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1.
Sci Rep ; 11(1): 15874, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34354134

RESUMO

The study aim was to examine possible correlates of convulsions in children hospitalized for acute gastroenteritis (AGE). Data collected in a prospective study of AGE hospitalizations in children aged 0-59 months in 3 hospitals in Israel during 2008-2015 were analyzed. Stool samples were tested for rotavirus using immunochromatography and stool culture was performed for the detection of Salmonella, Shigella and Campylobacter We compared clinical and demographic characteristics of children hospitalized for AGE who had convulsions (n = 68, cases) with children hospitalized for AGE without convulsions (n = 3505, controls). Age differed between children with and without convulsions (p = 0.005); the former were mostly toddlers aged 12-23 months (51%) compared to 30% of the control group. A higher percentage of cases tested positive for Shigella (11% vs. 4%, p = 0.002), the opposite was found for rotavirus (2% vs. 30% p < 0.001). A multivariable model showed that body temperature (OR 2.91 [95% CI 1.78-4.76], p < 0.001) and high blood glucose level (> 120 mg/dL) (OR 5.71 [95% CI 1.27-25.58] p = 0.023) were positively related to convulsions in children with AGE, while severe AGE (Vesikari score ≥ 11) was inversely related with convulsions (OR 0.09 [95% CI 0.03-0.24], p < 0.001). Conclusion: Elevated body temperature is associated with convulsions in children with AGE, but not severity of AGE, while hyperglycemia might reflect a neuroendocrine stress reaction to convulsions, AGE or both.


Assuntos
Gastroenterite/complicações , Convulsões/etiologia , Doença Aguda , Glicemia/análise , Glicemia/fisiologia , Temperatura Corporal/fisiologia , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Diarreia/virologia , Fezes/microbiologia , Feminino , Febre , Gastroenterite/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Israel/epidemiologia , Masculino , Estudos Prospectivos , Rotavirus/patogenicidade , Convulsões/fisiopatologia , Shigella/patogenicidade
2.
Endocrinology ; 162(9)2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34132779

RESUMO

Insulin resistance engenders a compensatory increase in plasma insulin. Inadequate compensation is a primary element in the pathogenesis of type 2 diabetes. The signal that heralds developing insulin resistance and initiates hyperinsulinemic compensation is not known. It has often been assumed to be increased glucose. We tested this assumption by determining whether development of fasting and/or glucose-stimulated hyperinsulinemia with diet-induced insulin resistance occurs because of concomitant elevation of glycemia. Male dogs (n = 58) were fed a hypercaloric, fat-supplemented diet for 6 weeks. Dogs underwent magnetic resonance imaging to quantify total and regional (visceral, subcutaneous) adiposity as well as euglycemic hyperinsulinemic clamps. A subset of animals also underwent an insulin-modified intravenous glucose tolerance test to assess insulin sensitivity, acute insulin response (AIRg), and glucose effectiveness. Fat feeding caused modest weight gain, increased visceral and subcutaneous fat, and insulin resistance at both peripheral and hepatic levels. Hyperinsulinemic compensation was observed in fasting levels as well as increased AIRg. However, we observed absolutely no increase in carefully measured fasting, evening (6 to 8 pm) or nocturnal glycemia (2 to 4 am). Insulin resistance and hyperinsulinemia occurred despite no elevation in 24-hour glucose. Compensatory development of hyperinsulinemia during diet-induced insulin resistance occurs without elevated fasting or 24-hour glycemia. These data refute the idea that glucose itself is a requisite signal for ß-cell upregulation. Alternative feedback mechanisms need to be identified.


Assuntos
Hiperglicemia/complicações , Hiperinsulinismo/etiologia , Resistência à Insulina/fisiologia , Animais , Glicemia/fisiologia , Dieta Hiperlipídica/efeitos adversos , Cães , Técnica Clamp de Glucose , Teste de Tolerância a Glucose , Hiperglicemia/metabolismo , Hiperinsulinismo/metabolismo , Masculino
3.
Nutrients ; 13(6)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34072748

