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Katte JC, McDonald TJ, Sobngwi E, Jones AG. The phenotype of type 1 diabetes in sub-Saharan Africa. Front Public Health 2023; 11:1014626. [PMID: 36778553 PMCID: PMC9912986 DOI: 10.3389/fpubh.2023.1014626] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
The phenotype of type 1 diabetes in Africa, especially sub-Saharan Africa, is poorly understood. Most previously conducted studies have suggested that type 1 diabetes may have a different phenotype from the classical form of the disease described in western literature. Making an accurate diagnosis of type 1 diabetes in Africa is challenging, given the predominance of atypical diabetes forms and limited resources. The peak age of onset of type 1 diabetes in sub-Saharan Africa seems to occur after 18-20 years. Multiple studies have reported lower rates of islet autoantibodies ranging from 20 to 60% amongst people with type 1 diabetes in African populations, lower than that reported in other populations. Some studies have reported much higher levels of retained endogenous insulin secretion than in type 1 diabetes elsewhere, with lower rates of type 1 diabetes genetic susceptibility and HLA haplotypes. The HLA DR3 appears to be the most predominant HLA haplotype amongst people with type 1 diabetes in sub-Saharan Africa than the HLA DR4 haplotype. Some type 1 diabetes studies in sub-Saharan Africa have been limited by small sample sizes and diverse methods employed. Robust studies close to diabetes onset are sparse. Large prospective studies with well-standardized methodologies in people at or close to diabetes diagnosis in different population groups will be paramount to provide further insight into the phenotype of type 1 diabetes in sub-Saharan Africa.
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Affiliation(s)
- Jean Claude Katte
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaoundé, Cameroon,*Correspondence: Jean Claude Katte ✉
| | - Timothy J. McDonald
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,Academic Department of Clinical Biochemistry, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Eugene Sobngwi
- National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaoundé, Cameroon,Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Angus G. Jones
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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2
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Jagannathan R, Stefanovski D, Smiley DD, Oladejo O, Cotten LF, Umpierrez G, Vellanki P. 1-h Glucose During Oral Glucose Tolerance Test Predicts Hyperglycemia Relapse-Free Survival in Obese Black Patients With Hyperglycemic Crises. Front Endocrinol (Lausanne) 2022; 13:871965. [PMID: 35721763 PMCID: PMC9202609 DOI: 10.3389/fendo.2022.871965] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/08/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Approximately 50% of obese Black patients with unprovoked diabetic ketoacidosis (DKA) or severe hyperglycemia (SH) at new-onset diabetes achieve near-normoglycemia remission with intensive insulin treatment. Despite the initial near-normoglycemia remission, most DKA/SH individuals develop hyperglycemia relapse after insulin discontinuation. Traditional biomarkers such as normal glucose tolerance at the time of remission were not predictive of hyperglycemia relapse. We tested whether 1-h plasma glucose (1-h PG) at remission predicts hyperglycemia relapse in Black patients with DKA/SH. METHODS Secondary analysis was performed of two prospective randomized controlled trials in 73 patients with DKA/SH at the safety net hospital with a median follow-up of 408 days. Patients with DKA/SH underwent a 5-point, 2-h 75-g oral glucose tolerance test after hyperglycemia remission. Hyperglycemia relapse is defined by fasting blood glucose (FBG) > 130 mg/dl, random blood glucose (BG) >180 mg/dl, or HbA1c > 7%. RESULTS During the median 408 (interquartile range: 110-602) days of follow-up, hyperglycemia relapse occurred in 28 (38.4%) participants. One-hour PG value ≥199 mg/dl discriminates hyperglycemia relapse (sensitivity: 64%; specificity: 71%). Elevated levels of 1-h PG (≥199 mg/dl) were independently associated with hyperglycemia relapse (adjusted hazard ratio: 2.40 [95% CI: 1.04, 5.56]). In a multivariable model with FBG, adding 1-h PG level enhanced the prediction of hyperglycemia relapse, with significant improvements in C-index (Δ: +0.05; p = 0.04), net reclassification improvement (NRI: 48.7%; p = 0.04), and integrated discrimination improvement (IDI: 7.8%; p = 0.02) as compared with the addition of 2-h PG (NRI: 20.2%; p = 0.42; IDI: 1.32%; p = 0.41) or HbA1c (NRI: 35.2%; p = 0.143; IDI: 5.8%; p = 0.04). CONCLUSION One-hour PG at the time of remission is a better predictor of hyperglycemia relapse than traditional glycemic markers among obese Black patients presenting with DKA/SH. Testing 1-h PG at insulin discontinuation identifies individuals at high risk of developing hyperglycemia relapse.
