Diabetes Research and Clinical Practice - Articles in Press

Feasibility, reliability and validity of the Iranian version of the Diabetes Quality of Life Brief Clinical Inventory (IDQOL-BCI) - Corrected Proof

2012-02-03

Abstract: Aims: To validate and culturally adapt the Diabetes-specific Quality of Life Brief Clinical Inventory (DQOL-BCI) for the Iranian population.Methods: After translation – back translation, content validity was assessed utilizing a panel of six experts. Based on a sample of 180 diabetic patients referred to two Diabetics Clinic Centers from September to May 2011 in Karaj, Iran, construct validity via detecting the factor structure, and convergent and discriminant validity were evaluated by scale-item correlations and known group analyses. Internal consistency and test–retest reliability were assessed in sample of 30 patients by Cronbach's and intraclass correlation coefficient (ICC).Results: The IDQOL-BCI showed good content validity (CVI values>0.75 and CVR values>0.99), internal consistency (α=0.75) and test–retest reliability (ICC=0.81). A 3-factor solution was found. In addition, high values of item-scale correlations confirmed the convergence validity, and some subscales and total scores differentiate between groups defined by sex, disease duration, income levels, drug using status and physical activity demonstrated the discriminant validity.Conclusions: Our findings demonstrate the initial feasibility, reliability and validity of the Iranian version of the IDQOL-BCI as a measure of diabetic-specific QOL measure in Iranian patients.

Diabetic ketoacidosis accompanied by hypothermia: A case report - Corrected Proof

2012-02-03

Abstract: Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus and is caused by insulin insufficiency. Hypothermia is defined as a core temperature of less than 35°C and is sometimes accompanied by DKA. We report two patients with diabetes who were admitted for DKA accompanied by hypothermia.

Hypoglycaemia and cardiovascular disease in Type 1 Diabetes. Results from the Catalan National Public Health registry on insulin pump therapy - Corrected Proof

Marga Giménez, Juan José López, Conxa Castell, Ignacio Conget — 2012-02-03

Abstract: Severe hypoglycaemia has recently been associated with an increased risk for cardiovascular disease (CVD) in diabetes. The retrospective analysis of a national registry on continuous subcutaneous insulin infusion points to a higher prevalence of CVD in Type 1 diabetic subjects with repeated severe hypoglycaemia at the time of starting CSII.

Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome - Corrected Proof

2012-02-01

Summary: Twenty-eight diabetics presenting with acute Charcot foot were immobilized and the temperature difference between limbs measured at each month. All patients had monthly follow-up visits for a year and the relapse rate was zero. We found that skin temperature is a good parameter to ensure safe immobilization withdrawal.

Self-reported hypoglycemia and impact on quality of life and depression among adults with type 2 diabetes mellitus - Corrected Proof

Andrew J. Green, Kathleen M. Fox, Susan Grandy, for the SHIELD Study Group — 2012-02-01

Abstract: Aims: This study evaluated the rate of self-reported hypoglycemia and examined the association of hypoglycemia with quality of life and depression among adults with type 2 diabetes mellitus (T2DM).Methods: Respondents to the 2008 US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) survey were asked the number of times they experienced hypoglycemia in the past 4 weeks and past 12 months. Respondents also completed the short form-12 (SF-12) questionnaire and the patient health questionnaire (PHQ-9). T2DM respondents reporting at least 1 hypoglycemic episode were compared with T2DM respondents who did not report hypoglycemia in the previous 12 months.Results: Of 2718 T2DM respondents, 23% reported experiencing hypoglycemia in the past 12 months. Respondents reporting hypoglycemia (n=627) had significantly lower (p<0.001) SF-12 scores for both physical health (mean±SD: 37.4±12.7 versus 40.9±12.7) and mental health (50.1±11.7 versus 52.4±10.1) compared with those without hypoglycemia (n=2091). Mean PHQ-9 scores were significantly higher (p<0.001) among respondents reporting hypoglycemia (5.2±5.8), compared with respondents who did not report hypoglycemia (3.9±5.0), indicating greater depression burden.Conclusion: Self-reported hypoglycemia was prevalent among individuals with T2DM and associated with lower health-related quality of life, and greater burden of depression.

Diabetes and life expectancy among Japanese – NIPPON DATA80 - Corrected Proof

2012-02-01

Abstract: Life expectancy (LE) among the Japanese population with or without diabetes mellitus was estimated. LE in 40-year old men and women was 41.1 and 47.5years in those without diabetes and 32.3 and 40.9years in those with diabetes. The LE of 40-year old men and women with diabetes was 8.8 and 6.6years shorter than in those without diabetes. Diabetes mellitus leads to a decrease in LE. The presence of impaired glucose tolerance also affected LE inversely.

Effect of percutaneous electrical muscle stimulation on postprandial hyperglycemia in type 2 diabetes - Corrected Proof

2012-02-01

Abstract: Aims: The aim of this study was to examine whether percutaneous electrical muscle stimulation (EMS) attenuates postprandial hyperglycemia in type 2 diabetes.Methods: Eleven patients with type 2 diabetes participated in two experimental sessions; one was a 30-min EMS 30min after a breakfast (EMS trial) and the other was a complete rest after a breakfast (Control trial). In each trial, blood was sampled before and at 30, 60, 90, and 120min after the meal.Results: Postprandial glucose level was significantly attenuated in EMS trial at 60, 90, and 120min after a meal (p<0.05). The C-peptide concentration was also significantly lowered in EMS trial (p<0.01). On the other hand, there was no significant increase in creatine phosphokinase (CPK) concentration in each trial.Conclusions: The present results provide first evidence indicating that EMS is a new exercise method for treating postprandial hyperglycemia in individuals with type 2 diabetes, especially who cannot perform adequate voluntary exercise because of excessive obesity, orthopedic diseases, or severe diabetic complications.

Serum fibroblast growth factor 21 was elevated in subjects with type 2 diabetes mellitus and was associated with the presence of carotid artery plaques - Corrected Proof

2012-01-31

Abstract: Aims: Fibroblast growth factor 21 (FGF21) is an important regulator of glucose/lipid metabolism. Although there are studies examining the relationship between serum FGF21 levels and glucose homeostasis, the role of FGF21 remains unclear. The objective of this study was to examine whether serum FGF21 levels are associated with metabolic parameters in subjects with varying degrees of obesity and glucose tolerance and with complications in subjects with type2 diabetes mellitus (T2DM).Methods: The study consisted of 213 subjects who were lean and had normal glucose tolerance (lean NGT), were overweight with NGT, had impaired glucose tolerance (IGT) or had T2DM. Serum FGF21 levels and their associations with the parameters of adiposity, glucose tolerance and the presence of diabetic complications were examined.Results: The serum FGF21 levels in T2DM were higher than in lean NGT. Serum FGF21 levels showed a positive correlation with the urine albumin-to-creatinine ratio (ACR) in all subjects except for the T2DM subjects, who showed a correlation after adjustment of age, gender and body mass index. Moreover, the subjects with carotid artery plaque showed higher serum FGF21 levels than those without complications.Conclusion: Serum FGF21 levels were associated with the urine ACR and diabetic complications including carotid artery plaque.

