1
|
Hunt NJ, Lockwood GP, Heffernan SJ, Daymond J, Ngu M, Narayanan RK, Westwood LJ, Mohanty B, Esser L, Williams CC, Kuncic Z, McCourt PAG, Le Couteur DG, Cogger VC. Oral nanotherapeutic formulation of insulin with reduced episodes of hypoglycaemia. NATURE NANOTECHNOLOGY 2024; 19:534-544. [PMID: 38168926 PMCID: PMC11026164 DOI: 10.1038/s41565-023-01565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
Injectable insulin is an extensively used medication with potential life-threatening hypoglycaemic events. Here we report on insulin-conjugated silver sulfide quantum dots coated with a chitosan/glucose polymer to produce a responsive oral insulin nanoformulation. This formulation is pH responsive, is insoluble in acidic environments and shows increased absorption in human duodenum explants and Caenorhabditis elegans at neutral pH. The formulation is sensitive to glucosidase enzymes to trigger insulin release. It is found that the formulation distributes to the liver in mice and rats after oral administration and promotes a dose-dependent reduction in blood glucose without promoting hypoglycaemia or weight gain in diabetic rodents. Non-diabetic baboons also show a dose-dependent reduction in blood glucose. No biochemical or haematological toxicity or adverse events were observed in mice, rats and non-human primates. The formulation demonstrates the potential to orally control blood glucose without hypoglycaemic episodes.
Collapse
Affiliation(s)
- Nicholas J Hunt
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
- Sydney Nano Institute, The University of Sydney, Camperdown, New South Wales, Australia.
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia.
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia.
| | - Glen P Lockwood
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia
| | - Scott J Heffernan
- Royal Prince Alfred Hospital, SLHD, Camperdown, New South Wales, Australia
| | - Jarryd Daymond
- Sydney Nano Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Sydney Business School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Meng Ngu
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia
- Department of Gastroenterology, Concord Repatriation General Hospital, SLHD, Concord, New South Wales, Australia
| | - Ramesh K Narayanan
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia
| | - Lara J Westwood
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Sydney Nano Institute, The University of Sydney, Camperdown, New South Wales, Australia
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia
| | - Biswaranjan Mohanty
- Sydney Analytical Core Research Facility, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lars Esser
- CSIRO Manufacturing, Clayton, Victoria, Australia
| | | | - Zdenka Kuncic
- Sydney Nano Institute, The University of Sydney, Camperdown, New South Wales, Australia
- School of Physics, The University of Sydney, Camperdown, New South Wales, Australia
| | - Peter A G McCourt
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia
- Department of Medical Biology, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - David G Le Couteur
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia
| | - Victoria C Cogger
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, New South Wales, Australia.
| |
Collapse
|
2
|
Tremamunno S, Tartaglione L, Telesca A, Rizzi A, Felici T, Mazzotta F, De Vita A, Rizzo E, Cambise N, Belmusto A, Pitocco D, Lanza GA. Insulin pump treatment vs. multiple daily insulin injections in patients with poorly controlled Type 2 diabetes mellitus: a comparison of cardiovascular effects. Endocrine 2024; 84:128-135. [PMID: 38197988 PMCID: PMC10987338 DOI: 10.1007/s12020-023-03651-w] [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: 09/23/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024]
Abstract
AIMS Both hyperglycaemia and large glycaemic variability are associated with worse outcomes in patients with Type 2 diabetes mellitus (T2DM), possibly causing sympatho-vagal imbalance and endothelial dysfunction. Continuous subcutaneous insulin injection (CSII) improves glycemic control compared to multiple daily insulin injections (MDI). We aimed to assess whether CSII may improve cardiac autonomic and vascular dilation function compared to MDI. METHODS We enrolled T2DM patients without cardiovascular disease with poor glycaemic control, despite optimized MDI therapy. Patients were randomized to continue MDI (with multiple daily peripheral glucose measurements) or CSII; insulin dose was adjusted to achieve optimal target ranges of blood glucose levels. Patients were studied at baseline and after 6 months by: 1) flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of the brachial artery; 2) heart rate variability (HRV) by 24-hour ECG Holter monitoring (HM). 7-day continuous glucose monitoring (CGM) was performed in 9 and 8 patients of Group 1 and 2, respectively. RESULTS Overall, 21 patients were enrolled, 12 randomized to CSII (Group 1) and 9 to MDI (Group 2). The daily dose of insulin and Hb1AC did not differ significantly between the 2 groups, both at baseline and at follow-up. Glucose variability showed some significant improvement at follow-up in the whole population, but no differences were observed between the 2 groups. Both FMD and NMD, as well as HRV parameters, showed no significant differences between the 2 groups at 6-month follow-up. CONCLUSIONS In this randomized small study we show that, in T2DM patients, CSII achieves a similar medium-term glycemic control compared to MDI, without any adverse effect on the cardiovascular system.
Collapse
Affiliation(s)
- Saverio Tremamunno
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Telesca
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamara Felici
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Mazzotta
- Diabetes Care Unit, Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio De Vita
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rizzo
- Diabetes Care Unit, Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nello Cambise
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Belmusto
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Antonio Lanza
- Department. of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
3
|
Hryciw DH, Patten RK, Rodgers RJ, Proietto J, Hutchinson DS, McAinch AJ. GPR119 agonists for type 2 diabetes: past failures and future hopes for preclinical and early phase candidates. Expert Opin Investig Drugs 2024; 33:183-190. [PMID: 38372052 DOI: 10.1080/13543784.2024.2321271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/16/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Type 2 diabetes (T2D) is metabolic disorder associated with a decrease in insulin activity and/or secretion from the β-cells of the pancreas, leading to elevated circulating glucose. Current management practices for T2D are complex with varying long-term effectiveness. Agonism of the G protein-coupled receptor GPR119 has received a lot of recent interest as a potential T2D therapeutic. AREAS COVERED This article reviews studies focused on GPR119 agonism in animal models of T2D and in patients with T2D. EXPERT OPINION GPR119 agonists in vitro and in vivo can potentially regulate incretin hormone release from the gut, then pancreatic insulin release which regulates blood glucose concentrations. However, the success in controlling glucose homeostasis in rodent models of T2D and obesity, failed to translate to early-stage clinical trials in patients with T2D. However, in more recent studies, acute and chronic dosing with the GPR119 agonist DS-8500a had increased efficacy, although this compound was discontinued for further development. New trials on GPR119 agonists are needed, however it may be that the future of GPR119 agonists lie in the development of combination therapy with other T2D therapeutics.
Collapse
Affiliation(s)
- Deanne H Hryciw
- School of Environment and Science, Griffith University, Nathan, Queensland, Australia
- Griffith Institute of Drug Discovery, Griffith University, Nathan, Queensland, Australia
| | - Rhiannon K Patten
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Raymond J Rodgers
- Robinson Research Institute, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Joseph Proietto
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dana S Hutchinson
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Andrew J McAinch
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Wawerski A, Siemiątkowska B, Józwik M, Fajdek B, Partyka M. Machine Learning Method and Hyperspectral Imaging for Precise Determination of Glucose and Silicon Levels. SENSORS (BASEL, SWITZERLAND) 2024; 24:1306. [PMID: 38400464 PMCID: PMC10893512 DOI: 10.3390/s24041306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
This article introduces an algorithm for detecting glucose and silicon levels in solution. The research focuses on addressing the critical need for accurate and efficient glucose monitoring, particularly in the context of diabetic management. Understanding and monitoring silicon levels in the body is crucial due to its significant role in various physiological processes. Silicon, while often overshadowed by other minerals, plays a vital role in bone health, collagen formation, and connective tissue integrity. Moreover, recent research suggests its potential involvement in neurological health and the prevention of certain degenerative diseases. Investigating silicon levels becomes essential for a comprehensive understanding of its impact on overall health and well-being and paves the way for targeted interventions and personalized healthcare strategies. The approach presented in this paper is based on the integration of hyperspectral data and artificial intelligence techniques. The algorithm investigates the effectiveness of two distinct models utilizing SVMR and a perceptron independently. SVMR is employed to establish a robust regression model that maps input features to continuous glucose and silicon values. The study outlines the methodology, including feature selection, model training, and evaluation metrics. Experimental results demonstrate the algorithm's effectiveness at accurately predicting glucose and silicon concentrations and showcases its potential for real-world application in continuous glucose and silicon monitoring systems.
Collapse
Affiliation(s)
| | - Barbara Siemiątkowska
- Faculty of Mechatronics, Warsaw University of Technology, Sw. A. Boboli St. 8, 02-525 Warsaw, Poland; (A.W.); (M.J.); (B.F.); (M.P.)
| | | | | | | |
Collapse
|
5
|
Shestakova MV, Severina AS. [Vascular complications of diabetes mellitus worldwide and in Russia: The path of 100 years. A review]. TERAPEVT ARKH 2023; 95:1039-1043. [PMID: 38158936 DOI: 10.26442/00403660.2023.12.202498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
With the discovery and introduction of insulin, the "palette" of life-threatening conditions for patients with diabetes mellitus has changed dramatically: from diabetic coma of the "pre-insulin era" to severe vascular complications in the modern period. The key risk factors for diabetic angiopathies in diabetes mellitus are poor glycemic control in combination with a long course of the disease. Over the past 30 years, there has been a downward trend in the incidence of late vascular complications of diabetes both worldwide and in Russia. In particular, the frequency of cardiovascular events (myocardial infarctions, strokes, amputations) decreased, and the incidence of several other complications, such as diabetic retinopathy and neuropathy, stabilized. However, the incidence of chronic kidney disease and chronic heart failure is still increasing. The Joslin Medal, awarded to patients over 50, 75 and even 80 years of life with diabetes, reflects success in the fight against this disease.
Collapse
|
6
|
Lyssenko V, Vaag A. Genetics of diabetes-associated microvascular complications. Diabetologia 2023; 66:1601-1613. [PMID: 37452207 PMCID: PMC10390394 DOI: 10.1007/s00125-023-05964-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/27/2023] [Indexed: 07/18/2023]
Abstract
Diabetes is associated with excess morbidity and mortality due to both micro- and macrovascular complications, as well as a range of non-classical comorbidities. Diabetes-associated microvascular complications are those considered most closely related to hyperglycaemia in a causal manner. However, some individuals with hyperglycaemia (even those with severe hyperglycaemia) do not develop microvascular diseases, which, together with evidence of co-occurrence of microvascular diseases in families, suggests a role for genetics. While genome-wide association studies (GWASs) produced firm evidence of multiple genetic variants underlying differential susceptibility to type 1 and type 2 diabetes, genetic determinants of microvascular complications are mostly suggestive. Identified susceptibility variants of diabetic kidney disease (DKD) in type 2 diabetes mirror variants underlying chronic kidney disease (CKD) in individuals without diabetes. As for retinopathy and neuropathy, reported risk variants currently lack large-scale replication. The reported associations between type 2 diabetes risk variants and microvascular complications may be explained by hyperglycaemia. More extensive phenotyping, along with adjustments for unmeasured confounding, including both early (fetal) and late-life (hyperglycaemia, hypertension, etc.) environmental factors, are urgently needed to understand the genetics of microvascular complications. Finally, genetic variants associated with reduced glycolysis, mitochondrial dysfunction and DNA damage and sustained cell regeneration may protect against microvascular complications, illustrating the utility of studies in individuals who have escaped these complications.
