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Effect of metformin on fibrinolytic parameters in insulin-treated, type 2 diabetic patients.

OBJECTIVE: In the present study, we measured fibrinolytic parameters, including PAI-1 antigen and activity in a group of type 2 diabetic patients in secondary oral anti-diabetic failure treated with insulin alone or with insulin plus metformin. RESEARCH DESIGN AND METHODS: 12 type 2 diabetic patients in secondary oral anti-diabetic failure were randomly allocated into two groups receiving insulin alone or insulin plus metformin 1000 mg twice a day; six weeks later, the treatments were swapped over. At the end of each treatment period, blood samples were withdrawn for metabolic and fibrinolytic analysis. RESULTS: There were no significant differences in fasting blood glucose, fructosamine or fibrinogen; LDL cholesterol, PAI-1 antigen and activity, insulin needs were reduced by the inulin plus metformin regimen (LDL cholesterol: 1.59 +/- 0.62 versus 1.28 +/- 0.5 mmol/l, PAI-1 antigen: 28.3 +/- 17.4 versus 23.9 +/- 18 ng/ml, PAI-1 activity: 23.8 +/- 9.6 versus 21.9 +/- 10 IU/ml, insulin needs: 64 +/- 18 versus 52 +/- 15 U/day (p<0.05). CONCLUSION: In type 2 diabetic patients with secondary oral treatment failure, insulin alone controlled blood glucose but had no effect on the levels of PAI-1; addition of metformin improved the fibrinolytic parameters.

Aged↗

Shared care for diabetes: supporting communication between primary and secondary care.

OBJECTIVE: To assess the effects on information exchange of electronic communication between physicians co-treating diabetic patients. DESIGN: Comparison of traditional paper-based communication for reporting and electronic communication. SETTING: General practitioners and an internal medicine outpatient clinic of an urban public hospital. SUBJECTS: A total of 275 diabetic patients, and the 32 general practitioners and one internal medicine consultant who cared for them. INTERVENTION: An electronic communication network, linking up the computer-based patient records of the physicians, thus enabling electronic data interchange. MAIN OUTCOME MEASURES: Number of letters sent and received per year by the general practitioners, the number of diabetes-related parameters (e.g. results of laboratory tests) in the patient records, and HBA1C levels. RESULTS: INTERVENTION GPs received more messages per year (1.6 per patient) than control GPs (0.5 per patient, P<0.05). Significant higher availability (P<0.05) was achieved for data on HBA1C levels, fructosamine levels, blood pressure measurements, cholesterol levels, triglyceride levels and weight measurements. INTERVENTION patients showed a slight but significant decrease of HBA1C levels in the second semester of 1994 (from 7.0 to 6.8, P = 0.03), control patients also showed a slightly decreased group mean, but this change was not significant (from 6.6 to 6.5, P = 0.52). The magnitudes of these mean differences, however, were not significantly different (intervention group: 0.21; control group: 0.12, P = 0.68). CONCLUSIONS: The electronic communication network for exchanging consultation outcomes significantly increased frequency of communication and the availability of data to the general practitioner on diagnostic procedures performed in the hospital, thus providing more complete information about the care that patients are receiving. A large-scale experiment over a longer period of time is needed to assess the effects of improved communication on quality of care.

Adult↗

An evaluation of parameters for the detection of subclinical rumen acidosis in dairy herds.

An observational study was conducted in six Danish dairy herds. A specially designed stomach tube was compared to the rumenocentesis technique as part of the monitoring of rumen pH. In contrast to a previous study, the use of the stomach tube appeared to reduce saliva contamination. However, correlation with the rumenocentesis technique was poor ( r = 0.33; p = 0.019) and a linear model could only partly explain variations between either results. The presence of subclinical rumen acidosis (SRA) was evidenced in one herd only, as judged by results obtained by the rumenocentesis technique. The present study revealed some limitations of the rumenocentesis technique in small or medium-sized herds due to difficulties in selecting sufficient numbers of cows in the respective groups at risk. The finding of two apparently clinical normal cows with rumen pH values below 5.0 leads to the consideration that such fluctuations may be temporary and at least does not give rise to clinical symptoms. However, the long-term effect of such fluctuations is not known. In general, primiparous cows seemed more prone to low ruminal pH values (< 6.0), higher ruminal concentrations of short-chain fatty acids, and possibly to metabolic acidosis, than were multiparous cows. Ruminal propionate was the most precise predictor of rumen pH, whereas milk fat percentage varied greatly between lactational groups. Blood lactate dehydrogenase (LDH), beta-hydroxybutyrate (BHB) and fructosamine as well as urine phosphorus excretion and renal net acid-base excretion (NABE) were related to ruminal acid load, but were not predictive of rumen pH. Monitoring of dairy herds for SRA should be performed routinely and employ several diagnostic tools (rumenocentesis, renal NABE determination) as well as specific knowledge of herd management and feeding routines.

