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Christofides EA, Stankiewicz A, Denham D, Bellido D, Franek E, Nakhle S, Łukaszewicz M, Reed J, Cózar-León V, Kosch C, Karaś P, Fitz-Patrick D, Handelsman Y, Warren M, Hollander P, Huffman D, Raskin P, Oroszlán T, Lillestol M, Ovalle F. Immunogenicity, Efficacy, and Safety of Biosimilar Insulin Glargine (Gan & Lee Glargine) Compared With Originator Insulin Glargine (Lantus) in Patients With Type 1 Diabetes After 26 Weeks Treatment. Endocr Pract 2024; 30:810-816. [PMID: 38876181 DOI: 10.1016/j.eprac.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/14/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To compare the immunogenicity, safety, and efficacy of Gan & Lee insulin glargine (GL Glargine) with that of the originator insulin glargine (Lantus) in patients with type 1 diabetes mellitus (T1DM). METHODS This was a phase 3, multicenter, randomized, open-label, equivalence study. Five hundred seventy-six subjects with T1DM were randomized 1:1 to receive either GL Glargine or Lantus treatment for 26 weeks. The primary end point was the percentage of subjects in each treatment group who developed treatment-induced anti-insulin antibody after baseline and up to visit week 26, which was evaluated using a country-adjusted logistic regression model. The study also compared the changes in glycated hemoglobin, and adverse events including hypoglycemia. RESULTS The percentage of subjects positive for treatment-induced anti-insulin antibody by Week 26 was 25.8% in the GL Glargine treatment group and 25.3% in the Lantus treatment group, with a 90% confidence interval (-5.4, 6.5) of the difference in proportions that fell completely between the similarity margins (-11.3, 11.3). The least squares mean difference between treatment groups for changes in glycated hemoglobin was -0.08 (90% confidence interval: -0.23, 0.06), and the other immunogenicity and safety profiles were comparable. CONCLUSION GL Glargine demonstrated similar immunogenicity, efficacy, and safety compared to Lantus over 26 weeks in patients with T1DM.
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Affiliation(s)
| | - Andrzej Stankiewicz
- NZOZ Medyczne Centrum Diabetologiczno-Endokrynologiczno-Metaboliczne "Diab-Endo-Met", Kraków, Poland
| | | | - Diego Bellido
- Complejo Hospitalario Universitario de Ferrol, Servicio Endocrinología y Nutricion, Ferrol, Spain
| | - Edward Franek
- Centralny Szpital Kliniczny Ministerstwa Spraw Wewnętrznych i Administracji w Warszawie, Centrum Diabetologiczne, Klinika Endokrynologii i Diabetologii, Warszawa, Poland
| | | | | | - John Reed
- Endocrine Research Solutions, Roswell
| | - Victoria Cózar-León
- Hospital Universitario Nuestra Señora de Valme, Universidad de Sevilla, Servicio de Endocrinología y Nutrición, Sevilla, Spain
| | | | - Piotr Karaś
- KO-MED Centra Kliniczne Lublin, Lublin, Poland
| | | | | | - Mark Warren
- Physicians East - Greenville, Endocrinology and Metabolism, Greenville
| | | | - David Huffman
- University Diabetes & Endocrine Consultants, Chattanooga
| | - Philip Raskin
- Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas
| | | | | | - Fernando Ovalle
- Department of Medicine, University of Alabama at Birmingham, Birmingham
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Lu X, Xie L, Zhao W, Zhang C, Luo X, Zhou Y. Prediction of Hypoglycemia in Diabetic Patients During Colonoscopy Preparation. Exp Clin Endocrinol Diabetes 2023; 131:274-281. [PMID: 37186280 DOI: 10.1055/a-2044-0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To explore the clinical outcomes and establish a predictive model of hypoglycemia during colonoscopy preparation for diabetic patients. METHODS Three-hundred ninety-four patients with diabetes who received colonoscopy were retrospectively enrolled in this study and assigned to hypoglycemia or non-hypoglycemia groups. Information about clinical characteristics and outcomes during colonoscopy preparation was collected and compared between the two groups. Logistic regression analysis was applied to identify the risk factors of hypoglycemia. These risk factors were used to construct a hypoglycemia predictive model verified by the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness fit test. RESULTS Among 394 participants, 66 (16.8%) underwent a total of 88 hypoglycemia attacks during the bowel preparation. Grade 1 hypoglycemia (≤3.9 mmol/L) comprised 90.9% (80/88) of all hypoglycemia attacks and grade 2 hypoglycemia accounted for 9.1% (8/88), signifying that grade 1 hypoglycemia is the most common type. No severe hypoglycemia was identified. The incidence of nocturnal hypoglycemia was 15.9%. Logistic regression analyses revealed that the main risk factors of hypoglycemia during colonoscopy preparation were postprandial C-peptide, serum triglyceride, gender, type of diabetes mellitus, and insulin injection frequencies. The area under the ROC curve of the hypoglycemia prediction model was 0.777 (95% CI: 0.720-0.833). CONCLUSION Diabetic patients are prone to develop mild to moderate hypoglycemia during colonoscopy preparation. This study proposes a predictive model that could provide a reference for identifying patients with a high risk of hypoglycemia during colonoscopy preparation.
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Affiliation(s)
- Xiaohua Lu
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lingqiao Xie
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wane Zhao
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chuangbiao Zhang
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xixi Luo
- Department of Endocrinology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yan Zhou
- Department of Interventional Radiology & Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Guo C, Deshpande M, Niu Y, Kachwala I, Flores-Bellver M, Megarity H, Nuse T, Babapoor-Farrokhran S, Ramada M, Sanchez J, Inamdar N, Johnson TV, Canto-Soler MV, Montaner S, Sodhi A. HIF-1α accumulation in response to transient hypoglycemia may worsen diabetic eye disease. Cell Rep 2023; 42:111976. [PMID: 36640318 PMCID: PMC9960808 DOI: 10.1016/j.celrep.2022.111976] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/16/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Tight glycemic control (TGC), the cornerstone of diabetic management, reduces the incidence and progression of diabetic microvascular disease. However, TGC can also lead to transient episodes of hypoglycemia, which have been associated with adverse outcomes in patients with diabetes. Here, we demonstrate that low glucose levels result in hypoxia-inducible factor (HIF)-1-dependent expression of the glucose transporter, Glut1, in retinal cells. Enhanced nuclear accumulation of HIF-1α was independent of its canonical post-translational stabilization but instead dependent on stimulation of its translation and nuclear localization. In the presence of hypoxia, this physiologic response to low glucose resulted in a marked increase in the secretion of the HIF-dependent vasoactive mediators that promote diabetic retinopathy. Our results provide a molecular explanation for how early glucose control, as well as glycemic variability (i.e., oscillating serum glucose levels), contributes to diabetic eye disease. These observations have important implications for optimizing glucose management in patients with diabetes.
