Tres versiones del "Ogtt Squeezer", un programa para evaluar de un vistazo la información metabólica de la curva de tolerancia a la glucosa / Three versions of the "Ogtt Squeezer", a program to evaluate ataglance the metabolic information of the oral glucose tolerance test

El diagnóstico clínico de resistencia insulínica (RI) es difícil, ya que el Clamp no es aplicable a la clínica. El así llamado "síndrome metabólico", un predictor clínico de la RI, no identifica alrededor de la mitad de los sujetos afectados. Previamente, definimos adecuadamente (Análisis ROC) los niveles de corte diagnóstico de los siguientes predictores bioquímicos: HOMA1, HOMA2, QUICKI e ISI-Composite, a través de analizar datos de 90 sujetos (53 no resistentes y 37 resistentes) que tenían una medición directa de su resistencia insulínica (Test de supresión pancreática, TSP, Test de Reaven) y también, una curva de tolerancia a la glucosa oral (CTG). Los puntos de corte obtenidos exhibieron un mucho mejor desempeño diagnóstico comparados con los puntos de corte convencionales. También encontramos un predictor nuevo, simple, económico y eficiente, el I0*G60. Definimos la "normalidad metabólica" de la CTG usando las medianas de los valores de varios parámetros en 312 sujetos con un G120 dentro de los 2 primeros terciles del grupo de normo-tolerantes a la glucosa (NGT, n=468; G120: 51-110 mg/dL, los con mejor función beta insular). A las medianas de la función beta insular y de la sensibilidad insulínica se les asignó un valor de un 100%. Se calculó el % relativo de función beta insular (%RFBI) y el % relativo de sensibilidad insulínica (%RSI) del resto de la cohorte (n=573) contra estos valores de referencia. El "OGTT Squeezer" se escribió en Excel. Las glicemias y las insulinemias de la CTG fueron las entradas del programa. Las salidas fueron: I0*G60, ISI-OL, QUICKI, and HOMA1 (predictores) y el índice insulinogénico, el índice de disposición, %RFBI y %RSI (parámetros). El programa también caracterizó la tolerancia glucídica de acuerdo a los criterios de la ADA 2003. El formato final del programa, HTML 5, facilita su uso. Desarrollamos tres versiones del programa: completa, abreviada y mínima.

Clinically, diagnosing insulin resistance (IR) is difficult since the Clamp is not applicable to clinical work. The so-called "Metabolic Syndrome", a clinical surrogate of IR, fails to identify around 50% of affected subjects. Previously, we properly defined (ROC Analysis) the diagnostic cut-offs of the following biochemical predictors: HOMA1, HOMA2, QUICKI, and ISI-Composite by analyzing data from 90 subjects (53 non-insulin-resistant and 37 insulin-resistant subjects) who had a direct measurement of insulin resistance (Pancreatic Suppression Test, PST, Reaven's Test), and also, an Oral Glucose Tolerance Test (OGTT). The resulting cut-offs exhibited much better performances compared with the conventional cut-offs. We also found a new, simple, inexpensive and efficient predictor, the I0*G60. We chose to define the "metabolic normalcy" of the OGTT by using the median values of several parameters in 312 NGT subjects with a G120 in the first 2 tertiles of the NGT group (n=468; G120: 51-110 mg/dL, those with the best beta-cell function). The median values of both Beta-Cell Function and Insulin Sensitivity of these subjects were assigned a 100% value. Both % Relative Beta-Cell Function (%RBCF) and % Relative Insulin Sensitivity (%RIS) of everyone else in the cohort (n=573) was calculated against these reference values. The "OGTT Squeezer" was written in Excel. The OGTT's glucose and insulin values served as the inputs of the program. The outputs were: I0*G60, ISI-OL, QUICKI, and HOMA1 (predictors), and Insulinogenic Index, Disposition Index, %RBCF, and %RIS (parameters). Moreover, the program characterized the OGTT according to the ADA 2003 criteria. The HTML 5 format of the program facilitates its use. We developed 3 versions of the program: complete, abbreviated, and minimal versions.

Two criteria of oral glucose tolerance test to diagnose gestational diabetes mellitus

SUMMARY OBJECTIVE To evaluate two different criteria, one or two cut-off values, of oral glucose tolerance test with 75g of glucose for the diagnosis of gestational diabetes mellitus. METHODS A cross-sectional study involving 120 records of pregnant women who received prenatal care at the service of a Brazilian university was carried out. Bivariate analysis of obstetric and perinatal outcomes was performed using the chi-square test. RESULTS Considering criterion I, 12.5% of patients were diagnosed with gestational diabetes mellitus. Patients were 3.57 times more likely to have a large fetus for the gestational age at birth (p=0.038). Using criterion II, gestational diabetes mellitus was diagnosed in 5.8% of patients, macrosomia was 7.73 times more likely to be found in the presence of gestational diabetes mellitus (p=0.004), and a large fetus for the gestational age at birth was 8.17 times more likely (p=0.004). CONCLUSIONS There was a difference in the prevalence of gestational diabetes mellitus between the two criteria analyzed. The new criterion proposed increased prevalence.

RESUMO OBJETIVO Avaliar dois critérios distintos, um ou dois valores de corte, do teste oral de tolerância à glicose com 75 g de glicose para o diagnóstico de diabetes mellitus gestacional. Métodos Estudo transversal envolvendo 120 prontuários de gestantes que realizaram pré-natal em um ambulatório de uma universidade brasileira. Análise bivariada dos resultados obstétricos e perinatais foi realizada pelo teste do qui-quadrado. Resultados Considerando o critério I, 12,5% das pacientes foram diagnosticadas com diabetes mellitus gestacional. As pacientes apresentaram uma chance 3,57 maior de ter um feto grande para a idade gestacional (p=0,038). Utilizando o critério II, o diabetes mellitus gestacional foi diagnosticado em 5,8% das pacientes. Mediante esse critério diagnóstico, a chance de macrossomia foi 7,73 vezes mais provável na presença de diabetes mellitus gestacional (p=0,004) e a chance de um feto grande para a idade gestacional foi 8,17 vezes maior de ocorrer (p=0,004). Conclusões Observou-se diferença na prevalência de diabetes melittus gestacional entre os dois critérios analisados, sendo que o novo critério proposto aumentou a prevalência.

Is biochemical hypoglycemia necessary during an insulin tolerance test?

