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Transportation Research Part A: Policy and Practice     Hybrid Journal   (Followers: 29, SJR: 2.433, h-index: 65)
Transportation Research Part B: Methodological     Hybrid Journal   (Followers: 27, SJR: 3.306, h-index: 70)
Transportation Research Part C: Emerging Technologies     Hybrid Journal   (Followers: 19, SJR: 1.943, h-index: 55)
Transportation Research Part D: Transport and Environment     Hybrid Journal   (Followers: 23, SJR: 1.255, h-index: 44)
Transportation Research Part E: Logistics and Transportation Review     Hybrid Journal   (Followers: 12, SJR: 2.155, h-index: 52)
Transportation Research Part F: Traffic Psychology and Behaviour     Hybrid Journal   (Followers: 17, SJR: 1.016, h-index: 43)
Transportation Research Procedia     Open Access   (Followers: 1)
Trastornos Adictivos     Full-text available via subscription   (Followers: 1, SJR: 0.132, h-index: 4)
Travel Behaviour and Society     Full-text available via subscription   (Followers: 3)
Travel Medicine and Infectious Disease     Hybrid Journal   (Followers: 1, SJR: 0.554, h-index: 23)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 22, SJR: 0.148, h-index: 12)
Trends in Biochemical Sciences     Full-text available via subscription   (Followers: 19, SJR: 11.198, h-index: 210)
Trends in Biotechnology     Full-text available via subscription   (Followers: 40, SJR: 3.859, h-index: 142)
Trends in Cardiovascular Medicine     Hybrid Journal   (Followers: 4, SJR: 1.158, h-index: 74)
Trends in Cell Biology     Full-text available via subscription   (Followers: 23, SJR: 10.198, h-index: 177)
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Trends in Endocrinology & Metabolism     Full-text available via subscription   (Followers: 14, SJR: 5.254, h-index: 108)
Trends in Environmental Analytical Chemistry     Hybrid Journal   (Followers: 1)
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Trials in Vaccinology     Open Access  
Tribology and Interface Engineering Series     Full-text available via subscription   (Followers: 4)
Tribology Intl.     Hybrid Journal   (Followers: 33, SJR: 1.512, h-index: 64)
Tribology Series     Full-text available via subscription   (Followers: 4)
Tsinghua Science & Technology     Full-text available via subscription   (Followers: 1, SJR: 0.179, h-index: 18)
Tuberculosis     Hybrid Journal   (Followers: 5, SJR: 1.729, h-index: 61)
Tunnelling and Underground Space Technology     Hybrid Journal   (Followers: 3, SJR: 1.687, h-index: 41)
Tzu Chi Medical J.     Full-text available via subscription   (SJR: 0.121, h-index: 7)
Ultramicroscopy     Hybrid Journal   (Followers: 2, SJR: 1.818, h-index: 80)
Ultrasonics     Hybrid Journal   (Followers: 4, SJR: 0.702, h-index: 56)
Ultrasonics Sonochemistry     Hybrid Journal   (Followers: 2, SJR: 1.469, h-index: 68)
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Ultrasound in Medicine & Biology     Full-text available via subscription   (Followers: 7, SJR: 0.939, h-index: 91)
UMK Procedia     Open Access  
Urban Forestry & Urban Greening     Hybrid Journal   (Followers: 9, SJR: 1.482, h-index: 29)
Urologic Clinics of North America     Full-text available via subscription   (Followers: 2, SJR: 0.85, h-index: 60)
Urologic Oncology: Seminars and Original Investigations     Hybrid Journal   (Followers: 6)
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Utilities Policy     Hybrid Journal   (Followers: 1, SJR: 0.546, h-index: 25)
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Value in Health     Hybrid Journal   (Followers: 26, SJR: 1.433, h-index: 54)
Vascular Pharmacology     Hybrid Journal   (Followers: 2, SJR: 1.281, h-index: 68)
Vehicular Communications     Full-text available via subscription   (Followers: 1)
Veterinary Clinics of North America: Equine Practice     Full-text available via subscription   (Followers: 10)
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Veterinary Immunology and Immunopathology     Hybrid Journal   (Followers: 10, SJR: 0.804, h-index: 67)
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Veterinary Parasitology     Hybrid Journal   (Followers: 10, SJR: 1.229, h-index: 81)
Vibrational Spectroscopy     Hybrid Journal   (Followers: 8, SJR: 0.52, h-index: 47)
Video J. and Encyclopedia of GI Endoscopy     Open Access  
Virology     Hybrid Journal   (Followers: 17, SJR: 1.784, h-index: 135)
Virology Reports     Open Access  
Virus Research     Hybrid Journal   (Followers: 2, SJR: 1.291, h-index: 78)
Vision Research     Hybrid Journal   (Followers: 14, SJR: 1.432, h-index: 113)
Vitamins & Hormones     Full-text available via subscription   (SJR: 0.891, h-index: 52)
Waste Management     Hybrid Journal   (Followers: 13, SJR: 1.88, h-index: 71)
Waste Management Series     Full-text available via subscription   (Followers: 2)
Water Research     Hybrid Journal   (Followers: 37, SJR: 3.026, h-index: 174)
Water Resources and Economics     Hybrid Journal   (Followers: 3)
Water Resources and Industry     Open Access   (Followers: 3)
Water Resources and Rural Development     Hybrid Journal  
Water Science : The National Water Research Center J.     Open Access   (Followers: 1)
Water Science and Engineering     Open Access   (Followers: 2)
Wave Motion     Hybrid Journal   (Followers: 2, SJR: 0.675, h-index: 38)
Wavelet Analysis and Its Applications     Full-text available via subscription   (Followers: 2)
Wear     Hybrid Journal   (Followers: 33, SJR: 1.371, h-index: 92)
Weather and Climate Extremes     Open Access   (Followers: 2)
Web Semantics: Science, Services and Agents on the World Wide Web     Hybrid Journal   (Followers: 10, SJR: 2.131, h-index: 49)
Wilderness & Environmental Medicine     Hybrid Journal   (Followers: 3)
Wine Economics and Policy     Open Access   (Followers: 5)
Woman : Psychosomatic Gynaecology and Obstetrics     Hybrid Journal  
Women and Birth     Full-text available via subscription   (Followers: 7, SJR: 0.584, h-index: 13)
Women's Health Issues     Full-text available via subscription   (Followers: 7, SJR: 1.237, h-index: 35)
Women's Studies Intl. Forum     Hybrid Journal   (Followers: 3, SJR: 0.378, h-index: 29)
World Crop Pests     Full-text available via subscription   (Followers: 1)
World Development     Hybrid Journal   (Followers: 58, SJR: 1.472, h-index: 94)
World Neurosurgery     Hybrid Journal   (Followers: 3, SJR: 0.585, h-index: 64)
World Patent Information     Hybrid Journal   (Followers: 10, SJR: 0.347, h-index: 19)
World Pumps     Full-text available via subscription   (Followers: 2, SJR: 0.104, h-index: 10)
World Science and Technology     Full-text available via subscription  
Wound Medicine     Hybrid Journal   (Followers: 1)
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen     Full-text available via subscription   (Followers: 1, SJR: 0.264, h-index: 19)
Zeitschrift für Medizinische Physik     Full-text available via subscription   (Followers: 1, SJR: 0.76, h-index: 18)
Zeszyty Naukowe Wielkopolskiego Centrum Onkologii     Full-text available via subscription  
Zoologischer Anzeiger - A J. of Comparative Zoology     Hybrid Journal   (Followers: 1, SJR: 0.56, h-index: 26)

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Journal Cover   Diabetes & Metabolism
  [SJR: 0.971]   [H-I: 62]   [52 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 1262-3636
   Published by Elsevier Homepage  [2801 journals]
  • Family history of diabetes and the risk of subclinical atherosclerosis
    • Abstract: Publication date: Available online 9 October 2015
      Source:Diabetes & Metabolism
      Author(s): G.-M. Park, Y.-R. Cho, S.-W. Lee, S.-C. Yun, E.H. Gil, D.W. Kim, T.-S. Kim, C.J. Kim, J.S. Cho, M.-W. Park, S.H. Her, Y.-H. Kim, D.H. Yang, J.-W. Kang, T.-H. Lim, C.H. Jung, E.H. Koh, W.J. Lee, M.-S. Kim, K.-U. Lee, H.-K. Kim, J. Choe, J.-Y. Park
      Aim This study investigated the influence of a family history of diabetes on the risk of subclinical coronary atherosclerosis according to coronary computed tomography angiography (CCTA) in asymptomatic individuals. Methods A total of 6434 consecutive asymptomatic individuals with no prior history of coronary artery disease voluntarily underwent CCTA evaluation as part of a general health examination. Coronary atherosclerotic plaque and significant coronary artery stenosis (degree of stenosis ≥50%) on CCTA were assessed. Logistic regression analysis was used to determine the association between a family history of diabetes and atherosclerotic plaque or significant coronary artery stenosis according to the degree of diabetes (normal, prediabetic and diabetic). Results Mean age of study participants was 53.7±7.6 years, and 4694 (73.0%) were male. A total of 1593 (24.8%) participants had a family history of diabetes in a first-degree relative. Among the study participants, 1115 (17.3%), 3122 (48.5%) and 2197 (34.1%) were categorized as diabetic, prediabetic and normal, respectively. In diabetic participants, after stepwise adjustments for clinical and laboratory variables, a family history of diabetes was significantly associated with non-calcified plaque (P <0.05 for all), but did not appear to be associated with either calcified or mixed plaques or with significant coronary artery stenosis (P >0.05 for all). In prediabetic and normal participants, a family history of diabetes was not associated with either atherosclerotic plaque or significant coronary artery stenosis (P >0.05 for all). Conclusion In asymptomatic diabetic individuals, a family history of diabetes is consistently associated with non-calcified coronary plaque after adjusting for risk factors.

