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

Insulin Sensitivity Indices for glycemia [ISI(gly)] and blood FFA [ISI(ffa)] can be calculated with the formulas: ISI(gly) = 2/[(INSp x GLYp) + 1], and ISI(ffa) = 2/[(INSp x FFAp) + 1], where INSp, GLYp and FFAp = insulinemic, glycemic, and FFA areas during OGTT (75 g glucose) of the person under study, simplified by considering only data at 0 and 2 h (0-2 h areas), according to WHO criteria or, better, at 0, 1 and 2 h (0-1-2 h areas). Expressed as unit/ volume.h-1, 0-1-2 h area is equal to 1/2 value at 0 min + value at 1 h + 1/2 value at 2 h, while 0-2 h area is equal to value at 0 + value at 2 h. Instead of areas, basal levels can also be used. Basal levels and areas are expressed taking the mean normal value as unit, so that in normal subjects ISI(gly) and ISI(ffa) are always around 1, with maximal variations between 0 and 2. Each laboratory should have its normal reference values for basal levels and OGTT areas. However, reliable mean normal values were selected from literature. Based on meta-analysis of published data, ISI(gly) and ISI(ffa) were reduced in subjects who were overweight and/or IGT and in NIDDM patients and their relatives. Moreover, correlation of ISI(gly) with the euglycemic clamp data was significant. However, it should be stressed that the clamp procedure is performed under artificially induced steady-state whereas ISI(gly) and ISI(ffa) are obtained under rather physiological conditions, with hormonal and metabolic variables unmodified, thus being suitable to assess whole-body insulin sensitivity in the clinical setting.
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PMID:Insulin sensitivity indices calculated from basal and OGTT-induced insulin, glucose, and FFA levels. 956 67

Persons with type II diabetes mellitus (DM), even without cardiovascular complications have a decreased maximal oxygen consumption (VO2 max) and submaximal oxygen consumption (VO2) during graded exercise compared with healthy controls. We evaluated the hypothesis that change in the rate of VO2 in response to the onset of constant-load exercise (measured by VO2-uptake kinetics) was slowed in persons with type II DM. Ten premenopausal women with uncomplicated type II DM, 10 overweight, nondiabetic women, and 10 lean, nondiabetic women had a VO2 max test. On two separate occasions, subjects performed 7-min bouts of constant-load bicycle exercise at workloads below and above the lactate threshold to enable measurements of VO2 kinetics and heart rate kinetics (measuring rate of heart rate rise). VO2 max was reduced in subjects with type II DM compared with both lean and overweight controls (P < 0.05). Subjects with type II DM had slower VO2 and heart rate kinetics than did controls at constant workloads below the lactate threshold. The data suggest a notable abnormality in the cardiopulmonary response at the onset of exercise in people with type II DM. The findings may reflect impaired cardiac responses to exercise, although an additional defect in skeletal muscle oxygen diffusion or mitochondrial oxygen utilization is also possible.
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PMID:Abnormal oxygen uptake kinetic responses in women with type II diabetes mellitus. 965 91

The available data suggest that the frequency of diabetes in pregnancy is highly variable, generally reflecting the underlying pattern of NIDDM in the particular population. Different ethnic groups in the same environmental setting experience widely variable risk. Impaired glucose tolerance is usually more prevalent than diabetes in women of childbearing age. Maternal age, overweight, parity, and family history of diabetes all predispose to gestational diabetes mellitus (GDM). Incidence of GDM is low in the absence of risk factors, suggesting that selective screening programs may be cost-effective. The worldwide epidemic of glucose intolerance predicted by the latest World Health Organization studies will undoubtedly increase the burden of GDM, especially in the developing countries.
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PMID:Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age. 970 21

Insulin sensitivity is impaired in overweight subjects with IGT and is accompanied by hyperinsulinemia, a condition, that might promote early B-cell exhaustion. Twelve subjects were recruited for a double-blind trial using either 100 mg of acarbose or placebo for three months. Insulin sensitivity was measured by hyperglycemic clamp and with the minimal model. Baseline characteristics such as body weight, BMI, blood glucose, HB-A1c and serum lipids did not change throughout the study period. The steady state glucose infusion rate (SSGIR) improved significantly following acarbose. The insulin sensitivity as measured by clamp (MI) or minimal model, (SI), however, increased only descriptively (p = 0.08). The fasting proinsulin was raised in all subjects during pretreatment. Following acarbose, the proinsulin dropped from 20.3 +/- 12.9 to 13.6 +/- 7.1 ng/ml, but remained unchanged in the placebo group. Due to the high variability of values and the low number of subjects in this study, differences were only descriptive and did not reach significance (p = 0.08). The proinsulin/insulin ratio, however, significantly decreased after 3 months of acarbose treatment. Acarbose might therefore be considered recommendable for the protection of the B-cell function and for delaying the transition of IGT to overt NIDDM.
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PMID:The effect of acarbose on insulin sensitivity and proinsulin in overweight subjects with impaired glucose tolerance. 971 Mar 65

An estimated 97 million adults in the United States are overweight or obese, a condition that substantially raises their risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. Obese individuals may also suffer from social stigmatization and discrimination. As a major contributor to preventive death in the United States today, overweight and obesity pose a major public health challenge.
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PMID:Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. 975 81

