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Results for “Glycemic levels”

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At least 163 records · Page 9Linked to original sources

PubMed1995

Long-term effect of eicosapentaenoic acid ethyl (EPA-E) on albuminuria of non-insulin dependent diabetic patients.

Dietary cod-liver oil containing eicosapentaenoic acid is effective on microvascular albumin leakage in diabetic patients with albuminuria. We determined the long-term effects of oral pure eicosapentaenoic acid ethyl (EPA-E: 900 mg/day) administration on diabetic nephropathy in non-insulin dependent diabetic (NIDDM) patients. The effects of EPA-E were determined by observing the changes of the index of urine albumin excretion level/urine creatinine (Cr) excretion level (UAI), the ratio of beta 2-microglobulin excretion level/urine Cr excretion level (beta 2-MG/Cr) and the ratio of N-acetyl-D-glucosaminidase excretion level/urine Cr excretion level (NAG/Cr) at 3, 6 and 12 months after the start of the treatment. Oral EPA-E administration immediately improved the increased UAI at 3 months after the start of treatment. A significant improvement of the UAI by EPA-E was sustained 12 months later. EPA E administration also tended to decrease the urine beta 2-MG/Cr ratio from 6 months, but the difference was statistically not significant. However, the urine NAG/Cr ratio was not changed by EPA-E administration. EPA-E administration did not affect blood pressure levels, glycemic control and lipid metabolism in these patients. The present data indicated that EPA-E administration improved increased albumin excretion in NIDDM patients with nephropathy and its effects on albuminuria sustained for at least 12 months after the start of treatment. However, tubular factors were not influenced by EPA-E administration.

Acetylglucosaminidase↗

PubMedDate not supplied

Cyclosporine in recent onset type I diabetes mellitus. Effects on islet beta cell function. Miami Cyclosporine Diabetes Study Group.

To confirm the immunological basis of type I diabetes and to determine if immune intervention alters the course of the disease, we studied the use of cyclosporine in a 1-year randomized, double-masked, placebo-controlled trial in 23 subjects enrolled within 6 weeks of diagnosis. Subjects included 12 males and 11 females, ages 9-38 years (mean, 19.7 +/- 1.8 years). Initial dosage of cyclosporine was 10 mg/kg/day, given as a single daily dose, adjusted on the basis of side effects and trough cyclosporine levels. Glycemic control and insulin dosage were similar in both cyclosporine and placebo groups. The frequency of freedom from insulin usage also was similar in both groups; however, it is not possible to draw conclusions about response rates, because of the very small sample size. Glucose tolerance, as measured by rate of intravenous glucose disposal did not differ between groups. Islet beta cell function was measured by determining C-peptide response to three secretogogues: intravenous glucagon, intravenous glucose, and a mixed formula meal (Sustacal). There were no differences between groups in the C-peptide responses either to intravenous glucagon or intravenous glucose. Moreover, acute insulin response to intravenous glucose was not restored in any subject. On the other hand, in comparison to the placebo group, the cyclosporine group did show an increased meal-stimulated C-peptide response after 3, 6, 9, and 12 months. When measured by regression analysis, the slope defining the rate of decline of beta cell function was significantly slower for the cyclosporine group than the placebo group (p less than 0.05). Thus, as measured in response to a physiological stimulus (meal challenge), cyclosporine preserves islet beta cell function when used in recent onset type I diabetes. Side effects were minimal and reversible upon cessation of immune intervention. The preservation of islet beta cell function by immune intervention is consistent with the hypothesis that type I diabetes has an immune mechanism involved in its pathogenesis.

Adult↗

PubMed2003

Relation of hemoglobin A1c to rate of major adverse cardiac events in nondiabetic patients undergoing percutaneous coronary revascularization.

