Androgens, visceral obesity and the risks for cardiovascular disease and diabetes mellitus

Given that there is a sex difference in cardiovascular disease, testosterone has long been regarded as the culprit for this difference. This position is no longer tenable. In epidemiological studies low plasma testosterone levels predict cardiovascular disease and diabetes mellitus, often clustered in the metabolic syndrome. Acute deprivation of testosterone, as in men treated for prostate cancer, leads to impairment of the risk factors for diabetes mellitus and cardiovascular disease. Testosterone administration to hypogonadal men decreases fat mass, increases lean body mass and leads to a reduction in plasma cholesterol, triglycerides and low-density lipoprotein (LDL)-cholesterol levels.Further studies are needed to investigate whether maintaining plasma testosterone levels in the mid-normal range improves the risk for cardiovascular disease and diabetes mellitus.     

多学科综合治疗肥胖症合并2型糖尿病

2型糖尿病常合并肥胖症、高血压、高血脂等代谢综合征症候群。对于此类难以控制的2型糖尿病合并肥胖症的诊断和治疗,内科常用非手术如控制饮食、运动、药物方式治疗;外科则可采用手术方式,改善2型糖尿病及其代谢综合征症候群,达到“治愈”糖尿病和高脂血症的目的。中南大学湘雅三医院对1例肥胖症合并2型糖尿病患者采用多学科协作综合治疗模式,取得了较好疗效。     

Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus

Increased glomerular filtration rate (GFR) has been implicated in the development of diabetic nephropathy. Large normal interindividual variations of GFR hamper the diagnosis of renal hemodynamic alterations. We examined renal functional reserve (RFR) in children with type 1 diabetes mellitus to assess whether hyperfiltration occurs. The renal hemodynamic response following dopamine infusion was examined in 51 normoalbuminuric diabetic children (7.7 ± 3.6 years) with a mean duration of diabetes of 6.2 years and compared them with 34 controls. Mean baseline GFR in diabetic children did not differ from the control population (130.7 ± 22.9 vs. 124.8 ± 25 ml/min per 1.73 m²), whereas renal plasma flow was significantly lower (463.7 ± 103.9 vs. 587.2 ± 105 ml/min per 1.73 m², p < 0.001), and filtration fraction was increased (29 ± 8 vs. 21 ± 2%, p < 0.001), compared with controls. The mean RFR was lower (p < 0.001) than in control subjects (−0.77 ± 23 vs. 21 ± 8 ml/min per 1.73 m²). This study documents an increased filtration fraction and reduced or absent RFR in children with type 1 diabetes mellitus in the stage before apparent nephropathy. GFR values were within normal range. Although the reduced RFR and increased filtration fraction indicate the presence of hemodynamic changes, their relevance to the development of hyperfiltration and subsequent diabetic nephropathy remains unknown.     

代谢手术治疗肥胖症和2型糖尿病的相关问题

代谢手术治疗肥胖症和2型糖尿病在国际上越来越受到重视。在我国经过10余年的发展,目前已经广泛开展。随着这一新的外科领域的发展,许多相关问题不断产生。临床医师既要吸取国外的相关经验,又要根据我国患者和学科发展的实际情况逐步形成自己的实践经验。因此,笔者对代谢手术治疗肥胖症和2型糖尿病的相关问题进行探讨,以期促进代谢手术在我国的健康发展。     

Relationship between carotid artery intima-media thickness and renal function in patients with diabetes mellitus

Objective To investigate the relationship between carotid artery intima-media thickness and renal function in patients with diabetes mellitus. Methods 424 patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their artery intima-media thickness (IMT), the patients were divided into normal group and higher IMT group. All patients according to UAER or 24h urinary protein were divided into normal proteinuria group, micro-proteinuria group and clinical proteinuria group. The biochemical examination, eGFR, and atherosclerotic plaque of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IMT and other parameters. Risk factors for eGFR decline were analyzed by binary logistic regression. Results Compared with normal group, patients in the higher IMT group were older [(63.3±10.2) year vs (52.5±10.6) year, P﹤0.05], and underwent longer duration of diabetes [(8.9±6.7) year vs (6.2±5.7) year, P﹤0.05]. Their level of eGFR was decreased [(75.92±28.00) ml/min vs (91.64±24.05) ml/min, P﹤0.05], while plaque incidence (71.3% vs 18.3%,χ2=112.42, P﹤0.01) and prevalence of hypertension (56.4% vs 29.6%, χ2=27.22, P﹤0.01) increased. Correlation analysis showed that IMT was positively correlated with age (r=0.503, P﹤0.01), duration of diabetes (r=0.204, P﹤0.01), 24 h urine protein (rs=0.175, P﹤0.05), plaque (rs=0.562, P﹤0.01), and hypertension (rs=0.193, P﹤0.01), but negatively correlated with eGFR (r=-0.307, P﹤0.01). Logistic regression analysis showed that age, serum uric acid, 24 h urine protein and carotid artery intima-media thickness were independent risk factors for eGFR decline [OR=1.115, 95%CI(1.053, 1.165), P﹤0.001; OR=1.008,95%CI (1.002, 1.014), P=0.006; OR=1.492, 95%CI(1.170,1.903), P=0.001; OR=1.619, 95%CI(1.121, 2.339), P=0.010]. Conclusion Carotid artery intima-media thickness is an independent risk factor for kidney function decline in patients of diabetes.     

