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대한당뇨병학회> International Congress of Diabetes and Metabolism> Effects of polydextrose on glycemic and insulinemic responses in healthy normal weight and overweight women when consumed during a breakfast meal

Effects of polydextrose on glycemic and insulinemic responses in healthy normal weight and overweight women when consumed during a breakfast meal

Alvin Ibarra , Kaisa Olli , Wilrike Pasman , Henk Hendriks , Esa Alhoniemi , Karl-heinz Herzig , Kirsti Tiihonen
  • : 대한당뇨병학회
  • : International Congress of Diabetes and Metabolism 2016권0호
  • : 프로시딩
  • : 2016년 10월
  • : 149-149(1pages)
International Congress of Diabetes and Metabolism

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Objective: Substantial evidence indicates that polydextrose (PDX), a soluble fiber, alters glucose metabolism and reduces the glycemic response when acting as a replacement for sugars. These effects are accompanied by a significant decline in insulin. This is the first study to assess the effects of PDX on glycemia and insulinemia in women only.
Methods: The study was acute, randomized, double-blinded and crossover in design in order to assess the effects of a breakfast containing 12.5 g of PDX (1600 kJ) versus an isocaloric control breakfast on glycemic and insulinemic responses in 32 women (27.4 ± 6.6 yrs; 25.9 ± 2.7 kg/m2). The levels of blood glucose and blood insulin were assessed before (-10 min), and 30, 60, 90, 150 and 240 min after breakfast. Glucose was measured using an enzymatic method (Gluco-quant Glucose/HK, Roche Diagnostics), and insulin was measured by ELISA (E170 Module, Roche Diagnostics). All results were expressed as iAUC and analyzed using a mixed model in SAS.
Results: The mean iAUC of blood glucose for the breakfast containing PDX was higher than the control breakfast (P = 0.06; 99 ± 140 mmol.L-1.min and 41 ± 122 mmol.L-1.min, respectively). The mean iAUC of blood insulin for the breakfast containing PDX was significantly lower than the control breakfast (P = 0.04; 4851 ± 3185 mU.L-1.min and 5756 ± 3622 mU.L-1.min, respectively). 
Conclusion: In our study, the glycemic response of PDX was similar to control during the first hour after breakfast and increased after but not significantly. Our trial is the first to report a delay in glucose absorption during the postabsorptive phase due to the consumption of PDX at breakfast time. The effect of PDX in delaying glucose absorption might help prevent weight gain and the development of type 2 diabetes. PDX significantly reduced the levels of insulin in women, as expected.

UCI(KEPA)

I410-ECN-0102-2021-500-000702651

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1Death of pancreatic ß-cells and death-associated inflammation in diabetes - effect of autophagy enhancer on human-type diabetes

저자 : Myung-shik Lee

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 1-1 (1 pages)

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We have been studying the role of cell death and cell death-associated inflammation/immunity in diabetes. Apoptosis of pancreatic β-cells contributes to the development not only of type 1 diabetes (T1D) but also of type 2 diabetes (T2D). In T1D, apoptosis of pancreatic β-cells is the last step in the development of disease. Apoptosis is also important in the initial event of T1D. During pancreas ontogeny, physiological β-cell apoptosis occurs, and such apoptotic β-cells may undergo secondary necrosis in autoimmune-prone mouse strains showing delayed macrophage removal of apoptotic cells. Such late apoptotic β-cells can stimulate antigen-presenting cells through innate immune receptors such as TLR2, which constitute the initial steps in T1D. In contrast to apoptosis, β-cell autophagy usually plays a protective role. β-cell autophagy is important in the maintenance of islet structure, mass and function, and its impairment undermines β-cell adaptation to metabolic stress and leads to β-cell apoptosis in obesity, suggesting that autophagy deficiency is a cause of the progression from obesity to diabetes. β-cell autophagy appears to be more important in human-type diabetes since human-type islet amyloid polypeptide (hIAPP) accumulating in islets of human T2D is amyloidogenic and cleared preferentially by autophagy. Recently, we developed an autophagy enhancer (MSL-7) that can improve metabolic profile of obese mice by enhancing lipid clearance and reducing inflammasome activation associated with mitochondrial dysfunction, in a manner dependent on Tfeb, a master regulator of lysosomal biogenesis and autophagy gene expression. MSL-7 also improved glucose tolerance andβ-cell function of hIAPP-transgenic mice on high-fat diet in vivo, accompanied by reduced islet hIAPP oligomer/amyloid accumulation and β-cell apoptosis. These results suggest that autophagy enhancer could have therapeutic potential against obese diabetes and human diabetes characterized by islet amyloid accumulation.

