is not affected by the presence of type 2 diabetes mellitus and by short-term treatment with diet or oral antidiabetic drugs but is directly related to glycaemic control in female patients with type 2 diabetes mellitus.

Administration, Oral↗
PubMed1998

Carbutamide--the first oral antidiabetic. A retrospect.

This work describes the history of the first oral antidiabetic in East and West Germany. M. Janbon and A. Loubatières reported experimental and clinical findings about a blood sugar-decreasing effect of a sulphonamide derivate, sulphoisopropyl thiodiazol (1942). These findings, however, did not prove to be useful in the treatment of diabetes. In 1952 the author found a series of hypoglycemic shocks with the sulfonamid-urea derivate carbutamdide during clinical tests of infectious diseases. These were reported to the pharmaceutical company Von Heyden in Dresden. The head chemist E. Haack went with my files from East to West Germany, to Boehringer Mannheim. Without mentioning the synthesis in Dresden, he synthesized carbutamide in Mannheim. The hypoglycemic effect was rediscovered by his friend H. Franke together with J. Fuchs. It took twenty years until the results of the author's research were officially acknowledged.

Administration, Oral↗
PubMed2003

Synthesis and antidiabetic activity of some new furochromonyl-2,4-thiazolidinediones.

A new series of furochromone-2,4-thiazolidinedione derivatives (VIIa-h) was prepared by Knoevenagel reaction of substituted-2,4-thiazolidinediones (VIa-h) with Khellin-2-carboxaldehyde (IV). The prepared compounds were tested for their insulinotropic activities in INS-1 cells. Compounds VIId and VIIf (at lower concentration; 1 microgram/ml) were able to increase insulin release in the presence of 5.6 mmol/l glucose. Both these compounds (VIId and VIIf) and VIIg increased glucose uptake in NIH-3T3 cells. Thus these 3 compounds should be tested for antidiabetic effects in vivo.

3T3 Cells↗
PubMed2002

Hepatotoxicity of commonly used drugs: nonsteroidal anti-inflammatory drugs, antihypertensives, antidiabetic agents, anticonvulsants, lipid-lowering agents, psychotropic drugs.

Hepatotoxic adverse drug reactions have contributed to the decline of many promising therapies, even among mainstream medication classes (bromfenac and troglitazone are recent examples). The spectrum of nonsteroidal anti-inflammatory drug-related liver toxicity continues to expand, with reports in children, interactive toxicity in persons with hepatitis C, and recognition of the toxicity of both the preferential and selective cyclooxygenase-2 inhibitors. Of the antihypertensive agents, methyldopa is now rarely prescribed and adverse effects are reported infrequently, whereas cases of liver injury associated with the angiotensin receptor and converting enzyme inhibitors are increasingly reported. Of the antidiabetic agents, acarbose, gliclazide, metformin, and human insulin have been implicated in causing liver injury. To date, the newer thiazolidinediones do not appear to share the hepatotoxic potential of troglitazone, although a few reports of acute hepatitis have accrued. Although liver injury has been associated with the "statins," the frequency of such toxicity is lower than that of the background population and the value of biochemical monitoring remains unproved. Newer concepts in anticonvulsant hepatotoxicity have been the recognition of the reactive metabolite syndrome, delineation of the risk factors for valproic acid toxicity, the potential role of carnitine in preventing valproic acid hepatotoxicity, and the toxicity of second-line antiepileptic drugs. Liver injury associated with newer psychotropic agents, particularly the selective serotonin reuptake inhibitors, is also discussed. The focus of the review is the hepatotoxicity of commonly used drugs with particular reference to recent and novel reports of toxicity. Well-known causes of liver injury such as chlorpromazine, phenytoin, and methyldopa are not discussed.

Adult↗
PubMed2003

Risk of hypoglycaemia with oral antidiabetic agents in patients with Type 2 diabetes.

