Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT)

BACKGROUND: The aim of this study was to evaluate the safety and effectiveness of insulin glargine in a large population from a variety of clinical care in Iranian people with type 2 diabetes mellitus (T2DM) and to measure the percentage of patients achieving glycosylated hemoglobin (HbA1c) <7% by the end of 24 weeks of treatment in routine clinical practice. METHODS: This study was a 24 week, observational study of patients with T2DM, for whom the physician had decided to initiate or to switch to insulin glargine. The safety and efficacy of glargine were assessed at baseline and at week 24. RESULTS: Seven hundred and twenty-five people with T2DM (63% female) including both insulin naïve and prior insulin users were recruited in this study. The mean age of the participants was 54.2±11.2 years, and the mean HbA1c level was 8.88%±0.93% at baseline. By the end of the study, 27% of the entire participants reached to HbA1c target of less than 7% and 52% had HbA1c ≤7.5%. No serious adverse event was reported in this study. Furthermore, overall hypoglycemia did not increase in prior insulin users and the entire cohort. In addition, body weight did not change in participants while lipid profile improved significantly. CONCLUSION: Treatment with insulin glargine could improve glycemic control without increasing the risk of hypoglycemic events in people with T2DM. In addition, a significant clinical improvement was observed in lipid profile.

Increased carotid artery intima-media thickness in pregnant women with gestational diabetes mellitus

Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness [IMT] in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT. This cross-sectional study carried out at Afzalipour Hospital [Kerman, Iran] between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test [OGCT] as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of midterm pregnancy [20 to 24 weeks] and full-term pregnancy [36 to 38 weeks] on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls [near and far walls] at four different angles was assessed. An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term [0.65 +/- 0.07 vs. 0.59 +/- 0.06 mm; p value = 0.002] and full-term [0.65 +/- 0.05 vs. 0.59 +/- 0.04 mm; p value < 0.001] pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group [p value > 0.05]. Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women

study of relation between plasma level of insulin-like growth factor-1 [IGF-1] and severity of coronary artery disease

Atherosclerosis and its related diseases are major causes of mortality in many countries. Our knowledge of its background is of much importance. In recent years, researches have been preformed on relation between atherosclerosis and IGF-I plasma levels and different results obtained. We decided to do this research, as few. Altogether One hundred and seven patients who were candidates for the coronary angiography were chosen for study. Blood samples were taken for measuring IGF-I, FBS, triglyceride, total cholesterol, LDL and HDL in plasma. Blood pressures of patients were recorded, and their BMIs accounted. It was also written in questionnaire if they had history of cigarette smoking. IGF-I plasma levels increased in relation to intensity of coronary artery stenosis; correlation coefficient between stenoses and IGF-I plasma levels was as follows: R= 0.204 p= 0.04. This suggested significant and meaningful relation between these variables. IGF-I plasma levels also showed rnild increase in relation to number of diseased coronary arteries. By using the analysis of spierman correlation coefficient, Rho= 0.189 and p= 0.058 were accounted. We concluded that IGF-I plasma levels were in direct and meaningful relation to stenosis values of coronary arteries, and in mild relation to number of diseased coronary arteries. These findings can explain the role of IGF-1 in process of atherosclerosis