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Affiliation(s)
- Chuanyu Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Monika Deshpande
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Yueqi Niu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Isha Kachwala
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Miguel Flores-Bellver
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Haley Megarity
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Taylor Nuse
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | - Michael Ramada
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jaron Sanchez
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Neelay Inamdar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Thomas V Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Maria Valeria Canto-Soler
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Silvia Montaner
- Department of Oncology and Diagnostic Sciences, School of Dentistry, Greenebaum Cancer Center, University of Maryland, Baltimore, MD 21201, USA
| | - Akrit Sodhi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Sanchez-Rangel E, Deajon-Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes. Ann N Y Acad Sci 2022; 1518:25-46. [PMID: 36202764 DOI: 10.1111/nyas.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the century since the discovery of insulin, diabetes has changed from an early death sentence to a manageable chronic disease. This change in longevity and duration of diabetes coupled with significant advances in therapeutic options for patients has fundamentally changed the landscape of diabetes management, particularly in patients with type 1 diabetes mellitus. However, hypoglycemia remains a major barrier to achieving optimal glycemic control. Current understanding of the mechanisms of hypoglycemia has expanded to include not only counter-regulatory hormonal responses but also direct changes in brain glucose, fuel sensing, and utilization, as well as changes in neural networks that modulate behavior, mood, and cognition. Different strategies to prevent and treat hypoglycemia have been developed, including educational strategies, new insulin formulations, delivery devices, novel technologies, and pharmacologic targets. This review article will discuss current literature contributing to our understanding of the myriad of factors that lead to the development of clinically meaningful hypoglycemia and review established and novel therapies for the prevention and treatment of hypoglycemia.
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Affiliation(s)
- Elizabeth Sanchez-Rangel
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jelani Deajon-Jackson
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janice Jin Hwang
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.,Division of Endocrinology, Department of Internal Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
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5
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He I, Smart G, Poirier BF, Sethi S, Jensen ED. An update on dental caries in children with type 1 diabetes mellitus. PEDIATRIC DENTAL JOURNAL 2022. [DOI: 10.1016/j.pdj.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Lijing W, Sujie K, Linxi W, Lishan H, Liqin Q, Zhidong Z, Kejun W, Mengjun Z, Xiaoying L, Xiaohong L, Libin L. Altered Caffeine Metabolism Is Associated With Recurrent Hypoglycemia in Type 2 Diabetes Mellitus: A UPLC-MS-Based Untargeted Metabolomics Study. Front Endocrinol (Lausanne) 2022; 13:843556. [PMID: 35784552 PMCID: PMC9248032 DOI: 10.3389/fendo.2022.843556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Recurrent hypoglycemia (RH) is well known to impair awareness of hypoglycemia and increase the risk of severe hypoglycemia; the underlying mechanism requires further understanding. We aimed to investigate the metabolic characteristic profile for RH in type 2 diabetes mellitus (T2DM) patients and explore the potential metabolic mechanism and prevention strategies. Methods We screened 553 community-based T2DM patients. T2DM with RH (DH group, n=40) and T2DM without hypoglycemia (DC group, n=40) were assigned in the case-control study, matched by propensity score matching. Non-targeted, global metabolite profiling was conducted using ultra-high performance liquid chromatography-mass spectrometry. Principal component analysis and supervised projections to latent structures-discriminant analysis were constructed to evaluate the potential biomarkers. Metabolites with a fold change of >2.0 or <0.5, a t-test q-value <0.05, and variable importance in projection value of >1 were identified as significantly differential metabolites. MetaboAnalyst was performed to analyze the related metabolic pathways. Results We identified 12 significantly distinct metabolites as potential biomarkers of RH, which were enriched in five pathways; the caffeine metabolic pathway was the most dominant related one. Caffeine and its main downstream metabolites (theophylline and paraxanthine, all q <0.05) were significantly lower during RH. The combination of these metabolites can serve as a reliable predictor biomarker for RH (area under the curve = 0.88). Regarding lipid metabolism, triglyceride was upregulated (P=0.003) and the O-Acylcarnitine was downregulated (q < 0.001). Besides, RH was accompanied by lower phenylalanine (q=0.003) and higher cortisone (q=0.005) levels. Conclusions RH in T2DM is accompanied by caffeine, lipolysis, phenylalanine, and cortisone metabolism abnormalities. Caffeine might be a reliable candidate biomarker and potential prevention strategy for RH, but further validation studies are needed. Clinical Trial Registry Chi CTR 1900026361, 2019-10-3.
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Affiliation(s)
- Wang Lijing
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ke Sujie
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wang Linxi
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huang Lishan
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi Liqin
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhan Zhidong
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wu Kejun
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhang Mengjun
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Liu Xiaoying
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liu Xiaohong
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liu Libin
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
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Baloch SG, Shaikh H, Shah S, Memon S, Memon AA. Synthesis of an insulin intercalated graphene oxide nanogel composite: evaluation of its release profile and stability for oral delivery of insulin. NANOSCALE ADVANCES 2022; 4:2303-2312. [PMID: 36133704 PMCID: PMC9417858 DOI: 10.1039/d1na00887k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 06/16/2023]
Abstract
Diabetes mellitus (DM) is a disorder of glucose regulation produced due to insufficient availability of insulin. Generally, insulin is given to diabetes patients via subcutaneous injection which is a painful method to deliver this drug. In this work we have made an attempt to develop an oral drug delivery system that can efficiently deliver insulin to the small intestine. An insulin intercalated GO based nanogel composite (In@GO NgC) was fabricated for oral delivery of insulin. The in vitro release of insulin from In@GO NgC was studied in artificial gastric (pH 1.2) and intestinal (pH 7.5) fluids. The In@GO NgC produced better release in artificial intestinal fluid as compared to gastric fluid. The enzymatic degradation of released insulin was also examined and the results revealed that even after 6 h of incubation, the gel remained stable and the un-degraded insulin seemed to be sufficient for the physiological processes. The efficacy of In@GO NgC was also confirmed by comparing its release profile with non-intercalated GO NgC and nanogel (Ng) without GO. The prepared nanogels were thoroughly characterized using FTIR, SEM, EDS, DSC and DLS. The better release profile and enzymatic stability of In@GO NgC suggests that it can be utilized for oral drug delivery of insulin.
