Diabetes Mellitus 2 Research Articles

Prevalence of Prediabetes in Overweight and Obese Children from the Pediatric Consultation of a Second Level Hospital

Childhood obesity represents a global public health problem, with Mexico occupying the first place in the prevalence of this pathological condition. In our country, this combined prevalence: Obesity and overweight, is reported by up to 39.4% in adolescents, being the most affected age group. This increase in the prevalence of childhood obesity is associated with an increase in the number of cases of Diabetes Mellitus 2 (DM2) in this population .

Increased Metabolic Benefit for Obese, Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.

We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients. Retrospective review was conducted of all patients age 60years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014. A total of 134 patients who underwent LSG (n=65) or LRYGB (n=69) were identified. Groups were similar with respect to age (64years, range 60-75years), BMI (44.0±6.1), and ASA score (91%≥ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p=0.75). Median follow-up was 39months (IQR 14-64months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p=0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36months was 26.9±9.0% in the LSG group and 23.9±9.3% in the LRYGB group, p=0.24. Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.

CARBOHYDRATE METABOLISM AND HYPOGLYCEMIA RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ISCHEMIC CEREBROVASCULAR DISEASES

In patients with Type 2 diabetes mellitus 2 (DM2) the active course of atherosclerosis, increased risk of stroke and cognitive impairment are observed. The cerebrovascular or neurodegenerative disorders, metabolic disorders, hypoglycemic episodes can play the part in the development of cognitive impairment. Objective : to evaluate carbohydrate metabolism and identification of hypoglycemic conditions for patients with T2DM and ischemic cerebrovascular disease. Materials and methods . 99 patients were studied, among them 46 (46.5 per cent) men and 53 (53,5%) women, average age 64 ± 8.3 years. Of these 46 patients with dyscirculatory encephalopathy (DE) and 53 with a history of ischemic stroke. Results. Patients showed cognitive changes. All patients had evidence of atherosclerosis of the main arteries of the head, signicant stenoses were observed in 42.4 per cent, and multiple atherosclerotic changes – 39.4% of the patients. The T2DM disease duration was 8.4 ± 6 years, HbA1c – a 7.8 ± 1.9 percent. Hypoglycemia is marked on the background antidiabetic therapy in 15% of patients, 7 of them are unrecognizable. In patients with hypogycemic episodes of disease duration and frequency of reduced GFR was significantly higher. Conclusions. Ischemic cerebrovascular disease in DM2 patients takes place on the background of atherosclerosis of the main arteries of the head, hypertension, renal dysfunction and are accompanied by the risk of iatrogenic hypoglycemia. Hypoglycemic states often develop with increasing duration of the disease of type 2 diabetes and reduction of the glomerular filtration rate. It is recommendable to regularly control blood glucose to reduce the risk of hypoglycemic conditions.

A sirtuin 1/MMP2 prognostic index for myocardial infarction in patients with advanced coronary artery disease

BackgroundSirtuin 1 (SIRT1) appears to play a protective role against endothelial dysfunction and oxidative stress. Instead, matrix metalloproteinase 2 (MMP2) is involved in acute coronary events, by promoting tissue remodeling. This study sought to determine the clinical value of a prognostic index arising from the combination of these two biomarkers for myocardial infarction (MI) in patients with advanced coronary artery disease. MethodsEighty-one patients with advanced coronary artery disease planned for open heart surgery were prospectively enrolled. Serum levels of SIRT1 and MMP2 were measured by ELISA. To look at the relation of these mediators with clinical characteristics, pre-operative data and patients demographics were collected. ResultsSIRT1 levels correlated marginally with a history of hypertension (ρ=0.2, p=0.084) and inversely with baseline urea (ρ=0.25, p=0.056). When performing additional adjustment, low SIRT1 levels were independently associated with diabetes mellitus 2(DM2) and subjects with SIRT1 <2.95ng/mL were more prone to present DM2 (82% sensitivity and 62% specificity). The index of low SIRT1 and high MMP2 respectively correlated with patients history of MI (ρ=0.3, p=0.01) and marginally with presence or history of atrial fibrillation (AF) (ρ=0.213, p=0.076). When adjusting for anthropometric and comorbidities, the combined index tended to have an association with impaired ejection fraction (EF)<55% (p=0.059). ConclusionsThe combined index of low SIRT1 and high MMP2 exhibited a significant correlation with history of MI and EF, promoting a potential prognostic tool for MI incidence in patients regardless their coronary artery disease status.

