Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial

ABSTRACT Objective To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. Subjects and methods The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. Results Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. Conclusions Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.

Comportamiento del ácido úrico en una casuística general y en pacientes con enfermedad vascular periférica / Behaviour of the uric acid in the general casuistic and in patients with peripheral vascular disease

Objetivo: determinar el comportamiento del ácido úrico en una casuística general y en los pacientes con enfermedad vascular periférica y calcular la prevalencia de hiperuricemia. Métodos: estudio descriptivo en 464 pacientes que asistieron al Laboratorio de Bioquímica del Instituto de Angiología y Cirugía Vascular durante el mes de mayo de 2013, y en un grupo de 85 ingresados con enfermedad vascular periférica. El ácido úrico se cuantificó en todos con un juego de reactivo enzimático comercial. La hiperuricemia se determinó tomando como referencia los valores internacionales de 415,4 µmol/L para hombres y 339 µmol/L para las mujeres. Se calculó la prevalencia de hiperuricemia total y ajustada según sexo. Resultados: la concentración de ácido úrico en la muestra fue de 320,3 µmol/L (IC: 310 a 330,6 µmol/L, 95 por ciento); con diferencia entre hombres y mujeres (354,1 vs. 291,3 µmol/L respectivamente, p= 3,74 x 10-9). Se encontró que los pacientes con macroangiopatía diabética mostraron valores elevados de ácido úrico (339,5 µmol/L), sin diferencias significativas al compararlo con la casuística general. Se halló una prevalencia de hiperuricemia de 27,6 por ciento, de ella el 24,8 por ciento para el sexo masculino y el 30 por ciento para el femenino. Conclusiones: se llama a la reflexión sobre este parámetro, tiene una alta prevalencia y no debe ser indicado como rutina, ya que puede ser un biomarcador de enfermedades vasculares como lo es para la hipertensión arterial, función renal y gota(AU)

Objective: to determine the behaviour of the uric acid in a general casuistic and in the patients with vascular periphery disease and calculating the prevalence of hyper-uricaemia. Methods: a descriptive study in 464 patients assisted at aboratory of Biochemistry of the Institute of Angiology and Vascular Surgery during the month of may of 2013 and in the 85 patients with vascular periphery disease was analyzed. Uric acid quantified in alls with a commercial game of enzymatic reagent. The hyper-uricaemia determined itself when taking the following values into account: 415.4 µmol/ L for man and 339.0 µmol/L for woman. Was calculated the total prevalence of hyper-uricaemia and tight-fitting according to sex. Results: the concentration of uric acid in the sample was of 320.3 µmol/L (95 percent CI: 310; 330,6) With difference between man and woman (354.1 vs. 29,3 µmol/L, p= 3,74 x 10-9). The patients with diabetic macroangiopathy had high concentration of uric acid (339.5 µmol/L) within significant difference with general casuistic. The prevalence of hyper-uricaemia was of the 27.6 percent; of her the 24.8 percent for the masculine sex and the 30.0 percent for the feminine. Conclusion: it is done called the reflection on this parameter, what has high prevalence, which must not be indicated like routine; since it can be a biomarker of vascular periphery disease as it is for the arterial hypertension, renal function and gout.