Type 2 Diabetes Mellitus Research Papers (original) (raw)

Background Diabetes may cause cardiomyopathy characterized by cardiac fibrosis. Recent studies of genetically modified mice have elucidated a role of the natriuretic peptides (NP), type-A and type-B (ANP and BNP), and their common receptor [natriuretic peptide receptor (NPR), type-A] in development of cardiac fibrosis. The role of NP type-C (CNP) and NPR type-B ( NPR-B) in the heart is less well established. In this study we examined if diabetes alters heart expression of the genes encoding the NP and its receptors.

- by
- •
- Mice, Natriuretic Peptides, Heart, Clinical Sciences

Aim: Non-insulin-dependent diabetes mellitus (type 2 diabetes) not responding to dietary treatment alone in patients with non-alcoholic liver cirrhosis is characterized by high postprandial hyperglycaemia. The control of postprandial hyperglycaemia in such patients, is generally achieved by the means of progressively higher doses of insulin, with an increasing risk of hypoglycaemia in the late postprandial period. The aim of this study was to evaluate the use of acarbose for the control of postprandial hyperglycaemia in 100 patients with wellcompensated liver cirrhosis and type 2 diabetes treated with insulin. Methods: The study was double blind with randomization of treatments into acarbose (52 patients) vs. placebo (48 patients) with parallel branches over a period of 28 weeks. Results: All patients tolerated the treatments well and no signi®cant variations in liver function tests were observed (< 5% vs. pretreatment). A signi®cant reduction of several parameters was observed only after acarbose treatment: fasting glycaemia (173 T 28 vs. 146 T 19 mg/dl; p < 0.01), postprandial glycaemia (230 T 24 vs. 148 T 20 mg/dl; p < 0.01), mean glycaemia (206 T 20 vs. 136 T 13 mg/dl; p < 0.01), mean variation (180 T 14 vs. 51 T 10 mg/dl; p < 0.01), HbA 1c (8.9 T 0.8 vs. 7.2 T 0.5; p < 0.05), C-peptide 2 h after a standard meal (4.5 T 1.9 vs. 2.8 T 1.7 ng/ml; p < 0.05), whereas the parameters did not change signi®cantly after the placebo. After acarbose treatment a signi®cant increase of intestinal voiding/week (+ 116% vs. + 10%; p < 0.01) and a parallel reduction of blood ammonia levels (± 52 T 9% vs. ± 9 T 5%; P < 0.01) were observed. Conclusions: The results clearly document the good tolerability and the absence of toxic effects of acarbose on liver, due to the lack of both intestinal absorption and hepatic metabolism of the drug at doses in the therapeutic range. In fact, acarbose increases the peristalsis movements of the gut, stimulates the proliferation of the saccarolytic bacteria and simultaneously reduces the proliferation of proteolytic bacteria, thus resulting active in the reduction of blood ammonia levels. These effects of acarbose may be advantageously exploited in the treatment of type 2 diabetic patients with well-compensated non-alcholic liver cirrhosis.

- by Salvatore Turco
- •
- Food, Blood Glucose, Liver Cirrhosis, Insulin

Background: Type 2 diabetes (T2D) is typically managed with a reduced fat diet plus glucose-lowering medications, the latter often promoting weight gain.

- by James McCarter
- •
- Type 2 Diabetes Mellitus

Libreta de viaje, hacia la calidad de vida Todos los derechos reservados. Esta publicación no puede ser reproducida, ni parcial ni totalmente, ni registrada en/o transmitida por un sistema de recuperación de información, en ninguna forma ni formato, por ningún medio, sea mecánico, fotocopiado, electrónico, magnético, electroóptico o cualquier otro, sin el permiso previo y por escrito de la editorial.

- by a s
- •
- Nutrition, Diabetes, Diabetes Mellitus and Its Complications, Type 2 Diabetes

Celiac disease is emerging in India and has become a public health problem.

- by Govind Makharia
- •
- Nutrition and Dietetics, Nutrition, India, Celiac Disease

5331 Right liver lobe/albumin ratio: Contribution to non-invasive assessment of portal hypertension Alempijevic T, 5336 Liver biopsy in a district general hospital: Changes over two decades Syn WK, Bruckner-Holt C, Farmer A, Howdle S, Bateman J 5343 Effects of a 24-week course of interferon-a therapy after curative treatment of hepatitis C virus-associated hepatocellular carcinoma 5351 Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches Lee SE, Yang SH, Jang JY, Kim SW 5357 Type 2 dıabetes mellıtus and CA 19-9 levels Uygur-Bayramiçli O, Dabak R, Orbay E, Dolapçıoğlu C, Sargın M, Kılıçoğlu G, Güleryüzlü Y, Mayadağlı A 5360 Holistic Acupuncture approach to idiopathic refractory nausea, abdominal pain and bloating Ouyang A, Xu L CLINICAL RESEARCH VIRAL HEPATITIS REVIEW World Journal of Gastroenterology 

- by Gamze Sargın
- •
- Prospective studies, Blood Glucose, Diabetes mellitus, World
- by Alan Meyers
- •
- Bariatric Surgery, Patient Safety, Evidence Based Medicine, Obesity