In patients with Type 2 diabetes, the appropriate intensity of glucose control is determined by age, life expectancy, and the presence of concomitant disease. Geriatric patients are especially susceptible to hypoglycaemia and therefore particular care should be taken in this group characterized by polypharmacy, renal or hepatic dysfunction, cardiovascular multimorbidity and malnutrition. As hypoglycaemia is a significant cause of morbidity and mortality, treatment regimens for diabetes should minimize the occurrence of hypoglycaemic episodes and be tailored to the patient's individual needs. The pharmacological options for treating Type 2 diabetes have increased considerably and the risk of hypoglycaemia of the currently available drugs varies considerably. Metformin, thiazolidinediones, and acarbose, oral antidiabetic drugs that decrease insulin resistance or postprandial glucose absorption, are associated with a low risk of hypoglycaemia. These drugs can also be used effectively in various combination regimens; however, by improving insulin sensitivity, combinations of metformin and thiolidinediones with sulphonylureas or meglitinides may considerably increase the risk of hypoglycaemia. On account of its complex pharmacoprofile glibenclamide is a problematic substance carrying a high risk of hypoglycaemia. There are limited preliminary data indicating that, under routine conditions, glimepiride may be associated with a lower risk of hypoglycaemia than glibenclamide and is no more likely to cause hypoglycaemia than other shorter-acting agents such as gliclazide and glipizide. Nateglinide and repaglinide as short-acting insulin secretagogues may be associated with a reduced risk of hypoglycaemia compared with glibenclamide, in particular when dosed flexibly. Repaglinide might be beneficial in individuals with renal impairment.

Clinical Trials as Topic↗
PubMed2005

Relationship between antidiabetic treatment with QT dispersion during acute coronary syndromes in type 2 diabetes: comparison between patients receiving sulfonylureas and insulin.

Patients with acute coronary syndromes (ACS) show prolongation of QT interval duration and its dispersion (QTd). Prolongation of QTd has been associated with inhomogeneity of ventricular recovery times and high arrhythmyogenic potential. Previous studies have shown that preservation of the ischaemic preconditioning is associated with shorter QTd. Sulfonylureas may inhibit cardiac ischaemic preconditioning. The effect, however, of the previous treatment with sulfonylureas on QTd in patients with ACS has not been studied so far. This cross-sectional study examined the effect of the previous antidiabetic treatment on QTd in patients with type 2 diabetes during ACS. A total of 150 patients with ACS (myocardial infarction: n = 120; unstable angina: n = 30) admitted to the coronary care unit of our hospital were studied. Three groups of patients were examined: patients without diabetes (n = 60); patients with type 2 diabetes treated with sulfonylureas alone or in combination with metformin (n = 50); and patients treated with insulin alone or in combination with metformin (n = 40). Standard 12-lead ECG recordings at admission to the coronary care unit were obtained. QT interval duration and QTd were measured using ECG analysis software. At admission, QTd was not different between diabetic and non-diabetic patients (72.1 +/- 21.7 vs. 78.4 +/- 21.3 msec, p = 0.13, respectively). Similarly, the values of the above interval were also not different between patients with type 2 diabetes treated with sulfonylureas and insulin (73.8 +/- 23.9 vs. 70.1 +/- 18.5 msec, p = 0.55, respectively). It is concluded that the previous treatment with either sulfonylureas or insulin does not affect QTd in patients with type 2 diabetes and ACS.

Aged↗
PubMed1995

Effect of troglitazone, a new oral antidiabetic agent, on fructose-induced insulin resistance.

Troglitazone, a newly developed oral antidiabetic agent, improves hyperglycemia, and has been reported to improve insulin resistance and to decrease hepatic glucose production in diabetic animals. However, the exact mechanism of Troglitazone on the improvement of insulin resistance is not known. Chronic administration of fructose to normal rats leads to hyperglycemia, and hyperinsulinemia; it induces insulin resistance. To reveal the mechanism of Troglitazone, we studied the effect of Troglitazone on serum glucose and insulin in the fructose-induced, insulin-resistant rats. Male Sprague-Dawley (SD) rats were fed either on standard chow or one containing fructose. Troglitazone was administrated as a food admixture (150 mg/kg/day) for 8 weeks. The rats were fed on (1) standard chow, (2) standard chow and Troglitazone, (3) fructose-enriched chow, or (4) fructose-enriched chow and Troglitazone. Blood samples were obtained every two weeks, and the levels of serum glucose and insulin were measured. Fructose-enriched chow increased serum glucose and insulin levels and insulin-to-glucose ratios. Troglitazone improved the fructose-induced increases in serum glucose, insulin levels, and insulin/glucose ratios. In conclusion, Troglitazone improved the fructose-induced insulin resistance.

