-
Experimental Diabetes Research 2011The importance of diabetes in the epidemiology of cardiovascular diseases cannot be overemphasized. About one third of acute myocardial infarction patients have... (Review)
Review
The importance of diabetes in the epidemiology of cardiovascular diseases cannot be overemphasized. About one third of acute myocardial infarction patients have diabetes, and its prevalence is steadily increasing. The decrease in cardiac mortality in people with diabetes is lagging behind that of the general population. Cardiovascular disease is a broad term which includes any condition causing pathological changes in blood vessels, cardiac muscle or valves, and cardiac rhythm. The ECG offers a quick, noninvasive clinical and research screen for the early detection of cardiovascular disease in diabetes. In this paper, the clinical and research value of the ECG is readdressed in diabetes and in the presence of cardiac autonomic neuropathy.
Topics: Animals; Autonomic Nervous System Diseases; Cardiovascular Diseases; Diabetes Complications; Diabetes Mellitus; Diabetic Neuropathies; Electrocardiography; Heart; Humans; Vertigo
PubMed: 21747831
DOI: 10.1155/2011/687624 -
Journal of Diabetes and Its... Mar 2015With the rise in childhood obesity, type 2 diabetes mellitus (T2DM) has been recognized to occur in adolescents with increasing frequency. Although much is known about... (Review)
Review
With the rise in childhood obesity, type 2 diabetes mellitus (T2DM) has been recognized to occur in adolescents with increasing frequency. Although much is known about T2DM in adults, few studies have examined the treatment and complications of T2DM in youth. The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study was designed to evaluate the efficacy of various treatments and provided a unique opportunity to study the disease progression and appearance of complications in a pediatric cohort with recent onset of the disease. In the TODAY study, hypertension was present in 11.6% of the population at baseline and increased to 33.8% by the end of the study. Prevalence of high-risk LDL-cholesterol rose from 4.5% at baseline to 10.7% at the end of the study. Microalbuminuria was found in 6.3% of the cohort at baseline and increased to 16.6%. Retinopathy was not assessed upon entry into TODAY, but was present in 13.9% of the TODAY cohort at the end of the study. Experience to date indicates that these complications and comorbidities are similar to those seen in adults, but occur on an accelerated timeline. The early manifestation of diabetes complications in youth-onset T2DM suggests that this group will be burdened with the tangible consequences of cardiovascular disease, nephropathy, and retinopathy in the third and fourth decades of life. It is hoped that through an early, aggressive approach to treatment and prevention, we may be able to curb the onset and progression of these potentially devastating outcomes.
Topics: Adolescent; Adolescent Medicine; Combined Modality Therapy; Comorbidity; Diabetes Complications; Diabetes Mellitus, Type 2; Disease Progression; Humans; Precision Medicine; Randomized Controlled Trials as Topic
PubMed: 25468310
DOI: 10.1016/j.jdiacomp.2014.10.009 -
The Effect of Metabolic Surgery on the Complications of Diabetes: What Are the Unanswered Questions?Frontiers in Endocrinology 2020It is now established that metabolic surgery (also known as bariatric surgery or obesity surgery) is an effective treatment for type 2 diabetes. Data from several... (Review)
Review
It is now established that metabolic surgery (also known as bariatric surgery or obesity surgery) is an effective treatment for type 2 diabetes. Data from several randomized controlled trials have shown that surgery, when used as an adjunct to best medical therapy, is superior to medical therapy alone in achieving glycaemic and metabolic treatment targets in diabetes care. This has resulting in metabolic surgery being recommended as a treatment option for obesity-associated type 2 diabetes in national and international diabetes care guidelines. While the superior glycaemic effect of surgery is clear, the effect of surgery on the complications of diabetes is not fully understood. There are observational and epidemiological data that indicate a preventative effect in cohorts who do not have complications at baseline, as well as a positive effect on those with established diabetic kidney disease. However, there is a dearth of randomized controlled studies that specifically examine the effect of surgery on the complications of diabetes. Therefore, we should remain cautious in some cases, especially in those with retinopathy or neuropathy, as there is potential for deterioration of disease post-operatively. Further study is needed on this important topic. A lot is known, but there remain several unanswered questions. This article summarizes what we know about the effect of metabolic surgery on the complications of diabetes, poses some unanswered questions, and suggests how we could answer them.
Topics: Bariatric Surgery; Cardiovascular Diseases; Diabetes Complications; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Neuropathies; Diabetic Retinopathy; Humans
PubMed: 32547487
DOI: 10.3389/fendo.2020.00304 -
Herz May 2012
Topics: Cardiology; Diabetes Complications; Heart Diseases; Humans
PubMed: 22476615
DOI: 10.1007/s00059-012-3609-x -
Diabetes Jul 2011
Review
Topics: Animals; Cardiomyopathies; Diabetes Complications; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Retinopathy; Humans; MicroRNAs; Myocardium; Receptor for Advanced Glycation End Products; Receptors, Immunologic
PubMed: 21709278
DOI: 10.2337/db11-0082 -
Cell Death & Disease Jan 2018Chronic or intermittent hyperglycemia is associated with the development of diabetic complications. Several signaling pathways can be altered by having hyperglycemia in... (Review)
Review
Chronic or intermittent hyperglycemia is associated with the development of diabetic complications. Several signaling pathways can be altered by having hyperglycemia in different tissues, producing oxidative stress, the formation of advanced glycation end products (AGEs), as well as the secretion of the pro-inflammatory cytokines and cellular death (pathological autophagy and/or apoptosis). However, the signaling pathways that are directly triggered by hyperglycemia appear to have a pivotal role in diabetic complications due to the production of reactive oxygen species (ROS), oxidative stress, and cellular death. The present review will discuss the role of cellular death in diabetic complications, and it will suggest the cause and the consequences between the hyperglycemia-induced signaling pathways and cell death. The signaling pathways discussed in this review are to be described step-by-step, together with their respective inhibitors. They involve diacylglycerol, the activation of protein kinase C (PKC) and NADPH-oxidase system, and the consequent production of ROS. This was initially entitled the "dangerous metabolic route in diabetes". The historical usages and the recent advancement of new drugs in controlling possible therapeutical targets have been highlighted, in order to evaluate the evolution of knowledge in this sensitive area. It has recently been shown that the metabolic responses to stimuli (i.e., hyperglycemia) involve an integrated network of signaling pathways, in order to define the exact responses. Certain new drugs have been experimentally tested-or suggested and proposed-for their ability to modulate the possible biochemical therapeutical targets for the downregulation of retinopathy, nephropathy, neuropathy, heart disease, angiogenesis, oxidative stress, and cellular death. The aim of this study was to critically and didactically evaluate the exact steps of these signaling pathways and hence mark the indicated sites for the actions of such drugs and their possible consequences. This review will emphasize, besides others, the therapeutical targets for controlling the signaling pathways, when aimed at the downregulation of ROS generation, oxidative stress, and, consequently, cellular death-with all of these conditions being a problem in diabetes.
Topics: Animals; Cell Death; Diabetes Complications; Humans; Models, Biological; Oxidative Stress; Reactive Oxygen Species; Signal Transduction
PubMed: 29371661
DOI: 10.1038/s41419-017-0135-z -
Minerva Endocrinologica Jun 2017Non alcoholic fatty liver disease (NAFLD, the hepatic fat accumulation) and non alcoholic steatohepatitis (NASH, the aggressive form of liver steatosis plus inflammation... (Review)
Review
Non alcoholic fatty liver disease (NAFLD, the hepatic fat accumulation) and non alcoholic steatohepatitis (NASH, the aggressive form of liver steatosis plus inflammation and hepatocyte necrosis) are reaching epidemic dimensions in subjects with diabetes mellitus (DM). Taking into account that the incidence of DM increases worldwide, these entities represent major health problems. There is accumulating evidence that diabetic subjects with NASH are at increased risk not only for cardiovascular disease compications but also for cirrhosis and hepatocellular cancer. On the other hand, the presence of NAFLD correlates with an increased risk for the development of DM. The most-widely accepted pathophysiological mechanisms relating DM and NAFLD include central obesity and insulin resistanc, but new insights are under scrutiny. Therapeutic modalities used for the management of diabetes have been studied for their impact on NAFLD/NASH and both neutral and beneficial effects have been reported. In this review, we discuss issues regarding the epidemiology, the pathophysiological pathways relating NAFLD with DM and consider strategies that may be useful in the management of NAFLD in the diabetic population.
