scholarly journals Cardiac Autonomic Neuropathy: A Progressive Consequence of Chronic Low-Grade Inflammation in Type 2 Diabetes and Related Metabolic Disorders

2020 ◽  
Vol 21 (23) ◽  
pp. 9005
Author(s):  
Nour-Mounira Z. Bakkar ◽  
Haneen S. Dwaib ◽  
Souha Fares ◽  
Ali H. Eid ◽  
Yusra Al-Dhaheri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Autonomic Neuropathy ◽  
Experimental Models ◽  
Cardiac Autonomic Neuropathy ◽  
Low Grade ◽  
Metabolic Inflammation ◽  
The Metabolic Syndrome ◽  
Cardiovascular Morbidity And Mortality

Cardiac autonomic neuropathy (CAN) is one of the earliest complications of type 2 diabetes (T2D), presenting a silent cause of cardiovascular morbidity and mortality. Recent research relates the pathogenesis of cardiovascular disease in T2D to an ensuing chronic, low-grade proinflammatory and pro-oxidative environment, being the hallmark of the metabolic syndrome. Metabolic inflammation emerges as adipose tissue inflammatory changes extending systemically, on the advent of hyperglycemia, to reach central regions of the brain. In light of changes in glucose and insulin homeostasis, dysbiosis or alteration of the gut microbiome (GM) emerges, further contributing to inflammatory processes through increased gut and blood–brain barrier permeability. Interestingly, studies reveal that the determinants of oxidative stress and inflammation progression exist at the crossroad of CAN manifestations, dictating their evolution along the natural course of T2D development. Indeed, sympathetic and parasympathetic deterioration was shown to correlate with markers of adipose, vascular, and systemic inflammation. Additionally, evidence points out that dysbiosis could promote a sympatho-excitatory state through differentially affecting the secretion of hormones and neuromodulators, such as norepinephrine, serotonin, and γ-aminobutyric acid, and acting along the renin–angiotensin–aldosterone axis. Emerging neuronal inflammation and concomitant autophagic defects in brainstem nuclei were described as possible underlying mechanisms of CAN in experimental models of metabolic syndrome and T2D. Drugs with anti-inflammatory characteristics provide potential avenues for targeting pathways involved in CAN initiation and progression. The aim of this review is to delineate the etiology of CAN in the context of a metabolic disorder characterized by elevated oxidative and inflammatory load.

Gut microbiota in health and disease: an overview focused on metabolic inflammation

2016 ◽  
Vol 7 (2) ◽  
pp. 181-194 ◽  
Author(s):  
R. Nagpal ◽  
M. Kumar ◽  
A.K. Yadav ◽  
R. Hemalatha ◽  
H. Yadav ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Gut Microbiota ◽  
Intestinal Barrier ◽  
Adverse Outcomes ◽  
Special Focus ◽  
Low Grade ◽  
Immune Functions ◽  
Metabolic Inflammation

In concern to the continuously rising global prevalence of obesity, diabetes and associated diseases, novel preventive and therapeutic approaches are urgently required. However, to explore and develop such innovative strategies, a meticulous comprehension of the biological basis of these diseases is extremely important. Past decade has witnessed an enormous amount of research investigation and advancement in the field of obesity, diabetes and metabolic syndrome, with the gut microbiota receiving a special focus in the triangle of nutrition, health and diseases. In particular, the role of gut microbiota in health and diseases has been one of the most vigorous and intriguing field of recent research; however, much still remains to be elucidated about its precise role in host metabolism and immune functions and its implication in the onset, progression as well as in the amelioration of metabolic ailments. Recent investigations have suggested a significant contribution of the gut microbiota in the regulation and impairment of energy homeostasis, thereby causing metabolic disorders, such as metabolic endotoxemia, insulin resistance and type 2 diabetes. Numerous inflammatory biomarkers have been found to be associated with obesity, diabetes and risk of other associated adverse outcomes, thereby suggesting that a persistent low-grade inflammatory response is a potential risk factor. In this milieu, this review intends to discuss potential evidences supporting the disturbance of the gut microbiota balance and the intestinal barrier permeability as a potential triggering factor for systemic inflammation in the onset and progression of obesity, type 2 diabetes and metabolic syndrome.

scholarly journals The role of testosterone in type 2 diabetes and metabolic syndrome in men

