1
|
Stone SI, Balasubramanyam A, Posey JE. Atypical Diabetes: What Have We Learned and What Does the Future Hold? Diabetes Care 2024; 47:770-781. [PMID: 38329838 PMCID: PMC11043229 DOI: 10.2337/dci23-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/21/2023] [Indexed: 02/10/2024]
Abstract
As our understanding of the pathophysiology of diabetes evolves, we increasingly recognize that many patients may have a form of diabetes that does not neatly fit with a diagnosis of either type 1 or type 2 diabetes. The discovery and description of these forms of "atypical diabetes" have led to major contributions to our collective understanding of the basic biology that drives insulin secretion, insulin resistance, and islet autoimmunity. These discoveries now pave the way to a better classification of diabetes based on distinct endotypes. In this review, we highlight the key biological and clinical insights that can be gained from studying known forms of atypical diabetes. Additionally, we provide a framework for identification of patients with atypical diabetes based on their clinical, metabolic, and molecular features. Helpful clinical and genetic resources for evaluating patients suspected of having atypical diabetes are provided. Therefore, appreciating the various endotypes associated with atypical diabetes will enhance diagnostic accuracy and facilitate targeted treatment decisions.
Collapse
Affiliation(s)
- Stephen I. Stone
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX
| | - Jennifer E. Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
2
|
Kubota-Mishra E, Huang X, Minard CG, Astudillo M, Refaey A, Montes G, Sisley S, Ram N, Winter WE, Naylor RN, Balasubramanyam A, Redondo MJ, Tosur M. High Prevalence of A-β+ Ketosis-Prone Diabetes in Children with Type 2 Diabetes and Diabetic Ketoacidosis at Diagnosis: Evidence from the Rare and Atypical Diabetes Network (RADIANT). Pediatr Diabetes 2024; 2024:5907924. [PMID: 38765897 PMCID: PMC11100136 DOI: 10.1155/2024/5907924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background A-β+ ketosis-prone diabetes (KPD) in adults is characterized by presentation with diabetic ketoacidosis (DKA), negative islet autoantibodies, and preserved β-cell function in persons with a phenotype of obesity-associated type 2 diabetes (T2D). The prevalence of KPD has not been evaluated in children. We investigated children with DKA at "T2D" onset and determined the prevalence and characteristics of pediatric A-β+ KPD within this cohort. Methods We reviewed the records of 716 children with T2D at a large academic hospital and compared clinical characteristics of those with and without DKA at onset. In the latter group, we identified patients with A-β+ KPD using criteria of the Rare and Atypical Diabetes Network (RADIANT) and defined its prevalence and characteristics. Results Mean age at diagnosis was 13.7 ± 2.4 years: 63% female; 59% Hispanic, 29% African American, 9% non-Hispanic White, and 3% other. Fifty-six (7.8%) presented with DKA at diagnosis and lacked islet autoantibodies. Children presenting with DKA were older and had lower C-peptide and higher glucose concentrations than those without DKA. Twenty-five children with DKA (45%) met RADIANT A-β+ KPD criteria. They were predominantly male (64%), African American or Hispanic (96%), with substantial C-peptide (1.3 ± 0.7 ng/mL) at presentation with DKA and excellent long-term glycemic control (HbA1c 6.6% ± 1.9% at follow-up (median 1.3 years postdiagnosis)). Conclusions In children with a clinical phenotype of T2D and DKA at diagnosis, approximately half meet criteria for A-β+ KPD. They manifest the key characteristics of obesity, preserved β-cell function, male predominance, and potential to discontinue insulin therapy, similar to adults with A-β+ KPD.
Collapse
Affiliation(s)
- Elizabeth Kubota-Mishra
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Marcela Astudillo
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
| | | | - Graciela Montes
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie Sisley
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
- USDA/ARS Children’s Nutrition Research Center, Houston, TX, USA
| | - Nalini Ram
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - William E. Winter
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Rochelle N. Naylor
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Departments of Pediatric and Medicine, University of Chicago, Chicago, IL, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - Maria J. Redondo
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
| | - Mustafa Tosur
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
- USDA/ARS Children’s Nutrition Research Center, Houston, TX, USA
| | - RADIANT Study Group
- The RADIANT Data Coordinating Center, Health Informatics Institute, University of South Florida, Tampa, FL, USA
| |
Collapse
|
3
|
Goedecke JH, Mendham AE. Pathophysiology of type 2 diabetes in sub-Saharan Africans. Diabetologia 2022; 65:1967-1980. [PMID: 36166072 PMCID: PMC9630207 DOI: 10.1007/s00125-022-05795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 01/11/2023]
Abstract
Sub-Saharan Africa (SSA) is the region with the highest projected rates of increase in type 2 diabetes (129% by 2045), which will exacerbate the already high prevalence of type 2 diabetes complications and comorbidities in SSA. In addition, SSA is grappling with poverty-related health problems and infectious diseases and is also undergoing the most rapid rates of urbanisation globally. These socioenvironmental and lifestyle factors may interact with genetic factors to alter the pathophysiological sequence leading to type 2 diabetes in sub-Saharan African populations. Indeed, current evidence from SSA and the diaspora suggests that the pathophysiology of type 2 diabetes in Black Africans is different from that in their European counterparts. Studies from the diaspora suggest that insulin clearance is the primary defect underlying the development of type 2 diabetes. We propose that, among Black Africans from SSA, hyperinsulinaemia due to a combination of both increased insulin secretion and reduced hepatic insulin clearance is the primary defect, which promotes obesity and insulin resistance, exacerbating the hyperinsulinaemia and eventually leading to beta cell failure and type 2 diabetes. Nonetheless, the current understanding of the pathogenesis of type 2 diabetes and the clinical guidelines for preventing and managing the disease are largely based on studies including participants of predominately White European ancestry. In this review, we summarise the existing knowledge base and data from the only non-pharmacological intervention that explores the pathophysiology of type 2 diabetes in SSA. We also highlight factors that may influence the pathogenesis of type 2 diabetes in SSA, such as social determinants, infectious diseases and genetic and epigenetic influences.
Collapse
Affiliation(s)
- Julia H Goedecke
- Biomedical Research and Innovation Platform and Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Amy E Mendham
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
4
|
Gavkare AM, Nanaware N, Rayate AS, Mumbre S, Nagoba BS. COVID-19 associated diabetes mellitus: A review. World J Diabetes 2022; 13:729-737. [PMID: 36188145 PMCID: PMC9521440 DOI: 10.4239/wjd.v13.i9.729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/20/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
A significantly higher rate of new-onset diabetes in many coronavirus disease 2019 (COVID-19) patients is a frequently observed phenomenon. The resultant hyperglycemia is known to influence the clinical outcome, thereby increasing the cost of treatment and stay in hospital. This will also affect the post-hospitalization recuperation. It has been observed that new-onset diabetes in COVID-19 patients is associated with considerable increase in morbidity and may be associated with increased mortality in some cases. This mini-review focuses on the possible causes to understand how COVID-19-related diabetes develops, various associated risk factors, and possible mechanism to understand the natural history of the disease process, clinical outcome, associated morbidities and various treatment options in the mana-gement of post COVID-19 diabetes. A literature search was performed in PubMed and other online database using appropriate keywords. A total of 80 articles were found, among which, 53 of the most relevant were evaluated/ analyzed and relevant data were included. The studies show that patients who have had severe acute respiratory syndrome coronavirus 2 infection leading to development of COVID-19 may manifest not only with new-onset diabetes but also worsening of pre-existing diabetes. Cytopathic effect and autoimmune destruction of insulin-secreting pancreatic beta cells, cytokine storm during the active phase of infection causing impaired insulin secretion and resistance, drug-induced hyperglycemia, undetected pre-existing hyperglycemia/diabetic condition, and stress-induced impairment of glucose metabolism are some of the possible potential mechanisms of COVID-19-associated new-onset diabetes mellitus. Many studies published in recent times have found a significantly higher rate of new-onset diabetes mellitus in many COVID-19 patients. Whether it is an inflammatory or immune-mediated response, direct effect of virus or combination of these is unclear. The resultant hyperglycemia is known to influence the clinical outcome and has been associated with considerable increase in morbidity and increased mortality in some cases.
Collapse
Affiliation(s)
- Ajay M Gavkare
- Physiology, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, Maharashtra, India
| | - Neeta Nanaware
- Physiology, Vilasrao Deshmukh Government Medical College, Latur 413512, Maharashtra, India
| | - Abhijit S Rayate
- Surgery, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, Maharashtra, India
| | - Sachin Mumbre
- Community Medicine, Ashwini Rural Medical College, Solapur 413006, Maharashtra, India
| | - Basavraj S Nagoba
- Microbiology, Maharashtra Institute of Medical Sciences & Research (Medical College), Latur 413531, Maharashtra, India
| |
Collapse
|
5
|
Badedi M, Muhajir A, Alnami A, Darraj H, Alamoudi A, Agdi Y, Mujayri A, Ageeb A. The severity and clinical characteristics of COVID-19 among patients with type 2 diabetes mellitus in Jazan, Saudi Arabia. Medicine (Baltimore) 2022; 101:e29215. [PMID: 35550472 PMCID: PMC9276086 DOI: 10.1097/md.0000000000029215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The objectives of the current study were to assess the severity and clinical characteristics of coronavirus disease 2019 (COVID-19) among Saudi adults with type 2 diabetes mellitus (T2DM) in Jazan region, Saudi Arabia. METHODS This retrospective cohort study included 412 patients with COVID-19 selected randomly from the Health Electronic Surveillance Network system, which contains the primary data on COVID-19 infections in Jazan. RESULTS COVID-19 disease duration was significantly longer in patients with T2DM (mean = 10.7 days) compared with those without T2DM (mean = 8.3 days) (P = .01). Six (7%) patients experienced an increase in blood glucose concentrations and had to escalate their total daily insulin dose accordingly. Median fasting and random blood glucose levels increased after infection with COVID-19 (pre-COVID median = 119 and 172 mg/dL, respectively; post-COVID median = 148 and 216 mg/dL, respectively) (P = .02). The total insulin dose pre-COVID (median = 42 units/d) increased after infection with COVID-19 (median = 58 units/d) (P = .01). Most patients with T2DM had clinical COVID-19 symptoms (91%) and the remainder (9%) were asymptomatic. A large proportion (80%) of T2DM patients with mild COVID-19 symptoms self-isolated at home. COVID-19 patients with T2DM (11%) who had an oxygen saturation of ≤ 90% and admitted to the intensive care unit were higher than those without T2DM (5%) (P = < .001). COVID-19 patients with T2DM (9%) had higher mortality rate than COVID-19 patients without T2DM (1%) (P = < .001). CONCLUSION COVID-19 patients with T2DM were associated with a higher risk of admission to the intensive care unit and mortality than COVID-19 patients without T2DM.
Collapse
Affiliation(s)
| | | | - Awaji Alnami
- General Directorate of Health Affairs, Jazan, Saudi Arabia
| | - Hussain Darraj
- General Directorate of Health Affairs, Jazan, Saudi Arabia
| | - Aymn Alamoudi
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Yasir Agdi
- General Directorate of Health Affairs, Jazan, Saudi Arabia
| | - Ahoud Mujayri
- General Directorate of Health Affairs, Jazan, Saudi Arabia
| | - Atif Ageeb
- General Directorate of Health Affairs, Jazan, Saudi Arabia
| |
Collapse
|
6
|
Gaba R, Balasubramanyam A. Covid-19: A new cause of "provoked" A-β+ Ketosis-Prone Diabetes. J Diabetes Complications 2022; 36:108147. [PMID: 35153127 PMCID: PMC8820105 DOI: 10.1016/j.jdiacomp.2022.108147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Ruchi Gaba
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, United States of America.
