DAPAGLIFLOZIN ASSOCIATED EUGLYCEMIC DIABETIC KETOACIDOSIS: A CASE REPORT

SGLT2 inhibitors are a new class of drugs for lowering blood sugar levels in type 2 diabetics. They have been shown to reduce cardiovascular risk along with improving glycemic control. Some of the SGLT2 inhibitors are Canagli?ozin, Dapagli?ozin, Empagli?ozin, Ertugli?ozin, Remogli?ozin. We are presenting a case of a 60-yearold female patient who is a known case of Type 2 Diabetes Mellitus presented to the emergency room with loss of responsiveness for 1 day gradual in onset. Her history revealed she is type 2 diabetic for the past 10yrs and was hospitalized 20days back when her RBS was 889mg/dl & urine ketones were positive with a diagnosis of type 2 DM with DKA. since then, she was put on Tab Dapagli?ozin 10mg OD along with other OHA's. On presentation, the patient was unconscious GCS-E1, V2, M2-5/15, pulse3 100/min, BP-80mm of hg systolic, glucometer RBS-211 mg/dl, ABG showed severe metabolic acidosis pH-6.86, HCO -2.9mmol/L, 2 PCO -24mm hg, PaO2-58mm hg, urine ketones came positive, and the patient was managed conservatively. The patient responded well, and her GCS improved with stabilization in her condition. Dapagli?ozin and other SGLT2 inhibitors can cause Euglycemic DKA, and these can be missed out in the emergency room as they have not so high blood sugar levels making the diagnosis of DKA dif?cult in emergency conditions

Cetoacidosis diabética euglucémica asociada al uso de inhibidores del cotransportador de sodio-glucosa 2

RESUMEN Mujer de 48 años con antecedentes de diabetes mellitus tipo 2 tratada con empaglifozina acudió a consulta después de 8 horas de dolor abdominal, náuseas, vómitos y falta de aliento. Tras el examen físico, la paciente estaba alerta, álgica, pálida, con mucosas secas, taquipneica, taquicárdica y con dolor abdominal difuso sin signos de irritación peritoneal. Los resultados de su laboratorio mostraron una glucemia sérica de 115 mg/dL (70-100 mg/dL), gasometría arterial con acidosis metabólica con anión gap elevado 20 mmol/L. El análisis de orina reportó cetonuria (cuerpos cetónicos 150) y la HbA1C fue 12,4% (4,8%-6%). Se descartó una causa quirúrgica de dolor abdominal y finalmente fue diagnosticada con cetoacidosis diabética euglucémica secundaria al uso de Inhibidores del cotransportador de sodio-glucosa 2.

ABSTRACT A 48-year-old woman with a history of type 2 diabetes mellitus treated with empaglifozine came to consultation after 8 hours of abdominal pain, nausea, vomiting, and shortness of breath. After the physical examination, the patient was alert, allergic, pale, with dry mucosa, tachypnea, tachycardia, and with diffuse abdominal pain without signs of peritoneal irritation. The results of his laboratory showed a serum glucose of 115 mg/dL (70-100 mg/dL), arterial blood gasometry with metabolic acidosis with an elevated gap anion of 20 mmol/L. Urine analysis reported ketonuria (150 ketone bodies) and HbA1C was 12.4% (4.8% -6%). A surgical cause of abdominal pain was ruled out and she was finally diagnosed with euglycemic diabetic ketoacidosis secondary to the use of sodium-glucose cotransporter inhibitors 2.

Cetoacidosis diabética euglucémica en un estado perioperatorio por resección de quiste epidermoide del ángulo pontocerebeloso / Euglycemic diabetic ketoacidosis in perioperative state due to resection of the epidermoid cyst of the pontocerebellar angle / Cetoacidose euglicêmica diabética em estado perioperatório devido à ressecção de cisto epidermóide do ângulo pontocerebelar

Resumen: La cetoacidosis diabética es una complicación aguda de la diabetes mellitus, caracterizada por acidosis metabólica con un aumento de la brecha aniónica y evidencia de cuerpos cetónicos en sangre u orina. En la mayor parte de los casos se presenta con hiperglucemia. La cetoacidosis diabética euglucémica se define por la tríada de glucosa con valores menores de 200 mg/dL, acidosis metabólica con anión gap elevado y cetonemia. Los factores asociados con esta entidad son embarazo, tratamiento con SGLT2, disminución da la ingesta calórica, enfermedades hepáticas, ingesta crónica de alcohol, uso de insulina previo a la hospitalización, sepsis, pancreatitis, aumento de las hormonas contrarreguladoras y estados perioperatorios. La base del tratamiento consiste en la corrección rápida de la deshidratación con fluidos intravenosos así como el uso de goteo de insulina junto con una solución que contiene dextrosa hasta que la brecha aniónica y los niveles de bicarbonato se normalicen. En este artículo se reporta el caso de una paciente que ingresa a UCI en el periodo perioperatorio inmediato.

