Relationship between sex hormones,lipids and visceral fat area in postmenopausal women with type 2 diabetes mellitus

正Objective To study the characteristics and correlation of sex hormone levels,blood lipids,and visceral fat area in postmenopausal women with T2DM.Methods A total of 258 cases of postmenopausal T2DM were recruited,including 46 cases of menopause for 1-5 years(group A),49 cases of menopause for 6-10 years(group B),and 163 cases with menopause more than 10     

绝经后2型糖尿病妇女的下丘脑-垂体-肾上腺轴功能改变与腹型肥胖的关系

目的 探讨绝经后2型糖尿病、肥胖妇女下丘脑-垂体-肾上腺(HPA)轴的功能.方法 比较正常对照组(C组)、糖尿病非肥胖组(DM组)和糖尿病腹型肥胖组(DM+OB组)的一般临床特征、血尿皮质醇及促肾上腺皮质激素(ACTH)的浓度;通过0.25 mg地塞米松抑制试验和口服醋酸可的松试验,观察HPA轴功能的改变.结果 (1)基础状态下,C组、DM组和DM+OB组的血尿皮质醇和ACTH浓度没有差异,但地塞米松抑制试验示DM+OB组血皮质醇显著高于C组(P<0.01),提示糖皮质激素(GC)的负反馈作用受损.(2)口服醋酸可的松试验示肝可的松的转换率DM+OB组、DM组、C组依次降低,其中DM+OB组和C组差别具有统计学意义(P<0.05).(3)垂体前叶激素ACTH、LH、FSH和TSH水平DM+OB组、DM组、C组依次降低,其中DM+OB组LH和FSH水平较C组显著下降(P<0.01).结论 绝经后糖尿病肥胖患者皮质醇的负反馈调节机制受损,并伴有肝11β-羟类固醇脱氢酶1(11β-HSD-1)活性下降.     

Screening for basal metabolic rate and visceral fat among postmenopausal osteoporosis with type 2 diabetes mellitus

BackgroundIn people with type 2 diabetes mellitus, there is an increase in basal metabolic rate (BMR) which is associated with level of glycaemic control. Women with postmenopausal osteoporosis have decreased BMR. The aim of the present study is to find the BMR using Meffin-St Jeor predictive equation in women with type 2 diabetes mellitus (T2DM) who have attained menopause with osteoporosis.Materials & methods100 women who have attained menopause, who were diagnosed to have osteoporosis with type 2 diabetes mellitus were assessed for BMR using Meffin-St Jeor predictive equation. Detailed history of diabetes and menopause were obtained. Blood glucose value was measured using standard glucometers. Body composition for visceral fat (VF) was measured using bioelectrical impedance analysis. Level of physical activity of the participants was measured using global physical activity questionnaire (GPAQ).ResultsThe median BMR of the participants was 1.075 (714, 1483.25). Statistically significant correlation was found between BMR and GPAQ (r_s = 0.731), BMR and VF (r_s = 0.678). However BMR was not correlated with FBS (r_s = 0.083) duration of diabetes (r_s = −0.046).ConclusionThere is a decrease in BMR in women with T2DM with postmenopausal osteoporosis. BMR was significantly correlated with level of physical activity and visceral fat.     

Diabetic retinopathy is associated with visceral fat accumulation in Japanese type 2 diabetes mellitus patients

The presence of diabetic retinopathy (DR) and increased of visceral fat accumulation (VFA) are associated with high mortality in type 2 diabetes mellitus patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and VFA in type 2 diabetes mellitus patients without insulin treatment. A total of 102 type 2 diabetes mellitus patients were divided into 2 groups: DR group (age, 60 ± 6 years [mean ± SD]; n = 31) and no diabetic retinopathy (NDR) group (59 ± 5 years, n = 71). The level of blood glucose was assessed by fasting plasma glucose, fasting immunoreactive insulin, homeostasis model assessment index, and hemoglobin A_1c. The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The body mass index and waist circumference were higher in the DR group than in the NDR group (P < .001 and P < .0005, respectively). Plasma levels of triglyceride were higher, whereas high-density lipoprotein cholesterol was lower, in the DR group than in the NDR group (P < .005 and P < .0001, respectively). Fasting plasma glucose (P < .0005), insulin concentrations (P < .0001), homeostasis model assessment index (P < .0001), and VFA (P < .0001) levels were higher in the DR group than in the NDR group. Multivariate logistic analysis revealed that DR was independently predicted by high VFA and insulin resistance. The results of this preliminary study indicate that the presence of DR was associated with high VFA and insulin resistance in Japanese patients with type 2 diabetes mellitus.     

