Recently, a team of scientists have designed a flexible glucose-monitoring device that conforms to the skin and is barely visible. The device contains the enzyme glucose oxidase, which is able to oxidize glucose and form hydrogen peroxide in the process. The patch can be connected to a portable electrochemical analyzer that has a dual function: power source and wireless data transmitter. The drug is delivered through microneedles coated in a layer of tridecanoic acid, a hydrophobic molecule that protects the needles from moisture. The team paid particular attention to the mechanical properties of the materials used to ensure that they could hold up to the everyday movement of life.
A transplant of insulin-producing islet cells has the patient's body naturally creating the hormone responsible for managing glucose in the blood.
The patient, Wendy Peacock, 43, has been giving herself insulin injections to control diabetes since she was diagnosed with the condition at age 17. Limited access to pharmacies may be one reason hospital readmission is more common among older patients in rural or smaller communities, a new study suggests. Better detection appears to explain the recent rise in the number of ALS, or Lou Gehrig's disease, cases in the United States, government health officials say. Children aged 1 and 2 years have relatively high rates of chemical eye burns, with everyday cleaners a common cause, researchers say. Not all adults with advanced kidney cancer that has spread require immediate, aggressive treatment, a small new study suggests. Vitamin D levels may drop after women stop using birth control pills or other contraceptives with estrogen, researchers report.
In another key step toward a vaccine against Zika virus, scientists have found that three different experimental vaccines are safe and effective in monkeys. Economics, climate, environment and population all likely contributed to Brazil's Zika outbreak, public health experts say.
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The tricyclic antidepressants are established treatments for peripheral diabetic neuropathy. The selective serotonin reuptake inhibitors present important benefits and risks in the treatment of comorbid depression and diabetes. With regard to body weight, a meta-analysis shows fluoxetine can achieve moderate but statistically significant weight loss in adults with type 2 DM (Norris et al., 2004). The serotonin-norepinephrine reuptake inhibitors (SNRIs) venlafaxine (Effexor) and duloxetine (Cymbalta) present potential advantages in the treatment of comorbid diabetes and depression. To our knowledge, there are no studies of mirtazapine (Remeron) for depression with comorbid diabetes or for diabetic neuropathy. There are also no studies of bupropion (Wellbutrin) specifically for the treatment of depression comorbid with diabetes. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you.
Disruptions in iron homeostasis are linked to a broad spectrum of chronic conditions including cardiovascular, malignant, metabolic, and neurodegenerative disease. The search for risk factors and methods of prevention for both CVD and diabetes are major efforts of the medical and research community. Epidemiological studies have been a powerful tool to probe the association between iron and CVD and diabetes. Virtually all of these epidemiological analyses have been used to probe the relationship between iron and CVD or diabetes. Cardiovascular disease is a broad term that includes ischemic and non-ischemic irregularities. The hypothesis that iron status could influence the risk of coronary heart disease was first proposed by Sullivan in the 1980s. Many of the studies discussed above focused on cardiovascular events such as acute myocardial infarction. Several recent studies have shown that serum ferritin is independently associated with preclinical measures of vascular diseases. The potentially damaging effect of iron on the heart, pancreas, liver and other organs was made evident in part through the study of hemochromatosis, a disorder in which excess iron is absorbed and deposited in tissues.
An alternative approach to the use of serum ferritin to assess the relationship between iron and CVD has been to assess the relationship between catalytic iron and heart disease.
Another approach to testing a potential link between iron and CVDs has been the study of dietary iron intake and risk. Metabolic syndrome refers to a collection of risk factors that increase the likelihood of heart disease, diabetes and stroke.
Similarly, many epidemiological studies have reported statistically significant associations of body iron with diabetes, although results from all studies are not entirely consistent.
