Association between sarcopenia and erectile dysfunction in males with type II diabetes mellitus.

BACKGROUND: The prevalence rates for both sarcopenia and erectile dysfunction (ED) gradually increase in middle-aged and elderly diabetic male population and they impair physical functioning, sexual functioning, and quality of life. The aim of the present study was to evaluate the sarcopenia in patients with diabetic ED. METHODS: The study included 98 male patients with type II diabetes mellitus (DM) aged 18-80 years. Blood chemistry and hormone levels were obtained. The International Index of Erectile Function (IIEF-5) questionnaire was administered to the patients. The patients were divided into three groups according to the IIEF-5 score; a score of 5-10 points indicated severe ED, a score of 11-20 indicated moderate ED, and a score of 21-25 points indicated no ED. The muscle mass, handgrip strength, timed up and go test, upper mid-arm circumference, calf circumference, and body mass index were obtained. The statistical analysis was performed using MedCalc Statistical Software version 12.7.7. All parameters were compared between the three groups. RESULTS: Of 98 patients included in the study, 84 patients had severe sarcopenia, 13 had moderate sarcopenia, while only one patient had normal muscle mass. The mean age was 56.59 ± 11.46 years. When patients were divided into three groups according to IIEF-5 score, 38 had severe ED, 39 had moderate ED, and 21 had no ED. There was a significant difference between the three groups in terms of handgrip strength, timed up and go test scores, upper mid-arm circumference, and calf circumference (p < .05 for all). CONCLUSIONS: Although muscle mass remains unchanged, muscle strength and physical performance decrease in diabetic ED patients. Diabetic patients with severe and moderate ED have lower muscle strength and physical performance.

Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus.

BACKGROUND: 25-(OH) vitamin D (VD) deficiency has been described as potential risk factor for the development of diabetes in many epidemiological studies. 25-(OH) VD deficiency and insulin resistance associated with this deficiency are common findings in patients with type 2 diabetes mellitus. The objective of this study is to evaluate the relationship between 25-(OH) VD levels and microalbuminuria. METHODS: The patients with type 2 diabetes mellitus aged between 40 and 65 years, who were admitted to the diabetes outpatient clinics of our hospital, were evaluated in two different groups. The first group consisted of 119 patients with insufficient 25-(OH) VD levels (10-30 ng/mL) and the second group consisted of 121 patients with 25-(OH) VD deficiency (≤10 ng/mL). The relationship between 25-(OH) VD levels and the level of microalbuminuria was evaluated in the two groups. RESULTS: The mean 25-(OH) VD level was 11.5 ng/mL and the mean HbA1c level was 9.1%. When the patient groups were evaluated according to 25-(OH) VD levels, HbA1c values were significantly higher in patients with a 25-(OH) VD level of 10 ng/mL or lower (p = .039). 25-(OH) VD levels were not significantly different between patients with different stages of renal failure (p = .119), whereas the level of microalbuminuria was significantly different (p = .030). CONCLUSIONS: This study found that the level of microalbuminuria was significantly higher in patients with 25-(OH) vitamin D deficiency compared to patients with 25-(OH) VD insufficiency.

Evaluation of protein C and protein S levels in patients with diabetes mellitus receiving therapy with statins and ACE inhibitors or angiotensin II receptor blockers.

AIMS: To evaluate protein C, protein S level in patients with diabetes mellitus receiving statin and ACE inhibitor/ARB therapy. METHODS: 95 patients were included in the study and divided into four groups depending on the use of statin and ACE inhibitor/ARB therapy. Group 1 comprised of patients receiving statin therapy (n = 15), Group 2 comprised of patients receiving ACE inhibitor/ARB therapy (n = 31), Group 3 comprised of patients receiving statin and ACE inhibitor/ARB therapy (n = 23), and Group 4 comprised of patients who did not receive either statin or ACE inhibitor/ARB therapy (n = 26). These four groups were compared with respect to protein C, protein S, fibrinogen, D-dimer, INR, and aPTT levels. RESULTS: There were statistically significant differences with respect to protein C levels. Group 1 and group 2 had higher protein C levels compared with group 4. (p < .01). Similarly, Group 3 had higher protein C levels compared with group 4. (p < .01). There was no significant difference between the groups with respect to protein S, INR, aPTT, and D-dimer levels. CONCLUSIONS: Diabetic patients receiving statin or ACE inhibitor/ARB therapy had higher protein C levels. Use of statin and ACE inhibitor/ARB therapy in diabetic patients decrease hypercoagulability and therefore could reduce the occurrence of cardiovascular events.

