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1
VESSBY, B., B. KARLSTRÖM, M. BOBERG, H. LITHELL, I. B. GUSTAFSSON, and C. BERNE. "Diet Therapy for Poorly Controlled Type 2 (Non-insulin-dependent) Diabetes Mellitus." Acta Paediatrica 74, s320 (July 1985): 44–49. http://dx.doi.org/10.1111/j.1651-2227.1985.tb10137.x.
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SHIMIZU, MITSUO. "IMPROVEMENT OF SERUM LIPIDS IN NON-INSULIN DEPENDENT DIABETES MELLITUS BY DIET THERAPY." KITAKANTO Medical Journal 42, no. 5 (1992): 425–31. http://dx.doi.org/10.2974/kmj1951.42.425.
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Cabanas, E. A., and E. J. Bastyr. "Very low calorie diet as an alternative to insulin therapy in non-insulin-dependent diabetes mellitus." Journal of the American Dietetic Association 94, no. 9 (September 1994): A21. http://dx.doi.org/10.1016/0002-8223(94)91651-9.
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Henry, R. R., T. A. Wiest-Kent, L. Scheaffer, O. G. Kolterman, and J. M. Olefsky. "Metabolic consequences of very-low-calorie diet therapy in obese non-insulin-dependent diabetic and nondiabetic subjects." Diabetes 35, no. 2 (February 1, 1986): 155–64. http://dx.doi.org/10.2337/diabetes.35.2.155.
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Deacon, C. F., S. Schleser-Mohr, M. Ballmann, B. Willms, J. M. Conlon, and W. Creutzfeldt. "Preferential release of proinsulin relative to insulin in non-insulin-dependent diabetes mellitus." Acta Endocrinologica 119, no. 4 (December 1988): 549–54. http://dx.doi.org/10.1530/acta.0.1190549.
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Abstract. A radioimmunoassay, using an antiserum that is specific for human proinsulin, has been used to study the response of serum proinsulin to low (25 g) and high (75 g) oral glucose loads in non-obese patients with noninsulin-dependent diabetes mellitus (NIDDM). Diabetic patients were treated by diet only (N = 8) or were receiving oral anti-hyperglycemic agents (N = 8) and therapy was not interrupted during the study. In the fasted state, proinsulin concentrations were higher (P<0.05) in the drug-treated patients (31 ± 3 pmol/l (sem)) compared with age- and weight-matched healthy subjects (22 ± 2 pmol/l; N = 10), but concentrations in the diet-treated patients 25 ± 3 pmol/l) were not significantly different. Following 25 g and 75 g glucose loads, the rises in serum immunoreactive insulin and C-peptide concentrations in both groups of diabetic patients were impaired and delayed relative to those in the control subjects. The responses of serum proinsulin, however, were not significantly different in the NIDDM patients compared with controls at any time point up to 180 min except in the case of drugtreated patients receiving 25 g of glucose who had elevated (P< 0.05) proinsulin concentrations at 150 min and 180 min after ingestion. It is concluded that NIDDM is not associated with an exaggerated release of proinsulin in response to glucose compared with healthy subjects, but the islets have maintained the ability to release proinsulin better than the ability to release insulin.
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Lisovskii, Oleg, Anna Zavyalova, Valeriya Novikova, Milena Yakovleva, Alexandr Gostimskii, Ludmila Tyrtova, and Ivan Lisitsa. "Nutritional stereotypes of children with insulin-dependent diabetes mellitus." Vestnik of Saint Petersburg University. Medicine 16, no. 1 (2021): 3–12. http://dx.doi.org/10.21638/spbu11.2021.101.
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In most cases, type 1 diabetes mellitus is an autoimmune disease characterized by the destruction of insulin-producing beta cells, which is the result of absolute insulin deficiency and, therefore, treatment is associated with the administration of insulin. The therapeutic treatment of type 1 diabetes includes the use of insulin for glycemic control, balanced nutrition and regular physical activity. Daily insulin requirements vary depending on age, diet, self-monitoring of blood glucose and daily routine. Obesity affects some patients with type 1 diabetes, which increases their insulin requirements and negatively affects their metabolic control. The type 1 diabetes diet is an essential part of the treatment program and helps to achieve glycemia targets and avoid insulin dose difficulties. Traditionally, for sick children and their parents, there are diet classes in the School of diabetes, but the equivalence in terms of diet and the actual nutrition of children is not sufficiently studied. Therefore, a combination of insulin therapy and an individual nutrition plan is necessary, which is the key to proper metabolic control. The usual nutritional guidelines for patients with type 1 diabetes should be the same as those for the general population.
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Gorrell, Jennifer Justice, Jennifer Schoelles Williams, and Paula Powell. "Review and Update of Insulin Dependent Diabetes Mellitus." Journal of Pediatric Pharmacology and Therapeutics 8, no. 4 (October 1, 2003): 252–65. http://dx.doi.org/10.5863/1551-6776-8.4.252.
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The purpose of this article is to provide the health care practitioner with a comprehensive review of the pathophysiology and treatment of Type 1 Diabetes Mellitus. Traditionally, insulin has been administered via an insulin syringe. In the recent past, diabetes research has focused on developing more convenient insulin delivery devices and longer acting insulin's in hopes of increasing compliance with insulin therapy and improving the management of Type 1 diabetes in both children and adults. Rapidly developing approaches to insulin delivery for Type 1 diabetes continue to be developed at a rapid rate, including administration via continuous subcutaneous insulin infusion in addition to other new approaches. With these advances in therapy, pediatric patients with Type 1 diabetes have been able to achieve strict glycemic control, although the treatment of hypoglycemia remains a burden. The objectives of this article are to the following: to review the epidemiology, risk factors, pathophysiology, clinical manifestations, and diagnostic criteria of Type 1 diabetes mellitus in children,; to discuss the management of these patients, including, insulin therapy, monitoring, diet and exercise, carbohydrate counting and treatment of hypoglycemia,; and to review insulin administration devices, including insulin pens, insulin jet injectors, insulin pumps, and novel insulin delivery systems.
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Chantelau, E. A., A. Frenzen, G. Gösseringer, I. Hansen, and M. Berger. "Intensive insulin therapy justifies simplification of the diabetes diet: a prospective study in insulin-dependent diabetic patients." American Journal of Clinical Nutrition 45, no. 5 (May 1, 1987): 958–62. http://dx.doi.org/10.1093/ajcn/45.5.958.
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Venhaus, A. "Intensive insulin therapy justifies simplification of the diabetes diet: a prospective study in insulin-dependent diabetic patients." American Journal of Clinical Nutrition 47, no. 1 (January 1, 1988): 162–63. http://dx.doi.org/10.1093/ajcn/47.1.162.
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Bingham, Pauline R., and Matthew C. Riddle. "Combined Insulin-Sulfonylurea Treatment of Type II Diabetes." Diabetes Educator 15, no. 5 (October 1989): 450–55. http://dx.doi.org/10.1177/014572178901500516.
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The literature on type II (noninsulin-dependent diabetes mellitus) proposes many forms of treatment. This diversity suggests that there is no single best way to treat this condition. At Oregon Health Sciences University, we have been using the combination of insulin given in the evening and sulfonylurea drugs given during the day as an alternative to multiple-dose insulin regimens when diet or diet and oral hypoglycemic agent therapies do not achieve adequate glucose control. This approach, while effective in our experience, is not widely accepted. This paper reviews the literature on combined insulin and sulfonylurea therapy for treatment of certain stages of type II diabetes, the rationale for use of this therapy, and our experience to date.
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Gyldenkerne, Christine, Kevin Kris Warnakula Olesen, Morten Madsen, Troels Thim, Lisette Okkels Jensen, Bent Raungaard, Henrik Toft Sørensen, Hans Erik Bøtker, and Michael Maeng. "Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease." Diabetes and Vascular Disease Research 16, no. 4 (April 3, 2019): 351–59. http://dx.doi.org/10.1177/1479164119836227.
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Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.
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Kavula, Michael P. "Diet and Exercise in the Management of Diabetes." Journal of Pharmacy Practice 5, no. 5 (October 1992): 254–59. http://dx.doi.org/10.1177/089719009200500504.
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Insulin-dependent diabetes mellitus (IDDM) individuals can benefit from using current nutritional concepts to control their intake of carbohydrates, protein, fats, and other nutrients to aid in the control of blood glucose and lipid levels by building consistency of meal times and injections of insulin into their overall program. The NIDDM patient, on the other hand, will need a diet that offers appropriate calories to sustain daily activities, but also promote weight loss. Exercise has important physiological and psychological benefits for all individuals including diabetics. Exercise programs need to be designed for the individual's ability and used as adjunctive therapy to improve glucose control and reduce cardiovascular risk factors.
