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

「Evaluation of Drug Activities: Pharmacometrics」, Vol. 1, 15×23cm判, 456頁, 5,700円, Vol.2 438頁, 5,400円, Academic Press, D. R. Laurence & A. L. Bacharach編

Treatment of streptozotocin-induced diabetes mellitus by transplantation of islet cells plus bone marrow cells via portal vein in rats

Type 2 diabetes is one of the most important diseases worldwide. It affects several organ systems including the liver and lipid metabolism. Many herbal formulations have shown anti-diabetic potential, however, their safety and efficacy remain a debate in the medical community. 
Aim: This study evaluates the therapeutic effects of the anti-diabetic polyherbal drug diawell in combination with metformin on liver enzyme and lipid profile in type 2 diabetic rats. 
Methodology: A total of 35 male Wistar albino rats weighing between 120-220 g were used for this study. The rats were placed on high fat diet, and diabetes was induced by a single intraperitoneal injection of freshly prepared streptozotocin (STZ) (45 mg/kg body wt). Fasting plasma glucose (FPG) was determined using the glucose oxidase method. Total Cholesterol (TC), Triglyceride (TG) and High density lipoprotein cholesterol (HDL-C) were determined using enzymatic methods. Low density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald equation. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined using Reitman-Frankel method, while alkaline phosphatase (ALP) was determined using the colorimetric phenolphthalein method. Liver sections were stained using haematoxylin and eosin (H&E) staining technique, and phytochemical analysis was also done on the herbal tablet. 
Results: The results show no significant differences in mean TC levels in all groups. TG level was significantly higher in the diabetic control when compared to the negative control. There were no significant differences in TG levels in the metformin group, and diawell group when compared to the diabetic control. TG levels in the combination group (metformin + diawell) was significantly lower versus the diabetic control, and showed no significant difference compared to the negative control. HDL-C was significantly higher in the negative control when compared to the diabetic control and the treatment groups. There were no significant differences in HDL-C levels in all the treatment groups, when compared to the diabetic control. LDL-C levels were significantly lower in the negative control compared to the diabetic control and treatment groups. There were no significant differences in LDL-C levels in all the treatment groups, when compared to the diabetic control. The diabetic control had significantly higher ALT, AST and ALP levels compared to the negative control and treatment groups. All the treatment groups showed no significant differences in ALT and AST levels compared to the negative control. Liver sections of the negative control showed normal histoarchitecture. The diabetic control showed inflammation and fatty deposition. The treatment groups showed a nearly normal histoarchitecture, with fatty deposits. 
Conclusion: High fat diet in combination with 45 mg/kg of STZ produced significant diabetes in the Wistar rats with dyslipidaemia and elevated liver enzyme levels. Metformin and the polyherbal tablet diawell had no impact on the lipid levels as it did not correct the dyslipidaema, however, the treatments showed hepatoprotective potentials and restored liver enzyme levels to normal. Lipid lowering drugs should be included in the management of type 2 diabetes, and there should be proper evaluation of anti-diabetic herbal products.

/pdf/therapeutic-effects-of-the-anti-diabetic-polyherbal-drug-3g62ol96xf.pdf

Therapeutic Effects of the Anti-diabetic Polyherbal Drug Diawell in Combination with Metformin on Liver and Lipid Parameters in Type 2 Diabetic Rats

