Correlation analysis of serum lipids, HbA1C levels and insulin resistance in obese type 2 diabetes patients / 公共卫生与预防医学

Objective To investigate the changes of blood lipid and glycosylated hemoglobin (HbA1c) levels in obese type 2 diabetes (T2DM) patients and their relationship with insulin resistance (Homa-IR). Methods A total of 120 cases of T2DM newly diagnosed in Motuo County, Tibet from February to October 2022 were selected as the observation group. According to BMI, the patients were divided into diabetes normal weight group (46 cases), overweight group (43 cases) and obesity group (31 cases); 145 healthy subjects were selected as the control group. The levels of HbA1c, fasting blood glucose (FPG), fasting insulin (FINS), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were detected in the study subjects, and Homa-IR and Homa-β indices were calculated. The height, weight, and abdominal circumference were measured. The differences in the levels of the above indicators between the observation group patients and the control group, as well as among various subgroups within the observation group were compared. The influencing factors of Homa-IR in obese T2DM patients were analyzed. Results Compared with the control group, a significant increase in BMI, abdominal circumference, blood pressure, HbA1c, FBG, FINS, TC, TG, LDL-C, UA, visceral fat area, and the levels of Home-IR and Home-β was found in the observation group (all P<0.05). There were significant differences in BMI, abdominal circumference, and the levels of FINS, Homa IR, Homa-β, and HbA1c in diabetes patients with different BMI (all P<0.05). Correlation analysis showed that TG levels in obese T2DM patients in the observation group were significantly correlated with HbA1c (r=0.396, P=0.027), Homa-IR (r=0.405, P=0.024), and Home-β (r=-0.401, P=0.025); LDL-C was significantly correlated with Homa-IR (r=0.411, P=0.022) and Homa-β (r=-0.412, P=0.021); HbA1c was significantly positively correlated with BMI (r=0.371, P=0.040). Conclusion Insulin resistance is closely related to TG, LDL-C, and BMI in obese T2DM patients from the Motuo ethnic minority of Tibet, suggesting that these factors may play a role in the occurrence of T2DM.

Efectos del entrenamiento de la fuerza en personas con Diabetes Mellitus Tipo II: revisión sistemática

El presente artículo busca analizar las evidencias aportadas del entrenamiento de la fuerza comprobando su influencia en la Diabetes Mellitus tipo II utilizando la literatura existente sobre este objeto de estudio. Se realizo una revisión sistemática siguiendo las directrices PRISMA donde el principal contexto fue el entrenamiento de la fuerza en pacientes con Mellitus II, siendo buscados en bases de datos Pubmed, Embase y Scopus donde fueron seleccionados 7 artículos. Los hallazgos señalan consistentemente que el entrenamiento de la fuerza bien programado incide gradualmente en algunos marcadores que identifican la diabetes Mellitus II al realizar intervenciones con sistemas de entrenamiento de la fuerza de forma positiva. Los autores recomiendan estudios con muestras mayores en lo posible de tipo control para verificar la incidencia del entrenamiento en las variables mencionadas en este estudio.

This Article Seeks analyzes the evidence provided by strength training, verifying its influence on Type II Diabetes Mellitus by using the existing literature on this subject of study. A systematic review was carried out following the PRISMA guidelines, where the main context was strength training in patients with Mellitus II. The search was carried out in Pubmed, Embase, and Scopus databases where 7 articles were selected. The findings consistently indicated that a well-structured strength training program gradually affected some markers that identify diabetes Mellitus II when performing interventions with strength training systems in a positive way. The authors recommend control-type studies with larger samples, if possible, to verify the incidence of training in the variables mentioned in this study.

Este artigo procura analisar as evidências fornecidas pelo treinamento de força, verificando sua influência no Diabetes Mellitus tipo II utilizando a literatura existente sobre este objeto de estudo. Foi realizada uma revisão sistemática seguindo as diretrizes PRISMA onde o principal contexto foi o treinamento de força em pacientes com Mellitus II, sendo pesquisada nas bases de dados Pubmed, Embase e Scopus onde foram selecionados 7 artigos. Os achados indicam consistentemente que o treinamento de força bem programado afeta gradualmente alguns marcadores que identificam o diabetes Mellitus II ao realizar intervenções com sistemas de treinamento de força de forma positiva. Os autores recomendam estudos do tipo controle com amostras maiores, se possível, para verificar a incidência de treinamento nas variáveis mencionadas neste estudo.

