Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.380
Filtrar
1.
Medicine (Baltimore) ; 99(17): e19663, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332610

RESUMO

Hyperglycemia in pregnancy (HIP) is related to adverse pregnancy outcomes. However, women with hyperglycemia in the second and third trimester of pregnancy (HISTTP) were not been observed. We aim to reveal associations between HISTTP and prematurity. To confirm which risk factor is better in predicting preterm delivery.This retrospective study included 660 patients, of which 132 have HISTTP and 528 have euglycemia. Univariate analysis was used to extract risk factors and multivariates logistic regression analysis to obtain odds ratio (OR) for prematurity. Mean decrease gini (MDG) in random forest algorithm was used to rank the risk factors.HISTTP women have higher prepregnancy BMI and a higher percentage of family history of hypertension, maternal adiposity, maternal anemia, gestational diabetes mellitus (GDM), prematurity, neonatal asphyxia in 1-minute (P < .05). Univariate analysis of prematurity showed that preterm women had higher rate of HISTTP (P < .01), second births, elderly pregnancy, hypertention, family history of hypertention and multiple perinatal infant (P < .05). Multivariate logistic regression analysis indicates that HISTTP (OR = 2.984, P = .0017), maternal hypertension (OR = 5.208, P = .001) and multiple perinatal infants (OR = 59.815, P < .0001) are independent risk factors for prematurity. After ranked the MDG, the top 3 risk factors were multiple perinatal infants, maternal hypertension, HISTTP. MDG of HISTTP is higher than that of GDM.Women with HISTTP deserve to be concerned, whose prematurity rate are increased. HISTTP is an independent risk factor and a better predictor of prematurity.


Assuntos
Hiperglicemia/complicações , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Segundo Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/metabolismo , Terceiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/metabolismo , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
2.
BMC Complement Altern Med ; 19(1): 309, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718632

RESUMO

BACKGROUND: Sheng Mai San (SMS) has been proven to exhibit cardio-protective effects. This study aimed to explore the molecular mechanisms of SMS on hyperglycaemia (HG)-induced apoptosis in H9C2 cells. METHODS: HG-induced H9C2 cells were established as the experimental model, and then treated with SMS at 25, 50, and 100 µg/mL. H9C2 cell viability and apoptosis were quantified using MTT and Annexin V-FITC assays, respectively. Furthermore, Bcl-2/Bax signalling pathway protein expression and Fas and FasL gene expression levels were quantified using western blotting and RT-PCR, respectively. RESULTS: SMS treatments at 25, 50, 100 µg/mL significantly improved H9C2 cell viability and inhibited H9C2 cell apoptosis (p < 0.05). Compared to the HG group, SMS treatment at 25, 50, and 100 µg/mL significantly downregulated p53 and Bax expression and upregulated Bcl-2 expression (p < 0.05). Moreover, SMS treatment at 100 µg/mL significantly downregulated Fas and FasL expression level (p < 0.05) when compared to the HG group. CONCLUSION: SMS protects H9C2 cells from HG-induced apoptosis probably by downregulating p53 expression and upregulating the Bcl-2/Bax ratio. It may also be associated with the inhibition of the Fas/FasL signalling pathway.


Assuntos
Apoptose/efeitos dos fármacos , Medicamentos de Ervas Chinesas/farmacologia , Hiperglicemia/fisiopatologia , Miócitos Cardíacos/citologia , Miócitos Cardíacos/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Animais , Sobrevivência Celular/efeitos dos fármacos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/genética , Hiperglicemia/metabolismo , Miócitos Cardíacos/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Proteína X Associada a bcl-2/genética , Proteína X Associada a bcl-2/metabolismo
3.
Int J Mol Sci ; 20(15)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31382355

RESUMO

NADPH oxidases (NOX) are enzyme complexes that have received much attention as key molecules in the development of vascular dysfunction. NOX have the primary function of generating reactive oxygen species (ROS), and are considered the main source of ROS production in endothelial cells. The endothelium is a thin monolayer that lines the inner surface of blood vessels, acting as a secretory organ to maintain homeostasis of blood flow. The enzymatic production of nitric oxide (NO) by endothelial NO synthase (eNOS) is critical in mediating endothelial function, and oxidative stress can cause dysregulation of eNOS and endothelial dysfunction. Insulin is a stimulus for increases in blood flow and endothelium-dependent vasodilation. However, cardiovascular disease and type 2 diabetes are characterized by poor control of the endothelial cell redox environment, with a shift toward overproduction of ROS by NOX. Studies in models of type 2 diabetes demonstrate that aberrant NOX activation contributes to uncoupling of eNOS and endothelial dysfunction. It is well-established that endothelial dysfunction precedes the onset of cardiovascular disease, therefore NOX are important molecular links between type 2 diabetes and vascular complications. The aim of the current review is to describe the normal, healthy physiological mechanisms involved in endothelial function, and highlight the central role of NOX in mediating endothelial dysfunction when glucose homeostasis is impaired.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/fisiopatologia , Hiperglicemia/fisiopatologia , NADPH Oxidases/metabolismo , Óxido Nítrico Sintase Tipo III/metabolismo , Animais , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Endotélio Vascular/metabolismo , Glucose/metabolismo , Humanos , Hiperglicemia/complicações , Hiperglicemia/metabolismo , Espécies Reativas de Oxigênio/metabolismo
4.
Postgrad Med ; 131(8): 597-606, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31419922

