New Anti-inflammatory Drug Improves Kidney Function In Patients With Type 2 Diabetes
New anti-inflammatory drug improves kidney function in patients with type 2 diabetes A new anti-inflammatory drug used by patients with type 2 diabetes improved their kidney function during a year-long study involving researchers from UT Southwestern Medical Center. The study findings, reported in today's New England Journal of Medicine, mark the first time a drug therapy has led to improved kidney function for patients with type 2 diabetes and chronic kidney disease. Previous studies have identified drugs that slowed the deterioration of kidney function, said Dr. Robert Toto, director of the Houston J. and Florence A. Doswell Center for the Development of New Approaches for the Treatment of Hypertension at UT Southwestern. "In diabetes, kidney function tends to deteriorate over time," Dr. Toto said. "No prior studies of this duration have shown what appears to be an increase in kidney function by any therapy, which makes this a very exciting development." Type 2 is the most common form of diabetes, the leading cause of kidney failure in the U.S. Diabetics account for nearly half of all new cases of end-stage renal disease, the point at which patients require dialysis or a kidney transplant, said Dr. Toto, professor of internal medicine. The study involved 227 adult patients with type 2 diabetes and chronic kidney disease. They were divided into four groups - three receiving different dosages of bardoxolone methyl, an anti-inflammatory drug, and the fourth group receiving a placebo and acting as a control. The patients were tracked for 56 weeks, with measurements of their kidney function taken every four weeks. At study-highlighted weeks 24 and 52, researchers saw an overall significant increase in the estimated glomerular filtration rates, which are measurements of ho Continue reading >>
"anti-inflammatory" Drugs And Their Effects On Type 2 Diabetes.
"Anti-inflammatory" drugs and their effects on type 2 diabetes. University Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom. There is a growing body of evidence for the role of inflammation in type 2 diabetes. In addition to the evidence presented elsewhere, evidence is emerging that many drugs that have apparent "anti-inflammatory" properties may reduce the incidence and/or delay the onset of type 2 diabetes. Statins have been found to lower inflammatory markers, and a post hoc analysis of the West of Scotland Coronary Prevention Study (WOSCOPS) suggested that pravastatin may reduce the risk of developing diabetes, although the Lipid Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) found no statistically significant effect of atorvastatin on risk of developing diabetes. Fibrates have been found to lower some markers of inflammation, and a prospective trial found that bezafibrate reduces risk of developing diabetes. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers appear to reduce some markers of inflammation, and a meta-analysis concluded that ACE inhibitors and angiotensin receptor blockers reduce risk of developing type 2 diabetes. Metformin is known to reduce the risk of developing diabetes, and more recent evidence suggests it also lowers C-reactive protein, in part because of its modest weight-reducing effect. Thiazolidinediones reduce risk of developing diabetes, and consistently lower inflammatory markers independent of adiposity effects. High-dose aspirin inhibits cyclooxygenase and IkappaB kinase-beta and reduces fasting plasma glucose concentration, although there has not, as yet, been a large-scale trial to examine the effect of aspirin on the risk of develop Continue reading >>
Non-steroidal Anti-inflammatory Drugs (nsaids): Making Safer Treatment Choices
No association with myocardial infarction No interaction with the antiplatelet effect of aspirin Paracetamol can be given for mild to moderate pain in adults at the recommended dose of 0.5 1 g, every four to six hours, to a maximum of 4 g per day.6 The major adverse effect associated with paracetamol is liver damage due to overdose and it should not be prescribed to patients with liver disease.6 Consider adding codeine to paracetamol in select patients If the risk of NSAID-related adverse events is high, it may be appropriate to consider adding codeine to paracetamol, in preference to NSAID treatment.11 For example, an older patient with osteoarthritis, diabetes and chronic kidney disease (CKD) may be particularly susceptible to the nephrotoxic effects of NSAIDs (see NSAIDs and renal function ). An appropriate starting dose