3-Hydroxybutyric Acid↗

[Stress hyperglycemia in sick cats: a retrospective study over 4 years].

Between January 1997 and December 2000 blood glucose concentrations were measured in 2278 sick cats at the time of their initial presentation at the hospital. In 827 cats (36%) hyperglycemia (blood glucose >8 mmol/l) was documented, 1388 cats (61%) had normal blood glucose levels, 63 cats (3%) were hypoglycemic. In 674 of 827 cats (81.5%) no further investigations were performed and the veterinarian judged the hyperglycemia to be stress related. In 153 of the 827 cats (18.5%) blood glucose measurements were repeated and/or serum fructosamine concentrations evaluated. In 106 cats (69%) stress hyperglycemia and in 47 (31%) diabetes mellitus was then diagnosed. Blood glucose concentrations in cats with stress hyperglycemia were between 8.1 and 60.4 mmol/l (Median 10.3), in cats with diabetes mellitus between 8.5 and 70.0 (Median 27.7). Blood glucose concentrations in cats with diabetes mellitus were significantly higher than in cats with stress hyperglycemia. Cats with stress hyperglycemia suffered from a variety of different diseases, the most frequently encountered were surgical problems, neoplasia, heart diseases, upper and lower urinary tract diseases. Blood glucose concentrations in cats with heart diseases and in cats with neoplasia was higher than in cats with other disorders, however, the difference was not significant. Cats with diabetes mellitus were significantly more frequent male castrated than cats with stress hyperglycemia. Cats with stress hyperglycemia were significantly older than cats with normoglycemia.

Age Factors↗

Effect of early stage of experimental diabetes on vascular functions in isolated perfused kidneys.

The present study investigates the renal vascular responsiveness to vasoactive agents in diabetic rats which present an early stage of renal failure. Adult male Wistar rats were administered alloxan (150 mg kg(-1), s.c.). Seven days later the right kidneys were isolated and perfused. Renal perfusion pressure was measured continuously. Concentration-response curves were plotted for noradrenaline (NA), sodium nitroprusside (SNP) and carbachol. In basal conditions, kidneys from diabetic rats presented a decreased vascular resistance compared with those from control rats. The vasoconstrictor response to NA showed decreased EC50 values in preparations from diabetic rats compared with control ones (EC50 nmols, control: 2.03 +/- 0.44, n = 8; diabetic: 0.84+/-0.18, n = 6, P < 0.05). This enhanced sensitivity to NA could be in line with the decreased glomerular filtration rate and cortical renal plasma flow previously described in vivo in our laboratory (Garcia, Girardi, Ochoa, Torres & Elias, 1998). Vasoconstrictor responses to phenylephrine were not however, different between diabetic and control rat kidneys. This suggests that the increased sensitivity to NA was due to impaired neuronal uptake since phenylephrine is not a substrate for neuronal uptake. After precontraction with phenylephrine, both endothelium-dependent (carbachol) and endothelium independent (SNP) vasodilator agents caused similar response in the preparations taken from the two groups of animals. So, the enhanced sensitivity to NA is not associated with a deficient dilator responsiveness of the renal vasculature. The vasodilator response to carbachol was the same in absence or presence of L-arginine in the perfusate, suggesting no alteration in its availability at this stage of diabetes. Diabetic animals showed increased plasma level of fructosamine and glycosylated haemoglobin (Hb A1c), indicating the presence of early glycated products at this stage of diabetes, which could be involved in a possible structural alteration of the vessels.

