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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications.
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PMID:Gastrointestinal complications of diabetes. 1861 80

Emerging attention has been paid to metabolic syndrome, which comprises several metabolic disorders including visceral obesity, diabetes mellitus, dyslipidemia, and hypertension. Whether the severity of each disease is mild to moderate, the comorbidity of these metabolic disorders has a serious impact on the development of atherosclerosis. Nonalcoholic fatty liver disease (NAFLD) is the major hepatic disorder in patients with metabolic syndrome, and indeed it is the most common cause of abnormal liver function tests in the working population in industrialized countries. In recent years, it has become recognized that NAFLD is no longer just a trivial disease, and a rather considerable proportion of the patients develop liver cirrhosis. Furthermore, chronic infection of hepatitis C virus also develops a pathological feature of steatohepatitis, and extended hepatic steatosis has a serious impact not only on the progression of hepatic fibrosis but also on the antiviral efficacy of interferon therapy. Emerging lines of studies indicated that insulin resistance, abnormal lipid metabolism, and dysregulation of cytokines/adipokines (e.g., tumor necrosis factor-alpha, adiponectin, and leptin) are profoundly involved in the pathogenesis of NAFLD. This review aims to integrate the reported evidence and to provide the current point of view for comprehensive understanding of the pathophysiology of steatohepatitis.
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PMID:Liver diseases and metabolic syndrome. 1864 37

Obesity is currently a worldwide epidemic, and will likely only increase in prevalence in the coming years. The incidence of the metabolic syndrome (MetS) seems to be paralleling obesity. The MetS is strongly linked to insulin resistance, abdominal obesity, diabetes mellitus, and dyslipidemia. Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of obesity and the MetS. Although not currently a formal component of the MetS, data suggest a very strong correlation between NAFLD and the MetS; insulin resistance appears to be the common factor. Nonalcoholic steatohepatitis (NASH) is a more advanced stage in the spectrum of NAFLD, which can progress to cirrhosis. Management strategies for NAFLD are conceivably similar to those for the MetS, which focus on lifestyle measures aimed at weight reduction and maintenance. The purpose of this review is to highlight the growing epidemic of obesity and the MetS, and the strong likelihood of an increase in the prevalence of the already widely existent combination of NAFLD/NASH. This article describes pharmacological treatments including novel therapies aimed at the hepatic pathophysiologic process, as well as surgical options. The increasing prevalence of obesity and the MetS places a large population at risk for developing hepatic failure. Therefore, NAFLD must be acknowledged as a major worldwide public health concern.
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PMID:Nonalcoholic fatty liver disease: hepatic manifestation of obesity and the metabolic syndrome. 1865 60

The presence of fatty liver per ultrasound and liver-associated enzymes were measured in a select cohort of youth with both obesity and insulin resistance, and the effect of metformin on these parameters evaluated. Fifty obese, multiethnic, insulin-resistant adolescents (mean age 15.1 yr, mean body mass index 39.8 kg/m2) were randomized to receive lifestyle recommendations plus either twice per day doses of 850 mg of metformin or placebo. Fasting and post-glucose challenge biochemistries and liver ultrasounds were compared at baseline and 6 months. The prevalence of fatty liver was 74%, elevated alanine aminotransferase (ALT) 14%, aspartate aminotransferase (AST) 14%, and gamma-glutamyl transferase (GGT) 17%. Fatty liver was mild in 23%, moderate in 31%, and severe in 46%. Fatty liver was more common in male and Hispanic subjects and elevated ALT more common in Hispanic subjects. Subjects with fatty liver appeared more insulin resistant (higher fasting insulin and triglycerides, lower high-density lipoprotein cholesterol) and had higher ALT and AST. At 6 months, mean ALT, GGT, and fasting insulin improved significantly in all subjects. Fatty liver prevalence (p < 0.04), severity (p < 0.04), and fasting insulin (p < 0.025) improved significantly with metformin compared to placebo. Non-alcoholic fatty liver disease (NAFLD) occurs with a high prevalence and severity in obese, insulin-resistant adolescents. While metformin plus lifestyle intervention appears promising, defining NAFLD therapies capable of preventing fibrosis and cirrhosis requires further study.
Pediatr Diabetes 2009 Feb
PMID:Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents. 1872 Nov 66

Non-alcoholic fatty liver disease (NAFLD), the major cause of abnormal liver function in the western world, is often associated with obesity and diabetes. In obese individuals, fat accumulation in the abdominal region affects both lipid and glucose metabolism, and a liver loaded with fat is insulin resistant. Insulin resistance (IR) is often associated with chronic low-grade inflammation, and numerous mediators released from immune cells and adipocytes contribute to development of IR. Recent results showing an important role for these mediators in NAFLD are providing us with a better understanding of this highly prevalent disease with implications for novel therapy development. This review highlights new aspects in development of liver steatosis and the relevance of various cytokines and adipocytokines in NAFLD.
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PMID:Insulin resistance, inflammation, and non-alcoholic fatty liver disease. 1892 93

