The potential beneficial role of isoflavones in type 2 diabetes mellitus.

Diabetes is a chronic global disease afflicting a substantial number of people worldwide. Different mechanisms have been highlighted in the progression of this disease such as dysfunction of pancreatic ß-cells, insulin resistance, elevated levels of free fatty acids which result in overproduction of reactive oxygen species, as well as pancreatic ß-cell failure and apoptosis. Isoflavones, are polyphenolic phytochemicals found in most leguminous plants, and have been identified as potentially useful antidiabetic agents. The pleiotropic effects of isoflavones include the targeting of numerous cell signaling pathways involved in the pathogenesis of diabetes. Several observational studies have supported the direct relationship between isoflavones intake and a lowered risk of diabetes. The aim of this review was to summarize relevant findings on the effects of isoflavone intake and risk of type II diabetes mellitus (T2DM), and to highlight some of the possible anti-diabetic molecular mechanisms of these polyphenols. Despite the promising therapeutic effects of isoflavones to moderate risk of T2DM, the underlying mechanisms for their preventive effects are still largely unknown. The acceptable human dosage levels of these polyphenols remain a debatable topic as these have a profound influence on the observed benefits. Considerable numbers of well-controlled, long-term human clinical studies of these phytochemicals are highly recommended. Furthermore, combinations of isoflavones and their derivatives in combination with other naturally isolated compounds, and perhaps even those drugs currently used therapeutically to control diabetes mellitus in clinical practice, may be worth exploring in the future.

Physicians' participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study.

OBJECTIVES: In participatory decision-making (PDM), physicians actively engage patients in treatment and other care decisions. Patients who report that their physicians engage in PDM have better disease self-management and health outcomes. We examined whether physicians' diabetes-specific treatment PDM preferences as well as their self-reported practices are associated with the quality of diabetes care their patients receive. METHODS: 2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n=4198) in 10 US health plans across the country and their physicians (n=1217). We characterized physicians' diabetes care PDM preferences and practices as 'no patient involvement,' 'physician-dominant,' 'shared,' or 'patient-dominant' and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients'satisfaction with physician communication; and (3) whether patients' A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control. RESULTS: Most physicians preferred 'shared' PDM (58%) rather than 'no patient involvement' (9%), 'physician-dominant' (28%) or 'patient dominant' PDM (5%). However, most reported practicing 'physician-dominant' PDM (43%) with most of their patients, rather than 'no patient involvement' (13%), 'shared' (37%) or 'patient-dominant' PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred 'shared' PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03-3.07] and patients of physicians who preferred 'patient-dominant' treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04-2.39] than those of providers who preferred 'no patient involvement' in treatment decision-making. There were no differences in patients' satisfaction with their doctor's communication or control of A1c, SBP or LDL depending on their physicians' PDM preferences. Physicians' self-reported PDM practices were not associated with any of the examined aspects of diabetes care in multivariate analyses. CONCLUSIONS: Patients whose physicians prefer more patient involvement in decision-making are more likely than patients whose physicians prefer more physician-directed styles to receive some recommended risk factor screening tests, an important first step toward improved diabetes outcomes. Involving patients in treatment decision-making alone, however, appears not to be sufficient to improve biomedical outcomes.

Frequency of a deletion polymorphism in the gene for angiotensin converting enzyme is increased in African-Americans with hypertension.

In white populations, a deletion polymorphism in the gene for angiotensin converting enzyme (ACE) appears to be associated with increased risk for myocardial infarction but not for hypertension. In a population-association study in African-Americans, we compared the frequency of the ACE deletion polymorphism in subjects with hypertension versus those with normal blood pressure. The frequency of the ACE deletion allele was greater in African-Americans with hypertension than in those with normal blood pressure (P < 0.05). These findings raise the possibility that in some patient subgroups, sequence variation in or near the ACE gene may contribute to the risk for hypertension.