Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin.

BACKGROUND: Hyperhomocysteinemia and vitamin B12 deficiency may be involved in the development of diabetic peripheral neuropathy (DPN). Metformin therapy may reduce vitamin B12 plasma levels, thus contributing to DPN. AIM AND METHODS: The purposes of this cross-sectional study were to assess (1) the potential associations of DPN with serum levels of homocysteine (tHcy), B-vitamins, and/or the common methylenetetrahydrofolate reductase (MTHFR) C677T mutation; (2) the influence of chronic treatment with metformin on tHcy and B-vitamins concentrations and, finally, (3) to evaluate whether, by this influence, metformin is a risk factor for DPN in a group of type 2 diabetic outpatients. RESULTS: Our data showed that fasting tHcy, folate, and vitamin B12 levels and the MTHFR C677T genotype distribution were comparable between subjects with (n = 79, 30 %) and without DPN (n = 184, 70 %). Metformin-treated subjects (n = 124, 47 %) showed significantly lower levels of vitamin B12 (P < 0.001), but the prevalence of DPN was not different when compared to those not treated with this drug (33 vs. 27 %, P = NS). At univariate regression analysis, DPN was associated with age, duration of diabetes, HbA1c, creatinine levels, and the presence of coronary heart disease (CHD), and negatively with HDL-C concentrations (P < 0.05 all), but at multivariate regression analysis, high creatinine levels (P = 0.06), low HDL-C levels (P = 0.013), and a higher prevalence of CHD (P = 0.001) were the only variables independently associated with DPN in this population. CONCLUSIONS: In conclusion, in these type 2 diabetic outpatients circulating levels of tHcy, folate, and the MTHFR C677T mutation are not associated with DPN, which was predicted by creatinine levels, CHD, and dyslipidemia. Metformin therapy is associated with a mild vitamin B12 level reduction, but not with DPN.

Twelve-month treatment with Liraglutide ameliorates Visceral Adiposity Index and common cardiovascular risk factors in type 2 diabetes outpatients.

AIM: In addition to the effects on glycemic control and body weight, GLP-1 receptor agonists may favorably affect other major cardiovascular disease (CVD) risk factors, although currently available data are still sparse. In this retrospective study, we evaluated the effects of 12-month treatment with liraglutide on major CVD risk factors in 115 type 2 diabetes outpatients (60 men and 55 women), on stable hypoglycemic, anti-hypertensive and/or lipid-lowering therapy. METHODS: Clinical and anthropometric data, metabolic and lipid profile, as well as the Visceral Adiposity Index (VAI), an obesity-related CVD risk factor, were measured in all participants at baseline and after 12-month treatment. RESULTS: Treatment with liraglutide was associated with a significant reduction from baseline values of fasting blood glucose (-42.1 mg/dl, P < 0.05), HbA1c (-1.5 %, -17 mmol/mol, P < 0.05), body weight (-7.1 kg, P < 0.05), waist circumference (-6.8 cm, P < 0.001), total-cholesterol (-27.4 mg/dl, P < 0.05), LDL-cholesterol (-25.4 mg/dl, P < 0.05), triglycerides (-56.1 mg/dl, P < 0.05), and non-HDL-C (-36.6 mg/dl, P < 0.05) and an increase of HDL-cholesterol concentrations (+9.3 mg/dl, P < 0.001), a significant reduction in both systolic and diastolic blood pressure (-14.7 mmHg, P < 0.001 and -9.0 mmHg, P < 0.05, respectively) and a decrease of VAI values (-1.6, P < 0.001). All these differences were independent of changes in BMI and comparable in men and women. CONCLUSIONS: In conclusion, 12-month treatment with liraglutide in add-on to on-going hypoglycemic therapy significantly ameliorates all major CVD risk factors and reduces cardiometabolic risk, as estimated by VAI values.

Transmission of Trichosporon asahii oesophagitis by a contaminated endoscope.