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, United States of America.
| |
Collapse
|
7
|
PD-1 blockade with pembrolizumab in classic or endemic Kaposi's sarcoma: a multicentre, single-arm, phase 2 study. Lancet Oncol 2022; 23:491-500. [DOI: 10.1016/s1470-2045(22)00097-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 12/26/2022]
|
8
|
Metwally AA, Mehta P, Johnson BS, Nagarjuna A, Snyder MP. COVID-19-Induced New-Onset Diabetes: Trends and Technologies. Diabetes 2021; 70:2733-2744. [PMID: 34686519 PMCID: PMC8660988 DOI: 10.2337/dbi21-0029] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/23/2021] [Indexed: 01/15/2023]
Abstract
The coronavirus disease 2019 (COVID-19) global pandemic continues to spread worldwide with approximately 216 million confirmed cases and 4.49 million deaths to date. Intensive efforts are ongoing to combat this disease by suppressing viral transmission, understanding its pathogenesis, developing vaccination strategies, and identifying effective therapeutic targets. Individuals with preexisting diabetes also show higher incidence of COVID-19 illness and poorer prognosis upon infection. Likewise, an increased frequency of diabetes onset and diabetes complications has been reported in patients following COVID-19 diagnosis. COVID-19 may elevate the risk of hyperglycemia and other complications in patients with and without prior diabetes history. It is unclear whether the virus induces type 1 or type 2 diabetes or instead causes a novel atypical form of diabetes. Moreover, it remains unknown if recovering COVID-19 patients exhibit a higher risk of developing new-onset diabetes or its complications going forward. The aim of this review is to summarize what is currently known about the epidemiology and mechanisms of this bidirectional relationship between COVID-19 and diabetes. We highlight major challenges that hinder the study of COVID-19-induced new-onset of diabetes and propose a potential framework for overcoming these obstacles. We also review state-of-the-art wearables and microsampling technologies that can further study diabetes management and progression in new-onset diabetes cases. We conclude by outlining current research initiatives investigating the bidirectional relationship between COVID-19 and diabetes, some with emphasis on wearable technology.
Collapse
Affiliation(s)
- Ahmed A Metwally
- Department of Genetics, Stanford University, Stanford, CA
- Illumina Artificial Intelligence Laboratory, Illumina Inc., San Diego, CA
- Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Giza, Egypt
| | | | | | | | | |
Collapse
|
9
|
Ishimwe MCS, Wentzel A, Shoup EM, Osei-Tutu NH, Hormenu T, Patterson AC, Bagheri H, DuBose CW, Mabundo LS, Ha J, Sherman A, Sumner AE. Beta-cell failure rather than insulin resistance is the major cause of abnormal glucose tolerance in Africans: insight from the Africans in America study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002447. [PMID: 34531244 PMCID: PMC8449936 DOI: 10.1136/bmjdrc-2021-002447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Uncertainties exist on whether the main determinant of abnormal glucose tolerance (Abnl-GT) in Africans is β-cell failure or insulin resistance (IR). Therefore, we determined the prevalence, phenotype and characteristics of Abnl-GT due to β-cell failure versus IR in 486 African-born blacks (male: 64%, age: 38±10 years (mean±SD)) living in America. RESEARCH DESIGN AND METHODS Oral glucose tolerance test were performed. Abnl-GT is a term which includes both diabetes and prediabetes and was defined as fasting plasma glucose (FPG) ≥5.6 mmol/L and/or 2-hour glucose ≥7.8 mmol/L. IR was defined by the lowest quartile of the Matsuda Index (≤2.98) and retested using the upper quartile of homeostatic model assessment of insulin resistance (HOMA-IR) (≥2.07). Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-β-cell failure was defined as Abnl-GT without IR. Beta-cell compensation was assessed by the Disposition Index (DI). Fasting lipids were measured. Visceral adipose tissue (VAT) volume was obtained with abdominal CT scan. RESULTS The prevalence of Abnl-GT was 37% (182/486). For participants with Abnl-GT, IR occurred in 38% (69/182) and β-cell failure in 62% (113/182). Compared with Africans with Abnl-GT-IR, Africans with Abnl-GT-β-cell failure had lower body mass index (BMI) (30.8±4.3 vs 27.4±4.0 kg/m2), a lower prevalence of obesity (52% vs 19%), less VAT (163±72 vs 107±63 cm2), lower triglyceride (1.21±0.60 vs 0.85±0.42 mmol/L) and lower FPG (5.9±1.4 vs 5.3±0.6 mmol/L) and 2-hour glucose concentrations (10.0±3.1 vs 9.0±1.9 mmol/L) (all p<0.001) and higher DI, high-density lipoprotein (HDL), low-density lipoprotein particle size and HDL particle size (all p<0.01). Analyses with Matsuda Index and HOMA-IR yielded similar results. Potential confounders such as income, education, alcohol and fiber intake did not differ by group. CONCLUSIONS Beta-cell failure occurred in two-thirds of participants with Abnl-GT and may be a more frequent determinant of Abnl-GT in Africans than IR. As BMI category, degree of glycemia and lipid profile appeared more favorable when Abnl-GT was due to β-cell failure rather than IR, the clinical course and optimal interventions may differ. TRIAL REGISTRATION NUMBER NCT00001853.
Collapse
Affiliation(s)
| | | | - Elyssa M Shoup
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Thomas Hormenu
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Hadi Bagheri
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Joon Ha
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | - Arthur Sherman
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| | - Anne E Sumner
- NIDDK, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Lontchi-Yimagou E, Feutseu C, Kenmoe S, Djomkam Zune AL, Kinyuy Ekali SF, Nguewa JL, Choukem SP, Mbanya JC, Gautier JF, Sobngwi E. Non-autoimmune diabetes mellitus and the risk of virus infections: a systematic review and meta-analysis of case-control and cohort studies. Sci Rep 2021; 11:8968. [PMID: 33903699 PMCID: PMC8076178 DOI: 10.1038/s41598-021-88598-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
A significant number of studies invoked diabetes as a risk factor for virus infections, but the issue remains controversial. We aimed to examine whether non-autoimmune diabetes mellitus enhances the risk of virus infections compared with the risk in healthy individuals without non-autoimmune diabetes mellitus. In this systematic review and meta-analysis, we assessed case-control and cohort studies on the association between non-autoimmune diabetes and viruses. We searched PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science with no language restriction, to identify articles published until February 15, 2021. The main outcome assessment was the risk of virus infection in individuals with non-autoimmune diabetes. We used a random-effects model to pool individual studies and assessed heterogeneity (I2) using the χ2 test on Cochrane's Q statistic. This study is registered with PROSPERO, number CRD42019134142. Out of 3136 articles identified, we included 68 articles (90 studies, as the number of virus and or diabetes phenotype varied between included articles). The summary OR between non-autoimmune diabetes and virus infections risk were, 10.8(95% CI: 10.3-11.4; 1-study) for SARS-CoV-2; 3.6(95%CI: 2.7-4.9, I2 = 91.7%; 43-studies) for HCV; 2.7(95% CI: 1.3-5.4, I2 = 89.9%, 8-studies;) for HHV8; 2.1(95% CI: 1.7-2.5; 1-study) for H1N1 virus; 1.6(95% CI: 1.2-2.13, I2 = 98.3%, 27-studies) for HBV; 1.5(95% CI: 1.1-2.0; 1-study) for HSV1; 3.5(95% CI: 0.6-18.3 , I2 = 83.9%, 5-studies) for CMV; 2.9(95% CI: 1-8.7, 1-study) for TTV; 2.6(95% CI: 0.7-9.1, 1-study) for Parvovirus B19; 0.7(95% CI: 0.3-1.5 , 1-study) for coxsackie B virus; and 0.2(95% CI: 0-6.2; 1-study) for HGV. Our findings suggest that, non-autoimmune diabetes is associated with increased susceptibility to viruses especially SARS-CoV-2, HCV, HHV8, H1N1 virus, HBV and HSV1. Thus, these viruses deserve more attention from diabetes health-care providers, researchers, policy makers, and stakeholders for improved detection, overall proper management, and efficient control of viruses in people with non-autoimmune diabetes.
Collapse
Affiliation(s)
- Eric Lontchi-Yimagou
- grid.412661.60000 0001 2173 8504Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, 3851 Yaoundé, Cameroon
| | - Charly Feutseu
- grid.412661.60000 0001 2173 8504Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, 3851 Yaoundé, Cameroon
| | - Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Alexandra Lindsey Djomkam Zune
- grid.29273.3d0000 0001 2288 3199Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Solange Fai Kinyuy Ekali
- grid.412661.60000 0001 2173 8504Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Louis Nguewa
- grid.508487.60000 0004 7885 7602INSERM, Cordeliers Research Centre, Sorbonne Paris Cité, Université Paris Descartes, Université Paris Diderot, Paris, France ,grid.508487.60000 0004 7885 7602Assistance Publique-Hôpitaux de Paris, Lariboisière Hospital, Department of Diabetes, Clinical Investigation Centre (CIC-9504), University Paris-Diderot, Paris, France ,grid.508487.60000 0004 7885 7602Faculty of Medicine, University Paris-Diderot, Paris, France
| | - Siméon Pierre Choukem
- grid.8201.b0000 0001 0657 2358Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Jean Claude Mbanya
- grid.412661.60000 0001 2173 8504Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, 3851 Yaoundé, Cameroon ,grid.412661.60000 0001 2173 8504Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon ,grid.460723.40000 0004 0647 4688National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Jean Francois Gautier
- grid.508487.60000 0004 7885 7602INSERM, Cordeliers Research Centre, Sorbonne Paris Cité, Université Paris Descartes, Université Paris Diderot, Paris, France ,grid.508487.60000 0004 7885 7602Assistance Publique-Hôpitaux de Paris, Lariboisière Hospital, Department of Diabetes, Clinical Investigation Centre (CIC-9504), University Paris-Diderot, Paris, France ,grid.508487.60000 0004 7885 7602Faculty of Medicine, University Paris-Diderot, Paris, France
| | - Eugene Sobngwi
- grid.412661.60000 0001 2173 8504Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, 3851 Yaoundé, Cameroon ,grid.412661.60000 0001 2173 8504Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon ,grid.460723.40000 0004 0647 4688National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| |
Collapse
|
11
|
Waddankeri SS, Swaraj Waddankeri M, Gurushantappa Mangshetty B. Clinical and Biochemical Characteristics and Treatment Outcomes of Ketosis-Prone Diabetes: The Remission Prone Diabetes. Int J Endocrinol Metab 2021; 19:e106799. [PMID: 34149844 PMCID: PMC8198612 DOI: 10.5812/ijem.106799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/22/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the severe acute complications of diabetes. It has long been considered a key clinical characteristic of type 1 diabetes mellitus (T1DM) with severe and irreversible deficient insulin levels. Ketosis-prone diabetes (KPD) has pathophysiology close to T2DM but shows signs and symptoms associated with T1DM. In general, patients with ketosis-prone diabetes display elevated glucose and ketone levels; also, a higher hemoglobin A1C than conventional T2DM. OBJECTIVES The current research aimed to elucidate the clinical presentation and outline a management plan for KPD in the Indian population. METHODS The present case series is a descriptive, prospective, and observational case series on six unprovoked cases of KPD. They were managed using the standard protocol of DKA management. RESULTS The recruited cases followed a set pattern of very high insulin requirement at diagnosis. On follow-up, the insulin requirement progressively declined, and all of the cases were able to stop insulin therapy after a mean period of four weeks. None of the cases presented any organ damage at diagnosis. There was no recurrence of DKA during the two-year follow-up. All of the cases had normal liver and renal functions. Autoantibodies were negative in all of the cases. CONCLUSIONS Ketosis-prone diabetes is the most under-recognized and under-diagnosed among all types of diabetes. Its recognition is of utmost importance as the approach of its treatment varies widely from that of the conventional type of diabetes. Proper follow-up, especially in unprovoked cases of DKA with obese phenotype, could help elucidate this rare entity of KPD where insulin can be stopped and maintain normoglycemia for a substantial period without insulin.
