المؤلفون: Alessandra Gandolfi, Sabrina Costa, Paolo Monti, Roberta Sara Catalano, Emanuele Bosi, Amelia Caretto, Vito Lampasona, Marina Scavini, Lorenzo Piemonti, Valeria Sordi, Chiara Molinari, Silvia Pellegrini, Andrea Laurenzi, Andrea Mario Bolla, Eleonora Bianconi, Elisa Borgonovo

المساهمون: Bolla, Andrea Mario, Gandolfi, Alessandra, Borgonovo, Elisa, Laurenzi, Andrea, Caretto, Amelia, Molinari, Chiara, Catalano, Roberta Sara, Bianconi, Eleonora, Monti, Paolo, Sordi, Valeria, Pellegrini, Silvia, Lampasona, Vito, Costa, Sabrina, Scavini, Marina, Bosi, Emanuele, Piemonti, Lorenzo

المصدر: The Journal of Clinical Endocrinology & Metabolism. 106:e507-e519

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Clinical Biochemistry, Placebo, Biochemistry, Gastroenterology, law.invention, Placebos, Young Adult, chemistry.chemical_compound, Endocrinology, Double-Blind Method, Randomized controlled trial, law, DPP-4 inhibitors, Insulin-Secreting Cells, Internal medicine, medicine, Humans, Vildagliptin, Glycemic, Sirolimus, Type 1 diabetes, rapamycin, C-peptide, business.industry, Insulin, Biochemistry (medical), Recovery of Function, long-standing type 1 diabetes, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Treatment Outcome, Italy, chemistry, vildagliptin, Drug Therapy, Combination, Female, Glycated hemoglobin, insulin antibody, business, medicine.drug

الوصف: Aim The aim of this study was to investigate whether treatment with rapamycin plus vildagliptin restores β-cell function in patients with long-standing type 1 diabetes. Methods A phase 2, single-center, randomized, double-blind, placebo-controlled study was conducted in long-standing type 1 diabetes patients randomly assigned (1:1:1) to 4 weeks of rapamycin (group 2), 4 weeks of rapamycin plus 12 weeks of vildagliptin (group 3), or double placebo (group 1). The primary outcome was the proportion of participants with a positive response to the Mixed-Meal Tolerance Test (C-peptide at 90 minutes > 0.2 nmol/L) at weeks 4 and 12. Secondary end points included insulin requirement, standard measures of glycemic control, and hormonal and immunological profile. Results Fifty-five patients were randomly assigned to group 1 (n = 18), group 2 (n = 19), or group 3 (n = 18). No patient in any group showed a positive C-peptide response, and there was no significant difference at 4 and 12 weeks for the primary outcome. At 4 weeks, insulin requirement decreased from 0.54 to 0.48 U/kg/day in group 2 (P = .013), from 0.59 to 0.51 U/kg/day in group 3 (P Conclusions Rapamycin reduced insulin requirement, but did not restore β-cell function in patients with long-standing type 1 diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d6512efb97aed11c147655230b7222e7Test
https://doi.org/10.1210/clinem/dgaa791Test

المؤلفون: Kåre I. Birkeland, Kristiane Birkeland Bleskestad, Hege Pihlstrøm, Rune Horneland, Jørn Petter Lindahl, Anders Åsberg, Karsten Midtvedt, Trond Jenssen, Espen Nordheim, Sindre Lee

المصدر: Scandinavian journal of clinical and laboratory investigation. 81(5)

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, medicine.medical_treatment, Clinical Biochemistry, Renal function, 030209 endocrinology & metabolism, 030230 surgery, Pancreas transplantation, urologic and male genital diseases, Single Center, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Insulin resistance, Internal medicine, Insulin Secretion, medicine, Humans, Insulin, Insulin secretion, Kidney transplantation, Retrospective Studies, Type 1 diabetes, business.industry, C-peptide, General Medicine, Middle Aged, medicine.disease, Kidney Transplantation, Endocrinology, surgical procedures, operative, Diabetes Mellitus, Type 1, chemistry, Female, Pancreas Transplantation, Insulin Resistance, business, Glomerular Filtration Rate

