Short-Term Treatment with Metformin Improves the Cardiovascular Risk Profile in First-Degree Relatives of Subjects with Type 2 Diabetes Mellitus who have a Metabolic Syndrome and Normal Glucose Tolerance without Changes in C-Reactive Protein or Fibrinogen

OBJECTIVE:

To study if metformin, when administered to first-degree relatives of type 2 diabetes mellitus subjects who have metabolic syndrome and normal glucose tolerance, could improve the cardiovascular risk profile and reduce the levels of both C-reactive protein and fibrinogen.

INTRODUCTION:

Metabolic syndrome is associated with higher cardiovascular morbidity and mortality. Metformin has vasculo-protective effects even in normoglycemic subjects, and C-reactive protein and fibrinogen are considered markers of endothelial injury and inflammation.

METHODS:

Thirty-one non-diabetic first-degree relatives of type 2 diabetes mellitus subjects with metabolic syndrome were randomized (1:1) and double-blinded for placement in the placebo and metformin groups (850mg bid/±90days); 16 subjects were administered metformin (mean age 40.0 [33.5–50] years; 13 females) and 15 subjects were in the placebo group (mean age 37.0 [32–42] years; 9 females). Blood samples were collected at baseline and at the end of treatment for biochemical analyses, including an assessment of C-reactive protein and fibrinogen levels.

RESULTS:

Metformin improved the lipid profile and decreased fasting plasma glucose, systolic blood pressure, weight and body mass index without changing body composition. For those in the placebo we identified no changes in fibrinogen (282.2 [220.4–323.7] mg/L vs. 286.7 [249.6–295.1] mg/L; NS) or in C-reactive protein levels (0.68 [0.3–1.2] vs. 0.64 [0.3–1.0] mg/L; NS). The same was also observed for the levels of fibrinogen (303.9 [217.6–347.6] mg/L vs. 290.9 [251.5–301.9] mg/L; NS) and C-reactive proteins (0.78 [0.3–1.1] vs. 0.80 [0.4–0.9] mg/L; NS) in the metformin group.

CONCLUSIONS:

Metformin treatment in first-degree relatives of type 2 diabetes mellitus sufferers who have metabolic syndrome and normal glucose tolerance improved the cardiovascular risk profile without changing the levels of C-reactive protein and fibrinogen.     

Insulin resistance in Nigerians with essential hypertension

Background

Reports on the association between hypertension and insulin resistance have been inconsistent even though most studies show a definite association. It is also not certain if the association between insulin resistance and hypertension applies to all populations.

Objective

To determine the prevalence of insulin resistance in hypertensive Nigerians and to examine the association of insulin resistance with hypertension and some anthropometric indices.

Methods

Thirty five adults with essential hypertension and thirty five normotensives were studied. Anthropometric parameters, blood pressure, fasting glucose and insulin were measured. Homeostasis model assessment (HOMA) was used to determine insulin resistance (IR).

Results

The hypertensive subjects had significantly higher fasting insulin and HOMA-IR compared with normotensives (p =0.02 and 0.04) respectively. There were significant correlations between HOMA-IR, BMI, waist and hip circumference in subjects with hypertension. At multiple linear regression, hypertension and body mass index were found to be the only significant predictors of insulin resistance.

Conclusion

The hypertensives we studied had a higher occurrence of insulin resistance compared to the normotensives. This makes it necessary for persons with hypertensive to have regular screening for diabetes and other categories of glucose intolerance as the increased insulin increases their risk of developing type 2 diabetes mellitus.     

Parameters measuring beta-cell function are only valuable in diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes

Purpose

The aim of this study was to identify the most precise and clinically practicable parameters that predict future oral hypoglycemic agent (OHA) failure in patients with type 2 diabetes, and to determine whether these parameters are valuable in various subgroups.

Materials and Methods

We took fasting blood samples from 231 patients for laboratory data and standard breakfast tests for evaluation of pancreatic beta-cell function. Hemoglobin A1c (HbA1c) levels were tested, and we collected data related to hypoglycemic medications one year from the start date of the study.

