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1.
Arch. endocrinol. metab. (Online) ; 66(1): 32-39, Jan.-Feb. 2022. tab
Article in English | LILACS | ID: biblio-1364313

ABSTRACT

ABSTRACT Objetivo: Maturity onset diabetes of the young (MODY) patients have clinical heterogeneity as shown by many studies. Thus, often it is misdiagnosed to type 1 or type 2 diabetes(T2DM). The aim of this study is to evaluate MODY mutations in adult T2DM patients suspicious in terms of MODY, and to show clinical and laboratory differences between these two situations. Subjects and methods: In this study, we analyzed 72 type 2 diabetic patients and their relatives (35F/37M) who had been suspected for MODY and referred to genetic department for mutation analysis. The gene mutations for MODY have been assessed in the laboratory of Marmara University genetics. Totally 67 (32F/35M; median age 36.1) diabetic patients were analyzed for 7 MODY mutations. Twelve patients who have uncertain mutation (VUS) were excluded from study for further evaluation. MODY(+) (n:30) patients and T2DM patients (n:25) were compared for clinical and laboratory parameters. Results: In MODY(+) subjects, mutations in GCK (MODY 2) (n:12; 40%) were the most common followed by HNF4A (MODY 1) (n:4; 13.3%). Diabetes diagnosis age was younger in MODY(+) group but not statistically significant. Sixty-six percent of MODY(+) subjects had diabetes history at 3-consecutive generations in their family compared with 28% of T2DM patients statistically significant (p:0.006). Gender, BMI, C-peptide, HbA1c, lipid parameters, creatinine, GFR, microalbuminuria, vitamin D and calcium were not statistically different between the groups. Conclusion: According to present study results, MODY mutation positivity is most probable in young autoantibody (-) diabetic patients diagnosed before 30 years of age, who have first degree family history of diabetes.


Subject(s)
Humans , Adult , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/genetics , C-Peptide , Hepatocyte Nuclear Factor 1-alpha/genetics , Mutation/genetics
2.
Arch. endocrinol. metab. (Online) ; 64(5): 584-590, Sept.-Oct. 2020. tab
Article in English | LILACS | ID: biblio-1131123

ABSTRACT

ABSTRACT Objective In this study, we aimed to determine the frequency of and the clinical and metabolic features of patients with latent autoimmune diabetes in adults (LADA) at a single center in Turkey. Subjects and methods Patients over 30 years of age diagnosed with type 2 diabetes who did not require insulin for a minimum of 6 months following diagnosis were included. Data from 324 patients (163 women; 161 men), with a mean age of 54.97 ± 7.53 years, were analyzed in the study. Levels of antibodies to glutamate decarboxylase (anti-GAD) were measured in all patients, and LADA was diagnosed in patients testing positive for anti-GAD antibodies. Results Anti-GAD positivity was identified in 5 patients (1.5%). Family history of diabetes, body mass index (BMI), age, sex distribution, insulin resistance, serum triglycerides, high-density lipoprotein, and low-density lipoprotein were similar in the LADA and type 2 diabetes patients. Median HbA1c was significantly higher (10.8% vs. 7.38%, p = 0.002) and fasting C-peptide was lower (0.75 ng/mL vs. 2.82 ng/mL, p = 0.009) in patients with LADA compared to in those with type 2 diabetes. Among the 5 patients with LADA, 4 were positive for antithyroid peroxidase antibodies. The median disease duration was relatively shorter among patients with LADA (4 years vs. 7 years, p = 0.105). Conclusion We observed a LADA frequency of 1.5% among Turkish patients followed for type 2 diabetes. The presence of obesity and metabolic syndrome did not exclude LADA, and patients with LADA had worse glycemic control than patients with type 2 diabetes did.


Subject(s)
Humans , Male , Female , Infant , Adult , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Latent Autoimmune Diabetes in Adults/epidemiology , Autoantibodies , Turkey/epidemiology , C-Peptide , Glutamate Decarboxylase , Middle Aged
4.
Journal of Gastric Cancer ; : 365-371, 2019.
Article in English | WPRIM | ID: wpr-764494

ABSTRACT

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.