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Laakso, M., M. Uusitupa, J. Takala, H. Majander, T. Reijonen, and I. Penttilä. "Effects of hypocaloric diet and insulin therapy on metabolic control and mechanisms of hyperglycemia in obese non-insulin-dependent diabetic subjects." Metabolism 37, no. 11 (November 1988): 1092–100. http://dx.doi.org/10.1016/0026-0495(88)90074-1.
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Henry, R. R., T. A. Wiest-Kent, L. Scheaffer, O. G. Kolterman, and J. M. Olefsky. "Metabolic Consequences of Very-Low-Calorie Diet Therapy in Obese Non-insulin-dependent Diabetic and Nondiabetic Subjects." Diabetes 35, no. 2 (February 1, 1986): 155–64. http://dx.doi.org/10.2337/diab.35.2.155.
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Davì, Giovanni, Mario Belvedere, Sergio Vingneri, Isabella Catalano, Carlo Giammarresi, Salvatore Roccaforte, Agostino Consoil, and Andrea Mezzetti. "Influence of Metabolic Control on Thromboxane Biosynthesis and Plasma Plasminogen Activator Inhibitor Type-1 in Non-insulin-dependent Diabetes mellitus." Thrombosis and Haemostasis 76, no. 01 (1996): 034–37. http://dx.doi.org/10.1055/s-0038-1650518.
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SummaryWe have previously shown that tight metabolic control by insulin therapy reduced thromboxane-dependent platelet activation in noninsulin-dependent diabetes mellitus (NIDDM) patients. The present study was undertaken to determine whether a similar effect could be obtained without switching diabetics in secondary failure to insulin treatment. For this purpose, we gave strict diet and exercise advise program and adjusted on a weekly basis the oral antidiabetic therapy (glipizide) that 26 patients with NIDDM had been given over the previous months.Basal measurements of urinary ll-dehydro-TXB2 and PAI-1 confirmed previous findings of enhanced levels of these parameters in NIDDM patients with macrovascular disease in comparison to age-and sex-matched controls. After 2-6 weeks, 16 patients achieved tight metabolic control associated with significant reduction of both thromboxane biosynthesis and PAI-1 levels; 10 patients remained in poor control and no significant decrease of both parameters was observed.We conclude that reduction of in-vivo platelet activation and PAI-1 antigen levels after metabolic improvement obtained by frequent reassessment of sulphonylurea therapy together with strict diet and exercise programs may have beneficial effects on the progression of diabetic micro- and macrovascular disease.
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de la Rosa, B., C. Moriel, M. J. Ce??al, J. Casas, and A. Marcos. "INFLUENCE OF DIET AND EXERCISE IN PATIENTS WITH INSULIN DEPENDENT DIABETES MELLITUS (IDDM)." Medicine & Science in Sports & Exercise 31, Supplement (May 1999): S55. http://dx.doi.org/10.1097/00005768-199905001-00089.
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Lariviere, F., D. B. Kupranycz, J. L. Chiasson, and L. J. Hoffer. "Plasma leucine kinetics and urinary nitrogen excretion in intensively treated diabetes mellitus." American Journal of Physiology-Endocrinology and Metabolism 263, no. 1 (July 1, 1992): E173—E179. http://dx.doi.org/10.1152/ajpendo.1992.263.1.e173.
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It is well known that inadequate insulin therapy stimulates body protein loss in insulin-dependent diabetes mellitus (IDDM). It is less well known, however, that accelerated body protein loss (as indicated by increased leucine oxidation) occurs in IDDM even during conventional glycemic control. It is not known whether intensified insulin therapy fully normalizes protein oxidation or, more importantly, whether such therapy is sufficient to allow the adaptive decrease of protein oxidation that normally occurs when protein intake is restricted below the customary surfeit level. We used two measures of protein oxidation [daily urinary nitrogen (N) excretion over several days of intensive insulin therapy and plasma [1-13C]leucine oxidation during short-term strict euglycemia] to assess the response of 7 men with IDDM and 12 normal men after adaptation first to a control diet providing maintenance energy and conventional (surfeit) protein then to an isoenergetic protein-free diet. After adaptation to the protein-free diet and during short-term strict euglycemia achieved using intravenous insulin, leucine turnover and oxidation decreased equivalently in normal and diabetic subjects. However, daily urinary obligatory N excretion, which indicated the effect of the low-protein diet and intensive subcutaneous insulin therapy over several days, was increased by 18% in the diabetic group (P less than 0.05). Even mildly elevated average blood glucose values well within the guidelines for intensive therapy were strongly correlated with high rates of urinary N excretion (r = 0.97, P = 0.0002). Thus insulin therapy of IDDM that imposes strict euglycemia is compatible with a normal ability to diminish body protein oxidation in response to protein restriction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Mazzaferro, EM, DS Greco, AS Turner, and MJ Fettman. "Treatment of feline diabetes mellitus using an α-glucosidase inhibitor and a low-carbohydrate diet." Journal of Feline Medicine and Surgery 5, no. 3 (June 2003): 183–89. http://dx.doi.org/10.1016/s1098-612x(03)00006-8.
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The purpose of this study was to determine the effect of an α-glucosidase inhibitor (acarbose), combined with a low-carbohydrate diet on the treatment of naturally occurring diabetes mellitus in cats. Eighteen client-owned cats with naturally occurring diabetes mellitus were entered into the study. Dual-energy X-ray absorptiometry (DEXA) was performed prior to and 4 months after feeding the diet to determine total body composition, including lean body mass (LBM) and percent body fat. Each cat was fed a commercially available low-carbohydrate canned feline diet and received 12.5 mg/cat acarbose orally every 12 h with meals. All cats received subcutaneous insulin therapy except one cat in the study group that received glipizide (5 mg BID PO). Monthly serum glucose and fructosamine concentrations were obtained, and were used to adjust insulin doses based on individual cat's requirements. Patients were later classified as responders (insulin was discontinued, n=11) and non-responders (continued to require insulin or glipizide, n=7). Responders were initially obese (<28% body fat) and non-responders had significantly less body fat than responders (<28% body fat). Serum fructosamine and glucose concentrations decreased significantly in both responder and non-responder groups over the course of 4 months of therapy. Better results were observed in responder cats, for which exogenousinsulin therapy was discontinued, glycemic parameters improved, and body fat decreased. In non-responders, median insulin requirements decreased and glycemic parameters improved significantly, despite continued insulin dependence. The use a low-carbohydrate diet with acarbose was an effective means of decreasing exogenous insulin dependence and improving glycemiccontrol in a series of client-owned cats with naturally occurring diabetes mellitus.
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Yamauchi, Akira, Izumi Takei, Akira Kasuga, Yuko Kitamura, Norimi Ohashi, Satomi Nakano, Sumiyo Takayama, Shinya Nakamoto, Fuminori Katsukawa, and Takao Saruta. "Depression of dehydroepiandrosterone in Japanese diabetic men—comparison between non-insulin-dependent diabetes mellitus and impaired glucose tolerance." European Journal of Endocrinology 135, no. 1 (July 1996): 101–4. http://dx.doi.org/10.1530/eje.0.1350101.
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Yamauchi A, Takei I, Kasuga A, Kitamura Y, Ohashi N, Nakano S, Takayama S, Nakamoto S, Katsukawa F, Saruta T. Depression of dehydroepiandrosterone in Japanese diabetic men—comparison between non-insulin-dependent diabetes mellitus and impaired glucose tolerance. Eur J Endocrinol 1996;135:101–4. ISSN 0804–4643 Hyperglycemia is known to reduce dehydroepiandrosterone (DHEA) circulating levels; however, the mechanism by which hyperglycemia decreases DHEA is not elucidated. In this study, serum DHEA and DHEA sulfate (DHEA-S) levels were compared in 50 men with non-insulin-dependent diabetes mellitus (NIDDM) and 50 age-matched men with impaired glucose tolerance (IGT) receiving only diet therapy. Serum concentrations of DHEA and DHEA-S in the NIDDM group were significantly lower than in the IGT group (7.8 and 9.7 nmol/l vs 3.4 and 4.9 μ mol/l, respectively; p< 0.01) but there was no significant difference in immunoreactive insulin between the two groups. When the results from both groups were combined, HbA1c was significantly inversely related to DHEA (r = −0.243. p<0.01) and DHEA-S (r = −0.305, p<0.01). Immunoreactive insulin showed no correlation with DHEA and DHEA-S. Multiple regression analysis showed that HbA1c was independently negatively related to both DHEA and DHEA-S. We conclude that hyperglycemia may decrease serum DHEA and DHEA-S in Japanese men with NIDDM, but the depression of DHEA(-S) is independent of serum insulin level. Akira Yamauchi, Department of Internal Medicine, Keio University School of Medicine. 35 Shinanomachi, Shinjuku-ku, Tokyo 160, Japan
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Campbell, Lance K., John R. White, and R. Keith Campbell. "Acarbose: Its Role in the Treatment of Diabetes Mellitus." Annals of Pharmacotherapy 30, no. 11 (November 1996): 1255–62. http://dx.doi.org/10.1177/106002809603001110.
