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Current Diabetes Reviews 2020The Diabetes Prevention Program study results indicated that metformin therapy was not as beneficial as a lifestyle modification for delaying the development of type 2... (Review)
Review
INTRODUCTION
The Diabetes Prevention Program study results indicated that metformin therapy was not as beneficial as a lifestyle modification for delaying the development of type 2 diabetes in individuals at high risk of the disease. A key feature in the etiology of type 2 diabetes mellitus, which appears in the prediabetic phase, is a significant deficiency, compared to healthy controls, in highly flexible poly-cis-unsaturated fatty acyl chains in membrane phospholipids. This deficiency lowers membrane flexibility, which in turn, reduces the amount of all functional Class I glucose transporters, and thereby reduces glucose-mediated ATP production. This leads to an increase in essentially saturated free fatty acid (FFA) levels for fatty-acid-mediated ATP production, which will set up a vicious cycle of raising the levels of essentially saturated FFAs and lowering the level of transmembrane glucose transport. Metformin suppresses hepatic gluconeogenesis, which reduces the plasma glucose concentration.
CONCLUSION
We hypothesize that chronic metformin treatment leads to an additional increase in essentially saturated FFAs, which causes an additional rise in membrane stiffness and hypoxia. So we propose that all these metformin-mediated activities accelerated the onset of type 2 diabetes in the participants of the metformin group in the Diabetes Prevention Program study, compared to the participants of the lifestyle-intervention group in this study. We propose that the biochemical reactions, involved in the fatty-acid-mediated ATP production, play an important part in the increase of the observed essentially saturated FFA concentrations. These statements should also extend to the metformin therapy of individuals with type 2 diabetes.
Topics: Blood Glucose; Cell Membrane; Diabetes Mellitus, Type 2; Disease Progression; Erythrocyte Membrane; Fatty Acids; Healthy Lifestyle; Humans; Hypoglycemic Agents; Metformin; Prediabetic State; Risk Assessment; Risk Factors
PubMed: 30451115
DOI: 10.2174/1573399814666181119145750 -
High Blood Pressure & Cardiovascular... Nov 2023The worldwide impressive growth of metabolic disorders observed in the last decades, especially type 2 diabetes mellitus and obesity, has generated great interest in the... (Review)
Review
The worldwide impressive growth of metabolic disorders observed in the last decades, especially type 2 diabetes mellitus and obesity, has generated great interest in the potential benefits of early identification and management of patients at risk. In this view, prediabetes represents a high-risk condition for the development of type 2 diabetes mellitus and cardiovascular diseases, and an ideal target to intercept patients before they develop type 2 diabetes gaining a prominent role even in international guidelines. For prediabetic individuals, lifestyle modification is the cornerstone of diabetes prevention, with evidence of about 50% relative risk reduction. Accumulating data also show potential benefits from pharmacotherapy. In this context, the only available data pertain to metformin as a pharmaceutical drug and vitamin D and L-arginine as nutraceuticals. L-arginine appears to be a very interesting tool in the clinical management of patients with pre-diabetes. In this review we summarize the current knowledge on the role of L-arginine in prediabetes as a potentially useful preventive strategy against the progression to type 2 diabetes, with a particular focus on the underlying molecular mechanisms and the past and ongoing trials. In this article we also report the interesting data about the perception of the prediabetic condition and its therapeutic management in the clinical practice in Italy. An early identification and a prompt management of people with prediabetes appears to be of paramount importance to prevent the progression to diabetes and avoid its cardiovascular consequences.
Topics: Humans; Prediabetic State; Diabetes Mellitus, Type 2; Metformin; Vitamins; Arginine
PubMed: 38060094
DOI: 10.1007/s40292-023-00613-1 -
The Veterinary Clinics of North... May 2023Diabetes mellitus (DM) has a heterogenous cause, and the exact pathogenesis differs between patients. Most diabetic cats have a cause similar to human type 2 DM but, in... (Review)
Review
Diabetes mellitus (DM) has a heterogenous cause, and the exact pathogenesis differs between patients. Most diabetic cats have a cause similar to human type 2 DM but, in some, DM is associated with underlying conditions, such as hypersomatotropism, hyperadrenocorticism, or administration of diabetogenic drugs. Predisposing factors for feline DM include obesity, reduced physical activity, male sex, and increasing age. Gluco(lipo)toxicity and genetic predisposition also likely play roles in pathogenesis. Prediabetes cannot be accurately diagnosed in cats at the current time. Diabetic cats can enter remission, but relapses are common, as these cats might have ongoing, abnormal glucose homeostasis.
