International Journal of Diabetes Mellitus - Articles in Press

Do we need to test for maturity onset diabetes of the young among newly diagnosed diabetics in Saudi Arabia? - Corrected Proof

Suzanne Elkholy, Amer A. Lardhi — 2011-03-17

Abstract: Monogenic forms of diabetes are still rare and not well understood. Their prevalence among children and young adults at diagnosis is thought to be between 1% and 2% of cases of diabetes. However, awareness of these conditions may be lacking, and screening for them genetically is not routinely undertaken, even when the clinical picture may point to their probability. The aim of this work is to identify the indicators for suspecting cases of monogenic diabetes beyond the neonatal period in children and young adults in Saudi Arabia, and to provide a draft for baseline investigations for those suspected cases, depending on available resources. The implications of the diagnosis of such conditions would be better management of cases, providing genetic counseling to families and planning health resources.

Significance of spirometry in a diabetic patient with chronic cough - Corrected Proof

Sultan Ayoub Meo — 2011-03-07

Abstract: Diabetes mellitus (DM) is a group of metabolic disease of all age groups especially the middle age and aged people. Diabetes can cause serious complications that involve multiple organs and physiological functions. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs and systems. Spirometry is a powerful tool used to detect, differentiate, follow and manage the patients with pulmonary disorders. Diabetic patients with a clinical history of respiratory complaints and any occupational and industrial exposure, in that condition, spirometry is more important to assess the risk and early diagnosis of lung disease.

How far has translation of research been implemented into clinical practice in India? Are the recommended guidelines adhered to? - Corrected Proof

2011-02-25

Abstract: The study assessed the pattern of diabetes care in India. Data on investigations, drug prescription, review visits and education methods were obtained from different health centers. HbA1c tests and self monitoring practices were inadequate. Basic investigations and drug prescriptions were compromised. Screening for complications was not regularly done. The patients preferred treatment from private to public health sector. There is non adherence of established guidelines for diabetes care. There is a wide gap between translation of research findings and recommendations and their implementation during practice at all levels of health care in India.

Case study: Use of vibration therapy in the treatment of diabetic peripheral small fiber neuropathy - Corrected Proof

Junggi Hong, Meredith J. Barnes, Nathan J. Kessler — 2011-02-24

Abstract: The aim of the study was to describe a case of type II diabetic peripheral small fiber neuropathic pain treated with whole body vibration therapy after a failed trial of conventional drugs and interventional pain management. A 64-year-old male had chronic diabetic peripheral neuropathic pain in both his feet for about 2years. The patient tried multiple pain medications and various interventional pain treatments without significant pain relief. After 4weeks of whole body vibration treatment the patient’s pain level and gait patterns significantly improved. These findings illustrate the importance of considering whole body vibration as a complimentary treatment in patients with diabetic peripheral neuropathic pain.

Efficiency of co-expression of transcription factors Pdx1, Ngn3, NeuroD and Pax6 with insulin: A statistical approach - Corrected Proof

Don F. du Toit, Benjamin Longo-Mbenza, Benedict J. Page, Venant Tchokonte-Nana — 2011-02-21

Abstract: Aim: The objective of this study was to investigate the time related profile and efficiency of co-expression of the homeodomain proteins Pdx1, NeuroD, Ngn3, Pax6 and caspase3 with insulin, and to establish the time periods post PDL optimum for islets transplantation.Study design/methods: In this experimental study, immunofluorescent staining procedure was performed on deparaffinized pancreatic duct ligated (PDL) tissues of 78 Sprague–Dawley rats. Quantification of protein coexpression was made using a computerized morphometry. The efficiency of co-expression was arbitrary defined by the value of mean ratio (score without unit) of insulin expression divided by each expression index of the other proteins, occurring within the time interval of 12–24h post PDL. Statistical tool was used to analyze the efficiency of co-expression of proteins; analysis of variances (one way ANOVA) was used to compare the means of co-expression indexes across the time periods pre- and post PDL. P-values less than 0.05 were considered statistically significant; no post hoc test was done.Results: The curve of insulin expression showed a crossover with that of the co-expression at different time periods pre- and post PDL. The optimal or higher efficiency of co-expression was observed for insulin and Ngn3 co-expression, while a good or medium efficiency was noted for the co-expression of insulin with Pdx1, insulin with NeuroD and insulin with Pax6. Low or weak efficiency was observed for the co-expression of insulin with caspase3.Conclusion: We therefore propose an early islets transplantation using 12–24h post PDL harvested pancreatic tissues.

