المؤلفون: McCartney CR, Gianoukakis AG, Gopalakrishnan G, McGill JB, Roach P, Siraj ES, True MW

المصدر: Journal of graduate medical education [J Grad Med Educ] 2019 Aug; Vol. 11 (4), pp. 378-381.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Accreditation Council for Graduate Medical Education Country of Publication: United States NLM ID: 101521733 Publication Model: Print Cited Medium: Internet ISSN: 1949-8357 (Electronic) Linking ISSN: 19498357 NLM ISO Abbreviation: J Grad Med Educ Subsets: MEDLINE

مواضيع طبية MeSH: Fellowships and Scholarships*, Endocrinology/*education, Endocrinology/organization & administration ; Humans ; United States

المؤلفون: Siraj ES; Department of Public Health Dentistry, Azeezia College of Dental Sciences and Research, Kollam, Kerala, India., Pushpanjali K; Department of Public Health Dentistry, Faculty of Dental Sciences, MSRUAS, Bengaluru, Karnataka, India., Manoranjitha BS; MDS in Public Health Dentistry, Moulaali, Hyderabad, Telangana, India.

المصدر: Dental research journal [Dent Res J (Isfahan)] 2019 Mar-Apr; Vol. 16 (2), pp. 104-109.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Medknow Country of Publication: Iran NLM ID: 101471186 Publication Model: Print Cited Medium: Print ISSN: 1735-3327 (Print) Linking ISSN: 17353327 NLM ISO Abbreviation: Dent Res J (Isfahan) Subsets: PubMed not MEDLINE

مستخلص: Background: Stevioside is a natural herbal sweetener extracted from Stevia rebaudiana . An in vitro study has proved the antibacterial efficacy of 0.2% Stevia aqueous solution against Streptococcus mutans and Lactobacillus acidophilus , and the present study was conducted to clinically evaluate the efficacy of Stevia leaf extract and Stevia product on plaque pH, when compared with sucrose solution.
Materials and Methods: A clinical trial was conducted among a sample of 22 undergraduate students who volunteered. After obtaining consent, students were instructed not to brush at night and not to use any mouth rinse during the course of the study. Baseline plaque pH was measured in situ using digital pH meter. Students were asked to rinse for 1 min with 0.2% aqueous solution of Stevia leaf extract and plaque pH was measured in situ at 4 time points (5, 10, 15, and 30 min) after each rinse. After a washout period of 2 days, 10% sucrose and 1% Stevia product solutions were similarly tested. Statistical analysis was performed using analysis of variance (ANOVA) test and repeated measures ANOVA. Tukey's HSD test was used to obtain multiple comparisons. The level of significance was set to be at P < 0.05.
Results: At 5, 10, 15, and 30 min, a significant difference in mean plaque pH values was observed between three test solutions ( P < 0.000). Post hoc Tukey's HSD test showed that the difference in mean pH values between aqueous Stevia extract and sucrose and Stevia product and sucrose was highly significant ( P < 0.000).
Conclusion: Stevia leaf extract and commercially available Stevia product did not significantly affect plaque pH values, implying that two solutions are non-fermentable and do not support bacterial survival.
Competing Interests: The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article.

