Effect of Linagliptin versus Metformin on Insulin Secretion, Insulin Sensitivity and Glucose Control in Subjects with Impaired Glucose Tolerance / Efecto de la Linagliptina Frente a la Metformina en la Secreción de Insulina, Sensibilidad a la Insulina y Control de la Glucosa en Sujetos con Intolerancia a la Glucosa

ABSTRACT Aim: The aim of the study is to evaluate the effect of linagliptin versus metformin on insulin secretion, insulin sensitivity and glucose control in patients with impaired glucose tolerance (IGT). Patients and methods: A randomized, double-blind, clinical trial with parallel groups was per-formed on 16 adults with IGT. Lipid profile and haemoglobin (HbA1c) were evaluated prior to and after the intervention. Glucose and insulin were measured at 0, 30, 60, 90 and 120 minutes after a 75-g oral dextrose load. Eight patients received metformin (500 mg) twice a day before meals for three months. The remaining eight patients received placebo (500 mg) in the morning and linagliptin (5 mg) in the evening before meals. The area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed. Results: After linagliptin administration, a significant decrease in glucose at 90 minutes (10.8 ± 2.6 vs 7.9 ± 2.2 mmol/L, p < 0.05), 120 minutes (8.8 ± 0.9 vs 6.5 ± 2.1 mmol/L, p < 0.05) and AUC of glucose (1168 ± 210 vs 953 ± 207 mmol/L, p < 0.05) were observed. Metformin administration decreased insulin significantly at 0 minutes (94.8 ± 25.8 vs 73.8 ± 24.6 pmol/L, p < 0.05). Conclusion: Three-month administration of linagliptin in patients with IGT decreased glucose at 90 and 120 minutes after a 75-g oral dextrose load and AUC of glucose. Metformin decreased insulin at 0 minutes.

RESUMEN Objetivo: El objetivo del estudio es evaluar el efecto de la linagliptina frente a la metformina en la secreción de insulina, la sensibilidad a la insulina, y el control de la glucosa en pacientes con intolerancia a la glucosa (IG). Pacientes y métodos: Se realizó un ensayo clínico aleatorio de doble ciego con grupos paralelos a 16 adultos con IG. El perfil lipídico y la hemoglobina (Hba1C) se evaluaron antes y después de la intervención. La glucosa y la insulina se midieron a los 0, 30, 60, 90 y 120 minutos después de un carga oral de 75-g dextrosa. Ocho pacientes recibieron metformina (500 mg) dos veces al día antes de las comidas por tres meses. Los ocho pacientes restantes recibieron placebo (500 mg) por la mañana y linagliptina (5 mg) por la noche antes de las comidas. El área bajo la curva (ABC) de la glucosa y la insulina, la secreción total de insulina, la primera fase de la secreción de insulina, y la sensibilidad a la insulina, fueron evaluadas. Resultados: Luego de la administración de la linagliptina, se observó una disminución significativa de la glucosa a los 90 minutos (10.8 ± 2.6 vs 7.9 ± 2.2 mmol/L, p < 0.05), 120 minutos (8.8 ± 0.9 mmol/L p < 0.05) y el ABC de la glucosa (1168 ± 210 vs 953 ± 207 mmol/L, p < 0.05). La administración de metformina redujo significativamente la insulina a los 0 minutos (94.8 ± 25.8 vs 73.8 ± 24.6 pmol/L, p < 0.05). Conclusión: Tres meses de administración de linagliptina en pacientes con IG disminuyó la glucosa a los 90 y 120 minutos después de una carga oral de dextrosa de 75-g y el ABC de la glucosa. La metformina disminuyó la insulina en 0 minutos.

Correlation analysis between short-term insulin-like growth factor-I and glucose intolerance status after transsphenoidal adenomectomy in acromegalic patients: a large retrospective study from a single center in China

ABSTRACT Objectives: Our study aimed to investigate the associations of glucose tolerance status with insulin-like growth factor-I (IGF-I) and other clinical laboratory parameters of acromegalic patients before and after the patients underwent transsphenoidal adenomectomy (TSA) by conducting a single-center, retrospective study. Subjects and methods: A total of 218 patients with acromegaly who had undergone TSA as the first treatment were retrospectively analyzed. Serum IGF-I, growth hormone (GH) and glucose levels were measured before and after surgery. Results: The follow-up levels for random GH, GH nadir, and the percentage of the upper limit of normal IGF-I (%ULN IGF-I) were decreased significantly. The percentages of normal (39.0%), early carbohydrate metabolism disorders (33.0%) and diabetes mellitus (28.0%) changed to 70.2%, 16.5% and 13.3%, respectively, after TSA. %ULN IGF-I at baseline was higher in the diabetes mellitus (DM) group than in the normal glucose tolerance group and impaired glucose tolerance (IGT) /impaired fasting glucose (IFG) groups before TSA, and the DM group exhibited a greater reduction in %ULN IGF-I value after surgery. The follow-up %ULN IGF-I value after surgery was significantly lower in the improved group, and Pearson's correlation analysis revealed that the reductions in %ULN IGF-I corresponded with the reductions in glucose level. Conclusion: This study examined the largest reported sample with complete preoperative and follow-up data. The results suggest that the age- and sex-adjusted IGF-I level, which reflects altered glucose metabolism, and the change of it are associated with improved glucose tolerance in acromegalic patients both before and after TSA.

