First Author: Merlinda Alu? Tokat
All Authors: Alu? Tokat M, Sanc? M, GirgeÃ§ S, Kulhan NG, Ã–zcan Ã‡Y
Journal Title: International journal of nursing practice
Abstract: Women with previous gestational diabetes mellitus (GDM) have at least sevenfold increased risk for developing type 2 diabetes compared with non-GDM mothers. The risk can be decreased by self-care measures.The aim of this study was to explore the postpartum education and lifestyle changes of Turkish women with previous GDM.This was a retrospective descriptive epidemiological study. A total of 111 women who had given birth within the previous 3-4?years were interviewed by telephone between December 2013 and April 2014.The 83.8% of the women with GDM had not received education related to exercise, while 40.5% received no education regarding the importance of diet. More importantly, while 68.5% had been informed about testing blood glucose levels postpartum, a large majority, 69.3%, did not know for how long they would have had to continue testing their glucose levels. However, 31.3% of those who monitored their glucose levels had glucose intolerance. In terms of lifestyle changes, less than half of the women, 48.6%, had made changes in their diet and the majority, 51.4%, were inactive.Women need access to sustained education and supportive counselling both to motivate and to minimize the risk of type 2 diabetes after GDM.
Evaluate the Effect of Education Interventions in the Prevention of Diabetic Foot Ulcers through Knowledge of the Disease and Self-Care Practices in Saudi Arabia
Authors: Muscogiuri G, DeFronzo RA, Gastaldelli A, Holst JJ
Abstract: Glucagon-like peptide-1 (GLP-1) is released in response to meals and exerts important roles in the maintenance of normal glucose homeostasis. GLP-1 is also important in the regulation of neurologic and cognitive functions. These actions are mediated via neurons in the nucleus of the solitary tract that project to multiple regions expressing GLP-1 receptors (GLP-1Rs). Treatment with GLP-1R agonists (GLP-1-RAs) reduces ischemia-induced hyperactivity, oxidative stress, neuronal damage and apoptosis, cerebral infarct volume, and neurologic damage, after cerebral ischemia, in experimental models. Ongoing human trials report a neuroprotective effect of GLP-1-RAs in Alzheimer's and Parkinson's disease. In this review, we discuss the role of GLP-1 and GLP-1-RAs in the nervous system with focus on GLP-1 actions on appetite regulation, glucose homeostasis, and neuroprotection.
Authors: Morgantini C, Imaizumi S, Grijalva V, Navab M, Fogelman AM, Reddy ST
Abstract: To determine the effect of the apolipoprotein A-I (ApoA-I) mimetic peptide, D-4F, on atherosclerosis development in a pre-existing diabetic condition.We induced hyperglycemia in 6-week-old apoE(-/-) female mice using streptozotocin. Half of the diabetic apoE(-/-) mice received D-4F in drinking water. Ten weeks later, plasma lipids, glucose, insulin levels, atherosclerotic lesions, and lesion macrophage content were measured.Diabetic apoE(-/-) mice developed ?300% more lesion area, marked dyslipidemia, increased glucose levels, and reduced plasma insulin levels when compared with nondiabetic apoE(-/-) mice. Atherosclerotic lesions were significantly reduced in the D-4F-treated diabetic apoE(-/-) mice in whole aorta (1.11 ± 0.73 vs. 0.58 ± 0.44, percentage of whole aorta, P < 0.01) and in aortic roots (36,038 ± 18,467 ?m²/section vs. 17,998 ± 12,491 ?m²/section, P < 0.01) when compared with diabetic apoE(-/-) mice that did not receive D-4F. Macrophage content in atherosclerotic lesions from D-4F-treated diabetic apoE(-/-) mice was significantly reduced when compared with nontreated animals (78.03 ± 26.1 vs. 29.6 ± 15.2 P < 0.001, percentage of whole plaque). There were no differences in glucose, insulin, total cholesterol, HDL cholesterol, and triglyceride levels between the two groups. Arachidonic acid, PGE?, PGD?, 15-HETE, 12-HETE, and 13-HODE concentrations were significantly increased in the liver tissue of diabetic apoE(-/-) mice compared with nondiabetic apoE(-/-) mice and significantly reduced by D-4F treatment.Our results suggest that oral D-4F can prevent atherosclerosis development in pre-existing diabetic mice and this is associated with a reduction in hepatic arachidonic acid and oxidized fatty acid levels.
Authors: Takahashi N, Nagamine M, Fukuda M, Motomura W, Abiko A, Haneda M, Fujiya M, Ieko M, Kohgo Y
Abstract: Occurrence of hypoglycemia in diabetes patients is very rare. We report here a case of frequent hypoglycemic attacks caused by inappropriate endogenous hyperinsulinemia in a female patient with poorly controlled diabetes and protein-losing gastroenteropathy. The blood glucose profiles of the patient were unstable. Results of the fasting test performed to investigate the cause of hypoglycemia suggested endogenous hyperinsulinism. Repeated selective arterial calcium injection tests suggested that hyperinsulinemia might be extrapancreatic in origin. However, efforts to detect a responsible lesion such as insulinoma were unsuccessful. Octreotide was used for the treatment of hypoglycemia and protein-losing gastroenteropathy. After treatment, although her leg edema caused by hypoalbuminemia persisted, hypoglycemia almost disappeared.