ABSTRACT Objective The insulin tolerance test (ITT) has been accepted as the gold standard test for assessing the integrity of the growth hormone (GH) - insulin-like growth factor (IGF-1) axis and the hypothalamic-pituitary-adrenal (HPA) axis. The goal of the test is to achieve clinical and biochemical hypoglycemia at a blood glucose level ≤ 40 mg/dL to effectively and correctly assess the HPA and GH-IGF-1 axes. In this study, the GH and cortisol responses of patients who achieved and failed to achieve biochemical hypoglycemia during an ITT were compared. Subjects and methods One hundred thirty-five patients with pituitary disorders were included in the study. Samples for blood glucose levels were obtained after clear symptoms of clinical hypoglycemia developed. The patients were enrolled in the hypoglycemic and nonhypoglycemic groups according to whether their plasma glucose level ≤ 40 mg/dL or > 40 mg/dL during an ITT, and the groups were compared in terms of their GH and cortisol responses. Results The mean age, body mass index and waist circumference of the two patient groups were found to be similar. The mean blood glucose level was significantly lower in the hypoglycemic group than in the nonhypoglycemic group (19.3 and 52.0 mg/dL, respectively). When the two groups were compared in terms of peak cortisol and GH responses, no statistically significant differences were found. Conclusion The data presented suggest that clinically symptomatic hypoglycemia is as effective as biochemically confirmed hypoglycemia during an ITT. Arch Endocrinol Metab. 2020;64(1):82-8

Resistencia a la insulina en mujeres con síndrome de ovario poliquístico / Insulin resistance in women with polycystic ovary syndrome

RESUMEN Introducción: La resistencia a la insulina es frecuente en el síndrome de ovario poliquístico, con diferencias entre fenotipos y discrepancias sobre cómo medirla. Objetivo: Identificar trastornos de la sensibilidad y resistencia a la insulina en mujeres con síndrome de ovario poliquístico, y determinar si es mayor en el fenotipo clásico. Métodos: Incluyó 152 mujeres: 45 sin síndrome de ovario poliquístico (Grupo I); 46 con síndrome de ovario poliquístico clínico (Grupo II); 61 con síndrome de ovario poliquístico clásico (Grupo III). Se realizó prueba de tolerancia a la glucosa oral, se calcularon índices de sensibilidad o resistencia a la insulina en ayunas (HOMA-IR, I0/G0, FIRI, ISI, Belfiore, Bennet, Quicki, Raynaud) y en la prueba de tolerancia a la glucosa oral (Belfiore2, Ribel, Ins2glu2, ATI, IITotal, DATI/DATG, Matsuda, BetaHOMA). Se emplearon las pruebas de Kruskal-Wallis, Mann-Whitney y Chi cuadrado. Resultados: Las mujeres con síndrome de ovario poliquístico tenían más obesidad global y central (p / 0,05), más nivel de glucemia a los 30, 120 y 180 minutos de la prueba de tolerancia a la glucosa oral (p / 0,05) y de insulinemia a los 30, 60 y 120 (p / 0,0001), lo que fue mayor en el grupo III. Se diagnosticó intolerancia en ayunas en una mujer de cada grupo y tolerancia alterada en una del II y III. No hubo diferencias significativas entre grupos para los índices de sensibilidad o resistencia a la insulina en ayunas; ni del HOMA entre mujeres normopeso vs. sobrepeso-obesidad (p / 0,05). La mediana de los índices de la prueba de tolerancia a la glucosa oral fue menor para los de sensibilidad (Belfiore2, Ribel) y mayor para los de resistencia a la insulina (Ins2glu2, ATI, IITotal) en el Grupo III. El DATI/DATG, Matsuda y BetaHOMA no tuvieron diferencias significativas. Conclusiones: Las mujeres con síndrome de ovario poliquístico tienen mayor respuesta glucémica, resistencia a la insulina e hiperinsulinismo postsobrecarga de glucosa que las mujeres con función ovárica normal, más manifiesta en el fenotipo clásico. Los índices de ayuno son menos sensibles, independientemente del peso corporal. Tienen mayor utilidad: insulinemia a los 60 minutos de la prueba de tolerancia a la glucosa oral, Belfiore2, ATI e IITotal(AU)

ABSTRACT Introduction: Insulin resistance is common in polycystic ovary syndrome, with differences between phenotypes and discrepancies on how to measure it. Objective: To identify disorders of insulin sensitivity and resistance in women with polycystic ovarian syndrome and determine if the latter is greater in the classic phenotype. Methods: The study included 152 women. 45 of them had no polycystic ovary syndrome (Group I), 46 had clinical polycystic ovary syndrome (Group II) and 61 had classic polycystic ovary syndrome (Group III). Oral glucose tolerance test was performed, fasting insulin sensitivity or resistance indices (HOMA-IR, I0 / G0, FIRI, ISI, Belfiore, Bennet, Quicki, Raynaud) were calculated and the tolerance test to oral glucose (Belfiore2, Ribel, Ins2glu2, ATI, IITotal, DATI / DATG, Matsuda, BetaHOMA) was also assessed. Kruskal-Wallis, Mann-Whitney and Chi square tests were used. Results: Women with polycystic ovarian syndrome had more global and central obesity (p /0.05), more blood glucose level at 30, 120 and 180 minutes of the oral glucose tolerance test (p /0.05 ) and insulinemia at 30, 60 and 120 (p /0.0001), which was higher in group III. Fasting intolerance was diagnosed in one woman in each group and altered tolerance in one of group II and group III, respectively. There were no significant differences between groups for fasting insulin sensitivity or resistance indices, nor for HOMA among normal weight women vs. overweight-obesity (p / 0.05). The median indexes of the oral glucose tolerance test were lower for those of sensitivity (Belfiore2, Ribel) and higher for those of insulin resistance (Ins2glu2, ATI, IITotal) in Group III. The DATI / DATG, Matsuda and BetaHOMA had no significant differences. Conclusions: Women with polycystic ovarian syndrome have higher glycemic response, insulin resistance and post-overload glucose hyperinsulinism than women with normal ovarian function, which is more evident in the classical phenotype. Fasting rates are less sensitive, regardless of body weight. Tests such as insulinemia 60 minutes after the oral glucose tolerance, Belfiore 2, ATI and IITotal are most useful(AU)

Valor de corte del índice de conicidad como predictor independiente de disglucemias / Cut-off value of the conicity index as an independent predictor of dysglycemia