Reasons for hospitalizations in adults with diabetes in Kuwait - Corrected Proof

Afaf M.S. Al-Adsani, Kholouda A. Abdulla — 2011-02-21

Abstract: Background: A large proportion of hospitalizations for diabetes are preventable. We carried out this study to determine the prevalence and reasons for hospitalization in adults with diabetes in Kuwait.Materials and methods: A cross-sectional study was conducted of all hospital admissions in the Department of Medicine at Al-Sabah Hospital in Kuwait during a 2-month period. Admissions were classified into three groups: (i) medical history of diabetes; (ii) unrecognized diabetes or new hyperglycemia (i.e., an admission for fasting blood glucose ⩾7mmol/l or random blood glucose ⩾11.1mmol/l); and (iii) no diabetes.Results: Diabetes was the principal or secondary diagnosis in 40.6% of hospitalizations. Unrecognized diabetes or new hyperglycemia was found in 12.9% of the patients. Patients with diabetes or new hyperglycemia were significantly older and had longer hospital stay compared to non-diabetic patients. The three most common reasons for hospitalizations in patients with diabetes were diseases of the cardiovascular system (53.6%), diseases of the respiratory system (22.8%), and diabetes as a principal diagnosis (6.3%). The five most frequent specific causes for hospitalizations in patients with medical history of diabetes as a secondary diagnosis were acute coronary syndrome (27.2%), pneumonia (14.3%), heart failure (11.2%), cerebrovascular accident (10.3%), and chronic obstructive airway disease (3.6%).Conclusion: Diabetes imposes a great burden on secondary health care in Kuwait. Effective primary care and hospital outpatient preventive and treatment strategies, including education, multifactorial intervention for cardiovascular risk factors, and influenza and pneumococcal immunizations for patients with diabetes may reduce these hospitalizations among diabetic patients.

Hypogonadism among Jordanian men with type 2 diabetes: Prevalence and associated factor - Corrected Proof

Ayman A. Alhayek, Yousef S. Khader, Sahar Jafal, Nahla Khawaja, Kamel Ajlouni — 2011-02-09

Abstract: Aims: Prevalence of hypogonadism is largely unknown in the general population and population of diabetics in Arab countries including Jordan. This study was conducted to determine the prevalence of hypogonadism among men with type 2 diabetes in Jordan and determine its associated factors.Methods: This cross-sectional study included a total of 1049 consecutive men with type 2 diabetes who attended the National Center for Diabetes, Endocrinology and Genetics (NCDEG) in Amman, Jordan, in the period from August 2008 to February 2009. Data were collected from medical records and using a pre-structured questionnaire. Clinical characteristic, anthropometric measurements and laboratory measurements were obtained. Hypogonadism was defined as total testosterone <3ng/ml.Results: Overall, 36.4% of patients with diabetes had total testosterone level <3ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3ng/ml, 80.2% had symptoms of androgen deficiency. About 16.9% of those with serum testosterone level <3ng/ml had primary hypogonadism and 83.1% had secondary hypogonadism. Age, monthly income of less than 500JD, obesity, and neuropathy were significantly associated with low serum total testosterone level.Conclusions: The prevalence of hypogonadism among men with type 2 diabetes in Jordan is high. This urgently calls for implementing early and universal screening programs irrespective of symptoms of androgen deficiency to detect those who have low serum total testosterone level at any early stage and to supplement testosterone accordingly.