2009 ◽  
Vol 53 (8) ◽  
pp. 901-907 ◽  
Author(s):  
Farid Saad
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Glucose Homeostasis ◽  
Plasma Testosterone ◽  
The Metabolic Syndrome ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Low Levels

Over the last three decades, it has become apparent that testosterone plays a significant role in glucose homeostasis and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a pro-inflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus, dramatically illustrated by androgen deprivation in men with prostate carcinoma. Lower total testosterone and sex hormone-binding globulin (SHBG) predict a higher incidence of the metabolic syndrome. There is evidence that hypotestosteronemia should be an element in the definition of the metabolic syndrome since low levels of testosterone are associated with or predict the development of the metabolic syndrome and of diabetes mellitus. Administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile for the development of diabetes and atherosclerosis. So far, studies on the effects of normalization of testosterone in hypogonadal men on glucose homeostasis are limited, but convincing, and if diabetes mellitus is viewed in the context of the metabolic syndrome, the present results of testosterone treatment are very encouraging.

scholarly journals A Comparison of the Prevalence of the Metabolic Syndrome among Sri Lankan Patients with Type 2 Diabetes Mellitus Using WHO, NCEP-ATP III, and IDF Definitions

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
H. M. M. Herath ◽  
N. P. Weerasinghe ◽  
T. P. Weerarathna ◽  
A. Amarathunga
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Type 2 Diabetes Mellitus ◽  
The Metabolic Syndrome ◽  
Type 2 Dm ◽  
Cardiovascular Morbidity And Mortality ◽  
The Mean ◽  
The Difference

Background. Presence of metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (type 2 DM) increases the risk of cardiovascular morbidity and mortality. Therefore, recognition of MetS in type 2 DM is important in initiating the appropriate preventive and therapeutic measures. The commonly used definitions have similarities and discrepancies. Aims of this study was to investigate the prevalence of MetS among patients with type 2DM using all three well known (WHO, IDF, and NCEP-ATP III) definitions and to identify the concordance and the difference of these three definitions. Methods. This cross-sectional study included patients with type 2 DM who were followed up at the regional diabetes centre in Galle, Sri Lanka. A total of 2913 type 2 DM patients were recruited by convenient sampling method, and their clinical and biochemical data were collected. Results. The mean age (SD) of the sample was 49.9 (10.2) years and the mean duration of diabetes was 5.04 (5.71). Prevalence of MetS was highest by WHO (70%) followed by IDF (44%) and NCEP-ATP III (29%) definitions. The prevalence was significantly higher in women according to all three definitions, and the difference was most marked with NCEP-ATP III and IDF definitions. Around 25% were identified as having MetS by all three definitions whereas around 45% were recognized with MetS by two definitions. While concordances between WHO with IDF (0.37, p < 0.001) and NCEP-ATP III (0.24, p < 0.001) criteria were poor, they were average (0.53, p < 0.001) between NCEP-ATP III and IDF criteria. Conclusions. The prevalence of MetS among patients with type 2 DM can significantly be varied based on the definition used and the three definitions of MetS recognized different set of individuals. The highest prevalence of MetS was observed with WHO (70.6%) whereas lowest was observed with NCEP-ATP III definition.

scholarly journals A study of prevalence of metabolic syndrome in patients with type 2 diabetes mellitus in a tertiary care referral hospital in West Bengal

2019 ◽  
Vol 8 (10) ◽  
pp. 2262
Author(s):  
Tamoghna Maiti ◽  
Sonai Mandal ◽  
Ratul Banerjee ◽  
Somenath Das ◽  
Amrita Panda
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
West Bengal ◽  
Cardiac Risk Factor ◽  
Diabetic Patients ◽  
Low Grade ◽  
The Metabolic Syndrome ◽  
Increased Risk

Background: The terms "metabolic syndrome", "insulin resistance syndrome" and "syndrome X" are now used specifically to define a constellation of abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease. It is a state of chronic low grade inflammation with the profound systemic effects. Several organisations gave several criteria to diagnose it. Effective preventive approaches include lifestyle changes, primarily weight loss, diet, and exercise, the appropriate use of pharmacological agents to reduce the specific risk factors.Methods: A cross-sectional study was done to evaluate the co-morbidity profile of patients, with metabolic syndrome and correlate clinical manifestations with specific components or metabolic syndrome, at the OPD of Bankura Sammilani Medical College and Hospitals, West Bengal. American Association of Clinical Endocrinologists criteria were chosen for diagnosis.Results: 100 patients were recruited having type II diabetes mellitus. Most of the patients were male between 20-70 years and maximum was on oral hypoglycemic agent with app 40% patient was without any glycemic control. In comorbidities hypertension was highest, followed by coronary artery disease, hypothyroidism and cerebrovascular accident. Waist-hip ratio was highest in female. All of the patients were having some cardiac risk factor assessed by ECG, echocardiography and thread mill test.Conclusions: The data demonstrates that metabolic syndrome is extremely common among diabetic patients. Frequency was much higher in women than men. Obesity is a key element in causing the metabolic syndrome and this factor was also more common in women.

