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[insulin Sensitizer--anti-diabetic Drugs, Metformin And Pioglitazone That Can Improve Insulin Resistance].
Abstract Nonalcoholic steatohepatitis (NASH), which is considered the hepatic manifestation of the metabolic syndrome is an increasingly cause of chronic liver disease in Japan. NASH is finally lead to liver cirrhosis and hepatocellular carcinoma as viral hepatitis, therefore, medical treatment should be considered, when NASH occurs. Treatment of patients with metabolic syndrome has been focused on the management of associated conditions such as obesity, hyperlipidemia, hypertension and hyperinsulinemia. Insulin resistance, that could accelerate liver inflammation and fibrosis by up-regulation of TNFa seems to be most important factor in many cases of NASH. The insulin-sensitizing drugs, which were biguanides (metformin) and thiazolidinediones (pioglitazone) have been shown to correct not only insulin resistance but also steatosis and inflammation in the liver. Metformin and pioglitazone might be useful drugs against NASH, however further investigations were needed. Continue reading >>
Diabetes Medication: Insulin-sensitizers & Insulin Mimetics
If diet and exercise are not adequate to bring your blood sugars under control, the next level of treatment to consider is oral blood sugar–lowering medication, commonly known as oral hypoglycemic agents (OHAs). There are three categories of OHAs, those that increase sensitivity to insulin, those whose action resembles that of insulin, and those that provoke your pancreas to produce more insulin. The first group is known as insulin sensitizers (or ISAs, for insulin-sensitizing agents); the second are the insulin mimetics (or IMAs, for insulin-mimetic agents), which act like insulin but do not build fat. Finally, there are the original OHAs, like sulfonylureas. I only recommend the insulin sensitizers and insulin mimetics, for reasons that will become plain in short order. (Some drug companies have combined the old OHAs with insulin sensitizers, a move I strongly challenge. Tell your doctor you do not want any product containing an agent that works by causing the pancreas to make more insulin. This includes the old sulfonylureas and the new, similar drugs called meglitinides.*) For people who still have sufficient insulin-producing capacity, insulin sensitizers alone may provide the extra help they need to reach their blood sugar target. Some insulin-resistant individuals who produce little or no insulin on their own may find a combination of insulin sensitizers and insulin mimetics useful in reducing their doses of injected insulin. *In addition to causing beta cell burnout, sulfonylureas also impair circulation in the heart and elsewhere by closing ATP-sensitive potassium channels that relax blood vessels. There are three ISAs currently on the market, and at this writing I prescribe all three of them—metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone Continue reading >>
Diabetes Medicine: Metformin
If you have diabetes, chances are you’re taking some type of medicine to help control it. If you have Type 1 diabetes, you must take insulin. But with Type 2 diabetes, there are many options, ranging from no medicine to diabetes pills to non-insulin injectables to insulin. While you may be able to manage your diabetes with healthy eating, weight control, and physical activity, there’s a high likelihood that at some point, you may need to take medication, including insulin. Unless your blood sugar and A1C levels are quite high, you would likely start on a type of diabetes pill. Today, there are nine classes of diabetes pills. Some are more commonly used (and more effective) than others: • Metformin • Sulfonylureas • Meglitinides • Thiazolidinediones (TZDs) • DPP-4 inhibitors • SGLT2 inhibitors • Alpha-glucosidase inhibitors • GLP-1 agonists • Bile acid sequestrants And to add to the mix, many of these medicines are available in combination form; for example, metformin can be combined with a sulfonylurea, a DPP-4 inhibitor, TZDs, or an SGLT2 inhibitor. Combination pills can save time and money and make pill-taking easier. This week, we’ll focus on one of the most commonly prescribed diabetes pills: metformin. What is metformin? Metformin is a medicine in a class called biguanides. It lowers blood sugar levels by decreasing the amount of glucose released into the bloodstream by the liver. Metformin is also an “insulin sensitizer,” meaning that it works to make the cells in your body more receptive to insulin. When cells are insulin sensitive, they are able to take more glucose from the blood to be used for energy. Because metformin does not signal the pancreas to release insulin, there is little risk of low blood sugar (hypoglycemia) when taking Continue reading >>
Insulin Sensitizers May Reduce Cancer Risk In Women
