Rosiglitazone improves insulin sensitivity and glucose tolerance in subjects with impaired glucose tolerance

OBJECTIVE: This study was designed to evaluate the effects of rosiglitazone (ROS) on insulin sensitivity, beta-cell function, and glycaemic response to glucose challenge and meal in subjects with impaired glucose tolerance (IGT). METHODS: Thirty patients with IGT (ages between 30 and 75 years and BMI (body mass index) < or = 27 kg/m2) were randomly assigned to receive either placebo (n = 15) or ROS (4 mg/day) (n = 15). All participants underwent a 75-g oral glucose tolerance test (OGTT), meal test, and frequently sampled intravenous glucose tolerance test (FSIGT) before and after the 12-week treatment. RESULTS: After 12 weeks of ROS treatment, there were significant increases in total cholesterol (TC) (4.25 +/- 0.22 vs 4.80 +/- 0.17 mmol/l, P < 0.001), high-density lipoprotein cholesterol (HDL-C) (1.25 +/- 0.07 vs 1.43 +/- 0.06 mmol/l, P < 0.05), and low-density lipoprotein cholesterol (LDL-C) (2.70 +/- 0.15 vs 3.37 +/- 0.17 mmol/l, P < 0.05) without changes in triglyceride concentration, TC/HDL-C and LDL-C/HDL-C ratio. Although the acute insulin response (AIR) to intravenous glucose and disposition index (measured as the ability of pancreatic beta-cell compensation in the presence of insulin resistance) remained unchanged, the insulin sensitivity (SI) and glucose effectiveness (SG) were remarkably elevated (0.38 +/- 0.06 vs 0.54 +/- 0.09 x 10(-5) min(-1)/pmol, P < 0.05; 0.017 +/- 0.002 vs 0.021 +/- 0.001 min(-1), P < 0.05, respectively) in the ROS group. The glucose, insulin, and c-peptide areas under curve (AUC) in response to OGTT and the glucose and insulin AUC during meal were significantly ameliorated in the ROS group. Five out of 15 (33%) and two out of 15 (13%) subjects treated with ROS and placebo, respectively, reversed to normal response during OGTT (P < 0.05). CONCLUSION: Rosiglitazone treatment significantly improved insulin resistance and reduced postchallenge glucose and insulin concentrations in patients with impaired glucose tolerance without remarkable effects on beta-cell secretory function.     

Brachial-ankle pulse wave velocity and systolic time intervals in risk stratification for progression of renal function decline

BackgroundCardiovascular dysfunction was associated with progression of renal function decline. This study was to assess whether combination of brachial-ankle pulse wave velocity (baPWV) and the ratio of brachial pre-ejection period (bPEP) to brachial ejection time (bET) was independently associated with progression of renal function decline.MethodsWe included 363 patients and classified them into four groups according to median values of bPEP/bET and baPWV. Groups 1, 2, 3, and 4 were patients with bPEP/bET and baPWV below the median, bPEP/bET above but baPWV below the median, bPET/bET below but baPWV above the median, and bPET/bET and baPWV above the median, respectively. The decline in renal function was assessed by the estimated glomerular filtration rate (eGFR) slope and the renal end points were defined as commencement of dialysis or ≥25% decline in eGFR. The relative risk of renal end points was analyzed by Cox regression method.ResultsThe eGFR slope was significantly associated with baPWV, bPEP/bET, and patients in groups 2, 3, and 4 (vs. group 1) (P < 0.006). Multivariate forward Cox regression analysis showed that high baPWV, high bPEP/bET, and patients in groups 2, 3, and 4 (vs. group 1) (P ≤ 0.047) were independent predictors of renal end points.ConclusionsOur results demonstrated higher baPWV and bPEP/bET were associated with faster renal function decline and adverse renal end points. Dividing patients into four groups using these two parameters might be useful in risk stratification for progression of renal function decline.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.77.     

Tailored internal limiting membrane flap technique for primary macular hole

Graefe's Archive for Clinical and Experimental Ophthalmology - To investigate the outcomes of primary full-thickness macular hole (MH) after surgical intervention with tailored internal...