Gudoy, Charies Jamille 12-Weierstrass

SYNTHESIS ABOUT ADVANCES IN BIOLOGY:

TYPE 2 DIABETES
Forecasts suggest that by the year 2030, 336 million people worldwide will be diagnosed with
diabetes. Diabetes mellitus is a lifelong metabolic disease that remains as a major global problem in
medicine due to defect in the secretion of insulin and/or defect in the action of insulin characterized by
hyperglycemia. Diabetes mellitus type 2 and metabolic syndrome are conditions associated with insulin
resistance. It is characterized by a hyperglycemic condition, which is caused by either insulin deficiency
or insulin resistance or both. The chronic hyperglycemic condition may lead to impairment at the
molecular level and result in the development of complications such as diabetic nephropathy or
cardiovascular disease.

Hypoglycemia is rarely severe in T2DM, especially in disease of short duration. Some protection
against hypoglycemia is afforded by the relatively intact glucose counter-regulatory pathways that
characterize the pathophysiology of early type 2 diabetes. To some extent, this protection explains why
hypoglycemic episodes in intensively treated individuals with type 2 diabetes, when they occur, are
rarely severe. As diabetes progresses and therapy intensifies to achieve recommended glycemic goals,
hypoglycemia frequency and severity increase. Thus, when it comes to instituting intensive therapy, fear
of hypoglycemia may contribute to health-care providers clinical inertia. Because maintaining glycemic
control is so important to both public and individual health, many new therapies and technologies have
been developed. In adults, hypoglycemia risk increases with age. Hypoglycemia is particularly
challenging in the elderly, because it may be compounded by polypharmacy, comorbidities, frequent
hospitalizations, and some concomitant therapies. Hypoglycemic symptoms can be beneficial, providing
early warning of dangerously low BG and triggering self-treatment. With some counter-regulatory
function remaining, hypoglycemia unawareness is less problematic, at least in early stages of T2DM.
Additionally, as patients become insulin-dependent, other counter-regulatory functions involving
epinephrine, norepinephrine and glucagon that oppose developing hypoglycemia are also blunted.
Because autonomic controls to counteract falling BG deteriorate, the risk of hypoglycemia increases and
glycemic control becomes hard to achieve in late-stage T2DM

Glycosylated hemoglobin (HbA1c) served as an indicator for long-term glycemic control. It

reflects as cumulative 2-3 months of blood glucose. As the gold standard for glycemic control
determined by Diabetes Complications and Control Trial, the HbA1c value of 7% served as a critical
value to reduce vascular complications risk. Also, the increase in HbA1c is considered an independent
risk factor for coronary heart disease (CHD) in patients with diabetes.

Ceruloplasmin is an enzyme and an acute-phase protein synthesized in the liver and a member
of blue multicopper oxidase. The physiological functions of ceruloplasmin are uncertain, but
ceruloplasmin has a role in copper transport, coagulation, angiogenesis, defense against oxidative stress,
and iron homeostasis.

Impact of Therapeutic Advances on Hypoglycemia in Type 2 Diabetes

Treatment algorithms for T2DM usually begin with diet and moderate exercise. In the
diet/exercise arm of the UKPDS, few patients experienced substantive (0.1%) or any hypoglycemia
(0.8%) annually. When diet/exercise fail to maintain adequate glycemic control, BG-lowering medication
is required and, when its action exceeds food intake balanced with activity level, hypoglycemia can
ensue. In general, agents with lower HBA1c-LC pose less risk, whereas those with higher HbA1c-LC tend
to increase risk, particularly when patients miss meals or engage in behavior that disturbs the
pharmacotherapyBG equilibrium. Incretin analogues, one of several new treatment choices for T2DM,
act under hyperglycemic conditions to mimic GLP-1 via pancreatic and extra pancreatic mechanisms.

