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1.
Diabetes Res Clin Pract ; 76(2): 265-8, 2007 May.
Article in English | MEDLINE | ID: mdl-17049662

ABSTRACT

We examine whether one-to-one lifestyle counseling for non-insulin-treated diabetic outpatients by a Certified Expert Nurse (CEN) can improve patients' health outcomes. Participants were randomly assigned to a 1-year lifestyle intervention (n=67) or to a usual care group (n=67). Main outcome measures were changes from baseline in: HbA(1C) and score of health related quality of life scales (SF-36 and Problem Areas in Diabetes Scale). Cognitive/behavioral modification for 1 year and satisfaction in CEN counseling was also measured by self-produced items. We found no significant differences in HbA(1C), BMI, blood pressure, serum lipids, or health related quality of life over 1 year between the two groups. Patients in the intervention group, however, showed modest but more favorable modification of cognition (p=0.004) and behavior (p<0.001) than subjects in usual care group. The low attrition rate (9%), more frequent hospital visit (12+/-2 times versus 11+/-3 times; p=0.03) and high degree of satisfaction (95%) in the intervention group indicate feasibility of the monthly CEN counseling in the outpatient settings of Japanese hospitals. Future research should confirm the long-term effectiveness of the CEN counseling on clinical outcomes and the cost effectiveness of a possibly time-consuming intervention.


Subject(s)
Diabetes Mellitus, Type 2/therapy , Directive Counseling , Life Style , Nurses , Aged , Blood Pressure , Body Mass Index , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/psychology , Female , Glycated Hemoglobin/metabolism , Humans , Japan , Lipids/blood , Male , Middle Aged , Nursing Staff , Outcome Assessment, Health Care , Outpatients/education , Patient Education as Topic
2.
J Oral Sci ; 47(1): 43-51, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15881228

ABSTRACT

We previously demonstrated that tumor necrosis factor (TNF)-alpha stimulated the production of activation protein (AP)-1, a transcriptional factor, in mouse osteoblastic MC3T3-E1 cells. Recent studies have shown the importance of ceramide and its metabolites as signal molecules for TNF-alpha-induced gene expression in several cell types. Therefore, our interest was to investigate whether sphingosine metabolites are involved in TNF-alpha-induced signaling in MC3T3-E1 cells. DL-threo-1-phenyl-2-hexadecanoyl-amino-3-pyrrolidino-1-propanol (PPPP), which causes accumulation of intracellular ceramide, stimulated the TNF-alpha-induced expression of the c-fos and c-jun genes. Gel shift assay clearly showed that PPPP increased the cytokine-induced specific binding of nuclear proteins to the 12-tetra-decanoyl phorbol 13-acetate-responsive element (TRE), a consensus sequence for AP-1. In addition, cell-permeable ceramide (N-acetylsphingosine, N-hexanoylsphingosine or N-octanoylsphingosine) stimulated expression of the c-fos and c-jun genes and nuclear protein binding to TRE. Interestingly, DL-threo-dihydrosphingosine (DHS), an inhibitor of sphingosine kinase, clearly blocked the ceramide analogue-induced stimulation. Sphingosine 1-phosphate (SPP) actually induced expression of these oncogenes and activated AP-1. Although TNF-alpha stimulated the AP-1-mediated expression of the monocyte chemoattractant JE/MCP-1, this stimulation was inhibited by DHS. SPP also stimulated JE/MCP-1 gene expression. The present study thus suggests that SPP acts as a signal molecule in ceramide-dependent signal transduction in TNF-alpha-induced AP-1 in osteoblastic MC3T3-E1 cells.


Subject(s)
Ceramides/pharmacology , Lysophospholipids/physiology , Osteoblasts/metabolism , Second Messenger Systems/physiology , Sphingosine/analogs & derivatives , Sphingosine/physiology , Transcription Factor AP-1/biosynthesis , Tumor Necrosis Factor-alpha/pharmacology , 3T3 Cells , Animals , Blotting, Northern , Ceramides/physiology , Chemokine CCL2/genetics , Electrophoresis, Polyacrylamide Gel , Enzyme Inhibitors/pharmacology , Gene Expression/drug effects , Genes, fos , Genes, jun , Mice , Mice, Inbred C57BL , Morpholines/pharmacology , Propanolamines/pharmacology , Pyrrolidines/pharmacology , Recombinant Proteins/pharmacology , Sphingomyelin Phosphodiesterase/metabolism , Sphingomyelin Phosphodiesterase/pharmacology , Tetradecanoylphorbol Acetate/metabolism , Tumor Necrosis Factor-alpha/physiology
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