1,721,019 research outputs found
Diabetes secondary to endocrine disorders and PCOS.
No full textA number of hormones participate physiologically in the regulation of blood glucose levels, and alterations in their production may cause hyperglycemia. In particular, hormones involved in the counterregulatory response to insulin, such as glucagon, catecholamines, cortisol, or GH, have a potent hyperglycemic action. Although abnormal overproduction of these hormones is rare, these forms of secondary diabetes should be recognized because they merit specific treatments and can even be cured by appropriate management. Exogenous glicorticoid excess is a more common cause of iatrogenic secondary diabetes, which may especially occur in subjects who have risk factors for type 2 diabetes. Somatostatin-secreting tumors, which are very rare, may also cause hyperglycemia, due to inhibition of insulin secretion. Similarly, treatment of some endocrine disorders by somatostatin analogs, particularly pasireotide, may induce hyperglycemia and secondary diabetes. Moreover, several other hormones modulate metabolic processes, with potential alterations of glucose levels in the case of abnormalities in their production. In particular, thyroid hormones regulate several steps of the glucose metabolism, with increased supply of glucose to tissues. In physiological conditions, these effects allow the body to meet the increased energy demand induced by thyroid hormones. However, thyroid dysfunction, especially hyperthyroidism, is associated with frequent alteration of glucose tolerance, with complex interactions with insulin action. There is evidence that sex hormones, by mechanisms that are still not completely understood, may also affect metabolic processes, including impaired insulin sensitivity. In particular, abnormalities in serum androgens are frequently associated with altered glucose levels. In this regard, there is a striking sexual dimorphism, as glucose intolerance is associated with reduced serum testosterone in men, but with increased serum testosterone in women. This latter phenomenon may be especially found in women with the polycystic ovary syndrome (PCOS), who are often insulin resistant. However, PCOS is a heterogeneous condition. Distinguishing the different clinical phenotypes of this syndrome is helpful in estimating the individual risk of metabolic abnormalities of these subjects
Insulin resistance and PCOS: chicken or egg?
No full textPCOS is a common and heterogeneous endocrine disorder in women of reproductive age, frequently associated with metabolic abnormalities. It was estimated that about 75% of these subjects have an impairment of insulin action, as measured by gold standard methods. While the relationship between insulin resistance and PCOS is consistently shown by a number of studies, the mechanisms underlying its primary origin still remains an unsolved issue. Insulin resistance and the associated hyperinsulinemia can induce both the endocrine and reproductive traits of PCOS. However, androgen excess, in turn, can impair insulin action, directly and/or through several changes occurring in different tissues. Body fat excess, which is another common feature in these women, can contribute to worsening the whole picture. Nevertheless, insulin resistance may also be found in many normal-weight individuals. Endocrine and metabolic abnormalities can develop in different moments, and probably there is fetal programming of these alterations. However, a number of vicious circles, with bidirectional relationships between androgen excess and insulin resistance, and with the contribution of several other factors, make it extremely difficult to understand where this process really originates. This review summarizes available evidence on this topic, in order to better understand the complex relationships linking hyperandrogenism and impaired insulin action in women with PCOS
Effetti dell’esercizio fisico in prevenzione e terapia del diabete.
No full textIl diabete, nelle sue diverse forme, è una patologia variegata e di grande rilevanza, con elevati costi individuali e collettivi. Chiare evidenze mostrano che l’esercizio fisico è uno strumento fondamentale di prevenzione del diabete tipo 2 e, probabilmente, anche del diabete gestazionale. In termini di cura tutte le forme di diabete possono beneficiare, in modo diverso, da un’attività fisica regolare. Questo è particolarmente vero per il diabete tipo 2, patologia in cui l’esercizio fisico è a tutti gli effetti uno strumento di terapia, dato che agisce sui meccanismi patogenetici della malattia, sull’eccesso ponderale, sui livelli circolanti del glucosio e sull’insieme dei fattori di rischio cardiovascolare, quindi sul controllo metabolico e sul rischio di complicanze croniche. Nel complesso, sia il training aerobico che quello di forza hanno azioni benefiche in questa forma di diabete e la loro combinazione dovrebbe essere prescritta ogniqualvolta sia possibile. In questi pazienti anche l’interruzione della sedentarietà protratta ha effetti metabolici positivi e dovrebbe essere raccomandata, laddove questo sia appropriato, accanto all’esercizio strutturato
The Multiple Functions of Insulin Put into Perspective: From Growth to Metabolism, and from Well-Being to Disease
Full text link: Insulin has pleiotropic effects, and is of importance both as a key regulator of glucose metabolism and as a growth factor [...]
