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Ma Y, Wu Y, Wang X, Gao G, Zhou X. Research Progress of Near-Infrared Fluorescent Probes Based on 1,3-Dichloro-7-hydroxy-9,9-dimethyl-2(9 H)-acridone (DDAO). CHINESE J ORG CHEM 2023. [DOI: 10.6023/cjoc202206044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Srivastava SP, Goodwin JE, Tripathi P, Kanasaki K, Koya D. Interactions among Long Non-Coding RNAs and microRNAs Influence Disease Phenotype in Diabetes and Diabetic Kidney Disease. Int J Mol Sci 2021; 22:ijms22116027. [PMID: 34199672 PMCID: PMC8199750 DOI: 10.3390/ijms22116027] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
Large-scale RNA sequencing and genome-wide profiling data revealed the identification of a heterogeneous group of noncoding RNAs, known as long noncoding RNAs (lncRNAs). These lncRNAs play central roles in health and disease processes in diabetes and cancer. The critical association between aberrant expression of lncRNAs in diabetes and diabetic kidney disease have been reported. LncRNAs regulate diverse targets and can function as sponges for regulatory microRNAs, which influence disease phenotype in the kidneys. Importantly, lncRNAs and microRNAs may regulate bidirectional or crosstalk mechanisms, which need to be further investigated. These studies offer the novel possibility that lncRNAs may be used as potential therapeutic targets for diabetes and diabetic kidney diseases. Here, we discuss the functions and mechanisms of actions of lncRNAs, and their crosstalk interactions with microRNAs, which provide insight and promise as therapeutic targets, emphasizing their role in the pathogenesis of diabetes and diabetic kidney disease.
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Affiliation(s)
- Swayam Prakash Srivastava
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06511, USA;
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06511, USA
- Correspondence: or (S.P.S.); (D.K.)
| | - Julie E. Goodwin
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06511, USA;
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Pratima Tripathi
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, India;
| | - Keizo Kanasaki
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo 693-0021, Japan;
| | - Daisuke Koya
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Correspondence: or (S.P.S.); (D.K.)
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Dutta Choudhury S, Pal H. Supramolecular and suprabiomolecular photochemistry: a perspective overview. Phys Chem Chem Phys 2021; 22:23433-23463. [PMID: 33112299 DOI: 10.1039/d0cp03981k] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this perspective review article, we have attempted to bring out the important current trends of research in the areas of supramolecular and suprabiomolecular photochemistry. Since the spans of the subject areas are very vast, it is impossible to cover all the aspects within the limited space of this review article. Nevertheless, efforts have been made to assimilate the basic understanding of how supramolecular interactions can significantly change the photophysical and other related physiochemical properties of chromophoric dyes and drugs, which have enormous academic and practical implications. We have discussed with reference to relevant chemical systems where supramolecularly assisted modulations in the properties of chromophoric dyes and drugs can be used or have already been used in different areas like sensing, dye/drug stabilization, drug delivery, functional materials, and aqueous dye laser systems. In supramolecular assemblies, along with their conventional photophysical properties, the acid-base properties of prototropic dyes, as well as the excited state prototautomerization and related proton transfer behavior of proton donor/acceptor dye molecules, are also largely modulated due to supramolecular interactions, which are often reflected very explicitly through changes in their absorption and fluorescence characteristics, providing us many useful insights into these chemical systems and bringing out intriguing applications of such changes in different applied areas. Another interesting research area in supramolecular photochemistry is the excitation energy transfer from the donor to acceptor moieties in self-assembled systems which have immense importance in light harvesting applications, mimicking natural photosynthetic systems. In this review article, we have discussed varieties of these aspects, highlighting their academic and applied implications. We have tried to emphasize the progress made so far and thus to bring out future research perspectives in the subject areas concerned, which are anticipated to find many useful applications in areas like sensors, catalysis, electronic devices, pharmaceuticals, drug formulations, nanomedicine, light harvesting, and smart materials.