Abstract: Diabetic ketoacidosis is an acute complication of diabetes, characterized by metabolic acidosis with an increase in the values of anion gap and evidence of ketone bodies in blood or urine. In most cases, it is present with hyperglycemia. Euglycemic diabetic ketoacidosis is defined by the triad of glucose with values < than 200 mg/dL, metabolic acidosis with high anion gap and ketonemia. The factors associated with this entity are pregnancy, treatment with SGLT2, decrease in caloric intake, liver disease, chronic alcohol intake, use of insulin prior to hospitalization, sepsis, pancreatitis, increase in counter-regulatory hormones and perioperative states. The basis of the treatment is the rapid correction of dehydration with intravenous fluids, as well as the use of insulin drip along with a solution containing dextrose until the anion gap, and bicarbonate levels normalize. In this article, a case of a patient admitted to the ICU in the immediate perioperative period is reported.

Resumo: A cetoacidose diabética é uma complicação aguda do diabetes mellitus, caracterizada por acidose metabólica com aumento do gap aniônico e evidência de corpos cetônicos no sangue ou na urina. Na maioria dos casos está presente com hiperglicemia. A cetoacidose diabética euglicêmica é definida pela tríade glicêmica com valores inferiores a 200 mg/dL, acidose metabólica com amplo ânion Gap e cetonemia. Os fatores associados a essa entidade são gravidez, tratamento com SGLT2, diminuição da ingestão calórica, doença hepática, ingestão crônica de álcool, uso de insulina antes da hospitalização, sepse, pancreatite, aumento de hormônios contra-regulatórios e estados perioperatórios. A base do tratamento consiste na correção rápida da desidratação com fluidos intravenosos, bem como no uso de infusāo de insulina, juntamente com uma solução contendo dextrose até o hiato aniônico e os níveis de bicarbonato voltarem ao normal. Neste artigo, é relatado o caso de um paciente admitido na UTI no período perioperatório imediato.

Euglycemic diabetic ketoacidosis: another masquerader!

Euglycemic ketoacidosis is defined by the triad of euglycemia, metabolic acidosis and ketonemia or ketonuria. In the current era of diabetic management, it is a serious concern with the usage of sodium glucose co-transporter 2 (SGLT2) inhibitors potentiated by a number of precipitating agents. Empagliflozin though a novel oral hypoglycemic agent in this category may also lead to this potential complication. Here we report a 59 year old male, type 2 diabetic who was on empagliflozin and presented with euglycemic ketoacidosis after a binge of alcohol.

Microalbuminuria among obese and non-obese individuals: a case control study

Background: Microalbuminuria among obesity cases reflects specific glomerular damage or is the marker of generalized endothelial cell dysfunction is still debatable. Thus, this study aimed to assess the presence of microalbuminuria among obese persons and non-obese individuals, who were euglycemic and normotensive.Methods: A case control study was conducted among patients attending outpatient department of general medicine in Govt Thiruvarur Medical College, Thiruvarur, for their illnesses from June 2017 to December 2017. A total of hundred participants with fifty obese cases and fifty non obese controls were included in this study. Detailed history and examination were done by the principal investigator and the same was documented in a proforma. Data entry was done using Microsoft excel and the statistical analysis includes odds ratio were calculated using Statistical Package for Social Sciences (SPSS) software version 17.Results: Among the study participants, 32% and 4% had microalbuminuria in obese and non-obese group, respectively. Also, obese participants were 11.29 times at higher chances of having microalbuminuria when compared to the non-obese patients with significant p value (p=0.002).Conclusions: Microalbuminuria can be used to predict the risk of complications in obese subjects in order to bring down the overall morbidity and mortality related to renal function.