الوصف: We explored glucometabolic and renal function after engraftment in all 159 consecutive patients with type 1 diabetes who received pancreas transplantation alone (PTA, n = 80) or simultaneous pancreas and kidney transplantation (SPK, n = 79) in Norway from 2012 until 2017. We report fasting levels of plasma glucose (FPG), C-peptide, eGFR and the homeostasis model assessment of insulin sensitivity (HOMA2(%S)) and beta-cell function (HOMA2(%B)) measured one to three times weekly during the first 8 and at 52 weeks after transplantation. One year after engraftment, in the PTA and SPK groups 52 and 64 were normoglycaemic without exogenous insulin, and two and zero patients were dead. Data at the 52-week visit were missing for 5 and 6 patients in the respective groups. During the first 8 weeks, FPG was lower, C-peptide and HOMA2(%S) were higher and eGFR was lower in the SPK group as compared with the PTA group (all p < .05). 30 out of 157 living patients needed insulin treatment 52 weeks after transplantation, 9/79 in the SPK group and 21/78 in the PTA group (p = .02). In conclusion, patients who underwent SPK showed lower insulin sensitivity, but higher insulin secretory capacity and lower mean blood glucose levels the first 8 weeks after transplantation. Also, a higher proportion of patients in the SPK group were insulin-free after 1 year, compared with the PTA group.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::40b4fbc4418c9ecc9591f7177cc3294dTest
https://pubmed.ncbi.nlm.nih.gov/34075856Test

المؤلفون: Niels Møller, Niels Jessen, Mogens Johannsen, Esben Thyssen Vestergaard, Mads Svart, Henrik Holm Thomsen, Jens J. Holst, Jens F. Rehfeld, Nikolaj Rittig, Bolette Hartmann

المصدر: Rittig, N, Svart, M, Thomsen, H H, Vestergaard, E T, Rehfeld, J F, Hartmann, B, Holst, J J, Johannsen, M, Møller, N & Jessen, N 2020, ' Oral D/L-3-hydroxybutyrate stimulates cholecystokinin-and insulin secretion and slows gastric emptying in healthy males ', The Journal of clinical endocrinology and metabolism, vol. 105, no. 10 . https://doi.org/10.1210/clinem/dgaa483Test

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Metabolite, medicine.medical_treatment, media_common.quotation_subject, Clinical Biochemistry, Administration, Oral, Incretin, Biochemistry, chemistry.chemical_compound, Endocrinology, Glucagon-Like Peptide 1, Internal medicine, Insulin Secretion, medicine, Humans, Insulin, Intestinal Mucosa, Infusions, Intravenous, Cholecystokinin, media_common, Cross-Over Studies, 3-Hydroxybutyric Acid, C-Peptide, Gastric emptying, business.industry, Biochemistry (medical), Appetite, Ketosis, medicine.disease, Healthy Volunteers, Gastric Emptying, chemistry, Dietary Supplements, Ketone bodies, business

الوصف: Background D-3-hydroxybutyrate (D-3-OHB) is a ketone body that serves as an alternative nutritional fuel but also as an important signaling metabolite. Oral ketone supplements containing D/L-3-OHB are becoming a popular approach to achieve ketosis. Aim To explore the gut-derived effects of ketone supplements. Methods Eight healthy lean male volunteers were investigated on 2 separate occasions: An acetaminophen test was performed to evaluate gastric emptying and blood samples were obtained consecutively throughout the study period. Results We show that oral consumption of D/L-3-OHB stimulates cholecystokinin release (P = 0.02), elevates insulin (P = 0.03) and C-peptide (P < 0.001) concentrations, and slows gastric emptying (P = 0.01) compared with matched intravenous D/L-3-OHB administration. Measures of appetite and plasma concentrations of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were unaffected by interventions. Conclusion Our findings show that D/L-3-OHB exert incretin effects and indicate luminal sensing in the gut endothelium. This adds to our understanding of ketones as signaling metabolites and displays the important difference between physiological ketosis and oral ketone supplements.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::75fb0425eab706723203de074f351f36Test
https://doi.org/10.1210/clinem/dgaa483Test

المؤلفون: Sascha R. Tittel, Nicole Prinz, Wolfram Karges, Joachim Brückel, Melanie Hess, Andreas Veigel, Reinhard W. Holl, Holger Haberland, Rainer Bachran, Desiree Dunstheimer, R Oeverink, Robert Birnbacher

