Objective: Diabetes and insomnia are serious public health problems worldwide. The cause-and-effect relationship between them is rather complicated. This study planned to evaluate the presence of ...insomnia and associated factors in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: A total of 81 (36 male and 45 female) patients with T2DM were recruited into our study. Pulmonary disease, congestive heart failure, Obstructive Sleep Apnea syndrome, and cognitive disorders were determined as exclusion criteria from the study. Demographic and disease characteristics were noted. Pittsburgh Insomnia Rating scale 20 (PIRS-20), Pittsburgh Sleep Quality index (PSQI), Beck Depression inventory (BDI), Beck Anxiety inventory (BAI), Berlin questionnaire, and Douleur neuropathique-4 questionnaire (DN-4) to detect neuropathic pain were filled in a face-to-face interview. Results: The mean age of our patients was 60.0±11.6 years, and median diabetes duration was 15 years (7-18 years). Median PIRS-20 score was 16 points (9-24 points) and 43.2% (n=35) had insomnia. Median PSQI score was 6 points (3, 5-8 points), and poor sleep quality was present in 50.6% (n=41) of the patients. There was no statistically significant difference between patients who had diabetes, with and without insomnia, in terms of sociodemographic features, micro- and macro-vascular complications, glycemic control, and Restless Legs syndrome. Conversely, significant association was observed between PIRS-20 and PSQI (r=0.78; p<0.001), between T2DM duration and BDI (r=0.24; p=0.02), and between DN-4 and BAI (r=0.46; p<0.01). Conclusion: Insomnia symptoms and poor night sleep quality are commonly encountered in T2DM patients. Considering the negative effects of sleep disturbance on T2DM, it is recommended that insomnia and other sleep disorders be evaluated as a part of routine clinical evaluation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Chronic migraine has a well-documented association with increased insulin resistance and metabolic syndrome. The hypothalamus may play a role in the progression of insulin resistance in ...chronic migraine through the regulation of orexigenic peptides such as neuropeptide Y. Insulin resistance may lead to increased risk of future type 2 diabetes mellitus in patients with chronic migraine, which is more likely to occur if other pathogenetic defects of type 2 diabetes mellitus, such as impaired pancreatic β-cell functions and defects in intestinal glucagon-like peptide-1 secretion after meals. We studied the relationship of fasting neuropeptide Y with insulin resistance, β-cell function, and glucagon-like peptide-1 secretion in non-obese female chronic migraine patients. We also aimed to investigate glucose-stimulated insulin and glucagon-like peptide-1 secretions as early pathogenetic mechanisms responsible for the development of carbohydrate intolerance.
Methods
In this cross-sectional controlled study, 83 non-obese female migraine patients of reproductive age categorized as having episodic migraine or chronic migraine were included. The control group consisted of 36 healthy females. We studied glucose-stimulated insulin and glucagon-like peptide-1 secretion during a 75 g oral glucose tolerance test. We investigated the relationship of neuropeptide Y levels with insulin resistance and β-cell insulin secretion functions.
Results
Fasting glucose levels were significantly higher in migraine patients. Plasma glucose and insulin levels during the oral glucose tolerance test were otherwise similar in chronic migraine, episodic migraine and controls. Patients with chronic migraine were more insulin resistant than episodic migraine or controls (p = 0.048). Glucagon-like peptide-1 levels both at fasting and two hours after glucose intake were similar in chronic migraine, episodic migraine, and controls. Neuropeptide Y levels were higher in migraineurs. In chronic migraine, neuropeptide Y was positively correlated with fasting glucagon-like peptide-1 levels (r = 0.57, p = 0.04), but there was no correlation with insulin resistance (r = 0.49, p = 0.09) or β-cell function (r = 0.50, p = 0.07).
Discussion
Non-obese premenopausal female patients with chronic migraine have higher insulin resistance, but normal β-cell function is to compensate for the increased insulin demand during fasting and after glucose intake. Increased fasting neuropeptide Y levels in migraine may be a factor leading to increased insulin resistance by specific alterations in energy intake and activation of the sympathoadrenal system.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although atherosclerosis and osteoporosis (OP) are seen in elderly patients, it is still a matter of research whether there is an age-independent relationship between them. In our study, we planned ...to investigate the relationship between carotid intima-media thickness (CIMT), OP, and bone turnover parameters in patients with type 2 diabetes mellitus (DM2) of both sexes.
A total of 69 patients and 40 healthy volunteers with chronic diseases such as DM2, hypertension, hyperlipidemia, and OP. Group 1 had 27 patients with DM2 and OP, group 2 had 42 patients with DM2 and no OP, and group 3 had 40 healthy volunteers without DM2 and OP.