2Diabetes and infection and COVID-19

저자 : Andrea Luk

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 1-1 (1 pages)

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Infection is a known complications of diabetes. In a very early communication by Dr John Lichty in 1915, deaths due to infection were reported in up to one third of people with diabetes. In a series of contemporary epidemiological studies, diabetes has been shown to associate with increased rates of infection of the respiratory tract, genitourinary tract, skin and musculoskeletal system. Most recently, severe complications and deaths from coronavirus 2019 (COVID-19) were reported to occur more frequently in people with diabetes than those without diabetes, matched for demographics and comorbidities.
Despite these strong associations, research in pharmacological and non-pharmacological approaches to prevent serious infections are lacking. From a recent analysis of the Hong Kong Diabetes Surveillance Database covering over 90% of the population with diabetes in Hong Kong, rates of hospitalisation due to influenza increased and hospitalisation due to pneumonia and other infection types were stagnant over a 16-year period from 2001 to 2016. In age-stratified analyses, rising trends for several infection types were detected in the youngest age group whose risk of pneumonia was increased 4-fold, tuberculosis 7-fold and general sepsis 11-fold compared with their age-matched counterparts without diabetes. As of now, pneumonia accounts for over 30% of deaths in Hong Kong adults with diabetes, surpassing cardiovascular disease and cancer. Hence the epidemiology of diabetes complication appears to have turned a full circle, with infection re-emerging once again as an important contributor to morbidities and mortality. These findings call for greater awareness of infection risks in our patients and improved public health measures including support for vaccination for this high-risk group.

3The GDF15-GFRAL pathway in metabolic regulation

저자 : Samuel N Breit

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 1-1 (1 pages)

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Growth Differentiation Factor-15 (GDF15) is a cytokine of the glial derived neurotrophic factor family, within the TGFb superfamily. It circulates in normal humans at concentrations of about 200-1200pg/ml but these levels can rise markedly in pregnancy or as part of many disease processes. In disease processes, its expression can be induced or increased in many different tissues by cell stress, mediated by transcription factors such as p53, CHOP and ATF4. Common metabolic disorders associated with increased serum levels of GDF15 include obesity, diabetes and mitochondrial diseases. In some chronic diseases like advanced cancer, chronic heart, liver or lung failure serum GDF15 levels can rise markedly. This can lead to an anorexia/ cachexia syndrome, an observation that first identified GDF15 as a previously unrecognised appetite regulator causing anorexia.
Circulating GDF15's major site of action is in small adjacent regions of the brainstem with a semi=permeable blood brain barrier, called the area postrema (AP) and nucleus of the solitary tract (NTS). There it binds to its receptor, a divergent member of the glial cell derived neurotropic factor receptor (GFR) family called GFR alpha like (GFRAL), and signals through its co-receptor Ret. Activation of the GFRAL positive neurons by GDF15 initiates neuronal pathways which lead to reduced food intake, altered metabolism and energy homeostasis by mechanisms that are still only partly understood, but have clear therapeutic application.
A major role of GDF15 thus seems to be to deliver signals of increased cell stress from tissues, via the circulation, to the brain. This then orchestrates a response to try to correct the cell stress and restore homeostasis. Using both human and animal experimental data, this presentation will discuss the biology and mechanisms of actions of GDF15 in regulation of appetite and energy and glucose homeostasis both in health and disease.

4Diabetes and COVID-19: Japanese perspectives

저자 : Mitsuru Ohsugi

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 1-2 (2 pages)

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Japan had experienced early waves of SARS-CoV-2 cases probably due to proximity to the mainland China and in part due to high volume of human flow in early 2020. Since then, although draconian lockdown seen in many other countries had not been implemented in Japan, state of emergency was declared several times by the Japanese government and partly volunteer-based but significant reduction of social and commercial activities was taken, the health care systems in Japan has barely evaded their collapse and waded multiple waves of COVID-19 case surge. Our Medical Center, National Center for Global Health and Medicine, took an initiative to build a nationwide registry of COVID-19 cases, which currently holds more that 50,000 cases. Insights from this registry was significant and in line with other global reports on risk factors for significant mortality and morbidity from COVID-19. In this lecture, two important risk factors for severe outcomes, obesity and hyperglycemia, will be focused and detailed.

