Diabetes epidemic sweeping the Arab world

The prevalence of type-2 diabetes mellitus(T2DM) has increased dramatically during the last 2 decades, a fact driven by the increased prevalence of obesity, the primary risk factor for T2 DM. The figures for diabetes in the Arab world are particularly startling as the number of people with diabetes is projected to increase by 96.2% by 2035. Genetic risk factors may play a crucial role in this uncontrolled raise in the prevalence of T2 DM in the Middle Eastern region. However, factors such as obesity, rapid urbanization and lack of exercise are other key determinants of this rapid increase in the rate of T2 DM in the Arab world. The unavailability of an effective program to defeat T2 DM has serious consequences on the increasing rise of this disease, where available data indicates an unusually high prevalence of T2 DM in Arabian children less than 18 years old. Living with T2 DM is problematic as well, since T2 DM has become the 5th leading cause of disability, which was ranked 10 th as recently as 1990. Giving the current status of T2 DM in the Arab world, a collaborative international effort is needed for fighting further spread of this disease.     

Diagnosis,treatment and prevention of type 2 diabetes mellitus in children and adolescents

During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. This trend, which parallels the increases in prevalence and degree of pediatric obesity, has caused great concern, even though T2DM remains a relatively rare disease in children. Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive β-cell decline, high treatment failure rate, and accelerated development of complications. Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide. What is more important for everyone to realize though, from patients, families and physicians to schools, health services and policy-makers alike, is that T2DM is a largely preventable disease that will be addressed effectively only if its major contributor (i.e., pediatric obesity) is confronted and prevented at every possible stage of life, from conception until adulthood. Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed.     

Neurogenic Obesity-Induced Insulin Resistance and Type 2 Diabetes Mellitus in Chronic Spinal Cord Injury

The population with SCI is at a significant risk for both insulin resistance and type 2 diabetes mellitus (T2DM) secondary to neurogenic obesity. The prevalence of insulin resistance and T2DM in persons with SCI suggests that disorders of carbohydrate metabolism are at epidemic proportions within the population. However, the true frequency of such disorders may be underestimated because biomarkers of insulin resistance and T2DM used from the population without SCI remain nonspecific and may in fact fail to identify true cases that would benefit from intervention. Furthermore, diet and exercise have been used to help mitigate neurogenic obesity, but results on disorders of carbohydrate metabolism remain inconsistent, likely because of the various ways carbohydrate metabolism is assessed. The objective of this article is to review current literature on the prevalence and likely mechanisms driving insulin resistance and T2DM in persons with SCI. This article also explores the various assessments and diagnostic criteria used for insulin resistance and T2DM and briefly discusses the effects of exercise and/or diet to mitigate disorders of carbohydrate metabolism brought on by neurogenic obesity.     

Metabolic surgery: A paradigm shift in type 2 diabetes management

Obesity and type 2 diabetes mellitus (T2DM) are major public health issues globally over the past few decades. Despite dietary interventions, lifestyle modifications and the availability of several pharmaceutical agents, management of T2DM with obesity is a major challenge to clinicians. Metabolic surgery is emerging as a promising treatment option for the management of T2DM in the obese population in recent years. Several observational studies and a few randomised controlled trials have shown clear benefits of various bariatric procedures in obese individuals in terms of improvement or remission of T2DM and multiple other health benefits such as improvement of hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainties about the long-term implications of metabolic surgery such as relapse of T2DM after initial remission, nutritional and psychosocial complications and the optimal body mass index for different ethnic groups exist. The article discusses the major paradigm shift in recent years in the management of T2DM after the introduction of metabolic surgery.     