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, endocrine system diseases, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Population, Context (language use), Hashimoto Disease, Biochemistry, Diabetes Therapy, Gastroenterology, Autoimmune Diseases, Young Adult, chemistry.chemical_compound, Sex Factors, Endocrinology, Addison Disease, Diabetic Neuropathies, Internal medicine, Diabetes mellitus, medicine, Albuminuria, Humans, Hypoglycemic Agents, Insulin, Prospective Studies, Registries, Child, education, Autoimmune disease, education.field_of_study, Type 1 diabetes, Diabetic Retinopathy, business.industry, Biochemistry (medical), Middle Aged, medicine.disease, Graves Disease, Diabetes Mellitus, Type 1, chemistry, Regression Analysis, Female, Microalbuminuria, Glycated hemoglobin, business

الوصف: Context Autoimmune diseases affect ~8% of the population. Type 1 diabetes mellitus (T1DM) is linked to other autoimmune diseases (AIDs), such as autoimmune thyroid disease or Addison’s disease (AD), that may impact diabetes therapy and outcome. Objective To analyze demographic and clinical characteristics of other AIDs in T1DM from a large standardized registry, the Prospective Diabetes Follow-up Registry (DPV). Methods We searched the registry for T1DM with the additional diagnosis of Hashimoto’s thyroiditis (HT), Graves’ disease (GD), and/or AD. T1DM with other AIDs (n = 6166, 5.4%) were compared with isolated T1DM (n = 107 457). For group comparisons, we used multivariable regression models with age, sex, diabetes duration, migration background, and type of insulin regimen as basic adjustments (microvascular endpoints: additionally adjusted for glycated hemoglobin). Results Patients with additional AIDs were more often female (54.7 vs 32.0%, P Conclusion T1DM with additional AIDs show heterogeneous differences compared with isolated T1DM. T1DM plus AD or HT requires more insulin. Further, the rate of neuropathy is higher in HT or GD, whereas the rate of microalbuminuria is lower.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9d9463a06644bfef389c08fe23d5b754Test
https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/87724Test

المؤلفون: Nirubasini Paramalingam, Elizabeth A. Davis, Paul A. Fournier, Wayne Soon, Heather C. Roby, Vinutha B Shetty, Timothy W. Jones

المصدر: The Journal of clinical endocrinology and metabolism. 106(1)

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, Adolescent, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Physical Exertion, Context (language use), Glycemic Control, Hypoglycemia, Biochemistry, chemistry.chemical_compound, Young Adult, Endocrinology, Internal medicine, Hyperinsulinism, medicine, Hyperinsulinemia, Aerobic exercise, Humans, Insulin, Drug Dosage Calculations, Exercise, Type 1 diabetes, Dose-Response Relationship, Drug, business.industry, Biochemistry (medical), Western Australia, medicine.disease, Diabetes Mellitus, Type 1, Glucose, chemistry, Exercise intensity, Female, Glycated hemoglobin, business, Body mass index

الوصف: Context Under basal insulin levels, there is an inverted U relationship between exercise intensity and exogenous glucose requirements to maintain stable blood glucose levels in type 1 diabetes (T1D), with no glucose required for intense exercise (80% V̇O2 peak), implying that high-intensity exercise is not conducive to hypoglycemia. Objective This work aimed to test the hypothesis that a similar inverted U relationship exists under hyperinsulinemic conditions, with high-intensity aerobic exercise not being conducive to hypoglycemia. Methods Nine young adults with T1D (mean ± SD age, 22.6 ± 4.7 years; glycated hemoglobin, 61 ± 14 mmol/mol; body mass index, 24.0 ± 3.3 kg/m2, V̇O2 peak, 36.6 ± 8.0 mL·kg–1 min–1) underwent a hyperinsulinemic-euglycemic clamp to maintain stable glycemia (5-6 mmol·L−1), and exercised for 40 minutes at 4 intensities (35%, 50%, 65%, and 80% V̇O2peak) on separate days following a randomized counterbalanced study design. Main Outcome Measures Glucose infusion rates (GIR) and glucoregulatory hormones levels were measured. Results The GIR (± SEM) to maintain euglycemia was 4.4 ± 0.4 mg·kg–1 min–1 prior to exercise, and increased significantly by 1.8 ± 0.4, 3.0 ± 0.4, 4.2 ± 0.7, and 3.5 ± 0.7 mg·kg–1 min–1 during exercise at 35%, 50%, 65%, and 80% V̇O2 peak, respectively, with no significant differences between the 2 highest exercise intensities (P > .05), despite differences in catecholamine levels (P .05). Conclusions Under hyperinsulinemic conditions, the exogenous glucose requirements to maintain stable glycemia during and after exercise increase with exercise intensity then plateau with exercise performed at above moderate intensity ( > 65% V̇O2 peak). High-intensity exercise confers no protection against hypoglycemia.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5b97b74a29d86fedc502b5e31429844fTest
https://pubmed.ncbi.nlm.nih.gov/33097945Test

