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Shao B, Li H, Zhang P, Teng X, Wang H, Verdi T, Bhat LT, Zhang F. The effect of gum consumption on blood pressure as a risk factor for coronary heart disease: A meta-analysis of controlled trials. INT J VITAM NUTR RES 2023; 93:61-71. [PMID: 33472439 DOI: 10.1024/0300-9831/a000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Guar gum has been used in the management of hypercholesterolemia, constipation, weight loss, type 2 diabetes mellitus and hypertension. Our aim was to verify the hypothesis that Guar gum can be used as an alternative to pharmacological agents in the treatment of mild hypertension. Thus, we conducted a systematic review and meta-analysis to evaluate the effectiveness of Guar gum in reducing blood pressure. We searched the Cochrane Library, PubMed/Medline, Scopus and Google Scholar databases for studies published in the English language up to June 2020 which evaluated the effects of gum consumption on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Nine randomized clinical trials with suitable comparison groups (placebo/control) reported SBP and DBP as outcome measures. These trials involved in total 640 participants. The overall results indicated that the consumption of gum resulted in a significant change in SBP (WMD: -1.190 mmHg, 95% CI: -2.011, -0.370) and DBP (WMD: -1.101 mmHg, 95% CI: -1.597, -0.605). Moreover, the greatest reduction in blood pressure was seen in patients with type 2 diabetes mellitus and metabolic syndrome who consumed Guar gum (WMD: -3.375 mmHg). In addition, there was a significant decrease in SBP if the gum dosage was > 15 g (WMD: -6.637 mmHg) and if the intervention duration was > 12 weeks (WMD: -1.668 mmHg). The results of the present dose-response meta-analysis support the employment of gum consumption in the reduction of SBP and DBP. Based on the sub-group analyses, we highlight that the greatest decrease in SBP was experienced if the gum dosage was > 15 g and when the intervention lasted > 12 weeks.
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Affiliation(s)
- Baowei Shao
- Department of Cardiac Surgery, Jinan Central Hospital, Shandong, China
| | - Haijie Li
- Department of Cardiac Surgery, Jinan Central Hospital, Shandong, China
| | - Pengfei Zhang
- Department of Cardiac Surgery, Jinan Central Hospital, Shandong, China
| | - Xilong Teng
- Department of Cardiac Surgery, Jinan Central Hospital, Shandong, China
| | - Honglu Wang
- Department of Cardiac Surgery, Jinan Central Hospital, Shandong, China
| | - Thais Verdi
- Department of iochemistry, physioPlogy, Training and Sports nutrition, Campinas State University, Brazil
| | - Latha T Bhat
- Department of Medical Surgical Nursing, Manipal College of Nursing Manipal, Manipal University, India
| | - Fengquan Zhang
- Department of Cardiac Surgery, Jinan Central Hospital, Shandong, China
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Association of Self-Reported Dietary and Drug Compliance with Optimal Metabolic Control in Patients with Type 2 Diabetes: Clinic-Based Single-Center Study in a Developing Country. J Nutr Metab 2018; 2018:3421476. [PMID: 30140455 PMCID: PMC6081544 DOI: 10.1155/2018/3421476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/07/2018] [Accepted: 05/17/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Influence of dietary and drug compliance of patients with diabetes on attainment of optimal metabolic (glucose and lipid) control remains underexplored in developing countries. Materials and methods Self-reported dietary and drug compliance score of 0–10, glycosylated hemoglobin (HbA1c), and low-density lipoprotein (LDL) levels were obtained from patients with diabetes. HbA1c <7% and LDL <100 mg/dL were used to define optimal glucose and lipid control, respectively. Proportions achieving each and both optimal parameters were estimated. Regression analysis was used to study the association of age, gender, age of onset and the duration of diabetes, self-reported dietary, and drug compliance scores with achievement of both parameters. Results Mean (SD) age and duration of diabetes of 207 patients were 55 (10) and 10 (03) years. Optimal glucose and LDL control were achieved by 30% and 62%, and 23% had achieved both. Regression analysis revealed significant association of self-reported high dietary compliance with achievement of both targets. Conclusions Findings highlight the suboptimal glucose and lipid control among patients with diabetes. Significant association of better dietary compliance with control of both parameters emphasizes the value of proper dietary adherence in achieving the optimal metabolic control among patients with diabetes.
