Pub Date : 2022-08-16DOI: 10.3390/diabetology3030035
Alexandre A. Vetcher, Kirill V Zhukov, Bagrat A. Gasparyan, Alexander Y. Shishonin
We demonstrate that the recovery of cervical vertebral arterial blood flow access to the rhomboid fossa causes the restoration of HbA1c level for the patients with pre-diabetic (pre-DM) condition. This observation is in good agreement with the consideration of the human body as a dissipative structure. Such consideration is the focus of the recently announced centralized aerobic-anaerobic energy balance compensation (CAAEBC) theory. According to the theory, observed connections between high blood pressure (HBP) and the lifted level of HbA1c can be hypothetically linked through the restrictions of blood flow access to rhomboid fossa, causing the delivery of incorrect information of blood oxygen availability. Below we provide detailed information of how in this case CAAEBC theory explains the very initiation of multiple chronic diseases, starting with type 2 Diabetes Mellitus (DM).
{"title":"Hypothetical Reason for the Restoration of HbA1c Level for Pre-Diabetic Patients through the Recovery of Arterial Blood Flow Access to Rhomboid Fossa","authors":"Alexandre A. Vetcher, Kirill V Zhukov, Bagrat A. Gasparyan, Alexander Y. Shishonin","doi":"10.3390/diabetology3030035","DOIUrl":"https://doi.org/10.3390/diabetology3030035","url":null,"abstract":"We demonstrate that the recovery of cervical vertebral arterial blood flow access to the rhomboid fossa causes the restoration of HbA1c level for the patients with pre-diabetic (pre-DM) condition. This observation is in good agreement with the consideration of the human body as a dissipative structure. Such consideration is the focus of the recently announced centralized aerobic-anaerobic energy balance compensation (CAAEBC) theory. According to the theory, observed connections between high blood pressure (HBP) and the lifted level of HbA1c can be hypothetically linked through the restrictions of blood flow access to rhomboid fossa, causing the delivery of incorrect information of blood oxygen availability. Below we provide detailed information of how in this case CAAEBC theory explains the very initiation of multiple chronic diseases, starting with type 2 Diabetes Mellitus (DM).","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"134 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77385899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-11DOI: 10.3390/diabetology3030034
G. Seghieri, F. Franconi, I. Campesi
Type 2 diabetes mellitus is a widespread and a chronic disease associated with micro- and macrovascular complications and is a well-established risk factor for cardiovascular disease, which are among the most important causes of death in diabetic patients. This disease is strongly affected by sex and gender: sex-gender differences have been reported to affect diabetes epidemiology and risk factors, as well as cardiovascular complications associated with diabetes. This suggests the need for different therapeutic approaches for the management of diabetes-associated complications in men and women. In this review, we describe the known sex-gender differences in diabetic men and women and discuss the therapeutic approaches for their management. The data reported in this review show that a sex-gender approach in medicine is mandatory to maximize the scientific rigor and value of the research. Sex-gender studies need interdisciplinarity and intersectionality aimed at offering the most appropriate care to each person.
