Review of Diabetic Studies最新文献

Background: Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes (T2D). Exercise can reduce the risk factors associated with CVD in T2D patients. However, research evaluating its beneficial effects in these patients has used different measurement protocols and types of exercise, complicating comparison.

Aim: To assess the effects of resistance training (RT) and combined training (CT) on the vascular function of T2D patients.

Methods: A database search (MEDLINE, Scopus, and Web of Science) was performed to identify relevant articles that were published up to August 2017. Only original studies evaluating the effects of RT or CT interventions on vascular function in T2D patients were included. The articles were reviewed independently by at least three reviewers. The Cochrane guidelines were used to assess the methodological quality of the studies. Fourteen studies were finally included. Two studies only used RT and twelve studies used CT as intervention strategy.

Results and conclusions: The results show that resistance training is a useful means for primary treatment of vascular diseases and maintenance of vascular function in T2D patients. However, more studies are necessary to gain full knowledge of the beneficial effects and to identify tailored exercise plans to optimize these benefits. The information provided in this review may help to improve current treatment of vascular diseases in T2D patients and to design future studies.

Background: Abdominal obesity is characterized by low-grade inflammation and plays a central role in the development of type 2 diabetes and cardiovascular diseases. Dietary factors can influence low-grade inflammation and affect adipose tissue function.

Aim: To investigate the separate and combined effects of whey protein and cereal fiber on inflammatory markers and adipose tissue gene expression in abdominal obesity.

Methods: We performed a 12-week, double-blind, randomized controlled dietary intervention in 65 adults with abdominal obesity. The participants were randomized to 4 groups using a 2 × 2 factorial design; they received either 60 g/day of whey protein or maltodextrin in combination with high-fiber wheat bran products (30 g fiber/day) or low-fiber refined wheat products (10 g fiber/day). Plasma concentrations of tumor necrosis factor α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), monocyte chemoattractant protein-1 (MCP-1), interleukin 1 receptor antagonist (IL-1Ra), and adiponectin were measured before and after intervention. Changes in gene expression related to inflammation, insulin signaling, and lipid metabolism were measured in abdominal subcutaneous adipose tissue.

Results: After intervention, TNF-α was reduced for both high-fiber groups compared with baseline, but did not significantly differ from the low-fiber groups. There were no differences in fasting or postprandial inflammatory markers between the groups. The relative gene expression of ribosomal protein S6 kinase B1 (S6K1) was increased after whey protein compared with maltodextrin consumption.

Conclusion: Intake of whey protein in combination with high cereal fiber content did not differentially affect low-grade inflammation or adipose tissue gene expression compared with maltodextrin and low fiber content in individuals with abdominal obesity.

Diabetic foot complications now represent the 10th leading cause of disease burden and disability. Wound healing is impaired, leading to chronic ulceration. Local high oxygen concentration is required by the metabolically active cells in the wound, which may render the region hypoxic, even in the absence of peripheral arterial disease. Therefore, the contribution of hyperbaric oxygen to improved healing rates has been extensively investigated. More recent developments include products delivering topical oxygen therapy (TOT) directly at the wound site, either by continuous delivery or by pressurized systems. A very recent systematic review has found that TOT increases wound healing rates in chronic, less severe diabetic foot ulcers (DFUs), and it promotes high rates of healing in more severe ulcers. Thus, TOT appears to be very promising to improve healing in DFUs. We now need more experience regarding its therapeutic place in the algorithm of DFU management and in relation to optimal patient selection.

Objective: The aim was to identify the level of knowledge, attitude, and practice (KAP) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) at Sigatoka Subdivisional Hospital (SSH) in 2018 since no studies have been done on this issue so far in Fiji.

Methods: A quantitative, cross-sectional study including 225 patients was carried out July 1, 2018, through August 31, 2018, using a validated self-structured questionnaire. Fijians, aged 30 years or above, with confirmed T2D and CKD who were attending the Special Outpatient Department (SOPD) at SSH, were included in the study using a purposive sampling method to identify eligible participants. Data was gathered by a questionnaire that covered questions related to each aspect of KAP.