Metabolic effects of visceral fat accumulation in type 2 diabetes

Visceral fat (VF) excess has been associated with decreased peripheral insulin sensitivity and has been suggested to contribute to hepatic insulin resistance. However, the mechanisms by which VF impacts on hepatic glucose metabolism and the quantitative role of VF in glycemic control have not been investigated. In the present study 63 type 2 diabetic subjects (age, 55 +/- 1 yr; fasting plasma glucose, 5.5-14.4 mmol/liter; hemoglobin A(1c), 6.1-11.7%) underwent measurement of 1) fat-free mass ((3)H(2)O technique), 2) sc and visceral abdominal fat area (magnetic resonance imaging), 3) insulin sensitivity (euglycemic insulin clamp), 4) endogenous glucose output ([(3)H]glucose infusion technique), and 5) gluconeogenesis ((2)H(2)O method). After adjustment for sex, age, body mass index, diabetes duration, ethnicity, and sc fat area, VF area was positively related to fasting hyperglycemia (partial r = 0.46; P = 0.001) as well as to hemoglobin A(1c) (partial r = 0.50; P = 0.0003). Insulin sensitivity was reciprocally related to VF independently of body mass index (partial r = 0.33; P = 0.01). In contrast, the relation of basal endogenous glucose output to VF was not statistically significant. This lack of association was explained by the fact that VF was positively associated with gluconeogenesis flux (confounder-adjusted, partial r = 0.45; P = 0.003), but was reciprocally associated with glycogenolysis (partial r = 0.31; P < 0.05). We conclude that in patients with established type 2 diabetes, VF accumulation has a significant negative impact on glycemic control through a decrease in peripheral insulin sensitivity and an enhancement of gluconeogenesis.     

Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus

The aim of the present study was to investigate the association of serum adiponectin concentration with regional adiposity and insulin resistance in subjects with type 2 diabetes mellitus. A total of 73 Japanese men with type 2 diabetes (aged 59 +/- 11 years and body mass index [BMI] 23.8 +/- 3.0 kg/m(2), mean +/- SD) were studied. Fasting serum adiponectin and leptin concentrations were determined by radioimmunoassay. Regional adiposity was measured by abdominal computed tomography (CT) at the umbilical level, and insulin resistance was estimated by homeostasis model assessment (HOMA-R). Univariate regression analysis showed that serum adiponectin levels were negatively correlated with subcutaneous and visceral fat areas. With multivariate regression analysis, visceral fat area was a predominant determinant of serum adiponectin levels. In contrast, subcutaneous fat area was strongly associated with serum leptin concentrations. Among subcutaneous and visceral fat areas, BMI, and serum leptin levels, both subcutaneous and visceral fat areas were independently associated with HOMA-R. In another model incorporating serum adiponectin levels, serum adiponectin levels were selected as an independent determinant of HOMA-R instead of visceral fat area. In conclusion, hypoadiponectinemia was associated with visceral fat accumulation rather than subcutaneous fat depot in Japanese men with type 2 diabetes mellitus. Both subcutaneous and visceral fat accumulation contribute to insulin resistance in these subjects, and the contribution of visceral fat may be mediated, in part, by hypoadiponectinemia.     