State of art on the mechanisms of laparoscopic sleeve gastrectomy in treating type 2 diabetes mellitus

Obesity and type-2 diabetes mellitus (T2DM) are metabolic disorders. Obesity increases the risk of T2DM, and as obesity is becoming increasingly common, more individuals suffer from T2DM, which poses a considerable burden on health systems. Traditionally, pharmaceutical therapy together with lifestyle changes is used to treat obesity and T2DM to decrease the incidence of comorbidities and all-cause mortality and to increase life expectancy. Bariatric surgery is increasingly replacing other forms of treatment of morbid obesity, especially in patients with refractory obesity, owing to its many benefits including good long-term outcomes and almost no weight regain. The bariatric surgery options have markedly changed recently, and laparoscopic sleeve gastrectomy (LSG) is gradually gaining popularity. LSG has become an effective and safe treatment for type-2 diabetes and morbid obesity, with a high cost-benefit ratio. Here, we review the me-chanism associated with LSG treatment of T2DM, and we discuss clinical studies and animal experiments with regard to gastrointestinal hormones, gut microbiota, bile acids, and adipokines to clarify current treatment modalities for patients with obesity and T2DM.     

Sugar intake from sweetened beverages and diabetes: A narrative review

Type 2 diabetes mellitus (T2DM) is one of the fastest growing public health concerns around the world. Sugar-sweetened beverage (SSB) consumption has been proven to be associated with adverse health consequences in the diabetic population. Reducing SSB consumption, body weight control, healthy diets, and increased physical activity have been suggested as strategies to improve diabetes prevention and management. This literature review provides an overview of: (1) The association between SSB consumption and the risk of T2DM; (2) Types of SSB consumption and T2DM; (3) The effect of obesity and inflammation on the association between SSB consumption and risk of T2DM; and (4) SSB consumption in T2DM patients. There is still work to be done to determine how SSB consumption is related to T2DM, but the current research on identifying the association between SSB consumption and T2DM is promising, with the most promising studies confirming the connection between SSBs, T2DM risk, and diabetes management. Future studies should explore more effective SSB related diabetes prevention and management interventions.     

Type 2 diabetes among Asian Americans: Prevalence and prevention

Type 2 diabetes mellitus (T2DM) is a growing problem among Asian Americans. Based on the Centers for Disease Control, the age-adjusted prevalence of T2DM for Asian Americans is 9%, placing them at “moderate risk”. However differential patterns of disease burden emerge when examining disaggregated data across Asian American ethnic groups; with Filipino, Pacific Islander, Japanese, and South Asian groups consistently described as having the highest prevalence of T2DM. Disentangling and strengthening prevalence data is vital for on-going prevention efforts. The strongest evidence currently available to guide the prevention of T2DM in the United States comes from a large multicenter randomized clinical control trial called the Diabetes Prevention Program, which targets individual lifestyle behavior changes. It has been translated and adopted for some Asian American groups, and shows promise. However stronger study designs and attention to several key methodological considerations will improve the science. Increased attention has also been directed toward population level downstream prevention efforts. Building an infrastructure that includes both individual and population approaches is needed to prevent T2DM among Asian American populations, and is essential for reducing health disparities.     

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies?

BACKGROUNDThe alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus (T2DM). Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM. There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM, but remission rates of T2DM after metabolic surgery can display great variability.AIMTo discuss the most commonly used surgical options including vertical sleeve gastrectomy, adjustable gastric banding, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.METHODSWe also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures.RESULTSIn light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patient with T2DM, but further studies are needed to clarify better the rate of diabetes remission.CONCLUSIONIn light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patients with T2DM, but further studies are needed to clarify better the rate of diabetes remission.     