Abnormalities in plasma glucose below the "diabetic range" of glycemia are associated with increased cardiovascular morbidity and mortality in patients without diabetes mellitus. The purpose of this study was to investigate the relation between ambient glycemic levels as measured by hemoglobin A1c and outcome after elective percutaneous coronary intervention (PCI). Baseline laboratory studies, including hemoglobin A1c, were drawn in 500 consecutive patients before elective PCI. Nondiabetic patients were defined as those without a history of diet or pharmacologically controlled diabetes mellitus and a hemoglobin A1c level <7.0%. Of the 500 patients studied, 291 (59%) were nondiabetic patients. Abnormal hemoglobin A1c levels (6% to 7%) were found in 30% of nondiabetic patients. Nondiabetic patients with an abnormal hemoglobin A1c level had a significantly higher rate of major adverse cardiac events (33% vs 22%, p = 0.04), target vessel revascularization (31% vs 19%, p = 0.02), and cardiovascular mortality (4.6% vs 0.5%, p = 0.03) compared with nondiabetic patients with hemoglobin A1c levels <6%. Multivariate analysis disclosed that a hemoglobin A1c level of 6% to 7% was a significant independent predictor of major adverse cardiac events, target vessel revascularization, and cardiovascular mortality 12 months after PCI in nondiabetic patients. These data demonstrate that an abnormal hemoglobin A1c level may have prognostic significance in nondiabetic patients who undergo PCI.

Aged↗

PubMed2006

Diastolic dysfunction and diabetic cardiomyopathy: evaluation by Doppler echocardiography.

Doppler echocardiography has largely contributed to show the existence of a distinct diabetic cardiomyopathy. Several studies have pointed out the evidence of left ventricular (LV) remodeling and hypertrophy in alterations of both midwall systolic mechanics and LV diastolic filling in diabetes mellitus (DM), independent of the coexistence of concomitant risk factors. Further progress will be provided by new ultrasound technologies in this clinical setting. The combination of pulsed tissue Doppler study of mitral annulus with transmitral inflow may be clinically valuable for obtaining information about left ventricular filling pressure (LVFP) and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. In the absence of epicardial coronary artery stenosis, the ultrasound assessment of coronary flow reserve (CFR) may identify the dysfunction of coronary microcirculation, in relation with glycemic levels, insulin resistance, sympathetic overdrive, endothelial dysfunction, abnormalities of the angiotensin-renin system, and LV remodeling/hypertrophy. Diastolic dysfunction and impairment of CFR may be associated in DM, with a likely common origin. In this view, a comprehensive transthoracic Doppler evaluation of diabetic patients should include the assessment of diastolic function and estimation of LVFP by tissue Doppler, and coronary microvascular function by CFR test. Additional analysis of regional wall motion during a stress test would be required in patients with suspected coronary artery disease, another cause of diastolic dysfunction.

Coronary Circulation↗

PubMed2004

Type 2 diabetes and the genetics of signal transduction: a study of interaction between adenosine deaminase and acid phosphatase locus 1 polymorphisms.

Acid phosphatase locus 1 (ACP1) is a highly polymorphic enzyme that has an important role in flavoenzyme activity and in the control of insulin receptor activity and band 3 protein phosphorylation status. Adenosine deaminase (ADA) is a polymorphic enzyme that catalyses the irreversible deamination of adenosine to inosine and has an important role in regulating adenosine concentration. Based on the hypothesis that ACP1 counteracts insulin signaling by dephosphorylating the insulin receptor and that adenosine has an anti-insulin action, we reasoned that low ACP1 activity (low dephosphorylating action on insulin receptor) when associated with high ADA activity (low adenosine concentration) would result in a cumulative effect towards an increased glucose tolerance. On the contrary, high ACP1 activity when associated with low ADA activity would result in a cumulative effect towards a decreased glucose tolerance. A total of 280 adult subjects with type 2 diabetes from the population of Penne (Italy) were studied. There was a nonsignificant trend toward an increase in the proportion of subjects with the complex type with high ACP1 activity and low ADA activity (ie, *B/*B; *A/*C; *B/*C; *C/*C//ADA*1/*2 and *2/*2) in type 2 diabetes relative to that observed in newborn infants from the same population. High ACP1 activity/low ADA activity joint genotype was positively associated with high glycemic levels and with high body mass index (BMI) values. Low ACP1 activity/high ADA activity joint genotype was also positively associated with dyslipidemia. These findings suggest that both ACP1 and ADA contribute to the clinical manifestations of type 2 diabetes and probably also have a marginal influence on susceptibility to the disease. Both additive and epistatic interactions between the 2 systems seem to be operative.