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Affiliation(s)
- Ram Jagannathan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta GA, United States
| | - Darko Stefanovski
- Department of Biostatistics, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Dawn D. Smiley
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, United States
| | - Omolade Oladejo
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, United States
| | - Lucia F. Cotten
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, United States
| | - Guillermo Umpierrez
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, United States
| | - Priyathama Vellanki
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Priyathama Vellanki,
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Riveline JP, Baz B, Nguewa JL, Vidal-Trecan T, Ibrahim F, Boudou P, Vicaut E, Brac de la Perrière A, Fetita S, Bréant B, Blondeau B, Tardy-Guidollet V, Morel Y, Gautier JF. Exposure to Glucocorticoids in the First Part of Fetal Life is Associated with Insulin Secretory Defect in Adult Humans. J Clin Endocrinol Metab 2020; 105:5609147. [PMID: 31665349 DOI: 10.1210/clinem/dgz145] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/25/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE High glucocorticoid levels in rodents inhibit development of beta cells during fetal life and lead to insulin deficiency in adulthood. To test whether similar phenomena occur in humans, we compared beta-cell function in adults who were exposed to glucocorticoids during the first part of fetal life with that of nonexposed subjects. RESEARCH DESIGN AND METHODS The study was conducted in 16 adult participants exposed to glucocorticoids during the first part of fetal life and in 16 nonexposed healthy participants with normal glucose tolerance who were matched for age, sex, and body mass index (BMI). Exposed participants had been born to mothers who were treated with dexamethasone 1 to 1.5 mg/day from the sixth gestational week (GW) to prevent genital virilization in children at risk of 21-hydroxylase deficiency. We selected offspring of mothers who stopped dexamethasone before the 18th GW following negative genotyping of the fetus. Insulin and glucagon secretion were measured during an oral glucose tolerance test (OGTT) and graded intravenous (IV) glucose and arginine tests. Insulin sensitivity was measured by hyperinsulinemic-euglycemic-clamp. RESULTS Age, BMI, and anthropometric characteristics were similar in the 2 groups. Insulinogenic index during OGTT and insulin sensitivity during the clamp were similar in the 2 groups. In exposed subjects, insulin secretion during graded IV glucose infusion and after arginine administration decreased by 17% (P = 0.02) and 22% (P = 0.002), respectively, while glucagon secretion after arginine increased. CONCLUSION Overexposure to glucocorticoids during the first part of fetal life is associated with lower insulin secretion at adult age, which may lead to abnormal glucose tolerance later in life.
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Affiliation(s)
- Jean-Pierre Riveline
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
- Paris Diderot- Paris VII University, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Baz Baz
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
| | - Jean-Louis Nguewa
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
| | - Tiphaine Vidal-Trecan
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
| | - Fidaa Ibrahim
- Unit of Hormonal Biology, Department of Biochemistry, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Philippe Boudou
- Unit of Hormonal Biology, Department of Biochemistry, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Eric Vicaut
- Assistance Publique-Hôpitaux de Paris, Clinical Research Unit, Fernand Widal Hospital, Sorbonne Paris Cité, Paris Diderot University, Paris, France
| | - Aude Brac de la Perrière
- Fédération d'endocrinologie Hopital Louis Pradel Groupement Hospitalier Est 28 av Doyen Lepine BRON
| | - Sabrina Fetita
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
| | - Bernadette Bréant
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Bertrand Blondeau
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Véronique Tardy-Guidollet
- Department of Biochemistry and Molecular Biology, Groupement Hospitalier Est 59 Boulevard Pinel Bron, France
| | - Yves Morel
- Department of Biochemistry and Molecular Biology, Groupement Hospitalier Est 59 Boulevard Pinel Bron, France
| | - Jean-François Gautier
- Department of Diabetes and Endocrinology, Lariboisière Hospital, APHP, Paris, France
- Paris Diderot- Paris VII University, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
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4