Association between psychological distress and gastrointestinal symptoms in diabetes mellitus

AIM:To examine the possible association between gastrointestinal symptoms and anxiety and depression in type 2 diabetes mellitus(T2DM).METHODS:The study was a matched case-control study based on a face to face interview with designed diagnostic screening questionnaires for gastrointestinal(GI) symptoms and T2DM,Patient Health Questionnaire(PHQ-9) for depression and General Anxiety Disorders(GAD-7) for anxiety.The questionnaire consisted of questions about symptoms and signs of anxiety and depression disorders.Also,socio-demographic characteristics,life style habits and the family history of patients were collected.It was carried out from June 2010 to May 2011 among Qatari and other Arab nationals over 20 years of age at Primary Health Care Centers of the Supreme Council of Health,Qatar,including patients with diabetes mellitus and healthy subjects over 20 years of age.RESULTS:In the studied sample,most of the studied T2DM patients with GI symptoms(39.3%) and healthy subjects(33.3%) were in the age group 45-54 years(P < 0.001).The prevalence of severe depression(9.5% vs 4.4%,P < 0.001) and anxiety(26.3% vs 13.7%,P < 0.001) was significantly higher in T2DM patients with GI symptoms than in general population.Obesity(35.7% vs 31.2%) and being overweight(47.9% vs 42.8%) were significantly higher in T2DM patients with GI symptoms than in healthy subjects(P = 0.001).Mental health severity score was higher in T2DM patients with GI symptoms than in healthy subjects;depression(8.2 ± 3.7 vs 6.0 ± 3.6) and anxiety(7.6 ± 3.3 vs 6.0 ± 3.7).The most significant GI symptom which was considerably different from controls was early satiety [odds ratio(OR) = 10.8,P = 0.009] in depressed T2DM patients and loose/watery stools(OR = 2.79,P = 0.029) for severe anxiety.Anxiety was observed more than depression in T2DM patients with GI symptoms.CONCLUSION:Gastrointestinal symptoms were significantly associated with depression and anxiety in T2DM patients,especially anxiety disorders.     

Association of obesity with hypertension and type 2 diabetes mellitus in India: A meta-analysis of observational studies

AIM To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus(T2DM) in India among adults. METHODS To conduct meta-analysis, we performed comprehensive, electronic literature search in the PubM ed, CINAHL Plus, and Google Scholar. We restricted the analysis to studies with documentation of some measure of obesity namely; body mass index, waist-hip ratio, waist circumference and diagnosis of hypertension or diagnosis of T2DM. By obtaining summary estimates of all included studies, the meta-analysis was performed using both RevM an version 5 and "metan" command STATA version 11. Heterogeneity was measured by I~2 statistic. Funnel plot analysis has been done to assess the study publication bias.RESULTS Of the 956 studies screened, 18 met the eligibility criteria. The pooled odds ratio between obesity and hypertension was 3.82(95%CI: 3.39 to 4.25). The heterogeneity around this estimate(I~2 statistic) was 0%, indicating low variability. The pooled odds ratio from the included studies showed a statistically significant association between obesity and T2DM(OR = 1.14, 95%CI: 1.04 to 1.24) with a high degree of variability.CONCLUSION Despite methodological differences, obesity showed significant, potentially plausible association with hypertension and T2DM in studies conducted in India. Being a modifiable risk factor, our study informs setting policy priority and intervention efforts to prevent debilitating complications.     

手术治疗2型糖尿病合并肥胖症26例

目的：探讨胃肠外科手术在治疗2型糖尿病（T2DM）合并肥胖症中的意义。方法：对26例T2DM合并肥胖症的患者行胃减容和胃肠短路手术,观察术后血糖、体质指数（BMI）等指标的变化。结果：术后1年空腹血糖4.9-8.8 mmol/L,平均6.3 mmol/L。治疗T2DM有效率100%,治愈率42.3%。体质量降低5-42 kg,平均降低17.5 kg。BMI降至20.8-32.0,平均25.5。结论：胃减容和胃肠短路手术是治疗T2DM合并肥胖症可行、有效的方法。     

