BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis, with near-identical incidence and mortality. According to the World Health Organization Globocan Database, the estimated number of new cases worldwide will rise by 70% between 2020 and 2040. There are no effective screening methods available so far, even for high-risk individuals. The prognosis of PDAC, even at its early stages, is still mostly unsatisfactory. Impaired glucose metabolism is present in about 3/4 of PDAC cases. METHODS: Available literature on pancreatic cancer and diabetes mellitus was reviewed using a PubMed database. Data from a national oncology registry (on PDAC) and information from a registry of healthcare providers (on diabetes mellitus and a number of abdominal ultrasound investigations) were obtained. RESULTS: New-onset diabetes mellitus in subjects older than 60 years should be an incentive for a prompt and detailed investigation to exclude PDAC. Type 2 diabetes mellitus, diabetes mellitus associated with chronic non-malignant diseases of the exocrine pancreas, and PDAC-associated type 3c diabetes mellitus are the most frequent types. Proper differentiation of particular types of new-onset diabetes mellitus is a starting point for a population-based program. An algorithm for subsequent steps of the workup was proposed. CONCLUSIONS: The structured, well-differentiated, and elaborately designed approach to the elderly with a new onset of diabetes mellitus could improve the current situation in diagnostics and subsequent poor outcomes of therapy of PDAC.

• Keywords
• age over 60 years, diagnostic algorithm, new-onset diabetes mellitus, pancreatic ductal adenocarcinoma,
• Publication type
• Journal Article MeSH
• Review MeSH

AIMS/HYPOTHESIS: The aim of this study was to investigate whether dynamic strength training modifies the control of lipolysis, with particular attention paid to the involvement of the antilipolytic adrenergic alpha 2A receptor (ADRA2A) pathway. METHODS: Twelve obese men (age: 47.4+/-2.8 years; BMI: 32.7+/-0.9) were investigated during a 210-min euglycaemic-hyperinsulinaemic clamp conducted before and after 3 months of dynamic strength training. Before and during the third hour of the clamp, the lipolytic effect of a perfusion of isoproterenol or adrenaline (epinephrine) alone or associated with the ADRA2A antagonist phentolamine was evaluated using the microdialysis method of measuring extracellular glycerol concentration (EGC) in subcutaneous abdominal adipose tissue (SCAAT). In addition, biopsies of SCAAT were carried out before and after training to determine mRNA levels RESULTS: The training increased insulin sensitivity in adipose tissue. The decrease of EGC was more pronounced during the clamp conducted after the training period than during the clamp done in pre-training conditions. Before and after the training, catecholamines induced an increase in EGC, the increase being lower during the clamp on each occasion. The isoproterenol-induced increase in EGC was higher after the training. Adrenaline-induced lipolysis was potentiated by phentolamine after but not before the training. There were no training-induced changes in mRNA levels of key genes of the lipolytic pathway in SCAAT. CONCLUSIONS/INTERPRETATION: In obese subjects, dynamic strength training improves whole-body and adipose tissue insulin responsiveness. It increases responsiveness to the adrenergic beta receptor stimulation of lipolysis and to the antilipolytic action of catecholamines mediated by ADRA2As.

• MeSH
• Epinephrine pharmacology   MeSH
• Adrenergic beta-2 Receptor Agonists MeSH
• Adrenergic alpha-2 Receptor Agonists MeSH
• Adrenergic alpha-2 Receptor Antagonists MeSH
• Receptors, Adrenergic, alpha-2 genetics   metabolism   MeSH
• Receptors, Adrenergic, beta-2 genetics   metabolism   MeSH
• 3',5'-Cyclic-AMP Phosphodiesterases genetics   physiology   MeSH
• Exercise physiology   MeSH
• Cyclic Nucleotide Phosphodiesterases, Type 3 MeSH
• Adult MeSH
• Phentolamine pharmacology   MeSH
• Glycerol analysis   blood   MeSH
• Glucose Clamp Technique MeSH
• Insulin physiology   MeSH
• Insulin Resistance physiology   MeSH
• Isoproterenol pharmacology   MeSH
• Fatty Acids, Nonesterified blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lipolysis MeSH
• RNA, Messenger analysis   MeSH
• Lipid Metabolism MeSH
• Obesity metabolism   physiopathology   MeSH
• Subcutaneous Fat, Abdominal chemistry   metabolism   MeSH
• Sterol Esterase genetics   physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Epinephrine MeSH
• Adrenergic beta-2 Receptor Agonists MeSH
• Adrenergic alpha-2 Receptor Agonists MeSH
• Adrenergic alpha-2 Receptor Antagonists MeSH
• Receptors, Adrenergic, alpha-2 MeSH
• Receptors, Adrenergic, beta-2 MeSH
• 3',5'-Cyclic-AMP Phosphodiesterases MeSH
• Cyclic Nucleotide Phosphodiesterases, Type 3 MeSH
• Phentolamine MeSH
• Glycerol MeSH
• Insulin MeSH
• Isoproterenol MeSH
• Fatty Acids, Nonesterified MeSH
• RNA, Messenger MeSH
• Sterol Esterase MeSH