Update on Diabetes Mellitus and Glucose Metabolism Alterations in Prader-Willi Syndrome
AbstractPurpose of ReviewThis review summarizes our current knowledge on type 2 diabetes mellitus (T2DM) and glucose metabolism alterations in Prader-Willi syndrome (PWS), the most common syndromic cause of obesity, and serves as a guide for future research and current best practice.Recent FindingsDiabetes occurs in 10 –25% of PWS patients, usually in adulthood. Severe obesity is a significant risk factor for developing of T2DM in PWS. Paradoxically, despite severe obesity, a relative hypoinsulinemia, without the expected insulin resistance, is frequently observed in PWS. The majority of PWS subjects with T2DM a re a...
Source: Current Diabetes Reports - February 6, 2020 Category: Endocrinology Source Type: research

Diabetes Management in Community Health Centers: a Review of Policies and Programs
We describe prior policies that have influenced diabetes management in CHCs, discuss current policies and programs, as well as present emerging innovations and future directions for diabetes care in this setting.Recent FindingsDomains for current diabetes policies and programs in CHCs include coverage requirements, quality reporting and incentives, prescription discounts, healthy behavior incentives, and team-based care. Policies in these areas affect the management of diabetes at multiple levels, from organizations that support CHCs to individual health centers, and the providers and patients based there.SummarySeveral do...
Source: Current Diabetes Reports - February 6, 2020 Category: Endocrinology Source Type: research

Are Lifestyle Interventions to Reduce Excessive Gestational Weight Gain Cost Effective? A Systematic Review
AbstractPurpose of ReviewLifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the com...
Source: Current Diabetes Reports - February 1, 2020 Category: Endocrinology Source Type: research

Policy Implications of Artificial Intelligence and Machine Learning in Diabetes Management
AbstractPurpose of ReviewMachine learning (ML) is increasingly being studied for the screening, diagnosis, and management of diabetes and its complications. Although various models of ML have been developed, most have not led to practical solutions for real-world problems. There has been a disconnect between ML developers, regulatory bodies, health services researchers, clinicians, and patients in their efforts. Our aim is to review the current status of ML in various aspects of diabetes care and identify key challenges that must be overcome to leverage ML to its full potential.Recent FindingsML has led to impressive progr...
Source: Current Diabetes Reports - February 1, 2020 Category: Endocrinology Source Type: research

Type 2 Diabetes and Atherosclerotic Cardiovascular Disease in South Asians: a Unique Population with a Growing Challenge
AbstractPurpose of ReviewThe purpose of this review is to summarize our current knowledge of factors that influence clinical decision making and management of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) among South Asians (SA).Recent FindingsASCVD and T2DM in SAs have been examined in recent times. Pathophysiologic and genetic factors including the role of adiponectin, visceral adiposity, lower beta cell function, and psycho-social factors like sedentary lifestyle, poor adherence to medications, and carbohydrate dense meals play a role in early development and the high-risk presentati...
Source: Current Diabetes Reports - January 30, 2020 Category: Endocrinology Source Type: research

Small Interventions for Big Change: Brief Strategies for Distress and Self-Management Amongst Youth with Type 1 Diabetes
This article asserts that brevity is critical to maximizing the reach, scalability, and impact of psychosocial interventions for youth with type 1 diabetes. The authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions. (Source: Current Diabetes Reports)
Source: Current Diabetes Reports - January 30, 2020 Category: Endocrinology Source Type: research

Origins of the Crisis in Insulin Affordability and Practical Advice for Clinicians on Using Human Insulin
AbstractPurpose of ReviewHigh insulin prices and cost-related insulin underuse are increasingly common and vexing problems for healthcare providers. This review highlights several factors that contribute to high prices and limited generic competition in the US insulin market.Recent FindingsAn opaque and complex pricing and reimbursement system for insulin, allegations of collusive practices by insulin manufacturers, and a lack of generic competition drive and sustain high insulin prices. When combined with increasing insurance deductibles and cost sharing, these factors contribute to cost-related insulin underuse and are a...
Source: Current Diabetes Reports - January 29, 2020 Category: Endocrinology Source Type: research