Collapse
Affiliation(s)
- Swaraj Shrikant Waddankeri
- Department of Medicine, Division of Diabetes and Endocrinology, M R Medical College, Kalaburgi, India
- Corresponding Author: Department of Medicine, Division of Diabetes and Endocrinology, M R Medical College, Kalaburgi, India.
| | | | | |
Collapse
|
12
|
Unnikrishnan R, Misra A. Infections and diabetes: Risks and mitigation with reference to India. Diabetes Metab Syndr 2020; 14:1889-1894. [PMID: 33002780 PMCID: PMC7505871 DOI: 10.1016/j.dsx.2020.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS The link between diabetes and increased risk of infectious disease has long been recognized, but has re-entered sharp focus following the COVID-19 pandemic. METHODS A literature search was conducted in PubMed for articles in English on diabetes and infection. RESULTS Diabetes predisposes to infections through alterations in innate and acquired immune defenses. Outcomes of infection are worse in people with uncontrolled diabetes, and infection can worsen hyperglycemia in hitherto well controlled diabetes (bidirectional relationship). Diabetes does not increase the risk of infection with COVID-19 per se, but predisposes to severe disease and poor outcomes. COVID-19 has also been linked to deterioration of glycemic control as well as new-onset diabetes. CONCLUSIONS Clinicians caring for people with diabetes should be aware of the increased risk of infections in this population, as well as the possibility of worsening hyperglycemia. A holistic approach with frequent monitoring of blood glucose levels and appropriate titration of medications, along with close attention to nutritional status, is essential to ensure the best possible outcomes.
Collapse
Affiliation(s)
- Ranjit Unnikrishnan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India.
| | - Anoop Misra
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India), New Delhi, India; Fortis C-DOC Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
| |
Collapse
|
13
|
Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 2020; 8:782-792. [PMID: 32687793 PMCID: PMC7367664 DOI: 10.1016/s2213-8587(20)30238-2] [Citation(s) in RCA: 550] [Impact Index Per Article: 137.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
Since the initial COVID-19 outbreak in China, much attention has focused on people with diabetes because of poor prognosis in those with the infection. Initial reports were mainly on people with type 2 diabetes, although recent surveys have shown that individuals with type 1 diabetes are also at risk of severe COVID-19. The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk, but limitations to their use and potential interactions with COVID-19 treatments should be carefully assessed. Finally, severe acute respiratory syndrome coronavirus 2 infection itself might represent a worsening factor for people with diabetes, as it can precipitate acute metabolic complications through direct negative effects on β-cell function. These effects on β-cell function might also cause diabetic ketoacidosis in individuals with diabetes, hyperglycaemia at hospital admission in individuals with unknown history of diabetes, and potentially new-onset diabetes.
Collapse
Affiliation(s)
- Matteo Apicella
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Michele Mantuano
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Mazoni
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy.
| |
Collapse
|
14
|
Angius F, Ingianni A, Pompei R. Human Herpesvirus 8 and Host-Cell Interaction: Long-Lasting Physiological Modifications, Inflammation and Related Chronic Diseases. Microorganisms 2020; 8:E388. [PMID: 32168836 PMCID: PMC7143610 DOI: 10.3390/microorganisms8030388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 01/13/2023] Open
Abstract
Oncogenic and latent-persistent viruses belonging to both DNA and RNA groups are known to cause serious metabolism alterations. Among these, the Human Herpesvirus 8 (HHV8) infection induces stable modifications in biochemistry and cellular metabolism, which in turn affect its own pathological properties. HHV8 enhances the expression of insulin receptors, supports the accumulation of neutral lipids in cytoplasmic lipid droplets and induces alterations in both triglycerides and cholesterol metabolism in endothelial cells. In addition, HHV8 is also known to modify immune response and cytokine production with implications for cell oxidative status (i.e., reactive oxygen species activation). This review underlines the recent findings regarding the role of latent and persistent HHV8 viral infection in host physiology and pathogenesis.
Collapse
|
15
|
Incani A, Marras L, Serreli G, Ingianni A, Pompei R, Deiana M, Angius F. Human Herpesvirus 8 infection may contribute to oxidative stress in diabetes type 2 patients. BMC Res Notes 2020; 13:75. [PMID: 32054515 PMCID: PMC7020602 DOI: 10.1186/s13104-020-4935-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate the link between Human Herpesvirus 8 (HHV8) infection and plasma oxidative stress in patients with diabetes mellitus type 2 (DM2). RESULTS Blood samples collected from DM2 and control subjects were screened for the presence of antibodies against HHV8 and for biomarkers of oxidative stress. We determined the products of radical damage on the plasma lipid fraction, such as malondialdehyde (MDA), fatty acid hydroperoxides (HP) and 7-ketocholesterol (7-keto), the oxidation products of unsaturated fatty acids (UFA) and cholesterol, respectively. The level of plasma antioxidant α-tocopherol (α-toc) was also assessed. Relevant differences were observed in the redox status in DM2 and either HHV8-positive or -negative control subjects. The level of α-toc significantly decreased in both DM2 and HHV8-positive subjects. Levels of MDA, HP and 7-keto were much higher in HHV8-positive and DM2 subjects, indicating that plasma oxidative stress is a common feature in both DM2 and HHV8-infection. In addition, 7-keto was further increased in HHV8-positive DM2 patients. We hypothesized that the HHV8-infection may contribute to the production of ROS, and hence to the oxidative stress closely related to the pathogenesis and development of DM2.
Collapse
Affiliation(s)
- Alessandra Incani
- Unit of Experimental Pathology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Luisa Marras
- Section of Applied Microbiology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Gabriele Serreli
- Unit of Experimental Pathology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Angela Ingianni
- Section of Applied Microbiology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Raffaello Pompei
- Section of Applied Microbiology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Monica Deiana
- Unit of Experimental Pathology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
| | - Fabrizio Angius
- Section of Applied Microbiology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
| |
Collapse
|
16
|
López-Rodríguez DM, Kirillov V, Krug LT, Mesri EA, Andreansky S. A role of hypoxia-inducible factor 1 alpha in Murine Gammaherpesvirus 68 (MHV68) lytic replication and reactivation from latency. PLoS Pathog 2019; 15:e1008192. [PMID: 31809522 PMCID: PMC6975554 DOI: 10.1371/journal.ppat.1008192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/22/2020] [Accepted: 11/05/2019] [Indexed: 12/15/2022] Open
Abstract
The hypoxia-inducible factor 1 alpha (HIF1α) protein and the hypoxic microenvironment are critical for infection and pathogenesis by the oncogenic gammaherpesviruses (γHV), Kaposi sarcoma herpes virus (KSHV) and Epstein-Barr virus (EBV). However, understanding the role of HIF1α during the virus life cycle and its biological relevance in the context of host has been challenging due to the lack of animal models for human γHV. To study the role of HIF1α, we employed the murine gammaherpesvirus 68 (MHV68), a rodent pathogen that readily infects laboratory mice. We show that MHV68 infection induces HIF1α protein and HIF1α-responsive gene expression in permissive cells. siRNA silencing or drug-inhibition of HIF1α reduce virus production due to a global downregulation of viral gene expression. Most notable was the marked decrease in many viral genes bearing hypoxia-responsive elements (HREs) such as the viral G-Protein Coupled Receptor (vGPCR), which is known to activate HIF1α transcriptional activity during KSHV infection. We found that the promoter of MHV68 ORF74 is responsive to HIF1α and MHV-68 RTA. Moreover, Intranasal infection of HIF1αLoxP/LoxP mice with MHV68 expressing Cre- recombinase impaired virus expansion during early acute infection and affected lytic reactivation in the splenocytes explanted from mice. Low oxygen concentrations accelerated lytic reactivation and enhanced virus production in MHV68 infected splenocytes. Thus, we conclude that HIF1α plays a critical role in promoting virus replication and reactivation from latency by impacting viral gene expression. Our results highlight the importance of the mutual interactions of the oxygen-sensing machinery and gammaherpesviruses in viral replication and pathogenesis.
Collapse
Affiliation(s)
- Darlah M. López-Rodríguez
- Department of Microbiology and Immunology and Miami Center for AIDS Research, Miami, Florida, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Varvara Kirillov
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, New York, United States of America
| | - Laurie T. Krug
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, New York, United States of America
- IV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Enrique A. Mesri
- Department of Microbiology and Immunology and Miami Center for AIDS Research, Miami, Florida, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Samita Andreansky
- Department of Microbiology and Immunology and Miami Center for AIDS Research, Miami, Florida, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
17
|
Krompa K, Barka I, Malard S, Tatulashvili S, Baudry C, Bihan H, Fysekidis M. Ketosis prone diabetes presenting as fulminant type 1 diabetes. Pan Afr Med J 2019; 31:38. [PMID: 30918564 PMCID: PMC6430860 DOI: 10.11604/pamj.2018.31.38.16162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/19/2018] [Indexed: 11/11/2022] Open
Abstract
Patients with ketosis prone diabetes have been reported primarily in Africans and African Americans. At presentation, both insulin secretion and insulin action are impaired in ketosis prone diabetes patients. Fulminant diabetes is a subtype of type 1 diabetes reported mainly in the Asian populations characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic symptoms with inappropriately low HbA1c (< 8.5%). We report here the first case of a ketosis prone diabetes presenting as fulminant diabetes.
Collapse
Affiliation(s)
- Katerina Krompa
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Ines Barka
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Stéphanie Malard
- Laboratoire Régional d'Histocompatibilité, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Sopio Tatulashvili
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Camille Baudry
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Hélène Bihan
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny, France
| | - Marinos Fysekidis
- Service d'Endocrinologie Diabétologie et Maladies Métaboliques, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny, France
| |
Collapse
|
18
|
Kibirige D, Lumu W, Jones AG, Smeeth L, Hattersley AT, Nyirenda MJ. Understanding the manifestation of diabetes in sub Saharan Africa to inform therapeutic approaches and preventive strategies: a narrative review. Clin Diabetes Endocrinol 2019; 5:2. [PMID: 30783538 PMCID: PMC6376682 DOI: 10.1186/s40842-019-0077-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 02/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Globally, the burden of diabetes mellitus has increased to epidemic proportions. Estimates from the International Diabetes Federation predict that the greatest future increase in the prevalence of diabetes mellitus will occur in Africa. METHODS This article reviews literature on the manifestation of diabetes in adult patients in sub-Saharan Africa highlighting the distinct phenotypes, plausible explanations for this unique manifestation and the clinical significance of comprehensively defining and understanding the African diabetes phenotype. RESULTS There are few studies on the manifestation or phenotype of diabetes in Africa. The limited data available suggests that, compared to the Western world, the majority of patients with diabetes in Africa are young and relatively lean in body size. In addition, hyperglycaemia in most cases is characterised by a significantly blunted acute first phase of insulin secretion in response to an oral or intravenous glucose load and pancreatic beta cell secretory dysfunction, rather than peripheral insulin resistance predominates. Genetic and environmental factors like chronic infections/inflammation, early life malnutrition and epigenetic modifications are thought to contribute to these distinct differences in manifestation. CONCLUSIONS While published data is limited, there appears to be distinct phenotypes of diabetes in sub-Saharan Africa. Large and more detailed studies are needed especially among newly diagnosed patients to fully characterize diabetes in this region. This will further improve the understanding of manifestation of diabetes and guide the formulation of optimal therapeutic approaches and preventive strategies of the condition on the continent.
