Journal of Diabetes and Its Complications - Articles in Press

Human bone marrow adiposity is linked with serum lipid levels not T1-diabetes - Corrected Proof

Jill M. Slade, Lindsay M. Coe, Ron A. Meyer, Laura R. McCabe — 2012-01-19

Abstract: Increased marrow adiposity is often associated with bone loss. Little is known about the regulation of marrow adiposity in humans. Marrow adiposity is increased in several mouse models including type I (T1)-diabetic mice, which also display bone loss. However, the impact of metabolic disease on marrow adiposity in humans has yet to be examined. This study measured bone marrow adiposity levels with iterative decomposition of water and fat with echo asymmetry and least-squares estimation magnetic resonance imaging and determined their relationship with T1-diabetes, bone mineral density (BMD), and serum lipid levels. Participants were adult T1-diabetic patients (glycosylated hemoglobin averaging 7.70%±0.4%) and age- and body-mass-index-matched nondiabetic subjects. Consistent with previous reports, serum osteocalcin levels were lower in subjects with T1-diabetes compared to controls (reaching statistical significance in females) and negatively correlated with disease duration (r=−0.50, P<.01). Furthermore, femur neck BMD inversely correlated with diabetes severity (r=−0.417, P<.05). While marrow adiposity was not altered by T1-diabetes, there was a striking positive correlation between vertebral, femur, and tibia marrow adiposity and serum lipid levels (low-density lipoprotein, total cholesterol, cholesterol:high-density lipoprotein ratio, and triglyceride; r≥0.383), reaching a significance of P<.001 in some comparisons. Marrow adiposity also displayed strong intrasubject correlations at multiple bone sites (r≥0.411, P<.05), increased with age (r=0.410, P<.05 at vertebral sites), and was reciprocally related to bone density (r≥−0.378, P<.05). Taken together, our data suggest that marrow adiposity may be an indicator of elevated serum lipid levels and decreased bone density.

Therapeutical potential of autologous peripheral blood mononuclear cell transplantation in patients with type 2 diabetic critical limb ischemia - Corrected Proof

2012-01-12

Abstract: Aim: The aim was to evaluate the therapeutic effectiveness of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood mononuclear cells (PBMNCs) in critical limb ischemia (CLI) of type 2 diabetic patients.Method: Forty diabetic patients with CLI were enrolled and randomized to treatment and control groups. In the treatment group, the patients received subcutaneous injections of recombinant human G-CSF (30 MU/day) for 5 days to mobilize stem cells. PBMNCs were collected and transplanted by multiple intramuscular injections of 1 ml in 1–1.5-cm depth into ischemic limbs.Results: At the end of 12 weeks of follow-up, the baseline and end point results in transplant group were as follows: Fontaine score improved from 3.8±03 to 3±0.5 (P=.0001), ankle brachial pressure index increased from 0.68±0.24 to 0.87±024 (P=.001), transcutaneous oxygen increased from 33±14 mmHg to 44±10 mmHg (P=.0001), and 6-min walking distance improved from 280±82 m to 338±98 m (P=.0001). Pain score decreased from 8.2±1.3 to 5.63±1.6 (P=.001), and the number of patients with limb ulcers was reduced from 9/20 (45%) to 3/20 (15%) (P=.031). In the control group, Fontaine score, 6-min walking distance, and pain score were improved; ankle brachial pressure index and transcutaneous oxygen pressure were not improved. The number of patients with limb ulcers did not change in the control group. There are improvement in amputation rates, collateral vessel development, and number of limb ulcers healed.Conclusions: These results indicate that the autologous transplantation of G-CSF that mobilized PBMNCs in CLI diabetic patients is safe and effective in patient compliant reduction and improved perfusion.

Effects of bile-acid-binding resin (colestimide) on blood glucose and visceral fat in Japanese patients with type 2 diabetes mellitus and hypercholesterolemia: an open-label, randomized, case–control, crossover study - Corrected Proof