The scourge of diabetes has led to an increase in the use of complementary and alternative medicine. The lack of regulation and control leads to the indiscriminate use of these herbals, with potential risk to patients. \nAim: This study evaluates the lipidaemic and hepatic status of type 2 diabetic rats treated with the polyherbal capsule glucoblock. \nMethodology: A total of 35 male Wistar albino rats weighing between 120-220 g were used for this study. The rats were placed on high fat diet and diabetes was induced by a single intraperitoneal injection of freshly prepared streptozotocin (STZ) (45 mg/kg body wt). Fasting plasma glucose (FPG) was determined using the glucose oxidase method. Total Cholesterol (TC), Triglyceride (TG) and High Density Lipoprotein Cholesterol (HDL-C) were determined using enzymatic methods. Low Density Lipoprotein Cholesterol (LDL-C) was calculated using the Friedewald’s equation. Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) were determined using Reitman-Frankel method, while alkaline phosphatase (ALP) was determined using the colorimetric phenolphthalein method. Liver sections were stained using haematoxylin and eosin (H&E) staining technique, and phytochemical analysis was also done on the herbal capsule. \nResults: The results show no significant differences in TC levels in all groups compared to the negative control. TG level was significantly higher in the diabetic control group when compared to the negative control. TG level in the singular treatment groups were significantly lower, but the combination group (glibenclamide + glucoblock) showed no significant difference compared to the diabetic control. The negative control had significantly higher HDL-C compared to the diabetic control and treatment groups. There were no significant differences in HDL-C levels in all the treatment groups, when compared to the diabetic control. The negative control had significantly lower LDL-C compared to the diabetic control and treatment groups. There were no significant differences in LDL-C levels in all the treatment groups, when compared to the diabetic control. ALT, AST and ALP levels were significantly higher in the diabetic control, but was significantly reduced to normal levels by the treatments. Liver sections of the negative control showed normal histoarchitecture. The diabetic control showed inflammation and fatty deposition. The treatment groups showed a nearly normal histoarchitecture, with fatty deposits. \nConclusion: High fat diet in combination with a sub-diabetic dose of streptozotocin produced significant diabetes in the Wistar rats with dyslipidaemia and elevated liver enzyme levels. The anti-diabetic treatments, glibenclamide and glucoblock did not correct the dyslipidaema caused by diabetes. However, the treatments had equipotent hepatoprotective effect and restored liver enzyme levels to normal as well as improving liver histology.

/pdf/lipidaemic-and-hepatic-status-of-type-2-diabetic-rats-4md7vimnp9.pdf

Lipidaemic and Hepatic Status of Type 2 Diabetic Rats Treated with the Polyherbal Capsule Glucoblock

The increased prevalence of diabetes, and the huge disease burden on patients has led to an increase in the use of complementary and alternative medicine in diabetes treatment and management. \nAim: This study evaluates the antidiabetic and antioxidant effects of the polyherbal capsule glucoblock and glibenclamide in type 2 diabetic rats. \nMethodology: A total of 35 male Wistar albino rats weighing between 120-220 g were used for this study. The rats were placed on high fat diet, and diabetes induced by a single intraperitoneal injection of freshly prepared streptozotocin (STZ) (45 mg/kg body Wt). Fasting plasma glucose (FPG) was determined using the glucose oxidase method. Fasting plasma insulin (FPI), total oxidant status (TOS), total antioxidant status (TAS) and superoxide dismutase (SOD) levels were quantitatively determined by a rat-specific sandwich-enzyme linked immunosorbent assay (ELISA) method. Insulin resistance (IR) was determined using the homeostatic model assessment of insulin resistance (HOMA-IR) method. Oxidative stress index (OSI) was determined by the ratio of TOS to TAS. Phytochemical analysis was also done on the herbal capsule. \nResults: Mean FPG levels were significantly lower (p˂0.05) in all groups, compared to the diabetic control. Mean FPG level was significantly higher (p˂0.05) in the combination group, but showed no significant difference (p>0.05) in the glibenclamide group, and glucoblock group, compared to the negative control. HOMA-IR was significantly higher (p<0.05) in the diabetic control compared to the negative control and treatment groups. The combination group had significantly higher (p˂0.05) HOMA-IR values, whereas the individual treatment groups showed no significant difference (p>0.05) when compared to the negative control. TOS was significantly higher (p<0.05) in the diabetic control compared to the negative control and treatment groups. The treatment groups showed no significant difference (p>0.05) in TOS, compared to the negative control. There was significantly lower (p˂0.05) TAS levels in the diabetic and treatment groups, compared to the negative control. OSI values were significantly lower (p˂0.05) in all groups when compared to the diabetic control. Also, OSI values were significantly higher (p˂0.05) in the treatment groups compared to the negative control. SOD was significantly lower (p<0.05) in the diabetic control compared to the negative control and treatment groups. The treatment groups showed no significant difference (p>0.05) in SOD levels, compared to the negative control. \nConclusion: Increase in total oxidant status and oxidative stress depleted antioxidant parameters. The polyherbal capsule glucoblock was effective when used alone and produced equipotent effect to the treatment with glibenclamide. However, the combination treatment did not fare better. Antioxidant therapy should be used together with antidiabetics in the management of diabetes, and care should be taken in the use herb-drug combinations.