Acid Phosphatase↗

PubMed1998

Diabetes mellitus in older persons.

The relative importance and mechanisms of deficient insulin secretion versus deficient action during aging are still debated. Whatever mechanisms eventually explain the emergence of impaired glucose tolerance during aging, the clinically important extrinsic modifiers of glycemic levels include diet, medications, activity, and chronic illness and stress. Although prospective studies are not available in the elderly, retrospective studies suggest that good blood glucose control reduces the likelihood and severity of stroke, cardiovascular disease, visual impairment, nephropathy, infections, and even cognitive dysfunction. Good control also seems to reduce nocturia, polyuria, and hypovolemia. Therapy of older persons begins with diet, exercise, and oral agents, failing which, insulin is employed. Since many of the newer oral agents carry less risk of hypoglycemia, achieving tighter control in the elderly has become more feasible.

Aged↗

PubMed1995

Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group.

PURPOSE: To answer the following questions regarding the effect of intensive diabetes management on retinopathy in insulin-dependent diabetes mellitus (IDDM): (1) Does intensive therapy completely prevent the development of retinopathy? (2) Are some states of retinopathy too advanced to benefit from intensive therapy? (3) Are the retinopathy endpoints in the Diabetes Control and Complications Trial (DCCT) clinically important? and (4) What other factors influence the effectiveness of therapy? METHODS: A total of 1441 patients, ranging in age from 13 and 39 years and with IDDM of 1 to 5 years' duration and no retinopathy at baseline (primary prevention cohort) or with 1 to 15 years' duration and minimal to moderate nonproliferative retinopathy (secondary intervention cohort), were assigned randomly to either intensive or conventional diabetes therapy. Intensive therapy, aimed at achieving glycemic levels as close to the normal range as possible, included three or more daily insulin injections or a continuous subcutaneous insulin infusion, guided by four or more glucose tests daily. Conventional therapy included one or two daily injections. Seven-field stereo-scopic fundus photography was performed every 6 months, for a mean follow-up of 6.5 years (range, 4-9 years). RESULTS: Intensive therapy reduced the risk of any retinopathy (> or = 1 microaneurysm) developing in the primary prevention cohort (70% of intensive versus 90% of conventional treatment group; P = 0.002) by 27%. It reduced the risk of retinopathy developing or progressing to clinically significant degrees by 34% to 76%. Intensive therapy was most effective when initiated early in the course of IDDM. It had a substantial beneficial effect over the entire spectrum of retinopathy studied in the DCCT and, with rare exceptions, in all patient subgroups. CONCLUSION: Although intensive therapy does not prevent retinopathy completely, it has a beneficial effect that begins after 3 years of therapy on all levels of retinopathy studied in the DCCT. The reduction in risk observed in the study is translatable directly into reduced need for laser treatment and saved sight. Intensive therapy should form the backbone of any healthcare strategy aimed at reducing the risk of visual loss from diabetic retinopathy.

Adolescent↗

PubMed2001

Risk factors for the development of diabetic retinopathy in Japanese type 2 diabetic patients.

This study investigated the risk factors for development of diabetic retinopathy (DR) in 787 type 2 diabetic patients with no retinopathy at the first visit. The subjects were followed up for at least 3 years (mean, 6.7 years). Among the baseline factors, significant correlations were observed between the development of DR and HbA1c (P < 0.0001), the method of therapy (P < 0.005), the duration of diabetes at the first visit (P < 0.005) and the past maximal body mass index (BMI) (P < 0.01). No significant correlation was found with the blood pressure, age, gender, TC or BMI. Among the follow-up variables, the mean HbA1c (P < 0.0001) and duration of diabetes (P < 0.001) correlated significantly with DR development, whereas the blood pressure and age did not. We found that a 1% decrease in HbA1c led to a 35% reduction in the risk of development of DR during the follow-up. The patients whose HbA1c at the first visit was higher than the median value of 8.2% showed a higher probability of development of DR during the next 3 years even when the same blood glucose control was maintained during the follow-up. In conclusion, our study demonstrated that the most important risk factor influencing the development of DR was the blood glucose control. Moreover, we found that the glycemic level at the first visit also influenced the development of DR.

