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Frontiers in Endocrinology 2020Diabetes mellitus is becoming more prevalent and even with new advancements which improve glycaemic control, complications of diabetes are common. Vascular complications... (Review)
Review
Diabetes mellitus is becoming more prevalent and even with new advancements which improve glycaemic control, complications of diabetes are common. Vascular complications of diabetes include the microvascular complications: retinopathy, nephropathy, and peripheral and autonomic neuropathy. Macrovascular complications are also common in patients with diabetes and arguably more concerning as they confer a high mortality risk yet are sometimes under-treated. Risk factors for diabetes complications start to occur in childhood and adolescents and some youths may be diagnosed with complications before transition to adult care. This article discusses the prevalence, risk factors, screening, and treatment recommendations for vascular complications in children and adolescents with diabetes.
Topics: Adolescent; Diabetes Complications; Humans; Risk Factors; Vascular Diseases
PubMed: 32582034
DOI: 10.3389/fendo.2020.00370 -
Archivio Italiano Di Urologia,... Dec 2020To investigate the incidence of diabetic cystopathy in relation to age, gender, type of diabetes, duration of diabetic disease and clinical evidence of peripheral...
OBJECTIVE
To investigate the incidence of diabetic cystopathy in relation to age, gender, type of diabetes, duration of diabetic disease and clinical evidence of peripheral neuropathy and to analyze the physiopathology of the various forms of diabetic cystopathy due to sensory impairment, motor-sensory impairment, motor impairment and hyperreflexia.
MATERIALS AND METHODS
In a retrospective multicenter cohort study the medical records of a cohort of 126 diabetic patients with (128 patients) or without (48 patients) urological symptoms were analyzed. Patients were observed at the Città di Alessandria Clinic of Policlinico di Monza and/or at the outpatient clinic of Alessandria Hospital from June 2018 to June 2020. The study excluded patients with central and/or peripheral neuropathy, spina bifida (mylomeningocele or meningocele) or spina bifida occulta; with persistent urinary infections; in anticholinergic treatment for enteric dysfunctions; in medical treatment for cervical-prostatic-urethral obstruction; with vaginal and/or rectal prolapse of II, III, IV degree; with previous spinal or pelvic surgery including radical prostatectomy, Wertheim hysterectomy or colorectal surgery. All the patients were studied with computed tomography (CT) scan of the urinary tract, voiding cystourethrography (VCUG), uroflowmetry, cystomanometry with intrinsic pressure assessment and compliance evaluation, electromyography (EMG) of the anal sphincter, pressure flow analysis, urethral pressure profile and, when advised, pharmacological tests.
RESULTS
Out of 126 diabetic patients, 48 did not show any signs or symptoms of urine voiding dysfunction; 30 were men and 18 women with an average age of 62.6 years; 20 had type I diabetes and were in treatment with insulin and 28 type II diabetes treated with oral hypoglycemic medication. The remaining 78 patients (48 men and 30 women), with an average age of 64.8 years, presented urological symptoms; 31 had type I diabetes and 47 had II type diabetes.
CONCLUSIONS
Diagnosis of the various forms of diabetic cystopathy and early treatment decreases complications and consequently accesses to outpatient facilities and hospital admissions, resulting in an improved quality of life.