The blend of meat and spices make for an authentic Mexican flavor that's sure to put a smile on your face! Once thought of as a disease that typically strikes affluent adults, type 2 diabetes has quickly spread all over the world, indifferent to socioeconomic status or age. The device contains an array of sensors that are patterned onto gold-doped graphene and connected by a gold mesh. Although diabetes is associated with blood glucose levels, studies have actually shown that these levels can be estimated from precise measurements of sweat glucose concentrations. The hydrogen peroxide is then involved in another chemical reaction that results in noticeable electrochemical changes, which the glucose and pH sensors measure. Detection of an excess of glucose in the bloodstream (hyperglycemia) triggers the delivery of metformin, a drug commonly used to treat type 2 diabetes. Once inserted into the skin, this hydrophobic layer is critical to the prevention of premature metformin release. They specifically designed the flexibility and mechanical robustness of the system in order to minimize the stresses that occur during mechanical deformations. In addition, the scientists used a serpentine design for the gold mesh because this configuration enhances the mechanical deformability of the system. 10 (UPI) -- The first patient to receive therapeutic delivery of islet cells in a new diabetes study no longer needs insulin therapy to control type 1 diabetes, according to doctors at the University of Miami's Diabetes Research Institute. Since she had the minimally-invasive procedure on August 18, Peacock has been off insulin, because her body is producing it naturally, and she no longer has the dietary restrictions that accompany type 1 diabetes.
4 (UPI) -- New research in Canada found parts of the brain responsible for speech compensate for declines in the function of the peripheral and central auditory system.
4 (UPI) -- Hundreds of clinical trials involving children are discontinued early, and even more that are completed never get published, according to researchers. Estimates show that about 30% of diabetes cases in the United States are undiagnosed (CDC, 2003). Reports link MAOIs with sudden hypoglycemia requiring emergency intervention (Goodnick, 1997). Tricyclic antidepressants increase weight, although specific agents differ substantially in amount of weight gain (Zimmermann et al., 2003). Neither drug has been specifically studied for treatment of depression and comorbid diabetes.
A placebo-controlled trial of bupropion in men with diabetes and erectile dysfunction who weren't depressed showed no worsening of sexual function and no change in measures of diabetic control during treatment (Rowland et al., 1997).
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This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Evidence supporting this contention derives from a variety of analytical approaches, ranging from molecular to population-based studies. The role of iron as a risk factor for CVD and diabetes has drawn attention in part due to the concept that it may be a risk factor susceptible to simple dietary modification. Association with iron has been mainly studied and found in ischemic cardiovascular diseases caused by atherosclerosis.
Sullivan hypothesized that the higher occurrence of CHD in men and post-menopausal women than in pre-menopausal women was due to higher iron stores in them compared to menstruating women (Sullivan, 1981, 1989). However, myocardial infarction is a complex endpoint resulting from multiple potential pathogenesis pathways. In addition to the ability of iron to promote lipid peroxidation, recent studies have implicated the peptide hormone hepcidin in atherosclerosis. Catalytic iron is the iron that is not bound to transferrin or ferritin and is available to take part in chemical reactions to produce oxidant products. Discordant results among studies may in part be due to imprecision in the surrogate markers used to measure iron status (ferritin, total iron binding capacity, transferrin saturation, serum iron, and dietary iron intake), which are all indirect measures of body iron stores. Unfortunately, only a limited number of intervention studies have been conducted, but results of these studies are at least suggestive that modulating iron can reduce risk. They include a large waistline, high triglyceride, low HDL cholesterol, high blood pressure and high fasting blood sugar. To study the association of iron with metabolic syndrome in normal individuals, a cross-sectional study in 6044 US adults was conducted.
Glucose-monitoring devices available on the market typically require the user to obtain a small blood sample that can be read to quantify the level of the sugar.
This setup both improves the electrochemical activity of graphene and enhances the biochemical sensitivity of the system. The readings from the device exhibited a lag time that is consistent with results from previous investigations of sweat glucose (meaning that there's a consistent delay between changes in blood levels and when those changes show up in the sweat). An ultrathin, neutral mechanical plane also helped increase the tolerance of the system to mechanical deformations.
