Abstract Sedentary behaviour (e.g. TV viewing, seated video game playing, prolonged sitting) has recently emerged as a distinct risk factor for cardiometabolic diseases in children and youth. This narrative review provides an overview of recent evidence in this area and highlights research gaps. Current evidence suggests that North American children and youth spend between 40% and 60% of their waking hours engaging in sedentary pursuits. Although data are lacking concerning temporal trends of objectively measured sedentary time, self-reported sedentary behaviours have increased over the past half century, with a rapid increase since the late 1990s. Excessive sedentary behaviour has been found to have independent and deleterious associations with markers of adiposity and cardiometabolic disease risk. These associations are especially consistent for screen-based sedentary behaviours (TV viewing, computer games, etc), with more conflicting findings observed for overall sedentary time. The above associations are possibly mediated by the influence of screen-based sedentary behaviours on energy intake. Although excessive sitting has been reported to have adverse acute and chronic metabolic impacts in adults, research on children is lacking. Research is particularly needed to investigate the impact of characteristics of sedentary behaviour (i.e. type/context, sedentary bout length, breaks in sedentary time, etc), as well as interventions that examine the health and behavioural impacts of sitting per se.
Pancreatic β-cells modulate insulin secretion through rapid sensing of blood glucose and integration of gut-derived signals. Increased insulin demand during pregnancy and obesity alters islet function and mass and leads to gestational diabetes mellitus and type 2 diabetes in predisposed individuals. However, it is unclear how blood-borne factors dynamically access the islets of Langerhans. Thus, understanding the changes in circulating molecule distribution that accompany compensatory β-cell expansion may be key to developing novel antidiabetic therapies. Here, using two-photon microscopy in vivo in mice, we demonstrate that islets are almost instantly exposed to peaks of circulating molecules, which rapidly pervade the tissue before clearance. In addition, both gestation and short-term high-fat-diet feeding decrease molecule extravasation and uptake rates in vivo in islets, independently of β-cell expansion or islet blood flow velocity. Together, these data support a role for islet vascular permeability in shaping β-cell adaptive responses to metabolic demand by modulating the access and sensing of circulating molecules.
Abstract Objective To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians. Method A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. Results Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP 3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers. Conclusions The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.
Objective: Oxidative stress, defined as an imbalance between reactive oxygen species production and breakdown by endogenous antioxidants, is closely associated with diabetes mellitus. The diabetes is characterized by hyperglycemia together with biochemical alterations of glucose and lipid peroxidation. Oxidative stress has been implicated in the pathogenesis of type 2 diabetes and its complications. Methods: This study was conducted to investigate the variation in oxidative stress-related parameters in type 2 diabetes. Blood serum samples were collected from diabetes patients and nondiabetes healthy controls. Glucose concentrations, levels of glycated hemoglobin (A1C) and serum oxidative stress markers (glucose-6-phosphate dehydrogenase [G6PDH], malondialdehyde [MDA], glutathione [GSH], glutathione reductase [GR], glutathione peroxidase [GPx] and superoxide dismutase [SOD]) were estimated. Results: Fasting serum glucose concentration in type 2 diabetes patients of both sexes was increased significantly as compared with the healthy controls. Level of A1C was greater than standards. Significant elevation in MDA level and depletion in GSH content were observed in diabetes patients in comparison with controls. The diminution in G6PDH activity was accompanied in part by a decrease in the antioxidative enzymes activities (GPx and GR), and in part by an increase in SOD activity in all diabetes patients as compared with the control group. The regression analysis showed no correlation between diabetes duration and severity of oxidative stress; however, there was a significant association between A1C and severity of oxidative stress. Conclusions: The present study shows that there is an oxidative stress state in type 2 diabetes patients compared with healthy subjects. Our data suggest that chronic hyperglycemia causes a significant change in oxidative stress markers.
Abstract Objective Oxidative stress, defined as an imbalance between reactive oxygen species production and breakdown by endogenous antioxidants, is closely associated with diabetes mellitus. The diabetes is characterized by hyperglycemia together with biochemical alterations of glucose and lipid peroxidation. Oxidative stress has been implicated in the pathogenesis of type 2 diabetes and its complications. Methods This study was conducted to investigate the variation in oxidative stress-related parameters in type 2 diabetes. Blood serum samples were collected from diabetes patients and nondiabetes healthy controls. Glucose concentrations, levels of glycated hemoglobin (A1C) and serum oxidative stress markers (glucose-6-phosphate dehydrogenase [G6PDH], malondialdehyde [MDA], glutathione [GSH], glutathione reductase [GR], glutathione peroxidase [GPx] and superoxide dismutase [SOD]) were estimated. Results Fasting serum glucose concentration in type 2 diabetes patients of both sexes was increased significantly as compared with the healthy controls. Level of A1C was greater than standards. Significant elevation in MDA level and depletion in GSH content were observed in diabetes patients in comparison with controls. The diminution in G6PDH activity was accompanied in part by a decrease in the antioxidative enzymes activities (GPx and GR), and in part by an increase in SOD activity in all diabetes patients as compared with the control group. The regression analysis showed no correlation between diabetes duration and severity of oxidative stress; however, there was a significant association between A1C and severity of oxidative stress. Conclusions The present study shows that there is an oxidative stress state in type 2 diabetes patients compared with healthy subjects. Our data suggest that chronic hyperglycemia causes a significant change in oxidative stress markers.
