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

One year after diagnosis, 250 patients with type 2 diabetes identified concerns related to having diabetes, in response to an open question and checklist. Their practice nurses independently reported what they believed were the patients' concerns. Nurses identified patients' main concerns in only 20% of cases. Patients' most frequent main concerns were 'fear of getting worse', 'following dietary advice' and 'damage caused by diabetes'. Nurses most frequently cited 'following dietary advice', 'illness or pain unrelated to diabetes' and 'overweight'. BMI over 25 was related to patient concerns about 'overweight' but not 'following dietary advice' nor 'taking exercise', mentioned also by people of lower weight. Only 19/106 patients with raised HbA1c levels reported concerns about high blood glucose levels. Nurse education in patient-centred care should build on the findings that patients focus more on current and future burden of symptoms and treatment than on blood glucose levels.
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PMID:Patient concerns in their first year with type 2 diabetes: patient and practice nurse views. 1116 25

Regular physical activity has profound effects on body composition and the utilisation of nutrients and help to maintain and increase skeletal muscle mass, with increased resting metabolic rate and enhanced capacity for lipid oxidation during rest and exercise. Regular exercise may also prevent or limit the loss of lean tissue (fat-free mass, FFM) during slimming regimens. Increased physical activity induces a number of favourable changes in the metabolism of lipoproteins: serum triglycerides are lowered by the increased lipolytic activity, the HDL concentration increases and the concentration of small dense LDL decreases. In addition, the enhanced metabolic capacity of skeletal muscle (metabolic fitness) will favorably influence risk factors such as insulin resistance and hypertension. Because regular physical activity has favorable effects on several of the comorbid conditions of obesity, particularly cardiovascular disease and type 2 diabetes, it is not surprising that the mortality rates seem to be lower in the overweight and moderately obese individuals who are physically fit compared with the unfit. The treatment of overweight and obese persons should perhaps be more focused on the level of regular physical activity than on body weight per se. For most of those who wish to reduce their body weight, it is recommended that they combine regular physical activity with a somewhat reduced energy intake, in particular of food rich in fat. Emphasis should be on promoting relatively low-intensity, long-duration physical activity which can be conveniently incorporated into daily life.
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PMID:[Physical activity, overweight and obesity]. 1118 89

There have been numerous recent reports of case series of type 2 diabetes mellitus (DM) in American Indian, African-American, Hispanic, Asian-American and white children from North America. A similar phenomenon has also been described in several other countries. Prevalence and incidence estimates vary depending on the age and ethnicity of the population, but it is estimated that type 2 DM represents 8-45% of patients with DM currently diagnosed in large US pediatric centers; however, this is likely to be an underestimation and incidence is probably rising. The young patients diagnosed with type 2 DM in the USA were generally overweight, had a strong family history of type 2 DM and often had signs of insulin resistance. The majority belonged to ethnic groups at high risk for type 2 DM. More girls than boys were diagnosed. The few data on follow-up available suggest a high prevalence of microvascular and macrovascular complications among young adults who developed type 2 DM during childhood. Type 2 DM in children has recently been recognized as a potential public health problem in North America. As obesity is currently on the increase in several industrialized or industrializing countries, a similar increase in type 2 DM in children may soon emerge worldwide, and this will require preventative measures.
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PMID:Emergence of type 2 diabetes mellitus in children: epidemiological evidence. 1120 15

The insulin resistance syndrome, a cluster of potent risk factors for atherosclerotic cardiovascular disease and type 2 diabetes in adults, is composed of hyerinsulinemia, obesity, hypertension and hyperlipidemia. In addition, left ventricular hypertrophy and its precursor increased left ventricular mass, is known to be a powerful predictor of adverse cardiovascular events, both as an independent risk factor and by association with the insulin resistance syndrome. Obesity appears to have a major role in the relations between the components of the insulin resistance syndrome, and their association with increased heart mass. Of significant impact in the adult population, atherosclerotic cardiovascular disease and death are rarely seen in the young, but the pathologic processes and risk factors associated with its development have been shown to begin during childhood. Recent studies revealed the presence of components of the insulin resistance syndrome also in children and adolescents, however, their associations are not well understood. A direct link between obesity and insulin resistance has also been reported in the young, as has the link between insulin resistance and abnormal lipid profile. There is an increasing amount of data to show that being overweight during childhood and adolescence is significantly associated with insulin resistance, abnormal lipids and elevated blood pressure in young adulthood. Weight loss in these situations results in a decrease in insulin concentration and an increase in insulin sensitivity toward normalcy. Moreover, it has been determined that increased left ventricular mass is present in childhood, and is related to other risk factors, namely obesity and insulin resistance. Based on current knowledge, it is reasonable to suggest that weight control, and lifestyle modification, could alter the incidence of the syndrome of insulin resistance, and improve the risk profiles for cardiovascular disease as children make the transition toward adolescence and young adulthood.
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PMID:Insulin resistance and cardiovascular risk in the pediatric patient. 1122 44

Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates of obesity, insulin resistance and type 2 diabetes. Supplementary feeding programs are common in the region; the number of beneficiaries significantly exceeds the malnourished. Weight-for-age definition of undernutrition without assessment of length will overestimate the dimension of malnutrition and neglect the identification of stunted overweight children. Providing food to low income stunted populations may be beneficial for some, although it may be detrimental for others, inducing obesity especially in urban areas. Defining the right combination of foods/nutrients, education and lifestyle interventions that are required to optimize nutrition and health is a present imperative.
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PMID:Obesity trends in Latin America: transiting from under- to overweight. 1123 81

The incidence of end-stage renal disease (ESRD) has risen considerably in the past two decades. This trend is partly due to the alarming rise in the incidence of type 2 diabetes over the same period, which in turn might be linked to the staggering increase in overweight and obesity. If these trends continue, ESRD can be expected not only to cause suffering of ever growing numbers of patients, but also to become an increasing financial as well as logistical burden on the health care system. Therefore, it is imperative not only to gain a better understanding of the molecular, cellular and metabolic mechanisms involved in renal pathology, but also to uncover treatment modalities, including lifestyle changes, that can help prevent and/or slow the progression of kidney pathogenesis. Insights into both of these aspects are provided by animal models of obesity and diabetes. It has long been known that food restriction, more so than restriction of any particular dietary component, can greatly enhance longevity in laboratory rodents. These findings are being extended into a variety of other mammals, including nonhuman primates. These studies have indicated that caloric restriction in nonobese laboratory animals does not primarily affect specific disease processes but rather nonspecifically slows the aging process. In contrast, a growing body of evidence suggests that in genetically obese animals, food restriction can prevent or greatly delay the onset of specific degenerative lesions, in particular glomerulonephritis associated with obesity and diabetes.
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PMID:Calorie restriction in obesity: prevention of kidney disease in rodents. 1123 85

The prevalence of type 2 diabetes varies from 1.1% in sub-Saharian Africa to 3.3% in developing countries and to 5.6% in the industrialised countries, which brings the number of diabetics in the world to 135 millions. The projections of the WHO suggest a 35% increase in the prevalence of diabetes. This increase is explained by a progressively more sedentary life style, the overabundant and attractive food sources, the increase in life expectancy leading to diabetogenic ageing and, more specifically for Europe, the baby-boom effect after the Second World War, and finally, the changes in diagnostic criteria (fasting glucose > or = 1.26 g/L (7 mM) on two occasions, serum glucose > or = 2 g/L 2 hours after a loading dose of 75 g of glucose, in terms of prevalence of diagnosis and the prediction of specific diabetic complications). Age, birth weight (over or underweight) and heredity are established non-modifiable risk factors, whereas it is possible to change high risk behaviour, overweight, the syndrome of insulin resistance and hyperglycaemia. The major role of hyperglycaemia in the specific microangiographic complications of diabetes which are aggravated by hypertension, has been established. Hyperglycaemia does not seem to be a major risk factor in macroangiographic complications, especially coronary artery disease, in contrast to smoking, hypertension and certain lipid or fibrinolytic abnormalities. Epidemiological analysis of diabetes shows its invalidating feature, especially in terms of fatal vascular risk, which may be attenuated by correction of all associated metabolic abnormalities. The progression of the incidence of diabetes should alert the physician to be more attentive in the diagnosis and management of diabetes, especially with regards to early dietary intervention.
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PMID:[Epidemiology of type II diabetes, diagnosis, prevalence, risk factors, complications]. 1129 57

