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1.
A Franssila-Kallunki A Rissanen A Ekstrand A Ollus L Groop 《The American journal of clinical nutrition》1992,55(2):356-361
To evaluate the effect of weight loss on substrate oxidation, energy expenditure, and insulin sensitivity we studied 12 obese subjects (body mass index 33.4 +/- 1.1) before and after 6 wk of a very-low-calorie diet (VLCD) with euglycemic insulin clamp in combination with indirect calorimetry. Body weight decreased from 105.3 +/- 4.6 to 94.1 +/- 4.0 kg (P less than 0.001) and fat mass from 47.2 +/- 3.6 to 37.7 +/- 3.0 kg (P less than 0.001). Total glucose disposal during insulin clamp increased from 30.4 +/- 4.3 to 38.4 +/- 4.4 mumol.kg lean body mass (LBM)-1.min-1 (P less than 0.05), insulin-stimulated glucose oxidation from 14.3 +/- 4.6 to 19.1 +/- 1.4 mumol.kg LBM-1.min-1 (P less than 0.05), and non-oxidative glucose metabolism from 16.0 +/- 3.8 to 19.3 +/- 3.6 mumol.kg LBM-1.min-1 (NS). Lipid oxidation decreased in the basal state (P less than 0.05) and during the insulin clamp (P less than 0.01). The basal rate of energy expenditure decreased from 99.1 +/- 4.6 to 88.5 +/- 2.7 kJ.kg LBM-1.min-1 (P less than 0.05) after weight reduction. A reduction in fat mass achieved by VLCD is associated with reduced lipid oxidation and, because of substrate competition, enhanced glucose oxidation. The physiological consequence is improved insulin sensitivity. 相似文献
2.
Insulin resistance precedes microalbuminuria in patients with insulin-dependent diabetes mellitus 总被引:4,自引:1,他引:3
Background. Insulin resistance has been associated
with hypertension and with renal complications in patients with type 1
diabetes mellitus. Causal relationships have not been fully explained.
Methods. We investigated whether insulin resistance
precedes microalbuminuria by measuring insulin resistance with a
euglycaemic clamp in combination with indirect calorimetry in 16
uncomplicated type 1 diabetic patients and in six healthy control subjects.
The patients had over 10 year duration of diabetes, and were expected to
experience either a complication-free or complicated disease course within
the next few years. They have thereafter been followed for the development
of microalbuminuria for 3 years. Results. In a
euglycaemic insulin clamp glucose disposal was lower in diabetic patients
compared with control subjects (7.5±2.9 and 12.6±2.0
mg/kg LBM/min; P<0.002), mainly due to impaired
glucose storage (4.3±2.3 vs
8.6±1.6 mg/kg LBM/min; P<0.001).
Three years later seven IDDM patients had albumin excretion rate over 30
mg/24 h; glucose disposal (5.5±2.1 vs
9.0±2.2 mg/kg LBM/min; P<0.01) had
been lower in patients who developed microalbuminuria compared with those
who remained normoalbuminuric. Conclusions. Insulin
resistance predicts the increment in urinary albumin excretion. Insulin
resistance depends mainly on impaired glucose storage in uncomplicated
IDDM. 相似文献
3.
PURPOSE: To study the ability of the alternative classification of the Wisconsin Study to predict progression to retinopathy requiring laser treatment in patients with diabetes. METHODS: A total of 1585 diabetic patients were included in the study. Of them, 294 (19%) were diagnosed with diabetes before and 1291 (81%) after age 30 years. Retinopathy was diagnosed on fundus photographs using a modification of the Wisconsin scale, and graded into 6 levels according to the worse eye. The first visit during the study period was used to represent baseline examination. The time points for detection of proliferative retinopathy (PDR) and clinically significant macular oedema (CSME) were recorded during a mean follow-up time of 2.9 years. RESULTS: Progression to PDR and/or CSME was significantly related to increasing severity of retinopathy at baseline (p<0.001; test for trend). Fifty per cent of patients with severe non-proliferative retinopathy (NPDR) (level 51) at entry progressed within one year to PDR and/or CSME; the 3-year risk for such progression in patients with mild (level 31) and moderate NPDR (level 41) was 25 and 60%, respectively. The incidence of progression to PDR and to CSME was 0.95 and 2.3/100 person-years, respectively. Progression to PDR and/or CSME was furthermore associated with a higher level of glycosylated haemoglobin, longer duration of the diabetes and use of antihypertensive treatment. CONCLUSION: Increasing severity of retinopathy as recorded by this modification of the alternative classification of the Wisconsin Study was significantly associated with increased risk of progression to retinopathy requiring treatment. 相似文献
4.