Topics: Humans; Cats; Male; Animals; Prediabetic State; Diabetes Mellitus, Type 2; Acromegaly; Obesity; Cat Diseases; Diabetes Mellitus
PubMed: 36898862
DOI: 10.1016/j.cvsm.2023.02.001 -
Biosensors & Bioelectronics May 2022Insulin is an essential and versatile hormone taking part in the control of blood glucose levels and protein anabolism. Abnormal levels of circulating insulin in the... (Review)
Review
Insulin is an essential and versatile hormone taking part in the control of blood glucose levels and protein anabolism. Abnormal levels of circulating insulin in the body can be problematic. Insulin resistance means the body fails to react with high or normal level insulin, causing our body to produce more insulin through feedback, and is the main cause of many chronic diseases such as type 2 diabetes and obesity. Pre-diabetes or obesity often occurs in people with high insulin resistance. Thus, quantification of insulin levels is essential for the early diagnosis and treatment of diabetes mellitus and obesity. Immunoassays and chromatography assays are currently reliable methods for insulin detection, although they are time-consuming, expensive, and require complex procedures, centralized instruments as well as trained personnel. Modern biosensing technologies have demonstrated success and huge potential for the quantification of insulin. This review provides a summary of the biological significance of insulin with a focus on the role of insulin resistance and its consequences in pre-diabetes/diabetes and obesity. The current practice for insulin detection followed by recent advances in developing biosensors for detection of insulin are reviewed, compared, and discussed from the aspects of detection principle, analytical performances, and challenges. Finally, future perspectives in the quantification of insulin in clinical settings are proposed.
Topics: Biosensing Techniques; Blood Glucose; Diabetes Mellitus, Type 2; Early Diagnosis; Humans; Insulin; Prediabetic State
PubMed: 35114469
DOI: 10.1016/j.bios.2022.114029 -
Primary Care Diabetes Aug 2023
Topics: Humans; Prediabetic State; Diabetes Mellitus, Type 2
PubMed: 37394313
DOI: 10.1016/j.pcd.2023.06.010 -
Journal of Pharmacy Practice Feb 2021Eighty-four million patients in the United States have prediabetes yet evidence-based interventions to prevent diabetes are infrequently used. The concept of prediabetes...
INTRODUCTION
Eighty-four million patients in the United States have prediabetes yet evidence-based interventions to prevent diabetes are infrequently used. The concept of prediabetes is contentious, although preventive interventions are guideline supported. Team-based care models incorporating pharmacists for prediabetes have been proposed; however, pharmacist perception regarding prediabetes has not been assessed. This study's objective was to assess ambulatory care pharmacists' perception of recommendations for prediabetes.
METHODS
An anonymous survey was electronically distributed through the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network. The primary outcome was the proportion of respondents who reported supporting 3 main recommendations related to prediabetes (ie, screening, evidence-based lifestyle-intervention, metformin). The study was approved by the University of South Florida Institutional Review Board. Data collection and analysis occurred in 2017.
RESULTS
The survey was distributed to approximately 2209 potential participants. One hundred thirty-three surveys were completed. The American Diabetes Association guideline was the most common primarily supported guideline related to prediabetes (89%). Of the respondents, 87% supported all 3 main recommendations regarding prediabetes. Qualitative feedback demonstrated the full range of opinions; programs for prediabetes, limited intervention for prediabetes, and against prediabetes as a concept.
CONCLUSIONS
The majority of ambulatory care pharmacists responding supported all main recommendations related to prediabetes and therefore may be practicable for disseminating diabetes prevention interventions. However, barriers to implementation should be expected.
Topics: Ambulatory Care; Humans; Perception; Pharmacists; Pharmacy Service, Hospital; Prediabetic State; United States
PubMed: 31238765
DOI: 10.1177/0897190019857844 -
Science Progress 2021Given that the complications of type 2 diabetes can start at an early stage, early detection and appropriate management of prediabetes are essential. We aimed to develop... (Review)
Review
Given that the complications of type 2 diabetes can start at an early stage, early detection and appropriate management of prediabetes are essential. We aimed to develop an expert opinion on prediabetes in Lebanon to pave the way for national guidelines tailored for the Lebanese population in the near future. A panel of seven diabetes experts conducted a thorough literature review and discussed their opinions and experiences before coming up with a set of preliminary recommendations for the detection and management of prediabetes in Lebanon. Lebanese physicians employ multiple tests for the diagnosis of prediabetes and no national cut-off values exist. The panel agreed that prediabetes screening should be focused on patients exceeding 45 years of age with otherwise no risk factors and on adults with risk factors. The panel reached that fasting plasma glucose (FPG) and HbA1c should be used for prediabetes diagnosis in Lebanon. FPG values of 100-125 mg/dL or HbA1c values of 5.7%-6.4% were agreed upon as indicative of prediabetes. For the management of prediabetes, a three-step approach constituting lifestyle modifications, pharmacological treatment and bariatric surgery is recommended. There should be more focus on research on prediabetes in Lebanon. This preliminary report will be further discussed with the Lebanese Society of Endocrinology, Diabetes and Lipids in 2021 in order to come up with the first Lebanese national guidelines for the detection and management of prediabetes in Lebanon.
