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1.
Phys Rev Lett ; 132(22): 221003, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38877941

RESUMO

The most widely studied formation mechanism of a primordial black hole is collapse of large-amplitude perturbation on small scales generated in single-field inflation. In this Letter, we calculate one-loop correction to the large-scale power spectrum in a model with sharp transition of the second slow-roll parameter. We find that models producing an appreciable amount of primordial black holes induce nonperturbative coupling on a large scale probed by cosmic microwave background radiation. Our result implies that a small-scale power spectrum can be constrained by large-scale cosmological observations.

2.
Phys Rev Lett ; 128(6): 061301, 2022 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-35213181

RESUMO

One-loop correction to the power spectrum in generic single-field inflation is calculated by using standard perturbation theory. Because of the enhancement inversely proportional to the observed red tilt of the spectral index of curvature perturbation, the correction turns out to be much larger than previously anticipated. As a result, the primordial non-Gaussianity must be much smaller than the current observational bound in order to warrant the validity of cosmological perturbation theory.

3.
Rep Prog Phys ; 84(11)2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34874316

RESUMO

We update the constraints on the fraction of the Universe that may have gone into primordial black holes (PBHs) over the mass range 10-5to 1050 g. Those smaller than ∼1015 g would have evaporated by now due to Hawking radiation, so their abundance at formation is constrained by the effects of evaporated particles on big bang nucleosynthesis, the cosmic microwave background (CMB), the Galactic and extragalacticγ-ray and cosmic ray backgrounds and the possible generation of stable Planck mass relics. PBHs larger than ∼1015 g are subject to a variety of constraints associated with gravitational lensing, dynamical effects, influence on large-scale structure, accretion and gravitational waves. We discuss the constraints on both the initial collapse fraction and the current fraction of the dark matter (DM) in PBHs at each mass scale but stress that many of the constraints are associated with observational or theoretical uncertainties. We also consider indirect constraints associated with the amplitude of the primordial density fluctuations, such as second-order tensor perturbations andµ-distortions arising from the effect of acoustic reheating on the CMB, if PBHs are created from the high-σpeaks of nearly Gaussian fluctuations. Finally we discuss how the constraints are modified if the PBHs have an extended mass function, this being relevant if PBHs provide some combination of the DM, the LIGO/Virgo coalescences and the seeds for cosmic structure. Even if PBHs make a small contribution to the DM, they could play an important cosmological role and provide a unique probe of the early Universe.

4.
Proc Jpn Acad Ser B Phys Biol Sci ; 92(8): 336-345, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27725472

RESUMO

We introduce a new analysis method to deal with stationary non-Gaussian noises in gravitational wave detectors in terms of the independent component analysis. First, we consider the simplest case where the detector outputs are linear combinations of the inputs, consisting of signals and various noises, and show that this method may be helpful to increase the signal-to-noise ratio. Next, we take into account the time delay between the inputs and the outputs. Finally, we extend our method to nonlinearly correlated noises and show that our method can identify the coupling coefficients and remove non-Gaussian noises. Although we focus on gravitational wave data analysis, our methods are applicable to the detection of any signals under non-Gaussian noises.


Assuntos
Gravitação , Ruído , Análise de Componente Principal , Dinâmica não Linear , Distribuição Normal
5.
Phys Rev Lett ; 113(6): 061302, 2014 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-25148314

RESUMO

We provide a simple but robust bound on the primordial curvature perturbation in the range 10(4) Mpc(-1)

6.
Proc Jpn Acad Ser B Phys Biol Sci ; 90(10): 422-32, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25504231

RESUMO

After reviewing the standard hypothesis test and the matched filter technique to identify gravitational waves under Gaussian noises, we introduce two methods to deal with non-Gaussian stationary noises. We formulate the likelihood ratio function under weakly non-Gaussian noises through the Edgeworth expansion and strongly non-Gaussian noises in terms of a new method we call Gaussian mapping where the observed marginal distribution and the two-body correlation function are fully taken into account. We then apply these two approaches to Student's t-distribution which has a larger tails than Gaussian. It is shown that while both methods work well in the case the non-Gaussianity is small, only the latter method works well for highly non-Gaussian case.