Evaluation of plaque characteristics in coronary artery patients with impaired glucose tolerance through optical coherence tomography

SUMMARY OBJECTIVE With the adoption of optical coherence tomography (OCT), this study targets the impacts on plaque characteristics brought about by impaired glucose tolerance (IGT) in patients with coronary artery disease. METHODS For this study, 150 patients with coronary artery disease were recruited. Regarding glycosylated hemoglobin (HbAlc), the patients were sectioned into normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM) groups. Coronary angiography (CAG) and OCT were conducted for 150 patients. RESULTS There were 186 plaques discovered in 150 patients (37, 40, 44, and 65 in the NGT, IFG, IGT, and DM groups, respectively). Compared to the NGT group, the lipid core size, which is presented as the average angle of the lipid arc, was markedly larger in the IFG,IGT and DM groups ( 135.7 ± 32.7 Ê, 161.2 ± 55.7 Ê, 162.5 ± 55.8 Ê, and 170.2 ± 59.7 Ê, respectively, all P values< 0.05). Meanwhile, the fibrous cap over the lipid core in the NGT group was remarkably thicker than that in the IFG, IGT, and DM groups (115.7 ± 47.7 μm vs. 77.7 ± 23.5 μm, 75.1 ± 23.2 µm, 71.2 ± 22.1 µm, all P values<0.05). CONCLUSION Coronary plaques in coronary artery patients with NDT are more stable than in those with IGT and DM.

RESUMO OBJETIVO Com a adoção da tomografia de coerência óptica (OCT), o presente estudo visa as características dos impactos na placa trazidos pela tolerância diminuída à glicose (IGT) em pacientes com doença na artéria coronária. MÉTODOS Cento e cinquenta doentes com doença arterial coronária foram recrutados para este estudo. De acordo com a hemoglobina glicosilada (HbAlc), os pacientes foram divididos em grupos: tolerância normal à glicose (NGT), diminuição da glicemia de jejum (IFG), diminuição da tolerância à glicose (IGT) e diabetes mellitus (DM). Angiografia coronária (CAG) e OCT foram conduzidas para 150 doentes. RESULTADOS Existem 186 placas descobertas em 150 doentes (37, 40, 44 e 65 nos grupos NGT, IFG, IGT e DM, respectivamente). Em relação ao grupo NGT, o tamanho do núcleo lipídico, que é apresentado como o ângulo médio do arco lipídico, foi significativamente maior nos grupos IFG, IGT e DM (135,7 ± 32,7 Ê, 161,2 ± 55,7 Ê, 162,5 ± 55,8 Ê, e 170,2 ± 59,7 Ê, separadamente, os valores de P<0,05). Entretanto, a tampa sobre o núcleo de lipídios fibrosos no grupo NGT estava bem mais grossa do que nos grupos IFG, IGT e DM (115,7 ± 47,7μm vs. 77,7 ± 23,5 μm, 75,1 ± 23,2 µm, 71,2 ± 22,1 µm, todos os valores de P<0,05). CONCLUSÃO Placas coronárias na artéria coronária de pacientes com NDT são mais estáveis do que em doentes com IGT e DM.

Postpartum Reclassification of Glycemic Status in Women with Gestational Diabetes Mellitus and Associated Risk Factors / Reclassificação pós-parto do estado glicêmico em mulheres com diabetes mellitus gestacional e fatores de risco associados

Abstract Objective The aims of the study were to evaluate, after pregnancy, the glycemic status of women with history of gestational diabetes mellitus (GDM) and to identify clinical variables associated with the development of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT). Methods Retrospective cohort of 279 women with GDM who were reevaluated with an oral glucose tolerance test (OGTT) after pregnancy. Characteristics of the index pregnancy were analyzed as risk factors for the future development of prediabetes (IFG or IGT), and T2DM. Results: T2DM was diagnosed in 34 (12.2%) patients, IFG in 58 (20.8%), and IGT in 35 (12.5%). Women with postpartum T2DM showed more frequently a family history of T2DM, higher pre-pregnancy body mass index (BMI), lower gestational age, higher fasting and 2-hour plasma glucose levels on the OGTT at the diagnosis of GDM, higher levels of hemoglobin A1c, and a more frequent insulin requirement during pregnancy. Paternal history of T2DM (odds ratio [OR] =5.67; 95% confidence interval [95%CI] =1.64-19.59; p =0.006), first trimester fasting glucose value (OR =1.07; 95%CI =1.03-1.11; p =0.001), and insulin treatment during pregnancy (OR =15.92; 95%CI =5.54-45.71; p < 0.001) were significant independent risk factors for the development of T2DM. Conclusion A high rate of abnormal glucose tolerance was found in women with previous GDM. Family history of T2DM, higher pre-pregnancy BMI, early onset of GDM, higher glucose levels, and insulin requirement during pregnancy were important risk factors for the early identification of women at high risk of developing T2DM. These findings may be useful for developing preventive strategies.

