21 research outputs found
Blood-based analysis of type-2 diabetes mellitus susceptibility genes identifies specific transcript variants with deregulated expression and association with disease risk
Despite significant progress by genome-wide association studies, the ability of genetic variants to conduce to the prediction or prognosis of type-2 diabetes (T2D) is weak. Expression analysis of the corresponding genes may suggest possible links between single-nucleotide polymorphisms and T2D phenotype and/or risk. Herein, we investigated the expression patterns of 24 T2D-susceptibility genes, and their individual transcript variants (tv), in peripheral blood of T2D patients and controls (CTs), applying RNA-seq and real-time qPCR methodologies, and explore possible associations with disease features. Our data revealed the deregulation of certain transcripts in T2D patients. Among them, the down-regulation of CAPN10 tv3 was confirmed as an independent predictor for T2D. In patients, increased expression of CDK5 tv2, CDKN2A tv3 or THADA tv5 correlated positively with serum insulin levels, of CDK5 tv1 positively with % HbA1c levels, while in controls, elevated levels of TSPAN8 were associated positively with the presence of T2D family history. Herein, a T2D-specific expression profile of specific transcripts of disease-susceptibility genes is for the first time described in human peripheral blood. Large-scale studies are needed to evaluate the potential of these molecules to serve as disease biomarkers
Insulin action in morbid obesity: a focus on muscle and adipose tissue
The aim of this review is to summarize the mechanisms underlying insulin
resistance in morbid obesity. Glucose regulation by insulin depends on
the suppression of endogenous glucose production and stimulation of
glucose disposal. In morbid obesity, glucose production by the liver is
increased. Moreover, the sensitivity of glucose metabolism to insulin is
impaired both in muscle (due to defects in insulin-stimulated glucose
utilization and decreased blood flow) and in adipose tissue (due to
decreased blood flow). However, recent studies suggest that expanded
total fat mass becomes a major consumer of glucose providing a sink for
glucose and compensating for insulin resistance. Metabolism and immunity
are closely linked. Bearing in mind the crosstalk between inflammatory
pathways and the insulin signaling cascade, adipose tissue derived
cytokines may represent a link between inflammation and metabolic
signals and mediate, at least in part, insulin resistance. Adipose
tissue plays a crucial role by buffering daily influx of dietary fat,
suppressing the release of non-esterified fatty acids into the
circulation and increasing triacylglycerol clearance. However, in morbid
obesity there is an impairment of the normal ability of adipose tissue
to buffer fatty acids, despite hyperinsulinemia. Lipotoxicity gradually
impairs insulin action in the liver and muscle, aggravating insulin
resistance
Thyroid disease in older people
Several changes in thyroid hormone secretion, metabolism, and action
occur with the increase in age. Aging is often associated with a
decrease in serum thyroid stimulating hormone and 13 levels, whereas
serum free T4 levels usually remain unchanged. The prevalence of thyroid
dysfunction is higher in the elderly as compared to the younger
population. In elderly individuals the non-specific clinical
manifestations of thyroid hormone excess or deprivation can cause
confusion in the clinical setup: while some of the symptoms of thyroid
disease are similar to those in younger patients, it is not uncommon for
both hyperthyroidism and hypothyroidism to be manifested in subtle ways
in older patients, often mimicking symptoms of aging or masquerading as
diseases of the cardiovascular, gastrointestinal, or nervous system. In
addition, diagnosis of thyroid disorders is commonly complicated, due to
chronic, non-thyroidal illness or medication therapy. Early diagnosis
and treatment of overt thyroid disorders is crucial, since these
disorders are associated with increased morbidity and mortality in the
elderly, usually due to common coexistent diseases such as diminished
cardiovascular reserve. Treatment of subclinical thyroid disease should
also be considered, based on a combination of age, symptoms and risk
factors in the individual patients. In addition, both prevalence and
aggressiveness of thyroid cancer increase with age. This review
summarizes the changes of thyroid function, as well as the clinical
manifestations and treatment of thyroid disorders with advancing age.
