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Piras A, Raffi M. A Narrative Literature Review on the Role of Exercise Training in Managing Type 1 and Type 2 Diabetes Mellitus. Healthcare (Basel) 2023; 11:2947. [PMID: 37998439 PMCID: PMC10671220 DOI: 10.3390/healthcare11222947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia associated with impaired carbohydrate, lipid, and protein metabolism, with concomitant absence of insulin secretion or reduced sensitivity to its metabolic effects. Patients with diabetes mellitus have a 30% more risk of developing heart failure and cardiovascular disease compared to healthy people. Heart and cardiovascular problems are the first cause of death worldwide and the main complications which lead to high healthcare costs. Such complications can be delayed or avoided by taking prescribed medications in conjunction with a healthy lifestyle (i.e., diet and physical activity). The American College of Sports Medicine and the American Diabetes Association recommend that diabetic people reduce total sedentary time by incorporating physical activity into their weekly routine. This narrative literature review aims to summarize and present the main guidelines, pre-exercise cardiovascular screening recommendations, and considerations for patients with diabetes and comorbidities who are planning to participate in physical activity programs.
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Affiliation(s)
- Alessandro Piras
- Department of Life Quality Studies, University of Bologna, 40126 Bologna, Italy
| | - Milena Raffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
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Khan WA, Malik A, Khan MWA. Depression linked to higher antibodies production against estrogenized insulin in type 1 diabetes. Int Immunopharmacol 2020; 86:106712. [DOI: 10.1016/j.intimp.2020.106712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
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Pappa E, Vastardis H, Mermelekas G, Gerasimidi-Vazeou A, Zoidakis J, Vougas K. Saliva Proteomics Analysis Offers Insights on Type 1 Diabetes Pathology in a Pediatric Population. Front Physiol 2018; 9:444. [PMID: 29755368 PMCID: PMC5932525 DOI: 10.3389/fphys.2018.00444] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/10/2018] [Indexed: 12/13/2022] Open
Abstract
The composition of the salivary proteome is affected by pathological conditions. We analyzed by high resolution mass spectrometry approaches saliva samples collected from children and adolescents with type 1 diabetes and healthy controls. The list of more than 2000 high confidence protein identifications constitutes a comprehensive characterization of the salivary proteome. Patients with good glycemic regulation and healthy individuals have comparable proteomic profiles. In contrast, a significant number of differentially expressed proteins were identified in the saliva of patients with poor glycemic regulation compared to patients with good glycemic control and healthy children. These proteins are involved in biological processes relevant to diabetic pathology such as endothelial damage and inflammation. Moreover, a putative preventive therapeutic approach was identified based on bioinformatic analysis of the deregulated salivary proteins. Thus, thorough characterization of saliva proteins in diabetic pediatric patients established a connection between molecular changes and disease pathology. This proteomic and bioinformatic approach highlights the potential of salivary diagnostics in diabetes pathology and opens the way for preventive treatment of the disease.
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Affiliation(s)
- Eftychia Pappa
- Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Heleni Vastardis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - George Mermelekas
- Proteomics Laboratory, Foundation of Biomedical Research of the Academy of Athens, Athens, Greece
| | | | - Jerome Zoidakis
- Proteomics Laboratory, Foundation of Biomedical Research of the Academy of Athens, Athens, Greece
| | - Konstantinos Vougas
- Proteomics Laboratory, Foundation of Biomedical Research of the Academy of Athens, Athens, Greece
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An Update on Hypertension in Children With Type 1 Diabetes. Can J Diabetes 2018; 42:199-204. [DOI: 10.1016/j.jcjd.2018.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/21/2018] [Indexed: 12/21/2022]
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Oxygen-induced impairment in arterial function is corrected by slow breathing in patients with type 1 diabetes. Sci Rep 2017; 7:6001. [PMID: 28729675 PMCID: PMC5519543 DOI: 10.1038/s41598-017-04947-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/24/2017] [Indexed: 12/28/2022] Open
Abstract
Hyperoxia and slow breathing acutely improve autonomic function in type-1 diabetes. However, their effects on arterial function may reveal different mechanisms, perhaps potentially useful. To test the effects of oxygen and slow breathing we measured arterial function (augmentation index, pulse wave velocity), baroreflex sensitivity (BRS) and oxygen saturation (SAT), during spontaneous and slow breathing (6 breaths/min), in normoxia and hyperoxia (5 L/min oxygen) in 91 type-1 diabetic and 40 age-matched control participants. During normoxic spontaneous breathing diabetic subjects had lower BRS and SAT, and worse arterial function. Hyperoxia and slow breathing increased BRS and SAT. Hyperoxia increased blood pressure and worsened arterial function. Slow breathing improved arterial function and diastolic blood pressure. Combined administration prevented the hyperoxia-induced arterial pressure and function worsening. Control subjects showed a similar pattern, but with lesser or no statistical significance. Oxygen-driven autonomic improvement could depend on transient arterial stiffening and hypertension (well-known irritative effect of free-radicals on endothelium), inducing reflex increase in BRS. Slow breathing-induced improvement in BRS may result from improved SAT, reduced sympathetic activity and improved vascular function, and/or parasympathetic-driven antioxidant effect. Lower oxidative stress could explain blunted effects in controls. Slow breathing could be a simple beneficial intervention in diabetes.
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Raman S, Dai H, DeLurgio SA, Williams DD, Lind M, Patton SR, Spertus JA, Kosiborod M, Clements MA. High hemoglobin A1c variability is associated with early risk of microalbuminuria in children with T1D. Pediatr Diabetes 2016; 17:398-406. [PMID: 26377593 PMCID: PMC6541408 DOI: 10.1111/pedi.12300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To test the hypothesis that HbA1c variability, as measured by standard deviation (SD), is associated with increased risk for incident microalbuminuria and persistent microalbuminuria in pediatric type 1 diabetes (T1D). METHODS A retrospective analysis using data from electronic health records was performed on 1195 patients from a pediatric diabetes clinic network in the Midwest USA from 1993 to 2009 with ≥1 yr of T1D, ≥4 total HbA1c values, ≥2 HbA1c values/yr, ≥1 urine microalbumin. Microalbuminuria, the main outcome was defined as albumin excretion rate ≥20 mcg/min or 2 of 3 consecutive urine microalbumin/creatinine ≥30 mg/gm. Patients who had persistently high microalbumin or who were treated with an angiotensin-converting-enzyme inhibitor within 1 yr were considered to have persistent microalbuminuria. Sex, race, age, diagnosis age, and duration were covariates. RESULTS Median numbers of per-patient HbA1c and microalbumin results were 14 and 3, respectively. Median intrapersonal mean HbA1c and SD were 8.62% (70.72 mol/mol) and 1.47% (16.07 mmol/mol), respectively. The median interquartile range (IQR) of diagnosis age was 9.4 yr (6.26-12.02) and diabetes duration was 4.97 yr (2.93-7.64). A total of 172 patients (14.4%) developed microalbuminuria; 55 (4.6%) had persistent microalbuminuria. Patients with higher SD of HbA1c had shorter time to microalbuminuria. In time-dependent Cox Proportional Hazard models, updated SD of HbA1c was significantly associated with microalbuminuria [univariate hazard ratio (HR) 1.48 (1.25-1.76); multivariable HR 1.28 (1.04-1.58)], whereas updated mean HbA1c was not [univariate HR 1.08 (0.97-1.22); multivariable HR 1.05 (0.92-1.2)]. Patients with persistent microalbuminuria had similar HRs. CONCLUSIONS HbA1c variability is independently associated with development of microalbuminuria in children with T1D, highlighting the importance of maintaining stable glycemic control in pediatric patients.