{"title":"Why We Need Sex-Gender Medicine: The Striking Example of Type 2 Diabetes","authors":"G. Seghieri, F. Franconi, I. Campesi","doi":"10.3390/diabetology3030034","DOIUrl":"https://doi.org/10.3390/diabetology3030034","url":null,"abstract":"Type 2 diabetes mellitus is a widespread and a chronic disease associated with micro- and macrovascular complications and is a well-established risk factor for cardiovascular disease, which are among the most important causes of death in diabetic patients. This disease is strongly affected by sex and gender: sex-gender differences have been reported to affect diabetes epidemiology and risk factors, as well as cardiovascular complications associated with diabetes. This suggests the need for different therapeutic approaches for the management of diabetes-associated complications in men and women. In this review, we describe the known sex-gender differences in diabetic men and women and discuss the therapeutic approaches for their management. The data reported in this review show that a sex-gender approach in medicine is mandatory to maximize the scientific rigor and value of the research. Sex-gender studies need interdisciplinarity and intersectionality aimed at offering the most appropriate care to each person.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"119 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77431692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-08DOI: 10.3390/diabetology3030033
D. Sajkov, Bliegh Mupunga, J. Bowden, Christopher Langton, N. Petrovsky
Obstructive sleep apnoea (OSA) and type 2 DM mellitus (T2DM) share obesity as a major risk factor. Furthermore, these conditions share overlapping mechanisms including inflammation, activation of the autonomic nervous system, and hypoxia-linked endocrinopathy. Hence, the pathogenesis of the two conditions may be more closely related than previously recognised. This raises the question of whether treatment of OSA might assist resolution of obesity and/or T2DM. Here, we present a narrative review of the literature to identify clinical and scientific data on the relationship between obstructive sleep apnoea and T2DM control. We found there is a paucity of adequately powered well-controlled clinical trials to directly test for a causal association. While routine screening of all T2DM patients with polysomnography cannot currently be justified, given the high prevalence of sleep disordered breathing in the overweight/obese population, all T2DM patients should at a minimum have a clinical assessment of potential obstructive sleep apnoea risk as part of their routine clinical care. In particular, screening questionnaires can be used to identify T2DM subjects at higher risk of OSA for consideration of formal polysomnography studies. Due to morbid obesity being a common feature in both T2DM and OSA, polysomnography should be considered as a screening tool in such high-risk individuals.
{"title":"Narrative Review: Obesity, Type 2 DM and Obstructive Sleep Apnoea—Common Bedfellows","authors":"D. Sajkov, Bliegh Mupunga, J. Bowden, Christopher Langton, N. Petrovsky","doi":"10.3390/diabetology3030033","DOIUrl":"https://doi.org/10.3390/diabetology3030033","url":null,"abstract":"Obstructive sleep apnoea (OSA) and type 2 DM mellitus (T2DM) share obesity as a major risk factor. Furthermore, these conditions share overlapping mechanisms including inflammation, activation of the autonomic nervous system, and hypoxia-linked endocrinopathy. Hence, the pathogenesis of the two conditions may be more closely related than previously recognised. This raises the question of whether treatment of OSA might assist resolution of obesity and/or T2DM. Here, we present a narrative review of the literature to identify clinical and scientific data on the relationship between obstructive sleep apnoea and T2DM control. We found there is a paucity of adequately powered well-controlled clinical trials to directly test for a causal association. While routine screening of all T2DM patients with polysomnography cannot currently be justified, given the high prevalence of sleep disordered breathing in the overweight/obese population, all T2DM patients should at a minimum have a clinical assessment of potential obstructive sleep apnoea risk as part of their routine clinical care. In particular, screening questionnaires can be used to identify T2DM subjects at higher risk of OSA for consideration of formal polysomnography studies. Due to morbid obesity being a common feature in both T2DM and OSA, polysomnography should be considered as a screening tool in such high-risk individuals.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82647754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-28DOI: 10.3390/diabetology3030032
Gagandeep Mann, M. Riddell, O. Adegoke
Insulin signaling plays a key role in glucose uptake, glycogen synthesis, and protein and lipid synthesis. In insulin-resistant states like obesity and type 2 diabetes mellitus, these processes are dysregulated. Regular physical exercise is a potential therapeutic strategy against insulin resistance, as an acute bout of exercise increases glucose disposal during the activity and for hours into recovery. Chronic exercise increases the activation of proteins involved in insulin signaling and increases glucose transport, even in insulin resistant states. Here, we will focus on the effect of acute exercise on insulin signaling and protein kinase B (Akt) pathways. Activation of proximal proteins involved in insulin signaling (insulin receptor, insulin receptor substrate-1 (IRS-1), phosphoinoside-3 kinase (PI3K)) are unchanged in response to acute exercise/contraction, while activation of Akt and of its substrates, TBC1 domain family 1 (TBC1D1), and TBC domain family 4 (TBC1D4) increases in response to such exercise/contraction. A wide array of Akt substrates is also regulated by exercise. Additionally, AMP-activated protein kinase (AMPK) seems to be a main mediator of the benefits of exercise on skeletal muscle. Questions persist on how mTORC1 and AMPK, two opposing regulators, are both upregulated after an acute bout of exercise.
