[Show abstract][Hide abstract] ABSTRACT: Context:
Insulin resistance reflects inadequate insulin-mediated utilization of metabolites and predicts type 2 diabetes (T2D) but is also frequently seen in long standing type 1 diabetes (T1D) and represents a major cardiovascular risk factor.
We hypothesized that plasma metabolome profiles allow identification of unique and common early biomarkers of insulin resistance in both diabetes types.
Design, setting and patients:
Two hundred-ninety-five plasma metabolites were analyzed by mass-spectrometry from patients of the prospective observational German Diabetes Study (GDS) with T2D (n=244) or T1D (n=127) and known diabetes duration of less than one year, and glucose tolerant persons (CON, n=129). Abundance of metabolites was tested for association with insulin sensitivity as assessed by hyperinsulinemic-euglycemic clamps and related metabolic phenotypes.
Main outcomes measures:
Sixty-two metabolites with phenotype-specific patterns were identified using age, sex and body mass index as covariates.
Compared to CON, the metabolome of T2D and T1D showed similar alterations in various phosphatidylcholine species and amino acids. Only T2D exhibited differences in free fatty acids compared to CON. Pairwise comparison of metabolites revealed alterations of 28 and 49 metabolites in T1D and T2D, respectively, when compared to CON. Eleven metabolites allowed differentiation between both diabetes types and alanine, alpha-amino-adipic acid, isoleucin and stearic acid showed an inverse association with insulin sensitivity in both T2D and T1D combined.
Metabolome analyses from recent onset T2D and T1D patients enables identification of defined diabetes type-specific differences and detection of biomarkers of insulin sensitivity. These analyses may help to identify novel clinical subphenotypes diabetes.
Full-text · Article · Feb 2016 · Journal of Clinical Endocrinology & Metabolism
[Show abstract][Hide abstract] ABSTRACT: Objective:
Subclinical inflammation has been implicated in the development of diabetic sensorimotor polyneuropathy (DSPN), but studies using electrophysiological assessment as outcomes are scarce. Therefore, we aimed to investigate associations of biomarkers reflecting different aspects of subclinical inflammation with motor and sensory nerve conduction velocity (NCV) in individuals with diabetes.
Design and methods:
Motor and sensory NCV was assessed in individuals with recently diagnosed type 2 (n=352) or type 1 diabetes (n=161) from the baseline cohort of the observational German Diabetes Study. NCV sum scores were calculated for median, ulnar and peroneal motor as well as median, ulnar and sural sensory nerves. Associations between inflammation-related biomarkers, DSPN and NCV sum scores were estimated using multiple regression models.
In type 2 diabetes, high serum interleukin (IL)-6 was associated with the presence of DSPN and reduced motor NCV. Moreover, higher levels of high-molecular weight (HMW) adiponectin, total adiponectin and their ratio were associated with prevalent DSPN and both diminished motor and sensory NCV, whereas no consistent associations were observed for C-reactive protein, IL-18, soluble intercellular adhesion molecule-1 and E-selectin. In type 1 diabetes, only HMW and total adiponectin showed positive associations with motor NCV.
Our results point to a link between IL-6 and both DSPN and slowed motor NCV in recently diagnosed type 2 diabetes. The reverse associations between adiponectin and NCV in type 1 and type 2 diabetes are intriguing, and further studies should explore whether they may reflect differences in the pathogenesis of DSPN in both diabetes types.
No preview · Article · Jan 2016 · European Journal of Endocrinology
[Show abstract][Hide abstract] ABSTRACT: Aims:
To summarize the current knowledge on the phenomenon of dogs, both trained and untrained, sensing hypoglycaemia and alerting their owners to it.
Electronic databases were searched for all types of articles reporting on untrained or trained 'diabetes alert' dogs. Articles published up until December 2014 in the English or German language were included.
Several case reports and observational studies provide evidence that animals can perform at a level above that attributable to chance, and may reliably detect low diurnal as well as nocturnal hypoglycaemic episodes. Behavioural changes in untrained dogs were reported during 38-100% of hypoglycaemic events experienced by their owners. The sensitivity and specificity of the performance of trained diabetes alert dogs sensing hypoglycaemia ranged from 22 to 100% and 71 to 90%, respectively. Additionally, 75-81% of patients with diabetes who owned a trained dog reported a subsequent improvement in their quality of life. Nevertheless, the available data are limited and heterogeneous because they rely on low patient numbers and survey-based studies prone to recall bias.
