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1.
Intensive lifestyle modifications with or without liraglutide 3mg vs. sleeve gastrectomy: A three-arm non-randomised, controlled, pilot study.
Capristo, E, Panunzi, S, De Gaetano, A, Raffaelli, M, Guidone, C, Iaconelli, A, L'Abbate, L, Birkenfeld, AL, Bellantone, R, Bornstein, SR, et al
Diabetes & metabolism. 2018;(3):235-242
Abstract
BACKGROUND/OBJECTIVES As only 1% of clinically eligible subjects choose to undergo surgical treatment for obesity, other options should be investigated. This study aimed to assess the effects of intensive lifestyle modification (ILM) with or without 3-mg liraglutide daily vs. sleeve gastrectomy (SG) on BMI after 1 year. SUBJECTS/METHODS In this study performed at an Italian university hospital, non-diabetic patients eligible for bariatric surgery were recruited from a weight-loss clinic and had the option to choose from three possible weight-loss programmes up to an allocation of 25 subjects in each arm matched by BMI and age. ILM consisted in 813kcal of a very low-calorie diet (VLCD) for 1 month, followed by a diet of 12kcal/kg body weight of high protein and high fat for 11 months plus 30min of brisk walking daily and at least 3h of aerobic exercise weekly. SG patients followed a VLCD for 1 month and a free diet thereafter. Patients were evaluated at baseline and at 1, 3, 6, 9 and 12 months. RESULTS A total of 75 patients were enrolled; retention was 100% in the SG and 85% in the two medical arms. SG reduced BMI by 32% (P<0.001 vs. medical arm), while ILM+liraglutide and ILM led to BMI reductions of 24% and 14%, respectively (P<0.001). More women allocated themselves to the ILM+liraglutide group. Weight loss was 43kg with SG, 26kg with ILM+liraglutide and 15kg with ILM alone. Lean body mass reductions were -11.6kg with SG, -6.3kg with ILM and -8.3kg with ILM+liraglutide. Prevalence of prediabetes was significantly lower with ILM+liraglutide, and insulin resistance was reduced by about 70% by both ILM+liraglutide and SG vs. 39% by ILM alone. Cardiometabolic risk factors were greatly reduced in all three groups. DISCUSSION At least in the short-term, liraglutide 3.0mg once daily associated with drastic calorie-intake restriction and intensive physical activity promoted a 24% weight loss, which was almost two times greater than ILM alone and only about 25% less than with SG, while preserving lean body mass. Although this study was non-randomised, it was designed to explore the efficacy of medical treatments for obesity in everyday clinical practice.
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2.
Multifactorial intervention for diabetes control among older users of insulin.
Machry, RV, Pedroso, HU, Vasconcellos, LS, Nunes, RR, Evaldt, CA, Yunes Filho, EB, Rodrigues, TDC
Revista de saude publica. 2018;:60
Abstract
OBJECTIVE To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy. METHODS This is a prospective, non-randomized, quasi-experimental study. We have included 45 patients over 60 years old, from both sexes, with glycated hemoglobin (HbA1c) > 8.5% using oral hypoglycemic agents and insulin. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement. All patients received insulin pen, refills of Neutral Protamine Hagedorn and regular insulin, needles for the pen, blood glucose meter, and capillary blood glucose tests (three tests/day). Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention. RESULTS Glycated hemoglobin at baseline was 10.34% (SE = 0.22%) and 8.54% (SE = 0.24%, p < 0.001) and 8.09% (SE = 0.21%, p < 0.001) at 12 and 24 weeks after intervention, respectively, with a significant reduction from baseline. CONCLUSIONS More frequent medical visits, with treatment inputs including the use of insulin pens and self-monitoring, have improved glycemic control (reduction of 2.25% in HbA1C, on average, at 24 weeks of follow-up). Our data support a change in the management and medical behavior of older patients with chronically decompensated diabetes.
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3.
Effect of Glycemic Regulation on Endocan Levels in Patients With Diabetes: A Preliminary Study.