Over the past several decades, excessive body weight has become a major health concern. As the obesity epidemic continues to expand, metabolic disorders associated with excess body weight, including type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease, have exponentially increased. Dysregulation of satiety hormones and factors that regulate long-term energy storage can disrupt normal metabolic functions and lead to excess body fat. While diet and exercise seem to provide a logical means for weight loss, an unhealthy lifestyle coupled to responses initiated by perceived energy deficit impede sustained long term weight loss. Furthermore, because of the additional lack of effective pharmaceutical interventions to treat excess body weight, patients with severe obesity resort to bariatric surgery as an effective alternative for treatment of obesity and resolution of its associated comorbidities. Interestingly, the precise method by which bariatric surgery promotes rapid improvement in systemic metabolism and long-term weight loss remains incompletely understood and may vary between procedures. Multiple mechanisms likely contribute to the improved glucose metabolism seen after bariatric surgery, including caloric restriction, changes in the enteroinsular axis, alterations in the adipoinsular axis, release of nutrient-stimulated hormones from endocrine organs, stimulation from the nervous system, and psychosocial aspects including a dramatic improvement in quality of life. The current review will highlight the potential contribution of these responses to the improvement in systemic energy metabolism elicited by bariatric surgery. (Translational Research 2013;161:63-72) Abbreviations: BMI ¼ body mass index; BPD/DS ¼ biliopancreatic diversion/duodenal switch (BPD/DS); GIP ¼ glucose-dependent polypeptide; GLP-1 ¼ glucagon-like peptide 1 (GLP-1); HOMA ¼ homeostasis model assessment; LAGB ¼ laparoscopic adjustable gastric band; PYY3-36 ¼ peptide YY 3-36; RYBG ¼ Roux-en-Y gastric bypass; SG ¼ sleeve gastrectomy; VLCD ¼ very low calorie diet

- by Alexandria M Bobe, PhD
- •
- Bariatric Surgery, Obesity, Energy Metabolism, Glucose

Aims: To determine the prevalence and risk factors for painful diabetic peripheral neuropathy (PDPN) and evaluate sleep impairment and quality of life in patients with PDPN. Methods: Data from the Korean Diabetes Association Neuropathy Study Group were used to evaluate 3999 patients with type 2 diabetes. PDPN was diagnosed using visual analogue scales (VAS) and medical history. The patients were asked to answer the Brief Pain Inventory-Short Form (BPI-SF), Medical Outcomes Study Sleep (MOS-Sleep) Scale, EuroQol (EQ-5D), and VAS. Results: Among the patients with diabetic peripheral neuropathy (n = 1338), 577 (43.1%) were diagnosed with PDPN (14.4% of all patients with type 2 diabetes). PDPN was independently associated with age, female gender, fasting plasma glucose, hypertension, and previous cerebrovascular events. All pain severity and interference measures were higher in patients with PDPN than in non-PDPN patients, and patients with PDPN reported more impaired sleep and lower EQ-5D and VAS scores. Conclusions: The prevalence of PDPN in Koreans was comparable to that in Western populations. PDPN may impair sleep and quality of life compared with non-PDPN, and physicians should carefully consider pain symptoms in patients with diabetic peripheral neuropathy.

- by Bong-yun Cha
- •
- Pain, Quality of life, Hospitals, Sleep disorders

The global prevalence of dementia has been estimated to be as high as 24 million, and is predicted to double every 20 years until at least 2040. As the population worldwide continues to age, the number of individuals at risk will also increase, particularly among the very old. Alzheimer disease is the leading cause of dementia beginning with impaired memory. The neuropathological hallmarks of Alzheimer disease include diffuse and neuritic extracellular amyloid plaques in brain that are frequently surrounded by dystrophic neurites and intraneuronal neurofibrillary tangles. The etiology of Alzheimer disease remains unclear, but it is likely to be the result of both genetic and environmental factors. In this review we discuss the prevalence and incidence rates, the established environmental risk factors, and the protective factors, and briefly review genetic variants predisposing to disease.

- by Richard Mayeux
- •
- Cognition, Diet, Medicine, Hypertension

The aim of the present study was to determine if micronutrients supplementation can improve neuropathy indices in type 2 diabetes. Materials and methods: In this randomized, double-blind, placebo-controlled clinical trial, 75 type 2 diabetes patients were assigned to three treatment groups, receiving one of the following daily supplement for 4 months: Group MV: zinc (20 mg), magnesium (250 mg), vitamin C (200 mg) and E (100 mg); Group MVB: both of the above mineral and vitamin supplements plus vitamin B1 (10 mg), B2 (10 mg), B6 (10 mg), biotin (200 mg), B12 (10 mg) and folic acid (1 mg); Group P: placebo. Results: 67 patients completed the study. Neuropathic symptoms based on the MNSI questionnaire improved from 3.45 to 0.64 (p = 0.001) in group MVB, from 3.96 to 1.0 (p = 0.001) in group MV and from 2.54 to 1.95 in placebo group after 4 months. There was no significant difference between three treatment groups in MNSI examinations after 4 months supplementations. Over 4 months of treatment, patients showed no significant changes in glycemic control, capillary blood flow or electrophysiological measures in MV and MVB groups compared with placebo group. Conclusions: These studies suggest that micronutrients supplementation might ameliorate diabetic neuropathy symptoms.