绝经后女性2型糖尿病合并高尿酸血症的相关因素研究

目的探讨绝经后女性2型糖尿病(T2DM)患者合并高尿酸血症(HUA)的相关因素。方法选取绝经后女性T2DM患者365例,依据女性血尿酸是否≥360μmol/L,分为正常尿酸(NUA)组316例和HUA组49例。分析2组临床相关指标及糖尿病慢性并发症和合并症的差异。结果与NUA组比较,HUA组糖尿病视网膜病变(61.2%vs 45.6%)、糖尿病肾病(67.3%vs 12.3%)、颈动脉粥样硬化斑块(65.3%vs 44.9%)、高血压(73.5%vs52.5%)、冠心病(34.7%vs 18.7%)及脂肪肝(61.2%vs 47.5%)的发病率明显升高(P0.05,P0.01)。多元线性回归分析显示,糖化血红蛋白(β=-0.207,P=0.026)、糖尿病病程(β=0.166,P=0.018)、LDL-C(β=0.184,P=0.009)、肌酐(β=0.356,P=0.002)是HUA的独立影响因素。结论绝经后女性T2DM合并HUA患者有较高的大小血管并发症的发生率。     

Serum adiponectin level in osteoporotic postmenopausal women with type 2 diabetes mellitus

Background

Diabetes Mellitus (DM) is a major health burden worldwide. Patients with type 2 DM has various complications, including impaired bone health. Adiponectin is novel adipocytokine that could influence bone metabolism.

2型糖尿病并内脏型肥胖患者内脏脂肪面积的分析

目的探讨2型糖尿病（T2DM）并内脏型肥胖患者的临床特点及内脏脂肪面积的相关性分析。 方法本研究收集2018年5月至2018年9月在山西大同大学第一附属医院住院的共350例T2DM患者的临床资料,测量内脏脂肪面积(VFA)和皮下脂肪面积( SFA),以VFA≥100 cm²作为内脏型肥胖的诊断标准。根据VFA值分为单纯2型糖尿病对照组(VFA<100 cm²)和糖尿病合并内脏型肥胖观察组(VFA≥100 cm²),测定所有患者的身高、体重、体质量指数（BMI）、腰臀比（WHR）及血糖、血脂、肾功能等指标,比较两组间差异。 结果T2DM并内脏型肥胖组中身高、体重、BMI、头围、颈围、腰围、臀围、WHR、VFA、SFA、甘油三脂（TG）、总胆固醇（TC）、血尿酸（UA）、舒张压均高于对照组（P<0.05）,以VFA为应变量,其他各因素为自变量,进行多元线性回归分析：体重、BMI、腰围、TG、舒张压被纳入回归方程,是T2DM并内脏型肥胖的独立危险因素。 结论体重、BMI、腰围、TG、舒张压的增高是VFA的危险因素,与T2DM并腹型肥胖相关。     

Serum DHEA-S level is associated with the presence of atherosclerosis in postmenopausal women with type 2 diabetes mellitus

We investigated the relationship between serum dehydroepiandrosterone-sulfate (DHEA-S) and insulin-like growth factor-I (IGF-I) to various parameters for atherosclerosis in type 2 diabetes. The levels of DHEA-S and IGF-I are known to decrease with aging and thereby might be associated with an increased risk of cardiovascular disease. One hundred forty-eight men and 106 postmenopausal women with type 2 diabetes were assessed in a cross-sectional study. Serum DHEA-S and IGF-I concentrations were measured and brachial-ankle pulse wave velocity (baPWV) and ultrasonographically-evaluated intima-media thickness (IMT) were assessed. Although simple regression analysis showed that log(DHEA-S) and IGF-I in men and log(DHEA-S) in women were significantly and inversely correlated with baPWV and IMT, only log(DHEA-S) in women was still significantly and inversely correlated with these atherosclerotic parameters after multiple regression analysis was adjusted for age, duration of diabetes, BMI, HbA(1C), systolic blood pressure, LDL-Cholesterol (C), serum creatinine, and smoking (Brinkman index). Serum DHEA-S level seemed to be associated with atherosclerosis in diabetic postmenopausal women independent of age, body stature, diabetic status, and other atherosclerotic risk factors, and might be a useful addition to other parameters for assessing the risk of atherosclerosis in this population.     