社会支持干预改善2型糖尿病患者抑郁状况

目的探讨社会支持干预对2型糖尿病合并抑郁患者抑郁状况的影响。方法将93例合并轻中度抑郁症状的社区2型糖尿病患者随机分为对照组46例和干预组47例。对照组给予常规糖尿病药物治疗和社区护理,干预组在对照组的基础上接受社会支持干预,包括成立糖友之家,进行社会支持相关讲座,鼓励家属参与,鼓励患者向朋友倾诉等。在干预前、干预4周末、8周末和12周末分别用抑郁自评量表(SDS)进行测量。结果两组SDS得分比较,组间效应、时间效应、交互效应均存在统计学意义(均P0.01)。结论社会支持干预可有效改善2型糖尿病合并抑郁患者的抑郁状况。     

Trends in prevalence of diabetes in Asian countries

Diabetes is a major lifestyle disorder,the prevalence of which is increasing globally.Asian countries contribute to more than 60% of the world’s diabetic population as the prevalence of diabetes is increasing in these countries.Socio-economic growth and industrialization are rapidly occurring in many of these countries.The urban-rural divide in prevalence is narrowing as urbanization is spreading widely,adversely affecting the lifestyle of populations.Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors.As a result,they develop diabetes at a younger age and at a lower body mass index and waist circumference when compared with the Western population.The adverse effect of physical inactivity and fatty food are manifested as the increasing rate of overweightness and obesity,even among children.The health care budgets for the disease management are meager and the health care outcome is far from the optimum.As a result,complications of diabetes are common and the economic burden is very high,especially among the poor strata of the society.National endeavors are urgently needed for early diagnosis,effective management and for primary prevention of diabetes.This editorial aims to highlight the rising trend in prevalence of diabetes in Asia,its causative factors and the urgent need to implement national strategies for primary prevention of type 2 diabetes.     

不同阶段2型糖尿病诱发骨质疏松症的致病机制研究进展

大量临床研究表明,2型糖尿病(type 2 diabetes mellitus,T2DM)患者的骨折风险明显增加。因此,T2DM诱发的骨质疏松症(osteoporosis,OP)被认为是最严重的糖尿病并发症之一。骨脆性增加是糖尿病性骨质疏松症(diabetic osteoporosis,DOP)的典型特征,其发病机制是多因素引起的,包括肥胖、高胰岛素血症、高血糖(hyperglycemia,HG)、晚期糖基化终产物(advanced glycation end products,AGEs)积聚和氧化产物积累以及微血管病变的存在等。这些因素在T2DM不同时期是相互平衡或相互促进的,而肿瘤坏死因子-α(tumor necrosis factor,TNF-α)、白细胞介素-1(interleukin 1,IL-1)、白细胞介素-6(interleukin 6,IL-6)等炎症因子的异常活化打破了骨形成和骨吸收的代谢平衡,导致骨脆性增加。骨强度和骨折风险的变化取决于疾病进展的阶段。因此,糖尿病骨病的病理生理变化可以通过分别考虑糖尿病早期和晚期骨骼相关因素来广泛讨论,其中早期阶段以胰岛素抵抗和高胰岛素血症为特征,这些因素会导致糖尿病发病和初始阶段的骨密度(bone mineral density,BMD)增加。而晚期阶段的特征是β细胞衰竭,AGEs和氧化产物的堆积,加速衰老和血管并发症的发展。为此,本文希望对T2DM的不同阶段与骨代谢的关系进行综述,以便更好的认识T2DM的进展加速骨脆性风险的病理过程和致病机制,为治疗T2DM和T2DM诱发的OP、降低T2DM患者骨折发生的风险发挥积极的作用。     

动机性访谈在老年2型糖尿病患者教育中的应用

目的探讨动机性访谈对老年2型糖尿病患者行为改变和糖化血红蛋白的影响。方法将80例住院老年2型糖尿病患者随机分为观察组和对照组各40例。观察组采用动机性访谈干预;对照组采用常规健康教育方法。干预前及干预后6周、3个月、6个月分别评估两组患者自我管理能力,同时在干预前、干预后第3、6个月检测糖化血红蛋白。结果观察组干预后不同时间点糖尿病自我管理能力总分及多维度均分显著高于干预前及对照组(P<0.05,P<0.01);与干预前比较,观察组患者干预后第3个月HbAlc显著下降(P<0.05)。结论动机性访谈在提高患者糖尿病自我管理能力及血糖控制水平方面具有明显的促进作用。     

Evaluation of the Finnish Diabetes Risk Score to predict type 2 diabetes mellitus in a Colombian population: A longitudinal observational study

AIM: To assess the performance of the Finnish Diabetes Risk Score(FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus(DM2) in a Colombian population.METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects(age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital's database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence. RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women. CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.     