- by Farhad Adelmanesh
- •
- Diabetes, Vitamins, Type 2 Diabetes, Medicine

Variants in the TCF7L2 gene have been associated with type 2 diabetes mellitus (T2DM), but the causal variant(s) is still unknown. We studied the TCF7L2 messenger RNA (mRNA) expression in paired samples of visceral and subcutaneous adipose tissue from 49 subjects using quantitative real-time polymerase chain reaction and its relation to obesity and T2DM. All subjects were genotyped for the previously described TCF7L2 diabetes risk variants. Independent of age, sex, obesity, and diabetes status, we found N3-fold higher TCF7L2 mRNA expression in subcutaneous compared with visceral adipose tissue. There was no correlation between visceral and subcutaneous TCF7L2 expression. No differences in adipose tissue TCF7L2 mRNA expression levels were found between diabetic and nondiabetic subjects, or between lean and obese subjects (all Ps N .05). In addition, there was no association between TCF7L2 genetic variants and mRNA expression. Based on our data, TCF7L2 mRNA expression is fat-depot specific but does not seem to provide the mechanistic link explaining genetic association with T2DM.

- by Peter Kovacs
- •
- Genetics, Metabolism, Biology, Medicine
- by H. Johnson and +1
- •
- Engineering, Physics, Chemistry, Biology

The unsatisfactory results associated with conventional treatments for symptoms of diabetic peripheral neuropathy (DPN) demonstrate a need for research into alternative therapies. The purpose of this study was to determine the efficacy of whole body vibration therapy (WBV) as a treatment for pain associated with DPN. Participants (n Z 8) with painful DPN received three treatment sessions per week for four weeks. Each session consisted of four bouts of 3 min of vibration (frequency 25 Hz, amplitude 5 mm). The primary outcome measures were changes in the visual analog pain scale (VAS) and changes in the neuropathic pain scale (NPS). WBV demonstrated a significant (p < 0.05) acute pain reduction in the VAS, and a significant chronic reduction in both the VAS and NPS scales. No side-effects were observed during this study. WBV appears to be an effective, non-invasive treatment for pain associated with DPN.

- by Junggi Hong
- •
- Complementary and Alternative Medicine, Vibration, Medicine, Pain Management

This is an Accepted Article that has been peer-reviewed and approved for publication in the Journal of Diabetes, but has yet to undergo copy-editing and proof correction. Please cite this article as an Accepted Article; doi:... more

- by Thep Himathongkam
- •
- Diabetes, Risk assessment, Adolescent, Asia

Oral health information was included in 89.5% of diabetes education programs in states with high diabetes prevalence compared to 85.9% in low prevalence states (P=0.22). However, management of dry mouth, demonstrations and return... more

- by Carolyn Jenkins
- •
- Diabetes, Self Care, Management Education, Oral health

Background. In the United Kingdom, diabetic nephropathy is a leading cause of end-stage renal disease. There is a higher incidence amongst subjects of Indo-Asian and African-Caribbean origin compared with Caucasians that is not wholly explained by the differences in the prevalence of diabetes. Therefore, we postulated that this observation could be related to variations in the rate of progression of renal disease according to racial origin. Methods. We conducted a retrospective case-note review of 1684 adult attendees of the diabetes clinic. Forty-®ve patients were found with renal impairment (serum creatinine P170 mmolul) due to diabetic nephropathy. The patients were of Indo-Asian (ns10), African-Caribbean (ns11), and Caucasian (ns24) origin. Progression of nephropathy was assessed by analysing (i) the doubling of serum creatinine through construction of Kaplan±Meier curves and (ii) the slope (b) of the rate of change in serum creatinine using linear regression analysis in relation to demographic variables, putative risk factors for nephropathy and antihypertensive drug therapy. Results. There were no statistically signi®cant differences between systolic and diastolic blood pressure, glycaemic control, smoking habit, baseline proteinuria, and usage of angiotensin-converting enzyme inhibitors between the three groups. The proportion of patients doubling their creatinine was signi®cantly higher in the Indo-Asian compared with the African-Caribbean and Caucasian groups (100, 45 and 50%; Ps0.025 respectively). In addition, the mean (95% CI) of b (mmolulumonth) was highest in the Indo-Asian (5.36 (2.21±8.52)) compared with the African-Caribbean (3.14 (0.82±5.46)) and Caucasian (2.22 (1.31±3.14)) groups (Ps0.035). The mean ranks of b were highest in the Indo-Asian group (Ps0.038) after adjusting for marginal differences in blood pressure age, gender, baseline proteinuria, anti-hypertensive treatment, and smoking habit. Conclusions. In this small cohort of type 2 diabetic subjects with established renal disease, the rate of decline in renal function is accelerated in Indo-Asian subjects. This observation could be related to differences in renoprotection from antihypertensive therapy.