Heterogeneity in Obesity: Genetic Basis and Metabolic Consequences
AbstractPurpose of ReviewOur review provides a brief summary of the most recent advances towards the identification of the genetic basis of specific aspects of obesity and the quantification of their consequences on health. We also highlight the most promising avenues to be explored in the future.Recent FindingsWhile obesity has been demonstrated to lead to adverse cardio-metabolic consequences, the determinants of inter-individual variability remain largely unknown. The elucidation of the molecular underpinnings of this relationship is hampered by the extremely heterogeneous nature of obesity as a human trait. Recent tech...
Source: Current Diabetes Reports - January 22, 2020 Category: Endocrinology Source Type: research

Technological Advancements in the Management of Type 2 Diabetes
AbstractPurpose of ReviewThe increasing prevalence of type 2 diabetes is driving the boundaries of clinical diabetes care outside of the traditional office setting. The purpose of this paper will be to review recent technological advances in the medical management of people with type 2 diabetes, spanning the spectrum of care from access to healthcare providers/educators, to continual virtual support methods, on-line management tools, and technologically integrated medication delivery systems.Recent FindingsRecent findings support a potential positive impact of technology on access to care, clinical outcomes, convenience, p...
Source: Current Diabetes Reports - December 20, 2019 Category: Endocrinology Source Type: research

The Effects of Lifestyle and/or Vitamin D Supplementation Interventions on Pregnancy Outcomes: What Have We Learned from the DALI Studies?
AbstractPurpose of ReviewThe DALI (vitamin D and lifestyle intervention in the prevention of gestational diabetes mellitus (GDM)) study aimed to prevent GDM with lifestyle interventions or Vitamin D supplementation (1600  IU/day). This review summarizes the learnings from the DALI studies among pregnant women with a BMI ≥ 29 kg/m2.Recent FindingsWomen diagnosed with GDM earlier in pregnancy had a worse metabolic profile than those diagnosed later. A combined physical activity (PA) and healthy eating (HE) lifestyle intervention improved both behaviours, limited gestational weight gain (GWG) and wa...
Source: Current Diabetes Reports - December 16, 2019 Category: Endocrinology Source Type: research

Diabetes and Cardiovascular Disease: an Update
AbstractPurpose of ReviewCardiovascular disease (CVD) is the leading cause of mortality in people with diabetes. Our aim was to review the pathophysiology of CVD in diabetes, review related landmark trials, and discuss the cardiovascular benefit of glucose-lowering agents. We have also discussed the role of controversial anti-platelet therapy.Recent FindingsRecent studies have shown the impact of glucose-lowering agents on CVD in people with diabetes. Statins are now recommended for all patients with diabetes over the age of 40 regardless of the LDL level given the cardiovascular benefit of these drugs. Current recommendat...
Source: Current Diabetes Reports - December 11, 2019 Category: Endocrinology Source Type: research

Organoids from the Human Fetal and Adult Pancreas
AbstractPurpose of ReviewNovel 3D organoid culture techniques have enabled long-term expansion of pancreatic tissue. This review comprehensively summarizes and evaluates the applications of primary tissue –derived pancreatic organoids in regenerative studies, disease modelling, and personalized medicine.Recent FindingsOrganoids derived from human fetal and adult pancreatic tissue have been used to study pancreas development and repair. Generated adult human pancreatic organoids harbor the capacity for clonal expansion and endocrine cell formation. In addition, organoids have been generated from human pancreatic ducta...
Source: Current Diabetes Reports - December 11, 2019 Category: Endocrinology Source Type: research