Association of insulin resistance and lipid profile with serum T3, T4, and TSH in patients with hypothyroidism

Background: Hypothyroidism is a common endocrine derangement met with in clinical practice. Deficiency of thyroid hormones can have a significant effect on lipid and carbohydrate metabolism. Aims and Objectives: The aim of the study was to study the association of insulin resistance and lipid profile with serum triiodothyronine (T3), tetraiodothyronine (T4), and thyroid-stimulating hormone (TSH) in hypothyroidism. Materials and Methods: A comparative cross-sectional study was conducted in a tertiary care hospital after obtaining clearance from the Institutional Ethics Committee. Thirty primary hypothyroid subjects were selected as cases based on their TSH values (>4 uIU/mL) and thirty normal subjects as controls after proper exclusion and after getting the informed consent. Their fasting plasma glucose levels, lipid profile, and serum T3, T4, TSH were measured. Homeostasis model Assessment using OXFORD HOMA 2 CALCULATOR was used to determine the insulin resistance (HOMA-IR). Results: The mean values of HOMA-IR, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were significantly higher in hypothyroid group than in normal controls. HOMA-IR showed a significant negative correlation with T3 and T4. The correlations of HOMA-IR, total cholesterol, LDL cholesterol, and triglycerides with TSH were positive. Conclusion: The present study shows that hypothyroidism leads to an elevated insulin resistance and dyslipidemia.

Variation of Proconvertase 1 and Resistin Gene as Risk Factor for Type II Diabetes Mellitus in Obesity Papua Population

@#Introduction: Risk factors for type 2 diabetes mellitus (T2DM) include obesity and some genetic factors. Obesity involves mild chronic inflammation that predisposes cells to insulin resistance. Two genes that influence obesity and insulin resistance are Proconvertase-1 (PC-1) and resistin (RETN). PC-1 affects the activation of hormones that regulate satiety and hunger. Resistin is one of the inflammatory factors that influence the occurrence of insulin resistance. This study aimed to determine the influence of polymorphism in the PC-1 gene rs1044498 (C>A) and resistin gene RETN + 299 G>A rs3745367 on the risk of diabetes in obese Papua population. Methods: This study involved 58 obese people with T2DM and 58 obese people without DM. We examined the characteristics of blood pressure, lipid profile and insulin resistance by HOMA-IR. The genes examined were PC-1 rs1044498 (C>A) and RETN+ 299 G>A rs3745367 by the PCR-RFLP method. The relationship of gene variations with biochemical parameters was determined with analysis of variance. The results were considered significantly different if P < 0.05. Results: In this study, parameters of diastolic blood pressure, triglycerides and insulin resistance were higher while high density lipoprotein (HDL) levels were lower and significantly different in the obese with T2DM group compared to the obese only group. The carrier of the A allele in the PC-1 gene rs1044498 was higher in the obese group than the obese with T2DM but not significantly different in biochemical parameters. Carrier of the AA genotype in the RETN gene + 299 G>A rs3745367 had higher triglycerides and HOMA-IR and lower HDL levels significantly different (P<0.05) than other genotypes in the obesity with T2DM group. Conclusion: PC-1 rs1044498 gene was a risk factor for obesity but not for T2DM, while RETN gene rs3745367 was a risk factor for dyslipidemia and diabetes in obese people in the Papua population.

