de la Monte SM, Elgas E, Tong M
… +2 more, Delikkaya B, Yang Y
Diabetes Manag (Lond)
· 2023 · PMID 39601020
BACKGROUND: Central Nervous System (CNS) abnormalities with insulin resistance and mediated by developmental exposures to ethanol can be avoided or remediated by consumption of dietary soy, which has insulin-sensitizing...BACKGROUND: Central Nervous System (CNS) abnormalities with insulin resistance and mediated by developmental exposures to ethanol can be avoided or remediated by consumption of dietary soy, which has insulin-sensitizing as well as antioxidant effects. However, choline supplementation has been shown to diminish Fetal Alcohol Spectrum Disorder (FASD) pathologies, and dietary soy contains abundant choline. This study was designed to determine if the therapeutic effects of soy were mediated by or independent of choline. METHODS: Human PNET2 cells exposed to 0 mM or 100 mM ethanol for 48 hours were seeded into 96-well or 12-well plates and treated with vehicle, choline chloride (75 μM), or 1 μM Daidzein+1 μM Genistein (D+G) for 24 h. The cells were then analyzed for viability (Hoechst 33342), mitochondrial function (MTT), and GAPDH, Tau, Acetyl Cholinesterase (AChE), Choline Acetyl Transferase (ChAT), and Aspartyl-Asparaginyl-β-Hydroxylase (ASPH) immunoreactivity. RESULTS: Choline and D+G significantly increased MTT activity (mitochondrial function) corrected for cell number relative to vehicle in control and ethanol-exposed cultures. Both choline and D+G prevented the ethanol-induced inhibition of GAPDH and ChAT and increased cellular accumulations of Tau. However, D+G significantly increased ASPH expression relative to vehicle and Choline. CONCLUSION: Choline and D+G differentially modulated the expression of neuronal proteins, mitochondrial function, and ASPH. Importantly, the prominently increased expression of ASPH by D+G corresponds with the insulin-sensitizer actions of soy isoflavones since ASPH is an insulin-responsive molecule. The findings further suggest that dietary soy may be more effective than choline for reducing ethanol-impaired neuronal migration linked to ASPH inhibition in FASD.
Summer SS, Couch SC, Shah AS
… +2 more, McNeill MP, Peairs AD
Diabetes Manag (Lond)
· 2019 · PMID 31363362
OBJECTIVE: Adolescents with type 1 diabetes (T1DM) must consider multiple factors in diet planning, including glycemic control and cardiovascular disease prevention, while ensuring adequate nutrition for growth. We exami...OBJECTIVE: Adolescents with type 1 diabetes (T1DM) must consider multiple factors in diet planning, including glycemic control and cardiovascular disease prevention, while ensuring adequate nutrition for growth. We examined diet composition, quality, and compliance for two dietary patterns - the traditional Dietary Approaches to Stop Hypertension (DASH) and a modified version of DASH in this population. METHODS AND FINDINGS: Two feeding studies were conducted. First, adolescents with T1DM consumed their usual diet for 3 days followed by traditional DASH for 6 days. Next, DASH menus were adjusted to align with T1DM nutrition guidelines, and this modified DASH for Diabetes (DASH-D) was tested on a new group of adolescents with T1DM for 6 days, following 3 days of usual diet. Usual diet was measured via 24-hr dietary recalls. Dietary composition of DASH-D was compared to DASH and usual diet. Eighteen adolescents (9/group) participated. Compared to usual diet, intake of protein, fiber, fruit, vegetables, lean meats, and low-fat dairy were higher, while saturated fat and added sugar were lower, in DASH-D. Percent energy from fat was higher, and from carbohydrate lower, in DASH-D versus traditional DASH, with food group intake reflecting these patterns. Participants consumed 87% of foods provided for DASH, and 98% of foods provided for DASH-D. In both DASH iterations, participants met national guidelines for fat, saturated fat, fiber, and fruit/vegetable intake, while usual diet fell short of these recommendations. CONCLUSIONS: The novel DASH-D pattern meets guidelines and may be a viable option for achieving nutrition goals for adolescents with T1DM.
