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Cai J, Peng P, Lu J, Shen Y, Wang C, Mo Y, Lu W, Zhu W, Xia T, Zhou J. Severe dawn phenomenon predicts long-term risk of all-cause mortality in patients with type 2 diabetes. Diabetes Metab Res Rev 2024; 40:e3813. [PMID: 38767128 DOI: 10.1002/dmrr.3813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/26/2023] [Accepted: 03/30/2024] [Indexed: 05/22/2024]
Abstract
AIMS The dawn phenomenon (DP) is an abnormal early morning blood glucose rise without nocturnal hypoglycaemia, which can be more easily and precisely assessed with continuous glucose monitoring (CGM). This prospective study aimed to explore the association between DP and the risk of all-cause mortality in patients with type 2 diabetes. MATERIALS AND METHODS A total of 5542 adult inpatients with type 2 diabetes in a single centre were analysed. The magnitude of DP (ΔG) was defined as the increment in the CGM-determined glucose value from nocturnal nadir (after 24:00) to prebreakfast. Participants were stratified into four groups by ΔG: ≤1.11, 1.12-3.33, 3.34-5.55, and >5.55 mmol/L. Cox proportional hazard regression models were used to evaluate the impact of DP on all-cause mortality risk. RESULTS During a median follow-up of 9.4 years, 1083 deaths were identified. The restricted cubic spline revealed a nonlinear (p for nonlinearity = 0.002) relationship between ΔG and the risk of all-cause mortality. A multivariate-adjusted Cox regression model including glycated haemoglobin A1c (HbA1c) showed that ΔG > 5.55 mmol/L was associated with 30% (95% CI, 1.01-1.66) higher risk of all-cause mortality, as compared with ΔG 1.12-3.33 mmol/L. CONCLUSIONS Higher ΔG is significantly related to an increased risk of all-cause mortality in type 2 diabetes, suggesting that severe DP should be given more attention as a part of glucose management to reduce the risk of long-term adverse outcomes.
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Affiliation(s)
- Jinghao Cai
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Peng Peng
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Chunfang Wang
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yifei Mo
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Wei Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Tian Xia
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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The Mechanism of Hyperglycemia-Induced Renal Cell Injury in Diabetic Nephropathy Disease: An Update. Life (Basel) 2023; 13:life13020539. [PMID: 36836895 PMCID: PMC9967500 DOI: 10.3390/life13020539] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Diabetic Nephropathy (DN) is a serious complication of type I and II diabetes. It develops from the initial microproteinuria to end-stage renal failure. The main initiator for DN is chronic hyperglycemia. Hyperglycemia (HG) can stimulate the resident and non-resident renal cells to produce humoral mediators and cytokines that can lead to functional and phenotypic changes in renal cells and tissues, interference with cell growth, interacting proteins, advanced glycation end products (AGEs), etc., ultimately resulting in glomerular and tubular damage and the onset of kidney disease. Therefore, poor blood glucose control is a particularly important risk factor for the development of DN. In this paper, the types and mechanisms of DN cell damage are classified and summarized by reviewing the related literature concerning the effect of hyperglycemia on the development of DN. At the cellular level, we summarize the mechanisms and effects of renal damage by hyperglycemia. This is expected to provide therapeutic ideas and inspiration for further studies on the treatment of patients with DN.
