Glucose In Diabetes Mellitus Research Articles

Optimalisasi Pengetahuan dan Skill Perawat Tentang Perawatan Diabetes Melalui Program Pelatihan dan Pendampingan Penerapan SDKI, SLKI dan SIKI

Diabetes Mellitus (DM) is a chronic metabolic disorder that will be suffered for a lifetime with the disease process continuing so that at one time it can cause complications. Comprehensive treatment must be carried out so that blood glucose levels in DM patients can be controlled and complications can be prevented as early as possible. Control of blood glucose in DM must be carried out through 5 pillars which include regulating diet, exercise, medication, monitoring blood glucose levels and education. The role of nurses in caring for DM patients includes the roles of care givers, counselors, educators, advocates who are oriented to the needs and health of patients. Nurses who act as educators and counselors in increasing the independence of patients and families to carry out integrated DM management. This role is carried out by carrying out nursing interventions regarding nursing management of DM patients. Efforts are needed to improve the competence of nurses in caring for DM patients. The solution to the problem is in the form of efforts to increase the knowledge and skills of nurses regarding the management of diabetes mellitus nursing care based on IDHS, SLKI and SIKI through training and mentoring and equipped with the distribution of DM care smart books for nurses. The target of this activity is nurses who work in Tugu Ibu hospitals in Cimanggis. The purpose of this activity is to improve the quality of care for DM patients. The output of this activity is an increase in the knowledge and skills of nurses in conducting assessments, determining diagnoses, planning, carrying out nursing actions and evaluating DM patients based on the SDKI, SLKI and SIKI which ultimately improves the quality of nursing care in DM patients.
 Keywords: Optimization, Treatment, DM, Training, Mentoring.

The Associations of Auto-Brewery Syndrome and Diabetes Mellitus: A Literature Review and Clinical Perspective.

Endogenous production of alcohol without the external intake of alcohol is called auto-brewery syndrome (ABS), and to get its levels to rise to a level that it has physical symptoms of alcohol intake is rare. The most common cause of ABS is the metabolism of ingested carbohydrates by intestinal microflora. This occurrence does not happen in all normal individuals but only in some high-risk individuals. Patients with diabetes mellitus (DM) have been hypothesized to be at high risk for ABS. We searched databases, such as PubMed, Medline, and PubMed Central, to search for existing literature with relevant keywords.In the finalized review, we have included 30 relevant articles. Alcohol formed in the gut gets absorbed in the bloodstream and immediately gets metabolized, so usually it does not achieve a level in blood high enough to cause symptoms. In high-risk patients, there is an increase in the level of bloodstream alcohol above a certain level, so it shows symptoms. Because there is higher blood glucose in DM, the patients have been shown to be at increased risk for developing ABS. Similarly, obesity is also a risk factor for DM, making it a high-risk condition for ABS. The most involved pathogens are Candida and Saccharomyces.

Hyperactivation of YAP/TAZ Drives Alterations in Mesangial Cells through Stabilization of N-Myc in Diabetic Nephropathy.

Mesangial cells (MCs) in the kidney are essential to maintaining glomerular integrity, and their impairment leads to major glomerular diseases including diabetic nephropathy (DN). Although high blood glucose elicits abnormal alterations in MCs, the underlying mechanism is poorly understood. We show that YAP/TAZ are increased in MCs of patients with DN and two animal models of DN. High glucose directly induces activation of YAP/TAZ through the canonical Hippo pathway in cultured MCs. Hyperactivation of YAP/TAZ in mouse MCs recapitulates the hallmarks of DN. Activated YAP/TAZ bind and stabilize N-Myc, one of the Myc family. N-Myc stabilization leads to aberrant enhancement of its transcriptional activity and to MC impairments. Our findings shed light on how high blood glucose in diabetes mellitus leads to DN and support a rationale that lowering blood glucose in diabetes mellitus could delay DN pathogenesis. Mesangial cells (MCs) in the kidney are central to maintaining glomerular integrity, and their impairment leads to major glomerular diseases, including diabetic nephropathy (DN). Although high blood glucose elicits abnormal alterations in MCs, the underlying molecular mechanism is poorly understood. Immunolocalization of YAP/TAZ and pathological features of PDGFRβ + MCs were analyzed in the glomeruli of patients with DN, in Zucker diabetic fatty rats, and in Lats1/2i ΔPβ mice. RiboTag bulk-RNA sequencing and transcriptomic analysis of gene expression profiles of the isolated MCs from control and Lats1/2iΔPβ mice were performed. Immunoprecipitation analysis and protein stability of N-Myc were performed by the standard protocols. YAP and TAZ, the final effectors of the Hippo pathway, are highly increased in MCs of patients with DN and in Zucker diabetic fatty rats. Moreover, high glucose directly induces activation of YAP/TAZ through the canonical Hippo pathway in cultured MCs. Hyperactivation of YAP/TAZ in mouse model MCs recapitulates the hallmarks of DN, including excessive proliferation of MCs and extracellular matrix deposition, endothelial cell impairment, glomerular sclerosis, albuminuria, and reduced glomerular filtration rate. Mechanistically, activated YAP/TAZ bind and stabilize N-Myc protein, one of the Myc family of oncogenes. N-Myc stabilization leads to aberrant enhancement of its transcriptional activity and eventually to MC impairments and DN pathogenesis. Our findings shed light on how high blood glucose in diabetes mellitus leads to DN and support a rationale that lowering blood glucose in diabetes mellitus could delay DN pathogenesis.