Topics: Cohort Studies; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Urinary Bladder Diseases
PubMed: 33348955
DOI: 10.4081/aiua.2020.4.314 -
Molecular Biology Reports Mar 2021Diabetes is likely one of the centenarian diseases which is apprehended with certainty to humans. According to established protocols of the World Health Organisation... (Review)
Review
Diabetes is likely one of the centenarian diseases which is apprehended with certainty to humans. According to established protocols of the World Health Organisation (WHO) and numerous investigated studies diabetes is analyzed as a stellar and leading health issue worldwide. Although, the implicit costs of this pathology are increasing every year, thus, there is a need to find a novel method which can provide promising results in the management of diabetes and can overcome the side effects associated with the conventional medication. Comprehensive review of this topic was undertaken through various research and review papers which were conducted using MEDLINE, BIOSIS and EMBASE database. Using various keywords, we retrieve the most relevant content for the thorough review on recent targets and novel molecular pathways for targeting diabetes and associated complications. From the detailed analysis, we have highlighted some molecular pathways and novel targets which had shown promising results in both in-vitro and in-vivo studies and may be considered as pipeline target for clinical trials. Furthermore, these targets not only abetted amelioration of diabetes but also helped in mitigation of diabetes associated complications as well. Thus, based on the available information and literature on these potential molecules, conclusive evidence can be drawn which confirms targeting these novel pathways may unleash an array of benefits that have the potential to overpower the benefits obtained from conventional therapy in the management of diabetes thereby decreasing morbidity and mortality associated with diabetic complications.
Topics: Diabetes Complications; Drug Development; Humans; Hypoglycemic Agents; Molecular Targeted Therapy
PubMed: 33763776
DOI: 10.1007/s11033-021-06294-0 -
Antioxidants & Redox Signaling Oct 2018The rising global prevalence of diabetes and its debilitating complications give rise to significant disability and premature mortality. Due to the silent nature of... (Review)
Review
SIGNIFICANCE
The rising global prevalence of diabetes and its debilitating complications give rise to significant disability and premature mortality. Due to the silent nature of diabetes and its vascular complications, and limitations in current methods for detection, there is a need for novel biomarkers for early detection and prognosis. Recent Advances: Metabolic memory and epigenetic factors are important in the pathogenesis of diabetic complications and interact with genetic variants, metabolic factors, and clinical risk factors. Micro(mi)RNAs interact with epigenetic mechanisms and pleiotropically mediate the effects of hyperglycemia on the vasculature. Utilizing mature profiling techniques and platforms, an increasing number of miRNA signatures and interaction networks have been identified for diabetes and its related cardiorenal complications. As a result, these short, single-stranded molecules are emerging as potential diagnostic and predictive tools in human studies, and may function as disease biomarkers, as well as treatment targets.
CRITICAL ISSUES
However, there is complex interaction between the genome and epigenome. The regulation of miRNAs may differ across species and tissues. Most profiling studies to date lack validation, often requiring large, well-characterized cohorts and reliable normalization strategies. Furthermore, the incremental benefits of miRNAs as biomarkers, beyond prediction provided by traditional risk factors, are critical issues to consider, yet often neglected in published studies.
FUTURE DIRECTIONS
All in all, the future for miRNA-based diagnostics and therapeutics for diabetic complications appears promising. Improved understanding of the complex mechanisms underlying miRNA dysregulation, and more well-designed studies utilizing prospective samples would facilitate the translation to clinical use.
Topics: Animals; Biomarkers; Diabetes Complications; Humans; MicroRNAs
PubMed: 28950710
DOI: 10.1089/ars.2017.7318 -
Current Vascular Pharmacology 2017Patients with diabetes usually exhibit diabetic dyslipidaemia. (Review)
Review
BACKGROUND
Patients with diabetes usually exhibit diabetic dyslipidaemia.
AIM
The aim of the review is to present the quantitative and qualitative alterations of lipids and lipoproteins and the associated mechanisms in patients with diabetic dyslipidaemia.
RESULTS
The main quantitative changes observed in patients with diabetic dyslipidaemia are increased triglycerides and decreased high-density lipoprotein (HDL) cholesterol levels. Qualitative abnormalities mainly include increased small dense low-density lipoprotein (LDL) particles (despite similar serum LDL cholesterol levels as non-diabetic subjects) and alterations in the apolipoprotein content of HDL particles. Alterations in the activities of enzymes involved in lipoprotein metabolism, such as cholesteryl ester transfer protein, and the lipoprotein content of lipid particles, along with their glycation and oxidation, play a role in the pathogenesis of diabetic dyslipidaemia.
