Diabetes Mellitus, Type 2
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Publication
Journal: Disease markers
October/20/2013
Abstract
To investigate the possible association between eNOS 4a/b polymorphism and the risk of developing type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) 173 T2DM patients with and without DN and 101 healthy subjects with ethnic background of Kurds were examined for the frequency of eNOS variants using PCR-RFLP method. The frequency of eNOS 4a/b genotypes between T2DM and controls was not significantly difference. Studying eNOS 4a/b variants alone indicated that the presence of eNOS 4a allele was not associated with the risk of developing DN. However, considering both polymorphisms of eNOS 4a/b and G894T indicated that the risk of macroalbuminuria significantly increased in the presence of either eNOS 4a or 894T allele by 2.45 times (p=0.014) and 3.7-fold (p=0.016), respectively. However, the concomitant presence of both alleles was not associated with the risk of macroalbuminuria. In microalbuminuric patients, in the presence of each allele, the risk of microalbuminuria increased 2.2 times (p=0.028) and 2.72-fold (p=0.057) for eNOS 4a and 894T alleles, respectively. However, the combined presence of both eNOS 894T and 4a alleles was not associated with the risk of microalbuminuria. The present study indicates the absence of association between eNOS 4a/b variants and the risk of developing T2DM and DN. Also, we demonstrated that eNOS 4a or 894T allele alone increased the risk of developing DN but this effect was modified by the concomitant presence of both alleles.
Publication
Journal: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
March/14/2010
Abstract
BACKGROUND
The benefits of self-monitoring blood glucose levels are unclear in patients with type 2 diabetes mellitus who do not use insulin, but there are considerable costs. We sought to determine the cost effectiveness of self-monitoring for patients with type 2 diabetes not using insulin.
METHODS
We performed an incremental cost-effectiveness analysis of the self-monitoring of blood glucose in adults with type 2 diabetes not taking insulin. We used the United Kingdom Prospective Diabetes Study (UKPDS) model to forecast diabetes-related complications, corresponding quality-adjusted life years and costs. Clinical data were obtained from a systematic review comparing self-monitoring with no self-monitoring. Costs and utility decrements were derived from published sources. We performed sensitivity analyses to examine the robustness of the results.
RESULTS
Based on a clinically modest reduction in hemoglobin A(1C) of 0.25% (95% confidence interval 0.15-0.36) estimated from the systematic review, the UKPDS model predicted that self-monitoring performed 7 or more times per week reduced the lifetime incidence of diabetes-related complications compared with no self-monitoring, albeit at a higher cost (incremental cost per quality-adjusted life year $113,643). The results were largely unchanged in the sensitivity analysis, although the incremental cost per quality-adjusted life year fell within widely cited cost-effectiveness thresholds when testing frequency or the price per test strip was substantially reduced from the current levels.
CONCLUSIONS
For most patients with type 2 diabetes not using insulin, use of blood glucose test strips for frequent self-monitoring (>or= 7 times per week) is unlikely to represent efficient use of finite health care resources, although periodic testing (e.g., 1 or 2 times per week) may be cost-effective. Reduced test strip price would likely also improve cost-effectiveness.
Publication
Journal: The journal of nutrition, health & aging
October/27/2013
Abstract
OBJECTIVE
To explore the relationship between nutritional status, functional capacity and health-related quality of life (HRQoL) in older adults with type 2 diabetes (T2DM).
METHODS
Cross-sectional study.
METHODS
Forty two non-insulin dependent older adults from a primary care center in Seville, Spain.
METHODS
Function was assessed with a battery of standardized physical fitness tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the European Quality of Life Questionnaire (EQ-5D-3L) was used to assess HRQoL.
