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Search: Subscribe for updatesRegister to receive email news alerts, daily digest, weekly roundup or Topic newsletters. Prevalence of type 2 diabetes in Scottish population Indicator Source: Scottish Diabetes Survey LATEST RESULTS At the end of 2013, there were 268,154 people diagnosed with diabetes in Scotland recorded on local diabetes registers. Diabetes mellitus is a disorder wherein there occurs a deficiency in the production of insulin hormone resulting in the increase of blood sugar.
Type 2 diabetes may be caused due to the increase in blood pressure and blood triglyceride levels. Insulin resistance in type 2 can be seen in conditions like obesity, pregnancy, infections and stress. The history of the patient to find any of the hereditary aspects of the disease is carefully analyzed at the first stage. The complications that correspond the diabetic condition include diabetic hyperglycemic hyperosmolar coma and diabetic ketoacidosis.
Keeping the body weight under control and maintaining a healthy lifestyle might prevent type 2 diabetes. However, a regular check up of blood glucose level and taking right doses of medicine of insulin can reduce its severity. Signup for Spinemonitor, Our Bi-Monthly eNewsletterGet new Case Studies in your inbox.SIGN UP NOW! The patient is a morbidly obese 63-year-old male who presented as a polytrauma after a ground level fall onto hard concrete.
During the trauma survey, the patient was found to have DISH (diffuse idiopathic skeletal hyperostosis).
Figure 2: Pre-treatment cervical sagittal CT demonstrating flowing anterior ossification (DISH). The patient was diagnosed with a flexion-distraction injury (Chance fracture) through the inferior endplate of T7 and a history of DISH (diffuse idiopathic skeletal hyperostosis). Please login or register, to gain full access to this case and participate in the discussion.
During the first 24 hours of being hospitalized, the patient underwent posterior single-stage T6-T9 percutaneous pedicle screw fixation with the goal of early mobilization and treatment of orthopedic injuries. At 3-month follow-up after a short stay in rehab, the patient continues to be non-weight bearing from his right femur fracture but is full strength in his lower extremities. Liraglutide marketed under the brand name Victoza, is a long-acting glucagon-like peptide-1 agonist (GLP-1 agonist an incretin) developed by Novo Nordisk for the treatment of type 2 diabetes.
It reduces meal-related hyperglycemia (for 12 hours after administration) by increasing insulin secretion, delaying gastric emptying, and suppressing prandial glucagon secretion. The strategies of use of incretin hormones in type 2 diabetes treatment include the use of DPP-4 inhibitors and exogenous GLP-1 substitution.
Liraglutide activates the GLP-1 receptor coupled to adenylyl cyclase by the stimulatory G-protein, Gs, in pancreatic beta cells. Type 2 diabetes is related with the risk of cardiovascular disease development which is the major cause of death.
The III phase of clinical study of liraglutide has common acronym LEAD (Liraglutide Effect and Action in Diabetes) included 4456 people.
Beneficial effect of incretin medications on cardiovascular system results both from direct and indirect influence on heart and arterial system. The summary of the LEAD program showed that liraglutide therapy cause body weight decreases.
In diabetic patients is an obvious association between lipid abnormalities and cardiovascular events.
Liraglutide decreases postprandial triglyceride, apolipoproteins: B-48, C III, and also cholesterol and triglyceride remnants which results in significant reduction of cardiovascular complication risk factors. Cardioprotective effect of liraglutide in comparison to metformin was showed in induced myocardial infarction in animals with diabetes, when similar metabolic control was achieved.
Small increases in heart rate of between 2 and 4 beats per minute have been observed with liraglutide treatment in the LEAD studies. GLP-1 and GLP-1 receptor agonists stimulate calcitonin release in rodents ; however, this effect is specific to rodents and has not been observed in primates including humans. In agreement with the FDA, is not recommended special surveillance in liraglutide treated individuals. The FDA has included a boxed warning on liraglutide’s label stating: ‘Liraglutide causes thyroid C-cell tumors at clinically relevant exposures in rodents. Liraglutide, marketed under the brand name Victoza, is a long-acting glucagon-like peptide-1 (GLP-1) analog that has been developed for the treatment of type 2 diabetes.
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Diabetes mellitus type-2 is one such disease relating to high blood glucose due to insulin resistance.

Consumption of fatty foods and alcohol intake at a higher level would also result in such disease. Insulin treatment with a syringe of insulin pump and oral medicines decrease the levels of blood sugar. Long term complications include coronary artery disease, diabetic neuropathy, hypertension, skin infections, stroke, peripheral vascular disease and atherosclerosis. Low alcohol consumption and quit smoking would ideally be suggested as the best preventive measures.