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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
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Gautier JF, Fetita LS, Riveline JP, Ibrahim F, Porcher R, Abi Khalil C, Velho G, Choukem SP, Hadjadj S, Larger E, Roussel R, Boudou P, Marre M, Ravussin E, Mauvais-Jarvis F. Sex Difference In the Effect of Fetal Exposure to Maternal Diabetes on Insulin Secretion. J Endocr Soc 2018; 2:391-397. [PMID: 29687090 PMCID: PMC5905383 DOI: 10.1210/js.2017-00482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/19/2018] [Indexed: 01/26/2023] Open
Abstract
We previously showed that fetal exposure to maternal type 1 diabetes (T1D) is associated with altered glucose-stimulated insulin secretion in adult offspring. Here, we investigated whether this β-cell defect displays a sex dimorphism. Twenty-nine adult nondiabetic offspring of T1D mothers (ODMs) were compared with 29 nondiabetic offspring of T1D fathers. We measured early insulin secretion in response to oral glucose and insulin secretion rate in response to intravenous glucose ramping. Insulin sensitivity and body composition were assessed by a euglycemic, hyperinsulinemic clamp and dual-energy X-ray absorptiometry, respectively. In response to oral glucose, male and female ODMs displayed a reduced insulin secretion. In contrast, in response to graded intravenous glucose infusion, only female ODMs (not males) exhibited decreased insulin secretion. There was no defect in response to combined intravenous arginine and glucose, suggesting that male and female ODMs exhibit a functional β-cell defect rather than a reduced β-cell mass. In conclusion, fetal exposure to maternal diabetes predisposes to β-cell dysfunction in adult male and female offspring. This β-cell defect is characterized by a sexual dimorphism following intravenous glucose stimulation.
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Affiliation(s)
- Jean-François Gautier
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FIRE, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
- Clinical Investigation Center, INSERM-CIC9504, Saint-Louis University Hospital, AP-HP, University Paris-Diderot Paris-7, Paris, France
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
| | - Lila Sabrina Fetita
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FIRE, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
| | - Jean-Pierre Riveline
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FIRE, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
| | - Fidaa Ibrahim
- Unit of Hormonology, Department of Biochemistry, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Raphaël Porcher
- Department of Biostatistics and Medical Computing, Saint-Louis University Hospital, AP-HP, University Paris-Diderot Paris-7, Paris, France
| | - Charbel Abi Khalil
- Department of Diabetes, Groupe Hospitalier Bichat - Claude Bernard, AP-HP, DHU FIRE, University Paris-Diderot Paris-7, Paris, France
| | - Gilberto Velho
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
| | - Simeon-Pierre Choukem
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FIRE, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
| | - Samy Hadjadj
- CHU Poitiers, Department of Endocrinology and Diabetes, Poitiers, France
- INSERM CIC 1402, Poitiers, France
| | - Etienne Larger
- Department of Diabetes, Cochin Hospital, AP-HP, Paris, France
| | - Ronan Roussel
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Clinical Investigation Center, Groupe Hospitalier Bichat - Claude Bernard, AP-HP, University Paris-Diderot Paris-7, Paris, France
| | - Philippe Boudou
- Unit of Hormonology, Department of Biochemistry, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Michel Marre
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Department of Diabetes, Groupe Hospitalier Bichat - Claude Bernard, AP-HP, DHU FIRE, University Paris-Diderot Paris-7, Paris, France
- CHU Poitiers, Department of Endocrinology and Diabetes, Poitiers, France
| | - Eric Ravussin
- Penington Biomedical Research Center, Baton Rouge, Louisiana
| | - Franck Mauvais-Jarvis
- Section of Endocrinology, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
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6
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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
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7
