Phenotypic and Genetic Characteristics of Lipodystrophy: Pathophysiology, Metabolic Abnormalities, and Comorbidities
This article focuses on recent progress in understanding the genetics of lipodystrophy syndromes, the pathophysiology of severe metabolic abnormalities caused by these syndromes, and causes of severe morbidity and a possible signal of increased mortality associated with lipodystrophy. An updated classification scheme is also presented.Recent findingsLipodystrophy encompasses a group of heterogeneous rare diseases characterized by generalized or partial lack of adipose tissue and associated metabolic abnormalities including altered lipid metabolism and insulin resistance. Recent advances in the field have led to the discove...
Source: Current Diabetes Reports - November 8, 2018 Category: Endocrinology Source Type: research

The Evolving Role of the Cardiologist in the Management of Type 2 Diabetes
AbstractPurpose of ReviewTo evaluate the treatment of type 2 diabetes from a cardiologist ’s view.Recent FindingsA new era in the treatment of type 2 diabetes began for the cardiologist in 2015 with the publication of the EMPA-REG outcome trial finding a significant reduction in CV death with empagliflozin (oral sodium-glucose co-transporter-2 [SGLT2] inhibitor) in patients with type 2 diabetes at increased cardiovascular risk. Shortly thereafter, the injectable glucagon-like peptide agonists (GLP-1) liraglutide and semaglutide found a significant reduction in composite major cardiovascular events (CV death, non-fata...
Source: Current Diabetes Reports - November 8, 2018 Category: Endocrinology Source Type: research

Implications of the CANVAS Study in Reducing Cardiovascular Outcomes
AbstractPurpose of ReviewIn recent years, Cardiovascular Outcome Event Trials (CVOTs) in type 2 diabetes mellitus (T2DM) have demonstrated that sodium glucose transporter 2 inhibitors (SGLT2i) could reduce major adverse cardiovascular events (MACE) and cardiovascular mortality independent of a glucose lowering mechanism. SGLT2i trials reported significant results that have generated biologically plausible theories with regard to the macrovascular benefit. In this review, we have summarized and discussed the results of the CANVAS program.Recent FindingsThe CANVAS program is unique as it is an analysis of two aggregated coho...
Source: Current Diabetes Reports - November 5, 2018 Category: Endocrinology Source Type: research

Genetics of Monogenic Diabetes: Present Clinical Challenges
AbstractPurpose of ReviewMonogenic forms of diabetes have specific treatments that differ from the standard care provided for type 1 and type 2 diabetes, making the appropriate diagnosis essential. In this review, we discuss current clinical challenges that remain, including improving case-finding strategies, particularly those that have transethnic applicability, and understanding the interpretation of genetic variants as pathogenic, with clinically meaningful impacts.Recent FindingsBiomarker approaches to the stratification for genetic testing now appear to be most effective in identifying cases of monogenic diabetes, an...
Source: Current Diabetes Reports - October 30, 2018 Category: Endocrinology Source Type: research

Update on Therapeutic Options in Lipodystrophy
AbstractPurpose of ReviewThe purpose of this review is to summarize the therapeutic approach for lipodystrophy syndromes with conventional treatment options and metreleptin therapy in detail and to point out the current investigational treatments in development.Recent FindingsThe observation of leptin deficiency in patients with lipodystrophy and the potential of leptin replacement to rescue metabolic abnormalities in animal models of lipodystrophy were followed by the first clinical study of leptin therapy in patients with severe lipodystrophy. This and several other long-term studies demonstrated important benefits of re...
Source: Current Diabetes Reports - October 29, 2018 Category: Endocrinology Source Type: research

Comparison of Lipid-Lowering Medications and Risk for Cardiovascular Disease in Diabetes
AbstractPurpose of the ReviewTo summarize available evidence regarding lipid-lowering interventions for the prevention of cardiovascular disease in patients with diabetes.Recent FindingsStatins and non-statin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL cholesterol.SummaryIn subjects with diabetes, with or without established cardiovascular disease, each 39  mg/dl reduction in LDL cholesterol observed with statins is associated with a 21% relative reduction in the risk of major coronary events at 5 years. Statins r...
Source: Current Diabetes Reports - October 29, 2018 Category: Endocrinology Source Type: research