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Jutterström L, Hörnsten Å, Sandström H, Stenlund H, Isaksson U. Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes-A randomized study. PATIENT EDUCATION AND COUNSELING 2016; 99:1821-1829. [PMID: 27372525 DOI: 10.1016/j.pec.2016.06.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/11/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes. METHODS 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011. RESULTS HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group. CONCLUSION Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes. PRACTICE IMPLICATIONS It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.
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Affiliation(s)
- L Jutterström
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Å Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - H Sandström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
| | - H Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
| | - U Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden.
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Krysiak R, Kowalcze K, Szkrobka W, Okopien B. The effect of metformin on prolactin levels in patients with drug-induced hyperprolactinemia. Eur J Intern Med 2016; 30:94-98. [PMID: 26858210 DOI: 10.1016/j.ejim.2016.01.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND In bromocriptine-treated hyperprolactinemic patients with impaired glucose tolerance, metformin was found to reduce plasma levels of prolactin. No previous study has investigated its impact on plasma prolactin in patients with drug-induced hyperprolactinemia. METHODS The study included 20 women with antipsychotic-induced hyperprolactinemia and 12 normoprolactinemic women, who, because of coexisting glucose metabolism abnormalities, were treated for 6months with metformin. Hyperprolactinemic patients with prediabetes received moderate doses of metformin (1.7g daily), while hyperprolactinemic and normoprolactinemic patients with type 2 diabetes were treated with high-dose metformin (2.55-3g daily). Fasting plasma glucose levels, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), glycated hemoglobin, as well as plasma levels of prolactin, thyrotropin, adrenocorticotropic hormone and insulin-like growth factor-1 were assessed at baseline and after 6months of treatment. RESULTS Despite reducing plasma glucose, HOMA1-IR, and glycated hemoglobin in all treatment groups, metformin decreased prolactin levels only if given at high doses to patients with elevated prolactin levels. No changes in thyrotropin, adrenocorticotropic hormone, and insulin-like growth factor-1 were observed in any treatment groups. CONCLUSIONS The obtained results suggest that the effect of metformin on plasma prolactin depends on its dose and is observed only in patients with elevated levels of this hormone.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland.
| | - Karolina Kowalcze
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Witold Szkrobka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Boguslaw Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
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Rule extraction using Recursive-Rule extraction algorithm with J48graft combined with sampling selection techniques for the diagnosis of type 2 diabetes mellitus in the Pima Indian dataset. INFORMATICS IN MEDICINE UNLOCKED 2016. [DOI: 10.1016/j.imu.2016.02.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Krysiak R, Gilowski W, Szkrobka W, Okopien B. The Effect of Atorvastatin on Cardiometabolic Risk Factors in Bromocriptine-Treated Premenopausal Women with Isolated Hypercholesterolemia. Cardiovasc Ther 2015; 33:282-7. [PMID: 26146893 DOI: 10.1111/1755-5922.12143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Hyperprolactinemia is often associated with hyperinsulinemia, insulin resistance, atherogenic dyslipidemia, and subclinical atherosclerosis. Dopamine agonists were found to reduce the prevalence of metabolic syndrome and cardiometabolic risk. The aim of this study was to compare the effect of statin therapy on cardiovascular risk factors between patients treated with a dopamine agonist and patients treated with metformin. METHODS The study included two age-, weight-, lipid-, and prolactin level-matched groups of premenopausal women with hypecholesterolemia and a history of hyperprolactinemia: patients treated with bromocriptine (5.0-7.5 mg daily, n = 14) and subjects receiving metformin (1.7-2.55 g daily, n = 17). Plasma prolactin, lipids, glucose homeostasis markers, and plasma levels of cardiometabolic risk factors were assessed before and after 12 weeks of atorvastatin treatment. RESULTS Baseline levels of the investigated variables were similar in women treated with bromocriptine and metformin. Apart from lowering total and LDL cholesterol, atorvastatin decreased plasma levels of uric acid, hsCRP, homocysteine, and fibrinogen, with no difference between treatment groups. CONCLUSIONS The obtained results suggest that the effect of atorvastatin on plasma lipids and circulating levels of cardiometabolic risk factors does not differ between patients receiving bromocriptine and metformin. Bromocriptine-statin combination therapy may be an alternative to metformin-statin combination therapy in hypercholesterolemic patients with glucose metabolism abnormalities in whom metformin administration is either contraindicated or results in adverse effects.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Gilowski
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.,Cardiology Department, Chrzanow District Hospital, Chrzanow, Poland
