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Diabetes at the wheel - the need for safety and fairness under the law

Valente, Nabais
Fonte: Diabetes Voice Publicador: Diabetes Voice
Tipo: Artigo de Revista Científica
Português
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Hypoglycaemia at the wheel is the most common acute risk for drivers with diabetes, and a concern for public road safety. Drivers with diabetes worldwide are subject to special legislation, although the restrictions and requirements vary considerably from one country to another. But are drivers with diabetes really a danger? Are they more likely to provoke an accident than people without the condition? João Manuel Valente Nabais steers us through the related research and reports from Europe on the EU’s latest laws on driving with diabetes

Diabetes Gestacional e Hemoglobina A1c

Carocha, A; Rijo, C; Amaral, N; Aleixo, F; Rocha, T
Fonte: Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo Publicador: Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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Introdução: Há estudos que revelam que a Hemoglobina A1c (HbA1c) é um indicador confiável do controlo glicémico em grávidas com diabetes gestacional (DG). Objetivo: Relacionar os níveis de HbA1c no terceiro trimestre e o prognóstico materno-fetal. Tipo de estudo: Retrospetivo. População: Quatrocentos e setenta e quatro mulheres vigiadas na consulta de diabetes e gravidez com o diagnóstico de DG. Métodos: Dividiu-se a população em dois grupos: HbA1c <6% (grupo um) e HbA1c ≥6% (grupo dois). Foram avaliados: fatores de risco para diabetes gestacional, ganho de peso na gravidez, idade gestacional (IG) do diagnóstico, complicações na gravidez, administração de insulina, IG no parto, peso ao nascer e resultado do rastreio pós-parto. Resultados: No grupo um obteve-se 420 mulheres e no grupo dois 54. O grupo dois havia mulheres com maior IMC (27 vs 29 kg / cm2; p-value 0,007), história pessoal de diabetes gestacional(14,3% vs 27,6%; p-value 0,004) e macrossomia prévia (7,6% vs 14,8%; p-value 0,039). Neste mesmo grupo uma maior percentagem de grávidas efetuou insulina (28,6% vs 48,1%; p-value 0,005) e apresentou maior ganho de peso durante a gravidez (24,8% vs 55,6%; p-value 0,000). Verificou-se um maior número de casos de recém-nascidos grandes para a IG (6...

Diabetes Gestacional e Hemoglobina A1c

Carocha, A; Rijo, C; Amaral, N; Aleixo, F; Rocha, T
Fonte: Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo Publicador: Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
Relevância na Pesquisa
46.277515%
Introdução: Há estudos que revelam que a Hemoglobina A1c (HbA1c) é um indicador confiável do controlo glicémico em grávidas com diabetes gestacional (DG). Objetivo: Relacionar os níveis de HbA1c no terceiro trimestre e o prognóstico materno-fetal. Tipo de estudo: Retrospetivo. População: Quatrocentos e setenta e quatro mulheres vigiadas na consulta de diabetes e gravidez com o diagnóstico de DG. Métodos: Dividiu-se a população em dois grupos: HbA1c <6% (grupo um) e HbA1c ≥6% (grupo dois). Foram avaliados: fatores de risco para diabetes gestacional, ganho de peso na gravidez, idade gestacional (IG) do diagnóstico, complicações na gravidez, administração de insulina, IG no parto, peso ao nascer e resultado do rastreio pós-parto. Resultados: No grupo um obteve-se 420 mulheres e no grupo dois 54. O grupo dois havia mulheres com maior IMC (27 vs 29 kg / cm2; p-value 0,007), história pessoal de diabetes gestacional(14,3% vs 27,6%; p-value 0,004) e macrossomia prévia (7,6% vs 14,8%; p-value 0,039). Neste mesmo grupo uma maior percentagem de grávidas efetuou insulina (28,6% vs 48,1%; p-value 0,005) e apresentou maior ganho de peso durante a gravidez (24,8% vs 55,6%; p-value 0,000). Verificou-se um maior número de casos de recém-nascidos grandes para a IG (6...