Non-alcoholic fatty liver disease is a chronic inflammation liver condition that is currently highly relevant because of its strong association with increasingly incident diseases such as obesity and type-2 diabetes mellitus. The primary purpose of this paper is to discuss the best part of current knowledge on the molecular mechanisms involved in hepatic steatosis development, the condition s initial stage, and on progression to steatohepatitis. Special attention has been paid to clinical and experimental obesity-related fatty liver. In the latter, the fa/fa rat is assessed, which constitutes an animal model for obesity with phenotype features similar to human obesity, including insulin resistance and dyslipemia. Hepatic steatosis is a complex, mainly metabolic condition where apparently non-compatible metabolic processes concur, in addition to oxidative stress, endoplasmic reticulum stress, mitochondrial dysfunction, and decreased expression of survival genes. Extrahepatic signals underlie the disorder, such as those arising from peripheral insulin resistance associated with an increase in adipose mass and systemic free fatty acids, together with intrahepatic signals leading to derangement of liver glycostatic and lipidostatic functions, as well as to greater vulnerability to other aggressions.
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PMID:[Molecular basis of obesity-related hepatic steatosis]. 1902 8

Non-alcoholic fatty liver disease includes a broad spectrum of liver abnormalities ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis and hepatocellular carcinoma. Patients with primary NASH have the metabolic (or insulin resistance) syndrome, condition typically associated with obesity, diabetes, hyperlipidemia and hypertension. To understand the mechanisms implicated in development of NASH, animal models of non-alcoholic fatty liver disease have been generated. These have greatly improved our understanding of some of the aspects of this disease. The challenge now is to identify the common mechanisms between the animal models and humans, which could eventually lead to a better prognosis and development of novel therapeutic strategies.
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PMID:Non-alcoholic steatohepatitis and animal models: understanding the human disease. 1902 69

Nonalcoholic fatty liver disease (NAFLD) is fast becoming the most common chronic liver condition in many parts of the world. It is a heterogeneous disease encompassing a broad spectrum of histologic states characterized universally by macrovesicular hepatic steatosis. NAFLD is now recognized as the hepatic manifestation of the metabolic syndrome and is a major cause of liver-related morbidity and mortality. The prevalence of the disease is increasing, tied closely to the increased prevalence of insulin resistance in industrialized countries. Risk factors for NAFLD include obesity, diabetes, insulin resistance, and hypertriglyceridemia. The clinical course of NAFLD depends upon the histologic subtype. Patients with simple hepatic steatosis generally are thought to have a benign long-term prognosis. However, nonalcoholic steatohepatitis can progress to cirrhosis and may have a similar prognosis as cirrhosis from other liver disease with progression to end stage liver disease and hepatocellular carcinoma. The decision to obtain a biopsy is determined by weighing the risks of the biopsy against the information obtained from the biopsy. No standardized therapeutic approach exists although many promising modalities are under investigation. This paper presents an overview of the incidence and prevalence of disease, diagnosis, histologic spectrum, natural history, pathogenesis, clinical course, and current treatment of nonalcoholic fatty liver disease.
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PMID:Nonalcoholic fatty liver disease. 1903 56

Non-alcoholic fatty liver disease is common among diabetic patients and carries the risk of non-alcoholic steatohepatitis (NASH) and progressive fibrosis and cirrhosis. This is illustrated by three patients with diabetes mellitus, two women aged 76 and 59, and a man aged 58. The first patient was referred to our clinic with ascites that appeared to be due to a previously unrecognized NASH associated with diabetes and which resulted in liver cirrhosis. She was treated with diuretics and subsequently remained stable. The male patient, suffering from overweight, had silently developed liver cirrhosis prompting referral to a transplantation centre. For this procedure he was put on a weight reduction programme. The third patient also had diabetes-associated liver cirrhosis, but was referred for transplantation when liver failure became inevitable. Because of the increasing prevalence of overweight and diabetes, there will be an increase in the number of patients with diabetes associated NASH and liver failure requiring transplantation.
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PMID:[Liver cirrhosis in diabetes mellitus; a complication not always recognized]. 1905 32

Nonalcoholic fatty liver disease (NAFLD) is a common disease that is usually accompanied by insulin resistance (IR). Whether or how NAFLD and IR are temporally and mechanistically related is controversial. Recent studies focus on their epidemiology, the importance of dietary fat, the role of adipocytokines and the sterol regulatory element-binding protein-1c. NAFLD and IR may progress to severe diseases, such as cirrhosis, diabetes or both, and understanding the pathogenesis of the precursor conditions has preventive and therapeutic implications. This review focuses on the possible relationships between NAFLD and IR and the treatment options available.
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PMID:Role of nonalcoholic fatty liver disease in the development of insulin resistance and diabetes. 1907 47


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