RESUMO

The aim of the report was to investigate the impact of soy protein and isoflavones on glucose homeostasis and lipid profile in type 2 diabetes. The studies used in this report were identified by searching through the MEDLINE and EMBASE databases (up to 2020). Meta-regression and subgroup analyses were performed to explore the influence of covariates on net glycemic control and lipid changes. Weighted mean differences and 95% confidence intervals (CI) were calculated by using random-effect models. Changes in the lipid profile showed statistically significant decreases in total cholesterol and LDL-C concentrations: ‒0.21 mmol/L; 95% CI, ‒0.33 to ‒0.09; p = 0.0008 and ‒0.20 mmol/L; 95% CI, ‒0.28 to ‒0.12; p < 0.0001, respectively, as well as in HDL-C (-0.02 mmol/L; 95% CI, -0.05 to 0.01; p = 0.2008 and triacylglycerols (-0.19 mmol/L; 95% CI, -0.48 to 0.09; p = 0.1884). At the same time, a meta-analysis of the included studies revealed statistically insignificant reduction in fasting glucose, insulin, HbA1c, and HOMA-IR (changes in glucose metabolism) after consumption of soy isoflavones. The observed ability of both extracted isoflavone and soy protein with isoflavones to modulate the lipid profile suggests benefits in preventing cardiovascular events in diabetic subjects. Further multicenter studies based on larger and longer duration studies are necessary to determine their beneficial effect on glucose and lipid metabolism.


Assuntos
Diabetes Mellitus Tipo 2 , Controle Glicêmico , Isoflavonas , Lipídeos/sangue , Proteínas de Soja , Idoso , Glicemia/efeitos dos fármacos , Glicemia/fisiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Metabolismo dos Lipídeos/fisiologia , Masculino , Pessoa de Meia-Idade
4.
BMC Endocr Disord ; 21(1): 83, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906667

RESUMO

BACKGROUND: Little is known about whether the influence of glycemic variability on arrhythmia is related to age in type 2 diabetes mellitus (T2DM). Therefore, we aimed to compare the association between glycemic variability and arrhythmia in middle-aged and elderly T2DM patients. METHODS: A total of 107 patients were divided into two groups: elderly diabetes mellitus group (EDM, n = 73) and middle-aged diabetes mellitus group (MDM, n = 34). The main clinical data, continuous glucose monitoring (CGM) and dynamic ECG reports were collected. The parameters including standard deviation of blood glucose (SDBG), largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), absolute means of daily differences (MODD), time in range (TIR), time below range (TBR), time above range (TAR), coefficient of variation (CV) were tested for glycemic variability evaluation. RESULTS: In terms of blood glucose fluctuations, MAGE (5.77 ± 2.16 mmol/L vs 4.63 ± 1.89 mmol/L, P = 0.026), SDBG (2.39 ± 1.00 mmol/L vs 2.00 ± 0.82 mmol/L, P = 0.048), LAGE (9.53 ± 3.37 mmol/L vs 7.84 ± 2.64 mmol/L, P = 0.011) was significantly higher in EDM group than those of MDM group. The incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia and ventricular premature beat were significantly higher in EDM group compared with the MDM group (all P < 0.05). Among patients with hypoglycemia events, the incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia and ventricular premature beat (all P < 0.05) were significantly higher in the EDM group than those in the MDM group. In EDM group, TIR was negatively correlated with atrial tachycardia in the MAGE1 layer and with atrial tachycardia and ventricular premature beat in the MAGE2 layer, TBR was significantly positively correlated with atrial tachycardia in the MAGE2 layer (all P < 0.05). In MDM group, TAR was positively correlated with ventricular premature beat and atrial tachycardia in the MAGE2 layer (all P < 0.05). CONCLUSIONS: The study demonstrated the elderly patients had greater glycemic variability and were more prone to arrhythmias. Therefore, active control of blood glucose fluctuation in elderly patients will help to reduce the risk of severe arrhythmia.


Assuntos
Arritmias Cardíacas/etiologia , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/sangue , Envelhecimento/fisiologia , Arritmias Cardíacas/sangue , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Glicemia/fisiologia , Automonitorização da Glicemia , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
5.
Am J Physiol Endocrinol Metab ; 320(6): E1044-E1052, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33900848