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Affiliation(s)
- Sharmistha Dutta Choudhury
- Radiation & Photochemistry Division, Bhabha Atomic Research Centre, Mumbai-400085, India. and Homi Bhabha National Institute, Anushaktinagar, Trombay, Mumbai-400094, India
| | - Haridas Pal
- Homi Bhabha National Institute, Anushaktinagar, Trombay, Mumbai-400094, India and Analytical Chemistry Division, Bhabha Atomic Research Centre, Mumbai-400085, India.
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Abstract
BACKGROUND In 2014, the total prevalence of diabetes was estimated to be 422 million people worldwide. Due to the aging population and continued increase in obesity rates, the prevalence is expected to rise to 592 million by 2035. Diabetes can lead to several complications, including cardiovascular disease, stroke, peripheral arterial disease, nephropathy, neuropathy, retinopathy, lower extremity amputation, and musculoskeletal impairments. CLINICAL QUESTION Up to 80% of patients referred for outpatient physical therapy have diabetes or are at risk for diabetes, providing an opportunity for physical therapists to intervene. Therefore, we asked, "What is the role of physical therapists in fighting the diabetes epidemic?" KEY RESULTS Physical therapists commonly prescribe physical activity for the treatment of diabetes and other chronic diseases, such as cardiovascular disease and osteoarthritis. Physical therapists may also screen for risk factors for diabetes and diabetes-related complications and modify traditional musculoskeletal exercise prescription accordingly. Physical therapists must advocate for regular physical activity as a key component of the treatment of chronic diseases in all patient interactions. CLINICAL APPLICATION This commentary (1) describes the diabetes epidemic and the health impact of diabetes and diabetes-related complications, (2) highlights the physical therapist's role as front-line provider, and (3) provides recommendations for physical therapists in screening for diabetes risk factors and diabetes-related complications and considerations for patient management. We focus on type 2 diabetes. J Orthop Sports Phys Ther 2020;50(1):5-16. Epub 28 Nov 2019. doi:10.2519/jospt.2020.9154.
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Blockade of the Adenosine A 3 Receptor Attenuates Caspase 1 Activation in Renal Tubule Epithelial Cells and Decreases Interleukins IL-1β and IL-18 in Diabetic Rats. Int J Mol Sci 2019; 20:ijms20184531. [PMID: 31540220 PMCID: PMC6770662 DOI: 10.3390/ijms20184531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/10/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
Diabetic nephropathy (DN) is the main cause of end-stage renal disease, which remains incurable. The progression of DN is associated with progressive and irreversible renal fibrosis and also high levels of adenosine. Our aim was to evaluate the effects of ADORA3 antagonism on renal injury in streptozotocin-induced diabetic rats. An ADORA3 antagonist that was administered in diabetic rats greatly inhibited the levels of inflammatory interleukins IL-1β and IL-18, meanwhile when adenosine deaminase was administered, there was a non-selective attenuation of the inflammatory mediators IL-1β, IL-18, IL-6, and induction of IL-10. The ADORA3 antagonist attenuated the high glucose-induced activation of caspase 1 in HK2 cells in vitro. Additionally, ADORA3 antagonisms blocked the increase in caspase 1 and the nuclear localization of NFκB in the renal tubular epithelium of diabetic rats, both events that are involved in regulating the production and activation of IL-1β and IL-18. The effects of the A3 receptor antagonist resulted in the attenuation of kidney injury, as evidenced by decreased levels of the pro-fibrotic marker α-SMA at histological levels and the restoration of proteinuria in diabetic rats. We conclude that ADORA3 antagonism represents a potential therapeutic target that mechanistically works through the selective blockade of the NLRP3 inflammasome.
