Statins Related To Diabetes Progression For Obese Patients
Statin therapy may be elevating risk of type 2 diabetes in high-risk adults. Statins or HMG-CoA reductase inhibitors provide several cardiovascular benefits in addition to lowering cholesterol. This could lead individuals to believe that statins may potentially aid in reducing diabetes risk. However, in numerous cardiovascular disease (CV) prevention studies, it has been consistently found that diabetes risk is increased with statin therapy. Because diabetes is not usually a direct measure in these CV disease studies, participants are often low-risk. The following study aimed to evaluate the effect of statin therapy on diabetes patients who are considered high-risk. Population data was analyzed from a 3-year study called the Diabetes Prevention Program (DPP), and an extension of this study called the DPP Outcomes Study (DPPOS). The DPP is a randomized, controlled trial that studied the effect of lifestyle changes, metformin use, and placebo on high-risk patients with obesity or overweight. There were 3,234 participants randomized to receive 1 of the 3 interventions. Participants were included if they were older than 25 years of age, had obesity or were overweight, had high fasting blood sugar levels, and had impaired glucose tolerance. Following the DPP, participants were given the option to join the DPPOS extension study. In both the DPP and DPPOS, use of statins and other medications was obtained through patient self-report at baseline and twice yearly at follow-up visits. Statin therapy along with hypertensive therapy was determined by the participants primary physicians outside of the study. Lipid panels and blood pressure were recorded once yearly. Diabetes was diagnosed using a 75 g oral glucose tolerance test once yearly, or by obtaining fasting plasma glucose l Continue reading >>
Diabetes Could Be A Warning Sign Of Pancreatic Cancer
"Experts have revealed the onset of diabetes, or existing diabetes getting much worse could be a sign of hidden pancreatic cancer," reports The Daily Express. The media reports follow a press release of a study presented at the European Cancer Congress (ECCO) yesterday. The research analysed nearly a million people with type 2 diabetes in Belgium and Italy, some of whom went on to be diagnosed with pancreatic cancer. The recent onset of diabetes appeared to be a possible warning sign of pancreatic cancer, with 25% of cases in Belgium and 18% in Italy being diagnosed within three months of a diabetes diagnosis. Faster progression of diabetes (where patients needed insulin or other more intensive treatments sooner) was also associated with a greater chance of being diagnosed with pancreatic cancer. Pancreatic cancer is rare and often has a poor outcome, partly because it is difficult to detect at an early stage. However, it's important to put these findings in context. Diabetes has previously been linked with pancreatic cancer, though it is unclear why. It could be that diabetes increases the risk of pancreatic cancer. What is probably more likely is that rapid onset or progression of diabetes could be a symptom of the cancer itself. Diabetes is fairly common in the UK, with around 4 million cases, while pancreatic cancer remains very rare. Just because you have diabetes does not mean you will go on to get pancreatic cancer. However, if you are concerned that you may have diabetes or that your diabetes is poorly controlled, you should talk to your GP. There are also steps you can take to reduce your risk of developing diabetes. Where did the story come from? The study was carried out by researchers from the International Prevention Research Institute in Lyon, France. The Continue reading >>
How Type 2 Diabetes Can Change Over Time
You probably already know that type 2 diabetes can cause long-term damage if you don’t control it, but it’s also important to understand that even well-controlled diabetes progresses over time — meaning you may have to adjust your treatment plan more than once. The key to learning about the progression of diabetes is to understand the role of your pancreas, which produces insulin. For people with type 1 diabetes, the pancreas does not make any insulin, so they must take it through injections. With type 2, the pancreas doesn’t make enough insulin or the cells don’t respond to it adequately, according to the American Academy of Family Physicians. This means that the body has trouble moving sugar from the blood into cells to be used for energy. Diet, exercise, and medication, if prescribed, can all help those with type 2 diabetes lower their blood sugar levels and help their bodies use insulin made by the pancreas, according to the American Diabetes Association (ADA). If blood sugar levels remain high, the ADA says, you may be at risk for such diabetes complications as vision loss, heart disease, nerve damage, foot or leg amputation, and kidney disease. However, proper diabetes management can help prevent or delay the onset of these complications. How Your Diabetes Treatment Plan Might Change Over time, your medications, diet, and exercise goals may need to be adjusted. “Initially the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, a San Francisco endocrinologist in practice with Kaiser Permanente in Northern California. After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, rec Continue reading >>
Glucose Targets For Preventing Diabetic Kidney Disease And Its Progression