Objetivo Os objetivos do estudo foram avaliar o estado glicêmico de mulheres com história de diabetes mellitus gestacional (DMG) após o parto e identificar fatores associados ao desenvolvimento de diabetes mellitus tipo 2 (DM2), glicemia de jejum alterada (GJA) e tolerância diminuída à glicose (TDG). Métodos Coorte retrospectiva de 279 mulheres com DMG reavaliadas com um teste oral de tolerância à glicose (TOTG) após a gestação. Foram analisados fatores prognósticos da gestação índice e fatores de risco para o futuro desenvolvimento de pré-diabetes (GJA ou TDG) e DM2. Resultados: Diagnosticou-se DM2 em 34 pacientes (12,2%), GJA em 58 (20,8%) e TDG em 35 (12,5%). Mulheres que evoluíram para DM2 apresentaram maior frequência de história familiar de DM2, índice de massa corporal (IMC) pré-gestacional mais elevado, menor idade gestacional, níveis superiores de glicemia de jejum e 2 horas após glicose no TOTG ao diagnóstico do DMG, hemoglobina glicada mais elevada, e uso mais frequente de insulina na gestação. História paterna de DM2 (odds ratio [OR] = 5,67; intervalo de confiança de 95% [IC95%] = 1,64-19,59; p = 0,006), glicemia de jejum do primeiro trimestre (OR = 1,07; IC95% = 1,03-1,11; p = 0,001) e o uso de insulina na gestação (OR = 15,92; IC95% = 5,54-45,71; p < 0,001) foram fatores de risco independentes para o desenvolvimento de DM2. Conclusão Houve elevada incidência de alterações no metabolismo da glicose em mulheres com DMG prévio. História familiar de DM2, IMC pré-gestacional elevado, DMG diagnosticado mais precocemente na gestação, com glicemias mais elevadas e necessidade de insulina, foram importantes fatores de risco associados à identificação precoce de mulheres com alto risco de desenvolvimento de DM2. Este conhecimento pode ser útil para o desenvolvimento de estratégias de prevenção.

Ejercicio físico interválico de alta intensidad mejora el control glicémico y la capacidad aeróbica en pacientes con intolerancia a la glucosa / High intensity interval training improves glycemic control and aerobic capacity in glucose intolerant patients

Background: Proper exercise training modifies intra miocellular energy utilization, glucose transport and mitochondrial biogenesis. Aim: To determine the therapeutic effects of a high intensity intermittent training (HIIT) program on glucose homeostasis, physical fitness and body fat in glucose intolerant patients. Patients and Methods: Eighteen patients with overweight or obesity and glucose intolerance were invited to participate in an exercise program consisting in three sessions per week for 3 months. Ten participants aged 35 ± 13 years who attended > 26 of the planned 36 sessions, were considered as adherent to exercise. The other eight participants aged 37 ± 17 years, who attended to a mean of 13 sessions, were considered as non-adherent. Both groups had similar body weight, body mass index, body fat, plasma glucose 2 h after an oral glucose load and maximal oxygen uptake. All these variables were measured at the end of exercise intervention. Each session consisted of 1 min exercise of cycling at maximal intensity until muscle fatigue followed by 2 min rest, repeated 10 times. Results: Among adherent participants, twelve weeks of HIIT improved signifcantly maximal oxygen uptake (6.1 + 3.6 mL/kg/min or 24.6%), reduced 2 h post load blood glucose (-33.7 + 47.9 mg/dL or -12.5%) and body fat (-4.3 + 5.6 kg). No signifcant changes were observed in the non-adherent group. Conclusions: HIIT exercise reduces blood glucose after an oral load in glucose intolerant patients.

Diabetes mellitus and impaired glucose tolerance in urban adult population / Diabete melito e tolerância diminuída à glicose em população adulta urbana

Objective: Estimating the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged between 30 and 69 years in the municipality of Campo Grande, state of Mato Grosso do Sul, Brazil. Methods: Population-based cross-sectional study conducted between October/2009 and February/2011. The investigation included the determination of fasting glucose and participants with blood glucose ≥ 200 mg/dL were considered diabetic. Nondiabetic patients, which showed blood glucose ≥ 100 mg/dL and < 200 mg/dL, underwent an oral glucose tolerance test (OGTT) to investigate whether they had DM or IGT. Results: 1.429 individuals participated in this investigation. The general prevalence, adjusted for sex and age, were: 12.3% for DM (95%CI: 10.5 to 13.9%) and 7.1% for IGT (95%CI: 5.7 to 8.4%). There was a higher prevalence of DM with increasing age in people with low educational level, family history of diabetes, overweight, obesity and central obesity. Among diabetic patients (n = 195), 25% were unaware they had the disease and were diagnosed through investigation. Among patients who already knew they had DM (n = 146), 37% were unaware of the potential chronic complications. Conclusion: This study confirms the increased prevalence of DM in Brazil and emphasizes the need for early diagnosis, as well as the importance of strict adherence to medical treatment in order to prevent its much feared complications. .

Objetivo: estimar a prevalência de diabete melito (DM) e a tolerância diminuída à glicose (TDG) na população urbana de idade entre 30 e 69 anos do município de Campo Grande/MS. Métodos: estudo transversal de base populacional realizado entre 10/2009 e 2/2011. Na investigação, foi realizada a dosagem da glicemia capilar em jejum e os participantes com glicemia ≥ 200 mg/dL foram considerados diabéticos. Os não diabéticos, que apresentaram glicemia ≥ 100 mg/dL e < 200 mg/dL, foram submetidos a um teste oral de tolerância à glicose (TOTG) para investigar se tinham DM ou TDG. Resultados: nesta investigação, participaram 1.429 indivíduos. As prevalências gerais, ajustadas por sexo e faixa etária, foram: para DM de 12,3% (IC95%: 10,5 a 13,9%) e para TDG de 7,1% (IC95%: 5,7 a 8,4%). Houve maior prevalência de DM com o aumento da idade, em pessoas com baixa escolaridade, histórico de diabete na família, sobrepeso, obesidade e obesidade central. Do total de diabéticos (n= 195), 25% não sabiam que tinham a doença e obtiveram o diagnóstico por meio da investigação. Dos pacientes que já sabiam ter DM (n= 146), 37% desconheciam as potenciais complicações crônicas. Conclusão: este estudo corrobora o aumento da prevalência de DM no Brasil e enfatiza a necessidade de sua constatação precoce, bem como da importância da adesão rigorosa ao tratamento médico com o intuito de prevenir suas temíveis complicações. .

