Elevated serum ceruloplasmin levels are associated with albuminuria in Korean men with type 2 diabetes mellitus

The aim of this study was to examine the possible association between serum ceruloplasmin, a copper carrying protein, and albuminuria in 456 males with type 2 diabetes. Multivariate regression analysis demonstrated that elevated serum ceruloplasmin was a determinant of albuminuria independently of conventional risk factors.     

Apolipoprotein (a) levels in type 1 and type 2 diabetes mellitus

Type 1 and type 2 diabetes mellitus are both characterized by increased cardiovascular mortality and morbidity. Since several reports have indicated that apolipoprotein (a) [apo (a)] levels are positively associated with an increased risk of macrovascular disease, we investigated whether apo (a) levels are elevated in both types of diabetes mellitus and may thus represent an independent risk factor for atherosclerotic disease. Apo(a) concentrations in type 1 diabetic patients were not significantly different from matched controls (276±78 vs 149±46 units/l). Type 2 diabetic patients had considerably higher levels of apo (a) than matched controls (471±89 vs 221±61 units/l,P=0.06), though the difference was not statistically significant. However, concentrations of apo (a) were above 300 units/l in 36% of type 1 and 67% of type 2 diabetic patients, but in only 14% and 25% respectively of matched control subjects. Plasma triglycerides were positively and independently correlated with apo (a) levels in both diabetic and non-diabetic subjects. On the other hand, no significant correlation was found between apo (a) levels and glycosylated haemoglobin, total cholesterol or high density lipoprotein cholesterol in any of the groups studied. In conclusion, apo (a) levels are not significantly elevated either in type 1 or type 2 diabetic patients without proteinuria and in moderate metabolic control; however, levels above 300 units/l were 2.6 times more frequent in both types of diabetes mellitus than in carefully age-, sex-, and weight-matched control subjects.     

Plasma lipid peroxidation products and antioxidant enzyme activities in patients with type 2 diabetes mellitus

Diabetes is associated with a significant increase in thiobarbituric acid reactive substances (TBARS) which are considered as an index of endogenous lipid peroxidation. The human body has a complex antioxidant defense system that prevents the initiation of free radical chain reactions. We measured plasma TBARS levels, superoxide dismutase (SOD) and catalase (CAT) activities and ocmpared their relation to the metabolic control of diabetes and diabetic microangiopathy. Sixty-four patients (19 men), aged 52.35±9.31 years with type 2 diabetes mellitus were included in the study. Thirty-six healthy subjects (12 men), aged 51.02±7.01 years formed the control group. TBARS levels and SOD activity were elevated in the diabetic group when compared with the control group (p<0.001 and p<0.00001, respectively). However CAT activity was significantly decreased in the diabetic group when compared with the control group (p<0.00001). Patients with diabetic nephropathy and retinopathy, but not neuropathy, had elevated TBARS levels but there was no statistically significant difference when compared with diabetic patients without microangiopathy (p>0.05). There was a positive correlation between plasma TBARS levels and SOD activity (r=0.770, p=0.0001) and a negative correlation between plasma TBARS levels and CAT activity (r=0.482, p=0.0001). There was also a negative correlation between SOD and CAT activities (r=−0.609, p=0.0001). We found significantly elevated TBARS levels in diabetic patients. We did not observe any correlation between TBARS levels and blood glucose and HbA_1c levels. Elevated TBARS levels and SOD activity and decreased CAT activity may be due to a compensation mechanism of the body. Received: 15 February 2001 / Accepted in revised form: 9 May 2002     

Treatment regimens with insulin analogues and haemoglobin A1c target of <7% in type 2 diabetes: A systematic review

We conducted a systematic review of randomized controlled trials that evaluated the effectiveness of insulin regimens (basal, biphasic, prandial, and basal-bolus) with insulin analogues to reach the haemoglobin A1c target of <7% in patients with type 2 diabetes. We identified 48 trials, with 85 arms and 30,588 patients. There were 38 arms using basal insulin, with 17,588 patients, and a primary outcome of 41.4% (95% CI = 35.6-47.4%); 26 arms using biphasic insulin, with 9237 patients, and a primary outcome of 46.5% (40.8-52.3%); 9 arms using prandial insulin, with 1605 patients, and a primary outcome of 39.6% (95% CI, 28.6-51.3%); and 12 arms using basal-bolus insulin, with 2114 patients, and a primary outcome of 53.9% (43.5-64). The high heterogeneity was related, in part, to first time insulin use, final insulin dose, and use of oral drug. The overall incidence of hypoglycaemia ranged from 0 to 4.71 events/patient/30 days; weight gain ranged from 1.75 kg for basal to 3 kg for biphasic insulin. The HbA1c target of <7% can be achieved in a percentage of type 2 diabetic patients ranging from 40% to 54% depending on the particular insulin regimen.     