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Affiliation(s)
- Sripriya Raman
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,University of Kansas Medical Center, Kansas City, KS, USA
| | - Hongying Dai
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,Department of Research Development and Clinical Investigations, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Stephen A. DeLurgio
- Department of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - David D. Williams
- Department of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Marcus Lind
- Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - John A. Spertus
- Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA,Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Mikhail Kosiborod
- Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA,Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Mark A. Clements
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,University of Kansas Medical Center, Kansas City, KS, USA
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Gordin D, Groop PH. Aspects of Hyperglycemia Contribution to Arterial Stiffness and Cardiovascular Complications in Patients With Type 1 Diabetes. J Diabetes Sci Technol 2016; 10:1059-64. [PMID: 26956240 PMCID: PMC5032944 DOI: 10.1177/1932296816636894] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Controlling the blood glucose level is of outmost importance for the prevention of the micro- and macrovascular diabetic complications observed in patients with type 1 diabetes (T1D). Although the pathogenesis behind the complex cascade of complications is far from solved, one possible mechanism could be a negative effect of glucose on the arteries resulting in a stiffening of the arteries and ultimately in vascular complications. Intriguingly, patients with T1D have been shown to suffer from premature arterial aging compared to nondiabetic subjects-an association that is even more evident in the presence of diabetic complications such as diabetic nephropathy. Arterial stiffness has in several patient populations been shown to independently predict cardiovascular disease. However, interventional studies aimed at attenuating arterial stiffness to reduce cardiovascular disease in T1D are yet to come. Moreover, most of the data on pharmacological treatments of arterial stiffening are directed toward pathophysiological pathways other than hyperglycemia. Interestingly, the sodium-glucose transport-2 (SGLT2) inhibitor empagliflozin was recently shown to reduce both blood pressure and arterial stiffness in patients with type 2 diabetes. Whether, these effects can also be replicated in patients with T1D is an intriguing question. Tight metabolic and antihypertensive control are still of central importance for the prevention and the treatment of diabetic complications. However, the need for a noninvasive intermediate marker to identify at risk patients for aggressive treatment is evident. One such tool might be arterial stiffness linking diabetes to increased cardiovascular risk. Future research efforts exploring large-scale databases will play a key role in the identification of other clinically useful markers.
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Affiliation(s)
- Daniel Gordin
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum, Helsinki, Finland Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Gordin D, Bernardi L, Rosengård-Bärlund M, Mäkinen VP, Soro-Paavonen A, Forsblom C, Sandelin A, Groop PH. Oxygen deteriorates arterial function in type 1 diabetes. Acta Diabetol 2016; 53:349-57. [PMID: 26159114 DOI: 10.1007/s00592-015-0775-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/21/2015] [Indexed: 12/23/2022]
Abstract
AIMS Although oxygen is commonly used to treat various medical conditions, it has recently been shown to worsen vascular function (arterial stiffness) in healthy volunteers and even more in patients in whom vascular function might already be impaired. The effects of oxygen on arterial function in patients with type 1 diabetes (T1D) are unknown, although such patients display disturbed vascular function already at rest. Therefore, we tested whether short-term oxygen administration may alter the arterial function in patients with T1D. METHODS We estimated arterial stiffness by augmentation index (AIx) and the pulse wave velocity equivalent (SI-DVP) in 98 patients with T1D and 49 age- and sex-matched controls at baseline and during hyperoxia by obtaining continuous noninvasive finger pressure waveforms using a recently validated method. RESULTS AIx and SI-DVP increased in patients (P < 0.05) but not in controls in response to hyperoxia. The increase in AIx (P = 0.05), systolic (P < 0.05), and diastolic (P < 0.05) blood pressure was higher in the patients than in the controls. CONCLUSIONS Short-term oxygen administration deteriorates arterial function in patients with T1D compared to non-diabetic control subjects. Since disturbed arterial function plays a major role in the development of diabetic complications, these findings may be of clinical relevance.
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Affiliation(s)
- Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Luciano Bernardi
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Milla Rosengård-Bärlund
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Ville-Petteri Mäkinen
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Biomedical and Molecular Science, University of Adelaide, Adelaide, SA, Australia
| | - Aino Soro-Paavonen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Anna Sandelin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland.
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
- Diabetes and Obesity Research Program, Research Program's Unit, University of Helsinki, Helsinki, Finland.
- The Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Gordin D, Saraheimo M, Tuomikangas J, Soro-Paavonen A, Forsblom C, Paavonen K, Steckel-Hamann B, Vandenhende F, Nicolaou L, Pavo I, Koivisto V, Groop PH. Influence of Postprandial Hyperglycemic Conditions on Arterial Stiffness in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:1134-43. [PMID: 26731258 PMCID: PMC4803174 DOI: 10.1210/jc.2015-3635] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT Patients with type 2 diabetes (T2D) are at an increased risk of cardiovascular disease. OBJECTIVE The objective of the study was to determine whether postprandial hyperglycemia affects arterial function in T2D. DESIGN A single-center, open-label study of three groups of men were studied: 1) T2D patients with albuminuria (n = 22), 2) T2D patients without albuminuria (n = 24), and 3) nondiabetic controls (n = 25). Patients were randomized to a two-period crossover study schedule, ingesting breakfast, with or without insulin lispro (to induce low or high postprandial glycemia). MAIN OUTCOME MEASURES Arterial stiffness was assessed by calculating pulse wave velocity (PWV) and augmentation index using applanation tonometry, and endothelial dysfunction was assessed using peripheral arterial tonometry, 30 minutes before breakfast and up to 240 minutes after breakfast. RESULTS At baseline, arterial stiffness was increased in patients. When adjusted for age and body mass index, in a combined group of patients with and without albuminuria, brachial PWV was higher during low (P = .032) and high (P = .038) postprandial glycemia vs controls. These differences were driven by the albuminuria group vs controls during low (P = .014) and high (P = .018) postprandial glycemia. No differences were observed in aortic PWV, augmentation index, or peripheral arterial tonometry ratio between patients and controls. Endothelin-1 and IL-6 were higher, and superoxide dismutase was lower, during postprandial hyperglycemia in T2D patients vs controls. CONCLUSIONS In patients with T2D and albuminuria, brachial PWV was higher under postprandial hyperglycemic conditions, relative to controls. These data suggest that hyperglycemia induces an increase in stiffness of intermediate-sized arteries. We found no changes in other parts of the arterial bed.
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Affiliation(s)
- Daniel Gordin
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Markku Saraheimo
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Jaana Tuomikangas
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Aino Soro-Paavonen
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Carol Forsblom
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Karri Paavonen
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Birgit Steckel-Hamann
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Francois Vandenhende
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Loizos Nicolaou
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Imre Pavo
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Veikko Koivisto
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics (D.G., M.S., J.T., A.S.-P., C.F., K.P., P.-H.G.), Folkhälsan Research Center, Biomedicum Helsinki, FI-00014 Helsinki, Finland; Abdominal Center Nephrology FI-00290 (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), University of Helsinki and Helsinki University Hospital, and Research Program Unit (D.G., M.S., J.T., A.S.-P., C.F., P.-H.G.), Department of Diabetes and Obesity, University of Helsinki FI-00014, and Division of Cardiology (K.P.), Department of Medicine, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Eli Lilly Export SA (B.S.-H.), Vernier, 1214 Geneva, Switzerland; ClinBAY (F.V., L.N.), 1470 Genappe, Belgium; Eli Lilly (I.P.), A-1030 Vienna, Austria; Eli Lilly (V.K.), 00330 Helsinki, Finland; and Baker IDI and Diabetes Institute (P.-H.G.), Melbourne, 3004 Victoria, Australia
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Sala D, Zorzano A. Differential control of muscle mass in type 1 and type 2 diabetes mellitus. Cell Mol Life Sci 2015; 72:3803-17. [PMID: 26091746 PMCID: PMC11113699 DOI: 10.1007/s00018-015-1954-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 12/25/2022]
Abstract
Diabetes mellitus--whether driven by insulin deficiency or insulin resistance--causes major alterations in muscle metabolism. These alterations have an impact on nutrient handling, including the metabolism of glucose, lipids, and amino acids, and also on muscle mass and strength. However, the ways in which the distinct forms of diabetes affect muscle mass differ greatly. The most common forms of diabetes mellitus are type 1 and type 2. Thus, whereas type 1 diabetic subjects without insulin treatment display a dramatic loss of muscle, most type 2 diabetic subjects show no changes or even an increase in muscle mass. However, the most commonly used rodent models of type 2 diabetes are characterized by muscle atrophy and do not mimic the features of the disease in humans in terms of muscle mass. In this review, we analyze the processes that are differentially regulated under these forms of diabetes and propose regulatory mechanisms to explain them.
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Affiliation(s)
- David Sala
- Development, Aging and Regeneration Program (DARe), Sanford-Burnham Medical Research Institute, 10901 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Antonio Zorzano
- Institute for Research in Biomedicine (IRB Barcelona), C/Baldiri Reixac 10, 08028, Barcelona, Spain.
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal 645, 08028, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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Simonsen JR, Harjutsalo V, Järvinen A, Kirveskari J, Forsblom C, Groop PH, Lehto M. Bacterial infections in patients with type 1 diabetes: a 14-year follow-up study. BMJ Open Diabetes Res Care 2015; 3:e000067. [PMID: 25767718 PMCID: PMC4352693 DOI: 10.1136/bmjdrc-2014-000067] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/09/2015] [Accepted: 02/15/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study explored the annual occurrence/incidence of bacterial infections, and their association with chronic hyperglycemia and diabetic nephropathy, in patients with type 1 diabetes. DESIGN In a register-based follow-up study, we investigated the frequency of bacterial infections in patients with type 1 diabetes (n=4748) and age-matched and sex-matched non-diabetic control (NDC) subjects (n=12 954) using nationwide register data on antibiotic drug prescription purchases and hospital discharge diagnoses, collected between 1996 and 2009. Diabetic nephropathy was classified based on the urinary albumin excretion rate (AER). RESULTS The hospitalization rate due to bacterial infections was higher in patients with diabetes compared with NDCs (rate ratio (RR) 2.30 (95% CI 2.11 to 2.51)). The rate correlated with the severity of diabetic nephropathy: RR for microalbuminuria was 1.23 (0.94 to 1.60), 1.97 (1.49 to 2.61) for macroalbuminuria, 11.2 (8.1 to 15.5) for dialysis, and 6.72 (4.92 to 9.18) for kidney transplant as compared to patients with diabetes and normal AER. The annual number of antibiotic purchases was higher in patients with diabetes (1.00 (1.00 to 1.01)) as compared with NDCs (0.47 (0.46 to 0.47)), RR=1.71 (1.65 to 1.77). Annual antibiotic purchases were 1.18-fold more frequent in patients with microalbuminuria, 1.29-fold with macroalbuminuria, 2.43-fold with dialysis, and 2.74-fold with kidney transplant as compared to patients with normal AER. Each unit of increase in glycated hemoglobin was associated with a 6-10% increase in the number of annual antibiotic purchases. CONCLUSIONS The incidence of bacterial infections was significantly higher in patients with type 1 diabetes compared with age-matched and sex-matched NDC subjects, and correlated with the severity of diabetic nephropathy in inpatient and outpatient settings.
