XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

AMP-activated protein kinase (AMPK) is a crucial cellular energy sensor. Once activated by falling energy status, it promotes ATP production by increasing the activity or expression of proteins involved in catabolism while conserving ATP by switching off biosynthetic pathways. AMPK also regulates metabolic energy balance at the whole-body level. For example, it mediates the effects of agents acting on the hypothalamus that promote feeding and entrains circadian rhythms of metabolism and feeding behaviour. Finally, recent studies reveal that AMPK conserves ATP levels through the regulation of processes other than metabolism, such as the cell cycle and neuronal membrane excitability.

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AMPK: a nutrient and energy sensor that maintains energy homeostasis

I read this book the same weekend that the Packers took on the Rams, and the experience of the latter event, obviously, colored my judgment. Although I abhor anything that smacks of being a handbook (like, \"How to Earn a Merit Badge in Neurosurgery\") because too many volumes in biomedical science already evince a boyscout-like approach, I must confess that parts of this volume are fast, scholarly, and significant, with certain reservations. I like parts of this well-illustrated book because Dr. Sj6strand, without so stating, develops certain subjects on technique in relation to the acquisition of judgment and sophistication. And this is important! So, given that the author (like all of us) is somewhat deficient in some areas, and biased in others, the book is still valuable if the uninitiated reader swallows it in a general fashion, realizing full well that what will be required from the reader is a modulation to fit his vision, propreception, adaptation and response, and the kind of problem he is undertaking. A major deficiency of this book is revealed by comparison of its use of physics and of chemistry to provide understanding and background for the application of high resolution electron microscopy to problems in biology. Since the volume is keyed to high resolution electron microscopy, which is a sophisticated form of structural analysis, but really morphology in a modern guise, the physical and mechanical background of The instrument and its ancillary tools are simply and well presented. The potential use of chemical or cytochemical information as it relates to biological fine structure , however, is quite deficient. I wonder when even sophisticated morphol-ogists will consider fixation a reaction and not a technique; only then will the fundamentals become self-evident and predictable and this sine qua flon will become less mystical. Staining reactions (the most inadequate chapter) ought to be something more than a technique to selectively enhance contrast of morphological elements; it ought to give the structural addresses of some of the chemical residents of cell components. Is it pertinent that auto-radiography gets singled out for more complete coverage than other significant aspects of cytochemistry by a high resolution microscopist, when it has a built-in minimal error of 1,000 A in standard practice? I don't mean to blind-side (in strict football terminology) Dr. Sj6strand's efforts for what is \"routinely used in our laboratory\"; what is done is usually well done. It's just that …

Methods in Enzymology.

The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org.

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Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration.

Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

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Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)

This special issue of PLEFA contains a selection of original research papers and brief surveys presented at the ninth biennial Congress of the International Society for the Study of Fatty Acids and Lipids (ISSFAL), held in Maastricht, the Netherlands from May 29 to June 2, 2010. The theme of the congress was ‘‘Lipids in Metabolic Health and Disease’’. Plenary lectures were given by renowned scientists from around the world, while selected topics were covered in concurrent sessions organised in three tracks: Lipids & Health, Lipids & Nutrition, and Biochemistry of Lipids. The Alexander Leaf Distinguished Scientist Award for Lifetime Achievement was presented to Norman Salem, Jr., Ph.D., University of Rochester, NY, for his major contribution to our current knowledge on docosahexaenoic acid (DHA). The winner of the Early Career Award was John Paul SanGiovanni, Ph.D., National Institutes of Health, Bethesda MD, for his studies on the relationship of long-chain polyunsaturated fatty acid intake with pathogenic processes. A new record was set for total attendance, which amounted to 609 participants from 38 countries. In order to encourage individuals early in their careers to do research in the area of fatty acids and lipids, 40 New Investigator Awards were provided. Nine of them entered a competition which included voting on a ballot form by all delegates. The three winners of the Top New Investigator Award (one for each track) were Giuseppe Astarita,

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Lipids in metabolic health and disease.

The Society for Heart and Vascular Metabolism (SHVM) has held its fifth annual conference in Maastricht, The Netherlands, from June 18 to 20, 2007.

This meeting followed the successful previous conferences held in Freiburg, Germany (2003), Montebello, Canada (2004), Oxford, UK (2005), and Semiahmoo/Seattle, USA (2006).

The overall theme of the Maastricht conference was New developments in cardiac lipid metabolism: from substrate to signaling. The most recent basic and clinical advances in the study of cardiac lipid metabolism in health and disease were presented and discussed by eminent scientists from around the world. The participants originated from 13 countries and 4 continents, reflecting the world-wide and growing interest in metabolic aspects of cardiac function and cardiac disease.

The scientific program of the Maastricht meeting comprised sessions on energy metabolism in the normal and diabetic heart, signaling pathways controlling cardiac metabolism, vascular metabolism and inflammation, cardiac metabolism in hypertrophy and the failing heart, uncoupling proteins and heart function, and clinical diagnostics and therapeutic effects.

The present focused issue of Cardiovascular Drugs & Therapy is a collection of selected papers presented during the conference and the abstracts of the short-oral and poster presentations. Together, they provide insight into our current understanding and most recent developments of cardiac metabolism in health and disease.

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Myocardial Metabolism—Therapeutic Aspects

The currently most prevalent cardiac diseases, diabetic cardiomyopathy and hypertrophic heart failure, each associate with a chronic change in energy substrate utilization towards a single type of substrate, i.e., fatty acids or glucose, respectively. Recent experimental studies suggest that proper cardiac contractile performance is dependent on a finely tuned balance between the utilization of these two substrates. Furthermore, re-balancing myocardial fuel supply (fatty acids versus glucose) appears an effective treatment option in cardiac disease.

Myocardial Fatty Acid-Glucose Fuel Balance as Target to Treat Cardiac Diseases

Acute insulin-mediated increase in the skeletal muscle fatty acid transporter CD36/FAT is impaired in insulin resistant conditions

There is growing recognition of the importance and multiple roles of substrate energy metabolism in both cardiac health and disease. Cardiac diseases are frequently accompanied by altered myocardial metabolism, while chronic changes in the type of myocardial substrate utilization are found to elicit cardiac contractile dysfunction. Examples are the increased glucose utilization, at the expense of fatty acids, in cardiac hypertrophy and ischemic heart failure, and the increased fatty acid utilization, at the expense of glucose, in obesity and diabetes-related cardiac dysfunction. Modulation of cardiac metabolism has emerged as a suitable therapeutic intervention in cardiac disease. Insights obtained during the past decade have revealed sarcolemmal substrate transport, facilitated by CD36 for fatty acids and by GLUT4 for glucose, to represent the main rate-governing kinetic step of substrate utilization, over-ruling intracellular sites of flux regulation. This suggests that manipulating the presence of substrate transporters in the sarcolemma may be an effective approach for metabolic modulation therapy. The present mini-review provides a short summary of the functioning of substrate transporters CD36 and GLUT4 in the heart, and discusses their application as targets for metabolic intervention.

https://www.cardiologyresearchjournal.com/articles/metabolic-modulation-to-treat-cardiac-diseases-role-for-membrane-substrate-transporters.pdf

Jan F. C. Glatz

Papers

Lipids in metabolic health and disease.

Myocardial Metabolism—Therapeutic Aspects

Myocardial Fatty Acid-Glucose Fuel Balance as Target to Treat Cardiac Diseases

Acute insulin-mediated increase in the skeletal muscle fatty acid transporter CD36/FAT is impaired in insulin resistant conditions

Metabolic Modulation to Treat Cardiac Diseases: Role for Membrane Substrate Transporters