Non-Diabetic Hyperglycemia in the Pediatric Age: Why, How, and When to Treat?
AbstractPurpose of reviewNon-diabetic hyperglycemia (NDHY) is a pathological condition that is not yet well known. The aim of this review is to examine approaches for management of this condition.Recent findingsWhile it is well known that persistent hyperglycemia in diabetes affects immune response and risk for diabetes-related micro- and macrovascular complications, little is known about the biological effects of transient NDHY, particularly in the pediatric age group.SummaryStress HY (SHY) is typically defined as blood glucose>  8.33 mmol/L (150 mg/dL) during physical stress, resolving spontaneously after dissi...
Source: Current Diabetes Reports - October 29, 2018 Category: Endocrinology Source Type: research

Blood Pressure Variability and Autonomic Dysfunction
AbstractPurpose of ReviewThis review considers the relationship between abnormal blood pressure (BP) variability and autonomic dysfunction through an attempt to answer questions about its clinical relevance and pertinence to diabetes and cardiovascular autonomic neuropathy (CAN) and which therapeutic measures can lessen its cardiovascular impact.Recent FindingsOffice, ambulatory, and home BP monitoring identify posture-related, circadian, short-term, and long-term BP variabilities. Abnormal BP variability is a risk marker for organ damage, mortality, and cardiovascular events. Moreover, BP variability changes are common in...
Source: Current Diabetes Reports - October 25, 2018 Category: Endocrinology Source Type: research

The Environmental Determinants of Diabetes in the Young (TEDDY) Study: 2018 Update
AbstractPurpose of ReviewThe environmental triggers of islet autoimmunity leading to type 1 diabetes (T1D) need to be elucidated to inform primary prevention. The Environmental Determinants of Diabetes in the Young (TEDDY) Study follows from birth 8676 children with T1D risk HLA-DR-DQ genotypes in the USA, Finland, Germany, and Sweden. Most study participants (89%) have no first-degree relative with T1D. The primary outcomes include the appearance of one or more persistent islet autoantibodies (islet autoimmunity, IA) and clinical T1D.Recent FindingsAs of February 28, 2018, 769 children had developed IA and 310 have progre...
Source: Current Diabetes Reports - October 23, 2018 Category: Endocrinology Source Type: research

Revisiting the Diabetes-Heart Failure Connection
AbstractPurpose of the ReviewTo summarize current clinical data investigating the link between diabetes and heart failure pathophysiology, the association of glucose control with heart failure, and the impact of current antihyperglycemic drugs on heart failure.Recent FindingsAlthough heart failure is one of the most prevalent outcomes occurring in real life and cardiovascular outcome trials, insufficient attention was given to this condition in diabetes research over the last decades. With both beneficial and detrimental findings for heart failure hospitalization in the health authority –mandated outcome trials for n...
Source: Current Diabetes Reports - October 20, 2018 Category: Endocrinology Source Type: research

Who Will Win: Induced Pluripotent Stem Cells Versus Embryonic Stem Cells for β Cell Replacement and Diabetes Disease Modeling?
AbstractPurpose of ReviewEver since the reprogramming of human fibroblasts to induced pluripotent stem cells (hiPSCs), scientists have been trying to determine if hiPSCs can give rise to progeny akin to native terminally differentiated cells as human embryonic stem cells (hESCs) do. Many different somatic cell types have been successfully reprogrammed via a variety of methods. In this review, we will discuss recent studies comparing hiPSCs and hESCs and their ability to differentiate to desired cell types as well as explore diabetes disease models.Recent FindingsBoth somatic cell origin and the reprogramming method are imp...
Source: Current Diabetes Reports - October 20, 2018 Category: Endocrinology Source Type: research

Chronic Care Management Services for Complex Diabetes Management: a Practical Overview
AbstractPurpose of ReviewFormalized chronic care management has the potential to improve the quality and cost-effectiveness of complex diabetes management in adults, but has historically not been sustainably supported by health care systems. This review discusses the application of the chronic care model in the care of complex diabetes and its translation in the current reimbursement structure designed by Centers for Medicare and Medicaid Services (CMS).Recent FindingsFollowing the introduction of Wagner ’s Chronic Care Model (CCM) in the late 1990s, evidence gathered over the past 2 decades has supported the shift i...
Source: Current Diabetes Reports - October 20, 2018 Category: Endocrinology Source Type: research

