Asociación entre síntomas depresivos de las madres y control metabólico en adolescentes con Diabetes Mellitus tipo 1 / Association between depressive symptoms in mothers and metabolic control in adolescents with type 1 diabetes

Resumen: Introducción: Un mal control metabólico en pacientes con Diabetes Mellitus tipo 1 (DM1) se asocia a complica ciones a corto y largo plazo. Los adolescentes con Diabetes tipo 1 presentan peor control metabólico comparado con pacientes de otros grupos etarios. Escasos estudios han demostrado una asociación entre síntomas depresivos de las madres con el control metabólico de sus hijos adolescente. Objetivo: Evaluar la asociación entre síntomas depresivos maternos y control metabólico de adolescentes con DM1. Sujetos y Método: Estudio observacional transversal realizado en adolescentes, edades 10 a 18 años, con diagnóstico de DM1 de más de un año de evolución y sus madres. Se aplicó test de Beck II, cuestionario de depresión infantil, cuestionario SALUFAM y cuestionario de datos sociodemográficos. Se realizó hemoglobina glicosilada capilar, como marcador de control metabólico. Resultados: Se estudiaron 86 parejas (madre-hijo adolescente), adolescentes de edad media 14.04 años y 5.95 años de evolución de DM1. El 25.6% (n 22) de las madres presentó síntomas depresivos, asociándose a peor control metabólico en sus hijos (HbA1c: 7.66% y 8.91%, p < 0.001). El 17.9% de adolescentes presentó síntomas depresivos, no asociándose a síntomas depresivos maternos ni a peor control metabólico. Los síntomas depresivos maternos se asociaron a menor nivel educacional materno y pater no, mayor número de hijos en la familia, presencia de otros hermanos con enfermedades crónicas y a mayor vulnerabilidad en salud (SALUFAM). Conclusiones: La presencia de síntomas depresivos maternos se asocia a peor control metabólico en el adolescente con DM1, siendo fundamental un enfoque multidisciplinario familiar para obtener mejores resultados metabólicos en los adolescentes.

Abstract: Introduction: Poor metabolic control in patients with Type 1 Diabetes Mellitus (T1DM) is associated with short- and long-term complications. Adolescents with T1DM present poorer metabolic control than patients of other age groups. Few studies have shown an association between mothers with depressive symptoms and the metabolic control of their adolescent children. Objective: To evaluate the associa tion between maternal depressive symptoms and metabolic control of their adolescents with T1DM. Subjects and Method: Cross-sectional observational study carried out with adolescents aged between 10 and 18 years, with T1DM diagnosis of at least 1 year ago and their mothers. The Beck Depression Inventory-II and the SALUFAM questionnaire were applied, and sociodemographic data were co llected. Glycosylated hemoglobin from capillary blood was used as a marker of metabolic control. Results: 86 couples (mother-adolescent children) were studied. The average age of the adolescents was 14.04 years and the average evolution time of T1DM was 5.95 years. 27.325.6% of mothers had depressive symptoms, which was associated with worse metabolic control of their children (HbA1c of 7.66% and 8.91%, p-value <0.001). 17.9% of adolescents had depressive symptoms, which was not associated with maternal depressive symptoms or worse metabolic control. Maternal depressive symptoms were also associated with lower maternal and paternal educational levels, high number of children in the family, presence of other siblings with chronic illnesses, and high health vulnera bility (SALUFAM). Conclusions: The mother's depressive symptoms can be associated with worst metabolic control in T1MD adolescents. It is fundamental a multidisciplinary family approach to get better metabolic controls in T1DM adolescents.

Influence of alisol B 23-acetate on blood glucose in type 2 diabetic mice / 中国药理学通报

Aim To explore whether alisol B 23-acetate possesses the therapeutic potential for treatment of type 2 diabetes mellitus ( T2DM ). Methods T2DM mouse model was established by combined administration of streptozotocin and nicotinamide. After three weeks of oral administration of rosiglitazone or alisol B 23-acetate, the blood glucose of type 2 diabetic mice was measured. Oral glucose tolerance test(OGTT) was carried out the next day. Rosiglitazone was chosen as positive drug. 2-[N-(7-nitrobenz-2-oxa-l, 3-diazol-4-yl) amino]-2-deoxy-D-glucose (2-NBDG) uptake assay in adipocytes was adopted to test whether alisol B 23-acetate had effect on glucose uptake in cells. 3T3-Ll pre-adipocytes differentiation model was performed to evaluate whether alisol B 23-acetate promoted adipo-genesis. Results Mice exhibited significantly higher blood glucose concentration after intraperitoneal injection of streptozotocin and nicotinamide for three weeks, as examined by blood glucose concentration on day 21 and OGTT on day 22, compared with normal mice in blank control group. After orally administrating alisol B 23-acetate at dose of 5 mg • kg-1 , 10 mg • kg-1 ,20 mg • kg-1 daily for three weeks, respectively, or orally administered rosiglitazone at dose of 10 mg • kg-1 daily for three weeks, blood glucose greatly decreased in type 2 diabetic mice. Moreover, insulin resistance was also improved to a certain degree during OGTT. Furthermore, alisol B 23-acetate not only increased insulin-induced glucose uptake in adipocytes at the concentration of 30 mmol • L-1 glucose, but also accelerated 3T3-L1 pre-adipocytes differentiation process at concentration of 1 μmol • L-1 and 10 μmol • L-1 . Conclusions Alisol B 23-acetate reduces blood glucose of type 2 diabetic mice, promotes pre-adipocyte differentiation and increases glucose uptake in adipocytes; however, the mechanism of action needs further exploration.

