Top PDF Type 2 diabetes: hypoinsulinism, hyperinsulinism, or both?

Type 2 diabetes: hypoinsulinism, hyperinsulinism, or both?

Type 2 diabetes: hypoinsulinism, hyperinsulinism, or both?

Genetic data that have accumulated over the last ten years suggest that T2DM is a genetically heterogeneous disease in which either or both of these two scenarios could be important in any given individual. The current study demonstrates that a third scenario, in which a primary beta-cell defect results in increased insulin secretion, and thus increased fetal growth, long-term beta-cell damage, and late-onset insulin defi ciency, may also be important in the pathogenesis of diabetes in some patients. It is not known how the same HNF4A mutation causes hyperinsulinism in the fetus and hypoinsulinism in the adult. Nor is it known why two very closely related genes, HNF4A and HNF1A, cause such different phenotypes. Genetic variants in the beta-cell specifi c (P2) promoter of HNF4A have been associated with
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Depressive Symptoms in Type 1 and Type 2 Diabetes Mellitus and Its Relationship with Glycemic Control

Depressive Symptoms in Type 1 and Type 2 Diabetes Mellitus and Its Relationship with Glycemic Control

Objective: The current study assessed depressive symptoms in Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) patients and explored whether these symptoms were associated with glycemic control. Methods: A cross-sectional design was used. Patients attending diabetes consultations participated in the study (N = 347). Participants completed the Beck Depression Inventory (BDI), and glycemic control was based on A1C criteria. Results: The mean score on the BDI, for either T1DM or T2DM, was not clinically significant and was not associated with diagnosis duration. The association between depression and glycemic control was significant in both DM types. T2DM participants presenting more depressive symptoms were those with greater glycemic control. T1DM and T2DM differences regarding depressive symptoms were in somatic symptoms. Conclusions: In T2DM depressive symptoms may be confounded with DM physical consequences. There is also the possibility that negative mood plays a mediating role in mobilizing survival strategies that promote glycemic control. Furthermore, the assessment of depressive symptomatology in patients with diabetes could benefit from the availability of a disease-specific measure.
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Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes

Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes

We observed no signiicant diferences in the risk of stillbirth, neonatal death, miscarriage, termination of pregnancy, or pre- term delivery between women with type 1 and type 2 diabetes. his inding is similar to that of a previous report regarding rates of miscarriage, termination of pregnancies, and preterm delivery [3]. Women with type 1 diabetes were more likely to have LGA infants and macrosomic infants than women with type 2 diabetes. his demonstrates improvement of outcome in type 2 diabetes, but conirms the increasing prevalence of LGA in type 1 diabetes that was described in a recent longitudinal Swedish study [10]. his inding suggests that more intensive prenatal care is required to improve glycemic control and perinatal outcomes in patients with type 1 diabetes. One possible solution is continuous glucose monitoring (CGM) during pregnancy, as randomized clinical tri- als using CGM during pregnancy demonstrated improved glyce- mic control and reduced frequency of LGA infants in women with type 1 and type 2 diabetes [14]. Our results in women with type 1 and 2 diabetes contradict these indings, suggesting that there was no signiicant diference in risk of macrosomia between women with type 1 and 2 diabetes [3]. We found no signiicant diferences in risk of congenital malformation between the two groups. In a previous study, pregnancies in women with type 2 di- abetes were no more likely than type 1 diabetes to result in mal- formation [3]. he Conidential Enquiry into Maternal and Child Health (CEMACH) study showed similar results in women with both types of diabetes [2]. In contrast, Roland et al. [8] found a higher rate of congenital malformations in women with type 2 di- abetes. Among women with overt diabetes before conception, the risk of structural anomaly in the fetus is reported to increase 4- to 8-fold [15] compared with the 1% to 2% risk for the general pop- ulation. In a cohort study of 2,359 pregnancies in women with pre-gestational diabetes, the major congenital anomaly rate was 4.6% overall, 4.8% for type 1 diabetes, and 4.3% for type 2 diabe- tes, more than double the expected rate. Neural tube defects were increased 4.2-fold and congenital heart disease by 3.4-fold. he association of glycemic control with congenital malformations has been consistently documented [16]. herefore, maternal glu- cose was considered to be important variable.
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Direct medical cost of type 2 diabetes in singapore.