Metabolic syndrome,hypertension, and diabetes mellitus after gastric banding: The role of aging and of duration of obesity

BackgroundBariatric surgery leads to resolution of arterial hypertension and diabetes mellitus; isolated reports indicate that response to bariatric surgery is lower in aged patients. The aim of this study was to evaluate the role of age and of duration of obesity on the frequency of co-morbidities in morbid obesity, as well as on improvement of co-morbidities.MethodsA total of 837 consecutive patients with known duration of obesity, undergoing gastric banding, were considered for this study; they were divided into quartiles of age and of duration of obesity. Presence of co-morbidities (diabetes mellitus, arterial hypertension, metabolic syndrome), metabolic variables (cholesterol and HDL-C, triglycerides, blood glucose), anthropometric variables, and loss of weight during 24 months were considered.ResultsOlder patients had a higher frequency of co-morbidities; duration of obesity only affected frequency of co-morbidities, but not response to surgery. At logistic regression, duration of obesity had a moderate independent effect on the frequency of diabetes. Older patients lost less weight than younger patients, but diabetes mellitus and arterial hypertension improved to the same extent in patients of different ages, and metabolic syndrome disappeared more in older patients, associated with a greater decrease of blood glucose. Frequency of removal of gastric banding and loss to follow-up were not different in different quartiles of age or in different quartiles of duration of obesity.ConclusionOlder patients, despite lower weight loss, have a response to bariatric surgery that is similar to that of younger patients; age and duration of obesity should not be considered as limits to indications to bariatric surgery.     

Maternal diabetes mellitus - early consequences for the offspring

Although several studies have focused on the effects of nutritional status during intrauterine development, few have addressed the impact of maternal diabetes mellitus on renal function and morphology in the young offspring. In the present study, renal morpho-functional aspects were studied in the offspring of diabetic rats. Diabetes was induced in female rats with a single dose of streptozotocyn (STZ), 10 days before mating. After weaning, the offspring (DO) had free access to food and water. Arterial blood pressure was measured, by tail plethysmography, from 2 months on. Renal function was evaluated in 2- and 3-month-old rats in the DO group and in controls (C). Analysis of renal morphology was carried out in newborn and in 1-, 2- and 3-month-old rats in both groups. Although the nephron number was not changed in the DO group, glomerular hypertrophy was observed from 2 months on. At the same age, the glomerular filtration rate was significantly reduced in DO, and blood pressure was significantly increased, when compared to C. Glucose tolerance test (GTT) from DO showed a different profile when compared to C. The number of PCNA positive cells in renal tissue was similar in both groups. Our data suggests that exposure to intrauterine diabetes may be an important cause of both impaired renal function and hypertension in offspring, without changes in the nephron number.     

Relationship between interventricular septum thickness and renal function in patients with type 2 diabetes mellitus

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus. Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their IVS, the patients were divided into normal group (IVS≤11 mm) and higher IVS group (IVS＞11 mm). All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml?min-1?(1.73 m2)-1 group and eGFR＜60 ml?min-1?(1.73 m2)-1 group. The demographic characteristic, biochemical examination, eGFR, and proteinuria of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IVS and other parameters. eGFR＜60 ml?min-1?(1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression. Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis. Results Compared with normal group, patients in the higher IVS group had higher systolic pressure (P=0.002), their level of Scr, BUN, 24 h urinary protein were increased (all P＜0.05), while the level of eGFR, albumin (ALB), hemoglobin (Hb) and fasting blood glucose were decreased (all P＜0.05). The prevalence of hypertension was increased (81.16% vs 58.67%, χ2=11.273, P=0.001), and there was also a difference in the proportion of patients in each stage of CKD (χ2=34.593, P＜0.001). Correlation analysis showed that IVS was positively correlated with BMI, systolic BP, Scr, BUN, 24 h urinary albumin, 24 h urinary protein (all P＜0.05), while negative correlation was observed between the thickened degree of IVS and Hb, albumin, eGFR and total calcium (all P＜0.05). It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P＜0.01). Logistic regression analysis showed that longer duration of diabetes, higher systolic pressure and BUN were independent risk factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05), while higher Hb and Alb were independent protective factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P＜0.05), while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P＜0.05). Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396, 95%CI=1.098-1.774, P=0.006). Conclusion Interventricular septum thickness is closely related to the state of renal function, as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.     

