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1.
A. F. H. Pfeiffer 《Der Diabetologe》2016,12(7):468-472
Background
Disturbances of glucose metabolism are common in chronic liver disease and about 30–40?% of patients with liver cirrhosis develop type 2 diabetes. The diabetes may be a direct consequence of the hepatic disease due to excessive insulin resistance or may be caused by classical type 2 diabetes.Blood glucose determination
Patients with chronic liver disease frequently have a normal fasting glucose despite manifest type 2 diabetes with postprandial excessive increases in glucose. Therefore, oral glucose tolerance tests should be performed after diagnosis of hepatic cirrhosis.Prognosis
Diabetes mellitus is associated with increased mortality and an increased risk of complications of liver cirrhosis including premature death, hepatocellular carcinoma, hepatic encephalopathy, and spontaneous bacterial peritonitis. Therapy of diabetes should include metformin and α?glucosidase inhibitors which can reduce the risk of these complications. Therefore, the diagnosis of diabetes has important consequences in chronic liver disease.2.
H. Kahles 《Der Diabetologe》2016,12(4):232-239
Objective
Vitamin D is not only essential for bone metabolism, but also has an additional immune-modulating effect on the immune system, which may play a role in the pathogenesis of several endocrine diseases.Aim
In this review, we debate the effects and recommendations of vitamin D supplementation, especially in the context of the nonclassical effects.Results
Evidence from animal model and epidemiological studies supports a role for vitamin D in many endocrine conditions. Vitamin D supplementation may play a role in the prevention of type 1 diabetes mellitus.Conclusions
Although observational studies support a potential role of vitamin D in endocrine disease, high-quality evidence from clinical trials to establish a place for vitamin D supplementation in optimizing endocrine health are lacking. Based on observational studies, vitamin D deficiency should probably be avoided in individuals at high risk of developing type 1 diabetes, specifically in early life.3.
Background
Diabetes is associated with a two- to three-fold increased risk of cardiovascular events, and cardiovascular disease is the leading cause of death in patients with diabetes. The association with cardiovascular disease is particularly strong in patients with type 2 diabetes who, in addition to hyperglycemia, exhibit other atherogenic stigmata of insulin resistance such as abdominal obesity, dyslipidemia, and arterial hypertension. However, patients with type 1 diabetes are also at an increased risk of cardiovascular events over the long term, which is partly explained by direct glucotoxic damage to the endothelium.Prophylaxis
Lowering glucose both in type 2 and type 1 diabetes over long observational periods has been found to be associated with a decreased risk of cardiovascular events; however, at least in the short term glucose lowering is less efficacious in decreasing cardiovascular risk than lowering LDL (low density lipoprotein) cholesterol or normalizing blood pressure. Overly aggressive glucose lowering at the price of frequent hypoglycemia can even negatively affect cardiovascular outcomes because hypoglycemia is associated with an increased cardiovascular event risk.Important cardiovascular diseases in diabetes
In addition to coronary diseases, the increased heart failure risk of patients with diabetes has attracted increasing interest.4.
C. Lebherz 《Der Diabetologe》2016,12(2):80-87
Background
Patients with type 2 diabetes are at increased risk of developing cardiovascular diseases and have been shown to greatly benefit from tight control not only of the blood glucose but also of LDL (low density lipoprotein) cholesterol levels.Cardiovascular risk reduction
So far an aggressive treatment regimen with potent statins has been recommended. The IMPROVE IT study caused a paradigm shift in that it showed additional cardiovascular risk reduction if LDL cholesterol was reduced below target levels independent of the pleiotropic statin actions. These effects were even more significant in patients with type 2 diabetes.Conclusions
Therefore even though statins are still first choice, a combination with ezetimibe or the novel PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors is warranted to further reduce cardiovascular risk. As secondary targets, non-HDL (high density lipoprotein) cholesterol or ApoB (apolipoprotein B) levels serve as surrogate markers for atherogenic lipid particles. Depending on the individual lipid levels, combination therapy with fibrates or ω?3 fatty acids might be of benefit.5.
