cost versus benefit of plant extracts (pycnogenol ® ) in diabetes risk reduction
Post on 13-Jan-2016
215 Views
Preview:
TRANSCRIPT
Cost Versus Benefit of Plant Extracts Cost Versus Benefit of Plant Extracts (Pycnogenol(Pycnogenol®®) in Diabetes Risk ) in Diabetes Risk
ReductionReduction
PycnogenolPycnogenol
Standardized extract from bark of French maritime pine (Pinus maritima)
Primarily comprises of Phenolic compounds (catechin, epicatechin, and
taxifolin) Flavonoids (procyanidins and proanthocyanidins)
Mediates a number of beneficial effects in the cardiovascular system
Hypertension, diabetes, dyslipidemia Improvement of endothelial function and NO
production
Bioflavonoids (PycnogenolBioflavonoids (Pycnogenol®®))in Reduction of Hypertensionin Reduction of HypertensionDuring Treatment of DiabeticsDuring Treatment of Diabetics
to Minimize use of to Minimize use of Pharmaceutical DrugsPharmaceutical Drugs
glucose transportis impaired
glucose transportis impaired
glucosetransporter
glucosetransporter
body cellbody cell
bloo
d su
gar
leve
l [m
g/dl
]
50
100
150
200
250
bloo
d su
gar
leve
l [m
g/dl
]
50
100
150
200
250
48 type II diabetes patients (40-75 years)double-blind, placebo controlled, 12 weeks treatment
They are on medication: sulfonylurea, metformin, glitazonesbut fasting blood is still high: >140 mg/dL (120 is healthy)
Patients are medicated with ACE-inihibtorsBut patients remain borderline hypertensive(average baseline systolic blood pressure 137 mmHg)
48 type II diabetes patients (40-75 years)double-blind, placebo controlled, 12 weeks treatment
They are on medication: sulfonylurea, metformin, glitazonesbut fasting blood is still high: >140 mg/dL (120 is healthy)
Patients are medicated with ACE-inihibtorsBut patients remain borderline hypertensive(average baseline systolic blood pressure 137 mmHg)Zibadi et al., Nutr Res 28: 315-320, 2008
O
OH
OH
OHOH
OH
O
OH
OH
OHOH
OH
O
OH
OH
OHOH
OH
O
OH
OH
OHOH
OH
OHOH
O
OH
OH
OH
OHOH
O
OH
OH
OH
ConstituentsConstituents
Procyanidins:linked catechin
subunits
Procyanidins:linked catechin
subunits
Composition defined in:United States
Pharmacopoeia (28)
Composition defined in:United States
Pharmacopoeia (28)
α-glucosidase disassembles starch
PycnogenolPycnogenol®® inhibits inhibits αα-glucosidase-glucosidase
Schäfer et al., Diab Res Clin Prac 77: 41-46, 2007
Schäfer et al., Diab Res Clin Prac 77: 41-46, 2007
PycnogenolPycnogenol®® slows sugar absorption slows sugar absorptionand prolongs satietyand prolongs satiety
3 weeks200 mg a day
3 weeks100 mg a day
3 weeks50 mg a day
Blood glucose after mealsBlood glucose after meals
Fasting blood glucose in the morningFasting blood glucose in the morning
-3.3%-4.7%
-5.3%
Liu et al., Diabetes Care 27: 839, 2004
Zibadi et al., Nutr Res 28: 315-320, 2008
start 1 month 2 months 3 months
HbA1c %
-0.8
-0.6
-0.4
-0.2
0 1 2 3 4
Zibadi et al., Nutr Res 28: 315-320, 2008
Zibadi et al., Nutr Res 28: 315-320, 2008
-4
-3
-2
-1
0 1 2 3 4
start 1 month 2 months 3 months
PlasmaEndothelin-1pg/ml
Zibadi et al., Nutr Res 28: 315-320, 2008
Zibadi et al., Nutr Res 28: 315-320, 2008
Zibadi et al., Nutr Res 28: 315-320, 2008
start 1 month 2 months 3 monthsSerum LDL
mg/dL
-14-12-10-8-6-4-2024
1 2 3 4
Zibadi et al., Nutr Res 28: 315-320, 2008
start 1 month 2 months 3 months
Urinaryalbuminmg/L
-12-10-8-6-4-20246
1 2 3 4
Zibadi et al., Nutr Res 28: 315-320, 2008
Comparison of risk-factor reduction with Comparison of risk-factor reduction with cardiovascular risk-reducing drugs versus Pycnogenol cardiovascular risk-reducing drugs versus Pycnogenol
Improvement in:
Pycnogenol Ramipril(10-5 mg
daily)
Pravastatin(10-20 mg
daily)
Nifedipine (10 mg daily)
Aspirin(500 mg
daily)
Systolic BP
Mean total cholesterol
LDL-cholesterol
Serum endothelin-1
Platelet Reactivity
5% Decrease 200 mg
daily
7.9% 120 mg daily
19.2% 120 mg daily
20% 100 mg daily
12.7% 125 mg daily
50% Dose reduction
-
-
-
-
-
11.5%
18.0%
-
-
-
-
-
50% dose reduction
-
-
-
-
-
0.75%
