1,315 research outputs found
Big data and diabetes: the applications of big data for diabetes care now and in the future
Aims: Review the current applications of Big Data in diabetes care and consider the future potential.
Methods: Scoping study of the academic literature on Big Data and diabetes care.
Results: Healthcare data are being produced at ever-increasing rates, and this information has the potential to transform the provision of diabetes care. Big Data is beginning to have an impact on diabetes care through data research. The use of Big Data for routine clinical care is still a future application.
Conclusions: Vast amounts of healthcare data are already being produced, and the key is harnessing these to produce actionable insights. Considerable development work is required to achieve these goals
The glucose triad and its role in comprehensive glycaemic control: current status, future management
The prevalence of type 2 diabetes across the world has been described as a global pandemic. Despite significant efforts to limit both the increase in the number of cases and the long-term impact on morbidity and mortality, the total number of people with diabetes is projected to continue to rise and most patients still fail to achieve adequate glycaemic control. Optimal management of type 2 diabetes requires an understanding of the relationships between glycosylated haemoglobin (HbA1c), fasting plasma glucose and postprandial glucose (the glucose triad), and how these change during development and progression of the disease. Early and sustained control of glycaemia remains important in the management of type 2 diabetes. The contribution of postprandial glucose levels to overall glycaemic control and the role of postprandial glucose targets in disease management are currently debated. However, many patients do not reach HbA1C targets set according to published guidelines. As recent data suggest, if driving HbA1C down to lower target levels is not the answer, what other factors involved in glucose homeostasis can or should be targeted? Has the time come to change the treatment paradigm to include awareness of the components of the glucose triad, the existence of glucose variability and their potential influence on the choice of pharmacological treatment? It is becomingly increasingly clear that physicians are likely to have to consider plasma glucose levels both after the overnight fast and after meals as well as the variability of glucose levels, in order to achieve optimal glycaemic control for each patient. When antidiabetic therapy is initiated, physicians may need to consider selection of agents that target both fasting and postprandial hyperglycaemia
Hypothesis: the "metabolic memory" - the new challenge of diabetes
W duĆŒych randomizowanych badaniach wykazano,
ĆŒe intensywne wyrĂłwnywanie glikemii od samego
poczÄ
tku po rozpoznaniu cukrzycy zmniejsza ryzyko
rozwoju powikĆaĆ cukrzycy zarĂłwno mikro-, jak
i makroangiopatii. Jednak wyniki badaĆ epidemiologicznych
i dane prospektywne wskazujÄ
, ĆŒe wpĆyw
kontroli metabolicznej we wczesnej fazie na efekty
kliniczne jest dĆugofalowy. To zjawisko okreĆlono
ostatnio jako "pamiÄÄ metabolicznÄ
". Do potencjalnych
mechanizmĂłw propagacji tej "pamiÄci" naleĆŒÄ
nieenzymatyczna glikacja biaĆek i lipidĂłw komĂłrkowych
oraz nadmiar reaktywnego tlenu i azotu w komĂłrce,
w szczegĂłlnoĆci powstajÄ
cy na poziomie
glikowanych biaĆek mitochondriĂłw, ktĂłre prawdopodobnie
wspĂłĆdziaĆajÄ
w celu utrzymania procesĂłw
sygnaĆowania w komĂłrce. SformuĆowanie teorii
"pamiÄci metabolicznej" wskazuje na koniecznoĆÄ
wczesnego intensywnego leczenia cukrzycy, ktĂłrego
celem jest normalizacja glikemii, oraz wĆÄ
czania
do terapii substancji redukujÄ
cych reaktywne zwiÄ
zki
w komĂłrkach oraz zmniejszajÄ
cych glikacjÄ, aby
zminimalizowaÄ odlegĆe powikĆania tej choroby.Large randomized studies have established that early
intensive glycaemic control reduces the risk of diabetic
complications, both micro- and macrovascular.
