Glycemia In Diabetic Patients Research Articles

Modern possibilities for assessing glycemia in diabetic patients

Modern possibilities for assessing glycemia in diabetic patients

Correlation between Diabetes Mellitus and Peri-implantitis: A Systematic Review.

Osseo-integrated implants provide effective treatment results for edentulous patients. However, despite the high success and survival rates of dental implants, several factors, such as poor oral hygiene and a history of periodontal disease, and systemic diseases, such as diabetes mellitus, could influence the outcome of the treatment. In fact, poor glycemic control can affect the healing process. Diabetes mellitus is considered a relative contraindication for dental implant therapy due to the fact that the success rates of the implants seem to be lower in diabetic patients, even if there is no total agreement among the results reported in the literature. The analysis of peri-implant inflammation indices, bone loss around the implant and glycemic index can provide us with useful information on the relationship between glycaemia in diabetic patients and the course of peri-implantitis, as well as implant success in the short term. The purpose of this review is to establish how peri-implant inflammation parameters vary in diabetic versus non-diabetic patients. This review was conducted on the basis of PRISMA. The search was conducted by three independent reviewers searching for keywords in three databases: PubMed, Scopus, Web Of Sciences (WOS), and the Cochrane Central Register of Controlled Trial. A total of 1159 records were identified, and 11 articles were included in the qualitative analysis. The analysis of the extracted data from the included studies suggests that some periimplant inflammation indices, such as bleeding on probing and bone loss around the implant, appear to be increased in diabetic patients with glycometabolic decompensation, compared with control not affected by diabetes mellitus.

MORINGA OLEIFERA LEAF POWDER FOR TYPE 2 DIABETES: A PILOT CLINICAL TRIAL

Background: Moringa oleifera Lam. (Moringaceae) leaves are commonly used for diabetes in Mali. This pilot clinical study aimed to evaluate its effect on post-prandial blood glucose in preparation for a larger trial. Methods: Diabetic patients and non-diabetic healthy volunteers (35 each) were asked to fast for 13 hours on three occasions. Blood glucose was measured before and after eating 100g of white bread (at 30, 60, 90, 120, 150 and 180 minutes). On their second and third study visits, they were given 1g and 2g respectively, of M. oleifera leaf powder, 30 minutes after eating the bread. The mean paired reduction in blood glucose at each time interval and the incremental area under the curve were calculated. Results: Ingestion of Moringa powder had no effect on blood glucose in non-diabetic participants, but in diabetic patients, it lowered blood glucose at 90 minutes. There was a trend towards lower incremental area under the curve when diabetic patients took 2g of Moringa. No side-effects were reported by any participant. Conclusions: Moringa oleifera leaf powder reduced post-prandial glycaemia in diabetic patients. A larger study is needed to define the optimal dose and to assess whether this translates into longer-term benefits.

EFFECT OF MORINGA AND OLIVE LEAVES POWDER CONSUMPTION ON HYPERGLYCEMIC STATE IN TYPE 2 DIABETES MELLITUS (A PILOT STUDY)

Study showed effects of Moringa oleifera (MO) and Olea europaea (OE) leaves powder on lowering blood sugar levels in diabetes patients. The aims of this study were to determine the effect of MO and OE leaves powder on blood glucose control in therapy type 2 diabetes mellitus (T2DM).Diabetic patients (160 with diet-controlled type 2 diabetes and 250 non-diabetic) healthy volunteers were asked to fast for 13 hours on three occasions. Blood glucose was measured before and after eating 100g of white carbohydrates (bread) (at 30, 60, 90, 120, 150 and 180 minutes). On their second and third study visits, they were given 1g and 2g respectively, of Moringa oleifera and Olea europaea leaves powder for 30 minutes after eating the bread.Ingestion of Moringa oleifera (MO) and Olea europaea (OE) leaves powder had no effect on blood glucose in non-diabetic participants, but in diabetic patients, Moringa oleifera and Olea europaea powder reduced post-prandial glycaemia in diabetic patients. A larger study is needed to define the optimal dose and to assess whether this translates into longer-term benefits.