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Vellanki P, Smiley DD, Stefanovski D, Anzola I, Duan W, Hudson M, Peng L, Pasquel FJ, Umpierrez GE. Randomized Controlled Study of Metformin and Sitagliptin on Long-term Normoglycemia Remission in African American Patients With Hyperglycemic Crises. Diabetes Care 2016; 39:1948-1955. [PMID: 27573938 PMCID: PMC5079604 DOI: 10.2337/dc16-0406] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/09/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE After intensive insulin treatment, many obese African American patients with new-onset diabetic ketoacidosis (DKA) and severe hyperglycemia are able to achieve near-normoglycemia remission. The optimal treatment to prevent hyperglycemic relapses after remission is not known. RESEARCH DESIGN AND METHODS This prospective, 4-year, placebo-controlled study randomly assigned 48 African American subjects with DKA and severe hyperglycemia to metformin 1,000 mg daily (n = 17), sitagliptin 100 mg daily (n = 16), or placebo (n = 15) after normoglycemia remission. Hyperglycemic relapse was defined as fasting glucose >130 mg/dL (7.2 mmol/L) and HbA1c >7.0% (53 mmol/mol). Oral glucose tolerance tests were conducted at randomization and at 3 months and then every 6 months for a median of 331 days. Oral minimal model and incremental area under the curve for insulin (AUCi) were used to calculate insulin sensitivity (Si) and β-cell function, respectively. Disposition index (DI) was calculated as a product of Si and incremental AUCi. RESULTS Relapse-free survival was higher in sitagliptin and metformin (P = 0.015) compared with placebo, and mean time to relapse was significantly prolonged in the metformin and sitagliptin groups compared with the placebo group (480 vs. 305 days, P = 0.004). The probability of relapse was significantly lower for metformin (hazard ratio 0.28 [95% CI 0.10-0.81]) and sitagliptin (0.31 [0.10-0.98]) than for placebo. Subjects who remained in remission had a higher DI (P = 0.02) and incremental AUCi (P < 0.001) than those with hyperglycemia relapse without significant changes in Si. CONCLUSIONS This study shows that near-normoglycemia remission was similarly prolonged by treatment with sitagliptin and metformin. The prolongation of remission was due to improvement in β-cell function.
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Affiliation(s)
- Priyathama Vellanki
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Dawn D Smiley
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Darko Stefanovski
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Isabel Anzola
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Wenlan Duan
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Megan Hudson
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Francisco J Pasquel
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Guillermo E Umpierrez
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
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8
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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.
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9
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San José P, Guerrero M, García-Martín I, Caballero J, Pérez-Maraver M. Impact and characteristics of the non-Caucasian population in hospital admissions for diabetes onset during 2003-2010. ACTA ACUST UNITED AC 2016; 63:285-90. [PMID: 27055747 DOI: 10.1016/j.endonu.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 11/17/2022]
Abstract
AIMS To assess the prevalence of non-Caucasian patients in hospital admissions for onset of symptomatic diabetes mellitus during the 2003-2010 period, and to analyze the characteristics differentiating them from the Caucasian population at diagnosis and 2 years later. MATERIAL AND METHODS A retrospective, observational study. INCLUSION CRITERIA Patients aged 18-40 years admitted for de novo symptomatic diabetes from January 2003 to October 2010. Prevalence of patients of non-Caucasian origin was analyzed, and clinical, biochemical, immunological, and beta-cell function of both populations were compared at diagnosis and 2 years later. RESULTS Nineteen percent of patients admitted to hospital for de novo symptomatic diabetes were non-Caucasian, with a progressive increase in recent years. Non-Caucasian patients had milder decompensation (3.0% had ketoacidosis, as compared to 15.2% in the Caucasian group, P<.05), lower presence of autoimmunity (27.2 vs. 73.1%, P<.01) and higher stimulated C-peptide levels (0.70±0.56 vs. 0.42±0.39 nmol/l, P<.05), mainly because of the subgroup with negative autoimmunity (0.82 vs. 0.25). Two years after diagnosis, less non-Caucasian patients were on intensified treatment (39.1 vs. 93.8%). CONCLUSIONS Non-Caucasian patients had a lower prevalence of autoimmunity, better beta-cell function at diagnosis, particularly due to the subgroup with negative autoimmunity, and less need for intensive treatment 2 years after diagnosis, features which are more characteristic of type 2 diabetes mellitus.
