Prevalence of diabetes and impaired glucose regulation in 45- to 64-year-old individuals in three areas of Finland.

AIMS: To determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) and possible regional differences in Finnish adults aged between 45 and 64 years. METHODS: A population sample of 2642 subjects aged between 45 and 64 years living in three geographical areas in Finland was invited to an oral glucose tolerance test. RESULTS: The glucose tolerance status of 2087 subjects (79.0%) was determined. The age-standardized prevalence of DM in men and women was 10.2% and 7.4%, respectively (P = 0.020 for difference between sexes), and that of IGT 10.5% in men and 9.2% in women. IFG in men was more than twice as common as in women (13.5% vs. 5.0%, respectively, P < 0.001). Abnormal glucose tolerance was most common in southern compared with southwestern and eastern Finland. Of all diabetic subjects, 44% were previously undiagnosed. CONCLUSIONS: The age-standardized prevalence of DM in 45- to 64-year-old Finns was within the range defined in previous studies on Europid populations. DM and IFG were more common in men than in women. Regional differences in the prevalence of abnormal glucose regulation suggest differences in lifestyle within an ethnically homogenous population.     

Lack of glucagon response in glucose counter-regulation in Type 1 (insulin-dependent) diabetics: Absence of recovery after prolonged optimal insulin therapy

Summary Mild hypoglycaemia was induced using an artificial pancreas in five normal subjects (from 5.00 ±0.15 to 2.83±0.15 mmol/l) by infusing 28 mU/m² per min soluble insulin for 60 min. Six Type 1 (insulin-dependent) diabetic patients were stabilized for 14h using an artificial pancreas. They were then rendered hypoglycaemic (from 4.94±0.09 to 2.89±0.11 mmol/l) by infusing 28mU/m² per min plus 16 ±3.8mU/min insulin for 60 min. Before the study, the diabetic patients were in optimal blood glucose control (mean blood glucose 6.72±0.11 mmol/l over the previous 14–20 days; HbA₁ 8.3±0.1%). During the insulin infusion test, blood glucose decrement was slower in the diabetic patients than in the control subjects. The blood glucose nadir was delayed in the diabetics until 75 min compared with 55 min in the control subjects. Blood glucose recovery rate in the diabetic subjects was severely impaired. In Type 1 diabetes, the counter-regulatory hormonal response to insulin induced hypoglycaemia is similar to that of non-diabetics, except for that of glucagon, the blunted response of which is not reversed by prolonged optimisation of blood glucose control. This impaired response of the A cell does not seem to be a consequence of insulin deficiency.     

The plasma C-peptide and insulin responses to stimulation with intravenous glucagon and a mixed meal in well-controlled Type 2 (non-insulin-dependent) diabetes mellitus: dependency on acutely established hyperglycaemia

Summary The dose-response relationships between acutely established hyperglycaemia and the plasma C-peptide and insulin responses to i. v. stimulation with 1 mg of glucagon and a standard mixed meal were investigated in 10 patients with well-controlled Type 2 (non-insulin dependent) diabetes mellitus. Hyperglycaemia was maintained for 90 min before stimulation using a hyperglycaemic clamp technique. Each test was performed on different steady state blood glucose levels of 6 mmol/l, 12 mmol/l, and 20 mmol/l, respectively. The plasma C-peptide and insulin responses after glucagon and the meal were potentiated markedly at each level of prestimulatory hyperglycaemia. After glucagon injection, the relative glucose potentiation of the insulin response was significantly higher than the relative glucose potentiation of the C-peptide response at each level of hyperglycaemia (p<0.01). This difference may be explained by a higher fractional hepatic removal of insulin at normoglycaemia, since the molar ratio between the incremental C-peptide and insulin responses after glucagon stimulation was higher at prestimulatory normoglycaemia (4.85 (3.65–12.05)) than at the prestimulatory blood glucose concentrations 12 mmol/l (2.41 (2.05–4.09)) (p< 0.01) and 20 mmol/l (2.24 (1.37–3.62)) (p<0.01). In conclusion, the islet B-cell responses to glucagon and a standard mixed meal are potentiated to a high degree by acutely established prestirnulatory hyperglycaemia in patients with well-controlled Type 2 diabetes. Acute prestirnulatory hyperglycaemia is also associated with a markedly reduced incremental C-peptide/insulin ratio after glucagon stimulation in such patients. Measurement of the insulin response after i. v. glucagon injection at acute hyperglycaemia compared with the response at normoglycaemia therefore seriously overestimates the relative glucose potentiation of pancreatic B-cell responsiveness in patients with well-controlled Type 2 diabetes.     

