Topics
A note about printing sections or a
complete copy of medbio.info.
Links to Medical Literature, Textbooks and
Websites
Medscape, a leading website for medical
information for physicians and patients.
Click here.
Literature
and Lectures
Banting Lecture
2009: An Unfinished Journey: Molecular Pathogenesis
to Prevention of Type 1A Diabetes, George S.
Eisenbarth
George
Eisenbarth give us essential insight into the
genetically determined autoimmune initiation of type
1 diabetes. This has been an area of confusion
for me and many others. We have long been
aware of the fact that the immune response
responsible for destroying beta cells is genetically
determined and yet, type 1 diabetes is less
connected to the genetic picture than type 2
diabetes. This lecture goes a long way in
explaining the causes of diabetes and the
possibilities of a future "cure".
Click here to download this lecture.
Navigating the Choices for
Diabetes Prevention, David M . Nathan, the New England Journal of Medicine
Many new drugs aimed at
preventing type 2 diabetes have been released during the past few years.
This important editorial in the New England Journal of Medicine gives guidelines
in interpreting findings concerned with two of these and provides a clear
suggestion for treatment of developing T2D. The editorial should be of
value to both doctors and patients.
Click
here to download the article.
"Connecting obesity, aging and
diabetes" and "A crucial role for adipose tissue p53 in the regulation of
insulin resistance"
A connection between obesity
and development of diabetes type 2 has been recognized for several years.
However, the mechanisms which underlie this have not been understood.
These 2 publications for the September 09 issue of Nature Medicine present data
suggesting a strong collocation between ROS, telomerase and p53 and the
development of aging-related disease and diabetes type 2. They are
especially well written and concepts and data are quickly comprehended.
Click
here to call of the "news" article and
here to call up
the research report.
Metformin Added to Insulin For
Type 2 Diabetes: Long-Term Effects, CME from Medscape.
We face a pandemic increase in
the incidence of T2D. This CME presents data from a large study and demonstrates that
adding metformin to insulin treatment improved glycemic control, reduced the
amount of insulin required, and improved weight loss and macrovascular
outcomes. This important publication can be downloaded by clicking here.
"When do the risks of diabetes
begin? A consensus statement from the American College of Endocrinology
and the American Association of Clinical Endocrinologists.
Blood glucose only slightly
above "normal" values have been associated with development of the "late
cellular damage" seen in diabetes. This "prediabetic" state is, in fact,
more widespread than type 2 diabetes and is a major danger to global health.
This paper gives essential insight into the risks involved in prediabetes and
valuable clinical approaches to control of further progress to type 2 diabetes.
Click here to download the
publication.
Understanding
and Addressing the Epidemic of Obesity: An Energy Balance Perspective. J.
O. Hill, Endocrine Reviews 27, 750-761 2006.
Hill presents a
sound and well-documented approach to the extremely difficult problem of
controlling overweight over time. Many of the "almost magical" approaches
to dieting are discussed. Most interesting is his discussion of
maintaining reduced weight. Most "dieters" regain weight after a short
period, but some few do manage to maintain their reduced body weight.
What characterizes this group? This article should be be "required
reading" for all interested in this problem.
Click here to come
further.
Multihormonal
Treatment Approaches and the Diabetes-Obesity Continuum, a CME from Medscape.
Pancreatic
ß-cells secrete amylin in addition to insulin and C-peptide. Amylin has
previously been shown to be involved in central regulation of appetite. An
analog, Pramlintide, is now clinically available. Pramlintide has been
shown to decrease the rate of gastric emptying, decrease the rate of
postprandial glucagon secretion and increase satiety, leading to weight loss.
This CME presents animal and clinical studies with this hormone, PYY and leptin.
Type 2 diabetes and obesity are discussed in detail. Lectures by S. L.
Aronoff, I. B. Hirsch and C. H. Wysham, Purdue University.
Pick up this CME here.
Type 2 Diabetes: The
Pathophysiologic Basis of Treatment Design, Ramachandiran Cooppan, MD.
Part of a CME from medscape entitled Achieving Optimal Glycemic Control In
Type 2 Diabetes: The Clinitian's Perspective.
The important role of glucagon in
development of type 2 diabetes has received little attention during the past
years. Dr. Cooppan presentation is an informative masterpiece,
covering this and many other aspects of insulin resistance and the T2D
epidemic. You can
call it up here. The CME as a whole gives an up-to-date overview
of causes and treatment of T2D.