Aging↗
PubMed2006

Mulberry latex rich in antidiabetic sugar-mimic alkaloids forces dieting on caterpillars.

Since ancient times, mulberry leaves (Morus spp.) have been used to rear the silkworm Bombyx mori. Because the silkworm grows well on mulberry leaves, the toxicities and defensive activities of these leaves against herbivorous insects have been overlooked. Here we show that mulberry leaves are highly toxic to caterpillars other than the silkworm B. mori, because of the ingredients of the latex, a milky sap exuded from mulberry leaf veins. The toxicity of mulberry leaves was lost when the latex was eliminated from the leaves, and artificial diets containing latex showed toxicity. Mulberry latex contained very high concentrations of alkaloidal sugar-mimic glycosidase inhibitors reported to have antidiabetic activities, such as 1,4-dideoxy-1,4-imino-D-arabinitol, 1-deoxynojirimycin, and 1,4-dideoxy-1,4-imino-D-ribitol. The overall concentrations of these inhibitors in latex reached 1.5-2.5% (8-18% dry weight) in several mulberry varieties, which were approximately 100 times the concentrations previously reported from whole mulberry leaves. These sugar-mimic alkaloids were toxic to caterpillars but not to the silkworm B. mori, indicating that the silkworm can circumvent the mulberry tree's defense. Our results suggest that latex ingredients play key roles in defense of this tree and of other plants against insect herbivory, and they imply that plant latexes are treasuries of bioactive substances useful as medicines and pesticides.

1-Deoxynojirimycin↗
PubMed1989

Antidiabetic effects of interleukin 1.

Interleukin 1 (IL-1), a cytokine released mainly by activated macrophages-monocytes, affects glucose homeostasis and may mediate some of the metabolic derangements observed during certain inflammatory and infectious processes. In this report, it is shown that IL-1 acts as a hypoglycemic agent not only in normal animals but also in mice at early stages of alloxan-induced diabetes and in genetically diabetic, insulin-resistant C57BL/Ks db/db mice and C57BL/6J ob/ob mice. In these animal models, a single injection of a low dose of human recombinant IL-1 normalized glucose blood levels for several hours. This effect was not mediated by possible insulin secretagogue actions of the cytokine. Furthermore, IL-1 markedly reduced the levels of triglycerides in blood of streptozotocin-induced diabetic mice at later stages of the disease. Although the final mechanism of action is at present unknown, the results showed that IL-1 is a hormone with powerful antidiabetic properties. Defective production of this cytokine associated with diabetes could contribute to aggravate the course of the disease during infectious and inflammatory processes.

Animals↗
PubMed1991

Hormone-regulated K+ channels in follicle-enclosed oocytes are activated by vasorelaxing K+ channel openers and blocked by antidiabetic sulfonylureas.

Follicular oocytes from Xenopus laevis contain K+ channels activated by members of the recently recognized class of vasorelaxants that include cromakalim and pinacidil and blocked by antidiabetic sulfonylureas, such as glibenclamide. These channels are situated on the adherent follicular cells and are not present in denuded oocytes. Cromakalim-activated K+ channels are also activated by increases in intracellular cAMP, and cAMP-activated K+ channels are blocked by glibenclamide. Although cromakalim and cAMP effects are synergistic, cromakalim activation of K+ channels is drastically reduced or abolished by treatments that stimulate protein kinase C (e.g., muscarinic effectors, phorbol esters). Gonadotropins, known to play an essential role in ovarian physiology, also activate cromakalim and sulfonylurea-sensitive K+ channels. Follicular oocytes constitute an excellent system for studying regulation of cromakalim-sensitive K+ channels that are important in relation to a variety of disease processes, such as cardiovascular dysfunction and asthma, as well as brain function.