People with diabetes have a higher rate of cancer compared to the general population, however, new evidence suggests that the type of anti-diabetic agent prescribed may impact this risk among women. Insulin sensitizers may reduce the risk of cancer among women while insulin secretagogues may increase this risk, according to a large retrospective analysis published in Diabetes, Obesity and Metabolism. "Clearly, when prescribing anti-diabetic medications, it's important to consider the impact a drug has on fueling cancer growth," said lead author Sangeeta Kashyap, MD, an endocrinologist and Associate Professor of Medicine at Cleveland Clinic's Endocrinology and Metabolism Institute, in Cleveland, Ohio. "With the recent publication by Sun et al, the differentiation of cancer risk by oral antihyperglycaemic agent therapy (OAA) has become sharper," commented Meei-Shyuan Lee, DrPH, of the School of Public Health, National Defense Medical Center, Taiwan. "That metformin—a biguanide—but not sulfonylureas decreases the risk of cancer in general and of primary liver cell, colorectal and pancreatic cancers in particular (taking into account all other OAAs) was made clear by Lee et al in a large cohort of dominantly Han Chinese subjects," she said. "Sun et al, in this study using the Cleveland Clinic Diabetes Registry, extend the 'total cancer' findings to a U.S. population, and to the use of thiazolidinediones by comparison with sulfonylureas," Dr. Lee said. "They propose that the difference in risk with different OAAs is a function of whether the OAAs are insulin sensitizers or secretagogues. This is plausible. It is also possible that certain OAAs deal with a common underlying pathogenesis for diabetes and tumorigenesis, the more we understand about energy dysregulation and Continue reading >>
Insulin Sensitizers
Thiazolidinediones decrease resistance to insulin. TZDs work to lower your blood sugar by increasing the muscle, fat and liver’s sensitivity to insulin. Thiazolidinediones (glitazones: rosiglitazone and pioglitazone) Thiazolidinediones (TZDs) work to lower your blood sugar by increasing the muscle, fat and liver’s sensitivity to insulin. TZDs are referred to as “insulin sensitizers” and also are blood sugar normalizing or euglycemics, (drugs that help return the blood sugar to the normal range without the risk of low blood sugars.) TZDs take a while to begin working (several weeks); so don’t stop the pill if you don’t notice your blood sugar responding right away. The main side effects are weight gain and fluid retention (you may notice your ankles swelling) and anemia. Fluid retention is most common in individuals who are also taking insulin secretagogues and insulin, and has been linked with an increased rate of congestive heart failure. Thiazolidinediones increase the amount of certain fat particles, called LDL. Women taking these medications have a greater chance of bone fractures. One of the thiazolidinediones, rosiglitazone, Avandia®, is reported to increase heart disease. The United States FDA has limited the use of this medication to those individuals already using it, and to those who have failed therapy with other medications, or who decline to take pioglitazone. Some European countries ( Germany and France) have withdrawn pioglitizone, Actos®, because of concern about an increased risk of bladder cancer. You shouldn’t take a thizolidinedione if you have congestive heart failure, or significant liver or kidney problems. If you are female or have an increased risk of heart disease, discuss with you provider whether these are appropriate medicati Continue reading >>
Insulin Sensitizers May Attenuate Lean Mass Loss In Older Men With Diabetes
OBJECTIVE To examine longitudinal changes in total and appendicular lean body mass in older men with impaired fasting glucose (IFG) or diabetes and to determine whether these changes differ by diabetes treatment. RESEARCH DESIGN AND METHODS A total of 3,752 ambulatory men aged ≥65 years at baseline participated in a multicenter longitudinal cohort study. Baseline glycemic status was categorized as normoglycemia, IFG, undiagnosed/untreated diabetes, or treated diabetes. Insulin sensitizer medication use (metformin and/or thiazolidinediones) was assessed by prescription medication inventory. The change in total lean and appendicular lean mass was derived from dual X-ray absorptiometry scans taken at baseline and 3.5 ± 0.7 years later. RESULTS This male cohort included 1,853 individuals with normoglycemia, 1,403 with IFG, 234 with untreated diabetes, 151 with diabetes treated with insulin sensitizers, and 111 with diabetes treated without insulin sensitizers. Men with untreated diabetes, diabetes treated without insulin sensitizers, or IFG had greater percentage loss in total or appendicular lean mass (P ≤ 0.05 in comparison to normoglycemic men). There remained a significantly greater percentage loss in appendicular lean mass for these groups even after adjustment for medical comorbidities or lifestyle factors. In contrast, the percentage loss in total or appendicular lean mass in men with diabetes treated with insulin sensitizers was significantly less than that in normoglycemic men in minimally and fully adjusted models. CONCLUSIONS Skeletal muscle loss was accelerated in men with IFG and diabetes, except when the latter was treated with insulin sensitizers. These findings suggest that insulin sensitizers may attenuate muscle loss. Aging is associated with adverse Continue reading >>
