scholarly journals Skewed Epigenetics: An Alternative Therapeutic Option for Diabetes Complications

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Gabriele Togliatto ◽  
Patrizia Dentelli ◽  
Maria Felice Brizzi
Keyword(s):  
Type 2 Diabetes ◽  
Chromatin Structure ◽  
Therapeutic Option ◽  
Vascular Complications ◽  
Morbidity And Mortality ◽  
Ros Generation ◽  
Metabolic Memory ◽  
Induced Changes

Vascular complications are major causes of morbidity and mortality in type 2 diabetes patients. Mitochondrial reactive oxygen species (ROS) generation and a lack of efficient antioxidant machinery, a result of hyperglycaemia, mainly contribute to this problem. Although advances in therapy have significantly reduced both morbidity and mortality in diabetic individuals, diabetes-associated vascular complications are still one of the most challenging health problems worldwide. New healing options are urgently needed as current therapeutics are failing to improve long-term outcomes. Particular effort has recently been devoted to understanding the functional relationship between chromatin structure regulation and the persistent change in gene expression which is driven by hyperglycaemia and which accounts for long-lasting diabetic complications. A detailed investigation into epigenetic chromatin modifications in type 2 diabetes is underway. This will be particularly useful in the design of mechanism-based therapeutics which interfere with long-lasting activating epigenetics and improve patient outcomes. We herein provide an overview of the most relevant mechanisms that account for hyperglycaemia-induced changes in chromatin structure; the most relevant mechanism is called “metabolic memory.”

scholarly journals The early use of insulin in type 2 diabetes

2004 ◽  
Vol 7 (2) ◽  
pp. 10-12
Author(s):  
PHILIP LEVY
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Insulin Therapy ◽  
Vascular Complications ◽  
Acting Insulin ◽  
Oral Agents ◽  
Early Use

60?70% of all patients with Type 2 Diabetes Mellitus will ultimately require insulin therapy for the management of their diabetes. Irisulin may be used alone, or in combination with oral agents. The early use of insulin can be very important in decreasing the incidence of micro-vascular complications and in helping to delay the onset of macro-vascular complications. The United Kingdom Prospective Diabetes Study and the Kumamoto Study have shown the beneficial effects of good glucose control in type 2 diabetes mellitus. The DECODE study has related overall mortality to the level of glucose control and specifically to the postprandial glucose. The American Association of Clinical Endocrinologists has established a goal of 6.5% or less for HgbAlc. The appropriate use of insulin will allow us to achieve this goal without causing the patient any undue harm. There are many barriers to insulin therapy including psychological barriers of both the patient and the doctor, and unrealistic fears of both insulin therapy and therapy with self-administered injections. These barriers will be discussed as well as methods to overcome them. Insulin therapy is beneficial and has no long term adverse effects. The incidence of severe hypoglycemia is extremely low in type 2 diabetes. Weight gain is minimal. Insulin therapy by reducing glucose toxicity may also increase the effectiveness of oral anti-hyperglycemic agents. The physician taking care of patients with diabetes should be aggressive and should have no fears of initiating insulin therapy. Insulin dosage is flexible and good control is possible in most patients. The most common use of insulin in type 2 diabetes is as an add-on to oral agents if control with oral agents alone is unsatisfactory. Frequently this involves the use of a single dose of intermediate or long acting insulin or an insulin mixture in the evening. If control is not attained with a single dose, then the patient can be placed on an insulin mixture 2 or 3 times a day. An alternative would be a short acting insulin analogue prior to each meal with a longer acting insulin given 1 or 2 times a day. Titration schedules for insulin dosing will be presented. Insulin available in Russia will be listed along with some guidelines on using these insulins. Increasing the use of insulin and starting insulin earlier in type 2 diabetes will lead to better control of diabetes, increased patient compliance, and decreased long-term complications of diabetes mellitus.

scholarly journals DIABETIC FOOT SYNDROME AS A POSSIBLE CARDIOVASCULAR MARKER IN TYPE 2 DIABETIC PATIENTS

2021 ◽  
Author(s):  
Mohd Riyaz Beg ◽  
Vidhi Gupta
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Diabetic Foot ◽  
Plasma Levels ◽  
Vascular Complications ◽  
Morbidity And Mortality ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality; in fact, some studies showed a higher prevalence of major, previous and new-onset, cardiovascular, and cerebrovascular events in diabetic patients with foot ulcers than in those without these complications. This is consistent with the fact that in diabetes there is a complex interplay of several variables with inflammatory metabolic disorders and their effect on the cardiovascular system that could explain previous reports of high morbidity and mortality rates in diabetic patients with amputations. Involvement of inflammatory markers such as IL-6 plasma levels in diabetic subjects confirmed the pathogenetic issue of the “adipovascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. In patients with diabetic foot, this “adipovascular axis” expression in lower plasma levels of adiponectin and higher plasma levels of IL-6 could be linked to foot ulcers pathogenesis by microvascular and inflammatory mechanisms. The purpose of this review is to focus on the immune inflammatory features of DFS and its possible role as a marker of cardiovascular risk in type 2 diabetes patients.

scholarly journals The Role of HbA1C for Diagnosis of Type-2 Diabetes Mellitus - A Review

2016 ◽  
Vol 11 (1) ◽  
pp. 30-32
Author(s):  
Shahana Zabeen ◽  
Sultana Rehana Akhter
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Large Body ◽  
Vascular Complications ◽  
Glucose Levels ◽  
Blood Glucose Levels