| | - Witold Szkrobka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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Krysiak R, Okopien B. The effect of metformin on the hypothalamic-pituitary-thyroid axis in women with polycystic ovary syndrome and subclinical hypothyroidism. J Clin Pharmacol 2014; 55:45-9. [PMID: 25079765 DOI: 10.1002/jcph.373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/28/2014] [Indexed: 01/28/2023]
Abstract
The effect of metformin treatment on the hypothalamic-pituitary-thyroid axis is relatively weakly understood. This study included 24 prediabetic patients with polycystic ovary syndrome and untreated subclinical hypothyroidism, 12 of whom had already been treated with bromocriptine (5.0-7.5 mg daily). The included patients received metformin (2.55 g daily) for 6 months. Glucose homeostasis markers, serum prolactin, and thyroid function tests were determined before, after 3 months, and at the end of the treatment. Beyond improving glucose homeostasis, metformin administered for 6 months reduced serum levels of thyrotropin but did not affect serum levels of total and free thyroid hormones. Thyrotropin-lowering effect of this agent was stronger in patients not treated with bromocriptine than in patients receiving this drug, and weakly correlated with an improvement in insulin sensitivity. The obtained results indicate that metformin treatment may have an impact on thyrotrope function in hypothyroid patients, probably by enhancing the effect of thyroid hormone action in the pituitary.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, PL 40-752, Katowice, Poland
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Tian C, Alomar F, Moore CJ, Shao CH, Kutty S, Singh J, Bidasee KR. Reactive carbonyl species and their roles in sarcoplasmic reticulum Ca2+ cycling defect in the diabetic heart. Heart Fail Rev 2014; 19:101-12. [PMID: 23430128 PMCID: PMC4732283 DOI: 10.1007/s10741-013-9384-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Efficient and rhythmic cardiac contractions depend critically on the adequate and synchronized release of Ca(2+) from the sarcoplasmic reticulum (SR) via ryanodine receptor Ca(2+) release channels (RyR2) and its reuptake via sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA2a). It is well established that this orchestrated process becomes compromised in diabetes. What remain incompletely defined are the molecular mechanisms responsible for the dysregulation of RyR2 and SERCA2a in diabetes. Earlier, we found elevated levels of carbonyl adducts on RyR2 and SERCA2a isolated from hearts of type 1 diabetic rats and showed the presence of these posttranslational modifications compromised their functions. We also showed that these mono- and di-carbonyl reactive carbonyl species (RCS) do not indiscriminately react with all basic amino acid residues on RyR2 and SERCA2a; some residues are more susceptible to carbonylation (modification by RCS) than others. A key unresolved question in the field is which of the many RCS that are upregulated in the heart in diabetes chemically react with RyR2 and SERCA2a? This brief review introduces readers to the field of RCS and their roles in perturbing SR Ca(2+) cycling in diabetes. It also provides new experimental evidence that not all RCS that are upregulated in the heart in diabetes chemically react with RyR2 and SERCA2a, methylglyoxal and glyoxal preferentially do.
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Affiliation(s)
- Chengju Tian
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198
| | - Fadhel Alomar
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198
- Department of Pharmacology, University of Dammam, Kingdom of Saudi Arabia
| | - Caronda J Moore
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198
| | - Chun Hong Shao
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198
| | - Shelby Kutty
- Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Jaipaul Singh
- School of Forensic and Investigative Sciences and School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Keshore R. Bidasee
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198
- Nebraska Center for Redox Biology, N146 Beadle Center, Lincoln NE 68588-0662
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Verge VMK, Andreassen CS, Arnason TG, Andersen H. Mechanisms of disease: role of neurotrophins in diabetes and diabetic neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2014; 126:443-60. [PMID: 25410238 DOI: 10.1016/b978-0-444-53480-4.00032-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuropathy is an insidious and devastating consequence of diabetes. Early studies provided a strong rationale for deficient neurotrophin support in the pathogenesis of diabetic neuropathy in a number of critical tissues and organs. It has now been over a decade since the first failed human neurotrophin supplementation clinical trials, but mounting evidence still implicates these trophic factors in diabetic neuropathy. Since then, tremendous advances have been made in our understanding of the complexities of neurotrophin signaling and processing and how the diabetic milieu might impact this. This in turn changes both our perception of how the altered trophic environment contributes to the etiology of diabetic neuropathy and the design of future neurotrophin therapeutic interventions. This chapter summarizes some of these findings and attempts to integrate neurotrophin actions on the nervous system with an increasing appreciation of their role in the regulation of metabolic processes in diabetes that impact the diabetic neuropathic state.
