Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 8 Articles
Obesity is physiological condition in which body fat is high than normal; while overweight is physiological condition in which body weight is high. A person may be overweight from extra muscle, bone, or water, as well as from having too much fat. Obesity is a major cause of morbidity and mortality. Obesity has reached outbreak proportions globally, with more than 1 billion adults overweight - at least 300 million of them clinically obese - and is a major donor to the global burden of chronic disease and disability. Often parallel in developing countries with under-nutrition, obesity is a complex condition, with severe social and psychological proportions, affecting virtually all ages and socioeconomic groups. Increased utilization of more energy dense, nutrient poor foods with high levels of sugar and saturated fats, combined with reduced physical activity. In this review the discussion is done about the causes, complications, prevention, approaches to treatment and related parameters of obesity....
Novel incretin-based drugs, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase-4 inhibitors\r\n(DPP-4i), have been last introduced in the pharmacological treatment of type 2 diabetes. In the last few years, the interest on the\r\nrelationship of gut hormones with bone metabolism in diabetes has been increasing. The aim of present paper is to examine in\r\nvitro and in vivo evidence on the connections between incretin hormones and bone metabolism.We also discuss results of clinical\r\ntrials and metaanalysis, explore the effects of incretin drugs in vitro on osteogenic cells and osteoclasts, and speculate on the\r\npossibility of different effects of GLP-1 RA and DPP-4i on the risk of bone fractures risk in humans. Although existing preliminary\r\nevidence suggests a protective effect on the bone, at least for DPP-4i, further controlled, long-term studies with measurement of\r\nbone markers, bone density, and clinical fractures rates are needed to substantiate and confirm those findings....
Diabetic patients have a higher risk of various types of cancer.However, whether diabetes may increase the risk of thyroid cancer has\r\nnot been extensively studied. This paper reviews and summarizes the current literature studying the relationship between diabetes\r\nmellitus and thyroid cancer, and the possible mechanisms linking such an association. Epidemiologic studies showed significant or\r\nnonsignificant increases in thyroid cancer risk in diabetic women and nonsignificant increase or no change in thyroid cancer risk in\r\ndiabetic men. A recent pooled analysis, including 5 prospective studies from the USA, showed that the summary hazard ratio (95%\r\nconfidence interval) for women was 1.19 (0.84ââ?¬â??1.69) and was 0.96 (0.65ââ?¬â??1.42) for men. Therefore, the results are controversial and\r\nthe association between diabetes and thyroid cancer is probably weak. Further studies are necessary to confirm their relationship.\r\nProposed mechanisms for such a possible link between diabetes and thyroid cancer include elevated levels of thyroid-stimulating\r\nhormone, insulin, glucose and triglycerides, insulin resistance, obesity, vitamin D deficiency, and antidiabetic medications such as\r\ninsulin or sulfonylureas...
Background: In the routine care of diabetes, mostly the clinical parameters are controlled and little attention is\r\npaid to the quality of life assessment. A questionnaire must be culturally adapted in the country where it is intended\r\nto be used. The aim of the study was to assess health-related quality of life in youths with type 1 diabetes using the\r\nPedsQL 3.0 Diabetes Module and to evaluate the psychometric properties in patient and control subjects.\r\nMethods: Diabetes and Generic Module were administered to 355 youths with type 1 diabetes (8-18 y/o) and\r\ntheir parents. Generic Module was completed by 294 age-matched control participants and their parents. Feasibility,\r\ninternal consistency reliability, reproducibility, convergent, discriminant and concurrent validities were evaluated.\r\nResults: Minimal floor and moderate ceiling effects and hardly any missing item responses proved the feasibility.\r\nCronbach�s ? was gretaer than 0.70 in all subscales and met the criterion of 0.90 in total-items reliability. Testretest\r\nreliability was demonstrated with Pearson coefficients. We found good agreement between the children�s and\r\nparents�s answers, although parents underestimated their diabetic children in all subscales. The instrument was able\r\nto differentiate between the health-related quality of life of optimal, suboptimal and high risk metabolic control. The\r\nDiabetes Modul???? subscales and the Generic Module total scale correlated well, except the worry subscale.\r\nConclusions: Diabetic youths had similar health-related quality of life as their non-diabetic peers. Parents\r\nunderestimated their diabetic child�s quality of life, but this was not the case in the healthy population. Both diabetic\r\nand healthy boys had better perception of quality of life than girls. The nationally adapted version of the Pediatric\r\nQuality of Life Inventory 3.0 Diabetes Module designed for children and adolescents was reliable and valid instrument\r\nfor assessing health-related quality of life in youths with type 1 diabetes...
