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1.
Changes in fasting patterns during Ramadan, and associated clinical outcomes in adults with type 2 diabetes: A narrative review of epidemiological studies over the last 20 years.
Hassanein, MM, Hanif, W, Malek, R, Jabbar, A
Diabetes research and clinical practice. 2021;:108584
Abstract
Although religious guidance exempts some Muslims with type 2 diabetes from fasting during Ramadan, many choose to fast. The associated risks for fasting adults with diabetes includes hypoglycemia, hyperglycemia, ketoacidosis, dehydration, and thrombosis. Thus, it is important that healthcare professionals support individuals who choose to fast to minimize risks. We reviewed three epidemiologic studies to understand how fasting patterns during Ramadan and associated clinical outcomes in adults with type 2 diabetes have evolved over two decades (2000-2020). Over a period of time people with diabetes choosing to fast during Ramadan are displaying increasingly complex profiles in terms of their diabetes, with increased disease duration, greater body mass index, and elevated pre-Ramadan mean glycated hemoglobin levels. Despite this, in the most recent study, >85% of adults with type 2 diabetes still chose to fast. Increased risk of hypoglycemia remains a major concern despite some improvements over time, which could be attributable to enhanced education programs, and changes in treatment type and/or dose prior to and/or during Ramadan. Our review highlights the evolution in fasting patterns over two decades and serves as an update for healthcare professionals to provide appropriate guidance to ensure that Ramadan fasting is safe and rewarding.
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2.
Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia.
Chávez-Reyes, J, Escárcega-González, CE, Chavira-Suárez, E, León-Buitimea, A, Vázquez-León, P, Morones-Ramírez, JR, Villalón, CM, Quintanar-Stephano, A, Marichal-Cancino, BA
Frontiers in public health. 2021;:559595
Abstract
Uncontrolled diabetes results in several metabolic alterations including hyperglycemia. Indeed, several preclinical and clinical studies have suggested that this condition may induce susceptibility and the development of more aggressive infectious diseases, especially those caused by some bacteria (including Chlamydophila pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae, among others) and viruses [such as coronavirus 2 (CoV2), Influenza A virus, Hepatitis B, etc.]. Although the precise mechanisms that link glycemia to the exacerbated infections remain elusive, hyperglycemia is known to induce a wide array of changes in the immune system activity, including alterations in: (i) the microenvironment of immune cells (e.g., pH, blood viscosity and other biochemical parameters); (ii) the supply of energy to infectious bacteria; (iii) the inflammatory response; and (iv) oxidative stress as a result of bacterial proliferative metabolism. Consistent with this evidence, some bacterial infections are typical (and/or have a worse prognosis) in patients with hypercaloric diets and a stressful lifestyle (conditions that promote hyperglycemic episodes). On this basis, the present review is particularly focused on: (i) the role of diabetes in the development of some bacterial and viral infections by analyzing preclinical and clinical findings; (ii) discussing the possible mechanisms by which hyperglycemia may increase the susceptibility for developing infections; and (iii) further understanding the impact of hyperglycemia on the immune system.
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3.
Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review.
Alakkas, Z, Alzaedi, OA, Somannavar, SS, Alfaifi, A
The American journal of case reports. 2020;:e923372
Abstract
BACKGROUND Steroids are used as anti-inflammatory agents, administered for a variety of medical conditions, either as short- or long-term treatment. Steroid use is associated with many adverse effects, including hyperglycemia, but ketoacidosis is rare. CASE REPORT We present the case of a 53-year-old woman who developed diabetic ketoacidosis after administration of methylprednisolone during treatment of immune thrombocytopenic purpura. She did not have diabetes or a family history of diabetes. Steroid-induced hyperglycemia with insulin resistance, lipolysis, and ketogenesis occurred and were likely to have precipitated the ketoacidosis. Blood glucose, blood gases, and urine test results were diagnostic for ketoacidosis. CONCLUSIONS The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, especially in patients who have risk factors for diabetes mellitus including obesity and long-term use of steroids, so that early identification of diabetic ketoacidosis can prevent further morbidity and mortality in chronic patients.
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4.
Clinical manifestation of non-ketotic hyperglycemia chorea: A case report and literature review.
