Month: March 2012

The new anti-diabetes drug GLP-1 receptor agonists

March 31, 2012 Diabetes, Drug Informatics, Pharmacology 1 comment , , ,

A GLP-1R agonist Exenatide approved by FDA.

This article comes from references available on internet. It is about a new drug called Glucagon-like Peptide-1 [GLP-1] Receptor Agonists.

So GLP-1R Agonists is analog of human glucagon-like peptide-1, and it acts as GLP-1 receptor agonist to increase insulin secretion in the presence of elevated blood glucose. Also it delays gastric emptying to decrease postprandial glucose and decreases glucagon secretion.

So what is Glucagon-like Peptide-1 [GLP-1]?

GLP-1 is one kind of native human hormones called Incretins, which is produced by the proglucagon gene in L-cells of the small intestine. GLP-1 decreases and control blood glucose by various mechanism including: [1].Liver: reduces hepatic glucose output by inhibiting glucagon release. [2]. Alpha cell: inhibits glucagon secretion. [3].CNS: promotes satiety. [4].Stomach: slows gastric emptying. [5].Beta cell: stimulates glucose-dependent insulin secretion and beta-cell differentiation and proliferation.

Thus, modulating GLP-1 levels and GLP-1 activity through administration of the native hormone, analogs, and mimetics or by inhibiting its degradation has become a major focus of investigation for treating type 2 diabetes over the past decade.

Another important thing, where can we find the receptor of GLP-1?

The receptor is found on pancreatic periductal cells and β-cells and in the kidney, heart, stomach, and brain. GLP-1 receptor (GLP-1R) knockout mice have fasting hyperglycemia and abnormal glucose tolerance but are not obese.

References:

[1].Medscape: Guideline Discusses Oral Pharmacotherapy for Type 2 Diabetes. Full reference: http://www.medscape.org/viewarticle/758426?src=cmemp
[2].Glucagon-Like Peptide 1-Based Therapies for Type 2 Diabetes: A Focus on Exenatide. Full reference: http://clinical.diabetesjournals.org/content/23/2/56.full
[3].Glucagon-Like Peptide-1 Receptor Agonists Promote Weight Loss. Full reference: http://www.medscape.org/viewarticle/757036

Guideline discusses oral pharmacotherapy for Type 2 diabetes

March 29, 2012 Diabetes, Pharmacology, Therapeutics No comments , ,

In this article the author disscuss several oral anti-diabetes drugs, including:

  • Metformin
  • Sulfonylureas
  • Meglitinides
  • Thiazolidinediones
  • Dipeptidyl Peptidase-4 [DPP-4] inhibitors
  • Glucagon-like Peptide-1 [GLP-1] Receptor Antagonists Note: According relative references I think Medscape have made a mistake. It should be Agonists instead of Antagonists.

I reviewed my pharmacology textbooks (a very old version) and found there were only four types of oral anti-diabetes drugs. They are Biguanides, Sulfonylureas, and α-glucosidase inhibitor. I searched on Medscape for the other types of oral anti-diabetes drug and what I found nothing. So I tried to serach on WebMD and Medscape for “Meglitinides” “Thiazolidinediones” “Dipeptidyl Peptidase-4 [DPP-4] inhibitors” “Glucagon-like Peptide-1 [GLP-1] Receptor Antagonists“. Note: It should be Agonists here

Oral anti-diabetes drugs.

Here is what I found on WebMD and Medscape:

Meglitinides includes Nateglinide and Repaglinide. Meglitinides works via increasing the amount of insulin produced by the pancreas. It’s similar to the way sulfonylureas works.

Thiazolidinediones includes Pioglitazone and Rosiglitazone. How dose Thiazolidinediones work is not well understood so far. But we do know that it works via improving the way cells in the body respond to insulin (or lowering insulin resistance). By the way Pioglitazone may help in the treatment of high cholesterol by reducing triglycerides and increasing high-density lipoproteins (HDL) in the blood. Rosiglitazone increases high-density lipoproteins (HDL) and slightly increases low-density lipoproteins (LDL).

Dipeptidyl Peptidase-4 [DPP-4] inhibitors includes Saxagliptin and Sitagliptin. They work via helping your body make more insulin after a meal. They also reduce blood sugar your body makes. They can make these effects by increasing and prolonging incretin hormone activity which are inactivated by DPP-4 enzyme.

PS: Incretins increase insulin release and synthesis from pancreatic beta cells and reduce glucagon secretion pancreatic alpha cells.

About Glucagon-like Peptide-1 [GLP-1] Receptor Antagonists, Note: It should be Agonists here there are some different opinions on internet. So I do not post the information about GLP-1 Receptor Antagonists. Maybe one key word was typed mistakenly. I have sent tweets to my friend for confirming. (more…)

Why Chinese patients abominate their angels

March 28, 2012 Society and Politics No comments , ,

Because by your holy cross you have redeemed the world.