Research of mechanisms of liraglutide inducing expression of fibroblast growth factor 21 in white adipose tissues of obese type 2 diabetic rats / 中国药理学通报

Aim To investigate the effect of liraglutide on expression of fibroblast growth factor 21 in white ad-ipose tissues and its mechanisms. Methods Male SD rats were subjected to a standard control diet or high-fat diet ( HFD) for 12 weeks, then the HFD group was in-jected introperitoneally with 30 mg · kg-1 streptozoto-cin to induce type 2 diabetes mellitus model. Half number of rats of type 2 diabetes mellitus were injected with liraglutide ( DM +LRG, 0. 4 mg · kg-1 · d-1 , two times one day ) for another 6 weeks. Serum bio-chemical indices and FGF21 levels were detected. The pathological changes in epididymal adipose tissues were detected by HE staining. The mRNA and protein ex-pression and phosphorylation of FGF21 , peroxisome proliferator-activated receptor γ ( PPARγ) , fibroblast growth factor receptor 3 (FGFR3),β-Klotho, liver ki-nase B1(LKB1), AMP-activated kinase (AMPK), a-cetyl-CoA carboxylase ( ACC ) and phosphorylation of signaling molecules in MAPK pathway were assessed by RT-PCR, immunohistochemistry and Western blot re-spectively. Results Body mass and serum lipid, ALT and AST levels increased in DM group, while FGF21 level decreased, and the volume of adipose cells in ep-ididymal adipose tissues was expanded. Expressions of FGF21, PPARγ, p-FGFR3, β-Klotho, p-LKB1, p-AMPK, p-ACC were down-regulated, while p-ERK, p-JNK and p-p38 expression were all increased. These indices were reverted by liraglutide treatment. Conclu-sion Liraglutide has significant lipid-lowering effect, which maybe related with increased FGF21 expression, activating AMPK pathway and inhibiting MAPK path-way.

Effects of astragalus polysaccharide on renal TGF-β1 /Smads signaling pathway in rats with diabetes mellitus / 中国药理学通报

Aim To investigate the effects of astragalus polysaccharide (APS) on renal TGF-β1/Smads signa-ling pathway in rats with diabetes mellitus(DM). Methods Wistar rats were randomly divided into nor-mal group,DM group,APS low dose (APS-low) group and APS high dose (APS-high) group. Rats in APS-low group and APS-high group respectively received 200 and 400 mg·kg-1·d-1APS for 8 weeks. Con-centrations of fasting blood-glucose(FBG),blood urea nitrogen and creatinine,as well as urinary kidney injury molecule-1 (KIM-1) and osteopontin (OPN) were measured. Levels of TGF-β1,Smad2,phosphorylated Smad2 (p-Smad2),Smad3,phosphorylated Smad3 (p-Smad3),Smad7,matrix metalloproteinase (MMP) 2,MMP-9,tissue inhibitor of matrix metalloproteinases (TIMP)-1 and TIMP-2 were investigated. Results Compared to control group,DM group had higher levels of FBG,blood urea nitrogen,creatinine KIM-1,OPN, TGF-β1,Smad2,p-Smad2,Smad3,p-Smad3,TIMP-1 and TIMP-2,but lower levels of Smad7,MMP-2 and MMP-9. APS significantly decreased the levels of FBG,blood urea nitrogen,creatinine KIM-1 and OPN, as well as inhibited the activity of TGF-β1/Smads sig-naling pathway. Conclusion The renoprotective effects of APS might be associated with the inhibition of TGF-β1/Smads signaling pathway.

Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy / 北京大学学报(医学版)