Direct medical cost of type 2 diabetes in singapore.

Despite the large number of people with DM, the financial burden in Singapore attributed to DM has not been investigated. Because type 2 diabetes mellitus (T2DM) accounts for ap- proximately 90% of DM cases and its prevalence increases with ageing, understanding the pat- terns of resource use and cost associated with T2DM is becoming increasingly important for policymakers and budget planners. Therefore, this study aims to identify the total direct medi- cal cost of T2DM in Singapore and to examine the relationship between direct medical costs and individual demographic characteristics, DM treatments (exercise or diet, taking oral medi- cations only, taking insulin only and taking both insulin and oral medications), disease control, complications and comorbidities.
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Increased mean platelet volume in type 2 diabetes mellitus

Increased mean platelet volume in type 2 diabetes mellitus

Diabetes mellitus (DM) impairs glucose tolerance. As such it is a genetically and clinically heteroge- neous disease requiring continuous follow up. Pa- tients with DM and vascular complications face an increased risk of mortality. Many studies are being conducted on the pathogenetic factors that play a role in complication development in DM. It is thought that platelets have an effective role in the development of vascular complications. It has been shown that diabetic patients have increased throm- botic adhesion and aggregation, thromboxane syn- thesis and platelet factor 4 plasma levels [1,2].
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Management of Type 2 Diabetes Mellitus in Older Adults

Management of Type 2 Diabetes Mellitus in Older Adults

Approximately 30% of people with diabetes have depressive symptomatology, 10% have major depression, and recent stud- ies have shown that people with diabetes have two-fold in- creased odds of depression compared with individuals without diabetes [22-25]. The coexistence of diabetes and major de- pression is associated with increased health care use, increased health care costs, and adverse health outcomes for diabetes [24,26]. Furthermore, depression is associated with hypergly- cemia and an increased risk for diabetic complications, and relief of depression is associated with improved glycemic con- trol. Depression is also a major contributor to functional dis- ability and quality of life. Functional disability in depressed patients is thought to result from decreased physical activity, decreased likelihood of seeking medical care, and increased susceptibility to disease [22,27]. Healthcare providers should be aware of the frequent coexistence of psychiatric conditions, such as depression or other psychiatric conditions, in elderly patients with diabetes. It is important to screen all diabetic el- derly patients for mental health issues as these may interfere with self-care and the overall management of diabetes. Recog- nition and management of psychiatric disorders will help to optimize diabetes management. Good diabetes control can also reduce mental health complications in these patients [28].
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Arq Bras Endocrinol Metab  vol.58 número2

Arq Bras Endocrinol Metab vol.58 número2

Our study has an important methodological strength over previous studies, since it is a prospective cohort. Our data about pregnancy variables and socioeconomic characteristics of participants were collected during the beginning of the third trimester. Moreover, our study results had a broad external validity because we evalu- ated all women who had been referred to our high-risk prenatal care. One possible limitation of the study is that we enrolled women labeled as gestational diabetes both by the Brazilian and the IADPSG/ADA criteria, since the discussion on GDM diagnostic procedures still remains a matter of great controversy (5,6,32,33). Another possible limitation is that the frequency of im- paired glucose we found may be overestimated due to more frequent return of GDM women with higher 2-h glucose values on the diagnostic OGTT.
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High Density Lipoprotein: A Therapeutic Target in Type 2 Diabetes

High Density Lipoprotein: A Therapeutic Target in Type 2 Diabetes

High density lipoproteins (HDLs) have a number of properties that have the potential to inhibit the development of atherosclero- sis and thus reduce the risk of having a cardiovascular event. These protective effects of HDLs may be reduced in patients with type 2 diabetes, a condition in which the concentration of HDL cholesterol is frequently low. In addition to their potential cardio- protective properties, HDLs also increase the uptake of glucose by skeletal muscle and stimulate the synthesis and secretion of insulin from pancreatic β cells and may thus have a beneficial effect on glycemic control. This raises the possibility that a low HDL concentration in type 2 diabetes may contribute to a worsening of diabetic control. Thus, there is a double case for targeting HDLs in patients with type 2 diabetes: to reduce cardiovascular risk and also to improve glycemic control. Approaches to raising HDL levels include lifestyle factors such as weight reduction, increased physical activity and stopping smoking. There is an ongoing search for HDL-raising drugs as agents to use in patients with type 2 diabetes in whom the HDL level remains low despite lifestyle interventions.
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Análise Integrativa de Perfis Transcricionais de Pacientes com Diabetes Mellitus...