What is the issue? In many parts of the world, diabetes is the most common reason that people experience kidney failure and need treatment with a kidney transplant or dialysis. Disability (blindness, limb loss, kidney failure) due to diabetes is caused by high blood glucose (sugar) levels. An important question is whether extra treatment to control blood glucose levels to near normal can safely prevent the health consequences of diabetes including lower life expectancy and loss of kidney function, without causing problems such as low blood glucose leading to loss of awareness or seizures. Some medical care of diabetes includes careful blood glucose control to low levels (measured by a blood test called the HbA1C) through the use of extra medication and careful blood glucose monitoring with the help of health professionals. What did we do? We looked at the evidence for tighter blood glucose control (lower blood glucose in the long term, that is HbA1c < 7% ) compared with less tight blood glucose control (HbA1c > 7%) in people who have either type 1 or type 2 diabetes. Blood glucose was achieved by any sort of treatment including pills or insulin. What did we find? Fourteen studies involving 29,319 people with at risk of diabetes complications were included and 11 studies involving 29,141 people were included in our analyses. Tighter blood glucose control generally didn't show any benefits for patients compared to less tight glucose control. There was no difference in the risks for patients on kidney failure, death, or heart disease complications. A very small number of patients (1 in every 1000 treated each year) might avoid a heart attack with more intense blood glucose management. Some patients would expect to have less protein leakage through kidney function although Continue reading >>
Defining And Characterizing The Progression Of Type 2 Diabetes
Go to: Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycerides; and lower HDL cholesterol predicted diabetes development. The Baltimore Longitudinal Study of Aging (3) concluded that although phenotypic differences in rates of progression are partly a function of diagnostic thresholds, fasting and postchallenge hyperglycemia may represent phenotypes with distinct natural histories in the evolution of type 2 diabetes. Does hyperglycemia evolve from normoglycemia gradually over time or as a step increase? Ferrannini et al. (4) measured plasma glucose and insulin levels during oral glucose testing at baseline and after 3 and 7 years of follow-up. In subjects with normal glucose tolerance on all three occasions (nonconverters), FPG increased only slightly over 7 years. In contrast, conversion to both impaired glucose tolerance (IGT) and diabetes among normal glucose tolerance subjects Continue reading >>
Defining And Characterizing The Progression Of Type 2 Diabetes
Type 2 diabetes is a progressive disease in which the risks of myocardial infarction, stroke, microvascular events, and mortality are all strongly associated with hyperglycemia (1). The disease course is primarily characterized by a decline in β-cell function and worsening of insulin resistance. The process is manifested clinically by deteriorations in multiple parameters, including A1C, fasting plasma glucose (FPG), and postprandial glucose levels. In this review, we will evaluate our current understanding of the role played by deteriorating β-cell function and other abnormalities linked with the progression of type 2 diabetes. An improved understanding of these abnormalities may provide the scientific groundwork for novel therapies that may help achieve and maintain good glycemic control. CHARACTERISTICS OF DISEASE PROGRESSION Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycer Continue reading >>
The Natural History Of Type 2 Diabetes: Practical Points To Consider In Developing Prevention And Treatment Strategies
CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000 PRACTICAL POINTERS Type 2 diabetes, previously referred to as adult-onset or non-insulin-dependent diabetes, progresses from an early asymptomatic stage with insulin resistance to mild postprandial hyperglycemia to frank diabetes requiring pharmacological intervention. Understanding this natural history of type 2 diabetes will guide primary care providers in formulating effective treatment regimens that reflect the pathological differences between these stages of the disease. The optimal medication regimen, when used in conjunction with dietary changes and exercise, will require modifications for each patient as the disease progresses. The term impaired glucose tolerance (IGT) or pre-diabetes was first coined in 1979 by the World Health Organization and the National Diabetes Data Group to replace the terms borderline, chemical, and asymptomatic diabetes mellitus. In 1997, an expert committee of the American Diabetes Association recommended the following criteria for IGT: a normal fasting plasma glucose (<126 mg/dl) with a postprandial plasma glucose of >140 mg/dl but <200 mg/dl 2 h after a 75-g oral glucose challenge.1 This stage of mild postprandial hyperglycemia is an extremely useful marker of patients at risk for the eventual development of type 2 diabetes. Patients with IGT may benefit from timely patient education and perhaps even more aggressive forms of intervention, such as diet, exercise, or medication. An estimated 15.7 million Americans have type 2 diabetes, representing 5.9% of the population. Only two-thirds of those affected are diagnosed and are being actively treated. Although these numbers are staggering, there are even more potential diabetic patients waiting in the wings: the prevalence of IGT is estimated Continue reading >>
Diabetic Neuropathy