المؤلفون: Ivan Soldatovic, Mirjana Sumarac-Dumanovic, Devaki Nair, Gordana Dragovic, Djordje Jevtovic, Al Musalhi Khawla, Mladen Andjić

المصدر: Experimental and Molecular Pathology. 105:115-119

مصطلحات موضوعية: Adult, Blood Glucose, Leptin, Male, 0301 basic medicine, medicine.medical_specialty, Clinical Biochemistry, Adipokine, 030204 cardiovascular system & hematology, Pathology and Forensic Medicine, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Insulin resistance, High-density lipoprotein, Internal medicine, Plasminogen Activator Inhibitor 1, Homeostasis, Humans, Insulin, Medicine, Molecular Biology, 2. Zero hunger, Acquired Immunodeficiency Syndrome, biology, Adiponectin, business.industry, medicine.disease, 3. Good health, Ferritin, 030104 developmental biology, Endocrinology, chemistry, Case-Control Studies, Ferritins, biology.protein, Female, Resistin, Insulin Resistance, Metabolic syndrome, business, Biomarkers, hormones, hormone substitutes, and hormone antagonists

الوصف: Background Data about correlation of interleukins (IL-1 α, IL-1 β, IFN γ, IL-2, IL-4, IL-6, IL-8, IL-10), adipocytokines (leptin, adiponectin, monocyte chemoattractant protein-1 (MCP-1), resistin, plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor alpha (TNFα), ferritin, C reactive protein (CRP) and vascular endothelial growth factor (VEGF) with homeostasis model assessment (HOMA) in HIV/AIDS patients are still limited. Therefore the aim of this study was to evaluate the possible correlations of serum levels of PAI-1, leptin and ferritin with HOMA in HIV/AIDS patients treated with combined antiretroviral therapy (cART). Methods This cross-sectional study included 64 HIV/AIDS patients, all Caucasians, receiving cART at the HIV/AIDS Centre, Belgrade, Serbia. PAI-1, leptin, ferritin and insulin levels were measured using the Metabolic Syndrome Array I (Randox Laboratories Ltd., London, UK), while adiponectin and resistin levels were measured using Metabolic Syndrome Array II (Randox Laboratories Ltd., London, UK), interleukins (IL-1 α, IL-1 β, IFN γ, IL-2, IL-4, IL-6, IL-8, IL-10), MCP-1, TNF-α as well as VEGF was measured using Cytokine Array I (Randox Laboratories Ltd., London, UK). Insulin resistance was determined using the homeostasis model assessment index (HOMA). Multicollinearity of independent variables in multivariate model was analyzed using Variance Inflation Factor. Results Correlation analysis revealed significant correlations between HOMA and waist circumference, body mass index, patients' age, number of cART combinations and triglycerides (p = 0.001, p = 0.001, p = 0.050, p = 0.044, p = 0.002, respectively). HOMA negatively correlated with levels of high density lipoprotein (HDL) (Rho = −0.282; p = 0.025). PAI-1 (Rho = 0.334; p= 0.007) and leptin (Rho = 0.492; p = 0.001) together with ferritin (Rho = 0.396, p = 0.001) positively and significantly correlated with HOMA. Levels of IL-1 α, IL-1 β, IFN γ, IL-2, IL-4, IL-6, IL-8, IL-10, adiponectin, MCP-1, resistin, TNF-α, CRP and VEGF did not significantly correlate with HOMA. Further, multiple logistic regression showed that there is a statistically significant correlation between PAI, leptin and ferritin with HOMA levels (p = 0.042; p Conclusions We showed significant correlation between PAI-1, leptin and ferritin, independently of each other with HOMA, in HIV/AIDS patients on cART.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::71b61192a948a8d77bc964537852399bTest
https://doi.org/10.1016/j.yexmp.2018.06.004Test

