Background
Diabetes mellitus is a leading cause of morbidity and mortality worldwide. Studies have shown that Zinc has numerous beneficial effects in both type-1 and type-2 diabetes. We aim to ...evaluate the literature on the mechanisms and molecular level effects of Zinc on glycaemic control, β-cell function, pathogenesis of diabetes and its complications.
Methods
A review of published studies reporting mechanisms of action of Zinc in diabetes was undertaken in PubMed and SciVerse Scopus medical databases using the following search terms in article title, abstract or keywords; (“Zinc” or “Zn”) and (“mechanism” or “mechanism of action” or “action” or “effect” or “pathogenesis” or “pathology” or “physiology” or “metabolism”) and (“diabetes” or “prediabetes” or “sugar” or “glucose” or “insulin”).
Results
The literature search identified the following number of articles in the two databases; PubMed (
n
= 1799) and SciVerse Scopus (
n
= 1879). After removing duplicates the total number of articles included in the present review is 111. Our results show that Zinc plays an important role in β-cell function, insulin action, glucose homeostasis and the pathogenesis of diabetes and its complications.
Conclusion
Numerous
in-vitro
and
in-vivo
studies have shown that Zinc has beneficial effects in both type-1 and type-2 diabetes. However further randomized double-blinded placebo-controlled clinical trials conducted for an adequate duration, are required to establish therapeutic safety in humans.
Background
This study evaluated the effects of zinc supplementation on glycemic control, other cardiometabolic and anthropometric parameters, and disease progression in prediabetes.
Methods
A ...randomized double‐blind placebo‐controlled Phase 2 clinical trial was conducted over a 12‐month period in 200 subjects (43% male; mean ± SD age 51.8 ± 7.3 years), randomly assigned (1: 1) to the treatment or control group. The treatment group received zinc (20 mg daily). Subjects were evaluated at baseline and at 1, 3, 6, and 12 months. The primary outcome was the change in glycemic control from baseline. Multiple regression analyses were performed, with change in outcome variables after intervention from baseline used as continuous dependent variables.
Results
In both groups, mean serum zinc concentrations prior to the trial were below normal (15.29–21.41 μmol/L). During the 12‐month follow‐up, a significantly higher percentage of participants developed type 2 diabetes in the control compared with zinc‐treated group (25.0% vs 11.0% respectively; P = 0.016). Fasting plasma glucose (FPG), 2‐h glucose levels in the oral glucose tolerance test (OGTT), homeostasis model assessment of insulin resistance (HOMA‐IR), total cholesterol (TC), and low‐density lipoprotein cholesterol (LDL‐C) were significantly lower in the treated group, with significant improvement in β‐cell function. In all four regression models, the best predictor of the dependent variables (i.e. change in FPG, 2‐h glucose in the OGTT, HOMA‐IR, and homeostatic model assessment of β‐cell function) was zinc treatment.
Conclusions
Zinc supplementation reduced blood glucose and insulin resistance while improving β‐cell function. Furthermore, supplementation reduced disease progression to diabetes and had beneficial effects on TC and LDL‐C.
摘要
背景
这项研究评估了补充锌治疗对糖尿病前期患者的血糖控制、其他心脏代谢与人体测量学指标以及疾病进展的影响。
方法
这是一项为期12个月的随机双盲安慰剂对照的2期临床试验, 纳入了200名受试者(43%为男性;平均± SD年龄为51.8 ± 7.3岁), 将他们随机(按照1:1比例)分配到治疗组或者对照组。治疗组接受补充锌治疗(每日20 mg)。在基线以及第1、3、6、12个月时对受试者进行了评估。主要结果为血糖控制从基线以来的变化情况。进行多元回归分析, 评估干预后从基线以来的结果变量(视为连续性因变量)变化情况。
结果
两组受试者在试验前的平均血清锌浓度都低于正常值(15.29‐21.41 µmol/L)。在为期12个月的随访期间, 对照组与补充锌治疗组相比明显有更高比例的参与者发生了2型糖尿病(分别为25.0%与11.0%;P = 0.016)。治疗组中的空腹血糖(FPG)、口服葡萄糖耐量试验(OGTT)的2小时血糖水平、稳态模型评估的胰岛素抵抗(HOMA‐IR)、总胆固醇(TC)以及低密度脂蛋白胆固醇(LDL‐C)都显著更低, 并且β细胞功能也有显著的改善。在所有的4种回归模型中, 因变量(亦即FPG、OGTT的2小时血糖、HOMA‐IR以及稳态模型评估的β细胞功能变化)的最佳预测因子为补充锌治疗。
结论
补充锌治疗可以降低血糖与胰岛素抵抗, 同时改善β细胞的功能。此外, 补充锌治疗还可以延缓患者进展为糖尿病, 并且对TC与LDL‐C也具有有益的影响
Highlights
Zinc deficiency is present in those with prediabetes, and can be corrected by zinc supplementation.
