The effects of early short-term insulin treatment vs. glimepiride on beta cell function in newly diagnosed type 2 diabetes with HbA1c above 9.

BACKGROUND: Type 2 diabetes mellitus (T2D) is a complex metabolic impairment. Beta cell (BC) failure is the most challenging among its pathogenetic mechanisms. Recognizing reversible contributors to BC failure could guide individualized approach to early T2D treatment. The aim of this study was to compare early short-term insulin treatment vs. glimepiride, both added to metformin, on BC function, glycemic and lipid control, during 12-month follow-up. METHODS: Eighty newly diagnosed T2D patients, 30-65 years of age, presenting with HbA1c ≥ 9% were enrolled in the study. They were randomly assigned to single-month initial insulin therapy (INS) added to metformin, or to glimepiride and metformin (OAD) as only treatment. Subjects assigned to initial insulin intervention were thereafter switched to OAD. C-peptide (C-Pep) was analyzed at baseline and 2 hours after standardized test meal (STM). All subjects were STM-retested after 3 and 12 months. HbA1c, serum lipids, BMI, HOMA IR, and HOMA B were assessed over follow-up. RESULTS: HbA1c was lower in INS vs OAD at 3-months: 6.26 ± 0.18% vs 6.78 ± 0.10% (p = 0.016), remaining so by 12 months (p =0.056). BMI-adjusted ΔC-Pep was greater in INS vs. OAD at 3 months (4.60 ± 0.59 vs. 3.21 ± 0.34 m2 /kg; p = 0.044), persisting by 12months (4.57 ± 0.56 vs. 3.04 ± 0.34 m2/kg; p = 0.023). Average ΔC-Pep improvement from recruitment to 3 months was 100.8% in INS,vs. 51.3% in OAD. Prevalence of STM-ΔC-Pep response greater than 2.4 ng/mL had risen 3.2-fold by 12 months in the INS, vs. 2.4-fold only in the OAD group (p = 0.018). DISCUSSION: Early short-term insulin intervention in newly diagnosed T2D improves beta cell function more than glimepiride, both added to metformin, resulting in a superior and longer lasting glycemic and lipid control.

Risk Factors for Coronary Artery Calcifications in Overweight or Obese Persons with Prediabetes: Can They Predict T2 Diabetes and Coronary Vascular Events?

BACKGROUND: It is difficult to predict the risk of developing atherosclerotic cardiovascular disease in subjects with prediabetes and obesity. The aim of this study was to assess risk factors for coronary artery calcifications (CACs) and the development of type 2 diabetes (T2D) and coronary vascular events (CVEs) after 7 years in 100 overweight or obese persons with prediabetes, according to the baseline coronary artery calcium score (CACS). METHODS: Lipids, HbA1c, uric acid, and creatinine were assessed. Glucose, insulin, and c-peptide were determined during an oral glucose tolerance test. Multi-sliced computerized tomography with evaluation of CACS was performed. After 7 years, the subjects were assessed for T2D/CVE. RESULTS: CACs were present in 59 subjects. No single biochemical marker could predict presence of a CAC. After 7 years, T2D developed in 55 subjects (61.8% initially had both IFG and IGT). A gain in weight was the only contributing factor for T2D. Nineteen subjects developed a CVE; increased initial clustering of HOMA-IR > 1.9, LDL > 2.6, and mmol/Land TGL > 1.7 mmol/L and higher CACS were present in that group. CONCLUSIONS: No risk factors for CACs could be identified. A gain in weight is associated with T2D development, as are higher CACS and clustering of high LDL+TGL+HOMA-IR with CVEs.

Smart Dimmable LED Lighting Systems.

This paper proposes energy-efficient solutions for the smart light-emitting diode (LED) lighting system, which provides minimal energy consumption while simultaneously satisfying illuminance requirements of the users in a typical office space. In addition to artificial light from dimmable LED lamps, natural daylight coming from external sources, such as windows, is considered as a source of illumination in an indoor environment. In order to reduce total energy consumption, the smart LED system has the possibility to dim LED lamps, resulting in reduced LED output power. Additionally, various LED lamps' functionality, such as semi-angle of the half illuminance and LED tilting, are introduced as an additional parameter to be optimized to achieve greater energy saving of the designed system. In order to properly exploit external lighting, the idea to reduce overall daylight intensity at a users' location is realized by the option to dim the windows with a shading factor. Based on the users' requirements for a minimal and desired level of illumination, the proposed optimization problems can be solved by implementing different optimization algorithms. The obtained solutions are able to give instructions to a smart LED system to manage and control system parameters (LEDs dimming levels, semi-angles of the half illuminance, orientation of LEDs, the shading factor) in order to design total illumination, which ensures minimal energy consumption and users' satisfaction related to illuminance requirements.