RESUMEN Introducción: En Cuba no existe consenso acerca del valor del índice de conicidad que debe ser considerado de riesgo para identificar disglucemias. Objetivos: Determinar el punto de corte del índice de conicidad como predictor de disglucemia en ambos sexos. Métodos: Estudio descriptivo transversal con 975 personas (523 mujeres y 452 hombres), que asistieron a consulta externa del Instituto Nacional de Endocrinología por sospecha de diabetes mellitus entre abril de 2008 y abril de 2013. Se les realizó interrogatorio, examen físico y estudios complementarios (prueba de tolerancia oral a la glucosa, insulinemia en ayunas, lípidos y ácido úrico). Se utilizó para el procesamiento estadístico el coeficiente de correlación de Pearson, análisis de regresión logística y el análisis de curvas Receiver Operator Characteristic. Resultados: En el sexo femenino se observó una correlación directamente proporcional y significativa entre el índice de conicidad y las variables glucemia en ayunas y a las 2 h, insulinemia en ayunas, colesterol, triglicéridos, ácido úrico y el índice "homeostasis model assessment of insulin resistance". En el sexo masculino se observó una correlacióndirectamente proporcional y significativa entre el índice de conicidad y las variables estudiadas, excepto con los triglicéridos. El índice de conicidad tuvo su mayor poder predictor de disglucemia con un punto de corte de 1,18 para las mujeres y 1,20 en hombres. Conclusiones: El punto de corte óptimo del índice de conicidad como predictor de disglucemia fue de 1,18 para las mujeres y 1,20 para los hombres; es decir que tuvo un buen poder predictivo de disglucemias en el sexo femenino, no así en el masculino(AU)

ABSTRACT Introduction: In Cuba, there is no consensus about the value of the conicity index that should be considered as risk to identify dysglycemia. Objective: To determine the cut-off point of conicity index as a predictor of dysglycemia in both sexes. Methods: Cross-sectional descriptive study was conducted with 975 people (523 women and 452 men), who attended an outpatient consultation at the National Endocrinology Institute for suspected diabetes mellitus from April 2008 to April 2013. Interrogation, physical examination and complementary studies (oral glucose tolerance test, fasting insulinemia, lipids and uric acid) were performed. Pearson's correlation coefficient, logistic regression analysis and Receiver Operator Characteristic curve analysis were used for statistical processing. Results: In the female subjects, a directly proportional and significant correlation was observed between the conicity index and the fasting blood glucose variables and at 2 h, fasting insulinemia, cholesterol, triglycerides, uric acid and the index homeostasis model assessment of insulin resistance. In the male subjects, a directly proportional and significant correlation was observed between the conicity index and the variables studied, except with triglycerides. The conicity index had its highest predictive power of dysglycemia with a cut-off point of 1.18 in women and 1.20 in men. Conclusions: The optimal cut-off point of conicity index as a predictor of dysglycemia was 1.18 for women and 1.20 for men; that is to say, it was a good predictor of dysglycemias in the female subjects, but not so for male subjects(AU)

Utilidad de una escala de riesgo para identificar pacientes con disglucemia / Utility of a risk scale to identify patients with dysglycemia

Introducción: la prevalencia de diabetes y prediabetes ha ido en aumento a nivel global y en Cuba. Para identificar individuos en riesgo de disglucemia se han desarrollado varias escalas. Objetivo: evaluar el desempeño de la escala de Bang y otros, para identificar individuos con disglucemia, en una población cubana laboralmente activa. Métodos: se realizó un estudio transversal en 2 902 pacientes, fueron clasificados en portadores o no de disglucemia, a través de las pruebas de glucemia en ayunas, de tolerancia a la glucosa y hemoglobina glucosilada. Se determinó la frecuencia de factores de riesgo de diabetes mellitus tipo 2 comprendidos en la escala de Bang y otros, y en el proceder enfocado en factores de riesgo de American Diabetes Association. Se determinó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y Odds Ratio de ambas estrategias. En ambos se calculó el área bajo la curva operativa del receptor. Resultados: se encontró relación entre cada uno de los factores de riesgo previstos en ambos procederes con el diagnóstico de disglucemia. Se encontró sensibilidad de 96,5 por ciento y 79,9 por ciento; especificidad de 20,9 por ciento y 59,1 por ciento; valor predictivo positivo de 10,7 por ciento y 16,1 por ciento; valor predictivo negativo de 98,4 por ciento y 96,8 por ciento; OR de 7,33 y 6,76 y área bajo la curva 0,77 y 0,79 para la escala de Bang y otros, y el procedimiento enfocado en factores de riesgo, respectivamente. Conclusiones: ambos procederes identificaron de forma aceptable el grupo de pacientes con disglucemia(AU)

Introduction: The prevalence of diabetes and prediabetes has been increasing globally and also in Cuba. Several scales have been developed to identify individuals at risk for dysglycemia. Objective: To evaluate the performance of the Bang et al. scale to identify individuals with dysglycemia in a Cuban labor-active population. Methods: A cross-sectional study was carried out on 2 902 patients, classified as having or not suffering from dysglycemia, through fasting glycemia, glucose tolerance test and glycosylated hemoglobin. The frequencies of risk factors for type 2 diabetes mellitus included in the Bang et al. scale and in the risk factor approach of the American Diabetes Association were determined. Sensitivity, specificity, positive predictive value, negative predictive value and Odds Ratio of both strategies were determined. In both, the area under the receiver operating curve was calculated. Results: A relationship was found between each of the predicted risk factors in both procedures with the diagnosis of dysglycemia. Sensitivity was 96.5 percent and 79.9 percent; Specificity of 20.9 percent and 59.1 percent; Positive predictive value of 10.7 percent and 16.1 percent; Negative predictive value of 98.4 percent and 96.8 percent; OR of 7.33 and 6.76 and area under the curve 0.77 and 0.79 for the scale of Bang et al. and the procedure focused on risk factors respectively. Conclusions: Both procedures identified in an acceptable manner the group of patients with dysglycemia(AU)

Evaluación de parámetros clínicos y de laboratorio relacionados con el diagnóstico de insulino resistencia / Evaluation of clinical and laboratory parameters related to the diagnosis of insulin resistance

