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Metabolites
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Glycometabolic Control in Older Patients with Type 2 Diabetes
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Glycometabolic Control in Older Patients with Type 2 Diabetes

A special issue of Metabolites (ISSN 2218-1989). This special issue belongs to the section "Endocrinology and Clinical Metabolic Research".

Deadline for manuscript submissions: closed (15 March 2023) | Viewed by 10049

Special Issue Editor

Dr. Valeria Calsolaro

E-Mail Website
Guest Editor
Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Interests: glycometabolic; type 2 diabetes mellitus (T2DM)
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Type 2 diabetes mellitus (T2DM) is a chronic condition with an increasing prevalence worldwide, especially in the older population. T2DM leads to micro- and microvascular complications, cognitive impairment, and risk of falls, fractures, and frailty. The ideal management of T2DM therapy in such a peculiar population could not disregard a broad evaluation of frailty, in order to set a glycemic target appropriate for the life expectancy and the reserve which the older patients present, as also underlined in the most recent guidelines. Incredibly interesting would then  be a detailed discussion about what the new therapeutic targets should be, especially in view of the new therapeutic strategies brought forth by new available drugs with a wide spectrum of action. Interest should particularly be addressed to older patients, both in the acute care setting and in the chronic one, considering the interplay with frailty, chronic diseases such as cardiovascular and renal impairment, and polytherapy.

Dr. Valeria Calsolaro
Guest Editor

Manuscript Submission Information

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Keywords

  • glycometabolic
  • type 2 diabetes mellitus (T2DM)
  • chronic diseases

Published Papers (4 papers)

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Research

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10 pages, 560 KiB  
Article
Vascular Damage and Glycometabolic Control in Older Patients with Type 2 Diabetes
by David Karasek, Jaromira Spurna, Dominika Macakova, Ondrej Krystynik and Veronika Kucerova
Metabolites 2023, 13(3), 382; https://doi.org/10.3390/metabo13030382 - 03 Mar 2023
Viewed by 1129
Abstract
Diabetes is one of the main risk factors for vascular damage, including endothelial dysfunction and arterial stiffness. The aim of this study was to compare selected parameters of vascular damage in patients with type 2 diabetes (T2D) in different age categories and to [...] Read more.
Diabetes is one of the main risk factors for vascular damage, including endothelial dysfunction and arterial stiffness. The aim of this study was to compare selected parameters of vascular damage in patients with type 2 diabetes (T2D) in different age categories and to determine their relationship to indicators of glycometabolic control. A total of 160 patients with T2D were included in this cross-sectional study. They were divided into four age quartiles (with mean ages of 42.1 ± 4.5, 51.6 ± 1.4, 59.2 ± 3.0, and 69.8 ± 3.8, respectively). All subjects were evaluated for indicators of glycometabolic control and for arterial stiffness parameters along with markers of endothelial damage—tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF). The oldest compared to the youngest participants showed significantly increased parameters of arterial stiffness (augmentation pressure 13.4 ± 8.6 vs. 6.7 ± 4.4 mm Hg, augmentation index 26.2 ± 11.3 vs. 19.6 ± 9.2 mm Hg, aortic pulse pressure 47.7 ± 17.1 vs. 33.7 ± 10.4 mm Hg, and pulse wave velocity 11.9 (10.1–14.3) vs. 8.2 (7.7–9.8) m/s) despite having similar glycometabolic control. Arterial stiffness parameters were mainly associated with age and blood pressure. Age and systolic blood pressure were major determinants of arterial stiffness regardless of glycometabolic control. The oldest patients also had the highest levels of vWF (153.7 ± 51.9 vs. 121.7 ± 42.5 %) but the lowest levels of PAI-1 (81.8 ± 47.5 vs. 90.0 ± 44.9 ng/mL). Markers of endothelial dysfunction correlated with metabolic parameters, but did not correlate with arterial stiffness. Age and systolic blood pressure are major determinants of arterial stiffness in patients with T2D regardless of glycometabolic control, whereas an unfavorable metabolic profile is mainly related to endothelial dysfunction. These results suggest a differential contribution of cardiometabolic risk factors to vascular damage in T2D patients over their lifetime. Full article
(This article belongs to the Special Issue Glycometabolic Control in Older Patients with Type 2 Diabetes)
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10 pages, 239 KiB  
Article
Lower Glucose Effectiveness Is Associated with Subclinical Reactive Hypoglycemia, Snacking Habits, and Obesity
by Ichiro Kishimoto and Akio Ohashi
Metabolites 2023, 13(2), 238; https://doi.org/10.3390/metabo13020238 - 06 Feb 2023
Cited by 2 | Viewed by 1329
Abstract
The effects of glucose effectiveness, the insulin-independent mechanism of glucose disposal, on hypoglycemia have not yet been fully investigated. Herein, in 50 males without a diagnosis of diabetes mellitus (median age 54 years, body mass index (BMI) ≥ 25), the index of glucose [...] Read more.
The effects of glucose effectiveness, the insulin-independent mechanism of glucose disposal, on hypoglycemia have not yet been fully investigated. Herein, in 50 males without a diagnosis of diabetes mellitus (median age 54 years, body mass index (BMI) ≥ 25), the index of glucose effectiveness (SgIo) was determined by a 75 g oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM) was performed for 6 days. The minimal glucose levels and the percentages of time below 70 mg/dL (3.9 mmol/L) (TBR70) during CGM were significantly associated with the SgIo tertile category in a biphasic manner. When TBR70 within 24 h after OGTT ≥ 0.6% was defined as subclinical reactive hypoglycemia (SRH), odds ratios of having SRH in SgIo tertile 1 (lowest) and tertile 3 (highest) compared to SgIo tertile 2 (middle) were both 11.7 (p = 0.007), while the odds ratios of the highest post-load insulin quartile were 22.9 (p = 0.001) and 1.07 (p = 0.742), respectively. The chances of having self-reported snacking habits, obesity (BMI ≥ 30), and impaired glucose tolerance were significantly higher in participants in SgIo tertile 1 compared to those in SgIo tertile 2, with odds ratios of 10.7 (p = 0.005), 11.2 (p = 0.02), and 13.8 (p = 0.002), respectively. However, there was no significant difference between SgIo tertile categories 2 and 3. In conclusion, SgIo is associated with SRH in a biphasic manner. In people with lower glucose effectiveness, the SRH-induced increase in appetite may create a vicious cycle that leads to obesity. Full article
(This article belongs to the Special Issue Glycometabolic Control in Older Patients with Type 2 Diabetes)