Diabetes Management and Future Trends

1. Michelle Renee Campbell, MLS (ASCP) 1. Medical Laboratory Sciences Program, Northern Illinois University, DeKalb, IL 2. Masih Shokrani, Ph.D. MT (ASCP)[⇑][1] 1. Medical Laboratory Sciences Program, Northern Illinois University, DeKalb, IL 1. Address for Correspondence: Masih Shokrani, Ph.D. MT (ASCP ), Associate Professor, Medical Laboratory Sciences Program, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL, 60115-2828, 815-753-6323, mshokrani{at}niu.edu 1. Compare treatment options for type 1 versus type 2 diabetes mellitus 2. List and describe the advantages and disadvantages of the various classes of drugs used to treat diabetes mellitus 3. Identify future trends in diabetes mellitus research and treatment. INTRODUCTION Proper management of diabetes mellitus is crucial for the health and well-being of patients. Various options exist for the treatment of both type 1 and type 2 diabetes allowing tailored treatment toward each patient. Multiple classes of drugs developed to treat diabetes mellitus can be examined including sulfonylureas, biguanides, and alpha-glucosidase inhibitors. On the horizon for treatment and management of diabetes mellitus, new developments utilize concepts such as stem cell therapy, dietary management, metabolomics and education. Diabetes Management Treatment for type 1 diabetes mellitus may include multiple components. Blood sugar levels must be monitored throughout the day using a glucometer. Self-monitoring by the patient has become increasingly practical with the advent of small, portable glucometers and similar supplies.1 Treatment with insulin is required for those with type 1 diabetes mellitus to provide consistent blood glucose management and prevent diabetic ketoacidosis. Diabetic ketoacidosis, the buildup of harmful ketones in the body due to the utilization of fat for energy, is a serious threat for diabetic patients.2 Multiple brands of insulin exist, each producing products that vary in intensity and length of action. Rapid-acting, long-acting and intermediate forms of insulin are available and may be administered via insulin pump, injection or an insulin pen.3 Rapid-acting insulin treatments include insulin aspart, glulisine and lispro. Regular insulin is considered short-acting and insulin neutral protamine Hagedorn (NPH) is intermediate-acting. Insulin determir and glargine are both long-acting varieties of insulin.4 One or a combination of these insulin options are tailored for the patient based on… ABBREVIATIONS: NPH - Neutral protamine Hagedorn, ACE - Angiotensin-converting enzyme, ARBs - Angiotensin II receptor blockers, SGLT-2 - Sodium glucose cotransporter-2, DPP-4 - Dipeptidyl peptidase 4, GLP-1 - Glucagon-like peptide-1, CDC - Center for Disease Control and Prevention, DPCP - Diabetes Prevention and Control Program 1. Compare treatment options for type 1 versus type 2 diabetes mellitus 2. List and describe the advantages and disadvantages of the various classes of drugs used to treat diabetes mellitus 3. Identify future trends in diabetes mellitus research and treatment. [1]: #corresp-1

Homeodomain interacting protein kinase 2 is downregulated through the peroxisome proliferator-activated receptor gamma signaling pathway in an insulin-resistant population.

