Current Diabetes Reviews - Volume 13, Issue 3, 2017

10.2174/157339981303170516191033

Schizophrenia is a chronic and debilitating brain disorder. It is associated with increased mortality, primarily due to elevated cardio-metabolic risk. Affected patients have higher rates of obesity, metabolic syndrome and diabetes [1]. Intrinsic factors contributing to this increased risk include a shared underlying pathophysiology between schizophrenia and diabetes mellitus involving stress, inflammation and genetics. Extrinsic contributing factors include diet, lifestyle, health care access, low socioeconomic status and overburden of traditional diabetes risk factors. Antipsychotics are associated with an increased risk of obesity, metabolic syndrome and diabetes mellitus [1]. Appetite-regulating hormones, pharmacodynamics and alterations in glucose metabolism may underlie the negative effect of these medications. Reduction in diabetes risk is achieved by mitigating traditional risk factors. Non-pharmacologic and pharmacologic approaches to cardio-metabolic risk reduction may be helpful in these patients.

With the rise of obesity there has been a concomitant increase in the incidence of type 2 diabetes (T2DM). As a result, the term “diabesity” has become a popular disease entity in the past several years. When lifestyle modification and pharmacotherapy fail to achieve successful weight loss and diabetes control, bariatric surgery is a recommended treatment option. Bariatric surgery has been shown to promote sustained T2DM remission in 30-63% of patients and improve other components of metabolic syndrome; thus a preferred term has been “metabolic surgery”. As the practice of bariatric surgery for the treatment of T2DM increases, so will the number of patients with T2DM not achieving remission or with T2DM recurrence. There are currently no clear evidence-based guidelines delineating the proper management of T2DM in post-bariatric surgery patients. The focus of this review is to discuss current data on the efficacy of bariatric surgery in promoting T2DM remission, factors that predict T2DM remission and recurrence, and current treatment options for persistent hyperglycemia in post-bariatric surgery patients. To increase long-term T2DM remission and prevent or delay recurrence, post-bariatric surgery patients need close follow up to encourage adherence to healthy nutrition and lifestyle practices that will lead to sustained weight loss. In addition to this, patients need adequate nutritional supplementation and periodic screening for vitamin, mineral and protein deficiencies. Therefore, we will conclude with a brief review of current recommendations for nutritional deficiency screening and supplementation.

Background: In 2009, approximately 40 million people were 65 years or older. The majority of people over the age of 65 have at least one chronic medical condition. In 2002-2003, the following medical conditions were common among older adults: hypertension (51%), arthritis (48%), heart disease (31%), cancer of any type (21%), and diabetes (16%). The cost of diabetes care, both direct and indirect, was $245 billion in 2012. Fifty-nine percent of the direct medical cost was for the population aged 65 and over. Methods: A literature review was conducted with a review of mostly peer-reviewed publications from 1987 – 2016 in the preparation of this manuscript. Results: Management goals include control and minimization of hypo- and hyperglycemia and their symptoms, evaluation and treatment of associated risks for atherosclerotic and micro-vascular disease; evaluation and treatment of related complications; support for diabetes self-management and education; maintenance or improvement of the patient's general health status. Conclusion: Providers, patients, caregivers and family members should be vigilant to recognize and manage, micro - and macro-vascular diseases quickly, to prevent increased incidence in morbidity and mortality, as well as medical costs of diabetes care attributed to this age group.

Diabetes is a growing health epidemic in the United States. Racial and ethnic minorities are disproportionately affected by diabetes and associated comorbidities and complications. The present review article aims to characterize the various ways in which minority populations are affected by diabetes. We address differences in prevalence of diabetes and associated conditions that include cardiovascular disease, hypertension, microvascular complications, and mortality. Additionally, we discuss factors that contribute to disparate diabetes-related outcomes, including physiology, culture and healthsystems. Finally, we look at outcomes of various interventions taken to address health disparities in diabetes care, specifically in racial and ethnic minority populations. 10.2174/1573399812666160926142036