Collapse
Affiliation(s)
- Valeriya Lyssenko
- Department of Clinical Science, Mohn Research Center for Diabetes Precision Medicine, University of Bergen, Bergen, Norway.
- Department of Clinical Sciences, Lund University Diabetes Center, Lund University, Lund, Sweden.
| | - Allan Vaag
- Department of Clinical Sciences, Lund University Diabetes Center, Lund University, Lund, Sweden
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
7
|
Enders J, Elliott D, Wright DE. Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy. Antioxid Redox Signal 2023; 38:989-1000. [PMID: 36503268 PMCID: PMC10402707 DOI: 10.1089/ars.2022.0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Significance: Diabetic peripheral neuropathy (DPN), a complication of metabolic syndrome, type I and type II diabetes, leads to sensory changes that include slow nerve conduction, nerve degeneration, loss of sensation, pain, and gate disturbances. These complications remain largely untreatable, although tight glycemic control can prevent neuropathy progression. Nonpharmacologic approaches remain the most impactful to date, but additional advances in treatment approaches are needed. Recent Advances: This review highlights several emerging interventions, including a focus on dietary interventions and physical activity, that continue to show promise for treating DPN. We provide an overview of our current understanding of how exercise can improve aspects of DPN. We also highlight new studies in which a ketogenic diet has been used as an intervention to prevent and reverse DPN. Critical Issues: Both exercise and consuming a ketogenic diet induce systemic and cellular changes that collectively improve complications associated with DPN. Both interventions may involve similar signaling pathways and benefits but also impact DPN through unique mechanisms. Future Directions: These lifestyle interventions are critically important as personalized medicine approaches will likely be needed to identify specific subsets of neuropathy symptoms and deficits in patients, and determine the most impactful treatment. Overall, these two interventions have the potential to provide meaningful relief for patients with DPN and provide new avenues to identify new therapeutic targets.
Collapse
Affiliation(s)
- Jonathan Enders
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Elliott
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Douglas E. Wright
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
8
|
Ho LJ, Sheu WHH, Lo SH, Yeh YP, Hwu CM, Huang CN, Hsieh CH, Kuo FC. Unhealthy lifestyle associated with increased risk of macro- and micro-vascular comorbidities in patients with long-duration type 2 diabetes: results from the Taiwan Diabetes Registry. Diabetol Metab Syndr 2023; 15:38. [PMID: 36890551 PMCID: PMC9996995 DOI: 10.1186/s13098-023-01018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/04/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle has been associated with obesity and type 2 diabetes. Whereas its association with vascular complications in patients with long-duration of type 2 diabetes is still uncertain. METHODS A total of 1188 patients with long-duration of type 2 diabetes from the Taiwan Diabetes Registry (TDR) data were analyzed. We stratified the severity of unhealthy lifestyle via scoring three factors (sleep duration <7 or >9 h, sit duration ≥ 8h, and meal numbers ≥ with night snack) and analyzed their associations with the development of vascular complications using logistic regression analysis. Besides, we also included 3285 patients with newly diagnosed type 2 diabetes as the comparison. RESULTS Increased numbers of factors that stand for unhealthy lifestyle were significantly associated with the development of cardiovascular disease, peripheral arterial occlusion disease (PAOD) and nephropathy in patients with long-duration of type 2 diabetes. After adjusting multiple covariables, having ≥ 2 factors of unhealthy lifestyle remained significant associations with cardiovascular disease and PAOD, with an odds ratio (OR) of 2.09 (95% confidence interval [CI] 1.18-3.69) and 2.68 (95% CI 1.21-5.90), respectively. Among individual factor for unhealthy lifestyle behaviors, we revealed that eating ≥ 4 meals per day with night snack increased the risk of cardiovascular disease and nephropathy after multivariable adjustment (OR of 2.60, 95% CI 1.28-5.30; OR of 2.54, 95% CI 1.52-4.26, respectively). Whereas sit duration for ≥ 8 h per day increased the risk of PAOD (OR of 4.32, 95% CI 2.38-7.84). CONCLUSION Unhealthy lifestyle is associated with increased prevalence of macro- and micro-vascular comorbidities in Taiwanese patients with long-duration type 2 diabetes.
Collapse
Affiliation(s)
- Li-Ju Ho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China
| | - Wayne Huey-Herng Sheu
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Su-Huey Lo
- Tao-Yuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua, Taiwan
| | - Chii-Min Hwu
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Chien-Ning Huang
- Institute of Medicine, Chung Shang Medical University Hospital, Taichung, Taiwan
| | - Chang-Hsun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China
| | - Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China.
| |
Collapse
|
9
|
Albuminuria as a biomarker of severity in diabetic retinopathy and in the response to intravitreal treatment in diabetic macular edema. Int Ophthalmol 2022; 43:2049-2056. [DOI: 10.1007/s10792-022-02604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
|
10
|
Borot S. [One hundred years after the discovery of insulin: a new revolution for patients living with type 1 diabetes?]. Biol Aujourdhui 2022; 216:29-35. [PMID: 35876518 DOI: 10.1051/jbio/2022005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 06/15/2023]
Abstract
The year 2021 saw the 100-year celebration of the discovery of insulin as a treatment for type 1 diabetes, saving lives of people previously condemned by the disease. However, insulin replacement, so different from physiological secretion, remains a challenge. Until the 1990s, people living with type 1 diabetes were treated with two injections of intermediate insulin and prandial regular insulin injections. Their kinetics led to frequent hypoglycemia, justifying meals taken at fixed times, with fixed amount of carbohydrates avoiding fast sugars. The development of rapid and then long acting insulin analogues in the 1990s and 2000s and the principle of patient empowerment have reduced these constraints by introducing the notion of functional insulin therapy, dissociating meals managed by rapid insulins from basal insulin (= insulin for living). Meals can be taken at variable times, with variable carbohydrate content and without food restrictions. But the revolution started 5 years ago, with the development of continuous glucose monitoring systems, freeing the patient from blood glucose controls, coupled thereafter to an insulin pump driven by artificial intelligence in the very recent hybrid closed-loop systems. These systems showed significant glucose control improvement, together with reduction of both the time spent in hypoglycemia and the mental burden on the individual, pending a cure for the disease for the next century.
Collapse
|
11
|
Dimova R, Chakarova N, Daniele G, Bianchi C, Dardano A, Del Prato S, Tankova T. Insulin secretion and action affect glucose variability in the early stages of glucose intolerance. Diabetes Metab Res Rev 2022; 38:e3531. [PMID: 35416379 DOI: 10.1002/dmrr.3531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 11/10/2022]
Abstract
AIMS Since it is unknown whether glucose variability (GV) is increased and whether this is related to worsening of insulin secretion and action in prediabetes, we have assessed insulin secretion and sensitivity, and daily GV in early stages of dysglycemia. MATERIALS AND METHODS Twenty subjects with normal glucose tolerance (NGT; age 45.0 ± 9.5 years; BMI 31.1 ± 6.4 kg/m2), 25 with NGT and 1hrOGTT>8.6 mmol/L (1hrOGTT; 45.7 ± 8.5 years; 32.4 ± 7.0 kg/m2), and 59 with isolated impaired glucose tolerance (iIGT; 47.7 ± 11.2 years; 31.3 ± 6.1 kg/m2) underwent OGTT and MMTT. CGM was performed with blinded FreeStyle Libre Pro for 24 h under standard conditions. Parameters of beta-cell function, insulin sensitivity and GV were calculated. RESULTS Overall insulin secretion and action as well as GV progressively worsened across glucose tolerance categories. On a matrix analysis, GV parameters were inversely related to ISSI-2; r = -0.37 to -0.52; p < 0.0001; and IGI; r = -0.28 to -0.48; p < 0.0001 for CV, SD, J-index, LI, HBGI and MAGE. Insulin secretion (IGI) and b-cell function (ISSI-2) emerged as independent contributors to GV in early stage of dysglycemia accounting for about 16%-38% of its variability. CONCLUSIONS Our results show that daily GV worsens already with mild impairment of glucose tolerance. The increase in GV is inversely related to insulin secretion and action.
Collapse
Affiliation(s)
- Rumyana Dimova
- Division of Diabetology, Department of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Nevena Chakarova
- Division of Diabetology, Department of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Giuseppe Daniele
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Bianchi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angela Dardano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tsvetalina Tankova
- Division of Diabetology, Department of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| |
Collapse
|
12
|
Umarani S, Dollaiah A, Vallabha K. Prospective clinical study of ocular manifestations in patients with type 2 diabetes mellitus. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_153_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Davidson MB. A Conversation on an Effective, Straightforward, Quantitative Approach to the Outpatient Use of Insulin. Diabetes Spectr 2022; 35:179-189. [PMID: 35668885 PMCID: PMC9160535 DOI: 10.2337/ds21-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
For primary care providers, using insulin can present challenges that can be met by a straightforward approach using the following principles. Depending on when it is injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle (e.g., overnight, morning, afternoon, or evening). The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting. Regarding which insulin types and insulin regimens to use, human insulin (NPH and regular) is as effective as analog insulins, and a two-injection intensified insulin regimen is as effective as a four-injection regimen.
Collapse
|
14
|
|
15
|
Liu X, Guo B, Zhang W, Ma B, Li Y. MiR-20a-5p overexpression prevented diabetic cardiomyopathy via inhibition of cardiomyocyte apoptosis, hypertrophy, fibrosis, and JNK/NF-κB signaling pathway. J Biochem 2021; 170:349-362. [PMID: 33837411 DOI: 10.1093/jb/mvab047] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) is a common cardiovascular disease. A declined miR-20a-5p was observed in hearts of diabetic mice, while its effect on DCM remains unknown. Herein, we established streptozotocin-induced DCM rat model and high glucose-stimulated H9C2 model of DCM. They then were treated with adenovirus expressing miR-20a-5p to explore the function of miR-20a-5p. ITT and ipGTT assay revealed that miR-20a-5p reduced blood glucose level. Besides, miR-20a-5p improved cardiac dysfunction reflected by reduced HW/BW and LVDP, and increased LVSP and ±LV dp/dt max. MiR-20a-5p prevented cardiomyocyte apoptosis, along with the up-regulated c-caspase-3, bax and down-regulated bcl-2. Moreover, miR-20a-5p alleviated cardiac hypertrophy as the parameters of ANP, BNP and MyHC-β decreased. Also, miR-20a-5p attenuated the cardiac fibrosis demonstrated by decreased TGF-β1, collagen I levels and the inflammatory response manifested by reduced IL-6, TNF-α and IL-1β production. Furthermore, miR-20a-5p prevented JNK phosphorylation and NF-κB p65nuclear translocation. Similarly, the effects of miR-20a-5p on DCM were confirmed in our in vitro experiments. Additionally, ROCK2 is a possible target gene of miR-20a-5p. ROCK2 overexpression reversed the protective effect of miR-20a-5p on DCM. Overall, miR-20a-5p may effectively ameliorate DCM through improving cardiac metabolism, and subsequently inhibiting inflammation, apoptosis, hypertrophy, fibrosis, and JNK/NF-κB pathway via modulating ROCK2.