Homeodomain interacting protein kinase 2 (HIPK2), the highly conserved nuclear serine/threonine kinase, is known to act as a co-repressor through interacting with a number of transcription factors. Notably, HIPK2 inhibits cell growth through the activation of p53. However, its in vivo function in insulin resistance is still unknown. Recently, the discovery by Sjolund et al.1 has implicated HIPK2 as a central modulator of adipogenesis. They found that deletion of HIPK2 in mice gave rise to decreased adipogenesis and increased insulin-sensitivity independence of the peroxisome proliferator-activated receptor gamma (PPARγ) signaling pathway. According to their result, we hypothesize that the expression of HIPK2 in the insulin-resistant population might be upregulated. To testify our supposition, we analyzed the publicly available expression data from two human insulin-resistant expression data in GEO datasets that use the same platform. Contrary to our deduction, the HIPK2 gene was downregulated in the insulin-resistant population (Figure ​(Figure11a,b). Figure 1 Decreased expression of homeodomain interacting protein kinase 2 (HIPK2) in an insulin resistant population was associated with the peroxisome proliferator-activated receptor gamma (PPARγ) signaling pathway. (a,b) Expression of HIPK2 detected ... PPARγ is the key transcription factor in adipogenesis, as well as glucose and fatty acid metabolism, and alterations in the pathway lead to insulin resistance and type 2 diabetes mellitus2. According to the report by Sjolund et al.1, the function of HIPK2 was not mediated by a PPARγ-dependent mechanism1. However, we identified that some downstream targets of PPARγ, which Sjolund et al. mentioned, were downregulated in adipocytes in insulin-resistant people, which is synchronously expressed with HIPK2 messenger ribonucleic acid expression (Figure ​(Figure1c).1c). Some transcription cofactors of PPARγ shown by GeneMANIA (http://www.genemania.org/) were also downregulated in the adipocytes of the insulin-resistant population (Figure ​(Figure11d). Rosiglitazone (Rosi), a member of the thiazolidinediones and an agonist of PPARγ, works as an insulin sensitizer in type 2 diabetes mellitus3. The present results showed that HIPK2 messenger ribonucleic acid expression was significantly increased in the presence of both Rosi and overexpressed PPARγ in murine marrow-derived U-33 cells, indicating a tendency of increased HIPK2 expression after administration of insulin sensitizer (Figure ​(Figure1e).1e). In agreement with this, several other articles published the same results that HIPK2 expression was elevated after administration of insulin sensitizer, rosiglitazone and troglitazone (Table S1), suggested by The Comparative Toxicogenomics Database (http://ctdbase.org/). Taken together, despite of Sjolund et al. discovery that HIPK2 deletion in mice induces increased insulin sensitivity and was not mediated by the PPARγ pathway, our data suggest that downexpression of HIPK2 was discovered in a population that suffered from decreased insulin sensitivity (insulin resistance) through the PPARγ-dependent pathway. This discrepancy might be caused by the following reasons: (i) metabolic differences between humans and murine; (ii) the discovery by Sjolund et al. was carried out on skeletal muscle, where the present results were shown in adipocytes; and (iii) our discovery was the result of a subset of humans, accordingly, the discovery by Sjolund et al. was based on a few HIPK2 knockout mice, the two studies all await further verification. Furthermore, we also showed that administration of insulin sensitizer could promote the elevated expression of HIPK2, thus providing a benefit for treatment of insulin resistance.

Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil

The aim of this study is to investigate the prevalence of potential drug-drug interactions (PDDIs), as well as classifying them in relation to level of severity, scientific evidence, time of onset, and potential clinical impact in adult and older adult patients with diabetes mellitus 2 (DM2). This cross-sectional study was conducted in a tertiary care outpatient center. The consecutive sample was made up of 140 patients with DM2. The Anatomical-Therapeutic-Chemical Classification was used for classifying the classes of medications. The PDDIs were analyzed using the DRUG-REAX® system. The relationships between PDDI and the associated factors were ascertained using a multiple logistic regression model. The prevalence of total PDDI was 75 %, and the prevalence of major severity PDDI was 20.7 %. Simvastatin (30.8 %), captopril/enalapril (12.8 %), and oral anti-diabetics/insulin (12.8 %) were the medications which were most involved in the major PDDI, bringing relevant potential clinical impacts such as rhabdomyolysis, hyperkalemia, and important glycemic alterations. Polypharmacy was associated with PDDI (adjusted odds ratio = 10.46, 95 % confidence interval = 4.10–26.71). Diabetics were highly exposed to clinically significant PDDI. It is important that health professionals should be aware of the risks related to PDDI, so that measures may be implemented in order to assure safe care for the patient.

