Does "afternoon diabetes" predict diabetes?

Twenty-eight men were given morning and afternoon oral glucose tolerance tests in 1969 and again in 1975. According to British Diabetic Association criteria all 28 had normal morning values in 1969 but seven had "afternoon diabetes". Four men had diabetic values in the morning in 1975 but only two of these had had afternoon diabetes in 1969. Better prediction of subsequent diabetes was obtained by calculating the area under the morning glucose tolerance curve in 1969. All four men who progressed to diabetes had areas exceeding 1000 units, which distinguished them absolutely from the other 24. They also tended to be more obese, but this was less predictive of subsequent diabetes.     

Gestational diabetes: a non-entity?

Screening for gestational diabetes is commonly recommended despite the absence of a common definition of gestational diabetes. Furthermore, there is no consensus about management or treatment. Those who recommend screening do so largely on the basis of fetal morbidity, which seems to be predominantly "macrosomia"--another term without an agreed definition. The implications of macrosomia in terms of actual morbidity are also not clear. R J Jarrett reviews the history of the subject and concludes that gestational diabetes is simply impaired glucose tolerance temporally associated with pregnancy. Its main importance is as a predictor of subsequent non-insulin dependent diabetes, but it fails the major tests for a condition suitable for a screening programme.     

Zinc and diabetes mellitus: is there a need of zinc supplementation in diabetes mellitus patients?

Diabetes mellitus is a group of metabolic disorders, the incidence of which varies widely throughout the world. The treatment of diabetes mellitus includes insulin, oral antidiabetic agents, and dietary regimens. Although the emphasis is on macronutrients intakes, there is strong evidence that there is an abnormal metabolism of several micronutrients in diabetic individuals. Zinc is one of the essential micronutrients of which status and metabolism is altered in this condition. This work is a short review about the close relation among zinc, glucose metabolism, and insulin physiology, as well as about the few experimental data about zinc absorption and zinc supplementation in diabetes mellitus patients.     

Setting research priorities for Type 1 diabetes

Diabet. Med. 29, 1321-1326 (2012) ABSTRACT: Aims Research priorities are often set by academic researchers or the pharmaceutical industry. The interests of patients, carers and clinicians may therefore be overlooked and research questions that matter may be neglected. The aims of this study were to collect uncertainties about the treatment of Type?1 diabetes from patients, carers and health professionals, and to collate and prioritize these uncertainties to develop a top 10 list of research priorities, using a structured priority-setting partnership of patients, carers, health professionals and diabetes organizations, as described by the James Lind Alliance. Methods A partnership of interested organizations was set up, and from this a steering committee of 10 individuals was formed. An online and paper survey was used to identify uncertainties. These were collated, and the steering group carried out an interim priority-setting exercise with partner organizations. This group of uncertainties was then voted on to give a smaller list that went forward to the final priority-setting workshop. At this meeting, a final list of the top 10 research priorities was agreed. Results An initial 1141 uncertainties were described. These were reduced to 88 indicative questions, 47 of which went out for voting. Twenty-four were then taken forward to a final priority-setting workshop. This workshop resulted in a list of top 10 research priorities in Type?1 diabetes. Conclusion We have shown that it is possible using the James Lind Alliance process to develop an agreed top 10 list of research priorities for Type?1 diabetes from health professionals, patients and carers.     

Is gestational diabetes an acquired condition?

Intrvenous injection of 30 mg of streptozotocin per kg body weight induces a mild diabetes in pregnant rats (first generation); the non-fasting blood glucose is increased and the percentage of endocrine tissue and also the percentage of granulated beta cells do not increase. The fetuses of these mildly diabetic pregnant rats have an increased percentage of pancreatic endocrine tissue and there is beta-cell degranulation. The modifications in the endocrine pancreas during intrauterine life causes persistent changes in later adult life (second generation), which are not perceptible in basal conditions, but become apparent in situations stressing the beta-cell activity, such as an intravenous glucose load or pregnancy. During pregnancy in the second generation rats an increased non-fasting blood glucose and no adaptation of the beta cells is seen. This inadequate adaptation to pregnancy causes changes in the fetal endocrine pancreas of the fetuses of the third generation. From these experiments it may be concluded that gestational diabetes is an acquired condition.     

Selenium and diabetes: an enigma?