MORINGA OLEIFERA LEAF POWDER FOR TYPE 2 DIABETES: A PILOT CLINICAL TRIAL

Background: Moringa oleifera Lam. (Moringaceae) leaves are commonly used for diabetes in Mali. This pilot clinical study aimed to evaluate its effect on post-prandial blood glucose in preparation for a larger trial. Methods: Diabetic patients and non-diabetic healthy volunteers (35 each) were asked to fast for 13 hours on three occasions. Blood glucose was measured before and after eating 100g of white bread (at 30, 60, 90, 120, 150 and 180 minutes). On their second and third study visits, they were given 1g and 2g respectively, of M. oleifera leaf powder, 30 minutes after eating the bread. The mean paired reduction in blood glucose at each time interval and the incremental area under the curve were calculated. Results: Ingestion of Moringa powder had no effect on blood glucose in non-diabetic participants, but in diabetic patients, it lowered blood glucose at 90 minutes. There was a trend towards lower incremental area under the curve when diabetic patients took 2g of Moringa. No side-effects were reported by any participant. Conclusions: Moringa oleifera leaf powder reduced post-prandial glycaemia in diabetic patients. A larger study is needed to define the optimal dose and to assess whether this translates into longer-term benefits.

Correlation between iron deficiency anemia and HbA1C levels in type 2 diabetes mellitus

The HbA1c levels, in general reflects the diabetic patients Glycaemic control status over the previous 3 months. HbA concentrations may be increased by Anaemia due to iron deficiency, independent of glycaemia in diabetic patients. Henceforth this study serves to find if there is a positive correlation between the iron deficiency anaemia status & the HbA1c levels amidst the diabetic population. Cases-100 iron-deficiency anaemia patients with diabetes having controlled plasma glucose levels, Controls -100 non-anaemic diabetic individuals. The study was done in the premises of Sree Balaji Medical College & Hospital. HbA levels was measured by ion exchange chromatography, ferritin by particle enhanced turbidometric immunoassay method, fasting plasma glucose by GOD - POD method. We found that HbA1c was elevated (7.3±0.9) in iron-deficient diabetic individuals compared to normal level (5.4±0.6) in controls. The study showed that there was a positive correlation between the iron deficiency anaemia status and increased HbA levels in the controlled diabetic population. Hence forth, the clinical significance of evaluating the iron deficiency anaemia status in diabetic patients has been proved to be significant in planning their further course of prompt diabetic management.

Peripheral polyneuropathy after acute methanol poisoning: Six-year prospective cohort study