The relation of protein C and protein S levels with cardiovascular risk in patients with diabetic neuropathy.

BACKGROUND: This study was conducted to determine the clinically significance of protein C and protein S levels as a cardiovascular risk marker in patients with diabetic neuropathy. METHODS: We included 71 subjects. 50 of them were diabetics, 27 of them also had diabetic neuropathy(DN), 21 subjects were non diabetic. We evaluated these 3 group subjects' protein C, protein S, fibrinogen, prothrombine time (PT), activated partial thromboplastine time (aPTT), total cholesterol, levels and Framingham Coronary Risk Score (FCRS). RESULTS: Non diabetic group's protein C levels were higher than patients with DN (p<0.05) and diabetic patients without DN (p<0.05). But there were no difference in terms of protein C levels between patients with DN and diabetic patients without DN. FCRS of control group was lower than diabetic subjects(p<0.01). CONCLUSIONS: We found that protein C and S levels were much lower in diabetic patients than non diabetics.There was no difference between diabetic patients with DN and diabetic patients without DN in terms of protein C and protein S levels. Further, we couldn't detect any finding that we can say protein C and Protein S levels can be used as a cardiovascular risk assessment marker in diabetic neuropathic patients.

Functional and nutritional state in elderly men with compensated hypogonadism.

OBJECTIVES: There are few data investigating the relationship between compensated hypogonadism and functional and nutritional status of elderly individuals. Impairment of functional and nutritional status of elderly men with compensated hypogonadism needs to be investigated. In this study, we tried to evaluate the association of functional and nutritional status with testosterone and LH levels in elderly with compensated hypogonadism. DESIGN: A cross-sectional study was performed. SETTING: A total of 1124 patients older than 70 years were screened. PARTICIPANTS: A total of 250 patients (patient group) with compensated hypogonadism and 250 subjects (control group) with normal hormone levels were allocated in the study. MEASUREMENTS: All parameters were compared in patient and control groups. The correlations between hormone levels and activities of daily living (ADL), instrumental activities of daily living (IADL), Mini Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and Geriatric Depression Scale (GDS) were evaluated. RESULTS: ADL, IADL, MMSE, and MNA scores were significantly lower in the patient group. Testosterone and LH levels were correlated with ADL (R = 0.221 and R = -0.262), IADL (R = 0.210 and R = -0.277), MMSE (R = 0.331 and R = -0.341), MNA (R = 0.211 and R = -0.297), and GDS (R = -0.214 and R = -0.211) in the patient group independently from age and body mass index. CONCLUSIONS: Our study showed that geriatric men with compensated hypogonadism had worse functionality, cognitive function, nutritional status, and mood compared with healthy controls.

Plasma viscosity in patients with metabolic syndrome.

BACKGROUND AND AIM: Plasma viscosity, which is affected by plasma lipid and protein composition, is a hemorheological parameter accepted as an early cardiovascular risk factor. In this study we aimed to investigate the alterations in plasma viscosity in patients with metabolic syndrome since both are early predictors of CVD. MATERIAL AND METHODS: A total number of 70 patients aged between 25-55 years with the diagnosis of metabolic syndrome according to IDF 2005 criteria and 32 age and sex matched healthy subjects were allocated consecutively in the study. Body mass index (BMI), arterial blood pressure, blood glucose, total cholesterol, HDL and triglyceride levels were measured and plasma viscosity was measured. The results of patients with MS and healthy subjects were compared. Correlation between components of the Metabolic Syndrome and plasma viscosity was assessed. RESULTS: BMI, systolic and diastolic blood pressure, waist circumference, serum lipid and glucose levels and plasma viscosity levels were higher in patient group (p < 0.001). A positive correlation was determined between plasma viscosity and waist circumference, hypertension and serum lipid levels (r = 0.401, p = 0.003). CONCLUSION: Plasma viscosity is increased in patients with metabolic syndrome and it is associated with waist circumference, hypertension and plasma lipid levels.