Background
The prevalence of nonalcoholic fatty liver disease (NAFLD) continues to increase. An estimated 25?% of the adult population worldwide and more than 50?% of patients with type 2 diabetes or obesity have NAFLD.Objectives
An overview of the natural history and complications of NAFLD is provided.Materials and methods
Following an extensive literature research, the current guidelines, expert opinions and studies focusing on NAFLD were analyzed.Results
The term NAFLD includes the entities nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), which are defined by histological parameters. Importantly, “benign” NAFL may progress towards more aggressive NASH with the development of liver fibrosis. The grade of fibrosis is the most important predictor for overall and liver-related mortality in NAFLD patients and patients suffering from type 2 diabetes mellitus have a higher risk for progressive fibrosis. Progressive NAFLD can develop into liver cirrhosis with the potential of fatal complications of portal hypertension and liver failure. Notably, hepatocellular carcinoma may also develop in noncirrhotic NAFLD. Furthermore, NAFLD is an independent risk factor for cardiovascular disease and extrahepatic malignancy, which represent the two most frequent causes of death in NAFLD patients. To date, a lifestyle intervention aiming at weight reduction and increased physical activity is the first-line therapy for NAFLD.Conclusions
NAFLD is one of the most common liver diseases and is associated with relevant hepatic and extrahepatic morbidity and mortality.6.
Thorsten Feige 《Der Diabetologe》2018,14(7):465-469
Background
Most type 1 diabetes mellitus patients are not capable of achieving close to normal glucose levels and thus face a constant risk of severe hypoglycemia and diabetic ketoacidosis.Objectives
Patients develop their own personal non-approved medical devices to compensate for gaps in the existing medical technology.Materials and methods
Current studies are assessed and basic work and challenges are discussed.Results
The authorization of such systems from patients themselves results in the development of medical devices suitable for use but approved only based on freely available algorithms. Legal framework conditions, lack of standards on the interoperability of medical devices and uncertainties about future technology trends are giving rise to ongoing controversies.Conclusions
There is a need to validate these new approaches, agree upon success criteria and provide solid evidence of their effectiveness.7.
D. F. Braus 《Der Diabetologe》2016,12(5):346-351
Background
One of four patients with type 2 diabetes mellitus (T2DM) has clinically relevant depression. On the other hand, depression increases the risk for T2DM as well as micro- and macrovascular complications.Objectives
This association may reflect a shared pathophysiology consisting of complex bidirectional interactions, which may influence therapy and prognosis.Materials and methods
Recent findings, reviews and basic literature are analysed and an update is presented and discussed.Results
Overall, accumulating evidence indicates a metabolic–mood syndrome with a linkage that includes stress sensitivity, insulin resistance (IR), neurohormonal dysregulation and inflammation. IR alters dopamine turnover and causes depression-like behaviour. Furthermore IR is associated with worse memory performance. Metabolic risk influences neurodevelopment. However, cross-sectional data do not support a genetic association between T2DM and depression.Conclusions
T2DM may promote depression and interact with neurodevelopment and neurodegeneration. Comorbidity seems to be particularly toxic. Both prevention of T2DM in depressed patients and treatment of depression in T2DM are of considerable significance. Serotonin reuptake inhibition (SSRI) and psychotherapy are effective in the treatment of depression.8.
Background
A paradigm shift in therapeutic management of sigmoid diverticulitis has occurred with increasing reluctance regarding surgical treatment. While there is still a clear surgical indication in cases of complications such as strictures, fistulas, perforations or persistent bleeding, an elective indication for sigmoid resection is not clearly defined, especially in chronic-recurrent courses.Objectives
The main aspects of elective surgery for sigmoid diverticulitis are discussed.Materials and methods
Relevant studies were selected and the reference lists from those studies were also searched.Results
An uncomplicated form of acute diverticulitis (Classification of Diverticular Disease [CDD] type 1a/b) is not an indication for surgery (exception: immunosuppressed patients). In acute complicated diverticulitis (except free perforation), elective surgery should only be recommended in case of a macroabscess (CDD type 2b). In chronic recurrent, uncomplicated diverticulitis (CDD typ 3a/b), indication for surgery should be individualized. However, indications for elective surgery are complications such as strictures or fistulas (CDD type 3c). Recent data show that patients with type 2b and 3 diverticulitis benefit from elective surgery, especially in terms of quality of life.Conclusions
Although the majority of patients with diverticulitis can be treated conservatively, elective surgery should also be considered in terms of better quality of life compared to conservative therapy.9.