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Chakraborty G, Ray AK, Singh PK, Pal H. A highly fluorescent turn-on probe in the near-infrared region for albumin quantification in serum matrix. Chem Commun (Camb) 2018; 54:8383-8386. [DOI: 10.1039/c8cc05058a] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A commercially available styryl based fluorophore in the near-IR region shows exceptional turn-on emission for serum albumins.
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Affiliation(s)
- Goutam Chakraborty
- Laser & Plasma Technology Division
- Bhabha Atomic Research Centre
- Mumbai 400085
- India
- Homi Bhabha National Institute
| | - Alok K. Ray
- Laser & Plasma Technology Division
- Bhabha Atomic Research Centre
- Mumbai 400085
- India
- Homi Bhabha National Institute
| | - Prabhat K. Singh
- Homi Bhabha National Institute
- Training School Complex
- Anushaktinagar
- Mumbai 400094
- India
| | - Haridas Pal
- Homi Bhabha National Institute
- Training School Complex
- Anushaktinagar
- Mumbai 400094
- India
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Chen J, Ren J, Loo WTY, Hao L, Wang M. Lysyl oxidases expression and histopathological changes of the diabetic rat nephron. Mol Med Rep 2017; 17:2431-2441. [PMID: 29207131 PMCID: PMC5783488 DOI: 10.3892/mmr.2017.8182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/06/2017] [Indexed: 02/05/2023] Open
Abstract
Diabetic nephropathy (DN) is a major complication of diabetes, the accumulation of extracellular matrix (ECM) is considered an indication of nephropathological changes. Lysyl oxidases (LOXs) are also associated with ECM. However, the majority of studies on LOXs have focused on their potential role in renal fibrogenesis and there has no examination of LOXs expression or the correlation with histopathological changes of DN, including glomerular basement membrane (GBM) thickening and glomerulosclerosis. In this study, the association between histological changes and LOXs was explored using a type 2 diabetes model of male Zucker diabetic fatty rats. The expression of LOX and lysyl oxidase-like 1 to 3 (LOXL1 to 3) levels were evaluated by immunohistochemical staining. The expression levels of LOX and LOXL2 in the kidney tissue in the diabetic group were significantly higher compared with those of the control group, but LOXL1 and LOXL3 expression levels were not significantly different between the two groups. These results indicated that LOXL2 and LOX may be critical factors involved in the progression of DN.
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Affiliation(s)
- Jun Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jie Ren
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Wings T Y Loo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong 999077, P.R. China
| | - Liang Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Min Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Jin Q, Feng L, Zhang SJ, Wang DD, Wang FJ, Zhang Y, Cui JN, Guo WZ, Ge GB, Yang L. Real-Time Tracking the Synthesis and Degradation of Albumin in Complex Biological Systems with a near-Infrared Fluorescent Probe. Anal Chem 2017; 89:9884-9891. [PMID: 28809472 DOI: 10.1021/acs.analchem.7b01975] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Qiang Jin
- Department
of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
- Institute
of Interdisciplinary Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201213, China
- Dalian
Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China
- Key Laboratory
of Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation
of Henan Province, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001, China
| | - Lei Feng
- State
Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian, 116024, China
- College
of Pharmacy, Academy of Integrative Medicine, Dalian Medical University, Dalian 116044, China
| | - Shui-Jun Zhang
- Department
of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
- Key Laboratory
of Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation
of Henan Province, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001, China
| | - Dan-Dan Wang
- Institute
of Interdisciplinary Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201213, China
| | - Fang-Jun Wang
- Dalian
Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China
| | - Yi Zhang
- Department
of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Jing-Nan Cui
- State
Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian, 116024, China
| | - Wen-Zhi Guo
- Department
of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Guang-Bo Ge
- Institute
of Interdisciplinary Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201213, China
- Dalian
Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China
| | - Ling Yang
- Institute
of Interdisciplinary Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201213, China
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Omar MS, Khudada K, Safarini S, Mehanna S, Nafach J. DiabCare survey of diabetes management and complications in the Gulf countries. Indian J Endocrinol Metab 2016; 20:219-227. [PMID: 27042419 PMCID: PMC4792024 DOI: 10.4103/2230-8210.176347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To describe the status of diabetes control and complications, and the quality of diabetes management in Saudi Arabia, Kuwait, and the United Arab Emirates, and to obtain an insight into the relationship between these factors. METHODS Patients with diabetes for>12 months were enrolled from specialist clinics and general hospitals. All available data from the patients' medical files including patient demographics; glycemic, lipid, and blood pressure status; diabetes-related complications; and diabetes management were recorded in data collection forms and analyzed. RESULTS Overall, 1290 patients with diabetes were enrolled with a mean (±standard deviation) age of 49.4 ± 12.3 years and duration of diabetes of 8.7 ± 5.9 years. Glycemic control was poor: Mean glycated hemoglobin A1c of 8.3 ± 2.0%, fasting and postprandial plasma glucose levels of 155.9 ± 57.1 mg/dL (8.7 ± 3.2 mmol/L), and 218.2 ± 87.4 mg/dL (12.1 ± 4.9 mmol/L), respectively. Diabetes-related complications such as neuropathy (34.9% of patients), background retinopathy (29.9%), and cataract (14.1%) were common. Cardiovascular complications were reported in <10% of patients, and microalbuminuria was detected in 34.4% of patients. Oral antidiabetic drug (OAD) monotherapy (43.3%) was the most common treatment, followed by insulin + OADs (39.3%) and insulin monotherapy (17.6%). CONCLUSION The status of diabetes care was found to be suboptimal. Further improvements in diabetes management are necessary to prevent or delay the development of diabetes-related complications.
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Affiliation(s)
| | - Khaled Khudada
- Department of Internal Medicine, Ahmadi Hospital, Kuwait Oil Company, Al Ahmadi, Kuwait
| | - Saher Safarini
- Department of Endocrinology and Metabolic Diseases, Dallah Hospital, Riyadh, Saudi Arabia
| | | | - Jalal Nafach
- Department of Endocrinology, Dubai Diabetes Center, Dubai, United Arab Emirates
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Mácsai E, Cseh A, Budai G, Mészáros G, Vásárhelyi B, Fischer K, Szabó A, Treszl A. Effect of 3 months of doxazosin therapy on T-cell subsets in type 2 diabetic patients. J Int Med Res 2010; 37:1982-7. [PMID: 20146898 DOI: 10.1177/147323000903700636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Doxazosin, an alpha(1)-adrenergic receptor inhibitor, is commonly administered to patients with type 2 diabetes, hypertension and nephropathy. The impact of 3 months' doxazosin therapy on the prevalence of activated and regulatory T lymphocytes was analysed in this pilot study of men with type 2 diabetes (n = 10) who received doxazosin 4 mg/day in addition to their ongoing therapy. The prevalence of CD4(+), CD8(+), CD25(+) and CD69(+) cells at baseline and after 3 months of add-on therapy was determined. The prevalence of regulatory T-cells was detected by two different approaches: forkhead box P3 (FoxP3) positivity; and the number of CD4(+)CD25(+high) cells. During 3 months of doxazosin therapy, patients' blood pressure, blood glucose control and lipid profiles all significantly improved. Simultaneously, the prevalence of activated T-cells (CD4(+)CD69(+) and CD8(+)CD69(+) cells) decreased, whereas that of regulatory T-cells increased. These results indicate an immunomodulatory action of doxazosin in type 2 diabetic patients.
