Current Diabetes Reviews - Volume 13, Issue 6, 2017

Background: In the era following the publication of results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Complications (DCCT/EDIC) study, care for patients with type 1 diabetes has dramatically improved. Objective/Methods: The present review specifically focused on the epidemiology of cardiovascular complications among adults with type 1 diabetes, summarizing evidence on the prevalence, incidence, mortality, as well as on predictors of cardiovascular disease in this population. The review covered papers published until December 2015. Conclusion: Despite these significant advancements in knowledge regarding the management of this chronic disease, however, individuals with type 1 diabetes continue to experience increased morbidity and mortality compared to the general population.

Background: If we are to gain a full and complete understanding of mechanisms of cardiovascular risk factors in adolescent type 1 diabetes mechanistic risk markers must be developed that predict risk accurately and which can be used as endpoints for short or intermediate term intervention studies aimed at reducing risk. A variety of biochemical and vascular markers have potential to meet these requirements. Biochemical markers include markers of inflammation, oxidation, and endothelial damage. Vascular markers include static and dynamic measures of arterial function. Adolescents with type 1 diabetes demonstrate alterations in many of these markers. Conclusion: For many of the biochemical markers precise cut-off points with high sensitivity and specificity are not available and many of the vascular measures require specific equipment and are operator dependent.

Background: Cardiovascular disease (CVD) as a result of macrovascular changes is the leading cause of mortality in patients with type 1 diabetes (T1DM). While CVD complications are seen predominantly in adulthood, the atherosclerotic process begins in childhood and is accelerated in patients with T1DM. This review focuses on the epidemiology of traditional CVD risk factors in adolescents with T1DM, its association with markers of CVD and an overview of studies looking into each individual risk factor. Conclusion: The risk factors that are reviewed here are hypertension, dyslipidemia, smoking, obesity, lack of exercise, hyperglycemia and diabetic nephropathy. We highlight the importance of early identification, and interventions, which include optimizing glycemic control, pharmacotherapy, regular physical activity and dietary changes.

Background: Despite recent advances in improved glycemic control, the magnitude of lifetime risk from premature cardiovascular disease in individuals with type 1 diabetes remains at least 10 fold higher than in the general population. The availability of lipoprotein fractionation has allowed the spotlight for this increased risk to shift from dysglycemia to diabetes-induced dyslipidemia associated with insulin resistance. Interventions designed to simultaneously improve both factors can have distinct and additive effects on slowing the initiation and progression of atherosclerotic lesions. As fullblown cardiovascular disease is not evident during childhood, there is a critical need to identify the most predictable surrogate markers that could assign elevated risk, as well as the design of safe and targeted interventions that could improve outcomes in this population. Conclusion: This review will examine the evidence supporting the notion that cardiovascular disease in type 1 diabetes is associated with significant insulin resistance and it begins in childhood, making it necessary to design rational clinical trials that will significantly reduce risk in this population.

Background: Gestational diabetes mellitus (GDM) is a common endocrine complication in pregnancy. While it has been established that age, family history of diabetes, insulin resistance and several biomarkers are associated with GDM but significant gaps remain in understanding risk factors for GDM. Soluble pro-renin receptor (s [Pro] RR) as a biomarker reflects the activation of renin-angiotensin system in tissues which may be related to insulin resistance Objective: The aim of this study was to determine the role of (s [pro] RR) in predicting GDM. Methods: one hundred-eighty singleton pregnant women in first trimester were enrolled. We excluded women with previous history of GDM, hypertension and consumption of drugs affected reninangiotensin system. A fasting blood glucose and s (pro) RR level were obtained during first trimester and OGTT was performed at 24-28 weeks of gestation. We used ROC curves to identify s (pro) RR cutoff points for detecting GDM and the difference in s (pro)RR level was assessed in GDM and non- GDM women. Results: Among 180 women, 24 (13.33%) had GDM. There was no significant difference between age and body mass index in subjects with GDM compared to non- GDM. The concentration of s (pro) RR was significantly higher in GDM subjects rather than non- GDM [29.27(24.60-35.92) vs. 22.89(19.46- 24.27), P<0.001]. Multiple logistic regression analysis revealed a significant association of s(pro) RR with GDM (odd ratio: 1.32, 95% CI: 1.17-1.48, P=0.04). A cut-off point 24.52 ng/ml of s(pro) RR had 75% sensitivity and 80% specificity for predicting GDM. Conclusion: Increased level of s (pro) RR in first trimester may be a marker for predicting GDM.

