Diagnosed T2DM Patients Research Articles

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors, in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.

Type 2 diabetes mellitus and risk of hydrocephalus: A 5 year population-based follow-up study in Taiwan

AimsType 2 diabetes mellitus (T2DM) involves many organ systems and is associated with a wide range of neurologic complications. However, it is not known whether T2DM is a risk factor of hydrocephalus. MethodsResearch data were retrieved from the National Health Insurance Research Database of Taiwan. A total of 25,903 individuals with T2DM aged 40–80years diagnosed during 2000–2003 and two times-number (n=51,806) age- and sex-matched comparisons during the same period were included. We tracked all individuals from their defined index visits for up to 5years to detect a new diagnosis of hydrocephalus. ResultsAmong the 25,903 patients, 9227 cases were newly diagnosed T2DM and 16,676 were pre-existing T2DM patients. During the follow-up period, 27 (0.3 %) of the newly diagnosed T2DM patients, 97 (0.6 %) of the pre-existing T2DM patients and 149 (0.3 %) of the comparison group developed hydrocephalus. The risk of hydrocephalus was significantly increased in patients with pre-existing diabetes but not in patients with newly diagnosed diabetes. ConclusionsLonger duration of type 2 diabetes is associated with an increased risk of the development of hydrocephalus. Further studies to confirm such association and to investigate the causality and mechanism are needed.

Improvement of β-cell function ameliorated glycemic variability in patients with newly diagnosed type 2 diabetes after short-term continuous subcutaneous insulin infusion or in combination with sitagliptin treatment: a randomized control trial.

Glycemic variability (GV) has been proposed as contributor to diabetes-related macrovascular complications. This randomized control trial evaluated a new combination therapy with continuous subcutaneous insulin infusion (CSII) plus sitagliptin (CSII + sitagliptin) vs. CSII only in terms of metabolic control, GV and β-cell function in patients with newly diagnosed type 2 diabetes (T2DM). 217 patients were randomized to two weeks of CSII (n = 108) or CSII + sitagliptin (n = 109) therapy. As a measure of GV, the coefficient of variation (CV) was computed from capillary blood glucose during the first and second week, respectively. β-cell function before and after treatment was determined with the Insulin Secretion-Sensitivity Index-2 (ISSI-2). Good metabolic controls were established with both therapies. CSII + sitagliptin therapy resulted in greater improvements in CV and ISSI-2 than CSII alone (all P = 0.000). For each group, change in CV was inversely correlated with change in ISSI-2 (r = -0.529, P = 0.000 and r = -0.433, P = 0.000, respectively). The multivariate regression analysis demonstrated that improved ISSI-2 was the only independent contributor to reduced CV in both groups (standardized β = -0.388, P = 0.004 and standardized β = -0.472, P = 0.000, respectively). Correction of β-cell function in newly diagnosed T2DM patients via use of either CSII or CSII + sitagliptin therapy was feasible in controlling GV to prevent secondary complications of T2DM. Moreover, CSII + sitagliptin therapy was superior to CSII monotherapy in terms of GV.

Costing of diabetes mellitus type II in Cambodia.

BackgroundDiabetes Mellitus Type II (T2DM) is a major and growing medical, social and economic burden in the East-Asian country of Cambodia. However, no economic modelling has been done to predict the number of cases and the budget impact.ObjectiveThis paper forecasts the epidemiological and economic consequences of T2DM in Cambodia. The Ministry of Health and related donor agencies are supported to select the most cost-effective interventions against the disease. At the same time this paper demonstrates the relevance and potential of health economic modelling for least developed countries.MethodsWe developed a Markov-Model for the specific situation of Cambodia. Data was taken from the scientific literature, grey literature in Cambodia and key-informant interviews.ResultsThe number of people living with T2DM is steadily increasing from 145,000 in the year 2008 to 264,000 in the year 2028 (+82 %). In the year 2008 the diagnosed T2DM patients would incur costs of some 2 million US$ to cover all of diabetes treatment. 57 % of this amount would have to be spent for OAD-therapy, the rest for insulin therapy. In the year 2028 this amount will have grown to some 4 million US$. If all patients (incl. non-diagnosed) had to be paid-for the respective figure would be 5.5 million and 11 million US$.Screening for T2DM is only cost-effective if the sensitivity of the test is high while the unit price is low. The results of this simulation call for targeting the high-risk groups. However, an increased availability of Oral Anti-Diabetic and Insulin Therapy is highly cost-effective.DiscussionType 2 Diabetes Mellitus is a major public health challenge in Cambodia. The simulations clearly indicate that prevention and treatment of this disease is highly cost-effective. However, not everything that is cost-effective might be affordable in Cambodia. This country will require external support to ease the growing burden of T2DM.