Authors: Joseph J, Svartberg J, Njølstad I, Schirmer H
Abstract: To determine the gender-specific incidence and risk factors of type-2 diabetes mellitus (T2DM) in a general population.The study is based on 12,431 men and 13,737 women aged 25-98 years, attending the Tromsø Study in 1994 and followed through 2005, who did not have diabetes when entering the study. Sex-specific hazard ratios were estimated from Cox proportional hazard models.A total of 522 cases of T2DM were registered, 308 among men and 214 among women. The age-standardised incidence rate was higher in men than in women, 2.6 (95% CI 2.32-2.90) and 1.6(95% CI 1.40-1.83) per 1000 person-years, respectively. In multivariate survival analysis, age, body mass index (BMI),triglycerides, high-density lipoprotein (HDL) cholesterol, hypertension, family history of diabetes, low education and smoking were independent predictors of T2DM in both genders (p<0.05). Total cholesterol and lack of leisure-time physical activity were independent predictors in men only. We found an interaction between HDL cholesterol and triglyceride levels(p<0.001) and between triglyceride levels and a positive family history of diabetes (p=.04). These interactions were independent of BMI. A positive family history combined with triglycerides in the highest tertile and BMI >25 kg/m(2) conveyed a 10-year risk of T2DM of 10% (95% CI 8-12%) vs. 0.2% (95% CI 0.08-0.31%) for the lowest risk group.A family history of diabetes, elevated BMI, and high triglyceride levels identifies independent of cardiovascular risk factors, a group with especially high risk of T2DM. [corrected]
Authors: Wong T, Ross GP, Jalaludin BB, Flack JR
Abstract: To explore clinical implications of overt diabetes in pregnancy on antenatal characteristics, adverse neonatal outcome and diabetes risk post-partum.Retrospective audit of prospectively collected data for all patients with gestational diabetes mellitus from 1993 to 2010. We defined overt diabetes in pregnancy as an HbA(1c) ? 8 mmol/mol (6.5%) or a fasting plasma glucose ? 7.0 mmol/l, or a 2-h glucose level ? 11.1 mmo/L on a 75-g oral glucose tolerance test as a surrogate for a random glucose ? 11.1 mmo/l.Our audit identified 1579 women with gestational diabetes and 254 with overt diabetes in pregnancy. Women with overt diabetes in pregnancy were diagnosed earlier in pregnancy, had a higher number of risk factors for gestational diabetes, higher antenatal HbA(1c), fasting and 2-h glucose levels, higher pre-pregnancy BMI and higher insulin use and dosage requirements than those with gestational diabetes. Overt diabetes in pregnancy was associated with an increased rate of large-for-gestational-age infant, neonatal hypoglycaemia and shoulder dystocia. Of the 133 patients with overt diabetes in pregnancy who attended a follow-up oral glucose tolerance test at 6-8 weeks post-partum, 21% had diabetes, 37.6% had impaired fasting glucose or impaired glucose tolerance, whilst 41.4% returned to normal glucose tolerance.In this patient cohort, overt diabetes in pregnancy significantly increased the risk of adverse pregnancy outcomes and post-partum impaired glucose regulation, but should not be regarded as synonymous with underlying diabetes. Two-hour glucose following a 75-g glucose load is a poor predictor of post-partum diabetes.
Authors: Amed S, Hamilton JK, Sellers EA, Panagiotopoulos C, Hadjiyannakis S, Shah BR, Booth GL, Laubscher TA, Dannenbaum D, Dean H
Abstract: Childhood type 2 diabetes (T2D) is increasing and may present differently across various populations. This study compares clinical features of T2D at diagnosis in Aboriginal children with Caucasian children and children from other high-risk ethnic groups.This retrospective observational study used data from a Canadian surveillance study where newly diagnosed cases of childhood T2D were reported (n = 227). Using descriptive statistics, clinical features at diagnosis of T2D were compared across different ethnic groups including Aboriginal (n = 100), Caucasian (n = 57), and other high-risk ethnic groups (n = 64). Comparisons were made between Aboriginal children living in central Canada (Manitoba/northwestern Ontario) (n = 74) and Aboriginal children from other regions of Canada (n = 26).Aboriginal children were younger, less obese, and less likely to have polycystic ovarian syndrome and dyslipidemia when compared to Caucasian children and children from other high-risk ethnic groups (p < 0.05). Aboriginal children from central Canada vs. those from other regions of Canada did not differ in age, body mass index z-score, family history of T2D, or presence of acanthosis nigricans. Those from central Canada had lower hemoglobin A1c levels (p < 0.05) and were less likely to have dyslipidemia than Aboriginal children from other regions (p < 0.05).Clinical features and rates of comorbidity in children with newly diagnosed T2D differ across various populations (Caucasian, Aboriginal, and children who belong to other high-risk ethnic groups) and across distinct Aboriginal populations (those living in central Canada vs. those living in other regions of Canada). Future research should determine specific genetic and environmental factors that contribute to these differences.
