Increasing Prevalence Of Type Research Articles

The impact of moderate combination exercise on HbA1c, IL-6, and TNF in type 2 diabetic and non-diabetic subjects: an interventional non-randomized clinical trial

Introduction: The main causes of worldwide increase in prevalence of type 2 diabetes are the daily consumption of excessive number of calories and sedentary lifestyle. Diabetes is usually accompanied by hypertension, lipid disorders and obesity that are considered as risk factors for developing diabetes. This study is designed to assess the benefit of a combined exercise programme (cardio “aerobic” and resistance) on HbA1c and the inflammatory markers (IL-6, and TNF) in type 2 diabetic (T2D) and non-diabetic (ND) subjects. Materials and methods: This is an interventional non randomized clinical trial conducted from 2016 to 2019 at exercise physiology laboratory at De Montfort University (DMU). Our target volunteers are T2D (HbA1c > 6.4), and ND (HbA1c < 5.8) with age group from 18-60 years old who are fit and able to do exercise. No restriction on weight. HbA1c, weight, BMI, waist and lung capacity were measured at baseline and at the 12th exercise session. In each exercise session the participant performed a combined exercise program consists of 30 min of resistance exercise followed by 20 min moderate cycling to be done twice a week for 6 weeks. Results: We enrolled 17 T2D intervention group 4 female and 13 male and 8 ND control group 5 female and 3 male. In both groups there was a significant reduction in HbA1c level after 6 weeks (P= 0.000). In T2D there were a significant weight reduction that decreased from (92.0± 4.3) to (90.0±4.5), (P< 0.001), BMI reduction that decreased from (30.8± 1.0) to (30.2± 0.9), (P< 0.001). In ND, the changes in weight reduction and BMI level were not significant. In T2D the changes in IL-6 level were only significant after the last exercise session. It was increased from 1.79±0.4 to 3.88±1.9 pg/ml (P=0.002), while it was not significant in ND group. In T2D and ND subjects, the changes in TNF level were insignificant. Conclusion: Development of combination exercise programs as a non-pharmacological intervention for diabetic and non-diabetic population are essential to decrease the prevalence of diabetes worldwide. In addition to conduction of public awareness events for proper implementation.

Prevalence of Type 2 Diabetes Among Asymptomatic Adults of Lahore Pakistan

Research from all over the world has shown a marked annual increase in prevalence of type 2 diabetes. Early screening of type 2 diabetes among asymptomatic adults especially in those who are obese or have as a familial trait could lessen the risk of developing microvascular complications like cardiovascular diseases, nephropathy, retinopathy and neuropathy. To find the prevalence of type 2 diabetes among asymptomatic adults. Two centers of Pakistan Health Research Council namely National Health Research Complex and Fatima Jinnah took part in conducting this 15 months long survey. After the ethical clearance voluntary study, participants fulfilling inclusion criteria were enrolled (2500 participants with age ≥ 35 years) from the nine towns and Defense Housing Authority of Lahore. There socio-demographic and clinical characteristics were noted by using a well-structured proforma. Each participant was tested for their HbA1C level using auto-analyzing system. Data were analyzed using SPSS version 20. Glycated hemoglobin (HbA1C) level greater than 7.0% was reported in 33.7% of participants interpreting type 2 diabetes in them. Family history of diabetes was seen in 31.9% participants. There were 32.5 and 6.5% hypertensive and cardiovascular disease participants. Obesity was present in 28.4% participants with a higher rate in those having type 2 diabetes. Thirty-four percent of adult population in Lahore is potentially type 2 diabetic. Early identification can save many lives from developing type 2 diabetes and its complications.

Current Views on Dopaminergic Drugs Affecting Glucose Homeostasis.