Results

Fasting C-peptide, postprandial insulin and C-peptide, the difference between fasting and postprandial insulin, fasting beta-cell responsiveness (M0), postprandial beta-cell responsiveness (M1), and homeostasis model assessment-beta (HOMA-B) levels were significantly higher in those with OHA response than in those with OHA failure. The area under the curve (AUC) of the receiver operating characteristic (ROC) measured with postprandial C-peptide to predict future OHA failure was 0.720, and the predictive power for future OHA failure was the highest of the variable parameters. Fasting and postprandial C-peptide, M0, and M1 levels were the only differences between those with OHA response and those with OHA failure among diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes.

Conclusion

In conclusion, postprandial C-peptide was most useful in predicting future OHA failure in type 2 diabetic subjects. However, these parameters measuring beta-cell function are only valuable in diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes.     

Effect of Chronic Administration of Hexane Extract of Byrsonima Crassifolia Seed on B-Cell and Pancreatic Oxidative Parameters in Streptozotocin-Induced Diabetic Rat

Background

In Mexican traditional medicine, the seeds of Byrsonima crassifolia have been used in the treatment of diabetes, rheumatism and for wound healing. The aim was to evaluate the effect of seeds of B. crassifolia on insulin release from the pancreatic beta cells in streptozotocininduced diabetic rats.

Materials and Methods

In the present study, we evaluated the beneficial effect of seeds B. crassifolia streptozotocin-induced type 1 diabetic rats. Insulin level; insulin sensitivity index, insulin content in pancreas, malonaldehyde, nitric oxide contents, oxidative stress parameters were assayed. Serum glucose levels were determined by the glucose oxidase method. To determine the insulin releasing activity, after extract treatment, the pancreas was excised. Pancreatic sections were processed for examination of insulin-releasing activity using an imunocytochemistry kit.

Results

Administration of the hexane extract (200 and 400 mg/kg), exhibited a significant reduction in serum glucose. Administration of streptozotocin decreased the number of beta cells with insulin secretory activity in comparison with intact rats; but treatment with the B. crassifolia seed extract increased significantly the activity of the beta cells in comparison with the diabetic control rats. The extract decreased serum glucose in streptozotocin-induced diabetic rats and increased insulin release from the beta cells of the pancreas.

Conclusion

These finding suggest that B. crassifolia seed has beneficial effect for diabetes through decreasing blood glucose and lipid levels, increasing insulin sensitivity index and insulin content, up-regulating antioxidant enzyme activity and decreasing lipid peroxidation.     

Delayed response of amylin levels after an oral glucose challenge in children with Prader-Willi syndrome

Purpose

Amylin secretion is increased parallel to insulin in obese subjects. Despite their marked obesity, a state of relative hypoinsulinemia occurs in children with Prader-Willi syndrome (PWS). Based on the hypothesis that amylin levels may be relatively low in PWS children, contributing to their excessive appetite, we studied amylin levels after oral glucose loading in children with PWS and overweight controls.

Materials and Methods

Plasma levels of amylin, glucagon, insulin, and glucose were measured at 0, 30, 60, 90, and 120 min after a glucose challenge in children with PWS (n = 18) and overweight controls (n = 25); the relationships among the variables were investigated in these two groups.

Results

Amylin levels were significantly correlated with insulin during fasting and during the oral glucose tolerance test in both groups. Amylin levels between 0 and 60 min after glucose loading were statistically different between the two groups. They were lower in children with PWS than in the controls between 0 and 30 min after glucose loading.

Conclusion

The relatively low levels of amylin, compared to those in overweight controls, during the early phase of glucose loading in patients with PWS, may contribute, in part, to the excessive appetite of PWS patients as compared to the overweight controls.     

High cardiorespiratory fitness is more beneficial in pre-diabetic men than women

OBJECTIVES:

To investigate gender-specific relationships between cardiorespiratory fitness and factors that predict the development of diabetes and to identify the risk factors that predict fasting plasma glucose and 2-hour plasma glucose levels.