Renal structural-functional relationships in early diabetes mellitus

  To define the earliest renal morphological changes in patients with type I diabetes, we studied renal function and morphometric analysis of renal biopsies in 59 patients with diabetes for 5 – 12 years and normal blood pressure, normal creatinine clearance (C _Cr), and negative dipstick urinary protein. Arteriolar hyalinization and intimal fibrous thickening were noted in 43%. Glomerular basement membrane thickness and fractional mesangial volume were increased in 51% and 56%, respectively. The pre-pubertal and post-pubertal years of diabetes were associated with similar degrees of renal structural changes, but during the pre-pubertal years normal urinary albumin excretion (UAE) was seen. Principal factor analysis of morphometric structural parameters yielded four clusters of variables: “glomerular size” correlated with patient age, C _Cr, and UAE; “peripheral capillary decrease” correlated with glycosylated hemoglobin, diastolic blood pressure, glomerular filtration rate, and UAE; “mesangial increase” correlated with UAE; and “interstitial scarring” correlated with diastolic blood pressure. This study provides unique documentation of renal structural abnormalities which precede clinically evident renal functional abnormalities and documents that these early structural abnormalities are present in the pre-pubertal years of diabetes as well as postpuberty, and are associated with each other in constellations that correspond to postulated mechanisms in diabetic nephropathy. Received October 10, 1996; received in revised form and accepted March 14, 1997     

Childhood hemolytic uremic syndrome is associated with adolescent-onset diabetes mellitus

Extra-renal manifestations of the hemolytic uremic syndrome in children are well described. Pancreatic involvement may manifest as transient hyperglycemia and permanent diabetes mellitus. Two previous case reports demonstrate short periods of “remission” between initial hyperglycemia and the development of permanent diabetes mellitus. We report an unusual case of a two-year-old Caucasian boy whose HUS-associated hyperglycemia resolved shortly after the acute phase of his illness only to recur as permanent diabetes mellitus at puberty. To our knowledge no other case is reported that demonstrates such a long interval between initial presentation and the development of permanent diabetes mellitus.     

骨疾病并存糖尿病患者的围手术期处理

目的: 探讨糖尿病患者骨科手术围手术期血糖的控制和对手术的影响。方法: 回顾性分析35例骨疾病并存糖尿病的患者接受骨科手术治疗围手术期的血糖调控情况。结果: 35例患者入院时空腹血糖(13 0±1 5) mmol/L, 经术前用胰岛素控制血糖至(7 .0±2 .3) mmol/L后, 分别接受全髋关节置换、股骨头置换、腰椎滑脱协和钢板脊柱内固定系统复位固定等复杂骨科手术治疗, 术中及术后继续用胰岛素控制血糖至基本正常水平, 本组术后血糖为(8. 0±1 .8) mmol/L。35例中, 仅1例(2. 9% ) 术后内固定松动, 未发生感染和其他并发症。术后患者症状体征均明显改善, 肢体功能恢复良好。结论: 糖尿病患者经正确的围手术期处理, 将血糖控制至基本正常水平, 可耐受复杂的骨科手术。     

腹腔镜袖状胃切除术治疗病态性肥胖症合并2型糖尿病的疗效及相关因素分析

目的:探讨腹腔镜袖状胃切除术(LSG)治疗病态性肥胖症合并2型糖尿病的临床疗效,并分析影响疗效的相关因素.方法:回顾分析2013年7月至2018年7月为45例病态性肥胖症合并2型糖尿病患者行LSG的临床资料及随访情况,分析手术对患者体重及血糖的控制情况,并应用单因素与多因素Logistic回归分析影响体重及血糖控制效果...     

Response to comment on: Statin use and risk of diabetes mellitus

In letter to the editor “Comment on: Statin use and risk of diabetes mellitus” authors found the statement “pravastatin 40 mg/d reduced the risk of diabetes by 30% in West of Scotland Coronary Prevention study” erroneous. As per our opinion the statement is right but had been referenced incorrectly.     