UPI also provides insightful reports on key topics of geopolitical importance, including energy and security. It became known as UPI after a merger with the International News Service in 1958, which was founded in 1909 by William Randolph Hearst. Given that psychiatrists are often the main physician contact for patients with severe mental illness, they play a vital role in recognizing the signs and symptoms of new-onset diabetes as well as the potentially life-threatening symptoms of hyper- and hypoglycemia (Table 1). This effect could be particularly troubling with concomitant use of diabetes medications such as insulin and the sulfonylureas that can cause hypoglycemia. They may indirectly improve diabetes by improving depression but also have a direct hyperglycemic effect. A randomized, placebo-controlled study demonstrated fluoxetine effectively reduced depressive symptoms in an eight-week trial, with a trend toward improved glycemic control in patients with diabetes (both types 1 and 2) and MDD (Lustman et al., 2000b). Despite evidence for improved depression, improved glycemic control and weight loss with SSRIs, one area in which they lack effectiveness is neuropathy. A single case report described new-onset type 2 DM in conjunction with mirtazapine-induced weight gain (Fisfalen and Hsiung, 2003).
Bupropion appears to be at least weight-neutral, if not weight-decreasing (Appolinario et al., 2004). With countless new studies and advanced treatments, there is much hope for diabetics, as they can bring about a good control over their sugar levels by ensuring a healthy lifestyle and not missing on the medications.Changed lifestyle patterns and dietary habits have contributed to the increase in diabetes and the age group of the affected is only turning younger. This review focuses on key epidemiological studies that assess the relationship between body iron status and chronic diseases, with particular emphasis on atherosclerosis ,metabolic syndrome and diabetes. Coronary heart disease is the most common type of heart disease, and costs the US over 100 billion each year (Go et al., 2013). Although this is an oversimplification, many (not all) reports suggest that there is indeed an association between iron and both CVD and diabetes, as detailed in this review. In this narrative review, we have not attempted to be comprehensive, but to focus on key epidemiological studies that have investigated these issues.
To measure ischemic disease outcome, several different endpoints have been used, including coronary heart disease (CHD), carotid artery plaque formation, coronary artery calcium deposition, carotid intima thickness, and atherosclerosis. However, serum ferritin can also be elevated by acute and chronic inflammation (Wang et al., 2010). An interesting finding common to some of these studies was the interaction of LDL with serum ferritin in increasing the risk of ischemic events. To circumvent this limitation, other studies used preclinical atherosclerosis as the dependent variable and explored its relationship to serum ferritin. Because these variables are subject to temporal and measurement variations, there is undoubtedly exposure misclassification in the subjects. In animal models, treatment with deferoxamine, an iron chelator, during ischemia improved recovery and reduced reperfusion-induced oxygen radical formation in rabbit hearts (Williams et al., 1991). The presence of three of these five risk factors, many of which are associated with obesity, is defined as metabolic syndrome3.
In another similar study, adjustment for BMI and components of the metabolic syndrome produced a null result (Jehn et al., 2007). A minimally or non-invasive alternative would probably help many patients stay on top of their health. When it warms the needles, the tridecanoic acid layer shifts, exposing the underlying polymer to the bodily fluids. Further evidence for potential benefits in glycemic control came from a study by Ghaeli et al.
Although extensively studied, SSRIs are not appropriate monotherapy for diabetic neuropathy (Duby et al., 2004). Multiple surrogates have been used to measure body iron status, including serum ferritin, transferrin saturation, serum iron, and dietary iron intake.
Risk factors include high blood pressure, high LDL cholesterol, smoking, diabetes, and obesity (MMWR Morb Mortal Wkly Rep 60, 2001).
Briefly, epidemiological studies can be divided into observational and experimental studies. We provide some historical context, but emphasize recent, well-controlled studies with large sample size.
CHD has been measured by myocardial infarction and cardiogenic angina occurrences and deaths from such incidents.
Accounting for the contribution of these variables thus becomes an important component of studies that use serum ferritin as a measure of body iron, as discussed below. In a cohort of 2873 Framingham women, an increase in incidence of CHD and disease severity was observed in women who had either natural or surgical menopause (Gordon et al., 1978).
A plausible biological mechanism underlying this interaction may be the ability of iron to produce reactive oxygen species.
