Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic gastroparesis corresponds to symptomatic as well as asymptomatic gastric retention without organic abnormality of stomach, pylorus or gut. This complication associated with autonomic neuropathy is found in about 50% of patients with type 1 and type 2 diabetes. It may be clinically important when it is associated with gastrointestinal symptoms limiting quality of life, alterations in glycaemic control and changes in oral drug absorption. In addition, acute changes in blood glucose concentration affect gastric motor function: gastric emptying is slowed down during hyperglycaemia and accelerated during hypoglycaemia. The diagnosis of gastroparesis may be confirmed by scintigraphy assessment of gastric emptying, preferably using a solid meal. Unfortunately, treatment options remain limited and often unsatisfactory. They first rely on life-style and dietary modifications. If necessary, pharmacological agents (metoclopramide, domperidone, cisapride, and erythromycin) may be considered. Cisapride is actually the most powerful agent for chronic use, but the risk of cardiac toxicity (increase of QT with "torsade de pointe") limits its general use. In some diabetic patients, gastroparesis may contribute to erratic glucose excursions, with precocious postprandial hypoglycaemia, late hyperglycaemia, and/or delayed recovery from hypoglycaemia after carbohydrate ingestion. Sometimes, the initiation of intensive insulin therapy and the use of prokinetic drugs could lead to significant improvement of blood glucose control in patients with diabetic gastroparesis.
 ...
PMID:[Diabetic gastroparesis]. 1603 19

Type 2 diabetes caused by obesity shows autonomic neuropathy. Molecular mechanism involved in enteric neurodegeneration is not clear. Neuronal nitric oxide synthase (nNOS) is one of the important agents involved in gastrointestinal function. Therefore, expression of nNOS in the duodenum LM-MP of type 2 diabetes model mouse was studied. Real time RT-PCR analysis showed reduction in nNOS expression in male diabetic LM-MP compared to male control. In contrast, female diabetic LM-MP had high level of nNOS mRNA compared to female control. Western blot determination of LM-MP showed reduction in nNOS protein in male diabetic LM-MP and high level of nNOS in female diabetic LM-MP compared to their respective controls. Expression of nNOS observed by Western blot was further confirmed by nNOS immunostaining of the mouse duodenum. TUNEL staining of mouse duodenum showed apoptosis in male diabetic enteric neurons. These studies suggest that nNOS expression in LM-MP varies with gender during early stage of type 2 diabetes. In addition, reduced expression of nNOS is likely to contribute to apoptosis seen in the enteric neurons of male type 2 diabetic mice.
 ...
PMID:Altered expression of neuronal nitric oxide synthase in the duodenum longitudinal muscle-myenteric plexus of obesity induced diabetes mouse: implications on enteric neurodegeneration. 1625 69

We describe here four male patients with long-term and poorly controlled type 2 diabetes mellitus. They shared many common characteristic complications, such as severe autonomic neuropathy, proliferative retinopathy and normocytic normochromic anemia without progressive renal failure and macroangiopathy. They also showed normal levels of erythropoietin and reticulocyte, which was considered relatively low. The coefficient of variation of R-R, a useful method to estimate autonomic failure, showed markedly advanced autonomic neuropathy in all four patients. Coronary angiography did not reveal stenosis, anomaly or collateral vessels, but left ventriclography showed diffuse or partial hypokinesis. Massive proteinuria, high urinary levels of N-acetyl-beta-D-glucosamidase (NAG) and beta2-microglobulin (beta2M) were detected, though creatinine clearance (Ccr) was not so deteriorated. Treatment with recombinant erythropoietin increased their hemoglobin and hematocrit levels. These common points have a possibility to be brought about by tubulointerstitial damage and microangiopathy may be involved in it.
 ...
PMID:Normocytic normochromic anemia due to automatic neuropathy in type 2 diabetic patients without severe nephropathy: a possible role of microangiopathy. 1632 60