RESULTS
There was an association between MNA-nutritional status and lower body strength as assessed by the chair sit-stand test (rho= .451; p= .037) and between MNA-nutritional status and EQ-5D-3L-HRQoL (EQ-5D-3Lutility, rho= .553; p<.001 and EQ-5D-3LVAS rho= .402; p<.001). An MNA item by item correlation analysis with HRQoL and lower limb strength demonstrated that HRQoL appears to be related to functional capacity (principally lower body strength, motor agility and cardiorespiratory fitness) among participants. These results were maintained when correlations were adjusted for co-morbidity.
CONCLUSIONS
Our results demonstrated that nutritional status is moderately associated with HRQoL and lower limb strength in patients with T2DM. Our data suggest that more emphasis should be placed on interventions to encourage a correct diet and stress the needed to improve lower body strength to reinforce better mobility in T2DM population.
Publication
Journal: Regulatory peptides
November/1/2004
Abstract
Exenatide (synthetic exendin-4), glucagon-like peptide-1 (GLP-1), and GLP-1 analogues have actions with the potential to significantly improve glycemic control in patients with diabetes. Evidence suggests that these agents use a combination of mechanisms which may include glucose-dependent stimulation of insulin secretion, suppression of glucagon secretion, enhancement of beta-cell mass, slowing of gastric emptying, inhibition of food intake, and modulation of glucose trafficking in peripheral tissues. The short in vivo half-life of GLP-1 has proven a significant barrier to continued clinical development, and the focus of current clinical studies has shifted to agents with longer and more potent in vivo activity. This review examines recent exendin-4 pharmacology in the context of several known mechanisms of action, and contrasts exendin-4 actions with those of GLP-1 and a GLP-1 analogue. One of the most provocative areas of recent research is the finding that exendin-4 enhances beta-cell mass, thereby impeding or even reversing disease progression. Therefore, a major focus of this is article an examination of the data supporting the concept that exendin-4 and GLP-1 may increase beta-cell mass via stimulation of beta-cell neogenesis, stimulation of beta-cell proliferation, and suppression of beta-cell apoptosis.
Publication
Journal: The journal of nursing research : JNR
May/4/2014
Abstract
BACKGROUND
Social support is related to patient self-care and health status. Patients' psychosocial issues play an important role in diabetes care.
OBJECTIVE
This study investigates correlations among social support, depression, and anxiety in patients with diabetes.
METHODS
A cross-sectional study design and purposive sampling were used. One hundred eleven patients with type-2 diabetes were recruited from three regional teaching hospitals in northern, central, and southern Taiwan, respectively. Questionnaires used included the social support and psychological referral inventory, Beck depression inventory, and Beck anxiety inventory.
RESULTS
Approximately 12.6% of the study population had depression, and 27.0% had anxiety. Depression and anxiety were positively correlated (r = .65, p < .01), whereas depression was negatively correlated with the sum of disease control types (r = -0.26, p < .01) and social support (r = -0.27, p <.01). The sum of disease control types and social support were the most important explanatory factors for depression in patients, explaining 45.5% of variance. Anxiety was correlated positively with age (r = .26, p < .01), total number of complications (r = .31, p < .01), and depression (r = .65, p < .01). Anxiety correlated negatively with weight (r = -0.20, p < .05) and sum of disease control types (r = -0.25, p < .05). The above variables were important explanatory factors for anxiety, accounting for 15.2% of variance.
CONCLUSIONS
Psychological factors, such as depression and anxiety, are common symptoms in patients with diabetes. If social support can be strengthened in these patients, then psychological factors can be improved. Professional care providers should focus on reducing the patient depression and anxiety levels, strengthening social support, and providing referrals to psychology-related professionals.