Índice HOMA-IR como indicador de riesgo de enfermedades endocrino-metabólicas en niños y adolescentes con obesidad

Resumen La obesidad infantil contribuye a la presencia de Resistencia a la Insulina (IR), lo que a su vez incrementa el riesgo de padecer alteraciones endocrino-metabólicas en la niñez. El HOMA-IR ha demostrado tener gran utilidad para la detección y seguimiento de estas patologías, sin embargo, se deben considerar las variables fisiológicas y patológicas a las que está sujeto su cálculo. Además tiene una buena correlación con el clamp euglucémico para la detección de IR, pero es indispensable marcar puntos de corte específicos para diagnosticar e identificar a los pacientes pediátricos con alto riesgo de Síndrome Metabólico y Diabetes 2, lo que evitaría las complicaciones en la adultez. Objetivo. Es evaluar el HOMA-IR, como indicador de riesgo de enfermedades endocrino-metabólicas en la población pediátrica con obesidad; así como mostrar sus limitaciones y utilidad diagnóstica. Método. Se realizó una revisión sistemática en las bases: Science Direct, Scopus, Scielo y Pubmed; utilizando los descriptores: "Índice HOMA-IR", "Obesidad Infantil" y "Resistencia a la Insulina". La búsqueda se restringió a artículos completos en español, inglés y portugués, entre 2007 y 2020. Se identificaron 3855 artículos, luego de aplicar las fases de análisis, se seleccionaron 10 artículos para la revisión, cada uno con puntos de corte específicos para la población estudiada y su respectiva curva ROC. Conclusión. Se concluyó que el HOMA-IR es un modelo confiable para el diagnóstico de IR temprana en niños, lo que permite una intervención terapéutica preventiva y diagnóstica, es un excelente predictor de enfermedades endocrino-metabólicas y complicaciones cardiovasculares futuras.

Abstract Childhood obesity contributes to the presence of Insulin Resistance (IR), which in turn increases the risk of endocrine-metabolic disorders in childhood. The HOMA-IR has proven to be very useful for the detection and monitoring of these pathologies, however, the physiological and pathological variables to which its calculation is subject must be considered. It also has a good correlation with the euglycemic clamp for the detection of IR, but it is essential to mark specific cut-off points to diagnose and identify pediatric patients at high risk of Metabolic Syndrome and Diabetes 2, which would avoid complications in adulthood. Objective. It is to evaluate the HOMA-IR, as an indicator of risk of endocrine-metabolic diseases in the pediatric population with obesity; as well as showing its limitations and diagnostic utility. Method. A systematic review was carried out in the bases: Science Direct, Scopus, Scielo and Pubmed; using the descriptors: "HOMA-IR Index", "Childhood Obesity" and "Insulin Resistance". The search was restricted to complete articles in Spanish, English and Portuguese, between 2007 and 2020. 3855 articles were identified, after applying the analysis phases, 10 articles were selected for the review, each with specific cut-off points for the population. studied and its respective ROC curve. Conclution. It was concluded that the HOMA-IR is a reliable model for the diagnosis of early IR in children, which allows a preventive and diagnostic therapeutic intervention, it is an excellent predictor of endocrine-metabolic diseases and future cardiovascular complications.

Resumo A obesidade infantil contribui para a presença de Insulin Resistance (IR), que por sua vez aumenta o risco de distúrbios endócrino-metabólicos na infância. O HOMA-IR provou ser muito útil para a detecção e monitoramento destas patologias; entretanto, as variáveis fisiológicas e patológicas às quais seu cálculo está sujeito devem ser levadas em conta. Ela também tem uma boa correlação com a pinça euglycaemic para a detecção de IR, mas é essencial estabelecer pontos de corte específicos para diagnosticar e identificar pacientes pediátricos com alto risco de Síndrome Metabólica e Diabetes 2, o que evitaria complicações na vida adulta. Objetivo. Avaliar o HOMA-IR como um indicador de risco de doenças endócrino-metabólicas na população pediátrica com obesidade, bem como mostrar suas limitações e utilidade diagnóstica. Método. Uma revisão sistemática foi realizada nas seguintes bases de dados: Science Direct, Scopus, Scielo e Pubmed; utilizando os descritores: "HOMA-IR Index", "Childhood Obesity" e "Insulin Resistance". A busca foi restrita a artigos completos em espanhol, inglês e português, entre 2007 e 2020. Um total de 3855 artigos foram identificados, e após a aplicação das fases de análise, 10 artigos foram selecionados para a revisão, cada um com pontos de corte específicos para a população estudada e sua respectiva curva ROC. Conclusão. Concluiu-se que o HOMA-IR é um modelo confiável para o diagnóstico de IR precoce em crianças, permitindo intervenção terapêutica preventiva e diagnóstica, e é um excelente preditor de doenças endocrinometabólicas e futuras complicações cardiovasculares.

Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism

ABSTRACT Objective: There are discrepancies about the relationship of IL-6, clusterin and irisin with obesity and obesity associated insulin resistance and also about their sexual dimorphism. This study aimed at evaluating the circulating levels of IL-6, clusterin and irisin in obese subjects of both sexes who had different grades of obesity and examining their sexual dimorphism and their association with insulin resistance. Subjects and methods: This study included 176 non-diabetic subjects of both sexes who were classified according to their sex into two groups; the male and the female groups. The male group (88 men) was classified according to BMI into; group 1 (22 lean men), group 2 (22 class I obese men), group 3 (22 class II obese men) and group 4 (22 class III obese men). The female group (88 women) was classified according to BMI exactly as the male group. Metabolic parameters, IL-6, clusterin, and irisin levels were measured. Data were analyzed by ANOVA test, post hoc Tukey's test and independent t-test. Pearson correlation was used to assess the association between variables. Results: In obese subjects of both sexes, circulating IL-6, clusterin and irisin levels were significantly elevated and positively correlated with HOMA-IR. Obese males showed significantly higher HOMA-IR, IL-6, clusterin and irisin levels than obese females. Conclusion: Obesity in both sexes, especially in males was associated with high levels of IL-6, clusterin and irisin and worsened the metabolic pattern. Circulating IL-6, clusterin and irisin may represent possible therapeutic targets for insulin resistance in obese subjects.

Sex differences in the link between blood cobalt concentrations and insulin resistance in adults without diabetes

BACKGROUND@#Little is known about the effects of environmental cobalt exposure on insulin resistance (IR) in the general adult population. We investigated the association between cobalt concentration and IR.@*METHODS@#A total of 1281 subjects aged more than 20 years with complete blood cobalt data were identified from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 cycle. Blood cobalt levels were analyzed for their association with IR among all populations and subgroups by sex. Regression coefficients and 95% confidence intervals (CIs) of blood cobalt concentrations in association with fasting glucose, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were estimated using multivariate linear regression after adjusting for age, sex, ethnicity, alcohol consumption, body mass index, education level, and household income. A multivariate generalized linear regression analysis was further carried out to explore the association between cobalt exposure and IR.@*RESULTS@#A negative association between blood cobalt concentration (coefficient = - 0.125, 95% CI - 0.234, - 0.015; P = 0.026) and HOMA-IR in female adults in the age- and sex-adjusted model was observed. However, no associations with HOMA-IR, fasting glucose, or insulin were found in the overall population. In the generalized linear models, participants with the lowest cobalt levels had a 2.74% (95% CI 0.04%, 5.50%) increase in HOMA-IR (P for trend = 0.031) compared with subjects with the highest cobalt levels. Restricted cubic spline regression suggested that a non-linear relationship may exist between blood cobalt and HOMA-IR.@*CONCLUSIONS@#These results provide epidemiological evidence that low levels of blood cobalt are negatively associated with HOMA-IR in female adults.

Rate of weight gain and its association with Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) among obese children attending Paediatric Endocrine Clinic, Hospital Universiti Sains Malaysia / Journal of the ASEAN Federation of Endocrine Societies

Objective@#We aimed to study the median time to gain weight from baseline and factors that were associated with rate of weight gain among obese children attending pediatric endocrine clinic Hospital USM.@*Methodology@#We recruited 70 participants with the mean age of 10.1 ± 2.94 years with exogenous or simple form of obesity from June 2019 until September 2020. We analyzed their demography (age, gender, ethnicity, family background), measured their anthropometry (weight, height, BMI) and monitored monthly weight increment and finally analyzed their HOMA-IR at baseline and after 6 months of follow up.@*Results@#The mean time to gain 5 kg from baseline was 16 weeks (95% CI): (15.2, 16.7). Multivariate analysis showed only HOMA-IR after 6 months was a significant predictor affecting time to gain 5 kg; Adjusted HR: (95% CI) 1.617 (1.232, 2.123), (p=0.001). @*Conclusion@#The time to gain 5 kg from baseline weight was increased 1.6 times in the presence of insulin resistance at 6 months follow up in patients with obesity. More intensive education and closed follow-up are recommended for children with obesity.