Subject(s)
Adult , Barium , Blood Glucose , C-Peptide , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Endoscopy, Digestive System , Esophagitis, Peptic , Fasting , Follow-Up Studies , Gastrectomy , Gastric Emptying , Gastroparesis , Glycated Hemoglobin A , Humans , Hypoglycemic Agents , Insulin , Vomiting
5.
Article in English | WPRIM | ID: wpr-764082

ABSTRACT

BACKGROUND AND OBJECTIVES: This study was performed to investigate whether stem cell therapy enhances β cell function by meta-analysis with proper consideration of variability of outcome measurements in controlled trial of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients. METHODS: A systematic search was performed from inception to January 2018 in PubMed, EMBASE, and Cochrane databases. β cell function was assessed by stimulated C-peptide, fasting C-peptide, normal glycosylated hemoglobin levels (HbA1C), and exogenous insulin dose patterns. The quality of the studies were assessed by both the Cochrane Collaboration's Risk of Bias (ROB) for Randomized controlled trials and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomized controlled trials. RESULTS: From the selected final 15 articles, total of 16 trials were analyzed. There were 6 T1DM trials (total 153 cases) and 10 T2DM trials (total 457 cases). In T2DM patients, the changes in stimulated C-peptide, HbA1c, and exogenous insulin dose versus baseline showed a favorable pattern with a significant heterogeneity in stem cell therapy. In T1DM, there was no significant difference between control group and stem cell therapy group in three indicators except for HbA1c. Most of the studies were rated as having high risk of bias in the quality assessment. CONCLUSIONS: The stem cell therapy for DM patients is not effective in T1DM but seems to be effective in improving the β cell function in T2DM. However the observed effect should be interpreted with caution due to the significant heterogeneity and high risk of bias within the studies. Further verification through a rigorously designed study is warranted.


Subject(s)
Bias , C-Peptide , Diabetes Mellitus , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Fasting , Glycated Hemoglobin A , Humans , Insulin , Population Characteristics , Stem Cells
6.
Article in English | WPRIM | ID: wpr-763661

ABSTRACT

BACKGROUND: We performed this study to identify factors related to intact incretin levels in patients with type 2 diabetes mellitus (T2DM). METHODS: We cross-sectionally analyzed 336 patients with T2DM. Intact glucagon-like peptide 1 (iGLP-1) and intact glucose-dependent insulinotropic polypeptide (iGIP) levels were measured in a fasted state and 30 minutes after ingestion of a standard mixed meal. The differences between 30 and 0 minute iGLP-1 and iGIP levels were indicated as ΔiGLP-1 and ΔiGIP. RESULTS: In simple correlation analyses, fasting iGLP-1 was positively correlated with glucose, C-peptide, creatinine, and triglyceride levels, and negatively correlated with estimated glomerular filtration rate. ΔiGLP-1 was positively correlated only with ΔC-peptide levels. Fasting iGIP showed positive correlations with glycosylated hemoglobin (HbA1c) and fasting glucose levels, and negative correlations with ΔC-peptide levels. ΔiGIP was negatively correlated with diabetes duration and HbA1c levels, and positively correlated with Δglucose and ΔC-peptide levels. In multivariate analyses adjusting for age, sex, and covariates, fasting iGLP-1 levels were significantly related to fasting glucose levels, ΔiGLP-1 levels were positively related to ΔC-peptide levels, fasting iGIP levels were related to fasting C-peptide levels, and ΔiGIP levels were positively related to ΔC-peptide and Δglucose levels. CONCLUSION: Taken together, intact incretin levels are primarily related to C-peptide and glucose levels. This result suggests that glycemia and insulin secretion are the main factors associated with intact incretin levels in T2DM patients.


Subject(s)
C-Peptide , Creatinine , Diabetes Mellitus, Type 2 , Eating , Fasting , Gastric Inhibitory Polypeptide , Glomerular Filtration Rate , Glucagon-Like Peptide 1 , Glucose , Glycated Hemoglobin A , Humans , Incretins , Insulin , Meals , Multivariate Analysis , Triglycerides
7.
Article in English | WPRIM | ID: wpr-763645

ABSTRACT

BACKGROUND: Recent in vivo studies indicated that R-spondin 1 (RSPO1) regulates food intake and increases insulin secretion, but its role in humans remains unknown. This study investigated the association between serum levels of RSPO1 and diverse metabolic parameters in humans. METHODS: The study population consisted of 43 subjects with newly diagnosed diabetes mellitus, and 79 non-diabetic participants. Serum levels of RSPO1 were measured using the enzyme-linked immunosorbent assay. The relationships between circulating RSPO1 and diverse metabolic parameters were analyzed. RESULTS: Circulating RSPO1 levels increased to a greater extent in the obese group than in the lean group. Moreover, serum levels of RSPO1 were higher in the insulin-resistant group than in the insulin-sensitive group. Serum levels of RSPO1 were significantly correlated with a range of metabolic parameters including body mass index, fasting C-peptide, homeostasis model assessment of insulin resistance index, and lipid profile. Moreover, levels were significantly associated with insulin resistance and obesity in non-diabetic subjects. CONCLUSION: This study demonstrated the association between serum levels of RSPO1 and a range of metabolic parameters in humans. Serum levels of RSPO1 are significantly related to obesity and insulin resistance, although the precise mechanisms remain unknown.