He denies numbness or weakness in extremities, but elicits severe pain in his back and right hip.
Fessler, MD, PhDProfessor, Department of Neurological SurgeryRush University Medical School Dr. Uribe’s decision to proceed with a percutaneous stabilization in this patient is an excellent alternative.
The product was approved by the European Medicines Agency (EMA) on July 3, 2009, and by the U.S.
The differences between native GLP-1 and liraglutide include exchange of lysine to arginin in 34 position and addition of glutamate to lysine in position 26; to glutamate also was added 16C fatty acid-palmitic acid. Liraglutide increases intracellular cyclic AMP (cAMP), leading to insulin release in the presence of elevated glucose concentrations. Liraglutide not only give the possibility of glycemic control but also could influence the cardiovascular parameters. The LEAD program covered six randomized studies analyzing the influence of drug administration at different therapeutical stages of type 2 diabetes treatment. The indirect effect is the influence on glycemic control with the lack of the risk of hypoglycemia, arterial blood pressure normalization, and body weight loss. The mechanisms responsible for body weight loss includes the influence on digestive system and central nervous system. Increased levels of triglycerides, LDL and lipoprotein particles are predictors of increased cardiovascular risk.
In fact the administration of Liraglutide leads to a reduction of independent arterial sclerosis risk factors such as C-reactive protein (CRP) and brain natriuretic peptide (BNP).
This may be explained by liraglutide action on the increase of cAMP concentration and decrease of caspase 3 activation responsible for the cardiomyocyte apoptosis induction.
According to the 2011 liraglutide label there have been seven cases of pancreatitis (including two chronic cases) in liraglutide- treated patients , which is consistent with the higher incidence in the type 2 diabetes population. However, phase 1 studies of liraglutide showed no clinically relevant changes in the QTc interval on electrocardiogram. Unstimulated serum calcitonin levels were measured at 3-month intervals for up to 2 years in 5002 patients receiving liraglutide or control therapy in the LEAD program.
It is unknown whether Victoza causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as human relevance could not be determined by clinical or nonclinical studies. Sebbene molte terapie antidiabetiche siano state approvate dall'Fda, nuovi trattamenti sono considerati necessari per conseguire gli obiettivi glicemici, in quanto la funzione beta-cellulare diminuisce con ll tempo nei pazienti affetti da diabete.
Even when diabetes is controlled, the disease can lead to chronic kidney disease and kidney failure.
Beware of caffeine, sugary foods, spices, exercise, sleep, alcohol, and stress because these can all impact blood sugar levels and increase diabetes complications. Food products which contains zinc are split peas, egg yolk, beef liver, lima beans, almonds, walnuts and buckwheat. Uribe presents an interesting fracture in a very complicated patient.A  The fracture itself is routine in a DISH patient experiencing an extension trauma. The secretion of this hormone is stimulated by gastrointestinal passage and digestion process. After subcutaneous administration, liraglutide forms heptameres which slow down the release of the substance into the bloodstream. This insulin secretion subsides as blood glucose concentrations decrease and approach euglycemia.
Liraglutide therapy lasting 26 weeks in patients suffering from type 2 diabetes led to significant cholesterol concentration reduction, including LDL fraction, triglycerides, and free fatty acids. The decrease in their concentration inhibits the inflammatory cytokine activation directly engaged in vascular wall destruction.
As with other incretin-based therapies, it is not possible to determine whether there is a link between pancreatitis and liraglutide because of the small number of cases observed. While cardiovascular risk was not specifically reported in the LEAD studies (other than blood pressure data), liraglutide treatment has been shown in a meta-analysis of the six LEAD studies to improve biomarkers of cardiovascular risk (high-sensitivity C-reactive protein and brain natriuretic peptide).
This sequential screening showed that calcitonin levels were low and did not change over time. Il 25 gennaio 2010, l'Fda ha approvato liraglutide, un Glp-1 (peptide-1-simil-glucagone) agonista recettoriale che puo essere assunto una volta al giorno per migliorare il controllo glicemico in adulti con diabete di tipo 2. Most people with diabetes do not develop chronic kidney disease that is severe enough to progress to kidney failure.
Nor can they explain fully the interplay of factors leading to kidney disease of diabetes - factors includingheredity, diet, and other medical conditions, such as high blood pressure.

Type 2 diabetes is popularly called adult-onset diabetes or non-insulin- dependent diabetes. Apart from medications reducing obesity and following a diabetic food plan is also suggested for such disease.