{"title":"Effects of Acute Muscle Contraction on the Key Molecules in Insulin and Akt Signaling in Skeletal Muscle in Health and in Insulin Resistant States","authors":"Gagandeep Mann, M. Riddell, O. Adegoke","doi":"10.3390/diabetology3030032","DOIUrl":"https://doi.org/10.3390/diabetology3030032","url":null,"abstract":"Insulin signaling plays a key role in glucose uptake, glycogen synthesis, and protein and lipid synthesis. In insulin-resistant states like obesity and type 2 diabetes mellitus, these processes are dysregulated. Regular physical exercise is a potential therapeutic strategy against insulin resistance, as an acute bout of exercise increases glucose disposal during the activity and for hours into recovery. Chronic exercise increases the activation of proteins involved in insulin signaling and increases glucose transport, even in insulin resistant states. Here, we will focus on the effect of acute exercise on insulin signaling and protein kinase B (Akt) pathways. Activation of proximal proteins involved in insulin signaling (insulin receptor, insulin receptor substrate-1 (IRS-1), phosphoinoside-3 kinase (PI3K)) are unchanged in response to acute exercise/contraction, while activation of Akt and of its substrates, TBC1 domain family 1 (TBC1D1), and TBC domain family 4 (TBC1D4) increases in response to such exercise/contraction. A wide array of Akt substrates is also regulated by exercise. Additionally, AMP-activated protein kinase (AMPK) seems to be a main mediator of the benefits of exercise on skeletal muscle. Questions persist on how mTORC1 and AMPK, two opposing regulators, are both upregulated after an acute bout of exercise.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78020312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-06DOI: 10.3390/diabetology3030031
R. Ansari, M. Harris, H. Hosseinzadeh, N. Zwar
Objective: The main aim of this study was to implement the Chronic Care Model (CCM) for the self-management of type 2 diabetes in primary health care settings of rural areas of Pakistan and identify its effectiveness and develop strategies for overcoming its challenges. The two core elements of the Chronic Care Model: patient Self-Management Support (SMS) and Delivery System Design (DSD), were implemented to improve the quality of life and risk behaviour of type 2 diabetes patients in the middle-aged population of rural Pakistan. Methods: Thirty patients with type 2 diabetes and 20 healthcare professionals were included in this study consisting of 10 general practitioners and 10 nurses recruited from various clinics (medical centres) of Al-Rehman Hospital in Abbottabad, Pakistan. The quantitative content analysis method was used to identify the frequency of the most recurring statements. A t-test was performed to see the mean difference of HbA1c at baseline after 3-months and 6-months follow-up between male and female patients with diabetes. The hypothesis was tested to identify that diabetes self-management has a gendered dimension in rural areas of Pakistan. Results: The quantitative analysis demonstrated that diabetes self-management has a gendered dimension in the rural areas of Pakistan as the mean difference of HbA1c after a 6-month intervention of the two components of the chronic care model between male and female patients of diabetes was 0.83 (p = 0.039) with 95% CI (−0.05; −1.61). The mean difference in BMI after the intervention of 6 months between males and females was significant (p < 0.05). The mean difference was 4.97 kg/m2, p = 0.040 with 95% CI (−0.24; −9.69). The results have shown that the two components of CCM were effective and improved clinical outcomes for diabetes patients of the rural areas of Pakistan. Conclusions: The application of the two Chronic Care Model’s components provided a viable structure for diabetes self-management education and assistance. As a result, developing systems that incorporate long-term diabetes self-management education has an effect on the health care system’s outcomes.