of codeine in combination with paracetamol for mild to moderate pain in adults is 15 mg, every four hours, as required.6 Codeine can be given in doses up to 60 mg, if required, but the total dose should not exceed 240 mg per day.6 The main adverse effects of codeine are gastrointestinal disturbance and potential respiratory depression.6 The effectiveness of codeine may vary between individuals due to genetic differences in metabolism, and it may not be an appropriate choice for all patients (see: Paracetamol with codeine may have variable efficacy ). Combining paracetamol with NSAIDs may be appropriate The combination of paracetamol with NSAIDs may provide more effective analgesia for some patients, e.g. for post-surgical pain, than either medicine alone.12 This combination treatment may allow the dose of NSAID required to achieve analgesia to be reduced (compared to NSAID treatment alone) therefore reducing the amount NSAID-related risk the patient Continue reading >>
Anti-inflammatory Foods Help Reverse Type 2 Diabetes
Inflammation is a process by which the body’s white blood cells and chemicals protect us from infection and foreign substances such as bacteria and viruses. Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process. Inflammation is not a synonym for infection, even in cases where inflammation is caused by infection. Although infection is caused by a microorganism, inflammation is one of the responses of the organism to the pathogen. Without inflammation, wounds and infections would never heal, causing cell and tissue damage. But, chronic inflammation fuels ongoing cell/tissue damage, leading to progressive destruction of the tissue, which could compromise the survival of the organism. In addition, chronic inflammation can lead to a variety of diseases, such as hay fever, periodontitis, atherosclerosis, rheumatoid arthritis, and even cancer (e.g., gallbladder carcinoma). It is for that reason that inflammation is normally closely regulated by the body and must be addressed if it is out of control. Normally, inflammation is helpful in assisting the body in healing cuts and bruises and occurs in the body when there is cell/tissue damage that needs to be repaired. Consequently, inflammation is good when you have a cut or injury because it is the body's natural defense in fighting off bad bacteria and promoting healing. However, cellular or chronic inflammation is a condition that happens when the body is in a continuous cycle of inflammation (without healing) or is trying to repair cells that are not damaged. Chronic inflammation is a long lasting inflammation (months Continue reading >>
Natural And Safe Anti-inflammatory Medicines
Natural and Safe Anti-Inflammatory Medicines Facebook 0 Twitter 0 livefyre Email Print An estimated 50 million Americans suffer from chronic pain, according to the American Pain Foundation. Thats a lot of pain. And that adds up to a lot of drug use, notably the category called NSAIDs, or non-steroidal anti-inflammatory drugs. Ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren) and Celebrex belong to this class of drugs. These drugs are designed to inhibit activity of what is known as the COX2 enzyme, a major factor in pain. This natural enzyme is created in all of us, and is responsible for the production of some of the agents called prostaglandins, which trigger pain and inflammation. The role of inflammation in pain is pretty straightforward. Any of a variety of insults can cause inflammation in the tissues of our bodies. External insults like burns, bites, scrapes, stings, cuts and bruises cause skin tissue to swell as protective fluids pour into damaged tissue between cells. Nerves may also be directly hurt. All of this activity is accompanied by pain. This is also the case with internal insults that may be diet-related or the result of wear and tear. Aging joints and ligaments can become occasionally or chronically inflamed, resulting in pain. Inflammation is now recognized as a key factor in virtually all chronic and degenerative diseases, including arthritis , heart disease, asthma, neurodegeneration, cancer, and kidney and bowel diseases. The idea behind anti-inflammatory drugs is simple. Stop the inflammation; stop the pain. The NSAIDs are COX-2 inhibitors. They do accomplish this, but along the way they can also cause liver and kidney damage, and increase the risk of heart attack and stroke. A recently published study reveals even gre Continue reading >>
Diabetes And Sick Days: What Meds Are Ok