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Affiliation(s)
- Shabana Gul Baloch
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Huma Shaikh
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Shahnila Shah
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Shahabuddin Memon
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
| | - Ayaz Ali Memon
- National Centre of Excellence in Analytical Chemistry, University of Sindh Jamshoro Pakistan
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8
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Grassi B, Onetto MT, Zapata Y, Jofré P, Echeverría G. Lower versus standard sucrose dose for treating hypoglycemia in patients with type 1 diabetes mellitus in therapy with predictive low glucose suspend (PLGS) augmented insulin pumps: A randomized crossover trial in Santiago, Chile. Diabetes Metab Syndr 2021; 15:695-701. [PMID: 33813244 DOI: 10.1016/j.dsx.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Recommended hypoglycemia treatment in adults with T1D consists of 15 g of rapid absorption carbohydrates. We aimed to evaluate the response to fewer carbohydrates for treating hypoglycemia in patients with T1D on insulin pumps with predictive suspension technology (PLGS). METHODS T1D patients on insulin pumps with PLGS were randomized to receive 10 or 15 g of sucrose per hypoglycemia for two weeks (S10 and S15 groups, respectively) when capillary blood glucose (BG) was <70 mg/dL, with crossover after two weeks. Evolution of capillary BG, active insulin, and suspension time were assessed. RESULTS 59 hypoglycemic episodes were analyzed, 33 in S10 and 26 in S15. Baseline BG in S10 was 54.3 ± 7.7 mg/dL versus 56.9 ± 8.8 in S15 (p = 0,239). Active insulin, present in 85% of the episodes, and PLGS suspension time were similar between groups. BG at 15 min was 77 mg/dL in S10 and 95 mg/dL in S15 (p = 0.0007). In S10, 21% of the episodes required to repeat the treatment after 15 min compared with none on S15, with a RR of 0,79 (95% CI 0.66, 0.940, p = 0,014) for successfully treating the episode. Sensor glucose was significantly different from BG at the moment of the hypoglycemia and control 15 min after treatment. No severe hypoglycemia and no rebound hyperglycemia occurred in neither group. CONCLUSIONS A hypoglycemia treatment protocol with a lower dose of sucrose might be insufficient despite PLGS technology. Our data suggest that standard doses of sucrose should still be recommended.
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Affiliation(s)
- Bruno Grassi
- Departament of Nutrition, Diabetes and Metabolism, School of Medicine. Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - María Teresa Onetto
- Departament of Nutrition, Diabetes and Metabolism, School of Medicine. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yazmín Zapata
- Departament of Nutrition, Diabetes and Metabolism, School of Medicine. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Jofré
- Departament of Nutrition, Diabetes and Metabolism, School of Medicine. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guadalupe Echeverría
- Departament of Nutrition, Diabetes and Metabolism, School of Medicine. Pontificia Universidad Católica de Chile, Santiago, Chile; Center of Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile, Santiago, Chile
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9
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Baker B, Schaeffler B, Hirman J, Hompesch M, Pederson S, Smith J. Tolerability of eptinezumab in overweight, obese or type 1 diabetes patients. Endocrinol Diabetes Metab 2021; 4:e00217. [PMID: 33855218 PMCID: PMC8029561 DOI: 10.1002/edm2.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction In addition to its role in the pathogenesis of migraine, calcitonin gene-related peptide (CGRP) is implicated in the regulation of insulin secretion. However, there are limited data on the use of CGRP inhibitor monoclonal antibodies in individuals who are overweight/obese and those with diabetes. Methods Two randomized, double-blind, placebo-controlled trials were conducted to assess the safety and metabolic effects of eptinezumab in non-migraine overweight/obese patients (study 1) and patients with type 1 diabetes (T1D; study 2). The primary end-point in overweight/obese patients was safety and changes in basal metabolic rate (BMR), defined as the energy expenditure during the fasting and resting states. In patients with T1D, the primary end-points were safety and insulin sensitivity as assessed by the bodyweight and insulin concentration corrected glucose infusion rate (M/I). Results A total of 24 patients were enrolled in study 1, and 21 patients were enrolled in study 2. In overweight/obese patients, there was no significant difference in the least squares (LS) mean change in BMR between the eptinezumab- and placebo-treated patients from baseline to day 7 (6.4 vs -25.2 Kcal/day; LS mean difference 31.6 [95% confidence interval -90.6, 153.8]). In patients with T1D, there was no significant difference in insulin sensitivity between the eptinezumab and placebo groups. Eptinezumab was well tolerated in both studies with a similar rate of adverse events between treatment groups, and no new safety signals were identified. Conclusion Eptinezumab was well tolerated and not associated with adverse metabolic effects in patients who were overweight/obese or had T1D, providing ongoing support for the use of eptinezumab in these subgroups of patients with migraine.
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Affiliation(s)
- Brian Baker
- Lundbeck Seattle BioPharmaceuticals, Inc.BothellWAUSA
| | | | - Joe Hirman
- Pacific Northwest Statistical ConsultingWoodinvilleWAUSA
| | | | | | - Jeff Smith
- Alder BioPharmaceuticals, Inc. (now known as Lundbeck Seattle BioPharmaceuticals, Inc.)BothellWAUSA
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Continuous Glucose and Heart Rate Monitoring in Young People with Type 1 Diabetes: An Exploratory Study about Perspectives in Nocturnal Hypoglycemia Detection. Metabolites 2020; 11:metabo11010005. [PMID: 33374113 PMCID: PMC7824609 DOI: 10.3390/metabo11010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022] Open
Abstract
A combination of information from blood glucose (BG) and heart rate (HR) measurements has been proposed to investigate the HR changes related to nocturnal hypoglycemia (NH) episodes in pediatric subjects with type 1 diabetes (T1D), examining whether they could improve hypoglycemia prediction. We enrolled seventeen children and adolescents with T1D, monitored on average for 194 days. BG was detected by flash glucose monitoring devices, and HR was measured by wrist-worn fitness trackers. For each subject, we compared HR values recorded in the hour before NH episodes (before-hypoglycemia) with HR values recorded during sleep intervals without hypoglycemia (no-hypoglycemia). Furthermore, we investigated the behavior after the end of NH. Nine participants (53%) experienced at least three NH. Among these nine subjects, six (67%) showed a statistically significant difference between the before-hypoglycemia HR distribution and the no-hypoglycemia HR distribution. In all these six cases, the before-hypoglycemia HR median value was higher than the no-hypoglycemia HR median value. In almost all cases, HR values after the end of hypoglycemia remained higher compared to no-hypoglycemia sleep intervals. This exploratory study support that HR modifications occur during NH in T1D subjects. The identification of specific HR patterns can be helpful to improve NH detection and prevent fatal events.
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11
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Berget C, Lange S, Messer L, Forlenza GP. A clinical review of the t:slim X2 insulin pump. Expert Opin Drug Deliv 2020; 17:1675-1687. [PMID: 32842794 DOI: 10.1080/17425247.2020.1814734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Insulin pumps are commonly used for intensive insulin therapy to treat type 1 diabetes in adults and youth. Insulin pump technologies have advanced dramatically in the last several years to integrate with continuous glucose monitors (CGM) and incorporate control algorithms. These control algorithms automate some insulin delivery in response to the glucose information received from the CGM to reduce the occurrence of hypoglycemia and hyperglycemia and improve overall glycemic control. The t:slim X2 insulin pump system became commercially available in 2016. It is an innovative insulin pump technology that can be updated remotely by the user to install new software onto the pump device as new technologies become available. Currently, the t:slim X2 pairs with the Dexcom G6 CGM and there are two advanced software options available: Basal-IQ, which is a predictive low glucose suspend (PLGS) technology, and Control-IQ, which is a Hybrid Closed Loop (HCL) technology. This paper will describe the different types of advanced insulin pump technologies, review how the t:slim X2 insulin pump works, and summarize the clinical studies leading to FDA approval and commercialization of the Basal-IQ and Control-IQ technologies.
