Central fat predicts deterioration of insulin secretion index and fasting glycaemia: 6-year follow-up of subjects at varying risk of Type 2 diabetes mellitus.

AIMS: To examine the relationships between body composition and changes in fasting glycaemia, and in indices of insulin secretion and insulin action over 6 years in females with a family history of Type 2 diabetes with or without prior gestational diabetes ('at risk' group, AR) and control females (control group, C). METHODS: At baseline and at follow-up, an oral glucose tolerance test and dual energy X-ray absorptiometry assessment of body composition were performed. Indices of insulin resistance (HOMA R') and insulin secretion (HOMA beta') were obtained from fasting insulin and glucose concentrations. RESULTS: At baseline, the groups were similar for age, body mass index, fasting levels of plasma glucose and insulin, HOMA R' and HOMA beta'. Despite similar total body fatness, AR had significantly greater waist circumference and central fat (both P < 0.02) compared with C. At follow-up there was a significant increase in central adiposity only in AR, and the fasting plasma glucose (FPG) level was higher in AR compared with C (5.0 +/- 0.2 vs. 4.3 +/- 0.2 mmol/l, P = 0.02). This rise in plasma glucose in AR was related to a decline in HOMA beta' (r = 0.45, P = 0.0065). Both the baseline and the increments in total and central abdominal fat mass were associated with the time-related decline in HOMA beta'. CONCLUSIONS: Six years after initial assessment, AR showed deterioration in FPG levels due predominantly to a decline in insulin secretion index without major change in insulin resistance index. Importantly, baseline body fatness (especially central adiposity), as well as increases in fatness with time, were the major predictors of the subsequent decline of insulin secretion index and the consequent rise in FPG.     

Leptin levels predict the development of insulin resistance in a sample of adult men–The Olivetti Heart Study

Background and aims

Leptin (LPT) is associated with unfavourable cardio-metabolic risk profile. Although a number of studies have found a positive association between LPT and insulin resistance (IR), no observational study has evaluated a prospective association to detect a predictive role of LPT in IR. Therefore, the aim of this study was to estimate the role of LPT on the incidence of IR in an 8-year follow-up of a sample of adult men (The Olivetti Heart Study).

Use of the DISST Model to Estimate the HOMA and Matsuda Indexes Using Only a Basal Insulin Assay

Background:It is hypothesized that early detection of reduced insulin sensitivity (SI) could prompt intervention that may reduce the considerable financial strain type 2 diabetes mellitus (T2DM) places on global health care. Reduction of the cost of already inexpensive SI metrics such as the Matsuda and HOMA indexes would enable more widespread, economically feasible use of these metrics for screening. The goal of this research was to determine a means of reducing the number of insulin samples and therefore the cost required to provide an accurate Matsuda Index value.Method:The Dynamic Insulin Sensitivity and Secretion Test (DISST) model was used with the glucose and basal insulin measurements from an Oral Glucose Tolerance Test (OGTT) to predict patient insulin responses. The insulin response to the OGTT was determined via population based regression analysis that incorporated the 60-minute glucose and basal insulin values.Results:The proposed method derived accurate and precise Matsuda Indices as compared to the fully sampled Matsuda (R = .95) using only the basal assay insulin-level data and 4 glucose measurements. Using a model employing the basal insulin also allows for determination of the 1-day HOMA value.Conclusion:The DISST model was successfully modified to allow for the accurate prediction an individual’s insulin response to the OGTT. In turn, this enabled highly accurate and precise estimation of a Matsuda Index using only the glucose and basal insulin assays. As insulin assays account for the majority of the cost of the Matsuda Index, this model offers a significant reduction in assay cost.     

Higher Metabolic Syndrome in Obese Asthmatic Compared to Obese Nonasthmatic Adolescent Males

The relationship between asthma and obesity has been documented in children and adolescents; however, few studies on metabolic syndrome and asthma have been performed. Objective. To determine the prevalence of metabolic syndrome in adolescents among the following groups: obese with asthma (OA), obese without asthma (ONA), nonobese with asthma (NOA), and nonobese without asthma (NONA). Patients and Methods. The authors measured anthropometric (height, weight, waist circumference, body mass index, and waist-hip ratio), clinical (Tanner stage, blood pressure, fat and muscle reserve, and exercise), and biochemical parameters (basal and load glucose, cholesterol, triglycerides, high-density lipoproteins, uric acid, and insulin) in 500 Mexican adolescents. Results. A total of 111 OA, 198 ONA, 63 NOA, and 71 NONA adolescents completed the study. There were no differences in age, height, Tanner stage, high-density lipoproteins, or basal glucose among groups. Cholesterol, triglycerides, uric acid, basal insulin, and homeostasis model assessment (HOMA)-IR were significantly higher among the obese than nonobese groups but were similar between the OA and ONA groups. The prevalence of impaired fasting glucose was significantly higher among ONA versus OA males. The prevalence of metabolic syndrome (define as ≥3 abnormal cardiometabolic risk factors by de Ferranti, Cook, and International Diabetes Federation [IDF] criteria) was higher among OA teens than in the ONA group; however, this association was significant only among males. Adolescents from the ONA group were able to perform significantly more vigorous exercise than the other groups. Conclusion. Adolescent males who were obese and also had mild persistent asthma had a significantly higher prevalence of metabolic syndrome than obese males without asthma. However, overall, asthma seems to confer a protective effect against the prediabetes condition in males.     

