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Articles by M. A. Ihnat
Total Records ( 2 ) for M. A. Ihnat
  M. A. Ihnat , J. E. Thorpe and A. Ceriello
  Large randomized studies have established that early intensive glycaemic control reduces the risk of diabetic complications, both micro- and macrovascular. However, epidemiological and prospective data support a long-term influence of early metabolic control on clinical outcomes. This phenomenon has recently been defined as ‘metabolic memory’. Potential mechanisms for propagating this ‘memory’ are the non-enzymatic glycation of cellular proteins and lipids, and an excess of cellular reactive oxygen and nitrogen species, in particular originated at the level of glycated-mitochondrial proteins, perhaps acting in concert with one another to maintain stress signalling. Furthermore, the emergence of this ‘metabolic memory’ suggests the need for very early aggressive treatment aiming to `normalize` glycaemic control and the addition of agents which reduce cellular reactive species and glycation in order to minimize long-term diabetic complications.
  A. Ceriello and M. A. Ihnat
  Much attention has been paid recently to the possibility that oscillating glucose may superimpose on glycated haemoglobin (HbA1c) in determining the risk for diabetes complications. Furthermore, recent evidence suggests that glucose variability, particularly if accompanied by frequent hypoglycaemic episodes, may adversely alter the prognosis of acutely ill patients. In vitro and animal studies confirm that oscillating glucose is more dangerous than stable constant high glucose, particularly in activating the pathways involved in the pathogenesis of diabetes complications. The production of free radicals, accompanied by an insufficient increase in intracellular antioxidant defences, seems to account for this phenomenon. In humans, studies also confirm that fluctuating glucose levels produce an increase in free radicals as well as endothelial dysfunction, and that these changes are greater than those produced by stable high glucose. Avoiding glucose fluctuations in diabetic patients and in crtically ill patients seems to be an emerging therapeutic challenge.
 
 
 
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