Effect Of Blood Glucose Control Research Articles

Advances in the Treatment of Type 2 Diabetes Mellitus

There is a rising worldwide prevalence of diabetes, especially type 2 diabetes mellitus (T2DM), which is one of the most challenging health problems in the 21st century. The associated complications of diabetes, such as cardiovascular disease, peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure, and blindness result in increasing disability, reduced life expectancy, and enormous health costs. T2DM is a polygenic disease characterized by multiple defects in insulin action in tissues and defects in pancreatic insulin secretion, which eventually leads to loss of pancreatic insulin-secreting cells. The treatment goals for T2DM patients are effective control of blood glucose, blood pressure, and lipids (if elevated) and, ultimately, to avert the serious complications associated with sustained tissue exposure to excessively high glucose concentrations. Prevention and control of diabetes with diet, weight control, and physical activity has been difficult. Treatment of T2DM has centered on increasing insulin levels, either by direct insulin administration or oral agents that promote insulin secretion, improving sensitivity to insulin in tissues, or reducing the rate of carbohydrate absorption from the gastrointestinal tract. This review presents comprehensive and up-to-date information on the mechanism(s) of action, efficacy, pharmacokinetics, pleiotropic effects, drug interactions, and adverse effects of the newer antidiabetic drugs, including (1) peroxisome proliferator-activated-receptor-γ agonists (thiazolidinediones, pioglitazone, and rosiglitazone); (2) the incretin, glucagon-like peptide-) receptor agonists (incretin-mimetics, exenatide. and liraglutide), (3) inhibitors of dipeptidyl-peptidase-4 (incretin enhancers, sitagliptin, and vildagliptin), (4) short-acting, nonsulfonylurea secretagogue, meglitinides (repaglinide and nateglinide), (5) amylin anlog-pramlintide, (6) α-glucosidase inhibitors (miglitol and voglibose), and (7) colesevelam (a bile acid sequestrant). In addition, information is presented on drug candidates in clinical trials, experimental compounds, and some plants used in the traditional treatment of diabetes based on experimental evidence. In the opinion of this reviewer, therapy based on orally active incretins and incretin mimetics with long duration of action that will be efficacious, preserve the β-cell number/function, and block the progression of diabetes will be highly desirable. However, major changes in lifestyle factors such as diet and, especially, exercise will also be needed if the growing burden of diabetes is to be contained.

Glycaemic control in acute coronary syndromes: prognostic value and therapeutic options

Type 2 diabetes and acute coronary syndromes (ACS) are widely interconnected. Individuals with type 2 diabetes are more likely than non-diabetic subjects to experience silent or manifest episodes of myocardial ischaemia as the first presentation of coronary artery disease. Insulin resistance, inflammation, microvascular disease, and a tendency to thrombosis are common in these patients. Intensive blood glucose control with intravenous insulin infusion has been demonstrated to significantly reduce morbidity and mortality in critically ill hyperglycaemic patients admitted to an intensive care unit (ICU). Direct glucose toxicity likely plays a crucial role in explaining the clinical benefits of intensive insulin therapy in such critical patients. However, the difficult implementation of nurse-driven protocols for insulin infusion able to lead to rapid and effective blood glucose control without significant episodes of hypoglycaemia has led to poor implementations of insulin infusion protocols in coronary care units, and cardiologists now to consider alternative drugs for this purpose. New intravenous or oral agents include the incretin glucagon-like peptide 1 (GLP1), its analogues, and dipeptidyl peptidase-4 inhibitors, which potentiate the activity of GLP1 and thus enhance glucose-dependent insulin secretion. Improved glycaemic control with protective effects on myocardial and vascular tissues, with lesser side effects and a better therapeutic compliance, may represent an important therapeutic potential for this class of drugs in acutely ill patients in general and patients with ACS in particular. Such drugs should be known by practicing cardiologists for their possible use in ICUs in the years to come.