RESUMO

Obesity and type 2 diabetes are rapidly increasing in the adolescent population. We sought to determine whether adipokines, specifically leptin, C1q/TNF-related proteins 1 (CTRP1) and CTRP9, and the hepatokine fibroblast growth factor 21 (FGF21), are associated with obesity and hyperglycemia in a cohort of lean and obese adolescents, across the spectrum of glycemia. In an observational, longitudinal study of lean and obese adolescents, we measured fasting laboratory tests, oral glucose tolerance tests, and adipokines including leptin, CTRP1, CTRP9, and FGF21. Participants completed baseline and 2-year follow-up study visits and were categorized as lean (LC, lean control; n = 30), obese normoglycemic (ONG; n = 61), and obese hyperglycemic (OHG; n = 31) adolescents at baseline and lean (n = 8), ONG (n = 18), and OHG (n = 4) at follow-up. Groups were compared using ANOVA and regression analysis, and linear mixed effects modeling was used to test for differences in adipokine levels across baseline and follow-up visits. Results showed that at baseline, leptin was higher in all obese groups (P < 0.001) compared with LC. FGF21 was higher in OHG participants compared with LC (P < 0.001) and ONG (P < 0.001) and positively associated with fasting glucose (P < 0.001), fasting insulin (P < 0.001), Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR; P < 0.001), and hemoglobin A1c (HbA1c; P = 0.01). CTRP1 was higher in OHG compared with ONG (P = 0.03). CTRP9 was not associated with obesity or hyperglycemia in this pediatric cohort. At 2 years, leptin decreased in ONG (P = 0.003) and FGF21 increased in OHG (P = 0.02), relative to lean controls. Altered adipokine levels are associated with the inflammatory milieu in obese youth with and without hyperglycemia. In adolescence, the novel adipokine CTRP1 was elevated with hyperglycemia, whereas CTRP9 was unchanged in this cohort.NEW & NOTEWORTHY Leptin is higher in obese adolescents and FGF21 is higher in obese hyperglycemic adolescents. The novel adipokine CTRP1 is higher in obese hyperglycemic adolescents, whereas CTRP9 was unchanged in this adolescent cohort.


Assuntos
Adipocinas/sangue , Glicemia/metabolismo , Obesidade Pediátrica/sangue , Adipocinas/análise , Adolescente , Glicemia/fisiologia , Criança , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Intolerância à Glucose/sangue , Intolerância à Glucose/complicações , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Resistência à Insulina/fisiologia , Estudos Longitudinais , Masculino , Obesidade Pediátrica/complicações , Estado Pré-Diabético/sangue , Estado Pré-Diabético/complicações
6.
Endocrinology ; 162(7)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33782700

RESUMO

The incretin effect-the amplification of insulin secretion after oral vs intravenous administration of glucose as a mean to improve glucose tolerance-was suspected even before insulin was discovered, and today we know that the effect is due to the secretion of 2 insulinotropic peptides, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). But how important is it? Physiological experiments have shown that, because of the incretin effect, we can ingest increasing amounts of amounts of glucose (carbohydrates) without increasing postprandial glucose excursions, which otherwise might have severe consequences. The mechanism behind this is incretin-stimulated insulin secretion. The availability of antagonists for GLP-1 and most recently also for GIP has made it possible to directly estimate the individual contributions to postprandial insulin secretion of a) glucose itself: 26%; b) GIP: 45%; and c) GLP-1: 29%. Thus, in healthy individuals, GIP is the champion. When the action of both incretins is prevented, glucose tolerance is pathologically impaired. Thus, after 100 years of research, we now know that insulinotropic hormones from the gut are indispensable for normal glucose tolerance. The loss of the incretin effect in type 2 diabetes, therefore, contributes greatly to the impaired postprandial glucose control.


Assuntos
Glicemia/fisiologia , Polipeptídeo Inibidor Gástrico/fisiologia , Peptídeo 1 Semelhante ao Glucagon/fisiologia , Homeostase/fisiologia , Incretinas/fisiologia , Insulina/fisiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Polipeptídeo Inibidor Gástrico/antagonistas & inibidores , Peptídeo 1 Semelhante ao Glucagon/antagonistas & inibidores , Humanos , Secreção de Insulina/efeitos dos fármacos , Período Pós-Prandial , Receptores dos Hormônios Gastrointestinais/antagonistas & inibidores
7.
PLoS Comput Biol ; 17(3): e1008852, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33788828

RESUMO

Plasma glucose and insulin responses following an oral glucose challenge are representative of glucose tolerance and insulin resistance, key indicators of type 2 diabetes mellitus pathophysiology. A large heterogeneity in individuals' challenge test responses has been shown to underlie the effectiveness of lifestyle intervention. Currently, this heterogeneity is overlooked due to a lack of methods to quantify the interconnected dynamics in the glucose and insulin time-courses. Here, a physiology-based mathematical model of the human glucose-insulin system is personalized to elucidate the heterogeneity in individuals' responses using a large population of overweight/obese individuals (n = 738) from the DIOGenes study. The personalized models are derived from population level models through a systematic parameter selection pipeline that may be generalized to other biological systems. The resulting personalized models showed a 4-5 fold decrease in discrepancy between measurements and model simulation compared to population level. The estimated model parameters capture relevant features of individuals' metabolic health such as gastric emptying, endogenous insulin secretion and insulin dependent glucose disposal into tissues, with the latter also showing a significant association with the Insulinogenic index and the Matsuda insulin sensitivity index, respectively.


