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Although Type 2 diabetes is preventable and treatable, it can cause serious health consequences if left uncontrolled. We want to make your experience easy and help you quickly find information that matters to you. If any post or images that appear on the site are in violation of copyright law, please email me and I will remove the offending information as soon as possible. Figure 2 : Immune therapy for type 1 diabetes mellitus[mdash]what is unique about anti-CD3 antibodies? Objectives: To determine the risk benefits of moderate intensity resistance training of upper limb in type 2 diabetes mellitus patients using augmentation index as a measure of arterial stiffness. Hurley BF and Roth SM Strength training in the elderly: effects on risk factors for agerelated diseases. Shenoy S, Arora E & Sandhu JS Effects of resistance training on metabolic profile of adults with type 2 diabetes. Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, Feldman CL and Levy D Impact of reduced heart rate variability on risk for cardiac events. The views expressed in IJMBS articles are those of the authors and do not reflect the official policy or position of the journal, the editor, the editorial board  or the  medical association. February 15, 2016 Spotlight on Zika – RCSIsmj staff writer Stephanie TungNovember 15, 2015 ‘Getting your Bell rung’: Is concussion the Death Knell for Contact Sports? The aim of this study is to determine the prevalence of vitamin B12 deficiency among Irish patients with type 2 diabetes mellitus on metformin therapy. Metformin acts on several tissues via activation of the adenosine monophosphate-activated protein kinase (AMPK) system to reduce serum glucose. The prevalence of vitamin B12 deficiency in patients with T2DM on metformin therapy in Ireland is unknown and the measurement of serum vitamin B12 in T2DM patients on metformin is not part of the standard annual review examination. This is a cross-sectional study to examine the prevalence of vitamin B12 deficiency in patients with T2DM on metformin attending the Beaumont Hospital diabetes service. Determine the background prevalence of vitamin B12 deficiency in patients with T2DM not on metformin and with no history of or treatment for autoimmune disease(s). Determine the prevalence of vitamin B12 deficiency in patients with T2DM on metformin and if the presence of vitamin B12 deficiency correlates with dose or duration of metformin therapy. Determine if metformin-induced vitamin B12 deficiency is associated with anaemia as measured by Hb and MCV, or peripheral neuropathy as measured by the absence of sensation to 10g monofilament. Data was analysed using student’s t-test (Microsoft Excel 2007) and Fisher’s test (GraphPad 2007). Two hundred and sixteen patients with T2DM on metformin therapy (137 males, 79 females) were identified, and a control group of 70 patients with T2DM not on metformin therapy (40 males, 30 females) was included in the study.
FIGURE 2: This relationship suggests that the duration of metformin therapy may influence vitamin B12 levels in the entire metformin group and the vitamin B12-deficient metformin subgroup.
Anaemia was found to be prevalent in all groups of patients: 31% in the vitamin B12-deficient metformin group, 24% in the metformin group with normal serum vitamin B12 levels and 14% in the control group. We would like to thank the staff of the Diabetes Day Centre in Beaumont Hospital for their tremendous help during this study.
In the pathogenesis of type 1 diabetes, HLA class II molecules on the surface of antigen-presenting cells (APCs) present fragments of pancreatic -cell proteins to a subclass of T cells called T helper (Th) cells.
SparkPeople’s Type 2 Diabetes Condition Center will show you how nutrition, fitness and lifestyle changes can help you manage your condition and prevent complications. Patients and Methods: Twenty middle aged individuals (40-60 years) with type 2 diabetes mellitus volunteered to participate. The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men. The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Resistance exercise training increases muscle strength, endurance, and blood flow in patients with chronic heart failure. High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial.
Effect of 12 weeks of moderate-intensity resistance training on arterial stiffness: a randomised controlled trial in women aged 32-59 years. Arterial stiffness, systolic blood pressure and logical treatment of arterial hypertension.
Exercise training for type 2 diabetes Mellitus Impact on Cardiovascular Risk: A Scientific Statement From the American Heart Association.


A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes.
Effects of high intensity resistance training on arterial stiffness and wave reflection in women.