The evaluation of insulin resistance (IR) in clinical practice is based on the determination of fasting insulin (I0) and insulin level after 2 hours in an oral glucose tolerance test (OGT). However, there are not adequate cutoff points to discriminate IR patients. Objectives: to evaluate the reliability of insulin levels in the diagnosis of IR using the intravenous insulin tolerance test (IVITT) as the gold standard. Patients and Method: The OGT and IVITT of patients who participated as cases or controls in research protocols were analyzed. We excluded those cases with fasting glycemia over126 mg/dl. Results: 128 cases, 111 F, 17 M; Age: 40.3 +/- 14.8 years; BMI: 33 +/- 8 kg/m2; Waist circumference, M: 100.3 +/- 9.4 cm, F: 96 +/- 15 cm. According to IVITT (KITT), 103 (80.5 percent) were IR (KITT < 4.5 percent) and 25 (19.5 percent) were non IR (KITT > 4.5 percent). Fasting (G0) and 120 minutes after glucose challenge glycemia (G120), I0 and I120, HOMA and area under the glycemia and insulin curve, were significantly higher in the IR, as the same as, hypertension and acanthosis nigricans features (p < 0.05). According to G120, 45 cases (35.2 percent) had glucose intolerance, 9 (7 percent) diabetes and 74 (57.8 percent) were normals. In addition to G0, only IVITT was significantly different among the 3 groups (p = 0.025), identifying most insulin resistant subjects. The sensitivity and specificity for a cutoff point of I120 at 60 µIU/mL, were 30 percent and 88 percent, respectively. Conclusion: Baseline and 120 minutes post glucose charge insulin levels and HOMA, do not discriminate insulin resistant subjects, especially when there is fasting or post-stimulus hyperglycemia. Therefore, they are not recommended for individual diagnosis or therapeutic decisions

Valor de corte de la circunferencia de la cintura como predictor de disglucemia / Cut-off point of the waist circumference as a predictor of dysglycemia

Introducción: la circunferencia de la cintura es un parámetro clínico útil para identificar alteraciones en el metabolismo de los carbohidratos, pero la Organización Mundial de la Salud recomienda que cada país o región debe establecer sus propios valores de corte. Objetivo: determinar el punto de corte de la circunferencia de cintura como predictor de disglucemia en una población cubana. Métodos: se realizó un estudio descriptivo transversal basado en 982 pacientes (457 hombres y 525 mujeres) que asistieron a las consultas del Instituto Nacional de Endocrinología por sospecha de diabetes mellitus tipo 2, entre abril de 2008 y abril de 2013. La metodología consistió en la realización de un interrogatorio y un examen físico, que incluyó la medición de la circunferencia de cintura y estudios de laboratorio que se completaron con una prueba de tolerancia a la glucosa oral. Se determinaron distribuciones de frecuencia de las variables cualitativas y de las cuantitativas, media y desviación estándar. Además se utilizaron el coeficiente de correlación de Pearson, regresión lineal simple, el análisis de las curvas Receiver Operator Characteristics y la prueba de chi cuadrado. Resultados: se halló una correlación positiva entre la circunferencia de cintura y los valores de glucemia, insulinemia, ácido úrico y el índice Homeostasis Model Assessment Estimate of Insulin Resistance. La circunferencia de la cintura en ambos sexos fue la variable con mayor poder predictor de disglucemia, con un punto de corte de cintura de 86,75 cm en hombres y 80,5 cm en las mujeres. Conclusiones: el punto de corte óptimo de la circunferencia de cintura como predictor de disglucemia en hombres es de 86,75 cm (87) y en mujeres de 80,5 cm (81) en una población cubana(AU)

Introduction: waist circumference is a useful clinical parameters to identify alterations in carbohydrate metabolism; however the World Health Organization recommends that each country or region should set its own cut off point values. Objective: to determine the cut-off point of the waist circumference as a predictor of dysglycemias in a Cuban population. Methods: a cross-sectional descriptive study was conducted in 982 patients (457 men and 525 females) who went to the medical offices of the National Institute of Endocrinology on suspicion of diabetes mellitus type 2 from April 2008 to April 2013. The methodology consisted of administration of questionnaires and physical examination including the measurement of waist circumference and lab studies that were completed with the oral glucose tolerance test. Frequency distributions of the qualitative and quantitative variables, the median and standard deviation were all determined. Additionally, Pearson´s correlation coefficient, the simple linear regressions, analysis of Receiver Operator Characteristic curves and the Chi-square test were also used. Results: positive correlation was found between the waist circumference and the glycemia, insulinemia, uric acid and the homeostasis model assessment estimate of insulin resistance. Waist circumference in both sexes was the variable with greatest predictive power for dysglycemia, with a cutoff point of 86.75 cm for men and 80.5 cm for women. Conclusions: the optimal cutoff point of waist circumference as a dysglycemia predictor in men is 86.75 cm (87) and in women is 80.5 (81) in a Cuban population(AU)

Elevated IGF-1 with GH suppression after an oral glucose overload: incipient acromegaly or false-positive IGF-1?

ABSTRACT Objective To report the evolution of patients with a suggestive clinical scenario and elevated serum insulin-like growth factor-1 (IGF-1), but growth hormone (GH) suppression in the oral glucose tolerance test (OGTT), in whom acromegaly was not initially excluded. Subjects and methods Forty six patients with a suggestive clinical scenario, who had elevated IGF-1 (outside puberty and pregnancy) in two measurements, but GH < 0.4 µg/L in the OGTT, were selected. Five years after initial evaluation, the patients were submitted to clinical and laboratory (serum IGF-1) reassessment. Patients with persistently elevated IGF-1 were submitted to a new GH suppression test and magnetic resonance imaging (MRI) of the pituitary. Results Four patients were lost to follow-up. During reassessment, 42 patients continued to show no “typical phenotype” or changes in physiognomy. Fifteen of the 42 patients had normal IGF-1. Among the 27 patients with persistently elevated IGF-1 and who were submitted to a new OGTT, GH suppression was confirmed in all. Two patients exhibited a lesion suggestive of microadenoma on pituitary MRI. In our interpretation of the results, acromegaly was ruled out in 40 patients and considered “possible” in only 2. Conclusion Our results show that even in patients with a suggestive clinical scenario and elevated IGF-1, confirmed in a second measurement and without apparent cause, acromegaly is very unlikely in the case of GH suppression in the OGTT.