A Review of Data of Findings on Night Shift Work and the Development of DM and CVD Events: a Synthesis of the Proposed Molecular Mechanisms
AbstractPurpose of ReviewNight shift work has become highly prevalent in our 24/7 societies, with up to 18% of the US work force working alternate shift schedules. However, studies indicate that there may be adverse health effects of chronic night work across diverse populations. These effects are likely due to misalignment of the circadian system with work schedules, mediated by the system ’s primary marker melatonin as well as other downstream molecules.Recent FindingsMelatonin has multiple biologic actions that are relevant to cardiometabolic disease, including modulation of oxidative stress, inflammation, and (vi...
Source: Current Diabetes Reports - October 20, 2018 Category: Endocrinology Source Type: research

Inflammation Markers in Type 2 Diabetes and the Metabolic Syndrome in the Pediatric Population
We present our current knowledge concerning the potential relationship between these cytokines, inflammation, metabolic syndrome (MetS), and type 2 diabetes mellitus (T2DM) in the pediatric population.Recent FindingsPro-inflammatory cytokines related to insulin resistance and MetS in children are tumor necrosis factor-alpha(TNF- α), interleukin (IL)-6, IL-1β, interferon gamma, pigment epithelium-derived factor, chemerin, vaspin, and fetuin A. Anti-inflammatory cytokines associated with insulin resistance and MetS in children are leptin, adiponectin, omentin, fibroblast growth factor(FGF)-21, osteocalcin, and iri...
Source: Current Diabetes Reports - October 18, 2018 Category: Endocrinology Source Type: research

Effect of Health Information Technologies on Glycemic Control Among Patients with Type 2 Diabetes
This study was to present meta-analysis findings across selected clinical trials for the effect of health information technologies (HITs) on glycemic control among patients with type 2 diabetes.Recent FindingsHITs may be promising in diabetes management. However, findings on effect size of glycated hemoglobin level (HbA1c) yielded from HITs varied across previous studies. This is likely due to heterogeneity in sample size, adherence to standard quantitative method, and/or searching criteria (e.g., type of HITs, type of diabetes, specification of patient population, randomized vs. nonrandomized trials).SummaryWe systematica...
Source: Current Diabetes Reports - October 18, 2018 Category: Endocrinology Source Type: research

Gut Microbiome in Obesity, Metabolic Syndrome, and Diabetes
AbstractPurpose of ReviewObesity and diabetes are worldwide epidemics. There is also a growing body of evidence relating the gut microbiome composition to insulin resistance. The purpose of this review is to delineate the studies linking gut microbiota to obesity, metabolic syndrome, and diabetes.Recent findingsAnimal studies as well as proof of concept studies using fecal transplantation demonstrate the pivotal role of the gut microbiota in regulating insulin resistance states and inflammation.SummaryWhile we still need to standardize methodologies to study the microbiome, there is an abundance of evidence pointing to the...
Source: Current Diabetes Reports - October 18, 2018 Category: Endocrinology Source Type: research

Pathogenesis of Lipid Disorders in Insulin Resistance: a Brief Review
AbstractPurpose of reviewInsulin resistance (IR) is recognized to play an important role in the pathogenesis of dyslipidemia. This review summarizes the complex interplay between IR and dyslipidemia in people with and without diabetes.Recent findingsIR impacts the metabolism of triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C) by several mechanisms. Trials with insulin sensitizing therapies, including biguanides and thiazolidinediones, have provided inconsistent results on lipid lowering in people with and without ...
Source: Current Diabetes Reports - October 17, 2018 Category: Endocrinology Source Type: research