For more than three decades, it has been known that manipulation of dopaminergic system could affect glucose homesotasis in experimental animals. The notion that glucose homeostasis in human might be influenced by dopaminergic drugs has attracted a great deal of attention in the past two decades. In spite of rapid advancements in revealing involvement of dopaminergic neurotransmission in insulin release, glucose up-take and pancreatic beta cell function in general through centrally and peripherally controlled mechanisms, there are discrepancies among observations on experimental animals and human subjects. With the expansion of pharmacotherapy in psychotic conditions, depression and endocrine abnormalities along with a sharp increase in prevalence of type two diabetes and disturbances of glucose homeostasis as a major risk factor for many cardiovascular complications and associated mortalities; it seems a critical analysis of recent investigations on drugs which act as agonists or antagonists of dopaminergic receptors in various tissues and organs may provide better insight into how safe and efficient these medicines could be prescribed. Furthermore, the other main objective of present review is to compare clinical data on significance of changes in blood glucose and insulin levels during short term and after long term treatment with these agents. This in turn would be beneficial for determining adequate strategies to combat or to avoid adverse effects associated with dopaminergic drug therapy.

The past decade in type 2 diabetes and future challenges.

There is today an exponential increase in prevalence of type 2 diabetes mellitus (T2DM), especially in young people. This downward shift in age of onset of T2DM has been shown by abundant evidence to be due to an increase in obesity among the young, the latter mainly attributable to unhealthy dietary habits and a sedentary lifestyle. It is therefore obvious that the prevention of diabetes rather its treatment is of is paramount importance. In the past decade, because concerns about the safety of antidiabetic agents took precedence over the issue of efficacy, almost all studies have been diabetes CVOTs and not traditional CVOTs. Until 2015, the evidence showed that antidiabetic agents are effective in terms of reduction of microvascular, as opposed to macrovascular, complications. However, following publication of the results of some new studies, it became clear that the new class of antidiabetic drugs, e.g., SGLT 2 inhibitors and GLP-1 agonists, are also effective in reducing cardiovascular disease (CVD). In the coming decade, numerous health challenges are expected to arise, the most important being the greater expansion of the therapeutic armamentarium for T2DM and the adoption of strategies for prevention of CVDs. In parallel, the new generation of antidiabetic agents will target the recently investigated pathophysiologic disorders of diabetes, while, ideally, treatments should include smart drugs without side effects.

Childhood obesity and cardiac remodeling: from cardiac structure to myocardial mechanics.

Epidemic of obesity, especially morbid obesity, among children and adolescents, is a key factor associated with the dramatic increase in prevalence of type 2 diabetes mellitus, arterial hypertension, and metabolic syndrome in this population. Furthermore, childhood obesity represents a very important predictor of obesity in adulthood that is related to cardiovascular and cerebrovascular diseases. Overweight and obesity in children and adolescents are associated with impairment of cardiac structure and function. The majority of studies investigated the influence of obesity on left ventricular remodeling. However, the impact of obesity on the right ventricle, both the atria, and myocardial mechanics has been insufficiently studied. The aim of this review article is to summarize all data about heart remodeling in childhood, from cardiac size, throughout systolic and diastolic function, to myocardial mechanics, using a wide range of mainly echocardiographic techniques and parameters. Additionally, we sought to present current knowledge about the influence of weight loss, achieved by various therapeutic approaches, on the improvement of cardiac geometry, structure, and function in obese children and adolescents.

Type 2 diabetes mellitus in pediatrics: a new challenge

The increased prevalence of childhood obesity in the last few years has been accompanied by the increase in prevalence of type 2 diabetes in pediatrics. In this paper, we will review the risk factors and the pathogenic determinants leading to type 2 diabetes in youth. We searched on PubMed with the key words: obesity, type 2 diabetes, children, adolescents, youth, non-alcoholic fatty liver disease, genes and selected those publications written in English that we judged to be relevant to the topic of the review. Based on the data present in the literature, we reviewed the following three topics: 1) the role of ectopic fat deposition, in particular of fatty liver, in the pathogenesis of pediatric type 2 diabetes; 2) the progression to type 2 diabetes in pediatrics and how it differs from adults, and 3) current theraputic options. Type 2 diabetes in youth is a complex disease, creating new challenges in treatment and prevention.

