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Belli M, Bellia A, Sergi D, Barone L, Lauro D, Barillà F. Glucose variability: a new risk factor for cardiovascular disease. Acta Diabetol 2023; 60:1291-1299. [PMID: 37341768 PMCID: PMC10442283 DOI: 10.1007/s00592-023-02097-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 06/22/2023]
Abstract
AIMS AND DATA SYNTHESIS Glucose variability (GV) is increasingly considered an additional index of glycemic control. Growing evidence indicates that GV is associated with diabetic vascular complications, thus being a relevant point to address in diabetes management. GV can be measured using various parameters, but to date, a gold standard has not been identified. This underscores the need for further studies in this field also to identify the optimal treatment. CONCLUSIONS We reviewed the definition of GV, the pathogenetic mechanisms of atherosclerosis, and its relationship with diabetic complications.
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Affiliation(s)
- Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Domenico Sergi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy.
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Freckmann G, Buck S, Waldenmaier D, Kulzer B, Schnell O, Gelchsheimer U, Ziegler R, Heinemann L. Insulin Pump Therapy for Patients With Type 2 Diabetes Mellitus: Evidence, Current Barriers, and New Technologies. J Diabetes Sci Technol 2021; 15:901-915. [PMID: 32476471 PMCID: PMC8258526 DOI: 10.1177/1932296820928100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increasing number of patients with type 2 diabetes mellitus (T2DM) use insulin pumps. The first insulin pumps especially designed for patients with T2DM have recently become available. However, national guidelines do not primarily recommend the use of continuous subcutaneous insulin infusion (CSII) for this patient group. The effectiveness of CSII in T2DM has not yet been convincingly demonstrated, despite some positive evidence. An overview and an assessment of various studies to date will be given. T2DM is a heterogeneous disease with a substantial phenotypic variability; therefore, it is difficult to provide general conclusions about the effectiveness of CSII in T2DM therapy. The pump types, characteristics, and associated barriers may play a relevant role for therapy outcome. Most advanced functions like various bolus dosages offered by conventional insulin pumps are not needed for T2DM treatment and complicate the device handling for this subject group. Additionally, new technologies like increased connectivity, advanced software features, and interoperability are currently becoming available representing further barriers. The implementation of this technological progress might be a benefit for pumps for T2DM as well. However, these have not been sufficiently examined either and increased security challenges due to integrated peripheral components should not be neglected in terms of a sound cybersecurity. Pump features and handling for patients with T2DM should be as easy as possible, indicating a need for insulin pumps specially designed for patients with T2DM. However, it has to be investigated if pumps designed for T2DM are more effective than other intensified insulin regimens.
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Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sina Buck
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
- Sina Buck, MSc, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Straße 8/2, Ulm 89081, Germany.
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Bernhard Kulzer
- Forschungsinstitut Diabetes Akademie Bad Mergentheim, Germany
| | - Oliver Schnell
- Forschergruppe Diabetes e.V., Helmholtz Zentrum, Munich, Germany
| | | | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Münster, Germany
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Advanced Glycation End Products: Potential Mechanism and Therapeutic Target in Cardiovascular Complications under Diabetes. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9570616. [PMID: 31885827 PMCID: PMC6925928 DOI: 10.1155/2019/9570616] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023]
Abstract
The occurrence and development of cardiovascular complications are predominantly responsible for the increased morbidity and mortality observed in patients with diabetes. Oxidative stress under hyperglycemia is currently considered the initial link to diabetic cardiovascular complications and a key node for the prevention and treatment of diabetes-related fatal cardiovascular events. Numerous studies have indicated that the common upstream pathway in the context of oxidative stress in the cardiovascular system under diabetic conditions is the interaction of advanced glycation end products (AGEs) with their receptors (RAGEs). Therefore, a further understanding of the relationship between oxidative stress and AGEs is of great significance for the prevention and treatment of cardiovascular complications in patients with diabetes. In this review, we will briefly summarize the recent research advances in diabetes with an emphasis on oxidative stress and its association with AGEs in diabetic cardiovascular complications.
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Treweeke A, Hall J, Lambie S, Leslie SJ, Megson IL, MacRury SM. Preliminary study of hypoxia-related cardiovascular mediator-markers in patients with end-stage renal disease with and without diabetes and the effects of haemodialysis. PLoS One 2017; 12:e0178171. [PMID: 28542479 PMCID: PMC5441650 DOI: 10.1371/journal.pone.0178171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/08/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Evidence points to activation of pro-inflammatory and pro-thrombotic stimuli during the haemodialysis process in end-stage renal disease (ESRD) with potential to predispose to cardiovascular events. Diabetes is associated with a higher incidence of cardiovascular disease in haemodialysis patients. We tested the hypothesis that a range of mediators and markers that modulate cardiovascular risk are elevated in haemodialysis patients with diabetes compared to those without. METHODS Men and women with diabetes (n = 6) and without diabetes (n = 6) aged 18-90 years receiving haemodialysis were recruited. Blood samples were collected and analysed pre- and post-haemodialysis sessions for (platelet-monocyte conjugates (PMC), oxidised LDL (Ox-LDL), endothelin 1 (ET-1) and vascular endothelial growth factor (VEGF-A). RESULTS PMC levels significantly increased after haemodialysis in both groups (diabetes p = 0.047; non-diabetes p = 0.005). Baseline VEGF-A was significantly higher in people with diabetes (p = 0.009) and post-dialysis levels were significantly reduced in both groups (P = 0.002). Ox-LDL and CRP concentrations were not significantly different between groups nor affected in either group post-dialysis. Similarly, ET-1 concentrations were comparable in all patients at baseline, with no change post-dialysis in either group. CONCLUSIONS In this pilot study, we have confirmed that circulating PMCs are increased following dialysis irrespective of diabetes status. This is likely to be a mechanistic process and offers a potential explanation for high rates of vascular events associated with haemodialysis. The higher VEGF-A concentrations between patients with and without diabetes is a previously unreported finding in diabetic ESRD. Further research is merited to establish whether VEGF-A is a marker or mediator (or both) of cardiovascular risk in haemodialysis.
