Clinical and biochemical characteristics of early onset type 2 diabetes in Kuwaiti youth

To assess clinical features and investigation results in early onset type 2 Kuwaiti diabetics. Descriptive study. Mubarak Alkabeer Hospital, Kuwait. Ninteen early onset type 2 diabetics. Clinical features and investigation results. All patients were overweight [n = 6, 16%] to obese [n = 13, 84%] at diagnosis with a mean BMI of 31.43 +/- 2.09 kg/ m2 and a mean waist circumference of 94 +/- 1.7 cm in females and 103.43 +/- 1.24 cm in males. Hypertension was reported in three cases with mean systolic blood pressure of 134.32 +/- 8.45 and mean diastolic blood pressure [DBP] of 87.05 +/- 10.34. Family history of type 2 diabetes was reported in 68.4% and maternal history of gestational diabetes in 52.6%. Ten patients [52.6%] had acanthosis nigricans. Six female patients [out of 12] had clinical features of polycystic ovary syndrome. Homeostasis model assessment was found to have strong positive correlation with BMI, waist circumference in females, triglycerides [TG] and DBP; and negative correlation with high-density lipoprotein cholesterol [HDL-C] and apolipoprotein A1. Similarly, high-sensitive C-reactive protein showed positive correlation with BMI, waist circumference in female and male patients, TG and DBP; and negative correlation with HDL-C. Early onset type 2 DM is increasingly recognized in Kuwait. This phenomenon is strongly associated with obesity; in particular central adiposity and chronic inflammatory states which appear early in these youngsters. Type 2 DM is frequently asymptomatic and should be considered in obese adolescents with positive family history

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