Diabetes/Metabolism Research and Reviews
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Advanced glycation end products and diabetic foot disease
Diabetes/Metabolism Research and Reviews - Tập 24 Số S1 - Trang S19-S24 - 2008
The mode of action of thiazolidinediones
Diabetes/Metabolism Research and Reviews - Tập 18 Số S2 - Trang S10-S15 - 2002
Constant and intermittent high glucose enhances endothelial cell apoptosis through mitochondrial superoxide overproduction Abstract Background It has been previously shown that hyperglycemia enhances free radical production, inducing oxidative damage, which in its turn activates the death pathways implicated in cell apoptosis and necrosis. But the possible involvement of this pathway in the hyperglycemia‐induced apoptosis of endothelial cells has not yet been reported. Methods To verify a possible connection between mitochondrial ROS production and apoptosis induced by both stable and oscillating high glucose, SOD, MnTBAP and TTFA was added to HUVEC cell culture medium. We measured nitrotyrosine and 8OHdG as oxidative stress parameters and Bcl‐2 expression and Caspase‐3 expression and activity as apoptosis indicators. Results Our results show that hyperglycemia, both stable or oscillating, increases oxidative stress and endothelial cell apoptosis through ROS overproduction at the mitochondrial transport chain level. Conclusion The prevention of mitochondrial oxidative damage seems to be a future important therapeutic strategy in diabetes. Copyright © 2006 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 22 Số 3 - Trang 198-203 - 2006
Effect of pioglitazone on urinary liver‐type fatty acid‐binding protein concentrations in diabetes patients with microalbuminuria Abstract Background Urinary liver‐type fatty acid‐binding protein (L‐FABP) is a useful marker for renal tubulointerstitial injury. Pioglitazone is reported to be effective in early diabetic nephropathy. The aim of the present study was to determine whether pioglitazone affects urinary L‐FABP levels in diabetic nephropathy patients with microalbuminuria. Methods Sixty‐eight patients with type 2 diabetes and microalbuminuria were randomized to a 12‐month treatment with pioglitazone (30 mg/d, n = 17), glibenclamide (5 mg/d, n = 18), voglibose (0.6 mg/d, n = 17), or nateglinide (270 mg/d, n = 16). Pre‐ and posttreatment urinary albumin excretion (UAE) and urinary L‐FABP concentrations were compared between the four treatment groups and 40 age‐matched healthy subjects. Results Pretreatment UAE and urinary L‐FABP levels differed little between the four groups. UAE and urinary L‐FABP levels were significantly greater in the diabetes patients than in the healthy subjects (UAE: p < 0.001; L‐FABP: p < 0.01). After 6 and 12 months, UAE and urinary L‐FABP were significantly lower in the pioglitazone treatment group than in the other treatment groups (UAE: 6 months, p < 0.01 and 12 months, p < 0.001; L‐FABP: 6 months, p < 0.05 and 12 months, p < 0.01). Conclusions Pioglitazone, but not glibenclamide, voglibose, or nateglinide, appears to be effective in reducing UAE and the urinary L‐FABP level, suggesting that pioglitazone has a specific role in ameliorating both glomerular and tubulointerstitial lesions associated with early diabetic nephropathy. Copyright © 2006 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 22 Số 5 - Trang 385-389 - 2006
The association of variable number of tandem repeats of the insulin gene with susceptibility to type 1 diabetes among Korean subjects Abstract Background There is ethnic variation in the variable number of tandem repeats of the insulin gene (INS VNTR), one of the susceptibility loci for developing type 1 diabetes (T1D). We evaluated the influence of the genotypes and subdivisions of INS VNTR on the development of T1D in Korean subjects. Methods The study included 352 Korean patients, under the age of 18 years who were diagnosed as having T1D, and 356 control subjects. The insulin − 23Hph I A/T single nucleotide polymorphism was used as a marker of class I and III alleles. Surrounding polymorphisms at nucleotide positions + 1127, + 1140, + 2331 and + 2336 were determined as subdivisions of INS VNTR. Results Classes I/I, I/III and III/III were observed at frequencies of 95.8, 4.2 and 0% among all subjects, respectively. Class I/III genotype was significantly less frequent in patients with T1D than in controls (2.56 versus 5.90%; odds ratio 0.419; P = 0.039). In a subdivision analysis, the ID/ID genotype was decreased among patients (P = 0.017, adjusted P = 0.085) and the IC allele tended to increase. The frequency of the class I/III genotype was significantly lower among patients who were diagnosed when younger than 7 years of age than in controls (odds ratio 0.115; P = 0.011). Conclusions INS VNTR has predominance of class I over class III alleles and is associated with susceptibility to T1D in Koreans. In addition, INS VNTR shows distinctive susceptibility according to the age at the onset of T1D. Copyright © 2010 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 26 Số 6 - Trang 474-480 - 2010