Collapse
Affiliation(s)
- Xiaoyu Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.,The Third Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, China
| | - Bingyan Guo
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Wei Zhang
- The Third Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, China
| | - Bocong Ma
- The Third Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, China
| | - Yongjun Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| |
Collapse
|
16
|
Shye M, Hanna RM, Patel SS, Tram-Tran N, Hou J, Mccannel C, Khalid M, Hanna M, Abdelnour L, Kurtz I. Worsening proteinuria and renal function after intravitreal vascular endothelial growth factor blockade for diabetic proliferative retinopathy. Clin Kidney J 2020; 13:969-980. [PMID: 33391740 PMCID: PMC7769550 DOI: 10.1093/ckj/sfaa049] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/16/2020] [Indexed: 12/12/2022] Open
Abstract
Systemic vascular endothelial growth factor (VEGF) inhibitions can induce worsening hypertension, proteinuria and glomerular diseases of various types. These agents can also be used to treat ophthalmic diseases like proliferative diabetic retinopathy, diabetic macular edema, central retinal vein occlusion and age-related macular degeneration. Recently, pharmacokinetic studies confirmed that these agents are absorbed at levels that result in biologically significant suppression of intravascular VEGF levels. There have now been 23 other cases published that describe renal sequela of intravitreal VEGF blockade, and they unsurprisingly mirror known systemic toxicities of VEGF inhibitors. We present three cases where stable levels of proteinuria and chronic kidney disease worsened after initiation of these agents. Two of our three patients were biopsied. The first patient's biopsy showed diabetic nephropathy and focal and segmental glomerulosclerosis (FSGS) with collapsing features and acute interstitial nephritis (AIN). The second patient's biopsy showed AIN in a background of diabetic glomerulosclerosis. This is the second patient seen by our group, whose biopsy revealed segmental glomerulosclerosis with collapsing features in the setting of intravitreal VEGF blockade. Though FSGS with collapsing features and AIN are not the typical lesions seen with systemic VEGF blockade, they have been reported as rare case reports previously. In addition to reviewing known elements of intravitreal VEGF toxicity, the cases presented encompass renal pathology data supporting that intravitreal VEGF blockade can result in deleterious systemic and renal pathological disorders.
Collapse
Affiliation(s)
- Michael Shye
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ramy M Hanna
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Medicine, Division of Nephrology, UCI School of Medicine, Irvine, CA, USA
| | - Sapna S Patel
- Department of Medicine, Division of Nephrology, Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Ngoc Tram-Tran
- Department of Medicine, Division of Nephrology, Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Jean Hou
- Department of Pathology, Division of Renal Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Collin Mccannel
- Department of Ophthalmology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Maham Khalid
- Department of Medicine, Division of Nephrology, UCI School of Medicine, Irvine, CA, USA
| | - Mina Hanna
- School of Medicine, University of Queensland-Ochsner Clinical School, Ochsner Health System, New Orleans, LA, USA
| | - Lama Abdelnour
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ira Kurtz
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Brain Research Center, Los Angeles, CA, USA
| |
Collapse
|
17
|
Yoon MK, Kang JG, Lee SJ, Ihm SH, Huh KB, Kim CS. Relationships between Thigh and Waist Circumference, Hemoglobin Glycation Index, and Carotid Plaque in Patients with Type 2 Diabetes. Endocrinol Metab (Seoul) 2020; 35:319-328. [PMID: 32615716 PMCID: PMC7386106 DOI: 10.3803/enm.2020.35.2.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/07/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study investigated the relationships of thigh and waist circumference with the hemoglobin glycation index (HGI) and carotid atherosclerosis in patients with type 2 diabetes. METHODS This observational study included 3,075 Korean patients with type 2 diabetes, in whom anthropometric measurements and carotid ultrasonography were conducted. HGI was defined as the measured hemoglobin A1c (HbA1c) level minus the predicted HbA1c level, which was calculated using the linear relationship between HbA1c and fasting plasma glucose levels. Carotid atherosclerosis was defined as a clearly isolated focal plaque or focal wall thickening >50% of the surrounding intima-media thickness. RESULTS The frequency of a positive HGI decreased with increasing thigh circumference in men and increased with increasing waist circumference in women after adjusting for potential confounding variables. Thigh and waist circumference had a combined augmentative effect on the likelihood of positive HGI, which was dramatically higher in patients in higher waist-to-thigh ratio quartiles (adjusted odds ratios for the highest compared to the lowest quartile: 1.595 in men and 1.570 in women). Additionally, the larger the thigh circumference, the lower the risk of carotid atherosclerosis, although in women, this relationship lacked significance after adjustment for potential confounders. CONCLUSION HGI was associated with thigh circumference in men and waist circumference in women. In addition, the combination of low thigh circumference and high waist circumference was strongly associated with a higher HGI in Korean patients with type 2 diabetes. In particular, thigh circumference was associated with carotid atherosclerosis in men. However, further longitudinal studies are warranted.
Collapse
Affiliation(s)
- Myung Ki Yoon
- Hallym University College of Medicine, Chuncheon,
Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon,
Korea
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon,
Korea
| | - Sung-Hee Ihm
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon,
Korea
| | - Kap Bum Huh
- Huh’s Diabetes Center and the 21st Century Diabetes and Vascular Research Institute, Seoul,
Korea
| | - Chul Sik Kim
- Department of Endocrinology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
| |
Collapse
|
18
|
Hodish I. For debate; pharmacological priorities in advanced type 2 diabetes. J Diabetes Complications 2020; 34:107510. [PMID: 32008894 DOI: 10.1016/j.jdiacomp.2019.107510] [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: 08/16/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/20/2022]
Abstract
A multitude of therapeutic agents have been available to treat patients with Type 2 diabetes. Unfortunately, many patients with advanced Type 2 diabetes continue to suffer from complications and premature death. To date, all available guidelines emphasize a variety of therapeutic aspects, goals, and pharmacological combinations, without directing the clinician as to which is a higher priority. The following review attempts to clarify which therapeutic option is more important for prognosis in patients with advanced type 2 diabetes. The body of evidence presented, reveal that the most important marker for prognosis is HbA1c. Each 1% incrementally higher HbA1c than ~7% is associated with 15%-45% reduced survival rates. Therefore, any agents that can achieve the time-sensitive objective of lowering HbA1c levels should be used.
Collapse
Affiliation(s)
- Israel Hodish
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical Center, Ann Arbor, Michigan, United States of America.
| |
Collapse
|
19
|
Abstract
AbstractDiabetes mellitus is a complex metabolic disorder, caused by defects in insulin action and/or insulin production and is defined as afasting hyperglycaemia of >126 mg/dl, with normoglycaemia being ≥70 and ≤ 110 mg/dl. There are two main types of diabetes. Type 1 diabetes (around 10% of cases) is an autoimmune disease, usually of early onset, in which pancreatic islet beta cells that secrete insulin are destroyed. Type 2 diabetes (around 85% of cases) is characterised principally by insulin resistance and impaired insulin secretion. Heredity and obesity are major risk factors for Type 2 diabetes. Diabetes is associated with potentially life-threatening microvascular and macrovascular complications caused by elevated serum glucose levels. Treatment of diabetes aims at restoring glycaemic control. In Type 1 diabetes, this can be achieved by injecting insulin. Oral hypoglycaemic medications that stimulate insulin secretion and/or modify glucose metabolism can be used as a first-line treatment in Type 2 diabetes mellitus. However, insulin is usually necessary in later phases of the disease. Lifestyle changes, such as diet and exercise, are also important. Glycaemic control can be measured by fasting blood glucose levels and also by glycosylated haemoglobin levels. The latter measure gives an indication of glycaemic control over a period of three months, and a reduction in glycosylated haemoglobin is the most appropriate treatment goal in the management of diabetes.
Collapse
Affiliation(s)
- B Charbonnel
- Clinique d'Endocrinologie, Nantes cedex, France.
| |
Collapse
|
20
|
Delfan M, Delphan M, Kordi MR, Ravasi AA, Safa M, Gorgani-Firuzjaee S, Fatemi A, Bandarian F, Nasli-Esfahani E. High intensity interval training improves diabetic cardiomyopathy via miR-1 dependent suppression of cardiomyocyte apoptosis in diabetic rats. J Diabetes Metab Disord 2020; 19:145-152. [PMID: 32550164 DOI: 10.1007/s40200-019-00485-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
Abstract
Purpose Diabetes and its complications such as diabetic cardiomyopathy still account for significant morbidity and mortality. High-quality evidence was shown the importance of exercise in controlling diabetes complications, but the molecular mechanism on diabetic cardiomyopathy is not yet fully understood. This study aimed to compare and investigate the effect of high intensity interval training (HIIT) and continuous endurance training (CET) on the signaling pathway of diabetic cardiomyopathy. Methods Hence, 21 Wistar rats with an average weight of 260 ± 10 g, after induction of diabetes (STZ 50 mg/kg BW) were randomly divided into three groups (control, CET and HIIT; n = 7). Training programs were conducted 5 days a week for 5 weeks. CET program was defined as running at 60% vVO2max for 30 min in each session and the HIIT program was defined as running at 85-90% vVO2max for 3 min followed by 1 min recovery (30-35% vVO2max), that was repeated four times in each session. The cardiac performance was analyzed via determination of end systolic and diastolic dimensions and the ejection fraction by echocardiography. To elucidate the responsible molecular mechanism of miR-1, IGF-1 and IGF-1R mRNA and apoptosis marker protein expression were investigated. Results Both training programs specifically HIIT, significantly reduced the blood glucose, enhanced heart performance, reduced miR-1 expression, induced IGF-1 and IGF-1R expression and reduced apoptotic protein expression. Conclusion We showed that HIIT is more effective than CET for reduction of diabetic cardiomyopathy as a complication of diabetes in animal models through suppressing miR-1 and its downstream apoptosis pathway.