J. H. Stupin 《Der Diabetologe》2016,12(1):13-21
Background
Exclusive breastfeeding provides optimal nutrition and health protection for mothers and their offspring.Health benefits of breastfeeding for diabetic women
Diabetic mothers who breastfeed in the first 4 months postpartum have improved metabolic parameters, e.g., lower blood lipids, lower blood glucose, and greater insulin sensitivity. Studies have reported that longer duration of breastfeeding in women with a history of gestational diabetes may reduce long-term risks of cardiometabolic disease, including type 2 diabetes.Health benefits of breastfeeding for children
Children of diabetic mothers may benefit from breastfeeding in that they have lower rates of hypoglycemia immediately after birth and lower rates of obesity in later life. It has been suggested that the latter benefits may only be observed if breastfeeding is continued beyond a certain period where breastmilk composition would have normalized over time.Conclusion
Due to several risk factors and pathophysiological mechanisms, diabetic women are less likely and for a shorter duration to breastfeed. Therefore, diabetic women should be encouraged to breastfeed exclusively for at least 4–6 months to improve maternal and child morbidity, to prevent noncommunicable diseases in later life, and to decrease health care costs.10.
Background
The gut microbiome has emerged as a key player in the modulation of the immune system and metabolism. Changes in the composition of the gut microbial ecosystems have been reported to be associated with metabolic diseases but also with the development and progression of cardiovascular diseases, inflammatory bowel disease, certain types of cancer and psychiatric diseases.Objective
The role of the gut microbiome in the pathophysiology of obesity and type 2 diabetes, and treatment approaches based thereon are discussed.Microbiome and pathophysiology
The pathophysiology in humans is not entirely understood. Studies in mice suggest a strong causal link between changes in the microbiome and the development of metabolic diseases. Potential mechanisms how the microbiome is linked to diseases of the host include signaling through lipopolysaccharides from gram-negative bacteria and interactions with the host immune system, fermentation of indigestible fiber to short chain fatty acids, modulation of bile acids, and bile acid signaling. Interactions between gut microbiota, its products, and the immune system may lead to an increased gut permeability resulting in visceral fat and liver inflammation with subsequent systemic subclinical inflammation (leaky gut hypothesis). Moreover, host-specific factors and environmental factors have been discussed to have a role.Conclusion
Increasing knowledge in this area could contribute to the treatment of obesity and type 2 diabetes with fecal or targeted microbiota transplantation.11.
Sridharan Raghavan Mark C. Pachucki Yuchiao Chang Bianca Porneala Caroline S. Fox Josée Dupuis James B. Meigs 《Journal of general internal medicine》2016,31(10):1127-1133
BACKGROUND
Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual’s obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown.OBJECTIVE
We aimed to estimate the relationship between obesity or diabetes in an individual’s social contacts and his/her T2D risk. We hypothesized that obesity and diabetes in social contacts would increase an individual’s T2D risk.DESIGN
This was a retrospective analysis of the community-based Framingham Offspring Study (FOS).PARTICIPANTS
FOS participants with T2D status, height and weight, and at least one social contact were eligible for this study (n?=?4797 at Exam 1). Participants’ interpersonal ties, cardiometabolic and demographic variables were available at eight exams from 1971 to 2008, and a T2D additive polygenic risk score was measured at the fifth exam.MAIN MEASURES
Primary exposures were T2D (fasting glucose?≥?7 mmol/L or taking diabetes medications) and obesity status (BMI?≥?30 kg/m2) of social contacts at a prior exam. Primary outcome was incident T2D in participants.KEY RESULTS
Incident T2D was associated with having a social contact with diabetes (OR 1.32, p?=?0.004) or with obesity (OR 1.21, p?=?0.004). In stratified analyses, incident T2D was associated with diabetes in siblings (OR 1.64, p?=?0.001) and obesity in spouses (OR 1.54, p =?0.0004). The associations between diabetes and obesity in social contacts and an individual’s incident diabetes risk were stronger in individuals with a high diabetes genetic risk score.CONCLUSIONS
T2D and obesity in social contacts, particularly siblings and spouses, were associated with an individual’s risk of incident diabetes even after accounting for parental T2D history. Assessing risk factors in an individual’s siblings and spouses can inform T2D risk; furthermore, social network based lifestyle interventions involving spouses and siblings might be a novel T2D prevention approach.12.