What the HLA-I! —Classical and Non-classical HLA Class I and Their Potential Roles in Type 1 Diabetes
AbstractPurpose of ReviewHyperexpression of classical HLA class I (HLA-I) molecules in insulin-containing islets has become a widely accepted hallmark of type 1 diabetes pathology. In comparison, relatively little is known about the expression, function and role of non-classical subtypes of HLA-I. This review focuses on the current understanding of the non-classical HLA-I subtypes: HLA-E, HLA-F and HLA-G, within and outside the field of type 1 diabetes, and considers the possible impacts of these molecules on disease etiology.Recent FindingsEvidence is growing to suggest that non-classical HLA-I proteins are upregulated, b...
Source: Current Diabetes Reports - December 9, 2019 Category: Endocrinology Source Type: research

The Use of Non-insulin Agents in Gestational Diabetes: Clinical Considerations in Tailoring Therapy
AbstractPurpose of ReviewTo assess evidence to date for use of non-insulin agents in treatment of gestational diabetes mellitus.Recent FindingsThere has been increasing interest in the use of non-insulin agents, primarily metformin and glyburide (which both cross the placenta). Metformin has been associated with less maternal weight gain; however, recent studies have shown a trend toward increased weight in offspring exposed to metformin in utero. Glyburide has been associated with increased neonatal hypoglycemia.SummaryGlycemic control during pregnancy is essential to optimize both maternal and fetal outcomes. There are a...
Source: Current Diabetes Reports - December 6, 2019 Category: Endocrinology Source Type: research

Bariatric Surgery in the Treatment of Type 2 Diabetes
AbstractPurpose of ReviewWe seek to characterize the impact of bariatric surgery on diabetes mellitus by recalling its history, examining the clinical data, exploring the putative mechanisms of action, and anticipating its future.Recent FindingsResults of clinical trials reveal that bariatric surgery induces remission of diabetes in 33 –90% of individuals at 1-year post-treatment versus 0–39% of medically managed. Remission rates decrease over time but remain higher in surgically treated individuals. Investigations have revealed numerous actions of surgery including effects on intestinal physiology, neuronal si...
Source: Current Diabetes Reports - December 4, 2019 Category: Endocrinology Source Type: research

Bridging the Gap for Patients with Diabetes and Cardiovascular Disease Through Cardiometabolic Collaboration
AbstractPurpose of ReviewCardiovascular disease (CVD) is the leading cause of morbidity and mortality in individuals with type 2 diabetes (T2D). Recent cardiovascular outcome trials (CVOTs) have established sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1 RA) as powerful medications that can lower glucose as well as reduce the risk of complications of CVD in many individuals with T2D. The combination of glycemic and cardiovascular benefits of SGLT2i and GLP1 RA has highlighted the importance of collaborative care of patients by diabetes and cardiovascular specialists. ...
Source: Current Diabetes Reports - December 4, 2019 Category: Endocrinology Source Type: research

Diagnostic Strategies for Gestational Diabetes Mellitus: Review of Current Evidence
In conclusion, current evidence favors universal screening for GDM using the one-step method. Early screening for GDM is not favorably supported by the literature. (Source: Current Diabetes Reports)
Source: Current Diabetes Reports - December 4, 2019 Category: Endocrinology Source Type: research

Brain Stimulation to Modulate Food Intake and Eating Behavior
AbstractPurpose of ReviewAppetitive behaviors are mediated through homeostatic and reward signaling of brain circuits. There has been increasing interest in the use of neuromodulation techniques aimed at targeting brain regions such as the lateral prefrontal and subcortical regions associated with dysregulation of eating behaviors.Recent FindingsInvasive brain stimulation techniques have demonstrated promising results in treating severe and enduring anorexia nervosa and morbid obesity. In addition, non-invasive techniques have been shown to successfully reduce food craving, hunger ratings, and calorie intake as well as bin...
Source: Current Diabetes Reports - December 2, 2019 Category: Endocrinology Source Type: research

