Impairments in Site-Specific AS160 Phosphorylation and Effects of Exercise Training

The purpose of this study was to determine if site-specific phosphorylation at the level of Akt substrate of 160 kDa (AS160) is altered in skeletal muscle from sedentary humans across a wide range of the adult life span (18–84 years of age) and if endurance- and/or strength-oriented exercise training could rescue decrements in insulin action and skeletal muscle AS160 phosphorylation. A euglycemic-hyperinsulinemic clamp and skeletal muscle biopsies were performed in 73 individuals encompassing a wide age range (18–84 years of age), and insulin-stimulated AS160 phosphorylation was determined. Decrements in whole-body insulin action were associated with impairments in insulin-induced phosphorylation of skeletal muscle AS160 on sites Ser-588, Thr-642, Ser-666, and phospho-Akt substrate, but not Ser-318 or Ser-751. Twelve weeks of endurance- or strength-oriented exercise training increased whole-body insulin action and reversed impairments in AS160 phosphorylation evident in insulin-resistant aged individuals. These findings suggest that a dampening of insulin-induced phosphorylation of AS160 on specific sites in skeletal muscle contributes to the insulin resistance evident in a sedentary aging population and that exercise training is an effective intervention for treating these impairments

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country

BACKGROUND: The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin). METHODS: This cross-sectional health examination survey was based on a population random sample from the Seychelles. It included 1011 subjects aged 25 to 64 years. Blood pressure (BP), body mass index (BMI), waist circumference, waist-to-hip ratio, total and HDL cholesterol, serum triglycerides and serum uric acid were measured. Data were analyzed using scatterplot smoothing techniques and gender-specific linear regression models. RESULTS: The prevalence of a serum uric acid level >420 μmol/L in men was 35.2% and the prevalence of a serum uric acid level >360 μmol/L was 8.7% in women. Serum uric acid was strongly related to serum triglycerides in men as well as in women (r = 0.73 in men and r = 0.59 in women, p < 0.001). Uric acid levels were also significantly associated but to a lesser degree with age, BMI, blood pressure, alcohol and the use of antihypertensive therapy. In a regression model, triglycerides, age, BMI, antihypertensive therapy and alcohol consumption accounted for about 50% (R2) of the serum uric acid variations in men as well as in women. CONCLUSIONS: This study shows that the prevalence of hyperuricemia can be high in a developing country such as the Seychelles. Besides alcohol consumption and the use of antihypertensive therapy, mainly diuretics, serum uric acid is markedly associated with parameters of the metabolic syndrome, in particular serum triglycerides. Considering the growing incidence of obesity and metabolic syndrome worldwide and the potential link between hyperuricemia and cardiovascular complications, more emphasis should be put on the evolving prevalence of hyperuricemia in developing countries

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Treatment for Symptomatic Calcific Tendinopathy of the Shoulder. Ultrasound-Guided Needling Lavage and Extracorporeal Shock Wave Therapy vs Extracorporeal Shock Wave Therapy. A prospective observational study

Background. Prevalence of plantar fasciitis is increased in type 2 diabetes. This study was aimed at assessing the correlates of ultrasonographic and elastosonographic parameters in plantar fascia (PF) individuals with type 2 diabetes encompassing vari­ous degrees of complications. Methods. This cross-sectional study included 98 patients with type 2 diabetes. Thick­ness of PF was assessed by ultrasonography, whereas elasticity of hard tissue (Elx-Hrd) at PF insertion and course and the subcutaneous-to-insertional strain ratio (Elx 2/1) were determined by elastosonography. Results. No significant differences were detected according to age category, sex, phys­ical activity, and presence of complications, except for higher Elx-Hrd insertion and Elx 1/2 in participants with cardiac autonomic neuropathy (CAN). Thickness of PF, Elx-Hrd insertion and Elx 1/2 correlated significantly with BMI, waist circumference, fat-free mass, and parameters of peripheral neuropathy and CAN; BMI, waist circum­ference, fat mass, fat-free mass, and CAN were independently associated with PF thickness, Elx-Hrd insertion, and Elx 1/2. Conclusions. Adiposity, body composition and presence of CAN are the main correlates of PF ultrasonographic and elastosonographic parameters, suggesting that body weight reduction, maintenance of muscle mass, and prevention of neuropathic complications may result in a decreased incidence of plantar fasciitis in individuals with type 2 diabetes

CARDIOVASCULAR RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. EPIDEMIOLOGICAL STUDY IN A DIABETES CLINIC POPULATION OF NORTHERN ITALY

Introduction: Diabetes mellitus (DM) is a major risk factor for cardiovascular (CV) events and coronary heart disease (CHD). Many algorithms are available to assess CV risk, some of which specific for diabetics. Most of them, however, can hardly be extrapolated to Mediterranean countries. Aim of the present study was to analyze CV risk and the incidence of events in a cohort of outpatients with type 2 DM living in Emilia Romagna. Methods: Clinical charts in the period 1991-1995 were analyzed. Diabetic patients aged 35-65 and no history of CV disease were eligible. Global risk was computed according to Framingham, RISKARD, Progetto Cuore and UKPDS algorithms and compared with the actual rate of events over the following 10 years. Results: 4337 patients were eligible. An absolute 10-yr rate of 9.8% was observed for CHD. Comparing patients with and without events, we found a significant (P < 0.05, Mann-Whitney U test) difference in several “classical” risk factors, plus duration of diabetes and HbA1c. Italian algorithms were more consistent with the observed data, but an underestimation of CV events was present, especially in females. Conclusions: Estimation of CV risk is dependent on the algorithm adopted and on the reference cohort. The performance of such functions is however low. Functions taking into account variables specific for diabetes severity should be adopted. The algorithm derived from the present study will be utilized for a prospective estimation of CV risk in our cohort