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Yadav Y, Romeres D, Cobelli C, Dalla Man C, Carter R, Basu A, Basu R. Impaired Diurnal Pattern of Meal Tolerance and Insulin Sensitivity in Type 2 Diabetes: Implications for Therapy. Diabetes 2023; 72:223-232. [PMID: 36346619 PMCID: PMC9871193 DOI: 10.2337/db22-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
To assess the diurnal patterns of postprandial glucose tolerance and insulin sensitivity, 19 subjects with type 2 diabetes (8 women; 60 ± 11 years; BMI 32 ± 5 kg/m2) and 19 anthropometrically matched subjects with no diabetes (ND; 11 women; 53 ± 12 years; BMI 29 ± 5 kg/m2) were studied during breakfast (B), lunch (L), and dinner (D) with identical mixed meals (75 g carbohydrates) on 3 consecutive days in a randomized Latin square design. Three stable isotopes of glucose were ustilized to estimate meal fluxes, and mathematical models were used in estimating indices of insulin action and β-cell function. Postmeal glucose excursions were higher at D versus B and at D versus L in type 2 diabetes (P < 0.05), while in ND they were higher at D versus B (P = 0.025) and at L versus B (P = 0.04). The insulin area under the curve was highest at B compared with L and D in type 2 diabetes, while no differences were observed in ND. Disposition index (DI) was higher at B than at L (P < 0.01) and at D (P < 0.001) in ND subjects, whereas DI was low with unchanging pattern across B-L-D in individuals with type 2 diabetes. Furthermore, between-meal differences in β-cell responsivity to glucose (F) and insulin sensitivity (SI) were concurrent with changes in the DI within groups. Fasting and postmeal glucose, insulin, and C-peptide concentrations, along with estimates of endogenous glucose production (EGP), Rd, SI, F, hepatic extraction of insulin, insulin secretion rate, extracted insulin, and DI, were altered in type 2 diabetes compared with ND (P < 0.011 for all). The data show a diurnal pattern of postprandial glucose tolerance in overweight otherwise glucose-tolerant ND individuals that differs from overweight individuals with type 2 diabetes. The results not only provide valuable insight into management strategies for better glycemic control in people with type 2 diabetes, but also improved understanding of daytime glucose metabolism in overweight individuals without impaired glucose tolerance or overt diabetes.
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Affiliation(s)
- Yogesh Yadav
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Davide Romeres
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Claudio Cobelli
- Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Ananda Basu
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Rita Basu
- Division of Endocrinology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
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Feng ZQ, Guo QY, Wang W, Yuan YY, Jin XG, Zhou H, Liu J, Lei HY, Yang XY, Liu J, Lu B, Shao JQ, Gu P. Time in range, especially overnight time in range, is associated with sudomotor dysfunction in patients with type 1 diabetes. Diabetol Metab Syndr 2021; 13:119. [PMID: 34702362 PMCID: PMC8549142 DOI: 10.1186/s13098-021-00739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/15/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Time in range (TIR) is advocated as key metric of glycemic control and is reported to be associated with microvascular complications of diabetes. Sudomotor dysfunction is among the earliest detectable diabetic peripheral neuropathy (DPN). We set about to research the relationship between TIR including overnight TIR and sudomotor function detected by SUDOSCAN with the intention of exploring the correlation of TIR including overnight TIR and early DPN in type 1 diabetes (T1D). METHODS 95 patients with T1D were enrolled. TIR including nocturnal TIR of 3.9-10.0 mmol/L was evaluated with CGM. SUDOSCAN measured feet electrochemical skin conductance (FESC) and sudomotor dysfunction was defined as average FESC < 60µS. Logistic regressions were applied to examine the independent association of TIR and overnight TIR with sudomotor function. RESULTS The overall prevalence of sudomotor dysfunction was 28.42%. Patients with sudomotor dysfunction had significantly lower TIR for the whole recorded phase and for nighttime. The sudomotor dysfunction prevalence progressively declined with the ascending tertiles of TIR and nocturnal TIR (P for trend < 0.05). Correlation analysis showed that the relationship between nocturnal TIR and FESC was stronger than that between TIR and FESC with correlation coefficients were respectively 0.362 and 0.356 (P < 0.001). Finally, logistic regression analysis indicated the independently negative relation between TIR and nocturnal TIR and sudomotor dysfunction (P < 0.05), and the correlation between nocturnal TIR and sudomotor dysfunction was more statistically significant. CONCLUSIONS TIR is negatively correlated with sudomotor dysfunction in T1D independent of HbA1c. Furthermore, decreased nocturnal TIR is more closely related to the impaired function of sudomotor nerves in sweat glands.
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Affiliation(s)
- Zhou-Qin Feng
- Department of Endocrinology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Qing-Yu Guo
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Wei Wang
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yan-Yu Yuan
- Department of Endocrinology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xu-Guang Jin
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Hui Zhou
- Department of Endocrinology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Jun Liu
- Department of Endocrinology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Hai-Yan Lei
- Department of Endocrinology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xin-Yi Yang
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jun Liu
- Department of Endocrinology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Bin Lu
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jia-Qing Shao
- Department of Endocrinology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, China.