To Assess the Clinical Impact of 18F-FDG PET/CT in Non-Treated Cases of Squamous Cell Carcinoma of Head and Neck Presenting with Clinically and/or Radiologically N0 Status

Background: The most common sites are the oral cavity, pharynx and larynx and 85% to 95% neoplasms of the head and neck are SCCHN. The preservation of function, especially as it relates to speech, swallowing, and mastication, as well as cosmetic considerations, are considered essentials for determining the most effective management paradigm for SCCHN. The most common known imaging modalities in clinical use are CT and MRI imaging, despite their suboptimal sensitivity and specificity for the detection of distant metastases. The aim of present study is to establish the impact of 18F-FDG PET/CT in clinically and/or radiologically negative neck in the assessment of cervical lymph nodes. Materials & Methods: The present study was conducted in the Department of Nuclear Medicine and PET CT, Sudhamayi Hospitals and Clinics, Cochin, Kerala over a period of about one and half years. The study group comprised of untreated patients of both sexes with age ranging from 20 to 81 years referred to our department with an established tissue diagnosis of SCCHN for 18F-FDG-PET/CT Whole Body scan for evaluation of disease status and staging. 8 -10 mCi of 18F-Flouro-Deoxy-Glucose (18F-FDG) was injected I.V. in euglycemic status. Time of injection was noted along with pre-injection and post injection counts. Whole body PET/CT images (head to mid-thigh) were acquired after 45 min to 60 min post injection. Data including age, sex, endoscopy (direct / indirect) findings, neck lymph nodes level by clinical examination and radiological finding, FNAC/histopathology report of the primary and /or lymph nodes and conventional imaging (CT/MRI when available) findings was recorded. SPSS software was used for analysis. Results: At presentation, in 32.4% (n-12) of patients no nodes were palpable. Ipsilateral (single / multiple levels) lymph nodes were present in 48.7% of the patients (n-18). Bilateral involvement was seen in 18.9% (n-7) of the cases. Patient with FDG non avid necrotic lymph node was staged N0 on PET/CT but clinically had N2c disease was excluded from further analysis. There was no change in the overall stage or management of this patient. Conclusion: 18F-FDG PET/CT can accurately predict N stage better than clinical / conventional imaging leading to change in nodal staging and thus overall staging of patients. Thus it acts as a valuable tool in determining the exact nodal spread of squamous cell carcinoma and thus establishing the exact treatment plan.

Cetoacidosis diabética euglucémica secundaria al uso de Dapagliflozina / Euglycemic diabetic ketoacidosis secondary to the use of Dapagliflozin

Los inhibidores del cotransportador sodio-glucosa tipo 2 son un grupo de fármacos que se utilizan en tratamiento de la diabetes tipo 2. Un efecto adverso que pueden producir es la cetoacidosis diabética euglucémica, una entidad clínica que se debe conocer para realizar el adecuado diagnóstico y tratamiento, suspendiendo la administración de dichos fármacos.

Inhibitors of sodium-glucose cotransporter type 2 are a group of drugs used in treatment of type 2 diabetes. Euglycemic diabetic ketoacidosis is an adverse effect that may occur and a clinical entity that should be known for proper diagnosis and treatment, suspending the administration of this medication.

Pharmacokinetics and pharmacodynamics of 40/60 premixed recombinant human insulin injection preparations / 中华临床营养杂志

