Metabolic syndrome components in Indian migrants with type 2 diabetes. A matched comparative study.

OBJECTIVE: To study the metabolic syndrome (MS) in Indian subjects with type 2 diabetes (T2D) in comparing them with controls from the Indian community and from the general population. METHOD: An adapted definition of MS by the Third report of the National Cholesterol Education Program's Adult Treatment Panel III was used. We defined three groups matched for sex and age (+/-5 years). Non parametric tests for comparison of matched samples and conditional logistic regression were used. RESULTS: We selected 71 Indians with T2D (group 1) and two control groups with fasting blood glucose<6.1 mmol/L: 71 Indians (group 2) and 213 subjects from the general population (group 3). Patients were 24 to 76 years-old and each group contained 56% men. Globally, MS was identified in 77% of the group 1 when diabetes was taken into account. When diabetes was excluded there were 47% of MS in group 1, 18% in group 2 and 16% in group 3. The clusters of four factors (hypertension, large waist circumference, hypertriglyceridemia and Low HDL-C) were more common in Indians. The most frequent factors were hypertriglyceridemia and large waist circumference in Indians. Indians with T2D had a 5-fold higher risk of MS than the general population group, OR (95% CI): 4.93 (2.71 - 8.97); P<0.001. CONCLUSION: The high frequency of MS and of hypertriglyceridemia in Indians with T2D highlights the need for screening and management of MS in this population facing a high cardiovascular risk.

[Survival analysis of diabetic patients on dialysis in Guadeloupe]. / Survie des patients diabétiques dialysés en Guadeloupe.

BACKGROUND: Both diabetes and hypertension, two conditions that can lead to renal failure, have a high prevalence in Guadeloupe. OBJECTIVE: To determine the clinical and epidemiological features of diabetic patients on end stage renal failure and to evaluate their survival. PATIENTS AND METHOD: Data of the Guadeloupe Kidney registry were analysed for patients who began chronic dialysis during 1978-1997. Follow up information on survival status was obtained up to January 26(th) 1999. Cox proportional hazard analysis was used to determine the relative risk (RR) of death between levels of independant variables. RESULTS: There were 784 dialysis patients of whom 174 (22%) were diabetics. Among the latter, there were 97 women (55,7%), mean age at the start of dialysis was 60.6 years (range 26-83) and arterial hypertension was present before the start of dialysis in 67% of them. Median survival MS (95%CI) was significantly lower in diabetics 42 months (31-52) than in non diabetics 83 months (70-96), p<10(-4). In diabetics, the cumulative probability of survival was 83% (1 year) and 39% (5 years) and the RR of death (95% CI) were 1.90 (1.10-3.22) and 3.43 (2.00-5.87) for diabetics admitted in dialysis in age-class 55-64 years and 65-83 years, respectively, when that for age-class 54 years was set at 1. 00. The RR for diabetics was 1.67 (1.33-2.10) relative to non diabetics. CONCLUSION: Prospective studies are warranted to describe the role of comorbid conditions in diabetic patients survival. Prevention of degenerative complications should be a priority in this population.

Metformin improved insulin resistance in type I, insulin-dependent, diabetic patients.

The biguanides have been shown to reduce insulin requirements in type I (insulin-dependent) diabetic patients with an increase in insulin binding to insulin receptors. The aim of this was to measure the effect of metformin (850 mg/twice daily) on insulin sensitivity. Ten type I diabetic patients of normal weight received metformin or placebo in addition to their insulin therapy for seven days. On the last day of metformin or placebo treatment, tissue sensitivity was measured by the euglycemic hyperinsulinaemic clamp procedure using the artificial pancreas. An 18% improvement in glucose uptake was observed after metformin therapy (P less than 0.01). Metformin was therefore effective in improving the insulin action in type I diabetic patients, although its use in such circumstances requires consideration of several other factors.