Subject(s)
Biomarkers , Body Mass Index , C-Peptide , Diabetes Mellitus , Eating , Enzyme-Linked Immunosorbent Assay , Fasting , Homeostasis , Humans , Insulin Resistance , Insulin , Obesity
8.
Article in English | WPRIM | ID: wpr-763494

ABSTRACT

We investigated weight loss effect of personalized diet education in overweight/obese Korean adults. Overweight/obese Korean adults (body mass index [BMI] ≥ 23 kg/m2 or waist circumference [WC] ≥ 90 cm for men, ≥ 85 cm for women) were recruited, and 40 participants who completed the 10-week intervention were finally included in the analyses. At first visit, study participants (small group with individual counseling) were educated for optimal diet by clinical dietitian, and checked for their compliance through telephone/text message every 1–2 week during the intervention. Anthropometric and biochemical parameters and dietary intake were investigated. Body weight, BMI, WC, and body fat mass were significantly reduced in whole participants. Hemoglobin A1c, insulin, and low-density lipoprotein cholesterol were also significantly decreased after the intervention. Total energy intake (EI) during the intervention was not significantly decreased compared to the baseline value, but the proportions of energy derived from macronutrients were within the ranges recommended by 2015 Dietary Reference Intake for Koreans. Based on actual EI, participants were classified into high-adherence (HA) (prescribed EI ± 25%, n = 29), low-adherence I (LA-I) ( 125% of prescribed EI, n = 4). Only HA group showed significant improvements in anthropometric parameters, glycemic control and lipid profile. Interestingly, LA-I group showed significant increases in glucose, insulin, C-peptide and insulin resistance. In conclusion, a shift from overweight/obesity to healthy weight can be accomplished by high adherence to personalized diet modification, not by EI reduction.


Subject(s)
Adipose Tissue , Adult , Body Weight , C-Peptide , Cholesterol , Compliance , Diet , Education , Energy Intake , Feeding Behavior , Glucose , Humans , Insulin , Insulin Resistance , Lipoproteins , Male , Nutritionists , Obesity , Overweight , Recommended Dietary Allowances , Waist Circumference , Weight Loss
9.
Article in English | WPRIM | ID: wpr-785724

ABSTRACT

BACKGROUND: Conflicting results have been reported on the efficacy of insulin degludec/insulin aspart (IDegAsp) compared to basal insulin in type 2 diabetes. We investigated the effects of changing basal insulin to IDegAsp on glycemic control and sought to identify factors related to those effects.METHODS: In this retrospective study of patients from three referral hospitals, patients with type 2 diabetes using basal insulin with hemoglobin A1c (HbA1c) levels less than 11.0% were enrolled. Basal insulin was replaced with IDegAsp, and data were analyzed from 3 months before to 3 months after the replacement.RESULTS: Eighty patients were recruited (52.5% male; mean age, 67.0±9.8 years; mean duration of diabetes, 18.9±8.5 years; mean HbA1c, 8.7%±1.0%). HbA1c levels increased during 3 months of basal insulin use, but significantly decreased after changing to IDegAsp (8.28%±1.10%, P=0.0001). The reduction was significant at 6 months in 35 patients whose longer-term data were available. Patients with a measured fasting plasma glucose (m-FPG) lower than their predicted FPG (p-FPG) by regression from HbA1c showed a significant HbA1c reduction caused by the change to IDegAsp, even without a significantly increased insulin dose. However, patients whose m-FPG was higher than their p-FPG did not experience a significant HbA1c reduction, despite a significantly increased insulin dose. Furthermore, the HbA1c reduction caused by IDegAsp was significant in patients with low fasting C-peptide levels and high insulin doses.CONCLUSION: We observed a significant glucose-lowering effect by replacing basal insulin with IDegAsp, especially in patients with a lower m-FPG than p-FPG.