What is Diabetic Neuropathy Diabetic neuropathy is a type of nerve damage that happens in people who have diabetes mellitus. It affects mainly the peripheral nerves. There are three types of peripheral nerve affected: motor, sensory, and autonomic. Motor nerve fibres carry signals to muscles to allow motions like walking and fine finger movements. Sensory nerves take messages in the opposite direction. They carry information to the brain about shape, movement, texture, warmth, coolness, or pain from special sensors in the skin and from deep in the body. Autonomic nerves are nerves that are not consciously controlled. These nerves have functions such as controlling the heart rate, maintaining blood pressure, and controlling sweating. Damage to these nerves makes it hard for the nerves to carry messages to the brain and other parts of the body. This can result in numbness (loss of feeling) or painful tingling in parts of the body. Diabetic neuropathy can also affect the following: Strength and feeling in different body parts. Ability of the heart to keep up with the body’s needs. Ability of the intestines to digest food. Ability to achieve an erection (in men). Statistics on Diabetic Neuropathy Diabetes mellitus is a common medical condition in the Australian community. It is estimated that approximately one in four Australians over the age of 25 years has diabetes or its precursor, impaired glucose metabolism (also associated with increased risk of heart disease). People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk. Patients with type 2 diabetes are at greater risk particularly if they have poor control of their blood sugars. The highest rates of neuropathy are among people who have had the disease for Continue reading >>
About Diabetes
Complications of diabetes Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs. There is evidence from large randomized-controlled trials that good metabolic control in both type 1 and 2 diabetes can delay the onset and progression of these complications. Diabetic retinopathy (eye disease) Etiology Diabetic retinopathy is a leading cause of blindness and visual disability. It is caused by small blood vessel damage to the back layer of the eye, the retina, leading to progressive loss of vision, even blindness. Symptoms Usually the patient complains of blurred vision, although other visual symptoms may also be present. Diagnosis Diagnosis of early changes in the blood vessels of the retina can be made through regular eye examinations. Treatment Good metabolic control can delay the onset and progression of diabetic retinopathy. As well, early detection and treatment of vision-threatening retinopathy can prevent or delay blindness. This involves regular eye examinations and timely intervention Nephropathy (kidney disease) Etiology Diabetic kidney disease is also caused by damage to small blood vessels in the kidneys. This can cause kidney failure, and eventually lead to death. In developed countries, this is a leading cause of dialysis and kidney transplant. Symptoms Patients usually Continue reading >>
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Prediabetes
Prediabetes is the precursor stage before diabetes mellitus in which not all of the symptoms required to diagnose diabetes are present, but blood sugar is abnormally high. This stage is often referred to as the "grey area."[1] It is not a disease; the American Diabetes Association says,[2] "Prediabetes should not be viewed as a clinical entity in its own right but rather as an increased risk for diabetes and cardiovascular disease (CVD). Prediabetes is associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension."[2] It is thus a metabolic diathesis or syndrome, and it usually involves no symptoms and only high blood sugar as the sole sign. Impaired fasting blood sugar and impaired glucose tolerance are two forms of prediabetes that are similar in clinical definition (glucose levels too high for their context) but are physiologically distinct.[3] Insulin resistance, the insulin resistance syndrome (metabolic syndrome or syndrome X), and prediabetes are closely related to one another and have overlapping aspects. Classification[edit] Impaired fasting glucose[edit] Main article: Impaired fasting glycaemia Impaired fasting glycaemia or impaired fasting glucose (IFG) refers to a condition in which the fasting blood glucose or the 3-month average blood glucose (A1C) is elevated above what is considered normal levels but is not high enough to be classified as diabetes mellitus. It is considered a pre-diabetic state, associated with insulin resistance and increased risk of cardiovascular pathology, although of lesser risk than impaired glucose tolerance (IGT). IFG sometimes progresses to type 2 diabetes mellitus. There is a 50% risk over 10 years of progressing to overt diabetes. Many newl Continue reading >>
Type 2 Diabetes
Print Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores o Continue reading >>
The Causes And Progression Of Type 2 Diabetes
Many people are born with a genetic predisposition to developing diabetes at some point in life – though this does not necessarily mean that they are destined to develop diabetes. We explore why and how type 2 diabetes develops in some people, and not others. First comes love…then comes marriage…then comes a baby - wait. That's not the progression we are talking about. We're talking about the progression of a disease. A very deadly disease at that, with type 2 diabetes being the 7th leading cause of death, according to the Centers for Disease Control and Prevention. How does Type 2 Diabetes Develop? Many people are born with a genetic predisposition to developing diabetes at some point in life - though this does not necessarily mean that they are destined to develop diabetes. It does, however mean that you they are more likely to develop diabetes than someone who is not genetically predisposed. Even if you don't have diabetes running in your family - you can certainly still develop it. After conception, your genes are all planned out and locked in for life, you might say. After this point, lifestyle takes over and plays the biggest role in whether you will develop type 2 diabetes in your lifetime. It's the classic nature vs. nurture argument, and we must consider both genetics and environment to explain how you get type 2 diabetes. As you grow and develop as toddler, how you eat can begin to influence the progression of type 2 diabetes. If you consume lots of sugary drinks and fruit juices, candy, and simple carbohydrates like crackers, cookies, and chips, then you are already increasing your risk, as a child, for type 2 diabetes. These kinds of foods cause your pancreas to begin working overtime to produce insulin in order to process all that sugar. So when you c Continue reading >>