Case Report: Maggots’ Infestation As a Predisposing Condition for Heparin-Induced Thrombocytopenia, a Newest Entity

IntroductionThromobocytopenia is a well-recognized complication of heparin with risk of venous or arterial thrombosis. Heparin induced thrombocytopenia, Type I (HIT-I) is a self-limiting, nonautoimmune, and most common form of thrombocytopenia. Heparin induced thrombocytopenia, Type - II (HIT-II) is an immune mediated and serious adverse drug reaction caused by formation of heparin-platelet factor 4 (PF4) complex antibodies. Its incidence ranges from 0.2% – 5.0% in patients exposed to heparin for more than 4 days and 0.2% for those treated with unfractionated heparin (UFH) for less than 4 days. HIT-II is referred as HIT in this abstract. Maggots’ therapy is used in clinical centers all over the world for the treatment of chronic wounds, such as leg ulcers, pressure sores, diabetic and necrotic ulcers, as well as infected surgical wounds, burns and trauma injuries. Maggots’ therapy has core beneficial effects on a non-healing wound by mechanisms of debridement, disinfection and enhanced healing. In the last decade, maggots have been used to treat wounds of thousands of patients worldwide, so clinicans have recognized maggots’ therapy as an important adjunct to conventional medicine. Despite its widespread usage, the relationship between maggots and heparin-induced thrombocytopenia is undiscovered and unexplored. We are reporting a first ever case of heparin-induced thrombocytopenia where maggots predisposed to this medical condition.CasePatient is a 50-year-old morbidly obese (body mass index 68) male with medical history significant for diabetes mellitus-2 and hypertension presented in the hospital with left lower leg pain, which was sharp, 6/10, non-radiating, with no aggravating, and relieving factors. On presentation, he was hemodynamically stable. Physical examination revealed bilateral lower extremity hyper-pigmentation, chronic stasis changes and a superficial posterior malodorous ulcer of the left leg infested with 5-6 maggots. Rest of the examination was unremarkable. Maggots were removed, started antibiotics and he received subcutaneous heparin as thromboprophylaxis. His platelets dropped from 108X109/L to 66X109/L after a single dose of subcutaneous unfractionated heparin. 4 T score revealed high pre-test probability. Laboratory results showed positive heparin-PF4 antibody. Imaging studies were negative for any venous or arterial thrombi/emboli. Heparin was discontinued immediately and argatroban was begun. There was noticeable rise in his platelet count. He was discharged upon symptomatic improvement of his leg pain along with normalization of his platelet counts.DiscussionHeparin-induced thrombocytopenia is a clotting disorder where antibodies like IgG, IgM, and IgA are provoked by heparin, and highly immunogenic complex of heparin-PF4. Then, heparin-PF4-antibody complex binds to an activated platelet surface, binding of this immune complex to endothelial cell surfaces and tissue factor leads to thrombosis. Genetic and patient-specific interactions may also have an impact on HIT. Maggots have been extensively studied in the wound healing process and various mechanisms of actions have been described in the literature. Maggots combat clinical infection by exudate production, ingestion of wound bacteria and secreting potent bactericidal agents. Maggots form granulation tissue by complex interactive healing process. Upon maggots’ exposure, growth factors, such as platelet-derived growth factor (PDGF), epidermal growth factor (EGF), fibroblast growth factor (FGF) and transforming growth factor (TGF), are produced and released from the wound site to rapidly recruit inflammatory cells via cytokines and chemokines to an injured area. These factors increase the capillary permeability to the wound site. Also, these growth factors are formed, stored and released from platelets, as is platelet factor 4 complex. Hence, maggots activate platelets, release immunogenic PF-4 complex and initiate the whole cascade of heparin-induced thrombocytopenia. We need further studies to validate the interrelation of maggots’ therapy or infestation and heparin-induced thrombocytopenia. DisclosuresNo relevant conflicts of interest to declare.

Case of fulminant type 1 diabetes mellitus associated with parvovirus B19 infection.