Hepcidin acts by binding ferroportin, an iron efflux pump present in both enterocytes and macrophages. This non-differential misclassification would reduce the ability of a study to identify a true association should one exist. Metformin is then released from the array of polymeric microneedles in a controlled, stepwise manner. In terms of weight, phenelzine (Nardil) appears to induce weight gain, although reports on other MAOIs are mixed (Zimmermann et al., 2003).
The lack of a uniform and standardized means of assessing body iron status has limited the precision of epidemiological associations.
Diabetes is itself a significant health problem that is reaching epidemic proportions, with a global prevalence of 382 million people in 2013. The difference between an observation and experimental study is that in the latter, an outcome is studied in a population in the absence or presence of an intervention by the investigator. The role of iron in CVD has generally been explored in a group of individuals using one of these defined endpoints.
Less frequently, the ratio of soluble transferrin receptor to ferritin has been used, as it has been suggested that this is a more precise measure for body iron store than ferritin alone (Skikne et al., 1990).
Binding of hepcidin to ferroportin triggers ferroportin degradation (Nemeth et al., 2004), thus inhibiting the delivery of iron to the circulation through the enterocyte as well as inhibiting iron recycling in macrophages. Adjustments were made for red meat consumption to rule out confounding by other known risk factors for stroke such as N-nitroso compounds and heterocyclic compounds (Forstermann, 2008). An additional potential problem, particularly in cross-sectional studies, is that observed elevations in serum ferritin may represent an effect rather than a cause of underlying pathology. A positive association of serum ferritin with the prevalence of metabolic syndrome in a study population of 8441 people including both sexes and from different provinces of China was recently reported (Li et al., 2013). The same study found significantly increased fasting blood glucose in patients without diabetes treated with the TCA imipramine (Tofranil).
Though the cure for this condition is still not in sight, there are many ways out there to keep the spike in blood sugar levels at bay and make your life hassle- free.From needle to scalpelWhile the main focus on diabetes is about ensuring a good control on diet and drugs, through oral and insulin injections along with weight maintenance, it isn't always the case as many people are unable to achieve that. For the purposes of this review, we have included all of these clinical entities under the umbrella of CVD and have not attempted to differentiate among them. Catalytically available iron has also been measured in some studies, with the goal of measuring reactive rather than total iron. The association was observed in normal weight men and not in overweight or obese men, most likely because of decreased iron absorption due to increased hepcidin in the chronic inflammatory state associated with obesity (Greenberg and Obin, 2006). This is important, given the association of these medications with the new onset of type 2 DM. However, path analysis showed the direct effect of nortriptyline was to worsen glycemic control (independent of weight gain), whereas depression improvement had an independent beneficial effect on glycosylated hemoglobin. As a result of which, majority of them end up requiring insulin injections as the damage to heart, kidneys, brain, and eye happens, also called microangiopathy ( disease of small blood vessels). Genetic and molecular techniques have helped to explicate the biochemistry of iron metabolism at the molecular level.
Observational studies include cohort studies, case-control studies and cross sectional studies.
This approach derives from the consideration that the preponderance of iron in the body is bound to proteins and is not available for participation in the potentially deleterious reactions that are thought to underlie much of the toxicity of iron, such as the formation of reactive oxygen species.
The first report in humans on the association between serum ferritin and CHD risk was published in Salonen et al.
When the study population was divided into ferritin octiles, both men and women showed a dose-dependent relationship between serum ferritin and atherosclerotic plaques.
In human subjects, a similar increase in cardiovascular death was observed in women heterozygous for the HFE gene (Roest et al., 1999). Adipocyte hepcidin expression is known to be positively correlated with obesity (Bekri et al., 2006). Prudent patient care may dictate extending this surveillance to patients treated for depression.