Treatment Of Type 2 Diabetes With A Combination Of Two Insulin Sensitizers - Increased Efficacy And Fewer Side-effects
Thiazolidinediones (TZD) and metformin lower cardiac risk factors, as well as lowering serum glucoses, and are therefore the best choice for initial therapy of type 2 diabetes. To choose between metformin and a thiazolidinedione is difficult because of the many benefits of both drugs. In most cases, a combination of metformin and a TZD is chosen, and this article describes the rationale for this decision. The basic principle of combination therapy is that with smaller doses of two drugs there is greater efficacy and fewer side-effects than with a large dose of either drug used as monotherapy. In the case of the addition of metformin to a TZD or vice versa, because of their different sites of action (liver with metformin and muscle with the TZD), it will result in a decrease in the hemoglobal (Hb) A1c that will be greater than that achieved by monotherapy with a larger dose of either drug. Perhaps of more importance is that, at lower doses, the side-effects of metformin (anorexia, nausea, and diarrhea) and TZDs (weight gain, edema, and dilutional anemia) are much less.Around 30% of patients initiated on metformin will develop gastrointestinal symptoms, and 3% will have to discontinue the drug. Of the remaining 27%, the majority will only tolerate metformin at less than the maximum dose of 2,500mg daily (usually one gram or less). Both metformin and TZDs lower cardiac events. This is important with type 2 diabetes, which has been described as a cardiac condition characterized by hyperglycemia and is a cardiac risk equivalent i.e., a 20% chance of a cardiac event over 10 years. Metformin lowers total low-density lipoproteins (LDL) and triglycerides, and TZDs variably lower triglycerides and raise total high-density lipoprotein (HDL). Of more importance is that by suppress Continue reading >>
- 10 Best Supplements for Diabetes- (+ how to take fewer pills… and major lifestyle advice)
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Lilly's Trulicity (dulaglutide) Label Updated to Include Use in Combination with Basal Insulin for Adults with Type 2 Diabetes
Current And Future Treatments Of Hiv-associated Dyslipidemia
Current and Future Treatments of HIV-Associated Dyslipidemia Metformin is a biguanide whose main mechanism of action is to improve hepatic insulin action.[ 98 ] Metformin has been found to have favorable effects on the lipid profile in patients with Type 2 diabetes mellitus.[ 98 ] Unfortunately, it appears that this benefit does not apply to HIV-positive patients without diabetes mellitus. It appears that the effect of metformin on total cholesterol, LDL, HDL and triglycerides is variable in this population.[ 99101 ] The thiazolidinediones, which are PPAR- agonists, are true insulin sensitizers affecting insulin action in peripheral tissues, such as skeletal muscle and adipose tissue.[ 102 ] There has been much interest in their use in the treatment of the lipodystrophy syndrome associated with ARVs. Although there has been hope that an increase in insulin sensitivity will improve lipid levels, their effect on the lipid profile has been mixed. In fact, some trials have shown a worsening in the lipid end points on these medications.[ 101 , 103105 ] Future Lipidology.2008;3(2):175-188.2008 Future Medicine Ltd. No writing assistance was utilized in the production of this manuscript. Table 1. Summary of Selected Protease Inhibitors and Their Effects on the Lipid Profile (Percentage Change Compared With Baseline Lipid Values) n = Number on active drug; NR = Not reported; NS = Not significant; PI = Protease inhibitor Table 2. Summary of Selected Protease Inhibitors and Their Effects On the Lipid Profile (Percentage Difference in Lipid Values Compared With Protease Inhibitor Naive Control) n = Number on active drug; NR = Not reported; NS = Not significant; PI = Protease inhibitor. Table 3. Selected Nucleoside Reverse Transcriptase Inhibitors and Their Effects on the Lipid Pro Continue reading >>
Metformin, Beyond An Insulin Sensitizer, Targeting Heart And Pancreatic Cells - Sciencedirect
Volume 1863, Issue 8 , August 2017, Pages 1984-1990 Author links open overlay panel XinYangab1 ZhipengXuab1 ChunlanZhangab ZixinCaiab JingjingZhangab Metformin exerts protective effects on insulin-targeted tissues as an insulin sensitizer. Metformin plays direct and indirect protection roles in the cardiovascular system. Metformin restores insulin secretion and protects cells from lipotoxicity/glucotoxicity. Metformin, a biguanide derivate, is known as the first-line antidiabetic agent for type 2 diabetes mellitus (T2DM) treatment. It reduces insulin resistance and decreases blood glucose concentration by inhibiting gluconeogenesis and suppressing hepatic glucose production with improved peripheral tissue insulin sensitivity. As an insulin sensitizer, metformin takes pleiotropic actions and exerts protective effects on multiple organs mainly in insulin-targeted tissues such as liver, muscle, and adipose tissues. Recent studies discover that metformin also plays essential roles in heart and pancreatic cells two important organs in metabolic regulation. Metformin not only protects T2DM patients from cardiovascular diseases and heart failure, but also restores insulin secretion activities and protects pancreatic cells from lipotoxicity or glucotoxicity. Although accumulated evidence shed light on the metformin action, the precise mechanism of metformin is still under investigation. Further laboratory investigations and clinical trials are needed to pinpoint a map of metformin action. Based on recent findings, this review characterizes the beneficial role of metformin in cardiovascular diseases and pancreatic cells. Continue reading >>