المؤلفون: Husam Ghanim, Nitesh D. Kuhadiya, Aditya Mehta, Manisha Garg, Ajay Chaudhuri, Manav Batra, Salman Khan, Paresh Dandona, Antoine Makdissi, Barrett Torre, Jeanne Hejna

المصدر: The Journal of Clinical Endocrinology & Metabolism. 101:3506-3515

مصطلحات موضوعية: Blood Glucose, Male, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, 030204 cardiovascular system & hematology, Biochemistry, law.invention, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Glucosides, Randomized controlled trial, law, Insulin, Medicine, Dapagliflozin, Middle Aged, Prognosis, Drug Therapy, Combination, Female, medicine.drug, Adult, medicine.medical_specialty, Adolescent, 030209 endocrinology & metabolism, Context (language use), Placebo, Young Adult, 03 medical and health sciences, Double-Blind Method, Diabetes mellitus, Internal medicine, Humans, Hypoglycemic Agents, Benzhydryl Compounds, Aged, Glycated Hemoglobin, Type 1 diabetes, business.industry, Liraglutide, Biochemistry (medical), medicine.disease, Diabetes Mellitus, Type 1, chemistry, Glycated hemoglobin, business, Biomarkers, Follow-Up Studies

الوصف: It is imperative that novel approaches to treatment of type 1 diabetes (T1D) are devised.The objective of the study was to investigate whether addition of dapagliflozin to insulin and liraglutide results in a significant reduction in glycemia and body weight.This was a randomized clinical trial.The study was conducted at a single academic medical center.Participants included T1D patients on liraglutide therapy for at least last 6 months.Thirty T1D patients were randomized (in 2:1 ratio) to receive either dapagliflozin 10 mg or placebo daily for 12 weeks.Change in mean glycated hemoglobin after 12 weeks of dapagliflozin when compared with placebo was measured.In the dapagliflozin group, glycated hemoglobin fell by 0.66% ± 0.08% from 7.8% ± 0.21% (P.01 vs placebo), whereas it did not change significantly in the placebo group from 7.40% ± 0.20% to 7.30% ± 0.20%. The body weight fell by1.9 ± 0.54kg (P.05 vs placebo). There was no additional hypoglycemia (blood glucose3.88 mmol/L; P = .52 vs placebo). In the dapagliflozin group, there were significant increases in the plasma concentrations of glucagon by 35% ± 13% (P.05), hormone-sensitive lipase by 29% ± 11% (P.05), free fatty acids by 74% ± 32% (P.05), acetoacetate by 67% ± 34% (P.05), and β-hydroxybutyrate by 254% ± 81% (P.05). Urinary ketone levels also increased significantly (P.05). None of these changes was observed in the placebo group. Two patients in the dapagliflozin group developed diabetic ketoacidosis.Addition of dapagliflozin to insulin and liraglutide in patients with T1D results in a significant improvement in glycemia and weight loss while increasing ketosis. If it is decided to use this approach, then it must be used only by a knowledgeable patient along with an endocrinologist who is well versed with it.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::941056e0e021451908906c5740522a35Test
https://doi.org/10.1210/jc.2016-1451Test

المؤلفون: Alfonso Javier Zapata-Garrido, José Carlos Jaime-Pérez, Miguel Angel Herrera-Rojas, César Homero Gutiérrez-Aguirre, David Gómez-Almaguer, Fernando J. Lavalle-González, Oscar González-Llano, Jose Angel Hawing-Zarate, Olga G. Cantú-Rodríguez, Consuelo Mancías-Guerra, Jesús Zacarías Villarreal-Pérez

