Gambaran Pengetahuan dan Upaya Pencegahan Diabetes Melitus: Literatur Review

Diabetes Mellitus ia a non-communicable disease characterized by high blood sugar levels due to impaired insulin function. Diabetes prevention encompassed modified and unmodifie factors. Age and heredity are the ummodified factors, whereas diet, pack of physical activity, drugs, stress, and pack of knowledge are the modified factors. Education and family support Van influence the level of knowledge that can affect a person both towards the environment and particular objects. To identify the level of knowledge, physical activity, and other prevention efforts to prevent diabetes. A Literature review was used on this study, The article was selected from the Pubmeed, Portal Garuda, and Scilit database. Five studies where selected based on inclusion criteria. This study showed that people with diabetes mellitus had good knowledge 377 respondents, 161 respondents gas suffcient knowledge, and 131 respondents lacked knowledge. While the prevention of diabetes mellitus had good prevention as many as 322 respondents, adequate prevention as 166 respondents, lack of prevention was 141 respondents. Physical activity gas a level of mild as many as 30 respondents, moderate as right respondents, high as two respondents. Many people had a lack of knowledge and prevention of diabetes mellitus, Nurse are expected to provide education or nursing care as well as phychological aspects. Keywords : Diabetes Melitus; Prevention; Knowledge. AbstrakDiabetes Melitus suatu penyakit tidak menular yakni gangguan metabolisme kronis yang disebabkan oleh banyak faktor dengan ditandai tingginya kadar gula darah sebagian dari akibat gangguan fungsi insulin, upaya pencegahan diabetes memiliki faktor risiko meliputi faktor yang tidak dapat diubah yakni umur dan keturunan dan faktor yang dapat diubah yakni makanan, aktifitas fisik yang kurang, obat- obatan,stress dan kurangnya pengetahuan. Tingkat pengetahuan dapat dipengaruhi oleh pendidikan dan dukungan keluarga yang dapat mempengaruhi seseorang baik terhadap lingkungan maupun objek tertentu. Mengetahui gambaran pengetahuan dan upaya pencegahan dan juga pencegahan dengan melakukan aktivitas fisik. Penelitian ini merupakan penelitian sekunder berjenis literatur review. Metode yang digunakan dalam pemilihan artikel yaitu dengan melakukan penelusuran literatur dari sumber database Pubmed, Portal Garuda, dan Scilit dan didapatkan 5 artikel yang sesuai dengan kriteria inklusi penelitian. Hasil analisis literatur review menunjukkan bahwa masyarakat dengan pengetahuan dan upaya pencegahan diabetes melitus memiliki pengetahuan baik dengan hasil sebanyak 377 responden, pengetahuan cukup sebanyak 161 responden, pengetahuan kurang sebanyak 131 responden. Sedangkan pencegahan diabetes melitus memiliki pencegahan baik sebanyak 322 responden, pencegahan cukup sebanyak 166 respondnen, pencegahan kurang baik sebanyak 141 responden. Dan pencegahan aktivitas fisik memiliki tingkat pencegahan ringan sebanyak 30 responden, pencegahan sedang sebanyak 8 responden, pencegahan tinggi sebanyak 2 responden. Masyarakat yang mengalami kurang pengetahuan dan pencegahan diabetes melitus paling banyak mengalami tingkat pengetahuan dan pencegahan baik. Diharapkan perawat dapat memberikan edukasi atau asuhan keperawatan dengan tetap memperhatikan aspek psikologi. Kata kunci : Diabetes Melitus; Pencegahan; Pengetahuan.

Etiology and Epidemiology of Maturity-onset Diabetes of the Young

Evidence indicates that Maturity-onset diabetes of the young (MODY) exhibits an autosomal dominant inheritance and is the most common type of monogenic diabetes. However, it should be noted that misdiagnosis of the condition is very common, as patients are usually mistaken for both types I and type II diabetes mellitus. In the present study, we have discussed the etiology, pathogenesis, and epidemiology of MODY based on an extensive literature review. Genetic mutations are mainly attributed to the development of the disease, which usually manifests throughout the second to fifth decades of life. Pancreatic islet cell destruction, impaired insulin secretion, defects regarding threshold to serum glucose levels, and other pathological events are usually observed in these patients. Data regarding the epidemiology of the condition is not adequately reported in the literature, especially among non-European populations, indicating the need to conduct future investigations. Ethnic and age variations are potentially epidemiological characteristics of the disease. However, not enough data are present in the literature to support such conclusions.