Adolescent↗

PubMed1992

Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in type I diabetes mellitus: evaluation of a path model.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

Adaptation, Psychological↗

PubMed2001

Reducing cardiovascular disease risk with diet.

OBJECTIVE: Past research efforts to determine the influence of the diet on cardiovascular (CV) health have focused on the individual roles of specific dietary components with debatable success. Awareness of the impact and complexity of nutrient interactions has expanded in recent years to include assessment of dietary patterns as they contribute to lower CV disease risk. RESEARCH METHODS AND PROCEDURES: In a series of multicenter studies, we compared a comprehensive, prepared meal plan, formulated to meet recommended intake levels of macro- and micronutrients, with a self-selected diet based on the exchange system. The three studies comprised adult participants with hypertension, hyperlipidemia, and type 2 diabetes (n = 560, 251, and 330, respectively). The first two studies (10 weeks) varied by the amount of contact with study personnel, and the third study assessed long-term effects over 52 weeks. Outcome measures included: blood pressure, lipid and lipoprotein levels, glycemic control, homocysteine, compliance, quality of life, and weight. RESULTS: The first study demonstrated significant improvements in all measures, with greater improvements with the prepared meal plan compared with the self-selected diet. The second study, designed to parallel the contact frequency that would occur in a real world clinical setting, also produced significant improvements in multiple CV risk factors. In the long-term study, in addition to sustained improvements in risk factors, significant weight loss was achieved and maintained over the 52 weeks. DISCUSSION: These trials demonstrate that regular consumption of a nutritionally complete diet offers multiple, concurrent clinical benefits for reducing CV disease risk and body weight.

Adult↗

PubMed1994

Hypoglycemic activity of juniper "berries".

This work studies the hypoglycemic activity of a decoction from juniper "berries" (Juniperus communis) both in normoglycemic and in streptozotocin-diabetic animals. Juniper decoction decreases glycemic levels in normoglycemic rats at a dose of 250 mg/kg. This effect can be achieved through: a) an increase of peripheral glucose consumption; b) a potentiation of glucose-induced insulin secretion. The administration of the decoction (125 mg total "berries"/kg) to streptozotocin-diabetic rats for 24 days results in a significant reduction both in blood glucose levels and in the mortality index, as well as the prevention of the loss of body weight. This effect seems to be mediated by the peripheral action of juniper.

Animals↗

PubMedDate not supplied

Adrenomedullary hormonal and glycemic modulation following gonadotropin and sex hormone administration in the soft-shelled turtle Lissemys punctata punctata.

The aim of the current investigation was to ascertain whether gonadotropins and sex hormones can modulate adrenomedullary and glycemic functions in turtles. Exogenous FSH (3.0 microg/100 gm body wt daily for 10 days) stimulated adrenomedullary activity by increasing nuclear diameter and cytoplasmic degranulation, and elevating adrenal norepinephrine and epinephrine, and blood glycemic levels in turtles. LH (3.0 microg/100 gm body wt daily for 10 days) had no significant effect and the combined treatment of FSH and LH (3.0 microg each/100 gm body wt daily for 10 days) failed to show further adrenomedullary stimulation and hyperglycemia beyond that of FSH alone. Estrogen treatment in low dose (25 microg/100 gm body wt daily for 10 days) had no significant effect on adrenomedullary activity or glycemia, but at higher doses (50 microg or 100 microg/100 gm body wt daily for 10 days) showed dose-dependent adrenomedullary stimulation by inducing the same manifestations as those of FSH. Progesterone in low dose (25 microg/100 gm body wt daily for 10 days) had no perceptible effect, but in other doses (50 microg/100 microg per 100 gm body wt daily for 10 days), suppressed dose-dependent adrenomedullary activity by reversing the changes to those of estrogen. Simultaneous treatment with estrogen and progesterone (50 microg each/100 gm body wt daily for 10 days) failed to show further changes beyond that of estrogen alone.