Evaluation of various insulin sensitivity indices in lean idiopathic hirsutism patients.

Hirsutism is characterized by excessive growth of terminal hair in a male pattern. Idiopathic hirsutism (IH) is a common cause of hirsutism. Since there are few data demonstrating IH is associated with insulin resistance, we tried to assess various insulin sensitivity indices in lean IH and compare with healthy subjects. A cross-sectional study was performed in 71 lean (BMI between 20-25 kg/m(2)) women (17-39 years old), 31 with IH and 40 healthy individuals. Blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), hepatic insulin sensitivity (ISI (HOMA)), Quicky index, reciprocal fasting insulin resistance index, fasting Belfiore index, and fasting glucose/insulin ration (GIR) were estimated using a single fasting sample of glucose and insulin levels. Raynaud indices calculated using the mathematical estimation in a single fasting sample of insulin levels were determined and compared in two groups. Fasting insulin, Raynaud index, HOMA-IR and Fasting insulin resistance index (FIRI) results were higher in IH group than in controls (p<0.01, for all). Fasting Belfiore index, QUICKI index, ISI(HOMA) and FIRI(-1) results were lower in IH group than in controls (p<0.01, for all). Our study showed that lean IH patients were more insulin resistant than healthy subjects. We propose that insulin sensitivity indices are useful methods for measuring insulin resistance in IH.

The investigation of insulin resistance and metabolic syndrome in male patients with early-onset androgenetic alopecia.

Epidemiological studies have shown that diseases associated with insulin resistance and coronary artery disease are more frequently observed in men with androgenetic alopecia (AGA). We aimed to identify the presence of insulin resistance and metabolic syndrome in male patients with early-onset AGA. Fifty male patients (18-30 years) with AGA stage ≥ 3 (Hamilton-Norwood scale), body mass index < 27 and 40 weight- and age-matched male subjects were the study population. The weight, height, and waist circumference of all patients was measured. Levels of fasting glucose, insulin, and lipids were evaluated and oral glucose tolerance tests undertaken. Insulin resistance was analyzed through various indices and the presence of metabolic syndrome was assessed. Values of diastolic blood pressure and total cholesterol were significantly higher in the AGA group. Among insulin indices, only HOMA insulin resistance (HOMA-IR) and fasting insulin resistance index (FIRI) were higher in the AGA group. Given the criteria for metabolic syndrome, no significant differences were observed between the two groups. Although not supported by the other indices, high scores of HOMA-IR and FIRI suggest that male patients with early onset-AGA have insulin resistance. These data may raise awareness in susceptible individuals that lifestyle changes in the early period of life can reduce the risk of insulin resistance.

The presence of insulin resistance and comparison of various insulin sensivity indices in women with androgenetic alopecia.

We aimed to identify the association of female androgenetic alopecia with insulin resistance and to evaluate various simple insulin sensitivity indices and beta cell function in women with androgenetic alopecia (AGA). A cross-sectional study was performed in 66 non-obese women (24-44 years old), 41 with AGA alone and 25 healthy individuals. Blood glucose, insulin, c-peptide levels, oral glucose tolerance test (OGTT); insulin sensitivity and beta cell function indices derived from a single blood sample and OGTT were determined and compared in the two groups. Women with AGA had impaired glucose tolerance (IGT) rates of 12.5%. In the control group IGT was 0%. Fasting glucose, c-peptide, insulin were higher in AGA group. When the indices were evaluated, Raynaud index, FIRI and HOMA-IR results found to be higher in the AGA group than in controls (p < 0.05, for all). Fasting insulin(-1), GIR, FIRI(-1), QUICKY index, ISI HOMA, HOMA-IS results were lower in AGAs than in controls (p < 0.05, for all). Our study showed that women with AGA alone were more insulin resistant than healthy subjects. We suggest that beta cell function and insulin sensitivity indices are useful methods for measuring insulin resistance in AGAs, and HOMA-IR is a good predictor of insulin resistance. We propose that OGTT should be applied in women with AGA.