Serum Magnesium Level Is Associated with Type 2 Diabetes in Women with a History of Gestational Diabetes Mellitus: The Korea National Diabetes Program Study

Gestational diabetes mellitus (GDM) is a strong predictor of postpartum prediabetes and transition to overt type 2 diabetes (T2DM). Although many reports indicate that low magnesium is correlated with deteriorated glucose tolerance, the association between postpartum serum magnesium level and the risk for T2DM in women with a history of GDM has not been evaluated. We analyzed postpartum serum magnesium levels and development of prediabetes and T2DM in women with prior GDM according to American Diabetes Association (ADA) criteria using the Korean National Diabetes Program (KNDP) GDM cohort. During a mean follow-up of 15.6+/-2.0 months after screening, 116 women were divided into three groups according to glucose tolerance status. Ultimately, eight patients (6.9%) were diagnosed with T2DM, 59 patients (50.9%) with prediabetes, and 49 patients (42.2%) with normal glucose tolerance (NGT) after follow-up. The T2DM group had the lowest serum magnesium level (0.65 [0.63-0.68] mM/L) in the postpartum period, but there was no significant difference between the prediabetes group (0.70 [0.65-0.70] mM/L) and the NGT group (0.70 [0.65-0.70] mM/L) (P=0.073) Multiple logistic regression analysis showed that postpartum HOMA-IR was a significant predictor of both prediabetes and T2DM. Moreover, we found that postpartum serum magnesium level was also a possible predictor for T2DM development. Serum magnesium level in the postpartum period may be a possible predictor for T2DM development in women with a history of GDM.

Study of platelet aggregation in subjects with early glucose intolerance (EGI).

Background: Role of platelet abnormalities like increased aggregation preceding cardiovascular complications in frank diabetic patients is well established. It was thus intended to see if such a relationship also exists in pre-diabetic stage like early glucose intolerance, so that vascular complications could be dealt with at the earliest. Objectives: To study platelet aggregation in subjects with EGI and to see if any correlation of platelet aggregation existed with parameters of metabolic syndrome. Methodology: We studied 75 patients, 25 each with EGI, frank diabetes and normal glucose tolerance based on oral glucose tolerance test (OGTT) with 75 gm glucose. All patients underwent detailed history and clinical examination. Measurements of various anthropometric parameters like height, weight, waist circumference (WC), BMI, WC/height ratio were also taken. Routine lab examination like complete blood count, peripheral blood smear, fasting lipid profile, KFT, and ECG were also done. Finally, all subjects underwent optical platelet aggregation test with agonist like ADP in 5 μgm concentration in a resting, fasting, and non-smoking state. Results: We found statistically significant increase in platelet aggregation in subjects with DM as well as EGI compared to normal. 40% subjects in EGI group and 52% in frank diabetic group had increased aggregation with ADP in 5 μgm concentration. No correlation of platelet aggregation was seen with various parameters of metabolic syndrome like weight, WC, BMI, fasting blood glucose, fasting triglyceride, total cholesterol, HDL and LDC cholesterol. Conclusion: Abnormal platelet behaviour like increased aggregation which precede the onset of cardio-vascular disease in subjects with DM starts in the latent diabetic stage like EGI itself. Abnormal glucose tolerance is the most important predictor of abnormal platelet behaviour and the anthropometric parameters of metabolic syndrome were not found to be correlated.

Determinación de marcadores séricos de trombosis e inflamación en sujetos con intolerancia a la glucosa: evidencia de un estado protrombótico / Determination of blood markers and inflammation in subjects with impaired glucose tolerance

Objetivo: Este estudio fue diseñado para explorar la presencia de un estado protrombótico, disfunción fibrinolítica e inflamación en sujetos con intolerancia a la glucosa, mediante la evaluación de los marcadores séricos de trombosis, fibrinólisis e inflamación. Métodos: Se estudiaron 48 individuos consecutivos, 25 intolerantes a la glucosa: (nueve hombres y 16 mujeres, 50.0 ±9.2 años) y 23 sujetos control (seis hombres y 17 mujeres, 48.0 ±11 años). Se compararon entre ambos grupos los niveles de dímero-D y fibrinógeno como marcadores de trombosis, el PAI-1 como marcador de fibrinólisis y la proteína C reactiva ultrasensible (PCR-us) como marcador de inflamación. Resultados: En los sujetos intolerantes a la glucosa respecto al grupo control, se observaron diferencias significativas en los marcadores de trombosis: fibrinógeno 317.7 ± 32.1 vs. 266.7 ± 25.4 mg/dL (p<0.0001), dímero-D 489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL (p<0.01) y en el marcador de fibrinólisis PAI-1 66.4 ± 30.7 vs. 35.5 ± 31.0 ng/mL (p<0.006). En el marcador de inflamación, PCR-us no se observó diferencia significativa, respecto al grupo control 0.45 ± 0.6 vs. 0.38 ± 0.4 mg/dL (p<0.28). Conclusiones: Estos resultados sugieren la presencia de un estado protrombótico con disfunción del sistema fibrinolítico, en sujetos intolerantes a la glucosa.

