Metabolic Memory and Implications for Treatment of Diabetes in Africa

Abstract

Metabolic memory is a new concept derived from the observations made in the post-trial monitoring of the UKPDS and DCCT/EDIC studies and suggests lasting effects of intensive treatment beyond the trial periods among previous subjects. One of the most attractive mechanisms underlying this concept is oxidative stress suggested as the unifying hypothesis for the four pathways implicated in the development of diabetic complications i.e., polyol pathway, increased advanced glycation end-products, activation of protein kinase C and increased hexosaminase pathway flux. Essentially it is thought that mitochondrial AGE formation is an irreversible process which explains the sustained nature of metabolic memory. A major implication for clinical practice is that poor glycaemic control in the early years of diabetes will most probably lead to increased onset and severity of complications even if good control is achieved in later years. Therefore management of diabetes should be started early, aggressive and multi-pronged approach to address all Co-morbidities