New therapies aimed at the preservation or restoration of beta cell function in type 1 diabetes

Management of patients with type 2 diabetes

BACKGROUND

The number of treatment options in the diabetes arena has grown dramatically in a short period of time, with a corresponding increase in the breadth and depth of literature from which physicians and diabetes organizations make evidence-based decisions. Thus, the purpose of this article is to provide an up-to-date review of the literature describing current treatment options and guidelines available for the management of type 2 diabetes and prevention of its complications.

METHODS

Pubmed searches were conducted for recent literature pertaining to the prevention of complications in type 2 diabetes. Comprehensive search terms were devised to identify articles describing micro- and macrovascular complications including nephropathy, neuropathy, retinopathy, and cardiovascular disease associated with type 2 diabetes.

CONCLUSIONS

The current body of literature demonstrates that a significant reduction in the incidence of diabetic complications is achievable with early initiation and long-term maintenance of controlled blood glucose and cardiovascular risk factors. Screening for diabetic complications should be initiated early and continued at regular intervals to ensure early pharmacological intervention.

Approaches in type 1 diabetes research: A status report

Type 1 diabetes is a multifactorial disease with an early age of onset, in which the insulin producing beta cell of the pancreas are destroyed because of autoimmunity. It is the second most common chronic disease in children and account for 5% to 10% of all diagnosed cases of diabetes. India is having an incidence of 10.6 cases/year/100,000, and recent studies indicate that the prevalence of type 1 diabetes in India is increasing. However in view of poor health care network, there is no monitoring system in the country. Of the 18 genomic intervals implicated for the risk to develop type 1 diabetes, the major histocompatibility complex (MHC) region on chromosome 6p21.31 has been the major contributor estimated to account for 40-50%, followed by 10% frequency of INS-VNTR at 5' flanking region of the insulin gene on chromosome 11p15.5. However, population studies suggest that > 95% of type 1 diabetes have HLA-DR3 or DR4, or both, and in family studies, sibling pairs affected with type 1 diabetes have a non-random distribution of shared HLA haplotypes. As predisposing genetic factors such as HLA alleles are known, immunological interventions to prevent type 1 diabetes are of great interest. In the present study we have reviewed the status of molecular genetics of the disease and the approaches that need to be adopted in terms of developing patient and suitable control cohorts in the country.