1
|
Li P, Kianmehr H, Guan D, Kulshreshtha A, Narayan KV, Ali MK, Umpierrez GE, Hu X, Fonseca VA, Shi L, Shao H. Renal function as an effect modifier of intensive glucose control in delaying cognitive function decline among individuals with type 2 diabetes: A revisit to the ACCORD MIND trial. Diabetes Obes Metab 2024; 26:3958-3968. [PMID: 38962812 PMCID: PMC11300148 DOI: 10.1111/dom.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
AIM Dysglycaemia accelerates cognitive decline. Intensive glucose control may help delay or prevent cognitive function decline (CFD). We aimed to determine how patient characteristics influence the effect of intensive glucose control [glycated haemoglobin (HbA1c) <6.0%] on delaying CFD in people with type 2 diabetes. RESEARCH DESIGN AND METHODS In this post-hoc analysis of 2977 type 2 diabetes participants from the ACCORD MIND trial, we applied the causal forest and causal tree algorithms to identify the effect modifier of intensive glucose control in delaying CFD from 68 variables (demographics, disease history, medications, vitals and baseline biomarkers). The exposure was intensive versus standard glucose control (HbA1c <6.0% vs. 7.0%-7.9%). The main outcome was cognitive function changes from baseline to the 40th month follow-up, which were evaluated using the digit symbol substitution test, Rey auditory verbal learning test, mini-mental state examination and Stroop test. We used Cohen's d, a measure of standardized difference, to quantify the effect size of intensive glucose control on delaying CFD. RESULTS Among all the baseline characteristics, renal function was the most significant effect modifier. Participants with urinary albumin levels <0.4 mg/dl [absolute function change (AFC): 0.51 in mini-mental state examination, 95% confidence interval (CI): 0.04, 0.98, Cohen's d: 0.25] had slower CFD with intensive glucose control. Patients with preserved renal function (estimated glomerular filtration rate between 60 and 90 ml/min/1.73 m2) were associated with small benefits (AFC: 1.28 in Stroop, 95% CI: 0.28, 2.27, Cohen's d: 0.12) when undergoing intensive glucose control. Conversely, participants with an estimated glomerular filtration rate <60 ml/min/1.73 m2 (AFC: -0.57 in the Rey auditory verbal learning test, 95% CI: -1.09, -0.05, Cohen's d: -0.30) exhibited faster CFD when undergoing intensive glucose control. Participants who were <60 years old showed a significant benefit from intensive glucose control in delaying CFD (AFC: 1.08 in the digit symbol substitution test, 95% CI: 0.06, 2.10, Cohen's d: 0.13). All p < .05. CONCLUSIONS Our findings linked renal function with the benefits of intensive glucose control in delaying CFD, informing personalized HbA1c goals for those with diabetes and at risk of CFD.
Collapse
Affiliation(s)
- Piaopiao Li
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Hamed Kianmehr
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Dawei Guan
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - K.M. Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | | | - Xin Hu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlotteville, VA
| | - Vivian A. Fonseca
- Department of Medicine and Pharmacology, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hui Shao
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| |
Collapse
|
2
|
Shi K, Zhang G, Fu H, Li XM, Gao Y, Shi R, Xu HY, Li Y, Guo YK, Yang ZG. Glycemic control and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: insight from ventricular remodeling using cardiac MRI. Cardiovasc Diabetol 2024; 23:148. [PMID: 38685007 PMCID: PMC11059653 DOI: 10.1186/s12933-024-02243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Glycemic control, as measured by glycosylated hemoglobin (HbA1c), is an important biomarker to evaluate diabetes severity and is believed to be associated with heart failure development. Type 2 diabetes mellitus (T2DM) and heart failure with reduced ejection fraction (HFrEF) commonly coexist, and the combination of these two diseases indicates a considerably poorer outcome than either disease alone. Therefore, glycemic control should be carefully managed. The present study aimed to explore the association between glycemic control and clinical outcomes, and to determine the optimal glycemic target in this specific population. METHODS A total of 262 patients who underwent cardiac MRI were included and were split by HbA1c levels [HbA1c < 6.5% (intensive control), HbA1c 6.5-7.5% (modest control), and HbA1c > 7.5% (poor control)]. The biventricular volume and function, as well as left ventricular (LV) systolic strains in patients in different HbA1c categories, were measured and compared. The primary and secondary outcomes were recorded. The association of different HbA1c levels with adverse outcomes was assessed. RESULTS Despite similar biventricular ejection fractions, both patients with intensive and poor glycemic control exhibited prominent deterioration of LV systolic strain in the longitudinal component (P = 0.004). After a median follow-up of 35.0 months, 55 patients (21.0%) experienced at least one confirmed endpoint event. Cox multivariable analysis indicated that both patients in the lowest and highest HbA1c categories exhibited a more than 2-fold increase in the risk for primary outcomes [HbA1c < 6.5%: hazard ratio (HR) = 2.42, 95% confidence interval (CI) = 1.07-5.45; P = 0.033; HbA1c > 7.5%: HR = 2.24, 95% CI = 1.01-4.99; P = 0.038] and secondary outcomes (HbA1c < 6.5%: HR = 2.84, 95% CI = 1.16-6.96; P = 0.022; HbA1c > 7.5%: HR = 2.65, 95% CI = 1.08-6.50; P = 0.038) compared with those in the middle HbA1c category. CONCLUSIONS We showed a U-shaped association of glycemic control with clinical outcomes in patients with T2DM and HFrEF, with the lowest risk of adverse outcomes among patients with modest glycemic control. HbA1c between 6.5% and 7.5% may be served as the optimal hypoglycemic target in this specific population.