Objective: This study was designed to explore the presence of a prothrombotic state, fibrinolytic dysfunction and infammation in impaired glucose tolerance subjects, by evaluating serum markers of thrombosis, fibrinolysis and infammation. Methods: In 48 consecutive adults, 25 patients with impaired glucose tolerance (nine men and 16 women, 50.0 ±9.2 years) were compared with 23 control subjects (six men and 17 women, 48.0 ±11 years). The markers of thrombotic activation used were D-dimer and fibrinogen. Fibrinolysis dysfuntion was evaluated with plasminogen activator inhibitor 1 (PAI-1) and the infammatory marker studied was hs-C reactive protein (hs-CRP). Results: The markers of thrombotic state were significantly higher in patients with impaired glucose tolerance (IGT) than in controls: D dimer (489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL) (p < 0.01) and fibrinogen (317.7 ±32.1 vs. 266.7 ±25.4 mg/dL) (p < 0.0001). Fibrinolytic marker PAI-1 also differed significantly between the two study groups (66.4 ± 30.7 vs. 35.5 ± 31.0 ng/ mL) (p < 0.006). However, hs-CRP, as infammation marker, (0.45 ± 0.62 mg/dL vs. 0.38 ± 0.47) did not differ significantly between the two study groups (<0.28). Conclusion: This result suggests the presence of a prothrombotic state with fibrinolytic dysfunction in subjects with impaired glucose tolerance.

Plasma kinetics of an LDL-like nanoemulsion and lipid transfer to HDL in subjects with glucose intolerance

OBJECTIVE: Glucose intolerance is frequently associated with an altered plasma lipid profile and increased cardiovascular disease risk. Nonetheless, lipid metabolism is scarcely studied in normolipidemic glucose-intolerant patients. The aim of this study was to investigate whether important lipid metabolic parameters, such as the kinetics of LDL free and esterified cholesterol and the transfer of lipids to HDL, are altered in glucose-intolerant patients with normal plasma lipids. METHODS: Fourteen glucose-intolerant patients and 15 control patients were studied; none of the patients had cardiovascular disease manifestations, and they were paired for age, sex, race and co-morbidities. A nanoemulsion resembling a LDL lipid composition (LDE) labeled with 14C-cholesteryl ester and ³H-free cholesterol was intravenously injected, and blood samples were collected over a 24-h period to determine the fractional clearance rate of the labels by compartmental analysis. The transfer of free and esterified cholesterol, triglycerides and phospholipids from the LDE to HDL was measured by the incubation of the LDE with plasma and radioactivity counting of the supernatant after chemical precipitation of non-HDL fractions. RESULTS: The levels of LDL, non-HDL and HDL cholesterol, triglycerides, apo A1 and apo B were equal in both groups. The 14C-esterified cholesterol fractional clearance rate was not different between glucose-intolerant and control patients, but the ³H-free-cholesterol fractional clearance rate was greater in glucose-intolerant patients than in control patients. The lipid transfer to HDL was equal in both groups. CONCLUSION: In these glucose-intolerant patients with normal plasma lipids, a faster removal of LDE free cholesterol was the only lipid metabolic alteration detected in our study. This finding suggests that the dissociation of free cholesterol from lipoprotein particles occurs in normolipidemic glucose intolerance and may participate in atherogenic signaling.

Análise de fatores que se associam a alterações no teste de tolerância oral à glicose, independentemente dos valores da glicemia de jejum / Analysis of factors associated with changes in the oral glucose tolerance test, regardless of the values of fasting glucose

OBJETIVO: Identificar fatores associados a alterações do teste oral de tolerância à glicose (TOTG), independentemente da glicemia de jejum (GJ). SUJEITOS E MÉTODOS: 377 pacientes (53,8 ± 15,2 anos; 77,7 por cento mulheres e IMC = 31,4 ± 5,9 kg/m²), sem história de diabetes melito (DM), foram submetidos ao TOTG e comparados de acordo com o resultado: normal (NGT), intolerantes (IGT) e DM. RESULTADOS: 202 pacientes (53,6 por cento) apresentaram TOTG alterado, sendo identificados 69 com DM (18,3 por cento) e 133 com IGT (35,3 por cento). Na análise multivariada, os fatores, além da GJ, que se associaram (P < 0,05) ao TOTG alterado foram: idade (DM = 58,7 ± 12,9; IGT = 56,7 ± 14,3; NGT = 49,6 ± 15,6 anos), hipertensão arterial (DM = 69,6 por cento; IGT = 63,9 por cento; NGT = 43,4 por cento), GJ (DM = 111,9 ± 9,2; IGT = 103,5 ± 10,3; NGT = 96,6 ± 11,1 mg/dL), HbA1C (DM = 6,1 ± 0,7 por cento; IGT = 6,1 ± 0,5 por cento; NGT = 5,8 ± 0,4 por cento), triglicérides (DM = 179,3 ± 169,9; IGT = 154,2 ± 84,1; NGT = 129,1 ± 71,9 mg/dL), HDL-c (DM = 44,7 ± 9,2; IGT = 47,5 ± 12,3; NGT = 50,6 ± 13,4 mg/dL) e ácido úrico em mulheres (DM = 5,3 ± 1,5; IGT = 5,3 ± 1,3; NGT = 4,7 ± 1,3 mg/dL). CONCLUSÃO: Idade, hipertensão arterial, níveis elevados de triglicérides, de HbA1C e de ácido úrico (em mulheres) e baixos níveis de HDL-c se associam a alterações do TOTG em pacientes com sobrepeso/obesidade, independentemente da GJ.

