Diabesity (E-Journal)
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Retinal multispectral imaging of ‘sub-clinical’ capillary micro-aneurysms in non-diabetics correlates with insulin resistance
No full textInsulin resistance (IR), short of diabetes mellitus, negatively impacts retinal vessel health. The purpose of this study was to evaluate the correlation between the number of sub-clinical retinal micro-aneurysms (MA#) identifiable by highly sensitive 580 nm multi-spectral retinal imaging (MSI 580 nm) and serological and calculated IR measures. Thirty (n=19 M; n=11 F) non-diabetic optometrists (n=54 eyes), 53.5 ± 7.6 years, were imaged at a professional conference using multispectral imaging (MSI) of the retina (RHATM, Annidis Corporation, Ottawa, Canada). A six parameter blood panel requisition: fasting glucose (FBS), 2 hr glucose (GTT) tolerance, HbA1c, fasting insulin, 2 hr insulin and 25 OH vitamin D liver reserve status were provided to each participant. MSI retinal images were reviewed and the MA# in the central 30 degrees were counted. The calculated clinical parameters used to diagnose IR were most highly correlated with retinal MA#, specifically insulin sensitivity. Subclinical MA#, less visible to non-spectral cameras but observed with multispectral imaging, correlate with insulin, pancreatic function and calculated measures of IR, more closely than FBS and vitamin D status. Future diabetes intervention research should focus upon MSI MA# and IR as actionable pre-diabetes and pre-retinopathy risk factors
The enigma of uric acid in metabolic syndrome
Get PDFMetabolic syndrome is a group of risk factors including an increased level of triglycerides, fasting blood glucose, blood pressure or waist circumference, and or a decreased level of HDL cholesterol. The level of uric acid in the blood has been associated with the presence of metabolic syndrome, which can aggravate the prognosis of cardiovascular diseases, type 2 diabetes mellitus and stroke. On the interest to identify the early biomarkers of metabolic syndrome, Popovic et al involved 1333 patients and showed using logistic regression that a significant association between the blood levels of uric acid in the subjects diagnosed with metabolic syndrome and in the group of obese patients, who had the body mass index of more than 30 kg/m2. This study shed some light in identifying a metabolically unhealthy phenotype
Matrix metalloproteinases and the vascular smooth muscle cell migration in hypertension
Get PDFVascular smooth muscle cells (VSMC) migration and proliferation may be the main precursors of the chronic and maladaptive vascular remodeling in hypertension. The proteolysis of extracellular matrix and the phenotype switch of VSMC need to occur in order to allow VSMC migration and the vascular remodeling and hypertrophy. The matrix metalloproteinases (MMPs) are well known to degrade many extracellular matrix and non-extracellular matrix components to favor VSMC migration and their phenotype switch. Targeting MMPs may reduce VSMC migration and the arterial maladaptation caused by hypertension and its cardiovascular events
Canagliflozin in the treatment of diabetes: Perspectives
Get PDFThe worldwide prevalence of type 2 diabetes mellitus (T2DM) has surpassed more than 380 million people in 2014 and the projections of new T2DM cases for the next years are not encouraging. At present, combination of diet and exercise do not guarantee an adequate control of glucose homeostasis in T2DM patients. Thus, oral agents that act improving peripheral insulin sensitivity and/or pancreatic beta-cell function are additionally used as monotherapy or in combination. However, many patients still experience inadequate control with the pharmacotherapy ‘weapons’ currently available. Canagliflozin is a novel selective inhibitor of sodium-glucose co-transporter 2 (SGLT2) that lowers blood glucose concentration mainly by augmenting urinary glucose excretion. Besides having an effective action in reducing HbA1c, canagliflozin treatment also may benefit those patients aiming to control body weight, blood pressure and hypoglycemia episodes since this drug positively impact on such parameters. Among the adverse effects, genital infections are the most frequent. Much caution is required for some groups of patients including those elderly and with chronic kidney disease since canagliflozin can worse their quality of life. Given its overall cardiometabolic improvements, canagliflozin seems to be an important ally to the treatment of a selective group of T2DM patients and its efficacy and safety must be kept under monitoring through long-term clinical trials as well as experimental studies to certify whether this class of drug comes to stay among T2DM therapy
Hyperinsulinemia: A unifying theory of chronic disease?