Suicide is the tenth leading cause of death in Americans of all ages. Presence of a chronic medical illness (e.g. Diabetes mellitus) increases the risk of suicide. The goal of this review is to examine the relationship between diabetes and depression, as well as diabetes and suicide. Earlier this year, the U.S. Preventive Task Force (USPTF) escalated their recommendation for depression to include not only routine screening for depression but additional focus on active follow up that requires measurement based care. As a result, it is important that persons with diabetes are also screened for suicidal ideation in the presence of a mood disorder. Due to the higher risk and access to potentially lethal medications in persons with diabetes, risk mitigation procedures should be in place that includes not only depression and suicide screening but also the use of inter-disciplinary teams. Appropriate medical monitoring is essential following a suicide attempt to avoid death particularly because these patients are prone to repeat attempts. 10.2174/1573399812666161005163618

Background: Diabetes is a common chronic condition among adults that can complicate the transition from the hospital to the community. Hospital readmission is an important contributor to total medical expenditures and is an emerging indicator of quality of care. Failure to acknowledge diabetes transition of care is associated with increased emergency department visits and 30-day readmissions. Methods: Literature review of transition of care models, sample tools and processes are presented. Updated guidelines and recommendations aiming to identify and address risk factors for readmission of patients with diabetes are provided. Results: Increased attention has been given to different aspects of diabetes care in regards to discharge planning. This includes early initiation of a discharge plan identifying readmission risk factors at time of admission. In addition, involvement of patients, families, care givers, health care providers and institutions to establish transitional care. Utilization of hospital resources includes medication reconciliation, diabetes education, care coordination, discharge planning, follow up appointments and post discharge care. Conclusion: Addressing transition of care is not a choice but an important quality of care marker. The transition of care determines where patients with diabetes will follow up and how payers will remunerate hospitals for management of diabetes during hospitalization, discharge planning process and readmission rates. Different transition of care models have been identified, utilized and evaluated. However, more research needs to be done to establish standardized transitional care guidelines specific to this population.

Introduction: Accelerated formation of AGE due to increasing rise in blood glucose levels leads to developments of metabolic changes, further leading to such complications as diabetic retinopathy which is a major reason of leading to blindness and affecting working population worldwide. Background: The results of recent investigations have demonstrated that the death of retinal ganglion cells (RGCs) and their axons is the common pathological changes in AGE-exposed retina and the possible mechanisms that are responsible for the onset and progression of RGC death and axonal degeneration in patients with diseases associated with AGEs accumulation are represented in this review. Identifying the mechanisms of the onset and the progression of RGC neuropathy can help in discovering the pathogenetic orientated treatment. Objective: This review describes recently discovered possible mechanisms of diabetic retinopathy obtained by laboratory studies with the suggestion that AGEs play an important role in the pathogenesis of diabetic retinal neuropathy triggering different mechanisms that result in neuronal dysfunction. For searching therapeutic approach the regenerative effect of different neurotrophic factors has been studied such as neurotrophin-4, hepatocyte growth factor, glial cell line-derived neurotrophic factor, and Tauroursodeoxycholic acid. Conclusion: The findings for the establishment of neuroprotective and regenerative therapies for AGE-related diseases including diabetic retinopathy are represented in this review.

Background: Although several epidemiological studies have reported an association between diabetes mellitus (DM) and orodental health. However, the occurrence of the co-morbidity of both diseases has been more of suspicion than evidence-based. DM is a serious public health concern globally, and in Nigeria. Studies have separately documented the prevalence of DM and orodental diseases, but data lack to adequately rationalise co-morbidity of both diseases. Objective: The study aimed to report evidence of co-morbidity of DM and orodental diseases in Nigeria. Method: Data published between December, 1970 and June, 2015 were used in writing the review. These data were collated from electronic literature archives and databases. Result: This review suggests evidence of the association of DM and orodental diseases. It revealed that both diseases are densely distributed in South-East, South-South and South-West geopolitical zones of Nigeria, and sparsely spread across other regions of the country. Conclusion: Co-morbidity of both diseases holds promise that will favour public health practice, especially in Nigeria. It is hoped that the association may lead to the establishment of a cost-effective DM screening protocol in Nigeria. Again, screening of DM in dentistries and vice versa may be possible through the relationship of both diseases. It is recommended that the driving force of the co-morbidity be investigated.