Adrenal Medulla↗

PubMed2001

Islets in alginate macrobeads reverse diabetes despite minimal acute insulin secretory responses.

BACKGROUND: Encapsulation of islets has been widely investigated as a treatment for diabetes. The characteristics and dynamics of insulin secretion by encapsulated islets in response to glucose and other secretagogues are not well understood. METHODS: In our study, macroencapsulated syngeneic islets at 3-4 wk after transplantation were studied for insulin release in response to i.v. glucose (hyperglycemic clamps at 250 or 350 mg/dl plasma glucose), arginine (i.v. bolus, 100 mg/kg), glucagon-like peptide-1 (i.v. infusion for 20 min, 2.2 pmol/kg/min), and meal challenge. Syngeneic islets (6000 islets) were encapsulated in alginate macrobeads (2-3 mm diameter) with or without poly-L-lysine coating and transplanted into the peritoneal cavity of STZ-diabetic Lewis rats. Normal (nontransplanted) and diabetic Lewis rats transplanted with "naked" islets under the kidney capsule served as controls. RESULTS: Animals transplanted with macrobeads displayed subnormal insulin responses to glucose, arginine, and glucagon-like peptide-1 despite achieving normoglycemia faster than animals with renal subcapsular islet transplants. Plasma insulin responses to meal challenges were blunted in animals with macrobeads resulting in increased plasma glucose excursions. CONCLUSIONS: We conclude that, after transplantation into diabetic Lewis rats, macroencapsulated islets have significantly impaired insulin secretion despite achieving normal fed glycemic levels.

Alginates↗

PubMed2002

The long-acting GLP-1 derivative NN2211 ameliorates glycemia and increases beta-cell mass in diabetic mice.

NN2211 is a long-acting, metabolically stable glucagon-like peptide-1 (GLP-1) derivative designed for once daily administration in humans. NN2211 dose dependently reduced the glycemic levels in ob/ob mice, with antihyperglycemic activity still evident 24 h postdose. Apart from an initial reduction in food intake, there were no significant differences between NN2211 and vehicle treatment, and body weight was not affected. Histological examination revealed that beta-cell proliferation and mass were not increased significantly in ob/ob mice with NN2211, although there was a strong tendency for increased proliferation. In db/db mice, exendin-4 and NN2211 decreased blood glucose compared with vehicle, but NN2211 had a longer duration of action. Food intake was lowered only on day 1 with both compounds, and body weight was unaffected. beta-Cell proliferation rate and mass were significantly increased with NN2211, but with exendin-4, only the beta-cell proliferation rate was significantly increased. In conclusion, NN2211 reduced blood glucose after acute and chronic treatment in ob/ob and db/db mice and was associated with increased beta-cell mass and proliferation in db/db mice. NN2211 is currently in phase 2 clinical development.

Animals↗

PubMed2002

Insulin inhibits glucose production by a direct effect in diabetic depancreatized dogs during euglycemia.

In our previous studies in nondiabetic dogs and humans, insulin suppressed glucose production (GP) by both an indirect extrahepatic and a direct hepatic effect. However, insulin had no direct effect on GP in diabetic depancreatized dogs under conditions of moderate hyperglycemia. The present study was designed to investigate whether insulin can inhibit GP by a direct effect in this model under conditions of euglycemia. Depancreatized dogs were made euglycemic (approximately 6 mmol/l), rather than moderately hyperglycemic (approximately 10 mmol/l) as in our previous studies, by basal portal insulin infusion. After approximately 100 min of euglycemia, a hyperinsulinemic euglycemic clamp was performed by giving an additional infusion of insulin either portally (POR) or peripherally at about one-half the rate (1/2 PER) to match the peripheral venous insulin concentrations. The greater hepatic insulin load in POR resulted in greater suppression of GP (from 16.5 +/- 1.8 to 12.2 +/- 1.6 micromol. kg(-1). min(-1)) than 1/2 PER (from 17.8 +/- 1.9 to 15.6 +/- 2.0 micromol. kg(-1). min(-1), P < 0.001 vs. POR), consistent with insulin having a direct hepatic effect in suppressing GP. We conclude that the direct effect of insulin to inhibit GP is present in diabetic depancreatized dogs under conditions of acutely induced euglycemia. These results suggest that, in diabetes, the prevailing glycemic level is a determinant of the balance between insulin's direct and indirect effects on GP.