Islet autoimmunity identifies a unique pattern of impaired pancreatic beta-cell function, markedly reduced pancreatic beta cell mass and insulin resistance in clinically diagnosed type 2 diabetes.

There is a paucity of literature describing metabolic and histological data in adult-onset autoimmune diabetes. This subgroup of diabetes mellitus affects at least 5% of clinically diagnosed type 2 diabetic patients (T2DM) and it is termed Latent Autoimmune Diabetes in Adults (LADA). We evaluated indexes of insulin secretion, metabolic assessment, and pancreatic pathology in clinically diagnosed T2DM patients with and without the presence of humoral islet autoimmunity (Ab). A total of 18 patients with at least 5-year duration of clinically diagnosed T2DM were evaluated in this study. In those subjects we assessed acute insulin responses to arginine, a glucose clamp study, whole-body fat mass and fat-free mass. We have also analyzed the pancreatic pathology of 15 T2DM and 43 control cadaveric donors, using pancreatic tissue obtained from all the T2DM organ donors available from the nPOD network through December 31, 2013. The presence of islet Ab correlated with severely impaired β-cell function as demonstrated by remarkably low acute insulin response to arginine (AIR) when compared to that of the Ab negative group. Glucose clamp studies indicated that both Ab positive and Ab negative patients exhibited peripheral insulin resistance in a similar fashion. Pathology data from T2DM donors with Ab or the autoimmune diabetes associated DR3/DR4 allelic class II combination showed reduction in beta cell mass as well as presence of autoimmune-associated pattern A pathology in subjects with either islet autoantibodies or the DR3/DR4 genotype. In conclusion, we provide compelling evidence indicating that islet Ab positive long-term T2DM patients exhibit profound impairment of insulin secretion as well as reduced beta cell mass seemingly determined by an immune-mediated injury of pancreatic β-cells. Deciphering the mechanisms underlying beta cell destruction in this subset of diabetic patients may lead to the development of novel immunologic therapies aimed at halting the disease progression in its early stage.

Increased Circulating Levels of Betatrophin in Newly Diagnosed Type 2 Diabetic Patients

Betatrophin, a newly identified hormone, has been recently characterized as a potent stimulator that increases the production and expansion of insulin-secreting β-cells in mice, but the physiological role of betatrophin remains poorly understood. This study measured for the first time serum betatrophin levels in newly diagnosed patients with type 2 diabetes (T2DM) and explored the correlations between its serum levels and various metabolic parameters in T2DM. We analyzed the concentrations of betatrophin by ELISA in blood samples of 166 well-characterized individuals in whom anthropometric parameters, oral glucose tolerance test (OGTT), glycosylated hemoglobin, blood lipids, insulin sensitivity (1/homeostasis model assesment of insulin resistance [1/HOMA-IR] and Matsuda index [ISIM]), and insulin secretion were measured. The participants were divided into newly diagnosed T2DM patients (n = 83) and age-, sex- and BMI-matched healthy control subjects (n = 83). Serum betatrophin levels were significantly higher in T2DM patients than in healthy control subjects (613.08 [422.19-813.08] vs. 296.57 [196.53-509.46] pg/mL; P < 0.01). Serum betatrophin positively correlated with age, 2-h post-OGTT glucose (2hPG), and postprandial serum insulin (PSI), but negatively with 1/HOMA-IR and ISIM in T2DM patients. In the control group, betatrophin was only positively associated with age. In T2DM subjects, multivariate regression analyses showed that age, 2hPG, and PSI were independent factors influencing serum betatrophin levels. Circulating concentrations of betatrophin are significantly increased in T2DM patients. Our results suggest that betatrophin may play a role in the pathogenesis of T2DM.

