Insulin最新文献 - Book学术

Author index 2009 作者索引2009

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80017-X

引用次数: 0

Subject index 2009 二零零九年主题索引

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80018-1

引用次数: 0

Increased risk for type 2 diabetes mellitus with HIV-1 infection 2型糖尿病合并HIV-1感染的风险增加

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80008-9

John G. Ryan DrPH

{"title":"Increased risk for type 2 diabetes mellitus with HIV-1 infection","authors":"John G. Ryan DrPH","doi":"10.1016/S1557-0843(10)80008-9","DOIUrl":"10.1016/S1557-0843(10)80008-9","url":null,"abstract":"<div>Background: The proportion of people with HIV-1 infection who have coexisting type 2 diabetes mellitus (DM) is increasing. The higher incidence of type 2 DM in this patient population is associated with increased survival from HIV-1 infection due to advanced HIV treatment strategies and therapies, as well as a complex interaction of diabetes risk factors, including family history, body composition, comorbidities, HIV treatment modality, and disease progression.Objective: The purpose of this article was to describe the impact of these contributing factors on the risk for type 2 DM among people with HIV-1 infection and the available treatment options for managing type 2 DM in these patients.Methods: The Ovid MEDLINE database was searched for English language articles published between January 2005 and June 2009. Various search strategies were applied to identify appropriate articles. The references listed in the retrieved documents were searched for additional articles. Nonhuman studies were excluded.Results: Abnormal glucose homeostasis and metabolic disturbances associated with HIV-1 infection appear to have become widespread after the introduction and application of potent antiretroviral therapy, including protease inhibitors (PIs), ritonavir-boosted PIs, nucleoside reverse transcriptase inhibitors (NRTIs), and nonnucleoside reverse transcriptase inhibitors (NNRTIs). PIs and NNRTIs may have pathogenic roles in insulin resistance, whereas the stage and progression of HIV-1 infection affect lipid values and glucose homeostasis. It is estimated that as many as 80% of patients currently treated with PIs develop insulin resistance compared with ~2% before the introduction of highly active antiretroviral therapy. Evidence suggests that statins may be contraindicated as a combination therapy with PIs when comanaging dyslipidemia and HIV-1 infection. Pharmacotherapy for HIV-1 infection must be monitored closely for its impact on patients' metabolic and cardiovascular systems, and necessary modifications made while monitoring and maintaining the stability of the viral load.Conclusions: The metabolic effects of combination therapies for HIV infection, including PIs, ritonavir-boosted PIs, NRTIs, and NNRTIs, appear to increase the risk for insulin resistance, type 2 DM, and poor cardiovascular disease outcomes. Because of differences in the pharmacokinetic properties between statins and PIs, it is critical for clinicians to properly manage combination antiretroviral therapy, as well as pharmacotherapy for DM and dyslipidemia, when managing patients with HIV-1 infection and insulin resistance. Clinicians must consider the stage of HIV disease and the demographic characteristics of patients with these comorbid diseases, both of which require careful attention to medical management, pharmacotherapy, and patient adherence to treatment recomm","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"5 1","pages":"Pages 37-45"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(10)80008-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77092818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Durable remission of diabetes after bariatric surgery: What is the underlying pathway? 减肥手术后糖尿病的持续缓解:潜在的途径是什么?

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80009-0

Jennifer B. Wilson BS, Walter J. Pories MD

{"title":"Durable remission of diabetes after bariatric surgery: What is the underlying pathway?","authors":"Jennifer B. Wilson BS, Walter J. Pories MD","doi":"10.1016/S1557-0843(10)80009-0","DOIUrl":"10.1016/S1557-0843(10)80009-0","url":null,"abstract":"<div>Background: In the past, type 2 diabetes mellitus (DM) was regarded as a progressive, incurable disease for which palliative therapy could not, over the long term, prevent the associated amputations, blindness, renal failure, and early mortality. This is no longer true. Full and durable remission of type 2 DM, with major decreases in morbidity and mortality, is now achieved regularly with several types of surgery that reduce contact between food and the foregut.Objectives: The aims of this article are to review the impact of bariatric surgery on obesity, remission of DM, and obesity-related morbidity and mortality, and the possible mechanisms for this advance.Methods: This article is based on our 2 meta-analyses of the literature published through April 30, 2006, as well as the most significant reports in the bariatric surgical literature that have been published in English since April 30, 2006. The studies included in our second meta-analysis provided the details of the methodology for the present literature review, including the levels of evidence.Results: Results of our 2 meta-analyses were published previously. Briefly, the analyses revealed that the clinical and laboratory manifestations of type 2 DM resolved or improved in most of the patients who underwent bariatric surgery; the responses were greatest in the patients who lost the most excess body weight; and the improvements were maintained for ≥2 years. The studies reported that intestinal operations such as gastric bypass reduced contact between food and the foregut, produced full and durable remission of DM, reduced mortality, and reversed other comorbidities associated with severe obesity (eg, asthma, gastroesophageal reflux, hypertension, stress incontinence). Insulin levels decreased markedly after surgery, as did glycosylated hemoglobin (A1C) and fasting blood glucose levels. Although these effects were initially attributed to weight loss, the rapid reversal of DM within a matter of days after surgery suggest that bariatric surgery changes the signaling mechanism of the gut with pancreatic islet cells, muscles, fat, the liver, and other organs.Conclusions: Bariatric surgery has opened new vistas, producing durable full remission of type 2 DM—a breakthrough previously considered impossible—with normalization of A1C levels over time and discontinuation of all antidiabetes medication for many patients. These advances create new opportunities for exploring the mechanisms of type 2 DM and its control through pharmaceutical approaches. DM is no longer an irreversible, incurable, or hopeless disease.</div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"5 1","pages":"Pages 46-55"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(10)80009-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88832610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

