China
Africa
Explore chapters and articles related to this topic
Impact of Dietary and Exercise Interventions on Brain Insulin Action and Brain Function
Published in André Kleinridders, Physiological Consequences of Brain Insulin Action, 2023
Within the Look AHEAD trial, lifestyle intervention based on low-fat diet, partially with meal replacements, and increased physical activity led to weight loss and glycemic improvements. However, not all patients achieved a maintainable weight reduction or an actually lowered glucose level. In this context, only improvement of glycemia was clearly associated with improved cognitive functions (169). Importantly, intensive lifestyle intervention had a less favorable effect on cognition in overweight and obese patients compared to standard care (170). Hyperglycemia, which is resistant to weight loss, might be linked to already impaired and irretrievable beta-cell function, ergo: insulin deficiency with or without insulin resistance. This could imply, that restoration of cognitive functions in the context of T2DM is only realistic if beta-cell function is still sufficiently intact. Patients with severe (primary, non-autoimmune) insulin-deficient diabetes (SIDD) and those with long-term severe insulin-resistant diabetes (SIRD), according to the Ahlqvist classification (171), would not benefit from this low-fat/exercise lifestyle intervention.
Sleep, sedation and coma
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
Death from malignant disease is not always the calm, dignified process so often portrayed on stage and screen.32 The last 48 hours of life may be difficult for 36%, and death ‘non-peaceful’ for 8.5%.29 Victorian physicians recorded the invariably peaceful deaths of patients,33 perhaps in part due to the liberal use of opioids at that time. It may be that modern oncological practice, which has the ability to prolong the life of some cancer patients, is elongating and complicating dying. Sustained and aggressive treatment of the primary malignancy increases the prospects of eventual multi-organ complications. Most patients with cancer do die with comfort and dignity due to the combination of natural processes and medicinal palliation. A minority suffer grave symptoms that defy the skills of multidisciplinary palliative care interventions. Some patients develop intolerable suffering despite excellent care.34 Intractable symptomatic distress may require deep sedation in order to achieve relief. This practice is referred to as palliative sedation, therapeutic sedation, terminal sedation or sedation of intractable distress of the dying (SIDD). Critics use the terms ‘slow euthanasia’ and ‘backdoor euthanasia’.
Personalized approach for type 2 diabetes pharmacotherapy: where are we and where do we need to be?
Published in Expert Opinion on Pharmacotherapy, 2021
Muhammad Abdul-Ghani, Ralph A. DeFronzo
Although virtually all T2DM patients manifest various degrees of insulin reistance and beta cell dysfunction, the severity of insulin resistance and the degree of beta cell dysfunction varies considerably among individual patients. Thus, patients with more severe insulin resistance will manifest hyperglycemia at a lower degree of beta cell failure compared to patients with less severe insulin resistance in whom more advance beta cell dysfunction is required to cause hyperglycemia. Thus, one can expect to identify distinct clusters of patients with different degrees of insulin resistance and beta cell dysfunction. Using HOMA-IR and HOMA-B to quantitate insulin resistance and insulin secretion, respectively, in the Swedish All New Diabetics in Scandia cohort (n = 8,980), Ahlqvist and colleagues [113] utilized cluster analysis techniques and identified 5 distinct groups of T2DM patients. The first cluster manifested moderate insulin resistance in combination with severe insulin deficiency (SIDD). This cluster of patients had more severe impairment in glucose metabolism and higher HbA1c. A second cluster included patients with more severe obesity associated with a severe insulin-resistant phenotype (SIRD) and less impaired beta cell function than SIDD subjects. The third cluster included obese patients without severe insulin resistance (MOD) and a fourth cluster of patients in whom diabetes developed in more advanced age (age-related diabetes, ARD). The latter two phenotypes manifested mild elevation in the HbA1c. The risk of diabetic complications varied considerably among the four clusters [113,114]. Patients with SIDD manifested an elevated risk of retinopathy, while patients with SIRD had an increased risk of diabetic kidney disease and high prevalence of CVD risk factors. A fifth cluster included patients with circulating diabetes autoantibodies, representing T1DM and LADA (Figure 1).