Análise Integrativa de Perfis Transcricionais de Pacientes com Diabetes Mellitus...

The major finding of our global partitioning analysis that examined the differences in transcription among each diabetes patient was the cluster of genes associated with inflammation. The high expression levels of these genes in some T1D and GDM patients seem to influence the global gene expression pattern of diabetic patients. Indeed, several important molecular mechanisms identified by clustering account for an intricate array of inflammation pathways. One important finding was the up-regulation of many mediators of the NOD-like signaling pathway. It has recently been suggested that NOD-like receptors can be induced by hyperglycemia and oxidative stress products, which could link metabolism and inflammation, particularly through the participation of IL1B [52]. In this study, many genes involved in these pathways were discovered to be induced in T1D and GDM patients, including NLRP3 (an important receptor of the NOD-like pathway), IL1B, CXCL1, CXCL2, IL6, IL8, TNF, RIPK2, TNFAIP3 and NFKB1A. TNF and IL1B are strongly involved in the regulation of nitric oxide biosynthetic processes [53] and are regulated by SOD2 (also induced in T1D and GDM) [54]. In addition, other upregulated genes including chemokines (CCL3, CCL4), cytokines (IL6, IL8, TNF) and transcription factors (NFKBIA, MAPK8) are involved with other inflammatory processes, such as toll-like and NFB signaling pathways, apoptosis regulation, the MAPKKK cascade, and regulation of IL-6 production. Curiously, genes associated with these processes were down-regulated in T2D compared with the other types of diabetes. To understand this result, we took advantage of the rank product analysis (paired analyses), which showed particular features of the involvement of these inflammatory pathways in each type of diabetes. The comparisons between T2D and GDM as well as between T1D and T2D revealed several interesting results. At the same time that NOD-like receptors were induced in T1D and GDM, hundreds of zinc finger protein genes were induced in T2D. Additionally, drug treatment with metformin in T2D patients influenced the gene expression patterns, whereas insulin treatment did not. As literature findings have indicated that the expression of transcription factors associated with T2D can be induced by hypoglycemiants, it is possible to hypothesize that these drugs may induce alterations in the normal T2D expression profile. Finally, the comparisons between T2D and T1D reveal the important genes associated with T2D diabetes, particularly transcription factors involved in glucose homeostasis (TCF7L2) [24][55], induction of NAD+ (FOXO3) [56] and regulation of cellular and systemic response to hypoxia (HIF1A) [57].
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Rev. LatinoAm. Enfermagem  vol.24

Rev. LatinoAm. Enfermagem vol.24

Initially, type 2 diabetes impacted more the rich countries, but with globalization it reached all continents. Adherence to self-care behavior, in type 2 diabetes is associated with social economic factors. In fact, individuals with lower income and less education are two to four times more likely to develop diabetes and tend to have poorer glycemic control, more diabetes complications, and higher mortality. Lack of access to health care is an important risk factor for the consequences of diabetes among the socioeconomically deprived. The poor are more likely to experience inequality of care once diabetes has developed despite health insurance coverage.
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Rev. bras. farmacogn.  vol.16 número1

Rev. bras. farmacogn. vol.16 número1

These data show that a reliable, cost saving therapy with traditionally used plants could be a possibility to lower the problems of untreated diabetes because of a lack of synthetic drugs. On the other side medicinal plants contain an enormous potential for the development of new drugs and the effi cient treatment of diabetes. But it is necessary that their effectiveness is proofed. In our study we could show that plants are able to inhibit the α-amylase activity. This mechanism belongs to fi rst line therapies in diabetes treatment. The demonstrated results might be a base for further studies with plants also from South, Central, and North America which are traditionally used in diabetes therapy (Barbosa-Filho et al., 2005).
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SEGMENTAL OR MOSAIC NEUROFIBROMATOSIS TYPE 1: A REPORT OF 2 PATIENTS