Polycystic ovarian syndrome among adolescent and young women: a hospital based observational study in a tertiary care teaching Hospital

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorder among women of fertile age. The incidence of PCOS as claimed by various observer ranges from 2.2% to as high as 26%. India is considered as an emerging epidemic area for PCOS and limited studies are done. Hence aim of this study is to find the prevalence of PCOS and determine the associated determining factors in adolescent girls.Methods: All the girls aged 15-24 years were approached and after undergoing detailed history, examination and investigations were further diagnosed as PCOS. The study subjects were then classified into two group: the PCOS and non-PCOS group and compared to determine significant differences as per the Rotterdam criteria.Results: The prevalence of PCOS was 7.5%, 18.68% and 11.18% as per NIH, Rotterdam and AES criteria respectively. BMI more than 30, waist circumference > 80 cm, hyperandrogenic manifestations, menstrual irregularity (oligomenorrhea) and family history of PCOS and DM showed statistically significant association with PCOS. Serum LH, LH/FSH ratio, S. Testosterones, serum insulin and HOMA-IR had significant association with PCOS. No significant association of Fasting blood sugar levels and deranged lipid profile was found with PCOS.Conclusions: PCOS is an emerging disorder during adolescents and hence awareness creation, early screening in order to inculcate early life style modifications and prevent metabolic and reproductive complications of this disease.

Effects of total iridoid glycosides of Picrorhiza scrophulariiflora against non-alcoholic steatohepatitis rats induced by high-fat and high-sugar diet through regulation of lipid metabolism / 中草药·英文版

Objective: To investigate the therapeutic effect of total iridoid glycosides of Picrorhiza scrophulariiflora (TIGP) on non-alcoholic steatohepatitis (NASH). Methods: SD rats were fed with high-fat and high-sugar diet for 8 weeks to establish NASH. TIGP were given orally at doses of 20, 40 and 80 mg/kg/d for 4 weeks. Triglycerides assay (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting plasma glucose (FPG), fasting insulin (FINS), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), chemokine-1 (MCP-1), leptin (LEP) in serum were tested. TG, TC, superoxide dismutase (SOD), malondialdehyde (MDA), and free fatty acid (FFA) in liver tissue were determined by colorimetric methods. Steatosis of hepatocytes and inflammation was performed by pathological examination. Results: The results showed that TIGP significantly decreased TC, TG and FFA in liver tissue, increased SOD activity, decreased MDA content, decreased serum levels of TG, TC, HDL-C/LDL-C, ALT, AST, GLU, HOMA-IR, TNF-α and LEP, and in addition, improved steatosis of liver cells compared to NASH. Conclusion: TIGP had anti-fatty liver effect against NASH rats induced by high-fat and high-sugar diet. Its mechanism was related to the regulation of lipid metabolism and reduction of insulin resistance, through inhibition of oxidative stress and inflammation.

Adiponectin, anthropometric measurements and insulin resistance in adolescence with obesity

@#Introduction: Obesity in adolescents can cause metabolic syndrome. Insulin resistance increases the risk of metabolic syndrome, which then increases the risk of premature death. Studies about anthropometric measurements and adiponectin levels as early markers of insulin resistance in obese adolescents are still limited. Methods: A cross-sectional study was performed on 59 obese adolescents aged 13–16 years. Obesity was established on the basis of the Centers for Disease Control and Prevention (CDC) curve (2000). Insulin and blood glucose level measurements were carried out using an enzymatic kit. Adiponectin levels were assayed using enzyme-linked immunosorbent assay (ELISA). The relationships between variables were evaluated by correlation analysis using SPSS. Results: Statistical tests showed a positive correlation between waist circumference (r=0.421; p=0.001) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (r=0.396; p=0.002). Waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) had a weak positive correlation with insulin (r=0.343; p=0.008 and r=0.311; p=0.017) and HOMA-IR (r=0.306; p=0.018). There was a weak negative correlation between adiponectin and insulin in obese adolescents (r=-0.278; p=0.033). Conclusion: Anthropometric measurements (waist circumference, WHR and WHtR) and adiponectin can be used for early detection of insulin resistance and hyperinsulinemia in obese adolescents.