Ram Pratap Singh Bundela Prachis Ashdhir Kumar Shwetanshu Narayan Mukesh Jain Rupesh Kumar Pokharna Sandeep Nijhawan 《Indian journal of gastroenterology》2017,36(3):193-196
Background
Inflammatory bowel disease (IBD) has been associated with increased risk of osteopenia and osteoporosis. Several risk factors contribute to this; however, studies evaluating their association have conflicting results.Methods
We conducted a cross-sectional study with prospective enrollment of adult ulcerative colitis patients attending the Gastroenterology Department of Sawai Man Singh Hospital, Jaipur Rajasthan between June 2015 and December 2015. Demographic data including age, gender, body mass index (BMI), disease duration, type of disease, prior steroid use and vitamin D levels were recorded and compared with bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA).Results
Of the 55 patients enrolled, 41 (74.5%) had abnormal BMD; out of this, 19 (34.5%) had osteopenia and 22 (40.0%) had osteoporosis. In univariate analysis, disease duration and history of steroid use were observed as statistically significant. However, on multivariate analysis, only duration of disease was found to be a significant independent predictor of low BMD. Age, gender, BMI, low levels of vitamin D and steroid usage were not associated with low BMD.Conclusion
Prevalence of low BMD is common in Indian ulcerative colitis patients. Prolonged disease duration appears to be the major risk factor.13.
Background and objectives
Patients with diabetes mellitus are at increased cardiovascular risk. While arteriosclerotic lesions have long been recognized as the underlying cause, more recent studies suggest alterations in the coagulation system to be equally important in this context.Materials and methods
A systematic PubMed search was performed.Results
In patients with diabetes mellitus, alterations in the coagulation system play a pivotal role. This not only contributes to the increased cardiovascular risk but also explains the low or nonresponse to antiplatelet therapy. These alterations in the coagulation system include changes in platelet and fibrin clot function. This is reflected by the recommendation of the 2013 ESC guidelines on antiplatelet therapy in diabetes.Conclusions
This article provides an overview of pathophysiological alterations in coagulation of patients with diabetes mellitus and the recommended antiplatelet therapy in the presence of coronary artery disease.14.
Anita D. Misra-Hebert Bo Hu Glen Taksler Robert Zimmerman Michael B. Rothberg 《Journal of general internal medicine》2016,31(8):871-877
Background
Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse.Objective
To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals.Design
Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008–December 2012.Participants
Employee patients with diabetes covered by the organization’s self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance.Intervention
Financial incentives for employer-sponsored disease management program participation and achieving goals.Main Measures
Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight.Results
A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p?<?0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change ?0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p?=?0.04) and (2.3 kg vs. 0.1 kg, DIC p?<?0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p?>?0.05).Conclusions
Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.15.
Zachary A. Marcum Christopher W. Forsberg Kathryn P. Moore Ian H. de Boer Nicholas L. Smith James S. Floyd 《Journal of general internal medicine》2018,33(2):155-165
Background
For patients with type 2 diabetes and chronic kidney disease (CKD), high-quality evidence about the relative benefits and harms of oral glucose-lowering drugs is limited.Objective
To evaluate whether mortality risk differs after the initiation of monotherapy with either metformin or a sulfonylurea in Veterans with type 2 diabetes and CKD.Design
Observational, national cohort study in the Veterans Health Administration (VHA).Participants
Veterans who received care from the VHA for at least 1 year prior to initiating monotherapy treatment for type 2 diabetes with either metformin or a sulfonylurea between 2004 and 2009.Main Measures
Metformin and sulfonylurea use was assessed from VHA electronic pharmacy records. The CKD-EPI equation was used to estimate glomerular filtration rate (eGFR). The outcome of death from January 1, 2004, through December 31, 2009, was assessed from VHA Vital Status files.Key Results
Among 175,296 new users of metformin or a sulfonylurea monotherapy, 5121 deaths were observed. In primary analyses adjusted for all measured potential confounding factors, metformin monotherapy was associated with a lower mortality hazard ratio (HR) compared with sulfonylurea monotherapy across all ranges of eGFR evaluated (HR ranging from 0.59 to 0.80). A secondary analysis of mortality risk differences favored metformin across all eGFR ranges; the greatest risk difference was observed in the eGFR category 30–44 mL/min/1.73m2 (12.1 fewer deaths/1000 person-years, 95% CI 5.2–19.0).Conclusions
Initiation of metformin versus a sulfonylurea among individuals with type 2 diabetes and CKD was associated with a substantial reduction in mortality, in terms of both relative and absolute risk reduction. The largest absolute risk reduction was observed among individuals with moderately–severely reduced eGFR (30–44 mL/min/1.73m2).16.