Penurunan Kadar Glukosa Darah Mencit (Mus Musculus) yang Diinduksi Hiperglikemia oleh Ekstrak Etanol Daun Sirsak (Annona muricata L.)

Hyperglycemia is one of the diabetes mellitus characteristics. Soursop leaves (Annona muricata L.) has been used traditionally to reduce blood glucose level and clinically need to be proven. The aim of this study was to observe the effect of ethanol extract of soursop leaves (EDS) on blood glucose levels of hyperglycemia mice (Mus musculus). This was an experimental study with a pre-post test control group design. Thirty mice was used as animal models and was hyperglycemia induced by alloxan 150mg/kg b.w, respectively. Treatment EDS has been given for 14 days with the variation of doses; 200 mg/Kg b.w, 300 mg/Kg b.w, and 400 mg/Kg bw. Fasting blood glucose level was measured before and after EDS treatment by glucocheck. Data were analyzed by ANOVA and Duncan for further tests to evaluate the effect of EDS while the difference in blood glucose levels in pre-post treament was analyzed by paired t-test. The result showed that EDS significantly reduced blood glucose levels (p < 0.05). EDS with 400 mg/Kg bw dose showed the strongest effect in reducing glucose levels, followed by 300 mg/Kg b.w and 200 mg/Kg b.w doses. In conclusion, EDS has the potential to develop as an agent to reduce blood glucose in diabetes mellitus.

Correlation between the antioxidant capacity of plasma and blood glucose level

Introduction: Oxidative stress on tissues can cause diseases such as diabetes mellitus (DM). Aim: This study aimed to pharmacologically evaluate the decrease in blood glucose levels and its relationship with the total antioxidant capacity of the blood compared to glibenclamide. Method: An experimental study with completely randomised designs was carried out. Rats were induced with streptozotosin followed by ethanolic extract for ten days. Results: The One-Way Anova test, showed that the increase of the total antioxidant capacity of plasma treated with ethanolic extract of Tinospora cordifolia and Curcuma zanthorrhiza was comparable in the same amount to glibenclamide (p=0.345), (p=0.289). There was a relationship between total blood antioxidant capacity and blood glucose levels, this linear association was expressed with the following mathematical equation: y = 20,253 - 2,946x. Conclusion: The antioxidant content of Tinospora cordifolia, Curcuma zanthorrhiza, and Cinnamomum verum has the potential to control blood glucose in diabetes mellitus.

Mean platelet volume (MPV): new diagnostic indices for co-morbidity of tuberculosis and diabetes mellitus

