Dietary fiber improves hyperglycemia in patients with type 2 diabetes through its physicochemical properties and possible modulation of gut hormone secretion, such as glucagon-like peptide 1 (GLP-1). We assessed the effect of dietary fiber-enriched cereal flakes (DC) on postprandial hyperglycemia and gut hormone secretion in patients with type 2 diabetes. Thirteen participants ate isocaloric meals based on either DC or conventional cereal flakes (CC) in a crossover design. DC or CC was provided for dinner, night snack on day 1 and breakfast on day 2, followed by a high-fat lunch. On day 2, the levels of plasma glucose, GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and insulin were measured. Compared to CC, DC intake exhibited a lower post-breakfast 2-hours glucose level (198.5±12.8 vs. 245.9±15.2 mg/dL, P<0.05) and a lower incremental peak of glucose from baseline (101.8±9.1 vs. 140.3±14.3 mg/dL, P<0.001). The incremental area under the curve (iAUC) of glucose after breakfast was lower with DC than with CC (P<0.001). However, there were no differences in the plasma insulin, glucagon, GLP-1, and GIP levels. In conclusion, acute administration of DC attenuates postprandial hyperglycemia without any significant change in the representative glucose-regulating hormones in patients with type 2 diabetes (ClinicalTrials.gov. NCT 01997281).
Adult ; Aged ; Area Under Curve ; Blood Glucose/*analysis ; Cross-Over Studies ; Diabetes Mellitus, Type 2/complications/diagnosis/*diet therapy ; Dietary Fiber/*therapeutic use ; Female ; Gastric Inhibitory Polypeptide/blood ; Glucagon/blood ; Glucagon-Like Peptide 1/*blood ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hyperglycemia/complications/diagnosis ; Insulin/blood ; Intestines/metabolism ; Male ; Middle Aged ; ROC Curve

Hepatic glycogenosis in type 1 diabetes mellitus (DM) can be caused by poor glycemic control due to insulin deficiency, excessive insulin treatment for diabetic ketoacidosis, or excessive glucose administration to control hypoglycemia. Mauriac syndrome, which is characterized by hepatomegaly due to hepatic glycogenosis, growth retardation, delayed puberty, and Cushingoid features, is a rare diabetic complication. We report a case of hepatic glycogenosis mimicking Mauriac syndrome. A 14-year-old girl with poorly controlled type 1 DM was admitted to The Catholic University of Korea, Seoul St. Mary's Hospital for abdominal pain and distension. Physical examination revealed hepatomegaly and a Cushingoid face. The growth rate of the patient had decreased, and she had not yet experienced menarche. Laboratory findings revealed elevated liver enzyme levels. A liver biopsy confirmed hepatic glycogenosis. Continuous glucose monitoring showed hyperglycemia after meals and frequent hypoglycemia before meals. To control hyperglycemia, we increased insulin dosage by using an insulin pump. In addition, we prescribed uncooked cornstarch to prevent hypoglycemia. After strict blood glucose control, the patient's liver functions and size normalized. The patient subsequently underwent menarche. Hepatic glycogenosis is a complication of type 1 DM that is reversible with appropriate glycemic control.
Abdominal Pain ; Adolescent ; Biopsy ; Blood Glucose ; Diabetes Complications ; Diabetes Mellitus, Type 1* ; Diabetic Ketoacidosis ; Female ; Glucose ; Glycogen Storage Disease* ; Hepatomegaly ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin ; Korea ; Liver ; Meals ; Menarche ; Physical Examination ; Puberty, Delayed ; Seoul ; Starch