Assuntos
Diabetes Mellitus Tipo 2 , Glucose , Resistência à Insulina/fisiologia , Modelagem Computacional Específica para o Paciente , Adulto , Glicemia/efeitos dos fármacos , Glicemia/fisiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Glucose/administração & dosagem , Glucose/metabolismo , Glucose/farmacologia , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial/efeitos dos fármacos , Período Pós-Prandial/fisiologia
8.
Acta Diabetol ; 58(8): 1035-1049, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33754166

RESUMO

OBJECTIVE: The intestinal microbiota to immune system crosstalk is a major regulator of metabolism and hence metabolic diseases. An impairment of the chemokine receptor CX3CR1, as a key regulator shaping intestinal microbiota under normal chow feeding, could be one of the early events of dysglycemia. METHODS: We studied the gut microbiota ecology by sequencing the gut and tissue microbiota. We studied its role in energy metabolism in CX3CR1-deficent and control mice using various bioassays notably the glycemic regulation during fasting and the respiratory quotient as two highly sensitive physiological features. We used antibiotics and prebiotics treatments, and germ free mouse colonization. RESULTS: We identify that CX3CR1 disruption impairs gut microbiota ecology and identified a specific signature associated to the genotype. The glycemic control during fasting and the respiratory quotient throughout the day are deeply impaired. A selected four-week prebiotic treatment modifies the dysbiotic microbiota and improves the fasting state glycemic control of the CX3CR1-deficent mice and following a glucose tolerance test. A 4 week antibiotic treatment also improves the glycemic control as well. Eventually, germ free mice colonized with the microbiota from CX3CR1-deficent mice developed glucose intolerance. CONCLUSIONS: CX3CR1 is a molecular mechanism in the control of the gut microbiota ecology ensuring the maintenance of a steady glycemia and energy metabolism. Its impairment could be an early mechanism leading to gut microbiota dysbiosis and the onset of metabolic disease.


Assuntos
Receptor 1 de Quimiocina CX3C/fisiologia , Diabetes Mellitus Tipo 2/microbiologia , Microbioma Gastrointestinal/fisiologia , Animais , Antibacterianos/administração & dosagem , Glicemia/fisiologia , Receptor 1 de Quimiocina CX3C/deficiência , Disbiose , Metabolismo Energético , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Prebióticos/administração & dosagem , Fatores de Risco
9.
Basic Clin Pharmacol Toxicol ; 128(6): 783-794, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33626236

RESUMO

In humans, food intake and glucose infusion have been reported to increase subcutaneous blood flow. Since local blood flow influences the rate of insulin absorption from the subcutaneous tissue, we hypothesised that an increase in blood glucose levels-occurring as the result of glucose infusion or food intake-could modulate the pharmacokinetic properties of subcutaneously administered insulin. The pharmacokinetic profile of insulin aspart was assessed in 29 domestic pigs that were examined in a fed and fasted state or included in hyperinsulinaemic clamp studies of 4 vs. 10 mmol/L glucose prior to subcutaneous (30 nmol) or intravenous (0.1 nmol/kg) insulin administration. Results showed that food intake compared to fasting accelerated absorption and decreased clearance of insulin aspart (P < 0.05). Furthermore, higher c-peptide but also glucagon levels were observed in fed compared to fasted pigs (P < 0.05). The pharmacokinetic profile of insulin aspart did not differ between pigs clamped at 4 vs. 10 mmol/L glucose. Hence, food intake rather than blood glucose levels within normal range modulates the pharmacokinetic properties of insulin aspart upon subcutaneous and intravenous administration in pigs.