Animals↗

Twenty-four-hour patterns of hormones and metabolites in week 9 and 19 of lactation in high-yielding dairy cows fed triglycerides and free fatty acids.

Effects of feeding crystalline triglycerides (TGA), free fatty acids (FFA), and a starch-rich ration (STA) on metabolite and hormone concentrations in blood plasma were studied in high-yielding dairy cows over a 24-h period in week 9 and 19 of lactating. Energy-corrected milk production in the three groups was similar, but was lower in week 19 than in week 9. Energy and protein intakes were greater in week 9 than in week 19, but energy and protein balances in the three groups and in weeks 9 and 19 were similar. Plasma glucose and triglyceride concentrations were lower in week 9 than in week 19. In cows fed FFA, glucose concentrations were highest in week 9. Plasma triglyceride, phospholipid and cholesterol concentrations were highest, whereas beta-hydroxybutyrate concentrations were lowest in FFA-fed cows in weeks 9 and 19. Concentrations of insulin-like growth factor-I in week 19 were lower in cows fed TGA and FFA than in those fed the starch-rich ration. Post-prandial responses were usually greater following morning than afternoon meals. Fructosamine, albumin, urea, growth hormone, thyroxine, and 3,5,3'-triiodothyronine concentrations were similar in weeks 9 and 19 and were not influenced by dietary treatment or feeding times. In conclusion, there were distinct metabolic and endocrine effects of feeding TGA and FFA compared with STA and the concentrations as well as the 24-h changes of various metabolic and endocrine traits in weeks 9 and 19 of lactation were also different.

3-Hydroxybutyric Acid↗

Addition of low-dose rosiglitazone to sulphonylurea therapy improves glycaemic control in Type 2 diabetic patients.

AIMS: This study was designed to test the efficacy and safety of low-dose rosiglitazone, a potent, insulin-sensitizing thiazolidinedione, in combination with sulphonylurea in Type 2 diabetic patients. METHODS: For the intention-to-treat analysis, 574 patients (59% male, mean age 61 years) were available, randomized to receive 26 weeks of twice-daily placebo (n = 192), rosiglitazone 1 mg (n = 199) or rosiglitazone 2 mg (n = 183) in addition to existing sulphonylurea treatment with gliclazide (47.6% of patients), glibenclamide (41.8%) or glipizide (9.4%) (two patients were taking carbutamide or glimepiride). Change in haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), fructosamine, insulin, C-peptide, albumin, and lipids were measured, and safety was evaluated. RESULTS: Mean baseline HbA1c was 9.2% and FPG was 11.4 mmol/l. Rosiglitazone at doses of 1 and 2 mg b.d. plus sulphonylurea produced significant decreases, compared with sulphonylurea plus placebo, in HbA1c (-0.59% and -1.03%, respectively; both P<0.0001) and FPG (1.35 mmol/l and 2.44 mmol/l, respectively; both P<0.0001). Both HDL-cholesterol and LDL-cholesterol increased and potentially beneficial decreases in non-esterified fatty acids and gamma glutamyl transpeptidase levels were seen in both rosiglitazone groups. The overall incidence of adverse experiences was similar in all three treatment groups, with no significant cardiac events, hypoglycaemia or hepatotoxicity. CONCLUSIONS: Overall, the combination of rosiglitazone and a sulphonylurea was safe, well tolerated and effective in patients with Type 2 diabetes.

Adult↗

Metabolic and cardiovascular effects of very-low-calorie diet therapy in obese patients with Type 2 diabetes in secondary failure: outcomes after 1 year.