血清铁蛋白在绝经后女性2型糖尿病并发肌少症患者的变化

目的探讨血清铁蛋白(ferritin,Fer)在绝经后女性2型糖尿病(type 2 diabetes mellitus,T2DM)并发肌少症患者中的变化及意义。方法选取2018年4月至2019年4月于苏州大学附属第一医院内分泌科住院的绝经后女性T2DM患者126例,以体成分分析仪完成身体测量,用电化学发光法测定血清Fer。按亚洲肌少症共识,以身高校正的四肢骨骼肌质量指数(appendicular skeletal muscle mass index,ASMI)及握力定义肌少症。采用数字法随机分为T2DM并发肌少症患者63例(肌少症组),不并发肌少症患者63例(非肌少症组)。比较两组人群一般资料、身体成分、血液学指标的差异,Spearman相关分析血清Fer与其余临床指标的相关性,二元Logistic回归分析绝经后女性T2DM患者并发肌少症的影响因素。结果肌少症组血清Fer较非肌少症组明显升高[214.79 (106.09)μg/L vs. 145.17 (85.04)μg/L,P<0.05]。Spearman相关分析显示血清Fer与病程、全身骨骼肌质量、四肢骨骼肌质量、ASMI、尿酸呈负相关(r=-0.209、-0.337、-0.392、-0.448、-0.214,P<0.05),与年龄、腰臀比、体脂百分比、糖化血红蛋白、游离甲状腺素呈正相关(r=0.181、0.199、0.208、0.201、0.182,P<0.05)。二元Logistic回归分析显示,高体质量指数、高全身骨骼肌质量是绝经后女性T2DM患者并发肌少症的独立保护因素(OR=0.090、0.159,P<0.05),而高血清Fer、高内脏脂肪面积是其独立危险因素(OR=1.021、1.125,P<0.05)。结论绝经后女性T2DM患者的铁蓄积与肌少症指标密切相关,高血清Fer是T2DM并发肌少症的独立危险因素。     

Exercise considerations for postmenopausal women with osteoporosis

Individuals with osteoporosis are at an increased risk of fracture due to a net loss of bone mass. The cellular mechanisms causing decreased bone mass are increased osteoclast-mediated bone resorption and/or decreased osteoblast-mediated bone formation. Clinical studies have shown that bone loss can be prevented by estrogen replacement therapy and calcium supplementation. Weight-bearing and strengthening exercise may also play a role in retarding bone loss in the postmenopausal woman, and it may even increase bone mass. The essential components of an exercise program include intensity, duration, frequency, and type of activity. Additional goals of a therapeutic exercise program are to improve flexibility and balance, and to prevent falls. Structure-function relationships in normal and osteoporotic bone and the effects of exercise on bone are reviewed. A rational approach for exercise strategies is discussed.     

Bone mass and bone resorption in postmenopausal women with type 2 diabetes mellitus

The aim of the present study was to examine the relationships between bone mass or bone resorption evaluated by urinary cross-linked N-telopeptides of type I collagen (NTx) concentration and known and potential contributors to bone mass or bone resorption such as sex hormones, age, duration of diabetes, glycemic control (hemoglobin A(1c) [HbA(1c)]), body mass index (BMI), severity of diabetic complications, smoking status, and current treatment of diabetes in postmenopausal women with type 2 diabetes mellitus (n = 196). In addition, the relationship of bone mass to pulse wave velocity, which is an earlier indicator of cardiovascular disease, was investigated in a subgroup of patients (n = 120). Bone mass was evaluated by the quantitative ultrasound method. A higher stiffness index indicates higher bone mass. Inverse correlations were found between the stiffness index and age (r = -0.374, P < .0001) and between the stiffness index and log (urinary albumin excretion) (r = -0.170, P = .0398), and a positive correlation was found between the stiffness index and serum dehydroepiandrosterone sulfate (DHEA-S) concentration (r = 0.201, P = .0136). No significant correlations were found between the stiffness index and duration of diabetes, HbA(1c), BMI, or serum estradiol concentration. No significant correlations were found between urinary NTx concentration and age, duration of diabetes, HbA(1c), BMI, serum estradiol concentration, or serum DHEA-S concentration. The stiffness index correlated inversely with urinary NTx concentration (r = -0.262, P = .0002). No significant correlation was found between the stiffness index and pulse wave velocity (r = -0.165, P = .0714). Multiple regression analysis demonstrated that serum DHEA-S concentration was an independent determinant of the stiffness index (beta = .207, P = .0428). In conclusion, serum DHEA-S concentration correlated positively with bone mass, whereas glycemic control, BMI, or duration of diabetes did not correlate with bone mass or urinary NTx concentration in postmenopausal women with type 2 diabetes mellitus.     

