Aace Comprehensive Diabetes Management Algorithm 2013: Task Force
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American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm – 2023 Update
2023, Endocrine PracticeThis consensus statement provides (1) visual guidance in concise graphic algorithms to assist with clinical decision-making of health care professionals in the management of persons with type 2 diabetes mellitus to improve patient care and (2) a summary of details to support the visual guidance found in each algorithm.
The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts who updated the 2020 AACE Comprehensive Type 2 Diabetes Management Algorithm based on the 2022 AACE Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan and consensus of task force authors.
This algorithm for management of persons with type 2 diabetes includes 11 distinct sections: (1) Principles for the Management of Type 2 Diabetes; (2) Complications-Centric Model for the Care of Persons with Overweight/Obesity; (3) Prediabetes Algorithm; (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Complications-Centric Algorithm for Glycemic Control; (7) Glucose-Centric Algorithm for Glycemic Control; (8) Algorithm for Adding/Intensifying Insulin; (9) Profiles of Antihyperglycemic Medications; (10) Profiles of Weight-Loss Medications (new); and (11) Vaccine Recommendations for Persons with Diabetes Mellitus (new), which summarizes recommendations from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention.
Aligning with the 2022 AACE diabetes guideline update, this 2023 diabetes algorithm update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and diabetes mellitus and highlights the importance of appropriate management of atherosclerotic risk factors of dyslipidemia and hypertension. One notable new theme is an emphasis on a complication-centric approach, beyond glucose levels, to frame decisions regarding first-line pharmacologic choices for the treatment of persons with diabetes. The algorithm also includes access/cost of medications as factors related to health equity to consider in clinical decision-making.
VPAC2 receptor mediates VIP-potentiated insulin secretion via ion channels in rat pancreatic β cells
2023, Experimental Cell ResearchVasoactive intestinal peptide (VIP), a small neuropeptide composing of 28 amino acids, functions as a neuromodulator with insulinotropic effect on pancreatic β cells, in which it is of vital importance in regulating the levels of blood glucose. VIP potently agonizes VPAC2 receptor (VPAC2-R). Agonists of VPAC2-R stimulate glucose-dependent insulin secretion. The purpose of this study was to further investigate the possible ion channel mechanisms in VPAC2-R-mediated VIP-potentiated insulin secretion. The results of insulin secretion experiments showed that VIP augmented insulin secretion in a glucose-dependent manner. The insulinotropic effect was mediated by VPAC2-R rather than VPAC1 receptor (VPAC1-R), through the adenylyl cyclase (AC)/protein kinase A (PKA) signalling pathway. The calcium imaging analysis demonstrated that VIP increased intracellular Ca2+ concentration ([Ca2+]i). In addition, in the whole-cell voltage-clamp mode, we found that VIP blocked the voltage-dependent potassium (Kv) channel currents, while this effect was reversed by inhibiting the VPAC2-R, AC or PKA respectively. Taken together, these findings suggest that VIP stimulates insulin secretion by inhibiting the Kv channels, activating the Ca2+ channels, and increasing [Ca2+]i through the VPAC2-R and AC/PKA signalling pathway. These findings provide theoretical basis for the research of VPAC2-R as a novel therapeutic target.
Anti-obesity effects of dichloromethane leaf extract of Gnidia glauca in high fat diet-induced obese rats
2019, HeliyonObesity is a chronic metabolic disorder characterized by increased adipose tissue mass due to positive energy balance. Prescription of anti-obesity drugs can be useful adjuncts to diet and exercise for obese patients who have failed to achieve weight loss. However, these drugs are ineffective and are associated with adverse effects. In recent times, medicinal plants have drawn a sharp focus owing to their biocompatibility and effectiveness. Attempts to determine the therapeutic effects and identification of bio-active principles from herbal prescriptions have become the prime focus in the validation of their folkloric usage and in drug discovery programs. Therefore, the present study aimed to determine the anti-obesity effects of Dichloromethane leaf extract of Gnidia glauca in high-fat-diet-induced obese rats.
Obesity was induced experimentally in white albino Wistar rats by feeding them with prepared high-fat-diet and water ad libitum for a period of 12 weeks. The in-vivo anti-obesity effects were determined by oral administration of Gnidia glauca at dosage levels of 200, 250 and 300 mg/kg body weight from the 6th to 12th week of study. Phytochemical analysis of Gnidia glauca was conducted using gas chromatography linked to mass spectrophotometer.
The results indicated that Gnidia glauca exhibited potent anti-obesity effects. It significantly reduced the body weight, organ weights, organo-somatic indices, anthropometric indices, the total fat content, adiposity index, atherogenic index as well as various lipid profiles. It also decreased the total feed intake. However, it significantly increased levels of high-density lipoproteins and rectal body temperature of rats. Quantitative phytochemical analysis also revealed the presence of various phytocompounds that have shown to be associated with anti-obesity effects.
The anti-obesity effects of Gnidia glauca maybe attributed to the phytochemicals present. The present study, therefore, scientifically validates the traditional use of Gnidia glauca as a potential candidate for the synthesis of new effective anti-obesity supplement.
New insights into bacterial bile resistance mechanisms: the role of bile salt hydrolase and its impact on human health
2018, Food Research InternationalBile acids (BA), the major components of bile, are biological detergents that facilitate the emulsification and solubilization of dietary lipids and also display potent antimicrobial activity, the bacterial membranes being their main targets. Considering the complicated nature of the stress produced by bile and BA, the microorganism tolerance requires different defence mechanisms including the presence of efflux pumps, bile salt hydrolase (BSH) enzyme, the intrinsic capacity of cells to maintain intracellular homeostasis and modifications in the architecture and composition of the cell membrane. Besides, the expression of proteins involved in carbohydrate and fatty acid metabolism, amino acid and nitrogenous base biosynthesis, and general stress response are commonly affected by the presence of bile. Among the microbial transformations, deconjugation of BA by BSH is the most important. Several studies indicate that BSH activity affects both the host physiology and the microbiota. In fact, it was strongly suggested that BSH could play an important role in the colonization and survival of bacteria in the gut. Also, recent work has shown that BSH and free BA participate in a variety of metabolic processes that include regulation of dietary lipid absorption, cholesterol metabolism, and energy and inflammation homeostasis.
In this review we summarize recent advances in the understanding of the mechanisms involved in the tolerance of bacteria to bile, with special emphasis on the contributions of studies applying an omic approach. Besides, the physiological and ecological role of BSH enzyme and its relevance to human health as well as the function of bile acid as metabolic regulator are also discussed.
Development of stability indicating liquid chromatographic method for estimation of novel anti-diabetic drug Evogliptin
2023, Separation Science Plus