Assuntos
Gravitação , Modelos Teóricos
7.
Phys Rev Lett ; 110(12): 121302, 2013 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-25166788

RESUMO

It is shown that the tension between recent neutrino oscillation experiments, favoring sterile neutrinos with masses of the order of 1 eV, and cosmological data which impose stringent constraints on neutrino masses from the free streaming suppression of density fluctuations, can be resolved in models of the present accelerated expansion of the Universe based on f(R) gravity.

8.
Sci Rep ; 12(1): 13427, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927458

RESUMO

Bone growth is most remarkable during puberty. This study aimed to clarify the effects of physique and physical strength on bone mineral density and bone metabolism markers during puberty to help improve bone growth during puberty and prevent future osteoporosis. There were 277 pubertal participants (125 boys and 152 girls) in this survey from 2009 to 2015, all aged 10/11 and 14/15 years. The measures included physical fitness/physique indices (such as muscle ratio etc.), grip strength, bone density (osteo sono-assessment index, OSI), and bone metabolism markers (bone-type alkaline phosphatase and type I collagen cross-linked N-telopeptide). At 10/11-years-old for girls, a positive correlation was found between body size/grip strength and OSI. At 14/15-year-old for boys, all body size factors/grip strength were positively correlated with OSI. The change in body muscle ratio was positively correlated with change in OSI for both sexes. The height, body muscle ratio and grip strength at 10/11-year-old were significantly associated with OSI (positively) and bone metabolism markers (negatively) at 14/15-year-old for both sexes. Adequate physique building after 10/11 years for boys and before 10/11 years for girls may be effective in increasing peak bone mass.


Assuntos
Densidade Óssea , Puberdade , Adolescente , Fosfatase Alcalina , Densidade Óssea/fisiologia , Desenvolvimento Ósseo , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Aptidão Física , Puberdade/fisiologia
9.
Phys Rev Lett ; 107(21): 211301, 2011 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-22181868

RESUMO

We completely clarify the feature of primordial non-Gaussianities of tensor perturbations in the most general single-field inflation model with second-order field equations. It is shown that the most general cubic action for the tensor perturbation h(ij) is composed only of two contributions, one with two spacial derivatives and the other with one time derivative on each h(ij). The former is essentially identical to the cubic term that appears in Einstein gravity and predicts a squeezed shape, while the latter newly appears in the presence of the kinetic coupling to the Einstein tensor and predicts an equilateral shape. Thus, only two shapes appear in the graviton bispectrum of the most general single-field inflation model, which could open a new clue to the identification of inflationary gravitational waves in observations of cosmic microwave background anisotropies as well as direct detection experiments.

10.
Phys Rev Lett ; 105(23): 231302, 2010 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-21231448

RESUMO

We propose a new class of inflation model, G inflation, which has a Galileon-like nonlinear derivative interaction of the form G(ϕ,(∇ϕ)(2))□ϕ in the Lagrangian with the resultant equations of motion being of second order. It is shown that (almost) scale-invariant curvature fluctuations can be generated even in the exactly de Sitter background and that the tensor-to-scalar ratio can take a significantly larger value than in the standard inflation models, violating the standard consistency relation. Furthermore, violation of the null energy condition can occur without any instabilities. As a result, the spectral index of tensor modes can be blue, which makes it easier to observe quantum gravitational waves from inflation by the planned gravitational-wave experiments such as LISA and DECIGO as well as by the upcoming CMB experiments such as Planck and CMBpol.