Ekstrak air daun ceplikan (Ruellia tuberosa L.) serta pengaruhnya terhadap kadar glukosa darah dan gambaran histologis pankreas tikus putih (Rattus norvegicus) diabetes mellitus

Background: Effective control of blood glucose and activities of antioxidant are key factors that prevent diabetes mellitus (DM) and its complications. There are lots of herbal plants that have those both effects. Ceplikan leaves (Ruellia tuberosa L.) is a traditional medicine which is empirically used to lower blood glucose level. Instead of antioxidant compound, there is assumed other compound in ceplikan leaves that has side effect to pancreatic beta cells.Objective: To identify the effect of ceplikan leaves extract to blood glucose level and pancreas histology description in white diabetic rats (Rattus norvegicus).Method: Thirty subjects of Wistar strain male white rats of 2-3 months old and of 150-200 grams weight were made diabetic with aloxan and randomly divided into 5 groups. Group I consisted of diabetic rats with aquadest, group II with glibenclamide, and Group III-V were given extract of ceplikan leaves in different concentrations that were 1.6 mg, 3.2 mg, and 6.4mg, respectively. Treatment was given orally per day within 30 days. Level of blood glucose was measured in the day of 0, 3, 4, and 30. Statistical analysis used repeated measures and t-test.Result: The supply of ceplikan leaves extract could reduce level of blood glucose of diabetic rats, although the decrease was insignificant. Average diameter of wider Langerhans island occurred to the group of diabetic rats that were given extract of ceplikan leaves dosage 6.4 mg. There was no significant difference (p > 0.05) in changes of blood glucose level before and after experiment in diabetic rats. Pancreas histological description of rats showed that there was improvement as indicated by greater quantity of Langerhans Island and wider diameter of Langerhans Island.Conclusion: Ceplikan leaves was safe and efficacious, so that self-medication of DM using ceplikan leaves could be sustained through formal approach.

Should White-Coat Hypertension in Diabetes Be Treated? Pro

White coat hypertension, which should be more descriptively termed “isolated clinic hypertension” (1), consists of a condition in which clinic (or office) blood pressure is repeatedly ≥140 mmHg systolic or 90 mmHg diastolic, whereas 24-h mean blood pressure is below its generally accepted upper limit of normality, i.e., <125/80 mmHg (1,2). This article will first show evidence from the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) population study that isolated clinic hypertension is associated with a prevalence of organ damage and a risk of cardiovascular morbidity and mortality, which, although less than those of patients with in- and out-of-office hypertension, are distinctly greater than those displayed by truly normotensive subjects. It will then emphasize that in diabetic subjects, limited evidence is available on the prevalence of isolated clinic hypertension as well as on its association with diabetic-related microvascular and macrovascular disease. In this context, some specific difficulties exist, i.e., 1 ) the uncertainty about whether the cut-off clinic and ambulatory blood pressure values to use should (or should not) be different from those used in nondiabetic individuals, 2 ) the small number of subjects and events in the few studies that have addressed this issue, and 3 ) the confounding effect of factors such as the duration of diabetes, the extent and type of blood pressure–lowering treatments, and the more or less effective blood glucose control when subjects with and without isolated clinic hypertension are compared. It will be concluded, however, that recommendations on this matter should take into due account that, in diabetes, cardiovascular and renal protection are enhanced by aggressive reductions in clinic blood pressure (<130/80 mmHg) and that lowering blood pressure is beneficial even when the initial clinic value is within the normal blood pressure range, i.e., 130–139 mmHg (2). This scores in favor of a systematic blood …

Prevention of proliferative changes of forestomach mucosa by blood glucose control with insulin in alloxan‐induced diabetic rats

Diabetes mellitus is one of the risk factors for carcinogenesis. Recently we reported that alloxan induces squamous cell carcinoma (SCC) with coincidental inflammation, bacteria/fungal infections, and a severe diabetic condition. The present study was conducted to examine the effects of blood glucose control with insulin on the proliferative changes of the forestomach in alloxan-induced diabetic rats. Male 15-week-old WBN/Kob rats were divided into a control group of non-treated rats with naturally occurring diabetes after 40 weeks of age (non-treated group), alloxan-induced diabetic rats (AL group), and alloxan-induced diabetic rats given insulin implant treatment (AL + In group). The animals were sacrificed at 90 weeks of age for histopathologic examination. The blood glucose and urinary glucose level of the AL + In group fluctuated variously from high to normal levels compared with a constantly high level of AL (for 75 weeks) as well as in the non-treated group (for 50 weeks). The mucosal hyperplasia in the forestomach developed in 88.2% of the AL group and 37.5% of the non-treated group, but in only 10.0% of the AL + In group. SCC was only detected in 23.5% of the AL group. Hyperplastic changes were constantly accompanied by inflammation and fungal/bacterial infections in the AL and non-treated groups, whereas inflammation and fungal infection were completely suppressed in the AL + In group. These findings demonstrate that blood glucose control suppressed neoplastic changes in alloxan-induced diabetic rats. We postulate that inflammation together with bacterial/fungal infections under prolonged severe diabetic conditions play a pivotal role in carcinogenesis.