Validation of HOMA-IR in a model of insulin-resistance induced by a high-fat diet in Wistar rats

ABSTRACT Objective The present study aimed to validate homeostasis model assessment of insulin resistance (HOMA-IR) in relation to the insulin tolerance test (ITT) in a model of insulin-resistance in Wistar rats induced by a 19-week high-fat diet. Materials and methods A total of 30 male Wistar rats weighing 200-300 g were allocated into a high-fat diet group (HFD) (55% fat-enriched chow, ad lib, n = 15) and a standard-diet group (CD) standard chow, ad lib, n = 15), for 19 weeks. ITT was determined at baseline and in the 19th week. HOMA-IR was determined between the 18-19th week in three different days and the mean was considered for analysis. Area under the curve (AUC-ITT) of the blood glucose excursion along 120 minutes after intra-peritoneal insulin injection was determined and correlated with the corresponding fasting values for HOMA-IR. Results AUC-ITT and HOMA-IR were significantly greater after 19th week in HFD compared to CD (p < 0.001 for both). AUC-OGTT was also higher in HFD rats (p = 0.003). HOMA-IR was strongly correlated (Pearson’s) with AUC-ITT r = 0.637; p < 0.0001. ROC curves of HOMA-IR and AUC-ITT showed similar sensitivity and specificity. Conclusion HOMA-IR is a valid measure to determine insulin-resistance in Wistar rats. Arch Endocrinol Metab. 2016;60(2):138-42.

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus

ABSTRACT Objective Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). Subjects and methods The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients’ ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. Results From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Conclusion Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.

Association of insulin resistance and GLP-2 secretion in obesity: a pilot study / Associação entre resistência insulínica e secreção de GLP-2 em obesos: um estudo piloto

OBJECTIVE: The objective of this pilot study was to determine whether glugagon-like peptide 2 (GLP-2) secretion relates to insulin sensitivity (IS) in obese subjects. SUBJECTS AND METHODS: Twenty four obese subjects [body mass index (BMI) 40.0 ± 3.0 kg/m² (mean ± standard deviation)] were included, nine of which were male, age 43 ± 8 years. Twelve subjects had type 2 diabetes, all treated with oral anti-diabetic agents only. The subjects were submitted to standard meal tolerance test (MTT) for dosage of the curves: glucose, insulin, and GLP-2. Insulin sensitivity was measured by HOMA-IR, and OGIS was derived from the MTT. Spearman linear correlations and partial correlations were obtained. RESULTS: There was an inverse relationship between the GLP-2 secretion and IS: HOMA-IR correlated with GLP-2 AUC (R = 0.504; p = 0.012), and OGIS correlated with GLP-2 incremental AUC (R = -0.54; p = 0.054). The correlation persisted after controlling for BMI. CONCLUSION: We found an association of GLP-2 secretion and insulin resistance (IR). The understanding of the underlying mechanisms may provide future directions in the pharmacological manipulation of incretins, and in the treatment of obesity and related metabolic disorders.

OBJETIVO: O objetivo deste estudo piloto foi determinar a relação entre a secreção de glugagon like peptide 2 (GLP-2) e a sensibilidade insulínica (SI) em indivíduos obesos. SUJEITOS E MÉTODOS: Vinte e quatro indivíduos obesos [IMC 40.0 ± 3.0 kg/m² (média ± desvio-padrão)] foram incluídos no estudo, sendo 9 homens, com idade de 43 ± 8 anos. Do total, 12 indivíduos tinham diabetes tipo 2, todos tratados somente com antidiabéticos orais. Os sujeitos foram submetidos ao teste de refeição padrão (MTT) para dosagens das curvas: glicose, insulina e GLP-2. A sensibilidade insulínica foi mensurada pelos HOMA-IR e OGIS, obtidos pelos valores do MTT. As correlações lineares e correlações parciais foram obtidas. RESULTADOS: Observou-se uma relação inversa entre a secreção de GLP-2 e SI: HOMA-IR correlacionou-se com GLP-2 AUC (R = 0,504; p = 0,012) e OGIS correlacionou-se com GLP-2 incremental AUC (R = -0,54; p = 0,054). A correlação persistiu controlando o IMC. CONCLUSÃO: Encontramos uma associação entre a secreção de GLP-2 e a resistência insulínica. A compreensão desses mecanismos poderá direcionar o futuro farmacológico da manipulação de incretinas no tratamento da obesidade e das desordens metabólicas.

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.

Resistencia a la insulina e historia familiar de diabetes en niños y adolescentes obesos con acantosis nigricans y sin ella / Insulin resistance and family history of diabetes in obese children and with and without acanthosis nigricans

Introducción: las complicaciones metabólicas más importantes para la morbilidad y mortalidad que se derivan de la obesidad tienen como común denominador la resistencia a la insulina. Objetivo: determinar la existencia de resistencia a la insulina e historia familiar de diabetes en un grupo de niños y adolescentes obesos con y sin acantosis nigricans. Métodos: se estudiaron 46 sujetos obesos con y sin acantosis nigricans (21 varones y 25 hembras), con edades entre 4 y 16 años, procedentes de la consulta de endocrinología del Hospital Pediátrico Docente William Soler, en el período de noviembre de 2006 a febrero de 2007. Se les realizó, además de examen físico y anamnesis, prueba de tolerancia a la glucosa con determinación de glucemia e insulinemia en ayunas y a las 2 h. Se utilizó como criterio de resistencia a la insulina el índice HOMA. Resultados: la mayoría de los pacientes (36 sujetos) presentaron resistencia a la insulina, independientemente de la presencia o no de acantosis nigricans, que no estuvo relacionada con el grado de obesidad ni con el pliegue tricipital de grasa, pero sí con la historia familiar de diabetes tipo 2. La presencia de acantosis nigricans estuvo relacionada con el grado de obesidad. Se encontró un 13 por ciento de pacientes con criterios de prediabetes. Conclusiones: la obesidad y la historia familiar de diabetes tipo 2 en los niños y adolescentes se relacionan con la presencia de resistencia a la insulina, independientemente de la presencia de acantosis nigricans(AU)

Introduction: the more important metabolic complications for morbidity and mortality derived from obesity have in common the insulin resistance. Objective: to determine the insulin resistance and the family history of diabetes in a group of obese children and adolescents with and without acanthosis nigricans. Methods: forty six obese subjects with and without acanthosis nigricans (21 boys and 25 girls) aged between 4 and 16, from the William Soler Teaching Children Hospital were studied from November, 2006 to February, 2007. Also, they underwent a physical examination and anamnesis, a test of glucose tolerance with determination of fasting glycemia and insulinemia and at 12 hours. As criterion of insulin resistance the HOMA index was used. Results: most of patients (36 subjects) had insulin resistance, independently of the acanthosis nigricans presence, which was neither related to the obesity degree nor the fat tricipital fold, but yes to the family history of type 2 diabetes. The presence of acanthosis nigricans was related to the obesity degree. There was a 13 percent of patients with pre-diabetes criteria. Conclusions: the obesity and the family history of type 2 diabetes in children and adolescents were related to presence of insulin resistance, independently of presence of acanthosis nigricans(AU)