New Insights Into The Progression Of Type 1 Diabetes
If you have Type 1 diabetes or know someone who does, you’re likely aware that this type of diabetes is an autoimmune disorder that results in the destruction of the beta cells (the cells that make insulin) in the pancreas. Having Type 1 diabetes means having to take lifelong insulin injections, and people who are diagnosed with this condition must start on insulin right away. Type 1 diabetes progresses Type 2 diabetes, the “other” type of diabetes, is a whole different ball of wax. This type of diabetes partly stems from insulin resistance, meaning that the pancreas produces insulin but the body has a hard time using it. Type 2 diabetes is often described as being “progressive”: caught in the early stages, for example, it’s possible to manage it through healthy eating, weight loss (if necessary), and physical activity. But over time, many people require the help of medication, often in the form of diabetes pills, and then, perhaps, noninsulin injectable meds. Eventually, insulin injections may be needed. In the case of Type 1 diabetes, researchers now believe that this disease also progresses at predictable rates and stages before a person develops signs and symptoms. The discovery of these stages is a big deal, as it will enable researchers to find ways to intervene to delay and hopefully prevent progression to the onset of symptoms and lifelong insulin dependence. Stages of Type 1 diabetes The discovery of the various stages leading up to symptomatic Type 1 diabetes are outlined in the October 2015 issue of the journal Diabetes Care. The paper is entitled “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.” Here’s a closer look at the crux of this paper. Stage 1: Auto Continue reading >>
Diabetic Neuropathy: What You Need To Know
Cause and symptoms of neuropathy Diabetic neuropathy is a complication of diabetes and usually occurs in association with chronically elevated blood glucose levels. Elevated glucose levels may damage the nerves--usually in the feet and legs--and this can result in pain, discomfort, and/or numbness. If numbness occurs, it can be very difficult for someone to detect if he/she has a wound on one or both feet, so the symptom of numbness can be particularly dangerous. If someone is not able to feel a puncture of the skin that causes a wound--or the pain that follows—a cut or scratch may be overlooked and eventually become infected. The symptoms of pain and discomfort can be debilitating for many people but fortunately there are medications that can be taken to help alleviate these symptoms. Diabetic neuropathy can also cause problems in other parts of your body. Gastroparesis is a condition that arises from damaged nerves in the digestive system, and can cause abdominal discomfort, nausea, vomiting, bloating, particularly after meals. Other gastrointestinal symptoms can include constipation or diarrhea. Nerve damage in other areas of the body can result in incomplete emptying of the bladder, incontinence, or sexual dysfunction. Damage to nerves that regulate blood flow and blood pressure can result in significant blood pressure drops when sitting or standing, causing a person to feel light-headed or even faint, particularly when standing from a sitting or lying position. Treatment of neuropathy If you already have nerve damage, there are things that can be done to slow the rate of progression or treat the symptoms. Maintaining good glucose control, as well as healthy blood pressure and cholesterol levels, has been shown to prevent the progression of neuropathy. If you have Continue reading >>
Five Stages Of Evolving Beta-cell Dysfunction During Progression To Diabetes
This article proposes five stages in the progression of diabetes, each of which is characterized by different changes in β-cell mass, phenotype, and function. Stage 1 is compensation: insulin secretion increases to maintain normoglycemia in the face of insulin resistance and/or decreasing β-cell mass. This stage is characterized by maintenance of differentiated function with intact acute glucose-stimulated insulin secretion (GSIS). Stage 2 occurs when glucose levels start to rise, reaching ∼5.0–6.5 mmol/l; this is a stable state of β-cell adaptation with loss of β-cell mass and disruption of function as evidenced by diminished GSIS and β-cell dedifferentiation. Stage 3 is a transient unstable period of early decompensation in which glucose levels rise relatively rapidly to the frank diabetes of stage 4, which is characterized as stable decompensation with more severe β-cell dedifferentiation. Finally, stage 5 is characterized by severe decompensation representing a profound reduction in β-cell mass with progression to ketosis. Movement across stages 1–4 can be in either direction. For example, individuals with treated type 2 diabetes can move from stage 4 to stage 1 or stage 2. For type 1 diabetes, as remission develops, progression from stage 4 to stage 2 is typically found. Delineation of these stages provides insight into the pathophysiology of both progression and remission of diabetes. STAGE 1: COMPENSATION The most common example of compensation is found with the insulin resistance due to obesity, which is accompanied by higher overall rates of insulin secretion (2) and increased acute glucose-stimulated insulin secretion (GSIS) following an intravenous glucose challenge (3). Much of the increase in insulin secretion undoubtedly results from an increa Continue reading >>
