Detrimental Effects of Energy Drink Consumption on Platelet and Endothelial Function

Background

Energy drink consumption has been anecdotally linked with sudden cardiac death and, more recently, myocardial infarction. As myocardial infarction is strongly associated with both platelet and endothelial dysfunction, we tested the hypothesis that energy drink consumption alters platelet and endothelial function.

Methods

Fifty healthy volunteers (34 male, aged 22 ± 2 years) participated in the study. Platelet aggregation and endothelial function were tested before, and 1 hour after, the consumption of 250 mL (1 can) of a sugar-free energy drink. Platelet function was assessed by adenosine diphosphate-induced (1 μmol/L) optical aggregometry in platelet-rich plasma. Endothelial function was assessed via changes in peripheral arterial tonometry and expressed as the reactive hyperemia index (RHI).

Results

Compared with baseline values, there was a significant increase in platelet aggregation following energy drink consumption, while no change was observed with control (13.7 ± 3.7% vs 0.3 ± 0.8% aggregation, respectively, P <.01). Similarly, RHI decreased following energy drink consumption (−0.33 ± 0.13 vs 0.07 ± 0.12 RHI [control], P <.05). Mean arterial pressure significantly increased following energy drink consumption, compared with control (P <.05). Heart rate was unaffected by energy drink consumption.

Conclusion

Energy drink consumption acutely increases platelet aggregation and decreases endothelial function in healthy young adults.     

High-intensity aerobic training improves endothelium-dependent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus

Background

The aim of this study is to compare the effect of physical exercise program on the endothelial function of patients with metabolic syndrome and type 2 diabetes mellitus.

Methods

Patients were randomized for high intensity aerobic training (HI: 80% maximum heart rate, n = 10), low intensity aerobic training (LI: 55% of maximum heart rate, n = 10) and control (n = 11). Before and after 6 weeks of training, subjects performed the maximal exercise test and a study of the endothelial function, through a high resolution ultrasound of the brachial artery, which was assessed after reactive hyperemia (endothelium dependent vasodilation) and nitrate administration (endothelium independent vasodilation).

Results

A total of 31 patients with metabolic syndrome and type 2 diabetes mellitus were studied, with mean age of 58 ± 6 years, The percentage diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (HI before 2.52 ± 2.85% and after 31.81 ± 12.21%; LI before 3.23 ± 3.52% and after 20.61 ± 7.76%; controls before 3.56 ± 2.33% and after 2.43 ± 2.14%; p < 0.05).

Conclusions

High intensity aerobic training improved the functional capability and endothelium dependent vasodilator response, but it does not improve the endothelium independent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus.     

One-week and 6-month cardiovascular magnetic resonance outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction

Introduction and objectives

Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction.

Methods

Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007-2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated.

Results

At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29 ± 15 vs. 29 ± 17%, P = .9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index (P > .2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6% in pharmacoinvasive strategy and 7% in primary angioplasty patients (P = .7).

Conclusions

A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty.Full English text available from:www.revespcardiol.org     

Acute effect of oral vitamin C on coronary circulation in young healthy smokers

Background

Recent studies suggest that smokers' coronary endothelial function is impaired because of increased oxidative stress, and their coronary flow velocity reserve (CFVR) is reduced. It is uncertain whether oral antioxidant vitamin C restores impaired CFVR in smokers. Recent technological advances in transthoracic Doppler echocardiography (TTDE) have resulted in the successful measurement of coronary flow velocity and noninvasive CFVR assessment.

Methods

We studied 13 healthy young male smokers and 12 nonsmokers. Coronary flow velocities in the left anterior descending coronary artery (LAD) were recorded with TTDE at rest and during hyperemia induced with intravenous infusion of adenosine triphosphate (ATP). CFVR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFVR and plasma concentrations of vitamin C were assessed at baseline and 2 and 4 hours after oral intake (2 g).

Results

Heart rate and blood pressure responses to ATP infusion were not affected by oral vitamin C, but plasma concentrations of vitamin C increased to physiological levels in both groups. CFVR was significantly higher in nonsmokers than in smokers at baseline (4.3 ± 0.4 vs 3.8 ± 0.8, P <.05). After oral vitamin C, it was increased significantly in smokers (3.8 ± 0.8 to 4.5 ± 0.7, P <.005, 4.5 ± 0.8, P <.005, respectively), but not in nonsmokers (4.3 ± 0.4 to 4.3 ± 0.3, 4.4 ± 0.7).