Collapse
Affiliation(s)
- Ke Shi
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ge Zhang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Gao
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Jung HH. Glycemic control and dementia risk in patients aged above and below 75 years. Diabetol Int 2024; 15:244-252. [PMID: 38524931 PMCID: PMC10959882 DOI: 10.1007/s13340-023-00684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/30/2023] [Indexed: 03/26/2024]
Abstract
Background There is a lack of data about the treatment effect of glycemic control on incident dementia in patients with advanced age. Methods In a nationwide Korean cohort of 79,076 diabetic patients 75 years or older and a representative cohort of 74,672 diabetics aged 50 to 74 years, multivariable-adjusted incidence of overt dementia was estimated across yearly-averaged on-treatment fasting blood glucose (FBG) levels. Results During 9-year follow-up, overt dementia was noted in 24,710 (31.2%) patients 75 years or older and in 5237 (7.0%) patients aged 50 to 74 years. For dementia risk, J-shaped associations were observed across on-treatment FBG levels (80-99, 100-109, 110-125, 126-139, 140-159, 160-179, and 180-900 mg/dl) in patients 75 years or older (respective incidence: 49.3, 45.7, 45.9, 45.7, 48.5, 51.5, and 57.9 per 1000 person-years) and in those aged 50 to 74 years (respective incidence: 8.9, 8.3, 7.7, 7.6, 8.0, 8.6, and 10.6 per 1000 person-years) with a significant interaction of FBG level and age group (P = 0.001). For all-cause mortality, the J-shaped association curve was left-shifted in patients 75 years or older (respective incidence: 64.9, 59.1, 57.6, 60.4, 64.0, 70.9, and 90.4 per 1000 person-years) relative to that in patients aged 50 to 74 years (respective incidence: 15.7, 13.4, 12.3, 12.2, 13.4, 15.7, and 21.8 per 1000 person-years; P < 0.001 for interaction). Conclusion The achieved glycemic level with the lowest risk for dementia and mortality was lower in older patients, and absolute risk increase related to poorly controlled glucose was greater in the elderly compared with younger patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-023-00684-4.
Collapse
Affiliation(s)
- Hae Hyuk Jung
- Department of Medicine, Kangwon National University School of Medicine, Kangwondaehakgil, Chuncheon, Gangwon-Do 24341 South Korea
- Department of Medicine, Kangwon National University Hospital, 156 Baekryung-ro, Chuncheon, Gangwon-do 24289 South Korea
| |
Collapse
|
4
|
Alhaddad AY, Aly H, Gad H, Elgassim E, Mohammed I, Baagar K, Al-Ali A, Sadasivuni KK, Cabibihan JJ, Malik RA. Longitudinal Studies of Wearables in Patients with Diabetes: Key Issues and Solutions. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115003. [PMID: 37299733 DOI: 10.3390/s23115003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
Glucose monitoring is key to the management of diabetes mellitus to maintain optimal glucose control whilst avoiding hypoglycemia. Non-invasive continuous glucose monitoring techniques have evolved considerably to replace finger prick testing, but still require sensor insertion. Physiological variables, such as heart rate and pulse pressure, change with blood glucose, especially during hypoglycemia, and could be used to predict hypoglycemia. To validate this approach, clinical studies that contemporaneously acquire physiological and continuous glucose variables are required. In this work, we provide insights from a clinical study undertaken to study the relationship between physiological variables obtained from a number of wearables and glucose levels. The clinical study included three screening tests to assess neuropathy and acquired data using wearable devices from 60 participants for four days. We highlight the challenges and provide recommendations to mitigate issues that may impact the validity of data capture to enable a valid interpretation of the outcomes.