Chronic inflammatory demyelinating polyneuropathy mimicking diabetic neuropathy in a young female with type 2 diabetes mellitus - Corrected Proof

2012-01-31

Abstract: The presentations of chronic inflammatory demyelinating polyneuropathy (CIDP) overlap with those of diabetic peripheral neuropathy (DPN). We described a young girl with CIDP underlying type 2 diabetes mellitus, presenting with progressive numbness and limb weakness, who was initially misdiagnosed to have DPN. Finally immunosuppressive therapy got good response.

Non-adherence to diabetes guidelines in primary care – The enemy of evidence-based practice - Corrected Proof

Samuel Seidu, Kamlesh Khunti — 2012-01-31

WHO estimates that more than 346 million people worldwide have diabetes, and the number is likely to more than double by 2030 without interventions . Over 90% of all people with diabetes have type 2 diabetes (T2DM) which in most cases is managed in Primary Care . T2DM is chronic disease that is associated with an increased risk of macro and micro-vascular complications and 70% will die of premature cardiovascular disease. The landmark UKPDS study of patients with newly diagnosed T2DM showed that in order for us to reduce the complications of type T2DM, it is necessary to control the HbA1c and blood pressure levels . Early tight glycaemic control, certainly in the first 10years after diagnosis, results in improvement in micro-vascular complications. In addition to this, there is a legacy effect of this early tight control in that, patients who came out of the trial 10years later, that is 20years after diagnosis, showed profound benefits from the point of view of mortality and cardiovascular events. Despite this, there are still wide variations of care, not just from region to region, but between primary care and secondary care even in the same region .

Plasma leptin levels increase to a greater extent following on-pump coronary artery surgery in type 2 diabetic patients than in nondiabetic patients - Corrected Proof

Murat Guvener, Halil Ibrahim Ucar, Mehmet Oc, Asli Pinar — 2012-01-30

Abstract: Aims: We aimed to evaluate whether leptin and ghrelin responses to cardiopulmonary bypass (CPB) are dependent on type 2 diabetes and whether these responses are associated with interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), cortisol and insulin.Methods: We examined stress-response patterns in plasma leptin, ghrelin, hsCRP, IL-6, cortisol and insulin levels before and up to 5 days after cardiopulmonary bypass in 20 patients with type 2 diabetes and 20 patients without diabetes.Results: Plasma leptin levels increased significantly in both groups (p<0.05) and rose significantly higher in diabetics when compared with nondiabetic patients (p=0.004). Plasma ghrelin levels increased significantly only in diabetics (p=0.033). Patients with and without diabetes showed significantly elevated serum concentrations of IL-6, hsCRP, cortisol and insulin (p<0.005 for IL-6, hsCRP; p<0.05 for cortisol, insulin) but the difference between the two groups was nonsignificant.Leptin was independently predicted by hsCRP (p<0.05, F=2.9), gender (women p<0.001, F=4.7), body mass index (BMI p<0.0001, F=6.1) whereas ghrelin levels were not associated with any variables in the total patient population. (critical F=2.26, p≤0.05).Conclusions: Acute phase response in diabetics differs by higher leptin levels independent of BMI, gender and IL-6, hsCRP, insulin and cortisol levels.

Formation of cyclic structure at amino-terminus of glucagon-like peptide-1 exhibited a prolonged half-life in vivo - Corrected Proof

2012-01-30

Abstract: The multiple physiological characterizations of glucagon-like peptide-1 (GLP-1) make it a promising drug candidate for the therapy of type 2 diabetes. However, the biological half-life of GLP-1 is short in vivo due to degradation by dipeptidyl peptidase-IV (DPP-IV) and renal clearance. The stabilization of GLP-1 is critical for its utility in drug development. In this study, several GLP-1 mutants containing an N-terminal cyclic conformation were prepared in that the existence of cyclic conformation is predicted to increase the stabilization of GLP-1 in vivo. In this study, the binding capacities of the mutants were determined, the stabilities of the mutants were investigated and the physiological functions of the mutants were compared with those of wild-type GLP-1 in animals. The results indicated that the mutant (GLP1N8) remarkably raised the half-life in vivo; it also showed better glucose tolerance and higher HbA1c reduction than GLP-1 and exendin-4 in rodents. These results suggest that the GLP-1 analog (GLP1N8) which contains an N-terminal cyclic structure might be utilized as possible potent anti-diabetic drugs in the treatment of type 2 diabetes mellitus.

The impact of structured blood glucose testing on attitudes toward self-management among poorly controlled, insulin-naïve patients with type 2 diabetes - Corrected Proof

2012-01-24

Abstract: Introduction: Patients with T2DM often view self-monitoring of blood glucose (SMBG) as burdensome and pointless, which may affect their broader attitudes toward diabetes management. We examined how a structured SMBG protocol influenced diabetes self-efficacy and autonomous motivation over time, and linked these to changes in glycemic control.Materials and methods: The Structured Testing Program (STeP) is a 12-month, two-arm, cluster-randomized trial that assessed the efficacy of structured SMBG in 483 insulin-naïve T2DM patients. Measures included: Confidence in Diabetes Self-Care for Type 2 patients (CIDS-T2), Diabetes-related Autonomous Motivation (DRAM), self-management behaviors and HbA1c.Results: Intent-to-treat (ITT) and per-protocol (PP) analyses showed significant increases in CIDS-T2 scores over time (main effects p<0.0001). PP analysis showed significant between-group differences (p<0.05), with adherent STG patients displaying greater CIDS-T2 improvement than ACG patients. PP analyses showed main and between-group effects in DRAM with similar findings. Changes in CIDS-T2 were related to HbA1c changes over time; no self-management variable mediated this relationship. CIDS-T2 and HbA1c displayed a significant time-concordant relationship.Discussion: Structured SMBG leads to significant increases in self-confidence and autonomous motivation associated with diabetes self-management. Changes in self-confidence are linked to changes in glycemic control and share a time-concordant relationship.

Hypoglycemia is associated with increased worry and lower quality of life among patients with type 2 diabetes treated with oral antihyperglycemic agents in the Asia-Pacific region - Corrected Proof

2012-01-24

Abstract: Aims: We examined the relationship of hypoglycemic symptoms with health-related quality of life and worry about hypoglycemia among type 2 diabetic patients using oral antihyperglycemic agents (AHA) in the Asia-Pacific region.Methods: A total of 2257 type 2 diabetic patients with at least 6 months of oral AHA were enrolled in China, Korea, Malaysia, Thailand, and Taiwan. Quality of life was measured with the EuroQol Visual Analog Scale (EQ-VAS) and EuroQol-5 Dimensions questionnaire (EQ-5D), and worry about hypoglycemia with the worry subscale of the Hypoglycemic Fear Survey-II (HFS).Results: The mean (SD) age was 58.7 (10.2) years and HbA1c was 7.5% (1.5). The proportion of patients with an HbA1c <6.5% and <7% was 24.9% and 41.8%, respectively. Hypoglycemic symptoms in the prior 6 months were reported by 35.8% of patients. Mean scores on the EQ-VAS and the EQ-5D were significantly lower for patients who had hypoglycemic symptoms compared to those who did not (73.6 vs. 76.9, p<0.001; 0.88 vs. 0.90, p<0.0001, respectively), whereas mean score on the HFS was significantly higher (12.5 vs. 6.3, p<0.001). In multivariate models, hypoglycemic symptoms were independently associated with scores on the EQ-5D, EQ-VAS, and HFS (all p≤0.01–0.001). Symptom severity was positively associated with fear of hypoglycemia (all p≤0.001).Conclusion: Hypoglycemic symptoms were associated with reduced quality of life and increased patient worry in patients with type 2 diabetes treated with AHA.

Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: A systematic review and meta-analysis - Corrected Proof

2012-01-19

Abstract: Aims: To verify the assertions that diabetes pandemic may be spreading across rural parts of low- and middle-income countries (LMICs), we performed a systematic review of published studies reporting diabetes prevalence in rural parts of LMICs.Methods: Electronic databases (EMBASE and MEDLINE) were searched for papers published from 1990 to 2011. Two independent reviewers screened the articles using structured criteria for inclusion and performed full-text reviews. Pooled prevalence of diabetes was estimated using meta-analysis. Potential factors influencing the estimates were identified by meta-regression and used for sensitivity analyses.Results: Rural prevalence of diabetes of LMICs was 5.6% (95% CI=4.6–6.6), and similar between men and women. This estimate remained robust in separate sensitivity analyses accounting for study quality, level of heterogeneity, age, and sex. In a multivariate meta-regression analysis, pooled prevalence varied by study year and region. Diabetes prevalence increased over time, from 1.8% (1.0–2.6) in 1985–1989, 5.0% (3.8–6.3) in 1990–1994, 5.2% (4.1–6.2) in 1995–1999, 6.4% (5.1–7.7) in 2000–2004, and to 8.6% (6.4–10.7) for 2005–2010 (p=0.001 for secular trend).Conclusions: Prevalence of diabetes in rural parts of LMICs has risen dramatically. As 55% of LMIC populations live in rural areas, this trend has enormous implications for the global burden of diabetes.

Predictors of suboptimal glycaemic control in type 2 diabetes patients: The role of medication adherence and body mass index in the relationship between glycaemia and age - Corrected Proof

2012-01-19

Abstract: Aims: To analyse predictors of glycaemic control including medication adherence and body mass index (BMI) in UK general practice patients with sub-optimally controlled type 2 diabetes.Methods: Baseline demographic, health- and treatment-related measures were evaluated as predictors of one year glycaemic control defined separately as HbA1c≤7.5% and a continuous measure of HbA1c concentration, using multivariate regression models. Significant predictors were adjusted for objectively assessed medication adherence and BMI.Results: One-year HbA1c concentration was associated with baseline HbA1c (p<0.001), BMI (p=0.02), and inversely associated with age (p=0.007) and objectively assessed adherence. Adherent patients had one-year (adjusted) HbA1c concentration 0.65% (95% CI −1.04, −0.25; p=0.001) lower than nonadherent. Odds ratios (95% CI) of HbA1c≤7.5% for 10-year higher age were 1.63 (1.08, 2.45); for adherent compared to non-adherent patients 1.89 (0.84, 4.25); for patients receiving >5 compared to ≤5 medications 0.32 (0.13, 0.76); and for each 1% increment in baseline HbA1c 0.48 (0.31, 0.73).Conclusions: The lower HbA1c achieved from greater adherence to glucose lowering treatment is comparable to that achieved with additional medication. Relationships between older age and better glycaemic control are not explained by better adherence, but may partly relate to lower BMI.

Use of haemoglobin A1c to detect impaired fasting glucose or Type 2 diabetes in a United Kingdom community based population - Corrected Proof

2012-01-18

Abstract: Aims: To evaluate the diagnostic accuracy of haemoglobin A1c (HbA1c) in screening for impaired fasting glucose and Type 2 diabetes (T2DM).Methods: We screened 3904 adults aged 45–70 (mean age 58.6 [standard deviation (SD) 6.9] years, mean body mass index (BMI) 29.9 [SD 4.7]kg/m2), with fasting plasma glucose (FPG) and HbA1c as part of a large diabetes prevention programme. We assessed the diagnostic accuracy of HbA1c for predicting impaired fasting glucose (IFG), (defined either as FPG 5.6–6.9mmol/l, or 6.1–6.9mmol/l), and T2DM (FPG≥7.0mmol/l).Results: The prevalences of IFG were 13.8% (FPG 5.6–6.9mmol/l) and 4.5% (FPG 6.1–6.9mmol/l) and of T2DM was 2.1%. Using FPG 5.6–6.9mmol/l as the IFG reference standard, HbA1c of 39–47mmol/mol (5.7–6.4%) was 63% sensitive and 81% specific, and HbA1c 43–47mmol/mol (6.1–6.4%) was 21% sensitive and 98% specific, in diagnosing IFG. HbA1c≥48mmol/mol (6.5%) was 61% sensitive and 99% specific in diagnosing T2DM. Having HbA1c 39–47mmol/mol (5.7–6.4%), male sex, and body mass index >29.5 together increased the odds of IFG 6.5-fold (95% confidence interval (CI) 5.5–7.8) compared to the pre-test odds.Conclusion: Defining ‘pre-diabetes’ at a lower HbA1c threshold of 39mmol/mol (5.7%) instead of 47mmol/mol (6.1%) increases its sensitivity in diagnosing IFG, but current American Diabetes Association definitions of ‘pre-diabetes’ based on HbA1c would fail to detect almost 40% of people currently classified as IFG. This has implications for current and future diabetes prevention programmes, for vascular risk management, and for clinical advice given to people with ‘pre-diabetes’ based on fasting glucose data.

The effect of hyperglycemia and hypoglycemia on glucose transport and expression of glucose transporters in human lymphocytes B and T: An in vitro study - Corrected Proof

Bożenna Oleszczak, Leszek Szablewski, Monika Pliszka — 2012-01-18

Abstract: Glucose transport in lymphocytes is regulated by many agents. It is interesting if only changing glucose concentrations in environment involves the impact on glucose uptake.The aims of this study were to investigate the impact of changing glucose concentrations in medium on deoxy-d-glucose uptake and what these conditions impact on the percent of cells with expression of chosen glucose transporters in human lymphocytes B and T.Isolated lymphocytes B and T obtained from healthy subject were cultivated in different concentrations of glucose. The experiments were carried out using tritium labeled deoxy-d-glucose and flow cytometry.In comparison to normoglycemia, hyperglycemia impairs the uptake of deoxy-d-glucose more than hypoglycemia. Lymphocytes B manifest significantly lower uptake of deoxy-d-glucose than lymphocytes T. Lymphocytes incubated in hyperglycemic and hypoglycemic medium show lower percent cells with expression of GLUT 1 and GLUT 3, and higher percent cells with expression of GLUT 4. The incubation of lymphocytes in hyperglycemic and hypoglycemic medium does not stimulate translocation of glucose transporters 3 and 4 to plasma membrane.Study shows that a change in concentration of glucose in incubation environment influence intracellular expression of glucose transporters in a significant part of lymphocytes B and T.

Health beliefs among individuals at increased familial risk for type 2 diabetes: Implications for prevention - Corrected Proof

2012-01-18

Abstract: Aim: To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes.Methods: Data analyses were based on the Family Healthware™ Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978).Results: After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups.Conclusions: Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders.