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Affiliation(s)
- Cari Berget
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
| | - Samantha Lange
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
| | - Laurel Messer
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
| | - Gregory P Forlenza
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
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12
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Llano A, McKay GA. Non-insulin therapies in addition to insulin in Type 1 DM treatment. Br Med Bull 2020; 134:54-62. [PMID: 32409841 DOI: 10.1093/bmb/ldaa011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Complications of Type 1 diabetes (T1DM) remain prevalent due to suboptimal glycaemic control despite advances in analogue insulin, its delivery and technological advances in glucose monitoring. Intensive insulin therapy is associated with hypoglycaemia and weight gain. Non-insulin-dependent glucose lowering strategies may provide a strategy in improving glycaemic control without hypoglycaemia and weight gain. SOURCES OF DATA Research papers and reviews about adjunctive treatment with insulin in T1DM in the published literature. AREAS OF AGREEMENT Non-insulin-dependent strategies may be beneficial inT1DM particularly when there is insulin resistance, but the evidence for benefit at the current time is limited. Although there have been trials with various drugs as adjunctive therapy to insulin in T1DM currently in the UK, there is only one sodium glucose transport protein 2 (SGLT2) inhibitor with a marketing authorization for use in this indication. AREAS OF CONTROVERSY Potential for harm with SGLT2 inhibitors in T1DM is a potential issue, particularly euglycaemic diabetic ketoacidosis. Clinical trials confirm that there is a risk albeit small, but emerging safety data have led to questions as to whether the risk of euglycaemic diabetic ketoacidosis is higher with the use of SGLT2 inhibitors in clinical practice. GROWING POINTS Patient education is paramount-the work being done in T1DM to ensure safe use of SGLT2 inhibitors may help improve safety in the prescribing of SGLT2 inhibitors in Type 2 diabetes. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need for larger clinical trials with SGLT2 inhibitors in T1DM and real world studies to clarify safety.
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Affiliation(s)
- Andrea Llano
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Gerard A McKay
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
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Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes. ACTA ACUST UNITED AC 2020; 68:47-52. [PMID: 32349942 DOI: 10.1016/j.endinu.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.
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Loganathan G, Balamurugan AN, Venugopal S. Human pancreatic tissue dissociation enzymes for islet isolation: Advances and clinical perspectives. Diabetes Metab Syndr 2020; 14:159-166. [PMID: 32088647 DOI: 10.1016/j.dsx.2020.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Successful clinical human allo or auto-islet transplantation requires the recovery of a sufficient number of functional islets from either brain-dead or chronic pancreatitis pancreases respectively. METHODS In the last two decades (2000-2019), significant progress has been made in improving the human islet isolation procedures and in standardizing the use of different tissue dissociation enzyme (TDE; a mixture of collagenase and protease enzymes) blends to recover higher islet yields. RESULTS AND CONCLUSIONS This review presents information focusing on properties and role of TDE blends during the islet isolation process, particularly emphasizing on the current developments, associated challenges and future perspectives within the field.
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Affiliation(s)
- Gopalakrishnan Loganathan
- Clinical Islet Cell Laboratory, Cardiovascular Innovation Institute, Department of Surgery, University of Louisville, Louisville, KY, USA; School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Appakalai N Balamurugan
- Clinical Islet Cell Laboratory, Cardiovascular Innovation Institute, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Subhashree Venugopal
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India.
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Berget C, Messer LH, Forlenza GP. A Clinical Overview of Insulin Pump Therapy for the Management of Diabetes: Past, Present, and Future of Intensive Therapy. Diabetes Spectr 2019; 32:194-204. [PMID: 31462873 PMCID: PMC6695255 DOI: 10.2337/ds18-0091] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IN BRIEF Insulin pump therapy is advancing rapidly. This article summarizes the variety of insulin pump technologies available to date and discusses important clinical considerations for each type of technology.
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Ersig AL. An Exploratory Study: Transition to Adulthood for College Students with Type 1 Diabetes and Their Parents. J Pediatr Nurs 2019; 46:12-17. [PMID: 30811974 DOI: 10.1016/j.pedn.2019.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/13/2019] [Accepted: 01/13/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE The transition to college and adulthood can be challenging for young adults with chronic health conditions and their parents. Few studies have simultaneously explored the experiences of college students and their parents during the transition to college. The purpose of this study was to explore the transition to adulthood for college students with type 1 diabetes (T1D) and their parents. DESIGN AND METHODS A descriptive exploratory study was conducted with college students with T1D and their parents. Data were collected online using quantitative surveys and open-ended questions. Descriptive statistics were generated for quantitative measures. Analysis of responses to open-ended questions used qualitative description. RESULTS College students (18-24 years) and parents described challenges with life-stage stress, diabetes management worries, and concern about T1D-related long-term complications. Respondents also described the critical role of the college peer network for support and help in case of crisis situations. Students reported stress related to uncertainty in diabetes management, while parents described constant worry about their child's diabetes. CONCLUSIONS Findings support the importance of assessing anticipated and current stressors of college students with T1D and other chronic health conditions and their parents during and after transition to college. PRACTICE IMPLICATIONS Nurses can support students and parents by providing anticipatory guidance about the transition to college. Assistance identifying established sources of support on college campuses, as well as planning for potential crisis situations, may help reduce stress experienced by students and parents.
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Affiliation(s)
- Anne L Ersig
- The University of Wisconsin-Madison, School of Nursing, Madison, WI, United States of America..
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18
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Mouslech Z, Somali M, Sarantis L, Christos D, Alexandra C, Maria P, Mastorakos G, Savopoulos C, Hatzitolios AI. Significant effect of group education in patients with diabetes type 1. Hormones (Athens) 2018; 17:397-403. [PMID: 30112705 DOI: 10.1007/s42000-018-0054-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) constitutes a real challenge in everyday practice for both physicians and patients. Due to the complexity of the disease and its unpredictable nature, structured education and training programs are nowadays implemented that ensure active patient involvement and self-care behaviors to achieve adequate glycemic control, prevent diabetic complications, and improve the quality of life of patients. These programs provide patients with the necessary knowledge and skills to self-monitor and self-manage the disease and its associated metabolic conditions. The aim of the study was to evaluate the effect of a structured 12-month education program that motivated patients to follow a healthy Mediterranean diet and exercise regularly as well as to adjust carbohydrate intake and insulin dose according to their needs. DESIGN The education group (EG) was comprised of 62 patients (45 males) with type 1 DM, mean age 36 ± 4.2 years and BMI 24.2 ± 3.1 kg/m2. An age- and BMI-matched control group (CG, n = 25, mean age 41 ± 6.4 years, BMI 25.7 ± 4.2 kg/m2) was composed of patients referred but not enrolled in the project. RESULTS At the end of this program, HbA1C levels were significantly decreased (8.5 ± 2.1% vs. 7.08 ± 0.79%, p < 0.0001) as was also the incidence of hypoglycemic episodes (p < 0.05). Regarding daily glucose fluctuations, significant improvement (p < 0.05) was observed, as reflected in low, high, and daily median glucose values. On the other hand, the above parameters remained stable in the CG. CONCLUSIONS These results strongly support the need for long-lasting structured education group courses for adult diabetic patients keen to change their habits in order to achieve self-management of the disease.