Impaired Insulin Clearance as the Initial Regulator of Obesity-Associated Hyperinsulinemia: Novel Insight Into the Underlying Mechanism Based on Serum Bile Acid Profiles

<b>OBJECTIVE</b> <div><p>To investigate the roles of insulin clearance and insulin secretion in the development of hyperinsulinemia in obese subjects and to reveal the association between insulin clearance and bile acids (BAs).</p> <p><b> </b></p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>In cohort 1, insulin secretion, sensitivity and endogenous insulin clearance were evaluated with an oral glucose tolerance test (OGTT) in 460 recruited participants. In cohort 2, 81 participants underwent an <a>intravenous glucose tolerance test</a> (IVGTT) and a hyperinsulinemic-euglycemic clamp to assess insulin secretion, endogenous and exogenous insulin clearance, and insulin sensitivity. Based on insulin resistance levels ranging from mild to severe, nondiabetic obese participants were further divided into 10 quantiles in cohort 1 and into tertiles in cohort 2. Forty serum BAs were measured in cohort 2 to examine the association between BAs and insulin clearance.</p> <p><b> </b></p> <p><b>RESULTS</b></p> <p>All obese participants had impaired insulin clearance, and it worsened with additional insulin resistance in nondiabetic obese subjects. However, insulin secretion was unchanged from quantile 1 to 3 in cohort 1, and no difference was found in cohort 2. After adjustments for all confounding factors, serum conjugated BAs, especially glycodeoxycholic acid (GDCA, β=-0.335, P=0.004) and taurodeoxycholic acid (TDCA, β=-0.333, P=0.003), were negatively correlated with insulin clearance<a>. The ratio of </a><a></a><a>unconjugated to conjugated BAs (UnconBA/ConBA</a>, β=0.335, P=0.002) was positively correlated with insulin clearance.</p> <p><b> </b></p> <p><b>CONCLUSIONS</b></p> <p>Hyperinsulinemia in obese subjects might be primarily induced by decreased insulin clearance rather than increased insulin secretion. Changes in circulating conjugated BAs, especially GDCA and TDCA, might play an important role in regulating insulin clearance.</p></div>

Impaired Insulin Clearance as the Initial Regulator of Obesity-Associated Hyperinsulinemia: Novel Insight Into the Underlying Mechanism Based on Serum Bile Acid Profiles

<b>OBJECTIVE</b> <div><p>To investigate the roles of insulin clearance and insulin secretion in the development of hyperinsulinemia in obese subjects and to reveal the association between insulin clearance and bile acids (BAs).</p> <p><b> </b></p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>In cohort 1, insulin secretion, sensitivity and endogenous insulin clearance were evaluated with an oral glucose tolerance test (OGTT) in 460 recruited participants. In cohort 2, 81 participants underwent an <a>intravenous glucose tolerance test</a> (IVGTT) and a hyperinsulinemic-euglycemic clamp to assess insulin secretion, endogenous and exogenous insulin clearance, and insulin sensitivity. Based on insulin resistance levels ranging from mild to severe, nondiabetic obese participants were further divided into 10 quantiles in cohort 1 and into tertiles in cohort 2. Forty serum BAs were measured in cohort 2 to examine the association between BAs and insulin clearance.</p> <p><b> </b></p> <p><b>RESULTS</b></p> <p>All obese participants had impaired insulin clearance, and it worsened with additional insulin resistance in nondiabetic obese subjects. However, insulin secretion was unchanged from quantile 1 to 3 in cohort 1, and no difference was found in cohort 2. After adjustments for all confounding factors, serum conjugated BAs, especially glycodeoxycholic acid (GDCA, β=-0.335, P=0.004) and taurodeoxycholic acid (TDCA, β=-0.333, P=0.003), were negatively correlated with insulin clearance<a>. The ratio of </a><a></a><a>unconjugated to conjugated BAs (UnconBA/ConBA</a>, β=0.335, P=0.002) was positively correlated with insulin clearance.</p> <p><b> </b></p> <p><b>CONCLUSIONS</b></p> <p>Hyperinsulinemia in obese subjects might be primarily induced by decreased insulin clearance rather than increased insulin secretion. Changes in circulating conjugated BAs, especially GDCA and TDCA, might play an important role in regulating insulin clearance.</p></div>