المؤلفون: Calles-Escandón J; Endocrinology Section, MetroHealth Regional, Case Western Reserve University, Cleveland, Ohio, United States of America., Koch KL; Section on Gastroenterology, Wake Forest University, Winston-Salem, North Carolina, United States of America., Hasler WL; Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, United States of America., Van Natta ML; Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Pasricha PJ; Section of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America., Tonascia J; Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Parkman HP; Section of Gastroenterology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America., Hamilton F; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States of America., Herman WH; Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan, United States of America., Basina M; Division of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, California, United States of America., Buckingham B; Division of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, California, United States of America., Earle K; Division of Endocrinology, California Pacific Medical Center, San Francisco, California, United States of America., Kirkeby K; Division of Endocrinology, California Pacific Medical Center, San Francisco, California, United States of America., Hairston K; Section of Endocrinology, Wake Forest University, Winston-Salem, North Carolina, United States of America., Bright T; Division of Endocrinology, Diabetes, and Metabolism, Texas Tech University School of Medicine, El Paso, Texas, United States of America., Rothberg AE; Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan, United States of America., Kraftson AT; Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan, United States of America., Siraj ES; Section of Endocrinology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America., Subauste A; Division of Endocrinology, University of Mississippi, Jackson, Mississippi, United States of America., Lee LA; Section of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America., Abell TL; Division of Gastroenterology, University of Louisville School of Medicine, Louisville, Kentucky, United States of America., McCallum RW; Section of Gastroenterology, Texas Tech University School of Medicine, El Paso, Texas, United States of America., Sarosiek I; Section of Gastroenterology, Texas Tech University School of Medicine, El Paso, Texas, United States of America., Nguyen L; Division of Gastroenterology, Stanford University School of Medicine, Palo Alto, California, United States of America., Fass R; Gastroenterology Division, MetroHealth Regional, Case Western Reserve University, Cleveland, Ohio, United States of America., Snape WJ; Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, United States of America., Vaughn IA; Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Miriel LA; Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Farrugia G; Section of Gastroenterology, Mayo Clinic, Rochester, Minnesota, United States of America.

مؤلفون مشاركون: NIDDK Gastroparesis Clinical Research Consortium (GpCRC)

المصدر: PloS one [PLoS One] 2018 Apr 13; Vol. 13 (4), pp. e0194759. Date of Electronic Publication: 2018 Apr 13 (Print Publication: 2018).

نوع المنشور: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

مواضيع طبية MeSH: Blood Glucose* , Diabetes Complications*, Gastroparesis/*drug therapy , Gastroparesis/*etiology , Insulin/*administration & dosage, Adolescent ; Adult ; Aged ; Female ; Gastroparesis/diagnosis ; Humans ; Infusions, Subcutaneous ; Male ; Middle Aged ; Pilot Projects ; Quality of Life ; Symptom Assessment ; Treatment Outcome ; Young Adult

مستخلص: Erratic blood glucose levels can be a cause and consequence of delayed gastric emptying in patients with diabetes. It is unknown if better glycemic control increases risks of hypoglycemia or improves hemoglobin A1c levels and gastrointestinal symptoms in diabetic gastroparesis. This study investigated the safety and potential efficacy of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in poorly controlled diabetes with gastroparesis. Forty-five type 1 or 2 patients with diabetes and gastroparesis and hemoglobin A1c >8% from the NIDDK Gastroparesis Consortium enrolled in a 24 week open-label pilot prospective study of CSII plus CGM. The primary safety outcome was combined numbers of mild, moderate, and severe hypoglycemic events at screening and 24 weeks treatment. Secondary outcomes included glycemic excursions on CGM, hemoglobin A1c, gastroparesis symptoms, quality-of-life, and liquid meal tolerance. Combined mild, moderate, and severe hypoglycemic events occurred similarly during the screening/run-in (1.9/week) versus treatment (2.2/week) phases with a relative risk of 1.18 (95% CI 0.85-1.64, P = 0.33). CGM time in hypoglycemia (<70 mg/dL) decreased from 3.9% to 1.8% (P<0.0001), time in euglycemia (70-180 mg/dL) increased from 44.0% to 52.0% (P = 0.02), time in severe hyperglycemia (>300 mg/dL) decreased from 14.2% to 7.0% (P = 0.005), and hemoglobin A1c decreased from 9.4±1.4% to 8.3±1.3% (P = 0.001) on CSII plus CGM. Symptom scores decreased from 29.3±7.1 to 21.9±10.2 with lower nausea/vomiting, fullness/early satiety, and bloating/distention scores (P≤0.001). Quality-of-life scores improved from 2.4±1.1 to 3.1±1.1 (P<0.0001) and volumes of liquid nutrient meals tolerated increased from 420±258 to 487±312 mL (P = 0.05) at 24 weeks. In conclusion, CSII plus CGM appeared to be safe with minimal risks of hypoglycemic events and associated improvements in glycemic control, gastroparesis symptoms, quality-of-life, and meal tolerance in patients with poorly controlled diabetes and gastroparesis. This study supports the safety, feasibility, and potential benefits of improving glycemic control in diabetic gastroparesis.

