ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This review describes the most important recent findings on the role of the renin-angiotensin system and its pharmacologic blockade in diabetic nephropathy. The pathway leading to activation of the renin-angiotensin system is analyzed, with emphasis on systemic and local renal renin-angiotensin systems; included is a discussion of angiotensin II receptors. Hemodynamic as well as nonhemodynamic actions of angiotensin II are presented. Based on evidence for genetic susceptibility to diabetic nephropathy, gene polymorphism is reviewed. Finally, the unique pharmacologic effects of angiotensin converting enzyme inhibitors and evidence for their clinical efficacy in diabetics with nephropathy are reviewed.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Insulinlike growth factor-I (IGF-I) displays considerable structural and functional homology to insulin, as does its cognate receptor, which appears to utilize signal transduction molecules similar if not identical to those of the insulin receptor. Over the past several years, major emphasis has been placed on defining the range of biologic effects of IGF-I in vivo and in determining the physiologic consequences of interaction of IGF-I with a range of specific serum carrier proteins, the IGF binding proteins. Although early studies enrolled mainly healthy volunteers, recent studies have addressed the potential role of recombinant human IGF-I (rhIGF-I) as a therapeutic agent in a variety of clinical syndromes of altered carbohydrate homeostasis, including severe insulin resistance and types I and II diabetes mellitus. Initial studies demonstrated considerable efficacy for all of these conditions but raised concerns over the potential short-term toxicity of rhIGF-I, particularly in older individuals. Recent studies have concentrated on defining the doses of rhIGF-I that are well tolerated and provide therapeutic efficacy. Work also has concentrated on defining rhIGF-I's mechanisms of action. These more recent studies raise the possibility that rhIGF-I will be a useful addition to the treatment of diabetes mellitus.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The advent of the use of reagents for measuring changes in serum insulinlike growth factor-I and the insulinlike growth factor binding proteins by sensitive techniques has resulted in multiple studies of both regulation of these substances in normal physiologic situations and their pathophysiologic alterations. These tests are now being utilized to determine not only the range of their variations in normal physiologic situations but also the utility of abnormal values in diagnosing disease states. To date, the tests have been used to diagnose growth hormone deficiency and excess as well as to monitor growth hormone replacement therapy. However, because secretion of insulinlike growth factor-I is also altered in diabetes, the diabetic state and responses to insulin therapy have received recent emphasis. Likewise, tumors that produce insulinlike growth factor-I or II, or forms of the insulinlike growth factor binding proteins, and cachectic states such as cirrhosis, AIDS, and burns have also been studied. These data are now well enough formulated for some conditions that we can begin to make predictions about the usefulness of these tests in medical diagnosis.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The use of anorectic agents for the treatment of obesity has recently gained wider acceptance. In general, clinical trials have shown that obese subjects treated with appetite suppressants lose significantly more weight than those treated with placebo and a prescribed diet. The majority of patients with non-insulin dependent diabetes mellitus (NIDDM) are obese, and this excess of body fat is thought to play a major role in the insulin resistance of NIDDM. The impact of appetite suppressant therapy on both weight loss and metabolic parameters in patients with NIDDM is reviewed.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Metformin (dimethylbiguanide) is an antihyperglycemic agent with a variety of extrapancreatic actions that counter insulin resistance in patients with type II diabetes. Recent studies have emphasized the drug's ability to curb excessive hepatic glucose production, reduce fatty acid oxidation, and improve the glucose-fatty acid cycle. Because the actions of metformin are modest in potency and do not raise insulin concentrations, the drug does not produce overt hypoglycemia. Lack of weight gain, improvements in the dyslipidemia, and potential benefits in terms of vascular parameters are useful advantages of the drug. The long-term glycemic control achieved with metformin is similar to that achieved with a sulfonylurea, and the different modes of action of these two types of drugs enable them to exert an additive effect when prescribed in combination.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Recently a pharmacologic optimization of the dietary principle of delaying the digestion of complex carbohydrates and absorption of glucose was introduced in North America when acarbose, an α-glucosidase inhibitor, was approved for use as an oral hypoglycemic medication in the treatment of non-insulin dependent diabetes mellitus. The reversible competitive inhibition by acarbose of the α-glucosidases in the small intestines translates into a slower and reduced increment in the postprandial rise in blood glucose after a carbohydrate meal. There is also a decrease in postprandial hyperinsulinemia with concomitant reduction in insulin resistance. Acarbose is effective when used alone or in combination with sulfonylureas, metformin, or insulin. In the United States it can be used as monotherapy or combined with sulfonylurea. The major adverse effects, which decrease with time, are gastrointestinal (flatulence, meteonsm, abdominal distention, and diarrhea). By starling with a low dose and increasing it slowly these side effects can be minimized. When acarbose is used with insulin or sulfonylurea, hypoglycemia can occur. Glucose, rather than sucrose or complex carbohydrates, should be used in the treatment of this hypoglycemia.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Diabetic retinopathy is a leading cause of new vision loss in the United States and other industrialized countries. Maximal control of the diabetic condition and other collateral medical problems, such as hypertension, renal disease, and lipid levels, regular dilated eye examinations, and laser surgery and vitrectomy when indicated can significantly reduce the risk of vision loss from diabetes. The appropriate use of laser surgery and vitrectomy, and the timing of follow-up evaluations, have been defined by major clinical trials in the United States. Recent studies reinforce the results of these trials.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Diabetic neuropathy encompasses a wide range of subclinical and clinical syndromes. Here, we provide a new classification of neuropathies based on their pathogenetic heterogeneity, dictating a need for specific therapies oriented to the underlying causative mechanisms. In addition to the traditional approach that associates neuropathy with persistently high blood glucose levels or microvascular insufficiency, recent observations related to the role of immune mechanisms and deficiency of neurotrophic factors are also presented. Diagnostic procedures should include a thorough evaluation of clinical, electrophysiologic, and quantitative sensory and autonomic function testing in order to distinguish diabetic neuropathies from other causes of nerve damage. An important diagnostic element is screening for signs of antineuronal autoimmunity that may dictate a need for immunotherapy. Other indications for specific therapies are discussed, including aldose reductase inhibitors, aminoguanidine, γ-linolenic acid,N-acetyl-L-carnitine, and gangliosides. In addition, we describe algorithms for the recognition and symptomatic management of painful diabetic neuropathy and mononeuropathies and discuss a global approach to the recognition and optimum treatment strategies for syndromes involving the autonomic nervous system, including cardiovascular, gastrointestinal, genitourinary, and metabolic aspects. New agents on the horizon for treating neuropathy are mentioned briefly.

ISSN:1068-3097    

出版商:OVID    

年代:1997

数据来源: OVID