抗糖尿病药的分类及其临床应用

抗糖尿病药是指用于降低血中的葡萄糖浓度来治疗糖尿病的一类药物.治疗的目的是使胰脏增加胰岛素的分泌量,或增加细胞对胰岛素的敏感性,或减少肠胃道吸收葡萄糖的速率.在临床实践中,要基于糖尿病的种类、患者的年龄和个人情况及其他原因选择抗糖尿病药.本研究系统地阐述抗糖尿病药物的分类和临床应用,为糖尿病患者对症下药和有效护理提供理论依据.     

糖尿病治疗药物应用及研究进展

糖尿病(DM)是以糖代谢失常的一种常见疾病,以高血糖为主要标志,其中I型糖尿病多发生于青少年,因胰岛素分泌缺乏,必须依赖胰岛素治疗。2型糖尿病多见于中老年人,主要由对胰岛素不敏感(即胰岛素抵抗)所致。自1992年第一个治疗DM的特效药物胰岛素问世以来,抗糖尿病药物的研发已取得长足进展,一些基于新的作用靶点的抗糖尿病药物已进入临床前或临床研究阶段。     

非胰岛素类糖尿病治疗新药研究进展

糖尿病是一种以高血糖为特征的慢性代谢性疾病,随着生活水平的提高,其发病率逐年上升,已成为危害人类健康的重要因素之 一。对于糖尿病的治疗药物研究,也从对传统机制的药物研究过渡到对具有新靶点和新作用机制的药物研究。其中基于这些新靶点设计 的新型非胰岛素类糖尿病治疗药物已进入临床研究阶段或已上市,给糖尿病的治疗带来了新的思路。按作用靶点和机制分类对较有开发 前景的非胰岛素类糖尿病治疗新药的研究进展进行综述。     

肥胖与糖尿病的连结点——胰岛素抗性蛋白

在研究抗糖尿病新药TZDS的作用机制发现胰岛素抗性蛋白（resistin),它是由脂肪细胞分泌的脂肪细胞特异性多肽。在肥胖小鼠中,胰岛素抗性蛋白与高血糖症和胰岛素抗性有关。在胰岛素抵抗和高血糖症中,胰岛素抗性蛋白升高,如果给予胰岛素抗性蛋白抗体则血糖下降,对胰岛素的敏感性也得到恢复。这表明胰岛素抗性蛋白可能与肥胖和糖尿病有关,可能为两者之间的连结点。     

2 型糖尿病治疗药物研究进展

2 型糖尿病（T2DM）是一种代谢障碍性疾病。传统抗糖尿病药物具有不同程度的副作用,如低血糖、胃肠道反应、体重增加、 心血管风险等,因此开发作用于新靶点和新作用机制的T2DM 治疗新药成为当前研究的热点。目前基于新靶点设计的糖尿病治疗新药有 些已上市,且获得良好的降糖效果,但大部分药物仍处于临床或临床前研究阶段,其疗效和安全性有待进一步临床验证。综述传统抗糖 尿病药物、T2DM 药物新靶点及基于新靶点设计的抗糖尿病新药的研究进展。     

日渐激烈的开发竞争促进胰岛素分泌有望实现

根据预测，2005年全世界的糖尿病患者将超过3亿人。正因为患者人数多，候选新药的开发蓬勃发展。但是因作用机制的不同，开发状况的明暗度也有所区别。最有希望的是GLP-1诱导体等新型胰岛素分泌促进剂。[编者按]     

抗类风湿性关节炎新药的研究与开发进展

依据美国药物研究与生产商协会 (PhRMA) 发布的报告和临床试验数据库（clinicaltrials.gov）与相关新药数据库的数据,对2014 年进入II ～Ⅲ期临床试验或获批的用于治疗类风湿关节炎的34 个候选新药的临床研发情况进行统计分析,着重将其中进入III 期临床试验或获批的9 个药物分为化学合成的、生物学原创的和仿制生物学的缓解病情类抗风湿药物以及治疗性疫苗等类别进行综述。     