Correlation study between Erythrocyte Acetylcholinesterase activity, Serum Malondialdehyde and Insulin sensitivity in Agricultural workers and non-agricultural workers in Nat-Kan Village, Magway Township / Journal of the ASEAN Federation of Endocrine Societies

Objective@#This study determined the correlation between erythrocyte acetylcholinesterase (AChE) activity, serum malondialdehyde (MDA) and insulin sensitivity in agricultural workers and non-agricultural workers.@*Methodology@#The cross-sectional comparative study was undertaken in 45 agricultural and 45 non-agricultural workers from Nat-Kan Village, Magway Township. Erythrocyte acetylcholinesterase activity and serum malondialdehyde were measured by spectrophotometric method. Insulin sensitivity was calculated by homeostasis model assessment (HOMA-IR).@*Results@#Mean erythrocyte AChE activity was significantly lower in agricultural (3553.99 IU/L) compared with non-agricultural workers (4432.68 IU/L) (p<0.001). A significant high level of mean serum MDA was observed in agricultural workers (0.74 versus 0.28 μmol/L, p<0.001). Median HOMA-IR value was significantly higher in agricultural (2.74) than that of non-agricultural workers (2.28) (p<0.05). The risk of insulin resistance was 2.8 times greater in agricultural workers than non-agricultural workers (OR 2.8, 95% CI, 1.18 to 6.72). Erythrocyte AChE activity had weak negative correlation with serum MDA level (r=-0.357, p<0.001) and HOMA-IR (ρ= -0.305, p<0.05). There was a significant but weak positive correlation between serum MDA level and HOMA-IR (ρ=0.355, p<0.001).@*Conclusion@#Organophosphate pesticide exposure lowered erythrocyte AChE activity and increased oxidative stress. Oxidative stress is partly attributed to the development of insulin resistance

Prevalence of Insulin Resistance among Cigarette Smokers in Sokoto Metropolis

Introduction: Cigarette smoking (CS) is a well-known risk factor for the development of metabolic diseases, various forms of cancer as well as insulin resistance (IR). IR is considered as an underlying derangement which very commonly aggravates metabolic syndrome. Aim: This study assessed the prevalence of IR in cigarette smokers in Sokoto metropolis using selected surrogate markers. Methodology: This cross sectional study was conducted in Sokoto among 108 subjects. Fasting venous blood samples were collected for plasma glucose, triglycerides and insulin estimation. Plasma glucose and serum triglycerides were analysed using enzymatic methods while insulin was assayed using ELISA method. Homeostasis model of assessment-IR (HOMA-IR), Quantitative insulin sensitivity check index (QUICKI), Mc Auley (McA) and fasting IR index (FIRI) were calculated using standard formula and IR cut-off of >2.5, <0.339, >5.8 and >2.3 respectively were used. Results: Based on the cut off mark, the prevalence of IR for HOMA-IR, QUICKI, McA, FIRI indices were 62(57.4%), 66(61.1%), 39(36.1%) and 60(55.6%) respectively. There was a significant correlation between HOMA-IR and FIRI (p< 0.05, r = 0.999). HOMA-IR also had a significant correlation with McA (p<0.05 r = -0.506). QUICKI had a significant correlation with McA (p<0.05 and r = 0.243). Conclusion: This study established a significantly high prevalence of IR among CS. Importantly, it can be concluded that cigarette smokers may be predisposed to the development of metabolic disease.

The effect of Ramipril and Telmisartan on blood pressure and insulin resistance in hypertensive patients