A comparative study of the clinical profile of fibrocalculous pancreatic diabetes and type 2 diabetes mellitus

AimsThe present study aimed to compare the clinical characteristics of patients with fibrocalculous pancreatic diabetes (FCPD) and those with type 2 diabetes mellitus (T2DM) to identify the characteristics distinctive of FCPD.MethodsA total of 133 patients with FCPD were compared with 665 patients with T2DM matched for duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular and macrovascular complications in both groups.ResultsThe mean duration of diabetes was 4.42 ± 5.65 years in the FCPD group and 4.51 ± 3.88 years in the T2DM group. FCPD participants were significantly younger at diagnosis and leaner than patients with T2DM. The FCPD group had higher fasting and postprandial glucose and HbA1c levels than the T2DM group. The FCPD group had significantly lower triglyceride, total cholesterol, low-density lipoprotein cholesterol, serum total calcium, hemoglobin, and serum creatinine values than the T2DM group. The prevalence of coronary artery disease, stroke, and retinopathy was significantly higher in the T2DM patients while the prevalence of distal symmetric polyneuropathy was significantly lower. On multivariate logistic regression analysis, duration of diabetes and HbA1c (OR = 1.17, P = 0 0.04) in FCPD patients and age (OR = 1.04, P < 0 0.001), duration of diabetes (OR = 1.17, P < 0 0.001) and HbA1c (OR = 1.28, P < 0.001) in T2DM patients were associated with microvascular complications.ConclusionsThere are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM. Timely diagnosis may have implications in the follow-up and management of patients.     

Hematological profile associated with type 2 diabetes mellitus

Background

Hematological changes affecting blood cells and the coagulation factors are shown to be associated with diabetes mellitus. We investigated some of the hematological risk factors implicated in the development of type 2 diabetes mellitus.

Clinical implication of alterations in serum Klotho levels in patients with type 2 diabetes mellitus and its associated complications

Aim

To investigate the clinical significance of serum α-Klotho and β-Klotho levels in patients with type 2 diabetes mellitus (T2DM) and its associated complications.

Circulating leptin and insulin in obese patients with and without type 2 diabetes mellitus: relation to ghrelin and oxidative stress

Aim

This case control study aimed to investigate relationship between appetite hormones (ghrelin and leptin) and body mass index (BMI), insulin and oxidative stress in simple obese and type 2 diabetes (T2DM) obese patients.

Methods

Thirty healthy controls; 30 simple obese and 30 T2DM obese patients were enrolled. Demographic and clinical data of all participants were reported. Serum levels of fasting blood glucose (FBG), postprandial blood glucose (PBG), lipid peroxide (LPO) and nitric oxide (NO) were measured by chemical methods while, insulin, leptin and ghrelin by ELISA kits.

Results

Serum levels of insulin, leptin, LPO were significantly higher while, ghrelin was significantly lower in simple obese and obese patients with diabetes versus controls. Insulin resistance was found in 76.67% simple obese and 93.33% obese patients with diabetes. Ghrelin showed a positive correlation with PBG in controls; but negative correlation with BMI in simple obese and with NO in obese patients with diabetes. Positive correlations were found between LPO and FBG, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and between leptin and FBG in obese patients with diabetes.

Conclusions

Our results suggested that hyperinsulinemia and hyperleptinemia may be most important mechanisms in decreasing ghrelin and inducing oxidative stress in simple obese and T2DM obese patients.     