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Affiliation(s)
- Zadalla Mouslech
- 1st Medical Propedeutic Dept. of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, 54621, Thessaloniki, Greece
| | - Maria Somali
- Endocrinology, Metabolism and Diabetes Unit, Euromedica General Clinic, 11 Marias Kallas & 2 Gravias Streets, 54645, Thessaloniki, Greece
| | - Livadas Sarantis
- Endocrine Unit, Metropolitan Hospital, 9 Ethnarchou Makariou, 18547, Athens, Greece.
| | - Daramilas Christos
- Endocrinology, Metabolism and Diabetes Unit, Euromedica General Clinic, 11 Marias Kallas & 2 Gravias Streets, 54645, Thessaloniki, Greece
| | - Chatzi Alexandra
- Endocrine Unit, 3rd Pediatric Department, Hippokration Hospital, Aristotle University, 49 Konstantinoupoleos, 54642, Thessaloniki, Greece
| | - Papagianni Maria
- Endocrine Unit, 3rd Pediatric Department, Hippokration Hospital, Aristotle University, 49 Konstantinoupoleos, 54642, Thessaloniki, Greece
| | - George Mastorakos
- Department of Endocrinology, Metabolism and Diabetes, Aretaeio Hospital, School of Medicine, National and Kapodistrian University Athens, 76 Vas. Sofias, 11528, Athens, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Dept. of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, 54621, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- 1st Medical Propedeutic Dept. of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, 54621, Thessaloniki, Greece
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Al Khalifah RA, Alnhdi A, Alghar H, Alanazi M, Florez ID. The effect of adding metformin to insulin therapy for type 1 diabetes mellitus children: A systematic review and meta-analysis. Pediatr Diabetes 2017; 18:664-673. [PMID: 28145083 DOI: 10.1111/pedi.12493] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
Abstract
We aimed to assess the effectiveness of adding metformin to insulin in type 1 diabetes mellitus (T1DM) children for improving metabolic outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) conducted on children age 6 to 19 years who are diagnosed with T1DM, and examined the effect of adding Metformin to standard insulin therapy. We performed literature searches on Ovid Midline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from the date of inception of the database to February 15, 2016. Two reviewers screened titles and abstracts independently, assessed full text eligibility, and extracted information from eligible trials. The primary outcome is glycated hemoglobin (HbA1c), and the secondary outcomes are health-related quality of life, body mass index (BMI), lipid profile, total insulin daily dose, hypoglycaemia, and diabetes ketoacidosis. We screened 736 studies, and included 6 RCTs with 325 patients. All RCTs were of low risk of bias, and included adolescents (mean age 15 years). The meta-analysis showed that the addition of Metformin resulted in decreased total insulin daily dose (TIDD) (unit/kg/d) (mean difference [MD] = -0.15, 95%CI, -0.24, -0.06), and reduced BMI kg/m2 (MD -1.46, 95%CI -2.54, 0.38), and BMI z-score (MD= - 0.11, 95%CI -0.21, -0.01), and similar HbA1c (%) (MD= - 0.05, 95%CI, -0.19, 0.29). The overall evidence quality was high to moderate. Current evidence does not support use of Metformin in T1DM adolescents to improve HbA1c. However, Metformin may provide modest reduction in TIDD and BMI.
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Affiliation(s)
- Reem A Al Khalifah
- Department of Pediatrics, Division of Pediatric Endocrinology, King Saud University, Riyadh, Saudi Arabia
| | | | - Hassan Alghar
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alanazi
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Ivan D Florez
- Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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20
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Gómez AM, Henao Carrillo DC, Muñoz Velandia OM. Devices for continuous monitoring of glucose: update in technology. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:215-224. [PMID: 28979168 PMCID: PMC5602456 DOI: 10.2147/mder.s110121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Continuous glucose monitoring (CGM) is a tool that allows constant evaluation of glycemic control, providing data such as the trend and fluctuation of interstitial glucose levels over time. In clinical practice, there are two modalities: the professional or retrospective and the personal or real-time CGM (RT-CGM). The latest-generation sensors are more accurate and sensitive for hypoglycemia, improving adherence to self-monitoring, which has allowed optimizing glycemic control. The development of algorithms that allow the suspension of the infusion of insulin during hypoglycemia gave rise to the integrated therapy or sensor-augmented insulin pump therapy with low glucose suspend, which has proven to be an effective and safe alternative in the treatment of diabetic patients with high risk of hypoglycemia. The objective of this review is to present the evidence of the advantages of RT-CGM, the clinical impact of integrated therapy, and cost-effectiveness of its implementation in the treatment of patients with diabetes mellitus.
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Affiliation(s)
- Ana María Gómez
- Endocrinology Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Oscar Mauricio Muñoz Velandia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia.,Department of Clinical Epidemiology, Pontificia Universidad Javeriana, Faculty of Medicine, Bogotá, Colombia
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Leung W, Ho FM, Li WP, Liang YC. Vitis thunbergii var. taiwaniana Leaf Extract Reduces Blood Glucose Levels in Mice with Streptozotocin-induced Diabetes. INT J PHARMACOL 2017. [DOI: 10.3923/ijp.2017.457.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wang X, Cheng D, Liu L, Li X. Development of poly(hydroxyethyl methacrylate) nanogel for effective oral insulin delivery. Pharm Dev Technol 2017; 23:351-357. [PMID: 28655281 DOI: 10.1080/10837450.2017.1295064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Because of uncomfortable, painful and even deleterious effects of daily injection of insulin, extensive efforts are being made worldwide for developing noninvasive drug delivery systems, especially via the oral route. In this study, we synthesized hydroxyethyl methacrylate (HEMA) nanogel via emulsion polymerization method. The morphology and stability of the nanogel were characterized by scanning electronic microscope and dynamic light scattering. In vivo results showed the soft HEMA nanogel had longer half-live in the body circulation and exhibited almost negligible uptake by the macrophage cells as compared with blank cells. For the FITC-dextran tracking for intestinal penetration, the results indicated that the FITC-dextran in the soft nanogel penetrated faster from the inner side of the abdominal segment, which explained why the soft HEMA nanogel could promote intestinal absorption of encapsulated insulin. In vivo delivery of insulin encapsulated in the soft HEMA nanogel sustained blood glucose control for 12 h, and the overall bioavailability of administrated insulin was much higher than free insulin. Our results showed that the insulin-loaded HEMA nanogel was able to efficiently control blood glucose as a delivery system, suggesting the HEMA nanogel using emulsion polymerization could be an alternative carrier for oral insulin delivery.