Conclusions

This study demonstrated that oral vitamin C restores coronary microcirculatory function and impaired CFVR against oxidative stress in smokers.     

Acute angiotensin II receptor blockade improves insulin-induced microvascular function in hypertensive individuals

Objective

An effect of insulin that is crucial for stimulating glucose uptake is its ability to increase the number of perfused capillaries, and thereby enhance its own delivery, and that of glucose, to muscle cells. To unravel possible mechanisms involved in the insulin-sensitizing effects of angiotensin II receptor blockers (ARBs) in hypertensive individuals we investigated the effect of single-dose ARB administration on insulin-mediated microvascular perfusion in hypertensive individuals.

Methods

We examined the effects of ARB administration on hyperinsulinemia-associated capillary density by measuring baseline skin capillary density, capillary density during reactive hyperemia (hyperemic capillary recruitment), and capillary density during venous congestion in 17 hypertensive individuals in the basal state, during a hyperinsulinemic euglycemic clamp, and during a hyperinsulinemic clamp with acute ARB administration (600 mg irbesartan), acute calcium channel blockade (CCB; 10 mg felodipine ER), as a control for the reduction in blood pressure, or placebo. In addition, insulin sensitivity and blood pressure were measured.

Results

Compared to the basal state, hyperinsulinemia increased baseline capillary density (57.3 ± 6.8 vs. 60.3 ± 7.9 n/mm², P < 0.01), but not hyperemic capillary recruitment. ARB and CCB treatment induced similar blood pressure reductions. Compared to placebo, ARB, but not CCB, increased hyperinsulinemia-associated baseline capillary density (+ 2.3 ± 3.4 (P = 0.02) and − 0.4 ± 4.4 n/mm², respectively). Hyperinsulinemia-associated hyperemic capillary recruitment was not altered by either treatment. Compared to placebo, neither ARB nor CCB treatment enhanced insulin sensitivity.

Conclusions

Acute ARB administration increases insulin-induced microvascular perfusion in mildly hypertensive individuals; this beneficial effect on microvascular perfusion was however not associated with increased insulin-mediated glucose uptake.     

Oestradiol supplement minimises coronary occlusion-induced myocardial infarction and ventricular dysfunction in oophorectomised female rats

Background

Endogenous oestrogen deficiency after menopause is associated with high risk of acute cardiac events and the protection of exogenous oestrogen supplements remains uncertain. This study investigates whether oestrogen therapy protects the heart from ischemic injury in oophorectomised rats.

Methods

Sexually mature female Sprague-Dawley rats (6 for each group) with bilateral oophorectomy underwent selective ligation (occlusion) of left coronary artery for 4 weeks. 17β-oestradiol (E2) supplements (10 μg, i.m., every other day) were started before (preventive-therapeutic supplement) or after coronary occlusion (therapeutic supplement).

Results

In oophorectomised rats plasma levels of E2 declined from 1301 ± 80 to 196 ± 48 pmol/L (p < 0.01) and cardiac expression of oestrogen receptors (ER) decreased by ∼ 60%. E2 supplements recovered the ER expression. Selective ligation of left coronary led myocardial infarction in the left ventricle, with an increase in plasma cardiac troponin I (cTn-I), decrease in systolic blood pressure (SBP), and reduction of left ventricular pressures. Preventive-therapeutic but not therapeutic E2 supplement reduced cTn-I levels (from 21.9 ± 2.0 to 6.0 ± 0.3 ng/mL, p < 0.01), minimised infarction (from 37.0 ± 1.2% to 18.1 ± 2.3%, p < 0.05), increased SBP (from 82 ± 4.2 to 97 ± 4.4 mm Hg, p < 0.05), and improved left ventricular end pressures in the oophorectomised rats following coronary occlusion.

Conclusion

Postmenopausal (ooporectomised) oestrogen supplement commenced before establishment of myocardial ischemia minimises myocardial infarction and ventricular dysfunction following the coronary artery occlusion. Cellular and molecular mechanisms underlying the cardiac protection of oestrogen therapy remain unclear, in which activation of cardiac ER expression and increasing in circulating CD90⁺ stem cells may be involved.     