Adipose tissue is an enormously active endocrine organ, secreting various hormones, such as adiponectin, leptin, resistin and visfatin, together with classical cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). All these adipocytokines play significant roles in the regulation of energy metabolism, glucose and lipid metabolism, reproduction, cardiovascular function and immunity. Adipocytokines are significantly regulated by nutritional status and can directly influence other organ systems, including brain, liver and skeletal muscle. Adiponectin plays a key role as an anti-inflammatory hormone. Upregulated expression of resistin, vaspin, apelin and TNF-α plays a significant role in induction of insulin resistance linked with obesity and type 2 diabetes. Ghrelin, the circulating peptide, has been found to stimulate appetite and regulate energy balance. Thus, it can be considered 1 of the candidate genes for obesity and type 2 diabetes. Omentin is a novel adipokine produced by visceral adipose tissue. Circulating levels of omentin are decreased in insulin-resistant states, for example, in obesity and diabetes. IL-6 plays a vital role in regulating the accumulation of lipids intramyocardially. Based on the biologic relevance of these adipocytokines, they can no longer be considered as energy storage sites alone but must also be considered in metabolic control. Hence, the present review summarizes the regulatory roles of adipocytokines in diabetes linked with obesity. Le tissu adipeux est un organe endocrinien très actif, qui sécrète diverses hormones telles que l'adiponectine, la leptine, la résistine et la visfatine, ainsi que des cytokines typiques telles que le facteur de nécrose tumorale alpha (TNF-α) et l'interleukine-6 (IL-6). Toutes ces adipocytokines jouent des rôles importants dans la régulation du métabolisme énergétique, des métabolismes du glucose et des lipides, la reproduction, le fonctionnement cardiovasculaire et l'immunité. Les adipocytokines sont régulées de manière significative par l'état nutritionnel et peuvent directement influencer d'autres systèmes organiques, y compris le cerveau, le foie et les muscles squelettiques. L'adiponectine joue le rôle essentiel d'une hormone aux effets anti-inflammatoires. L'expression régulée à la hausse de la résistine, la vaspine, l'apeline et le TNF- α joue un rôle important dans l'induction de l'insulinorésistance liée à l'obésité et au diabète de type 2. On a constaté que la ghréline, un peptide circulant, stimule l'appétit et régule le bilan énergétique. Par conséquent, on peut la considérer comme le 1 des gènes candidats de l'obésité et du diabète de type 2. L'omentine est une nouvelle adipokine produite par le tissu adipeux viscéral. Les concentrations circulantes de l'omentine sont diminuées lors d'états d'insulinorésistance, par exemple en cas d'obésité et de diabète. L'IL-6 joue un rôle vital dans la régulation de l'accumulation intramyocardique des lipides. Selon la pertinence biologique de ces adipocytokines, elles ne peuvent plus être considérées comme les seuls sites de stockage de l'énergie, mais doivent également être considérées dans la régulation du métabolisme. En conséquence, la revue actuelle résume les rôles régulateurs des adipocytokines lors de diabète lié à l'obésité.