Pharmacologic Randomized Clinical Trials in Prevention of Type 2 Diabetes
AbstractPurpose of ReviewThere have been many randomized clinical trials testing lifestyle and drug interventions to prevent the development of type 2 diabetes in nondiabetic adults at high risk of the disease. We review the major trials using pharmacologic interventions with the primary outcome of preventing diabetes. The trials are grouped according to the main mechanism by which the drugs were thought to have the potential for preventing diabetes.Recent FindingsDrugs in several different classes have been effective in reducing the incidence of diabetes, but evidence for other long-term benefits, such as avoidance of com...
Source: Current Diabetes Reports - December 2, 2019 Category: Endocrinology Source Type: research

Diabetic Gastroparesis and Glycaemic Control
AbstractPurpose of ReviewGastroparesis is an important complication of diabetes that may have a major impact on the quality of life as a result of upper gastrointestinal symptoms and impaired glycaemic control. Current management strategies include optimising blood glucose control, dietary modifications and supportive nutrition. Pharmacologic approaches with drugs that have prokinetic and/or antiemetic effects are also used widely; however, current available treatments have major limitations. There is increasing recognition that the rate of gastric emptying (GE) is a key determinant of the glycaemic response to a meal.Rece...
Source: Current Diabetes Reports - December 2, 2019 Category: Endocrinology Source Type: research

Sleep in Pregnancy and Maternal Hyperglycemia: a Narrative Review
AbstractPurpose of ReviewPrevalence of gestational diabetes is increasing globally and sleep may be a modifiable lifestyle factor associated with it. However, existing findings have been inconsistent.Recent FindingsMajority of studies reviewed found a link between extreme sleep durations and elevated risk of maternal hyperglycemia. The findings with sleep-disordered breathing are less consistent. Methodological differences across studies, in terms of sleep assessment methods (subjective vs. objective), study population (low vs. high risk), classification of gestational diabetes and sleep problems, may have contributed to t...
Source: Current Diabetes Reports - November 27, 2019 Category: Endocrinology Source Type: research

Thiazolidinediones: the Forgotten Diabetes Medications
AbstractPurpose of ReviewThiazolidinediones (TZDs) are the only pharmacologic agents that specifically treat insulin resistance. The beneficial effects of TZDs on the cardiovascular risk factors associated with insulin resistance have been well documented. TZD use has been limited because of concern about safety issues and side effects.Recent FindingsRecent studies indicate that cardiovascular toxicity with rosiglitazone and increase in bladder cancer with pioglitazone are no longer significant issues. There are new data which show that pioglitazone treatment reduces myocardial infarctions and ischemic strokes. New data co...
Source: Current Diabetes Reports - November 27, 2019 Category: Endocrinology Source Type: research

Hospitalization as an Opportunity to Optimize Glycemic Control in Oncology Patients
AbstractPurpose of ReviewMany patients experience hyperglycemia during cancer treatment, either as a new-onset condition or as an exacerbation of existing diabetes. This can impact treatment and outcomes, increasing the risk of complications and worsening health-related quality of life (HRQoL). These issues may be particularly significant when patients are hospitalized and/or acutely ill. The purpose of this review is to identify common barriers and strategies specific to the inpatient setting to improve glycemic control and minimize complications both while patients are hospitalized and after discharge.Recent FindingsHype...
Source: Current Diabetes Reports - November 27, 2019 Category: Endocrinology Source Type: research

mHealth Interventions for Disadvantaged and Vulnerable People with Type 2 Diabetes
AbstractBackgroundMobile- and Internet-delivered (collectively, digital) interventions are widely used by persons with diabetes (PWD) to assist with self-management and improve/maintain glycemic control (hemoglobin A1c [A1c]). However, evidence concerning the acceptance and benefits of such interventions among disadvantaged/vulnerable PWD is still quite limited.Purpose of ReviewWe reviewed studies published from 2011 –April 2019 evaluating the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes (T2D). ...
Source: Current Diabetes Reports - November 25, 2019 Category: Endocrinology Source Type: research