Combination therapy with liraglutide and sulfonylurea for a type 2 diabetic patient with high titer of anti-insulin antibodies produced by insulin therapy - Corrected Proof

2012-01-18

Excessive production of anti-insulin immunoglobulin G antibodies (IAs) in type 2 diabetic patients receiving insulin therapy causes unstable glycemic control and unexpected hypoglycemia. Although several therapeutic approaches have been reported , the efficacy of glucagon-like peptide-1 (GLP-1) mimetics on these patients remains unknown.

Islet autoantibodies and residual beta cell function in type 1 diabetes children followed for 3–6 years - Corrected Proof

2012-01-17

Abstract: Aims: To test if islet autoantibodies at diagnosis of type 1 diabetes (T1DM) and after 3–6 years with T1D predict residual beta-cell function (RBF) after 3–6 years with T1D.Methods: T1D children (n=260, median age at diagnosis 9.4, range 0.9–14.7 years) were tested for GAD65, IA-2, ZnT8R, ZnT8W and ZnT8Q autoantibodies (A) at diagnosis, and 3–6 years after diagnosis when also fasting and stimulated RBF were determined.Results: For every 1-year increase in age at diagnosis of TID, the odds of detectable C-peptide increased 1.21 (1.09, 1.34) times for fasting C-peptide and 1.28 (1.15, 1.42) times for stimulated C-peptide. Based on a linear model for subjects with no change in IA-2A levels, the odds of detectable C-peptide were 35% higher than for subjects whose IA-2A levels decreased by half (OR=1.35 (1.09, 1.67), p=0.006); similarly for ZnT8WA (OR=1.39 (1.09, 1.77), p=0.008) and ZnT8QA (OR=1.55 (1.06, 2.26) p=0.024). Such relationship was not detected for GADA or ZnT8RA. All OR adjusted for confounders.Conclusions: Age at diagnosis with T1D was the major predictor of detectable C-peptide 3–6 years post-diagnosis. Decreases in IA-2A, and possibly ZnT8A, levels between diagnosis and post-diagnosis were associated with a reduction in RBF post-diagnosis.

Visceral fat mass is always, but adipokines (adiponectin and resistin) are diversely associated with insulin resistance in Chinese type 2 diabetic and normoglycemic subjects - Corrected Proof

Jun Bu, Qiong Feng, Jianmin Ran, Qingmei Li, Guangzhong Mei, Yang Zhang — 2012-01-16

Abstract: Aims: The present study investigated alteration of abdominal visceral fat mass (VFM) and its relationship to adipokines and insulin resistance (IR) in obese and non-obese type 2 diabetes and normoglycemic subjects.Methods: Twenty-two diabetic patients and 37 normoglycemic controls were subgrouped into obese and non-obese according to their BMI. VFM was quantified by computed tomography. Plasma adiponectin and resistin, two adipokines exert contrary effects on insulin sensitivity were measured. Insulin sensitivity was evaluated by an established HOMA model.Results: Obese subjects showed remarkably expanded VFM, while non-obese diabetes obtained more abundant VFM than non-obese controls (104±50cm2 vs. 77±26cm2, P<0.05). Plasma adiponectin was only significantly decreased in obese diabetes. Plasma resistin was increased in diabetes, but compared between obese and non-obese subjects. Diabetic patients and obese controls were significantly insulin resistant. HOMA-IR index positively correlated to VFM in both groups (r=0.563, P=0.011 for diabetes and r=0.671, P=0.000 for controls). In diabetes but not controls, plasma adiponectin negatively related to VFM (r=−0.687, P=0.000) and HOMA-IR index (r=−0.659, P=0.002), while resistin had no relation to IR and VFM in both groups.Conclusions: Increased VFM may lead to IR by mechanisms beyond adipokines in Chinese type 2 diabetic and normoglycemic subjects.

An overview of the pharmacokinetics, efficacy and safety of liraglutide - Corrected Proof

Bruce Bode — 2012-01-16

Abstract: Objective: Incretin-based therapies, including glucagon-like peptide 1 (GLP-1) receptor agonists, are the latest addition to the range of available medications for the management of patients with type 2 diabetes. The GLP-1 analog liraglutide has been approved for use in Europe and the US for over a year and has undergone evaluation in several pharmacokinetic/pharmacodynamics studies and in an extensive phase 3 clinical program. The aim of this review is to assess the pharmacokinetics, efficacy and safety of the phase 3 data.Methods: Data are presented from the pharmacokinetics/pharmacodynamics studies of liraglutide and from nine published phase 3 studies, including the six Liraglutide Effect and Action in Diabetes (LEAD) studies.Results: Liraglutide is effective at improving indices of glycemic control, and has a good tolerability and safety profile. Beneficial effects on weight (mean reduction of 1–3.4kg) and blood pressure (systolic blood pressure decreased by 2.1–6.7mmHg) are also observed.Conclusion: Liraglutide is an effective and well tolerated option for the treatment of type 2 diabetes.

Impact of health professionals’ contact frequency on response to a lifestyle intervention with individuals at high risk for diabetes - Corrected Proof

2012-01-16

Abstract: Aim: To determine the independent effects of total and each health professional's frequency of contacts, on changes in anthropometric measures and physical capacity following a lifestyle intervention offered by a multi-disciplinary team in adults at high risk for type 2 diabetes.Materials and methods: A 12-month lifestyle intervention was performed in 48 adults with prediabetes. Participants were randomly assigned to either an individual counselling group (every six weeks)+an optional series of 25 group seminars (every week) or to the group seminars only. Physical activity level, energy intake, anthropometric measures, and physical capacity were assessed.Results: Total frequency of contacts with any professional was associated with change in body weight, BMI and, waist circumference (all P≤.05). However, no frequency of contacts with a specific professional was associated with the studied outcomes, except for changes in physical capacity. The latest was significantly improved in participants who attended at least two group sessions with the kinesiologist (P=.02).Discussion: To improve anthropometric measures, total contact frequency seems to be more important than contact frequency with any specific professionals. However, to improve physical capacity, meeting with a kinesiologist for two or more occasions, in group sessions, seems to be an effective strategy.

Musculoskeletal pain in patients with type 2 diabetes - Corrected Proof

S. Molsted, J. Tribler, O. Snorgaard — 2012-01-16

Abstract: Aims: The aims were to investigate the prevalence of musculoskeletal pain in patients with type 2 diabetes and demonstrate possible associated factors.Methods: Nine hundred fifty-one patients completed a validated questionnaire used in The Danish Health and Morbidity Survey and results were compared to data for 2923 matched subjects from the Danish population. Musculoskeletal pain was self-reported Pain in the shoulder and neck; Low-back pain; and Pain in the arm, hand, knee and/or hip.Results: Compared to the age, gender and region matched controls patients reported musculoskeletal pain 1.7–2.1 times as frequent (p<0.001). Pain was more frequently reported in women (p<0.001). Low-back pain and Pain in the arm, hand, knee and/or hip was associated with body mass index (p<0.005). Low-back pain was associated with a sedentary life style, impaired quality of life and reduced physical function (p<0.05).Conclusions: The prevalence of musculoskeletal pain was seriously increased in patients with type 2 diabetes. It was associated with body mass index, reduced quality of life, low physical function and the ability to be physical active. Focus on musculoskeletal pain in clinical practice is therefore of major importance in lifestyle interventions in type 2 diabetes.