Goto it here.
Management of type 2 diabetes;
a consensus statement from the ADA and EASD, October 2008. This is presented in
a CME from Medscape which you can
call up here.
The ADA and EASD have issued a
updated guide for the treatment of hyperglycemia seen in T2D. This is
quite timely since there have come several new approaches to control of
hyperglycemia. Summarized, the consensus gives most support to
"well-validated core therapies" but presents good advice for use of other
alternatives.
The Diabetes-Obesity
Continuum: The Growing Body of Evidence for a Multi-hormonal Approach to
Treatment, (CME, Medscape, December 2007).
Click here to call it up.
There has been much discussion
concerning the roles of gut hormones in control of metabolism, plasma glucose
levels and body weight. Furthermore, amylin, a peptide hormone co-released
with insulin from pancreatic beta-cells strongly influences these factors.
This course gives insight into the actions of these hormones as well as the
commercially available analogue of amylin, pramlintide.
Neurohormonal Regulators of
Obesity: Mediating Weight Loss Through Peptide Hormone Therapeutics: (CME,
Medscape, February 2008).
Overeating and obesity are
strongly correlated development of type 2 diabetes. Three outstanding lectures;
Why Can't People Lose Weight?, Neurohormonal Regulation of Energy
Balance, and Advances in Neurohormonal Therapy in Treatment of Obesity
present up-to-date insight into hormonal and central control of
body weight and appetite. This is a program that should be of interest to all those
concerned with obesity and associated illnesses.
Click here to call it up.
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Websites
SUGARS-4-KIDS.COM
Sugars4kids is
an attempt to present an important nutritional topic in an understandable way
for teenagers.
You can call it up
here.
Wikipedia:
The English Wikipedia
has a very good review article over insulin and its actions. You can call
it up by
clicking here.
-------------------------------------------
More links to
literature:
Orchestration of Glucose
Homeostasis: The Banting Lecture 2006.
Professor Richard N. Bergman
presents a new approach to defining the factors involved in development of type
2 diabetes. Most modern research has focused on the molecular mechanisms
of insulin action. Dr. Bergman and his associates have taken a more
physiologically oriented approach. They have shown that transport of
insulin to target cells is rate-limiting for initiation of insulin action and
that this is disturbed in T2D. Furthermore, changes in FFA release to the
circulation correlate well with loss of sensitivity to the hormone. These
actions appear to account for over half of the loss of insulin sensitivity seen
in T2D patients. This paper is a must for all those who work with diabetic
patents. It can be downloaded from
Medscape (click here) or from
Diabetes 2007;56(6):1489-1501 (click here).
New Mechanisms of Glucose
Control: Expanding Therapeutic Options with Incretin Mimetic Therapies.
This new CME from Medscape (J.
P. Sheehan and P. N. Weissman, Joslin Diabetes Center) is a must for medical
students and all those who work with diabetic patients. Quote from
Medscape: "This activity will
discuss the multiple pathophysiologic factors causing type 2 diabetes, including
incretin function and dysfunction, and will outline the newer mechanisms and
resulting clinical strategies to target these factors. The goal is for
clinicians to more effectively, safely and precisely achieve near-normal
metabolic control for their patients". This resource is a "slide show"; a
lot of info on the slides with somewhat limited texts. Click
here to download this comprehensive article.
Primary Prevention of
Cardiovascular Diseases in People With Diabetes Mellitus: A Scientific Statement
from the American Heart Association and the American Diabetes Association (Medscape).
Diabetes patients, both type 1
and type 2, run a high risk of developing cardiovascular disease. This is
a new and concise review of present standings of the AHA and ADA on prevention
CVD in these patients. Recommendations concerning diet, dietary
supplements and exercise are presented and weighted.
Click here to call
up this important publication.
The Nuclear Receptor LXR is a Glucose Sensor.
N. Mitro, P. A. Mak, L.
Vargas, C. Godio, E. Hampton, V. Molteni, A. Kreusch and E. Saez, Nature 445,
219-223 (2007). The authors clearly demonstrate that glucose
directly binds and activates LXR-α and LXR-ß. Glucose in physiological
levels inhibits synthesis of PEPCK and, therefore, activation of gluconeogenesis
and activates energy storage by increasing lipid synthesis. These are most
exciting observations and might perhaps lead to an understanding of the
development of T2DM. This paper has been cited by most of the leading
journals involved with endocrinology and is a "must" for students and physicians
involved in the field.