In the midst of cold and flu season, you may wonder what medications are safe to take without greatly impacting blood glucose levels when you have diabetes. Overall, it's the sickness that increases blood glucose in people with diabetes, not the medication used to treat it. However, some medications should be used with caution. Stacey O'Donnell, R.N., B.S., C.D.E., nurse manager, at Joslin Diabetes Center, goes over different types of medications and how they could impact your diabetes. Examples: Tylenol, Aspirin Effect on diabetes: No effect. Use cautiously if you have renal disease. Anti-inflammatory Examples: Ibuprofen, such as Advil, Motrin, Nuprin Effect on diabetes: No effect. Also should be used carefully if you have renal disease. Examples: Allegra, Bumex Effect on diabetes: Caution should be used in patients who have diabetes with renal disease, cardiac disease and high blood pressure. General guidelines for taking medications for people with diabetes are to avoid products containing sugar, such as sucrose, dextrose, fructose, lactose and honey, O'Donnell says. Also, choose products with little or no alcohol. A suggested list of sugar-free cough and cold medicines includes: Chlor-Trometon tablets Dimetapp Elixir Scot-Tussin DM Liquid Cerose-DM Liquid Continue reading >>
Anti-inflammatory Diets
Hype or Hope? A quick perusal of the Web or the health and diet section of any bookstore will turn up a number of articles and books with the word “inflammation” in the title. Authors blame the insidious condition for everything from hay fever and depression to crow’s feet; many assure readers that adherence to their specialized, anti-inflammation diet plan will help them shed pounds, banish pain, and reverse the clock. The types of foods common to many of these diets include whole grains, dry beans and legumes, oily fish, nuts and seeds, fruits, vegetables, and certain herbs and spices. These sound like nutritious foods, but is inflammation really the cause of so many ills? And will following a particular diet cure it? We do know that there is an association between chronic inflammation and obesity, diabetes, and heart disease. What’s less clear is how the association works, how concerned you should be about it, and what, if anything, you can do about it. But first, a little background on inflammation is needed. What is inflammation? We’re all familiar with acute inflammation, which you can feel and often see quite distinctly. Inflammation is the body’s natural response to injury and the first step in healing; in its acute form, it can be quite dramatic. Whether you have a virus or a cut, the body sends white blood cells to the site of infection or injury, where they release chemicals to protect you. The most obvious sign of acute inflammation is pain, such as when you have a sore throat; you may also experience fever in the case of an infection, or swelling as your body deals with a traumatic injury. Chronic inflammation is not so easy to identify. “What we’re talking about here is low-grade inflammation that you don’t see or feel easily,” says Viv Continue reading >>
Other Dangerous Drugs For People With Diabetes
A major problem with all drugs is that busy doctors often ignore potentially damaging drug side effects. Often they aren't even aware that these side effects are listed in the drug's official FDA-required label (called the "Prescribing Information" online.). That is because most doctors get their information about drugs from reps sent out by pharmaceutical companies or doctors who are well-compensated by these companies to promote the latest, most expensive drugs to their peers. Unfortunately, all the major drug companies have a long record of suppressing information about damaging side effects of all their drugs. Periodically, one of these drugs will kill or injure enough people that it comes to the attention of the FDA and the media. Even then, the FDA will usually only post an "alert" and will allow the drug to continue to be sold. Busy doctors apparently don't read these alerts, as they continue to prescribe drugs that have generated serious alerts in quantities that result in billions of dollars of drug company revenue each year. Proof that doctors are woefully ignorant of the side effects of even the most heavily prescribed drugs was provided by this study: Physician Response to Patient Reports of Adverse Drug Effects: Implications For Patient-Targeted Adverse Effect Surveillance.Golomb, Beatrice A, et al. Drug Safety. 30(8):669-675, 2007. TIt was a study of a group of patients prescribed a statin drug that verified that doctors ignore patients' reports of even the most significant side effects. As reported, it found that Eighty-seven percent of patients reportedly spoke to their physician about the possible connection between statin use and their symptom....Physicians were reportedly more likely to deny than affirm the possibility of a connection. Rejection of a Continue reading >>
