Measurement of the walking duration with therapeutic shoes in neuropathic diabetic patients by a novel device (Show-me).
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Diabetic Foot↗
Biomedical subjects
Rudolf Prager
Publications and source records attributed to Rudolf Prager.
Lipoprotein(a) as a predictor of cardiovascular disease in a prospectively followed cohort of patients with type 1 diabetes.
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Cardiovascular Diseases↗
Increased plasma amylin in type 1 diabetic patients after kidney and pancreas transplantation: A sign of impaired beta-cell function?
OBJECTIVE: In response to hyperglycemia, beta-cells release insulin and C-peptide, as well as islet amyloid pancreatic polypeptide, which is involved in glucose homeostasis. After successful pancreas-kidney transplantation (PKT), type 1 diabetic patients may revert to a nondiabetic metabolism without exogenous insulin therapy and re-secrete all beta-cell hormones. RESEARCH DESIGN AND METHODS: Using mathematical models, we investigated hormone (amylin, insulin, C-peptide) and metabolite (glucose, free fatty acids) kinetics, beta-cell sensitivity to glucose, and oral glucose insulin sensitivity index (OGIS) in 11 nondiabetic type 1 diabetic patients after PKT (BMI 25 +/- 1 kg/m2, 47 +/- 2 years of age, 4 women/7 men, glucocorticoid-free), 6 matching nondiabetic patients after kidney transplantation (25 +/- 1 kg/m2, 50 +/- 5 years, 3 women/3 men, on glucocorticoids), and 9 matching nondiabetic control subjects (24 +/- 1 kg/m2, 47 +/- 2 years, 4 women/5 men) during a 3-h 75-g oral glucose tolerance test (OGTT). RESULTS: PKT patients had higher fasting amylin (19 +/- 3 vs. control subjects: 7 +/- 1 pmol/l) and insulin (20 +/- 2 vs. control subjects: 10 +/- 1 microU/ml; each P < 0.01) levels. Kidney transplant subjects showed increased OGTT plasma insulin at 90 min and C-peptide levels (each P < 0.05). In PKT patients, plasma glucose from 90 to 150 min was 9-31% higher (P < 0.05 vs. control subjects). Amylin clearance was comparable in all groups. Amylin's plasma concentrations and area under the concentration curve were up to twofold higher in PKT patients during OGTT (P < 0.05). OGIS was not significantly different between groups. beta-Cell sensitivity to glucose was reduced in PKT patients (-64%, P < 0.009). Fasting plasma amylin was inversely associated with beta-cell sensitivity to glucose (r = -0.543, P < 0.004). CONCLUSIONS: After successful PKT, type 1 diabetic patients with nondiabetic glycemia exhibit increased fasting and post-glucose load plasma amylin, which appears to be linked to impaired beta-cell function. Thus, higher amylin release in proportion to insulin might also reflect impaired beta-cell function in type 1 diabetic patients after PKT.
Adult↗
[The metabolic syndrome: effects of a pronounced weight loss induced by bariatric surgery].
The prevalence of obesity is rising worldwide dramatically, affecting up to 50 percent of the population. The epidemic of obesity leads to a marked increase in the metabolic syndrome, a cluster of cardiovascular risk factors characterized by visceral obesity, insulin resistance, low HDL-Cholesterol, hypertriglyceridemia, and a subclinical proinflammatory state. In the last years, the NCEP and the WHO highlighted and defined the key features of the metabolic syndrome to facilitate the clinical diagnosis and preventive interventions. The conservative therapy of obesity and the metabolic syndrome by life style intervention and pharmacological interventions leads only to moderate weight loss with inconstant long-term success. Intervention by bariatric surgery can serve as a model for the metabolic effects of permanent weight loss. In several studies the pronounced weight loss induced a reduction of almost all components of the metabolic syndrome, including glucose and lipid status and is followed by an improvement in the quality of life. Recent research suggested a decrease in mortality rate in addition to cost effectiveness of bariatric surgery.
Bariatrics↗
PAI-1 4G/5G insertion/deletion promoter polymorphism and microvascular complications in type 2 diabetes mellitus.