Collapse
Affiliation(s)
- Ahmad Yaser Alhaddad
- Department of Mechanical and Industrial Engineering, Qatar University, Doha 2713, Qatar
| | - Hussein Aly
- KINDI Center for Computing Research, Qatar University, Doha 2713, Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Doha 24144, Qatar
| | | | - Ibrahim Mohammed
- Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Department of Internal Medicine, Albany Medical Center Hospital, Albany, NY 12208, USA
| | | | - Abdulaziz Al-Ali
- KINDI Center for Computing Research, Qatar University, Doha 2713, Qatar
| | | | - John-John Cabibihan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha 2713, Qatar
| | | |
Collapse
|
5
|
Aldafas R, Crabtree T, Vinogradova Y, Gordon JP, Idris I. Efficacy and safety of intensive versus conventional glucose targets in people with type 2 diabetes: a systematic review and meta-analysis. Expert Rev Endocrinol Metab 2023; 18:95-110. [PMID: 36718676 DOI: 10.1080/17446651.2023.2166489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of study is to re-evaluate the risk-benefits of intensive glycemic control in the context of multi-factorial intervention in adults with T2D. METHODS We searched Ovid MEDLINE, Embase, Cochrane, and CINHAL for randomized control trials comparing standard glucose targets to intensive glucose targets with pre-specified HbA1clevels. Subgroup analysis was also performed to account for the inclusion of glucose only versus multi-factorial intervention trials. Results are reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS Fifty-seven publications including 19 trials were included. Compared to conventional glycemic control, intensive glycemic control decreased the risk of non-fatal myocardial infarction (0.8, 0.7-0.91), macroalbuminuria (0.72, 0.5--0.87), microalbuminuria (0.67, 0.52-0.85), major amputation (0.6, 0.38-0.96), retinopathy (0.75 ,0.63-0.9), and nephropathy (0.78, 0.63-0.97). The risk of hypoglycemia increased with intensive glycemic control than conventional treatment (2.04, 1.34-3.1). No reduction in all-cause or cardiovascular mortality was observed. However, in the context of multifactorial intervention, intensive glucose control was associated with a significant reduction in all-cause mortality (0.74, 0.57-0.95). CONCLUSION Targeting HbA1c levels should be individualized based on the clinical status, balancing risks and benefits and potential risk for developing these complications among people with T2D.
Collapse
Affiliation(s)
- Rami Aldafas
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Faculty of Public Health, College of Health Science, the Saudi Electronic University, Riyadh, Saudi Arabia
| | - Thomas Crabtree
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
| | - Yana Vinogradova
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Jason P Gordon
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Health Economic Outcomes Research, Birmingham, UK
| | - Iskandar Idris
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, NIHR, Nottingham BRC, University of Nottingham, UK
| |
Collapse
|
6
|
Alhaddad AY, Aly H, Gad H, Al-Ali A, Sadasivuni KK, Cabibihan JJ, Malik RA. Sense and Learn: Recent Advances in Wearable Sensing and Machine Learning for Blood Glucose Monitoring and Trend-Detection. Front Bioeng Biotechnol 2022; 10:876672. [PMID: 35646863 PMCID: PMC9135106 DOI: 10.3389/fbioe.2022.876672] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is characterized by elevated blood glucose levels, however patients with diabetes may also develop hypoglycemia due to treatment. There is an increasing demand for non-invasive blood glucose monitoring and trends detection amongst people with diabetes and healthy individuals, especially athletes. Wearable devices and non-invasive sensors for blood glucose monitoring have witnessed considerable advances. This review is an update on recent contributions utilizing novel sensing technologies over the past five years which include electrocardiogram, electromagnetic, bioimpedance, photoplethysmography, and acceleration measures as well as bodily fluid glucose sensors to monitor glucose and trend detection. We also review methods that use machine learning algorithms to predict blood glucose trends, especially for high risk events such as hypoglycemia. Convolutional and recurrent neural networks, support vector machines, and decision trees are examples of such machine learning algorithms. Finally, we address the key limitations and challenges of these studies and provide recommendations for future work.
