Glucagon Response to Glucose Challenge in Patients with Idiopathic Postprandial Syndrome.

BACKGROUND: Postprandial syndrome is characterized by hunger, weakness, and anxiety neurosis after meals. Although abnormal glucagon response is a suggested mechanism, inaccuracies in conventional glucagon measurement methods have prevented precise analysis. Recently, a more reliable dual-antibody sandwich enzyme-linked immunosorbent assay for glucagon was developed. METHODS: We conducted a 75-g oral glucose tolerance test (OGTT) extending to 4 hours in 14 patients with idiopathic postprandial syndrome. In addition to blood glucose and insulin, glucagon concentration was measured with the novel method and analyzed retrospectively. RESULTS: Median (lower quartile, upper quartile) age and body-mass index were 40 years (30, 49) and 24.9 (23.1, 26.2), respectively. The OGTT revealed that one patient had a diabetic pattern, and two were glucose intolerant. Fasting insulin was 7.6 µU/mL (6.8, 8.8) and reached 73.7 µU/mL (54.3, 82.6) at 30 min. Insulin remained elevated until 180 min. Fasting glucagon was 21.1 pg/mL (16.1, 33.8), reached a nadir of 6.9 (3.5, 10.3) at 60 min, one-third the baseline level, and remained suppressed until 180 min. We observed two types of glucagon dynamics: a lower fasting glucagon with further suppression and a normal or higher fasting glucagon with a subsequent large decrease. CONCLUSIONS: These data suggest that glucagon suppression is greater in patients with idiopathic postprandial syndrome than in previously studied healthy subjects. The present data will contribute to our understanding and future research of this syndrome.

Effects of GLP-1RA and SGLT2i, Alone or in Combination, on Mouse Models of Type 2 Diabetes Representing Different Disease Stages.

Glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-dependent glucose transporter 2 inhibitor (SGLT2i), in addition to lowering glucose, have pleiotropic effects on the heart, kidneys, and liver. These drugs have thus come into widespread use for treating type 2 diabetes (T2DM). However, mechanistic comparisons and effects of combining these drugs have not been adequately studied. Employing diet-induced obese (DIO) mice and db/db mice as models of the early and advanced stages of T2DM, we evaluated effects of single or combined use of liraglutide (a GLP-1RA) and ipragliflozin (a SGLT2i). Treatments with liraglutide and/or ipragliflozin for 28 days improved glycemic control and reduced hepatic lipid accumulation similarly in DIO mice. In contrast, in db/db mice, despite similar favorable effects on fatty liver, liraglutide exerted no beneficial effects on glycemic control. Improved glycemic control in db/db mice treated with ipragliflozin was accompanied by increased pancreatic ß-cell area and insulin content, both of which tended to rise further when ipragliflozin was combined with liraglutide. Our data suggest that liraglutide is more efficient at an earlier stage and ipragliflozin can be effective in both stages. In addition, their combined use is a potential option for treating advanced stage diabetes with fatty liver disease.

Quantitative assessment of people-oriented forestry in Bangladesh: a case study in the Tangail forest division.

Forests represent more than just a livelihood to many people in developing countries. In Bangladesh, for example, overwhelming poverty and socio-economic pressures have resulted in an unstable situation where intensive pressure on forest resources is having increasingly negative consequences for the population. Some studies have evaluated the benefits of people-oriented forestry activities from an investment, as well as a participant, point of view. In the study area located in the Tangail Forest Division, a total of 11,854 ha of woodlot, 2704 ha of agroforestry and 945 km of strip plantations have been raised in a benefit-sharing program that is inclusive of land encroachers and other economically disadvantaged people. Since 2000-2001, a total of 3716 ha of woodlot, 890 ha of agroforestry and 163 km of strip plantations have been harvested to the benefit of 6326 individuals. Investment analysis indicates that woodlot plantation is not financially viable but agroforestry is the most profitable. These results were somewhat unexpected since initial analysis suggested that the woodlot plantation profit would be greater than, or at least equal to, that of the agroforestry plantation if the number of planted seedlings per unit area was taken into account. The per unit area net present value (NPV) was highest in the agroforestry plantation ($1662) and negative in the woodlot plantation (-$397). The benefit cost ratio (BCR) was also highest in the agroforestry plantation (1.64) and lowest in the woodlot plantation (0.86). This study also showed that some individuals who were formally classified as encroachers have now become vital stakeholders. On average, participants received $800, $1866 and $1327 over the course of 13 years from strip, agroforestry and woodlot plantations, respectively. Average annual return per participant was $62, $144 and $102, respectively, which was in addition to each individual's yearly income. This added income is a significant contribution to monetary resources and improves socio-economic conditions at a grass roots level. Overall then this program can be considered a financial success as a plantation raising strategy. However, despite this financial progress, the program cannot be considered a true form of participatory people-oriented forestry because it shows serious deviations from the original concept or model for participatory people-oriented forestry that is outlined in the project document. These discrepancies are especially notable with regard to (i) beneficiary selection, (ii) gender equity, (iii) professional attitude and corruption, (iv) funding and (v) program approach. However, other countries faced with similar challenges of forest overuse and degradation may adopt this practice for achieving self-reliance and environmental stability.