| | - Ping Gu
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
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Wangnoo S, Shunmugavelu M, Reddy SVB, Negalur V, Godbole S, Dhandhania VK, Krishna N, Gaurav K. Role of Gliclazide in safely navigating type 2 diabetes mellitus patients towards euglycemia: Expert opinion from India. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jang C, Lee HJ, Yook JG. Radio-Frequency Biosensors for Real-Time and Continuous Glucose Detection. SENSORS (BASEL, SWITZERLAND) 2021; 21:1843. [PMID: 33800771 PMCID: PMC7961512 DOI: 10.3390/s21051843] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
This review paper focuses on radio-frequency (RF) biosensors for real-time and continuous glucose sensing reported in the literature, including our recent research. Diverse versions of glucose biosensors based on RF devices and circuits are briefly introduced, and their performances are compared. In addition, the limitations of the developed RF glucose biosensors are discussed. Finally, we present perspectives on state-of-art RF biosensing chips for point-of-care diagnosis and describe their future challenges.
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Affiliation(s)
- Chorom Jang
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul 03722, Korea;
| | - Hee-Jo Lee
- Department of Physics Education, College of Education, Daegu University, Gyeongsan 38453, Korea;
| | - Jong-Gwan Yook
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul 03722, Korea;
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Ogawa S, Nako K, Ito S. Effects of sodium-glucose cotransporter 2 inhibitors on hypoglycaemia in brittle diabetic patients with decreased endogenous insulin secretion. Endocrinol Diabetes Metab 2019; 2:e00044. [PMID: 30815573 PMCID: PMC6354752 DOI: 10.1002/edm2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/17/2018] [Accepted: 09/24/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2Is) on fasting blood glucose concentration (FBG) in patients with unstable FBG despite undergoing intensive insulin therapy (IIT) remain unclear. This study aimed to identify the effects of SGLT2Is on unstable FBGs. MATERIALS AND METHODS Thirty brittle diabetic patients with unstable FBGs despite undergoing IIT were included in the study. SGLT2Is were added and used in combination. We evaluated the data of the subjects in Evaluation 1 (immediately before using SGLT2Is) and evaluations 2, 3 and 4 (4, 24 and 48 weeks after starting concomitant therapy, respectively). FBGs were measured every day for a period of 28 days immediately before conducting Evaluations 1, 2, 3 and 4. The mean value of the 28 sets of FBG data (FBG mean) and their standard deviation (SD) values were established as each evaluation's FBGs. The changes in the mean values of the 30 subjects as well as their SD before and after concomitant therapy were evaluated. RESULTS The concomitant use of SGLT2Is helped reduce not only FBG mean but also SD. FBG max dropped, and the frequency of occurrence of hyperglycaemic FBG (>11.1 mmol/L) decreased. However, FBG min did not drop, and the frequency of occurrence of hypoglycaemic FBG (<3.9 mmol/L) increased. The frequency of occurrence of subjective hypoglycaemia decreased. The decrease in the SD of FBG was related to the decrease in subjective hypoglycaemia. CONCLUSION Concomitant use of SGLT2Is in patients with brittle diabetes appears to be useful in terms of improvement of FBG and fewer occurrences of hypoglycaemic events.
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Affiliation(s)
- Susumu Ogawa
- Division of Nephrology, Endocrinology and Vascular MedicineTohoku University HospitalSendaiJapan
- Division of Research in Student Support, Section of Clinical Medicine, Institute for Excellence in Higher EducationTohoku UniversitySendaiJapan
| | - Kazuhiro Nako
- Division of Nephrology, Endocrinology and Vascular MedicineTohoku University HospitalSendaiJapan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular MedicineTohoku University HospitalSendaiJapan
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Basu A, Joshi N, Miles J, Carter RE, Rizza RA, Basu R. Paradigm Shifts in Nocturnal Glucose Control in Type 2 Diabetes. J Clin Endocrinol Metab 2018; 103:3801-3809. [PMID: 30020503 PMCID: PMC6179178 DOI: 10.1210/jc.2018-00873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/27/2018] [Indexed: 01/17/2023]
Abstract
CONTEXT A better understanding of nocturnal regulation of glucose homeostasis will provide the framework for designing rational therapeutic strategies to improve the management of overnight glucose in patients with type 2 diabetes (T2D). OBJECTIVE To establish the nocturnal pattern and regulation of glucose production (EGP) in humans and to determine whether the pattern is dysregulated in people with T2D. DESIGN Subjects were infused with [3-3H] glucose overnight. Arterial blood samples were drawn for hormones and analytes to estimate EGP throughout the night. Deuterium-labeled water was provided to measure gluconeogenesis (GNG) using the hexamethylenetetramine method of Landau. SETTING Mayo Clinic Clinical Research Trials Unit, Rochester, MN, USA. PARTICIPANTS AND INTERVENTIONS A total of 43 subjects [23 subjects with T2D and 20 nondiabetic (ND) subjects comparable for age and body mass index] were included in this study. MAIN OUTCOME(S) MEASURE(S) Glucose and EGP. RESULTS Plasma glucose, C-peptide, and glucagon concentrations were higher throughout the night, whereas insulin concentrations were higher in subjects with T2D vs ND subjects at 1:00 and 4:00 am but similar at 7:00 am. EGP was higher in the subjects with T2D than in the ND subjects throughout the night (P < 0.001). Glycogenolysis (GGL) fell and GNG rose, resulting in significantly higher (P < 0.001) rates of GNG at 4:00 and 7:00 am and significantly (P < 0.001) higher rates of GGL at 1:00, 4:00, and 7:00 am in T2D as compared with ND. CONCLUSIONS These data imply that optimal therapies for T2D for nocturnal/fasting glucose control should target not only the absolute rates of EGP but also the contributing pathways of GGL and GNG sequentially.