Collapse
Affiliation(s)
- Maryam Delfan
- Department of Exercise Physiology, Faculty of Sport Sciences, Alzahra University, Tehran, Iran
| | - Mahmoud Delphan
- Department of Physical Education and Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Mohammd Reza Kordi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Ali Asghar Ravasi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Majid Safa
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sattar Gorgani-Firuzjaee
- Department of Medical Laboratory Sciences, School of Allied Health Medicine, AJA University of Medical sciences, Tehran, Iran
| | - Ahmad Fatemi
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Department Hematology, School of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Bandarian
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th floor, Shariati Hopital, North Kargar Ave., Tehran, Iran
| |
Collapse
|
21
|
Fiallo‐Scharer R, Palta M, Chewning BA, Rajamanickam V, Wysocki T, Wetterneck TB, Cox ED. Impact of family-centered tailoring of pediatric diabetes self-management resources. Pediatr Diabetes 2019; 20:1016-1024. [PMID: 31355957 PMCID: PMC6827338 DOI: 10.1111/pedi.12899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The American Diabetes Association recommends a family-centered approach that addresses each family's specific type 1 diabetes self-management barriers. OBJECTIVE To assess an intervention that tailored delivery of self-management resources to families' specific self-management barriers. SUBJECTS At two sites, 214 children 8-16 years old with type 1 diabetes and their parent(s) were randomized to receive tailored self-management resources (intervention, n = 106) or usual care (n = 108). METHODS Our intervention (1) identified families' self-management barriers with a validated survey, (2) tailored self-management resources to identified barriers, and (3) delivered the resources as four group sessions coordinated with diabetes visits. Mixed effects models with repeated measures were fit to A1c as well as parent and child QOL during the intervention and 1 year thereafter. RESULTS Participants were 44% youth (8-12 years) and 56% teens (13-16 years). No intervention effect on A1c or QOL was shown, combining data from sites and age groups. Analyzing results by site and age group, post-intervention A1c for teens at one site declined by 0.06 more per month for intervention teens compared to usual care (P < 0.05). In this group, post-intervention A1c declined significantly when baseline A1c was >8.5 (-0.08, P < 0.05), with an even larger decline when baseline A1c was >10 (-0.19, P < 0.05). In addition, for these teens, the significant improvements in A1c resulted from addressing barriers related to motivation to self-manage. Also at this site, mean QOL increased by 0.61 points per month more during the intervention for parents of intervention youth than for usual care youth (P < 0.05). CONCLUSIONS Tailored self-management resources may improve outcomes among specific populations, suggesting the need to consider families' self-management barriers and patient characteristics before implementing self-management resources.
Collapse
Affiliation(s)
- Rosanna Fiallo‐Scharer
- Department of PediatricsMedical College of Wisconsin/Children's Hospital of WisconsinMilwaukeeWisconsin
| | - Mari Palta
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin,Department of Biostatistics and Medical InformaticsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| | - Betty A. Chewning
- Sonderegger Research Center, Division of Social and Administrative Sciences in Pharmacy, School of PharmacyUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Victoria Rajamanickam
- Department of Biostatistics and Medical InformaticsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| | - Tim Wysocki
- Center for Health Care Delivery ScienceNemours Children's Health SystemJacksonvilleFlorida
| | - Tosha B. Wetterneck
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| | - Elizabeth D. Cox
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin,Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| |
Collapse
|
22
|
Zuo X, Liu X, Chen R, Ou H, Lai J, Zhang Y, Yan D. An in-depth analysis of glycosylated haemoglobin level, body mass index and left ventricular diastolic dysfunction in patients with type 2 diabetes. BMC Endocr Disord 2019; 19:88. [PMID: 31455303 PMCID: PMC6712657 DOI: 10.1186/s12902-019-0419-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Glycosylated hemoglobin (HbA1c) has a detrimental impact on the myocardium with left ventricular (LV) diastolic dysfunction. Obesity is a risk factor of type 2 diabetes. To understand the relationships between HbA1c, body mass index (BMI) and LV diastolic dysfunction, we performed this interaction analysis in patients with type 2 diabetes. METHODS Total 925 type 2 diabetes patients were selected from the patients who were diagnosed and treated at the First Affiliated Hospital of Shenzhen University. Patients' BMI levels were defined as normal (BMI < 24 kg/m2) and overweight /obese (BMI ≥ 24 kg/m2). Patients' HbA1c levels were grouped as HbA1c ≥ 9%、7% ≤ HbA1c < 9% and HbA1c < 7%. Logistic regression, stratified, interaction analysis, multivariate Cox regression and curve fitting analysis were performed to investigate the correlations and interactions between HbA1c and BMI with LV diastolic dysfunction. RESULTS The BMI levels were significantly associated with LV diastolic dysfunction in the patients with type 2 diabetes [adjusted model: 1.12 (1.05, 1.20), P = 0.001]. While HbA1c levels had association with LV diastolic dysfunction only in normal BMI group patients [adjusted model: 1.14 (1.01, 1.30), P = 0.0394] and curve correlation was observed. There was a significant interaction between BMI and HbA1c to affect LV diastolic dysfunction (P = 0.0335). Cox regression model analysis showed that the risk of LV diastolic dysfunction was a U type correlation with HbA1c levels in the normal weight group and the turning point was HbA1c at 10%. HbA1c level was not found to have a significant association with LV diastolic dysfunction in overweight/obese group. CONCLUSIONS In patients with type 2 diabetes, correlation between LV diastolic dysfunction and HbA1c was interactively affected by BMI. Glycemic control is beneficial to the heart function in normal body weight patients. For overweight/obese patients, the risk of LV diastolic dysfunction was not determined by the HbA1c level, indicating it may be affected by other confounding factors.
Collapse
Affiliation(s)
- Xin Zuo
- Department of Endocrinology, Xiangya-Shenzhen Endocrinology and Metabolism Center, the First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Xueting Liu
- Department of Endocrinology, Xiangya-Shenzhen Endocrinology and Metabolism Center, the First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Runtian Chen
- Department of Endocrinology, Xiangya-Shenzhen Endocrinology and Metabolism Center, the First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Huiting Ou
- Department of Endocrinology, Xiangya-Shenzhen Endocrinology and Metabolism Center, the First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Jiabao Lai
- Department of Endocrinology, Xiangya-Shenzhen Endocrinology and Metabolism Center, the First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Youming Zhang
- Genomic and Environmental Medicine Section, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, SW3 6LY, UK.
| | - Dewen Yan
- Department of Endocrinology, Xiangya-Shenzhen Endocrinology and Metabolism Center, the First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China.
| |
Collapse
|
23
|
Choudhary P, de Portu S, Delbaere A, Lyon J, Pickup JC. A modelling study of the budget impact of improved glycaemic control in adults with Type 1 diabetes in the UK. Diabet Med 2019; 36:988-994. [PMID: 30710449 DOI: 10.1111/dme.13924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/08/2023]
Abstract
AIMS To develop a novel interactive budget impact model that assesses affordability of diabetes treatments in specific populations, and to test the model in a hypothetical scenario by estimating cost savings resulting from reduction in HbA1c from ≥69 mmol/mol (8.5%) to a target of 53 mmol/mol (7.0%) in adults with Type 1 diabetes in the UK. METHODS A dynamic, interactive model was created using the projected incidence and progression over a 5-year horizon of diabetes-related complications (micro- and macrovascular disease, severe hypoglycaemia and diabetic ketoacidosis) for different HbA1c levels, with flexible input of population size, complications and therapy costs, HbA1c distribution and other variables. The model took a National Health Service and societal perspective. RESULTS The model was developed, and in the proposed hypothetical situation, reductions in complications and expected costs evaluated. Achievement of target HbA1c in individuals with HbA1c ≥69 mmol/mol (8.5%) would reduce expected chronic complications from 6.8 to 1.2 events per 100 person-years, and diabetic ketoacidosis from 14.5 to 1.0 events per 100 person-years. Potential cumulative direct cost savings achievable in the modelled population were estimated at £687 m over 5 years (£5,585/person), with total (direct and indirect) savings of £1,034 m (£8,400/person). CONCLUSIONS Implementation of strategies aimed at achieving target glucose levels in people with Type 1 diabetes in the UK has the potential to drive a significant reduction in complication costs. This estimate may provide insights into the potential for investment in achieving savings through improved diabetes care in the UK.
Collapse
Affiliation(s)
- P Choudhary
- King's College London School of Life Course Sciences, London, UK
| | - S de Portu
- Medtronic International Trading, Tolochenaz, Switzerland
| | - A Delbaere
- Medtronic International Trading, Tolochenaz, Switzerland
| | - J Lyon
- Medtronic UK, Watford, UK
| | - J C Pickup
- King's College London School of Life Course Sciences, London, UK
| |
Collapse
|
24
|
Hanna RM, Barsoum M, Arman F, Selamet U, Hasnain H, Kurtz I. Nephrotoxicity induced by intravitreal vascular endothelial growth factor inhibitors: emerging evidence. Kidney Int 2019; 96:572-580. [PMID: 31229276 DOI: 10.1016/j.kint.2019.02.042] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 01/19/2023]
Abstract
Vascular endothelial growth factor (VEGF) inhibitors have emerged as powerful tools to treat malignant neoplasms and ocular diseases by virtue of their ability to inhibit angiogenesis. Recent data indicate that intravitreal injections of VEGF inhibitors can lead to significant systemic absorption as well as a measurable reduction of plasma VEGF activity. There is increasing evidence showing that vitreal absorption of these drugs is associated with cases of accelerated hypertension, worsening proteinuria, glomerular disease, thrombotic microangiopathy, and possible chronic renal function decline. In this review, the 3 most commonly used anti-VEGF agents-bevacizumab, ranibizumab, and aflibercept-are discussed, highlighting their intravitreal absorption and associated effects on the kidney as a target organ system. We provide clinical suggestions for clinicians to both better manage patients receiving anti-VEGF agents intravitreally and detect any putative systemic renal effects of these agents. While acknowledging the risks of aberrant retinal angiogenesis, it is important for clinicians to be aware of the potential for adverse renal risks with use of these agents.