Diabetes: Medical vs Surgical Disease?

Gurel, Ogan
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em /01/2008 Português
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The distinction between the medical and the surgical approach to disease has been a cornerstone of medical practice, and indeed with respect to the business and technology of medicine. It is common knowledge that diabetes is a medical disease—namely that drug therapy, whether it be via insulin or other medications, is the primary approach to therapy. This article argues that a reevaluation of the generalized (e.g., medication-based) approach to systemic blood sugar control may be in order. A consideration of the growing importance of interventional, device-based, or other surgical approaches to the primary management of diabetes has enormous implications for clinical practice as well as, of course, the business and technology of diabetes care.

Patch-Pump Technology to Manage Type 2 Diabetes Mellitus: Hurdles to Market Acceptance

Skladany, Matthew J.; Miller, Michaela; Guthermann, Joshua S.; Ludwig, Christopher R.
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em /11/2008 Português
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The recent development of novel “patch”-type insulin infusion pump (IIP) technologies has created an opportunity to improve the quality of life for a broader type 2 diabetes patient demographic. At first glance, type 2 diabetes patients represent a large percentage of the total diabetes patient population; however, adoption of traditional IIP products and multiple daily injection (MDI) therapy has remained limited amongst this patient segment. With an insulin reservoir, delivery system, and cannula integrated into a small, wearable, disposable or semidisposable device, patch pumps simplify traditional IIP therapy, while potentially offering therapeutic benefits over traditional MDI therapy. Herein, potential benefits of patch-pump technology for type 2 diabetes patients are considered while outlining the hurdles to broad product adoption that will likely limit the near term commercial opportunity.

Consumer Engagement for Diabetes Technology: Easier Said Than Done

Gruber, David
Fonte: Diabetes Technology Society Publicador: Diabetes Technology Society
Tipo: Artigo de Revista Científica
Publicado em 01/05/2010 Português
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Direct spending on diabetes, already exceeding $118 billion, is forecast to reach $336 billion in 2034, driven by newly diagnosed cases secondary to an aging, increasingly sedentary, obese population and the advent of comorbidities, particularly cardiovascular complications affecting more than one-third of persons with diabetes. Traditional, directive, and fragmented approaches to patient management based on acute intervention and specialty care has been unable to stem the impending tsunami of diabetes-related complications and costs. Health care reform and the growing shortage of primary care physicians will only exacerbate the situation.

Central Role for Interleukin-2 in Type 1 Diabetes

Hulme, Maigan A.; Wasserfall, Clive H.; Atkinson, Mark A.; Brusko, Todd M.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Português
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Type 1 diabetes presents clinically with overt hyperglycemia resulting from progressive immune-mediated destruction of pancreatic β-cells and associated metabolic dysfunction. Combined genetic and immunological studies now highlight deficiencies in both the interleukin-2 (IL-2) receptor and its downstream signaling pathway as a central defect in the pathogenesis of type 1 diabetes. Prior intervention studies in animal models indicate that augmenting IL-2 signaling can prevent and reverse disease, with protection conferred primarily by restoration of regulatory T-cell (Treg) function. In this article, we will focus on studies of type 1 diabetes noting deficient IL-2 signaling and build what we believe forms the molecular framework for their contribution to the disease. This activity results in the identification of a series of potentially novel therapeutic targets that could restore proper immune regulation in type 1 diabetes by augmenting the IL-2 pathway.

β-Cell Failure in Type 2 Diabetes: A Case of Asking Too Much of Too Few?