Click on the title to come further.
Type 2 Diabetes: Reducing
Insulin Resistance and Cardiovascular Risk.
Enrique Caballero, MD and Paul
S. Jellinger, MD, MACE at The Joslin Diabetes Center (affiliated with Harvard
Medical School) have produced an outstanding CME program. This gives
insight into the causes of diabetes and relationship to cardiovascular disease.
The program is mounted at Medscape
and can be downloaded by
clicking here.
Remember, you must register with Medscape.com.
There is no fee.
Resurrecting the Beta Cell in
Type 2 Diabetes: Examining Tomorrow's Breakthroughs Today.
Robert R. Henry, MD; Charles
F. Burant, MD, PhD; Daniel J. Drucker, MD; Educational Reviewer: Melissa
Meredith, MD: Medscape 2006.
New methods of treating
diabetes have emerged during the past few years. This CME from Medscape
gives clear insight into some of the progress made and future expectations.
Download this very
interesting publication by clicking here.
Through the
Looking Glass: Current and Future Perspectives on the Role of Hormonal Interplay
in Glucose Homeostasis.
A CME course
from Medscape which gives an up-to-date insight into regulation of blood sugar
levels, control of glucagon-induced hepatic gluconeogenesis and appetite
by amylin and pramlintide (a synthetic derivative of amylin).
Click here to call up this
publication.
NDEI.org; Literature and CMEs for physicians and
medical students.
The National
Diabetes Education Initiative is an excellent source for information for
clinicians and students. You can download articles, slides and CME's.
Registration is required but is free. The monograph "ß-Cell
Adaptation and Failure: Opportunities for Prevention and Treatment of Type 2
Diabetes" is
especially useful.
Click here to come further.
From Medscape:
The "metabolic syndrome" has been
widely sighted as the initiator of diabetes type 2, hypertension and CVD.
Here is an important addition to the debate. Click the underlined text to
come further.
A Debate on the Metabolic Syndrome: Evolving Challenges and
Controversies CME/CE 09/28/2005
Patients with metabolic
syndrome have increased risk for cardiovascular and renal disease. This program
reviews data from several large trials and offers ways to help patients manage
their risk factors.
Textbooks:
Metabolic Regulation, a Human Perspective, Keith N. Frayn; 2nd ed., 2003,
Blackwell Science, Malden, MA.
Pocket Atlas of Nutrition,
H. K. Biesalski and P. Grimm; 3rd ed., 2004,
Thieme
New York, N. Y.
These two books are concise
and, at the same time, give excellent overviews of our anatomy, physiological
functions, and energy requirements throughout life.
Frayn's book is a joy to read.
It gives an up-to-date insight into our metabolism and the factors controlling
this. The anatomy, physiology, and biochemistry of our daily live are most
clearly explained with just the right degree of details. The Pocket Atlas of Nutrition, in spite
of its title, gives an unusually rich insight into our functions and combines
anatomy, physiology and biochemistry in a series of detailed but clear diagrams
and good texts. Distribution of nutrients in food sources is extremely
well documented as are bodily requirements from birth to old age. Good
balanced arguments for and against supplements are presented.
Sorry, no links here. You
must go to a book shop or library to thumb through these references.
Integration of metabolism:
is it "all in the mind"?
It has been commonly assumed
that hormonal integration of metabolism occurs mainly at target organs such as
the liver, adipose tissue and muscles. However, appreciation of the
important role of the hypothalamus in these processes has become apparent this
spring (2005). The following articles are keys to understanding of the
role of the hypothalamus in coordination of weight control, appetite and blood
glucose levels. Hypothalamic receptors for glucose, long-chain fatty
acids, leptin and insulin appear to be involved in neurogenic regulation of
hepatic metabolism. Central resistance to fatty acids and peptide hormones
may lie behind development of type 2 diabetes and obesity. These concepts
are discussed in the section on "Central control of
appetite and body weight" here at MedBio.
1.
Hypothalamic Sensing of Circulating Fatty Acids is Required for Glucose
Homeostasis T.K.T.Lam, A. Pocai, R. Gutierrez-Juarez, S. Obici, J. Bryan. L.