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Affiliation(s)
- A. Treweeke
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
| | - J. Hall
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
| | - S. Lambie
- Department of Medicine, Raigmore Hospital, Inverness, Scotland
| | - S. J. Leslie
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
- Department of Medicine, Raigmore Hospital, Inverness, Scotland
| | - I. L. Megson
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
| | - S. M. MacRury
- Division of Health Research, University of the Highlands and Islands, Inverness, Scotland
- Department of Medicine, Raigmore Hospital, Inverness, Scotland
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ALrefai AA, Alsalamony AM, Fatani SH, Kamel HFM. Effect of variable antidiabetic treatments strategy on oxidative stress markers in obese patients with T2DM. Diabetol Metab Syndr 2017; 9:27. [PMID: 28546831 PMCID: PMC5444104 DOI: 10.1186/s13098-017-0220-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/25/2017] [Indexed: 01/19/2023] Open
Abstract
AIM To evaluate the effect of different anti-diabetic treatment strategy on oxidative stress markers in patients with type 2 diabetes mellitus (T2DM). SUBJECT AND METHODS A total of 93 patients with T2DM treated with metformin (G1 = 25), OHA (G2 = 22), OA and insulin (G3 = 26) and insulin alone (G4 = 20). In all patients, lipid profile and glycemic indices were assessed using routine laboratory tests. MDA and Oxidized LDL were assessed using commercially available ELISA kits. Laboratory tests were performed at baseline and at a control visit after 24 weeks of treatment. RESULTS A significant decrease in the levels of MDA with improvement of glycemic control was observed in the group receiving OHA in combination with insulin therapy. A similar decrease of oxLDL was observed in all diabetic subgroups with borderline significance in those receiving metformin alone. The remaining clinical and biochemical parameters were not changed during follow-up in any of the involved groups. CONCLUSION A combination therapy with insulin was more effective in glycemic control and MDA reduction in T2DM. Whereas, a significant oxLDLc reduction was observed in T2DM irrespective of categories of antidiabetic treatment or glycemic control.
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Affiliation(s)
- Abeer A. ALrefai
- Medical Biochemistry Department, Faculty of Medicine, Menoufia University, Shebîn El Kôm, Egypt
| | - Alsayed M. Alsalamony
- Department of Internal Medicine, Diabetes and Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Sameer H. Fatani
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University (UQU), Makka, Saudi Arabia
| | - Hala F. M. Kamel
- Medical Biochemistry Department, Faculty of Medicine, Ain Shams University (ASU), Cairo, Egypt
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Schaschkow A, Mura C, Dal S, Langlois A, Seyfritz E, Sookhareea C, Bietiger W, Peronet C, Jeandidier N, Pinget M, Sigrist S, Maillard E. Impact of the Type of Continuous Insulin Administration on Metabolism in a Diabetic Rat Model. J Diabetes Res 2016; 2016:8310516. [PMID: 27504460 PMCID: PMC4967706 DOI: 10.1155/2016/8310516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 02/07/2023] Open
Abstract
Exogenous insulin is the only treatment available for type 1 diabetic patients and is mostly administered by subcutaneous (SC) injection in a basal and bolus scheme using insulin pens (injection) or pumps (preimplanted SC catheter). Some divergence exists between these two modes of administration, since pumps provide better glycaemic control compared to injections in humans. The aim of this study was to compare the impacts of two modes of insulin administration (single injections of long-acting insulin or pump delivery of rapid-acting insulin) at the same dosage (4 IU/200 g/day) on rat metabolism and tissues. The rat weight and blood glucose levels were measured periodically after treatment. Immunostaining for signs of oxidative stress and for macrophages was performed on the liver and omental tissues. The continuous insulin delivery by pumps restored normoglycaemia, which induced the reduction of both reactive oxygen species and macrophage infiltration into the liver and omentum. Injections controlled the glucose levels for only a short period of time and therefore tissue stress and inflammation were elevated. In conclusion, the insulin administration mode has a crucial impact on rat metabolic parameters, which has to be taken into account when studies are designed.
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Affiliation(s)
- A. Schaschkow
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - C. Mura
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - S. Dal
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - A. Langlois
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - E. Seyfritz
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - C. Sookhareea
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - W. Bietiger
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - C. Peronet
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - N. Jeandidier
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
- Department of Endocrinology, Diabetes, and Metabolic Diseases, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS), 67000 Strasbourg Cedex, France
| | - M. Pinget
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
- Department of Endocrinology, Diabetes, and Metabolic Diseases, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS), 67000 Strasbourg Cedex, France
| | - S. Sigrist
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
| | - E. Maillard
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg (UdS), Boulevard René Leriche, 67200 Strasbourg, France
- *E. Maillard:
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