Anti-inflammatory Drug, Used For Decades, Now Found To Lower Blood Glucose Levels In People With Type 2 Diabetes
Anti-Inflammatory Drug, Used for Decades, Now Found to Lower Blood Glucose Levels in People with Type 2 Diabetes In a modern-day clinical trial of a medicine belonging to one of the worlds oldest classes of drugs, researchers have found that a drug related to aspirin and salicylate, which was first used by ancient Egyptians and Greeks to ease pain caused by inflammation, also has glucose-lowering properties and may be a potential treatment for people with type 2 diabetes, according to results presented at the American Diabetes Associations 72nd Scientific Sessions. Salsalate, a pain medication used for decades as a treatment for rheumatoid arthritis, is notable for lacking many of the side effects of aspirin and is available as an inexpensive, generic prescription drug. Small, preliminary trials of salsalate indicated that it may be effective as a treatment for type 2 diabetes. The exciting thing here is that this drug is relatively inexpensive and has a long safety record for other uses, such as treating joint pain, said Steven Shoelson, MD, PhD, Associate Director of Research at the Joslin Diabetes Center and Principal Investigator for the study. We now have to determine whether the degree to which this drug lowers blood glucose levels is large enough to warrant using it as an addition to the diabetes drug armamentarium. In a year-long trial sponsored by the National Institutes of Health, researchers compared use of salsalate to placebo in 286 patients with type 2 diabetes and found that it reduced A1C levels (a measure of average blood glucose levels over time) by 0.24 percent and fasting blood glucose levels by 11 mg/dl over 48 weeks. Although these improvements may seem modest, the group taking salsalate achieved them while requiring lower doses of other diabetes Continue reading >>
Pain Medicines For Diabetic Neuropathy - Topic Overview
Pain Medicines for Diabetic Neuropathy - Topic Overview Articles OnPain Medicines for Diabetic Neuropathy Duloxetine ( Cymbalta ), which is an antidepressant. It may cause dry mouth , nausea , constipation , diarrhea , and sometimes dizziness and hot flashes . Anticonvulsants such as carbamazepine , gabapentin , and pregabalin . Anticonvulsants are also frequently prescribed to reduce pain linked with diabetic neuropathy . Lidocaine or mexiletine . Lidocaine comes as a patch that you can put on your skin where the pain is the worst. Mexiletine is an oral medicine similar to lidocaine. Both medicines are used to relieve pain caused by neuropathy . Capsaicin cream. Capsaicin is a substance contained in cayenne peppers. Although it may not provide complete pain relief, it may help relieve minor pain in some people. Capsaicin cream is applied directly to the skin over the painful area. Nonprescription pain relievers. These include acetaminophen and nonsteroidal anti-inflammatory drugs ( NSAIDs ), such as aspirin , ibuprofen , or naproxen . Although they may provide some temporary pain relief, they are not effective for long-term treatment of severe pain. Note: People with diabetes need to be especially careful when taking NSAIDs because these medicines may upset kidney function. Be safe with medicines. Read and follow all instructions on the label. Narcotic pain relievers such as oxycodone , which may reduce moderate to severe pain from diabetic neuropathy . But narcotics are usually only given to people who do not have a personal or family history of addiction . Narcotics may also cause side effects that could make symptoms of autonomic neuropathy worse. So narcotics are not often the first type of medicine tried for symptoms of diabetic neuropathy. If you begin taking an Continue reading >>
Diabetic Neuropathy Medication: Nonsteroidal Anti-inflammatory Drugs (nsaids), Analgesic, Topical, Anticonvulsant, Antidepressant, Tricyclic, Antidepressant, Selective Serotonin/norepinephrine Reuptake Inhibitor (ssnri), Antidepressant, Serotonin Reuptake Inhibitor, Antiarrhythmic Agent, Class I-b, Prokinetic Agents, Antidepressant, Tetracyclic, Synthetic Adrenocortical Steroids, Cholinergic Agent, Laxative, Bowel Evacuant
