Journal of diabetes
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Branched-chain amino acids (BCAA) have increasingly been studied as playing a role in diabetes, with the PubMed search string "diabetes" AND "branched chain amino acids" showing particular growth in studies of the topic over the past decade (Fig. ). In the Young Finn's Study, BCAA and, to a lesser extent, the aromatic amino acids phenylalanine and tyrosine were associated with insulin resistance (IR) in men but not in women, whereas the gluconeogenic amino acids alanine, glutamine, or glycine, and several other amino acids (i.e. histidine, arginine, and tryptophan) did not show an association with IR. Obesity may track more strongly than metabolic syndrome and diabetes with elevated BCAA. ⋯ A final fascinating preliminary set of observations is that of the effects of empagliflozin on metabolomics; evidence of increased Krebs cycle activation and of higher levels of BCAA metabolites, such as acylcarnitines, suggests that sodium-glucose cotransporter 2 (SGLT2) inhibition may, to some extent, involve BCAA metabolism. Certainly, we do not yet have a full understanding of these complex associations. However, the suggestion of multiple roles of BCAA in the development of IR promises to be important and to lead to the development of novel effective T2D therapies.
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Journal of diabetes · Mar 2018
Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes.
The aim of the present study was to assess the longitudinal accumulation of diabetes-related complications and the effect of glycemic control on the Diabetes Complications Severity Index (DCSI) score in people with newly diagnosed type 2 diabetes (T2D). ⋯ Baseline glycemic control had no apparent effect on longitudinal changes in DCSI score. Worsening or persistently poor glycemic control was associated with an increased risk of an increase in the DCSI score.
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Journal of diabetes · Mar 2018
Randomized Controlled Trial Multicenter StudyEfficacy and safety of pregabalin for painful diabetic peripheral neuropathy in a population of Chinese patients: A randomized placebo-controlled trial.
Limited information exists regarding the efficacy of pregabalin in Chinese patients with painful diabetic peripheral neuropathy (pDPN). ⋯ Pregabalin did not significantly improve the primary measure of pain in the trial. Significant reductions in MPS were observed when excluding the GCP non-compliant patient/site and in the severe pDPN subpopulation. Pregabalin was well tolerated in Chinese pDPN patients.
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Journal of diabetes · Mar 2018
Multicenter StudyPrevalence of and risk factors for diabetic ketosis in Chinese diabetic patients with random blood glucose levels >13.9 mmol/L: Results from the CHina study in prEvalence of diabetiC Ketosis (CHECK) study.
The aim of the present study was to investigate the prevalence of diabetic ketosis (DK) and its risk factors in Chinese diabetes patients with severe hyperglycemia. ⋯ The prevalence of DK is lower in patients with T2DM than T1DM, but the number of patients with DK is higher for those with T2DM because of more T2DM patients in China. Patients with T2DM who have a younger age, shorter duration of diabetes, and a lack of antidiabetic treatment will suffer from DK more often than older patients with longer T2DM duration and receiving antidiabetic treatment.
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The relationships of glycemic control over time with the development of complications have been investigated in several studies, but new areas of debate continue to arise. Does glycemic control have greater benefit when attained earlier than when attained later in the natural history of diabetes? Is it simply the duration of better or worse levels of glycemia that lead a given individual to have fewer or greater levels of complications? Might glycemic control have similar benefit throughout the duration of diabetes until irreversible damage occurs, perhaps varying by organ system (neurologic, renal, retinal, cardiovascular)? Specific benefits or adverse effects of treatment agents may further complicate the interpretation of what has been characterized as "metabolic memory." The notion of metabolic memory was based on findings of the Diabetes Control and Complications Trial (DCCT) of type 1 diabetes (T1D), in which the initial 2% HbA1c separation between the groups of patients randomized to intensive or conventional control was lost during the follow up Epidemiology of Diabetes Interventions and Complications (EDIC) study, when the two groups of participants returned to standard treatment and showed similar HbA1c levels but the initial intensively treated group continued to have lower rates of development of microvascular and, subsequently, macrovascular complications. Similarly, a decade after the conclusion of the UK Prospective Diabetes Study (UKPDS), patients with type 2 diabetes (T2D) in the intensive therapy group, despite showing similar levels of glycemic control to those receiving standard care, continued to have significant reductions in microvascular endpoints and reductions in myocardial infarction and all-cause mortality. ⋯ Perhaps, then, uncontrolled glycemia of long duration may not be offset by subsequent intensive control, but intensive treatment from the time of diagnosis, even with "bad glycemic legacy" (but of short duration), will be effective in decreasing risk of later complications. Does the retrospective study by Pantalone et al. hint at a different aspect of metabolic memory, namely that poor control of glycemia at baseline does not affect the development of complications later if it is effectively managed subsequently? That effects of initial hyperglycemia could be dispelled with excellent glycemic control? Such an interpretation gives cause for optimism and can be used in empowering people developing diabetes to participate in their care. Analysis of more datasets with serial measures of HbA1c may allow us to further understand these relationships, and certainly the underlying molecular mechanisms of metabolic memory deserve further investigation.