BACKGROUND: Plasminogen activator inhibitor-1 (PAI-1) plays an important role in the regulation of fibrinolysis and extracellular matrix turnover. PAI-1 4G/5G insertion/deletion polymorphism in the PAI-1 promoter region has been shown to modulate PAI-1 plasma levels. We investigated the relationship between this polymorphism and the prevalence of diabetic nephropathy and retinopathy in patients with type 2 diabetes in the Austrian population. PATIENTS AND METHODS: 147 consecutive patients with type 2 diabetes mellitus (96 men, 51 women; median age, 65 years; IQR, 59-71) were analyzed for the PAI-1 4G/5G genotype. RESULTS: The genotype distribution in the individuals tested was as follows: 17% (n = 25) 5G/5G, 54% (n = 80) 4G/5G, and 29% (n = 42) 4G/4G. Patients homozygous for allele 4G had a significantly higher risk of diabetic proliferative retinopathy than patients without signs of diabetic retinopathy or nonproliferative retinopathy (OR, 7.3; 95% CI, 1.4-38.8; P = 0.02). No significant associations were observed between the PAI-1 genotype and the presence of albuminuria. CONCLUSION: According to our results, diabetic proliferative retinopathy might be associated with the prevalence of PAI-1 genotype 4G/4G.
Aged↗
[Peritoneal dialysis in patients with diabetic nephropathy].
Since the introduction of peritoneal dialysis (PD) into clinical nephrology at the end of the 1970s, many improvements have led to acceptance of this method as renal replacement therapy equivalent to hemodialysis. It is unclear whether the diabetic patient is the ideal candidate for PD and if this procedure should be the preferred method of treatment of renal failure in these patients, especially when kidney transplantation cannot be performed. PD may provide several advantages for diabetic patients with end-stage renal failure; for example, better hemodynamic stability is achieved during peritoneal ultrafiltration and vascular access surgery becomes unnecessary. On the other hand, the continuous glucose absorption may lead to increased insulin requirements, obesity and hyperlipidemia. Furthermore, peritoneal protein loss may aggravate malnutrition, which is frequently present in these patients. However, for a differentiated assessment of outcome in PD, the individual history (diabetes type 1 or type 2) and accompanying comorbidity of diabetic patients have to be considered. Nowadays nephrologists have to be aware of the concept of individualized therapy, which is integrated into an overall plan and takes into account the different conditions of diabetic patients and their treatment options. By improving removal of sodium and water, as well as improving quality of metabolic control, new dialysis solutions (icodextrin, neutral-pH solutions) and automated PD could have a positive impact on outcome in diabetic patients. In contrast, from retrospective studies on PD there is evidence of higher long-term mortality rates in elderly women with diabetes and in patients with cardiac insufficiency than in those on hemodialysis. Further research is necessary in order to optimize individualized therapy for diabetic patients with end-stage renal disease in the future.
Austria↗
The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus.
OBJECTIVE: To compare the effects of a 4-month strength training (ST) versus aerobic endurance training (ET) program on metabolic control, muscle strength, and cardiovascular endurance in subjects with type 2 diabetes mellitus (T2D). DESIGN: Randomized controlled trial. SETTING: Large public tertiary hospital. PARTICIPANTS: Twenty-two T2D participants (11 men, 11 women; mean age +/- standard error, 56.2+/-1.1 y; diabetes duration, 8.8+/-3.5 y) were randomized into a 4-month ST program and 17 T2D participants (9 men, 8 women; mean age, 57.9+/-1.4 y; diabetes duration, 9.2+/-1.7 y) into a 4-month ET program. INTERVENTIONS: ST (up to 6 sets per muscle group per week) and ET (with an intensity of maximal oxygen consumption of 60% and a volume beginning at 15 min and advancing to a maximum of 30 min 3x/wk) for 4 months. MAIN OUTCOME MEASURES: Laboratory tests included determinations of blood glucose, glycosylated hemoglobin (Hb A1c), insulin, and lipid assays. RESULTS: A significant decline in Hb A1c was only observed in the ST group (8.3%+/-1.7% to 7.1%+/-0.2%, P=.001). Blood glucose (204+/-16 mg/dL to 147+/-8 mg/dL, P<.001) and insulin resistance (9.11+/-1.51 to 7.15+/-1.15, P=.04) improved significantly in the ST group, whereas no significant changes were observed in the ET group. Baseline levels of total cholesterol (207+/-8 mg/dL to 184+/-7 mg/dL, P<.001), low-density lipoprotein cholesterol (120+/-8 mg/dL to 106+/-8 mg/dL, P=.001), and triglyceride levels (229+/-25 mg/dL to 150+/-15 mg/dL, P=.001) were significantly reduced and high-density lipoprotein cholesterol (43+/-3 mg/dL to 48+/-2 mg/dL, P=.004) was significantly increased in the ST group; in contrast, no such changes were seen in the ET group. CONCLUSIONS: ST was more effective than ET in improving glycemic control. With the added advantage of an improved lipid profile, we conclude that ST may play an important role in the treatment of T2D.
