Insulin最新文献

{"title":"Postprandial physiology and the pathogenesis of type 2 diabetes mellitus","authors":"Stephen N. Davis MD, FRCP","doi":"10.1016/S1557-0843(08)80029-2","DOIUrl":"10.1016/S1557-0843(08)80029-2","url":null,"abstract":"<div><p><strong>Background:</strong> Patients with type 2 diabetes mellitus (DM) have an increased risk of cardiovascular morbidity and mortality. Recent studies implicate postprandial hyperglycemia as an important driver of the increased risk of cardiovascular disease in patients with type 2 DM or prediabetes.</p><p><strong>Objectives:</strong> This article reviews the postprandial physiology of glucose and insulin, the role of postprandial hyperglycemia in the increased risk of cardiovascular disease in patients with type 2 DM, and the role of insulin and other agents in reducing that risk.</p><p><strong>Methods:</strong> Relevant articles for this review were identified through a search of MEDLINE (1999-2007; Englishlanguage articles only). The search terms used were <em>glucose, insulin, pathophysiology, postprandial, hyperglycemia, and cardiovascular risk.</em></p><p><em>Results:</em> The concentration of glucose in plasma is determined by the relative rates of glucose entering and leaving the circulation. The rate at which intestinally absorbed glucose disappears from the circulation is controlled primarily by insulin. Insulin stimulates cells in insulin-sensitive tissue to increase uptake of glucose and acts directly on the liver to suppress hepatic glucose production and postprandial pancreatic a-cell secretion of the glucoregulatory hormone glucagon. Elevations of glucose in plasma may increase cardiovascular risk in several ways. Postprandial hyperglycemia has been shown to increase the production of free radicals and attenuate antioxidant defenses, activate prothrombotic pathways, induce vasoconstriction, and increase circulating levels of adhesion molecules. Postprandial hyperglycemia also has been correlated with carotid intima-media thickness, a surrogate marker for cardiovascular dysfunction. Insulin may reduce cardiovascular risk. Insulin is a known vasodilator that increases blood flow through the macrovasculature and microvasculature. It also appears to have direct anti-inflammatory effects, suppressing the generation of reactive oxygen species and proinflammatory transcription factors, as well as antiatherogenic effects, reducing postprandial hypertriglyceridemia, total atherosclerotic area, and number of aortic lesions.</p><p><em>Conclusions:</em> The adverse effects of postprandial hyperglycemia, together with the accompanying dyslipidemia, on cardiovascular health suggest that postprandial hyperglycemia should be a primary target of antidiabetic therapy. There is ample evidence to show that reducing postprandial hyperglycemia in patients with type 2 DM or prediabetes can reduce cardiovascular risk. Insulin may be an ideal agent for the treatment of postprandial hyperglycemia owing to its antihyperglycemic and cardioprotective effects.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 ","pages":"Pages 132-140"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80029-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"119226221","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}

{"title":"The why and wherefore of glucose control in type 2 diabetes mellitus","authors":"John W. Hare MD","doi":"10.1016/S1557-0843(08)80027-9","DOIUrl":"10.1016/S1557-0843(08)80027-9","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 ","pages":"Pages 124-125"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80027-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89211379","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}

{"title":"Sunshine on a rainy day: Good news for diabetes","authors":"C. Shaefer","doi":"10.1016/S1557-0843(08)80016-4","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80016-4","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"22 1","pages":"56-58"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83477229","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}

{"title":"Global diabetes landscape—type 2 diabetes mellitus in South Asia: Epidemiology, risk factors, and control","authors":"Rajeev Gupta MD, PhD,&nbsp;Praneet Kumar MBBS, DHA","doi":"10.1016/S1557-0843(08)80019-X","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80019-X","url":null,"abstract":"<div><p><strong>Background:</strong> Type 2 diabetes mellitus (DM) is a new epidemic in South Asia and is the result of societal influences and changing lifestyles. Epidemiologic studies suggest that the prevalence of DM has increased exponentially in urban and rural populations.</p><p><strong>Objective:</strong> This study was conducted to determine trends in the prevalence of DM in various countries in South Asia.</p><p><strong>Methods:</strong> We performed an extensive, systematic MEDLINE search for primary articles that reported on the epidemiology of DM in South Asia. Additional articles were obtained from personal collections and references cited in the primary articles. No formal meta-analysis was performed because of differing methodologies and diagnostic criteria.</p><p><strong>Results:</strong> Epidemiologic studies conducted in India during the 1960s and 1970s, using random and postload blood glucose estimations, reported DM in 1% to 4% of urban populations and 1% to 2% of rural populations. More standardized epidemiologic studies in adults since the late 1980s reported DM in 5% to 15% of urban populations, 4% to 6% of semiurban populations, and 2% to 5% of rural populations. A significantly increasing trend has been observed in urban populations (exponential trend R² = 0.74), whereas the increase is slower (R² = 0.29) in rural populations. The diabetes scenario is similar in other South Asian countries. Current prevalence rates are 5% to 16% in urban areas and 2% to 8% in rural areas. Risk factors for DM in this region are increasing sedentariness, dietary excess, obesity (especially high waist-to-hip ratio), low birth weight, and genetic influences.</p><p><strong>Conclusions:</strong> DM is a major public health problem in South Asia. The prevalence is higher in urban areas than in rural areas and is increasing. Population-based measures to control the epidemic of DM include avoidance of adiposity through enhanced physical activity and regulated calorie intake. A comprehensive national chronic care program is needed.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 78-94"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80019-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91756445","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}

{"title":"CME information 67th American diabetes Association annual scientific session updates","authors":"","doi":"10.1016/S1557-0843(08)80026-7","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80026-7","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 ","pages":"Pages 122-123"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80026-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134842315","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}

{"title":"Carbohydrate counting basics","authors":"Jacqueline Gomes RD, MBA","doi":"10.1016/S1557-0843(08)80024-3","DOIUrl":"10.1016/S1557-0843(08)80024-3","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 117-118"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80024-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87954455","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}

{"title":"Global diabetes landscape—type 2 diabetes mellitus in South Asia: Epidemiology, risk factors, and control","authors":"Rajeev Gupta, Praneet Kumar","doi":"10.1016/S1557-0843(08)80019-X","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80019-X","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"14 1","pages":"78-94"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74257141","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}

{"title":"CME test answer sheet and evaluation form for 67th american diabetes association annual scientific session updates","authors":"","doi":"10.1016/S1557-0843(08)80031-0","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80031-0","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 ","pages":"Pages 143-144"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80031-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134842317","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}

{"title":"Advanced Insulin Management program reduces A1C levels and regimen-related distress without weight gain in patients with type 1 diabetes mellitus","authors":"L. Fish, H. Wetzler, J. Davidson, C. Ofstead, Mary L. Johnson","doi":"10.1016/S1557-0843(08)80017-6","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80017-6","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"7 1","pages":"59-66"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88864194","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}

{"title":"Sunshine on a rainy day: Good news for diabetes","authors":"Charles F. Shaefer Jr. MD, FACP, FCCP","doi":"10.1016/S1557-0843(08)80016-4","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80016-4","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 2","pages":"Pages 56-58"},"PeriodicalIF":0.0,"publicationDate":"2008-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80016-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91756446","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}