BackgroundMethanol is a widely used industrial short-chain aliphatic alcohol with known neurotoxic properties. Mass poisoning outbreaks due to the consumption of methanol-adulterated alcoholic drinks present a challenge to healthcare providers due to the high mortality and serious central nervous system (CNS) damage in survivors. However, the impact of methanol exposure on the peripheral nervous system is unknown. ObjectivesTo investigate the role of acute methanol exposure in the development of peripheral polyneuropathy (PNP) during the years following discharge from the hospital. MethodsA total of 55 patients with confirmed methanol poisoning (mean age of 47.9 ± 3.6 years; 9 females) were examined 4 times within a 6-year prospective longitudinal cohort study. The program included neurological and electromyographic examinations, visual evoked potentials, ocular examinations with retinal nerve fibre layer thickness measurements, brain magnetic resonance imaging, and a series of biochemical and toxicological tests. ResultsPNP was observed in 20/55 (36 %) patients, which, in most of the cases, was mild axonal sensorimotor neuropathy. In 8/55 (15 %) patients, worsening of electromyographic findings was registered during the follow-up period, including 5 cases with newly diagnosed PNP and 3 cases of PNP progression. In one subject, complete reversal of PNP was registered after cessation of alcohol intake. The patients with PNP were significantly older (57.3 ± 5.3 versus 42.5 ± 3.9 years; p < 0.001), with higher blood glucose (5.93 ± 0.97 versus 4.81 ± 0.32 mmol/L; p = 0.035) and lower vitamin B1 (45.5 ± 7.4 versus 57.5 ± 5.2 ug/L; p = 0.015) concentrations. The number of chronic alcohol abusers was significantly higher in the PNP group (17/20 versus 20/35; p = 0.034). No associations between PNP prevalence/ dynamics and acute parameters of poisoning severity, arterial blood pH (7.26 ± 0.07 with PNP versus 7.18 ± 0.09 without PNP; p = 0.150), or serum methanol (1320.0 ± 700.0 with PNP versus 1430.0 ± 510.0 mg/L without PNP; p = 0.813) and ethanol (460.0 ± 560.0 with PNP versus 340.0 ± 230.0 mg/L without PNP; p = 0.675) concentrations at admission were found. No difference in the number of patients with visual (9/20 with PNP versus 12/35 patients without PNP; p = 0.431) and CNS sequelae (9/20 with PNP versus 15/35 patients without PNP; p = 0.877) of poisoning was present. DiscussionDespite the relatively high number of PNP cases, no association was found between the severity of acute methanol poisoning and the prevalence of PNP and its dynamics during six years of observation. We did not find an association between methanol-induced visual/ brain damage and the prevalence of PNP in survivors of poisoning. A high prevalence of PNP and its progression might be attributed to other causes, mainly a history of chronic alcohol abuse and insufficiently treated diabetes mellitus. Our results highlight the importance of complete cessation of alcohol consumption and better control of glycaemia in diabetic patients in the prevention and treatment of peripheral PNP.

New Insight into Diabetes Management: From Glycemic Index to Dietary Insulin Index.

Despite efforts to control hyperglycemia, diabetes management is still challenging. This may be due to focusing on reducing hyperglycemia and neglecting the importance of hyperinsulinemia; while insulin resistance and resultant hyperinsulinemia preceded diabetes onset and may contribute to disease pathogenesis. The present narrative review attempts to provide a new insight into the management of diabetes by exploring different aspects of glycemic index and dietary insulin index. The current data available on this topic is limited and heterogeneous. Conventional diet therapy for diabetes management is based on reducing postprandial glycemia through carbohydrate counting, choosing foods with low-glycemic index and low-glycemic load. Since these indicators are only reliant on the carbohydrate content of foods and do not consider the effects of protein and fat on the stimulation of insulin secretion, they cannot provide a comprehensive approach to determine the insulin requirements. Selecting foods based on carbohydrate counting, glycemic index or glycemic load are common guides to control glycemia in diabetic patients, but neglect the insulin response, thus leading to failure in diabetes management. Therefore, paying attention to insulinemic response along with glycemic response seems to be more effective in managing diabetes.

Multimodal α-Glucosidase and α-Amylase Inhibition and Antioxidant Effect of the Aqueous and Methanol Extracts from the Trunk Bark of Ceiba pentandra.

