To screen or not to screen for pre-type 1 diabetes?

The incidence of type 1 diabetes is increasing worldwide and the disease is an onerous burden both to the individual and to society. There are thus important reasons to screen for the disease before it becomes manifest: (1) to improve understanding of the natural history of the prediabetic period; (2) to gain further insights into the immunopathogenesis of the disease; (3) to identify individuals for prevention trials; (4) to make an earlier diagnosis in order to reduce morbidity and mortality. Great strides have been made, yet there is still a great deal to be learned. Opponents of screening argue that screening tests for the disease have a low positive predictive value and that predicting the disease without a primary prevention capability raises ethical considerations because of induced stress, lifestyle changes, cost and potential effects on insurability. The greatest single barrier against large-scale population screening and prevention of the disease remains the lack of an effective intervention. However, screening in the context of well-designed research studies must continue - ultimately the benefit to the individual and to society will be immense.     

Screening for celiac disease in poorly controlled type 2 diabetes mellitus: worth it or not?

Background

Recent studies have demonstrated that immune factors might have a role in the pathophysiology of insulin resistance and type 2 diabetes mellitus (T2DM). Inappropriate glycemic control in patients with T2DM is an important risk factor for the occurrence of diabetes complications. The prevalence of celiac disease (CD) is high in type 1 diabetes mellitus however, there are scarce data about its prevalence in T2DM. Our aim was to investigate the prevalence of celiac disease among insulin-using type 2 diabetes patients with inappropriate glycemic control.

Methods

IgA tissue transglutaminase antibodies (tTGA IgA) test was performed as a screening test. A total of 135 patients with T2DM whose control of glycemia is inappropriate (HbAlc value >7%) in spite of using insulin treatment for at least 3-months (only insulin or insulin with oral antidiabetic drugs) and 115 healthy controls were enrolled in the study. Upper gastrointestinal endoscopy with duodenal biopsy was performed to all patients with raised tTGA IgA or selective lgA deficiency.

Results

Gender, age, body mass index (BMI) and tTGA IgA, kreatinin, calcium, LDL-cholesterol (LDL-C), total cholesterol, 25-OH vitamin D₃ levels were similar between groups. Systolic and diastolic blood pressure, waist circumference, fasting plasma glucose, postprandial plasma glucose, urea, sodium, HbA1c, LDL-C, triglyceride, vitamin B12 levels were significantly higher in DM group (p < 0.0001). BMI, high-sensitive CRP, microalbuminuria, and AST, ALT, potassium, phosphorus levels were significantly higher in the T2DM group (p < 0.05). HDL-cholesterol and parathormone levels were significantly lower in the T2DM group (p < 0.05). Two of the 135 patients with T2DM were diagnosed with CD (1.45%).

Conclusions

The prevalence of celiac disease among patients with type 2 diabetes, with poor glycemic control despite insulin therapy, is slightly higher than the actual CD prevalence in general population. Type 2 diabetic patients with inappropriate control of glycemia in spite of insulin treatment might be additionally tested for Celiac disease especially if they have low C-peptide levels.

     

Obesity--a risk factor for diabetic retinopathy in type 2 diabetes?

The aim of the study was to investigate whether obesity, independently or associated with other risk factors, increases the risk for the diabetic retinopathy in type 2 diabetic persons. Data of 156 diabetic persons that have consecutively attended the Outpatient Department in the Vuk Vrhovac Institute in Zagreb during two months period were studied. According to their body mass index (BMI) they were divided into three groups: group 1 (BMI < or = 25; n = 49), group 2 (BMI 26-29.9; n = 52) and group 3 (BMI > or = 30; n = 55). The three groups did not differ in age, duration of diabetes, treatment, cholesterol, HDL-cholesterol and triglycerides. With increase in BMI, we observed a significant deterioration of HbA1c and a significant increase in LDL-cholesterol, systolic and diastolic blood pressure. Statistical analyses shown that the prevalence of retinopathy increased significantly with higher body weight (gr. 1: 40.8%, gr. 2: 63.4%, gr. 3: 63.6%;p < 0.05), but also with correlation to quality of metabolic control (HbA1c) and systolic blood pressure. Therefore, obesity may be, because of its significant correlation to quality of metabolic control (HbA1c) and systolic blood pressure, considered as risk factor for diabetic retinopathy in type 2 diabetic persons.     

Should we account for detectability in population trends?

Capsule?Accounting for changes in detectability over time which could invalidate population trends for common and widespread breeding birds in the UK, resulted in little change in trends for the majority of species considered.

Aims?To examine whether detectability has a significant influence on population trends for common and widespread breeding birds in the UK.