Results: The relation of native Fijians (i-Taukei) to Fijians of Indian descent (FID) was approximately 1:1. The majority of participants had high levels of knowledge, attitude, and practice (61.8%, 63.6%, and 88.4%, respectively). However, a few areas of low knowledge were evident, such as the relation between high blood pressure and renal status in people with diabetes and the need for renal transplant in end-stage kidney disease (ESKD) abroad. Low attitude was apparent for the impact and management of diabetic kidney disease (DKD). Low practice was evident regarding clinic attendance, self-monitoring, and opting for non-medical treatment.

Conclusions: The majority of T2D patients with CKD had a high level of knowledge, but weaknesses were observed in the self-management of CKD and clinic attendance. This information should be considered by clinicians and policy-makers to improve management and treatment of CKD in T2D.

Objective: This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes.

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I² statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests.

Results: Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels.

Conclusions: Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.

Objectives: The aim of this study was to investigate the spatial variation of diabetes in relation to the geographical variability of socio-environmental characteristics in the urban districts of Athens.

Methods: A sample of 2,445 individuals from the greater area of Athens was randomly enrolled in the ATTICA study between 2001 and 2002. Diabetes was defined according to American Diabetes Association criteria. Geographical and statistical analyses were applied to examine the relationship between diabetes prevalence and factors related to education, economic status, population density, immigrant status, and availability of urban green areas. Diabetes prevalence and socio-environmental factor mapping was based on the Geographic Information Systems (GIS) technology. Variograms and spatial quasi-Poisson regression analysis evaluated the associations of diabetes with the socio-environmental variables at the municipal level.

Results: According to the geographical analysis and mapping, the highest proportions of people with diabetes were found in the West sector and in one district of the East and South sector each. Regression analysis revealed that the proportion of inhabitants with higher education is negatively correlated with diabetes prevalence in the regional areas of Athens.

Conclusions: The study revealed that socio-environmental status in residential areas, especially educational and economic levels, is correlated with diabetes prevalence at the aggregate level. These correlations may reflect socio-economic segregation patterns at the district level, and different prevalence rates of diabetes among individuals with higher income and educational levels.

Objectives: The aim of this study was to explore the differences in OXT levels in metabolic syndrome (MetS) subjects, newly diagnosed type 2 diabetes mellitus (T2D), and prediabetes subjects vs. MetS subjects without glucose intolerance (non-diabetic MetS). It was also intended to determine the relationship between plasma OXT levels and inflammatory markers in those subjects.

Methods: Along with 45 lean and normoglycemic controls, a total of 190 MetS subjects (61 men, 129 women) were enrolled. Colorimetric enzymatic assays of the following components were performed: plasma OXT, high-sensitivity C-reactive protein (hs-CRP), macrophage chemoattractant protein 1 (MCP-1), plasminogen activator inhibitor 1 (PAI-1), matrix metalloproteinase 9 (MMP-9), resistin, adiponectin, leptin, macrophage migration inhibitory factor (MIF), tumor necrosis factor α (TNF-α), thrompospondin 1 (TSP-1), interleukin 10 (IL-10), interleukin 6 (IL-6), and glucagon.

Results: hsCRP, PAI-1, resistin, leptin-to-adiponection-ratio (LAR), TNF-α, TSP-1, and MIF were significantly higher in both MetS groups (prediabetic and T2DM) than in MetS-only subjects. Leptin and MMP-9 were significantly higher in the MetS-T2DM group (but not in MetS-prediabetics) vs. MetS-only subjects. Conversely adiponectin, OXT, MCP-1, and IL-10 were significantly lower in both MetS groups (prediabetic and T2DM) than in MetS-only subjects. There was no marked discrepancy in either glucagon or IL-6 levels among the three MetS groups. In the entire MetS study population, OXT correlated substantially and proportionally with MCP-1, IL-10, and IL-6; it correlated negatively with HbA1c, fasting plasma glucose (FPG), PAI-1, MMP-9, TNF-α, TSP-1, resistin, adiponectin, leptin, LAR, and MIF. No association could be observed between OXT and glucagon.

Conclusions: OXT may be a substantial surrogate predictive/prognostic tool and putative pharmacotherapeutic target in metabolic anomalies and related disorders.