RESUMO

The association between cancer and dysglycemia has been well documented. It is underappreciated, however, that sustained dysglycemia could potentially be a catalyst toward a pro-cancer physiologic milieu and/or increase the burden of cancer. Hyperglycemia, hyperinsulinemia and energy metabolism at large impact a cascade of growth pathways, epi/genetic modifications, and mitochondrial changes that could feasibly link to tumor processes. Oxidative stress is a recurring motif in cell dysfunction: in diabetes, oxidative stress and reactive oxygen species (ROS) feature prominently in the damage and demise of pancreatic beta cells, as well as cell damage contributing to diabetes-related complications. Oxidative stress may be one intersection at which metabolic and oncogenic processes cross paths with deleterious results in the development of precancer, cancer, and cancer progression. This would augur for tight glucose control. Regrettably, some medical societies have recently relaxed hemoglobin A1c targets. A framework for the hyperglycemic state is presented that helps account and translate the full scope of effects of dysglycemia to ultimately improve clinical best practices.


Assuntos
Hiperglicemia/epidemiologia , Hiperglicemia/fisiopatologia , Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Proteínas de Ligação a DNA/biossíntese , Progressão da Doença , Metabolismo Energético/fisiologia , Hemoglobina A Glicada , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/genética , Hiperinsulinismo/fisiopatologia , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Neoplasias/genética , Obesidade/epidemiologia , Estresse Oxidativo/fisiologia , Prognóstico , Proteínas Proto-Oncogênicas/biossíntese , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/fisiologia
5.
Medicine (Baltimore) ; 98(28): e16255, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305406

RESUMO

RATIONALE: Hemichorea-hemiballism, a rare manifestation of non-ketotic hyperglycemia, characterized by involuntary arrhythmic motions involving one side of the body, results from focal lesions in the contralateral caudate nucleus and putamen. Hyperkinetic disorders can be complications of uncontrolled diabetes mellitus and should not be ignored. PATIENT CONCERNS: We present the case of a 39-year-old woman who presented to the emergency department with a 3-day history of left-sided hemichorea-hemiballism. She had type 2 diabetes mellitus with poor control and maintenance of regular hemodialysis. DIAGNOSES: The patient was diagnosed as hyperglycemia, normal ketone body and hemichorea-hemiballism based on laboratory examination, computed tomography (CT) scan, and brain magnetic resonance image (MRI). INTERVENTIONS: Intensive glycemic control via insulin injection was prescribed for correction of hyperglycemia. OUTCOMES: The unilateral involuntary movements subsided progressively over four weeks. The patient's hemichorea had completely resolved at the three-month follow-up. LESSONS: This unusual clinical presentation is often accompanied by severe hyperglycemia. Appropriate blood glycemic control is important. If physicians recognize and provide early treatment for this disease, it is usually treatable and has a good prognosis.


Assuntos
Coreia/complicações , Diabetes Mellitus Tipo 2/complicações , Discinesias/complicações , Hiperglicemia/complicações , Adulto , Coreia/diagnóstico , Coreia/tratamento farmacológico , Coreia/fisiopatologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Diagnóstico Diferencial , Discinesias/diagnóstico , Discinesias/tratamento farmacológico , Discinesias/fisiopatologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/tratamento farmacológico , Hiperglicemia/fisiopatologia
6.
Int Rev Neurobiol ; 145: 127-176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31208522

RESUMO

Peripheral neuropathy is a common and debilitating complication of diabetes and prediabetes. Recent clinical studies have identified an association between the development of neuropathy and dyslipidemia in prediabetic and diabetic patients. Despite the prevalence of this complication, studies identifying molecular mechanisms that underlie neuropathy progression in prediabetes or diabetes are limited. However, dysfunctional mitochondrial pathways in hereditary neuropathy provide feasible molecular targets for assessing mitochondrial dysfunction in neuropathy associated with prediabetes or diabetes. Recent studies suggest that elevated levels of dietary saturated fatty acids (SFAs) associated with dyslipidemia impair mitochondrial dynamics in sensory neurons by inducing mitochondrial depolarization, compromising mitochondrial bioenergetics, and impairing axonal mitochondrial transport. This causes lower neuronal ATP and apoptosis. Conversely, monounsaturated fatty acids (MUFAs) restore nerve and sensory mitochondrial function. Understanding the mitochondrial pathways that contribute to neuropathy progression in prediabetes and diabetes may provide therapeutic targets for the treatment of this debilitating complication.