Insulin Sensitizers For Type 1 And Type 2 Diabetes
Insulin Sensitizers for Type 1 and Type 2 Diabetes This activity is intended for physicians, pharmacists, diabetes educators, and other professionals conducting diabetes research or providing care for persons with diabetes. Improve strategies for the prevention, diagnosis, and management of diabetes. Reassess and modify current practice methods in order to enhance the care of persons with diabetes. Support the clinical practice of health professionals providing care for persons with diabetes. Upon completion of this activity, participants will be able to: Describe advances in insulin therapy for diabetes. Discuss the mechanisms underlying obesity and insulin resistance. Evaluate the role of insulin sensitizers in the management of diabetes. Describe new clinical approaches to assessing diabetic neuropathy. Identify controversies in diabetes meal planning. Assess new advances in our understanding of islet biology. Associate Clinical Professor of Medicine, Mount Sinai Medical School, New York, NY Medical Education Collaborative, a nonprofit education organization, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Medical Education Collaborative designates this educational activity for a maximum of 2 hours in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This educational activity for 2.4 contact hours is provided by Medical Education Collaborative. Provider approved by the California Board of Registered Nursing, Provider Number CEP-12990 for 2.4 contact hours. Medical Education Collaborative, Inc. has assigned 2 contact hours (0.20 CEUs) of continuing phar Continue reading >>
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
Effect Of Insulin Sensitizer Metformin On Ad Biomarkers
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive loss of memory and other cognitive functions. It is the most common cause of dementia in older adults, affecting approximately 18 million people worldwide, including almost 500,000 in the Philadelphia tri-state area. After age 65, the incidence of AD rises exponentially, doubling every five years. By age 85, almost half of us will have AD. In 2030, as many as 7.7 million Americans could have AD, and by 2050 this number could rise to 11-16 million people. The annual cost of AD in the United States is about $200 billion. AD-related medical complications are among the most common causes of death in the elderly population. Despite these alarming statistics, a "cure" for AD may not be essential since delaying the onset of AD by just 5 years could have a profound impact on this disorder by reducing the incidence and cost of AD by 50% between now and 2050. AD is difficult to recognize in its earliest stages, in which the principal complaint is typically an increase in episodes of forgetfulness. This stage is now commonly referred to as mild cognitive impairment (MCI). Neuroimaging and CSF biomarkers have demonstrated good accuracy in predicting which MCI patients later "convert" to AD and which tend to remain stable or revert to more normal cognition. The diagnosis of AD itself is made when increased loss of memory and other cognitive abilities (eg, language, praxis, and executive function) affect daily functioning. As the symptoms of dementia inevitably worsen, patients may become incapable of even basic activities such as feeding and dressing themselves. The disease course often spans more than a decade, creating a vast social and financial burden on society and extracting an immeasurable e Continue reading >>
Effect Of Insulin Sensitizer Metformin On Alzheimer's Disease Biomarkers
Summary Previous studies and Dr. Steven Arnold's laboratory work have shown that the brain in Alzheimer's disease is resistant to the healthy growth effects of insulin and that re-sensitizing brain cells to insulin may be a useful therapeutic strategy. Dr. Steven Arnold and colleagues have identified the anti-diabetes drug, metformin, as a safe medicine that enters the brain and re-sensitizes insulin receptors. This proposal seeks to conduct an efficient clinical trial with metformin in people with mild cognitive impairment and early dementia due to Alzheimer's disease to determine its effect on cognitive functioning and physiological and biochemical biomarkers of Alzheimer's disease. Details The goal of this project is to determine if treatment with a common FDA-approved insulin-sensitizing, anti-diabetes medicine—metformin—can improve cognitive abilities and modify physiological and biochemical abnormalities in people (without diabetes) who have mild