Monitoring exercise intensity in diabetes: applicability of "heart rate-index" to estimate oxygen consumption during aerobic and resistance training
No full textPURPOSE: Accurate quantification and monitoring of exercise "dose", described by oxygen consumption (VO2), is necessary for exercise prescription and individualization. However, due to the complexity and elevated cost of direct, gold-standard methods, this is rarely done outside research laboratories. Heart rate-index (HRindex) is a new simple method to estimate VO2 in healthy and clinical populations. We tested the performance of HRindex to estimate VO2 in diabetic patients during aerobic (AT) and isotonic training (IT). METHODS: Data from 12 males (age: 64 ± 5 years; BMI: 26 ± 12) with type 2 diabetes were analysed. VO2 and heart rate were measured during one AT and one IT session. Furthermore, VO2 was indirectly estimated based on HRindex. Then, the correspondence between measured and estimated VO2 was evaluated by two-way RM-ANOVA, correlation and Bland-Altman analysis. RESULTS: Estimated average VO2 values during AT (1292 ± 366 ml/min) were not different from (p = 0.243) and highly correlated with (r = 0.87, p < 0.001) the measured values (1369 ± 417 ml/min), with a small bias and imprecision. Conversely during IT, HRindex overestimated VO2 compared to the actual measures (1048 ± 404 vs 667 ± 230 ml/min, p ≤ 0.001) and only a moderate correlation was found between values (r = 0.43, p ≤ 0.001), with a large bias and imprecision. CONCLUSION: VO2 of aerobic exercises can be accurately estimated in diabetes patients using HRindex. During isotonic exercise, this method is not recommended for monitoring metabolic intensity due to large overestimation and imprecision. In aerobic exercise, HRindex offers a simple and valid alternative to the direct VO2 determination and may favour the applicability of time-resolved measures of exercise "dose"
Editorial: Effects of pharmacologic therapy for diabetes mellitus on the endocrine system
No full textAmong non-communicable diseases, type 2 diabetes mellitus (T2DM) is significantly increasing not only in the western populations but also in those from East and South Asian countries such as China and India. Therefore, its macrovascular (i.e. cardiovascular) and microvascular damages are expected to rise worldwide, with a significant increase in social and economic burden of diabetes. In those diabetic patients not achieving therapeutic targets by means of lifestyle measures, pharmacologic therapy must be considered. Interestingly, the new glucoselowering agents - in particular glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) - have been associated with a number of extra-glycaemic effects, including cardiovascular benefits, nephron protection, and weight loss, reducing both morbidity and mortality in patients with type 2 diabetes and substantially improving the clinical management of this condition. This still limited body of work indicates a potential great interest in the extra-glycaemic actions of these new classes of antidiabetic drugs, particularly on the endocrine system. It can be expected that in the next years the choice of the pharmacological treatments for subjects with type 2 diabetes will be increasingly done not only according to HbA1C targets, costs, and potential side effects, but also for the capacity of drugs to prevent and/or treat organ damage, including in this concept both classical and nonclassical targets (i.e. kidney, heart, bone, testis, etc.). Nevertheless, further studies are required to clarify the relationships between antidiabetic drugs action and effects on these targets, independently of glucose control
Current treatment for Polycystic Ovary Syndrome: focus on adolescence
Full text linkPolycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women and it is associated with an increased rate of infertility. Its etiology remains largely unknown, although both genetic and environmental factors play a role. PCOS is characterized by insulin resistance, metabolic disorders and low-grade chronic inflammation. To date, the treatment of PCOS is mainly symptomatic and aimed at reducing clinical signs of hyperandrogenism (hirsutism and acne), at improving menstrual cyclicity and at favoring ovulation. Since PCOS pathophysiology is still largely unknown, the therapeutic interventions currently in place are rarely cause-specific. In such cases, the therapy is mainly directed at improving hormonal and metabolic dysregulations typical of this condition. Diet and exercise represent the main environmental factors influencing PCOS. Thus, therapeutic lifestyle changes represent the first line of intervention, which, in combination with oral contraceptives, represent the customary treatment. Insulin resistance is becoming an increasingly studied target for therapy, most evidence stemming from the time-honored metformin use. Relatively novel strategies also include the use of thiazolidinediones and GLP1-receptor agonists. In recent years, a nutraceutical approach has been added to the therapeutic toolkit targeting insulin resistance. Indeed, emerging data support inositol and alpha-lipoic acid as alternative compounds, alone or in combination with the aforementioned strategies, with favorable effects on ovulation, insulin resistance and inflammation. Nevertheless, additional studies are required in adolescents, in order to assess the effectiveness of diet supplements in preventing negative impacts of PCOS on fertility in adult age. This review focuses on the main therapeutic options for PCOS to date
Walking for subjects with type 2 diabetes: A systematic review and joint AMD/SID/SISMES evidence-based practical guideline
Full text linkAIMS: Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects.DATA SYNTHESIS: Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior.CONCLUSIONS: There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use. This article is co-published in the journals Sport Sciences for Health and Nutrition, Metabolism and Cardiovascular Diseases
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