Glycogenic hepatopathy (GH) is an uncommon cause of serum transaminase elevation in type I diabetes mellitus (DM). The clinical signs and symptoms of GH are nonspecific, and include abdominal discomfort, mild hepatomegaly, and transaminase elevation. In this report we describe three cases of patients presenting serum transaminase elevation and hepatomegaly with a history of poorly controlled type I DM. All of the cases showed sudden elevation of transaminase to more than 30 times the upper normal range (like in acute hepatitis) followed by sustained fluctuation (like in relapsing hepatitis). However, the patients did not show any symptom or sign of acute hepatitis. We therefore performed a liver biopsy to confirm the cause of liver enzyme elevation, which revealed GH. Clinicians should be aware of GH so as to prevent diagnostic delay and misdiagnosis, and have sufficient insight into GH; this will be aided by the present report of three cases along with a literature review.
Acute Disease ; Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Delayed Diagnosis ; Diabetes Mellitus, Type 1/complications/*pathology ; Diagnostic Errors ; Female ; Glycogen Storage Disease/complications/*diagnosis/ultrasonography ; Hepatitis/diagnosis ; Hepatomegaly/complications/*diagnosis/ultrasonography ; Humans ; Liver/pathology ; Recurrence ; Young Adult

This study was done to characterize the natural course of C-peptide levels in patients with type 1 diabetes and identify distinguishing characters among patients with lower rates of C-peptide decline. A sample of 95 children with type 1 diabetes was analyzed to retrospectively track serum levels of C-peptide, HbA1c, weight, BMI, and diabetic complications for the 15 yr after diagnosis. The clinical characteristics were compared between the patients with low and high C-peptide levels, respectively. The average C-peptide level among all patients was significantly reduced five years after diagnosis (P < 0.001). The incidence of diabetic ketoacidosis was significantly lower among the patients with high levels of C-peptide (P = 0.038). The body weight and BMI standard deviation scores (SDS) 15 yr after diagnosis were significantly higher among the patients with low C-peptide levels (weight SDS, P = 0.012; BMI SDS, P = 0.044). In conclusion, C-peptide level was significantly decreased after 5 yr from diagnosis. Type 1 diabetes patients whose beta-cell functions were preserved might have low incidence of diabetic ketoacidosis. The declines of C-peptide level after diagnosis in type 1 diabetes may be associated with changes of body weight and BMI.
Adolescent ; Body Mass Index ; Body Weight ; C-Peptide/*blood ; Child ; Child, Preschool ; Diabetes Complications ; Diabetes Mellitus, Type 1/blood/*diagnosis ; Diabetic Ketoacidosis/epidemiology ; Diabetic Retinopathy/epidemiology ; Female ; Follow-Up Studies ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Infant ; Male ; Peripheral Nervous System Diseases/epidemiology ; Retrospective Studies

Blood Glucose ; metabolism ; Diabetes Complications ; prevention & control ; Diabetes Mellitus, Type 1 ; blood ; metabolism ; physiopathology ; Diabetes Mellitus, Type 2 ; blood ; metabolism ; physiopathology ; Dinoprost ; analogs & derivatives ; blood ; Glucose ; metabolism ; Glycated Hemoglobin A ; Humans ; Hypoglycemic Agents ; pharmacology ; Insulin ; pharmacology ; Oxidative Stress

OBJECTIVETo review the incident status of childhood type 1 diabetes mellitus hospitalized in the Children's Hospital of Zhejiang University School of Medicine from 1999 to 2009 and to explore the clinical value of IL-10 in diabetic ketoacidosis.

METHODSThe clinical data of 263 children with type 1 diabetes mellitus hospitalized in the Children's Hospital of Zhejiang University School of Medicine from January 1999 to February 2009 were retrospectively reviewed. Serum lipid levels were measured in 48 children with type 1 diabetes mellitus and in 24 healthy children. The diabetic children were classified into two subgroups, with or without ketoacidosis. Serum lipid and cytokines levels were compared.

RESULTSChildhood type 1 diabetes mellitus was common in females (56.3%). The peak incident age of the disease was between 6 and 11.9 years. Diabetic ketoacidosis was as the presenting symptom for the first visit in 86 cases (32.7%). The levels of serum lipid, blood glucose and HbA1c in diabetic children with ketoacidosis were significantly higher than those without ketoacidosis (P<0.05). Logistic analysis demonstrated that the increased levels of blood glucose, serum lipid and HbA1c were risk factors for diabetic ketoacidosis. The level of serum IL-10 in diabetic children with ketoacidosis was significantly higher than that in patients without ketoacidosis (P<0.01), while there were no differences in serum levels IL-2, IL4, IL-6, TNF-α and IFN-γ between them. Serum levels IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ in diabetic children were significantly higher than those in healthy children (P<0.01).

CONCLUSIONSKetoacidosis is a common acute complication of type 1 diabetes mellitus. The disorders of glucose and lipid metabolism are the risk factors for ketoacidosis in diabetic children. IL-10 may be a sensitive index of diabetic ketoacidosis in children with type 1 diabetes mellitus.

Adolescent ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1 ; blood ; complications ; Diabetic Ketoacidosis ; blood ; diagnosis ; Female ; Humans ; Infant ; Interleukin-10 ; blood ; physiology ; Logistic Models ; Male ; Retrospective Studies

Adult ; Alveolar Bone Loss ; therapy ; Blood Glucose ; metabolism ; Chronic Periodontitis ; blood ; complications ; diagnostic imaging ; therapy ; Dental Scaling ; Diabetes Mellitus, Type 1 ; blood ; complications ; drug therapy ; Diabetes Mellitus, Type 2 ; blood ; complications ; drug therapy ; Humans ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Male ; Metformin ; therapeutic use ; Middle Aged ; Patient Education as Topic ; Periodontal Index ; Radiography, Panoramic ; Root Planing ; Sulfonylurea Compounds ; therapeutic use

OBJECTIVETo explore the mechanism of laparoscopic adjustable gastric banding (LAGB) in the treatment of obese patients with type 2 diabetes mellitus (T2DM).

METHODSA total of 20 patients with obesity and T2DM were treated with LAGB. During the postoperative 1, 3, 6, 9, 12 months, the body weight changes were monitored and body mass indices (BMI) were calculated. The serum levels of leptin, GLP-1, and ghrelin were examined preoperatively and 1, 3, 6, 9, 12 months after LAGB using enzyme-linked-immunosorbent assay (ELISA). At the same time, the fasting serum insulin (FINS), C-peptide, glycated hemoglobin (HbA1c) levels were examined by electrochemiluminescence and the level of fasting blood glucose (FBG) was tested with oxidase test.

RESULTSAt postoperatively 12 months, all the 20 patients lost weight. The mean body weight decreased from (108 + or - 18) kg to (71 + or - 16) kg (P<0.05) and BMI decreased from 38 + or - 5 to 29 + or - 6 (P<0.05). The HOMA-IR decreased from (12.8 + or - 7.4) to (3.4 + or - 2.0) (P<0.01). The serum ghrelin level increased from (7.8 + or - 1.9) microg/L to (11.6 + or - 2.6) microg/L (P<0.01). The serum leptin level declined from (24.9 + or - 13.7) microg/L to(12.9 + or - 5.1) microg/L (P<0.01). The serum GLP-1 level increased from (0.58 + or - 0.12) microg/L to(0.80 + or - 0.06) microg/L (P<0.01). After LAGB, there were positive correlations between serum leptin level and FBG, FINS, HbA1c,and C-peptide level. Serum ghrelin and GLP-1 were negatively correlated with FBG, FINS, HbA1c,C-peptide.

CONCLUSIONSLAGB is effective in treatment of obesity patients with T2DM. The mechanism may be associated with the increase of serum GLP-1 and ghrelin and the decrease of serum leptin and insulin resistance.

Adult ; Blood Glucose ; Body Mass Index ; Diabetes Mellitus, Type 2 ; complications ; surgery ; Female ; Gastroplasty ; methods ; Ghrelin ; metabolism ; Glucagon-Like Peptide 1 ; metabolism ; Glycated Hemoglobin A ; metabolism ; Humans ; Laparoscopy ; Leptin ; metabolism ; Male ; Middle Aged ; Obesity ; complications ; surgery ; Young Adult

OBJECTIVEUse laser confocal microscopy overspeed camera technique and fluorescence albumin labeling to study the acting mechanism of Qishen Yiqi Drop Pill (QYDP) for intervening irido-microangiopathy (IMAP) in diabetic rats.

METHODSRat model of diabetes mellitus type 1 (DM1) was established by intraperitoneal injection of streptozocin (STZ). The model rats were randomly divided into three groups, the treatment group, the model group and the control group. At the same time a normal control group was set up. The treatment group was medicated with QYDP (prepared into liquid form), and the control group with Duobeisi liquor (1 g/kg per day) for 10 months. The dynamic state of iris microcirculation in rats was observed using laser confocal microscopy overspeed camera.

RESULTSCompared with the treatment group, blood flow in iris of model rats was slower significantly (P < 0.01); the fluorescence density and leakage area of inside and outside iris vessels, and the iris vascular diameter were significantly higher in the model group than those in the treatment group (P < 0.01).

CONCLUSIONQYDP has definite effect in improving iris microcirculation, which can accelerate the blood flow, inhibit the abnormal expansion of vessels and improve the increased iris micro-vascular permeability.

Animals ; Capillary Permeability ; drug effects ; Diabetes Mellitus, Experimental ; complications ; drug therapy ; Diabetes Mellitus, Type 1 ; complications ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Iris ; blood supply ; Iris Diseases ; etiology ; prevention & control ; Male ; Phytotherapy ; Rats ; Rats, Sprague-Dawley

BACKGROUND: We investigated whether the presence of diabetes mellitus (DM) was related to the degree of the anemia in predialytic patients with renal failure and what was the most relevant factor for anemia in patients with chronic kidney disease (CKD) from DM (DM-CKD). METHODS: Seventy seven patients (47 predialytic patients with long-term type 2 DM (DM-CKD) and 30 predialytic patients whose disease was due to other causes (non DM-CKD)) were enrolled in this study. The blood hemoglobin (Hb) and hematocrit, and the creatinine, ferritin, vitamin B12, folate, iron, LDH, albumin, hs-CRP, intact-PTH, erythropoietin, leptin and Insulin-like growth factor I (IGF-1) levels were measured using standard methods. The estimated GFR was calculated using the abbreviated MDRD equation. RESULTS: The two groups did not significantly differ as to age, gender, the serum creatinine level and the inflammatory status. The Hb level was significantly lower in the DM-CKD patients than that in the non DM-CKD patients (8.5+/-1.7 g/dL vs 9.6+/-1.6 g/dL, respectively, p=0.01). The Hb level was significantly lower in the DM-CKD patients who were being treated with ACE inhibitors (the DM-ACE patients) than that in the non DM-CKD patients who were being treated with ACE inhibitors (the non DM-ACE patients) (8.5+/-1.5 g/dL vs 10.8+/-1.6 g/dL, respectively, p=0.001). Multiple regression analysis indicated that serum IGF-1 concentration was independently associated with the Hb level (beta=0.425, p=0.02) in the DM-CKD patients. CONCLUSIONS: The Hb concentration was significantly lower in the DM-CKD patients than that in the non DM-CKD patients. It was independently associated with the serum IGF-1 concentration in the DM-CKD patients.
Adult ; Aged ; Aged, 80 and over ; Anemia/blood/diagnosis/*etiology ; Case-Control Studies ; Diabetes Mellitus, Type 1/blood/*complications ; Female ; Glomerular Filtration Rate ; Hemoglobins/analysis ; Humans ; Insulin-Like Growth Factor I/*analysis ; Male ; Middle Aged ; Renal Insufficiency, Chronic/blood/*complications ; Risk Factors