Collapse
Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA.
| | - Marina Barsoum
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Farid Arman
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Umut Selamet
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Huma Hasnain
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Ira Kurtz
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA; UCLA Brain Research Institute, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| |
Collapse
|
25
|
Valentini A, Cianfarani MA, De Meo L, Morabito P, Romanello D, Tarantino U, Federici M, Bertoli A. FRAX tool in type 2 diabetic subjects: the use of HbA 1c in estimating fracture risk. Acta Diabetol 2018; 55:1043-1050. [PMID: 29980834 DOI: 10.1007/s00592-018-1187-y] [Citation(s) in RCA: 8] [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: 04/06/2018] [Accepted: 06/30/2018] [Indexed: 12/18/2022]
Abstract
AIMS Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fractures, despite having greater bone mineral density (BMD) than non-diabetic subjects. This has led to the hypothesis that the presence of impaired bone quality among diabetics reduces bone strength. The Fracture Risk Assessment Score (FRAX) algorithm, introduced to facilitate the evaluation of fracture risk, underestimates the risk of fracture in diabetic patients. The purpose of this study is to confirm the relationship between the degree of metabolic compensation and the 10-year probability of a major fracture or a hip osteoporotic fracture observed in our previous study and to ascertain whether glycosylated hemoglobin (HbA1c) can improve the predictive value of FRAX in patients with T2DM. METHODS Our data derive from a retrospective clinical study conducted at the "Tor Vergata" Polyclinic in Rome on 6355 subjects over 50 years of age evaluated for osteoporosis. All available clinical records were examined. HbA1c was available for 242 of these subjects and all had had a Dual-energy X-ray Absorption (DXA) scan of the lumbar spine and femoral neck. The risk of fracture was estimated using the Italian version of the FRAX algorithm. RESULT Patients with T2DM had BMD and T-scores higher than those of non-diabetic subjects, while FRAX average values were higher in the non-diabetic group. HbA1c and FRAX are inversely correlated with each other: for each incremental percentage point of HbA1c growth, the FRAX major osteoporotic fracture probability is reduced by 0.915 points and the FRAX hip osteoporotic fracture probability by 1.438 points. The introduction of a correction factor derived from HbA1c, resulted in mean FRAX values of diabetic patients equivalent to those of non-diabetic subjects. CONCLUSIONS We propose a correction factor derived from HbA1c that could enhance the predictive ability of fracture risk estimated by the FRAX algorithm in subjects with T2DM.
Collapse
Affiliation(s)
- Alessia Valentini
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Maria Assunta Cianfarani
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Livia De Meo
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Pasquale Morabito
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Daniele Romanello
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Roma "Tor Vergata", Rome, Italy
| | - Massimo Federici
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Aldo Bertoli
- Department of Systems' Medicine, University of Roma "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| |
Collapse
|
26
|
Goodarzi F, Zahed S, Hassanzadeh A, Esfahani MN, Nourian M, Zamani-Alavijeh F. The effects of mobile text messages on raising knowledge of men with type 2 diabetes, Isfahan, 2015: an educational experimental study. Electron Physician 2018; 10:7243-7248. [PMID: 30214708 PMCID: PMC6122863 DOI: 10.19082/7243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 03/12/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Diabetes is one of the most common metabolic disorders which are rapidly increasing. Distance training is a cost-effective, easy and accessible way in which time and place dimensions of communication are removed. OBJECTIVE To determine the effects of mobile text messages on raising knowledge of men with type 2 diabetes. METHODS This educational experiment recruited 76 people selected by convenient sampling from a population of male patients with type 2 diabetes presenting to Sedigheh Tahereh Research Center in Isfahan, Iran, in 2015. They were randomly assigned into intervention and control groups. Data were collected with a questionnaire of demographic characteristics and questions pertaining to the variable of knowledge, through interview. The intervention group received training and follow-up through cell phones and text messages for 12 weeks. Data were analyzed in IBM-SPSS version 20 using Mann-Whitney test, Chi-square, Independent-samples t-test and paired-samples t-test. RESULTS Findings suggested that patients' knowledge in both groups significantly increased after the training (p<0.001). However, this rise in the intervention group was significantly higher than that of the control group (p<0.001). CONCLUSION The results indicated that designing and implementing educational programs based on text messages and cell phones can improve knowledge in diabetics.
Collapse
Affiliation(s)
- Fataneh Goodarzi
- M.Sc., Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shakiba Zahed
- Ph.D. Candidate, Department of Health Education and Promotion, School of Heath, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Lecturer, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmood Nasr Esfahani
- Manager, Department of Patient Health Education, Alzahra University Hospital, Isfahan University of Medical Science, Isfahan, Iran
| | - Mojgan Nourian
- Assistant Professor, Department of Community Nutrition and Food Science Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Associate Professor, Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
27
|
Comparative study of antihypertensive and antioxidant effects of clove and metformin on renal dysfunction in streptozotocin-induced diabetic rats. PHARMANUTRITION 2018. [DOI: 10.1016/j.phanu.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
28
|
Mostafa SA, Coleman RL, Agbaje OF, Gray AM, Holman RR, Bethel MA. Modelling incremental benefits on complications rates when targeting lower HbA 1c levels in people with Type 2 diabetes and cardiovascular disease. Diabet Med 2018; 35:72-77. [PMID: 29057545 DOI: 10.1111/dme.13533] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 01/01/2023]
Abstract
AIM Glucose-lowering interventions in Type 2 diabetes mellitus have demonstrated reductions in microvascular complications and modest reductions in macrovascular complications. However, the degree to which targeting different HbA1c reductions might reduce risk is unclear. METHODS Participant-level data for Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) participants with established cardiovascular disease were used in a Type 2 diabetes-specific simulation model to quantify the likely impact of different HbA1c decrements on complication rates. Ten-year micro- and macrovascular rates were estimated with HbA1c levels fixed at 86, 75, 64, 53 and 42 mmol/mol (10%, 9%, 8%, 7% and 6%) while holding other risk factors constant at their baseline levels. Cumulative relative risk reductions for each outcome were derived for each HbA1c decrement. RESULTS Of 5717 participants studied, 72.0% were men and 74.2% White European, with a mean (sd) age of 66.2 (7.9) years, systolic blood pressure 134 (16.9) mmHg, LDL-cholesterol 2.3 (0.9) mmol/l, HDL-cholesterol 1.13 (0.3) mmol/l and median Type 2 diabetes duration 9.6 (5.1-15.6) years. Ten-year cumulative relative risk reductions for modelled HbA1c values of 75, 64, 53 and 42 mmol/mol, relative to 86 mmol/mol, were 4.6%, 9.3%, 15.1% and 20.2% for myocardial infarction; 6.0%, 12.8%, 19.6% and 25.8% for stroke; 14.4%, 26.6%, 37.1% and 46.4% for diabetes-related ulcer; 21.5%, 39.0%, 52.3% and 63.1% for amputation; and 13.6%, 25.4%, 36.0% and 44.7 for single-eye blindness. CONCLUSIONS These simulated complication rates might help inform the degree to which complications might be reduced by targeting particular HbA1c reductions in Type 2 diabetes.
Collapse
Affiliation(s)
- S A Mostafa
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism
| | - R L Coleman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism
| | - O F Agbaje
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism
| | - A M Gray
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford
| | - R R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - M A Bethel
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism
| |
Collapse
|
29
|
Dimova R, Tankova T, Chakarova N. Vitamin D in the Spectrum of Prediabetes and Cardiovascular Autonomic Dysfunction. J Nutr 2017; 147:1607-1615. [PMID: 28768837 DOI: 10.3945/jn.117.250209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/27/2017] [Accepted: 06/30/2017] [Indexed: 11/14/2022] Open
Abstract
Vitamin D is a fat-soluble secosteroid hormone with pleiotropic effects. 1,25-Dihydroxyvitamin D coordinates the biosynthesis of neurotransmitters in the central nervous system, which regulate cardiovascular autonomic function and may explain its putative role in the development of cardiovascular autonomic neuropathy (CAN). CAN is an independent risk factor for mortality in patients with diabetes and prediabetes and is associated with an increased risk of developing type 2 diabetes and cardiovascular disease. Accumulating data indicate the presence of peripheral nerve injury at these early stages of dysglycemia and its multifactorial pathogenesis. Prediabetes is associated with vitamin D insufficiency. Vitamin D is proposed to prevent the progression of glucose intolerance. The putative underlying mechanisms include maintenance of the intracellular calcium concentration, direct stimulation of insulin receptor expression, and enhancement of the insulin response to glucose transporters. Vitamin D exerts a protective effect on peripheral nerve fibers by decreasing the demyelination process and inducing axonal regeneration. The effects of vitamin D supplementation on glucose tolerance and related autonomic nerve dysfunction have been a recent focus of scientific interest. Although well-designed observational studies are available, the causative relation between vitamin D deficiency, glucose intolerance, and CAN is still debatable. One reason might be that interventional studies are unpersuasive with regard to the beneficial clinical effects of vitamin D supplementation. Because of its favorable side effect profile, vitamin D supplementation might represent an attractive therapeutic option for treating the pandemic prevalence of prediabetes and vitamin D deficiency. Vitamin D supplementation can improve glucose tolerance and cardiovascular autonomic function and can thus reduce cardiovascular mortality among subjects with different stages of glucose intolerance and autonomic dysfunction. However, more patient-centered trials on the use of vitamin D supplementation in different conditions are needed.
Collapse
Affiliation(s)
- Rumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University, Sofia, Sofia, Bulgaria
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University, Sofia, Sofia, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University, Sofia, Sofia, Bulgaria
| |
Collapse
|
30
|
Christiansen SC, Fougner AL, Stavdahl Ø, Kölle K, Ellingsen R, Carlsen SM. A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach. Diabetes Ther 2017; 8:489-506. [PMID: 28503717 PMCID: PMC5446388 DOI: 10.1007/s13300-017-0263-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range. METHODS Based on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach. Finally, we discuss safety measures and the achievements reported in some recent AP studies that have utilized the double SC approach. RESULTS Most studies show that a double SC AP increases the time in range compared to a sensor-augmented insulin pump and shortens the time in hypoglycemia. Despite these achievements, the proportion of time spent in hyperglycemia is still roughly 20-40%, and hypoglycemia is still present 1-4% of the time. The main factors limiting further progress are the latency of SC CGM (at least 5-10 min) and the slow pharmacokinetics of SC-delivered fast-acting insulin. The maximum blood insulin level is reached after 45 min and the maximum glucose-lowering effect is observed after 1.5-2 h, while the glucose-lowering effect lasts for at least 5 h. CONCLUSIONS Although using a double SC AP leads to significant improvements in glucose control, the SC approach has severe limitations that hamper further progress towards a robust AP.