Peairs AD, Shah AS, Summer S
… +2 more, Hess M, Couch SC
Diabetes Manag (Lond)
· 2017 · PMID 29333199
OBJECTIVE: Glucose variability (GV) independently increases risk for vascular events in patients with diabetes. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern emphasizes fruits, vegetables, whole grai...OBJECTIVE: Glucose variability (GV) independently increases risk for vascular events in patients with diabetes. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern emphasizes fruits, vegetables, whole grains, lean meats, and low fat dairy and has the potential to reduce postprandial blood glucose (BG) excursions, however, its effect on GV is not known. The purpose of this work was to assess feasibility and collect preliminary data on the efficacy of the DASH diet on GV in adolescents with type 1 diabetes (T1D). METHODS: Twenty one adolescents recruited from the Diabetes Center of Cincinnati Children's Hospital Medical Center with T1D (11-17y) participated in one of two phases of a controlled feeding study. The first phase tested the acceptability and blood glucose response to a traditional DASH diet (DASH) and the second phase tested a DASH diet specifically modified for diabetes (DASH-D) to improve glucose response to meals. For each phase, participants consumed first their usual diet, and then a controlled DASH diet while wearing continuous glucose monitoring (CGM) systems for 3 days of each diet. All foods were provided to the patients during the DASH dietary periods and 24 h dietary recalls were conducted during the usual diet periods to assess daily intake. RESULTS: Sixteen participants (14.1 +/- 2.2y) were included in final analyses (DASH n=7, DASH-D n=9). Both DASH diets were significantly higher in fruits, vegetables, fiber, vitamin A, and % energy from protein than usual intakes. DASH was higher in carbohydrate (CHO) (60 50%) and lower in fat (21 36%) than usual intake, resulting in higher GV (Standard Deviation and Lability Index) and more low BG excursions (3 ± 2.8 7.1 ± 3.3, p=0.024). DASH-D was modified to better match CHO and fat content of patients' usual intakes in phase 1 (50/30/20 for CHO/fat/pro respectively, which resulted in no difference in GV between DASH-D and usual intake. There were also trends for lower average BG (144.1 168.9, p=0.072) and less percentage of time spent in the hyperglycemic range (39.3 ± 25.5 54.1 ± 19.4, p=0.07) on DASH-D compared to usual intake. CONCLUSION: The DASH dietary pattern tended to result in less hyperglycemia and an overall lower BG compared to usual care. Modifying a traditional DASH diet by increasing heart healthy fats improves glycemic response to DASH and may be beneficial for long term cardiovascular benefits in youth with T1D.
Coughlin SS, Hatzigeorgiou C, Anglin J
… +5 more, Xie D, Besenyi GM, De Leo G, Stewart J, Wilkins T
Diabetes Manag (Lond)
· 2017 · PMID 28794802
BACKGROUND: Diet and exercise therapy have been reported to be effective in improving blood glucose control and are an important part of treatment of type 2 diabetes mellitus. OBJECTIVE: The goal of this study is to exam...BACKGROUND: Diet and exercise therapy have been reported to be effective in improving blood glucose control and are an important part of treatment of type 2 diabetes mellitus. OBJECTIVE: The goal of this study is to examine the efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus, as measured by Hgb-A1c, cardiovascular indicators, physical activity, weight, and BMI. Also of interest are optimal strategies for subject recruitment, the number of intervention sessions attended, and participant use of the Fitbit watch to monitor their physical activity and track food and beverage consumption. METHODS: A pre/post-test design will be used in this pilot study. Non-institutionalized adult patients (n=50) aged 18-65 years who have been seen at the Augusta Health outpatient clinics (General Internal Medicine or Family Medicine) for type 2 diabetes in the past 12 months, and who are interested in reducing their risk of disease recurrence through healthy lifestyle behaviors, will be eligible to participate. At orientation visit, eligible individuals will be asked to provide written informed consent. Consenting volunteers (n=50) will be asked to complete the baseline and 6-month follow-up questionnaire and to participate in 12 weekly group sessions of 90 min duration, involving physical activity and to meet with a dietitian (baseline, one month, 90 days) to receive individualized advice on diet and nutrition. The technology-based intervention will use wrist-worn Fitbit Blaze physical activity monitoring devices. CONCLUSIONS: This pilot study will provide important information about the feasibility and preliminary efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus. The use of consumer-facing devices such as the Fitbit watch has the potential advantage over the use of research accelerometers, pedometers, or actigraphs in increasing the likelihood that the intervention will be sustainable after the study ends.