Costes, Safia; Langen, Ralf; Gurlo, Tatyana; Matveyenko, Aleksey V.; Butler, Peter C.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Português
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The islet in type 2 diabetes (T2DM) is characterized by a deficit in β-cells, increased β-cell apoptosis, and extracellular amyloid deposits derived from islet amyloid polypeptide (IAPP). In the absence of longitudinal studies, it is unknown if the low β-cell mass in T2DM precedes diabetes onset (is a risk factor for diabetes) or develops as a consequence of the disease process. Although insulin resistance is a risk factor for T2DM, most individuals who are insulin resistant do not develop diabetes. By inference, an increased β-cell workload results in T2DM in some but not all individuals. We propose that the extent of the β-cell mass that develops during childhood may underlie subsequent successful or failed adaptation to insulin resistance in later life. We propose that a low innate β-cell mass in the face of subsequent insulin resistance may expose β-cells to a burden of insulin and IAPP biosynthetic demand that exceeds the cellular capacity for protein folding and trafficking. If this threshold is crossed, intracellular toxic IAPP membrane permeant oligomers (cylindrins) may form, compromising β-cell function and inducing β-cell apoptosis.

Effects of energy-restricted diets containing increased protein on weight loss, resting energy expenditure, and the thermic effect of feeding of type 2 diabetes

Luscombe-Marsh, N.; Clifton, P.; Noakes, M.; Parker, B.; Wittert, G.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2002 Português
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Objective - To determine the effect of a high-protein (HP) diet compared with a low-protein (LP) diet on weight loss, resting energy expenditure (REE), and the thermic effect of food (TEF) in subjects with type 2 diabetes during moderate energy restriction. Research design and methods - In this study, 26 obese subjects with type 2 diabetes consumed a HP (28% protein, 42% carbohydrate) or LP diet (16% protein, 55% carbohydrate) during 8 weeks of energy restriction (1,600 kcal/day) and 4 weeks of energy balance. Body weight and composition and REE were measured, and the TEF in response to a HP or LP meal was determined for 2 h, at weeks 0 and 12. Results - The mean weight loss was 4.6 ± 0.4 kg (P < 0.001), of which 4.5 ± 0.4 kg was fat (P < 0.001), with no effect of diet (P = 0.6). At both weeks 0 and 12, TEF was greater after the HP than after the LP meal (0.064 vs. 0.050 kcal · kcal-1 energy consumed · 2 h-1, respectively; overall diet effect, P = 0.003). REE and TEF were reduced similarly with each of the diets (time effects, P = 0.02 and P < 0.001, respectively). Conclusions - In patients with type 2 diabetes, a low-fat diet with an increased protein-to-carbohydrate ratio does not significantly increase weight loss or blunt the fall in REE.; N.D. Luscombe...

Predictors of delayed gastric emptying in diabetes

Jones, K.; Russo, A.; Stevens, J.; Wishart, J.; Berry, M.; Horowitz, M.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2001 Português
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Objective — To define the predictors of the rate of gastric emptying in patients with diabetes. Research design and methods — A total of 101 outpatients with diabetes (79 type 1 and 22 type 2) underwent measurements of gastric emptying of a solid/liquid meal (scintigraphy), upper gastrointestinal symptoms (questionnaire), glycemic control (blood glucose concentrations during gastric emptying measurement), and autonomic nerve function (cardiovascular reflexes). Results— The gastric emptying of solid and/or liquid was delayed in 66 (65%) patients. Solid (retention at 100 min 64 6 3.2 vs. 50.2 6 3.6%, P , 0.005) and liquid (retention at 100 min 22.761.7 vs. 16.061.8%, P,0.001) gastric emptying was slower in women than in men. Of all upper gastrointestinal symptoms (including nausea and vomiting), only abdominal bloating/ fullness was associated with slower gastric emptying (P , 0.005). A multiple regression analysis demonstrated that both abdominal bloating/fullness and female sex were predictors of slower gastric emptying of both solids and liquids. Conclusions — We conclude that the presence of abdominal bloating/fullness but not any other upper gastrointestinal symptom is associated with diabetic gastroparesis and that gastric emptying is slower in diabetic women than in diabetic men.; Karen L. Jones...