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Affiliation(s)
- Xiaomei Wang
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
| | - Dan Cheng
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
| | - Linglin Liu
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
| | - Xuejun Li
- a Department of Geriatrics , Southwest Hospital Affiliated to the Third Military Medical University , Chongqing , China
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Al Khalifah RA, Suppère C, Haidar A, Rabasa-Lhoret R, Ladouceur M, Legault L. Association of aerobic fitness level with exercise-induced hypoglycaemia in Type 1 diabetes. Diabet Med 2016; 33:1686-1690. [PMID: 26773719 DOI: 10.1111/dme.13070] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/13/2015] [Accepted: 01/11/2016] [Indexed: 12/16/2022]
Abstract
AIM To determine the impact of physical fitness level on hypoglycaemia risk during exercise in people with Type 1 diabetes. METHODS A total of 44 patients [34 adults (aged 22-70 years) and 10 adolescents (aged 12-18 years)] with Type 1 diabetes, treated with insulin pump therapy, underwent a standardized exercise session. Cardiorespiratory fitness (maximum oxygen uptake) was measured and classified, based on established norms for age and sex, into either poor (< 25th percentile) or good fitness level (> 25th percentile). Plasma glucose levels were measured every 10 min, each patient performed physical activity at 60% maximum oxygen uptake either on a treadmill for 1 h or on a bicycle for 30 min. Frequency of hypoglycaemia (plasma glucose < 4 mmol/l) and decline in plasma glucose levels during exercise were assessed. RESULTS In all, 23 patients had a good exercise fitness level. Hypoglycaemic events occurred in 17/23 patients (74.0%) in the good fitness level group compared with 8/21 patients (38.0%) in the poor fitness level group (P = 0.02). Both groups had similar pre-exercise plasma glucose levels. The plasma glucose values during exercise in the good fitness level group compared with the poor fitness level group were: plasma glucose nadir 3.9 ± 1.6 vs 5.5 ± 2.4 mmol/l (P = 0.01) and plasma glucose change -4.6 ± 3.4 vs. -2.1 ± 3.1 mmol/l (P = 0.01). The correlation between the plasma glucose nadir and maximum oxygen uptake was r = -0.38 (P = 0.01). CONCLUSIONS Patients with good fitness level seem to be more prone to hypoglycaemia during exercise. This could be the result of better insulin sensitivity and the fact that they tend to exercise at greater work thresholds. These results are a step toward a better understanding of the association between physical fitness and exercise-induced hypoglycaemia.
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Affiliation(s)
- R A Al Khalifah
- Department of Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Department of General Pediatrics, Division of General Pediatrics, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - C Suppère
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - A Haidar
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - R Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Montreal Diabetes Research Center, Montréal, Québec, Canada
| | - M Ladouceur
- Centre de Recherche CHUM, Saint-Denis, Montréal, Québec, Canada
| | - L Legault
- Department of Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
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24
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A role for leptin-regulated neurocircuitry in subordination stress. Physiol Behav 2016; 178:144-150. [PMID: 27887997 DOI: 10.1016/j.physbeh.2016.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/07/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023]
Abstract
The visible burrow system produces a distinct combination of psychological and metabolic stress on, primarily, subordinate individuals that results in pronounced physiologic and behavioral dysfunction. However, the mechanisms underlying the consequences of chronic subordination stress are largely unknown. The simplest mechanistic explanation is that adaptations within brain systems with overlapping functions of both psychological and metabolic control provide immediate benefits that result in lasting susceptibility to diseases, disorders, and increased mortality rates in subordinates. Circuits regulated by leptin adapt to fluctuating levels of energy storage, such that the loss of leptin action within leptin-regulated neurocircuitry results in dysfunction in physiologic and behavioral systems implicated in the consequences of chronic social subordination. Thus, leptin-regulated neurocircuitry may provide a window into understanding the consequences of social subordination stress. This review examines the neural systems of leptin physiology implicated in social subordination stress: energy balance, motivation, HPA axis, and glycemic control.
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Ghazanfar H, Rizvi SW, Khurram A, Orooj F, Qaiser I. Impact of insulin pump on quality of life of diabetic patients. Indian J Endocrinol Metab 2016; 20:506-11. [PMID: 27366717 PMCID: PMC4911840 DOI: 10.4103/2230-8210.183472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM Diabetes is an emerging health problem, both in developing and developed countries and has an enormous economic and social impact. The objective of our study was to find the impact of insulin pump on the quality of life of patients with type 2 diabetes (T2D) and compare it to the quality of life of patients with T2D using an insulin pen. SUBJECTS AND METHODS This is a case-control study which was conducted among patients with T2D presenting between November 2014 and November 2015. A total of 83 patients with T2D, using insulin pump were enrolled in the study as cases and 322 patients with T2D not using insulin pump but using insulin pens were enrolled as controls. Short form-36 quality of life questionnaire was used for data collection. RESULTS Mean age of patients using insulin pump was 52.49 ± 9.28 while the mean age of patients not using insulin pump was 54.72 ± 16.87. Mean score of all domains in the questionnaire was found to be higher in patients using insulin pump as compared to patients not using insulin pumps (P < 0.05). In 81.1% of the patients, the insulin pump decreased the frequency of hypoglycemic episodes. CONCLUSION Insulin pump has significantly improved the quality of life of patients in terms of better self-esteem, decreased stress, and better mood. It has resulted in improved physical health, meal time flexibility, and ease of travel. It allows patient to have more active participation in social and recreational activities improving their personal and family life.
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Affiliation(s)
| | - Syed Wajih Rizvi
- R Endocrinology Clinic and Endocrine Department of Robert Wood Johnson Hospital, New Jersey, United States of America
| | - Aliya Khurram
- R Endocrinology Clinic, New Jersey, United States of America
| | - Fizza Orooj
- R Endocrinology Clinic, New Jersey, United States of America
| | - Iman Qaiser
- R Endocrinology Clinic, New Jersey, United States of America
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Dagogo-Jack S. Philip E. Cryer, MD: Seminal Contributions to the Understanding of Hypoglycemia and Glucose Counterregulation and the Discovery of HAAF (Cryer Syndrome). Diabetes Care 2015; 38:2193-9. [PMID: 26604275 PMCID: PMC4876742 DOI: 10.2337/dc15-0533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Optimized glycemic control prevents and slows the progression of long-term complications in patients with type 1 and type 2 diabetes. In healthy individuals, a decrease in plasma glucose below the physiological range triggers defensive counterregulatory responses that restore euglycemia. Many individuals with diabetes harbor defects in their defenses against hypoglycemia, making iatrogenic hypoglycemia the Achilles heel of glycemic control. This Profile in Progress focuses on the seminal contributions of Philip E. Cryer, MD, to our understanding of hypoglycemia and glucose counterregulation, particularly his discovery of the syndrome of hypoglycemia-associated autonomic failure (HAAF).