Publication
Journal: The Journal of clinical endocrinology and metabolism
October/6/2004
Abstract
Glucocorticoids play an important role in the pathogenesis of obesity and insulin resistance. Impaired conversion of cortisone (E) to cortisol (F) by the type 1 isoenzyme of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) in obesity may represent a protective mechanism preventing ongoing weight gain and glucose intolerance. We have studied glucocorticoid metabolism in 33 male subjects with type 2 diabetes mellitus [age, 44.2 +/- 13 yr; body mass index (BMI), 31.1 +/- 7.5 kg/m(2) (mean +/- sd)] and 38 normal controls (age, 41.4 +/- 14 yr; BMI, 38.2 +/- 12.8 kg/m(2)). Circulating F:E ratios were elevated in the diabetic group and correlated with serum cholesterol and homeostasis model assessment-S. There was no difference in 11beta-HSD1 activity between diabetic subjects and controls. In addition, 11beta-HSD1 activity was unaffected by BMI in diabetic subjects. However, in control subjects, increasing BMI was associated with a reduction in the urinary tetrahydrocortisol+5alpha-tetrahydrocortisol:tetrahydrocortisone ratio (P < 0.05) indicative of impaired 11beta-HSD1 activity. The degree of inhibition correlated tightly with visceral fat mass. Changes in 11beta-HSD1 activity could not be explained by circulating levels of adipocytokines. Impaired E to F metabolism in obesity may help preserve insulin sensitivity and prevent diabetes mellitus. Failure to down-regulate 11beta-HSD1 activity in patients with diabetes may potentiate dyslipidemia, insulin resistance, and obesity. Inhibition of 11beta-HSD1 may therefore represent a therapeutic strategy in patients with type 2 diabetes mellitus and obesity.
Publication
Journal: The American journal of medicine
February/24/2010
Publication
Journal: Congenital heart disease
September/29/2013
Publication
Journal: Quality management in health care
October/11/2004
Publication
Journal: Pain medicine (Malden, Mass.)
May/3/2011
Abstract
OBJECTIVE
The aim of the current study was to examine the health outcomes of patients suffering from painful diabetic peripheral neuropathy (pDPN) over a 3-year period, relative to patients with diabetes but without neuropathic pain and controls.
METHODS
The current study included participants who completed three consecutive waves of the National Health and Wellness Survey (2006-2008). These participants were categorized into one of three groups: those with pDPN (N=290), those with diabetes but without pDPN ("diabetes without pDPN group"; N=1,037), and those not diagnosed with diabetes ("control group"; N=8,162).
METHODS
Health status (Short Form-12v2), work productivity (Work Productivity and Activity Impairment Questionnaire), and resource use were examined with repeated-measures models adjusting for demographic and clinical factors.
RESULTS
The pDPN group reported significantly lower levels of physical quality of life. Moreover, physical quality of life scores for the pDPN group decreased at a significantly faster rate over a 3-year period relative to other groups. In addition, the pDPN patients reported significantly higher levels of impairment of work productivity and activity, greater resource use, and higher total 3-year per-patient costs.
CONCLUSIONS
Confirming and expanding upon the literature, our results indicate a significantly worse trajectory of quality of life outcomes over time and long-term increased total costs for pDPN patients relative to non-pDPN diabetes patients and controls.
Publication
Journal: Free radical biology & medicine
July/12/2015
Abstract
The expansion of adipose tissue (AT) is, by definition, a hallmark of obesity. However, not all increases in fat mass are associated with pathophysiological cues. Indeed, whereas a "healthy" fat mass accrual, mainly in the subcutaneous depots, preserves metabolic homeostasis, explaining the occurrence of the metabolically healthy obese phenotype, "unhealthy" AT expansion is importantly associated with insulin resistance/type 2 diabetes and the metabolic syndrome. The development of a dysfunctional adipose organ may find mechanistic explanation in a reduced ability to recruit new and functional (pre)adipocytes from undifferentiated precursor cells. Such a failure of the adipogenic process underlies the "AT expandability" paradigm. The inability of AT to expand further to store excess nutrients, rather than obesity per se, induces a diabetogenic milieu by promoting the overflow and the ectopic deposition of fatty acids in insulin-dependent organs (i.e., lipotoxicity), the secretion of various metabolically detrimental adipose-derived hormones (i.e., adipokines and lipokines), and the occurrence of local and systemic inflammation and oxidative stress. Hitherto, fatty acids (i.e., lipokines) and the oxidation by-products of cholesterol and polyunsaturated fatty acids, such as nonenzymatic oxysterols and reactive aldehyde species, respectively, emerge as key modulators of (pre)adipocyte signaling through Wnt/β-catenin and MAPK pathways and potential regulators of glucose homeostasis. These and other mechanistic insights linking adipose dysfunction, oxidative stress, and impairment of glucose homeostasis are discussed in this review article, which focuses on adipose peroxidation as a potential instigator of, and a putative therapeutic target for, obesity-associated metabolic dysfunctions.