Gandhi K, Vu BK, Eshtehardi SS
… +2 more, Wasserman RM, Hilliard ME
Diabetes Manag (Lond)
· 2015 Nov · PMID 27066110
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Suboptimal adherence remains a significant concern for adolescents with Type 1 diabetes, the treatment regimen for which is complex and includes numerous behaviors. Accurate assessment of adherence is critical for effect...Suboptimal adherence remains a significant concern for adolescents with Type 1 diabetes, the treatment regimen for which is complex and includes numerous behaviors. Accurate assessment of adherence is critical for effective healthcare and to measure trial outcomes. Without a valid biomarker of adherence, assessment strategies must rely on measuring management behaviors. This paper provides an overview of approaches to measure adherence, with an emphasis on contemporary, validated measures that are appropriate for current diabetes care. Objective measures include electronic data from diabetes management devices. Subjective measures include self/parent-report questionnaires, structured interviews and diaries/logbooks. Practical strategies for selecting measurement approaches for clinical and research purposes are reviewed, and implications of adherence assessment for clinical care delivery and adherence-promotion are discussed.
Larkin ME, Walders-Abramson N, Hirst K
… +4 more, Keady J, Ievers-Landis CE, Venditti EM, Yasuda PM
Diabetes Manag (Lond)
· 2015 Nov · PMID 27057209
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AIM: To explore associations between health-related quality of life (HRQOL) and comorbidities in youth with Type 2 diabetes. PATIENTS & METHODS: Of 699 youth in the TODAY study, 685 (98%) had baseline HRQOL data, 649 (93...AIM: To explore associations between health-related quality of life (HRQOL) and comorbidities in youth with Type 2 diabetes. PATIENTS & METHODS: Of 699 youth in the TODAY study, 685 (98%) had baseline HRQOL data, 649 (93%) at 6 months and 583 (83%) at 24 months. Comorbidities were defined by sustained abnormal values and treatment regimens. RESULTS: At baseline, 22.2% of participants demonstrated impaired HRQOL. Only depressive symptoms distinguished those with versus without impaired HRQOL and were significantly related to later impaired HRQOL (p < 0.0001). A significant correspondence between impaired HRQOL and number of comorbidities (p = 0.0003) was noted, but was driven by the presence of depressive symptoms. CONCLUSION: Results emphasize the need for evaluation of depressive symptoms. Other comorbidities did not have a significant impact on HRQOL in this cohort.
Diabetes Manag (Lond)
· 2015 · PMID 26535059
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Vitamin A has a critical role in embryonic development, immunity and the visual cycle. In recent years, evidence has demonstrated that vitamin A can also regulate metabolic pathways implicated in the pathogenesis of obes...Vitamin A has a critical role in embryonic development, immunity and the visual cycle. In recent years, evidence has demonstrated that vitamin A can also regulate metabolic pathways implicated in the pathogenesis of obesity and diabetes. This has increased interest in the possible antiobesity and antidiabetic properties of natural and synthetic vitamin A derivatives. However, whether vitamin A deficiency or aberrations in vitamin A metabolism contribute to the pathogenesis of diabetes is not known. This perspective article will review what is currently known and new data regarding the link between vitamin A and the clinical manifestations of common and atypical forms of diabetes.
Hood KK, Hilliard M, Piatt G
… +1 more, Ievers-Landis CE
Diabetes Manag (Lond)
· 2015 · PMID 30100925
Behavioral management of diabetes leads to better health outcomes. This paper reviews the available literature on facilitators of behavior change in people with diabetes and highlights approaches and strategies diabetes...Behavioral management of diabetes leads to better health outcomes. This paper reviews the available literature on facilitators of behavior change in people with diabetes and highlights approaches and strategies diabetes care providers can utilize. The research and clinical evidence points to the critical nature of considering the content and structure of recommendations, and utilizing problem solving and teamwork approaches. Furthermore, close attention to individual and community factors will optimize behavior change. These factors include health literacy, community infrastructure, support within the family, and whether there are co-occurring eating and mood issues. Recommendations are provided to optimize communication and embed behavior change approaches in clinical and community encounters.
Williams JL, Walker RJ, Smalls BL
… +2 more, Campbell JA, Egede LE
Diabetes Manag (Lond)
· 2014 Jan · PMID 25214893
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AIM: Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diab...AIM: Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diabetes remain unclear. The goal of this study was to distinguish whether interventions were effective and identify areas for future research. METHODS: Medline was searched for articles published between January 2000 and May 2013, and a reproducible strategy was used. Study eligibility criteria included interventions measuring medication adherence in adults with Type 2 diabetes. RESULTS: Twenty seven studies met the inclusion criteria and 13 showed a statistically significant change in medication adherence. CONCLUSION: Heterogeneity of the study designs and measures of adherence made it difficult to identify effective interventions that improved medication adherence. Additionally, medication adherence may not be solely responsible for achieving glycemic control. Researchers must emphasize tailored interventions that optimize management and improve outcomes, and examine the need for clear indicators of medication adherence.