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Affiliation(s)
- Ananda Basu
- Department of Endocrinology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Nisha Joshi
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota
| | - John Miles
- Division of Endocrinology, Metabolism and Genetics, University of Kansas Medical Center, Kansas City, Kansas
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Robert A Rizza
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Rita Basu
- Department of Endocrinology, University of Virginia School of Medicine, Charlottesville, Virginia
- Correspondence and Reprint Requests: Rita Basu, MD, Department of Endocrinology, Center for Diabetes Technology, University of Virginia School of Medicine, Room 3108, 560 Ray C. Hunt Drive, Charlottesville, Virginia 22908. E-mail:
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Martis R, Brown J, Crowther CA. Views and Experiences of New Zealand Women with Gestational Diabetes in Achieving Glycaemic Control Targets: The Views Study. J Diabetes Res 2017; 2017:2190812. [PMID: 29226155 PMCID: PMC5684580 DOI: 10.1155/2017/2190812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/12/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Optimal glycaemic control in women with gestational diabetes mellitus (GDM) reduces maternal and infant morbidity. METHOD A survey was administered to women diagnosed with GDM to explore their views and experiences in achieving optimal glycaemic control. RESULTS Sixty women participated. Enablers included being taught to test capillary blood glucose in group settings where the health professional demonstrated this on themselves first (60, 100%); health professionals listening (41, 68%); being reminded to perform blood glucose testing (33, 55%); and being provided healthy meals by friends and family (28, 47%). Barriers included not having information in a woman's first language (33, 55%); being offered unhealthy food (19, 31%); not being believed by health professionals (13, 21%); receiving inconsistent information by health professionals (10, 16%); never being seen twice by the same health professional (8, 13%); and long waiting hours at clinics (7, 11%). Two-thirds of women (37, 62%) reported that food costs were not a barrier, but that they were always or frequently hungry. CONCLUSION Optimising experiences for women with GDM for achieving glycaemic control and overcoming barriers, regardless of glycaemic targets, requires further focus on providing meaningful health literacy and support from health professionals, family, friends, and work colleagues.
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Affiliation(s)
- Ruth Martis
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Julie Brown
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Caroline A. Crowther
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Sun L, Hu C, Qian Y, Zheng C, Liang Q, Lv Z, Huang Z, Qi K, Huang J, Zhou Q, Yang Z. Age-Based Differences in the Genetic Determinants of Glycemic Control: A Case of FOXO3 Variations. PLoS One 2015; 10:e0126696. [PMID: 25993007 PMCID: PMC4439071 DOI: 10.1371/journal.pone.0126696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/06/2015] [Indexed: 12/21/2022] Open
Abstract
Background Glucose homeostasis is a trait of healthy ageing and is crucial to the elderly, but less consideration has been given to the age composition in most studies involving genetics and hyperglycemia. Methods Seven variants in FOXO3 were genotyped in three cohorts (n = 2037; LLI, MI_S and MI_N; mean age: 92.5±3.6, 45.9±8.2 and 46.8±10.3, respectively) to compare the contribution of FOXO3 to fasting hyperglycemia (FH) between long-lived individuals (LLI, aged over 90 years) and middle-aged subjects (aged from 35–65 years). Results A different genetic predisposition of FOXO3 alleles to FH was observed between LLI and both of two middle-aged cohorts. In the LLI cohort, the longevity beneficial alleles of three variants with the haplotype “AGGC” in block 1 were significantly protective to FH, fasting glucose, hemoglobin A1C and HOMA-IR. Notably, combining multifactor dimensionality reduction and logistic regression, we identified a significant 3-factor interaction model (rs2802288, rs2802292 and moderate physical activity) associated with lower FH risk. However, not all of the findings were replicated in the two middle-aged cohorts. Conclusion Our data provides a novel insight into the inconsistent genetic determinants between middle-aged and LLI subjects. FOXO3 might act as a shared genetic predisposition to hyperglycemia and lifespan.
