Effects on post-prandial glucose and AGE precursors from two initial insulin strategies in patients with Type 2 diabetes uncontrolled by oral agents

ObjectiveProgressive β-cell dysfunction in Type 2 diabetes results in the need for insulin therapy in many patients. Yet the best regimen to prescribe to patients transitioning from oral anti-hyperglycemic drugs (OADs) is not clear. We sought to compare the effects of two standard initial insulin strategies (basal insulin alone versus premixed insulin) on post-prandial glucose metabolism and precursors of advanced glycation end-products in patients with type 2 diabetes suboptimally controlled on OADs.Research Design and MethodsThis was a 6-month, open-label, single-center study using a cross-over design. 14 subjects were randomized to one of two protocols: once daily insulin glargine or twice-daily 75%/25% neutral protamine lispro/lispro mix. At 12 weeks, the subjects were crossed-over to the opposite protocol. During each period, insulin doses were titrated to target fasting blood glucose of 90–110mg/dL. At baseline and after the two 12-week treatment periods, subjects were studied in the Clinical Research Center; they consumed three liquid mixed isocaloric meals at 4-h intervals, and glucose, free fatty acids (FFA), lipids, and α-dicarbonyls (3-deoxyglucosone [3-DG] and methylglyoxal [MG]) were measured before and after each meal. Patient data were analyzed in the context of their assigned insulin strategy groups.ResultBoth insulin regimens led to a significant improvement in glycemic profiles, including fasting glucose and HbA1c, compared to baseline. However, mean post-prandial glucose was lower with lispro mix than with glargine (153 ± 36 vs. 199 ± 49 mg/dL, respectively; P = 0.001). Likewise, there was a reduction in both fasting (48 ± 13 vs. 57 ± 19, P = 0.047) and post-prandial (53 ± 19 vs. 63 ± 23; P = 0.007) 3DG levels with lispro mix as compared to glargine. No differences were noted in MG concentrations.ConclusionIn type 2 diabetes patients failing OAD therapy, an initial insulin regimen of twice daily premixed insulin results in significantly improved post-prandial glucose levels as well as a reduction in a precursor of AGEs. The effect of these two initial insulin regimens on long-term diabetic complications requires further study.     

Laparoscopic Colposuspension for Recurrent Stress Incontinence after Tension-free Vaginal Tape

Study Objective

To demonstrate laparoscopic colposuspension for recurrent stress incontinence after failed tension-free vaginal tape (TVT).

Anal endosonography and its role in assessing the incontinent patient

Anal endosonography is now recognized as an important investigation in the assessment of faecal incontinence. The endosonographer needs to be aware that the anatomy of the anal sphincter is complex and therefore there can be pitfalls in the interpretation of images. The findings have clinical implications on subsequent management and can contribute to prognosticating outcome. However, anal endosonography has a complementary role and other investigations, such as anal manometry, should be performed before intervention.     

Poly(N-isopropylacrylamide)-based semi-interpenetrating polymer networks for tissue engineering applications. Effects of linear poly(acrylic acid) chains on rheology

Semi-interpenetrating polymer networks (semi-IPNs), comprised of poly(N-isopropylacrylamide-co-acrylic acid) (p(NIPAAm-co-AAc)) hydrogels and linear p(AAc) chains, were synthesized, and the effects of the p(AAc) chains on semi-IPN rheology were examined. Oscillatory shear rheometry studies were performed and the rheological data were analyzed as a function of temperature, frequency, and p(AAc) chain amount (weight average molecular weight (Mw) 4.5 x 10(5) g/mol). At 22 degrees C, the semi-IPNs, as well as control p(NIPAAm-co-AAc) hydrogels, demonstrated rheological data that were representative of soft, loosely cross-linked solids. Furthermore, only the highest p(AAc) chain amount tested affected the rigidity of the p(NIPAAm-co-AAc)-based semi-IPNs, as compared to the p(NIPAAm-co-AAc) hydrogels. At 37 degrees C, the complex shear moduli (G*) demonstrated by the p(NIPAAm-co-AAc)-based semi-IPNs were significantly greater than G* exhibited by the p(NIPAAm-co-AAc) hydrogels, and the semi-IPN G* values significantly increased with increasing p(AAc) chain amount. These results can be used to develop p(NIPAAm)-based semi-IPNs with tailored mechanical properties that may function as scaffolds in tissue engineering initiatives.