An open-label, 52-week trial of duloxetine for MDD showed a mean weight gain of approximately 5 lb (Raskin et al., 2003). In cases as complicated as these, the only proven tool for complete resolution of diabetes is the metabolic surgery. Plausible explanations for how iron contributes to the pathogenesis of these chronic diseases are beginning to be elucidated. A cohort study is an analysis of risk factors where a disease-free study population is identified and followed prospectively over time and a subsequent evaluation is done to find the association between the exposure and disease outcome. A limitation of this approach is that since catalytically available iron represents a relatively small fraction of total iron, its measurement is technically challenging. Subjects with malignancy and liver diseases were excluded to eliminate the confounding effect of inflammation and mild liver disease, but no adjustments were made for any inflammatory markers. Although no significant association of ischemic events with iron was reported, most of the deaths were related to ischemic complications, and thus the contribution of catalytic iron could not be ruled out completely. Inhibiting the 2C9 isoenzyme will increase sulfonylurea levels, potentially leading to dangerous hypoglycemia (Cozza et al., 2003). Most evidence supports the hypothesis that excess iron contributes to chronic disease by fostering excess production of free radicals. While this kind of study can provide strong scientific evidence of an association between risk factors and disease and a temporal framework to assess causality, it is limited by the requirement for a large sample size and long follow-up duration.
In this cohort of randomly selected 1931 Eastern Finnish men, serum ferritin concentration had a significant association with ischemic heart disease risk.
Thus, acute or chronic inflammatory conditions could have confounded the findings in this study by affecting serum ferritin levels at the time of measurement. The mechanism of action is largely related to bypassing the food to upper part of the intestines and release of certain gut hormones that act on the pancreas, on insulin, its action on the tissues and also end organs. Overall, epidemiological studies, reinforced by basic science experiments, provide a strong line of evidence supporting the association between iron and elevated risk of cardiovascular disease and diabetes. Since hepcidin is decreased in patients with hereditary hemochromatosis, this model provides a potential explanation for the previous observation that atherosclerosis risk is not increased in subjects with hereditary hemochromatosis (van der et al., 2006).
Unfortunately, these studies did not report the relationship between serum ferritin and outcome. Thus it gives a permanent cure to many patients, from this traditionally regarded as a progressive, unrelenting disease called diabetes," says Dr Peters.
In this narrative review we attempt to condense the information from existing literature on this topic. A case control study on the other hand starts with groups with and without an outcome and evaluates how much a suspected exposure might have contributed to the present outcome status. Total blood leucocyte count was adjusted in the statistical analysis to rule out the potential confounding effect of inflammation or chronic vascular disease that would elevate serum ferritin independent of body iron status.
However, a recent experimental study provided evidence that hepatic hepcidin expression is not correlated with atherosclerosis progression in a mouse model Kautz et al. It thus remains unaddressed whether or not catalytic iron is more strongly associated than serum ferritin with outcome.
Thus in comparison to cohort studies, case control studies are relatively quicker to conduct, inexpensive and require comparatively fewer subjects. Cross sectional studies collect and analyze the data on exposure and disease at one specific time point.
After this report, the group conducted another nested case-control study within the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) cohort and found that men with high body iron stores were at increased risk of acute myocardial infarction (AMI), confirming their original observation (Tuomainen et al., 1998). Further, the authors reported that increasing macrophage iron accumulation in mice with atherosclerosis either through a genetic mutation in the ferroportin gene or through parenteral iron administration failed to increase the size of atherosclerotic lesions or lesion calcification.
Iron depletion in such patients has been shown to improve histological liver damage and abnormal liver function when compared to lifestyle modification (Valenti et al., 2014).
Such studies cannot evaluate cause and effect relationships since there is no temporal assessment. In the hierarchy of evidence-based medicine, experimental studies (or more specifically randomized controlled trials) are recognized as level I of scientific evidence.
Long term safety of this form of insulin though, remains to be established," says Dr Misra.The modes of insulin administration have indeed developed. Of course, it must also be emphasized that for a potential hazard, such as elevated body iron, a randomized controlled trials cannot be performed ethically, although it could be done for a study of iron reduction by, for example, phlebotomy. It is still in infancy stage and in years to come it may be made available to people," says Dr Koul.
In particular, supervised resistance training has been shown to lead to significant improvement in insulin sensitivity.
Based on this scientific knowledge, the personalised nutrition plan helps balance our hormones, enzymes and our biochemistry," says Kaur.The programme though is no replacement for your diabetologist, as it just helps control your sugar levels faster, with the right lifestyle and diet, while you pop the pills.
Treatment of type 2 diabetes 2014 espa?ol|
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