AIMS: To evaluate the short-term and 1-year outcomes of an intensive very-low-calorie diet (VLCD) on metabolic and cardiovascular variables in obese patients with Type 2 diabetes (T2DM) and symptomatic hyperglycaemia despite combination oral anti-diabetic therapy +/- insulin, and to assess patient acceptability and the feasibility of administering VLCD treatment to this subgroup of patients in a routine practice setting. METHODS: Forty obese patients with T2DM (22 M, mean age 52 years, body mass index (BMI) 40 kg/m2, duration of T2DM 6.1 years) and symptomatic hyperglycaemia despite combination oral therapy (n = 26) or insulin + metformin (n = 14) received 8 weeks of VLCD therapy (750 kcal/day) followed by standard diet and exercise advice at 2-3-month intervals up to 1 year. Insulin was discontinued at the start of the VLCD, and anti-diabetic therapy was adjusted individually throughout the study, including (re)commencement of insulin as required. RESULTS: Immediate improvements in symptoms and early weight loss reinforced good compliance and patient satisfaction. After 8 weeks of VLCD, body weight and BMI had fallen significantly: 119 +/- 19-107 +/- 18 kg and 40.6-36.6 kg/m2, respectively, with favourable reductions in serum total cholesterol (5.9-4.9 mm), blood pressure (10/6 mmHg) and fructosamine (386 +/- 73-346 +/- 49 microm) (equates to an HbA1c reduction of approximately 1%). Sustained improvements were evident after 1 year, with minimal weight regain, e.g. mean body weight 109 +/- 18 kg and BMI 37 +/- 4 kg/m2. Glycaemic control tended to deteriorate after 1 year. CONCLUSIONS: The absence of a control group is a major limitation, but the results indicate that 8 weeks of VLCD treatment may be effective and well tolerated in symptomatic obese patients with T2DM in secondary failure, producing sustained cardiovascular and metabolic improvements after 1 year. VLCD therapy is a treatment option that deserves greater consideration in this difficult-to-treat patient population.

Adult↗

Influence of different planes of energy supply prior to the breeding season on blood metabolites in female mink (Mustela vison).

Metabolic blood profiles were studied in a total of 30 female mink (Mustela vison) at different planes of nutrition prior to the breeding season in a control (CON; n = 10), a flushed (FLUSH; n = 10) and a negative energy balance group (NEG; n = 10). The animals were kept in metabolism cages or under normal farm conditions, respectively. The experiment, which was divided into six 1-week periods, started on 6 February and continued until 20 March. Flushing was performed by restricted feeding in periods 2 and 3 and refeeding in periods 4 and 5. The animals were weighted weekly and blood sampled at the end of periods 1, 2 and 4, 1 week after changes in the food supply of the FLUSH group. Plasma was analysed for insulin, insulin-like growth factor-1, total triiodothyronine, total thyroxine, free thyroxine, glucose and fructosamine. Generally, within the FLUSH group, animal live weights and blood metabolites were strongly influenced by energy supply, these variables remained almost constant in the CON group. In the NEG group the live weight, total triiodothyronine, total thyroxine, insulin and glucose concentrations decreased significantly. Differences in blood metabolites between the FLUSH and CON groups were non-significant, reflecting only small differences when considered over the total experimental period, thus reflecting an acute response to a varied energy supply, while the differences between the NEG group and the CON and FLUSH groups were significant, indicating a considerable chronic response in all metabolites to a constantly low energy supply.

Animal Nutritional Physiological Phenomena↗

Four-week low-glycemic index breakfast with a modest amount of soluble fibers in type 2 diabetic men.

Low-glycemic index diets are associated with a wide range of benefits when followed on a chronic basis. The chronic effects, however, of the substitution of 1 meal per day are not well known in diabetic subjects. Therefore, we aimed to evaluate whether the chronic use of a low-glycemic index breakfast (low-GIB) rich in low-GI carbohydrates and a modest amount of soluble fibers could have an effect on lipemia at a subsequent lunch, and improve glucose and lipid metabolism in men with type 2 diabetes. A total of 13 men with type 2 diabetes were randomly allocated in a double-blind cross-over design to a 4-week daily intake of a low-GI versus a high-GI breakfast separated by a 15-day washout interval. The low-GI breakfast was composed of whole grain bread and muesli containing 3 g beta-glucan from oats. Low-GIB induced lower postprandial plasma glucose peaks than the high-GIB at the beginning (baseline, P <.001) and after the 4-week intake (P <.001). The incremental area under the plasma glucose curve was also lower (P <.001, P <.01, baseline, and 4 weeks, respectively). There was no effect on fasting plasma glucose, insulin, fructosamine, or glycosylated hemoglobin (HbA(1c)). Fasting plasma cholesterol, as well as the incremental area under the cholesterol curve, were lower (P <.03, P <.02) after the 4-week low-GIB period than after the high-GIB period. Apolipoprotein B (apo B) was also decreased by the 4-week low-GIB. There was no effect of the low-GI breakfast on triacylglycerol excursions or glucose and insulin responses at the second meal. The high-GIB, however, tended to decrease the amount of mRNA of leptin in abdominal adipose tissue, but had no effect on peroxisome proliferator-activated receptor gamma (PPARgamma) and cholesterylester transfer protein (CETP) mRNA amounts. In conclusion, the intake of a low-GI breakfast containing a modest amount (3 g) of beta-glucan for 4 weeks allowed good glycemic control and induced low plasma cholesterol levels in men with type 2 diabetes. The decrease in plasma cholesterol associated with low-GI breakfast intake may reduce the risk of developing cardiovascular complications in subjects with type 2 diabetes.