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Affiliation(s)
- Johan R Simonsen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Research Program Unit, Department of Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Research Program Unit, Department of Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Kirveskari
- Helsinki University Hospital Laboratory, Department of Bacteriology, Helsinki University Central Hospital, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Research Program Unit, Department of Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Research Program Unit, Department of Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Research Program Unit, Department of Diabetes and Obesity, University of Helsinki, Helsinki, Finland
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Patients with type 1 diabetes show signs of vascular dysfunction in response to multiple high-fat meals. Nutr Metab (Lond) 2014; 11:28. [PMID: 24959195 PMCID: PMC4067102 DOI: 10.1186/1743-7075-11-28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/05/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A high-fat diet promotes postprandial systemic inflammation and metabolic endotoxemia. We investigated the effects of three consecutive high-fat meals on endotoxemia, inflammation, vascular function, and postprandial lipid metabolism in patients with type 1 diabetes. METHODS Non-diabetic controls (n = 34) and patients with type 1 diabetes (n = 37) were given three high-caloric, fat-containing meals during one day. Blood samples were drawn at fasting (8:00) and every two hours thereafter until 18:00. Applanation tonometry was used to assess changes in the augmentation index during the investigation day. RESULTS Three consecutive high-fat meals had only a modest effect on serum LPS-activity levels and inflammatory markers throughout the day in both groups. Of note, patients with type 1 diabetes were unable to decrease the augmentation index in response to the high-fat meals. The most profound effects of the consecutive fat loads were seen in chylomicron and HDL-metabolism. The triglyceride-rich lipoprotein remnant marker, apoB-48, was elevated in patients compared to controls both at fasting (p = 0.014) and postprandially (p = 0.035). The activities of the HDL-associated enzymes PLTP (p < 0.001), and CETP (p = 0.007) were higher and paraoxonase (PON-1) activity, an anti-oxidative enzyme bound to HDL, decreased in patients with type 1 diabetes (p = 0.027). CONCLUSIONS In response to high-fat meals, early signs of vascular dysfunction alongside accumulation of chylomicron remnants, higher augmentation index, and decreased PON-1 activity were observed in patients with type 1 diabetes. The high-fat meals had no significant impact on postprandial LPS-activity in non-diabetic subjects or patients with type 1 diabetes suggesting that metabolic endotoxemia may be more central in patients with chronic metabolic disturbances such as obesity, type 2 diabetes, or diabetic kidney disease.
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Close TE, Cepinskas G, Omatsu T, Rose KL, Summers K, Patterson EK, Fraser DD. Diabetic ketoacidosis elicits systemic inflammation associated with cerebrovascular endothelial cell dysfunction. Microcirculation 2014; 20:534-43. [PMID: 23441883 DOI: 10.1111/micc.12053] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 02/19/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine if the DKA-induced inflammation in juvenile mice provokes activation and dysfunction of CVECs. METHODS DKA in juvenile mice was induced with administration of STZ and ALX. Blood from DKA mice was assessed for cytokines and soluble cell adhesion proteins, and either DKA plasma or exogenous compounds were applied to immortalized bEND3. RESULTS DKA increased circulating levels of IL-6, IL-8(KC), MCP-1, IL-10, sE-selectin, sICAM-1, and sVCAM-1. Stimulation of bEND3 with DKA plasma caused cellular activation (increased ROS and activation of NF-κΒ), upregulation of a proadhesive phenotype (E-selectin, ICAM-1, and VCAM-1), and increased leukocyte-bEND3 interaction (leukocyte rolling/adhesion). TEER, a measure of bEND3 monolayer integrity, was decreased by DKA plasma. Activation and dysfunction of bEND3 with DKA plasma were suppressed by plasma heat treatment (56°C, 1 hour) and replicated with the application of DKA recombinant cytomix (IL-6, IL-8[KC], MCP-1, and IL-10), implicating circulating inflammatory protein(s) as mediators. Treatment of bEND3 with β-OH-butyrate, the main ketone elevated in DKA, failed to mimic the DKA plasma-induced activation and dysfunction of bEND3. CONCLUSIONS DKA elicits systemic inflammation associated with CVEC activation and dysfunction, possibly contributing to DKA-associated intracranial microvascular complications.
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Affiliation(s)
- Taylor E Close
- Children's Health Research Institute, London, ON, Canada
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Abstract
Physical exercise is firmly incorporated in the management of type 1 diabetes (T1DM), due to multiple recognized beneficial health effects (cardiovascular disease prevention being preeminent). When glycemic values are not excessively low or high at the time of exercise, few absolute contraindications exist; practical guidelines regarding amount, type, and duration of age-appropriate exercise are regularly updated by entities such as the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Practical implementation of exercise regimens, however, may at times be problematic. In the poorly controlled patient, specific structural changes may occur within skeletal muscle fiber, which is considered by some to be a disease-specific myopathy. Further, even in well-controlled patients, several homeostatic mechanisms regulating carbohydrate metabolism often become impaired, causing hypo- or hyperglycemia during and/or after exercise. Some altered responses may be related to inappropriate exogenous insulin administration, but are often also partly caused by the "metabolic memory" of prior glycemic events. In this context, prior hyperglycemia correlates with increased inflammatory and oxidative stress responses, possibly modulating key exercise-associated cardio-protective pathways. Similarly, prior hypoglycemia correlates with impaired glucose counterregulation, resulting in greater likelihood of further hypoglycemia to develop. Additional exercise responses that may be altered in T1DM include growth factor release, which may be especially important in children and adolescents. These multiple alterations in the exercise response should not discourage physical activity in patients with T1DM, but rather should stimulate the quest for the identification of the exercise formats that maximize beneficial health effects.
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Affiliation(s)
- Pietro Galassetti
- Department of Pediatrics, University of California Irvine, Irvine, California, USA.
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Cherney DZI, Reich HN, Scholey JW, Daneman D, Mahmud FH, Har RLH, Sochett EB. The effect of aliskiren on urinary cytokine/chemokine responses to clamped hyperglycaemia in type 1 diabetes. Diabetologia 2013; 56:2308-17. [PMID: 23893332 DOI: 10.1007/s00125-013-3000-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/28/2013] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Acute clamped hyperglycaemia activates the renin-angiotensin-aldosterone system (RAAS) and increases the urinary excretion of inflammatory cytokines/chemokines in patients with uncomplicated type 1 diabetes mellitus. Our objective was to determine whether blockade of the RAAS would blunt the effect of acute hyperglycaemia on urinary cytokine/chemokine excretion, thereby giving insights into potentially protective effects of these agents prior to the onset of clinical nephropathy. METHODS Blood pressure, renal haemodynamic function (inulin and para-aminohippurate clearances) and urinary cytokines/chemokines were measured after 6 h of clamped euglycaemia (4-6 mmol/l) and hyperglycaemia (9-11 mmol/l) on two consecutive days in patients with type 1 diabetes mellitus (n = 27) without overt nephropathy. Measurements were repeated after treatment with aliskiren (300 mg daily) for 30 days. RESULTS Before aliskiren, clamped hyperglycaemia increased filtration fraction (from 0.188 ± 0.007 to 0.206 ± 0.007, p = 0.003) and urinary fibroblast growth factor-2 (FGF2), IFN-α2 and macrophage-derived chemokine (MDC) (p < 0.005). After aliskiren, the filtration fraction response to hyperglycaemia was abolished, resulting in a lower filtration fraction after aliskiren under clamped hyperglycaemic conditions (p = 0.004), and none of the biomarkers increased in response to hyperglycaemia. Aliskiren therapy also reduced levels of urinary eotaxin, FGF2, IFN-α2, IL-2 and MDC during clamped hyperglycaemia (p < 0.005). CONCLUSIONS/INTERPRETATION The increased urinary excretion of inflammatory cytokines/chemokines in response to acute hyperglycaemia is blunted by RAAS blockade in humans with uncomplicated type 1 diabetes mellitus.
