vendex and Diabetes-Mellitus--Type-2

The purpose of this study was to investigate the effect of diabetes, motor nerve impairment, and training status on neuromuscular function by concurrent assessment of the torque-velocity relationship and muscle fiber conduction velocity (MFCV).. Four groups were studied (n = 12 each): sedentary patients with diabetes in the first (lower) and fourth (higher) quartile of motor nerve conduction velocity (D1 and D4, respectively), trained diabetic (TD) patients, and nondiabetic sedentary control (C) subjects. Maximal isometric and isokinetic contractions were assessed over a wide range of angular velocities for the elbow flexors and knee extensors to evaluate the torque-velocity relationship. Simultaneously, MFCV was estimated from surface electromyography of the vastus lateralis and biceps brachii.. Isometric strength was similar among groups. The dynamic strength of elbow flexors was reduced in patients with diabetes at the higher contraction speeds. The strength of knee extensors was lower in sedentary patients with diabetes at all velocities considered, with significantly lower values in D1 than that in D4 at 60°, 90°, and 120°·s(-1), whereas it was similar between TD and C subjects, especially at low contraction velocities. At the vastus lateralis, but not the biceps brachii, MFCV was lower in D1 and D4 as compared with TD and C subjects, showing similar values.. Muscle weakness in diabetes affects also the upper limb, although to a lower extent than the lower limb, is only partly related to motor nerve impairment, and is dependent on contraction velocity. Exercise training might counteract diabetes-induced alterations in muscle fiber contractile properties and MFCV.

Topics: Aged; Biomechanical Phenomena; Case-Control Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Electromyography; Exercise Therapy; Humans; Male; Middle Aged; Motor Neurons; Muscle Contraction; Muscle Strength; Muscle, Skeletal; Neural Conduction; Single-Blind Method; Torque

Limited ankle dorsiflexion has been implicated as a contributing factor to plantar ulceration of the forefoot in diabetes mellitus. The purpose of this study was to compare outcomes for patients with diabetes mellitus and a neuropathic plantar ulcer treated with a total-contact cast with and without an Achilles tendon lengthening. Our primary hypothesis was that the Achilles tendon lengthening would lead to a lower rate of ulcer recurrence.. Sixty-four subjects were randomized into two treatment groups, immobilization in a total-contact cast alone or combined with percutaneous Achilles tendon lengthening, with measurements made before and after treatment, at the seven-month follow-up examination, and at the final follow-up evaluation (a mean [and standard deviation] of 2.1 +/- 0.7 years after initial healing). There were thirty-three subjects in the total-contact cast group and thirty-one subjects in the Achilles tendon lengthening group. There were no significant differences in age, body-mass index, or duration of diabetes between the groups. Outcome measures were time to healing of the ulcer, ulcer recurrence rate, range of dorsiflexion of the ankle, peak torque (strength) of the plantar flexor muscles, and peak plantar pressures on the forefoot.. Twenty-nine (88%) of thirty-three ulcers in the total-contact cast group and all thirty ulcers (100%) in the Achilles tendon lengthening group healed after a mean duration (and standard deviation) of 41 +/- 28 days and 58 +/- 47 days, respectively (p > 0.05). (One patient in the Achilles tendon lengthening group died before treatment was completed.) In the first seven months of follow-up, sixteen (59%) of the twenty-seven patients in the total-contact cast group who were available for follow-up and four (15%) of the twenty-seven patients in the Achilles tendon lengthening group who were available for follow-up had an ulcer recurrence (p = 0.001). At the time of the two-year follow-up, twenty-one (81%) of the twenty-six patients in the total-contact cast group and ten (38%) of the twenty-six patients in the Achilles tendon lengthening group had ulcer recurrence (p = 0.002). Compared with the group treated with the total-contact cast, the group treated with Achilles tendon lengthening had increased dorsiflexion and it remained increased at seven months (p < 0.001). Plantar flexor peak torque also decreased after Achilles tendon lengthening (p < 0.004), but it returned to baseline after seven months. Peak plantar pressures on the forefoot during barefoot walking were reduced (p < 0.0002) following Achilles tendon lengthening yet returned to baseline values within seven months after treatment.. All ulcers healed in the Achilles tendon lengthening group, and the risk for ulcer recurrence was 75% less at seven months and 52% less at two years than that in the total-contact cast group. Achilles tendon lengthening should be considered an effective strategy to reduce recurrence of neuropathic ulceration of the plantar aspect of the forefoot in patients with diabetes mellitus and limited ankle dorsiflexion (

Topics: Adult; Aged; Ankle Joint; Casts, Surgical; Diabetes Mellitus, Type 2; Diabetic Foot; Female; Follow-Up Studies; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Postoperative Care; Range of Motion, Articular; Secondary Prevention; Torque; Weight-Bearing; Wound Healing

The objective of this study is to investigate the association between muscle function, body composition, and metabolic control in adults with type 2 diabetes mellitus (DM2).. Forty-eight individuals with DM2 were divided into four groups according to the severity of obesity (body mass index [BMI]: lean [LN, n = 10], overweight [OW, n = 16], obese class I [OBI, n = 15], and obese class II [OBII, n = 7]). Absolute peak torque (TQ), relative peak torque (TQ/body weight [BW]), total work (TW), and fatigue index (FI) were assessed by means of an isokinetic dynamometer during concentric knee extensor contraction. Spearman's correlation coefficients were used to estimate the association between measurements.. Although OBII had higher insulin levels than both LN and OW groups, no significant differences were found between groups for TQ, TQ/BW, TW, and FI, as well as between metabolic variables and muscle measurements. There was a positive correlation between BMI and TQ (r. Metabolic variables do not correlate with muscle strength and endurance in DM2. However, severity of obesity measured by the BMI is positively associated with muscle force-generating capacity and endurance.

