Diabetes/metabolism research and reviews
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Diabetes Metab. Res. Rev. · Sep 2009
ReviewDiabetes mellitus and gastric emptying: questions and issues in clinical practice.
It is long known that both type 1 and type 2 diabetes can be associated with changes in gastric emptying; a number of publications have linked diabetes to delayed gastric emptying of variable severity and often with poor relationship to gastrointestinal symptomatology. In contrast, more recent studies have reported accelerated gastric emptying when adjusted for glucose concentration in patients with diabetes, indicating a reciprocal relationship between gastric emptying and ambient glucose concentrations. This review proposes that gastroparesis or gastroparesis diabeticorum, a severe condition characterized by a significant impairment of gastric emptying accompanied by severe nausea, vomiting, and malnutrition, is often overdiagnosed and not well contrasted with delays in gastric emptying. ⋯ The fact that delayed gastric emptying can also be observed in non-diabetic individuals under experimental conditions in which hyperglycaemia is artificially induced suggests that a delay in gastric emptying rate when blood glucose concentrations are high is actually an appropriate physiological response to hyperglycaemia, slowing further increases in blood glucose. The article discusses the strengths and weaknesses of various methodologies for assessing gastric emptying, especially with respect to the diabetes population, and reviews newer diabetes therapies that decelerate the rate of gastric emptying. These therapies may be a beneficial tool in managing postprandial hyperglycaemia because they attenuate rapid surges in glucose concentrations by slowing the delivery of meal-derived glucose.
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Diabetes mellitus is the most common endocrine disease in childhood and adolescence. Type 1 diabetes accounts for over 90% of diabetes in children. During the past decades, epidemiological studies have clearly shown a worldwide increase in the incidence of both type 1 and type 2 diabetes in many countries. ⋯ However, new technologies are not a panacea, and the benefit they provide can be completely achieved only if adequately and especially individually determined. Furthermore, it is inevitable that new modalities of treatment for people with diabetes will be considered critically by healthcare planners and providers in the prevailing global environment of increasing costs of medical care and pressure for rational allocation of resources. Therefore, new technologically derived devices and therapeutic opportunity for diabetes should be rationally utilized in order to offer real advantages and reduce the relevant worldwide cost of diabetes.
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Diabetes Metab. Res. Rev. · Sep 2009
Randomized Controlled Trial Multicenter Study Clinical TrialEffects of therapy in type 1 and type 2 diabetes mellitus with a peptide derived from islet neogenesis associated protein (INGAP).
Islet neogenesis associated protein (INGAP) has beta cell regenerating effects in experimental models. ⋯ INGAP peptide increases C-peptide secretion in T1DM and improves glycaemic control in T2DM. Longer-term exposure, more frequent dosing, better tolerated formulations or combination with other therapies may be necessary to achieve optimal clinical response.