/pdf/antidiabetic-and-antioxidant-effects-of-the-polyherbal-drug-2ok1lsgzna.pdf

Antidiabetic and Antioxidant Effects of the Polyherbal Drug Glucoblock and Glibenclamide in Type 2 Diabetic Rats

Aim: This study evaluated the anti-arthritic activity of a herbal formulation used in the management of rheumatoid arthritis in Nigeria. 
Design: Thirty-five (35) albino wistar rats were used. They were divided into seven groups of seven rats each, with Group A serving as negative control while Group B was the positive control. Groups B, C, D and E were induced with rheumatoid arthritis by injecting 0.1 ml of Complete Freund’s Adjuvant into the right hind paw of each rat. The rats were treated with the standard drug and herbal formulation respectively for 28 days as follows: Group C (treated with a standard drug, Celebrex), Group D (treated with the herbal drug, Jointeez), Group E (treated with a combination therapy of Jointeez and Celebrex). At the end of the 28-day treatment period, the rats were anaesthesized with chloroform and sacrificed through puncture of the jugular vein. Five millilitres (5 ml) of blood samples were put into plain bottles for the analysis of biochemical parameters. 
Place and Duration of Study: This study was conducted in the Department of Medical Laboratory Science, Rivers State University, from September to December, 2018. 
Methodology:  The inflammatory markers, tumour necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and C-reactive protein, were analysed using ELISA technique. 
Results: The levels of TNF-α (p<0.001), IL-6 (p =0.01) and C-reactive protein (p <0.001) were significantly reduced in the treated rats compared to the positive control group. There were significant reduction in the paw diameters of the treated rats (p <0.001). The combination therapy used in this study did not offer significantly different therapeutic advantage over the monotherapies used in this study. The herbal formulation used in this study offered similar therapeutic activities as the orthodox drug used in this study. 
Conclusion: The herbal formulations can be used as safe therapies for the management of rheumatoid arthritis in our population. It is recommended that herbal formulations be integrated into our healthcare system in the management of rheumatoid arthritis.

/pdf/anti-arthritic-activity-of-a-herbal-formulation-jointeez-in-3sqzitazsp.pdf

Anti-arthritic Activity of a Herbal Formulation (Jointeez) in Albino Wistar Rats

Diabetes mellitus is an epidemic, with a huge disease burden on the patients. This has led to an increase in the use of herbal remedies and combination therapies to reduce this burden. 
Aim: This study evaluates the biochemical and oxidative changes in type 2 diabetic rats, treated with metformin and the polyherbal drug diawell. 
Methodology: A total of 35 male Wistar albino rats weighing between 120-220 g were used for this study. The rats were placed on high fat diet, and diabetes was induced by a single intraperitoneal injection of freshly prepared streptozotocin (STZ) (45 mg/kg body wt). Fasting plasma glucose (FPG) was determined using the glucose oxidase method. Fasting plasma insulin (FPI), total oxidant status (TOS), total antioxidant status (TAS) and superoxide dismutase (SOD) levels were quantitatively determined by a rat-specific sandwich-enzyme linked immunosorbent assay (ELISA) method. Insulin resistance (IR) was determined using the homeostatic model assessment for insulin resistance (HOMA-IR) method. Oxidative stress index (OSI) was determined by the ratio of TOS to TAS. Phytochemical analysis was also done on the herbal tablet. 
Results: Mean FPG levels were significantly lower (p˂0.05) in all groups, except the group administered diawell, which was not significantly different (p>0.05), compared to the diabetic control. Mean FPG levels were significantly higher (p˂0.05) in the metformin group, diawell group, but showed no significant difference (p>0.05) in the combination group, compared to the negative control. HOMA-IR was significantly higher (p<0.05) in the diabetic control compared to the negative control and treatment groups. The metformin and diawell groups had significantly higher (p˂0.05) HOMA-IR values, whereas the combination (metformin + diawell) showed no significant difference (p>0.05) when compared to the negative control. TOS was significantly higher (p<0.05) in the diabetic control compared to the negative control and treatment groups. The metformin and diawell groups had significantly higher (p˂0.05) TOS values, whereas the combination (metformin + diawell) showed no significant difference (p>0.05) when compared to the negative control. There was significantly lower (p˂0.05) TAS levels in the diabetic and treatment groups, compared to the negative control. OSI values were significantly lower (p˂0.05) in all groups when compared to the diabetic control. Also, OSI values were significantly higher (p˂0.05) in the treatment groups compared to the negative control. 
Conclusion: There was depletion of antioxidant parameters and an increase in oxidative stress in the diabetic rats. Administration of metformin and the polyherbal tablet diawell individually, were not effective in correcting the pathological and biochemical changes associated with diabetes. However, the combination treatment produced a better glycaemic response and attenuated the oxidant status in the rats. Antioxidant therapy should be incorporated in diabetes management, and anti-diabetic herbals properly evaluated.