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Affiliation(s)
- Valerie M K Verge
- Department of Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Canada; Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon City Hospital, Saskatoon, Canada.
| | - Christer S Andreassen
- Department of Otorhinolaryngology and Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Terra G Arnason
- Department of Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Canada; Department of Medicine, Division of Endocrinology and Metabolism, University of Saskatchewan, Saskatoon, Canada
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Thakur G, Mitra A, Pal K, Rousseau D. Effect of flaxseed gum on reduction of blood glucose and cholesterol in type 2 diabetic patients. Int J Food Sci Nutr 2013; 60 Suppl 6:126-36. [PMID: 19548163 DOI: 10.1080/09637480903022735] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The effects of ingestion of flaxseed gum on blood glucose and cholesterol, particularly low-density lipoprotein cholesterol, in type 2 diabetes were evaluated. Flaxseed gum was incorporated in wheat flour chapattis. Sixty patients of type 2 diabetes were fed a daily diet for 3 months, along with six wheat flour chapattis containing flaxseed gum (5 g), as per the recommendations of the American Diabetic Association. The control group (60 individuals) consumed an identical diet but the chapattis were without gum. The blood biochemistry profiles monitored before starting the study and at monthly intervals showed fasting blood sugar in the experimental group decreased from 154 ± 8 mg/dl to 136 ± 7 mg/dl (P=0.03) while the total cholesterol reduced from 182 ± 11 mg/dl to 163 ± 9 mg/dl (P=0.03). Results showed a decrease in low-density lipoprotein cholesterol from 110 ± 8 mg/dl to 92 ± 9 mg/dl (P=0.02). The study demonstrated the efficacy of flax gum in the blood biochemistry profiles of type 2 diabetes.
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Affiliation(s)
- Goutam Thakur
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, India
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Krysiak R, Okopien B. Lymphocyte-suppressing and systemic anti-inflammatory effects of high-dose metformin in simvastatin-treated patients with impaired fasting glucose. Atherosclerosis 2012; 225:403-7. [DOI: 10.1016/j.atherosclerosis.2012.09.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/27/2012] [Accepted: 09/24/2012] [Indexed: 11/24/2022]
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Garcia-Garcia E, Narbona E, Carbonell-Barrachina ÁA, Sanchez-Soriano J, Roche E. The effect of consumption of inulin-enriched Turrón upon blood serum lipids over a 5-week period. Int J Food Sci Technol 2012. [DOI: 10.1111/j.1365-2621.2012.03202.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Garcia-Garcia
- Department of Applied Biology-Nutrition; Miguel Hernandez University; Elche; Alicante; Spain
| | | | - Ángel A. Carbonell-Barrachina
- Department of Agro-Food Technology; Food Quality and Safety Group; Miguel Hernandez University; Elche; Alicante; Spain
| | | | - Enrique Roche
- Department of Applied Biology-Nutrition; Miguel Hernandez University; Elche; Alicante; Spain
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Simmons LR, Molyneaux L, Yue DK, Chua EL. Steroid-induced diabetes: is it just unmasking of type 2 diabetes? ISRN ENDOCRINOLOGY 2012; 2012:910905. [PMID: 22830041 PMCID: PMC3398625 DOI: 10.5402/2012/910905] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/29/2012] [Indexed: 12/11/2022]
Abstract
Aims. We compared the demographic profile and clinical characteristics of individuals with new onset steroid-induced diabetes (NOSID) to Type 2 diabetes (T2DM) patients with and without steroid treatment. Methods. The demographic profile and clinical characteristics of 60 individuals who developed NOSID were examined and matched to 60 type 2 diabetes patients receiving steroid therapy (T2DM+S) and 360 diabetic patients not on steroids (T2DM) for age, duration of diabetes, HbA1c, gender, and ethnicity. Results. Patients who developed NOSID had less family history of diabetes (P ≤ 0.05) and were less overweight (P ≤ 0.02). NOSID was more commonly treated with insulin. Despite a matching duration of diabetes and glycaemic control, significantly less retinopathy was found in the group of patients with NOSID (P < 0.03). Conclusions. It appears that steroid treatment primarily precipitated diabetes in a group of individuals otherwise less affected by risk factors of diabetes at that point in time, rather than just opportunistically unmasking preexisting diabetes. Furthermore, the absence of retinopathy suggests that patients with NOSID had not been exposed to long periods of hyperglycaemia. However, the impact of the underlying conditions necessitating steroid treatment and concomitant medications such as immunosuppressants on diabetes development remain to be defined.