المؤلفون: Siraj ES; Division of Endocrinology and Metabolic Disorders, Eastern Virginia Medical School, Norfolk, VA, United States., Homko C; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States., Wilson LA; Johns Hopkins University, Baltimore, MD, United States., May P; Johns Hopkins University, Baltimore, MD, United States., Rao AD; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States., Calles J; Case Western Reserve University, Cleveland, OH, United States., Farrugia G; Mayo Clinic, Rochester, NY, United States., Hasler WL; University of Michigan, Ann Arbor, MI, United States., Koch KL; Wake Forest University, Winston-Salem, NC, United States., Nguyen L; Stanford University, Palo Alto, CA, United States., Snape WJ; California Pacific Medical Center, San Francisco, CA, United States., Abell TL; University of Louisville, Louisville, KY, United States., Sarosiek I; Texas Tech University Health Science Center, El Paso, TX, United States., McCallum RW; Texas Tech University Health Science Center, El Paso, TX, United States., Pasricha PJ; Johns Hopkins University, Baltimore, MD, United States., Clarke J; Johns Hopkins University, Baltimore, MD, United States., Tonascia J; Johns Hopkins University, Baltimore, MD, United States., Hamilton F; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States., Parkman HP; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.

المصدر: Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2018 Feb 13; Vol. 9, pp. 32. Date of Electronic Publication: 2018 Feb 13 (Print Publication: 2018).

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Frontiers Research Foundation] Country of Publication: Switzerland NLM ID: 101555782 Publication Model: eCollection Cited Medium: Print ISSN: 1664-2392 (Print) Linking ISSN: 16642392 NLM ISO Abbreviation: Front Endocrinol (Lausanne) Subsets: PubMed not MEDLINE

مستخلص: Introduction: Individuals with diabetes are at increased risk for complications, including gastroparesis. Type 1 diabetes mellitus (T1DM) is an autoimmune disorder resulting in decreased beta-cell function. Glutamic acid decarboxylase-65 antibody (GADA) is the most commonly used test to assess autoimmunity while C-peptide level is used to assess beta-cell function. Patients with type 2 diabetes mellitus (T2DM), who are GADA positive, are labeled latent autoimmune diabetes in adults (LADA).
Objective: To characterize patients with T1 and T2DM who have symptoms of gastroparesis using GADA and C-peptide levels and to look for association with the presence of gastroparesis and its symptom severity.
Design: 113 T1DM and 90 T2DM patients with symptoms suggestive of gastroparesis were studied. Symptom severity was assessed using Gastroparesis Cardinal Symptom Index (GCSI). Serum samples were analyzed for GADA and C-peptide.
Results: Delayed gastric emptying was present in 91 (81%) of T1DM and 60 (67%) of T2DM patients ( p  = 0.04). GADA was present in 13% of T2DM subjects [10% in delayed gastric emptying and 20% in normal gastric emptying ( p  = 0.2)]. Gastric retention and GCSI scores were mostly similar in GADA positive and negative T2DM patients. GADA was present in 45% of T1DM subjects [46% in delayed gastric emptying and 41% in normal gastric emptying ( p  = 0.81)]. Low C-peptide levels were seen in 79% T1DM patients and 8% T2DM. All seven T2DM patients with low C-peptide were taking insulin compared to 52% of T2DM with normal C-peptide.
Conclusion: GADA was present in 13% while low C-peptide was seen in 8% of our T2DM patients with symptoms of gastroparesis. Neither did correlate with degree of delayed gastric emptying or symptom severity.
Clinicaltrialsgov Identifier: NCT01696747.