Fat Versus Carbohydrate-Based Energy-Restricted Diets for Weight Loss in Patients With Type 2 Diabetes
AbstractPurpose of ReviewThe prevalence of combined obesity and diabetes has increased dramatically in the last few decades. Although medical and surgical weight management are variably effective in addressing this epidemic, it is essential to parallel these strategies with a hypocaloric diet comprising the appropriate macronutrient composition to induce weight loss, enhance glycemic control, and improve cardiovascular risk factors. This review reports the current evidence of the role of carbohydrates and fat-based diets for weight management in patients with combined type 2 diabetes (T2D) and obesity.Recent FindingsLow-ca...
Source: Current Diabetes Reports - October 17, 2018 Category: Endocrinology Source Type: research

Beyond Statins: Who and When to Prescribe?
AbstractPurpose of ReviewStatins are the most evidence-based therapy to target LDL-C to reduce atherosclerotic events. Yet, many people are unable to achieve adequate reduction in this key atherogenic factor. Moreover, residual risk of cardiovascular events may persist even after “optimal” LDL-C due to elevations in triglyceride-rich lipoproteins. Therefore, additional therapies beyond statins are needed, particularly in patients with diabetes.Recent FindingsClinical trials with ezetimibe and PCSK9 inhibitors have reported further reductions in cardiovascular events, beyond statins. The latter are particularly ...
Source: Current Diabetes Reports - October 15, 2018 Category: Endocrinology Source Type: research

Diabetes and HIV
AbstractPurpose of ReviewThis review seeks to address the epidemiology and pathophysiological basis of the interaction between HIV infection and diabetes and the implication for treatment. Its importance stems from the current context of the growing burden of both conditions and the possible mechanisms of interactions that may exist but not yet sufficiently examined.Recent FindingsHIV infection is associated with increased risk of insulin resistance, and ART is associated with metabolic derangement and the occurrence of type 2 diabetes. The increasing survival among people with HIV infection in developing countries is para...
Source: Current Diabetes Reports - October 8, 2018 Category: Endocrinology Source Type: research

Pancreas Pathology During the Natural History of Type 1 Diabetes
AbstractPurpose of reviewWe provide an overview of pancreas pathology in type 1 diabetes (T1D) in the context of its clinical stages.Recent findingsRecent studies of pancreata from organ donors with T1D and non-diabetic donors expressing T1D-associated autoantibodies reveal pathological changes/disease mechanisms beyond the well-known loss of β cells and lymphocytic infiltrates of the islets (insulitis), including β-cell stress, dysfunction, and viral infections. Pancreas pathology evolves through disease stages, is asynchronous, and demonstrates a chronic disease that remains active years after diagnosis. Critic...
Source: Current Diabetes Reports - October 6, 2018 Category: Endocrinology Source Type: research

App-Based Insulin Calculators: Current and Future State
AbstractPurpose of ReviewTo perform a comprehensive literature review and critical assessment of peer-reviewed manuscripts addressing the efficacy, safety, or usability of insulin calculator apps.Recent FindingsManaging diabetes with insulin can be complex, and literacy and numeracy skills pose barriers to manual insulin dose calculations. App-based insulin calculators are promising tools to help people with diabetes administer insulin safely and have potential to improve glycemic control. While a large number of apps which assist with insulin dosing are available, there is limited data evaluating their efficacy, safety, a...
Source: Current Diabetes Reports - October 4, 2018 Category: Endocrinology Source Type: research

Ketosis-Prone Diabetes (Flatbush Diabetes): an Emerging Worldwide Clinically Important Entity
AbstractPurpose of ReviewKetosis-prone diabetes or Flatbush diabetes has been widely recognized as a clinical entity since 1984. Most of the early clinical studies focused on African American or Afro-Caribbean individuals. It is now being recognized as an important clinical entity in sub-Saharan Africans, Asian and Indian populations, and Hispanic populations. Major questions remain as to its pathogenesis and whether it is a unique type of diabetes or a subset of more severe type 2 diabetes with greater loss of insulin action in target tissues. This review summarizes the main clinical and mechanistic studies to improve the...
Source: Current Diabetes Reports - October 2, 2018 Category: Endocrinology Source Type: research