Systemic Bioenergetic Capacity Changes with Cognitive Status and Insulin Sensitivity in Older Adults

Systemic mitochondrial dysfunction is reported with AD progression, suggesting that peripheral blood cells may be used to investigate systemic mitochondrial alterations related to cognitive decline. We aimed to identify bioenergetic signatures associated with AD-related dementia and differences in insulin sensitivity associated with AD risk. We analyzed mitochondrial bioenergetics in peripheral blood cells collected from 365 older adults with varying cognitive status (normal, mild cognitive impairment, and AD) and insulin sensitivity. Normoglycemic individuals exhibited lower maximal bioenergetic capacity with AD (PBMCs: 239.6 pmol·min−1, p = 0.02; Platelets: 151.7 pmol·min−1, p = 0.06) compared to normal cognition (PBMCs: 271.5 pmol·min−1; Platelets: 171.7 pmol·min−1). Individuals with impaired insulin sensitivity exhibited lower maximal bioenergetic capacity in platelets with AD (171.6 pmol·min−1, p = 0.008) compared to normal cognition (210.6 pmol.min−1). Participants with impaired insulin sensitivity also exhibited unique bioenergetic profiles exemplified by overall higher levels of mitochondrial respiration, indicating that comorbidities such as diabetes can significantly influence bioenergetic capacity. We observed strong positive associations between maximal respiration in normoglycemic individuals with cognitive function, as measured by Modified Preclinical Alzheimer’s Cognitive Composite (mPACC5) (p = 0.06), and fatty acid oxidation in individuals with impaired insulin sensitivity with cortical thickness (p = 0.05). This study demonstrates that circulating cells may provide a cost-effective and minimally invasive way to monitor systemic bioenergetic changes associated with AD risk, progression, and insulin sensitivity. These findings also suggest that blood-based bioenergetics are related to key features of AD development and progression and should be further developed as a potential biomarker.

Association of single nucleotide polymorphisms with insulin secretion, insulin sensitivity, and diabetes in women with a history of gestational diabetes mellitus

Background This study investigated whether single nucleotide polymorphisms (SNPs) reported by previous genome-wide association studies (GWAS) to be associated with impaired insulin secretion, insulin resistance, and/or type 2 diabetes are associated with disposition index, the homeostasis model assessment of insulin resistance (HOMA-IR), and/or development of diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM). Methods Seventy-two SNPs were genotyped in 374 women with previous GDM from Southern Sweden. An oral glucose tolerance test was performed 1–2 years postpartum, although data on the diagnosis of diabetes were accessible up to 5 years postpartum. HOMA-IR and disposition index were used to measure insulin resistance and secretion, respectively. Results The risk A-allele in the rs11708067 polymorphism of the adenylate cyclase 5 gene (ADCY5) was associated with decreased disposition index (beta = − 0.90, SE 0.38, p = 0.019). This polymorphism was an expression quantitative trait loci (eQTL) in islets for both ADCY5 and its antisense transcript. The risk C-allele in the rs2943641 polymorphism, near the insulin receptor substrate 1 gene (IRS1), showed a trend towards association with increased HOMA-IR (beta = 0.36, SE 0.18, p = 0.050), and the T-allele of the rs4607103 polymorphism, near the ADAM metallopeptidase with thrombospondin type 1 motif 9 gene (ADAMTS9), was associated with postpartum diabetes (OR = 2.12, SE 0.22, p = 0.00055). The genetic risk score (GRS) of the top four SNPs tested for association with the disposition index using equal weights was associated with the disposition index (beta = − 0.31, SE = 0.29, p = 0.00096). In addition, the GRS of the four SNPs studied for association with HOMA-IR using equal weights showed an association with HOMA-IR (beta = 1.13, SE = 0.48, p = 9.72874e−11). All analyses were adjusted for age, body mass index, and ethnicity. Conclusions This study demonstrated the genetic susceptibility of women with a history of GDM to impaired insulin secretion and sensitivity and, ultimately, to diabetes development.