脐带间充质干细胞在糖尿病治疗中的研究进展

糖尿病是一种以高血糖为特征的代谢性疾病,胰岛β细胞功能衰竭和胰岛素抵抗是糖尿病的主要病因。然而,目前的治疗方法,如口服抗糖尿病药物及胰岛素注射,尚不能逆转胰岛β细胞功能衰竭,而胰腺移植又受到供体来源的限制。随着干细胞与再生医学的发展,脐带间充质干细胞(umbilical cord mesenchymal stem cells,UC-MSCs)由于来源丰富、免疫原性低、无伦理问题等,成为治疗糖尿病的理想细胞类型。现就UC-MSCs在糖尿病治疗中的研究进展进行综述,为UC-MSCs移植治疗糖尿病的临床应用研究提供参考。     

120例肝源性糖尿病患者临床特点分析

目的:探讨肝源性糖尿病的临床特点及其治疗,以提高对该病的诊疗水平.方法:120例肝源性糖尿病(HD)患者,其中46例行OGTT试验,检测了血糖、胰岛素、C肽、胰岛素敏感指数(ISI),HOMA-IR及空腹血糖、空腹胰岛素(FPG/FINS)评估胰岛素抵抗,并与50例2型糖尿病(T2DM)患者进行对比分析.结果:21例(17.5％)HD患者有三多一少糖尿病典型症状.OGTT结果显示HD组空腹血糖低于T2DM组(P＜0.05);胰岛素+C肽释放试验显示T2DM组和HD组胰岛素分泌呈高峰延迟型,HD患者各时段胰岛素及C肽水平高于T2DM患者(P＜0.05,P＜0.01).HD组的FPG/FINS及HOMA-IR低于HD组,ISI高于HD组,差异均有统计学意义(P＜0.05).经治疗后血糖大部分控制在正常或接近正常水平,9例病例均死于肝病并发症.结论:胰岛素抵抗可能是肝源性糖尿病重要的发病机制.肝源性糖尿病以餐后高血糖为特征,临床症状不典型,短期不良预后主要与原发慢性肝病有关.     

1型糖尿病治疗方法的回顾与展望

1型糖尿病是由包括病毒感染、药物接触及自身免疫在内的各种原因导致的胰岛β细胞凋亡所引起的,主要表现为由血清中胰岛素的绝对缺乏引起的高血糖。在过去数十年中,外源补充胰岛素一直是1型糖尿病的最主要治疗方法。随着人们对1型糖尿病机制的深入了解及生命科学相关技术的发展,科研工作者及临床医生开始探索治疗1型糖尿病的新方法,其中包括将分泌胰岛素的外源胰岛或干细胞移植入体内。或将胰岛素基因直接导入体内,合成并分泌体内缺乏的胰岛素等。本文对胰岛移植、干细胞和基因疗法用于治疗1型糖尿病的主要方式做一简要回顾与综述,并重点讨论近年来的研究进展及其临床应用的可行性。     

常用口服降糖药的药物基因组学研究进展

近年来,中国 2 型糖尿病(T2DM)发病率呈快速增长趋势。T2DM 是一种慢性代谢性疾病,涉及全身各个系统,甚至可能引起严 重的并发症。大多数 T2DM 患者需长期口服降糖药物。口服降糖药的药物基因组学研究可指导个体化治疗,改善疗效,降低用药成本,减 少不良反应和并发症风险,已成为当前研究的热点。综述常用口服降糖药药效学和药代动力学参数的相关基因多态性研究进展,为更加合理、 有效地进行糖尿病临床个体化治疗提供参考。     

Anatomical,Morphological, and Chemical Characterizations and Biological Activities of Gagea taurica Steven (Liliaceae): A New Record for the Turkish Flora