Artificially sweetened versus regular mixers increase gastric emptying and alcohol absorption

Background

Mixed alcoholic drinks are increasingly being consumed in “diet” varieties, which could potentially empty more rapidly from the stomach and thereby increase the rate of alcohol absorption when compared with “regular” versions containing sugar.

Methods

We studied 8 healthy males twice in randomized order. On each day, they consumed an orange-flavored vodka beverage (30 g ethanol in 600 mL), made with either “regular” mixer containing sucrose (total 478 kcal), or “diet” mixer (225 kcal).

Results

Gastric half-emptying time measured by ultrasound (mean ± standard deviation) was less for the “diet” than the “regular” drink (21.1 ± 9.5 vs 36.3 ± 15.3 minutes, P <.01). Both the peak blood ethanol concentration (0.053 ± 0.006 vs 0.034 ± 0.008 g%, P <.001) and the area under the blood ethanol concentration curve between 0 and 180 minutes (5.2 ± 0.7 vs 3.2 ± 0.7 units, P <.001) were greater with the “diet” drink.

Conclusions

Substitution of artificial sweeteners for sucrose in mixed alcoholic beverages may have a marked effect on the rate of gastric emptying and the blood alcohol response.     

Melatonin reduces night blood pressure in patients with nocturnal hypertension

Purpose

Nocturnal hypertension is associated with a high risk of morbidity and mortality. A blunted nocturnal surge in melatonin excretion has been described in nondipping hypertensive patients. We therefore studied the potency of melatonin to reduce nighttime blood pressure (BP) in treated hypertensive patients with nocturnal hypertension.

Patients and Methods

Thirty-eight treated hypertensive patients (22 males, mean age 64 ± 11 years) with confirmed nocturnal hypertension (mean nighttime systolic BP >125 mm Hg), according to repeated 24-hour ambulatory blood pressure monitoring (ABPM), were randomized in a double-blind fashion to receive either controlled release (CR)-melatonin 2 mg or placebo 2 hours before bedtime for 4 weeks. A 24-hour ABPM was then performed.

Results

Melatonin treatment reduced nocturnal systolic BP significantly from 136 ± 9 to 130 ± 10 mm Hg (P = .011), and diastolic BP from 72 ± 11 to 69 ± 9 mm Hg (P = .002), whereas placebo had no effect on nocturnal BP. The reduction in nocturnal systolic BP was significantly greater with melatonin than with placebo (P = .01), and was most prominent between 2:00 am and 5:00 am (P = .002).

Conclusions

Evening CR-melatonin 2 mg treatment for 4 weeks significantly reduced nocturnal systolic BP in patients with nocturnal hypertension. Thus, an addition of melatonin 2 mg at night to stable antihypertensive treatment may improve nocturnal BP control in treated patients with nocturnal hypertension.     

Prediction of improvement in left ventricular function during a 1-year follow-up after acute myocardial infarction by the degree of acute resolution of electrocardiographic changes

Background and Purpose

Reperfusion therapy results in better left ventricle (LV) function in cases of successful myocardial reperfusion; however, insufficient reperfusion or reocclusion of the infarct-related artery is associated with LV dysfunction. This study was proposed to determine whether the rate of ECG stage dynamics, after mechanical, thrombolytic, or spontaneous recanalization, is a predictor of improvement in LV function.

Methods

Twenty-seven consecutive patients, observed for 1 year, were divided into group A (11, change rate of ≥2 ECG stages per 2 days), group B (13, no rapid change), and cases with reocclusion (3).

Results

Clinical and radiographic signs of heart failure tended to decrease in group A but tended to increase in other cases. Echocardiographic dyssynergic score decreased, and LV ejection fraction increased only in group A: 4.3 ± 1.2 vs 2.7 ± 1.5, P = .04, and 42.0 ± 4.8 vs 46.0 ± 8.3, P = .049, respectively; in group B, the values were 3.4 ± 2.4 vs 3.4 ± 2.2 and 44.0 ± 6.9 vs 43.8 ± 9.3, respectively.

Conclusions

Rapid ECG stage changes predict follow-up improvement in LV function.     

