Type II Diabetes

The present study was designed to quantitate the interaction between the decrease in target tissue insulin action seen in subjects with Type II diabetes and the mass action effect of glucose exerted via the prevailing hyperglycemic state. To this end, euglycemic glucose clamp studies were performed in 26 control subjects using insulin infusion rates of 15, 40, 120, 240, and 1,200 mU/M2 per min and in 10 Type II diabetic subjects using insulin infusion rates of 120 and 1,200 mU/M2 per min. The results of these euglycemic studies indicated that insulin-stimulated peripheral glucose disposal was decreased in the Type II diabetics due to a combined receptor (rightward shift in the dose-response curve) and postreceptor defect in insulin action (decreased maximal response), whereas the decrease in insulin-mediated suppression of hepatic glucose output (HGO) was consistent with a defect in insulin binding (rightward shift in dose-response curve). Hyperglycemic glucose clamp studies were also performed in the Type II diabetics at their respective fasting serum glucose levels (mean [+/- SE] 280 +/- 17 mg/dl) employing insulin infusion rates of 15, 40, 120, and 1,200 mU/M2 per min. In the presence of their basal level of hyperglycemia, the noninsulin-dependent diabetes mellitus (NIDDM) subjects exhibited rates of overall glucose disposal that were similar to those observed in control subjects studied at euglycemia at similar steady […]

Although MAPK insulin signalling pathway was not investigated in this study, previous data from researchers [40] support the idea that alterations in MAPK signal transduction contributes to development of Type II diabetes as well. The coordinated regulation of glucose uptake from circulation and endogenous glucose pro- duction is indispensable to maintain constant blood glucose level. The liver contributes to this process through controlling the gluconeogenesis and glycogenol- ysis. Suppression of endogenous glucose production during the postprandial state is attributed to insulin. Moreover, insulin activates glycogen synthase while sim- ultaneously inactivates phosphorylase a and phosphoryl- ase kinase to control glycogen metabolism through the MAPK pathway [27]. Mice lacking MAPK phosphatase-1

Type-II diabetes also called as diabetes mellitus is a metabolic disorder which causes sugar levels in body to raise up. Unlike Type-I diabetes, Type-II diabetes can be reversible. The treatment can be different from one person to other person. Some need only lifestyle changes like reducing weight, leading healthy lifestyle etc. and doesn’t require taking insulin. While others need to take medical treatment which involves medicines, insulin injections and following good lifestyle to maintain sugar levels. During metabolic activity intake of food is converted to energy. This process requires hormone called insulin which helps in converting sugars to energy. Type-II diabetes is caused when body slowly loses its capacity to absorb insulin, which actually controls the sugar level, thereby sugar levels in body will not be controlled and hence higher sugar values in Type-II diabetes patients. This is also referred as “adult- onset” diabetes as this is developed in later stages of life. This has other name “insulin resistance” as body is showing resistance to absorb insulin. This is more common when compared to other types of diabetes. Statistics show that out of 100 diabetes patients, 90 have Type-II diabetes.

Emerging as an epidemic of the 21st century type II diabetes has become a major health problem throughout the globe. Known treatments of type II diabetes mellitus have limitations such as weight gain and hypoglycaemias. A new perspective is the use of incretin hormones and incretin enhancers. Incretin mimetics are a new class of pharmacological agents with multiple antihyperglycemic actions that mimic the actions of incretin hormones such as glucagon-like peptide (GLP)-1. DPP-4, a protease that specifically cleaves dipeptides from proteins and oligopeptides after a penultimate N-terminal proline or alanine, is involved in the degradation of a number of neuropeptides, peptide hormones and cytokines, including the incretins GLP-1 and GIP. Based on preliminary clinical data, incretin mimetics and DPP-IV inhibitors show potential for treating type II diabetes.