المؤلفون: Atun R; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA. Electronic address: ratun@hsph.harvard.edu., Davies JI; Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa., Gale EAM; University of Bristol, Bristol, UK., Bärnighausen T; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa., Beran D; Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland., Kengne AP; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa., Levitt NS; Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa., Mangugu FW; Aga Khan University Hospital, Nairobi, Kenya., Nyirenda MJ; Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda., Ogle GD; International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia., Ramaiya K; Shree Hindu Mandal Hospital, Dar Es Salaam, Tanzania., Sewankambo NK; Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda., Sobngwi E; University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon., Tesfaye S; Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK., Yudkin JS; Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK., Basu S; Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA., Bommer C; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany., Heesemann E; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany., Manne-Goehler J; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA., Postolovska I; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Sagalova V; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany., Vollmer S; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany., Abbas ZG; Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania., Ammon B; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Angamo MT; School of Pharmacy, Jimma University, Jimma, Ethiopia., Annamreddi A; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Awasthi A; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Besançon S; NGO Santé Diabète, Bamako, Mali., Bhadriraju S; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Binagwaho A; Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda., Burgess PI; University of Liverpool, Liverpool, UK., Burton MJ; International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK., Chai J; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Chilunga FP; Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi., Chipendo P; Harvard Medical School, Harvard University, Boston, MA, USA., Conn A; The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA., Joel DR; Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana., Eagan AW; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA., Gishoma C; Rwanda Diabetes Association, Kigali, Rwanda., Ho J; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Jong S; Leiden University, Science Based Business, Leiden, Netherlands., Kakarmath SS; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Khan Y; Joslin Diabetes Center, Boston, MA, USA., Kharel R; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA., Kyle MA; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Lee SC; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Lichtman A; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Malm CP; Yale-New Haven Hospital, New Haven, CT, USA., Mbaye MN; Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal., Muhimpundu MA; The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda., Mwagomba BM; Ministry of Health, Government of Malawi, Lilongwe, Malawi., Mwangi KJ; Kenya Ministry of Health, Division of Non-communicable diseases, Nairobi, Kenya., Nair M; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Niyonsenga SP; The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda., Njuguna B; Moi Teaching and Referral Hospital, Uasin Gishu, Kenya., Okafor OLO; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Okunade O; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Park PH; Partners In Health, Rwinkwavu, South Kayonza, Rwanda., Pastakia SD; Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya., Pekny C; The Ohio State University, Columbus, OH, USA., Reja A; Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia., Rotimi CN; Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA., Rwunganira S; The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda., Sando D; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Sarriera G; University of Vermont, Burlington, VT, USA., Sharma A; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Sidibe A; Hôpital national du Mali, Bamako, Mali., Siraj ES; Eastern Virginia Medical School, Norfolk, VA, USA., Syed AS; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Van Acker K; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA., Werfalli M; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.

المصدر: The lancet. Diabetes & endocrinology [Lancet Diabetes Endocrinol] 2017 Aug; Vol. 5 (8), pp. 622-667. Date of Electronic Publication: 2017 Jul 05.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't; Review

بيانات الدورية: Publisher: The Lancet, Diabetes & Endocrinology Country of Publication: England NLM ID: 101618821 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2213-8595 (Electronic) Linking ISSN: 22138587 NLM ISO Abbreviation: Lancet Diabetes Endocrinol Subsets: MEDLINE

مواضيع طبية MeSH: Health Policy*, Diabetes Complications/*therapy , Diabetes Mellitus/*therapy, Africa South of the Sahara ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Diabetes Complications/diagnosis ; Diabetes Complications/epidemiology ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/epidemiology ; Health Services Accessibility ; Humans ; Risk Factors

