Review of insulin and its analogues in diabetes mellitus

Abstract

DIABETES MELLITUSD iabetes mellitus (DM) is a metabolic disorder resulting from a defect in insulin secretion, insulin action or both [1][2][3][4]. Insulin defi ciency in turn leads to chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism [1][2][3][4]. As the disease progresses tissue or vascular damage ensues leading to severe diabetic complications such as retinopathy [5,6], neuropathy [7,8], nephropathy [9,10], Cardiovascular complications [11,12] and ulceration [13,14]. Th us diabetes covers a wide range of heterogeneous diseases. Diabetes is the most common endocrine disorder and by the year 2010, it was estimated that more than 200 million people worldwide had DM and 300 million will subsequently have the disease by 2025 [15][16][17]. Th e diagnostic criteria and the classifi cation of diabetes was fi rst put forward by the World Health Organization (WHO) in 1965[18] then by the National Diabetes Data Group (NDDG) in 1979 [19] and this was followed by simplifi ed recommendations by the WHO in 1980 [20]. Th ese WHO recommendations were modifi ed slightly in 1985 [21]. Th e latest recommendations have been published by the American Diabetes Association (ADA) in 1997 and by the WHO in 1999. Both groups agree on the recommendations and criteria [2,22].According to the ADA recommendation changes in 1997, the fasting glucose concentration should be used in routine screening for diabetes as well as epidemiological studies; the threshold for fasting glucose was changed from 7.8 mmol/L (140 mg/dl) to 7.0 mmol/L (126 mg/dl); however the 2 hrs glucose criterion remains as 11.1 mmol/L (200 mg/dL). For the diagnosis of diabetes, at least one of the below criteria must apply. Th e WHO diagnosis and classifi cation of diabetes mellitus (1999) are identical to those of ADA, a fasting glucose = 7.0 mmol/L (126 mg/dl) and /or a 2 hrs glucose = 11.1 mmol/L (200 mg/dL). Th e report states that diagnosis should not be based on a single glucose determination but requires confi rmatory symptoms or blood/plasma determination. Ideally therefore, both the 2 hrs and fasting value should be used. Th ese recommendations contrast with those of ADA Expert Committee which gives primacy to the fasting plasma glucose. Th e WHO classifi cation includes both clinical stages (normoglycaemia, impaired glucose tolerance/impaired fasting glucose (IGT/IFG), diabetes and aetiological types of diabetes mellitus, identical to the ADA except that WHO group includes classifi cation formerly known as gestational impaired glucose tolerance (GIGT) and GDM: fasting glucose = 7.0 mmol/L (126 mg/dL) and/or 2 hrs glucose = 7.8 mmol/ L (140 mg/dL) after a 75-g OGTT.Diabetes mellitus may be categorized into several types but the two major types are type I and type II [21,23]. On the basis of aetiology, the term type I and type II were widely used to describe IDDM and NID-DM, respectively. Th e term juvenile -onset diabetes has sometimes been used for IDDM and maturity-onset for NIDDM.Type I (Ia, Ib) ß-cell destruction with litt...

Empowerment in the Treatment of Diabetes and Obesity

“…The plan of self-control was adjusted to the patients' illness and not to their priorities, objectives, possibilities, and lifestyle. It is very difficult for patients with diabetes to comply with all medical recommendations and maintain constant normoglycemia [2], even though they are aware of the long-term complications resulting from chronic hyperglycemia. As a result, we often observe continuous stress in both the patient and the health care professionals.…”

Identifying New Isatin Derivatives with GSK-3β Inhibition Capacity through Molecular Docking and Bioassays

“…Additionally, signals in the range of d 7.66-7.85 ppm associated with aromatic hydrogens of other aryl groups, along with the observed coupling constant, permitted us to determine the presence of a monosubstituted ring in the structure, confirming the final structure of 2e. Despite the isatin signals, signals in the 13 C NMR spectrum related to two additional aryl groups were observed in addition to signals from two methylene carbons at d 41.1 and 57.9 ppm.…”

“…The coupling constant of these hydrogens is characteristic of a 1,2-dissubstitute aromatic ring. The 13 C NMR spectra shows two signals at approximately d 158 and 182 ppm related to the carbons of the ketone and amide functions of isatin.…”

In Vitro and In Vivo Evaluation of Nanoparticles Prepared by Nano Spray Drying for Stomach Mucoadhesive Drug Delivery

“…[5] In spite of these worrying figures, the success of strategies to promote glycemic control in clinical practice is far from satisfactory, and many patients with type 2 diabetes still fail to achieve long-term glycemic control, even when receiving treatment with recent antidiabetes medications. [6][7][8] Metformin hydrochloride is recommended by all guidelines as a first-line treatment for type 2 diabetics if the patient's blood glucose level is not controlled by lifestyle measures alone. [9] Both the American Diabetes Association and the International Diabetes Federation (IDF) suggest using metformin hydrochloride in all cases where blood glucose levels are inadequately controlled by nonpharmacological therapies.…”