Decreased serum brain-derived neurotrophic factor in Chinese patients with Type 2 diabetes mellitus.

It was also found that the serum BDNF levels in Chinese patients with T2DM were significantly lower than those in healthy controls. The BDNF levels in female patients with T2DM were higher than those in male patients. In Chinese patients with T2DM, the serum BDNF level was associated with HDL-C. These results suggested that the serum BDNF levels are different between females and males and its level reflects the lipid and glucose metabolism. Patients with T2DM also have higher BMI than the controls. So the phenomenon that the BDNF level was lower in patients with T2DM could be explained by the effect of BDNF on obesity. Some previous results demonstrated that plasma BDNF levels were significantly lower in patients with T2DM compared with non-diabetic subjects. Suwa et al .[ 4] reported that serum BDNF levels in newly diagnosed female patients with T2DM were significantly higher than those in controls. In the present study, we observed lower serum BDNF levels in patients with T2DM than in healthy controls and higher levels in female than in male patients. Our study supports the hypothesis that patients with long-standing diabetes may have lower serum BDNF levels [9]. A previous study demonstrated that plasma or serum levels of BDNF were decreased in patients with T2DM [9]. Inverse correlation between serum BDNF levels and duration of diabetes was also found. Another study showed higher serum BDNF levels in newly diagnosed female patients with T2DM [4]. These inconsistent findings may be due to the duration of diabetes. It was hypothesized that insulin resistance in newly diagnosed T2DM patients contributes to higher levels of serum BDNF [4]. The lower serum BDNF levels were found in young non-obese subjects with low insulin sensitivity [8]. In summary, we found that the serum BDNF levels were lower in Chinese patients with T2DM than those in the healthy controls and its levels were higher in female patients

LDL cholesterol/HDL cholesterol ratio in newly diagnosed type 2 diabetic patients complicated with metabolic syndrome

Objective To investigate the change of low-density lipoprotein cholesterol(LDL-C)/high-density lipoprotein cholesterol(HDL-C)ratio in newly diagnosed patients with type 2diabetes mellitus(T2DM)and metabolic syndrome(MS),and to discuss its relationship with the clinical parameters.Methods Totally 140 newly diagnosed T2 DM patients were selected for this study,and they were divided into MS group(n=73)and non-MS group(n=67)according to the presence of MS;the normal control group included 73participants(NC group).All participants underwent an oral glucose tolerance test(OGTT)and insulin releasing test;meanwhile,the blood glucose,insulin,blood lipid and other items were measured.The LDL-C/HDL-C ratios of each group were calculated.Clinical parameters and LDL-C/HDL-C ratios were compared among different groups,and correlation analysis was made between LDL-C/HDL-C ratios and clinical indices.Furthermore,all participants were divided into three groups according to LDL-C/HDL-C levels and the prevalence rates of MS were compared.Results The LDL-C/HDL-C ratios of MS group(3.18±0.85)and non-MS group(2.61±0.93)were significantly higher than that in NCgroup(2.26±0.70,P0.05),and the LDL-C/HDL-C ratio of MS group was significantly higher than that in non-MS group(P0.05).The prevalence rates of MS were significantly increased in the patients with the elevation of LDL-C/HDL-C(11.27%,35.21%,and 56.34%,P0.05).Correlation analysis showed that LDL-C/HDL-C ratio was positively correlated with the body mass index(BMI),waist circumference(WC),waist-hip ratio(WHR),systolic blood pressure(SBP),diastolic blood pressure(DBP),postprandial plasma glucose(PPG),fasting insulin(FINS),postprandial insulin(PSI),homeostasis model assessment of insulin resistance(HOMA-IR),triglyceride(TG),cholesterol(CHOL)and LDL-C(P0.05),and negatively correlated with HDL-C(P0.01).When LDL-C/HDL-C was taken as the dependent variable,multiple regression analysis showed that HDL-C,LDL-C and FINS entered the equation(P0.01).Conclusion The LDL-C/HDL-C ratio is increased in T2 DM patients complicated with MS,and the prevalence rate of MS is higher in patients with high LDL-C/HDL-C value.The ratio of LDL-C/HDL-C may be a better index for the early detection of MS compared with LDL-C,which provides a simple,feasible strategy for the prevention and treatment of MS.