Glycation of fibrinogen in uncontrolled diabetic patients and the effects of glycaemic control on fibrinogen glycation

Introduction Evidence exists for a relationship between glycaemic control and macrovascular disease. Non-enzymatic glycation of proteins may explain this relationship in part. We investigated the effect of blood glucose control, under out-patient conditions, on fibrinogen glycation as well as the relationship between glycated fibrinogen and glycaemic control using a new sensitive method for the measurement of glycated fibrinogen. Materials and methods Blood samples were taken from twenty subjects with uncontrolled Type 2 diabetes (HbA1c > 7%) to determine the levels of glycation. The subjects were then treated with insulin in order to control blood glucose. Twenty age and BMI matched non-diabetic subjects were included as a reference group. Results The subjects with diabetes had significantly higher mean fibrinogen glycation at baseline than the non-diabetic subjects (7.84 vs 3.89 mol glucose / mol fibrinogen; p < 0.001). After control of blood glucose, fibrinogen glycation was reduced significantly in the subjects with diabetes (7.84 to 5.24 mol glucose / mol fibrinogen; p < 0.0002). The change in glycation during the intervention correlated significantly with the change in capillary glucose in the diabetic group ( r = 0.6, p = 0.005). Fibrinogen glycation was comparable to HbA1c in predicting glycaemic control ( p = 0.54). Fibrinogen glycation correlated best with the average fasting capillary glucose of the preceding 5–8 days ( r = 0.54, p = 0.014). Conclusion We conclude that glucose control under out-patient conditions decreases fibrinogen glycation in subjects with Type 2 diabetes and that glycated fibrinogen compares well with HbA1c in its relation to glycaemic control.

No NFAT, No Fat

Obesity is a common health problem in the United States and other countries, so intensive efforts are focused on understanding the signaling pathways that control metabolism and the growth and physiology of fat-storing cells (adipocytes). Noting that there are similarities in obesity and inflammatory responses, Yang et al . explored the role of members of the NFAT (nuclear factor of activated T cells) family for a possible role in regulating glucose homeostasis, insulin sensitivity, and obesity. NFAT proteins are best known as critical mediators for expression of cytokines in response to activation of T cells in the immune system. However, Yang et al . found that increased expression of NFATc2 and NFATc4 was associated with differentiation of cultured mouse 3T3-L1 adipocytes or with obesity in a mouse model. Consistent with such effects, NFATc4 is expressed primarily in nonimmune tissues, including muscle and fat. Double knockout mice lacking NFATc2 and NFATc4 (Nfatc2 −/− Nfatc4 −/− mice) were resistant to obesity caused by ingestion of a high-fat diet and accumulated fewer adipocytes than did normal animals (regardless of their diet). The Nfatc2 −/− Nfatc4 −/− animals also showed a higher metabolic rate, greater heat production, more effective control of blood glucose after oral administration of glucose, and increased sensitivity to insulin. Adiopocytes secrete regulatory peptides (adipokines) and, similar to their effects on cytokine production in the immune system, the NFAT proteins appeared to regulate expression of genes encoding adipokines in adipocytes. Chromatin immunoprecipitation experiments showed association of NFATc2 with the promoter of the gene encoding the adipokine resistin. Pharmacological blockade of NFAT activation also reduced expression of resistin mRNA. NFAT has been previously implicated in roles outside the immune system, including heart development and neural pathfinding. The new work shows an even broader repertoire for the NFAT proteins that includes key roles in metabolic pathogenesis and expression of adipokine genes. T. T. C. Yang, H. Y. Suk, X. Y. Yang, O. Olabisi, R. Y. L. Yu, J. Durand, L. A. Jelicks, J.-Y. Kim, P. E. Scherer, Y. Wang, Y. Feng, L. Rossetti, I. A. Graef, G. R. Crabtree, C.-W. Chow, Role of transcription factor NFAT in glucose and insulin homeostasis. Mol. Cell. Biol. 26 , 7372-7387 (2006). [Abstract] [Full Text]