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Affiliation(s)
- Liang Sun
- The key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, China
| | - Caiyou Hu
- Department of Neurology, Jiangbin Hospital, Nanning, Guangxi, China
| | - Yu Qian
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China
| | - Chenguang Zheng
- Department of Cardiothoracic Surgery, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, China
| | - Qinghua Liang
- Department of Neurology, Jiangbin Hospital, Nanning, Guangxi, China
| | - Zeping Lv
- Department of Neurology, Jiangbin Hospital, Nanning, Guangxi, China
| | - Zezhi Huang
- Office of longevity cultural, People’s government of Yongfu County, Yongfu, Guangxi, China
| | - Keyan Qi
- Lab of Genetics and Metabolism, Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Jin Huang
- Department of obstetrics, Beijing Shunyi Airport Hospital, Beijing, China
| | - Qin Zhou
- Department of Neurology, Jiangbin Hospital, Nanning, Guangxi, China
| | - Ze Yang
- The key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing, China
- * E-mail:
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Roeder HA, Moore TR, Ramos GA. Insulin pump dosing across gestation in women with well-controlled type 1 diabetes mellitus. Am J Obstet Gynecol 2012; 207:324.e1-5. [PMID: 23021699 DOI: 10.1016/j.ajog.2012.06.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/12/2012] [Accepted: 06/14/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We hypothesized that bolus and basal insulin doses in women with type 1 diabetes mellitus who use insulin pumps would increase 2-fold to maintain hemoglobin A1c <6.5% across gestation. STUDY DESIGN This was a retrospective study of 9 women with type 1 diabetes mellitus with preconceptional hemoglobin A1c ≤ 7.4% using insulin pumps. The primary outcome was absolute and percentage change of basal and bolus insulin from preconception to delivery. RESULTS Total daily dose of insulin increased from 33.3 ± 7.8 U/d before conception to 93.5 ± 27.9 U/d at delivery. Basal rates rose modestly (50% increase, from 16.2 ± 6.5 U/d to 24.0 ± 9 U/d); bolus insulin doses quadrupled from 17.1 ± 6.1 U/d to 69.5 ± 29.6 U/d (P = .0001). Bolus insulin increased from approximately 50% of total daily dose of insulin before conception to 75% of total daily dose of insulin at 36 weeks' gestation. CONCLUSION In well-controlled type 1 diabetes mellitus, insulin requirements increased 3-fold from before conception to 36 weeks' gestation. Most of this requirement was attributed to an increase in bolus rates that are required for control with meals.