Utilidad del índice HOMA-IR con una sola determinación de insulinemia para diagnosticar resistencia insulínica / Usefulness of HOMA-IR index with an only insulinemia determination to diagnose an insulin resistance

Introducción: el índice HOMA-IR es un procedimiento simple, poco invasivo, y que permite, mediante una fórmula validada y bien establecida, precisar un valor numérico expresivo de resistencia insulínica. Calcular el índice HOMA-IR con un solo valor de insulinemia pudiera presentar una mayor variabilidad, lo cual se trata de solucionar con al menos la media de 3 insulinemias, de acuerdo con la fórmula original. En varios estudios es habitual que se realice con una sola determinación de insulinemia. Por esa razón se decidió hacer un estudio en pacientes con diabetes tipo 2 y comparar los resultados en cuanto a sensibilidad y especificidad con una sola determinación de sangre para la insulinemia y glucemia.Objetivo: evaluar la sensibilidad y especificidad de cada una de las determinaciones de insulinemia realizadas cada 5 min contra la media de estas durante la aplicación de la fórmula para el índice HOMA-IR.Métodos: se estudiaron 60 pacientes con diagnóstico de diabetes tipo 2, que acudieron a los servicios de consulta externa y de orientación en el Centro de Atención al Diabético de La Habana. Tenían un tiempo de evolución de la diabetes menor de 5 años como promedio, con predominio en el sobrepeso corporal, fueron captados en un período de 6 meses de forma consecutiva, y se les realizaron determinaciones de insulinemias y glucemias en ayunas mediante trocar y extracción de sangre venosa a los 0,5 y 10 min, para realizarles el cálculo del modelo homeostático de Matthews conocido como HOMA-IR.Resultados: un 88,3 por ciento tenía un HOMA-IR mayor de 3,2. La sensibilidad de una sola muestra de insulinemia, aunque elevada para confirmar el diagnóstico de resistencia insulínica, es variable, y la especificidad de una de las muestras resultó baja con un 14 por ciento. Se aprecia una adecuada concordancia entre los valores predictivos positivos con la sensibilidad y los valores predictivos negativos con la especificidad de la prueba. Conclusiones: una sola determinación de insulinemia para estudiar el HOMA-IR es de utilidad en la práctica diaria, aunque resulta de mucha mayor precisión aplicar la fórmula original para una mejor reproducibilidad(AU)

Introduction: HOMA-IR index is a simple and not much invasive procedure allowing by a validated and well established formula to specify exactly a value expression of insulin resistance. To estimate the HOMA-IR index with an only numerical value of insulinemia could to present a greater variability, something that could be solved with at least the mean of three insulinemias, according to original formula. En some studies it is habitual to perform it with a single insulinemia determination. Thus, we conducted a study in patients presenting type 2 diabetes and to compare the results as regards the sensitivity and specificity with a single blood determination for insulinemia and glycemia. Objectives: to assess the sensitivity and specificity of each of insulinemia determinations performed each 5 min versus the mean of these determinations during the application of formula for HOMA-IR index. Methods: sixty patients diagnosed with type 2 diabetes attended in the Center for Diabetic Care of La Habana were studied. They had a diabetes course time lower than 5 years as average with predominance of body excess weight recruited during 6 months in a consecutive way and the carrying out of fasting insulinemias and glycemias determinations by trocar and venous blood extraction at 0,5 and 10 min for a calculation of Mathews's hemostatic model known as HOMA-IR. Results: a 88,3 percent had a HOMA-IR greater than 3,2. The sensitivity of a single sample of insulinemia, although high to confirm the insulin resistance diagnosis, it is variable and specificity of one of samples was low with a 14%. There is an appropriate concordance among the positive predictor values with sensitivity and the negative predictive values with the test specificity. Conclusions: a single insulinemia determination to study HOMA-IR is useful in daily practice, although it is necessary much accuracy to apply the original formula for a better reproducibility(AU)

High cardiorespiratory fitness is more beneficial in pre-diabetic men than women

OBJECTIVES: To investigate gender-specific relationships between cardiorespiratory fitness and factors that predict the development of diabetes and to identify the risk factors that predict fasting plasma glucose and 2-hour plasma glucose levels. INTRODUCTION: Different risk factors (e.g., low cardiorespiratory fitness) may cause elevated plasma glucose levels in men compared to women. Therefore, gender-specific analyses are needed. METHODS: Cardiorespiratory fitness (maximal power output achieved during a standard cycle ergometry test), resting blood pressure, total serum cholesterol, high-density lipoprotein cholesterol and triglyceride levels were measured in 32 pre-diabetic men (mean age: 57.2 + 6.8 years; mean body mass index (BMI): 28.5 + 3.0 kg/m²) and 40 pre-diabetic women (mean age: 55.0 + 7.3 years, mean BMI: 30.4+5.7 kg/m²). A stepwise regression with backward variable selection was performed to construct models that predict 2-hour and fasting plasma glucose levels. RESULTS: Maximal power output was inversely related to the 2-hour plasma glucose level in the entire group (r= -0.237, p<0.05), but this relationship was significant only for males (r= -0.404, p<0.05). No significant correlation was found between female gender and cardiorespiratory fitness. Age and cardiorespiratory fitness were significant predictors of 2-hour plasma glucose levels in men. High-density lipoprotein cholesterol was predictive of 2-hour plasma glucose levels in women. Triglycerides in women and BMI in men were the only predictors of fasting plasma glucose levels. CONCLUSIONS: These findings may have consequences for the development of gender-specific diabetes prevention programs. Whereas increasing cardiorespiratory fitness should be a key goal for men, improving the lipid profile seems to be more beneficial for women. However, the present results do not negate the positive effects of increasing cardiorespiratory fitness in women.