Two cases of oesophageal trichosporonosis due to a suspected nosocomial infection are reported. Both the patients were immunocompetent and had undergone an endoscopic examination on the same day. Six strains of Trichosporon were isolated: three strains from the oesophageal biopsy of the first patient, one strain from the endoscopic forceps, one from the air in the endoscopy room, and one from the oesophageal biopsy of the second patient. The nosocomial nature of the infection and the role of the endoscopic forceps in transporting the micro-organism was suspected, but the morphology and physiology of the isolated strains did not confirm such hypothesis. To elucidate the nature of the infection and the genetic similarities of the strains isolated, all strains were typed with RFLPs of the rDNA fragment and with RAPD. The results of RAPD using primer (GTG)5 (GACA)4, M13 core sequence, and the 15-mer oligonucleotide GAGGGTGGXGGXTCT indicated the molecular identity of three strains supporting the hypothesis concerning a transport of the aetiological agent from the first patient to the second and that the carrier was the forceps of the endoscopic device.

Computed tomography visceral adipose tissue volume measurements of Italians. Predictive equations.

OBJECTIVES: To evaluate total visceral adipose tissue (AT) volumes in relation to single slices of visceral AT area measured at different levels and to other simple anthropometric measurements. DESIGN: Only outpatients examined in a metabolic unit were considered; subjects without conditions known to affect AT distribution who gave their informed consent were recruited. SETTING: All subjects were hospitalized in the Department of Internal Medicine of the University of Messina. SUBJECTS: 90 adult subjects of which 18 men and 42 pre- and 30 post-menopausal women. Ages ranged from 18 to 69 years and body mass indexes ranged from 22 to 50. INTERVENTIONS: The AT volume was calculated by computed tomography from the AT area of five scans and from the distances between these scans. RESULTS: AT area at the level of the 2nd-3rd lumbar vertebra had by itself the highest predictive power in men (s.e. = 6.8%), in post-menopausal women (s.e. = 7.4%) and, together with age, in pre-menopausal women (s.e. = 14%). Of the non-radiological parameters it was waist circumference, together with age, which showed the highest predictive power in men (s.e. = 21%), pre-menopausal women (s.e. = 25%) and, together with height, in post-menopausal women (s.e. = 33%). CONCLUSIONS: A single scan measurement at the lumbar level was confirmed to be representative of total visceral AT volume. Waist circumference was the non-radiological parameter that best correlated with volume.

Gastric infection by Helicobacter pylori and antral gastritis in hyperglycemic obese and in diabetic subjects.

The aim of this work was to ascertain if diabetes and obesity can affect gastric colonization by Helicobacter pylori. 59 hospitalized subjects with dyspepsia and endoscopic antral gastritis were selected. They were divided into three groups: I) 13 patients with normal body weight and without disease other than gastritis (control group); II) 15 patients with essential obesity of whom 10 had impaired glucose tolerance (IGT); III) 31 patients with type II diabetes mellitus, of whom 14 were obese. Three gastric biopsies were obtained from each patient for histologic examination and H. pylori detection by means of rapid urea test, culture and histological evidence of Helicobacter-Like Organisms (HLO). Age, sex, blood glucose, cholesterol, triglycerides, HDL-cholesterol, basal gastrine, duration of illness, body weight were statistically analysed. Differences between the three groups were not statistically significant. There was a higher prevalence of H. pylori infection both in obese and in diabetic patients with respect to control subjects. Prevalence became still higher in obese patients with impaired glucose tolerance. Among the three tests used for the detection of H. pylori, culture and rapid urea were reliable and specific, while the histologic test was highly sensitive but barely specific. Our data suggest that both obesity and type II diabetes may be associated with an increased incidence of H. pylori-colonization. This could be related to the reduced gastric motility observed in both pathologies and chemical changes in gastric mucosa following non-enzymatic glycosylation processes.

Correlation between urinary activity of N-acetyl-beta-D-glucosaminidase (NAG) and albumin excretion rate in type II (non-insulin-dependent) diabetic subjects.