Publication
Journal: BMJ open
July/22/2015
Abstract
OBJECTIVE
Investigate factors associated with the onset of diabetes in women aged more than 49 years.
METHODS
Cross-sectional, population-based study using self-reports with 622 women. The dependent variable was the age of occurrence of diabetes using the life table method. Cox multiple regression models were adjusted to analyse the onset of diabetes according to predictor variables. Sociodemographic, clinical and behavioural factors were evaluated.
RESULTS
Of the 622 women interviewed, 22.7% had diabetes. The mean age at onset was 56 years. The factors associated with the age of occurrence of diabetes were self-rated health (very good, good) (coefficient=-0.792; SE of the coefficient=0.215; p=0.0001), more than two individuals living in the household (coefficient=0.656, SE of the coefficient=0.223; p=0.003), and body mass index (BMI) (kg/m(2)) at 20-30 years of age (coefficient= 0.056, SE of the coefficient=0.023; p=0.014).
CONCLUSIONS
Self-rated health considered good or very good was associated with a higher rate of survival without diabetes. Sharing a home with two or more other people and a weight increase at 20-30 years of age was associated with the onset of type 2 diabetes.
Publication
Journal: International journal of cancer
June/1/2015
Abstract
This study examined whether glycated hemoglobin A1C (HbA1C) and chronic liver diseases are associated with hepatocellular carcinoma (HCC) risk in Type 2 diabetic patients. A retrospective cohort study consisting of 51,705 patients with Type 2 diabetes aged 30 and over enrolled in the National Diabetes Care Management Program before 2004 was used in Cox proportional hazards models. HbA1C was independently associated with HCC incidence, and multivariate-adjusted hazard ratio (HR) of HCC was 1.20 (95% confidence interval, CI: 1.02-1.41) for patients with a level of HbA1c ≥ 9% compared with patients with a level of HbA1c <7% after multivariate adjustment. We observed a significant linear trend in HCC incidence with increasing HbA1c (p for trend = 0.02, HR = 1.07, 95% CI = 1.01-1.12 for every 1% increment in HbA1c). We observed significant HRs of HCC for patients with a level of HbA1c ≥ 9% with alcoholic liver damage, liver cirrhosis, HBV, HCV and any one of chronic liver diseases compared with patients with a level of HbA1c <9% and no counterpart comorbidity in the entire sample (HR = 8.63, 95% CI = 1.41-52.68; HR = 5.02, 95% CI = 3.10-8.12; HR = 2.53, 95% CI = 1.10-5.85; HR = 1.79, 95% CI = 1.01-3.17; and HR = 3.59, 95% CI = 2.56-5.02, respectively). Our results suggest significant joint associations of HbA1c ≥ 9% and chronic liver diseases. Lifestyle or treatment interventions such as maintaining a satisfactory glycemic control and chronic liver diseases may reduce the burden of HCC.