Collapse
Affiliation(s)
- Sverre Christian Christiansen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anders Lyngvi Fougner
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, Stjørdal, Norway
| | - Øyvind Stavdahl
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Konstanze Kölle
- Department of Engineering Cybernetics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Central Norway Regional Health Authority, Stjørdal, Norway
| | - Reinold Ellingsen
- Department of Electronic Systems, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sven Magnus Carlsen
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
31
|
Dimova R, Tankova T, Guergueltcheva V, Tournev I, Chakarova N, Grozeva G, Dakovska L. Risk factors for autonomic and somatic nerve dysfunction in different stages of glucose tolerance. J Diabetes Complications 2017; 31:537-543. [PMID: 27894750 DOI: 10.1016/j.jdiacomp.2016.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/30/2022]
Abstract
AIM The present study evaluates autonomic and somatic nerve function in different stages of glucose tolerance and its correlation with different cardio-metabolic parameters. MATERIAL AND METHODS Four hundred seventy-eight subjects, mean age 49.3±13.7years and mean BMI 31.0±6.2kg/m2, divided according to glucose tolerance: 130 with normal glucose tolerance (NGT), 227 with prediabetes (125 with impaired fasting glucose (IFG) and 102 with isolated impaired glucose tolerance (iIGT)), and 121 with newly-diagnosed T2D (NDT2D), were enrolled. Glucose tolerance was studied during OGTT. Antropometric indices, blood pressure, HbA1c, serum lipids, hsCRP and albumin-to-creatinine ratio were assessed. Body composition was estimated by a bioimpedance method (InBody 720, BioSpace). Tissue AGEs accumulation was assessed by skin autofluorescence (AGE-Reader-DiagnOpticsTM). Electroneurography was performed by electromyograph Dantec Keypoint. Cardiovascular autonomic neuropathy (CAN) was assessed by ANX-3.0 method applying standard clinical tests. RESULTS CAN was found in 12.3% of NGT, 19.8% of prediabetes (13.2% of IFG and 20.6% of iIGT), and 32.2% of NDT2D. The prevalence of diabetic sensory polyneuropathy (DSPN) was 5.7% in prediabetes and 28.6% in NDT2D. The panel of age, QTc interval, waist circumference, diastolic blood pressure, and 120-min plasma glucose was related to sympathetic activity (F [5451]=78.50, p<0.001). The panel of age, waist circumference, and QTc interval was related to parasympathetic power (F [3453]=132.26, p<0.001). HbA1c and age were related to sural SNAP (F [2454]=15.12, p<0.001). HbA1c and AGEs were related to sural SNCV (F [2454]=12.18, p<0.001). CONCLUSIONS Our results demonstrate a high prevalence of autonomic and sensory nerve dysfunction in early stages of glucose intolerance. Age, postprandial glycemia, central obesity, diastolic blood pressure and QTc interval outline as predictive markers of CAN; hyperglycemia, glycation and age of DSPN.
Collapse
Affiliation(s)
- Rumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria.
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria
| | | | - Ivailo Tournev
- Department of Neurology, Medical University Sofia, Sofia, 1431, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria
| | - Greta Grozeva
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria
| | - Lilia Dakovska
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, 1431, Bulgaria
| |
Collapse
|
32
|
Miyake H, Kanazawa I, Sugimoto T. Decreased serum insulin-like growth factor-I level is associated with the increased mortality in type 2 diabetes mellitus. Endocr J 2016; 63:811-818. [PMID: 27349183 DOI: 10.1507/endocrj.ej16-0076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mortality is increased in type 2 diabetes mellitus (T2DM). Although previous studies showed that decreased serum insulin-like growth factor-I (IGF-I) levels are associated with diabetic complications, little is known about the association between serum IGF-I level and the mortality in patients with T2DM. This is a historical cohort study with end-point of all-cause mortality in 234 men and 191 women with T2DM. Standard deviation of serum IGF-I [IGF-I (SD)] was calculated by adjusting for age and gender. Of 234 male and 191 female, 46 and 25 patients died, respectively, for the follow-up period of almost 7 years. Unadjusted survival analyses showed that lower IGF-I was associated with higher mortality in men and women (p<0.001 and p=0.004, respectively). In Cox regression analyses adjusted for age, duration of diabetes, body mass index, HbA1c, and serum creatinine, serum IGF-I was inversely associated with the mortality [men, hazard ratio (HR)=0.40, 95% confidence interval (CI)=0.25-0.64 per SD increase, p<0.001; women, HR=0.28, 95%CI 0.08-0.96, p=0.043]. When IGF-I was replaced to IGF-I (SD), the relationships are still significant. After additional adjustments for serum albumin, systolic blood pressure, ALT, LDL-cholesterol, smoking, and past history of cardiovascular disease, the association between serum IGF-I and the mortality in men remained significant (HR=0.31, 95%CI 0.15-0.65, p=0.002), but not in women. The present study showed that lower serum IGF-I levels were associated with the increased all-cause mortality in patients with T2DM, suggesting that serum IGF-I could be clinically useful for assessing the risk of mortality in the population.
Collapse
Affiliation(s)
- Hitomi Miyake
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
| | | | | |
Collapse
|
33
|
Chandalia HB, Thadani PM. Glycemic targets in diabetes. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
34
|
Nicolucci A, Buseghin G, De Portu S. Short-term cost analysis of complications related to glycated hemoglobin in patients with type 1 diabetes in the Italian setting. Acta Diabetol 2016; 53:199-204. [PMID: 25943859 DOI: 10.1007/s00592-015-0755-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
AIMS The aim of this study is to assess the impact of the diabetes-related complications on costs and to shed light on the potential savings that could be obtained by the National Healthcare System if better glycemic control was to be achieved in the type 1 diabetes population. METHODS Epidemiologic data were used to distribute diabetes type 1 patients into A1c levels, and the relative risk of diabetes-related complications associated with the level of A1c was extrapolated from published risk curves. The costs associated with all complications in the Italian settings, retrieved from published literature, were used to estimate the economic impact of complications in each A1c level from the NHS perspective and the potential savings that could be obtained should a treatment strategy allow to achieve better metabolic control. RESULTS The reduction in the number of complications translates into consistent monetary savings compared to current scenario. Within 5 years, €29 and €33 million would be saved if all patients reduced their A1c level by 1 % and within the range 7-8 % (53-64 mmol/mol), respectively. CONCLUSIONS This work allows focusing on the impact of managing the diabetes-related complications on the overall costs, not yet reported in the literature. It was shown that the potential savings for the National Healthcare Service associated with a more effective glycemic control are substantial.
Collapse
Affiliation(s)
| | | | - Simona De Portu
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| |
Collapse
|
35
|
Gregory JM, Kraft G, Scott MF, Neal DW, Farmer B, Smith MS, Hastings JR, Allen EJ, Donahue EP, Rivera N, Winnick JJ, Edgerton DS, Nishimura E, Fledelius C, Brand CL, Cherrington AD. Insulin Delivery Into the Peripheral Circulation: A Key Contributor to Hypoglycemia in Type 1 Diabetes. Diabetes 2015; 64:3439-51. [PMID: 26085570 PMCID: PMC4587648 DOI: 10.2337/db15-0071] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/10/2015] [Indexed: 12/25/2022]
Abstract
Hypoglycemia limits optimal glycemic control in type 1 diabetes mellitus (T1DM), making novel strategies to mitigate it desirable. We hypothesized that portal (Po) vein insulin delivery would lessen hypoglycemia. In the conscious dog, insulin was infused into the hepatic Po vein or a peripheral (Pe) vein at a rate four times of basal. In protocol 1, a full counterregulatory response was allowed, whereas in protocol 2, glucagon was fixed at basal, mimicking the diminished α-cell response to hypoglycemia seen in T1DM. In protocol 1, glucose fell faster with Pe insulin than with Po insulin, reaching 56 ± 3 vs. 70 ± 6 mg/dL (P = 0.04) at 60 min. The change in area under the curve (ΔAUC) for glucagon was similar between Pe and Po, but the peak occurred earlier in Pe. The ΔAUC for epinephrine was greater with Pe than with Po (67 ± 17 vs. 36 ± 14 ng/mL/180 min). In protocol 2, glucose also fell more rapidly than in protocol 1 and fell faster in Pe than in Po, reaching 41 ± 3 vs. 67 ± 2 mg/dL (P < 0.01) by 60 min. Without a rise in glucagon, the epinephrine responses were much larger (ΔAUC of 204 ± 22 for Pe vs. 96 ± 29 ng/mL/180 min for Po). In summary, Pe insulin delivery exacerbates hypoglycemia, particularly in the presence of a diminished glucagon response. Po vein insulin delivery, or strategies that mimic it (i.e., liver-preferential insulin analogs), should therefore lessen hypoglycemia.
Collapse
Affiliation(s)
- Justin M Gregory
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Guillaume Kraft
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Melanie F Scott
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Doss W Neal
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Ben Farmer
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Marta S Smith
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Jon R Hastings
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Eric J Allen
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - E Patrick Donahue
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Noelia Rivera
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Jason J Winnick
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Dale S Edgerton
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | | | | | | | - Alan D Cherrington
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
36
|
Abstract
IN BRIEF Insulin therapy is challenging for providers as well as for patients. This article describes a set of principles underlying appropriate insulin treatment and a detailed discussion of how to use them.
Collapse
|
37
|
Abstract
Diabetic nephropathy (DN) is the most common cause of end-stage renal disease (ESRD). About 20%-30% of people with type 1 and type 2 diabetes develop DN. DN is characterized by both glomerulosclerosis with thickening of the glomerular basement membrane and mesangial matrix expansion, and tubulointerstitial fibrosis. Hyperglycemia and the activation of the intra-renal renin-angiotensin system (RAS) in diabetes have been suggested to play a critical role in the pathogenesis of DN. However, the mechanisms are not well known. Studies from our laboratory demonstrated that the transcription factor-upstream stimulatory factor 2 (USF2) is an important regulator of DN. Moreover, the renin gene is a downstream target of USF2. Importantly, USF2 transgenic (Tg) mice demonstrate a specific increase in renal renin expression and angiotensin II (AngII) levels in kidney and exhibit increased urinary albumin excretion and extracellular matrix deposition in glomeruli, supporting a role for USF2 in the development of diabetic nephropathy. In this review, we summarize our findings of the mechanisms by which diabetes regulates USF2 in kidney cells and its role in regulation of renal renin-angiotensin system and the development of diabetic nephropathy.
Collapse
Affiliation(s)
- Shuxia Wang
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA
| |
Collapse
|
38
|
Efremova NV, Bolotskaya LL, Atarshchikov DS, Bondarenko ON, Ilyin AV, Shestakova MV. [Use of human insulin analogues in young patients with type 1 diabetes mellitus: Results of the RESULT observational program on the use of insulin glargine (Lantus) in combination with insulin glulisine (Apidra) as a basal-bolus regimen]. TERAPEVT ARKH 2015; 87:42-49. [PMID: 26978173 DOI: 10.17116/terarkh2015871042-49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To implement in 2009-2012 the RESULT observational program on the use of insulin glargine (Lantus) in combination with insulin glulisine (Apidra) as a basal-bolus regimen in patients with type 1 diabetes mellitus (DM) to evaluate the efficiency and safety of therapy with human insulin analogues. MATERIAL AND METHODS The program covered 100 patients aged 19 to 25 years from 7 regions of the Russian Federation, who had had DM onset at the age of 9-13 years, were using human recombinant insulins as continuous insulin therapy, and had glycated hemoglobin (HbA1c) levels of 7 to 9%. The main inclusion criterion was switching to insulin therapy with the human insulin analogues Lantus and Apidra. RESULTS A total 41 men and 59 women were followed up. Their mean baseline HbA1c level was 8.3±0.7%. After 24 months of therapy, HbA1c was significantly decreased to 7.7±0.7%; its change compared with that at Visit 1 was -0.6±0.6% (p<0.001). There was a significant reduction in fasting and postprandial blood glucose levels at 3 months of a follow-up. The number of symptomatic and asymptomatic glycemic episodes declined. No nocturnal or severe hypoglycemic episodes were recorded at 24 months of therapy. Microvascular complications did not progress during the follow-up. CONCLUSION The use of human insulin analogues is effective and safe in treating young diabetic patients, improves their quality of life and confers no risk of asymptomatic or nocturnal hypoglycemic states.