5Diabetes and COVID-19: general introduction

저자 : Soo Lim

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 1-1 (1 pages)

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Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin-angiotensin-aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium-glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted.

6Intermittent fasting and low carbohydrate diet on body weight in overweight/obese adults

저자 : Jee-hyun Kang

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 2-2 (1 pages)

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Recently, the intermittent fasting and the very low carbohydrate diet for the treatment of obesity have become popular with the public. This review will provide the recent evidence or the efficacy on body weight and the safety of the intermittent fasting and the low carbohydrate diet in overweight and obese adults.

7Planning and practice of evaluating the evidences on benefit and risk of trendy dietary pattern

저자 : Kee-ho Song

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 2-2 (1 pages)

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A low carbohydrate diet and time-restricted feeding are commonly used diet patterns for the treatment of obesity and diabetes. However, the effect of these two diet patterns on glycemic control and weight control is not well known. We included studies with the following characteristics: 1) controlledstudies with randomized (RCTs) designs; 2) intervention groupwith low carbohydrate diet or time-restricted feeding; 3) study duration ≥ 12 weeks; 5) age of participants >18 years. The validity of the studies was independently assessed by twoauthors using the tool of the “Risk of bias” tooldeveloped by the Cochrane Collaboration for RCTs.

8Intermittent Fasting in diabetes/prediabetes, evidence evaluation on glycemic control

저자 : Suk Chon

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 2-2 (1 pages)

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Recently, an intermittent fasting diet has been widely popularized as being helpful for weight loss. However, there is no sufficient evidence for the efficacy and safety of this diet. In particular, evidence on the efficacy and safety of glycemic control in diabetes and pre-diabetes is more unclear. In this lecture, systematic review and meta-analysis results will be introduced and discussed on the effects and safety of intermittent fasting on glycemic control in people with pre-diabetes and diabetes.

9Covid-19 vaccine development in Taiwan

저자 : Szu-min Hsieh

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 2-2 (1 pages)

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In response to the pandemics of human infections due to SARS-CoV-2, many vaccine candidates from several platforms have been developed rapidly under rolling review process and EUA policy. Taiwan also has programs to establish and manufacture the protein-based Covid-19 vaccine to face the threat of pandemics, in addition to purchased adenovirus-vectored vaccines and mRNA vaccines. In this lecture, I will introduce the similarity between our domestic protein-based vaccine (MVC-1901) and Moderna mRNA vaccine, and up-to-date data and publication about the MVC-1901 vaccine.

10“Low Carb Diet” in diabetes/prediabetes, evidence evaluation on glycemic control

저자 : Jong Han Choi

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2021권 0호 발행 연도 : 2021 페이지 : pp. 2-2 (1 pages)

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The clinical practice guidelines for diabetes do not suggest standard carbohydrate, protein, and fat ratios in medical nutrition therapy for diabetic patients but recommend individualization according to the patient characteristics. Simultaneously, they recommend reducing carbohydrate intake to improve glycemic control, according to studies on the weight reduction and glucose-lowering efficacy of a low-carbohydrate diet. However, they also do not recommend specific ratios or amounts of carbohydrates but recommend individualizing it according to the judgment of the attending physician based on the medical history, medications, and eating habits of the patients. It is incredibly challenging to make standardized recommendations, especially in diabetic patients because they have higher risks of harm, such as hypoglycemia, from a low-carb diet than the general population. In the absence of expert recommendations, diabetic patients are uncritically accepting and widely spreading various trendy low-carb diets that have no medical evidence but can be harmful. Accordingly, the new guidelines of the Korean Diabetes Association (KDA) recommend that you avoid following highly trendy diets that have not been verified for medical efficacy and safety, such as extreme low-carbohydrate and high-fat diets. Therefore, the Food and Nutrition Committee of the KDA intends to update the novel medical evidence clarifying the benefits and harms of a low-carb diet in diabetes/prediabetes patients by conducting an extensive literature review and meta-analysis of recent studies on low-carb diets.