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OBJECTIVES: To review the clinical pharmacology of acarbose, an alpha-glucosidase inhibitor, and to summarize its role in the pharmacotherapy of diabetes mellitus. DATA SOURCES: A MEDLINE search identified all relevant articles, including reviews; Bayer Pharmaceuticals. STUDY SELECTION: Due to the large number of clinical trials available, specific criteria were used to narrow the focus of this review: (1) randomized, double-blind, placebo-controlled, parallel-group study design; (2) a minimum of 25 patients enrolled per treatment arm; (3) a treatment duration of 90 days or more; and (4) adherence to Food and Drug Administration Good Clinical Practice guidelines. DATA EXTRACTION: All clinical trials that were available up to December 1995 were reviewed. Preliminary trials and unpublished reports were not reviewed. DATA SYNTHESIS: Acarbose is effective in reducing postprandial hyperglycemia. It does not stimulate endogenous insulin secretion and, therefore, will not cause hypoglycemia when used as monotherapy. The enhanced glycemic control achieved with acarbose is additive to that of sulfonylureas. It lowers postprandial serum glucose and insulin concentrations and does not promote weight gain. Acarbose can be used as first-line therapy with diet and exercise, or it can be used in combination with sulfonylureas to lower hemoglobin Alc concentrations an additional 0.5–0.9%. Acarbose is not a cure for diabetes, nor is it a substitute for diet, exercise, oral hypoglycemic agents, or insulin. Adverse effects are gastrointestinal and can be diminished by starting with an initial dosage of 25 mg tid. Depending on patient response, the dosage can be increased up to a maximum of 100 mg tid over time. CONCLUSIONS: Acarbose, through its unique mechanism of action, appears to be a safe and effective adjunctive agent to diet/exercise therapy or sulfonylurea therapy for treatment of non-insulin-dependent diabetes mellitus.
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Giannopoulou, I., and J. H. Rimmer. "INTERACTION OF EXERCISE AND DIET ON THE GLUCOSE AND LIPID METABOLISM OF WOMEN WITH NON-INSULIN DEPENDENT DIABETES MELLITUS (NIDDM)." Medicine & Science in Sports & Exercise 30, Supplement (May 1998): 175. http://dx.doi.org/10.1097/00005768-199805001-01001.
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Gumbiner, B., J. A. Wendel, and M. P. McDermott. "Effects of diet composition and ketosis on glycemia during very-low-energy-diet therapy in obese patients with non-insulin-dependent diabetes mellitus." American Journal of Clinical Nutrition 63, no. 1 (January 1, 1996): 110–15. http://dx.doi.org/10.1093/ajcn/63.1.110.
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Ikenaga, Hideki, Hiromichi Suzuki, Naohito Ishii, Hajime Itoh, and Takao Saruta. "Enzymuria in Non-Insulin-Dependent Diabetic Patients: Signs of Tubular Cell Dysfunction." Clinical Science 84, no. 4 (April 1, 1993): 469–75. http://dx.doi.org/10.1042/cs0840469.
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1. To evaluate tubular damage in diabetic patients, we measured the 24 h urinary excretion of five enzymes (N-acetyl-β-D-glucosaminidase, γ-glutamyl transpeptidase, dipeptidyl aminopeptidase IV, alanine aminopeptidase and alkaline phosphatase) that originate in renal proximal tubular cells. 2. Studies were performed on 118 non-insulin-dependent diabetic patients, 59 non-diabetic patients with chronic renal disease and 47 normal control subjects. First, the correlation between renal function, glycaemic control and urinary enzyme excretion was investigated. Secondly, the subjects were treated by controlled diet therapy to assess the effects of better glycaemic control on urinary enzyme excretion. 3. Regardless of a diabetic or non-diabetic cause of renal dysfunction, all of the five enzymes showed abnormal urinary excretion in patients with renal insufficiency (serum creatinine concentration < 2.0 mg/dl). In diabetic patients, however, an increase in N-acetyl-β-D-glucosaminidase excretion and a decrease in γ-glutamyl transpeptidase excretion were noted even in those who had no signs of renal dysfunction, including microalbuminuria. Moreover, the excretion of these two enzymes had a higher degree of correlation with glycaemic control and renal function than did that of the other three enzymes. Multiple regression analysis revealed that excretion of N-acetyl-β-D-glucosamindase is best correlated with urinary protein (r2 = 0.35), whereas excretion of γ-glutamyl transpeptidase is closely associated with glomerular filtration rate (r2 = 0.33). 4. In diabetic patients, diet therapy improved glycaemic control but had no effects on renal function, microalbumin excretion and β2-microglobulin excretion. In contrast, abnormal N-acetyl-β-D-glucos-aminidase and γ-glutamyl transpeptidase excretion were both significantly improved in diabetic patients without overt renal dysfunction. However, in non-diabetic patients and diabetic patients with renal insufficiency, there were no changes in urinary enzyme excretion. 5. These results suggest that there is reversible tubular damage in the early stages of diabetic nephropathy. Measurement of urinary excretion of N-acetyl-β-D-glucosaminidase and γ-glutamyl transpeptidase may be especially useful in the detection of this tubular dysfunction.
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Meshcheryakova, V. A., Kh Kh Sharafetdinov, O. A. Plotnikova, and T. A. Yatsyshina. "Clinical evaluation of the effectiveness of textured soy products in the diet therapy of patients with non-insulin-dependent diabetes mellitus." Problems of Endocrinology 45, no. 2 (April 1, 1999): 6–9. http://dx.doi.org/10.14341/probl11728.
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Therapeutic efficacy of diets including texturated soybean products (TSP) is assessed in 30 inpatients with non-insulindependent diabetes mellitus (NIDDM), followed up for 28 days. TSP were well tolerated and caused no side effects. Addition of TSP to the traditional diet no. 9 improved the efficacy of correction of carbohydrate and lipid metabolism disorders in patients with NIDDM. Increased level of uric acid in the serum, observed during daily consumption of TSP for 2 weeks, requires monitoring of its levels in NIDDM patients with concomitant hyperuricaemia and gout.
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OLAGUNJU, A. S., F. G. OLORUNFEMI, O. J. TEIBO, S. A. BELLO, T. E. FABUNMI, and O. M. AJAO. "Functional-Foods Use: A Novel Dietary Regimen for Type 2 Diabetes Treatment and Management." International Journal of Innovative Science and Research Technology 5, no. 6 (June 26, 2020): 340–45. http://dx.doi.org/10.38124/ijisrt20jun078.
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The benefit of food as medicine is that healing and health promotion begins as soon as the next meal and this is known some decades ago as the significance of diet in health improvement, and prevention of diseases came to vanguard. Type 2 (non-insulin dependent) diabetes mellitus is a complex, multi-faceted disease particularized by high blood glucose (hyperglycemia), insulin resistance, pancreatic beta-cell dysfunction and altered insulin secretion. Recent data indicates a disturbing increase in the rate of hitches among individuals having type 2 diabetes mellitus despite the availability of several pharmacological involvements such as oral hypoglycemic agents and insulin therapy for its control. As a response to this, functional foods for example whole grains, cinnamon, legumes, nuts were developed, which are now vital substitutes for enhancing nutrition and public health. Therefore, investigation into the advantages of functional foods on type 2 diabetes mellitus is essential and can decide if these can be a proper substitute for the inhibiting, treatment and management of this pathology and related metabolic effects.
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Starostina, E. G. "Diet barriers in type 2 diabetic patients and their coping strategies." Almanac of Clinical Medicine 47, no. 2 (May 31, 2019): 98–111. http://dx.doi.org/10.18786/2072-0505-2019-47-016.