Association between serum ferritin, hemoglobin, iron intake, and diabetes in adults in Jiangsu, China

Shi, Z.; Hu, X.; Yuan, B.; Pan, X.; Meyer, H.; Holmboe-Ottesen, G.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2006 Português
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Objective:— To investigate the association between iron status, iron intake, and diabetes among Chinese adults. Research design and methods— This cross-sectional household survey was carried out in 2002 in Jiangsu Province, China. The sample contained 2,849 men and women aged ≥20 years with a response rate of 89.0%. Iron intake was assessed by food weighing plus consecutive individual 3-day food records. Fasting plasma glucose (FPG), serum ferritin, and hemoglobin were measured.Results— The prevalence of anemia was 18.3% in men and 31.5% in women. Mean hemoglobin and serum ferritin increased across groups with increasing FPG. The prevalence of anemia among women was 15.0% in individuals with FPG >7.0 mmol/l compared with 32.6% in individuals with FPG<5.6 mmol/l. There was a similar, however not significant, trend among men. In women, after adjusting for known risk factors, the odds ratio (OR) of diabetes was 2.15 (95% CI 1.03– 4.51) for subjects in the upper quartile of hemoglobin compared with the rest, and the corresponding OR for the upper quartile of serum ferritin was 3.79 (1.72– 8.36). Iron intake was positively associated with diabetes in women; fourth quartile intake of iron yielded an OR of 5.53 (1.47–20.44) compared with the first quartile in the multivariate analyses. In men...

A 25-year longitudinal evaluation of gastric emptying in diabetes

Chang, J.; Russo, A.; Bound, M.; Rayner, C.; Jones, K.; Horowitz, M.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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OBJECTIVE: To evaluate the natural history of gastric emptying in diabetes. RESEARCH DESIGN AND METHODS: Thirteen patients with diabetes (12, type 1; 1, type 2) had measurements of gastric emptying, blood glucose levels, glycated hemoglobin, upper gastrointestinal symptoms, and autonomic nerve function at baseline and after 24.7 ± 1.5 years. RESULTS: There was no change in gastric emptying of either solids (% retention at 100 min) (baseline 58.5 ± 5% vs. follow-up 51.9 ± 8%; P = 0.35) or liquids (50% emptying time) (baseline 29.8 ± 3 min vs. follow-up 34.3 ± 6 min; P = 0.37). Gastric emptying of solid at follow-up was related to emptying at baseline (r = 0.56, P < 0.05). At follow-up, blood glucose concentrations were lower (P = 0.006), autonomic function deteriorated (P = 0.03), and gastrointestinal symptoms remained unchanged (P = 0.17). CONCLUSIONS: In unselected patients with diabetes, gastric emptying appears remarkably stable over 25 years.; Jessica Chang, Antonietta Russo, Michelle Bound, Christopher K. Rayner, Karen L. Jones and Michael Horowitz

Early prediction of gestational diabetes mellitus in Vietnam: clinical impact of currently recommended diagnostic criteria

Tran, T.; Hirst, J.; Do, M.; Morris, J.; Jeffery, H.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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OBJECTIVE: We aimed to compare the discriminative power of prognostic models for early prediction of women at risk for the development of gestational diabetes mellitus (GDM) using four currently recommended diagnostic criteria based on the 75-g oral glucose tolerance test (OGTT). We also described the potential effect of application of the models into clinical practice. RESEARCH DESIGN AND METHODS: A prospective cross-sectional study of 2,772 pregnant women was conducted at a referral maternity center in Vietnam. GDM was determined by the American Diabetes Association (ADA), International Association of the Diabetes and Pregnancy Study Groups (IADPSG), Australasian Diabetes in Pregnancy Society (ADIPS), and World Health Organization (WHO) criteria. Prognostic models were developed using the Bayesian model averaging approach, and discriminative power was assessed by area under the curve. Different thresholds of predicted risk of developing GDM were applied to describe the clinical impact of the diagnostic criteria. RESULTS: The magnitude of GDM varied substantially by the diagnostic criteria: 5.9% (ADA), 20.4% (IADPSG), 20.8% (ADIPS), and 24.3% (WHO). The ADA prognostic model, consisting of age and BMI at booking, had the best discriminative power (area under the curve of 0.71) and the most favorable cost-effective ratio if implemented in clinical practice. Selective screening of women for GDM using the ADA model with a risk threshold of 3% gave 93% sensitivity for identification of women with GDM with a 27% reduction in the number of OGTTs required. CONCLUSIONS: A simple prognostic model using age and BMI at booking could be used for selective screening of GDM in Vietnam and in other low- and middle-income settings.; Thach S. Tran...