Assuntos
Glicemia/fisiologia , Ingestão de Alimentos/fisiologia , Hipoglicemiantes/farmacocinética , Insulina Aspart/farmacocinética , Animais , Peptídeo C/sangue , Diabetes Mellitus , Glucagon/sangue , Técnica Clamp de Glucose , Insulina/sangue , Masculino , Suínos
10.
JAMA Netw Open ; 4(1): e2030913, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33416883

RESUMO

Importance: Accurate clinical decision support tools are needed to identify patients at risk for iatrogenic hypoglycemia, a potentially serious adverse event, throughout hospitalization. Objective: To predict the risk of iatrogenic hypoglycemia within 24 hours after each blood glucose (BG) measurement during hospitalization using a machine learning model. Design, Setting, and Participants: This retrospective cohort study, conducted at 5 hospitals within the Johns Hopkins Health System, included 54 978 admissions of 35 147 inpatients who had at least 4 BG measurements and received at least 1 U of insulin during hospitalization between December 1, 2014, and July 31, 2018. Data from the largest hospital were split into a 70% training set and 30% test set. A stochastic gradient boosting machine learning model was developed using the training set and validated on internal and external validation. Exposures: A total of 43 clinical predictors of iatrogenic hypoglycemia were extracted from the electronic medical record, including demographic characteristics, diagnoses, procedures, laboratory data, medications, orders, anthropomorphometric data, and vital signs. Main Outcomes and Measures: Iatrogenic hypoglycemia was defined as a BG measurement less than or equal to 70 mg/dL occurring within the pharmacologic duration of action of administered insulin, sulfonylurea, or meglitinide. Results: This cohort study included 54 978 admissions (35 147 inpatients; median [interquartile range] age, 66.0 [56.0-75.0] years; 27 781 [50.5%] male; 30 429 [55.3%] White) from 5 hospitals. Of 1 612 425 index BG measurements, 50 354 (3.1%) were followed by iatrogenic hypoglycemia in the subsequent 24 hours. On internal validation, the model achieved a C statistic of 0.90 (95% CI, 0.89-0.90), a positive predictive value of 0.09 (95% CI, 0.08-0.09), a positive likelihood ratio of 4.67 (95% CI, 4.59-4.74), a negative predictive value of 1.00 (95% CI, 1.00-1.00), and a negative likelihood ratio of 0.22 (95% CI, 0.21-0.23). On external validation, the model achieved C statistics ranging from 0.86 to 0.88, positive predictive values ranging from 0.12 to 0.13, negative predictive values of 0.99, positive likelihood ratios ranging from 3.09 to 3.89, and negative likelihood ratios ranging from 0.23 to 0.25. Basal insulin dose, coefficient of variation of BG, and previous hypoglycemic episodes were the strongest predictors. Conclusions and Relevance: These findings suggest that iatrogenic hypoglycemia can be predicted in a short-term prediction horizon after each BG measurement during hospitalization. Further studies are needed to translate this model into a real-time informatics alert and evaluate its effectiveness in reducing the incidence of inpatient iatrogenic hypoglycemia.


Assuntos
Diagnóstico por Computador/métodos , Hipoglicemia/diagnóstico , Aprendizado de Máquina , Idoso , Glicemia/análise , Glicemia/fisiologia , Feminino , Hospitalização , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco
12.
Sci Rep ; 11(1): 1176, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441946

RESUMO

The benefits of self-monitoring of blood glucose (SMBG) on glycemic control among type 2 diabetes (T2DM) patients not receiving insulin remains controversial. This study aimed to examine the association between SMBG and glycemic control in these patients. This retrospective longitudinal study enrolled 4987 eligible patients from a medical center in Taiwan. Data were collected from electronic medical records at 0 (baseline), 3, 6, 9, and 12 (end-point) months after enrollment. Patients were assigned to the early SMBG group or to the non-user group depending on whether they performed SMBG at baseline. Differences in glycated hemoglobin (HbA1c) reduction between groups at each time-point were assessed using SMBG group-by-time interaction in generalized estimating equations models, which were established using backward elimination method for multivariate regression analysis. Subgroup analyses for patients using non-insulin and insulin secretagogues were performed additionally. The estimated maximal difference in HbA1c reduction between groups (early SMBG users vs. non-users) was 0.55% at 3 months. Subgroup analyses showed maximal differences of 0.61% and 0.52% at 3 months in the non-insulin and insulin secretagogues groups, respectively. SMBG group-by-time interaction was statistically significant at 3 months and lasted for 12 months. The finding suggests that performing SMBG at disease onset was positively associated with better glycemic control in newly diagnosed non-insulin-treated T2DM patients, regardless whether non-insulin secretagogues or insulin secretagogues were used.


