Demographic and metabolic characteristics of individuals with progressive glucose tolerance

We evaluated changes in glucose tolerance of 17 progressors and 62 non-progressors for 9 years to improve our understanding of the pathogenesis of type 2 diabetes mellitus. Changes in anthropometric measurements and responses to an oral glucose tolerance test (OGTT) were analyzed. We identified 14 pairs of individuals, one from each group, who were initially normal glucose tolerant and were matched for gender, age, weight, and girth. We compared initial plasma glucose and insulin curves (from OGTT), insulin secretion (first and second phases) and insulin sensitivity indices (from hyperglycemic clamp assay) for both groups. In the normal glucose tolerant phase, progressors presented: 1) a higher OGTT blood glucose response with hyperglycemia in the second hour and a similar insulin response vs non-progressors; 2) a reduced first-phase insulin secretion (2.0 ± 0.3 vs 2.3 ± 0.3 pmol/L; P < 0.02) with a similar insulin sensitivity index and a lower disposition index (3.9 ± 0.2 vs 4.1 ± 0.2 µmol·kg-1·min-1 ; P < 0.05) vs non-progressors. After 9 years, both groups presented similar increases in weight and fasting blood glucose levels and progressors had an increased glycemic response at 120 min (P < 0.05) and reduced early insulin response to OGTT (progressors, 1st: 2.10 ± 0.34 vs 2nd: 1.87 ± 0.25 pmol/mmol; non-progressors, 1st: 2.15 ± 0.28 vs 2nd: 2.03 ± 0.39 pmol/mmol; P < 0.05). Theses data suggest that β-cell dysfunction might be a risk factor for type 2 diabetes mellitus.

Insulin secretion, insulin sensitivity, and hepatic insulin extraction in first-degree relatives of type 2 diabetic patients

To identify early metabolic abnormalities in type 2 diabetes mellitus, we measured insulin secretion, sensitivity to insulin, and hepatic insulin extraction in 48 healthy normal glucose-tolerant Brazilians, first-degree relatives of type 2 diabetic patients (FH+). Each individual was matched for sex, age, weight, and body fat distribution with a person without history of type 2 diabetes (FH-). Both groups were submitted to a hyperglycemic clamp procedure (180 mg/dl). Insulin release was evaluated in its two phases. The first was calculated as the sum of plasma insulin at 2.5, 5.0, 7.5, and 10.0 min after the beginning of glucose infusion, and the second as the mean plasma insulin level in the third hour of the clamp procedure. Insulin sensitivity index (ISI) was the mean glucose infusion rate in the third hour of the clamp experiment divided by the mean plasma insulin concentration during the same period of time. Hepatic insulin extraction was determined under fasting conditions and in the third hour of the clamp procedure as the ratio between C-peptide and plasma insulin levels. FH+ individuals did not differ from FH- individuals in terms of the following parameters [median (range)]: a) first-phase insulin secretion, 174 (116-221) vs 207 (108-277) æU/ml, b) second-phase insulin secretion, 64 (41-86) vs 53 (37-83) æU/ml, and c) ISI, 14.8 (9.0-20.8) vs 16.8 (9.0-27.0) mg kg-1 min-1/æU ml-1. Hepatic insulin extraction in FH+ subjects was similar to that of FH- ones at basal conditions (median, 0.27 vs 0.27 ng/æU) and during glucose infusion (0.15 vs 0.15 ng/æU). Normal glucose-tolerant Brazilian FH+ individuals well-matched with FH- ones did not show defects of insulin secretion, insulin sensitivity, or hepatic insulin extraction as tested by hyperglycemic clamp procedures

Disfunção arterial como possível mecanismo de agressão cardíaca empacientes com Diabetes Mellitus tipo II: estudo doppler-ecocardiográfico / Arterial dysfunction as a possible mechanism od cardiac injury in type II Diabetic Patients: a doppler-echocardiography study

Objetivo - Avaliar a estrutura e função do ventrículo esquerdo (VE) e a rigidez arterial em portadores de diabetes mellitus tipo II. Métodos - Foram estudados 13 doentes diabéticos de ambos os sexox (55 "mais ou menos" 8 anos) sem outras doenças. A estrutura e funçäo do VE foram avaliadas por meio de ecodopplercardiografia associada à monitorizaçäo näo invasiva da pressäo arterial (PA). Os resultados foram comparados aos obtidos em grupo de indivíduos normais de mesma idade (n=12). Resultados - Näo houve diferenças entre os grupos quanto a PA diastólica, dimensöes das câmaras esquerdas e índices de funçäo sistólica e diastólica. Os pacientes diabéticos apresentaram índice de massa do VE (101 "mais ou menos" 10 vs 80 "mais ou menos" 14 g/m2; p "menor" 0,001) e índice de rigidez arterial sistêmica ( 0,86 "mais ou menos" 0,26 vs 0,69 "mais ou menos" 0,19 mmHg/mL; P "menor" 0,05) significantemente maiores que os controles. Conclusäo - O diabets mellitus está associado a aumento da rigidez arterial sistêmica e esse fator poderia contribuir para seus efeitos adversos sobre o VE.