Arman, Y, Akpinar, TS, Kose, M, Emet, S, Yuruyen, G, Akarsu, M, Ozcan, M, Yegit, O, Cakmak, R, Altun, O, et al
Angiology. 2016;(3):239-44
Abstract
Endothelial-specific molecule 1 (endocan) is expressed by endothelial cells and may have a major role in the regulation of cell adhesion and in the pathogenesis of inflammatory disorders. We aimed to assess change in endocan levels after 3 months of lifestyle change recommendations and guideline-based treatment. Diabetic patients (n = 77) who had neither chronic kidney disease nor chronic inflammatory disease were included. After baseline evaluation, the patients were advised lifestyle changes, and their medical treatment was determined individually according to recommendations of the American Diabetes Association (ADA) guidelines. At the end of third month patients were reevaluated. Baseline endocan levels were significantly increased in the study group compared with the control group. The third-month laboratory workup showed significant reductions in hemoglobin A1c, urinary albumin-to-creatinine ratio (UACR), and endocan levels. Only δ-UACR was independently correlated with δ-endocan in multivariate linear regression analysis. Our findings suggest that serum endocan concentrations are elevated in patients with type 2 diabetes and decrease following anti-hyperglycemic treatment. Furthermore, decrease in endocan concentrations might be associated with improved glycemic control and reductions in UACR.
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Intact Regulation of the AMPK Signaling Network in Response to Exercise and Insulin in Skeletal Muscle of Male Patients With Type 2 Diabetes: Illumination of AMPK Activation in Recovery From Exercise.
Kjøbsted, R, Pedersen, AJ, Hingst, JR, Sabaratnam, R, Birk, JB, Kristensen, JM, Højlund, K, Wojtaszewski, JF
Diabetes. 2016;(5):1219-30
Abstract
Current evidence on exercise-mediated AMPK regulation in skeletal muscle of patients with type 2 diabetes (T2D) is inconclusive. This may relate to inadequate segregation of trimeric complexes in the investigation of AMPK activity. We examined the regulation of AMPK and downstream targets ACC-β, TBC1D1, and TBC1D4 in muscle biopsy specimens obtained from 13 overweight/obese patients with T2D and 14 weight-matched male control subjects before, immediately after, and 3 h after exercise. Exercise increased AMPK α2β2γ3 activity and phosphorylation of ACCβ Ser(221), TBC1D1 Ser(237)/Thr(596), and TBC1D4 Ser(704) Conversely, exercise decreased AMPK α1β2γ1 activity and TBC1D4 Ser(318)/Thr(642) phosphorylation. Interestingly, compared with preexercise, 3 h into exercise recovery, AMPK α2β2γ1 and α1β2γ1 activity were increased concomitant with increased TBC1D4 Ser(318)/Ser(341)/Ser(704) phosphorylation. No differences in these responses were observed between patients with T2D and control subjects. Subjects were also studied by euglycemic-hyperinsulinemic clamps performed at rest and 3 h after exercise. We found no evidence for insulin to regulate AMPK activity. Thus, AMPK signaling is not compromised in muscle of patients with T2D during exercise and insulin stimulation. Our results reveal a hitherto unrecognized activation of specific AMPK complexes in exercise recovery. We hypothesize that the differential regulation of AMPK complexes plays an important role for muscle metabolism and adaptations to exercise.
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Prevalence of abnormal gastric emptying in asymptomatic women with newly detected diabetes and its reversibility after glycemic control-a prospective case control study.
Laway, BA, Malik, TS, Khan, SH, Rather, TA
Journal of diabetes and its complications. 2013;(1):78-81
Abstract
OBJECTIVE Effects of systemic hyperglycemia and normoglycemia on gastric emptying in people with type 2 diabetes are not clear. The aim of the study was to investigate the gastric emptying time in people with newly detected diabetes before and after control of diabetes compared with healthy controls. METHODS Gastric emptying to solid meal was studied in 30 asymptomatic women with newly detected diabetes before and after achieving euglycemia and compared with 20 healthy age, sex and weight matched controls using egg white labelled with Technetium 99m Sulfur Colloid. RESULTS Delayed gastric emptying was seen in 90% of women with diabetes and none in healthy controls. Lag phase was 83.1±11.8 min in cases compared to 37.2±4.0 in controls (p=0.05). Gastric emptying at 4h was 46.73%±4.84% in cases and 97.65%±0.59% in controls (p=0.05).T50 was 250±8.8 min in cases against 94.70±5.10 min in controls (p<0.05). After control of diabetes, lag phase normalized to 37.2±4.0 min against 35.2±4.6 min in controls. Similarly all other parameters also normalized after control of diabetes. CONCLUSIONS Delayed gastric emptying to solids was seen in 90% of women with type 2 diabetes at the time of hyperglycemia and normalized after control of diabetes.