Subject(s)
Adult , Blood Glucose , C-Peptide , Diabetes Mellitus, Type 2 , Fasting , Humans , Hyperglycemia , Insulin , Male , Referral and Consultation , Retrospective Studies
10.
Article in English | WPRIM | ID: wpr-785711

ABSTRACT

BACKGROUND: An early identification of the risk groups might be beneficial in reducing morbidities in patients with gestational diabetes mellitus (GDM). Therefore, this study aimed to assess the biochemical predictors of glycemic conditions, in addition to fasting indices of glucose disposal, to predict the development of GDM in later stage and the need of glucose-lowering medication.METHODS: A total of 574 pregnant females (103 with GDM and 471 with normal glucose tolerance [NGT]) were included. A metabolic characterization was performed before 15+6 weeks of gestation by assessing fasting plasma glucose (FPG), fasting insulin (FI), fasting C-peptide (FCP), and glycosylated hemoglobin (HbA1c). Thereafter, the patients were followed-up until the delivery.RESULTS: Females with NGT had lower levels of FPG, FI, FCP, or HbA1c at the early stage of pregnancy, and therefore, showed an improved insulin action as compared to that in females who developed GDM. Higher fasting levels of FPG and FCP were associated with a higher risk of developing GDM. Moreover, the predictive accuracy of this metabolic profiling was also good to distinguish the patients who required glucose-lowering medications. Indices of glucose disposal based on C-peptide improved the predictive accuracy compared to that based on insulin. A modified quantitative insulin sensitivity check index (QUICKIc) showed the best differentiation in terms of predicting GDM (area under the receiver operating characteristics curve [ROC-AUC], 72.1%) or need for pharmacotherapy (ROC-AUC, 83.7%).CONCLUSION: Fasting measurements of glucose and C-peptide as well as the surrogate indices of glycemic condition could be used for stratifying pregnant females with higher risk of GDM at the beginning of pregnancy.


Subject(s)
Blood Glucose , C-Peptide , Diabetes, Gestational , Drug Therapy , Fasting , Female , Glucose Metabolism Disorders , Glucose , Glycated Hemoglobin A , Humans , Insulin , Insulin Resistance , Metabolic Diseases , Metabolism , Pregnancy , ROC Curve
11.
Article in Chinese | WPRIM | ID: wpr-813232

ABSTRACT

To explore the clinical features and complications of 545 hospitalized type 1 diabetic patients.
 Methods: All data of 545 patients with typical type 1 diabetes (T1DM) who were hospitalized in the Department of Endocrinology, the Second Xiangya Hospital, Central South University were collected. The data were analyzed retrospectively to explore the clinical features and complications. Clinical and biochemical characteristics were analyzed through comparison between different subgroups according to the onset age (≤13 years old, 14-29 years old, ≥30 years old).
 Results: The median onset age of T1DM patients was 27.0 (15.0, 40.0) years, and the middle-onset was 42.1%. Among the 3 groups, the proportion of female (58.0%) was the highest in the ≤13 years old group, concomitant with the lowest SBP and serum creatinine levels as well as the lowest incidence of all microvascular complications (21.0% of diabetic nephropathy, 23.3% of diabetic retinopathy, 34.1% of diabetic peripheral neuropathy; all P<0.05). Moreover, the fasting C peptide and peak C peptide levels were the lowest in ≥30 years old group compared with the other two groups, and the incidence of ketosis (33.5%) and all macrovascular complications were the highest among the three groups (all P<0.05).
 Conclusion: There are about half of the hospitalized patients with T1DM whose onset ages are ≥30 years. The incidence of ketosis at the onset and the risk for various microvascular and macrovascular complications after onset are higher than those with the onset age <30 years.


Subject(s)
Adolescent , Adult , C-Peptide , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Diabetic Nephropathies , Female , Humans , Male , Retrospective Studies , Risk Factors , Young Adult
12.
Arch. endocrinol. metab. (Online) ; 62(6): 585-590, Dec. 2018. tab
Article in English | LILACS | ID: biblio-983810