Publication
Journal: International journal of oncology
December/20/2018
Abstract
Metformin (MET) is the first‑line treatment for type 2 diabetes mellitus. Several epidemiological studies have suggested the potential anti‑cancer effects of MET, including its activity against pancreatic ductal adenocarcinoma (PDAC). Gemcitabine (GEM) has become the standard chemotherapy for PDAC; however, acquired resistance to GEM is a major challenge. In this study, we evaluated the anti‑tumor effects of MET against GEM‑resistant PDAC in a mouse xenograft model. GEM‑resistant BxG30 PDAC cells were implanted into BALB/c nude mice. The mice were divided into 4 groups (control, GEM, MET, and combined treatment with GEM + MET) and treated with the drugs for 4 weeks. Compared with the control mice, the final tumor volumes were significantly decreased in the mice treated with GEM + MET. Treatment to control volume ratios (T/C%) were calculated as 80.2% (GEM), 54.0% (MET) and 47.2% (GEM + MET). The anti‑tumor activity of GEM alone against BxG30 tumor xenografts was limited. MET treatment alone exerted satisfactory anti‑tumor effects; however, the optimal T/C% was achieved by treatment with GEM + MET, indicating that this combined treatment regimen potently inhibited the growth of GEM‑resistant PDAC. The expression of hypoxia‑inducible factor 1α (HIF‑1α) and the phosphorylation of ribosomal protein S6 (S6), an important downstream effector of the mammalian target of rapamycin (mTOR) signaling pathway, were also assessed by western blot analysis. The phosphorylation of S6 was inhibited by incubation with MET, but not with GEM, and the expression of HIF‑1α under hypoxic conditions was significantly inhibited by MET treatment, but not by GEM treatment. The production of vascular endothelial growth factor was also suppressed by MET treatment, but not by GEM treatment, as determined by ELISA. Taken together, the data of this study demonstrate that the anti‑tumor activity of MET is mediated via the suppression of mTOR‑HIF‑1 signaling, reflecting a different underlying mechanism of action than that of GEM. These results may prove to be clinically significant and reveal the potential of MET as an effective therapeutic drug for PDAC.
Publication
Journal: Frontiers in bioscience (Landmark edition)
April/20/2011
Abstract
Aberrant alterations in glucose and lipid concentrations and their pathways of metabolism are a hallmark of diabetes. However, much less is known about alterations in concentrations of amino acids and their pathways of metabolism in diabetes. In this review we have attempted to highlight, integrate and discuss common alterations in amino acid metabolism in a wide variety of cells and tissues and relate these changes to alterations in endocrine, physiologic and immune function in diabetes.
Publication
Journal: The Bulletin of Tokyo Dental College
April/11/2019
Abstract
The purpose of this cross-sectional study was to determine whether there is an association between hemoglobin A1c (HbA1c) level and the presence or absence of decayed teeth in patients with type 2 diabetes mellitus. The patients and data on their age and sex, the presence or absence of dental claims, medical history of diabetes mellitus, and workplace dental examinations were obtained from a Japanese healthcare database available for epidemiological studies. The HbA1c levels were obtained from results of the Specific Health Checkups and Specific Health Guidance tests conducted by the Japanese Ministry of Health, Labour and Welfare. Data on a total of 1,897 patients were analyzed. Patients with poorly controlled diabetes (HbA1c≥6.5, n=779) had more decayed teeth than those in whom it was well controlled (HbA1c<6.5, n=1,118). Multiple logistic regression analysis with the presence or absence of decayed teeth as a dependent variable revealed a significant association between an HbA1c level of ≥8.0 and decayed teeth (odds ratio: 1.69; 95% confidence interval, 1.24-2.29), even after adjusting for dental attendance. This suggests that a poorly controlled blood HbA1c level is a risk factor for dental caries. More thorough oral hygiene instruction and education on preventive treatment for dental caries in patients with poorly controlled diabetes are needed.
Publication
Journal: Diabetes, obesity & metabolism
May/2/2006
Abstract
Basal insulin therapy is an integral part of the intensive management of type 1 diabetes and it is also often used in type 2 diabetes. An ideal insulin regimen in patients with diabetes would mirror the 24-h insulin profile of a non-diabetic person, thereby preventing hyperglycaemia without inducing hypoglycaemia. Until recently, available insulins have pharmacokinetic disadvantages, compared to physiological insulin secretion. Insulin detemir is a new basal insulin analogue recently available for commercial use in the UK. Clinical trials have demonstrated lower fasting plasma glucose levels, lower variability in plasma glucose, predictable action profile and a reduced risk of nocturnal hypoglycaemia and weight gain, compared to conventional basal insulins. This study reviews the properties and potential use of insulin detemir.