Objective:To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).Methods:In this study,461 patients with type 2 diabetes who received PCNL in Peking Uni-versity People’s Hospital from June 2006 to December 2015 were reviewed.There were 281 males and 180 females with an average age of 57 years were included,of whom,137 were diagnosed with SIRS after PCNL.The demographic data,clinical features,and test results were compared between the patients with SIRS and without SIRS,trying to identify the correlation between their clinical characters and the occur-rence of SIRS.Results:The SIRS was significantly correlated with the patients’preoperative white blood cell counting (×109 /L)[7.76 (4.00 -17.96)vs.6.31 (2.00 -17.40),P <0.001 ],preopera-tional blood glucose level (mmol /L)[7.30 (3.08 -19.90)vs.6.40 (3.42 -16.78),P <0.001], operative time (min)[75 (20 -270)vs.60 (20 -200),P <0.001 ],length of stay (d)[12 (2 -46)vs.11 (3 -29),P =0.019],staghorn stones [38.8% (33 /85)vs.27.7% (104 /376),P =0.042],and preoperational urinary tract infection [36.8% (50 /136)vs.26.6% (81 /304),P =0.032].There was no significant correlation between the SIRS and the patients’age,body mass index, preoperative hemoglobin level,preoperative serum creatinine,and transfusion.In multivariate analysis, abnormal preoperative white blood cell counting (OR =3.194,95% CI:1.531 -6.666,P =0.002), operative time longer than 60 min (OR =1.635,95% CI:1.088 -2.456,P =0.018),and preopera-tional blood glucose level higher than normal 7.1 mmol /L were significantly correlated with the presence of SIRS.Conclusion:The high level of preoperational blood glucose,abnormal preoperative white blood cell counting,and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Diferencias en la aterosclerosis coronaria entre hombres y mujeres con Diabetes Mellitus tipo 2 evaluados con el Score de Gensini / Differences in coronary atherosclerosis assessed with the Gensini score between men and women with type 2 Diabetes

Antecedentes y Objetivos: Las mujeres diabéticas tienen mayor morbi-mortalidad asociada a eventos coronarios isquémicos que los hombres. Este estudio describe la extensión, magnitud y severidad de la ateros-clerosis coronaria entre hombres y mujeres con diabetes mellitus tipo 2. Métodos: Estudio de tipo descriptivo que incluyó a 162 pacientes diabéticos consecutivos con sospecha de aterosclerosis coronaria y estudiados con coronariogra-fía. La magnitud de la aterosclerosis fue cuantificada utilizando el Score de Gensini. Resultados: La edad promedio fue 64.8 años. Noventa y cuatro eran mujeres (58.0 por ciento). El tiempo de evolución de la diabetes fue mayor para mujeres que para hombres (152.1 +/- 90.0 vs 120.2 +/- 99.4 meses) respectivamente (p<0.05). Las mujeres tuvieron un índice de masa corporal (30.5 +/- 5.1), superior al de los hombres (28.5 +/- 5.2) (p<0.05). La aterosclerosis coronaria significativa estuvo presente en el 61.7 por ciento de toda la población diabética, siendo en hombres de 76.5 por ciento versus 51.5 por ciento en mujeres (odds ratio: 1.5). El número de placas ateroscle-róticas fue 195 en 68 hombres (2,86 placa/paciente) y de 168 en 94 mujeres (1,78 placa/paciente) (p<0.0043). La presencia de aterosclerosis significativa en 1, 2 y 3 vasos se observó en el 7.4 por ciento; 17.6 por ciento y 51.5 por ciento de los hombres, respectivamente, versus el 12.8 por ciento; 10.6 por ciento y 27.7 por ciento en las mujeres, (p<0.0002). La magnitud de la enfermedad coronaria medida con el Score de Gensini fue 69.4 +/- 66.7 en hombres versus 35.6 +/- 47.3 en mujeres (p<0.005). Conclusión: En este estudio observamos que hombres diabéticos tienen mayor extensión, magnitud y severidad de aterosclerosis coronaria que las mujeres diabéticas.

Diabetic women have higher morbidity and mortality associated with ischemic coronary events than diabetic men, but the extension of coronary artery disease in both groups is less well established. Aim: to compare the extension, magnitude and severity of coronary atherosclerosis between men and women with type 2 diabetes mellitus. Method: 162 consecutive diabetic patients with suspected coronary atherosclerosis studied by coronary angiography were included. The magnitude of atherosclerosis was quantified using the Gensini Score. Results: The average age was 64.8 years. Ninety-four patients were women (58.0 percent). Diabetes was present for 152 +/- 90.0 months for women and 120 +/- 99.4 months for men (p <0.05). Women had a higher body mass index (30.5 +/- 5.1) than men (28.5 +/- 5.2, p<0.05). The presence of significant coronary atherosclerosis in the entire diabetic population was of 61.7 percent: 76.5 percent in men and 51.5 percent in women (OR 1.5). The mean number of atherosclerotic plaques was 195 in 68 men (2.86 plaques/patient) and 168 in 94 women (1.78 plaques/patient, p=0.0043). Significant atherosclerosis in 1, 2 and 3 vessels was observed in 7.4 per cent, 17.6 percent and 51.5 percent of men, respectively, versus 12.8 percent, 10.6 percent and 27.7 percent in women (p<0.0002). The magnitude of coronary disease measured by Gensini Score was 69.4 + 66.7 in men versus 35.6 +/- 47.3 in women (p<0.005). Conclusion: Men with diabetes have greater extension, magnitude and severity of coronary atherosclerosis than diabetic women.

Application of glucose clamp technique in the study of diabetes mellitus / 中华内分泌代谢杂志

The article introduces the applic at ion of glucose clamp technique in the study of diabetes. The changes in insulin sensitivity, insulin secretion, metabolism of glucose, lipids and protein, etc. in euglycemic or hyperglycemic status in vivo can be investigated by glucose cla mp technique.