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Affiliation(s)
- Lisa R Simmons
- Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Level 6, West Wing, Camperdown, NSW 2050, Australia
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Urrutia-Rojas X, McConathy W, Willis B, Menchaca J, Luna-Hollen M, Marshall K, Lacko A, Spellman C. Abnormal glucose metabolism in Hispanic parents of children with acanthosis nigricans. ISRN ENDOCRINOLOGY 2011; 2011:481371. [PMID: 22363881 PMCID: PMC3262632 DOI: 10.5402/2011/481371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/13/2011] [Indexed: 11/23/2022]
Abstract
Objective. Assess the prevalence of abnormal glucose metabolism among Hispanic parents of children with acanthosis nigricans (AN). Methods. Hispanic families (n = 258) were evaluated for metabolic and anthropometric parameters including fasting glucose levels and AN status. Results. Mothers with AN+ children had IFG (17.3%) and 4% had glucose levels ≥126 mg/dL (P = 0.028) compared to 7.1% and 1.8% of mothers with AN− children, respectively. Mothers of AN+ children also had greater odds of having impaired fasting glucose levels (OR: 3.917, 95% CI: 1.475–10.404; P < 0.004) but this was not the case for fathers (OR: 1.125, 95% CI: 0.489–2.586; P = 0.781). Mothers of AN+ children were also more likely to be AN+ (OR: 5.76, 95% CI: 2.98–11.13, P < 0.001). Screening discovered glucose levels >126 mg/dL in 9% of fathers with AN+ children. Conclusions. Hispanic mothers of AN+ children are at higher risk of carbohydrate metabolism abnormalities. AN in children can be a marker for prevention and delay programs aimed at identifying adults at risk for diabetes.
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Affiliation(s)
- Ximena Urrutia-Rojas
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Abstract
Thyroid disease and type 1 but also type 2 diabetes mellitus (DM) are strongly associated, and this has important clinical implications for insulin sensitivity and treatment requirements. The pathophysiological basis of this association has only recently been better elucidated. It rests on a complex interaction of common signalling pathways and, in the case of type 1 diabetes and autoimmune thyroid disease, on a linked genetic susceptibility. The pathophysiological mechanisms underlying this linked regulation are increasingly being unravelled. They are exemplified in the regulation of 5' adenosine monophosphate-activated protein kinase (AMPK), a central target not only for the modulation of insulin sensitivity but also for the feedback of thyroid hormones on appetite and energy expenditure. The present review will discuss these concepts and their consequences for the clinical care of patients with DM and thyroid disorders. Moreover, it makes reference to the added effect of metformin in suppressing TSH.
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Affiliation(s)
- Leonidas H Duntas
- Endocrine Unit, Evgenidion Hospital, University of Athens Medical School, Athens, GreeceService d' Endocrinologie-Diabète-Maladies Métaboliques, Centre Hospitalier, Lyon-Sud, FranceDepartment of Endocrinology, The Christie, Manchester Academic Health Science Centre, Manchester, UK
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Parati G, Bilo G, Ochoa JE. Benefits of tight blood pressure control in diabetic patients with hypertension: importance of early and sustained implementation of effective treatment strategies. Diabetes Care 2011; 34 Suppl 2:S297-303. [PMID: 21525472 PMCID: PMC3632196 DOI: 10.2337/dc11-s243] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 2008, when the UK Prospective Diabetes Study (UKPDS) group presented their 30-year findings concerning the possible sustained effects of improved glycemic control after 10 years of extended follow-up in type 2 diabetic patients, a so-called "legacy effect" was reported to address the long-term emergent and/or sustained benefits of early improved glycemic control. Opposite results were obtained by the Hypertension in Diabetes Study (HDS) carried out in the frame of UKPDS, with no evidence of any legacy effect on cardiovascular (CV) outcomes for an initial 4-year period of tight blood pressure (BP) control. Thus, it was concluded that BP control has to be continued over time, since, although it had a short time-to-effect relationship in preventing stroke, BP control was associated with a short persistence of its clinical benefits once the intervention was discontinued. These findings are unique because, whereas most interventional trials in hypertension that included diabetic patients have shown a reduction in CV outcomes shortly after starting treatment, only the UKPDS-HDS specifically explored the possible persistence of clinical benefits after discontinuing intensive BP-lowering intervention. This article aims to provide a critical interpretation of the UKPDS findings of lack of BP legacy, in the context of the currently available evidence on the benefits of antihypertensive treatment. The importance of effective BP control in type 2 diabetic patients to prevent CV outcomes and other diabetes-related complications is underlined, with emphasis on early, tight, and continuous BP control to optimize patients' protection.