Zinc supplementation in those with prediabetes reduced blood glucose and insulin resistance while improving β‐cell function.
Disease progression to diabetes was reduced with zinc supplementation.
Zinc supplementation also had beneficial effects on total and low‐density lipoprotein cholesterol.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Prevalence of diabetes mellitus (DM) has reached epidemic proportions in Sri Lanka. Presently there are studies on the community prevalence of distal peripheral neuropathy (DPN) in Sri Lanka. We ...describe prevalence, patterns and predictors of DPN in patients with DM in Sri Lanka. Data were collected as part of a national study on DM. In new cases DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) score, while in those with established diabetes both DNS and Toronto-Clinical-Scoring-System (TCSS) were used. A binary logistic-regression analysis was performed with 'presence of DPN' as the dichomatous dependent variable and other independent co-variants. The study included 528 diabetic patients (191-new cases), with a mean age of 55.0 ± 12.4 years and 37.3% were males, while 18% were from urban areas. Prevalence of DPN according to DNS score among all patients, patients with already established diabetes and newly diagnosed patients were 48.1%, 59.1% and 28.8% respectively. Prevalence of DPN in those with established DM as assessed by TCSS was 24% and the majority had mild DPN (16.6%). The remainder of the abstract is based on subjects with established DM. The prevalence of DPN in males and female was 20.0% and 26.4% respectively. The mean age of those with and without DPN was 62.1 ± 10.8 and 55.1 ± 10.8 years respectively (p < 0.001). The majority of those with DPN were from rural-areas (75.3%) and earned a monthly income < Sri Lankan Rupees 12,000 (87.6%). In the binary logistic-regression presence of foot ulcers (OR:10.4; 95%CI 1.8-16.7), female gender (OR:6.7; 95%CI 2.0-9.8) and smoking (OR:5.9; 95%CI 1.4-9.7) were the strongest predictors followed by insulin treatment (OR:4.3; 95%CI 1.3-6.9), diabetic retinopathy (OR:2.7; 95%CI 1.3-5.4), treatment with sulphonylureas (OR:1.8; 95%CI 1.1-3.2), increasing height (OR:1.8; 95%CI 1.2-2.4), rural residence (OR:1.8; 95%CI 1.1-2.5), higher levels of triglycerides (OR:1.6; 95%CI 1.2-2.0) and longer duration of DM (OR:1.2; 95%CI 1.1-1.3). There is a high prevalence of DPN among Sri Lankan adults with diabetes. The study defines the impact of previously known risk factors for development of DPN and identifies several new potential risk factors in an ethnically different large subpopulation with DM.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Hypertensive emergencies are potentially life threatening and require prompt blood pressure control with intravenous agents. Preparation of intravenous infusions is time consuming. Usefulness of ...sublingual nitroglycerin in this setting is not known. We aimed to assess the benefit of sublingual nitroglycerin as a bridge to IV therapy. In a clinical audit in an emergency department, patients presenting with hypertensive emergencies requiring intravenous nitroglycerin were administered single spray of sublingual nitroglycerin awaiting commencement of intravenous infusion. Blood pressure was monitored every 5 min to observe the degree and speed of reduction.