Disordered control of intestinal sweet taste receptor expression and glucose absorption in type 2 diabetes

Young, R.; Chia, C.; Isaacs, N.; Ma, J.; Khoo, J.; Wu, T.; Horowitz, M.; Rayner, C.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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We previously established that the intestinal sweet taste receptors (STRs), T1R2 and T1R3, were expressed in distinct epithelial cells in the human proximal intestine and that their transcript levels varied with glycemic status in patients with type 2 diabetes. Here we determined whether STR expression was 1) acutely regulated by changes in luminal and systemic glucose levels, 2) disordered in type 2 diabetes, and 3) linked to glucose absorption. Fourteen healthy subjects and 13 patients with type 2 diabetes were studied twice, at euglycemia (5.2 ± 0.2 mmol/L) or hyperglycemia (12.3 ± 0.2 mmol/L). Endoscopic biopsy specimens were collected from the duodenum at baseline and after a 30-min intraduodenal glucose infusion of 30 g/150 mL water plus 3 g 3-O-methylglucose (3-OMG). STR transcripts were quantified by RT-PCR, and plasma was assayed for 3-OMG concentration. Intestinal STR transcript levels at baseline were unaffected by acute variations in glycemia in healthy subjects and in type 2 diabetic patients. T1R2 transcript levels increased after luminal glucose infusion in both groups during euglycemia (+5.8 × 10⁴ and +5.8 × 10⁴ copies, respectively) but decreased in healthy subjects during hyperglycemia (-1.4 × 10⁴ copies). T1R2 levels increased significantly in type 2 diabetic patients under the same conditions (+6.9 × 10⁵ copies). Plasma 3-OMG concentrations were significantly higher in type 2 diabetic patients than in healthy control subjects during acute hyperglycemia. Intestinal T1R2 expression is reciprocally regulated by luminal glucose in health according to glycemic status but is disordered in type 2 diabetes during acute hyperglycemia. This defect may enhance glucose absorption in type 2 diabetic patients and exacerbate postprandial hyperglycemia; Richard L. Young...

The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes

Groop, P.H.; Thomas, M.; Moran, J.; Waden, J.; Thorn, L.; Makinen, V.P.; Rosengard-Barlund, M.; Saraheimo, M.; Hietala, K.; Heikkia, O.; Forsblom, C.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
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OBJECTIVES This study aimed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes. RESEARCH DESIGN AND METHODS The Finnish Diabetic Nephropathy (FinnDiane) study is a national multicenter prospective follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals, 33 district hospitals, and 26 primary health care centers across Finland. RESULTS During a median 7 years of follow-up, there were 291 deaths (7%), 3.6-fold (95% CI 3.2–4.0) more than that observed in the age- and sex-matched general population. Excess mortality was only observed in individuals with chronic kidney disease. Individuals with normoalbuminuria showed no excess mortality beyond the general population (standardized mortality ratio [SMR] 0.8, 95% CI 0.5–1.1), independent of the duration of diabetes. The presence of microalbuminuria, macroalbuminuria, and end-stage kidney disease was associated with 2.8, 9.2, and 18.3 times higher SMR, respectively. The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease. In addition, the glomerular filtration rate was independently associated with mortality...