Epigenetics Variation and Pathogenesis in Diabetes
AbstractPurpose of ReviewGreat strides have recently been made in elucidating the role of genetic sequence variation in diabetes pathogenesis. Increasingly, studies are focusing on other factors that may contribute to the pathogenesis of diabetes, such as epigenetics, a term “traditionally” encompassing changes to the DNA that do not alter sequence and are heritable (primary methylation and histone modification) but often expanded to include microRNAs. This review summarizes latest findings on the role of epigenetics in diabetes pathogenesis.Recent FindingsRecent studies illustrate roles for methylation changes...
Source: Current Diabetes Reports - October 2, 2018 Category: Endocrinology Source Type: research

Can We Re-Engineer the Endocrine Pancreas?
AbstractPurpose of ReviewEngineering endocrine pancreatic tissue is an emerging topic in type 1 diabetes with the intent to overcome the current limitation of β cell transplantation. During islet isolation, the vascularized structure and surrounding extracellular matrix (ECM) are completely disrupted. Once implanted, islets slowly engraft and mostly are lost for the initial avascular phase. This review discusses the main building blocks required to engin eer the endocrine pancreas: (i) islet niche ECM, (ii) islet niche vascular network, and (iii) new available sources of endocrine cells.Recent FindingsCurrent approach...
Source: Current Diabetes Reports - October 2, 2018 Category: Endocrinology Source Type: research

Ketosis-Prone Diabetes (Flatbush Diabetes): an Emerging Worldwide Clinically Important Entity
AbstractPurpose of ReviewKetosis-prone diabetes or Flatbush diabetes has been widely recognized as a clinical entity since 1984. Most of the early clinical studies focused on African American or Afro-Caribbean individuals. It is now being recognized as an important clinical entity in sub-Saharan Africans, Asian and Indian populations, and Hispanic populations. Major questions remain as to its pathogenesis and whether it is a unique type of diabetes or a subset of more severe type 2 diabetes with greater loss of insulin action in target tissues. This review summarizes the main clinical and mechanistic studies to improve the...
Source: Current Diabetes Reports - October 2, 2018 Category: Endocrinology Source Type: research

Epigenetics Variation and Pathogenesis in Diabetes
AbstractPurpose of ReviewGreat strides have recently been made in elucidating the role of genetic sequence variation in diabetes pathogenesis. Increasingly, studies are focusing on other factors that may contribute to the pathogenesis of diabetes, such as epigenetics, a term “traditionally” encompassing changes to the DNA that do not alter sequence and are heritable (primary methylation and histone modification) but often expanded to include microRNAs. This review summarizes latest findings on the role of epigenetics in diabetes pathogenesis.Recent FindingsRecent studies illustrate roles for methylation changes...
Source: Current Diabetes Reports - October 2, 2018 Category: Endocrinology Source Type: research

Can We Re-Engineer the Endocrine Pancreas?
AbstractPurpose of ReviewEngineering endocrine pancreatic tissue is an emerging topic in type 1 diabetes with the intent to overcome the current limitation of β cell transplantation. During islet isolation, the vascularized structure and surrounding extracellular matrix (ECM) are completely disrupted. Once implanted, islets slowly engraft and mostly are lost for the initial avascular phase. This review discusses the main building blocks required to engin eer the endocrine pancreas: (i) islet niche ECM, (ii) islet niche vascular network, and (iii) new available sources of endocrine cells.Recent FindingsCurrent approach...
Source: Current Diabetes Reports - October 2, 2018 Category: Endocrinology Source Type: research

Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation
AbstractPurpose of ReviewThe study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management.Recent FindingsBoth type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management.SummaryIndividuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recu...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

Glycemic Outcomes of Islet Autotransplantation
AbstractPurpose of ReviewWhile there has been a growing utilization of total pancreatectomy with islet autotransplantation (TPIAT) for patients with medically refractory chronic pancreatitis over the past few decades, there remains a lack of consensus clinical guidelines to inform the counseling and management of patients undergoing TPIAT. In this article, we review the current clinical practice and published experience of several TPIAT centers, outline key aspects in managing patients undergoing TPIAT, and discuss the glycemic outcomes of this procedure.Recent FindingsAiming for lower inpatient glucose targets immediately...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