      PubDate: 2015-10-11T10:31:32Z
  • Weight loss at a high cost: Orlistat-induced late-onset severe kidney
    • Abstract: Publication date: Available online 9 October 2015
      Source:Diabetes & Metabolism
      Author(s): B. Buysschaert, S. Aydin, J. Morelle, M.P. Hermans, M. Jadoul, N. Demoulin
      Aim This report describes a case of kidney failure secondary to orlistat, a lipase inhibitor commonly used in the treatment of obesity. Case report An 80-year-old man with type 2 diabetes who was being treated with orlistat developed rapidly progressive kidney failure. Low-grade albuminuria argued against diabetic nephropathy. Renal biopsy showed tubulointerstitial nephritis associated with numerous calcium oxalate crystals. Enteric hyperoxaluria was attributed to the orlistat treatment. The latter was stopped and the patient received calcium supplements. Six months after orlistat withdrawal, oxaluria was normalized and kidney function stabilized. Conclusion Oxalate nephropathy may result from hyperoxaluria secondary to orlistat treatment. This suggests that kidney function and oxaluria be closely monitored in patients taking orlistat.

      PubDate: 2015-10-11T10:31:32Z
  • Hypoglycaemic episodes in patients with type 2
           diabetes – risk factors and associations with
           patient-reported outcomes: The PANORAMA Study
    • Abstract: Publication date: Available online 9 October 2015
      Source:Diabetes & Metabolism
      Author(s): D. Simon, P. de Pablos-Velasco, K.G. Parhofer, L. Gönder-Frederick, I. Duprat Lomon, H. Vandenberghe, E. Eschwège, C. Bradley
      Aim To explore the frequency of hypoglycaemic episodes, their risk factors, and associations with patient-reported outcomes in patients with type 2 diabetes enrolled in the PANORAMA cross-sectional study. Methods Five thousand seven hundred and eighty-three patients aged ≥ 40 years with type 2 diabetes duration ≥ 1 year were recruited in nine European countries. Patients reported severe and non-severe hypoglycaemic episodes during the past year at a single study visit. Patient-reported outcomes were measured by the Audit of Diabetes-Dependent Quality of Life, Diabetes Treatment Satisfaction Questionnaires, Hypoglycaemia Fear Survey-II, and EQ-5D Visual Analog Scale. Results During the previous year, 4.4% of the patients experienced ≥1 severe hypoglycaemic episode; among those without severe hypoglycaemia, 15.7% experienced ≥1 non-severe episode. Patients experiencing any hypoglycaemic episode reported a greater negative impact of diabetes on quality of life, greater fear of hypoglycaemia, less treatment satisfaction and worse health status than those with no episodes. In multivariate analyses hypoglycaemia was significantly associated with longer diabetes duration; presence of microvascular and, to a lesser extent, macrovascular complications; treatment with insulin, glinides or sulfonylureas; and use of self-monitoring blood glucose. Conclusion In patients with type 2 diabetes, severe hypoglycaemic episodes were not uncommon and one in five experienced some form of hypoglycaemia during the previous year. Hypoglycaemia was associated with more negative patient-reported outcomes. The risk of hypoglycaemia increased with diabetes duration, presence of diabetes-related complications, use of self-monitoring blood glucose, insulin secretagogues, and insulin treatment.

      PubDate: 2015-10-11T10:31:32Z
  • Effects of a very low-calorie diet on insulin sensitivity and insulin
           secretion in overweight/obese and lean type 2 diabetes patients
    • Abstract: Publication date: Available online 4 October 2015
      Source:Diabetes & Metabolism
      Author(s): C. Liu, C. Li, J. Chen, Y. Liu, Q. Cheng, X. Xiang, G. Chen

      PubDate: 2015-10-08T09:52:45Z
  • Coffee consumption and risk of the metabolic syndrome: A meta-analysis
    • Abstract: Publication date: Available online 1 October 2015
      Source:Diabetes & Metabolism
      Author(s): F. Shang, X. Li, X. Jiang
      Aims The association between coffee consumption and risk of the metabolic syndrome (MetS) remains controversial. For this reason, a meta-analysis including dose–response analysis was conducted to quantitatively summarize the association between coffee intakes and MetS risk. Methods A search was made of PubMed and the China National Knowledge Infrastructure (CNKI) for relevant articles published between 1 January 1999 and 31 May 2015. All observational studies related to the relationship of coffee consumption and risk of MetS were included in the meta-analysis. The result was estimated by a random-effects model, while the dose–response relationship was assessed by a restricted cubic spline model. Results Eleven published reports including 13 studies with a total of 159,805 participants were eligible for our meta-analysis. The aggregated result (and 95% CI) for the highest vs lowest category of coffee consumption was 0.872 (0.781–0.975). After excluding one study with a relative risk (RR)<0.300, the aggregated result (and 95% CI) was 0.889 (0.801–0.986). A non-linear relationship was found between coffee consumption and the MetS in the dose–response analysis. Conclusion This meta-analysis suggests that coffee consumption is associated with a low risk of MetS, and further studies to address the question of causality are now needed.

      PubDate: 2015-10-03T08:25:44Z
  • Role of the autonomic nervous system in activation of human brown adipose
           tissue: A review of the literature
    • Abstract: Publication date: Available online 26 September 2015
      Source:Diabetes & Metabolism
      Author(s): L. Bahler, R.J. Molenaars, H.J. Verberne, F. Holleman
      Brown adipose tissue (BAT) is able to convert calories into heat rather than storing them. Therefore, activated BAT could be a potential target in the battle against obesity and type 2 diabetes. This review focuses on the role of the autonomic nervous system in the activation of human BAT. Although the number of studies focusing on BAT in humans is limited, involvement of the sympathetic nervous system (SNS) in BAT activation is evident. Metabolic BAT activity can be visualized with 18F-fluorodeoxyglucose, whereas sympathetic activation of BAT can be visualized with nuclear-medicine techniques using different radiopharmaceuticals. Also, interruption of the sympathetic nerves leading to BAT activation diminishes sympathetic stimulation, resulting in reduced metabolic BAT activity. Furthermore, both β- and α-adrenoceptors might be important in the stimulation process of BAT, as pretreatment with propranolol or α-adrenoceptor blockade also diminishes BAT activity. In contrast, high catecholamine levels are known to activate and recruit BAT. There are several interventional studies in which BAT was successfully inhibited, whereas only one interventional study aiming to activate BAT resulted in the intended outcome. Most studies have focused on the SNS for activating BAT, although the parasympathetic nervous system might also be a target of interest. To better define the possible role of BAT in strategies to combat the obesity epidemic, it seems likely that future studies focusing on both histology and imaging are essential for identifying the factors and receptors critical for activation of human BAT.

      PubDate: 2015-09-30T08:14:11Z
  • Neuregulin 1 improves glucose tolerance in adult and old rats
    • Abstract: Publication date: Available online 26 September 2015
      Source:Diabetes & Metabolism
      Author(s): K. Caillaud, N. Boisseau, G. Ennequin, V. Chavanelle, M. Etienne, X. Li, P. Denis, D. Dardevet, A. Lacampagne, P. Sirvent
      Aim Studies both in vitro and ex vivo of rodent skeletal muscle have highlighted the potential involvement of neuregulin 1 (NRG1) in glucose metabolism regulation, yet nothing is known of the role of NRG1 in systemic glucose homoeostasis. For this reason, it was hypothesized that systemic delivery of NRG1 might improve glucose tolerance and that the effect might be age-dependent. Methods Glucose tolerance tests were performed in 6-month-old (adult) and 22-month-old (old) male Wistar rats 15min after a single injection of either NRG1 (50μg/kg) or saline (controls). Skeletal muscle and liver samples were also collected 30min after the acute NRG1 or saline treatment, while the phosphorylation status of ErbB receptors and AKT was assessed by Western blotting. Results Acute NRG1 treatment decreased the glycaemic response to an oral glucose load in both adult and old rats. NRG1 injection did not activate ErbB receptors in skeletal muscle, whereas phosphorylation of ErbB3 and AKT was markedly increased in the liver of NRG1-treated adult and old rats compared with controls. Conclusion This study shows that NRG1 has a possible glucose-lowering effect in the liver and via an ErbB3/AKT signaling pathway. This NRG1 effect is also maintained in old rats, suggesting that the NRG1/ErbB signaling pathway might represent a promising therapeutic target in insulin resistance states.

      PubDate: 2015-09-30T08:14:11Z
  • Determining the association between types of sedentary behaviours and
           cardiometabolic risk factors: A 6-year longitudinal study of French adults
    • Abstract: Publication date: Available online 26 September 2015
      Source:Diabetes & Metabolism
      Author(s): M. Menai, H. Charreire, E. Kesse-Guyot, V.A. Andreeva, S. Hercberg, P. Galan, J.-M. Oppert, L.K. Fezeu
      Aim This study identified the longitudinal associations between leisure-time sedentary behaviours [television (TV) viewing, computer use and reading (h/week)] and cardiometabolic risk factors, including the metabolic syndrome. Methods A total of 2517 participants (mean±SD age: 55.5±4.9years) were assessed in 2001 and in 2007 for physical activity and leisure-time sedentary behaviours, anthropometry, body composition, blood pressure, fasting blood glucose and lipids, using standardized methods. Multivariate generalized linear (beta, 95% CI and P values) and logistic (OR and 95% CI) regression models were used to assess cross-sectional associations between sedentary behaviours and cardiometabolic risk factors, while a 6-year longitudinal study explored these associations as well as the odds of developing the metabolic syndrome, as defined by the NCEP ATPIII. Results Increased TV viewing time over the follow-up period was positively associated with increases in body mass index (BMI; P <0.01) and percent body fat (P <0.001), and marginally with waist circumference (P =0.06). Reverse associations were also found, with changes in BMI, percent fat mass and waist circumference positively associated with TV viewing and computer use. Associations between reading and cardiometabolic risk factors were less consistent. Each 1-h/week increase in baseline TV viewing and in reading was associated with an increase in the chances of developing the metabolic syndrome (OR=1.031, 95% CI: 0.998–1.060, P =0.07; and OR=1.032, 95% CI: 1.002–1.065, P =0.02; respectively). Conclusion The present study data emphasizes the notion of differential associations of specific sedentary behaviours with cardiometabolic risk factors. They are also evidence that different longitudinal associations should be taken into account when designing public health objectives of interventions aimed at improving cardiometabolic health.