Collapse
Affiliation(s)
- Davis Kibirige
- Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 51-59, Nakiwogo Road, P.O. BOX 49 Entebbe, Uganda
- Department of Medicine, Uganda Martyrs hospital Lubaga, Kampala, Uganda
| | - William Lumu
- Department of Medicine, Mengo Hospital, Kampala, Uganda
| | - Angus G. Jones
- National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Liam Smeeth
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew T. Hattersley
- National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Moffat J. Nyirenda
- Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 51-59, Nakiwogo Road, P.O. BOX 49 Entebbe, Uganda
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
19
|
Cui M, Fang Q, Zheng J, Shu Z, Chen Y, Fan Y, Zhao J, Wood C, Zhang T, Zeng Y. Kaposi's sarcoma-associated herpesvirus seropositivity is associated with type 2 diabetes mellitus: A case-control study in Xinjiang, China. Int J Infect Dis 2019; 80:73-79. [PMID: 30639407 DOI: 10.1016/j.ijid.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/24/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the potential relationship between Kaposi's sarcoma-associated herpesvirus (KSHV) infection and type 2 diabetes mellitus (DM-2) in Xinjiang, China. METHODS A case-control study of consecutively included DM-2 patients and normal controls was conducted among the Uygur and Han populations in Xinjiang Uygur Autonomous Region, China. Blood samples were collected and KSHV seroprevalence, antibody titers, and viral load were investigated. Logistic regression analysis and multiple linear regression analysis were applied to explore determinants of the main outcome measures. RESULTS A total of 324 patients with DM-2 and 376 normal controls were included. The seroprevalence of KSHV was 49.1% (95% confidence interval (CI) 43.6-54.5%) for diabetic patients and 23.7% (95% CI 19.4-28.0%) for the control group. After adjusting for variables of ethnicity, sex, body mass index, occupation, educational level, marital status, age, and smoking and alcohol consumption habits, the association between DM-2 and KSHV infection still existed (odds ratio (OR) 2.94, 95% CI 2.05-4.22), and the risk of KSHV infection increased with glucose concentration (OR 1.35, 95% CI 1.21-1.51). KSHV was more likely to express both the latent and lytic antigens in diabetic patients (latent: OR 3.27, 95% CI 2.25-4.75; lytic: OR 3.99, 95% CI 2.68-5.93). Antibody titers and viral load increased in patients with higher blood glucose levels (p<0.001). CONCLUSIONS Patients with DM-2 have an elevated risk of KSHV infection. Both antibody titers and viral load increased with blood glucose levels.
Collapse
Affiliation(s)
- Meng Cui
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Qiwen Fang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Jun Zheng
- Department of Stomatology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Zhanjun Shu
- Division of AIDS Research, National Traditional Chinese Medicine Clinical Research Bases in Xinjiang, Urumqi 830000, China; The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830013, China
| | - Yin Chen
- The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830013, China
| | - Yage Fan
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Juan Zhao
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Charles Wood
- Nebraska Center of Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Yan Zeng
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China.
| |
Collapse
|
20
|
Sjöholm Å. Ketosis-Prone Type 2 Diabetes: A Case Series. Front Endocrinol (Lausanne) 2019; 10:684. [PMID: 31749761 PMCID: PMC6843078 DOI: 10.3389/fendo.2019.00684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022] Open
Abstract
Ketosis-prone type 2 diabetes ("Flatbush diabetes") carries features of both classical type 1 and type 2 diabetes and is highly prevalent in African populations. The disease, which is highly ketosis-prone, but neither chronically insulinopenic nor autoimmune, is discussed regarding pathogenesis, diagnosis and treatment from a patient case perspective.
Collapse
|
21
|
Lontchi-Yimagou E, Legoff J, Nguewa JL, Boudou P, Balti EV, Noubiap JJ, Kamwa V, Atogho-Tiedeu B, Azabji-Kenfack M, Djahmeni EN, Etoa M, Lemdjo G, Balla V, Dehayem MY, Foufelle F, Mbanya JC, Gautier JF, Sobngwi E. Human herpesvirus 8 infection DNA positivity is associated with low insulin secretion: A case-control study in a sub-Saharan African population with diabetes. J Diabetes 2018; 10:866-873. [PMID: 29707905 DOI: 10.1111/1753-0407.12777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/07/2018] [Accepted: 04/22/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Viruses have been considered potential triggers for the development of diabetes. This study assessed insulin secretion and insulin sensitivity in human herpesvirus 8 (HHV8)-infected and uninfected sub-Saharan African people with diabetes. METHODS In all, 173 people with non-autoimmune diabetes were enrolled consecutively: 124 with type 2 diabetes mellitus (T2DM) and 49 with ketosis-prone diabetes (KPD) admitted in hyperglycemic crisis. Those with KPD were further subdivided into those with new-onset ketotic-phase KPD (n = 34) or non-ketotic phase KPD (n = 15). All participants were screened for HHV8-specific antibodies and genomic DNA. Blood samples were collected for analysis of fasting glucose, HbA1c, lipid profile, and C-peptide, with insulin resistance and secretion estimated by homeostasis model assessment. RESULTS Among the 173 diabetic participants, 88 (50.9%) were positive for HHV8 antibodies (Ac-HHV8+), including 15 (8.7%) positive for HHV8 DNA (DNA-HHV8+). The seroprevalence of HHV8 was similar between T2DM (55.6%) and KPD (61.2%) subjects. Of those with and without ketotic-phase KPD, 35.3% and 46.7% were Ac-HHV8+, respectively. Body mass index was significantly in lower DNA-HHV8+ than DNA-HHV8- subjects. Low-density lipoprotein and total cholesterol were significantly higher, but C-peptide and homeostatic model assessment of β-cell function (HOMA-β) were significantly lower in DNA-HHV8+ than DNA-HHV8- participants. After excluding DNA-HHV8+ participants, triglyceride concentrations were significantly higher in Ac-HHV8+ (n = 73) than Ac-HHV8- (n = 85) subjects. In contrast, HOMA-β was significantly higher among Ac-HHV8+ than Ac-HHV8- participants. CONCLUSIONS In the present study, HHV8 DNA positivity was associated with low insulin secretion in this sub-Saharan African diabetes population.
Collapse
Affiliation(s)
- Eric Lontchi-Yimagou
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jérôme Legoff
- Université Paris Diderot, Sorbonne Paris Cité, INSERM U941, Microbiology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Philippe Boudou
- Unit of Hormonal Biology, Department of Biochemistry, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric V Balti
- Diabetes Research Center, Brussels Free University - VUB, Brussels, Belgium
| | - Jean J Noubiap
- Department of Medicine, Groote Schuur Hospital and Universty of Cape Town, Cape Town, South Africa
| | - Vicky Kamwa
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Barbara Atogho-Tiedeu
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
| | - Marcel Azabji-Kenfack
- Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon
| | - Eric N Djahmeni
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Martine Etoa
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Gaelle Lemdjo
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Vanessa Balla
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Mesmin Y Dehayem
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | | | - Jean-Claude Mbanya
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Eugene Sobngwi
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| |
Collapse
|
22
|
Kabakambira JD, Baker RL, Briker SM, Courville AB, Mabundo LS, DuBose CW, Chung ST, Eckel RH, Sumner AE. Do current guidelines for waist circumference apply to black Africans? Prediction of insulin resistance by waist circumference among Africans living in America. BMJ Glob Health 2018; 3:e001057. [PMID: 30364383 PMCID: PMC6195140 DOI: 10.1136/bmjgh-2018-001057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background To lower the risk of diabetes and heart disease in Africa, identification of African-centred thresholds for inexpensive biomarkers of insulin resistance (IR) is essential. The waist circumference (WC) thresholds that predicts IR in African men and women have not been established, but investigations recently conducted in Africa using indirect measures of IR suggest IR is predicted by WC of 80–95 cm in men and 90–99 cm in women. These WC cannot be used for guidelines until validated by direct measurements of IR and visceral adipose tissue (VAT). Therefore, we determined in a group of African-born black people living in America (A) the WC, which predicts IR and (B) the influence of abdominal fat distribution on IR. Methods The 375 participants (age 38±10 years (mean±SD), 67% men) had IR determined by HOMA-IR and Matsuda index. VAT and subcutaneous adipose tissue (SAT) were measured by abdominal CT scans. Optimal WC for the prediction of IR was determined in sex-specific analyses by area under the receiver operating characteristic (AUC-ROC) and Youden index. Results Women had more SAT (203±114 vs 128±74 cm2) and less VAT than men (63±48 vs 117±72 cm2, p<0.001). Optimal WC for prediction of IR in men and women were: 91 cm (AUC-ROC: 0.80±0.03 (mean±SE)) and 96 cm (AUC-ROC: 0.81±0.08), respectively. Regression analyses revealed a significant sex–VAT interaction (p<0.001). Therefore, for every unit increase in VAT, women had a 0.94 higher unit increase in SAT and 0.07 higher unit increase in WC than men. Conclusion Working with a group of African-born black people living in America, we accessed technology, which validated observations made in Africa. Higher SAT at every level of VAT explained why the WC that predicted IR was higher in women (96 cm) than men (91 cm). For Africans to benefit from WC measurements, convening a panel of experts to develop evidence-based African-centred WC guidelines may be the way forward.
Collapse
Affiliation(s)
- J Damascene Kabakambira
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA.,National Institute of Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Rafeal L Baker
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Sara M Briker
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Amber B Courville
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lilian S Mabundo
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Christopher W DuBose
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA.,National Institute of Minority Health and Health Disparities, Bethesda, Maryland, USA
| |
Collapse
|
23
|
Yuan H, Liu Z, Wu X, Fang Q, Zheng J, Zeng Y, Zhang T. Social behavioral correlates of Kaposi sarcoma-associated herpesvirus infection among Han and Uygur populations in Xinjiang, China. J Med Virol 2018; 91:457-462. [DOI: 10.1002/jmv.25332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/26/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Huangbo Yuan
- Department of Epidemiology; School of Public Health, Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education, Fudan University; Shanghai China
| | - Zhenqiu Liu
- Department of Epidemiology; School of Public Health, Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education, Fudan University; Shanghai China
| | - Xuefu Wu
- Department of Epidemiology; School of Public Health, Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education, Fudan University; Shanghai China
| | - Qiwen Fang
- Department of Epidemiology; School of Public Health, Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education, Fudan University; Shanghai China
| | - Jun Zheng
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, Department of Biochemistry; Shihezi University School of Medicine; Shihezi China
| | - Yan Zeng
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases, Department of Biochemistry; Shihezi University School of Medicine; Shihezi China
| | - Tiejun Zhang
- Department of Epidemiology; School of Public Health, Fudan University; Shanghai China
- Key Laboratory of Public Health Safety; Ministry of Education, Fudan University; Shanghai China
| |
Collapse
|
24
|
Lontchi-Yimagou E, Boudou P, Nguewa JL, Noubiap JJ, Kamwa V, Djahmeni EN, Atogho-Tiedeu B, Azabji-Kenfack M, Etoa M, Lemdjo G, Dehayem MY, Mbanya JC, Gautier JF, Sobngwi E. Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population. J Diabetes Metab Disord 2018; 17:37-43. [PMID: 30288384 PMCID: PMC6154517 DOI: 10.1007/s40200-018-0336-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/01/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Eric Lontchi-Yimagou
- 1Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, PO Box 87, Yaoundé, Cameroon
| | - Philippe Boudou
- 2Unit of Hormonal Biology, Department of Biochemistry, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Jean Louis Nguewa
- 3Inserm UMRS 1138, Cordeliers Research Centre, University Paris-6, 75006 Paris, France
| | - Jean Jacques Noubiap
- 4Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Vicky Kamwa
- University hospital of Birmingham, Birmingham, UK
| | | | - Babara Atogho-Tiedeu
- 1Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, PO Box 87, Yaoundé, Cameroon
| | - Marcel Azabji-Kenfack
- 7Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Martine Etoa
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Gaelle Lemdjo
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | | | - Jean Claude Mbanya
- 1Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, PO Box 87, Yaoundé, Cameroon.,National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,8Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean-Francois Gautier
- 2Unit of Hormonal Biology, Department of Biochemistry, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 1 avenue Claude Vellefaux, 75010 Paris, France.,3Inserm UMRS 1138, Cordeliers Research Centre, University Paris-6, 75006 Paris, France
| | - Eugène Sobngwi
- 1Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, PO Box 87, Yaoundé, Cameroon.,National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,8Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| |
Collapse
|
25
|
Innis-Whitehouse W, Wang X, Restrepo N, Salas C, Moreno K, Restrepo A, Keniry M. Kaposi sarcoma incidence in females is nearly four-fold higher in the Lower Rio Grande Valley compared to the Texas average. Cancer Treat Res Commun 2018; 16:45-52. [PMID: 31299002 DOI: 10.1016/j.ctarc.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022]
Abstract
The Lower Rio Grande Valley (LRGV) is located on U.S.-Mexican border with a population that is 90% Hispanic [1]. Comprised of Hidalgo, Cameron, Starr and Willacy counties, this region has the highest poverty rate and one of the highest incidences of Type 2 diabetes in the United States [2-4]. Previous studies demonstrated a high prevalence of Human Herpes Virus 8 (HHV8) in the LRGV [5-7]. HHV8 infection has been causally linked to Kaposi Sarcoma (KS) [8]. Here, we retrospectively examine the incidence of KS in the LRGV in a set of HIV-negative Hispanic patients. Strikingly, the incidence of KS was higher in LRGV women compared to the Texas state average (nearly four-fold higher in McAllen-Edinburg-Pharr Metro Statistical Area). This unique profile aligns with the increased HHV8 prevalence in the LRGV, suggesting that HHV8 contributes to a high incidence of HIV-negative KS on the U.S.-Mexican border in Texas.
