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OBJECTIVE: Numerous validated questionnaires use self-reported data to quantify individuals' risk of having diabetes or developing it in the future. Evaluations of these tools have primarily used nationally representative data, limiting their application in clinical and community settings. This analysis tested the effectiveness of the American Diabetes Association (ADA) risk questionnaire for identifying prediabetes in a community-based sample of Latinas. METHODS: Data were collected using the ADA risk questionnaire and assessing A1C. Among 204 participants without diabetes, we examined the association between individual characteristics and glycemic status. We then calculated the performance characteristics (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of the ADA risk questionnaire for detecting prediabetes, using A1C results as the gold standard to define the outcome. RESULTS: All participants were women of self-reported Hispanic/Latino ethnicity. Their mean ADA risk score was 5.6 ± 1.6. Latinas who had prediabetes were older, with significantly higher rates of hypertension and a higher ADA risk score than those without prediabetes. At a risk score ≥5-the threshold for high risk set by the ADA-the questionnaire had the following test performance characteristics: sensitivity 77.8%, specificity 41.7%, PPV 76.2%, and NPV 43.9%. CONCLUSION: The ADA risk questionnaire demonstrates reasonable performance for identifying prediabetes in a community-based sample of Latinas. Our data may guide other groups' use of this tool in the same target population. Future research should examine the effectiveness of this questionnaire for recruiting diverse populations into diabetes prevention programs. In addition, unique diabetes risk assessment tools for specific target populations are needed and may outperform questionnaires developed using nationally representative data.
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UNLABELLED: The impact of gastroparesis on diabetes management and control from the patient perspective has not been well characterized. The aim of this study was to identify patient perceptions regarding the impact of gastroparesis on managing their diabetes. METHODS: Patients with diabetes being referred for gastroparesis were enrolled in this prospective study. Gastroparetic symptom severity was assessed with the Patient Assessment of Upper GI Symptoms (PAGI-SYM). A questionnaire examined the impact of gastroparesis on diabetes related symptoms and control. RESULTS: 54 diabetic gastroparesis patients (36 T1DM, 18 T2DM) participated. Duration of diabetes averaged 17.4±1.4years and gastroparetic symptoms 5.1±1.1years. Patients rated their most severe symptoms as postprandial fullness, early satiety, and nausea. Two thirds of diabetic subjects identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control (44 of 54 patients) and that extra time and effort were required for care of their diabetes (45 of 54). Patients with T1DM, compared to those with T2DM, more often expressed that since developing gastroparesis, their blood sugars have been higher, they have had more frequent episodes of hypoglycemia, and they found that their gastroparetic symptoms worsened if blood sugars were too high. CONCLUSIONS: Gastroparesis has a significant impact on patients' perceived ability to self-manage and control their diabetes. T1DM patients, in particular, associate their gastroparesis with episodes of hyper- and hypo-glycemia, and find their gastroparetic symptoms worsen with poor control. Future research should focus on strategies to support self-management of patients with diabetic gastroparesis.
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Atitude Frente a Saúde , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Gastroparesia/complicações , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Autogestão , Adulto , Estudos de Coortes , Terapia Combinada , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Gastroparesia/epidemiologia , Gastroparesia/fisiopatologia , Gastroparesia/psicologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Autorrelato , Autogestão/psicologia , Índice de Gravidade de Doença , Estresse Psicológico/complicações , Estresse Psicológico/psicologiaRESUMO
The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35-40% of total calories) or a control group that was placed on the usual pregnancy diet (50-55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18-45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.
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We recently showed that insulin increased ER stress in human adipose tissue. The effect of insulin resistance on ER stress is not known. It could be decreased, unchanged, or increased, depending on whether insulin regulates ER stress via the metabolic/phosphoinositide 3-kinase (PI3K) or alternate signaling pathways. To address this question, we examined effects of lipid-induced insulin resistance on insulin stimulation of ER stress. mRNAs of several ER stress markers were determined in fat biopsies obtained before and after 8-h hyperglycemic-hyperinsulinemic clamping in 13 normal subjects and in 6 chronically insulin-resistant patients with type 2 diabetes mellitus (T2DM). In normal subjects, hyperglycemia-hyperinsulinemia increased after/before mRNA ratios of several ER stress markers (determined by ER stress pathway array and by individual RT-PCR). Lipid infusion was associated with inhibition of the PI3K insulin-signaling pathway and with a decrease of hyperinsulinemia-induced ER stress responses. In chronically insulin-resistant patients with T2DM, hyperglycemic-hyperinsulinemia did not increase ER stress response marker mRNAs. In summary, insulin resistance, either produced by lipid infusions in normal subjects or chronically present in T2DM patients, was associated with decreased hyperinsulinemia-induced ER stress responses. This suggests, but does not prove, that these two phenomena were causally related.