Clinical assessment of dietary interventions and lifestyle modifications in Madhumeha (type- 2 Diabetes Mellitus)

Background:India leads the world with maximum number of diabetes patients being termed as the “diabetes capital of the world.” Certain risk factors including unsatisfactory diet, overweight, and a sedentary lifestyle are potentially reversible. Acharayas have widely described the role of diet and activities to control Madhumeha (type 2 diabetes mellitus [T2DM]) along with medications. Habitual consumption of roasted or dry Barley (Hordeum vulgare L.) flour, Mudga (Phaseolus aureus Roxb.) and Amalaki (Emblica officinalis Gaertn.) prevents the manifestation of Prameha.Aim:To assess the clinical effects of dietary interventions and life style modifications in Madhumeha patients.Materials and Methods:Present study was carried out on 56 patients of Madhumeha from S.S. Hospital, Banaras Hindu University, Varanasi. Dietary interventions and life style modifications schedule was prepared based on Ayurvedic principles and patients were advised to follow this regimen. Three consecutive follow-ups were done for 3 months at the interval of one month each.Results:Significant improvement was observed in clinical signs and symptoms along with plasma glucose and glycosylated hemoglobin (HbA1c) in Madhumeha patients after these interventions (P < 0.001).Conclusion:Dietary interventions and life style modifications are two important tools by which adequate glycemic control can be obtained, especially in newly diagnosed T2DM patients and in patients who are on antidiabetic medication, but not properly controlled.

Adherence to Self-Care Behavior in Patients Diagnosed with Type 2 Diabetes Mellitus in the Outpatient Department of the Philippine General Hospital

Objective. The objective of this study is to determine the level of adherence of T2DM patients to the recommended self-care behavior: healthy eating, being active, glucose monitoring, medication adherence, problem-solving, healthy coping and risks reduction. Methodology. This is a cross-sectional study consisting of administration of the Behavior Score Instrument among 126 diagnosed T2DM patients in the Outpatient Department of the Philippine General Hospital. Data obtained were encoded and analysed using the Stata 12 program where a corresponding score was given to the answers to every question and the average was stratified by the level of adherence to the recommended self-care behaviors. Results and Conclusion. Majority of the participants have good adherence in five of the seven identified self-care behaviors: medication taking (76.2%), healthy coping (65.9%), healthy eating (50.0%), problem solving (47.6%) and being active (46.0%). In terms of glucose monitoring and risks reduction, 63.5% and 55.6% of the participants have fair adherence respectively. Overall, 43.7% have good compliance to the self-care behaviors while 54.8% and 1.6% have fair and poor compliance respectively.

Improved post-prandial ghrelin response by nateglinide or acarbose therapy contributes to glucose stability in Type 2 diabetic patients.