      PubDate: 2015-09-30T08:14:11Z
  • Type 2 diabetes and insulinoma: An unusual association
    • Abstract: Publication date: Available online 19 September 2015
      Source:Diabetes & Metabolism
      Author(s): J.-C. Maiza, C. Wantz

      PubDate: 2015-09-22T07:00:44Z
  • Screening for gestational diabetes in the Lombardy region: A
           population-based study
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): F. Nicotra, C. Molinari, N. Dozio, M.T. Castiglioni, B. Ibrahim, A. Zambon, G. Corrao, M. Scavini
      Aim As the treatment of hyperglycaemia during pregnancy with diet or insulin reduces the risk of adverse maternal outcomes and perinatal complications, screening for gestational diabetes mellitus (GDM) is included, albeit to variable extents, in all guidelines of care for pregnant women. The aim of the present investigation was to estimate the proportion of pregnancies screened for GDM in Lombardy between 2007 and 2010, and to identify predictors of screening. Methods A retrospective cross-sectional study using regional healthcare utilization databases of Lombardy was conducted. The study included all residents of Lombardy without pregestational diabetes who delivered between 1 January 2007 and 31 December 2010. The proportion of pregnancies with at least one screening test for GDM was calculated, along with the odds ratios and 95% confidence intervals associated with selected covariates for GDM screening. Results Of the 362,818 pregnancies included in the sample, 30% were screened for GDM. The proportion of pregnancies screened increased slightly from 2007 (27%) to 2010 (33%) and with maternal age (from 28% among women<25 years to 32% among those ≥35years), and varied widely across local health management organizations (HMOs) of residence (range: 20% to 68%). Socioeconomic indicators (education, immigrant status), obstetric history and prepregnancy hypertension were independent predictors of GDM screening. Conclusion The study finding of a low rate of pregnant women screened for GDM among residents of Lombardy supports the need for programmes to improve training of healthcare professionals, to raise women's awareness of GDM and to eliminate barriers to GDM screening.

      PubDate: 2015-09-18T06:04:24Z
  • Intermittent hypoxia is an independent marker of poorer glycaemic control
           in patients with uncontrolled type 2 diabetes
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): M. Torrella, I. Castells, G. Gimenez-Perez, A. Recasens, M. Miquel, O. Simó, E. Barbeta, G. Sampol
      Aim This study investigated the association between intermittent hypoxia and glycaemic control in patients with uncontrolled type 2 diabetes (T2D) not treated for sleep apnoea. Methods This was a single-centre cross-sectional study of stable patients with T2D and HbA1c ≥7% (53mmol/mol). Patients underwent overnight pulse oximetry and, if intermittent hypoxia—defined by a 4% oxyhaemoglobin desaturation index≥15—was observed, respiratory polygraphy was performed. All participants completed the Pittsburgh Sleep Questionnaire and Hospital Anxiety and Depression Scale. The association between intermittent hypoxia and poorer glycaemic control (defined by an HbA1c level above the median of 8.5%) was estimated by multivariate logistic regression analysis. Results Out of 145 patients studied, 54 (37.2%) had intermittent hypoxia (with sleep apnoea confirmed in 53). Patients with intermittent hypoxia had 0.7% (7.7mmol/mol) higher median HbA1c levels than patients without intermittent hypoxia (P =0.001). Intermittent hypoxia was associated with poorer glycaemic control after adjusting for obesity, age at onset and duration of diabetes, insulin requirement, sleep quality and depressive mood (OR: 2.31, 95% CI: 1.06–5.04, model adjusted for body mass index; OR: 2.46, 95% CI: 1.13–5.34, model adjusted for waist-to-height ratio). Conclusion Intermittent hypoxia, a consequence of sleep apnoea, is frequent and has a strong independent association with poorer glycaemic control in patients with uncontrolled T2D.

      PubDate: 2015-09-18T06:04:24Z
  • Impact of diabetes on neutrophil-to-lymphocyte ratio and its relationship
           to coronary artery disease
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): M. Verdoia, A. Schaffer, L. Barbieri, G. Aimaretti, P. Marino, F. Sinigaglia, H. Suryapranata, G. De Luca
      Background Coronary artery disease (CAD) is the leading cause of mortality among diabetic patients, and the neutrophil-to-lymphocyte ratio (NLR) has recently emerged from among inflammatory parameters as a potential indicator of vascular complications and poorer outcome in patients with diabetes. This study aimed to evaluate: 1) the impact of diabetes on NLR; and 2) the role of NLR on the extent of CAD among diabetic patients undergoing coronary angiography. Methods Consecutive patients undergoing coronary angiography were included. Diabetic status and main chemistry parameters were assessed at the time of admission. Significant CAD was defined as at least one vessel with stenosis>50%, while severe CAD was left main and/or three-vessel disease, as evaluated by quantitative coronary angiography (QCA). Results Diabetes was observed in 1377 of 3756 patients (36.7%); they were older, and displayed higher-risk cardiovascular profile and more complex CAD. Diabetic status was also associated with a significant increase in NLR (P =0.004). Among diabetics, higher NLR tertile values were related to ageing (P <0.001), dyslipidaemia (P <0.001), renal failure (P <0.001), body mass index (P <0.001), previous percutaneous coronary revascularization (P =0.004) and cerebrovascular events (P =0.003), acute presentation (P <0.001), treatment at admission with beta-blockers/statins/ASA (all P <0.001), diuretics (P =0.01) or clopidogrel (P =0.04), platelet count (P =0.03), white blood cell count, creatinine, glycaemia and C-reactive protein (P <0.001), and inversely related to haemoglobin, triglyceride levels (P <0.001) and smoking (P =0.03). NLR was associated with multivessel disease (P <0.001), degree of stenosis (P =0.01), type C lesions (P =0.02), coronary calcifications and intracoronary thrombus (P <0.001), but inversely with in-stent restenosis (P =0.003) and TIMI flow grade (P =0.02). Also, NLR was directly related to CAD prevalence (P <0.001; adjusted OR [95% CI]: 1.62 [1.27–2.07], P <0.001) and CAD severity (P <0.001; adjusted OR [95% CI]: 1.19 [1.00–1.43], P =0.05). Conclusion NLR is increased among diabetic patients and, in such patients, is independently associated with the prevalence and severity of CAD. Further studies are now needed to confirm present results and to evaluate the underlying pathophysiological mechanisms behind our findings.

      PubDate: 2015-09-18T06:04:24Z
  • Anthropometrics indices of obesity, and all-cause and cardiovascular
           disease-related mortality, in an Asian cohort with type 2 diabetes
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): R.B.T. Lim, C. Chen, N. Naidoo, G. Gay, W.E. Tang, D. Seah, R. Chen, N.C. Tan, J. Lee, E.S. Tai, K.S. Chia, W.Y. Lim
      Aim The study investigated the relationship of general (body mass index [BMI]) and central (waist circumference [WC]; waist–hip ratio [WHipR]; waist–height ratio [WHeightR]) adiposity with all-cause and cardiovascular disease (CVD)-related mortality in an Asian population with diabetes. Methods A total of 13,278 participants with type 2 diabetes mellitus (T2DM) recruited from public-sector primary-care and specialist outpatients clinics in Singapore were followed-up for a median duration of 2.9 years, during which time there were 524 deaths. Cox proportional-hazards regression and competing-risk models were used to obtain hazard ratios (HRs) for anthropometric variables of all-cause and CVD-related mortality. Results After adjusting for BMI, the highest quintiles of WC, WHipR and WHeightR were all positively associated with mortality compared with the lowest quintiles, with WHeightR exhibiting the largest effect sizes [all-cause mortality HR: 2.13, 95% confidence interval (CI): 1.33–3.42; CVD-related mortality HR: 3.42, 95% CI: 1.62–7.19]. Being overweight but not obese (BMI:≥23.0 but<27.5kg/m2) was associated with a decreased risk of CVD-related mortality in those aged≥65 years (HR: 0.47, 95% CI: 0.29–0.75), but not in those aged<65 years (HR: 1.11, 95% CI: 0.49–2.50). Conclusion Overweight, but not obesity, was associated with a reduction in risk of mortality. This was seen in T2DM patients aged≥65 years, but not in those younger than this. At the same BMI, having higher central-obesity indices such as WC, WHipR and WHeightR also increased the risk of mortality.

      PubDate: 2015-09-18T06:04:24Z
  • Potential influence of Type A personality on plasma C-reactive protein
           levels in people with diabetes
    • Abstract: Publication date: Available online 15 September 2015
      Source:Diabetes & Metabolism
      Author(s): J.-C. Chauvet-Gélinier, B. Trojak, C. Lemogne, L.-S. Aho-Glélé, M.-C. Brindisi, B. Bouillet, E. Ponavoy, V. Meille, I. Simoneau, K. Chahraoui, G. Vaillant, J.-M. Petit, S.M. Consoli, B. Bonin, B. Vergès
      Aim Type A personality, although classically known as a factor linked to increased vascular risk, has recently been associated with increased survival in patients with diabetes. As low-grade inflammation predicts a poor outcome, the present study explored the potential associations between Type A and plasma levels of C-reactive protein (CRP) in diabetes. Methods Type A personality was assessed by the Bortner questionnaire in people with diabetes. The association between Type A and plasma CRP levels was examined by multivariable linear regression, and structural equation modelling (SEM) was performed to determine the impact of the major clinical, biological and psychological confounders. Results The study included 626 participants with type 1 and type 2 diabetes from the Diabetes and Psychological Profile study. Multivariable analyses showed an independent inverse association between Type A score and CRP levels. The structural model adjusted for age, gender, diabetes type and duration, body mass index (BMI), smoking status, alcohol abuse, oral antidiabetic and statin treatments, HbA1c levels, lipids, perceived stress, anxiety and depression revealed significant associations between CRP and Type A (β =−0.135, 95% CI: −0.242, −0.028; P =0.014), BMI (β =0.194, 95% CI: 0.038, 0.350; P =0.015) and HDL cholesterol (β =−0.132, 95% CI: −0.245, −0.020; P =0.014). Conclusion Our present study data indicate that Type A personality is independently associated with lower CRP levels. This lower level of inflammation might explain the better clinical outcomes associated with Type A personality in patients with diabetes.

