Low triglyceride levels are associated with a better metabolic control in patients with type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>Although it is well known in the literature that high triglyceride serum (TG) levels can jeopardize the metabolic control, little is known about the influence of low TG on type 1 diabetes patients (T1D). The aim of this study is to investigate the distribution of TG serum levels in individuals with T1D and its relationship with metabolic control.</p> <p>Findings</p> <p>We reviewed the medical charts of 180 patients with T1D, who were classified in groups according to TG levels: 1) low (below 50 mg/dL); 2) normal (50-150 mg/dL); 3) high (above 150 mg/dL). TG were low in 21.1% (n = 38; group 1), normal in 68.6% (n = 123; group 2) and high in 10.6% (n = 19; group 3). High TG was associated with a poor metabolic control (p < 0.001). Patients with TG lower than 50 mg/dL had a lower HbA1c than those with TG between 50 and 150 mg/dL (7.41+/-1.50% vs 8.56%+/-1.94%; p = 0.002).</p> <p>Conclusion</p> <p>TG lower than 50 mg/dL was common and might be associated with a better metabolic control in patients with T1D, although it is not clear whether the former is the cause or consequence for the latter.</p

NK Cells and Type 1 Diabetes

Type 1 diabetes (T1D) is characterized by an immuno-mediated progressive destruction of the pancreatic β cells. Due to the ability of NK cells to kill target cells as well as to interact with antigen-presenting and T cells, it has been suggested that they could be involved in one or multiple steps of the immune-mediated attack that leads to T1D. Abnormalities in the frequency and activity of NK cells have been described both in animal models and patients with T1D. Some of these alterations are linked to its onset while others seem to be a consequence of the disease. Here, we discuss the main characteristics of NK cells and review the studies that investigated the role of NK cells in T1D, both in mouse models and humans

Revisão da hiperglicemia pós-prandial e a hipoglicemia no controle do diabetes mellitus: o papel da insulina lispro e suas pré-misturas nos picos e vales

Correction of post-prandial hyperglycemia is increasingly becoming important to patients with diabetes type 1 (DM1) and type 2 (DM2) in order to reduce their risk of morbidity and mortality. Epidemiological studies have indicated that there is a strong relationship between the degree of glycemic control, determined by HbA1c levels, and the frequency of cardiovascular events and mortality. Acute hyperglycemia has been implicated as a contributed factor for increasing the incidence of myocardial infarction, cardiac mortality and in the genesis of the microangiopathic complications. Intensive treatment, usually involving multiple insulin injections, and tight glucose control have been suggested by trials as DCCT, Kumamoto and UKPDS as the ideal treatment in patients with DM in order to prevent chronic diabetic complications. However, intensive treatment may lead to an increased incidence of hypoglycemic episodes, including severe hypoglycemia, which can be a limiting factor for achievement of optimal metabolic control. Ideal agents to treat DM should improve the postprandial and global glycemic control with no increased or less risk of hypoglycemia. We revise the clinical profile of a rapid-acting human insulin analogue, insulin lispro, and of a new long-acting analog insulin lispro NPL and fixed mixtures of insulin lispro and NPL (insulin lispro Mix25 and insulin lispro Mix50). Lispro mixtures, like insulin lispro itself, reduce the postprandial glucose rise compared to human insulin NPH or mixtures of similar ratios with equivalent doses of the insulin. Additionally insulin lispro, lispro Mix25 and Mix50 decrease the risk of hypoglycemia associated with human insulin preparations, particularly nocturnal episodes. Insulin lispro Mix25 may be a good therapy for DM1 or DM2 who are currently taking a similar ratio of short- to intermediate-acting insulin, using NPH alone, or experiencing inadequate control on oral antidiabetic agents.A correção da hiperglicemia pós-prandial está ganhando importância cada vez maior em pacientes com diabetes tipo 1 (DM1) e tipo 2 (DM2) na redução do risco de morbidade e mortalidade. Estudos epidemiológicos têm indicado que há uma relação forte entre o grau de controle glicêmico, determinado pelos níveis de HbA1c, e a freqüência de eventos cardiovasculares e mortalidade. Neste contexto, a hiperglicemia aguda tem sido implicada como um fator contribuinte para maior incidência de infarto do miocárdio, mortalidade cardíaca e na gênese de complicações microangiopáticas. Tratamento intensivo, geralmente envolvendo múltiplas injeções, e controle glicêmico estrito foram sugeridos pelos estudos DCCT, Kumamoto e UKPDS como o tratamento ideal em pacientes com DM para prevenir as complicações crônicas. Entretanto, o tratamento intensivo pode levar a uma maior incidência de episódios hipoglicêmicos, incluindo hipoglicemia severa, que pode ser um fator limitante para o atingimento de um bom controle metabólico. Agentes ideais para tratar o DM devem melhorar o controle glicêmico pós-prandial e global sem aumentar ou reduzindo o risco de hipoglicemia. Revisamos o perfil clínico de um análogo ultra-rápido da insulina humana, insulina lispro, e um novo análogo de longa duração insulina lispro NPL e as pré-misturas de insulina lispro e NPL (insulina lispro Mix25 e insulina lispro Mix50). As pré-misturas de lispro, assim com a insulina lispro, reduzem o incremento da glicemia pós-prandial comparado à insulina humana NPH ou pré-misturas de insulina humana em doses equivalentes. Adicionalmente, a insulina lispro, lispro Mix25 e lispro Mix50 reduzem o risco de hipoglicemia associado às preparações das insulinas humanas, principalmente os episódios noturnos. Insulina lispro Mix25 pode ser um bom tratamento para pacientes com DM1 ou DM2, que estejam atualmente em uso de uma pré-mistura de insulina humana de razão insulina ação curta/intermediária semelhante, de NPH isoladamente, ou com controle inadequado com agentes anti-diabéticos orais

Relato de caso: diabetes Flatbush - da cetoacidose ao tratamento não-farmacológico

Um subgrupo de pacientes, em sua maioria negros ou hispânicos e obesos, tem a cetoacidose diabética (CAD) como forma de apresentação de diabetes mellitus (DM), mas, devido à sua evolução clínica, posteriormente é classificado como DM tipo 2. Estes indivíduos têm pesquisa de auto-anticorpos anti-GAD, anti-IA2 e anti-insulina negativa, mas freqüentemente em associação com HLA classe II de risco para DM tipo 1 (DRB1*03 e/ou DRB1*04). Este subtipo peculiar de DM é denominado diabetes flatbush. Neste artigo, relatamos o caso de uma paciente de origem caucasiana com tais características, na qual foi possível retirada da insulinoterapia. Os possíveis fatores associados a esta evolução favorável serão discutidos