Wang, W, Tang, X, Feng, H, Sun, F, Liu, L, Rajah, GB, Yu, F
Medicine. 2020;(22):e19801
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Abstract
INTRODUCTION Chorea is considered a special complication of diabetes mellitus. Here we report a case of chorea associated with non-ketotic hyperglycemia (NKH). PATIENT CONCERNS The patient was a 79-year-old Asian woman. She had a history of type 2 diabetes mellitus more than 30 years, but with a poor control of blood sugar. She complained of acute onset of right limb involuntary activities, and being admitted to neurology department. DIAGNOSIS The patient was then diagnosed with NKH chorea. INTERVENTIONS Intravenous infusion of insulin was given to reduce blood glucose. Haloperidol was used to control motor symptoms. OUTCOMES Her symptoms improved quickly after treatment. In the past year, the patient's blood sugar was well controlled and her chorea did not recur. LESSONS If there are sudden abnormal movements in patients, in addition to thinking of chorea, hepatolenticular degeneration and other diseases, we should also pay attention to blood sugar, especially in diabetic patients with poor blood sugar control and negative ketone, we should consider the possibility of NKK chorea. CONCLUSIONS NKH chorea is a special complication of diabetes.
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5.
Glycemic Variability and CNS Inflammation: Reviewing the Connection.
Watt, C, Sanchez-Rangel, E, Hwang, JJ
Nutrients. 2020;(12)
Abstract
Glucose is the primary energy source for the brain, and exposure to both high and low levels of glucose has been associated with numerous adverse central nervous system (CNS) outcomes. While a large body of work has highlighted the impact of hyperglycemia on peripheral and central measures of oxidative stress, cognitive deficits, and vascular complications in Type 1 and Type 2 diabetes, there is growing evidence that glycemic variability significantly drives increased oxidative stress, leading to neuroinflammation and cognitive dysfunction. In this review, the latest data on the impact of glycemic variability on brain function and neuroinflammation will be presented. Because high levels of oxidative stress have been linked to dysfunction of the blood-brain barrier (BBB), special emphasis will be placed on studies investigating the impact of glycemic variability on endothelial and vascular inflammation. The latest clinical and preclinical/in vitro data will be reviewed, and clinical/therapeutic implications will be discussed.
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The Role of Dietary Antioxidants on Oxidative Stress in Diabetic Nephropathy.
Gerardo Yanowsky-Escatell, F, Andrade-Sierra, J, Pazarín-Villaseñor, L, Santana-Arciniega, C, De Jesús Torres-Vázquez, E, Samuel Chávez-Iñiguez, J, Ángel Zambrano-Velarde, M, Martín Preciado-Figueroa, F
Iranian journal of kidney diseases. 2020;(2):81-94
Abstract
Diabetic nephropathy (ND) is the leading cause of end-stage renal disease and oxidative stress (OS) has been recognized as a key factor in the pathogenesis and progression. Hyperglycemia, reactive oxygen species, advanced glycation end products, arterial pressure, insulin resistance, decrease in nitric oxide, inflammatory markers, and cytokines, among others; are involved in the presence of OS on ND. This revision focus on diverse studies in experimental and human models with diabetes and DN that has been demonstrated beneficial effects of different dietary antioxidant as resveratrol, curcumin, selenium, soy, catechins, α-lipoic acid, coenzyme Q10, omega-3 fatty acids, zinc, vitamins E and C, on OS and the capacity for antioxidant response. Therefore, this interventions could have a positive clinical impact on DN.
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7.
Biologic excipients: Importance of clinical awareness of inactive ingredients.
Ionova, Y, Wilson, L
PloS one. 2020;(6):e0235076
Abstract
Due to the complexity and fragility of biological drug products, several challenges exist in their formulation development. Excipients are added to increase product stability, maintain tonicity, and facilitate drug delivery. The potential implications of these additive substances merit clinical consideration. We assessed the safety risk of excipients on the basis of their type and variability through an assessment framework, which quantifies excipient complexity in 230 biological formulations, and identifies excipient-related adverse events through published case reports. A biologic on average contained 4.45 excipients, half of that found in oral medications. The frequency distribution was heavily skewed towards the most commonly occurring excipients: water (40.4%), sodium chloride (38.3%), polysorbate 80 (28.7%), sucrose (24.4%), and mannitol (20.9%), with 44.4% of formulations not listing the concentration of the most commonly occurring inactive ingredients. A literature search revealed only 17 case reports of excipient-related adverse events, suggesting the need for more clarity for clinicians on the safety of chemical additives. These cases included injection site reactions, anaphylaxis, hyperglycemia, and acute renal failure. With the expansion of the biopharmaceutical market, it is important to consider the safety data of biologic excipients, so that therapy can be tailored appropriately for a specific patient.