OBJECTIVE: To identify factors associated with changes in oral glucose tolerance test (OGTT), regardless of fasting glucose (FG). SUBJECTS AND METHODS: 377 patients (53.8 ± 15.2 years, 77.7 percent women and BMI = 31.4 ± 5.9 kg/m²) with no history of diabetes mellitus(DM), underwent OGTT and compared according to the results: normal (NGT), impaired (IGT) and DM. RESULTS: 202 patients (53.6 percent) had altered glucose tolerance: 69 with DM (18.3 percent) and 133 with IGT (35.3 percent). In multivariate analysis, factors regardless of FG that were associated (P < 0.05) with changes in the OGTT were age (DM = 58.7 ± 12.9; IGT = 56.7 ± 14.3; NGT = 49.6 ± 15.6 years), hypertension (DM = 69.6 percent; IGT = 63.9 percent; NGT = 43.4 percent), FG (DM = 111.9 ± 9.2; IGT = 103.5 ± 10.3; NGT = 96.6 ± 11.1 mg/dL), HbA1C (DM = 6.1 ± 0.7 percent; IGT = 6.1 ± 0.5 percent; NGT = 5.8 ± 0.4 percent), triglycerides (DM = 179.3 ± 169.9; IGT = 154.2 ± 84.1; NGT = 129.1 ± 71.9 mg/dL), HDL-c (DM =44.7 ± 9.2; IGT = 47.5 ± 12.3; NGT = 50.6 ± 13.4 mg/dL) and uric acid in women (DM = 5.3 ± 1.5; IGT = 5.3 ± 1.3; NGT = 4.7 ± 1.3 mg/dL). CONCLUSION: Age, hypertension, elevated triglycerides, HbA1C, uric acid (in women) and low HDL-C are associated with changes in the OGTT patients with overweight / obesity, irrespective of FG.

The Associations of Total and Differential White Blood Cell Counts with Obesity, Hypertension, Dyslipidemia and Glucose Intolerance in a Korean Population

Although many studies have reported an association between total white blood cell count and metabolic syndrome, relatively few reports are available on the association between differential white blood cell counts and metabolic syndrome. The medical records of 15,654 subjects (age, median 46, range 14-90 yr; 8,380 men and 7,274 women) who visited the Center for Health Promotion were investigated. It was found that as total white blood cell (WBC) and differential WBC counts increased the frequencies of diabetes, hypertension, obesity, dyslipidemia, and metabolic syndrome also increased. Moreover, these significant relationships persisted after adjusting for age, gender, smoking, alcohol intake, educational background, and household income. The odds ratios (95% CI) for metabolic syndrome was 2.64 (2.30- 3.04) in the highest quartile of total WBC count, with corresponding figures of 2.14 (1.88-2.44) for neutrophils, 2.32 (2.03-2.64) for lymphocytes, 1.56 (1.37-1.78) for monocytes, 1.36 (1.20-1.54) for basophils, and 1.82 (1.59-2.08) for eosinophils versus the lowest quartiles of the appropriate total and differential counts, respectively, after adjusting for the variables mentioned above. These independent associations were also observed by subgroup analyses according to the smoking status. Our data suggest that even within normal ranges, total WBC count and the differential WBC counts are associated with the presence of metabolic syndrome.

The prevalence of type 2 diabetes mellitus and impaired fasting glucose in semi-urban population of Nepal.

The increase in life expectancy in developing countries and as a result of increasing obesity and other life style changes, the global incidence of type 2 diabetes mellitus (T2DM) is increasing. The purpose of this study was to investigate the prevalence of T2DM and impaired fasting glucose (IFG) in semi-urban population of Nepal and to compare the prevalence between men and women and among different age groups. A total 740 adults (286 men and 454 women) aged 21 to 94 years (men +/- SD; 45.6 +/- 15.6 years) were included. The prevalence of T2DM and IFG was 9.5% and 19.2% in the whole population. Prevalence of T2DM was higher in men (11.8%) then in women (7.9%), similarly IFG was noted higher in men (25%) then in women (15.4%0). The prevalence of T2DM and IFG was seen to be increased with age in the whole population. Among women, the prevalence of T2DM and IFG was 2.9% and 12.8% in 21 to 40 years age group, 9.7% and 13.8% in 41 to 60 years age group and 15.4% and 27.7% in > 60 years age group. Among men, it was 4.7% and 22.6% in 21 to 40 years age group, 13.3% and 30.5% in 41 to 60 years age group and 23% and 17.3% in > 60 years age group. To conclude, the overall prevalence of T2DM and IFG increases with age. Prevalence of IFG is highest among middle age men where as the prevalence of T2DM is highest among older men.

Correlation between change in serum homocysteine levels during hyperinsulinemia and insulin sensitivity.