The Role of Accessory Cells in Islet Homeostasis
AbstractPurposes of ReviewScattered throughout the pancreas, the endocrine islets rely on neurovascular support for signal relay to regulate hormone secretion and for maintaining tissue homeostasis. The islet accessory cells (or components) of neurovascular tissues include the endothelial cells, pericytes, smooth muscle cells, neurons (nerve fibers), and glia. Research results derived from experimental diabetes and islet transplantation indicate that the accessory cells are reactive in islet injury and can affect islet function and homeostasis in situ or in an ectopic environment.Recent FindingsRecent advances in cell labe...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

Oral Agents for the Treatment of Gestational Diabetes
AbstractPurpose of ReviewTo review the current evidence of the safety and efficacy of the use of oral agents for treatment of gestational diabetes (GDM).Recent FindingsThe use of metformin and glyburide in pregnancy for treatment of GDM has dramatically increased since the early 2000s. Meta-analyses suggest that glyburide may increase the risk for large for gestational (LGA) infants and neonatal hypoglycemia. Conversely, metformin may potentially decrease rates of pregnancy-induced hypertension, LGA, neonatal hypoglycemia, and maternal weight gain. However, recent long-term offspring studies indicate a potential detrimenta...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation
AbstractPurpose of ReviewThe study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management.Recent FindingsBoth type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management.SummaryIndividuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recu...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

Glycemic Outcomes of Islet Autotransplantation
AbstractPurpose of ReviewWhile there has been a growing utilization of total pancreatectomy with islet autotransplantation (TPIAT) for patients with medically refractory chronic pancreatitis over the past few decades, there remains a lack of consensus clinical guidelines to inform the counseling and management of patients undergoing TPIAT. In this article, we review the current clinical practice and published experience of several TPIAT centers, outline key aspects in managing patients undergoing TPIAT, and discuss the glycemic outcomes of this procedure.Recent FindingsAiming for lower inpatient glucose targets immediately...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

The Role of Accessory Cells in Islet Homeostasis
AbstractPurposes of ReviewScattered throughout the pancreas, the endocrine islets rely on neurovascular support for signal relay to regulate hormone secretion and for maintaining tissue homeostasis. The islet accessory cells (or components) of neurovascular tissues include the endothelial cells, pericytes, smooth muscle cells, neurons (nerve fibers), and glia. Research results derived from experimental diabetes and islet transplantation indicate that the accessory cells are reactive in islet injury and can affect islet function and homeostasis in situ or in an ectopic environment.Recent FindingsRecent advances in cell labe...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

Oral Agents for the Treatment of Gestational Diabetes
AbstractPurpose of ReviewTo review the current evidence of the safety and efficacy of the use of oral agents for treatment of gestational diabetes (GDM).Recent FindingsThe use of metformin and glyburide in pregnancy for treatment of GDM has dramatically increased since the early 2000s. Meta-analyses suggest that glyburide may increase the risk for large for gestational (LGA) infants and neonatal hypoglycemia. Conversely, metformin may potentially decrease rates of pregnancy-induced hypertension, LGA, neonatal hypoglycemia, and maternal weight gain. However, recent long-term offspring studies indicate a potential detrimenta...
Source: Current Diabetes Reports - September 28, 2018 Category: Endocrinology Source Type: research

The Effect of Age on the Progression and Severity of Type 1 Diabetes: Potential Effects on Disease Mechanisms
AbstractPurpose of ReviewTo explore the impact of age on type 1 diabetes (T1D) pathogenesis.Recent FindingsChildren progress more rapidly from autoantibody positivity to T1D and have lower C-peptide levels compared to adults. In histological analysis of post-mortem pancreata, younger age of diagnosis is associated with reduced numbers of insulin containing islets and a hyper-immune CD20hi infiltrate. Moreover compared to adults, children exhibit decreased immune regulatory function and increased engagement and trafficking of autoreactive CD8+ T cells, and age-related differences in β cell vulnerability may also contri...
Source: Current Diabetes Reports - September 26, 2018 Category: Endocrinology Source Type: research