Methods?Using data collected over 16 years of the UK Breeding Bird Survey (1994–2009) and focusing on a random sample of 20 common and widespread bird species, we examine the extent to which controlling for temporal change in detectability would influence national population trends.

Results?Population trends were significantly different for only 2 of the 20 species, Common Blackbird and Winter Wren. This difference corresponds to an apparent fall off in detectability of these species between 2005 and 2009. For the remaining species, controlling for detectability resulted in no significant difference in population trends.

Conclusions?The importance of detectability should be examined as part of any long-term monitoring programme. However, currently we do not find sufficient support for routinely incorporating detectability into population trends for widespread and abundant breeding birds in the UK.     

Should we expect population thresholds for wildlife disease?

Host population thresholds for the invasion or persistence of infectious disease are core concepts of disease ecology and underlie disease control policies based on culling and vaccination. However, empirical evidence for these thresholds in wildlife populations has been sparse, although recent studies have begun to address this gap. Here, we review the theoretical bases and empirical evidence for disease thresholds in wildlife. We see that, by their nature, these thresholds are rarely abrupt and always difficult to measure, and important facets of wildlife ecology are neglected by current theories. Empirical studies seeking to identify disease thresholds in wildlife encounter recurring obstacles of small sample sizes and confounding factors. Disease control policies based solely on threshold targets are rarely warranted, but management to reduce abundance of susceptible hosts can be effective.     

Creatine-induced glucose uptake in type 2 diabetes: a role for AMPK-α?

This study focused on understanding the signaling mechanisms leading to GLUT-4 translocation and increased skeletal-muscle glucose uptake that follow creatine (Cr) supplementation in type 2 diabetes (n = 10). AMPK-α protein content presented a tendency to be higher (p = 0.06) after Cr supplementation (5 g/d for 12w). The changes in AMPK-α protein content significantly related (p < 0.001) to the changes in GLUT-4 translocation (r = 0.78) and Hb1Ac levels (r = ?0.68), suggesting that AMPK signaling may be implicated in the effects of supplementation on glucose uptake in type 2 diabetes.     

Stem-cell therapy for diabetes cure: how close are we?

Transplantation of insulin-producing cells offers a promising therapy to treat diabetes. However, due to the limited number of donor islet cells available, researchers are looking for different sources of pancreatic islet progenitor or stem cells. A stem cell with extensive proliferative ability may provide a valuable source of islet progenitor cells. Several studies have demonstrated that a progenitor/stem-cell population can be expanded in vitro to generate large numbers of islet progenitor cells. However, efficient and directed differentiation of these cells to an endocrine pancreatic lineage has been difficult to achieve. We discuss here various pancreatic islet stem cells that we and others have obtained from embryonic, fetal or adult human tissues. We review the progress that has been achieved with pancreatic islet progenitor cell differentiation in the last 2 decades and discuss how close we are to translate this research to the clinics.     

Should we expand the indications for analysis of fetal chromosomes?

The usual indications of amniocentesis for prenatal diagnosis are briefly reviewed. Some situations which are note included in these usual indications are discussed: mothers of 34 years, young aunts of a trisomic child, patients with a previous aborted conceptus diagnosed as trisomic by histological examination of the placenta or tissue culture. It is anticipated that, if accepted, these "unusual" criteria would not overload a given laboratory with an excess of analysis, and would certainly relief anxiety of motivated couples.     

Does type 2 diabetes predispose to osteoporotic bone fractures?

Chronic complications of diabetes are associated mainly with changes in major and small arterial vessels as well as in peripheral and autonomic fibers of the nervous system. For years it has been suggested that DM2 does not predispose to osteoporosis because bone mineral density (BMD) in DM2 patients is commonly normal or even increased. However, results of recent large cross-sectional studies have indicated that patients with DM2 have significantly increased risk of bone fractures, predominantly hip fractures (by 70%). Results of these studies suggest that the increased risk of fractures in DM2 is independent of BMD. In this group of patients is frequently associated the loss of vision caused by diabetic eye disease, peripheral neuropathy, arterial hypertension, orthostatic hypotonia (caused by autonomic neuropathy or/and by concomitant antihypertensive treatment), and ischemic disease of the brain, heart and lower extremities--conditions that predispose to falls. There are no specific methods of prophylaxis and treatment of osteoporosis associated with diabetes; therefore they should be based on widely accepted principles as in non-diabetic populations. It seems that in DM2 patients the most purposeful strategy could be the popularization of healthy attitudes aiming the elimination of unfavorable dietetic and environmental factors, such as low physical activity, smoking, and low vitamin D intake, as well as education against falls.