Objective To study the pharmacokinetics and pharmacodynamics of the 40/60 premixed recombinant human insulin injection preparation,and to compare with 30/70 preparation,regular insulin,and neutral protamine Hagedorn (NPH).Methods In this positive control,single dose,open label,Latin square crossover study,20 male healthy volunteers were recruited from May 2006 to March 2007,and divided into four groups.On 4 test days,40/60 preparation,30/70 preparation,regular insulin,and NPH were administered to each of the 4 groups,the interval was 7-70 days before 2 test days.The pharmacokinetics and pharmacodynamics were evaluated by euglycemic glucose clamp technique.Results According to the analysis of variance,there were statistically significant differences in pharmacokinetics and pharmacodynamics of the 4 insulin formulations between the 4 groups (all P ＜ 0.05).For the 40/60 premixed recombinant human insulin,the pharmacokinetic parameter time to peak (Tmax) and mean retention time (MRT) were (105.00 ±24.33) minutes and (321.77 ± 56.29) minutes,respectively;the glucose-lowering effects reflected by the pharmacodynamic parameter Tmax and MRT were (167.75 ± 26.48) minutes and (248.33 ± 14.96) minutes,respectively.Compared with 30/70 premixed recombinant human insulin,40/60 preparation showed no significant differences in the pharmacokinetics parameters of blood insulin concentration,including peak concentration [(91.67 ± 13.03) mU/L vs.(84.96 ± 14.75) mU/L,P =0.119],Tmax [(105.00 ± 24.33) minutes vs.(122.25 ± 39.35) minutes,P =0.128],MRT [(321.77 ± 56.29) minutes vs.(332.12 ± 49.20) minutes,P =0.645] and area under the curve in 0-16 hours [AUCIns 0-16,(24 918 ± 6 610)h · mU/L vs.(26 768 ± 8 032)h· mU/L,P=0.084];however,statistically significant differences were observed in AUCIns0-4 [(16 991 ± 3 673) h · mU/L vs.(12 407 ± 3 441) h · mU/L,P =0.042] and AUCIns 0-8 [(23 283 ± 4 939) h · mU/L vs.(19 397 ±5 314)h · mU/L,P =0.046].Pharmacodynamic parameters showed no statistically significant differences (all P ＞ 0.05).Compared with 30/70 premixed insulin,the relative bioavailability of 40/60 premixed insulin was (118.9 ± 35.9) ％,and the relative biological effectiveness was (106.6 ± 35.2) ％.There was no clinically significant abnormalities in the safety indexes before and after the tests.No hypoglycemic events,allergic reactions,or local injection adverse reaction occurred in this trial.Conclusions The 40/60 premixed recombinant human insulin preparation demonstrated different properties in insulin absorption in 8 hours after injection compared with the 30/70 preparation,mainly because of the difference in proportions of short-and intermediate-acting insulin in the mixture.This new premixed insulin may provide a new option for personalized diabetes management.

Pharmacokinetics, pharmacodynamics, and bioequivalence study of SciLin TMR recombinant human insulin injection preparation / 中华临床营养杂志

Objective To study the pharmacokinetics and pharmacodynamics of recombinant human insulin preparations SciLin TM R and Humulin (R) R,and to evaluate their bioequivalence in Chinese healthy volunteers.Methods In this positive control,single dose,open label,randomized cross-over study,20 male healthy volunteers were recruited from March to October 2007,and tested on two experimental days with an interval of 7-14 days.The volunteers were divided into two groups with a random number table,one group was injected with SciLin TMR for the first time and Humulin (R) R for the second time,the other group was injected with the opposite.The pharmacokinetics and pharmacodynamic properties were evaluated by euglycemic glucose clamp study.Results Time to peak concentration [Tmax,(105.8 ± 19.1) minutes vs.(103.5 ± 18.1) minutes,P =0.389) and time to maximum glucose infusion rate [TGIRmax,(132.8 ± 16.8) minutes vs.(132.8 ± 18.6) minutes,P =0.697] for SciLin TMR and Humulin(R) R were similar.The relative bioavailability of SciLin TMR was (102.2 ± 7.6) ％,and the relative biological effectiveness was (107.4 ± 18.8) ％.The 90％ confidence interval(CI) of peak concentration(Cmax) and area under the curve of blood glucose concentration at 0-10 hours (AUCIns 0-10) of SciLin TM R were 99.32 ％-102.62 ％ (equivalent range 70％-143 ％) and 98.98 ％-104.99 ％ (equivalent range 80％-125％),respectively;90％ CI of the maximum glucose infusion rate (GIRmax) and AUCGIR0-10 were 97.36％ ～ 103.49％ (equivalent range 70％-143％) and 98.72％-113.54％ (equivalent range 80％-125％),respectively,indicating that SciLin TMR and Humulin (R) R was bioequivalent.There was no clinically significant abnormalities in the safety indexes before and after the tests.During the trial,no hypoglycemic events,allergic reactions,or local injection adverse reaction occurred.Conclusion The studied recombinant human insulin preparation SciLin TMR may be bioequivalent as Humulin (R) R.