Sex differences in the relationship between socioeconomic status and metabolic syndrome: The Korean National Health and Nutrition Examination Survey - Corrected Proof

2012-01-16

Abstract: Aims: To investigate sex differences in the relationship between socioeconomic status (SES) and the prevalence of metabolic syndrome (MetS) in Korean adults.Methods: We examined the relationship between SES, as measured by household income or education level, and the prevalence of MetS in Korean adults who participated in the 2007–2008 Korean National Health Examination and Nutrition Survey (KNHANES). The adjusted odds ratios (ORs) for MetS were calculated using multivariate logistic regression analysis across household income and education level quartiles.Results: We found significant differences between men and women in the association between SES and MetS, with a positive association for men and an inverse association for women. The adjusted OR and 95% confidence interval (95% CI) for MetS for the highest vs. lowest quartile of household income was 1.59 (1.15–2.20) in men. The adjusted ORs for MetS for the highest vs. lowest quartile of household income and education level were 0.54 (0.41–0.72) and 0.26 (0.17–0.38) in women, respectively.Conclusions: We found sex differences in the relationship between SES and the prevalence of MetS in Korea. These findings suggest that sex-specific public health interventions that consider SES are needed for the prevention and treatment of MetS.

Strong association of common variants in the IGF2BP2 gene with type 2 diabetes in Lebanese Arabs - Corrected Proof

2012-01-16

Abstract: Objective: Several genome-wide association studies and replication analyses have identified common variation at the insulin-like binding protein 2 (IGF2BP2) gene to be associated with type 2 diabetes (T2DM). The aim of this study was to replicate in a Lebanese Arab population identified associations of IGF2BP2 variants rs4402960 and rs1470579 with T2DM.Methods: This case–control study involved 544 T2DM patients and 606 control subjects. Genotyping was done by the allelic exclusion method.Results: T allele of rs440960 (P=6.5×10−6) and C allele of rs1470579 (P=5.3×10−4) were significantly associated with T2DM; both SNPs were in strong LD (D′=0.83, r2=0.58). While both IGF2BP2 SNPs were significantly associated with T2DM under additive and recessive models, only rs4402960 remained significantly associated with T2DM under the dominant model. Taking the common rs4402960/rs1470579 GA haplotype as reference, multivariate analysis confirmed the positive association of TC (P=0.009; OR, 1.43; 95%CI, 1.09–1.87), and TA (P<0.001; OR=5.49; 95%CI=2.09–14.39) haplotypes with increased T2DM risk. These differences remained significant after applying the Bonferroni correction for multiple testing.Conclusion: We validate that IGF2BP2 susceptibility variants rs4402960 and rs1470579 associate with T2DM in Lebanese Arabs.

Metformin alters the expression profiles of microRNAs in human pancreatic cancer cells - Corrected Proof

Weiguang Li, Yaozong Yuan, Liya Huang, Minmin Qiao, Yongping Zhang — 2012-01-16

Abstract: Aims: To investigate the effect of metformin on the expression profiles of microRNAs in human pancreatic cancer cells.Methods: MicroRNAs real-time PCR Array was applied to investigate differentially expressed miRNAs in Sw1990 cells treated with or without metformin. Stem-loop real time RT-PCR was used to confirm the results of the array assay in Sw1990 and Panc-1 cells. The effects of miR-26a on cell growth, apoptosis, invasion and migration abilities were respectively examined by CCK8 assay, Apoptosis assay, Matrigel invasion and migration assay. HMGA1 was proved to be a target of miR-26a by Luciferase reporter assay, Real-time PCR and Western-blotting.Results: Nine miRNAs were significantly up-regulated in metformin treated cells. Metformin up-regulated the expression of miR-26a, miR-192 and let-7c in a dose-dependent manner. Forced expression of miR-26a significantly inhibited cell proliferation, invasion, migration and increased cell apoptosis, whereas knockdown of miR-26a obtained the opposite effect. Furthermore, we demonstrated that HMGA1, an oncogene, is a direct target of miR-26a. Nude mice xenograft models confirmed that metformin up-regulated the level of miR-26a and surpressed the expression of HMGA1 in vivo.Conclusion: These observations suggested that modulation of miRNA expression may be an important mechanism underlying the biological effects of metformin.

Impact of diabetes, high triglycerides and low HDL cholesterol on risk for ischemic cardiovascular disease varies by LDL cholesterol level: A 15-year follow-up of the Chinese Multi-provincial Cohort Study - Corrected Proof

2012-01-13

Abstract: Aims: A large proportion of ischemic cardiovascular disease occur in people without hypercholesterolemia. We aimed to investigate whether risk factors other than low-density lipoprotein cholesterol (LDL-C) have different impacts on cardiovascular risk in people with low verses high LDL-C levels.Methods: A total of 30,378 participants (35–64 years) were followed for 15 years in the Chinese Multi-provincial Cohort Study. Associations of coronary heart disease (CHD) and ischemic stroke with risk factors other than LDL-C were assessed in participants with low (<130mg/dL) and high (≥130mg/dL) LDL-C levels.Results: During the follow-up, 65.5% of CHD and 70.2% of ischemic stroke events occurred in participants with low LDL-C. High triglycerides predicted CHD (HR=1.74, 95% CI 1.25–2.42, P=0.001), and low HDL-C predicted ischemic stroke (HR=1.54, 95% CI 1.18–2.03, P=0.002) only in participants with low LDL-C. Diabetes predicted CHD in participants with high LDL-C (HR=2.38, 95% CI 1.31–4.34, P=0.005), but not in those with low LDL-C. Older age, male, hypertension, central obesity, and smoking had similar effects on the risk in both groups.Conclusions: Triglycerides and low HDL-C should be addressed in the management of dyslipidemia in people with low LDL-C. When LDL-C is high, tighter management of glycemia and LDL-C is warranted.

Association of left ventricular diastolic dysfunction with elevated NT-proBNP in type 2 diabetes mellitus patients with preserved ejection fraction: The supplemantary role of tissue doppler imaging parameters and NT-proBNP levels - Corrected Proof

Sedat Çiftel, Serhat İçağasıoğlu, Gürsel Yıldız, Gonca Tekin, Hüseyin Aydin — 2012-01-12

Abstract: Background: Early diagnosis of cardiovascular disease in diabetic patients may be important to introduce treatment early. Echocardiography is a method used to show the ventricular functions. A ventricular hormone, BNP is used to identify the changes in the ventricular function in early period. NT-proBNP which is a more stable compound with a longer half-life is used in measurement of BNP.Methods: Left ventricular diastolic dysfunction (LVDD) was detected and NT-proBNP levels were measured in forty-four asymptomatic patients with ages of 30–70 and type 2 DM and control group consisted of 40 healthy individuals from the same age group.Results: NT-proBNP levels were found as 566.7±738.5pg/ml in the diabetics with LVDD detected, 166.3±137.1pg/ml in the diabetics without LVDD and 134.5±77.2pg/ml in the control group. Levels of NT-proBNP were significantly higher in the group with left ventricular diastolic dysfunction (p<0.05). However, when the levels of NT-proBNP in the diabetic patients without LVDD were compared with the controls, the difference was not significant (p>0.05). NT-proBNP levels were found significantly higher in LVDD group compared to the controls without a difference between the ejection fractions (p<0.05).Conclusion: High levels of NT-proBNP was correlated tissue Doppler echocardiography findings in type 2 DM patients with preserved ejection fraction.