11.
PLoS One ; 15(11): e0242308, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33201904

RESUMO

Pulmonary diseases, including chronic obstructive pulmonary disease (COPD), are major chronic diseases that result in decreased pulmonary function. Relationships between body composition and pulmonary function have been reported. However, few epidemiological studies have used the visceral fat area (VFA) to measure body composition. This study aimed to examine the relationship between body composition and pulmonary function. A cross-sectional study was conducted between 2015 and 2016, using data obtained from 1,287 residents aged between 19 and 91 years living in the Iwaki area of Hirosaki City, a rural region in Aomori Prefecture, Japan. Pulmonary function was evaluated using the forced vital capacity (FVC) as a percentage of the predicted value (predicted FVC%) and the ratio of forced expiratory volume in one second (FEV1) to FVC. The measurements for evaluating body composition included the body fat percentage (BFP) of the whole body and trunk, skeletal muscle index (SMI), body mass index (BMI), VFA, waist circumference (WC) at the navel level, and waist-to-hip ratio (WHR). To adjust for potential confounders, Spearman's partial correlation analysis was used to examine the relationship between the measurements of body composition and pulmonary function. There were significant correlations between the predicted FVC% and the following parameters: BFP (whole body and trunk) in younger males; SMI in older males; WC, VFA, BMI, and SMI in younger females; and BFP (whole body and trunk) and VFA in older females. Contrastingly, WC and VFA in younger males and WC in younger females were correlated with the FEV1/FVC ratio. VFA was correlated with the FEV1/FVC ratio in younger males and predicted FVC% in older females. These findings suggest that visceral fat accumulation may increase the development of obstructive pulmonary disease in young males and accelerate the decline of pulmonary function (predicted FVC%) in older females.


Assuntos
Composição Corporal/fisiologia , Capacidade Vital/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Resistência à Insulina , Interleucina-6/análise , Gordura Intra-Abdominal/fisiologia , Japão , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Circunferência da Cintura , Relação Cintura-Quadril , Adulto Jovem
12.
Nutrients ; 12(11)2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33105547

RESUMO

Little is known about the relationship between polyunsaturated fatty acids (PUFAs) and reactive oxygen species (ROS) in the general population. Therefore this study aimed to describe the association of PUFAs with ROS according to age and sex in the general population and to determine whether PUFA levels are indicators of ROS. This cross-sectional study included 895 participants recruited from a 2015 community health project. Participants were divided into 6 groups based on sex and age (less than 45 years old (young), aged 45-64 years (middle-aged), and 65 years or older (old)) as follows: male, young (n = 136); middle-aged (n = 133); old (n = 82); female, young (n = 159); middle-aged (n = 228); and old (n = 157). The PUFAs measured were arachidonic acid (AA), dihomo gamma linolenic acid (DGLA), AA/DGLA ratio, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ROS considered in the analysis were basal ROS and stimulated ROS levels. Multiple linear analyses showed: (1) significant correlations between PUFA levels, especially DGLA and AA/DGLA ratio, and neutrophil function in the young and middle-aged groups; (2) no significant correlations in old age groups for either sex. Because PUFAs have associated with the ROS production, recommendation for controlled PUFA intake from a young age should be considered.


Assuntos
Ácidos Graxos Insaturados/metabolismo , Neutrófilos/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Ácido 8,11,14-Eicosatrienoico/metabolismo , Adulto , Idoso , Envelhecimento , Ácido Araquidônico/metabolismo , Estudos Transversais , Ácidos Docosa-Hexaenoicos/metabolismo , Ácido Eicosapentaenoico/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Caracteres Sexuais , Adulto Jovem
13.
Clin Chim Acta ; 382(1-2): 59-64, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17482589

RESUMO

BACKGROUND: Glycated albumin (GA) has been utilized to monitor mid-term glycemic control, and reflects the status of blood glucose more rapidly and effectively than hemoglobin A(1c) (HbA(1c)). To examine the relationship between GA level and structural changes or glycation sites of albumin, we analyzed pre- and post-treatment samples from a diabetic patient with extraordinary increase of GA. METHOD: A female diabetic patient with poor glycemic control had a GA >94% and was treated with intensive insulin therapy to decrease blood glucose. We analyzed changes in fluorescence derived from tryptophan (Trp) and advanced glycation end product (AGE) of albumin isolated/purified from pre- and post-treatment samples. To determine the sites of glycation of albumin, samples were carboxymethylated and digested by Glu-C endoprotease, and peptides were analyzed using liquid chromatography/mass spectrometry. RESULTS: GA level decreased almost linearly and reflected the improved glycemic state well. Trp-related fluorescence of pre- and post-treated samples did not change while AGE-related fluorescence increased depending on GA level. Ten major glycation sites were detected in the pre-treatment sample, while 3 major glycation sites were detected in post-treated samples. CONCLUSIONS: GA level reflects the status of blood glucose more rapidly than HbA(1c). Since GA level was related to AGE-related fluorescence and number of glycation sites, it might be a good marker for not only glycemic control of diabetic patients but also structural and functional changes of albumin.