After myocardial infarction carvedilol improves insulin resistance compared to metoprolol.

PRINCIPLES: Both carvedilol and metoprolol have cardioprotective effects and decrease infarct size in myocardium. We compared effects of carvedilol and metoprolol on insulin resistance and serum lipid levels after myocardial infarction. METHODS: Fifty-nine patients aged between 30 and 70 and BMI = 25-30 kg/m2, who were diagnosed with myocardial infarction with ST segment elevation, were considered to be eligible for the study. Patients were randomly allocated to two different therapy protocols. Metoprolol 100 mg bid or carvedilol 25 mg bid was added to their standardized therapy regimen. Baseline to week 4 and 12, fasting blood glucose, serum lipid profile, BMI, C-peptide, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were measured. RESULTS: After 12 weeks of metoprolol therapy HOMA-IR, insulin and C-peptide levels were significantly higher (p < 0.05 for all) and total cholesterol and triglyceride levels decreased significantly (p < 0.05 for all) compared to baseline. After 12 weeks of carvedilol therapy HOMA-IR, insulin and C-peptide (p < 0.05 for all), total cholesterol and triglyceride (p = 0.001 for all) decreased significantly compared to baseline. Carvedilol provided more decrease in total cholesterol and LDL levels than metoprolol (p = 0.043 and p = 0.021, respectively). CONCLUSIONS: In patients after myocardial infarction, carvedilol added to background therapy improved insulin resistance and lipid profile.

The effect of dual PPAR alpha/gamma stimulation with combination of rosiglitazone and fenofibrate on metabolic parameters in type 2 diabetic patients.

We assessed the additive effect of dual peroxisome proliferators activated receptors (PPAR) alpha/gamma induction, achieved by the addition of fenofibrate to rosiglitazone, on metabolic control and diabetic dyslipidemia. Fourty type 2 diabetic patients with poor metabolic control who were taking oral antidiabetic agents and/or insulin were included in the study. Patients received 4 mg of rosiglitazone per day for 12 weeks. Later, 200mg of fenofibrate per day was added to the therapy regimen for another 12 weeks. HbA1c, uric acid, serum lipid profile and body mass index (BMI) were assessed at the start and at the 12th and the 24th weeks of the study. BMI values at the 12th and the 24th weeks of the study increased significantly (p<0.01) while for HbA1c levels there was a reduction at the 12th and the 24th weeks of 11% (p<0.001) and 13% (p<0.002), respectively. The change in HbA1c levels after the addition of fenofibrate to the rosiglitazone therapy was not statistically significant. The change in LDL levels with rosiglitazone at the 12th week was not statistically significant while the addition of fenofibrate to rosiglitazone decreased mean LDL levels from 126.8+/-29.6 mg/dL to 106.7+/-26.7 mg/dL (p<0.001). The mean percent reduction in triglyceride levels at the 12th and the 24th weeks were 19% and 33%, respectively (p<0.001). HDL levels increased from 44.59 mg/dL to 50.14 mg/dL (p<0.001) at week 12. A further increase of 16% (p<0.001) was observed after the addition of fenofibrate to rosiglitazone. In type 2 diabetic patients dual PPAR alpha/gamma stimulation by means of concomitant administration of rosiglitazone and fenofibrate improves the atherogenic dyslipidemic profile of these patients with good tolerability.