« Paradoxe des fumeurs » et stratégie de reperfusion à la phase aiguë de l’infarctus du myocarde

Previous studies have shown that smokers with acute myocardial infarction (AMI) treated by thrombolysis have lower mortality rates than nonsmokers, a phenomenon often termed “smoker's paradox”. This “smoker's paradox” has been rarely studied in case of primary angioplasty.

Aim of the study

To evaluate the impact of smoking status on the early mortality of patients admitted with AMI with regard to the strategy of reperfusion (intravenous thrombolysis versus primary angioplasty).

Patients and methods

Study undertaken from the Monsatir registry of ST elevation MI including 688 patients having had either a hospital or a prehospital thrombolysis (n = 397) or a primary angioplasty (n = 291). Among those patients, 482 (70.1%) were active smokers.

Results

In the thrombolysis group, the prevalence of hypertension, diabetes and anterior location of MI was significantly less among smokers. In the group primary angioplasty, only diabetes and hypertension were less frequent. The immediate mortality was significantly less among smokers in case of thrombolysis comparatively to non-smokers (5.3 vs 13%; p = 0.008). By multivariate analysis, cardiogenic shock (p < 0.0001), anterior MI (p = 0.03) and active smoking (p = 0.03) were independent predictive factors of mortality in case of thrombolysis. A trend toward a lower mortality among smokers was observed in the primary angioplasty group (10 vs 17.6%; p = 0.07).

Conclusion

“The smoker's paradox” seems to be observed mainly among patients having had thrombolysis.     

Association between serum soluble TNFα receptors and renal dysfunction in type 2 diabetic patients without proteinuria

Aim

The aim of our study was to investigate whether serum levels of soluble tumor necrosis factor α receptor (sTNFR) 1 and 2 are markers for renal dysfunction in type 2 diabetic patients without overt proteinuria.

Methods

Japanese type 2 diabetic patients without overt proteinuria (n = 168) enrolled in the prospective observational follow-up study in 2001 were retrospectively analyzed. At baseline, the serum levels of sTNFR1 and sTNFR2 were measured by sandwich ELISA. The associations between these markers and change in estimated glomerular filtration rate (eGFR) after 5 years were evaluated.

Results

The levels of sTNFR1 and sTNFR2 closely correlated. At baseline, sTNFR1 and sTNFR2 associated inversely with eGFR. After 5 years, patients with high level of both sTNFR1 and sTNFR2 showed a greater decline in eGFR (−13.8 ± 15.5% versus −8.5 ± 11.8%, P = 0.027) and a 4-fold higher risk for a GFR decline of ≥25% than those with high level of only one receptor or low level of both receptors. These associations were enhanced in diabetic women.

Conclusions

The higher levels of sTNFR1 and sTNFR2 were associated with a greater decline in eGFR in type 2 diabetic patients without proteinuria, especially in diabetic women.     

The association between in utero hyperinsulinemia and adolescent arterial stiffness

Aim

To determine the relationship between in utero hyperinsulinemia and children's arterial stiffness at adolescence.

Methods

Indices of arterial stiffness were measured using the SphygmoCor apparatus in 129 adolescents (42 offsprings of mother with gestational diabetes and 87 offsprings of mother with normal glucose tolerance during pregnancy) at 15 years of age.

Results

Adolescent of mothers with gestational diabetes had similar central aortic blood pressure, augmentation pressure (AP), augmentation index (AI), and carotid-femoral pulse wave velocity (PWV) as that of controls. However, both umbilical cord C-peptide and insulin levels correlated positively AI (R = 0.28 and 0.24; p = 0.011 and 0.035, respectively), and umbilical insulin level correlated positively with AP (R = 0.25; p = 0.025). The correlations were significant between umbilical cord C-peptide and AP (R = 0.24; p = 0.035) and AI (R = 0.29; p = 0.011) after adjustment for subjects’ age, sex, body weight and height. Adolescents who had umbilical cord C-peptide levels at highest quartile (n = 25), based on the reference ranges of the original cohort, had a significant greater PWV (5.26 ± 0.12 m/s vs 4.98 ± 0.12 m/s; p = 0.0049) than those with C-peptide levels at the lower 3 quartiles (n = 57) after adjustment for age, sex, body weight and height.