Dietary phytic acid lowers the blood glucose level in diabetic KK mice

Phytic acid, myo-inositol hexaphosphate, is a plant component existing in most grains and legumes. Although much attention has been focused on the biologic actions of phytic acid in human beings and animals, its effect on the blood glucose level in diabetic models has not been evaluated. This study was conducted to examine the supplementary effect of phytate on the blood glucose level in a diabetic rodent model. Thirty male diabetic KK mice were fed with purified diets supplemented with 0% (P0), 0.5% (P5), or 1.0% (P10) sodium phytate for 8 weeks. Diet intake, body and organ weights, and levels of fasting and random blood glucose, hemoglobin A 1c, as well as insulin were measured. A glucose tolerance test was conducted. There was no significant difference in diet intake, body weight, and organ weight among the experimental groups. The concentrations of fasting and random blood glucose were lower in the groups fed with the phytate diets, and the significant ( P < .05) difference from P0 was found only in the P10 group. Hemoglobin A 1c levels were significantly ( P < .05) lower in the P5 and P10 groups as compared with those in the P0 group. There was no significant difference in insulin levels among the experimental groups. The blood glucose levels after 30 minutes of glucose injection were significantly lower in the P5 and P10 groups than in the P0 group. These results suggest that phytate reduced the blood glucose levels of diabetic mice. Effective blood glucose control by phytate may be an alternative for the management of diabetes and disorders of carbohydrate metabolism.

Premixed Insulin Analogues for the Treatment of Diabetes Mellitus

Premixed insulin analogues, consisting of rapid-acting and intermediate-acting insulin analogues, were developed to more closely mimic physiological endogenous insulin secretion and meet the needs of patients who require both basal and prandial insulin but wish to limit the number of daily injections. There is considerable variability in onset and duration of action, as well as peak insulin levels, obtained with human insulin formulations such as premixed human insulin 70/30. To overcome these limitations, premixed insulin analogues were developed. Peak insulin levels are twice as high and reached in half the time with the rapid-acting insulin component of a premixed insulin analogue. In the US, two premixed insulin analogue formulations are currently available: insulin lispro 75/25 (75% insulin lispro protamine suspension and 25% insulin lispro) and biphasic insulin aspart 70/30 (BIAsp 70/30; 70% insulin aspart protamine suspension and 30% insulin aspart). They are generally administered twice daily, just before breakfast and dinner. Data from various randomised trials show that both insulin lispro 75/25 and BIAsp 70/30 provide more effective postprandial control of blood glucose than premixed human insulin 70/30 or human insulin isophane suspension (NPH insulin). Longer-term glycaemic control, evaluated as changes in glycosylated haemoglobin, is comparable for premixed insulin analogues and premixed human insulin 70/30 in most studies. Three comparative, randomised trials have shown that patients with type 2 diabetes mellitus using premixed insulin analogues twice daily are more likely to reach glycaemic goals than those using only insulin glargine once daily. Some patients can also reach glycaemic goals with once-daily administration of a premixed insulin analogue. Although the incidence of hypoglycaemia is low, direct comparison across trials of premixed insulin analogues is difficult because of inconsistencies in reporting. Within trials, the incidence of both major (rare) and minor hypoglycaemic episodes during treatment with premixed insulin analogues is low and comparable with rates found with human insulin 70/30. Premixed insulin analogues can be safely used, and are effective and convenient for achieving overall glycaemic control in patients with diabetes. In addition, given the convenience of mealtime dose administration, compliance with insulin therapy may increase with premixed insulin analogues.

