The US Food and Drug Administration (FDA) has approved drug label revisions for the GLP-1 agonist exenatide to incorporate information obtained from post-marketing reports of acute renal failure and insufficiency experienced by some patients taking the drug.

The FDA are also revising the prescribing information for the dipeptidyl peptidase-4 inhibitor sitagliptin (Merck and Company, New Jersey, USA) due to post-marketing reports of acute pancreatitis in a small number of patients.

The FDA received 78 reports of altered kidney function (62 cases acute renal failure, 16 cases renal insufficiency) in patients using exenatide (Amylin Pharmaceuticals Inc, San Diego, California, USA, and Eli Lily and Company, Indianapolis, Indiana, USA) between April 2005 and October 2008, which lead to the recent drug label revisions.

These patients represent a small minority, as over 6.6 million prescriptions for exenatide were dispensed in the USA during the same time period. In addition, some patients who developed kidney problems had pre-existing kidney disease or had at least one significant risk factor for kidney problems.

The drug label changes advise clinicians that exenatide should not be used in Type 2 diabetic patients with severe renal impairment (creatinine clearance below 30 ml/min) or end-stage renal disease. They also advise caution when increasing existing dose to or starting treatment of exenatide 10 mcg in patients with moderate renal impairment (creatinine clearance 30??”50 ml/min).

Finally, careful monitoring is recommended for development of renal dysfunction in Type 2 diabetic patients taking exenatide without existing kidney problems, with suggestions to consider changing to an alternative antidiabetic medication if kidney problems arise after initiating exenatide therapy.

Between October 2006 and February 2009, the FDA received 88 post-marketing reports of acute pancreatitis in Type 2 diabetes patients taking sitagliptin, with two cases of hemorrhagic or necrotizing pancreatitis.

The FDA is currently working with the manufacturer of sitagliptin and combination sitagliptin/metformin therapy to revise the prescribing information to incorporate information about possible risks for pancreatitis in patients with and without a prior history of the condition.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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Urinary albumin excretion is correlated with blood pressure (BP) and glycemic control in normoalbuminuric patients with Type 2 diabetes, a large study has demonstrated.

The finding is interesting because it suggests that albuminuria is a continuous variable that is correlated with a factor that is potentially susceptible to therapeutic intervention, explain the study authors writing in the journal Diabetologia.

Hermann Haller (Hanover Medical School, Germany) and fellow researchers used data from the ROADMAP (Randomised Olmesartan and Diabetes Microalbuminuria Prevention) study to investigate correlates of urinary albumin excretion in normoalbuminuric patients with diabetes. “This may be important because even within the normoalbuminuric range, higher rates of albuminuria are known to be associated with higher renal and cardiovascular risk,” they explain.

The ROADMAP study is a randomized, double-blind, placebo-controlled, phase III study being conducted in 19 European countries. The study population comprises 4449 White adults aged 18??”75 years with Type 2 diabetes, normoalbuminuria (defined as ?35 mg [women] or ?25 mg [men] albumin/g urinary creatinine), and at least one additional cardiovascular risk factor.

Analysis of baseline data revealed that albuminuria was significantly correlated with a number of continuous variables. The strongest correlations were observed for nighttime systolic BP and glycated hemoglobin, with r_s values of 0.19 and 0.18, respectively.

Other significant correlates, with r_s values ranging from 0.16 to 0.8, were mean 24-hour systolic and diastolic BP, nighttime diastolic BP, fasting glucose, office systolic BP, estimated glomerular filtration rate, hemoglobin, triaglycerides, and pulse pressure.

Albuminuria was also significantly correlated with certain categorical variables, such as the presence of the metabolic syndrome, female gender, and use of antihypertensive therapy.

Haller and co-authors conclude: “Although observational correlations do not prove causality, in normoalbuminuric Type 2 diabetic patients the albumin excretion rate is correlated with many factors that are potentially susceptible to intervention.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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When you are looking for a suitable treatment for diabetes, you do not always need to consider drugs and prescription medications. Effective results can be achieved if other options are considered including a herbal cure for diabetes.

There has been a great deal of research surrounding diabetes over the years, due to the fact that there are a large number of sufferers the world over. Clinical studies and research have often recommended the use of a natural or a herbal cure for diabetes, rather than relying solely on drugs.

When you use medication you make yourself susceptible to many of the associated side effects. When it comes to a natural or herbal cure for diabetes, you will find that there are no side effects to worry about.

Here are some ideas to consider when you are making the decision between a natural and a herbal cure for diabetes. You will probably find that you can safely combine a few ideas to come up with a holistic treatment.

Diet plan

Developing a balanced plan in regards to your diet is a necessary step to take when treating diabetes. The foods that should be included are as follows:

? Low glycemic index

? Rich in fibre

? Small amount of protein

? Lower levels of carbohydrates

By altering your diet according to the information above, many have found that they have a reduced reliance on medications. It has also been found that correct food choices can limit the need for insulin and reduced the blood sugar levels.

What you will find as you are trying to treat diabetes is that following a good diet will help with weight loss as well as high blood pressure.

Exercise

Exercise will help to improve overall health and well being whether you suffer from diabetes or not. Keeping up with some regular activity will help to lower the bad cholesterols (LDL) in the body and will increase the good cholesterol (HDL).

You will also find that exercise can help to improve blood circulation, lower blood glucose levels, strengthen the immune system and is effective for weight management.

Herbal cure for diabetes

Herbal medicines can have a significant impact when used to treat diabetes. A herbal cure for diabetes may be achievable when using some of the following herbs:

? Garlic

? Curry leaves

? Fenugreek seeds

? Amla

? Madhuca

A good example that has worked for others involves eating 8 to 10 curry leaves a day for a minimum of 12 weeks, making sure the leaves are fresh. Some people have had a significant improvement in their diabetes condition through swallowing a garlic clove each day as well.

Due to their positive results there are many that are now considering a herbal cure for diabetes along with the lifestyle changes such as the food choices and exercise. This is the most natural way to treat diabetes without relying on medications for the rest of your life.