Real time presence of a microbiologist in a multidisciplinary diabetes foot clinic - Corrected Proof

2012-01-09

Abstract: Multidisciplinary foot-care teams (MDFT) are recommended in the management of severe diabetic foot disease . However, even though infection is often the dominant immediate risk, it is rare to have real time input from a microbiologist. We highlight the value of a microbiologist as a MDFT member.

Body mass index correlates with waist circumference in school aged Italian children - Corrected Proof

2012-01-09

Abstract: This study demonstrates the existence of a linear correlation between Body Mass Index (BMI) and waist circumference in Italian school aged children and suggests an indirect method (from weight and height) to estimate waist circumference, whose increase may be indicative for the diagnosis of the metabolic syndrome.

Corrigendum to “Prevalence of metabolic syndrome and its risk factors in adult Malaysians: Results of a nationwide survey” [Diabetes Res. Clin. Pract. 91 (2011) 239–245] - Corrected Proof

2012-01-09

Prevalence of undiagnosed diabetes mellitus and cardiovascular risk factors in Hong Kong professional drivers - Corrected Proof

2012-01-06

Abstract: Aims: To investigate the prevalence of undiagnosed diabetes mellitus (DM) and cardiovascular risk factors among professional drivers in Hong Kong.Methods: Chinese professional drivers with no history of DM were invited to complete a questionnaire on their health status, followed by taking their body measurements, fasting blood glucose (FG) and lipids. 75g OGTT were performed when FG≥5.6 to <7.0mmol/L.Results: Of these 3376 drivers (male 92.6%, mean age 50.9±7.6 years), the prevalence of undiagnosed DM, prediabetes, and metabolic syndrome was 8.1% (272/3376, 95% CI 7.1–9.0%), 10.0% (337/3376, 95% CI 9.0–11.0%) and 26.8% (904/3376, 95% CI 25.3–28.3%) respectively, while the corresponding WHO Standard Population age-standardized prevalence was 7.8%, 9.0% and 24.7% respectively. Many of them were obese (51.2%), had hypertension (57.0%) and high cholesterol (58.7%), and a third had hypertriglyceridaemia (34.9%) and low HDL-cholesterol (29.3%). Their median working hours were 60.0 (IQR 14)h. Majority had exercise <1h/week (56.0%) and ate out ≥6times/week (54.9%).Conclusions: Hong Kong professional drivers have higher prevalence of undiagnosed DM, cardiovascular risk factors and metabolic syndrome than the general population. Therefore, health care measures targeting against them should be taken to prevent and detect DM and cardiovascular diseases.

Prevalence of metabolic syndrome and its risk factors in adult Malaysians: Results of a nationwide survey - Corrected Proof

2012-01-05

Abstract: Aim: To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the ‘Harmonized’ criteria.Methods: A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations.Results: Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malays (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridemia (47.4%).Conclusions: Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country's healthcare costs and services.

Thymosin beta 4 ameliorates hyperglycemia and improves insulin resistance of KK Cg-Ay/J mouse - Corrected Proof

Jian Zhu, Li-Ping Su, Lei Ye, Kok-Onn Lee, Jian-Hua Ma — 2012-01-05

Abstract: Object: To evaluate the efficacy of thymosin beta 4 (Tβ4) on hyperglycemia and insulin sensitivity in a mouse model of type 2 diabetes mellitus (T2DM).Methods: KK mice were divided into the following groups: KK control group, with saline treatment; KK Tβ4 group, with daily Tβ4 100ng/10g body weight intraperitoneal injection for 12 weeks. Non-diabetic C57BL mice were used as normal control. OGTT, plasma insulin, HbA1c, serum adiponectin, Tβ4, cholesterol, and triglyceride were measured before and after Tβ4 treatment. The phosphorylated AKT and total AKT protein levels of skeletal muscle from all groups were determined.Results: After Tβ4 treatment, repeat OGTT showed a significant decrease in glucose profiles in the KK Tβ4 group compared with the KK control group. The KK-Tβ4 group had reduced mean HbA1c and triglyceride levels, and increased adiponectin compared with KK control group. C57BL mice showed normal glucose homeostasis. The phosphorylated AKT levels of skeletal muscle were significantly increased in KK Tβ4 group compared with KK control group after glucose stimulation. C57BL mice showed no changes in phosphorylated AKT levels after Tβ4 treatment.Conclusions: Tβ4 improved glucose intolerance and ameliorated insulin resistance in KK mouse. Tβ4 may be a potential alternative insulin sensitizer for treatment of T2DM.

Progress in stem cell therapy for the diabetic foot - Corrected Proof

Xiao-Yan Jiang, De-Bin Lu, Bing Chen — 2012-01-05

Abstract: The diabetic foot is a common and severe complication of diabetes comprising a group of lesions including vasculopathy, neuropathy, tissue damage and infection. Vasculopathy due to ischemia is a major contributor to the pathogenesis, natural history and outcome of the diabetic foot. Despite conventional revascularization interventions including angioplasty, stenting, atherectomy and bypass grafts to vessels, a high incidence of amputation persists. The need to develop alternative therapeutic options is compelling; stem cell therapy aims to increase revascularization and alleviate limb ischemia or improve wound healing by stimulating new blood vessel formation, and brings new hope for the treatment of the diabetic foot.

High YKL-40 levels predict mortality in patients with type 2 diabetes - Corrected Proof

2012-01-04

Abstract: Aims: We determined levels of the inflammatory marker YKL-40 in a population of patients with type 2 diabetes (T2D) and investigated the association with mortality.Methods: In a prospective observational follow-up study, 290 patients with T2D, normoalbuminuria (n=177), microalbuminuria (n=71) and macroalbuminuria (n=42) were followed for a median (range) of 17.2 (0.2–23.0) years. Serum YKL-40 concentration was determined at baseline.Results: Baseline median (IQR) YKL-40 level was 46ng/ml (36–67) in patients with normoalbuminuria, 61ng/ml (43–114) in microalbuminuric patients, and 81.5ng/ml (60–157) in patients with macroalbuminuria, p<0.001. During follow-up 189 patients (65.2%) died, 119 (41.0%) from cardiovascular causes. All-cause mortality was increased in patients with YKL-40 levels in the second and third tertile (hazard ratios (95% CI) compared with the first tertile, (1.50 (1.03–2.19), p=0.034, and 2.88 (2.01–4.12), p<0.001). This association persisted after adjustment for cardiovascular risk factors but was attenuated after additional adjustment for urinary albumin excretion rate and glomerular filtration rate.Cardiovascular mortality was increased with YKL-40 levels in the third tertile compared with the first tertile, (2.70 (1.78–4.08)), p<0.001. This association was diminished after adjustment for covariates.Conclusions: In patients with T2D and increasing albuminuria high YKL-40 levels predict all-cause mortality.