Trastornos metabólicos asociados con la evolución hacia la diabetes mellitus tipo 2 en una población en riesgo / Metabolic disorders associated with the evolution to type 2 diabetes mellitus in a risk group

INTRODUCCIÓN: el estado clínico y metabólico de la población en riesgo de padecer diabetes mellitus tipo 2 (DM2) es muy heterogéneo. OBJETIVO: identificar los factores que influyen en la progresión hacia la diabetes en los subgrupos de pacientes con distintos tipos y gravedad de los trastornos metabólicos. MÉTODOS: se realizó un estudio prospectivo en 209 sujetos en alto riesgo de progresión hacia la diabetes mellitus tipo 2 (antecedentes de trastornos de la tolerancia a la glucosa sin hiperglucemia en ayunas) para examinar los trastornos metabólicos que se asocian con la progresión hacia la diabetes. Se estudió la tolerancia a la glucosa, la secreción de insulina y la sensibilidad a la insulina al inicio del estudio y 2 años después. RESULTADOS: se encontró que el riesgo de desarrollo de diabetes mellitus dependía significativamente del grado de deterioro de la tolerancia a la glucosa presente en el estudio inicial (tolerancia a la glucosa normal, 10 por ciento; tolerancia a la glucosa alterada, 14,6 por ciento; tolerancia a la glucosa alterada + glucemia en ayunas alterada, 56,7 por ciento). En el grupo con tolerancia a la glucosa normal el factor predictivo fundamental de evolución hacia la diabetes mellitus era la deficiencia de la respuesta insulinosecretora inicial (OR: 8,13; IC de 95 por ciento; 1,83 a 36,0). En los sujetos con tolerancia a la glucosa alterada con glucemia en ayunas alterada y sin esta, el factor determinante era la glucemia en ayunas (OR: 5,41; IC de 95 por ciento; 2,15 a 13,6). La resistencia a la insulina no fue un factor predictivo significativo en ninguno de los subgrupos estudiados. CONCLUSIONES: los trastornos de la glucemia posprandial en las etapas iniciales de la evolución de la diabetes mellitus tipo 2 son inconstantes o reversibles, y no son suficientes para basar su diagnóstico precoz y las actividades preventivas o terapéuticas. La aparición de glucemia en ayunas alterada marca el inicio de una etapa de progresión acelerada hacia la diabetes mellitus tipo 2, por lo que en este grupo es necesario intensificar las medidas para revertir o enlentecer el deterioro metabólico. En el grupo con alto riesgo de diabetes y tolerancia a la glucosa normal, el único factor metabólico identificado como marcador pronóstico de la progresión hacia la diabetes es la baja respuesta insulínica. Se recomienda incorporar la evaluación de la capacidad funcional de la célula beta para la detección precoz de personas en riesgo de padecer diabetes(AU)

INTRODUCTION: The clinical and metabolic state of persons in risk of suffer type 2 diabetes mellitus (DM2) is very heterogeneous. Objetive: to identify the factors influencing in progression to diabetes in subgroups of patients with different types and the severity of metabolic disorders. A prospective study was conducted in 209 subjects in high risk of progression to type 2 diabetes mellitus (backgrounds of disorders related to glucose tolerance without fasting hyperglycemia) to examine the metabolic disorders associating with progression to diabetes. Glucose tolerance, insulin secretion and insulin sensitivity were studied at onset and two years later. RESULTS: we found that the risk to develop diabetes mellitus was in a significant dependence of the deterioration degree of glucose tolerance present in the initial study (normal glucose tolerance, 10 percent; altered glucose tolerance, 14,6 percent; altered glucose tolerance + altered fasting glycemia, 56,7 percent). In the group with a normal glucose tolerance the fundamental predictive factor of evolution to diabetes mellitus was the failure of initial insulin secretory response (OR: 8,13; 95 percent CI; 1,83 to 36,0). In the subjects with altered glucose tolerance with fasting altered glycemia and without it, determinant factor was the fasting glycemia (OR: 5,41; 95 percent CI; 2,15 to 13,6). The insulin resistance was not a significant predictive factor in any study subgroups. CONCLUSIONS: postprandial glycemia disorders in early stages of evolution to type 2 diabetes mellitus are changeable or reversible and insufficient to base its early diagnosis and the preventive or therapeutical activities. Appearance of an altered fasting glycemia is the onset of an accelerated progression stage to type 2 diabetes mellitus, thus, in this group it is necessary to intensify the measures to revert or slow the metabolic deterioration. In group with a high risk of diabetes and a normal glucose tolerance the only metabolic factor identified as a prognostic marker of progression to diabetes is the poor insulin-response. It is recommended to add the assessment of the functional ability of Beta-cell for the early detection of persons in risk of diabetes(AU)

Evaluación de la sensibilidad a la insulina en el síndrome de ovarios poliquísticos / Evaluation of insulin-sensitivity in polycistic ovary syndrome

INTRODUCCIÓN: las mujeres con síndrome de ovarios poliquísticos tienen un aumento del riesgo de padecer resistencia a la insulina, dislipidemia, obesidad, hipertensión arterial y diabetes mellitus tipo 2; por lo tanto, tienen mayor probabilidad de desarrollar enfermedad cardiovascular. OBJETIVO: determinar la frecuencia y características de los trastornos de la sensibilidad a la insulina en un grupo de mujeres con síndrome de ovarios poliquísticos. MÉTODOS: se estudiaron 23 mujeres con este diagnóstico según los criterios de la Androgen Excess Society (AES), a las cuales se les realizaron determinaciones de glucemias e insulinemias basales y durante la prueba de tolerancia a la glucosa endovenosa de muestras múltiples. Se calcularon varios índices matemáticos de sensibilidad a la insulina e insulinorresistencia. RESULTADOS: 65 por ciento de las mujeres tenían insulinorresistencia (índice HOMA-IR ³ 3,22). El análisis del área bajo la curva de insulinemia durante la prueba evidenció que las mujeres con insulinorresistencia tenían insulinemias mayores en estado basal y posestimulación; en ambos grupos las concentraciones fueron similares a las iniciales al final de la prueba. El área glucémica e insulinémica 0-10 y el área total de la insulinemia fueron significativamente mayores en las mujeres con insulinorresistencia. Todos los índices I0/G0, FIRI, ISI, Belfiore, BENNET y QUICKI tuvieron buena correlación con el HOMA-IR. CONCLUSIONES: la frecuencia de insulinorresistencia e hiperinsulinismo en las mujeres con síndrome de ovarios poliquísticos estudiadas fue alta y las estimaciones de insulinorresistencia en estado de ayuno pueden predecir la respuesta durante la estimulación endovenosa con glucosa(AU)