المصدر: The Journal of Clinical Endocrinology & Metabolism. 101:2141-2148

مصطلحات موضوعية: Adult, Blood Glucose, 0301 basic medicine, medicine.medical_specialty, Adolescent, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Clinical Biochemistry, Context (language use), Hematopoietic stem cell transplantation, Transplantation, Autologous, Biochemistry, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, Endocrinology, Ambulatory care, Diabetes mellitus, Internal medicine, medicine, Humans, Child, Type 1 diabetes, business.industry, Insulin, Biochemistry (medical), Hematopoietic Stem Cell Transplantation, medicine.disease, Surgery, Transplantation, Diabetes Mellitus, Type 1, Treatment Outcome, 030104 developmental biology, chemistry, Glycated hemoglobin, business, Immunosuppressive Agents

الوصف: Efforts to find a cure for type 1 diabetes have focused on the removal of the autoimmune pathophysiologic substrate, with the use of immunosuppressive regimens including autologous hematopoietic stem cell transplantation (AHSCT).The main objective of determining long-term insulin independence as well as changes in glycated hemoglobin (HbA1c). Secondary outcomes were procedure morbidity and the need for hospital management.We enrolled patients with type 1 diabetes between 2012 and 2014. Median follow-up was 34 months (range, 25-56 mo).Ambulatory care.We decided to carry out an AHSCT protocol using a less toxic and affordable simplified method based on fludarabine in an outpatient setting.Patients were of both sexes, age 8-25 years, with positive levels of anti-GAD antibodies, a C-peptide level1.0 ng/mL, and3 months since diagnosis.Insulin independence.Sixteen patients were included. Overall response was 81% with seven patients achieving insulin independence (44%); six were partial responders (37%) whereas three were nonresponders (19%). The HbA1c level showed a mean decrease of -2.3% at 6 months in the Insulin Independence group. Median age was 12 years old (range, 8-17 years old). A mean of 11.5 × 10(6) CD34+ cells (SD ± 8.2) was obtained. Related mortality at 100 days was 0% as well as during follow-up. Outpatient setting was 100%.Simplified AHSCT in an outpatient setting is a feasible, safe and potentially therapeutic intervention for early-onset type 1 diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::eb182851e41232145991840aab4628c7Test
https://doi.org/10.1210/jc.2015-2776Test

المؤلفون: Tine W. Hansen, Steen Andersen, Peter Rossing, Signe Rosenlund

المصدر: The Journal of Clinical Endocrinology & Metabolism. 100:4181-4188

مصطلحات موضوعية: Adult, Blood Glucose, Male, Insulin pump, medicine.medical_specialty, Adolescent, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Renal function, Blood Pressure, Context (language use), Biosensing Techniques, Biochemistry, Young Adult, chemistry.chemical_compound, Insulin Infusion Systems, Endocrinology, Internal medicine, Diabetes mellitus, medicine, Albuminuria, Humans, Hypoglycemic Agents, Insulin, Aged, Glycemic, Glycated Hemoglobin, Type 1 diabetes, Creatinine, business.industry, Biochemistry (medical), Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Treatment Outcome, chemistry, Female, medicine.symptom, business, Glomerular Filtration Rate

الوصف: Context: The effect of glycemic control on persisting albuminuria remains unclear. Insulin delivery and glucose variability may be important. Objective: This study aimed to investigate the effect of 1-year treatment with sensor-augmented insulin pump (SAP) or multiple daily injections (MDIs) on albuminuria. Design, Patients, and Methods: This was a randomized controlled open-label parallel trial composed of 60 patients with type 1 diabetes with a history of albuminuria and on stable renin-angiotensin system inhibition, were randomly assigned to SAP or MDI. Urine albumin creatinine ratio (UACR) was measured in three urine samples at all visits. Glucose variability and glomerular filtration rate (51Cr-EDTA-GFR) were measured at beginning and study end. Using linear mixed model, change in UACR between groups was analyzed as intention to treat. Main Outcome Measure: Change in UACR was measured. Results: Fifty-five patients (SAP, n = 26; MDI, n = 29) completed the study. Diabetes duration (mean ± SD, 33 ± 12 y), UACR (geometric mean, 99 mg/g; interquartile range, 37–233 mg/g), 51Cr-EDTA-GFR (94 ± 22 mL/min/1.73m2), glycosylated hemoglobin (HbA1c) (9.0 ± 1.1%), glucose variability (calculated as SD), 4.0 ± 1.0 mmol/l; no-group differences (P ≥ .06 for all). After 1 year, change in UACR was mean, −13%; 95% confidence interval, −39 to 22 with SAP vs mean, 30%; 95% CI, −12 to 92% on MDI treatment (unadjusted P = .051; adjusted for HbA1c, P = .04). HbA1c decreased 1.3 ± 1.0 vs 0.6 ± 1.0% (P = .013), glucose variability decreased 0.9 ± 1.1 vs 0.3 ± 1.0 mmol/L (P = .04), and 51Cr-EDTA-GFR declined 5.6 ± 9.6 vs 3.4 ± 13 mL/min/1.73m2 (P = .50) with SAP vs MDI treatment. There were no changes in blood pressure (P ≥ .27). Conclusion: SAP treatment reduced UACR in a randomized controlled trial in type 1 diabetes patients with a history of albuminuria on stable renin-angiotensin system inhibition. Significance was reached after adjustment. SAP treatment reduced HbA1c and glucose variability (calculated as SD).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ded1194920965da3a45dca1f8e796c05Test
https://doi.org/10.1210/jc.2015-2839Test

