Zeitschrift für metabolisches Syndrom

Impaired insulin signaling in conditions of over-nutrition and obesity leading to insulin resistance is a major component of the cardiorenal metabolic syndrome and leads to the development of diabetes and Cardiovascular Disease (CVD). Dysregulation of the Renin-Angiotensin-Aldosterone (RAAS) axis is thought to play a major contributory role to the development of insulin resistance in overweight and obesity. The Insulin Receptor Substrate protein 1 (IRS-1) is a critical signaling and docking molecule in the insulin signaling pathway. IRS-1 mediates both upstream and downstream components of the insulin signaling cascade through binding of the Insulin Receptor (IR) to its N-terminus, as also allowing docking of the p85 subunit of Phosphatidylinositol 3-Kinase (PI3K) upon tyrosine phosphorylation, thereby facilitating glucose uptake through phosphorylation of protein kinase B (Akt). IRS-1 is tightly regulated principally through the mechanism of phosphorylation and has been known to undergo proteasomal degradation in the cytosol upon excessive serine-threonine phosphorylation on its residues. Multiple stimuli, including components of the RAAS, namely angiotensin, and aldosterone, as well as several different serine kinases acting through different pathways, have been shown to play a role in IRS-1 mediated degradation. In recent years, aldosterone has emerged as a key modulator of the insulin metabolic pathway, primarily through its ability to cause cellular oxidative stress leading to degradation of IRS-1, thus reducing glucose uptake. However, to date, no studies have been carried out on the effect of aldosterone in cardiac cells. Since insulin resistance is a major factor in the development of CVD, we show here time and dosedependent degradation of IRS-1 by aldosterone in HL-1 cardiomyocytes, using over-expression studies of fluorescentlylabeled recombinant IRS-1 protein. We further show, through the use of the mineralocorticoid receptor (MR)-specific antagonist eplerenone, that this effect is mediated primarily by the Glucocorticoid Receptor (GR), mostly by causing increased oxidative stress and rendering the cardiomyocytes susceptible to impaired cellular function and damage

Background: An Emergency Department (ED) is a medical treatment facility dedicated to emergency medicine with an expectedly higher mortality rate. There is no available data on the pattern of mortality in the medical emergency room of the Federal Teaching Hospital Abakaliki (FETHA), a tertiary health facility in Abakaliki South-eastern Nigeria. Hence, this study was undertaken to determine the pattern of mortality of cases seen at the Medical Emergency unit of FETHA and compare it with that elsewhere in the country with the view of using the data generated as a baseline for planning purposes and for future studies. Method: This is a retrospective, descriptive and hospital-based study of the demographics and mortality pattern of patients seen at the medical emergency unit of the Federal Teaching Hospital Abakaliki (FETHA) over an 18 months period from January 2014 to June 2015. The analysis was done using the Statistical Package for Social Sciences (SPSS) version 19 software. Result: A total number of 4,270 patients were seen over the study period with 184 deaths giving a mortality rate of 4.31%. The mortality included 104 men and 80 women. The age range and mean age of the mortality were 20108 years and 50.54 ± 12.42years respectively. Stroke accounted for 23% (43) of the mortality. Others were Heart failure, chronic liver disease, chronic kidney disease, diarrhoeal diseases, diabetes mellitus and others in descending order of frequencies. When the causes of mortality were grouped according to the systems affected, neurological disorders accounted for about 30% of the mortality while gastrointestinal, cardiovascular, respiratory and renal disorders accounted for 17%, 14%, 10%, and 7% respectively. Non-communicable diseases accounted for 70% while communicable diseases accounted for 30% of the mortality. Conclusion: The most common cause of death is a non-communicable disease at the prime productive age with male preponderance. There is a need for elaborate health education at grass root and also for the creation of separate emergency rooms for different medical specialties in tertiary health facilities to facilitate a prompt Specialist review.

Aim: Insulin resistance is a common health disorder that contributes to developed overt diabetes among prediabetes subjects. The aim of the study is to examine the effects of a combined programme of aerobic and resistance exercise on insulin resistance among prediabetes subjects (Pre-D) using Oral Glucose Tolerance Test (OGTT) as a tool to define the improvement in insulin resistance.