Assuntos
Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/fisiopatologia , Transtornos Heredodegenerativos do Sistema Nervoso/fisiopatologia , Dinâmica Mitocondrial/fisiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Animais , Dislipidemias/complicações , Dislipidemias/fisiopatologia , Gânglios Espinais/metabolismo , Transtornos Heredodegenerativos do Sistema Nervoso/complicações , Humanos , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Doenças do Sistema Nervoso Periférico/complicações
7.
Nutrients ; 11(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234301

RESUMO

Overnutrition during critical windows of development plays a significant role in life-long metabolic disease risk. Early exposure to excessive nutrition may result in altered programming leading to increased susceptibility to obesity, inflammation, and metabolic complications. This study investigated the programming effects of high-fat diet (HFD) exposure during the lactation period on offspring adiposity and inflammation. Female C57Bl/6J dams were fed a normal diet or a 60% HFD during lactation. Offspring were weaned onto a normal diet until 12 weeks of age when half were re-challenged with HFD for 12 weeks. Metabolic testing was performed throughout adulthood. At 24 weeks, adipose depots were isolated and evaluated for macrophage profiling and inflammatory gene expression. Males exposed to HFD during lactation had insulin resistance and glucose intolerance as adults. After re-introduction to HFD, males had increased weight gain and worsened insulin resistance and hyperglycemia. There was increased infiltration of pro-inflammatory CD11c+ adipose tissue macrophages, and bone marrow was primed to produce granulocytes and macrophages. Bone density was lower due to enhanced marrow adiposity. This study demonstrates that maternal HFD exposure during the lactational window programs offspring adiposity, inflammation, and impaired glucose homeostasis.


Assuntos
Tecido Adiposo/fisiopatologia , Adiposidade , Medula Óssea/fisiopatologia , Dieta Hiperlipídica/efeitos adversos , Hiperglicemia/etiologia , Inflamação/etiologia , Lactação , Exposição Materna/efeitos adversos , Fenômenos Fisiológicos da Nutrição Materna , Obesidade/etiologia , Tecido Adiposo/metabolismo , Fatores Etários , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Medula Óssea/metabolismo , Feminino , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Inflamação/sangue , Inflamação/fisiopatologia , Mediadores da Inflamação/sangue , Resistência à Insulina , Masculino , Camundongos Endogâmicos C57BL , Células Mieloides/metabolismo , Estado Nutricional , Obesidade/sangue , Obesidade/fisiopatologia , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Ganho de Peso
8.
J Diabetes Res ; 2019: 2936962, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31214621

RESUMO

Objective: Hypoxia is central in the pathogenesis of diabetic retinopathy (DR). Hypoxia-inducible factor-1 (HIF-1) is the key mediator in cellular oxygen homeostasis that facilitates the adaptation to hypoxia. HIF-1 is repressed by hyperglycemia contributing by this to the development of complications in diabetes. Recent work has shown that the HIF-1A Pro582Ser polymorphism is more resistant to hyperglycemia-mediated repression, thus protecting against the development of diabetic nephropathy. In this study, we have investigated the effect of the HIF-1A Pro582Ser polymorphism on the development of DR and further dissected the mechanisms by which the polymorphism confers a relative resistance to the repressive effect of hyperglycemia. Research Design and Method: 703 patients with type 1 diabetes mellitus from one endocrine department were included in the study. The degree of retinopathy was correlated to the HIF-1A Pro582Ser polymorphism. The effect of glucose on a stable HIF-1A construct with a Pro582Ser mutation was evaluated in vitro. Results: We identified a protective effect of HIF-1A Pro582Ser against developing severe DR with a risk reduction of 95%, even when adjusting for known risk factors for DR such as diabetes duration, hyperglycemia, and hypertension. The Pro582Ser mutation does not cancel the destabilizing effect of glucose but is followed by an increased transactivation activity even in high glucose concentrations. Conclusion: The HIF-1A genetic polymorphism has a protective effect on the development of severe DR. Moreover, the relative resistance of the HIF-1A Pro582Ser polymorphism to the repressive effect of hyperglycemia is due to the transactivation activity rather than the protein stability of HIF-1α.