ABSTRACT

ABSTRACT Objective: The aim was to characterize blood glucose fluctuations in patients with fulminant type 1 diabetes (FT1DM) at the stable stage using continuous blood glucose monitoring systems (CGMSs). Subjects and methods: Ten patients with FT1DM and 20 patients with classic type 1 diabetes mellitus (T1DM) (the control group) were monitored using CGMSs for 72 hours. Results: The CGMS data showed that the mean blood glucose (MBG), the standard deviation of the blood glucose (SDBG), the mean amplitude glycemic excursions (MAGE), the blood glucose areas and the percentages of blood glucose levels below 13.9 mmol/L were similar between the two groups. However, the percentage of blood glucose levels below 3.9 mmol/L was significantly higher in the FT1DM group compared to the T1DM group (p < 0.05). The minimum (Min) blood glucose level in the FT1DM group was significantly lower than that of the T1DM group (p < 0.05). Patients with FT1DM had severe dysfunction of the islet beta cells and alpha cells compared to patients with T1DM, as indicated by lower C-peptide values and higher glucagon/C-peptide values. Conclusion: In conclusion, patients with FT1DM at the stable stage were more prone to hypoglycemic episodes as recorded by CGMSs, and they had a greater association with severe dysfunction of both the beta and alpha islet cells compared to patients with T1DM.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Blood Glucose/analysis , Diabetes Mellitus, Type 1/blood , Reference Values , Blood Glucose/metabolism , C-Peptide/blood , Glucagon/blood , Blood Glucose Self-Monitoring/methods , Case-Control Studies , Retrospective Studies , Statistics, Nonparametric , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Insulin/blood
13.
J. bras. nefrol ; 40(4): 375-387, Out.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-984594

ABSTRACT

ABSTRACT Introduction: Preclinical trials have shown that C-peptide may contribute to the treatment of diabetic kidney disease (DKD). This systematic review and meta-analysis aimed to assess the use of C-peptide in attenuating the outcomes of DKD. Methods: Searches were made on databases PubMed, Web of Science, and Scielo for in vivo clinical and preclinical trials written in English, Portuguese or Spanish that looked into the use of C-peptide in the attenuation of the outcomes of DKD. Results: Twelve papers were included in this review, one clinical and eleven preclinical trials. In the clinical trial, DKD patients given C-peptide had lower levels of albuminuria than the subjects in the control group, but glomerular filtration rates were not significantly different. The main parameters assessed in the preclinical trials were glomerular filtration rate (six trials) and albuminuria (five trials); three trials described less hyperfiltration and three reported lower levels of albuminuria in the groups offered C-peptide. The meta-analysis revealed that the animals given C-peptide had lower glomerular volumes and lower urine potassium levels than the groups not given C-peptide. Conclusion: The results of the studies included in the systematic review diverged. However, the meta-analysis showed that the animals given C-peptide had lower glomerular volumes and lower urine potassium levels.


RESUMO Introdução: Estudos pré-clínicos demonstraram que o peptídeo C pode contribuir para a terapia da doença renal do diabetes (DRD). Esta revisão sistemática e meta-análise teve como objetivo avaliar a utilidade do peptídeo C na atenuação dos desfechos da DRD. Métodos: Foram utilizadas as bases de dados PubMed, Web of Science e Scielo, e definidos como critérios de elegilibilidade ensaios clínicos e pré-clínicos in vivo, redigidos em inglês, português ou espanhol, que avaliaram a utilidade do peptídeo C na atenuação dos desfechos da DRD. Resultados: Doze artigos foram incluídos nesta revisão: onze ensaios pré-clínicos e um ensaio clínico. No ensaio clínico, os pacientes com DRD que receberam peptídeo C apresentaram menor albuminúria do que os do grupo controle, contudo não houve diferença significativa em relação à taxa de filtração glomerular. Os principais parâmetros avaliados pelos estudos pré-clínicos foram taxa de filtração glomerular (seis estudos) e albuminúria (cinco estudos), dos quais três encontraram menor hiperfiltração e três verificaram menor albuminúria no grupo que recebeu peptídeo C. A meta-análise demonstrou que os animais que receberam peptídeo C apresentaram menor volume glomerular e menor excreção urinária de potássio em comparação com aqueles que não o receberam. Conclusão: Os resultados dos estudos incluídos nesta revisão sistemática foram divergentes. Contudo, a meta-análise demonstrou que a administração do peptídeo C em animais resultou em menor volume glomerular e menor excreção urinária de potássio.


