Electronic letters to:

Review:
Alice Y.Y. Cheng and I. George Fantus
Oral antihyperglycemic therapy for type 2 diabetes mellitus
CMAJ 2005; 172: 213-226 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Herbal drugs in Type 2 diabetes mellitus
Laxminarayana Bairy Kurady   (26 January 2005)
[Read eLetter] Thiazolidinediones: effect on lipid profile
Pankaj Madan   (24 January 2005)

Herbal drugs in Type 2 diabetes mellitus 26 January 2005
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Laxminarayana Bairy Kurady
Asian Institute of Medicine , Science and Technology, 08000, Sungai Petani, Malaysia.

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Re: Herbal drugs in Type 2 diabetes mellitus

klbairy{at}yahoo.com Laxminarayana Bairy Kurady

Sir, the artilce "Oral antihyperglycemic therapy for type 2 diabetes mellitus" is quite comprehensive and informative. But the herbal drugs does not find a place in the review. Of late herbal drugs are gaining more and more importnace in the management of diabetes mellitus maily as adjuvants. Over 100 anti-diabetic formulations prepared from herbs, and/or minerals are enumerated in the classical Ayurveda works. Most of these formulations are yet to be scientifically studied to determine their relative potency and mechanism of action in the control of hyperglycemia. Those which were are studied there are significant methodological shortcomings, specifically: there were few randomised control trials and case control trials; appropriate statistical methods were not used in reporting the results. The majority of the studies tested non-insulin dependent diabetes mellitus (type 2) patients only. Despite these limitations, there is sufficient data for several herbs or herbal formulas to warrant further studies.

One of the best studied herbal formulations with anti-diabetic properties is Cogent db. It contains 9 herbs. Most ingredients have antidiabetic properties. Some have prominent ant-free radical properties while some have nerve toning porperties.

Cogent db can reduce blood glucose levels within three month period of treatment. It can cause significant reduction in the total glycated hemoglobin and HBA 1c to control levels within 90 days. Further it has triglyceride and cholesterol lowering property and it is non toxic to liver, kidney or bone marrow.

Cogent db can be prescribed as a first line treatment in cases where diet and excercise fail to produce desirable glycemic control. It is also useful as a supplement to conventional allopathic oral anti-diabetic drugs. The tonic effects of Cogent db on nerves and blood vessels suggest that this herbal drug can ameliorate the development of diabetic micro- angiopathy and neuropathy. So it is evedent that Ayurvedic drugs will finds a place in the management of Type 2 diabetes mellitus.

Reference: Shekar KC, Achike FI, Gurpreet Kaur, Kumar P and Rohaini H. A preliminary evaluation of the safety and efficacy of Cogent db (an Ayurvedic Drug) in the Glycemic control of patients with Type 2- Diabetes. The /journal of Alternative and Complementary Medicine, 2002, 8(4): 445- 457.

Conflict of Interest:

None declared
Thiazolidinediones: effect on lipid profile 24 January 2005
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Pankaj Madan
University College of Medical Science and Guru Teg Bahadur Hospital, Delhi

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Re: Thiazolidinediones: effect on lipid profile

pankajmadaan{at}rediffmail.com Pankaj Madan

Sir

In response to the review ‘Oral hypoglycemic therapy for type 2 diabetes mellitus”, I thought it would be useful to add a few information regarding the effect of thiazolidinediones on lipid profile.

The effect of thiazolidinediones on serum lipids and lipoproteins varies with agent used viz. Pioglitazone or rosiglitazone. HDL levels show an increase with use of either of the two drugs (1-10). However, LDL levels remain unchanged when monotherapy with pioglitazone or combination of pioglitazone and sulfonylurea, metformin or insulin is used (1-5). In contrast, using rosiglitazone either as monotherapy or in combination is associated with an increase in LDL cholesterol levels (6-10). Thirdly, while pioglitazone has been shown to decrease triglyceride levels, the effects of rosiglitazone on triglycerides have been variable, ranging from a 2% increase in triglyceride levels to 19% decrease in triglycerides (1- 5, 7, 8, 10).

Cheng AYY et al, in their review have mentioned the effect of thiazolidinediones on HDL cholesterol but they have overlooked the agents’effects on LDL and triglycerides.

Studies comparing the two agents simultaneously are scant and the cause of this variation in lipid levels in unknown.

References:

1. Aronoff S, Rosenblatt S, Braithwaite S, Egan JW, Mathisen AL, Schneider RL. Pioglitazone hydrochloride monotherapy improves glycemic control in the treatment of patients with type 2 diabetes: a 6-month randomized placebo-controlled dose-response study. Diabetes Care 2000;23:1605-11.

2. Rosenblatt S, Miskin B, Glazer NB, Prince MJ, Robertson KE. The impact of pioglitazone on glycemic control and atherogenic dyslipidemia in patients with type 2 diabetes mellitus. Coron Artery Dis 2001;12:413-23.

3. Einhorn D, Rendell M, Rosenzweig J, Egan JW, Mathisen AL, Schneider RL. Pioglitazone hydrochloride in combination with metformin in the treatment of type 2 diabetes mellitus: a randomized, placebo controlled study. Clin Ther 2000;22:1395-409.

4. Kipnes MS, Krosnick A, Rendell MS, Egan JW, Mathisen AL, Schneider RL. Pioglitazone hydrochloride in combination with sulfonylurea therapy improves glycemic control in patients with type 2 diabetes mellitus: a randomized, placebo- controlled study. Am J Med 2001;111:10-7.

5. Rosenstock J, Einhorn D, Hershon K, Glazer NB, Yu S. Efficacy and safety of pioglitazone in type 2 diabetes: a randomised, placebo- controlled study in patients receiving stable insulin therapy. Int J Clin Pract 2002;56:251-7.

6. Lebovitz HE, Dole JF, Patwardhan R, Rappaport EB, Freed MI. Rosiglitazone monotherapy is effective in patients with type 2 diabetes. J Clin Endocrinol Metab 2001;86:280-88. [Errata, J Clin Endocrinol Metab 2001;86:1659, 2002;87:iv.]

7. Fonseca V, Rosenstock J, Patwardhan R, Salzman A. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA 2000;283:1695-702. [Erratum, JAMA 2000;284:1384.]

8. Gomez-Perez FJ, Fanghanel-Salmon G,Antonio Barbosa J, et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans with type 2 diabetes. Diabetes Metab Res Rev 2002;18:127-34.

9. Vongthavaravat V, Wajchenberg BL, Waitman JN, et al. An international study of the effects of rosiglitazone plus sulphonylurea in patients with type 2 diabetes. Curr Med Res Opin 2002;18:456-61.

10. Raskin P, Rendell M, Riddle MC, Dole JF, Freed MI, Rosenstock J. A randomized trial of rosiglitazone therapy in patients with inadequately controlled insulin-treated type 2 diabetes. Diabetes Care 2001;24:1226-32.

Conflict of Interest:

None declared