2型糖尿病全天血糖水平与糖化血红蛋白血糖漂移幅度的相关性分析

目的探讨2型糖尿病（T2DM）患者日内不同时间的血糖水平与糖化血红蛋白（HbA1c）及血糖漂移幅度的关系。方法选取2002年12月至2005年10月上海交通大学附属第六人民医院内分泌代谢科新诊断T2DM患者60例，采用动态血糖监测系统（CGMS）进行持续3d的血糖监测并分析日内不同时点、时段的血糖水平、HbA1c、餐后血糖漂移幅度（PPGE）及平均血糖漂移幅度（MAGE）之间的关系。结果（1）他DM患者HbA1c与全天8次血糖水平均呈显著正相关（r=0．62～0．70，P均〈0．01），与PPGE不相关（P〉0．05），逐步回归分析显示空腹及中、晚餐后2h血糖进入最后的方程（校正R^2=0.566，P〈0．01）。（2）HbA1c与全天不同时段的平均血糖水平均呈显著正相关（r=0．57～0．74，P均〈0．01），晚餐前1h、晚餐后2～3h及晨3：00～6：00时间段的平均血糖水平是其独立影响因素。（3）CGMS所示的日内平均血糖水平与HbA1c相关性最强（r=0．81，P〈0．01）。（4）MAGE与HbA1c不相关（P〉0．05），三餐PPGE及晨3：00的血糖水平为影响MAGE的独立参与因素（校正R^2=0．427，P〈0．01）。结论T2DM患者HbA1c与全天平均血糖水平的关系最密切，而日内血糖的漂移变化主要归因于餐后及夜间血糖的漂移。因此，他DM的血糖监测及干预治疗应针对全天血糖谱。     

Comparison of effects of anagliptin and alogliptin on serum lipid profile in type 2 diabetes mellitus patients

Introduction

Anagliptin (ANA) improves dyslipidemia in addition to blood glucose levels. However, there are no comparative studies on the effects of ANA and other dipeptidyl peptidase‐4 inhibitors on serum lipid profile. We compared the effects of ANA on serum lipid profile with those of alogliptin (ALO) in type 2 diabetes mellitus outpatients.

Materials and Methods

The study participants were 87 type 2 diabetes mellitus patients who had been treated with dipeptidyl peptidase‐4 inhibitors for ≥8 weeks and had a low‐density lipoprotein cholesterol (LDL‐C) level of ≥120 mg/dL. Participants were switched to either 200 mg/day ANA or 25 mg/day ALO for 24 weeks.

Results

There was no significant difference in percentage change in LDL‐C level at 24 weeks between the ANA and ALO groups. Treatment with ANA for 12 weeks significantly decreased LDL‐C levels, one of the secondary end‐points. Treatment with ANA for 24 weeks significantly improved apolipoprotein B‐100 levels, and the percentage change in LDL‐C levels at 24 weeks correlated significantly with the percentage change in apolipoprotein B‐100 levels in the ANA group.

Conclusions

The LDL‐C‐lowering effects of ANA and ALO at 24 weeks were almost similar in patients with type 2 diabetes mellitus. However, the results showed a tendency for a decrease in LDL‐C level at 24 weeks in the ANA group, and that such improvement was mediated, at least in part, through the suppression of apolipoprotein B‐100 synthesis.     

Effect of ciprofibrate on lipoprotein metabolism and oxidative stress parameters in patients with type 2 diabetes mellitus and atherogenic lipoprotein phenotype

The effect of ciprofibrate therapy on plasma lipids and lipoproteins, HDL and LDL subfraction profile, fractional esterification rate of HDL cholesterol (FER_HDL) and the resistance of LDL and serum lipids to oxidation was studied in 24 males with type 2 diabetes and atherogenic lipoprotein phenotype (ALP). We also examined the effect of ciprofibrate therapy on oxidative DNA damage in peripheral lymphocytes. No differences in glucose, HbA1C and BMI levels were found after three months of ciprofibrate therapy. Ciprofibrate significantly decreased total cholesterol and triglyceride levels by 5.5% and 50% (p = 0.05; 0.001, respectively) and increased HDL-cholesterol levels by 8.5% (p = 0.05). FER_HDL and LDL subfraction profile were also favorably affected, However, no effect on HDL subclasses was found. There were no statistically significant differences in lipid resistance to oxidation measured in serum and in LDL (lag time and V_max) before and after therapy. No significant effect of ciprofibrate was found on oxidative DNA damage. The evaluation of the relationship between oxidative damage purines with lag time in LDL and maximal rate of serum lipid oxidation showed significant correlations after therapy (r = −0.58; 0.47, p = 0.01; 0.05, respectively), but only trends before starting ciprofibrate treatment. Type 2 diabetes mellitus represents a complex metabolic disorder expressed in glucose and lipoprotein disturbances and increased oxidative stress. Ciprofibrate therapy favorably affected major features of lipid abnormalities of diabetic patients, but the level of oxidative stress assessed by in vitro and in vivo methods was not changed. The evaluation of expected logical correlations between the parameters of lipoprotein metabolism, lipid resistance in serum and LDL, and oxidative DNA damage showed that those correlations were more relevant and significant after ciprofibrate treatment and were not related with glucose homeostasis. Received: 13 March 2000 / Accepted in revised form: 7 November 2000     