Platelet dysfunction associated with dyslipidemia reveals a pattern of coagulation factors that increases coagulation, while on the other hand, decreases thrombolysis. In this case, platelet dysfunction could favor atherosclerosis and vascular thrombosis. Impair- ment in plasma fibrinolytic activity and tissue plasmin- ogen activator activity, when plasminogen activator inhibitor-1 activity is increased, induces both throm- bosis and defective dissolution of a clot once formed. Platelets in type II diabetes patients adhere to the endothelium because of insufficient generation of prostacyclin (PGI2) and nitric oxide (NO) by the vascular endothelium. Consequently, vasoconstriction and platelet aggregation could occur more rapidly than in healthy people. Insulin, by sensitizing the platelet to PGI2, is a natural antagonist of platelet hyperactivity, and in addition, it enhances the endothelial generation of PGI2 and NO. Thus, defects in insulin action in diabetes create a disordered platelet activity. Aspirin can block thromboxan synthesis by acetylation of the platelet cyclooxygenase and may be used to prevent cardiovascular disease in diabetic and nondiabetic patients [3, 45].

The study concluded that almost half of the patients with clinical inertia. More effort is required to improve knowledge and confidence of physicians. Glycemic control is affected by occupation, socioeconomic status, physical activity, diet and follow up regularity. Initiation of insulin is associated with poor glycemic control in patients with type II diabetes mellitus. These findings warrant additional studies examining the benefits of rapid titration to maximum doses and earlier initiation of insulin therapy. Also, further research is needed to understand the clinician, patient, and system barriers to therapy intensification.

Dr.S.Suguna post graduate student in the Department of physiology, Thanjavur Medical College, Thanjavur is doing a study on pulmonary functions tests in Type II Diabetes Mellitus. The procedures have been explained to me clearly. I understand that there are no risks involved in the above procedure. I hereby give my consent to participate in this study. The data obtained here may be used for research and publication.

Question 66 of the QualiAB questionnaire deals with 14 (fourteen) items about routine activities performed in case of patients with Type II Diabetes. There was a statistically significant difference between the two categories of BHU in the requirements evaluated in items 1, 2, 5, 8 and 10, which deal about non-adoption of care according to the primary care protocol aimed at patients with DM II; follow-up adopts the protocol of basic care; performing annual examination of total cholesterol and fractions; control, evaluation and guidance of foot care and; supply of glycometer, respectively to items, as observed in Table 3.

Methods: A total of 64 persons from Erbil city participated in this cross-sectional study. They were divided into two groups, each group involving 32 persons. The cases group included those suffering from type II diabetes and were selected by simple random sampling method. The other group included those not possessing any types of disease including diabetes mellitus. Examination of Helicobacter pylori, glycated hemoglobin (HbA1c), besides measuring blood pressure and body mass index were performed for all individual subjects in both groups. Chi-Square and unpaired t-test were used for data analysis.

The Absolute Neutrophil Count is slightly higher in the test than the control. This may be attributed due to infection. Neutrophil, a type of Polymorpho Nuclear cell, which acts as a first line of defence against the entry of microorganisms inside the body, loses its normal functional ability under hyperglycaemic condition, seen in type II Diabetes Mellitus (Eisaku Ueta et al.). Neutrophils from diabetic patients show reduced adherence to the microbial cells (Bagdade et al, Anderson). Also other key functions of neutrophils such as chemotaxis, phagocytosis, oxidative burst and bactericidal activity are greatly reduced (Rayfield et al, Marhoffer et al, Repine JE et al). Polyols produced from glucose disrupts osmotic balance across the neutrophil cells and plasma and this also

In this paper, the Bayesian Neural Network architecture is used for predictive analysis of type II diabetes. With an intention to select the optimal algorithm, a comparative study over the Pima diabetes dataset using various neural network algorithm was performed. Bayesian Regularization showed the best results against the other algorithms, in terms of accuracy and error minimization. The architecture gained up to 87 % accuracy at the error rate of 0.11429, at epoch 285. Different neural network algorithms were tested for comparative study based on the proposed architecture to clearly identify the difference in the error value and computational values. Future works can be carried out by using different deep learning and ANFIS techniques. Then a strong evaluation of various Machine Learning algorithms could be ensembled and various techniques can be compared with respect to its strengthens.