Introduction: One challenging problem in patients suffering from Diabetes Mellitus (DM) is the elevate incidence of cardiovascular events. Exercise has been proved useful in reducing cardiovascular risks in these patients. However, both type 1 and 2 DM significantly affect the cardiovascular response during exercise. Therefore, on one side exercise is considered to be a valid therapeutic tool for DM, whereas on the other side during exercise these patients may experience troubles in the cardiovascular regulation. Background: Several impairments at central and at peripheral level have been reported during exercise in both types of DM. For example, sympathetic dysfunctions have been demonstrated in type 1 and 2 DM. Furthermore, impairments in hemodynamics have been often reported. The purpose of the present paper is to briefly review the latest data on the role played by type 1 and 2 DM in the cardiovascular regulation during dynamic exercise. Conclusion: Hemodynamic dysfunctions may develop in both type 1 and 2 DM during exercise. However, these cardiovascular dys-regulations are different between the two kinds of diabetes.

Introduction: Diabetes Mellitus (DM) is a chronic hyperglycemic condition with major health concern on a global scale. DM is a heterogeneous metabolic disorder stemming from defective insulin secretion and/or resistance to action of insulin. Diabetes is recognized cause of male sexual dysfunction and affects reproductive function in humans and animal models, including the endocrine control of spermatogenesis, erectile dysfunction and ejaculation disorder. Testicular disorder is characteristically marked by reductions of testicle weight, sperm count and motility, as well as changes in the morphology of the seminiferous epithelium. Altered testosterone level is another characteristic of diabetic animals. Studies have demonstrated that DM increases apoptosis in germ cells and lead to the interruption of spermatogenesis, mainly by exerting an influence on Bcl-2 protein and cysteinedependent aspartate-directed proteases. DM also increases oxidative stress in testicular cells and excessive production of radical oxygen species has been demonstrated. Several strategies can be used as means of prevention and/or treatment for diverse types of damage to testicles by DM such as regular physical exercise, stress reduction and food intake of substances with antioxidant potential. A hypoglycemic and antioxidant potential diet, in particular, the seafood, can be a valuable instrument of guard against damage caused by DM, both the systemic level as testicular level. The objective of this review is to summarize evidences that study the antioxidant, anti-inflammatory and anti-apoptosis role of seafood in testicles morphology damages induced by diabetes mellitus. Conclusion: The seafood plays an antioxidant, anti-inflammatory and anti-apoptosis role in testicles morphology damages induced by diabetes mellitus. This relation seems to be associated with Omega-3 and carotenoids (astaxanthin) levels.

Background: Uncontrolled or long-term diabetes mellitus is conducive to vascular and oxidative stress disturbances that impede several physiological systems, which may in turn elicit psychological symptoms. Objective: We assess the sexual and hormonal complications of diabetes mellitus that impair reproductive function in males and females. Methods: A comprehensive MEDLINE® search was guided using key words relevant to diabetes mellitus and reproductive health. Results: We reviewed the pathogenesis, clinical manifestations, imaging modalities, pharmacological treatment, and intervention options for each diabetic reproductive complication in males and females. Erectile dysfunction secondary to angiopathic, neuropathic, and myopathic damage is a leading complication of diabetes in males. Other reproductive complications include ejaculatory dysfunction, hypogonadism, modified semen parameters, and delayed puberty. Specifics of reproductive dysfunction in diabetic women are less definite than in men due to the lack of standardized evaluation of sexual function in women as well as the increased role of psychological morbidity. Despite this, it is known to manifest as hypogonadism, hypoactive sexual desire disorder, dyspareunia, menstrual dysfunction, and polycystic ovarian syndrome. Conclusion: Longitudinal studies with larger sample sizes are necessary to better comprehend the connection between diabetes and sexual dysfunction, chiefly in females. Understanding and dividing the role of fertility and sexual issues in reproductive dysfunction can help guide evaluation and management.