目的:本研究的主要目的是在巴基斯坦农村地区的初级卫生保健机构实施慢性护理模式(CCM)进行2型糖尿病的自我管理，并确定其有效性并制定克服其挑战的策略。实施慢性护理模式的两个核心要素:患者自我管理支持(SMS)和交付系统设计(DSD)，以改善巴基斯坦农村中年2型糖尿病患者的生活质量和风险行为。方法:从巴基斯坦阿伯塔巴德Al-Rehman医院的各个诊所(医疗中心)招募了30例2型糖尿病患者和20名医护人员，其中包括10名全科医生和10名护士。定量内容分析方法用于确定最常见语句的频率。采用t检验观察男性和女性糖尿病患者随访3个月和6个月后基线HbA1c的平均差异。对这一假设进行了检验，以确定巴基斯坦农村地区糖尿病自我管理具有性别维度。结果:定量分析表明，在巴基斯坦农村地区，糖尿病自我管理存在性别维度，在慢性护理模式的两个组成部分干预6个月后，男性和女性糖尿病患者的HbA1c平均差异为0.83 (p = 0.039)， 95% CI (- 0.05;−1.61)。干预6个月后，男女BMI均值差异有统计学意义(p < 0.05)。平均差异为4.97 kg/m2, p = 0.040, 95% CI (- 0.24;−9.69)。结果表明，CCM的两个组成部分是有效的，改善了巴基斯坦农村地区糖尿病患者的临床结果。结论:慢性护理模型的两个组成部分的应用为糖尿病自我管理教育和援助提供了一个可行的结构。因此，发展纳入长期糖尿病自我管理教育的系统对卫生保健系统的结果有影响。
{"title":"Implementation of Chronic Care Model for Diabetes Self-Management: A Quantitative Analysis","authors":"R. Ansari, M. Harris, H. Hosseinzadeh, N. Zwar","doi":"10.3390/diabetology3030031","DOIUrl":"https://doi.org/10.3390/diabetology3030031","url":null,"abstract":"Objective: The main aim of this study was to implement the Chronic Care Model (CCM) for the self-management of type 2 diabetes in primary health care settings of rural areas of Pakistan and identify its effectiveness and develop strategies for overcoming its challenges. The two core elements of the Chronic Care Model: patient Self-Management Support (SMS) and Delivery System Design (DSD), were implemented to improve the quality of life and risk behaviour of type 2 diabetes patients in the middle-aged population of rural Pakistan. Methods: Thirty patients with type 2 diabetes and 20 healthcare professionals were included in this study consisting of 10 general practitioners and 10 nurses recruited from various clinics (medical centres) of Al-Rehman Hospital in Abbottabad, Pakistan. The quantitative content analysis method was used to identify the frequency of the most recurring statements. A t-test was performed to see the mean difference of HbA1c at baseline after 3-months and 6-months follow-up between male and female patients with diabetes. The hypothesis was tested to identify that diabetes self-management has a gendered dimension in rural areas of Pakistan. Results: The quantitative analysis demonstrated that diabetes self-management has a gendered dimension in the rural areas of Pakistan as the mean difference of HbA1c after a 6-month intervention of the two components of the chronic care model between male and female patients of diabetes was 0.83 (p = 0.039) with 95% CI (−0.05; −1.61). The mean difference in BMI after the intervention of 6 months between males and females was significant (p < 0.05). The mean difference was 4.97 kg/m2, p = 0.040 with 95% CI (−0.24; −9.69). The results have shown that the two components of CCM were effective and improved clinical outcomes for diabetes patients of the rural areas of Pakistan. Conclusions: The application of the two Chronic Care Model’s components provided a viable structure for diabetes self-management education and assistance. As a result, developing systems that incorporate long-term diabetes self-management education has an effect on the health care system’s outcomes.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88787683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-06DOI: 10.3390/diabetology3030030
Paul Zimmermann, F. Aberer, M. Eckstein, Sandra Haupt, Maximilian P. Erlmann, O. Moser
Autoimmune pancreatic β-cell loss and destruction play a key role in the pathogenesis and development of type 1 diabetes, with a prospective increased risk for developing micro- and macrovascular complications. In this regard, orally administrated verapamil, a calcium channel antagonist, usually intended for use as an anti-arrhythmic drug, has previously shown potential beneficial effects on β-cell preservation in new-onset type 1 diabetes. Furthermore, observational data suggest a reduced risk of type 2 diabetes development. The underlying pathophysiological mechanisms are not well investigated and remain widely inconclusive. The aim of this narrative review was to detail the role of verapamil in promoting endogenous β-cell function, potentially eligible for early treatment in type 1 diabetes, and to summarize existing evidence on its effect on glycemia in individuals with type 2 diabetes.