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Affiliation(s)
- Gianfranco Parati
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
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Abstract
The rising global burden of chronic renal disease, the high cost of providing renal replacement therapies, and renal disease also being a risk factor for cardiovascular disease is increasing focus on renal disease prevention. This article focuses on the aspects of renal disease (specifically poststreptococcal glomerulonephritis [PSGN] and chronic kidney disease [CKD]) in Indigenous populations in Australia, New Zealand, Canada, and the United States that diverge from those typically seen in the general population of those countries. The spectrum of renal and many other diseases seen in Indigenous people in developed countries is similar to that seen in developing countries. Diseases like PSGN that have largely disappeared in developed countries still occur frequently in Indigenous people. CKD during the childhood years is due to congenital anomalies of the kidney and urinary tract in up to 70% of cases and occurs later in polycystic kidney disease and childhood-onset diabetes. Several risk factors for CKD in adulthood are already present in childhood.
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Affiliation(s)
- Gurmeet R Singh
- Child Health Division, Menzies School of Health Research, Charles Darwin University Darwin, PO Box 41096, Casuarina, NT 0810, Australia.
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18
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Alabraba V, Farnsworth A, Leigh R, Dodson P, Gough SCL, Smyth T. Exubera inhaled insulin in patients with type 1 and type 2 diabetes: the first 12 months. Diabetes Technol Ther 2009; 11:427-30. [PMID: 19580355 DOI: 10.1089/dia.2008.0131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Following National Institute for Clinical Excellence approval of inhaled insulin Exubera (Pfizer, New York, NY) in 2006, we established a dedicated clinic in January 2007 to monitor the efficacy and safety of Exubera. Between January and October 2007, eight patients started Exubera: six because of needle phobia (DSM-IV criteria) and two with injection site problems. METHODS Data were collected at the clinic over a 12-month period from February 2007 at 3-, 6-, 9-, and 12-month intervals. The clinic is jointly led by a consultant diabetologist and a diabetes specialist nurse within the secondary care setting. RESULTS Inhaled insulin was well tolerated in all eight patients who had previously experienced significant problems with initiation or intensification of subcutaneous insulin injections. Mean hemoglobin A1c was 10.7% (range, 8.1-14.2%) at initiation, 8.3% (7.2-9.4%) at 3 months, 7.7% (6.9-9.0%) at 6 months, 7.4% (6.7-8.4%) at 9 months, and 7.5% (6.5-8.7%) at 12 months. At 6 months, six patients had a reduction in forced expiratory volume in the first second (FEV1) by 4-12%, whereas five patients had a reduction of 2-12% at 12 months. One developed dyspnea, with a 29% fall in FEV1, which was transient and secondary to an upper respiratory tract infection. Two patients with the highest starting and most improved hemoglobin A1c developed significant retinopathy. CONCLUSIONS Our 12-month audit data demonstrate that the initiation of inhaled insulin in this difficult-to-treat group of patients resulted in a significant improvement in glycemic control. The subsequent withdrawal of an alternative and acceptable form of insulin treatment now presents a renewed challenge for our patients and healthcare professionals.
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Affiliation(s)
- Victoria Alabraba
- Diabetes Centre, Selly Oak Hospital, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom
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19
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-x. [PMID: 19219862 DOI: 10.1002/dmrr.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359:1577-89. [PMID: 18784090 DOI: 10.1056/nejmoa0806470] [Citation(s) in RCA: 5062] [Impact Index Per Article: 316.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes. METHODS Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories. RESULTS Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). CONCLUSIONS Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number, ISRCTN75451837.)
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Affiliation(s)
- Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill Hospital, Headington, Oxford OX3 7LJ, United Kingdom.
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