Assuntos
Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/fisiopatologia , Retinopatia Diabética/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Nefropatias Diabéticas/genética , Feminino , Genótipo , Glucose/análise , Células HEK293 , Humanos , Hiperglicemia/genética , Hiperglicemia/fisiopatologia , Hipóxia , Masculino , Pessoa de Meia-Idade , Mutação , Prolina/genética , Fatores de Risco , Serina/genética , Ativação Transcricional , Adulto Jovem
9.
Exp Eye Res ; 186: 107708, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31242444

RESUMO

Previous studies have reported that topical exposure to the toll-like receptor (TLR) 9 ligand CpG-ODN causes widespread ocular inflammation, including retinal microglial activation and posterior segment inflammation. Here we sought to determine the effects of systemic exposure to CpG-ODN in the retina and whether this inflammatory response was altered with Cx3cr1 deficiency or hyperglycemia. Male non-diabetic Cx3cr1+/gfp and Cx3cr1gfp/gfp littermates (normoglycemic controls) and Cx3cr1+/gfpIns2Akitaand Cx3cr1gfp/gfpIns2Akita diabetic mice were injected intraperitoneally with 40 µg CpG-ODN. Immunofluorescence staining was performed 1 week later to assess the expression of MHC Class II and glial fibrillary acidic protein (GFAP), as well as to identify morphological changes to microglia and changes in retinal macrophage cell density. Systemic exposure to CpG-ODN induced the upregulated expression of both GFAP on retinal Müller cells and MHC Class II on the retinal vasculature. Additionally, there was an increased accumulation of macrophages in the subretinal space 1 week after exposure to systemic CpG-ODN as well as characteristic morphological changes to microglia indicative of an activated phenotype. These preliminary studies demonstrate that low-grade inflammatory changes were not enhanced in Cx3cr1-deficient or diabetic mice, indicating that the inflammatory response to systemic CpG-ODN in the retina is unaltered in the context of Cx3cr1 deficiency or prolonged hyperglycemia.


Assuntos
Oligodesoxirribonucleotídeos/farmacologia , Retina/patologia , Análise de Variância , Animais , Quimiocina CX3CL1/deficiência , Diabetes Mellitus Experimental , Modelos Animais de Doenças , Células Ependimogliais/metabolismo , Proteína Glial Fibrilar Ácida/metabolismo , Antígenos de Histocompatibilidade Classe II/metabolismo , Hiperglicemia/fisiopatologia , Masculino , Camundongos , Retina/efeitos dos fármacos , Retina/metabolismo
10.
Diabetes Res Clin Pract ; 152: 1-8, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31078665

RESUMO

AIMS: It is known that autonomic nerve activity (ANA) affects glucose metabolism by regulating the secretion of insulin and glucagon. Sympathetic nerve stimulation results in increased blood glucose levels. ANA also showed a circadian variation, and sympathetic nerve activity was minimal at night and began to rise at arousal. Therefore, a drastic alteration in ANA around wake-up would be associated with glycemic variability (GV) known risk factor for cardiovascular disease. We investigated the relation between ANA around wake-up and either morning or daily GV. METHODS: We simultaneously performed Holter ECG and continuous glucose monitoring system in 41 patients with type 2 diabetes (T2D). ANA was assessed by heart rate variability (HRV) analysis. Delta (Δ) wake-up was defined as the difference between the maximum and minimum value during 1 h before and after wake-up time, before breakfast. RESULTS: Δ of low frequency/high frequency (LF/HF) around wake-up time (Δ LF/HF wake-up) was positively associated with Δ glucose wake-up, standard deviation (SD) glucose wake-up, the mean amplitude of glucose excursions (MAGE24h), and SD glucose24h after adjustment for age, sex, BMI, the duration of diabetes, and the prevalence of diabetic polyneuropathy (ß = 0.47, p = 0.011, ß = 0.48, p = 0.009, ß = 0.54, p = 0.002 and ß = 0.41, p = 0.0025, respectively). No association was found between Δ LF/HFwake-up and either mean blood glucose for 24 h, or HbA1c as parameters of chronic hyperglycemia. CONCLUSIONS: In T2D, the fluctuation in fasting sympathetic nerve activity around wake-up was positively associated with not only morning but also daily GV.


Assuntos
Nível de Alerta/fisiologia , Glicemia/metabolismo , Ritmo Circadiano/fisiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Frequência Cardíaca/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Idoso , Automonitorização da Glicemia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/metabolismo , Angiopatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Progressão da Doença , Eletrocardiografia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Fatores de Risco , Sistema Nervoso Simpático/metabolismo
11.
Rev Esp Med Nucl Imagen Mol ; 38(4): 224-228, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30987886

RESUMO

PURPOSE: To analyze epidemiological and anthropometric features of patients with brown adipose tissue (BAT) activation detected by fluorine18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). MATERIAL AND METHODS: From 2005 to 2017, 818 18F-FDG PET/CT studies positive for BAT detection were retrospectively included, 742 examinations performed on the adult population and 76 PET/CT on the pediatric population. A Chi-squared test was performed to compare features distribution between the adult and pediatric patients. RESULTS: Adults showed a higher rate of BAT detection in females (79% vs. 61%, P<0.001) and in hyperglycaemic patients (>100mg/dL) (24% vs. 16%, P=0.02), no significant difference was found with regard to overweight patients (BMI>25kg/m2) (22% vs. 20%, P=.55). Considering females only, the adults showed a higher rate of BAT detection both in hyperglycaemic (83% vs. 42%, P<0.001) and overweight patients (80% vs. 67%, P=0.005). In both populations BAT activation happened more frequently in cold seasons; there was no significant distribution difference with regard to season of birth (P=0.2). CONCLUSIONS: Sex, glycemia and BMI play a major role in predicting BAT activation, with significant differences between adults and pediatric patients. Cold exposure is confirmed as an important predicting factor, while season of birth is not significant.