Zn2+ toxicity is implicated in pancreatic -cell death that occurs secondarily to: streptozotocin exposure in vitro;\r\nand both autoimmune attack or streptozotocin in vivo models of T1DM. This is demonstrated by reduced -cell death\r\nor diabetic incidence in vitro or in NOD mice after treatment with Zn2+ preferring chelators, pyruvate, nicotinamide,\r\na reduced zinc diet, sirtuin inhibitors, or zinc transporter knockout. These therapeutics are also demonstrated to be\r\n \r\n \r\n \r\n2+ neurotoxicity.\r\nAims: To determine if the sirtuin pathway is involved in Zn2+-, streptozotocin-, or cytokine- mediated -cell death\r\nin vitro, and streptozotocin-, or NOD induced T1DM in vivo.\r\nMethods: Sensitivity of MIN6 cells expressing empty vector, sirtuin protein-1 (SIRT1) or its siRNA, to Zn2+,\r\nstreptozotocin, or cytokines, and effects on NAD+ levels were determined. Covariance of manipulating SIRT1 levels\r\nwith diabetic incidence was tested in vivo.\r\nResults: 1) sirtuin pathway inhibition or SIRT1 knockdown attenuated Zn2+-, STZ-, and cytokine-mediated\r\ntoxicity and NAD+ loss in -cells, 2) SIRT1 overexpression potentiated these toxicities, 3) young SIRT1 -cell\r\ntransgenic mice have improved glucose tolerance under basal conditions, but upon aging showed increased\r\nsensitivity to streptozotocin compared to SIRT1 +/- mice, and 4) SIRT1 +/- mice in an NOD background or exposed\r\nto streptozotocin trended toward reduced diabetic incidence and mortality compared to wildtype.\r\nConclusions: These results have implicated SIRT1-mediated NAD+ loss in Zn2+, STZ, or cytokine toxicities of\r\nMIN6, and in NOD or streptozotocin T1DM animal models. Modulation of -cell Zn2+ and NAD+ levels, and the sirtuin\r\npathway could be novel therapeutic targets for T1DM....
The glucagon-like peptide-1 (GLP-1) receptor is one of the best validated therapeutic targets for the treatment of type 2 diabetes\nmellitus (T2DM). Over several years, the accumulation of basic, translational, and clinical research helped define the physiologic\nroles of GLP-1 and its receptor in regulating glucose homeostasis and energy metabolism. These efforts provided much of the\nfoundation for pharmaceutical development of the GLP-1 receptor peptide agonists, exenatide and liraglutide, as novel medicines\nfor patients suffering from T2DM. Now, much attention is focused on better understanding the molecular mechanisms involved\nin ligand induced signaling of the GLP-1 receptor. For example, advancements in biophysical and structural biology techniques\nare being applied in attempts to more precisely determine ligand binding and receptor occupancy characteristics at the atomic\nlevel. These efforts should better inform three-dimensional modeling of the GLP-1 receptor that will help inspire more rational\napproaches to identify and optimize small molecule agonists or allosteric modulators targeting the GLP-1 receptor. This article\nreviews GLP-1 receptor physiology with an emphasis on GLP-1 induced signaling mechanisms in order to highlight new molecular\nstrategies that help determine desired pharmacologic characteristics for guiding development of future nonpeptide GLP-1 receptor\nactivators....
Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and\r\norganizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is\r\nscanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We\r\ncollected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care\r\nmanagement of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI).\r\nThen, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity\r\nover a 4 year- follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no\r\nfulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57ââ?¬â??1.89]), cardiovascular (1.74 [95% CI 1.50ââ?¬â??2.01]) and cancer\r\n(1.35 [95% CI 1.14ââ?¬â??1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs\r\nfor incidence of major cardiovascular events up to 2.03 (95% CI 1.26ââ?¬â??3.28) for lower extremity amputations. Receiving\r\nspecialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout\r\nthe whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that\r\nmanagement of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable\r\nimpact on all-cause mortality and CV incidence, provided that guidelines are implemented...
Objective. To investigate the association between type 2 diabetes, glucose-lowering therapies (monotherapy with either metformin,\r\nsulphonylurea or insulin) and cancer risk in Taiwan. Methods. Using Taiwanââ?¬â?¢s National Health Research Institutes database of\r\n1,000,000 random subjects from 2000ââ?¬â??2008, we found 61777 patients with type 2 diabetes (age =20 years) and 677378 enrollees\r\nwith no record of diabetes. Results. After adjusting for age and sex, we found patients with diabetes to have significantly higher risk\r\nof all cancers (OR: 1.176; 95% CI: 1.149ââ?¬â??1.204,P < 0.001). Diabetic patients treated with insulin or sulfonylureas had significantly\r\nhigher risk of all cancers, compared to those treated with metformin (OR: 1.583; 95% CI: 1.389ââ?¬â??1.805, P < 0.001 and OR: 1.784;\r\n95% CI: 1.406ââ?¬â??2.262, P < 0.001). Metformin treatment was associated with a decreased risk of colon and liver cancer compared\r\nto sulphonylureas or insulin treatment. Sulfonylureas treatment was associated with an increased risk of breast and lung cancer\r\ncompared to metformin therapy. Conclusions. Taiwanese with type 2 diabetes are at a high risk of breast, prostate, colon, lung, liver\r\nand pancreatic cancer. Those treated with insulin or sulfonylureas monotherapy are more likely to develop colon and liver cancer\r\nthan those treated with metformin....
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