Topics: Diabetes Complications; Diabetes Mellitus; Humans; Non-alcoholic Fatty Liver Disease
PubMed: 27990792
DOI: 10.23736/S0391-1977.16.02562-1 -
Saudi Journal of Gastroenterology :... 2011Symptoms suggestive of gastroparesis occur in 5% to 12% of patients with diabetes. Such a complication can affect both prognosis and management of the diabetes;... (Review)
Review
Symptoms suggestive of gastroparesis occur in 5% to 12% of patients with diabetes. Such a complication can affect both prognosis and management of the diabetes; therefore, practicing clinicians are challenged by the complex management of such cases. Gastroparesis is a disorder characterized by a delay in gastric emptying after a meal in the absence of a mechanical gastric outlet obstruction. This article is an evidence-based overview of current management strategies for diabetic gastroparesis. The cardinal symptoms of diabetic gastroparesis are nausea and vomiting. Gastroesophageal scintiscanning at 15-minute intervals for 4 hours after food intake is considered the gold standard for measuring gastric emptying. Retention of more than 10% of the meal after 4 hours is considered an abnormal result, for which a multidisciplinary management approach is required. Treatment should be tailored according to the severity of gastroparesis, and 25% to 68% of symptoms are controlled by prokinetic agents. Commonly prescribed prokinetics include metoclopramide, domperidone, and erythromycin. In addition, gastric electrical stimulation has been shown to improve symptoms, reduce hospitalizations, reduce the need for nutritional support, and improve quality of life in several open-label studies.
Topics: Diabetes Complications; Gastroparesis; Humans
PubMed: 21372345
DOI: 10.4103/1319-3767.77237 -
MedGenMed : Medscape General Medicine Sep 2004The risk of ischemic heart disease is 2-4 times greater in diabetes, occurs at a younger age, and is much higher in women with diabetes. The risk of coronary disease is... (Review)
Review
The risk of ischemic heart disease is 2-4 times greater in diabetes, occurs at a younger age, and is much higher in women with diabetes. The risk of coronary disease is increased in patients with poor glycemic control, but studies have not shown a major impact of improved glucose management on cardiovascular mortality. This apparent contradiction may be due to the many potential mechanisms of increased cardiovascular damage in diabetes, including hypertension; abnormal clotting function due to changes in fibrinolysis, platelet adherence, and plasminogen activity; abnormal vascular reactivity; and abnormal lipid patterns and particles. Some, but not all, of these issues are related to lifestyle factors, including diet, exercise, and cigarette smoking. The treatment of hypertension and hypercholesterolemia has been more successful in reducing cardiovascular mortality than reducing HbA1c levels. One of the major, unresolved questions is whether insulin resistance rather than hyperglycemia is the primary risk factor for cardiovascular disease (CVD). Antidiabetic agents that target insulin resistance may be more cardioprotective than those that primarily augment insulin secretion.
Topics: Cardiovascular Diseases; Diabetes Complications; Heart Diseases; Humans; Hyperglycemia
PubMed: 15647712
DOI: No ID Found -
Pathobiology : Journal of... 2016Chitotriosidase (CHIT1) belongs to chitinase family. So far this enzyme has been the best investigated human chitinase regarding its biological activity and association... (Review)
Review
Chitotriosidase (CHIT1) belongs to chitinase family. So far this enzyme has been the best investigated human chitinase regarding its biological activity and association with various disorders. In a healthy population, CHIT1 activity is very low and originates in the circulating polymorphonuclear cells. Conversely, during the development of acute/chronic inflammatory disorders, the enzymatic activity of CHIT1 increases significantly. Recently, CHIT1 has also been involved in the pathogenesis of diabetes mellitus (DM). Mounting evidence from experimental studies revealing the increase of CHIT1 levels in pathological conditions, such as atherosclerosis, coronary artery disease, acute ischemic stroke, cerebrovascular dementia, nonalcoholic fatty liver disease, and osteolytic processes suggest its critical role in the evolutions and complications of DM. This review is addressed to provide mechanistic insights by highlighting the relationship between CHIT1 and diabetes, and their contribution in the exacerbation of this disease.
Topics: Biomarkers; Diabetes Complications; Diabetes Mellitus; Hexosaminidases; Humans
PubMed: 27116685
DOI: 10.1159/000443932