Method: 20 prediabetes subjects were asked to join a supervised combined exercise program consists of 30 min of resistance exercise followed by 20 min cycling twice at moderate-intensity a week for 6 weeks.

Result: a significant improvement in Blood Glucose (BG) after combination exercise at two occasions when compared to BG before exercise (Pre S1), after 1st exercise session (Post S1) and at the end of intervention trial (Post S12).

Conclusion: The result of this study has shown that 6 weeks of moderate-intensity exercise combined with aerobic and resistance exercise program had significantly ameliorated insulin resistance among Pre-D.

Aim: An excessive number of calories consumed daily, in addition to a sedentary lifestyle, are the main causes of increasing Type 2 Diabetes (T2D) prevalence worldwide. Diabetes is usually accompanied by hypertension, lipid disorders, and obesity.

The aim of this study is to show that the combination exercise is effective. It will compare T2D and Non-Diabetes (ND) volunteer doing combination exercise consisting of resistance and cycling. The interventions are minor and fairly short consisting of 12 episodes of exercise over 6 weeks, yet this was enough to produce measurable change and improvement.

This included the re-categorization of two T2D volunteers to being ND, using normal metrics. A literature search was conducted by using electronic databases (Science direct, google scholar, Medline, Embase, Sports medicine, PubMed, CINAHL, Cochrane library, and Scopus) from April 2015 until January 2019.

Results show that changes in primary and secondary outcomes are significant between the different groups. The primary outcome is HbA1c, and the secondary outcomes are weight, waist, BMI, lipid, BP, HR, lactate and body fitness. Moreover, this study focuses on the changes in incretin level in the T2D group for effects of exercise on the secretion of this hormone and compare within T2D who are using a different medication for diabetes

Results: After just six weeks, there was a reduction in the HbA1c level for the T2D volunteers which is significant (P=0.000). Moreover, in ND the reduction was also significant (P=0.000). In the T2D group who are using (Metformin and SGT2-I group), their result shows elevation in GLP-1 in the assessment of the both acute and chronic effect of the programme. GLP-1 in this group was (3.9 ± 1.5) and increased to (8.4 ± 1.2), (P=0.345) after S1 and then increased more to (11.0 ± 0.8), (P=0.196) after 6 weeks of exercise. This was of interest because of the inference that incretins and exercise were linked. The crucial factor is metformin.

Conclusion: In T2D and ND combination exercise has a beneficial effect on HbA1c, the improvement was higher in T2D. The anthropometric variables (weight, waist, BMI and lung capacity) improved significantly as well in T2D and ND.

Exercise is also important to improve GLP-1 secretion. Despite the range of studies on incretin undertaken here, still, there is a need to compare the effect of exercise and different types of pharmacological therapy on GLP1.

This study compared the effect of exercise on T2D plus medication in volunteers. It has been found that within the T2D group only Metformin and SGT2-I group was improved. Both SGLT2 inhibitors and metformin have been found to affect body weight and this may explain the improvement of GLP-1 level, suggesting an area for future investigation.

Background: Warning labels on tobacco products are considered effective to make the people aware of the consequences of tobacco use, and to bring about a behavioral change like quitting and reducing tobacco use.

Material and Methods: A cross-sectional study was carried out in the town of Kangra in Himachal Pradesh using a house to house survey (using Krish grid framework) to assess the effectiveness of the warnings on tobacco products with help of a questionnaire earlier used in the GATS India survey, 2010.

Results: Amongst the 98% of smokers who had seen the advertisement, 64% of males had thought about quitting whereas among females 100% of smokers contemplated quitting on noticing the warnings. This association, however, was not found to be statistically significant. Sensitivity towards the warnings was higher among those above 70 years of age with 66% of the smokers contemplating quitting after seeing the warnings and among those between 10-29 years of age, 52% of the smokers thought about quitting after seeing the warnings. This again was not found to be statistically significant. Among smokeless tobacco users too only 63.9% male users thought about quitting after seeing the warnings whereas 100% female users thought about quitting after seeing the warnings.

Conclusion: The effectiveness of warnings can be enhanced by making the warnings bigger, clearer with visible color contrast and easily interpretable so that the 35% population who do not contemplate quitting after seeing these warnings are also reached out.