Early-Life Arsenic Exposure, Nutritional Status, and Adult Diabetes Risk
AbstractPurpose of ReviewIn utero influences, including nutrition and environmental chemicals, may induce long-term metabolic changes and increase diabetes risk in adulthood. This review evaluates the experimental and epidemiological evidence on the association of early-life arsenic exposure on diabetes and diabetes-related outcomes, as well as the influence of maternal nutritional status on arsenic-related metabolic effects.Recent FindingsFive studies in rodents have evaluated the role of in utero arsenic exposure with diabetes in the offspring. In four of the studies, elevated post-natal fasting glucose was observed when...
Source: Current Diabetes Reports - November 22, 2019 Category: Endocrinology Source Type: research

Natural Alternative Sweeteners and Diabetes Management
AbstractPurpose of ReviewThe goal of this review is to discuss the data on natural alternative sweeteners and their effects on glucose homeostasis and other metabolic parameters within the past five years. We sought to answer whether common natural alternative sweeteners have a positive or negative effect on glucose control in both human and animal models, and whether the data supports their widespread use as a tool to help reduce the prevalence of diabetes and associated comorbid conditions.Recent FindingsRecent studies suggest that natural alternative sweeteners may reduce hyperglycemia, improve lipid metabolism, and hav...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Lowering Targeted Atherogenic Lipoprotein Cholesterol Goals for Patients at “Extreme” ASCVD Risk
AbstractPurpose of ReviewTo review randomized interventional clinical and imaging trials that support lower targeted atherogenic lipoprotein cholesterol goals in “extreme” and “very high” atherosclerotic cardiovascular disease (ASCVD) risk settings. Major atherosclerotic cardiovascular event (MACE) prevention among the highest risk patients with ASCVD requires aggressive management of global risks, including lowering of the fundamental atherogenic ap olipoprotein B-associated lipoprotein cholesterol particles [i.e., triglyceride-rich lipoprotein remnant cholesterol, low-density lipoprotein cholester...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Human Endogenous Retroviruses and Type 1 Diabetes
AbstractPurpose of the ReviewThe aim of this review is to discuss recent data pointing at an involvement of human endogenous retroviruses (HERVs) in type 1 diabetes (T1D) onset and progression.Recent FindingsThe envelope protein of HERV-W family, named HERV-W-Env, was detected in pancreata from T1D patients and was shown to display pro-inflammatory properties and direct toxicity toward pancreatic beta cells.SummaryThe etiopathogenesis of T1D remains elusive, even if conventional environmental viral infections have been recurrently involved. Nonetheless, a new category of pathogens may provide the missing link between genet...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Glucose Management and the Sex Difference in Excess Cardiovascular Disease Risk in Long-Duration Type 1 Diabetes
AbstractPurpose of ReviewThe protection against CVD observed in women compared to men in the general population is essentially erased in type 1 diabetes. This review will discuss evidence regarding the role of glucose management on CVD risk by sex, with a particular focus on studies of long-duration type 1 diabetes of>  20 years.Recent FindingsAcross studies, women with type 1 diabetes have similar or worse glycemic control compared to men, despite higher rates of intensive insulin therapy. The association between HbA1c and CVD risk does not seem to differ by sex, but few studies have reported on sex-specifi...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Pancreatic Islet Transcriptional Enhancers and Diabetes
AbstractPurpose of ReviewCommon genetic variants that associate with type 2 diabetes risk are markedly enriched in pancreatic islet transcriptional enhancers. This review discusses current advances in the annotation of islet enhancer variants and their target genes.Recent FindingsRecent methodological advances now allow genetic and functional mapping of diabetes causal variants at unprecedented resolution. Mapping of enhancer-promoter interactions in human islets has provided a unique appreciation of the complexity of islet gene regulatory processes and enabled direct association of noncoding diabetes risk variants to thei...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Crosstalk Between Lipids and Mitochondria in Diabetic Kidney Disease
AbstractPurpose of ReviewThe goal of this review is to review the role that renal parenchymal lipid accumulation plays in contributing to diabetic kidney disease (DKD), specifically contributing to the mitochondrial dysfunction observed in glomerular renal cells in the context of DKD development and progression.Recent FindingsMitochondrial dysfunction has been observed in experimental and clinical DKD. Recently, Ayanga et al. demonstrate that podocyte-specific deletion of a protein involved in mitochondrial dynamics protects from DKD progression. Furthermore, our group has recently shown that ATP-binding cassette A1 (a pro...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Academic Detailing in the New Era of Diabetes Medication Management
AbstractPurpose of ReviewEducating clinicians on how to improve the medical management of type 2 diabetes in the modern pharmacologic era represents an enormous challenge given the number of medications available and the diversity across guideline recommendations. Academic detailing uses active social marketing techniques to deliver in-office, face-to-face educational encounters between a trained clinical educator (academic detailer) and a primary care clinician and can improve the quality of prescribing and management decisions, leading to better patient outcomes.Recent FindingsThis updated review provides context on how ...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes
AbstractPurpose of ReviewThis review will focus on the long-term outcomes in offspring exposed to in utero hyperglycemia and gestational diabetes (GDM), including obesity, adiposity, glucose metabolism, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, and puberty.Recent FindingsThere is evidence, mostly from observational studies, that offspring of GDM mothers have increased risk of obesity, increased adiposity, disorders of glucose metabolism (insulin resistance and type 2 diabetes), and hypertension. In contrast, evidence from the two intervention studies of treatment of mild GDM and childhood measures of ...
Source: Current Diabetes Reports - November 21, 2019 Category: Endocrinology Source Type: research