Hormonal and metabolic study of a case of adiposis dolorosa (Dercum's disease)

A case of a 43-year-old nonobese woman with adiposis dolorosa (Dercum's disease) is reported. Muscle glucose uptake and oxidation before and after ingestion of 75 g of glucose were similar to control group values, although a greater insulin release(16,578 vs 6,242 ñ 1,136 uU/3 h) occurred simultaneously. In vitro studies of abdominal normal and painful subcutaneous adipose tissue of the patient revealed lower responsiveness to norepinephrine and lack of response to the antilipolytic effect of insulin in the painful adipose tissue (0.98 vs 1.43 uM FFA/106 cells at 5.0 uM of norepinephrine). The disease was not correlated with the HLA system and there were no alterations in hormonal secretion at the pituitary, adrenal, gonadal, and thyroid levels. These findings indicate the presence of peripheral insulin resistance in this patient with adiposis dolorosa

Effect of oral glucose on peripheral muscle fuel metabolism in fasted men

1. The metabolic adaptations of peripheral muscle during a 5-day "modified" fast (daily oral intake of 200 g of glucose)were studied in 12 normal males. the volunteers were studied nintially after receiving a balanced 2,400-Kcal diet for at least 3 days (S1) and then after 5 days of modified fast (S2). The forearm muscle exchange of energy substrate (glucose) and the carbohydrate and lipid oxidation rates in muscle were measured during the postabsorptive state (S1) and after an oral glucose challenge (S2). 2. Glucose intolerance was not observed in either situation. Arterial glucose levels increased from a basal value of 83 mg/100 to 171 mg/100ml in S1 and to 187 mg/100ml in S2 at 30 and 60 min, respectively, and returned to basal values at 180 min in both studies. Increased forearm glucose uptake was observed in S2 compared do S1(131.7 ñ 17.1 vs 92.6 ñ 12.0 mg 100 ml forearm **-1 h**1), with decreased glucose oxidation (23.8 ñ 3.7 vs 30.4 ñ 4.7 mg 100 ml forearm**-1 3h**-1) and increased glucose storage (9.80 ñ 16.6 vs 62.2 ñ 10.8 mg 100 ml forearm**-1 3h**-1) as muscle glycogen. 3. Basal serum free fatty acid (FFA) levels were significantly more elevated in S2 than S1 (1030 ñ 95 vs 657 ñ 59 micron mol/l; P < 0.05zz0 but were markedly reduced by glucose ingestion in both studies (352 ñ 33 (S2) vs 364 ñ 30 (S1) micron mol/l at 120 min). Basal FFA oxidation was similar in both studies (0.091 ñ 0.015 (S1) vs 0.105 ñ 0.019 (S2) mg 100 ml forearm **-1) and decreased significantly 3 after glucose ingestion only in S1 (0.030 ñ 0.010 (S1) vs 0.078 ñ 0.020 (S2) mg 100 ml forearm[[-1 min**-1; P < 0.05). 4. The insilun response to oral glucose was similar in both studies (11,060 ñ 899(S1) vs 11,078 ñ 918(S2) micronU ml**-1 3h**-1, but tjhe peak concentration occurred later (60 min (S2) vs 30 min (S1) and basal levels were significantly lowe in S2 compared to S1 (9.2) ñ 1.7 vs 11.1 ñ 1.5 micronU/ml; P < 0.05)...

Diabetes potencial e gestacional.Morbidade materno-fetal. / Potencial and gestational diabetes Maternal and fetal morbidity

Os autores estudaram retrospectivamente 103 gestantes com diabetes potencial e que foram submetidas ao teste oral de tolerancia a glicose (GTT) apos a 28a. semana de gestacao. Os resultados mostraram que 32% das pacientes tinham GTT alterado (diabetes gestacional, grupo I) e 68% com GTT normal (grupo II). As pacientes do grupo I apresentaram maior incidencia de toximia gravidica e candidiase vaginal. Tambem tiveram 42,4% de partos operatorios contra apenas 28,6% do grupo II. No que se refere ao peso dos recem-nascidos nao houve diferenca significativa entre eles. Entretanto os RN do grupo I apresentaram maior morbidade do que os do grupo II. Finalmente, e proposta uma conduta para o rastreamento da diabetes gestacional

Endocardite em protese de dura-mater provocada pelo Acremonium kiliense. / Endocarditis in prosthesis of dura mater caused by Acremonium kiliense

Os autores registram caso de endocardite em protese de dura-mater, com evolucao desfavoravel, seguida de embolia com abscesso froto-parietal, a direita. Acremonium kiliense GRUTZ, 1925 foi isolado em cultura pura, das duas lesoes. O exame histopatologico revelou a presenca de filamentos micelianos septados, formando massas compactas, diferentes dos encontrados em casos de aspergilose, candidiase e zigomicose. Nao existiam sinais clinicos de qualquer comprometimento do sistema imunologico do paciente