Collapse
Affiliation(s)
- Ahmad Yaser Alhaddad
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
| | - Hussein Aly
- KINDI Center for Computing Research, Qatar University, Doha, Qatar
| | - Hoda Gad
- Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Abdulaziz Al-Ali
- KINDI Center for Computing Research, Qatar University, Doha, Qatar
| | | | - John-John Cabibihan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
| | | |
Collapse
|
7
|
Mitochondria-Mediated Cardiovascular Benefits of Sodium-Glucose Co-Transporter 2 Inhibitors. Int J Mol Sci 2022; 23:ijms23105371. [PMID: 35628174 PMCID: PMC9140946 DOI: 10.3390/ijms23105371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Several recent cardiovascular trials of SGLT 2 (sodium-glucose cotransporter 2) inhibitors revealed that they could reduce adverse cardiovascular events in patients with T2DM (type 2 diabetes mellitus). However, the exact molecular mechanism underlying the beneficial effects that SGLT2 inhibitors have on the cardiovascular system is still unknown. In this review, we focus on the molecular mechanisms of the mitochondria-mediated beneficial effects of SGLT2 inhibitors on the cardiovascular system. The application of SGLT2 inhibitors ameliorates mitochondrial dysfunction, dynamics, bioenergetics, and ion homeostasis and reduces the production of mitochondrial reactive oxygen species, which results in cardioprotective effects. Herein, we present a comprehensive overview of the impact of SGLT2 inhibitors on mitochondria and highlight the potential application of these medications to treat both T2DM and cardiovascular diseases.
Collapse
|
8
|
Crabtree T, Ogendo JJ, Vinogradova Y, Gordon J, Idris I. Intensive glycemic control and macrovascular, microvascular, hypoglycemia complications and mortality in older (age ≥60years) or frail adults with type 2 diabetes: a systematic review and meta-analysis from randomized controlled trial and observation studies. Expert Rev Endocrinol Metab 2022; 17:255-267. [PMID: 35614863 DOI: 10.1080/17446651.2022.2079495] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Guidelines for type 2 diabetes (T2D) recommend individualized HbA1c targets to take into account patient age or frailty. We synthesized evidence from randomized controlled trials and observational studies for intensive glycemic control (HbA1c target ≤58 mmol/mol) versus standard care, in elderly (age ≥60 years) or frail adults with T2D. METHODS Searches were performed utilizing recognized terms for T2D, frailty, older age, and HbA1c control and outcomes of interest. Meta-analysis was performed where possible. Primary outcomes included all-cause mortality, severe hypoglycemia, and hospital admission rates. Vascular complications, cognitive decline, and falls/fractures were secondary outcomes. RESULTS 7,528 studies were identified of which 15 different clinical studies were selected. No difference was noted in all-cause mortality with intensive control (pooled hazard ratio 0.96, 95% confidence interval 0.90-1.03), but risk of severe hypoglycemia increased (2.45, 2.22-2.72). Intensive control was associated reductions in microvascular (0.73, 0.68-0.79) and macrovascular complications (0.84, 0.79-0.89). Outcome data for risk of hospitalization, cognition, and falls/fractures were limited. CONCLUSION Intensive glycemic control was associated with reduced rates of complications but increased severe hypoglycemia. Significant heterogeneity exists and the impact of different drug regimens is unclear. Caution is needed when setting glycemic targets in elderly or frail individuals.
Collapse
Affiliation(s)
- Thomas Crabtree
- Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jael-Joy Ogendo
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Yana Vinogradova
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Jason Gordon
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Health Economic Outcomes Research, Birmingham, UK
| | - Iskandar Idris
- Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, NIHR, Nottingham BRC, University of Nottingham, UK
| |
Collapse
|
9
|
Pan Y, Liu T, Wang X, Sun J. Research progress of coumarins and their derivatives in the treatment of diabetes. J Enzyme Inhib Med Chem 2022; 37:616-628. [PMID: 35067136 PMCID: PMC8788346 DOI: 10.1080/14756366.2021.2024526] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Diabetes is a group of metabolic diseases characterised by chronic hyperglycaemia caused by multiple causes, which is caused by insulin secretion and/or utilisation defects. It is characterised by increased fasting and postprandial blood glucose levels due to insulin deficiency or insulin resistance. It is reported that the harm of diabetes mainly comes from its complications, and the cardiovascular disease caused by diabetes is the primary cause of its harm. China has the largest number of diabetic patients in the world, and the prevention and control of diabetes are facing great challenges. In recent years, many kinds of literature have been published abroad, which have proved that coumarin and its derivatives are effective in the treatment of diabetic complications such as nephropathy and cardiovascular disease. In this paper, the types of antidiabetic drugs and the anti-diabetic mechanism of coumarins were reviewed.
Collapse
Affiliation(s)
- Yinbo Pan
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, Shandong, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Teng Liu
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, Shandong, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaojing Wang
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, Shandong, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jie Sun
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, Shandong, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| |
Collapse
|