Subject(s)
Humans , Animals , C-Peptide/therapeutic use , Diabetic Nephropathies/drug therapy , Treatment Outcome
14.
Rev. bras. ter. intensiva ; 30(3): 286-293, jul.-set. 2018. tab
Article in Portuguese | LILACS | ID: biblio-977969

ABSTRACT

RESUMO Objetivo: Verificar a incidência da hiperglicemia de estresse em crianças em condição grave e investigar a etiologia da hiperglicemia com base em um modelo de avaliação da homeostasia. Métodos: Estudo prospectivo de coorte, conduzido em uma unidade de terapia intensiva pediátrica da Cairo University, que incluiu 60 crianças com doença grave e 21 controles saudáveis. Utilizaram-se os níveis séricos de glicose, insulina e peptídeo C, avaliados em até 24 horas após a admissão. O modelo de avaliação da homeostasia foi utilizado para analisar a função das células beta e a sensibilidade à insulina. Resultados: A hiperglicemia foi estimada em 70% dos pacientes. Valores de glicemia ≥ 180mg/dL se associaram com desfechos piores. Os níveis de glicemia se correlacionaram de forma positiva com o Pediatric Risk for Mortality (PRISM III) e o número de órgãos com disfunção (p = 0,019 e p = 0,022, respectivamente), enquanto os níveis de insulina se correlacionaram de forma negativa com o número de órgãos com disfunção (r = -0,33; p = 0,01). O modelo de avaliação da homeostasia revelou que 26 (43,3%) das crianças em condições graves tinham baixa função de células beta e 18 (30%) baixa sensibilidade à insulina. Detectou-se patologia combinada em apenas dois (3,3%) pacientes. Baixa função de células beta se associou de forma significante com a presença de disfunção de múltiplos órgãos, disfunção respiratória, cardiovascular e hematológica, e presença de sepse. Conclusões: A disfunção de células beta pareceu ser prevalente em nossa coorte e se associou com disfunção de múltiplos órgãos.


ABSTRACT Objective: This study aimed to study the incidence of stress hyperglycemia in critically ill children and to investigate the etiological basis of the hyperglycemia based on homeostasis model assessment. Methods: This was a prospective cohort study in one of the pediatric intensive care units of Cairo University, including 60 critically ill children and 21 healthy controls. Serum blood glucose, insulin, and C-peptide levels were measured within 24 hours of admission. Homeostasis model assessment was used to assess β-cell function and insulin sensitivity. Results: Hyperglycemia was estimated in 70% of patients. Blood glucose values ≥ 180mg/dL were associated with a poor outcome. Blood glucose levels were positively correlated with Pediatric Risk for Mortality (PRISM III) score and number of organ dysfunctions (p = 0.019 and p = 0.022, respectively), while insulin levels were negatively correlated with number of organ dysfunctions (r = −0.33, p = 0.01). Homeostasis model assessment revealed that 26 (43.3%) of the critically ill patients had low β-cell function, and 18 (30%) had low insulin sensitivity. Combined pathology was detected in 2 (3.3%) patients only. Low β-cell function was significantly associated with the presence of multi-organ dysfunction; respiratory, cardiovascular, and hematological dysfunctions; and the presence of sepsis. Conclusions: β-Cell dysfunction appeared to be prevalent in our cohort and was associated with multi-organ dysfunction.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Stress, Physiological/physiology , Sepsis/complications , Hyperglycemia/etiology , Multiple Organ Failure/physiopathology , Blood Glucose/metabolism , C-Peptide/blood , Intensive Care Units, Pediatric , Case-Control Studies , Incidence , Prospective Studies , Cohort Studies , Critical Illness , Sepsis/epidemiology , Egypt , Insulin-Secreting Cells/pathology , Homeostasis , Hyperglycemia/epidemiology , Insulin/blood , Multiple Organ Failure/epidemiology
15.
Article in English | WPRIM | ID: wpr-714104