Topics: Aged; Anthropometry; Body Composition; Body Mass Index; Body Weight; Diabetes Mellitus, Type 2; Female; Humans; Knee Joint; Male; Muscle Strength; Muscle, Skeletal; Obesity; Risk Factors; Torque

Success of dental implant is associated with the surface modification. To evaluate whether the selective laser melting-superfinished titanium (Ti6Al4V) implants have a better early osseointegration in type 2 diabetes mellitus rats compare to pure titanium implants and acid-etched treated (SLA) implants, we designed a screw-shaped implant which was batch-fabricated by selective laser melting (SLM). Then the implants were randomly inserted in tibias of rats with type 2 diabetes mellitus (T2DM). After surgical operation, the SLM group showed the best bone formation around the implants with the highest bone-implant contact rate among the three groups.Removal torque tests and histomorphological analyses all revealed a stronger connection between the bone because its good surface characteristics and mechanical properties. SLM implant may be a novel implant for T2DM patients.

Topics: Animals; Dental Implants; Diabetes Mellitus, Type 2; Humans; Osseointegration; Rats; Surface Properties; Titanium; Torque

Although exercise can prevent progression to T2D among people with prediabetes, little is known about fatigue during exercise in people with prediabetes compared to T2D. The purpose of the study was to compare the magnitude and mechanisms of fatigability of the ankle dorsiflexor muscles between people with prediabetes and T2D. Ten people with prediabetes (6 females, 51.7 ± 6.9 years) and fourteen with T2D (6 females, 52.6 ± 6.2 years) who were matched for age, body mass index and physical activity performed an intermittent (6 s contraction: 4 s relaxation) fatiguing task at 75% maximal voluntary contraction (MVC) with the dorsiflexors. Electrical stimulation was used to assess contractile properties of the dorsiflexor muscles before and after the fatiguing task. People with prediabetes had a longer time-to-task failure, i.e. greater fatigue resistance (7.9 ± 5.1 vs. 4.9 ± 2.5 min, P = 0.04), and slower rate of decline of the (potentiated) twitch amplitude (6.5 ± 3.1 vs. 16.5 ± 11.7%·min

Topics: Adult; Diabetes Mellitus, Type 2; Female; Humans; Isometric Contraction; Male; Muscle Fatigue; Muscle, Skeletal; Prediabetic State; Torque

Fatiguing exercise is the basis of exercise training and a cornerstone of management of type 2 diabetes mellitus (T2D); however, little is known about the fatigability of limb muscles and the involved mechanisms in people with T2D. The purpose of this study was to compare fatigability of knee extensor muscles between people with T2D and controls without diabetes and determine the neural and muscular mechanisms for a dynamic fatiguing task. Seventeen people with T2D [ten men and seven women: 59.6 (9.0) yr] and twenty-one age-, body mass index-, and physical activity-matched controls [eleven men and ten women: 59.5 (9.6) yr] performed one hundred twenty high-velocity concentric contractions (one contraction/3 s) with a load equivalent to 20% maximal voluntary isometric contraction (MVIC) torque with the knee extensors. Transcranial magnetic stimulation (TMS) and electrical stimulation of the quadriceps were used to assess voluntary activation and contractile properties. People with T2D had larger reductions than controls in power during the fatiguing task [42.8 (24.2) vs. 26.4 (15.0)%; P < 0.001] and MVIC torque after the fatiguing task [37.6 (18.2) vs. 26.4 (12.1)%; P = 0.04]. People with T2D had greater reductions than controls in the electrically evoked twitch amplitude after the fatiguing task [44.0 (20.4) vs. 35.4 (12.1)%, respectively; P = 0.01]. However, the decrease in voluntary activation was similar between groups when assessed with electrical stimulation [12.1 (2.6) vs. 12.4 (4.4)% decrease; P = 0.84] and TMS ( P = 0.995). A greater decline in MVIC torque was associated with larger reductions of twitch amplitude ( r

Topics: Case-Control Studies; Diabetes Mellitus, Type 2; Electric Stimulation; Electromyography; Evoked Potentials, Motor; Exercise; Female; Humans; Isometric Contraction; Knee; Knee Joint; Lower Extremity; Male; Middle Aged; Muscle Contraction; Muscle Fatigue; Muscle, Skeletal; Physical Endurance; Sex Characteristics; Torque; Transcranial Magnetic Stimulation