Adverse Effects of Glycemia-Lowering Medications in Type 2 Diabetes
AbstractPurpose of ReviewTreatment of patients with type 2 diabetes mellitus is focused on preventing the occurrence and delaying the development of macro- and micro-vascular complications. Glycemic control can help prevent these complications, but there is concern about the adverse effects of glycemia-lowering medications. A rational approach is to balance the desired low risk of adverse events against the unwanted higher risk of major complications resulting from suboptimal glucose control.Recent FindingsUsing the above approach, approved glucose-lowering agents have favorable benefit-to-risk profiles for use in most pat...
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Financing Diabetes Care in the U.S. Health System: Payment Innovations for Addressing the Medical and Social Determinants of Health
AbstractPurpose of ReviewReview innovations in health care financing promoting health system investments in addressing medical and social determinants of health (SDH) for patients with diabetes.Recent FindingsParticular payment models implemented in the public and private sectors increasingly offer flexibility in health care organizations (HCOs) to allocate resources towards helping patients with diabetes overcome the medical and socio-economic problems driving poor population and individual health.SummaryThe barriers imposed by the traditional fee-for-service (FFS) payment model to incorporating SDH into health care deliv...
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Patient-Reported Outcome Measures in Registry-Based Studies of Type 2 Diabetes Mellitus: a Systematic Review
AbstractPurpose of ReviewPatient-reported outcome measures (PROMs) and patient registries both play important roles in assessing patient outcomes. However, no study has examined the use of PROMs among registries involving patients with type 2 diabetes mellitus (T2DM). Our objective is twofold: first, to review the range of PROMs used in registry-based studies of patients with T2DM; second, to describe associations between these PROMs, T2DM and its complications.Recent FindingsThe International Consortium for Health Outcomes Measurement (ICHOM) Diabetes Standard Set recommended routine usage of PROMs to assess psychological...
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Glycemic Management in the Operating Room: Screening, Monitoring, Oral Hypoglycemics, and Insulin Therapy
AbstractPurpose of ReviewThis review provides a literature update and practical outline for the management of diabetes and stress hyperglycemia for adult surgical patients in the pre- and intraoperative settings.Recent FindingsHyperglycemia in surgical patients has been associated with increased risk of complication in both diabetic and non-diabetic patients in the perioperative setting. While current recommended perioperative blood glucose target is
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

