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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pancreas is the central organ for digestion and for control of glucose homeostasis. Indications for major pancreatic surgery are complications of chronic and acute pancreatitis and pancreatic malignancies. The postoperative pancreatic function is determined by type of resection, resection of adjacent organs, the underlying disease and preoperative pancreatic function. Standard treatment following major pancreatic surgery includes the administration of pancreatic enzyme preparations and inhibition of acid secretion by proton pump inhibitors. Postoperatively most patients also develop diabetes mellitus, which requires insulin substitution. Hypoglycemia is the most difficult clinical problem to handle following total pancreatectomy.
Best Pract Res Clin Gastroenterol 2004 Oct
PMID:Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. 1549 88

The glucagon-like peptides (glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2)) are released from enteroendocrine cells in response to nutrient ingestion. GLP-1 enhances glucose-stimulated insulin secretion and inhibits glucagon secretion, gastric emptying and feeding. GLP-1 also has proliferative, neogenic and antiapoptotic effects on pancreatic beta-cells. More recent studies illustrate a potential protective role for GLP-1 in the cardiovascular and central nervous systems. GLP-2 is an intestinal trophic peptide that stimulates cell proliferation and inhibits apoptosis in the intestinal crypt compartment. GLP-2 also regulates intestinal glucose transport, food intake and gastric acid secretion and emptying, and improves intestinal barrier function. Thus, GLP-1 and GLP-2 exhibit a diverse array of metabolic, proliferative and cytoprotective actions with important clinical implications for the treatment of diabetes and gastrointestinal disease, respectively. This review will highlight our current understanding of the biology of GLP-1 and GLP-2, with an emphasis on both well-characterized and more novel therapeutic applications of these peptides.
Best Pract Res Clin Endocrinol Metab 2004 Dec
PMID:Clinical endocrinology and metabolism. Glucagon-like peptide-1 and glucagon-like peptide-2. 1553 74

Exercise provides a means of increasing energy expenditure and may help adjust energy balance for weight loss and maintenance. At least 30 minutes a day of moderate intensity aerobic exercise per day is recommended for weight loss and maintenance but greater amounts appear to increase the magnitude of weight loss and maintenance. Resistance training has recently been shown to have positive effects on body composition but does not typically show significant decreases in weight. Regardless of weight loss, both aerobic exercise and resistance training have been shown to diminish risk factors for cardiovascular disease and diabetes. Since exercise is only effective if sustained, behavioural strategies such as self-monitoring, goal setting, social support, etc. are used to help individuals start and maintain exercise programs and show improved results compared to exercise programs without behavioural strategies. The available evidence indicates that exercise is an important component of weight loss and perhaps the best predictor of weight maintenance.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:The role of exercise for weight loss and maintenance. 1556 36

Non-alcoholic fatty liver disease (NAFLD) is a frequent syndrome encompassing fatty liver alone and steatohepatitis (NASH). Often asymptomatic, the suspicion arises because of abnormal aminotransferases or a bright liver on abdominal ultrasound. It should be suspected during evaluation of associated conditions as obesity, diabetes or dyslipidaemia. The diagnostic evaluation must exclude other potential causes of liver disease and may include a liver biopsy, the only method able to confirm features of necroinflammation and fibrosis that define NASH and its prognostic implications. Indeed, the presence of necroinflammation has been associated with a significant risk of progression to cirrhosis and eventually hepatocellular carcinoma. Age >45 years, obesity and diabetes have also been associated with an increased risk of liver fibrosis and progression to cirrhosis. Given the high prevalence of NAFLD, general measures of life-style changes, focusing on exercise, diet, and total alcohol abstinence, should be implemented before a liver biopsy is considered.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH): diagnosis and clinical course. 1556 40

Since its original description as a rare disease of iron overload resulting in liver disease, diabetes mellitus, and bronzing of the skin ('bronze diabetes'), hereditary hemochromatosis has undergone several redefinitions leading to widely varying estimates of its prevalence. Over the last decade, the finding of a relatively high prevalence of the C282Y polymorphism of the HFE gene associated with hemochromatosis in Northern European populations suggested that the disease may be much more common than previously thought. However, several large population-based studies have now shown that the penetrance of the C282Y/C282Y genotype is very low, indicating that C282Y homozygosity is a necessary but not sufficient factor in causation of the disease. Studies are now focusing on other genetic and environmental factors, including alcohol, that may contribute to differential expression of C282Y homozygosity.
Best Pract Res Clin Haematol 2005 Jun
PMID:The penetrance of hereditary hemochromatosis. 1573 85

Hereditary haemochromatosis is a primary inherited disorder of iron metabolism leading to progressive iron loading of parenchymal cells of the liver and other organs with diverse clinical manifestations, including cirrhosis, diabetes and skin pigmentation. This chapter will focus on HFE-associated hereditary haemochromatosis, which accounts for approximately 90% of cases in Caucasian populations. Penetrance is incomplete, with variable clinical expression. The majority of cases demonstrate biochemical expression, but a much lower proportion develop advanced disease. Clinical disease--especially hepatic fibrosis--is related to the level of body iron stores, which is reflected primarily in the liver. The available evidence indicates that adequate screening and diagnostic strategies ensure that early case detection and treatment occur prior to the development of irreversible end-organ damage. The most cost-effective methods of early case detection are family (cascade) screening and evaluation of potential cases by primary care physicians with a high index of clinical suspicion.
Best Pract Res Clin Haematol 2005 Jun
PMID:Role of early case detection by screening relatives of patients with HFE-associated hereditary haemochromatosis. 1573 86