The past decade has witnessed a dramatic increase in the prevalence of obesity. Comorbidities of obesity include type 2 diabetes mellitus, hypertension, and lipid abnormalities, all of which contribute to cardiovascular disease (CVD) and are associated with endothelial dysfunction. These abnormalities frequently cluster in individuals, and the term metabolic syndrome is now widely used to define this cluster. The syndrome is frequently (although not invariably) associated with insulin resistance and CVD. Diabetes is associated with CVD, which may be asymptomatic in some cases, particularly when associated with autonomic neuropathy. This has implications for guidelines on the evaluation of patients with erectile dysfunction (ED) and CVD. Treatment of ED in men with diabetes has been revolutionized by the introduction of phosphodiesterase 5 inhibitors. However, men with diabetes tend to respond less positively to these agents, at least as currently prescribed. This decreased responsiveness may be related to the severity of endothelial function in patients with diabetes. Additional therapeutic strategies may be needed to overcome this problem.
 ...
PMID:Endothelial and erectile dysfunction, diabetes mellitus, and the metabolic syndrome: common pathways and treatments? 1638 60

The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p = .0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.
 ...
PMID:The association of psychological factors, physical activity, neuropathy, and quality of life in type 2 diabetes. 1658 98

Heart rate variability (HRV), a measure of autonomic function, can predict survival outcomes. Cardiovascular disease is a known complication of diabetes, and we aimed to determine if autonomic dysfunction was associated with carotid artery atherosclerotic plaques in type 2 diabetic patients. We assessed frequency domain HRV from power spectral analysis of 24 h Holter ECG recordings, expiration/inspiration (E/I) ratio during deep breathing, acceleration index (AI) of R-R interval in response to head-up tilt, and the degree of carotid artery atherosclerosis in 61 type-2 diabetic patients (39 males, 45-69 years). Studies were carried out 5-6 years after diagnosis (baseline) and repeated 8 years after diagnosis (follow-up). At baseline, patients diagnosed with autonomic neuropathy, with abnormal E/I ratio and abnormal AI measurements, had decreased low frequency (LF) HRV. Baseline E/I ratio correlated with day (r = 0.34; P < 0.001) and night-time (r = 0.44; P < 0.001) LF power. Night-time HRV did not differ in patient with and without autonomic neuropathy. Reduced common carotid artery diameter and atherosclerotic intima-media thickness (IMT) both correlated with HRV at baseline. At follow-up, all HRV variables decreased significantly. Furthermore, patients with lower LF power at baseline, had a larger increase in the thickness of the carotid bulb intima-media at follow-up. Our results show that LF HRV power is associated with the extent and progression of carotid atherosclerosis in type 2 diabetes. A low LF HRV may predict the progression of atherosclerosis in these patients.
 ...
PMID:Decreased heart rate variability may predict the progression of carotid atherosclerosis in type 2 diabetes. 1676 52

The aim of the study was to assess the relationship between the autonomic nerve disturbance and atherosclerotic changes in patients with type 2 diabetes. Aortic distensibility and max carotid intima-media thickness (Max IMT) were evaluated using brachial ankle pulse wave velocity (PWV) and high-resolution B-mode ultrasonography, respectively, in 135 patients (69 men, 66 women, 57 +/- 16 years) with type 2 diabetes. The autonomic neuropathy was evaluated using coefficient of variation of the RR interval (CV(R-R)) of electrocardiograms recorded at rest in a supine position. There was a significant negative correlation between CV(R-R)and Max IMT (r= -0.488, p< 0001). There were also significant negative correlations between CVR-(R a)nd the left and the right PWV(r=0.518, p<0.001; r=0.551, p<0.001, respectively). Patients with normal Max IMT, but decreased CVR-R, had a high PWV compared to patients with normal Max IMT and normal CVR-(R. )Therefore, decreased CVR-(R i)n type 2 diabetic patients may reflect atherosclerotic changes. Thus, the measurement of CVR-(R i)s a simple and quantitative test for assessing atherosclerotic as well as neuropathic complications in diabetic patients.
 ...
PMID:[The relationship of autonomic functional disturbance and atherosclerosis in type 2 diabetes]. 1678 14