ABSTRACT

BACKGROUND: We evaluated the clinical characteristics of insulin resistance and β-cell dysfunction in newly diagnosed, drug-naive people with type 2 diabetes by analyzing nationwide cross-sectional data. METHODS: We collected the clinical data of 912 participants with newly diagnosed diabetes from 83 primary care clinics and hospitals nationwide from 2015 to 2016. The presence of insulin resistance and β-cell dysfunction was defined as a homeostatic model assessment of insulin resistance (HOMA-IR) value ≥2.5 and fasting C-peptide levels < 1.70 ng/mL, respectively. RESULTS: A total of 75.1% and 22.6% of participants had insulin resistance and β-cell dysfunction, respectively. The proportion of participants with insulin resistance but no β-cell dysfunction increased, and the proportion of participants with β-cell dysfunction but no insulin resistance decreased as body mass index (BMI) increased. People diagnosed with diabetes before 40 years of age had significantly higher HOMA-IR and BMI than those diagnosed over 65 years of age (HOMA-IR, 5.0 vs. 3.0; BMI, 28.7 kg/m2 vs. 25.1 kg/m2). However, the β-cell function indices were lower in people diagnosed before 40 years of age than in those diagnosed after 65 years of age (homeostatic model assessment of β-cell function, 39.3 vs. 64.9; insulinogenic index, 10.3 vs. 18.7; disposition index, 0.15 vs. 0.25). CONCLUSION: We observed that the main pathogenic mechanism of type 2 diabetes is insulin resistance in participants with newly diagnosed type 2 diabetes. In addition, young adults with diabetes are more likely to have higher insulin resistance with obesity and have higher insulin secretory defect with severe hyperglycemia in the early period of diabetes than older populations.


Subject(s)
Body Mass Index , C-Peptide , Diabetes Mellitus, Type 2 , Fasting , Humans , Hyperglycemia , Insulin , Insulin Resistance , Obesity , Primary Health Care , Young Adult
16.
Article in English | WPRIM | ID: wpr-739784

ABSTRACT

BACKGROUND: In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy. METHODS: Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up < 7%. RESULTS: HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P < 0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P < 0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022). CONCLUSION: The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system.


Subject(s)
Adult , Blood Glucose Self-Monitoring , Blood Glucose , C-Peptide , Diabetes Mellitus, Type 2 , Fasting , Follow-Up Studies , Glucose , Glycated Hemoglobin A , Humans , Insulin , Insurance , Insurance, Health, Reimbursement , Korea , Multivariate Analysis , Prevalence
17.
Article in English | WPRIM | ID: wpr-713447

ABSTRACT

PURPOSE: Low vitamin D level is common in adults with diabetes mellitus (DM). We assessed vitamin D level and its associated factors in Korean youth with type 1 DM. METHODS: Type 1 DM cases (n=85) and healthy controls (n=518) aged < 20 years were included and grouped into 3 categories according to vitamin D level: deficiency ( < 20 ng/mL), insufficiency (20–30 ng/mL), or sufficiency (≥30 ng/mL). RESULTS: The mean serum vitamin D level was significantly lower (21.6±8.5 ng/mL vs. 28.0±12.0 ng/mL, P < 0.001) and vitamin D deficiency prevalence was significantly higher (48% vs. 26%, P < 0.001) in type 1 DM cases than in healthy controls. Logistic regression analysis revealed that type 1 DM cases were more likely to have vitamin D deficiency (P=0.004), independent of sex, age, and body mass index. Type 1 DM cases with vitamin D deficiency/insufficiency were mainly diagnosed in winter (November to April) (P=0.005), and the duration of diabetes was longer than in those with vitamin D sufficiency (P=0.046). However, season of diagnosis, duration of diabetes, prescribed daily insulin dose, and glycosylated hemoglobin and C-peptide levels were not associated with 25-hydroxyvitamin D (25(OH)D) level in type 1 DM cases after adjustment for other factors. CONCLUSIONS: We recommend assessment of serum 25(OH)D level in type 1 DM cases and to treatment if findings indicate insufficiency. Further studies investigating the mechanisms underlying vitamin D deficiency in youth with type 1 DM are needed.


Subject(s)
Adolescent , Adult , Body Mass Index , C-Peptide , Case-Control Studies , Child , Diabetes Mellitus , Diabetes Mellitus, Type 1 , Diagnosis , Glycated Hemoglobin A , Humans , Insulin , Logistic Models , Prevalence , Seasons , Vitamin D , Vitamin D Deficiency
18.
Article in Chinese | WPRIM | ID: wpr-776674

ABSTRACT

OBJECTIVE@#To study the protective effect of vitamin A on residual pancreatic β cell function in children with type 1 diabetes mellitus (T1DM) and its mechanism.@*METHODS@#A total of 46 children with T1DM (with a course of disease of 0.5-1 year) were randomly divided into an intervention group and a non-intervention group (n=23 each). The children in both groups were given insulin treatment, and those in the intervention group were also given vitamin A at a daily dose of 1 500-2 000 IU. A total of 25 healthy children were enrolled as the control group. The daily dose of insulin was calculated for the children with T1DM, and the serum levels of glycosylated hemoglobin (HbA1C), stimulated C-peptide, vitamin A, and interleukin-17 (IL-17) were measured before intervention and 3 months after intervention.@*RESULTS@#Before vitamin A intervention, the intervention group and the non-intervention group had a significantly lower serum level of vitamin A and a significantly higher level of IL-17 than the control group (P<0.01). After 3 months of intervention, the intervention group had significantly lower serum IL-17 level and insulin dose and a significantly higher level of stimulated C-peptide than the non-intervention group (P<0.05).@*CONCLUSIONS@#Vitamin A may protect residual pancreatic β cell function, possibly by improving the abnormal secretion of IL-17 in children with T1DM.