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Affiliation(s)
- Patricia San José
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), España.
| | - Mireia Guerrero
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), España
| | - Isabel García-Martín
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), España
| | - Jordi Caballero
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), España
| | - Manuel Pérez-Maraver
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), España
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10
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Gosmanov AR, Gosmanov NR. Advancing clinical care for the patients with ketosis-prone diabetes: from knowledge to action. J Diabetes Complications 2015. [PMID: 26210987 DOI: 10.1016/j.jdiacomp.2015.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Aidar R Gosmanov
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN.
| | - Niyaz R Gosmanov
- Section of Endocrinology and Diabetes, University of Oklahoma Health Science Center, Oklahoma City, OK
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Hyperglycaemia per se does not affect erythrocyte glucose-6-phosphate dehydrogenase activity in ketosis-prone diabetes. DIABETES & METABOLISM 2015; 41:326-330. [PMID: 26337344 DOI: 10.1016/j.diabet.2014.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/06/2014] [Accepted: 07/15/2014] [Indexed: 11/23/2022]
Abstract
AIM Previously, we described patients with ketosis-prone type 2 diabetes (KPD) and glucose-6-phosphate dehydrogenase (G6PD) deficiency, but no mutation of the G6PD gene. Our present study used two complementary approaches to test whether hyperglycaemia might inhibit G6PD activity: (1) effect of acute hyperglycaemia induced by glucose ramping; and (2) effect of chronic hyperglycaemia using correlation between G6PD activity and HbA1c levels. METHODS In the first substudy, 16 KPD patients were compared with 11 healthy, non-diabetic control subjects of the same geographical background. Erythrocyte G6PD activity and plasma glucose were assessed at baseline and every 40 min during intravenous glucose ramping that allowed maintaining hyperglycaemia for more than 3h. In the second substudy, erythrocyte G6PD activity and HbA1c levels were evaluated in 108 consecutive African patients with either type 2 diabetes or KPD, and a potential correlation sought between the two variables. RESULTS The maximum plasma glucose level after 200 min of glucose perfusion was 20.9±3.7 mmol/L for patients and 10.7±2.3mmol/L for controls. There was no difference between baseline and repeated G6PD activity levels during acute hyperglycaemia in either KPD patients (P=0.94) or controls (P=0.57), nor was there any significant correlation between residual erythrocyte G6PD activity and HbA1c levels (r=-0.085, P=0.38). CONCLUSION Neither acute nor chronic hyperglycaemia affects erythrocyte G6PD activity. Thus, hyperglycaemia alone does not explain cases of G6PD deficiency in the absence of gene mutation as described earlier.
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Gaillard TR, Osei K. Racial Disparities in the Pathogenesis of Type 2 Diabetes and its Subtypes in the African Diaspora: A New Paradigm. J Racial Ethn Health Disparities 2015; 3:117-28. [PMID: 26896111 DOI: 10.1007/s40615-015-0121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 01/23/2023]
Abstract
The global epidemic of diabetes has extended to the developing countries including Sub-Sahara Africa. In this context, blacks with type 2 diabetes in the African Diaspora continue to manifest 1.5-2 times higher prevalent rates than in their white counterparts. Previous studies have demonstrated that blacks with and without type 2 diabetes have alterations in hepatic and peripheral insulin sensitivity, beta-cell function, and hepatic insulin clearance as well as hepatic glucose dysregulation when compared to whites. In addition, non-diabetic blacks in the African Diaspora manifest multiple metabolic mediators that predict type 2 diabetes and its subtypes. These pathogenic modifiers include differences in subclinical inflammation, oxidative stress burden, and adipocytokines in blacks in the African Diaspora prior to clinical diagnosis. Consequently, blacks in the African Diaspora manifest subtypes of type 2 diabetes, including ketosis-prone diabetes and J type diabetes. Given the diversity of type 2 diabetes in blacks in the African Diaspora, we hypothesize that blacks manifest multiple early pathogenic defects prior to the diagnosis of type 2 diabetes and its subtypes. These metabolic alterations have strong genetic component, which appears to play pivotal and primary role in the pathogenesis of type 2 diabetes and its subtypes in blacks in the African Diaspora. However, environmental factors must also be considered as major contributors to the higher prevalence of type 2 diabetes and its subtypes in blacks in the African Diaspora. These multiple alterations should be targets for early prevention of type 2 diabetes in blacks in the African Diaspora.
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Affiliation(s)
- Trudy R Gaillard
- Division of Endocrinology Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 561 McCampbell Hall, South, 1581 Dodd Drive, Columbus, OH, 43210, USA.
| | - Kwame Osei
- The Ohio State University Wexner Medical Center, 561 McCampbell Hall, 5th Floor South, 1581 Dodd Hall, Columbus, OH, 43210, USA.