Collapse
Affiliation(s)
- Wendy Innis-Whitehouse
- School of Medicine, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX 78539, USA.
| | - Xiaohui Wang
- School of Mathematical and Statistical Sciences, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX 78539, USA.
| | - Nicolas Restrepo
- Department of Biology, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX 78539, USA.
| | - Carlos Salas
- Department of Biology, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX 78539, USA.
| | - Katia Moreno
- Texas Oncology, 1901 S. 2nd St., McAllen, TX 78503, USA.
| | | | - Megan Keniry
- Department of Biology, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX 78539, USA.
| |
Collapse
|
26
|
Choukem SP, Mbanya JC. Diabetes Academy Africa: training the next generation of researchers in sub-Saharan Africa. LANCET GLOBAL HEALTH 2018. [PMID: 29530415 DOI: 10.1016/s2214-109x(18)30066-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Simeon-Pierre Choukem
- Department of Internal medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon; Health and Human Development (2HD) Research Network, Douala, Cameroon; Diabetes and Endocrine Unit, Department of Internal Medicine, Douala General Hospital, Douala, P.O. Box 4856, Cameroon.
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Laboratory of Molecular Medicine and Metabolism, Biotechnology Centre of Nkolbisson, University of Yaoundé 1, Yaoundé, Cameroon; National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| |
Collapse
|
27
|
Utumatwishima JN, Chung ST, Bentley AR, Udahogora M, Sumner AE. Reversing the tide - diagnosis and prevention of T2DM in populations of African descent. Nat Rev Endocrinol 2018; 14:45-56. [PMID: 29052590 DOI: 10.1038/nrendo.2017.127] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA1c, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene-environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.
Collapse
Affiliation(s)
- Jean N Utumatwishima
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Margaret Udahogora
- Dietetics Program, University of Maryland, College Park, 0112 Skinner Building, Office 0125 Skinner Building, College Park, Maryland 20742, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
- National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| |
Collapse
|
28
|
Angius F, Madeddu MA, Pompei R. Commentary: High Glucose Induces Reactivation of Latent Kaposi's Sarcoma-Associated Herpesvirus. Front Microbiol 2017; 8:1796. [PMID: 28966613 PMCID: PMC5606166 DOI: 10.3389/fmicb.2017.01796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/05/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabrizio Angius
- Biomedical Sciences, Università degli Studi di CagliariCagliari, Italy
| | - Maria A Madeddu
- Biomedical Sciences, Università degli Studi di CagliariCagliari, Italy
| | - Raffaello Pompei
- Biomedical Sciences, Università degli Studi di CagliariCagliari, Italy
| |
Collapse
|
29
|
Vellanki P, Umpierrez GE. DIABETIC KETOACIDOSIS: A COMMON DEBUT OF DIABETES AMONG AFRICAN AMERICANS WITH TYPE 2 DIABETES. Endocr Pract 2017; 23:971-978. [PMID: 28534682 DOI: 10.4158/ep161679.ra] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE More than half of African Americans (AA) with a new diagnosis of diabetic ketoacidosis have clinical and metabolic features of type 2 diabetes during follow-up. This particular presentation of diabetes has been termed as ketosis-prone type 2 diabetes (KPDM) or atypical diabetes. METHODS We review the epidemiology, diagnosis, pathophysiology, and acute and long-term management of AA with KPDM and compare these similarities to patients with type 2 diabetes. RESULTS In contrast to the long-term insulin requirement of auto-immune type 1 diabetes, patients with KPDM are able to discontinue insulin after a few months of therapy and maintain acceptable glycemic control for many years on either diet or oral agents. Patients with KPDM have significant impairment of both insulin secretion and insulin action at presentation; however, at the time of near-normoglycemia remission, insulin secretion and action improve to levels similar to hyperglycemic patients with ketosis-resistant type 2 diabetes. In the long term, however, patients with KPDM have a decline in β-cell function similar to patients with type 2 diabetes. Recent studies indicate that treatment with metformin and dipeptidyl peptidase-4 inhibitors can prolong the period of near-normoglycemia remission for several years compared to placebo therapy. CONCLUSION KPDM is a unique but common presentation of newly diagnosed African Americans with type 2 diabetes. ABBREVIATIONS A(+/-) = auto-antibody positive/negative AA = African Americans DKA = diabetic ketoacidosis FFA = free fatty acids G6PD = glucose-6-phosphate dehydrogenase GAD-65 = 65-kDA glutamic acid decarboxylase HBA1c = glycated hemoglobin A1c HHV8 = human herpes virus 8 HLA = human leukocyte antigen KPDM = ketosis-prone type 2 diabetes.
Collapse
|
30
|
Zhu B, Bu L, Zhang M, Gusdon AM, Zheng L, Rampersad S, Li J, Qu S. HbA 1c as a Screening tool for Ketosis in Patients with Type 2 Diabetes Mellitus. Sci Rep 2016; 6:39687. [PMID: 28009017 PMCID: PMC5180185 DOI: 10.1038/srep39687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/25/2016] [Indexed: 12/21/2022] Open
Abstract
Ketosis in patients with type 2 diabetes mellitus (T2DM) is overlooked due to atypical symptoms. The objective of this study is to evaluate the value of hemoglobin A1c (HbA1c) as a screening tool for ketosis in T2DM patients. This retrospective study consisted of 253 T2DM patients with ketosis at Shanghai 10th People’s Hospital during a period from January 1, 2011 to June 30, 2015. A control group consisted of 221 T2DM patients without ketosis randomly selected from inpatients during the same period. Receiver operating characteristic curve (ROC) analysis was used to examine the sensitivity and specificity of HbA1c as an indicator for ketosis. Higher HbA1c levels were correlated with ketosis. In patients with newly diagnosed T2DM, the area under the curve (AUC) was 0.832, with 95% confidence interval (CI) 0.754–0.911. The optimal threshold was 10.1% (87 mmol/mol). In patients with previously diagnosed T2DM, the AUC was 0.811 (95% CI: 0.767–0.856), with an optimal threshold of 8.6% (70 mmol/mol). HbA1c is a potential screening tool for ketosis in patients with T2DM. Ketosis is much more likely with HbA1c values at ≥10.1% in patients with newly diagnosed T2DM and HbA1c values at ≥8.6% in patients with previously diagnosed T2DM.
Collapse
Affiliation(s)
- Bing Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Le Bu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Manna Zhang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Aaron M Gusdon
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Liang Zheng
- Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China
| | - Sharvan Rampersad
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jue Li
- Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Endocrinology, School of Medicine, Nanjing Medical University, Nanjing, China
| |
Collapse
|
31
|
Katchunga PB, Cikomola J, Tshongo C, Baleke A, Kaishusha D, Mirindi P, Tamburhe T, Kluyskens Y, Sadiki A, Bwanamudogo S, Kashongwe Z, Twagirumukiza M. Obesity and diabetes mellitus association in rural community of Katana, South Kivu, in Eastern Democratic Republic of Congo: Bukavu Observ Cohort Study Results. BMC Endocr Disord 2016; 16:60. [PMID: 27835951 PMCID: PMC5105280 DOI: 10.1186/s12902-016-0143-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Factual data exploring the relationship between obesity and diabetes mellitus prevalence from rural areas of sub-Saharan Africa remain scattered and are unreliable. To address this scarceness, this work reports population study data describing the relationship between the obesity and the diabetes mellitus in the general population of the rural area of Katana (South Kivu in the Democratic Republic of the Congo). METHODS A cohort of three thousand, nine hundred, and sixty-two (3962) adults (>15 years old) were followed between 2012 and 2015 (or 4105 person-years during the observation period), and data were collected using the locally adjusted World Health Organization's (WHO) STEPwise approach to Surveillance (STEPS) methodology. The hazard ratio for progression of obesity was calculated. The association between diabetes mellitus and obesity was analyzed with logistic regression. RESULTS The diabetes mellitus prevalence was 2.8 % versus 3.5 % for obese participants and 7.2 % for those with metabolic syndrome, respectively. Within the diabetes group, 26.9 % had above-normal waist circumference and only 9.8 % were obese. During the median follow-up period of 2 years, the incidence of obesity was 535/100,000 person-years. During the follow-up, the prevalence of abdominal obesity significantly increased by 23 % (p <0.0001), whereas the increased prevalence of general obesity (7.8 %) was not significant (p = 0.53). Finally, diabetes mellitus was independently associated with age, waist circumference, and blood pressure but not body mass index. CONCLUSION This study confirms an association between diabetes mellitus and abdominal obesity but not with general obesity. On the other hand, the rapid increase in abdominal obesity prevalence in this rural area population within the follow-up period calls for the urgent promoting of preventive lifestyle measures.
Collapse
Affiliation(s)
- Philippe Bianga Katchunga
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Justin Cikomola
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Christian Tshongo
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Arsene Baleke
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - David Kaishusha
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Patrick Mirindi
- Regional School of Public Health (ERSP), Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Théodore Tamburhe
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
- Institut de technique médicale, hôpital général de référence de Katana, Katana, Sud-Kivu Democratic Republic of the Congo
| | - Yves Kluyskens
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
- Department of Pharmacology, Faculty of Medicine and Health sciences, Ghent University, Ghent, Belgium
| | - Antoine Sadiki
- Department of Clinical Biology, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Socrate Bwanamudogo
- Department of Clinical Biology, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Zacharie Kashongwe
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Marc Twagirumukiza
- Observatory NCDs VLIR-UOS/UCB, Faculty of Medicine of the Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
- Department of Pharmacology, Faculty of Medicine and Health sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
32
|
Cikomola JC, Vandepoele K, Katchunga PB, Kishabongo AS, Padalko EY, Speeckaert MM, Delanghe JR. The association between fructosamine-3 kinase 900C/G polymorphism, transferrin polymorphism and human herpesvirus-8 infection in diabetics living in South Kivu. Acta Trop 2016; 163:14-9. [PMID: 27461879 DOI: 10.1016/j.actatropica.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/12/2016] [Accepted: 07/17/2016] [Indexed: 02/08/2023]
Abstract
Prevalences of human herpesvirus-8 (HHV-8) infection and diabetes mellitus are very common in certain parts of Africa, containing iron-rich soils. We hypothesized that some genetic factors could have a link with susceptibility to HHV-8 infection. We focused on ferroportin Q248H mutation (rs11568350), transferrin (TF) polymorphism and fructosamine-3 kinase (FN3K) 900C/G polymorphism (rs1056534). The study population consisted of 210 type 2 diabetic adults and 125 healthy controls recruited in Bukavu (South Kivu). In the whole study population (diabetics+healthy controls), ferroportin Q248H mutation was detected in 47 subjects (14.0%) with 43 heterozygotes and 4 homozygotes. TF phenotype frequencies were 88.1% (CC), 10.4% (CD) and 1.5% (BC). Genotype frequencies of FN3K 900C/G polymorphism were respectively 9,3% (CC), 43.3% (GC) and 47.4% (GG). Prevalence of HHV8-infection in the study population was 77.3%. HHV-8 infection rate and HHV-8 IgG antibody titer were significantly higher in diabetics then in controls (p<0.0001). Significant differences were observed in HHV-8 infection rate and in HHV-8 IgG antibody titer according to FN3K rs1056534 (p<0.05 and p<0.05, respectively) and TF polymorphism (p<0.05 and p=0.005, respectively). No significant differences in HHV-8 infection rate and in HHV-8 IgG antibody titer were observed in the ferroportin Q248H mutation carriers (rs11568350) in comparison with ferroportin wild type. In a multiple regression analysis, FN3K rs1056534, TF polymorphism and presence of diabetes mellitus were predictors for HHV-8 infection. In contrast to these findings, ferroportin Q248H mutation (rs11568350) did not influence the susceptibility for an HHV-8 infection in sub-Saharan Africans.
