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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Issues of quality of life (QOL) have often been considered for patients with insulin-dependent diabetes mellitus (IDDM, type I diabetes). Daily blood glucose monitoring and need for self-injections pose an obvious threat to the attainment of QOL, as does concern about long term complications. In contrast, non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) may be considered less severe, and has attracted less research interest. In fact, type II patients may also be aware of their heightened vulnerability to physical complications, as well as being affected by the need for heightened vigilance and attention to diet and exercise regimens. Issues associated with the theory and development of QOL measures are discussed largely in relation to type I diabetes and cancer. Generic measures have advantages in allowing comparisons to be made across different disease groups, and are, therefore, often favoured by health economists. In contrast, disease-specific scales are more sensitive to changes in treatment regimens, and may therefore be the instruments of choice in evaluating new treatments. In general, there has been less attention paid to how the meaning of QOL changes throughout the lifespan, and our review of the literature therefore emphasises a developmental perspective when considering the processes through which diabetes may affect an individual's QOL. Measures which, at the least, take into account changes in meaning of QOL throughout the lifespan need to be developed.
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PMID:Quality of life in type II diabetes: evaluation and applications. 1015 98

Insulin resistance, a smaller than expected response to a given dose of insulin, is associated with many common diseases including, ageing, polycystic ovarian disease, syndrome X, cancer, infections, trauma and, most significantly, obesity and type 2 diabetes mellitus. The biochemical basis of insulin resistance in type 2 diabetes has been the subject of many studies. Earlier studies have indicated that quantitative regulation of the insulin sensitive glucose transporters (Glut-4) and insulin receptors themselves may contribute to this disorder, however, these two factors are probably inadequate to explain the extent of insulin resistance. This point also became apparent by the development of only mild hyperinsulinaemia in mice with a targeted mutation in the Glut-4 gene. Studies on postreceptor defects in type 2 diabetes has recently focused on the intrinsic catalytic activity of the insulin receptor and downstream signalling events. A reduction in tyrosine phosphorylation of both the insulin receptor (IR) and the insulin receptor substrate-1 (IRS-1) has been noted in both animal and human type 2 diabetes. Importantly, this appears to occur in all of the major insulin-sensitive tissues, namely the muscle, fat and liver. It is now clear that decreased signalling capacity of the insulin receptor is an important component of this disease. I will review some of the potential mechanisms underlying this deficiency.
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PMID:The role of TNFalpha and TNF receptors in obesity and insulin resistance. 1039 91

A major issue in human nutrition is the optimal relation of carbohydrate-to-fat in the diet. According to some investigators, a high proportion of fat energy to total energy favors the development of several chronic diseases. Among these are obesity, coronary heart disease, diabetes, and cancer. The theory that a high proportion of fat relative to other nutrients promotes the development of obesity is founded on research with experimental animals and in human population surveys. This theory has been difficult to prove in prospective feeding studies in humans; therefore it remains a contentious issue. Regarding coronary heart disease, little evidence supports a claim that a high proportion of dietary fat predisposes to disease. On the other hand, strong evidence bolsters the claim that certain fatty acids raise the risk for coronary heart disease. These include saturated fatty acids and trans fatty acids, both of which raise serum cholesterol levels. In contrast, neither monounsaturated nor polyunsaturated fatty acids raise serum cholesterol levels and seemingly pose little risk for coronary disease. The relationship between dietary fat and type 2 diabetes is tied largely to the issue of obesity, because obesity is a major cause of diabetes. Although animal studies and epidemiological studies have implicated dietary fat as a factor in cancer, recent prospective epidemiological data in humans have cast doubt on the possibility of a strong relationship. In summary, clear evidence points to the need to reduce intakes of saturated and trans fatty acids in the diet. Beyond this change, a balanced ratio of unsaturated fatty acids to carbohydrate leading to fat intake of approximately 30% of total energy seems appropriate for the American public.
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PMID:The optimal ratio of fat-to-carbohydrate in the diet. 1044 27

Obesity and overweight are clearly associated with many serious conditions, including type II diabetes mellitus, hypertension, and coronary heart disease. Excess weight also increases the risk of death. Recent evidence suggests that weight gain itself, even if persons remain within the "normal" weight range, also increases the risk of medical illnesses and premature death. Persons who gain 5.0 to 7.9 kg (11 to 17.3 lb) as adults are 1.9 times more likely to develop type II diabetes mellitus and 1.25 times more likely to develop coronary heart disease than those who lose weight or maintain a stable weight after age 18 years. Gaining 11 to 20 kg (24.2 to 44 lb) or more in adulthood increases the risk of ischemic stroke 1.69 to 2.52 times. The relationship between weight gain and breast cancer has been difficult to study, primarily because postmenopausal hormone replacement therapy can mask the effect of weight gain on cancer risk. Accordingly, weight gain in adulthood has been associated with an increased risk of breast cancer only among women who have never used hormone replacement therapy. In addition to its adverse effects on disease outcomes, weight gain also impairs physical functioning, reduces quality of life, and is associated with poor mental health. These psychological and mental health consequences of weight gain can become an added burden for patients with schizophrenia and other mental disorders.
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PMID:Physical and psychological consequences of weight gain. 1054 35