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Affiliation(s)
- David Z I Cherney
- Division of Nephrology, University Health Network - Toronto General Hospital, Banting and Best Diabetes Centre, University of Toronto, 585 University Ave, 8N-845, Toronto, ON M5G 2N2, Canada.
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Chen YW, Hsieh PL, Chen YC, Hung CH, Cheng JT. Physical Exercise Induces Excess Hsp72 Expression and Delays the Development of Hyperalgesia and Allodynia in Painful Diabetic Neuropathy Rats. Anesth Analg 2013; 116:482-90. [DOI: 10.1213/ane.0b013e318274e4a0] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Gruden G, Barutta F, Chaturvedi N, Schalkwijk C, Stehouwer CD, Pinach S, Manzo M, Loiacono M, Tricarico M, Mengozzi G, Witte DR, Fuller JH, Perin PC, Bruno G. NH2-terminal probrain natriuretic peptide is associated with diabetes complications in the EURODIAB Prospective Complications Study: the role of tumor necrosis factor-α. Diabetes Care 2012; 35:1931-6. [PMID: 22699286 PMCID: PMC3425012 DOI: 10.2337/dc12-0089] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Circulating levels of NH(2)-terminal probrain natriuretic peptide (NT-proBNP), a marker of acute heart failure, are associated with increased risk of cardiovascular disease (CVD) in the general population. However, there is little information on the potential role of NT-proBNP as a biomarker of vascular complications in type 1 diabetic patients. We investigated whether serum NT-proBNP levels were associated with micro- and macrovascular disease in type 1 diabetic subjects. RESEARCH DESIGN AND METHODS A cross-sectional nested case-control study from the EURODIAB Prospective Complications Study of 507 type 1 diabetic patients was performed. Case subjects (n = 345) were defined as those with one or more complications of diabetes; control subjects (n = 162) were those with no evidence of any complication. We measured NT-proBNP levels by a two-site sandwich electrochemiluminescence immunoassay and investigated their associations with complications. RESULTS Mean NT-proBNP levels were significantly higher in case than in control subjects. In logistic regression analyses, NT-proBNP values >26.46 pg/mL were independently associated with a 2.56-fold increased risk of all complications. Odds ratios of CVD (3.95 [95% CI 1.26-12.35]), nephropathy (4.38 [1.30-14.76]), and distal symmetrical polyneuropathy (4.32 [1.41-13.23]) were significantly increased in patients with NT-proBNP values in the highest quartile (>84.71 pg/mL), independently of renal function and known risk factors. These associations were no longer significant after inclusion of TNF-α into the model. CONCLUSIONS In this large cohort of type 1 diabetic subjects, we found an association between NT-proBNP and diabetic micro- and macrovascular complications. Our results suggest that the inflammatory cytokine TNF-α may be involved in this association.
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Affiliation(s)
- Gabriella Gruden
- Department of Internal Medicine, University of Turin, Turin, Italy.
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Swärd P, Rippe B. Acute and sustained actions of hyperglycaemia on endothelial and glomerular barrier permeability. Acta Physiol (Oxf) 2012; 204:294-307. [PMID: 21812939 DOI: 10.1111/j.1748-1716.2011.02343.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Microalbuminuria is an established marker of systemic endothelial dysfunction, which for patients with diabetes signals an increased risk of both diabetic nephropathy and cardiovascular complications. A better understanding of the pathogenesis of microalbuminuria is important in the quest of finding new approaches to treat patients with diabetes. Direct acute effects of episodes of hyperglycaemia (HG) could have implications for the microalbuminuria seen in early diabetes before renal structural alterations have started, especially in those patients with poor glycaemic control. This review summarizes the literature evidence that acute or sustained HG may lead to an increased vascular or glomerular permeability. Special focus is on glomerular barrier permeability. There is evidence in the literature that HG increases systemic capillary and glomerular barrier permeability within 20-30 min in vivo in rats and mice. Furthermore, exposure of monolayers of cultured endothelial cells to HG has been shown to increase monolayer permeability rapidly and transiently (during 60-100 min). Instant cellular changes following F-actin cytoskeleton rearrangements, which could be abrogated by Rho-kinase (ROCK) inhibition, are implicated. Data in this review also suggest that activation of protein kinase C, the polyol pathway, and an increased release of reactive oxygen species (ROS) and cytokines could contribute to the increase in barrier permeability induced by HG. Recent in vitro data from cultured podocyte monolayers also designates a role of insulin in acute podocyte F-actin remodelling, underpinning the complexity of the mechanisms leading to glomerular and endothelial barrier alterations in diabetes mellitus.
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Affiliation(s)
- P Swärd
- Department of Nephrology, University of Lund, University Hospital of Lund, Sweden
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Korczak DJ, Pereira S, Koulajian K, Matejcek A, Giacca A. Type 1 diabetes mellitus and major depressive disorder: evidence for a biological link. Diabetologia 2011; 54:2483-93. [PMID: 21789690 DOI: 10.1007/s00125-011-2240-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 05/27/2011] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS A growing body of research suggests that the prevalence of major depressive disorder (MDD) in children and youth with type 1 diabetes mellitus is significantly higher than that of youth without type 1 diabetes and is associated with increased illness severity. The objective of this article is to review the current literature on the pathophysiology of these two common diseases with respect to potential areas of overlapping biological dysfunction. METHODS A search of English language articles published between 1966 and 2010 was conducted and augmented with manual review of reference lists from the identified publications. RESULTS The evidence suggests plausible mechanisms whereby a biological relationship between type 1 diabetes and MDD may exist. These include the effects of circulating cytokines associated with autoimmune diabetes, the direct impact of insulin deficiency on neurogenesis/neurotransmitter metabolism, the effects of the chronic hyperglycaemic state, occurrence of iatrogenic hypoglycaemia and the impact of basal hyperactivity of the hypothalamic-pituitary-adrenal axis. CONCLUSIONS/INTERPRETATION Shared biological vulnerabilities may be implicated in the comorbidity of type 1 diabetes and MDD. Further research is warranted to determine the magnitude of associations and confirm their observation in clinical populations.
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Affiliation(s)
- D J Korczak
- Department of Psychiatry, The Hospital for Sick Children, Rm 1145 Burton Wing, 555 University Avenue, Toronto, ON, Canada, M5G 1X8.