Current management options for treating type 2 diabetes are diverse. Many different classes of antidiabetes therapies are used in clinic, and several new candidates are in late-phase clinical trial. This therapeutic abundance is a windfall for patients because it facilitates individualized patient care. Evidence-based positioning of these agents is challenging, however, requiring comprehensive and balanced familiarity with each drug class. In this review, I provide a clinical update of glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of incretin-based, injectable antidiabetes therapies which improve fasting and postprandial blood glucose control through glucose-dependent pancreatic islet cell hormone secretion without significant risks for hypoglycemia. Chronic use of GLP-1RAs also promotes body weight loss through stimulation of GLP-1 receptors localized in hypothalamic satiety centres that regulate appetite, resulting in reduced caloric intake. Since 2005, when GLP-1RAs first received regulatory approval for type 2 diabetes, this class has expanded to include long-acting, once-weekly GLP-1RAs. Recent cardiovascular outcome trials demonstrate that long-term use of GLP-1RAs (liraglutide and semaglutide) reduce cardiovascular and renal complications of diabetes. Illustrating that GLP-1RAs are favourable in high-risk patients with type 2 diabetes. This review provides a clinical appraisal of the GLP-1RA class, highlighting intraclass similarities and differences, summarizing the clinical development of incretin-based diabetes therapies and focusing on currently approved GLP-1RAs. The review also discusses the implications of structural differences between GLP-1RA molecules and comments on the risks and benefits associated with GLP-1RAs and their positioning in treating type 2 diabetes. Les options thérapeutiques actuelles du diabète de type 2 sont nombreuses; un grand nombre de classes d'antidiabétiques sont utilisées en clinique et plusieurs nouveaux médicaments candidats font l'objet d'essais cliniques de phases avancées. Cette abondance de traitement procure un avantage certain aux patients, car elle facilite la personnalisation des soins. Le positionnement fondé sur des données factuelles de ces agents constitue un défi et sous-entend qu'il faut connaître les classes de médicaments en profondeur et aussi bien les unes que les autres. La présente revue propose une mise à jour clinique sur les agonistes des récepteurs du GLP-1 (peptide-1 apparenté au glucagon), une classe d'antidiabétiques à base d'incrétines administrés par injection qui améliorent la maîtrise des glycémies à jeun et postprandiale grâce à ses effets sur la sécrétion d'hormones par les cellules glucodépendantes des ilots pancréatiques, sans entraîner un risque significatif d'hypoglycémie. L'emploi à long terme des agonistes des récepteurs du GLP-1 favorise également la perte de poids par une stimulation des récepteurs du GLP-1 se situant dans le centre de la satiété de l'hypothalamus qui régule l'appétit, entraînant une diminution de l'apport calorique. Depuis 2005, année où les agonistes des récepteurs du GLP-1 ont été homologués dans le traitement du diabète de type 2, cette classe de médicament s'est élargie pour inclure des agents à longue durée d'action administrés 1 fois par semaine. Des études récentes sur les résultats cardiovasculaires ont révélé que l'emploi à long terme des agonistes des récepteurs du GLP-1 (liraglutide et sémaglutide) diminue les complications cardiovasculaires et microvasculaires du diabète, ce qui appuie leur utilisation chez les patients atteints de diabète de type 2 exposés à un risque élevé. Une évaluation de la classe des agonistes des récepteurs du GLP-1 est présentée afin de souligner les similitudes et les différences entre les agents de cette classe et résumer le développement clinique des traitements antidiabétiques à base d'incrétines en portant une attention particulière aux agonistes des récepteurs du GLP-1 actuellement homologués. La revue porte également sur les répercussions des différences structurelles qui existent entre les diverses molécules agonistes des récepteurs du GLP-1 et formule des observations sur les risques et les bienfaits associés à ces médicaments et sur leur positionnement dans le traitement du diabète de type 2.
Abstract Patients with diabetes often face serious complications due to limited self-management skills, the inability to adhere to care regimens, and psychosocial factors. Although regular self-monitoring of blood glucose is known to benefit patients receiving insulin therapy, its role in patients not treated with insulin has been unclear. However, recent studies have demonstrated that structured self-monitoring of blood glucose can significantly benefit patients who are not taking insulin, facilitating improved self-awareness and clinical decision making. We hypothesize that effective self-management by patients with type 2 diabetes who do not need insulin requires a behavioural intervention that enables the association between lifestyle behaviours, such as dietary intake and physical activity, and overall glycemic control. Mobile health applications (apps), coupled with wireless medical peripheral devices, can facilitate self-monitoring; deliver tailored, actionable knowledge; elicit positive behaviour changes and promote effective self-management of diabetes. Although existing apps incorporate tracking and feedback from healthcare providers, few attempt to elicit positive behaviour changes for the purposes of developing patients' self-care skills. The purpose of this article is to present a systematic approach to the design and development a diabetes self-management mobile app, which included 1) a scoping review of literature; 2) the development of an overarching theoretical approach and 3) validation of the app features through user-centred design methods. The resulting app, bant II, facilitates 1) self-monitoring of blood glucose, physical activity, diet and weight; 2) identification of glycemic patterns in relation to lifestyle; 3) remedial decision making and 4) positive behaviour change through incentives.
Abstract Objective Many studies have reported the relationship between depression and diabetes, but the results have been inconsistent. Our aim was to conduct a systematic review through meta-analysis to assess the association of depression with the risk for developing diabetes. Methods We retrieved the studies concerning depression and the risk for diabetes. Meta-analysis was applied to calculate the combined effect values and their 95% confidence intervals. The risk for publication bias was assessed by the Egger regression asymmetry test. Results As many as 33 articles were included in the meta-analysis, for a total of 2 411 641 participants. The pooled relative risk for diabetes was 1.41 (95% CI, 1.25–1.59) for depression, and the combined relative risk for type 2 diabetes mellitus was 1.32 (95% CI, 1.18–1.47). Conclusions Depressed people have a 41% increased risk for developing diabetes mellitus and a 32% increased risk for developing type 2 diabetes. The mechanisms underlying this relationship are still unclear and need further research.