SEGMENTAL OR MOSAIC NEUROFIBROMATOSIS TYPE 1: A REPORT OF 2 PATIENTS

Um homem de 64 anos (Doente 2), saudável, foi observado na nossa consulta por lesões assintomáticas com características similares às da doente 1, mas em menor número, localizadas na face anterolateral do braço esquerdo, em disposição grosseiramente linear (Fig.s 2A e 2B). O quadro apresentava cerca de 25 anos de evolução. O restante exame físico e a avalia- ção oftalmológica eram normais. A história familiar era negativa, sendo os descendentes do doente saudáveis. A TC cerebral e a ecogafia abdominal não mostraram alterações de relevo. Foi efectuada biópsia excisional de uma das lesões. O exame histológico foi compatível com o diagnóstico de neurofibroma cutâneo (Fig. 2C). Tendo em conta o quadro clínico e o exame anátomo- -patológico foi estabelecido o diagnóstico de NF1 seg- mentar. Por desejo do doente foi efectuado tratamento cirúrgico das lesões com laser CO 2 .
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PREVALENCE OF TESTOSTERONE DEFICIENCY IN PATIENTS OF DIABETES MELLITUS LESS  THAN 40 YEARS OF AGE

PREVALENCE OF TESTOSTERONE DEFICIENCY IN PATIENTS OF DIABETES MELLITUS LESS THAN 40 YEARS OF AGE

In the present study, total 90 male patients of diabetes mellitus of age below 40 years were taken from medical outpatient department and indoor patients of medical wards of a tertiary care teaching hospital of South Delhi. They were evaluated for complains regarding sexual dysfunction. Hormonal assays of serum free testosterone, LH, FSH, C-peptide, HbA1c and lipid profile were carried out in all patients.

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Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society

Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society

The desirable goal for A1C, as defined by the previous position statement in 2007, recommended A1C levels < 6.5%. In this new Position Statement, the recommended A1C goal was redefined to <7.0% as shown in table 3. However, according to the ADA's 2010 statement, in patients with a history of severe hypoglycemia, patients with limited life expectancies, children, individuals with comorbidities, those with longstanding diabetes, advanced age and those with advanced microvascular or macrovascular complications" intensive glycemic control may outweigh its benefits. But for patients with short duration of diabetes, long life expectancy, and no signifi- cant CVD a level of A1c even lower than the general goal of <7%, has been suggested if this can be achieved with- out significant hypoglycemia or other adverse effects [3- 5].
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Atividade física regular no idoso com Diabetes Mellitus tipo 2

Atividade física regular no idoso com Diabetes Mellitus tipo 2

Submission of an article implies that the work described has not been published previously (except in the form of an abstract or as part of a published lecture or academic thesis or as an electronic preprint, see http://www. elsevier.com/sharingpolicy), that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. To verify originality, your article may be checked by the originality detection service CrossCheck http://www.elsevier.com/editors/plagdetect.
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Arq. NeuroPsiquiatr.  vol.75 número8

Arq. NeuroPsiquiatr. vol.75 número8

Objective: To evaluate neuropathic pain and peripheral vascular disease in diabetics and compare this with the length of time since diagnosis in type 1, and type 2 diabetes. Methods: A cross-sectional study with 225 diabetics chosen from their responses on the DN4 questionnaire, who were then evaluated with the ankle-brachial index (ABI), separating type 1 diabetes from type 2 diabetes. Results: A higher incidence of neuropathic pain in those over 60 years of age showed an ABI > 1.3. Neuropathic pain was related to an abnormal ABI in 144 patients (64.2%). A statistically signiicant value was obtained in type 2 diabetes patients with more than 10 years from disease onset, 69 with altered ABI and 25 with normal ABI. There was an altered ABI (< 0.9) observed in 33% of type 1 diabetes patients and in 67% of type 2 diabetes patients. Conclusion: The ABI test in type 1 diabetes and type 2 diabetes patients is important even in those who are asymptomatic. A diagnosis of more than 10 years prior, regardless of the presence of neuropathic pain or ischemic signs, altered the ABI. Keywords: diabetes mellitus; diabetic neuropathies; ankle-brachial index.
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Aprendizagem na Diabetes tipo 2 - Vertente Alimentar : Monografia : Learning how to live with type 2 Diabetes - nutritional aspects