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1Cross-species genetic mapping of targets in metabolism and aging

저자 : Johan Auwerx

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 3-3 (1 pages)

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Our understanding of genetic mechanisms that define complex traits has been hindered by the difficulty of obtaining comprehensive omics datasets across a broad range of biological “layers”. Complete data on the genome of individuals can be readily obtained, but the full complexity of the transcriptome, proteome, metabolome, and phenome have remained largely out of reach. This is, however, beginning to change, with the development of robust multi-layered omics strategies that are pioneered in model organisms. We here profiled the healthspan and lifespan in > 80 cohorts of the BXD mouse genetic reference population. Large variability was observed across all omics layers; to understand how these differences stem from genetic variance, we exploited a multilayered set of molecular phenotypes―genomics, transcriptomics, proteomics, and metabolomics. With this multi-omics strategy, large networks of proteins could be analyzed and causal variants identified in proteins involved in determination of lifespan (e.g. Mrps5, Jmjd3), glucose homeostasis (e.g. Dhtkd1), hypertension (Ubp1) and in mitochondrial supercomplex formation (Cox7a2l ). These new candidates were then validated using cross-species genetic strategies in C.elegans, mouse, and human. Our large-scope multi-omics measurements in mouse populations combined with cross-species validation hence provided us with robust conserved and mechanistically defined pathways that underpin complex traits involved in metabolism and aging.

2Diabetes & metabolic syndrome in Korea: epidemiology & novel risk factors

저자 : Moon-kyu Lee

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 4-4 (1 pages)

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The prevalence of diabetes or metabolic syndrome (MetS) has steadily increased in Korea and obesity is one of the most important risk factors for them. The prevalence of MetS in Korea increased rapidly from 24.9% in 1998 to 31.3% in 2007 and so did the prevalences of diabetes and obesity. MetS was associated with an increased risk of cardiovascular diseases (CVDs), and in particular was associated with the risk of coronary heart disease (CHD) in men and stroke in women. Diverse risk factors for either diabetes or metabolic syndrome have been reported, such as age, dietary habits, physical fitness, sleep deprivation, and decreased heart rate recovery (HRR). It has also been reported that the serum calcium concentration is positively correlated with glucose level. In addition, serum bilirubin has been consistently shown to be negatively correlated with the cardiovascular diseases (CVDs) as well as with CVD-related diseases and risk factors such as arterial hypertension, diabetes, MetS, and obesity. We analyzed data from the Korean Health and Genome Study to examine the association of serum total bilirubin (TB) and corrected calcium levels with the risk of DM development. DM incidence increased across baseline TB and calcium tertile categories. Hazard ratio (HR) for developing DM was higher in the highest tertiles compared with the lowest after adjusting for confounding variables. These results suggest that there could be multiple, diverse risk factors for diabetes and metabolic syndrome, which should be considered in the development of prevention strategies.

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Pyruvate dehydrogenase complex (PDC) is a key enzyme to control metabolic flux during the fed-fast cycle. Adequate regulation of PDC is very important not only in the rapid selection of fatty acid and glucose metabolism and also in adequate selection of metabolic fate for glycolysis and oxidative phosphorylation. The main mechanism of insulin resistance followed by dietary fat-induced obesity is closely associated with mitochondrial dysfunction and endoplasmic reticulum (ER) stress. In this presentation, we want to show the role of pyruvate dehydrogenases kinase(PDK) involved in dietary fat-induced insulin resistance, used Wild-type (WT) mice and several different models of global pyruvate dehydrogenase kinase(PDK) knockout mice such as PDK2 knockout mice, PDK4 knock mice on fed low fat (LFD) or high fat (HFD) diets.

4An approach to the older person with diabetes mellitus

저자 : Hyung Joon Yoo

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 9-9 (1 pages)