Assuntos
Glicemia/metabolismo , Glicemia/fisiologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Glicemia/efeitos dos fármacos , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hemoglobina A Glicada/metabolismo , Controle Glicêmico/métodos , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Taiwan
13.
J Clin Endocrinol Metab ; 106(2): e875-e890, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-33165596

RESUMO

CONTEXT: Perturbed inositol physiology in insulin-resistant conditions has led to proposals of inositol supplementation for gestational diabetes (GDM) prevention, but placental inositol biology is poorly understood. OBJECTIVE: Investigate associations of maternal glycemia with placental inositol content, determine glucose effects on placental expression of inositol enzymes and transporters, and examine relations with birthweight. DESIGN AND PARTICIPANTS: Case-control study of placentae from term singleton pregnancies (GDM n = 24, non-GDM n = 26), and culture of another 9 placentae in different concentrations of glucose and myo-inositol for 48 hours. MAIN OUTCOME MEASURES: Placental inositol was quantified by the Megazyme assay. Relative expression of enzymes involved in myo-inositol metabolism and plasma membrane inositol transport was determined by quantitative RT-PCR and immunoblotting. Linear regression analyses were adjusted for maternal age, body mass index, ethnicity, gestational age, and sex. RESULTS: Placental inositol content was 17% lower in GDM compared with non-GDM. Higher maternal mid-gestation glycemia were associated with lower placental inositol. Increasing fasting glycemia was associated with lower protein levels of the myo-inositol synthesis enzyme, IMPA1, and the inositol transporters, SLC5A11 and SLC2A13, the expression of which also correlated with placental inositol content. In vitro, higher glucose concentrations reduced IMPA1 and SLC5A11 mRNA expression. Increasing fasting glycemia positively associated with customized birthweight percentile as expected in cases with low placental inositol, but this association was attenuated with high placental inositol. CONCLUSION: Glycemia-induced dysregulation of placental inositol synthesis and transport may be implicated in reduced placental inositol content in GDM, and this may in turn be permissive to accelerated fetal growth.


Assuntos
Diabetes Gestacional/metabolismo , Glucose/farmacologia , Inositol/metabolismo , Monoéster Fosfórico Hidrolases/genética , Placenta/metabolismo , Adulto , Glicemia/fisiologia , Estudos de Casos e Controles , Células Cultivadas , Diabetes Gestacional/sangue , Diabetes Gestacional/genética , Regulação para Baixo , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Glucose/metabolismo , Proteínas Facilitadoras de Transporte de Glucose/efeitos dos fármacos , Proteínas Facilitadoras de Transporte de Glucose/genética , Proteínas Facilitadoras de Transporte de Glucose/metabolismo , Humanos , Recém-Nascido , Masculino , Monoéster Fosfórico Hidrolases/efeitos dos fármacos , Monoéster Fosfórico Hidrolases/metabolismo , Placenta/patologia , Gravidez , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Proteínas de Transporte de Sódio-Glucose/efeitos dos fármacos , Proteínas de Transporte de Sódio-Glucose/genética , Proteínas de Transporte de Sódio-Glucose/metabolismo
14.
Eur J Sport Sci ; 21(2): 213-223, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32052709

RESUMO

Training with low carbohydrate availability enhances endurance training adaptations but training volume may be compromised. We explored whole-body metabolism and performance with delayed carbohydrate feeding during exercise undertaken following acute sleep-low training. We hypothesised this strategy would not suppress fat oxidation and would maintain exercise performance. The study involved three experimental trials and included 9 men and 1 woman (⩒O2peak = 58.8 ± 5.5 mL kg-1 min-1). Each trial started in the afternoon with an exhaustive cycling protocol. The following morning 1-h of steady-state cycling (SS) was followed by a time trial (TT). Carbohydrates (CHO) were not ingested in recovery from exhaustive exercise or during next day exercise in the Placebo trial (PLA); CHO were not ingested during recovery but were fed (15 g every ∼15-min) from 30-min into SS and continued during the TT in the delayed feeding trial (DELAY); CHO were provided during recovery (1.2 g/kg/h for 7 h) and next day exercise (as in DELAY) in a third condition (CHO). Exercise metabolism was assessed using indirect calorimetry and blood sampling. Fat oxidation rates during SS were similar in PLA (0.83 ± 0.17 g/min) and DELAY (0.78 ± 0.14 g/min) (p > 0.05) and higher than CHO (0.57 ± 0.27 g/min) (p < 0.05). There were no significant differences in TT performance (49.1 ± 10.7, 43.4 ± 7.6, 41.0 ± 7.9 min in PLA, DELAY and CHO, respectively; p > 0.05). Delayed carbohydrate feeding could be a strategy to maintain high-fat oxidation rates typically associated with exercise undertaken after the sleep-low approach to training but the acute performance effects remain inconclusive.