Collapse
Affiliation(s)
- N V Efremova
- Endocrinology Research Centre, Ministry of Health of Russia, Moscow, Russia
| | - L L Bolotskaya
- Endocrinology Research Centre, Ministry of Health of Russia, Moscow, Russia
| | - D S Atarshchikov
- Endocrinology Research Centre, Ministry of Health of Russia, Moscow, Russia
| | - O N Bondarenko
- Endocrinology Research Centre, Ministry of Health of Russia, Moscow, Russia
| | - A V Ilyin
- Endocrinology Research Centre, Ministry of Health of Russia, Moscow, Russia
| | - M V Shestakova
- Endocrinology Research Centre, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
39
|
Diabetes and Heart Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Alonso-Morán E, Orueta JF, Fraile Esteban JI, Arteagoitia Axpe JM, Marqués González ML, Toro Polanco N, Ezkurra Loiola P, Gaztambide S, Nuño-Solinis R. The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country. BMC Public Health 2014; 14:1059. [PMID: 25300610 PMCID: PMC4197247 DOI: 10.1186/1471-2458-14-1059] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is associated with a diverse range of pathologies. The aim of the study was to determine the incidence of diabetes-related complications, the prevalence of coexistent chronic conditions and to report multimorbidity in people with type 2 diabetes living in the Basque Country. METHODS Administrative databases, in four cross sections (annually from 2007 to 2011) were consulted to analyse 149,015 individual records from patients aged ≥ 35 years with type 2 diabetes mellitus. The data observed were: age, sex, diabetes-related complications (annual rates of acute myocardial infarction, major amputations and avoidable hospitalisations), diabetes-related pathologies (prevalence of ischaemic heart disease, renal failure, stroke, heart failure, peripheral neuropathy, foot ulcers and diabetic retinopathy) and other unrelated pathologies (44 diseases). RESULTS The annual incidence for each condition progressively decreased during the four-year period: acute myocardial infarction (0.47 to 0.40%), major amputations (0.10 to 0.08%), and avoidable hospitalisations (5.85 to 5.5%). The prevalence for diabetes-related chronic pathologies was: ischaemic heart disease (11.5%), renal failure (8.4%), stroke (7.0%), heart failure (4.3%), peripheral neuropathy (1.3%), foot ulcers (2.0%) and diabetic retinopathy (7.2%). The prevalence of multimorbidity was 90.4%. The highest prevalence for other chronic conditions was 73.7% for hypertension, 13.8% for dyspepsia and 12.7% for anxiety. CONCLUSIONS In the type 2 diabetes mellitus population living in the Basque Country, incidence rates of diabetes complications are not as high as in other places. However, they present a high prevalence of diabetes related and unrelated diseases. Multimorbidity is very common in this group, and is a factor to be taken into account to ensure correct clinical management.
Collapse
Affiliation(s)
- Edurne Alonso-Morán
- O + berri, Basque Institute for Healthcare Innovation, Torre del BEC (Bilbao Exhibition Centre), Ronda de Azkue 1, 48902 Barakaldo, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Lee JH, Lee JH, Jin M, Han SD, Chon GR, Kim IH, Kim S, Kim SY, Choi SB, Noh YH. Diet control to achieve euglycemia induces significant loss of heart and liver weight via increased autophagy compared with ad libitum diet in diabetic rats. Exp Mol Med 2014; 46:e111. [PMID: 25168310 PMCID: PMC4150935 DOI: 10.1038/emm.2014.52] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/30/2014] [Indexed: 02/06/2023] Open
Abstract
Intensive glucose control increases the all-cause mortality in type 2 diabetes mellitus (T2DM); however, the underlying mechanisms remain unclear. We hypothesized that strict diet control to achieve euglycemia in diabetes damages major organs, increasing the mortality risk. To evaluate effects on major organs when euglycemia is obtained by diet control, we generated a model of end-stage T2DM in 13-week-old Sprague-Dawley rats by subtotal pancreatectomy, followed by ad libitum feeding for 5 weeks. We divided these rats into two groups and for the subsequent 6 weeks provided ad libitum feeding to half (AL, n=12) and a calorie-controlled diet to the other half (R, n=12). To avoid hypoglycemia, the degree of calorie restriction in the R group was isocaloric (g per kg body weight per day) compared with a sham-operated control group (C, n=12). During the 6-week diet control period, AL rats ate three times more than rats in the C or R groups, developing hyperglycemia with renal hyperplasia. R group achieved euglycemia but lost overall body weight significantly compared with the C or AL group (49 or 22%, respectively), heart weight (39 or 23%, respectively) and liver weight (50 or 46%, respectively). Autophagy levels in the heart and liver were the highest in the R group (P<0.01), which also had the lowest pAkt/Akt levels among the groups (P<0.05 in the heart; P<0.01 in the liver). In conclusion, glycemic control achieved by diet control can prevent hyperglycemia-induced renal hyperplasia in diabetes but may be deleterious even at isocaloric rate when insulin is deficient because of significant loss of heart and liver mass via increased autophagy.
Collapse
Affiliation(s)
- Jun-Ho Lee
- Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ju-Han Lee
- 1] Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea [2] Rmedica-Stem Cell, Seoul, Republic of Korea
| | - Mingli Jin
- Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang-Don Han
- Department of Neurology, Konkuk University School of Medicine, Chungju Hospital, Chungju, Republic of Korea
| | - Gyu-Rak Chon
- Department of Pulmonary and Critical Care Medicine, Konkuk University School of Medicine, Chungju Hospital, Chungju, Republic of Korea
| | - Ick-Hee Kim
- Department of Surgery, Konkuk University School of Medicine, Chungju Hospital, Chungju, Republic of Korea
| | - Seonguk Kim
- Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung-Young Kim
- Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Soo-Bong Choi
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju Hospital, Chungju, Republic of Korea
| | - Yun-Hee Noh
- Department of Biochemistry, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
42
|
Alkayyali S, Lyssenko V. Genetics of diabetes complications. Mamm Genome 2014; 25:384-400. [PMID: 25169573 DOI: 10.1007/s00335-014-9543-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/13/2014] [Indexed: 12/11/2022]
Abstract
Chronic hyperglycemia and duration of diabetes are the major risk factors associated with development of micro- and macrovascular complications of diabetes. Although it is believed that hyperglycemia induces damage to the particular cell subtypes, e.g., mesangial cells in the renal glomerulus, capillary endothelial cells in the retina, and neurons and Schwann cells in peripheral nerves, the exact mechanisms underlying these damaging defects are not yet well understood. Clustering of micro- and macrovascular complications in families of patients with diabetes suggests a strong genetic susceptibility. However, until now only a handful number of genetic variants were reported to be associated with either nephropathy (ACE, ELMO1, FRMD3, and AKR1B1) or retinopathy (VEGF, AKR1B1, and EPO), and only a few studies were carried out for genetic susceptibility to cardiovascular diseases (ADIPOQ, GLUL) in patients with diabetes. It is, therefore, obvious that the accumulation of more data from larger studies and better phenotypically characterized cohorts is needed to facilitate genetic discoveries and unravel novel insights into the pathogenesis of diabetic complications.
Collapse
Affiliation(s)
- Sami Alkayyali
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Lund, Sweden,
| | | |
Collapse
|
43
|
Njie-Mbye YF, Kulkarni-Chitnis M, Opere CA, Barrett A, Ohia SE. Lipid peroxidation: pathophysiological and pharmacological implications in the eye. Front Physiol 2013; 4:366. [PMID: 24379787 PMCID: PMC3863722 DOI: 10.3389/fphys.2013.00366] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/25/2013] [Indexed: 01/17/2023] Open
Abstract
Oxygen-derived free radicals such as hydroxyl and hydroperoxyl species have been shown to oxidize phospholipids and other membrane lipid components leading to lipid peroxidation. In the eye, lipid peroxidation has been reported to play an important role in degenerative ocular diseases (age-related macular degeneration, cataract, glaucoma, diabetic retinopathy). Indeed, ocular tissues are prone to damage from reactive oxygen species due to stress from constant exposure of the eye to sunlight, atmospheric oxygen and environmental chemicals. Furthermore, free radical catalyzed peroxidation of long chain polyunsaturated acids (LCPUFAs) such as arachidonic acid and docosahexaenoic acid leads to generation of LCPUFA metabolites including isoprostanes and neuroprostanes that may further exert pharmacological/toxicological actions in ocular tissues. Evidence from literature supports the presence of endogenous defense mechanisms against reactive oxygen species in the eye, thereby presenting new avenues for the prevention and treatment of ocular degeneration. Hydrogen peroxide (H2O2) and synthetic peroxides can exert pharmacological and toxicological effects on tissues of the anterior uvea of several mammalian species. There is evidence suggesting that the retina, especially retinal ganglion cells can exhibit unique characteristics of antioxidant defense mechanisms. In the posterior segment of the eye, H2O2 and synthetic peroxides produce an inhibitory action on glutamate release (using [(3)H]-D-aspartate as a marker), in vitro and on the endogenous glutamate and glycine concentrations in vivo. In addition to peroxides, isoprostanes can elicit both excitatory and inhibitory effects on norepinephrine (NE) release from sympathetic nerves in isolated mammalian iris ciliary bodies. Whereas isoprostanes attenuate dopamine release from mammalian neural retina, in vitro, these novel arachidonic acid metabolites exhibit a biphasic regulatory effect on glutamate release from retina and can regulate amino acid neurotransmitter metabolism without inducing cell death in the retina. Furthermore, there appears to be an inhibitory role for neuroprostanes in the release of excitatory amino acid neurotransmitters in mammalian retina. The ability of peroxides and metabolites of LCPUFA to alter the integrity of neurotransmitter pools provides new potential target sites and pathways for the treatment of degenerative ocular diseases.
