Pathophysiology of vascular disease in diabetes: effects of gliclazide

Article Abstract:

One of the major adverse effects of diabetes mellitus is the greatly increased risk for macrovascular and microvascular (large and small blood vessel) diseases such as coronary heart disease and retinal damage, respectively. Understanding how diabetes causes vascular disease and developing treatments that can prevent it have received a great deal of attention. A number of approaches for preventing vascular disease in diabetics have been pursued. Diabetes involves poor control of blood glucose levels. Insulin and sulfonylurea agents, such as gliclazide, are used to maintain glycemic (blood glucose) control in diabetics. It is believed by many that good glycemic control can prevent vascular disease. Some researchers have attempted to define specific vascular problems and develop drugs that specifically address these problems, while others have explored the use of drugs that maintain glycemic control and have specific actions against vascular disease. This study reviews the use of gliclazide in achieving glycemic control and preventing vascular disease. The process of atherosclerosis (the deposition of fatty cholesterol plaques within blood vessels) is complicated and not clearly understood, but there are a number of abnormalities that contribute to it. Diabetes is thought to play a role in the development of a number of these abnormalities, including damage to the tissues that line blood vessels, increased platelet adhesiveness and aggregation, increased lipoprotein levels, and alterations in the function of macrophages. Gliclazide appears to counter several of these abnormalities, in addition to its ability to maintain glycemic control. Some studies have shown that gliclazide improves fibrinolytic (break down of fibrin, a component needed for blood clotting) activity, which could reduce initial vascular damage. Other studies have shown that gliclazide may prevent platelet aggregation and platelet adhesiveness. Further studies of the beneficial effects of gliclazide in preventing vascular disease are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Development and progression, Diabetic angiopathies

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Current status of non-insulin-dependent diabetes mellitus (type II): management with gliclazide

Article Abstract:

Non-insulin-dependent diabetes (NIDDM) is a common disorder in adults that greatly increases the risks for complications such as heart disease, kidney disease, and circulatory disorders. Recent advances in understanding NIDDM have led to improved treatments. Genetic factors are involved in the development of this disease, but are not well understood. The disease affects about 3 to 7 percent of adults in Western countries, but it is found at much higher rates in certain populations. The incidence (number of new cases) of diabetes increases with age in all populations and regions. It appears to be caused both by diminished secretion of and diminished sensitivity to insulin. Glucose metabolism is adversely affected, resulting in elevated blood levels of glucose and cholesterol and high blood pressure. Diabetes is involved in the development of vascular damage, which is manifested in cardiovascular, kidney and eye diseases. Standard treatment may include weight loss, exercise, and drug therapy with sulfonylurea agents. Early and effective treatment of this disease can prevent or lessen the severity of many of the disease complications. Current dietary treatment consists of a complex carbohydrate, low-fat diet. A recent study has challenged the efficacy of this diet, but further research is needed before new dietary recommendations can be made. Exercise is generally considered beneficial unless the diabetes is poorly controlled or certain complications are present. Sulfonylurea agents, such as gliclazide, have been shown to counter some of the metabolic abnormalities associated with NIDDM. Recent research has shown it to be both effective and safe. Its use, alone and in combination with insulin therapy, should further improve the outlook for patients with NIDDM. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Diabetes, Diabetes mellitus

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Oral treatment of diabetes mellitus: the contribution of gliclazide

Article Abstract:

Non-insulin-dependent diabetes mellitus (NIDDM), sometimes referred to as adult onset diabetes, is a major cause of death and disease in adults. It strikes about one-fifth of all persons over 66 years of age and is found at higher rates in people with a positive family history of the disease and in black and Hispanic populations. People with NIDDM have a much higher risk for developing heart disease, kidney disease, eye problems, poor circulation, and have a much higher rate of limb amputations. In a large study, the 6-year mortality from cardiovascular causes was 3.2 deaths per 1,000 males who did not have diabetes or other risk factors for heart disease and 15.9 deaths per 1,000 diabetic men with no other risk factors. In men with 1, 2 or 3 classic risk factors for heart disease, mortality rates were increased to 6.8, 13.8, and 25.2 deaths, respectively, per 1,000 nondiabetic men, and 29.0, 35.4, and 45.9 deaths, respectively, per 1,000 diabetic men. The negative health effects of NIDDM are indisputable. Treatments that would alter the negative effects of NIDDM are highly desirable. Sulfonylurea drugs have been used for 35 years to treat NIDDM and the effectiveness of these drugs in preventing some of the side effects of the disease appears to be good. Gliclazide is one type of sulfonylurea that is used in many places except the United States. Studies have found it to be effective with low toxicity. The European Association for the Study of Diabetes held a conference on September 23, 1989 at which studies examining gliclazide were presented. The American Journal of Medicine presented these studies in its supplemental issue of June 24, 1991. (Consumer Summary produced by Reliance Medical Information, Inc.)

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