Thirty-seven patients met the selection criteria. Mean age was 65.8 years (SD 7.04), and 29 were males (88.4%). Mean values of systolic, diastolic and mean blood pressures on admission were 217, 137, 163 mmHg. At 5 and 10 min after sublingual nitroglycerin, mean reduction of mean arterial blood pressure by 12.3 and 16.3% was achieved. Only 2 patients (5.4%) showed an overcorrection of blood pressure. Minimum of 15 min were required to set up a nitroglycerin intravenous infusion. Sublingual nitroglycerin spray allows rapid blood pressure control in hypertensive emergencies and is a useful bridge during the time to prepare intravenous infusion.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To examine the effects of aerobic training (AT) and resistance training (RT) compared to standard care on glycemic control in South Asian Sri Lankan adults with Type 2 Diabetes Mellitus (T2DM).
...Randomized controlled trial (RCT) with parallel-group design recruited 86 sedentary Sri Lankans (aged 35–65 years) with T2DM into aerobic training (AT, n = 28), resistance training (RT, n = 28) and control (CN, n = 30) groups. Supervised progressive exercise training consisting of 75 min per session, 2 days per week for 12 weeks was conducted. The primary outcome was pre- and post-intervention absolute change in hemoglobin A1c (HBA1c). Secondary outcomes were serum lipids, liver enzymes, chronic inflammatory status, anthropometry, body composition and blood pressure.
The absolute change in HbA1c of RT vs. CN was −0.08% (95% CI, 0.8% to −0.7%, p = 0.8) and AT vs. CN was −0.22% (95% CI, 0.95% to −0.5%). Subgroup analysis (n = 49) with a high baseline HbA1c (>7.5%), absolute reduction in HbA1c in exercise groups were statistically significant (RT vs. CN was −0.37%; 95% CI 1.3% to −0.6%, p = 0.04 and AT vs. CN was −0.57%; 95% CI 1.7% to −0.6%, p = 0.03). The effect sizes (total and subgroup HbA1c >7.5%) ranged from 0.7 to 1.0 in AT, 0.4 to 1.1 in RT compared to 0.35 to 0.6 for the CN. Secondary outcomes did not significantly differ among groups.
Exercise training 2 days/week improved glycemic control in Sri Lankan adults with T2DM and the effects were significant in high baseline HbA1c (>7.5%) groups (RT > AT).
•First adequately powered randomized controlled exercise trial conducted in Sri Lankans with type 2 diabetes mellitus.•Exercise improved glycemic control and resistance training was more effective in patients with poor glycemic control.•Two days of exercise, 150 min per week in total was more feasible to adhere which gave the desired glycemic benefits.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In traditional medicine Cinnamon is considered a remedy for respiratory, digestive and gynaecological ailments. In-vitro and in-vivo studies from different parts of the world have demonstrated ...numerous beneficial medicinal effects of Cinnamomum zeylanicum (CZ). This paper aims to systematically review the scientific literature and provide a comprehensive summary on the potential medicinal benefits of CZ.
A comprehensive systematic review was conducted in the following databases; PubMed, Web of Science, SciVerse Scopus for studies published before 31st December 2012. The following keywords were used: "Cinnamomum zeylanicum", "Ceylon cinnamon", "True cinnamon" and "Sri Lankan cinnamon". To obtain additional data a manual search was performed using the reference lists of included articles.
The literature search identified the following number of articles in the respective databases; PubMed=54, Web of Science=76 and SciVerse Scopus=591. Thirteen additional articles were identified by searching reference lists. After removing duplicates the total number of articles included in the present review is 70. The beneficial health effects of CZ identified were; a) anti-microbial and anti-parasitic activity, b) lowering of blood glucose, blood pressure and serum cholesterol, c) anti-oxidant and free-radical scavenging properties, d) inhibition of tau aggregation and filament formation (hallmarks of Alzheimer's disease), e) inhibitory effects on osteoclastogenesis, f) anti-secretagogue and anti-gastric ulcer effects, g) anti-nociceptive and anti-inflammatory activity, h) wound healing properties and i) hepato-protective effects. The studies reported minimal toxic and adverse effects.
The available in-vitro and in-vivo evidence suggests that CZ has many beneficial health effects. However, since data on humans are sparse, randomized controlled trials in humans will be necessary to determine whether these effects have public health implications.