Topics: Adult; Diabetes Mellitus, Type 2; Expert Testimony; Fasting; Humans; Lebanon; Prediabetic State
PubMed: 34261386
DOI: 10.1177/00368504211029439 -
Nephron 2021Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20-30% of renal transplant recipients and... (Review)
Review
Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20-30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of PTDM would help limiting its consequences. In this review, we analyse novel aspects of PTDM, based on studies of the last decade, such as the clinical evolution of PTDM, early and late, the reversibility rate, diagnostic criteria, risk factors, including pre-transplant metabolic syndrome and insulin resistance (IR) and the interaction between these factors and immunosuppressive medications. Also, we discuss novel pathogenic factors, in particular the role of β-cell function in an environment of IR and common pathways between pre-existing cell damage and tacrolimus-induced toxicity. The relevant role of prediabetes in the pathogenesis of PTDM and cardiovascular disease is also addressed. Finally, current evidence on PTDM treatment is discussed.
Topics: Diabetes Mellitus; Humans; Insulin Resistance; Kidney Transplantation; Prediabetic State; Transplant Recipients
PubMed: 33902027
DOI: 10.1159/000514288 -
The Aging Male : the Official Journal... Dec 2023Formal risk assessment is crucial for diabetes prevention. We aimed to establish a practical nomogram for predicting the risk incidence of prediabetes and prediabetes...
BACKGROUND
Formal risk assessment is crucial for diabetes prevention. We aimed to establish a practical nomogram for predicting the risk incidence of prediabetes and prediabetes conversion to diabetes.
METHODS
A cohort of 1428 subjects was collected to develop prediction models. The LASSO was used to screen for important risk factors in prediabetes and diabetes and was compared with other algorithms (LR, RF, SVM, LDA, NB, and Treebag). Multivariate logistic regression analysis was used to construct the prediction model of prediabetes and diabetes, and drawn the predictive nomogram. The performance of the nomograms was evaluated by receiver-operating characteristic curve and calibration.
RESULTS
These findings revealed that the other six algorithms were not as good as LASSO in terms of diabetes risk prediction. The nomogram for individualized prediction of prediabetes included "Age," "FH," "Insulin_F," "hypertension," "Tgab," "HDL-C," "Proinsulin_F," and "TG" and the nomogram of prediabetes to diabetes included "Age," "FH," "Proinsulin_E," and "HDL-C". The results showed that the two models had certain discrimination, with the AUC of 0.78 and 0.70, respectively. The calibration curve of the two models also indicated good consistency.
CONCLUSIONS
We established early warning models for prediabetes and diabetes, which can help identify prediabetes and diabetes high-risk populations in advance.
Topics: Humans; Prediabetic State; Incidence; Proinsulin; Diabetes Mellitus; Algorithms; Machine Learning; Nomograms; Retrospective Studies
PubMed: 37156752
DOI: 10.1080/13685538.2023.2205510 -
Ophthalmic Research 2023We aimed to detect early retinal microcirculation changes in prediabetic patients and investigate their correlation with clinical examinations. (Review)
Review
INTRODUCTION
We aimed to detect early retinal microcirculation changes in prediabetic patients and investigate their correlation with clinical examinations.
METHODS
Forty-seven prediabetic individuals, 29 controls, and 81 type 2 diabetic mellitus (T2DM) patients were enrolled in this study. A review of clinical data and spectral-domain optical coherence tomography angiography (SD-OCTA) parameters of macular vessel diameter (VD), foveal avascular zone (FAZ), and macular vessel area density (VAD) was performed.
RESULTS
Levels of low-density lipoprotein cholesterol and triglycerides in prediabetes and T2DM groups were significantly higher than those in the control group. The urine microalbumin-to-creatinine ratio (ACR) was mildly and moderately increased in the prediabetes and T2DM groups, respectively. The estimated glomerular filtration rate of the three groups was within the normal range. SD-OCTA showed that VAD in the superficial macular area was decreased in the prediabetes group compared to the control group (p = 0.01). The FAZ size, particularly in the deep layer, was expanded in the prediabetes group. In the deep retinal layer of the macular area, VD and FAZ size in the prediabetes group were larger than those in the control group. In the prediabetes group, the axial length was significantly correlated with macular VD and FAZ size (p < 0.05), and ACR was correlated with FAZ size (p < 0.05). Age had a negative correlation with VAD (p < 0.01). ACR had a positive correlation with FAZ size (p < 0.05).
CONCLUSIONS
Enlargement and irregularity of the FAZ area, deep capillary dilation, and a decrease in VAD occur in the retina of prediabetic patients with mild kidney function impairment.
Topics: Humans; Prediabetic State; Fluorescein Angiography; Retinal Vessels; Retrospective Studies; Retina; Tomography, Optical Coherence; Diabetes Mellitus, Type 2
PubMed: 36382640
DOI: 10.1159/000527957