Synthetic retinoids, ligands for the RAR and RXR members of the steroid/thyroid superfamily of nuclear hormone receptors, are used for the treatment of psoriasis, acne, photoaging and cancer. Retinoid mechanisms of action for these conditions largely involve effects on epithelial differentiation and modulation of inflammation with some impact on the immune system. Retinoid medicinal chemistry in recent years has identified ligands highly specific for one of the three RAR subtypes (RAR-alpha) and for the RXR family of receptors, as well as antagonists for the RARs, RARalpha and the RXRs. Structure-activity relationships among the novel retinoid classes are reviewed along with potential therapeutic activities and side effects. RAR-alpha specific retinoids inhibit cancer cell growth but lack other retinoid toxicities, including skin irritation now ascribed to RAR-gama. RXR-specific retinoids lower blood glucose in animal models of type 2 diabetes albeit with a potential for mild hypothyroidism. Function-selective retinoids, especially a class of RAR antagonists called inverse agonists, have unexpected gene regulatory activity. Given the diverse properties and tissue distributions of the retinoid receptors, synthesis of additional classes of receptor-specific and function-selective ligands has the potential to produce novel therapeutic applications.
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PMID:Therapeutic applications for ligands of retinoid receptors. 1063 71

In patients with diabetes mellitus, contradictory results have been reported indicating both increased and reduced risks of malignancies. In the present trial all insulin-treated diabetic patients (n = 2720) attending our centre since 1995 were studied. Of these patients, 28 (type 1/type 2: n = 1/27, 23 women) developed malignancies during insulin therapy: 11 patients developed cancer of the breast, 4 patients cancer of the pancreas, 3 patients cancer of the kidneys and 10 patients developed other malignancies. The characteristics of these patients [mean +/- SD (range)] were as follows: age 68.8 +/- 8.6 (52.0 87.0) years, diabetes duration 13.1 +/- 8.1 (0.5-29.0) years, duration of insulin therapy at the time of the diagnosis of malignancy 4.3 +/- 5.7 (0.5 24.0) years, insulin dosage 0.67 +/- 0.43 (0.11-1.72) IU/kg body weight, mean HbAlc 9.6 +/- 1.9 (6.8-14.9)% (HPLC, Diamat, normal range 4.4%-5.9%). The prevalences of nephropathy, retinopathy (non-proliferative: n = 7) and peripheral neuropathy were 35.7%, 25.0% and 46.4% respectively. When the features of the 27 patients with type 2 diabetes were compared with the characteristics of the type 2 diabetic patients (n = 117, 63 women) studied in a population-based survey of insulin-treated diabetic patients, also performed in the area of Jena [JEVIN; Schiel R et al. (1997a)] there were no significant differences in the duration of insulin therapy (JEVIN: 4.7 +/- 4.3 years, P = 0.64), insulin dosage (JEVIN: 0.55 +/- 0.27 IU/kg body weight, P = 0.08), mean HbAlc (JEVIN: 9.0 +/- 2.1%, P = 0.16) and the prevalences of long-term complications of diabetes. The quality of diabetes control in insulin-treated patients suffering from malignancies is comparable to that of a selection-free population of diabetic patients. Furthermore, in comparison to non-diabetic subjects our diabetic patients showed no altered risk for malignancies as a function of insulin dosage, the duration of diabetes or insulin therapy, the quality of diabetes control or the prevalence of long-term complications of the disease.
J Cancer Res Clin Oncol 2000 Jul
PMID:Malignancies in patients with insulin-treated diabetes mellitus. 1092 64

Although an association between diabetes and cancer was found over 100 years ago, the issue underwent different interpretations over the subsequent decades, and only modern, prospective, epidemiological cohort and case-control studies conducted in several countries have provided reliable evidence of an increased cancer risk in diabetic patients, mainly in those with type 2 diabetes. This risk varies according to the tumor site: it is the greatest for primary liver cancer, moderately elevated for pancreatic cancer, and relatively low for colorectal, endometrial, breast, and renal cancers. The cause of the association is not clear and remains the subject of different hypotheses. The most frequently cited reason is the potential effect of insulin. Found in high concentrations, due to insulin resistance in most patients with type 2 diabetes, this hormone is believed to express a mitogenic effect. This hypothesis needs to be confirmed in appropriately programmed prospective studies, but it may already be helpful in choosing an adequate treatment for type 2 diabetes to achieve optimal metabolic control with a simultaneous reduction in hyperinsulinemia, such as diet, physical exercise, metformin, and acarbose.
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PMID:Diabetes mellitus and cancer. 1102 48