Publication
Journal: Revista gaucha de enfermagem
April/21/2010
Abstract
This article describes the experience in making a protocol for nursing consultations in order to subsidize the assistance provided for diabetic patients attended in Hospital das Clínicas State University of Campinas, São Paulo, Brazil, at the stage of beginning their insulin therapy. The development of the protocol was divided into two working stages. On the first stage, a literature research was carried out to survey the scientific production related to the orientations and nursing care, by the introduction of insulin therapy. The second stage was the building of the protocol proposal based on the achieved results. The conception process allowed the acknowledgment of both nursing consultations and systematization of care as a valuable tools to identify the problems individually, besides planning, carrying out, and assessing the assistance and health service plan continually, bringing about the improvement of care and the standardization of documents and records.
Publication
Journal: International journal of clinical practice
November/8/2018
Abstract
OBJECTIVE
To examine incidence and in-hospital outcomes of Clostridium difficile infection (CDI) among patients with type 2 diabetes (T2DM); compare clinical variables among T2DM patients with matched non-T2DM patients hospitalised with CDI and identify factors associated with in-hospital mortality (IHM) among T2DM patients.
METHODS
We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients that had CDI as primary or secondary diagnosis in their discharge report. For each T2DM patient, we selected a gender, age, readmission status and year-matched non-diabetic patient.
RESULTS
We identified 44 695 patients with CDI (21.19% with T2DM). We matched 3040 and 5987 couples with a primary and secondary diagnosis of CDI, respectively. Incidence of CDI was higher in T2DM patients (IRR per hospital admission 1.12; 95% CI 1.09-1.14, IRR per population 1.26; 95% CI 1.22-1.29). IHM decreased over time in T2DM and non-T2DM patients (from 15.36% and 13.35%, in 2001-2003 to 10.36% and 11.73% in 2013-2015), despite a concomitant increase in CDI diagnoses overtime. Among those with CDI as secondary diagnosis IHM was higher in nondiabetic 16.17% than in T2DM patients 13.19% (P < 0.001). In T2DM patients higher mortality rates were associated with older age, comorbidities, severe CDI, and readmission. Primary diagnosis of CDI was associated with lower IHM (OR 0.71; 95% CI 0.60-0.84) than secondary diagnosis.
CONCLUSIONS
Incidence of CDI was higher in T2DM patients. IHM decreased over time, regardless of the existence or not of T2DM. IHM was significantly lower in T2DM patients with CDI as primary diagnosis than non diabetic patients.
Publication
Journal: Archives of physiology and biochemistry
September/29/2013
Abstract
OBJECTIVE
To assess the relationship of serum osteocalcin levels with blood glucose, insulin resistance and lipid profile in central Indian men with type 2 diabetes.
METHODS
Anthropometric and biochemical parameters were measured in 56 newly diagnosed type 2 diabetic men and in 56 age and body mass index (BMI) matched controls. Insulin resistance was calculated by homeostasis model assessment of insulin resistance (HOMA-IR).
RESULTS
After adjustment for age and BMI, osteocalcin levels were negatively correlated with fasting plasma glucose (p = 0.0004), fasting insulin (p = 0.0311), HOMA-IR (p = 0.0023), and triglycerides (p = 0.0095), and positively correlated with high density lipoprotein (HDL)-cholesterol (p = 0.0042) in type 2 diabetic patients. In multivariate logistic regression analyses that adjusted for age, BMI, waist circumference and waist-to-hip ratio, osteocalcin was inversely associated with the presence of type 2 diabetes (p < 0.0001).