The aim of this study was to compare muscle strength in male subjects with type 2 diabetes mellitus (DM2) with and without low plasma testosterone levels and assess the relationship between muscle strength, testosterone levels, and proinflammatory cytokines. Males (75) aged between 18 and 65 years were divided into 3 groups: control group that did not have diabetes and had a normal testosterone plasma level (>250 ng/dL), DnormalTT group that had DM2 with normal testosterone levels, and the DlowTT group that had DM2 and low plasma testosterone levels (<250 ng/dL). The age (means±SD) of the groups was 48.4±10, 52.6±7, and 54.6±7 years, respectively. Isokinetic concentric and isometric torque of knee flexors and extensors were analyzed by an isokinetic dynamometer. Plasma testosterone and proinflammatory cytokine levels were determined by chemiluminescence and ELISA, respectively. Glycemic control was analyzed by glycated hemoglobin (HbA1C). In general, concentric and isometric torques were lower and tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β plasma levels were higher in the groups with diabetes than in controls. There was no correlation between testosterone level and knee torques or proinflammatory cytokines. Concentric and isometric knee flexion and extension torque were negatively correlated with TNF-α, IL-6, and HbA1C. IL-6 and TNF-α were positively correlated with HbA1C. The results of this study demonstrated that muscle strength was not associated with testosterone levels in men with DM2. Low muscle strength was associated with inflammatory markers and poor glycemic control.

Topics: Adolescent; Adult; Aged; Cytokines; Diabetes Mellitus, Type 2; Female; Humans; Inflammation Mediators; Interleukin-6; Isometric Contraction; Knee; Male; Middle Aged; Muscle Strength; Testosterone; Torque; Tumor Necrosis Factor-alpha; Young Adult

Skeletal muscle strength is poorly described and understood in diabetic participants with diabetic peripheral neuropathy. This study aimed to investigate the extensor and flexor torque of the knee and ankle during concentric, eccentric, and isometric contractions in men with diabetes mellitus type 2 with and without diabetic peripheral neuropathy.. Three groups of adult men (n=92), similar in age, body mass index, and testosterone levels, were analyzed: 33 non-diabetic controls, 31 with type 2 diabetes mellitus, and 28 with diabetic peripheral neuropathy. The peak torques in the concentric, eccentric, and isometric contractions were evaluated using an isokinetic dynamometer during knee and ankle flexion and extension.. Individuals with diabetes and diabetic peripheral neuropathy presented similar low concentric and isometric knee and ankle torques that were also lower than the controls. However, the eccentric torque was similar among the groups, the contractions, and the joints.. Regardless of the presence of peripheral neuropathy, differences in skeletal muscle function were found. The muscle involvement does not follow the same pattern of sensorial losses, since there are no distal-to-proximal impairments. Both knee and ankle were affected, but the effect sizes of the concentric and isometric torques were found to be greater in the participants' knees than in their ankles. The eccentric function did not reveal differences between the healthy control group and the two diabetic groups, raising questions about the involvement of the passive muscle components.

Topics: Adult; Aged; Ankle; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Humans; Isometric Contraction; Knee; Lower Extremity; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Range of Motion, Articular; Torque

Exenatide once weekly, an injectable glucagon-like peptide-1 receptor agonist, has been shown to reduce A1C, fasting glucose, and body weight in patients with type 2 diabetes. Exenatide 2.0 mg is dispersed in poly-(D,L-lactide-co-glycolide) polymer microspheres, which require resuspension in aqueous diluent before subcutaneous injection. A single-use, dual-chamber pen was developed to improve the convenience of exenatide once weekly delivery and tested following Food and Drug Administration (FDA) guidance.. Design development goals were established, and validation tests (dose accuracy, torque/force requirements, usability, and ease-of-use) were performed. Dose accuracy was tested under a variety of conditions. After 10 exploratory studies in 329 patients, the final design's usability and ease-of-use were tested in untrained health care practitioners (HCPs; n = 16) and untrained/trained patients (n = 30/17). Usability testing evaluated completion of multiple setup, dose preparation, and injection steps. Ease-of-use impression was assessed using a scale of 1-7 (1 = very difficult, 7 = very easy).. The dual-chamber pen successfully met development goals and delivered target volume (650 µL ± 10%) under tested conditions (mean 644.7-649.3 µL), with torque and force requirements below prespecified maximum values. In the final user study, most participants (≥87%) correctly completed pen setup, dose preparation, and injection steps. Mean ease-of-use scores were 5.8, 6.3, and 6.5 out of 7 in untrained HCPs, untrained patients, and trained patients, respectively.. With self-education or minimal training, participants accurately and precisely suspended, mixed, and delivered exenatide-containing microspheres using the dual-chamber pen with high ease-of-use scores. The dual-chamber pen was FDA-approved in February 2014.

Topics: Adult; Device Approval; Diabetes Mellitus, Type 2; Drug Administration Schedule; Equipment Design; Exenatide; Humans; Hyperglycemia; Hypoglycemic Agents; Injections, Subcutaneous; Lactic Acid; Microspheres; Peptides; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Reproducibility of Results; Risk Factors; Self Administration; Syringes; Torque; United States; United States Food and Drug Administration; Venoms