Collapse
Affiliation(s)
- Ya Fatou Njie-Mbye
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University Houston, TX, USA
| | - Madhura Kulkarni-Chitnis
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University Houston, TX, USA
| | - Catherine A Opere
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University Omaha, NE, USA
| | - Aaron Barrett
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University Omaha, NE, USA
| | - Sunny E Ohia
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University Houston, TX, USA
| |
Collapse
|
44
|
Analysis of serum and urinal copper and zinc in Chinese northeast population with the prediabetes or diabetes with and without complications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:635214. [PMID: 24175012 PMCID: PMC3794628 DOI: 10.1155/2013/635214] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/21/2013] [Indexed: 01/09/2023]
Abstract
This study investigated the association of copper and zinc levels in the serum or urine of patients living in northeast China, with either prediabetes or diabetes. From January 2010 to October 2011, patients with type 1 diabetes (T1D, n = 25), type 2 diabetes (T2D, n = 137), impaired fasting glucose (IFG, n = 12) or impaired glucose tolerance (IGT, n = 15), and age/gender matched controls (n = 50) were enrolled. In the T2D group, there were 24 patients with nephropathy, 34 with retinopathy, and 50 with peripheral neuropathy. Serum copper levels were significantly higher in IFG, IGT, and T2D groups. Serum zinc level was dramatically lower, and urinary zinc level was significantly higher in both T1D and T2D subjects compared with controls. The serum zinc/copper ratio was significantly lower in all the patients with IFG, ITG, T1D, and T2D. The serum copper level was positively associated with HbA1c in T2D subjects. Simvastatin treatment in T2D patients had no significant effect on serum and urinary copper and zinc. These results suggest the need for further studies of the potential impact of the imbalanced serum copper and zinc levels on metabolic syndrome, diabetes, and diabetic complications.
Collapse
|
45
|
Taub PR, Higginbotham E, Henry RR. Beneficial and detrimental effects of glycemic control on cardiovascular disease in type 2 diabetes. Curr Cardiol Rep 2013; 15:332. [PMID: 23314689 DOI: 10.1007/s11886-012-0332-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Epidemiological data demonstrates that improved regulation of blood glucose correlates with better cardiovascular (CV) outcomes. Conversely, some interventional studies have demonstrated that tight glycemic control has no benefit or can even result in worse CV outcomes. These conclusions parallel the paradox that glycemic control has proven beneficial for microvascular outcomes, while few studies have demonstrated significant macrovascular benefits. This imprecise understanding conveys the need to better comprehend the mechanisms of glycemic control and its impact on CV disease. Such variations in data also require a more comprehensive approach to diabetes and CV disease in which multiple biomarkers such as low density lipoprotein (LDL), low adiponectin, elevated C-reactive protein (CRP) and well established clinical parameters such as high blood pressure, weight, and functional status are incorporated into clinical decision making. Reliance on one parameter in isolation such as glycemic control and one biomarker such as HbA1C does not provide an accurate assessment of CV outcomes.
Collapse
Affiliation(s)
- Pam R Taub
- University of California, San Diego, San Diego, CA, USA.
| | | | | |
Collapse
|
46
|
Musabayane CT. The effects of medicinal plants on renal function and blood pressure in diabetes mellitus. Cardiovasc J Afr 2013; 23:462-8. [PMID: 23044503 PMCID: PMC3721953 DOI: 10.5830/cvja-2012-025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/03/2012] [Indexed: 11/12/2022] Open
Abstract
Abstract Diabetes mellitus is one of the most common chronic global diseases affecting children and adolescents in both the developed and developing nations. The major types of diabetes mellitus are type 1 and type 2, the former arising from inadequate production of insulin due to pancreatic β-cell dysfunction, and the latter from reduced sensitivity to insulin in the target tissues and/or inadequate insulin secretion. Sustained hyperglycaemia is a common result of uncontrolled diabetes and, over time, can damage the heart, eyes, kidneys and nerves, mainly through deteriorating blood vessels supplying the organs. Microvascular (retinopathy and nephropathy) and macrovascular (atherosclerotic) disorders are the leading causes of morbidity and mortality in diabetic patients. Therefore, emphasis on diabetes care and management is on optimal blood glucose control to avert these adverse outcomes. Studies have demonstrated that diabetic nephropathy is associated with increased cardiovascular mortality. In general, about one in three patients with diabetes develops end-stage renal disease (ESRD) which proceeds to diabetic nephropathy (DN), the principal cause of significant morbidity and mortality in diabetes. Hypertension, a well-established major risk factor for cardiovascular disease contributes to ESRD in diabetes. Clinical evidence suggests that there is no effective treatment for diabetic nephropathy and prevention of the progression of diabetic nephropathy. However, biomedical evidence indicates that some plant extracts have beneficial effects on certain processes associated with reduced renal function in diabetes mellitus. On the other hand, other plant extracts may be hazardous in diabetes, as reports indicate impairment of renal function. This article outlines therapeutic and pharmacological evidence supporting the potential of some medicinal plants to control or compensate for diabetes-associated complications, with particular emphasis on kidney function and hypertension.
Collapse
Affiliation(s)
- C T Musabayane
- Department of Human Physiology, Faculty of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| |
Collapse
|
47
|
El-Naggar N, Almansari A, Khudada K, Salman S, Mariswamy N, Abdelfattah W, Hashim F. The A1 chieve study - an observational non-interventional study of patients with type 2 diabetes mellitus initiating or switched to insulin analogue therapy: subgroup analysis of the Gulf population. Int J Clin Pract 2013; 67:128-38. [PMID: 23305475 DOI: 10.1111/ijcp.12078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIM To evaluate the safety and effectiveness of insulin analogues (insulin aspart, insulin detemir and biphasic insulin aspart 30, alone or in combination) in type 2 diabetes mellitus (T2DM) patients in routine clinical practice in the Gulf as a subgroup of the A(1) chieve multi-national study. METHODS A total of 10,704 T2DM Gulf patients with uncontrolled T2DM on oral antidiabetics ± insulins other than insulin aspart, insulin detemir or biphasic insulin aspart 30, who initiated or switched to study insulins were included and followed up for 24 weeks in the context of the A(1) chieve study. RESULTS Baseline HbA(1c) (± SD) was poor: 9.7 ± 1.7%. At Week 24, an improvement in HbA(1c) of -2.3 ± 1.6% was observed in the entire cohort, and -2.4 ± 1.5% and -2.1 ± 1.7% for insulin-naïve patients and prior insulin users respectively. Overall, rates of hypoglycaemia increased in those new to insulin therapy, whereas a reduction was observed in those switching from other insulins. A marginal reduction in body weight (-0.8 ± 4.4 kg) was noted in the entire cohort, whereas the overall lipid profile and systolic blood pressure (-6.2 ± 15.3 mmHg) improved. CONCLUSIONS Initiating or switching to insulin analogues was well tolerated and resulted in significant improvements in glycaemic control in T2DM patients in the Gulf.
Collapse
Affiliation(s)
- N El-Naggar
- Hai AlJamea Hospital, Jeddah, Kingdom of Saudi Arabia.
| | | | | | | | | | | | | |
Collapse
|
48
|
The relationship between quality of self-monitoring and glycemic control in romanian children with type 1 diabetes mellitus. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2012. [DOI: 10.2478/v10255-012-0029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractObjectives: Optimal glycemic control is mandatory in diabetic children andadolescents for the prevention of diabetes complications, but it is difficult to beobtained due to a series of factors, including the limited availability of blood glucoseself-monitoring tests. The aim of our study was to investigate the relationshipbetween the number of daily self-monitoring tests and quality of glycemic control.Material and method: We enrolled 783 individuals previously diagnosed with Type 1Diabetes Mellitus and investigated the significance of differences in HbA1c valuesbetween groups with distinct number of blood glucose measurements at home foreach age group. Results: We found significant improvements of glycemic controlwith the increase in the number of daily tests, with some particularities among thegroups. Conclusions: Among other intrinsic and external factors, blood glucose selfmonitoringhas an important role in obtaining a good glycemic control.
Collapse
|
49
|
König M, Holzhütter HG. Kinetic modeling of human hepatic glucose metabolism in type 2 diabetes mellitus predicts higher risk of hypoglycemic events in rigorous insulin therapy. J Biol Chem 2012; 287:36978-89. [PMID: 22977253 DOI: 10.1074/jbc.m112.382069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A major problem in the insulin therapy of patients with diabetes type 2 (T2DM) is the increased occurrence of hypoglycemic events which, if left untreated, may cause confusion or fainting and in severe cases seizures, coma, and even death. To elucidate the potential contribution of the liver to hypoglycemia in T2DM we applied a detailed kinetic model of human hepatic glucose metabolism to simulate changes in glycolysis, gluconeogenesis, and glycogen metabolism induced by deviations of the hormones insulin, glucagon, and epinephrine from their normal plasma profiles. Our simulations reveal in line with experimental and clinical data from a multitude of studies in T2DM, (i) significant changes in the relative contribution of glycolysis, gluconeogenesis, and glycogen metabolism to hepatic glucose production and hepatic glucose utilization; (ii) decreased postprandial glycogen storage as well as increased glycogen depletion in overnight fasting and short term fasting; and (iii) a shift of the set point defining the switch between hepatic glucose production and hepatic glucose utilization to elevated plasma glucose levels, respectively, in T2DM relative to normal, healthy subjects. Intriguingly, our model simulations predict a restricted gluconeogenic response of the liver under impaired hormonal signals observed in T2DM, resulting in an increased risk of hypoglycemia. The inability of hepatic glucose metabolism to effectively counterbalance a decline of the blood glucose level becomes even more pronounced in case of tightly controlled insulin treatment. Given this Janus face mode of action of insulin, our model simulations underline the great potential that normalization of the plasma glucagon profile may have for the treatment of T2DM.
Collapse
Affiliation(s)
- Matthias König
- Institute of Biochemistry, University Medicine Charité Berlin, 10117 Berlin, Germany.
| | | |
Collapse
|
50
|
Quantifying the contribution of the liver to glucose homeostasis: a detailed kinetic model of human hepatic glucose metabolism. PLoS Comput Biol 2012; 8:e1002577. [PMID: 22761565 PMCID: PMC3383054 DOI: 10.1371/journal.pcbi.1002577] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/08/2012] [Indexed: 02/02/2023] Open
Abstract
Despite the crucial role of the liver in glucose homeostasis, a detailed mathematical model of human hepatic glucose metabolism is lacking so far. Here we present a detailed kinetic model of glycolysis, gluconeogenesis and glycogen metabolism in human hepatocytes integrated with the hormonal control of these pathways by insulin, glucagon and epinephrine. Model simulations are in good agreement with experimental data on (i) the quantitative contributions of glycolysis, gluconeogenesis, and glycogen metabolism to hepatic glucose production and hepatic glucose utilization under varying physiological states. (ii) the time courses of postprandial glycogen storage as well as glycogen depletion in overnight fasting and short term fasting (iii) the switch from net hepatic glucose production under hypoglycemia to net hepatic glucose utilization under hyperglycemia essential for glucose homeostasis (iv) hormone perturbations of hepatic glucose metabolism. Response analysis reveals an extra high capacity of the liver to counteract changes of plasma glucose level below 5 mM (hypoglycemia) and above 7.5 mM (hyperglycemia). Our model may serve as an important module of a whole-body model of human glucose metabolism and as a valuable tool for understanding the role of the liver in glucose homeostasis under normal conditions and in diseases like diabetes or glycogen storage diseases.
Collapse
|