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Lu H, Hu F, Zeng Y, Zou L, Luo S, Sun Y, Liu H, Sun L. Ketosis onset type 2 diabetes had better islet β-cell function and more serious insulin resistance. J Diabetes Res 2014; 2014:510643. [PMID: 24829925 PMCID: PMC4009153 DOI: 10.1155/2014/510643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/13/2014] [Accepted: 03/16/2014] [Indexed: 12/16/2022] Open
Abstract
Diabetic ketosis had been identified as a characteristic of type 1 diabetes mellitus (T1DM), but now emerging evidence has identified that they were diagnosed as T2DM after long time follow up. This case control study was aimed at comparing the clinical characteristic, β-cell function, and insulin resistance of ketosis and nonketotic onset T2DM and providing evidence for treatment selection. 140 cases of newly diagnosed T2DM patients were divided into ketosis (62 cases) and nonketotic onset group (78 cases). After correction of hyperglycemia and ketosis with insulin therapy, plasma C-peptide concentrations were measured at 0, 0.5, 1, 2, and 3 hours after 75 g glucose oral administration. Area under the curve (AUC) of C-peptide was calculated. Homoeostasis model assessment was used to estimate basal β-cell function (HOMA-β) and insulin resistance (HOMA-IR). Our results showed that ketosis onset group had higher prevalence of nonalcoholic fatty liver disease (NAFLD) than nonketotic group (P = 0.04). Ketosis onset group had increased plasma C-peptide levels at 0 h, 0.5 h, and 3 h and higher AUC(0-0.5), AUC₀₋₁, AUC₀₋₃ (P < 0.05). Moreover, this group also had higher HOMA-β and HOMA-IR than nonketotic group (P < 0.05). From these data, we concluded that ketosis onset T2DM had better islet β-cell function and more serious insulin resistance than nonketotic onset T2DM.
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Affiliation(s)
- Hongyun Lu
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Fang Hu
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Yingjuan Zeng
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Lingling Zou
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Shunkui Luo
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Ying Sun
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hong Liu
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Liao Sun
- Department of Endocrinology & Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
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14
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Affiliation(s)
- Pierre Lefèbvre
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, University of Liège, Liège, Belgium.
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15
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Liu B, Yu C, Li Q, Li L. Ketosis-onset diabetes and ketosis-prone diabetes: same or not? Int J Endocrinol 2013; 2013:821403. [PMID: 23710177 PMCID: PMC3655588 DOI: 10.1155/2013/821403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 11/17/2022] Open
Abstract
Objective. To compare clinical characteristics, immunological markers, and β -cell functions of 4 subgroups ("A β " classification system) of ketosis-onset diabetes and ketosis prone diabetes patients without known diabetes, presenting with ketosis or diabetic ketoacidosis (DKA) and admitted to our department from March 2011 to December 2011 in China, with 50 healthy persons as control group. Results. β -cell functional reserve was preserved in 63.52% of patients. In almost each subgroup (except A- β - subgroup of ketosis prone group), male patients were more than female ones. The age of the majority of patients in ketosis prone group was older than that of ketosis-onset group, except A- β - subgroup of ketosis prone group. The durations from the patient first time ketosis or DKA onset to admitting to the hospital have significant difference, which were much longer for the ketosis prone group except the A+ β + subgroup. BMI has no significant difference among subgroups. FPG of ketosis prone group was lower than that of A- β + subgroup and A+ β + subgroup in ketosis-onset group. A- β - subgroup and A+ β + subgroup of ketosis prone group have lower HbA1c than ketosis-onset group. Conclusions. Ketosis-onset diabetes and ketosis prone diabetes do not absolutely have the same clinical characteristics. Each subgroup shows different specialty.
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Affiliation(s)
- Beiyan Liu
- Endocrinology and Metabolism Department of the Second Hospital Affiliated to Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province 150086, China
| | - Changhua Yu
- Endocrinology and Metabolism Department of the Second Hospital Affiliated to Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province 150086, China
| | - Qiang Li
- Endocrinology and Metabolism Department of the Second Hospital Affiliated to Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province 150086, China
- *Qiang Li:
| | - Lin Li
- Endocrinology and Metabolism Department of the Second Hospital Affiliated to Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province 150086, China
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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.