Washing the feet and checking blisters or infection on the feet would be some of the methods of prevention. During the therapy with this medication, very low risk of hypoglycemia was proved which is related to the mechanism of action of liraglutide, it reduces glycemy only on the condition of elevated blood glucose level.
Both mechanisms, prolonged stomach emptying and satiety centre stimulation in brain, result in the reduction of food intake and body weight loss.
GLP-1 analogues may influence the early stages of aterogenesis by inhibition of monocyte adhesion to the vascular wall.
The recently started LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) study aims to assess and confirm the cardiovascular safety of liraglutide, and investigate the potential for improved cardiovascular outcome.
These data do not suggest any significant risk for activation of C-cells in humans in response to liraglutide. L'approvazione e stata garantita sulla base di considerazioni attente sui benefici del farmaco. They have found that high blood pressure and high levels ofblood glucose increase the risk that a person with diabetes will progress to kidney failure.
From the glycemy regulation point of view, one of the most important elements is the influence on the receptor in beta pancreatic cells. The effect of better glycemic control was accompanied by the reduction in systolic blood pressure at an average by 3,41 mmHg, which can be considered as a protective action from further diabetic complications such as cardiovascular complications. Nei trial clinici, quando impiegato in aggiunta ad altri antidiabetici, liraglutide ha portato alla riduzione della concentrazione media di emoglobina glicata da 0,8 a 1,4% rispetto al placebo. Binding to the receptor stimulates insulin secretion, GLP-1 is responsible for the secretion of 50 to 70% of insulin in response to oral glucose administration.
It should be also stressed that introduced modifications protect liraglutide from the action of the DPP-4. The use of liraglutide was related to TNF alfa inhibition and hyperglycemia-dependant gene PAI-1, ICAM-1, VCAM-1 induction in the cultures of human endothelial cells. Quando paragonato a una monoterapia con una sulfonilurea, liraglutide era associata a un ridotto rischio di ipoglicemia.
So the pharmacokinetic profile of liraglutide, which makes it suitable for once daily administration, is a result of self-association that delays absorption, plasma protein binding and stability against metabolic degradation by DPP-IV.
Molecular mechanism of this process has not been explained, maybe Liraglutide may regulate expression of mRNA of NUR77 protein. In some cases emotional disturbance might cause increase in blood pressure leading to the disease ultimately. Despite the fact that in response to gastrointestinal passage stimulation, quite big amount of GLP-1 hormone is secreted, only a small part of it reach pancreatic islets. This signal pathway seems to play a key role in endothelial cells protection in type 2 diabetes and in metabolic syndrome. Innanzitutto, dati da roditori suggeriscono che liraglutide e associata con un rischio accresciuto di iperplasia focale tiroidea a cellule C e a tumori di cellule C, valori la cui rilevanza negli umani e sconosciuta. This happens because of action of an enzyme dipeptidyl peptidase-4 (DPP-4) which decomposes GLP-1 in blood within 2–4 minutes. At the same time, observed increase in the production of nitric oxide (NO) and inhibition of NF-?B partially by AMPK (AMP activate protein kinase), which documents anti-inflammatory influence of liraglutide on vascular endothelium cells even in hyperglycemia.
L'Fda conclude che l'aumento di carcinoma nei roditori si trasla in un basso rischio per gli umani.
The effect mentioned above can explain observed earlier vasodilative properties of the medication and its beneficial influence on cardiovascular system in patients suffering from type 2 diabetes. Un altro possible rischio e un accresciuto pericolo di pancreatite dovuto al farmaco; un dato che emerge da rapporti postmarketing comuni a exenatide e sitagliptin, entrambi che agiscono sulla via Glp-1.
Ethnic group is collected by the survey but subject to variable response rates and may require several years of data to be combined.
Una domanda finale e se sia possibile aumentare il rischio di eventi cardiovascolari da terapie antidiabetiche (un allerta, in tal senso, era stato lanciato dall'Fda nel dicembre 2008): il programma di sviluppo di fase 2 e 3 non ha soddisfatto tale criterio.
In ogni caso, l'Fda sostiene che tutti i prodotti sviluppati per il trattamento del diabete, comportano rischi e potenziali problemi richiedono ulteriori studi. The Scottish Public Health Observatory estimates that almost half of type 2 diabetes can be attributed to obesity.
Diabetes is an important cause of disability and increases the risk of coronary heart disease and other health problems.
Overweight and obesity are also important risk factors: the risk of type 2 diabetes is around ten times higher among those with a BMI over 30 compared to those with a BMI under 30.

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