المؤلفون: Siraj ES; Lewis Katz School of Medicine at Temple University, Section of Endocrinology, 3322North Broad St., Philadelphia, PA 19140, USA. Electronic address: elias.siraj@tuhs.temple.edu., Gupta MK; Cleveland Clinic, Department of Endocrinology, Diabetes & Metabolism, 9500 Euclid Avenue, Cleveland, OH 44195, USA., Yifter H; Addis Ababa University, Endocrine Unit, PO Box 9086, Addis Ababa, Ethiopia., Ahmed A; Addis Ababa University, Endocrine Unit, PO Box 9086, Addis Ababa, Ethiopia., Kebede T; Addis Ababa University, Endocrine Unit, PO Box 9086, Addis Ababa, Ethiopia., Reja A; Addis Ababa University, Endocrine Unit, PO Box 9086, Addis Ababa, Ethiopia., Abdulkadir J; Addis Ababa University, Endocrine Unit, PO Box 9086, Addis Ababa, Ethiopia.

المصدر: Journal of diabetes and its complications [J Diabetes Complications] 2016 Aug; Vol. 30 (6), pp. 1039-42. Date of Electronic Publication: 2016 May 07.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Science Pub. Co Country of Publication: United States NLM ID: 9204583 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-460X (Electronic) Linking ISSN: 10568727 NLM ISO Abbreviation: J Diabetes Complications Subsets: MEDLINE

مواضيع طبية MeSH: Autoantibodies/*blood , Diabetes Mellitus, Type 1/*blood , Diabetes Mellitus, Type 2/*blood , Islets of Langerhans/*immunology, Adult ; Case-Control Studies ; Cross-Sectional Studies ; Diabetes Mellitus, Type 1/immunology ; Diabetes Mellitus, Type 2/immunology ; Ethiopia ; Female ; Glutamate Decarboxylase/immunology ; Humans ; Insulin/immunology ; Male ; Middle Aged ; Prevalence

مستخلص: Background & Aims: Our understanding of the role of autoimmunity in the pathogenesis of diabetes in African populations is limited. This study aims to evaluate the prevalence of 4 different islet cell-associated antibodies in Ethiopian patients with diabetes and non-diabetic controls.
Methods: A total of 187 subjects from a diabetic clinic at an Ethiopian hospital were evaluated in a cross-sectional study. Fifty-five patients had type 1 diabetes mellitus (T1DM), 86 had type 2 diabetes mellitus (T2DM) and 46 were non-diabetic controls. Islet cell-associated antibodies were measured using 4 different assays for antibodies against islet cells (ICA), glutamic acid decarboxylase (GADA), insulin (IAA) and the protein tyrosine phosphatase-like IA-2 (IA-2A).
Results: Comparing the antibody positivity in subjects with T1DM versus T2DM, the results were as follows: 29% versus 3.5% for GADA; 21% versus 2.7% for ICA; 27% versus 16% for IAA. In the control group, the only positive result was for IAA at 2%. IA-2A was absent in all groups. The combi-assay for GADA and IA-2A detected all GADA-positive subjects. T2DM patients who were GADA positive had lower BMI, lower C-peptide levels and all of them were on insulin therapy.
Conclusions: Compared to Caucasians, Ethiopians with T1DM have less prevalence of islet cell-associated antibodies, but the rates are higher than in T2DM. GADA is present in Ethiopians, whereas IA-2A seems to be absent. GADA positivity in T2DM correlates with clinical features of T1DM, indicating the existence in Ethiopia of the subgroup, latent autoimmune diabetes in adults.
(Copyright © 2016 Elsevier Inc. All rights reserved.)

المؤلفون: Homko C; Sections of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA; Endocrinology, Diabetes, and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA., Siraj ES; Endocrinology, Diabetes, and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA., Parkman HP; Sections of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA. Electronic address: henry.parkman@temple.edu.

المصدر: Journal of diabetes and its complications [J Diabetes Complications] 2016 Jul; Vol. 30 (5), pp. 826-9. Date of Electronic Publication: 2016 Mar 29.