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field
AbstractPurpose of ReviewSummarize biopsychosocial factors associated with using continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas (AP) systems and provide a “call to the field” about their importance to technology uptake and maintained use.Recent FindingsInsulin pumps and CGMs are becoming standard of care for individuals with type 1 diabetes (T1D). AP systems combining a CGM, insulin pump, and automated dosing algorithm are available for commercial use. Despite improved glycemic control with AP system use, numerous barriers exist which may limit their benefit. Studies on components of...
Source: Current Diabetes Reports - September 26, 2018 Category: Endocrinology Source Type: research

Metabolic Surgery as a Treatment Option for Type 2 Diabetes Mellitus: Surgical View
AbstractPurpose of ReviewType 2 diabetes mellitus (T2DM) is increasing in prevalence and associated with numerous metabolic complications leading to increased mortality and costs. Metabolic surgery, or surgery to treat T2DM and obesity, is effective at achieving remission from T2DM. This review discusses the most commonly used surgical options including the adjustable gastric band, the Roux-en-Y gastric bypass, the sleeve gastrectomy, and the biliopancreatic diversion with duodenal switch and their ability to treat and prevent T2DM.Recent FindingsThere is an increasing body of literature that justifies the inclusion of met...
Source: Current Diabetes Reports - September 26, 2018 Category: Endocrinology Source Type: research

The Effect of Age on the Progression and Severity of Type 1 Diabetes: Potential Effects on Disease Mechanisms
AbstractPurpose of ReviewTo explore the impact of age on type 1 diabetes (T1D) pathogenesis.Recent FindingsChildren progress more rapidly from autoantibody positivity to T1D and have lower C-peptide levels compared to adults. In histological analysis of post-mortem pancreata, younger age of diagnosis is associated with reduced numbers of insulin containing islets and a hyper-immune CD20hi infiltrate. Moreover compared to adults, children exhibit decreased immune regulatory function and increased engagement and trafficking of autoreactive CD8+ T cells, and age-related differences in β cell vulnerability may also contri...
Source: Current Diabetes Reports - September 26, 2018 Category: Endocrinology Source Type: research

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field
AbstractPurpose of ReviewSummarize biopsychosocial factors associated with using continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas (AP) systems and provide a “call to the field” about their importance to technology uptake and maintained use.Recent FindingsInsulin pumps and CGMs are becoming standard of care for individuals with type 1 diabetes (T1D). AP systems combining a CGM, insulin pump, and automated dosing algorithm are available for commercial use. Despite improved glycemic control with AP system use, numerous barriers exist which may limit their benefit. Studies on components of...
Source: Current Diabetes Reports - September 26, 2018 Category: Endocrinology Source Type: research

Metabolic Surgery as a Treatment Option for Type 2 Diabetes Mellitus: Surgical View
AbstractPurpose of ReviewType 2 diabetes mellitus (T2DM) is increasing in prevalence and associated with numerous metabolic complications leading to increased mortality and costs. Metabolic surgery, or surgery to treat T2DM and obesity, is effective at achieving remission from T2DM. This review discusses the most commonly used surgical options including the adjustable gastric band, the Roux-en-Y gastric bypass, the sleeve gastrectomy, and the biliopancreatic diversion with duodenal switch and their ability to treat and prevent T2DM.Recent FindingsThere is an increasing body of literature that justifies the inclusion of met...
Source: Current Diabetes Reports - September 26, 2018 Category: Endocrinology Source Type: research

Artificial Pancreas or Novel Beta-Cell Replacement Therapies: a Race for Optimal Glycemic Control?
AbstractPurpose of ReviewNew treatment strategies are needed for patients with type 1 diabetes (T1D). Closed loop insulin delivery and beta-cell replacement therapy are promising new strategies. This review aims to give an insight in the most relevant literature on this topic and to compare the two radically different treatment modalities.Recent FindingsMultiple clinical studies have been performed with closed loop insulin delivery devices and have shown an improvement in overall glycemic control and time spent in hypoglycemia. Beta-cell transplantation has been shown to normalize or greatly improve glycemic control in T1D...
Source: Current Diabetes Reports - September 24, 2018 Category: Endocrinology Source Type: research