2012-01-12

Abstract: Objective: The objective was to examine the effects of colestimide on blood glucose, visceral fat, adipocytokines, and bile acid conjugate fractions in Japanese patients.Methods: This study was an open-label, randomized, case–control, crossover study of colestimide 3 g/day in 40 Japanese patients with type 2 diabetes mellitus (T2D) and hypercholesterolemia. Patients were assigned to the colestimide group in which pravastatin and colestimide were administered orally and to the statin group in which pravastatin alone was administered orally. The principal outcome measures were serum lipid levels, fasting plasma glucose level in the early morning, hemoglobin A1c (HbA1c), visceral fat area (VFA), and serum 1,5-anhydroglucitol (1,5-AG) level.Results: Serum low-density lipoprotein cholesterol levels significantly decreased from 113±38 mg/dl at baseline to 90±20 mg/dl (P=.009) at week 12 of colestimide administration. HbA1c significantly decreased from 7.4%±0.9% at baseline to 6.9%±0.9% (P=.001) at week 12 of colestimide administration. Serum 1,5-AG levels increased from 9.4±10.1 μg/ml to 12.4±9.5 μg/ml (P=.05) at week 12 of colestimide administration. The statin group showed no significant changes in lipids and 1,5-AG. However, ΔVFA was inversely correlated with Δcholic acid, and multivariate analysis revealed that ΔVFA was a significant explanatory variable.Conclusions: Colestimide holds promise not only for the treatment of hypercholesterolemia but also for the possible improvement of T2D and visceral fat obesity.

Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus - Corrected Proof

Omar Abdulhameed Al-Khawaldeh, Mousa Ali Al-Hassan, Erika Sivarajan Froelicher — 2012-01-09

Abstract: Objective: The objective was to evaluate the relationships between diabetes management self-efficacy and diabetes self-management behaviors and glycemic control.Methods: A cross-sectional design was used. A convenience sample of 223 subjects with type 2 diabetes, ≥25 years old, who sought care at the National Diabetes Center in Amman, Jordan, was enrolled. A structured interview and medical records provided the data. The instruments included a sociodemographic and clinical questionnaire, a diabetes management self-efficacy scale, and a diabetes self-management behaviors scale. Glycosylated hemoglobin was used as an index for glycemic control. The analyses are presented as proportions, means (±S.D.), odds ratios, and 95% confidence intervals obtained from logistic regressions.Results: Diet self-efficacy and diet self-management behaviors predicted better glycemic control, whereas insulin use was a statistically significant predictor for poor glycemic control. In addition, subjects with higher self-efficacy reported better self-management behaviors in diet, exercise, blood sugar testing, and taking medication. The findings showed that more than half of the subjects did not have their diabetes under control and that only 42% had attended diabetes education programs.Conclusions: The majority of subjects did not have their diabetes controlled; their self-efficacy was low, and they had suboptimal self-management behaviors. Therefore, strategies to enhance and promote self-efficacy and self-management behaviors for patients are essential components of diabetes education programs. Furthermore, behavioral counseling and skill-building interventions are critical for the patients to become confident and be able to manage their diabetes.

Recent advances in understanding the biochemical and molecular mechanism of diabetic retinopathy - Corrected Proof

2012-01-09

Abstract: One of the major complications in patients with diabetes is diabetic retinopathy (DR), a leading cause of blindness worldwide. It takes several years before any clinical signs of retinopathy appear in diabetic patients, which gives an ample opportunity for scientists to uncover biochemical and molecular mechanism implicated early in the development and progression of the disease. During the past few decades, research progress has been made in investigating the pathophysiology of the disease; however, due to nonavailability of human retinal samples at different stages of the disease and also due to lack of a proper animal model of DR, the exact molecular mechanism has not been elucidated, making therapeutic a difficult task. In this review article, we have discussed a number of diabetes-induced metabolites such as glucose, lipids, amino acids, and other related factors and molecules that are implicated in the pathophysiology of the DR. Furthermore, we have highlighted neurodegeneration and regulation of neurotrophic factors, being recognized as early events that may be involved in the pathology of the disease in the course of DR. An understanding of the biochemical and molecular changes especially early in the diabetic retina may lead to new and effective therapies towards prevention and amelioration of DR, which is important for the millions of individuals who already have or are likely to develop the disease before a cure becomes available.