INTRODUCTION:

Different risk factors (e.g., low cardiorespiratory fitness) may cause elevated plasma glucose levels in men compared to women. Therefore, gender-specific analyses are needed.

METHODS:

Cardiorespiratory fitness (maximal power output achieved during a standard cycle ergometry test), resting blood pressure, total serum cholesterol, high-density lipoprotein cholesterol and triglyceride levels were measured in 32 pre-diabetic men (mean age: 57.2±6.8 years; mean body mass index (BMI): 28.5±3.0 kg/m²) and 40 pre-diabetic women (mean age: 55.0±7.3 years, mean BMI: 30.4±5.7 kg/m²). A stepwise regression with backward variable selection was performed to construct models that predict 2-hour and fasting plasma glucose levels.

RESULTS:

Maximal power output was inversely related to the 2-hour plasma glucose level in the entire group (r = −0.237, p<0.05), but this relationship was significant only for males (r = −0.404, p<0.05). No significant correlation was found between female gender and cardiorespiratory fitness. Age and cardiorespiratory fitness were significant predictors of 2-hour plasma glucose levels in men. High-density lipoprotein cholesterol was predictive of 2-hour plasma glucose levels in women. Triglycerides in women and BMI in men were the only predictors of fasting plasma glucose levels.

CONCLUSIONS:

These findings may have consequences for the development of gender-specific diabetes prevention programs. Whereas increasing cardiorespiratory fitness should be a key goal for men, improving the lipid profile seems to be more beneficial for women. However, the present results do not negate the positive effects of increasing cardiorespiratory fitness in women.     

385 C/A polymorphism of the fatty acid amide hydrolase gene is associated with metabolic syndrome in the Chinese Han population

Introduction

The endocannabinoid system participates in food intake, energy balance and lipid and glucose metabolism. The biological effects of cannabinoids are limited by the activation of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH). This study aims to analyse whether 385 C/A polymorphism of FAAH is associated with metabolic syndrome (MetS) in the Chinese Han population.

Material and methods

A total of 112 subjects at risk for MetS and 80 healthy controls from Fuzhou, China were genotyped for 385 C/A polymorphism of FAAH using TaqMan assay. Anthropometric measurements and biochemical assessments such as BMI, waist circumference, blood pressure, serum triglycerides (TG), serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, fasting plasma glucose, and plasma insulin levels were performed.

Results

CA and AA genotypes of FAAH had higher incidence in MetS subjects than in control subjects. CA and AA genotypes of FAAH in subjects with MetS had relatively elevated levels of waist circumference, body mass index, homeostasis model assessment of insulin resistance (HOMA-IR) and serum triglycerides, and lowered level of high-density lipoprotein cholesterol (HDL-c) compared with CC genotype in MetS subjects.

Conclusions

Results suggest that 385 C/A polymorphism of the FAAH gene may confer an increased risk of MetS in the Chinese Han population.     

Antidiabetic and haematinic effects of Parquetina nigrescens on alloxan induced type-1 diabetes and normocytic normochromic anaemia in Wistar rats

Background

The plant, Parquetina nigrescens is used in folklore medicine to treat diabetes mellitus and its complications in several parts of West Africa.

Objective

To determine the effect of Parquetina nigrescens extract on fasting blood glucose in alloxan-induced diabetic rats.

Methods

The blood glucose levels, complete blood count, erythrocyte indices and osmotic fragility, body and organ weights were evaluated.

Results

Diabetic rats treated with the extract showed significant (P<0.01) reduction of the blood glucose to levels comparable to that of the non-diabetic control and those treated with chlorpropamide (standard drug). Similarly, there was significant (P<0.01) reduction in the complete blood count in the diabetic rats.

Discussion

The anaemia, leucopenia and thrombocytopenia associated with the diabetes were corrected in the animals treated with the extract and chlorpropamide. The extract also reduced the erythrocyte osmotic fragility, body and organ weights. Parquetina nigrescens demonstrated antidiabetic property by reducing the elevated blood glucose in alloxan treated rats which is comparable to animals that received the standard drug.