Collapse
|
33
|
High Glucose Induces Reactivation of Latent Kaposi's Sarcoma-Associated Herpesvirus. J Virol 2016; 90:9654-9663. [PMID: 27535045 DOI: 10.1128/jvi.01049-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/05/2016] [Indexed: 01/11/2023] Open
Abstract
A high prevalence of Kaposi's sarcoma (KS) is seen in diabetic patients. It is unknown if the physiological conditions of diabetes contribute to KS development. We found elevated levels of viral lytic gene expression when Kaposi's sarcoma-associated herpesvirus (KSHV)-infected cells were cultured in high-glucose medium. To demonstrate the association between high glucose levels and KSHV replication, we xenografted telomerase-immortalized human umbilical vein endothelial cells that are infected with KSHV (TIVE-KSHV cells) into hyperglycemic and normal nude mice. The injected cells expressed significantly higher levels of KSHV lytic genes in hyperglycemic mice than in normal mice. We further demonstrated that high glucose levels induced the production of hydrogen peroxide (H2O2), which downregulated silent information regulator 1 (SIRT1), a class III histone deacetylase (HDAC), resulting in the epigenetic transactivation of KSHV lytic genes. These results suggest that high blood glucose levels in diabetic patients contribute to the development of KS by promoting KSHV lytic replication and infection. IMPORTANCE Multiple epidemiological studies have reported a higher prevalence of classic KS in diabetic patients. By using both in vitro and in vivo models, we demonstrated an association between high glucose levels and KSHV lytic replication. High glucose levels induce oxidative stress and the production of H2O2, which mediates the reactivation of latent KSHV through multiple mechanisms. Our results provide the first experimental evidence and mechanistic support for the association of classic KS with diabetes.
Collapse
|
34
|
Lontchi-Yimagou E, Tsalefac M, Tapinmene LMT, Noubiap JJN, Balti EV, Nguewa JL, Dehayem M, Sobngwi E. Seasonality in diabetes in Yaounde, Cameroon: a relation with precipitation and temperature. BMC Public Health 2016; 16:470. [PMID: 27266270 PMCID: PMC4896003 DOI: 10.1186/s12889-016-3090-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/10/2015] [Indexed: 12/04/2022] Open
Abstract
Background Diabetes is a growing health concern in developing countries, with Cameroon population having an estimated 6% affected. Of note, hospital attendees appear to be increasing all over the country, with fluctuating numbers throughout the annual calendar. The aim of the study was to investigate the relationship between diabete hospitalization admission rates and climate variations in Yaounde. Methods A retrospectively designed study was conducted in four health facilities of Yaounde (Central Hospital, University teaching hospital, Biyem-Assi and Djoungolo District Hospitals), using medical records from 2000 to 2008. A relationship between diabetes (newly diagnosed diabetes patients or decompensated diabetics) hospitalization admissions and climate variations was determined using the “2000–2008” national meteorological database (precipitation and temperature). Results The monthly medians of precipitation and temperature were 154mm and 25 °C, respectively. The month of October received 239mm of precipitation. The monthly medians of diabetic admissions rates (newly diagnosed or decompensated diabetes patients) were 262 and 72 respectively. October received 366 newly diagnosed diabetics and 99 decompensated diabetics. Interestingly, diabetic hospitalization admissions rates were higher during the rainy (51 %, 1633/3232) than the dry season, though the difference was non-significant. The wettest month (October) reported the highest cases (10 %, 336/3232) corresponding to the month with the highest precipitation level (239mm). Diabetes hospitalization admissions rates varied across health facilities [from 6 % (189/3232) in 2000 to 15 % (474/3232) in 2008]. Conclusion Diabetes is an important epidemiological disease in the city of Yaounde. The variation in the prevalence of diabetes is almost superimposed to that of precipitation; and the prevalence seems increasing during raining seasons in Yaoundé.
Collapse
Affiliation(s)
- Eric Lontchi-Yimagou
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Maurice Tsalefac
- Departement of Geography, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Medical Diagnostic Center, Yaoundé, Cameroon
| | - Eric Vounsia Balti
- Diabetes Research Center, Faculty of Medicine and Pharmacy, Brussels Free University, Brussels, Belgium
| | - Jean-Louis Nguewa
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | - Mesmin Dehayem
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eugene Sobngwi
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon. .,National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon. .,Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| |
Collapse
|
35
|
Relationship between HHV8 infection markers and insulin sensitivity in ketosis-prone diabetes. DIABETES & METABOLISM 2016; 43:79-82. [PMID: 27262367 DOI: 10.1016/j.diabet.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/10/2016] [Accepted: 05/01/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Peripheral tissue resistance to insulin action is a characteristic of type 2 diabetes mellitus (T2DM). It has also been reported that some chronic viral infections can contribute to insulin resistance. Human herpesvirus (HHV)-8 infection has been detected in T2DM patients in previous studies. Our study investigated whether the presence of the virus is associated with insulin resistance in patients with ketosis-prone type 2 diabetes (KPD), as reported with other viruses. RESEARCH DESIGN AND METHODS A total of 11 insulin-free KPD patients positive (+) and seven patients who were negative (-) for HHV-8 infection were recruited; the latter had KPD that was well controlled (HbA1c=6.2±0.7%). A two-step euglycaemic-hyperinsulinaemic clamp test coupled with deuterated [6,6-2H2]glucose was used to assess insulin sensitivity, non-esterified fatty acid (NEFA) suppression and endogenous glucose production. RESULTS In KPD patients, whether HHV-8+ or HHV-8-, there were no differences in NEFA release, endogenous glucose production or insulin sensitivity (M value). CONCLUSION Asymptomatic HHV-8 infection does not appear to be associated with decreased insulin sensitivity in diabetic patients. These results should now be confirmed in a larger sample population.
Collapse
|
36
|
London J, Boutboul D, Agbalika F, Coppo P, Veyradier A, Gérard L, Oksenhendler E, Azoulay E, Galicier L. Autoimmune thrombotic thrombocytopenic purpura associated with HHV8-related Multicentric Castleman disease. Br J Haematol 2016; 178:486-488. [DOI: 10.1111/bjh.14152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan London
- Service de Médecine Interne; Hôpital Cochin; Assistance Publique - Hôpitaux de Paris (AP-HP); et Université Paris Descartes; Paris France
| | - David Boutboul
- Service d'Immuno-hématologie; Hôpital Saint-Louis; APHP; et Université Paris Diderot; Paris France
| | - Felix Agbalika
- Service de Virologie; Hôpital Saint-Louis; AP-HP; et Université Paris Diderot; Paris France
| | - Paul Coppo
- Service d'Hématologie; Hôpital Saint-Antoine; APHP; et Université Pierre et Marie Curie; Paris France
- Centre National de Référence des Microangiopathies Thrombotiques; Hôpital Saint-Antoine; AP-HP; Paris France
| | - Agnès Veyradier
- Centre National de Référence des Microangiopathies Thrombotiques; Hôpital Saint-Antoine; AP-HP; Paris France
- Service d'Hématologie biologique; Hôpital Lariboisière; APHP; Paris France
| | - Laurence Gérard
- Service d'Immuno-hématologie; Hôpital Saint-Louis; APHP; et Université Paris Diderot; Paris France
| | - Eric Oksenhendler
- Service d'Immuno-hématologie; Hôpital Saint-Louis; APHP; et Université Paris Diderot; Paris France
| | - Elie Azoulay
- Centre National de Référence des Microangiopathies Thrombotiques; Hôpital Saint-Antoine; AP-HP; Paris France
- Service de Soins Intensifs; Hôpital Saint-Louis; AP-HP; et Université Paris Diderot; Paris France
| | - Lionel Galicier
- Service d'Immuno-hématologie; Hôpital Saint-Louis; APHP; et Université Paris Diderot; Paris France
- Centre National de Référence des Microangiopathies Thrombotiques; Hôpital Saint-Antoine; AP-HP; Paris France
| |
Collapse
|
37
|
Nulu S. Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor. Glob Public Health 2016; 12:396-415. [PMID: 26948138 DOI: 10.1080/17441692.2016.1154584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behaviour, risk and disease, which implicitly locates 'risk' within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with 'alternative' environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralise health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralising health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualising strategies that may address both behavioural and structural determinants of health.
Collapse
Affiliation(s)
- Shanti Nulu
- a Department of Medicine , Yale University , New Haven , CT , USA
| |
Collapse
|
38
|
High Prevalence of Human Herpesvirus 8 Infection in Diabetes Type 2 Patients and Detection of a New Virus Subtype. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 973:41-51. [PMID: 27864801 DOI: 10.1007/5584_2016_73] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The prevalence of Human Herpesvirus 8 (HHV8) DNA and antiviral antibodies in Diabetes type 2 (DM2) and control subjects was studied, in order to confirm a possible link between DM2 and HHV8 infection. The HHV8-DNA from diabetic patients was typed for detecting possible genomic differences with known HHV8 reference viruses.DM2 patients and healthy controls were examined for the presence of HHV8 DNA into the peripheral blood lymphocytes. Both anti-lytic and latent phase antibodies were detected in HHV8 positive and negative diabetic patients, as well in a number of controls. The HHV8 ORF K1 and ORF 26 genes from DM2 patients were typed and matched to reference strains.A significant prevalence of HHV8 DNA in DM2 subjects versus healthy controls was detected (about 58 % against 27 %). Anti-lytic phase, but not anti-latent phase antibodies, were significantly increased in DM2 patients versus controls. In addition, about 30 % of HHV8 strains isolated from DM2 lymphocytes showed consistent differences in the ORF 26 gene sequence, so that a new HHV8 subtype was proposed. These findings give additional support to the hypothesis that HHV8 could be considered an additional risk factor for DM2 onset.