Impact of common variation in bone-related genes on type 2 diabetes and related traits

Billings, L.; Hsu, Y.H.; Ackerman, R.; Dupuis, J.; Voight, B.; Rasmussen-Torvik, L.; Hercberg, S.; Lathrop, M.; Barnes, D.; Langenberg, C.; Hui, J.; Fu, M.; Bouatia-Naji, N.; Lecoeur, C.; An, P.; Magnusson, P.; Surakka, I.; Ripatti, S.; Christiansen, L.;
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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Exploring genetic pleiotropy can provide clues to a mechanism underlying the observed epidemiological association between type 2 diabetes and heightened fracture risk. We examined genetic variants associated with bone mineral density (BMD) for association with type 2 diabetes and glycemic traits in large well-phenotyped and -genotyped consortia. We undertook follow-up analysis in ∼19,000 individuals and assessed gene expression. We queried single nucleotide polymorphisms (SNPs) associated with BMD at levels of genome-wide significance, variants in linkage disequilibrium (r2 > 0.5), and BMD candidate genes. SNP rs6867040, at the ITGA1 locus, was associated with a 0.0166 mmol/L (0.004) increase in fasting glucose per C allele in the combined analysis. Genetic variants in the ITGA1 locus were associated with its expression in the liver but not in adipose tissue. ITGA1 variants appeared among the top loci associated with type 2 diabetes, fasting insulin, β-cell function by homeostasis model assessment, and 2-h post–oral glucose tolerance test glucose and insulin levels. ITGA1 has demonstrated genetic pleiotropy in prior studies, and its suggested role in liver fibrosis, insulin secretion, and bone healing lends credence to its contribution to both osteoporosis and type 2 diabetes. These findings further underscore the link between skeletal and glucose metabolism and highlight a locus to direct future investigations.; Liana K. Billings...

Weight gain in early life predicts risk of islet autoimmuity in children with a first-degree relative with type 1 diabetes

Couper, J.; Beresford, S.; Hirte, C.; Baghurst, P.; Pollard, A.; Tait, B.; Harrison, L.; Colman, P.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
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OBJECTIVE—In a prospective birth cohort study, we followed infants who had a first-degree relative with type 1 diabetes to investigate the relationship between early growth and infant feeding and the risk of islet autoimmunity. RESEARCH DESIGN AND METHODS—Infants with a first-degree relative with type 1 diabetes were identified during their mother's pregnancy. Dietary intake was recorded prospectively to determine duration of breast-feeding and age at introduction of cow's milk protein, cereals, meat, fruit, and vegetables. At 6-month reviews, length (or height) and weight, antibodies to insulin, GAD65, the tyrosine phosphatase-like insulinoma antigen, and tissue transglutaminase were measured. Islet autoimmunity was defined as persistent elevation of one or more islet antibodies at consecutive 6-month intervals, including the most recent measure, and was the primary outcome measure. RESULTS—Follow-up of 548 subjects for 5.7 ± 3.2 years identified 46 children with islet autoimmunity. Weight z score and BMI z score were continuous predictors of risk of islet autoimmunity (adjusted hazard ratios 1.43 [95% CI 1.10–1.84], P = 0.007, and 1.29 [1.01–1.67], P = 0.04, respectively). The risk of islet autoimmunity was greater in subjects with weight z score >0 than in those with weight z score ≤0 over time (2.61 [1.26–5.44]...

Maternal and neonatal circulating markers of metabolic and cardiovascular risk in the Metformin in Gestational Diabetes (MiG) trial: Responses to maternal metformin versus insulin treatment

Barrett, H.; Gatford, K.; Houda, C.; De Blasio, M.; McIntyre, H.; Callaway, L.; Nitert, M.; Coat, S.; Owens, J.; Hague, W.; Rowan, J.
Fonte: Amer Diabetes Assoc Publicador: Amer Diabetes Assoc
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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OBJECTIVE: This study was designed to compare glucose, lipids, and C-reactive protein (CRP) in women with gestational diabetes mellitus treated with metformin or insulin and in cord plasma of their offspring and to examine how these markers relate to infant size at birth. RESEARCH DESIGN AND METHODS: Women with gestational diabetes mellitus were randomly assigned to metformin or insulin in the Metformin in Gestational Diabetes trial. Fasting maternal plasma glucose, lipids, and CRP were measured at randomization, 36 weeks' gestation, and 6-8 weeks postpartum as well as in cord plasma. Women with available cord blood samples (metformin n = 236, insulin n = 242) were included. RESULTS: Maternal plasma triglycerides increased more from randomization to 36 weeks' gestation in women treated with metformin (21.93%) versus insulin (9.69%, P < 0.001). Maternal and cord plasma lipids, CRP, and neonatal anthropometry did not differ between treatments. In logistic regression analyses adjusted for confounders, the strongest associations with birth weight >90th centile were maternal triglycerides and measures of glucose control at 36 weeks. CONCLUSIONS: There were few differences in circulating maternal and neonatal markers of metabolic status and no differences in measures of anthropometry between the offspring of women treated with metformin and the offspring of women treated with insulin. There may be subtle effects of metformin on maternal lipid function...