Background: Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs) have become keystones of therapy for hypertension but there are very few studies where they have been compared with each other. This study attempted to compare the effect of Ramipril and Telmisartan on Blood Pressure and Insulin Resistance in Hypertensive patients (JNC 8).Methods: An open label, randomized, prospective and comparative study of twelve- week duration was conducted on 60 patients of hypertension (JNC-8), with the collaboration of Department of Pharmacology and Department of Medicine, Government Medical College, Amritsar. Group A and B were given Telmisartan 40mg and Ramipril 2.5 mg OD respectively. Blood Pressure was recorded on every visit, whereas, fasting plasma insulin and HOMA-IR values were recorded at the baseline and at the end of the study. Fasting blood sugar was done at 0, 4 and 12 weeks.Results: At the end of 12 weeks, a significant reduction in Systolic/Diastolic blood pressure was observed in group A with a drop of ~14/9 mmHg (p<0.001) and in group B too, the fall of ~11.6/7.2 mmHg was significant (p<0.001). However, in inter-group comparison only SBP difference was significant between two groups (p<0.05). Change in HOMA-IR value was also significant in both the groups (p<0.001). The inter-group difference for HOMA-IR between both the groups (A vs B) was also statistically significant (p<0.01).Conclusions: Telmisartan 40 mg OD was more effective than Ramipril 2.5 mg OD in controlling the SBP and improving Insulin resistance at the end of 12 weeks.

Augmentation of Insulin Secretion Induced by Rhizophora Mucronata and Avicennia ‎Marina Extracts in Streptozotocin-Induced Diabetic Rats

Background: Diabetes mellitus is a chronic metabolic disease and is considered as the third leading cause of death in the developedcountries. Objectives: The aim of this study was to assess the antidiabetic, antioxidant and insulin-enhancing potentials of the aqueous extractsof R. mucronata and A. marina or combination of them. Materials and methods: The effects of daily oral administration of aqueous extract fromthe leaves of R. mucronata, A. marina (400 mg/kg BW for each) and combination of both for 6 weeks on streptozotocin-induced diabetic ratswere evaluated considering the blood glucose and insulin levels in the serum. Oxidant/antioxidants status was assessed in the cardiac andmuscular tissues. Immunohistochemical expression of insulin in the pancreatic tissue was also assessed. Results: Oral administration of theplants extracts alleviated the diabetes-induced changes in serum glucose, insulin and antioxidants status in the heart and muscles compared tothe untreated rats. In addition, these plants enhanced insulin secretion by β-cells of Langerhans as evidence immunohistochemically andbiochemically through calculation of HOMA- β. Conclusion: The extract of R. mucronata exhibited a promising antidiabetic, antioxidant andinsulin-enhancing effects compared with A. marina extract alone or in combination with R. mucronata.

Relationship between Left Ventricular Mass Index and Insulin Resistance in Obese Subjects

Obesity is an underestimated condition of clinical and public health importance across the world. Obesity has been associated with Left ventricular hypertrophy and insulin resistance, both of which are associated with cardiovascular morbidity and mortality. The aim of present study to determine relationship between left ventricular mass index and Insulin resistance in obese subjects. Methods: The present study is a observational study conducted in Guru Nanak Dev Hospital attached to Govt. Medical college Amritsar. Total 50 normotensive nondiabetic obese subjects of both genders were included in the study. Results: There was strong positive correlation of Left Ventricular Mass Index (LVMI) with HOMA-IR. Pearson’s correlation coefficient (r) = 0.298 and P value was < 0.05. Left ventricular hypertrophy was present in 38% and 70% of obese subjects when left ventricular mass was indexed to body surface area and height respectively. Conclusion: The present study concludes that left ventricular mass index is strongly related with insulin resistance in normotensive nondiabetic obese subjects. So their earlier detection will reduce cardiovascular morbidity and mortality.

Study on Uric Acid as Biomarker for Insulin Resistance in Type 2 Diabetic Mellitus

Serum uric acid (SUA) is an end product of purine metabolism. SUA is excreted mainly through the kidneys. Multiple mechanisms have been reported to show the association of hyperuricemia with glucose intolerance. The association between insulin and renal resistance to absorption of urates has been found out to be the most important among these mechanisms. Methods: This comparative study contains 50 subjects of type 2 diabetes having an age group of 40-65 years were participated in case & 50 healthy subjects as control group. This case control study conducted in the department of department of biochemistry, LPS institute of Cardiology, GSVM medical college, Kanpur. Results: In the case-control study were found 54% male and 46% female in case group & 42% female and 58% female. We suggested that in study group 44% cases were belongs to 61-65 age group followed by other while in control group 42% were belongs to 61-65 age group followed by other age group. Conclusion: This study conclude that there were significant correlation between uric acid and HOMA-IR value. Hyperuricemia is related to risk factors for insulin resistance in type 2 diabetes. The study concluded a significant progressive relationship between increased uric acid level with respect to HOMA-IR levels which is an indices of insulin resistance.