Collapse
|
39
|
Du S, Yang X, Shi D, Su Q. Characteristics of Type 2 Diabetes with Ketosis in Baoshan, Yunnan of China. J Diabetes Res 2016; 2016:7854294. [PMID: 26881259 PMCID: PMC4736950 DOI: 10.1155/2016/7854294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/20/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The study provided data to demonstrate the characteristics of type 2 diabetes (T2D) with ketosis in rural parts of south-west border of China in order to help health professionals with optimizing diabetic care. METHODS All hospitalized adult diabetic patients consecutively between January 2011 and July 2015 in Baoshan People's Hospital, Yunnan province of China, were evaluated. T2D with ketosis, ordinary T2D (without ketosis), and type 1 diabetes (T1D) patients were analyzed according to the clinical and biochemical parameters and chronic complications in these subjects. RESULTS The prevalence of T2D with ketosis was 12% in the whole study subjects. Overweight and obese patients were predominant (49.1%) in T2D patients with ketosis. The mean HbA1c (13.3 ± 3.1%, P = 0.01), fasting plasma glucose (16.9 ± 6 mmol/L, P < 0.0001), and plasma triglyceride (4.0 ± 4.0 mmol/L, P < 0.0001) in T2D patients with ketosis were significantly higher than ordinary T2D patients without ketosis. Infections were the most common inducements in T2D patients with ketosis. Chronic complications including peripheral neuropathy (34.9%), retinopathy (12.7%), diabetic foot (18.1%), and persistent microalbuminuria (11.7%) were common in T2D patients with ketosis. CONCLUSIONS . This study indicated the poor glycemic control in diabetic patients in rural areas of south-west part of China. More efforts were urgently required to popularize public health education and improve medical quality in diabetic treatment in these regions.
Collapse
Affiliation(s)
- Shichun Du
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Xia Yang
- Department of Endocrinology, Baoshan People's Hospital, Yunnan 678000, China
| | - Degang Shi
- Department of Endocrinology, Baoshan People's Hospital, Yunnan 678000, China
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- *Qing Su:
| |
Collapse
|
40
|
Wang X, Tan H. Male predominance in ketosis-prone diabetes mellitus. Biomed Rep 2015; 3:439-442. [PMID: 26171144 DOI: 10.3892/br.2015.461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/22/2015] [Indexed: 02/05/2023] Open
Abstract
The incidence of ketosis-prone diabetes mellitus (KPDM) shows a higher prevalence in men. The clear male predominance of this syndrome and its underlying pathogenesis mechanisms are unclear. KPDM, once described as atypical diabetes mellitus, idiopathetic type 1 diabetes (type 1B diabetes) and flatbush diabetes, is an uncommon form of diabetes characterized by severe reversible insulin deficiency. KPDM was first described and mostly observed in males of African-American descent and recently in Asian populations, including Japanese and Chinese. Patients with KPDM often present acutely with diabetic ketoacidosis without any immunological autoantibody to islet antigens of classic type 1 diabetes but demonstrate clinical and metabolic features of type 2 diabetes. Accumulating data indicated that gender-related body fat distribution, hormonal and genetic factors are associated with the diabetic process and the human glucose homeostasis and metabolism. A controversial question is whether and to what degree those factors contribute to the phenomenon of male predominance in KPDM. The present review focuses on the role of gender hormones and other potential precipitating factors in explaining the male predominance in KPDM patients.
Collapse
Affiliation(s)
- Xiaohao Wang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Huiwen Tan
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|
41
|
Pompei R. The Role of Human Herpesvirus 8 in Diabetes Mellitus Type 2: State of the Art and a Medical Hypothesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 901:37-45. [PMID: 26542602 DOI: 10.1007/5584_2015_5014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Diabetes is a common chronic disease due to an altered glucose metabolism, caused by the quantitative and/or qualitative dysfunction of the insulin hormone. Two types of diabetes are recognized: juvenile diabetes, or type 1, which has an autoimmune origin, and adult diabetes, or type 2 (DMT2), which covers 90-95 % of all diabetic patients.The causes of DMT2 are not yet clear: heredity, life style, nutrition, and environment are considered the main risk factors. Several viral infections, namely cytomegalovirus, coxsackie and other enteroviruses, rubella and hepatitis C virus, have been claimed to be associated with some forms of diabetes. The direct role of viruses as a cause or as a risk of type 1 diabetes has been amply described in several recent reviews. Therefore, this review focuses attention on the role of a human herpes pathogenic virus in the onset of DMT2. By carrying out an analysis of recent literature, we describe the findings reported on an extremely deceitful virus, such as Human Herpes virus 8, and present a medical hypothesis on a possible relationship between this virus and DMT2.
Collapse
Affiliation(s)
- Raffaello Pompei
- Department of Biomedical Sciences, University of Cagliari, via Porcell 4, 09124, Cagliari, Italy.
| |
Collapse
|
42
|
Balti EV, Ngo-Nemb MC, Lontchi-Yimagou E, Atogho-Tiedeu B, Effoe VS, Akwo EA, Dehayem MY, Mbanya JC, Gautier JF, Sobngwi E. Association of HLA class II markers with autoantibody-negative ketosis-prone atypical diabetes compared to type 2 diabetes in a population of sub-Saharan African patients. Diabetes Res Clin Pract 2015; 107:31-6. [PMID: 25511714 DOI: 10.1016/j.diabres.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
AIM We investigated the association of HLA DRB1 and DQB1 alleles, haplotypes and genotypes with unprovoked antibody-negative ketosis-prone atypical diabetes (A(-) KPD) in comparison to type 2 diabetes (T2D). METHODS A(-) KPD and T2D sub-Saharan African patients aged 19-63 years were consecutively recruited. Patients positive for cytoplasmic islet cell, insulin, glutamic acid decarboxylase or islet antigen-2 autoantibodies were excluded. Odds ratios were obtained via logistic regression after considering alleles with a minimum frequency of 5% in the study population. Bonferroni correction was used in the case of multiple comparisons. RESULTS Among the 130 participants, 35 (27%) were women and 57 (44%) were A(-) KPD. DRB1 and DQB1 allele frequencies were similar for both A(-) KPD and T2D patients; they did not confer any substantial risk even after considering type 1 diabetes susceptibility and resistance alleles. We found no association between A(-) KPD and the derived DRB1*07-DQB1*02:02 (OR: 0.55 [95%CI: 0.17-1.85], P=0.336); DRB1*11-DQB1*03:01 (OR: 2.42 [95%CI: 0.79-7.42], P=0.123); DRB1*15-DQB1*06:02 (OR: 0.87 [95%CI: 0.39-1.95], P=0.731) and DRB1*03:01-DQB1*02:01 (OR: 1.48 [95%CI: 0.55-3.96], P=0.437) haplotypes. Overall, we did not find any evidence of susceptibility to ketosis associated with DRB1 and DQB1 genotypes (all P>0.05) in A(-) KPD compared to T2D. Similar results were obtained after adjusting the analysis for age and sex. CONCLUSION Factors other than DRB1 and DQB1 genotype could explain the propensity to ketosis in A(-) KPD. These results need to be confirmed in a larger population with the perspective of improving the classification and understanding of the pathophysiology of A(-) KPD.
Collapse
Affiliation(s)
- Eric V Balti
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium; National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Marinette C Ngo-Nemb
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Eric Lontchi-Yimagou
- Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon; Université Paris Diderot, Paris, France
| | - Barbara Atogho-Tiedeu
- Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon
| | - Valery S Effoe
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Elvis A Akwo
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Mesmin Y Dehayem
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Jean-Claude Mbanya
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon; University of Technology, Kingston, Jamaica
| | - Jean-François Gautier
- Université Paris Diderot, Paris, France; Department of Diabetes and Endocrinology, Saint-Louis Hospital, Paris, France; INSERM, UMRS 872, Cordeliers Research Center, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Eugene Sobngwi
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon.
| |
Collapse
|
43
|
Xie XJ, Hu Y, Cheng C, Feng TT, He K, Mao XM. Should diabetic ketosis without acidosis be included in ketosis-prone type 2 diabetes mellitus? Diabetes Metab Res Rev 2014; 30:54-9. [PMID: 24038858 DOI: 10.1002/dmrr.2448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 07/31/2013] [Accepted: 08/19/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND The incidence of ketosis-prone type 2 diabetes is very low except for people of sub-Saharan African origin and African Americans. However, there also are some type 2 diabetes patients with diabetic ketosis without acidosis (DKWA). We question whether DKWA should be included as a subtype of ketosis-prone type 2 diabetes mellitus and compared the clinical characteristics of DKWA and diabetic ketoacidosis (DKA) patients. METHODS The study population consisted of 594 consecutive unrelated Chinese inpatients with newly diagnosed type 2 diabetes. Demographic and clinical characteristics (age, gender, family history of diabetes, body mass index, blood pressure and plasma lipid parameters) were recorded. The patients were divided into ketosis-resistant diabetes (KRD), DKWA and DKA groups on the basis of urinary ketones, blood pH and bicarbonate levels. The blood glucose and c-peptide levels of the patients were also evaluated. RESULTS The prevalence of KRD, DKWA and DKA were 78.33%, 19.72% and 1.95%, respectively, in the study population. The clinical characteristics of patients with DKWA group patients were similar to those with DKA, except that DKA patients had higher blood glucose and deteriorated β cell function. CONCLUSIONS Diabetic ketosis without acidosis and DKA patients share similar clinical characteristics; DKWA should be considered ketosis-prone type 2 diabetes. Therefore, the prevalence of ketosis-prone type 2 diabetes might be underestimated.
Collapse
Affiliation(s)
- Xiao-Jing Xie
- Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, 68 ChangLe St., Nanjing, China
| | | | | | | | | | | |
Collapse
|
44
|
Caselli E, Rizzo R, Ingianni A, Contini P, Pompei R, Di Luca D. High prevalence of HHV8 infection and specific killer cell immunoglobulin-like receptors allotypes in Sardinian patients with type 2 diabetes mellitus. J Med Virol 2013; 86:1745-51. [PMID: 24122895 DOI: 10.1002/jmv.23771] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2013] [Indexed: 02/05/2023]
Abstract
The development of type 2 diabetes is thought to involve both environmental, possibly infectious, and genetic factors. Recently, a high prevalence of human herpesvirus 8 (HHV8) infection was observed in type 2 diabetes patients, and specific killer cell immunoglobulin-like receptors (KIR) allotypes were associated to both increased susceptibility to herpesvirus infection and risk to develop diabetes. However, no clear gene-disease or virus-disease associations have been established. To investigate the possible interplay between HHV8 infection, KIR allotype and type 2 diabetes, virus prevalence and KIR genotype were analyzed by PCR in 168 patients affected by type 2 diabetes and 108 control individuals belonging to the Sardinian population. Results showed a significant increase of HHV8 prevalence in type 2 diabetes patients versus controls (57% vs. 17%, P < 0.001), and a significant increase of KIR2DL2/DS2 homozygosity in diabetes patients infected with HHV8 compared to uninfected ones (64% vs. 14%, P < 0.0001), resulting in a significant OR of 11.31. In addition, the analysis of the frequency of the KIR2DL2/DS2 receptor and its HLA-C1 ligand, accordingly to the status of HHV8 infection, showed a significant increased correlation between KIR2DL2/DS2, type 2 diabetes and HLA-C1C1 genotype in the type 2 diabetes patients infected with HHV8 compared to uninfected ones (62% vs. 15%, P < 0.0001, OR = 8.64). These findings provide preliminary evidence that HHV8 infection might be a cofactor for type 2 diabetes in a specific subset of genetically susceptible individuals, and suggest the possibility that such patients might have an impaired immune-mediated component contributing to the development of type 2 diabetes.