Metabolic memory: Mechanisms and implications for diabetic retinopathy - Corrected Proof

Liwei Zhang, Baihua Chen, Luosheng Tang — 2012-01-03

Abstract: Chronic hyperglycemia of diabetes leads to microvascular complications that severely impact quality of life. Diabetic retinopathy (DR) may be the most common of these and is a leading cause of visual impairment and blindness among working age adults in developed nations. Many large-scale type 1 and type 2 diabetes clinical trials have demonstrated that early intensive glycemic control can reduce the incidence and progression of micro and macrovasular complications. On the other hand, epidemiological and prospective data have revealed that the stressors of diabetic vasculature persist beyond the point when glycemic control has been achieved. These kinds of persistent adverse effects of hyperglycemia on the development and progression of complications has been defined as “metabolic memory”, and oxidative stress, advanced glycation end products and epigenetic changes have been implicated in the process. Recent studies have indicated that such “hyperglycemic memory” may also influence DR, suggesting that manipulation of hyperglycemic memory may prove a beneficial approach to prevention and treatment. This review summarizes the evidence from DR-related clinical trials and mechanistic studies to investigate the significance of metabolic memory in DR and understand its potential as a target of molecular therapeutics aimed at reversing hyperglycemic memory.

Proliferative diabetic retinopathy is a predictor of coronary artery disease in Japanese patients with type 2 diabetes - Corrected Proof

Tomohide Yamada, Takanobu Itoi, Yuka Kiuchi, Mitsuru Nemoto, Shigeo Yamashita — 2011-12-30

Abstract: A retrospective cohort study was performed to investigate the relationship between diabetic retinopathy and coronary artery disease in 371 Japanese adult patients with type 2 diabetes. We found that proliferative retinopathy was significantly associated with an increased risk of coronary artery disease, even after adjustment for classical coronary risk factors.

Personal continuous glucose monitoring (CGM) in diabetes management: Review of the literature and implementation for practical use - Corrected Proof

M. Joubert, Y. Reznik — 2011-12-30

Abstract: Aim: Despite recent advances in diabetes therapy including the new long- and rapid-insulin analogs, insulin intensification strategies such as basal/bolus or pump therapy and sophisticated methods for insulin titration derived from the principles of functional insulin therapy, many patients fail to reach or maintain target glycosylated hemoglobin (HbA1c) values, putting them at increased risk for vascular complications. Continuous glucose monitoring (CGM) systems represent an important advance in diabetes technology that can facilitate optimal glucose control in type 1 diabetes.Method: This review focuses on the efficacy and safety of CGM systems in diabetes management. The different CGM devices available are also described, as the way to use them and the educational approach to the patient in a step-by-step progression toward optimal glycemic control.Results: In type 1 diabetes, CGM systems are associated with 0.5–1% reduction in HbA1c without increased risk of hypoglycemia. CGM efficacy correlates with compliance to sensor wear, whatever the patient's age range.Conclusion: Efficacy of CGM systems is now proven but indications, terms of use and educational issues of this new technology still need to be specified.

Effects of renin–angiotensin system blockades on cardiovascular outcomes in patients with diabetes mellitus: A systematic review and meta-analysis - Corrected Proof

2011-12-26

Abstract: Aim: To determine whether renin–angiotensin system (RAS) blockade is beneficial for cardiovascular outcomes in patients with diabetes mellitus (DM) using meta-analysis.Methods: The MEDLINE and Cochrane library databases were searched for randomized controlled trials published up to June 2010. We also reviewed reference lists from identified trials and review articles to identify any other relevant studies, and the ClinicalTrials.gov website to identify randomized controlled trials that were registered as completed but not yet published. A random-effects model was used to combine the estimates for risk ratios (RR).Results: Eligible studies were randomized controlled trials (including post hoc analyses) assessing the effects of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers on cardiovascular events compared to controls in patients with DM. Nineteen clinical trials with 41,042 patients and 6039 cardiovascular events were identified. RAS blockade significantly reduced the risk of major cardiovascular events (RR 0.92, 95% confidence interval [CI] 0.84–1.00, I2 statistic 53%) and myocardial infarction (RR 0.82, 95% CI 0.72–0.94, I2=55%). There were trends towards fewer strokes and lower all-cause mortality but these were not statistically significant.Conclusions: The available evidence shows that treatment with RAS blockade can routinely be considered for diabetic patients to reduce major cardiovascular events.

Societal correlates of diabetes prevalence: An analysis across 94 countries - Corrected Proof

2011-12-22

Abstract: Aims: To quantify relationships between societal-level factors and diabetes prevalence and identify potential policy responses.Methods: Using data from International Diabetes Federation, World Health Organization, World Bank, and Food and Agricultural Organization, we extracted recent estimates for country-level variables: total caloric availability; sugar, animal fat, fruit and vegetable availability; physical inactivity markers (vehicles per capita and value-added from service sector); gross domestic product per capita (GDP); imports; and age-adjusted mortality rate. We used generalized linear models to investigate relationships between these factors and diabetes prevalence.Results: Median global diabetes prevalence was 6.4% in 2010. Every additional percentage point of calories from sugar/sweeteners and from animal fats were associated with 5% (OR: 1.05, 95% CI 1.02–1.07) and 3% (OR: 1.03, 95% CI 0.99–1.06) higher diabetes prevalence, respectively, while each additional unit in fruit and vegetable availability was associated with 3% lower diabetes prevalence (OR: 0.97, 95% CI 0.93–0.99). One percent higher GDP from the service industry was associated with a 1% higher diabetes prevalence (OR: 1.01, 95% CI 0.99–1.02).Conclusion: Macro-level societal factors are associated with diabetes prevalence. Investigating how these factors affect individual-level diabetes risk may offer further insight into policy-level interventions.

Elevated asymmetric dimethylarginine in plasma: An early marker for endothelial dysfunction in non-alcoholic fatty liver disease? - Corrected Proof

2011-12-21

Abstract: Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease. Asymmetric dimethylarginine (ADMA) is a novel marker of endothelial dysfunction and atherosclerosis. We aimed to investigate circulating ADMA concentrations in biopsy proven NAFLD and also to search its association with carotid atherosclerosis.Methods: Sixty-seven nondiabetic and normotensive patients with NAFLD and 35 healthy controls were enrolled. Plasma ADMA was measured along with glucose, lipids and insulin levels. Insulin resistance (IR) was assessed by homeostasis model assessment-estimated insulin resistance (HOMA-IR) method. Carotid atherosclerosis was evaluated by carotid artery intima-media thickness (CIMT) using carotid ultrasonography.Results: ADMA levels and CIMT measurements were significantly higher in NAFLD group than the controls. However, the difference regarding the CIMT disappeared when the findings were adjusted according to the metabolic parameters and insulin sensitivity. In contrast, the difference for ADMA remained significant between two groups. No significant association was found between ADMA, CIMT and histopathological findings.Conclusions: Plasma ADMA levels are increased in subjects with NAFLD. This increase seems to be independent from traditional cardiovascular risk factors, insulin resistance and liver histology. Circulating ADMA may be an earlier marker of vascular damage with respect to CIMT in subjects with NAFLD.