CONCLUSIONS
Osteocalcin may play a protective role in the pathogenesis of type 2 diabetes, not only through direct involvement in glucose homeostasis, but also through improving lipid profile.
Publication
Journal: Scientific reports
September/29/2013
Abstract
Adipocytes hypertrophy is the main cause of obesity and its affliction such as type 2 diabetes (T2D). Since superparamagnetic iron oxide nanoparticles (SPIONs) are used for a wide range of biomedical/medical applications, we aimed to study the effect of SPIONs on 22 and 29 risk genes (Based on gene wide association studies) for obesity and T2D in human adipocytes. The mRNA expression of lipid and glucose metabolism genes was changed upon the treatment of human primary adipocytes with SPIONs. mRNA of GULP1, SLC30A8, NEGR1, SEC16B, MTCH2, MAF, MC4R, and TMEM195 were severely induced, whereas INSIG2, NAMPT, MTMR9, PFKP, KCTD15, LPL and GNPDA2 were down-regulated upon SPIONs stimulation. Since SEC16B gene assist the phagocytosis of apoptotic cells and this gene were highly expressed upon SPIONs treatment in adipocytes, it is logic to assume that SPIONs may play a crucial role in this direction, which requires more consideration in the future.
Publication
Journal: Diabetes
April/18/2006
Abstract
Activating transcription factor 6 (ATF6) is important for protective cell response to accumulation of unfolded and misfolded proteins in endoplasmic reticulum, and disturbances of this process can contribute to beta-cell apoptosis. We analyzed the structural gene located within a region on 1q21-q23 linked with type 2 diabetes in several populations for variants in the Pima Indians. Functionally important segments of ATF6 were sequenced in 15 diabetic and 15 nondiabetic Pimas and representative single nucleotide polymorphisms (SNPs) tested for association with type 2 diabetes in 900-1,000 subjects. We identified 20 variants including three amino acid substitutions [Met(67)Val, Pro(145)Ala, and Ser(157)Pro]. Pro(145)Ala and Ser(157)Pro were in a complete linkage disequilibrium and showed a nominal association with type 2 diabetes (P = 0.05; odds ratio 2.3 [95% CI 1.0-5.2]) and with 30-min plasma insulin during oral glucose tolerance test in 287 nondiabetic individuals (P = 0.045). Although the associations with type 2 diabetes and plasma insulin levels are marginal and their functional consequences are yet unknown, all three amino acid substitutions are located in a functionally important part of ATF6. Because these variants are not unique to the Pimas, it will be feasible to investigate their association with type 2 diabetes in other populations to better evaluate their significance for a predisposition to the disease.
Publication
Journal: Health affairs (Project Hope)
April/10/2011
Abstract
In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.
Publication
Journal: Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke
April/24/2006
Abstract
BACKGROUND
Fee-for-service life-style advice, a "green prescription" was introduced in Norway in 2003 as an alternative to the prescription of drugs to patients with moderate hypertension or risk of type 2 diabetes. The prescription includes an assessment of diet and/or physical activity, and an individual plan for change with systematic follow up from the GP. Material was provided by the Directorate of Health and Social Affairs, and a special fee of NOK 200 was established. The Research Institute of the Norwegian Medical Association has evaluated GPs' attitudes to and use of this scheme.
METHODS
A representative sample of 1134 Norwegian GPs, of whom 59% responded. Ten of the respondents were also interviewed comprehensively over the telephone.
CONCLUSIONS
Green prescriptions has low legitimacy among Norwegian GPs. Advise on lifestyle to patients with moderate hypertension or risk of type 2 diabetes is already an integral and natural component of GP work and calls for no extra fee or bureaucratic procedures. There is a risk of medicalisation in that non-patients become patients. On the other hand, patients who already are on drugs, but who may be able to reduce or eliminate these if they change their lifestyle, are not included in the scheme. Further development of the concept should to a larger degree include collaboration with the GPs.
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