The change of insulin levels after six weeks antidepressant use in drug-naïve major depressive patients

Background

A reciprocal relationship between diabetes risk and depression has been reported. There are few studies investigating glucose–insulin homeostasis before and after short-term antidepressant treatment in drug-naïve major depressive disorder (MDD) patients.

Methods

This study included 104 healthy controls and 50 drug-naïve MDD patients diagnosed according to the DSM-IV criteria. These MDD patients were randomly assigned to receive fluoxetine or venlafaxine for six weeks. Depressive symptoms, body mass index, fasting plasma levels of glucose and insulin were measured.

Results

Compared to the healthy controls, the fasting plasma insulin and the homeostasis model of assessment for pancreatic β-cell secretory function (HOMA-β) was significantly lower in the MDD patients before antidepressant treatment (7.7±4.8 μIU/mL vs. 5.1±4.2 μIU/mL, p=0.006; 114.2±72.3% vs. 74.8±52.0%, p=0.005, respectively). However, these indices were not correlated with depression severity. After 6 weeks of fluoxetine or venlafaxine treatment, the level of HOMA-β borderline significantly increased (108.1±75.5%, p=0.059).

Limitations

The study was limited by the follow-up duration and lack of a placebo group.

Conclusions

Antidepressants might affect insulin secretion independently of the therapeutic effects on MDD. Further studies are needed to investigate the long-term effects of antidepressants on insulin regulation in MDD patients.     

维生素D3联合格列美脲治疗2型糖尿病的疗效观察

目的探讨维生素D_3片联合格列美脲片治疗2型糖尿病的临床疗效。方法选取2016年2月—2017年1月在襄阳市中心医院接受治疗的2型糖尿病患者86例,依据治疗方法差别分为对照组与治疗组,每组各43例。对照组初始口服格列美脲片,1 mg/次,1次/d,根据血糖调整用药,最大维持剂量不超过6 mg/d。治疗组在对照组的基础上口服维生素D_3片,1片/次,2次/d。两组患者均治疗4周。比较两组治疗前后临床疗效、血糖指标变化以及内环境稳态模型评估-β(HOMA-β)、HOMA-IR和25(OH)D_3水平。结果治疗后,对照组和治疗组的总有效率分别为81.40%和95.35%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(Hb Alc)及空腹胰岛素(FINS)水平均显著下降(P0.05);且治疗组血糖指标变化水平显著好于对照组(P0.05)。治疗后,两组HOMA-β及25(OH)D_3水平显著升高,并且HOMA-IR水平明显降低,同组比较差异具有统计学意义(P0.05);且治疗组上述指标改善情况显著优于对照组,两组比较差异具有统计学意义(P0.05)。结论维生素D_3片联合格列美脲片治疗2型糖尿病具有较好的临床效果,可有效改善胰岛素抵抗和提高敏感性,具有一定的临床推广应用价值。     

振源胶囊联合沙格列汀治疗2型糖尿病的临床研究

目的探讨振源胶囊联合沙格列汀治疗2型糖尿病的临床效果。方法选取2017年2月—2018年2月在皖南医学院弋矶山医院就诊的2型糖尿病患者155例,随机分成对照组(77例)和治疗组(78例)。对照组患者口服沙格列汀片,1片/次,1次/d;治疗组患者在对照组基础上口服振源胶囊,2粒/次,3次/d。两组患者均连续治疗6周。观察两组患者临床疗效,同时比较治疗前后两组患者血清指标水平、稳态模型评价(HOMA)和不良反应情况。结果治疗后,对照组临床有效率为85.71%,显著低于治疗组的96.15%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者空腹血糖和糖化血红蛋白(Hb A1c)水平均显著降低(P0.05),空腹C肽水平显著升高(P0.05),且治疗组这些指标水平明显优于对照组(P0.05)。治疗后,两组患者HOMA-IS和HOMA-β水平显著升高(P0.05),HOMA-IR水平显著降低(P0.05),且治疗组患者HOMA指标水平明显优于对照组(P0.05)。治疗期间,治疗组患者药物不良反应发生率为3.85%,显著低于对照组的14.29%,两组比较差异具有统计学意义(P0.05)。结论振源胶囊联合沙格列汀治疗2型糖尿病降糖效果显著,不良反应低,具有一定的临床推广应用价值。