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Care of the older person with diabetes can't be restricted to the management of hyperglycemia, associated risk factors, and specific diabetic complications. An integrated approach should include also the assessment and management of gerontological problems.
Gerontology is composed of 3 fields such as gerontological biology, gerontological sociology, and geriatric medicine. What is the practical way to integrate the gerontological features of older person with diabetes to the management of the older person with diabetes? I selected one topic from each field of gerontology, vascular aging from biology, health literacy from sociology, and geriatric syndrome from geriatric medicine respectively.
Fluctuating glucose levels increased proliferation and migration of OLETF rat vascular smooth muscle cells (VSMCs) via MAPK (ERK1/2), BMK1, PI3K, and NF-κB pathways. These effects were inhibited by the antioxidant rutin.
Only 23.8% of elderly diabetic patients had appropriate health literacy. Older persons with diabetes were heterogenous in social aspects including health literacy.
Both his diabetes mellitus and his aging interact toward the direction of the increased incidence of the geriatric syndromes. Education is a common element of both diabetes control and geriatric syndrome care. But it has been perceived that conventional education (CE) programs for diabetics are not as effective for the older. We designed a geriatrically reinforced education (GRE) for application in older diabetics with geriatric syndromes. We observed that the application of GRE made glucose control and the status of geriatric syndromes get better in older adults with diabetes.
In summary, in terms of the integrating care of coexisting diabetes and geriatric problems, geriatrically reinforced education (GRE) may be a beneficial tool on the management of older adults with diabetes.

5SGLT2 inhibition: is there a downside?

저자 : Merlin C Thomas

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 13-13 (1 pages)

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Inhibition of renal glucose reabsorption by the inhibition of the Sodium Glucose Transporter 2 (SGLT2) has emerged as not only a practical way to lower glucose levels in patients with type 2 diabetes without increasing the risk of hypoglycaemia or weight gain, but also with the clear potential for vasculoprotective effects that are independent to the achieved glucose control. The strong expectation surrounding drugs of this class has led to a rapid expansion of their use. However, such exciting data should be tempered by the potential for adverse effects, as the first priority in our patients must be to minimise the potential for harm. It is clear that complete deficiency of SGLT2 in humans is not dangerous, and leads to a condition known as benign familial glycosuria. Consequently, subtotal blockade of SGLT2 that occurs during pharmacological inhibition is often considered equally benign. However, in the setting of diabetes, SGLT2 inhibition increases urine output proportional to glycosuria, resulting in troublesome polyuria and nocturia in some patients, especially those with bladder/pelvic floor/prostate dysfunction. SGLT2 inhibition increases the frequency of genital mycotic infections in both men and women, although both are readily treatable and rarely severe or recurrent. Curiously, urinary tract infects are not increased by SGLT2 inhibitors, possibly as increased urine flow/frequent bladder emptying offsets the effect of glycosuria. Recent data has also emerged that SGLT2 inhibition increases ketogenesis, and in some selected settings may be associated with ketoacidosis. For the most part, each of these adverse effects can be mitigated by judicious prescribing and treatment planning.

6Cardiovascular & renal outcomes of incretin-based therapy

저자 : Kyung Mook Choi

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 14-14 (1 pages)

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Vascular complications are the most important cause of morbidity and mortality in patients with diabetes. Macrovascular complications consist of coronary artery disease (CAD) and cerebrovascular disease, while microvascular complications embrace nephropathy, neuropathy, and retinopathy. Recently, incretin-based therapy, such as dipeptidyl peptidase IV inhibitors (DPP4I) or glucagon-like peptide-1 (GLP-1) receptor agonists, has drawn attention as a potential therapeutic option for the prevention of cardiovascular and renal complications in patients with type 2 diabetes. Previous studies have shown that incretin-based therapy can reduce oxidative stress, inflammation, glomerulosclerosis, and fibrosis in kidney as well as albuminuria. Furthermore, accumulating evidence demonstrates the direct and indirect actions of incretin-based therapy on the cardiovascular system. Randomized controlled clinical trials are under way to investigate the impact of incretin-based therapy on cardiovascular and renal outcomes in patients with type 2 diabetes. The present talk will summarize the pathophysiological mechanisms and therapeutic interventions of incretin-based treatment in patients with type 2 diabetes.