For the treatment of diabetic neuropathy, acute cases may be able to be managed with standard analgesics, but other agents will likely be necessary for chronic pain. Occasionally, muscle relaxants may be of benefit in the first 2 weeks of therapy. Each type of pain or a combination of pain types should be treated. Reevaluation of the painful neuropathy should be performed every 6 weeks. [ 96 ] Every effort should be made to taper and eventually to stop therapies. Therapies may need to be reinstated at later dates if symptoms flare up. The pharmacologic agents listed below are commonly used for the symptomatic treatment of diabetic neuropathy. Most are not specifically approved by the United States Food and Drug Administration for this use, however. [ 18 , 80 , 82 , 83 , 67 , 25 , 20 , 97 , 98 , 99 ] Zeng L, Alongkronrusmee D, van Rijn RM. An integrated perspective on diabetic, alcoholic, and drug-induced neuropathy, etiology, and treatment in the US. J Pain Res. 2017 Jan 20. 10:219-228. [Medline] . [Full Text] . Boulton AJ, Malik RA. Diabetic neuropathy. Med Clin North Am. 1998 Jul. 82(4):909-29. [Medline] . Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000Res. 2016. 5: [Medline] . [Full Text] . Bromberg MB. Peripheral neurotoxic disorders. Neurol Clin. 2000 Aug. 18(3):681-94. [Medline] . Goetz CG, Pappert EJ. Textbook of Clinical Neurology. Philadelphia: WB Saunders Co; 1999. Pourmand R. Diabetic neuropathy. Neurol Clin. 1997 Aug. 15(3):569-76. [Medline] . Sugimoto K, Murakawa Y, Sima AA. Diabetic neuropathy--a continuing enigma. Diabetes Metab Res Rev. 2000 Nov-Dec. 16(6):408-33. [Medline] . Vinik AI, Park TS, Stansberry KB, Pittenger GL. Diabetic neuropathies. Diabetologia. 2000 Aug. 43(8):957-73. [Medline] . Wilson JD. Williams Textbook o Continue reading >>
Anti-inflammatory Agents In The Treatment Of Diabetes And Its Vascular Complications
The association between hyperglycemia and inflammation and vascular complications in diabetes is now well established. Antidiabetes drugs may alleviate inflammation by reducing hyperglycemia; however, the anti-inflammatory effects of these medications are inconsistent and it is unknown whether their beneficial metabolic effects are mediated via modulation of chronic inflammation. Recent data suggest that immunomodulatory treatments may have beneficial effects on glycemia, β-cell function, and insulin resistance. However, the mechanisms underlying their beneficial metabolic effects are not always clear, and there are concerns regarding the specificity, safety, and efficacy of immune-based therapies. Herein, we review the anti-inflammatory and metabolic effects of current antidiabetes drugs and of anti-inflammatory therapies that were studied in patients with type 2 diabetes. We discuss the potential benefit of using anti-inflammatory treatments in diabetes and important issues that should be addressed prior to implementation of such therapeutic approaches. The prevalence of diabetes is on the rise, with 415 million people affected worldwide according to recent data from the International Diabetes Federation (1). This number is predicted to increase further, with 642 million people expected to develop diabetes by 2040. While many factors are known to contribute to the development of diabetes and its complications, the involvement of the immune system in the pathogenesis of metabolic diseases has been gaining interest. It has long been appreciated that inflammation is central to the pathology of the pancreatic islet in type 1 diabetes. However, growing evidence suggests that inflammation also plays an important role in the pathogenesis of type 2 diabetes, including obesit Continue reading >>
Nsaid Lowers Glucose Levels In Type 2 Diabetes
NSAID Lowers Glucose Levels in Type 2 Diabetes Chronic low-grade inflammation found in many patients with diabetes Salsalate, a generic non-steroidal anti-inflammatory drug (NSAID) used to treat arthritis, significantly lowered blood glucose levels and decreased inflammatory mediators in patients with type 2 diabetes. Further research is needed to understand the side effects of this agent in patients with diabetes, the study authors noted in the July 2 issue of Annals of Internal Medicine. Epidemiologic studies have suggested that a low-grade, chronic inflammation is present in patients who have diabetes, and precedes and predicts the development of diabetes in people who do not yet have the disease, said lead author Allison B. Goldfine, MD, Associate Professor at Harvard Medical School and Section Head of Clinical Research at Joslin Diabetes Center, Boston, Massachusetts. Our study adds to a growing body of science to demonstrate that one can specifically target