نوع المنشور: Comparative Study; Journal Article

بيانات الدورية: Publisher: Elsevier Science Pub. Co Country of Publication: United States NLM ID: 9204583 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-460X (Electronic) Linking ISSN: 10568727 NLM ISO Abbreviation: J Diabetes Complications Subsets: MEDLINE

مواضيع طبية MeSH: Attitude to Health* , Self-Management*/psychology, Diabetes Mellitus, Type 1/*complications , Diabetes Mellitus, Type 2/*complications , Gastroparesis/*complications , Hyperglycemia/*prevention & control , Hypoglycemia/*prevention & control, Adult ; Cohort Studies ; Combined Modality Therapy ; Diabetes Mellitus, Type 1/blood ; Diabetes Mellitus, Type 1/psychology ; Diabetes Mellitus, Type 1/therapy ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/psychology ; Diabetes Mellitus, Type 2/therapy ; Female ; Gastroparesis/epidemiology ; Gastroparesis/physiopathology ; Gastroparesis/psychology ; Hospitals, University ; Humans ; Male ; Middle Aged ; Philadelphia/epidemiology ; Prevalence ; Prospective Studies ; Psychiatric Status Rating Scales ; Self Report ; Severity of Illness Index ; Stress, Psychological/complications ; Stress, Psychological/psychology

مستخلص: Unlabelled: The impact of gastroparesis on diabetes management and control from the patient perspective has not been well characterized. The aim of this study was to identify patient perceptions regarding the impact of gastroparesis on managing their diabetes.
Methods: Patients with diabetes being referred for gastroparesis were enrolled in this prospective study. Gastroparetic symptom severity was assessed with the Patient Assessment of Upper GI Symptoms (PAGI-SYM). A questionnaire examined the impact of gastroparesis on diabetes related symptoms and control.
Results: 54 diabetic gastroparesis patients (36 T1DM, 18 T2DM) participated. Duration of diabetes averaged 17.4±1.4years and gastroparetic symptoms 5.1±1.1years. Patients rated their most severe symptoms as postprandial fullness, early satiety, and nausea. Two thirds of diabetic subjects identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control (44 of 54 patients) and that extra time and effort were required for care of their diabetes (45 of 54). Patients with T1DM, compared to those with T2DM, more often expressed that since developing gastroparesis, their blood sugars have been higher, they have had more frequent episodes of hypoglycemia, and they found that their gastroparetic symptoms worsened if blood sugars were too high.
Conclusions: Gastroparesis has a significant impact on patients' perceived ability to self-manage and control their diabetes. T1DM patients, in particular, associate their gastroparesis with episodes of hyper- and hypo-glycemia, and find their gastroparetic symptoms worsen with poor control. Future research should focus on strategies to support self-management of patients with diabetic gastroparesis.
(Copyright © 2016 Elsevier Inc. All rights reserved.)

المؤلفون: Siraj ES; Temple University School of Medicine, Philadelphia, PA esiraj@temple.edu., Rubin DJ; Temple University School of Medicine, Philadelphia, PA., Riddle MC; Oregon Health & Science University School of Medicine, Portland, OR., Miller ME; Wake Forest School of Medicine, Winston-Salem, NC., Hsu FC; Wake Forest School of Medicine, Winston-Salem, NC., Ismail-Beigi F; Case Western Reserve University School of Medicine, Cleveland, OH., Chen SH; Wake Forest School of Medicine, Winston-Salem, NC., Ambrosius WT; Wake Forest School of Medicine, Winston-Salem, NC., Thomas A; Henry Ford Medical Center, Detroit, MI., Bestermann W; Holston Medical Group, Kingsport, TN., Buse JB; University of North Carolina School of Medicine, Chapel Hill, NC., Genuth S; Case Western Reserve University School of Medicine, Cleveland, OH., Joyce C; Memorial University Health Sciences Centre, St. John's, NL, Canada., Kovacs CS; Memorial University Health Sciences Centre, St. John's, NL, Canada., O'Connor PJ; HealthPartners Institute for Education and Research, Minneapolis, MN., Sigal RJ; University of Calgary Cumming School of Medicine, Calgary, AB, Canada., Solomon S; Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, TN.