Aged↗
N-terminal pro-B-type natriuretic peptide as an indicator of possible cardiovascular disease in severely obese individuals: comparison with patients in different stages of heart failure.
BACKGROUND: Mild stages of heart failure might be difficult to diagnose in severely obese individuals with a body mass index (BMI) >40 kg/m(2). Measurement of the N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is feasible for detecting cardiac impairment. The aims of our study were to measure NT-proBNP in plasma of severely obese patients and to compare the results with results for patients in different stages of manifest cardiac dysfunction. METHODS: In 61 severely obese individuals (median BMI, 43.2 kg/m(2)) and 96 nonobese patients with existing heart failure [classified into New York Heart Association (NYHA) classes I-IV], NT-proBNP was measured in the fasting condition. A medical history, physical examination, electrocardiography, blood chemistry, and chest x-ray were performed in the obese group. In addition, echocardiography was performed in the NYHA group. RESULTS: In obese individuals, NT-proBNP was increased to a median of 356 (interquartile range, 221-458) pmol/L [854 (530-1099) ng/L] and was comparable (P >0.05) to the median value for NYHA I patients {289 (258-451) pmol/L [694 (619-1082) ng/L]}, but was significantly lower than in the other NYHA groups (P <0.001 for each). CONCLUSION: The prognostic relevance of increased NT-proBNP for risk of developing cardiac insufficiency in severely obese patients needs to be further evaluated.
Adult↗
Improvement of insulin resistance and early atherosclerosis in patients after gastric banding.
OBJECTIVE: To evaluate the effect of massive weight loss on insulin sensitivity, soluble adhesion molecules, and markers of the insulin resistance syndrome (IRS). RESEARCH METHODS AND PROCEDURES: Eighteen morbidly obese patients underwent gastric banding and were evaluated before and 6 and 12 months after surgery. Total insulin secretion, hepatic insulin extraction, and insulin sensitivity were analyzed by oral glucose-tolerance test model analysis. In addition, soluble intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, leptin, high-sensitivity C-reactive protein, plasminogen activating factor-1 (PAI-1), and tissue plasminogen activator were measured. RESULTS: BMI dropped from 45.22 +/- 5.62 to 36.99 +/- 4.34 kg/m(2) after 6 months and 33.72 +/- 5.55 kg/m(2) after 12 months (both p < 0.0001). This intervention resulted in a significant reduction of blood pressure (p < 0.00001), triglycerides (p < 0.01), fasting blood glucose (p = 0.03), basal insulin (p < 0.001), and basal C-peptide (p = 0.008) levels. Total insulin secretion decreased (p < 0.05), whereas hepatic insulin extraction (p < 0.05) and oral glucose insulin sensitivity index (p < 0.0001) increased compared with baseline. Leptin (p < 0.0001) and E-selectin levels decreased significantly after 6 and 12 months (p = 0.05), whereas significantly lower levels of intercellular adhesion molecule-1 and PAI-1 were only seen after 6 months. Subclinical inflammation, measured by high-sensitivity C-reactive protein, was lowered to normal ranges. No changes were observed in vascular cell adhesion molecule-1 and tissue plasminogen activator levels. DISCUSSION: Although gastric banding ameliorates several features of the IRS, including 29.05% improvement in insulin sensitivity and blood pressure and reduction of soluble adhesion molecules and PAI-1, considerable weight loss did not normalize all components of the IRS in morbidly obese patients.
Adult↗
Evaluation of a new insulinotropic agent by using an innovative technology: efficacy and safety of nateglinide determined by continuous glucose monitoring.