- by John Yudkin
- •
- Kidney, Hypertension, Caribbean region, Ethnic Groups
- by Liz Steed
- •
- Information Systems, Political Science, Library and Information Studies, Blood Glucose

Myocardial infarction causes a cascade of events, which leads to heart failure, debilitation and death. This study examined possible cardioprotective effect of oleuropein in rats with acute myocardial infarction. Male Sprague-Dawly rats were allocated to five groups: sham, myocardial infarction receiving vehicle, and three myocardial infarction receiving oleuropein at 10, 20, and 30 mg/kg/day for 7 days, and underwent sham operation or coronary ligation. Twenty-four hours later, animals underwent echocardiographic and hemodynamic studies, and infarct areas, serum concentrations of oxidative stress and inflammatory markers were determined. Myocardial infarction group receiving vehicle had significantly lower left ventricular developed and systolic pressures, rate of rise/decrease of left ventricular pressure, stroke volume, ejection fraction and cardiac output, and serum superoxide dismutase and glutathione reductase than those of sham group. Pretreatment with oleuropein prevented the reduction of these variables. Moreover, the group had a significantly higher serum malondialdehyde, interleukin-1b, TNF-a, creatin kinase-MB, and troponin I, lactate dehydrogenase, and infarct area than those of sham group. Pretreatment with oleuropein prevented the increase of these variables. The findings indicate that coronary ligation results in acute myocardial infarction characterized by impaired cardiac function, and oleuropein pretreatment prevented cardiac impairment partly by reducing oxidative stress and release of proinflammatory cytokines.

- by Ali Akbar Nekooeian
- •
- Biomarkers, Oxidative Stress, Electrocardiography, Antioxidants
- by Laurent Billot
- •
- Diabetes, Clinical Sciences, Aged, Oral Hypoglycemic Agents

Objective Epidemiological studies have linked vitamin D deficiency with the susceptibility to type 1 diabetes. Higher levels of the active metabolite, 1!,25dihydroxyvitamin D, could protect from immune destruction of the pancreatic " cells.

- by Jason Cooper
- •
- Metabolism, Diabetes, Vitamin D, Gene

A large number of micropropagated Euphorbia millii shoots from temporary immersion bioreactor showed thick broad leaves that were translucent, wrinkled and/or curled and brittle, symptoms of hyperhydricity. The environment inside bioreactor normally used in plant micropropagation is characterised by high relative humidity, poor gaseous exchange between the internal atmosphere of the bioreactor and its surrounding environment, and the accumulation of ethylene, conditions that may induce physiological disorders. A comparison of hyperhydric shoots (HS) with normal plants shows marked increase in malondialdehyde (MDA) content in HS plants. MDA, a decomposition product of polyunsaturated fatty acids hydroperoxides, has been utilized very often as a suitable biomarker for lipid peroxidation, which is an effect of oxidative damage. This hypothesis is also confirmed by the higher lipoxygenase (LOX) activity in HS plants. The potential role of antioxidant enzymes in protecting hyperhydric shoots from oxidative injury was examined by analyzing enzyme activities and isozyme profiles of hyperhydric and non-hyperhydric leaves of E. millii. Superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) activity were significantly higher in hyperhydric tissue as compared to non-hyperhydric normal leaf tissue. After native polyacrylamide gel electrophoresis (PAGE) analysis, seven SOD isoenzymes were detected and the increase in SOD activity observed in hyperhydric tissue seemed to be mainly due to Mn-SOD and Cu/Zn-SOD. The activity of ascorbate peroxidase (APX), glutathione reductase (GR), monodehydroascorbate reductase (MDHAR) and dehydroascorbate reductase (DHAR) was proportionally increased in HS tissue compared to normal leaves indicating a crucial role in eliminating toxic H 2 O 2 from plant cells. The depletion of GSH and total glutathione in spite of higher GR activities observed in HS tissue indicates that mechanism of antioxidant defense was by enhanced oxidation of GSH to GSSG by DHAR yielding ascorbate (AA). The antioxidant metabolism has been shown to be important in determining the ability of plants to survive in hyperhydric stress and the up regulation of these enzymes would help to reduce the build up of ROS.

- by Yaser Dewir
- •
- Andrology, Immunology, Nonparametric Statistics, Aging

Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process. r (L. Potvin). 0277-9536/03/$ -see front matter r 2002 Published by Elsevier Science Ltd. PII: S 0 2 7 7 -9 5 3 6 ( 0 2 ) 0 0 1 2 9 -6

- by Treena Delormier
- •
- Sociology, Program Evaluation, Anthropology, Health Promotion

Diabetes" and related "Health Beliefs Concerning Diabetes" (Bradley's questionnaires, 1984), a fully randomized short-of structured outpatient education for Functional Insulin Treatment (FIT: selective insulin dosages for eating, fasting or term controlled Study 1 (four weeks, 32 patients), and longterm uncontrolled pilot Study 2 (three years, 68 patients) were correcting hyperglycaemia) on perceived control over diabetes and related health beliefs. FIT was thought to influence the performed. Results: The short-term study revealed that FIT induced the feeling of independence from situational control perception of self-efficacy in diabetes, in contrast to conventional treatment, based on scheduled, rigid food intake and while self-managing diabetes. In the long-term study, the patients were increasingly freed from the feeling of being under insulin delivery-it allows flexible eating, provided independent control of glycemia. Methods: Structured, comprehen-the control of physician and treatment-related restrictions, which-together with higher perceived self-efficacy-con-sive, outpatient group training in FIT for selective use of insulin either for eating, fasting or correction included practi-tributed to the feeling of "empowerment." This was associated with high treatment satisfaction and significant improvement cal "insulin games." The FIT program focused on everyday criteria for choices of insulin dosages and thus on the patient's of glycemic control. Conclusion: Structured out-patient group training for FIT results in measurable improvement of pa-ability to execute his/her newly gained flexible treatment to his/her everyday life while preventing acute and late complica-tients' perceived control over diabetes and self-efficacy.