Assuntos
Tecido Adiposo Marrom/diagnóstico por imagem , Envelhecimento/fisiologia , Temperatura Baixa , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Termogênese/fisiologia , Tecido Adiposo Marrom/fisiologia , Adiposidade , Adolescente , Adulto , Índice de Massa Corporal , Criança , Comorbidade , Feminino , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/fisiopatologia , Itália , Masculino , Especificidade de Órgãos , Sobrepeso/diagnóstico por imagem , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Parto , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Estações do Ano , Caracteres Sexuais
12.
BMC Res Notes ; 12(1): 207, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947749

RESUMO

OBJECTIVE: Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to identify predictors of poor glycemic control in patients with type 2 diabetes (T2D). A cross-sectional study was conducted among systematically selected 357 diabetic patients. Data were collected through direct patients' interviews and medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 22.0. RESULTS: Participants' mean age was (± SD) 56.1 ± 11.6 years. Nearly four in five (77.9%) of the participants had comorbidities, mainly of hypertension, and 60.2% had diabetic complications, mainly diabetes neuropathy. Poor glycemic control was found in 68.3% of the participants with a mean (± SD) FBG of 174.1 ± 48.9 mg/dL. Being female gender, having greater body mass index and low medication adherence was significantly associated with poor glycemic control. In conclusion, the overall aspects of glycemic control level of patients were far from the standards. Being female, greater body mass index and poor medication adherence were predictors of poor glycemic control. In response to this finding, an aggressive intervention that targets in improving the glycemic control is required.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Neuropatias Diabéticas/diagnóstico , Hiperglicemia/diagnóstico , Hipertensão/diagnóstico , Hipoglicemiantes/uso terapêutico , Adolescente , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/fisiopatologia , Etiópia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hiperglicemia/fisiopatologia , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Sexuais , Atenção Terciária à Saúde
13.
BMC Res Notes ; 12(1): 212, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961663

RESUMO

OBJECTIVE: To assess the self-care practices and associated factors among diabetic patients in West Ethiopia. RESULTS: A total of 252 study participants were included in the study, of this 54.8% were male. Of the participants more than half 150 (59.5%) had poor glycemic control and 153 (60.7%) of the participants had good self-care. Majority of the study participants 209 (82.9%) had adequate foot care and more than half 175 (69.4%) and 160 (63.5%) had adequate dietary plan and exercise management respectively. However of the total diabetic patients only 38 (15.1%) had adequate blood glucose testing practices. On multivariable logistic analysis poor self-care practices were more likely to occur among male patients (AOR = 5.551, 95% CI = 2.055-14.997, p = 0.001), patients living in rural area (AOR = 5.517, 95% CI = 2.184-13.938, p < 0.001), patients with duration of diabetes < 6 years (AOR = 41.023, 95% CI = 7.373-228.257, p < 0.001), patients with no access for self-monitoring blood glucose (AOR = 9.448, 95% CI = 2.198-40.617, p = 0.003), patients with poor knowledge about diabetes (AOR = 67.917, 95% CI = 8.212-561.686, p < 0.001) and patients with comorbidities (AOR = 18.621, 95% CI = 4.415-78.540, p < 0.001).


Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Diabetes Mellitus Tipo 2/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Hiperglicemia/diagnóstico , Hipoglicemiantes/uso terapêutico , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Etiópia , Feminino , Educação em Saúde/estatística & dados numéricos , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hiperglicemia/fisiopatologia , Modelos Logísticos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e Questionários
14.
Can J Diabetes ; 43(7): 510-514, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30930073

