Nutritional management of type 2 diabetes in subjects with obesity: an international guideline for clinical practice.

Type 2 diabetes mellitus (T2DM) and obesity represent a global public health problem. Current nutritional recommendations focused on weight loss and overall dietary quality. However, there is no consensus on the optimal macronutrient composition of the diet, particularly for the long-term management of T2DM in subjects with obesity. An international panel of experts reviewed and critically appraised the updated literature published on the topic. This review primarily examines the evidence for areas of consensus and uncertainty about nutritional therapy in patients with T2DM and obesity. The aim of this article is to provide nutritional advice to manage these patients in clinical practice.

Gestational obesity: An unconventional endocrine disruptor for the fetus.

Obesity has reached pandemic proportions and is a growing concern throughout the world. A parallel trend has also been observed among women in reproductive age, leading to the increasing global prevalence of gestational obesity (GO). The well-known obesity-related health problems also extend to pregnancy, where they are responsible for giving rise to a variety of medical and obstetrical complications, resulting in an increased incidence of adverse maternal and fetal outcomes. In this context, several epidemiological and clinical studies have shown that nutritional changes through different stages of gestation can have a substantial impact on the future health and development of the child. Therefore, it is clear that GO is a modifiable endocrine disruptor that negatively influences the health of the fetus and the newborn, with long-term metabolic implications. This review aims to describe the impact of GO on maternal and fetal outcomes using the available scientific literature and highlighting the evidence-based nutritional approaches currently recommended for the management of GO.

Nutritional guidelines for the management of insulin resistance.

Obesity and its related co-morbidities, namely type 2 diabetes (T2D), pose a significant global public health problem. Insulin resistance (IR) in muscle and liver is the core pathophysiologic defect that underlies obesity preceding and predicting the onset of T2D in susceptible humans. There is a broad population with IR that has no indication for prescription of medications, who still need medical consultation and specific advice in this respect. This prevalent need can be achieved by appropriate diet, exercise, and other behavioral therapies for lifestyle interventions. Despite a well-recognized role of IR in the progression to metabolic diseases, no specific nutritional recommendations exist to manage this condition, to the best of our knowledge. An international panel of experts reviewed and critically appraised the updated literature published about this topic. This review primarily examines the evidence for areas of consensus and ongoing uncertainty or controversy about diet and exercise approaches for IR. The aim of this article is to present the most common IR states, namely obesity and Polycystic Ovary Syndrome (PCOS), and provide nutritional advice to manage IR, hyperinsulinemia, and reactive hypoglycemia. These nutritional guidelines could prevent progression or worsening of IR with resultant beta-cell failure and, as a result, T2D.

Impaired left ventricular diastolic function in T2DM patients is closely related to glycemic control.

BACKGROUND: Left ventricular (LV) diastolic dysfunction commonly is observed in individuals with type 2 diabetes mellitus (T2DM). We employed transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMRI) to investigate the hypothesis that LV diastolic dysfunction in T2DM is associated with poor glycemic control. METHODS: Forty subjects, 21 with normal glucose tolerance (NGT) and 19 with T2DM, were studied with CMRI and TTE to assess LV function. Early-to-late transmitral flow ratio (E/A) and deceleration time (DecT) were assessed with both modalities. Normalized (to body surface area) end-diastolic volume (EDV/BSA) and normalized peak LV filling rate (pLVFR/BSA) were assessed with CMRI. Early transmitral flow velocity to septal velocity (E/e') and isovolumetric relaxation time (IVRT) were measured using TTE. Dimensional parameters were normalized to body surface area (BSA). RESULTS: CMRI measurements demonstrated impaired E/A (1.13 ± 0.34 vs 1.62 ± 0.42, P < .001), increased DecT (174 ± 46 ms vs 146 ± 15, P = .005), as well as lower EDV/BSA (63 ± 10 vs 72 ± 9 mL/m2, P < .01) and pLVFR/BSA (189 ± 46 vs 221 ± 48 mL s-1 m-2, P < .05) in T2DM subjects. TTE measurements revealed lower E/A (1.1 ± 0.4 vs 1.4 ± 0.2, P < .001) and E/e' (6.8 ± 1.5 vs 8.7 ± 2.0, P < .0001) with higher DecT (203 ± 22 ms vs 179 ± 18, P < .001) and IVRT (106 ± 14 ms vs 92 ± 10, P < .001) in T2DM. Multiple parameters of LV function: E/ACMRI (r = -.50, P = .001), E/ATTE (r = -.46, P < .005), pLVFR/BSA (r = -.35, P < .05), E/e' (r = -.46, P < .005), EDV/BSACMRI (r = -.51, P < .0001), EDV/BSATTE (r = -.42, P < .01) were negatively correlated with HbA1c. All but E/e' also were inversely correlated with fasting plasma glucose (FPG). CONCLUSIONS: Impaired LV diastolic function (DF) was found in T2DM subjects with both CMRI and TTE, and multiple LVDF parameters correlated negatively with HbA1c and FPG. These results indicate that impaired LVDF is inversely linked to glycemic control in T2DM patients.