Conclusions

In utero hyperinsulinemia appears to increase the offspring's arterial stiffness at early adolescence.     

Serum visfatin is associated with type 2 diabetes mellitus independent of insulin resistance and obesity

Objective

The aim of this study was to evaluate the association of serum visfatin, adiponectin and leptin with 2 diabetes mellitus (T2DM) in the context of the role of obesity or insulin resistance, which is not well understood.

Methods

A total of 76 newly-diagnosed T2DM patients and 76 healthy control subjects, matched for age, body mass index (BMI) and sex ratio, were enrolled. Anthropometric parameters, glycemic and lipid profile, insulin resistance (measured by homeostasis model assessment of insulin resistance index [HOMA-IR]), leptin, adiponectin, and visfatin were assessed.

Results

On the contrary to adiponectin, serum leptin and visfatin levels were higher in T2DM patients compared with controls (10.07 ± 4.5, 15.87 ± 16.4, and 5.49 ± 2.4 vs. 12.22 ± 4.9 μg/ml, 8.5 ± 7.8 ng/ml and 3.58 ± 2.2 ng/ml, respectively, P < 0.01). Waist circumference and BMI were correlated with leptin and adiponectin but not with visfatin. Leptin, adiponectin and visfatin all were associated with T2DM following adjusting for obesity measures. After controlling for HOMA-IR, visfatin remained as an independent predictor of T2DM (odds ratio = 1.32, P < 0.05). In a multiple regression analysis to determine visfatin only triglycerides and fasting glucose remained in the model (P < 0.05).

Conclusion

Elevation of visfatin in T2DM is independent of obesity and insulin resistance and is mainly determined by fasting glucose and triglycerides.     

Physiologic evaluation of myocardial bridging: a new analysis for an old disease

Background

Myocardial bridging (MB) is the most common congenital coronary anomaly. However, the functional relevance of MB is not well understood.

Methods

Eighteen patients with lone MB were consecutively enrolled. Fractional flow reserve (FFR) was measured before and after dobutamine infusion. Diastolic FFR was calculated by offline analysis. Cutoff values for functional significance of FFR and diastolic FFR were 0.75 and 0.76, respectively.

Results

Baseline systolic percent diameter stenosis and lesion length of MB were 70 ± 16% and 24 ± 7 mm. FFR and diastolic FFR were 0.92 ± 0.05 and 0.89 ± 0.07 at maximal hyperemia induced by adenosine, respectively (P = 0.006). Despite the angiographic stenosis, only 1 lesion was functionally significant. After dobutamine infusion, percent diameter stenosis (84 ± 11%, P = 0.002) and lesion length (26 ± 6 mm, P = 0.019) were aggravated and diastolic FFR was lowered (0.84 ± 0.10, P = 0.006). Two additional lesions became functionally significant after dobutamine infusion. Angiographic percent diameter stenosis at diastole was correlated with dobutamine diastolic FFR (R = -0.58, P = 0.04), but stenosis at systole was not. During median follow-up of 54 months, 2 patients underwent target-lesion revascularization.

Conclusions

Dobutamine increased the morphologic and functional severity of MB. Dobutamine-FFR seems to be helpful in the functional assessment of MB.     

Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis

Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH)

Objective

To compare initial fibrosis and fibrosis after IT in patients with AIH.

Methods

A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28 ± 8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy.

Results

Fibrosis decreased from 2.9 ± 0.3 to 2.2 ± 0.3 (p = 0.005) and histological activity index from 6.8 ± 0.45 to 2.6 ± 0.2 (P < .001). In subgroups, fibrosis decreased from 3.6 ± 0.4 to 1.4 ± 0.3 (P < .001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement.

Conclusion

Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response.     

Active Lipid Management In Coronary Artery Disease (ALMICAD) study

Purpose

Many providers have implemented specialized lipid clinics to more effectively identify, monitor, and treat hyperlipidemia in patients with coronary artery disease. The effectiveness of such a strategy is not known. We sought to investigate whether a specialized clinic achieves better lipid results and clinical outcomes than standard care.