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8.
The Interplay between Diabetes and Alzheimer's Disease-In the Hunt for Biomarkers.
Kubis-Kubiak, A, Dyba, A, Piwowar, A
International journal of molecular sciences. 2020;(8)
Abstract
The brain is an organ in which energy metabolism occurs most intensively and glucose is an essential and dominant energy substrate. There have been many studies in recent years suggesting a close relationship between type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) as they have many pathophysiological features in common. The condition of hyperglycemia exposes brain cells to the detrimental effects of glucose, increasing protein glycation and is the cause of different non-psychiatric complications. Numerous observational studies show that not only hyperglycemia but also blood glucose levels near lower fasting limits (72 to 99 mg/dL) increase the incidence of AD, regardless of whether T2DM will develop in the future. As the comorbidity of these diseases and earlier development of AD in T2DM sufferers exist, new AD biomarkers are being sought for etiopathogenetic changes associated with early neurodegenerative processes as a result of carbohydrate disorders. The S100B protein seem to be interesting in this respect as it may be a potential candidate, especially important in early diagnostics of these diseases, given that it plays a role in both carbohydrate metabolism disorders and neurodegenerative processes. It is therefore necessary to clarify the relationship between the concentration of the S100B protein and glucose and insulin levels. This paper draws attention to a valuable research objective that may in the future contribute to a better diagnosis of early neurodegenerative changes, in particular in subjects with T2DM and may be a good basis for planning experiments related to this issue as well as a more detailed explanation of the relationship between the neuropathological disturbances and changes of glucose and insulin concentrations in the brain.
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9.
How Important Is Eating Rate in the Physiological Response to Food Intake, Control of Body Weight, and Glycemia?
Argyrakopoulou, G, Simati, S, Dimitriadis, G, Kokkinos, A
Nutrients. 2020;(6)
Abstract
The link between eating rate and energy intake has long been a matter of extensive research. A better understanding of the effect of food intake speed on body weight and glycemia in the long term could serve as a means to prevent weight gain and/or dysglycemia. Whether a fast eating rate plays an important role in increased energy intake and body weight depends on various factors related to the studied food such as texture, viscosity and taste, but seems to be also influenced by the habitual characteristics of the studied subjects as well. Hunger and satiety quantified via test meals in acute experiments with subsequent energy intake measurements and their association with anorexigenic and orexigenic regulating peptides provide further insight to the complicated pathogenesis of obesity. The present review examines data from the abundant literature on the subject of eating rate, and highlights the main findings in people with normal weight, obesity, and type 2 diabetes, with the aim of clarifying the association between rate of food intake and hunger, satiety, glycemia, and energy intake in the short and long term.
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10.
Glycemic Index (GI) or Glycemic Load (GL) and Dietary Interventions for Optimizing Postprandial Hyperglycemia in Patients with T2 Diabetes: A Review.
Vlachos, D, Malisova, S, Lindberg, FA, Karaniki, G
Nutrients. 2020;(6)
Abstract
UNLABELLED The increasing prevalence of type 2 diabetes (T2D) worldwide calls for effective approaches to its management. Strategies for diabetes have generally focused on optimizing overall glycemic control as assessed by glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) values. However, since 2001, the American Diabetes Association has established postprandial glucose (PPG) as an independent contributor to both HbA1c and diabetes complications, and increasing evidence suggests that all three glycemic parameters of HbA1c, FPG, and postprandial glucose (PPG) are independently important. OBJECTIVES The objective of this review was to comprehensively summarize the literature on the effects of nutritional strategies incorporating glycemic index (GI)/glycemic load (GL) on the postprandial hyperglycemia in people with T2D, as well as to provide recommendations for effective dietary strategies addressing both the dietary glycemic index and load in clinical practice. DESIGN An advanced Pubmed search was conducted. A total of 10 randomized controlled studies met the inclusion criteria. Six studies compared low-GI with higher GI meals, three included studies that compared reduced carbohydrate content with higher carbohydrate content, and one study compared meals of low-GI (with high or low fiber) with meals of higher GI (with high or low fiber). RESULTS Most of the clinical trials resulted in significant improvement (p < 0.05) of postprandial hyperglycemia. Conclusions: Either reducing the amount of carbohydrate in a meal or increasing consumption of soluble fiber has a favorable effect on postprandial glucose excursions.