Hypertension is the most common cause of death. Therefore it is recognized as a major civilization disease next to diabetes, hyperuricemia, asthma etc. The objective was to use artificial neural networks (ANNs) to handle demographic data and to produce system of hypertension risk prediction. Database used in the development of hypertension risk model was obtained from CDC (BRFSS--Behavioral Risk Factor Surveillance System). Screening for optimal ANN architecture was performed among various backpropagation and fuzzy neural networks with use of 10-fold cross-validation scheme. Single ANNs as well as experts committees were tested. Best results were found to be around 75%--expressed as total classification rate. Java applet was designed to be the interface between ANN system and end user. Spreadsheet form was chosen to facilitate navigation and used by healthcare non-specialists. Free of charge Internet publication is expected soon at the address [url: see text].
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PMID:Artificial neural networks as an engine of Internet based hypertension prediction tool. 1574 7

Bone density, bone turnover and fracture susceptibility were evaluated in 1,132 randomly recruited women, all 75 years old. Seventy-four of the women had diabetes, while 1,058 women did not. Areal bone mineral density (aBMD) of the hip and lumbar spine was investigated by dual energy X-ray absorptiometry (DXA), and bone mass of the calcaneus was measured by ultrasound. Urinary deoxypyridinoline/creatinine (U-DPD/Crea) and serum C-terminal cross-linked telopeptide of type 1 collagen (S-CTX) were assessed as markers of bone resorption. Serum bone-specific alkaline phosphatase (S-bone ALP) and serum osteocalcin (S-OC) were assessed as markers of bone formation. Also, serum 25(OH) vitamin D and serum parathyroid hormone (S-PTH) were assessed. Fracture susceptibility was evaluated retrospectively and prospectively for up to 6.5 years. In diabetic women, the aBMD of the femoral neck was 11% higher (p<0.001), and BMD of the lumbar spine was 8% higher (p=0.002) than in non-diabetic women. There was no difference in bone mass by ultrasound of the calcaneus. Women with diabetes had higher BMD of the femoral neck (p<0.001) and lumbar spine (p=0.03) also after correction for differences in body weight. In diabetic women, U-DPD/Crea, S-CTX, and S-OC were decreased when compared with non-diabetic women (p=0.001 or less). After correction for covariance of body weight and plasma creatinine, S-CTX (p<0.001) and S-OC (p<0.001) were still lower in the diabetic women. Diabetic patients had hypovitaminosis D (p=0.008), a difference explained by differences in time spent outdoors and body weight. S-PTH did not differ between the groups. Women with diabetes had no more lifetime fractures (52%) than women without diabetic disease (57%), (p=0.31). This study shows that elderly women with diabetes and without severe renal insufficiency have high bone mass and low bone turnover. The high bone mass and low bone turnover is not likely to have a strong influence on fracture susceptibility.
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PMID:Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus. 1582 89

Type 1 diabetes mellitus is preceded by autoimmunity against the insulin-producing islet beta cells. Autoantibodies against islet antigens such as insulin, glutamic acid decarboxylase, and the protein tyrosine phosphatase-like molecule IA-2 are found in most patients with type 1 diabetes and are now established markers for the clinical diagnosis and the preclinical phase of this disease. The development of islet autoantibodies and diabetes is influenced by genetic and environmental factors, and the detection and characterization of islet autoantibodies in euglycemic members of affected families identifies some individuals who have a markedly elevated risk for type 1 diabetes. This ability to accurately predict diabetes risk in non-diabetic subjects will prove very useful for targeted recruitment of participants of interventional studies aimed at preventing the progression to type 1 diabetes in subjects at risk.
Best Pract Res Clin Endocrinol Metab 2005 Mar
PMID:Diabetes-related antibodies in euglycemic subjects. 1582 25

Islet autoimmunity is made evident by the appearance of islet-cell antibodies directed against insulin (IAA), glutamic acid decarboxylase (GADA), protein tyrosine phosphatase IA-2 (IA-2Ab) and other autoantigens. IAA and IA-2Ab are predominantly detected in childhood type 1 diabetes mellitus (T1DM), while frequency of GADA is not affected by age. In adult-onset T1DM patients, GADA is the immune marker of higher diagnostic sensitivity. In adult diabetic patients not requiring insulin treatment for at least 6 months after diagnosis, GADA identifies the so-called latent autoimmune diabetes in adults (LADA). In over 80% of cases, LADA patients develop insulin dependency within a few years after the diagnosis and have an increased risk for the development of other organ-specific autoimmune diseases. High GADA titers identify a subgroup of LADA patients with low body mass index (BMI), low C-peptide levels and increased frequency of T1DM-related HLA class II haplotypes. GADA assay should be offered to every diabetic patient, and in cases of positivity screening for other autoimmune diseases should be carried out.
Best Pract Res Clin Endocrinol Metab 2005 Mar
PMID:Diabetes-related antibodies in adult diabetic patients. 1582 26


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