In the control group, CIMT was measured lower than the patients with DM2 (0.8 + 0.1 and 1.1 + 0.3,
< 0.001, respectively). Femur T score and lumbar T score values of patients with DM2 were lower than the control group (-0.48 + 1.1 and 0.7 + 0.6,
< 0.001, and -1.3 + 1.5 and 0.6 + 0.5,
< 0.001, respectively). Bone turnover markers in DM2 compared to the control group (C-terminal telopeptide of type 1 collagen: 240.9 ± 211.1 and 606.5 ± 200.8,
< 0.001; bone-specific alkaline phosphatase: 47.9 ± 15.5 and 431.5 ± 140,
< 0.001; and osteocalcin: 13.2 ± 5.0 and 19.7 ± 9.2,
< 0.001, respectively) were lower. Patients with femoral region (TSF) T score and lumbar region (TSL) T score below -2.5 were found to have higher CIMT values than those without (1.2 ± 0.23 mm and 0.9 ± 0.23 mm,
= 0.006, and 1.1 ± 0.28 mm and 0.95 ± 0.21 mm,
= 0.003, respectively). In linear regression analysis, age (
= 0.01,
< 0.001), OP (
= 0.166,
= 0.001), and DDM2 (
= 0.222,
= 0.04) were found to be effective on CIMT, while DM2 (
) = -0.754,
< 0.001), CIMT (
= -0.258,
= 0.021), body mass index (
= 0.355,
= 0.028), and age (
= -0.229,
= 0.029) were found to be independent factors on TSF.
Bone turnover and bone mineral density are decreased in DM2 patients. In addition, subclinical atherosclerosis is more common in DM2 patients. Findings suggest that there is a relationship between subclinical atherosclerosis and OP due to metabolic factors other than age.
The effect of diabetic polyneuropathy (DPN) and autonomic neuropathy (AN) on bone turnover in type 2 diabetes mellitus (DM) is uncertain due to the lack of data. In this study, we tried to determine ...the effect of DPN and AN on bone metabolism.
The study included patients with type 2 DM (aged 18-80 years) and age-matched healthy individuals who presented to the Departments of Metabolism and Diabetes, Geriatrics, and General Internal Medicine, Cerrahpaşa Medical School, Istanbul University. The patients were examined to find out whether they had AN, and neuropathy scores were recorded by exploring peripheral neuropathy. Bone mineral density was measured by dual-energy X-ray (DXA). Demographic characteristics, the presence of microvascular complications, and biochemical data were obtained from patients' files. Serum cross-linked C-telopeptide (Ctx), osteocalcin, and bone-specific alkaline phosphatase (B-ALP) were analyzed.
The study comprised a total of 64 patients: 23 had type 2 DM and osteoporosis (OP) (duration of diabetes 10.1 ± 7 years; mean age 63 ± 9.1 years; female/male 18/5; Group 1), 41 had type 2 DM and non-OP (duration of diabetes 10.3 ± 7.6 years; mean age 58 ± 7.4 years; female/male 30/11; Group 2), and 26 healthy volunteers made up the control group (mean age 62 ± 11.9 years; female/male 14/12; Group 3). The bone turnover parameters were lower in type 2 DM individuals. The levels of osteocalcin (13.3 ± 5.2 ng/mL) and B-ALP (44.7 ± 10.9 IU/L) in patients with type 2 DM were lower than those of healthy subjects: osteocalcin (20.6 ± 10 ng/mL) and B-ALP (111 ± 31.4 IU/L;
= 0.001 and
= 0.000, respectively). Ctx levels (193.5 ± 49.3; 207.6 ± 40 ng/mL) were recorded to be similar (
= 0.2). AN was also noted as a risk factor for OP. For patients without AN, the likelihood of developing OP (odds ratio) was 0.7. The corresponding ratio for patients with AN was 9.3.
Among the independent variables, the neuropathy score was determined to have an impact on bone turnover. AN was identified to be a significant risk factor for OP.
The goals of Type 2 diabetes treatment are to eliminate the hyperglycemia resulting from insulin insufficiency and/or insulin resistance, delay beta cell damage/depletion, and prevent other metabolic ...co-morbidities and complications. In the current treatment algorithms, lifestyle changes (medical nutrition therapy, physical exercise) and oral anti-diabetics are followed by insulin therapy, which is considered a replacement therapy for Type 2 diabetes. Pre-mixed insulin preparations, which are an option for patients with poor blood glucose level control under oral anti-diabetics treatment, have been developed to meet both basal and prandial insulin needs by simulating the physiological changes in insulin levels. The consensus on the necessity of individualizing insulin therapy requires physicians to have a detailed knowledge of the various uses of insulin. Therefore, this comprehensive consensus statement has been prepared by a panel of expert endocrinologists from different regions of Turkey to help physicians use biphasic insulin aspart 30 in suitable patients at the right time. In this statement, expert panel opinions on (a) Recommendations for the appropriate initiation, titration, and intensification of insulin treatment, and (b) The treatment algorithms in initiation, titration, and intensification of biphasic insulin aspart 30 treatment and special conditions specific to changing treatment regimen are presented.