/pdf/biochemical-and-oxidative-changes-in-high-fat-diet-c8gkeskgah.pdf

Biochemical and Oxidative Changes in High Fat Diet/Streptozotocin-induced Diabetic Rats Treated with Metformin and the Polyherbal Diawell

Aim: This study evaluated the combined effect of coconut water and garlic tincture on lipid and antioxidants profile of albino rats fed with high fat diet and alcohol. 
Study Design: This study is a non-randomized experimental study design. 
Place and Duration of Study: Rivers State University Chemical Pathology Laboratory, Department of Medical Laboratory Science, the study was done between 20th November, 2018-30th June 2019. 
Methodology: A total number of 45 Wister albino rats were used with the weight ranged from 120-200 grams. The animals were grouped into two major groups, the control Group A and the test Group B. Blood samples were collected via cardiac puncture into heparinized bottle for standard laboratory investigation of lipid profile, and Superoxide dismutase (SOD), Total antioxidant capacity (TAC) and Malondialdehide (MDA). Plasma SOD and MDA were determined using ELISA methods, TAC was determined using FRAP Colorimetric method while lipid profile were determined using enzymatic method. 
Results: The results revealed that, alcohol induced oxidative stress group exhibited significant differences in MDA levels amongst the groups, and no significance differences in SOD and TAC levels as compared with negative control groups. There were significant differences in the Total Cholesterol and low density lipoprotein levels, amongst the groups. However, these changes appear to improve with coconut water and garlic tincture treatment. Treatment with coconut water alone following 30% alcohol treatment, showed a significant decrease in MDA level, no significant increase in SOD and TAC. Similar observation was recorded for the garlic tincture treatment alone. Treatment with low dose of combined coconut water with garlic tincture following 30% alcohol treatment, shows significant decrease in MDA level, significant increase in SOD, no significant increase in TAC. Treatment with low and higher doses of combined coconut water with garlic tincture following HFD treatment showed similar results, no significant decrease in TG levels, a significant decrease in MDA, TC and LDL levels, a significant increase in TAC and HDL levels and no significant increase in SOD. However, no difference was observed at higher dose. Histological findings revealed changes in hepatocellular architecture, such as inflammatory cell aggregates, dilation of sinosidal space, fatty droplet after treatment with alcohol and high fat diet. However, upon garlic tincture and coconut water treatment, there was amelioration of these abnormalities. 
Conclusion: The mixture of coconut water and garlic tincture seem to exerted an antioxidant and antiatherogenic effect on alcohol-induced oxidative stress and HFD-induced dyslipidaemia in rats. 

/pdf/synergistic-effect-of-coconut-water-and-garlic-tincture-on-5aanwp2y96.pdf

Davies G. Tamuno-Emine

Papers

Antidiabetic and Antioxidant Effects of the Polyherbal Drug Glucoblock and Glibenclamide in Type 2 Diabetic Rats

Anti-arthritic Activity of a Herbal Formulation (Jointeez) in Albino Wistar Rats

Biochemical and Oxidative Changes in High Fat Diet/Streptozotocin-induced Diabetic Rats Treated with Metformin and the Polyherbal Diawell

Synergistic Effect of Coconut Water and Garlic Tincture on Lipids and Oxidative Profile of Albino Rats Treated with High Fat Diet and Alcohol