Prevalence and determinants of psychological insulin resistance among type 2 diabetic patients in Kinshasa, Democratic Republic of Congo

Background: Psychological insulin resistance (PIR) is a common but unappreciated phenomenon by health care providers with a negative impact on the control of type 2 diabetes mellitus. Aim: To determine the frequency of PIR and its determinants in patients with type 2 diabetes. Setting: This study was conducted in Kinshasa in three health centres providing management of diabetic patients. Methods: This study was a multicentric, cross-sectional study conducted from 01 November 2017 to 31 March 2018 in Kinshasa among 213 type 2 diabetic patients who were taking oral anti-diabetic drugs. A standardised questionnaire, the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ), was used for data collection. Results: The average age of participants was 59.8 ± 11.1 years with a male to female ratio of 1.5. The prevalence of PIR was 42.7%; and its main determinants were 50 years of age (odds ratios [OR] adjusted 2.05; 95% confidence interval [CI] 1.98­4.27; p = 0.045), the presence of complications (OR adjusted 3.33; 95% CI 1.68­6.60; p = 0.001), lack of knowledge about insulin therapy (OR adjusted 1.96; 95% CI 1.03­3.71; p = 0.040) and the high cost of insulin (OR adjusted 2.32; 95% CI 1.08­4.95; p = 0.030).Conclusion: The study showed that almost half of type 2 diabetic patients had PIR with the main determinant factors related to the patient and the health system. The establishment of a therapeutic education programme, improved 'provider­patient' communication and the development of approaches to increase access to drugs are crucial to reduce the prevalence of PIR

Conjugated Linoleic Acid and lipid profile of postmenopausal women

Most animal studies have shown that trans-10 and cis-12 isomers of Conjugated linoleic Acid, [CLA] tend to increase insulin resistance. But the effect of equal isomers of CLA [50:50 ratios of cis-9, trans-11: trans-10, cis-12 isomers] on lipid profiles, glucose, and insulin resistance and sensitivity in postmenopausal women is not clear. In the present study, we performed a randomized, double blind, placebo-controlled trial to examine the changes in lipid profiles, glucose, and insulin concentration following 4 CLAG80 capsules containing 3.2g CLA [50:50 ratios of cis-9,trans-ll: trans-10, cis-12 isomers] or 4 placebo capsules supplementation for 12 weeks in postmenopausal women. Seventy six healthy postmenopausal women were randomized to receive placebo or 3.2 g CLA for 12 weeks. Anthropometric measurements were done. Blood samples were collected after 12-14 hours fasting before and after intervention. Insulin resistance and insulin sensitivity were estimated based on the homeostasis [HOMA] and QUIKI models. In weeks 0, 6 and 12 during the trial, subjects completed 3d dietary records. These dietary records were coded by the same dietitian, and analyzed with the Food Processor program. There were no significant effect on serum lipids, insulin, glucose, insulin resistance and insulin sensitivity over 12 weeks in postmenopausal women. Mixed isomer CLA supplementation had no effect on serum insulin, lipids profile, glucose and insulin resistance/sensitivity during 12 weeks of intervention in postmenopausal women