Molecular and Biochemical Pathways Encompassing Diabetes Mellitus and Dementia

: Diabetes mellitus is a major metabolic disorder that has now emerged as an epidemic, and it affects the brain through an array of pathways. Diabetes mellitus patients can develop pathological changes in the brain, which eventually take the shape of mild cognitive impairment progressing to Alzheimer’s Disease. A number of preclinical and clinical studies demonstrate this fact, and it comes out to be those molecular pathways such as amyloidogenesis, oxidative stress, inflammation, and impaired insulin signaling are identical in diabetes mellitus and dementia. However, the critical player involved in the vicious cycle of diabetes mellitus and dementia is insulin, whose signaling, when impaired in diabetes mellitus (both type 1 and 2), leads to a decline in cognition, although other pathways are also essential contributors. Moreover, it is not only that diabetes mellitus patients indicate cognitive decline at a later stage; many Alzheimer’s Disease patients also reflect symptoms of diabetes mellitus, thus creating a vicious cycle inculcating a web of complex molecular mechanisms and hence categorizing Alzheimer’s Disease as ‘brain diabetes’. Thus, it is practical to suggest that anti-diabetic drugs are beneficial in Alzheimer’s Disease; but only smaller trials, not the larger ones, have showcased positive outcomes mainly because of the late onset of therapy. Therefore, it is extremely important to develop more of such molecules that target insulin in dementia patients along with such methods that diagnose impaired insulin signaling and the associated cognitive decline so that early therapy may be initiated and the progression of the disease be prevented.

IUGR with catch-up growth programs impaired insulin sensitivity through LRP6/IRS-1 in male rats

Intrauterine growth restriction combined with postnatal accelerated growth (CG-IUGR) could lead to long-term detrimental metabolic outcomes characterized by insulin resistance. As an indispensable co-receptor of Wnt signaling, LRP6 plays a critical role in the susceptibility of metabolic disorders. However, whether LRP6 is involved in the metabolic programing is still unknown. We hypothesized that CG-IUGR programed impaired insulin sensitivity through the impaired LRP6-mediated Wnt signaling in skeletal muscle. A CG-IUGR rat model was employed. The transcriptional and translational alterations of the components of the Wnt and the insulin signaling in the skeletal muscle of the male CG-IUGR rats were determined. The role of LRP6 on the insulin signaling was evaluated by shRNA knockdown or Wnt3a stimulation of LRP6. Compared with controls, the male CG-IUGR rats showed an insulin-resistant phenotype, with impaired insulin signaling and decreased expression of LRP6/β-catenin in skeletal muscle. LRP6 knocked-down lead to reduced expression of the IR-β/IRS-1 in C2C12 cell line, while Wnt3a-mediated LRP6 expression increased the expression of IRS-1 and IGF-1R but not IR-β in the primary muscle cells of male CG-IUGR rats. The impaired LRP6/β-catenin/IGF-1R/IRS-1 signaling is probably one of the critical mechanisms underlying the programed impaired insulin sensitivity in male CG-IUGR.

Short-term physical inactivity induces diacylglycerol accumulation and insulin resistance in muscle via lipin1 activation

Physical inactivity impairs muscle insulin sensitivity. However, its mechanism is unclear. To model physical inactivity, we applied 24-h hind-limb cast immobilization (HCI) to mice with normal or high fat diet (HFD), and evaluated intramyocellular lipids and the insulin signaling pathway in the soleus muscle. While 2-wk HFD alone did not alter intramyocellular diacylglycerol (IMDG) accumulation, HCI alone increased it by 1.9-fold and HCI after HFD further increased it by 3.3-fold. Parallel to this, we found increased PKCε activity, reduced insulin-induced 2-deoxy-glucose (2-DOG) uptake, and reduced phosphorylation of IRβ and Akt, key molecules for insulin signaling pathway. Lipin1, which converts phosphatidic acid to diacylglycerol, showed increase of its activity by HCI, and dominant-negative lipin1 expression in muscle prevented HCI-induced IMDG accumulation and impaired insulin-induced 2-DOG uptake. Further, 24-h leg cast immobilization in human increased lipin1 expression. Thus, even short-term immobilization increases IMDG and impairs insulin sensitivity in muscle via enhanced lipin1 activity.