Nateglinide, a new insulinotropic agent, specifically targets prandial glycemic excursions. Recently, innovative technologies have become available that provide the possibility to measure 72-h blood glucose values continuously. The aim of this study was to evaluate the effects of nateglinide on 24-h blood glucose profiles in diabetic patients. Eighteen patients with type 2 diabetes mellitus--seven on diet only and 11 on metformin monotherapy--participated in the study. Mean age was 60 years, mean diabetes' duration was 7.4 years, and mean hemoglobin A1c was 8.4%. They underwent a 72-h glucose monitoring using a continuous glucose monitoring system (CGMS, Medtronic MiniMed, Northridge, CA) under their usual diabetes therapy and a standardized breakfast. After this period, therapy with nateglinide, 120 mg three times a day before meals, was initiated. Three days later patients again underwent 72-h glucose monitoring. Mean blood glucose values and mean fasting blood glucose values decreased significantly, from 172 mg/dL before to 131 mg/dL (P< 0.0004) and from 172 mg/dL before to 126 mg/dL (P< 0.0005), respectively, with nateglinide therapy. Postprandial hyperglycemia, expressed as mean blood glucose over a time period of 2 h after a meal, declined significantly after all three daily meals. The number of blood glucose values above 140 mg/dL decreased from 207 without to 98 during nateglinide therapy. Nateglinide was not associated with hypoglycemia or other adverse events. We found in this study, using CGMS, that nateglinide has a glucose-lowering potency that not only affects postprandial hyperglycemia, but also overnight and fasting blood glucose values.
Blood Glucose↗
Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding.
Weight reduction after gastric bypass surgery has been attributed to a decrease of the orexigenic peptide ghrelin, which may be regulated by insulin and leptin. This study examined effects of long-term weight loss after laparoscopical adjustable gastric banding on plasma ghrelin and leptin concentrations and their relationship with insulin action. Severely obese patients (15 women, three men, 36 +/- 12 yr) underwent clinical examinations every 3 months and modified oral glucose tolerance tests to assess parameters of insulin sensitivity and secretion every 6 months. After surgery, body mass index fell from 45.3 +/- 5.3 to 37.2 +/- 5.3 and 33.6 +/- 5.5 kg/m(2) at 6 and 12 months, respectively (P < 0.0001). This was associated with lower (P < 0.0001) plasma glucose, insulin, insulin resistance, waist circumference, and blood pressure. Plasma leptin decreased from 27.6 +/- 9.5 to 17.7 +/- 9.8 (P = 0.0005) and 12.7 +/- 5.1 ng/ml (P < 0.0001). Plasma ghrelin was comparable before and at 6 months (234 +/- 53; 232 +/- 53 pmol/liter) but increased at 12 months (261 +/- 72 pmol/liter; P = 0.05 vs. 6 months). At 6 and 12 months, ghrelin levels correlated negatively with fasting plasma insulin levels and hepatic insulin extraction but not with body mass or insulin action. In conclusion, prolonged weight loss results in a rise of fasting ghrelin concentrations that correlates with fasting insulin concentrations but not improvement of insulin sensitivity.
Adult↗
[Indication for bariatric surgery].
Morbid obesity is defined as obesity with body mass index (BMI) > or = 40 kg/m2 with secondary serious diseases. Conservative treatment generally fails to produce long-term weight loss in these patients, since several bariatric surgical techniques have been developed which are based on gastric restriction and/or gastric malabsorption resulting in permanent weight loss over years. Preoperative evaluation might detect suitable patients and reduce both non-surgical and surgical complications. Postoperative follow-up in a multidisciplinary program, including specialists in various fields of medicine, e.g. surgery, internal medicine, radiology, paediatrics and nutritional surveillance are mandatory in the treatment of patients after obesity surgery. Bariatric surgery results in a major weight loss, with amelioration of most obesity-associated conditions. The most serious side effect of some surgical procedere is malnutrition.
Body Mass Index↗
[Type 2 diabetes mellitus--screening and prevention].
The prevalence of diabetes is increasing in westernized countries. In addition, about half of all patients suffering from diabetes are not diagnosed. The current article represents the recommendations of the Austrian Diabetes Association for the screening and prevention of type 2 diabetes, based on currently available evidence.
Austria↗
[Therapy with oral antidiabetic drugs].
Hyperglycemia contributes to morbidity and mortality in diabetic patients. Reaching treatment targets with regard to control of glycemia is thus a central goal in the treatment of diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the practical use of oral antidiabetic drugs according to current scientific evidence.
Administration, Oral↗
[Therapy with insulin].
Hyperglycemia contributes to morbidity and mortality in diabetic patients. Reaching treatment targets with regard to control of glycemia is thus a central goal in the treatment of diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the practical use of insulin according to current scientific evidence.