Cardiac lipoprotein lipase: Metabolic basis for diabetic heart disease

The heart has a limited potential to synthesize fatty acid (FA), and, therefore, FA is supplied from several sources: lipolysis of endogenous cardiac triglyceride (TG) stores or from exogenous sources in the blood. Lipoprotein lipase (LPL), synthesized in cardiomyocytes, catalyzes the breakdown of the TG component of lipoproteins to provide FA to the heart. It is the vascular endothelial-bound LPL that determines the rate of plasma TG clearance, and, hence, it is also called heparin-releasable (HR) "functional" LPL. Functional LPL is regulated by numerous dietary and hormonal factors and is sensitive to pathophysiological alterations like those observed during diabetes. In this condition, absolute or relative lack of insulin impairs cardiac glucose transport and oxidation, resulting in FA becoming the preferred means of energy supply. To make available this increased requirement of the heart for FA, the diabetic heart upregulates its luminal LPL activity by posttranslational mechanisms. Chronically elevated cardiac LPL can result in abnormal FA supply and utilization by the heart tissue that could potentially initiate and sustain cardiac dysfunction during diabetes. As effective blood glucose control is difficult during diabetes, it is conceivable that a parallel increase in functional cardiac LPL activity may predispose people with diabetes to premature death from cardiac disease. By gaining more insight into the initial metabolic processes in the diabetic heart, we can attempt to piece together a part of the cascade of events leading to diabetic heart disease.

Efficacy and Safety of an Insulin Infusion Protocol in a Surgical ICU

Hyperglycemia is associated with complications in the surgical intensive care unit. The purpose of this study was to determine the efficacy and safety of nurse-driven insulin infusion protocols in lowering blood glucose (BG) in critical illness. All patients in a 24-bed surgical intensive care unit who required i.v. insulin infusions during 3 noncontiguous 6-month periods from 2002 to 2004 were evaluated. In the preintervention phase, 71 patients received a physician-initiated insulin infusion without a developed protocol. They were compared with 95 patients who received a nurse-driven insulin infusion protocol with a target BG of 120 to 150 mg/dL and to 119 patients who received a more stringent protocol with a target BG of 80 to 110 mg/dL. There was a stepwise decrease in average daily BG levels, from 190 to 163 to 132 mg/dL (p < 0.001). The less stringent protocol decreased the time to achieve a BG level < 150 mg/dL from 14.1 to 7.4 hours compared with physician-driven management (p < 0.05) resulting in similar time on an insulin infusion (53 versus 48 hours). The more intensive protocol brought BG levels < 150 mg/dL in 7.2 hours and < 111 mg/dL in 13.6 hours, but increased the length of time a patient was on an insulin infusion to 77 hours. The incidence of severe hypoglycemia (BG < 40 mg/dL) was statistically similar between the groups, ranging between 1.1% and 3.4%. Implementation of a nurse-driven protocol led to more rapid and more effective BG control in critically ill surgical patients compared with physician management. Tighter BG control can be obtained without a significant increase in hypoglycemia, although this is associated with increased time on an insulin infusion.

Effects of Okchun-San, a herbal formulation, on blood glucose levels and body weight in a model of Type 2 diabetes

The effective control of blood glucose is the key to preventing or reversing diabetic complications. In this study, we examined the effects of Okchun-San (OCS), a Korean herbal medicine formula, on the blood glucose levels in diabetic C57BL/KsJ db/ db mice. Herbal medicines were prepared from dried herbs by adding Coicis semen (OCS-C) or Oryzae semen (OCS-O). The experimental animals were divided into a control group and three sample groups; the sample groups received OCS-C (200 mg/kg), OCS-O (200 mg/kg), or acarbose (5 mg/kg) orally once a day for 12 days. On days 5 and 12, the fasting blood glucose levels of vehicle-treated db/ db mice were significantly higher than day 0, while those of OCS-C, OCS-O, or acarbose-treated mice had not increased compared to the control group ( p < 0.01). During intraperitoneal glucose tolerance test (IPGTT), OCS-C group showed improved glucose sensitivity compared to the control group. These results suggest that OCS-C can be useful as an anti-diabetic therapy for Type 2 diabetic patients by lowering the blood glucose level.