BackgroundTuberculosis (TB) and type 2 diabetes mellitus (DM) are global health diseases with high morbidity and mortality. Few studies have focused on platelet indices in TB-DM coinfection patients. The objective of this work was to analyze the platelet indices in TB, DM and TB-DM patients to assess the predictive value of the platelet index for the risk of these diseases.MethodsIn total, 246 patients admitted to our hospital were distributed into three groups (113 TB, 59 DM and 74 TB + DM). A total of 133 individuals were also recruited as healthy controls (HC). Platelet indices, namely, platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW), were compared among the four groups, and the relationship with inflammatory markers was explored by using statistical software.ResultsOur study discovered that MPV and PCT were significantly downregulated in TB + DM patients (9.95 ± 1.25 fL, 0.20 ± 0.05%, P < 0.0001, P = 0.0121, separately) compared with DM individuals (10.92 ± 1.17 fL, 0.22 ± 0.04%). Moreover, the changes in MPV were significantly higher in TB + DM patients (9.95 ± 1.25 fL, P = 0.0041) than in TB patients (9.42 ± 1.01 fL). No differences were found in PLT and PDW among the four groups (P > 0.05). The sensitivity and specificity of MPV in the differential diagnosis of DM patients vs TB + DM patients were 64.9 and 66.1% (P < 0.0001), respectively, and the sensitivity and specificity of MPV between TB patients and TB + DM patients was 60.8 and 66.4%, respectively (P = 0.003). MPV improved the diagnosis sensitivity when it was combined with clinical parameters, such as fasting blood glucose in DM and Mycobacterium tuberculosis culture result in TB (76.3% vs 64.9, 72.6% vs 60.8%, P < 0.0001, P = 0.001, respectively). In addition, the sensitivity and specificity of PCT in the differential diagnosis of DM patients vs TB + DM patients were 69.5 and 59.4%, respectively (P = 0.008). PCT improved the diagnosis sensitivity when combined with fasting blood glucose in DM (72.9% vs 64.9%, P = 0.004). In addition, MPV was linked to CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) in the TB + DM patients (r = 0.3203, P = 0.0054, r = 0.2504, P = 0.0307) but PCT was not (r = 0.1905, r = 0.008675, P > 0.05, respectively).ConclusionsOur research shows that MPV and PCT might be good clinical laboratory markers to distinguish TB + DM patients from TB or DM individuals, thus providing support for earlier clinical diagnosis, prevention, and therapy.

Management of Blood Glucose in Diabetes Mellitus Using Modified Jawonjihwang-tang: A Retrospective Case Series of 76 Patients

Objectives The purpose of this study was to evaluate the effectiveness of the management of blood glucose in diabetes mellitus using modified Jawonjihwang-tang in a Korean medical clinic, retrospectively. Methods From 2006 to 2018, 150 patients diagnosed with diabetes who visited a Korean medical clinic were treated with Korean medicine. Then, 81 of them were prescribed Jawonjihwang-tang. Five cases who changed the formula during the procedure were excluded; therefore, 76 cases were finally selected. Their therapeutic effects were evaluated by the variance in glycated hemoglobin (HbA1c). Results After administration of Jawonjihwang-tang, most patients exhibited a decreased level of HbA1c, and 24 patients had normalized the level of HbA1c. The HbA1c level of all patients decreased from 9.1±2.2 to 7.8±2.2 significantly (p<0.001). Conclusions It is concluded that Jawonjihwang-tang may control blood glucose in diabetes patients. However, more prospective randomized clinical trials are warranted to verify this conclusion. Keywords: diabetes mellitus, Jawonjihwang-tang, glycated hemoglobin, herbal medicine, Korean medicine

Metabolic Stress and Cardiovascular Disease in Diabetes Mellitus: The Role of Protein O-GlcNAc Modification.

Mammalian cells metabolize glucose primarily for energy production, biomass synthesis, and posttranslational glycosylation; and maintaining glucose metabolic homeostasis is essential for normal physiology of cells. Impaired glucose homeostasis leads to hyperglycemia, a hallmark of diabetes mellitus. Chronically increased glucose in diabetes mellitus promotes pathological changes accompanied by impaired cellular function and tissue damage, which facilitates the development of cardiovascular complications, the major cause of morbidity and mortality of patients with diabetes mellitus. Emerging roles of glucose metabolism via the hexosamine biosynthesis pathway (HBP) and increased protein modification via O-linked β-N-acetylglucosamine (O-GlcNAcylation) have been demonstrated in diabetes mellitus and implicated in the development of diabetic cardiovascular complications. This review will discuss the biological outcomes of the glucose metabolism via the hexosamine biogenesis pathway and protein O-GlcNAcylation in regulating cellular homeostasis, and highlight the regulations and contributions of elevated O-GlcNAcylation to the pathogenesis of diabetic cardiovascular disease.

Different functional roles for K+ channel subtypes in regulating small intestinal glucose and ion transport.