Recent studies highlight an important role of ghrelin in glucose homeostasis, while the association between ghrelin regulation and glucose fluctuation is unclear. We compared the effects of two postprandial hypoglycemic agents on ghrelin response and determined the contribution of ghrelin response to glucose stability in Type 2 diabetic (T2DM) patients. Forty newly- diagnosed T2DM patients were randomly allocated to receive nateglinide or acarbose for 4 weeks, with twenty body mass index (BMI)-matched normoglycemic subjects as controls. Mean glucose values and daily average glucose excursion were assessed using continuous glucose monitoring system. Serum ghrelin levels were determined by enzyme-linked immunosorbent assay. T2DM patients had similar fasting ghrelin levels (p=0.546), while their postprandial ghrelin suppressions at 30 min and 120 min were reduced as compared to BMI-matched normoglycemic controls (p<0.01). Both nateglinide and acarbose increased post-prandial ghrelin suppression at 120 min and reduced ghrelin area under the curve (AUCGHRL) (p<0.05), while only nateglinide increased postprandial ghrelin suppression at 30 min (p<0.01), which was positively correlated with the increased early-phase insulin secretion by 4 weeks of nateglinide therapy (r=0.48, p=0.05). The decrease in AUCGHRL was positively correlated with the decrease in daily average glucose excursion and mean glucose values either by 4 weeks of nateglinide or acarbose therapy (p<0.05). Both nateglinide and acarbose increase post-prandial ghrelin suppression. Improved ghrelin regulation is most likely to play a role in glucose stability in T2DM patients with nateglinide or acarbose therapy.

The endothelial dysfunction in patients with type 2 diabetes mellitus is associated with IL-6 gene promoter polymorphism in Chinese population

The purpose of this study is to examine the effects of IL-6 gene promoter -174G/C and -572G/C polymorphism on endothelial function of Chinese T2DM and normal glucose regulation (NGR) subjects. 512 newly diagnosed T2DM patients and 483 NGR subjects were recruited and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) was performed for the IL-6 gene promoter -174G/C and -572G/C polymorphism. Flow-mediated dilation (FMD) was measured as a non-invasive indicator for endothelial function. The results show that the C allele and CC genotype at -174 of IL-6 gene promoter region was extremely rare in both T2DM and NGR groups; genotypes' and alleles' frequency at -572 of IL-6 gene promoter region is of no difference between T2DM and NGR groups; within T2DM group, higher plasma IL-6 concentration and lower FMD was found in patients with -572 GC (2.36 ± 0.69, 4.23 ± 3.82%) or GG (2.32 ± 0.74, 4.24 ± 3.67%) genotype, compared with patients with CC (2.15 ± 0.62, 5.28 ± 3.94%) genotype. The conclusion of the study is that in comparison with patients of CC genotype, the T2DM patients of -572 GC or GG genotype may have more aggravated endothelial dysfunction (ED) and be at higher risk for coronary artery disease (CAD).

Old Drug Acquires New Target: Metformin and Sirt1

Type 2 diabetes mellitus [T2DM] is a progressive metabolic disease which requires multiple and frequent treatment plan adjustments during the course of the disease. Conventional therapeutic strategy usually starts with lifestyle interventions supported by prescription of one glucose-lowering drug. When insulin resistance progresses and the monotherapy option becomes insufficient to control plasma glucose, patients are usually switched to a double drug regimen. In the worst case scenario further progression of insulin resistance and decline in endogenous insulin production require administration of exogenous insulin which becomes an unavoidable therapeutic imperative for many T2DM patients [1]. Metformin is the oldest and most widely prescribed first choice anti-diabetic drug representing the group of guanidinebased hypoglycemic agents. Most newly diagnosed T2DM patients are placed on metformin monotherapy which is later supplemented or often substituted by sulphonylureas, thiazolidinediones and dipeptidyl peptidase-4 inhibitors [2]. The antidiabetic properties of guanidine-related compounds were acknowledged for many centuries by the widespread use of G. officinalis (also known as French lilac, Goat’s rue or Italian Fitch) in diabetes care. However, in scientific terms, the hypoglycemic effect of guanidines, in particular the effect of isoamylene guanidine, was first demonstrated by C.K.Watanabe in 1918 [3]. The toxicity of guanidines imposed a significant limit on their pharmacological exploration, until a less toxic biguanidine analog – N,N-dimethylimidodicarbonimidic diamide (metformin) was synthesized in 1922. The discovery of insulin, whose hypoglycemic activity remains unsurpassed as well as the identification of other glucose-lowering compounds, weakened interest towards clinical use of guanidine-related compounds, including metformin, for decades. Therefore, it was not until 1979 that metformin was introduced in Europe and approved for T2DM use by the FDA in 1994. The moderate hypoglycemic activity of metformin resulting in low risk of hypoglycemia is complemented by the wide spectrum of pharmacological activity of the drug. Besides controlling blood glucose, metformin is known to have some “pleiotropic effects” such as reduction of plasma free fatty acids, LDL and VLDL, promotion of body weight loss, decrease in cardiovascular mortality and morbidity, prevention of hepatosteatosis and some anti-neoplastic effect [ 4]. Despite significant clinical research on metformin use in T2DM patients, the molecular mechanisms underlying the anti-diabetic properties of the drug remain surprisingly obscure. It is believed though that hypoglycemic action of metformin reflects its direct effect on the hepatic gluconeogenic pathway and on glucose utilization in peripheral tissues. While most of the hepatic effects of metformin develop due to induction of AMP-activated protein kinase (AMPK) and/or changes in CREBP-binding protein phosphorylation, the effect of metformin on glucose uptake is rather related to enhanced expression of glucose transporters [5,6]. Recent reports have unveiled a variety of new molecular mechanisms to explain the anti-diabetic activity of metformin. Among exciting scientific findings there are newly emerging reports suggesting that metformin can mediate its anti-diabetic activity through the family of proteins called sirtuins. This piece of information comes from the report of Caton PW et al . [7] who described increased levels of SIRT1 protein and its activity in the livers of metformin-treated db/db mice and HepG2 cells, a hepatocyte