Assuntos
Tecido Adiposo/metabolismo , Carboidratos da Dieta/administração & dosagem , Metabolismo Energético/fisiologia , Exercício Físico/fisiologia , Resistência Física/fisiologia , Adulto , Biomarcadores/sangue , Glicemia/fisiologia , Calorimetria Indireta , Teste de Esforço , Ácidos Graxos não Esterificados/sangue , Feminino , Voluntários Saudáveis , Humanos , Insulina/sangue , Ácido Láctico/sangue , Masculino , Adulto Jovem
16.
Acta Diabetol ; 58(2): 139-144, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32583078

RESUMO

AIMS: Nowadays, the ongoing pandemic of COVID-19 caused by the novel coronavirus Syndrome-Coronavirus-2 (SARS-CoV-2) is an emerging, rapidly evolving situation. Complications such as hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease are major risk factors for patients with COVID-19. METHODS: No meta-analysis has explored if or not diabetes related to mortality of patients with COVID-19. Therefore, this meta-analysis first aims to explore the possible clinical mortality between diabetes and COVID-19, analyze if diabetes patients infected with SARS-CoV-2 are exposed to the worst clinical prognostic risk, and to evaluate the reliability of the evidence. RESULTS: Our results showed a close relationship between diabetes and mortality of COVID-19, with a pooled OR of 1.75 (95% CI 1.31-2.36; P = 0.0002). The pooled data were calculated with the fixed effects model (FEM) as no heterogeneity appeared in the studies. Sensitivity analysis showed that after omitting any single study or converting a random effect model to FEM, the main results still held. CONCLUSIONS: Our meta-analysis showed that diabetes increases the mortality of patients with COVID-19. These results indicated the disturbance of blood glucose in the COVID-19 patients. More importantly, this meta-analysis grades the reliability of evidence for further basic and clinical research into the diabetes dysfunction in COVID-19 patients.


Assuntos
COVID-19/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus/mortalidade , Glicemia/fisiologia , COVID-19/epidemiologia , COVID-19/patologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/mortalidade , Pandemias , Reprodutibilidade dos Testes , Fatores de Risco , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença
17.
Complement Ther Med ; 56: 102585, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33197660

RESUMO

While the chronic effects of certain styles of yoga on cardiometabolic factors have been investigated, little is known about the acute effects of a single yoga session on these outcomes. Moreover, vinyasa yoga's potential to modulate cardiometabolic outcomes has not been established. The purpose of this study is to determine the acute effects of a vinyasa yoga session on arterial stiffness, wave reflection, lipid and glucose concentrations, and mood in adults with prior yoga experience. Thirty yoga practitioners with a minimum of 3 months of practice experience were enrolled into the study. Carotid-femoral pulse wave velocity (cf-PWV), augmentation index (AIx), lipid profile, glucose concentrations, and mood (Positive and Negative Affect Scale) were assessed at baseline and immediately following a 1 -h vinyasa yoga session. After the yoga session, participants had significantly lower AIx (p < 0.001), non-HDL cholesterol (p < 0.05), and negative affect (p < 0.01) compared to baseline. These results highlight the efficacy of a single bout of yoga in altering wave reflection while improving mood and lipid concentrations in healthy adults with a history of yoga practice.


Assuntos
Glicemia/fisiologia , Lipídeos/sangue , Rigidez Vascular/fisiologia , Ioga , Adulto , Afeto/fisiologia , Idoso , Humanos , Pessoa de Meia-Idade , Análise de Onda de Pulso , Adulto Jovem
18.
J Diabetes Res ; 2020: 5436832, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33294461

RESUMO

The ongoing pandemic of COVID-19 is now the major issue in global health. Evidence implies that patients with diabetes are at a higher risk of severe disease or death due to COVID-19 than individuals without diabetes. However, the underlying mechanism for this differential effect in individuals with and without diabetes is not clearly understood. We have reviewed the pathophysiological pathways which may facilitate the entry of virus or an increase in its infectivity in host cells in the diabetic milieu. We suggest that the preexisting pathological pathways in patients with poorly controlled diabetes increase the risk of infectivity and are responsible for the higher levels of tissue injury and death in patients with diabetes.