[Case report of mucormycosis in a patient with secondary methimazole-induced agranulocytosis]. / Mucormicosis en un paciente con agranulocitosis secundaria a metimazol. Informe de un caso.

Agranulocytosis is a rare side effect of antithyroid drugs, it occurs in less than 0.5% of patients, usually during the first few months of treatment. It is considered to be the most serious adverse effect of these medications since it may be complicated by serious, life-threatening infections. Mucormycosis is a severe mycotic infection that usually develops in immunocompromised hosts, such aspatients with diabetes mellitus, hematologic malignancies or immunosuppressive therapy. The association of mucormycosis with methimazole-induced agranulocytosis has not been previously described. The objective of this case presentation is to analyze the case ofa woman with diffuse toxic goiter and methimazole-induced agranulocytosis who developed rhino-palatal mucormycosis.

Mucormicosis en un paciente con agranulocitosis secundaria a metimazol: informe de un caso / Case report of mucormycosis in a patient with secondary methimazole-induced agranulocytosis

La agranulocitosis es una complicación poco frecuente de los medicamentos antitiroideos, se presenta en menos de 0.5% de los pacientes en los primeros meses de tratamiento. Se considera el efecto adverso más grave de estos medicamentos, ya que se puede complicar con infecciones severas con una tasa alta de mortalidad. La mucormicosis es una infección micótica severa observada en huéspedes inmunocomprometidos como pacientes con diabetes, neoplasias hematológicas o con tratamiento inmunosupresor; sin embargo, la asociación de mucormicosis con agranulocitosis por metimazol no se ha reseñado previamente. El objetivo de este informe es analizar el caso de una mujer con bocio tóxico difuso y agranulocitosis asociada a metimazol, quien desarrolló mucormicosis rinopalatina.

Agranulocytosis is a rare side effect of antithyroid drugs, it occurs in less than 0.5% of patients, usually during the first few months of treatment. It is considered to be the most serious adverse effect of these medications since it may be complicated by serious, life-threatening infections. Mucormycosis is a severe mycotic infection that usually develops in immunocompromised hosts, such aspatients with diabetes mellitus, hematologic malignancies or immunosuppressive therapy. The association of mucormycosis with methimazole-induced agranulocytosis has not been previously described. The objective of this case presentation is to analyze the case ofa woman with diffuse toxic goiter and methimazole-induced agranulocytosis who developed rhino-palatal mucormycosis.

Healing of diabetic foot ulcers in L-arginine-treated patients.

Experimentally, we demonstrated the beneficial effects of L-arginine on regulation of hyperglycemia and dyslipidemia in experimental diabetes, in addition to a positive anti-aggregating effect in platelets in animals and humans. Here, the effect of L-arginine on foot ulcers from diabetic patients was studied. Three groups of diabetic patients were included: 11 patients without ulcer received neither treatment and served as controls. Eleven patients with diabetic ulcer received the standard treatment, this group served as diabetic control with diabetic ulcer. Eleven remain patients with diabetic ulcer received 10 mM L-arginine subcutaneously on the site of the wound. Biopsy with punch number 5 on wound site comprising both ulcerative and contiguous undamaged skin were performed in all patients with ulcerative lesions before any treatment. Patients with intact skin had biopsy performed with punch number 5 on external malleolar region of right lower limb. Biopsies were examined by light and confocal microscopy utilizing histochemical and immunohistochemical methods. Initial and final blood samples were collected to determine glucose, triglycerides, total cholesterol, glycated hemoglobin (HbA(1c)), low (LDL), and high density lipoproteins (HDL). Significant differences (P < 0.05) were observed between initial and final serum glucose levels for treated patients, and initial serum glucose levels between treated and control patients without diabetic ulcer. Glycated hemoglobin, triglycerides, cholesterol, and lipoprotein levels showed no significant changes. Eight patients treated with L-arginine reached total wound healing and the remaining three who abandoned the study because of change of residence showed relevant improvement. Histochemistry and immunohistochemistry methods have shown vascular impairment in both patients with diabetic ulcer (prior to treatment) and control patients without diabetic ulcer. Our observations strongly support efficacy of L-arginine for successful wound healing of diabetic ulcers.