Amelioration effect of duodenal-jejunal bypass surgery on insulin-resistance in Goto-Kakizaki rats / 中国实验动物学报

Objective To establish a Goto-Kakizaki ( GK) rat model of duodenal-jejunal bypass( DJB) and ob-serve the changes in insulin-resistance after surgery, and to explore the mechanism of DJB surgery in treatment of type 2 di-abetes mellitus.Methods Male Goto-kakizaki diabetic rats(GK,n=36)were used as experiment group and 18 healthy male Wistar rats as blank group.GK rats were randomly divided into two groups: diabetic control group and DJB surgery group ( n=18) .Euglycemic-hyperinsulinemic clamp technique was performed in 6 rats randomly taken from each group at third week, sixth week and ninth week after surgery, respectively.The expression levels of Gck, G6P, PEPCK mRNA in the liver and GLUT4 content on skeletal muscle cell plasma membrance were detected one week after the clamp test. Results In the DJB surgery group at the end of third week and sixth week after surgery, the levels of glucose infusion rates and the expression levels of Gck, G6P, PEPCK mRNA in the liver showed no statistically significant difference as com-pared with the diabetic control group (P>0.05).In the DJB surgery group at the end of 9th week after surgery, the glu-cose infusion rate and expression level of Gck mRNA in the liver were significantly higher, and the expression of G6P and PEPCK mRNA was significantly lower than those in the diabetic control group ( P0.05 for all) .Conclusions Our results indicate that the mechanism of DJB surgery improving blood glucose level may be closely related to the amel-ioration of insulin-resistance in the liver, thereby augmenting glucose uptake and inhibiting gluconeogenesis in liver through the regulation of glucose metabolism-related enzymes.There is no significant improvement in insulin-resistance in the skele-tal muscles during the experiment period.This result implies that the effect of DJB surgery on type 2 diabetes is related to the duration of therapy.

Establishment and Application of Hyperinsulinemic-Euglycemic Clamp Technique in Conscious Rats / 天津医药

Objective To establish the hyperinsulinemic-euglycemic clamp(HEC) technique in conscious rats, and to explore the effect of acute infusion of lipid on glucose infusion rate (GIR) in rats. Methods Ten SD rats were random-ly divided into two groups, 5 rats for each group. The right jugular vein and left carotid artery were catheterized and under-went a HEC with infusion of lipid (intralipid group) for 6 hours, and with continuing infusion of 5%glucose (control group). The plasma levels of free fatty acid(FFA) and GIR were measured by HEC method. Results The level of FFA concentration increased by 17.6-fold, and GIR was reduced by 27%in the intralipid group compared to those of control group (P＜0.001). Conclusion The rat model of HEC has been successfully established by intravenous intralipid infusion, which can be con-firmed by HEC technique.

Role of Imatinib in Achieving Euglycemic State in Patient with GIST.

Gastrointestinal stromal tumor (GIST) are rare tumors arising from Interstitial Cells of Cajal and require immunohistochemical marker c-kit (CD 117) for diagnosis. Imatinib Mesylate is an orally administered drug which competitively inhibits tyrosine kinase associated with the KIT protein. We present a rare case report highlighting role of Imatinib Mesylate in achieving euglycemic state in patient with GIST. Imatinib Mesylate is an effective form of treatment for patients with KIT (CD 117) positive unresectable and/ or metastatic malignant GIST. Proper patient selection and adequate treatment may help in achieving euglycemic state in patient with GIST.

The effect of metformin on expression of vaspin mRNA in insulin resistant rats induced by high-fat diet / 中华内分泌代谢杂志

High-fat diet-induced insulin resistance rat model was assessed by euglycemic-hyperinsulinemic clamp technique.Compared with the control group,the vaspin mRNA expression in adipose tissue was significantly decreased in insulin resistant rats induced by high-fat diet( P＜0.05 ),which was increased by metformin( P＜0.05 ).These data indicate that metformin may ameliorate insulin resistance in rats via upregulating vaspin mRNA expression.