RESUMO

This overview deals with mechanisms whereby hyperglycemia-induced oxidative stress compromises vascular endothelial function and provides a background for a recently published study illustrating the beneficial impact of endothelial sodium-glucose cotransporter 2 (SGLT2) inhibitors in attenuating hyperglycemia-induced vascular dysfunction in vitro. The data provide new insight that can possibly lead to improved drug therapy for people with type 2 diabetes. The working hypotheses that underpinned the experiments performed are provided, along with the findings of the study. For the causes of hyperglycemia-induced vascular endothelial dysfunction, the findings point to the key roles of: 1) functional endothelial SGLT2; 2) oxidative stress-induced signalling pathways including mammalian sarcoma virus kinase, the EGF receptor-kinase and protein kinase C; and 3) mitochondrial dysfunction triggered by hyperglycemia was mitigated by an SGLT2 inhibitor in the hyperglycemic mouse aorta vascular organ cultures. The overview sums up the approaches implicated by the study that can potentially counteract the detrimental impact of hyperglycemia on vascular function in people with diabetes, including the clinical use of SGLT2 inhibitors for those with type 2 diabetes already being treated, for example, with metformin, along with dietary supplementation with broccoli-derived sulforaphane and tetrahydrobiopterin. The caveats associated with the study for extending the findings from mice to humans are summarized, pointing to the need to validate the work using vascular tissues from humans. Suggestions for future clinical studies are made, including the assessment of the impact of the therapeutic strategies proposed on measurements of blood flow in subjects with diabetes.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Hiperglicemia/fisiopatologia , Estresse Oxidativo/efeitos dos fármacos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Transportador 2 de Glucose-Sódio/química , Biomarcadores/análise , Biopterina/análogos & derivados , Biopterina/uso terapêutico , Glicemia/análise , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/metabolismo , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/metabolismo , Endotélio Vascular/patologia , Humanos , Incidência , Isotiocianatos/uso terapêutico , Prognóstico
15.
Sci Total Environ ; 668: 1004-1012, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31018442

RESUMO

Arsenic (As) toxicity and diabetes mellitus (DM) are emerging public health concerns worldwide. Although exposure to high levels of As has been associated with DM, whether there is also an association between low and moderate As exposure and DM remains unclear. We explored the dose-dependent association between As exposure levels and hyperglycemia, with special consideration of the impact of demographic variables, in 641 subjects from rural Bangladesh. The total study participants were divided into three groups depending on their levels of exposure to As in drinking water (low, moderate and high exposure groups). Prevalence of hyperglycemia, including impaired glucose tolerance (IGT) and DM was significantly associated with the subjects' drinking water arsenic levels. Almost all exposure metrics (As levels in the subjects' drinking water, hair and nails) showed dose-dependent associations with the risk of hyperglycemia, IGT and DM. Among the variables considered, sex, age, and BMI were found to be associated with higher risk of hyperglycemia, IGT and DM. In sex-stratified analyses, As exposure showed a clearer pattern of dose-dependent risk for hyperglycemia in females than males. Finally, drinking water containing low-to-moderate levels of As (50.01-150 µg/L) was found to confer a greater risk of hyperglycemia than safe drinking water (As ≤10 µg/L). Thus the results suggested that As exposure was dose-dependently associated with hyperglycemia, especially in females.


Assuntos
Intoxicação por Arsênico/complicações , Diabetes Mellitus/fisiopatologia , Exposição Ambiental , Hiperglicemia/fisiopatologia , Poluentes Químicos da Água/análise , Adulto , Arsênico/análise , Intoxicação por Arsênico/epidemiologia , Bangladesh/epidemiologia , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Suscetibilidade a Doenças , Água Potável/química , Feminino , Cabelo/química , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Unhas/química , Prevalência , Abastecimento de Água
16.
J Med Case Rep ; 13(1): 50, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30827279

RESUMO

BACKGROUND: Myxedema coma is profound decompensated hypothyroidism usually precipitated by stressors, and its occurrence in association with total thyroidectomy or metabolic disorders, such as diabetic ketoacidosis, is unusual. CASE PRESENTATION: A 43-year-old Asian man with history of total thyroidectomy who was scheduled for a second radioactive iodine therapy presented to our hospital with decreased mental status and hyperglycemia. He had a history of thyroid cancer but did not have diabetes mellitus. He was in a hypothermic state and had a Glasgow Coma Scale score of 10 out of 15 at presentation; arterial blood gas analysis revealed a state of metabolic acidosis and laboratory findings suggested hyperglycemia with glycosuria, ketoacidosis, and severe hypothyroidism. A thyroid function test showed thyroid-stimulating hormone of 34.126 uIU/mL, free thyroxine of 1.02 ng/dL, and triiodothyronine of 1.04 ng/mL. The glycated hemoglobin of this patient was checked due to hyperglycemia and the value of glycated hemoglobin was 16.5% which met the criteria for a diagnosis of diabetes. After treatment for myxedema with liothyronine 5 mcg two times per day and levothyroxine 175 mcg once daily via a nasogastric tube and diabetic ketoacidosis with intravenously administered fluid and insulin, his clinical condition rapidly improved including mental status, hyperglycemia, and acidosis. During the hospitalization, a workup for diabetes mellitus was performed and the results suggested that a diagnosis of type 2 diabetes mellitus would be appropriate. CONCLUSIONS: This case demonstrated that diabetic ketoacidosis not only could be a potential contributor to myxedema coma but also mask typical clinical features, making diagnosis more difficult. Considering the possibility of an increasing number of potential patients with hypothyroidism developed after thyroidectomy, constant vigilance is required for a better clinical outcome, including early recognition and management in critical care in advance for unusual diabetic ketoacidosis which could precipitate decompensated hypothyroidism.