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Background: Factors hindering effective nutritional therapy (diet barriers, DB) in type 2 diabetes mellitus (DM2), their coping strategies and association with biomedical and psychosocial characteristics of the Russian patients have not been studied.Aim: To identify the role and clinical correlates of DB and diet coping in various categories of patients with DM2.Materials and methods: This cross-sectional cohort study included 297 consecutively recruited out- and in-patients with DM2 (mean age 61±10.1 years, diabetes duration 1 to 35 years). All patients had standard clinical and laboratory assessments and filled in questionnaires on DB, diet coping, level of knowledge on DM, state/trait anxiety scale, depression scale (modified Zung), Diabetes Treatment Satisfaction questionnaire (DTSQ), Audit of Diabetes-dependent Quality of Life questionnaire (Ru-ADDoQL). Mann-Whitney, chi-square and Fischer's exact test were used for group comparisons. Final analysis was based on multiple and logistic regression models.Results: Mean (±SD) number of DB per patient was 8.4±4.9 and similar in insulin-treated and non-insulin-treated patients. The most prevalent were DB related to poor physical well-being (51% of the patients), additional financial burden (54%) and decreased food variety (41%). The highest weighted prevalence was identified for 6 DB, such as “difficulties to adhere to the diet in unexpected situations” (1.8 scores), “having to spend a lot for the diet” (1.4), “if I eat not regularly, I feel unwell”, “I cannot eat tasty foods and enjoy them” (1.3 each), “when I eat more than I am allowed, I feel unwell”, “I would like to eat what it is not allowed for me” (1.2 each), and “it is difficult to fully abstain from sweets” (1.1). Number of DB per patient increased significantly with age and decreased with higher educational level and social status. There were differences in types of DB between male and female patients, between those currently employed and non-employed, and between highly compliant and non-compliant to their diabetes regimen. There was an inverse correlation between DB numbers and total dietary adherence score, diabetes-dependent quality of life score, subjective assessment of personal health status and a direct correlation between DB number and trait anxiety. No impact of past participation in a diabetes education program or of the level of knowledge on diabetes on DB number was found. For most DB the patients demonstrated the socalled compliant coping (i.e., adherence to the diet recommendations), excluding the DB “I am not allowed to eat when I am hungry”, which was associated mostly with intermediate coping styles that might unfavorably influence one's health status. The compliant diet coping scores were in a weak negative correlation with DB number and with the patient's level of knowledge on diabetes. DTSQ score weakly but significantly correlated with the total score of compliant and intermediate diet coping.Conclusion: Main DB in DM2 are related to physical discomfort, financial problems and limitations in food choices. Individual DB content depends on age, gender, educational level, social status and employment. Higher numbers of DB per patient is associated with decreased possibility of compliant diet coping style. Overloaded diet recommendations are associated with an increase in DB number that may lead to poorer patient compliance to diabetes treatment in general, as well as to poorer diabetes-dependent quality of life. Elderly patients, as well as those with lower educational level, unemployed, with uncontrolled diabetes, poor general compliance and higher levels of anxiety and depression have the highest DB numbers. Individual DB are to be considered during therapeutic patient education in DM2 and patient-tailored approach to therapy.
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SCHNEIDERMAN, LAWRENCE J. "Alternative Medicine or Alternatives to Medicine? A Physician's Perspective." Cambridge Quarterly of Healthcare Ethics 9, no. 1 (January 2000): 83–97. http://dx.doi.org/10.1017/s0963180100901099.
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Regina R. is a 12-year-old girl with recently diagnosed insulin-dependent diabetes. Before discharging her from the hospital, her family physician and consulting diabetes specialist try to instruct the girl and her parents in the appropriate program of treatment, including diet, insulin, and regular self-monitoring. However, the parents become upset when they learn what is involved in insulin treatment and inform the family physician they plan to employ the services of an alternative healing clinic that promises to cure their daughter with a combination of herbal potions, macrobiotics, aroma therapy, therapeutic touch, Ayurveda, homeopathy, and guided imagery.
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Gundermann, K., and M. Kundurovich. "«Essential» phospholipids in diabetes mellitus. Review of the results all over the world." Problems of Endocrinology 40, no. 3 (December 15, 1994): 59–62. http://dx.doi.org/10.14341/probl12054.
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The purpose of the review is to evaluate the results obtained with the use of EPL (essential phospholipids) for the treatment of diabetes mellitus in the light of modern scientific knowledge, as well as to highlight the role of lipostabil in the treatment of diabetes mellitus. Since some studies did not set as their primary task the study of the effect of EPL on serum lipids and lipoproteins, and diabetes-specific parameters, such as blood glucose concentration, glycated hemoglobin (HbA1c), ketonemia, as well as possibilities, were put on the forefront. development of late complications (atherosclerotic vascular changes or retinopathy), then the evaluation of these studies was carried out in accordance with the measured parameters.
The most important studies were analyzed. Since the beginning of the 90s, interest in the use of lipostabil in the treatment of diabetes has grown markedly. This interest was reflected in a double blind study by R. Kirsten et al., Completed in 1993. To date, there are data on 650 patients with insulin-dependent and non-insulin-dependent diabetes mellitus; one study is mainly related to diabetic retinopathy. The duration of therapy ranged from 14 days to 39 months, in most studies - several months. In some cases, lipostabil was used only orally, in others, simultaneously with intravenous administration, or therapy began with intravenous administration of the drug and continued with the use of oral capsules. The treatment of EPL was initially carried out on the background of only a diet, and then in combination with oral antidiabetic drugs or insulin.
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Starostina, Ye G., G. R. Galstyan, and I. I. Dedov. "Liberal diets in type I diabetes mellitus (Review of literature and authors’ data)." Problems of Endocrinology 40, no. 3 (December 15, 1994): 31–35. http://dx.doi.org/10.14341/probl12011.
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The treatment options for insulin-dependent (T1DM) and insulin-independent (T2DM) diabetes mellitus are significantly different, although they have a number of common goals (eliminating the symptoms of hyperglycemia, minimizing the risk of hypoglycemia, and preventing micro- and macroangiopathies). The main method for the correction of hyperglycemia in T2DM is the normalization of body weight (BW) with a low-calorie diet and increased physical activity. With T1DM, the genesis of which is associated not with excess BW, but with autoimmune death of p-cells and insulin deficiency, insulin replacement therapy is the main treatment method, and dietary restrictions for T1DM patients, according to modern views, are auxiliary and should be prescribed only to the extent in which their insulin therapy is different from the physiological secretion of insulin.
The fundamental principles of traditional diet therapy for T1DM have been critically reviewed in recent years. The most important requirement of traditional dietetics is the so-called "calorie balance"; hence, with an excess BW, a hypocaloric diet is usually recommended, with a deficiency of BW, a diet with a high calorie content, and with normal BW, one that guarantees the maintenance of BW. However, it has recently been proven that with normal BW, the lowest rates of morbidity and mortality are by no means always observed. In contrast, the highest expected life expectancy was found in individuals with relatively small excess BW. Based on this, patients with T1DM are unlikely to strive at all costs for a true "ideal weight". A diet with a reduced number of calories compared to a healthy person with the same physical activity cannot provide a patient with T1DM with a normal weight of sufficient physical performance. A deficiency of carbohydrates leads to an insufficient supply of energy to the body. In adults, this is manifested by a decrease in working capacity, in children - by a lag in physical development. In addition, insufficient intake of carbohydrates is accompanied by the emptying of glycogen depots in the liver and an increased risk of hypoglycemia. With a deficiency of carbohydrates, endogenous fats begin to be consumed as an energy source, which leads to acetonuria.
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Turkina, T. I., L. F. Marchenko, Ye O. Doroshenko, M. I. Martynova, V. Ya Arion, and Ye A. Golovidova. "Potentialities of T-activin in the treatment of children with diabetes mellitus." Problems of Endocrinology 42, no. 1 (February 15, 1996): 14–17. http://dx.doi.org/10.14341/probl11902.
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The effects of T-activin added to basic therapy of children with insulin-dependent diabetes mellitus (IDDM) on the blood serum lipid and phospholipid metabolism were studied in 30 patients aged 6 to 14 with the newly detected condition. Diabetes symptoms manifested 1 week to 3 months before the beginning of insulin therapy. The mean daily insulin dose in the decompensation phase was 0.82 U/kg b. w. The patients were divided into 2 groups: group 1 children were administered basic therapy (diet + insulin), vitamin В15, aevitum, lipamide, cholenzyme. Group 2 patients in addition to basic therapy were subcutaneously injected T-activin in a dose of 1.75 to 2 mg/kg b. w. once a day at 18 oclock for 5 days. Lipid metabolism was studied by thin-layer chromatography. A combination of basic therapy with T-activin had a more favorable impact on the time course of cholesterolemia than a combination of basic therapy with lipotropic agents. Evidently, T-activin added to insulin therapy exerts hypocholesterolemic effects. Tactivin therapy brought about the normalization of the lipid and phospholipid spectrum of lymphocyte membranes and enriched them with nonesterified fatty acids, the source of synthesis of such bioactive substances as leukotrienes and prostaglandins. After therapy the dose of exogenous insulin was reliably reduced in both groups, this reduction being more expressed in group 2 (with T-activin) than in group 1. We believe that T-activin is conducive to better functioning of the insulin receptor of lymphocytes and consider prescription of T-activin to children with IDDM pathogenetically justified.
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Negrato, Carlos Antonio, Renan Magalhães Montenegro Junior, Lilia Maria Von Kostrisch, Maria Fatima Guedes, Rosiane Mattar, and Marilia B. Gomes. "Insulin analogues in the treatment of diabetes in pregnancy." Arquivos Brasileiros de Endocrinologia & Metabologia 56, no. 7 (October 2012): 405–14. http://dx.doi.org/10.1590/s0004-27302012000700001.