Background: Diabetes mellitus, a condition of multifactorial origin, is related to the intestinal microbiota by numerous molecular mechanisms. Controlling the vast increase in the prevalence of diabetes needs a natural and safe solution. Probiotics, known as live microorganisms that exert health benefits to the host, have anti-diabetic property. Objective: This review will highlight the current evidences in probiotic effectiveness and future prospects for exploring probiotic therapy in the prevention and control of diabetes. Methods: We searched Pub Med and Science Direct by using “Probiotics” and “Diabetes” for searching the studies aiming the app lication of probiotics and the beneficial effects of probiotics in diabetes prevention and control. Results: It has been shown that probiotics can increase insulin sensitivity and reduce autoimmune responses by modulating intestinal microbiota and decreasing the inflammatory reactions and oxidative stress. Recent evidences show that probiotics influences the host through modulating intestinal permeability and mucosal immune response, manipulating eating behaviors by appetite-regulating hormones and controlling gut endocannabinoid (eCB) system that is believed to be associated with inflammation and diabetes. Moreover, modulating the intestinal microbiota by probiotics controls host metabolism by affecting energy extraction from food and by biochemically converting molecules derived from the host or from gut microbes themselves. Conclusion: Experimental and clinical evidences support the hypothesis that the modulation of the gut microbiota by probiotics could be effective in prevention and management of diabetes.

Background: With the use of intensive insulin therapy and insulin secretagogues to optimize glycemic control in diabetes, hypoglycemia continues to present a clinical challenge. Hypoglycemia has been implicated in nocturnal sudden death in type 1 diabetes, and the mechanism underlying this is postulated to be cardiac arrhythmia. Objective: This article reviews the evidence surrounding hypoglycemia and cardiac arrhythmia. Methods: A structured search of the Pubmed bibliographic database was undertaken, and relevant peerreviewed articles on the topic were included in the review. Results: Since the initial description of nocturnal sudden death in type 1 diabetes over twenty years ago, numerous studies have been performed to try and improve our understanding of the effects of hypoglycemia on cardiac rhythm. This includes animal models of diabetes that have permitted valuable insights into the pathophysiology of arrhythmia generation, involving direct effects of hypoglycemia on the cardiac myocyte, effects from sympatho-adrenal activation and a reduced arrhythmia threshold. In humans, the use of tools such as the hypoglycemic clamp or subcutaneous continuous glucose monitoring have helped explore the interaction between hypoglycemia and cardiac rhythm in both controlled and real world settings. Proving a causal link with fatal cardiac arrhythmia is clearly more difficult, as simultaneous monitoring of cardiac rhythm and blood glucose level is rarely performed in this setting. However substantial circumstantial evidence, including that from large randomized clinical trials, exists to support the theoretical risk of arrhythmic death conferred by hypoglycemia. This has reshaped opinion surrounding intensive glucose lowering in patients with diabetes and heart disease, and is reflected in recent international guidelines. Conclusion: This article reviews the postulated mechanisms, the extensive evidence base and the current recommendations around hypoglycemia and arrhythmia.

Background: Diabetic nephropathy (DN) is one of the foremost causes of mortality in diabetic patients as a result of increased urinary albumin excretion (UAE) rate and compromised renal function. Introduction: Determination of increased excretion of albumin in urine chiefly attribute to the onset and progression of DN. However, due to certain limitations of albuminuria, the search for more sensitive, specific and reliable renal biomarkers is required for early prediction of DN. Methods: Bibliographic investigation was made to scrutinize the data reporting relevant biomarkers associated with DN and may be used to predict the onset and progression of nephropathy. Result and Conclusion: Optimization of biomarkers for a clinical situation requires a prospective validation in large numbers of patients with diabetic nephropathy and needs to be performed in different critically ill populations.