Studies on the mechanism of xylitol-induced insulin secretion in dogs

Summary The effect of infusion of small doses of xylitol into the pancreatic artery upon insulin release was studied in anaesthetized dogs, in order to decide whether the strong insulin-releasing effect of xylitol in dogs is mediated by a direct action of xylitol upon the islets or indirectly by some of its metabolites. Xylitol or glucose was infused at 0.5–1.0 mg/kg · min either into the femoral vein or into the superior pancreaticoduodenal artery, and the changes in plasma insulin were measured in the superior pancreaticoduodenal vein. Infusion into the pancreatic artery always resulted in a sharp increase in insulin release, whereas intravenous infusion caused no or little increase. Infusion of xylitol into the superior pancreaticoduodenal artery produced a prompt increase in plasma insulin in the superior pancreaticoduodenal vein but not in the splenic vein. These data suggest that xylitol has a direct stimulatory effect upon islet cells. — During intravenous infusion of epinephrine (1.0 g/kg. min), plasma insulin did not increase despite intravenous administration of glucose or xylitol (0.4 g/kg). There was a rebound rise of plasma insulin after cessation of epinephrine infusion. Plasma insulin responses to intravenous injection of glucose or xylitol (0.4 g/kg) were inhibited also by the intravenous infusion of diazoxide (0.2 mg/kg · min), but this was somewhat variable among individual dogs. The suppression by epinephrine or diazoxide of both glucose and xylitol-induced hyperinsulinaemia may suggest that there is some common mechanism between the insulin-releasing effects of glucose and xylitol.

---

Untersuchungen zum Mechanismus der verstärkten Insulinsekretion unter Xylit

Zusammenfassung An anaesthesierten Hunden wurde die Wirkung der Infusion kleiner Xylit-Mengen in die Pankreasarterie auf die Insulinfreisetzung untersucht, um zu klären, ob das Xylit direkt oder über einen seiner Metabolite auf die Insulinausschüttung wirkt. Xylit oder Glucose wurde in Mengen von 0.5–1.0 mg/kg/min entweder in die Femoralvene oder in die A.pankreaticoduodenalis sup. infundiert und die Änderung des PlasmaInsulins in der V.pankreatico-duodenalis sup. gemessen. Zufuhr über die Pankreasarterie löste immer eine abrupte Steigerung der Insulinfreisetzung aus, während intravenöse Gaben zu keinem oder nur einem geringen Anstieg führten. Die Xylit-Infusion in die A.pankreaticoduodenalis sup.bewirkte zwar eine prompte Steigerung der Plasma-Insulinspiegel in der V.pankreatico duodenalis sup., nicht aber in der Milzvene. — Diese Befunde sprechen dafür, daß Xylit die Inselzellen direkt stimuliert. Während einer i.v.Infusion von 1.0 g/kg/min Adrenalin stieg das Plasma-Insulin trotz intravenöser Zufuhr von 0.4 g/kg Glucose oder Xylit nicht an. Nach Beendigung der Adrenalin-Infusion wurde ein verstärkter Wiederanstieg des Plasma-Insulins beobachtet. Auch durch i.v.Gaben von 0.2 mg/kg/min Diazoxid ließ sich die Wirkung der Infusion von 0.4 g/kg Glucose oder Xylit unterdrükken, wobei sich jedoch Unterschiede zwischen den einzelnen Tieren ergaben. Die Aufhebung des Xylit- u. Glucose-Effektes auf die Insulinsekretion durch Adrenalin und Diazoxid könnte darauf hinweisen, daß die Steigerung der Insulinfreisetzung durch Glucose und Xylit auf einem gemeinsamen Mechanismus beruht.