Assuntos
Glicemia/metabolismo , Complicações do Diabetes/sangue , Diabetes Mellitus/sangue , Albumina Sérica/química , Albumina Sérica/metabolismo , Cromatografia Líquida , Complicações do Diabetes/metabolismo , Diabetes Mellitus/metabolismo , Feminino , Fluorometria , Hemoglobinas Glicadas/metabolismo , Produtos Finais de Glicação Avançada , Humanos , Espectrometria de Massas , Pessoa de Meia-Idade , Albumina Sérica/análise , Albumina Sérica Glicada
14.
Ann N Y Acad Sci ; 958: 117-30, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12021091

RESUMO

Slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) is characterized by (1) late age of onset, with initial features of NIDDM and subsequent progression to insulin-dependent stage; (2) high predictive value of autoantibodies against glutamic acid decarboxylase (GADAb) and islet cell antibodies (ICA) for progression of beta cell failure; (3) less predominant T cell response, which may attack and eventually destroy beta-cells in affected pancreas. These findings may suggest a rationale for intervention to prevent slowly progressive beta cell dysfunction in this type of diabetes. We identified three independent risk factors for progression of beta cell failure in SPIDDM: (1) sulfonylurea treatment; (2) ICA-positive periods; and (3) initial body weight. We hypothesized that removal of the risk factors for further progression of beta cell dysfunction will have beneficial effects on intervention strategy in treating SPIDDM. In our pilot study, we used a small dose of insulin instead of sulfonylurea in the early stage of treatment of patients with SPIDDM. Insulin-treated SPIDDM patients had a sustained C peptide response (CPR), while most of sulfonylurea-treated patients progressed to an insulin-dependent state. We organized a randomized multicenter clinical trial to study early treatment to prevent the progression of beta cell dysfunction in SPIDDM (the Tokyo Study). It was demonstrated that early intervention with insulin therapy is an effective treatment modality in the early stage of SPIDDM patients who had preserved beta cell function at entry (integrated value of serum C peptide values at 0, 30, 60, 90, and 120 minutes; Sigma CPR >or= 10 ng/mL) and high GADAb (>10 U/mL). Preventive insulin treatment was ineffective in the patients who had diminished insulin reserve at entry (Sigma CPR < 10 ng/mL). Insulin intervention to preserve beta cell dysfunction in SPIDDM is effective and safe in patients with preserved beta cell function and high GADAb titers at the initiation of insulin.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/patologia , Insulina/farmacologia , Insulina/uso terapêutico , Ilhotas Pancreáticas/efeitos dos fármacos , Idade de Início , Progressão da Doença , Glutamato Descarboxilase/imunologia , Antígenos de Histocompatibilidade Classe I/imunologia , Humanos , Ilhotas Pancreáticas/patologia , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
15.
Ann N Y Acad Sci ; 1005: 362-9, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14679093