Cognitive impairment in type 2 diabetes mellitus - Corrected Proof

2011-02-08

Abstract: Background: Type 2 diabetes mellitus (T2DM) is a modern day epidemic. Chronic course of diabetes is detrimental to the cognitive functions.Aim: To decipher the pattern of cognitive impairment in relation to the duration of diabetes.Study design: Cross-sectional.Material and methods: T2DM patients (Group I: ⩽5 years duration of diabetes, n=11; Group II: >5 years duration of diabetes, n=17) without clinical evidence of central nervous system damage and non-diabetic controls (n=18) were studied clinically and P300 event-related potentials (ERPs) recorded using three stimuli oddball paradigm. Subjects were examined with Folstein mini-mental state examination (MMSE) for cognitive function and those showing scores more than 26 (maximum score=30) were enrolled for the study. Patients with known diabetic complications were excluded.Results: P300 latencies in diabetic group did not relate linearly to the duration of diabetes. Diabetic subgroups with ⩽5 years and >5 years duration of diabetes showed striking differences, patients with over 5 years of disease duration had much prolonged P300 latencies in contrast to patients with 5 years or less disease duration who showed trends similar to that of control group. Differences in P300 amplitudes between groups were non-significant. Hypertensive diabetics showed much prolongation in P300 latencies compared to normotensive diabetics.Conclusions: P300 ERPs revealed cognitive dysfunction which was not detected by neuro-psychometric test (MMSE). Patients with T2DM have decreased cognitive function which is more prominent when the disease duration exceeds 5 years. Co-existence of hypertension with T2DM further increases the risk of cognitive impairment.

Methanolic extract of Marrubium vulgare ameliorates hyperglycemia and dyslipidemia in streptozotocin-induced diabetic rats - Corrected Proof

2011-02-08

Abstract: Aim and background: Marrubium vulgare is used in traditional medicine in some countries such as Mexico in the treatment of diabetes. On the other hand, some studies reported the antioxidant effect of the extract due to its flavonoid content. The current study was designed to investigate the antidiabetic and antidyslipidemic effects of the methanolic extract of the aerial part of M. vulgare in streptozotocin-induced diabetic rats.Materials and methods: The antidiabetic activity of a daily single oral dose of 500mg/kg/day of M. vulgare for 28days was evaluated by measuring the fasting blood glucose and the peak of blood glucose level within 120min of oral glucose tolerance test (OGTT) in diabetic rats. In addition, the effect of the extract on blood plasma insulin was measured as well as its effect on tissue glycogen contents in muscles and liver. Moreover, its effect on the oxidant status was evaluated.Results: M. vulgare significantly reduced the blood glucose level starting on the second week. Furthermore, the extract of M. vulgare showed significant increase in plasma insulin and tissue glycogen contents. The antidyslipidemic effect was demonstrated by a significant reduction in plasma total cholesterol (TC), triglycerides (TG), and low density lipoprotein-cholesterol (LDL-C), while the cardio-protective lipid, high density lipoprotein-cholesterol (HDL-C), was increased.Conclusion: The present data suggest that M. vulgare’s methanolic extract has antihyperglycemic with antidyslipidemic effect. The protective effect of the extract may be in part due to its antioxidant activity.

Hypoglycemic and hypolipidemic effect of Allopolyherbal formulations in streptozotocin induced diabetes mellitus in rats - Corrected Proof

Ratendra Kumar, Vimal Arora, Veerma Ram, Anil Bhandari, Priti Vyas — 2011-02-08

Abstract: Aim of the study: In the present study, we examined and compared the effect of Polyherbal (PH), Allopolyherbal-A (APH-A), Allopolyherbal-B (APH-B), and Allopolyherbal-C (APH-C) formulations on hyperglycemia, lipid profile, renal, and hepatic function in streptozotocin (STZ) induced diabetes mellitus in rats.Materials and methods: The hypoglycemic activity (along with other parameters) of Polyherbal and Allopolyherbal formulations was investigated in STZ induced diabetes in rats. Polyherbal (PH) (3.63g/kgbodywt.); Allopolyherbal-A (APH-A) [(5mgGliclazide+1.81gPH)/kgbodywt.]; Allopolyherbal-B (APH-B) [(4mgGliclazide+2.17g of PH)/kgbodywt.]; Allopolyherbal-C (APH-C) [(2mg of Gliclazide+2.904g of PH)/kgbodywt.], and Gliclazide (10mg/kgbodywt.) were administered once a day, orally by gavages for 21days.Blood glucose levels were measured on 0, 7, 14, and 21days of the study; total cholesterol, triglycerides, LDL, VLDL, HDL, serum creatinine, SGOT, and SGPT were estimated on 21st day.Results: Gliclazide, Polyherbal (PH), Allopolyherbal-A (APH-A), Allopolyherbal-B (APH-B), and Allopolyherbal-C (APH-C) formulations treated rats showed significant (P<0.01) decrease in blood glucose, total cholesterol, triglycerides, LDL, VLDL, serum creatinine, SGOT, and SGPT level, along with significant increase in HDL.Conclusions: Present findings provide experimental evidence that the combination of allopathic hypoglycemic drugs with hypoglycemic Polyherbal formulations provides effective and rapid glycemic control and can also minimize the cardiovascular risk factors of type II diabetes mellitus.