Reactive hypoglycemia in lean young women with PCOS and correlations with insulin sensitivity and with beta cell function.

Reactive hypoglycemia (RH), which is a postprandial hypoglycemic state, occurs within 2-5 h after food intake. It is classified as idiopathic, alimentary, or diabetic reactive hypoglycemia. We studied the incidence of reactive hypoglycemia and looked for any correlations between it and the presence of insulin sensitivity and/or beta cell function in young lean polycystic ovary syndrome (PCOS) patients. This study was designed as a cross-sectional study in 64 lean young women with PCOS (BMI < or = 25 kg/m2). Various indices of insulin sensitivity and beta cell function derived from the oral glucose tolerance test (OGTT) results were used. We found the rate of RH to be 50% in lean young women with PCOS. DHEA-S and PRL levels were found to be lower in subjects with RH (P < 0.05 and P > 0.05, respectively). Beta cell function indices such as the insulinogenic index (at 120 min), CIR (at 120 min) and HOMA beta cell index were found to be insignificantly higher in the RH group than the nonreactive hypoglycemia (NRH) group. The 4 h glucose level, but not the 3 h glucose level, was significantly correlated with insulin resistance indices, such as fasting insulin level, HOMA-IR, Quicky index, and FIRI in the RH group. Significantly decreased DHEA-S levels were an interesting finding. In conclusion, there is an urgent need to investigate RH in lean young women with PCOS. Our results indicate that more definite insulin resistance occurs in subjects with RH in the fourth hour of the OGTT than those with RH in the third hour. In addition, RH in the fourth hour together with a low DHEA-S level may be predictive of future diabetes in young women with PCOS even when they are not obese.

Comparison of lunch and bedtime NPH insulin plus mealtime insulin Lispro therapy with premeal regular insulin plus bedtime NPH insulin therapy in type 2 diabetes.

AIM: Nonfasting plasma glucose is claimed to be a better marker of diabetic control than fasting plasma glucose in type 2 diabetes. In this study we compared the efficacy and safety profile of two different intensive insulin treatment strategies in patients with uncontrolled type 2 diabetes despite using a twice-daily insulin regimen. METHODS: We studied 60 insulin-treated patients who had uncontrolled type 2 diabetes. The study was a 6-month, open-label, randomised, parallel clinical trial conducted in two diabetes centres. The main end-points for analysis were weekly self-monitored blood glucose readings, HbA1c levels, total daily insulin dose, weight gain and the number of hypoglycaemic episodes. RESULTS: The breakfast 2-h, lunch 2-h and dinner 2-h postprandial glucose values and pre-dinner glucose values were significantly lower in the Lispro group than the regular insulin group. The HbA1c value at the end of the study was significantly lower in the Lispro group (7.3 +/- 0.7%) compared with the regular insulin group (7.7 +/- 0.7%; P<0.05). Mean insulin doses were similar in the treatment groups initially and at the end. There was a statistically significant increase in insulin dose in both groups from baseline to the end of the study (P<0.05). Overall hypoglycaemia rates were comparably low and similar in both groups during the study. CONCLUSIONS: We have shown that mealtime insulin Lispro plus additional lunch and bedtime NPH insulin is superior to premeal regular insulin plus bedtime NPH insulin for overall glycaemic regulation with similar weight gain and comparable rates of hypoglycaemia.

Phenytoin-induced toxic cholestatic hepatitis in a patient with skin lesions: case report.

Phenytoin is a highly effective and widely prescribed anticonvulsant agent, but it can be associated with dose-related side effects and hypersensitivity reactions. We present a case of phenytoin-induced cholestatic hepatotoxicity in a 47-year-old woman who had exfoliative dermatitis, an increase in liver enzymes with a cholestatic pattern, and eosinophilia after 25 days of phenytoin therapy. The diagnostic workup showed no other possible causes, and the results of a percutaneous liver biopsy were consistent with drug-induced toxic hepatitis. Within 3 weeks after discontinuing phenytoin therapy, her liver function tests returned to normal values.