      PubDate: 2015-09-18T06:04:24Z
  • Editorial board
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4

      PubDate: 2015-09-18T06:04:24Z
  • Sleep habits and diabetes
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): S. Larcher, P.-Y. Benhamou, J.-L. Pépin, A.-L. Borel
      Sleep duration has been constantly decreasing over the past 50years. Short sleep duration, sleep quality and, recently, long sleep duration have all been linked to poor health outcomes, increasing the risk of developing metabolic diseases and cardiovascular events. Beyond the duration of sleep, the timing of sleep may also have consequences. Having a tendency to go early to bed (early chronotype) compared with the habit of going to bed later (late chronotype) can interfere considerably with social schedules (school, work). Eventually, a misalignment arises in sleep timing between work days and free days that has been described as ‘social jet lag’. The present review looks at how different sleep habits can interfere with diabetes, excluding sleep breathing disorders, and successively looks at the effects of sleep duration, chronotype and social jet lag on the risk of developing diabetes as well as on the metabolic control of both type 1 and type 2 diabetes. Finally, this review addresses the current state of knowledge of physiological mechanisms that could be linking sleep habits and metabolic health.

      PubDate: 2015-09-18T06:04:24Z
  • Impact of classical risk factors of type 2 diabetes among Asian Indian,
           Chinese and Japanese populations
    • Abstract: Publication date: Available online 14 September 2015
      Source:Diabetes & Metabolism
      Author(s): L. He, J. Tuomilehto, Q. Qiao, S. Söderberg, M. Daimon, J. Chambers, J. Pitkäniemi
      Aims This review investigated the population impact of major modifiable type 2 diabetes (T2D) risk factors, with special focus on native Asian Indians, to estimate population attributable risks (PARs) and compare them with estimates from Chinese and Japanese populations. Methods Information was obtained on risk factors in 21,041 Asian Indian, 17,774 Chinese and 17,986 Japanese populations from multiple, large, cross-sectional studies (the DECODA project) of T2D. Crude and adjusted PARs were estimated for the major T2D risk factors. Results Age had the highest crude and adjusted PARs among Asian Indians and Chinese in contrast to waist–hip ratio among Japanese. After adjusting for age, the PAR for body mass index (BMI) in Asian Indians (41.4% [95% CI: 37.2%; 45.4%]) was second only to triglycerides (46.4% [95% CI: 39.5%; 52.8%]) compared with 35.8% [95% CI: 29.9%; 41.4%] in Japanese and 38.4% [95% CI: 33.5%; 43.2%] in Chinese people. The PAR for BMI adjusted for age, LDL and triglycerides (39.7% [95% CI: 31.6%; 47.2%]) was higher than for any other factor in Asian Indians, and was much higher than in the Chinese (16.8% [95% CI: 3.0%; 30.9%]) and Japanese (30.4% [95% CI: 17.5%; 42.2%]) populations. Conclusion This review provides estimates of the association between major risk factors and prevalences of T2D among Asian populations by examining their PARs from large population-based samples. From a public-health point of view, the importance of BMI in Asian Indians is especially highlighted in comparison to the other Asian populations. Given these results and other recent findings on the causality link between BMI and T2D, it can be postulated that obesity may be involved in the aetiology of T2D through interaction with ethnic-specific genetic factors, although ethnicity itself is not a direct risk factor for T2D as people of all ethnic backgrounds develop diabetes.

      PubDate: 2015-09-18T06:04:24Z
  • Ten-year improvement of insulin resistance and growth with recombinant
           human insulin-like growth factor 1 in a patient with insulin receptor
           mutations resulting in leprechaunism
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): M. de Kerdanet, M. Caron-Debarle, S. Nivot, T. Gaillot, O. Lascols, B. Fremont, M. Bonaure, S. Gie, C. Massart, J. Capeau
      Aim Leprechaunism, a rare genetic disease resulting from mutations in two alleles of the insulin receptor gene, is characterized by severe insulin resistance, retarded growth and, usually, premature death. The ability of treatment with recombinant human insulin-like growth factor 1 (rhIGF1) to improve metabolic and clinical parameters in the long-term is still controversial. Methods Mutations were looked for in the insulin receptor gene of a four-month-old female baby with leprechaunism. The patient's skin fibroblasts were analyzed for response to insulin and IGF1. At the clinical level, the very long-term effects of treatment with rhIGF1/rhIGFBP3 were evaluated by clinical and metabolic parameters. Results The patient's diagnosis was based on compound heterozygous mutations in two alleles of the insulin receptor gene, thus confirming leprechaunism. Cultured fibroblasts showed a decreased number of insulin receptors and were insulin-resistant. However, IGF1 was able to stimulate IGF1 receptor signalling, suggesting possible activation of a salvage pathway. Treatment with IGF1/IGFBP3 for 8.7years, then IGF1 for 2years, resulted in normalization of circulating levels of IGF1 and IGFBP3. Large daily variations in glycaemia and insulinaemia persisted, but mean glycaemia decreased. Regarding growth, the patient's BMI Z score normalized and length/height score improved. Our patient presented normal neurological development and academic achievement. The treatment was free of adverse effects. Conclusion Our results provide evidence that rhIGF1 with and without rhIGFBP3 can prevent fatal outcomes, and improve growth and metabolic parameters, for more than 10years in a patient with leprechaunism. Long-term rhIGF1 for severe insulin resistance syndrome should be considered.

      PubDate: 2015-09-18T06:04:24Z
  • Evaluation of the relationship between cardiovascular risk factors and
           periaortic fat thickness in children with type 1 diabetes mellitus
    • Abstract: Publication date: September 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 4
      Author(s): N. Akyürek, M.E. Atabek, B.S. Eklioglu, H. Alp

      PubDate: 2015-09-18T06:04:24Z
  • Hyperglycaemia per se does not affect erythrocyte glucose-6-phosphate
           dehydrogenase activity in ketosis-prone diabetes
    • Abstract: Publication date: Available online 1 September 2015
      Source:Diabetes & Metabolism
      Author(s): S.P. Choukem, E. Sobngwi, J.P. Garnier, S. Letellier, F. Mauvais-Jarvis, F. Calvo, J.-F. Gautier
      Aim Previously, we described patients with ketosis-prone type 2 diabetes (KPD) and glucose-6-phosphate dehydrogenase (G6PD) deficiency, but no mutation of the G6PD gene. Our present study used two complementary approaches to test whether hyperglycaemia might inhibit G6PD activity: (1) effect of acute hyperglycaemia induced by glucose ramping; and (2) effect of chronic hyperglycaemia using correlation between G6PD activity and HbA1c levels. Methods In the first substudy, 16 KPD patients were compared with 11 healthy, non-diabetic control subjects of the same geographical background. Erythrocyte G6PD activity and plasma glucose were assessed at baseline and every 40min during intravenous glucose ramping that allowed maintaining hyperglycaemia for more than 3h. In the second substudy, erythrocyte G6PD activity and HbA1c levels were evaluated in 108 consecutive African patients with either type 2 diabetes or KPD, and a potential correlation sought between the two variables. Results The maximum plasma glucose level after 200min of glucose perfusion was 20.9±3.7mmol/L for patients and 10.7±2.3mmol/L for controls. There was no difference between baseline and repeated G6PD activity levels during acute hyperglycaemia in either KPD patients (P =0.94) or controls (P =0.57), nor was there any significant correlation between residual erythrocyte G6PD activity and HbA1c levels (r =−0.085, P =0.38). Conclusion Neither acute nor chronic hyperglycaemia affects erythrocyte G6PD activity. Thus, hyperglycaemia alone does not explain cases of G6PD deficiency in the absence of gene mutation as described earlier.

      PubDate: 2015-09-06T05:19:05Z
  • Linking RAGE and Nox in diabetic micro- and macrovascular complications
    • Abstract: Publication date: Available online 29 August 2015
      Source:Diabetes & Metabolism
      Author(s): C. Koulis, A.M.D. Watson, S.P. Gray, K.A. Jandeleit-Dahm
      Diabetes-associated micro- and macrovascular complications contribute to the increased morbidity and mortality observed in diabetes. Diabetes leads to accelerated generation of advanced glycation end products (AGEs) and activation of their receptor, RAGE, as well as activation of NAD(P)H oxidase (Nox), an enzyme dedicated to the production of reactive oxygen species, which ultimately leads to a pro-inflammatory environment characterised by oxidative stress. This review outlines the current evidence about the contribution of and interaction between the AGE-RAGE axis and Nox derived ROS formation in the development and progression of micro- and macrovascular diabetic complications (especially in atherosclerosis and nephropathy), and the mechanisms by which this occurs. We also outline novel treatments targeting the AGE-RAGE axis and specific Nox isoforms, which hold great promise in attenuating the development of diabetes-associated atherosclerosis and diabetic nephropathy.

      PubDate: 2015-09-01T04:56:04Z
  • Urinary and genital infections in patients with diabetes: How to diagnose
           and how to treat
    • Abstract: Publication date: Available online 29 August 2015
      Source:Diabetes & Metabolism
      Author(s): P. Njomnang Soh, F. Vidal, E. Huyghe, P. Gourdy, J.M. Halimi, B. Bouhanick
      Diabetes is a predisposing factor for urinary tract and genital infections in both women and men. Sodium–glucose cotransporter-2 (SGLT2) inhibitors constitute a novel therapeutic class indicated for type 2 diabetes (T2D) patients, and are already on the market in a few countries in Europe. They decrease glycaemia mainly by enhancing glucose excretion in urine by reducing renal glucose reabsorption via the action of SGLT2 in the kidneys. In general, they are well tolerated, but their mode of action results in specific side effects as well as an increased risk of genital (vulvovaginitis and balanitis) and urinary tract infections, for which T2D patients are already at high risk, reported within the first 6 months of treatment. Usually these infectious events are successfully treated with standard therapies, but diabetologists are not accustomed to dealing with them. The aim of this review is to describe the different types of lower urinary tract and genital infections, and the treatment strategies currently available for patients with diabetes.