PERIPHERAL ARTERIAL DISEASE

Background: The increase in prevalence of type 2 diabetes and its complications is alarming. The incidence of diabetic footulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries.This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiarycare settings in Abbottabad. Methods: This was a prospective descriptive study-being conducted at Northern Institue of Medical Sciences(NIMS) and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer thanten days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation ofperipheral arterial pulses in the lower limbs. Ankle-brachial index (ABI) is the ratio of the systolic blood pressure at the ankle to that in the arm.Peripheral arterial disease (PAD) was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severeaccording to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American DiabetesAssociation. Results: A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age ofstudy subjects was 53.68±9.51 years. There were 33 (39.75%) males and 50 (60.24%) females with M to F ratio of 1:1.51. Mean duration ofdiabetes was 13.67±5.80 years (ranging from 9-23 years). Majority 57 (68.67%) of our patients were obese having poor glycemic control.Peripheral arterial disease has been found in 35(42.16%) patients, out of them 18(51.42%) had mild PAD as their ABI values remained between0.70-0.90, 15(42.85%) had moderate PAD due to their ABI values between 0.50-0.69 and 2 (5.71%) had severe PAD as their ABI values liebelow 0.49. Conclusions: Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial diseasein type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients.

BMI and Lipid Levels in Mexican American Children Diagnosed with Type 2 Diabetes

The purpose of this study was to determine potential associations between obesity as measured by body mass index (BMI) and lipid values in Mexican American (MA) children diagnosed with type 2 diabetes. Obesity in children is considered to be an emerging epidemic that is accompanied by an increase in prevalence of type 2 diabetes. Literature shows that there is a direct and strong relationship between abnormal lipid levels and obesity in Caucasian and African American children without type 2 diabetes. However, it was unknown whether Mexican American children diagnosed with type 2 diabetes have abnormal lipid levels. A retrospective medical-record review was conducted on paediatric patients who received medical care from a military medical centre in the Southwest region of the United States. A convenience sample of records was used to study the relationship between obesity as measured by BMI and lipid levels in 49 Mexican American children diagnosed with type 2 diabetes. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and BMI were reviewed. Data were analysed using descriptive and logistic regression statistics. Ninety percent of the sample was obese and 75% had two or more abnormal lipid values. Abnormal levels of total cholesterol, HDL, and triglycerides were found to be statistically significant. The main findings indicate that MA children diagnosed with type 2 diabetes had significant associations between obesity as measured by BMI and abnormal total cholesterol, HDL, and triglyceride levels. As the BMI increased, the probability of abnormal total cholesterol and triglyceride levels increased. Similarly, as the BMI increased, the probability of abnormal HDL values increased. Mexican American children in this study had obesity levels similar to those in a study by the National Center for Health Statistics. In this study a step has been taken toward understanding a physiologic marker for cardiovascular disease in children.

Prevalence of Type 2 Diabetes Mellitus among Kuwaiti Children and Adolescents

Objectives: To determine the prevalence of type 2 diabetes among 6- to 18-year-old Kuwaiti children. Subjects and Methods: Children with type 2 diabetes were identified at 182 schools (50 primary, 63 intermediate, and 69 secondary) randomly selected using the 2000/2001 educational districts’ registers as a sampling frame. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 2 diabetes was based on the World Health Organization and the American Diabetes Association criteria. Results: Type 2 diabetes was identified in 45 of the 128,918 children surveyed, thereby giving an overall prevalence of 34.9 per 100,000 [95% confidence interval (CI) 24.7–45.1]. There was a significant difference in prevalence between males (47.3, 95% CI 28.7–65.8) and females (26.3, 95% CI 14.8–37.8) at p = 0.05 and a significant trend for an increase in prevalence of type 2 diabetes with age (p = 0.026). The overall age-adjusted prevalence rate in the 2002 Kuwaiti population was 33.2 (95% CI 26.6–39.9), 41.6 (95% CI 31.2–52.0) in male and 24.6 (95% CI 16.4–32.7) in female children; the difference was significant at p = 0.013. There was no significant difference in prevalence between regions. Children with type 2 diabetes had a significantly higher frequency (51.1%) of a positive family history of diabetes than children of a similar age without type 2 diabetes (22.2%) (p = 0.004). Conclusion: The prevalence of type 2 diabetes in adult Kuwaitis is spreading to children and adolescents, making it an emergency public health problem. Efforts need to be initiated to address prevention strategies of type 2 diabetes in youth.

