Quality of life and treatment satisfaction in adults with Type 1 diabetes: A comparison between continuous subcutaneous insulin infusion and multiple daily injections

Aims: The aim of this case-control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Methods: Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF-36 Health Survey (SF-36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio. Results: Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA1c were similar. Of control subjects, 90% followed glargine-based MDI regimens and 10% used NPH-based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions (β = 5.96; P < 0.0001), daily hassles (β = 3.57; P = 0.01) and fears about hypoglycaemia (β = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score (β = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine- or NPH-based MDI regimens. Conclusions: This large, non-randomized, case-control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine-based or NPH-based MDI regimens. © 2008 The Authors

The metabolic response to the activation of the beta-adrenergic receptor by salbutamol is amplified by acylated ghrelin.

BACKGROUND: It is well recognized that beta-adrenergic receptors mediate important endocrine and metabolic actions. In fact, beta-adrenergic receptor activation negatively influences GH secretion while exerting relevant metabolic actions such as the stimulation of insulin secretion, glycogenolysis, and lipolysis. AIM: We have already shown that the activation of the GH secretagogue receptor (GHS-R)-1a by acylated ghrelin (AG) counteracts the inhibitory effect of salbutamol (SALB), a beta2-adrenergic agonist, on GH release. The aim of the present study in humans was to clarify whether the metabolic response to SALB is affected by the infusion of AG, also known to exert significant metabolic actions. METHODS: Six healthy young male volunteers underwent the following testing sessions in random order at least 5 days apart: a) SALB (0.06 microg/kg/min iv from 0 to 60 min) alone; b) SALB in combination with AG (1.0 microg/kg/min iv from -60 to 60 min); c) isotonic saline. Insulin, glucose, and free fatty acids (FFA) levels were evaluated every 15 min. RESULTS: As expected, with respect to saline, SALB administration tended to increase both insulin secretion [Delta area under the curve (DeltaAUC): 0.16+/-0.09 vs 0.003+/-0.077 x 10(3) microU/ml/min; p>0.05] and FFA levels (DeltaAUC: 8.0+/-7.3 vs -4.0+/-4.0 mEq/l/min; p>0.05), while glucose levels did not change. The metabolic response to SALB was significantly modified under the exposure of AG. In fact, under AG infusion, SALB elicited a more marked increase of FFA (DeltaAUC: 22.3+/-3.2 vs 8.0+/-7.3 mEq/l/min; p0.05). Under AG, the baseline glucose levels were more elevated but, again, in combination with AG, SALB did not significantly modify glucose levels. CONCLUSIONS: Beta-adrenergic receptors and AG are likely to interact at the metabolic level. In humans, the lypolitic response to a beta2-adrenergic agonist such as SALB is amplified by AG. Meanwhile, during the co-treatment, the marginal insulinotropic effect was not associated with an increase in glycemia

Circulating obestatin levels in normal and Type 2 diabetic subjects.

BACKGROUND: Obestatin has been discovered as a new product of the ghrelin gene. Its physiological actions are still a matter of debate, but it seems that this peptide is likely to be involved in the control of insulin secretion and action as well as of adipocyte function. It has been already shown that obestatin secretion in humans is negatively modulated by food intake. AIM: To clarify obestatin secretion in normal subjects and in patients with Type 2 diabetes (T2D) in basal conditions and after a standardized meal. SUBJECTS/METHODS: Five normal subjects and 5 T2D patients were studied during infusion of saline (iv for over 5 h from -120 to +180 min). A standardized lunch was served at 0 min. Obestatin, glucose, and insulin levels were assayed at -120, -90, -60, -45, -30, -15, 0, 15, 30, 45, 60, 90, 120, 150, and 180 min. RESULTS: From -120 to 0 min, obestatin levels in normal and T2D subjects were similar (area under the curve: 32.3+/-5.6 pg/ml/min vs 31.1+/-1.0 pg/ml/min). After the meal, circulating obestatin levels underwent a clear decrease in normal subjects (0 min: 300.6+/-34.7 pg/ml vs nadir at 60 min: 161.8+/-29.4 pg/ml; p=0.002) but not in diabetic patients (0 min: 267.2+/-16.5 pg/ml vs nadir at 180 min: 226.0+/-10.5 pg/ml). CONCLUSION: This study shows that normal and diabetic subjects display similar levels of circulating obestatin in fasting condition. However patients with T2D look refractory to the inhibitory effect of meal on obestatin secretion

Thermal Analysis of FeCoCu Pre-Alloyed Powders Used for Diamond Tools

By simulating the pressureless sintering process, the thermal effects of FeCoCu pre-alloyed powders have been investigated. According to the notions of the Kissinger method, the activation energies in the expansion-shrinkage conversion stage are analyzed. Results show that with Fe content increasing, the specimens’ specific heat capacity values present the increasing trend. The 25 %Fe–15 %Co–60 %Cu specimens have negative enthalpy value at 10 and 20°C/min heating rate but positive values at 30 °С/min. For the specimens with lower Cu content, the enthalpies are always positive. It is established that both the specific heat capacity and enthalpy are larger when at higher heating rates. The activation energy of the 65 %Fe–15 %Co–20 %Cu specimens is 10 times higher than that of the 25 %Fe–15 %Co–60 %Cu specimens and the 45 %Fe–15 %Co–40 %Cu specimens.При моделюванні процесу спікання без тиску досліджено термічні ефекти в попередньо легованих порошках FeCoCu. З використанням методу Кіссінджера проаналізовано енергію активації на стадії розширення–усадка. Результати показують, що при збільшенні вмісту Fe значення питомої теплоємності демонструють тенденцію до зростання. Зразки 25 %Fe–15 %Co–60 %Cu мають негативні значення ентальпії при швидкості нагріву 10 ° і 20 °С/хв, але позитивні при 30 °С/хв. Для зразків з меншим вмістом Cu ентальпія завжди позитивна. Встановлено, що питома теплоємність і ентальпія більші при більш високіх швидкостях нагрівання. Енергія активації зразків 65 %Fe–15 %Co–20 %Cu у 10 разів вища, ніж зразків 25 %Fe–15 %Co–60 %Cu і 45 %Fe–15 %Co–40 %Cu.При моделировании процесса спекания без приложения давления исследованы термические эффекты в предварительно легированных порошках FeCoCu. С использованием метода Киссинджера проанализирована энергия активации на стадии расширение–усадка. Результаты показывают, что с увеличением содержания железа значения удельной теплоемкости образцов демонстрируют тенденцию к повышению. Образцы 25 %Fe–15 %Co–60 %Cu имеют отрицательные значения энтальпии при скорости нагрева 10 и 20 °С/мин, но положительные при 30 °С/мин. Для образцов с меньшим содержанием Cu энтальпия всегда положительна. Установлено, что удельная теплоемкость и энтальпия больше при более высоких скоростях нагрева. Энергия активации образцов 65 %Fe–15 %Co–20 %Cu в 10 раз выше, чем образцов 25 %Fe–15 %Co–60 %Cu и 45 %Fe–15 %Co–40 %Cu