ABSTRACTAlthough K+ channels are important in mediating the driving force for colonic ion transport, their role in small intestinal transport is poorly understood. To investigate this, small intestinal short circuit currents (Isc) and HCO3− secretion were measured in mice, and intracellular pH (pHi) was measured in small intestinal epithelial SCBN cells. The expression and location of Kv subtypes were verified by RT-PCR, western blotting and immunohistochemistry. Diabetic mice were also used to investigate the role of Kv subtypes in regulating intestinal glucose absorption. We found that KV7.1 is not involved in duodenal ion transport, while KCa3.1 selectively regulates duodenal Isc and HCO3− secretion in a Ca2+-mediated but not cAMP-mediated manner. Blockade of KCa3.1 increased the rate of HCO3− fluxes via cystic fibrosis transmembrane conductance regulator (CFTR) channels in SCBN cells. Jejunal Isc was significantly stimulated by glucose, but markedly inhibited by 4-aminopyridine (4-AP) and tetraethylammonium (TEA). Moreover, both Kv1.1 and Kv1.3 were expressed in jejunal mucosae. Finally, 4-AP significantly attenuated weight gain of normal and diabetic mice, and both 4-AP and TEA significantly lowered blood glucose of diabetic mice. This study not only examines the contribution of various K+ channel subtypes to small intestinal epithelial ion transport and glucose absorption, but also proposes a novel concept for developing specific K+ channel blockers to reduce weight gain and lower blood glucose in diabetes mellitus.

Phytochemical Composition and Effect of Nauclea Latifolia Aqueous Extracts on Blood Glucose Levels of Streptozotocin-Induced Diabetic Wistar Albino Rats

Researches targeted at understanding and controlling abnormally high level of blood glucose in Diabetes mellitus are ongoing. In spite of many available anti-diabetic drugs in the market, safer and cheaper remedies from plant material are being sought for due to the unwanted side effects of these drugs. In this research work, we looked at the beneficial blood glucose lowering effect of the plant Nauclea latifolia in streptozotocin-induced diabetic albino Wistar rats. The extracts were first screened for the presence of phytochemicals using standard methods and the result showed the presence of saponins, tannins, reducing sugar, phlobatannins, anthraquinone, flavonoids, steroids and alkaloids. The study design involved 30 male albino Wistar rats which were divided into 6 groups. Groups 1 and 2 represent the Normal Control and Diabetic Control respectively. Groups 3, 4 and 5 were Diabetic rats treated orally with 500mg/kg body weight of aqueous extracts of Stem-bark, Leaves and Root-bark respectively while Group 6 were Diabetic rats treated with 5mg/kg body weight of Glibenclamide. The extracts and Glibenclamide were administered for 28 days. Blood glucose levels were determined on days 0, 7, 14, 21 and 28 by tail tipping method using Glucometer (Accu-Chek, Manheim, Germany). The extracts and Glibenclamide reduced significantly (p&lt;0.05) the Fasting Blood Glucose levels in the diabetic treated rats compared with the Diabetic Control. Amongst the extracts the root-bark is more efficacious, decreasing the glucose level by 49.80% while the stem-bark and leaves brought about reduction by 28.76% and 12.15% respectively. The findings imply that the extracts of this plant have blood glucose lowering ability and should be further evaluated for its beneficial effect in Diabetes mellitus management.