However, epidemiological and prospective data
support a long-term influence of early metabolic
control on clinical outcomes. This phenomenon has
recently been defined as 'metabolic memory'. Potential
mechanisms for propagating this 'memory'
are the non-enzymatic glycation of cellular proteins
and lipids, and an excess of cellular reactive oxygen
and nitrogen species, in particular originated at the
level of glycated-mitochondrial proteins, perhaps
acting in concert with one another to maintain stress
signalling. Furthermore, the emergence of this 'metabolic
memory' suggests the need for very early
aggressive treatment aiming to 'normalize' glycaemic
control and the addition of agents which reduce
cellular reactive species and glycation in order to
minimize long-term diabetic complications
Natural history and risk factors for diabetic kidney disease in patients with T2D: lessons from the AMD-annals
The Associazione Medici Diabetologi (AMD) annals initiative is an ongoing observational survey promoted by AMD. It is based on a public network of about 700 Italian diabetes clinics, run by specialists who provide diagnostic confirmation and prevention and treatment of diabetes and its complications. Over the last few years, analysis of the AMD annals dataset has contributed several important insights on the clinical features of type-2 diabetes kidney disease and their prognostic and therapeutic implications. First, non-albuminuric renal impairment is the predominant clinical phenotype. Even though associated to a lower risk of progression compared to overt albuminuria, it contributes significantly to the burden of end-stage renal disease morbidity. Second, optimal blood pressure control provides significant but incomplete renal protection. It reduces albuminuria but there may be a J curve phenomenon with eGFR at very low blood pressure values. Third, hyperuricemia and diabetic hyperlipidemia, namely elevated triglycerides and low HDL cholesterol, are strong independent predictors of chronic kidney disease (CKD) onset in diabetes, although the pathogenetic mechanisms underlying these associations remain uncertain. Fourth, the long-term intra-individual variability in HbA1c, lipid parameters, uric acid and blood pressure plays a greater role in the appearance and progression of CKD than the absolute value of each single variable. These data help clarify the natural history of CKD in patients with type 2 diabetes and provide important clues for designing future interventional studies
Increased glycation and oxidative damage to apolipoprotein B100 of LDL cholesterol in patients with type 2 diabetes and effect of metformin
OBJECTIVE The aim of this study was to investigate whether apolipoprotein B100 of LDL suffers increased damage by glycation, oxidation, and nitration in patients with type 2 diabetes, including patients receiving metformin therapy.
RESEARCH DESIGN AND METHODS For this study, 32 type 2 diabetic patients and 21 healthy control subjects were recruited; 13 diabetic patients were receiving metformin therapy (median dose: 1.50 g/day). LDL was isolated from venous plasma by ultracentrifugation, delipidated, digested, and analyzed for protein glycation, oxidation, and nitration adducts by stable isotopic dilution analysis tandem mass spectrometry.
RESULTS Advanced glycation end product (AGE) content of apolipoprotein B100 of LDL from type 2 diabetic patients was higher than from healthy subjects: arginine-derived AGE, 15.8 vs. 5.3 mol% (P < 0.001); and lysine-derived AGE, 2.5 vs. 1.5 mol% (P < 0.05). Oxidative damage, mainly methionine sulfoxide residues, was also increased: 2.5 vs. 1.1 molar equivalents (P < 0.001). 3-Nitrotyrosine content was decreased: 0.04 vs. 0.12 mol% (P < 0.05). In diabetic patients receiving metformin therapy, arginine-derived AGE and methionine sulfoxide were lower than in patients not receiving metformin: 19.3 vs. 8.9 mol% (P < 0.01) and 2.9 vs. 1.9 mol% (P < 0.05), respectively; 3-nitrotyrosine content was higher: 0.10 vs. 0.03 mol% (P < 0.05). Fructosyl-lysine residue content correlated positively with fasting plasma glucose. Arginine-derived AGE residue contents were intercorrelated and also correlated positively with methionine sulfoxide.
CONCLUSIONS Patients with type 2 diabetes had increased arginine-derived AGEs and oxidative damage in apolipoprotein B100 of LDL. This was lower in patients receiving metformin therapy, which may contribute to decreased oxidative damage, atherogenicity, and cardiovascular disease
Managing weight and glycaemic targets in people with type 2 diabetesâHow far have we come?
Introduction: As the vast majority of people with type 2 diabetes (T2D) are also overweight or obese, healthcare professionals (HCP) are faced with the task of addressing both weight management and glucose control. In this narrative review, we aim to identify the challenges of reaching and maintaining body weight targets in people with T2D and highlight current and future treatment interventions. Methods: A search of the PubMed database was conducted using the search terms âdiabetesâ and âweight loss.â. Results: According to emerging evidence, treating obesity may be antecedent to the development and progression of T2D. While clinical benefits typically set in upon achieving a weight loss of 3â5%, these benefits are progressive leading to further health improvements, and weight loss of >15% can have a disease-modifying effect in people with T2D, an outcome that up to recently could not be achieved with any blood glucose-lowering pharmacotherapy. However, advanced treatment options with weight-loss effects currently in development including the dual GIP/GLP-1 receptor agonists may enable simultaneous achievement of individual glycemic and weight goals. Conclusion: Despite considerable therapeutic progress, there is still a large unmet medical need in patients with T2D who miss their individualized glycemic and weight-loss targets. Nonetheless, it is to be expected that development of future therapies and their use will favourably change the scenario of weight and glucose control in T2D
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