{"title":"Verapamil and Its Role in Diabetes","authors":"Paul Zimmermann, F. Aberer, M. Eckstein, Sandra Haupt, Maximilian P. Erlmann, O. Moser","doi":"10.3390/diabetology3030030","DOIUrl":"https://doi.org/10.3390/diabetology3030030","url":null,"abstract":"Autoimmune pancreatic β-cell loss and destruction play a key role in the pathogenesis and development of type 1 diabetes, with a prospective increased risk for developing micro- and macrovascular complications. In this regard, orally administrated verapamil, a calcium channel antagonist, usually intended for use as an anti-arrhythmic drug, has previously shown potential beneficial effects on β-cell preservation in new-onset type 1 diabetes. Furthermore, observational data suggest a reduced risk of type 2 diabetes development. The underlying pathophysiological mechanisms are not well investigated and remain widely inconclusive. The aim of this narrative review was to detail the role of verapamil in promoting endogenous β-cell function, potentially eligible for early treatment in type 1 diabetes, and to summarize existing evidence on its effect on glycemia in individuals with type 2 diabetes.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89503940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-21DOI: 10.3390/diabetology3030029
Tat-kei Lai, S. Cincotti, Cristian Pisu
Several factors affect the relationship between a diabetic patient and a healthcare worker. Among these, there is the well-being of healthcare workers and how they perceive their work environment, especially in the context of the presence or absence of gender inequality. To show the importance of these aspects, a selected sample of healthcare workers who were exposed daily to people (mainly diabetic patients) within the working environment were interviewed. The different opinions of the interviewees show that in an environment where factors that negatively affected their work and personal well-being were minimized, healthcare workers were able to fully express their potential. They expressed great satisfaction with their work involving daily contact with patients, while achieving the type of patient–healthcare worker relationship model desired for a better management of diabetic patients’ care.
{"title":"Gender Inequality and Well-Being of Healthcare Workers in Diabetology: A Pilot Study","authors":"Tat-kei Lai, S. Cincotti, Cristian Pisu","doi":"10.3390/diabetology3030029","DOIUrl":"https://doi.org/10.3390/diabetology3030029","url":null,"abstract":"Several factors affect the relationship between a diabetic patient and a healthcare worker. Among these, there is the well-being of healthcare workers and how they perceive their work environment, especially in the context of the presence or absence of gender inequality. To show the importance of these aspects, a selected sample of healthcare workers who were exposed daily to people (mainly diabetic patients) within the working environment were interviewed. The different opinions of the interviewees show that in an environment where factors that negatively affected their work and personal well-being were minimized, healthcare workers were able to fully express their potential. They expressed great satisfaction with their work involving daily contact with patients, while achieving the type of patient–healthcare worker relationship model desired for a better management of diabetic patients’ care.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"143 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77444864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-20DOI: 10.3390/diabetology3020027
P. Tatti, Singh Pavandeep
Gender difference in all fields of medicine and biology has recently become a topic of great interest. At present, most studies report gender differences in their secondary analysis; however, this information receives scant attention from clinicians, and is often overwhelmed by press trumpeting the overall main positive results. Furthermore, and more importantly, any statistical evaluation of results obtained without specific and careful planning in the study for the topic of research is probably worthless. There are few studies in animals, but these are not typically useful because of the different biology, pharmacodynamics and pharmacokinetics compared to humans. Type 1 diabetes is a disease where gender difference can be easily evaluated. Irrespective of the cause of the loss of pancreatic beta-cell function, the common denominators of all forms of type 1 diabetes are the absence of circulating insulin and a reduction in peripheral insulin sensitivity leading to exogenous injections being required. Consequently, exogenous insulin infusion, with any of the widely used research tools, such as the insulin–glucose clamp, can be easily used to evaluate gender difference. Female patients with type 1 diabetes have many factors that impact glucose level. For example, the hormones that drive the ovulatory/menstrual cycle and the connected change at the time of the menopause have a role on insulin action; thus, one should expect great research emphasis on this. On the contrary, there is a dearth of data available on this topic, and no pump producer has created a gender-specific insulin infusion profile. Patients are usually approached on the basis of their diagnosis. This review is intended to focus on personalized treatment, more specifically on gender, according to the modern way of thinking.