CONCLUSION
Diabetic dyslipidaemia is associated with quantitative and qualitative alterations of lipids and lipoproteins, which are associated with increased cardiovascular risk.
Topics: Animals; Diabetes Complications; Diabetes Mellitus, Type 2; Dyslipidemias; Humans; Lipids; Lipoproteins
PubMed: 28155609
DOI: 10.2174/1570161115666170201105425 -
Phytomedicine : International Journal... Jul 2020Diabetes mellitus is a multifactorial disorder with the risk of micro- and macro-vascular complications. High glucose-induced derangements in metabolic pathways are... (Review)
Review
BACKGROUND
Diabetes mellitus is a multifactorial disorder with the risk of micro- and macro-vascular complications. High glucose-induced derangements in metabolic pathways are primarily associated with the initiation and progression of secondary complications namely, diabetic nephropathy, neuropathy, and retinopathy. Adenosine monophosphate-activated protein kinase (AMPK) has emerged as an attractive therapeutic target to treat various metabolic disorders including diabetes mellitus. It is a master metabolic regulator that helps in maintaining cellular energy homeostasis by promoting ATP-generating catabolic pathways and inhibiting ATP-consuming anabolic pathways. Numerous pharmacological and plant-derived bioactive compounds that increase AMP-activated protein kinase activation has shown beneficial effects by mitigating secondary complications namely retinopathy, nephropathy, and neuropathy.
PURPOSE
The purpose of this review is to highlight current knowledge on the role of AMPK and its activators from plant origin in diabetic microvascular complications.
METHODS
Search engines such as Google Scholar, PubMed, Science Direct and Web of Science are used to extract papers using relevant key words. Papers mainly focusing on the role of AMPK and AMPK activators from plant origin in diabetic nephropathy, retinopathy, and neuropathy was chosen to be highlighted.
RESULTS
According to results, decrease in AMPK activation during diabetes play a causative role in the pathogenesis of diabetic microvascular complications. Some of the plant-derived bioactive compounds were beneficial in restoring AMPK activity and ameliorating diabetic microvascular complications.
CONCLUSION
AMPK activators from plant origin are beneficial in mitigating diabetic microvascular complications. These pieces of evidence will be helpful in the development of AMPK-centric therapies to mitigate diabetic microvascular complications.
Topics: AMP-Activated Protein Kinases; Animals; Cardiovascular Diseases; Diabetes Complications; Diabetic Angiopathies; Diabetic Nephropathies; Diabetic Neuropathies; Dietary Supplements; Enzyme Activation; Humans
PubMed: 30935723
DOI: 10.1016/j.phymed.2018.12.031 -
Current Opinion in Hematology May 2019Microvascular ischemic disease of the brain is a common cause of cognitive impairment and dementia, particularly in the context of preexisting cardiovascular risk... (Review)
Review
PURPOSE OF REVIEW
Microvascular ischemic disease of the brain is a common cause of cognitive impairment and dementia, particularly in the context of preexisting cardiovascular risk factors and aging. This review summarizes our current understanding of the emerging molecular themes that underlie progressive and irreparable vascular disease leading to neuronal tissue injury and dementia.
RECENT FINDINGS
Cardiometabolic risk factors including diabetes and hypertension are known to contribute to vascular disease. Currently, the impact of these risk factors on the integrity and function of the brain vasculature has been target of intense investigation. Molecularly, the consequences associated with these risk factors indicate that reactive oxygen species are strong contributors to cerebrovascular dysfunction and injury. In addition, genetic linkage analyses have identified penetrant monogenic causes of vascular dementia. Finally, recent reports begun to uncover a large number of polymorphisms associated with a higher risk for cerebrovascular disease.
SUMMARY
A comprehensive picture of key risk factors and genetic predispositions that contribute to brain microvascular disease and result in vascular dementia is starting to emerge. Understanding their relationships and cross-interactions will significantly aid in the development of preventive and intervention strategies for this devastating condition.