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Abstract
A paradoxical drug reaction constitutes an outcome that is opposite from the outcome that would be expected from the drug's known actions. There are three types: 1. A paradoxical response in a condition for which the drug is being explicitly prescribed. 2. Paradoxical precipitation of a condition for which the drug is indicated, when the drug is being used for an alternative indication. 3. Effects that are paradoxical in relation to an aspect of the pharmacology of the drug but unrelated to the usual indication. In bidirectional drug reactions, a drug may produce opposite effects, either in the same or different individuals, the effects usually being different from the expected beneficial effect. Paradoxical and bidirectional drug effects can sometimes be harnessed for benefit; some may be adverse. Such reactions arise in a wide variety of drug classes. Some are common; others are reported in single case reports. Paradoxical effects are often adverse, since they are opposite the direction of the expected effect. They may complicate the assessment of adverse drug reactions, pharmacovigilance, and clinical management. Bidirectional effects may be clinically useful or adverse. From a clinical toxicological perspective, altered pharmacokinetics or pharmacodynamics in overdose may exacerbate paradoxical and bidirectional effects. Certain antidotes have paradoxical attributes, complicating management. Apparent clinical paradoxical or bidirectional effects and reactions ensue when conflicts arise at different levels in self-regulating biological systems, as complexity increases from subcellular components, such as receptors, to cells, tissues, organs, and the whole individual. These may be incompletely understood. Mechanisms of such effects include different actions at the same receptor, owing to changes with time and downstream effects; stereochemical effects; multiple receptor targets with or without associated temporal effects; antibody-mediated reactions; three-dimensional architectural constraints; pharmacokinetic competing compartment effects; disruption and non-linear effects in oscillating systems, systemic overcompensation, and other higher-level feedback mechanisms and feedback response loops at multiple levels. Here we review and provide a compendium of multiple class effects and individual reactions, relevant mechanisms, and specific clinical toxicological considerations of antibiotics, immune modulators, antineoplastic drugs, and cardiovascular, CNS, dermal, endocrine, musculoskeletal, gastrointestinal, haematological, respiratory, and psychotropic agents.
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Affiliation(s)
- Silas W Smith
- Department of Emergency Medicine, New York University School of Medicine, New York, NY 10016, USA.
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Abstract
Primary goals in the treatment of type 2 diabetes mellitus (T2DM) include lowering blood glucose levels sufficiently to prevent micro- and macrovascular complications while limiting side effects, such as hypoglycemia and excessive weight gain. Patients with T2DM are typically treated initially with oral antidiabetes agents; however, as the disease progresses, most will require insulin to maintain glycemic control. Often insulin therapy is initiated with basal insulin, and the objective of this article is to present the conceptual aspects of basal insulin therapy and use these concepts to illustrate important clinical aspects. This will be accomplished within a broader contextual discussion of the normal physiologic patterns of insulin secretion, which consist of sustained levels of basal insulin production throughout the day, superimposed with bursts of insulin secretion following a meal (termed bolus or prandial insulin secretion) that slowly decay over 1 to 3 hours. Long-acting basal insulin analogs form a key component of basal-bolus therapy and provide basal support for patients with T2DM. Insulin therapy is often initiated with basal insulin, and newer long-acting analogs, such as insulin glargine and insulin detemir, provide steady, reliable basal insulin coverage in addition to significant advantages over traditional long-acting insulins. This article will integrate conceptual aspects of basal insulin therapy in the context of physiology, molecular pharmacology, and clinical implications of modern basal insulin analogs to provide a foundational understanding of basal insulin biology and physiology.
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Affiliation(s)
- Kevin D Niswender
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University School of Medicine, Nashville, TN 37232-0475, USA.
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Affiliation(s)
- Linda M. Fleeman
- Animal Diabetes Australia; 181 Boronia Road Boronia VIC 3155 Australia
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15
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The association of phosphoinositide 3-kinase enhancer A with hepatic insulin receptor enhances its kinase activity. EMBO Rep 2011; 12:847-54. [PMID: 21720388 DOI: 10.1038/embor.2011.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/11/2011] [Accepted: 05/16/2011] [Indexed: 12/31/2022] Open
Abstract
Dysfunction of hepatic insulin receptor tyrosine kinase (IRTK) causes the development of type 2 diabetes. However, the molecular mechanism regulating IRTK activity in the liver remains poorly understood. Here, we show that phosphoinositide 3-kinase enhancer A (PIKE-A) is a new insulin-dependent enhancer of hepatic IRTK. Liver-specific Pike-knockout (LPKO) mice display glucose intolerance with impaired hepatic insulin sensitivity. Specifically, insulin-provoked phosphoinositide 3-kinase/Akt signalling is diminished in the liver of LPKO mice, leading to the failure of insulin-suppressed gluconeogenesis and hyperglycaemia. Thus, hepatic PIKE-A has a key role in mediating insulin signal transduction and regulating glucose homeostasis in the liver.