Complement activation in obesity,insulin resistance,and type 2 diabetes mellitus

Amplified inflammatory reaction has been observed to be involved in cardiometabolic diseases such as obesity, insulin resistance, diabetes,dyslipidemia, and atherosclerosis. The complement system was originally viewed as a supportive first line of defense against microbial invaders, and research over the past decade has come to appreciate that the functions of the complement system extend beyond the defense and elimination of microbes, involving in such diverse processes as clearance of the immune complexes, complementing T and B cell immune functions, tissue regeneration, and metabolism. The focus of this review is to summarize the role of the activation of complement system and the initiation and progression of metabolic disorders including obesity, insulin resistance and diabetes mellitus. In addition, we briefly describe the interaction of the activation of the complement system with diabetic complications such as diabetic retinopathy, nephropathy and neuropathy, highlighting that targeting complement system therapeutics could be one of possible routes to slow down those aforementioned diabetic complications.     

A male patient with right-sided thoracic kidney,diabetes mellitus,hearing loss and renal dysfunction

A 48-year-old man with diabetes mellitus and hypertension was found to have a thoracic right-sided ectopic kidney with a sensorineuronal hearing loss and tubular abnormalities such as hyponatremia, hypokalemia, metabolic alkalosis with microalbuminuria. He was treated with ACEI and sodium and potassium supplements. However, this only partially corrected his metabolic abnormalities.     

Fatty liver disease in diabetes mellitus

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM), likely reflecting the frequent occurrence of obesity and insulin resistance in T2DM. NAFLD also can occur in type 1 DM (T1DM), but must be distinguished from the more common glycogen hepatopathy as a cause of hepatomegaly and liver function abnormalities in T1DM. Weight reduction achieved by diet and exercise is effective in preventing and treating NAFLD in obese diabetic subjects. Bariatric surgery also has been shown to reverse NAFLD in T2DM, and recently approved weight loss medications should be evaluated for their impact on the development and progression of NAFLD. There is limited evidence suggesting that specific drugs used for blood glucose control in T2DM [thiazolidinediones (TZDs), glucagon-like peptide-1 (GLP-1) analogs, and dipeptidyl peptidase-4 (DPP-4) inhibitors] and also statins may have a role in preventing or treating NAFLD in patients with diabetes.     

Factors related to renal haemodynamics in young type-1 diabetes mellitus patients

The influence of metabolic control (HbA_1c), noradrenaline (NA) and insulin-like growth factors (IGF-I and IGF-II) on renal function and size was investigated in 11 insulin-dependent diabetes mellitus patients aged 11–17 years. Renal function was evaluated in terms of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal size was determined as renal parenchymal volume (RPV) by ultrasonography. The patients' HbA_1c values ranged from 8.2% to 12.9% (normal range 5.5–8.5%) and their GFR and ERPF were higher than normal. Their IGF-II values were higher, and NA and IGF-I levels were lower than those of healthy controls. Inverse correlations between NA and GFR (r=–0.66) and NA and ERPF (r=–0.63) were found. No correlation was found between serum IGF-I and renal functional parameters. The IGF-II values correlated with GFR and HbA_1c (r=0.63,r=0.70 respectively). There were linear correlations between RPV and GFR, RPV and ERPF, HbA_1c and GFR, and ERPF and RPV. Decreased NA concentrations and increased IGF-II values appear to be factors contributing to renal hyperfunction in these patients.     

胰腺癌与糖尿病相关性分析

目的 分析胰腺癌与糖尿病的相互关系以及胰腺癌患者合并糖尿病的临床及病理特征.方法 选择吉林大学中日联谊医院2008年1月至2010年12月住院的符合胰腺癌诊断标准的患者151例作为胰腺癌组,抽取同期住院的年龄、性别匹配的非内分泌系统、非消化系统、非肿瘤相关疾病患者195例作为对照组.应用病例对照研究的方法,分析胰腺癌与糖尿病的相互关系;将所有胰腺癌患者分为糖尿病组及非糖尿病组,分析胰腺癌患者合并糖尿病的临床及病理特征.结果 糖尿病患者患胰腺癌的OR值为3.678(95％ CI 2.30～6.69).糖尿病病程2年以内者患胰腺癌的OR值为5.91(95％ CI 3.03～8.00),P＜0.05;糖尿病病程为2～5年者患胰腺癌的OR值为1.308 (95％ CI0.37～4.60),P＞0.05;糖尿病病程5年以上者患胰腺癌的OR值为胰腺癌1.16(95％ CI 0.44～3.19),P＞0.05.糖尿病与非糖尿病两组胰腺癌患者在性别、年龄、体质指数、是否存在梗阻性黄疸、是否发生转移及肿瘤部位方异差异无统计学意义,P＞0.05.结论 (1)胰腺癌与糖尿病存在明显的相关性.(2)糖尿病可能是胰腺癌的一种临床表现.对于病程在2年以内的新发糖尿病患者,应警尿糖尿病可能为胰腺癌发生的早期信号.(3)胰腺癌合并糖尿病的患者在性别、年龄、体质指数、是否存在梗阻性黄疸、肿瘤部位及是否远处转移方面无特殊性.