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Affiliation(s)
- Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, The University of Tennessee Health Science Center, Memphis, TN
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27
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Pieber TR, Famulla S, Eilbracht J, Cescutti J, Soleymanlou N, Johansen OE, Woerle HJ, Broedl UC, Kaspers S. Empagliflozin as adjunct to insulin in patients with type 1 diabetes: a 4-week, randomized, placebo-controlled trial (EASE-1). Diabetes Obes Metab 2015; 17:928-35. [PMID: 26080652 PMCID: PMC4745028 DOI: 10.1111/dom.12494] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/06/2015] [Accepted: 05/10/2015] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the pharmacodynamics, efficacy and safety of empagliflozin as adjunct to insulin in patients with type 1 diabetes. METHODS A total of 75 patients with glycated haemoglobin (HbA1c) concentrations of ≥7.5 to ≤10.5% (≥58 to ≤91 mmol/mol) were randomized to receive once-daily empagliflozin 2.5 mg, empagliflozin 10 mg, empagliflozin 25 mg, or placebo as adjunct to insulin for 28 days. Insulin dose was to be kept as stable as possible for 7 days then adjusted, at the investigator's discretion, to achieve optimum glycaemic control. The primary exploratory endpoint was change from baseline in 24-h urinary glucose excretion (UGE) on day 7. RESULTS Empagliflozin significantly increased 24-h UGE versus placebo on days 7 and 28. On day 28, adjusted mean differences with empagliflozin versus placebo in changes from baseline in: HbA1c were -0.35 to -0.49% (-3.8 to -5.4 mmol/mol; all p < 0.05 vs. placebo); total daily insulin dose -0.07 to -0.09 U/kg (all p<0.05 vs placebo); and weight were -1.5 to -1.9 kg (all p < 0.001 vs. placebo). In the placebo, empagliflozin 2.5, 10 and 25 mg groups, respectively, adverse events were reported in 94.7, 89.5, 78.9 and 100.0% of patients, and the rate of symptomatic hypoglycaemic episodes with glucose ≤3.0 mmol/l not requiring assistance was 1.0, 0.4, 0.5 and 0.8 episodes per 30 days. CONCLUSIONS In patients with type 1 diabetes, empagliflozin for 28 days as adjunct to insulin increased UGE, improved HbA1c and reduced weight with lower insulin doses compared with placebo and without increasing hypoglycaemia.
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Affiliation(s)
- T R Pieber
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - J Eilbracht
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - J Cescutti
- Boehringer Ingelheim France, Reims, France
| | - N Soleymanlou
- Boehringer Ingelheim Canada Ltd./Ltee, Burlington, Canada
| | | | - H J Woerle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - U C Broedl
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - S Kaspers
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
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Iwasaki S, Kozawa J, Fukui K, Iwahashi H, Imagawa A, Shimomura I. Coefficient of variation of R-R interval closely correlates with glycemic variability assessed by continuous glucose monitoring in insulin-depleted patients with type 1 diabetes. Diabetes Res Clin Pract 2015; 109:397-403. [PMID: 26047681 DOI: 10.1016/j.diabres.2015.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/29/2015] [Accepted: 05/02/2015] [Indexed: 02/06/2023]
Abstract
AIMS In type 1 diabetic patients, insulin secretory capacity, meals and physical activity correlate with glycemic variability. Autonomic function associated with gastrointestinal motility and counterregulatory hormone secretion is another candidate which correlates with glucose variability. The aim of this study is to clarify a new clinical parameter associated with glycemic variability in insulin-depleted patients with type 1 diabetes. METHODS We studied 31 inpatients with type 1 diabetes. We evaluated glycemic variability calculated by continuous glucose monitoring, clinical parameters and the coefficient of variation of R-R interval (CVR-R). Glycemic variability was also assessed during the daytime and nighttime. RESULTS The CVR-R showed a significant negative correlation with the whole-day standard deviation (SD) (r = -0.50, p = 0.007), mean amplitude of glycemic excursions (MAGE) (r = -0.47, p=0.011), M-value (r = -0.38, p = 0.048) and mean of daily differences (MODD) (r = -0.59, p = 0.001). The CVR-R also showed a significant negative correlation with the nighttime SD (r = -0.59, p = 0.001), MAGE (r = -0.47, p=0.011), M-value (r = -0.53, p = 0.004) and MODD (r = -0.65, p = 0.0003). And furthermore, the CVR-R also showed a significant negative correlation with the daytime SD (r = -0.44, p = 0.019) and MAGE (r = -0.50, p = 0.006), but not with the daytime M-value or MODD. The nighttime SD was significantly higher in patients with diabetic polyneuropathy than in patients without it (p = 0.016), while the CVR-R was significantly lower in patients with polyneuropathy than in patients without it (p = 0.009). CONCLUSIONS CVR-R is closely correlated with glycemic variability, especially during nighttime, in insulin-depleted patients with type 1 diabetes. Measuring CVR-R may help us to presume the degree of glycemic variability in those patients.
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Affiliation(s)
- Shingo Iwasaki
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Junji Kozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kenji Fukui
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan; Department of Community Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiromi Iwahashi
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Akihisa Imagawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
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Nie SP, Chen H, Zhuang MQ, Lu M. Anti-diabetic medications do not influence risk of lung cancer in patients with diabetes mellitus: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2015; 15:6863-9. [PMID: 25169538 DOI: 10.7314/apjcp.2014.15.16.6863] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Several preclinical and observational studies have shown that anti-diabetic medications (ADMs) may modify the risk of lung cancer. We performed a systematic review and meta-analysis evaluating the effect of metformin, sulfonylureas (SUs), thiazolidinediones (TZDs), and insulin on the risk of lung cancer in patients with diabetes mellitus (DM). MATERIALS AND METHODS We conducted a systematic search of Pubmed and Web of Science, up to August 20, 2013. We also searched the Conference Proceedings Citation Index (CPCI) and China National Knowledge Infrastructure (CNKI) for abstracts from major meetings. Fixed or random effect pooled measures were selected based on heterogeneity among studies, which was evaluated using Q test and the I2 of Higgins and Thompson. Meta-regression was used to explore the sources of between-study heterogeneity. Publication bias was analyzed by Begg's funnel plot and Egger's regression test. Associations were assessed by odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 15 studies (11 cohort, 4 case-control) were included in this meta-analysis. In observational studies no significant association between metformin (n=11 studies; adjusted OR=0.99, 95%CI: 0.87-1.12), SUs (n=5 studies; adjusted OR=0.98, 95%CI: 0.79-1.22), or TZDs (n=7 studies; adjusted OR=0.92, 95%CI: 0.75-1.13), insulin (n=6 studies; adjusted OR=1.13, 95%CI: 0.79-1.62) use and risk of developing lung cancer was noted. There was considerable inherent heterogeneity between studies not explained by study design, setting, or location. CONCLUSIONS Meta-analysis of existing studies does not support a protective or harmful association between ADMs use and risk of lung cancer in patients with DM. There was considerable heterogeneity across studies, and future, well-designed, prospective studies would be required for better understanding of any association.