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Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.
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Cannata, Francesca, Gianluca Vadalà, Fabrizio Russo, Rocco Papalia, Nicola Napoli, and Paolo Pozzilli. "Beneficial Effects of Physical Activity in Diabetic Patients." Journal of Functional Morphology and Kinesiology 5, no. 3 (September 4, 2020): 70. http://dx.doi.org/10.3390/jfmk5030070.
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One of the main goals of diabetic therapy is to achieve the best metabolic control to prevent the development and progression of potential complications. A multidisciplinary approach characterized by the combination of diet, physical activity (PA) and drug therapy with oral and injectable (non-insulin) pharmacological agents, is desirable to optimize metabolic control. The aim of this review is to explain the contribution of PA and its beneficial effects on patients affected by type 1 (T1D) and type 2 diabetes (T2D). We provide an overview of evidence on the effects of PA for the main two types of diabetes mellitus (DM) to identify the right level of PA to be recommended. We discuss the physiological and clinical role of PA in people with DM. It can be concluded that the objective of antidiabetic therapy should be the achievement and optimization of metabolic control through a multidisciplinary approach involving non-pharmacological therapy such as diet and PA, which has a crucial role.
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Lee, Dae Ho, Hu Huang, Kangduk Choi, Christos Mantzoros, and Young-Bum Kim. "Selective PPARγ modulator INT131 normalizes insulin signaling defects and improves bone mass in diet-induced obese mice." American Journal of Physiology-Endocrinology and Metabolism 302, no. 5 (March 1, 2012): E552—E560. http://dx.doi.org/10.1152/ajpendo.00569.2011.
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INT131 is a potent non-thiazolidinedione (TZD)-selective peroxisome proliferator-activated receptor-γ modulator being developed for the treatment of type 2 diabetes. In preclinical studies and a phase II clinical trial, INT131 has been shown to lower glucose levels and ameliorate insulin resistance without typical TZD side effects. To determine whether the insulin-sensitizing action of INT131 is mediated by effects on insulin-mediated glucose homeostasis and insulin signaling, high-fat diet-induced obese (DIO) insulin-resistant mice treated with INT131 were studied. INT131's effects on bone density were also investigated. Treatment with INT131 enhanced systemic insulin sensitivity, as revealed by lower insulin levels in the fasted state and an increase in the area above the curve during an insulin tolerance test. These effects were independent of changes in adiposity. Insulin-stimulated PI3K activity in skeletal muscle and adipose tissue of DIO mice was significantly reduced ∼50–65%, but this was restored completely by INT131 therapy. The INT131 effects on PI3K activity are most likely due to increased IRS-1 tyrosine phosphorylation. Concurrently, insulin-mediated Akt phosphorylation also increased after INT131 treatment in DIO mice. Importantly, INT131 therapy caused a significant increase in bone mineral density without alteration in circulating osteocalcin in these mice. These data suggest that a newly developed insulin-sensitizing agent, INT131, normalizes obesity-related defects in insulin action on PI3K signaling in insulin target tissues by a mechanism involved in glycemic control. If these data are confirmed in humans, INT131 could be used for treating type 2 diabetes without loss in bone mass.
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Kulshreshtha, Mayank, Pragati Srivastava, and Dharamveer Panjwani. "Endocrine and Therapeutic Basis of Diabetes Mellitus Therapy." International Journal of Pharmaceutical Sciences and Nanotechnology 12, no. 2 (March 31, 2019): 4441–52. http://dx.doi.org/10.37285/ijpsn.2019.12.2.2.
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This review article describes the role of hormones, microvascular complications, pharmacological and non-pharmacological treatments and precautions of diabetes therapy. Diabetes mellitus (DM) is a chronic, lifelong condition that affects ability to use the energy found in food. According to World Health Organization (WHO), it is estimated 422 million adults are suffered with DM up to latest 2016 data. It occurs throughout the world but is more common in the more developed countries. Increase in prevalence is occurring in low- and middle-income countries including in Asia and Africa, where most patients will probably be found by 2030. The WHO estimates that diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death. We summarized the published scientific data and new development in the field of diabetes with a search of PubMed, Google scholar, med know and other online resources. Various hormones play an important role in which insulin has a more importance in DM. Pharmacological treatment included various side effects while herbal drugs are found to be safe. Diet and exercise are the excellent key points to cure the disease. Avoid high sugar diet and various foods whose sugar levels are high should be avoided at the age 40. Overall, better knowledge, balanced life style, and daily exercise are the excellent treatment of diabetes and effective glucose control.
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Jain, Sushil K. "L-Cysteine supplementation as an adjuvant therapy for type-2 diabetes." Canadian Journal of Physiology and Pharmacology 90, no. 8 (August 2012): 1061–64. http://dx.doi.org/10.1139/y2012-087.
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Diabetes remains a major public health issue. According to the American Diabetes Association, 23.5 million, or 10.7% of people in the USA aged 20 years and older, have diabetes. Type-2 diabetes is treated both by controlling the diet and with oral hypoglycemic drugs. However, for many patients, achieving a tight control of glucose is difficult with current regimens. This chapter discusses a relatively low-cost dietary supplement that could be used as an adjuvant therapy for type-2 diabetes. A review of the literature indicates that cysteine-rich whey protein improves glucose metabolism in diabetic animals and type-2 diabetic patients. Similarly, in animal studies, improvement in glucose metabolism is observed after supplementation with L-cysteine, or molecules containing a cysteine moiety. This chapter discusses the biochemical mechanisms by which L-cysteine can upregulate the insulin-dependent signaling cascades of glucose metabolism. Further studies are needed to examine whether clinical interventions using L-cysteine as an adjuvant therapy indeed help to control glycemia and vascular inflammation in the diabetic patient population.
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Brunetti, Luigi, and R. Keith Campbell. "Clinical Efficacy of Colesevelam in Type 2 Diabetes Mellitus." Journal of Pharmacy Practice 24, no. 4 (August 2011): 417–25. http://dx.doi.org/10.1177/0897190011406125.
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Purpose: The clinical experience and role in therapy of colesevelam in type 2 diabetes mellitus (T2DM) is discussed. Summary: Colesevelam HCl is a bile acid sequestrant (BAS) with proven efficacy in reducing elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia. Colesevelam HCl gained food and drug administration (FDA) approval in 2008 as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. In randomized controlled studies, colesevelam (add-on therapy with metformin, sulfonylureas, and insulin) has shown significant percentage reductions in glycosylated hemoglobin A1c (HbA1c) ranging from 0.5% to 0.54%. Reductions in LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) ranging from –12.8% to –16.7% and –4.0% to –10.3%, respectively, were also observed. Although no direct comparisons have been made, the safety and tolerability profile of this agent appears to be better than other BAS, with the most common side effects being gastrointestinal related. Conclusion: Colesevelam is effective as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. Due to its effects upon LDL-C and glycemic parameters and favorable safety profile, colesevelam can play a role in an array of T2DM patients.
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Fang (方璞), Pu, Xinyuan Li (李欣源), Huimin Shan (单慧敏), Jason J. Saredy, Ramon Cueto, Jixiang Xia (夏继祥), Xiaohua Jiang (蒋晓华), Xiao-Feng Yang (杨晓峰), and Hong Wang (王虹). "Ly6C + Inflammatory Monocyte Differentiation Partially Mediates Hyperhomocysteinemia-Induced Vascular Dysfunction in Type 2 Diabetic db/db Mice." Arteriosclerosis, Thrombosis, and Vascular Biology 39, no. 10 (October 2019): 2097–119. http://dx.doi.org/10.1161/atvbaha.119.313138.
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Objective: Hyperhomocysteinemia (HHcy) is a potent risk factor for diabetic cardiovascular diseases. We have previously reported that hyperhomocysteinemia potentiates type 1 diabetes mellitus-induced inflammatory monocyte differentiation, vascular dysfunction, and atherosclerosis. However, the effects of hyperhomocysteinemia on vascular inflammation in type 2 diabetes mellitus (T2DM) and the underlying mechanism are unknown. Approach and Results: Here, we demonstrate that hyperhomocysteinemia was induced by a high methionine diet in control mice (homocysteine 129 µmol/L), which was further worsened in T2DM db/db mice (homocysteine 180 µmol/L) with aggravated insulin intolerance. Hyperhomocysteinemia potentiated T2DM-induced mononuclear cell, monocyte, inflammatory monocyte (CD11b + Ly6C + ), and M1 macrophage differentiation in periphery and aorta, which were rescued by folic acid-based homocysteine-lowering therapy. Moreover, hyperhomocysteinemia exacerbated T2DM-impaired endothelial-dependent aortic relaxation to acetylcholine. Finally, transfusion of bone marrow cells depleted for Ly6C by Ly6c shRNA transduction improved insulin intolerance and endothelial-dependent aortic relaxation in hyperhomocysteinemia+T2DM mice. Conclusions: Hyperhomocysteinemia potentiated systemic and vessel wall inflammation and vascular dysfunction partially via inflammatory monocyte subset induction in T2DM. Inflammatory monocyte may be a novel therapeutic target for insulin resistance, inflammation, and cardiovascular complications in hyperhomocysteinemia+T2DM.