Adipose Tissue↗

Improved glucose control decreases the interaction of plasma low-density lipoproteins with arterial proteoglycans.

The entrapment and retention of plasma low-density lipoproteins (LDL) by arterial proteoglycans (PG) is a process central to atherogenesis. We postulated therefore that accelerated atherosclerosis of diabetic individuals may result from hyperglycemia-associated modifications in LDL that enhance their interaction with arterial PG. To evaluate the role of clinical treatment on this process, LDL-PG binding was evaluated in uncontrolled type 2 diabetic subjects on monotherapy followed by combination therapy. After a 4-week washout (baseline), subjects were randomized to receive glipizide GITS monotherapy (20 mg/d, n = 12) or metformin monotherapy (2.5 g/d, n = 8) for 6 weeks followed by combination treatment with both agents for 12 weeks. Fasting blood glucose and fructosamine were significantly reduced with monotherapy and further reduced with combination therapy P <.01). With combination therapy, glycated hemoglobin (GHb) levels were significantly reduced from baseline for the group initially treated with glipizide GITS (8.5% v 10.5%, P <.0005), or initially with metformin (6.7% v 9.7%, P <.0005). No significant changes in total plasma cholesterol (TPC), LDL, high-density lipoprotein (HDL), or triglycerides (TG) were measured after monotherapy or combination therapy. Plasma LDL was isolated by differential ultracentrifugation. In an in vitro binding assay, LDL from subjects on combination glipizide GITS/metformin demonstrated significantly less binding to arterial PG than LDL obtained after monotherapy with either agent (7.6 +/- 0.5 v 10.7 +/- 0.9 microg LDL cholesterol/microg PG [mean +/- SEM], P <.05). These data demonstrate that combination treatment with glipizide GITS/metformin will further improve glucose control in type 2 diabetic subjects and may favorably improve diabetes-associated modification of LDL-arterial PG binding.

Adult↗

Monitoring techniques for diabetes mellitus in the dog and the cat.

One of the keys to achieving glycemic control in animals with diabetes mellitus is the appropriate selection and interpretation of analytic monitoring tests. Diabetic animals are subject to many of the same problems described in human diabetics. Diabetics are more susceptible to infection, and wound healing is often impaired. Decreased insulin promotes lipolysis and moderate hyperlipidemia, which can lead to falsely lowered fructosamine levels, impaired renal circulation, and atherosclerosis. Hyperglycemic, hypoinsulinemic animals continue to lose weight despite an increased appetite and an increased intake because they are not able to use glucose. Many unregulated diabetic animals will present with vomiting and diarrhea that can exacerbate electrolyte abnormalities seen with the osmotic diuresis present in an uncontrolled state. Canine diabetics are prone to cataract formation secondary to sorbitol accumulation in the lens. Cats, on the other hand, can present with diabetic distal neuropathy, which may be reversible with appropriate treatment. With all of these potential complications, it is important to monitor these animals regularly; this is the only way that glycemic control can be properly maintained over time. This article reviews the monitoring parameters available to the modern practitioner and outlines the benefits of each test, as well as caveats, in their interpretation.

Animals↗

Does estradiol treatment normalize the hypothalamic-pituitary-adrenal axis in streptozotocin-induced ovariectomized diabetic female rats?