RESUMO

In 1996, we designed a randomized multicenter study to assess the effects of small doses of insulin on beta cell failure in slowly progressive type 1 diabetes (the Tokyo Study). We report here the preliminary results of this study. Glutamic acid decarboxylase 65 antibody (GADA)-positive patients were randomly divided into 2 groups: one group received insulin (Ins group), the other a sulfonylurea (SU group). Fifty-four patients (24 Ins group, 30 SU group) were analyzed at the end of a 4-year period. All patients underwent a 75 g oral-glucose test (O-GTT) every 6-12 months. The insulin-dependent stage was defined based on an integrated value of serum C-peptide levels on O-GTT ( summation operator CPR; sum of CPR at 0, 30, 60, 90, and 120 min) below 4.0 ng/mL. The summation operator CPR in the SU group decreased progressively from 22.0 +/- 10.6 to 11.3 +/- 7.5 ng/mL over the 48-month period (p < 0.001 vs. baseline). The summation operator CPR in the Ins group was unchanged. Among the SU group, 30% of subjects (9/30) progressed to IDDM, while 8.3% of Ins group subjects (2/24) progressed to IDDM (p = 0.087). With regard to the subjects who had a preserved C-peptide response ( summation operator CPR >/= 10 ng/mL), the proportion of SU group subjects who progressed to IDDM was significantly higher than that of the Ins group (7/28, 25% vs. 0/21, 0%, p = 0.015). Among subjects with a high GADA titer (>/=0 U/mL), 9/14 (64.3%) of the SU group, but only 2/16 (12.5%) of the Ins group, developed IDDM (p = 0.0068). As to those with a high GADA titer and a preserved C-peptide response, SU group subjects progressed to IDDM (7/12, 58.3%) more frequently than Ins group subjects (0/14, 0%) (p = 0.0012). In summary, our results suggest that small doses of insulin effectively prevent beta cell failure in slowly progressive type 1 diabetes. We recommend avoiding SU treatment and instead administering insulin to NIDDM patients with high GADA titer.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina/administração & dosagem , Autoanticorpos/sangue , Peptídeo C/sangue , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/prevenção & controle , Progressão da Doença , Relação Dose-Resposta a Droga , Teste de Tolerância a Glucose , Glutamato Descarboxilase/imunologia , Humanos , Isoenzimas/imunologia , Estudos Prospectivos
16.
Drug Des Devel Ther ; 8: 799-810, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24970998

RESUMO

Cilnidipine (Cil), which is an L-/N-type calcium channel blocker (CCB), has been known to provide renal protection by decreasing the activity of the sympathetic nervous system (SNS) and the renin-angiotensin system. In this study, we compared the effects of the combination of Cil and amlodipine (Aml), which is an L-type CCB, with an angiotensin (Ang) II receptor blocker on diabetic cardiorenal damage in spontaneously type 2 diabetic rats. Seventeen-week-old Otsuka Long-Evans Tokushima Fatty rats were randomly assigned to receive Cil, Aml, valsartan (Val), Cil + Val, Aml + Val, or a vehicle (eight rats per group) for 22 weeks. Antihypertensive potencies were nearly equal among the CCB monotherapy groups and the combination therapy groups. The lowering of blood pressure by either treatment did not significantly affect the glycemic variables. However, exacerbations of renal and heart failure were significantly suppressed in rats administered Cil or Val, and additional suppression was observed in those administered Cil + Val. Although Val increased the renin-Ang system, Aml + Val treatment resulted in additional increases in these parameters, while Cil + Val did not show such effects. Furthermore, Cil increased the ratio of Ang-(1-7) to Ang-I, despite the fact that Val and Aml + Val decreased the Ang-(1-7) levels. These actions of Cil + Val might be due to their synergistic inhibitory effect on the activity of the SNS, and on aldosterone secretion through N-type calcium channel antagonism and Ang II receptor type 1 antagonism. Thus, Cil may inhibit the progression of cardiorenal disease in type 2 diabetes patients by acting as an N-type CCB and inhibiting the aldosterone secretion and SNS activation when these drugs were administered in combination with an Ang II receptor blocker.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Síndrome Cardiorrenal/tratamento farmacológico , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Animais , Bloqueadores dos Canais de Cálcio/farmacologia , Canais de Cálcio Tipo L/metabolismo , Canais de Cálcio Tipo N/metabolismo , Di-Hidropiridinas , Masculino , Ratos , Ratos Endogâmicos OLETF
17.
Diabetes Technol Ther ; 15(3): 237-40, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23402316