cognitive impairment or early dementia due to Alzheimer's disease. These investigators have designed a brief, efficient, and sensitive clinical trial with a "crossover" design to detect beneficial effects of metformin for Alzheimer's disease. In this study, “crossover” refers to the fact that participants will be randomly assigned to two groups. One group will receive 8 weeks of metformin and then 8 weeks of placebo, while the second group will receive the reverse order. Both groups will have in-depth baseline assessments before starting on medication, then two other assessments—one after each metformin or placebo treatment. The study will measure memory and thinking abilities with a brief but very sensitive novel computerized cognitive test battery as well as several well established paper and pencil tests. To Continue reading >>
Evaluating The Effect Of Insulin Sensitizers Metformin And Pioglitazone Alone And In Combination On Women With Polycystic Ovary Syndrome: An Rct
Go to: Polycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders diagnosed by detection of at least two of the following criteria; polycystic ovaries on ultrasound, menstrual irregularities, hyperandrogenism based on biochemical and/or clinical manifestation (1). Insulin resistance and hyperinsulinemia may play an important role in pathogenesis of PCOS and overweight in PCOS women (2, 3). It has been reported that insulin resistance and consequent hyperinsulinemia play a prominent role in hyperandrogenemia through direct way, induction of androgen production by theca cells, and indirect ways like elevation of luteinizing hormone (LH) secretion, decreasing insulin-like growth factor (IGF) binding protein, and reducing hepatic synthesis of sex hormone binding globulin (SHBG) and consequently free androgen level augmentation occurs (4-6). Hyperinsulinemia and insulin resistance in PCOS patients appears to simulate or aggravate hyperandrogenism because of gonadotropin secretory disturbance (2). It has been postulated that abnormalities in insulin action (both insulin resistance and hyperinsulinemia), contribute to important comorbidities including: glucose intolerance, type 2 diabetes mellitus (DM2), dyslipidemia, increased plasma triglycerides and decreased plasma high-density lipoprotein cholesterol (HDL-C), hypertension, and atherosclerosis (7, 8). Likewise, insulin resistance has adverse effect on fertility and pregnancy rate (9, 10). PCOS is also associated with increased risk of endometrial cancer (11). Since there is a relationship between PCOS and insulin resistance, administration of drugs to ameliorate insulin sensitivity and ovarian activity is suggested to treat this syndrome (12). Various clinical studies have focused on two differen Continue reading >>
Insulin-sensitizing Agents In Polycystic Ovary Syndrome
Abstract Insulin-sensitizing agents have been recently proposed as the therapy of choice for polycystic ovary syndrome (PCOS), since insulin resistance and associated hyperinsulinemia are recognized as important pathogenetic factors of the syndrome. Moreover, since almost all obese PCOS women and more than half of those of normal weight are insulin resistant, and therefore present some degree of hyperinsulinemia, the use of insulin sensitizers should be suggested in most patients with PCOS. Insulin sensitizer treatment has been associated with a reduction in serum androgen levels and gonadotropins, and with an improvement in serum lipids and in prothrombotic factor plasminogen-activator inhibitor type 1, whatever the insulin sensitizer used. This therapy has also been associated with a decrease in hirsutism and acne, and with a regulation of menses and an improvement of ovulation and fertility. Notable improvements in all these parameters have also been described after a change in lifestyle approach, particularly in the presence of obesity. Lifestyle interventions should therefore be combined with insulin sensitizers in PCOS when obesity is present. Introduction Polycystic ovary syndrome (PCOS), one of the most common causes of ovulatory infertility, affects 4–7% of women (1). Since the first description by Stein and Leventhal in 1935 (2), this syndrome has, over the years, been defined in different ways. In 1990 the National Institutes of Health (NIH) established new diagnostic criteria for this disorder, which were based on the presence of hyperandrogenism and chronic oligoanovulation, with the exclusion of other causes of hyperandrogenism such as adult-onset congenital adrenal hyperplasia, hyperprolactinemia, and androgen-secreting neoplasms (3). More recently, a c Continue reading >>
Metformin, Beyond An Insulin Sensitizer, Targeting Heart And Pancreatic Cells.
Metformin, beyond an insulin sensitizer, targeting heart and pancreatic cells. Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, Hunan 410011, China. More Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, Hunan 410011, China. More Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, Hunan 410011, China. More Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, Hunan 410011, China. More Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, Hunan Continue reading >>