Postprandial hyperglycemia and oxidative stress are important factors that worsen the health condition of patients with type 2 diabetes. We recently showed that extracts from Ceiba pentandra mitigate hyperglycemia in dexamethasone- and high diet/streptozotocin-induced diabetes. Herein, we evaluated the postprandial regulatory properties and the antioxidant effects of the aqueous (AE) and methanol (ME) extracts from the stem bark of Ceiba pentandra. The phytochemical analysis of AE and ME was performed using the LC-MS technique and the total phenolic and flavonoid assays. Both extracts were tested for their ability to inhibit superoxide anion (O2•ـ), hydrogen peroxide (H2O2), protein oxidation, alpha-amylase, and alpha-glucosidase activities. The mode of enzyme inhibition was also determined in a kinetic study. AE and ME were both rich in phenolic and flavonoid compounds. ME was 2.13 and 1.91 times more concentrated than AE in phenolic and flavonoid compounds, respectively. LC-MS allowed the identification of 5 compounds in both extracts. ME and AE inhibited O2•ـ with IC50 of 51.81 and 34.26 μg/ml, respectively. On H2O2, they exhibited IC50 of 44.84 and 1.78 μg/ml, respectively. Finally, they exhibited IC50 of 120.60 and 140.40 μg/ml, respectively, in the inhibition of protein oxidation induced by H2O2, while showing IC50 of 39.26 and 97.95 μg/ml on the protein oxidation induced by AAPH. ME and AE inhibited alpha-amylase with IC50 of 6.15 and 54.52 μg/ml, respectively. These extracts also inhibited alpha-glucosidase, demonstrating IC50 of 76.61 and 86.49 μg/ml. AE exhibited a mixed noncompetitive inhibition on both enzymes, whereas ME exhibited a competitive inhibition on α-amylase and a pure noncompetitive inhibition on α-glucosidase. These results demonstrate that ME and AE scavenge reactive oxygen species and prevent their effects on biomolecules. Besides, ME and AE inhibit carbohydrate digestive enzymes. These properties may contribute to reduce postprandial hyperglycemia and regulate glycemia in diabetic patients.

Is the Preoperative Glycated Hemoglobin (HbA1c) Level Predictive of the Severity of Diabetic Hand Infection According to Surgical and Clinical Outcomes?

We purposed to investigate whether preoperative HbA1c level is associated with the severity of surgical treatment in diabetic hand infection cases. Between December 2015 and October 2018, 102 patients were surgically treated due to diabetic hand infection. Of the patients, 75 who met the criteria for diabetic hand infection were included in the study. The patients were divided into two groups: Group 1, < 8.5% HbA1c level (poorly controlled); and Group 2, 8.5% or higher HbA1c level (uncontrolled). Preoperative, intraoperative, and postoperative data were recorded. Drainage, VAC, ray/open amputation, and microsurgical reconstruction were performed according to the examination and clinical findings. p<0.05 was considered statistically significant. The study groups consisted of 41 patients (5 female/36 male; median age 59 years, range 32-68) in Group 1 and 34 patients (6 female/28 male; median age 62 years, range 28-67) in Group 2. The mean follow-up period was 21.14±10.42 months in Group 1 and 16.70±10.19 months in Group 2, which were not significantly different (p>0.05). The most common microbiological pathogen was polymicrobial in both study groups (39% in Group 1 and 41.2% in Group 2). Drainage was the most common surgical procedure in both groups and there was no significant difference between the groups in terms of the surgical techniques that were used (p>0.05). Although HbA1c level is an important biomarker for monitoring glycemia in diabetic patients, it is not associated with the severity of surgical treatment in diabetic hand infections.

Использование персональных систем непрерывного мониторинга гликемии у пациентов с сахарным диабетом на инсулине

Использование персональных систем непрерывного мониторинга гликемии у пациентов с сахарным диабетом на инсулине

Budget Impact Analysis of Self-Monitoring of Blood Glucose vs. Flash-Continuous Glucose Monitoring in Intensive Insulin Users with Diabetes Type 2 Covered by Medicare and Medicaid

