ABSTRACT
Introduction: Vitamin D deficiency is being evaluated asimportant risk factor in development of insulin resistance andVitamin D supplementation may be beneficial in managementof type 2 DM. A pre-post Intervention study in a tertiary carehospital was conducted to observe the effect of Vitamin Dsupplementation in glycemic control and insulin resistance inType 2 Diabetes Mellitus.Material and Methods: Estimation of Fasting and postprandial plasma sugar, 25 hydroxy Vitamin D, serum fastinginsulin and Insulin resistance, calculated using Homeostaticmodel assessment of Insulin resistance (HOMA-IR) method,in 300 known cases of Type2 Diabetes Mellitus and 50 age andsex matched healthy controls was done. Oral supplementationof Vit D, 60,000IU/week for 4 weeks was given to the group ofDiabetics with decreased vit D level <20 ng/ml. Fasting seruminsulin and Vit D level was repeated after 7 days of 4th doseof vit D supplementation. The pre and post supplementationvalues of Fasting serum Insulin, vitamin D levels and Bloodsugar levels were recorded and statistically analysed.Results: The prevalence of vitamin D deficiency (< 20 ng/mL). in type II diabetics was 30%. Comparison of parametersafter supplementation to the Vit D deficient Diabetic group,revealed a significant decrease in Fasting plasma glucose (pvalue 0.0028) with no significant change in the mean baseline2 h plasma glucose or HbA1c. There is a statistically significantdecrease in Fasting serum insulin levels (p <0.0031) anddecrease in insulin resistance (p=<0.0001) after 4 weeks ofVit D supplementation.Conclusion: Supplementation of Vit D results in decreasingthe insulin levels and insulin resistance in the Vitamin Ddeficient type 2 diabetics in Indian population. VitaminD supplementation in Diabetics could be beneficial inmanagement of Type 2 DM.
ABSTRACT
The evaluation of insulin resistance (IR) in clinical practice is based on the determination of fasting insulin (I0) and insulin level after 2 hours in an oral glucose tolerance test (OGT). However, there are not adequate cutoff points to discriminate IR patients. Objectives: to evaluate the reliability of insulin levels in the diagnosis of IR using the intravenous insulin tolerance test (IVITT) as the gold standard. Patients and Method: The OGT and IVITT of patients who participated as cases or controls in research protocols were analyzed. We excluded those cases with fasting glycemia over126 mg/dl. Results: 128 cases, 111 F, 17 M; Age: 40.3 +/- 14.8 years; BMI: 33 +/- 8 kg/m2; Waist circumference, M: 100.3 +/- 9.4 cm, F: 96 +/- 15 cm. According to IVITT (KITT), 103 (80.5 percent) were IR (KITT < 4.5 percent) and 25 (19.5 percent) were non IR (KITT > 4.5 percent). Fasting (G0) and 120 minutes after glucose challenge glycemia (G120), I0 and I120, HOMA and area under the glycemia and insulin curve, were significantly higher in the IR, as the same as, hypertension and acanthosis nigricans features (p < 0.05). According to G120, 45 cases (35.2 percent) had glucose intolerance, 9 (7 percent) diabetes and 74 (57.8 percent) were normals. In addition to G0, only IVITT was significantly different among the 3 groups (p = 0.025), identifying most insulin resistant subjects. The sensitivity and specificity for a cutoff point of I120 at 60 µIU/mL, were 30 percent and 88 percent, respectively. Conclusion: Baseline and 120 minutes post glucose charge insulin levels and HOMA, do not discriminate insulin resistant subjects, especially when there is fasting or post-stimulus hyperglycemia. Therefore, they are not recommended for individual diagnosis or therapeutic decisions
Subject(s)
Humans , Male , Adolescent , Insulin Resistance , Glucose Tolerance Test/methods , Case-Control Studies , ROC Curve , Sensitivity and Specificity , Homeostasis , Insulin/bloodABSTRACT
Objective. To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates. Methods. Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test. Results. In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+0.23 vs 1.87+0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+9.8 vs 64.3+8.0 mg/dl) and fasting insulin levels (1.44+1.19 vs 1.73+1.38 μU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+0.3 vs 4.75+0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+9.4 vs 85.6+8.4 mg/dl) and fasting insulin levels (6.95+4.27 vs 15.73+3.29 μU/ml) (p<0.001).The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+3.3 μU/ml; p<0.001). Conclusions. Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.
Subject(s)
Anthropometry , Blood Glucose/analysis , Breast Feeding , Female , Humans , Infant , Infant Formula , Infant, Low Birth Weight , Infant, Newborn , Insulin Resistance , Male , Statistics, NonparametricABSTRACT
The aim of the present study was to assess the effects of endurance training on leptin levels and adipose tissue gene expression and their association with insulin, body composition and energy intake. Male Wistar rats were randomly divided into two groups: trained (N = 18) and sedentary controls (N = 20). The trained group underwent swimming training for 9 weeks. Leptin and insulin levels, adiposity and leptin gene expression in epididymal and inguinal adipose tissue were determined after training. There were no differences in energy intake between groups. Trained rats had a decreased final body weight (-10 percent), relative and total body fat (-36 and -55 percent, respectively) and insulin levels (-55 percent) compared with controls (P < 0.05). Although trained animals showed 56 percent lower leptin levels (2.58 ± 1.05 vs 5.89 ± 2.89 ng/mL in control; P < 0.05), no difference in leptin gene expression in either fat depot was demonstrable between groups. Stepwise multiple regression analysis showed that lower leptin levels in trained rats were due primarily to their lower body fat mass. After adjustment for total body fat, leptin levels were still 20 percent (P < 0.05) lower in exercised rats. In conclusion, nine weeks of swimming training did not affect leptin gene expression, but did lead to a decrease in leptin levels that was independent of changes in body fat.