Different kidney diseases are often associated with high urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), a lysosomal enzyme involved in the breakdown of glycoproteins, whose activity is also increased in diabetic patients with poor metabolic control or vascular complications. In order to evaluate the relationship between renal function and urinary NAG levels in diabetes mellitus, 30 type II diabetic patients without evidence of kidney disease and 18 control subjects were studied. In each subject 24-h urinary excretion rates of NAG (fluorimetric method), albumin and beta 2-microglobulin (radioimmunoassay), together with 51Cr-EDTA clearance were performed. In diabetic patients urinary levels of NAG (356 +/- 25 vs 162 +/- 9.2 nmol/h/mg creatinine, p less than 0.0001) and albumin (21 +/- 2.5 vs 4.3 +/- 0.5 mg/24h, p less than 0.0001) were significantly higher than in the controls, while beta 2-microglobulin levels and 51Cr-EDTA clearance did not differ in the two groups. Moreover in diabetic patients NAG and albumin levels were positively and significantly correlated (r = 0.63, p less than 0.001). These results suggest that urinary NAG excretion rate may be altered early in diabetic patients with apparently normal renal function; its diagnostic value seems to be similar to that of the albumin excretion rate.

Serum activity of beta-N-acetylglucosaminidase in obese hyperinsulinemic subjects.

We have measured serum activity of beta-N-acetylglucosaminidase (NAG, fluorimetric method) in some groups of obese subjects with similar degrees of overweight but with different insulin secretion and glucose tolerance (GT) during OGTT. In the control group (35 normal subjects, mean body weight 102% of ideal body weight, normal GT) NAG was 282 +/- 77 nmol S/h/ml; in group I (11 subjects, body weight 149%, normal GT and insulin levels) NAG was 304 +/- 55; in group II (19 subjects, body weight 142%, normal GT and high insulin levels) NAG was 453 +/- 90 (p less than 0.001 vs group I and controls); in group III (14 subjects, body weight 154%, impaired GT and high insulin levels) NAG was 481 +/- 108 (p less than 0.005 vs group I and controls); in group IV (16 subjects, body weight 153%, diabetic GT and high insulin levels) NAG was 657 +/- 109 (p less than 0.001 vs other groups). Moreover in the whole series NAG levels and insulin areas, but not NAG levels and degree of overweight, were significantly correlated (r=0.46, p less than 0.001). These data show that hyperinsulinism (especially when there is also pathological glucose tolerance) can positively affect NAG levels, probably through altered glycoprotein turnover, of which NAG serum levels are a sensitive indicator.

Serum and urinary activities of beta-N-acetylglucosaminidase and beta-glucuronidase in diabetic patients.

Serum and urinary activities of two acid glycohydrolases, beta-n-acetyl-glucosaminidase and beta-glucuronidase, were significantly higher in a group of diabetic patients when compared to a control group. No significant differences were found between patients without vascular complications and those with retinopathy and/or large vessel disease, while the highest enzyme levels were present in diabetics in poor metabolic control. In diabetics with nephropathy, urinary excretion of both enzymes was further increased, so that the serum/urine activity ratio (greater than 1 in normal subjects and in diabetics without nephropathy) was inverted (less than 1). These data seem to show that the high activity of these enzymes, commonly observed in diabetes mellitus, is related to the illness rather than to its vascular complications, being higher in patients in poor metabolic control. Furthermore serum/urine activity ratio may be a useful indicator in the monitoring of diabetic nephropathy.

[Calcium and endocrine pancreas secretion. I. Effects of an infusion of calcium on plasma levels of insulin and glucagon]. / Calcio e secrezione endocrina pancreatica. -I) Effetti di una infusione di calcio sui livelli plasmatici di insulina e glucagone.

The authors have investigated the behaviour of IRI, IRG and blood glucose levels during a calcium infusion (15 mg/Kg body weight per 90') and during an equivalent saline infusion, in normal subjects. No evident differences were observed between the two infusions; only a slight but not significant decrease of glucagon levels appeared during calcium administration. Further experiences are clearly required, especially during alpha and beta cells stimulation, to better elucidate relationships between calcium and pancreatic endocrine secretion "in vivo".