- by Kinga Howorka
- •
- Treatment Outcome, Adolescent, Everyday Life, Self Efficacy

3D morphology of mitochondrial network 4Pi microscopy 3D image analysis Pancreatic β-cell Type-2 diabetes Morphological diagnostic Insulin production in pancreatic β-cells is critically linked to mitochondrial oxidative phosphorylation. Increased ATP production triggered by blood glucose represents the β-cells' glucose sensor. Type-2 diabetes mellitus results from insulin resistance in peripheral tissues and impaired insulin secretion. Pathology of diabetic β-cells might be reflected by the altered morphology of mitochondrial network. Its characterization is however hampered by the complexity and density of the three-dimensional (3D) mitochondrial tubular networks in these cell types. Conventional confocal microscopy does not provide sufficient axial resolution to reveal the required details; electron tomography reconstruction of these dense networks is still difficult and time consuming. However, mitochondrial network morphology in fixed cells can also be studied by 4Pi microscopy, a laser scanning microscopy technique which provides an ∼ 7-fold improved axial resolution (∼ 100 nm) over conventional confocal microscopy. Here we present a quantitative study of these networks in insulinoma INS-1E cells and primary β-cells in Langerhans islets. The former were a stably-transfected cell line while the latter were transfected with lentivirus, both expressing mitochondrial matrix targeted redoxsensitive GFP. The mitochondrial networks and their partial disintegration and fragmentation are revealed by carefully created iso-surface plots and their quantitative analysis. We demonstrate that β-cells within the Langerhans islets from diabetic Goto Kakizaki rats exhibited a more disintegrated mitochondrial network compared to those from control Wistar rats and model insulinoma INS-1E cells. Standardization of these patterns may lead to development of morphological diagnostics for Langerhans islets, for the assessment of β-cell condition, before their transplantations.

- by Mark Lessard
- •
- EM, Electron Tomography, Mitochondria, Confocal Microscopy

Smoking habit is associated with diabetic macular edema in Type 1 diabetes mellitus patients Diabetic macular edema (DME) affects up to 29% of patients with diabetic retinopathy (DR) and is the most frequent cause of visual impairment in these patients . However, risk factors for DME have not been fully established. Recently, Romero et al. (2007) prospectively studied 112 type 1 diabetes mellitus (DM) patients (age 39.9±10.5 years; DM duration 23.4±7.5 years; 48.2% males) to evaluate risk factors for DME. After 15 years, the incidence of DME was 20.5%. In logistic multivariate regression models, adjusted for gender and age, A 1c test and low-density lipoprotein (LDL) cholesterol levels, arterial hypertension, macroangiopathy, severity of retinopathy, and macroalbuminuria were the recognized risk factors for DME. In a cross-sectional study, we evaluated 224 Type 1 DM patients aged 33.3±13.9 years, with 16.5±9.6 years of DM duration (105 males) regularly attending the DM outpatient clinic at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. A complete clinical evaluation was performed as previously described . DME was defined as one or more of the following: any retinal thickening within 500 μm of the center of the macula, with or without loss of retinal transparency; hard exudates associated with retinal thickening within 500 μm of the center of the macula; or one disc area of thickening within one disc diameter of the center of the macula (ETDRS, 1985). Twenty-four percent of the patients had nonproliferative DR (mild, n=38; moderate, n=9; severe, n=7), and 20.7 % (n=46) proliferative DR. The prevalence of DME was 9.4% (n=21). In univariate analysis, patients with DME had higher levels of urinary albumin excretion (UAE) [26.2 mg/dl (0.1-1105) vs. 8.7 (0.1-71110), P=.049] than those without it. DM duration, body mass index, blood pressure levels, glycemic (A 1c test) and lipid profile (total, LDL, and high-density lipoprotein cholesterol and triglycerides) did not differ between groups. Current or former smoking habit (50% vs. 25%; P=.034) and diabetic nephropathy (micro-and macroalbuminuria) (58.8% vs. 29.5%; P=.026) were more frequent in patients with than those without DME. The severity of DR was also associated with DME (P for trend .027). In logistic multivariate regression analysis, with the presence of DME as the dependent variable and DM duration, smoking habit, systolic blood pressure, A 1c test, and UAE as independent ones, only the smoking habit was associated with DME (OR 2.02, 95%CI 1.01-4.00; P=.04). Differences between our results and those of Romero et al., besides study design, could be explained by the younger age and shorter DM duration of our patients: a difference of about 6 years of age [6.6 years (95% CI 3.6-9.5; Pb.0001)] and of 7 years of DM duration [6.9 years (95% CI 4.7-8.9; Pb.0001)]. The present data demonstrated that, besides glycemic, lipid, and blood pressure control, the smoking habit, a nontraditional DME risk factor, should also be taken into account in order to prevent it. To our knowledge, this is the first report of this association.

- by Jorge Esteves
- •
- Diabetes, Diabetes Mellitus and Its Complications, Smoking, Risk factors

Objective: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia. Methods: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-TrLndelag Health Study (HUNT) (the HUNT2 in 1995Y1997 and the HUNT3 in 2006Y2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2. Results: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors. Conclusions: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.