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Vanikar, A. V., S. D. Dave, U. G. Thakkar, and H. L. Trivedi. "Cotransplantation of Adipose Tissue-Derived Insulin-Secreting Mesenchymal Stem Cells and Hematopoietic Stem Cells: A Novel Therapy for Insulin-Dependent Diabetes Mellitus." Stem Cells International 2010 (2010): 1–5. http://dx.doi.org/10.4061/2010/582382.
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Aims. Insulin dependent diabetes mellitus (IDDM) is believed to be an autoimmune disorder with disturbed glucose/insulin metabolism, requiring life-long insulin replacement therapy (IRT), 30% of patients develop end-organ failure. We present our experience of cotransplantation of adipose tissue derived insulin-secreting mesenchymal stem cells (IS-AD-MSC) and cultured bone marrow (CBM) as IRT for these patients.Methods. This was a prospective open-labeled clinical trial to test efficacy and safety of IS-AD-MSC+CBM co-transplantation to treat IDDM, approved by the institutional review board after informed consent in 11 (males : females: 7 : 4) patients with 1–24-year disease duration, in age group: 13–43 years, on mean values of exogenous insulin requirement of 1.14 units/kg BW/day, glycosylated hemoglobin (Hb1Ac): 8.47%, and c-peptide levels: 0.1 ng/mL. Intraportal infusion of xenogeneic-free IS-AD-MSC from living donors, subjected to defined culture conditions and phenotypically differentiated to insulin-secreting cells, with mean quantum: 1.5 mL, expressing Pax-6, Isl-1, and pdx-1, cell counts: /μL, CD45−/90+/73+:40/30.1%, C-Peptide level:1.8 ng/mL, and insulin level: 339.3 IU/mL with CBM mean quantum: 96.3 mL and cell counts: /μL, CD45−/34+:0.62%, was carried out.Results. All were successfully transplanted without any untoward effect. Over mean followup of 23 months, they had a decreased mean exogenous insulin requirement to 0.63 units/kgBW/day, Hb1Ac to 7.39%, raised serum c-peptide levels to 0.38 ng/mL, and became free of diabetic ketoacidosis events with mean 2.5 Kg weight gain on normal vegetarian diet and physical activities.Conclusion. This is the first report of treating IDDM with insulin-secreting-AD-MSC+CBM safely and effectively with relatively simple techniques.
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McShane, L. M., N. Irwin, D. O’Flynn, Z. J. Franklin, C. M. Hewage, and F. P. M. O’Harte. "Glucagon receptor antagonist and GIP agonist combination for diet-induced obese mice." Journal of Endocrinology 229, no. 3 (June 2016): 319–30. http://dx.doi.org/10.1530/joe-15-0463.
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Ablation of glucagon receptor signaling represents a potential treatment option for type 2 diabetes (T2DM). Additionally, activation of glucose-dependent insulinotropic polypeptide (GIP) receptor signaling also holds therapeutic promise for T2DM. Therefore, this study examined both independent and combined metabolic actions of desHis1Pro4Glu9(Lys12PAL)-glucagon (glucagon receptor antagonist) and d-Ala2GIP (GIP receptor agonist) in diet-induced obese mice. Glucagon receptor binding has been linked to alpha-helical structure and desHis1Pro4Glu9(Lys12PAL)-glucagon displayed enhanced alpha-helical content compared with native glucagon. In clonal pancreatic BRIN-BD11 beta-cells, desHis1Pro4Glu9(Lys12PAL)-glucagon was devoid of any insulinotropic or cAMP-generating actions, and did not impede d-Ala2GIP-mediated (P<0.01 to P<0.001) effects on insulin and cAMP production. Twice-daily injection of desHis1Pro4Glu9(Lys12PAL)-glucagon or d-Ala2GIP alone, and in combination, in high-fat-fed mice failed to affect body weight or energy intake. Circulating blood glucose levels were significantly (P<0.05 to P<0.01) decreased by all treatments regimens, with plasma and pancreatic insulin elevated (P<0.05 to P<0.001) in all mice receiving d-Ala2GIP. Interestingly, plasma glucagon concentrations were decreased (P<0.05) by sustained glucagon inhibition (day 28), but increased (P<0.05) by d-Ala2GIP therapy, with a combined treatment resulting in glucagon concentration similar to saline controls. All treatments improved (P<0.01) intraperitoneal and oral glucose tolerance, and peripheral insulin sensitivity. d-Ala2GIP-treated mice showed increased glucose-induced insulin secretion in response to intraperitoneal and oral glucose. Metabolic rate and ambulatory locomotor activity were increased (P<0.05 to P<0.001) in all desHis1Pro4Glu9(Lys12PAL)-glucagon-treated mice. These studies highlight the potential of glucagon receptor inhibition alone, and in combination with GIP receptor activation, for T2DM treatment.
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Ubaidurrohmah Savitri, Faradea, Risma Andani Ayu Safitri, Wening Pangesthi Maharani, Lela Dwi Andriani, Umi Kalsum, Astri Proborini, Subandi Reksohusodo, and Rahma Dian Hanifarizani. "PENGARUH PEMBERIAN SARI TOMAT (Solanum lycopersicum L) DAN INSULIN TERHADAP KADAR GLUKOSA, KADAR LDL, KADAR KOLESTEROL DAN BERAT BADAN LAHIR TIKUS PUTIH STRAIN WISTAR (Rattus Norvegicus) BUNTING DENGAN MODEL DIABETES MELLITUS TIPE 2." Journal of Issues in Midwifery 5, no. 1 (April 8, 2021): 10–23. http://dx.doi.org/10.21776/ub.joim.2021.005.01.2.
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Diabetes Mellitus is a chronic disease caused by abnormal working insulin, insulin secretion or both so that the body tends to have high glucose levels. Type 2 diabetes mellitus can cause elevated levels of LDL and cholesterol. Risks obtained by fetuses with type 2 diabetes can be in the form of macrosomia due to hyperglycemia and hyperinsulin in the body of the fetus. Insulin is the first choice pharmacological therapy for type 2 DM that can be given during pregnancy. Non-pharmacological therapy as recommended by the World Health Organization (WHO) on a healthy diet by increasing consumption of fruits and vegetables. Good fruit consumed for pregnant women with diabetes mellitus (DM) type 2 is tomatoes (Solanum lycopersicum L). The purpose of this study was to determine the administration of tomato extract (Solanum lycopersicum L) and insulin can affect glucose levels, LDL levels, cholesterol levels and birth weight of white wistar galur (Rattus norvegicus) pregnant women with type 2 diabetes mellitus models. experimental design using the pre post test only control group design and post test only control group design. Termination was done on the 17th day of pregnancy and then followed by measurements of LDL levels, cholesterol and birth weight. Data analysis using the One Way Anova test and Kruskal Wallis then continued with the Post Hoc test using. The results showed that there were significant differences between glucose levels, LDL levels, cholesterol levels and BW born in the insulin treatment group and the tomato juice treatment (p value = 0.00 <α = 0.05). The conclusion of giving insulin and tomato juice affects a decrease in glucose levels, LDL levels, cholesterol levels and birth weight.
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Lakshmanan, Arun Prasath, Amira Kohil, Farah El Assadi, Sara Al Zaidan, Shaikha Al Abduljabbar, Dhinoth Kumar Bangarusamy, Fawziya Al Khalaf, Goran Petrovski, and Annalisa Terranegra. "Akkermansia, a Possible Microbial Marker for Poor Glycemic Control in Qataris Children Consuming Arabic Diet—A Pilot Study on Pediatric T1DM in Qatar." Nutrients 13, no. 3 (March 4, 2021): 836. http://dx.doi.org/10.3390/nu13030836.
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In Qatar, Type 1 Diabetes mellitus (T1DM) is one of the most prevalent disorders. This study aimed to explore the gut microbiome’s relation to the continuous subcutaneous insulin infusion (CSII) therapy, dietary habits, and the HbA1c level in the pediatric T1DM subjects in Qatar. We recruited 28 T1DM subjects with an average age of 10.5 ± 3.53 years. The stool sample was used to measure microbial composition by 16s rDNA sequencing method. The results have revealed that the subjects who had undergone CSII therapy had increased microbial diversity and genus Akkermansia was significantly enriched in the subjects without CSII therapy. Moreover, genus Akkermansia was higher in the subjects with poor glycemic control (HbA1c > 7.5%). When we classified the subjects based on dietary patterns and nationality, Akkermansia was significantly enriched in Qataris subjects without the CSII therapy consuming Arabic diet than expatriates living in Qatar and eating a Western/mixed diet. Thus, this pilot study showed that abundance of Akkermansia is dependent on the Arabic diet only in poorly controlled Qataris T1DM patients, opening new routes to personalized treatment for T1DM in Qataris pediatric subjects. Further comprehensive studies on the relation between the Arabic diet, ethnicity, and Akkermansia are warranted to confirm this preliminary finding.