Primary care nurses: effects on secondary care referrals for diabetes.

BackgroundPrimary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with the introduction of primary care nurses, and whether these changes were related to the number of diabetes-related contacts in a general practice.MethodsHealthcare utilisation was assessed for a period of 365 days for 301 newly diagnosed and 2124 known T2DM patients in 2004 and 450 and 3226 patients in 2006 from general practices that participated in the Netherlands Information Network of General Practice (LINH). Multilevel logistic and linear regression analyses were used to analyse the effect of the introduction of primary care nurses on referrals to internists, ophthalmologists and cardiologists and diabetes-related contact rate. Separate analyses were conducted for newly diagnosed and known T2DM patients.ResultsReferrals to internists for newly diagnosed T2DM patients decreased between 2004 and 2006 (OR:0.44; 95%CI:0.22-0.87) in all practices. For known T2DM patients no overall decrease in referrals to internists was found, but practices with a primary care nurse had a lower trend (OR:0.59). The number of diabetes-related contacts did not differ between practices with and without primary care nurses. Cardiologists' and ophthalmologists' referral rate did not change.ConclusionsThe introduction of primary care nurses seems to have led to a shift of care from internists to primary care for known diabetes patients, while the diabetes-related contact rate seem to have remained unchanged.

Change of serum soluble CD14 level in newly diagnosed type 2 diabetes and its significance

To determine the correlation of serum soluble CD14 (sCD14) level with the injury of vascular endothelial cells and chronic low grade inflammation in newly diagnosed Type 2 diabetes (T2DM). ELISA was used to examine serum sCD14 and serum soluble E-selectin (sE-selectin) level, while immunoturbidimetric assay was used to detect serum high sensitivity C reactive protein (hsCRP). The levels of serum sCD14, sE-selectin, and hsCRP in newly diagnosed T2DM group were higher than those in the euglycemic group [sCD14: (300.7+/-136.6) ng/mL vs. (273.3+/-86.0) ng/mL); sE-selectin: (21.3+/-7.7) ng/mL vs. (32.9+/-11.4) ng/mL; hsCRP: (1.45+/-1.21) mg/L vs. (2.37+/-1.45)mg/L], and there was a significant difference in the latter two parameters between the 2 groups(P<0.01). In the patients with newly diagnosed T2DM, after matching blood pressure, blood sugar, and blood lipid, the levels of serum sCD14, sE-selectin, and hsCRP in the obese group were higher than those in the non-obese group. There was no significant difference in the former 2 parameters between the 2 groups. The serum sE-selectin was correlated with fasting blood sugar (r=0.369, P<0.001), 2-hour postprandial blood sugar (r=0.421, P<0.001), glycosylated hemoglobin (r=0.291, P=0.005), sCD14(r=0.312, P=0.002), and homeostasis model assessment-insulin resistance(r=0.247, P=0.018) in the newly diagnosed T2DM group. Stepwise regression ana-lysis showed that the serum sCD14 was one of the chief influencing factors on serum sE-selectin. Serum sCD14 levels tend to increase in newly diagnosed T2DM patients, especially in the obese diabetic patients, which is one of the chief influencing factors to induce the injury of vascular endothelial cells. The innate immunity mediated by Toll-like receptor 4 may take part in the injury of vascular endothelial cells in newly diagnosed T2DM patients.