- by Tzeng-Ji Chen
- •
- Education, Behavior Modification, Depression, Obesity

The deletion-allele of the angiotensin-converting enzyme (ACE) gene and elevated ACE activity are associated with increased risk of severe hypoglycemia in type 1 diabetes. We explored whether genetic and phenotypic variations in other components of the renin-angiotensin system are similarly associated. METHODS: Episodes of severe hypoglycemia were recorded in 171 consecutive type 1 diabetic outpatients during a 1-year follow-up. Participants were characterized at baseline by gene polymorphisms in angiotensinogen, ACE, angiotensin-II receptor types 1 (AT1R) and 2 (AT2R), and by plasma angiotensinogen concentration and serum ACE activity. RESULTS: Three risk factors for severe hypoglycemia were identified: plasma angiotensinogen concentration in the upper quartile (relative rate [RR] vs. lower quartile 3.1, 95% confidence interval [CI,] 1.4-6.8), serum ACE activity in the upper quartile (RR vs. lower quartile 2.9, 95% CI, 1.3-6.2), and homo-or hemizygosity for the A-allele of the X chromosome-located AT2R 1675G/A polymorphism (RR vs. noncarriers 2.5, 95% CI, 1.4-5.0). The three risk factors contributed independently to prediction of severe hypoglycemia. A backward multiple regression analysis identified a high number of renin-angiotensin system-related risk factors and reduced ability to perceive hypoglycemic warning symptoms (impaired hypoglycemia awareness) as predictors of severe hypoglycemia. CONCLUSIONS: High renin-angiotensin system activity and the A-allele of the AT2R 1675G/A polymorphism associate with high risk of severe hypoglycemia in type 1 diabetes. A potential preventive effect of renin-angiotensin system blocking drugs in patients with recurrent severe hypoglycemia merits further investigation.

- by Amar Sethi
- •
- Genetics, Prospective studies, Renin Angiotensin Aldosterone System, Hypoglycemia

Chronic condition management in general practice is projected to account for 50% of all consultations by 2051. General practices under present workforce conditions will be unable to meet this demand. Nurse led collaborative care models of chronic disease management have been successful overseas and are proposed as one solution. This article provides an interim report on a prospective randomised trial to investigate the acceptability, cost effectiveness and feasibility of a nurse led model of care for chronic conditions in Australian general practice. A qualitative study focused on the impact of this model of care through the perceptions of practice staff from one urban and one regional practice in Queensland, and one Victorian rural practice. Primary benefits of the collaborative care model focused on increased efficiency and communication between practice staff and patients. The increased degree of patient self responsibility was noted by all and highlights the motivational aspect ...

- by Desley Hegney
- •
- Health Sciences, General Practice, Australia, Family Practice
- by Danielle Hessler and +1
- •
- Self Care, General Internal Medicine, Treatment Outcome, Follow-up studies

To check the reliability of the commonly used neurological scoring systems taking the nerve conduction studies as the reference. Diagnosed diabetics (n=60) were selected by purposive sampi ng Detection and grading of neuropathy were done according to Diabetic Neuropathy Symptom Score (DrNS), modified Neuropathy Symptom Score (NSS), Diabetic Neuropathy Examination (DNE) and modified Neuropathy Disability Score (NDS). For the nerve conduction studies, amplitudes, velocities and latencies of minimum two (Sural, Peroneal) and maximum six, i.e., three sensory (Sural, Ulnar, Median) and three motor (Peroneal, Ulnar, Tibial) nerves were checked. If the patient had 2 or more than two abnormal findings in any of the nerve he was labeled to have peripheral sensorimotor neuropathy. Later the sensitivity, specificity and diagnostic efficacy of each neurological score was checked taking nerve conduction studies as the gold standard. Taking the NCS as gold standard DNS, DNE, NSS and NDS had 64.1%...

- by Nadeem Ahmed
- •
- Clinical Sciences, Questionnaires, Reproducibility of Results, Disease Progression
- by Reinhard Eher
- •
- Type 2 Diabetes, Prospective studies, Blood Glucose, Blood Pressure

The case of a patient with emphysematous cystitis who presented with complaints of lower abdominal pain, dysuria, and pneumaturia is presented. The presenting symptoms, differential diagnosis, and radiographic and cystoscopic appearances of emphysematous cystitis, a rare complication of lower urinary tract infection occurring almost exclusively in diabetics, are reviewed. Treatment consists of urinary drainage, prompt initiation of antibiotic therapy, and strict glucose control. The prognosis usually is excellent.

Aims In view of the relationship between microvascular pathology and organ complications in diabetes mellitus, the aim of the present study was to examine the microvascular response of upper arm skin to non-immunological contact irritants... more

- by Vesa Koivukangas
- •
- Microcirculation, Skin, Clinical Sciences, Benzoic Acid

The Utrecht Diabetes Project (UDP) is a shared-care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist. To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs' motives for enrolling them. Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs. Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out-patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out-patient clinics had more patients with diabetes > 10 years or with complications. UDP patients' records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin. Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care. Diabet. Med. 18, 459-463 (2001)

- by G. E. H. M. Rutten
- •
- Documentation, Telemedicine, Family Practice, Smoking