De Novo Lipogenesis as a Source of Second Messengers in Adipocytes
AbstractPurpose of ReviewObesity is a major risk factor for type 2 diabetes. Although adipose tissue allows storage of excess calories in periods of overnutrition, in obesity, adipose tissue metabolism becomes dysregulated and can promote metabolic diseases. This review discusses recent advances in understandings how adipocyte metabolism impacts metabolic homeostasis.Recent FindingsThe ability of adipocytes to synthesize lipids from glucose is a marker of metabolic fitness, e.g., low de novo lipogenesis (DNL) in adipocytes correlates with insulin resistance in obesity. Adipocyte DNL may promote synthesis of special “...
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Emerging Concepts in the Treatment of Diabetic Retinopathy
AbstractPurpose of ReviewDiabetic retinopathy (DR) is the leading cause of vision loss in working-age adults in the developed world. This review discusses the current approach to managing the disease, such as glycemic and blood pressure control, as well as laser photocoagulation, as well as emerging concepts and controversies on novel therapies.Recent FindingsIn recent years, the rise of intraocular anti-angiogenesis treatments is changing the paradigm of classic laser photocoagulation in the management of DR, but its long-term benefits remain an area of controversy. We also discuss new targets including anti-inflammation,...
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Diabetes and Disasters: Recent Studies and Resources for Preparedness
This article highlights recent studies that look at the impact of disasters on people with diabetes and also shows recent resources for consumers, health care providers, and policy makers to improve resiliency in people with diabetes.Recent FindingsRecent articles have looked at the short-term impact of disasters upon people with diabetes and its comorbidities such as Hurricane Sandy in 2012, the triple disaster of 2011 in Japan (earthquake, tsunami, and nuclear accident), and the 2016 Kumamoto earthquake in Japan as well as the long-term impact of disasters such as Hurricane Katrina in 2005.SummarySeveral public and priva...
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Updates in Glycemic Management in the Hospital
AbstractPurpose of ReviewTo provide an update of glycemic management during metabolic stress related to surgery or critical illness.Recent FindingsThere is a clear association between severe hyperglycemia, hypoglycemia, and high glycemic variability and poor outcomes of postoperative or critically ill patients. However, the impressive beneficial effects of tight glycemic management (TGM) by intensive insulin therapy reported in one study were never reproduced. Hence, the recommendation of TGM is now replaced by more liberal blood glucose (BG) targets (
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Letter to the Editor Regarding “Public Health Approaches to Type 2 Diabetes Prevention: The US National Diabetes Prevention Program and Beyond”
(Source: Current Diabetes Reports)
Source: Current Diabetes Reports - November 20, 2019 Category: Endocrinology Source Type: research

Pancreas Transplantation from Donors after Circulatory Death: an Irrational Reluctance?
AbstractPurpose of ReviewBeta-cell replacement is the best therapeutic option for patients with type 1 diabetes. Because of donor scarcity, more extended criteria donors are used for transplantation. Donation after circulatory death donors (DCD) are not commonly used for pancreas transplantation, because of the supposed higher risk of complications. This review gives an overview on the pathophysiology, risk factors, and outcome in DCD transplantation and discusses different preservation methods.Recent FindingsStudies on outcomes of DCD pancreata show similar results compared with those of donation after brain death (DBD), ...
Source: Current Diabetes Reports - November 18, 2019 Category: Endocrinology Source Type: research

USA Vs Europe: Who Is Leading the Diabetes Tech Race?
AbstractPurpose of ReviewTo highlight global advancements in diabetes technology and compare available technologies and device approval processes in the USA and Europe and their impact on safety and innovation.Recent FindingsThe last two decades have seen a rapid growth in diabetes technology driven by the impetus to improve glycemic control, avoid complications of insulin therapy, improve quality of life, and hand more autonomy to individuals with diabetes. Meanwhile, changes to regulatory processes in the USA and Europe aim to facilitate entry of new devices into the marketplace.SummaryMajor strides have been made in dig...
Source: Current Diabetes Reports - November 16, 2019 Category: Endocrinology Source Type: research

