Statins ; A double weapon in treating dyslipidemic osteoporotic menopausal type 2 diabetics

Recent reports have been suggested the possible role of 3-hydroxy-3 methyl gluteryl Coenzyme A [HMG-C0A] reductase inhibitors to represent an entirely new approach in treating osteoporosis by stimulating the proliferation and differentiation of osteoblasts, the specialized cells that create new bone formation. Also, statins have been reported to prevent bone resorption through blocking an early step in mevalonate pathway and so preventing prenylation, a step that is required for osteoclasts function. The aim of the present work was to study the effect of HMG-CoA reductase inhibitors [statins]; simvastatin and pravastatin, on bone mineral density [BMD] of dyslipidemic postmenopausal females with type 2 diabetes mellitus and having osteoporosis. Thirty postmenopausal dyslipidemic type 2 diabetic females above 50 years with no history of any disease or drugs that affect bone metabolism were included in this study and classified into 2 groups; I] included 15 patients received 40mg daily of simvastatin and II] included 15 patients received 40mg daily of pravastatin both for 3 months. Each patient was subjected to full history taking, complete clinical examination, laboratory investigations including, fasting and post-prandial plasma glucose, glycosylated haemoglobin, alanine aminotransferase [ALT], serum cholesterol and triglycerides, serum calcium [total and ionized] and phosphorus. Serum osteocalcin, biochemical marker of bone formation, was measured by immunometric assay and urinary deoxypyridinoline [DPD], biochemical marker of bone resorption was measured by competitive immunoassays. Dual energy X-ray absorptiometry [DEXA] was used to assess BMD of forearm [peripheral site] and L2-L3 lumbar vertebrae [axial site]. The results of the present work can be summarized as follows; the serum levels of osteocalcin and the BMD revealed significant increase and the urinary levels of DPD revealed significant decrease after 3 months of simvastatin in group I. A mild change in osteocalcin, urinary DPD and BMD had been noticed after 3 months of pravastatin in group II, yet it did not reach a statistical significant level. Also, there was significant reduction of serum cholesterol and triglycerides levels after 3 months therapy of either simvastatin or pravastatin and none of the patients showed any abnormal change in ALT levels supporting the safety of these drugs regarding their effect on the liver. Our results suggest the beneficial unexpected role of lipophyllic statins, simvastatin, in prevention and treatment of osteoporosis. Further studies are needed to reach the best effective dose and mode of administration of statin in preventing and treating osteoporosis. Also, the possibility of using statins in combination with other currently used drugs in this domain

role of prolactin in the etiology of feminization in schistosomal hepatic fibrosis

Basal levels of Estradiol, Testosterone, and Prolactin were measured in 20 schistosomal patients and 10 normal controls. Prolactin response to provocation by Chlorpromazine [50 mg 1.M.] was also studied in the 20 schistosomal patients. Patients were divided into two groups. Group 1 included 10 patients with signs of feminization in the form of one or more of the following: Gynaccomastia, female escutcheon, female body habitus, and cutaneous arterial spider naevi. Group II included 10 patients without feminine manifestations. The basal levels of estradiol were not different in the three groups. Testosterone levels were significantly lower in schistosomal patients of both groups. Basal prolactin was significantly higher in schistosomal patients of both groups. The level was higher in patients without feminine manifestations than in patients with such manifestations. Prolactin response to stimulation was also higher in patients without feminine manifestations although the difference did not reach statistical significance. The results suggest that prolactin has no significant role in the pathogencsis of feminine manifestations in schistosomal patients

Effect of addition of oil and a dietary fibre preparation to a popular Egyptian meal on blood glucose and plasma insulin in NIDD patients

Cooked beans is a popular meal for most of the Egyptians. We aimed to study blood glucose and insulin response to a beans meal and the effect of adding oil and excess fibre. We studied 21 non-insulin dependent diabetic patients [in 2 groups], and 10 controls. An oral carbohydrate tolerance curve was performed for all patients and controls using 480 gm of cooked beans [equivalent to 75 gm carbohydrates]. On the next day the curve was repeated after addition of 3 table spoonfuls of corn oil [58 gm] in group I [11 patients] and in controls or 2.84 gm of dietary fibre in group II [10 patients]. Beans were eaten with 160 gm whole meal bread. Compared to the values before the addition of oil, the mean percent increment rise of glucose and insulin after addition of oil, was not significant in diabetics [group, I] or controls [except at 120 and 180 minutes in controls]. In group II diabetics there was significant reduction in the values of percent increment rise of blood glucose and insulin at 60 and 90 minutes after the addition of the fibre diet if compared to the respective values without the fibre diet. In conclusion, corn oil is not harmful to diabetics and adding fibres to complex carbohydrate meals improves metabolic control