this low-grade inflammation to improve metabolism in patients with diabetes, she said. The study involved 286 participants with poorly controlled type 2 diabetes (A1C 7.0%-9.5%; mean A1C, 7.85%) despite treatment with diabetes medications, exercise, and dietary changes. None of the patients were taking insulin. The patients were randomized to salsalate 3.5 g per day or placebo in addition to their regular diabetes medications (ie, metformin, insulin secretagogue, or dipeptidyl peptidase-4 inhibitor, alone or in combination) for 48 weeks. Patients who were currently on insulin, thiazolidinediones, glucagon-like peptide-1 agonists, NSAIDs, warfarin, or uricosuric agents were not eligible for the trial. At 48 weeks, the salsalate group had a 37% lower mean change in A1c level compared to the placebo group (-0.53% Continue reading >>
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Nsaids (anti-inflammatory Pain Relievers) Safety
Other NSAIDs available by prescription include Daypro , Indocin , Lodine , Naprosyn , Relafen , and Voltaren . Cox-2 inhibitors are a newer form of prescription NSAID. Two of them -- Bextra and Vioxx -- are no longer sold because of concerns about their side effects. The third, Celebrex, is still available. How Anti-Inflammatory Pain Relievers Work While the details are different, all of these medicines work in more or less the same way. They block the effects of chemicals that increase the feeling of pain. Unlike many other painkillers, they also help by reducing swelling, which can further reduce pain. Sometimes swelling is a key cause of pain . But the problem with NSAIDs -- or any systemic drug -- is that they can affect the entire body, not just the part that hurts. "If you use a drug to ease one problem, like an achy joint," Goldberg tells WebMD, "it's likely to cause a different reaction somewhere else too." Anti-Inflammatory Pain Relievers: The Risks For most people, taking an over-the-counter NSAID for the occasional headache or backache is very safe. "The bigger risks are for people who have chronic pain and take NSAIDs in the long-term," says Goldberg. The most common side effect from all NSAIDs is damage to the gastrointestinal tract, which includes your esophagus , stomach, and small intestine. More than half of all bleeding ulcers are caused by NSAIDs, says gastroenterologist Byron Cryer, MD, a spokesperson for the American Gastroenterological Association. "Gastrointestinal bleeding is a serious issue," says Cryer. "But we've seen in many surveys that people really underestimate this risk." Most ulcers caused by NSAIDs will heal once you stop taking the drug, according to the American College of Gastroenterology. Researchers developed Cox-2 inhibitors -- Continue reading >>
Aspirin-like Drug May Help Diabetics Control Blood Sugar
Over the years, I’ve written and edited many articles for medical journals. I have to say I’m now finding it a bit odd to be on the flip side as the subject of such an article (along with 285 other people). A couple years ago, I volunteered to take part in a clinical trial testing whether an old, aspirin-like drug called salsalate could help control blood sugar in people with type 2 diabetes. The results of that trial, called TINSAL-T2D, are reported in the current issue of Annals of Internal Medicine. All 286 volunteers were given blue pills to take every day for nearly a year. Half of us got pills containing salsalate; the others got placebo pills. Over the course of the trial, those in the salsalate group had lower blood sugar levels, and some were even able to reduce dosages of other diabetes medications they were taking. “We were very pleased with the findings of the TINSAL-T2D study,” said lead author Dr. Allison B. Goldfine, associate professor of medicine at Harvard-affiliated Joslin Diabetes Center. “They indicate that salsalate, a drug that has been marketed for over 40 years for the treatment of arthritis, could be an inexpensive additional therapeutic option to treat patients with diabetes.” Inflammation and diabetes Salsalate is an old drug that’s closely related to aspirin. Use of these drugs and their natural precursor use can be traced back at least 3,500 years. Today, salsalate is used to treat arthritis pain. One advantage it has over aspirin and other nonsteroidal anti-inflammatory drugs is that it doesn’t irritate the digestive tract. No one knows exactly how salsalate helps control blood sugar. But its effectiveness supports the idea that inflammation plays a role in type 2 diabetes. In addition to improving blood sugar control, sals Continue reading >>