OBJECTIVE: To study the correlation between the changes in homocysteine (Hcy) levels during hyperinsulinemia and insulin sensitivity. MATERIAL AND METHOD: Forty-five subjects who underwent hyperinsulinemic euglycemic clamp were studied. Twenty-five subjects had normal glucose tolerance, seven had impaired glucose tolerance, and 13 had type 2 diabetes mellitus. Serum Hcy was measured before (Hcy 0) and at 120 minutes (Hcy 120) of glucose clamp. The change in Hcy levels during hyperinsulinemia was expressed as absolute difference between Hcy 0 and Hcy 120 (deltaHcy) and percentage difference over Hcy 0 (%deltaHcy). Insulin sensitivity index (ISI) was used to correlate with variables of interest. RESULTS: The ISI was not correlated with Hcy 0 and Hcy 120 but was correlated with deltaHcy and %deltaHcy. The deltaHcy and %deltaHcy were not significantly different between subjects with normal and abnormal glucose tolerance, whereas they were significantly different between subjects whose ISI were above and below the mean value. CONCLUSION: Although the change in Hcy levels during hyperinsulinemia was correlated with insulin sensitivity, the Hcy levels per se were not found to be correlated with insulin sensitivity. The change in Hcy levels during hyperinsulinemia was significantly different in subjects whose ISI was above and below the mean value but not in subjects with normal and abnormal glucose tolerance. This indicated that insulin resistance, not the glucose tolerance status, affected Hcy metabolism.

Postprandial glycemia and cardiovascular disease in diabetes mellitus

This article reviews the role of fasting and postprandial glycemia to the overall glycemic control of patients with type 2 diabetes and glucose intolerance, as well as their causal relationship upon micro and macrovascular complications. Recent studies have suggested that a third component of the glucose triad, the postprandial glucose excursions, might have a role in the overall glycemic load and might also reflect glycemic control. Epidemiological and intervention studies are presented in the article, supporting the conclusion that postprandial hyperglycemia in impaired glucose tolerance and diabetic subjects is a more powerful marker of cardiovascular disease risk than fasting hyperglycemia, then the treatment directed at specifically lowering postprandial glucose is crucial, as underlined by the American Diabetes Association.

O presente artigo revisa o papel da glicemia de jejum e pós-prandial em relação ao controle glicêmico de pacientes com diabetes do tipo 2 e com intolerância à glicose, assim como sua relação causal sobre as complicações micro e macrovasculares. Estudos recentes têm sugerido que um terceiro componente na tríade glicêmica, as excursões glicêmicas pós-prandiais, podem ter influência sobre a carga glicêmica total, e podem também refletir sobre o controle glicêmico. Estudos epidemiológicos e de intervenção são apresentados neste artigo, suportando a conclusão de que a hiperglicemia pós-prandial na intolerância à glicose e em pacientes com diabetes é um marcador mais potente de risco cardiovascular do que a hiperglicemia de jejum, portanto o tratamento dirigido especificamente para reduzir a glicemia pós-prandial é crucial, conforme sugerido pela American Diabetes Association.

Evaluación crítica del test de tolerancia oral a la glucosa para el diagnóstico de resistencia insulínica en pacientes con síndrome de ovario poliquístico / Critical evaluation of the oral glucose tolerance test for the diagnosis of insulin resistance in patients with polycystic ovary syndrome

El test de tolerancia oral a la glucosa (TTOG) es el más frecuentemente utilizado en la práctica clínica para el diagnóstico de resistencia insulínica (RI). El objetivo del presente trabajo fue la evaluación de la utilidad de los índices basales e índices TTOG, en mujeres con síndrome de ovario poliquístico (SOP) y del valor predictivo de los índices basales sobre la glucemia a los 120 minutos postprandial (G 120). Se estudiaron 114 pacientes con diagnóstico de SOP y 29 mujeres normales. A todas se les realizó un TTOG. Se dosó insulina y glucosa séricas cada 30 min durante las 2 horas del test y se determinaron los siguientes índices: Indices basales: GLU/lNS (glucemia en ayunas / insulinemia en ayunas), HOMA (modelo homeostático) y QUICKI (índice cuantitativo de sensibilidad insulínica) e índices TTOG: AI (área bajo la curva de insulina) e ISI composite (índice de sensibilidad insulínica). Se observaron correlaciones significativas entre los índices basales y los índices TTOG. Hubo 9 pruebas con índices basales normales que presentaban índice TTOG patológicos. Ninguna paciente con niveles de insulina menores a 9.9 Ul/ml presentó RI, mientras que todas las pacientes con niveles de insulina mayores a 18.4 Ul/ml tuvieron RI. Catorce pacientes (10.5%) presentaron G 120 ³ a 140 mg%. En 4 de los 14 casos (12.2%), los valores basales no hicieron sospechar la posibilidad del diagnóstico de hiperglucemia post prandial. En conclusión, en pacientes con SOP, los índices basales son útiles para diagnosticar RI. Proponemos realizar TTOG para diagnóstico de RI en aquellas pacientes que presenten insulinemias en ayunas entre 9.9 y 18.4 Ul/ml. En pacientes con SOP, se recomienda la evaluación periódica de la G 120.