      PubDate: 2015-09-01T04:56:04Z
  • Indication, organization, practical implementation and interpretation
           guidelines for retrospective CGM recording: A French position statement
    • Abstract: Publication date: Available online 7 August 2015
      Source:Diabetes & Metabolism
      Author(s): M. Joubert, S. Baillot-Rudoni, B. Catargi, G. Charpentier, A. Esvant, S. Franc, B. Guerci, I. Guilhem, V. Melki, E. Merlen, A. Penfornis, E. Renard, J.P. Riveline, P. Schaepelynck, A. Sola-Gazagnes, H. Hanaire
      Aim The benefits of retrospective continuous glucose monitoring (retroCGM) recording have been widely explored in clinical studies, and many diabetes physicians routinely use this examination. However, the method of interpretation of CGM recordings has never been precisely described. Method An expert French panel of physicians met for two days to discuss several aspects of retroCGM use and to produce a position statement. Results The guidelines cover the indications for retroCGM, the general organization and practical implementation of CGM recordings, a description of the different devices available and guidelines for the interpretation of retroCGM recordings. Conclusion This consensus document should help clinicians in the proper use of retroCGM.

      PubDate: 2015-08-11T04:22:55Z
  • Review of heart failure treatment in type 2 diabetes patients: It's
           at least as effective as in non-diabetic patients!
    • Abstract: Publication date: Available online 4 August 2015
      Source:Diabetes & Metabolism
      Author(s): N. Girerd, F. Zannad, P. Rossignol
      Our society is currently facing an epidemic of diabetes and heart failure. Historically, certain cardiology treatments, mainly beta-blockers, have been considered ‘dangerous’ in diabetic patients, but the time has come for personalized medicine to be applied in the field of cardiology, especially in heart failure (HF). To determine whether HF treatment should be individualized according to diabetes status, this review of the available randomized evidence was carried out, with special emphasis on treatment-effect modification in relation to diabetes. Based on a large body of evidence in the literature, our review concludes that HF treatment should be the same for diabetic and non-diabetic patients. In concurrence, international guidelines now strongly advocate the use of HF drugs, including beta-blockers, in diabetic HF patients. The benefit of HF treatment is at least as favourable in such patients as in non-diabetic patients on a relative basis. Given the higher risk of events in diabetics, this could translate to an even greater absolute impact of HF treatment in these patients, which should further encourage caregivers to more aggressively manage HF in diabetic patients. To this end, non-cardiologists, including general practitioners and endocrinologists/diabetologists who treat diabetic HF patients, should be considered part of the HF drug optimalization process, including the referral of patients to specialized centres for possible implantable cardiac defibrillators and/or cardiac resynchronization indication assessment.

      PubDate: 2015-08-07T04:12:33Z
  • Pharmacological stimulation of serotonin 5-HT1B receptors enhances
           increases in plasma active glucagon-like peptide-1 levels induced by
           dipeptidyl peptidase-4 inhibition independently of feeding in mice
    • Abstract: Publication date: Available online 30 July 2015
      Source:Diabetes & Metabolism
      Author(s): K. Nonogaki, T. Kaji
      Aim Glucagon-like peptide-1 (GLP-1), an incretin hormone, is released from intestinal L cells in response to nutrient ingestion. Dipeptidyl peptidase-4 (DPP-4) rapidly degrades the active form of GLP-1 to an inactive form in the bloodstream. The present study aimed to investigate the role of serotonin (5-HT)1B receptors in the regulation of plasma active GLP-1 levels and glucose tolerance under DPP-4 inhibition. Methods C57BL6J mice treated with or without alogliptin, a highly selective DPP-4 inhibitor, for 4 days were intraperitoneally injected with either saline, the 5-HT1B/2C receptor agonist meta-chlorophenylpiperazine (mCPP) at 2.5mg/kg and 5mg/kg or the selective 5-HT1B receptor agonist CP94253 at 2.5mg/kg and 5mg/kg, and food-deprived after treatment. An hour later, plasma active GLP-1 levels were determined. Also, a glucose tolerance test was done by injecting d-glucose (2g/kg) following the injection of saline or CP94253 (5mg/kg) in mice treated with alogliptin. Results Intraperitoneal injection of mCPP (2.5 and 5mg/kg) or CP94253 (2.5 and 5mg/kg) in mice treated with alogliptin for 4 days significantly increased plasma active GLP-1 levels compared with saline controls in mice that were food-deprived after the injections. While intraperitoneal injection of either mCPP or CP94253 alone had no significant effect on plasma active GLP-1 levels, the injection of CP94253 improved glucose tolerance in mice treated with alogliptin compared with saline. Conclusion These findings suggest that pharmacological stimulation of 5-HT1B receptors enhances the increases in plasma active GLP-1 induced by DPP-4 inhibition independently of feeding and also improves glucose tolerance in mice.

      PubDate: 2015-08-03T03:46:23Z
  • Maternal uniparental disomy of chromosome 4 and homozygous novel
           mutation in the WFS1 gene in a paediatric patient with Wolfram syndrome
    • Abstract: Publication date: Available online 10 July 2015
      Source:Diabetes & Metabolism
      Author(s): D.T. Papadimitriou , E. Manolakos , C. Bothou , G. Zoupanos , I. Papoulidis , S. Orru , F. Skarmoutsos , A. Delides , C. Bakoula , A. Papadimitriou , F. Urano

      PubDate: 2015-07-13T16:24:16Z
  • Alcohol and disease prevention
    • Abstract: Publication date: Available online 7 July 2015
      Source:Diabetes & Metabolism
      Author(s): G. Testino , S. Leone , P. Borro

      PubDate: 2015-07-09T16:14:32Z
  • Pregnancy adverse outcomes related to pregravid body mass index and
           gestational weight gain, according to the presence or not of gestational
           diabetes mellitus: A retrospective observational study
    • Abstract: Publication date: Available online 2 July 2015
      Source:Diabetes & Metabolism
      Author(s): E. Cosson , C. Cussac-Pillegand , A. Benbara , I. Pharisien , M.T. Nguyen , S. Chiheb , P. Valensi , L. Carbillon
      Aim This study retrospectively evaluated the complications associated with prepregnancy overweight (OW) or obesity (OB) and gestational weight gain (GWG) in women with or without universally screened and treated gestational diabetes mellitus (GDM). Methods A total of 15,551 non-Asian women without pregravid diabetes or hypertension who delivered singleton babies (2002–2010) were classified according to GDM (13.5%), pregestational body mass index (BMI; normal range: 18.5–24.9kg/m2), OW (26.2%), OB (13.9%; BMI≥30kg/m2) and GWG (<7kg: 32%; 7–11.5kg: 37%; 11.6–16kg: 23%;>16kg: 8%). Main outcome measures were large/small for gestational age (LGA/SGA), caesarean section, preeclampsia, preterm delivery and shoulder dystocia. Results GDM was associated with more LGA babies [Odds Ratio (OR): 2.12, 95% confidence interval (CI): 1.85–2.43], caesarean section (OR: 1.49, 95% CI: 1.34–1.65) and preeclampsia (OR: 1.59, 95% CI: 1.21–2.09). OW/OB and GWG were associated with LGA infants whatever the GDM status, and with SGA babies only in women without GDM. LGA status was independently associated with GWG in women with GDM (11.6–16kg: OR: 1.74, 95% CI: 1.49–2.03 and>16kg OR: 3.42, 95% CI: 2.83–4.13 vs 7–11.5kg) and in women without GDM (OR: 2.14, 95% CI: 1.54–2.97 or OR: 2.65, 95% CI: 1.68–4.17, respectively), and with BMI only in women without GDM (OR: 1.12, 95% CI: 1.00–1.24, per 10kg/m2). SGA status was independently associated with OW (OR: 0.86, 95% CI: 0.77–0.98), OB (OR: 0.84, 95% CI: 0.72–0.98) and GWG<7kg (1.14, 95% CI: 1.01–1.29) only in women without GDM. Conclusion In our European cohort and considering the triumvirate of GDM, BMI and GWG, GDM was the main contributor to caesarean section and preeclampsia. OW/OB and GWG contributed to LGA and SGA infants mainly in women without GDM.

      PubDate: 2015-07-05T14:15:41Z
  • Lower-extremity arterial revascularization: Is there any evidence for
           diabetic foot ulcer-healing'
    • Abstract: Publication date: Available online 10 June 2015
      Source:Diabetes & Metabolism
      Author(s): J. Vouillarmet , O. Bourron , J. Gaudric , P. Lermusiaux , A. Millon , A. Hartemann
      The presence of peripheral arterial disease (PAD) is an important consideration in the management of diabetic foot ulcers. Indeed, arteriopathy is a major factor in delayed healing and the increased risk of amputation. Revascularization is commonly performed in patients with critical limb ischaemia (CLI) and diabetic foot ulcer (DFU), but also in patients with less severe arteriopathy. The ulcer-healing rate obtained after revascularization ranges from 46% to 91% at 1 year and appears to be improved compared to patients without revascularization. However, in those studies, healing was often a secondary criterion, and there was no description of the initial wound or its management. Furthermore, specific alterations associated with diabetes, such as microcirculation disorders, abnormal angiogenesis and glycation of proteins, can alter healing and the benefits of revascularization. In this review, critical assessment of data from the literature was performed on the relationship between PAD, revascularization and healing of DFUs. Also, the impact of diabetes on the effectiveness of revascularization was analyzed and potential new therapeutic targets described.