Effects of macronutrient composition of the diet on body fat in indigenous people at high risk of type 2 diabetes - Corrected Proof

Lorraine A. Brooking, Sheila M. Williams, Jim I. Mann — 2011-12-19

Abstract: Aims: We compared, in New Zealand Māori at risk of type 2 diabetes, advice emphasizing fiber rich carbohydrate and fat reduction (HCHF) and a high protein (HP) diet incorporating food preferences of indigenous people, with a control group (CONT).Methods: Eighty-four participants were randomized to three groups. Consecutive 8 week periods of supervised weight loss, supervised weight maintenance and unsupervised adherence to the prescribed diet using culturally sensitive methods were employed in intervention groups. Dietary compliance, body composition, blood pressure and metabolic variables were measured.Results: Body weight was reduced throughout on HP −2.6 (95% confidence interval: −4.4, −0.8)kg and HCHF (−1.6 (−3.0, −0.3)kg) compared with CONT. Total body fat (−1.6 (−3.0, −0.3)kg) and waist circumference (−3.0 (−5.7, −0.2)cm) showed sustained decreases on HP compared with CONT. Diet records suggested reasonable compliance with dietary advice on HP. Carbohydrate intake, but not dietary fiber, increased at the expense of fat on HCHF.Conclusions: While moderate weight loss occurred on both HP and HCHF, HP was associated with some further favorable differences compared with the control group.

Serious psychological distress, health risk behaviors, and diabetes care among adults with type 2 diabetes: The California Health Interview Survey 2007 - Corrected Proof

Jinah K. Shin, Ya-Lin Chiu, Sarah Choi, Soyeon Cho, Heejung Bang — 2011-12-12

Abstract: Aims: To examine the association between type 2 diabetes and serious psychological distress (SPD) and to assess if SPD was an independent risk factor for health risk behaviors and diabetes care among adults with diabetes.Methods: Cross-sectional analysis was performed using the 2007 California Health Interview Survey with adults in California. Multiple logistic models were used to examine the associations between the multiple risk and outcome factors.Results: Of the participants, 6.9% of adults had diagnoses of type 2 diabetes. SPD was present in 7.0% of adults with diabetes but only in 3.5% of adults without diabetes. Multiple logistic regression analysis revealed that participants with diabetes were significantly more likely than those without diabetes to experience SPD (OR=1.81; 95% CI=[1.3–2.5], p=0.0002), adjusting for other factors. In addition, participants with diabetes and SPD were more likely to report insufficient physical activity and more current cigarette smoking than participants without SPD. SPD among participants with diabetes, however, did not significantly affect good diabetes care.Conclusions: The findings suggest that adults with diabetes are more likely to experience SPD than adults without diabetes. Further research is needed to explore the underlying mechanisms for this association among adults with both diabetes and SPD.

Association analysis of −429T/C and −374T/A polymorphisms of receptor of advanced glycation end products (RAGE) gene in Malaysian with type 2 diabetic retinopathy - Corrected Proof

2011-12-12

Abstract: Conflicting results have been reported in different populations on the association between two particular RAGE gene polymorphisms (−429T/C and −374T/A) and retinopathy in diabetic patients. Therefore this study was designed to assess the association between both gene polymorphisms with retinopathy in Malaysian diabetic patients. A total of 342 type 2 diabetic patients [171 without retinopathy (DNR) and 171 with retinopathy (DR)] and 235 healthy controls were included in this study. Genomic DNA was obtained from blood samples and the screening for the gene polymorphisms was done using polymerase chain reaction-restriction fragment length polymorphism approach. Overall, the genotype distribution for both polymorphisms was not statistically different (p>0.05) among the control, DNR and DR groups. The −429C minor allele frequency of DR group (12.0%) was not significantly different (p>0.05) when compared to DNR group (16.1%) and healthy controls (11.3%). The −374A allele frequency also did not differ significantly between the control and DNR (p>0.05), control and DR (p>0.05) as well as DNR and DR groups (p>0.05). This is the first study report on RAGE gene polymorphism in Malaysian DR patients. In conclusion, −429T/C and −374T/A polymorphisms in the promoter region of RAGE gene were not associated with Malaysian type 2 DR patients.

A systematic review of the association of diabetic retinopathy and cognitive impairment in people with Type 2 diabetes - Corrected Proof

R. Crosby-Nwaobi, S. Sivaprasad, A. Forbes — 2011-12-12

Abstract: A systematic review of studies reporting data on the relationship between diabetic eye disease and cognitive impairment in Type 2 diabetes was conducted. The increase in cognitive impairment has mirrored the global increase in diabetes. The aim of the systematic review was to determine the level of association between diabetic retinopathy and cognitive impairment. Item selection, data extraction and critical appraisal were undertaken using standard procedures and independently verified by two researchers. 3 out of 10 potentially relevant studies were included. All studies showed a level of association between diabetic retinopathy and cognitive impairment, suggesting a near threefold increased risk of cognitive impairment in patients with diabetic retinopathy compared to those without. An association of cognitive impairment and severity of diabetic retinopathy was found in males. Diabetic retinopathy was more strongly linked to impairment in the cognitive domains of verbal learning and recent memory. An increased risk of cognitive impairment in patients with diabetic retinopathy was found in the reviewed studies. However, the relationship of severity of diabetic retinopathy and cognitive impairment has not been established. Further studies with standardized measurements for cognitive impairment and diabetic retinopathy are required to delineate this relationship and the role of other factors in this relationship.

Measuring health-related quality of life in diabetic peripheral neuropathy: A systematic review - Corrected Proof

S.C. Smith, D.L. Lamping, G.D.H. Maclaine — 2011-12-12

Abstract: We undertook a systematic review of disease-specific measures of health-related quality of life (HRQL) in diabetic peripheral neuropathy (DPN) to appraise the scientific (psychometric) evidence and make recommendations about the best instrument(s) to use. DPN is a common complication of diabetes mellitus. A need to consider the broad impact of DPN, rather than just pain and the increasingly recognised need to assess patient-reported outcomes such as HRQL in evaluating healthcare has led to a demand for rigorous outcome measures. To identify appropriate disease-specific measures, we searched four databases: PubMed, Embase, PsycINFO and CINAHL Plus. Data were extracted from each article using a standard data extraction form and the psychometric properties of each HRQL measure were reviewed. We identified three DPN-specific measures of HRQL: PN-QOL-97, Norfolk QOL-DN, NeuroQoL. All three measures satisfy at least one criterion for both reliability and validity, though all also have some disadvantages. Where there is no requirement for multi-language versions, the PN-QOL-97 is a useful instrument. Studies that involve multiple languages would need to use the shorter QOL-DN but would also need to incorporate complementary instruments to address the psychological and emotional impact of DPN.

Pegylated interferon-α2b and ribavirin combination therapy induces Hashitoxicosis followed by type 1 diabetes mellitus - Corrected Proof

2011-12-12

Abstract: The combination of pegylated interferon-α2b (PEG-IFNα) and ribavirin (RBV) is a standard treatment for chronic hepatitis C. The case of a patient with chronic hepatitis C who developed Hashitoxicosis followed by type 1 diabetes mellitus (T1DM) with PEG-IFNα plus RBV combination therapy, but not IFNα alone, is presented.