Troglitazone and structurally related compounds (pioglitazone, rosiglitazone etc.) containing thiazolidinediones (TZD) are a novel class of antidiabetic agents which decrease blood glucose in diabetic animal models and in patients with Non-Insulin-Dependent Diabetes Mellitus (NIDDM) through alleviating insulin resistance. A large body of evidence is now accumulating indicating that insulin resistance and/or resulting hyperinsulinemia underlie the pathogenesis of not only diabetes but also of the clustering syndrome called "syndrome X" or "insulin resistance syndrome" which includes hypertension, dislipidemia and hypercoagulation. Therefore, TZD class of insulin sensitizers seem to have therapeutic potential to improve this clustering syndrome in addition to diabetes. Moreover, it was demonstrated that the TZD class of insulin sensitizers including troglitazone bind and activate the peroxisome proliferator-activated receptor gamma (PPARgamma), a nuclear hormone receptor. Although PPARgamma is predominantly expressed in adipose tissue, one of the target tissues for insulin, it have been subsequently found to be expressed in macrophages, vascular smooth muscle cells (VSMC), endothelial cells and several cancer cell lines. PPARgamma activation by PPARgamma agonists such as TZD class of insulin sensitizers in these cells modulates these cell functions such as the production of inflammatory cytokine by macrophages, proliferation and migration of VSMC, and growth or differentiation in cancer cells. In addition, troglitazone has potent antioxidant effect, and suppresses both L-type and receptor operated Ca2+ channel and protein kinase C. Thus since TZD class of insulin sensitizers has many kind of therapeutic effect in addition to lowering blood glucose, these agents expect to have therapeutic potential beyond diabetes.
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PMID:Troglitazone and related compounds: therapeutic potential beyond diabetes. 1106 64

A sedentary lifestyle, obesity, and a Westernized diet have been implicated in the aetiology of both colorectal cancer and non-insulin dependent diabetes mellitus, leading to the hypothesis that hyperinsulinaemia may promote colorectal cancer. We prospectively examined the association between colorectal cancer risk and factors related to insulin resistance and hyperinsulinaemia, including BMI, physical activity, diabetes mellitus, and blood glucose, in a cohort of 75 219 Norwegian men and women. Information on incident cases of colorectal cancer was made available from the Norwegian Cancer Registry. Reported P values are two-sided. During 12 years of follow up, 730 cases of colorectal cancer were registered. In men, but not in women, we found a negative association with leisure-time physical activity (P for trend = 0.002), with an age-adjusted RR for the highest versus the lowest category of activity of 0.54 (95% CI = 0.37-0.79). Women, but not men, with a history of diabetes were at increased risk of colorectal cancer (age-adjusted RR = 1.55; 95% CI = 1.04-2.31), as were women with non-fasting blood glucose > or = 8.0 mmol l(-1)(age-adjusted RR = 1.98; 95% CI = 1.31-2.98) compared with glucose <8.0 mmol l(-1). Overall, we found no association between BMI and risk of colorectal cancer. Additional adjustment including each of the main variables, marital status, and educational attainment did not materially change the results. We conclude that the inverse association between leisure-time physical activity and colorectal cancer in men, and the positive association between diabetes, blood glucose, and colorectal cancer in women, at least in part, support the hypothesis that insulin may act as a tumour promoter in colorectal carcinogenesis.
Br J Cancer 2001 Feb 02
PMID:Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. 1116 10

The action of growth hormone (GH) via its receptor involves many organ systems and metabolic pathways. These diverse actions are reviewed in this paper in the context that they may represent unwanted side-effects of GH therapy for growth promotion. The monitoring of GH therapy in large multicentre international databases has demonstrated a low frequency of adverse events. Tumour recurrence or new malignancy are not increased. Headaches, especially in the first few months of therapy, require close evaluation as benign intracranial hypertension is found infrequently, especially in children with GH deficiency and chronic renal failure (CRF). Children at risk for slipped capital femoral epiphysis and scoliosis require close monitoring during therapy. Decreased insulin sensitivity that is dose-dependent is observed during GH therapy. Glucose homeostasis, however, is not affected, but a recent report of increased incidence of Type 2 diabetes mellitus in children undergoing GH therapy requires prospective surveillance.
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PMID:Safety issues in children and adolescents during growth hormone therapy--a review. 1173 34


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