COMPARATIVE STUDY BETWEEN BERBERINE AND EXENDINE 4 ON ADULT MALE DIABETIC ALBINO RATS

Background: Exendin-4 is a similar peptide to glucagon - like peptide-1, and can interfere with various receptors of glucagon like peptide-1and is evaluated for the regulation of blood glucose in diabetes mellitus. Berberine (BBR) is demonstrated to have a hypoglycemic effect in vitro and in vivo. Objective: Comparing between the effects of berberine and exendine 4 on adult male diabetic albino rats. Materials and Methods: Thirty two adult male albino rats of local strain were housed in 8 suitable metal cages (20 × 32 × 20 cm for every 4 rats). They were divided into four equal groups: Group I served as a control group, group II was diabetic control, group III was diabetic group treated with berberine, and group IV was diabetic group received exendin-4. Body weight was measured daily till the end of the experimental period .Blood samples were collected for measuring fasting glucose, fasting insulin, homeostasis model assessment insulin resistance ( HOMA –IR), C-peptide, glycosylated hemoglobin (Hb A1c), cholesterol(CHO), triglycerides (TG), low density lipoprotein cholesterol (LDL-c), and high density lipoproteins cholesterol (HDL-c). The pancreas of the sacrificed rats were excised and randomly processed for histological staining and biochemical assays for superoxide dismutase (SOD) and malondialdehyde (MDA). Results: Alloxan-induced diabetes mellitus was associated with significant higher levels of blood glucose, HOMA –IR, Hb A1c, total cholesterol, triglycerides, LDL-c and pancreatic MDA with significantly lower levels of body weight, insulin, C-peptide, HDL-c and pancreatic SOD as compared with normal control group. Berberine in diabetic rats produced significant lower levels of body weight, blood glucose, HOMA –IR, Hb A1c, total cholesterol, triglycerides, LDL and pancreatic MDA with significantly higher levels of insulin , C-peptide , HDL and pancreatic SOD as compared with control diabetic group. Exendin-4 showed significant lower levels of blood glucose, HOMA –IR, total cholesterol, TG, LDL-c and pancreatic MDA levels, and significant higher levels of insulin , HDL-c, C-peptide and pancreatic SOD as compared with the control diabetic rats. Results of the present study showed that the effects of exendin-4 produced insignificant changes of body weight as compared with control diabetic group. Conclusion: Exendin-4 was more potent in reducing hyperglycemia than berberine, while berberine has a better body weight reduction. Furthermore, berberine treatment significantly increased pancreatic antioxidant enzymes activities as well as exendin-4. Berberine and exendin-4 treatment protected and preserved pancreatic β-cell architecture and integrity.

Effect of Swimming, Cycling, Walking and Yoga Exercise on Blood Glucose in Diabetes Mellitus

Effect of Swimming, Cycling, Walking and Yoga Exercise on Blood Glucose in Diabetes Mellitus

EFFECT OF EXENDINE-4 WITH OR WITHOUT MUSCULAR EXERCISE ON DIABETES MELLITUS IN MALE ALBINO RATS

Background: Exendin-4 (glucagon like peptide-1 agonist) is an insulinotropic gut peptide and is being evaluated for the regulation of blood glucose in diabetes mellitus. Objective: Evaluating the possible effects of exendin-4 administration with or without muscular exercise on diabetic male albino rats. Materials and Methods: Forty adult male albino rats were divided into four equal groups: Group I served as a normal control group, group II was diabetic control, group III was diabetic group treated with exendin-4, and group IV was diabetic group subjected to swimming exercise and receiving exendin-4. At the end of the experimental period, blood samples were collected for measuring of blood glucose, total cholesterol, triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL) and C-peptide. Results: Alloxan-induced diabetes mellitus was associated with significant higher levels of serum blood glucose, total cholesterol, TG and LDL-C with significant lower levels of HDL-C and C-peptide as compared with the control normal group. Exendin-4 with or without muscular exercise showed significant lower levels of blood glucose, total cholesterol, TG and LDL-C levels, and significant higher levels of HDL-C and C-peptide as compared with the control diabetic rats. Conclusion: Exendin-4 therapy has a marked effect on improvement of blood glucose, C-peptide level and lipid profile. This was most probably due to increasing insulin sensitivity and decreasing hepatic fat biosynthesis. As regards the differences between the muscular exercise with exendine-4 group (group 4) and exendine-4 treated group (group 3), the obtained data showed a significant lower value of serum triglyceride in the muscular exercise with exendine-4 group compared with the exendine-4 treated group.

The effect of eggplant (Solanum melongena L.) extract peroal against blood glucose level of white rat (Ratus novergicus) wistar strain diabetic model

Eggpant (Solanum melongena L.) that are common in Indonesia are already known contain anthocyanins as antioxidants as well as α-glukosidase inhibitor that can inhibit the rise of blood glucose in diabetes mellitus (DM). This study aimed to determine that the eggplant extract has antihyperglicemic effect and the effective dose as well. This was an experimental study with post test only control group design. We used 25 rats that devided into 5 groups: negative control group (PO), positive control group (PA), and 3 treatment groups (P1,P2,P3). The rats in PA, P1,P2 and P3 were injected intraperitonally with aloksan 150 mg/kgBW/day so they have blood glucose level above 200 mg/dL. Treatment group were given eggplant extract by dose P1=383 mg/kgBW/day, P2=686 mg/kgBW/day, and P3=1372 mg/kgBW/day. On day 15 after DM, the rats were terminated and the blood glucose level were measured using a sphectrophotometer. The Result of One Way ANOVA test showed that they was a significant differences between treatment groups and PA, no significant differences between P1 and P3 to PO, but there were a significant differences between P2 and PO. It can be concluded that eggplant extract may lower blood glucose level of DM rats near to normal, but the difference in dose in this study do not affect the magnitude of decrease in blood glucose level.