Outage capacity of FSO link with pointing errors and link blockage.

In this paper, we analyze the outage capacity performance of free-space optical (FSO) systems. More precisely, taking the stochastic temporary blockage of the laser beam, atmospheric turbulence, misalignment between transmitter laser and receiver photodiode and path loss into account, we derive novel accurate analytical expressions for the outage capacity. The intensity fluctuations of the received signal are modeled by a Gamma-Gamma distribution with parameters directly related to the wide range of atmospheric conditions. The analytical results are validated by Monte Carlo simulations. Furthermore, when the intensity fluctuations are caused only by atmospheric turbulence, derived expressions are reduced to the simpler forms already presented in literature. The numerical and simulation results show that the link blockage causes appearance of the outage floor that is a significant energetic characteristic of an FSO system. The results also show that there exists an optimal value of the laser beam radius at the waist for minimizing outage probability in order to achieve the specified outage capacity. This optimal value depends on atmospheric turbulence strength and standard deviation of pointing errors, but it is also strongly dependent on the probability of link blockage.

The effect of combination therapy of insulin glargine, metformin, and sitagliptin on insulin secretion, insulin resistance, and metabolic parameters in obese subjects with type 2 diabetes.

Introduction: A combination of drugs is required for treatment of obese subjects with diabetes, due to multiple pathogenic mechanisms implicated in the development of both diabetes and obesity. Objective: Assessment of the effect of sitagliptin added to insulin glargine and metformin, in obese subjects with type 2 diabetes. Methods: A total of 23 obese subjects on metformin and insulin glargine participated in the study. Titration of insulin glargine during a one-month period preceded the addition of 100 mg of sitagliptin daily. Body mass index, waist circumference, fasting, and prandial glucose were measured monthly, lipids and hemoglobin A1c (HbA1c) every three months, insulin, c-peptide and glucagon at the start and after six months of treatment. Homeostatic models for insulin secretion (HOMA B) and insulin resistance (HOMA IR) were calculated. Results: Participants were 58.65 ± 7.62 years of age with a body mass index of 35.06 ± 5.15 kg/m², waist circumference of 115.04 ± 15.5 cm, and the duration of diabetes of 4.11 ± 2.57 years. With the titration of insulin glargine, target fasting glucose levels were not achieved. Waist circumference and body mass index decreased during three months of sitagliptin treatment, thereafter remaining stable. HbA1c decreased significantly after three and six months of therapy. C-peptide increased significantly, while glucagon level fell. HOMA indexes were unchanged. Conclusion: Sitagliptin can improve diabetes control and induce modest weight loss in obese subjects poorly controlled on insulin glargine and metformin. Titration of insulin glargine to optimal fasting glucose values is a prerequisite of success of this combination therapy.

Determination of ibuprofen in combined dosage forms and cream by direct UV spectrophotometry after solid-phase extraction.

Solid-phase extraction method followed by direct UV spectrophotometry at 264 nm was developed and applied for the selective ibuprofen determination in two-component formulation of ibuprofen and pseudoephedrine-HCl, combined powder which contains ibuprofen in the form of salt with L-arginine and 10% ibuprofen cream. Procedures for ibuprofen determination in complex pharmaceutical preparations by direct UV spectrophotometry lack selectivity because of interferences of other active substances and fat components. A limited number of spectrophotometric methods applicable to these samples are based on derivative (first and second-order) UV spectroscopy. Common HPLC procedures are more selective but more expensive and for creams also require some type of extraction because the large amount of oily excipients would clog up the column. The proposed solid-phase extraction method proved to be suitable for analysis of ibuprofen in combined tablets, powders and creams by direct UV spectrophotometry. Also the method provides an effective clean-up of the cream and allows ibuprofen determination by HPLC analysis. For the extraction three different commercial sorbents were tested: anion exchange Oasis MAX, hydrophilic-lipophilic balanced Oasis HLB and reverse-phase Chromabond C18ec. The optimization of the SPE method was first done on standard ibuprofen solutions and then the suitability of the method was checked on solutions of commercial pharmaceutical samples. The method yields good results for all three types of commercial preparations on the anion-exchange Oasis MAX cartridges, with recoveries of 90-100.2%. The interferences in UV analysis were not registered and good precision (RSD < 6%) was obtained. The present method has been verified as accurate as the reference HPLC with the great advantage of less expensive instrumentation. For this reason, the method would be suitable for a routine and rapid drug quality control.