---

Etudes sur le mécanisme de la sécrétion d'insuline provoquée par le xylitol chez des chiens

Résumé L'effet sur la sécrétion d'insuline de l'infusion de petites doses de xylitol dans l'artère pancréatique a été étudié chez des chiens anesthésiés, afin de savoir si l'effet fortement insulino-sécréteur du xylitol chez les chiens est dû à une action directe du xylitol sur les îlots ou à une action indirecte par l'intermédiaire de certains de ses métabolites. Le xylitol ou le glucose était infusé la dose de 0.5–1.0 mg/kg. min, soit dans la veine fémorale, soit dans l'artère pancréatico-duodénale supérieure, et les variations de l'insuline plasmatique étaient mesurées dans la veine pancréatico-duodénale supérieure. L'infusion dans l'artère pancréatique provoquait toujours une rapide augmentation de la sécrétion d'insuline, tandis que l'infusion intraveineuse ne causait pas ou peu d'augmentation. L'infusion de xylitol dans l'artère pancréaticoduodénale supérieure provoquait une augmentation prompte de l'insuline plasmatique dans la veine pancréatico-duodénale supérieure, mais pas dans la veine splénique. Ces données suggèrent que le xylitol a un effet stimulateur direct sur les cellules des îlots. — Pendant l'infusion intraveineuse d'adrénaline (1.0 g/kg. min), l'insuline plasmatique n'augmentait pas malgré l'administration intraveineuse de glucose ou de xylitol (0.4 g/kg). Après l'arrêt de l'infusion d'adrénaline, l'insuline plasmatique présentait un phénomène de rebound. Les réponses de l'insuline plasmatique l'injection intraveineuse de glucose ou de xylitol (0.4 g/kg) étaient également inhibées par l'infusion intraveineuse de diazoxide (0.2 mg/ kg. min), mais ceci était un peu variable selon les chiens. La suppression par l'adrénaline ou le diazoxide de l'hyperinsulinémie provoquée par le glucose et le xylitol peut suggérer qu'il existe un mécanisme commun entre les effets insulino-sécréteurs du glucose et du xylitol.

     

C反应蛋白和高密度脂蛋白对血凝素样氧化型低密度脂蛋白受体1表达的影响

目的观察C反应蛋白和高密度脂蛋白对单核细胞株THP-1来源的巨噬细胞血凝素样氧化型低密度脂蛋白受体1蛋白和mRNA表达的影响,以及血凝素样氧化型低密度脂蛋白受体1表达的变化与细胞内胆固醇含量变化的关系。方法THP-1单核细胞株经佛波酯诱导分化为巨噬细胞。用不同浓度C反应蛋白或高密度脂蛋白在体外干预巨噬细胞,测定干预前后巨噬细胞血凝素样氧化型低密度脂蛋白受体1蛋白和mRNA表达的变化,并采用高效液相色谱测定巨噬细胞内胆固醇含量的变化。结果与对照组相比,C反应蛋白或高密度脂蛋白均可以诱导THP-1来源的巨噬细胞血凝素样氧化型低密度脂蛋白受体1蛋白和mRNA表达增加(P<0.05),C反应蛋白使巨噬细胞内总胆固醇和胆固醇酯含量显著增加(P<0.01),而高密度脂蛋白使细胞内总胆固醇和胆固醇酯显著降低(P<0.01)。结论C反应蛋白和高密度脂蛋白都能引起THP-1来源的巨噬细胞表面血凝素样氧化型低密度脂蛋白受体1表达上调,提示血凝素样氧化型低密度脂蛋白受体1并不是介导巨噬细胞参与炎症反应病理生理变化的关键性受体。     

Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

Aims/hypothesis The aim of this study was to investigate the effects of lifestyle intervention on the levels of plasminogen activator inhibitor (PAI-1) and fibrinogen in subjects participating in the Finnish Diabetes Prevention Study (DPS).Methods In five DPS centres, 321 subjects with impaired glucose tolerance (intervention group, n=163; control group, n=158) had their PAI-1 and fibrinogen levels measured at baseline and at the 1-year follow-up. Additional 3-year follow-up assessments were carried out in a sample of 97 subjects in one of the DPS centres (Turku). The intervention programme included an intensive lifestyle intervention aiming at weight reduction, healthy diet and increased physical activity.Results During the first intervention year, PAI-1 decreased by 31% in the intervention group but showed no change in the control group (p<0.0001). In the Turku subgroup, the decrease in PAI-1 persisted throughout the 3-year follow-up. Changes in PAI-1 were associated with the number of lifestyle changes made during the first year (p=0.008). Weight reduction was the most important factor explaining the decrease in PAI-1. Changes in fibrinogen levels did not differ between the groups.Conclusions/interpretation In addition to the previously reported reduction in the risk of type 2 diabetes in DPS participants with impaired glucose tolerance, the intensive dietary and exercise intervention had beneficial long-term effects on fibrinolysis as indicated by the reduced levels of PAI-1. These results suggest that elevated PAI-1 levels in obese subjects with impaired glucose tolerance are mostly reversible by lifestyle changes, especially those geared to weight reduction.     

