DIABETES

Diabetes

Diabetes

Diabetes mellitus is a chronic condition in which the pancreas, a gland near the stomach, fails to make insulin or does not make enough insulin, or in which the body becomes insensitive to insulin. Insulin is a hormone that works to convert what we eat to glucose or sugar. Insulin supplies muscles and other tissues with glucose for growth and energy. Without insulin, the body's blood sugar cannot be regulated, leading to a buildup of sugar in the blood (hyperglycemia) and loss of fuel for the body. Symptoms of diabetes include excessive thirst, frequent urination, unexplained weight loss, extreme hunger, vision changes, tingling in the hands or feet, dry skin, and sores that are slow to heal.

Diabetes is a foremost public wellbeing problem. In 2005, approximately 1.1 million people worldwide died from diabetes. Diabetes is the sixth premier cause of death in the joined States. The penalties of diabetes are severe. Diabetes is associated with heart disease, stroke, kidney failure, blindness, nontraumatic amputations, and nerve damage.

1. Prevention of Diabetes

Diet, exercise, and an overall healthy lifestyle can, on a patient-specific basis, lessen or eliminate the chances of developing type 2 diabetes. These measures also lessen the severity and chances of long-term complications in patients diagnosed with the disease; often, however, patients must utilize antidiabetic medications, either as monotherapies or in combinations, to manage their disease. Drug treatment is used in patients with type 2 diabetes in order to achieve consistent glycemic control and decrease the possibility of a cardiovascular event. A broad spectrum of oral antidiabetic drugs, including pioglita-zone (the focus of the PROactive study), target the known components of type 2 diabetes; sales of these agents are shown in Table

In addition to the oral antidiabetic agents discussed in the following sections, some patients require insulin therapy to approach or maintain a euglycemic state. Short-acting (insulin lispro) and long-acting (insulin glargine) insulin formulations are typically used in combination with other medications or alone following an unacceptable response of type 2 diabetes patients to previous treatments.

Sulfonylureas

Sulfonylureas are insulin secretagogues that stimulate insulin secretion from the pancreatic islet ß cells and lower plasma glucose levels. This class of agent, used as a monotherapy or in combination with other oral antidiabetic agents or insulin, has been a popular choice as a first-line therapy since its introduction in the 1950s. Since that time, three generations of sulfonylureas have been developed. The first-generation agents, which include tolbutamide (generics), tolazamide (generics), acetohexamide (generics), and chlorpropamide (Pfizer's Diabinese, generics), are rarely used today.

The second-generation agents, which include glyburide (Pfizer's Micronase, Sanofi-Aventis's Diabeta, generics), glipizide (Pfizer's Glucotrol, Glucotrol XL, generics), and gliclazide (Servier's Diamicron, Molteni & C.F. LLI Alitti's Diabrezide, Dainippon's Glimicron, generics), are far more potent than the first-generation agents and are considered efficacious and safe. In the United States, a micronized version of glyburide (Pfizer's Micronase) is also available; this agent has enhanced absorption characteristics that enable a faster onset of action compared with nonmicronized glyburide. A drawback of these second-generation agents is their short ...