Clinical and biochemical characteristics of early onset type 2 diabetes in young diabetics

Early onset type 2 diabetes is no longer rare. Many studies have shown a trend to an earlier age of onset of type 2 DM and pointing to a loosing of the relative protection of young age to type 2 DM, largely attributable to the fattening of modem society. A descriptive study was conducted on a series of 19 early onset type 2 diabetics. Typical insulin-resistant phenotypes were described in these youngsters. Mean Age 17.53 +/- 1.4 years. All patients are overweight [n = 6, 16%] to obese [n = 13, 84%] at diagnosis with mean BMI [31.43 +/- 2.09 Kg/ m2] and mean waist circumference is [94 +/- 1.7 cm in females and 103.43 +/- 1.24 cm in males]. Hypertension was reported in 3 cases with mean systolic blood pressure [SBP] 134.32 +/- 8.45 and mean diastolic blood pressure [DBP] 87.05 +/- 10.34. Family History of type 2 diabetes was reported in 68.4% of the patients and maternal history Of Gestational DM presents in 52.6%. Ten patients [52.6%] have acanthosis nigricans; a cutaneous marker of insulin resistance. 6 female patients [out of 12] had clinical features suggestive of PCOS in the form of irregular menses and hirsutism. HOMA as a measure of insulin resistance was found to have a strong positive correlation with BMI, waist circumference in females, TG, DBP and a negative correlation with HDL-C and Apo A-1.Similarly hsCRP showed a positive correlation with BMI, waist circumference in females and males, TG, DBP and a negative correlation with HDL-C. In conclusion, early onset type 2 DM is increasingly recognized as a part of the accelerating epidemic in the world. This phenomenon is strongly associated with obesity and in particular, central adiposity, as a determinant of insulin resistant and chronic inflammatory states which seam to appear very early in these youngsters. Type 2 DM is frequently asymptomatic and should be considered in obese adolescent from at-risk ethnic groups who have positive family histories

Lean PCOS: is it inflammatory or insulin resistant state?

The syndrome of polycystic ovary [PCOS] is one of the most frequent disorder in women [obese and lean]. PCOS is a complex and heterogenous disorder and there is still a debate for its endocrine, metabolic and inflammatory pathogenesis our aim to evaluate the insulin resistance and the inflammatory marker in lean PCOS women. A total of 28 lean women fulfilling the diagnostic criteria of PCOS compared with a 20 age and BMI matched healthy control women were enrolled in the study. C reactive protein, insulin resistance index [HOMA-IR], Adiponectin and endocrin parameters [LH, FSH, Testosterone, SHBG, 17 OH progesterone, TSH and prolactin] were measured. HOMA-IR was significantly higher in lean PCOS as compared with control group [p < 0.05], however CRP and serum adiponectin were not statistically different between the two groups. Lean PCOS is associated with insulin resistance which is independent of adiposity. Adiponectin does not seem to be actively involved in the pathogenesis of PCOS and lean PCOS is not associated with low grade inflammation

Elevated serum resistin levels in women with prior gestational diabetes

Resistin was not studied before as a potential biochemical mediator of insulin resistance in patients with prior GDM. Gestational diabetes mellitus [GDM] is a risk factor for both type 2 diabetes [DM2] and insulin resistance syndrome. Early reports suggested that resistin is associated with insulin resistance and type 2 DM. However subsequent studies have not supporting these findings. The aim of this study is to evaluate the role of resistin as a biomarker of insulin resistance in women with prior GDM. This study was conducted on 20 women with a history of GDM and 16 women with a history of normal pregnancy [control group]. The two groups were matched regarding the age, BMI, postpartum duration and the parity numbers. For all subjects, Serum resistin and HOMA IR were measured. As compared with control group, HOMA IR and serum resistin were significantly higher in women with history of previous GDM [3.97 +/- 0.71 Vs 3.51 +/- 0.5, P = 0.034], [4.9 +/- 0.89 Vs 3.5 +/- 1.06, P = 0.011] respectively. Furthermore serum resistin levels was significantly positively correlated with both BMI and HOMA IR in women with prior GDM [r 0.500, P = 0.025; r 0.527, P = 0.017] respectively. To the best of our knowledge, this is the first study addressing resistin in women with prior GDM which might explain the underlying pathogenetic mechanisms for future development of type 2 DM

Improved procoagulant activity and dyslipidemia in obese patients post bariatric surgery

Obesity is an increasing health problem worldwide. Obesity has characteristics of a prothrombotic state along with other endocrine and metabolic disturbances. We focused on the pathophysiological substrate of hypercoagulability and the potential consequences of weight loss post bariatric surgery on biochemical markers of procoagulant activity and dyslipidemia. A total 24 morbidly obese patients [18 women, 6 men] of mean age 32.96 +/- 5.9 and mean BMI 44.25 +/- 2.8 kg/m2 underwent restrictive gastric surgery [vertical banded gastroplasty,VBG]. Body mass index, blood pressure, lipid profile, plasma fibrinogen and plasminogen activator inhibitor-1 were monitored at baseline, 6 and 12 months post surgery. A significant weight loss was observed in all patients during the one year follow-up period. Mean body mass index was 44.25 +/- 2.8 kg/m2 before surgery, and significantly decreased to 37.79 +/- 2.60 kg/m2 at 6 month [p<0.001] and to 35.62 +/- 2.69 kg/m2 at 12 [P<0.001] months post bariatric surgery. After the dramatic weight reduction, a significant reduction in TC [p<0.01], LDL-C [p<0.01] and TG [p<0.001], plasma fibrinogen [p<0.001] and PAI - l [p<0.001] levels were observed throughout 12-month follow-up, with a significant rise in HDL-C[p<0.001]. Bariatric surgery could optimize cardiovascular risk profile and exert beneficial effects on thrombosis and the hemostasis axis in obesity. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk