Coadjuvants in the Diabetic Complications: Nutraceuticals and Drugs with Pleiotropic Effects

Abstract

Because diabetes mellitus (DM) is a multifactorial metabolic disease, its prevention and treatment has been a constant challenge for basic and clinical investigators focused on translating their discoveries into clinical treatment of this complex disorder. In this review, we highlight recent experimental and clinical evidences of potential coadjuvants in the management of DM, such as polyphenols (quercetin, resveratrol and silymarin), cultured probiotic microorganisms and drugs acting through direct/indirect or pleiotropic effects on glycemic control in DM. Among several options, we highlight new promising therapeutic coadjuvants, including chemical scavengers, the probiotic kefir and the phosphodiesterase 5 inhibitors, which besides the reduction of hyperglycemia and ameliorate insulin resistance, they reduce oxidative stress and improve endothelial dysfunction in the systemic vascular circulation. In the near future, experimental studies are expected to clear the intracellular pathways involving coadjuvants. The design of clinical trials may also contribute to new strategies with coadjuvants against the harmful effects of diabetic complications.

Keywords: antioxidants; diabetes; kefir; phosphodiesterase inhibitors; polyphenols; probiotic; quercetin; resveratrol; sildenafil; silymarin.

Figure 1

Schematic representation of metabolic complications of diabetes mellitus in two important target organs, and the main effects exhibited by three important coadjuvants currently under investigation with the aim of preventing and treating this complex disease. Arrows up (↑): increase; arrows down (↓): decrease.