Oral glucose tolerance test (OGTT) is the most commonly used method to evaluate insulin resistance (IR) in the clinical practice. Our objective was to evaluate the diagnostic utility of fasting tests compared with OGTT tests in women with PCO, and the ability of fasting tests to detect postprandial hyperglycemia. One hundred fourteen women with PCO and 29 normal women were evaluated by a 2 hours OGTT. Fasting plasma insulin (INS) and glucose were measured during the test. GLU:INS ratio (r) (fasting glucose/fasting insulin), HOMA (homeostatic model assessment), QUICKI (quantitative insulin sensitivity check index) (fasting tests), as well as the AUCI (area under the curve of INS) and ISI composite (ISI) (insulin sensitivity index) (OGTT tests), were determined. A significant correlation between fasting tests and OGTT tests was found. Normal fasting tests with abnormal OGTT tests were found in 9 patients. No patient with fasting insulin levels less than 9.9 UI/ml were IR, and all women with fasting insulin levels over 18.4 UI/ml were classified as having IR. We found glucose levels 120 min post glucose load (G 120) ³ 140 mg/dl in 14 patients (12.2%). Fasting glucose and insulin levels and the fasting tests, were poor predictors of impaired glucose tolerance (IGT) and type 2 diabetes (DBT 2). Thus, fasting tests are useful in the diagnostic of IR in PCO patients. OGTT is necessary when the fasting insulin levels range between 9.9 and 18.4 UI/ml. Women with PCO should undergo periodic screening for abnormal glucose tolerance.

Impaired glucose regulation in adults in Jamaica: who should have the oral glucose tolerance test?

OBJETIVO: Comparar los criterios publicados por la Organización Mundial de la Salud (OMS) en 1999 acerca del uso de la prueba de glucemia en ayunas (PGA) y de la prueba de tolerancia a una dosis oral de glucosa con valoración a las dos horas (PTG2h) para identificar a adultos hiperglucémicos en Jamaica. Como la PTG2h no se administra normalmente en un contexto clínico, se investigaron los factores asociados con la inutilidad de la PGA para detectar a personas con hiperglucemia según la PTG2h. MÉTODOS: Se examinó una muestra aleatoria de 2 096 adultos de 25 a 47 años de edad que vivían en la ciudad de Spanish Town, Jamaica, para determinar la presencia de diabetes. Una vez que se eliminó a 215 personas por diversos motivos, entre ellos la ausencia de datos, quedaron 1 881 personas entre las cuales se encontraban 187 que se sabía de antemano que tenían diabetes y otras 1 694 que fueron sometidas tanto a la PGA como a la PTG2h. RESULTADOS: La PGA permitió detectar 83 casos de diabetes, mientras que la PTG2h permitió detectar 72. El estadístico kappa de comparación entre los dos criterios de valoración fue de 0,31 (intervalo de confianza de 95%: 0,28û0,34), valor que revela una concordancia moderada. Se observaron 261 casos de intolerancia a la glucosa tras la PTG2h y 92 casos de hiperglucemia en ayunas. En estas últimas 92 personas, la PTG2h sirvió para identificar 34 casos de intolerancia a la glucosa y 14 casos de diabetes. De las personas que se mostraron normoglucémicas según la PGA, 14% tenían intolerancia a la glucosa o diabetes, según la PTG2h. Algunos factores tuvieron valor pronóstico en relación con la falta de detección de la intolerancia a la glucosa o la diabetes. Estos fueron la edad, el índice de masa corporal, la concentración de la obesidad en el tronco y el abdomen, la tensión sistólica y el sexo femenino. De acuerdo con la curva de eficacia diagnóstica, una glucemia en ayunas de 5,1 mmol/L tendría valor pronóstico con respecto a la presencia de una glucemia de 7,8 mmol/L según la PTG2h. CONCLUSIONES: Algunas personas cuya glucemia en ayunas está dentro de lo normal tienen intolerancia a la glucosa o diabetes; por lo tanto, para identificarlas es necesario hacer la PTG2h. Se puede mejorar la detección de casos de intolerancia a la glucosa en Jamaica si se reduce el umbral de normalidad para la PGA o si se toman en cuenta los datos clínicos para identificar a las personas en alto riesgo.

Glycemic status in hyperthyroid subjects.

This was an observational case-control study carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka jointly with the 'Thyroid and Endocrine Clinic' of the same institution during the period of January 2002 to December 2002. Sixty-five (65) newly diagnosed hyperthyroid patients between 20-60 years of age were studied, where forty-five (45) were Graves' disease and twenty (20) were TMNG (Toxic multinodular goiter) patients. Thyrotoxicosis was diagnosed by history, clinical examination and biochemical investigations- FT4, TSH, and Radioactive iodine uptake (RAIU) test. Thirty (30) age and sex matched healthy subjects were taken as control. The mean age was 33.02+/-9.24 years in Graves' disease and 37.55+/-9.49 years in TMNG. Female predominance observed in both the diseases. Glucose intolerance was found in 72.3% of thyrotoxic patients, which is much higher than European population. Our study showed Diabetes mellitus (DM) in 11% of Graves' disease patients. The incidence of DM in Graves' disease was slightly higher in our population. Incidence of DM in TMNG in our study was much lower (5%) than that of Graves' disease (11%) but the incidence of IGT (Impaired glucose tolerance) in TMNG was more (85%) in relation to Graves' disease (54%). Percentage of RAIU was more marked in Graves' disease than TMNG. There is a significant positive correlation (p<0.05) between plasma glucose and FT4 in Graves' disease. Glucose intolerance is frequently found in Thyrotoxic patients.