Background
Diabetes mellitus is a disease which leads to vascular damage resulting in subsequent severe cardiovascular complications, such as myocardial infarction and stroke. This process is aggravated by coexisting hypertension.Objective
This analysis gives a review of the latest study results on prognosis, blood pressure targets, drug therapy and interventional therapy in patients with diabetes and hypertension. Selected studies published in recent years with practical relevance for patients with diabetes and hypertension are presented.Summary
Patients with simultaneous diabetes and hypertension have a poorer prognosis and a higher cardiovascular risk compared to patients with diabetes but without hypertension. Patients with diabetes and hypertension benefit from interventional blood pressure therapy17.
Kiyuri Naicker Douglas Manuel Simon Øverland Jens C. Skogen Jeffrey A. Johnson Børge Sivertsen Ian Colman 《Diabetology & metabolic syndrome》2018,10(1):84
Background
Population attributable fractions (PAFs) are frequently used to quantify the proportion of Type 2 diabetes cases due to single risk factors, an approach which may result in an overestimation of their individual contributions. This study aimed to examine Type 2 diabetes incidence associated with multiple risk factor combinations, including the metabolic syndrome, behavioural factors, and specifically, depression and anxiety.Methods
Using data from the population-based HUNT cohort, we examined incident diabetes in 36,161 Norwegian adults from 1995 to 2008. PAFs were calculated using Miettinen’s case-based formula, using relative risks estimated from multivariate regression models.Results
Overall, the studied risk factors accounted for 50.5% of new diabetes cases (78.2% in men and 47.0% in women). Individuals exposed to both behavioural and metabolic factors were at highest risk of diabetes onset (PAF?=?22.9%). Baseline anxiety and depression contributed a further 13.6% of new cases to this combination. Men appeared to be particularly vulnerable to the interaction between metabolic, behavioural and psychological risk factors.Conclusion
This study highlights the importance of risk factor clustering in diabetes onset, and is the first that we know of to quantify the excess fraction of incident diabetes associated with psychological risk factor interactions.18.
Purpose of Review
Recent studies have demonstrated a higher risk of incident diabetes associated with statin use, causing concern among patients and clinicians. In this review, we will assess the evidence and proposed mechanisms behind statin therapy and its association with incident diabetes. We will then review the current recommendations for statin use in light of this association and suggest next steps for clinicians managing these patients and researchers exploring this phenomenon.Recent Findings
The annual risk of developing new-onset diabetes with statin treatment is approximately 0.1%. In comparison, the absolute risk reduction of major coronary events with statin use is approximately 0.42% annually.Summary
Statins are associated with the development of incident diabetes, particularly among those with predisposing risk factors for diabetes. However, the benefit of statin use among these patients in preventing major coronary events strongly favors statin use despite its risk of incident diabetes.19.
Leon Lenchik Ashley A. Weaver Robert J. Ward John M. Boone Robert D. Boutin 《Current rheumatology reports》2018,20(12):74
Purpose of Review
Osteoporosis is disproportionately common in rheumatology patients. For the past three decades, the diagnosis of osteoporosis has benefited from well-established practice guidelines that emphasized the use of dual x-ray absorptiometry (DXA). Despite these guidelines and the wide availability of DXA, approximately two thirds of eligible patients do not undergo testing. One strategy to improve osteoporosis testing is to employ computed tomography (CT) examinations obtained as part of routine patient care to “opportunistically” screen for osteoporosis, without additional cost or radiation exposure to patients. This review examines the role of opportunistic CT in the evaluation of osteoporosis.Recent Findings
Recent evidence suggests that opportunistic measurement of bone attenuation (radiodensity) using CT has sensitivity comparable to DXA. More importantly, such an approach has been shown to predict osteoporotic fractures.Summary
The paradigm shift of using CTs obtained for other reasons to opportunistically screen for osteoporosis promises to substantially improve patient care.20.
Beatriz San Millan Susana Teijeira Carmen Domínguez Irene Vieitez Carmen Navarro 《Journal of inherited metabolic disease》2010,33(3):105-111