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"Type 2 diabetes mellitus"
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Diagnosing the legacy : the discovery, research, and treatment of type 2 diabetes in Indigenous youth
In the late 1980s, pediatric endocrinologists at the Children's Hospital in Winnipeg began to notice a new cohort appearing in their clinics for young people with diabetes. Through dozens of interviews, Krotz shows the impact of the disease on the lives of individuals and families, especially in communities far removed from the medical personnel and facilities available in the city.
Book
Genetic drivers of heterogeneity in type 2 diabetes pathophysiology
Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes
1
,
2
and molecular mechanisms that are often specific to cell type
3
,
4
. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (
P
< 5 × 10
−8
) that map to 611 loci, of which 145 loci are, to our knowledge, previously unreported. We define eight non-overlapping clusters of T2D signals that are characterized by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type-specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial cells and enteroendocrine cells. We build cluster-specific partitioned polygenic scores
5
in a further 279,552 individuals of diverse ancestry, including 30,288 cases of T2D, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned polygenic scores are associated with coronary artery disease, peripheral artery disease and end-stage diabetic nephropathy across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings show the value of integrating multi-ancestry genome-wide association study data with single-cell epigenomics to disentangle the aetiological heterogeneity that drives the development and progression of T2D. This might offer a route to optimize global access to genetically informed diabetes care.
A meta-analysis of genome-wide association studies of type 2 diabetes (T2D) identifies more than 600 T2D-associated loci; integrating physiological trait and single-cell chromatin accessibility data at these loci sheds light on heterogeneity within the T2D phenotype.
Journal Article
The type 2 diabetes diet book
Using this guide, you can design a low-carb, low-calorie diet that helps you shed weight while controlling your diabetes. --from publisher description.
Book
Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial
Abstract
Context
Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment.
Objective
Compare the remission of T2DM following surgical or nonsurgical treatments.
Design, setting, and participants
Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016.
Interventions
61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years.
Main Outcomes and Measures
Diabetes remission assessed at 5 years.
Results
The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01).
Conclusions
Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.
Journal Article
Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
This double-blind, randomized trial compared canagliflozin with placebo in patients with type 2 diabetes and evidence of kidney disease that was treated with renin–angiotensin system blockade. The canagliflozin group had a lower risk of kidney disease progression or cardiovascular events than the placebo group.
Journal Article
Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes
In a follow-up study of patients with type 2 diabetes, mortality benefits in those originally assigned to antihypertensive therapy were evident at the end of follow-up, but in-trial glucose differences did not result in long-term benefits in mortality or macrovascular events.
Post-trial follow-up studies involving patients with diabetes have previously shown long-term beneficial effects of earlier periods of intensive glucose control, but not blood-pressure lowering, on a range of outcomes, including mortality and macrovascular events.
1
–
3
The Epidemiology of Diabetes Interventions and Complications (EDIC) study, an extension of the Diabetes Control and Complications Trial (DCCT) involving young patients with type 1 diabetes and no history of cardiovascular disease, hypertension, or hypercholesterolemia, showed a lower risk of macrovascular events, as well as a sustained benefit with respect to microvascular complications, beyond the period of intensive glucose control.
1
The post-intervention follow-up of the . . .
Journal Article
Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes
In this trial in persons with chronic kidney disease and type 2 diabetes, combination therapy with finerenone and empagliflozin led to a greater reduction in the urinary albumin-to-creatinine ratio than either drug alone.
Journal Article
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction
In this randomized, placebo-controlled trial, investigators evaluated the effects of the sodium–glucose cotransporter 2 inhibitor dapagliflozin in patients with heart failure and a reduced ejection fraction with or without type 2 diabetes. The risk of worsening heart failure or cardiovascular death was lower among those who received dapagliflozin, regardless of the presence or absence of diabetes.
Journal Article
Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes
Patients with type 2 diabetes and high cardiovascular risk were assigned to receive either the glucagon-like peptide 1 analogue liraglutide or placebo. The rate of first occurrence of cardiovascular death, nonfatal MI, or nonfatal stroke was lower with liraglutide.
Type 2 diabetes is a complex metabolic disorder that is characterized by hyperglycemia and associated with a high risk of cardiovascular, microvascular, and other complications.
1
,
2
Although glycemic control is associated with reductions in the risk of microvascular complications, the macrovascular benefits of glycemic control are less certain. Furthermore, concern has been raised about the cardiovascular safety of antihyperglycemic therapies.
3
Consequently, regulatory authorities have mandated cardiovascular safety assessments of new diabetes treatments.
4
,
5
Liraglutide, an analogue of human glucagon-like peptide 1 (GLP-1),
6
has been approved for the treatment of type 2 diabetes. Its efficacy in lowering glucose levels has been . . .
Journal Article
Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes
Five-year data showed that among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing or resolving hyperglycemia, even among those with a BMI of less than 35.
Observational studies
1
–
6
and randomized, controlled trials, which have generally been short-term studies,
7
–
19
have shown that bariatric surgery, when used specifically to treat diabetes, significantly improves glycemic control and reduces cardiovascular risk factors. In the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, we reported that, at 1 year and 3 years after randomization, both gastric bypass and sleeve gastrectomy were superior to intensive medical therapy alone in achieving excellent glycemic control (i.e., glycated hemoglobin ≤6.0%), reducing cardiovascular risk, improving quality of life, and decreasing medication use.
8
–
10
The current article provides results of the final, 5-year . . .
Journal Article