Diabetes: scope and management

Currently, 8 million Americans have diagnosed diabetes and an equal number have the undiagnosed disease, according to the U.S. National Institutes of Health (NIH). Insulin-dependent or Type 1 diabetes mellitus (IDDM) nearly always occurs before the age of 18 years. Type 1 diabetes results from autoimmune activity against the islet cells of the pancreas.

Non-insulin dependent or Type 2 diabetes accounts for nearly 95% of all cases of the disease in the United States, and is classically observed to have its onset during adulthood. Recent epidemiologic evidence has suggested a trend toward an increased earlier prevalence of Type 2 diabetes. Some evidence points to a primary pancreatic beta-cell defect in the genesis of Type 2 diabetes. Obesity is considered the greatest single risk factor for the development of this type of the disease. Other risk factors for type 2 diabetes include a family history of this disease, age over 40 years, a Hispanic, African-American, American Indian, Asian-American, or Pacific Island heritage, and a history of gestational diabetes or delivering a baby with a weight exceeding 9 pounds.

Although there is no cure for diabetes; strong evidence suggests that most of its acute and chronic complications are preventable and even, to varying degrees, reversible with strict blood glucose control.

Treatment

The primary goal in the management of diabetes is the normalisation of blood glucose. Other goals include the normalisation of serum lipids and prevention of hypoglycemia. This typically begins with dietary modification to limit carbohydrate loads to levels that produce predictable changes in postprandial blood glucose levels, which facilitates the medical treatment of the disease with insulin and/or oral antihyperglycemic agents. Exercise has both immediate and longer-term beneficial effects on insulin sensitivity, and may be of particular benefit in Type 2 diabetes and obesity in Type 1 diabetes, since obesity is highly correlated with insulin resistance.

Ref: AltMedDex&tradel Protocols [DIABETES MELLITUS - Complete Monograph] MICROMEDEX(R) Healthcare Series Vol. 124. Accessed online 25th April 2005 http://www.micromedex.com/products/altmeddex/

Table 1. Efficacy of bitter melon extracts versus glibenclamide in reducing blood glucopse levels in rats with alloxan-induced diabetes

Extract % reduction after one week % reduction after four weeks
Ethanol extract 49.2 39.0
Chloroform extract 3.9 3.8
Water extract 49.0 50.8
Glibenclamide 50.8 51.5
Untreated diabetic 270.9 359.8

Table 2. Antihyperglycemic effects of bitter melon

Pancreatic activities Enhancement of beta cells4
Insulin promoting or mimetic5, 6
Extra-pancreatic activities Increased GLUT4 transporter protein of muscles7
Increased glucose utilisation in liver and muscle tissues3, 8
Inhibition of gluxose-6-phosphatas and fructose-1, 6-bisphosphatase in the liver and stimulation of red-cell and hepatic glucose-6-phosphate dehydrogenase activities9
Inhibition of glucose transport at the brush border of the small intestine10
Restoration of depressed enzymes activity in the liver responsible for carbohydrate metabolism (including hexokinase, glucoskinase, phosphofructokinase)2

From Grover JK, Yadav SP J Ethnopharmacol 93(1):123-132, 2004.1

References

  1. Grover JK, Yadav SP. Pharmacological actions and potential uses of Momordica charantia: A review. J Ethnopharmacol 93(1):123-132, 2004.
  2. Rathi SS, Grover JK, Vats V. The effect of Momordica charantia and Mucuna pruriens in experimental diabetes and their effect on key metabolic enzymes involved in carbohydrate metabolism. Phytother Res 16(3):236-243, 2002.
  3. Sarkar S, Pranava M, Marita R. Demonstration of the hypoglycemic action of Momordica charantia in a validated animal model of diabetes. Pharmacol Res 33(1):1-4, 1996.
  4. Ahmed I, Adeghate E, Sharma AK, et al. Effects of Momordica charantia fruit juice on islet morphology in the pancreas of the streptozotocin-diabetic rat. Diabetes Res Clin Pract 40(3):145-151, 1998.
  5. Welihinda J, Karunanayake EH, Sheriff MH, Jayasinghe KS. Effect of Momordica charantia on the glucose tolerance in maturity onset diabetes. J Ethnopharmacol 17(3):277-282, 1986.
  6. Higashino H, Suzuki A, Tanaka Y, Pootakham K. [Hypoglycemic effects of Siamese Momordica charantia and Phyllanthus urinaria extracts in streptozotocin-induced diabetic rats (the 1st report)]. Nippon Yakurigaku Zasshi 100(5):415-421, 1992. [in Japanese]
  7. Miura T, Itoh C, Iwamoto N, et al. Hypoglycemic activity of the fruit of the Momordica charantia in type 2 diabetic mice. J Nutr Sci Vitaminol (Tokyo) 47(5):340-344, 2001.
  8. Karunanayake EH, Jeevathayaparan S, Tennekoon KH. Effect of Momordica charantia fruit juice on streptozotocin-induced diabetes in rats. J Ethnopharmacol 30(2):199-204, 1990.
  9. Shibib BA, Khan LA, Rahman R. Hypoglycaemic activity of Coccinia indica and Momordica charantia in diabetic rats: depression of the hepatic gluconeogenic enzymes glucose-6-phosphatase and fructose-1,6-bisphosphatase and elevation of both liver and red-cell shunt enzyme glucose-6-phosphate dehydrogenase. Biochem J 292 ( Pt 1):267-270, 1993.
  10. Matsuda H, Dai Y, Ido Y, et al. Studies on Kochiae Fructus. V. Antipruritic effects of oleanolic acid glycosides and the structure-requirement. Biol Pharm Bull 21(11):1231-1233, 1998.