We also seek to determine if the dose and duration of metformin use is associated with vitamin B12 deficiency and if the vitamin B12 deficiency is associated with clinical complications. Metformin, a biguanide, is the first-line oral hypoglycaemic agent used in the treatment of the overweight or obese patient with T2DM. The primary effect of metformin is to suppress hepatic gluconeogenesis.2 Side effects of metformin therapy are gastrointestinal upset and, rarely, lactic acidosis.
The objective of this study is to determine the prevalence of vitamin B12 deficiency among Irish patients with T2DM on metformin therapy.
Participant selection Inclusion criteria for study group: a diagnosis of T2DM and a prescription history of metformin for ?18 months. Demographic data The following data was recorded for each patient: age, sex, weight, height, body mass index (BMI), years with diabetes, total daily dose of and years on metformin, haemoglobin (Hb), mean corpuscular volume (MCV), glycated haemoglobin (HbA1c), vitamin B12, folate, thyroid-stimulating hormone (TSH), free thyroxine (T4), urine albumin-creatinine ratio (ACR), serum creatinine, and the presence or absence of peripheral neuropathy measured using a 10g monofilament. Groups were similar with respect to age, sex, duration of diabetes, weight, BMI and HbA1c (Table 1).
The metformin group and the vitamin B12-deficient group was divided into those who were on metformin therapy for over five years and those who had taken it for less than five years. In those patients on metformin therapy, it was found that vitamin B12 deficiency existed in one out of three patients, compared to one out of 14 patients in the control group.
The high incidence of anaemia in patients with T2DM is a concern and may reflect the association of T2DM with shortened red cell lifespan or possibly mild renal impairment. The prevelance of vitamin B12 deficiency in patients with type 2 diabetes: a cross sectional study. In turn, the autoreactive Th cells stimulate cytotoxic T cells (CTLs) to attack insulin-producing -cells (); HLA class I proteins on the -cell surface present -cell peptides to CTLs. Approximately 17 million Americans are diabetics.The first thing you need to do is find yourself a good internal medicine physician in general practice. Resistance training and arterial compliance: keeping the benefits while minimizing the stiffening. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Reduced heart rate variability and mortality risk in an elderly cohort: The Framingham Study.
Is a long-term aerobic plus resistance training program feasible for and effective on metabolic profiles in type 2 diabetic patients? Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men.
Heart rate and muscle sympathetic nerve variability during reflex changes of autonomic activity. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50- to 65-yr-old men. Changes in human skeletal muscle contractility and hormone status during 2 weeks of heavy strength training. Metabolic, thermoregulatory, and psychophysiological responses during arm and leg exercise.
Arm blood flow and oxygenation on the transition from arm to combined arm and leg exercise in humans.
Unfavorable effects of resistance training on central arterial compliance: a randomized intervention study. The incidence of type 2 diabetes mellitus in the Irish population is increasing, and it is therefore important to minimise morbidity. This would inform the need for routine annual vitamin B12 measurements in T2DM patients on metformin. Inclusion criteria for control group: a diagnosis of T2DM and no history of metformin use in the past five years.
All data collected was acquired by the examination of participants’ hospital charts and their diabetes folders stored in the Diabetes Day Centre, and identification of patients at the weekly diabetes outpatient clinics and through the use of the hospital’s electronic database, Patient Information Profile Expander (PIPE). Seventy-one (33%) patients on metformin had a vitamin B12 deficiency compared to only five (7.5%) in the control group (pTable 2). Thus, there is an increased risk of developing vitamin B12 deficiency in patients with T2DM on metformin therapy for over five years. However, since there was no statistically significant correlation between the average Hb or MCV and vitamin B12 levels in the groups, we cannot conclude that vitamin B12 is responsible. Th cells also stimulate B cells to produce antibodies against cells of the islets of Langerhans.


Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. We also want to determine whether dose and duration of metformin therapy is associated with vitamin B12 deficiency, and whether vitamin B12 deficiency in patients on metformin is associated with clinical complications such as anaemia or peripheral neuropathy. Number of years with diabetes was calculated based on the date of diagnosis as indicated in the medical chart. Among patients with vitamin B12 deficiency on metformin therapy, there was no difference in relation to age, sex, duration of diabetes, BMI or diabetes control as measured by HbA1c (Table 3). In the metformin group, 17 patients had a mild vitamin B12 deficiency, 33 had a moderate deficiency and 21 had a severe deficiency. There was a statistically significant correlation between the dose of metformin and vitamin B12 deficiency – the higher the dose, the lower the average vitamin B12 level. The weaknesses of the study are a lack of sufficient data, as illustrated by the incomplete peripheral neuropathy data, and dependency on diabetic charts without full examination of each patient’s medical records, since many of the diabetic files had incomplete data. Moreover, KIR receptors on natural killer cells (NK) can also engage with HLA class I proteins on the islet cells and, depending on the type of KIR, help to activate or inhibit autoimmune responses against -cells.
This physician can tell you in quite exact terms what your condition is and work out a treatment and diabetic diet plan, not one that will cure your disease, but one that will control it and keep you alive with the least possible damage to your system. It is essential to determine the prevalence of this condition in order to prevent the occurrence of complications, such as peripheral neuropathy and megaloblastic anaemia. For those charts that did not mention a particular date of diagnosis, the date of the earliest documentation of a diagnosis of diabetes was used.
Out of the five deficient patients in the control group, two patients were found to be mildly vitamin B12-deficient, two were moderately deficient and one was severely deficient (Figure 3). However, the data on serum vitamin B12 levels and metformin therapy, including dose and duration of therapy, were available for all patients. Data was collected through the examination of participants’ hospital charts and the use of the electronic database (Patient Information Profile Expander) in Beaumont Hospital, Dublin.
If the date that metformin was commenced was not available in the medical records, the number of years on metformin was calculated based on the date of the earliest medical record documenting the use of metformin. We compared the vitamin B12 levels among patients taking less than 1,000mg of metformin per day to patients taking doses over 1,000mg per day, and the difference was found to be statistically significant (pFigure 1).
The majority of patients, both in the metformin and control groups, did not have neuropathy.
All of the serum vitamin B12 levels were performed within three months of the start of the study and so reflect the current risk of vitamin B12 deficiency in patients with T2DM on metformin attending Beaumont Hospital’s diabetes service. This study finds a high prevalence of vitamin B12 deficiency in patients with type 2 diabetes mellitus on metformin therapy. The dose of metformin was based on the most recent medical record documenting the dose.Patients with a vitamin B12 measurement in the three months preceding study initiation were included in the study. However, the recorded values for neuropathy were too few to draw any solid conclusions regarding the risk of neuropathy among those with vitamin B12 deficiency. We have thus demonstrated a high prevalence of vitamin B12 deficiency in patients with T2DM treated with metformin. An inverse relationship exists between vitamin B12 levels and the dose and duration of metformin use.
Vitamin B12 is required for DNA synthesis, cellular repair and the normal production of red blood cells. Serum vitamin B12 was measured using an immunoassay (Beckman Coulter – Unicel DxI 800 Access Immunoassay System) with a co-efficient of variation of approximately 10% or less. Possible explanations for the lack of association with neuropathy or macrocytic anaemia in our study may be the small study population, or that these side effects require longer periods of deficiency in order to manifest. As such, we suggest that the measurement of vitamin B12 should become an essential part of the annual review in all patients with T2DM on metformin therapy. Therefore, we suggest that the measurement of vitamin B12 should become an essential part of the annual review in all patients with type 2 diabetes mellitus on metformin therapy. We are interested in determining whether low vitamin B12 levels are associated with complications such as peripheral neuropathy, and thus refer to data from annual reviews. In the vitamin B12-deficient patients on metformin, four out of 53 (7.5%) recorded values indicating neuropathy compared to six out of 108 (4%) recorded values for the patients on metformin with normal vitamin B12 levels. Among the vitamin B12-deficient controls (five patients), three neuropathy values were recorded, one of which was positive (33%). Within the normal controls, 42 neuropathy values were recorded, one of which was positive (2%).



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