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Galassetti PR, Rosa JS, Heydari S, Oliver SR, Flores RL, Pontello AM, Ibardolaza M. Inflammatory cytokine profiles during exercise in obese, diabetic, and healthy children. J Clin Res Pediatr Endocrinol 2011; 3:115-21. [PMID: 21911323 PMCID: PMC3184511 DOI: 10.4274/jcrpe.v3i3.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Modulation of inflammatory status is considered a key component of the overall health effects of exercise. This may be especially relevant in children with obesity (Ob) or type 1 diabetes (T1DM), in which an imbalance between pro- and anti-inflammatory mediators could accelerate onset and progression of cardiovascular complications. To date, exercise-induced alterations in immuno-modulatory mediators in Ob and T1DM children remain largely unknown. METHODS In this study, we monitored the kinetic profiles of 8 pro-and anti-inflammatory cytokines (TNF-a, IL-6, IL-2, IL-8, IL-5, IL-13, IL-10, IL-4) during a standardized exercise challenge (ten 2-min cycling bouts at 80% VO2max, separated by 1-min intervals) in 23 Ob (12 females, 11 males), 23 T1DM (10 females and 13 males) patients and 20 healthy (CL, 10 females and 10 males) children. Blood glucose of T1DM patients was kept in the 4.4-6.1 mM range for at least 90 minute prior to and during exercise. Blood samples were drawn at rest and after every other exercise bout. RESULTS In Ob, TNF-a and IL-2 were significantly greater (p<0.0167) as compared to T1DM and CL, both at baseline and throughout exercise. All other variables, while not significant, were quantitatively elevated in Ob vs. CL. In T1DM, IL-4 and IL-8 levels were similar to Ob, IL-2 and TNF-a similar to CL, and IL-6, IL-5, IL-13, IL-4 levels were intermediate between the Ob and CL groups. CONCLUSIONS During exercise, therefore, both Ob and T1DM children displayed exaggerated pro-inflammatory responses, although with clearly different magnitude and involved mediators. Our data support the necessity to identify specific exercise formats through which each at-risk pediatric population can draw maximal beneficial health effects.
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Affiliation(s)
- Pietro R. Galassetti
- University of California, Institute for Clinical and Translational Science, Irvine, CA, USA
| | - Jaime S. Rosa
- University of California, Department of Pharmacology, Irvine, CA, USA
| | - Shirin Heydari
- University of California, Institute for Clinical and Translational Science, Irvine, CA, USA
| | - Stacy R. Oliver
- University of California, Department of Pharmacology, Irvine, CA, USA
| | - Rebecca L. Flores
- University of California, Institute for Clinical and Translational Science, Irvine, CA, USA
| | - Andria M. Pontello
- University of California, Institute for Clinical and Translational Science, Irvine, CA, USA
| | - Milagros Ibardolaza
- University of California, Institute for Clinical and Translational Science, Irvine, CA, USA
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Krause MP, Riddell MC, Hawke TJ. Effects of type 1 diabetes mellitus on skeletal muscle: clinical observations and physiological mechanisms. Pediatr Diabetes 2011; 12:345-64. [PMID: 20860561 DOI: 10.1111/j.1399-5448.2010.00699.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Matthew P Krause
- Dept of Pathology & Molecular Medicine, McMaster University, 1200 Main St., W. Hamilton, ON, Canada L8N 3Z5
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Giménez M, Gilabert R, Lara M, Conget I. Preclinical arterial disease in patients with type 1 diabetes without other major cardiovascular risk factors or micro-/ macrovascular disease. Diab Vasc Dis Res 2011; 8:5-11. [PMID: 21109602 DOI: 10.1177/1479164110388674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate preclinical atherosclerosis in T1D and its relationship with glucose profile and endothelial/ inflammatory markers. Thirty-eight T1D patients without additional cardiovascular risk factors or micro-/macrovascular complications and 22 healthy matched subjects were included. FMD and cIMT/fIMT were performed in addition to 72-h continuous glucose monitoring and the measurement of endothelial/inflammatory markers. Lower FMD percentages and greater cIMT/fIMT were observed in patients with T1D in comparison with controls (FMD 7.0 ± 3.1% vs. 9.6 ± 2.2%; p<0.005; cIMT 0.523 ± 0.091 mm vs. 0.471 ± 0.061 mm; p<0.05 and fIMT 0.512 ± 0.172 mm vs. 0.394 ± 0.061 mm; p<0.01, for patients and controls, respectively). T1D subjects in the highest tertile of cIMT were older than those in the lowest group (39.9 ± 9.5 vs. 29.6 ± 4.7 years; p<0.005) and had a longer duration of the disease (18.7 ± 5.4 years vs. 11.8 ± 6.4 years). The higher the cIMT tertile, the greater the fIMT (0.397 ± 0.114 mm vs. 0.431 ± 0.082 mm vs. 0.583 ± 0.197 mm; p<0.05). MAGE was negatively correlated to FMD (r=-0.328; p<0.05) and positively to cIMT (r=0.322; p<0.05). There were no differences between cIMT tertiles in terms of metabolic parameters or endothelial and inflammatory markers. Signals of preclinical atherosclerosis in T1D even in the absence of cardiovascular risk factors and micro- / macrovascular disease are reported. Our findings suggest that daily glucose instability could negatively impact vascular function and structure.