Aggressive diabetes therapy must be matched with comprehensive patient education that
emphasizes the causes of hypoglycemia as well as symptoms, treatment, BG monitoring, interpretation
of results, and how to make therapeutic, behavioral and nutritional adjustments to reduce
hypoglycemia risk. Referral to a CDE is warranted, particularly if time constraints limit physician
involvement in patient education.

Plasma Glucose and Serum Ceruloplasmin in Metabolic Syndrome and Diabetes Mellitus Type 2

The primary clinical outcome of metabolic syndrome is cardiovascular disease. Majority of the
individuals with metabolic syndrome will have insulin resistance and this can later result in increased risk
for type 2 diabetes mellitus.

Study population consisted of 150 individuals50 individuals with diabetes mellitus type 2, 50
individuals with metabolic syndrome, and 50 age- and sex-matched healthy controls. The study found a
statistically significant increase in the fasting and postprandial plasma glucose levels in diabetics when
compared to metabolic syndrome. And this study shows a statistically significant decrease in the serum
ceruloplasmin in metabolic syndrome and diabetes mellitus type 2, when compared to control group.
Further, when compared to metabolic syndrome, a statistically significant decrease in serum
ceruloplasmin level was observed in diabetes mellitus type 2. The decrease in the serum ceruloplasmin
in the metabolic syndrome and diabetes mellitus observed in the study may be due to the increased
utilization of the antioxidants, including ceruloplasmin, to neutralize the reactive oxygen species
produced in excess in these conditions. Significant negative correlation was observed between the
plasma glucose and ceruloplasmin in diabetes mellitus type 2 but not in metabolic syndrome.

Individual Lipids and Lipid Ratios in Type-2 Diabetic Patients: Association with Glycemic Control Status

A total of 80 patients (43 males and 37 females) with type-2 diabetes were included in this
study, which was carried out at Sanglah General Hospital, Denpasar, Bali, Indonesia. Subjects were
classified into two groups according to their HbA1c levels (good glycemic control and bad glycemic
control). All data were analyzed with a computer program. Each variable was analyzed descriptively.
ShapiroWilk and Kolmogorov Smirnov test was used to determine normality of data. Mean standard
deviation (SD) and median (minimummaximum) were used to present data with and without normal
distribution, respectively. To determine statistical significant difference, parametric statistic
(independent t-test) and nonparametric statistic (MannWhitney U-test) were used as appropriate.
Correlation analysis was performed with Pearson (parametric) or Spearman (nonparametric).
Multivariate analysis with logistic regression was performed to determine variables, which associated
with poor glycemic control in patients with diabetes. Receiver-operating curve (ROC) analysis was used
to predict poor glycemic control in patients with diabetes. Statistical significance of data was set at p-
value of less than 0.05.

The present study found that individual lipids and lipid ratios did not differ significantly between
good glycemic control and poor glycemic control group. The value of individual lipids and lipid ratios also
did not correlate with HbA1c. Parameters of individual lipids and lipid ratios were not independently
associated with poor glycemic control, which was analyzed by logistic regression. The glycemic control is
delineated by the amount of HbA1c. In addition, fasting and postprandial blood glucose levels were
closely related with HbA1c. The Diabetes Complications and Control Trial (DCCT) determined HbA1c as
the best beneficial marker of glycemic control. The increase in HbA1c is currently considered as an
independent risk factor for CVD in an individual with diabetic condition or not. The research found that
HbA1c demonstrated significant correlations with lipid abnormalities.
 Based on the articles that have shown above, it concludes that ceroplasmin acts as an
antioxidant through its ferroxidase activity. In diabetes mellitus, increased oxidative stress is a risk factor
for atherosclerosis and coronary heart disease. As type 2 diabetes progresses and therapy intensifies to
achieve recommended glycaemic goals, hypoglycaemia frequency and severity increase. Thus, when it
comes to instituting intensive therapy, fear of hypoglycaemia may contribute to health-care providers
clinical inertia. Because maintaining glycaemic control is so important to both public and individual
health, many new therapies and technologies have been developed.