Assuntos
Coma/fisiopatologia , Diabetes Mellitus Tipo 2/diagnóstico , Cetoacidose Diabética/fisiopatologia , Hiperglicemia/sangue , Mixedema/fisiopatologia , Tireoidectomia , Tiroxina/uso terapêutico , Tri-Iodotironina/uso terapêutico , Adulto , Gasometria , Coma/sangue , Coma/tratamento farmacológico , Coma/etiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cetoacidose Diabética/sangue , Cetoacidose Diabética/complicações , Cetoacidose Diabética/tratamento farmacológico , Hemoglobina A Glicada/metabolismo , Humanos , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Hipotireoidismo/etiologia , Masculino , Mixedema/sangue , Mixedema/tratamento farmacológico , Mixedema/etiologia , Testes de Função Tireóidea , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireotropina/sangue , Resultado do Tratamento
17.
Diabetes Res Clin Pract ; 150: 138-143, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30872063

RESUMO

AIM: Animal studies have suggested that acute hyperglycemia induces transient renal hypoxia and kidney damage, yet this has not been tested in humans. Therefore, we assessed in human subjects the effect of acute hyperglycemia on renal tissue oxygenation as measured with blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI). METHODS: In this single center prospective interventional study, healthy overweight subjects were recruited. BOLD-MRI was performed before and immediately after the intravenous administration of 0.15 g/kg of glucose in a 20% solution under standard hydration and fasting conditions. R2* maps were analyzed using the twelve layer concentric objects (TLCO) technique, a semi-automatic procedure which divides the kidney parenchyma in 12 equal layers at increasing depth. R2* is a measure of local desoxyhemoglobin concentrations, with high R2* values corresponding to low oxygenation. RESULTS: Nineteen overweight subjects were enrolled (age 37 ±â€¯10 years, BMI 28.9 ±â€¯3 kg/m2, HbA1c 5.4 ±â€¯0.3%, 57.9% women): 5 were glucose intolerant, none had diabetes. The mean glycemia rose from 4.5 ±â€¯0.3 mmol/l to 9.0 ±â€¯0.9, 8.9 ±â€¯0.7, 7.7 ±â€¯0.6 and 6.8 ±â€¯0.8 mmol/l at respectively 1, 10, 20 and 30 min after IV glucose. Circulating insulin levels quadrupled. The mean R2* values decreased significantly in all kidney layers, irrespective of glucose intolerance. The lower BMI, the larger the decrease in R2*(spearman's r = 0.41, p = 0.035). CONCLUSION: These data show that acute hyperglycemia decreases the R2* signal in humans, suggesting an acute increase in renal tissue oxygenation. The precise mechanism of this observation remains unknown, and whether this phenomenon also occurs in patients with diabetes needs additional studies.


Assuntos
Hiperglicemia/fisiopatologia , Rim/metabolismo , Imagem por Ressonância Magnética/métodos , Sobrepeso/fisiopatologia , Consumo de Oxigênio , Oxigênio/metabolismo , Adulto , Feminino , Voluntários Saudáveis , Humanos , Rim/fisiopatologia , Masculino , Estudos Prospectivos
18.
J Am Soc Nephrol ; 30(4): 578-593, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30867247

RESUMO

BACKGROUND: Glomerular hyperfiltration is common in early diabetes and is considered a risk factor for later diabetic nephropathy. We propose that sodium-glucose cotransporter 1 (SGLT1) senses increases in luminal glucose at the macula densa, enhancing generation of neuronal nitric oxide synthase 1 (NOS1)-dependent nitric oxide (NO) in the macula densa and blunting the tubuloglomerular feedback (TGF) response, thereby promoting the rise in GFR. METHODS: We used microperfusion, micropuncture, and renal clearance of FITC-inulin to examine the effects of tubular glucose on NO generation at the macula densa, TGF, and GFR in wild-type and macula densa-specific NOS1 knockout mice. RESULTS: Acute intravenous injection of glucose induced hyperglycemia and glucosuria with increased GFR in mice. We found that tubular glucose blunts the TGF response in vivo and in vitro and stimulates NO generation at the macula densa. We also showed that SGLT1 is expressed at the macula densa; in the presence of tubular glucose, SGLT1 inhibits TGF and NO generation, but this action is blocked when the SGLT1 inhibitor KGA-2727 is present. In addition, we demonstrated that glucose increases NOS1 expression and NOS1 phosphorylation at Ser1417 in mouse renal cortex and cultured human kidney tissue. In macula densa-specific NOS1 knockout mice, glucose had no effect on NO generation, TGF, and GFR. CONCLUSIONS: We identified a novel mechanism of acute hyperglycemia-induced hyperfiltration wherein increases in luminal glucose at the macula densa upregulate the expression and activity of NOS1 via SGLT1, blunting the TGF response and promoting glomerular hyperfiltration.