糖化血红蛋白在急性心肌梗死中的应用价值

糖化血红蛋白(HbA1c)是衡量血糖控制的重要标准,糖尿病是冠心病的等危症,HbA1c对急性心肌梗死的发病,紧急支架置入术后再狭窄及无复流发生具有预见性.     

Ⅱ型糖尿病合并高血压对脂代谢及胰岛素敏感性的影响

目的：观察Ⅱ型糖尿病合并高血压对脂代谢及胰岛素敏感性的影响。方法：对20例Ⅱ型糖尿病合并高血压患者和20例Ⅱ型糖尿病无高血压患者的空腹血糖（FBG）,血脂,胰岛素（FINS）,C肽（FCP）,胰岛素敏感指数（ISI）进行对照,结果：Ⅱ型糖尿病合并高血压组与无高血压组比较,甘油三酯（TG）,FINS,FCP水平显著升高（P＜0．05）,高密度脂蛋白（HDL）,ISI水平显著降低（P＜0．05）,结论：Ⅱ型糖尿病合并高血压时脂代谢紊乱及胰岛素抵抗更加明显。     

2型糖尿病合并脑梗塞与血脂、血压分析

分析2型糖尿病合并脑梗塞与血脂、血压异常的关系.收集我院2型糖尿病患者100例,其中合并脑梗塞者60例,正常对照组40例.分别测定血脂、血压并进行比较.结果糖尿病合并脑梗塞组血甘油三酯、载脂蛋白B、收缩压明显升高,高密度脂蛋白、载脂蛋白A1显著降低.血甘油三酯、收缩压升高、高密度脂蛋白降低是糖尿病并发脑梗塞的危险因素.     

2型糖尿病患者血瘦素水平与高血压的相关性研究

选择122例2型糖尿病患者,分为合并高血压组和血压正常组,各组又分别分为肥胖和非肥胖亚组.测定其体重指数(BMI)、空腹血糖(FBG)和胰岛素、糖化血红蛋白(HbA1c)及血清瘦素水平,并作相关性分析.结果显示,2型糖尿病患者高血压组与非高血压组间血清瘦素水平无差异(P＞0.05);血清瘦素水平与BMI、空腹胰岛素呈正相关关系(P＜0.01),与血压无明显相关性(P＞0.05);但在合并高血压组,血清瘦素水平与HbA1c呈负相关关系(P＜0.05).提示2型糖尿病患者的血清瘦素水平与血压无明显相关性,但合并高血压患者长时间血糖控制不良可能会导致血清瘦素水平的下降.     

The impact of Ramadan fasting on metabolic profile among type 2 diabetes mellitus patients: A meta-analysis

Background and aimsMajority of Muslims with type 2 diabetes mellitus (T2DM) fasted during Ramadan regardless of possible risk of complication. This systematic review aims to assess the impact of Ramadan fasting on metabolic profile and hypoglycemia event among T2DM patients.MethodsLiterature searching was conducted on December 2019 at PUBMED, Medline (EBSCOhost), and ProQuest databases using the following keywords: Ramadan fasting, type 2 diabetes mellitus, glycemic and lipid profile, anthropometry measurements, and hypoglycemia. Observational studies in adults and published in English which analyze the glucose parameters, lipid profile, and hypoglycemia among T2DM patients during Ramadan were included in the analysis. All studies were assessed for its risk of bias using New-Castle Ottawa Scale. The heterogeneity of the studies was analyzed using I² (square) test and the overall mean difference between studied parameters before and after Ramadan fasting was calculated using Weighted Mean Difference (WMD) test using Stata 13.ResultsA total of 28 observational studies that were conducted in Middle Eastern, African, and Asian countries were included. This review found decrease in FPG level by −15.28 (95% CI -17.22, −13.34) mg/dl, HbA1c by −0.27 (95% CI -0.32, −0.22)%, total cholesterol by −12.88 (95% CI -14.68, −11.09) mg/dL, LDL-C by −4.42 (95% CI -6.17, −2.66)mg/dl, HDL-C by −1.09 (95% CI -1.71 – 0.47) mg/dL, triglyceride by −2.47 (95% CI -3.69 – 1.24) mg/dL and decreased anthropometry measurement. No studies reported fatal hypoglycemia event.ConclusionsRamadan fasting resulted in slight improvement of overall metabolic profile and anthropometry among T2DM patients with relatively low incidence of hypoglycemia.     