Kampo Medicine in the 21st Century / 日本東洋医学雑誌

As the 21st century advances, evidence-based medicine (EBM) has come to be regarded as essential in all field of medical sciences and practical medicine. Creating medicines have been searching for based on EBM and development of new medicine has been carried out.In Japan the number of diabetic patients has increased to 129% during recent 10 years. The number of diabetic complications has also increased and hemodyalysis has been introduced in approximately 16,000 patients/year with diabetic nephropathy in Japan in 2008.Additinally many diabetic patients are suffering from numbness, cold sensation and pains in extremities derived from diabetic neuropathy. Therefore reduction of diabetic complications is one of the most important considerations in the field of diabetic patient care.Diabetes mellitus is equivalent to wasting-thirst in Jomgiiyaolue.We have reported the effectiveness of Goshajinkigan (GJG) for the treatment of nembness associated with diabetic neuropathy for the first time in Japan in 1984.In controlled comparative study, GJG showed significantly higher rates of improvement of this symptom versus mechobalamin.Insulin resistance has an important role on the occurrence of type 2 diabetes and metabolic syndrome.We have studies the effects of Kampo medicine on the insulin resistance using the euglycemic clamp and molecular biological techniques.1) Animal experimental studies: The improvement of insulin resistance in STZ rats by the administration of GJG might be via NO pathway and due, at least in part, to correct in the abnormal early steps of insulin signaling pathway in skeletal muscle.2) Clinical Studies: Effects of GJG on insulin resistance in patients with type 2 diabetes were investigated. HOMA-R was significantly decreased after GJG treatment (P=0.019). On the other hand, HOMA-R in the control group did not show significant difference. HOMA-R returned to the pre GJG treatment level1month after GJG discontinuation (P=0.018). The high-dose clamp resulted in a significantly increased insulin action (MCR levels) after GJG treatment.These animal experimental and clinical studies suggest that GJG might be effective for improving insulin resistance in the patients with type 2 diabetes.Kampo formulations might be useful not only for the prevention and the treatment of diabetic complications but also effective for the prevention and treatment of type 2 diabetes.In conclusion GJG has been used for the treatment of numbness and dysnuria since the statement in Yanshijishengfang. We have found the effectiveness of GJG on the treatment of diabetic neuropathy and on the prevention and the treatment of type 2 diabetes. We would like to continue these scientific activities.

Establishment of euglycemic clamp technique in beagle dogs / 军事医学科学院院刊

Objective To establish a euglycemic clamp technique in beagle dogs. Methods The euglycemic clamp technique was applied in healthy beagle dogs and the blood glucose, insulin, C-peptide, insulin and glucagon were monitored during the clamp. Results The blood glucose was controlled within the basal level.The coefficient of variation was less than 5% during the clamp. The serum insulin concentration finally reached(40.0±3.8)mIU/L stably and a significant inhibition was shown in endogenous insulin by the determination of C-peptide. But there was no significant increase in serum glucagon compared with basal values.Conclusion Methodology confirmed that the euglycemic clamp technique is successful in beagle dogs and can be applied in the study of pharmacodynamics of insulin preparations.

Application of hyperinsulinemic euglycemic clamp in the diagnosis and treatment of newly-onset diabetic patients / 中华临床营养杂志

Objective To evaluate the application value of hyperinsulinemic euglycemic clamp in the diagnosis and treatment of newly-onset diabetic patients. Methods Totally 11 newly-onset diabetic inpatients (10 patients with type 2 diabetes mellitus and 1 patient with latent autoimmune diabetes of adulthood) who were diagnosed in the Department of Endocrinology of Peking Union Medical College Hospital from January 2009 to August 2009 were included in this study. Hyperinsulinemic euglycemic clamp was applied to measure the glucose disposal rate (M value). Afterwards insulin pump therapy was applied and the total insulin dosage per day to get to the target of the fasting and postprandial blood glucose was calculated. Final]y the relationships between insulin dosage per day and the M value, body mass index (BMI) , fasting blood glucose, fasting insulin level were separately analyzed. Results The insulin dosage was only negatively correlated with M value (r = - 0. 83, P = 0. 003), and was not significantly correlated with BMI (r = 0.54, P = 0.106), fasting blood glucose (r = - 0. 16, P =0. 657) , and fasting insulin (r = 0. 16, P = 0. 659). The formula of insulin dosage and M value according to the mathematic model as follows: insulin dosage per day = - 3. 327 M + 49. 849. Conclusion Hyperinsulinemic euglycemic clamp can effectively evaluate the insulin sensitivity in the newly-onset type 2 diabetic patients, and thus can be a useful tool in deciding the clinical insulin dosage.

