Thursday, 28 November 2013

Diabetes Treatments In conventional medicine perspective

Diabetes is defined as a condition caused by insufficient insulin entering the bloodstream to regulate the glucose. It is either caused by cells in pancreas dying off or receptor sites clogged up by fat and cholesterol. In some cases, diabetes is also caused by allergic reactions of cells in the immune system.
V. Treatments
A. In conventional medicine perspective
The aim of the treatment is to prolonged life, relieve symptoms and prevent complication as well as enhancing the life quality
A. 1. Life style management
According to the study by Diakonissen-Krankenhaus Salzburg, Salzburg, Österreich, aiabetes education, nutritional advice, exercise recommendations and training for smoking cessation comprise the mainstay of diabetes treatment before starting drug therapy. Prevention as well as treatment of diabetes mellitus is positively influenced by life-style modification(71).  Other in the study of The sample aged 53.5±6.6 years, 72.7% aged 50 to 59 years; 45.3% were women; an average of 8±2.08 years in the disease’s evolution. suggested that it is necessary to improve life styles on physical activity, self-esteem, diet and attachment to the treatment(72).  And in a cross-sectional correlational study indicate that poor metabolic control of diabetic patients has a detrimental effect on quality of life, and when diabetic patients use more self-control skills, they may achieve better quality of life(73).
A.2. Non medication therapy
1. Exercise
Along with diet and medication, exercise is the third cornerstone of type 2 diabetes treatment. Persons with type 2 diabetes should perform at least 90 min per week of vigorous (> 65% of VO (2)max) aerobic exercise or 150 min per week of moderate-intensity (40-65% of VO (2)max) aerobic physical activity. Performing at least 240 min of physical activity per week is associated with greater cardiovascular disease risk reductions as well as with less cardioÂ-vascular events compared with lower volumes of activity, according to the study by Abteilung Bewegung und Gesundheit, Erlangen(74).
2. Diet therapy
Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes. In the study of 215 overweight people with newly diagnosed type 2 diabetes who were never treated with antihyperglycemic drugs and had hemoglobin A(1c) (HbA(1c)) levels less than 11%, found that after 4 years, 44% of patients in the Mediterranean-style diet group and 70% in the low-fat diet group required treatment (absolute difference, -26.0 percentage points [95% CI, -31.1 to -20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet and concluded that compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes(75).
A.3. Medication
A.3.1. Oral administration
1. Beta-blocker therapy
In the study to determine the use and association with one-year mortality of beta-blocker therapy for the treatment of acute myocardial infarction (AMI) in elderly diabetic patients and to examine whether beta-blocker therapy was associated with increased rates of hospital readmission for diabetic complications traditionally associated with beta-blockers, researchers showed that Beta-blockers are associated with a lower one-year mortality rate for elderly diabetic patients to a similar extent as for nondiabetics, without increased risk of readmission for diabetic complications. Increasing the use of beta-blockers in elderly diabetic patients represents an opportunity to improve the care and outcomes of these patients after AMI(76). Major side effects include the precipitation or worsening of congestive heart failure, and significant negative(77).
2. Metformin
The oral antidiabetic medicine is the first for patient of type II diabetes, in particular, in overweight and obese people and those with normal kidney function by improving your body responds to insulin to reduce high blood sugar levels with side effect ot limit to nausea, diarrhea, and gas. Over doses can cause vomiting, diarrhea, abdominal pain, tachycardia, drowsiness, and, rarely, hypoglycemia or hyperglycemia, according to the study by Jeffrey R. Suchard, MD and Thomas A. Grotsky, MD(78)
3. Sulfonylurea
The medaction helps to increase the amount of insulin made by your body makes, and lower blood sugar levels. Unfortunately, Patients with type 2 diabetes exposed to sulfonylureas and exogenous insulin had a significantly increased risk of cancer-related mortality compared with patients exposed to metformin(79). Other study indicated that they did not identify an increased mortality risk among the different combinations of sulfonylureas and metformin, suggesting that overall mortality is not substantially influenced by the choice of sulfonylurea(80).
Side effects are not limit to Sweating, Shaking, Feeling hungry and anxious, etc.