Gagea genus, which is native to the Mediterranean and Black Sea regions, has attracted significant attention due to its biodiversity and potential health benefits. In this study, the biochemical composition and biological activities of methanol extracts from various parts of G. taurica were investigated, along with their anatomical and morphological characteristics. The best antimicrobial activity was found to be MeOH extracts of corm and leaf against several Candida strains with MIC=640 μg/mL. The highest level of phenolics together with significant results of antioxidant activities were observed in flowers extracts. The α-amylase inhibition assay results showed that the highest inhibition percentage was observed with acarbose (59 %), followed by leaf extract (43 %). Leaf exhibited the most effective inhibitory activity in AChE inhibition assay, whereas flower demonstrated the most significant inhibitory activity in BChE inhibition assay. Hesperidin was found as 1621.0001 ng/ml value in flower extract and 283.9339 ng/ml value leaf.     

Antidiabetic activity of a xanthone compound, mangiferin

Mangiferin (MF) isolated from Anemarrhena asphodeloides Bunge rhizome, was tested for antidiabetic activity in KK-Ay mice, an animal model of type-2 diabetes. MF lowered the blood glucose level of KK-Ay mice 3 weeks after oral administration (p < 0.01). However, no effect on the blood glucose level in normal mice was seen, indicating that MF could be useful in treating type-2 diabetes. In addition, MF improved hyperinsulinemia and, on insulin tolerance test, reduced blood glucose levels of KK-Ay mice. From these findings, it seems likely that MF exerts its antidiabetic activity by decreasing insulin resistance.     

Alpha-glucosidase inhibitory and antiplasmodial properties of terpenoids from the leaves of Buddleja saligna Willd

In our continuing search for biologically active natural product(s) of plant origin, Buddleja saligna, a South African medicinal plant, was screened in line with its traditional use for antidiabetic (yeast alpha glucosidase inhibitory) and antiplasmodial (against a chloroquine sensitive strain of Plasmodium falciparum (NF54)) activities. The hexane fraction showed the most promising activity with regards to its antidiabetic (IC₅₀?=?260?±?0.112?µg/ml) and antiplasmodial (IC₅₀?=?8.5?±?1.6?µg/ml) activities. Using activity guided fractionation three known terpenoids (betulonic acid, betulone and spinasterol) were isolated from this species for the first time. The compounds displayed varying levels of biological activities (antidiabetic: 27.31?µg/ml?≥?IC₅₀?≥?5.6?µg/ml; antiplasmodial: 14?µg/ml?≥?IC₅₀?≥?2?µg/ml) with very minimal toxicity.     

Synthesis and biological evaluation of 3-arylcoumarin derivatives as potential anti-diabetic agents

A variety of substituted 3-arylcoumarin derivatives were synthesised through microwave radiation heating. The method has characteristics of environmental friendliness, economy, simple separation, and purification process, less by-products and high reaction yield. Those 3-arylcoumarin derivatives were screened for antioxidant, α-glucosidase inhibitory and advanced glycation end-products (AGEs) formation inhibitory. Most compounds exhibited significant antioxidant and AGEs formation inhibitory activities. Anti-diabetic activity studies showed that compounds 11 and 17 were equipotent to the standard drug glibenclamide in vivo. According to the experimental results, the target compound 35 can be used as a lead compound for the development of new anti-diabetic drugs. The whole experiment showed that anti-diabetic activity is prevalent in 3-arylcoumarins, which added a new natural skeleton to the development of anti-diabetic active drugs.     

Effects of diabetes type and treatment on zinc status in diabetes mellitus

Zinc status was assessed in 53 diabetic patients: 18 insulin-dependent diabetic patients (IDDM), 22 noninsulin-dependent diabetic patients (NIDDM) treated with oral antidiabetic agents, and 13 insulin-treated, noninsulin-dependent diabetic patients (IRDM). Plasma zinc concentrations were in the usual range for healthy subjects in these three groups (15.3±0.9 μmol/L). Urinary zinc excretions were elevated in the IDDM group (18.3±4.1 μmol/24 h;p<0.01 vs normal) and in the NIDDM group (17.5±3.5 μmol/24 h;p<0.01 vs normal), but normal in the IRDM group (11.3±2.4 μmol/24 h). In 14 NIDDM patients treated with transient continuous sc insulin injections, urinary zinc decreased from 16.5±2.2 μmol/24 h before insulin treatment to 11.5±0.3 μmol/24 h after insulin treatment without any modification in plasma zinc concentrations.     