In recent years diabetes has become one of the most common metabolic diseases in developed countries and it is closely related to supernutrition and obesity. Since untreated diabetes produces oxidative stress responsible for secondary complications of the disease, antioxidant supplements were considered as being favourable for the therapy of diabetes. However, the situation has changed recently, since large cross-sectional and interventional trials revealed a positive correlation between a high Se status and diabetes incidence in humans. Thus, currently available data on the role of Se in diabetes are inconsistent and an enigma appears to exist for the relation between selenium and diabetes. This review summarizes selected human and animal studies, pointing to beneficial and critical virtues of Se in diabetes. Moreover, the review discusses possible underlying mechanisms how Se may influence diabetes in both directions. From the current literature, the following information can be extracted: (1) In populations with a high Se status, with the single exception of pregnant women, Se supplements cannot be recommended for the prevention of diabetes; (2) Anti-diabetic effects of Se seem to be restricted to high and nearly toxic doses which cannot be used in humans; and (3) Future investigations should consider the stage of the disease.     

Eicosanoids, β-cell function, and diabetes

Arachidonic acid (AA) is metabolized by cyclooxygenase (COX), lipoxygenase (LOX), and cytochrome P450 (CYP) enzymes into eicosanoids, which are involved in diverse diseases, including type 1 and type 2 diabetes. During the last 30 years, evidence has been accumulated that suggests important functions for eicosanoids in the control of pancreatic β-cell function and destruction. AA metabolites of the COX pathway, especially prostaglandin E(2) (PGE(2)), appear to be significant factors to β-cell dysfunction and destruction, participating in the pathogenesis of diabetes and its complications. Several elegant studies have contributed to the sorting out of the importance of 12-LOX eicosanoids in cytokine-mediated inflammation in pancreatic β cells. The role of CYP eicosanoids in diabetes is yet to be explored. A recent publication has demonstrated that stabilizing the levels of epoxyeicosatrienoic acids (EETs), CYP eicosanoids, by inhibiting or deleting soluble epoxide hydrolase (sEH) improves β-cell function and reduces β-cell apoptosis in diabetes. In this review we summarize recent findings implicating these eicosanoid pathways in diabetes and its complications. We also discuss the development of animal models with targeted gene deletion and specific enzymatic inhibitors in each pathway to identify potential targets for the treatment of diabetes and its complications.     

Of fat, β cells, and diabetes

The molecular mechanisms linking diet, obesity, and type 2 diabetes are still poorly understood. In a recent paper, Ohtsubo et?al. (2011) show that high lipid levels induce nuclear exclusion of Foxa2 and HNF1α in β cells, leading to impaired expression and glycosylation of proteins controlling glucose-stimulated insulin secretion.     

Insulin--a primary autoantigen in type 1 diabetes?

Two recently published papers highlight the importance of insulin as a major autoantigenic target of the T cell autoimmune attack in the non-obese diabetic mouse model of diabetes and in type 1 diabetes in humans. Knowledge of the major targets of the autoimmune attack will enable us specifically to focus on these to develop treatments that could alter the ability of pathogenic T cells to cause diabetes. Targeting these T cells could be a strategy for the prevention and cure of the diabetes in the future.     

Type 1 diabetes as a relapsing-remitting disease?

Chronic immunological processes that underlie persistent viral infections and autoimmune disorders such as multiple sclerosis can be relapsing-remitting in nature. The progressive loss of beta-cell mass during the development of autoimmune type 1 diabetes (T1D) can also be non-linear, but the exact nature and kinetics of the immunological processes that govern T1D are not known. Here, we propose that the immunological process that is at the root of T1D is relapsing-remitting in nature and discuss the unresolved controversies and therapeutic implications of this hypothesis.     