Subjects and Methods

A total of 1233 patients who had coronary disease documented by coronary angiography were randomized to lipid clinic or standard care groups by their providers and followed for 2 years. The primary end point was a composite of death, myocardial infarction, repeat revascularization, and stroke.

Results

Lipid clinic (n = 617) and standard care (n = 616) groups had no significant baseline differences. After 2 years, the lipid clinic group had similar total cholesterol (166 ± 42 mg/dL vs 166 ± 41 mg/dL, P = .83), low-density lipoprotein cholesterol levels (84 ± 32 vs 85 ± 32, P = .28), and percentage of patients with low-density lipoprotein cholesterol less than 100 mg/dL (77.5% vs 77.6%, P = .97). There were no significant differences in the primary end point (12.3% vs 11.4%, P = .60) and mortality (7.6% vs 7.3%, P = .80) between the lipid clinic and standard care groups.

Conclusions

In patients identified by diagnostic coronary angiography and managed within a single health care system, implementation of a specialized lipid clinic did not achieve greater attainment of hyperlipidemia treatment goals or improved cardiac outcomes.     

Gabapentin Toxicity in Patients with Chronic Kidney Disease: A Preventable Cause of Morbidity

Background

Gabapentin is frequently used as an analgesic in patients with chronic kidney disease. Although gabapentin is well known for its favorable pharmacokinetics, it is exclusively eliminated renally, and patients with chronic kidney disease are at risk for toxicity. Existing literature on such risk is lacking.

Methods

We examined the Mayo Clinic Rochester database from 1998 to 2007 in patients with serum gabapentin measurements and known medical outcomes. A total of 729 patients were stratified according to their estimated glomerular filtration rate: group I, 126 individuals with estimated glomerular filtration greater than 90 mL/min/1.72 mm³; group II, 594 individuals with estimated glomerular filtration less than 90 mL/min/1.72 mm³ without dialysis; group III, 9 individuals with chronic dialysis.

Results

Patients in groups II and III had higher serum gabapentin levels (8.39 ± 0.32 μL/mL and 58.8 ± 10.22 μL/mL, respectively) than in group I (5.52 ± 0.32 μL/mL, P < .01). Toxicity occurred exclusively in groups II (5.56%) and III (77.8%); toxic manifestations were more severe in group III than in group II. Elderly individuals with multiple comorbidities were overrepresented in those with toxic manifestations. Gabapentin toxicity was suspected initially in only 41.5% of symptomatic cases.

Conclusion

Gabapentin toxicity in patients with chronic kidney disease is underrecognized. Patients with chronic kidney disease often receive inappropriately high gabapentin dosage for their kidney function, occasioning overt toxicity; advanced age and comorbidity predispose these patients for toxicity. Heightened awareness of such preventable risk, amid the chronic kidney disease epidemic, would be cost-effective and improve healthcare quality.     

Incretin secretion is not restored by short-term strict glycaemic control in Korean hyperglycaemic patients with type 2 diabetes

Aims

To determine whether short-term strict glycaemic control could restore incretin secretion in type 2 diabetic patients. The factors associated with incretin levels were also investigated.

Methods

A meal tolerance test (MTT) was performed in eighteen poorly controlled (pDM) and fifteen well controlled (wDM) diabetic patients. Fourteen patients in the pDM group underwent follow-up MTT after strict glycaemic control. The secretions of intact glucagon-like peptide-1 (iGLP-1) and total glucose-dependent insulinotropic polypeptide (tGIP) during MTT were calculated by total and incremental area under the curve (TAUC and IAUC) values.

Results

Posttreatment HbA1c level was significantly improved in the pDM group (11.2 ± 0.9 to 7.9 ± 0.9%). However, the secretion of incretin hormones was not increased in the posttreatment pDM group (TAUCiGLP-1, 3612 ± 587 to 2916 ± 405 pmol/L min; TAUCtGIP, 9417 ± 1099 to 8338 ± 903 pmol/L min). IAUCiGLP-1 was negatively correlated (r = −0.446, P = 0.011) and independently associated (β = −137.2, P = 0.027) with insulin resistance assessed by homeostasis model assessment.

Conclusions

Incretin secretion is not restored by short-term strict glycaemic control. Decreased incretin secretion seems to develop early in the course of type 2 diabetes with increasing insulin resistance, but not to be influenced by glycaemic status.