The Impact of Pancreatic Beta Cell Heterogeneity on Type 1 Diabetes Pathogenesis
AbstractPurpose of ReviewTo discuss advances in our understanding of beta-cell heterogeneity and the ramifications of this for type 1 diabetes (T1D) and its therapy.Recent FindingsA number of studies have challenged the long-standing dogma that the majority of beta cells are eliminated in T1D. As many as 80% are present in some T1D subjects. Why don ’t these cells function properly to release insulin in response to high glucose? Other findings deploying single-cell “omics” to study both healthy and diseased cells—from patients with both T1D and type 2 diabetes (T2D)—have revealed cell subpopul...
Source: Current Diabetes Reports - September 24, 2018 Category: Endocrinology Source Type: research

Lifestyle Factors Affecting the Gut Microbiota ’s Relationship with Type 1 Diabetes
AbstractPurpose of ReviewThe incidence of type 1 diabetes (T1D) is rising drastically for the past decades at a rate that cannot be explained by genetic changes alone. Environmental changes are considered to be the main drivers of this change. Recently, the gut microbiota has been suggested as a missing link between known environmental disease modulators and T1D promotion. Lifestyle factors have changed over time and have altered the gut microbiota-host interaction affecting T1D development. The purpose of this review is to discuss recent data emphasizing the modulatory potential of early lifestyle factors on gut microbiot...
Source: Current Diabetes Reports - September 24, 2018 Category: Endocrinology Source Type: research

Artificial Pancreas or Novel Beta-Cell Replacement Therapies: a Race for Optimal Glycemic Control?
AbstractPurpose of ReviewNew treatment strategies are needed for patients with type 1 diabetes (T1D). Closed loop insulin delivery and beta-cell replacement therapy are promising new strategies. This review aims to give an insight in the most relevant literature on this topic and to compare the two radically different treatment modalities.Recent FindingsMultiple clinical studies have been performed with closed loop insulin delivery devices and have shown an improvement in overall glycemic control and time spent in hypoglycemia. Beta-cell transplantation has been shown to normalize or greatly improve glycemic control in T1D...
Source: Current Diabetes Reports - September 24, 2018 Category: Endocrinology Source Type: research

The Impact of Pancreatic Beta Cell Heterogeneity on Type 1 Diabetes Pathogenesis
AbstractPurpose of ReviewTo discuss advances in our understanding of beta-cell heterogeneity and the ramifications of this for type 1 diabetes (T1D) and its therapy.Recent FindingsA number of studies have challenged the long-standing dogma that the majority of beta cells are eliminated in T1D. As many as 80% are present in some T1D subjects. Why don ’t these cells function properly to release insulin in response to high glucose? Other findings deploying single-cell “omics” to study both healthy and diseased cells—from patients with both T1D and type 2 diabetes (T2D)—have revealed cell subpopul...
Source: Current Diabetes Reports - September 24, 2018 Category: Endocrinology Source Type: research

Lifestyle Factors Affecting the Gut Microbiota ’s Relationship with Type 1 Diabetes
AbstractPurpose of ReviewThe incidence of type 1 diabetes (T1D) is rising drastically for the past decades at a rate that cannot be explained by genetic changes alone. Environmental changes are considered to be the main drivers of this change. Recently, the gut microbiota has been suggested as a missing link between known environmental disease modulators and T1D promotion. Lifestyle factors have changed over time and have altered the gut microbiota-host interaction affecting T1D development. The purpose of this review is to discuss recent data emphasizing the modulatory potential of early lifestyle factors on gut microbiot...
Source: Current Diabetes Reports - September 24, 2018 Category: Endocrinology Source Type: research

Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults
AbstractPurpose of reviewEvidence-based treatments for prediabetes can prevent and delay the development of type 2 diabetes in adults. In this review, we propose a framework for population-based diabetes prevention that links screening and prevention activities across key stakeholders. We also discuss gaps in current practice, while highlighting opportunities to improve diabetes screening and prevention efforts population-wide.Recent findingsAwareness of diabetes risk is low, and many adults with prediabetes are not identified through existing screening efforts. Accumulating evidence and policies support expansion of the D...
Source: Current Diabetes Reports - September 19, 2018 Category: Endocrinology Source Type: research