Therapeutic Possibilities

Published: 2021-06-29 07:09:36
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Category: Science

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The latest therapeutic possibilities are being separated into two groups: the symptomatic and pathogenetically oriented therapy. One of the most important components of etiology based treatment is the stabilization of glycemic control. Based on safety and efficay data alpha-lipoic and benfotiamine acid should be considered as primary choices among pathogenetically oriented treatments of diabetic neuropathy. Interesting data were published about the aldose reductase inhibitor ranirestat. The symptomatic effect of antiepileptic drugs in diabetic painful neuropathy (DPN) is originated from several probable pharmacological properties. Gabapentin and Pregabalin have the largest efficacy and the most low frequency of adverse reactions among these drugs. Antidepressants also introduced for symptomatic treatment in DPN. In the last months few studies were released about the benefits of duloxetine. Mostly the combination therapy will be constantly applied in the future for the planning and treatment of DPN, the best choice could be collaborate symptomatic treatment and pathogenetically oriented.
The global stretch of diabetes mellitus is a most important contributing factor to the prediction that cardiovascular disease will become the main reason of mortality worldwide by the year 2020. (Bell 2002) Patients with diabetes display a patently augmented incidence of adverse cardiovascular events and less favourable results f after coronary interventions or from myocardial infarction. Additionally to affiliate dyslipidemia and hypertension, escalating data insinuates that damaged glycemic homeostasis has an unequivocal influence on the propagation and formation of atherosclerotic plaque. This is expected to underscore the investigation that even in the deficiency of ischemic symptoms the incidence of diabetes bestows a potential risk of clinical events similar to that pragmatic in non-diabetic survivors of myocardial infarction. As a consequence, treatment and prevention of diabetes is a main component of strategies intended to decrease cardiovascular risk (Horowitz 1993)
Clarifying the issues that support cardiovascular disease in diabetes is essential for the development of new therapeutic advances. (World Health Organization 1999) The occurrence of hypertension, hyperglycemia, and dyslipidemia, in correlation with systemic oxidative stress and inflammation, accelerates the propagation and formation of atherosclerotic plaque.(Horowitz 1993) This instigates observations from necropsy and small clinical studies that diabetes is categorized by diffuse atherosclerosis, with a preference for participation of distal segments in reasonably small vessels. However, no systematic evaluation of the pattern of associated arterial wall remodelling and coronary atherosclerosis has been achieved in a huge cohort of diabetic patients by imaging of the entire thickness of the coronary artery wall. (Wild, Roglic, Green, Sicree, King 2004)
Intravascular ultrasound (IVUS) allows evaluation of the effect of clinical characteristics on variations in coronary atheroma volume. More in recent times, IVUS has been utilized to assess the influence of medical therapies on the history of plaque progression. The present investigation conducted on the progression and extent of associated arterial wall remodelling and atherosclerosis in a larger number of diabetic patients presented with coronary artery disease whom went through serial evaluation by IVUS (Deshpande, Harris-Hayes, Shootman 2008)

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