This article reviews the pharmacological and clinical aspects of glimepiride, the latest second-generation sulfonylurea for treatment of Type 2 diabetes mellitus (DM). Glimepiride therapy ameliorates the relative insulin secretory deficit found in most patients with Type 2 DM. It is a direct insulin secretagogue; indirectly, it also increases insulin secretion in response to fuels such as glucose. Its action to augment insulin secretion requires binding to a high affinity sulfonylurea receptor, which results in closure of ATP-sensitive potassium channels in the beta-cells of the pancreas. The question has been raised whether insulin secretagogues by acting on vascular or myocardial potassium channels may prevent ischaemic preconditioning, a physiological adaptation that could affect the outcome of coronary heart disease, but there is evidence against this concern being applicable to glimepiride. Glimepiride's antihyperglycaemic efficacy is equal to other secretagogues. It has pharmacokinetic properties that make it less prone to cause hypoglycaemia in renal dysfunction than some other insulin secretagogues, particularly glyburide (also known as glibenclamide in Europe). Its convenient once daily dosing may enhance compliance for diabetic patients who often also require medications for other co-morbid conditions, such as hypertension, hyperlipidaemia and cardiac disease. Glimepiride is approved for monotherapy, for combination with metformin and with insulin. Clinically, its reduced risk of hypoglycaemia makes it preferable to some other insulin secretagogues when attempting to achieve recommended glycaemic control (haemoglobin A(1c) (HgbA(1c)) 7%). Using suppertime neutral protamine Hagedorn (NPH) and regular insulin with morning glimepiride in overweight diabetic patients achieves glycaemic goals more quickly than insulin alone and with lower insulin doses.
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PMID:Clinical review of glimepiride. 1133 17

Obesity is one of the most important predictors and causes of such lifestyle diseases as metabolic syndrome, type 2 diabetes, and cardiovascular disease. It is thus imperative to follow the trend longitudinally in the population. Measurement of obesity in children and adolescents is difficult; many studies use the body mass index as a measure, regardless of the fact that it is inappropriate. Skinfolds or the ponderal index should be used, instead. Recent Danish studies suggest that the incidence of childhood and adolescent obesity is increasing and that those who are overweight are even more so today than earlier. Obesity is caused by a number of factors, genetic, social, environmental, and lifestyle, all of which play an important role. One of the main causes of the increase in childhood obesity in Denmark today is the lower level of physical activity than formerly. The prospects for the future are an increase in obesity and incidence of lifestyle diseases with a poorer quality of life and a shorter life time expectancy.
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PMID:[Obesity among children--with particular reference to Danish circumstances]. 1140 67

The prevalence of overweight and obese children has doubled, and the incidence of type 2 diabetes in children (0-19 y) has increased 4-fold during the past several decades. As a result we can anticipate an increased number of metabolic studies in children. There are few data on measures of glucose metabolism in normal children, and virtually none relating to their reproducibility. The aims of this study were 1) to provide new data on energy expenditure and glucose, lipid, and protein metabolism in nonobese, healthy children and adolescents; 2) to evaluate their reproducibility; and 3) on the basis of these data, to perform power calculations for metabolic studies. Eight nonobese subjects (8-16 y) were studied on two occasions, preceded by 7 d of a diet with identical energy content and macronutrient distribution. Gluconeogenesis, measured by deuterium oxide, accounted for 50% of glucose production. Insulin sensitivity, measured by the labeled minimal model, averaged 4.9 x 10(-4) mL(mU x min)(-1). Glucose appearance rate was significantly higher (p < 0.01) in the children than in the adolescents. Furthermore, we demonstrated that for energy intake and expenditure, plasma concentrations of glucose and C-peptide, and rates of appearance of glucose and leucine, a 10% difference can be detected in fewer than five subjects with a power of 80% and a type I error of 5%. Insulin concentration, gluconeogenesis, insulin secretory indices, insulin sensitivity, and glucose effectiveness were more variable, but with the above power a difference of 25% could be detected in 7-11 subjects using a paired study design.
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PMID:Glucose production, gluconeogenesis, and insulin sensitivity in children and adolescents: an evaluation of their reproducibility. 1142 Apr 28


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