Mild streptozotocin diabetes in the Göttingen minipig. A novel model of moderate insulin deficiency and diabetes

Nonrodent models of diabetes are needed for practical and physiological reasons. Induction of mild insulin-deficient diabetes was investigated in male G?ttingen minipigs by use of streptozotocin (STZ) alone (75, 100, and 125 mg/kg) or 125 mg/kg combined with pretreatment with nicotinamide (NIA; 0, 20, 67, 100, 150, and 230 mg/kg). Use of NIA resulted in a less steep slope of the regression line between fasting plasma glucose and changing doses compared with STZ [-7.0 +/- 1.4 vs. 29.7 +/- 7.0 mM. mg(-1). kg(-1), P < 0.0001]. Intermediate NIA doses induced moderate changes of glucose tolerance [glucose area under the curve increased from 940 +/- 175 to 1,598 +/- 462 mM. min, P < 0.001 (100 mg/kg) and from 890 +/- 109 to 1,669 +/- 691 mM. min, P = 0.003 (67 mg/kg)] with reduced insulin secretion [1,248 +/- 602 pM. min after 16 days and 1,566 +/- 190 pM. min after 60 days vs. 3,251 +/- 804 pM. min in normal animals (P < 0.001)] and beta-cell mass [5.5 +/- 1.4 mg/kg after 27 days and 7.9 +/- 4.1 mg/kg after 60 days vs. 17.7 +/- 4.7 mg/kg in normal animals (P = 0.009)]. The combination of NIA and STZ provided a model characterized by fasting and especially postprandial hyperglycemia and reduced, but maintained, insulin secretion and beta-cell mass. This model holds promise as an important tool for studying the pathophysiology of diabetes and development of new pharmacological agents for treatment of the disease.     

Global diabetes landscape—type 2 diabetes mellitus in South Asia: Epidemiology,risk factors,and control

Background: Type 2 diabetes mellitus (DM) is a new epidemic in South Asia and is the result of societal influences and changing lifestyles. Epidemiologic studies suggest that the prevalence of DM has increased exponentially in urban and rural populations.Objective: This study was conducted to determine trends in the prevalence of DM in various countries in South Asia.Methods: We performed an extensive, systematic MEDLINE search for primary articles that reported on the epidemiology of DM in South Asia. Additional articles were obtained from personal collections and references cited in the primary articles. No formal meta-analysis was performed because of differing methodologies and diagnostic criteria.Results: Epidemiologic studies conducted in India during the 1960s and 1970s, using random and postload blood glucose estimations, reported DM in 1% to 4% of urban populations and 1% to 2% of rural populations. More standardized epidemiologic studies in adults since the late 1980s reported DM in 5% to 15% of urban populations, 4% to 6% of semiurban populations, and 2% to 5% of rural populations. A significantly increasing trend has been observed in urban populations (exponential trend R² = 0.74), whereas the increase is slower (R² = 0.29) in rural populations. The diabetes scenario is similar in other South Asian countries. Current prevalence rates are 5% to 16% in urban areas and 2% to 8% in rural areas. Risk factors for DM in this region are increasing sedentariness, dietary excess, obesity (especially high waist-to-hip ratio), low birth weight, and genetic influences.Conclusions: DM is a major public health problem in South Asia. The prevalence is higher in urban areas than in rural areas and is increasing. Population-based measures to control the epidemic of DM include avoidance of adiposity through enhanced physical activity and regulated calorie intake. A comprehensive national chronic care program is needed.     

Macroautophagy: protector in the diabetes drama?

Macroautophagy ("autophagy") is regulated by the same insulin-amino acid-mTOR signaling pathway that controls protein synthesis. Although the literature does not so far include any direct studies confirming this, we expect autophagy to increase during insulin resistance. We discuss the possibility that this may be a useful mechanism for eliminating damaged mitochondria and other cell structures to prevent cell death.     

Coeliac disease in Type 1 diabetes from 1990 to 2009: higher incidence in young children after longer diabetes duration

Diabet. Med. 29, e286-e289 (2012) ABSTRACT: Aims To determine the incidence of coeliac disease in young people with Type?1 diabetes and to examine the effect of age at diabetes onset and disease duration. Methods This was a clinic-based observational cohort study of 4379 people aged ≤?18?years (49% male) between 1990 and 2009 from Sydney, Australia. Screening for coeliac disease was performed at diagnosis and 1-2?yearly using anti-endomysial and/or anti-tissue transglutaminase immunoglobulin?A (IgA) antibodies. Coeliac disease was diagnosed by small bowel biopsy based on Marsh score ≥?III. Results Coeliac disease was confirmed by biopsy in 185; of these, 61 (33%) were endomysial or tissue transglutaminase IgA antibody-positive at diabetes diagnosis. Mean age at diabetes onset was 6.6?±?4.0 vs. 8.4?±?4.1?years in those without coeliac disease (P?相似文献