Obesity is common in NIDDM; in a cohort of 314 diabetics in Singapore, 44.3% are overweight. Management of obesity in diabetics differs from that in non-diabetics in that it is more urgent; weight maintenance is more difficult and hypoglycaemic medication may cause weight changes. Like in the non-diabetic, management of obesity in diabetic requires a pragmatic and realistic approach. A team approach is required: the help of the nurse educator, the dietitian, behaviour modification therapist, exercise therapist etc are required. A detailed history, careful physical examination and relevant investigations are required to assess the severity of the diabetic state and to exclude an occasional underlying cause of the obesity in the obese NIDDM. Weight loss is urgent in the obese NIDDM, especially those with android obesity. There must be a reduction in caloric intake. Weight loss leads to improvement in the glucose tolerance, insulin sensitivity, reduction in lipid levels and fall in blood pressure in the hypertensive. Exercise is of limited value except in the younger obese NIDDM. Metformin is the hypoglycaemic drug of choice as it leads to consistent weight reduction. The sulphonylureas may cause weight gain. Insulin should be avoided where possible as it causes further weight gain. Other hypoglycaemic agents include Glucobay (alpha-glucosidase inhibitor) and Troglitazone (insulin sensitizer) which do not alter the weight. Orlistat (lipase inhibitor) is promising as it causes reduction of weight, blood-glucose and lipid levels. Anti-obesity drugs (noradrenergic and serotonergic agents) have modest effects on weight reduction in the obese NIDDM; a widely use preparation, Dexfenfluramine (Adifax) has been withdrawn because of side effects. Surgery such as gastric plication is the last resort in treating the morbidly obese NIDDM. The discovery of leptin in 1994 has led to intense research into energy homeostasis in obesity; hopefully this will lead to better treatment of obesity in diabetics and non-diabetics.
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PMID:Management of obesity in NIDDM (non-insulin-dependent diabetes mellitus). 984 3

Insulin use in NIDDM is a frequent situation. Many acute clinical circumstances justify a transient insulin therapy including ketoacidosis decompensation or hyperosmolar state and severe intercurrent diseases. The problem is more complex when glycemic control is no longer obtained despite maximal doses of oral treatment. Type 2 diabetes is then defined as an insulin-requiring diabetes. There is actually no consensus, but lots of arguments advocate an intensive insulin therapy based on multiple daily injections in this clinical state. However, when patient's overweight is important or if the clinical context is unfavourable, conventional insulin therapy or combined treatment using bedtime insulin and daytime oral agents may be tried.
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PMID:[Insulin in the treatment of type 2 diabetes]. 992 17

Researchers have sought to explain nonadherence to standard medical regimens by investigating a variety of sociodemographic variables, and, less often, by exploring variations between the health perspectives and life circumstances of the individual. While divergence between lay and professional perspectives on the etiology and treatment of chronic diseases, such as noninsulin dependent diabetes mellitus, may possibly account for the documented low rates of adherence to biomedical recommendations, health beliefs and activities are best understood as connected to an individual's personal history and circumstances. In order to evaluate the relationship between causal explanation of NIDDM and adherence, ethnographic interviews were conducted among 51 older (65+) women with diabetes and their physicians. We chose to investigate adherence to dietary recommendations because it represents one of the most challenging lifestyle modifications and is particularly important to maintaining glycemic control. The interviews involved ethnomedical and food frequency intake questionnaires and semi-structured interviews. Results reveal a stronger association between dietary adherence and etiological perspectives on diabetes than any sociodemographic factors, including ethnicity, education and income or other health belief factors. Informants suggested five categories that they believed were responsible for the onset of their NIDDM; poor past dietary practices (n = 22); familial tendency to have diabetes (n = 10); improper bodily functioning (n = 10); personal risk factors (n = 6); and currently being overweight (n = 3). Analyses indicated that those who implicate former dietary practices, currently being overweight, or having improper bodily functions were more likely to follow a standard recommended diet for individuals with diabetes. These findings also highlight the attempt by individuals with NIDDM to create 'stories' of meaning of their diabetes by linking their current management strategies for NIDDM with past practices and history. In addition, our results question the utility of the 'biomedical/alternative' labels.
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PMID:Stories of meaning: lay perspectives on the origin and management of noninsulin dependent diabetes mellitus among older women in the United States. 1007 51

Onset and progress of several diseases common in adults such as diabetes mellitus, hyperlipidemia and hypertension are closely correlated with environmental factors. In recent years besides aging, lack of exercise, overweight, excess intake of fat and carbohydrates are recognized to be increasingly important to develop so called life-style related diseases especially in type 2 diabetes. The system of the insulin action from the biosynthesis of insulin and excretion in the pancreatic beta cells to receptor and insulin signal transmissions is often influenced by unfavorable life style in the modernized era. Either for primary or for secondary prevention, education not only in patients but in general public must be extensively conducted.
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PMID:[Diabetes mellitus as a life-style related disease--importance of environmental factors on pathogenesis and progress of type-2 diabetes]. 1019 27

The prevalence of type 2 diabetes is set to increase. The UKPDS has shown that better average glycaemic control over time leads to a reduction in microvascular complications. Macrovascular outcomes are also reduced in overweight subjects treated with metformin. The UKPDS and our own data, however, show that the natural history of type 2 diabetes is one of progressive deterioration in glycaemic control despite treatment. Lipid parameters emerges as the strongest predictors of outcomes in type 2 diabetes and suggest where therapeutic endeavours might best be directed. Ongoing trials of lipid-modifying therapies in type 2 diabetes will help to substantiate this. In the meantime, efforts to improve glycaemic control should not be pursued to the exclusion of other abnormalities that may have a greater relevance to outcomes of type 2 diabetes. There is an urgent need for better prevention and intervention strategies as we approach the new millennium.
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PMID:Type 2 diabetes towards the new millennium--the relative importance of glycaemic versus lipid control. 1034 26


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