Decreased insulin secretion and insulin sensitivity are associated with liver function in subjects with fasting glucose between 100 and 109 mg/dL in Taiwanese population.

OBJECTIVE: In 2003, the American Diabetes Association recommended that the lower limit for the diagnosis of impaired fasting glucose (IFG) should be reduced from 110 to 100 mg/dL in the analysis of the associated risk factors of IFG. It has been proposed that liver dysfunction may contribute to the development of type 2 diabetes. A primary aim was to investigate the relationship between liver enzyme and insulin resistance (IR) in IFG group. The secondary aim was to investigate IR and beta-cell function assessed by homeostasis model assessment (HOMA-IR and HOMA-%B, respectively) in subjects with fasting plasma glucose (FPG) between 100 and 109 mg/dL. METHODS: We enrolled 284 subjects whose medical history and physical examination required tests to screen for metabolic abnormalities. In addition, we also excluded all factors affecting glucose or insulin metabolism. According to the FPG level, they were divided into the following groups: group A, FPG < 100 mg/dL; group B, FPG = 100 to 109 mg/dL; group C, FPG = 110 to 125 mg/dL. RESULTS: Group B as compared with group A had significant increase of HOMA-IR and decrease of HOMA-%B. Among the whole population, the fasting insulin level, the fasting glucose, HbA1c, HOMA-IR, alanine aminotransferase, gamma-glutamyltranspeptidase, aspartate aminotransferase, and the diastolic blood pressure all increased significantly as the glycemic status progressed, whereas HOMA-%B levels decreased significantly as the glycemic status progressed. The lipid profile, alkaline phosphatase, and systolic blood pressure did not differ significantly among 3 different glycemic classifications. CONCLUSIONS: Study results indicate that, first, there was a significant decrease of insulin sensitivity and insulin secretion in subjects with fasting glucose from 100 to 109 mg/dL compared with subjects with normal fasting glucose. Second, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltranspeptidase were associated with IR as the glycemic status progressed in the IFG group.

Subacute thyroiditis following influenza vaccine (Vaxigrip) in a young female.

Subacute thyroiditis (SAT), also called de Quervain thyroiditis or granulomatous thyroiditis, is a self-limiting, possibly viral, and inflammatory thyroid disorder that is usually associated with thyroid pain and systemic symptoms. This report details a case of SAT possibly associated with influenza vaccine (Vaxigrip) in a young female. The diagnosis, therapeutic management and outcome are discussed.

Emphysematous cystitis, a rare complication of urinary tract infection in a male diabetic patient: a case report.

Emphysematous cystitis is a rare complication of urinary tract infection, characterized by spontaneous gas formation in the urinary bladder due to bacterial fermentation. Approximately 50 to 80% of patients with this disease are diabetic, and there is a higher incidence in females. We report a case of emphysematous cystitis in a diabetic male who was admitted under the impressions of hypoglycemia, acute bronchitis, and chronic renal failure. Treatment of the emphysematous cystitis consisted of adequate urinary drainage, empirical antibiotic therapy, and strict blood sugar control. The patient recovered satisfactorily after 9 days of hospitalization.

Carney complex, a familial Cushing's syndrome due to primary pigmented nodular adrenocortical disease: a case report.

A 45-year-old woman with adrenocorticotropin (ACTH)-independent hypercortisolism, diabetes mellitus, and hypertension had undergone left adrenalectomy for ACTH-independent Cushing's syndrome 20 years prior to this presentation. There was cushingoid appearance 1 year after surgery. However, Cushing's syndrome recurred; ACTH-independent Cushing's syndrome was diagnosed and abdominal computerized tomography showed a right adrenal tumor, which was removed. Histology revealed primary pigmented nodular adrenocortical disease (PPNAD). The patient had also undergone hysterectomy for uterine masses diagnosed as uterine myxoma. Right breast and neck skin masses were also found, both of which were removed and diagnosed as mammary myxoid fibroadenoma and cutaneous myxoma. She had a homozygotic twin sister who also had Cushing's syndrome and had undergone bilateral adrenalectomy 13 years previously with a pathologic diagnosis of PPNAD. The twin sister also had skin, breast, and uterine masses, all of which were resected. The pathologic results were the same as this patient's. According to the clinical presentations, histologic findings, and positive family history, familial PPNAD (Carney complex) was diagnosed.