Kari Harno

Lipoprotein Lipase Activity and Serum Lipoproteins in Untreated Type 2 (Insulin-Independent) Diabetes Associated with Obesity

SummarySerum lipoproteins and the heparin-releasable lipoprotein lipase (LPL) activity of adipose tissue and skeletal muscle were measured in 36 untreated obese patients with Type 2 (insulin-independent) diabetes and the values were compared with those of non-diabetic subjects of similar age, sex and relative body weight. In diabetic men, the LPL activity of adipose tissue was significantly reduced when expressed per tissue weight or per fat cell (p<0.01). Diabetic females had slightly but not significantly lower LPL activity in adipose tissue than the non-diabetic females. The muscle LPL activity was similar in diabetic and non-diabetic subjects of both sexes. When the diabetic men were classified according to fasting blood glucose, the patients with high glucose levels had lower adipose tissue LPL activity than those with moderate hyperglycaemia. In both diabetic and non-diabetic subjects, there was a significant positive correlation between HDL cholesterol concentrations and adipose tissue LPL activity. It is concluded that Type 2 diabetes influences adipose tissue LPL activity and plasma lipoprotein concentrations and that this effect is superimposed on the similar changes produced by obesity alone.

Lipoprotein Lipase and Hepatic Endothelial Lipase are Key Enzymes in the Metabolism of Plasma High Density Lipoproteins, Particularly of HDL2

In spite of the close association of plasma high density lipoproteins (HDL) with atherosclerotic vascular disease there is still relatively little knowledge on the pathways of HDL synthesis and degradation and on the factors which regulate the concentration of HDL and of its subfractions HDL2 and HDL3. It is becoming increasingly evident that circulating HDL particles are formed by a stepwise assimilation of constituents derived from different sources (Nikkila 1978a,b). The primary HDL particle (“nascent” HDL) is elaborated by intestine and liver but immediately after its delivery to the circulation it becomes associated with apoprotein A-I and is transformed to HDL3. Another step in HDL synthesis takes place during degradation of the triglyceride-rich lipoproteins (VLDL and chylomicrons) at peripheral capillary beds by the action of lipoprotein lipase (LPL). Recently, preliminary evidence has been obtained for a role of yet another endothelial lipolytic enzyme, hepatic lipase (HEL), in the metabolism of HDL. The present paper summarizes some of the data indicating that the two heparin-releasable endothelial enzymes are important in the regulation of plasma HDL (HDL2) levels.

Active Assistance Technology Reduces Glycosylated Hemoglobin and Weight in Individuals With Type 2 Diabetes: Results of a Theory-Based Randomized Trial

BACKGROUND Type 2 diabetes is an individual health challenge requiring ongoing self-management. Remote patient reporting of relevant health parameters and linked automated feedback via mobile telephone have potential to strengthen self-management and improve outcomes. This research involved development and evaluation of a mobile telephone-based remote patient reporting and automated telephone feedback system, guided by health behavior change theory, aimed at improving self-management and health status in individuals with type 2 diabetes. SUBJECTS AND METHODS This research comprised a randomized controlled trial. Inclusion criteria were diagnosis of type 2 diabetes, elevated glycosylated hemoglobin (HbA1c) levels (range, 6.5-11%) or use of oral diabetes medication, and 30-70 years of age. Intervention subjects (n=24) participated in remote patient reporting of health status parameters and linked health behavior change feedback. Control participants (n=24) received standard of care including diabetes education and healthcare provider counseling. Patients were followed for approximately 10 months. RESULTS Intervention participants achieved, compared with controls and controlling for baseline, a significantly greater mean reduction in HbA1c of -0.40% (95% confidence interval [CI] -0.67% to -0.14%) versus 0.036% (95% CI -0.23% to 0.30%) (P<0.03) and significantly greater weight reduction of -2.1 kg (95% CI -3.6 to -0.6 kg) versus 0.4 kg (95% CI -1.1 to 1.9 kg). Nonsignificant trends for greater intervention compared with control improvement in systolic and diastolic blood pressure were observed. CONCLUSIONS Sophisticated information technology platforms for remote patient reporting linked with theory-based health behavior change automated feedback have potential to improve patient outcomes in type 2 diabetes and merit scaled-up research efforts.

Self-Monitoring of Blood Glucose in Type 2 Diabetes: Recent Studies

The increasing role for structured and personalized self-monitoring of blood glucose (SMBG) in management of type 2 diabetes has been underlined by randomized and prospective clinical trials. These include Structured Testing Program (or STeP), St. Carlos, Role of Self-Monitoring of Blood Glucose and Intensive Education in Patients with Type 2 Diabetes Not Receiving Insulin, and Retrolective Study Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes (or ROSSO)-in-praxi follow-up. The evidence for the benefit of SMBG both in insulin-treated and non-insulin-treated patients with diabetes is also supported by published reviews, meta-analyses, and guidelines. A Cochrane review reported an overall effect of SMBG on glycemic control up to 6 months after initiation, which was considered to subside after 12 months. Particularly, the 12-month analysis has been criticized for the inclusion of a small number of studies and the conclusions drawn. The aim of this article is to review key publications on SMBG and also to put them into perspective with regard to results of the Cochrane review and current aspects of diabetes management.