Number of circulating endothelial progenitor cells as a marker of vascular endothelial function for type 2 diabetes

Vascular endothelial dysfunction is an early marker of atherosclerosis seen in type 2 diabetes (T2DM). Circulating endothelial progenitor cell (EPC) is involved in the neovasculogenesis and maintenance of vascular homeostasis, whose impairment may have an important role in the pathogenesis of diabetic vasculopathy. This study was performed to investigate the relationship between vascular endothelial function and circulating EPC number in T2DM. A total of 46 newly diagnosed T2DM patients (DM group) and 51 healthy subjects (NG group) were recruited. Metformin was administered to all patients for 16 weeks. Endothelial function was assessed by flow-mediated brachial artery dilatation (FMD). EPC was defined by CD45( low)/CD34(+)/VEGFR2(+) and quantified by flow cytometry. The EPC number in the DM group was significantly lower than that in the NG group (p < 0.001), and improved markedly after treatment (p < 0.001). The results of FMD were consistent with EPC variations among the three groups (p < 0.001). In multivariate regression analysis, the EPC number was an independent risk factor for FMD at baseline (p < 0.05). The absolute changes of EPC number showed significant correlation with the changes of FMD before and after treatment (r = 0.63, p < 0.001). This study demonstrated that the circulating EPC number was related to endothelial function and could be considered as a surrogate biological marker of endothelial function for T2DM.

Glipizide controlled‐release tablets, with or without acarbose, improve glycaemic variability in newly diagnosed Type 2 diabetes

1. The aim of the present study was to compare the effects of glipizide controlled-release (CR) tablets monotherapy with that of glipizide CR tablets plus acarbose on glycaemic variability in newly diagnosed Type 2 diabetes (T2DM) patients using a continuous glucose-monitoring system (CGMS). 2. Forty newly diagnosed T2DM patients whose glycated haemoglobin A1c (HbA1c) levels ranged from 7.0% to 9.8% were randomized to either monotherapy or combination therapy. Overall glycaemic control and blood glucose variability were evaluated by CGMS parameters. 3. After 8 weeks treatment, fasting and postprandial blood glucose, HbA1c, glycated albumin (GA), mean blood glucose (MBG), mean amplitude of glycaemic excursions (MAGE), postprandial incremental area under the curve (AUC(pp)) and homeostasis model assessment of insulin resistance decreased significantly in both groups (P < 0.01). There was also a significant decrease in the mean of daily differences (MODD) in the combination therapy group. Mean changes in MBG, MAGE, MODD and AUC(pp) were significantly greater in the combination therapy group than in the monotherapy group (all P < 0.01), whereas no significant differences were found in the mean changes of HbA1c and GA. Multivariate regression analysis showed that the decrement in AUC(pp) was significantly associated with decreases in MAGE. 4. In conclusion, glipizide CR tablets alone or in combination with acarbose can improve overall blood glucose levels and glycaemic variability. Combination therapy using glipizide CR tablets and acarbose was more effective in reducing intraday and day-to-day glycaemic variability than glipizide CR tablet monotherapy.