We recently found circulating corticosterone (CS) levels to be significantly lower in diabetic female rats as compared with proestrous control animals. This reduction in CS was correlated with the hypoestrogenic state of the diabetic female. It was the purpose of this study to evaluate basal and corticotropin releasing hormone (CRH)-stimulated CS secretion in ovariectomized (OVX) control (C) and streptozotocin-induced diabetic (D) rats given blank, 5 mcg and 20 mcg estradiol (E2) implants to determine if adrenal CS secretion in the diabetic is normalized by E2 treatment. After 3 weeks of diabetes, pituitary-adrenal function was assessed in rats from each group with a CRH stimulation test. The remaining rats were sacrificed for determination of CS, E2, testosterone and fructosamine in serum. Suppressed CS secretion in OVX female diabetic rats was partially restored with E2 therapy. Basal CS levels were significantly higher in 20 mcg E2 treated C and D rats compared with OVX rats. However, C rats had significantly higher basal CS compared with D rats in similarly E2 treated groups. The CS response to CRH stimulation was not different between OVX female diabetic and control rats. Estrogen enhanced the CS response to CRH stimulation in control animals but not in diabetic animals suggesting altered estrogen action at the pituitary level in diabetic animals.

Adrenal Glands↗

Dietary substitution of medium chain triglycerides in subjects with non-insulin-dependent diabetes mellitus in an ambulatory setting: impact on glycemic control and insulin-mediated glucose metabolism.

OBJECTIVE: We have previously shown in an acute inpatient setting that dietary substitution of 77.5% of fat kcal as medium chain triglycerides (MCT) increased insulin-mediated glucose metabolism in patients with non-insulin-dependent diabetes mellitus (NIDDM), and that this effect appeared to be mediated by increases in insulin-mediated glucose disposal. The purpose of this study was to test the application of dietary substitution of medium chain triglycerides as an adjunctive tool in ambulatory therapy of NIDDM. METHODS: Five subjects with NIDDM underwent a baseline 6 hour insulin/glucose euglycemic clamp study, with simultaneous 3H-glucose infusion for calculation of glucose disposal rate and hepatic glucose output. Subjects were then randomized to begin one of two 30-day experimental diets, with long chain (LCT) or medium chain triglycerides (MCT), and subsequent crossover to the other diet. A 6 hour euglycemic clamp was repeated after each diet phase. RESULTS: Diet records and urinary organic acid excretion indicated a high level of dietary compliance by the study participants. Postprandial blood glucose excursions were less after one month on the diet with MCT than after the LCT diet (p = 0.004). However, fasting serum glucose, serum fructosamine (a measure of glycemia), fasting insulin, hepatic glucose output, and insulin-mediated glucose metabolism were not improved by the dietary substitution of MCT. CONCLUSION: These data indicate that supplementation of a tolerable amount of MCT in a conventional diabetic exchange diet has little impact on glycemic control in subjects with NIDDM in an ambulatory setting.

Adult↗

Vitamin A (retinol) status of first nation adults with non-insulin-dependent diabetes mellitus.

OBJECTIVE: Poorly controlled insulin-dependent diabetes mellitus (IDDM) has been reported to be associated with an impaired metabolic availability of vitamin A. The purpose of this study was to examine vitamin A status in a select group with non-insulin dependent diabetes mellitus (NIDDM). METHODS: Participants included 106 (male, female, > 40 years) Plains Cree adults residing in central Alberta, with NIDDM (n = 59) and non-diabetic controls (n = 47). Non-fasting plasma samples were collected and concentrations of retinol, zinc, alpha-tocopherol, total protein, albumin, retinol binding protein (RBP), transthyretin (TTR), cholesterol, triglycerides, glucose, insulin, and fructosamine were determined. Multiple linear regression was used to identify predictors of plasma RBP concentration. Three repeated 24-hour recalls and a food frequency questionnaire were used to determine vitamin A intakes. RESULTS: Diabetic subjects had similar intake and plasma concentration of vitamin A compared to controls. Factors such as alpha-tocopherol, zinc, total protein, albumin, and TTR, which are known to influence vitamin A metabolism, also remained unaffected in subjects with diabetes. Plasma levels of vitamin A carrier protein (RBP), however, were elevated in diabetic subjects, possibly as a result of hyperinsulinemia. The subjects with diabetes had many characteristics of the insulin resistant syndrome, including central obesity, hypertension, and hypertriglyceridemia. Poor metabolic control, based on plasma glucose, was a significant predictor of RBP concentration in diabetic subjects. CONCLUSIONS: The plasma concentration of RBP was elevated in diabetic subjects and was associated with normal circulatory availability of retinol. The subjects with NIDDM, characterized by insulin resistance without insulin deficiency, thus, appear to be associated with normal vitamin A status.