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16
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Plasma proteomic profiles of bovine growth hormone transgenic mice as they age. Transgenic Res 2011; 20:1305-20. [PMID: 21365322 DOI: 10.1007/s11248-011-9499-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 02/20/2011] [Indexed: 12/17/2022]
Abstract
Attenuation of the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis results in extended lifespan in many organisms including mice. Conversely, GH transgenic mice have excess GH action and die prematurely. We have studied bovine (b) GH transgenic mice (n = 9) and their wild type (WT) littermates (n = 8) longitudinally and have determined several age-related changes. Compared to WT mice, bGH mice lost fat mass, became hypoglycemic and had lower insulin levels at older ages despite being hyperinsulinemic when young. To examine plasma protein differences in bGH mice relative to controls, samples at 2, 4, 8, 12 and 16 months of age were analyzed by two-dimensional gel electrophoresis followed by identification using mass spectrometry. We found several differences in plasma proteins of bGH mice compared to controls, including increased apolipoprotein E (five isoforms), haptoglobin (four isoforms) and mannose-binding protein-C (one out of three isoforms), and decreased transthyretin (six isoforms). In addition, clusterin (two out of six isoforms) and haptoglobin (four isoforms) were up-regulated in bGH mice as a function of age. Finally, alpha-2 macroglobulin (seven isoforms) was altered in an isoform-specific manner with two isoforms increased and two decreased in bGH mouse plasma compared to controls. In conclusion, identification of these proteins suggests that bGH mice exhibit an increased inflammatory state with an adverse lipid profile, possibly contributing to their diminished life expectancy. Also, these newly discovered plasma proteins may be indicative or 'biomarkers' of a shortened lifespan.
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Ganzer CA, Crogan NL. Diabetes in African Americans: The Critical Importance of Cognitive Assessment. Geriatr Nurs 2010. [DOI: 10.1016/j.gerinurse.2010.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Foster WG, Agzarian J. Toward less confusing terminology in endocrine disruptor research. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2008; 11:152-161. [PMID: 18368550 DOI: 10.1080/00927870701873214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The realization that environmental contaminants interact with hormone receptors and mimic or antagonize the actions of endogenous hormones led to introduction of terms such as endocrine disruptor, endocrine disrupter, hormonally active chemicals, and hormone mimics into the scientific and lay press. Reports suggesting a link between exposure to chemicals adversely affecting the endocrine system and (1) increasing rates of hormone-dependent cancers (breast, prostate, and testicular), (2) developmental detrimental effects in the male reproductive tract, (3) falling sperm counts, and (4) endometriosis resulted in an explosion of research, regulatory actions, and policy changes aimed at better understanding the hazards posed by these chemicals with subsequent restriction in their use. With increasing concern, there is worldwide action to develop testing strategies to allow for early identification of chemicals possessing endocrine disruptor activity. However, despite an expanding literature and numerous expert panel meetings, there continues to be controversy surrounding how to best define endocrine disruptors, resulting in (1) ambiguous use of the term, (2) confusion in the literature, and (3) publication of contentious lists of chemicals purported to be endocrine disruptors. Herein it is argued in favor of a more restrictive definition with adoption of a less ambiguous term, and in favor of development of a classification system to enhance more effective communication and facilitate appropriate allocation of limited resources in this highly charged area of toxicology.
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Affiliation(s)
- Warren G Foster
- Centre for Reproductive Care and Reproductive Biology Division, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5.
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Abstract
The prevalence of diabetes mellitus has been increasing steadily in the last 30 years and it is predicted that there will be 300 million people affected by 2025. Insulin deficiency is a feature of both Type 1 and 2 diabetes; insulin treatment, obligatory in Type 1, will also be required in many Type 2 patients. Insulin glargine is the first available synthetic insulin that can truly be described as basal - administered as a once-daily subcutaneous injection it raises the background, or basal, insulin level without a significant peak action and less hypoglycemia than previously used basal insulins. Insulin glargine is the first basal insulin that can be administered as a single injection daily as part of an intensive basal-bolus insulin regimen in Type 1 diabetes. In Type 2 diabetes, insulin glargine, administered once daily with one or two oral hypoglycemic drugs, can enable more than 50% of patients to achieve an A1c of less than 7%. The titration of the insulin glargine dose to an appropriate level over a period of weeks is essential to its successful use in Type 2 diabetes.