Fagerudd JA Pettersson-Fernholm KJ Riska MK Grönhagen-Riska C Groop PH 《Kidney international》2000,58(3):959-965
BACKGROUND: In non-insulin-dependent diabetes mellitus (NIDDM), there is a clustering of an elevated urinary albumin excretion rate (U-AER) in nondiabetic relatives of albuminuric patients. Whether this is also the case in insulin-dependent diabetes mellitus (IDDM) is unknown. METHODS: Overnight U-AER was measured in 186 nondiabetic first-degree relatives of 80 IDDM patients with diabetic nephropathy (U-AER > 200 microg/min or 300 mg/24 hours; DN+) and in 52 relatives of 25 IDDM patients without nephropathy (U-AER < 20 microg/min; DN-). The two groups of relatives were comparable regarding gender distribution, age, obesity, blood pressure, prevalence of antihypertensive therapy, and smoking habits. RESULTS: No difference was found in overnight U-AER between relatives of patients with DN+ and DN- [median (range), 3.4 (0.1 to 372) vs. 4.0 (0.2 to 62) microg/min, respectively, P = NS]. The proportion of relatives with a U-AER = 10 microg/min was 12% in DN+ compared with 8% in DN- (P = NS). Among relatives of DN+, those with antihypertensive treatment (AHT+) had higher U-AER compared with those without [AHT+ vs. AHT-, 5.0 (0.5 to 372) vs. 3.4 (0.1 to 26.5) microg/min, P < 0.01], a phenomenon that was not seen among relatives of DN-[AHT + vs. AHT-, 3.6 (2.1 to 24.3) vs. 4.0 (0. 2 to 61.5) microg/min, P = NS]. However, this analysis was impaired by the small number of relatives of DN- with hypertension (N = 7). CONCLUSIONS: In IDDM, we found no clustering of elevated U-AER in nondiabetic relatives of patients with nephropathy. This is different from what has been reported in NIDDM, and suggests heterogeneity in the genesis of albuminuria in diabetes. 相似文献
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People with diabetes hold major responsibility for the day‐to‐day management of their chronic condition. The management that, amongst others, includes blood glucose monitoring, medication taking, diet and physical activity, aims at normalizing blood glucose levels. In many individuals, the level of glycaemia, however, frequently exceeds the recommendations. This observation, together with patients' and practitioners' reports, suggests that active self‐management is suboptimal. Various reasons, both individual and environment related, contribute to the suboptimal concordance with treatment regimen. The aim of this review is to discuss some of the barriers to optimal diabetes self‐management. 相似文献
10.
Martinus Richter Per-Henrik Agren Jean-Luc Besse Maria Coester Hakon Kofoed Nicola Maffulli Martijn Steultjens Amir Reza Vosoughi Milad Bahari 《Foot and Ankle Surgery》2021,27(5):496-500
BackgroundThe Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish). From other languages under validation, the Persian version finished data acquisition and underwent further validation.MethodsThe Persian version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Persian version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.ResultsThe internal consistency was confirmed in the Persian version (Cronbach’s Alpha 0.82). The Standard Error of Measurement (SEM) was 0.38 and is similar to other language versions. Between baseline and follow-up, 97% of patients showed an improvement on their EFAS score, with excellent responsiveness (effect size 1.93).ConclusionsThe Persian EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co. 相似文献