Metabolically healthy obesity: Is it really healthy for type 2 diabetes mellitus?

Metabolically healthy obese (MHO) individuals are reported to have a lower risk of developing cardiovascular diseases in comparison with individuals with metabolic syndrome. However, the association between MHO and type 2 diabetes (T2DM) is still controversial. Some studies indicated that MHO is a favorable phenotype for T2DM, but more studies showed that MHO individuals have an increased risk of developing T2DM compared with metabolically healthy normal-weight individuals, especially among those who would acquire metabolically unhealthy obesity. This has been supported by finding insulin resistance and low-grade inflammatory responses in MHO individuals with a tendency for impaired beta-cell dysfunction. Studies also showed that liver fat accumulation increased the risk of incidence of T2DM in MHO. Here, we reviewed current literature on the relationship between MHO and T2DM, discussed the determinants for the development of diabetes in MHO, and summarized the measures for the prevention of T2DM in MHO.     

功能MRI评估2型糖尿病早期肾损害研究进展

糖尿病肾病（DKD）是糖尿病微血管并发症，亦为导致终末期肾脏病的主要原因。早期诊断、及时干预可有效控制DKD病情进展并改善预后。近年来，功能MRI （fMRI）逐渐用于定量评估2型糖尿病（T2DM）患者早期肾损害。本文就fMRI评估T2DM早期肾损害研究进展进行综述。     

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

Hepatitis C virus(HCV) infection and diabetes mellitus are two major public health problems that cause devastating health and financial burdens worldwide. Diabetes can be classified into two major types: type 1 diabetes mellitus(T1DM) and T2 DM. T2 DM is a common endocrine disorder that encompasses multifactorial mechanisms, and T1 DM is an immunologically mediated disease. Many epidemiological studies have shown an association between T2 DM and chronic hepatitis C(CHC) infection. The processes through which CHC is associated with T2 DM seem to involve direct viral effects, insulin resistance, proinflammatory cytokines, chemokines, and other immunemediated mechanisms. Few data have been reported on the association of CHC and T1 DM and reports on the potential association between T1 DM and acute HCV infection are even rarer. A small number of studies indicate that interferon-α therapy can stimulate pancreatic autoim-munity and in certain cases lead to the development of T1 DM. Diabetes and CHC have important interactions. Diabetic CHC patients have an increased risk of developing cirrhosis and hepatocellular carcinoma compared with nondiabetic CHC subjects. However, clinical trials on HCV-positive patients have reported improvements in glucose metabolism after antiviral treatment. Further studies are needed to improve prevention policies and to foster adequate and cost-effec-tive programmes for the surveillance and treatment of diabetic CHC patients.     

Age of onset of diabetes and all-cause mortality

Diabetes mellitus continues to present a large social, financial and health system burden across the world. The relationship between age of onset of the different types of diabetes and all-cause mortality is uncertain. In this review paper, the relationship between age of onset of the different types of diabetes and all-cause mortality will be reviewed and an update of the current evidence will be presented. There is strong evidence of the relationship between age of onset of type 2 diabetes mellitus (T2DM) and all-cause mortality, good evidence of the relationship between age of onset of T1DM and all-cause mortality and no evidence of the relationship between age of onset of gestational diabetes or prediabetes and all-cause mortality. Further research is needed to look at whether aggressive management of earlier onset of T2DM can help to reduce premature mortality.