      PubDate: 2015-06-14T08:10:37Z
  • Efficacy of dual-hormone artificial pancreas to alleviate the
           carbohydrate-counting burden of type 1 diabetes: A randomized crossover
    • Abstract: Publication date: Available online 10 June 2015
      Source:Diabetes & Metabolism
      Author(s): V. Gingras , R. Rabasa-Lhoret , V. Messier , M. Ladouceur , L. Legault , A. Haidar
      Aim Carbohydrate-counting is a complex task for many patients with type 1 diabetes. This study examined whether an artificial pancreas, delivering insulin and glucagon based on glucose sensor readings, could alleviate the burden of carbohydrate-counting without degrading glucose control. Methods Twelve adults were recruited into a randomized, three-way, crossover trial ( identifier No. NCT01930097). Participants were admitted on three occasions from 7AM to 9PM and consumed a low-carbohydrate breakfast (women: 30g; men: 50g), a medium-carbohydrate dinner (women: 50g; men: 70g) and a high-carbohydrate lunch (women: 90g; men: 120g). At each visit, glucose levels were randomly regulated by: (1) conventional pump therapy; (2) an artificial pancreas (AP) accompanied by prandial boluses, matching the meal's carbohydrate content based on insulin-to-carbohydrate ratios (AP with carbohydrate-counting); or (3) an AP accompanied by prandial boluses based on qualitative categorization (regular or large) of meal size (AP without carbohydrate-counting). Results The AP without carbohydrate-counting achieved similar incremental AUC values compared with carbohydrate-counting after the low- (P =0.54) and medium- (P =0.38) carbohydrate meals, but yielded higher post-meal excursions after the high-carbohydrate meal (P =0.004). The AP with and without carbohydrate-counting yielded similar mean glucose levels (8.2±2.1mmol/L vs. 8.4±1.7mmol/L; P =0.52), and both strategies resulted in lower mean glucose compared with conventional pump therapy (9.6±2.0mmol/L; P =0.02 and P =0.03, respectively). Conclusion The AP with qualitative categorization of meal size could alleviate the burden of carbohydrate-counting without compromising glucose control, although more categories of meal sizes are probably needed to effectively control higher-carbohydrate meals.

      PubDate: 2015-06-14T08:10:37Z
  • Low bilirubin levels are an independent risk factor for diabetic
           retinopathy and nephropathy in Japanese patients with type 2 diabetes
    • Abstract: Publication date: Available online 6 June 2015
      Source:Diabetes & Metabolism
      Author(s): S. Hamamoto , H. Kaneto , S. Kamei , M. Shimoda , K. Tawaramoto , Y. Kanda-Kimura , F. Kawasaki , M. Hashiramoto , M. Matsuki , T. Mune , K. Kaku

      PubDate: 2015-06-06T07:10:22Z
  • Periaortitis induced by metformin
    • Abstract: Publication date: Available online 4 June 2015
      Source:Diabetes & Metabolism
      Author(s): H. Hamasaki , M. Hakoshima , H. Yanai

      PubDate: 2015-06-06T07:10:22Z
  • Changes in N-terminal pro-B-type natriuretic peptide and incidence of
           diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)
    • Abstract: Publication date: Available online 3 June 2015
      Source:Diabetes & Metabolism
      Author(s): O.A. Sanchez , D.A. Duprez , H. Bahrami , C.A. Peralta , L.B. Daniels , J.A. Lima , A. Maisel , A.R. Folsom , D.R. Jacobs
      Aims This study looked at whether the inverse association of circulating N-terminal pro-B-type natriuretic peptide (NT-proBNP) with incident diabetes is modified by changes in NT-proBNP (ΔNT-proBNP) levels. Methods Plasma NT-proBNP was assayed at baseline and 3.2years later (visit 3) in the Multi-Ethnic Study of Atherosclerosis (MESA). ΔNT-proBNP was calculated as NT-proBNPvisit3 –NT-proBNPbaseline. A Poisson distribution was fitted to determine the incidence density of diabetes, adjusted for age, race, gender, educational attainment, antihypertensive medication, total intentional exercise and plasma IL-6 levels. In the primary analysis (n =3236 without diabetes up to visit 3, followed for a mean of 6.3 years), incidence density was regressed for the following categories of baseline NT-proBNP: (1)<54.4pg/mL; (2) 54.4–85.9pg/mL; and (3) 86–54.2pg/mL. This was crossed with categories of ΔNT-proBNP as medians (ranges): (1) −6.2 (−131–11.7) pg/mL; (2) 19.8 (11.8–30.1) pg/mL; (3) 44.0 (30.2–67.9) pg/mL; and (4) 111.2 (68.0–3749.9) pg/mL. Results The incidence density of diabetes followed a U-shaped association across categories of ΔNT-proBNP within categories of baseline NT-proBNP after adjusting for other covariates (P =0.02). At each level of baseline NT-proBNP, the incidence density of diabetes was lowest for small-to-moderate increases in NT-proBNP. Conclusion This analysis suggests that NT-proBNP has a biphasic association with diabetes in which the risk of incident diabetes decreases within a ‘physiological range’ of ΔNT-proBNP, and plateaus or increases as NT-proBNP concentrations increase, probably in response to pathophysiological conditions leading to high levels of NT-proBNP.

      PubDate: 2015-06-06T07:10:22Z
  • Editorial board
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3

      PubDate: 2015-06-06T07:10:22Z
  • Similar glucose control with basal–bolus regimen of insulin detemir
           plus insulin aspart and thrice-daily biphasic insulin aspart 30 in
           insulin-naive patients with type 2 diabetes: Results of a 50-week
           randomized clinical trial of stepwise insulin intensification
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3
      Author(s): R. Malek , F. Ajili , S.H. Assaad-Khalil , A. Shinde , J.W. Chen , E. Van den Berg
      Objective This study aimed to demonstrate the non-inferiority of 50-week treatment with stepwise insulin intensification of basal–bolus insulin analogues [insulin detemir (IDet) and aspart (IAsp)] versus biphasic insulin aspart 30 (BIAsp30) in insulin-naive type 2 diabetes mellitus (T2DM) patients not controlled by oral glucose-lowering drugs (OGLDs). Research design and methods In this open-label multicentre, multinational, randomized, parallel-arm treat-to-target trial, 403 insulin-naive patients with T2DM in four African countries were randomized to either an IDet+IAsp (n =200) or BIAsp1-2-3 (n =203) treatment group. Stepwise insulin intensification was performed at the end of 14, 26 and 38 weeks, depending on HbA1c values. The primary endpoint was change in HbA1c after 50 weeks of treatment. Safety variables were hypoglycaemia incidence, occurrence of adverse events and weight gain. Results Non-inferiority of the IDet+IAsp versus BIAsp1-2-3 treatment regimen was demonstrated by their similar HbA1c levels at the end of trial (IDet+IAsp: baseline 8.6%, 50 weeks 7.4%; BIAsp1-2-3: baseline 8.7%, 50 weeks 7.3%; full analysis set difference: 0.1% [95% CI: −0.1, 0.3]; per protocol: 0.2% [95% CI: −0.1, 0.4]). At week 50, 40.3 and 44.9% of patients achieved HbA1c <7.0% with IDet+IAsp and BIAsp1-2-3, respectively. The rate of overall hypoglycaemia during the trial was also similar in both groups (IDet+IAsp: 9.4 events/patient-year; BIAsp1-2-3: 9.8 events/patient-year). Conclusion Insulin initiation and intensification using IDet+IAsp was not inferior to BIAsp1-2-3 in insulin-naive patients with T2DM not controlled by OGLDs. Both regimens led to similar reductions in HbA1c values after 50 weeks of treatment.

      PubDate: 2015-06-06T07:10:22Z
  • Comparing kidney outcomes in type 2 diabetes treated with different
           sulphonylureas in real-life clinical practice
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3
      Author(s): Y.-h. Lee , C.J. Lee , H.S. Lee , E.Y. Choe , B.-W. Lee , C.W. Ahn , B.-S. Cha , H.C. Lee , B. Balkau , E.S. Kang
      Aim Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D. Methods A total of 4486 patients treated with either glimepiride or gliclazide for more than 2years were followed for up to 5.5years (median: 4.7years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to>132.6μmol/L (1.5mg/dL) were also compared. Results In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95% confidence interval (CI): 0.29–1.12] or doubling of creatinine (HR: 0.74, 95% CI: 0.44–1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate≥60mL/min/1.73m2, HR: 0.21, 95% CI: 0.04–0.99) and good glycaemic control (HbA1c <7%, HR: 0.35, 95% CI: 0.14–0.86), and in older subjects (≥62years, HR: 0.52, 95% CI: 0.27–0.99). Conclusion In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.

      PubDate: 2015-06-06T07:10:22Z
  • Liraglutide in whole-pancreas transplant patients with impaired glucose
           homoeostasis: A case series
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3
      Author(s): B. Cariou , C. Bernard , D. Cantarovich
      Hyperglycaemia may develop after whole-pancreas transplantation (PTX) in patients with type 1 diabetes mellitus (T1DM), but the efficacy and tolerability of GLP-1 receptor agonists have not been assessed in this population. This report is a 6-month prospective follow-up of six T1DM recipients of PTX (mean time after PTX: 68.8±45.7 months), all of whom had an HbA1c >6.5% (48mmol/mol) [mean: 7.1% (54mmol/mol)] after initiation of liraglutide alone at 0.6mg once daily titrated to 1.2mg once daily at week 1. Gastrointestinal disorders were reported in three of the six patients, with discontinuation of liraglutide in only one patient. HbA1c improved in the five remaining patients, with a median decrease of 0.8% (0.0–2.7%) at 6 months, and the median decrease in body weight was 2.0kg. Immunosuppressive treatments remained unchanged with liraglutide. Thus, liraglutide appears to be an effective and well-tolerated option in PTX patients with impaired glucose homoeostasis, regardless of the cause.