Get PDFGlobally, there is an increasing prevalence of non-communicable diseases. The morbidity and mortality from these conditions confer a greater economic societal burden. Epidemiological research associates insulin resistance in the etiology of these diseases, but there is limited evidence for the mechanism of damage. Emerging research suggests that hyperinsulinemia, a symptom of insulin resistance, may cause these pathological changes, and therefore be an independent contributor to these diseases. This review shows that hyperinsulinemia, or excessive insulin secretion, should be considered independently to insulin resistance, defined as glucose uptake rate, even though the two conditions are intertwined and will co-exist under normal conditions. Hyperinsulinemia directly and indirectly contributes to a vast array of metabolic diseases including all inflammatory conditions, all vascular diseases, gestational and type 2 diabetes, non-alcoholic fatty liver disease, obesity and certain cancers and dementias. The mechanisms include increased production of: insulin growth factor-1; reactive oxidative species and advanced glycation end-products; and triglyceride and fatty acids. Hyperinsulinemia also directly and indirectly affects many other hormones and cytokine mechanisms including leptin, adiponectin and estrogen. There is limited research standardizing the hyperinsulinemia diagnostic process. Methodological concerns and lack of standardized reference ranges preclude the use of fasting insulin. Most research has also focused on insulin resistance and it is unknown whether these methods translate to hyperinsulinemia
Lorcaserin: Making headway
Get PDFObesity is a global problem which has reached epidemic proportions. Obesity is morbidly associated with metabolic syndrome, type-2 diabetes, cardiovascular disease and increased cancer risk. There is an alarming increase in the incidence of obesity in young children which puts them at a greater risk for developing diseases at a much earlier age. Obesity also imposes a heavy burden on the healthcare system. Lorcaserin, a novel anti-obesity drug, is a selective agonist to 5-HT2C receptors thereby reducing food intake and promoting weight loss. Lorcaserin has 15-times and 100-times higher selectivity for the 5-HT2C receptor compared to the 5-HT2A and 5-HT2B receptors, respectivel
Effects of barley on post-prandial glycemic response
Get PDFBarley contains very high levels of dietary fibre and β-glucan relative to other cereal grains, offering potential as a postprandial glycemic response lowering agent for the growing number of individuals looking to manage blood glucose levels. Although research is generally supportive of the PPGR lowering effect of β-glucan, there are still gaps in our understanding of 1) the precise mechanism by which β-glucan lowers blood glucose, and 2) how the PPGR after barley consumption may be influenced by factors that may alter β-glucan molecular weight and/or viscosity
Uric acid level and the presence of metabolic syndrome: experiences from Vojvodina Region in Serbia
Get PDFIntroduction: Uric acid level (UAL) might represent an indirect marker of metabolic syndrome (MS). Study investigates differences in UAL in the overall study group and in separate groups of normal weight, overweight and obese subjects, regarding the presence of MS. Materials and Methods: Cross sectional study included 1333 participants. Anthropometrical measurements and relevant blood analysis were performed. For diagnosis of MS we used NCEP ATP III criteria. Results: 50.64% of the participants have fulfilled criteria for MS diagnosis. In the overall study group, participants with MS were older (
Role of multimeric forms of adiponectin in metabolic disorders
Get PDFAdiponectin, also called Acrp30, is a 30-kDa protein that circulates in the blood at high levels (2-10 µg/ml in human) and constitutes 0.01% of the total plasma protein. In contrast to other adipokines such as leptin, adiponectin is believed to be an anti-inflammatory and insulin-sensitizing hormone whose levels are reduced in obesity. Adiponectin can exist in the blood as a trimer, with the potential to associate into hexamers and ï¬nally into multimers of high molecular weight (HMW) species. Adiponectin primarily mediates its insulin-sensitizing effects through various signaling proteins including the activation of adenosine monophosphate (AMP)-activated protein kinase (AMPK). Recent reports suggest the anti-inflammatory and cytoprotective effects of adiponectin are mediated by direct activation of PI3K-Akt pathway. Interestingly adiponectin is also reported to decrease body weight by centrally mediated stimulation of energy expenditur
Endoplasmic reticulum stress in the pathogenesis of diabetes
Get PDFThe accumulation of unfolded protein in the endoplasmic reticulum (ER) causes ER stress. Cells activate unfolded protein responses (UPR) to cope with such a stressful situation. Increasing evidence suggests that ER stress is involved in the pathogenesis of diabetes, especially insulin resistance and the impairment of insulin secretion. In addition, several UPR components have been suggested to play a key role in diabetes. In the present review, we summarize and discuss recent knowledge of ER stress regarding the pathogenesis of diabetes