Investigational PPAR-γ agonists for the treatment of Type 2 diabetes

The tremendous increase in the global prevalence of Type 2 diabetes (T2D) and its conglomeration of metabolic disorders has dramatically intensified the search for innovative therapies to fight this emerging epidemic. Over the last decade, the family of nuclear receptors, especially the peroxisome proliferator-activated receptors (PPARs), has emerged as one of the most important drug targets aimed at combating the metabolic syndrome. Consequently, compounds that activate the PPARs have served as potential therapeutics for the treatment of T2D and the metabolic anomalies associated with this disorder. This review focuses on the currently marketed compounds and also describes the discovery and development of the next generation of PPAR ligands that are under investigation for the potential treatment of T2D and the metabolic syndrome.

Building cultural bridges: understanding ethnicity to improve acceptance of insulin therapy in patients with type 2 diabetes.

Type 2 diabetes is a significant healthcare problem in the Latino/Hispanic community. As with most patients with type 2 diabetes, Latino patients will eventually require insulin therapy to maintain glycemic control. Some cultural barriers to starting insulin therapy among Latino patients have been reported. This review explores the implications of the increasing prevalence of type 2 diabetes in Latino patients, defines cultural values and differences that may affect acceptance of insulin therapy, and reviews available strategies that may facilitate initiation of insulin treatment in this group. A literature search was conducted for publications related to Hispanic Americans, Latino persons, type 2 diabetes, and insulin therapy by using PubMed/National Center for Biotechnology Information. Despite evidence that earlier initiation of insulin therapy improves outcomes in patients with type 2 diabetes, Latino patients appear to be more resistant to insulin therapy than non-Hispanic Whites. Physician challenges associated with addressing the negative perceptions about insulin therapy are further compounded by cultural and language barriers often encountered when treating Latino patients. Scarce information regarding specific insulin regimens in Latino patients is available. Increased cultural awareness and competence among healthcare providers and increased use of Spanish-speaking diabetes educators seem to improve diabetes outcomes among Latino patients. Also, implementation of simpler insulin regimens may increase acceptance of insulin therapy and improve clinical outcomes in Latino patients. A relatively simple titration regimen using once-daily bedtime basal insulin glargine has demonstrated efficacy for improving glycemic control in many patients with type 2 diabetes and is a strategy that may also be useful for Latinos as an introduction to insulin therapy and as the foundation of a more comprehensive insulin regimen in the future.

Partial Angiotensin–Converting Enzyme Inhibition During Acute Orthostatic Stress in Persons With Tetraplegia