Effects of short-term continuous subcutaneous insulin infusion on fasting plasma vaspin levels in patients with recent-onset type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on plasma visceral adipose tissue-derived serine protease inhibitor ( vaspin ) levels in patients with recentonset type 2 diabetes mellitus, and to study the association between insulin sensitivity and vaspin levels.Methods Thirty patients with recent-onset type 2 diabetes mellitus were treated with CSII for 2 weeks.Euglycemic-hyperinsulinemic clamps (EHC) were performed to evaluate the insulin sensitivity in type 2 diabetes group. Plasma vaspin levels were measured by an ELISA kit. The association between plasma vaspin levels and metabolic parameters were analyzed. Results Fasting plasma vaspin levels were higher in type 2 diabetes than in impaired glucose regulation and normal glucose tolerance groups [( 1.83±0.55 vs 0. 43±0.21 and 0.56±0.26) ng/ml,P＜0.05]. With CSII,vaspin levels [( 1.19 ±0.57 vs 1.83 ±0.55 ) ng/ml, P＜0.05] and homeostasis model assessment for insulin resistance [HOMA-IR ,2.30 ( 1.09-7.2 ) vs 4.28 ( 1.7-6.47 ), P＜0.05] were significantly decreased,accompanied with an increase in glucose metabolic rate [(5. 10±0.51 vs 2.99±0.42 )mg·kg-1·min-1 ,P＜0.05] in type 2 diabetes group. Changes in circulating vaspin concentrations were correlated positively with changes in HOMA-IR. Conclusion In type 2 diabetic patients,elevated plasma vaspin levels are significantly decreased after CSII treatment. Vaspin may play a role in improving insulin sensitivity of diabetic humans.

Evaluation of insulin resistance in type 1 diabetes with euglycemic-hyperinsulinemic clamp / 中华内科杂志

Objective To investigate insulin resistance in type 1 diabetes(T1DM)with euglycemic-hyperinsulinemic clamp.Methods Eight cases of newly diagnosed T1DM and 8 cases of newly diagnosed type 2 diabetes(T2DM)were selected.Their insulin sensitivity index(ISI)was evaluated with euglycemic-hyperinsulinemic clamp after 2 week insulin intensive treatment and compared with that of 10 heMthy volunteers(normal control group,NC group).Results Age,BMI,fasting insulin(Fins),fasting C-peptide in the TI DM group were significantly lower than those in the NC group.while waist-to-hip ratio (WHR),systolic blood pressure(SBP),diastolic blood pressure(DBP),TC,TG,LDL-C,HDL-C were not significantly different between the T1DM and NC groups.Age,BMI,WHR,Fins,fasting C-peptide,SBP,TC,TG in the T1DM group were significantly lower than those in the T2DM group.The ISI of the NC,TlDM and T2DM groups were 12.83±1.09,9.95±0.50,3.80±0.20,respectively.There was significant difference among the three groups(P＜0.05).Conclusion The ISI in T1DM Was significantly lower than that in NC group,but higher than that in T2DM.

Evaluating the effect of rosiglitazone on Insulin resistance with a hyperinsulinemic euglycemic clamp in patients with type 2 diabetes / 中华临床营养杂志

emic euglycemic clamp quantitively.

Association between serum level of interleukin-18 and insulin resistance in women with polycystic ovary syndrome / 中华内分泌代谢杂志

Objective To evaluate the relationship between interleukin-18(IL-18) and insulin resistance, measured by euglycemic hyperinsulinemic clamp, in women with polycystic ovary syndrome (PCOS). Methods Forty-two young women with PCOS and 38 age-and body mass index (BMI)- matched control women were recruited in this study. A complete hormonal assay was performed and serum IL-18 level was determined in each subject. And euglycemic hyperinsulinemic clamp test was completed in 41 of the above subjects. Results Serum IL-18 levels were increased in the PCOS women, as compared with the control (P=0.033). When all subjects were divided into lean and obese groups, the IL-18 levels were slightly increased in the obese subjects (P=0.902). IL-18 levels were negatively correlated with all the clamp parameters [mean glucose infusion rate (M), M-to-insulin ratio (M/I) and glucose metabolic clearance rate (MCRg), r =-0.419,-0.396,and-0.405,P=0.006,0.010 and 0.009 respectively], but were positively associated with HOMA-β index(r=0.334, P=O.035). Conclusion Serum IL-18 level was significantly increased in PCOS women and was strongly associated with the parameters obtained from the euglycemic hyperinsulinemic clamp, indicating that IL-18 may be an important mediator between inflammation and insulin resistance.