Abstract
We studied the community prevalence, patterns and predictors of hypertension in a large sub-population of South Asian adults with a view of identifying differential risk factors. Data were ...collected between years 2005-2006 and 5000 adults were invited for the study. The sample size was 4485, and about 39.5% were males. Mean systolic and diastolic blood pressures were 127.1 ± 19.8 mmHg and 75.4 ± 11.3 mmHg, respectively. Age-adjusted prevalence in all adults, males and females was 23.7%, 23.4% and 23.8%, respectively. Urban adults had a significantly higher prevalence of hypertension than rural adults. In the binary logistic-regression analysis, male gender (OR: 1.2), increasing age, Sri Lankan Moor ethnicity (OR: 1.6), physical inactivity (OR: 1.7), presence of diabetes (OR: 2.2) and central obesity (OR: 2.3) all were significantly associated with hypertension. In conclusion, nearly one-third of the Sri Lankan adult population is hypertensive. Hence, public health initiatives should encourage healthier lifestyles with emphasis on preventing obesity and increasing physical activity.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Identity is the essence of performance and performance is the essence of identity. Without identity our performance does not assume any cultural significance. Our relative identity allows our ...performance to be located in the socio-cultural space. Our identity forms the foundation for the discursive significance of our performance. However, our identity is not unique, it is established by performing a pre-existing script. The biological basis of identity can be understood by applying learning theories and by analyzing how these leant behavior is embedded in our neuronal network in the brain and how these behavior patterns are controlled by psychological factors to result in the identity we observe. Recent developments in the fields of neuroscience and functional neuro imaging have enabled us to study objectively the process of neural mechanisms and map areas of brain that are involved in learning various behavior patterns. These neuronal networks and the neuro transmitters play a key role in memory and behavior of animals. Aby studying the particular pattern of behavior and the brain area that mediates that behavior it will be possible to determine neuronal networks that control core identity characteristics and that control other less important characteristics. With the emergence of studies in neuroplasticity the possibility of relearning behaviors through new neuronal pathways may open new avenues to treat conditions that affect identity. Understanding the biological basis of identity will lead to widening of research area and better understanding of the concept.
Patients' knowledge on prescribed medications play a key role in the long term management of cardiac diseases and in determining their outcome. The present study evaluates the knowledge about ...prescribed medication among cardiac patients and aim to identify factors influencing knowledge.
A descriptive-cross-sectional study was conducted among 200 adult patients attending clinics at the Cardiology Unit of the National Hospital of Sri Lanka. Knowledge assessment focused on four different sections; drug name, dose, frequency and indication. The total score of 60 was calculated by giving each component the following weighted scores; drug name = 20, indication = 20, drug dose = 10 and frequency = 10. A binary logistic regression analysis to evaluate factors associated with 'good knowledge' (total score ≥ 40) was performed.
Among 200 participants 56.5% (n = 113) were males. Mean age was 59.7 ± 8.2 years and a majority (n = 170, 85.0%) were older than 50 years of age. Sinhala was the primary language of 91.5% (n = 183) of participants, while English was the primary language in only two of the study participants (1.0%). Eighty four percent of the participants were educated up to secondary education or above, while 2.5% (n = 5) had no formal education. The overall knowledge (total score-60) on prescribed medications among the study population was 'poor' (score ≤ 20) in 46%, 'adequate' (score 21-40) in 36.5% and 'good' (score ≥ 40) in 17.5%. The results of the binary logistic regression analysis indicates that Secondary (OR-1.53) and Tertiary levels (OR-2.79) of education, self-reported perception of illness as being Moderate (OR-1.23) or Severe (OR-1.70) and being educated by a doctor (as reported by patients) (OR-1.69) significantly increased the odds of having a 'Good Knowledge of Drugs'. Majority of the patients were unable to read and understand the information written in English. The doctor's contributed towards educating on drug information only in 33.0% of the patients.
In a resource-poor setting in patients with Limited English Proficiency, lower level of education and misperception of illness severity resulted in reduced knowledge on prescribed medications. Furthermore, being educated by a doctor significantly improved knowledge. However the doctors' contribution at present to deliver quality health information to their patients was at an unsatisfactory level.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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