Further research is needed to confirm the preliminary data on the reliability and mechanism underlying the dogs' abilities to detect hypoglycaemia, and its impact on patient outcomes. This article is protected by copyright. All rights reserved.
No preview · Article · Oct 2015 · Diabetic Medicine
[Show abstract][Hide abstract] ABSTRACT: Current prevalence and incidence numbers illustrate the progressive development of diabetes worldwide. Social changes through industrialization have deeply intervened in the movement behavior of people. Given that a lack of exercise is an important risk factorforthe development of diabetes, physical activity is of key importance in the prevention as well as in the treatment of diabetes. Family doctors can contribute tremendously through empathic and good advice to integrate physical activity, as part of the treatment. The content of these consultations should advocate movement, explain correlations between disease and behavior and refer to specialists. The clinical picture of diabetes is usually accompanied by psychological impairments which should be addressed in the primary care consultation. In collaboration with the patient, instructions should be based entirely on the needs, objectives and conditions of the same, to enable sustainable sports participation. Current recommendations advocate a minimum of movement of more than 150 min moderate activity (strength and endurance training). In addition, high-intensity interval training shows good results and attempts in short time to achieve maximum effects. Sport recommendations should be made individually for any patient and should be performed in appropriate institutions. Before, during and after any physical activity, even in the course of several hours thereafter, blood glucose should be measured and recorded in a diary. Any changes in physical activity require a treatment adaptation to prevent adverse events.
No preview · Article · Jul 2015 · Internistische Praxis
[Show abstract][Hide abstract] ABSTRACT: This study aimed to perform a comprehensive analysis of interlobular, intralobular and parenchymal pancreatic fat in order to assess their respective effects on beta cell function.
Fifty-six participants (normal glucose tolerance [NGT] (n = 28), impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) (n = 14) and patients with type 2 diabetes (n = 14)) underwent a frequent-sampling OGTT and non-invasive magnetic resonance imaging (MRI; whole-body and pancreatic) and proton magnetic resonance spectroscopy ((1)H-MRS; liver and pancreatic fat). Total pancreatic fat was assessed by a standard 2 cm(3) (1)H-MRS method, intralobular fat by 1 cm(3) (1)H-MRS that avoided interlobular fat within modified DIXON (mDIXON) water images, and parenchymal fat by a validated mDIXON-MRI fat-fraction method.
Comparison of (1)H-MRS techniques revealed an inhomogeneous distribution of interlobular and intralobular adipose tissue, which increased with decreasing glucose tolerance. mDIXON-MRI measurements provided evidence against uniform steatosis, revealing regions of parenchymal tissue void of lipid accumulation in all participants. Total (r = 0.385, p < 0.01) and intralobular pancreas adipose tissue infiltration (r = 0.310, p < 0.05) positively associated with age, but not with fasting or 2 h glucose levels, BMI or visceral fat content (all p > 0.5). Furthermore, no associations were found between total and intralobular pancreatic adipose tissue infiltration and insulin secretion or beta cell function within NGT, IFG/IGT or patients with type 2 diabetes (all p > 0.2).
The pancreas does not appear to be another target organ for abnormal endocrine function because of ectopic parenchymal fat storage. No relationship was found between pancreatic adipose tissue infiltration and beta cell function, regardless of glucose tolerance status.
[Show abstract][Hide abstract] ABSTRACT: People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET-DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe.
INTERPRET-DD is a 2-year longitudinal study, taking place in 16 countries' diabetes outpatients' facilities, investigating the recognition and management of depressive disorders in people with Type 2 diabetes. Clinical interviews are used to diagnose depression, with clinical and other data obtained from medical records and through patient interviews. Pathways to care and the impact of treatment for previously unrecognized (undocumented) depression on clinical outcomes and emotional well-being are being investigated.
Initial evidence indicates that a range of pathways to care exist, with few of them based on available recommendations for treatment. Pilot data indicates that the instruments we are using to measure both the symptoms and clinical diagnosis of depression are acceptable in our study population and easy to use.
Our study will increase the understanding of the impact of comorbid diabetes and depression and identify the most appropriate (country-specific) pathways via which patients receive their care. It addresses an important public health problem and leads to recommendations for best practice relevant to the different participating centres with regard to the identification and treatment of people with comorbid diabetes and depression. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Full-text · Article · Feb 2015 · Diabetic Medicine