The current study sought to overcome these difficulties by examining glomerular structure in Pima Indians with type II diabetes. Pima Indians develop type II diabetes at an early age and are not afflicted by equally early development of hyper- tension, atherosclerosis, or nondiabetic renal disease (7, 8). In addition, the onset of diabetes and the magnitude of albumin- uria in individual Pima subjects have been recorded in the course of ongoing epidemiologic studies. We were thus able to examine glomerular structure in Pima subjects in whom the duration of diabetes and the development of clinically appar- ent glomerular injury, reflected by albuminuria, were well doc- umented. An initial aim was to determine if the sequence of glomerular structural changes in type II diabetes is similar to that observed in type I diabetes. A key structural finding in type I diabetes has been that progressive mesangial expansion contributes to loss of glomerular function (3, 4). The current study examined whether mesangial expansion follows the same pattern in type II diabetes. A second aim was to assess the potential contribution of visceral epithelial cell injury to the progression of diabetic glomerulopathy. The elaborately shaped visceral epithelial cell, or podocyte, appears to be inca- pable of replication in adult animals (9–11). Recent studies have further suggested that loss of podocytes imposes a bur- den on the remaining cells, which precipitates the develop- ment of glomerular sclerosis. These experimental findings prompted us to assess podocyte number in patients with dia- betic glomerulopathy.

Traditionally various plants are being used to treat diabetes. It is believed that herbal medicine has little side effects as well as it requires no cost in few cases. So the herbal medicine solve the problem for the poor (Habibet al, 2005). WHO approves the use of plant drugs for the different diseases including diabetes as well. Therefore studies with plant extract are useful to know their efficacy, mechanism of action and safety. Hence a study entitled on “Effect of medicinal plants on type II diabetes ’’ was planned with following objectives:

ABSTRACT: Gliflozin drugs is the sodium-glucose co-transporter 2 inhibitor is the newly developed class of oral hypoglycaemic agents used for the treatment of the type-II diabetes mellitus. This class approved by food and drug administration in 2013 for the treatment of diabetes, with a unique mechanism of action. SLGT-2 proteins are macromolecule reabsorb the filtered glucose molecule from (PCT) in the kidney. This class of drugs block SGLT-2 protein from the site of the proximal convoluted tubule (PCT) in the kidney, resulting in prevent reabsorption of a glucose molecule and allow excretion of glucose molecule through urine. By this mechanism, the gliflozins drug lowers the blood glucose level in the body.SGLT-2 inhibitors are the newest class of anti-diabetic drugs grab more attention when it is used in combination with insulin and other anti-diabetic drugs. Gliflozins shows various adverse effect such as ketoacidosis, urinary tract infection, bone fracture, and foot and leg amputation. This article explained pathogenesis and pathophysiology of type-II diabetes mellitus with a detailed mechanism of action of a gliflozin class of drugs. Also, latest gliflozin class drugs introduced and approved are discussed in this review.

Abstract: Introduction: Diabetic foot problems account for many hospital admissions and if they are not treated properly can lead to life threatening amputations. Moreover they are preventable by self-care practices, early diagnosis and proper management. Therefore, patient’s knowledge and practice regarding foot care remains a mainstay of management. Objective: To describe the level of knowledge and practice of foot care among patients with Type ii diabetes. Methodology: A group of Patients having diagnosed with Type Ll diabetes (N=384) were selected from diabetic clinics of General Hospital Kurunegala for this descriptive cross sectional study. Data were collected by interviewer administered questionnaire and check list. Patient’s knowledge and practice on diabetic foot care were inquired. A scoring system ranging from 0-36 was utilized to analyze the responses given for level of knowledge and practice. Results: Mean age was 58.2 years (SD ±10) and male to female ratio was 1:3. Diabetes was diagnosed >11 years among 37.8%. Majority (72%) of study sample have not undergone foot examination at the clinic during previous year. 74.4% had diabetes related foot problems. There were 72.4% presented with neuropathic signs and symptoms and 27.6% presented with ischemic signs and symptoms. Regarding foot care knowledge, the mean score was 14.6, 42% had scored above >50% of total knowledge score. Regarding foot care practices, the mean score was 12.5, 89.8% participants had scored <50% of total practice score. A Statistically significant association exists between the foot care knowledge and practice scores (p<0.05, χ2= 15.9). Conclusion: According to results, knowledge on diabetic foot care was not up to the standard; however their practices of foot care were further unsatisfactory. Therefore patient education on self-care management of foot should be incorporated into the routine care of patients with diabetes both in the clinic and in the community. Examination of foot by clinic team, counseling, providing information and education during clinic sessions would help to improve this situation.