Diabetes Manag (Lond)
· 2014 Mar · PMID 25197322
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Controlling blood glucose in hospitalized patients is important as both hyperglycemia and hypoglycemia are associated with increased cost, length of stay, morbidity and mortality. A limiting factor in stringent control i...Controlling blood glucose in hospitalized patients is important as both hyperglycemia and hypoglycemia are associated with increased cost, length of stay, morbidity and mortality. A limiting factor in stringent control is the concern of iatrogenic hypoglycemia. The association of hypoglycemia with mortality has led to clinical guideline changes recommending more conservative glycemic control than had previously been suggested, with the use of patient specific approaches when appropriate. Healthier, stable patients may be managed with stricter control while the elderly and severely ill may be managed less aggressively. While the avoidance of hypoglycemia is essential in clinical practice, recent studies suggest that a higher mortality rate occurs in spontaneous rather than iatrogenic hypoglycemia. Therefore, inpatient hypoglycemia may be viewed more as a biomarker of disease rather than a true cause of fatality.
Diabetes Manag (Lond)
· 2013 Nov · PMID 24932222
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Diabetic retinopathy (DR) is the leading cause of new-onset blindness in working-age individuals in the USA and represents a growing worldwide epidemic. Classic risk factors for onset or progression of DR include poor gl...Diabetic retinopathy (DR) is the leading cause of new-onset blindness in working-age individuals in the USA and represents a growing worldwide epidemic. Classic risk factors for onset or progression of DR include poor glycemic control, hypertension and hyperlipidemia; however, these factors account for only a small proportion of the risk of DR. New systemic risk factors are emerging, which may allow for personalized risk profiling and targeted treatment by physicians. In addition, early studies of vitreous fluid in patients with DR have resulted in a new paradigm: diabetes causes inflammation in the retina, which is mediated by multiple small signaling molecules that induce angiogenesis and vascular permeability. Future treatment of DR may involve two approaches: early vitreous analysis, followed by drug treatment targeted to the unique vitreous composition of the patient; and collaboration between ophthalmologists and primary care providers to address the unique systemic risk profile of each diabetic patient.
Diabetes Manag (Lond)
· 2013 May · PMID 24634696
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Type 1 diabetes (T1D) results from the specific immune-mediated destruction of the insulin-producing β-cells of the pancreas. In genetically susceptible individuals, a still undetermined initiating 'hit' triggers a casca...Type 1 diabetes (T1D) results from the specific immune-mediated destruction of the insulin-producing β-cells of the pancreas. In genetically susceptible individuals, a still undetermined initiating 'hit' triggers a cascade of events that eventually leads to autoreactive CD8 T cells infiltrating the pancreatic islets and, subsequently, destroying them. There is increasing evidence that viruses, especially enteroviruses, are major environmental candidates; however, despite decades of investigation, we still lack certainty with regard to the causation of T1D. Moreover, studies in animal models of diabetes suggest a protective role of certain enteroviral infections upon diabetes contraction, making the quest for viral involvement in T1D even more difficult. Analyzing the foundation and the results of the most current work in the field, this article gives a brief overview of current knowledge, as well as providing an outlook for future directions.
Diabetes Manag (Lond)
· 2013 Sep · PMID 24505231
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Tolerogenic strategies that specifically target diabetogenic immune cells in the absence of complications of immunosuppression are the desired treatment for the prevention or even reversal of Type 1 diabetes (T1D). Antig...Tolerogenic strategies that specifically target diabetogenic immune cells in the absence of complications of immunosuppression are the desired treatment for the prevention or even reversal of Type 1 diabetes (T1D). Antigen (Ag)-based therapies must not only suppress disease-initiating diabetogenic T cells that are already activated, but, more importantly, prevent activation of naive auto-Ag-specific T cells that may become autoreactive through epitope spreading as a result of Ag liberation from damaged islet cells. Therefore, identification of auto-Ags relevant to T1D initiation and progression is critical to the design of effective Ag-specific therapies. Animal models of T1D have been successfully employed to identify potential diabetogenic Ags, and have further facilitated translation of Ag-specific tolerance strategies into human clinical trials. In this review, we highlight important advances using animal models in Ag-specific T1D immunotherapies, and the application of the preclinical findings to human subjects. We provide an up-to-date overview of the strengths and weaknesses of various tolerance-inducing strategies, including infusion of soluble Ags/peptides by various routes of delivery, genetic vaccinations, cell- and inert particle-based tolerogenic approaches, and various other strategies that target distinct tolerance-inducing pathways.