Subject(s)
Blood Glucose , C-Peptide , Diabetes Mellitus, Type 1 , Glycated Hemoglobin A , Humans , Infant , Insulin , Insulin-Secreting Cells , Vitamin A
19.
Article in English | WPRIM | ID: wpr-765773

ABSTRACT

Bariatric surgery has evolved from the surgical measure to treat morbid obesity into the epochal remedy to treat metabolic syndrome as a whole, which is represented by type 2 diabetes. Numerous clinical trials have unanimously advocated bariatric or metabolic surgery over the non-surgical interventions, demonstrating markedly superior metabolic outcomes not only in morbidly obese patients who satisfy traditional criteria for bariatric surgery (body mass index [BMI] >35kg/m²) but also in less obese or even in simply overweight patients. Nevertheless, not all the diabetic patients can achieve the most desirable outcomes, that is, diabetes remission, after metabolic surgery and candidates for metabolic surgery should be selected carefully based on the comprehensive preoperative assessment of the risk-benefit ratio. Predictors for diabetes remission after metabolic surgery can be largely classified into 2 groups based the mechanism of action; 1) indices for the preserved pancreatic beta-cell function, such as younger age, shorter duration of diabetes, and higher C-peptide level, and 2) those represent the potential reserve for reduction in insulin resistance, such as higher baseline BMI, and visceral fat area. Several prediction models for diabetes remission have been suggested by merging these predictors to guide clinicians and patients' joint decision-making process. Among them, 3 models, DiaRem, ABCD, and Individualized Metabolic Surgery (IMS) scores provide intuitive scoring systems which can be simply utilized in the routine clinical practice and have been validated in the independent external cohort. These prediction models need further validation in the various different ethnicities to ensure the universal applicability.


Subject(s)
Bariatric Surgery , C-Peptide , Cohort Studies , Humans , Insulin Resistance , Intra-Abdominal Fat , Joints , Obesity, Morbid , Overweight
20.
Article in English | WPRIM | ID: wpr-718330

ABSTRACT

BACKGROUND: Measurement of insulin and C-peptide concentrations is important for deciding whether insulin treatment is required in diabetic patients. We aimed to investigate the analytical performance of insulin and C-peptide assays using the Lumipulse G1200 system (Fujirebio Inc., Tokyo, Japan). METHODS: We examined the precision, linearity, and cross-reactivity of insulin and C-peptide using five insulin analogues and purified proinsulin. A method comparison was conducted between the Lumipulse G1200 and Roche E170 (Roche Diagnostics, Mannheim, Germany) systems in 200 diabetic patients on insulin treatment. Reference intervals for insulin and C-peptide concentrations were determined in 279 healthy individuals. RESULTS: For insulin and C-peptide assays, within-laboratory precision (% CV) was 3.78–4.14 and 2.89–3.35%, respectively. The linearity of the insulin assay in the range of 0–2,778 pmol/L was R2=0.9997, and that of the C-peptide assay in the range of 0–10 nmol/L was R2=0.9996. The correlation coefficient (r) between the Roche E170 and Lumipulse G1200 results was 0.943 (P < 0.001) for insulin and 0.996 (P < 0.001) for C-peptide. The mean differences in insulin and C-peptide between Lumipulse G1200 and the Roche E170 were 19.4 pmol/L and 0.2 nmol/L, respectively. None of the insulin analogues or proinsulin showed significant cross-reactivity with the Lumipulse G1200. Reference intervals of insulin and C-peptide were 7.64–70.14 pmol/L and 0.17–0.85 nmol/L, respectively. CONCLUSIONS: Insulin and C-peptide tests on the Lumipulse G1200 show adequate analytical performance and are expected to be acceptable for use in clinical areas.


Subject(s)
C-Peptide , Diabetes Mellitus , Humans , Insulin , Methods , Proinsulin
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