Glycohemoglobin A1c: A promising screening tool in gestational diabetes mellitus

CONTEXT:

Current screening tests for gestational diabetes mellitus (GDM) are inconvenient. Therefore, alternative screening tests for GDM are desirable. The use of glycohemoglobin A1c (HbA1c) in screening for GDM remains controversial.

AIM:

We undertook this study to evaluate the utility of HbA1c in screening for GDM.

SETTINGS AND DESIGN:

Retrospective study in a tertiary teaching hospital.

MATERIALS AND METHODS:

Laboratory records were reviewed to identify pregnant women who underwent both oral glucose tolerance test (OGTT) and HbA1c measurements over a 16-months period. The association of OGTT with HbA1c was evaluated.

STATISTICAL ANALYSIS USED:

Data were collected using SPSS software. Comparisons of the means and calculations of sensitivities were performed.

RESULTS:

Of 145 eligible patients, 124 had GDM and 21 patients did not, per OGTT. The percentages of patients with HbA1c values (reference range of 4.8%–6.0%) equal to or above sequential cut-point values of 5.0%, 5.5%, 6.0%, 6.5% and 7.0% (i.e., sensitivity values) were 100%, 98.4%, 87.1%, 62.9% and 39.5%, respectively. The mean HbA1c of the patients with GDM was 6.9 + 0.8% compared to 6.4 + 0.6% for those without GDM (P< 0.006). At an arbitrary cut-off value of 6.0% (the upper limit of normal), HbA1c would have picked up 87.1% of patients with GDM.

CONCLUSIONS:

This study suggests that HbA1c is a reasonably sensitive screening measure of GDM in this high-risk population. Acknowledging limitations resulting from the study design, further prospective studies are warranted to verify this conclusion, and to evaluate the specificity of HbA1c as a screening test for GDM.     

2型糖尿病胰岛细胞胰岛素抵抗的机制

胰岛素抵抗是2型糖尿病(T2DM)主要病理生理机制之一.肝脏、肌肉和脂肪组织存在胰岛素抵抗.近年来研究显示,胰岛α细胞与β细胞也存在胰岛素抵抗.高糖、高游离脂肪酸(FFA)、氧化应激、炎性反应均可导致胰岛素抵抗:高糖作用可下调胰岛α、β细胞磷脂酰肌醇3激酶(PI3K)/蛋白激酶B(PKB)途径;高FFA抑制胰岛素受体底物(IRS)及PI3K活性;氧化应激使胰岛α、β细胞的IRS表达下降;炎性因子可干扰IRS/PI3K信号通路.     

2型糖尿病相关因素与sICAM-1关系的探讨

为探讨2型糖尿病(DM)患者可溶性细胞间粘附分子(sICAM—1)水平变化及其与血糖代谢控制、胰岛素抵抗(IR)、血压(BP)、体重指数(BMI)的关系，采用酶联免疫吸附法测定51例2型DM患者及20例查体健康者的血清sICAM—1水平，同时检测其空腹胰岛素(FIN)、糖化血红蛋白(GHbAlc)、空腹血糖(FPG)、Bp、BMI。结果显示，2型DM患者血清sICAM—1显著高于正常对照组(P＜0．01)，且血清sICAM—1与BMI、GHbAlc及收缩压呈正相关，相关系数r分别为0．441、0．435、0．311，P＜0．01、0．01、0．05。提示2型DM血清sICAM—1水平升高可能由肥胖和高血糖引起，控制血糖、减轻体重有助于降低sICAM—1。