Cost comparison of cardiovascular Cost comparison of cardiovascular risk-reducing drugs with Pycnogenolrisk-reducing drugs with Pycnogenol
Drug Dose (mg) Cost per Pill Yearly Cost
Pycnogenol
Ramipril
Pravastatin
Nifedipine
Aspirin
100200
10
40
20
325
$0.61$0.39
$1.67
$1.67
$2.50
$0.01
$223$142
$608
$608
$913
$4.85
Side effects for diabetes treatmentsSide effects for diabetes treatments
Pycnogenol Metformin Glipizide Repaglinide
Side effect prevalence
Side effect description
Minimal
Dizziness, nausea
Common
Abdominal pain, diarrhea
Minimal
Hypoglycemia
Minimal
Hypoglycemia
Cost-effectiveness of pycnogenol and Cost-effectiveness of pycnogenol and traditional treatments for type II diabetestraditional treatments for type II diabetes
Pycnogenol(125 mg/day)
Metformin(2,000 mg/day)
Glipizide(20 mg/day)
Repaglinide(2 mg/day)
Improvement in:
HbA1c (%)
Fasting glucose (mg/dL)
LDL level (%)
0.80
23.7
11.94
1.4
52
15
1.82
74
No effect
1.1
36.1
9.51
Cost-effectiveness of pycnogenol and Cost-effectiveness of pycnogenol and traditional treatments for type II diabetestraditional treatments for type II diabetes
Pycnogenol(125 mg/day)
Metformin(2,000 mg/day)
Glipizide(20 mg/day)
Repaglinide(2 mg/day)
Cost for each increment ofimprovement
HbA1c (cost fora reduction of 1 percentage point)
Fasting glucose (cost per mg/dL reduction)
LDL level (cost for each percent reduction)
Total yearly cost
$181
$10
$19
$226
$415
$11
$39
$582
$184
$5
N/A
$336
$844
$26
$98
$929
The total economic cost of diabetes in The total economic cost of diabetes in 2007 for the USA was 147 billion dollars, 2007 for the USA was 147 billion dollars, excluding the losses in quality of life. Per excluding the losses in quality of life. Per capita annual cost of health care for people capita annual cost of health care for people with diabetes was $11,744. Globally, with diabetes was $11,744. Globally, direct health care costs of diabetes range direct health care costs of diabetes range from 2.5% to 15% of annual health care from 2.5% to 15% of annual health care budgets. The significant costs of poorly budgets. The significant costs of poorly controlled diabetes clearly place a strain on controlled diabetes clearly place a strain on individuals and communities.individuals and communities.
Pycnogenol shows promise as a Pycnogenol shows promise as a supplement to traditional diabetes supplement to traditional diabetes treatments and is competitively treatments and is competitively cost-effective as compared to the cost-effective as compared to the pharmaceutical regimen. pharmaceutical regimen.
The cost and prevalence of diabetes continues The cost and prevalence of diabetes continues to increase, which makes a cost-effective to increase, which makes a cost-effective supplement like Pycnogenol very promising as supplement like Pycnogenol very promising as a mediator of this cost and should be a mediator of this cost and should be considered as a supplement for type II considered as a supplement for type II diabetics after considering the potential diabetics after considering the potential benefits.benefits.
Due to the relative cost-effectiveness of Due to the relative cost-effectiveness of Pycnogenol, supplementation should be Pycnogenol, supplementation should be beneficial for patients at risk for CVD who are beneficial for patients at risk for CVD who are maxed out on the traditional treatment but still maxed out on the traditional treatment but still exhibit uncontrolled risk factors.exhibit uncontrolled risk factors.
While CVD remains the leading cause of While CVD remains the leading cause of death in the USA, innovative and effective death in the USA, innovative and effective therapies are necessary, and Pycnogenol therapies are necessary, and Pycnogenol offers a potential cost-effective treatment that offers a potential cost-effective treatment that may help reduce the prevalence may help reduce the prevalence of CVD.of CVD.
top related