Raymond JK, Duke DC, Shimomaeda L
… +1 more, Harris MA
Diabetes Manag (Lond)
· 2013 Jul · PMID 24416076
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AIM: This study aimed to prospectively investigate transition beliefs, knowledge and needs of pediatric patients with diabetes and their parents. PATIENTS & METHODS: Parallel youth and parent questionnaires evaluating th...AIM: This study aimed to prospectively investigate transition beliefs, knowledge and needs of pediatric patients with diabetes and their parents. PATIENTS & METHODS: Parallel youth and parent questionnaires evaluating the transition process were distributed over a 6-month time period. Respondents included 123 pediatric patients with diabetes (11-19 years old) and their parents. RESULTS: Few families had discussed the transition of diabetes care (∼25%). Most had not established a transition plan (∼90%). Youth and parents agreed that seeing the doctor alone, discussions about transition and transition itself should occur at 17-18 years of age. CONCLUSION: Youth with diabetes and their parents are not prepared for transition to adult care. Transition discussions should begin at an earlier age. Additional research is needed to learn how and when to begin these discussions.
Diabetes Manag (Lond)
· 2013 May · PMID 25067957
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Sirtuins are a class of NAD-dependent deacetylases, such as deacetylases, that have a wide array of biological functions. Recent studies have suggested that reduced sirtuin action is correlated with Type 2 diabetes. Both...Sirtuins are a class of NAD-dependent deacetylases, such as deacetylases, that have a wide array of biological functions. Recent studies have suggested that reduced sirtuin action is correlated with Type 2 diabetes. Both overnutrition and aging, which are two major risk factors for diabetes, lead to decreased sirtuin function and result in abnormal glucose and lipid metabolism. Therefore, restoring normal levels of sirtuin action in Type 2 diabetes may be a promising method of treating diabetes. This article reviews the biological functions of three of the seven mammalian sirtuins - SIRT1, SIRT3 and SIRT6 - that have demonstrated prominent metabolic roles and early potential for drug targeting. Clinical trials investigating the use of sirtuin activators for treating diabetes are already underway and show promise as alternatives to current diabetes therapies. Thus, further research into sirtuin activators is warranted and may lead to a new class of safe, effective diabetes treatments.
Karadimos MJ, Kapoor A, El Khattabi I
… +1 more, Sharma A
Diabetes Manag (Lond)
· 2012 May · PMID 23049620
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Over the last decade, our knowledge of β-cell biology has expanded with the use of new scientific techniques and strategies. Growth factors, hormones and small molecules have been shown to enhance β-cell proliferation an...Over the last decade, our knowledge of β-cell biology has expanded with the use of new scientific techniques and strategies. Growth factors, hormones and small molecules have been shown to enhance β-cell proliferation and function. Stem cell technology and research into the developmental biology of the pancreas have yielded new methods for in vivo and in vitro regeneration of β cells from stem cells and endogenous progenitors as well as transdifferentiation of non-β cells. Novel pharmacological approaches have been developed to preserve and enhance β-cell function. Strategies to increase expression of insulin gene transcription factors in dysfunctional and immature β cells have ameliorated these impairments. Hence, we suggest that strategies to minimize β-cell loss and to increase their function and regeneration will ultimately lead to therapy for both Type 1 and 2 diabetes.
Diabetes Manag (Lond)
· 2012 May · PMID 23024708
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Sirtuins are a group of NAD(+)-dependent enzymes that post-translationally modify histones and other proteins. Among seven mammalian sirtuins, SIRT1 has been the most extensively studied and has been demonstrated to play...Sirtuins are a group of NAD(+)-dependent enzymes that post-translationally modify histones and other proteins. Among seven mammalian sirtuins, SIRT1 has been the most extensively studied and has been demonstrated to play a critical role in all major metabolic organs and tissues. SIRT1 regulates glucose and lipid homeostasis in the liver, modulates insulin secretion in pancreatic islets, controls insulin sensitivity and glucose uptake in skeletal muscle, increases adiponectin expression in white adipose tissue and controls food intake and energy expenditure in the brain. Recently, SIRT3 has been demonstrated to modulate insulin sensitivity in skeletal muscle and systemic metabolism, and Sirt3-null mice manifest characteristics of metabolic syndrome on a high-fat diet. Thus, it is reasonable to believe that enhancing the activities of SIRT1 and SIRT3 may be beneficial for Type 2 diabetes. Although it is controversial, the SIRT1 activator SRT1720 has been reported to be effective in improving glucose metabolism and insulin sensitivity in animal models. More research needs to be conducted so that we can better understand the physiological functions and molecular mechanisms of sirtuins in order to therapeutically target these enzymes for diabetes treatment.