Although the (13)C-octanoic acid breath test (OBT) has been applied to diabetic patients for assessing gastric emptying, such studies are still limited. Gastric emptying was measured using solid meal containing (13)C-octanoic acid in 52 patients with Type 2 diabetes mellitus and 4 diabetic patients with mitochondrial DNA (mitDNA) 3243 mutation. Delayed gastric emptying was detected in 29% of patients with Type 2 diabetes mellitus, and multiple regression analysis showed that gastric emptying was independently associated with gastrointestinal symptoms and cardiac autonomic neuropathy. Gastric emptying was not related to gastric dysrhythmia in cutaneous electrogastrography (EGG). Diabetic patients with mitDNA 3243 mutation showed delayed gastric emptying. Because the pathogenesis of delayed gastric emptying is multifactorial in diabetic patients, the recently developed OBT is useful for studying gastric emptying in various clinical settings of diabetic patients.
 ...
PMID:Gastric emptying in patients with Type 2 diabetes mellitus and diabetes associated with mitochondrial DNA 3243 mutation using 13C-octanoic acid breath test. 1694 16

Erythromycin (EM) is a common antibiotic known to be a specific agonist of motilin receptors. We have previously reported that administration of EM improves glycemic control in type 2 diabetes patients. In the present study, we tested the effect of EM on growth hormone (GH) secretion in normal and type 2 diabetic subjects. Erythromycin (300 mg) was administered orally in fasted type 2 diabetic (n=12) and normal (n=10) subjects. Blood samples were obtained before and 2 h after the administration. Blood glucose, plasma insulin, somatostatin (SS), and GH levels were determined. The same fasted groups received intravenous erythromycin infusion (10 mg/kg per hour) for 60 min. Blood samples were collected just prior to the infusion and at 15, 30, 45 and 60 min, and plasma GH and somatostatin levels during the infusion were determined. Oral EM administration increased insulin levels and decreased blood glucose levels. GH levels were significantly decreased, while SS levels did not change in normal subjects. In diabetic subjects, there was an increase in insulin levels, but no change in blood glucose, SS, and GH levels. Intravenous EM infusion resulted in a marked decrease in GH levels, while no change in SS levels occurred in normal subjects. There were no changes in SS and GH levels in diabetic subjects during the infusion. When diabetic subjects were divided into two groups with and without autonomic neuropathy, no changes in GH levels were seen in either group. We conclude that EM decreases GH levels in normal subjects while not changing SS levels. This effect was not observed in type 2 diabetic subjects.
 ...
PMID:A motilin agonist, erythromycin, decreases circulating growth hormone levels in normal subjects but not in diabetic subjects. 1707 Apr 43

In most Western countries, diabetic nephropathy (DN) has become the single most common condition found in patients with end-stage renal disease (ESRD). This is to some extent due to better survival of diabetic patients with renal failure, but mostly due to the dramatic increase in the prevalence of type 2 diabetes. The majority of type 2 diabetic patients with renal failure suffer from nodular glomerulosclerosis (Kimmelstiel-Wilson); but ischemic nephropathy, irreversible acute renal failure (mostly acute on chronic) and diabetes co-existing with primary renal diseases are common as well. Classical DN evolves in a sequence of stages. After a period of glomerular hyperfiltration, increased urinary albumin excretion [microalbuminuria (MA)] i.e. 30-300 mg/day or 20 - 200 microg/minute indicates the onset of overt DN. Risk factors for development of DN are positive family history, hyperglycemia in the mother during pregnancy, high blood pressure, obesity and insulin resistance. Poor glycemic control (HbAlc) and elevated systolic blood pressure (> 135 mm Hg) interact in enhancing the risk of DN. Proteinuria and smoking are major promoters of progression. The risk of onset of microalbuminuria can be reduced by lowering of blood pressure and specifically by blockade of the renin angiotensin system (RAS). In patients with established DN, the target systolic blood pressure should be <130 mm Hg and RAS blockade is obligatory. Treating all cardiovascular risk factors is a high priority. Antihypertensive management is rendered difficult by extreme volume sensitivity, pronounced activation of the RAS and autonomic neuropathy. Cardiac events are excessively frequent, glycemic control becomes difficult and autonomic diabetic neuropathy with gastroparesis and diabetic foot are additional problems. Hemodialysis or continuous ambulatory peritoneal dialysis should be started relatively early. In the absence of contraindications, transplantation (renal transplantation, combined kidney/pancreas transplantation or pancreas after kidney transplantation) is the treatment of choice.
 ...
PMID:Diabetic nephropathy. 1718 81


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>