Motivation for diet and exercise management among adults with type 2 diabetes Aim: The aim of this study was to investigate diet and exercise management and how indicators of intrinsic motivation such as ability expectations and values are associated with diet and exercise management among adults with type 2 diabetes. Background: Motivational problems are probably one of the main reasons for poor diabetes management. However, the mechanisms involved in the motivation for adequate selfmanagement are still unclear. Design and methods: A cross-sectional design including a postal questionnaire that investigated diet and exercise management as well as intrinsic motivational factors such as ability expectations and values related to these behaviours was used to collect the data. A sample comprising 425 adults with type 2 diabetes aged between 30 and 70 completed the questionnaire. Results: Reported diet management was more in accordance with recommendations than reported exercise management. Yet results indicated equally high ability expectations and positive values for exercise and diet management. Moreover, results demonstrated that ability expectations and values explained more variance in exercise (21.6%) than in diet management (7.6%). Conclusions: The modest association between intrinsic motivational factors and diet management may imply that there are important extrinsic factors that play a significant role in determining dietary behaviour. The combination of lower exercise activity than recommended and high ability expectations and values for such activity may reflect that subjective exercise norms are formed individually in accordance with what most people recognise as the appropriate level of physical activity. Finally, results may indicate that there is potential for improving exercise management by stimulating intrinsic motivation as well as by more clearly communicating recommendations for such management.

- by Edvin Bru
- •
- Nursing, Diet, Motivation, Exercise
- by Paul Zimmet
- •
- Australia, Type 2 Diabetes, Autoimmune diseases, Insulin

Adiponectin has been associated with common metabolic disorders. The current study was conducted to measure and compare levels of adiponectin with obesity, type 2 diabetes mellitus (T2DM) and gender in Punjabi subjects from Faisalabad, Pakistan. Serum adiponectin was measured by enzyme-linked immunosorbent assay (ELISA) along with measurements of some clinically important analytes (fasting blood glucose, cholesterol, triglycerides) as well as body mass index (BMI) in 80 subjects. The main results were significantly (p < 0.003) decreased serum adiponectin level in T2DM patients (n = 40) compared to non-diabetic controls (n = 40). In obese subjects, (n = 40) also, there was a decrease, but it was not significant. Adiponectin levels in the subgroups of diabetic and obese patients were also observed, but no significant gender-based differences were found.

- by Fazli Rabbi Awan
- •
- Obesity, Pakistan, Medicine, Clinical Sciences

Fifty-seven type 2 diabetic patients with metabolic syndrome and on insulin were assessed by a paired analysis before and 6 months after addition of metformin as combination therapy to evaluate the impact of the association on glycemic control, blood pressure, and lipid profile. This was a historical cohort study in which the files of type 2 diabetic patients with metabolic syndrome on insulin were reviewed. The body mass index (BMI), waist circumference, lipid profile, A1C level, fasting blood glucose level, daily dose of NPH insulin, systolic blood pressure, and diastolic blood pressure were assessed in each patient before the start of metformin and 6 months after the initiation of combination therapy. Glycemic control significantly improved (P < 0.001) after the addition of metformin (1404.4 ± 565.5 mg/day), with 14% of the 57 patients reaching A1C levels up to 7%, and 53% reaching values up to 8%. There was a statistically significant reduction (P < 0.05) of total cholesterol (229.0 ± 29.5 to 214.2 ± 25.0 mg/ dL), BMI (30.7 ± 5.4 to 29.0 ± 4.0 kg/m 2), waist circumference (124.6 ± 11.7 to 117.3 ± 9.3 cm), and daily necessity of insulin. The reduction of total cholesterol occurred independently of the reductions of A1C (9.65 ± 1.03 to 8.18 ± 1.01%) and BMI and the reduction of BMI and WC did not interfere with the improvement of A1C. In conclusion, our study showed the efficacy of the administration of metformin and insulin simultaneously without negative effects. No changes were detected in HDL-cholesterol or blood pressure.

- by João Sá
- •
- Treatment Outcome, Medicine, Metabolic syndrome, Lipids

BACKGROUND: The aim of this study was to compare the effects of 10 weeks of resistance or treadmill exercises on glycemic indices levels prior to and immediately following exercise in adults with type 2 diabetes. RESEARCH DESIGN AND METHOD: Twenty inactive subjects (mean age 53.5 years) with type 2 diabetes enrolled in the study. Baseline HbA1c, blood glucose levels, heart

- by Muhammed Al Jarrah
- •
- Research Design, Medicine, Blood Glucose, Blood Pressure

Background: The purpose of our study was to compare ankle range of motion and stiffness in individuals with and without diabetes mellitus using a reliable and valid technique and to document the effect of knee flexion and severity of pathology on ankle range of motion and stiffness. Methods: Twenty-five individuals with diabetes mellitus and 64 nondiabetic individuals, similar in age and gender profile, participated in this study. Results: Results revealed that individuals with diabetes mellitus had both significantly lower peak dorsiflexion range of motion (5.1 and 11.5 degrees, p < 0.001) and higher passive ankle stiffness (0.016 and 0.008 Nm/kg/degree, p < 0.01) than non-diabetic individuals. In individuals with diabetes mellitus, a positive relationship between glycemic control and duration of diabetes mellitus and ankle stiffness ((r 2 = 0.48 and 0.24 respectively, p < 0.01 for both) was found. Conclusion: While decreased range of motion and increased stiffness in the diabetes mellitus population seem clinically intuitive, as far as we know this is the first study to confirm the concurrent existence of both these findings in the plantarflexors in individuals with diabetes mellitus. We applied a reliable and valid technique, one that allowed control of confounding factors such as knee flexion position and differences in determination of end range of motion, and documented a mean 41% loss in dorsiflexion excursion. Changes in the muscle, stemming from underlying pathology, are hypothesized to account for a significant part of the lost range of motion. Changes in ankle range of motion and stiffness may have important implications in plantar loading and ulcer formation.