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Affiliation(s)
- Marga Giménez
- Endocrinology and Diabetes Unit, Hospital Clínic I Universitari, Bareclona, Spain
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Giménez M, Gilabert R, Monteagudo J, Alonso A, Casamitjana R, Paré C, Conget I. Repeated episodes of hypoglycemia as a potential aggravating factor for preclinical atherosclerosis in subjects with type 1 diabetes. Diabetes Care 2011; 34:198-203. [PMID: 20929996 PMCID: PMC3005490 DOI: 10.2337/dc10-1371] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate through early preclinical atherosclerosis assessment whether repeated episodes of hypoglycemia represent an aggravating factor for macrovascular disease in type 1 diabetes. RESEARCH DESIGN AND METHODS After sample-size calculation, a case-control study of 25 patients with type 1 diabetes and repeated severe/nonsevere hypoglycemia (H-group) compared with 20 age- and sex-matched type 1 diabetes control subjects (C-group) was designed. Assessment of preclinical atherosclerosis consisted of flow-mediated brachial dilatation (FMD) and carotid and femoral intima-media thickness (IMT) studies. To consider hypoglycemia awareness, two different questionnaires and symptomatic response to an acute induction to hypoglycemia were used. Evaluation of the glycemic profile was obtained from continuous glucose monitoring. Endothelial function/inflammation markers were measured in euglycemia/hypoglycemia. A multivariate linear regression analysis was performed to test whether repeated hypoglycemia was independently associated with atherosclerosis. RESULTS H-group subjects displayed hypoglycemia unawareness and presented a higher percentage of continuous glucose values and area under the curve <70 mg/dl compared with the C-group (14.2 ± 8.9 vs. 6.3 ± 7.1%, P < 0.02 and 2.4 ± 1.8 vs. 0.6 ± 1.0 mg/dl/day, P < 0.01). The percentage of maximal FMD was lower in the H-group than in the C-group (6.52 ± 2.92 vs. 8.62 ± 3.13%, P < 0.05). A significantly higher IMT was observed at both carotid and femoral sites in the H-group (carotid 0.53 ± 0.09 vs. 0.47 ± 0.08 mm, P < 0.05 and femoral 0.51 ± 0.17 vs. 0.39 ± 0.09 mm, P < 0.05). Baseline inflammation and endothelial function markers were higher in the H-group (leukocytes 7.0 ± 1.8 vs. 5.6 ± 1.4 × 10³/ml, von Willebrand factor 119 ± 29 vs. 93 ± 26%, fibrinogen 2.82 ± 0.64 vs. 2.29 ± 0.44 g/l, and soluble intercellular adhesion molecule-1 408 ± 224 vs. 296 ± 95 ng/ml; P < 0.05 for all). CONCLUSIONS In addition to the induction of hypoglycemia unawareness and an increased risk for severe hypoglycemia, repeated hypoglycemia could be related to and considered an aggravating factor for preclinical atherosclerosis in type 1 diabetes. The precise mechanisms explaining this association remain to be clarified.
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Affiliation(s)
- Marga Giménez
- Endocrinology and Diabetes Unit, Hospital Clínic, Barcelona, Spain
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Cherney DZI, Scholey JW, Sochett E, Bradley TJ, Reich HN. The acute effect of clamped hyperglycemia on the urinary excretion of inflammatory cytokines/chemokines in uncomplicated type 1 diabetes: a pilot study. Diabetes Care 2011; 34:177-80. [PMID: 20841614 PMCID: PMC3005484 DOI: 10.2337/dc10-1219] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Acute glycemic variability contributes to diabetic complications potentially through induction of inflammation. Our objective was to determine whether acute hyperglycemia affects urinary secretion of inflammatory cytokines/chemokines in humans with uncomplicated type 1 diabetes. RESEARCH DESIGN AND METHODS Blood pressure, renal hemodynamics (inulin and paraaminohippurate clearances), and urine samples were obtained after 6 h of clamped euglycemia (4-6 mmol/l) and hyperglycemia (9-11 mmol/l) on two consecutive days in subjects with type 1 diabetes (n = 25). Forty-two urinary cytokines/chemokines were measured using a Luminex platform. RESULTS Clamped hyperglycemia produced an expected increase in glomerular filtration rate (131 ± 4 to 148 ± 8 ml/min/1.73 m²). Clamped hyperglycemia was associated with significant increases in urinary eotaxin, fibroblast growth factor-2, granulocyte-macrophage colony-stimulating factor, interferon-α 2, interleukin-2 and -12, monocyte chemoattractant protein-3, macrophage-derived chemokine, macrophage inflammatory protein-1α, platelet-derived growth factor, tumor necrosis factor-α, and CD40 ligand (P < 0.05). CONCLUSIONS Acute hyperglycemia results in increased urinary excretion of inflammatory cytokines/chemokines in humans with uncomplicated type 1 diabetes, and this may contribute to kidney injury.
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Affiliation(s)
- David Z I Cherney
- Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
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Ahola AJ, Mäkimattila S, Saraheimo M, Mikkilä V, Forsblom C, Freese R, Groop PH. Many patients with Type 1 diabetes estimate their prandial insulin need inappropriately. J Diabetes 2010; 2:194-202. [PMID: 20923484 DOI: 10.1111/j.1753-0407.2010.00086.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many factors contribute to the need for prandial insulin in Type 1 diabetes. However, patients' success in achieving normal postprandial glucose concentration is understudied. The aim of the present study was to determine how often patients with Type 1 diabetes achieve normal postprandial glucose concentrations and to evaluate factors associated with postprandial hypo- and hyperglycemia. METHODS Data on food intake, physical activity, insulin administration, and blood glucose concentration were collected using a self-administered questionnaire from 331 patients with Type 1 diabetes (43% men; mean age 49 ± 12 years; mean diabetes duration 32 ± 13 years). Of these, 179 provided data on blood glucose concentrations measured 110-150 min postprandially. One such meal per patient was randomized for analyses. RESULTS Hypoglycemia (< 4.0 mmol/L), normoglycemia (4.0-7.9 mmol/L), and hyperglycemia (≥ 8.0 mmol/L) were observed after 23%, 36%, and 41% of meals, respectively. The three postprandial glycemia groups did not differ with respect to the meal composition or the timing of the postprandial blood glucose measurement. In women, postprandial hyperglycemia was associated with shorter diabetes duration and higher preprandial blood glucose concentration, whereas postprandial hypoglycemia was associated with higher physical activity. No single factor explained the postprandial glycemic state in men. CONCLUSIONS A total of 64% of patients estimated their prandial insulin need inappropriately, suggesting that estimation of the optimal prandial insulin dose is not easy, even after a long duration of diabetes.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
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Chatzigeorgiou A, Harokopos V, Mylona-Karagianni C, Tsouvalas E, Aidinis V, Kamper EF. The pattern of inflammatory/anti-inflammatory cytokines and chemokines in type 1 diabetic patients over time. Ann Med 2010; 42:426-38. [PMID: 20568978 DOI: 10.3109/07853890.2010.495951] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the profile of pro- and anti-inflammatory cytokines in type 1 diabetes mellitus (T1DM) and the way they are connected in co-regulated networks and determine whether disease duration influences their pattern. METHODS Plasma levels of 20 cytokines and soluble CD40 (sCD40) from 44 uncomplicated patients and 22 healthy controls (HCs) were measured using enzyme-linked immunosorbent assay (ELISA) and protein array technology. RESULTS Patients showed significantly higher levels of sCD40, IL-1a, IL-2, IL-4, IL-5, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage inflammatory protein (MIP)-1a, MIP-1b, regulated on activation normal T cell expressed and secreted (RANTES), matrix metalloproteinase (MMP)-9, and a trend to higher IL-6 than did HCs. RANTES and sCD40 discriminated significantly between diabetics and HCs. In patients with disease duration >6 months, cytokines were organized in two clusters mainly regulated by Th17 and Th1/Th2 cells respectively, while in those with disease duration <or=6 months a set of Th1-cytokines was separated apart from the second cluster. Monocyte chemotactic protein (MCP)-1 was revealed as the most discriminant factor between patients with disease duration of more than and less than 6 months. CONCLUSIONS A parallel elevation of both inflammatory and anti-inflammatory cytokines was observed in patients compared with HCs. In T1DM patients with disease duration <or=6 months, Th1-cytokines were organized on a separate cluster, suggesting a possible role of Th1 cells in the progress of beta-cell destruction during the first period of the disease.