Topics: Animals; Dementia, Vascular; Diabetes Complications; Genetic Predisposition to Disease; Humans; Hypertension; Risk Factors
PubMed: 30883434
DOI: 10.1097/MOH.0000000000000502 -
Current Diabetes Reviews 2017Diabetes mellitus is one of the most common metabolic problems and is characterized by persistent hyperglycaemia. Exposure to chronic hyperglycaemia can affect many... (Review)
Review
INTRODUCTION
Diabetes mellitus is one of the most common metabolic problems and is characterized by persistent hyperglycaemia. Exposure to chronic hyperglycaemia can affect many tissues including the Achilles Tendon, which is one of the largest tendons in the body. The current literature on the effects of hyperglycaemia on tendons is sparse, though evidence on rat models does suggest a process of chronic degeneration, which is increased in the presence of neuropathy and deformity. There is no epidemiological data on rupture of Achilles tendon in diabetes. Similarly, the knowledge of the best treatments for this condition in people with diabetes is also lacking.
CONCLUSION
In this review we have systematically analysed current literature in this area and suggested future studies.
Topics: Achilles Tendon; Animals; Diabetes Complications; Humans; Prognosis; Risk Factors; Rupture, Spontaneous; Tendinopathy
PubMed: 27333801
DOI: 10.2174/1573399812666160620100616 -
The Medical Clinics of North America Mar 2015Management of diabetes in the elderly necessitates careful consideration of concomitant geriatric syndromes and comorbid conditions that increase the risk of... (Review)
Review
Management of diabetes in the elderly necessitates careful consideration of concomitant geriatric syndromes and comorbid conditions that increase the risk of complications, including severe hypoglycemia. Whereas healthy older adults can use therapeutic approaches recommended for their younger counterparts, treatment plans for frail elderly patients need to be simplified and A1c and blood pressure goals relaxed with the development of impairments in function, cognition, vision, and dexterity. The goals of diabetes management in the elderly should be to maintain quality of life and minimize symptomatic hyperglycemia and drug side effects, including hypoglycemia.
Topics: Aged; Aged, 80 and over; Comorbidity; Diabetes Complications; Diabetes Mellitus; Humans; Hypoglycemia; Quality of Life; Risk Factors
PubMed: 25700588
DOI: 10.1016/j.mcna.2014.11.008 -
Current Opinion in Organ Transplantation Aug 2017The intention of this study is to summarize present knowledge about adverse effects of hyperglycemia in diabetes, and in this context review more recent data concerning... (Review)
Review
PURPOSE OF REVIEW
The intention of this study is to summarize present knowledge about adverse effects of hyperglycemia in diabetes, and in this context review more recent data concerning the effects of pancreas transplantation on a wide range of diabetic complications.
RECENT FINDINGS
Effective blood glucose control by insulin delays progression of microvascular complications and probably improves survival in type 1 diabetes. A successful pancreas transplantation combined with a kidney graft has recently been found to prevent diabetic kidney lesions, and registry data support improved long-term patient survival. Cardiovascular mortality was reduced in one study, even though coronary heart disease was not significantly altered. Advanced coronary lesions may be too advanced in these patients at baseline. However, with a successful single pancreas transplant, which is generally performed in patients with near-normal kidney function, pancreas transplantation may improve left ventricular function. Development of retinopathy and neuropathy is delayed with functioning pancreas grafts, and both quality of life and certain skin lesions may improve after pancreas transplantation.
SUMMARY
In patients with type 1 diabetes, pancreas transplantation may improve cardiac outcomes and ameliorate diabetic lesions in the kidney transplant. Also quality of life, neuropathy, retinopathy, and healing of certain skin lesions may be improved.
Topics: Diabetes Complications; Humans; Pancreas Transplantation; Quality of Life; Survival Analysis
PubMed: 28598888
DOI: 10.1097/MOT.0000000000000436