مؤلفون مشاركون: ACCORD Investigators

المصدر: Diabetes care [Diabetes Care] 2015 Nov; Vol. 38 (11), pp. 2000-8. Date of Electronic Publication: 2015 Oct 13.

نوع المنشور: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.

بيانات الدورية: Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE

مواضيع طبية MeSH: Cardiovascular Diseases/*mortality , Diabetes Mellitus, Type 2/*drug therapy , Diabetes Mellitus, Type 2/*mortality , Hypoglycemic Agents/*administration & dosage , Insulin/*administration & dosage, Adult ; Aged ; Dose-Response Relationship, Drug ; Female ; Glycated Hemoglobin/metabolism ; Humans ; Hypoglycemia/chemically induced ; Hypoglycemia/epidemiology ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors

مستخلص: Objective: In the ACCORD trial, intensive treatment of patients with type 2 diabetes and high cardiovascular (CV) risk was associated with higher all-cause and CV mortality. Post hoc analyses have failed to implicate rapid reduction of glucose, hypoglycemia, or specific drugs as the causes of this finding. We hypothesized that exposure to injected insulin was quantitatively associated with increased CV mortality.
Research Design and Methods: We examined insulin exposure data from 10,163 participants with a mean follow-up of 5 years. Using Cox proportional hazards models, we explored associations between CV mortality and total, basal, and prandial insulin dose over time, adjusting for both baseline and on-treatment covariates including randomized intervention assignment.
Results: More participants allocated to intensive treatment (79%) than standard treatment (62%) were ever prescribed insulin in ACCORD, with a higher mean updated total daily dose (0.41 vs. 0.30 units/kg) (P < 0.001). Before adjustment for covariates, higher insulin dose was associated with increased risk of CV death (hazard ratios [HRs] per 1 unit/kg/day 1.83 [1.45, 2.31], 2.29 [1.62, 3.23], and 3.36 [2.00, 5.66] for total, basal, and prandial insulin, respectively). However, after adjustment for baseline covariates, no significant association of insulin dose with CV death remained. Moreover, further adjustment for severe hypoglycemia, weight change, attained A1C, and randomized treatment assignment did not materially alter this observation.
Conclusions: These analyses provide no support for the hypothesis that insulin dose contributed to CV mortality in ACCORD.
(© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)

المؤلفون: Siraj ES, Williams KJ

المصدر: The New England journal of medicine [N Engl J Med] 2015 Oct 29; Vol. 373 (18), pp. 1782.

نوع المنشور: Letter; Comment

بيانات الدورية: Publisher: Massachusetts Medical Society Country of Publication: United States NLM ID: 0255562 Publication Model: Print Cited Medium: Internet ISSN: 1533-4406 (Electronic) Linking ISSN: 00284793 NLM ISO Abbreviation: N Engl J Med Subsets: MEDLINE

مواضيع طبية MeSH: Glucagon-Like Peptide 1/*analogs & derivatives , Hypoglycemic Agents/*administration & dosage , Obesity/*drug therapy, Female ; Humans ; Male

المؤلفون: Siraj ES; From the Section of Endocrinology, Diabetes and Metabolism, Temple University School of Medicine, Philadelphia (E.S.S., K.J.W.); and the Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden (K.J.W.)., Williams KJ

المصدر: The New England journal of medicine [N Engl J Med] 2015 Jul 02; Vol. 373 (1), pp. 82-3.

نوع المنشور: Editorial; Comment

بيانات الدورية: Publisher: Massachusetts Medical Society Country of Publication: United States NLM ID: 0255562 Publication Model: Print Cited Medium: Internet ISSN: 1533-4406 (Electronic) Linking ISSN: 00284793 NLM ISO Abbreviation: N Engl J Med Subsets: MEDLINE

مواضيع طبية MeSH: Glucagon-Like Peptide 1/*analogs & derivatives , Hypoglycemic Agents/*administration & dosage , Obesity/*drug therapy, Female ; Humans ; Male