Assuntos
COVID-19/epidemiologia , Diabetes Mellitus/epidemiologia , SARS-CoV-2 , Apoptose , Glicemia/fisiologia , COVID-19/imunologia , COVID-19/fisiopatologia , Comorbidade , Diabetes Mellitus/imunologia , Diabetes Mellitus/fisiopatologia , Humanos , Inflamação/fisiopatologia , Estresse Oxidativo , Sistema Renina-Angiotensina/fisiologia
19.
Medicine (Baltimore) ; 99(40): e22266, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019401

RESUMO

INTRODUCTION: Gestational hyperinsulinism is a metabolic disease which is widely concerned at home and abroad. It is a clinical consensus that the embryo implantation ability of patients with hyperinsulinemia is decreased and the abortion rate after implantation is high. The treatment of gestational hyperinsulinism with Multiple dietary fiber diets has been proven. However, due to the lack of evidence, there is no specific method or recommendation, it is necessary to carry out a systematic evaluation of Multiple dietary fiber diet, to provide effective evidence for further research. METHODS AND ANALYSIS: The following databases will be searched from their inception to August 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, Chinese Biomedical Database WanFang, VIP medicine information, and CNKI. Primary outcomes: Fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance, glycosylated hemoglobin. Additional outcomes: Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), triglycerides (TG), total serum cholesterol (TC). Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews (SR) of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of Multiple dietary fiber diet interventions in the treatment of gestational hyperinsulinism. CONCLUSION: The SR of this study will summarize the current published evidence of Multiple dietary fiber for the treatment of gestational hyperinsulinism, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study is a SR, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. OPEN SCIENCE FRA NETWORK (OSF) REGISTRATION NUMBER: August 19, 2020. osf.io/tbc7z. (https://osf.io/tbc7z).


Assuntos
Fibras na Dieta/uso terapêutico , Hiperinsulinismo/dietoterapia , Complicações na Gravidez/dietoterapia , Glicemia/fisiologia , Fibras na Dieta/administração & dosagem , Fibras na Dieta/efeitos adversos , Feminino , Hemoglobina A Glicada/análise , Humanos , Resistência à Insulina/fisiologia , Lipídeos/sangue , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
20.
Midwifery ; 91: 102839, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33010591

RESUMO

PROBLEM: There are different conclusions about the effects of resistance training on blood sugar levels and pregnancy outcomes in gestational diabetes mellitus (GDM) patients. BACKGROUND: Resistance training is recommended as an easier and more practical method to exercise for women with GDM due to their growing belly. Although some researchers have explored this notion, there are no consistent conclusions about its effects. AIM: To explore whether resistance training has an effect on blood sugar levels and pregnancy outcomes in patients with GDM in randomized controlled trials. METHOD: Pubmed, Cochrane Library, CINAHL, Embase, Scopus, Web of Science, Clinical Trials, CKNI, Wanfang Database, VIP Database, and Chinese Biomedical Literature Database were systematically searched since their establishment to April 2019. Relevant meta-analyses, reviews, and eligible literature were also searched. The quality of the included literature was evaluated according to the Cochrane Assessment Manual 5.1.0. Meta-analysis was performed using Revman 5.3 software. FINDINGS: A total of four studies (n = 242 patients) were included. Compared to the control group, there were statistical differences in fasting blood glucose level [MD=-0.37, 95%CI=(-0.65, -0.09), Z = 2.62, P = 0.009], average 2-h post-meal blood glucose level [MD=-0.96, 95%CI=(-1.80, -0.12), Z = 2.25, P = 0.02], insulin dosage [MD=-0.58, 95%CI=(-0.99, -0.17), Z = 2.75, P = 0.006], rate of insulin injection [RR=0.52, 95%CI=(0.31, 0.86), Z = 2.54, P = 0.01], and incidence of macrosomia [RR=0.15, 95%CI=(0.04,0.66), Z = 2.53, P = 0.01] in the intervention group consisting of GDM patients. There were no statistical differences in preterm delivery outcomes [RR=0.44, 95%CI=(0.09, 2.16), Z = 1.01, P = 0.31]. CONCLUSION: Resistance training can improve blood sugar levels, insulin usage, and some adverse pregnancy outcomes in patients with GDM and is therefore worthy of clinical promotion.


Assuntos
Glicemia/análise , Treinamento de Força/normas , Adulto , Glicemia/fisiologia , Correlação de Dados , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Humanos , Gravidez , Resultado da Gravidez/epidemiologia , Treinamento de Força/métodos
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