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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
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Eubanks A, Raza F, Alkhouli M, Glenn AN, Homko C, Kashem A, Bove A. Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome. Cardiovasc Diabetol 2012; 11:154. [PMID: 23270513 PMCID: PMC3549932 DOI: 10.1186/1475-2840-11-154] [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] [Received: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored. Methods We performed a retrospective analysis of 872 patients admitted to Temple University Hospital from 2004–2009 with DKA or HHS. Patients were included if they had cardiac troponin I (cTnI) measured within 24 hours of hospital admission, had no evidence of acute coronary syndrome and had a follow up period of at least 18 months. Of the 264 patients who met the criteria, we reviewed the baseline patient characteristics, admission labs, EKGs and major adverse cardiovascular events during the follow up period. Patients were categorized into two groups with normal and elevated levels of cardiac enzymes. The composite end point of the study was the occurrence of a major cardiovascular event (MACE) during the follow up period and was compared between the two groups. Results Of 264 patients, 24 patients were found to have elevated cTnI. Compared to patients with normal cardiac enzymes, there was a significant increase in incidence of MACE in patients with elevated cTnI. In a regression analysis, which included prior history of CAD, HTN and ESRD, the only variable that independently predicted MACE was an elevation in cTnI (p = 0.044). Patients with elevated CK-MB had increased lengths of hospitalization compared to the other group (p < 0.001). Conclusions Elevated cardiac troponin I in patients admitted with decompensated diabetes and without evidence of acute coronary syndrome, strongly correlate with a later major cardiovascular event. Thus, elevated troponin I during metabolic abnormalities identify a group of patients at an increased risk for poor long-term outcomes. Whether these patients may benefit from early detection, risk stratification and preventive interventions remains to be investigated.
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Affiliation(s)
- Anthony Eubanks
- Cardiology Section, Temple University School of Medicine, PA, USA
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Wang X, Li YL, Wu H, Liu JZ, Hu JX, Liao N, Peng J, Cao PP, Liang X, Hai CX. Antidiabetic effect of oleanolic acid: a promising use of a traditional pharmacological agent. Phytother Res 2012; 25:1031-40. [PMID: 21254272 DOI: 10.1002/ptr.3385] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia. Although the clear mechanisms of DM and insulin resistance are still to be cleared, it has been well documented that reactive oxygen species (ROS) play a pivotal role in DM and multiple types of insulin resistance. For the past few years, natural substances have been shown to have the potential to treatment DM. Attention has been especially focused on plants rich in triterpenoids, which generally show antioxidant and antiglycation effect. In our previous studies, it was shown that oleanolic acid (OA), a natural triterpenoid and an aglycone of many saponins, is a potent antioxidant acting as not only a free radical-scavenger through direct chemical reactions but also as a biological molecule, which may enhance the antioxidant defenses. The present study aimed to investigate the potential antidiabetic effect of OA. Oleanolic acid showed a significant blood glucose-lowering and weight-losing effect in diabetic animals induced by streptozotocin (STZ). In the insulin resistant model, it was also shown that OA may promote insulin signal transduction and inhibit oxidative stress-induced hepatic insulin resistance and gluconeogenesis, in which process the phosphorylation of ERK and the protective effect on mitochondrial function may be involved. These findings may significantly better the understanding of the pharmacological actions of OA and advance therapeutic approaches to DM.
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Affiliation(s)
- Xin Wang
- Department of Toxicology, Faculty of Preventive Medicine, the Fourth Military Medical University, Xi'an 710032, China
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Gómez-Sámano MÁ, Gulias-Herrero A, Cuevas-Ramos D, Brau-Figueroa H, Mehta R, Vargas-Gutiérrez D, Meza-Arana CE, Nieves-Niebla JM, Vázquez-Hernández MO. Metformin and improvement of the hepatic insulin resistance index independent of anthropometric changes. Endocr Pract 2012; 18:8-16. [PMID: 21742607 DOI: 10.4158/ep11072.or] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the change in the hepatic insulin resistance index (HIRI) after metformin treatment. METHODS In this retrospective cohort study, Mexican mestizo patients with a body mass index (BMI) of 25 kg/m(2) or greater were evaluated. Participants were classified into 2 groups: patients who received metformin and patients who did not. Both groups were followed up for a median of 6 months (range, 4-10 months). The HIRI was calculated at baseline and at follow-up in both groups. We evaluated the independent effect of metformin on HIRI after adjustment for the difference in basal and final values (DELTA) of BMI, waist circumference, glucose, and insulin. RESULTS A total of 71 patients were enrolled (51 [72%] female). Forty-one patients received metformin and 30 patients did not. Mean age was 36.3 ± 12.2 years and mean BMI was 42.2 ± 10.7 kg/m(2). After metformin treatment, HIRI significantly decreased from 38 ± 10.7 to 34.7 ± 9.5 (P = .03). In contrast, the control group had a nonsignificant increase in HIRI (37.6 ± 11.7 to 40.0 ± 14.0, P = .22). Weight significantly decreased in both groups (group 1: 114.6 ± 33.8 kg to 107.6 ± 28.9 kg, P<.01; group 2: 104.8 ± 28.5 kg to 98.9 ± 26.0 kg, P<.01). After BMI adjustment, the total metformin dosage correlated negatively with HIRI (r = -0.36, P = .03). Using a linear regression model (F = 6.0, r2 = 0.37, P = .002) adjusted for DELTA BMI and DELTA waist circumference, the administration of metformin resulted in independent improvement in the HIRI level (standardized β = -0.29, t = -2.0, P = .04). CONCLUSIONS Metformin improves HIRI independently of anthropometric changes. In persons with elevated HIRI levels, metformin may be considered among the treatment options.