Insulin resistance in obese and lean women with polycystic ovarian syndrome

Background: According to NIH criteria for PCOS, the estimated prevalence of this disorder has been reported to range from 4% to 10% of women in their reproductive years, which designates PCOS as the most common endocrinopathy of women. Insulin resistance is common in PCOS and obesity contributes an additional component to insulin resistance in obese PCOS.Methods: The study was a prospective study. One-hundred and twenty PCOS women were divided into two groups: Group O - obese (n = 60) and Group L - lean (body mass index [BMI] cutoff <23 kg/m2). Oral glucose tolerance test, serum fasting insulin and HOMA- IR were compared between these groups.Results: Impaired glucose tolerance was seen in 33.3 % of lean PCOS and 36.7% of obese PCOS women. 5% of lean PCOS and 10% of obese PCOS women had hyperinsulinemia. 38.3% of lean PCOS and 51.7% of obese PCOS women had insulin resistance. But the differences were not statistically significant. However, HOMA-IR and fasting insulin values showed a significant positive correlation with BMI.Conclusions: Both obese and lean women with PCOS are vulnerable to the problems of insulin resistance irrespective of BMI and insulin resistance shows a positive correlation with BMI.

++Diagnostic Usefulness of HOMA-β and HOMA-IR in Diabetes Mellitus –A Review

Homeostatic model of assessment (HOMA) is a statistical method for assessing pancreatic β – cell function (HOMA - β) andinsulin resistance (HOMA – IR). Both are calculated using fasting plasma glucose (FPG) and insulin but with differentformulae. A modified form of HOMA is emerging using Connective Peptide (C - Peptide) concentration, but studies based onthis have been very limited. More than 500 research papers have been published about the use of HOMA to assess DiabetesMellitus (DM) and Cardiovascular Disease (CVD), but the main area of its application is in the field of DM. HOMA – IRhas been diagnostically more useful in all types of DM and obesity, in assessing prediabetes and detecting DM in theelderly. It has also been found to be useful during the gestational period. HOMA indices have been widely used along withGlycosylated Hemoglobin (HbA1c), but good standardization is very important for better clinical use of HOMA. This reviewarticle has given condensed highlights on the clinical usefulness of HOMA in monitoring the control of DM at various stagesusing simple formulae to calculate HOMA indices. The parameters used were FPG and insulin. HOMA indices were alsocompared with other parameters such as HbA1c and two emerging parameters Obstatin and Visfatin, but very few studieshave been reported about their clinical usefulness. The contents of this review articles can be very useful for futureresearchers to expand the application of HOMA indices to the other diseases induced by the uncontrolled DM

Insulin Resistance Is Associated with Early Gastric Cancer: A Prospective Multicenter Case Control Study

BACKGROUND/AIMS: Recently, increased body weight has been found to be associated with an increasing risk of several cancers, including gastric cancer. The true pathogenic role of hyperglycemia in the development of gastric cancer remains unclear as hyperglycemia and its associated conditions may work as carcinogenic factors. The goal of this study was to clarify the factors associated with early gastric cancer and evaluate a homeostasis model assessment of the insulin resistance (HOMA-IR) index, fasting glucose, and lipid profile as predictors of early gastric cancer. METHODS: A total of 63 patients with early gastric cancer between November 2012 and March 2013 were included. Preoperative serum lipid profile levels and serum fasting glucose were examined prospectively in patients with early gastric cancer. The same number of controls were evaluated and matched to the early gastric cancer group for age and gender. We performed multivariate logistic regression analysis to identify independent risk factors for early gastric cancer. RESULTS: Univariate analysis showed that risk for early gastric cancer was associated with diastolic blood pressure (BP), total cholesterol, fasting glucose, and HOMA-IR. In the multivariate-adjusted model, higher total cholesterol, fasting glucose, body mass index, and diastolic BP were strongly associated with an increased risk of early gastric cancer. CONCLUSIONS: Hyperglycemia, a lower high-density lipoprotein cholesterol level, and a low HOMA-IR level appear to be associated with early gastric cancer risk.