Can antioxidants prevent the complications of long-standing diabetes?

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It is well known that high blood sugar plays a central role in the microvascular complications of diabetes mellitus.  These complications include diabetic nephropathy (kidney disease), neuropathy (nerve dysfunction), and retinopathy (eye disease).  New information is shedding light on exactly how high levels of blood glucose may cause these complications.

The link between hyperglycemia (high blood sugar) and diabetic complications appears to be oxidative stress.  High glucose levels are proposed to increase the amount of reactive oxygen species in several ways.  This increase in reactive oxygen species results in oxidative injury to cells and tissues.

With the understanding that oxidative stress may play a significant role in the kidney, peripheral nerve and eye disease of diabetes, investigators have begun to evaluate the potential for antioxidant therapy in diabetes.

Antioxidants are compounds which quench the injurious reactivity of reactive oxygen species.  Other treatment options may be to inhibit the enzymes which form the reactive oxygen species in the first place.

Antioxidants that have been investigated for the prevention and treatment of diabetic complications include Vitamin C, Vitamin E, alpha lipoic acid, curcumin, aldose reductase inhibitors and growth factors.  Research is able to detect a positive effect in diabetic rats, but unfortunately the therapeutic efficacy in men and women with diabetes has yet to be proven.

Medications which seem to effectively reduce the overall oxidative stress burden by working earlier on in the oxidative cascade include statins, ACE inhibitors and angiotensin receptor blockers (ARBs).  In fact, there appears to be synergistic effect when statins are taken with an ACE inhibitor or ARB.  Synergism in medicine means that the effect of one medication is increased with the addition of a second medication.

Many individuals with diabetes are placed on ACE inhibitors and angiotensin receptors blockers for hypertension.  These are the number one choice for antihypertensives in diabetic patients due to kidney protective effects.

Statins are used to control high cholesterol in patients.  Occasionally, patients without high cholesterol or known coronary heart disease, but who have a history of stroke or transient ischemic attack, are placed on statins for prevention of future strokes.

Vitamin C, Vitamin E, alpha lipoic acid, and curcumin can be obtained over the counter in most drug stores, health food stores and certain online drug stores.  Of these supplements, curcumin shows the most promise in diabetic complications and is safe when taken as directed.  Patients on warfarin or with bleeding disorders should discuss curcumin with their physicians before starting it as curcumin can increase the risk of bleeding.

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