Stations of Cross. Because by your holy cross you have redeemed the world.

March 23, 2012 a sunny Friday. But the bright sunshine did not drive away the darkness enviroment between Chinese physicians and patients. A young intern phsician named Wang Hao was murdered by a 17-years age patients. Wang was trained to save others’ lifes, but he could not save the life of himself.

The  heavy news spread around quickly on the internet after Dr. Wang was murdered. Sina news, Tecent news, 163 news etc all reported and emphasized this incident. The official of China Ministry of Health stated the point that the 17-years age murder must be seriously punished.

Also other phsicians in the first affiliated hospital of Harbin Medical University cannot dissimulate their fear after Wang’s death. CCTV broadcasted a special program about this incident three days ago. The title is “Murdering physicians: probably we could be murders too.” Now this incident has become the topist hotspot in China.

Today when I was at outpatient pharmacy, I heard a middle age patient said: “The physician being killed deserved this.” I did not know where the patient came from, what was his job, or what education he had received. But I did know that the middle age patient terribly abominated physicians who cure his diseases.

There is an investigation about Wang’s death on internet. The investigation is “how do you feel about Dr. Wang’s death”. Among the 6,000 respondents, more than 4,000 chose delight about this incident. (more…)

Chinese physician murdered by a 17-years age patient

March 27, 2012 Society and Politics No comments , ,

The deceased intern Wang Hao.

It was a black Friday on March 23, 2012, at the first affiliated hospital of Harbin Medical University, about 17 pm. Four physicians of  Dept. Clinical Immunology were under attacked and one phsician died, three wounded. The murder is a Chinese young man aged 17 years.

The physician be murdered named Wang Hao, who was 28 years age. He was an intern physician in the hospital. The mortal wound on his chest by a fruite knife caused his death. According to Wang’s colleagues, he was a nice young man who was handsome, optimistic and pleased to helping others. His academic records always were A, and he won many prizes when in school.

Just before this incident Wang received the offer from the Chinese University of Hong Kong, and he was going to pursue his Ph.D study in the university.

Now the murder has been arrested, who is a 17 years age patient. The intention why he murdered Wang is that he thought the physicians did not take care of him enough. The murder is a patient who suffers both ankylosing spondylitis and tuberculosis.

As all we know, ankylosing spondylitis is a disease caused by immune system disorders, so the therapeutic strategies commonly include immunosuppressive agents such as cortisol, methotrexate and so on. But the murder also suffers tuberculosis which is a infectious disease because of the dysfunction of immune system.

So the physicans told the 17 years age child to treat tuberculosis first, after that when the tuberculosis is cure , we will start to treat the ankylosing spondylitis. What the physicians said is true and understandable and all other physicians will adopt this strategy as what Wang and his colleagues have done. But the young patient and murder did not understood this. He just believed Wang and his colleagues did not care enough about him.

So 17 pm, March 23, 2012 at the first affiliated hospital of Harbin Medical University, the young murder bought a fruite knife near the hospital then turned back to the ward of Dept. Clinical Immunology and raided Wang and other three physicians. Unfortunately, the intern physician named Wang Hao lost his life. It was a black Friday for the physicians in the first affiliated hospital of Harbin Medical University.

Chinese physicians go back on Hippocratic oath

March 27, 2012 Society and Politics No comments , ,

The symbol of Health-care: Star of Life

Life changes in a heartbeat. The life God give to us is precious and when our lifes are threaten, health-care providers or teams play a important role in saving our lifes. In China, health-care professionals always compared to angel, the emissary of God. So Chinese physicians alway are thinked to be honest and selfless.

But now, 21 century, 2012. The relationship between healt-care professionals and patients are terrible and tense. Here I can tell you that health-care providers in China are paid very very low compared to United States. The Chinese government is rich, but they pay very very low money to health-care system and professionals.

So what do physicians do under this situation? They find a way called “Paying the doctors via the medication”. For example, a Chinese physican’s wage is 10,000 RMB, about 5,000+ RMB comes from medical representative. How? If the physician prescribe a agent, the medical representative give 0.5 or 1 RMB to the physician as a reward. Of course this is not allowed by Chinese government and society. But the fact is that it is real, but not public, just in secret. So the physicians alway prescribe a lot of medications which are not necessary to the diseases status and patients. The more they prescribe, the more reward they get. So physicians in China is paid low by the government, so they have to get money via other ways. The main way is the reward from medical representative.

The Oath of Louis Lasagna, a modern version of the Hippocratic Oath.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.