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Effect of the yellow passion fruit peel flour (Passiflora edulis f. flavicarpa deg.) in insulin sensitivity in type 2 diabetes mellitus patients.
de Queiroz, Mdo S, Janebro, DI, da Cunha, MA, Medeiros, Jdos S, Sabaa-Srur, AU, Diniz, Mde F, Dos Santos, SC
Nutrition journal. 2012;:89
Abstract
BACKGROUND A study with the yellow passion fruit peel flour showed positive action in blood glucose control as therapies' adjuvant in patients with type 2 diabetes mellitus. Therefore, we evaluated its effect on insulin sensitivity since there is a quest for studies that focus at better understanding of insulin resistance aspects in diabetic patients. Furthermore its relationship with chronic complications can also give good prospects for alternative treatments. METHODS A total of 43 type 2 diabetes volunteers (28 females and 15 males) ingested 30 g/day of the yellow passion fruit peel flour for two months. The levels of blood glucose and fasting insulin, HOMA index and glycated hemoglobin were measured for each patient before and after dietary supplementation. RESULTS There was a significant difference in the fasting blood glucose values (P = 0.000) and glycated hemoglobin (P = 0.032) after supplementation. It was also seen a reduction in HOMA IR (P = 0.005) in the supplemented group, however it was not observed changes in insulin values for females. HOMA beta (P = 0.000) showed significant increase in its values for the studied group. CONCLUSIONS The supplementation used decreased insulin resistance in type 2 diabetic patients, suggesting a positive action in blood glucose control as adjuvant therapy in conventional treatments.
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The role of family history in clinical symptoms and therapeutic outcomes of women with polycystic ovary syndrome.
Hu, Z, Wang, Y, Qiao, J, Li, M, Chi, H, Chen, X
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2010;(1):35-9
Abstract
OBJECTIVE To investigate the association between family history and clinical symptoms of polycystic ovary syndrome (PCOS) that were thought to be inherited, by treating women with PCOS with contraceptive pills and metformin, and assessing outcomes. METHODS Of 164 women with PCOS, 49 with menstrual abnormalities, hyperandrogenism, and abnormal glucose and/or insulin levels underwent a 3-month treatment with contraceptive pills and metformin. Family history was taken, and physical and ultrasound examinations were performed. Serum levels of glucose, insulin, lipoproteins, lipids, and reproductive hormones were measured before and after treatment. RESULTS The serum levels of low-density lipoprotein, total cholesterol, apolipoprotein B, and triglycerides were higher in the patients with a family history of the studied symptoms than in those with no such family history. After treatment, changes in testosterone and glucose levels, glucose area under curve, and homeostasis model assessment value differed in the 2 groups. CONCLUSION The patients with a family history of PCOS symptoms thought to be inherited were more sensitive to oral contraceptive and metformin treatment.
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8.
[Changes of blood pressure, blood glucose and blood lipids levels after intensive treatment in incipient diabetes II patients].