Failure to maintain the benefits of home-based intervention in adolescents with poorly controlled type 1 diabetes.

Couper, J.; Taylor, J.; Fotheringham, M.; Sawyer, M.
Fonte: AMER DIABETES ASSOC Publicador: AMER DIABETES ASSOC
Tipo: Artigo de Revista Científica
Publicado em //1999 Português
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OBJECTIVE: To determine whether a 6-month home-based intervention program in adolescents with poorly controlled diabetes improves metabolic control and whether benefits are maintained after the intervention. RESEARCH DESIGN AND METHODS: Adolescents with a mean HbA1c of > 9.0% over the preceding 12 months received either routine care in a diabetes clinic and an ambulatory intervention for 6 months (n = 37) or routine care only (n = 32). A diabetes educator provided monthly home visits and weekly phone contact to educate and support the adolescents in setting goals for insulin adjustment, blood glucose monitoring, and target blood glucose range. There was no systematic change in the frequency of insulin injections. After the intervention, there was a 12-month follow-up when the intervention and control groups both received only routine care. Outcome measures were HbA1c and Diabetes Knowledge Assessment (DKN). RESULTS: During the intervention, mean HbA1c fell (baseline: 11.1 +/- 1.3%, 6 months: 9.7 +/- 1.6%; P = 0.0001) and mean knowledge scores increased (P = 0.0001) in the intervention group but not in control subjects. However, this improvement in HbA1c and increase in knowledge was not maintained in the intervention group at 12- and 18-month follow-up assessments. Parents' knowledge scores also improved significantly from baseline levels in the intervention group at 6 and 12 months (P = 0.001...

Common genetic variants highlight the role of insulin resistance and body fat distribution in type 2 diabetes, independently of obesity

Scott, Robert A.; Fall, Tove; Pasko, Dorota; Barker, Adam; Sharp, Stephen J.; Arriola, Larraitz; Balkau, Beverley; Barricarte, Aurelio; Barroso, In?s; Boeing, Heiner; Clavel-Chapelon, Fran?oise; Crowe, Francesca L.; Dekker, Jacqueline M.; Fagherazzi, Guy;
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Article; accepted version
Português
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This is the author accepted manuscript. The final version is available from the American Diabetes Association via http://dx.doi.org/10.2337/db14-0319; We aimed to validate genetic variants as instruments for insulin resistance and secretion, to characterise their association with intermediate phenotypes, and to investigate their role in T2D risk among normal-weight, overweight and obese individuals.We investigated the association of genetic scores with euglycaemic-hyperinsulinaemic clamp- and OGTT-based measures of insulin resistance and secretion, and a range of metabolic measures in up to 18,565 individuals. We also studied their association with T2D risk among normal-weight, overweight and obese individuals in up to 8,124 incident T2D cases. The insulin resistance score was associated with lower insulin sensitivity measured by M/I value (? in SDs-per-allele [95%CI]:-0.03[-0.04,-0.01];p=0.004). This score was associated with lower BMI (-0.01[-0.01,-0.0;p=0.02) and gluteofemoral fat-mass (-0.03[-0.05,-0.02;p=1.4x10-6), and with higher ALT (0.02[0.01,0.03];p=0.002) and gamma-GT (0.02[0.01,0.03];p=0.001). While the secretion score had a stronger association with T2D in leaner individuals (pinteraction=0.001), we saw no difference in the association of the insulin resistance score with T2D among BMI- or waist-strata(pinteraction>0.31). While insulin resistance is often considered secondary to obesity...