A man aged in his 60′s was admitted to Kobe Rosai Hospital, Kobe, Japan, because of impaired consciousness. One week before admission, he manifested erythema on his trunk and extremities that was associated neither with fever nor with flulike symptoms. Thirst and nausea developed within a few days of erythema onset. Whereas the erythema disappeared spontaneously, the thirst and nausea worsened. A family member noticed abnormal behavior of the patient and took him to the emergency room of the hospital, where his consciousness was found to be impaired. He manif-ested ketonuria and metabolic acidosis with marked hyperglycemia, a slightly increased hemoglobin A1c content (National Glycohemoglobin Standardization Program value calculated from the Japan Diabetes Society value,1) and a low serum C-peptide level (Table 1). His hemoglobin A1c at an annual health check-up carried out 17 days previously was 5.5%. Serum levels of amylase and lipase were high, and liver and kidney function were slightly and severely attenuated, respectively. Computed tomography showed no morphological abnormalities of abdominal organs including the pancreas. The patient was immediately admitted to the hospital, and treated according to standard care for diabetic ketoacidosis by intravenous supplementation with electrolyte fluid and insulin. His consciousness returned to normal as the hyperglycemia and acidosis were ameliorated. On the day of admission, the serum titer of antibodies to glutamic acid decarboxylase was borderline high, but it had returned to a normal level on a second test carried out 2 weeks later. Tests for islet cell antibodies and antibodies to anti-insulinoma-associated protein-2 antibody were negative. Human Leukocyte antigen typing revealed the patient to harbor DRB1*09:01-DQB1*03:03 and DRB1*04:05-DQB1*04:01alleles, the latter of which confers susceptibility to fulminant type 1 diabetes mellitus2. The patient was diagnosed with fulminant type 1 diabetes mellitus and discharged 36 days after admission with multiple daily subcutaneous insulin injections. We examined antibody titers for various viruses in serum obtained on the first and 21st days of hospitalization (Table S1). Among those examined, only immunoglobulin M class antibodies to parvovirus B19 changed substantially during the first 3 weeks of hospitalization, decreasing from 1.32 (normal range <0.8) to 0.96, suggestive of a recent infection with parvovirus B19. Given that erythema is a common clinical manifestation of parvovirus B19 infection3, the skin rash experienced by the present patient 1 week before admission might have been caused by infection with the virus. It is of note that parvovirus B19 infection is known to trigger a variety of autoimmune disease-like conditions including systemic lupus erythematosus, rheumatoid arthritis and autoimmune cytopenia3. Similarity in amino acid sequence between parvovirus B19 proteins and human proteins thought to be related to such diseases has been implicated in the pathogenesis of autoimmune disorders triggered by this virus3. Although the pathophysiology of fulminant type 1 diabetes mellitus remains unclear, immunologic processes triggered by viral infection have been implicated4. Further accumulation of clinical evidence for the association of viral infection with fulminant type 1 diabetes mellitus together with basic studies of the mechanistic link between viral infection and β-cell destruction should provide further insight into the pathogenesis of this condition. The authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Allograft Reconstruction of a Chronic Quadriceps Tendon Rupture with Use of a Novel Technique.

Chronic ruptures of the quadriceps tendon are uncommon injuries, most frequently seen in patients over the age of forty1. The mechanism of injury is often a slip and a fall, either on a flat surface or on stairs1. It can also be associated with underlying medical conditions, such as gout or diabetes mellitus2. More than half of these patients generally are not able to return to their preinjury recreational activities, and many are not able to return to their preinjury occupation1. The results after chronic or recurrent ruptures are worse, primarily caused by tendon retraction that leads to a gap between the tendon and patella; in these cases, a V-Y advancement or allograft reconstruction is generally necessary3. We present a novel technique with use of an Achilles tendon allograft with bone block fixation, which we believe provides superior fixation in cases of chronic or recurrent quadriceps tendon ruptures. An Achilles tendon-bone block allograft is commonly used for reconstruction of the patellar tendon, in which case the bone block is fitted into the proximal aspect of the tibia4. However, to our knowledge, the placement of an Achilles tendon bone block into the patella for quadriceps tendon reconstruction previously has not been reported in the literature. The patient was informed that data concerning the case …

Coping Strategies and Self-Efficacy for Diabetes Management in Older Mexican Adults