Vitamin D receptor (FokI, BsmI and TaqI) gene polymorphisms and type 2 diabetes mellitus : A North Indian study

The vitamin D receptor (VDR) gene is a candidate gene for susceptibility to several diseases. Studies on association between VDR polymorphisms and risk of type 2 diabetes (T2DM) in different ethnic populations are yet inconclusive. This study was conducted to evaluate association between VDR polymorphisms and genetic susceptibility to T2DM in the north Indian population. One hundred clinically diagnosed T2DM patients and 160 healthy controls from the north Indian population were recruited for genetic association study. Genomic DNA was extracted from blood and genotyped for the single nucleotide polymorphism SNPs of FokI (T/C) [rs2228570], BsmI (A/G) [rs1544410] and TaqI (C/T) [rs731236] by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. Genotype distribution and allelic frequencies were compared between patients and controls. Mean values and odds ratios (ORs) with 95% confidence interval (CI) were calculated using SPSS software (version 15.0). The genotype distribution, allele and haplotype frequencies of VDR polymorphism did not differ significantly between patients and controls. Mean age and waist-hip ratio of patients were found to be associated with VDR polymorphism. Combination studies showed FFBbtt increased the risk of T2DM in north Indians. Our data suggest that VDR gene polymorphism in combination of genotypes is associated with the risk of T2DM and thus requires further studies as a probable genetic risk marker for T2DM.

The features of postprandial glucose state in type 2 diabetes mellitus

To study the features of postprandial glucose state in individuals with normal glucose regulation (NGR) and type 2 diabetes (T2DM) and the relations between hemoglobin A1c (HbA1c) and postprandial glucose in T2DM. 41 NGR individuals and 60 newly diagnosed T2DM patients without previous management in Shanghai were measured by continuous glucose monitoring system for 3 days. The postprandial glucose spike (PGS), time to PGS (Deltat), postprandial glucose excursion (PPGE), duration of postprandial glucose (DUR) and incremental area under the curve of postprandial glucose (IAUC) were calculated in each individual. (1) The levels of PGS and Deltat in the T2DM group were significantly higher than those of the NGR group (all P < 0.01). The levels of PPGE, DUR and IAUC of the T2DM group were 5.87 mmol/L +/- 0.19 mmol/L, 14.1 h +/- 0.3 h and 2.04 mmol.L(-1).d +/- 0.09 mmol.L(-1).d respectively, all significantly higher than those of the NGR group (2.10 mmol/L +/- 0.12 mmol/L, 8.3 h +/- 0.4 h and 0.43 mmol.L(-1).d +/- 0.03 mmol.L(-1).d respectively, all P < 0.01). The breakfast had higher PGS and lower Deltat than those of lunch and dinner in the T2DM group (both P < 0.01). The PPGE was arranged from high to low in the order of breakfast, dinner and lunch. The highest IAUC appeared during dinner. (2) There was a significantly correlation between PPGE and IAUC (r = 0.93, P < 0.01) in the T2DM group. After being adjusted by preprandial glucose, the partial correlation of HbA1c and IAUC disappeared (before r = 0.29, P = 0.03, after P = 0.05). (3) The relative contribution of postprandial glucose to overall glucose levels in the T2DM group was significantly higher than that of the NGR group (18.1% +/- 0.8% vs 8.0% +/- 0.7%, P < 0.01), but both were significantly lower than those of preprandial glucose. (4) Relative contribution of postprandial hyperglycemia to overall diurnal hyperglycemia decreased progressively from the lowest to the highest quarter of HbA1c. By contrast, the relative contribution of preprandial hyperglycemia showed a significant increase with increasing levels of HbA1c. Postprandial hyperglycemia played a major role when the HbA1c level below 7.5% (P < 0.05). (1) The features of postprandial glucose state in T2DM is representative in the delay of PGS and excessive glucose excursion for a long time after the ingestion of a meal. (2) HbA1c can't reflect postprandial glucose excursions. PPGE can be used as a simple clinic index to evaluate the amplitude of postprandial glucose excursions. (3) Postprandial glucose excursions play a major role in T2DM suffering from mild or moderate hyperglycemia. The present results suggest that postprandial hyperglycemia is an important target for intervention when T2DM patients are approaching the ideal glycemic control.