Areca nut procyanidins ameliorate streptozocin-induced hyperglycemia by regulating gluconeogenesis

Hepatic gluconeogenesis is a major contributor to blood glucose in diabetes mellitus. Our previous study indicated that areca nut extract enriched with catechin-based procyanidins from oligomers to polymers gave rise to anti-inflammatory effects in vitro and in vivo. Here we have surveyed the molecular features of areca nut procyanidins (ANPs) using quadrupole time-of-flight liquid chromatography/mass spectrometry (Q-TOF LC/MS) and the resulting mass spectrum accurately described ANP from monomer to hexadecamer. Furthermore, the potential of ANP in terms of blood glucose homeostasis was explored using cyclic adenosine monophosphate (cAMP)/dexamethasone stimulated primary mouse hepatocytes and multiple low dose streptozocin (MLD-STZ) treated mice. With the primary hepatocytes, ANP dose-dependently inhibited gluconeogenesis and reduced the mRNA expression of two gluconeogenic key enzymes, phosphoenol-pyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase). Intragastrically feeding of 10mg/kg ANP for 4weeks reduced the levels of fasting blood glucose, PEPCK and G6Pase in MLD-STZ mice. In additional, the level of 5'-AMP-activated protein kinase (AMPK) expression showed a trend towards being restored in the ANP treated MLD-STZ-mice. This study indicated that ANP has the potential to improve hyperglycemia by regulating gluconeogenic related kinases in MLD-STZ-mice.

Effect of trimetazidine treatment on the transient outward potassium current of the left ventricular myocytes of rats with streptozotocin-induced type 1 diabetes mellitus

Cardiovascular complications are a leading cause of mortality in patients with diabetes mellitus (DM). The present study was designed to investigate the effects of trimetazidine (TMZ), an anti-angina drug, on transient outward potassium current (Ito) remodeling in ventricular myocytes and the plasma contents of free fatty acid (FFA) and glucose in DM. Sprague-Dawley rats, 8 weeks old and weighing 200-250 g, were randomly divided into three groups of 20 animals each. The control group was injected with vehicle (1 mM citrate buffer), the DM group was injected with 65 mg/kg streptozotocin (STZ) for induction of type 1 DM, and the DM+TMZ group was injected with the same dose of STZ followed by a 4-week treatment with TMZ (60 mg·kg−1·day−1). All animals were then euthanized and their hearts excised and subjected to electrophysiological measurements or gene expression analyses. TMZ exposure significantly reversed the increased plasma FFA level in diabetic rats, but failed to change the plasma glucose level. The amplitude of Ito was significantly decreased in left ventricular myocytes from diabetic rats relative to control animals (6.25 ± 1.45 vs 20.72 ± 2.93 pA/pF at +40 mV). The DM-associated Ito reduction was attenuated by TMZ. Moreover, TMZ treatment reversed the increased expression of the channel-forming alpha subunit Kv1.4 and the decreased expression of Kv4.2 and Kv4.3 in diabetic rat hearts. These data demonstrate that TMZ can normalize, or partially normalize, the increased plasma FFA content, the reduced Ito of ventricular myocytes, and the altered expression Kv1.4, Kv4.2, and Kv4.3 in type 1 DM.

Study of Hemoglobin and Human Serum Albumin Glycation with Electrochemical Techniques

AbstractHigh concentration glucose in diabetes mellitus may stimulate nonenzymatic glycation of proteins. Hemoglobin (Hb) and human serum albumin (HSA) are among the most sensitive proteins for the modification by glucose. In this paper, we report our study of Hb and HSA modification by glucose using electrochemical methods. Compared with native Hb, it is found that highly glycated Hb presents lower electron transfer reactivity and electrocatalytic activity toward O2 and H2O2, and the glycation is glucose concentration and time dependent. Meanwhile, the changes of the electrochemical signal of heme after binding with HSA and glycated HSA have also suggested that proteins modified by high concentration glucose lasting for months and years in diabetes mellitus might be the reason for diabetes mellitus complication.

