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From Texas, USA:

Is there any documentation on the use of antioxidants, i.e. pycnogenol, alpha lipoic acid, and/or grape seed extract or other nutritional items to improve diabetic blood sugar control and delay or prevent diabetic complications? An article, "Advanced Glycosylation Endproducts (AGE)" in Diabetes Self-Management, March/April 1997 pp 6-10, says that diabetic complications are possibly caused by AGE. These irreversible AGE and associated crosslinks are created by oxidation, the article says. Can antioxidants play a role in minimizing these AGE or the creation of these AGE?


I am not aware of any trial assessing the influence of antioxidants and metabolic control. Products of advanced protein glycosylation (advanced glycation end products, or AGEs) accumulate in tissues of diabetes patients (as well in normal subjects although at much lower rate given the small fluctuations of blood sugar over time) as a function of time and average blood sugar concentration. AGEs can induce permanent abnormalities in extracellular matrix component function, stimulate cytokine and reactive oxygen species (free radicals) production trough AGE-specific receptors and modify intracellular proteins. They seem to play a pivotal role in the pathogenesis of diabetic complications and they may also figure prominently in the pathogenesis of age-related disorders affecting connective tissue, lens, blood vessels and nerves (for example, recent reports provide evidence that AGE may be involved in the development of Alzheimer's disease).

Pharmacological inhibition of AGE formation with antioxidants is possible although so far I am aware only of the use of the pharmacologic agent called aminoguanidine in long-term diabetic animals, where it seems to prevent diabetic retinopathy, nephropathy, neuropathy, and arterial abnormalities in these animal models. Clinical trials in humans are currently in progress.


Original posting 26 Sep 97


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