Conclusion

Paraquetina nigrescens stabilized the erythrocyte membrane, decreased the body weight probably by lowering lipogenesis. However, the mechanism underlying the antidiabetic and haematinic properties of Parquetina nigrescens remains to be elucidated.     

The association between estimated average glucose levels and fasting plasma glucose levels

OBJECTIVE:

The level of hemoglobin A1c (HbA1c), also known as glycated hemoglobin, determines how well a patient''s blood glucose level has been controlled over the previous 8–12 weeks. HbA1c levels help patients and doctors understand whether a particular diabetes treatment is working and whether adjustments need to be made to the treatment. Because the HbA1c level is a marker of blood glucose for the previous 60–90 days, average blood glucose levels can be estimated using HbA1c levels. Our aim in the present study was to investigate the relationship between estimated average glucose levels, as calculated by HbA1c levels, and fasting plasma glucose levels.

METHODS:

The fasting plasma glucose levels of 3891 diabetic patient samples (1497 male, 2394 female) were obtained from the laboratory information system at the Izmir Bozyaka Training and Research Hospital in Turkey. These samples were selected from patient samples that had hemoglobin levels between 12 and 16 g/dL. The estimated glucose levels were calculated using the following formula: 28.7 x HbA1c – 46.7. Glucose and HbA1c levels were determined using hexokinase and high performance liquid chromatography (HPLC) methods, respectively.

RESULTS:

A strong positive correlation between fasting plasma glucose levels and estimated average blood glucose levels (r = 0.757, p<0.05) was observed. The difference was statistically significant.

CONCLUSION:

Reporting the estimated average glucose level together with the HbA1c level is believed to assist patients and doctors determine the effectiveness of blood glucose control measures.     

Effects of age on plasma glucose levels in non-diabetic Hong Kong Chinese

Aim

To analyze the relationship between age and plasma glucose levels in Hong Kong Chinese population.

Methods

We performed a cross-sectional study with 15 603 non-diabetic subjects from the community of Hong Kong. Plasma glucose concentration was measured in blood specimens from the subjects. The time of blood taking varied, depending on the availability of the patients.

Results

There were 11 148 (71.4%) women and 4455 (28.6%) men (mean age: 50.1 ± 16.1 years). There were 6901 (44.2%) patients who had plasma glucose measured in the fasting condition, 2999 (19.2%) who were 2-hour post-prandial, and 5703 (36.6%) who had plasma glucose measured at a random time. The correlation coefficients between age and plasma glucose levels in fasting, 2-hour post-prandial, and random group of patients were 0.159, 0.169, and 0.114, respectively (adjusted for body mass index, smoking, and gender; all P values <0.001). Fasting and random plasma glucose level increased by 0.15 mmol/L, while 2-hour post-prandial plasma glucose level increased by 0.26 mmol/L per decade-increase in age.

Conclusion

Plasma glucose levels progressively increase with age in Hong Kong Chinese non-diabetic subjects.Diabetes mellitus is nowadays reaching epidemic proportion in many parts of the world (1). Although the development of hyperglycemia is multi-factorial, insulin resistance and impairment in pancreatic insulin secretion have been among the most commonly reported pathogenetic mechanisms associated with diabetes (2). Aging is thought to be one of the most important factors that affect these mechanisms (3-5).Insulin secretion can be decreased as a consequence of progressive organ impairment which often happens in the old age and can affect the pancreas. On the other hand, aging is one of the major causes for developing insulin resistance (3,4). However, despite the widely reported higher prevalence of diabetes among the elderly, the information on the relationship between age and plasma glucose levels is relatively limited.In this study, we aimed to analyze the relationship between age and plasma glucose levels in 15 603 non-diabetic Hong Kong Chinese.     

Napping Is Associated with Increased Risk of Type 2 Diabetes: The Guangzhou Biobank Cohort Study

Study Objective:

Intentional napping is very common, particularly in China. However, there are limited data regarding its potential health effects. We therefore examined the possible relationship between napping and type 2 diabetes.

Design:

Cross-sectional analysis of baseline data from the Guangzhou Biobank Cohort Study.