      PubDate: 2015-06-06T07:10:22Z
  • Increased TSH in obesity: Evidence for a BMI-independent association with
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3
      Author(s): C. Bétry , M.A. Challan-Belval , A. Bernard , A. Charrié , J. Drai , M. Laville , C. Thivolet , E. Disse
      Aim This study aimed to determine whether the association between thyroid-stimulating hormone (TSH) and body mass index (BMI) is related to leptin concentration in obese individuals. Methods Plasma TSH and leptin assays were performed in 800 consecutive patients, hospitalized for a nutritional checkup, with a BMI≥30kg/m2. Various anthropometric, hormonal and metabolic parameters, including age, weight, BMI, insulin, leptin and TSH, were measured or calculated. Univariate and multivariate regression analyses were performed to identify any significant relationships between these parameters. Also, characteristics of the patients in the lowest and highest quartiles of TSH distribution were compared. Results TSH was positively correlated with both BMI and leptin. When multiple regression analysis was performed, TSH and leptin maintained a significant association independent of BMI. Patients in the fourth quartile of TSH distribution displayed higher BMI and higher leptin levels in comparison to the first quartile. Conclusion Our study has confirmed an increase in TSH in conjunction with BMI in obese subjects. This increase was correlated with leptin independently of BMI. It is hypothesized that the increase in TSH observed in obese subjects was the consequence of both fat mass accumulation and a positive energy-balance.

      PubDate: 2015-06-06T07:10:22Z
  • Efficacy of vildagliptin and sitagliptin in lowering fasting plasma
           glucose: Results of a randomized controlled trial
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3
      Author(s): R. Göke , P. Eschenbach , E.D. Dütting
      Aim This study compared the efficacy of vildagliptin and sitagliptin in lowering fasting plasma glucose (FPG) as single-pill combinations (SPCs) with metformin. Methods The randomized crossover, open-label, active-controlled study design assessed the FPG-lowering abilities of a vildagliptin/metformin (50/1000mg twice daily) SPC compared with a sitagliptin/metformin (50/1000mg twice daily) SPC after 2 weeks of treatment in 99 type 2 diabetes patients uncontrolled by stable metformin therapy (1000–2000mg/day). Results The change in FPG from baseline to day 14 was significantly greater (P <0.02, Wilcoxon) with vildagliptin [–21.9mg/dL (SD 27.0)] than with sitagliptin [–14.5mg/dL (SD 23.0)]. After 14 days of treatment, the mean FPG was 137.8mg/dL (SD 28.5) with vildagliptin and 140.1mg/dL (SD 26.5) with sitagliptin (P <0.05, Wilcoxon). Conclusion Both of these DPP-4 inhibitors, given as SPCs twice daily with metformin, lowered FPG after 14 days of treatment. However, vildagliptin produced a significantly greater reduction in FPG vs baseline compared with sitagliptin, which may translate into clinical relevance.

      PubDate: 2015-06-06T07:10:22Z
  • Screening for dysglycaemia during pregnancy: Proposals conciliating
           International Association of Diabetes and Pregnancy Study Group (IADPSG)
           and US National Institutes of Health (NIH) panels
    • Abstract: Publication date: June 2015
      Source:Diabetes & Metabolism, Volume 41, Issue 3
      Author(s): E. Cosson , P. Valensi , L. Carbillon
      The International Association of Diabetes and Pregnancy Study Group (IADPSG) has proposed that blood glucose levels for the diagnosis of gestational diabetes mellitus (GDM) be the values associated with a 1.75-fold increase in the risk of neonatal complications in the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. However, this recommendation was not adopted by the US National Institutes of Health (NIH) panel as it would have been responsible for a huge increase in the prevalence of GDM with no clear evidence of a reduction of events at such blood glucose values. Considering this aspect, we now propose the use of a blood glucose threshold combination associated with an odds-ratio of 2.0 for neonatal disorders [fasting plasma glucose (FPG)≥95mg/dL, or a 1-h glucose value after a 75-g oral glucose tolerance test (OGTT)≥191mg/dL or a 2-h glucose value≥162mg/dL] for GDM diagnosis. This would lead to a lower prevalence of GDM and concentrate medical resources on those with the highest risk of complications. This would also allow the use of a similar FPG value for both the diagnosis and therapeutic target of GDM. The IADPSG also proposed screening for dysglycaemia during early pregnancy, using FPG measurement with a similar threshold after 24 weeks of gestation. We propose the same strategy considering an FPG value≥95mg/dL as abnormal, but only after confirmatory measurements. We also believe that an OGTT should not be used before 24 weeks of gestation as normal values during that time are as yet unknown.

      PubDate: 2015-06-06T07:10:22Z
  • Association between thyroid hormones, thyroid antibodies and insulin
           resistance in euthyroid individuals: A population-based cohort
    • Abstract: Publication date: Available online 3 June 2015
      Source:Diabetes & Metabolism
      Author(s): A. Amouzegar , E. Kazemian , S. Gharibzadeh , L. Mehran , M. Tohidi , F. Azizi
      Aim The association between insulin resistance and thyroid function in euthyroid subjects has not yet been clarified. This study aimed to investigate the association between thyroid function within the normal reference range and insulin resistance in participants of the Tehran Thyroid Study (TTS). Methods This cross-sectional study was conducted within the framework of the TTS. Of 5786subjects aged≥20 years, 2758euthyroid subjects free of thyroid disorders, diabetes, chronic kidney disease and cardiovascular disease, and not taking steroids and lipid-lowering agents, were included. Serum concentrations of free thyroxine (FT4) and TSH were measured. The homoeostasis model assessment index for insulin resistance (HOMA-IR) was used to evaluate IR. Results On linear regression analysis, a negative association was found between serum FT4 levels and HOMA-IR in the model with age, smoking and physical activity (B=−0.09, P <0.001) and in the WC-adjusted model with age, smoking and physical activity for men (B=−0.06, P <0.01). In addition, there was a positive association between serum TSH levels and HOMA-IR in both models [with age, smoking and physical activity (B=0.07, P =0.006), and age, smoking, physical activity and adjusted for WC (B=0.05, P =0.01)] that was not more significant on logistic regression analysis. In women, neither serum FT4 nor TSH levels were associated with HOMA-IR; the prevalence of IR decreased from 27.2 to 19.1 with increasing tertiles of FT4 only in men (P =0.01). No significant differences were observed in HOMA-IR and its components between thyroid peroxidase antibody (TPOAb)-negative and -positive groups. Also, it was found that metabolically healthy but obese (MHO) subjects had higher levels of TSH than individuals who were MONW (metabolically obese but normal weight; P <0.01). Conclusion Low FT4 was independently associated with IR in healthy euthyroid Iranian men.

      PubDate: 2015-06-06T07:10:22Z
  • Treatment maintenance duration of dual therapy with metformin and
           sitagliptin in type 2 diabetes: The ODYSSEE observational study
    • Abstract: Publication date: Available online 12 May 2015
      Source:Diabetes & Metabolism
      Author(s): P. Valensi , G. de Pouvourville , N. Benard , C. Chanut-Vogel , C. Kempf , E. Eymard , C. Moisan , J. Dallongeville
      Aim The study compared the duration of maintenance of treatment in patients with type 2 diabetes (T2D) using dual therapy with either metformin and sitagliptin (M-Sita) or metformin and a sulphonylurea (M-SU). Materials and methods This observational study included adult patients with T2D who had responded inadequately to metformin monotherapy and therefore had started de-novo treatment with Met-Sita or Met-SU within the previous eight weeks. Patient follow-up and changes to treatment were performed according to their general practitioner's usual clinical practice. The primary outcome was time to change in treatment for whatever cause. HbA1c and symptomatic hypoglycaemia were also documented. Results The median treatment duration for patients in the M-Sita group (43.2 months) was significantly longer (P <0.0001) than in the M-SU group (20.2 months). This difference persisted after adjusting for baseline differences and confounders. A similar reduction in HbA1c was noted in both arms (–0.6%), and the incidence of hypoglycaemia prior to treatment modification was lower with M-Sita (9.7%) than with M-SU (21.0%). Adverse events potentially related to treatment were reported in 2.8% (n =52) and 2.7% (n =20) of patients in the M-Sita and M-SU arms, respectively. Conclusion Under everyday conditions of primary diabetes care, dual therapy with M-Sita can be maintained for longer than M-SU. In addition, while efficacy, as measured by changes in HbA1c, was similar between treatments, the incidence of hypoglycaemia was lower in patients taking M-Sita.

      PubDate: 2015-05-13T06:48:37Z
  • Is HbA1c a valid surrogate for macrovascular and microvascular
           complications in type 2 diabetes'
    • Abstract: Publication date: Available online 6 May 2015
      Source:Diabetes & Metabolism
      Author(s): T. Bejan-Angoulvant , C. Cornu , P. Archambault , B. Tudrej , P. Audier , Y. Brabant , F. Gueyffier , R. Boussageon
      Recent recommendations regarding type 2 diabetes (T2D) patients’ treatments have focused on personalizing glycosylated haemoglobin (HbA1c) targets. Because the relationship between HbA1c and diabetes prognosis has been established from large prospective cohorts, it is valid to question the extrapolation from population-based risk reduction estimations to individual predictions. Our study aimed to investigate the relationship between HbA1c reductions and clinical outcomes in randomized controlled trials (RCTs), using a meta-regression approach. Included were RCTs comparing intensive vs. standard glucose-lowering regimens for cardiovascular events and microvascular complications in T2D patients. Eight studies (33,396 patients) providing data for HbA1c reductions were found. In our meta-regression, HbA1c decreases were not significantly associated with reductions in our main study outcomes: total and cardiovascular mortality. They were also not associated with any of the secondary endpoints, including myocardial infarction, stroke and severe hypoglycaemia. Sensitivity analysis showed a significant correlation only between HbA1c-lowering and severe hypoglycaemia (P =0.014). Meta-regression analysis could find no significant association between HbA1c-lowering and a decrease in clinical outcomes, thereby questioning the use of HbA1c as a surrogate outcome for T2D-related complications. Thus, RCTs vs. placebo are urgently required to evaluate the risk–benefit ratios of therapeutic strategies beyond HbA1c control in T2D patients.