Animals↗
PubMed1995

An antidiabetic thiazolidinedione is a high affinity ligand for peroxisome proliferator-activated receptor gamma (PPAR gamma).

Thiazolidinedione derivatives are antidiabetic agents that increase the insulin sensitivity of target tissues in animal models of non-insulin-dependent diabetes mellitus. In vitro, thiazolidinediones promote adipocyte differentiation of preadipocyte and mesenchymal stem cell lines; however, the molecular basis for this adipogenic effect has remained unclear. Here, we report that thiazolidinediones are potent and selective activators of peroxisome proliferator-activated receptor gamma (PPAR gamma), a member of the nuclear receptor superfamily recently shown to function in adipogenesis. The most potent of these agents, BRL49653, binds to PPAR gamma with a Kd of approximately 40 nM. Treatment of pluripotent C3H10T1/2 stem cells with BRL49653 results in efficient differentiation to adipocytes. These data are the first demonstration of a high affinity PPAR ligand and provide strong evidence that PPAR gamma is a molecular target for the adipogenic effects of thiazolidinediones. Furthermore, these data raise the intriguing possibility that PPAR gamma is a target for the therapeutic actions of this class of compounds.

Adipocytes↗
PubMed2002

The antidiabetic agent LG100754 sensitizes cells to low concentrations of peroxisome proliferator-activated receptor gamma ligands.

Insulin resistance and non-insulin-dependent diabetes mellitus are major causes of morbidity and mortality in industrialized nations. Despite the alarming rise in the prevalence of this disorder, the initial molecular events that promote insulin resistance remain unclear. The data presented here demonstrate that LG100754, an antidiabetic RXR ligand, defines a novel type of nuclear receptor agonist. Surprisingly, LG100754 has minimal intrinsic transcriptional activity, instead it enhances the potency of proliferator-activated receptor (PPAR) gamma-retinoid X receptor heterodimers for PPARgamma ligands. The ability of LG100754 to both increase PPARgamma sensitivity and relieve insulin resistance implies that a deficiency in endogenous PPARgamma ligands may represent an early step in the development of insulin resistance.

Animals↗
PubMed2001

Antidiabetic effect of a prodrug of cysteine, L-2-oxothiazolidine-4-carboxylic acid, through CD38 dimerization and internalization.

CD38 is a bifunctional enzyme synthesizing (ADP-ribosyl cyclase) and degrading (cyclic ADP-ribose (cADPR) hydrolase) cADPR, a potent Ca(2+) mobilizer from intracellular pools. CD38 internalization has been proposed as a mechanism by which the ectoenzyme produced intracellular cADPR, and thiol compounds have been shown to induce the internalization of CD38. Here, we show that the disulfide bond between Cys-119 and Cys-201 in CD38 may be involved in CD38 dimerization and internalization. We tested the effect of a reducing agent, l-2-oxothiazolidine-4-carboxylic acid (OTC), a prodrug of cysteine, on CD38 internalization in pancreatic islets. OTC enhanced insulin release from isolated islets as well as CD38 internalization and cytoplasmic Ca(2+) level. Furthermore, islet cells treated with antisense CD38 oligonucleotide showed inhibition of OTC-induced insulin secretion. Intake of OTC in db/db mice ameliorated glucose tolerance, insulin secretion, and morphology of islets when compared with control mice. These data indicate that OTC improves glucose tolerance by enhancing insulin secretion via CD38/cADPR/Ca(2+) signaling machinery. Thus, OTC may represent a novel class of antidiabetic drug.

ADP-ribosyl Cyclase↗
PubMed2003

The antidiabetic agent sodium tungstate activates glycogen synthesis through an insulin receptor-independent pathway.