Setting:

Community-based elderly association in Guangzhou, China.

Participants:

19,567 Chinese men and women aged 50 years or older.

Measurements and Results:

Self-reported frequency of napping was obtained by questionnaire and type 2 diabetes was assessed by fasting blood glucose and/or self-reports of physician diagnosis or treatment. Participants reporting frequent naps (4-6 days/week and daily) were 42% to 52% more likely to have diabetes. The relationships remained essentially unchanged after adjustments were made for demographics, lifestyle and sleep habits, health status, adiposity, and metabolic markers (odds ratio for diabetes 1.36 [95% CI 1.17–1.57] in 4-6 days/week, 1.28 [1.15–1.44] in daily nappers). Similar associations were found between napping and impaired fasting glucose. Removal of those with potential ill health and daytime sleepiness did not alter the observed associations.

Conclusions:

Napping is associated with elevated prevalence of diabetes and impaired fasting glucose in this older Chinese sample. Our finding suggests that it is less likely that diabetes leads to daytime sleepiness. This raises the possibility that napping may increase the risk of diabetes. Confirmation by longitudinal studies is needed.

Citation:

Lam KbH; Jiang CQ; Thomas GN; Arora T; Zhang WS; Taheri S; Adab P; Lam TH; Cheng KK. Napping is associated with increased risk of type 2 diabetes: the Guangzhou Biobank Cohort Study. SLEEP 2010;33(3):402-407.     

Can fasting plasma glucose and glycated hemoglobin levels predict oral complications following invasive dental procedures in patients with type 2 diabetes mellitus? A preliminary case-control study

OBJECTIVE:

To evaluate the effects of the levels of glycemic control on the frequency of clinical complications following invasive dental treatments in type 2 diabetic patients and suggest appropriate levels of fasting blood glucose and glycated hemoglobin considered to be safe to avoid these complications.

METHOD:

Type 2 diabetic patients and non-diabetic patients were selected and divided into three groups. Group I consisted of 13 type 2 diabetic patients with adequate glycemic control (fasting blood glucose levels <140 mg/dl and glycated hemoglobin (HbA1c) levels <7%). Group II consisted of 15 type 2 diabetic patients with inadequate glycemic control (fasting blood glucose levels >140 mg/dl and HbA1c levels >7%). Group III consisted of 18 non-diabetic patients (no symptoms and fasting blood glucose levels <100 mg/dl). The levels of fasting blood glucose, glycated HbA1c, and fingerstick capillary glycemia were evaluated in diabetic patients prior to performing dental procedures. Seven days after the dental procedure, the frequency of clinical complications (surgery site infections and systemic infections) was examined and compared between the three study groups. In addition, correlations between the occurrence of these outcomes and the glycemic control of diabetes mellitus were evaluated.

RESULTS:

The frequency of clinical outcomes was low (4/43; 8.6%), and no significant differences between the outcome frequencies of the various study groups were observed (p>0.05). However, a significant association was observed between clinical complications and dental extractions (p = 0.02).

CONCLUSIONS:

Because of the low frequency of clinical outcomes, it was not possible to determine whether fasting blood glucose or glycated HbA1c levels are important for these clinical outcomes.     

The impact of metabolic syndrome on metabolic,pro-inflammatory and prothrombotic markers according to the presence of high blood pressure criterion

OBJECTIVES:

We explored whether high blood pressure is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome.

METHODS:

We evaluated 135 consecutive overweight/obese patients. From this group, we selected 75 patients who were not under the regular use of medications for metabolic syndrome as defined by the current Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria. The patients were divided into metabolic syndrome with and without high blood pressure criteria (≥130/≥85 mmHg).

