Current Diabetes Reviews - Volume 10, Issue 5, 2014

Technological innovations are rising rapidly and are inevitably becoming part of the health care environment. Patients frequently access Social media as a forum for discussion of personal health issues; and healthcare providers are now considering ways of harnessing social media as a source of learning and teaching. This review highlights some of the complex issues of using social media as an opportunity for interaction between public- patient-healthcare staff; considers the impact of self- education and self-management for patients with diabetes, and explores some recent advances in delivering education for staff. When using any information technology, the emphasis should rely on being assessed rigorously to show it promotes health education safely, can be recognized as delivering up-to- date health information effectively, and should ensure there is no bias in selective communication, or disadvantage to isolated patient groups.

Over the last decade the internet has come to permeate every aspect of our lives. With huge leaps in accessibility of the internet via mobile personal devices such as smart cellular phones and tablets, individuals are connected to the internet virtually all the time. It is no surprise therefore that social media now dominates the lives of many people within society. The authors take a look at how social media is influencing diabetes with particular focus on weight perception, weight management and eating behaviours. The authors explore the concept of how the advertising of Size 0 models and photo-shopping of images which are easily available on line and via social media is causing an increase in the number of young people with distorted body images. This has led to an increased number of people resorting to sometimes drastic weight loss programmes. We focus on the bid for ‘low-fat’ consumption and highlight how this could actually be leading to an increased risk for developing diabetes or worsening the complications of diabetes. We also discuss the increase of eating disorder in diabetes related to this distorted body image.

Treatment compliance and adherence are often a challenge in patients with type 1 diabetes, particularly for adolescent and young adult patients. With the availability of the internet and smart phone applications (apps) there is a hope that such technology could provide a means to encourage treatment adherence in this group of patients. This review focuses on whether telemedicine and smartphone technology in diabetes can influence self-management in young people with diabetes. A large number of smartphone apps are targeted at people with diabetes, but a limited number of welldesigned evaluation studies have been performed. As our review shows, the evidence base for efficacy of most of these applications is minimal and improvement in hard outcomes such as HbA1c and complication development is largely lacking.

Glucagon-like peptide 1 (GLP1) is a major incretin hormone. This means that it is secreted by the gut in response to food and helps in reducing post-prandial glucose exertion. It achieves this through a number of mechanisms, including stimulating insulin release by pancreatic β-cells in a glucose-dependent manner; inhibition of glucagon release by pancreatic α-cells (also in a glucose-dependent manner); induction of central appetite suppression and by delaying gastric empting thereby inducing satiety and also reducing the rate of absorption of nutrients. However, GLP1 receptors have been described in a number of extra-pancreatic tissues, including the endothelium and the myocardium. This suggests that the physiological effects of GLP1 extend beyond post-prandial glucose control and raises the possibility that GLP1 might have cardiovascular effects. This is of importance in our understanding of incretin hormone physiology and especially because of the possible implications that it might have with regard to cardiovascular effects of incretin-based therapies, namely DPP-IV inhibitors (gliptins) and GLP1 analogues. This review analyzes the animal and human data on the effects of GLP1 on the cardiovascular system in health and in disease and the currently available data on cardiovascular effects of incretin-based therapies. It is the author’s view that the physiological role of GLP1 is not only to minimize postprandial hypoglycaemia, but also protect against it.

Our study objective was to evaluate glucose tolerance and effecting factors among diabetes patients’ with home care program (PHCP) in Malaysian community. A 24-week longitudinal quasi-experimental -single blind - pre/post-test study design was used to assess the effectiveness of a diabetes education program to enhance self-care practices. An attrition rate of 25% implied longitudinal design of the study in the calculation of sample size. Hence the sample size of the study was 106 subjects (53 cases and 53 focus group). The level of significance was set at 0.05. Ethical clearance had been made prior to conducting this study. Of the 109 subjects who met the study-entry criteria, 3 subjects declined to participate due to lack of time and interest. No significant parameters were revealed in the demographic and clinical characteristics of participants who completed the study. Focus group showed significant reduction in HbA1c value with mean 1.1% as compared to cases with a mean 0.06%. Similarly, hypothesis on self-care management suggest significantly improved practices among focus group [M=2.94, SD=2.25] for case group M=0.47, SD=1.36; t[127.64]=-8.23, p≤0.001] with moderate effect size [eta squared=0.06]. Total physical activity was defined as the combination of non-leisure and leisure activities. There was a statistically significant difference for increase in total physical levels between the focus [M=14.01, SD=6.41] and case groups [13.21, SD=5.22; t[148.04]=-3.15, p=0.002] with no difference in the non-leisure activity [p=0.43]. As for the case group, there was no significant difference in SMBG practices from baseline [M=0.70, SD=1.35] to follow-up [M=0.47, SD=1.36, t[72]=0.97, P=0.34] and no relationship was found between the number of blood glucose tests done with demographic or clinical variables. This study offered improved self-care practices and physical activity after PHCP but with problematic dietary care. This might be due to social and cultural habits among Malaysian population.