In diabetes mellitus, chronic hyperglycemia leads to formation of advanced glycation end products (AGEs). Binding of AGEs to receptors of AGE (RAGE) causes deleterious effects. In populations with a ...high consumption of
n-3
long-chain polyunsaturated fatty acids, a lower prevalence of diabetes mellitus has been reported. We aimed to investigate the effects of
n-3
fatty acid (EPA and DHA) supplementation on the levels of AGEs (carboxymethyl lysine (CML) and pentosidine), sRAGE, and nuclear factor kappa B (NF-kB) in type 2 diabetes mellitus (T2DM). T2DM patients (
n
= 38) treated with oral hypoglycemic agents, without insulin were supplemented with
n-3
fatty acids (1.2 g/day) for 2 months. Plasma CML, pentosidine, sRAGE, and NF-kB levels were measured by ELISA both before and after the supplementation.
n-3
fatty acid supplementation significantly reduced fasting glucose (
p
< 0.01), glycated hemoglobin (HbA
1c
) (
p
< 0.05), and pentosidine (
p
< 0.05) levels. The supplementation induced percentage changes in pentosidine and HbA
1c
and in pentosidine and creatinine were observed to be correlated (
r
= 0.349,
p
< 0.05) and (
r
= 0.377,
p
< 0.05), respectively. Waist circumference and systolic and diastolic pressures were significantly decreased due to
n-3
supplementation (
p
< 0.001,
p
< 0.01,
p
< 0.01), respectively. Our results show that supplementation with
n-3
fatty acid has beneficial effects on waist circumference; systolic and diastolic blood pressures; and the levels of glucose, HbA
1c
, and pentosidine in T2DM patients. However, the supplementation failed to decrease these parameters to the reference ranges for healthy subjects. In addition, the supplementation did not appear to induce any significant differences in CML, sRAGE, or NF-kB.
This expert panel of diabetes specialists aimed to provide guidance to healthcare providers on the best practice in the use of innovative continuous glucose monitoring (CGM) techniques through a ...practical and implementable document that specifically addresses the rationale for and also analysis and interpretation of the new standardized glucose reporting system based on standardized CGM metrics and visual ambulatory glucose profile (AGP) data. This guidance document presents recommendations and a useful algorithm for the use of a standardized glucose reporting system in the routine diabetes care setting.
The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the ...predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region‐specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health‐seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high‐risk people with regular and systematic monitoring of cardiorenal parameters, development of region‐specific care pathways for timely referral to specialists, followed by guideline‐recommended care with novel antidiabetics are imperative. Adherence to guideline‐recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon‐like peptide 1 receptor agonists with demonstrated cardiorenal benefits—thus paving the way for overcoming care gaps in a cost‐effective manner. Leveraging digital technology like electronic medical records can help generate real‐world data and provide insights on voids in adoption of newer antidiabetic medications. A patient‐centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.
摘要
2型糖尿病是中东及北非(MENA)和非洲(AFR)地区的一大公共卫生问题，心肾并发症(CRC)是过早发病和死亡的主要原因。心脏代谢危险因素的高发、患者和医生缺乏认识、基础设施不足以及经济限制导致MENA和AFR患者的CRC年龄显著提前。在这篇综述中，我们提出了MENA和AFR地区专家的共识和建议，强调了区域特有的挑战和潜在的区域控制中心管理解决方案。了解社会文化障碍的卫生专业人员可以通过简单的教育工具显著提高患者的意识并鼓励寻求健康的行为。增加医生在早期识别CRC和基于风险分层的个性化治疗方面的知识，同时更好地控制血糖，从而减轻治疗的惰性。必须对高危人群进行早期诊断，对心肾功能进行定期和系统的监测，制定特定区域的护理路径，及时转诊至专家，然后根据指南建议的治疗，使用新型抗糖尿病药物。遵循指南推荐的治疗可以使用钠葡萄糖共转运体2抑制剂和胰高血糖素样肽1受体激动剂，它们已被证明对心肾有好处，从而以经济高效的方式为治疗技术的鸿沟铺平道路。利用数字技术，如电子病历，可以辅助生成真实世界的数据，以填补对较新的抗糖尿病药物效果观察的空白。以患者为中心的方法、不同专科医生之间的协作护理以及政策制定者的参与是改善MENA和AFR地区患者结局和治疗质量的关键。
Highlights
This consensus document identifies challenging areas and strategic recommendations for the effective management of cardiorenal complications in type 2 diabetes mellitus in the Middle East and North Africa and Africa.
There is a need for optimum glycemic control, early identification of cardiorenal complications, along with risk management through optimal low‐density lipoprotein cholesterol and blood pressure control, smoking cessation, and lifestyle management.
Suboptimal use of international guidelines and treatment inertia delay initiation of adequate therapy.
Early diagnosis of high‐risk people with regular and systematic monitoring of cardiorenal parameters, development of region‐specific care pathways for timely referral to specialists, followed by guideline‐recommended care with novel antidiabetics are imperative for optimal management.
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