RESULTS:

Compared to the 45 metabolic syndrome patients without high blood pressure, the 30 patients with metabolic syndrome and high blood pressure had significantly higher glucose, insulin, homeostasis model assessment insulin resistance index, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, uric acid and creatinine values; in contrast, these patients had significantly lower high-density lipoprotein-cholesterol values. Metabolic syndrome patients with high blood pressure also had significantly higher levels of retinol-binding protein 4, plasminogen activator inhibitor 1, interleukin 6 and monocyte chemoattractant protein 1 and lower levels of adiponectin. Moreover, patients with metabolic syndrome and high blood pressure had increased surrogate markers of sympathetic activity and decreased baroreflex sensitivity. Logistic regression analysis showed that high-density lipoprotein, retinol-binding protein 4 and plasminogen activator inhibitor-1 levels were independently associated with metabolic syndrome patients with high blood pressure. There is a strong trend for an independent association between metabolic syndrome patients with high blood pressure and glucose levels.

CONCLUSIONS:

High blood pressure, which may be related to the autonomic dysfunction, is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome.     

Insulin Resistance Is an Important Risk Factor for Cognitive Impairment in Elderly Patients with Primary Hypertension

Purpose

Insulin resistance plays a role in the development of dementia and hypertension. We investigated a possible relationship between cognitive impairment and insulin resistance in elderly Chinese patients with primary hypertension.

Materials and Methods

One hundred and thirty-two hypertensive elderly patients (>60 years) were enrolled in this study, and assigned into either the cognitive impairment group (n=61) or the normal cognitive group (n=71). Gender, age, education, body mass index (BMI), waist hip ratio (WHR), total cholesterol (TC), triglyceride (TG), C-reactive protein (CRP), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), creatinine (Cr), fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model of assessment for insulin resistance index (HOMA-IR), systolic blood pressure, diastolic blood pressure, smoking history, atherosclerosis and the proportion of uncontrolled hypertension were compared between the two groups. Multi-factorial logistic regression analysis was performed.

Results

No significant differences were found in gender, age, TC, CRP, HDL-C, LDL-C, Cr, BP, smoking history, atherosclerosis and the proportion of uncontrolled hypertension between the two groups. The cognitive impairment group had lower education levels, and higher BMI, WHR, TG, FPG, FINS, and HOMA-IR levels than the control group. Logistic regression analysis revealed the levels of education, BMI, WHR, and HOMA-IR as independent factors that predict cognitive impairment in patients.

Conclusion

Our study demonstrates that poor education and increased BMI, WHR, and HOMA-IR are independent risk factors for cognitive impairment in elderly patients with hypertension. Insulin resistance plays an important role in the development of cognitive impairment in primary elderly hypertensive patients.     

Cross-sectional pilot study about the health status of diabetic patients in city of Misurata, Libya

Background

Being a leading cause of death worldwide, epidemiological studies about diabetes mellitus have encouraged governments to initiate or improve local diabetes monitoring and prevention strategies.

Objective

The main objective of this study was to examine the profile of diabetic patients in the city of Misurata, the third largest city in Libya.

Methods

260 diabetic cases of both gender randomly selected from the total number of patients admitted to the centre of diabetes and endocrine disorders, Misurata -Libya for the period between January to March 2008. Data collected from patients'' files and by directly questioning the patients. SPSS software version 13 was used for the statistical analysis and presentation of the data.

Results

87% of all patients were type 2 diabetics, while only 9.9% were type 1. 73% of all patients had family history of diabetes. 52% of all diabetic patients were obese, with more obesity in females (70% of females) than males (33.8% of males). Obesity was more pronounced in type 2 patients (56.8%) than in type 1 patients (11.5%). 38% of all patients were treated with insulin while 35.4% were treated with oral hypoglycemics. Meanwhile 32.6% of type 2 diabetic patients were treated with insulin. Only 9.2% of all patients had fasting blood sugar below 140 mg/dl, whereas 55% had levels in the range of 140–180 mg/dl, while 35.8% had levels above 180 mg/dl. Microvascular complications included retinopathy (16.2% of all patients), neuropathy (11.2%), nephropathy (1.5%) and combination of neuropathy and retinopathy (6.5%).

Conclusion

High percentage of risk factors including obesity, family history of diabetes, hypertension and microvascular complications requires a Libyan national policy for the surveillance, prevention and control of diabetes and its complications.     