PCSK9: The functional relevance of fenofibrate–statin combination therapy to reduce residual cardiovascular risk - Corrected Proof

Jean-Charles Fruchart — 2011-01-03

Abstract: Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a key role in the regulation of low-density lipoprotein cholesterol (LDL-C) levels by virtue of its ability to target the LDL-receptor. Mutations of PCSK9 result in either a decrease (i.e. gain of function mutations) or an increase (i.e. loss of function mutations) in LDL receptor levels. For gain of function variants, this translates into an increase in plasma concentrations of LDL-C and increased susceptibility to cardiovascular disease. In contrast, loss of function variants substantially lower LDL-C levels and cardiovascular disease incidence. Given that statins also increase PCSK9 expression, which is counterproductive to their effect on LDL-receptor regulation, it is suggested that adding a PCSK9 inhibitor might increase the LDL-C lowering efficiency of statin treatment. Peroxisome proliferator-activated receptor agonists such as fenofibrate repress PCSK9 expression. In vitro studies show that co-administration of fenofibrate with a statin counteracts statin-induced expression of PCSK9, further increasing LDL-receptor activity. Clinically, this approach results in enhanced LDL-C lowering efficiency of the statin, thereby supporting the functional relevance of combination treatment with fenofibrate and a statin. Finally, evidence that PCSK9 levels are also associated with changes in plasma levels of glucose, triglycerides and high-density lipoprotein cholesterol suggests that PCSK9 may be a potential target in patients with type 2 diabetes or metabolic syndrome. Such an approach could impact the substantial residual cardiovascular risk that exists in statin-treated patients.

Prediabetes awareness, healthcare provider’s advice, and lifestyle changes in American adults - Corrected Proof

Ike S. Okosun, Rodney Lyn — 2011-01-03

Abstract: Purpose: The purpose of this study was to examine whether persons who are aware of their prediabetes were more likely than persons with normal glycemia to report lifestyle changes (weight control, physical activity and fat/calories intake), and to determine the interactive effect of persons aware of their prediabetes and persons reporting doctor/health care provider’s (DHCP) advice on overall lifestyle change.Methods: Data from the 2005 to 2006 and 2007 to 2008 US National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether persons who are aware of their prediabetes were more likely than persons with normal glycemia to report lifestyle changes.Results: Persons who are aware of their prediabetes were more likely than persons with normal glycemia to report increased weight control (OR=1.72; 95% CI=1.34–2.20) and physical activity (OR=1.28; 95% CI=1.02–1.61), and reduced fat/calorie intake (OR=1.82; 95% CI=1.41–2.34), after adjusting for age, BMI, persons reported DHCP advice, race/ethnicity, sex, education and household income. Persons who reported DHCP advice were more likely than persons who did not report DHCP advice to report increased weight control (OR=1.87; 95% CI=1.67–2.09) and physical activity (OR=1.59; 95% CI=1.43–1.78), and reduced fat/calorie intake (OR=2.19; 95% CI=1.96–2.46), after adjusting for confounders. There was no significant interaction between persons aware of their prediabetes and persons that reported DHCP advice with reported overall lifestyle change.Conclusions: Creating diabetes risk awareness in at-risk groups and increased counseling of at-risk groups by doctors/health care providers may be the keys to prevent diabetes.