Diabetes mellitus and related cardiovascular comorbidities are still a big challenge in Saudi Arabia, despite the advanced medical care provided to all people. Most treatment modalities concentrate more on normalizing blood glucose to controlling hyperglycemia without paying enough attention to the already formed harmful metabolites as advanced-glycation end products (AGEs) and sorbitol. Retinopathy, cataract, nephropathy, and peripheral neuropathy are seen in diabetes and are partly due to the polyol pathway that forms sorbitol from glucose. Till now, treatment of early AGEs and sorbitol effects has not received enough attention. Both AGEs and sorbitol result from hyperglycemia and cause diabetic neuropathy, angiopathy, and retinopathy. Both AGEs and sorbitol cause tissue damage through oxidative stress (formation of reactive oxygen species). Antioxidant therapy is vital to combat oxidative stress-induced tissue damage exerted by AGEs and sorbitol. Serum AGEs is higher in diabetic patients with cardiovascular disease than in those without. AGEs, content in the arterial walls collagen of diabetics, is significantly higher than that in non-diabetic patients. AGEs in renal tissues obtained from diabetic patients with end-stage renal disease are as twice as AGEs content in the tissue of diabetic patients without renal disease. AGEs levels positively correlated with increased arterial wall stiffness in diabetic patients. AGEs are found in atheromatous plaques in coronary arteries of diabetic patients. AGEs are biomarkers for the severity of coronary artery atherosclerosis in type II diabetic patients. Antioxidant medicinal nutrition derived from prophetic medicine, e.g., Nigella sativa, oral honey, olive oil, vinegar, and barely, proved effective in combating oxidative stress sorbitol-induced tissue damage, AGEs formation, and AGEs effects. Such nutritional therapy proved effective in exerting tissue protection. All that is discussed in this review.
Key words: Diabetes mellitus, AGEs, sorbitol, Nigella sativa, olive oil, barley, vinegar
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