Correlations of visceral fat accumulation and atherosclerosis in Japanese patients with type 2 diabetes mellitus

We tested the hypothesis that increased abdominal visceral fat accumulation (VFA) is associated with insulin resistance and aortic stiffness in patients with type 2 diabetes mellitus not receiving insulin treatment. The study consisted of 22 Japanese patients with type 2 diabetes mellitus and high VFA (> or =100 cm(2); age, 61 +/- 7 years; high VFA group) and a control group of 18 age-matched patients with normal VFA (<100 cm(2); age, 60 +/- 8 years; normal VFA group). Brachial-ankle pulse wave velocity (BaPWV) was measured by automatic oscillometric method. The BaPWV was used as an index of atherosclerosis. The body mass index values (P < .05), waist circumferences (P < .0005), and waist-to-hip ratios (P < .05) were larger in the high VFA group than in the normal VFA group. The BaPWV was higher in the high VFA group than in the normal VFA group (P < .0001). Fasting plasma glucose (P < .05), insulin concentrations (P < .0001), and the homeostasis model assessment (HOMA) index (P < .001) were higher in the high VFA group than in the normal VFA group. Multiple regression analysis showed that the VFA level was independently predicted by BaPWV and the HOMA index. Our results indicate that the elevation of VFA in Japanese patients with type 2 diabetes mellitus is characterized by increased aortic stiffness and insulin resistance and that BaPWV and the HOMA index are independent predictors of VFA.     

2型糖尿病患者甲状腺激素与内脏脂肪面积的相关性分析

目的探究2型糖尿病患者甲状腺激素与腹部内脏脂肪面积(visceral fat area,VFA)的相关性。方法收集2018年3月至2019年7月在宁波市第一医院纳入标准化代谢性疾病管理中心(National Metabolic Management Center,MMC)的729例2型糖尿病患者,测定甲状腺激素及生化指标,并应用生物电阻抗法测定VFA和皮下脂肪面积(subcutaneous fat area,SFA)。采用Spearman相关性分析和多元线性回归进行分析。结果Spearman相关性分析显示,T3、FT3与VFA呈正相关(r=0.225、0.211,P<0.01),FT4与VFA负相关(r=-0.112,P<0.01),而T4、TSH与VFA无相关性(均P>0.05)。多元线性回归分析显示,FT4、FT3与VFA有独立的相关关系(P<0.01),每增加1 pmol/L FT4,VFA减少1.759 cm^2,每增加1 pmol/L FT3,VFA增加3.256 cm^2。结论2型糖尿病患者的FT3、FT4与VFA相关。     

Elevated vitamin D status in postmenopausal women on thiazolidinediones for type 2 diabetes

Thiazolidenediones (TZD) have been reported to lead to non-vertebral bone loss in postmenopausal women with diabetes, but the true incidence of vertebral fractures has been under-detected because two-thirds of vertebral fractures are silent. TZD is also related to increased adiposity, with a consequently greater risk of vitamin D deficiency-both of which seem to aggravate the untoward effect of TZD on bone. The aim of this study is to determine whether TZD use is associated with prevalence of vertebral fractures and low vitamin D status in postmenopausal women with type 2 diabetes. A group of 102 postmenopausal women with type 2 diabetes, 52 TZD users for at least 12 months, and 50 non-TZD users were enrolled in the study. Any data regarding diabetes, age at menopause, co-morbidities, and drug use were recorded. Blood sampling and thoraco-lumbar radiography were performed. Bone mineral density (BMD) of L2-L4 and the femur were measured by dual-energy X-ray absorptiometry (DXA). The occurrence of vertebral fractures at one level or more in subjects on TZD was higher than those not on TZD, but did not reach statistical significance (19.2 vs. 14.0%, P = 0.5). Total hip BMD in subjects on TZD was significantly lower than those not on TZD (0.96 ± 0.15 vs. 1.02 ± 0.11; P < 0.05). Levels of 25(OH)D in TZD users were significantly higher (35.3 ± 1.5 vs. 25.9 ± 1.2 ng/dl; P < 0.001). The prevalence of vitamin D deficiency was 75.5% in subjects not on TZD compared to 34.6% in those on TZD (OR 6.4, 95% CI 2.6-15.6). Higher circulating 25(OH)D was observed in TZD users. TZD use was associated with lower total hip BMD but not with vertebral fracture.     