      PubDate: 2015-05-09T06:44:17Z
  • Oral magnesium supplementation improves glycaemic status in subjects with
           prediabetes and hypomagnesaemia: A double-blind placebo-controlled
           randomized trial
    • Abstract: Publication date: Available online 27 April 2015
      Source:Diabetes & Metabolism
      Author(s): F. Guerrero-Romero , L.E. Simental-Mendía , G. Hernández-Ronquillo , M. Rodriguez-Morán
      Aim This study evaluated the efficacy of oral magnesium supplementation in the reduction of plasma glucose levels in adults with prediabetes and hypomagnesaemia. Methods A total of 116 men and non-pregnant women, aged 30 to 65years with hypomagnesaemia and newly diagnosed with prediabetes, were enrolled into a randomized double-blind placebo-controlled trial to receive either 30mL of MgCl2 5% solution (equivalent to 382mg of magnesium) or an inert placebo solution once daily for four months. The primary trial endpoint was the efficacy of magnesium supplementation in reducing plasma glucose levels. Results At baseline, there were no significant statistical differences in terms of anthropometric and biochemical variables between individuals in the supplement and placebo groups. At the end of follow-up, fasting (86.9±7.9 and 98.3±4.6mg/dL, respectively; P =0.004) and post-load glucose (124.7±33.4 and 136.7±23.9mg/dL, respectively; P =0.03) levels, HOMA-IR indices (2.85±1.0 and 4.1±2.7, respectively; P =0.04) and triglycerides (166.4±90.6 and 227.0±89.7, respectively; P =0.009) were significantly decreased, whereas HDL cholesterol (45.6±10.9 and 46.8±9.2mg/dL, respectively; P =0.04) and serum magnesium (1.96±0.27 and 1.60±0.26mg/dL, respectively; P =0.005) levels were significantly increased in those taking MgCl2 compared with the controls. A total of 34 (29.4%) people improved their glucose status (50.8% and 7.0% in the magnesium and placebo groups, respectively; P <0.0005). Conclusion Our results show that magnesium supplementation reduces plasma glucose levels, and improves the glycaemic status of adults with prediabetes and hypomagnesaemia.

      PubDate: 2015-05-01T06:34:35Z
  • A novel heterozygous mutation in the glucokinase gene is responsible for
           an early-onset mild form of maturity-onset diabetes of the young, type 2
    • Abstract: Publication date: Available online 25 April 2015
      Source:Diabetes & Metabolism
      Author(s): D.T. Papadimitriou , P.J. Willems , C. Bothou , T. Karpathios , A. Papadimitriou

      PubDate: 2015-04-27T06:17:29Z
  • Lower serum zinc levels are associated with unhealthy metabolic status in
           normal-weight adults: The 2010 Korea National Health and Nutrition
           Examination Survey
    • Abstract: Publication date: Available online 20 April 2015
      Source:Diabetes & Metabolism
      Author(s): H.K. Yang , S.H. Lee , K. Han , B. Kang , S.Y. Lee , K.H. Yoon , H.S. Kwon , Y.M. Park
      Aim This study investigated whether serum zinc concentration is associated with glucose tolerance, insulin resistance and metabolic health status in Korean adults. Methods Subjects with available serum zinc levels were recruited from the fifth Korea National Health and Nutrition Examination Survey (KNHANESV) cohort. Those in the highest quartile on homoeostasis model assessment for insulin resistance (HOMA-IR) and with a body mass index (BMI) of 18.5–25kg/m2 were classified as metabolically obese and normal weight (MONW). Results A total of 1813 subjects with a mean age of 45.2±0.5 years and a mean BMI of 24.01±0.11kg/m2 were enrolled. Those in the lower serum zinc quartiles exhibited higher levels of fasting blood glucose and insulin resistance indices compared with those in the higher quartiles. However, these associations were positive only in normal-weight subjects. Those categorized as MONW exhibited significantly lower serum zinc levels than the metabolically healthy and normal weight (MHNW) subjects (131.6±3.0μg/dL vs 141.7±2.8μg/dL, respectively; P =0.0026), whereas serum zinc levels did not differ according to metabolic health in obese subjects. The odds ratio for being categorized as MONW was 4.12 (95% CI: 1.75, 9.72) among those in the lowest serum zinc quartile compared with those in the highest quartile even after adjusting for possible confounding factors. Conclusion Lower serum zinc levels were associated with unhealthy metabolic status in normal-weight adults. Further prospective studies are required to define the role of zinc in metabolic health.

      PubDate: 2015-04-23T06:13:35Z
  • Using the respective contributions of postprandial and basal glucose for
           tailoring treatments in type 2 diabetes
    • Abstract: Publication date: Available online 17 April 2015
      Source:Diabetes & Metabolism
      Author(s): L. Monnier , C. Colette

      PubDate: 2015-04-18T05:29:25Z
  • Individualizing treatment of type 2 diabetes by targeting postprandial or
           fasting hyperglycaemia: Response to a basal vs a premixed insulin regimen
           by HbA1c quartiles and ethnicity
    • Abstract: Publication date: Available online 14 April 2015
      Source:Diabetes & Metabolism
      Author(s): A.J. Scheen , H. Schmitt , H.H. Jiang , T. Ivanyi
      Aim This study evaluated the proportions of prandial (PHG) vs fasting hyperglycaemia (FHG) over 24h in a group of patients with type 2 diabetes (overall and for Caucasian vs Asian patients), and tested the hypothesis that an insulin regimen with a prandial component allows a greater response than basal insulin at low glycated haemoglobin (HbA1c) levels with a higher proportion of PHG than FHG. Methods Relative contributions of PHG and FHG to overall hyperglycaemia were analyzed by baseline HbA1c quartiles and by ethnicity at baseline and after 24-week treatment with either insulin glargine or insulin lispro mix 25 in the DURABLE study. Results With increasing baseline HbA1c, the mean relative contribution of PHG to the total area under the curve decreased (from 41% to 27%) while FHG was increased (from 59% to 73%). Both insulins decreased FHG, but only insulin lispro mix 25 decreased PHG. More patients with baseline HbA1c <9%, where PHG was more relevant, achieved the target HbA1c of<7% at endpoint with insulin lispro mix 25 compared with glargine. On average, Asians had a 10% larger contribution of PHG at all HbA1c quartiles, and a lower proportion of Asians reached the HbA1c target of<7% with either insulin treatment compared with Caucasians. Conclusion At baseline, the contribution of FHG to overall hyperglycaemia predominated at all HbA1c quartiles, whereas PHG was more clinically relevant at lower HbA1c levels and with a greater response to insulin lispro mix 25. Asians had a greater proportion of PHG and a lesser response to either insulins compared with Caucasians. Thus, responses to diabetes drugs by baseline HbA1c and ethnicity are worth investigating to better target and individualize treatment.

      PubDate: 2015-04-18T05:29:25Z
  • Predicting factors of hypoglycaemia in elderly type 2 diabetes patients:
           Contributions of the GERODIAB study
    • Abstract: Publication date: Available online 3 April 2015
      Source:Diabetes & Metabolism
      Author(s): L. Bordier , M. Buysschaert , B. Bauduceau , J. Doucet , C. Verny , V. Lassmann Vague , J.P. Le Floch
      The burden of hypoglycaemia is important, particularly in elderly type 2 diabetes (T2D) patients. Unfortunately, however, few studies are available concerning this population. GERODIAB is a prospective, multicentre, observational study that aims to describe the 5-year morbidity and mortality of 987 T2D patients aged 70years and older. After analyzing the frequency of and factors associated with hypoglycaemia in the 6months prior to study inclusion, it was found that hypoglycaemia was associated with retinopathy, lower levels of LDL cholesterol and altered mini-Geriatric Depression Scale (GDS) scores.

      PubDate: 2015-04-05T03:52:16Z
  • Antidiabetic agents: Potential anti-inflammatory activity beyond glucose
    • Abstract: Publication date: Available online 18 March 2015
      Source:Diabetes & Metabolism
      Author(s): A.J. Scheen , N. Esser , N. Paquot
      A growing body of evidence is emerging to show that abdominal obesity, the metabolic syndrome, type 2 diabetes, cardiovascular disease and microvascular diabetic complications are intimately related to chronic inflammation. These observations pave the way to the development of new pharmacological strategies that aim to reduce silent inflammation. However, besides specific anti-inflammatory agents, glucose-lowering medications may also exert anti-inflammatory effects that could contribute to improved outcomes in diabetic patients. Most studies have used metformin, an AMP-activated protein kinase (AMPK) activator, and thiazolidinediones (TZDs), which act as peroxisome proliferator-activated receptor-gamma (PPARγ) agonists. Both pharmacological classes (considered insulin-sparing agents or insulin sensitizers) appear to have greater anti-inflammatory activity than insulin-secreting agents such as sulphonylureas or glinides. In particular, TZDs have shown the widest range of evidence of lowered tissue (visceral fat and liver) and serum inflammation. In contrast, despite reducing postprandial hyperglycaemia, the effect of α-glucosidase inhibitors on inflammatory markers appears rather modest, whereas dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) and glucagon-like peptide-1 (GLP-1) receptor agonists appear more promising in this respect. These incretin-based therapies exert pleiotropic effects, including reports of anti-inflammatory activity. No human data are available so far regarding sodium-glucose cotransporter type 2 (SGLT2) inhibitors. Although they may have indirect effects due to reduced glucotoxicity, their specific mode of action in the kidneys does not suggest systemic anti-inflammatory activity. Also, in spite of the complex relationship between insulin and atherosclerosis, exogenous insulin may also exert anti-inflammatory effects. Nevertheless, for all these glucose-lowering agents, it is essential to distinguish between anti-inflammatory effects resulting from better glucose control and potential anti-inflammatory effects related to intrinsic actions of the pharmacological class. Finally, it would also be of major clinical interest to define what role the anti-inflammatory effects of these glucose-lowering agents may play in the prevention of macrovascular and microvascular diabetic complications.

      PubDate: 2015-03-20T03:19:37Z
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