The insulin gene in diabetes Abstract Lack of insulin production or abnormalities affecting insulin secretion are key to the development of almost all forms of diabetes, including the common type 1 (insulin‐dependent) and type 2 (non‐insulin‐dependent) diabetes and the more rare forms of maturity‐onset diabetes of the young (MODY). Because insulin has such a central role in the pathogenesis of both forms of diabetes, the insulin gene (INS ) has always been considered a candidate susceptibility gene. A number of studies have shown that the allelic variation and parent‐of‐origin effects affect the transmission and expression of the insulin gene in pancreatic β‐cells and extra‐pancreatic tissues. These observations have led to the formulation of new hypotheses to explain the biological mechanisms by which functional differences in the expression of the insulin gene may contribute to diabetes susceptibility. Copyright © 2002 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 18 Số 1 - Trang 13-25 - 2002
Prevention of gestational diabetes mellitus: a review of studies on weight management Abstract Entering pregnancy with overweight, obesity or gaining excessive gestational weight could increase the risk of gestational diabetes mellitus (GDM), which is associated with negative consequences for both the mother and the offspring. The objective of this article was to review scientific evidence regarding the association between obesity and GDM, and how weight management through nutritional prevention strategies could prove successful in reducing the risk for GDM. Studies published between January 1975 and January 2009 on the relationship between GDM, pre‐pregnancy body mass index (BMI), gestational weight gain and nutritional prevention strategies were included in this review. Results from these reports suggest that maternal obesity assessed by pre‐pregnancy BMI is associated with an increased risk of GDM. They also show an association between gestational weight gain and increased risk for GDM. Higher dietary fat and lower carbohydrate intakes during pregnancy appear to be associated with a higher risk for GDM, independent of pre‐pregnancy BMI. Some studies showed that restricting energy and carbohydrates could minimize gestational weight gain. However, a firm conclusion on the most effective nutritional intervention for the control of gestational weight gain and glycaemic responses could not be reached based on available studies. In light of the studies reviewed, we conclude that weight management through nutritional prevention strategies could be successful in reducing the risk of GDM. Further studies are required to identify the most effective diet composition to prevent GDM and excessive gestational weight gain. Copyright © 2009 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 26 Số 1 - Trang 17-25 - 2010
A study on the association of serum 1,5‐anhydroglucitol levels and the hyperglycaemic excursions as measured by continuous glucose monitoring system among people with type 2 diabetes in China Abstract Background Blood glucose excursion is an important component of the glycaemic burden, but there are no indexes that can directly reflect them. The aim was to evaluate the values and significance of serum 1,5‐anhydroglucitol (1,5‐AG) in people with type 2 diabetes mellitus in China and to elucidate the relationship between 1,5‐AG and traditional indexes of glycaemic excursions by continuous glucose monitoring. Methods A total of 576 healthy adults and 292 patients were included, and their 1,5‐AG, fasting blood glucose and postprandial blood glucose and glycated haemoglobin were measured. For the 34 patients, their mean blood glucose, standard deviation of blood glucose, mean amplitude of glucose excursion, mean of daily differences, low blood glucose M‐value index and the area under the curve for blood glucose above 180 mg/dL were calculated by use of a continuous glucose monitoring system. Results Serum levels of 1,5‐AG among healthy adults were 28.44 ± 8.76 µg/mL with a significant gender bias rather than age bias. The 1,5‐AG levels in people with type 2 diabetes mellitus were 4.57 ± 3.71 µg/mL, which were lower than those seen in the healthy adults. There was a correlation between 1,5‐AG and