XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

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Treating TB in people with HIV

Polyamines (PAs) are low molecular weight aliphatic nitrogenous bases containing two or more amino groups. They are produced by organisms during metabolism and are present in almost all cells. Because they play important roles in diverse plant growth and developmental processes and in environmental stress responses, they are considered as a new kind of plant biostimulant. With the development of molecular biotechnology techniques, there is increasing evidence that PAs, whether applied exogenously or produced endogenously via genetic engineering, can positively affect plant growth, productivity, and stress tolerance. However, it is still not fully understood how PAs regulate plant growth and stress responses. In this review, we attempt to cover these information gaps and provide a comprehensive and critical assessment of the published literature on the relationships between PAs and plant flowering, embryo development, senescence, and responses to several (mainly abiotic) stresses. The aim of this review is to summarize how PAs improve plants' productivity, and to provide a basis for future research on the mechanism of action of PAs in plant growth and development. Future perspectives for PA research are also suggested.

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Polyamine Function in Plants: Metabolism, Regulation on Development, and Roles in Abiotic Stress Responses.

Data analysis methods.

Plant-derived protein hydrolysates (PHs) have gained prominence as plant biostimulants because of their potential to increase the germination, productivity and quality of a wide range of horticultural and agronomic crops. Application of PHs can also alleviate the negative effects of abiotic plant stress due to salinity, drought and heavy metals. Recent studies aimed at uncovering the mechanisms regulating these beneficial effects indicate that PHs could be directly affecting plants by stimulating carbon and nitrogen metabolism, and interfering with hormonal activity. Indirect effects could also play a role as PHs could enhance nutrient availability in plant growth substrates, and increase nutrient uptake and nutrient-use efficiency in plants. Moreover, the beneficial effects of PHs also could be due to the stimulation of plant microbiomes. Plants are colonized by an abundant and diverse assortment of microbial taxa that can help plants acquire nutrients and water and withstand biotic and abiotic stress. The substrates provided by PHs, such as amino acids, could provide an ideal food source for these plant-associated microbes. Indeed, recent studies have provided evidence that plant microbiomes are modified by the application of PHs, supporting the hypothesis that PHs might be acting, at least in part, via changes in the composition and activity of these microbial communities. Application of PHs has great potential to meet the twin challenges of a feeding a growing population while minimizing agriculture’s impact on human health and the environment. However, to fully realize the potential of PHs, further studies are required to shed light on the mechanisms conferring the beneficial effects of these products, as well as identify product formulations and application methods that optimize benefits under a range of agro-ecological conditions.

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Biostimulant Action of Protein Hydrolysates: Unraveling Their Effects on Plant Physiology and Microbiome

Polyamines are amine-containing, low molecular weight, and ubiquitous polycationic molecules present in almost all cells and free-living microbes, which are formed by aliphatic hydrocarbons replaced with multiple amino groups. They have been considered as a new kind of plant biostimulant, which play vital roles in diverse plant growth and developmental processes, and environmental stress responses. However, little is known regarding the effects of polyamines specifically on the elicitation of bioactive compounds in medicinal plant production. Therefore, in this review, we attempt to cover these gaps of information. Supply of polyamines, whether by exogenous application or through genetic engineering, could positively affect medicinal plant growth, productivity, and stress tolerance; however, these effects depend on type and dose of polyamine application and plant species. Furthermore, polyamines play as precursor for the several groups of alkaloids (pyrrolizidine, tropane, and quinolizidine alkaloids) and phenolamides, so these bioactive compounds could significantly increase the concentration of the above-mentioned natural products.

Polyamines and their possible mechanisms involved in plant physiological processes and elicitation of secondary metabolites

Fenugreek (Trigonella foenum-graecum L.) has a long and respected history of medicinal uses in Middle East and Persian medicine. The hypocholesterolaemic and hypoglycaemic effects of fenugreek were attributed to its major steroidal sapogenin, diosgenin and its major alkaloid, trigonelline. The knowledge of diosgenin and trigonelline biosynthesis is derived from studies of cholesterol and nicotinic acid production through acetyl-CoA→ mevalonate→ isopentenyl pyrophosphate→ squalene→ lanosterol→ cholesterol→ diosgenin and quinolinic acid→ nicotinamide adenine dinucleotide→ nicotinamide→ nicotinic acid→ trigonelline pathways, respectively. This paper reviews the secondary metabolites and metabolic pathways of diosgenin and trigonelline production in fenugreek as a medicinal plant and economical crop.

Bioengineering of important secondary metabolites and metabolic pathways in fenugreek (Trigonella foenum-graecum L.).

Fenugreek (Trigonella foenum-graecum L.), wild or cultivated, is widely distributed throughout the world and belongs to the Fabacecae family. It is an old medicinal plant and has been commonly used as a traditional food and medicine. Fenugreek is known to have hypoglycemic, and hypocholesterolaemic, effects. Recent research has identified fenugreek as a valuable medicinal plant with potential for multipurpose uses and also as a source for preparing raw materials of pharmaceutical industry, especially steroidal hormones. A significant increase in quantity and quality yields through the suitable management of cultivation, breeding and biotechnology practices could make an immediate and important contribution to farm and pharmaceutical industry income. To achieve these goals with regard to sustainable production, we reviewed a summary of biology, cultivation and biotechnology of fenugreek in this paper.

Ali Mehrafarin

Papers

Polyamines and their possible mechanisms involved in plant physiological processes and elicitation of secondary metabolites

Bioengineering of important secondary metabolites and metabolic pathways in fenugreek (Trigonella foenum-graecum L.).

A review on biology, cultivation and biotechnology of fenugreek (trigonella foenum-graecum l.) as a valuable medicinal plant and multipurpose

Changes in the essential oil content and composition of Thymus daenensis Celak. under different drying methods

Application of plant biostimulants as new approach to improve the biological responses of medicinal plants- a critical review