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Okada, S., K. Ichiki, S. Tanokuchi, and Z. Ota. "Dose-Dependent Effect of Hydroxymethylglutaryl – Coenzyme A Reductase Inhibitor on Serum Cholesterol with Limited Dietary Restrictions: A Case Study." Journal of International Medical Research 21, no. 2 (March 1993): 105–11. http://dx.doi.org/10.1177/030006059302100207.
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Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitor (pravastatin sodium) can selectively inhibit cholesterol biosynthesis in the liver and may lower serum cholesterol concentrations even where there are no particular dietary restrictions. A 72-year old housewife with non-insulin-dependent diabetes mellitus complicated by hyperlipaemia type IIb, who did not follow directions for diet therapy or kinesitherapy, was administered HMG–CoA reductase inhibitor. The initial dose of 10 mg/day HMG–CoA reductase inhibitor was increased by 10 mg/day every 4 weeks to 30 mg/day, maintained at 30 mg/day for 8 weeks and then reduced gradually until discontinuation after a further 27 weeks. Test results showed the changes in low-density lipoprotein cholesterol and apoprotein B to be dose-dependent. The findings represent the first clinical evidence that hypercholesterolaemia can be adequately managed by the use of HMG–CoA reductase inhibitor, even when no specific dietary restrictions are imposed, and may contribute to improvements in the quality of daily life for many patients suffering from hyperlipaemia type IIb.
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Tonorezos, Emily S., Debra A. Kent, Chaya S. Moskowitz, and Kevin C. Oeffinger. "Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 9552. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.9552.
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9552 Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity, insulin resistance and increased visceral adiposity. A history of cranial radiation therapy (CRT) worsens this risk. In non-cancer populations, adherence to a Mediterranean Diet has been shown to improve metabolic parameters and risk of diabetes mellitus. Whether diet may contribute to insulin resistance and increased adiposity in ALL survivors is not known. Methods: We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Fasting blood was obtained on all subjects and insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral adiposity was measured by abdominal CT. Adherence to a Mediterranean Diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using univariate analysis. Results: Subjects were majority female (56%); 25% were minority or Hispanic white. A history of CRT was present in 15 (29%) men and 25 (38%) women. Among all subjects, greater adherence to a Mediterranean diet pattern was associated with improved HOMA-IR (p=0.14), visceral adiposity (p=0.03), subcutaneous adiposity (p=0.005), waist circumference (p=0.02), and body mass index (p=0.03) (all unadjusted analyses). The effect of adherence to a Mediterranean diet on insulin resistance was especially notable in men who did not receive CRT (p=0.06). Higher dairy intake was found to worsen HOMA-IR (p=0.014), but other individual components of the Mediterranean diet, such as low intake of meat and high intake of fruits and vegetables, were not significant. Inclusion of PAEE did not alter our findings, although higher PAEE was associated with lower body mass index. Conclusions: Adherence to a Mediterranean diet pattern, especially low consumption of dairy products, may improve insulin resistance in survivors of childhood ALL. Further study is warranted.
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de Wit, Leon, Doortje Rademaker, Daphne N. Voormolen, Bettina M. C. Akerboom, Rosalie M. Kiewiet-Kemper, Maarten R. Soeters, Marion A. L. Verwij-Didden, et al. "SUGAR-DIP trial: oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial." BMJ Open 9, no. 8 (August 2019): e029808. http://dx.doi.org/10.1136/bmjopen-2019-029808.
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IntroductionIn women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM.MethodsThe SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals.Trial registration numberNTR6134; Pre-results.
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Nezhinskaya-Astapenko, Z. P., T. V. Sekret, and M. V. Vlasenko. "PREVALENCE OF DIABETIC KETOACIDOSIS AND ITS ETIOLOGICAL FACTORS IN THE PODILLYA REGION OF UKRAINE." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 18, no. 4 (December 20, 2018): 33–40. http://dx.doi.org/10.31718/2077-1096.18.4.33.
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The diabetes mellitus is one of the most common diseases of the world. It is characterized by a large number of complications, including ketoacidosis and its severe form known as ketoacidosis diabetic coma. The aim was to estimate the causes of the development of diabetic ketoacidosis and the duration of treatment of an acute state in different age groups. Materials and methods. The random sampling of patients included 55 individuals with diabetes mellitus admitted to intensive care unit of the Vinnytsia Regional Highly Specialized Endocrinological Center aged from 9 up to 70 years in an emergency condition of diabetic ketoacidosis during 2009-2014. Average age of patients was 31,58 ± 17,18 years. Patients were divided into 3 clinical groups depending on their age. Diagnosis of diabetic ketoacidosis was made on the basis of the order of the Ministry of Public Health of Ukraine No. 254, 27.04.06. The results obtained were statistically processed by the Russian-language "Statistica 6.1" StatSoft, 1995. Results. In the most of the cases (27,2%) the acute condition was caused by improper diet. Insulin therapy disturbance ranked the 2nd place and made up 21,8% of all cases. 20 % of ketoacidosis cases were a disease debut in first diagnosed diabetes mellitus. An average duration of hospital staying ranged from 2,33 to 3,09 days and depended on clinical form of diabetic ketoacidosis. Conclusions. The commonest causes resulting in the emergency of diabetic ketoacidosis were improper diet, non-compliance with insulin therapy, and first diagnosed diabetes mellitus. The duration of the hospital treatment did not depend on age of patients, however considerably differed according to clinical form of diabetic ketoacidosis.
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Schweisberger, Cintya, Nila Palaniappan, Nicole Wood, Lauren Amos, and Kelsee Halpin. "Hyperglycemia Requiring Insulin Among Pediatric Patients Diagnosed With Hemophagocytic Lymphohistiocytosis." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A451—A452. http://dx.doi.org/10.1210/jendso/bvab048.922.
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Abstract Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disorder marked by massive cytokine release due to macrophage and T-cell activation. Hallmarks of the diagnosis include fever, splenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogemia, and elevations in ferritin and soluble IL-2 receptor. Given HLH is associated with critical illness, elevation in inflammatory markers, and treated with glucocorticoids, the development of hyperglycemia during its course is not unexpected. However, detailed descriptions of the severity of hyperglycemia and strategies in insulin management among HLH patients are lacking. We describe 10 years’ experience at a single tertiary pediatric health center with HLH patients who developed insulin dependent hyperglycemia. Objectives: To describe the demographics, clinical and laboratory findings, treatment regimens, and outcomes for children with HLH treated with insulin due to hyperglycemia. Study Design: Retrospective chart review from 2010 through 2019 of youth 0 to 21 years of age who required insulin therapy during or shortly after a hospitalization where they were diagnosed with HLH using established criteria. Descriptive statistics were used to characterize the population of interest. Results: Of 30 patients diagnosed with HLH, 33% (n=10) required insulin therapy. Half (n=5) were female and half (n=5) male. The mean age was 8.4 years (7.8 months - 17 years). The majority (80%) were non-Hispanic white. Mean BMI at admission was 53rd percentile (5th - 87th percentile). Max serum glucose ranged from 267 to 725 mg/dL (mean 421 mg/dL). Marked inflammation was present (max CRP 2.6 - 44.9 mg/dL, max ferritin 1,091 - 90,219 ng/mL). All were treated with dexamethasone, doses ranging from 5 to 11 mg/m2/day and duration from 2 to 70 days. Most (90%) received parenteral nutrition (PN) with a mean max GIR of 8 mg/kg/min (SD=2.7). Intravenous infusions of regular insulin were used in 80% of patients, though 2 patients were later transitioned to long and short acting subcutaneous insulin. Mean duration of IV insulin therapy was 9.5 days (2–24 days); however, 2 patients died while on IV insulin therapy. The majority (70%) needed insulin within 5 days of starting steroids. Two patients (20%) were treated with subcutaneous insulin only (no IV). Only 1 patient was discharged home on insulin therapy. Mean hospital stay was 60 days (10–202 days). Mortality was 50% (n=5). Conclusions: One-third of pediatric HLH patients required insulin during their hospitalization for severe hyperglycemia likely secondary to multiple factors including glucocorticoid use, parenteral nutrition, inflammation, and severe illness. Insulin is typically started within 5 days of initiating steroid therapy, limited to IV infusions, and often is not needed by the time of discharge. Risk of mortality is very high.