المؤلفون: Werner Regittnig, Philipp Eller, Martina Brunner, Sabine Zenz, Reingard Raml, Thomas R. Pieber, Stefan Korsatko, Julia K. Mader, Sophie H. Narath, Thomas Augustin, Christoph Magnes, Beate Boulgaropoulos

المصدر: The Journal of clinical endocrinology and metabolism. 103(4)

مصطلحات موضوعية: 0301 basic medicine, Adult, Blood Glucose, Male, medicine.medical_specialty, Epinephrine, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Clinical Biochemistry, 030209 endocrinology & metabolism, Endogeny, Context (language use), Hypoglycemia, Biochemistry, Glucagon, Drug Administration Schedule, 03 medical and health sciences, chemistry.chemical_compound, Norepinephrine, Young Adult, 0302 clinical medicine, Endocrinology, Internal medicine, Diabetes mellitus, medicine, Humans, Insulin, Type 1 diabetes, C-Peptide, business.industry, C-peptide, Biochemistry (medical), Awareness, Middle Aged, medicine.disease, 030104 developmental biology, Diabetes Mellitus, Type 1, chemistry, Glucose Clamp Technique, Female, business

الوصف: Context Complete loss of β-cell function in patients with type 1 diabetes mellitus (T1DM) may lead to an increased risk of severe hypoglycemia. Objective We aimed to determine the impact of C-peptide status on glucagon response and endogenous glucose production (EGP) during hypoglycemia in patients with T1DM. Design and Setting We conducted an open, comparative trial. Patients Ten C-peptide positive (C-pos) and 11 matched C-peptide negative (C-neg) patients with T1DM were enrolled. Intervention Plasma glucose was normalized over the night fast, and after a steady-state (baseline) plateau all patients underwent a hyperinsulinemic, stepwise hypoglycemic clamp with glucose plateaus of 5.5, 3.5, and 2.5 mmol/L and a recovery phase of 4.0 mmol/L. Blood glucagon was measured with a specific and highly sensitive glucagon assay. EGP was determined with a stable isotope tracer technique. Main Outcome Measure Impact of C-peptide status on glucagon response and EGP during hypoglycemia. Results Glucagon concentrations were significantly lower in C-pos and C-neg patients than previously reported. At baseline, C-pos patients had higher glucagon concentrations than C-neg patients (8.39 ± 4.6 vs 4.19 ± 2.4 pmol/L, P = 0.016, mean ± standard deviation) but comparable EGP rates (2.13 ± 0.2 vs 2.04 ± 0.3 mg/kg/min, P < 0.391). In both groups, insulin suppressed glucagon levels, but hypoglycemia revealed significantly higher glucagon concentrations in C-pos than in C-neg patients. EGP was significantly higher in C-pos patients at hypoglycemia (2.5 mmol/L) compared with C-neg patients. Conclusions Glucagon concentrations and EGP during hypoglycemia were more pronounced in C-pos than in C-neg patients, which indicates that preserved β-cell function may contribute to counterregulation during hypoglycemia in patients with T1DM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1473c2fad6ce104f42655327826871b4Test
https://pubmed.ncbi.nlm.nih.gov/29408994Test