Diabetes as a case study of chronic disease management with a personalized approach: The role of a structured feedback loop

As non-communicable or chronic diseases are a growing threat to human health and economic growth, political stakeholders are aiming to identify options for improved response to the challenges of prevention and management of non-communicable diseases. This paper is intended to contribute ideas on personalized chronic disease management which are based on experience with one major chronic disease, namely diabetes mellitus. Diabetes provides a pertinent case of chronic disease management with a particular focus on patient self-management. Despite advances in diabetes therapy, many people with diabetes still fail to achieve treatment targets thus remaining at risk of complications. Personalizing the management of diabetes according to the patients individual profile can help in improving therapy adherence and treatment outcomes. This paper suggests using a six-step cycle for personalized diabetes (self-)management and collaborative use of structured blood glucose data. E-health solutions can be used to improve process efficiencies and allow remote access. Decision support tools and algorithms can help doctors in making therapeutic decisions based on individual patient profiles. Available evidence about the effectiveness of the cycles constituting elements justifies expectations that the diabetes management cycle as a whole can generate medical and economic benefit.

Glucose tolerance in amyotrophic lateral sclerosis.

Abstract– Blood glucose and plasma insulin during an oral glucose tolerance test were determined in 21 patients with amyotrophic lateral sclerosis and in 10 control patients matched for age, obesity and physical activity. In addition, 125I‐insulin binding to circulating erythrocytes were studied in a subgroup of 4 ALS patients and 8 controls.

Health coaching by telephony to support self-care in chronic diseases: clinical outcomes from The TERVA randomized controlled trial

BackgroundThe aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes.MethodsAn open-label cluster-randomized parallel groups trial. Pre- and post-intervention anthropometric and blood pressure measurements by trained nurses, laboratory measures from electronic medical records (EMR). A total of 2594 patients filling inclusion criteria (age 45 years or older, with type 2 diabetes, coronary artery disease or congestive heart failure, and unmet treatment goals) were identified from EMRs, and 1535 patients (59%) gave consent and were randomized into intervention or control arm. Final analysis included 1221 (80%) participants with data on primary end-points both at entry and at end. Primary outcomes were systolic and diastolic blood pressure, serum total and LDL cholesterol concentration, waist circumference for all patients, glycated hemoglobin (HbA1c) for diabetics and NYHA class in patients with congestive heart failure. The target effect was defined as a 10-percentage point increase in the proportion of patients reaching the treatment goal in the intervention arm.ResultsThe proportion of patients with diastolic blood pressure initially above the target level decreasing to 85 mmHg or lower was 48% in the intervention arm and 37% in the control arm (difference 10.8%, 95% confidence interval 1.5–19.7%). No significant differences emerged between the arms in the other primary end-points. However, the target levels of systolic blood pressure and waist circumference were reached non-significantly more frequently in the intervention arm.ConclusionsIndividualized health coaching by telephony, as implemented in the trial was unable to achieve majority of the disease management clinical measures. To provide substantial benefits, interventions may need to be more intensive, target specific sub-groups, and/or to be fully integrated into local health care.Trial registrationClinicalTrials.gov Identifier: NCT00552903

Serum lipoproteins and indices of glucose tolerance during diuretic therapy: a comparison between hydrochlorothiazide and piretanide.

Summary Two diuretic drugs, hydrochlorothiazide (HCT) and piretanide (PT), were compared for their effects on plasma lipoproteins and glucose tolerance in 24 hypertensive male subjects over a period of 12 weeks. In comparison with preceding placebos, both drugs caused an increase of total cholesterol, low-density lipoprotein (LDL) cholesterol, total triglyceride, and very-low-density lipoprotein (VLDL) triglyceride concentrations, whereas no significant change occurred in high-density lipoprotein (HDL) cholesterol. The alterations were partly reversible in patients receiving HCT. Apoprotein A and B concentrations were increased by PT but were little influenced by HCT. Also, the LDL/HDL cholesterol ratio was increased during PT. Neither drug invariably influenced the postheparin plasma lipase activities, oral glucose tolerance, plasma insulin levels, or insulin binding to red cells. The results suggest that diuretic drugs may promote the hepatic secretion of VLDL. The mechanism of this action remains to be established, and the clinical relevance of these findings is still not clearly understood.

Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol

SummarySerum lipoprotein lipid and apoprotein concentrations were determined in 21 hypertensive men during administration of two beta-blockers, penbutolol or atenolol, for 6 months preceded by a 4 week placebo period. Post-heparin plasma lipoprotein lipase and hepatic lipase activities were also measured.There was a trend to an increase of triglyceride and VLDL triglyceride concentrations during penbutolol administration, but the changes were not significant. Penbutolol also increased the total cholesterol by 11% at 3 months (mainly due to increase of VLDL cholesterol), but this effect diminished at 6 months.Atenolol did not cause any significant change in the total cholesterol but increased HDL cholesterol by 7% at 1 month, the change being due to rise of the HDL3. The HDL3 accounted also for a significant decrease of HDL cholesterol seen in the men receiving penbutolol at 6 months. HDL2 cholesterol as well as the LDL/HDL2 cholesterol ratio remained unchanged in both groups.Neither drug consistently influenced the post-heparin plasma lipase activities or the serum apoprotein A or B concentrations.In contrast to an earlier study the results suggest that the clinically most important HDL subfraction, the HDL2, remains unaffected during treatment with beta-blockers.

The Role of Self-Monitoring of Blood Glucose in Glucagon-Like Peptide-1-Based Treatment Approaches: A European Expert Recommendation

The role of glucagon-like peptide (GLP)-1-based treatment approaches for type 2 diabetes mellitus (T2DM) is increasing. Although self-monitoring of blood glucose (SMBG) has been performed in numerous studies on GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, the potential role of SMBG in GLP-1-based treatment strategies has not been elaborated. The expert recommendation suggests individualized SMBG strategies in GLP-1-based treatment approaches and suggests simple and clinically applicable SMBG schemes. Potential benefits of SMBG in GLP-1-based treatment approaches are early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and diabetes education. Its length and frequency should depend on the clinical setting and the quality of metabolic control. It is considered to play an important role for the optimization of diabetes management in T2DM patients treated with GLP-1-based approaches.