{"title":"Gender Difference in Type 1 Diabetes: An Underevaluated Dimension of the Disease","authors":"P. Tatti, Singh Pavandeep","doi":"10.3390/diabetology3020027","DOIUrl":"https://doi.org/10.3390/diabetology3020027","url":null,"abstract":"Gender difference in all fields of medicine and biology has recently become a topic of great interest. At present, most studies report gender differences in their secondary analysis; however, this information receives scant attention from clinicians, and is often overwhelmed by press trumpeting the overall main positive results. Furthermore, and more importantly, any statistical evaluation of results obtained without specific and careful planning in the study for the topic of research is probably worthless. There are few studies in animals, but these are not typically useful because of the different biology, pharmacodynamics and pharmacokinetics compared to humans. Type 1 diabetes is a disease where gender difference can be easily evaluated. Irrespective of the cause of the loss of pancreatic beta-cell function, the common denominators of all forms of type 1 diabetes are the absence of circulating insulin and a reduction in peripheral insulin sensitivity leading to exogenous injections being required. Consequently, exogenous insulin infusion, with any of the widely used research tools, such as the insulin–glucose clamp, can be easily used to evaluate gender difference. Female patients with type 1 diabetes have many factors that impact glucose level. For example, the hormones that drive the ovulatory/menstrual cycle and the connected change at the time of the menopause have a role on insulin action; thus, one should expect great research emphasis on this. On the contrary, there is a dearth of data available on this topic, and no pump producer has created a gender-specific insulin infusion profile. Patients are usually approached on the basis of their diagnosis. This review is intended to focus on personalized treatment, more specifically on gender, according to the modern way of thinking.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73553460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-20DOI: 10.3390/diabetology3020028
A. Abdelhafiz, S. Bisht, I. Kovacevic, Daniel Pennells, A. Sinclair
The global prevalence of comorbid diabetes and frailty is increasing due to increasing life expectancy. Frailty appears to be a metabolically heterogeneous condition that may affect the clinical decision making on the most appropriate glycaemic target and the choice of the most suitable hypoglycaemic agent for each individual. The metabolic profile of frailty appears to span across a spectrum that starts at an anorexic malnourished (AM) frail phenotype on one end and a sarcopenic obese (SO) phenotype on the other. The AM phenotype is characterised by significant weight loss and less insulin resistance compared with the SO phenotype, which is characterised by significant obesity and increased insulin resistance. Therefore, due to weight loss, insulin therapy may be considered as an early option in the AM frail phenotype. Insulin-related weight gain and the anabolic properties of insulin may be an advantage to this anorexic phenotype. There is emerging evidence to support the idea that insulin may improve the muscle function of older people with diabetes, although this evidence still needs further confirmation in future large-scale prospective studies. Long acting insulin analogues have a lower risk of hypoglycaemia, comapred to intermediate acting insulins. Additionally their simple once daily regimen makes it more appropriate in frail older patients. Future research on the availability of new once-weekly insulin analogues is appealing. The goals of therapy are to achieve relaxed targets, avoid hypoglycaemia and to focus on the maintenance of quality of life in these vulnerable patients.