7GLP-1 receptor agonists: similarities and differences

저자 : Chang Hee Jung

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 15-15 (1 pages)

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The gastrointestinal hormone glucagon-like peptide-1 (GLP-1) lowers postprandial glucose concentrations by regulating pancreatic islet-cell function, with stimulation of glucose-dependent insulin and suppression of glucagon secretion. In addition to endocrine pancreatic effects, mounting evidence suggest that several gastrointestinal actions of GLP-1 are at least as important for glucose lowering. GLP-1 reduces gastric emptying rate and small bowel motility, thereby delaying glucose absorption and decreasing postprandial glucose excursion.
Currently available GLP-1 receptor agonists (GLP-1 RAs) can be categorized as either “short-acting compounds”, which provide short-lived receptor activation (such as exenatide and lixisenatide) or as “long-acting compounds” (for example albiglutide, dulaglutide, exenatide long-acting release, and liraglutide), which activate the GLP-1 receptor continuously at their recommended dose. The pharmacokinetic differences between these drugs lead to important differences in their pharmacodynamics profiles.
In this session, I'd like to deal with the similarities and differences between short-acting GLP-1 RAs and long-acting GLR-1 RAs. I hope that this review will help various GLP-1 RAs treatment to be tailored to the needs of each patient with type 2 diabetes.

8Ultra-long acting insulin: How long should it be?

저자 : Hyuk-sang Kwon

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 16-16 (1 pages)

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Relative insulin deficiency with insulin resistance is the main pathogenesis of type 2 diabetes mellitus (T2DM). However, T2DM is a progressive disease, so oral medications may not be enough to control glucose levels, and exogenous insulin is needed in type 2 diabetes eventually.
Insulin is classified into basal and prandial insulin; basal insulins inhibit hepatic glucose production and provide constant level of insulin action throughout the day whereas prandial (mealtime) insulins act rapidly to lower glucose levels following meals. Traditional basal insulin is NPH and it is intermediate-acting (up to 12 hours) with higher risk of hypoglycemia. In contrast, insulin glargine and detemir is relatively long-acting (up to 24 hours) insulin and less hypoglycemia (overall and nocturnal) than NPH. So introduction of insulin glargine and detemir provided an improvement in basal insulin therapy.
Now ultra-long-acting basal insulins like insulin glargine U300 and degludec are available. They have longer half-life, flatter glycemic profiles compared with glargine U100 or detemir as well as NPH. Currently, no specific AACE or ADA recommendations for use of these new basal insulins. Guidelines generally emphasize the value of basal insulin compared with NPH insulin (eg. less hypoglycemia). This lecture will review ultra-long acting basal insulins in detail.

9Clinical practice guidelines in management of type 1 diabetic patients

저자 : Dong-hyeok Cho

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 17-17 (1 pages)

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Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. Only < 5% of people with diabetes have this form of the disease. The Diabetes Control and Complications Trial (DCCT) showed definitively that improved glycemic control is associated with significantly decreased rates of microvascular and neuropathic complications in type 1 diabetes.
Proper type 1 diabetes management is composed of a handful of elements: blood glucose control and insulin management, exercise, nutrition and support. The American Diabetes Association recommends using patient age as one consideration in the establishment of glycemic goals, with targets for preprandial, bedtime/overnight, and hemoglobin A1c levels. In 2014, the ADA released a position statement on the diagnosis and management of type 1 diabetes in all age groups. An A1C goal of < 7.5% is recommended across all type 1 pediatric patients, and for many type 1 adults is < 7%. Individualized lower or higher targets may be used based on patient need.
Patients with type 1 diabetes require lifelong insulin therapy. Most people with type 1 diabetes should be treated with multiple-dose insulin injections or continuous subcutaneous insulin infusion. Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity.
Screening for diabetic complications is an important component of ongoing care. At least once a year, assess urinary albumin and estimated glomerular filtration rate, an initial dilated and comprehensive eye examination and tests for diabetic neuropathy in patients with type 1 diabetes with duration of ≥ 5 years or adult type 1 diabetes.

10Education programs for the better self-management of children and adolescents with type 1 diabetes

저자 : Eun-kyung Kwon

발행기관 : 대한당뇨병학회 간행물 : International Congress of Diabetes and Metabolism 2016권 0호 발행 연도 : 2016 페이지 : pp. 18-18 (1 pages)

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Type 1 diabetes, which usually happens to the pediatric age group, is one of representative chronic diseases among children. It requires education and management from an experienced professional diabetes team from the moment of diagnosis and asks the patients to self-monitor their blood sugar level for life to prevent complications.
Proper self-management education programs should be provided right after diagnosis and should not be a one-time event but be provided on an ongoing basis.
They can promote the adjustment of patients and their families and play an essential role in their better quality of life.
This lecture will provide an introduction of the various education programs implemented to improve patients' self-management in the clinical field of a hospital and will share the experiences. It will also discuss future-oriented educational programs and their directions.

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