Biomedical subjects

Vivian Fonseca

Publications and source records attributed to Vivian Fonseca.

39 records · Page 3Linked to original sources

PubMedDate not supplied

Metabolic memory in diabetes--focus on insulin.

Large-scale clinical trials have demonstrated that metabolic control achieved early in the course of diabetes substantially reduces development and progression of diabetes and the associated microvascular complications. Additionally, prospective observational studies have demonstrated that atherogenic and inflammatory mediators are elevated even prior to the onset of diabetes and significantly contribute to subsequent development of macrovascular complications. Collectively, these data suggest that metabolic memories are stored early in the course of diabetes. We believe that insulin suppresses inflammation and also suppresses glucotoxicity and lipotoxicity (and the consequences thereof, such as the formation of advanced glycation end products and epigenetic phenomena), and thus has a pivotal and beneficial role. Comprehensive metabolic control, especially when instituted early, may alter the natural history of diabetic complications by affecting this metabolic memory. Thus, our overall goal is to understand in more detail the molecular mechanisms involved in these changes, thereby affording us opportunities to reduce the long-term effects of diabetes.

Diabetes Mellitus↗

PubMedDate not supplied

The rationale and design of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial.

Beta-blockers utilized in the Type 2 diabetic patient result in an even greater decrease in cardiac events than in the nondiabetic patient. Unfortunately, first-and second-generation beta-blockers are associated with the worsening of insulin resistance, deterioration of glycemic control, peripheral vasoconstriction, potentially worsening peripheral vascular disease, and more frequent and severe hypoglycemia. The third-generation beta-blockers have unique properties, including alpha1-blockade, and have been shown to lower insulin resistance, improve glycemic control, and vasodilate resistance arterioles. The Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial has been designed to compare a third-generation (carvedilol) with a second-generation beta-blocker (metoprolol) in a cohort of participants with hypertension and Type 2 diabetes. The primary outcome measure of the study is change in the HbA1c. The study is powered to detect a difference in HbA1c of 0.3 units (%) between the groups. Secondary endpoints include changes in insulin resistance, fasting glucose, and the lipid profile. Differences in the side-effect profile (cold extremities, fatigue, impotence, and hypoglycemia) will also be assessed. The GEMINI trial, therefore, is the first large randomized trial to assess whether utilizing a third-generation beta-blocker yields a favorable metabolic profile in the patient with Type 2 diabetes and hypertension.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Newly diagnosed diabetes/hyperglycemia in hospitals: what should we do?

OBJECTIVE: To examine the clinical problem of newly diagnosed diabetes/hyperglycemia in hospitals, and to develop a management strategy. METHODS: A review of the literature on outcomes and management of such patients. RESULTS: There are very few published papers on this subject, the majority being in patients with cardiovascular disease. However, there is recognition that the problem is common. No randomized clinic trials have been carried out on therapeutic strategies in such patients. The limited data available suggest that patients with newly diagnosed diabetes and hyperglycemia tend to have a poor prognosis. CONCLUSION: Newly diagnosed diabetes/hyperglycemia in hospital is a common problem and is associated with a poor prognosis. Therefore, it seems appropriate that such patients be managed the same way as patients with established diabetes. Following discharge, appropriate diagnostic testing is needed to establish the presence or absence of diabetes so that long-term treatment plans can be initiated.

Diabetes Mellitus↗