scholarly journals Recent advances in managing/understanding the metabolic syndrome

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 370 ◽  
Author(s):  
Carlos A. Aguilar-Salinas ◽  
Tannia Viveros-Ruiz
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
De Novo ◽  
New Drugs ◽  
Low Grade ◽  
Treatment Targets ◽  
Positive Effects ◽  
The Metabolic Syndrome

The metabolic syndrome (MetS) concept gathers in a single entity a set of metabolic abnormalities that have in common a close relationship with ectopic deposit of lipids, insulin resistance, and chronic low-grade inflammation. It is a valuable teaching tool to help health professionals to understand and integrate the consequences of lipotoxicity and the adverse metabolic consequences of insulin resistance. Also, it is useful to identify subjects with a high risk for having incident type 2 diabetes. Systems biology studies have gained a prominent role in understanding the interaction between adipose tissue dysfunction, insulin action, and the MetS traits and co-morbidities (that is, non-alcoholic steatohepatitis, or NASH). This approach may allow the identification of new therapeutic targets (that is, de novo lipogenesis inhibitors for NASH). Treatment targets on MetS are the adoption of a healthy lifestyle, weight loss, and the control of the co-morbidities (hyperglycemia, dyslipidemia, arterial hypertension, among others). The long-term goals are the prevention of type 2 diabetes, cardiovascular events, and other MetS-related outcomes. In the last few decades, new drugs derived from the identification of innovative treatment targets have come on the market. These drugs have positive effects on more than one MetS component (that is, hyperglycemia and weight control). New potential treatment targets are under study.

scholarly journals Relationship of Metabolic Syndrome Defined by IDF or Revised NCEP with Glycemic Control among Malaysians with Type 2 Diabetes

2020 ◽  
Author(s):  
Riyadh Saif-Ali ◽  
Nor Azmi Kamaruddin ◽  
Molham AL-Habori ◽  
Sami A Al-Dubai ◽  
Wan Zurinah Wan Ngah
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Diabetic Patients ◽  
C Peptide ◽  
The Metabolic Syndrome ◽  
Cardiovascular Morbidity And Mortality

Abstract Background Chronic complication of Type 2 Diabetes (T2D) such as macrovascular disease is amplified with the increase in the number of the metabolic syndrome (MetS) risk factors. Specific criteria for diagnosis of MetS are essential to help in glycemic control and reduce cardiovascular morbidity and mortality in diabetic patients with metabolic syndrome.Methods The study is cross-sectional observational study which involved 485 T2D patients who are receiving treatment at the University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. Metabolic syndrome among the T2D patients was diagnosed based on IDF and NCEP-R criteria. C-peptide and glycated hemoglobin (HbA1c) levels were determined by an automated quantitative immunoassay analyzer and high-performance liquid chromatography, respectively. The metabolic syndrome factors, glucose, triglyceride and HDL cholesterol were measured by spectrophotometer Results Application of IDF and NCEP-R criteria respectively resulted in 73% and 85% of T2D subjects being diagnosed with MetS. The concordance of these criteria in diagnosing MetS among T2D was low (κ =0.33, P<0.001). Both IDF and NCEP-R criteria indicated that T2D with five criteria of MetS had higher insulin resistance (P=2.1×10-13, P=1.4×10-11), C-peptide (P=1.21×10-13; 4.1×10-11), blood glucose (P=0.01; 0.021) and HbA1c (P=0.039; 0.018) than those T2D without MetS respectively. Conclusion Although, there is a low concordance between IDF and NCEP-R criteria in the diagnosis of MetS among T2D, both criteria showed that T2D with five criteria of MetS had higher insulin resistance, blood glucose and HbA1c.

Sign in / Sign up

Export Citation Format

Share Document