Improvement in coronary endothelial function is independently associated with a slowed progression of coronary artery calcification in type 2 diabetes mellitus

To examine a relationship between alterations of structure and function of the arterial wall in response to glucose-lowering therapy in type 2 diabetes mellitus (DM) after a 1-year follow-up (FU). In DM (n = 22) and in healthy controls (n = 17), coronary artery calcification (CAC) was assessed with electron beam tomography and carotid intima-media thickness (IMT) with ultrasound, whereas coronary function was determined with positron emission tomography-measured myocardial blood flow (MBF) at rest, during cold pressor testing (CPT), and during adenosine stimulation at baseline and after FU. The decrease in plasma glucose in DM after a mean FU of 14 +/- 1.9 months correlated with a lower progression of CAC and carotid IMT (r = 0.48, P < or = 0.036 and r = 0.46, P < or = 0.055) and with an improvement in endothelium-related DeltaMBF to CPT and to adenosine (r = 0.46, P < or = 0.038 and r = 0.36, P < or = 0.056). After adjusting for metabolic parameters by multivariate analysis, the increases in DeltaMBF to CPT after glucose-lowering treatment remained a statistically significant independent predictor of the progression of CAC (P < or = 0.001 by one-way analysis of variance). In DM, glucose-lowering treatment may beneficially affect structure and function of the vascular wall, whereas the observed improvement in endothelium-related coronary artery function may also mediate direct preventive effects on the progression of CAC.

Self-monitoring of blood glucose in diabetes mellitus: arguments for an individualized approach.

The utility of glucose self-monitoring in different types and stages of diabetes is controversial, as there is only sparse relevant evidence from randomized controlled clinical trials. In this analysis, the authors aim to develop individualized recommendations based on clinical needs and the available literature. The PubMed database was searched for articles that appeared up to 30 September 2008 containing the terms "measurement," "control","monitoring," and "hypoglycemia"; the retrieved articles were supplemented by other articles that were cited in them. A directed search was also made for the recommendations of the German, European, American, and international diabetological societies. Conclusions were then drawn about the useful modalities and extent of glucose self-monitoring on the basis of the clinical features of the major types of diabetes and the main treatment strategies for them. With the exception of intensified treatment strategies (which rely on blood-sugar regulation with insulin), only a few evidence-based recommendations can be derived from randomized clinical trials and meta-analyses. Nonetheless, a strategy for self-monitoring according to the patient's individual needs can be derived from the characteristics of therapeutic regimens: depending on the type of diabetes from which the patient suffers, the predicted number of glucometer strips required for self-monitoring will vary from almost none to roughly 400 per month. The decision to use glucose self-monitoring, as well as the type and extent of self-monitoring that will be used, should be based on the individual patient's type of diabetes, treatment regimen, and clinical characteristics. Like any other type of therapeutic intervention, self-monitoring should have a well-documented, rational justification.

Detection of Transketolase in Bone Marrow–Derived Insulin-Producing Cells: Benfotiamine Enhances Insulin Synthesis and Glucose Metabolism

Adult bone marrow (BM)-derived insulin-producing cells (IPCs) are capable of regulating blood glucose levels in chemically induced hyperglycemic mice. Using cell transplantation therapy, fully functional BM-derived IPCs help to mediate treatment of diabetes mellitus. Here, we demonstrate the detection of the pentose phosphate pathway enzyme, transketolase (TK), in BM-derived IPCs cultured under high-glucose conditions. Benfotiamine, a known activator of TK, was not shown to affect the proliferation of insulinoma cell line, INS-1; however, when INS-1 cells were cultured with oxythiamine, an inhibitor of TK, cell proliferation was suppressed. Treatment with benfotiamine activated glucose metabolism in INS-1 cells in high-glucose culture conditions, and appeared to maximize the BM-derived IPCs ability to synthesize insulin. Benfotiamine was not shown to induce the glucose receptor Glut-2, however it was shown to activate glucokinase, the enzyme responsible for conversion of glucose to glucose-6-phosphate. Furthermore, benfotiamine-treated groups showed upregulation of the downstream glycolytic enzyme, glyceraldehyde phosphate dehydrogenase (GAPDH). However, in cells where the pentose phosphate pathway was blocked by oxythiamine treatment, there was a clear downregulation of Glut-2, glucokinase, insulin, and GAPDH. When benfotiamine was used to treat mice transplanted with BM-derived IPCs transplanted, their glucose level was brought to a normal range. The glucose challenge of normal mice treated with benfotiamine lead to rapidly normalized blood glucose levels. These results indicate that benfotiamine activates glucose metabolism and insulin synthesis to prevent glucose toxicity caused by high concentrations of blood glucose in diabetes mellitus.