Diabetes Mellitus 2 (DM2) affects 20% of the elderly population in Mexico, causes disability and death, and demands many life-style changes. Since DM2 control is largely responsibility of the patient, management itself is source of stress. Coping is a process by which persons face stressful situations, and active coping have proved being effective in disease control. Social-cognitive perspective suggests that self-efficacy believes can regulate human functioning, therefore they could promote specific coping if relations between them are found. The study aim was to examine the association between coping strategies and self-efficacy in DM2 management in a group of 126 Mexican adults over 54 years old (= 68.57, SD = 7.19), which answered an interview about sociodemographics data, self-efficacy in diabetes and coping strategies. The most common kind of coping used by the sample was self-recreation (= 50.41, SD = 19.50) and religious faith (= 50.04, SD = 17.65), and in self-efficacy the domain of taking the medicines had the greater score (= 90.25, SD = 16.08). Total score in self-efficacy had significant correlations with active coping (r = .402, p ≤ .01) and self-recreation (r = .291, p ≤ .01). We concluded that there are relationships between self-efficacy beliefs in diabetes management and active coping. The correlation found can be used to guide future interventions with these patients, but the relation should be studied deeper for directional search, if is proved that DM self-efficacy beliefs enhance active coping; self-efficacy based interventions should be promote.

Effects of icosapent ethyl on lipid and inflammatory parameters in patients with diabetes mellitus-2, residual elevated triglycerides (200–500 mg/dL), and on statin therapy at LDL-C goal: the ANCHOR study

BackgroundIcosapent ethyl (IPE) is a high-purity prescription form of eicosapentaenoic acid (EPA) ethyl ester indicated as an adjunct to diet to reduce triglyceride (TG) levels in adult patients with severe (≥500 mg/dL) hypertriglyceridemia. ANCHOR was a 12-week, phase 3 study that evaluated the efficacy and safety of IPE in patients (N = 702) with residual high fasting TG levels (≥200 and <500 mg/dL) despite having optimized low-density lipoprotein cholesterol (LDL-C) levels (≥40 and <100 mg/dL) on statin therapy. Among patients randomized to IPE (4 g/day or 2 g/day) or placebo, 514 (73%) had diabetes mellitus.MethodsA post hoc subgroup analysis of the ANCHOR study was conducted to assess the effects of IPE on median placebo-adjusted percent change from baseline in efficacy end point parameters in 3 subgroups: total (all subjects with diabetes—overall median baseline glycosylated hemoglobin A1c [A1c] = 6.8%), better-controlled diabetes (below median baseline A1c), and less-controlled diabetes (above median baseline A1c).ResultsBaseline efficacy parameters were similar among all groups except high-sensitivity C-reactive protein (hsCRP), which was higher in the total and less-controlled diabetes groups. Compared with placebo, IPE 4 g/day significantly reduced TG, non-high-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol (VLDL-C), lipoprotein-associated phospholipase A2, apolipoprotein B (Apo B), total cholesterol, high-density lipoprotein cholesterol, VLDL-TG, oxidized LDL, and remnant-like particle cholesterol in all 3 diabetes groups, LDL-C in the total diabetes group, and hsCRP in the total and less-controlled diabetes groups. Decreases in hsCRP and Apo B were much greater in patients with less-controlled diabetes. There were no significant increases in fasting plasma glucose, A1c, insulin, or homeostasis model assessment-estimated insulin resistance in any group.ConclusionIPE 4 g/day significantly improved lipid and lipid-related parameters without worsening glycemic control in patients with diabetes and mixed dyslipidemia, with possibly greater effects among those with less-controlled diabetes.Trial registrationClinicaltrials.gov Identifier NCT01047501

Efecto del ejercicio físico en el control metabólico y en factores de riesgo de pacientes con diabetes mellitus tipo 2: estudio cuasi experimental

Background: There is evidence that physical exercise leads to reduced metabolic derangement in persons with diabetes mellitus 2 (DM2). Objetive: To learn about the effects of physical exercise in controlling DM2. Methods: A pre and post treatment quasi-experimental study was conducted from January to May, 2011. 40 DM2 subjects were assessed. Two subgroups were formed: one with 20 patients (the experimental group) and another one with the remaining 20 patients (the control group). The variables analyzed were: age, sex, body mass index, waist circumference, fasting blood glucose levels, cholesterol, triglycerides and blood pressure (systolic and diastolic). We designed an aerobic exercise program that was applied to the experimental group. We measured the variables for both groups at baseline, at week 6 and 12. Results: Obese people predominated in both groups, with a