Alberta↗

Anthropometric characteristics, dietary patterns and risk of type 2 diabetes mellitus in Vietnam.

OBJECTIVE: To determine the impact of anthropometric characteristics and dietary patterns on Type 2 diabetes mellitus in Vietnam. METHODS: Data from 144 subjects (9m/39f newly diagnosed diabetics; 18m/78f control subjects) were analyzed in this case-control study. Height, weight, waist and hip circumferences and percent body fat were measured. Dietary intakes were assessed by 24-hour recall on three non-consecutive weekdays. Fasting blood samples were collected for the analysis of plasma glucose, fructosamine, protein and lipid concentrations. RESULTS: Although the body mass index (BMI, kg/m(2)) was similar between diabetic and control subjects, diabetic subjects had significantly greater percent body fat (31.1 +/- 5.8% vs. 27.7 +/- 6.2%) and waist-hip ratios (WHR, 0.91 +/- 0.07 vs. 0.86 +/- 0.08). Diabetic subjects had higher intakes of protein (p < 0.01), especially animal protein (p < 0.001), and consumed more meat (p < 0.01) than control subjects. Percent body fat and WHR were positively associated with diabetes (odds ratios [OR] 1.53 [95%CI 1.29-1.79] and 1.09 [95% CI 0.89-1.58], respectively) as were protein intake (OR 1.21 [95% CI 1.12-1.31]) and animal protein intake (OR 1.18 [95% CI 1.10-1.26]). CONCLUSIONS: This study indicates that percent body fat and WHR are risk factors associated with diabetes even when the BMI is normal. Evolving dietary patterns with increasingly more protein and meat consumption may also contribute to the deterioration of glucose metabolism among Vietnamese people.

Adipose Tissue↗

Inaccurate glycosylated hemoglobin A1C measurements in human immunodeficiency virus-positive patients with diabetes mellitus.

Persistent differences in blood glucose and serum glycosylated hemoglobin (HbA1C) measurements were observed in 4 human immunodeficiency virus-positive patients with diabetes mellitus, all of whom were taking drugs associated with hemolysis, which interferes with the reliability of HbA1C levels. Determination of fructosamine levels was a more accurate alternative for measuring average glycemic control in these patients.

Adult↗

Food seasoning spices mixture improves glucose metabolism and lipid profile in fructose-fed hyperinsulinemic rats.

Fructose feeding has been shown to induce insulin resistance in rats, associated with hyperinsulinemia, hyperglycemia, and hypertriglyceridemia. We have investigated the effect of administering food seasoning spices mixture (SM) on glucose, insulin, and lipids in circulation and carbohydrate enzymes in the erythrocytes of high fructose-fed rats. Additionally, we also measured the protein glycation status by assaying the levels of glycated hemoglobin, fructosamine, and plasma protein glycation. Male Wistar rats received a daily diet containing either 60% fructose or 60% starch (control). The rats were administered SM at three different doses (10, 30, or 50 mg/day per rat) orally 15 days later. At the end of the 45-day experimental period, fructose-fed rats showed significantly higher levels of plasma glucose and insulin, dyslipidemia, and alterations in enzyme activities. Treatment with SM significantly reduced plasma glucose and insulin levels and brought about a favorable lipid profile. In these rats, the activities of enzymes of glucose metabolism were normal. These effects were observed at all three doses of SM. High homeostasis model assessment (HOMA) values indicated insulin resistance in fructose-fed rats, while the HOMA values in SM-treated fructose-fed rats were comparable to those of control rats. We conclude that administration of SM improves glucose metabolism and plasma lipid profile in fructose-fed rats, possibly through improved insulin-sensitizing actions of the active constituents.

Animals↗