Wednesday , December 13 2017
Home / Resources / Clinical Gems

Clinical Gems

Our clinical gems come from the top selling medical books, and text books because knowledge is everything when it comes to diabetes.

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #102: Pathogenesis of Nonalcoholic Fatty Liver Disease (NAFLD) Part 4

Hypertriglyceridemia and low HDL cholesterol, increased risk of type 2 diabetes: Under fasting conditions, the liver of subjects with NAFLD overproduces triglyceride-enriched VLDL particles despite hyperinsulinemia when compared to equally obese subjects without NAFLD. Insulin normally decreases production of VLDL by inhibiting adipose tissue lipolysis, and by directly suppressing hepatic production of VLDL.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #101: Pathogenesis of Nonalcoholic Fatty Liver Disease (NAFLD) Part 3

Cause of NAFLD: physical inactivity: Although physical training predominantly enhances muscle insulin sensitivity, cross-sectional epidemiologic data and studies on effects of physical training suggest that exercise may decrease liver fat even in the face of unchanged body weight [50]. In a cross-sectional study in 72,359 healthy Korean adults, subjects who were exercising regularly had a 28–53% lower risk of NAFLD across almost all BMI deciles.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #100: Pathogenesis of nonalcoholic fatty liver disease (NAFLD) Part 2

Cause of NAFLD: obesity and abnormalities in adipose tissue. Although both NAFLD and the MetS can occur in nonobese subjects, the prevalence of NAFLD is markedly increased in obesity as is that of the MetS. In the third National Health and Nutrition Examination Survey (NHANES), the prevalence of NAFLD averaged 7.5% and 6.7% in normal-weight men and women but was 57 and 44% in persons with a body mass index (BMI) greater than 35 kgm−2.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #99: Pathogenesis of nonalcoholic fatty liver disease (NAFLD) Part 1

NAFLD is defined as steatosis (greater than 5–10% of hepatocytes are fatty), which is not due to excess use of alcohol (defined in European and American guidelines as greater than 20 g of alcohol daily for women and greater than 30 g for men), or other conditions as determined by careful family and medical history, and laboratory tests to exclude at least steatosis due to viral and autoimmune causes and iron overload.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #98: Metabolomics: Applications in Type 2 Diabetes Mellitus and Insulin Resistance Part 4

Future directions and potential application of metabolite profiling in type 2 diabetes: metabolomics approaches have unmasked a variety of metabolic pathways influenced by T2DM or insulin resistance, moving the field of metabolic physiology beyond a “glucocentric” viewpoint of these conditions. However, a difficulty in interpretation is that the fasting concentration of a metabolite only reflects a single moment in time, and etiology or tissue origins of any metabolite differences across comparator groups requires further validation.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #95: Metabolomics: Applications in Type 2 Diabetes Mellitus and Insulin Resistance Part 1

Type 2 diabetes mellitus (T2DM) is not simply a disorder of blood sugar control, but a condition in which multiple biochemical pathways are impacted. An illustrative example of this is the elevated blood ketone body concentration typical of T2DM, which can progress to diabetic ketoacidosis if insulin action and/or availability deteriorates.The elevations of ketone bodies and the acetone accumulation (with associated “sweet breath odor”) of severe or poorly controlled diabetes are indicative of abnormal fatty acid homeostasis and specifically, high lipolysis and hepatic beta-oxidation.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #94: Lipid and Lipoprotein Metabolism, Hypolipidemic Agents, and Therapeutic Goals Part 6

Nicotinic acid (niacin) has been used for more than 50 years to lower LDL-C and TGs, and increase the level of HDL-C. Indeed, niacin is the most potent HDL-C-raising pharmacologic agent available. Of note, we still, at this late time in the life of niacin, do not have definitive evidence regarding its mechanism(s) at the molecular level.

Read More »

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #93: Lipid and Lipoprotein Metabolism, Hypolipidemic Agents, and Therapeutic Goals Part 5

Diet and lifestyle modification: Appropriate lifestyle interventions involving diet and exercise can lead to weight loss, and since obesity is a major contributor to the IR and T2DM, weight loss should provide significant benefits to individuals with these problems. The Diabetes Prevention Program demonstrated that a 6% weight loss and the addition of two hours of exercise per week was associated with a 58% reduction in the incidence of new T2DM in a group with IGT. Similar results were obtained in the Finnish Diabetes Prevention Study using similar interventions.

Read More »