Probiotics for human health –new innovations and emerging trends

The role of the gut microbiome in human health and disease with a particular emphasis on therapeutic use of probiotics under specific medical conditions was mainly highlighted in 1st Annual conference of Probiotic Association of India (PAi) and International Symposium on “Probiotics for Human Health - New Innovations and Emerging Trends” held on 27th-28th August, 2012 at New Delhi, India. There is increasing recognition of the fact that dysbiosis or alteration of this gut microbiome may be implicated in gastro-intestinal disorders including diarrheal diseases, ulcerative colitis, inflammatory bowel diseases, life style diseases viz. Diabetes Mellitus-2 and obesity etc. This report summarizes the proceedings of the conference and the symposium comprehensively. Although, research on probiotics has been continuing for the past few decades, the subject has been currently the major focus of attention across the world due to recent advances and new developments in genomics, transcriptomics, proteomics, metabolomics and emergence of new generation of high through put sequencing technologies that have immensely helped in understanding the probiotic functionality and mode of action from nutritional and health perspectives. There is now sufficient evidence backed up with good quality scientific clinical data to suggest that probiotic interventions could indeed be effective in various types of diarrheal diseases, other chronic gastrointestinal inflammatory disorders like pouchitis, necrotizing entero-colitis, allergic responses and lactose intolerance etc. This report makes a modest attempt to give all the stake holders involved in development of probiotic based functional/health foods an overview of the current status of probiotics research at the Global and National level. The most crucial issues that emerged from the lead talks delivered by the eminent speakers from India and abroad were the major focus of discussions in different plenary and technical sessions. By discussing some of these issues from scientific perspectives, the conference could achieve its prime objective of disseminating the current knowledge on the prospects of probiotics as potential biotherapeutics in the management of human health and diseases.

Rapid Determination of the Thermal Nociceptive Threshold in Diabetic Rats

Painful diabetic neuropathy (PDN) is characterized by hyperalgesia i.e., increased sensitivity to noxious stimulus, and allodynia i.e., hypersensitivity to normally innocuous stimuli1. Hyperalgesia and allodynia have been studied in many different rodent models of diabetes mellitus2. However, as stated by Bölcskei et al, determination of "pain" in animal models is challenging due to its subjective nature3. Moreover, the traditional methods used to determine behavioral responses to noxious thermal stimuli usually lack reproducibility and pharmacological sensitivity3. For instance, by using the hot-plate method of Ankier4, flinch, withdrawal and/or licking of either hind- and/or fore-paws is quantified as reflex latencies at constant high thermal stimuli (52-55 °C). However, animals that are hyperalgesic to thermal stimulus do not reproducibly show differences in reflex latencies using those supra-threshold temperatures3,5. As the recently described method of Bölcskei et al.6, the procedures described here allows for the rapid, sensitive and reproducible determination of thermal nociceptive thresholds (TNTs) in mice and rats. The method uses slowly increasing thermal stimulus applied mostly to the skin of mouse/rat plantar surface. The method is particularly sensitive to study anti-nociception during hyperalgesic states such as PDN. The procedures described bellow are based on the ones published in detail by Almási et al 5 and Bölcskei et al 3. The procedures described here have been approved the Laboratory Animal Care and Use Committee (LACUC), Wright State University.

Guilty by Association: Platelet Reactivity and Inflammation in Psoriatic Arthritis

Patients with rheumatoid arthritis (RA) die prematurely from cardiovascular disease (CVD)1. The risk of adverse cardiovascular events and subsequent mortality in patients with RA is comparable to that associated with type 2 diabetes mellitus2. There is an emerging body of evidence that patients with other forms of inflammatory arthritis (IA), in particular psoriatic arthritis (PsA), are at a similarly elevated risk of CVD3. Platelets play a key role in the complex chain of events leading to the thrombotic occlusion of a coronary artery4. Antiplatelet therapy with aspirin and/or a variety of other agents is effective at reducing the mortality associated with incident CVD5 and is recommended for the primary prevention of same in patients at high risk of atherothrombotic events4. Despite the greatly increased risk of heart disease and strokes, there are currently no antiplatelet guidelines for the primary prevention of CVD in patients with IA3, and platelet function remains largely uninvestigated in this patient population. It is within this context that the recent work of Di Minno and colleagues, reported in this issue … Address correspondence to Dr. MacMullan; E-mail: pmacmullan{at}hotmail.com