Short-term intervention reduces bioelectrical impedance analysis-measured visceral fat in type 2 diabetes mellitus

In 25 patients with Type 2 diabetes mellitus, the short-term in-hospital calorie restriction combined with moderate exercise reduced visceral fat. The reduction of visceral fat can improve metabolic cardiovascular risk factors, while the reductions in body weight and waist circumference were small and reduction in subcutaneous fat was not significant.     

Hyperhomocysteinemia is associated with visceral adiposity in Japanese patients with type 2 diabetes mellitus

This study aims to investigate the relationship between the circulating level of homocysteine and body adiposity in Japanese patients with type 2 diabetes mellitus. We measured the body mass index (BMI), waist and hip circumferences, visceral and subcutaneous adiposities, visceral/subcutaneous (V/S) adiposity ratio, and insulin resistance as assessed by the Homeostasis Model Assessment (HOMA) index in patients with hyperhomocysteinemia. The study group consisted of 17 Japanese patients with type 2 diabetes and hyperhomocysteinemia (age: 62+/-10 years, mean+/-S.D.), and the control group consisted of 24 age-matched type 2 diabetes patients with normohomocysteinemia (60+/-11 years). The visceral adiposity, HOMA index, and V/S ratio were significantly higher in the hyperhomocysteinemia group than in the normohomocysteinemia group (P<0.05). In contrast, the BMI, hip circumference, and subcutaneous adiposity were similar between the two groups (P>0.1). Furthermore, multiple regression analysis showed that hyperhomocysteinemia was closely related to insulin resistance and visceral adiposity. Our results indicate that the presence of hyperhomocysteinemia in our population of Japanese patients with type 2 diabetes-associated insulin resistance was associated with increased visceral but not subcutaneous adiposity.     

Lovastatin effects on bone mineral density in postmenopausal women with type 2 diabetes mellitus

The objective of this study was to examine the effects of lovastatin on bone mineral density (BMD) of postmenopausal women with type 2 diabetes mellitus (DM). The study was an open-label clinical trial conducted from March 2002 to November 2003. Fifty-five postmenopausal women age 54–67 years with type 2 DM were allocated to lovastatin-treated and control (without lovastatin) groups based on low-density lipoprotein cholesterol (LDL-C) >130 or ≤130 mg/dl. The first group received lovastatin (20 mg daily titrated every 3 months to keep LDL-C less than 130 mg/dl) for a total of 18 months. The second group received their own diabetic regimen without statin. The BMD of the lumbar spine (L₁-L₄), femoral neck, Wards triangle, trochanter and total hip was measured by dual-energy X-ray absorptiometry at baseline and after 18 months. In the 28 women treated with lovastatin, the BMD increased in lumbar spine (from 0.946 (0.122) to 0.978 (0.135) g/cm², p<0.01) and Ward’s triangle (from 0.685 (0.123) to 0.780 (0.186) g/cm², p<0.01). In the 27 women not treated with statin, the changes in BMD at all bone sites were not statistically significant. BMD was higher in femoral neck (1.2% vs. −2.7%, p<0.05), Ward’s triangle (13.9% vs. 3.3%, p<0.05), trochanter (−0.1% vs. −2.9%, p<0.05), total hip (1.2% vs. −1.4%, p<0.05) and lumbar spine (3.4% vs. 1.2%, p>0.05) at the end of the study. Treatment with lovastatin may prevent bone loss in postmenopausal women with type 2 DM.