Exercise and Cardiovascular Risk among Masters Athletes with Type 2 Diabetes
AbstractPurpose of ReviewThis review was designed to provide a scientific and clinical framework for the care of physically active men and women with an emphasis on the management of T2DM.Recent FindingsThe preventative and therapeutic benefits of physical activity (PA) on adult onset or Type 2 Diabetes Mellitus (T2DM) are well established. Individuals diagnosed with or are at risk for T2DM should be counseled and maximally supported to pursue an active or athletic lifestyle. Optimally, this translates into the adoption of an athletic lifestyle. “Masters athletes”, men and women above the age of 35 who regularl...
Source: Current Diabetes Reports - November 14, 2019 Category: Endocrinology Source Type: research

The Role of Bariatric Surgery on Diabetes and Diabetic Care Compliance
This article seeks to review the role of bariatric surgery on short- and long-term resolution of T2DM, recurrence, and compliance with T2DM medication following bariatric surgery.Recent FindingsSeven randomized control trials have examined metabolic surgery versus medical therapy in glycemic control in patients meeting criteria for severe obesity. Six out of seven studies demonstrate a significant advantage in the surgical arms with regards to glycemic control, as well as secondary endpoints such as weight loss, serum lipid levels, blood pressure, renal function, and other parameters. While patient compliance with lifestyl...
Source: Current Diabetes Reports - November 14, 2019 Category: Endocrinology Source Type: research

A Practice in Maturation: Current Perspectives on the Transition from Pediatric to Adult Care for Young Adults with Diabetes
AbstractPurpose of ReviewThis review of available literature and resources highlights the challenges in transition from pediatric to adult care for young adults with diabetes, summarizes practical recommendations for facilitating the process, and identifies areas for improvement in current transition practice.Recent FindingsObservational studies highlight suboptimal transition preparation counseling, gaps between pediatric and adult care, and increased post-transition hemoglobin A1c and acute care utilization. Studies showing improved outcomes with later age at transition allows for an extended focus on transition preparat...
Source: Current Diabetes Reports - November 14, 2019 Category: Endocrinology Source Type: research

Risk of Type 1 Diabetes in the Offspring Born through Elective or Non-elective Caesarean Section in Comparison to Vaginal Delivery: a Meta-Analysis of Observational Studies
ConclusionSummarized crude risk estimates showed a small increased T1D risk in children and young adults born through elective CS compared to vaginal delivery, but with significant heterogeneity. Adjusted risk estimates by study design indicated a slightly increased T1D risks associated with elective or non-elective CS. (Source: Current Diabetes Reports)
Source: Current Diabetes Reports - November 11, 2019 Category: Endocrinology Source Type: research

Updates from the Evidence Base Examining Association between Periodontal Disease and Type 2 Diabetes Mellitus: Current Status and Clinical Relevance
AbstractPurpose of the ReviewEpidemiological surveillance documents an escalating epidemic prevalence of both type 2 diabetes (T2DM) and periodontal disease (PD). The principal goals of this review are to: 1) re-examine the clinical significance of associations between PD and T2DM, based on strength of collective evidence as determined by systematic review and meta-analysis, and 2) review findings of the systematic reviews and meta-analyses in light of the current understanding of PD-associated pathophysiology and intersection with T2DM pathophysiology.Recent FindingsTooth loss predicts risk for chronic disease and mortali...
Source: Current Diabetes Reports - November 6, 2019 Category: Endocrinology Source Type: research

Replacing Pumps with Light Controlled Insulin Delivery
AbstractPurpose of ReviewThe aim of this review is to summarize the development of the photoactivated depot (PAD) approach for the minimally invasive and continuously variable delivery of insulin.Recent FindingsUsing an insulin PAD, we have demonstrated that we can release native, bioactive insulin into diabetic animals in response to light signals from a small external LED light source. We have further shown that this released insulin retains bioactivity and reduces blood glucose. In addition, we have designed and constructed second generation materials that have high insulin densities, with the potential for multiple day...
Source: Current Diabetes Reports - November 6, 2019 Category: Endocrinology Source Type: research