Back to Wilson and Jungner: 10 Good Reasons to Screen for Type 2 Diabetes Mellitus

The US Preventive Services Task Force (USPSTF) operates under the Agency for Healthcare Research and Quality, one of 11 divisions of the US Department of Health and Human Services. A panel of preventive medicine and health care experts, the USPSTF reviews existing literature and evidence to make recommendations regarding preventive care measures.1 Primary care practitioners rely on such guidelines to make medical decisions, and insurance companies and government agencies use this information to determine payment for services rendered and for credentialing of institutions. Recently, the USPSTF updated its guidelines on screening adults for type 2 diabetes mellitus2,3 (Table 1).4 This report was based on a literature review of the existing data in both MEDLINE and the Cochrane Library databases. Members of the USPSTF concluded that screening for diabetes in asymptomatic individuals with hypertension (blood pressure >135/80 mm Hg) was merited. Unfortunately, they did not recommend or highlight the importance of screening other at-risk populations who would be screened under the American Diabetes Association (ADA) guidelines, citing lack of direct or indirect evidence supporting population screening.2 However, the authors acknowledge that direct evidence, such as a randomized trial that compared treated vs untreated persons in whom screening detected diabetes, will not be available because “withholding treatment from persons with known diabetes is unethical….” The ADA also concluded that a study of this type is unlikely to occur and developed guidelines based on existing data and expert opinion that recommend screening for diabetes mellitus in a much wider population because of the epidemic in the United States.4 TABLE 1. ADA and USPSTF Criteria to Screen for Diabetes Mellitusa In addition, the criteria used to develop these new USPSTF recommendations have been a subject of interest. Although USPSTF states its guidelines are based on explicit criteria,1 experts have questioned its more restrictive screening criteria used to develop its diabetes screening guidelines compared with that used for another chronic disease, obesity.5 This query has merit considering the impact USPSTF guidelines have on population health. Clearly, screening for disease must meet certain criteria to be medically and financially acceptable. Perhaps the most recognized criteria were determined by Wilson and Jungner6 in 1968. These principles (Table 2), which the World Health Organization follows, define the basis of preventive medicine 40 years later and are largely considered the standards by which screening tests are judged and determined. TABLE 2. Wilson and Jungner Criteria for Disease Screening (Adopted by the World Health Organization) Because of the potential far-reaching implications of the new USPSTF guidelines, it is important to examine the merits of diabetes screening using the 10 criteria of Wilson and Jungner since national screening recommendations profoundly affect health care delivery and outcomes.

The membrane attack complex as an indicator of complement hyperactivation in type 2 diabetes mellitus

Aim. Comparative analysis of the levels of the membrane attack complex (MAC) - an end product of complement activation, and of hemolytic activitiesof C1 and C3 complement components in sera of patients with diabetes mellitus 2 (DM2) and healthy subjects. Materials and methods. 37 DM2 patients (7 men, 26 women, mean age 58?9 years (M?б) and 37 healthy subjects without a family history of hereditarydiabetes (17 men, 20 women, mean age 52?12 years). Serum MAC levels were measured by ELISA, C1 and C3 hemolytic activities by usingrabbit antibody-sensitized ram erythrocytes and C1, C3-deficient sera. Results. Mean values of all measured parameters in DM2 patients were significantly higher than in controls. Conclusion. Pathogenesis of DM2 is characterized by hyperactivation of the complement system including both the classical and terminal cascadesand by hyperproduction of its cytotoxic products.

Long-standing diabetes and its effects on outcomes in colon cancer.

e14019 Background: Diabetes mellitus 2 (DM2) is associated with increased colon cancer risk and is thought to be secondary to carcinogenesis induced by increased insulin and insulin growth factor-1...

Effectiveness of surgical weight loss on the remission of type 2 diabetes mellitus: A systematic review

Effectiveness of surgical weight loss on the remission of type 2 diabetes mellitus: A systematic review