Sodium tungstate is a powerful antidiabetic agent when administered orally. In primary cultured hepatocytes, tungstate showed insulin-like actions, which led to an increase in glycogen synthesis and accumulation. However, this compound did not significantly alter the insulin receptor activation state or dephosphorylation rate in cultured cells (CHO-R) or in primary hepatocytes, in either short or long term treatments. In contrast, at low concentrations, tungstate induced a transient strong activation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) after 5-10 min of treatment, in a similar way to insulin. Moreover, this compound did not significantly delay or inhibit the dephosphorylation of ERK1/2. ERK1/2 activation triggered a cascade of downstream events, which included the phosphorylation of p90rsk and glycogen synthase-kinase 3beta. Experiments with a specific inhibitor of ERK1/2 activation and kinase assays indicate that these proteins were directly involved in the stimulation of glycogen synthase and glycogen synthesis induced by tungstate without a direct involvement of protein kinase B (PKB/Akt). These results show a direct involvement of ERK1/2 in the mechanism of action of tungstate at the hepatic level.

Animals↗
PubMed2004

A new class of peroxisome proliferator-activated receptor agonists with a novel binding epitope shows antidiabetic effects.

The peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors belonging to the NR1 subfamily of nuclear receptors. The PPARs play key roles in the control of glucose and lipid homeostasis, and the synthetic isoform-specific PPAR agonists are used clinically to improve insulin sensitivity and to lower serum triglyceride levels. All of the previously reported PPAR agonists form the same characteristic interactions with the receptor, which have been postulated to be important for the induction of agonistic activity. Here we describe a new class of PPARalpha/gamma modulators, the 5-substituted 2-benzoylaminobenzoic acids (2-BABAs). As shown by x-ray crystallography, the representative compounds BVT.13, BVT.762, and BVT.763, utilize a novel binding epitope and lack the agonist-characteristic interactions. Despite this, some compounds within the 2-BABA family are potent agonists in a cell-based reporter gene assay. Furthermore, BVT.13 displays antidiabetic effects in ob/ob mice. We concluded that the 2-BABA binding mode can be used to design isoform-specific PPAR modulators with biological activity in vivo.

Animals↗
PubMed2005

Inhibition of alpha-glucosidase by aqueous extracts of some potent antidiabetic medicinal herbs.

Diabetes mellitus is one of the most prevalant diseases of adults. Agents with alpha-glucosidase inhibitory activity have been useful as oral hypoglycemic drugs for the control of hyperglycemia in patients with type 2; noninsulin-dependent, diabetes mellitus (NIDDM). Investigation of some medicinal herbs: Urtica dioica, Taraxacum officinale, Viscum album, and Myrtus communis with alpha-glucosidase inhibitor activity was conducted to identify a prophylactic effect for diabetes in vitro. All plants showed differing potent alpha-glucosidase inhibitory activity. However, Myrtus communis strongly inhibited the enzyme (IC50 = 38 microg/mL). The inhibitory effect of these plants and some common antidiabetic drugs against the enzyme source (baker's yeast, rabbit liver, and small intestine) were also searched. Approximately all inhibitors used in this study showed quite different inhibitory activities, according to alpha-glucosidase origins. Furthermore, subsequent separation of the active material from Myrtus communis by HPLC showed that only one fraction acted as an a-glucosidase inhibitor.

Enzyme Activation↗
PubMed1999

Inhibition of galactose-induced cataractogenesis by troglitazone, a new antidiabetic drug with an antioxidant property, in rat lens culture.

Troglitazone is a new antidiabetic drug with a combined chemical structure of thiazolidinedione and alpha-tocopherol like structure (chroman ring). We evaluated the effect oftroglitazone on the morphological and biochemical changes in rat lenses cultured with galactose. Culturing in 30 mM galactose medium for 48 hrs resulted in vacuole formation in the cortex of lens equator (early phase of cataract). A significant amount of galactitol accumulation and lipid peroxide formation were also observed in lenses exposed to galactose. These morphological and biochemical changes associated with galactose were inhibited by 2 or 20 microM troglitazone present in the galactose medium. These results confirm the previous finding that troglitazone delayed the formation of cataract in rats fed a galactose diet. The anticataract effect of troglitazone was discussed in terms of antioxidant property of the drug.

Aldehyde Reductase↗