For many years, the diagnosis of diabetes has been made through the laboratory- based measurement of fasting or random blood glucose levels or using OGTT. In the case of diabetes, the major outcome of interest is long term micro vascular complications for which a large body of data has been accumulated leading to the endorsement of HbA1C for diagnosis in many countries worldwide, with some variations in cut-offs and testing strategies.Faridpur Med. Coll. J. Jan 2016;11(1): 30-32

scholarly journals The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study

Diabetologia ◽  
2015 ◽  
Vol 59 (2) ◽  
pp. 275-285 ◽  
Author(s):  
Marlene Ø. Krag ◽  
Lotte Hasselbalch ◽  
Volkert Siersma ◽  
Anni B. S. Nielsen ◽  
Susanne Reventlow ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Morbidity And Mortality ◽  
Personal Care ◽  
Follow Up Study ◽  
The Impact

Long-Term Glycemic Variability and Vascular Complications in Type 2 Diabetes: Post Hoc Analysis of the FIELD Study

2020 ◽  
Vol 105 (10) ◽  
pp. e3638-e3649 ◽  
Author(s):  
Emma S Scott ◽  
Andrzej S Januszewski ◽  
Rachel O’Connell ◽  
Gregory Fulcher ◽  
Russell Scott ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fasting Glucose ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Total Mortality ◽  
Glycemic Variability ◽  
Increased Risk ◽  
Post Hoc

Abstract Aims To investigate whether long-term glycemic variability (GV) is associated with vascular complication development in type 2 diabetes. Methods In a post hoc FIELD trial analysis, GV was calculated as the standard deviation and coefficient of variation (CV) of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose. Baseline variables were compared across quartiles of on-study variability by chi square and ANOVA. Prospective associations between baseline to 2-year GV and subsequent vascular and mortality outcomes were analyzed using landmark logistic and Cox proportional hazards regression. Results Baseline factors associated with higher on-study GV included younger age, male gender, longer diabetes duration, and higher pharmacological therapies usage. Both HbA1c and fasting glucose CV were associated with increased risk of microvascular complications (HR 1.02 [95% CI, 1.01-1.03] P < 0.01; and HR 1.01 [95% CI, 1.00-1.01] P < 0.001, respectively). HbA1c and fasting glucose CV were associated with increased cardiovascular disease (HR 1.02 [95% CI, 1.00-1.04]; and HR 1.01 [95% CI, 1.00-1.02], both P < 0.05). HbA1c CV associated with increased stroke (HR 1.03 [95% CI, 1.01-1.06) P < 0.01). Glucose CV associated with increased coronary events (HR 1.01 [95% CI, 1.00-1.02] P < 0.05). Both HbA1c and glucose CV associated with increased total mortality (HR 1.04 [95% CI, 1.02-1.06]; and HR 1.01 [95% CI, 1.01-1.02], both P < 0.001) and noncardiovascular mortality (HR 1.05 [95% CI, (1.03-1.07]; and HR 1.02 [95% CI, 1.01-1.03], both P < 0.001). HbA1c CV associated with coronary mortality (HR 1.04 [95% CI, 1.01-1.07] P < 0.05). Conclusions Long-term GV was associated with increased risk of vascular outcomes in type 2 diabetes.

Anti-Diabetic Atherosclerosis Effect of Prunella vulgaris in db/db Mice with Type 2 Diabetes

2012 ◽  
Vol 40 (05) ◽  
pp. 937-951 ◽  
Author(s):  
Sun Mi Hwang ◽  
Jin Sook Kim ◽  
Yun Jung Lee ◽  
Jung Joo Yoon ◽  
So Min Lee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vascular Dysfunction ◽  
Plasma Cholesterol ◽  
Vascular Complications ◽  
Hdl Cholesterol ◽  
Dependent Manner ◽  
Prunella Vulgaris ◽  
Long Term Effect

Diabetes mellitus is the leading cause of vascular complications such as atherosclerosis. This study was designed to investigate whether Prunella vulgaris (APV) would inhibit diabetic atherosclerosis in db/db mice with type 2 diabetes. The db/db mice were treated with high fat/high cholesterol (HFHC) diet and an aqueous extract of APV (100 and 200 mg/kg/day) for eight weeks to examine the long-term effect on metabolic abnormalities and diabetic atherosclerosis. APV treatment markedly lowered blood glucose and systolic blood pressure. The db/db mice experienced an increase in blood urea nitrogen as well as a decrease of creatinine clearance, the latter of which was restored by treatment with APV. Treatment with APV markedly decreased total plasma cholesterol, triglyceride, and LDL-cholesterol and also increased the HDL-cholesterol. In addition, malondialdehyde and TGF-β1 were decreased by treatment of APV. On the other hand, total NO level was decreased in db/db mice. However, the NO level was increased by treatment with APV, suggesting an association with vascular dysfunction. Vascular relaxation of aortic rings by acetylcholine or SNP-inducement was ameliorated by APV in a dose-dependent manner. Damage of vascular intima and hypertrophic of media were observed in db/db mice; however its dysfunction was improved by the treatment of APV. APV treatment significantly reduced the aortic expressions of ICAM-1, VCAM-1, ET-1, and nitrotyrosine. Furthermore, expression of eNOS in aortic was remarkably increased by APV treatment. Taken together, APV suppressed hyperglycemia and diabetic vascular dysfunction in HFHC diet-db/db mice. The present data suggest that Prunella vulgaris may prevent development of diabetic atherosclerosis.

Abstract #238: Improved Short Term and Long Term Outcomes of Early Insulin Initiation in Type 2 Diabetes Over 10 Years

2017 ◽  
Vol 23 ◽  
pp. 50
Author(s):  
Jothydev Kesavadev ◽  
Shashank Joshi ◽  
Banshi Saboo ◽  
Hemant Thacker ◽  
Arun Shankar ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Initiation ◽  
Long Term Outcomes ◽  
Short Term
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