Aprendizagem na Diabetes tipo 2 - Vertente Alimentar : Monografia : Learning how to live with type 2 Diabetes - nutritional aspects

dos HC pelas refeições. O nível 2, ou intermédio, foca as relações entre os alimentos, a terapêutica medicamentosa, a actividade física regular, os níveis de glicose no sangue e introduz os passos necessários para gerir estas variáveis, baseando-se nos padrões de glicemia. O nível 3, ou avançado, foi concebido para ensinar os doentes com DM tipo 1 que se encontram com um esquema intensivo de insulina ou com bomba de infusão de insulina. (45, 46) Incide no ajuste entre a insulina de acção rápida e a quantidade de HC consumida a cada refeição. (45) Ou seja, no nível 3 utiliza-se o “factor de correcção” ou “factor de sensibilidade”. Para isso divide-se 1500 pela dose diária total de insulina (DDTI), e o resultado será o efeito na diminuição da glicemia, em mg/dl, de 1 unidade de insulina rápida. Para os análogos de insulina ultra-rápida o critério é o mesmo, contudo neste caso divide-se 1800 pela DDTI. Não podemos esquecer que, a real diminuição da glicemia de 1 unidade de insulina extra depende de muitos factores, como a ingestão alimentar e a actividade física regular. Além disso é necessário saber qual a relação entre a insulina e os HC, por tal realiza-se a regra dos 500, na qual se divide 500 por DDTI. O resultado é o número de gramas de HC que 1 unidade de insulina cobre. (17)
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DAPAGLIFLOZIN: SELECTIVE SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITOR IN  TYPE 2 DIABETES

DAPAGLIFLOZIN: SELECTIVE SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITOR IN TYPE 2 DIABETES

A novel approach for treating hyperglycemia, targets receptors for renal glucose reabsorption. 5 The kidneys play an important but underappreciated role in the overall regulation of blood glucose levels in the body. In normal individuals, glucose present in the plasma is filtered by the kidneys, but virtually all of it is reabsorbed, such that less than 1% of glucose is excreted in urine. 6,7 In patients with T2DM who have hyperglycemia, a greater amount of glucose is filtered and paradoxically the glucose resorptive capacity of the kidneys is increased despite the fact that this retention process contributes to sustaining the hyperglycemia of diabetes. 8 This leads to glucotoxicity, which worsens insulin resistance and contributes to dysfunction in the beta cells of the pancreas. This method of controlling hyperglycemia appears to minimise deleterious effects that exacerbate T2DM complications.
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Arq Bras Endocrinol Metab  vol.43 número5

Arq Bras Endocrinol Metab vol.43 número5

A recently published study in which 195 patients with Type 2 diabetes were randomized to receive preprandial repaglinide or once or twice daily glibenclamide for 14 weeks, also showed eq[r]

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O Autocuidado no Controle do Diabetes Mellitus Tipo 2 / Self-care in the Control of Diabetes Mellitus Type 2

O Autocuidado no Controle do Diabetes Mellitus Tipo 2 / Self-care in the Control of Diabetes Mellitus Type 2

Braz. J. of Develop., Curitiba, v. 6, n.5, p.29755-29770 may. 2020. ISSN 2525-8761 A Organização Mundial da Saúde (OMS) e a Sociedade Brasileira de Diabetes (SBD), informam que hiperglicemia avança cada vez mais, a números alarmantes, sendo considerada causa de mortalidade prematura, superada apenas pela hipertensão. Essa epidemia de fundo nutricional possui fatores desencadeadores como falha do sistema público de saúde, carecendo de informações quanto ao gerenciamento dos cuidados e no diagnóstico dos sintomas do DM2. O autocuidado na DM2 é laborioso pois requer que habilidades e conhecimentos sejam informados ao paciente de forma clara e objetiva para que a monitorização da glicemia, o gerenciamento da medicação, as mudanças na alimentação e a atividade física, sejam realizadas com sucesso (SAMPAIO et al., 2015; IMAZU et al., 2015), evitando assim, que haja descontinuidade do tratamento, podendo ocasionar futuras complicações da doença (DIAS et al., 2018; CORRÊA et al., 2017).
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