A 12-wk follow-up study to evaluate the effects of mixing insulin lispro and insulin glargine in young individuals with type 1 diabetes.

OBJECTIVE: This study was performed to compare in real-life conditions the serum profile of insulin lispro (IL) after a subcutaneous (SC) injection, separate and mixed with insulin glargine (IG), using a sensitive radioimmunoassay for the specific determination of serum IL, and to evaluate the 12-wk effect of the mixture on glycemic control in young individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS: The IL serum profiles were evaluated in 10 individuals with type 1 diabetes [age 21.9 ± 3.8 yr; diabetes duration 13.4 ± 4.9 yr; body mass index 25.1 ± 3.2 kg/m2; hemoglobin A1c (HbA1c) 8.3 ± 0.8%] during a mixed meal test (MMT) using IL and IG as separate (baseline) and mixed injection. The glycemic variability by continuous glucose monitoring system (CGMS) and the long-term diabetes control with HbA1c were also evaluated at baseline and after 12 wk mixing the two insulins. RESULTS: The mixture of IL with IG decreased IL maximum serum concentration (Cmax(IL) ) (29.4 ± 5.1 µU/mL vs. 13.7 ± 4.2 µU/mL; p = 0.03) without changing the time to reach the Cmax (Tmax(IL) ), the IL area under the curve (AUC(IL) (0-240) ), and the glucose dynamics during the MMT. The glucose variability and the HbA1c were equivalent to baseline after 12 wk mixing both insulins. CONCLUSIONS: These data suggest that mixing IL with IG immediately before the SC injection decreases IL serum peak concentration without affecting the glycemic profile after 12 wk in this group with type 1 diabetes mellitus.

Aerobic exercise capacity and pulmonary function in athletes with and without type 1 diabetes.

OBJECTIVE: To compare the aerobic exercise capacity and pulmonary function between athletes with and without type 1 diabetes. RESEARCH DESIGN AND METHODS: Fifty-one adult age-matched individuals were assessed in random order to the maximum volume of O(2) consumption (Vo(2 peak max)) (ml/kg/min), anaerobic threshold (ml/kg/min), peak pulmonary ventilation (Ve), heart rate (beats per min), time to exhaustion (min), forced vital capacity (FEV) (%), forced expiratory volume in the first second (FEV1) (%), total lung capacity (TLC) (%), and lung diffusion capacity for carbon monoxide (DL(CO)) (%). Individuals were 27 with type 1 diabetes: 15 athletes (ADM) and 12 nonathletes (NADM); and 24 healthy individuals: 12 ADM and 12 NADM. Duration of diabetes was 14.6 ± 6.2 and 15.2 ± 6.7 years in ADM and NADM, respectively. RESULTS: Vo(2 peak) (max) was higher in ADM than in NADM (P < 0.001). The anaerobic threshold was lower in subjects with type 1 diabetes than in control subjects (P < 0.001). FEV1 was lower in ADM than in other groups (NADM, athletes control, and nonathletes control, P < 0.001). CONCLUSIONS: Aerobic capacity in subjects with type 1 diabetes with programmed exercise is similar to the capacity of normal athletes despite lower anaerobic threshold and FEV1.

Growth hormone replacement improves thyroxine biological effects: implications for management of central hypothyroidism.

CONTEXT: The biological significance of GH-induced changes in serum TH concentrations is unknown. It has been suggested that serum free T(4) (FT(4)) should be targeted at the high-normal range during GH replacement. OBJECTIVE: Our objective was to evaluate the effects of GH replacement on T(4) biological effects. HYPOTHESIS: If GH modulates thyroxine biological effects, serum FT(4) should be targeted accordingly. DESIGN AND SETTING: We conducted observational (study 1) and interventional (studies 2 and 3)/outpatient studies. PATIENTS: Thirty-two GH-deficient patients (13 off GH; 22 on l-T(4)) participated in the study. INTERVENTIONS: In study 2, levothyroxine was administered to increase FT(4) (>1.0 ng/dl). In study 3, GH was administered or withdrawn. MAIN OUTCOME MEASURES: We measured FT(4), total T(3) (TT(3)), myocardial isovolumic contraction time (ICT), and resting energy expenditure (REE). RESULTS: In study 1, off-GH and on-GH groups had similar FT(4), but off GH showed lower TT(3) (P < 0.01) and REE (P = 0.02), higher ICT (P < 0.05) than on-GH and controls. On GH, ICT and REE correlated only with TT(3) (r = -0.48; r = 0.58; P < 0.05). Off GH, ICT correlated only with FT(4) (P < 0.01). In study 2, off GH, levothyroxine intervention increased FT(4) (P = 0.005) and TT(3) (P = 0.012), decreased ICT (P = 0.006), and increased REE (P = 0.013); ICT and FT(4) changes correlated (r = -0.72; P = 0.06). On GH, levothyroxine increased FT(4) (P = 0.0002), TT(3) (P = 0.014), and REE (P = 0.10) and decreased ICT (P = 0.049); REE and TT(3) changes correlated (r = 0.60; P = 0.05). In study 3, GH decreased FT(4), increased TT(3), decreased ICT, and increased REE (P < 0.05). REE correlated (P < 0.05) with IGF-I (r = 0.57) and TT(3) (r = 0.64). ICT correlated only with TT(3) (r = -0.46). CONCLUSIONS: GH replacement improves the biological effects of T(4). Serum FT(4) should be targeted at the high-normal range in GH-deficient patients only off GH replacement.

Early subclinical limited axial and large joint flexibility in type 1 diabetes mellitus adolescents.

OBJECTIVE: The objective of this study was to compare the axial and large joint mobility in adolescents with and without type 1 diabetes mellitus (DM1). PATIENT AND METHODS: To check this relationship, 72 DM1 adolescents aged 9-20 years were admitted into the trial and compared with 46 healthy control subjects aged 10-18 years. The youths were compared with regard to anthropometrics (age, proportion female/male, weight, height, and BMI) data. The years from DM1 diagnosis and HbA(1c) (index) were 4.9 +/- 3.6 years and 1.40 +/- 0.39%, respectively. The values of the tests of flexibility of the movements of cervical joint, the abduction of scapular, wrist and back-lumbar joints and abduction of lame-femoral were obtained through the Fleximeter. RESULTS: The DM1 patients and controls did not differ regarding age (DM1 median 16, range 9-20 years vs. controls 16, range 10-18 years) and BMI (DM1 mean+/-S.D. 21.49 +/- 3.69 kg/m(2) vs. controls 20.76 +/- 2.81 kg/m(2)). The scapular, back-lumbar, and lame-femoral flexibility were, respectively, significantly lower (P < .001) in DM1 adolescents (175 +/- 8 degrees , 107 +/- 4 degrees , 66 +/- 10 degrees) compared with controls (189 +/- 13, 116 +/- 14, 76 +/- 12), but the cervical joint mobility was the same in both groups (DM1: 98 +/- l2 degrees vs. control: 101 +/- 13 degrees). CONCLUSION: Thus, the results of our study show a subclinical limited axial and large joint mobility in DM1 adolescents. Future prospective studies are needed to ascertain whether the joint limitations found in these DM1 adolescents will persist into adulthood and play a role in the development of other diabetic complications.