Introduction: Self-Monitoring of Blood Glucose (SMBG) uses capillary blood glucose to measure glycemia in diabetic patients. Recently FDA-approved Flash Continuous Glucose Monitoring (F-CGM) reveals glucose levels when scanned by the reading device. The Centers for Medicare and Medicaid Services (CMS) have announced to reimburse F-CGM at the same level as CGM devices. Aim: This analysis’ objective was to quantify the CMS budget impact (BI) of F-CGM reimbursement in patients with type 2 diabetes (T2DM) on intensified insulin therapy (IIT), and compare it to the BI of conventional SMBG via cost-related break-even metrics. These were chosen because - in the absence of RCT-based, primary endpoint-driven clinical superiority evidence of F-CGM over SMBG for this population (REPLACE study) - they are well-suited to inform budget allocation decisions. Methods: An economic model was developed in Excel. CMS reimbursement/patient co-insurance levels for SMBG and F-CGM were used; data on morbidity, treatment and usage patterns were sourced from the literature and official websites. Different scenarios were simulated to elicit break-even points between F-CGM and SMBG. Results: The annual cost of SMBG with 3.7 tests per day (see REPLACE) is $180 per patient, compared to $2,156 incurred per F-CGM patient, representing a cost difference of $1,976/year or $5.41/day. This implies a budget break-even ratio of 1:12 patients (F-CGM:SMBG). Both technologies would break even at a consumption of 44 test strips per day. A year’s SMBG budget would last only 30 days if spent on F-CGM. Conclusion: With diabetes budgets under pressure, thoughtful spending policies are needed. It is recommended to analyze in detail which T2DM subgroups will benefit most from F-CGM, focusing reimbursement to the latter. SMBG, being an established technology, represents - at current reimbursement levels - an attractive spending option to budget holders. Disclosure M. Stueve: Employee; Self; JnJ GmbH Life Scan. Y.F. Zoellner: Research Support; Self; J&amp;J Medical GmbH, LifeScan.

Components of the Complete Blood Count in Type 2 Diabetes Mellitus with Inadequate Glycemic Control

Objective: Inadequate control of glycemia in diabetic patients is the primary cause of both micro- and macrovascular complications. Several components of complete blood count were investigated and have found to be higher in diabetic patients. We aimed to evaluate white blood cell (WBC), neutrophil, lymphocyte and platelet counts and, red cell distribution width (RDW), mean platelet volume (MPV) and platelet distribution width (PDW) in type 2 diabetes mellitus (T2DM) patients with inappropriorate glycemic management (HbAlc &amp;gt;7%) despite using insulin therapy.Methods: 135 type 2 diabetic patients with inappropriorate blood glucose management (HbAlc value &amp;gt;7 %) despite using insulin therapy for at least 3-month period (only insulin or insulin plus oral hypoglycemic agents) and 121 healthy subjects were included in the study. Demographic, anthropometric and laboratory data were recorded.Results: WBC, neutrophil, lymphocyte and monocyte counts were higher in DM group (p&amp;lt;0.0001). WBC counts were positively correlated with diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC) and high-sensitive C- reactive protein (hsCRP), fasting plasma glucose (FPG), post-prandial glucose (PPG), HbA1c and triglyceride levels (p&amp;lt;0.05). Neutrophil counts were positively correlated with hsCRP, FPG, HbA1c, BMI, PPG, LDL-Cholesterol (LDL-C) and microalbumin levels (p&amp;lt;0.05). Lymphocyte counts were positively correlated with systolic blood pressure (SBP), DBP, BMI, WC and FPG, HbA1c, LDL-C and triglyceride levels (p&amp;lt;0.05). WBC, neutrophil and lymphocyte counts were negatively correlated with HDL-Cholesterol (HDL-C) levels (p&amp;lt;0.05). PDW was higher in DM group (16.65±0.59 to 16.51±0.51, p:0.043). PDW was positively correlated with age, DBP, FPG, PPG, HbA1c, LDL-C and triglyceride levels (p&amp;lt;0.05). Monocyte to HDL-C ratio was higher in DM group (13.50 ± 5.34 to 10.54 ± 4.29, p&amp;lt;0.0001).Conclusions: In this study white blood cell, neutrophil and lymphocyte counts and PDW were higher in type 2 diabetic patients with inappropriorate glycemic management despite insulin therapy and they were correlated wıth cardio-metabolic risk factors. Leukocyte subtypes and PDW may be used as a marker for cardiovascular diseases in these patients.