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Estresse do Retículo Endoplasmático/fisiologia , Resistência à Insulina/fisiologia , Tecido Adiposo/metabolismo , Adulto , Diabetes Mellitus Tipo 2/metabolismo , Emulsões , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Feminino , Humanos , Hiperglicemia/metabolismo , Hiperinsulinismo/metabolismo , Insulina , Masculino , Pessoa de Meia-Idade , Inibidores de Fosfoinositídeo-3 Quinase , Fosfolipídeos , RNA Mensageiro/metabolismo , Transdução de Sinais/efeitos dos fármacos , Óleo de Soja , Resposta a Proteínas não Dobradas/efeitos dos fármacosRESUMO
OBJECTIVE: Our primary purpose was to assess the impact of objectively measured nighttime sleep duration on gestational glucose tolerance. We additionally examined associations of objectively measured daytime sleep duration and nap frequency on maternal glycemic control. METHODS: Sixty-three urban, low-income, pregnant women wore wrist actigraphs for an average of 6 full days in mid-pregnancy prior to screening for hyperglycemia using the 1-h oral glucose tolerance test (OGTT). Correlations of nighttime and daytime sleep durations with 1-h OGTT values were analyzed. Multivariable logistic regression was used to evaluate independent associations between sleep parameters and hyperglycemia, defined as 1-h OGTT values ≥130 mg/dL. RESULTS: Mean nighttime sleep duration was 6.9±0.9 h which was inversely correlated with 1-h OGTT values (r=-0.28, P=.03). Shorter nighttime sleep was associated with hyperglycemia, even after controlling for age and body mass index (adjusted odds ratio [OR], 0.2 [95% confidence interval {CI}, 0.1-0.8]). There were no associations of daytime sleep duration and nap frequency with 1-h OGTT values or hyperglycemia. CONCLUSIONS: Using objective measures of maternal sleep time, we found that women with shorter nighttime sleep durations had an increased risk for gestational hyperglycemia. Larger prospective studies are needed to confirm our negative daytime sleep findings.
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Diabetes Gestacional , Hiperglicemia/complicações , Complicações na Gravidez , Transtornos do Sono-Vigília/complicações , Sono , Actigrafia , Adulto , Índice de Massa Corporal , Distúrbios do Sono por Sonolência Excessiva/complicações , Feminino , Teste de Tolerância a Glucose , Humanos , Pobreza , Gravidez , Estudos Prospectivos , Medição de Risco , População Urbana , Adulto JovemRESUMO
Endoplasmic reticulum (ER) stress is increased in obesity and is postulated to be a major contributor to many obesity-related pathologies. Little is known about what causes ER stress in obese people. Here, we show that insulin upregulated the unfolded protein response (UPR), an adaptive reaction to ER stress, in vitro in 3T3-L1 adipocytes and in vivo, in subcutaneous (sc) adipose tissue of nondiabetic subjects, where it increased the UPR dose dependently over the entire physiologic insulin range (from â¼ 35 to â¼ 1,450 pmol/L). The insulin-induced UPR was not due to increased glucose uptake/metabolism and oxidative stress. It was associated, however, with increased protein synthesis, with accumulation of ubiquitination associated proteins, and with multiple posttranslational protein modifications (acetylations, methylations, nitrosylations, succinylation, and ubiquitinations), some of which are potential causes for ER stress. These results reveal a new physiologic role of insulin and provide a putative mechanism for the development of ER stress in obesity. They may also have clinical and therapeutic implications, e.g., in diabetic patients treated with high doses of insulin.
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Tecido Adiposo/metabolismo , Insulina/farmacologia , Resposta a Proteínas não Dobradas/efeitos dos fármacos , Células 3T3-L1 , Adulto , Animais , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Feminino , Glucose/metabolismo , Humanos , Insulina/sangue , Masculino , Camundongos , Pessoa de Meia-Idade , Estresse Oxidativo , Processamento de Proteína Pós-Traducional , Ubiquitinação , Resposta a Proteínas não Dobradas/genéticaRESUMO
Women developing gestational diabetes mellitus (GDM) must be made aware of its definition and incidence, and the risk factors associated with the development of complications in pregnancy. The potential problems inherent in this condition make screening and diagnosis imperative as early as possible during the antenatal period. Affected individuals must be given a simple understanding of the basic pathophysiology of the condition. They must be taught self-management skills involving nutrition counselling, exercise, and monitoring of metabolic status by blood glucose and urine ketone testing. Pharmacological management is usually by insulin administration. The antenatal care programme will monitor foetal movement and provide information about preparation for labour and delivery. Education is also provided on the benefits of breastfeeding. After delivery, pastpartum counselling is mandatory to explain the risk of developing GDM in subsequent pregnancies, the risk of developing type 2 diabetes and the need for establishing healthy life style changes; that is, weight maintenance and increased physical activity. Postpartum evaluation and annual blood glucose testing is important.(AU)