In search of the holy grail? The quest to reduce macrovascular disease in type 2 diabetes mellitus 为了寻找圣杯?减少2型糖尿病大血管病变的探索

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80003-X

Charles F. Shaefer Jr. MD, FACP, FCCP

引用次数: 0

Hospital hypoglycemia: From observation to action 医院低血糖:从观察到行动

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80007-7

Haritha Bellam MD , Susan S. Braithwaite MD

{"title":"Hospital hypoglycemia: From observation to action","authors":"Haritha Bellam MD , Susan S. Braithwaite MD","doi":"10.1016/S1557-0843(10)80007-7","DOIUrl":"10.1016/S1557-0843(10)80007-7","url":null,"abstract":"<div>Background: A preponderance of evidence indicates that when treatment of hyperglycemia with insulin is provided for certain hospitalized populations, the attainment of appropriate glycemic targets improves nonglycemic outcomes such as mortality rates, morbidities (eg, wound infection, critical illness polyneuropathy, bacteremia, new renal insufficiency), duration of ventilator dependency, transfusion requirements, and length of hospital stay. Nevertheless, randomized controlled trials (RCTs) of intensive insulin therapy and studies of outcomes before and after implementation of tight glycemic control have consistently recognized an increased incidence of hypoglycemia as a complication associated with the use of lower glycemic targets and higher doses of insulin.Objectives: This commentary compares the quality of the available evidence on the clinical impact of iatrogenic hypoglycemia. We present treatment strategies designed to prevent iatrogenic hypoglycemia in the hospital setting.Methods: The PubMed database and online citations of articles tracked subsequent to publication were searched for articles on the epidemiology, clinical impact, and mechanism of harm of hypoglycemia published since 1986. In addition, we searched the literature for RCTs conducted since 2001 concerning intensive insulin therapy in the hospital critical care setting, including meta-analyses; letters to the editor were excluded. The retrieved studies were scanned and chosen selectively for full-text review based on the study size and design, novelty of findings, and evidence related to the possible clinical impact of hypoglycemia. Reference lists from the retrieved studies were searched for additional studies. Reports were summarized for the purpose of comparing and contrasting the qualitative nature of information about iatrogenic hypoglycemia in the hospital.Results: Eight RCTs of intensive glycemic management, 16 observational studies of hospitalized patients with hypoglycemia (including studies of outcomes before and after implementation of tight glycemic control), and 4 case reports on patients with hypoglycemia were selected for discussion of the incidence of hypoglycemia, significance of hypoglycemia as a marker or cause of poor prognosis, and clinical harm of hypoglycemia. Hypoglycemia was identified in clinical trials as either a category of adverse events or a complication of intensified insulin treatment. For example, a recent meta-analysis found that the incidence of severe hypoglycemia was higher among critically ill patients treated with intensive insulin therapy than among control patients, with a pooled relative risk of 6.0 (95% CI, 4.5–8.0). In the largest multisite RCT on glycemic control among patients in intensive care units (ICUs) conducted to date, deaths were reported for 27.5% (829/3010 patients) in the intensive-treatment group and 24.9% (751/3012 pati","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"5 1","pages":"Pages 16-36"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(10)80007-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86681778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 13

A brief review 简要回顾

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80004-1

Elliot J. Rayfield MD, FACE, FACP

引用次数: 0

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80002-8

Steven V. Edelman MD (Editor), Derek LeRoith MD, PhD (Editor)

引用次数: 0

A report from the 45th Annual Meeting of the European Association for the Study of Diabetes 一份来自第45届欧洲糖尿病研究协会年会上的报告

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80006-5

引用次数: 0

Insulin Pub Date : 2010-01-01 DOI: 10.1016/S1557-0843(10)80014-4

Luigi F. Meneghini MD, MBA (Associate Professor of Clinical Medicine, Director, Clinical Operations for the Division of Endocrinology, Diabetes & Metabolism, Director, Eleanor and Joseph Kosow Diabetes Treatment Center)

引用次数: 0