1,720,991 research outputs found
Subclinical Hypothyroidism and Metabolic Syndrome: A Common Association by Chance or a Cardiovascular Risk Driver?
No full textThe metabolic syndrome (MS) and subclinical hypothyroidism (SCH) are highly prevalent in the general population. Cross-sectional epidemiological data suggest that a mutual association exists between the two, although the cause-effect relationship remains poorly elucidated. As SCH raises cholesterol, blood pressure, and visceral fat, it is easy to understand why it associates with MS. Rather, the reasons whereby MS patients are at higher risk for SCH are less apparent. Some studies have reported that SCH is itself characterized by high cardiovascular risk. Therefore, the coexistence of SCH and MS may identify subjects at a particularly high risk for future cardiovascular events. Recent data published in Metabolic Syndrome and Related Disorders indicate that carotid intima-media thickness, a marker of initial atherosclerosis and a possible predictor of future events, is higher in patients with both SCH and MS than in the presence of each condition alone. In this Editorial, we discuss the clinical implications of SCH and MS association and the interpretation of such recent findings
Euglycemic Ketoacidosis
No full textPurpose of Review Diabetic ketoacidosis is a life-threatening complication of diabetes characterized by hyperglycemia, acidosis, and ketosis. Ketoacidosis may occur with blood glucose level < 200 mg/dl (improperly defined as euglycemic ketoacidosis, euKA) and also in people without diabetes. The absence of marked hyperglycemia can delay diagnosis and treatment, resulting in potential serious adverse outcomes. Recent Findings Recently, with the wide clinical use of sodium glucose co-transporter 2 inhibitors (SGLT2i), euKA has come back into the spotlight. Use of SGLT2i use can predispose to the development of ketoacidosis with relatively low or normal levels of blood glucose. This condition, however, can occur, in the absence of diabetes, in settings such as pregnancy, restriction on caloric intake, glycogen storage diseases or defective gluconeogenesis (alcohol abuse or chronic liver disease), and cocaine abuse. euKA is a challenging diagnosis for most physicians who may be misled by the presence of normal glycemia or mild hyperglycemia. In this article, we review pathophysiology, etiologies, clinical presentation and the management of euKA
Angiogenic Abnormalities in Diabetes Mellitus: Mechanistic and Clinical Aspects
No full textDiabetes causes severe pathological changes to the microvasculature in many organs and tissues and is at the same time associated with an increased risk of coronary and peripheral macrovascular events. We herein review alterations in angiogenesis observed in human and experimental diabetes and how they contribute to diabetes onset and development of vascular complications
SGLT2 inhibitors and diabetic ketoacidosis: data from the FDA Adverse Event Reporting System
Full text linkSodium-glucose co-transporter-2 inhibitors (SGLT2i) are indicated for the treatment of type 2 diabetes and may also improve glucose control in type 1 diabetes. In 2015, regulatory agencies warned that SGLT2i may favour diabetic ketoacidosis (DKA). We provide a detailed analysis of DKA reports in which an SGLT2i was listed among suspect or concomitant drugs in the US Food and Drug Administration Adverse Event Reporting System (FAERS)
Sodium-glucose co-transporter-2 inhibitors and diabetic ketoacidosis: An updated review of the literature
No full textEffects of SGLT2 inhibitors on circulating stem and progenitor cells in patients with type 2 diabetes
No full textSynergistic Interactions Among Metabolic Syndrome Components and Homeostasis Model Assessment of Insulin Resistance in a Middle-Aged General Population over Time.
No full textBackground: Insulin resistance is considered a hallmark feature of the metabolic syndrome, but how metabolic syndrome components and insulin resistance measures interact over time is unclear. The homeostasis model assessment of insulin resistance (HOMA-IR) is a static index of insulin resistance typically used in epidemiological studies. We explored how HOMA-IR is affected by clustering metabolic syndrome components over time in a population of middle-aged, healthy subjects.
Methods: A total of 1757 subjects aged 41.3 +/- 7.5 years (39% males) free from diabetes at baseline were followed-up for a median of 5.7 years. At baseline and at the end of observation, we determined metabolic syndrome components and HOMA-IR.
Results: Cross-sectionally, HOMA-IR was synergistically increased by clustering of at least two to three metabolic syndrome components as determined at baseline and at study end by departure from additivity. Some combinations of metabolic syndrome components were associated with a significant synergic increase in HOMA-IR, and some combinations of two components entailed a synergistic risk of developing metabolic syndrome. Over time, the average change in HOMA-IR was more than additively affected by change in the number of metabolic syndrome components. Baseline HOMA-IR values were predictive of incident metabolic syndrome independent from age, sex, and each metabolic syndrome component.
Conclusions: We show synergistic interaction between clustering metabolic syndrome components and insulin resistance, estimated by HOMA-IR, cross-sectionally and over time. This more than additive effect explains the incremental value of HOMA-IR in predicting metabolic risk
The Toll of Lockdown Against COVID-19 on Diabetes Outpatient Care: Analysis From an Outbreak Area in Northeast Italy
No full textLong-term Prediction of Cardiovascular Outcomes by Circulating CD34+ and CD34+CD133+ Stem Cells in Patients With Type 2 Diabetes
No full textOBJECTIVE:
Cardiovascular risk varies substantially in the population with diabetes, and biomarkers can improve risk stratification. Circulating stem cells predict future cardiovascular events and death, but data for the population with diabetes are scant. In this study we evaluated the ability of circulating stem cell levels to predict future cardiovascular outcomes and improve risk discrimination in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS:
A cohort of 187 patients with type 2 diabetes was monitored for a median of 6.1 years. The primary outcome was time to a first cardiovascular event, defined as 3-point major adverse cardiovascular event (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) plus hospitalization for cardiovascular causes. At baseline, we measured six stem/progenitor cell phenotypes in peripheral blood based on expression of CD34, CD133, and KDR.
RESULTS:
The primary outcome occurred in 48 patients (4.5/100 patient-years). Patients with incident cardiovascular events had significantly lower CD34+ and CD34+CD133+ cells than those without. Higher rates of cardiovascular events occurred in patients with below median levels of CD34+ and CD34+CD133+. In Cox proportional hazard regression analyses, a reduced CD34+ (hazard ratio 2.21 [95% CI 1.14-4.29]) and CD34+CD133+ (2.98 [1.46-6.08]) cell count independently predicted future events. Addition of the CD34+ cell count to the reference model or the UK Prospective Diabetes Study risk engine improved C statistics, continuous net reclassification improvement, and/or integrated discrimination index.
CONCLUSIONS:
In patients with type 2 diabetes, a reduced baseline level of circulating CD34+ stem cells predicts adverse cardiovascular outcomes up to 6 years later and improves risk stratificatio
Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy
Full text linkIn late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D)
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