glycated haemoglobin, fasting blood glucose, and postprandial blood glucose (r = −0.251, −0.195 and −0.349, respectively; all had p < 0.05). The continuous glucose monitoring system demonstrated that 1,5‐AG presents a negative correlation with mean blood glucose, standard deviation of blood glucose, mean amplitude of glucose excursion and mean of daily differences for 7 days and with the area under the curve for blood glucose above 180 mg/dL on the third, fourth and seventh days. Conclusions 1,5‐AG may serve as a marker of hyperglycaemia and 7‐day hyperglycaemic excursions as well as being a useful adjunct to glycated haemoglobin for blood glucose monitoring in patients with diabetes. Copyright © 2012 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 28 Số 4 - Trang 357-362 - 2012
Achieving durable glucose control in the intensive care unit without hypoglycaemia : a new practical IV insulin protocol Abstract Background Hyperglycaemia occurs in a substantial portion of critically ill patients in our intensive care units. Near normalization of elevated blood glucose levels with IV insulin may improve outcome. However, currently published IV insulin protocol are not ideal; most are relatively complex and often result in hypoglycaemia. We designed a protocol that would be practical to use while incorporating the necessary complexities required to achieve good glucose control, coupled with a low incidence hypoglycaemia. Methods The essential part of the protocol is a matrix specifying the amount by which an insulin flow rate is to be changed. The intersection of the current and the previous blood glucose values on the matrix locates the appropriate cell containing the required change in insulin flow rate. No additional calculations or tables are required. Results The initial glucose level obtained by blood glucose meter (BGM) averaged 253.5 ± 95.6 mg/dL and fell below 140 within 9.3 h on the protocol. The average BGM on the protocol was 133.5 ± 43.9 mg/dL. Only 0.09% of all glucose values were <40 mg/dL and insulin had to be held only 2.2% of the time on the protocol. Physician input was not required and nursing accuracy in applying the protocol was greater than 94%. This protocol has been adopted as the default IV insulin protocol for the NorthShore‐LIJ Health System and several other medical centers. Conclusion A practical IV insulin protocol that has been extensively tested is presented. The protocol has been implemented at multiple institutions indicating its ease of use and excellent results. Copyright © 2006 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 23 Số 1 - Trang 49-55 - 2007
Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy SUMMARY Diabetic peripheral neuropathy (DPN) affects up to 50% of patients with diabetes and is a major cause of morbidity and increased mortality. Its clinical manifestations include painful neuropathic symptoms and insensitivity, which increases the risk for burns, injuries and foot ulceration. Several recent studies have implicated poor glycaemic control, duration of diabetes, hyperlipidaemia (particularly hypertryglyceridaemia), elevated albumin excretion rates and obesity as risk factors for the development of DPN. Although there is now strong evidence for the importance of nerve microvascular disease in the pathogenesis of DPN, the risk factors for painful DPN are not known. However, emerging evidence regarding the central correlates of painful DPN is now afforded by brain imaging. The diagnosis of DPN begins with a careful history of sensory and motor symptoms. The quality and severity of neuropathic pain if present should be assessed using a suitable scale. Clinical examination should include inspection of the feet and evaluation of reflexes and sensory responses to vibration, light touch, pinprick and the 10‐g monofilament. Glycaemic control and addressing cardiovascular risk is now considered important in the overall management of the neuropathic patient. Pharmacological treatment of painful DPN includes tricyclic compounds, serotonin–norepinephrine reuptake inhibitors (e.g. duloxetine), anticonvulsants (e.g. pregabalin), opiates, membrane stabilizers, the antioxidant alpha lipoic acid and others. Over the past 7 years, new agents with perhaps less side effect profiles have immerged. Management of patients with painful neuropathy must be tailored to individual requirements and will depend on the presence of other co‐morbidities. There is limited literature with regard to combination treatment. Copyright © 2012 John Wiley & Sons, Ltd.
Diabetes/Metabolism Research and Reviews - Tập 28 Số S1 - Trang 8-14 - 2012
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