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Affiliation(s)
- E Mácsai
- Department of Internal Medicine, Csolnoky Hospital, Veszprém, Hungary
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Abstract
Hypertension can be detected very often in patients with diabetes mellitus. In some cases, hypertension develops as a consequence of diabetic nephropathy. Although diabetic nephropathy may occur both in type 1 and in type 2 diabetes, some differences can be observed in the clinical picture according to the type of diabetes. In the majority of patients with type 2 diabetes or prediabetes, the pathomechanism of hypertension can be explained by the concept of the metabolic syndrome. In order to avoid or decrease target organ damage, the goal of antihypertensive treatment in diabetes mellitus is to be set at <130/80 mmHg. The initial antihypertensive therapy is usually based on the evaluation of the global cardiovascular risk. Apart from modifying nutrition and lifestyle, pharmacological treatment with combination of antihypertensive drugs is generally required in order to achieve treatment goal. Diabetic or antidiabetic properties of antihypertensive drugs and antihypertensive characteristics of some antidiabetic drugs should be considered in the everyday clinical practice.
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Affiliation(s)
- György Jermendy
- Fovárosi Bajcsy-Zsilinszky Kórház III. Belgyógyászati Osztály Budapest Maglódi út 89-91. 1106.
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Cortinovis M, Cattaneo D, Perico N, Remuzzi G. Investigational drugs for diabetic nephropathy. Expert Opin Investig Drugs 2008; 17:1487-500. [PMID: 18808309 DOI: 10.1517/13543784.17.10.1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Diabetic nephropathy is one of the main causes of end-stage renal disease (ESRD) and is associated with elevated cardiovascular morbidity and mortality. OBJECTIVE Current renoprotective treatments for diabetic nephropathy include strict glycemic and optimal blood pressure control, proteinuria/albuminuria reduction and the use of renin-angiotensin-aldosterone system (RAAS) blocking agents. However, the renoprotection provided by these treatments is only partial, calling for more effective approaches. METHODS This review examines emerging strategies for the treatment of diabetic nephropathy, including aggressive RAAS blockade, statins, glitazones, ruboxistaurin, and other promising agents. RESULTS/CONCLUSIONS In diabetic patients with overt nephropathy, multipharmacological interventions represent a promising way to prevent progression to ESRD. Results of ongoing trials are needed to establish whether the current standard of care of diabetic nephropathy might be improved with these new strategies.
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Affiliation(s)
- Monica Cortinovis
- Mario Negri Institute for Pharmacological Research, Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Via Gavazzeni 11, 24125 Bergamo, Italy.
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Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther 2008; 88:1254-64. [PMID: 18801858 PMCID: PMC3870323 DOI: 10.2522/ptj.20080020] [Citation(s) in RCA: 871] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 05/16/2008] [Indexed: 02/07/2023]
Abstract
UNLABELLED In 2005, it was estimated that more than 20 million people in the United States had diabetes. Approximately 30% of these people had undiagnosed cases. Increased risk for diabetes is primarily associated with age, ethnicity, family history of diabetes, smoking, obesity, and physical inactivity. Diabetes-related complications--including cardiovascular disease, kidney disease, neuropathy, blindness, and lower-extremity amputation--are a significant cause of increased morbidity and mortality among people with diabetes, and result in a heavy economic burden on the US health care system. With advances in treatment for diabetes and its associated complications, people with diabetes are living longer with their condition. This longer life span will contribute to further increases in the morbidity associated with diabetes, primarily in elderly people and in minority racial or ethnic groups. In 2050, the number of people in the United States with diagnosed diabetes is estimated to grow to 48.3 million. RESULTS from randomized controlled trials provide evidence that intensive lifestyle interventions can prevent or delay the onset of diabetes in high-risk individuals. In addition, adequate and sustained control of blood sugar levels, blood pressure, and blood lipid levels can prevent or delay the onset of diabetes-related complications in people with diabetes. Effective interventions, at both the individual and population levels, are desperately needed to slow the diabetes epidemic and reduce diabetes-related complications in the United States. This report describes the current diabetes epidemic and the health and economic impact of diabetes complications on individuals and on the health care system. The report also provides suggestions by which the epidemic can be curbed.
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Affiliation(s)
- Anjali D Deshpande
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
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