Introduction: Individuals with tetraplegia rely on the renin-angiotensin system for orthostatic blood pressure control.Objectives: To determine the effect of partial angiotensin-converting enzyme (ACE) inhibition on heart rate (HR), active plasma renin (PR), and mean arterial blood pressure (MAP)during acute orthostasis in subjects. with tetraplegia (n = 7) and nondisabled persons (n = 8).Methods: Subjects were instructed to avoid caffeine and alcohol for 24 hours before testing and to report to the laboratory between 1 0 AM and 1 PM. Progressive head-up tilt (15°,25°, 35°, and 45°)was performed on 2 separate days; Day 1 : without ACE inhibition; Day2:after intravenous (IV) infusion of enalaprilat (0.625mg).Results: HR was reduced during orthostasis in the tetraplegia compared with the nondisabled group(P < 0.0001 ), and was unaffected by ACE inhibition in either group. PR was not increasedwith orthostasis in either group, but was increased after ACE inhibition in both groups (P < 0.001 ). MAP wasnot affected by orthostasis in either group, but was reduced with ACEinhibition in both groups (P < 0.01).In the tetraplegia group, MAP was initially reducedafter ACE inhibition, but was maintained thereafter withincreasing angles of tilt,and nosubject complainedof symptomatic orthostatic hypotension.Conclusion: Subjects with tetraplegia were tolerant of an acute bout of orthostatic stress after partial ACE inhibition. This may have clinical relevance because of the increasedprevalence of type 2 diabetes mellitus in this population and the use of ACE inhibitors for the treatment ofprogressive renal and cardiovascular disease.

Cost-effective management of recalcitrant diabetic foot ulcers

The worldwide increase in prevalence of type 2 diabetes has resulted in a parallel increase in diabetic foot ulcers--a pervasive and significant problem associated with this disease [2]. Currently, an estimated 10.3 million people have been diagnosed with diabetes, while an additional estimated 5.4 million people with diabetes remain undiagnosed, representing a sixfold increase in the incidence of diabetes over the past four decades [9]. Approximately 15% (more than 2 million individuals, based on these estimates) of all people with diabetes will develop a lower-extremity ulcer during the course of the disease [10-12]. While most of these ulcers can be treated successfully on an outpatient basis, some will persist and become infected. Ultimately, between 14% and 20% of patients with lower-extremity diabetic ulcers will require amputation of the affected limb [13-15]. Diabetic foot ulcers can result in staggering financial burdens for both the healthcare system and the patient. For example, analysis of the 1995 Medicare claims revealed that lower-extremity ulcer care accounted for $1.45 billion in Medicare costs and contributed substantially to the high cost of care for diabetics, compared with Medicare costs for the general population [5]. Therapies that promote rapid and complete healing and reduce the need for expensive surgical procedures would impact these costs substantially. Results of this analysis suggest that becaplermin may ultimately be more cost-effective for the treatment of chronic diabetic foot ulcers than other treatment modalities, despite its higher initial dollar cost. This finding may be attributed to a combination of factors. First, expenses incurred in more prolonged treatment, such as office visits and the need for additional dressings, can be avoided when healing completes in a shorter period. Second, rapid and complete ulcer healing may reduce the incidence of significant morbidities (such as amputation or infection) and premature mortality; consequently, the financial burden associated with these complications would be reduced. Finally, the value of improved quality of life in patients with healed ulcers and the reduction in financial burden for patients who return to work cannot be ignored. These promising results warrant further investigation in larger controlled clinical studies to define more clearly the cost-effectiveness of becaplermin in this patient population.

Metabolic and endocrine changes in climacteric women

The climacteric period is associated with gradual reduction of sex hormones secretion. Substantial evidence indicates that estrogen deficiency contributes to the long-term metabolic consequences. A range of age-related changes (e.g. a reduction in growth hormone (GH), dehydroepiandrosterone (DHEA), melatonin) may be involved in aggravation of described abnormalities. Our studies on plasma satiety and appetite-stimulating neuropeptides indicate that the modification of appetite preferences contributes to overconsumption of fat in postmenopausal women. It is known that 60% of postmenopausal women have central body obesity. This trend obviously favours insulin resistance, an atherogenic plasma lipid–lipoprotein profile, abnormal blood coagulation and the increase in prevalence of type 2 diabetes. This cluster of metabolic abnormalities may be described as menopausal metabolic syndrome. Importantly, the alterations that women suffer in the climacteric period are assumed to be a risk factor leading to a 26–30% increase in death due to coronary heart disease in the postmenopausal group.