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Affiliation(s)
- Shu-Ping Nie
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China E-mail :
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30
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Weiss R, Garg SK, Bergenstal RM, Klonoff DC, Bode BW, Bailey TS, Thrasher J, Schwartz F, Welsh JB, Kaufman FR. Predictors of Hypoglycemia in the ASPIRE In-Home Study and Effects of Automatic Suspension of Insulin Delivery. J Diabetes Sci Technol 2015; 9:1016-20. [PMID: 25986629 PMCID: PMC4667346 DOI: 10.1177/1932296815586014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hypoglycemia varies between patients with type 1 diabetes and is the main obstacle to therapy intensification. We investigated known and potential risk factors for hypoglycemia in subjects with type 1 diabetes. METHOD In the ASPIRE In-Home study (NCT01497938), a randomized trial of the threshold suspend (TS) feature of sensor-augmented insulin pump (SAP) therapy, subjects' propensity to nocturnal hypoglycemia (NH) was established in a 2-week run-in phase and assessed in a 3-month study phase via continuous glucose monitoring. Categorical variables were tested for association with NH rates in both phases. RESULTS Elevated rates of NH were significantly associated with baseline A1C ≤7%, with bolus insulin deliveries unassisted by the bolus estimation calculator, and with assignment to the control group during the study phase. CONCLUSIONS Routine use of the TS feature and the bolus estimation calculator are strategies that may reduce the risk of NH.
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Affiliation(s)
- Ram Weiss
- Department of Human Metabolism and Nutrition, Hebrew University, and the Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
| | | | | | | | | | | | - James Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, AR, USA
| | - Frank Schwartz
- Ohio University College of Osteopathic Medicine, Athens, OH, USA
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31
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Thulé PM, Jia D, Safley S, Gordon K, Barber G, Yi H, Nalli S, Onderci M, Sharma J, Shires J, Weber CJ. Engineered insulin secretion from neuroendocrine cells isolated from human thyroid. World J Surg 2015; 38:1251-61. [PMID: 24549997 DOI: 10.1007/s00268-014-2457-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Insulin-secreting beta-like cells are vulnerable to diabetic autoimmunity. We hypothesized that human thyroid neuroendocrine (NE) cells could be engineered to secrete human insulin, be glucose-responsive, and avoid autoimmunity. METHODS Collagenase-digested thyroid tissue was cultured and subjected to size-based fluorescence-activated cell sorting. Insulin secretion and storage in NE cells transduced with viral vectors carrying an insulin sequence was assessed by enzyme-linked immunosorbent assay (ELISA) and immunogold transmission electron microscopy (TEM). Baseline mRNA expression was assessed by Illumina expression array analysis. Transduction with retrovirus expressing transcription factors PDX1, NGN3, MAFA, or HNF6 altered mRNA expression in a custom polymerase chain reaction (PCR) array. Gastrin-releasing peptide (GRP) in conditioned medium and cell lysates was determined by reverse transcription (RT)-PCR, ELISA, and immunohistochemistry. RESULTS Isolation yielded an average of 2.2 × 10(6) cells/g thyroid tissue, which stained for calcitonin/calcitonin gene-related protein, expressed genes consistent with NE origins, and secreted GRP. Transduced cells secreted 56 % and retained 48 % of total insulin produced. Immunogold TEM revealed insulin in secretory vesicles. PDX1, NGN3, and MAFA overexpression increased expression of genes typical for hepatocytes and beta cells. Overexpression of HNF6 also increased the message of genes critical for glucose sensing. CONCLUSIONS Human thyroid NE cells can produce human insulin, fractions of which are both secreted and retained in secretory granules. Overexpression of HNF6, PDX1, or NGN3 enhances expression of both hepatocyte and beta cell typical mRNAs, including the message of proteins critical for glucose sensing. These data suggest that reimplantation of engineered autologous NE cells may develop as a viable treatment for diabetes mellitus type 1.
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Affiliation(s)
- Peter M Thulé
- Section Endocrinology & Metabolism, Atlanta VA Medical Center, Decatur, GA, USA,
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32
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Flak JN, Patterson CM, Garfield AS, D'Agostino G, Goforth PB, Sutton AK, Malec PA, Wong JMT, Germani M, Jones JC, Rajala M, Satin L, Rhodes CJ, Olson DP, Kennedy RT, Heisler LK, Myers MG. Leptin-inhibited PBN neurons enhance responses to hypoglycemia in negative energy balance. Nat Neurosci 2014; 17:1744-1750. [PMID: 25383904 PMCID: PMC4255234 DOI: 10.1038/nn.3861] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/10/2014] [Indexed: 12/29/2022]
Abstract
Hypoglycemia initiates the counter regulatory response (CRR), in which the sympathetic nervous system, glucagon, and glucocorticoids restore glucose to appropriate concentrations. During starvation, low leptin restrains energy utilization, enhancing long-term survival. To ensure short-term survival during hypoglycemia in fasted animals, the CRR must overcome this energy-sparing program and nutrient depletion. Here, we identify in mice a previously unrecognized role for leptin and a population of leptin-regulated neurons that modulate the CRR to meet these challenges. Hypoglycemia activates leptin receptor (LepRb) and cholecystokinin (CCK)-expressing neurons of the parabrachial nucleus (PBN), which project to the ventromedial hypothalamic nucleus. Leptin inhibits these cells and Cckcre-mediated ablation of LepRb enhances the CRR. Inhibition of PBN LepRb cells blunts the CRR, while their activation mimics the CRR in a CCK-dependent manner. PBN LepRbCCK neurons represent a crucial component of the CRR system, and may represent a therapeutic target in hypoglycemia.
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Affiliation(s)
- Jonathan N Flak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Giuseppe D'Agostino
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, and Department of Pharmacology, University of Cambridge, Cambridge, UK
| | | | - Amy K Sutton
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Paige A Malec
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | | | - Mark Germani
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Justin C Jones
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael Rajala
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Leslie Satin
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | | | - David P Olson
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Robert T Kennedy
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Lora K Heisler
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, and Department of Pharmacology, University of Cambridge, Cambridge, UK
| | - Martin G Myers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
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33
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Javitt JC. A Safety Net for Diabetics. Science 2014; 343:1076-7. [DOI: 10.1126/science.343.6175.1076-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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34
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Szwergold BS, Miller CB. Potential of Birds to Serve as a Pathology-Free Model of Type 2 Diabetes, Part 1: Is the Apparent Absence of the RAGE Gene a Factor in the Resistance of Avian Organisms to Chronic Hyperglycemia? Rejuvenation Res 2014; 17:54-61. [PMID: 24313337 DOI: 10.1089/rej.2013.1498] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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