Recently Uncontrolled Glycemia in Diabetic Patients Is Associated with the Severity of Intracranial Atherosclerosis

Diabetes mellitus is a specific risk factor for intracranial atherosclerosis (ICAS) regardless of race. However, it is largely unknown whether poor glycemic control is associated with the severity of ICAS in diabetic patients. We selected diabetic patients with acute ischemic stroke who were prospectively registered between March 2005 and December 2015. The patients who had a high-risk source of cardiogenic embolism were excluded. ICAS was graded from 0 to 3 by the number of significant (≥50%) stenoses on intracranial magnetic resonance angiography, and was divided into 4 types: unilateral anterior, bilateral anterior, posterior, and anterior plus posterior. Ordinal and multinomial regression tests were applied for the factors influencing the number and types of ICAS. A total of 774 patients with noncardioembolic acute ischemic stroke with diabetes were enrolled. The multiplicity of ICAS was independently associated with age (odds ratio [OR], 1.035 per 1 year, 1.018-1.052; P < .001), hypertension (OR, 1.992, 1.336-2.965; P = .001), and glycated hemoglobin (HbA1c; OR, 1.207 per 1%, 1.089-1.338; P < .001) in the ordinal regression model. In multinomial regression, bilateral anterior stenosis tended to be correlated with age (OR, 1.042, 1.008-1.077; P = .016) and HbA1c (OR, 1.201 per 1%, .991-1.520; P = .057). Both anterior and posterior stenoses were significantly associated with age (OR, 1.056, 1.029-1.084; P < .001), hypertension (OR, 2.584, 1.404-4.762; P = .002), and HbA1c (OR, 1.272, 1.070-1.511; P = .006). Age, concomitant hypertension, and HbA1c were factors associated with multiple intracranial stenoses. Further study is warranted to elucidate whether poor glycemic control facilitates ICAS in diabetic patients.

Prevalence of Urinary Tract Infection and Antimicrobial Susceptibility among Diabetic Patients with Controlled and Uncontrolled Glycemia in Kuwait.

Diabetic patients have higher risk of urinary tract infection (UTI). In the present study, we investigated the impact of glycemic control in diabetic patients on UTI prevalence, type of strains, and their antimicrobial drugs susceptibility. This study was conducted on urine samples from 722 adult diabetic patients from which 252 (35%) samples were positive for uropathogens. Most UTI cases occurred in the uncontrolled glycemic group (197 patients) versus 55 patients with controlled glycemia. Higher glycemic levels were measured in uncontrolled glycemia group (HbA1c = 8.3 ± 1.5 and 5.4 ± 0.4, resp., P < 0.0001). Females showed much higher prevalence of UTI than males in both glycemic groups (88.5% and 11.5%, resp., P < 0.0001). In the uncontrolled glycemia group 90.9% of the UTI cases happened at ages above 40 years and a clear correlation was obtained between patient age ranges and number of UTI cases (r = 0.94; P = 0.017), whereas in the group with controlled glycemia no trend was observed. Escherichia coli was the predominant uropathogen followed by Klebsiella pneumoniae and they were together involved in 76.2% of UTI cases. Those species were similarly present in both diabetic groups and displayed comparable antibiotic resistance pattern. These results highlight the importance of controlling glycemia in diabetic patients to reduce the UTI regardless of age and gender.

Hyperglycation of extra and intracellular proteins; marker or active element of diabetic pathomechanisms

States of chronic hyperglycaemia, irrespective of the diabetes type result in excessive non enzymatic glycation of several proteins in extra and intracellular compartments of the body. Hyperglycation of hemoglobin is employed for assessment of long term control of glycaemia in diabetic patients. However, hyperglycaemia may change biological properties of several proteins thereby contributing to miss function and structural impairments of several organs in the course of diabetes.

Management of glycemia in diabetic patients with stage IV and V chronic kidney disease.