4. Thiazolidinediones
The medicine lower blood sugar levels by increasing the body’s sensitivity to insulin. Unfortunately, it can causes liver cancer and colorectal cancer in type 2 diabetes mellitus, according to the study of  a total of 606,583 type 2 diabetic patients, age 30 years and above, without a history of cancer were identified from the Taiwan National Health Insurance claims database during the period between January 1 2000 and December 31 2000, by Department of Internal Medicine, National Taiwan University Hospital(81). Other suggested that it may cause bone loss(82) and bladder cancer(83). Side effects of Thiazolidinediones are not limit to
heart failure, weight gain, fluid tetention and risk of bone fracture, etc.
5. Insulin
The aim of insulin therapy is to treat diabetes by controlling the amount of sugar (glucose) in the blood. BIAsp 30, a biphasic insulin,  has been shown to be more effective in terms of glycaemic control than standard biphasic human insulin 30 (BHI 30). In the study by Institute of Biomedical Research, University of Birmingham, a strong evidence was provided for better glycaemic control with BIAsp 30 without increases in the incidence of major hypoglycaemia or nocturnal hypoglycaemic episodes. Overall, weight gain with BIAsp 30 was minimal and not significantly greater than with basal insulin or BHI 30. The reported efficacy and tolerability of BIAsp 30 in the treatment of diabetes based on a variety of clinical endpoints is supported by a good body of evidence relating to its use in different dosage regimens and in comparison with other insulin treatment regimens(84). Side effects are rare, but  allergic reactions can be severe and pose a significant risk to health(85).
6. DPP-IV Inhibitors
The medicine helps to lower glycated hemoglobin, fasting and postprandial glucose levels, with a low incidence of hypoglycemia and no weight gain and only given to patient can not tolerate first line medicine. There is a trend towards increasing use of DPP-IV inhibitors, which are no less efficacious and safe in Asians than Caucasians and may have some advantages over existing oral antidiabetic agents, particularly for certain high-risk groups(86). Clinical trials have shown that vildagliptin is effective in significantly lowering glycosylated hemoglobin (HbA1c), fasting plasma glucose, and prandial glucose levels. beta-cell function may also be improved. The drug has placebo like tolerability and rate of hypoglycemia events. Vildagliptin expands non-injectable treatment options available for management of T2DM patients, who are poorly controlled with monotherapy(87).  Other study suggeested that Vildagliptin represents a safe and effective new approach to targeting GLP-1 deficiencies in patients with type 2 diabetes by inhibiting DPP IV(88). Side effects are not limit to incidences of hypoglycemia increased with longer duration and optimal results with minimal adverse effects were achieved with 25 mg twice daily and 50 mg once daily doses(89).
7. Etc.
A.3.2. Insulin or insulin and oral medication therapy
The conbination of GLP-1 analogues and isulin may be effective in the treatment of type 2 diabetes mellitus, as  GLP-1 stimulate insulin production and secretion, and suppress glucagon secretion, depending on the blood glucose level and have an effect on the brain, enhancing satiety, and on the gut, where they delay gastric emptying(90).
Unfortunately, In a 136 insulin-naïve respondents (57% female, 69% Latino, mean age 51.1±10.3 years; $200-$1000 median monthly household income; grade 8-12 median education) revealed a 48% prevalence of complete unwillingness to begin insulin, researchers found that  Latino respondents were younger, lived fewer years in the U.S., had less education, were more likely unwilling to use insulin (53% vs. 30%, p=0.03), and reported a more negative attitude to 8 of 9 PIR domains (p≤0.01 for each). Fewer years in the U.S. predicted greater unwillingness and a more negative attitude on 8 of 9 PIR domains (p≤0.03 for each); and less education predicted greater feelings of unfairness (p=0.01)(91).
A.4. Surgery
Although surgery is rare and only in nonmorbidly obese patients with uncontrolled type 2 diabetes
1. In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes, showed that in obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone(92). Other indicated that clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for 2 years or more(93).
Laparosopic gastric sleeve gastrectomy resulted in remission of poorly controlled nonmorbidly obese T2DM patients up to 50% at 1 year after operation. The effect is related more to the decreasing of insulin resistance because of calorie restriction and weight loss rather than to the increasing of insulin secretion. C-peptide >3 ng/mL is the most important predictor for a successful treatment(94). But other indicated that Laparoscopic ileal interposition associated with a sleeve gastrectomy (LII-SG) is a safe and effective operation for the treatment of type 2 diabetic (T2DM) patients with BMI below 35. As the clamp technique, II-SG significantly improved IS and β-cell function as early as 30 days postoperatively in a T2DM population with a BMI of 21.9-33.8.(95).
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