Type II diabetes (T2D) is a progressive condition affecting approximately 350 million adults worldwide. Whilst skeletal muscle insulin resistance and beta-cell dysfunction are recognised causes of T2D, progressive loss of lean muscle mass (reducing surface area for glucose disposal area) in tandem with ageing-related adiposity (i.e. sarcopenic obesity) also plays an important role in driving hyperglycaemia progression. The anabolic effects of nutrition on the muscle are driven by the uptake of amino acids, into skeletal muscle protein, and insulin plays a crucial role in regulating this. Meanwhile glucagon-like peptide (GLP-1) and glucose- dependent insulinotropic peptide (GIP) are incretin hormones released from the gut into the bloodstream in response to macronutrients, and have an established role in enhancing insulin secretion. Intriguingly, endocrine functions of incretins were recently shown to extend beyond classical insulinotropic effects, with GLP-1/GIP receptors being found in extra-pancreatic cells i.e., skeletal muscle and peripheral (muscle) microvasculature. Since, incretins have been shown to modulate blood flow and muscle glucose uptake in an insulinindependent manner, incretins may play a role in regulating nutrient-mediated modulation of muscle metabolism and microvascular tone, independently of their insulinotropic effects. In this review we will discuss the role of skeletal muscle in glucose homeostasis, disturbances related to insulin resistance, regulation of skeletal muscle metabolism, muscle microvascular abnormalities and disturbances of protein (PRO) metabolism seen in old age and T2D. We will also discuss the emerging non-insulinotropic role of GLP-1in modulating skeletal muscle metabolism and microvascular blood flow.

Background: Retrospective evaluations of mortality risks in cohorts of patients with type 2 diabetes (T2D), receiving oral glucose-lowering drugs (OGLDs) gave conclusions about association between certain OGLDs and mortality that do not exactly agree with each other. Different approaches were used: recording the outcomes depending on the first prescription, later changes were ignored or receiving one of OGLDs according to data of last documented visit before the end of observation period; without change of OGLD during the whole observation; treatment intervals - period from onset of treatment to onset of the next drug treatment, or until outcome. Impact of each study approach was not evaluated yet. We conducted such comparative analysis using the database of Ukrainian Diabetes Register. Methods: All-cause mortality in retrospective cohorts of 36 449 type 2 diabetes patients treated with glibenclamide, gliclazide or metformin monotherapy all of which were included at least in one of evaluation models: “first prescription” - 2 862 /257, “last prescription” - 34 818 / 4 224; “unchanged” - 8 786/680 and “treatment intervals” - 13 546/3 142 T2D patients / death cases respectively, were evaluated using Cox regression with gender, age, and diabetes duration adjusting. We compared the mortality risk (Hazard ratios -HRs) associated with Gliclazide or Metformin versus Glibenclamide monotherapy. Results: Gliclazide or metformin-treated patients demonstrated lesser mortality risk than glibenclamide-treated ones in all four evaluation models, but age and duration stratification can influence this phenomenon in case of “first prescription model”. In case of “without change OGLD” model the increase of mortality risk in glibenclamide-treated group is the most evident when comparing to gliclazide-treated, rather than to metformin-treated one. When comparing gliclazide vs metformin mortality risk for this model, gliclazide-treated patients demonstrated lesser mortality risk than metformintreated ones: gender, age and diabetes duration adjusting HR = 0.51 (0.35-0.72), p<0.001. Conclusion: Different approaches used for mortality analysis in observation studies of T2D patients can present discrepant results.