Assuntos
Glucose/metabolismo , Hiperglicemia/fisiopatologia , Glomérulos Renais/fisiopatologia , Túbulos Renais Distais/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Transportador 1 de Glucose-Sódio/metabolismo , Animais , Retroalimentação Fisiológica , Taxa de Filtração Glomerular , Glucosídeos/farmacologia , Humanos , Inulina/metabolismo , Glomérulos Renais/metabolismo , Túbulos Renais Distais/fisiopatologia , Masculino , Camundongos , Camundongos Knockout , Óxido Nítrico/biossíntese , Óxido Nítrico Sintase Tipo I/genética , Fosforilação , Pirazóis/farmacologia , Transdução de Sinais , Transportador 1 de Glucose-Sódio/antagonistas & inibidores
19.
Endocrinology ; 160(5): 1247-1261, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30874792

RESUMO

Much effort has been directed at studying the orexigenic actions of administered ghrelin and the potential effects of the endogenous ghrelin system on food intake, food reward, body weight, adiposity, and energy expenditure. Although endogenous ghrelin's actions on some of these processes remain ambiguous, its glucoregulatory actions have emerged as well-recognized features during extreme metabolic conditions. The blood glucose-raising actions of ghrelin are beneficial during starvation-like conditions, defending against life-threatening falls in blood glucose, but they are seemingly detrimental in obese states and in certain monogenic forms of diabetes, contributing to hyperglycemia. Also of interest, blood glucose negatively regulates ghrelin secretion. This article reviews the literature suggesting the existence of a blood glucose-ghrelin axis and highlights the factors that mediate the glucoregulatory actions of ghrelin, especially during metabolic extremes such as starvation and diabetes.


Assuntos
Glicemia/metabolismo , Ingestão de Alimentos/efeitos dos fármacos , Grelina/metabolismo , Grelina/farmacologia , Adiposidade/efeitos dos fármacos , Adiposidade/fisiologia , Animais , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Ingestão de Alimentos/fisiologia , Metabolismo Energético/efeitos dos fármacos , Metabolismo Energético/fisiologia , Grelina/sangue , Humanos , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Obesidade/sangue , Obesidade/fisiopatologia
20.
Pak J Pharm Sci ; 32(1(Supplementary)): 327-331, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30829211

RESUMO

Diabetic cardiomyopathy (DC) is a serious complication of diabetes. Apoptosis, inflammatory and ROS production are among the factors that are involved in the progression of diabetic cardiomyopathy. 6-shogaol is reported to inhibit apoptosis and reduce inflammatory and ROS production. This study aimed to study the effect of 6-shogaol (6S) on the progression of diabetic cardiomyopathy in vitro. To develop DC model, H9c2 cell line was exposed to high glucose (HG) level (33 M glucose) for 24 h and used as a model for diabetic cardiomyopathy. Another set of H9c2 cell lines were 1 h pretreated with different conc. of 6-shogaol (5-20 µM). Cell viability, apoptosis, ROS production, IL-6, TNF-alpha and NF-κB were estimated in these cell lines treated with HG level or pretreated with 6-shgoal before HG. Exposing cardiomyocytes H9c2 cells to HG produced dramatic changes in cell biology and chemistry. There is a significant reduction in cell viability and enhancement in cell apoptosis as compared with control. In addition, ROS production, IL-6, TNF-α levels were increased in H9c2 line treated with HG. Also, there is overexpression of NF-κB in cells treated with HG levels alone. On the other hand, pretreatment of cardiomyocytes H9c2 cells with 6-shogaol (5-20µM) significantly improved cell viability and reduced apoptosis, in addition, 6S at a dose of 10 µM abrogated the deleterious effects of HG on oxidative stress and inflammatory parameters via modulation of NF-κB pathway. Therefore, 6S has a potential protective effect against hyperglycemia-induced DC in vitro.


Assuntos
Cardiotônicos/farmacologia , Catecóis/farmacologia , Hiperglicemia/fisiopatologia , Miócitos Cardíacos/efeitos dos fármacos , NF-kappa B/metabolismo , Animais , Apoptose/efeitos dos fármacos , Caspase 3/metabolismo , Linhagem Celular , Sobrevivência Celular , Cardiomiopatias Diabéticas/fisiopatologia , Interleucina-6/metabolismo , Medições Luminescentes/métodos , Miócitos Cardíacos/metabolismo , NF-kappa B/antagonistas & inibidores , Ratos , Espécies Reativas de Oxigênio/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA