Insulin secretion and sensitivity as determinants of HbA1c in type 2 diabetes.

BACKGROUND: Defects in insulin secretion and sensitivity, two major determinants of glycaemic control, can occur and progress or not in parallel. The present study was designed to compare the respective roles of both determinants on HbA1c, in type 2 diabetic patients, according to whether or not residual beta-cell function was stimulated with insulin secretagogues. MATERIALS AND METHODS: Insulin secretion and insulin sensitivity were both estimated using the homeostasis model assessment (HOMA). HbA1c, insulin sensitivity (HOMA2%S) and insulin secretion (HOMA2%B) were determined in 289 noninsulin-using type 2 diabetic patients who were further divided into two groups according to treatment: metformin alone (group I, n = 57) or metformin and glyburide (group II, n = 232). The patients of both groups were further divided into three subsets in order to test the dependence of HbA1c on HOMA2%B and HOMA2%S. RESULTS: In group I mean HbA1c were greater (8.4%) in patients with HOMA2%B < 50% than in the two subsets with HOMA2%B > or = 50%: 7.2 and 6.8% (P = 0.0013). In group II mean values of stimulated-insulin secretion (HOMA2%B) were lesser (40.7 and 30.1%) in the two subsets of patients with HbA1c > or = 8% than in patients with HbA1c < 8%: 55.1% (P < 0.0001). By contrast, we found no differences in both groups with HOMA2%S. A stepwise multiple regression showed that HOMA2%B contributed to HbA1c more than HOMA2%S both in groups I (33.5% vs. 23.4%) and II (22.7% vs. 8%). CONCLUSIONS: Although the role of insulin sensitivity is not negligible, insulin secretion appears to be the major determinant of diabetic control in overt type 2 diabetic patients who are treated with metformin alone or with a two-drug therapy combining metformin and glyburide.

Primary prevention of cardiovascular events and type 2 diabetes: should we prioritize our interventions?

The diagnosis of type 2 diabetes is based on elevated blood glucose levels. However, in most individuals, metabolic abnormalities as well as cardiovascular risk factors co-exist with a significant proportion of patients presenting with elevated blood pressure, high triglycerides and decreased HDL-cholesterol in addition to hyperglycemia. The risk of cardiovascular disease in people with type 2 diabetes is very high as cardiovascular death represents the number 1 killer in this population. An integrated approach controlling all risk factors as well as blood glucose has been demonstrated to effectively reduce the risk of cardiovascular complications. However, this requires the administration of multiple medications and some patients will have difficulties adhering to the prescribed regimen, limiting the number of drugs the physician can prescribe. In this review, we will summarize the efficacy of different approaches in primary prevention to help practitioners prioritize interventions in these situations.

Obesity management: attitudes and practices of French general practitioners in a region of France.

OBJECTIVES: To document the attitudes and practices of French general practitioners (GPs) regarding obesity management. RESEARCH METHODS AND PROCEDURES: A cross-sectional survey of a randomly selected sample of 744 French GPs was conducted, of which 607 questionnaires were returned. The measures included views on weight management, definitions of success, approaches to and strategies recommended for weight management and prevention, problems, frustrations, and expectations in managing obesity. RESULTS: GPs have a high awareness of obesity as a medically relevant issue, with 90% of them considering it to be a disease. However, they are only 42% to consider themselves well prepared to manage obesity and 51% to find obesity management professionally rewarding. They are 66% to believe that only a small percentage of patients can lose weight and maintain that loss but have unrealistic goals, with only 20% of them considering weight maintenance as a success. They do not consider collaboration with other health professionals like dietitians as a priority. Only 34% of the GPs believe that the currently available drugs are effective. Their views regarding bariatric surgery are in agreement with the recommendations of international experts. Their main expectations regarding obesity management are to improve their professional intervention through formation, education and easy-to-use tools, rather than improving their collaboration with other health professionals. DISCUSSION: There remains considerable opportunity to improve GPs' practice in obesity management. Medical education, increased cooperation with dietitians, improved long-term follow-up, and implementing better use of the available documents are key issues.