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Affiliation(s)
- Antonios Chatzigeorgiou
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, GR-11527, Athens, Greece
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Ceriello A, Esposito K, Ihnat M, Thorpe J, Giugliano D. Effect of acute hyperglycaemia, long-term glycaemic control and insulin on endothelial dysfunction and inflammation in Type 1 diabetic patients with different characteristics. Diabet Med 2010; 27:911-7. [PMID: 20653749 DOI: 10.1111/j.1464-5491.2009.02928.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the possibility of reversing endothelial dysfunction and inflammation by glucose normalization, antioxidants and insulin per se, in different subgroups of Type 1 diabetic patients. METHODS Three subgroups of Type 1 diabetic patients were studied: patients within 1 month of diagnosis (subgroup 1); patients with approximately 5 years' disease duration and with glycated haemoglobin (HbA(1c)) <or= 7.0% (subgroup 2) or > 7.0% since diagnosis (subgroup 3). Participants underwent four procedures: 2-h hyperglycaemic clamp followed by: (A) 12 h near-normalization of blood glucose, with the addition of vitamin C during the last 6 h; (B) 12-h vitamin C and near-normalization of blood glucose for the last 6 h; (C) both vitamin C and near-normalization of blood glucose for 12 h; (D) hyperglycaemic-hyperinsulinaemic clamp for 12 h, with the addition of vitamin C during the last 6 h. RESULTS After 2 h of hyperglycaemia, markers of endothelial dysfunction, nitrotyrosine, 8-iso prostaglandin F2alpha, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, interleukin (IL)-6 and IL-18 were increased in all the subgroups. Levels were normalized, at all time points, by treatments A, B and C in the subgroups 1 and 2. In the third subgroup, levels were normalized only by the simultaneous normalization of blood glucose and vitamin C treatment. During treatment D, the levels were improved at 6 h in all the subgroups, but normalized at 12 h only after vitamin C in subgroups 1 and 2, but not in subgroup 3. CONCLUSIONS This study suggests that different subgroups of Type 1 diabetic patients react identically to acute hyperglycaemia and insulin, but differently to glucose normalization.
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Affiliation(s)
- A Ceriello
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Comelli F, Bettoni I, Colombo A, Fumagalli P, Giagnoni G, Costa B. Rimonabant, a cannabinoid CB1 receptor antagonist, attenuates mechanical allodynia and counteracts oxidative stress and nerve growth factor deficit in diabetic mice. Eur J Pharmacol 2010; 637:62-9. [DOI: 10.1016/j.ejphar.2010.03.061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 03/09/2010] [Accepted: 03/31/2010] [Indexed: 12/31/2022]
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Baitaluk M, Ponomarenko J. Semantic integration of data on transcriptional regulation. ACTA ACUST UNITED AC 2010; 26:1651-61. [PMID: 20427517 DOI: 10.1093/bioinformatics/btq231] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
MOTIVATION Experimental and predicted data concerning gene transcriptional regulation are distributed among many heterogeneous sources. However, there are no resources to integrate these data automatically or to provide a 'one-stop shop' experience for users seeking information essential for deciphering and modeling gene regulatory networks. RESULTS IntegromeDB, a semantic graph-based 'deep-web' data integration system that automatically captures, integrates and manages publicly available data concerning transcriptional regulation, as well as other relevant biological information, is proposed in this article. The problems associated with data integration are addressed by ontology-driven data mapping, multiple data annotation and heterogeneous data querying, also enabling integration of the user's data. IntegromeDB integrates over 100 experimental and computational data sources relating to genomics, transcriptomics, genetics, and functional and interaction data concerning gene transcriptional regulation in eukaryotes and prokaryotes. AVAILABILITY IntegromeDB is accessible through the integrated research environment BiologicalNetworks at http://www.BiologicalNetworks.org CONTACT baitaluk@sdsc.edu SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Michael Baitaluk
- San Diego Supercomputer Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Rosa JS, Flores RL, Oliver SR, Pontello AM, Zaldivar FP, Galassetti PR. Resting and exercise-induced IL-6 levels in children with Type 1 diabetes reflect hyperglycemic profiles during the previous 3 days. J Appl Physiol (1985) 2009; 108:334-42. [PMID: 20007854 DOI: 10.1152/japplphysiol.01083.2009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Poor glycemic control in Type 1 diabetes (T1DM) causes long-term cardiovascular complications, at least in part via chronic, low-grade inflammation associated with recurrent hyperglycemia. While physical activity can reduce both inflammation and cardiovascular risks, the underlying molecular mechanisms remain unclear. This is particularly important for T1DM children, for whom the prevention of long-term cardiovascular complications must include optimization of exercise-related anti-inflammatory strategies. We therefore studied the effect of prior hyperglycemia on resting and exercise-induced inflammatory status (plasma IL-6) in T1DM children. Glycemia was continuously recorded with a continuous glucose monitoring system (CGMS) system for 63 h preceding a 30-min intermittent cycling exercise protocol at approximately 80% peak rate of oxygen uptake (VO2max). Euglycemia (4.4-6.1 mM) was maintained for 90 min before, during, and 30 min after exercise. IL-6 plasma concentration (pg/ml) was measured at baseline, at end exercise, and 30 min postexercise. Subjects were then divided into quartiles based on average glycemia during the CGMS recording. IL-6 levels (pg/ml) were lowest in the quartile with lowest average 3-day glycemia and increased proportionally to greater hyperglycemic exposure; this was observed at baseline (0.86 +/- 0.10, 1.06 +/- 0.16, 1.14 +/- 0.14, 1.20 +/- 0.16), absolute IL-6 change (Delta) at end exercise (0.20 +/- 0.16, 0.32 +/- 0.10, 0.48 +/- 0.09, 0.62 +/- 0.13), and Delta at 30 min postexercise (0.49 +/- 0.13, 0.71 +/- 0.16, 0.89 +/- 0.14, 1.38 +/- 0.33). Therefore, poorly controlled glycemic profile, even in the 63 h preceding an exercise challenge, can alter inflammatory adaptation in T1DM children. Our data underscore the necessity to fully understand all molecular aspects of physical activity to provide the scientific rationale for exercise regimens that will be able to maximize health benefits for T1DM children.
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Affiliation(s)
- Jaime S Rosa
- Department of Pharmacology, School of Medicine, University of California, Irvine, Irvine, USA.
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