- by Charles Saltzman
- •
- Biomedical Engineering, Medicine, Age, Blood Glucose

Background: Tight junctions (TJs) represent the major barrier within the paracellular pathway between intestinal epithelial cells. Disruption of TJs leads to intestinal hyperpermeability (the so-called "leaky gut") and is implicated in the pathogenesis of several acute and chronic pediatric disease entities that are likely to have their origin during infancy. Aim: This review provides an overview of evidence for the role of TJ breakdown in diseases such as systemic inflammatory response syndrome (SIRS), inflammatory bowel disease, type 1 diabetes, allergies, asthma, and autism. Conclusion: A better basic understanding of this structure might lead to prevention or treatment of these diseases using nutritional or other means.

- by Zhanju Liu
- •
- Child, Celiac Disease, Intestines, Epithelial cells

Diabetes mellitus type 1 is a form of diabetes mellitus that results from the autoimmune destruction of insulin-producing beta cells in the pancreas. The current gold standard therapy for pancreas transplantation has limitations because of the long list of waiting patients and the limited supply of donor pancreas. Mesenchymal stem cells (MSCs), a relatively new potential therapy in various fields, have already made their mark in the young field of regenerative medicine. Recent studies have shown that the implantation of MSCs decreases glucose levels through paracrine influences rather than through direct transdifferentiation into insulin-producing cells. Therefore, these cells may use pro-angiogenic and immunomodulatory effects to control diabetes following the cotransplantation with pancreatic islets. In this review, we present and discuss new approaches of using MSCs in the treatment of diabetes mellitus type 1.

- by Jana Katuchova
- •
- Medicine, Cell Differentiation, Clinical Sciences, Endocrine pathology

Diabetes mellitus is a chronic disease with serious health consequences. The association between diabetes and periodontal disease is well documented. However, the progression and healing of endodontic infections in diabetic patients has not been adequately studied. In this review, diabetes mellitus is explored as a potential modulating factor of endodontic pathosis. Recent data on the relationship between the clinical presentation of pulpal and periradicular disease, as well as the outcome of endodontic treatment in diabetic and nondiabetic patients, are presented. Diabetics who present for endodontic treatment, particularly those with periradicular pathosis, may have increased perioperative symptoms. Cases with preoperative periradicular lesions are less likely to be determined successful two years or longer postoperatively if the patient reports a history of diabetes. Studies examining the pathogenesis of periradicular lesions in mouse models with uncontrolled type 1 diabetes sugg...

- by Ashraf Fouad
- •
- Microbiology, Dentistry, Dental Education, Diabetes mellitus

Hypoglycaemia is a frequent and greatly feared side-effect of insulin therapy, and a major obstacle to achieving nearnormal glucose control. This review will focus on the more recent developments in our understanding of the mechanisms that underlie the sensing of hypoglycaemia in both non-diabetic and diabetic individuals, and how this mechanism becomes impaired over time. The research focus of my own laboratory and many others is directed by three principal questions. Where does the body sense a falling glucose? How does the body detect a falling glucose? And why does this mechanism fail in Type 1 diabetes? Hypoglycaemia is sensed by specialized neurons found in the brain and periphery, and of these the ventromedial hypothalamus appears to play a major role. Neurons that react to fluctuations in glucose use mechanisms very similar to those that operate in pancreatic Band A-cells, in particular in their use of glucokinase and the K ATP channel as key steps through which the metabolic signal is translated into altered neuronal firing rates. During hypoglycaemia, glucose-inhibited (GI) neurons may be regulated by the activity of AMP-activated protein kinase. This sensing mechanism is disturbed by recurrent hypoglycaemia, such that counter-regulatory defence responses are triggered at a lower glucose level. Why this should occur is not yet known, but it may involve increased metabolism or fuel delivery to glucose-sensing neurons or alterations in the mechanisms that regulate the stress response.

- by Rory McCrimmon
- •
- Endocrinology, Nutrition, Medicine, Blood Glucose

Diabetic muscle infarction (DMI) is a rare, long-term complication of poorly controlled diabetes (typically of type I). DMI was first described in 1965 and more than 100 cases have been reported thereafter in the English literature. Usually, there is a coexistence with concomitant nephropathy, neuropathy, and retinopathy. The etiology remains uncertain, but appears to be attributable to diabetic microangiopathy and hypercoagulability and is believed that hypoxia-reperfusion injury is involved. DMI presents with sudden onset of pain associated with a tender mass in the thigh in most instances. The diagnosis is based on magnetic resonance imaging, which is not specific but highly indicative. Treatment is conservative with relapses occurring in 50% of the patients, but not necessarily in the same muscle group. We describe a case of DMI that occurred 4 months after simultaneous kidney and pancreas transplantation in one patient with type I diabetes mellitus and end-stage renal disease.

Qualitative research on self-management for people with Type 2 Diabetes Mellitus (T2DM) has typically reported one-off retrospective accounts of individuals' strategies. The aim of this research was to identify the ways in which self-management strategies are perceived by people with T2DM as being either supportive or unsupportive over time, by using qualitative findings from both longitudinal intervention studies and usual care.

- by Julia Frost
- •
- Quality of life, Self Care, Library and Information Studies, Great Britain