对男男性接触者AIDS高危性行为健康干预研究

目的　评价健康干预措施对男男性接触者 (MSM)艾滋病 (AIDS)高危性行为的影响效果。方法　采用不记名问卷调查方式 ,并用Spss软件进行统计。结果　干预时间超过 1年的MSM ,近 1年肛交性伴侣数和无保护性被动肛交的发生率显著低于 <1年者 (P <0 0 5 ) ;但近 1年性伴侣数、偶遇性伴侣数、外地性伴侣数、外地偶遇性伴侣数、无保护性肛交的偶然性伴侣数、近 1年用过安全套、最近 1次保护性肛交及近 1年无保护性主动肛交的比例 ,近 1年在公共场所寻找偶遇性伴侣、参与性交易及参加群交的比例 ,随着干预时间的延长有不同程度的改变 ,但改变无显著的统计学意义 (P >0 0 5 )。结论　健康干预可减少MSM的AIDS高危性行为 ,但它是一个长期而复杂的工程 ,需要深入持久地开展     

2型糖尿病患者糖尿病肾病相关危险因素分析

目的　探讨 2型糖尿病患者糖尿病肾病相关危险因素。方法　应用多因素逐步回归的分析方法对 68例糖尿病肾病 (DN)患者有关危险因素 (病程、血压、血糖、胰岛素、C 肽、血脂 )进行分析。结果　DN组与非DN组比较 ,血压、血糖、胰岛素明显升高 (P <0 .0 5 ) ,多元回归分析显示 ,与DN相关的危险因素为舒张压、空腹及餐后血糖、空腹胰岛素和病程等。结论　DN的发生与高血压、高血糖、高胰岛素血症、病程相关     

High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction

Background and aimsTriglyceride glucose (TyG) index is considered a new surrogate marker of insulin resistance that associated with the development of vascular disease. The aim of this study was to evaluate the prognostic value of TyG index in patients with acute myocardial infarction (AMI).Methods and resultsA total of 3181 patients with AMI were included in the analysis. Patients were stratified into 2 groups according to their TyG index levels: the TyG index <8.88 group and the TyG index ≥8.88 group. The incidence of major adverse cardiovascular events (MACEs) during a median of 33.3-month follow-up were recorded. Multivariable Cox regression models revealed that the TyG index was positively associated with all-cause death [HR (95% CI): 1.51 (1.10,2.06), p = 0.010], cardiac death [HR (95% CI): 1.68 (1.19,2.38), p = 0.004], revascularization [HR (95% CI): 1.50 (1.16,1.94), p = 0.002], cardiac rehospitalization [HR (95% CI): 1.25 (1.05,1.49), p = 0.012], and composite MACEs [HR (95% CI): 1.19 (1.01,1.41), p = 0.046] in patients with AMI. The independent predictive effect of TyG index on composite MACEs was mainly reflected in the subgroups of male gender and smoker. The area under the curve (AUC) of the TyG index predicting the occurrence of MACEs in AMI patients was 0.602 [95% CI 0.580,0.623; p < 0.001].ConclusionHigh TyG index levels appeared to be associated with an increased risk of MACEs in patients with AMI. The TyG index might be a valid predictor of cardiovascular outcomes of patients with AMI.Trial registrationRetrospectively registered.     

Efficacy and safety of combination therapy with SGLT2 and DPP4 inhibitors in the treatment of type 2 diabetes: A systematic review and meta-analysis

Background

This review evaluated the efficacy and safety of a combination therapy comprising a sodium-glucose cotransporter type 2 inhibitor (SGLT2i) and dipeptidyl peptidase-4 inhibitor (DPP4i) in type 2 diabetes.