Diabetic kidney disease is a leading cause of end-stage kidney disease worldwide. Data suggest that prevention of progression to end-stage may lie in excellent blood glucose control; however, as kidney disease progresses, the risk of hypoglycemia increases, due to unpredictable insulin kinetics and altered pharmacokinetics of hypoglycemic agents. In addition, whole classes of hypoglycemic agents become contraindicated and regimens must be adjusted for declining kidney function. There is no consensus regarding the best therapy for the patient with advanced chronic kidney disease. In the best of circumstances, the care of these patients will involve intensive monitoring, with the input of a team of health care providers creating a coordinated care plan, including dietary advice and a drug regimen tailored to the specific issues faced by the individual patient. An open dialogue is necessary at all times, as patients may become frustrated and attempt self-treatment using over the counter alternatives.

Glycosylated Hemoglobin in Diabetic Foot and its Correlation with Clinical Variables in a North Indian Tertiary Care Hospital

HbA1c reflects glycemia over 2-3 months and is the standard measure used to monitor glycemia in diabetic patients, but studies have not shown an association of HbA1c with DFU. We hypothesized that elevated HbA1c would be most associated with extremity of DFU/DFI. To test this hypothesis we conducted a prospective study of 161 DFU individuals treated at the R G Centre for Diabetes & Endocrinology, AMU. 64.8% were males and the 37.0% had ulcer >1 month. The majority of ulcer was neuropathic (50%) and amputation was done in 28.4%. HbA1c >6.5% were significantly associated with Wagner grades, UTG, BMI, retinopathy, nephropathy, hypertension, neuropathy and smoking. A significant correlation was found between UTG (r=-0.219, p=0.005), ulcer duration >1 month (r=-0.233, p=0.002), BMI (r=0.154, p=0.05), ESR (r=-0.169, p=0.031), Neuropathy (r=-0.007, p=0.048), nephropathy (r=-0.165, p=0.036), hypertension (r=0.207, p=0.007), retinopathy (r= 0.167, p=0.037) and smoking (r=0.164, p=0.034)with HbA1c >6.5%. The diabetic patients with A1c>6.5% showed a high risk of ulcer development in their foot. A significant correlation was observed with the clinical variables (ulcer duration >1 month, BMI, ESR, Neuropathy, nephropathy, hypertension, retinopathy and smoking with A1c>6.5% which is independent of concomitant infections in DFU patients.

Management of glycemia in diabetic patients with diabetic kidney disease

Management of glycemia in diabetic patients with diabetic kidney disease

Angiotensin converting enzyme 2: A new important player in the regulation of glycemia

In spite of the novel antidiabetic drugs available on the market, type 2 diabetes mellitus (T2DM) affects nearly 25 million people in the USA and causes about 5% of all deaths globally each year. Given the rate and proportion by which T2DM is affecting human beings, it is indispensable to identify new therapeutic targets that can control the disease. Recent preclinical and clinical studies suggest that attenuating the activity of the renin-angiotensin system (RAS) could improve glycemia in diabetic patients. Angiotensin-converting enzyme 2 (ACE2) counteracts RAS overactivity by degrading angiotensin-II (Ang-II), a vasoconstrictor, to Ang-(1-7) which is a vasodilator. A decrease in ACE2 and an increase in A disintegrin and metalloproteinase (ADAM17)-mediated shedding activity have been observed with the progression of T2DM, suggesting the importance of this mechanism in the disease. Indeed, restoration of ACE2 improves glycemia in db/db and Ang-II-infused mice. The beneficial effects of ACE2 can be attributed to reduced oxidative stress and ADAM17 expression in the islets of Langerhans in addition to the improvement of blood flow to the β-cells. The advantage of ACE2 over other RAS blockers is that ACE2 not only counteracts the negative effects of Ang-II but also increases Ang-(1-7)/Mas receptor (MasR) [a receptor through which Ang-(1-7) produces its actions] signaling in the cells. Increased Ang-(1-7)/MasR signaling has been reported to improve insulin sensitivity and glycemia in diabetic animals. Altogether, ACE2/Ang-(1-7)/MasR axis of the RAS appears to be protective in T2DM and strategies to restore ACE2 levels in the disease seem to be a promising therapy for Ang-II-mediated T2DM.