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Affiliation(s)
- Miguel Ángel Gómez-Sámano
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
In Sub-Saharan Africa, prevalence and burden of type 2 diabetes are rising quickly. Rapid uncontrolled urbanisation and major changes in lifestyle could be driving this epidemic. The increase presents a substantial public health and socioeconomic burden in the face of scarce resources. Some types of diabetes arise at younger ages in African than in European populations. Ketosis-prone atypical diabetes is mostly recorded in people of African origin, but its epidemiology is not understood fully because data for pathogenesis and subtypes of diabetes in sub-Saharan African communities are scarce. The rate of undiagnosed diabetes is high in most countries of sub-Saharan Africa, and individuals who are unaware they have the disorder are at very high risk of chronic complications. Therefore, the rate of diabetes-related morbidity and mortality in this region could grow substantially. A multisectoral approach to diabetes control and care is vital for expansion of socioculturally appropriate diabetes programmes in sub-Saharan African countries.
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Affiliation(s)
- Jean Claude N Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
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Molitvoslovova, NA, Nikonova TV. Ketosis-prone type 2 diabetes mellitus (review of the literature). DIABETES MELLITUS 2009. [DOI: 10.14341/2072-0351-5456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Idiopathic ketosis-prone type 2 diabetes is intermediate between two major forms of diabetes mellitus. The aim of this review is to analyse factors contributingto its development and occurrence and to discuss approaches to differential diagnosis of this pathology.
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-xii. [PMID: 19405078 DOI: 10.1002/dmrr.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The liver plays a pivotal role in energy metabolism. Under the control of hormones, especially insulin, the liver stores or releases glucose as needed by the body's systems. It is also responsible for an important part of non-esterified fatty-acid and aminoacid metabolism. Assessing hepatic insulin resistance is almost always synonymous with measuring hepatic glucose production (HGP) and calculating indices of hepatic insulin resistance. The most frequently used method to this end is the isotope dilution technique using a tracer. Among tracers, stable isotope-labelled glucose molecules are particularly advantageous over radioactive isotope-labelled glucose and are, therefore, the tracers of choice. The tracer is infused either on its own after an overnight fast to evaluate fasting HGP, or with some among the usual insulin-sensitivity tests to assess HGP suppression by insulin and/or glucose. In a fasting state, HGP is easily calculated whereas, during insulin or glucose infusion, some formula are needed to correct for the non-steady-state condition. The hepatic insulin-resistance index is the product of HGP and the corresponding plasma insulin concentration. Although subject to error, the isotope dilution method nevertheless remains an irreplaceable tool for assessing hepatic insulin resistance in clinical research. From a practical point of view, some easily obtainable indices and clinical or biochemical parameters can serve as surrogates or markers of hepatic insulin resistance in clinical practice. Finally, drugs such as metformin or glitazones can improve hepatic insulin resistance, hence their use in hepatic insulin-resistant states such as type 2 diabetes and non-alcoholic fatty liver disease.
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Affiliation(s)
- S-P Choukem
- Service de Diabétologie et d'Endocrinologie, Hôpital Saint-Louis, Université Paris-Diderot Paris-7, 75475 Paris Cedex 10, France
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