Trends of insulin use among US adults with type 2 diabetes: the Behavioral Risk Factor Surveillance System, 1995–2007 - Corrected Proof

2012-01-09

Abstract: Objective: People with type 2 diabetes may need insulin therapy to compensate for their underlying pathogenic abnormalities and to improve glycemic control. We examined trends of insulin use among US adults aged ≥40 years with type 2 diabetes.Methods: We analyzed data from the Behavioral Risk Factor Surveillance System collected annually during 1995–2007. Insulin use was assessed by self-report. Log-linear regression analyses with a robust error variance estimator were performed to estimate the prevalence, prevalence ratios, and their 95% confidence intervals.Results: The overall crude and age-standardized proportion of insulin use decreased from 35% and 36% in 1995 to 23% and 22% in 2007, respectively. After adjustments for age, sex, race/ethnicity, education attainment, body mass index, and diabetes duration, the overall prevalence decreased from 33% to 22% (P<.0001 for linear trend). The decreasing rates were similar across sex (P=.23 for interaction between sex and survey year) and race/ethnicity (P=.35 for interaction between race/ethnicity and survey year).Conclusion: The proportion of insulin use decreased from 1995 to 2007 among US adults aged ≥40 years. Continuing efforts may be needed to properly identify those who may need to initiate and maintain insulin therapy among patients with type 2 diabetes as medically indicated.

The combination of carotid and lower extremity ultrasonography increases the detection of atherosclerosis in type 2 diabetes patients - Corrected Proof

2012-01-09

Abstract: Objective: To evaluate the prevalence of atherosclerosis detected by both carotid and lower extremity ultrasonography in hospitalized Chinese type 2 diabetic patients and to examine whether plaque formation in the carotid arteries could be an indicator of generalized atherosclerosis in type 2 diabetes mellitus.Methods: Totally, 709 hospitalized Chinese type 2 diabetic patients (men 357, women 352) aged from 18 to 88 years were included. Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound. Atherosclerosis was defined as the presence of either the carotid or lower extremity plaque in any of the above-mentioned arteries segments. The prevalence of atherosclerosis was calculated, and the risk factors associated with atherosclerosis were evaluated using binary logistic regression.Results: The prevalence of atherosclerosis was 81.23% in male and 77.56% in female type 2 diabetic patients, respectively. There was no significant difference in the prevalence of atherosclerosis in patients between the sexes. The prevalence of atherosclerosis was significantly higher in the lower extremity arteries than in the carotid arteries (73.91% and 44.43%, respectively, P<.001). Atherosclerosis was significantly associated with smoking, age, duration of diabetes, systolic blood pressure, total number of white blood cells, and mean carotid and femoral intima-media thickness (IMT).Conclusions: The prevalence of atherosclerosis was very high in Chinese inpatients with type 2 diabetes. Carotid atherosclerosis could not be an indicator of generalized atherosclerosis in type 2 diabetes. The combination of carotid and lower extremity ultrasound examination can significantly improve the detection of atherosclerosis in type 2 diabetes.

Clinical, biochemical, and immunological characteristics of newly diagnosed nonobese diabetic patients aged 18–45 years in China - Corrected Proof

Shi Zhang, Qi Sun, Kai Feng, Yong Fu, Ou Wang, Fan Ping, Yuxiu Li — 2012-01-09

Abstract: Background: The purpose was to characterize the clinical, biochemical, and immunological features of newly diagnosed adult-onset nonobese diabetic patients in China.Methods: Newly diagnosed diabetic patients aged 18–45 years with body mass index<23 kg/m2 were included. Excluding one mitochondrial diabetes patient, there were 102 diabetic patients enrolled in this study. Clinical and biochemical data were collected and analyzed. Radioimmunoassay was used to detect islet autoantibodies.Results: Among the 102 study participants, 68.6% had type 1 diabetes (T1DM), 20.6% had type 2 diabetes (T2DM), and 10.8% had latent autoimmune diabetes in adults (LADA). About 92% of the T1DM patients presented hyperglycemic symptoms. The corresponding number in T2DM and LADA patients was 13% and 38%, respectively (P<.01). C-peptide in T2DM patients (1.4±0.7 ng/ml) was significantly higher than that in T1DM (0.4±0.3 ng/ml) and LADA (0.4±0.2 ng/ml) patients (P<.01). The prevalence of glutamic acid decarboxylase antibody (GADA) (64.3%) in T1DM patients was higher than that of insulin autoantibody (17.1%) (P<.05). GADA and islet cell antibody (ICA) combination was positive in 75.7% of T1DM patients.Conclusion: T1DM patients accounted for majority of the study sample. In addition, the clinical symptoms of T1DM patients were more severe compared with T2DM patients. GADA is the most sensitive autoantibody marker for adult-onset T1DM and LADA. GADA and ICA are the best test combination for adult-onset autoimmune diabetes. Specific types of diabetes should be in mind when diabetes presents itself with special transmission mode or with other extrapancreatic manifestations.