RESUMO

BACKGROUND: In an earlier continuous glucose monitoring (CGM)-based study, we reported that sitagliptin not only reduced 24-h mean glucose levels but also suppressed postprandial glucose increases, thus reducing the range of glycemic fluctuations in type 2 diabetes patients. In this study, we investigated whether sitagliptin might provide similar benefits in type 2 diabetes patients receiving insulin therapy by using CGM. PATIENTS AND METHODS: The study included a total of 13 type 2 diabetes patients in whom stable glycemic control had been achieved after admission for glycemic control. Insulin regimens used included long-acting insulin preparations once daily in four patients and biphasic insulin preparations twice daily in nine, with the daily insulin dose being 19.0±12.7 U. During the CGM-based study, the patients were given insulin therapy alone on Days 1 and 2 and were given sitagliptin 50 mg/day as add-on treatment on Days 3-6, with their daily insulin doses maintained. RESULTS: The add-on treatment with sitagliptin led to significant decreases in 24-h mean glucose levels and SDs of 288 glucose levels measured by CGM for 24 h, as well as in the indices for magnitude of glucose variability and proportion of time in hyperglycemia, compared with insulin therapy alone (P<0.01), whereas there was no significant change seen in regard to the proportion of time in hypoglycemia with or without add-on treatment with sitagliptin. CONCLUSIONS: This CGM-based study clearly demonstrated that insulin therapy alone, whether with long-acting or biphasic insulin preparations, does not provide adequate glycemic control in type 2 diabetes patients. In contrast, add-on sitagliptin was shown to narrow the range of 24-h glucose fluctuations in these patients, suggesting that add-on treatment with sitagliptin is effective for postprandial glucose control in type 2 diabetes patients receiving insulin therapy.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Hemoglobinas Glicadas/metabolismo , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Pirazinas/administração & dosagem , Triazóis/administração & dosagem , Idoso , Povo Asiático , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/farmacologia , Masculino , Projetos Piloto , Período Pós-Prandial , Estudos Prospectivos , Pirazinas/farmacologia , Fosfato de Sitagliptina , Triazóis/farmacologia
18.
Diabetes Technol Ther ; 15(9): 762-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23931715

RESUMO

OBJECTIVE: A low-carbohydrate/high-monounsaturated fatty acid liquid diet (LC/HMD) was investigated for its role in long-term glycemic control in tube-fed type 2 diabetes patients who require insulin therapy. PATIENTS AND METHODS: The study included 10 type 2 diabetes patients requiring insulin therapy who were being tube-fed with a high-carbohydrate liquid diet (HCD). With stable glucose control maintained, these patients were monitored for glucose levels for 4 consecutive days by using continuous glucose monitoring (CGM). The patients were continued on HCD during the first 2 days and were switched to an LC/HMD during the final 2 days. The patients were then continued on the LC/HMD, and seven of the 10 patients were monitored for glucose levels for 2 consecutive days by using CGM after 3 months of feeding with the LC/HMD. Insulin regimens used included basal-bolus insulin in five of these seven patients and intermediate-acting insulin in two patients. RESULTS: Based on CGM data, the indices for glucose variability, such as SDs of 288 glucose levels for 24 h, total area for the range of glucose variability, mean amplitude of glycemic excursions, and 24-h mean glucose levels were significantly decreased 3 months after switching from the HCD to the LC/HMD. Additionally, despite the significant decrease in required insulin dose, the hemoglobin A1c (HbA1c) values were significantly decreased 3 months after switching. CONCLUSIONS: Study results demonstrated that the LC/HMD not only narrowed the range of glucose variability, but also decreased the required insulin dose and HbA1c values in diabetes patients on tube feeding who required insulin therapy, suggesting the LC/HMD may be useful in long-term glycemic control in these patients.


Assuntos
Glicemia/metabolismo , Ritmo Circadiano/efeitos dos fármacos , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dieta com Restrição de Carboidratos , Nutrição Enteral , Ácidos Graxos Monoinsaturados/uso terapêutico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Insulina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Peptídeo C/urina , Transtornos de Deglutição/complicações , Diabetes Mellitus Tipo 2/sangue , Gastrostomia , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade
19.
Diabetes Technol Ther ; 14(5): 423-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22316114