Honey: is it a safe sweetner for diabetics

The objective of this study was to determine whether or not honey could be used as a sweetening agent for non insulin dependent diabetics instead of sucrose. The work included 11 non-insulin dependent diabetic patients for whom an oral glucose tolerance test was performed on 2 alternative days. A carbohydrate load composed of 3 tea spoonfuls of honey together with a mixed flour bread [160 gm] was given on one occasion and 3 tea spoonfuls of sucrose with mixed flour bread [160 gm] on another. Blood glucose was determined in the fasting state and at 30, 60, 90, 120 and 180 minutes after the carbohydrate load. Serum samples were stored for insulin estimation by radio-immunoassay. Results showed that the values of the percent increment rise of blood glucose or serum insulin after sucrose were not significantly different from those after honey. It can be concluded that honey is not suitable to be used as a sweetening agent for non-insulin dependent diabetics in amounts higher than any other absorbable sugar allowance

effect of comparison of complex carbohydrates and high fibre preparations on post-prandial blood glucose and insulin levels in non-insulin dependent diabetics

Since the last decade, the physiological effects of dietary fibres and their possible role in prevention and management of many diseases have been emphasized. The aim of the present work has been to study the possible effects of supplementary different complex carbohydrates, consumed by the Egyptian population, with high fibre preparation, on the post-prandial blood glucose and insulin levels- in non-insulin dependent diabetics. This work has been carried out on 30 NIDD, who have been subjected to oral carbohydrate tolerance tests using boiled rice, boiled potatoes or bread [equivalent to 75 g glucose] at different occasions. Then the same patients have been subjected to the same tests after supplementing each carbohydrate load with high fibre preparation in the form of ceral bran and citrus fruit fibres. Blood glucose and insulin levels have been estimated using RIA technique for the latter. The maximum increment rise of glucose occurred at 90 minutes post-prandial and rice elecited the lowest glucose response, while potatoes elecited the highest one. Similarly rice elecited the lowest plasma insulin response. Supplementation of fibres led to marked and significant reduction of blood glucose level at 60 and 90 minutes in cases of rice and bread [P < 0.05] while the reduction is not significant in cases of potatoes [P > 0.05]. On the other hand addition of high fibre preparation did not affect siguificantly insulin resnonse

Prevalence of coronary heart disease in diabetics and correlation with plasma lipid changes

This study was carried en 50 diabetic patients. Seventeen cases were insulin dependent [IDDM] and 33 non-insulin dependent [NIDDM]. Every participant was subjected to: 1] Detailed history taking and clinical examination. 2] Laboratory investigations which included: estimation of fasting and postprandial blood glucose levels estimation of total serum cholesterol, triglyceride and high density lipoprotein [HDL] -cholesterol levels and determination of lipoprotein electrophoretic pattern. Out of the 50 diabetics included in this work 11 [22%] had coronary heart disease [CHD]. The prevalence of CHD among the 50 diabetic patients was analysed in relation to plasma lipid and lipoprotein values. The results suggest that CHD in diabetics is more likely to occur.When plasma lipid concentrations are raised. Hypertriglyceridemia was the most common lipid abnormality met with in this study. Raised serum triglyceride and pre beta lipoprotein values showed a more pronounced relation with CHD than did raised serum cholesterol and beta lipoproteins or decreased HDL-Cholesterol values

Glucose tolerance, plasma insulin, growth hormone, and free fatty acids in hepatic schistosomiasis

The purpose of the present study was to examine glucose tolerance in hepatic schitosomiasis together with some factors which may affect this tolerance. In forty-nine patients, the glucose disappearance rate was slower than in controls [1.27 + 0.28 and 1.64 +/- 0.26 per cent per minute, means +/- S.D., respectively]. The exogenous insulin sensitivity tests were normal and the insulin response after intravenous glucose administration was comparable to controls except after 90 minutes when it was significantly higher in hepatic schistosomiasis patients than controls [24.45 +/- 14.6 and 16.44 +/- 7.8 uU/ml. mean +/- S.D., respectively]. The growth hormone response to intravenous insulin administration was also comparable to controls. The plasma free fatty acids [FFA] were significantly higher in schistosomal patients than controls 592 +/- 172 and 209 +/- 97 ueq/1, mean +/- S.D., respectively.]. It is suggested that the glucose intolerance demonstrated in hepatic schitosomiasis might be due to a relative decrease of insulin secretion. Raised plasma FFA may also play a part