Effects of twice-daily injections of premixed insulin analog on glycemic control in type 2 diabetic patients

Purpose

Premixed insulin is effective to improve glycemic control; however, clinicians may be less likely to know which premixed insulin is appropriate for which patients. This study aimed to evaluate the effects of twice-daily injections of premixed insulin lispro on glycemic control in type 2 diabetic patients.

Materials and Methods

Forty type 2 diabetic patients, who had been treated with twice-daily injections of human protamine mixture 30/70 insulin for at least 12 months, were divided into two groups; one group whose blood glucose 2 hours after breakfast was greater than 200 mg/dL, was switched to lispro mix50, and the other group whose blood glucose 2 hours after breakfast < 200 was switched to lispro mix25.

Results

Glycated haemoglobin (HbA1c) significantly improved in the Mix50 group from 8.3% to 7.5% (at 12 weeks; p < 0.05), and to 7.5% (at 24 weeks; p < 0.05). On the other hand, HbA1c levels in the Mix25 group were slightly decreased from 8.1% to 7.7% at 12 weeks (p < 0.05), and to 7.9% at 24 weeks (not significant). Both postprandial plasma glucose and fasting plasma glucose levels were significantly improved in the Mix50 group, but not in the Mix25 group. Overall, 95% of subjects preferred premixed lispro insulin from human insulin in the viewpoint of the timing of insulin injection by questionnaire analysis.

Conclusion

Switching from human protamine mixture 30/70 insulin to lispro mix50 twice-daily injection therapy in patients with high postprandial plasma glucose could improve their glycemic control and quality of life.     

Sex difference of type 2 diabetes affected by abdominal obesity versus overall obesity

Purpose

This research compares the predictive value of the abdominal obesity indicator, waist circumference (WC), and the overall obesity indicator, body mass index (BMI), among men and women with regard to type 2 diabetes.

Materials and Methods

This study used data collected from 4,400 households selected by a stratified multistage probability sampling method during the 2001 Korea National Health and Nutrition Examination Survey (KNHANES). The final study sample included 4,684 subjects over 30 years of age who had completed the health examination required for the analysis of the health interview and health behavior surveys.

Results

Both men and women showed significant differences in fasting blood glucose (FBG) or HbA1c levels based on abdominal obesity irrespective of BMI. However, the presence of overall obesity among men with abdominal obesity was not significantly correlated with FBG or HbA1c levels, while the presence of overall obesity among women with abdominal obesity was significantly different in regard to FBG or HbA1c levels.

Conclusion

Both WC and BMI emerged as a measures of risk factors for type 2 diabetes among women while only WC emerged as a risk factor for diabetes among men.     

Association between Serum 25-Hydroxyvitamin D Level and Insulin Resistance in a Rural Population

Purpose

A low serum 25-hydroxyvitamin D [25(OH)D] level in the blood has been correlated with an increased risk of diabetes mellitus; however, the association between serum 25(OH)D level and insulin resistance has not been established in a Korean rural population. The aim of this study was to investigate the independent association between serum 25(OH)D level and insulin resistance in rural Korean adults.

Materials and Methods

This study used data from the Korean Genome Epidemiology Study-Kangwha Study. In the 2011 study, 1200 adults completed health examinations. In an ancillary study, serum 25(OH)D level was measured in a subsample (n=813). After excluding those taking vitamin D supplements, a cross-sectional analysis was carried out on 807 participants (324 men and 483 women) aged 40 to 89 years old. Measured from overnight fasting blood samples, glucose and insulin levels were used to calculate the homeostasis model assessment for insulin resistance (HOMA-IR). Measures of glucose, insulin, and HOMA-IR were log-transformed for parametric tests.

Results

Serum 25(OH)D level was inversely associated with HOMA-IR (β=-0.003, p=0.039) in a univariate analysis. However, the association was not significant after adjustment for sex and age (β=-0.002, p=0.123) or after adjustment for sex, age, body mass index, smoking status, alcohol intake, and regular exercise (β=-0.003, p=0.247).

Conclusion

Our findings suggest that vitamin D is not independently associated with insulin resistance in Korean men and women.