Authors: Diano S, Horvath TL
Abstract: Neuropathies are severe complications of diabetes. In this issue of Neuron, Campanucci et al. report that hyperglycemia-induced elevation of reactive oxygen species impairs synaptic transmission of sympathetic neurons leading to diabetes-induced dysautonomias. These observations provide new insights into the etiology of diabetic complications and suggest potential novel therapeutic approaches for neuropathies.
Authors: Xie B, Ye XL, Sun ZL, Jia M, Jin H, Ju CP, Yao L, De Vladmir CH, Yang Y
Abstract: The prevalence of diabetes has been growing rapidly in developing countries. This causes devastating economic burdens and increases demands on the health care system. Therefore, there is an urgent need to find a cost-effective and multi-faceted approach for diabetes care. Peer support models provide a potentially low-cost, flexible means which complements the current existing health care services. In this way, trained peer leaders can become qualified extensions to a formal healthcare system, capable of assisting education delivery and bolstering the efforts of professional staff. As such, creating a cultural specific peer support program and determining whether it is acceptable and cost-effective in rural communities of China is crucial. This study aims to implement and evaluate biophysical and psychosocial outcomes of peer support program for people with type 2 diabetes in rural communities, and to explore the program's feasibility and sustainability in China.This study is a cluster randomised controlled trial. All consenting patients will be randomised by community staff members to receive either peer support or the control care. The data collection and analysis including social demographics, health status, psychosocial status, economic status and biomedical measures will be collected at baseline, 6 months, and 12 months. The primary indicator measured is the change in HbA1c, whereas secondary indicators include biophysical, psychosocial functioning and other lifestyle factors. Finally, economic evaluations will determine whether the program is cost effective.This protocol is a cluster randomized, controlled trial of group-based peer support for people with type 2 diabetes in the community settings of rural China. Results from this trial may provide evidence to the effectiveness of peer support; furthermore, they will provide valuable information concerning the acceptability and feasibility of a new approach to improve diabetes self-management among resource-constrained settings.ClinicalTrials.gov Identifier: NCT02119572, April 18, 2014.
Authors: Hajduk J, Klupczynska A, Derezi?ski P, Matysiak J, Kokot P, Nowak DM, Gaj?cka M, Nowak-Markwitz E, Kokot ZJ
Abstract: The aim of this pilot study was to apply a novel combined metabolomic and proteomic approach in analysis of gestational diabetes mellitus. The investigation was performed with plasma samples derived from pregnant women with diagnosed gestational diabetes mellitus (n = 18) and a matched control group (n = 13). The mass spectrometry-based analyses allowed to determine 42 free amino acids and low molecular-weight peptide profiles. Different expressions of several peptides and altered amino acid profiles were observed in the analyzed groups. The combination of proteomic and metabolomic data allowed obtaining the model with a high discriminatory power, where amino acids ethanolamine, L-citrulline, L-asparagine, and peptide ions with m/z 1488.59; 4111.89 and 2913.15 had the highest contribution to the model. The sensitivity (94.44%) and specificity (84.62%), as well as the total group membership classification value (90.32%) calculated from the post hoc classification matrix of a joint model were the highest when compared with a single analysis of either amino acid levels or peptide ion intensities. The obtained results indicated a high potential of integration of proteomic and metabolomics analysis regardless the sample size. This promising approach together with clinical evaluation of the subjects can also be used in the study of other diseases.
Authors: Zhang Q, Zhao X, Chen M, Fang Z, Chen Y, Wang Y
Abstract: To examine the effects of intensive insulin therapy (IIT) in Chinese male patients with newly diagnosed type 2 diabetes in 12 months on plasma adiponectin and leptin levels and to assess whether changes in plasma adiponectin and leptin could be associated with subsequent weight gain or not.Overall 84 patients were taken IIT. Total, and high-, and low-molecular-weight (HMW, LMW) adiponectin and leptin concentrations were measured at the time of study inclusion, days 7, and 1, 3, 6 and 12 months after IIT, respectively. Patients' body weight was recorded every time when adiponectin and leptin were measured.With improvement of diabetes control, plasma total and HMW adiponectin and leptin concentrations increased from inclusion to 3 months significantly and progressively, but remained steady after 6 months. Weight increased relatively modestly with a mean gain of 2kg for 12 months. Moreover, higher increments of total and HMW adiponectin from inclusion to 12 months were associated with significantly less subsequent weight gain after adjustment for confounding factors: the patients in the lowest tertile of total adiponectin increased by 2.47kg compared to patients in the highest tertile who increased by 0.56kg (P-value=0.006). Whereas, the higher increments of leptin levels under the same condition were linked with more subsequent weight gain significantly (P-value=0.003).Our researches suggest that glycaemic control with IIT increases total and HMW adiponectin and leptin in newly diagnosed type 2 diabetes male patients, the elevation of total and HMW adiponectin and leptin levels may predict weight gain after IIT.