Aguilar-Bryan, G. J. Schwartz and L. Rossetti, Nature Medicine 11, 320-327, 2005
2.
Insulin
Signaling in the Central Nervous System, D. Porte Jr, D. G. Baskin and M.W.
Schwartz, Diabetes 54, 1264-1276, 2005.
3.
Hypothalamic
KATP channels control hepatic glucose production, A. Pocai, T.K.T.
Lam, R. Gutierrez-Juarez, S. Obici, J. Bryan. L. Aguilar-Bryan, G. J. Schwartz
and L- Rossetti, Nature Medicine 11, 320-327, 2005
Medscape, "Insulin
Resistance and Type 2 Diabetes: A Comprehensive Review".
This case-based study goes through the
association between type 2 diabetes and cardiovascular disease.
Life-style, diet and exercise are discussed in depth. This article gives a
good all-round picture of situation of the type 2 diabetic patient.
Medscape's Resource Center for Incretin Hormones in Diabetes and Metabolism
Is a new method of treating type 2 diabetes
now developing? An excellent introduction can be found here at Medscape. "Incretin hormones are produced by the
gastrointestinal tract in response to nutrient entry and are necessary for the
maintenance of glucose homeostasis. These compounds are now being investigated
for their therapeutic potential in type 2 diabetes. Many of these agents are
first-in-class compounds that target physiologic defects not addressed by
current medications, and may represent a significant addition to our
armamentarium for the treatment of type 2 diabetes and other metabolic
disorders".
CME
"Changing the Course of Disease: Gastrointestinal Hormones and Tomorrow's
Treatment of Type 2 Diabetes (November 2004)
A new and important CME from Medscape. This program
can be run as multimedia lectures or read on your screen. The first
section gives an overview of the endocrinology of gastrointestinal hormones.
The second section and third sections present clinical applications of the
incretin system. Control of
diabetes type 2 with conventional agents and the newer glucagon-like-peptide 1 (GLP-1)
and associated agents
is comprehensively presented. The incretin hormones may represent a dramatic start for a new approach to
treatment of insulin resistance and diabetes type 2.
The program was written for physicians and interested medical students.
"Flash in the Pan" or the science and politics of our
diets. A really good analysis from Nature,
Vol 433 No 7028 pp785-906
of Dietary Guidelines for Americans, 2005 (the official guidelines
published every five years by the US Department of Health and Human Services and
the US Department of Agriculture). The suggestions in the guidelines are
very sound and should help establish similar global guidelines to combat the
overweight epidemic. But the politics...
See also "Food
FAQs"
from the same issue of Nature.
Choosing "the right" foods is not easy!
Cell
Metabolism
This is a new journal, first issued in January
2005. It is designed to fill to present high-quality research in the field
of metabolic diseases. Overweight, diabetes, hypertension and
atherosclerotic heart disease threaten ever-increasing numbers globally.
In spite of this, a single publication presenting advances in knowledge in this
field has been lacking. Cell metabolism should be a "must" for all of us
who work in this area.
Science 299, 845-860, 2003.
A special section of Science giving the most up-to-date coverage of the
overweight problem . Energy-balance, and genetic mechanisms of weight and
appetite regulation are discussed. A must for those interested in
weight control and good health.
An special issue of Nature which takes up many
key issues concerning the molecular biology of obesity. This is "required
reading" for comprehension of causes the global overweight epidemic.
NCIB: The Genetic Landscape of Diabetes
The National Center for Biotechnology Information's
service dedicated to presentation of the latest genetic findings in
the field of diabetes. The few genes found to be involved in development
of various forms of diabetes are listed.
WHO, a "fact-sheet" about diabetes.
Diabetes is a rapidly expanding global threat.
Here are the facts!
Websites for students and physicians:
Medscape:
Diabetes and Endocrinology
Medscape is perhaps the world's leading source for medical
news and up-to-date information. This section is dedicated to the control of metabolism and
related illnesses. New users must register;
this is gratis.
Medical Biochemistry
Professor Michael W. King's extensive site for
medical students. Features an "interactive text book" highlighting most of
the elements of medical
biochemistry.
Diabetes for Professionals
This site presents information for students
and medical professionals. The latest research results in the field of
diabetes are summarized.