Austria↗
[Diabetic nephropathy].
Diabetes mellitus is the leading single cause for renal replacement therapy. Its development and progression, however, can be ameliorated by adequate therapy. The present article represents the recommendations of the Austrian Diabetes Association for the prevention and treatment of diabetic nephropathy.
Albuminuria↗
Basal and dynamic proinsulin-insulin relationship to assess beta-cell function during OGTT in metabolic disorders.
The fasting proinsulin-to-insulin ratio is a currently used marker of beta-cell dysfunction. This ratio is calculated at the basal condition, but its behavior in dynamic conditions, i.e., during glucose stimulation, could be more informative. Given the different kinetics of the peptides, a mathematical model was necessary to analyze the oral glucose tolerance test (OGTT) data of insulin, C-peptide, and proinsulin in 55 healthy (NGT), 30 impaired glucose-tolerant (IGT), and 31 type 2 diabetic (T2DM) subjects. The model provided for secretion and disappearance of the peptides and an index of beta-cell function under dynamic conditions. Total proinsulin secretion during the OGTT was not different (P > 0.053) among NGT (0.17 +/- 0.01 mmol/l in 3 h), IGT (0.22 +/- 0.02), and T2DM (0.21 +/- 0.02) subjects. The proinsulin-to-insulin molar ratio measured from basal samples was higher (P < 0.0001) in T2DM (0.39 +/- 0.05) than in NGT (0.14 +/- 0.01) and IGT (0.13 +/- 0.02) subjects, and similar results (P < 0.003) were found by the dynamic index (0.27 +/- 0.04, 0.14 +/- 0.01, 0.15 +/- 0.01 in T2DM, NGT, IGT subjects, respectively). The basal ratio significantly correlated with the dynamic index, and the regression line slope was lower than 1 (0.43 +/- 0.08, 0.61 +/- 0.10, and 0.56 +/- 0.03 in NGT, IGT, and T2DM subjects, respectively, P < 0.0001). Impaired beta-cell function in T2DM could then be indicated by proinsulin-to-insulin indexes at both basal and dynamic phases.
Adult↗
Mode of action of ipomoea batatas (Caiapo) in type 2 diabetic patients.
We have previously reported the beneficial effects of Caiapo, the extract of white-skinned sweet potato (ipomoea batatas), on fasting plasma glucose, as well as on total and low-density lipoprotein (LDL) cholesterol in type 2 diabetic patients. The present study aimed to describe the underlying mechanism responsible for the improvement in metabolic control following administration of Caiapo in those type 2 subjects. A total of 18 male patients (age=58+/-8 years, body mass index [BMI]=27.7+/-2.7 kg/m2, mean +/- SEM) treated only by diet were randomized into 3 groups (placebo, low-dose Caiapo, 2 g/d, and high-dose, 4 g/d). Parameters related to glucose tolerance, glucose disappearance, and insulin secretion were obtained by performing both frequently sampled intravenous glucose tolerance test (FSIGT) and oral glucose tolerance test (OGTT) before and after 6 weeks of treatment with Caiapo. Following treatment with high dose Caiapo, insulin sensitivity significantly ameliorated when assessed both with OGTT (from 308+/-13 mg/min/m2 to 334+/-10, P=.048) and FSIGT (from 1.21+/-0.32 10(4) min(-1)/(microU/mL) to 1.73+/-0.40, P=.021). Improvement of insulin sensitivity with the low dose was observed only with the FSIGT (from 2.02+/-0.70 10(4) min(-1)/(microU/mL) to 2.76+/-0.89, P<.05). Glucose effectiveness did not change. While no changes in glucose tolerance were observed in the placebo and low-dose groups, it increased from 0.85+/-0.13 %min(-1) to 1.46+/-0.13 (P<.02) in patients on high dose. No significant changes were seen in any of the parameters related to insulin dynamics: insulin secretion (from C-peptide), distribution, clearance, and hepatic extraction remained virtually the same after the treatment. In conclusion, short-term treatment with 4 g/d of the nutraceutical Caiapo consistently improved metabolic control in type 2 diabetic patients by decreasing insulin resistance without affecting body weight, glucose effectiveness, or insulin dynamics. No side effects related to the treatment were observed. Thus these results indicate that Caiapo could potentially play a role in the treatment of type 2 diabetes.
Blood Glucose↗