{"title":"Insulin in Frail, Older People with Type 2 Diabetes—Low Threshold for Therapy","authors":"A. Abdelhafiz, S. Bisht, I. Kovacevic, Daniel Pennells, A. Sinclair","doi":"10.3390/diabetology3020028","DOIUrl":"https://doi.org/10.3390/diabetology3020028","url":null,"abstract":"The global prevalence of comorbid diabetes and frailty is increasing due to increasing life expectancy. Frailty appears to be a metabolically heterogeneous condition that may affect the clinical decision making on the most appropriate glycaemic target and the choice of the most suitable hypoglycaemic agent for each individual. The metabolic profile of frailty appears to span across a spectrum that starts at an anorexic malnourished (AM) frail phenotype on one end and a sarcopenic obese (SO) phenotype on the other. The AM phenotype is characterised by significant weight loss and less insulin resistance compared with the SO phenotype, which is characterised by significant obesity and increased insulin resistance. Therefore, due to weight loss, insulin therapy may be considered as an early option in the AM frail phenotype. Insulin-related weight gain and the anabolic properties of insulin may be an advantage to this anorexic phenotype. There is emerging evidence to support the idea that insulin may improve the muscle function of older people with diabetes, although this evidence still needs further confirmation in future large-scale prospective studies. Long acting insulin analogues have a lower risk of hypoglycaemia, comapred to intermediate acting insulins. Additionally their simple once daily regimen makes it more appropriate in frail older patients. Future research on the availability of new once-weekly insulin analogues is appealing. The goals of therapy are to achieve relaxed targets, avoid hypoglycaemia and to focus on the maintenance of quality of life in these vulnerable patients.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"164 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80276257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-14DOI: 10.3390/diabetology3020026
M. Kouvari, D. Sergi, N. D'Cunha, A. Bulman, D. Panagiotakos, N. Naumovski
The prevalence of non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), is increasing in parallel with the rising rates of obesity and type 2 diabetes. Approximately one in four adults are diagnosed with liver steatosis globally. NAFLD is associated with insulin resistance, hypertension, obesity, visceral adiposity, and dyslipidaemia. These risk factors are often accompanied by inflammation and oxidative stress, which also play a role in extrahepatic diseases, including conditions related to the central nervous system, such as mild cognitive impairment and Alzheimer’s disease. The number of people living with dementia is approximately 55 million and is estimated to increase to approximately 2 billion people by 2050. Recent studies have found that NAFLD is associated with poorer cognition. The aim of this review was to summarise the findings of hitherto studies that have linked NAFLD with cognition and dementia, as well as to discuss the potential liver–brain pathways.
{"title":"Is Non-Alcoholic Fatty Liver Disease Connected with Cognition? The Complex Interplay between Liver and Brain","authors":"M. Kouvari, D. Sergi, N. D'Cunha, A. Bulman, D. Panagiotakos, N. Naumovski","doi":"10.3390/diabetology3020026","DOIUrl":"https://doi.org/10.3390/diabetology3020026","url":null,"abstract":"The prevalence of non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), is increasing in parallel with the rising rates of obesity and type 2 diabetes. Approximately one in four adults are diagnosed with liver steatosis globally. NAFLD is associated with insulin resistance, hypertension, obesity, visceral adiposity, and dyslipidaemia. These risk factors are often accompanied by inflammation and oxidative stress, which also play a role in extrahepatic diseases, including conditions related to the central nervous system, such as mild cognitive impairment and Alzheimer’s disease. The number of people living with dementia is approximately 55 million and is estimated to increase to approximately 2 billion people by 2050. Recent studies have found that NAFLD is associated with poorer cognition. The aim of this review was to summarise the findings of hitherto studies that have linked NAFLD with cognition and dementia, as well as to discuss the potential liver–brain pathways.","PeriodicalId":72798,"journal":{"name":"Diabetology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85766906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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