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Ametov, Aleksander Sergeevich, and Dinara Gadgimagomedovna Gusenbekova. "The role of dipeptidyl peptidase 4 inhibitors in fat metabolism in patients with type 2 diabetes and obesity." Diabetes mellitus 18, no. 3 (July 5, 2015): 85–92. http://dx.doi.org/10.14341/dm2015385-92.
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Objective. To evaluate the influence of combined therapy of sitagliptin and metformin on fat metabolism in patients with type 2 diabetes mellitus.Methods. The study included 82 patients (age, 55.3±9.1 years) with obesity and lipid metabolism disorders. None of the patients had reached their target glycated haemoglobin levels after metformin and diet therapy. Patients in group 1 (n=42) received 1.5–2-g metformin daily before the study and were switched to a formulation of 100-mg sitagliptin and 2-g metformin once a day. Patients in group 2 (n=40) were on a diet therapy before inclusion and were started on 2-g metformin/day. The following were evaluated at baseline and after 6 months of therapy: fasting glucose levels, postprandial glucose levels, glycated haemoglobin, weight, body mass index, waist circumference and lipid profile; insulin, proinsulin, leptin and adiponectin levels; insulin resistance using the homeostatic model assessment (HOMA) of β-cell function (HOMA-β) and insulin resistance (HOMA-IR). In addition, magnetic resonance imaging was performed to assess the amount of visceral fat for the total cohort.Results. After 6 months, glycated haemoglobin decreased by 18.52% (p 0.001) in group 1 and by 8.17% (p 0.001) in group 2. Fasting plasma glucose and postprandial glucose levels in group 1 were reduced by 21% (p 0.001) and 26.35% (p 0.001), respectively; the corresponding reductions in group 2 were 1.45% (p 0.05) and 5.31% (p 0.05), respectively. HOMA-β increased by 33% in group 1 (p 0.001) and by 11% in group 2 (p 0.05). Adiponectin levels increased by 27.06% (p 0.001) in group 1 and by 7.16% in group 2 (p 0.001). Leptin levels were reduced by 30.47% (p 0.001) in group 1 and by 5.41% in group 2 (p 0.001). Magnetic resonance imaging showed a 7.52% reduction in visceral fat for group 1 (p 0.001) and a 1.76% reduction for group 2 (p 0.01). The comparison of subcutaneous fat dynamics did not show statistically significant differences between the groups.Conclusion. Compared with metformin monotherapy, sitagliptin and metformin combination therapy had a prominent effect on non-glycaemic parameters, with more marked decreases in visceral fat and leptin and increases in adiponectin levels.
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Koren-Iton, Amit, Shiran Salomon-Zimri, Alex Smolar, Efrat Shavit-Stein, Amir Dori, Joab Chapman, and Daniel M. Michaelson. "Central and Peripheral Mechanisms in ApoE4-Driven Diabetic Pathology." International Journal of Molecular Sciences 21, no. 4 (February 14, 2020): 1289. http://dx.doi.org/10.3390/ijms21041289.
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Apolipoprotein E (APOE) ε4 gene allele and type 2 diabetes mellitus (T2DM) are prime risk factors for Alzheimer’s disease (AD). Despite evidence linking T2DM and apoE4, the mechanism underlying their interaction is yet to be determined. In the present study, we employed a model of APOE-targeted replacement mice and high-fat diet (HFD)-induced insulin resistance to investigate diabetic mechanisms associated with apoE4 pathology and the extent to which they are driven by peripheral and central processes. Results obtained revealed an intriguing pattern, in which under basal conditions, apoE4 mice display impaired glucose and insulin tolerance and decreased insulin secretion, as well as cognitive and sensorimotor characteristics relative to apoE3 mice, while the HFD impairs apoE3 mice without significantly affecting apoE4 mice. Measurements of weight and fasting blood glucose levels increased in a time-dependent manner following the HFD, though no effect of genotype was observed. Interestingly, sciatic electrophysiological and skin intra-epidermal nerve fiber density (IENFD) peripheral measurements were not affected by the APOE genotype or HFD, suggesting that the observed sensorimotor and cognitive phenotypes are related to central nervous system processes. Indeed, measurements of hippocampal insulin receptor and glycogen synthase kinase-3β (GSK-3β) activation revealed a pattern similar to that obtained in the behavioral measurements while Akt activation presented a dominant effect of diet. HFD manipulation induced genotype-independent hyperlipidation of apoE, and reduced levels of brain apoE in apoE3 mice, rendering them similar to apoE4 mice, whose brain apoE levels were not affected by the diet. No such effect was observed in the peripheral plasma levels of apoE, suggesting that the pathological effects of apoE4 under the control diet and apoE3 under HFD conditions are related to the decreased levels of brain apoE. Taken together, our data suggests that diabetic mechanisms play an important role in mediating the pathological effects of apoE4 and that consequently, diabetic-related therapy may be useful in treating apoE4 pathology in AD.
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Akcam, Boyaci, Pirgon, Kaya, Uysal, and N. Dundar. "Therapeutic Effect of Metformin and Vitamin E Versus Prescriptive Diet in Obese Adolescents with Fatty Liver." International Journal for Vitamin and Nutrition Research 81, no. 6 (November 1, 2011): 398–406. http://dx.doi.org/10.1024/0300-9831/a000086.
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Objective: The aim of the study was to determine whether metformin or vitamin E treatment for six months is effective in reducing body weight, blood pressure, and also ameliorating insulin resistance, adiponectin, and tumor necrosis factor (TNF)-alpha in obese adolescents with non-alcoholic fatty liver disease (NAFLD). Methods: Sixty-seven obese adolescents with liver steatosis (age range, 9 - 17 years) were included in the study. The metformin group received an 850-mg dose of metformin daily and the vitamin E group received 400 U vitamin E /daily, in capsule form for 6 months, plus an individually tailored diet, exercise, and behavioral therapy. Results: After 6 months later, there was a significant decline in body mass index, and fasting insulin and homeostatic model assessment (HOMA) values in all three groups. Moreover, in comparingson of changes in HOMA among the groups, the metformin- treated group showed significantly improved metabolic control and insulin sensitivity (HOMA) at the end of the study. There were no significant differences for changes of adiponectin, TNF-alpha, in all three groups after 6 months study. Conclusion: These data suggest that metformin treatment is more effective than dietary advice and vitamin E treatment in reducing insulin resistance, and also in ameliorating metabolic parameters such as fasting insulin and lipid levels, in obese adolescents having NAFLD.
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Jacob, Jordan, Jared Rosenberg, and Joon Young Kim. "Incretin as a Pathophysiological Component and Target for Treatment in Youth Type 2 Diabetes (T2D)." JOHSK 1, no. 1 (October 31, 2020): 24–27. http://dx.doi.org/10.47544/johsk.2020.1.1.24.
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Incretin hormones have recently been considered an important pathophysiological factor for T2D in adults and youth due to their role in augmenting insulin secretion (Michaliszyn et al., 2014). It is recognized that glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are glucose-dependent hormones released from the gut that stimulate insulin release from pancreatic β-cells (Muscelli et al., 2006). Thus, the insulin response to oral glucose is significantly greater than the intravenous (IV) glucose administration response; this is known as the incretin effect (Michaliszyn et al., 2014). To date, adults with T2D demonstrate a remarkable decrease in the incretin effect (Nauck et al., 1986), whereas there is lack of evidence in pediatric populations. The incretin effect is also associated with β-cell glucose sensitivity (βCGS), attesting incretins as a high-promising target for T2D treatment (Michaliszyn et al., 2014). Utilizing GLP-1 receptor agonists can be advantageous as a therapeutic option for both adults and youth (Tamborlane et al., 2019; Vanderheiden et al., 2016; Yeow et al., 2017). While metformin and insulin were the sole treatment options for Y-T2D prior to FDA approval (in 2019) for the use of GLP-1 agonists, a recent RISE (Restoring Insulin Secretion) clinical trial reported disappointing results that both metformin alone and insulin glargine for three months followed by metformin for nine months were not effective in restoring/preserving β-cell function in youth with prediabetes and T2D (RISE Consortium & RISE Consortium Investigators, 2019). On the contrary, the role of GLP-1 and the efficacy of the GLP-1 receptors in T2D signifies a strong target for potential treatment. Additional clinical trials are warranted to see if monotherapy of GLP-1 agonist vs. combined (metformin + liraglutide) therapy is effective to reserve Y-T2D to prediabetes and/or normal state. More importantly, future research should focus on disease prevention rather than treatment to avoid aggressive complications and metabolic degradations of Y-T2D (RISE Consortium & RISE Consortium Investigators, 2019). Altogether, it would be germane to investigate whether lifestyle changes (diet, physical activity, exercise medicine) can improve the incretin effect in conjunction with glycemic control in youth.