Furanocoumarin Content,Antioxidant Activity,and Inhibitory Potential of Heracleum verticillatum,Heracleum sibiricum,Heracleum angustisectum,and Heracleum ternatum Extracts against Enzymes Involved in Alzheimer's Disease and Type II Diabetes

Hexane extracts of Heracleum verticillatum, H. sibiricum, H. angustisectum, and H. ternatum were studied for their furanocoumarin content antioxidant potential and acetylcholinesterase and α‐amylase inhibitory activities. Quantification of the furanocoumarins was performed by ¹H‐NMR. Pimpinellin was found to be the main component in the roots of all studied species. Bergapten and imperatorin were the major compounds in the fruits of H. sibiricum and H. verticillatum, respectively, while byakangelicol dominated in H. angustisectum and H. ternatum fruits. The leaf and fruit extracts of H. angustisectum demonstrated the highest DPPH radical scavenging activity and TEAC (IC₅₀ 0.58 mg/mL and 1.83 mm , respectively). The root extracts of H. verticillatum and H. angustisectum were found to be the most effective against acetylcholinesterase (IC₅₀ 0.30 and 0.34 mg/mL, respectively). The studied extracts were not active or demonstrated a weak inhibitory effect (%Inh. up to 29.7) towards α‐amylase.     

Tannic acid as a natural antioxidant compound: Discovery of a potent metabolic enzyme inhibitor for a new therapeutic approach in diabetes and Alzheimer's disease

Multiple studies have been recorded on the synthesis and design of multi‐aim anti‐Alzheimer molecules. Using dual butyrylcholinesterase/acetylcholinesterase inhibitor molecules has attracted more interest in the therapy for Alzheimer's disease. In this study, a tannic acid compound showed excellent inhibitory effects against acetylcholine esterase (AChE), α‐glycosidase, α‐amylase, and butyrylcholinesterase (BChE). IC₅₀ values of tannic acid obtained 11.9 nM against α‐glycosidase and 3.3 nM against α‐amylase, respectively. In contrast, K_i values were found of 50.96 ± 2.18 µM against AChE and 53.17 ± 4.47 µM against BChE. α‐Glycosidase inhibitor compounds can be utilized as a novel group of antidiabetic drugs. By competitively decreasing glycosidase activity, these inhibitor molecules help to hamper the fast breakdown of sugar molecules and thereby control the blood sugar level.     

Characterization of sulfonylurea receptors in isolated human pancreatic islets

Current information on pancreatic islet sulfonylurea receptors has been obtained with laboratory animal pancreatic β cells or stable β-cell lines. In the present study, we evaluated the properties of sulfonylurea receptors of human islets of Langherans, prepared by collagenase digestion and density-gradient purification. The binding characterisitics of labeled glibenclamide to pancreatic islet membrane preparations were analyzed, displacement studies with several oral hypoglycemic agents were performed, and these latter compounds were tested as for their insulinotropic action on intact human islets. [³H]glibenclamide saturable binding was shown to be linear at ≤0.25 mg/ml protein; it was both temperature and time dependent. Scatchard analysis of the equilibrium binding data at 25°C indicated the presence of a single class of saturable, high-affinity binding sites with a K_d value of 1.0 ± 0.07 nM and a Bmax value of 657 ± 48 fmol/mg of proteins. The displacement experiments showed the following rank order of potency of the oral hypoglycemic agents we tested: glibenclamide = glimepiride > tolbutamide > chlorpropamide ≫ metformin. This binding potency order was parallel with the insulinotropic potency of the evaluated compounds. J. Cell. Biochem. 71:182–188, 1998. © 1998 Wiley-Liss, Inc.