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Biomedical subjects

Anat Tsur

Publications and source records attributed to Anat Tsur.

3 recordsLinked to original sources

[The guidelines for the diagnosis prevention and treatment of type 2 diabetes mellitus--2005].

The incidence and prevalence of diabetes have reached epidemic proportions worldwide. The reasons for the pandemic are the sharp rise in obesity, decline in physical activity and the increase in life expectancy. There are some 400,000 people with diagnosed diabetes in Israel and they are at a markedly increased risk for cardiovascular disease, blindness, end-stage renal disease and lower limb amputation. To effectively lower this significantly increased burden of disease, a comprehensive multidisciplinary approach to chronic disease management is required. To facilitate such an approach, the Israel Diabetes Association published a guideline for the diagnosis, prevention and treatment of diabetes. The guideline, based on the ADA (American Diabetes Association) and IDF (International Diabetes Federation) guidelines, was approved by other national professional societies including hypertension, family practice, obesity, nephrology, atherosclerosis and internal medicine. The guidelines highlight the metabolic syndrome and prediabetic states, interventions for the prevention of diabetes, the new definitions of diabetes and impaired glucose metabolism and the newly defined targets for glucose, lipid, cholesterol and blood pressure control. In addition, the recommendations for periodic review and screening for complications are summarized. The need for patient education and empowerment are emphasized as is the need for the development and implementation of unique tools including computerized treatment flow-charts, prompts and quality measures, for the long term management of a complex metabolic disease.

Blood Glucose↗

[Primary care for type 2 diabetes].

The prevalence of type 2 diabetes is dramatically increasing worldwide and expected to double over the next 25 years, reaching epidemic proportions and thus incurring a considerable financial burden on the health care system. In order to cure the epidemic and minimize expensive complications, a program aimed at optimizing metabolic control and improving surveillance and quality assessment needs to be developed and implemented nation-wide. Most diabetic patients should be treated within the primary care system. In order to meet treatment targets, improve metabolic control and avoid complications, the knowledge and skills needed to treat this chronic disease should be reinforced by dedicated multidisciplinary teams from centers specializing in diabetes care. The specialized diabetes clinics should be devoted to both the treatment of complicated cases of diabetes, that are not achieving treatment targets in the primary care setting, and to the education, updating and empowerment of all primary care teams involved in the treatment of patients with diabetes. A local framework for shared care should be developed through the combined efforts, of the staff of the diabetes center and the primary care physicians and nurses in order to secure the shared goals of optimal treatment and prevention of complications.

Diabetes Mellitus, Type 2↗

Pancreatic Duodenal Homeobox (PDX-1) in health and disease.

Insulin is expressed exclusively in the adult beta-cells of the islets of Langerhans. Pancreatic Duodenum Homeobox-1 (PDX-1) is a major regulator of transcription in these cells. It transactivates the insulin gene by binding to a specific DNA motif in its promoter region. Glucose, the main physiological regulator of insulin secretion, also regulates insulin gene transcription through PDX-1. While acute exposure to high glucose concentrations causes an increase in PDX-1 binding, and consequently in insulin mRNA levels, chronic hyperglycemia (toxic to the beta-cell) leads to a decrease in PDX-1 and insulin levels. PDX-1 is absolutely required for pancreas development. In view of the selective expression in adult beta-cells, pancreatic agenesis in both the pdx-1 null mouse and a human carrying a homozygous mutation of PDX-1 was an unexpected and remarkable finding. The homozygous clinical phenotype was neonatal diabetes mellitus (DM) and exocrine insufficiency. Heterozygosity for PDX-1 mutations was found in some individuals with a newly characterized subtype of maturity-onset diabetes of the young (MODY4) and in others with type 2 DM. This review underlines the unique role of PDX-1 in maintaining adult beta-cell-specific functions in normal and disease-related states.

Animals↗