Animals↗

PubMed1995

A simulation model for glucose kinetics and estimates of glucose utilization rate in type 1 diabetic patients.

A glucose kinetic model is described that contains insulin-independent and insulin-dependent pathways of glucose uptake and includes a saturating flux term for glucose transport into the cells by the glucose transporters. The rate of glucose utilization was estimated in control subjects and diabetic patients by use of a bolus of [3-3H]glucose. Diabetic patients were studied after three regimens of insulin therapy: 1) after 24 h of insulin withdrawal, 2) after conventional insulin therapy, and 3) after an overnight insulin infusion such that plasma glucose was maintained between 4 and 6 mmol/l. In addition, the model was used to simulate published results from glucose clamp experiments with a range of glycemic levels and insulin concentrations. Estimates of glucose utilization flux in diabetic patients and model simulation suggest that high plasma glucose concentrations in uncontrolled diabetic patients can be attributed to a high glucose production rate by the liver associated with a reduction in glucose metabolic clearance rate due to relative saturation of the available pool of glucose transporters.

Adolescent↗

PubMed2000

Glomerular basement membrane selective permeability in short-term streptozotocin-induced diabetic rats.

In diabetes, the glomerular basement membrane undergoes thickening and structural alterations with loss of glomerular permselectivity properties. However, the onset of the alterations at early phases of diabetes is unclear. Aiming to determine the functional and structural alterations of the glomerular wall in the early stages of diabetes, we have studied the distribution of endogenous circulating albumin and type IV collagen in the glomerular basement membrane, using the immunocytochemical approach. The streptozotocin-injected hyperglycemic rat was our animal model. Renal tissues were examined after 10 days, 2, 4 and 6 months of hyperglycemia. Upon immunogold labelings, changes in the glomerular permeability to endogenous albumin were found altered as early as upon ten days of hyperglycemia. In contrast, no structural modifications were detected at this time point. Indeed, glomerular basement membrane thickening and an altered type IV collagen labeling distribution were only observed after four months of hyperglycemia, suggesting that functional alterations take place early in diabetes prior to any structural modification. In order to evaluate the reversibility of the glomerular alterations, two-month-old diabetic animals were treated with insulin. These animals showed a significant restoring of their glomerular permselectivity. Our results suggest a link between glycemic levels and alteration of glomerular permeability in early stages of diabetes, probably through high levels of glycated serum proteins.

Animals↗

PubMedDate not supplied

Satisfaction with automated telephone disease management calls and its relationship to their use.

PURPOSE: This paper reports the results of an assessment of automated telephone disease management (ATDM) among patients in 2 randomized trials evaluating ATDM as an adjunct to usual care. METHODS: During the 12-month follow-up interview, 256 low-income adults with diabetes from the intervention groups of 2 randomized trials were asked to respond to questions about their satisfaction with the ATDM process. Variation in satisfaction was examined across groups, and satisfaction reports were correlated with the extent to which patients completed ATDM assessments and used them to report glycemic levels or access educational messages. RESULTS: Overall, 85% of patients reported that they were satisfied with the ATDM calls, 82% reported that they would be more satisfied with their health care if such calls were available to patients, and 76% reported that they personally would choose to receive such calls in the future. Most patients reported few difficulties completing ATDM assessments and found the calls to be a useful adjunct to their care. Some, however, found the calls intrusive; 16% reported that the calls were a bother. CONCLUSIONS: Patients were satisfied with ATDM calls as part of their diabetes care. Satisfaction played some part in determining patients' use of ATDM assessment and health education, although other barriers also contributed to less than optimal usage rates.

Aftercare↗