INTRODUCTION: women with polycistic ovary syndrome have a increasing risk of insulin resistance, dyslipidemia, obesity, hypertension and type 2 diabetes mellitus; thus, with higher likelihood to develop cardiovascular disease. OBJECTIVE: to determine the frequency and features of insulin sensitivity disorders in a group of women with polycistic ovary syndrome. METHODS: twenty three women with this diagnosis were studied according to the Androgen Excess Society (AES) criteria,underwent basal glycemia and insulinemia determinations and during frequently sampled intravenous glucose tolerance test). Several insulin sensitivity and insulin resistance mathematic indexes were calculated. RESULTS: sixty-five percent of women had insulin resistance (HOMA-IR ³ 3.22 rate). Analysis of area under the curve of insulin during the test revealed that women with insulin resistance had higher insulinemia rates in baseline state and post-stimulation;in both groups concentrations were similar to the initial ones at the end of test. Glycemia and insulinemia 0-10 areas and insulin area were higher in women with insulin resistance. All indexes including Io/Go, FIRI, ISI, Belfiore, BENNET and QUICKI had a good correlation with HOMA-IR. CONCLUSIONS: insulin resistance and hyperinsulinism frequency in women with policystic ovary syndrome was high and the fasting insulin resistance assessment may to predict the response during the glucose-intravenous stimulation(AU)

Trastornos de la glucemia y de la acción de la insulina en una población de riesgo de diabetes / Glycemia and insulin action disturbances in diabetes-risk population

OBJETIVO: conocer la frecuencia de hiperglucemia y resistencia a la insulina en un grupo de pacientes con riesgo de padecer trastornos del metabolismo de los carbohidratos. MÉTODOS: se realizó un estudio transversal descriptivo en una población del policlínico Reina, se estudiaron 118 pacientes, a los que se les midieron glucemia de ayuno y posprandial, después de una carga oral de glucosa e insulinemia. Se aplicó el índice de HOMA-IR para el cálculo de la insulinorresistencia. RESULTADOS: se obtuvo 5,1 porciento de pacientes con diabetes, todos mayores de 60 años de edad e hipertensos; 25,4 porciento de la muestra mostró algún grado de hiperglucemia en el rango de prediabetes. Los trastornos de la glucemia se incrementaron de manera paralela al aumento de la edad (p= 0,005). La insulinorresistencia fue detectada en 21,2 porciento del total de pacientes incluidos y en 53,8 porciento de los que presentaron algún trastorno del metabolismo hidrocarbonado; resultó aún más relevante en los pacientes con diabetes, en los que afectó a 83,3 porciento (p= 0,001). CONCLUSIONES: los trastornos asociados a la hiperglucemia asintomática y la resistencia a la insulina, asociada a la hiperglucemia, son frecuentes en la práctica clínica cuando se estudian grupos de riesgo de padecer diabetes(AU)

OBJECTIVE: to know the hyperglycemia frequency and resistance to insulin in a group of patients with risk of carbohydrates metabolism disturbances. METHODS: a cross-sectional and descriptive study was conducted in a population from the Reina polyclinic. A total of 118 patients were studied to measure the fast and postprandial glycemia after an oral load of glucose e insulinemia. For insulin-resistance calculus HOMA-IR index was applied. RESULTS: there was a 5.1 percent of diabetic patients aged over 60 and hypertensive; 25.4 percent of sample showed some degree of hyperglycemia in the pre-diabetes rank. Glycemia disturbances increased in a parallel way to age increase (p= 0.005). Insulin-resistance was detected in 21,2 percent of total of included patients and in 53.8 per of those presenting with some hydrocarbon metabolism disturbance being more marked in diabetic patients affecting to 83.3 percent (p= 0.001). CONCLUSIONS: hyperglycemia-associated disturbances and insulin-resistance associated with hyperglycemia are frequent in clinical practice when risk group are studied due to diabetes(AU)

Heterogeneidad de los trastornos metabólicos de las etapas iniciales de la diabetes mellitus 2 / Metabolic disorders and its diversity during early stages of type 2 diabetes mellitus

La prediabetes ha sido definida como una situación de riesgo de padecer diabetes mellitus, que precede a la aparición de las formas clínicas de la enfermedad y es causada por trastornos de la secreción de insulina y de la sensibilidad a la insulina. Es objetivo del trabajo establecer el perfil de trastornos metabólicos de un grupo de sujetos en la etapa subclínica de la diabetes mellitus para identificar subpoblaciones susceptibles a intervenciones específicas. Se utilizó la información obtenida sobre el estado de la tolerancia a la glucosa, de la sensibilidad a la insulina y de la secreción de insulina en el estudio inicial de un grupo de 40 participantes en una investigación prospectiva, a los que, 2 años después, se les diagnosticó una diabetes manifiesta. Los sujetos con diabetes mellitus inicial presentaban un amplio rango de trastornos de la tolerancia a la glucosa (tolerancia a la glucosa normal, 22 por ciento; tolerancia a la glucosa alterada, 35 por ciento; y tolerancia a la glucosa alterada + glucemia en ayunas alterada, 43 por ciento). El 95 por ciento de los obesos y el 50 por ciento de los no obesos presentaban resistencia a la insulina, mientras que se encontró una disminución de la secreción de insulina en el 50 por ciento de los sujetos de ambos grupos. No se encontró asociación entre el grado de deterioro de la tolerancia a la glucosa y los trastornos metabólicos estudiados. Los sujetos en las etapas iniciales de la diabetes constituyen una población heterogénea con distintos grados de deterioro del metabolismo energético, por lo que las intervenciones para prevenir la diabetes en estas personas requieren un diagnóstico y tratamiento personalizado(AU)

The prediabetes has been defined as a risk situation related with the presence of future diabetes, preceding appearance of clinical ways of the disease, and it is provoked by disorders from insulin secretion and the sensitivity to insulin. To establish a metabolic disorders profile from a group of subjects in the diabetes mellitus subclinical stage to identify subpopulations sensitive to specific interventions. To used the information gathered on glucose tolerance stage, on insulin-sensitivity, and on insulin secretion in an initial study of 40 patients participating in a prospective research, which two years later were diagnosed with manifest diabetes. Subjects with initial diabetes mellitus had a wide range of disorders related to a glucose tolerance (tolerance to normal glucose (22 percent), tolerance to altered glucose (35 percent), and tolerance to altered glucose + altered fast glycemia (43 percent). The 95 percent of the obese subjects and the 50 percent of the non-obese ones had a insulin resistance, whereas there was a decrease of insulin secretion in 50 percent of subjects of both groups. There as not a association between deterioration level of tolerance to glucose and study metabolic disorders. Subjects in early stages of diabetes are a heterogeneous population with different levels of energy metabolism deterioration, where interventions to prevent diabetes in these persons need a diagnosis and personalized treatment(AU)