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Affiliation(s)
- Cecilia M Lansang
- a University of Florida, Room H2, Health Science Center, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Laurence Kennedy
- b University of Florida, Room H2, Health Science Center, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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Vantyghem MC, Press M. Management strategies for brittle diabetes. ANNALES D'ENDOCRINOLOGIE 2007; 67:287-96. [PMID: 17072232 DOI: 10.1016/s0003-4266(06)72600-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Type 1 diabetes is an intrinsically unstable condition. However, the term "brittle diabetes" is reserved for those cases in which the instability, whatever its cause, results in disruption of life and often recurrent and/or prolonged hospitalization. It affects 3/1000 insulin-dependent diabetic patients, mainly young women. Its prognosis is poor with lower quality of life scores, more microvascular and pregnancy complications and shortened life expectancy. Three forms have been described: recurrent diabetic ketoacidosis, predominant hypoglycemic forms and mixed instability. Main causes of brittleness include malabsorption, certain drugs (alcohol, antipsychotics), defective insulin absorption or degradation, defect of hyperglycemic hormones especially glucocorticoid and glucagon, and above all delayed gastric emptying as a result of autonomic neuropathy. Psychosocial factors are very important and factitious brittleness may lead to a self-perpetuating condition. The assessment of brittle diabetes requires quantification of the variability of blood glucose levels. To quantify instability, measures which have been developed, include Mean Amplitude of the largest Glycemic Excursions (MAGE), Mean Of Daily Differences (MODD), Lability Index (LI), Low Blood Glucose Index (LBGI), Clarke's score, Hyposcore, and continuous blood glucose monitoring. Once psychogenic problems have been excluded, therapeutic strategies require firstly, the treatment of underlying organic causes of the brittleness whenever possible and secondly optimising standard insulin therapy using analogues, multiple injections and consideration of Continuous Subcutaneous Insulin Infusion. Alternative approaches may still be needed for the most severely affected patients. Isolated islet transplantation (IIT), which restores glucose sensing, should be considered in cases of hypoglycaemic unawareness and/or lability especially if the body mass index is < 25, but with current immunosuppressive protocols patients must have normal renal function and preferably no plans for pregnancy. Implantable pumps have advantages for patients who either weigh more than 80 kgs or have abnormalities of kidney or liver function or are highly sensitised.
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Affiliation(s)
- M-C Vantyghem
- Endocrinology and Metabolism Department/ERIT-M0106, Lille University Hospital, 6 Rue du Pr Laguesse, 59037 Lille Cedex, France.
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Guo L, Tabrizchi R. Peroxisome proliferator-activated receptor gamma as a drug target in the pathogenesis of insulin resistance. Pharmacol Ther 2005; 111:145-73. [PMID: 16305809 DOI: 10.1016/j.pharmthera.2005.10.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Accepted: 10/03/2005] [Indexed: 01/08/2023]
Abstract
Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors that belong to the nuclear hormone receptor superfamily. The activation of PPAR-gamma, an isotype of PPARs, can either increase or decrease the transcription of target genes. The genes controlled by this form of PPAR have been shown to encode proteins or peptides that participate in the pathogenesis of insulin resistance. Insulin resistance is defined as a state of reduced responsiveness to normal circulating concentrations of insulin and it often co-exists with central obesity, hypertension, dyslipidemia, and atherosclerosis. There is substantial evidence that links obesity with insulin resistance and type-2 diabetes. The early phase of obesity-related insulin resistance has 2 components: (a) interruption of lipid homeostasis leading to the increased plasma concentration of fatty acids that is normally suppressed by the activation of PPAR-gamma, and (b) activation of factors such as cytokines depressed by PPAR-gamma that cause insulin resistance. Therefore, it is logical to suggest that activation of PPAR-gamma may partially reverse the state of insulin resistance. Evidently, activation of the nuclear receptor, PPAR-gamma, by thiazolidinediones has been reported to ameliorate insulin resistance. Although hepatotoxity and possibility to induce congestive heart failure (CHF) limit the widely use of thiazolodinediones, they are still powerful weapon to fight against insulin resistance and type-2 diabetes if use properly. This article reviews the physiology of PPAR-gamma and insulin-signaling transduction, the pathogenesis of insulin resistance in obesity-related type-2 diabetes, the pharmacological role of PPAR-gamma in insulin resistance, and additional effects of thiazolidinediones.
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Affiliation(s)
- Liang Guo
- Division of Basic Medical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada A1B 3V6
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Harmon C, Willoughby DF, Floyd C. A lesson in early morning hyperglycemia. Nurse Pract 2004; 29:58-63. [PMID: 15625495 DOI: 10.1097/00006205-200411000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Corinne Harmon
- School of Nursing at Greenville Technical College, Greenville, SC, USA
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