Introduction: The incidence of type 1 diabetes (T1D) is increasing worldwide and there is a very large need for effective therapies. Essentially no therapies other than insulin are currently approved for the treatment of T1D. Drugs already in use for type 2 diabetes and many new drugs are under clinical development for T1D, including compounds with both established and new mechanisms of action. Content of the Review: Most of the new compounds in clinical development are currently in Phase 1 and 2. Drug classes discussed in this review include new insulins, SGLT inhibitors, GLP-1 agonists, immunomodulatory drugs including autoantigens and anti-cytokines, agents that regenerate β-cells and others. Regulatory Considerations: In addition, considerations are provided with regard to the regulatory environment for the clinical development of drugs for T1D, with a focus on the United States Food and Drug Administration and the European Medicines Agency. Future opportunities, such as combination treatments of immunomodulatory and beta-cell regenerating therapies, are also discussed.

Introduction: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis. Rarely these patients can present with blood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA. The possible etiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcohol consumption, chronic liver disease and glycogen storage disorders. DKA in pregnancy has also been reported to present with euglycemia. The recent use of sodium glucose cotransporter 2 (SGLT2) inhibitors has shed light on another possible mechanism of euglycemic DKA. Clinicians may also be misled by the presence of pseudonormoglycemia. Conclusion: Euglycemic DKA thus poses a challenge to physicians, as patients presenting with normal BG levels in ketoacidosis may be overlooked, leading to a delay in appropriate management strategies. In this article, we review all the possible etiologies and the associated pathophysiology of patients presenting with euglycemic DKA. We also discuss the approach to diagnosis and management of such patients. Despite euglycemia, ketoacidosis in diabetic patients remains a medical emergency and must be treated in a quick and appropriate manner.

Background: Autoantibodies (AAbs) against islet autoantigens (AAgs) are used for type 1 diabetes (T1D) diagnosis and prediction. Islet-specific AAbs usually appear early in life and may fluctuate in terms of number and titer sometimes for over 20 years before T1D develops. Whereas their predictive power is high for pediatric subjects with high genetic risk who rapidly progress to multiple AAb positivity, they are less reliable for children with low genetic risk, single AAb positivity and slow disease progression. Objective: It is unknown how AAbs develop and whether they are involved in T1D pathogenesis. So far an increase in AAb number seems to only indicate AAg spreading and progression towards clinical T1D. The goal of this review is to shed light on the possible involvement of AAbs in T1D development. Method: We thoroughly review the current literature and discuss possible mechanisms of AAb development and the roles they may play in disease pathogenesis. Results: Genetic and environmental factors instigate changes at the molecular and cellular levels that promote AAb development. Although direct involvement of AAbs in T1D is less clear, autoreactive B cells are clearly involved in various immune and autoimmune responses via antigen presentation, immunoregulation and cytokine production. Conclusion: Our analysis suggests that understanding the mechanisms that lead to islet-specific AAb development and the diabetogenic processes that autoreactive B cells promote may uncover additional biomarkers and therapeutic targets.

Introduction: In this prospective study, we establishing the association of obesity in type 2 diabetes patients with various inflammatory markers and adipocytokines, as risk factors for cardiovascular disease (CVD). Materials and Methods: In this work, a total of 85 individuals gave concern and were divided into 4 groups based on their body mass indices (BMI). Anthropometrics details were obtained from each individual and different laboratory tests were performed to measure levels of adipocytokines such as adiponectin, leptin and resistin and inflammatory markers such as TNF-α, IL-6 and hsCRP. All the 82 patients with T2D were studied in four groups, A includes obese with BMI >30 kg/m2, B includes overweight with BMI ranging 25 to 30 kg/m2), C includes non-obese with BMI< 25 kg/m2. Group D was control, included non-obese (BMI< 25kg/m2) and non-diabetic individuals. Result & Discussion: There was an increase in plasma insulin levels in T2D patients, especially with exhibiting high BMI and diabetic conditions in Group A. Adiponectin was higher in the control group which is significant with the value of p<0.05 compared to other three groups. There was negative correlation observed found to be significant, between obesity and adiponectin. Positive correlation was seen among leptin, resistin and inflammatory markers among T2D and control individuals which were significant. T2D groups had an increase in plasma insulin and adiponectin, but decreased leptin, resistin and inflammatory markers compared to control. Overall, T2D patients showed a significant correlation between plasma insulin, adipocytokines and other inflammatory markers clearly designate the impact of metabolic conditions such as obesity on these factors and vice versa. Increased levels of the parameters restrained in the study correlate T2D and obesity to cardiovascular diseases.