Zhao, XH, Xu, ZR, Lu, XY, Zhang, Q, Yang, YM
Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences. 2010;(2):198-201
Abstract
OBJECTIVE To evaluate the effect of intensive treatment on the blood sugar, blood lipids and blood pressure levels in incipient diabetes II patients. METHODS One hundred and sixty incipient diabetes patients were allocated into two groups according to chronological order: 80 cases received routine treatment and 80 cases received intensive treatment. Fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1C), blood pressure, blood cholesterol (TC), triglyceride (TG), LDL cholesterol-C (LDL-C), alanine aminotransferase (ALT) and aspertate aminotransferase (AST) were tested before treatment. For intensive treatment group blood pressure, blood sugar and blood lipids were regularly tested, and the therapeutic protocols were adjusted according to the test results until the therapeutic target reached. After six months, HbA1C, blood pressure, TC, LDL-C, ALT and AST were tested again and comparison was made between the two groups. RESULTS There was a significant decrease in TC and LDL-C in the intensive treatment group compared with those in the routine treatment group (P <0.05). CONCLUSION The intensive treatment on the incipient diabetes II patients facilitate the control of the blood lipids and blood sugar.
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Sitagliptin treatment of patients with type 2 diabetes does not affect CD4+ T-cell activation.
White, PC, Chamberlain-Shea, H, de la Morena, MT
Journal of diabetes and its complications. 2010;(3):209-13
Abstract
Dipeptidyl peptidase IV (DPP4) inhibitors have recently become widely used for treating type 2 diabetes, but in meta-analyses are associated with a mildly increased risk of all-cause infections. CD26 is a cell-surface form of DPP4 which can costimulate T-cell proliferation, raising the possibility that DPP4 inhibitors might adversely affect immune function. To address this issue in an observational study, two groups of 20 subjects each were recruited from a private endocrinology practice; one group consisted of type 2 diabetes patients treated for at least 6 months with the DPP4 inhibitor, sitagliptin, whereas patients in the other group had never been treated with this agent. The groups were similar with regard to sex and racial composition, body mass index, hemoglobin A(1c), and use of other medications for diabetes, but the sitagliptin group was slightly older. A blood sample from each patient was analyzed for CD4+ T-cell activation in response to phytohemagglutinin using adenosine triphosphate (ATP)-stimulated bioluminescence. There was not a significant difference in T-cell activation between the treatment groups (median, 419 and 481 ng/ml ATP in the groups that were and were not treated with sitagliptin, respectively). Thus the observed increased rate of infection in diabetic patients treated with sitagliptin cannot be explained by a major effect on T-cell activation. Randomized studies, preferably using several assays of immune function, should be performed to confirm and extend these findings.
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10.
Normal insulin response to short-term intense exercise is abolished in Type 2 diabetic patients treated with gliclazide.
Szewieczek, J, Dulawa, J, Strzałkowska, D, Batko-Szwaczka, A, Hornik, B
Journal of diabetes and its complications. 2009;(6):380-6
Abstract
BACKGROUND Physical activity is an essential component of diabetes management; however, exercise is associated with the risk for metabolic decompensation. The aim of the study was to analyze insulin response to the short-term intense exercise in middle-aged Type 2 diabetic patients treated with gliclazide. MATERIALS AND METHODS Fourteen Type 2 diabetic patients (47.9+/-1.6 years, mean+/-S.E.M.), treated with gliclazide, and 14 healthy controls (45.1+/-1.0 years) were submitted to standard graduated submaximal (90% HR(max)) exercise treadmill testing at 2 h after standardized breakfast. Serum glucose, insulin, proinsulin, C peptide, growth hormone, insulin-like growth factor-1, and cortisol concentrations; and plasma lactate, glucagon, epinephrine, and norepinephrine concentrations were measured during the periexercise period up to the 60th min of the recovery period. RESULTS Significant hemodynamic (heart rate, systolic, and diastolic blood pressure), metabolic (lactate concentration), and hormonal (epinephrine and norepinephrine levels) responses to the exercise were similar in patients and healthy subjects. Glucose, insulin, and proinsulin levels were higher in the diabetic group at the preexercise and at all the next analyzed time points. The insulin concentration increased during the postprandial period in both groups and decreased subsequently during the exercise only in the control group, without concurrent C peptide decline. The C peptide-to-insulin ratio increased during the exercise and decreased immediately postexercise only in the control group. CONCLUSIONS The initial decrease of the insulin serum concentration during short-term intense exercise in normal middle-aged men is primarily related to the increased clearance of the hormone. Normal insulin response to the exercise was abolished in Type 2 diabetic patients treated with gliclazide.