Determinants of High-Dose Insulin Usage and Upper Extremity Muscle Strength in Adult Patients With Type 2 Diabetes

Abstract Type 2 Diabetes Mellitus (T2DM) accelerates the incidence and increases the prevalence of sarcopenia in older adults. This suggests an urgent need for identifying effective sarcopenia treatments for older adults with T2DM. It is unknown whether traditional approaches, such as progressive resistance exercise training (PRET), can effectively counteract sarcopenia in older patients with T2DM. To test the efficacy of PRET for the treatment of sarcopenia in older adults with T2DM, 30 subjects (15 T2DM and 15 age- and sex- matched controls) underwent metabolic testing with muscle biopsies before and after a 13-week full-body PRET program. Primary outcome measures included changes in appendicular lean mass, muscle strength, and mixed muscle fractional synthesis rate (FSR). Before PRET, BMI-adjusted appendicular lean mass was significantly lower in the T2DM group (0.7095±0.0381 versus 0.8151±0.0439, p<0.0001). As a result of PRET, appendicular lean mass adjusted for BMI and muscle strength increased significantly in both groups, but to a lesser extent for the T2DM group (p=0.0009) . Preliminary results for FSR (n=25) indicate that subjects with T2DM had lower basal FSR prior to PRET (p=0.0197) . Basal FSR increased significantly in the control group after PRET (p=0.0196), while it did not change in the T2DM group (p=0.3537). These results suggest that in older adults the positive effect of PRET on muscle anabolism and strength is reduced by T2DM . Thus, older adults with T2DM may require more intensive, multimodal and targeted sarcopenia treatment. Funded by NIH R01AG049611 and P30AG024832.

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Combination Therapy with an SGLT2 Inhibitor as Initial Treatment for Type 2 Diabetes: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8010045 ◽

2019 ◽

Vol 8 (1) ◽

pp. 45 ◽

Cited By ~ 17

Author(s):

Tamara Y. Milder ◽

Sophie L. Stocker ◽

Christina Abdel Shaheed ◽

Lucy McGrath-Cadell ◽

Dorit Samocha-Bonet ◽

...

Keyword(s):

Type 2 Diabetes ◽

Combination Therapy ◽

Low Dose ◽

Meta Analysis ◽

Sglt2 Inhibitor ◽

Cochrane Library ◽

High Dose ◽

Dose Combination ◽

Inhibitor Combination

Background: Guidelines differ with regard to indications for initial combination pharmacotherapy for type 2 diabetes. Aims: To compare the efficacy and safety of (i) sodium-glucose cotransporter 2 (SGLT2) inhibitor combination therapy in treatment-naïve type 2 diabetes adults; (ii) initial high and low dose SGLT2 inhibitor combination therapy. Methods: PubMed, Embase and Cochrane Library were searched for randomised controlled trials (RCTs) of initial SGLT2 combination therapy. Mean difference (MD) for changes from baseline (HbA1c, weight, blood pressure) after 24–26 weeks of treatment and relative risks (RR, safety) were calculated using a random-effects model. Risk of bias and quality of evidence was assessed. Results: In 4 RCTs (n = 3749) there was moderate quality evidence that SGLT2 inhibitor/metformin combination therapy resulted in a greater reduction in HbA1c (MD (95% CI); −0.55% (−0.67, −0.43)) and weight (−2.00 kg (−2.34, −1.66)) compared with metformin monotherapy, and a greater reduction in HbA1c (−0.59% (−0.72, −0.46)) and weight (−0.57 kg (−0.89, −0.25)) compared with SGLT2 inhibitor monotherapy. The high dose SGLT2 inhibitor/metformin combination resulted in a similar HbA1c but greater weight reduction; −0.47 kg (−0.88, −0.06) than the low dose combination therapy. The RR of genital infection with combination therapy was 2.22 (95% CI 1.33, 3.72) and 0.69 (95% CI 0.50, 0.96) compared with metformin and SGLT2 inhibitor monotherapy, respectively. The RR of diarrhoea was 2.23 (95% CI 1.46, 3.40) with combination therapy compared with SGLT2 inhibitor monotherapy. Conclusions: Initial SGLT2 inhibitor/metformin combination therapy has glycaemic and weight benefits compared with either agent alone and appears relatively safe. High dose SGLT2 inhibitor/metformin combination therapy appears to have modest weight, but no glycaemic benefits compared with the low dose combination therapy.

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Circulating Neutrophil Extracellular Trap Levels in Well-Controlled Type 2 Diabetes and Pathway Involved in Their Formation Induced by High-Dose Glucose

Pathobiology ◽

10.1159/000444881 ◽

2016 ◽

Vol 83 (5) ◽

pp. 243-251 ◽

Cited By ~ 18

Author(s):

Arina Miyoshi ◽

Mai Yamada ◽

Haruki Shida ◽

Daigo Nakazawa ◽

Yoshihiro Kusunoki ◽

...

Keyword(s):

Type 2 Diabetes ◽

Neutrophil Extracellular Trap ◽

High Dose ◽

Extracellular Trap ◽

Trap Levels

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Rapid control of ectopic Cushing’s syndrome during the COVID-19 pandemic in a patient with chronic hypokalaemia

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-21-0038 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Ziadoon Faisal ◽

Miguel Debono

Keyword(s):

Type 2 Diabetes ◽

Case Report ◽

Cushing’S Syndrome ◽

Cushing's Syndrome ◽

Alternative Methods ◽

Ectopic Acth Syndrome ◽

High Dose ◽

List Type ◽

Ectopic Acth

Summary In this case report, we describe the management of a patient who was admitted with an ectopic ACTH syndrome during the COVID pandemic with new-onset type 2 diabetes, neutrophilia and unexplained hypokalaemia. These three findings when combined should alert physicians to the potential presence of Cushing’s syndrome (CS). On admission, a quick diagnosis of CS was made based on clinical and biochemical features and the patient was treated urgently using high dose oral metyrapone thus allowing delays in surgery and rapidly improving the patient’s clinical condition. This resulted in the treatment of hyperglycaemia, hypokalaemia and hypertension reducing cardiovascular risk and likely risk for infection. Observing COVID-19 pandemic international guidelines to treat patients with CS has shown to be effective and offers endocrinologists an option to manage these patients adequately in difficult times. Learning points This case report highlights the importance of having a low threshold for suspicion and investigation for Cushing’s syndrome in a patient with neutrophilia and hypokalaemia, recently diagnosed with type 2 diabetes especially in someone with catabolic features of the disease irrespective of losing weight. It also supports the use of alternative methods of approaching the diagnosis and treatment of Cushing’s syndrome during a pandemic as indicated by international protocols designed specifically for managing this condition during Covid-19.

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