RESUMO

BACKGROUND: We compared the effects of miglitol as an add-on to bolus insulin and dose-intensified bolus insulin on postprandial glycemic excursions by continuous glucose monitoring (CGM). SUBJECTS AND METHODS: The glucose levels of 21 type 2 diabetes patients admitted for glycemic control were monitored for three consecutive days by CGM after stable glycemic control was achieved with bolus or basal-bolus insulin therapy. During the 3-day period, bolus insulin administration was continued in 11 patients on Day 1; the dose of bolus insulin in these patients was increased by 2 U before each meal on day 2, and on day 3, 50 mg of miglitol was administered before each meal in addition to the initial dose of bolus insulin given on Day 1. In the remaining 10 patients, the order of administration on Day 2 and Day 3 was reversed. RESULTS: Of the glycemic fluctuations observed during the 24-h period, postprandial glycemic excursions showed a greater reduction during treatment with dose-intensified bolus insulin and during treatment with miglitol plus bolus insulin than during treatment with bolus insulin alone; however, miglitol plus bolus insulin treatment had a more potent effect than treatment with dose-intensified bolus insulin on reducing postprandial glycemic excursions immediately after meals. Changes in area under the curve (ΔAUC) occurring within 1 h and 2 h after each meal were significantly smaller during treatment with miglitol plus bolus insulin than during treatment with dose-intensified bolus insulin, whereas ΔAUC within >2 h after each meal, except dinner, was significantly greater during treatment with miglitol plus bolus insulin than during treatment with dose-intensified bolus insulin. CONCLUSION: Our findings suggest that miglitol as an add-on to bolus insulin in patients with type 2 diabetes may be one of the beneficial therapeutic options that provides a more rigorous postprandial glycemic control without increasing the risk for hypoglycemia before the next meal.


Assuntos
1-Desoxinojirimicina/análogos & derivados , Automonitorização da Glicemia , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Período Pós-Prandial , 1-Desoxinojirimicina/administração & dosagem , Adulto , Idoso , Área Sob a Curva , Glicemia/metabolismo , Automonitorização da Glicemia/métodos , Estudos Cross-Over , Diabetes Mellitus Tipo 2/sangue , Relação Dose-Resposta a Droga , Feminino , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/metabolismo , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
20.
Diabetes Technol Ther ; 14(7): 619-23, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22540521

RESUMO

OBJECTIVE: This study compare the effect of various liquid diets on 24-h glycemic variability in diabetes patients on tube feeding. PATIENTS AND METHODS: The study included type 2 diabetes patients in whom percutaneous endoscopic gastrostomy had been performed for dysphagia as a sequela of cerebrovascular disease and who had been put on tube feeding with a standard high-carbohydrate liquid diet (HCD). Once stable glycemic control was achieved, these patients were continuously monitored for glucose levels for 5 days on continuous glucose monitoring. Of the 14 patients included, seven were given HCD on day 1, a low-carbohydrate/high-monounsaturated fatty acid liquid diet (LCD) on Days 2 and 3, and a isoleucine-containing liquid diet (ICD), which is known to promote glycemic uptake by skeletal muscle, thus suppressing increases in glucose levels, on Days 4 and 5, with the remaining seven given the same diets but ICD given on Days 2 and 3 and LCD given on Days 4 and 5. All comparisons were made under the same caloric conditions (caloric intake, 800-1200 kcal/day). RESULTS: The 24-h mean glucose level was significantly lower with LCD and ICD than with HCD but was also significantly lower with LCD than with ICD. On the other hand, the SD of 288 glucose levels over a 24-h period, 24-h total area for glycemic fluctuations, and mean amplitude of glycemic excursion were significantly lower with LCD than with HCD or ICD, whereas they did not differ significantly between HCD and ICD. CONCLUSIONS: LCD and ICD led to significant decreases in mean glucose levels, compared with HCD. However, of the diets compared, LCD had the greatest effect on glycemic variability in these patients on tube feeding.


Assuntos
Glicemia/metabolismo , Transtornos de Deglutição/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Nutrição Enteral , Ácidos Graxos Monoinsaturados/administração & dosagem , Isoleucina/administração & dosagem , Idoso , Automonitorização da Glicemia , Estudos Cross-Over , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/cirurgia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Ingestão de Energia , Nutrição Enteral/métodos , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Estudos Prospectivos
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