(C) 2011 Elsevier Ireland Ltd. All rights reserved
Insulin Action in Hyperthyroidism: A Focus on Muscle and Adipose Tissue
Hyperthyroidism leads to an enhanced demand for glucose, which is
primarily provided by increased rates of hepatic glucose production due
to increased gluconeogenesis (in the fasting state) and increased Cori
cycle activity (in the late postprandial and fasting state). Adipose
tissue lipolysis is increased in the fasting state, resulting in
increased production of glycerol and nonesterified fatty acids. Under
these conditions, increased glycerol generated by lipolysis and
increased amino acids generated by proteolysis are used as substrates
for gluconeogenesis. Increased nonesterified fatty acid levels are
necessary to stimulate gluconeogenesis and provide substrate for
oxidation in other tissues (such as muscle). In the postprandial period,
insulin-stimulated glucose uptake by the skeletal muscle has been found
to be normal or increased, mainly due to increased blood flow. Under
hyperthyroid conditions, insulin-stimulated rates of glycogen synthesis
in skeletal muscle are decreased, whereas there is a preferential
increase in the rates of lactate formation vs. glucose oxidation leading
to increased Cori cycle activity. In hyperthyroidism, the Cori cycle
could be considered as a large substrate cycle; by maintaining a high
flux through it, a dynamic buffer of glucose and lactate is provided,
which can be used by other tissues as required. Moreover, lipolysis is
rapidly suppressed to normal after the meal to facilitate the disposal
of glucose by the insulin-resistant muscle. This ensures the
preferential use of glucose when available and helps to preserve fat
stores. (Endocrine Reviews 31: 663-679, 2010
Insulin effects in muscle and adipose tissue
The major effects of insulin on muscle and adipose tissue are: (1)
Carbohydrate metabolism: (a) it increases the rate of glucose transport
across the cell membrane, (b) it increases the rate of glycolysis by
increasing hexokinase and 6-phosphofructokinase activity, (c) it
stimulates the rate of glycogen synthesis and decreases the rate of
glycogen breakdown. (2) Lipid metabolism: (a) it decreases the rate of
lipolysis in adipose tissue and hence lowers the plasma fatty acid
level, (b) it stimulates fatty acid and triacylglycerol synthesis in
tissues, (c) it increases the uptake of triglycerides from the blood
into adipose tissue and muscle, (d) it decreases the rate of fatty acid
oxidation in muscle and liver. (3) Protein metabolism: (a) it increases
the rate of transport of some amino acids into tissues, (b) it increases
the rate of protein synthesis in muscle, adipose tissue, liver, and
other tissues, (c) it decreases the rate of protein degradation in
muscle (and perhaps other tissues).
These insulin effects serve to encourage the synthesis of carbohydrate,
fat and protein, therefore, insulin can be considered to be an anabolic
hormone. (C) 2011 Elsevier Ireland Ltd. All rights reserved
Increases in muscle blood flow after a mixed meal are impaired at all stages of type 2 diabetes
Objective In type 2 diabetes, although the impairment of postprandial
muscle blood flow response is well established, information on the
effect of this impairment on glucose uptake and lipid metabolism is
controversial. Design Postprandial forearm blood flow responses and
metabolic parameters were assessed in a cross-sectional study of
subjects at various stages of insulin resistance. Patients Eleven
healthy subjects (CONTROLS), 11 first-degree relatives of type-2
diabetics (RELATIVES), 10 patients with impaired glucose tolerance
(IGT), 10 diabetic patients with postprandial hyperglycaemia (DMA), and
13 diabetic patients with both fasting and postprandial hyperglycaemia
(DMB). Measurements All subjects received a meal. Blood was drawn from a
forearm deep vein and the radial artery at specific time-points during a
period of 360 min for measurements of glucose, insulin, triglycerides
and nonesterified-fatty acids. Forearm muscle blood flow was measured
with strain-gauge plethysmography. Glucose uptake and ISI Index were
calculated. Results Peak-baseline muscle blood flow was higher in
CONTROLS (3.32 +/- 0.4) than in RELATIVES (0.53 +/- 0.29), IGT (0.82 +/-
0.2), DMA (1.44 +/- 0.34), DMB (1.23 +/- 0.35 ml/min/100 ml tissue), P <
0.001. Glucose uptake (AUC0-360,mu mol/100 ml tissue) was higher in
CONTROLS (1023 +/- 132) than in RELATIVES (488 +/- 42), IGT (458 +/-
43), DMA (347 +/- 63), DMB (543 +/- 53), P < 0.001. ISI index,
postprandial triglycerides and nonesterified-fatty acids behaved in a
similar way. Peak-baseline muscle blood flow correlated positively with
glucose uptake (r = 0.440, P = 0.001) and ISI index (r = 0.397, P =
0.003), and negatively with postprandial triglycerides (r = -0.434, P =
0.001) and nonesterified-fatty acids (r = -0.370, P = 0.005).
Conclusions These results suggest that increase in muscle blood flow
after a meal is impaired at all stages of type-2 diabetes. This defect
influences glucose uptake and is associated with impaired lipid
metabolism in the postprandial state
Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes
Background and Aims. Vinegar has been shown to have a glucose-lowering effect in patients with glucose abnormalities. However, the mechanisms of this effect are still obscure. The aim of this randomised, crossover study was to investigate the effect of vinegar on glucose metabolism in muscle which is the most important tissue for insulin-stimulated glucose disposal. Materials and Methods. Eleven subjects with DM2 consumed vinegar or placebo (at random order on two separate days, a week apart), before a mixed meal. Plasma glucose, insulin, triglycerides, nonesterified fatty acids (NEFA), and glycerol were measured preprandially and at 30–60 min for 300 min postprandially from the radial artery and from a forearm vein. Muscle blood flow was measured with strain-gauge plethysmography. Glucose uptake was calculated as the arteriovenous difference of glucose multiplied by blood flow. Results. Vinegar compared to placebo (1) increased forearm glucose uptake (p=0.0357), (2) decreased plasma glucose (p=0.0279), insulin (p=0.0457), and triglycerides (p=0.0439), and (3) did not change NEFA and glycerol. Conclusions. In DM2 vinegar reduces postprandial hyperglycaemia, hyperinsulinaemia, and hypertriglyceridaemia without affecting lipolysis. Vinegar’s effect on carbohydrate metabolism may be partly accounted for by an increase in glucose uptake, demonstrating an improvement in insulin action in skeletal muscle. This trial is registered with Clinicaltrials.gov NCT02309424