The Application of Plasma 1,5-Anhydro-D-glucitol for Monitoring Type 2 Diabetic Patients

Aim: Recent data have suggested that effective control of postprandial blood glucose can reduce the risk of macroangiopathic complications of diabetes, especially cardiovascular risk. 1,5-Anhydro-D-glucitol (1,5-AG) has been proposed as a marker of short-term hyperglycaemic excursions. We aimed to evaluate its usefulness in patients with type 2 diabetes and have attempted to indicate when 1,5-AG monitoring should be used in ordinary diabetes care settings. Methods: The study group consisted of 130 type 2 diabetic patients aged 36–69 years. 1,5-AG plasma level, HbA1c concentrations and daily glucose profile were measured. Mean blood glucose (MBG), M-value were calculated and maximal daily glycaemia (MxG) was established as indicators of short-term hyperglycaemic episodes. Results: 1,5-AG plasma level was negatively and HbA1c was positively correlated with fasting glycaemia (FG), MBG, M-value and MxG. Multivariate regression analysis revealed that 1,5-AG plasma level is determined by MxG only, while FG determined HbA1c concentration in blood. The analysis of 1,5-AG level and HbA1c distributions in well and poorly controlled patients revealed that persons with low HbA1c values may have decreased 1,5-AG plasma level. Conclusion: 1,5-AG plasma level monitoring is the useful method to identify well controlled, exclusively based on HbA1c levels type 2 diabetic patients with transient hyperglycaemia, accordingly patients at high risk of macroangiopathic complications.

Effect of Glycemic Control on Electrophysiologic Changes of Diabetic Neuropathy in Type 2 Diabetic Patients

Diabetic neuropathy is a common complication of diabetes mellitus. Effective blood glucose control retards changes in nerve conduction velocity in type 1 diabetes. This study examined the relationship between glycemic control and electrophysiologic changes in diabetic neuropathy in 57 type 2 diabetic patients. Nerve conduction in the peroneal motor nerve, tibial motor nerve, and sural nerve were measured at study entry and at follow-up 24+/-3.12 months later. Changes in individual nerves are expressed as a percentage change (PC) and overall electrophysiologic changes are expressed as the sum of individual PCs. The PCs for peroneal motor nerve velocity, tibial motor nerve velocity, and sural nerve velocity were all lower in patients with a mean HbA1c of 8.5% or less compared with those in patients with a mean HbA1c of more than 8.5%, and SPCV (sum of PC in velocity) was significantly inversely correlated with mean HbA1c. However, there was no significant difference in SPCV in subjects with or without hypertension, hypertriglyceridemia, or low high-density lipoprotein cholesterol concentration. In conclusion, hyperglycemia is the most important etiology for electrophysiologic progression in type 2 diabetic patients. Furthermore, a mean HbA1c of more than 8.5% will result in significant deterioration in electrophysiology.

Metformin and vascular protection: a diabetologist's view

The diabetologist's short-term priority is often to gain rapid control of severe and symptomatic hyperglycaemia, with the longer term objective of preventing or delaying the onset of the debilitating and life-threatening complications that result from continued poor glycaemic control. Indeed, guidelines for the management of type 2 diabetes are centred firmly on measures of glycaemic control, based on evidence from the landmark UK Prospective Diabetes Study and Diabetes Control and Complications Trial. Nevertheless, we must remember that most type 2 diabetic patients ultimately die from a cardiovascular cause. A comprehensive approach is needed, where effective control of blood glucose takes place alongside aggressive management of cardiovascular risk factors. A substantial database of clinical evidence, including the ground-breaking UK Prospective Diabetes Study, underpins the place of metformin both as an effective oral antihyperglycaemic agent and for reducing the risk of morbid cardiovascular events.

Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness.

Stress hyperglycemia is frequent in critically ill patients. The aim of this study was to investigate the effect of blood glucose control with insulin on endocrine, metabolic, and immune function in an animal model of severe injury. Seventy-two hours after alloxan injection and exogenous insulin infusion combined with continuous iv parenteral nutrition, male New Zealand White rabbits received a burn injury and were allocated to a normoglycemic (n = 17) or hyperglycemic (n = 13) group. In the normoglycemic group, blood glucose levels were kept between 3.3 and 6.1 mmol/liter by insulin infusion, whereas in the hyperglycemic group blood glucose levels were maintained at 13.8-16.6 mmol/liter. Blood was drawn for biochemical analysis at regular time points. At 24 and 72 h after burn injury, immune function of monocytes was assessed in vitro. Maintenance of normoglycemia with exogenous insulin after severe trauma to a large extent prevented weight loss, lactic acidosis, and hyponatremia. Furthermore, within 3 d after injury, the intervention improved phagocytosis of monocytes investigated in fresh cells by more than a mean 150% (P = 0.006) and after 24-h incubation with or without lipopolysaccharide by more than a mean 4-fold (P = 0.001) and 2-fold (P = 0.05), respectively. Oxidative killing after 24-h incubation was also improved by 2-fold (P = 0.05), but no effect on chemotaxis was detected. Concomitantly, inflammation and stress-induced growth hormone hypersecretion were suppressed. Prevention of catabolism, acidosis, excessive inflammation, and impaired innate immune function may explain previously documented beneficial effects of intensive insulin therapy on outcome of critical illness.

News round‐up from the diabetes world

News round‐up from the diabetes world

Classical cardiovascular risk factors: predictive value and treatment of the elderly. The rocky road to evidence-based medicine

Coronary heart disease and cerebrovascular disease are still the most common causes of death in Western countries. A number of risk factors have been identified in young and middle-aged adults, such as dyslipidemia, hypertension and diabetes. Their prevalence and importance, however, are less clear in the elderly. In terms of dyslipedemia it is questionable whether hypercholesterolemia is a definite risk factor. On the other hand, mortality can be reduced by lowering LDL cholesterol, but the benefit in the oldest old is not yet known. Systolic blood pressure rises with age and is discussed controversely as a potential risk factor in the elderly. Some large trials could show a clear relationship between high blood pressure while others did not see any association. Similar to the treatment of hypercholesterolemia, antihypertensive drugs showed beneficial effects in elderly people until the age of 80. But the treatment of the oldest old cannot be recommended in general. Diabetes and impaired glucose tolerance are some of the most common diseases in elderly people. They are considered to be an important risk factor until the age of 75. Their role in the oldest old is still under debate. Until now, we do not know anything about possible treatment effects because of the lack of controlled trials. Elderly people seem to have a risk profile different from younger people; especially in extreme ages the predictive role of classical risk factors is unclear. On the other hand, drug treatment could reduce mortality and morbidity in patients with hypercholesterolemia or hypertension. There are no studies which investigated the effects of blood glucose control in the elderly. The collection of sufficient data is a geriatric challange in order to decide whether treatment is useful or not.

Effects of antihypertensive drugs or glycemic control on antioxidant enzyme activities in spontaneously hypertensive rats with diabetes.

The activities of glomerular intrinsic antioxidant enzymes (AOEs) were measured in a diabetic spontaneously hypertensive rat (SHR) model. The effects of antihypertensive drugs, i.e. captopril or triple therapy (hydralazine, reserpine, and hydrochlorothiazide), on glomerular intrinsic AOE activities in this model were evaluated. The effects of blood glucose control on the AOE activities were also determined. The aim of the present study was to determine whether activities of glomerular intrinsic AOEs might correlate with disease activity in diabetic SHR. This study showed a decrease of glomerular intrinsic AOE, i.e. Cu/Zn-SOD and Mn-SOD (SOD = superoxide dismutase), glutathione peroxidase, and catalase, activities in diabetic SHR. Glomerular Cu/Zn-SOD or Mn-SOD, glutathione peroxidase, and catalase activities in nondiabetic SHR were slightly lower than those in nondiabetic WKY rats. These activities in diabetic SHR were significantly improved after captopril or triple therapy or blood glucose control. The levels of urinary albumin excretion, creatinine clearance, and glomerular tuft areas in diabetic SHR were also improved after the therapy. It appears that hypertension and hyperglycemia may influence the glomerular intrinsic AOE activities, albuminuria, creatinine clearance, and glomerular tuft areas in diabetic SHR. Thus, it is indicated that control of blood pressure or blood glucose is a very important factor for preventing renal injuries in the diabetic SHR model.

Ｓｔｒｅｐｔｏｚｏｔｏｃｉｎ誘発糖尿病ラットに対する血糖コントロールが実験的歯周炎に及ぼす影響 ２． 無菌飼育ラットにおけるインスリンの効果

Ｓｔｒｅｐｔｏｚｏｔｏｃｉｎ誘発糖尿病ラットに対する血糖コントロールが実験的歯周炎に及ぼす影響 ２． 無菌飼育ラットにおけるインスリンの効果