Descriptive cross-sectional study was carried out on 120 eyes of type 2 diabetics in duration of 5 months from August 2018 to January 2019 at Abdullah Memorial Hospital, Faisalabad. Non-probability Convenient sampling technique was used to scrutinize whole population and subjects with minimum 6/12 vision with or without correction was included and age group 35 to 65 years of both genders. Eye of diabetic type 2 without any sign of retinopathy were included. Any individual with congenital color vision defect, retinal, optic nerve or choroidal lesion was excluded. Subjects reported in outpatient department and willing to participate were included in this study. Consent was obtained and ethical review was done according to the Declaration of Helsinki. Slit lamp examination was performed for anterior and posterior segment examination to exclude corneal opacity, lenticular opacity or any other ocular pathology. Fundus was examined for the exclusion of diabetic retinopathy. Ishihara plates were used initially to screen out congenital defects. Later, D-15 test was performed for evaluation of color vision for acquired changes due to diabetes. Test was performed thrice and an average result was considered. Data was entered using latest version 20 of SPSS and chi-square was used to assess the association between color anomaly and type 2 diabetes.

Along with previous studies, Fontbonne and et al. (11) designed a study to compare 4 years changes in cognitive performance among elderly subjects. Subjects without any detectable cognitive dysfunction were classified into; normal, impaired fasting glucose, or diabetic. Their cognitive abilities were assessed by a global test (MMSE). Results showed after 4 years, diabetic subjects had a lower performance on all tests except the MMSE. In addition, diabetic patients tended to have an undesirable improvement in cognitive function for more than 4 years compared to those who had normal glucose (11). Also, a systematic review was done by Biessels and et al. (12). This systematic review examines the incidence of dementia in people with T2DM. Results showed the incidence of "any dementia" was higher in individuals with T2DM than in those without diabetes. The findings of mechanistic studies suggested that vascular disease and alterations in glucose, insulin, and amyloid metabolism underlie the pathophysiology, but which of these mechanisms are clinically relevant is unclear (12).

To our knowledge, this is the first study done on the Lebanese population to examine the correlation of homocysteine levels and T2DM. The mean Hc plasma levels in patients without diabetes in our study popula- tion (15.3  ±  8.7) was elevated and found to be higher than what has been reported in previous studies (range = 12–14 mmol/l) [25]. We observed a significantly negative correlation between hyperhomocysteinemia and T2DM. This negative correlation remained significant whether Hc plasma levels where ≥10 or ≥15, indicating a consistent threshold association. Given the correlation of T2DM and coronary artery disease (CAD), a previous study conducted on our study subjects showed an associ- ation of hyperhomocysteinemia with the degree of coro- nary artery stenosis in CAD patients [26].

It was observed in this study that hearing loss is more common in patients with diabetes related complications (p value 0.0019). Maximum co-relation of sensorineural hearing loss was seen with Diabetic Neuropathy (Peripheral neuropathy and diabetic foot ulcers). Also, glycemic status had significant correlation with hearing loss that may be explained by diabetic microangiopathy of the inner ear. Strongest co-relation was found with deranged glycosylated Heamoglobin (p value 0.006*10^- 9). PPBS cut off, if taken at 140 mg/dL was not significant (p value 0.0611), however taking the same at 200 mg/dL (p value 0.0011) or 300 mg/dL (p value 0.000002) was certainly significant. Significant relation was also found with glycosurea (p value 0.02*10^-7), serum creatinine (p value 0.00003) and albuminurea (p value 0.0233) in decreasing order of strength. However, total Serum Cholesterol had no significant relationship (p value 0.757). Other studies also came up with similar results. 11,19,26 Dalton et al found weak association between NIDDM and hearing loss, but at same time also stating that auditory symptoms were more common in patients with NIDDM and nephropathy as compared to those with NIDDM and no nephropathy. 27

There are various modes of treatment of diabetes mellitus in naturopathy. Naturopathic treatment modalities focus on lifestyle modification aimed at treating diseases, promotion of positive health and prevention of diseases and disease complications. Hydrotherapy is also a treatment which is used in the treatment of diabetes mellitus. It consists of a combination of hot and cold treatment. It uses its temperature effects in treating the condition. These form of water applications are in practise since old age days. It uses its temperature effects in all its form like solid, liquid, ice, vapour, and steam internally and externally. Hydrotherapy is given in different temperatures. The temperature at which the treatments are given are given in the table below. Gastrohepatic pack is one of the hydrotherapy treatments which is used in the treatment of diabetes mellitus.