Review

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17 pages, 661 KiB  
Review
Metabolic Impact of Frailty Changes Diabetes Trajectory
by Alan J. Sinclair and Ahmed H. Abdelhafiz
Metabolites 2023, 13(2), 295; https://doi.org/10.3390/metabo13020295 - 16 Feb 2023
Cited by 10 | Viewed by 2272
Abstract
Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which [...] Read more.
Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which can present with an anorexic malnourished phenotype and a sarcopenic obese phenotype. The sarcopenic obese phenotype individuals have significant loss of muscle mass and increased visceral fat. This phenotype is characterised by increased insulin resistance and a synergistic increase in the cardiovascular risk more than that induced by obesity or sarcopenia alone. Therefore, in this phenotype, the trajectory of diabetes is accelerated, which needs further intensification of hypoglycaemic therapy and a focus on cardiovascular risk reduction. Anorexic malnourished individuals have significant weight loss and reduced insulin resistance. In this phenotype, the trajectory of diabetes is decelerated, which needs deintensification of hypoglycaemic therapy and a focus on symptom control and quality of life. In the sarcopenic obese phenotype, the early use of sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists is reasonable due to their weight loss and cardio–renal protection properties. In the malnourished anorexic phenotype, the early use of long-acting insulin analogues is reasonable due to their weight gain and anabolic properties, regimen simplicity and the convenience of once-daily administration. Full article
(This article belongs to the Special Issue Glycometabolic Control in Older Patients with Type 2 Diabetes)
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14 pages, 590 KiB  
Review
Potential Role of Copper in Diabetes and Diabetic Kidney Disease
by Guido Gembillo, Vincenzo Labbozzetta, Alfio Edoardo Giuffrida, Luigi Peritore, Vincenzo Calabrese, Claudia Spinella, Maria Rita Stancanelli, Eugenia Spallino, Luca Visconti and Domenico Santoro
Metabolites 2023, 13(1), 17; https://doi.org/10.3390/metabo13010017 - 22 Dec 2022
Cited by 12 | Viewed by 4597
Abstract
Copper is a fundamental element for the homeostasis of the body. It is the third most abundant essential transition metal in humans. Changes in the concentration of copper in the blood are responsible for numerous diseases affecting various organs, including the heart, brain, [...] Read more.
Copper is a fundamental element for the homeostasis of the body. It is the third most abundant essential transition metal in humans. Changes in the concentration of copper in the blood are responsible for numerous diseases affecting various organs, including the heart, brain, kidneys, and liver. Even small copper deficiencies can lead to the development and progression of several pathologies. On the other hand, excessive exposure to copper can cause toxicity in many human organs, leading to various systemic alterations. In the kidney, increased copper concentration in the blood can cause deposition of this element in the kidneys, leading to nephrotoxicity. One of the most interesting aspects of copper balance is its influence on diabetes and the progression of its complications, such as Diabetic Kidney Disease (DKD). Several studies have shown a close relationship between copper serum levels and altered glycemic control. An imbalance of copper can lead to the progression of diabetes-related complications and impaired antioxidant homeostasis. A high Zinc/Copper (Zn/Cu) ratio is associated with improved renal function and reduced risk of poor glycemic control in patients with type two diabetes mellitus (T2DM). Furthermore, the progression of DKD appears to be related to the extent of urinary copper excretion, while regulation of adequate serum copper concentration appears to prevent and treat DKD. The aim of this review is to evaluate the possible role of copper in DKD patients. Full article
(This article belongs to the Special Issue Glycometabolic Control in Older Patients with Type 2 Diabetes)
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