Collapse
Affiliation(s)
- Elisabetta Caselli
- Department of Medical Sciences, Microbiology Unit, University of Ferrara, Ferrara, Italy
| | | | | | | | | | | |
Collapse
|
45
|
Choukem SP, Fabreguettes C, Akwo E, Porcher R, Nguewa JL, Bouche C, Kaze FF, Kengne AP, Vexiau P, Mbanya JC, Sobngwi E, Gautier JF. Influence of migration on characteristics of type 2 diabetes in sub-Saharan Africans. DIABETES & METABOLISM 2013; 40:56-60. [PMID: 24076360 DOI: 10.1016/j.diabet.2013.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 07/06/2013] [Accepted: 07/14/2013] [Indexed: 12/22/2022]
Abstract
AIM This study compared the clinical and biochemical characteristics and microvascular complications found in three groups of type 2 diabetes (T2D) patients: Africans living in Africa; African immigrants living in France; and Caucasians living in France. METHODS Diagnosed T2D Africans living in Cameroon (n=100) were compared with 98 African migrants diagnosed with T2D after having moved to France, and a group of 199 T2D Caucasian patients living in France. All underwent clinical and biochemical evaluations, and all were assessed for microvascular complications. RESULTS The median duration of stay of the migrants in France was 15years before being diagnosed with diabetes. Despite similar durations of diagnosis, they were 8.9years younger at the time of diagnosis than Africans living in Cameroon (P<0.001). Caucasians and African immigrants in France had lower HbA1c values than Africans in Cameroon (P<0.001); they were also more aggressively treated for hypertension and dyslipidaemia and, therefore, had significantly lower blood pressure levels and better lipid profiles. Diabetic nephropathy and retinopathy rates were higher in Cameroon than in the two other groups. After adjusting for age, diabetes duration, HbA1c, hypertension and other covariates, only the prevalence of diabetic nephropathy (OR: 5.61, 95% CI: 2.32-13.53; P<0.0001) was higher in Cameroon compared with those living in France. CONCLUSION Our results suggest that Africans who emigrate to France may develop diabetes earlier than those staying in their home country. However, the latter may be a reflection of late diagnosis of diabetes. Also, the less adequate diabetes and hypertension control in the latter would explain their higher rates of nephropathy. Large-scale cohorts are now warranted to substantiate these observations.
Collapse
Affiliation(s)
- S P Choukem
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France; Department of Clinical Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | - C Fabreguettes
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | - E Akwo
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - R Porcher
- Department of Biostatistics and Medical Computing, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | - J L Nguewa
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | - C Bouche
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | - F F Kaze
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé-1, Yaoundé, Cameroon
| | - A P Kengne
- South African Medical Research Council and University of Cape Town, Cape Town, South Africa; The George Institute for International Health, the University of Sydney, Sydney, Australia
| | - P Vexiau
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | - J C Mbanya
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon; Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé-1, Yaoundé, Cameroon
| | - E Sobngwi
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon; Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé-1, Yaoundé, Cameroon
| | - J-F Gautier
- Department of Diabetes and Endocrinology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France; INSERM U872, Cordeliers Institute of Biomedical Research, Paris-6 University, Paris, France.
| |
Collapse
|
46
|
Katchunga PB, Baguma M, M'buyamba-Kabangu JR, Philippé J, Hermans MP, Delanghe J. Ferroportin Q248H mutation, hyperferritinemia and atypical type 2 diabetes mellitus in South Kivu. Diabetes Metab Syndr 2013; 7:112-115. [PMID: 23680252 DOI: 10.1016/j.dsx.2013.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The ferroportin Q248H mutation is relatively common in sub-Saharan Africa. No previous study examined its relationship with atypical diabetes mellitus (DM) in this area. OBJECTIVE To determine the potential interactions between ferroportin Q248H mutation, hyperferritinemia and DM in South Kivu (RDC). METHODOLOGY Presence of ferroportin Q248H mutation and iron status were investigated in diabetic patients (n=179, age (mean) 57.7 years, CRP (median) 0.16 mg/L) and non-diabetic subjects (n=86, age 44.5 years, CRP 0.07 mg/L) living in the city of Bukavu. Hyperferritinemia was considered for values greater than 200 and 300 μg/L in women and in men, respectively. RESULTS The prevalence of ferroportin Q248H mutation [12.1%] was non-significantly higher in diabetics than non-diabetics [14.0% vs. 8.1%, p=0.17]. Similarly, hyperferritinemia frequency was higher in diabetic patients with Q248H mutation [44.0% vs. 14.3%, p=0.16] and in mutation carriers [37.0% vs 16.5%, p=0.001] than in the control groups, respectively. The association between Q248H mutation and DM was nevertheless not significant [adjusted OR 1.70 (95% CI: 0.52-5.58), p=0.37], whereas hyperferritinemia [OR 2.72 (1.24-5.98), p=0.01] showed an independent effect after adjustment for age and metabolic syndrome. CONCLUSIONS The present work suggests a potential association between abnormal iron metabolism, ferroportin Q248H mutation and atypical DM in Africans, which may be modulated by environmental factors.
Collapse
Affiliation(s)
- Philippe Bianga Katchunga
- Faculty of Medicine NCD's Observatory, Catholic University of Bukavu/VLIR-UOS, PO Box 235, Bukavu, The Democratic Republic of the Congo.
| | | | | | | | | | | |
Collapse
|
47
|
Kibirige D, Ssekitoleko R, Mutebi E, Worodria W. Overt diabetes mellitus among newly diagnosed Ugandan tuberculosis patients: a cross sectional study. BMC Infect Dis 2013; 13:122. [PMID: 23497232 PMCID: PMC3599954 DOI: 10.1186/1471-2334-13-122] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/27/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a documented increase of diabetes mellitus in Sub Saharan Africa, a region where tuberculosis is highly endemic. Currently, diabetes mellitus is one of the recognised risk factors of tuberculosis. No study has reported the magnitude of diabetes mellitus among tuberculosis patients in Uganda, one of the countries with a high burden of tuberculosis. METHODS This was a cross-sectional study conducted among 260 consenting adult patients with a confirmed diagnosis of tuberculosis admitted on the pulmonology wards of Mulago national referral and teaching hospital in Kampala, Uganda to determine the prevalence of diabetes mellitus and associated clinical factors. Laboratory findings as well as the socio-demographic and clinical data collected using a validated questionnaire was obtained. Point of care random blood sugar (RBS) testing was performed on all the patients prior to initiation of anti tuberculosis treatment. Diabetes mellitus was diagnosed if the RBS level was ≥ 200mg/dl in the presence of the classical symptoms of diabetes mellitus. RESULTS The prevalence of diabetes mellitus among the admitted patients with tuberculosis was 8.5%. Only 5 (1.9%) patients with TB had a known diagnosis of diabetes mellitus at enrolment. Majority of the study participants with TB-DM co-infection had type 2 diabetes mellitus (n=20, 90.9%).At bivariate analysis, raised mean ALT concentrations of ≥80 U/L were associated with DM (OR-6.1, 95% CI 1.4-26.36, p=0.032) and paradoxically, HIV co-infection was protective of DM (OR-0.32, 95% CI 0.13-0.79, P=0.016). The relationship between DM and HIV as well as that with ALT remained statistically significant at multivariate analysis (HIV: OR- 0.17 95%CI 0.06-0.51, p=0.002 and ALT: OR-11.42 95%CI 2.15-60.59, p=0.004). CONCLUSION This study demonstrates that diabetes mellitus is common among hospitalized tuberculosis patients in Uganda. The significant clinical predictors associated with diabetes mellitus among tuberculosis patients were HIV co-infection and raised mean serum alanine transaminase concentrations.
Collapse
Affiliation(s)
- Davis Kibirige
- Department of Medicine, St. Raphael of St. Francis hospital Nsambya, P.O.BOX 7146, Kampala, Uganda
| | - Richard Ssekitoleko
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious diseases unit, Mulago National referral and Teaching Hospital, Kampala, Uganda
| | - Edrisa Mutebi
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Endocrine unit, Mulago National referral and Teaching Hospital, Kampala, Uganda
| | - William Worodria
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Pulmonology unit, Mulago National referral and Teaching Hospital, Kampala, Uganda
| |
Collapse
|
48
|
Li LX, Zhao CC, Ren Y, Tu YF, Lu JX, Wu X, Zhang WX, Zhu JA, Li MF, Yu LB, Bao YQ, Jia WP. Prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study. Cardiovasc Diabetol 2013; 12:18. [PMID: 23324539 PMCID: PMC3583071 DOI: 10.1186/1475-2840-12-18] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background The features of carotid atherosclerosis in ketosis-onset diabetes have not been investigated. Our aim was to evaluate the prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed Chinese diabetic patients with ketosis but without islet-associated autoantibodies. Methods In total, 423 newly diagnosed Chinese patients with diabetes including 208 ketosis-onset diabetics without islet-associated autoantibodies, 215 non-ketotic type 2 diabetics and 79 control subjects without diabetes were studied. Carotid atherosclerosis was defined as the presence of atherosclerotic plaques in any of the carotid vessel segments. Carotid intima-media thickness (CIMT), carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on Doppler ultrasound examination. The clinical features of carotid atherosclerotic lesions were analysed, and the risk factors associated with carotid atherosclerosis were evaluated using binary logistic regression in patients with diabetes. Results The prevalence of carotid atherosclerosis was significantly higher in the ketosis-onset diabetic group (30.80%) than in the control group (15.2%, p=0.020) after adjusting for age- and sex-related differences, but no significant difference was observed in comparison to the non-ketotic diabetic group (35.8%, p=0.487). The mean CIMT of the ketosis-onset diabetics (0.70±0.20 mm) was markedly higher than that of the control subjects (0.57±0.08 mm, p<0.001), but no significant difference was found compared with the non-ketotic type 2 diabetics (0.73±0.19 mm, p=0.582) after controlling for differences in age and sex. In both the ketosis-onset and the non-ketotic diabetes, the prevalence of carotid atherosclerosis was markedly increased with age (both p<0.001) after controlling for sex, but no sex difference was observed (p=0.479 and p=0.707, respectively) after controlling for age. In the ketosis-onset diabetics, the presence of carotid atherosclerosis was significantly associated with age, hypertension, low-density lipoprotein cholesterol and mean CIMT. Conclusions The prevalence and risk of carotid atherosclerosis were significantly higher in the ketosis-onset diabetics than in the control subjects but similar to that in the non-ketotic type 2 diabetics. The characteristics of carotid atherosclerotic lesions in the ketosis-onset diabetics resembled those in the non-ketotic type 2 diabetics. Our findings support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes.
Collapse
Affiliation(s)
- Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- Pierre Lefèbvre
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, University of Liège, Liège, Belgium.
| |
Collapse
|
50
|
Choukem SP, Sobngwi E, Boudou P, Fetita LS, Porcher R, Ibrahim F, Blondeau B, Vexiau P, Mauvais-Jarvis F, Calvo F, Gautier JF. β- and α-cell dysfunctions in africans with ketosis-prone atypical diabetes during near-normoglycemic remission. Diabetes Care 2013; 36:118-23. [PMID: 22933436 PMCID: PMC3526247 DOI: 10.2337/dc12-0798] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Ketosis-prone atypical diabetes (KPD) is a subtype of diabetes in which the pathophysiology is yet to be unraveled. The aim of this study was to characterize β- and α-cell functions in Africans with KPD during remission. RESEARCH DESIGN AND METHODS We characterized β- and α-cell functions in Africans with KPD during remission. The cohort comprised 15 sub-Saharan Africans who had been insulin-free for a median of 6 months. Patients in remission were in good glycemic control (near-normoglycemic) and compared with 15 nondiabetic control subjects matched for age, sex, ethnicity, and BMI. Plasma insulin, C-peptide, and glucagon concentrations were measured in response to oral and intravenous glucose and to combined intravenous arginine and glucose. Early insulin secretion was measured during a 75-g oral glucose tolerance test. Insulin secretion rate and glucagon were assessed in response to intravenous glucose ramping. RESULTS Early insulin secretion and maximal insulin secretion rate were lower in patients compared with control participants. In response to combined arginine and glucose stimulation, maximal insulin response was reduced. Glucagon suppression was also decreased in response to oral and intravenous glucose but not in response to arginine and insulin. CONCLUSIONS Patients with KPD in protracted near-normoglycemic remission have impaired insulin response to oral and intravenous glucose and to arginine, as well as impaired glucagon suppression. Our results suggest that β- and α-cell dysfunctions both contribute to the pathophysiology of KPD.
Collapse
Affiliation(s)
- Siméon-Pierre Choukem
- Department of Diabetes and Endocrinology, Saint-Louis University Hospital, Assistance Publique–Hôpitaux de Paris, University Paris-Diderot Paris-7, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|